AF - 46182/
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Village of Fridley, Minn.
BIJILDING PE�t.MIT �°• 17 8 0
Date: ....�� ...�.�!� ..............
t�%��'�`�( .
Owner....................................... Builder .....�.�.�l.°�.°�i�.... ... ............
Address ...................................... Address ....�.Z..�.�.... `:�y.°�.............
LQ AT[ON F BUILD[NG
No. . �.� .��. Street . . ! �1. ���'e.!:Pe. s�. � . . (..� !�, . . Part of Lot . . . . . . . . . . . . . . . .
Lot . .. . .1�,. .. .. . Block . . . .. . � . . . . .. .. . Addition or Sub-Division ..��1. e� �: � �a.��.... I./. !..!I.S..
/ r� y
Corner Lot . ... .. .. .. . Inside Lot . . .. ... ... . Setback . .. ►�. "... Sideyard . �.. ..�..G�.. .�� .°.'�. '�''"'°'RL.
DESCRIPT[ON OF BU[LDING
To be Used as:
� PiV.` � .! ./ . !� .�. . . Front . . � �. Depth .�. .��. . . I-ieight . �.'S . . Sq. Ft. �� �. � Cu. Ft. . . . . . . . .
�d.+ �"�t. . Q.t'.. ./.-� .� Front . � � . . Depth . .� �. .,,_ Height . .��. . . Sq. Ft. . .. .. . . . Cu. Ft. . .. . . . . .
v � �d
Type of Construction �r �l !�l. �. . . . . Est. Cost . �� `� ."'. �. . . . To be Completed . . . . . . . . . . . . . . . . . .
Tn 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
ordiriances of the village of Fridley.
ff
.....................................................
�'°� ' ...... ..............
Tn consideration of the payment of a fee of $. /.�.�. .., permit is hereby granted to
. . .. . . .. .. .. .. . . . . . . . . . . . . to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and h8s agents, employe�a and worlmien, in All work
done in, around and upon said building;'or any part thereof, shall conform in all respects to the ordiriances of
Fridley, Minnesota. regarding location; construction, alteration, maintenance, repair and moving of builsiings with-
in the village limits and this permiE'may be revoked at any time upon violation of any of the provy�ions of said
ordinances.
;�, . . . . . . . G� - . . . . . !.1/1��� . . . : . . . . . . .
Buiiding Inspector
__. �!'.,
NOTICE:
This permit does not cover the consfruction, instalia,tion or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate Ae�mits for these items.
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SUBJECT MIT N . i
City of Fridley 15 3 91 A
r AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ��_
z
� � RECEIPT NO.
� 1 y______ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. L��, �� (/
� ` , /
� /"'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BV
�"'"� � ,�� 612-571-3450 910-F15 / /
8 13 79
JOB ADDRESS 1356 Hillcrest �ive N.E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ],], 3 MQOre Lake �1�.�.5 SHEET
2 PROPEHTYOWNER MAILADDRESS ZIP PHONE
Oscar Iiaugen 1356 Hillcrest Drive N.E. 571-8336
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Milton L. Johnson Co. 2513 Central Avenue N.E. 781-9548
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
%
8 DESCRIBE WORK
Reroof structure
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING S�. FT. CU. FT.
AUTHORIZED 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 WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1 rj
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
SIGNATUREOFCONTRACTORORAUTFiOHIZEDAGENT IDATEI WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT
t„
� � :���� �, ��-��:j ����
SIGNATUREOFOWNERiIFOWNERBUILDEFi �DATE) BLDG �NSP �P.T
CITY OF FRIDLEY •
ARPLICATIOP� FOR RESIDENTIAL QUILDIPJG PCRMITS
{Pdew, Alterations, Additions, or Repairs)
OWP�ER: '('� � C' r� �. �. � �
�
ADDRESS: /���t�� ���c����� T"�� /��
TEL �VO: S%i � �°� �'�
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BUI LDER : i �� � � � ��'�� � � °' °� �� ,
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ADQRESS: �� �j ���'�2�— ��
TEL N0: `%��—��`��
Construction Location •
STitE�T NO:I�� STREET: /7' ���%�`-� %��• �° � �
a
LOT: %O BLOCK: � ADDITION : _ d � ) �E�� � � f-$ ��_ �2 � .� �
Corner Lot: Insicle Lot: Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed buildang location dxawn on certificates to scale.
QESCRIPTIOtd OF CONSTRUCTION � �
Front: Depth: Height:
Squa�e. Feet_ Cxibic Feet: �
Front: Depth: H eight:
Square• Feet: Cubic . Feet:
. �-u
/
Type of Construction: ��--�� Estimated Cost: $� s�� -
Zb Be Cbmpleted -
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desi.red: $� $ _
SEE REVERSE SIDE OF SHEET ,
The under'signed hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of fiuildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATEo �'r� " � SIGNATUI2E: �� �
� 2E
Stipulations:
�� �
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BUILDIIJG PCR�'IIT F�t� SCHEDULE' .
S�CTION 2. The 2nspector. ot 33uilclinqs shall, �-�e£ore issuing �eizni.t-s for the erection
of any bui].ding or. sL•ructurc, or Lor any additi.on to any cxisting buildinq or stnicture,
ar for any alteration or repairs to•any exi::ting builaing or structure, upon application
tlierefor.c, require the paymenL- by the applicant for sucl� pexmiL-�of fces to. tlie amount
herein below seti forth and in the manner herein provided to-witi:� ��
NEW CONSTRUCTION: Single rami].y IIomes and Garages: $�.00/1,000 cubic feet.
PLI�N C1iLCY.: 25 percent of bui.lding permit fee. ,
DRIV�WAY D�PI2ESSrON: (Concrete,Curb Streets Only) � � '
• Alternat-e A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$],�.75
Alternate B: Removal and replaCement of concrete curb and
,' gutter and install a 3 foot wide approach with
• - 6 inch depth; Driveway wi.dth plus 6 feet x$17.85
;11 �►:_. ► 1' ' �l
ror the purpose of computing fees for buildinq pex'mits, the cubical contents of any
building or addition, is determined by multiplying i-he ground area covered from a
point six (6) inches below the floor line of the basement or th� cellar to the
average heights of the upper surface or to the average height of the roof suriace
af the nain gable of a pitched roof.
For repairs or alterations to an existing.structure, the fee shall be at the rate
of $3.00 per each five hundred dollars-($500.00) or fraction thereof S.n the cost
of all pxoposed work.
In•no case shall the fee charged for any permit as set forth in Section�2 be less�
than $7.50 plus $.50 state surcharge.
VERIFICATIO� OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours from the time
oi application to allow for proper review of the proposed structure and of the
construction si•te.
A Certa.ficate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
C � . � '' 1
�PPlication for a Certificate of Oceupancy shall be made ten (10) days prior to the
use or occupancy of any structure for �ahich a k�uilciing pexm.it has been issued; and
said structure shall not be used or occupied un�il a Certifica�.e oi' Occupancy has
been issued.
�°� tr`.!
T
sua�ECT PERMIT N
City of Fridley a-' 2 8 �
' ` AT THE TOP OF THE TWINS g U I L D I N G P. E R M I T EC PT NO. �
�
� `L ______ COMMUNITY OEVELOPMENT DIV.
r j � PROTECTIVE INSPECTION SEC.
' i '
l.-__� �����,,� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV
i 612-571-3450 g1 o-F15
7/10/81 � /
JOB ADDRESS 1356 Hill�res.t Drive N.E.
1 LEGAL LOT NO. BLOCK TRACT OF ADDIT�ON SEE ATTACHED
DESCR. ]_], 3 Moore L3�C@ H].�.�.S SHEET
2 PROPEHTY OWNER MAIL ADORESS ZIP PHONE
Oscar Haugen 1356 H:i.11crest Drive N.E. 571-8336
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Rod Johnson Building 7835 Gloria Ciscle, Mounc7s. View, NIDT 786-0702
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
12@S ].C�P�ITtl�.�.
7 CLASS OF WORK
O NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK ,
Construct a 21'S" x 14' Addition to D6,relling.
9 CHANGE OF USE FROM TO
STIPULATIONS
VI�ARNING
Before digging cali tocat uiilitka SEPER�ITE F'�Rt���'� +��'Q��� �R ���
���EPHONE • ELECTRIC -GAS Etc. HEATI�IG. PLUM�i�1t� ��i� ���.
R�C�UfREQ BY I.A1�
SEPARATE PERMITS ARE RE�UIRED fOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PEHMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 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
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GFIANTING OF A PERMIT �.O OSO �S`S.O3
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM�T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR �OCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. NONE
`/ PLAN CHECK FEE TOTAL FEE
x 1 i
/ s�+-' � o � ��
SIGNATUREOF(� N R CTORORAUTHOR12EDAGENT IC�ATEI WHEN PROPERL �ACIDATED THIS IS YOUR PERMIT
� c�.� '� l�
SIGNATUREOFOWNERIIFOWNERBUILDERI IDATEIJ BLDG INSP � TE
. CITY Of F(tIDLCY ' • � �
, � AP('LICIITIO:d FOlt fZ�SI[)Ei�ITI/1i_ I3UILD1tiG PEFtt�ITTS ' .
(Ide►��, Al terations, Additions, or Repairs) ,
� OtJIdER: C� SC��� � RV ��� QUILDER: _��D ���}-UU�^�iu./� r3U�c.��e�� .
IiDDRESS: _C!��,� �.���. e��sT :� /IUDRESS: %3� � ,f�,LG�IA C/A�C�,E .
TEL �0: _�7 � " � � 3 t� 7�� r�sa: ���— • o �G `a . .
- �
' Construciion Location '
• STItL•'F�T' ri0: ) �j �j b � STREET: �-I � C. (� C' (l� � .� T� '
LOT: /� � BLOQC: .� ADAITION: 9d%QD,� �1�� ���' '—'_.
Corner Lot: Inside Lot:;��� SetbacY.: •�� � � Sideyards: °'i +
Ap�licant attach to tliis form two Certificates o£ Survey of lot and
. proposed building location drawn on certi�icates to scale.
� DESCRIPTIOfd OF COtdST�',UCTIOPd •� �
�(�cz�� ttAp�J Front: `�' �� Depth: / �� Height: ! i
�
.
Square. Feet_ �<U� Ctibic Fcet: ���� �0
t
�.
. Front: Depth: � Neight:
. Square- Feet: Cubic I'eet:
�i � 33.�3 = �e,0bz.y� - � �o,��o.�
Type o£ Construction : 'F ��� 1,� E Es�.i.mated Cost: $ ��
7b Be Cbr.�pleted: _ g L - � � • � �
` . . � Alt. A Alt. 8
Proposed Driver�ay Width Tf New Opening Is Desired: $' $
, . .. SE� Rc.VERSE SIDE OF SiIEET
�iie undexsigned liereb}► make� application for a permit fcr the �:vrk� herein specified,
agreeing to do.all work in strict accordance t•rith the City of I'ridley Ordinances znd
rulings of i:lte Depzrtment of Buildings, and hereby declares that all tlie iacts and
r.apr��entations stated :1i this application are true and correct.
�� � .
D:�T�: ` SIGNATUF�E: � +�' /��
. � � .
Stipulatio s: • �. � '
p • C�3.�o � .. � .
p.� ►� .7� .- .
S.0 S. d3 . � .
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J3UIL1)I(1G ('CfZ141T (=E:t� :;(:{(f:pUL�� � .
:;l:C'.CI01•� 2. •').'1�& 7n�.:��cctc�r. of: llua.l.c?il��� :::li:i].]., r�eto�:cf �.:; ,uit�g penniL;; for 4hc crr.cL•ion
ut .�ny )�u�.l.�l.in�� ax :;i:�'uct:uzc, �r. �a�: t�ny acicli.t:i��n +.:� atiy cr,i:;L-i.nc� )�tiilcli►ic1 �i ;;LrucL•w:e,
,. ci�' f:��- z,r,y aJ.i:r.rc�tion nr. r.e�;,air.s t.o •�-�ny exi. .t:in�,� )�uiJ.di,�u.J oz sC�uc:ture, uJ�c.n nr�pli.cata.o»
�'ihcr.�for.e, r.equzr.c LJi� paymenL• l�y t]ie ar�p].i.c:ant: foi- ;;uch per.mi.L• of.� tec, to ilie arn�unt•
hcX�in beJ.o�•� sct for.th �uld S.i� tlie �nanne�: hcrei.n ��rov�.dc:cl L-o-�:�a.L•: .
. . , . .
tal.l? COtJS'!'I:UCTIOt�: �ing7.c 1'�zmil.y iloiaes and Gar.ac�es: ;:d.00/),000 cui�xc teet:.
'PJ..T:t�t Cl!}:CI;: 25 ��er.cerit. aL' huz.lcli�lcJ ��er.miL- L•ce.
UI2IVl;l?111' llL•'1'P1:SSI0t•I: (Cpncretq Gtiirb �L-rec�s Only) � �'
' A].tcrnai:e A: ltainoval and replaccmen� oi concxete curb and.
quLter only; Uriveway t�idth plus 6 ieet• x$13. �0
Aa.ternate B: P.�moval and rep�.acem�•nt of concrete curb and
� •� guttcr and in�tall a 3 foot V�ide approach t��f L-h ''
� ,• 6 inch depi:h; Drive;�ay wic:th �plus G ieet x-$15� 7�
• . ADDI T l O�AL I �lFOR��nLr or� �
For the purl�se of co�npuL-ing fees for building permit�,. L-he cubical. contents of any
i�uil.di.ng or addition, is deter.:ni.ned by rnultiplying tlie ground area cc�vered irom a
p�a.nt �if (G) inches belo•r� the iloor l.ine o�' L-he basement or tha cellar to thc
average heights oY•'ihe •up�er surface or to the average height af the roof. surface
of the raain gal�J.e of a p�.tched roof. �
Fox' reFai.rs or a].terations to an existing stnicture, the tee shall� be at the xate
of $3.00 Pex each fivc hundred dollars •� ($SQ0.00) or fracL-ion L-hereaf in the cost
oi all proposed wor.k. , . -
Yn •no case sha�.l the fee cliarged fc�r any pPac►nit as set iorth �n Sectian 2 be less �
than $?.50 plus $.50 sta�e surcharge. � . � - '
_ VERIFICATIO� OF FOU;�In1�TI0tJ
WOTE: Pexmit� �or construction will be issued a minimum af 24 hours from t1�e time
of application to a].loiv for proper rc��iew of the pro,posed siructure and oi �he -
construction site. �
;
R Cert.ificate � of Survey of the l�t, sho�,�ing the location of the foundata.on once it
has been constnicted <<fill be required bef.are pr.oceedinq erith the iraming.
..�RT I F I CATE OF OCGUPANCti' ' '
?►ppl.icatic�n ior a Certificate oi Occupancy shall kie mad;� ten (10) days prior to the
u�e or OCCUF3I1Cj7 oi an}► stz�ucture for �,rhich a liui.lcling permit l�as been issu�d; and
s�-;.ic2 S�L'llCtlilC 52131�. i�ot be used or oceupied tuitil a Ceri:ificZte oi' Occurzncy has
bccn xssued. �
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sua�ecr PER .
City of Fridley 2 � 8 2 8
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
RECE
� � COMMUNITY DEVELOPMENT DIV.
� � �1���y
� ; r ------�
r � � PROTECTIVE INSPECTION SEC.
i . �
� � /�"1 � CITY HALL FRIDLE� SS43Z NUMBER REV. OATE PAGE OF APPROVED BV
�'""'� � ,'� 612-571-3450 910-F15 5/17/91 / /
JOB ADDRESS 1356 Hillcrest Drive NE
1 LEGAL LOT NO. BLOCK TRACT Oi; ADDITiON SEE ATTACHED
DESCR. �-1 3 Moore :Lake H].Z1S SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PNONE
Dale Moss 1356 Hillcrest Drive NE 572-0424
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO.
S aine
4 ARCHITECT OR DESIGNEH MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAiL ADDRESS ZIP PNONE LICENSE NO.
8 USE OF BUILDING
Res identi.al
7 CLASS OF WORK
O NEW L}� ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Construct a 204 square foot deck addition
8 CHANGE OF USE FROM TO
STIPULATIONS
See notati,ons on plan,
i
�����.��
Before diggirg c211 for
all utility locations
454-0002
REQUIRED BY LAW
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATIN(3,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID If WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WOf;K IS SUSPENDED OR ABANDONED FOH 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 �- STALIS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PFiOVISIONS OF LAWS VALUATION SUFTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $l, 550 tiS` e%S
WITN WHETHER SPECIFIED HEFEIN OR NOT. TNE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEqMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON- $3'J.00 Fire SC $�..SS
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CFIECK FEE TOTAL FEE
9,33
SIGNATURE OF CONTRACTOR OR AUTNORIZED AGENT IDATEI �I�IFIEN ROPER Y V I T D IS VOUF PERMIT
D��,�=� ',�/ �� C , 5=1� q I
SiGN EA 0 OW ERUFCj NEfiBURDER� �iDATE� BLOG �NSp OoTE
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A`1 AND 1�2
Huildinq Permit Applicatiaai
�t�ctio� Fi�]ress: 13S(a J�� I 1 crec � Lia� . ri►. �°
Effective 1/1/91
I.�Cj'dl D2SCr'1�1aQ"1: � I�ve,l� ��c�.►�vo �I,l►�nea
Owner xame & �� : � c�.7� � c S� � a �-.P rr, c � la�s.e_� �e1.. # s'7� -o �1o2'f
contractor: h�,� Z+e1. # —
�f37'Y?C:C � � � �
Attach to this applicatia�, a�7erkificate of S'urvey of the
lot, with �h,e praposeci ao�Ctia�n drawn c� it to scale.
D�C�tIP'PI�T �' �Tl'
LIVII�C3 �i: Ie�ngth Width He�ight Sq. Ft.
C�RAGE AREA: IP.IK�1 Width Height , Sq. F't.
. �
n� �i. I�- wiath I o xyt/cran�d sq. F't.
a�: �`��H � � `1
�c� � � � � 5� � 1 �� � �`°�y � �l
Gorner IAt [] Inside Ivt [.� Ft. Yd Setback Side Yard Setba �
��pe of C�struction: _ f _ �'� _° ' j " '�-��; FS- t;�ted Cost: $ ����
Approx. C�aampletion Date:
Proposed Driveway Width If New op�ir�q Is Desir�d: Ft. S $
Width + 6' See Back Page
DA'PE: APPLICAN'r: z✓ i�� � Tel. #
[�±44`�i}_f��i:�i�1'�
Piermit Fee $ �_�c �� Fee Sd�tile an R�veise Side
Fire S�rcha�ge S �° . ooi x�t vaivatia� �i/ioth ��
state sur�iarge S .'-� yj .,so/Si, o0o valuat�tan
SAC C�arge $ $650 per SAC Unit
DriVeway E���vw $ Alt. "A" or Alt. "B" Above
Park Fee $ Fee Determir�ad by Er�ginePSi,r�g
sewer rlain criazge $ Agr�aent NeoessaYY I l Not Ne�ssary [ l
. v
-� M.:� 1 : M ., �.
$ ��
�
��� � �
�, _, v
8 ��� �
�-� �
:il � � � ' :ri'. � �,-.:�i� _'�.:I:���1� �
�e Chief Huildir�q Offici.al shall, before issuir�g pera�its for t�e erection of any
buildir�g or stn�ure, or for any additi aai to ariy exist3rr� buildityg or structur�e, or
for arYy alterdtiaaz or repair to ariy existiryg buildirig ar strwcture. upon apPlicatia�
therefore, r�quire ti�e payment by t��e applicant far sudi permit of fees tc the aana.mt
i�.in belcw set forth arni in ti�e mant�er l�+ein provid,ed to- wit:
ZO►I'AL VAIIJE
$1 to $500
$5oi to S2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 tA $500,000
��
$15 (Minim� Fee is $15 plus s��+a*�)
$15 for fiYSt $500 plus $2 for each additional $l00 or
fraction th,ereof, to ar,a irr.lu�dir�g $a, o00
$45 for first $2,000 plus $9 for each additional $1,000
or fractioQi thereof, to aT�d includir�g $25, 000
$252 for first $25,000 plus $6.50 for eac� a�itional $1,000
or frdCticdi thel�eof, to arld inClucling $50, 000
$414.50 for first $50,000 plus $4.50 for each additiarsal
$1, 000 0�' fract3aai thetieof, to ar�d including $100, 000
$639.50 for fixst $1�0,000 plus $3.50 for each aclditional
$1, 000 or fractiaal tlier+eof, to ar�d includir�g $500, 000
$500,001 to $1,000,000 $2039.50 for th�e fiYSt $500,000 plus $3 for each ac�ditional
$1,000 or fractian theraof, to arid including $1,000,000
$1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for each additional
$1,000 or fractian th�reof
�tIVE�iY �SI�T EBC�W
(C�oax�rete � Streets �lY)
Alternate ngn : R,�oval ar�d replav�opnt of c�rb arxi gutter anly - DriveWay width plus
6 feet time� $13.50.
Alte.rnate "B" : R,�oval and re�lao�ent of curb ard gutter ar�d install a 3 foot wide
approach with 6 itxii depth - D�iveway width plus 6 feet times $15.75.
�/:�; �a1 s+: M ��, •1' �a�:n,n : M � �I
Piermits for o�uctioai will be isst�ed a minim� of a4 hou�s fr� th�e time of
application to allav far prop�r review of the prrq�osed stru,cture arid of the
co�structi� site.
A DeYtificate of S�vey of the lat, stiowir�g the locatia� of the fwr�c7ation �ce it has
it has been ooa�structred will be required before prooeedii�g with the fra4ni,ng.
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sue�ecr PERMIT NO.
City of Fridley 2 2 4 0
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r �'__.�
� ` RECEIPT NO.
� ; L _ COMMUNITY DEVELOPMENT OIV.
r � � PROTECTIVE INSPECTION SEC. /a!�
i ` �
� /�'�1 � CITY HALL FRIDLE� 55432 NUMBER NEV OATE PAGE OF APPROVED BY
�"""'�"� ,'� 612-571-3450 910-F15 4/5/94 � �
JOB ADDRESS 1356 Hillcrest Drive NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 11 3 Moore Lake Hills SHEET
2 PROPERTYOWNER MAILADDRESS 21P PNONE
Dale Moss 1356 Hillcrest Drive E -
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO.
Sam.e
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PMONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO.
8 USE OF BUILDINCi
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House Tear-off 20 S uar
9 CHANOE QF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY (3ROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OF 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 CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VAIUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OP WOHK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �1 �SOO �.75
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �3S.00 Fire SC I.SO
PLAN CHECK FEE TOTAL FEE
37.25
SIGNATUREOFCONTRACTORORAUTFIORI2EDAGENT IDATEI WHEN ERL VALIDATED TMIS IS YOUR PERMIT
,� � ������� � �-�-��
S�G L E OF O iiF OW R IL�ER� �DATE� BLDG �NS� OaTE T-
NEW
ADDN
ALTER
�l
[1
ffi
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Applicadon
Effective 1 / 1 /94
%lfi"� 2/ �
Constr+uctionAdciress: l �.� � ��`�l C/�L°S f ,(�/' • 1 V ` � • —
Legal Description: /<,��� _ /%� � �
Owner Name & Address: 1� ��? , i� �5 S Tel. #� 7� -���
Contractor: �Q ( � MN LICENSE #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction dra.�vn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel.#.
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: I.ength Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: ��A'R - o Ff ��1 C- ���� � C? ��
Corner Lot (] Inside Lot j] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimat� Cost: $
Approx. Completion Date:
_ (Cost on Back)
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: APPLICANT: Tel. #
P+e�it Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
S � S ��
� / ��
�
$ , ��
$
$
$
$
$
$
$ � �% � 5�
C�— ��M ��.��� .� `1 A'1
F� Sche�ule on Reverse Side
.IX�1 of Permit Valuation (1/lUth%)
$.SO/$1,000 Valuation
$S� per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" . Above
$450.00 Conservadon Plan Review
Fe� Determined by Engin�ring
Agreement Necessary [ ] Not Necessary [ ]
��
�
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing p�mits for the erection of any building or structure,
or for any addition to any existing building or stru�hire, or for any alteration or repair to any existing
building or structure, upon application therefore, require the payment by the appiicant for such permit
of fees to the amount herein below set focth and in the manner herein provided to-wit:
TOTAL VALUE
$1 � � to $500
$501 to $2,000
FEES
$15 (Minimum Fee is $15 plus surcharge)
$15 for first $500 plus $2 for each additional $i00 or
fraction �ereof, to and including $2,OOU
$2,001 to $25,000 .$45 for first $2,000 plus $9 for each additional $1;000 �
. or fraction thereof, to and including $25,000 -
$25;001 to $50,000 � .$252 for first� $25,000 pt�s $6.50 far each additional $1;000
� or fraction the�eof, to. and including $50,000
$50,001 to $100,000
$10(},001 to $500,000
$500,001 to $1,000,000
$1,UOQ,001 and up
$414.50 for first $50,000 plus $4.50 for each additional
$1,000 or fraction thereof, to aad including $100,000
$539.50 for first $1�,OU0 plus $3.50 for each additional-
$1,040 or fraction thereof, to and including -$5Q0,000
$2039.50 for the firs�t $500,000 plus $3 for each additional
$1,000 or fraction thereof, to and including $1,(�0,000
$3539.50 for �the first $1,000,000 plus $2 for each additional
$1,OU0 or fraction �thereof -
DRIVEWAY DEPRESSION ESCROW
-:- --
- - - -- - - _ _ - - - {Cunca�ete� �utb �iT� iiwy j
Altema�e "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 fe� times
$13.50.
�.Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide.
approach with 6 inch depth - Driveway widtfi plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for conshuction will be issued a minimum of 24 hours from the time of application to allow
for proper review of the proposed sh-ucture and of the coastruction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been
constructed will be required before proceediag with the framing.
sue�ecT PERMIT
City of Fridley 4 �
AT THE TOP OF TNE TWINS g U I L D I N G P E R M I T �" O O
r
; � EIPT NO.
COMMUNITY OEVEIOPMENT OIV.
r � v � � PROTECTIVE INSPECTION SEC. / /
� � ��
i..•. `��'���,.� CITY HALL FRIDLE� SS�3i NUMBEP pEV DATE PAGE OF APVROVEO BY
� �� 763-571-3450 s�aF�s 4/1/03 / /
JOB ADDRESS 1356 Hillcrest Drive NE
1 LEGAL �OT NO. BLOCK TRACT Ofl ADDITION SEE ATTACMED
oesca. 11 3 Moore Lake Hills SMEET
2 PROPEiiTY OWNER MAIL ADDRESS LIP PMONE
Dale/3ean Moss 1356 Hillcrest Drive NE 763-572-0424
3 CONTRACTOR MAIL ADDRESS ZIP PMONE LICENSE NO
Ciark Contracting Inc 13133 89 N, Ma le Grove MN 55369 763-420-7987
e ARCh11TECT OR DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO.
20267426
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OP BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION O ALTERATION � FiEPAIR O MOVE O REMOVE
8 OESCRIBE WORK
Reside House & Garage
9 CHAN(3E OF USE FROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive
barrier be placed over exterior sheathing to protect the interior wall covering.
Exceptions for this provision would be ii sheathing is aa approved weatherproof
panel or when the siding is an approved weather barrier. Vinyl siding is not
a weatherproo� coveriag un�ess �he manufacturer states this ia the�r application
guidelines. Call for inspeciion of wrap beiore coveri�g. Cauik and flash all
exterior openings.
SEPARATE PERMITS ARE RE�UIRED FOR ELECTiiICAL, PLUMBING, MEATING, TYPE OF CONST OCCUPANCV GROUP OCCUPANCY LOAD
VENTI�ATING OR AIR CONOITIONING
TMIS PEiiM1T BECOMES NULL AND VOIO IF WORK OF CONSTRUCTION 20NING SO. fT CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 80 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPEN�ED OR ABANOONED POii A PERI00 OF 120 DAYS AT
ANV TIME AFTEH WORK IS COMMENCEO. NO DWLG. UNITS OFFSTqEET PARKING
I MEREBY CEfiTIFV THAT I HAVE READ ANO EXAMINEO THIS APPLICATION ]. STA�LS GAHAGES
AND KNOW TME SAME TO BE TRUE AND COpNECT. ALl PROVISIONS OF LAWS yp�UATION SURTAX
ANO OROINANCES GOVEFNING 7HIS TVPE Of WORK WILL BE COMPLIEO
WITH WMETMER SPECIFIEO MEREIN OR NOT. TNE GRANTING OF A PERMIT �S � OOO �c�.. SO
DOES NOT PRESUME TO GIVE AUTMORI7Y TO VIOLATE OR CANCEL TME pEqMIT fEE SAC CMARGE
PROVISIONS OF ANY OTMER STATE OR LOCAL LAW REGULATING CON-
STqUCTION OR TME PERfORMANCE Of CONSTRUCTION �ljj.2,rj j+�re SC �rj.Q�
�/ PIAN CMECK fEE TOTAL FEE
' -/ � �% Lic nse SC $5.00 $123.75
GN4TUAEOFCON•A4CTOAOpAUTMOp�ZEDaGENT 0� E� WMEN PROPERIV VALIDATED THIS IS V UR PERMIT
S�GNOTUAE O� OWNEA��� OWNEpBWIDEA� �D�rE� � G�NS �' �61�
N-
NEW [ ]
ADDN [ ]
ALTER [}�
Construction Address:
Legal Description:
CITY OF FRIDLEY Effective 1/1/2003
6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
�
'� /�, �
Owner Name Address: � ,� Tel. # 7�3 572- OyZ �l
Contractor. �C.�c� ��t�Ail�� ll�� MN LICENSE #�C -Z02(%Y�
Address:� 31.� 3'��� V�j�L,� ��20 U�.,dM�t, SS3�q Tel. # i6�-°�ZO ?�/8' 7
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
�e�.S�d@ �o�,�.se, c�..�cl C���..
Construction Type:_ S tdi�, Estimated Cost: $ J,�CZ�. ��
Driveway Curb Cut �dth Needed: Ft. + 6 Ft = Ft x$ _�
0
DATE: ��� �-� APPLICANT: Tel. #�rZ"7a/ �%8��
Call (763) 572-3604 for Permit Fees if ma ng in application. Fax to 763�71-1287 if using credit card and we will
call you for card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
$ III.�S�
$ �- ��
$ �- S?�
$
$ �� �b
$
$
$
$
$ %��� ��
Fee Schedule on Reverse Side
.001 of Pennit Valuation (1/10th%)
$.50/$1,000 Valuation
$1275 per SAC Unit
$5.00 (State Licensed Residential Contra�tors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ) Not Necessary [ ]
� r
_ •.
; 11 1 I► �'�: UIY �I �1:1�1 1
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair 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:
TOTAL VALUE
$1 to $500
$501 to $2,�0
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$lOQ,001 to $500,000
$500,001 to $1,000,000
��
$23.50
$23.50 for first $500 plus $3.05 for each additional $1Q0 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,0(30 or fraction thereof, to and including $100,Q00
$993.75 for first $100,000 plus $5.60 for each additional
$1,(�0 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1, 000 or fraction thereof, to and including $1,000, 000
$1,000,001 and up $5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
cuRS cu�r Escxow
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet times $17.00.
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing
proceeding with the framing. New Houses Onlv
�.
foundation will be required before
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
, ° FRIDLEY, MN 55432
57"1-36U4 r'AX:
ADDRESS : 1356 HILLCREST DR NE
PIN : 243024120032
LEGAL DESC : MOORE LAKE HILLS
: LOT 11 BLOCK 3
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : PIPING, REPAIR OR ALTR
VALUATION .
NOTE: PH.952-933-1868 CONTACT PERSON JOANN
APPLICANT
PRACTICAL SYSTEMS
4342B SHADY OAK RD
HOPKINS, MN 55343
OWNER
MOSS DALE ALLAN & JEAN M
1356 HILLCREST DR NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
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 after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worb
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate cel the provisions of any other state or local law
regulating co tru n or the performance of construction.
Applicant _ __ Date � �
: , : �L�l��'��'� � • :�'�E�
571-1"lif7
PERMIT NO.: 2004-02264
DATE ISSUED: 12/09/2004
STATE SURCHARGE, MECH FLAT
GAS PIPING FEE
TOTAL
PAID WITH CHECK # VISA
SEPARATE PERMITS RE�UIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0.50
15.00
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Building
Inspections
763-572=3604
�ATE i�— `o�3—c7
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
�ITE ADDRES3 �35� � i( �f1+�:i� oP• �L
Permit No.:
�- -. :
►'.!�i� :! f
,
YOUR E-MAII. ADDRESS r�Ylo��%3,3�0 �.nCn � e�
I"HIS APPLICANT IS: � OWNER �CONTRACTOR
PROPERTY OWNER/ Nq�: ��(� � �c� S
TENANT ADDRHSS:�,B `Z ar��.�g I�,g �= �.�.�. � CrrY p` s'rqT�,.���y3 Z
PHONE: ?(�r `3 — 5�7 � --� � �, t(
CONTRACTOR
SUBMTT A COPY OF �TATE ��SE # EXP DATE
YOUR STATE LICENSE ADDRESS: CITY STATE ZIP
WTTH APPLICATION pHOME Fesr
PROPERTY TYPE
PERNIIT TYPE
TYPE OF WORK:
Y/NEW
❑ BASEI�NT FWISH ❑ ROOF
� DECK ❑ SIDING
❑ SWII�IIvI
� � � _—i r,
❑ DRAIN T[LE
❑ OTHER
DESCRIBE WORK BEING DONE:_�lc�� t��`nafow ' .
SIZE OF IlVII'ROVEMENT
NUMBER OF SQUARE.S _
GARAGES
PROP05£D SIZE:
PROPOSED HEIGH'f:
❑ HOUSE OAiLY
❑ HOUSE & GAR.AGE
� AITACHED GARAGE
❑ DETACHED GARAGE
HEIGHT
BASENIENT REMODELING SUBMIT•
1. F.xisting Ffoor Plan
2. Proposed fl�r plan
3. List of struct�ual membecs to be used
F�
SIDING FOR NEW CONSIRUCTION lNCLUDMG DECKS,
❑ Vmyl OSoffit � ADDTIIOAIS & PORC}�S SUBMIT•
O Aluminum ' ❑ Trim 1. Site Plan/Sruvey showing the existing struclvres
❑ Odter . • ❑ Fascia
and praposed proj�t.
WAVDOWS 2. Two sets of construcdon plans
IN E3QSTIIJG OPENINGS Y� Dldo LACAI7QN OF WIIVDO S 3• F"efSY ���ons
OR FORNEW OPENINGS-�ESCRIBE SfZE OF �_. .,. �yS��� �r�,,� In -�/�
OPIIJWG CHANGES 8c %�`�'—'' �
. �n ��t���R� �n� ��. � �w�w . � � w.� M . _ _ _ _ —_ _ - . . . ai
ALL FEES ARE BASED ON VALUATIOIV, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $� P� 0 D OCCUPANCY_ TYPE
Permit Fee
Plan Review
Fire Surcharge
S�rchazge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park F�
Sewer Main Charge
Total Dne
$ J�� See Back Page for Fee Schedule
$ 65% of Building Pernut Fee
$ % D77 .001 times the total job va.luation
' $ %� �� .0005 x Permit Valuation Minimum $.50
$ $S.QO (State Licensed Residential Contractors)
$ $1675 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ � ,%� Make checks payable to: Citv of Fridlev Attar
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in
c�nformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; thax I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accor8ance with the approved
plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT �.ip� �� PRINT NAME J Qa,�► �lC�S DATE_ /0 -� —v °�
Page 2- Bvi.Ldi.n.g Residential Application
BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing pem:uts for the erection of any building or
shv.cture, or for any ad.dition to any existing building or structure, or for any alteration or repair
to any existing buildS.ng or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herei.n below set forth and in the manner herein
provided to-wit:
VERIFICATION OF FOUNDATION
Permits for constructi�n will be i.ssued a m;n;T„um of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site.
A Certificate of Survey of t�e lot, showing the location of the existing foun.dation will be
required before proceeding with the firaming. New Houses Onlv
City of Fridley
Building Inspections Department
6431 Universiiy Avenue NE
Fridley, MN 55432
'7.63-572-3604
Fax: 763-502-4977