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sus�ecr PER
City of Fridley � �� 12680 ��'
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
! ;, R IPT N
� • COMMUNITY DEVELOPMENT DIV.
f �z: ---- �
� � PROTECTIVE INSPECTION SEC.
� �
1 � i
( �"'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�----� � •'� si2-5so-3aso 910-F15 8 1 �4 / /
JOB ADDRESS
1 LEGAL LOT NO. B O ACT OR ADDITION SEE ATTACHED
DESCR. 24 2 Sandhurtst Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
C. F. Hartman 193 Hartman Circle N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION �] REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
reroof
9 CHANGE OF USE FPOM TO
STIPULATIONS
Replace any deteriorated flashing
SEPERA?E PERMITS RE�UIRED FO,R -WIRIN�,
HEATING, PLt�i�BiNG A�tD SlG�S.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. FT. . CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
. OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED 320. OO . SO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- rj. OO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
'� 5. 50 n
SiGNAs Eo CONTRACTOFOHAUTHORIZEDAGENT IDATEI EN PROPERLY VALIDATED TH .� YOUR PERMIT 4
4
. � = -.-�--; ��-
YSSIGNATUREOFOWNERIIFOWNERBUILDERI IDATEI BLDG iNSP DATE
AP.PLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME : � ;�. -;�.;:�.'� �-a ,i�� 1 r-� �1,� BUILDER : ��7i 11; ,
ADDRESS: �^� :�����'�'sj�-��� �r4`: ADDRESS: _�a=1r31` .
N0: �`-" � STREET• �,�i �°�� ,,��� �F� , �:'; ��a � � �!� �,' � �.
�-
LOT: �'� BLOCR: � A.DDITION: ,��\� �l,t�\ �.i � Z,°�=�` ,'°` ,r�-j!1i1�(�_
CORNER LOT: INSIDE I.OT: SETBACK: SIDEYARD:
Applicant attach to this form Ztao Certificates of Survey of Lot aad proposed
building location drawn on these Certificates.
HESCRIPTION OF BUILDING
" To Be IIsed �s:
_--.�
���� � � ctin r � ;� �4�.CFront: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
�►pe of Construction: Estimated Cost: $.�-�(`"; . L���
• To Be Completed: � �' ) � �" .
The nndersigned hereby makes applicativn for a permit for the work herein
specified, agreeing to do all work in stiict accordance with the City of
Fridley Ordinances an.d rulings of the Department of Buildings, and hereby
declares that all the facts aad representations stated in this application
are true and correct.
� �
DATE : � " �- � '� � x <' �� S IGNAT[JRE : �''�: � ":-a 9 , � � w� ' � r ;� i ' r
�.,.
(See Reverse Side For Additiona.l Information. ) J �, /f ���
�
,� ,
A i
G �=
.
BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuiag permits for the
exection of any building or structure, or for any addition to any existing .
building or structure, or for any alteration or repairs to any existing
building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in
the manner herein provided to-wit:
'UNIFORM BUILDING CODE: 'I`ype l, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any buildi.ng or addition, is determined by multiplying the gxound area
covered from a point si.x (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average �
�height of the roof surface of the ma.in gable of a pitched roof.
For repairs or alterations to an e�cisting structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In no case shall the fee chaxged for any pernxit as set forth in Section 2 be
less than. $5 e 00.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minim�nn of 24 hours from the
time of application, to allow for proper review of the proposed structure and
of the construction site.
A Certified Survey o�f the lot, showing the location of the foundation, oace it
has been constructed, will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) da.ys prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied uatil a Certificate
of Occupancy has been issued.
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