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City of Fridley, Minn. N° 8715
BUILDING PERMIT
nate: rqarcn 16, ].,�66
�: Clemron, Inc. �� Clemx�on, �nc.
Ad�ea� Adaress 701 Colvmbia Blvd. N.E.
LOCATION OF BUILDING
No. �_ St�eet eT8.Ck8o?'± S�?'�??� AT.r+.. Part of Lot
Melod Manor 3rd
Lot �_ Block �_ Adaition or Sub-Division � � �
Coraer Lot � Inesde Lot 3etback �� � Sideyard �?! 8tazi. 1]..�
Sewer IIevatton — _ - _ _ --- Founda.tion IIevatfon
DESCRIPTION OF BUILDING
To be Used as:
D►�re]-13xig �t � 26 � �P� 2 t xe�ght �! sq. Ft. �.� c:u. �_21,.81tD
� Ga�'ag� r�ront �.� nepth _22! xe��t �.Q± sq. �. --�7� cn. �c. _�2n
1j�pe of construction r'Y'� F�t. cost ��4 To be completea —9�16�b6
Ia cona4dera��on oP the fesuaacae to me o4 a permit to build9n� described e I agree to do
th� proposed work ffi accordance with the description above E, aad in co�plian a'll provlsfbns oP
or8iaances of the dq► oP Fridley. �,
G`
Ia ca�eideratlon of the PaYment oP a Pee ot $�Q�_.� permit 18 hBleby 8=�ated to Cl Pmr�nn Tnr± _
to construct the building or additfon as descrlbed above. Thispe rmit is graated up�
the e�cpress conditton that theperson to whom it is 6+�� and his agent� employees and worl�nen, 9n all work
done in, around and upon eaid building� or anyp thereo$ at�all conPorm ia aII respeete to the o�dinsaces aP
Fridley� Miaaesota regardisg loc�tlon� conatruction�, alteratlon, meiatenance. repair aad a►oving oE build�ags
within the dty limita and tbis permit may be revoked at aRY time upon vlolatlon of any oE the F�vis�lons oP ea�d
orr]inencea
; .�.�.� ��� `il�>> -�' —_ -
Nonce�
'11�f pamit doa ae! eora tiw eoe�uaHon, t�talHtloe �e� �rWeo� P�+�6. Ya 6ude�, a�w� or wahr. B� an to a�
�lu BoUdi� Intp�etar ter apara� paimNs �e� fh�a Ns�m.
�
APPLICATION FOR BUILDING .P�'a1�1IT
CITY OF FRIDLEY, MINNESOTA
� �i �' .,�'.� /� � � � �/' ; l i . �
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,�.,�-aP.c,� '7 3�� ��� LOCATTON OF StTII,D NG
�: ���.��
Na.� ��%�0 Street Part of Lat
Lot ,�',�`�'� Block Addition or Subdivision
s� �
i
Corner Lot `/'��Inaide I,ot Setback �,� �a Side Yard_ ��� �,�/�--�
SEt�ER ELEVATION ' FOUNDATION ELE9ATION
Applicant attach to this form T�io Certi�icates of Survep of Lot aad proposed bLiid-
ing locatioa dr�wn on these Certificates.
DESCRI�iION OF SUILDING
To used �,s :
,' �. . / �
Froat ��i -� ���.�h �� �-CI Height' 4 � .
Sq. Ft. Cu. Ft•�_, - ,_�,�� ��
.
Froat_ ��p �� Dapth �^2` He3ght �� �� '
Sq. FC. �� � �s Cu. Ft. � � �� �
� o�
Tqpe, of Construction �.�i�� , Estimated Cost
�
To be Completed
The undersigned hereby makes application for a permit for ehe work herein specified,
agreeing to do all work in etrict accordance with the City of Fridley Ordinancea aad
ruliags of the Department of Buildings., and hereby declares that all the facCe aad
representations eCated in this application a=e true and correcC. ",,
�
�Schedule of Fee Costa can be found on Che Reverse S�.de).
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BUILDING PERI�T FEE S�IEDLiLE
Sectioa 2. The Znspector of Buildings shall, before isaui�g any pe�it for
the erection of any bu3lding or structure, or for any addition to any e�tii.st-
iag bu3lding or eCructure, or for any alterat�.ons or repairs to any esis��.xag
build3ag or seructure, upoa application therefor, require the pay�caent by the
applicant for such permit of fees tv the amouat hereia below set forth ar_d
in the maaaer herein provided to-wit:
2.1. For any such permit for the esection o,f any fire-proof building� other
than a garage, warehouae, factory or grain elevator, or for the erectio� of
anq fire-proof addition, for similar occupaacq, to aaq existiag building
shall be at the rate of $1,40 for each one thousand cubic feet, or fractic+n
thereof, in such cubical contents.
2.2. For any such permit for eh� erection of anq fire-proof garage, warehouse,_
factory or grain elevator, or for the erectioa of any fire-proof adclition,
for eimilar occupancy, to any existing buildimg sha11 1�e at the rate of $1.25
for each one thousand cub3c feet, classified as "fireproof" by Section 5G2 of
the Minneapoli� Build3ng Code.
HOUSES
2.3. For anq such permit for the erection of any non-fireproof builct�r..; �4:Les
than a garege� warehouse, factory or graia elevator, or aaq non-fireg�c���
addition, for a3milar occupaacy, to any exiatiag building - peru:it $�..a0 �or
each one thousand cubic feet.
GARAGES
2_4� For aaq such permit for the e�ear�n� �r �,r:�� �,,,�o��:.,.,���,..,� g$�a�e,
warehouse, factory or graia elevato�, ��• r;�;- �_:: �-..F=�� � P
,. .,. .�.cs� c�� �u� nna��•r�x.:p�toof
additioa, #or .s�.m4.lar occupaacy, t�a =,� ,��.�c.0 ::;�.�. �,=r- Y-L�:b o�- for each s�ch
__- �buildiag or addition - niaety rF±�W� �=;,;;,��;�1 �-,r ��,,.;1 �,�,e �bc�sand cu��!� feet
or fract3on thereof, in the c�:�yc�� �:.�-�c-:.,.�� �:;1�:��or with a�ninimum oi $4.OQ.•
For the purpose of computing fees f-�;r �,p�, e�.rl.i�g pArn� �,s, the cubical contents
of any building or additioa Co a uaife::.� c�5;;�:t tbr�u�;hout by multiply�.ag the •
ground area covered from a point sig (6) i�z::��s bel:�ca the floor liae of .;.�e
basement or cellar to the average height of t�� ;��;���r s�x�£ace or to the ��
average height of the rooi aurface of the main �aule of a pitched roof.
2.5. For repairs or alterations to an exieting structure, the �ee shall be
at the rate of $3.00 per each Five Huadred Dollars ($500.00) or fraction
thereof in the coat of a11 proposed work.
2= In no case ahall the fee_.charged.#er_any pe�mi� a�s Bet forth in
Section 2 be less.thaa $4.0p.
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CHIM�JEY AND STACK VERIFICATiON
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes (�)
2. Is free from rust or deterioration Yes ()
3. Has no foreign objects lodged within Yes ()
4. Is securely supported Yes ()
5. M�eis all current CodP re4uirements for size and
total BTU connected
6. Has To ta 1 hea ti ng BTU' s of
All other BTU's
TOTAL
Rema rk s
No ( )
No ( )
No ( )
No ( )
Yes ( ) No ( )
Company
Signed By
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N�F�T LOSj Cf-1LCULh;T?GhJ FOR 5.T4'6�tr1ICN-74r��> Jf�CF':S�P.I �T.N.Ee
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HOUSE HEATING TEST RECORD
P�� `� y�� � a�-���-- �S �•�• APT. F�ooR crrir sueuRB ��
ADDR ESS
OCNPANT OWNER �� � �� � `�p1��
HEAT LOSS DATE HTG. INtS�T. a' ' �-,,�
SOLD BY ����'�� �`, lNSTALLED BY =� c{ � � -
Eleetricol Work By Gaa Lins By S� ��
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS ESIGN CONVERSIOPI
MAKE ` � � MAKE OF BURNER
Mod�l � 1�i l � .i Modsl
S�riol � � � �° Max. BTU Rati�g
INPUT ��F �� MAKE OF FURNACE
Modsl _
CONTROLS �r
THERMOSTAT����THeat Plug �o � Vent Sizs
Valve �� - KIND OF LINER SIZE�_NONE
Limit �c� Draft Hood � � sguloror �
Limit S�Hing }��� Fi Iters Siss � mber �
Fan Sstting R�' l�� Chimnsr Location Insids Outsi.dsq
Pilot Typs C��B� (�� Chimnsy Conatruction ���`=�� �� l!`� �°�
Pilot Moks '� ,
Pilot Modsl �� Smoks Bomb � Wiring ��-
Pilot Timing ��� a'�'� D►aft � � S� � � Tsat Taq �� � � � � ��
L.W. Cut Off — Door Prsssws Liq6tiny last. I��- �� ��
�• ��) ei 6� Date 7�sted '�V � v 1 �
Prsssure P�re�nt C0�
I�ut CFH �� P�ro�nt 02 r" Company Tssting '�
Stack T�mp. ��� 0 P�runt CO ��� Na� ei Tsshr
.� `
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M
/� �J�'2-G�� � iJl�,-t,c � G�-,
� �Y D d �,�� �'"�r� � /��
�r�� ��, -
CHIMWEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes (� No ()
2. Is free from rust or deterioration Yes � No ()
3. Has no foreign objects lodged within Yes � No ()
4. Is securely supported Yes � No ()
5. Meets �11 current Code requirements for size and
total BTU connected Yes (ro}�No ( )
6. Has Total heating BTU's of ��-${ �o �
All other BTU's `—
TOTAL ���� ��
Rema rk s t�� o�E
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Su9�8CT
c�ty of Fridley
AT TME TOP OF THE TWINS g � I L D I N G P E R M I T
i�
� �
� `V ����� COMMUNITY DEVELOPMENT DIV.
% � �� PROTECTIVE INSPECTION SEC.
�
1 . �
i..--�� �'�' �.� CITY HALL FRIDLEY 55132 NUMBEF
t 612-571-3450 9t0-F15
10B ADDRESS �400 Jackson Street NE
t LEGAL �OT NO. BLOCK TRACT OF AODtTION
oescA. 25 3 Melody Manor
2 PROPERTY OWNEFi MAII AOORESS
Don Sivanich
3 CONTRACTOfi MAIL ADDRESS
Eaqleview Const. Inc. 2937 174th �ane
4 ARCNITECT OR DESIGNER MAIL AODRESS
5 ENGINEER MAIL ADDRESS
8 USE OF BUILDING
Residential
7 CLASS OF WORK
REV DATE PAGE OF
6/7/99 / /
rd
ZIP PMOI
7Rti_5
21P PMONE
29627
RECEIPT NO.
����
APPROVED BY
SEE ATTACNED
S►1EET
LICENSE NO
'0�3
LICENSE NO.
LICENSE NO
❑ NEW O ADDITION ❑ ALTERATION � REPAIR O MOVE O REMOVE
8 OESCRIBE WORK
Reroof house and qaraqe (25 Sa) Tear-off
9 CHAN(;E OF USE FROM
STIPULATIONS
TO
Underlayment must comp1y with the State Building Code.
TYPE OF CONST.
SEPARA7E PERMITS ARE REOUIRED FOFi EIECTFICAL, PIUMBING, MEATIN(i,
VENTI�ATING Ofi AIR CONOITIONING
TMIS PERMIT BECOMES NULI AND VOIO If WORK Ofi CONSTRUCTION 20NING
AUTHOqIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANOONED FOR A PER100 OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED NO OWLG. UNI
I MEREBY CERTIfY THAT I HAVE READ ANO EXAMINEO THIS APPLICATION
AND KNOW TME SAME TO BE TRUE AND COFREC7. ALL PROVISIONS Of LAW$ yp�UATION
AND ORDINANCES GOVERNING TMIS TYPE Of WORK WILL BE COMPLIED $2185
WITM WHETHER SPECIFIED NEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OF CANCEL TME pEqMIT FEE
PROVISIONS O: ANY OTNER STATE OR LOCAL LAW REGULATING CON•
STRUCTION OF THE PERFORMANCE OF CONSTNUCTION $$3. Z5
PLAN CMECK FEI
� � � Lic
NATU O� CON • ACiOp Oii sUTMOp�2ED nGENT 1 ATE� EN `
S�GN4�UAE O� OWNEAd� OWNEp BUROE�1� iDAiE� w r. �re
OGCUPANCY GROUP OCCUPANCV�OAO
SO. fT CU fT.
OfFSTREET PARKING
STAILS GARAGES
SUR7AX
$1.09
SAC CHARGE
Fir SC 2.19
T07 L FEE
5 0 91.53
��IID / 'TMIS I�OUR P�M��
/
� .
NEVV [ ]
ADDN
ALTER
Effective 5/10/99
[ l CITY OF FRIDLEY
[] SINGLE FAMII.Y AND DUPLEXES R-1 AND It�2
BUII,DING PERMIT APPLICATION
�
��
� � ��
r-- � "J
Construction Address: � ��%� � �-n �.
Lega1 Description:
Owner Name & Address: �J6v1 � i�/�c � �c�i Tel. #� �g� � �o�S�
Contractor: ��✓�� ��, � MN LICENSE #�� Co 7 O�F'}
Address: � � � ; `7 % � `i�`=` G�e S 5 3 G�' Tel. # �S 3 � �Y � 9
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTI�R:
DESCRIPTION OF IlVIPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
� � )
Construction Type: � timated Cost: $ � 5 � <�l � �S �
Driveway C�rb Cut Width Needed: Ft. + 6 Ft = Ft x$
_$ -
�
DATE: � G �l� APPLICANT: % Tel. # �� `S�� �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPUL�TIONS:
$ �' �. ��
$ � ��
� / �i
$
$ _� � �� C�
$
$
$
$
� �/. ��
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 Necess�y [ ]
BUII..DING PERNIIT' FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addidon 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 $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,Q00
$100,001 to $500,000
$500,001 to $1,�,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fracrion thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each addirional $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
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each addirional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,0(}0 plus $3.15 for each additional
$1,000 or fraction thereof
DRNEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet tunes $15.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of applicaY�on to �llow foa° proper
review of the proposed structure and of the construction site.
A Certificate of Surve� of the lot, showing the location of the foundation once it has it h� b�en constru�t.�d will
be required before praceeding with the framing.
�
City of Fridley
AT TFIE TOP OF THE TWINS � � t L D I N� P E R M I T
i �
� �
� ; v ____� COMMUNITY DEVEIOPMENT OIV.
r � � PROTECTIVE INSPECTION SEG.
l"--� ��"' �.1 CITY MALL FFIOLEV SS��2 NUMBER
t 612-571-3450 9t0-F15
JOB ADDRESS
7400 Jackson Street NE
1 LEGAI �OT NO. BLOCK TRACT Oii ADOITION
oescA. 25 3 Melodv Mano�
2 PROPERTY OWNER MAIL AODRES$
Donald Sivanich
3 CONTRACTOR MAIL ADORESS
Owner
4 ARCNITECT OR DESIGNER MAII ADDRESS
5 ENGINEER MAIL ADDRESS
8 USE OF BUILDING
Residential
7 CLASS OF WORK
REV OATE PAGE Oi
11/5/99 / /
rd
21P PMOt�
7Rh_S
ZIP PMONE
ZIP PHONE
MIT NO. �
30479
RECEIPT NO.
�� !
1VVROVEO Br
SEE ATTACHED
SHEET
LICENSE NO
LICENSE N0.
LICENSE NO
❑ NEW O ADDITION 0 ALTERATIQN � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
. Replace windows and doors: Renlace 18' x 13' Deck
9 CHANGE OP USE FROM
STIPULATIONS
See stipulations on plan.
Provide smoke detectors in all sleeping rooms and on all levels of the house.
s.�p�rE P�Rn���rs a�p���e� ��
VVNIRING, �IEATl6�Cy �,Ll���>1V� AN� Si��1g�,
SEPARATE PERMITS ARE FiEQUIRED FOfi ELECTRICAL, PLUMBING. MEATING, 'r� vr vv'•V ~yyyrl
VENTILATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NULL AND VOID IF WORK OF CpNSTFlUCTION 20NING SC. fT
AUTMORIZED IS NOT COMMENCED V�!ITHIN 80 DAY9. OR IF CONSTRUCTION
Ofl WORK IS SUSPENDED OR ABANOONEO FOR A PERIOD OF 1�0 DAYS AT
ANY 71ME AF7ER WOqK IS COMMENCED. NO OWLG. UNITS
I MEREBY CERTIfV THAT I MAVE REAO AND EXAMIN�D TFIIS APPLICATION STALLS
AND KNOW THE SAME TO BE TRUE ANO CORREC7. ALL PROVISIONS OF LAWS VA�UATION
ANO ORDINANCES GOVERNING TMIS TVPE OF WORK WILI BE COMP�IED
WITM WHETHER SPECIFIEO HEREIN OR NOT. TNE GRANTING OF A PERMIT �.Z 199.GO
OOES N07 PHESUME TO GIVE AUTMOfiITV TO VIOLATE OR CANCEL THE pEWMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCA� LAW REGUTATING CON-
STRUCTION OR TNE PERFORMANCE OF CONSTFUCTION .A'22(� _ f)r'i
4TUAE O^ Cj�l7qpCTO�A�MOA�ZED:GEN1 � / 1� 1
f I R1 ► /
_ Y �-!\ � /� � �'
J;
ROUP OCCUPANCVLOAD
CU FT.
OFFSTREET PARKING
IGARAGES
AL
9
L � �'�7 � {
e _
r�w � �
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRIDLEY
[] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUII..DING PERMIT APPLICATION
construcdon Address:
Legal Description:
Owner Name & Address:
Contractor:
��
l \/ �q -�-(� -E-�
��
�� ��
°� �b
Tel. � �� � �`� �.�
MN LICENSE #
Address: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construcrion drawn on it to scale.
DESCRII'TION OF IMPRO`'EMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
� -�
DECS AREA: Length � Width ��_ Hgt/Ground � Sq. Ft.
�' OTHER: � S �"
�iU�Vt � c�ca�' �/�r c��e�
C��° .�P G���-C .� �l9�
Consriuction Type: Es ' ted Cost: $ - � � �� ( � %� � 99,(��j
%��C� C� � `�� . / g
Driveway C�rb C�t Width Needed: Ft. + 6 Ft = Ft x$ ������ $ �� � r�
DATE:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
TOTAL
STIPLTL,ATIONS:
APPLICANT:
CITY USE ONLY
Tel. #
$��� �,�� Fee Schedule on Reverse Side
$ / • / � .001 of Permit Valuation (1/lOth%)
$ � $.50/$1,0� Valuarion
$ $1050 per SAC Unit
$ $5.00 (Sta.te Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
� � �t/o 3.�
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erecrion 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 applicarion 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 $2,000
$2,001 to $25,000
$25,001 to $50,�0
$SO,QOl to $1�,000
$100,(�1 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,040 plus $14.00 for each additional$1,000
or fraction thereof, to and including $25,OQ0
$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,(}00 or fraction thereof, to and including $100,000
$993.75 for first $100,Q00 plus $5.60 for each additional
$1,000 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 $1,0�,000
$5,608.75 for the first $1,000,0� plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing.
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��' O.�NOTES''tQ4N—'�_DENOTES OQAINAGE /►NO l)TII.ITY EASEMEN?
��� �•
;.�,,:.: . ..
�` .Y 25y��p,�K 3.___MELOC�f MANOR 3aD DOI'f ►ON
ANOKA C MT�I
;��,. ; 4t�:,., y,,s a o hw a� �� .�+totrair o�'o s�rhey �'fl�t e�aeri�s �N,r a�«► aFxi�►b�d /a�e, ead
�i�' �p ���'�'�1^1T�ir�n a�d dl ris��t a+� ma�ls .��a''y• � ar asaid /ard As wr'NSyed bj � 1�-= -- �J
R' � � �Tdl`3:?S� •
'� �. SU8 URBAN ENG/NEER/NG . INC. � .
r.�:
�� Ga, �t!',� . ' �,;f ,�7 Y 1 E�s, � Sur�(eyar�„�„�� `s'.V
�;, A �r.. �, _ �k� SCD�C�L:��4� �-!�'"�"'_� � . f�r
r.
..9,�'�.�.. t�•' ,. '���
D' ,
t
sue.iee� ERMIT NO.
City of Fridley 3 0515
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
�
' ' RECEIPT NO.
� � COMMUNITY OEVELOPMENT DIV. �� ` �
' j y - �
r � � � PROTEGTIVE INSPECTION SEC.
� ., �
i..•-� ��'��,.� CITY MA�L FRIOLE� SSI� NUMBEN NEV DATE VAGE OF APPROVED BY
L 612-571-3450 910-F15 11/ 16/99 / /
JOB ADDRESS �400 Jackson Street NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
OESCR. 2S 3 Melod Manor 3rd SNEET
2 PROPERTY OWNER MAIL ADDRES$ ZIP PMONE
Donald Sivanich 786-5035
3 CONTiiACTOR MAIL ADORESS 21P PHONE IICENSE NO
'I�vin City Exteriors Co Inc 9060 Zachar Ln N Ma. Ie Grove 55369 425-4737 2535
4 ARCHITECT OR DESIGNER MAII AODRESS ZIP PMONE IICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PHONE IICENSE NO
8 USE Of BUILOING
Residential
7 CLASS OF WOFiK
❑ NEW O ADDITION ❑ ALTERATION �Uc REPAIR O MOVE O REMOVE
8 DESCRIBE WOfiK
Reside
9 CHANOEOFUSEfROM TO
STIPULATIONS
Call for bui.ldi.ng wrap inspection before covering.
�crmlt Inspection Cards
'�if� �e Mailed
To Homeo�n�� �'o Post
TVpE OF CONST. OCCUPANCY GtiOUP OCCUPANCV LOAD
SEPARATE PERMITS AiiE RECUIRED FOR ELECTiiICAL. PIUMBING, NEATING.
VENTILATING OR AIR CONOITIONING.
THIS PERMIT BECOMES NULL ANO VOID IF WORK Ofi CONSTfiUCT10N IONING SQ. FT CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 OAYS. OFi IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTEii WORK IS COMMENCED NO. DWIG. UNITS OFFSTREET PARKING
I MEREBY CERTIFY THAT I MAVE READ AND EXAMINED THIS APPLICATION STA�LS GARAGES
AND KNOW TNE SAME TO BE TRUE AND CORRECT. AI,L PROVISIONS OF LAWS VAIUATION SURTAIf
AND ORDINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMPLIEO
WITM WHETHER SPECIfIED MEREIN OR NOT. THE GRANTING OF A PERMIT GOOO 3.OQ
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEqMIT FEE SAC CMARGE
PROVISIONS OF ANY OTHEFI STATE OR LOCAI LAW FEGUTATING CON-
STRUCTION OR 7ME PERfORMANCE Of CONSTRUCTION ],ZS . ZS Fire C C) . OO
PLAN CHECK f EE TOTA f E
r��' e .25
S�GN4iUpE O� CON"AACTQA OA AUT110p�ZE0 oGENT �D�TE� EN RO , VALIOA MIS IS VOU PE M T
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S�GN4TUAE O� OWNEA��F OWNEpBU0.0Ep� IDATE� iNS� ��`TE
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ConstructionAddress :
Legal Description:
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
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Effective 1 / 1 /99
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Owner Name & Address: ��-�,� �� �p�} � � � f � Tel. # ��� s��-� �
Contractor: TWI1V CITY EXTERIOKS CO., INC. MNLICENSE# 2535
Address: 9060 ZACHARY LANE N MAPLE GROVE, MN 55369 Tel. # 612-425-4737
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.
- DESCKIPTION OF Il1ZPR0'VEMENT
Length
Length
Length
Width Height
Width Height
Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: �� �/�� Estimated Cost: $ �� ���'
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �/�°� % APPLICANT: � Tel. # 612 -4 2 5-4 7 3 7
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ �Fee Schedule on Reverse Side
�
$ ��� .001 of Permit Valuation (1/lOth%)
$_ � �� �� $.50/$1,000 Valuation
$ $1050 per 3AC Unit
$ � $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ 1 __NQt 1�1�.ssa� � �
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