PRE 2010 DOCSCity cif Fridley, Minn.
BI -"ING PERAUT 'N? 5254
Date: ___�,— _""• '``" �°'
0
Owner: _ ' Builder
Address".1 A;J4_. - Address
LOCATION OF BUIL
No..___ Streetart ofmot _
Lot _ _n Block Addition or Sub-Divion
'
Corner Lot _ _ _ Inside Lot ftback "_'-�Sideyard
Sewer Elevation _ Fotattion Elevation
DESCRIPTION OF BUILDING
To U
Front Depth.. a Height Sq. Ft. �� d-" O Cu.
_ F Depth ____�a,rieght Sq. Ft. — Cu. Ft.
Type of Construction s=�".: _<_ �--Est. cost s e b' ,r ` ` w 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 with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ , 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
within the city limits and this permit may be revoked at any tune upon violation of any of the provisions of said
ordinances.
j >,r
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, Bae heating, sower or water. Be sure to see
the Building Inspector for separate permits for these Items.
4
4 . .
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name - Builder �Y'n
Address V7 �annyzamla Address aaLte _
OF BUILDING
No.
of Lot
Lot Block Addition or Sub.Div.
Corner Lot Inside Lot _V",_SM Bads Side -Yard,_,
SEWER ELEVATION fUMMATION=EMATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To ruse as:
j,,r CaA 4_ Front Depth Height
Sq. Ft. _3�L„_Cu. Ft.,�®�
Front Depth Height
Sq. Ft.
Type of
To be completed
Cu. Ft.
ted Cost
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 declares that all the facts and representa-
tions stated in this application are true a�ncorrect.
(A Schedule of Fee costs can be found on the Reverse Side.)
SUBJECT
R
City of Fridley
28391
THE TWINS
57%-N04
BUILDING
PERMIT
R
iry �_���_ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
��
CITY HALL FRIDLEY 55432
NUMBER
REV
GATE
PAGE Of
APPROVED BY
612-571-3450
910-F15
10/23/98
JOB ADDRESS
172 Panorama Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
7
2
1 CArlson's Summit Manor South Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Duane DAvis
572-8250
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 O ALTERATION REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof house (14 Sq) Tear-off
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
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
$1199
$.60
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
$40,25
Fire/9C $1.20
PLAN CHECK FEE
TOTA FEE
.05
R OF CONTRA AUTHORIZED AGENT iDATE-
N P P R LI AT THIS IS YOUR PERMIT
da���nI
AgNATIAE
/T (� A
OF OWNER,IF OWNER BUiLDERi 9DA TE-
SLOG NSP
OA rE
t.
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION ,.
� A
ConstructionAddress: 17 C PD Ab Rs m8i 4-,(' (' N� L
Legal Description:
Owner Name & Address: -7DU A K e O
A V t s
Tel. #
57 2- 8 2-' c7
Contractor: c r
('
MN LICENSE #
Sq. Ft.
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
LIVING AREA: Length
Width
Height
Sq. Ft.
GARAGE AREA: Length
Width
Height
Sq. Ft.
DECK AREA: Length
Width
Hgt/Ground
Sq. Ft.
OTHER: HOU.
`Re-'fo J-
(t--`
1e�tz o --
Construction Type:
Driveway Curb Cut Width Needed:
DATE: 10 _ Z -3 -q U'
Ft. + 6 Ft =
Estimated Cost: $ //99
(Fee Schedule on Back)
Ft x $ = $
Tel. # G7-1--OZSO
. STIPULATIONS:
CITY USE ONLY
Permit Fee
/
$ ' 70 . S7
Fee Schedule on Reverse Side
Fire Surcharge
$ /, o O
.001 of Permit Valuation (1/10th%)
State Surcharge
$ 60
$.50/$1,000 Valuation
SAC Charge
$
$1000 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
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
$ �US
. STIPULATIONS: