AF - 43559,
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PART€A!. R�►iE �C���i3L�
Q�JIPIT4 FrJ1A7d kiR:
�1a�nac� S]:cll � Durt Wark
Rrp?a±�rment a1 l�rnare
P,�pa�r� f,r Aitc rations--up to 15d0.00
Repairs & A1.Pratlons earh add. fS00.Q0
1[�CIi. i�I.A.itDS AIlt
plunnee Shell Ec Duct Wori� Lo 130,00� BN
sse� add. Q0.000 B'I'tJ .
iiep2aCCr.�ea2 of fl�rnaCr
Rtpairs & A'te*ations--u� to 5500.00
Rtpafrs k A}trtstio�s each add. f500.00
1tA'i s"''. T��I.
.. sio.00 i
s.00 $
6 (Xa S
. 3W E
EIO 00 f
3.W i�.
8.00 �_ �,. o—D
6.00 �
3.Q0 ;
STEAM or HOT WJITER $YSTEbi
i�.rrr:acr She:1 Sc Lir,es-- to 4Q0 �q. !: *.DR Sirar.► $20+� S
F�rnace Shell �4 Linr—to 640 sq tt. EDR Fiot Wa2er 20 00 S,
Each add 2f� sq. ft. E17R Steam R txl �
Each ac3� 320 sq. tt EDR Hot Watez 3.00� �
QIL BIIR4iEx'i—to ] gaL per hour 6.00 S
over 3 gai. per hour-See Fee Schedule
G11S DIIRlPER CuD tn 199,000 B'TU) S.Od s � �`71
wer 199.000 B'TLJ Sk F«� Scbsdul•
G118 FITTINC FEE8: !(O RJ�TE TOTAL
lst 3 ilxtures x� Z00 S
AddiUonal F7�rt�ues , x .96 t--- --
Cas Rsnge tA 199.00P ai 6.00 =
u� co�moxura
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u.r��►rroxs � ��s
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FI?6AL.�-.? 3 -%
State 5urcharge .Sd
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ro�r�. �s k�
�3rpt. of Bi��m. P3.ua� �-3�t�9
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citr or �rta��,:
Th� unciersigned hereb•r makes aflplication for a p�rmit 1oi the v.ot� �e:dr
specified agrF_•cing to dc ai; �ork �n strict accordance with the Ci:y Ordfrianter
and ru�ing ot the Depa� tm�nt c�t F3uildir.ds, a�d hereby dectares that aTi th! taett
and re►;r�sPntatiuns stat� in tF�is applicaiion are t e and correct.
� i� , F��dley,�R'tinn_.�. � �..,�� �/ �.1@ /��
�?wner
Kind of Building , ��'�''�
►JseB aQ .—�:� l
To be compieteci about �� ���
Estimatcw3 Cos�, S
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ew. Building Permit No. ---- _-- — Pormit Tto.
f�x�',«: ,s� • t + °_ r .
XF..ATING o �EFt Pi.A Lr� Ho! Water, Wum Air—No
Trade Name Stze No��� ,��,� ��/q'
Capacity�_.-- — S4. lrt E.D.R.��'�� BTtJ H.F
Total Connected Lood �
` � ,�� Rfnd ot !Lt u` � ` `:`�
BURNER — 1?a�e Name- Siu No
Capadty 3q. !'t, L.DR B'i'�1 g,F
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t�oaeRS—orrt�
� � SuB�ECT � . � � .
City of Fridley 2 9 7 8 8
A7 THE TOP OF THE TWINS g � I L D 1 N G P E R M I T
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� ; y__���� COMMUNITV OEVELOPMENT DIV. l/�� /
r � � PFIOTECTIVE INSPECTION SEC. �� ��
1 � �
� � �"'1 � CITY HA�L FRIOIE� 55��2 NUM�ER AEV O�TE P�GE O� �PVpOvED Br
�.---�•' '•� 612-571-3450 91Q-F15 6/29/99 / /
108 AOpRESS 6424 Baker Avenue NE
1 LEGAL �OT N0. BLOCK TRACT OR ADDITION SEE ATTACHED
oesca. 1 2 of 6 2 Moore Lake Hi hl ands SNEET
2 PFOPEiiTY OWNEF MAII, ADDRES$ Z�P PHONE
Allen Gibne 74-261
3 CONTRACTOR MAIL ADORESS ZIP PHONE IICENSE NO
Bud et Exteriors 8017 Pi -
1 ARCHITECT OR OESIGNER MAI� AO�RESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADORESS ZIP PHONE IICENSE NO
6 USE OF BUILDING
Residential
7 CIASS OF WORK
O NEW O ADDITION O ALTERATION X(A REPAIR p MOVE O REMOVE
8 DESCRIBE WORK
Reroof house (19 S) Tear-off; Reside house
9 CHANGEOfUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
Call for building wrap inspection before covering.
Permit Inspection Car
Wili Be Maile ds
To Homeowner t d
o Post
TYPEOFCONST. OCCUPANCVGROUP OCCUPANCVLOAO
SEPARATE PERMITS ARE REOUIRED FOR ELECTFICAL, PLUMBING, NEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANO VOIO IF WORK OR CONSTRUCTION ZpNING SO. FT CU FT.
AUTHORIZED IS NOT COMMENCED VjIITHIN 60 OAYS. OR IF CON57RUCTION
OA WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 �AYS AT
ANV TIME AFTER WORK IS COMMENCED. NO DWLG. UN17S OfFSTREET PARKING
I HEREBY CERTtf V THAT I MAVE FiEAD AND EXAMINEO THIS APPLICATION STAllS GAfiAGES
AND KNOW TME SAME TO BE TRUE ANO CORFECT. ALL PROVISIONS OF LAWS VALUATION SU:iTAX
ANO ORDINANCES GOVERNING THIS TVPE OF WOFK WI�L BE COMPLIED 1
WITM WMETMER SPECIFIEO HEREIN Ofi NOT. THE GRANTING OF A PERMIT 17 OO1 H. �JO
OOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pEqM17 FEE SAC CNARGE
PROVISIONS OF ANV OTHER STATE OR IOCA� LAW REGULATING CON-
STRUCTION OR TME PERfOFMANCE OF CONSTRUCTION 293.25 Fire SC 16.��
PLAN CNECK FEE TOiAL fEE
$322 5
S�GN4TUAEO�CON�AACTOQOAAUTMOA�2EOOGENt �OATE� N OPER V V IOATED TMIS S VOUR PERMIT
4
_- S�GN4TUAE O� OWNEQ��� OWNEQ BU�IOEA� �O�TE� B� �NSP ' ��<<E
,
NEW � [ ] ��i�� �� � ? � �
ADDN [ l �P � � ;�L � . �� CITY OF FRIDLEY
ALTER j] SINGLE F�Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddres s :
Legal Descr'iptior�:
Owner Na�
,
Contractor:
Address: XI
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Effective 1 / 1 /99
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MN LICENSE # � � � Ll
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
I,ength
DESCRIPTION OF LMPROVEMENT
Width He�bht
Width Height
Width Hgt/Ground
,�I �J
Construction Type: °� !' '� ` Estimated Cost: $
Sq. Ft.
Sq. Ft.
Sg. Ft.
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�IL�.7'7•"
(Fee Schedule on Back)
Driveway Curb Cut Width. Needed: Ft. + 6 Ft = Ft x$ _�
r yG�
DATE: � Z APPLICANT: Tel. # C�f Z'O�% �! LD �
! �� )
CITY USE ONLY �t _ _,,,.,
Permit Fee �g3 ��N$ ° Fee Schedule on Reverse Side
Fire Surcharge ��,OQ $ '' .001 of Permit Valuation (1/lOth%)
State Surcharge c�'.� $ $.50/$1,000 Valuation
�
SAC Charge $/— $1050 per SAC Unit
License Surcharge $��"' 6l� $5.00 (State Licensed Residential Contractors)
---r--
Diiveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $i Agreement Necessary [] Not Necessary []
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TOTAL $
STIPULATIONS:
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