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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Date: !X —eo " Gr Owner: _ � - Z� Builder Address Address N°575 LOCATION OF BUILDING No. Street—* Prow Fart of Lot Let/t-"50 Block Addition or Sub -Division . Corner Lot Inside Lot Setback _�"' ' . � ideyard _ Sewer Elevation _ Foundation Elevation DESCRIPTION OF BUILDING To be Vsed as: of ... Fro Depth%ight Sq. Ft: Cu. Ft. W316 Front Depth Height Sq. Ft. Cu. Ft. Type of Construction t.-.., 0 FstC "�7. be Completed i In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee dT —$-6 &ga,., permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at; any time upon violation of any of the provisions of said ordinances. I I "--� 'W ( ) NOTICE This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sure to we the Building Inspector for separate permits for these hams. r M ID SU CT..`�0_Cc�',�� •' )RolJ ,Trt_LL_ C>_ Tb� XOAqU FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner's N.C'-&' Address //o / Address LOCATION OF BUILDING No. ,C // Street/.... f U4 /, -4,2 ZC�Part of Lot LotL�Block Addition or Subdivisio Corner Lot r% Inside Lot Setback Side -Yard SEVER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: -- Front Depth Heigh sq. Ft. ti cu. Front____._�_Dep �. Leight Sq. Ft. Cu. Ft. Type of Construction Estimated Cost To be Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and ruling of the Department of Build- ings, and hereby declares that all the facts and representations stated in this application are true and correct..;) r (Schedule of Fee Costa can be found on the Reverse Side). r 222 NED SUEtTF�'�T r,O CnTFOEI:� ^NCE TO i CI`r`x: 01" IF LEY, lIll z ESOTA' I I , I i - -- -- 1- ----y i I I , I i I II i I � I I � I I _ _ i City of Fridley Application for Plumbing and Gas Fitting Perndt Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location I � x � Z z z _ O , W Z z • F • N WATER HTR. GAS EIEC �� -�c2 o S < (�4°d �4a �o Base 1st 7 7 2nd T _ 3rd _ 4th • Future Connection Opeaiaga Connected with I Sewer ❑ * New Fixture, Old Openings Cesspool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ....... .............. x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $M Catch Basin ...... ..................... x 3.25 $ Water Heater (Up to 200,000 BTL) ...... x 2.00 $ 0100 New Ground Run Old Bldg. ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $-�d Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description................................................$ TOTAL FEE City of Fridley: The undersigned hereby .makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts. and representations stated in this application are true and correct. Fridley, Minn 5 19_ Owner ��ye �` i.✓Y Y 5 �7 Kind of Building Used as � � To be completed about Estimated Cost, $ 2W'� o Ol Ne Building Permit No. !� Permit No.// ROUGH L2 FINAL 4 z 2M 7-59 Business Phone No — 3 � 3 eD Application for Power Plants and: Healing. Cooling, Ventilation..ReMgerati" and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ....................... 2.00 $ _ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 ....... :...... 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam....... 8.00 $ pp Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ O Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $'— OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule cJ �� GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x $1.50 $ Additional Fixtures ................. x .50 $� r Gas Range to 200,000 BTU ........... x 2.00 $ 'iIR CONDITIONING r $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ ?S ROUGH FINAL Dept. of Bldgs. Phone SU. 4-7470 The undersigned hereby makes applic9tion for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this applicatidn are true and correct. Fridley, Owner Kind of Building Used as To be completed about Estimated Cost, $ Old ew Building Pei ESCRIPTIC HEATING or POWER PLANTS --Steam, Trade Name Capacity -*, Sq. Ft. E.D.R- Total Connected Load— S % 02 BURNER — Trade Name , (REMARKS -OVER) 4 z 2M 7-59 Business Permit Q� Water, Warm Air—No Size No- - o BTU H.P. Rind of Fuer �✓�?�� - No- v /-," -f t9 - The ,"-ft9- H.P. Application for Power Ptants and Healing. Coding. Yentiiation. AeMgeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ....................... 2.00 $ _ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ FAN HEATING SYSTEM See Fee Schedule STEAM or HOT WATER SYSTEM $ Furnace Shell & Lines—to 400 sq. ft. IDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VATING SYST $ f ALTERATIONS & REPAIRS TOTAL FEE $ �j ROUGH— OUGH FINAL— FINAL Dept. of Bldgs. Phone SII. 4-7470 Location o`// 2 / %. E City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Fridley, Minn — %� ` -- 19 Owner Kind n• <� Used as. To be completed about :2! —/-- / 1= Estimated Cost, $ 1_1�0 Permit No. � /' e� / Permit N DESCRIPTION OF WORK HEATING or POWER PIANTS--Steam, Not Water, Warm Air—No Trade Name Size No Capacity Sq. Ft. E.D.R BTU A.P. Total Connected Load Kind of Fuel BURNER — Trade Name Size No Capacity Sq. Ft. EM.R BTU H.P. (REMARKS -OVER) Sign ;ARNIG PLUMBING & HEAT INC TEL. RAA_ By 4 22 7-59 Business Phone No City of Fridley AT Tib TOP OF THE TWIN$ t L---"'-COMMVNITY DEVELOPUENT 01Y, i PR0T9CT1V2 010ftCTN)N BEPT. 01 --- CITY NALL FRIOL$Y $6q>t U Permit No. —L PLUMBING PERMIT APPLICATI=did -MA _L_ 0 12/15/73 1 1 1 goo aaaress — ner�Ad ress Pone Plumbing Contractor A ress Phone Kind of Buildin � Use Completion Date _'rstimaLved Cost 11 II f _Plumbing Fixture Rates: NO.. RATE TOTAL �_ W ! I i! i ! -- --; Number Fixtures x $2.00_ Future Fixtures, x $1.50 ZONV New Fixture -Old Open. x $1.50 O •,ddV j Catch, Basin 1 x $3.25to Qvsl I 1 x,d I Water Heater -9Q / x I I Ground Run Old Bldg. x $3.25 sao, 'MNIVU I I I I Elec. Water Heater x $2:00 $N1SY9I k"DlVol I I I w I _Gas Fitting Fees: !mow I— :O BNIVU? I I I to t u tloo,d ! I p, � I 1st 3 Fixtures x $2.00 :Z.3I I saaMONSI I I I I i Additional Fixtures x $ .75 iF C I •1NIlOJ I �N1aal I I I I Gas Range -199,000 BTU x $5.00 q w NSYMI I I ( I I I Repairs &Alterations See x OWN --I I I I I I Description: Code I BN16Va I I I I - State Surcharge .50 TOTAL FEE $ son,L11 ( I I Neva I I I IThe undersigned hereby makes application for a permit °'�"�"°I 'for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling tlllYMl I I I I of the Department of Buildings, and hereby declare that all'the facts d representations stated in this app tion ar true and correct. ss 'Signature Date CIIYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6131 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 • FAX (612)571-1287 May 30, 1991 D-62 Properties 11201 Woodhill Lane N.E. Blaine, MN 55434 RE: 211 - 79th Way N.E. Dear Property Manager: A recent inspection revealed that trees at the northwest corner of the above referenced property appears to be creating a visual obstruction at the intersection of 79th Way/Ashton Avenue. This obstruction extends into what is called the "vision safety zone" (see enclosed definition) restricting a clear sight path for motorists at this intersection. Please take the appropriate action to bring this property into compliance with the enclosed ordinance. I will be reinspecting on or shortly after June 17, 1991, at which time compliance is expected. Feel free to call me at 572-3595 if you have questions or wish to discuss this further. Thanks for your cooperation! Sincerely, Steven Barg Planning Assistant SB:ls C-91-154 y LOCATION 211 - 79th Aveems' .__ E. OWNER STEVE HAWRYSH LOT 17-18-19-20 BLOCK 3 ADD. Spring Brook Park Permii No. Construction Date Contractor Cost Final 5751 Building Permit, 8 Unit Apartment 2/20/62 Steve Hawrysh $67.00 2970 Electrical Permit 3/29/62 0. B. Thompson Elec. $65.45 11/27/62 2284 Plumbing Permit 5/28/62 Farr Plumbing Co. $54.50 2284 Plumbing Rough 6/13/62 1989 Heating Permit 6/8/62 Farr Plumbing & Htg $35.40 1997 Heating Permit 6/11/62 Jarnig's Plumbing $6.00 5145 Sewer & Water Permit 7/26/62 Farr Plumbing Co. $30.00 2970 Electrical Rough 5/28/62 3617 Electrical Permit 2/4/63 Michael Kane Elec. $2.00 2/7/63 �.•« as 7-59 • t MEMO TO: CITY ENGINEER CHIEF BUILDING INSPECTOR FROM: A.CTI13G CITY MANAGER DATE NOVEMBER 9, 1970 MEMO: #234► -119-70 Councilman Breider called today and asked what the code was when some of the buildings north of 79th Avenue were built. Mr. Breider felt the general appearance of the buildings, fences, etc. in these areas leave something to be desired. He feels that if there is any way that the City can force a landscaping code or plan they should do it. Mr. Breider asked if one of the Inspectors could be put on this project to really go over the building permit applications .in detail and to make an inspection of all the buildings in the general area to determine whether there is something that can be done by the City to force these people to do some landscaping and upgrading of the appearance of their properties. 11/24/70 The surveys of the buildings in this area have been completed and attached is a summary report of the survey. The complete report is over one hundred pages long and can be reviewed in the Building Inspection Office. We hope to work with the property owners to see that they improve their property's appearance and landscaping early next summer. We will seek voluntary compliance as much as possible and then rroceed with the legal actions available to the City. ASIM iii. QURESHI, P.E. City Engineer -Director of Planning Report On Area North Of 79th Way As Requested By The City Manager In Response To A Request By Councilman Breider 181 Ely -Street N.E.: Building Permit #6229 issued 10/18/62 Building Permit #9116 issued 12/7/66 A building permit for construction of additional storage area was granLed to Aladdin Pools Incorporated on December 7, 1966, subject to the following conditions; 1. All exposed concrete block (old and new) be painted. 2. A 7 foot redwood fence (stained or painted) be provided to enclose the storage yard. 3. Crushed rock or blacktop (or better) be provided off Ashton, North of the fence and also front drive and parking lot. The remainder of the lot outside the fence to be sodded or landscaped. 4. A Certificate of Occupancy be issued when all the requirements are met. Inspection shows the following discrepancies; 1. Areas to be sodded or seeded are overgrown with weeds. 2. Fence has not been painted or stained. One section in the Northwest corner is falling down. 3. Only the front of the building has been painted. All other areas are unpainted block. 4. There is no driveway North of the fence. 5. No Certificate of Occupancy has been issued. We can use stipulations of building permit for landscaping. 161 Ely Street N.E.: Building Permit #5790 issued 3/2/62 Board of Appeals variance to reduce front yard setback from 100 feet to 44 feet 6 inches to build an addition was granted on December 1, 1965, and approved by Council but a building permit for the above addition apparently was never issued. There is some planting and landscaping on the front of building (South side).. There is concrete curb in front of the building and on the East side of the front parking area. Some precast concrete bumpers are stacked in parking area. There is a circular drive with some rock but most -of the area is dirt. Most areas are overgrown with weeds. Parking area can be required under 1961 City Ordinance and lots can be maintained under pr9sent nuisance ordinances. Compliance to the 1969 City Code can be required by January 1, 1973. 0 Report on Area North of 79th Way Requested by City Manager Page 2 160 Ely Street N.E.: Building Permit #5529 issued 9/11/61 Building Permit #6824.issued 11/.5/63 Original building permit stipulates front of building to be stucco and brick with side yard setback on East to be 5 feet and front yard setback to be 35 feet. The building permit for the addition in 1963 stipulates a front yard setback of 35 feet and a side yard setback of 20 feet. The sketch attached to the building permit shows the 20 foot side yard on the West side of the building. The sketch also shows a blacktop parking area in front of the building. Inspection shows no blacktopping in front of building and no landscaping of any kind. Front yard setback appears too short. Some improvements could be made by compliance with 1963 building permit, also by using 1963 Zoning Ordinance in effect at time of second building permit. Other compliance can be made by January 1, 1973. 140 Liberty Street N.E.: Building Permit #5159 issued 3/16/61 Building Permit #10,532 issued 1/2/70 Original permit stipulated that front of building must be stucco or brick or both. Front yard setback was 35 feet and East side yard was 0 feet. The second building permit was for interior alterations only. No stipulations were noted on the building permits. This building should be considered with 148 Liberty Street because there is only five feet between buildings and originally the permit was granted for a common wall. 148 Liberty Street N.E.: Building Permit #6380 issued 3/11/63. Originally; permit was granted for addition to existing building at 140 Liberty but nearly 1 year after permit was issued (2/21/64) apparently a verbal arrangement was made to separate the two buildings with the second addition being added to the existing building as per permit plans. .There are now two separate buildings approximately 5 feet apart. Inspection shows one concrete drive up to East end of building and one concrete drive to loading ramp at West end of building. Rest of lot is dirt with no landscaping. Parking, and landscaping can be enforced under some provisions of the 1963 City Ordinances, and balance by January 1, 1973. 14 Report on Area North of 79th Way Requested by City Manager Page 3 151 Longfellow Street N.E.: Building Permit IP6398 issued 3/28/63 A front yard variance from 100 feet to 60 feet was granted on March 21, 1962 to allow erection of the above building. The Board of Appeals also stipulated that the building was to be 50 feet from the West property line. The Council concurred. A sketch attached to the Board of Appeals minutes shows a building 68 feet by 70 feet with the West side 50 feet from the property line. The building permit issued was for a building 85 feet by 44 feet. The building on the site is considerably less than 50 feet from the West property line. Stipulations on the building permit stated that the parking lot and driveway must be blacktopped with the balance of the front to be sodded and planted. A recent complaint was issued against this property because water and oil were running from this building into a shallow pool adjoining the residential property on the West and the water and oil seeped onto the lawn. There were also complaints of illegal parking and poor maintenance. The owner was notified and the vehicles were parked in a different area; the lot was cleaned up; interior masonry work eliminated the water and oil flow; and the owner has stated that a six foot screen fence will be erected between his property and the residential property West of the building. The fence is to be done by November 242, 1970 and the holes along the west side of the building filled shortly thereafter. Compliance in this case is voluntary, for the most part, but compliance can be obtained under 1963 Ordinances and present ordinances. 181 -79th Way N.E.: Building Permit #5889 issued 5/10/62 J. This is an•8 unit apartment building which is landscaped and being maintained in an adequate manner. 211 -79th Way N.E.: Building Permit #5751 issued 2/10/62 This is an 8 unit apartment building which is landscaped and being maintained in an adequate manner. 231 -79th Way N.E.: Building Permit #10,059 issued 12/10/68 This is a:7 unit apartment building which is landscaped and being maintained in an adequate manner. Report on Area North of 79th Way Requested by City Manager Page 4 136 Liberty Street N.E.: This is a nonconforming use of an automobile junk yard. According to the Zoning Ordinance this may continue as a nonconforming use if it is enclosed in a fenced area. The owner has been notified to move all vehicles onto his own property and fence the area from public view. The fence has been started and one section is complete. Materials and equipment are on the site. Vehicles are being moved from adjoining property. CONCLUSION: It seems although no specific area was mentioned that the area North of 79th Way mentioned by Mr. Breider would most likely be the industrial buildings along the West side of the railroad tracks. The apartment buildings along 79th Way seem adequate in appearance and maintenance and the residential area for the most, also appears adequate. The industrial area is being improved in those areas where we have proper authority under applicable ordinances and some problems will be eliminated this fall. However, a general plan for the area should be worked out so that a concerted effort could be made to improve the whole area at once, probably beginning next spring. In the meantime specific ordinance violations such as undue amountsof litter or poor maintenance can be corrected as they occur. I a Ll�� -- — - - - --- AL D. BAGSTArcial-Inspector Building Off ADB/mh . SUBJECT PER e--_ City of Fridley 23140 AT THE TOP OF THE TWINS BUILDING PERMIT I REW��NO. L. � COMMUNITY DEVELOPMENT DIV _______ r I a. PROTECTIVE INSPECTION SEC 493+ NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIOLEY 55432 612-571-3450 910-F15 12/6/94 JOB ADDRESS 211 79 Way NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 17-20 3 Spring Brook Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mel Hartman 211 79 Way NE 786-3081 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Top Gun Roofing 5014 Parrish Ave NE Rogers, MN 55374-9009 - 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE 13REMOVE x❑ 8 DESCRIBE WORK Reroof House 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $5,000 $2.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $72.00 Fire SC $.5.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE License SC $5.00 $84.50 SIGNATURE OF CONT FACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY LIDATED - B'CDG 4'.' THIS IS YOUR PERMIT r)Ai SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) NEW [ ] ADDN (] CITY OF FRIDLEY ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: 6 Legal Description: Owner Name & Address: Contractor: Address: Effective 1/1/94 -0- 4i33 -*,49 34 MN LICENSE # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Comer Lot [ ] Inside Lot [ ] Ft. Yd, Setback Side Yard Setbacks Akr&k1 Estimated Cost: Type of Construction: UU Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = t $ _ $ DATE: l l APPLICANT: Qi' Tel. #��— CITY USE ONLY Permit Fee f,ll $ Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $800 per SAC Unit License Surcharge $ 15,6() $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL low STIPULATIONS: