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vill$ge Of Frlal�y, Minn.
�ITH�ING PEgi.MI�
N° 15'7
o��� o� �v���c�oR o� ��n.�nvGs
Owner �'.�..�..�,�"'�,�� � �-�,�
Architect Frid':ey, Minn.. �'"4i�'��^��� ! � , 19��
Builder� � �
�,,,�,�,�,, .�,� � � �"� �
� �, ' � `�� . � �� � `` `�
' .:,�,��`��3�`..r�'�*� �`-�. �, 1 x,+� � �' � ,�'r,� ,��.���-,�`�'
� LOCAidON OF BUII.DING
�
No. ,'� Street �'�`�� ,��. . t`� �� Part of Lot
-� ,� �
Lot .. ,�� �'`x Block � � "� = . � .;. . .
" Addition or Sub-Division ._�;��".��""=,„+� � � �"
J�;�CRI�'�T�I� OF BUI��I1�G
r� � " � � �
k?ront_ �' `"" Depth ��-- �� �Yeight Stories Manner of Construction �f ��" t �": r"�� '4 ' '
t e � ¢ , .. ,.. �` `,�_�
To F�e used as t �, = � ��F `�r ._ _ � ^ Ta he conipleted � ��� r� � �� �` � 'r Estimaied �ost * ; ,�-
zne puucung �����»-a •^w�-�.ti^ � aescribed in the above statement. This permit is granted
upon the express condition that the person to whom it is granted, and his agents, employees and workm.en, in all
the work done in, axound and upon said building, or any part thereoP, sha.11 conform in all respects to the ordi-
nances of Fridley, Minn., regarding the construction, alteration, maintenance, repair and moving of buildings
within the city limits, and this permit may be revoked at any time upon violation of any of the provisions of said
s-,,.
ordinancea. � �
�� �
��' '� ,��������nspector of Buildings.
AGREEMENT AND SWO�t,N STATEI��NT
In consideration of the issue and delivery to me by the Inspector �f Build�n�s of Fridley of
the above permit, I hereby agree to do the proposed work in �,cco�daiiee with the description
above set forth and according to the provisions of the ordinanees nf Friclley, a.nd, bein; firs� duly
sworn, I hereby state and say that the facts stated by me and c�nta,ined in the above permit are
true as therein stated.
� £ �,� � s..��.� �`�•�; �`��``�a" � � -
Subscribed and sworn to before me at Fridley, Minne ota, this "�
ti,
�<
day of �'� .�► ��....,. A .D. 19 � ;� + " �
� . �., .. _ ,.- .. �.
City of Fridley
AT THE TOP OF THE TWINS
r
� �
� ; y ___.._ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
t . ,
i•.-.� �"' �'� CITY HALL FRIDLEV 55432
i 612-571-3450
SUBJECT
BU ILDING PERMIT
NUMBER REV. DATE PAGE OF
910-F15 8�1�88 � �
10B ADDRESS 1538 Gardena Avenue N.E.
1 LEGAL �OT NO. BIOCK TRACT OR ADDITION
DESCR. 3O Aua. sub. #92
2 PROPERTY OWNER
John Tiller
3 CONTRACTOR
Same
4 ARCHITECT OR DESIGNER
5 ENGINEER
MAIL ADORESS
1538 Ga�dena Avenue N. E.
MAIL ADDRESS
ADDRESS
MAIL ADDRESS
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION O ALTERATION
8 DESCRIBE WORK
Garage Repairs
9 CHANGE OF USE FROM
�a'� ���
TO
ZIP
ZIP
C� REPAIR
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y,., 61�1 L- "'
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PERMI .
_ _19618
ECEIPT NO.
�9�/�
APPROVED 8V �
SEE ATTACHED
SHEET
571-8091
PHONE IICENSE NO.
PHONE UCENSE N0.
LICENSE NO.
❑ MOVE ❑ REMOVE
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>�a.��e.,; oi w^ridley, r err�it s�a;� re re����:ed Wt �:s�a;> time t��on. ��7a'af,cn cg ar_,, of p
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t�7nT L l City of Fridley EEfective 5/L88
1�,DD�T [ ) R-1 AND R-2
ALTER [ I Building Permit Application
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•- -
Address:
Attach to this appl ication, a Certif icate o� Slirvey of the
lot, with the prop�soed oonstruction c3ra�+m on it to scale.
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Heic�t
Hgt /Gro�a
St�. Ft.
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_.. Side Yard Setbacks
�].ilt3�d COSt : $ �O � iDCi
Proposed Driveway Width If New Opening Is Desirec3: $,
Wic�th + 6'
Di4TE : ' ` ` �O APPLICANr:
Pe=mit I�ee
State Surchatge
SAC Q�arge
Driveway Fscrow
P�rk Ppe
Sewer Main Q�arge
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(1TY OSE Q�LY
Alt. A Alt. B
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See Back Page
Tel. #
l�ee Schec�le on Reverse Side
5.50/51,000 Valuation
5550 per SAC Unit
Al� '7�" or Alt. 'B" Above
F�ee Determirred by F�gineering
Agreenent Nea�essary [ I Nat Neoessary []
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<
sue�ecr PERMIT NO.
City of Fridley 2 0 6 9 3�
AT THE TOP OP THE TWINS gU I L D I N G P E R M I T
i � RECEIPT NO.
� .
� • COMMUNITY DEVELOPMENT DIV. /7
r � �' � PROTECTIVE INSPECTION SEC. ,3� /D �
� �
� . �
l.--. � ��'�� ,, j CITY HALL FRIDLE� 55432 NUMBER pEV. DATE PAGE OF APPROVED BV
j' �� 612-571-3450 910-F15 12/12/90 � �
J08 ADDRESS 1538 Gardena Avenue N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3O AllC�i. Sl1U. #g2 SHEET
2 PROPERTY OWNER MAII ADORESS ZIP PHONE
Vicki Tiller 1538 Gardena Avenue N.E. 572-9248
3 CONTRACTOR MAIL ADDRESS Z�F PHONE LICENSE NO.
��I� Best Siding Co. Inc. 12612 Central Avenue N.E�, �laine 75401888
d ARCHITECT OR DESIGNER MAIL AODRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION G� FiEPA1R ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Vinyl Siding
9 CHANGEOFUSEFROM TO
STIPULATIONS
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAD
SEPARATE PERMITS ARE FiE�UIREO FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID If WORK OR CONSTRUCTION ZONING S�. FT. CU. FT.
AUTHORIZEO IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OH A$ANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OfFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION �' STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE Of WORK WILL BE COMPLIEO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $'rJ 660 $2• 83
OOES NOT PRESUME TO G�VE AUTHORITY TO V�OLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OF THE PERFORMANCE Of CONSTRUCTION. $$Z.00 Fire SC $5.66
PLAN CHECK fEE TOTA� FEE
$89.49
SIGNATUREOPCONTFACTORORAUTMOR12EDAGENT IDATE� VV EN-P� V Y TED THIS IS YOUR PEfiM^1T
� �J�
SiGNATUREOFOWNEAi�FOWNERBU�LDEi71 iDATEi LOG iN5 pF7E
NEW [ ] Effective 8/16/90
AD�N [ ] R-1 AND I�2
ALTF�t [ ] Builcti.t�g Ppxmit Applicati�
Oonstruction Address: �538 Gardinia Ave. , Frialey, MN
Legal Descriptioaz: r e s i d en t i al
Own�x Name & Address: Vicki Tille�° ( same as above) Zh1. # 572-9248
CorYtractor: Best Sidin� Company Incorporated �el. # 754-1888
Address: 1261 Z Cen�tral Ave. NE, Blaine, �
Attach to thi.s application, a Qertificate of Suxvey of the
lot, with the prc��osed vorLSt�n�ctioci drawn oci it to scale.
���_ «• . .,-
LivII�G AREA: Length width Height Sq. F't.
Qs1tiAGE AREA: Length Width I�eight Sq. Ft.
D�CIC AREA: Length Width Hqt/Gro�u�d Sq. Ft.
O�: VinXi sid?ng,, aluminum soffit C� fascia
Corner Iot [] Inside 7At [] Ft. Yd Setback Side Yard SetbacJcs
�ype of �nstYUCtion: siding, soffitc�fascia ��1 Dost: $5,660.00
Approx. Oompletion Date: 1�,,( 2 4 j 9 v
Praposed Driv�way Width If New Opening Is Desir+ed: Ft. $ $
Width + 6' See Baalc Page
�ATE: 12/6/y0 APPLICANT: Best Siding �ompany .inc. �, #754-�88$
�
Permit Fee $ �� C7�
Fire SuYrllarge $ '�, (�p
state su�chaYge S __ c�.�3
SAC Charge $
Driv�way E��ro�w $
Park Fee $
sewpx Main c��aYge S
�, $ � y �i
CITY USE �Y
Fee Sc�edule an Reverse Sicle
.001 x P�ermit Valuation (1/lOth $)
$.5o/$i,000 va�uation
$600 per SAC Unit
Alt. "A" or Alt. "B" Abave
Fee Determined by Et�gine�rir�g
� ���Y [ ] Not Ne�ssarr L l
�• •. �. • ....-=_=_ �
i► . .
� �- - �
,......��
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-� Uc���
G� '� `�
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.. .-. �,,., . .. . _. . ... . . . , b "�.....i..m�...-. ;
SUBJECT
c�ty of Fridley
AT THE TOP Of THE TWINS g� I L D I N G P E R M I T
r
� �
� • COMMUNITV OEVELOPMENT DIV.
L PFiO7ECTIVE INSPECTION SEC.
� __��
r ; ;
� . ,
� t �"'1 : GITV HALL FRIDIEV 55432 r+UMBER FEV DntE
�""'�"� �'� 612-571-3450 910-Ft5 4/1Q/91
J08 ADDRESS 1538 Gardena Avenue NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 30 Alld, Sub. #�2
2 PROPEHTY OWNER MAIL ADDRESS 21P
Vicki Tiller 1538 Gardena Avenue
3 CONTRACTOR MAIL ADDRESS Z�P
Best Siding Co. Inc. 12612 Central Ave NE., Hlaine, MN
4 AFiCHITECT OR DESIGNER MAIL ADDF;ESS Z�P
5 ENGINEER MAIL AODRESS Z�P
VAGE OF
� �
" 20757
R�EC_EIPT,._ NO�
3 � 7Yl
APPROVED 8�
SEE ATTACHED
SHEET
572-9248
PHONE LICENSE NO.
75�-1888
PHONE LICENSE NO.
PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW �l ADDITION C� ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
New 8� x 19� & 4' x 28t' Deck AdditiQn and l0 Squares of Roof�.ng
9 CHANGEOFUSEFROM TO
STIPULATIONS
See notatiqns on p1an�
TYPE OF CONS�
SEPARATE PERMITS ARE REOUIRED FOF ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
TH�S PERMIT BECOMES NULL AND VOtD IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OH IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOFl A PERIOD OF 120 OAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. U�
I HEHEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1
AND KR9W TNE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND OROINANCES GOVERNING THIS TVPE OF WORK WILI BE COMPLIEO
WITH WHETHER SPECIFIED HEREIN OH NOT. THE GRANTING OF A PERMIT �2 t�Q�
DOES NOT PRESUME TO GIVE AU HORITY TO VIOIATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER ST OR LO lAW REGULATING CON-
T CTION O THE P FORMA E O S RUCTION. SS�i.00
� `-� / PLAN CHECK F
C
SIGNATUREOFCON7RAC ORAUTNORI2E GENT IDATEI �11/ EN
� -
STALLS
GROUP OCCUPANCVl.OAD
CU.FT.
�fSTREET PARKING
IGARAGES
JFTAX
$1.25
�C CHARGE
Fire SC $2,50
�TAL FEE
$57,75
HIS IS YO PERMIT
. . :�ri ..:
� [ ]
� � �
�� [ ]
Oo�stxlx.�tion Address:
R-1 AND 1�2
Bu;�dir�q Permit Applicatian
Effective 1/1,/91
Le�gal Desc.'r'iptian: �.l� � �v 0
«� � � �: U► �fc, �, � I � � �. # s � � - qa ��
oo�tza�tor: �3e sZ� �` �d � v�� C'�o , �'�c � �e1. �k 7s�f -1 � �' �'
�: � /a�r� G��.�[ �r. (�.1�. � �a � � �
Attach to this applicatian, a Oertificate of S�vey of the
lat, with the proPosed constnictiori drawn cn it to scale.
� : : r• • •i- � �• • � • :. i:�
• � •�:,.. - . . - . �
r • • r.- •�:,�� - . . - .�
.
�J« -�� - . ;� • �,. . . e�. � .
$Q. �.
$Q. �.
$Q. Ft. �..� "�
aa�: e� tJ i�' � GV !
�t,"��-' r"�►� ",, ��^�� � `�t'� � �o tJ'Z��X7 � �'�,� ��" ��*.�
Cornex Lat [] Inside Lc�t [] Ft. Yd S�ck S de Yard Setbacks
Zj�pe of �nstruction: Fstimated ODSt: $ �Je�C � �b� �a � `� �
Approx. GtRg�letiaal Dat;e: � � � ��
'��; �.... � ; c.i c�
Piro��osed Driveway Width If New Openirg Desired: Ft. $ $
Width + 6' See Back Page
n�: �--�q--�' J �c�rr: C� �. # 2s� -l�� 8'_
Permit Fee $ ��'' �R t.i V
Fire S�rge $ e'�
State Surcharge $ � `�..�
SAC Q�arge $
Drive�ray Fsc2�ow $
Park Fee $
sewpx Main c2�arge $
TOTAL $ �• 1�
STIP[TIATIC�tS :
CITY �SE �Y
F�ee Sd�ec�ale cn Reverse Side
.001 x Permit Valuatiac► (1/lOth $)
S•50/S1,000 Valuatiari
$650 per SA�C Unit
Alt. "A" ar Alt. "B" AbOVe
Fee Det�nmit�ed by E�ngir�eerirg
�m �LY [ l � N�YY I ]
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1 ■
INCORPORATED
NARCH 9, 1994
MINNESOTA DEPARTHENT OF HEALTH
925 DELAWARE STREET
HINNEAPOLIS,MN. 55414
ATTN: GROUND WATER CONTROL UNIT
DOUG EDSON, 627-5141
SUBJECT: UNUSED OR INOPERABLE WELL
WELL QRILLING FOR FOUR GENERATIONS
15688 JARVIS STREET N.W. / ELK RIVER, MN 55330
PHONE: (612) 427-B100 / FAX: (612) 427-0533
�
� /` �
THIS LETTER IS TO NOTIFY YOU OF A WATER WELL THAT IS NOT FUNCTIONAL
ACCORDING TO THE MINNESOTA WATER WELL CONSTRUCTION CODE.
E.H. RENNER & SONS INC. WAS CONTACTED BY THE OWNER OF THIS PROPERTY
OR AN INTERESTED PARTY RND WE HAVE SUBMITTED TO THEM AN ESTIMATE
FOR THE SEALING OF THIS WELL.
THE OWNER MAY HAVE ALSO RECEIVED ADDITIONAL ESTIMATES AND HIRED
ANY NUM9ER OF MINNESOTA LICENSED WATER WELL CONTRACTORS IN THE AREA
TO SEAL THIS WELL. HOWEVER, THERE IS A POSSIBILITY THAT THIS WELL
MAY NO� BE.P:ROPERLY SEALED AND THUS JEOPARDIZING THE GROUND WATER
AND PUBLIC,H�ALTH.
SITE ADDRESS: 1538 GARDENA AVENUE CITY: FRIDLEY
WELL DIANETER: 3" ESTIHATED DEPTH: 120' LOCATION:WELL ROOH
OWNER/CONTRACTOR: VICKI TILLER PHONE: 572-9248
ADDRESS: SAME WORK:
DATE SEEN: AUG.'93
CONTACT PERSON: PHONE:
IF E.H. RENNER & SONS I�IC. CAN BE OF ANY FQRTHER ASSISTRNCE ON THIS
SITE PLEASE FEEL FREE TO CONTACT ME.
5I1dCERELY SUBHITTED,
KEVIN D HOPPE
WELL ABANDONHENT DIRECTOR
CCs CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
� �s%FRIDLEY, HN. 55432
� ATTN: DARREL CLARK
F49
An Eqpal OpportvnRy Employsr
SITE DIAGRAM
CaQ F� �.1�
i
� .�
�Nti-
���
. sua�ecr � . .
City of Fridley
AT TNE TOP Of TNE TWINS g � f� D I N� P E R�M l T
r
� �• COMMUNITY OEVELOPMENT pIV. C�7��3�0'i
' � �: ---�--� ��
r � � Pq07ECTIVE INSPECTION SEC.
� 1 � •
� _ �"'f � CITY NALL FRIOLE� SSIJ2 NUMeER REV
�""'�' �'' 612-571-3450 9t0-F15
10B ADDRE55 1538 Gardena Avenue NE
t LEGAL �OT NO. BLOCK TRACT OR AODITION
oesca. 30 Aud. Sub 4�92
2 PROPERTV OWNER MAII ADDRES$
Leroy Walkner 1538 Gardena Avenue NE
3 CON7RACTOR MAIL ADDRESS
Same
� ARCHITECT OR DEStGNER MAIL ADORESS
5 ENGINEER
6 USE Of BUIIDING
Residential
7 CLASSOFWORK � NEW
B DESCRIBE WOfiK
Waterproof basement
9 CHANGE OF USE FROM
STIPULATIONS
MAII ADORESS
9/24/O1� /
ZIP
ZIP
O:
�
2195
/ �
8�
$EE ATTACHED
SHEET
PHONE
763-781-0000
PHONE LICENSE NO
PHONE IICENSE NO.
PHONE LICENSE NO
O ADDITION O ALTERATION � REPAIR O MOVE O REMOVE
TO
SEPARATE PEIiM�TS ARE REOUIqEO fOR EIECTRICAL, PLUMBING. NEATING, � �
VENTILATING OR AIR CONOITIONING
TMIS PERMIT BECOMES NULL AND VOIO IF WORK ON CONSTRUCTION 2pNING
AUTHORIZEO IS NOT COMMENCEO V�IITHIN 60 DAVS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONEO fOR A PER100 OP 120 OAYS AT
ANV TIME AF7EFl WORK IS COMMENCED. NO DW4G. UN
1 HEREBV CERTIFV THAT 1 MAVE READ ANO EXAMINEO TMIS APPLICATIpN 1
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION
ANO ORDINANCES GOVERNING TMIS TVPE OF WORK WILL BE COMP4�ED
WITH WHE7MEA SPECIFIEO HEpEIN OR NOT. TME GRANTING OF A GEFMIT �%SO
DOES NOT PFlESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEI THE pEqMl7 FEE
PROVISIONS OF ANY OTMER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR TNE PERfORMANCE Of CONSTRUCTION �.32.GS
TU�7E OF CON�A .tOA O UTHOp�1ED �GEN� iD�iE�
, / � �
V
OWNEQ��F OWNEABU40EA� �DA�Ei
�� r
OCCUPANCYGROUP OCCUPANCvLOAD
SO. fT CU FT
OfFSTREET PARKING
STALlS GApAGES
SURTAX
$.50
SAC CHAAGE
Fi.e SC $.75
r a� FEE
� 33.90
�
E
N� f l Effective 1i1i2001
ADDN [] '. CITY OF FRIDLEY (763) 572-3604 Bldg insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: _1� � �Savc�ir� /�r�2
Legai Description:
Owner Name & Addre�s,� �vrx��_��,�vc.PV Tel. #�� - 7�S'l—c��
Contractor:
MN LICENSE #
Address: Tel. #
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width
Length Width
Height Sq. Ft.
Hg�/Ground Sq. Ft.
Estimated Cost: $ ��� � . �' ��
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: _���—D� APPLICANT: �- Tel. # ��93 � %��'�v
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 fo� Permit Fees if mailing in application
$ 4�%S� Fee Schedule on Reverse Side
$ � %s .001 of Permit Valuation (1/10th%)
$ �S-� $.50/$1,000 Valuation
$ $1150 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 [ ]
$ �� . �
�_+� - l
� YC�
^ �
-�-----r
SuB�ECT
City of Fridley
AT TNE TOP OF TME TWINS g U I L D I N G P E R M I T
f
� �
� ; y ����� COMMUNITY DEVELOPMENT pIV.
r � � ppOTEC7IVE INSPECTION SEC.
� � �"'1 � CITY MALL FFIOIE� 55132 NUMBER NEV O�TE
�""�" �'' 763-571-3450 910-F 15 5/ 19 / 03
�oe nooaESS 1538 Gardena Avenue NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION
oesca. 30 Auditor's Subdivision �F'92
2 PROPERTV OWNER MAIL ADORESS
Leroy Walkner 1538 Gardena Avenue NE
3 CON7RACTOF MAIL ADQRESS
Same
♦ ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAII ADDHESS
6 USE OF BUIIOING
Residential
7 CIASS OF WORK
p NEW
v�GE OF
/ /
33529
RECEIPT NO.
�'7 3 �
APGROVED BY�
SEE ATTACMEO
SMEET
21P PHONE
763-286-9932
21P PNONE LICENSE NO
ZIp PHONE IICENSE NO.
ZIP PHONE LICENSE NO
�J ADDITION O ALTERATION ❑ REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Construct a 28' x 22' Garage; construct a 28' x 22' deck
9 CHANGE Of USE FROM
STIPULATIONS
See notations on plan.
SE�PERATE PERMI�s
aUIRED FOR:
wiRi� N�nNs
PLUMBIN�qND SI6�VS
TO
W������
Before di99�ng call for
a�� ���tY locations
REQU�R�oo2
ED BX L�11�
7YPE OF CONST. OCCUP�
SEPARATE PERMITS ARE AEOUIRED FOR ELECTRICAL, PLUMB�NG, MEATING,
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NUIL ANO VOIO IF WORK Oii CONSTRUCTION 20NING SO. fT
AUTHORIZED IS NOT COMMENCEO WITHIN 60 OAVS. Oii IF CONSTRUCTION
OR WORK tS SUSPENDED OR A9ANDONEO FOR A PERI00 OF 120 OAVS A7
ANV TIME AfTEii WORK IS COMMENCED. NO DWLG. UNIT$
I MEREBV CERTIFV THAT 1 HAVE READ ANO EXAMINEO THIS APP�ICATION 1 STA�LS
AND KNOW THE SAME TO BE TRUE ANO CORRECT ALL PROVISIONS Of LAWS VALUATION
AND ORpINANCES GOVERNING TMIS TVPE Of WORK WILL BE COMPLIEO $28�975
WITM WHETHER SPECIFIED MEREIN Oii NOT TME GRANTING OF A PEFiM1T
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OF CANCEL THE pEqMIT fEE
PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGU�ATING coN- �431.65
STiiUCTION OR THE PERfORMANCE OF CONSTRUCTION
TUpE OF CON'aACTpa OA �UTMOA�2E0 AGENT iDATE�
� O� nWNfPi��� ILDEH� �� I��T�
P �OCCUPANCVLOAO
CU
OFFSTREET PARKING
GARAGES
SURTAX
$14.48
Fire SC $28.97
�TAL FEE
$475.10
THIS /Ig OUR EAMIT
( L. �1�
NEW
ADDN
ALTER
( ] CIIY OF FRIDLEY
[] 6431 University Ave NE, Fridley, MN 55432
[] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: l�� g�-ct �'�a l`t�J�
Effective 1 /1 /2003
(763) 572-3604 B�dg 1�
(763) 571-1287 F�x �
x
�� � `j t.
� __�
Legal Description: -
Owner Name & Address: ,��You l�(ia �YI et/ Tel. #, ��b ��
Contractor: � � � MN LICENSE #
Address: _ Tel. #
LIVING AREA:
GARAGE AREA:
OTHER:
Attach to this application, a Certificate of Survey of the �
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft. �
Length Width � Height �� Sq. Ft. X „3 :/535�
Length Width � Hgt/Ground _� Sq. Ft. / X o?•/f =�� � 9
Constnaction Type: � Estimated Cost: � /�J � � _
Driveway Curb Cut Width Needed: Ft. + s Ft = Ft x$ _$
DATE: �''�-5-D-3 APPLICANT: Tel. #
Call (763) 572-3604 for Permit Fees if mailing in a lication. Fax to 763,571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
� .6
$
$ / .
$ ---��
$ -- � �'
$
$
$
$
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1275 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 [ ]
TOTAL $ l�7. %d STIPULATIONS�
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