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iCity of Fridiey, Minn. i
BUILDING PERMIT x� ss2o
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[� ._ . .�_ Builder _. .._..........._.__...._...._..._._..._..__....---
Address__--_...__,..._._._.—.._.._._._.....:._.. _.._..._...._ Addreu
Na ��.fe_.... S4eet �O�_� 1 . .�'s.sa+a'r f /
Lot _._ --•--°- Block _�orS.._......_._..__._. Addit[on or Sub-D1vLion�..j:
J �
Corner Lot _._�_..._._.__ Inaide Lot ...._.._,��.. _... $ethack �_..._.�....__ 5ideyard
3ewer E7evarion ...__...__.._.._...__.__�...._. ___.—...._._._._ Foundahon Elevation ...�....._
� DESCRIPTION OF BUILDING
v �Ic'�,�p� i/ p.� /�/
_. _ PY�oat _'��L�. DePt6 �._� Hei6ht E_ZL._.. S4. FC 1L.aL.jQ
_ _ y �� ._..�,�_//"�,�-�+y ��jy,��/Q� �. �. �z�
lype of tructlon Cy����Rrt,�,ri�l.� Eat. Cost ...."/. ._i] ...i[...L/-l/..�lx Com8leted ...
Cu. Ft�E4,�.�Q
GSi. Ft .y�,�0
xn conaideration of the issuanae W tne of a permit to construct The building deacribed above, I agree to do
Uu propoaed work in accordance with the d�scription above set for and in �gy with 1 provisions f
oadiqaaoee of the dRY of Fridley. //
� .C�/
Ea ca�sideration of the payment of a fee oE
Permit is h.ereby granted
. to conatruct the building or addiUon as described above. 17us permit is granted upon
the exPrnse conditlAn that thepe rson to whom it is Sraated and his aS�ta, emploYees and worlanen, in all work.
dare in, around and upon said building, or any part thereof, shall conform in all reapects to the ordinances oP
Frldlel'. Minnesota regarding location, conatructiun, atterat�on, maintenance, repair and moving of buildings
within the dty liffits and this Permit may be revoked at arU' time upanv�p oP any of tbe P�viaions of caid
ordinanc�. /'1 � n/ 1
BuildlnB �'
NOTICE:
iNs P� dw �M eowe 1M mmtraeHee� Ieq�IlNkn Mr w(d�y. Plunbbo. YN hN1(ny, awu et wM�r. N wn ro sw
Ila lvlidi�y I��eMr for apn�M pw�ih /er 16u� IMm�, � .
7 _ . ..
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNGR' S P7AME O/!//,t �� ,(r v lj U�// BUILDER
ADDRESS ��O S/�/GI6 HNo� A� ADDRSSS
/�� � a
LOCATION OF ING
No, �,� (p Street Part of Lot
Lot�_Block_�Addition or Subdiviaion �
Corner Lot Inaide Lot ` SeCback � S , Side-Yard / � ��
SEWER ELEVATiON FOUNDATION ffi.SVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates.
DESCRIPTION OF SUILDING
Ta b sed se: / �
-�/�'�
Front pepth ��J Height �-�
Sq. Ft. Cu, gt,
Front�_pepth�_Height � �
Type of Construction
To be
Sq. Ft. Cu. Ft.
Estimated Cost
The undersigned hereby makea application for a permit for the work herein specified,
agreeing to do all work in strfct accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
r.epreaentationa stated in this application are true and correct.
DATE
i � .
il�. i�� !%
(schedule of Fee Costs can be found on the Reverae Side).
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, sus�ctr � . . �. � � PER . ...
City of Fridley 3 i 8 6 8
�"ME'°°°°'�E,�„N5 BUILDIN� PERMIT
� � � � � HECE� . �
� �� COMMUN�TY QE�EIQPMENT OIV, 572-3604
r � v � PROTEGTIVE INSVECT�ON SEC.
�
t
� _ /"9 � CITV N�IL Ffl10LE� 63�J1 NuM�EA � pEV O�Tfi o�GE OF �ovRO'/ED !r
i.---� • •,' 612-571-3450 9to-F�5 6/1/O1 / / �
�oe �ooaess 136 Glen Creek Road NE -
1 �EGAI �OTNO. BIQCK � TR�CTOit��DITION SEEATTACHEO
DESCN. !} 2 Oak.Creek Addition P1aC 2 SHEE1
p PROGERTYOWNER . MAILADDRE55 21V PFIONE
Paul Bauhahn 136 Glen Creek Road NE
9 LONTRACTOF MAILADORESS ZIG PMONE LICENSENO
Richard Hastings Contr 6331 Riverview Ter NE, Fridley, MN 55432 574-996b
d qRCMITELTORDESIGNEN MAILAOORE55 � ' ZIP GNONE IIGENSENO.
4051
5 ENG�NEEF MAILAODRE55 . ZIi PMONE LICENSENO
6 USE OF BN�DING � �
Residential
7 ClASSOF WOpK ' '
❑ NEW O ADDITION O ALTERATION �� HEPA�H O MOVE �� O REMOVE
B DESCRIBE WONK � �
Reroof House & Garage (22 Sq) Tear-off
9 CHANGE OF USE FpOM TO
STIPULATIONS .
Underlayment must comply with the State Building Code.
TYPEOFCONSi. OCCUPpNCVGROUP OGCUPANC�LOIID
SEPARATE PERMIT54RE AEOUIqED FOR EIECTqICAL, 7LUMBING. MEATING.
VENTILATING OR 0.1R QpNDfT10NING. � � -
TMIS PERMIT BECOMES NULL ANO �OID IF WORK OF GONS7RUGTIOM ZONING SQ FT CU F�.
nUTMORIZED IS NOi COMMENCED N�ITHIN 80 DAYS. OR IF CONSiRUCT10N �
OR WOFK IS $USPENDED ON 4BANDONEO FOH A PEP100 OF 120 DAYS A7 '
RNV TIME I.FTER WOPN IS COMMENCED. ' NO. DWLG. UNITS OFFSTREET GARNING
I NE�7EBY CER7IFY TNAT 1 HA4E pEAD AND E%AMIN�D iM15 APp�ICI.TION 1 $iALlS GARAGE$
ANDKNOWTMESAMETOBETqVEANDCOAAECT.I.LIPROYI$IQNSOF�AWS yAWAT1ON SUi1TAX
nN0 ORDINANCES GOVERNING TMIS TVGE OF WOFK Wlll BE GOMVUEO �Z�ZSQ . �l.lz
WITM WNETHER $PECIFIEO HE:�E�N OR NOT. TNE GRI.Ni1NC Of A VEAMIT
DOES NOT PRESUME TO GWE AUTNORITY TO VIOL�7E OR CnNLEL THE pEAM17FEE SACCMApGE@
PAOYISIONS OF 4NY OTNEF 57ATE OR LOCAL tAW REGULATING CON� @83.ZS Fire SC .yZ. �LS
STRlIC710N OF TME OERFOFMANCE OF CONSTRUCTION '�
�� � � / VUNCN CR FEE Tp 4L FEE
Licens $5.00 91.62
S�G�+�ruaEO�CO�+'A�CiOAOa�u� Ai2ED�GEMi �TE� EN FOP ��LIDA 0 TMIS IS Y R P. Ij.
U
S�GN�ruaEO�OwaEA���Ow�+EnBV4DEA� � � i �� � . � � B� �iq5o � � n<�k
NEW [ ] Effective 1/1/2001
ADDN [] . CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMITAPPLICATION
Construction Address: ��� GLt K� CIZ� E{� lZc�
Legal Description:
Owner Name & Address: �AH � t3 Ft u h,+� �i N Tel. #
Contractor. ��c�i /�ft � �A-�'�i K 6 S MN LICENSE# �p5�
Address: � 3 3 l �� �4=-'!�U <<= �J fiEtZ� Tel. # S�7 �i — l`'���
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a CeRificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length _
Length _
Length _
22
DESCRIPTION OF IMPROVEMENT
Ind.7ii
Width
Width
Height Sq. Ft.
Height Sq. Ft.
HgUGround Sq. Ft.
Construction Type: I�� 1� pFr c�-it�dPAOI� Estimated Cost: $ ��S`�
Driveway Curb Cut Width Needed: _Ft. + 6 Ft =_Ft x$ _
DATE: � n / APPLICANT: _C����/�/ i����- Tel. # S � � ` � 'j���
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ �-�� Fee Schedule on Reverse Side _
Fire Surcharge $—�J �:001 of Permit Valuation (1/10th%)
State 3archarge___ �_ _�__$.5�/�1,G^u0 Valua`�on - - _ __ _
SAC Charge $ $1150 per SAC Unit
License Surcharge $ ti�. DO $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
TOTAL
STIPULATIONS:
$�
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