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; Village of Fridley, : Minn. .
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BUILDING PERIl�IIT �° i 6 4 5 `�,
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Date: . . :a. . . . . . . . . . . . . . . . . . . . . . . ',
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Owner ..:":j .•'.,��P.� .."s. . r�. ..... �.. Builder ....... .... ..... ......... ,= ;
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Address .. . ..... . _ .. . . Address ..... . ...... . ....... ..... '��
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� LOCATION .
�3kF $UlLD1NG Ir
No. . .�� � �� s" `: r•� �;. . . s :=� � � k � � � . . Part of Lot • . . . . . . . . . . . . . .
p Street �"� � . . -
Lot .... . Block .���f ..� . Addition.or.Sub-1}iuision .. . .. ....... .. �'i
Corner Lot . . . . . . . . . . . Tnside I:ot � Setback . ; :� :�.� Sideyard. . .°.t� �. . . . . . . . . . . j
,
' DESCR[PTION OF BUILDING ;
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To be iTse� as •
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� � . .�. . . Front � �"`.�f . . . Depth� . . .�.�'.: . Height . . . . . . . .' Sq. Ft . . . . . . . . Cu. F`i. . . . . . . .
., nt ... Depth Height _ .... Sq. Ft. .... Cu. Ft ....
.. .......,....... .... ;.... _
Type of Canstruction ,�:: :�`.'.. . +:. . . . Est, Co§t �'�'�� �'•� , To be` Completed ... .. ..... ......
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In` consideration of the issuance t� me of a permit ta construct the iZUilding described above, I agree to do
the proposed work in aceordance with the description . above set forth ancl in comgliance with aII ,provisions of
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ardinances of ihe village oP Friclley. �.�' ., "` ,
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In �o�sideration oP the payment of a fee of $.`��. •:�-'�. . . ., permit is hereby grented to . . w . . : ; <�"� . . . .
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:* �- ,�°:` `"'�' -'�' �"'�; .^ to construet fhe bui�dfng or addition as desGC^ibed above. Thia t is anted
� Permi gr nPon
the.express condition that the person to whom it is granted and his agents, employe� and worl�nen, in all 'a'ork
done in, around and upon said buiiding, or any part tYiereof, shail conform in all re�cts to the ' vrslinances oi _'
k'ridley, Ntinnesota regarding la:ation, construction, altera.t3on, maintenance, rePair aa8 moving o4 buildings vvith-
in the village limits and, this perm�t rnay be revoked at any time u�n violation of any of ihe prbvisibns of said
orclinances. � ' ; �,,� R _
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. ..... ..r.. .. .... SL�1diII In6pectOr
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, NOTICE: . ` '
This permit does nbt cover the construction, instatlafiion or alteration for vvlring, plumbing, gas heating, '
sewer or v�ater. Be sure;to see t�uilding Inspector for separate Ae�mits for,�'� items.
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SUBJECT P, 14. 5
City of Fridley
AT THE TOP OF THE TWINS g U i L D I N G P E R M
r
; � RECEIPT NO.
� � COMMUNITY DEVELOPMENT DIV.
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r � � PROTECTIVE INSPECTION SEC.
1 . �
1 � /"�1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�""� � ,'� 612-560-3450
910-F15 5/19/77 . � �
JOB ADDRESS 5124 Horizon Drive N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. j, 5 5 �Cl.l�.SOIl� S Stm�mit Manor cuOLl'�1 SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Gerald Bock.et 5124 Horizon Drive N.E.
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Reside House
9 CHANGE OF USE FROM TO
ySTIPULATIONS
SEPERATE � PERMITS REQUIRED F� y!�����y�
i�tE�AT1NC� PLUM�B�Nt� AND SIGlVS�. � .
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. M3SOI17.'te
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UN�TS 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. $5OO yS`.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
P,ROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $7 �SO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
$8.0�
SiGNn URE oF CONT C7oa OR AurH rzE0 GE IDATEI HEN PROPE LY VALIDATE THIS IS YOUR PERMIT
i �� AD � CJ�✓V � �� —
SIGNATUREOFO NERUFOWNE BUILDERI IDA 1 � BLDG WSP DA7E
CITY OF FKIDLEY,
APPLICATION FOR RESIDENTIAL BUILDING PERt�ITS
�NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWf7ER: �P�YQ `� I�, /��G/�`�i� BUILDER: V Q/-%j��i .- �
Address : ��� y /�B/"� ?i4l� ,�/; Address :
Tel . No . ��p,6— /���
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No. : ��.Z y Street: e�/r//"� 2-4%�d .U�'�
t �LOT: � � BLOCK: � ADDITION: ��� �irs,p� S
CORNER LOT: INSIDE LOT: SLTBACK: SIDEYARDS:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building loca�ion drawn on these Certificates.
DESCRIPI'ION OF BUILDING
To Be Used As:
�rGL�
,p ront: Depth: Height:
Square I'ee�: Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: 1� \ Estimated Cost: $ S��Q� ��
To Be Completed: � ��/ Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
The undersigned 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 Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct. See reverse side for additional inforni n.
DATE: � 5IGNATURE: �
Stipulations:
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BUILDI(JC PERt�IIT FEt SCHEDULE
5ECTION 2. The Inspector af Buildings shall, before issui.ng permits for the erection
o� 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 hereiri provided to-wit:
NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet..
PLAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSION: (Concrete Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$11.75
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3 foot wide approach with
6 inch depth; Driveway width plus 6 feet x$15.40
_ADDITIONAL INFORMATIQN
For the purpose of computing fees for building permits, the cubical contents of any
building or addition, is determined by multiplying the ground area covered from a
point six (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 main gable of a pitched roof.
For repai.rs 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 in the cost
of all proposed 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.
VERIFICATIOy OF FOUNDATION
NOTE: Permits for construction will be issued a minimtun of 24 hours from the time
of application to allow for proper review of the proposed structure and of the
construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
_CtRTIFICATE OF O�GupANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occuparicy of any structure for which a building permit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
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