AF - 43052sua�ecr NO.
c�ty of Fridley 2 6 4 9
' , AT THE TOP OF TME TW�NS B U I L D I N G � E R M I T �`°' RE IPT NO.
r °
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COMMUNITY DEVELOPMENT DIV.
r � V � PROTECTIVE INSPECTION SEC.
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� � �'�'1 � CITY H ALL FRIDIE� 55�32 NUMBER REV DA�E PAGE Of APPROYEO BY
�..___1l: `.� 612-571-3450 910-F�5 7/6/98 / /
JOB AODRESS 6440 Dellwood Drive NE
t LEGAL LOT NO. BIOCK TRACT OR ADDITION SEE ATTACHEO
oesca. Pt 10 Auditor's Subdivision �688 SHEET
2 PROPERTY OWNER MAIL ADOfiESS ZIP PHONE
Sandra Freeman 6440 Dellwood Drive NE
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Donner Construction Co 6305 Camden 4�312, Brooklyn Center, MN 55430 6904
b ARCHITECT OR DESIGNER MAII ADDRESS ZiP PHONE LICENSE NO.
566-5377
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE Of BUILDING
Residential
7 CLASS OF WOFK
❑ NEW ❑ ADDITION ❑ ALTERATION C� REPAIR p MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Garage (20 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMI7S ARE REOUIRED FOR ELECTRICAL, PIUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PEFMIT BECOMES NULI AND VOIO IF WORK OR CONSTRUCTION ZONING SO. FT. CU. fT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAVS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFfSTREET PARKING
I HEREBY CERTIfY THAT I HAVE READ AND EXAMINED THIS APPLICA710N 1 5TAlLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION SUiiTAX
ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT �1,668 �.H3
DOES NOT PRESUME TO GIVE AUTMOFITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL lAW REGULATING CON-
STRUCTION OR THE P FOR CE OF CONSTRUCTION. �S�F.00 Fire SC �1.6%
PLAN CHECKFEE TOT FEE
Licens $5.0 $61.50
SiGNA7UAE OF CON'RA iOA OA AUTH RIZED GENi IDA 1 N P OPE VALIDA E'THIS IS VOUR PERMIT
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S�GNATURE OF OWNEA UF OWNEA BWLDERi iDATE� � BIAG NSP �iFtE
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�W � � Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [] . SINGLE FAMILY �AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION �;��,�5� G��3
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ConstructionAddress: _ ��� �a .� � � CL�Ca �/7 � ��°
Legal Description:
Owner Name & Address: �� E-',E ��i Tel. #�'
0
Contractor: b���� � ?����% � � MN LICENSE # � "I���_
Address: � 3 D� ���� t° � � � / �- A 1 � C .5 ��f 3 � Tel. # ,��� � � �1,2
LIVING AREA:
GARAGE AREA:
DECK AREA:
Attach to this application, a Cert�ficate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width � HgdGround Sq. Ft.
OTHER:
dS � - � � �i � �, �' �
Construction Type: pD F� G�D� _�P O�� Estimated Cost: $ O �--�
_ (Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$
_$
DATE: (� APPLICANT: Tel. # � � —�J��
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ ; �:,v
$ I�
$ �3
$
$ �, �
$
$
$
$
� ��; s
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1 / l Oth %)
$.50/$1,000 Valuation
$1000 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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