PRE 2010 DOCSBUILDING PERMIT
Village of Fridley, Minn. ° 2 4 4 4
Date'.. :'.': $�. .. ....... .
Owner
Builder .......... ...... ...
� c'�.GG4d.>i��':!r"'....:... ....................
Address+ j+�. Address ..........
LOCATION OF BUILDING
No.. �/c�.......,. Street .fi ........ Part of Lt
Lot ............ Block .../....... .. Addition or Sub -Division
40
Corner Lot .............'Inside Lot ............ Setback ............ Sideyard; ` ........................
DESCRIPTION OF BUILDING
To�as:
t
. ... .:... Front jia .... Depth *2.8/ ... Height 14* ... Sq. Ft., 4 Cu. Ft.
.................... Front Depth ........Height Sq. Ft. .... Cu. Ft.........
Type of Construction '.' {... Est. COST 947.0 ............... To be Com 1 ted
In consideration of the issuance to me of a permit to construct the building d above, I agree to do
the proposed work=in accordance with the description above set forth and in comp with all provisions of
ordinances of the village of Fridley.,
consideration of the payment of a fee of permit is herZy granted to
°f kCA,9rAV......... to construct the building or addition as described above.rdeng,
ranted upon
the express candition.that the person `to,whom it is granted and his agents, employees in all work
done in, around and upon said building, or any part thereof, shall conform in all J �dinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance; -repair antildings with-
in the village limits and this permit may be revoked at any time upon violation of ions of said
ordinanew.
g Inspector
NOTICE:
This permit does not cover the construction, installation or aiteratlor for wiring iumbing; gas heating, ,
sewer or water. Be sure to see the Building Inspector for separate permits for these I me.
Village of Fridley, Minn.
BUILDING PERMIT
° 1851
Date: .:..: .... `... ...... .
Builder ..�;c�` �J.. ��` .�:.
Owner....... .. .. ................... d � �.
Address ...................................... Address ../....,.°�� ....��.......1�..........
LOCATION OF BUILDING
No. .�. P�: Street .... . d .................... Part�Zt...............Lot .... :...... Block .....Q ........... Addition or Sub -Division ... e
Corner Lot ........... Inside Lot ........... Setback ........... Sideyard ......:.... ....lf4.......
DESCRIPTION OF BUILDING
To be used as:
air ...... Front .� . Y . Depth . m'� Height Sq. Ft. ........ Cu. Ft. ........
....... A .............. Front ........ Depth .. Height ........ Sq. Ft. ........ Cu. Ft. ........
Type of Construction s. ..... Est. Cost .!/. d d a ......... To be Completed ..................
In 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 71thn all provisions of
ordinances of the village of Fridley.
L1 �
/ In consideration of the payment of a fee of $..° permit is hereby granted to
to construct the building or addition as described above. This pe 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 village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
f
.....�,�-�. .:-.. ................ Building Inspector
NOTICE:
This permit doeLbRoete
' the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be the Building Inspector for separate permits for these items.
INCIDENT REPO?iT
'JFRIIDLEY POLICE DEPARTMENT
84-41149
MNOOZaB00
OFFENSE OR INCIDENT
OIIen Door
DAY: $
M T W TH
F S
DATE REPORTED TIME RECEIVED
TIME DISPATCHED TIME ARRIVED
TIME COMPLETED
5 /27184 1055
1055
DATE OCCURRED
TISK OCCURRED
NRD:
R - radio
CFS
.ri�)7/R4
1055
V
P - phone
INC
PLACE OF OCCURRENCE
GRID a
A - alarm
ARR
1482 Mississinni
11
I+
NAME OF COMPLAINANT/VICTIM
008
I - 1n person
JUV
Chris Lee V - visual
HOME ADDRESS PHONE N - mail
1482 T - other
BUSINESS ADDRESS PHONE
REPORTED BY
Fridley Pnl i nrg Depart_ =t 1
ADDRESS PHONE 01 9540 S
OFF
PROP
OFFICER ASSIGNED SQUAD 6 ISN U0C DISP
REPLACEMENT VALUE:
Ri �rar FFI rEr SVR A NT VALUE OF DAMAGE:
ASSISTINf�OFFICER)S) StlPVR APPROVAL
Morrissey VALUE RECOVERED:
ARRESTED/SUSPECT(S) OR DESCRIPTION TIME OF ARREST
2
WITNESSES ADDRESS PHONE 000
2
DETAILS OF INCIDENT: ADDITIONAL REPORTS.
While doing a house check at 1482 Mississippi, we found the east door of the house
to be unlocked. We also found the window of the east door to be broken out. We attempted
to find a keyholder, but were unable to locate any.'rWe secured the door and cleared.
This house has been boarded up for some time. It appears as though juveniles have been
entering the house for some time.
Copy to City Inspector- attempt to locate ownerto beard up window at above location. NIJ
COUNTY MINNESOTA TAXPAYER'S COPY STATEMENT OF PROPERTY TAX PAYABLE IN 1984
C. BAILEY, TREASURERPROPERTY DESCRIPTION FOR TAX PURPOSES ONLY -
(THE LEGAL DESCRIPTION OF YOUR PROPERTY MAY DIFFER.)
A, MINNESOTA' ; 55303 7 �
MILL RATE AMOUNT
& STAT,e '
R13 30 24 42
0055 0$0809Sa'
TOWNSHIP OR CITY 14.34000
162.19
_a g SCHOOL DISTRICT 60.33200
N
Z OTHER TAXING DISTRICTS 4. 916 0 0
55.61 ''
LEE DALE T &.
CHRISTIN5 E
1 220. 9,4
e. CREDITS WHICH REDUCE YOUR TAX:
`IIRCHASER t -
THE N 1 15.78,
FT OF°('LOT' 1 }
` 9LK ;"1 ` S :.RI.NG VALLEY S118J
IESCRIPTION
T0,' EASE OF RECORD
C. MI817.AI+IDB CRBDiT
D. DCC / TITLE II CREDIT
041 r
No. TAX AFTER CREDITS
7}p�
11. SPECIAL ASSESSMENTS ADDED TO YOUR
TAXPAYER -AGENT " '
OWNER -CONTRACT PURCHASER
*
570.94
LEE, DALE T CHRISTINE E
p `
.}r� 11.4,xSSELL CO
`�'�>., 'f+,rl;.;,r1-482f.:MISSISSIPPI
�
NE
y, (pa ..
��'+ ; #' 30, WARD ST
FRIDLE:Y._ MN 55432 "
gSPRINGFIELD
-OH 45501
a 4t{Ilb/1.� 1tMP B{.i: xitOy rj� ACRi1- OA SCHOOL Ot}T. WS Ni! PtSCAL 111113P. RAW* NES/ IM PROVBM CHT/ EBT. MARKET VALUE ASSESSED VALUE
14: --B: H 61700 INAINA
A 1'1310
,ARE YOU ELIGIBLE FOR A REFUND?
I OUT If YOU'RE ELIGIBLE FOR ONE OR BOTH OF THESE REFUNDS
MINNESOTA PROPERTY TAX REFUND
} ,., -
and THE SPECIAL PROPERTY TAX REFUND
I M 1PR USING THESE AMOUNTS:
z
(mount on tine 1012 2 Q
line Vichedule 3 +"a fits,'
-mourn on line 12 ' 6 5 0.0 0`
(ine 2. schedule 3
a 's
A E,ORM M -10R7 -READ THE BACK OF THIS FORM.
ISb�AMOUNT
.,
1LF.,TAX
t; } „ ; '3,; YOUR ITEMIZED STATEMENT
MILL RATE AMOUNT
& STAT,e '
It COUNTY, 28.36300
320.79',
TOWNSHIP OR CITY 14.34000
162.19
_a g SCHOOL DISTRICT 60.33200
682.3 5i
Z OTHER TAXING DISTRICTS 4. 916 0 0
55.61 ''
AREA WIPE TAX 101.72700
a TAX BEFORE CREDITS
1 220. 9,4
e. CREDITS WHICH REDUCE YOUR TAX:
A. STATE SCHOOL AGRICULTURE CREDIT
S. STATE PAID HOMESTEAD CREDIT
650.00
C. MI817.AI+IDB CRBDiT
D. DCC / TITLE II CREDIT
E. AGRICINUTURE PRESERVE
No. TAX AFTER CREDITS
570.94
11. SPECIAL ASSESSMENTS ADDED TO YOUR
A.
t$, ;TOTAL TAX
570.94
REALESTATESECOND HALF TAX REAL ESTATE TAXES
} PAYABLE IN YEAR PAYABLE IN YEAR (�
,VOID PENALTY, PAY ON OR BEFORE MAYA S
t iN. Afll iHO1 IRDi PROPEIITt IOCNTIPtCAT1oN Nu MBER ON CHECK
,. °.
�INI�t1�:�G�24 42 0055 HZO 00308095
�� - pwis CROWN$ ATABLE'TON DONALD C. BAILEY, ANOKA COUNTY TREASURER
'. r
PtR�5.47
2
OiIT
PRI;HGF It LD
k 1'
5,
IFS
OH 45501-
117
W ADORES{ IS INCORRECT. CN ECK BOK.
INDICATE CORRECT ADDRESS ON BACK.
THIS STUB AND RETURN IT WITH YOUR IST HALF PAYMENT
TO AVOID PENALTY, PAY ON OR BEFORE OCT. 15
PLEASE INCLUDE PROPERTY IDENTIFICATION NUMBER ON CHECK
PINI R13 30 24 42 0055 H2O OOSOSO95
MAKE CHEONS PAVALEE TOI DONALD C. BAILEY, ANOKA COUNTY TREASURER
SECOND HALF PAYMENT
255.47
TAXPAYER -AGENT
%KISSELL CO 117
30 WARD ST
SPRINGFIELD OH 45501
• V ADDRESS IS INCORRECT, CN SICK
BOK.
' INDICATE CORRECT ADDRESS ON BACK.
DETACH THIS STUB AND RETURN IT WITH YOUR 2ND HALF PAYMENT 1
Lill Ur HUJILY
APPLICATION FOR PLUMBING AND CTAS FITTING PERMIT_
F ITE SCHt�u! E -
PLUMBIN,FIXTURE RATES: N0. RATE TOTAL
ver F:zturee. S S.CO $
Futsre Fixtures. $ 3.50 $
-_ Old Op-anlnq, Hew Fixture $ 1.50 S
-- Bear =Ispenaer - _- -- $ 4.00 $
Blow =Sf Basin $ 5.00 $
Catch Basin $ 5•30 S
Rain *r__r Leader 5.co S
Hydras:: -c Valve S S.OU $
Susp as Reeeiving Tank $ 5.00 $
Waver :resting Appliance - $ 7.00 S
Hot xatar Beater. S 5.00 $
Cas Ra=;e $ 10.00 $
baa _ryer $ 10.00 $
ALL OTY.---AS }IND/OR REPAIRS AND ALTEP.ATIONS
11 of Talue of Fixture or Appliance
ReussPtc• on Fee State Surcharge
$ .
(515.00) TOTAL PEE $ f
Job Address 7S j
CePartment of Buildanys •��
City of Fridley
Tel. 1571-3450
The undersigned here --,w sakes application for a Permit for the work herz_n
specified agreeing to !.'A all work in strict accordance with•the City C> -;.s
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.
A I . /
OWNER s
KIND OP BUILOL
USED AS -- TO BE COKPLETED ABOUT C7 /
ESTI:ts.7ED CCST
OLD - Kr—W BUILDING PEt!:T 50- PEn4?T NO.
Signed By
Tel. No.l®
RC4;-H INSP.
Date
FINAL INSP.
Date
AFi+RCIVAL FOR PEWMIT
MIN11ui14 FEE FOR .ANY PLUMBING. PERMIT IS $10.00
PLUS THE $.50 STATE SURCHAkGE
x
o
Watei
H=
a
04
A v -L
o
v
_
e
--
Heater
t
m
a
s
v
w
w
'M
3
3
o
as
Iec
U.
U'
31
-INC
_
I
3rd
-- -
4 th
_
(R) ' F'3=re Connection Opening
Connected with Sever'
(•) • %ew Fixture, Old :Vening
Mater
F ITE SCHt�u! E -
PLUMBIN,FIXTURE RATES: N0. RATE TOTAL
ver F:zturee. S S.CO $
Futsre Fixtures. $ 3.50 $
-_ Old Op-anlnq, Hew Fixture $ 1.50 S
-- Bear =Ispenaer - _- -- $ 4.00 $
Blow =Sf Basin $ 5.00 $
Catch Basin $ 5•30 S
Rain *r__r Leader 5.co S
Hydras:: -c Valve S S.OU $
Susp as Reeeiving Tank $ 5.00 $
Waver :resting Appliance - $ 7.00 S
Hot xatar Beater. S 5.00 $
Cas Ra=;e $ 10.00 $
baa _ryer $ 10.00 $
ALL OTY.---AS }IND/OR REPAIRS AND ALTEP.ATIONS
11 of Talue of Fixture or Appliance
ReussPtc• on Fee State Surcharge
$ .
(515.00) TOTAL PEE $ f
Job Address 7S j
CePartment of Buildanys •��
City of Fridley
Tel. 1571-3450
The undersigned here --,w sakes application for a Permit for the work herz_n
specified agreeing to !.'A all work in strict accordance with•the City C> -;.s
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.
A I . /
OWNER s
KIND OP BUILOL
USED AS -- TO BE COKPLETED ABOUT C7 /
ESTI:ts.7ED CCST
OLD - Kr—W BUILDING PEt!:T 50- PEn4?T NO.
Signed By
Tel. No.l®
RC4;-H INSP.
Date
FINAL INSP.
Date
AFi+RCIVAL FOR PEWMIT
MIN11ui14 FEE FOR .ANY PLUMBING. PERMIT IS $10.00
PLUS THE $.50 STATE SURCHAkGE
SUBJECT
PIERMIJ- .
City of Fridley
2 0 4 03
AT THE TOP OF THE TWINS
BUILDING PERMIT
i
CEIPT N
#
I COMMUNITY DEVELOPMENT DIV.,
r L PROTECTIVE INSPECTION SEC.
"L
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
6/4/90
JOB ADDRESS 1482 M::ss;is ippi. Street N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
N14 of 1
1
Spring 'Valley Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Gus Gustafson 1482 Miss ss ppi. Street N.E. 572-8005
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
AWIA Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Resident i.41.
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
later, or alterations
9 CHANGE OF USE FROM TO
STIPULATIONS
See. notations: on plan,
SEPARATE PERMITS REQUIRED FOR
WIRING, HEATING, PLUMBING AND SIGNS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SQ. 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 I 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
$5,000
$2.550
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.
$72.00.
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$74.50
SIG RE OFCONTRAC RORAUTHORIZEDAGENT MATEI
,4"VHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
i I
SIGNATURE OF OWNER OF OWN R tjUIEWRi
BLDG INSP FATE
NEW [ 7 Effective 1/1/90
ADEN [ ] R-1 AND R-2
ALTER [ ] Building Permit Application
Construction Address:
r.
legal Description:
Owner Name & Address: (94,5 7 �) jC-6 Tel. # �-94905-
contractor:
_ .If Tei. # "
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Wwz
LIVIIJG AREA. length `dpi " Heigham Sq. F't
GARAGE AREA: length Width Height Sq. Ft.
DECK AREA: length Width Hgt/Ground Sq.. Ft.
OTMM: mac -'/c i,9'
ACM C)OK,,,�� --- -..
Corner lot �4 Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimated Cost: $_
Approx. Cmupletion Date: .1%d�l tel` SOdO, 6
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
Width + 6' See Back Page
DATE: APPLICANT: Tel
Permit Fee
State Surcharge
SAC Charge
Driveway Escrow
Park Fee
Sewer Main Cha
STIPULATIONS:
$ ,4C�
$ a ,�
CITY USE ONLY
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
lee Determined by Engineering
►greement Necessary [ ] Not Necessary [ ]
O & LI f
026 CSG- qu,04)
PURCHASE ORDER
PURE SED BY
D D f DEPARTMENT ) F 73108
O✓ THIS NUMBER MUST APPEAR
ON ALL CORRESPONDENCE
SENT TO US
11 THIS DOCUMENT GOOD FOR PURCHASES UNDER $1,000.00 ONLY
SUPPLIER ZAUA) 2SOAj
ADDRESS / )c/40
110 Ll 11"f ES V30;
PHONE N0. / WL_j - J /'7 /c
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS OR IF CONSTRUCTION
ORWORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 12Q 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 WORK WILL BE COMPLIEO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER JSTATE OR LOCAL LAW REGULATING CON.
STRUCT 0 OR
TER OR ANCE OF CONSTRUCTION
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT I TEP
S-GNATURE OF OWNER,,F OWNER BUILDER, IOATE,
v
PAYMENT VOUCHER
BY SIGNING THIS DOCUMENT BELOW I HEREDO AUTHORIZE
PAYMENT AND THAT THE GOODS AND SERVICES HAVE BEEN
RECEIVED OR RENDERED AND ALL CfIY GUIDELINES HAVE
BEEN FOLLOWED IN THE PROCUREMENT OF THE BELOW
STATED ITEMS.
II
NO DWLG. UNITS OFFSTREET PARKING
1 STALLS GARAGES
VALUATION' SURTAX
$800 $4...QA ,�5()
PERMIT FEE SAC CHARGE
t153 -a5- Fire SC $9r68 •
PLAN CHECK F TOT FEE
x,33. s -
HEN PRO ALID+TjFD THIS IS YOUR PERMIT
i
wl n I.SO fPATF
SUBJECT
mRMIT N.I�
City of Fridley
321 b 0
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
`
RECEIPTA40--'
I • _ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
r F � PROTECTIVE
572-3004
1 . F
CITY HALL FRIDLEY 55432
NUMBER
REV
GATE
PAGE Of
APPROVED BY
612-571-3450
910415
9/11/01
10B ADDRESS 1482 Mississippi Street
NE,
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
Pt. Lot 1
1
Spring Valley Addition SHEET
2 PROPERTY OWNER MAIL ADORES$
ZIP PHONE
-Shaun Peterson 1482 Mississippi Street NE 763-574-9855
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
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION
JO ALTERATION ❑ REPAIR ❑ MOVE
❑ REMOVE
8 DESCRIBE WORK
Change roof line on part of house
from flat roof to pitched roof
9 CHANGE OF USE FROM
TO
PURCHASE ORDER
PURE SED BY
D D f DEPARTMENT ) F 73108
O✓ THIS NUMBER MUST APPEAR
ON ALL CORRESPONDENCE
SENT TO US
11 THIS DOCUMENT GOOD FOR PURCHASES UNDER $1,000.00 ONLY
SUPPLIER ZAUA) 2SOAj
ADDRESS / )c/40
110 Ll 11"f ES V30;
PHONE N0. / WL_j - J /'7 /c
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS OR IF CONSTRUCTION
ORWORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 12Q 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 WORK WILL BE COMPLIEO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER JSTATE OR LOCAL LAW REGULATING CON.
STRUCT 0 OR
TER OR ANCE OF CONSTRUCTION
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT I TEP
S-GNATURE OF OWNER,,F OWNER BUILDER, IOATE,
v
PAYMENT VOUCHER
BY SIGNING THIS DOCUMENT BELOW I HEREDO AUTHORIZE
PAYMENT AND THAT THE GOODS AND SERVICES HAVE BEEN
RECEIVED OR RENDERED AND ALL CfIY GUIDELINES HAVE
BEEN FOLLOWED IN THE PROCUREMENT OF THE BELOW
STATED ITEMS.
II
NO DWLG. UNITS OFFSTREET PARKING
1 STALLS GARAGES
VALUATION' SURTAX
$800 $4...QA ,�5()
PERMIT FEE SAC CHARGE
t153 -a5- Fire SC $9r68 •
PLAN CHECK F TOT FEE
x,33. s -
HEN PRO ALID+TjFD THIS IS YOUR PERMIT
i
wl n I.SO fPATF
NEW I l Effective 1/1/2001
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: S Z js s `PPS s-, dU e
Legal Description:
Owner Name & Address: 0 [d -e N' -e I'S Tel. #
Contractor: dxa6 wv\'a r MN LICENSE #
Address: Tel. #
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 IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length
Driveway Curb Cut Width Needed: Ft. + 6 = Ft x $ _ $
DATE: 6 O APPLICANT: Tel. # Ao�� 17jn�
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee •G -Fee Schedule on Reverse Side
Fire Surcharge .001 of Permit Valuation (1/10th%)
State Surcharge. , --ez$ O $.50/$1,000 Valuation
SAC Charge $ $1150 per SAC Unit
License Surcharge $ $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Parkfee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ]
TOTAL $��e"W-'�
STIPULATIONS:
C./