PRE 2010 DOCSCity of Fridley('2
AT THE TOP OF THE TWINS
P,
SUBJECT
BUILDING PERMIT
P IT NO.
7 2 6
I
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
612-571-3450
NO.
g�
]C%�
NUMBER
910-F15
REV
DATE
8/18/98
PAGE OF
APPROVED BY
JOB ADDRESS
160 Panorama Avenue
1 LEGAL
DESCR.
LOT NO.
6
BLOCK
TRACT OR ADDITION
1 Carlson` s Summit Manor South
SEE ATTACHED
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Richard Bartholomew
572-8257
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Right Way Roofing Inc853-nn49
3999
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 ❑ ALTERATION REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (23 S 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
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
ZONING
SO. FT.
CU. FT.
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
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
VALUATION
$1918
SURTAX
$.96
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
$62.25
Fire SC $1.92
PLAN CHECK FEE
TOT FEE
License 5. OQ
0.13 jf
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
P OPE FA61DAVY
BLDG N F
THIS IS MVR RMIT
�)A
SIGNATURE OF OW NER OF OWNER BUILDER) IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: I uo pmo y Oy
Legal Description:
Owner Name & Address: V-161&1fra (-)ouf+in nl n VVW A 7 Tel. # 9, -+Z- S Z57 -
Contractor: QAq V'4- LUCK izopFC nc MN LICENSE # 0003Ct 4'G
Address: 1 ZQ D G- , qqi1'1 !U- Tel. # 5sc,;�)-QQLA
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: [ Drab. C12 ('a",( (ZD ILCltrt. �
Construction Type: Estimated Cost: $�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: Q APPLICANT: VQL1l. VU CA, EH V\ Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$120,13
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 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 [ ]