PRE 2010 DOCSCity of Fridley32981
SUBJECT
IT
AT THE TOP OF THE TWINS
BUILDING
PERMIT(:
r
RECEIP10.
• COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
/41('—�/Q®
r F � PROTECTIVE
E . F
NUMBERREv
DATE
PAGE OF
APPROVED 6V
CITY HALL FRIDLEY 55432
763-571-3450 1
910-F15
8/13/02
JOB ADDRESS 1668 MISSISSIPPI ST NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
Auditor's Sub. #22
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Larry Delanne
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE
LICENSE NO
Titus Winger Const 17715 12 Ave N, Plymouth, MN 55447
612-685-6104
20270544
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 Q REPAIR
R
❑ MOVE
❑ REMOVE
B DESCRIBE WORK
Reroof House & Garage (18 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
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
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
$1,929
$.96
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-
STRUCTION
$69.25
Fire SC
$1.93
OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHEC E
T TAL FEE
Li ns SC
.0 0
$77.14
SIGN AT IRE OF RORA UTHORIZED AGENT fIDA
WH P
RLY VA
TED THIS IS Y
UR PERM IT
B10IN
gAtE
S-GNATURE OF OWNER„F OWNER BUILDER, (DATE,
NEW [ ] CITY OF FRIDLEY Effective 1/1/2002
ADDN () 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg insp
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
\ l -
Construction Address:
Legal Description:
Owner Named Address: L-A c r q & r% Tel: #
Contractor.:, + AC. N , 113 1 A c r` MN LICENSE # BC,;QQ%05 Yl
Address: MPS- I��' �tU¢ kr_ p, t�►nc�'� AI Tel. # (O (QZL $S -616Z
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 Width Hgt/Ground Sq. Ft
OTHER: z !2 s:(:w
p®
Construction Type: ��� ��� - Estimated Cost: $/� 9
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $
DATE: /3 APPLICANT: Tel. # L Ia -3a3
Call (763) 572-3604 for Permit Fees if mailing in application or 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
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ S Fee Schedule on Reverse Side
$ .001 of Permit Valuation (1/10th%)
$ $.50/$1,000 Valuation
$ $1200 per SAC Unit
$ 5,-00 $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 [ ]
$ 7,124 STIPULATIONS: