AF - 45615City of Fridley, Mann..
BUILDING PERMIT
N° 5963 ' i
Date: .��.� '�"(IR _..—.._..._._._�
Owner: f��"�'�- _ Builder _�����M��� .... _...:._.._._....._ _
Address_...---........_..—_..__...---.._....__.__...-----..._.__ Address _.._......__._....—...._._.__.._.._..._.....__......_.—.......�._._...._
/'' / OCA'�ION� LD�II G ,,:
No. .�F �a� Strcet . -�eAMG����'F�'�G�'�.__... P �;L�. �,�W��� .�
Lot _',%; �..—__ Block .__. . . .. . Addition or 5ub-D' ' on _R{�.d'
7� --. -..--. _.. _. _ / /�J ��.`}
Corner I.ot ____..._—_ Inside Lot .__._. �. Setback ...s�.�� -..__ Sideyard _..._,C. �!"='.......:._�f f:.__.—._
Sewer Elevation-
Foundatioa IIevation
DESCRIPT60N OF BUILDING
To .�. . Used • . � � �
_ �. _.....- � Front �#� DePth ��-.. Height �_...�.r....._.. Sq. Ft ���
.. �. .. �—.. . � � n � �^'�..._. Depth _„� -� Height �� Sq. Ft y����
�e of o�tion . ... _ . � � .�� ... _ � Est. Cost �.¢'�.� _���--_ To be Completed ...___
�.
eu.
F�I�q��/'�
r^t,,.d I-L._s'r"
In consideration of the issuance to me of a permit to constrvct the building described above, I agree to do
the prop9sed work in accordance with the description abme set forth and in compliance with all provisions of
ordinances of the city of FY�idley.
Ea consideration of the payment of a fee of $�.�.C'�� , permit is hereby g�anted
' _ —_ to construct the building oi addition as described above. This permit is granted upon
the express mndition 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 rnspects W the ordinances of
Fridley, Minnesota regarding location, construction, ffiteration, maintenance, repair and moving of buildings
withix� the city ]imits and this permit may be revoked at ax�y tvne upon violaj,ica-et a�y of the provisions of said
ordinances. /"f tlAi .''� �
Building Inspector
NOTICE
Shis p�emN doa not covor �hs aonstwc�ion, iroralLlion for wirmg, piumbing, paa he�ting, awar w watsr. B� auro ro sM
IM 6uildinp In�p�ceer for wparaN permil� for f6�a il�ms.
4
_ : r�
Ownar'8
APPLICATION FOR SUILDING PERMIT
CITY OF FRIDLEX, MINNL'SQTA
Address 3S3?- - S��,ce�? di. Address .�,�a - 3- �.C)�
oF suxr�xNc
No. /�(a.� 3treet��lEiC G�yW�art of Lot
Lot !� Block Addition or Subdiviaio dl Z�
� �
Corner Lot Ineide Lot Setback-��Side-Yard 1%
S�R FLEVAT20N FOLJATDATION ELEVATION
Agplicant attach to this form Certificate of Survey of Lot and
proposed building location.
To be used ase
DESCRiPTIODi OF BtTILDI1dG
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost
To be Completed
The undersigned hereby makes application far a permlt for the work
herein specified, agreeing to do all work in strict accordance with
the City of Fridley Ordinances and ruling of the Depaxtment of Huild-
ings, and hereby declares that all the facta and re esentations �
stated inrt�iie agplication are true and correct.� p4s�
Fee Costg can be found on the Reverse Side).
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HEAT LOS.S CALCULATIONS DEPAfYtMEKf OF BUILDINGS ' hIINNEAPOLIS, MINN.
Weat6eratrips A'S' 'V' ' Conattuction No. Iosulation
Guide
Windowa ( Dooro I Reference I Out. Wall [nt. Wall C,eiling Roof Floor II Kind How Applied
Yea—No es— 0 19—
,Fl.� �, ?� Room L.eneth ={ Width ( Height „ Fl,� 1' j� Room Length � 3 Widt6�� Height �
Windows and Doors—Crackage and Area Windows and Doora—Crackage and Area
Wtdth Hmlghi- No. o! Llneel [S. Are¢ Wldt� Hels�t No. o[ Llneal ft� Area
No. of oane of9¢ne 11¢�te of crack ��U. ft. - No, ot oave of pnne Ilehb - o[ cnck ea. tt.
�
Infiltration � ; 4�
Glaaa
Exp. wall X � tj X
Net e:p. wal!
Int. wall
Required aq. h. E.D.R. or eq. ins. W.A. Leader area
! Fl.� "hj '.`_,'✓ Room � l.ength C� Width
Windows and Doon—Cracicage and Area
Wtdth Hefaht No. ot Lfneal it. Aran
No. ot Dane of yana 11[hls of enek p. [[.
t 7.i: f. ';. D12 M4 '�1.
�866 � . ��, j C
Fap. wall K °�`
Net exp. wall � r'
Int. wall
Ceiling �f 'j
Floor
Tota! Bm.
Required sq. fL E.D.R. or aq. ina. W.A. Leader area
t�.I�� ti,+�' �, x� ���h -�,p w;a�►, ��1
Windowa and Doore—Crackaae and Area T
Infiltration
Gles�
Fxp. walt j " Y
Net exp. wall
Jn�..�wll 1
CeilinB yC /�
Floor
Btu
Btu
. �
� l'> (: f.") �I
L•�
Infiltration
Glua
Fap. wall f v y
Net up. wall
Int. wall
Ceiling ,d � 3 K
Fluoc
Total Btu.
Required aq. ft. E.I
FI.I�l: 1 i`—d�J�p{
Windows and D�
wlatn Het
Na ot oana O[ D
or nq. ins. W.A. Leader area
�m I l.ength � Width '
—Gackage and Ares
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tlgTb o[ crack W. [t•
! �,lS ��,
�esE � ,y� � '
Exp. wall � � �. �r. �- ,".
Net exp. well *""
Int. wall
Ceiling � / `
F7oor
Tota1 Btu.
Required aq. ft E.D.R. or aq. ina. W.A. Leader area
j FI. �� i�`�j Room I Length ��? Width S�
Windowa and Doora—Crackaee and Area �
Io6ltratioa
Glaaa
Fap. wall � y `� ;[
Net ezp. wall
Int. wall
� II Total Btu.
E.D.R. or sq. ins. W.A. Lea�r area Required sq. ft. E.D.R. or sq. ins. WA. I.eader arca
Btu
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HEAT LOSS CAIiGIA.ATIONS DEPARTMENf OF BiJILDINC.S
Weathaatripa Gu� Conatcuctioo No.
Windowe Doora `Reference Out.lC�al1 Int. Walf Ceiling Roof F7oor Kind
Yes— o( Yea— o II 19_ I I
` Fl.� �"4 ( Room Lengeh Width Height F7.� Room � L
Windows and Doore—Crackage and Acea `� Windowa and Doora—�c�
Glaas �
F.�cp. wall 'j ►C �!
Net exp. wall
Int. wall
Ceiling � ti[ � ` q
Floor
7'otai Bw.
Required sq. ft. E.D.R. or p. ina. W.A. L.eader area �
I Fl.� #'� �t� Room Length I I� Width 11 Height
Iofiltratioa
Glu�
Exp. wall �
Net ezp. wall
Int. wall
�Ceiling
Floor f
Total Btu.
Requiced sq.
t�.I+�sG
•x��" li`ti
i.R. or sq. ina. W.A. Leader a
Room �Length � ;1.9 Width
ara—Craekaae and Area
Exp. wall �:�j7 �! �
Net e:p. wall
Int, wall
Ceiling
Floor j �5 x � �
Total Btu.
Requircd aq. ft. E.D.R. or p. ina.
ares
�l4
L \G
!�
. MINNEAPOLIS� M[NN. ��
Insulacion
How
Ace�a'
Infiltration
Glaaa
�P. Weu
xN �=P. Wau
Int. wall
Ceiling
Floor
Total Btu.
Required aq. ft. E.D.R. or sq. ina. W.A. Leader area
F1.I Room I LeoHth Width
Windows and Doora—Crackage and Area
` W1atn HHght No. ot L4nee7 tt. A�rea
nlnnn� �ISti1� nfrrMk [L.
Glaas
F�cp.
Net e:p. wall
Int. wall
Ceiling
Floor
'fotal
sa. ft. E.D.R. or aa. ins. W.A. L.eader area
I Length W
:rackage and Area
ta. o[ Llnenl [t. /
tehu o[ enek si
Btu �
� Infihration
� � - Glaae
Exp. wall
f �: ; ;L Net exp. wall
Int. wal!
Ceiling
Z � i�: � Floor
IKeqmred aq. tt. t.U.K. or aq. ins. WA. Leader ana
Btu
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sus�scr � PERMI O.
c�ty of Fridley �� 5$ a
�.'� qTTHETOPOFTHENJINS gUILDiNG���PERM��IT � � �
, � . .. � R EIPT N0.
� COMMUNITV DEVELOPMENT DIV. �
��r � L PROTECTIVE INSPECTION SEC. . � � ljs'�
�
i-.-_� ��'° ,.� CSTY MALL � FqIDLEY �55a32 NUMBER aEV. oAtE PACE oF appqo�ED 6r� .
L � 612-571-3450 g70-F15 / /
7 22 80
ioe aoor,ess 1463 Glacier Lane N.E,
1 LEGAL �OTNO. BLOCK TRACTONADOITION SEEATTACHED
oesca. 11 3 Innsbruck 2nd Addition s"EET
Y PROPEHTVOWNEF MAILADDRESS � � ZIP PHONE
Larry 1SXYiiitd4 Ki.nney 1463 Glacier Lane 571-4526
3 CONTRACTOR � � � MAILADDRESS � ZIP PHONE LICENSENO.
Cla ton Follett Brqokl Center 560-0828
a�.ARCHITECTORDESIGNER �� MAILA�DflE55 ZIP PHONE I�CENSENO.
5 ENGINEER � MAILADDRESS � 21P PHONE � LICENSENO.
e USEOFBU�LDING �
1
7 CIASSOF WORK
❑ NEW ❑ ADDITION ❑ ALTERA710N ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORN . � .
1 L
9 CHANGE OF USE FROM TO �
STIPULATIONS � �
SEAERATE PERMITS REQUtREp FOR il�FRft4G,
HEAflMG� PLUMSlNG ANO SIGNS
TYPEQf CONST. OGCUPANCYGR�UP OCCUPANCYIOAD
SEPARATE PERMITS ARE RE�U�RE� FOR ELECTAICAI; PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. � � �
THIS PERMIT BECOMES Nl1LL AND VOID If WORK OR CONSTRUGTION ZONWG� SQ.PL � CU.FT.
AUTHORIZEO IS NOT GOMMENCEO WITHIN 6U DAYS, OR IF CONSTRUCTI�N
OR WORK IS SUSPENDED OR ABANDONED�iOR A PEFIOD OF 120 DAVS AT �
ANV TIME AGTER WORK �S COMMENCEO. NO. �WLG. UMFS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE REAO AND EXAMINEO THIS APPUCATION 1 � STALLS G/+RAGES
ANDKNOWTHESAMETOBETRUEANDCORFECT.ALLPROVISIONSOFLAWS yq�UATION � � SURTAX
�AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO $`Z�OOO SZ.00
WtTH. WHETHER SPEGIFIED HEREtN OR NOT: THE GRANTING OF A CERMiT �
-00ES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE O(7 CANCEL TME pERMITFEE . SACCHARGE
PROVISIONS OF ANV OTMEH STATE OR LOCAL LAW REGULATING CON- $]_Z.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
� PLANCHECKFEE . TOTALFEE
$ 3.00 $16.00
.�SiGenrU oi caN"AaC�oaoRaUrH eiZEOaGENr � ATEi y WHEN PROPERIY Kp IDATE� THIS IS VOUR PERMR
a.t�� Y�i 7 �.�k,�,� a� l�
� S�GNniUFEOFDWNEAIIFOWNERB01L0EPi I� BLOG iN5? OP E
0
CITY OF FRIDLEY � •
ARPI.ICA7I0i� FOR RESID[PdTIAL f3UILDIP�G P[RMITS
(Ncvr> Alterations, Additions, or Repairs)
04lP�[It: � �rr . L. � I1�1o,u .75A/4LrXn7.
ADDRESS: ���, 3 �J-�cL� �`�r l..a,v�e.� _
7I:L N0: c�'I/ -y'foZ�
BUILD[R: � _—a/�f'
"' • _ _
noorz�ss: � ,tfr�6 f �h en+er
TEL IJO: ��(1- DA,� �
' Construction Location ,
STRI;CT NO :_ 1�/� 3 _ STItEET: � I 121 � A.v� P. .,.�, —
IpT: `._�__ BLOCK: �_ IilIDITION.: �T�br uc� _� ��� i 1� 1 trn i
Corner Lotc Inside. Lot: SetbacY.e Sideyzrds:
Applicant attach to tl�is form two Certi£icates of Survey of lot and
proiwsed building location drasan on certificates to scale.
DESCRIPTIOW OF CONSTRUCTION
t1..1�JS.�— Pront: �' o?� � Depth: /°� � Height: � �� ��
Squar.e. Feet_�3� Qibic I'eet:
F�cr.�:
Depth:
Sguare Feet: (.13bic Feet:
Type oi Coizstruction: �S �
'iU Be � Cbmpleted: ��..� l. - Q:te���j 1'� I`1 ti� �� �
V C}
Proposed Driveway Width If New Opening Is Desised: _
Height:
8stimated Cost: $ p'��(9-p-�'O
Alt. A Alt. 13
$ _ $
$EE REVERSli SIDE OF SHEET-
Zfie under.signed hercUy makes application for a perniit for the work her.ein specified,
agreeing to clo all work in strict accordance with the City of Pridley Urdiiiances and
Xulings of the DePar���� of IIuildings, and heneby declares t}�yt all the fact-s and
represent�tions stated in this application are true and correct.
DATE: '/� SIGNATUI2E:
.�
Stipula aons:
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GEORGE E. HOPKINS • Registered Land Surveyor and Civil Engincer
Phoae SO. t-8856 t0701 Nicollet Avenue South
. � � � � Minneapolis 20, Miaa. �
PLAT OF SURVEY
. � �� � � � � 3cale 1 Snch 4� � �teet � �
PROPERTY UF �! Od`Jr°V Y✓ �i/%man
Dexribed es Lot l� Blaek 'j,�, LnnshrllCk '�xl Ad�i�inn _
' �'L0�
45.29 -
_ Uf�l�}y easemen�
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Rhia syrvey ttes made and certificate dramst Por the purpos� of shorring the
boundaries of the loi and ihe easement oP r�ord. There are no encroachmeats.
&iil.sling stakea raere not set. by the surveyor.
CERTIFICATE OF SURVEY
� � I hereby crrtity that an �_.�OG.e__: 19_�. I avrYeyed the property desvlbed above and tt�at the above ylat L� a coseet .
represenCation of sald aurve7 ' '/� �
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s�erec. PERM
'� City of Fridley � y� � F Q'
ATTHETOPOFTHETWINS gUILDING PERMI
�
� COMMUNITY DEVELOPMENT OW. �„ !
f � ti � PROTEC11vE INSPEC710N SEC. S l� a,�/f
i
, � ����I ' CITY HPLL fRIDLE� 55/3T NUMBER MEV O�iF P1Gf O� NPPROVE� BV
i"'"� � ,'' 612-571-3450 910-F75 11/8/96 / /
100 AODRESS 1463 Glacier Lane NE
1 LEGAL �OTNO. BLOCK TRACTORADD�T�ON SEEATTACHED
oesca. 3 1 Innsbruck Subplat 4 sNeer
2 PROPERTVOWNER MAILADORESS Z�P PMONE
Larry Kinney 1463 Glacier Lane NE 571-4526
3 CONTqAGTOR MAILADDFESS ZIP PMONE LICENSENO.
Cit Wide Builders Inc 12110 61 Ave W, P1 outh Mn 55442 639-1446 4968
a ARCMITECTONDESIGNER MAILADDHESS ZIP PMONE LICENSENO.
5 ENGINEEN MAILADDRESS ZIP PMONE LICENSENO
6 USE OF BUILDING
Residential
7 CLASSOFWORK �
❑ NEW ❑ ADDITION _O ALTEFATION ❑ REPAIR ❑ MOVE ❑ HEMOVE
7C
8 DESCRiBE WORK
Re lace deck (22' x 16')
9 LHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
TYPEOFCON57. OCCUPANCVGROUP OCCUPANCYLOAD
SEPARATE PEPMITS AIiE REOUIRE� FOR ELECTFICAL. GLUMBING. NEATING.
VENTI�ATING �R AIR CONDITIONING.
THIS PEFMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ,FT. CU. R.
AUTHORIZEO IS NOT COMMENCED W�THIN 80 DAYS. OR li CONSTpUCTION
OR WORK IS SUSPEN�ED OR ABANDONED FOR A PERI00 OF 120 DAYS AT
ANY TIME AfiER WORK IS COMMENCED. NO- DWLG. UNITS OFFSTREE7 PARKING
I HEPEBY CERTIFY THAT I HAVE READ AND E%AMWED THIS A7VLICATION 1 STALIS GARAGES
AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yp�UATION $URTA%
AND ORDINANCES GOVERNING TMI$ TYPE OF WORK WILL BE COMPLIED $2�661 $1.33
WITH WHETNER SPECIFIED HEREIN O(i NOT. TNE GRANTING OF A PEAMIT
DOES NOT PRESUME TO GIVE AUTHOFITV TO VI ATE OR CANCEL THE pEpMITfEE SACCMARGE
PPOVISIONS OF Y OTHER STATE OR LO L AW REGULATING CON- @
STPUCTION O E PERFORMANCE F CO T Cil .p]�i.%rJ Fire .SC $2.66
P�AN CHECK FEE TOTnL FEE
L ense SC $5.00 $83.74
S�GHnruREO�CO�+: cio oAnui a4E nGEmT iDniEi WHEN PAOPERLV VALI ED THIS IS �OUR PERMIT
/
S�GNaipqEOFOWNEPJ�OWNERBUM1OEA� � iD4iEi 6lOG 5� C���l
NEW
ADDN
ALTER
� l Effective 3/1/9'6 �a�
L ] CI1'I' OF FRIDLEY �� � �+�/'
[ ] SINGLE FAMILY AND DUPLEXES R-1 AND R- � ��1� �n, � � � ��l
Building Permit Application Z � ,��
( !,
ConstructionAddress: � 7 �b 3 � LA�,%�,� `.�wh �, � �(,�""`1
Legal Descripiion:
Owner Name & Address:
_ Tei.# S7/- �S ��
Contractor: C�� („��f> ,� � i [/_1 � S -1� c. MN LICENSE # � '�/6 �'
Address: _ I a I/ 0 6/�r � v� Gv . ln ��l�c oi1Nt Gkrv SS � y2 Tel. # � 3 9- i yv6
Attach to [his application, a Certificate of Survey of the
lot, with the proposed consuuction drawn on it to scale.
OF Il1�IPRpVEMENT
LIVING AREA: I.engt�t _ . Width ••Height Sq. Ft. • �.
' G�RA�E. AREA: : .L• engtli � � � • � -Width' � . ' ' ; Heigf►t ' � ' ' � Sq. Ft. .
� DECK AREA: Length � 2' Width l d, HgUGmund �� Sq. Ft. 3 O c� ��7
OTHER: I�,�%!s� c�,.� r> 16Y� � I/J,�' G/� =�ff, G l, �
Comer Lat [) Inside Lot [] Ft: Yd Setback -,_ .�: Sidt Yard Setbacks .
` 1j�e of Constructionc �'� GI�"` ., .: Estimated Cost: $ . S- o o u d—
Approx. Completion Date: J/% � o��_
` ,(Cost on'Back}`
Driveway G�rb Ciit W�dth Needed: Ft: + t= : Ft x$ _$'
DATB: �___y�2� APPLICANF: /l �� Tel. # � � % � / �i' �/�
' . ��--
• CiTY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surchazge
Driveway Fscrow
Emsion Control
Park Fee �
5ewer Main Charge
TOTAL
STIPULATIONS_
$ �7y ?t
$ d. U 4
$ /.�3
$ 5, �'t'
$
$
$
$ 3�y
Fee Schedule on Reverse Side
.001 of Permit Valuation (1liQkh%)
$SO/$1,000 valuation
$900 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary ( ] Not Necessary [ ]
�
�
,
GEORGE E. HOPKINS • Regis[ered Land Surveyor and Civil Engineer
Phone SO. 1-8856 � 10701 Nicollet Avenue South
Minneapolis 20, Mian.
PLAT O�' S�T�VEY
PROPERTY �OF
�' .e i • ��'�t ��.• i�� a�
H
"^' deqc�e5 ircn manumen�
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2
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�OT —�_
M '
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,
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R�2o6.ea M � M
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3cale 1 inch 4� teet
'
This survey was made and certi4icate dramn for the puzpose oP ehoxing ths
boutda.ries of the lob and the eas�ent oY recorri. There.are no enCroachmazsEe.
BniZding atakea were not set.by the ssu�y�eyor.
N
CERTIFICATE OF SURVEY
- �� °�• -- Dne.. ___ �g_,� I surveyed Ch`p, p�.p descrlbed above and that the .above plat L� a cotrcet ���
. � ' <' / /% _ � ..�
�
- . suu[Gr .. . . � , � � P .
� City of Fridley 3 0 � 7
RiTNE10POF?NE7W�N5 g���DING PERMIT
;.
� � COMMUNITY DEVELORh'IENT D�Y. ^
��� � � PROtEC�1VE 7NSFECT�ON SEC. 572�'3s� ' �
r � �-.
�
� � I�'•� . CITY N�LL FRIDLE� 55�32 MUMBFR AE4 O�TE OWE . pF �voFOVEO !r
�""'� � �'' 61�-571-3450 g10-Fi5 8/13/O1 / /
IOBADDRESS 1463 Glacier Lane �
f LEGA� LOTNO. BLOCN �� ' �� TRACiONADDITION . SEEA7TALNEO
oESCa. 3 1 Innsbruck Subplat 4 s"EET
1 PROPERTYQWNEF . MAI�ADpNES$� 21C PNONE
Larry Kinney, 1463 Glacier Lane, Fridley, MN 55421 763-571-4526
9 CONTRACTOR MAILADDRESS Z�p PMONE IICEN5EN0
Sela Roofing fi Remodeling, 4100 Excelsior Blvd, St. Louis Park, MN 55416 1050
� ARCNITECTOR�ESIGNER MAILAOOAESS ' ZIP �XONE �ICENSENO.
952-823-
5 ENGINEER MAILADORESS , Z�P PMONE UCENSENO
6 USE OF BUtL01NG -
Residential
7 CLASSOF WORK O NEW ❑ ADDITION D ALTERATION A5 � REPAIR ❑ MOVE ,� ❑ REMOVE
B DESCRIBEWORK � � . �
Re-roof (tear-off) 25 sq. (H S G)
9 CMANGEOFUSEFROY � TO
f
STIPULATIONS .
Underlayment must meet State Building Code.
� � � � � TVP -OF CONST. OCCUPANCY GROUP OCCUPpNCY lOI.O
SEPARATE PERMITS ARE REOUIRED iOA ELECTRICF�, PIUMBING. NEATING,
VENTILATING OR AIR GONDITIONING. � � �
THIS PENMIT BECOMES NULI �NO �OIO IF WORK OP CpNSTRppTION 20NING 50. FT. CU. FT.
AUTMOFIZED IS NOT COMMENCED N(ITHIN 60 OAVS. OR IF CONSiRpCT10N .
OR WORK IS SUSPENDED ON ABANQON�D FOR A PENIO� OF {� DAYS A4 '
AN� TIME AFTER WORN IS COMMENCED. ' NO. DM�IG. UNITS OFFSTREET VARNING
I MEAE81' CEATIfY THAT I MAVE REPD AND E%AMIN�D THIS APP�ICA7IQN $TALLS G4FAGE5
AND KNOW TME SAME i0 BE TAUE AND COPRELi. ALL pROWS10N5O� LAWS �yA�UATION SUR1A%
AND ORDIN�NCES GOVERNING TMIS iYPE OF WOAK WILL BE COMPI,IED
WITN WMETHEN SGECIFIED MEAEIN Qp NOT. THE GRANTING OF A VEFMIT �2,680.00 � $1.34
OOES NO( Pp£SUME TO GIVE AUTHOAITY TO ��OLATE OA CAMCEI TME pERMITFEE SACCHAPGE
PROVISIONS OF ANY T P$TATE Op IOCAL L4W REGUTAiING CON- @
STRUCT//IO��N R!H PMRNCE OF CONSTRUCTION � �H3.�LS Fire SC y��L.GH
�w r GL4N CMECNfEE TOTALFEE
�-13-°� License SC $5.00 $92.27
S�G�+aiuA � H'Pa�tOAOA�urr.Oa�ZED�GEh* �0�*E� WMEN OROPEaIY YA�IDATED TFNS IS YOUA PERMIT
S�GN�I�qEO�OW�+EA���OW�+ENBWIDEA� �O��E� � BLOG'ih5^ �� � ����f
N� I 1 Effective 1/1I2001
ADDN [] , CITY OF FRIDLEY �763) 572-3604 Bldg Insp
ALTER [] SINGIE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMITAPPLICATION
Construction Address ��� �S 3 G 1 G C � f�' �.. 4 h G ,/� �.� .
Legal Description:
Owner Name & Address: �4r� � il i n n<� Tel. # 7G 3- 5 71- �IS� 6
Contractoe MN LICENSE # � d s�'
Address: ��� �OFING & REMODELING, INC. Tel. # � 5�- ?f � 3 " $ °�/�
SELA ROOFING & REMODELIlV���is5'��ication, a Certificate of Survey of the
4100 EXCELSIOR BLVD. ° � e proposed construction drawn on it to scale.
ST. LOUIS PARK, MN B6¢16
ID �0001060 DESCRIPTION OF IMPROVEMENT
LIVtNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Length
Length
Length
Width
Width
Height,
Height _
HgUGround
Sq. Ft.
Sq. Ft.
Sq. Ft.
� v nr �r� / Q
Construction Type: �Zc�ro � R Lroo7' Estimated Cost: �,�J �f �4�(J�
Driveway Curb Cut Width Needed: _Ft. + 6 Ft = F $ _$
DATE: O �3 �0� APPUCANT: ^ Tel. #�Se�' ��3 ^�Gy�
CITY USE ONLY - Cali (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ c.>3.a�� Fee Schedule on Reverse Side
Fire Surcharge $ %� .001 of Permit Valuation (1/10th%)
State 5urcharge $ $.50/$1,000 Valuation
SAC Charge $ $1150 per SAC Unit
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ $- (�D $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Pian Review
$ Fee Determined by Engineering
$ Agreement Necessary [ j Not Necessary []
$�.o'- ��
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