AF - 42061!
City of Friclley, Minn.
�
BUILI�ING PERMIT N� 6 7 4 3
• � ���� �
nat�: _.._..� w--...�. � _�.- � .� _... ...____.__..._....
Owner: . .__ .___.:.�~��.._.._.. � .. . _._.._.r_ � rBuilder _. ..._. _. . ... �....._.._.._....._ ............._.
Address
CJ
Address
/ �
LO TI P BUILDING
No. .�..l�'..�.�........ Street ... ...._. ...r..: . . _...�...... ._ __.!'..__ ............................ Part o t ....._..
.. . ..._... . _ . ... .
Lot _...C_ �.._�'.�.__ Block ._.._..-----• •-- . ............. Addition or Sub-Division . ��. _e:_._._ • �
! ��._. _. .._. ! t...�.�1��" `,. � �. - _ _.. _.___..,.._
Corner Lot ...__...------.._..._.. Inside Lot •--•--...�.r...--'_.._..._..... Setback ..-.�'-�-•----.....--•--.... ideyard ..._..�_..._.. __.,t ....._...._._..._.__........
Sewer E'Zevatiart _._._...._._._...._._..._...._._..._._----...._._._.--- .............---•-••- Foundation Elevation
� DESCRIPTION O� BUILDING
. 1 �'
T U.�•....... Front �� De ih •:r..�.1�� ' g �._.. Sq. F� ��a;:L""''i,.'u. FL �����T.l.`°
. _ _.__.._. ._. p ... . Hei ht .. ..:
..__
- ....... _ .G ..1��.__._.. Depth ..�._�.1..� � ht ....,1.�� Sq. Ft. _...F- ��. F� _.�L.2�
Type of nstruction :��:�� ...._.. Est. Cos17_.,1.._.�.-�;�.--� To be Completed _..._..__.__...:._.__..__._.....
In consideration of the issuance to me of a permit to constzvct the building described above, T agree to do
th� proposed work in accordance with the description above aet d in compliance with ovisions of
ordinances of the city of Fridley. �
y� � % �
�L..._.SL. .�
In ca�isideration of the payment of a fee of �. ''_y
....----•...._._, pexmit is hereby granted to_._....—� .—
._..�_,........_.._..._......_..._.:._____....___ to construct the building or addition as described above. This pernut is granted upon
the exAress condition that the person to whom it is granted and his agents, ernployees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respecta to the ordinances o�
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and movinS of buildings
within the city limits and this permit may be revoked a t a�yta�y� upon viqlatio�,e��ny of the p='ovisions of said
ordinances. / \ _� /1 / 1
��
� NOTICE:
ihis p�rmit dws not eover ths eonslrueHoe, inshi�atlon for wieiny. Phimbin9. oa h�Nin�, »wK or waNr. 8� wn to sN
fla evildteg Insp�eror for separat� p�rmifs {x fhes� i�ns.
City of Fridley
Application for P`lambing and Gas Fitfing Pern�it
Dept. of Bldgs. Phoae SU 4-7470
DESCRIPTION OF WORK L�8�n f� �r „� - �� 1 C
Number, Kind and Location of Fixlures !
; U� � I�6 � I � f? 13 � IO � 1 ; ILL O IU � I< i IU' � IU' � I�U' O 1 F I N I G STER ELEC.
Base '
lst / %
2nd
3rd
4th _ _
• Future Connectfon OPenings
* New Fixture, Old Opeaings
PARTIAL RATE SCHEDULE
3ewer
Cesspool
PLIIMBING FIXTURE RATES: �O. RATE TOTAL
Number F`ixtures . . .. . . . ... . . . . . . .. .. . . � x $1.50 $ %� U U
Future Fixture Opening . . . . . . . . . . . . . . . . __� x 1.20 $�1 ��—�
New Fixture Old Opening . . . . . . . . . . . . . x 1.0� $
I
ICatch Basin .... x 3.25 $
Water Heater (Up to 200,000 BTLn . . . . . .—� x 2.00 $� �)
i New Ground Run Old Bldg . . . . . . . . . . . . . x 3.25 $
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the facl
and representations stated in this application are true and correct.
Fridley, Minn_ �:� � � , 19� �
Owner �/ C. K�n` �� I �' ��
�
Kind of Building f % a'YY1 t�.
, �i
Used as _� t 1 ��! + `� �s �
�
To be completed about LLL� -C�� —
�" ,' ,j �_
Estimated Cost, $
Old—New. Building Permit No. �'� Permit No. �� _._
�' ,-•''�
.._ � _ . �, _ , .� ,� 6 , � s'-''/ ,� � rl
ROUGH
� FINAL
GAS FITTING FEES: NO. RATE TOTAL
lst 3 Fixtures . . . . . . . . . . . . . . . . . . . . . . . . . . �� x $1.50 $ � --`� �
Additional Fixtures . . . .. ............. .. x .50 $
Gas Range to 200,000 BTiJ ............ .. x 2.00 �
I REPAIRS & ALTERATIONS—Refes to Code
Description ................................................$—
TOTAL F'E� --
�.� - %°
d2
f
Business Phone
��
�' .
v _ '`"
Application �or Power Plants and Heating. Cooling, Ventilation. Refrigerertion and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
Furnace Shell & Duct Work . . . . . . . . . . . . . . ... . . . . . . . . . .
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 . . . . . . . . . . . . . . . . . .
Repairs & Alterations each add. �500.00 . . . . . . . . . . . . . . .
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU . . . . . . . . . . . .
each add. 60,000 BTCT . . .. ...... ... ... .. . . .. .
Replacement of Furnace .............................
Repairs & Alterations--up to $500.00 . . . . . . . . . . . . . . . . .
� Repairs & Alterations each add. $500.00 . . ... . . . . . .. . .
3�'EAM or HOT WATER SYSTEM
� Furnace Shell & Lines—ta 400 sq. ft. EDA Steam ....
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ..
Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . .
Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . .
RATE TOTAL
8.00 $
5.00 �
5.00 $
2.50 $
8.00 $ 8 . 00
2.00 �
5.00 $
5.00 $
2.50 $
8.00 $
8.00 $
2.50 $
2.50 $
OIL BURIVER—to 3 gal. per hour . . . . . . . . . . . . . . . . . . . . 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU> . . . . . . . . . . . . . . . . . . . . . . . 5.00 $ 5.00
GAS FITTING FEE5: NO RATE TOTAL
lst 3 Fixtures .. ...... ... .......... x $1.50 $ 1.50 _
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU . . . . . . . , . . . x 2.00 $
AIR CONDITIONING �
FAN HEATING SYSTEM See Fee Schedule
VENTILATING BYSTEM $
�ALTERATIONS & REPAIRS TOTAL FEE $
ROUGH
FINAL
Dept. of Bldgs. Phoae 3U 4-7470
Location 26 5 E 1 tL
City of Fridley:
The undersigned hereby inakes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
�idley, T2inn. 10-2 � lg 63
Owner Remco Construction fb
Kind of Building Fr.
Used as R@S. _
To be completed about i1-2-63
Estimated Cost, $ 4�0.00
c
Old—New. Building Permit No. � Permit No. ���
DE$CRIPTION OF WORR
HEATING or POWER PI,ANZS-�5team, Hot Water, VPazm Air—No. '
Trade Ivame ���xinghouse Size No. ��A-lAA
Capacity Sq. Ft. E.D.R. BTLJ lOnM g,p,
Total Connected Load-1�0� 71l► Kind of Fuel Gas
BURNER — Trade Name Size No.
Capacity Sq. Ft. E.D.R. BTLJ H.p,
(REMARKS-OVER)
.,��<z 2M
FRED VOGT & C0.
Signe
By _ 3260 Gorham Ave. • WE. 9-6767
St Louis Pork 26, Minnesoto
Business Phone No.
_ �.•9..� .�.:;��., �� .�� � �3
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�EAT l,QSS CA1.CU4.ATIQNS UEPA,�tTME'.NT UF' BUILDII�C,� l�,�lINNE.APOUS, MI�ti'.
Weakher�r�ps �. G� T Conitruction No,^-v �� �I`� In�ulstion ���� p
VV�sadoa� i �cw • — I--
r Rcference � Out. aall Int. Wi1l Ceams Root Floar Kmd How Applied
4'�r� —� � �e�o i9— � __.� __ -- — — -------
_—Fi � � Ro�m Length Width 1Height �I Fl. Room LengRh �,, Widt4�
�__��__ _ _�� _ �_ , � � ►
� e 1�%indows anc� L�oors---Cracksge and Arca �� �� I Windo�vs and Doors---CrackaQe and Area
tY;�th f3sf�t�i. No. o( Lln�a! tt. Area � � � WIdtA Hei`h4 No. o[ Lln�al ft. Ar��
_;T%q. of p►ne dt pano flshte nf �cY �q. fi. w 1 � No. of Dwo� of Dane ll�ht• ot crack q. tt.
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a grr�ittr:c�oa � Q � � - � — — -- _ � r
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t�iet e�, wa(!
.- ��t. �vall - - -
����iiing "�` 2
#�� dnor
Y�?'zat�,! &u.
F�exquired sq. fi. E.D.�t. or p. ini. W.A. l.esder area
� �.( � �y ^ Raam � L.ength�� Width
Window� atxl �oan--Ctacka�e aad Area
WIdYh � Helsht No. o[ Llo�al [t. Ar�a
_ Na. ot N�e �; D�M 11��ls ot cnek p. tt.
� �r.� d S / S/ , �7
_ �nfilfration -
n.���
�`.�tp. wal� �
{: �t� t2�. WI:ll
�nl, wall ^
t:aiing f'1
k �nc�. ..
w
� • ( � c�.., ---- _.
—. lE�p. wa�t .��`_
�' Net e:p. wall
_., _ Int. wall
I •
Hesght
Coef. &u
.26lav�,
7 �S'S��
f_�—� I
S P /� d-o . !
�equired �q. ft. it.O.R. or sq. ini. W.A. I.eader area
�� F:. Room t L,cn�th Width
Windo+rs and Lloors--�Crackage and Area
00
_..N � o/ SA .�t � �sAt• o�e� k �r�.
_.��
� 1a61trat`on
�OC
-Gtaa ---_ _ - ------ ,..! U �
��'sp. wall �' _. � �.;,
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;Vet es�+. K+a13 _..r_ _.. _.. _ � �±.
�nt. wali r
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—_ _.___ .. ___ _._.._�
�4r4v�rr_� 3� � ,;.3'} x� ar �� �:as � r"� �.�etcser ar,•s
Heig4ee
Ceiling�
Floor
Total Btu.
%
/l
Heia�}a� � '
Cocf. �1Qaa �
� ��w+
s i��,.� .
Rcquircd �q. ft. E.D.R. or sq. in:. W.A. Leader area
/ Fi.l �.y� Room I Length/ j,. Width
�Windows and Doort--Crackage and Area
No. ot'Da a�o[eDano IIiAb Iot cr�ck pr tt.
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Hei�ht Q �
Inbitration __ _ _��� �' �
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F.zp. wall ,��. _�_
Net exp. wall _ `��'
Int. wall .�
--Ceiling ���. ---- �i Y
� J._�.s
Floor / �
�
Total Btu. ��'.,
�Required sq. ft. E.D.R. or bq. ini. W.A. Leader area /
�1. Room I L.ength Width • F3ei�ht�+�m
Windowa and Doon---Cracka�e and Aree �
IdtR H�l�ht No. o( Ltn�al tt. Ar��
No. of pan• o[ pan• Ilsht• ef cr►ck �Q. tt.
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r.�. �
sue�ecT PERMIT NO.Y
City of Fridley .�- °I � ” �`
ATTHETOPOFTHETWINS gUILDING PERMIT ��""�� '+�
� � RECEIPT NO.
� �
• COMMUNITY DEVELOPMENT DIV. / � �
' j L ��-�' ,
r � � PROTECTIVE INSPECTION SEC. ��
, ' /"'1 � CITY HALL FRIDLEv 55432 NUMBER REV. DATE �AGE OF APPROVEO BV
�""""'�� ,�� 612-571-3450 910-F15 5/3/94 � �
JOB ADDRESS
265 E1 Street NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oescR. g,10 14 S rin Brook Park SHEET
2 PROPERTY OWNER MAII ADORESS 21P PHONE
Curtis Walber 265 E1 Street NE 786—G659
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUIIDING
Residential �
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION C1 REPAIR ❑ MOVE O REMOVE
1L
8 DESCRIBE WOFK
Reside House
9 CHANGEOFUSEFROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTHICAL, PLUMBING, HEATING,
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 OF ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTFEET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF IAWS VA�UATION SUFiTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOfiK WILL BE COMPLIED �S � OOO �2. 5O
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- @72 � oo Fire SC �.r3. OO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ��
PLAN CHECK FEE TOTAL FEE
$79.50
SIGNATUFlE OF CON'RACTOR OR AUTHOAIZED AGENi IDATEI WHE LY V IDATED THIS IS YOUR PEFMIT
��-�-: C� ��,G�-.--s �% �y_ - � °��
SiGNATUAEOFOWNERUFOWNERBUILDEAi iDATE� BLDG �NSP �itiTE
NEW
ADDN
ALTER
fl
(1
(1
CiTY OF FRiDLEY
S[NGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: -- �-(��—� �=�--�r/�C� L— . __�/� /"O � L=�'--�- /�11_1�
Legal Description:
Owner I�fame & Address: (°J��i � t ,� R,��'� Tet. #?
Contractor. ,S � �, /' _ MIV L[CENSE #
Adciress:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width
Width
Width
Tel. #
Height Sq. Ft.
Height Sq. Ft.
HgtlGround Sq. Ft.
Comer Lot [] Inside Lot j] Ft . Yd Setback Side Yard Setbacks
Type of Construction: �/' /�/ � L Estimated Cost: $�
Approx. Completion Date:
v e�
(Cost on Back}
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � � APPLICANT: C�� � �a,��-� Tel. #
Permit Fee
Fire Surcharge
State Surchacge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ ,��� � Fee Schedule on Reverse Side
$ .� : �) L> .001 of Permit Valuation (1 / l Oth %)
$ � .S� $.50!$1,000 Valuation
$ $800 per SA� Unit
$ $5.00 (State Licensed Residendal Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary ( ] Not Necessary [ ]
,;
;3
� � S�
1/1/94
C�
�
SUBJECT N . �
City of Fridley 2 6 8 6 9
AT THE TOP OF TNE TWINS g � I L D I N G P E R M I T
� � RECEIPT NO.
� • COMMUNITV DEVELOPMENT DIV.
r � � � PROTECTIVE INSPECTION SEC. �� 7�
� �
t � �
L.-_=�A ,��"';.� CITY HALL fRIDIEr 55132 NUMBER AEV . OATE PAGE OF ApPpOVEO BV
L J� 612-571-3450 9�0-F�5 7/29/98 � �
JOB ADDRESS
2b5 E1 St NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
�esca. g and 10 14 S rin Brook Park SHEET
2 PROPER7Y OWNER MAIL ADORESS 21P PHONE
Brad Ledermann 572-9033
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO.
Franzen Const Co 4250 5th St NE Col. Hei hts 55421 788-4071 2744
< ARCHITECT OR DESIGNER MAII AODRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAtI AOQRESS ZIP PHONE IICENSE NO.
6 USE Of BUILDING
Residential
7 CLASSOF WORK � NEW C� ADDITION L� ALTERATION ❑ REPAIR p MOVE O REMOVE
8 DESCRIBE WORK
Add deck area 14'��14' • chan e window to atio door
9 CHANGE OF USE FFOM TO
STIPULATIONS
See notations on plan.
,.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE FEOU�REO FOR ELECTRICAL, PLUMBING, HEATING.
VENTI�ATING OR Alii CONDITIONING.
THIS PERMIT BECOMES NULI AN� VOIO IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCEO WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONED FOIi A PERI00 OF 120 DAYS AT
ANY TIME AFTER WOHK IS COMMENCEO. NO. DWLG. UNI7S OFFSTREET PARKING
I HEfiEBY CERTIFV TMAT I HAVE REAO AND EXAMINED THIS APPLICATION STALLS GAHAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVEfiNING THIS TYPE OF WOFK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT 1.(�
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS Of ANY OTHER STATE OR LOCAL LAW REGULATING CON- �
STRUC OR TH� PERFORMANCE OF CONSTRUCTION � Y' SC . Z6
PIAN CHECK FEE TA� FEE
� � Licen S 5 97.14
�GNATU�7E OF CON7RACTOA OF AUTM 2E AGENT IDATEI N OP VA TED THIS IS OU�M��
�
S�GNATUREOFOWNEA��FOWNEABUILDERI �DA i' � � BLD iNSP r�pTE
NEW
ADDN
ALTER
[l
[]
[]
ConstructionAddress:
Legal Description:
Owner Name & Address:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
� �� G�'��, � f �..-�
Effective 1 / 1 /98
b� �
�� ���
0'
���. e�f'e v� v� Tel. # . `��� �3
Contractor: �Y a H� e U- -g�,r � p'� � MN LICENSE # �� y� _
Address:
�� �
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
�� Sl� �` c`' —E�,�� OY (,S \ Tel.# ��''�—��?�
Attach to this application, a Certificate of Survey of the ���°2�
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
/ ��� A`L,2
Length Width Height 5q. Ft. /�
Length Width Height Sq. Ft. ,��� �
,,
Length % Width /� Hgt/Ground � Sq. Ft. /��
1�� 1 A�,c� r�A>?�� °- ��1 a� ����, �1DDc�e� i7�
�� � - �DL) �� � .-�
Construction Type: % Estimated Cost: $ �`�� �
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: — � � `��APPLICANT: .� Tel. # %��` 7� 7�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
. STIPULATIONS:
CITY USE ONLY
$ , 2� Fee Schedule on Reverse Side
$ � .001 of Permit Valuation (1 / l Oth %)
$ $.50/$1,000 Valuation
$ $1000 per SAC Unit
$ rj `L� $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 [ ]
$ y� ��
f�I.QC K l4 � . �.i'421�.,1 � . F3k'C)Ol�. .PARK
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� '�''�)NU*� ',�+, ` ' " LAND SURVEYOR
� � ,e�y'�*�'�� 1} �y+ti �.k�1 ' . , , . '
u� ���` �� REGIST[REO UNOEN lAWS OF STATE OF MINNESOTA
�MA�M �l6�„�;� x �
' k-� ;y�� .�. u 4 ���.�� „ LICLNf[D �Y O�DINANCLb OF CiTY pi M1NN[APQIIb
'"`"'� ;' 3300 LYNOALE AVE SO. MINNEAPOLIS 9. MINN.
�� ��v:,'',� TAYLOR 4•0370
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'��' � l I hereby cer�tify tha1; the annsxed ia a true
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�°-' and oarre ct plat of a survey of :
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"��� `` Lots 9 and 10, Slock 14, Spring Brook Fark�
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�` ' � Anoka County, I•u.nna s�ta.
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�`�� <�,r�� "�-��/ � Cy' 1�s aurve,yed by me this 9'�h day of Soptembor
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F3ui.�ding --
Znspections
'163-572-3604
pA'£E1 X�/�
SI7'E ADD1iESS o�
THIS aPPLICANT I5:
Q�����
SUBMIT A COPY OF
YOUTt STATE �..�C�'NSE
�JITH APPLiCATTQN
��tOP�YtTY '�X�k:
CITY OF FRIDLEY
ST.�II.DING
�.ESYDENTYAL A�PY.YCA�TItJN�
CI'�'X O�' FR�D��"Y
�ermit No..
Rec;eived By:
Dai:e kec°d:
YOUR E-MAA,FL A UDRESS __ _ _
O 4WNER �C(?NX'RAC'i'OR
,ADDRFSS: GiTY _ _STA7'6 ZIP
PHONE: �_7f,� � 7�— %J`��_
�77a-
S7ATE LICENSE #����i� �, �XP DATE �. �_DiO
ADDR£SS:J'�%YL�'IL�/u�/�IE�� �/OCC�� J�� __ __CTTY LL�fi��ST,a.T,�IP�o�
Q MI�
PEYtMTT '�'XpE D �w�xnox _ a G.a�ac
❑ $ASEMETR FxNISH � RpOF
O DEGK � SID1Nf3
- II SWIlV11v7
r�rE o� wo�:
�rscxis� wozuc BErnr�
SIZE OF
Kvur �rv�
I�UN�E3t OF SQi1�S .�
�Y2aGES � �l
PitOPaSfiD 8I?.E:
PROPQSED E�iGi�TT:
�G
O Vinyl
❑ A}uminutn
❑ Ocher
wmrnows
IN fi7QS�3Cr OPENINGS �Yes dNo
OR FOR NEW OPfiNxNOS-DESGRi�� STZE QF
pPENING C�.61�ICrE.S &
TYFE p� WINDOW TO F1E DdSTALi.ED
ALL �'EES A1ZE Ba,S�D pN r
�.
Plaz► Revicw
a.
Surcharge
Fzre Surchazge
License Su�charge
SAG Charge
Curb Cut Escrow
Erosio� Gontrol
Park �ee
Sewer Maan Gharge
n
a r�ma�ows
Q DRAIId TtLE
❑ OTFiEi�
LENGTH . __ _ WLD`�_
❑ HOUSE Bc GAR4G�
❑ A7T�ACfiEA GARAGE
O Db7ACl-lED GARAGE
C7soffrt
D Trim
❑ Fascia
LOCATId210F wINDOWS
�c.
�SASEMENf RENLGj�rJ,�j�+1G SUSMTT:
l. 5xistutg F7var Plaa
2. Praposed Hoor ptan
3. LisE o�ssrucri,ral members to bc t�sed
FOR NEW CONS�,UCT'iON AICLUDIIJG DECKS,
�z�mor�s. � �oxc�s sv$Mrr:
I. Sitc PiardSurvey showiug the exisdnp shvcLUres
and propased prqjcd.
2. T�vo scts �'opnsbuction plans
3_ F„eagyC�iavlations
ALU�#,TION, YNC�.UD�NG THE COS'� OF LABO�t AND NIATE:RIAT.S:
USIN�X947 U.B.0 FEE SC�iEDiJLE)
� Q � ���1 q � ne�r�rrperrt�v TYPE
$
$ /, �
$ —o�� 15��' -
$—�)
$
$
$
� —
8�e Back Page �or �'ee Schedule
65% of Buiiding Pemnit �'ee
(.0005) tivaes the total job valuation — Mizai�um $.50
.001 x Pe�rmit Val�ation (1/10%)
$SAO (State Licensed Residential Gom�a.ctors)
$1450 per SAG Unit (Plans to M'�VCC for detenmination)
l�+6$= f�x,$20=$
$450 Goz�servation Pla�a Review
�'ee bete�rrnined by Et�gineering
Ageement necessary ( ) �TOn Necessary ( )
Make checks payabie to: City of ��idiey Atta<
Tti15 TS AN APPLICATIO'k�i FpR A YERMif NOT VALID UI�TIL FROCE555D
Z hereby appiy �or a buildizig permit and � acknowledge that the information above zs cvmplete and acc«rate; tifaL the work w411 be in
conforma�ce with tiie ordiwar�c.es and codes of the Gity of Fridley and with the Minu�esota Constxuction Codes; that I understand this is not a
pencnit but only azi application fox a permit and worlk is not to start without a peimit; that ttae work wiil be u� accordance with the �praved
pian in t,�,e case of all worEc w ch requ�res review an,d approvai of pa$ns-
SIGNATURE OF APPLICANT __� _,,,,r�PRINT NAME �tn � �% pf�TE O�-� y-o 6