PRE 2010 DOCSCity of Fridley, Minn.
WELDING PERMIT N® 3821
Date: ....... .......... ....................
Owner............. ... ............ .... Builder ................... .......
Address ................ .................... Address .............................................
LOCATION QF BUILDING
No..Cil/../..�... Street ...e .... ..... .. .......... of Lot ...............................
Lot ....�.... Block ..... 0.......... Addition or Sub -Division .......................................
Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ...........................
DESCRIPTION OF BUILDING
T be U ed as: ,
Front ,Depth ..ef Height ... Sq. Ft,?.? A. Cu. Ft.,�OCV
Front ........Depth ..... ./ H�
ei %.... Sq. Ft. ........ Cu. Ft. ........
Type of Construction ................. •Eat. CoJ/.......... To be Completed ...................
In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
.............
In consideration of the payment of a fee of $.1 .......... 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 his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. r J
:.t.(� .r/'!! wf. fix...... Building Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
.��r� (�U��
�. Builder..
Owners Nam
• s(
,•.
Address P Address _.
LOCATION OF BUILDING
ioL: StreetPart of Lot
a
Lot Block . _ ` _.,Addition or Sub. Div.00.
1
.Corner LotInside Lot •`� Z Few �� Set. Back
_.:,Applicant: attach to this form Certificate of Survey of•`Let and proposed
'-building location.
., .
DESCRIPTION OF BUILDING
To be used as
® Front. Z'—" Depth_ Height L") �.
.Sq:' Ft,� Cu. Ft. <2
Fro n " 9- Dep . ight .
"'t
Sq. Ft Cu. Ft.
Type of -Construction-" `J .. Estimated Cost _.:.�.�.
To be completed..
The undersigned hereby makes application for a permit for the work
herein specified, agreeing to do all work in strict aecordanee with the
City Ordinahc.es and -ruling of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are trus'and correct: ►
Date R r Signature
(A"Sohedule of Fee Costs can be found on the Reverse Side)
City of Fridley
r 4T THE TOP OF TME TWINY
tL-------COMMUNITY 0[V9LObM[NT QIV,
I PROT[CTIV[ wfftcTom [[PT,
CITY HALL i1110L4Y YM[
Job Address
53-81,-S-915.51
iusJ[GT
PLUMBING PERMIT APPLICATION
671 N. E. Marigold Terrace
Owner June Johnson Address Phone
Contractor MURG-ASIrC Address Phone
ft! �►i�QU AW"
Kind of Building lUse MPUS, MINN..
on
Frame
12-9-7h
Res.
Gas Fitting Fees:
lst 3 Fixtures x $2.00
r
Additional Fixtures x $ .75
Gas Range -199,000 BTU 1 x $5.00 5.00
Repairs & Alterations
See
Description: Code
State Surcharge Class "Aw 5-archargly u50¢ .50
TOTAL FEE $ 5.50
The undersigned hereby makes application for a permit
for the work herein specified, agreeing to do all work
in strict accordance with the City' -Ordinances and ruling
of the Department of Buildings, and hereby declare that
all'the facts and representations stated in this
Rnn1L2.eSjW are true qfi an correct.
mia e&
Date
t
10.00
Plumbing Fixture Rates;
NO.
RATE TOTAL
Number Fixtures
x
$2.00 $
Future Fixtures
x
$1.50
New Fixture -Old Open.
x
$1.50
Catch Basin
x
$3.25
Water Heater -99,000 BTU
x
$3.00
Ground Run Old Bldg.
x
$3.25
Elec. Water Heater
x
$2.00
Gas Fitting Fees:
lst 3 Fixtures x $2.00
r
Additional Fixtures x $ .75
Gas Range -199,000 BTU 1 x $5.00 5.00
Repairs & Alterations
See
Description: Code
State Surcharge Class "Aw 5-archargly u50¢ .50
TOTAL FEE $ 5.50
The undersigned hereby makes application for a permit
for the work herein specified, agreeing to do all work
in strict accordance with the City' -Ordinances and ruling
of the Department of Buildings, and hereby declare that
all'the facts and representations stated in this
Rnn1L2.eSjW are true qfi an correct.
mia e&
Date
t
V
SUBJECT P T NO.
City of Fridley
®12556BUILDING
AT THE TOP OF THE TWINS
PER I T
t
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
LL�
r � � PROTECTIVE INSPECTION SEC.
1 �
`
'` CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF APPROVED BY
"---A � 612-560-3450
910-F15
5/24/74
JOB ADDRESS 671 Marigold Terrace N.E.
1 LEGAL
LOT N0.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
$
3
Donnay's Lakvieyv. Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Clarence Johnson 671 Marigold Terrace N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
M Residential
7 CLASS OF WORK ❑ NEW EX ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 20' x 10' Addition onto back of dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS See notations in red on sketch.
SEPERATE PERMITS REAMED FOR WIRINt�,
HEATING, PLUMBING AND SIGNS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame
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
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 SAMETO 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
$4,050.00
2.03
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$15.70
PLAN CHECK FEE
TOTAL FEE
r
$17.73
I ATUREOFCONTRA OR RAUTHO IZEDAGENT .(DATE)
PR ERLY VALIDAT'D TH IS YOU PERMIT
BLDG )NSP DATE
G ATURE OF OWNER OF NER BUILDER) EI
V
OWNER'S
ADDRESS
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
NO:. STREET:��
LOT: BLOCK: ADDITION:
CORNER LOT: INSIDE LOT: v SETBACK; -SIDE-YARD:..
s
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used s:
Front :o�D
Depth: /o Height:_ "-910
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: Estimated Cost: 00
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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.
DATE: SIGNATURE•
.(See Reverse Side For Additional Informa on.)
F: r
CIYY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
Gas Piping (Needed with new.furnace)
Gas Range
Gas Dryer
Rate TOTAL
$ 20.00
$ 10.00 $
$ 10.00 $
$ 10.00 $
*Air Conditioning - All Sizes $ 10.00 $
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $
Commercial/industrial
1 % of Value of Appliance or Work
State Surcharge
TOTAL FEE
$
JOB ADDRESS
The undersigned hereby makes application for a permit for the work
herein specified agreeing to do all work in strict accordance with the
city codes and ruling of the Building Division, and hereby declares
that all the facts and representations stated in this application are
true and correct. //-/-/-,g/ ,1991
OWNER �
BUILDING USED AS
ESTIMATED COST®®`— PERMIT NO. Q}��
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units--/— Circle One (Steam) (Hot Water) 0 arm Ai
Trade Name Jw>,'&4FZ, Size No.�4��0�0�0-%�_
BTU Go -M . HP EDR
Fuel Total Connected Load .� D
$ .50 Burner Trade Name Size No.
BTU HP EDR
deme Energy Service
14505 21st Avenue North
Smite 222
HEATING COMPANY Plymouth, ]trills 55447
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Signed By / Tel No. :�,Z7�-0
Approved By Rough -In Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
it
CHIMNEY 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 all current Code requirements for
size and total BTU's connected Yes ( ) No ( )
6. Has total heating BTU's of ® �y
All other BTU's
TOTAL BTU's
Remarks _
,Y, �/zI Edi% 1ic/57ALLLc�'
List Alterations Being Done:
- Rome Ener" Selmdee
14505 21st A ev aae North
. Suite 222
HEATING COMPANY Plymouth' MN 55447
Signed By
Date
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND CTAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
New fixtures
Future fixtures
Old Opening, New fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Mater Leader
Hydraulic Valve
Sump or Receiving Tank
Water Treating Appliance
Not Nater Heater
Gae Range
Gas Dryer
RATE
$ 5.00
S 3.50
$ 1.50
$ 4.00
$ 5.00
$ 5.00
$ 5.00
$ 5.00
$ 5.00
$ 7.00
$ 5.00
$ 10.00
$ 10.00
TOTAL
Back Flow Preventer Required. . . Yes ( ) No ( )
Type $ 5.00 $
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
It of value of Fixture or Appliance 5
Reinspection Fee $ State Surcharge S .50
($15.00) TOTAL FEE 0
Effective May 1, 1990
Job Address J �/-= c_ .:�. C V -
,y r c
Department of Buildings
City of Fridley
Tel. 1571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. / /—/� q / 19
OWNER��
KIND OF BUILDING
USED AS Z" " 7 J.- � k
TO BE COMPLETED ABOUT
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO. f 2
Company _/1--1
Signed By �� ";•�,,
e�Te
Tel. No. Gf 7
ROUGH INSP.
Date
L�
FINAL INS, /2- _ ( --q/
Date
APPROVAL FOR PERMIT —&Yd
4INIHUM FEE FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE S.50 ST4TE SURCHARGE
N
>,
Wq
U
K
W
Wdter
a
e
u
p
h
Heater
Y
U
'lec
M
N
W
C
Y
e
"C
1.
q
C r
M O
i
.�C
O
14
d N
u
w
0
U
a
a
A
H
3
ow
H
w
uta
o
;as
lat
2nd
lyd
4th
(R) - Future Connection Opening
Connected with Sewer
(') - New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
New fixtures
Future fixtures
Old Opening, New fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Mater Leader
Hydraulic Valve
Sump or Receiving Tank
Water Treating Appliance
Not Nater Heater
Gae Range
Gas Dryer
RATE
$ 5.00
S 3.50
$ 1.50
$ 4.00
$ 5.00
$ 5.00
$ 5.00
$ 5.00
$ 5.00
$ 7.00
$ 5.00
$ 10.00
$ 10.00
TOTAL
Back Flow Preventer Required. . . Yes ( ) No ( )
Type $ 5.00 $
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
It of value of Fixture or Appliance 5
Reinspection Fee $ State Surcharge S .50
($15.00) TOTAL FEE 0
Effective May 1, 1990
Job Address J �/-= c_ .:�. C V -
,y r c
Department of Buildings
City of Fridley
Tel. 1571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. / /—/� q / 19
OWNER��
KIND OF BUILDING
USED AS Z" " 7 J.- � k
TO BE COMPLETED ABOUT
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO. f 2
Company _/1--1
Signed By �� ";•�,,
e�Te
Tel. No. Gf 7
ROUGH INSP.
Date
L�
FINAL INS, /2- _ ( --q/
Date
APPROVAL FOR PERMIT —&Yd
4INIHUM FEE FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE S.50 ST4TE SURCHARGE
SUBJECT
PE -•
City of Fridley
2 2 2 70
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
NO.
_ COMMUNITY DEVELOPMENT DIV.
v PROTECTIVE INSPECTION SEC.
0
CITY HALL FRIDLEY 55432
IL
NUMBER
REV
DATE
PAGE OF
APPROVED BY
---- l . 612-571-3450
910-F15
12/22/93
JOB ADDRESS 671 Marigold Terrace NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
8
3
Donnay r s Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Craig/Renee Rees 671 Marigold Terrace NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Panelcraft 3118 Snelling Ave S, Minneapolis, MN 721-•6628 2179
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USEOFBUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$11,000
$5.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$126.00
Fire SC $11.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
License SC $5. IN$147.50
HEN PROP Y (DATED THIS IS YOUR PERMIT
�TURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
BLDG )NSP V MATE
SIGNATURE OF OWNER 0F OWNER BUILDER) (DATE) ,,.
NEW [ ] Effective 5126/93
ADDN[ ] CITY OF FRIDLEY
ALTER {�� SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: _ia V -t - MA�,KOLt>
Legal Description:
Owner Name & Address: �,�,�g kF� /
g��s a Mgpg�e,otb 7-kRTel #
Contract":+�� �, �z< �A �� MN LICENSE # txxpz I -T 5
Address: 31119 �r4L-LL)vqc Avc . 5. MPL---'> Nry Tel. #Uzi -&41 p8
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
GARAGE AREA: Length
DECK AREA: Length
OTHER:
DESCRIPTION OF IMPROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Width Hgt/Ground Sq. Ft.
Corner Lot [ I Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction:Estimated Cost: $ I l , OCA
Approx. Completion Date: i /rte
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
MFIq
DATE: 1 z z APPLICANT: / Tel. # -w-4P&-28
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$750 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$ Conservation Plan Review $450.00
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ S° STIPULATIONS:
G
SuBjECT
City of Fridley
29050
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
REC
� 1 >r ______ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
r PROTECTIVE
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
3/23/99
JOB ADDRESS
671 Marigold Terrace NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
g
3
Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Craig Rees 671 Marigold Terrace NE 571-2194
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Panelcraft of MN 3118 Snelling Ave S, M ls., MN 55406 721-6628 2179
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
O NEW O ADDITION 0 ALTERATION ( REPAIR O MOVE 0 REMOVE
8 DESCRIBE WORK
Reroof House & Garage (23 Sq) Tear-off; Fascia
9 CHANGE OF USE FROM 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.
Permit Inspection Cards
Will Be Mailed
To Homeowner To Post
SEPARATE PERMITS ARE REQUIRED 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
ZONING
SQ. 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
I 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 TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT
$2,434
$1.22
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHA E
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$74.75
Fire C $2.43
PLAN CHECK FEETOTAL
E
Lice S $5.
3.40
SIGNATURE OF CONTRACTOR OR AUIMORI2E0 AGENT IOATE,
EN7PMPERLIDATE, T SIS JUR PERMIT
BLDG N5o GATE
S-GNATURE OF OWNER tIF OWNER BUILDERi 'FATE'
G
Irl L W
ADDN I I CITY OF [-RIDLEY
AI:TI�R SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Istruction Address:
Legall)escription:
Owner Name & Address:
Cuntractor6?,
Address: .3 // � A414i
LIVING AREA:
GARAGE AREA:
DECK ARI -A:
OTHER:
WIM,
Tel. #
MN LICENSE #
�AAr o �Y1 SD Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
W ICCIIVC 1/1/`4
a -7 98
66D a
S7/ -2/9V
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.-
Length
t.Length Width Hgt/Ground Sq. Ft.
Corner Lot O Inside Lot (] Ft. Yd Setback Side Yard Setbacks -
-ne of Construction: Estimated Cost: $ J oZ
,,Fox. Completion Date: a
(Cost- on Back)
Driveway Curb Cut Width Needed: Ft. + G lit = I t x $
DATE: /�% '/ - �l APPLICANT: Tel. # `/ 2-/ - 6 a �i
CITY USE OINLY
Permit Fee $ 2,-//- 7-5' Fee Schedule on Reverse Side
hire Surcharge $_ _2 • L13
001. of Permit Valuation (1/10th%)
$.50/$1,000 Valuation ��
SAC Charge $._ D c,
$800 per SAC Unit.
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Sewer Main Charge $ -- -- -___- Agreement Necessary I I Not Necessary
'TOTAL
STIPULATIONS: �� zz -7�
State Surcharge '2-
License Surcharge $__
Driveway escrow $_ --
Erosion Control $
Park Fee
$