AF - 38542Dat�:
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Owner:
Address
City of Fridley, Minn.
BUILDING PERMIT
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N° �4582
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Builder_......_.__...._.._ �..�. _._...___..�._._..._._____—..________
Address _....__..,.�.-� •.�� ..__�- ���� �..._.,.._-----------
LOCATIO�V OF BUILDING
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No �--�'f�-��_. Street _.�:.� ±,' ;�±°-�.e..'��:=�=:�r��,,,' ... . Part oP Lot ...... .-•--•-- -•-- ---_..._
-�----•�-•------. __._ -- r -- --._
..� #n 6 .�
Lot ---_��...�.........._....._ Block ....._..--�•,��-------......._...---- dition or Sub- 'vision ..c:�.d�r-�.���'�r��`-:_r����..t..��L�...� �
.! � . r'` ,t Q! �° ' .
Corner Lot ..................._.....---...... Inside Lot ....._.... . --- ...---� -........ Setbac � ..----�---•�---........_. .
�5 ��.,, --.. .��-.��...�...���Sideyard .•----.:�._......---�--. ..--�----� �"
o,
SewerIIeva.tion -----_.........---.__........_.....--------•-------•�-- ...................................... Foundation Elevation _.................._...........---...._......_--•-�--....._._....._.--�--•-•-----�----•-
DESCRIPTION OF BUILDING
To �e Used as;
���-r�. �:--�-�----- Front .. �_�— Depth ---..�:4�_ I3eight .. �� �'�_ Sq. F� �� a� t"�` Cu. F't. �.s�-��
---�- ..............-- -!�... ..---..................... Front • . ------........._.. Depth . � --- �--..._.. He' ....._............._ . �!. FL _..._...- ---��-�---- Cu. Ft. ._.._....._.... �---
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of Construction .........-�,-�_"'`�'�=-=.�'.�,�� . st. Cost_ .......................��._ .._..
Z'YP� � ��-- To be Completed .....-----.---..__..._._.--•-----.._........
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TH1S i'ERMiT DQES ('Jt�T AUTh�iOE�lZE VI�LP�1'��
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lnPJ OF Af�1'Y ;;?i�!�1iE LArdD CJVEi`d;4fJT� A(J�i
EUILDING F�ESTFtIrT�OR1S.
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 of $..... ..._.:._..:.--_--------, Permit is hereby granted to....._...--.----.--..------..--------...__......_.
.�_ ...__—.._.._.._..___�__ to construct the building or addition as described above. This �rmit 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, arwmd and upon said building, or any gart thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the cfty limtts and this permit may be revoked at any time upon violation',;of any of the provisions of said
ordinances. ,�' ~ �` /,' � �f r
I119p@CtOP
NOTICE:
This permit does not cover the eonstruction, inatallallon for wiring, plumbing, gas heafieg, sewer or water. 8e sure 10 see �
the Building Inspecfor for aeparate permifs for fhese items.
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APPLICATION FOB BUILDING PER�iIT
CITY �F FRIDLEY, N�JN�OTA
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� LOCATION OF BUILDING
No. ��� �� Stree� ^"'� Y• Part af Lot ���°,� ,,.," .__.^
�t � g�,o� ,� Addition r uw.b,Div. ��iti ���u �
��i+l�r • . ` � .. �yq
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Corner Lot_Ineide T,ot�, 8et Back �� �_���� n-�`��'�`�ide-Yard .._
SEW� ELEVATION � FOUNDATIdN ELEVATION
Applican� attach to this form Certificate of 5urvey of Lot and proposed building
loca.tion.
To be u ed as:
`' Fi�on�
�—
Sq. Ft. - � Cf .Cu. Ft.
DESCRIPTION OF BtTZLDTNG
e°
D�
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Front Depth Height _____,_ �
�. Ft. -- �• F�� . —
�
e of Construct3o Est3mated Cost�9 ��
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To be compl
The undersigned hereby makes application for a permit for the work laare�.n specifi�l,
agreeing to do s11 work in strict accordance with the City.Ordinances and ruling of
the Department of Buildings, e�nd hereby declares that ell the facts and representa
tione stated i:n this e�pplication are true corr ct. �
DATE r � / � SIGNATZkZE
(A Schedule of Fee coste can be found on the Reverse Side.)
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BIIILDING PERMIT FEE SCI�DULE
Secst3on 2. The Inspector of Buildings shall, before issuin� any permi.t
for the erect3on of any building or structure, or for any addit3on to
ang existing buiiding or s#,ructure, or for any alteratiobs or repairs
to any exiating bu3lding or structure, upon application therefor� reqnire
the �a�ment bg the agplican� Por such permit of fees to the amount he,re9.n
below aet forth and in the manner here�n proe3aed ta-wit:
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2.1. For any's`�i;h permit for the erection of an�r f3.re-proof building� other
than a gexage, warehouse, factor� or grain eleva.tor, or for the erection of
any fireproof addition� for similar occupancy, ta a.qy existin� bui.ld3ng
sha11 be at the rate of �1.40 for each one thousand cubic feet� or f�action .
thereof, in such cubic�.7. contents. .,
2.2.. For any such permi.t for the erection of any f3reproof garage, ware- �
hous�, fact,oryr or grain elevator, or for the ereation of any f3reproof, .
addition for similar occupar�c�+, to any exiet3ng buildin� shall be at the
rate of �1..25 for each one thousand cubic feet, classified as "fireproof" .
bg Saction 502 of the Minneapolis Buil.ding Code.
OUSES
2.3. For an�y such pe,rmit for the erect3on of any non-f3reproof build3ng
other than e garage, warehouse� factory or grain eleqator, or any nori-
fireproof addition, for simi],ar occupancy, to any exiat3ng building.
Permit �]..00 for each one thousand cubic feet.
GARAGFS
2.4. For an�r such permit for the erection of at�p non-fireproof gara�e,
warehouse, faetory or grain elevator, or Por the erect3on of any non-
fireproo� addition, for similar occupancy, to arry existing buildin� er
for each such building or addition. Ninety Cente for each one thousancl
cubic feet or f`raction thereof, in the cubical contents thereof with a
min3mum of �..00. �
For the purpose of computi.ng fees for building permits the cubica]. contents
of any building or e.ddition to a uniform height throughcut by multiply3ng
the ground area covered i'rom �, point six (6) irlches below the f'loor line of
the basement or cellar to the average height of the upper aurface or to the
e.verage height af the roof surface oP the main gable of a p3tched roof.
2.5. For repairs or alterat3ons to an exiating strueture, the fee shall be
at the rate of �3.00 for each Fivs Hundred Dollars (�500.00), or t'raction ,
thereof in the coat of all proposed work:
2.6. In no case shall the fee charged for 8ny perm3.t as set forth in
Section 2 be less than �L,,.00.
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sus�ECr PERMIT NO.
City of Fridley - � 15 �`�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
r
; � RECEIPT NO
• COMMUNITY DEVELOPMENT DIV.
� � 1: ------� �
r � � PROTECTIVE INSPECTION SEC.
1 . �
� � /"�1 � CITY HALL FRIDLEY SS4$2 NUMBER REV. DATE PAGE OF APPROVED BV
�'----� • •�' 612-571-3450 910-F15 4/28/80 � �
JOB ADDRESS 5045 Clearview Lane N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 9 5 Carlson's $11IOIII1't MdllOi $011'�1 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Dean Mickelson 5045.Clea.rview Drive N.E.
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Lloyd's Construction 7870 S rin Lake Park Road -
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential .
7 CLASS OF WORK
� NEW X ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 18' x 12' Deck and exterior remodelin
9 CHANGEQFUSEFROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. 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 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VAIUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANT�NG OF A PERMIT $8►r'JOO $4.Z�J
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTIO R THE PERFORMANCE OF CONSTRUCTION. y�S,�..00
PLAN CHECKFEE TOTALFEE
� $6s.00
SIGNATUREOFCONiRACTORORAUTHOHl2 AGENT ! ATE) w e WHEN PROPERLY ALIDATEO THIS IS YOU,R PERMIT
C�-�1tx.Q_ ��.�v 'S� � °�
SIGNATUREOFOWNERIIFOWNEFBUILDEP71 �DATEI BLDG WSP �ATE
C1TY �� r-k����e�� •
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AP-f'LIC/1TIOI�d rOft I��SID�:(�1'IPtI_ I'sUll..l)IPlG PEi�tf•1ITS .
. ((deV�, �liter�.tians, Addil:�on,, ar l:cpairs)
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QldtdER: ��� ��� ,�`. �� e-� ew���'��'=����-��,.��� BUILDEI�: �d D d �� �
ADDRCSS : ��0 �'° �° � � �� � f�___�___�t�,' '�' f� j�, /�DGP.CSS: /�% �iA� >� � ,� ���
TCI. t�0: TEL (�d0: °���'�' � � �
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LOT: � BLOQC: � ADDITIOII: ��� .P � � � �� ,�� .,�' '.�+ ,% � �.��
Cornex Lot: � Inside Lat: --!�-- SetbacY.: Sideyaxds:
ApP2icant attach to this forra t-��o C�rtificates af Survey of 1ot and
pxoposed building location dra�cn on cex i-a.ticates to scale.
� DESCRIPTIOid OF CONSTRUCTIQ^! �
��,�� � P� Frontc � Depth: _ Heighi:
Squa�e Feet: Cubic Feet:
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o t� �.+, P Depth o IIeight:
• ��``°�C� .
, Cubic Feet:
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���pe o� Construction: � ;�'��,� ,� ����� ��° � � �a �� ° Est�mated Cost: $ C�,� ,�j
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�b �3e Cbmpleted: b //� �,�>
� A].t. A AlL--. B
Proposed Driveway Width Sf Nek Opena.ng Is Desixed: .$ � $,�
, S�� ILV�RSL SIDE OF SHE�2' .
The unde.rsigried hereUy makes applicatiaxY �or a permi�. f.or the s:�rk herein sPecified,
aqreea.ng to do all c•rork in stric4 �icco.rclance �vit�.tii -the City oi I'ridley Ordinances anc�
rulings o� tl�e Deparisiient oi B11iI�::S�cJsd and lZere�iy de�l� res i.liat a21 t2ie iacts and
represe_ntatioiis si.ated in i.hi�. applicaf.ion arc true and correct. � .
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Dt�2�f�: �U SIGNA��,r� e - 4�'" �,�iis"�v°--�� @
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P� � r. �.�'� � � Z s� t. o� � :: � .
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� 1SUl l_1)JI`IU 1'L'ILI'll I I'1;1:. :�l.11l:lJUI�L ,
:,J.•:Cx101d 2. '�'he J.II'.:��ecL-or. oT: l)ui.1.c1�.i��J�� .:h�i7.i.� ),ef.t�,:c: i. �s►�.trig Z�e»niLs �oi L•he erc:cL•�.on
of any l�uia.rl:i.nc� ur. :�Cruc�t:ul:c, or. S`ar. ar,y .aclil�.t:i.csn t:� cii,y c�r�.:.:c�.�«� L��il.c3i.n�� ar. �L•ructuxe,
, ui' 1.��' ��nl ri.lt:c_�rrit.i.ot� oz� �.e���!i.r: t.o •an� c>:.i_:;Lii�c� }�iti.]_c]S.n�� or st.rucLurc, u��on a�,plicaL•ion
t:1�c1'ef:�r.c�, y�cc�u.ir.c U�e �>ayment I�y tl�e �z�.,J�J.a.r:ant: L�or. rucl� �7er�n�t of �'ces La L•}ie vnounL
hc�rci» bc1UY� scL• �or.Ch and i3i Lhc rnanncr h�zea.n pa-�vic7GCI t•o-w�_L•: . ,
)�l's4J COt1�:7'I?UC7'IOI�: Sir�gle 1'ami).y 1lomcs; and G�7r.actc.:., : $�1. C��1/1, 000 eubi.c ieet�. •
l'J,nt� C111:CY.: ?.5 i�cr.ccnt of l�ui.lding }��en;�5.{� .fce.
b1�IVl;I•7T,X UL•'PIiL•'SSIOid: (C�»crete, Curh �tr_ceLs Or�] y} '
� h1Lc:rn�ii.e A: }:c:inaval an�3 �-eY�lacr:menL oi cancreL-e curb and
c3utter o�ily; 13ri.veway w.i.dL-ii plus 6 feeL- x Y�.5,75
n1L-ez-naL•c 13: IZemoval. and l:cp].�zcemenL o£ concrete curb and -
. � ' gui:ter. �z��d i.n�ta).J. a 3 f-odL• wide anproach with ''
' ,- 6 inch {lc�tli; Drivc;•�ay width p].us G i'eet x$17. £35 �
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ADllIT1Qf�l�� INf=0R�1f�TI0N
7?or the purPose of computing i'ees i'oz l�uilding per�ni.t�, L-he cuba_cal conteni:s af any
builcla.nq or addition, i.s deternnined b1� inu1L-a.pJ.ya.ny the c3round area covered i'rom a
poznt six (6) inches below.ihc iloor line oi the basemeni� or th� cellar ta the
average �ieights af i1ic: upper. surface or L-o '�he avcrage }�eight oi' i:he roof suriace
o� fiaie ;aain c�abJ.e of a pitch�d r_oof . �
I'or re����irs or alteratio:�s to an exist5ng s'truci�ur_e, the fee shall be at the rate
oi $3. f)� �iex� eacti five 1lundred doJ.lars -($500.00) or fraction thereoi in fihe cast
ofi �11 proposed work. . , '
In �no case sl�a�.�. the fee charged for any permit as . set forth a.n Sec�ion 2 be less �
than $7.50 p].us $.50 si�ate. suxcliarqe. � • '
VCRTFICA " Oi (�� ! D IO
' id0`�'F�: Permii:s ; or constzuci:ion �vill be issued a minimum of 2� hours from the time
oi a�plicatioii to allow ior proper r�view of t}ie praposed structure and of the
coristruction site.
A Certificate oi' Survey af ihe lo�� showing the :Locati.on of: the foundation once i�
lras becn coiistzzic�ed will be a:equired befo�-e px-ocecdiiig �vit]i the iraming.
�RT r F t c�T� .QC �� UPAn�cY . .
App�icati.on ior a Certificate ot Occu��ancy shall be made i.en (10} da�►s prior ta the
use oz occu���ncy o� aiiy stxuctuLe ior a�2iir.li a buildii�c� i�erniit lias bec�n issued; and
said struct�ure sllall �ioi; be used or occti�?ied ui7'�il a CerL-iticate of Occul�ancy has
been S.ssued.
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SUBJECT I .
City of Fridley � 0 18840
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � R .
� 1 v__�_� COMMUNITY DEVELOPMENT DIV. /��
r � � PROTECTIVE INSPECTION SEC. ,� � L� ��
1 i �
( � ��"��; � CITY HALL FRIDLEY 55432 NUMBER REV. DATE VAGE OF APPqOVEO BY
�'""'�� �� 612-571-3450 9t0-F15 3/30/8� � �
JOB ADDRESS 5045 Clearv iew Lane N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oescR. 9 5 Carlson's Su�it Manor 5outh Addn. SHEET
2 PROPERTYOWNER MAILADDRESS 21P PNONE
Dean Nicholson 5045 Clearview Lane N.E. 572-8722
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Ron 5plett Construction 7620 Ka.lk RQad, Hamel, NIN 55430 42Q-3177
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS Z�P PHONE LICENSENO.
8 USE OF BUILDIN(i
Residential
7 CLASSOFWORK � N� �J ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WOHK
Construct a, 16' x 14' Addition with a 16' x 8` Deck
9 CHANOEOFUSEFROM TO
STIPULATIONS
� ������
,�tir��:��s� SEPARAT� t'ERIVIITS REQUIRED F��
��or�'����g E��R���GAS��°� WlRIIV+�, �1E�il.�G, �'LU�Ni.�3lf�� =�J\9.� S�IG��,
t������ o
E�� �� �,�°,�
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SEPARATE PERMITS AHE REQUIHED FOR ELECT8ICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. 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 AFTEH WORK IS COMMENCED. • NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $5,150 S2 • 58
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN- $56. SO �
TRUCTION O THE PEHFORMANCE OF CONSTRUCTION.
a PLAN CHECK FEE TOTAL FEE
(,:� � �d �� $14.13 $�3.21
SI NATUREOFCONiRACTORO AUTHORIZEDAGENT iDATEI WHEN PROPERLY LIDATED THIS IS YOUR PERMIT
�- 1- �
SIGNATUF7E OF OWNER IIF OWNER BUILDERI IDATEI BLDG INSP �f.TE
N� [ ] City of Fridley
ADDN. � .. �R-1 A1�D R-2
pI,TER. [ ] Building Permit Applicatioa
Construetion Address: 0'��� �� CLf��v/f w
Effeetive u/1/86
Legal Deseription:
Owner Name & Address : ���'N � � ��°L S o /V Tel . � S %a '� �a �'
Contractor: �Ql�l Si°�F T� Te1. �youlo- 3� 7''�'
Address: %�e� � �«�-'� �d �A/� }� �� �y3 n —
Attaeh to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to seale.
DESCRIPTION OF IMPROYEMENT
� � fi � Sq. Ft. a � �
� SC Hei
LIVING AREA: Length � Width 8bt
GARAGE AREA: Len�th Width Height Sq. Ft.
DECg AREA: Length �_ Width Hgt/Ground 3io%�� Sq. Ft. /d $
OTHER: �� �� . � . Z.Ei tI" M�i���• ` 'o " �� � ��
Corner Lot 3] I�nside Lot [] �Ft. Yd. Setbaek Side Yard Setback ________
ma�
Type of Construetion:
Approx. Completion Date:
Estimated Cost: $ �
� 1�'V.tl�
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
DATE: 3 -a � � �� APPLICANT: �� C Tel . � 'ya G' 3 / � �
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
SeWer Main Charge
TOTAL
STIPULATIONS: ���P:�
CITY QSE ONLY
$ ���� Fee Schedule on Reverse Side
� 25� of Building Permit Fee
$ .� � $.50/$1,000 Valuatioa
$ a' $ 525 Per SAC Unit
� � Fee Determined by Engineering
$ n i Agreement Necessary [] Not Neeessary []
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BIIILDING PERMIT FEE SCHEDOLE
0
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The Chief Building Official shall, before issuing permits for the erection of any
building or structure, or for any addition to any existing building or structure, or
for any alteration or repair to any existing building or structure, upon applicatio n
therefore, require the payment by the applieant for sueh germit of fees to the amount ,
herein below set forth and in the manner herein provided to-Wit:
Total Valuation
$1.00 to $500.00
Fees
$10.00 (Minimum Fee is $15.00)
$501.00 to $2,000.00 $10.00 for the first �500 plus $1.50 for eaeh
additional $100 or fraction thereof, to and ineluding
$2,000.
$2�001.00 to $25,000.00 $32•50 For the first $2,000 plus $6.00 for each
additional $1,000 or fraetion thereof, to and
ineluding $25,000.
$25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $�.50 for eaeh
additional $1,000 or fraction thereof, to and
ineluding $50,000.
$50,001.00 to $100�000.00 $283.00 for the first $50,000 plus $3.00 for each
additional $1,000 or Praetion thereof� to and
ineluding $100,000.
$100,001.00 and up
$433.00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraetion thereof.
DRIYEWAY DEPRESSION ESCROiT
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus
6 feet times $13•50
Alternate "B": Removal and replaeement of curb and gutter and install a 3 foot wide
approaeh with 6 inch depth - Driveway width plus 6 feet times $15.75
VERIFICATION OF FOONDATION
Permits for construetion will be issued a minimum of 24 hours from the time of
application to allow for proper review of the proposed structure and of the
eonstruction site.
A Certificate of Survey of the lot, showing the location of the foundation onee it
has been eonstrueted will be required before proceeding with the framing.
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' -' � SuBJECT - - �
City of Fridley 910 9
�
AT TME TOP OF TME TWINS g � I L D I N G P E R M I T
; � RECEIPT NO.
� ; v _ COMMUNITY DEVELOPM�NT DIV.
f � � PROTECTIVE INSPECTION SEC. /5��
i = �
l-_-.� �r���,'� CITY MALL FRIDLE� SS�32 NUMBBR pEV OATB PAGE O� APPROVED BY
L 612-571-3460 9/0-F15 3/30/99 / /
J08 ADDRESS 5045 Clearview Street NE
t LEGAI �OT NO. BLOCK TRACT OR AODITION SEE ATTACMED
oescA. g 5 Carlson's Summit Manor South Addition St1EET
2 PROPERTY OWNER MAIL AOOR�S$ ZIP PHONE
Dean Nicholson 5045 Clearview St NE 572-8733
3 CON7RACTOR MAIL ADDiiESS 21P PHONE LICENSE NO
Sk line Desi n Inc 7620 Kalk Rd Hamel MN 55340 420-3177 6431
4 ARCHITECT OR OESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRE$S 21P PHONE LICENSE NO
8 USE OF BUIIDING
Resideatial
7 CLASS OF WOHK
- p NEW O ADOITION O ALTERATION � REPAIR O MOVE ❑ FiEMOVE
8 OESCRIBE WORK
Reside House & Gara e
9 CHAN(iE OF USE FROM TO
STIPULATIONS
Call.for building wrap inspection before covering.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
TYP�OFCONST. OCCUPANCVGROUP OCCUPANCYLOAD
SEPARATE PEqMITS ARE REOUIREO fOR EIECTRICAL, PLUMBING, MEATING,
VENTILATING Oq AIR CONDITIONING-
THIS PERMIT BECOMES NULL AND VOIO If WORK Ofi CONSTRUCTION ZONING SO. fT CU FT
AUTHOR12E0 IS NOT COMMENCED V�!ITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERI00 OF 1T0 DAYS A7 '
ANV TIME AFTER WORK IS COMMENCED. NO OWLG. UNITS OFFSTFEET PARKING
I NEFIEBV CERTIfV THAT 1 NAVE READ ANO �XAA�INEO TNIS APPLICATION 1 STA�LS GARAGES
ANO KNOW TME SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VALUATION SURTAX
AND OROINANCES GOVERNING TMIS TYPE OF WpRK WILL QE COMPLIED @
WITM WHETMER SPECIFIED MEREIN Oii NOT. TME GRANTING OF A PERMIT W3,850 $1.92
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE Oq CAMCEL TME pEqMIT FEE SAC CMARGE
PROVISIONS OF ANV OTHER STATE OR LOCAI LAW REGUTATING CON-
STqUCTION ?ME �ERFORMANCE Of CONSTRUCTION �87.25 Fire S�', �3.85
� PLAN CHECK FEE TOTAL FEE
Zicense SC $5.00 $98.02
S NOTUpE 0� CON'AACTOa Op 4U pi2ED nGENi �D�TE� WNEN PFOPEpI ALIOATED TMIS IS VOUF1 PEAMIT
t � �
S�GNOTUAEO�OWNEA���OWNEpBWLDEA� �DATE� � BLO �NSp � O�tE
�w � � � Effective 1/1/99
ADDN [ ] CITY OF FRIDLEY (� �
pI,� [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �\
BUILDING PERMIT APPLICATION /�
� �v )
co�a��ao�►aa��s: J v � � c� � ��,� � s ; �' �
Legal Description:
Owner Name & Address: ���'� ���i��sU � � s� ys c� �� �J� � � � Tel. # S » ° � >� .3
Contractor: s�<< <�.� e ��s: o�-� o�� MN LICEN5E ���3 /�
Address: �7� 2-c� /C�-�-i� �� i�i���� �� .s'�3�c� Tel. # yav --.�� � ? CG- a-�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIP'rION OF IlVIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: � .s;� �'��u� -� G,��E
u C
Construction Type: � Estimated Cost: $ ��� �
(Fee Schedule on Back)
Driveway G�rb Cut Width Needed: Ft. + 6 Ft = � Ft x$ _$
DATE: 3 r 3 � - % � APPLICANT: '�irn_�-P-.� � �� _ Tel. #�i �� L/ � - � � `' �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Eserow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ � `7 �S
$ �.�5
$ � �
$
$ s vv
$
$
$
$
/:
r r-
CTI'Y USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lUth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors) � .
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
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