AF - 45508City of Fridley, Minn..
BUILDIlO�G PEI�1V.[IT N° � 5 3 5 4
Date: . � �..��_.�.""':, ' � __ ...v____..,_..
....�. __.._. �.. � � _._ _ _
�
Owner: ._ �� ; _.���....�.._ _......._ .._._-----------------•--.......----•-----••---•-•-------...---....---�•---._........_..._._....
_�.._ _�....__ f, , - Builder ..----
Address_..._.---___.._..._..----•-----_...__.___..�_....._.._._._—...._...._...._..._------_._ Address -- -- T .. --=----...-----...._.-----._.........._.......__
,» LO TION O� RfG
�
No. ��--�� Street _ .....�� . t"�...,r-a�..'��� .. ....'.-• --' -�!'�-'P f Lot ---
------ ._._... ._.._. ._....
Lot _...���..._.._._� Block _.._.___...�.-.� --_....--- .--- Addition or Sub-Divisio� � .........�£'_.. .._ .. � .���.____....
Corner Lot .__._........._.___ Inside Lot _.�i�____..... Setback .-• -.�.�----� Sidey ---- � ...:: .........._::....._' ._.._..-----
Sewer Elevation __..___........._._...._....._.._._...._.....___....._...._...__ Foundation IIevation
DESCRIPTION OF �UILDBNG
To�ie Used � � ,�' ,r .�*�' �:•�"`�
�� ,� !�!_ �; s., �' � � , � � j' 'r ,�� ,�
-�r.°,�,''.-���=�--�; .•�.* _::..� Front ......_� -,� Depth�,... �:._.�: Height �_"'�.�....__ �q. Fi. �.`..�,...'...:�' Cu. Ft�".::«�_,,,,,:�,..°t..�
_..._.._.._•-•----•----�---f ----.._._...� F on __..----•---��--•--.. Depth ....._... .W. Height ....._....;._�v-_ Sq. Ft. ....._ ............._.. Cu. Ft. .........._�..........
� ' � ��.�' � �'� a.�
Type of Construction ..----.�..,.-*_�.k �...�.._`:.,�.... Est. C st �_„<�,,,��....!�� _..".�°".". To be Campleted .....� ............._.....__.---_............_._
In consideration of the issuance to me of a permit to construct the buiiding described above, I agree to do
the proposed work in accordance with the description above set farth and in compliance with all provisions of
ordinances of the city of Fridley.
_ ±�l..___.._..._...._._. ____.____
rx�" a� ; � ,,,�,.,:•�-^*'.'"""'"
In consideration of the payment of a fee of $•' ....._.., pexmit is hereby granted to.._._�_..__._. .._._...
�—._._.
_.__.__..___..__. ___ to canstruct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
dane in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked a t any time upan violatiAa-o1'�any of the provisions of said
ordinances. ... .A. , l
j' �` " ����" �;�:r���;��Building Inspector
NOTICE:
This permh does not eover th� eons�ruation, in:fallation for wiring, plumbing, gss heating, sswe� or water. B� sun fo :s�
the Buildin� In�pedo� for separate psrmits for thess items.
� a�4
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pwnex• r s
lddress
APPLICATION FOR BUII�ING PF�Ml'P
CITY OF FRIDLEY, MINNE50T1
LOCATION OF BUILDING
:
No.� Street � ����,�.rPar't of Lot _� �`�,��
Lot Block �%/`�� Addition or Subdivision� � %" r° �,�s G �1/
-6errter-�a�-�Iriside Lot 3etback � •_�Side-Yarci �/�% /
-
SEWEEt ELEVATION FOUNDATION ELEVATION
Applicant attaah to this form Certificate of Survey of Lot and propoaed building
location.
To be used ass
DFSCRIPTION OF BUILDING
r ��
Sq. Ft. Cu. Ft.
FSront Depth Height
Sq. Ft. Cu. F
Type of Construction � c'� �f �. Eatimeted Coa 1 10��� �
To be Completed c� ,� �
The underaigned herebq makes application for a permit for the work herein apecified,
agreeing to do all work in atrict accordance with the City Ordinances and ruling of
the Departmsnt of Buildings, aud hereby declares that all the facts and representationa
stated in this application are true and correct. M � � . �
�
(A Schedule of Fes Coata can be found on the Reverse Side.)
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HEAT LO6S CALCULATIONS D�PAiii'�' OF BUILDlNGS MINNEAPOLIS, MINN.
Weatherstrips AS.H. .E. Construction No. Insulation
Guide
�1Vindows Doon ReFsre�tce �t. �ntil1 bnt.Wa11 Ceiling I Roof ��Io�r. Kind I How Applied
Yea�-Na � Yes---No 19 f
'/ Fl.l L� v Room Lengch ,zF,` Widch i� � Height 8° � Fl.� j3,�� Room I Len�th 7� Width T° Hei�ht
Win ows and Daors---�Crackage and Area 21. : e.� T� ��. Windows and Doors—Crackage and Area �=�, rt , i►�
idth . iJo. of Ltrwl h. Ara Width eiaht Na o[ Lineal k. Aret
No. of o penc, 1 s of u�cic sq. ft. No. ot pa�e o[ pane lighu of crack aq. Et.
„5 p '� 7` Y / 32 �` Z /6 �i
, � e � a �9 zo _ _ _ _ _ —_
ln6ltration
G�aas
E:p. wal!
Net ezp. wall
Iat: ivs�l � ..: .
���
�����
�—�
.
�r��
��ei
T 1�3�0
k. E.11:R. or aq, ins. W.A. Leader area �
Room I Len�th io° Width N' Height 8�
d Doors-C'.rackage and Area_ q: tu Ts, '
�(, Lo
�Za L I
: Infiltration
' ; Glaaa
> Ezp. �well
�; Net ezp. wall
� , Int. walt
,
�
r�
l3
Q Infiltration n
p Glass � / -�
! Ezp. wall p
� Net ezp. wall y! o
_ Int. wall , _ _.. .
_ ,o
c� Ceil. or floor S 3 /� 3
o Total Btu. a 7
Required sq.k.E.D.R. or. aq. ins. W.A. Leaderarea
/ Fl.� $/ Qco Room � Length I3° Width /o Hei�ht 8°
,n Windows snd Doora--Crackage and Area �� �� T�t � m
idth Haght No. of inenl R. Area
No, at of p4ne lights ot aack sq. (t.
�L ' /L 2 3 L /
r
Coef. Btu � �
y/o / y o lnfiltrstion
,» /S'S-a Gless
� Ezp. wall
te� � 7 o Net ezp. waIl
� lnt. wall
3
z�
Btu
/!� �c�
3 !o . 3 7
: �eil. ' //o o .Pn Ceil. ao�� . /3� /o � 3�0
Total Btu. -' _ Tota,�, �u. � v
- --_.
Requued aq: k. E.D.R. or�sq. ins. W.A. Leader area Required sq. ft.E.D.R. or aq.ins.W.A. Leader area
i FI_� 1��-t" Room I Lenath �3 ° Widch io ` Heighc 8° / Fl.�'+t,2 ,d��,r> Room � Length /� � Width /,S° Height 8°
: e�n;d Asea `= t, i�e,�;,
h. _ Arca
:rack w. fc.
���
_�
��
1 f Coef. &u
1n61tratioA , � b
. �� '
F�cp. wall
Net esp. wall /D '70
Int. wall '
: Ceil. a�3�' 7 /p /370
Tocal' �u. .SS
- Required sq. h. E.D.�. or �q, ias. W. A. l.eader area
D.56
�IV1 �/�Z•Z /3v ZoNE �Z
�Rr�I► P't's Cs_ P*irtwa . �.��� ,:��. � . . .
Windows snd Doors--Crackage and Area /3 :� T,,�,;,,
Width Hcighc No of Lineal R. Area
Jo. ot p�e of pana lights of creck aq.� k.
.il � 4 L 6 //
L 2.z 30 / zo /3
In5ltration
Glass
Exp. wall
Ne� ezp, wall
lnt. wall
Btu
' /o yZ�
CeiL or floor � /U �
Total Btu.
Required sq. k.,E.D.R, or sq. ias. W.A. l,tader area
b s���.� �� �
.z.3c�a ,$fs� /� b'i2 j 7�vt.• S"$� 73�
...... . . � _.
��"„ ,y'.�E. ... . . . . . _ .. . . .
HEAT LOSS CALCULA'�14NS �P�F.,�I' OF BU1LDlNGS
Weatherstripe �•H•V•�" Conshvction No.
Guide
MINNEAPOLIS, MINN.
insulation
Windows I Doors Re#erence �t. Wall I Int. Wall Ceiling I Roof � F�aor �� Kind ( How Applied
' Yea—No Yes--No 19
F1./ � j �Room � Length //'' Width /t � Height g o Fl.� Room � Length Width Hei�ht
} Win ows and Doora—Crackage and Area B= w T� ��,�. Windowa and Doore—Cracka e and Area
idth i�u No. of Lineal k. Arcs WidtM Heiqht No. of Lineal k. Ares
No. of pene oi; 1 s of a�ck aq. ft. tdo• of pane of pane li�hu of ereck aq. k.
L ZZ �o / 2 o i 3
� � � Coef. Btu
Infiltratian 2 c 5�0 0 0
Glasa � 3 ^z� b �
Exp. wall o o —
Net ezp. wall /� i c�
_ Int:-w�`ta i _, �..._.____ �: T
�/ �o �/�o
Ceil.or 800r i 5f N/ � / 4� y d
Total Bcu. .�z o 0
Reyuired scr. ft. E.11.R. or sq. ina. W.A. Leader area
`�Fl•� 1e�G Room I Length 2=- Width i a Height ��
Windowa and Doors—C:racka e and Area 2 z= �.o T.� �.,�
Width Heiaht No, of Lineal h. Area
� No. of pene of Wene li�d+ts of uack sq.-h'
3 2� � Z �' �
lnfiltration
Glass
Ezp. wall
Net exp. wall
Iat wall
Ceil. os 800r
T l Bc
Cocf. Btu
2S �o i oca
// S� a
/78
)L7 y�l '� 3 N8
yS d L z�i � �1
ota u.
_� _...._ _..__
Required sq, ft. E.D.R. oraq. ina. W.A. Leader area
Fl.� Room � Length Widch �
Windo�va and Doora—Crackage and` Area
Width iRht Na. af Li Area
' No. ot oE p�ne 1' ts o[ erack W. (t.-
Glass.
Eap. wall
• Net ezp. w�ll
Int. wall
Ceii. or floor
Total Bta.
�
Required sq.�E.
D.56
, s�x r�r, c... r�e,�,.
Coef.l Btu
R. or sq.ins. W. A. L.eader area
.I Btu
In6ltration
Glass
Ezp. wall
Nec ezp. wali
In�. wall _
Ceil. or Aoor
Total Btu.
Required aq.ft.E.D.R. or. aq. ina. W.A. Leaderuea
Fl.� Room � Length Width 1
Windows snd Doora--Crackage and Area I
idth Height No. of Lineal ft. Area
No. �of oane of uane liahts of crack aa. ft.
1 l { Co�f. Btu
Infiltration
Glasa
Exp. wall
Net ezp. waA
]nt. wall
Ceil. or floor
' Total Btu.
�Zequired s+q. ft. E.D.R. or sq. ins.W.A. Leader area
FI.� Room � Length Width Height
Windows and Doors--Crackage and Area
Infiltrarion �
Glass
Exp. wall
Net. exp. wsll
lnt. wall
Ceil. or 800r
_. - -
Total ;Btu.
Reauired sa. k. E.D.R. or aa, ins. W.A.
Bhl
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,
, sus�ecr PERM I
City of Fr��le�
AT TWE TOP OF �HE TWlNS U I�;D I�� � E R M I T �� O�
�:
''� '> � . ECEIPT NO
COMMUNITY DEVEtOPA4�NT DN.
1 �L ------, � 7�,y f
� . � PROTECTiVE IN3PEQTION SEC.
t .. ,
4� �- � i��-� � . C1TY HALL . FRIDt-EY rj,S!{3Z . NUMBER � �� � REV. DATE � PAGE � OF �� APPROVED BY . �
"•�•�••� � �'1 612-560-3450
910-F15 � �
JOB ADDRE�S �S� G82'(�@Ila
1 LEGAL LOTNO. BLOGK:` TRACTORADDITION SEEATTACHED
oescR: � 1 Carl Petexson Acfi,dition . sHEEr
2 PROPEt�T�F aWNER MAIL ADDRESS ZtP PHONE
xx .
3 GONTRAG OH `, MAIL pDDRESS Z�P PHONE ' LICENSE NQ.
4 ARGHITECT f)R �fSIGNER MAIL ADQRESS ` ZIP PHONE IICENSE N0.
5'ENGINEER ` MA�tAQDRESS ��P PHONE IICENSE NO.
& USE OF BUILDING
: � cLnSS oF wo�►K ' ffi MEW O ADDITION ❑ ALTERATION O REPAIR ❑_ MOVE ❑ REMOVE
e o�s�fl+eEwo��tri�ct 1Ox10 ga�den shed
9 CHANC� Of USE FRQM TO
STtRUUA�'IONS :
SEPARA7E PERMITS ARE REf]UIHED FOA ELECFI�IGA1.. PCLM87N(3, HEATIMG, TYPE OF COMST. .00GUPANCY GROUP ACCl1PANCY LOAD
VENTILATING OR AIR CONDITION�N<s, WOOCI� €1"'S�IE
THIS PERMiT BECOMfS NULL ANQ wOID IF ; 1Nf1flK OR CQNSTRUCTION Zpp��NG �; SQ. FT. `CU. FL
AUFHpR12ED t$ NOT COMM@NCED WITHIN 60 UA�f�, {iR-1F CONSTRUCTION '. IOO %OO
OR WQR1C IS Sl3SPEND�D Of� ABANQQ:CdET}�{?R A�'El�OO OF 120 DAYS AT
/CF�Y iIMEAFTER WORK IS COMMENCEp. `- NO: D1/YdLG. UNITS OFFSTREET PARKING
I,kER�BY� CE}'tTIFY THAT I HAVE READ AND' EXRMINED THIS APPLICATION STALLS GARAGfS
AND iCNOi�U THE$AMf TO BE TRUE AND CORREGT. ACt PROVISIONS OF LAWS VALUATIQN' SURiAX
AND ORDINAMCES GOYERNING THlS TYPf OF WQRK WILL BE COMPLIED
WITH WHE7HER SPEGkFIED HfRfIN-OR NpT, THE GRANTING OF A PERMIT
pOES A1�T PRE3UME TO GIV£ AUTHOfiI7Y TO VIOLATE OR CANCEL THE pER i SACCMA GE
FRUVISIQ • ANY OTHER STAtE OH LOCAL LAW REGULATtNG CON- � °
I' ' ST PERFORMA�ICE OF CONSTRUCTION. • ����"Y
,' PLAIV GHE�K FEE TOTAL FEE -
$5.50 .
ONTRk O R� E IDnTEt �RQPERLY V.,' ?ED 7H IS YOUR FERMIT ''�
��Z f �
' 1 _�_... &OPpUVNEflI LS R. ILDE � IDATE . - ���, ...� BL � � � D
'C.;.�� � � . . . a+ G' �. . . �-� . . � - . .
�PP1,I�;�ITION FOR RLSI1)ENTIAL, ALTERt�`I'Ii!�`,
OR �'1i)lli'I'ION 13UILAING P�:RMIT
CI7'�' OF 1�1:1DL�;X, �1I�NNf:SiJ'['f�
QW�T�A � S NA,��:��i'• I"l,�R�L 11� t-�� K��BU ILDER • ��L �
AAARESS; ��SS ���D���I N-�• ADDRESS:
NO ;. �%�g S TREET :�A� D�iU �4 N.�. � 2 tb Lc �I
I,4� : a TaLOCK : / ADDITION : �j4 �'L ��'T��.� O �
CQRNER LOT: INSIDE 1,OT: )c SETBACK: SIDEYAI:D;
Ag�alican� attach to this Lorm �ao Certificates of Survey of Lot and proposed
bailditi� lvcation drawn on these Certificates. �
11�SGRIPTIUN OF BUILDING
To B� Used As;
� �q-�e DEJV S �c-1� �
Froz►t: �� Depth: /0 / HeighC: � `—�
Square Feet• ,.,��� Cubic Feet: "� �70 U
Front: llepth: Height:
Square k'eet; Cubic Feet:
r,UOOD Fd�f�Ml: °�
Type o� Gonstruction; Eatima.�ed Cost: � Z�Z�
�o Be Cpmpleted: it%v� �� � 9�3
7.'he undeXSi�ned hezeby makes applicativn for a permit for the work herei�,
apecified, agreeing to do all work in stiict accoXdance with the City of
Fxidley Ordinances and rulings of the llepa en- u ldings, d her by
dec].ares that -�11 the facts and represent tion s ated in t pp at
axe true and �urr�ct.
AATE: � °Z7 73 �.IC;�A'I.'URE:
(Sea Reverse Side For Additional Information.)
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I� �-+�'w- t�l%^���YSt'�� _+, owner of the properL•y los�ate.d.
at /� 7fl Gq.R p,�,�� � have no abjection to the C�_i:y
allowing the constructian of a�q.�,p�„� S'KEo to be l�cate� �,t
1S� �l�2d E N� without thC. requir�:d cer_ ��f icaL-e of
survey that the City ordinarily requires fo� a�I new ccnstru ion.
SignE�u ���
____._._,.._.efi�'� iS�B C-�fl-k�.�A- .1�.�
�:ddCess F'P—IDLFs'y y i'tIJ
8 z s '�3
,.nutc: _ _�
Witness �
. . � r
�
sue�ecr P NO.
_ c�ty of Fr�ai�y . i48s8
qT THE TOP OF THE TWINS B U I L D t�� ' P E R M I T
�
� � RECEI .
� 1 y_'� � COMµUNITY' DEVEkOPMENT DIV. �� ���
� � PROTECTfl/E IN3PEGTION SEC.
1 . �
-� � /"'1 �� CITY HALL FRIDLEV � 55432� NuMaea REV. OATE PAGE OF APPROVED BY � �
- �'••_1`•� `'J 612-560-3450
910-F15 8 21 78 � �
JOB ADDRESS 1588 G3'rf�P•l1d Av��ue N.�. �
1 LEGA� LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 ], C3r�. P@'�YuOri AClt�lt].Ori SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Giies McConville 1588 Gardena Avenue N.E.
3 CONTRAC70R MAIL ADDRESS ZIP PMONE LICENSE NO.
$ZiIG�
4 ARCHITECTORDEStGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MA1L ALIDRESS ZIP PHONE LICENSE NO.
6 dSEOF BUILDING
Resi.denti.al
7 CLASSOF WORK
O NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ MOVE � REMOVE
X
8 �ESCRIBE WORK
Construct a 21' x 25' Addition to Datellin
9 CHAN(3E qF USE FROM TO .. �
r : '..
� STIPUtATIONS ��vy� �� ���forcing if �lock+�wz�11s, as shp�wn on'�p].ans. Frovide
smok�e detector. Gomplet� and submit plans £o�:�;roof construction by
August 31. i978. Cover a11 exposed styxofoam°�shea�hi.ng,;with � inch
sh�etrock. :
�� ; VItARl�G
��P�AT� PERMt1'5 REQU�RED Fp . 8atore di�git�g cel� ivaN uti�itie
HEATlI�G, .PLt��$�NG AN� StGNS. � Y�''1RMV�, TEtEi�fl[�E•E�fC3RIG-GAS �t
� REQUIR�A 8Y �,A
SEPAHATE PERMITS ARE HEQIlIRED FOR EIECTRICAL, PLUM�ING, HEATING, TYPE OF CON$T. OCCUPANCY GROUP OCCUPANCY LOAD
,: Wood �ra�e
VENTItATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NUIL AND VOI� 1F VYORK OR CONSTRUCTION ZONING Sf): FT.. CU. FT.
AUFHC2RIZEQ iS NOT COMMENCED WITHIN 60 DAVS, 0R IP CONSTRUCTION SZS- I.O� �JOO
bR WORK IS SUSPENDED �A ABANDONED fOR A P£RfpD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG: UNITS OFFSTREET PARKWG
- 1 HfR6BY CERFIFY THAT I HAVE READ AND EXAMINED THIS APPUCATION 1 STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL PROVISIONS OF LAWS VALUATION SURTAX
AND OHDINANCES GOVERNING THIS TYPE OF WQRK WILL BE COMPLIED.
W17H WHETHER SPECIFIED HEREIN OR NOT. THE'GRANTING OF A PERMIT t�16�Q86 y�8.O�
DOES N�T PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERPORMANCE OF CONSTRUCTION. �S`42. oa r�o��
PLAN CHECK FfE TOTAL FEE
. � . - SIGNATUREOFCONTRACiOROAAUT RI EDAGENT� IDATE) �j.�.�{i ERLY-�VALIDATED.THtS �IS YOU ���PERMIT � � �
� 2 ff ' .2r 7$
� � . � � S16NATU EOFOWNERIIFOWNERBUIIDEAI' � IOATEI B&9G SP. � DATE .
` ,
CITY O[= FfZIU�EY ,
APPLTC�"fIOi� FOft RESIll(�NTI/1L LUIi_DING PEFti'IITS
iIVEW, IILTL"R�TIONS, ADDITIO(J�, OR REPAI(ZS)
• ;
' �owc��cR: (�--��� ?3UILDI:I2: •
' Addxess : ������� �/ �'� Rdc3ress :
���No. :�� � �
' _ �,oT:
`CORIdER LOT:
�
Tel. No..
Street: �//��7�%� �
� �
BIACY.
INSID� 7AT:
ADDITION:
S�TBACY.: SIDL•'YT�RDS:
:Ap�lic.a'r�t attach 'to this form Tao Certii-icates of Survey of LoL- and pro�osed
:`bui:lding locatioai drawn on these Certificates. �
DESCRI PTIO('� OF BUI LDI NG
To Be Used As: ��i� � d/OOd a/C�v� /�c�/•�QJ'V l•Sf/N �IP��ii,
/ �
. Front: 021 Depth: 2� Height: �
Square Feet: .3a� Cubic Feet: --�� ��G)
�—
Front: Depth: � Height: ,
� Square I'eet: Cubic Feet:
Type o� Construction: ��d�v���, �'�,/4, Estimated Cost: $
. 7.b XIIe Completed: � %� /�'% ji�'
Alt. A Alt. B
Pr�posed Driveway %tidth If New Opening Ts Desired $ $_
(SEE REVERSE SIDE OF SHEF:T)
The�i�ndersigned hereby ma3:es application for a permit for the work herein
s�i��if�_eci, agreeing to do all �.�ork in strict accord��tice with the City of
`�'rid;tey Ordinances and ruliiigs of ti�e DepartmeTit oi �uildiiigs, ar�cl liereby
dec�.ares i.iiat all the facts and representations stai:cd in i:his application
•�xe trt�c: �ici correct. See reverse side for additiotial info�-mation.
�i�'i'E: ��!�' �J SIGNATUF.E:
T. ���e.,� /��CO-r/L W�-�GG�
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� � �- SUBJECT � P� ��
City of Fridley � 15 4 2
AT THE TOP OP THE TWINS g U I L D I N G P E R M I T
r
� �
RECEIPT N
� �• COMMUAIITY DEVELOPMENT DIV.
� j V �
r � � PROTECTIVE INSPECTION SEC. 4��j
1 � � . � � . . . . � .
, � r'��1 �.CITY HALL.. FRIDLE� 55432 NUMBER REV.. � DATE PAGE OF APPROVEO B��
�"""`� � ��� 612-571�-3450 9t0-F15 � � / /
JOB ADDRESS
1588 Gardena
t LEGAL t0T N0. BIOCK TRACT OR ADDITION SEE ATTACHED
` DESCR. 2 1 CdL'1 P@'tE.'15021 ACIC�7.'t10I1 SHEET
2 PROPERTY OWNER MAIL AODRESS ZIP PHONE
3 CONTRACTDR MAII ADDRESS Z�P PHONE LICENSE NO.
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE N0.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUlLD1NG
Gara e
7 CLASS:OF WORK
❑ NEW �] ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Aclditic>n to current ara e, L-sha d
9' CHANGE pF USE FROM TO
STIPULATIONS
None
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRIGAL; PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. Y'dIYle
THIS PERNf1T BECOMES NUII AND VOID IF WORK OR GONSTRUCTION ZONING SO. FT. Cll. FT.
AUTHOpIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION
OR WORK.IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R 1. 4SO ISO
ANY TIME AFTER WORK IS COMMENCE0. NO. DWI.G. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1, STALLS 2 GARAGES ].
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALIJQTION SURTAX
AND ORdINANGES GOVERNING THtS TYPE OP WOHK WILL BE COMPLIED /OD'�
WITH WHETHER SPEC{FIED HEREIN OR NOT. THE GRANTING OF A PERMIT $�. OO . rJO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. %. 'rJO
PLAN CHECK FEE TOTAL FEE
���1 79 8.00
iGN TUREOFCON'RA TORORAU R12EDAGENT ' fDATEI yyF{�N PR PERLY ALIDATE THIS IS��Vf�U,�ERjv11T
� y l / �/�
� SiGNATUREOPOWNER11F0� ER�BUILDERi � IDA7E'� � C�G ----L—�---
BLDG INSP DFiE
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`" �` � 4 CITY OF FRIDLEY . � w
ARPLICATION FOR RESIDENTIAL BUILDING PERMITS
� (tJew, Alterations, Additions, or Repairs)
/ r
' owr�ER: �f,l� 4 � o.�uv', f
`�' �c
ADDRESS : /;5�� ��4 ��
TEL N0: v�%��O/O �
BUILDER: . Si'�'Lt� �
AQDRESS: •
TEL N4: '
�
" Construction Location
- STREET NO: �� STREET: �'��r�_� `�`
. -�
LOT : 'Z BLOCK : �1^ ADDITION : ��t"� t �r.j ! �,� r Ot`/ �
.
.
Corner Lot: Inside Lot: Setback: Sideyards:
ApPlicant attach to this form t�ao Cert�,ficates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIO�� OF CONSTRUCTION
� (� Front: Depth: Height:
• � �� � � ' ����' S a�e. Feet: � Gtibic Feet:
� �
' Front: Depth: Height:
Square• Feet: Cubic Feet:
� /, OOc�
Type of Construction: �j�1�(- C)��(;� Estimated Cost: $ �.
.-
Rb Be Cbmpleted: y� Q 11 �� �
7
Alt. A Alt. B
Prop�sed Driveway Width If New Opening Is Desired: N $� $
� SEE REVERSE SIDE OF SHEET
The undersigned hereby makes application for a permit for the w�rk herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in this application re true an d correct.
DATE: SIGI�IATURE : �"'-`-
_�J� G I
Stipulations:
� �fl
�° .
�o 0
.�
r�nti`1 I r �.. 2 2'
• %��t*�
�' �
�-�— � C ' _ � �
0
� i�,�
SuBJECT •
Cit✓Y of Fridle
AT THE TOP OF THE TWINSy ?�?� 2
� BUILDING PERMIT
„
, � RECEIPT NO.
� COMMUNITY DEVELOPMENT DIV.
� � �: ------� �/ 0 �
r � � PROTECTIVE INSPECTION SEC.
� �
' � �'�'1 � CITY HALL FRIDLE� 55432 NUMBEF AEV DATE PAGE Uf APPRO�ED B�
�.---�; �.' 612-571-3450 9�0-Ft5 7/18/97 / /
JOB AODRESS 1588 Gardena Avenue NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITtON SEE ATTACMED
DESCR. L 1 Carl Peterson Addition SHEET
2 PROPERTV OWNER MAIL ADORESS ZIP PHONE
Roger Wilson 1588 Gardena Avenue NE 586-9910
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO
Same
e ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PHONE IICENSE NO
6 USE OF BUILDING
Residential
7 CIASS OF WORK
❑ NEW � ADDITION C� ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside house and install new double door
9 CHANGEOFUSEFROM TO
STIPULATIONS
Install building wrap and have inspection of same unless
manufacturer's specifications state it is not required.
TYPEOPCONST. OCCUPANCY GROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, 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 PEHIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GAFiAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VAIUATION SURTAX
AND OR�INANCES GOVERNING THIS TYPE Of WORK WIIL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �7SO �. SO
DOES NOT PRESUME TO GIVE AUTHORITV TO VtOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PiiOVISIONS OF ANY OTHER STATE OR LOCAL �AW REGULATING CON- $29�2r) Fi e SC �.75
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE T AL FEE
$30.50
.SiG� C7 p UT iZEDAGENT IDATEi yyH P Y VALI T D THIS IS VOUR PERMIT
�/� � � `��"'7�
S�GNATUC7EOFOWNER�iFOWNEABUiLDERi � �OATE� - OG iNS ��FTE
NEW
ADDN
ALTER
�l
[)
[l
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1 / 1 /97
S % D-�
�
ConstructionAddress: �..��""�� ��Q�,,,w �A ��
Legal Description: �,� � 2 /pc� /��,�h l �.r.�..�$�,,, ,,C�� •�C, �a �,
Owner Name & Address: ��,r- p� r..�,YSo vr Tel. #_��6 .- � g, �
Contractor: _����„�,� MN LICENSE#
Address: �S--�g �Q ��, � Tel. #
Altach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scaie.
LIVING AREA:
GARAGE A►REA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
�ng� Width Height Sq. Ft.
�ng� Width Height Sq. Ft.
�ng� Width Hgt/Ground Sq. Ft.
�-c s�r.i. d- .� sa�rii `z � s�e �,a � d�
Construction Type: `a 1�� ��� Estimated Cost: $ '�7S'D ��
(�'ee Schedule on Back)
Driveway C�rb Cut Width Needed: Ft. + 6 Ft = Ft.�x $ _$
DATE: 7�' � APPLICANT: Tel. # S3'6 �- �q � b
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULA"C[ONS:
CITY USE ONLY
$ �.�S Fee Schedule on Reverse Side
$ � %� .001 of Permit Valuation (1/lOth%)
� � �� $.50/$1,000 Valuation
$ $950 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 [ ]
$ -�D, �Z�
i Y
(J l �'
���
1 ��J��
�
SUBJECT Q •
City of Fridley 2 6 0 4 6�
�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
„ .
� � COMMUNI7V DEVELOPMENT DIV. /)
� •
r � �' � PROTECTIVE IMSPECTION SEC. �� �0�
� . .
� � /"'1 � CITY HAII FRIDLE� 55�32 NUMBER REV �OATE PAGE OF APPROVEO BY
�""�' �'' 612-571-3450 910-F15 5/ 13 / 98 / /
JOB ADDRESS 1588 Gardena Avenue NE
1 LEGAI �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
DESCR. Z 1 Carl Peterson Addition SHEfT
2 PHOPERTY OWNEii MAIL ADORESS ZIP PHONE
Roger Wilson 1588 Gardena Avenue NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE IICENSE NO.
Tim Leger Contr 12033 Louisiana Ave N, Champlin, MN 55316 422-1611
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZtP PHONE LICENSE NO.
2��22818
5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION � ALTERATION C� REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Garage (35 Sq) Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PIUMBING, HEATING.
VENTILATING OR AIR CONOITIONING.
THiS PERMIT BECOMES NUIL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. fT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR li CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONED FOR A PERIOD Of 120 DAYS AT
AIJY 71ME AFTER WORK IS COMMENCED. NO. DWIG. UNITS OfFSTREET PARKING
1 HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 1 STAILS GAFAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS ypLUAT10N SURTAX
AND ORDINANCES GOVERNING TMIS TVPE OF WORK WiLL BE COMPLIED
WITH WHETHEA SPECIFIED HEREIN OR NOT. THE GRANTING OF A pERM1T �2,919 �1.46
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS Of ANV OTMER STATE OR LOCAL LAW REGULATING CON-
TRUCTVON OR THE PERFO MANCE OP CONSTRUCTION. �7�F.7S Fire SC �Z.9Z
� PLAN CHECKFEE TOTALFEE
Lic��nse $5. $84.13
S�GNATUAEQFCON�RACTO RAUTMOQ�2EOAGENi l0ATE1 N P OP VALIDA D THIS IS VOUR PERMIT
� � (� � ��/ ✓ .
SiGNATUAEOFOWNEAi��OWNERBUILDEAI IDATE� t � ip$P ppTE
K
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �
BUILDING PERMIT APPLICATION � Q � �
_ �. � �3�
ConstructionAddress: � j 8 � �o�rtl, ��1�C� �}U e �i }� .
Legal Description:
Owner Name & Address: t.v Tel. #
Contractor: � T w� Lc�r,!' MN L.ICENSE # ZDO ZZ 8 t�j
Address: ( Zp 33 l..c��. � S� v; �, +�t�c � C'�v�t71�.c�i �"S i L Tel. #�/ZZ -- �6 /'/
r
Attach to this application, a Certificate of 5urvey of the
lot, with the proposed construction drawn on it to scale. �
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Length
Length
Length
DESCRIPTION OF IlVIPROVEMENT
Width Height
Width Height
�idth Hgt/Ground
�� ��
Sq. Ft. -
Sq. Ft.
Sq. Ft.
� ,,
d�
Construction Type:�'� f� p�-� % J�Ei op'� _______ ___ Estunated Cost: $ , 9l�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � /.,3 °
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �s"�
$
$ � 'Y� o
$
$ ��o�
$
$
$
$
$ �j .
CITY USE ONLY
Fee Schedule on Reverse Side
Tel.#(�!, �S��S�7
.001 of Pemut Valuation (1/lOth%)
$.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 [ ]
y�.�
SuB�ECT
City of Fridley 2614.8 '
' , AT THE TOP OF THE TWINS BU ILDING PERMIZ RE 1�-
r
� �` .���_ COMMUNITY OEVELOPMENT DIV. D�
� � � PROTECTIYE INSPECTION SEC.
r , ,
� ; ,
� � /"'1 � CITY HALL fRIDLE� 55432 NUMBER REV DATE PAGE OF APPROVEO BY �
�""'� � �'' 612-571-3450 9�0-Ft5 6/4/98 � �
�oe nooaess 1588 Gardena Avenue NE
t IEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACMED
OESCR. 2 1 Carl Peterson Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Roger Wilson 1588 Gardena Avenue NE 586-9910
3 CONTRACTOR MAIL ADDRESS Z�P PMONE UCENSE NO.
Same
4 AfiCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION ❑ REPAIR ❑ MOVE O HEMOVE
R
8 DESCRIBE WOFK
Construct a 16' x 12' Shed in Rear Yard
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
TVPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAI, P�UMBING, 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 OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I MEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPIICATION 1 STALLS GAHAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF t,AWS VA�UATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETNER SPECIFIED HEREIN OR NOT. TME GRANTING OF A PERMIT � 1� OOO �. SO
DOES NOT PRESUME TO GIVE AUTHORI7V TO VIOLATE OR CANCEL THE pERMl7 FEE SAC CMARGE
PqOVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR TH fORMANCE OF CONSTRUCTION. �3�F.7S Fire SC �Z.00
PLAN CNECK fEE TOTAL FEE
$3 .25
SIGNA UAE FCO TOAO TMOR�2E0/GENT IDATEI N OPERLV V DATED T IS IS NOUR PERMIT
•� ,.� �-y-�� . , _ .
SiG TUAEOFOWNEAUFOWNEABWIDEAI iDATEi BL iNSP ��FTE
�
NEW [ ] Effective 1/1/98
ADDN [ J CITY OF FRIDLEY
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 I�� �
BLTILDING PERMIT APPLICATION � D�
e �' 3
ConstructionAddress: ��g g ��aC P�� �r � � �� � ,j�S��3 Z
Legal Description:
Owner Name & Address: � b9 c�" �•! ► %S � � Tel. # .S�'d �O - `1 � to
� -
Contractor:
MN LICENSE #
Address: Tel. #
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
.� �
Length �� Width ! Z Height ! D+ Sq. Ft. l q 2
Length Width � Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
S'���4 2 �$ �Cp
�
o�o
Estimated Cost: $ /�%��%
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � '" `� "' � � APPLICANT: '" � Tel. # .Sp4- 4 � � °
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ ��, s
$ �- U �
$ �Q
$
$
$
$
$
$
$ ��.o?S
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ J Not Necessary []
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FRIDLEY
BOARD OF APP��
EXHIBiT No�
ME�tN� oa�
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City of Fridle�
AT TME TOP Oi THE 7y41NS
� �
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� ; y ����� COMMUMITY QEVEIQFtAENT DIV.
r � � PROTECTIVE INSPECTION SEC.
� � �
� � �"'1 � CI7Y HAII FpIDLE`/ 55�32
�""�"� �'' 612-571-3450
sus�eti r
BU1LD11'�J� PERMIT
5�2'��0�
NUMBfP pEV OATB PAGE OF
9to-Ft5 5/29/O1 � �
�oe nooaess 1588 Gardena Avenue NE �
1 IEGAI �OT NO. BLpCK TRACT OR ADDITION
oesca. 2 1 Carl Peterson Addition
� PFOPERTY OWNER MAIL ADDRES$
ERMIT NO.
3i�55
o���Q
AGVROVEO Br
SEE ATTACMED
SHEET
Roger Wilson 1588 Gardena Avenue NE 763-586-9771
3 CONTRACTOR MAIL AD�RESS ZIP PHONE LICENSE NO
Cornerstone Custom Construction Inc 1330 133 Lane NE, STE 1, Ham Lake, MN 55304
a ARCNITECT OR �ESIGNER MAIL ADORESS ' ZIP PHONE UCENSE NO.
612-308-7947 20224759
5 ENGINEER MAII AODRESS ZIP PHONE UCENSE NO
6 USE OF BUILOING
Residential
� Cuss oF woRK p ADDITION O ALTERATI
� NEW QN �J REPA�R ❑ MOVE O REMOVE
8 DESCRIBE WOFiK
Remove existing deck; construct a 240 sf deck
9 CNANGE OF USE FROM
STiPULATIONS
See notations on plan.
TO
�/ARNING
Before digging call for
all utility locations
454-0002
�EQl11RED BY I.,AW
� i rc vr Vv�+
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL. PLUMBING, MEATING.
VENTI�ATING OR AIF CON�ITIONING
THIS PERMIT BECOMES NULI AND VOID �F WQRK Op CONSTRUCTIQN 20MNG
AUTHORiZED IS NOT COMMENCED V�!ITHIN 60 OAYS. Oii IF CONS7RUCTION �
OR WORK IS SUSPENDED OR ABANQONEO fOR � PER100 OF 12q OAY$ A7
ANV TIME AfTE:i WOFK IS COMMENCEO. ' NO; OWIG. l
I HEREBV CERTIfV THAT I HAVE REAO ANp �XAMIN�O THIS APPUCAiION 1
ANO KNOW THE SAME TO 8E TF1UE ANO CORRECt. A�� PAOVISiQNS bf �AWS VALUATION
AND ORDINANCES GOVERNING TMIS TVPE OF WOFiK WI�4 g� CpMP�IEQ
WITM WMETMER SPECIFIED MEREIN Op NOT. 7NE GRANTtNG OF A PERMIT ��,640
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TNE pERM17fEE
PROVISIONS OF ANY OTHER STATE OR IOCAI LAW REGUTATING CON•
STRUCTION OR TME PERfOiiMANCE OF CONSTFUCTION �S.3.ZS
P4AN CMECK
Q ,_ Licens
S�GN UpE OF �ONrAACtO p �UTMOA�ZEO �GENT IOATEi E�
� etE�
SO. FT
STALLS
$5.
ALI
UP OCCUPANCVIOAD
CU FT
fSTREET PARKtNG
IGARAGES
RTAX
$1.32
Fire SC $2.64
�L FEE
$92.21
MIS IS Y R P MIT
v��--��'G
r�afE
NEW [ ] Effective 1/1/2001
ADDN (] �. CITY OF FRIDLEY (763) 572�604 Bidg Insp
ALTER [] SING�E FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: /S8� Ga�ta�� ��c.•''� ��'�
Legal Description: L*�+f 2�'l���c / C�.+v,t �#� s.►.� if'..�Gr'.�far^�
Owner Name & Address: �E'� G�i�ra.� Tet. #?63- J�6-q�l
Contractor: ��oA.v6�rToNP �'ur7�••r+ ��� t t�c�ctiON. rwC MN LICENSE #�c - 2oz2g��S9
Address: �330 �33'"�'" f.� �F' s��� /,!1.,� G..�e .�� Tel. #�6�2) 3�-795'7
sr
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.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length
Length �AL - Y� �
Width
Width d
�/ - p'� �rf ,� f,
Height Sq. Ft.
H UGround a
9 � Sq. Ft. 2 yd-�
Construction Type: ,0� Estimated Cost: $ � �'e v � % ��
Driveway Curb Cut Wdth Needed: Ft. + 6 Ft = Ft x$ _$,
DATE: y4 APPLICANT: �y /ys�P Tel. # G�Z '���-%�y 7
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 for Permit Fees if mailing in application
$ .�'S Fee Schedule on Reverse Side
$ o? �� .001 of Permit Valuation (1/10th%)
$ / � 3� $.50/$1,000 Valuation
$ $1150 per SAC Unit
$ �� 40 $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 [ j
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