AF - 45227! 1
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City of Fridley, Minn.
BUILDING PERMIT
nate: ..----.. S_E._I'_T..�_I'�F�...�.��... �91r.�...._.__.._._.�_._......_.
N° 4224
Owner: ...._M.�:on __EaroldsOZ1..-----.-----------.......---- .................... Builder ...._P2TL...'.��'__._CON�'�RUCTIOIIT._C�.�__._._.._..._...
Adaress _...124.. �ibr�lt�r Rg�.d N� E. .._......_ Ad�ress ---�.500--_Lyndal.e_ gvenue .North--
_ ......_..____.
Fridley, Minnesota Minneapolis M3saneso-ta
LOCATION OF BUILDING
ivo. --.---1....�..+_'_.-.------..... street _...__GibTaltor Ro�.d N. E• -----_.. Part of Lot ....._-----.._....__.._.__._......---....._. _._....._._._
- ��- �- - - -� . .... .. ..... ..............._.._. ... .
Lot ...................................... Block ....._................................_............. Addition or Sub-Division .--�--......5...�.�.3NlIT....M�N...QF%..._........_................._._._....._. _
Corner Lot
Sewer Elevation
To be Used as:
InsideLot ....._...g ....................... Setback ............................--•-----........ Sideyard
............_..--•----•--._......._..----------�----�• ........................ Foundation Elevation ..---.............
DESCRIPTION OF BUILDING
D.7F11.��lZ1�,....C�'.�,g�.._ Front .....---.20.r.. Depth ....._..21r.t.... Height ......_1Q �..-- Sq. F� --'��------- Cu. Ft �t�.�..._..
............................................................ Front ........................ Depth ...................._.. Height .......---.............. Sq. F� ...................._.. Cu. Ft
Type of Construction ..........._FY'am6 .......................... Est Cost....�1a.��.........._.........._........ To be Completed --�--.....--••---_......
In considera.tion of the issuance to me of a permit to construct the building described above, I agree to do
.�- -------� ----•- �- - -- - • ... .. .
In consideration of the payment of a fee of $....5��.... , permit is hereb � v
•-----..... y granted to....._.....-----.._ ............._......................_..
_._._ __._.._.........._.. ___. _.._. _. _..._.. to construct 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
done in, around and upon said building, or any part thereof, shall conform in all respecta to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city ]imits and this permit may be revoked at any time upan violation of any of e provisions of said
ordinances.
Bwtlding Inspector
NOTICE:
Thia permit does not cover the wnstruetion, installation for wiring, plumbfng, gas heating, sewe� or water. Be surs fe se�
the Building Inspeetor for separate permifs for fhese hems.
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TIDN FOR $UILDING PERMIT
CITY OF FRIDLEY, MINNESOT�
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SEWER ELEVAZ`i0N FOUIV'DATION ELEVATION
Appli�a.nt attach to this for� Certifica.te ' of �Survey o� Lot and groposed. bui�:din� �
location. � � . " -
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DE5^.R.�PTION OF BUILDIlVG
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O b8 1lS8Cl 88 S . �
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P._ ,
� Front � `� Depth Heig�i� �� . ..
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Sq, Ft.� Cuo Ft� Z� -- .. � ,�
� Front • Dept�. Height
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Sq. Ft. Cu. Ft. � •
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Type of Gonstruction _� `. Estimated Gost � ����"`"
To be com�leted � � .
' ,,,.,; .
The undersigned. herc�'ay r�akes auplic�.��,ion.,,��r e permit �i'or tY�e work herein specif3ed.�
agreeing to do al.l �,�oj_°k in st�^�c�t �,cco��dance with the City -Orrdi�nances and ruling of
the Department o�' 3u�]_dings, a-r.ci her�b�*.`:declaxes tha.t all the facts and representa-
tions st�ted in this appli�ation are true and correcto ..
, .
DATE 5IGVA`.CUR� ,�
(A Schedule of Fee costs ca� b� foar�d on t�ie everse Side.)
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BUILDING PERMIT F'EE SCHEDULE
Section 2. The:,Inspector of Buildingi����Sh�lZ, before issuing any permit
for the erectio�i:of�.:;any�building or structure� or for any addition to
any exis�ing building,or structure, or for any alterati,ons or regairs to
any ex,is�ing bu'ilding �dr structure, upon�,applicat,�on therefor,,� ��'equire
the paytnent by the applicant for such permit of fees to the amount
herein below, set.forth and in the manner herein providec��to-wit:
2.1 For an� such pex°nit for the erection of any fireproof buildingt
other than a garage� waxehouse; factory or grain elevator, or for the .
erection of any fireproof addition, f�ir simila.r occupancy, to any �
existing building shall be at the rate of �1.40 for et�.ch one thousa.�d
cubic feet, or fra ction thereof, i�. such cubical contents.
2.2 Fox any su�i� -���1 ��t� for- t�,e � erection` of any fireproof gaxage, ware-
., .�....,..,
house� factory o`r grain elevator, or for the erection of any fireproof
addition for similar occupancy, to any existing building shfa.11=h�;:at.•the�:�
rate of �1.2� for each one :thgusand : c�zbic. fee:t:, � alas�s��fi�ed- as �'"fireproof'�
. .
. _.,:..k�,y_..Sect�,e�--•�02--af�- t�h��� Minneapolis Building Code. �
�,�.�......� . . ., . . '.j • . .... . ... , ; .. � . - �......._.... 6 . . _. .., � ' '"' • -. ."_ '..«... • . r.
o- . �. . . .. � � i
,_,_.,a.._...�.;.._H9.�lSES------_.�.._ ..:�_..�..._.. ._... . . _ �
2.3 For any such per�i.t for.the.erection o� any non-fireproof building
other the.n a garage, wareho`�i'se; �factory or grain elevator, or any .
non-fireproof addition, for similar occupanc.y,. to any existing buil.ding.`
Permit $1.00::.�'pr� ea�a�� �o�e_thousand cubic- feet.
-�-----.___.�- ._..._ --- -._-- � ...._ ' _ _... _ . . � . . � � ,
. ... .. G�GES .. .
_-_.------- �2�.:�-"��' any -such permit for the erection �f . any non-fi.�ep�'o.of .g�rage, ��
warehouse,: �actof��r__or _,g�°ain ..el�vator, or for � the erection of any -no�- . :
�--�-.---•-----•f�.x�ooi addition, for similar oCcupancy, to any exis�ting, buiiding or
.. .....
�- for each such ti.uileiing�. or addition:� �- Ninety ;Cents� for each one . -
.. . ._ .
_.----.-----•�---�nrnx�'�;rid� cu�bic feet or fraction thereof, in the: cubical contents thereof .
_. . . ,w�itk�. a m�n3:mum o �� �4.00 , .: , �. , _ .. _ . . , _
_c� .
For the purpose of campu;ta.:�g;��ees,�;fo�.:bu.ilding perm.its the cubica.l
contents of any buildirig or addition to a uniform hei ht thr�ug�out by •.
multiplying the ground �'ea covered fro� a point six �6) inEhes�below
the fl�or line of the basenent or cellax to the average height.,of the
_...
upper surface or to the av�r.a�e height of _the rcioi surface of �the° mairi �- V
...�.._....._.�.abl�.._a��'a'�pi�e�ied �roof; __. •. ... . ," . ,
2.5 For repairs or alterations����o�an existing structure, the fee sha.17: .,
be at the rate of �3.00 for•_ae�ci� Fi.ve _Hundred Dollar�" -�-�500.00}; bx` "�
. , . .
fractig�i thereo-€ -i�--�-Yre ats�st of a11 proposed work. ,..... : _
._�..._,_-....:�.,._.. , ........._ ...
2.6 In no case shall the fe� cYi�xgecl for
Section 2 be less ;�han �/�.00.
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any permit as set forth in
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City of Fridley, Minn.
BUILDING PERMIT
Date: �Y 9, 1966
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�r: BANFORD B��, BRENNY BROTf.�RS COMPANi'
Ad�as 124 Gilbralter Road N. E. A�S 6011 - 3rd St. N'. E.
Fridley, Minnesota 55421 Fridley, Minnesota 55421
� LOCATION OF BUILDING
No. 124 S,�t Gibraltor Road 1V. E. p� op �t
� 19 S1� 2 Addition or 3ub-Division .� Carls on � s_ Summit Manor e S outh
Coraer Lot
Sewer IIevattam
Ine�de Lot Setback — Sideyard
Fo�mdat4on IIevation
DESCRIPTION OF BUILDING
To be Used as:
Kitchen Addn. �t 14 �� 5 H�t 10 �. � 70 �, �-t, �00
FYont Depth fTeight 5q. Ft Cu. F't.
Type oP Construcl3on Frame F�t. Cost _$l, 000 To be Completed
In conslderatlon o4 the issueace to me of a permit to conatruct the building
the proposed work fn accordance wlth the drescrlption sbove� set forth ead in co
or8inancea of the dty oP FridleY• \�,� A ,
In cam�ideratlon oE t'i►e payment oP a fee of $ 4_� , permit 9s
I agiee to do
provlsions of
to construct the bullci9ag or adaition as deseribed above. Ttuts t is granterl
the elcpr� c�nditlon that the peison to whom it fs granted and hfa agent�, employees an wor in all rk
done in, around and u�n eaid building, or any�rt thereoP, shall conPorm in all respects to the o oP
Fridley, Minnesota ar�n� locat4on, construction, alteration, maintenance� repa9r aad moving of
wlo��� dLy ]imits��and U�s permit may be revoked at aqy tinae upon violation of a�► oE the provieiona o d
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AL?�EN G. JENSEN �� �
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NOTIC6a
ilds ptnmH doa aof co�nr tla eem�eueHon, In�taD�loa fer vrWeO. P��� Ya baNeW a�ru er wat�e. B� am to t»
da Boildlrt9 le�dor hr pp�raf� p�mHs Ior f�a N�ot.
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OWNER�S NAME
APPLICATION FOR BUILDING PE1tI�T
CITY OF FRIDLE�Y, MINNESOTA
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ADDRESS �,�- �,�,� D RE
LQCA UN OF BUTLD� ;r,'
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NQ.� _�� STREET � k� .i� _ �.��RT OF LUT
LOT BLOCR ADDITION OR STIBDIVISION
GORNER L�T INSIDE LOT SET�ACR SIDE-YARD
SEWER ELEVATION FOIINDATION ELEVATIQN
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificatea.
DESCRIPTION OF BOILDING
To be_ use� �; ��
/ � �� - a �� G ,��
` � .�- Front��epth � � Height � �
Sq. P't.�� � Gu. Ft. �_.��
Front Depth Seight
Sq. Ft. Cu. Ft.
�,� ,
Type of Construction ,� �,�� � Eatimated Coat_,��,�� �"
_ �
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To be completed
�
The undersigned herebq makea application for a permiC for the work herein
specified, agreeing to do a11 work in strict accordaace with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declare� that a11 the facts and repreaentatione stated in this application
are true snd correct.
DATE SIGNATURE
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(Schedule of Fee Coats can be found on the Reverse Side)�
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Bi1�DING PEIt�iIT FEE SG�EDDLB
SECTION 2. The Inspector of Buildinga ahall, before iasuing any permit for
the erection of any building or aCructuxe, or for any addition to any existing
building or structuref or for any alterations or repaira to any exiating
building or atructure, upon application therafore, require the payment by the
applicant for such permit of fee� to the amouat herein below �et forth and in
the manne�°herein provided to-wit: � �
2�.1:�� For any such�permit fo� th�-erection�of any fire-proof buildtng,
othei than a garage, warehouse, factory o� grain elevator, or for the erection
of any fire-proof addition, for s�imilar occupancy, to any eaisting building�
ahall be at the rate�of $1.40 for each on� thousand cubic feet, or fraction
thereof, in such cubical contenta.
2.2 For any such permit for the erection of any fire-proof garage,
warehouse, factory or;gzain elevator, or for th�e erection of any fire�»proof
addition, for similar occupancy, to any egieting building ahall be at the
raee of $1.25 for each one thousand nub:ic feet, classified ae "fireproof01
by Sectioa 502 of the M3nneapolis Building Code.
SOIISES
2.3. For any such permit for the e�ection of any noa-fireproof
building, other tban a garage, ware�ouse, factorq or grain elevator, or
any non-fireproof addition, for eimilar occupancy, to any existing building -
pernuLt $1.00 for each one thousand cubic feet.
GARAGES
2.4. For any auch permit for the erection of any non-fireproof garage,
warehouae, factory or grain elevator, or for the erection of any non-fire•proof
addition, for similar occupancy; to any existing buiiding or for each �uch
build3ng or addition - ninety cents ($0.9A) for each one thous.and cubic feet
or fraction�thereof, in the cubical contents thereof with the minimum of $4.00.
For the purpose of computing fees for build�ing permita, the cubical contents
of any building or addition to a uniform height throughout by mulCiglying the
ground area covered fram a point si.x (6j inches�below the floor line of the
basement or cellar to the average h�ight of the upper surface or to the average
height of the roof sur£ace of the uoain gable of a pitched roof.
2.5. For repairs.or alterationa to an existing structure, the fee shall
be at the rate of $3.00 pa�r each Five Hundred Dollare ($500.00) or fractlon �
thereof in the cost of all prz�posed work.
2.6. In no case shall the fee charged for any permit as aet forth in
Section 2 be less than $4.00.
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STORM REPAIR DAMAGE FEES;
Residential:
Coumnercial;
� ` . Y4
Eatimated Cost of v�ork up to �5C�.00 -$5,�0
Estimated Cost of worac o� a� ;`� ��«'t� ��U -$� L, �0
�� �
Estim�.t�''�Gost of wr,�l� u� to �`•�'�rLt!J -$:Y'��0
Esti��te� Cost of wurk oti�er $�G�.vO -$�..,00 ,. , a
SUBJECT oE " � 619 7
City of Fridley
' ` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ECEIPT NO
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� �L _.____ COMMUNITY DEVELOPMENT DIV.
r j � PROTECTIVE INSPECTION SEC. �/ ��.l
1 ; ( V
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� � /"'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BV
�""""� � ,�� 612-571-3450 910-F15 5/21/81 / /
JOB ADDRESS 124 Gi.braltar Road N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ]_9 2 ed�],gpn,� g$�II�nl't M3IlOi S011'tY1. SHEET
2 PROPERTYOWNER MAILADDRESS 21P PHONE
Dale Cruse 124 Gibraltar Road N.E. 561-0681
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
A1 Baker Construction 2531 Tnt. Medicine Lake Drive, Plymoutli 559-9673
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USEOF BUILDING
Res idential
7 CLASS OF WORK
❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install steel siding on entire d�aellin
9 CHANGE OF USE FROM TO
STIPULATIONS ,
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET 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 LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTiNG OF A PERMIT �2� QOQ yS`�.. QO
DOES NOT PRESUME TO GIVE AUTHORITY TO YIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
1STRUCTION R THE PERFORMANCE OF CONSTRUCTION. y4`�.2. QO
PLAN CHECK FEE TOTAL FEE
,l S�'.� /- �� $13 . E10
SiG E Co THAC OROR UTHORIZE�AGENT IDATEI WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT
'� �� /` �� .� �. a°
SIGNA REOFOW ER�IFOWNERBUILDERi IDATEI � BLDG iNSP � E
czrY ar Fi�1o�_cY .
A('PLICRTIO'J F�OIZ (tESIUEi�IT1/1i_ allILf)T.ilG PGf��iTTS '
(fJe��r, 1t1 ter��tions, /IddiLions, or Re{�airs)
� O1�J1lER: �ci\e..�C:�,c�.a.�a.c. ',. . L'UILpE:R: -�1 C3c,..k.e.� C.�n;�t��►.c,}�on •
ItDDRFSS: �a�► _f���;�c�.\'��-c _� _�- ADDRESS: �.�3� � 1-�let� ����ti l_c>.�e. l�cv�e.
TCL h0: - . _ _ ��yr.�,d,�.�-4. , y�r�r. SS4`11
_ Sb� • ObB1 TEL (�d�: SS��1�`�3
� Consi:ruc�ion Location '
. s�cz��c rio : 1 a�1 sT��:T: C� �\ b c c►.\ � e. c
Lo7�: / 9 $LOCfc : � �nnz�rzoia : C�2CSd.�1's Sc:�m mt •— !�fl-,vo 2 �2r
Corner Lat: Inside Lot: SetbacY.: Sideyards:
1�p�licant at�ach to this form tcao Certificates of Survey of lot and
proposed building location drawn on cert.ificates to sGale. ' .
DESCRIPTIOf� OF C�PISTRUCTIOPd • �
����� �S� I'ront: � Depth: Height:
Square �'eet: Gtiibic Feet:
0
1e'ront :
Squar.e� I'e�t: �
DePth : H eight:
Cubic I'eet:
Type of Consicruc�ion: S�-e.�.� S� stimated Cos�: $�oss�oep
7b $e �r�pleted: 3w�¢� �S \q�1
` . . Alt. A Alt. B
Praposed Drivec•iay �vidth If New Opening Is Desired: $' $
. .. S�E Rc.VERSI: SiD� OF SHEET
Ziie undersigned hereby m�}:e� a�plic�-ttion ior a permit for the �:nrJ:� herein specified,
agrceing to c�o ,all work in s��r�.ct c'1CCQYCIance �•�ith the City of Pridlel� Ordinances and
xulings of i:he Depart-ment. of Bu.�].dings, and hereby declares that all the iacts and
represen �7tioz�s stated �n this application axe true and correct.
D7:T�: _ �eZ�! � f SIGN21_CUF`.E :
Sti��ulations :
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. � . I3U11_J)Ih�G�('f_f�M�YT r��:�� :�r.�lrr�ut_��� � .
F;1�:C:'!.':C012 2. � 7.']i� 7n�.c��ecic�r. of' l�u�.lc?i���J :::)u�l.)., }�cfor.r. i.r,::ui.�ig l.�c�iniL•:; f.ox [:hc erccL•i.on
af .,.ny l�u:;.l.�l.i.�,;� ar. .:,I:�"UG1:111'C� w- Tc,�: t,na� acicli.t:S�,n !:o any c�:S.�i.3.iuJ l.,uilc]i.nc1 �L :;L•r.uc�ur.c.
. ci�' i:c»� tu�,y ci.l.t:�.r,.�L•i�,n or. r.c��ai.r.s� t�o •any c�:i.r.I;].)lC{ �)11).�.C�7J1'l or. .;L�:uctti•r_c, uj,c,rt ar�J�1S_c:at.i.a»
�th��r..:f.or.c, r.cqu.i.rc t.11;,� p��ymci,t: 1�y tlic ax�z�].�.c:an!: f.`ar. s�ucli per.mi.L• 01: fec:; ta tLe �naunt•
hcz�:i�i bc.l.o�•i sr.L for.tli �u�d i.�i �hc i�anrien c�rca_n r»:ava,cl!:cl L•o-e::it: .
171:1�1 COIJ�;�I7:IJC5CI01�: Singl.e l.'c�mil.y tl�ire� and Ga�-�zc�cs: ;:4.00/).,0�0 euL-i.c fec:t:. .
).'Ll:�l CI11:C7:: 25 Z�er.ce��t: �L• i�u3.].cii_�a�J J�cr.miL i'ce.
Uli]:l�I'sl•;nY llL•'1'P.c:5S:�0I•:: (CqncrcLq C�irb ;Lr_cets Only) � �
' Rltcrnat:e l�: ltcinoval a�id rej>J.acen�eilt oi coricrete cazb and
qui:L-er only; l�riveway ti��idt}i p].iis 6 feet• r. $13. �0 �
hlt:erneiL•e II: 32rmoval and rei�;.acem�,�t of concrete curb and
• gui:ter and iiistall a 3 f-oot �aic�e anproach t.�ith ''
.� 6 5.nch c�epth; Drive;•ray �•ric:th �pl.us 6£eet x$1S_. 75
• . �n1 i� onn� 1 r�J�o��;,�nLi ohd
For the pur���e �� CO�t�7ti'Z.I�i�� {�S ior-lrstr��.z�ing perrnit.�;,. i:iie cul�ic�ZT co:ztents o� any
build�.ng or a.ddition, is deL-cr.tnined by rnultipl_yi.ny ihe ground area c��vcred L-ro:� a
point sS.:t (G) inches below LYie tloor 7.ine of tlie basemcnt: or the cel.lar to 'tlic
averac�� iicights oi the �upper surface or t� ihe averaye 2ieight of the roof surf:ace
oi i:he r►ain ga}�le of a pitched rooi. '
Fox ze�ai.rs or a7.tFrations to an eyisting strticture, ti�e fee shall be at the rate
of .�3 . QO per. each fivc hundred doJ.lars -($500. 00) er fracLion tllerc:af in the cost
oi-' all proposed wor.Y. , • �
In •no r.ase sha�.l 'ihe fce clZazyed i'c�r any pexlnit as set iorth �.n Section 2 be less �
'EZ2d11 $7.50 Plus $.50� state surcharge. � • '
_ veRrFrc�Trov oF r-ou��nn�-ior�
NOTE: Pennits �or cons.L-ruct•ion cri].1 be issued a minim�n a� 24 hours fr_om the ti.me
nt a�plicatian to �l.low �or �roper rcview of i:he proposed si-ructure and of ihe
construction site. '
11 Certificate � o� 5ui-vey of the lot, sho�,=ing the locai.ion of the foundation once 3.t
has bee2z cons �ructea i,*aLIJ_ �b� req�z�ec� !.�e; c�r� ��::=�:��a,��I thc fraxnixiq .
�t=.$IIFJGATE �F ���UP/1(�CY ' � '
?►PP1ica�ic�n f:�r a Certific�te O� OCCIlp�'lI1C}l sh�].1 be mac3� ten (10) da�►s pri.or i:o the
use or OCCLlZ?�11Cj7 oi an}� st�.ucture £or �rlxicli a L�Uilc�:i_ilg pennit l.as been issued; and
stiacl struct:u�-e : hal.l_ iiot L�e used oz- occupiecl t:zi�il a Ccz�j.iicate of Occul�;tnay h�s
�CCIl xssu4ci.
0
0
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Building BUILDING Permit No.: � �?��-
Inspections RESIDENTIAL APPLICATION Rece�vea By:
763-572-3604 CITY OF FRIDLEY Da�dO 0
DATE O� YOUR E-MAIL ADDRESS
SITE ADDRE S � 4 � �
THIS APPLICANT IS: ❑ OWNER �CONTRACTOR
PROPERTY OWNER/ NAME: � �
TENANT ADDRESS: �
�(r� _CI1'Y STATE ZIP
�CQ_U �WLr1lCOZVS Q�IlC�D00YS
CONTRACTOR 15300 2SthAve N
�1�071t�Z '�I�I'I �'S'��% p DATE
SUBMIT A COPY OF Lic#20165884 3 31 08
YOUR STATE LICENSE �� � CI7'Y STATE ZIP
WITH APPLICATION 763-355-1300
PROPERTY TYPE LE FAMII.Y W CONSTRUCTION SIZE_ _
O TWO PAMILYINEW C�NSiKUCTIUN 51'GRIFS
PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED i�JVINDOWS
❑ BASEMENT FINISH ❑ ROOF O DRAIN TII,E
❑ DECK ❑ SIDING � OTHER
❑ SWIMMING POOL
TYPE OF WORK: � N�' � ADDITION D_�Q �
❑ MAINTENANCE/REPAIR ❑ REMODELING N`•
DESCRIBE WORK BEING DONE: �,Q�j,C� � ppw tAY W�CvJ Nv �{�`AnJI c!(`el�Krj
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S. Ft.
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan
PROPOSED SIZE: O DETACHED GARAGE 2• Proposed floor plan
PROPOSED HEIGHT: 3. List of structural members to be used
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl OSoffit ADDITIONS_ & PORCHES SUBMIT•
❑ Aluminum ❑ Trim l. Site Plan/Survey showing the existing structures
O Other � Fascia and proposed project.
VVINDD�,VS I 2. Two sets of construction plans
IN EXISTING OPENINGS es ❑No LOCATION OF WINDOWS G�i l�1 ��� � 3. Energy Calculations
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES & --`
TYPE OF WINDOW TO BE INSTALLED W NUMBER OF WINDOWS
ALL NL� EJ Alt� IfAJEll U1V VALUA11U1V� 11V(;LUll1N(i'1'HL�' (:U5"1� Ul�� LABUK ANll MATERIALS:
Q�2(� (USING TAE 997 U.B.0 FE SCHEDULE)
UiJ ! � TOTAL JOB VALUATION $,� � �--�� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surchazge
Surchazge
License Surcharge
SAC Chazge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ �(� �.,�5' See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ �� .001 times the total job valuation
$ �� .0005 x Permit Valuation Minimum $.50
$ �u� $5.00 (State Licensed Residential Contractors)
$ $1675 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$/,�( � S¢ Make c6ecks payable to: City of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge thaY the information above is complete and accurate; thai the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work w �i requires review and app v�l o plans
SIGNATURE OF APPLICANT 4��ME�Q� N.�C�Y, ��DATE C� 2.3 c7 .