AF - 43020a
BUILDING PERMIT
�i�lage of ��rid�ey, Minn. �°• 2 5 9 4
Date �•"�."".�. :"":`. :� �� . . . . .. . . .. . . . . .. . . . . .
�' ' Builder
Owner • :.:«"'����-�`� . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address �.' .��. :� .,� . . . . . .�!�`������s�` Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LOCAT[ON OF BU[LDING
No. �"�` .... Street �.c� ............. Yart of Lot .......................
����:� � � .,��°::��
Lot . ....�......... Block . .. �........... Addition or Sub-Division �.�."f:��t�'. ��i�
�`'- ,� #.
Corner Lot . . . . . . . . . . . . Inside Lot . . . . . . . .. . . . Setback �,��'"",�;� Sideyard y,�,� .: ' "'.,�!" . . . . . . . . . . . . .
DES�CRIPT[OI� OF BUILDENG
�o be Used as �
�"�� � Cu �'"�"% s e,.
r� # r
�y ;:�, a. '�, . . . . Front ��!'�.q . . Depth � ��# .�F. Height . ��� � . . : Sq. F���". y'� r;;,; Cu. Ft. . . . . . . . .
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.................... Front ........ Depth ........ Height ......... Sq. Ft. ........ Cu. Ft. ........
Type of Construction�,����;,�,�.,�t. Est. Cost�,°.�.�,.:����:...�.�..... To be Completed .L�...�''�'i�""i!tJ'�.+�°�
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In consideration af th� issuance to me of a perrnit 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 village af Fridley.
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In consideration of the payment of a fee of $. ..�t� .,,permit is hereby granted to .. ��:y�:t.e�1.......
..;����,r.,".� ... :.... to construct the building or ad dition as described above. This ermit is granted upon
he express condition that the person to wham 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
�'ridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this perrnit may be revoked at any time u n violation of any of the provisions of said
ordinances. -f��� ���
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Inspector
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NOTICE:
This permit does not cover the construction, instalfation or alteration for wiring, piumbing, gas heating,
sewer or water. Be sure to see the 6uiiding Inspeotor'ior separaie permits for ihese items.
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s�e�ecr IT N .
City of Fridley � � � � 2
AT THE TOP OF TME TWINS g U I L D I N G P E R M I T
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, � RECEIPT NO.
� COMMUNITY DEVEIOPMENT DIV.
, � ---- . ���8
r � � � PFOTEC7IVE INSPECTION SEC.
i �
� � �"'1 � CITY HALL FRIDLE� 55432 NUMBER REV DATE �AGE oF APPRO�EO B�
�"""�� ,�� 612-571-3450 910-F15 8/12/96 � �
JOB ADDRESS 6328 Dellwood Drive NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. Fj 1 Moore Lake Highlands 3rd SHEET
2 PAOPEA7Y OWNER MAIL ADDRESS ZIP PHONE
Richard/Betty Patterson 6328 Dellwood Drive NE 571-8715
3 CONTRACTOR MAII ADDRESS Z�F PHONE UCENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL AOOFiESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL AODRESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION � ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a handicap ramp off back of house (23'2" x 5' & 4' x 40')
9 CHANGEOFUSEFROM TO
STIPULATIONS ' ��
See notations on plan.
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V
TYPEOFCONST. OCCUPANCVGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
' THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED Ofi ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTFEET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPL�CATION 1 STALIS GAFAGES
AND KNOW THE SAME TO BE TRUE AND CORFECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND OADINANCES GOVERNlNG 7HIS TYPE Of WORK WILL 8E COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �2�000 �I.00
OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PFOVISIONS OF ANY 07HER STATE OR LOCAL LAW REGULATING CON- $62.25 Fire SC �Z.Q�
STRUCTION OR THE PERfORMANCE OF CONSTRUCTION.
HECK FEE TpTAL FEE
., —
$65.25
�crvn aeoF -?vcroao p,uTr+ R�ze nceNr �onre� HEN O RLY VA DATED THiS vOUR PERMIT
� �°� � J
SiGNA REOf � NEAiIFOWN RBU�LDERI � IDATEI BL�OG �NSP , ��47E
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NEW
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1
Building Permit Application
ConstructionAddress:�, ��;�.�QJ �'j �i�—
Legal Description: �.oV (� � p�oe K � �i�012-� Lfl E �-� J(-'rN �� r� D s 3r`D
� Owner Name & Address� `1CrG��Wc°� c�tu�. ��G�T�{ �f �Sl)Yl Tel. # 571- SZ�7 I 5
Contractor: _�y�{� �[) {��, j m,fl�•j MN LICENSE #
Address: �,DG� i�,l Rflp 11� S II�I I�1 Tel. #� rj S��' �j ��
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 VVidth Height Sq. Ft.
GARAGE AREA; Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OT�R: CurJ � h? �G�" `-� � k���} �' H f� C��O I C fl�' ���1 I�'1 �
Corner Lot [] Lnside Lot [] Ft. Yd Setback Side Yard Setbacks
Tyg,e of Construction: �{aN G i C:� P t�Arn P�'��,i�,n, Estimated Cost: $�p;=���
Approx. Completion Date:
��. °°r�
(Cost on Back)
Driveway C�rb C�it Width Needed: Ft. + Ft �t x$ _$
DATE: �i - l � ` � � APPLICANT: , --r-____� Tel. # � ~f � - � �I I �-
ITY USE ONLY
Permit Fee
Fire Surchaxge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� � �_as
$ o?.Z�c�
� l• ov
$
$ `�
$
$
$
$
� _ . as-
�..� -
Fee Schedule on Reverse Side
. 001 of Permit Valuation (1 / l Oth %)
$.50/$1,000 Valuation
$900 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 [ ]
Building BUILDING Permit No.::�►�-c_�c -�-f ��
Inspections RESIDENTIAL APPLICATION Recei�ed sy:
763-572-3604' CITY OF FRIDLEY Date Rec'ct: -�-�-�
DATE
l0 /I'3 /���
YOUR E-MAIL ADDRESS �� ►'� - �
SITE ADDRESS ���-� .Aa�lwv�ai ,� r /�l�
THIS A.PPLICANT IS: �OWNER OCONTRACTOR
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
i�' -
STAT6 L[CENSE #
ADDRESS:
PHONE
INGLE FAMILY/NEW
❑ TWO FAMILY/NEW C(
PERMIT TYPE ❑ �DITION ❑ GARAG
❑ BASEMENT FIN]SH ❑ ROOF
�DECK ❑ SIDING
❑ SWIMM
TYPE OF WORK:
FAX
EXPDATE
�r� v STATF3YYI�IP 5 S',� a
CITY STATE ZIP
❑ DRAIN TILE
❑ OTHER
DESCRIBE WORK BEING DONE: L�.e�% ac�a<< �o�
SIZE OF IMPROVEMENT J�o � x d�l � LENGTH /(o � WIDTH � HEIGHT S. Ft.
ROOFIN D HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
GARAGES ❑ ATTACHED GAR.AGE 1. Existing Floor Plan
PROPOSED SIZE: 0 DETACHED GARAGE 2• Proposed floor plan
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit ADDITIONS & PORCHES SUBMIT:
D Aluminum O Trim 1. Site Plan/Survey showing the existing structures
p p�� ❑ Fascia and proposed project.
2. Two sets of construction pians
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS OYes �No LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CEiANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION_ S - US 1 C� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Chazge
Total Due
� S .O�
$ �-� ��
$
$
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the totai job valuation
.OQOS x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attac
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT[L PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application f permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work ich,�e uires review an approval of plans.
SIGNATLJRE OF APPLICAN � PRINT NAME Tl 12•� o l[.��___f��DA1'E /D� / I�00�
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