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City of Fridley, Minn.
BUII.DING PERMIT
��: ..�":-.G.-.�'.9 ................
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N° 3�41
� ^ �Owner ....................................... Builder �riR/.f!y'!..!�................ ��f.I.
Addrees...................................... Address .............................................
LOCATION OF BUILDING
No. l A. ✓.42. . . Street . . `'Fl1rGeC.1t . .lV/Ir:iGl�t. .... .. .. . Par�tiD/L Lot .. .. .. .. ... .. . .
Lot ..o�o`�.... Btock ....oZ . Additloa or SubDfvlsionY•�lG.�6�J�.�..........
Corner Lot ............ 7nside Lot ............ 3etbac]c ............ SideYard ...........................
DESCRIPTION OF BUILDING
: �/
. � .... �,r. .y-�.6 n�n'Z.Y."�' x�ant %1.2.:Q �s4. rY. �Q�7. c,v. r-�. ��yS.6
............ ...... Front ........ DePth ......)..�{ H ht ....� S4. FY. ........ Gh Fk ........
ljpe of Conetruction ................... F�st Cost./. PC���.��%o be Completed ...................
/
" In consfderation of the issuance to me of a permit to conshvct the building deslbed above, I agree to do
� tlm propased work in accordance wiTh the deaiaiptton above set forfh and 'm oompliance with a11 of `� (/��
ord3nances of the� cit3' of Frld1eY.
X %%.
`,, ............ ����
.... . ... . . . .... . �.
In conaideration of the payment of a fee of S• °[ �.... ., Permlt ia hereby granted to
�
... .. .. .. .. .... ..... ..... to rnnstruct ihe � buUdlog or addition as described above. This permit is Branted upon
the exPreas condlUon that the person Lo whom it fe granted and his agents, employees and worl�en, ia all wa¢�k
done in, around and upon said building, or any part thereof, shaII � conform in all respects to the ord'mances of
FridleY, Mianesota regarding locahoa. construction, alteration, maintenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at any time upon violation of any of the aos of said
ordinances. � �
Building
NOTICE:
Thia parmit does not cover tha conatruotion, InstallaUon or alte�ation for wl�inp, plumbiny, qas heatinq,
sewet or.wabrt Be wre to �ea the Buildinp Inspeotor fo� separate parmib fo� thete Itema
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City of Fridley, Mi.nn.
BUILDING PERMI� N� 4�s .
Date: ..—.. +� _ '
f
Owner: � � . Builder _
. _.—..._._.._._...._..._.._._—....._......._.
Address _---------...___ ..__ Address
��T��K.�UILDING c c
�t . � S''�---� sc�t ,
—�--���
-- �� —�_ . � � Addition or Sub-D' ' 'on � � �� j i
Corner I.ot _..----- �de Lot _.__ � _ �back������� Sideyard _.S� .
_ ,---
Sewer Elevatlon _—.—..---- -.._ Fo datloa Elevation _.._.....__...------
DESCRIPTION OF BUILDING
To U /"/
_.. _.. • .�t- FYont /g / ��[/�
��-- �Pth �..t..__ Height J_..,�,��...__ S9. �. �� Cu. Ft f.I__�
--.........._. .._........____. FYo _._._.._.._ DePth —._-..y_,/�t� Height _....T�..__ Sq. Ft. _._...._.__...... Cu. Fk _...__..__..._
Type of Construction ��___ Est. Cos4!..y(.�_.� �"'"�~
�.... _.........._._..... To be Completed ....._...._..._._...-------
In consideration of the issuance to me of a permit to construct fhe -building described abwe, I agree to do
,a the proposed work in accordance with the descriptioa atiwe set forth and in compliance with all� pruvisiona of
�� ordinances of the city oE Fridley,
In consideratioa of the pe�yn�ent of a fee of °�
. —, Peimit ia hereby g�anbed to
to construct the building or addition as described atiove. This I�rmit is granted up�
a�e�sarouna and upon s�aid bw�'ldin orom it is �anted and his agents, employees and worl�en, in all work
��eY, �n�+esota regarding location,gcons��� ��ti' �� CO�orm in all respects to }he ordinances of
ordinances. atY ]imits and this °� �, maiatenaace, repair and moving of buildings
Permit may be rnvoked at any time upon violation oi aqy of the provisions of said
ZnsPector
NOi10E:
This p�nail doss eoe covar eh� conqryctio�, imhp�ry•on for wirin9. Plumb6�p, par fie�Kny, swr�r m wahr. H wn b sw
Ihs 6uilding Imp�ifor fer wparo» p�rmhs for Me» ipms, � .
4
' 6PPLICATION F�t BIIILDING P5R?SIT
. CITY �' FRIDIEY� AffNNtSOTA
O�mer's Name��/ l7l�l /J//G'! Builder 1 �.
Addresa 1(�.� /� .�A�/� [ L r�tAddresa
BRILDIHG
No. / d.� � 3tree t of
Lot a�' Block °�— Bddition or 9ubdivision
Corner Lot Insida Lot � 3etback Side-Yard
SF�lER EI�'yV�TION� : _ . FOt1NDATI(1�i, ELEYATION �,
Apglicant attach to thia form Certificate o�-Surney of I�ot and proposed building
locetion. ' ��'
OF BIIIIDING
To be used ea:
U _ / �
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[
Sq. Ft. ��� Cu. Ft.
Front Depth Height
Sq. Ft. Cu. F't.
Type of Conatruction_�T//liw._i% � � EstimBted Coat
To be Completed
The undersigned hereby mskea application for a permit for the work herein specified,
agreeing to do all work in strict accordance uith the City Ordinances axid ruling of
the Depertment of Buildinga, and harebg declares that all the facts and represet'itationa
stated in thie application are true and correct. J� //
� .. � r !X _ . I A// �
� / �
(A Schedule of Fee Coata can be found on the Reverse Side.)
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City of Fridley t969
;,
ATTMETOPOFTH£TWINS BUILD�ING PERMIT
,�
• COMMUNITY DEVELOPMENT DIV. q
. ' i y """� pe<..
r� � � PRO7ECTIVE 1NSPECTION SEC. 3a �p
� � �
1,._. A /"'1'� CITY HALL FRIDLE� SS13$ MUMBEP PEV OATE PAGE OF AGPROVED BY
J4 ' 612-571-3450 9�0-Fts 9/30/88 � �
IOBADDRESS 1032 Hackmann Circle
7 LEGAL �OT NO. 9LOCK TRACT OP ADDITION _ SEE ATTACHED
DESCR. ZZ 2 Parkview Aeiqhts SNEET
2 PHOPERTVOWNER MAILAODRESS 210 PHONE
Kermit Gillund 1032 Hackmann Circle N.E, 571-6057
& GONTRACTOR MAILA�DRE55 Z�P PHONE UCENSENO.
SaI6E
< ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADORESS 21P PNONE LICENSENO.
6 USE OF BUIIDiNG '
Residential
7 GLASS OP WOHK
❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
B -UESCRIBE WORK
Replace concrete steps with wood steps
9 GHANGEOFUSEFROM TO
STIPULATIONS
SEPARATE PEflMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEAi1NG, TYPE OF GOMST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NUII AND VOI� IF WOHK OR CONSTRUCTION ZONING SO.FT. CU.FT.
AUTHORIZE� IS NOT COMMENCED WITHIN 60 OAYS. OF IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT �
ANV TIME AFTER WORK IS COMMENCED. - NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBV CERTIFV THAT I HAVE READ AND E%AMINEO THIS APPLICATION 1 STALIS GARAGES
ANDKNOWTMESAMETOBETRUEANOCORRECT.ALLPROVISIONSOFLAWS yp�U�TION SURTA%
AND ORDINANCES GOVERNING THIS TYPE OF WORK WIIL BE COMPLIED $SOO � S. SO
WITN WMETHER SPECIFIED MERE�N OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OP CANCEL THE pERMITFEE SACCHARGE
PFOVISIONS OF ANV OiHER S7ATE OR LOCAL LAW REGULATING CON- $j.S� OO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECKfEE TOTALFEE
$15,SQ
$WNRTUREOFpONTRAGiOAOR<UTNORIZEDRGENi IONTEI
WMEN PROPERL ALIDATED THIS IS VOUR PERMIT
s: �
SiGNaTURED%OWNEPtliOWNEPBNLDEFi iOdTEi BLDG ��+Sa q�
t�W [ )
Ai�td [ J
AL�R [ 7
Gbnstructian Addcess
r�� DescriFtim:_
Owner Nane & Address
Cbritractor • G
Address:
City of Fridley
R-1 AI�ID R-2
�,;�dinq Permit ApQlication
�
Effective 5/LSS
Tel. �s�! 1L� s�%
Te1. #
Attad► to this application, a Certifirate of S�rvey of the
lot, with the p�oposoed constructim drasvn on it to scale.
♦I �. ::✓� _ .
r: ; : � : :+' :
� a,«; : : a• - ,
��y.l:�' •�:�.%a
I
•. . �_ .- .
�ype a�f Wnstructim: _
Approx. C1�mpl.etion Lhte:
�
Width Heic�t
Width Height
F�idtY1 Hgt/Gtrnnd _
Ft. Yd Setback
Proposed Driveway Width If New Opening Is Desired:
�� i�111
&j. Et.
Stj. L�.
9q. Et.
Side Yard Sethacks
�timatea cost: s SOG• d
Alt. A Alt. 8
S 8
+ 6' See Back Page
Fe�it Plee
State S�rcharge
SAC �arge
Driveway 8e¢w
Park Fee
Sewer !lain �arge
1+�Ai�
3PIPUl.�IONS:
s 13, u t�
S .�V
� �
�. ��7/-6n�%
Ppe Sched�le on Reverse Side
5.50/51,000 Yaluatioai
5550 per SAC Unit
Alt 'A' oz Al� 'B" Above
Ppe Determined by f�gineering
Ac,�eaoent Neoessary [ l Not Neoessary [ l
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City of F'ridley
AT THE TOP OF TNE 7WIN5
;.
.
� � �� COMMUNITY DE�ELOPMENT 014.
� � � PROTECTIVE INSPECTION SEC.
r ,
,
L.�_.�. '• `.J GITY H�LL FRIDLEv SS�J2 M�
� 612-571-3450
JOB ADDRE55 1032 Hackmann Circle NE
1 LEGAL ��TNO. BLOCN � �. TFACTOR
DESCR. o0 0 . n_�t__
� ARCMITECT OR
AODFESS
BUILDING PERMIT
�lE11 MEV 01T[ P�GE O�
910.F15 10/15/98 � �
28271
icrcio�-
d �a�
WXOVEO !v
SEEATiACMED
SMEE7
VNONE IICENSE NO
NO
❑ NEW ❑ ADDITION O ALTERATION � REPAIH ❑ MOVE � O REMOVE
B OESCRtBE WORK
9 CHANGEOFUSEFROM TO
STIPULATIONS .
Underlayment must comply with the State Building Code.
SE�ARATE PERMITS ARE NEOUIREO FOR EIECTRICAL, PLUMBING. XEATING.
VENTILATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULI �ND VOID �F WOfiK OA CONSTNUGTION
RUTHORIZED IS N0T COMMENCEO WITHIN 80 OAYS. OH IF LONSTRUCTION
OR WORN IS SUSPENDEO OR 11BANQONED FON R PERIOD OF 120 DAYS AT
ANY TIME AFTER WORN IS COMMENCED. '
I HEAEBY CERTIFY TMAT 1 H�VE AEAD AND E%AMINED iH15 APVLICA710N
AND KNOW TME SAME TO BE T9UE AND LOPRECT. �{,� PqpV1510N50F LAWS
AND ORDIN�NCES GOVEANING THIS TVPE Of WORK Wl�l BE COMGIiED
THEfi SPECIFIED MEAEIN OF NOT. THE GR�NtINC OF � PERMIT
OES NO PRESUME TO GIVE AUTMORITY Tp VIOLATE OR CANCEI 7HE
OV1510 O 4 pTHER STATE OA LOC�L lAW REGUI�TING CON-
5 UCTIO TME EPFQRMANCE OF CONSTRUCTION
STALL$
ES
i
L
..,.
NEW [ l
ADDN [ ]
ALTER [ ]
ConstructionAddress:
Legal Description: _
Owner Name & Addr
Contractor: �
Address: ,�' �
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
CTTY OF FRIDLEY
SINGLE FANIILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
\
a���q��
b
i j j VNCJ� Tel. Ji �S7 I'� d�'�
I8 �� �� ��vfN LICENSE l! o2C04rO�C O
5"lA 3�� Te�. t� 3� °6S��I//�
Attach to tkiis application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Driveway Curb Cut Width Needed:
DATE: I � J � g'
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surchazge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
r�.yv:��
STIPULATIONS:
DESCRIPTION OF IlbIPROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Wi�ith ^ ^ HgUGround � Sq. Ft.
3
e
0
� �
Estimated Cost: $ � ��� n
— �
(Fee Schedule on Back)
Ft x $ _ $
— ^
Tel. N
$ . %� Fe�'Schedule on Reverse Side
$ � a,j .001 of Permit Valuation (1/lOth%)
$ � /t $.50/$1,000 Valuation
$ $1000 per SAC Unit
$ S �p $5.00 (State Licensed Residential Conuactors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary ( ]
$��
s�e�ec� P.EfiM�T
� City of Fridley 3 8 6 7
,, �TTHETOPOFTMETWINS gUILDING PERMIT pE IPTNO.
.
. �
� ` _ COMMUNITY OEVELOFMENT DIY.
r � V PROTEC7IVE �NSiEC710N SEC. a�
�
I
� � /"'f � LITY N►Ll FRIOLE� SS�l2 M�V�EN AEY O�TF o�GE O� �h�OVEDlr
i'""� � '� 763-571-3450 siaFiS 9//9/03 / /
lOBAODRESS 1032 Hackmann Circle NE
t LEGA� ��T NO. BLOCN TRACT OR �DOITION SEE A7TACNED
DESCN. ZZ 2 Parkview Heights SMEEt
2 PROPERTVOWNER MAILADORES$ 21V PHONE
Kermit Gillund 1032 Hackmann Circle NE 763-571-6057
J CONTRACTpR MAILADORESS ZIP VMONE UCENSENO
Same
� ARCNITECTOR DESIGNEN MAIL ADDFE55 LP PMONE �ICENSE NO.
5 ENGINEER MAILAD�PE55 ZIG PMONE LILENSENO
8 USEOFBUIIDING Residential
7 C�ASSOFWORK
❑ NEW ❑ ADDITION � AL?ERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Enlarge a window opening into a sliding glass door opening
9 CHANGE OF USE FPOM TQ
STIPULATIONS
See notations on plan.
7YPE OF CANST OCCVPANCY GROUP OCCUPnNC� LOAO
$E�ARATE PEHMITS ARE REOU�FED FON EIECTRICAI, PIUMB�NCr, HEIITING.
VENTILATING ON AIR CONOITIONING
TMI$ PENMIT BECOMES NUII 4ND VOID IF WORK OR GONSTRUCTION 20NING SO.FT CU FT
AUTMORIZED IS NOT COMMENCED WITHIN 80 DAYS. ON IF CONSTRUCTION
OF WORK IS SUSPENOED OR 11BANOONE� FOR A PER100 OF 1X1 DAYS AT
ANY TIME AFTER WORN IS COMMENCE� NO DWLG. UNIT$ OFFSTREET P1IRKING
I HEREBY CERTIFV THAT I MAVE REAO �ND E%AMINED TNIS �PPLICATION 1 STA��S GAPAGES
ANOKNOWTMESAMET�BETRUEANDCOAAECT.A��PqpV1510N50F�AW5 yAWAT�ON SURTAI(
AND OADINANCE$ G�YERNING (MI$ TY4E OF WORK WILL BE COMPLIED @ @
w1TM WNETHEN SPECIFIE� MEAEIN OR NOT TME GFANT�NG OF � PERMIT pl �HOO W. JO
DOES NOT PRESUME TO GIVE AUTMOA�T� TO �iOLATE OF C�NCEL TMf pEPMITFEE � SA��H�RGE
PROVISIONS Of 4NY OTNER $TRTE OR LOCAL L4W RECUUTING CON�
$iqUCTION ON iME �ERFOAM/NCE OF CONSTiiUCTION $63.15 Fire SC �1.8�
PLRN CMECNFEE TOT�LFEE
$65.85
iGw nEO�CON'Aa. OeOa�o��0A4EDSGE�.r iprtF WHEN �ROPEAIY VGLIDA7ED TNiSIS VOUA PEAMiT
C�- �-( =9 3
U4EO�OwHEa���OwNEABw�OEAi �D�iE� B�OG �ti5 •�E
NEW
ADDN
ALTER
�� CITY OF FRtDLEY Effective 1/1/2003
�� 6431 University Ave NE, Frtdley, MN 55432 (763) 5T2�604 Bidg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (T63) 571-128T Fax
BUILDING PERMIT APPLICATION
ConsVuction Address: �0.307� /Ja
Legal Description: �a
Owner Name 8 Addre
(.� i r`
u
Tel. # ��'-S7/-GA S
Contractor. � i r�C/ �l ��� MN LICENSE
Address: Tel. #
UVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this applica6on, a Certificate of Survey of the
lot, with the proposed construction drawn on it ta scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Widih HgUGround,� Sq. F1.
Constructian Type!` �' � iAl 5����%�u� �+'�55 Estimated GosC 3����' DO
doo� c�/�ie�a z<<i��c /.�/asd..Cdi;v ow
Driveway Cutb Cut Width Needed: _Ft. + 6 Ft =_Ft x = S
� �/'
DATE: � APPUCANT: Tei. # /,b� �%%� D ��
Call (763) 572-3604 to� Pertnit Fees if maili g in application. Fax to 763ST1-1287 if using credit card and we will
cail 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
TOTAL
$ i /S�
�
$
$
$
$
$
$
g l0�-C�
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 [ J
- : •.�1
_� ,
,_�,�
,�,5
�u F"
%'
�
�
r�
�Y�
�i� �� �-���a�S �N
�� 5� �� �y� E�,e��n 2h�c�1
�� `�� � d� I� ��
���31�,�,1�
� ��G
ADDRESS
PIN
LEGAL DESC
CITY OF FRIDLEY
6431 UNIVERSITY AVENLJE NE
FRIDLEY, MN 55432
l63) 572-3604 FAX: ('7631571-1287
: 1032 HACKMANN CIR NE
: 243024240053
: PARKVIEW HGHTS ADD
: IAT 22 BLOCK 2
PE NO.: 2004-01322
DATE ISSUED: 08/12/2004
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOW/DOOR REPL
VALUATION : $ 4,700.00
NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING AOOMS AND ON ALL LEVELS OF Tf� DWELLING PER R317
OF Tf� 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS.
INSTALL 12 WINDOWS WITHIN EXISTING OPENINGS.
G\ � irl C�l.\�Y�1
WINDOWS AMERICA 20248265
559 SHOREVIEW PARK RD
SHOREVIEW, MN 55126
OWNER
GILLUND KERMIT E& SYLVIA Y
1032 HACKMANN CIR NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This geanit becomes null and void if work or constcuction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time aftec work is commenced.
I hereby certify that I have read and examined this
application and Imow the same to be true and correct. All
provisions of laws and ordinances goveming this type of worN
will be complied with whether specified herein or not. 'I'he
grantiug of a pemrit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulnCtrigroepstruc,hqn or the performance of consWction.
Bldg
BUII,DING PERMIT FEE
FIRE SURCHARGE
STATESURCHARGE,VALUE
TOTAL
PAID WITH CHECK # 09536
11125
4.70
2.35
11830
Permii Inspectian Cards
Wiil Be Mailed
To Homeowner To Post
SEPARATE PERMITS REQUIRED FOR WORK OTf�R TfIAN DESCRIBED ABOVE.
.. �-�''Y�375r
r
NEW [) CfTY OF FRIDLEY Effective 1/1/2003
ADDN [] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPUCATION �C)C.� �` D j��
(
Construction Address: l� 3� �� ����"' � � �
_. _ _ _ �
Legal Desuiption: , ,c?/ (�d S'�
Owner Name 8� Address: Q�/!
- /v� — Te�. # 71a3
� MN IICENSE # �%a�Oa�P �
Contractor. � , (� Tel. # ��`�J � ^ c7d�,�
..��n � a_
ssI a�
Attach to this application, a Certificate of Survey of the
lot, with the proposed consVuc6on drav�m on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length
Width Height Sq. Ft.
GARAGE AREA: Length
Width Height Sq. Ft.
DECK AREA: Length Width HgUGround Sq. Ft.
OTHER:
a c�o�c.) Estimated Cost: S ��4 700 �
Construction Type: ���M�S
Driveway Curb Cut Width Needed: _.Ft. + 6 Ft =_Ft x S =$ �
DATE: O �/� APPUCANT: �/I D �14Q �� Te� / �� �/��
Call (763) 572-3604 for Pertnit Fees if mailing in application. Fax to 763571-1287 if using credit card and we will
call you for card num6er. CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
g ( j), � Fee Schedule on Reverse Side
$ r� .001 of Pertnit Valuation (1/10th%)
$____f� $.50/$1,000 Valuation
$ $1275 per SAC Unit `
$ , D� $5.00 (State Licensed Residential Contractors)
g Alt. ��P��� or Alt. ��g,� Above
$ $450.00 Conservation Plan Review
g Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
. TOTAL. _ __ __ $ _
r�-..7,`3� ST�PIII ATIONS. __ _ . _ ..,.
/ ��
L
NEVJ [ ]
ADDN []
ALTER [ J
Construction Address1'
Legal Description:
Owner Name & Address:
Contractor. � n!�:
oririrace � Y i 2� r
G�-�8�3
CITY OF FRIDLEY
6431 University Ave NE, Fridley, MN 55432 (763) 5 2-3604 Bld� �p
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 5 1-1287 ;�
BUILDING PERMIT APPUCATION � '
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MN LICENSE # G �S a
Tei. # 6 2 "366 �(14 g
Attach to this appiication, a Certificate of Survey of the
bt, with the proposed construction drawn on it to'scale.
DESCRIPTION OF IMPROVEMENT
LMNG AREA: Length Width Height Sq. Ft
GARAGE AREA:
DECK AREA:
Length Width Height Sq. Ft
Length ��� Width � HgUGround � �( Sq. Ft ��
OTFiER:
Construction Type: /�/T"w' ��° �C Estimated Cost: S��{ U o o, o� L� lP I•/W
Driveway Curb Cut Width Needed: _Ft + 6 Ft =_Ft x$ _
DATE: S� a� APPLICANT: v�S f-t L�c '^"'� Tel. # 6/2- 3o s�! 1 q Q
Call (763) 572-3604 for Permit Fees 'rf mailing in application. Fau to 763-571-1287 'rf using credit card and we will call
you for card number.
CI7Y USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
L 2
/
$ . a5 Fee Schedule on Reverse Side
$ J`� � � 65°/a of Permit Fee
$___= i� .001 of Permit Valuation (1I10th%)
$ $.50/$1,000 Valuation
$ $1450 per SAC Unit
$� $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Aft. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ ��Q� STIPULATIONS:
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C. E. COULTER
LAND SURVEYOR
REGISTERED UNOER LAWS OF STATE OF MINNESOTA
110EN5eD pY ORDINANCG OF CIT OT MINRfiIJOLIG
3300 LYNDALE AVE. SO. MINNEAPOLIS 8. MINN.
TAYLOR 4•0370
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I hereby certify that the above is a true and correct plat o£ a survey o£:
Lot Twenty-two (22), Block Two (2), Parkview Fieights, Anoka County, Minnesota.
As surveyed t�y me this 4th. day of May 1959 A. D.
Signed C�, �'_�. -'(o �--�<-��t�
Minnesota Registration No. 2584
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