AF - 40670SUBJECT ,
City of Fridley 15 5 91
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T� �
r
� � RE EI .
� 1 L_____ COMMUNITY DEVEIOPMENT DIV. ��%/� ��
r � � PFOTECTIVE INSPECTION SEC.
� i � %�'�- 3/
� �'�'1 � CITY HALL FRIDLE� $5432 NUMBER REV. DATE PAGE OF APPROVED BY
�'----� • •�� 612-571-3450 910-F15 / /
12/26/79
JOB ADDRESS 5476 East Brenner Pass N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 12 1$ Innsbruck North Townhouse � PZc1't 5 SHEET
2 PROPERTYOWNEii MAILADDRESS ZIP PHONE
Darrel Farr Develogment Corp. 7286 - 72rid Lane North, Brooklyn Park, NIDT
3 CONTRACTOR MAILADORESS ZIP PHONE LICENSENO.
Same 55428 560-8110
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
�O NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Construct an 18' x 28' 7.bwnhouse (A Unit)
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY 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 PEHIOD OF 120 DAYS AT �.5� �.4��.�.2
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ]. STAL�S GARAGES
AND KNOW THE SAME TO BE TRUE AND COR,RECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 528��-60 $�.4•O8
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. .,SSG.4'rJ yS`�Zr'J.00
PLAN CHECKFEE TOTALFEE
14.11 $ 509 . 64
SIGNATUREOFCONTRACTORORAUTNORIZEDAGENT �DATEI WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
- � r��.L, �� .�� � _ � �
SIGNATUREOFOWNERUFOWNERBUILDEiii IDATEI BLDG iNSP qAT �
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C0121Ji�it L�J1': '✓ TIJSID� LOT: S,^:TI31�CI:e . SxUI'•Y71RDS: '
�Pi�licant attach �o this toxm ��o Certifi.cafies of Survey_ pf Lot ar�d propased .
bui.lding locai•ion clraa�n on these Certificates. -
' . •� . .
� DESCRI PTT01'J OF BUI LDI t�G �-��,�-� _-
.. . • . . . . � . -
To J3e Used Rs: � � � . . - • ' . .
• �__�___i���,s�'�'.,�. . Fxont s / � Depth : � ;oZ � ' Nei.ght : � � . . � ' . .
. . - . . Square FeeL: JS/o�, . , Cubic �'eet: . / �!/�, - . -
'1`xont: Dcpth: �� Neight: • -
Squar.e Feet:� Cubic Feet: '
� Type o.i Consiruction: ��-t.�-;� g�_ �i�c..�� Estimated Cost: $��G .
%
'�Eb 23e Comnleted: ��'� � . Alt. A A].t. B
' Pxoposed DrivewaX liidi-h I£ 21e�� O�ening Is Desired $ $
� ' (SE� 12�VEF•SE SIDr OF SiIi:ETj
Tiie undersigned he�-eLy makGS application for a permit for the c,rork herein
specified, ar,reeing to do all i.ork in strS.ct acc�l:d� tv Ui t2�e Ci.t�• of .
Fzidley OZC�111:IilCCS and ruli.ngs of the Dc��a� ta�cnt f ruil � I1CJS � and hcz-eby �
deel.ares L-h, t all the facts and regreseni.aL-io . stat L- ' appl�cat-ian
axe true and co�:rect-. Se� xeve�: �e si SOJC ' 011 ''lOI1. _
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, HOUSE HEATINSi, TEST RECORD'� `,
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OCCUPANT � OWIUER �°-�� ����"��;'` %`� '/��'.� �•`� �"
HEAT LOSS DATE HTG. INST.
SOLD BY � ::'' INSTALLED
Electrical Work By `�'�' �"'� �%� �� l`�°� Gas Line By .
TYPE OF HEAT GA_ FA,�. HW_ STEAM SPACE HTR.
i" GAS DESIGN
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UNIT HTR. OTHER_
CONVERSION
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Draft Hood �� �� °'-� � �°�"� � �� �egulator
Filters Size Number
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sue�ecT PER .
Cit}� of Fridley �� 16 0 9 9
AT TME TOP OF THE TWINS g U I L D I N G P E R M I T ��
�
; � RECEIPT NO
� ; y ����� COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTtON SEC. �
� � �
� � �'�'1 � CITY HALL FRIOLE� 55432 NUMBEA REV DATE PAGE OF APaROVED B�
�"'"� � ,'� 612-571-3450 9�0-F15
4/1/81 � �
�oe aooaess See Below
1 LECaAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 1—( j� Innsbruck North To�wnhouse 6th Addn. SHEET
2 PROPERTY OWNER MAIL AODHESS ZIP PNONE
Darrel A. Farr Develo�ment 46Q0 Lake Road, RoUbinsdale, 1�H�i 536-9936
3 CONTRACTOR MAILADDRESS IIP PMONE LICENSENO
Same
4 ARCHITECTORDESIGNER MAILADDi;ESS 21P PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PMONE LICENSE NO
6 USE OF BUILDING
Garages
7 CLASS OF WORK
� NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE � REMOVE
8 DESCRIBE WORK
Construct a 54'8" x 22' Garage Unit
9 CHANGEOFUSEFROM TO
STIPULATIONS
. Lot 1- 5482 East Brenner Pass N.E,
Lot 2- 5478 East Brenner Pass NoE,
Lot 3- 5480 East Brenner Pass N,E.
Lot 4- 5474 East Brenner Pass N.E,
Lot 5- 5476 East Brenner Pass N.Ee
I,�t 6- 5480 East Brenner Pass NoEo
Provide one raw of concrete blocks under bottom plates.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING. HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTqUCTION ZONING SQ. FT. CU. FT.
AUTHORIZEO IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCEO. NO. DWLG. UNITS OFFSTFEET PARKING
I NEREBY CERTIFY TNAT I HAVE READ AND EXAMINED THIS APPLICATION STA�LS GARAGES
ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VALUATION SUFiTAX
aND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED ],O�GOO $5.30
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �
DOES NOT PRESUME TO GIVE AUTNORITY TO VIOLATE OR CANCEL TME pEFiM1T FEE SAC CHAFGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR TNE PERFORMANCE OF CONSTRUCTION. $48. OS
PLAN CHECK FEE TOTAL FEE
$53.38
S�GNATUAEO�CON'RACTOpOAAUTNOAIZEDAGENT IGATEI yy N PRO E iD ED TMIS IS VOUR PERMIT
S�GN47LAEC°Ot'r4EA��cOWNEABU�IDER� �DATE� BLDG �NS� ��/rE /
sue�cc� RMIT NO.
c�ty of Fridley 3108 3
AT THE TOP OF TNE TWINS 6 U I L D I N G P E R M I T
i . RECEIPT NO.
� �
COMMUNITY DEVELOPMENT DIV. ���
V PiIOTECTIVE INSPECTION SEC.
i � -�
r � " _:
� � ��"1 � CITV MALL FRIOLEr SSIJ� NUMBER REV OATE � pAGE Of APPpOVEO 8�
��-°� � �'' 612-571-3450 s�aF�s 6/27/00 � �
�oe nooRESS 5474, 76, 78, 80, 82, 84 Ratscsc East Brenner Pass
t LEGAI LOT NO. BLOCK TRACT Ofi ADDITION SEE ATTACMEO
oescR. 7-12 13 Innsbruck North Townhouse Plat G SNEET
2 PROPERTY OWNER MAII AODRES$ 21P PMONE
Innsb�uck Townhome Association 651-224-5482
3 CONTRACTOR MAIL ADDRESS 21P PMONE LICENSE NO
Garlock-French Roofi.ng Corp., 2301 E. 25th St., Mpls., MN 55406 612-722-7129 00001423
a ARCMITECT OR OESIGNER MAIL ADORESS ' 21P PMONE LICENSE NO.
S EN(31NEER MAII ADORESS ZIP PMONE IICENSE NO
8 USE OF BUILDING
Residential
� CLASS Of WORK
O NEW O ADDITION O ALTERATION � REPAIR O MOVE O REMOVE
B DESCRIBE WORK •
Reroof Townhouse B�.ilding (Tear Of�
9 CHANGE OF USE fiiOM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAI, PLUMBINCs, NEATINO.
VENTIIATING OR AIR CONDITIONINO
THIS PERMIT BECOMES NUIL AND VOID If WORK OR CONSTiiUCTION 20NING SO. FT CU FT.
AUTNORIZEO IS NOT COMMENCEO WITMIN 80 OAYS. Oii IF CONSTFUCTION
OR WORK IS SUSPENDEO OR ABANOONEO fOR A PER100 OF 120 OAVS AT
ANV TIME AFTER WOAK IS COMMENCED. NO OWLG. UNITS OFFSTREET PAqKING
I MEREBV CEiiTIFV TMAT I HAVE REAO ANO EXAMINED TMIS APPLICATION 6 STALLS GARAGES
ANO KNOW TNE SAME TO BE TRUE AND CORRECT. ALL PROVISIOAIS OF LAWS yp�UAT10Pl SURTAII
ANO OAOINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WMETNEq SPECIFIEO NEREIN Oii NOT. THE GRANTING OF A PERMIT �21,631.00 .�IO.HO
DOES NOT PRESUME TO GIYE AUTMORITY TO VIOIATE OR CANCEI TME pEpM1T FEE SAC CHARGE
PFOVISIONS OF ANV OTHER STATE Op LOCAL LAW REGUlA71NG CON-
STRUCTIpN OR TNE PERFORMANCE OF CONSTRUCTION $349. ZrJ Fire .�C .�21. 6�
PLAN CMECK FEE TOTAL, FEE
$3 .68
S�GN�TUpEOFCON:AACiOpOpAUTMOp�ZEO�GENT iO�iE� E PROPE ALIOATED �5 IS YOUF PEpMIT �
�_� �
S�GN��UpEO�OWNEpi��O�NNEpBURDEN� ' - - �DATF� �NSo � � -��Diff� � �
SuB�ECr � Q. .
City of Fridley 3 3 5 6
AT TME TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � RECEIPT NO.
• COMMUNITY OEVELOPMENT DIV. �D/
' j V �����
l � � PROTECTIVE INSPECTION SEC.
i ` �
� �"'1 • CITY MALL fflIOLEr SS��i NUMBER pEV OATE PAGE Oi AVPROVEO B�
�"'"�� �'� 763-571-3450 9i0-F15 3/6/03 / /
J08 AOORESS 5474, 5476, 5482, 5484 EAST BRENNER PASS NE
t IEGAL ��T NO. BLOCK TRACT Ofi ADDITION SEE ATTACMED
oesca. 7,9,10,12 13 Inns SMEET
2 PROPERTY OWNER MAIL AOORESS ZIP VHONE
Various
3 CONTRACTOR MAIL ADORESS ZIP PMONE LICENSE NO
Loon State Construction C 6-
1 AiiCF11TECT OR OESIGNER MAIL ADORESS IP P ONE LICENSE NO
20282972
5 ENGINEER MAII ADDiiESS ZIP PHOHE IICENSE NO
8 USE OF BUILOING
Townhouses
7 CLASS OF WORK
O NEW O AODITION O ALTERATION O FiEPAIR O MOVE O REMOVE
x
B .DESCRIBE WOqK
Chimney Repair
9 CHANt3E OF USE FROM TO
STIPULATIONS
Corrections per Building OfficiaZ inspection.
SEPARA7E PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING, MEATING, TYPE OF CONST OCCUPANCY GROUP OCCUPANCV LOAD
VENTI�ATING Oii Alii CON01710NING
TMIS PERMIT BECOMES NULL AND VOID If WORK OR CONSTFUCTION 20NING SO. FT CU FT
AUTHORIZEO IS NOT COMMENCEO WITMIN 60 DAYS. OF IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 OAVS AT
ANY TIME AF7ER WORK IS COMMENCED. NO DWLG. UNITS OFfSTREET PARKING
I HERE9Y CERTIFY THA7 I HAVE iiEAD AN� EXAMINEO TMIS APPLICATION 4 STA��S GARAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SUIiTA%
ANO OROINANCES GOVERNING 7MIS TYPE OF WOfiK WILL BE COMPLIED
WITM WME7MER SPECIFIED HEREIN OA NOT. THE GRANTING OF A PERMIT �7 f SOO � 3.]S
DOES NOT PRESUME TO GIVE AUTHORI7Y 70 VIOLA7E Oq CANCEI TME pEqMIT FEE SAC CMARGE
PiiOV�510N�S ANY OTHER STATE OR LOCAL LAW REGULATING coN- � 153 . LS
ST� GiION O PERfOFMANCE Of CONSTRUCTION Fire SC �%..5�
PLAN CMECK FEE TOiA� fEE
` 3 G �3 License SC $5.00 $169.50
S�GN• �CON"NACTOpOp�UTMOp�LED�GENT �D�iE� WMEN PROPERLY VAl10ATED THIS IS YOUp PERMIT
-- � �1 (�
S�GNe�UNE O� OWNEp��� OWNEpBU4DEpi �DATE� BLO � S qp t
�
�—
SuB�ECT
c�ty of F��a�ey
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i �
� �
� �V _���� � COMMUNITY OEVELOPMENT OIV.
f � � PROTECTIVE INSPECTION SEC.
� � ,
L---_� �"' �'� CITY MA�L FFiIOIE� 531�2 NU4BEN
L 763-571-3450 910-F15
10B AODRESS 5474, 5476, 5478, 5480, 5482 5
1 IEGAL LO7 NO. BLOCK TRACT OR ADOITION
oescR. 7_12 13 Innsbruck N
Various
� CONTRACTOR • MAIL AOORESS
Loon State Construction 1600 C
� ARCNITECT OR DESIGNER MAIL ADORESS
5 EN(31NEER MAIL ADDRESS
REV
ATE I PAGE OF
3/24/03 � �
3338�
/�-/�-�
APpROYED BY
SEE ATTACMED
SMEET
E '
ZIP PMONE LICENSE NO
,_NIlV 55432 763-286-6757
ZIP PMONE LICENSE N0.
20282972
21P PMONE IICENSE NO
8 USE OF BUIIDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION O ALTERATION C� REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reside Garage Building
9 CNANOEOFUSEFROM TO
STIPULATIONS
SEPARA7E PEFMITS ARE REOUIfiEO FOR ELECTRICAL. PLUMBING, HEATING, ��rc vr a.an
VENTILATING OH AIR CONOITIONING
THIS PERMIT 9ECOMES NULL AND VOIO IF WORK OF CONSTRUCTION 20NING
AUTMORIZEO IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANOONE� FOF1 A PER100 Of 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO DWLG.
1 MEREBY CERTIFY 7HAT 1 MAVE FEAD AND EXAMINED TMIS APPLICATION
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS yp�UATION
AND OROINANCES GOVERNING THIS TYPE Of WORK WILL BE COMPLIEO
WITH WHETMER SPECIFIEO MEREIN OR NOT. TME GRANTING OF A PERMIT �9 f OOO
DOES NOT PFESUME TO GIVE AUTMORI7Y TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF OTMER S7ATE OR IOCAL LAW REGULATING CON- @
STRUCT R 7HE P F ANCE OF CONSTRUCTION y�I.C)J.2
PIAN CNECN
�- .� o� D icen
Si •TUNEO� ' ACTOAOpAUTMOp�IEDAGENT 0� Ei I W E
S�GNATUAEO�OWNEA���OwNfpBw�Dfp� iO�TE� , e. _
��
UNITS
SQ.FT
STA��S
e SC $5.00
GROUP OCCUPANCVLOAD
CU FT
REET PARKING
IGARAGES
$4.50
AC CNAqGE
Fire SC $9.00
OTAL FEE
$185.75 �
TMIS IS Y�p PEFlMI
sue�ecT PERMIT NO.
c�ty of Fridley 3 4 0 2
AT THE TOP OF THE TW�NS g � I L D I N G P E R M I T
f
i �
COMMUNITY DEVELOPMENT DIV. IPT NO.
r �
•
� j V �'��� � O
f � � PROTEC7IVE INSPECTION SEC.
� _ �"'1 � CITY MAIL FRIDIE� SS1�2 NUMBEA pEV D�TE v�GE Of �PaaOVEO Br
�'""'� � �'' 763-571-3450 910-F15 4/1/03 / /
�oe nooaess 5474, 76, 78, 80,82, 84 East Brenner Pass NE
t IEGAI LOT NO. BLOCK TRACT OR AODITION SEE ATTACFIED
oescR. 7-12 13 Innsbruck North Townhouse plat 6 SMEET
2 PROPERTY OWNER MAII ADDRESS ZIP PHONE
Various
J CONTRACTOR MAIL ADORESS ZIP PHONE LICENSE NO
Loon State Construction 1600 Co Hwy 10, S rin Lake Park, MN 55432 763-780-5666
� ARCMITECT OR DESIGNEfl MAIL ADORESS ZIP PMONE LICENSE NO.
20282972
S ENGINEER MAIL ADORESS ZIP PMONE LICENSE NO
8 USE OF BUILDING
Townhouse Building
7 CLASS OF WORK
❑ NEW O ADDITION O ALTERATION C� REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reside Townhouse Building
9 CHANOE OF USE FROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Cod.e, requires that a weather resistive
barrier be placed over exterior sheathing to protect the interior wall covering.
Exceptions for this provision would be if sheathing is an approved weatherprooi
panei or when the siding is an approved weather barrier. Vinyl siding is not
a weatherproof covering unless the manufacturer states this in their application
guidelines. Call �or inspection of wrap before covering. Caulk and flash a11
exterior openings.
:;
SEPARATE PERMITS ARE REOUIRED FOp ELECTRICAL, PLUMBING, NEATING, TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD
VENTI�A7ING OR AIR CONOITIONING
TMIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION 20NING SO. FT CU FT
AUTHORIZEO IS NOT COMMENCED WITHIN BO DAYS, OR IF CONS7qUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OfFSTFEET PARKING
I MEREBY CERTIFY TNAT I MAVE READ AND EXAMINEO THIS APPLICA710N 6 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND COpRECT. A�l PROVISIONS OF �AW$ yA�UATION SURTAX
AND OROINANCES GOVERNING TMIS TYpE OF WORK WILL BE COMPLIED
WITH WME7MER SPECIFIED MEREIN OR NOT TNE GRANTING OF A PERMIT �20�000 $IO.00
DOES NOT PRESUME TO GIVE AUTMORI7Y TO VIOLATE OR CANCEL THE pERMIT fEE SAC CNARGE
PROVISIONS OF A S7ATE OR LOCAL LAW REGUTATING CON-
RUCTI� ME PER E Of CONSTRUC710N $321.25 Fire .SC �2�.��
PLAN CNECK fEE TOTA FEE
L � � `� License $5.0 $ 56.25
S�GN rupEO�C 10pONAUTMOp�ZED�GENT IOATE� N O VALIOA EO HIS IS YO R PERMIT
__ • /
S�GNSTUAE O� OWNEA��� OwNEABW�DEN� iO�tE� BlD �HSo ���rt
���•
" Building
Inspections
763-572-3b04
763-502-4977 FAX
BU�D�(i Permit No. �
RESIDENTIAL APPLICATION R���a sy:
C�TY OF FRIDLEY n� R�°a:"
DATE � Y E-MAII. ADDRE9S K� I il ��� r! C a �1/ S�fP r. t`�'i
sTtE�►nvxESS_S�/ 7�i E�. r�NN-e�' �aa�°S �r i o( �ev�.�•�,� N
�s Arr�C�rr�s: o owx�R t+�ee�acTO� —'
PROpERTY OWNER/ �. a ✓e�✓ M �, �, �
1�► .��M�i
SUBMIT A COPY OF
YOUR STATE LICEATSE
AND CERTII�TCATE OF
�xsuRarrcE
PROPERTY TypE
TYPE
BFSCRIBE WORIC Bffi3i3
w
Ann�ss: sy °� �o � ar��N�-
rxo�: `7,G 3 s 7�{ — ,-3 ��
NAME: _ /� i ,u �. � �e �
sra� rac�asE � �- e
ADDRESS: _ �- .3 / % / `�.I7/ 6� L.�l /V
rxoxE �, / 2—�D LI — Q q p�
�'sLE FAIVIII,Y/NEW CONSTRUCITON
❑ TWO FAMILY/NEW CONSTItUCTTON
■:�•� ��.� ii� ■��•
` �� " ■ ur c
O NEW HOME CONSTRUCITON ❑ ADDITION
I7 MAIl�ITIIdANCFJREI'AIIt �-R�iotADII.ING
7• Q rev� -e k rs�, a� �—
k;
- r.ra�G /f .f �,�. �
��ER OF SQUARES ❑ HOU3E OHI,Y
Cl HOUSE 1� GARA(�E
_ R G. CJ ATTACI-IED GARA(3E
��� s� O DET.4CHED C,AItqGE
PROPOSED I�ItiFiT:
" ' 03offit
t� Atuminum ❑ Tritn
❑ Other p Fas�ia
IN� OPENiNCiS �Yes pDTo LOCATIOI�i OF WIldDOW3
4R FOR NEW OPENIN(3S.DF�CRigE S�E pg
OPENII�i(3 CHANGES.@
ALL
Pennit Fe8
Plan Review
Fire Surcharge
Surchazge
Lic�se Siucharge
SAC Charr�e
Cwb Cut Escrow
Brosion Ccmtrol
Park F�
Sewer Main Chazge
ARE BASED OAT VALUATION, IATCLUDING TTI�E COST OF
T.......� � (US� � 1997 U.B.0 FEE SCHEDi3I.E)
_„ FxP DATE s r �
CITY��i.. %u� g
� '�� ? — r� z. — �
--�--�— �,_,_.,.
�
ws
0 DRA1N TII,E
0 OTI�IER
ld �e.�.o � e,7c =
�- , i
�
�.ea _c c� •�.
�' '
I. Faqsti�F'barPlan
2. Pmpased $COr plaa
3. Li� of shnchual membas bu yE usad
FOR NEW CON3TiiUCTTON TNCLUDING I3ECKS,
�ONS & PORC'I3ES Si MIT.
t. Site 1'lan/3tII'vey showaig t2� eras� �tacdttes
��Po��l�
2. Two sets of c�shuction pleffi
3. En�gy Cekutep8ns
Ii.�
a � �� ,� 5ee Back Paga for Fae Schedule
$ + 65% Of BlWding Petmit Fee
$ .001 timas the total joh valuation
$ �, Sd .0005 x Pe�mit Valt�ation Minimum $.gp
$ $5.00 {State Licensed Residential Contractors)
$ $200U p� SAC Unit (Pl�s to MWCC for determination)
$ � �+6�i= ftx$21 =$
$ $�50 Cons�v�ion Plan Raeiew
$ Fes Det�tled by Engine�ing
er� �88ment IIe�eSS�tY () NOtI NeCesgatY ()
THIS Is AN APPLICAITON FOR A PERiVIIT NOT VALID UNTII, pROCESSED
I hereby appfy for a building pemiit and I acknowledge that the information above is campleta �d acctirats, that the work will be in
conformanco with �e ordinanc� and c�es of the City of Fridley and with the Minnesata. Cons�vcdon Cod�; that I wid�stand this is not a
pernrit but only an application for a pernrit and work is not to start without a
approved plan in the case of al! or �whic�t uires evi and Permit on site; that the work will be in accordm�ce v►�th the
aP�xi'oval of plans.
SIGNATURE OF APPLICEINT c'"'� c � PRINf idAME "P � I �C (`/'�f� e"� � l DATE� 7/ o q
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