AF - 46760�
•
Date:
•�,�_
� . . . •
C,�ty of Fridley, Muin.
BUILDING PERMIT N� _ 6738 ,�,�
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� Builder .
Address_.._..._.�..._.�._._...._...._..._. _�...._..__._...__._._...._....___......_.._ Address
L CATIO Fr B DING
No. /�.� ._ Street . . _ �. _.._. Part o t ...._.._ _.......—_..._
... Block ._._._..._._..�. `� tion or Sub-Division � . -
Lot ._ ..__. _..
G� ! -•-
Corner Lot ____..._..._....__ Inside Lot ._.___.._.._...._.._...__ Setback �T... _._.._.._ Sideyard ._.......�._..___..._�.�.....__.__.�.
Sewer Elevation
Foundation Elevation
/ DESCRIPTION OF BUILDING
T Used
_ Front � �. Depth �� Height �. Sq. F� ���-!�- Cu. Ft ���
_ ..�. t_l.._........�_ Depth _� FTeight �� Sq. Ft. �.� Cu. F't. ��
Type of truction .,�Z���.?�..r�_.. Es� Ca�1�`�-�, ..�.-��'T'o be Completed __._.._._
/
In consideration of the issuance to me of a permit to caa�struct
the p�opoeed work in accordance with the description above set fcyr
o�dinances o! the dty of F�idley. _ /�
In caosiderat[�u of the payment of a fee of
above, I agree to do
rijth all pmvisions of
permit is hereby granted to—
to oonstruct the buflding or addition as described above. This permit is granted up�
the express ooadition that theperson to whom it'is granted and his agents, employees and worl�en, in all work
Fridl e aMin�nesoand upan said building, or any part thereof, shall conform in all respects to the ordinances of
regarding location, constructioq alterafilon, maintenance, repair and moving of buildings
wio '�� city limits and this permit may be revoaced at time^po� vi4lation of an,y of the provisions of said
�1
Buiiding Inspector
� �TICE:
ihis p«wil dws w� eowr tlw �etiee, imhll�Nee fee �rirLY. P�9► Yas M�Nno, aw�r er wabr. 6� sun fo sN
tM lniWiy I��Pwer fer s�prah Pwsfb for fh� i1«m.
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OWNER' S P]AME
ADDRESS �/Grf �f i� i � ''
APP'LICATION F08 BUII.DING PERMIT
. C�7Y� Og �FRIDLEY, MINI4ES0'D'A .: •
�ILDER � Yi�t��
bti�ss �S5„-�..
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LOCATION OF BUII.DING
No. �� � Street� �_( Part of Lot
—T�—a
Lot Block Addition or Subdivision �/,,,, i�Q ,,,J,_�,�.
i
Corner, Lot ' Inside vot d Se�back � S� Side Yas�el -�
r i . —'t--+-�T � � ' ± �
SEWER EI:EVATION' • - BOIINDATIOl� SI.$VATION
• . � , , . .
.. ,, . . i , .
Applicant attach to this form 1�o Certificates of Survey of Lot and proposed build-
ing �.ocation drawn on these Certificatea.
To be used as:
DESCRIPTION OF BUILDING
Front Depth Height
Sq. Ft. Cu. Ft.
Froat Depth Height
Sq. Ft. Cu. Ft.
Type of Construction ��" Estimated Cost
To be Completed
The undersigned hereby makes application for a pe,rttti� for the work herein specified,
agreeing to do all work in strict accordaaca with the City oF Fridley Ordinances and
rulings of the Department of Buildings, and hexebq;declares that,all the facts aad
xepresentations stated in this application are �rue and cq�ycect.
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(Schedule of Fee Costs can be fou�d-.��, �he Reverse Si�e).
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P�C A
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OG
Su9�ECT
City of Fridley
AT TME TOP OF TME TWINS gU I L D I N G P E R M I
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COMMUNITY DEVELOPMENT DIV.
i �V �"�• ,
r � � PROTECTIVE INSPECTION SEC.
� _ .
� �"'1 � CITY MALI f R101E� SSI$2 NU4SEN AEV
�'""� � �'� 61 �-571-3a50 s� aF� s
JOB AODRESS 129 Hartman Circle NE
1 LEGAL ��7 NO. BLOCK TRACT OR AOOITION
DESCR. 8 2 Sandhurst Addi ti o
2 PROPERTY OWNER MAIL ADDRESS
Gerald McDonald
� CONTpACTOR MAIL ADORESS
Suburban Exteriors 9701 Penn Ave S Ste #107 B
a ARCHtTECT OR DESIGNER MAfL ADDRESS
5 ENGINEER MAIL ADDRESS
8 USE OF BUILOING
Residential
7 CIASS Oi WOqK
O�iE
5/18/99
ZIP
21P
vAGE Of
/ /
�71-7
PHONE
�1-82
PNONE
PHONE
�EfiMIT NO.
29489
T NO.
��3y
A/►AOVED Sv
SEE ATTACNEO
SMEET
LICENSE NO
4289
UCENSE NO
IICENSE NO
� NEW O ADDITION O ALTERATION �JX REPAIR O MOVE O REMOVE
8 OESCRIBE WORK
Reroof house and aaraae (24 Sa) Tear-off
8 CHANGE OF USE fROM
STIPULATIONS
TO
Underlayment must comply with the State Building Code.
TYPE OF CONST
SEPARA7E PERMITS ARE REOUIqED FOR ELECTiiICAL, P�UMBING, MEAT�NG.
VENTILATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONS7RUCTION ZpNING
AUTHOAIZEO IS NOT COMMENCED WITHIN 60 OAVS. Oii IF CONSTRUC710N
OA WORK IS SUSPENOED OR ABANOONEO :OR A PERI00 Of 120 OAYS AT
ANV TIME AFTER WOqK IS COMMENCEO. NO DWIG. UN
I HEREBY CERTiFV TNAT I MAVE REAO ANO EXAMINED THIS APP�ICA710N
ANO KNOW TME SAME TO BE TRUE ANO CORRECT ALl PROVISIONS OF LAWS VA�UATION
AND OROINANCES GOVERNING THIS 7YPE Of WORK WI�� BE COMPLIEO
WITH WMETMER SPEC�FIE� MEREIN OR NOT. THE GRANTING OF A PERMIT $2056
OOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL TME pEqMIT fEE
PpOVIS10N5 OF ANY OTHER STATE OR LOCAL lAW REGUTATING CON-
STRUCTION Oi7 TME PERfORMANCE Of CONSTRUCTION $3. Zrj
r :� PLAN CMECK F
- ' /� � `'vt�-r-'' � 1 C
S�GN TUAE O� CON'i7GC.TOA Op �UTMOp�ZED AGENt IDATE� , ,�� ,
OCCUPANCVGROUP OCCUPANCvLOAD
SO.FT CU FT
OFFSTREET PARKING
STA��S GAiiAGES
SURTAX
1.03
SAC C RGE
Fi SC 2.06
TO A FEE
1 34
VA � HIS IS�� PEBI�II = /
//Y /��C 7
NEW
ADDN
ALTER
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CI1'Y OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
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ConstructionAddress:- � o� -f
Le�al Descrigtion: t/l� d�
L. JlQ_ -- �1,��-e�.:
a��. 3_3,
Effective 1 / 1 /99
��3��
...� ��.��
�P�R�g�
Owner Name & Address: � :Q�,�c Q� �lc � �,Q .(�. Tel. # S i � - � � ��
Contractor: .c ,c �.� �+ •,�, �� � on A MN LICENSE # �-( a �'t �
Address: �( � O % � 2.inm �N� --� � � :� � / a � Tel. # �� � - � a 3�
� Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECB AREA:
� OTI�R:
DESCRIPTION OF IlVIPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
. o� vv �o ° . -
Construction Type: Estimated Cost: : $ ` � `. -
�� � � � �.
(Fee Schedule on Back) a'
Driveway Curb Cut Width Nceded: Ft. + 6 Ft = Ft x$ _$
DATE: 5- r �� g APPLICANT: � n.�.w� .�i�r�ti�t �r Tel. # � g �- g a 302
�
Permit Fee � 3'� $ �����
Fire Surcharge a.Ob $ .
State Surcharge (� � 3 $ �--�
SAC Charge $
License Surcharge $ ��
Driveway Escrow $
Erosion Control $
Pazk Fee $
Sewer Main Charge $
3
TOTAL $ � � •
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 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 [ ]
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