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PRE 2010 DOCSCity of Fridley, Minn. BURDING PERMIT Date: AUGUST 27, 1965 SIG ANDERSON Builder CLEMRON, INC. �d (' -? 6 No 8414 Address Address 701 Bolumbia Blvd. Minneapolis, Minnesota LOCATION OF BUILDING No, 7367 Street MEMORY LANE N E Part of Lot Lot 2 -- Block 4 Addition or Sub -Division ..—_ 1V,ODY MANOR, 3RD ADDITION Corner Lot _ Inside Lot — X Setback 35 � _ Sideyard 10' and 5 r Sewer Elevation To be Used as: Foundation Elevation DESCRIPTION OF BUILDING DWEM—ING Front 41' Depth 25 ' Height 20' Sq. Ft. 1025 Cu. FL 20, 5 0 ATT. GARAGE Front 2 0 Depth 23 Height 8 Sq. Ft 46 0 ctL rL _ 4,600 Type of Construction FRAME Est. Cost 23 5 00 z 00 _ To be Completed In consideration of the issuance to me of a permit to co building jpj�cri a I agree to do the proposed work in accordance with the description abov set fo and in c oe a'il provisions of ordinenoes of the city of Fridley. In consideration of the payment of a fee of $_26. 00 , permit is hereby granted to CLEKKON, INC. 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 within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. ALLEN G. JENSEN Building Inspector NOTICE: ibis permit don not emu the construction, buhliation for wiring, plumbing, gas heattng, sewer or water. Be Sem to see the Butidtng Iespedor for Separate permdb for them Nems. APPLICATION FOR BUILDING PERMET CITY OF FRIDLEY, MINNESOTA OWNER'S ADDRESS - ADDRESS LOCATION OF BUILDING No. Street .Far of Lots Lot__ Block Addition or Sub ision / Corner Lot Inside Lotk�setback�.�Side SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form TWo.Certif,•icates of Survey of Lot and proposed build- ing location drawn on these Certificates. DESCRIPTION OF BUILDING To be a ; Front/ —® rapth — Height Sq. Ft._Cu.. rt. i Front_ DepthHeight Sq. Ft. ��� Cu. Ft. a Type of Construction 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 accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations state in this application and correct. DATE SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side) p ; Original PERMIT for Power Plants and Heating, Cool. ing, Ventilation, Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK i Permit N° 4707 Fee n No. o. Heating Plants to be installed--altered—repaired Make C Oil fired ; Coal fired ; Gas fired—; Gas Authorization No. Remarks Approved Final Inspection Date , 19_ Inspector Office of the Inspector of Buildings City of Fridley City of Fridley, Minn. A oC ( , 19—'20 Owner �.- Location �% l� 7 /17J� 2yo..— or Kind of Building - JL How Occupied Work to be Commenced ,19_ To be Completed ® ,19:9 0 Estimated Cost, $ 96 0, QNew, Building Permit Permission is hereby granted to s to install—erect—use the material and devices described in the above statement. This permit is granted upof the express condition that he person to whom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the specifications set forth in the approved application for this permit on file in the office of the Inspector of Buildings. Inspector of Buildings 42 2M I l-67 V SUBJECT ERMI City of Fridley 18 8 811 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT N • COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r PROTECTIVE 1 ` � CITY HALL FRIDLEY 55432 j NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/16/87 JOB ADDRESS 7367 Memory Lane N.E. 1 LEGAL LOT NO, BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 4 Melody Manor 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Sig Anderson 7367 Memory Lane N.E. 784-5342 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Northwestern Company 542 West Main Street, Anoka 55303 421-2333 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW Ij ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 121 x 241 Addition to Dwelling and a 51 x 101 Foyer Addition 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. SEPARATE PERMITS REOUME FOR pf .: Q� PIING, H"--PTINd, PWW81NG AND SIGNS. ANG f644 ,i iq can ioui utii4ties iCI.Ci��IbiVi; • ��Etit�� • ��S �t�. SQUIRED BY LAW 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 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 ISTALLS 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 $26,500 $13.25 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 O . ONSTRUCTION. $179, 50 None PLAN CHECK FEE TOTALFEE $ 44,88 $237.63 SIGNATU E OF CONTRACTOR OR AUTHO IZED AGENT (DATE) WHEN PROPERLY (DATED THIS IS YOUR P RMIT ---'BLDG (NSP ' GATE SIGNATURE OF OWNER IIF OWNER BUILDER( IDATEI NEW [ ] City of Fridley Effective 4/1/86 ADDN. �R-1 AND R-2 ALTER. Building Permit Application Construction Address Legal Description: Owner Name & Address: �� �z 0er''Sdv3 Tel. #7 d �-53�� Contractor: 4-1 l�y�eSJ��✓I -v _ 2-33 Tel. #te17 Address: LIVING AREA: 5k: 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. ,�1 Length Width Height Sq. Ft. 3 " Length WidthHgt/Ground Sq. Ft. / 338)( W.(03-r-U6.4SI2S%f Corner Lot [ ] Inside Lot [VT Ft. Yd. Setback Type of Construction:v �/�`✓�'�� Approx. Completion Date: + 101006 VO..Aoaa•1 50AC. Side Yard Setback Estimated Cost: $ a6�5ad Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: v/ $ $ See Back Page for Explanation DATE: Aj7 EZ APPLICANT: Tel. Permit Fee Plan Check State Surcharge SAC Charge ay� Park Fee Sewer Main Charge TOTAL STIPULATIONS: M As .CITY USE ONLY $ eJ�Fee Schedule on Reverse Side $ �� .825% of Building Permit Fee $3► a $.50/$1,000 Valuation $ $ 525 per SAC Unit $ Fee Determined by Engineering $ 0 $ �1 ^• Agreement Necessary [ ] Not Necessary [ ] ace szu aS,00u.— 00.64 2xy•�+ _ 9.00 r + REINSPECTION FEE $30.00 *Air Conditioners can not be placed J6 a side yard without written permission from adjoining property owner. Approved B Rough—In Date Final Date. FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Effective On January 1, 1995 CITY. OF FRIDLEY INSPECTION DIV. 6431 University Ave NE APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, Fridley, MN 55432 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES 572-3604 JOB ADDRESS RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes ar Residential rulings of the Building Division, and hereby declares that all the facts and Furnace Shell and Duct Work, Burner — $ 20.00 $ representations stated in this application are true and � o� �t. Also Replacement Furnace 1995 (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) $10.00 $ OWNER_ Gas Range $10.00 $ BUILDING USED AS Gas Dryer $10.00 $ . ESTIMATED COST Ab PERMIT NO. �� I *Air Conditioning — All Sizes $10.00 $ c'� DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST, ON BACK) $________ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) 1% of Value of Appliance or Work Trade Name Size No. Commercial/Industrial $ BTU HP EDR Fuel � Total Connected Load 1 % of Value of Appliance or Work _ State Surcharge $ .150 Burner Trade Name Size No. EDR BTU Hp TOTAL FEE rs �� HEATING COMPANYi���� MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION a Tel No.� � ✓�� REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $ 50 STATE SURCHARGE Signe 9 REINSPECTION FEE $30.00 *Air Conditioners can not be placed J6 a side yard without written permission from adjoining property owner. Approved B Rough—In Date Final Date. FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE NOTE: #1 through #8 required when using a side vent furnace. CMMMY 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 All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes () No ( ) 8. Has combustion air been provided for water heater Yes () No ( ) Remarks: HEATING CO: Signed By: Date: SPAR SUBJECT P City of Fridley 29847 AT THE TOP OF THE TWINS BUILDING PERMIT `T NO. COMMUNITY DEVELOPMENT DIV. j PROTECTIVE INSPECTION SEC. E E r NUMBER REV DATE PAGE OF APPROVED By = I "I CITY HALL FRIDLEY 55432 612-571-3450 910-F15 7/9/99 JOB ADDRESS 7367 Memor Lane NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 4 1 Melody Manor. 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE JEFF Nelson -Bun ert784-2850 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS of WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ®C REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Rarnof house and garaqp (29 Sq) lear-gif 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIRED 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 SO. 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 1923 .96 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION 69.25 Fire SC 1.92 PLAN CHECK FEE TOTALFEE SiGNATUR OF CONTRACTORORAUTNORREO ENS i TEi � !r � NEN OP LV VALI TEO THIS I YOUR PERMIT 2, .9 10 F OWNER,IF OWNER BUILDER. iDA E� BLDG iNSP rI.TE SPAR NEW [ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY dl q ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION (k Construction Address: Legal Description: 736 Owner Name & Address: Jack Me ko tn- J�^TCl- SQ lI V.— Tel. # 6/,74 l 2JY-2 iSS Q Contractor: se- f MN LICENSE # Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IlVIPROVEMENT Length Width Length Width Length Width sC Tel. # Height Sq. Ft. Height Sq. Ft. Hgt/Ground Sq. Ft. ? 2P_ timated ost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: I APPLICANT: Tel. # S�O CITY USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.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 Necessary [ ] vvu U v SUBJECT PrRMIT NO: City of Fridley 31505' 1505 AT THE TOP OF THE TWINS BUILDING PERMIT r _ RECEIPTNO%. COMMUNITY DEVELOPMENT DIV. _ ___ fr ------ PROTECTIVE INSPECTION SEC. r E 1 � � NUmEIER qEv DATE vAGE OF AVVROVED By 1 = 1 CITY HALL FRIDLEY 55432 %j 612-571-3450 910415 10/20/00 JOB ADDRESS 7367 Memory Lane NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 4 1 Melody Manor 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jeff Nelson-Bungert 7367 Memory Lane NE 784-2850 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 Residential 7 CLASS OF WORK O NEW O ADDITION O ALTERATION REPAIR O MOVE O REMOVE B DESCRIBE WORK Reroof House & Garage (22 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 SO. 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 1 ISTALLS 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 @ $2,250 $1.12 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 PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $83.25 Fire SC $2.25 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK TAL FEE 17$86.62 SIGNATURE OF CON 'aACTO-0—ITHGAIZE GENT IGATE, HE VALIDAYED THIS IS YOUR PERMIT PAROLY AE NEA iIF OWN BUILOERI IDAT I BL G INS GATE vvu U v NEW 0 Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction AddrE Legal Description: Owner Name & Address: _ Contractor: -!5e Tel. # ' `9V— '8� MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Abuse. Hgt/Ground Sq. Ft. OTHER: e, -ro �/buse % aarage, A& d ,'Qj Construction Type: Estimated Cost: $, Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$ DATE: `fid �U APPLICANT: Tel. # 1l' 3 76Y—A00 CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application $ Fee Schedule on Reverse Side $ �•aSr .001 of Permit Valuation (1/10th%) $ /• l� $.50/$1,000 Valuation $ $1100 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 Necessary [ ] $ 66.6 J -6.0 NAMMIJ SUBJECTE City of Fridley 3"370 4 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. _._��_ r v PROTECTIVE INSPECTION SEC.3)c NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 763-571-3450 910-Ft 5 6/10/03 JOB ADDRESS 7367 Memory Lane NE i LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DIE 2 4 1 Melody Manor 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jeff Nelson-Bungert 7367 Memory Lane NE 763-784-2850 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 B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE % B DESCRIBE WORK Replace.four windows in basement within existing openings 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Cade. Caulk and flash all exterior openings. 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 SO. 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 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 $1,350 $.67 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- $50.95 Fire STRUCTION OR THE PERFORMANCE OF CONSTRUCTION SC $1.35 PLAN CHECK FEE TOTALFEE $52.97 WHEN PROPERLY VALIDATED THIS IS Y UR P RMIT SiGN4 R OFCON-R T R RAUTMOR�I GENT iD iE� p T F NE ,6 OWNER BU4DER1 DAT 06 iNSF' OA E NAMMIJ NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 5714287 Fax BUILDING PERMIT APPLICATION Construction Address: Legal Description: -X--_ Owner Name & Address: Contractor. OW -nig C �i MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. 4 GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: LengthlWidth Hgt/Ground Sq. Ft. OTHER: �rvd��e Construction Type: Estimated Cost: $ % Jr Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: Ll q/APPLICANT: Tel. # / �—12 Call (763) 572-3604 for Permit Fees if m III g pplication. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ ��� Fee Schedule on Reverse Side $ J, 2S- .001 of Permit Valuation (1/10th% $ �' $.50/$1,000 Valuation $ $1275 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 Necessary [ ] 9 $