AF - 47110�t
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Gity of Fridley, Minn.
. BiTII.DING PERMIT N° 3 9 3 6
D�te: . . . V. �. . .1. . .°. � . . . �!� . . . . . . . . . . .
Owner .��il��'!.•�,/ .... . ....... .... Builder .. ... .............................
Adrlre� ...................................... Address .............................................
. �. � ATION OF BUtLDINC . . . . . .. .. . . .. .. . . . . . . .
No. . `� Street . . . . . . . . . . � . . . . . . . . ,L'�rt of Lot
Lot ............ B2ock .................. Addition or Sub-Di'vi�ia� .......................................
Corner Lot ............ Inaide Lot ... ...... Setback ............ Sideyard ...........................
DESCRIPTION OF BU[LDING
� LTo be sed as:
�,Gl�-.!'..�. . . . . . F�t a. a' � DepthaP.� .—` a Height �a"'.(? Sq. Ft. �rT. . .0 G�. F't. I.1. . �!' �
/�r�
.................... Front ........ Depth ........ Height ........ Sq. F`t. ....... (..i1. F`t. ........
,��� fl . �^ : To be Completed . . . . . . . . . . . . . . . .
Type o! Construction ................... Est. Cost... . ...
In consideration of �he issuance to me o! s permit to conatruct the building desribed above, I agree to do
the proposed work in accflrda,nc� with the de�ripttoa above set forth and in compliance with all provisions of
ordinances of the city of FridleY. . .
. :?r.. . �. �:.-.. . .� . .. .. . . . . . . . . . . . . . .
�
In consideration of the payment of a fee o! �. �—�"�� permit is� hereby granted to . . . . . . . . . . . . . . . . . . .
......................... to construct the building or addition as deacribed above. This permit is granted upon
the express condition #hat the person to whom it ia granted and h�is age�� emPloyees and worinnen, in all work
done in, around and upon said buiiding, or aay part thenwf, shall c±onform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buiidings with-
in the city limits and t,Ms permit may be revoked at any time upon violation of any of the provisions of said
ordinances: �,.
:.�� ��..�•�:.I.!� Buildix�g Inapector
NOTICE:
This permit does not cover the conatruotlon, installation or alteration fo� wi�inq, plumbia�gas heating, I ;'
sewo� o� watar. Be su�e to ae� the Buildinp Inapeator for separate permib for theae itema
CITY QF FttIDLLY
: Effective Aug. 1, 1981
APPLICIITIO'1 FOft RCSIDL"idTIA� QU1LQIfSG PCRif I7S
(Ne��, Alterations, Additions, or Repairs)
0�lNER: ��.,� r���� a -� 1
ADJRESS : G � -e f�.�/ -e �( � L
TEL n0: S % I � (� � �
. /r��. �cv
l3UI LDER : U i��/ v,� /�`�/� �,I�
IIDDRCSS: 1L �� 2 ' � ��-..- S ?� �
TEL f�0: � � �- "���Lv
Construction Location
ST1tI�sT NO: ��� s�rrr: l'f ��{ N� if ��
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.
i
LOT: �Z____� BLOQC: �_ ADDITION: �j�t/N+¢Y .S' �l��F j/� o �t/ � A-�✓�J/2
Corner Lot: Insiiic Lot: SetbacY.: Sideyards:
Applicant attach to this form two Certificates of S�rvey of lot and
pzoposed building location drawn on certiiicates to scale.
f� S i�Q W�,�{ �} � U,�,��,,,�, DESCRIPTIO�� OF COi�JSTF�JCTIOPi
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� �U ,,r -Ca�2 u- }o; 1 Front: Depth:
�zi °'`�'�'¢`� �` � Squanc t'eet: Wbic Feet:
l�ront:
.Height:
Depth: Neight:
Squar.e FeAt: Ctibic Teet:
(� � Ci
iype of Con ,truction : � ��� n/(�/+�( � 7 u'1 �V � Estimated Cost: $ � � �J
Rb Be Ot�r.�pleted: g"` 2-- `� 3
Alt. A Alt. B
Proposed Driveway width If New Openinq Is Desired: $ $
_ . S�� P.F.V£R�F.' SIDE OF SiIE�T _
Zhe undersiqned hereby ma):c� applicaticn for a permit fcr the �:ark herein specified,
agreeis}3 to c� .all work in strict accordanec with the Ci�y of I'ridley Ordivances and
rulin�s of tlle Deikzrt7nent of Bui2dings, and hereby declares thzt all tlie facts and
represes�t,.ttiens stated �n this application aze true and c�rect. �
D: T�: � �' Z (1� � � sicrTnzvr�.:
�tii�ulations :
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/ 3d
`� � 9, � C�
���%�i�"L �/
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Sul�Eti •
City of Fridley 2 9 5 6 7
AT TNE TOP OF TME TWINS g� I L D I N G P E R M I T
r
� ` RE O.
� • COMMUNITV OEVEIOPMENT DIV. �/��
~ PROTECTIVE INSPECTION SEC.
' '•'•
r ; ';
� . .
� _ �"'1 � CITY MALL FRIOLE� S51J2 NUMlEp NEV DATE v�GE Of •VtNOVEO !v
�""� � �'� 612-571-3450 910-F15 5/26/99 / /
J08 AODRESS 640 Helene Place NE
t LEGAL LOT NO. BLOCK TRACT Op AODITION SEE ATTACHEO
oesca. 7 9 Donnay's Lakeview Manor SNEET
2 PqOPERTY OWNEfi MAIL AOOiiESS ZIP PNONE
Steve Johnson 640 Helene Place NE 571-5732
3 CONTRACTOR MAIL ADORESS ZIP PMONE LICENSE NO
Gulden Roofing 3820 Patriot Ln, Lexington, MN 55014 783-7181 CITY
s ApCMITECT OR DESIGNER MAIL AOORESS 21P PHONE LICENSE NO
5 ENGINEER MAIL ADDqESS 21P PMONE IICENSE NO
8 USE OF BU�LD�NG
Residential
7 CIASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION (� REPAIR O MOVE O REMOVE
8 OESCRIBE WORK
Reroof House & Garage (25 Sq) Tear-off
9 CHANGEOfUSEfROM TO
STIPULATIONS Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
TYPEOFCONST. OCCUPANCVGROUP OCCUPANCVLOAp
SEPAqATE PERMITS ARE REQUIqEO FOR ELECTqICAL, PIUMBING. MEATING.
VENTI�ATING OR AIR CONOITIONiNG.
THIS PERMIT BECOMES NULL ANO VOIO If WORK OR GONSTRUCTION ZONING SO. FT CU FT
AUTHOq1ZE0 IS NOT COMMENCE� WITMIN 60 OAYS. OR IF CONSTRUCTION
OR WpRK IS SUSPfNOED OR ABANDONE� fOA A PERIOD OF }2a DAYS A7
ANY TIME AF7Eii WORK IS COMMENCED. NO DWLG. UNITS OffSTFEET PARKING
I MEREBY CEiiTIfV 7MAT I HAVE READ ANO EXAMINED THIS APPLICATION 1 STA��S GARAGES
ANO KNOW TME SAME TO BE TRUE ANO CORR�CT. ALL PROVISIONS OF �AWS VA�UATION SURTAX
ANp ORDINANCES GOVERNING TMIS TVPE OF WORK WILL BE COMPLIED
WITM WME7HEp SPECIFIEO MEREIN OA NOT. TME GRANTING OF A PERMIT 2, 1LF2 1.O]
DOES NOT PRESUME TO GIVE AU7NORI7V TO VIOIATE Op CANCEL THE pEqM1T FEE SAC CHARGE
PROVISIONS Of ANY OTNER STATE OR LOCA� LAW REG IATING CON-
STRUCTI tME PERfORMANCE OF C STRUCTION �83.ZS Fire SC �Z.I�F
� PLAN CMECK FEE TOTA� FEE
� z� Ci ' en $86.46
S�GN• nE O� CON'aA�TOA Op AUTHOA�ZED AGENT 10• E�
-- M �V V 1 TED THIS IS YO=� EQMIT ^
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$�GNATUqEO�OWNEAi��O�NNEpBU�IDEA� �D�iE� �OG �NSo n�rE
rr�w � �
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRIDLEY
[) SINGLE FA1�iILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
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Owner Name & Address: �_ � ,o�o�,J�,pn� ����,.� Tel. # ��—���Z
Contractor: � MN LICENSE # ZOI "�'� �� a
Address: � �,�J ,/J Tel. # �(�? 3=�%g�
LIVING AREA:
GARAGE AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF Il1�IPROVEMENT
Length Width Height
Length Width Height
DECK AREA: Ixngth
OTI�R:
Width �
._ �
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: % ��c� Estimated Cost: $ s`7�(�� � l!�
,(� vo
Driveway C�rb G�t Width Needed: Ft. + 6 Ft = Ft x$ _$ �
DATE: S .2� `� g
Permit �ee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPiJI,ATIONS:
s
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,_
(i�Y� J /!�
CITY USE ONLY
Tel. #�/Z 7�� �%
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.OQ Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
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