AF - 40478�
a` ,
Vill�ge of Fri�.ey,lHiinn.
`�` �UILD:ING 1'II�11'IIT ' :`'Y;`
N° 152 y,..
O�ce of II6TSPEG°rOR OF �i7II1DINGS
L �:'+. 4 i., � „� �.:'�' � r .. .
Oevner - � �`
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Apchitect Fridley, Minn., ��,�,�� , � �' , 18�_
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Builder �i'" `��
�`/o.? 0 / LOCATION OF
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No. Street � M � ���.r'�4'"� i� �,
'rs_ �
Lot Block Additioa'�o�'�i
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To be used ae_
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of Lot
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�ILDIl�G �� � � °„�
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[anner of Construction '"!� ?�'�;�,�*�F: '�_
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� � ° Estimated Cost`
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Permit is heraby �raatet� to �` � .� to �,�.� "��'��"�,r----
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t}ie building ��°����",_s�� > �ade��i'�ed in the above siatemeut. This permit fs granted
� �.
upon the espress condition tha� the rson � whain i fa gra.nted, aad his agente, employees and worlmnen, in all
>the work done iit, axound and" upon d bufiding, or any part thereoP, shall conPorm 9n all respects to the ordi-
na;uces oP Fridley, Minn., regardfag the conetruction, alteration, maintenance, repair and moving of buildinge
within, the city limite, and this permit may be renoked at �ny time.upoa violaiioa of an� oP the provlsfons of eaid
ordinances. �•�
�w��� � � ,,�y :d
� ��' � �� � i� �` BpECtOP Oi B1I�If1�Ilg^S.
AGRffil�ENT A1�TD SwOgtN STATEMENT
In considera�tioa of the issue and deliveiy`to ffie by the Iaspector �f �uildings of Fridley of ..
the above permit, I hereby agree to do the propose�l work in accordaace with the descraption
above set forth anci according to the provisions of the ordinances of Fridley, a,nd, being first dul�
sworn, I hereby state and say �hat the facts stated by me a.nd contained in the above permit are
true as therein stat�.
, t, , :.�"' u ,,
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Subaeribed and sworn to before me at Fridley, Minne ta, this—��,� � '�
�.. '� �
day of ��.� t A.D. 19'��. , �--
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SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R
;,
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COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
1 . �
� _ ��"1 � CITY HAIL FRIDLEV 55432 NUMBER REV. DATE
1._--� � �'� si2-5so-sa5o 910-F15 10/16
JOB ADDRESS 7201 East River Road N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
oesca. 12,13 1 Hillcrest Addition
2 PROPERTYOWNER MAILADDRESS
Donald L. Lennox 7201 East River Road N.E.
3 CONTRACTOR MAILADDRESS
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER
ILDING
MAIL ADDRESS
I PAGE OF
3 � �
ZIP
F� 12358
RECEIPT NO.
lo �Sd �-
APPROVED BV
SEE ATTACHED
SHEET
PHONE LICENSE NO.
PHONE LICENSE NO.
PHONE LICENSE NO.
s use oF eu Res idential
7 CLASSOFWORK � NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK COI19tTl1Ct a 24' x 32' Garage
8 CHANGE OF USE FROM
TO
STIPULATIONS provide a hard surface driveway.
l{►F'.ED �'�� ��ti�1�'�tNC,
R�T� pER�A1TS RE p S1GN�•
SEp� 4LU�ygING AN
NEp,1►NG�
TYPE OF COI
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. CZ
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OH WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT —1
ANY TIME AFTEH WORK IS COMMENCED. NO. DWLG.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3 �F�
OCCUPANCY GROUP OCCUPANCY LOAD
S�. FT. CU. FT.
768 7680
OFFSTREET PARKING
STALLS IGARAGES
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- �y 14.20
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �°" �
PLAN CHECK FEE
a
IRE OF CONTRACTOR OR ORIZED AGENT 1DATE)
� � �� �
���� � > . . �2�'Isl-7��[J�./_� � v .G ��
1.73
CHARGE
AL FEE
15.93 �
HIS IS YOUR PERMIT
�
aPPI,ICATION FOR RLSIllENTIAL, ALTEIta'TIi�N,
UR E1i)lll'I'ION �UILDING PERMIT
CI'1'�' OF 1-1:1ULl�Y, �1INNFSO'tA
OWNF.� � S NAME : �ty� c�,QtiQ „� - BTJ ILDER : � � G��� � � �
,�nvxx:ESS : %� 1 ���P �ti�,�, �Q � a o � � � �� •
ADDRES S : % `� 1 � (����-� _
NO . . O ,4 S TREET :, (�„ �-q,./L � '`�-r-�-2` � � � '
�
LO�:
RLOCK : � ADDITION :� �� � .,, � �-�K.�a ��, �,�,
CORN�R LOT: INSIDE I.OT:��SETBACK: SIDEYAitD;
Ag�licant attach to this Lorm �ao Certificates of Survey of Lot and proposed
bui.ldirig location drawn on these Cextificates. �
�ESCRIPTIUN OF BUILDING
To a Used As:
- Front • � � Depth : �J Z-- Heigh� • � �
Square Feet: � � Cubic Feet: / ���C-�
Front: Depth: Height:
Square Feet; Cubic Feet:
Type o� Const�-uction: � r� e� ti� ` Eetima.ted Cos�: $�'�/�j� °-
' U�
To Be Crnnpleted:
The undexsigned hexeby ma.kes applicativn fox a permit for the work hexain
�psc�fied� agxeeing to do all work in st�ic� accoxdance with the City af
Fxidley Ordinances and rulings of thc> Department of Buildings, and hereby
de�larea that .�11 thc facts and xepresentationa stated in this application
8�� true and � ,�rr�•c t .
� � -
DATE : ��— � – � S IC;�ATURE: �' � °
(See Revexae Side For Additiona.l Tnforma.tion.
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BUI LDIN� 1'�1L'�91 T I��:E 5C!-I}:llUl_k:
S�CT�pN 2. The Lnspect��r �f B�ii.id�n�s shall, before issuing permits fox the
e7;8etion of sny buiiding or stru���ure, ur fox an�� addition to ��ny existing
buildfng or structure, ur jor ._�ny .�ltexati.on or r�pair.s to any existing
building or structure, iipon application ttierelor�, r�q�,ire the payment by the
gpplicant for such permit of fees tc r.h�• amount herein below set forth and in
�he manner hexein provided to-s•�it:
UNZFQRM BUILDING COAE: Type. 1, 2& 4-$2.15 far each onc� thousand cubic
fset, ox fxaction therc�of, in such cubical contents. T}•pe 3& 5-$1.85 for
each ane �housand cubi� feet.
:�UUITIONAL INI�ORI�IATION
Fox the purpose of computing L-ees fnr building permits, the cubical contents
of any buildinr; or .-�ddition, is determined by multiplying the ground area
aAY��'ed �7CVm a point six (6) inches below the floux line of the basement
ox Ch� Ce11az� to tl��� average heiKlits ,�f the upper surface or to the average •
li�i��t �f the raof surface of ttie ma,in gable of a pitched roof.
�ox xepair� ox a�Ce7rations to an existing structuze, the fee shal]. be at �he
7rate o� ,5�.00 pex each five hundred dollars ($500.00) ox fraction thereaf in
t1�e Co�� of al.l proposed work.
Ta na case shall the fee charged for any permit as set forth in Section 2 be
1e�s than $S.OQ. '
VERIFICATTON OF FOUNDATION
NqTI:t Pc�xmits far construction will be issued a minimum of 24 hours fr+om th�
�3me o� application, to allow for proper review of the proposed structure and
oi �h� Gox�stxuction site.
A Certified Survey of the lot, showin� the location of the foundation, once it
haa been constxucted, will be required before proceedin� with the framing.
�'liRTIFICATE UF �JC(;UPANCY
Appliaation for a CerCiiicate oi Uccupancy shall be made ten (10) da.ys prior
to the u�se or occupancy of any structure for which a building permit has been
�.aet��sd; �nd s,iid structure shall not be used or occupied until a Certificate
of pcCUp�,ncy has been issued.
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CITY OF FRIDLEY
8431 UNIVERSITY AVENUE N.E., FRIDLEY. MINNESOTA 56432
Mr. Don Lennox
7201 East River Road N.E.
Fridley, NIN 55432
Re: Mobile Home at 7201 East River Rc�ad N.E.
Dear Mr . I�ennox :
TELEPHONE ( 812)571-3450
It was noted on April 27, 1982 that a�bile home (office trailer) was
being moved onto your property at 7201 East River Road N.E. A review
of our files noted that a trailer permit has not been approved by the
City Council to locate this trailer on your property.
We will expect the mobile home to be removed from the property by
May 15, 1982 or obtain permission from the City Council to park this
trailer on your property.
We would appreciate your prompt attention to this matter and if any
questi.ons or problems result fran this letter� please feel free to
contact me at 571-3450.
Sincerely,
��'
DARREL G. CLARK
Chief Building Official
DGC/mh
ENC: Trailer Application
0
SUBJECT
c�ty of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
� • COMMUNITY DEVELOPMENT DIV.
L PROTECTIVE INSPECTION SEC.
� � _��� ,
r , ';
`.--_� ��'•' �.� CITY HALL FRIDLEV 85432 NUMBER
i 612-571-3450 910-F15
J08 ADDRESS 7201 East River Rd NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 1Z,13 1 Hillcrest
2 PROPERTY OWNER MAIL ADORESS
Phyllis Lennox 7201 East River R
3 CONTRACTOR MAILADORESS
Same
4 ARCHITECT Op DESIGNER MAIL ADDRESS
5 ENGINEER MAII ADDRESS
6 USE OF BUILDING
Residential
REV
7 CLASS OF WORK
❑ NEW � ADDITION O ALTERATION
8 DESCRIBE WORK
Reside Dwellin�
9 CHANGEQFUSEFROM
STIPULATIONS
TO
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATINCi,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTHUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
OATE PAGE OF
6/17/94 � �
22617
-E€?PT NO.
�a71
APPROVED BV
SEE ATTACHED
SHEET
� � � -. o�,o _
ZIP PHONE UCENSE NO.
Z�p PHONE LICENSE NO.
ZIP PHONE LICENSE NO
REPAIR ❑ MOVE ❑ REMOVE
SQ
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PHOVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF 1NORK WILL BE COMPLIED @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT W2fOOO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PEHFORMANCE OF CONSTRUCTION. ��FS.00
OF CON i RACTOR OR AUTM H12E0 AGENT IDATEI
. . .�
ic nwu[a � nwNE Bu1LDERi IDATEI
,
GROUP IOCCUPANCYLOAD
CU. FT.
OFFSTREET PARKING
IGAHAGES
SURTAX
�1.0�
SAC CHARGE
Fire SC $2.00
TOTAIFEE
$48.00
:D THIS IS YOUR PERMIT
�1
e1v��i�t�i
�
IvEW
ADDN
ALTER
li
(I
r�
Construction Address:
Legal Description:
CITY OF FRIDLEY
SIIYGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
�
Effective 1 / il94
��a�/
Owner Name & Address: J% �;��a ,o ..� �� --t�' Tel. # .� 7/ %64 �
Contractor: �'l��„`, MN LICENSE #
�
Address: ��� v � ��.�--� � r;�-e�. �� Tel. #
Attach to this applirdtion, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
�
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length . Width Hgt/Ground Sq. Rt.
OTHER: �:r7...P .���2 � �—�
Coraer Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks
Type of Coastruction: ��„� Estimated Cost: $ �,�--�� U-�
T
Approx. Compledon Date:
(Cost on Ba.ck)
Driveway C�rb Cut Width Needed: Ft. ± 6 Ft = Ft x$ _�
DATE: ' cJ APPLICANT: �; - �c:> � . - -� � L- � Tel. # S �/ 7 � O �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$
$
$
$
$
$
$
$
$
� ��� ���A
�• C`° ��
/�. C� (`�
� �
$ � �' � �
('ITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$800 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt "A° or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engin�ring
Agreeme.nt Necessary [ l Not Necessary ( 1
STIPULATIONS: -
BUILDING PERMIT FEE SCHEDULE
0
The Chief Building Officia! shall, before issuing permits for the erection of any buitding or structure,
or for any addition to any existing building or sbructure, or for any alteration or repair to any existing
building or structure, upon application therefore, require the payment by the applicant for such permit
of fees to the amount herein be(ow set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 � to $S00
$SOl to $2,000
$2,001 to $25,000
$25;001 to $50,000 • .
$50,001 to $100,000
FEES
$15 (Minimum Fee is $15 plus surcharge)
$15 for first $�p plus $2 for each additional $100 or
fraction thereof, to and including $2,000
$45 for first $2,ppp plus $g for each additional $1;000
or fraction thereof, to and including $25,000
$252 �for first� $25,ppp pl�s $(.SO for each additional $1;000
or fraction thereof, �o. and including $50,000 -.
$414.50 for first $50,000 plus $4..50 for each additional
$1,000 or fraction thereof, to aad including $100,000
$100,U01 to $500,000 �$639.50 for fir� -$10p,ppp plus $3_SO for each additional�
$1,000 or fraction thereof, to and inciuding -$500,000
$500,001 ta► $1,OQ0,000
$1,00(3,001 and up
$2039.50 for the fust $SOp,ppp plus $3 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$3539.5� for the first $i,ppp,ppp plus $2 for each additional
$1,OU0 or fraction �thereof � -
DRIVEWAY DEPRESSIpN ESCROW
(Concrete Ctirb Streets On1Y)
Alternate "A": Removai and replacement of curb and gutter only - Driveway width plus 6 feet times
$13.50.
Alternate "B": Removal and reptacement of curb and gutter and instau a 3 foot wide.
approach with 6 inch depth - Driveway width plus 6 feet times $15_75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow
for proper review of the proposed stnucture and of the coastruction site.
A Certificate of Sucvey of the lot, showing the iocation of the foundation once it has it has been
constructerl will be required before proceeding with the framing.
-� � _
_
_
CITYOF
FR[DLEY
FRIDLEY MLJNICIPAL CENTER • 6431 LTNIVERSITY AVE. I�1.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
May 6, 2002
Phyllis Lennox
7201 East River Road NE
Fridley MN 55432
Re: Paved Driveways
Dear Ms. Lennox:
In 1997, the City Council adopted an ordinance declaring gravel driveways a public nuisance.
They were declared a public nuisance for a number of reasons, such as: they can cause
erosion, contaminate soil with oil and other vehicles fluids, and deposit soil and gravel in the
City's storm sewers and detention ponds. When gravel driveways were declared a public
nuisance, the City Council gave property owners five years to have their gravel driveways
paved. The five-year deadline is quickly approaching, which means all gravel driveways within
the City of Fridley must be paved with approved concrete or asphalt by December 31, 2002.
If on December 31, 2002, your driveway hasn't been paved a citation will be issued and filed at
the Anoka County Courthouse. A misdemeanor citation is a criminal offense and is punishable
by up to 90 days in jail and/or a$700 fine.
If you've already paved your driveways, Thank you! Please call me at 763-572-3595, so I can
update our files.
For your convenience, a brochure on the City's loan program has been enclosed. You can use
this loan program to acquire financing for your driveway improvement project. Please call Jim
Hesnik at 612-335-2651, if you have any questions regarding this program.
Thank you for your cooperation! As you successfully complete your driveway improvement
project, please call me at 763-572-3595, so I can do an inspection of your property and update
our files. If you have any other questions, please feel free to call me at the above number.
Sincerely,
Stacy Str mberg
Planner
G02-53
_
_
C� 1 I �F
FItIDL�.Y
FRIDLEY MUNICIPAL CENTER • 6431 UIVIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
July 2, 2002
Phyllis Lennox
7201 East River Road NE
Fridley MN 55432
Subject: Paved Driveway Reminder
Dear Ms. Lennox:
This letter is a friendly reminder that all driveways within the City of Fridley need to be paved by
December 31, 2002*.
As you are aware, the City Council adopted an ordinance declaring gravel driveways a public
nuisance. They were declared a public nuisance for a number of reasons, such as: they can
cause erosion, contaminate soil with oil and other vehicles fluids, and deposit soil and gravel in
the City's storm sewe�s and detention ponds. When gravel driveways were declared a public
nuisance, the City Council gave property owners five years to have their gravel driveways
paved. The five-year deadline is quickly approaching, which means all gravel driveways within
the City of Fridley must be paved with approved concrete or asphalt by December 31, 2002*.
If you've already paved your driveways, thank you! Please call me at 763-572-3595, so I can
update our files.
For your convenience, a brochure on the City's loan program has been enclosed. You can use
this loan program to acquire financing for your driveway improvement project. Please call Jim
Hesnik at 612-335-2651, if you have any questions regarding this program.
Thank you for your cooperation! As you successfully complete your driveway improvement
project, please call me at 763-572-3595, so I can do an inspection of your property and update
our files. If you have any other questions, please feel free to call me at the above number.
Sincerely,
Stacy S mberg
Planner
'If on December 31, 2002, your driveway hasn't been paved a citation will be issued and filed at the Anoka County Courthouse. A
misdemeanor citation is a criminal offense and is punishable by up to 90 days in jail and/or a$700 fine.
C-02-83
� F.rom: City oP Fridley To: 7632622826 Page: ?15 Qate: 5/2$lZOQg 4:22:59 PM
�
Building B UILDING Perniit No.: -�� �0 8
Inspections �S���Tl�, AppLICATION Received By:
763-572-3604 �jTy pF FRIDLEY t�ate Rec'd:
763-soa-4�7� F�
�r�tcr�v� �-i-o9
r .� ..., _ �
DAT���.1��_
SLTE AUU�t6sS �
7H1S APPLICANT IS:
PROPERTY OWNEB/
TElYA11iT
SJBMIT A COPY �F
YOUIt STATE L1C£NSE
AiVD CERTtFICA7'E OF
iNSURANCE
PRQPER.TY TYFE
YAUR �-MA[L
� �
o�wn��
�AM�: r-� r, - er, n
�vv►��SS: °7 a t Eus
PHOTNE:
AIAME:_ " I !J%7G-%'e. �
sTar� Lic�rosE �
avnx�ss� ,�Sc'�t�, 1 !_ � cr n
rnurvt E C7 � —
❑ StNCLE NAMlLY/NE�S' CONSTRUCTIQN
OTVVO NAMILY/NEW (:ONST1ttJCT1pN
❑ SRS�M�NT k�1NISH ❑ Knpr^--�-.��
O DBCK O S iU? NG
�SWIMMING PC�L
7'YPE OF WORK2 � NEW HOMt C`OMSTRULTION O ADll1TIl�N
MAINT�NANCF1'1ZtPAIR O It�MODtLINC
ll�SCltlt�� WORK StING vONE: �
Sl'L� OF 1MPRUVkMkNT L�NGTH y�r�yT}�
ItOOF7VG D :]OUS� ANLY
NUMSk:R AK SQllAR�S 0 FiOUSt & CA1L4G�
GAl2ACES � ATTAGHcU t1AliAQt
P120f�ASEU S1L�: � D�7ACH�U CA ItAGE
PRCIPOStU H�IGtIT:
c
.= txp uar�
GTY� � y�1S7AT��LIP,
c '7�o�b � �^ �_
lES
❑ �'IIdDOWS
CI D1tA[N T1L�
O OTHF:A
V c.� ;rt
H�IC HT $ �r{
k3AS tM�NT 1�'MOL1tiLING Sl; 8MI7:
1. ��tstiog}rioorP�an
2. Propcsad Anor plan
3- Lisl ofsnnclural member� to be used
SIULVG l+OR NEW CONSTIZL�TION thICLUDINC U�CZCS,
� Yinyt QSoffi1 8.t)�ITIQN�i & pnRCHtS SUHMIT•
❑ Ah�minwn p TriR: 1. Site Plan/Surveyshow�ng the exntirig �Inichrre,c
� n�� O l�a,ac.a and ptopoced project.
WI VDUWS 2. Twa r.afs ofconstrncHon plat4c
:NEXIST[NGOP�NINCiS ❑Ye� ❑Nu L(7CATIONOhW1NU0WS 3. t�eBY��IculalionR
Olt N(7R IVEW QPkN!►NGS-DtSClt18� Sl'LE n!+
OPENING CHANfitS &
TY PE OK WlN1J0 W TO B� iTJSTALLtU NUh1H�R nk+ WINllOWS
ALL FE�S AR� BASED OlY VALUATIOi�, INCLUDING THE COST OF LABpR AIYD MATERIALS;
{US[NG THE 1997 U.B.0 EEE SCHEDUL�)
'OT4LJOB YAI,UATION $ � � OCCUpAIYCY �rva�
Plan Rcvicw
F'vc Surohargc
Surchargc
LiccnRC Surctr�rgc
SAC Chargc
Curb Cut E,ccrov►
Erasion Control
Park Foc
Scwcr Main Chargc
� `,d �as �3ack Pagc for Fcc Schcdulc
S -� - v 65'% of Build'tng Pqmit Fcc
� _ i-�,C�' .001 tienc;,5 thc total job vaivation
� .OU05 x Pw�rnit Vaivation Minimum $.SO
$ $5.0t? (Statc Giccnscd Rosidcntial Contractors)
� $2000 per SAC Unit (Plan�; to MWCC for dctcrmination?
� ft+6ft= ftx$21 =$
$ $4S0 Conscrvation Plan �evicw
$ Fcc Dctcrcniacd by E�nginccru�g
$ Agresc�nont nccc:ssary ( ) Non Ncccssary { }
e t,..�, --• - -
TF21S 1S AN APPLIGATIpN l�li A PEILMIT-NAT VALIll UNTIL PR()Ck:SStll
l hcrcby an�ly for a build'_n� permit and i acknowlcdgc that thc infotmation abovc; is corr,plcic arid accuratc; that thc work will bc in
coafonnancc with shc ordinanc� and codas of thc City of Fridlcy and w:th thc M innc,offi Conxtruction Codcs; tFat 1 undc�tand thi� ic not a
permit but only an application for a permit and work i� not to start withour a perrait on aitc; ti�at thc work will bc in accordancc with thc
approvcxl plan ia thc casc of .vor whi rcq� ic:w� and approval of �la s.
SICrNATUR� O!� APPLICANT PRI,�IT IVAMt .6t DAT� ��•� s
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Buildix�g BUILDING Permit No.: " �►I I
Inspections RESIDENTIAL APPLICATION Receiv� By: " "
763-s�2-36Q4 CITY OF FRIDLEY n��
763-502-497? FAX gppE�l'[V6 I-1-o� 'l � �
DATE II 3^ ��I YOUIt E-MAIL AQDRESS
5,��,���� 7ao� c. R���.d ��d �N. �sy3z
THES APPUCAAI'I' [S: , �4 OWIYER OCOIVTRACTOR
rROr�TY owrr��v N,►�aE: —� I l�. ! o r
TENANT "'
ApDRE5S: i%�(�) _� '�: t JC�' �� CITY �r, STA7'E�,ZIP 55�13Z
PHONE: �TS�-�Z�IO' 3Le%%
CONTRAGTOR NAME:
SUBMIT A COPY OF g�ATE 410ENSE � IXI' DA7'L�
YOUR STATE LICENSE
AND CERTIFICATE OF AbDRESS: CiTY STA'iE ZIP
1NSURANCE PHONE FAX
PROPERTY TYPE al SINGL6 FAMILYIN6W CONSTRUC'ROTf SIZL �-,S� s�, �L •
O TWO FAMILYMEW CQN379tUCTlON STOWESJ_
PERMIT TYPE ��DITION 0 GARAGEtSHBD D WlNDOWS
O BASEMENT FINISW � ROOF O DIWN T[LE
o uECK a sia�va o o�
o swnwMrNO noot�
TYPE OF WORK: O NEW HOME CONSTRUC['IOTV O ADD1170N
■I MAIN'I'ENANC�/R�PA1R � RBMODE4ING
�esc�ee wa�uc �Fawa nor�: � , . ( �� � las
SIZEOFIMPROVFMENT �NG'I' WIDTH HEIGHT s F1'
ROORlIVG �;I HOUSE ONLY }�p�,�yj_ a�' R�y�ODfil,iTl(i SIl3l4L�7':
NUMBE1t OF SQUARES Zd O HOUSB & OARAGE � �� �� p�
GA�GES ❑ ATTACHED GARAGE 2. Proposed Haarptea
PROP05I;D 51'L�: O DE7ACHED GARAGE 3. L.tst aC�u�turol members m bo us�
PRQP05ED HE[GHT:
�p� FORNEW CONS'IRUC'!'lON INCLUDIN(i DECKS,
Annl'i'fON3_BePORC - 1B�_
O Vinyl OSoAit i. Si�e PiardSutvey showing the existing sU�tuces
O Aluminum O Trim �� P�Q�
O Otl�r � rascia 2. Two � of construction ptans
WtNbOW3 3. &rergy CalculaGona
tN HXI3TIN(i OPEAIMGS CIYes ONo LOCAT[ON OF WINDOWS
OR FOR NEW QP�IIAIG3-DFSCRIHB S1ZE OF
OPCNING CHANGFS &
TYPE OF WINIJLIW TO 8E INSTALLED NUMBER OF W[NDO�IiS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERiALS:
V,
Plan Review
Fire S�charge
Surcharge
License Surcharge
SAC Char�e
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
��
(USIlVG TNE 1997 U.B.0 FEE SCHEDULE)
$ �' 3=� �" See Back Page far Fe,e Sche�ule
$ 65% of Building Aermit Fee
$ ''� .001 dmes the bo4a1 job vatustion
$ � �� .00OS x Permit Valuation Minimum $.SO
$ $5.00 (State Licensed Residea�Nal Contractors)
$ $2000 per SAC Unit {Plans to MWCC for detenniaedion)
$ ti+6ft= ftx$21=$
$ $450 Conservation Ptan Review
$ Fee Determined by Engineerin�
$ Agreement necesgary ( ) Non Necessa�y ( )
$ �, e� Make checcks psy�ble to: Citr of Frldlev Att�c
THIS [S AN APPLICATION FOR A PBRMTE'-NOT VAI,1D UNTIL PROCES3SD
1 hareby appty for a building permit and 1 acknowledge that rhe infa�nation above is complete and accurat� that the wark will ba in
conformance with the ordinencas and cotl�a of the Crty of Fridtey and with the Minnesota Consbvcdoa Cod�; that I under�and this is not a
permit but only an applit�tion Por a permit and work is not to stert without a permit on sits; that the work will be in accardanc� with the
approved plan in the cese oFall work w ich requiras review aod approval of plana.
S1C3NANREOFAPPLLCANT y L-- /�Ul�' PRINTAfAME�r��_L ,_FNc�(� v� DATE _ I�-03—(aQ
NOTE:
ARE
, _ . . . . ". _" Wb� 9 4 �8£ �0 L 600Z/E/6 4 :a3ea ��_ Z/ L :a5ed � L L9S 6LS£9L :uao��. , .. ..,. . , . .".. . _ _ �.,..,, .. .... .