AF - 46634� � �
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BUILDING PERMIT
Yillage of Fridley, Minn. No
Q
2Q96
Date . . . . . . . . . . . .a.�. . � � ,�''l, S� . . . . . . . . . . . .
Owner .��r'i-:�!!i!1r0.. . .............. Builder ...... ..................�.................
Address......................................... Address .........................................
LOCATtON OF BUIL ING
No. . ��t�l. . . . . . . . . Street . . . . . . :!'{A/1!� . . . ��� L�L[�. . . . Part of Lot . . . . . . . . . . . . . . . .
Lot .....�.......... Block ......./........ Addition or Sub-Division �.. .. .. ... ..
Corner Lot . . . . . . . . . . . . Inside Lot . . . �,/. . . . . . Setback . . �t . . . . . . . . l . .
5ideyard . ��/. M'LS!y.�. . . . . . .
DES�RIPTION OF BUtLDING
To be Used as:
. .�'�, • � b
,�. .�4�. . .�.�. � �. `. ."?.� Front . . . . . . Depth �.�. . . Height . �q. Ft. ��T e'�. Cu. F't. . . . . . . . .
..4lQ�C+�S.� Front .l �... Depth ��. Height �G,is!'V+�� Sq. E`t. .�d4• Cu. Ft. ........
� /�
Type of Construction FI�A. m. �. . . Fst Cost . . . �y. �Q�% . . . . . . . . . . To be Completed . . . .(p.�ii'� . . . .
• � , � / � �
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the villaQe of �'ridley.
� r�ide tion of the payment of a fee of .[�f� . J permit is heTeby granted to .�.'F .�. .....
to construct the building or ad dition as des�ribed above. This permit is granted upon
the express condition that the person to whotn it is grant 's agents, employees and worlrn�en, in all work
done in, around and upon said building, or any part eof, shall nfo to the ordinances of
Fridley, Minnesota regarding location, construction teration, main ena e, d ' g of buildings with-
in the village limits and this permit may be revo at any time u n o tio any the provisions of said
ordinances, r, _ . , _
Inspector
NOTICE:
This permit does not cove� the construction, installation or alte� for wiring, plumbing, gas heating,
sewer or wate�. Be suro to see the Building Inspeotor for separate permits for these items.
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c�ty of Fridley � � � ���2
AT THE TOP OF THE TWINS g U i L D i N G P E R M i T
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� �` __��_ COMMUNiTY DEVELOPMENT DIV. �� f �
r � V � PROTECTIVE INSPECTION SEC. j
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� � ���'1 • CITV HALL f RIDI.E� 55432 NUMBER AEV OATE �AGE OF APPFO�ED B�
�---'�'� �'' 612-57 t-3450 910-F15 6/ 19 /96 � �
JOB ADDRESS 120 Hartman Circle NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oESCA. 1 1 Sandhurst Addition SHEET
2 PROPERTV OWNER MAI� AODRESS ZIP PHONE
Elsie Elliott 120 Hartman Circle NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE IICENSE NO
L J Roofing 10151 Fol Blvd, Coon Ra ids MN 55448 767-1587 9036
A ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS Z�P PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS Of WORK
O NEW ❑ ADDITION O ALTEHATION p REPAIR ❑ MOVE O REMOVE
1i
8 DESCRIBE WORK
Reroof House & Garage (29 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPEOfCONST. OCCUPANCYGROUP OCCUPANCV�OAD
SEPARATE PERMITS AFE REOUIRED FOR ELEC7RICAL, PIUMBING, HEATiNG,
VENTIIATING OR AIR CONDITtONING.
THIS PERMIT BECOMES NULL AND VOIO 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 DAVS AT
ANY TIME AFTEfi WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 S7AlLS GARAGES
AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND OHDINANCES GOVEHNING THIS TVPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN Oii NOT. THE GpANTING Of A PEFMIT �2,392 �I.ZO
OOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEI THE pERM1T FEE SAC CMARGE
ROVISIONS OF ANY OTHER STATE OR LOCA� LAW REGUTATING CON- $74.75 Fire SC �2.39
S UCT�ON OR 7HE PERFORMANCE Of CONSTRUC710N
�j� ��% / PLAN CHECK FEE TOTAL FEE
f` '� � License SC $5.00 $83.34
SIGNATU�7EOFCON CTOAORAUTHORIZEDAGENT IDATEI WHEN PqOPERLY LIDAT D THIS IS Y fi PERMIT
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CITY OF FRIDLEY
SINGLE FAMII,Y AND DUPLEXES R-1 AND iZ-2
Building Permit Application
ConstructionAddress: �Zo /�r� �, a,, C, �c %
Legal Description: /�C s� ��n �� w (
Owner Name & Address: ��ls i P. �/� (�(���
Contractor:
Address: /� ( J�/
LIVING AREA:
GARAGE AREA:
DECB AREA:
OTI�R:
0
Effective 3/ 1 /96
Tel. #
MN LICENSE # qo 3 �
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IlVIPROVEMENT
Width
Width
Width
Height
Height
Hgt/Ground
'�i`i
�
Tel. # �� 7 /r�%
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks 2� f�
Type of Construction: ��� o�-�- Estimated Cost: $���� �%2
Approx. Completion Date: �/ 3o g
(Cos t on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: Q' � APPLICANT: �,/lf �S� Tel. # 7� 7- /./ �' �
Pernut Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ • /�
$ � •�g
� /, �O
$
$ 5 - �d
$
$
$
$
� ��..3
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuadon (UlOth%)
$.50/$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 [ ]
STIPULATIONS: _ - -
Building
Inspections
7b3-572-3b04
6178 ADDRBSS
n�us nepucnrrr ts:
PROP�RTY OWNt�R/
TENANT
BUILDING
RESIDENTIAL APPLICATI�N
CITY OF FRIDLEY
� YOUR &MAIL ADDRES3
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OOWNER ONTItACTOR
�ss: �e..
R. ��1- c�i, n
3UBMl'i' A COPY OF sTATB LICENSE U Gf� b1
YOUR STATE LICENSE ADDRESS:��
WiTH APPL[CA7'(ON PHp�,�� - R/ �3
PROP6rRTY TYPE _ SlNGLB FAMILY/NEW 001
P'ERMIT TYPE O ADDITION
a Bns�a�r Fn,nsx
G DECK
DBSCRIBB WORK BEIiVG
NuMBIiR oF SQUARes
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P1tOPU3ED SIZE:
I'ROP09ED H81(iH'1':
Viqyl
O a�uminum
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1N�NaOPENWG3 a ONo
OR FOR NBW OPBNRJI3:�'�CRIBB StZE 08
OPENING CHANCiBS dc t _
Permit Fee
Ples► Reviow
Ftre Surehsrge
Surchar�e
t,iceroe Suc+charge
SAC Charge
Curb Cut Bscrow
Erosion Controi
Park Foa
Sewer Mein Charge
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RUGTION
CfiON
GARAC�S/SHSD
D ROOF
❑ SIDING
O SWIMMIN(3 POQL
ADl)ii'!ON
O REMODEUNG
Z US 1 �o�.,t � '�
O HOUSB 8 GARACB
O ATfACHED OARAGE
O DEiACHED GARAGE
OSo11it
D Tdm
O Fascia
LOCATION OI� WtNDDWS
i _ SlT � �
.1W P. NUMBER OF WINDOWS I�
LUATION, INCLQDING THE COST OF
(USINC THE 1997�1.B.C_FLE SCHLDULL�
Permit
Received By:,
Date R�.'.d:_
M
0 DRAM 7'ILE
0 OTHER
wi"'� .1
�=�.Z'�
e z�r ��2y
AASEMB*C!' l��!!ODELINC gC�}MIT.
I . 6xiating Floor Pian
2. P(opused flooi pltn
3. List of �Inwqaal mpober� W bo wed
FOR NEW OONSl'RUCf10N INCLUDiNO D6�CK3.
ADDITIONS. g PORCHE4 4UBM1T:
t. SiCe PlanlSurvoy �howing the ex�g Wnquree
and proPa�ed Pmjat
2. Two �W ofoon�lruction plw
3. Enargy Caieuladons
s �t�/ . ZS See Back Page for Fa Sci�ule
S�� 65% of Suilding Permit Fee
S i Z�D .001 timea the total job val�ntion
$ �.00 .0005 x Permit Veluation Minimum S.SO
$ �.0 v SS.00 (State Licensed Residerniai Contractors)
$ 51673 per SAC Unit (Plsns to MWCC for detaminetion)
S ft+68= ftxS21 =S
s sasa eon�rv�ioa P�an Rev;ew
S Fa Detdmined by Englneering
� _ _ _ � _ Agrcement nexxssary ( ) Non Necess�y ( )
THIS IS AN APP[JCA'fION FOR A PFRMIT-NOT VALIp UNT1L PROCESSED
i hereby apply for a buiiding permit and 1 acknowledge that the information above is compleee and accurate; that the work will be in
conforn�anoe with the ordin ees and codes of the City of Fridley and wid� the Minnesota Conctruction Codes; that I under�nd this i� not a
permit but only an applic ' for work ls not to start without a permit; thac the work will be in accordance with du approved
plan in the cese of aU work h uires re ew and approval of plans.
SIONATUREOFAPPLIC _ _ PRINTNAME��a�.11..,Y.rJ/ I�lfeLf-G'��� �/{ /�Z
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