PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT ' N? s124
Date-
Owner: A_V Builder
Address Address
0, ALOCATIO ING
62�
No. `' Ctreet ��� to Part of t
Lot ___ Block Addipa or Sub-Division
Corner Lot Inside Lot—a'"""`^,••��Setback Sideyard
Sewer Elevation ________._ Foundation Elevation
AV DESCRIPTION OF BUILDING
Front Depth _U?" He ght Sq. Ft. Cu. Ft.
09 IK Age Front Depth eight Sq. Ft. ', Cu. Ft.
Type of ction Est. To be Completed
u
In consideration of the issuance to me of a permit to construct the building described above, Io to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinanoea of the city of Fridley.
It i
In consideration of the payment of a fee of Vii-"
to construct the building or additio
the express condition that the person to whom it is granted a]
done in, around and upon said building, or any part thereof,
Fridley, Minnesota regarding location, construction, alteratic
within
the city limits and this permit may be revoked at any
ord
, permit is hereby granted to
t as described above. This permit is granted upon
d his,, agents, :employees and workmen, in all work
shall conform in all respects to the ordinances of
1, maintenance, repair and moving of buildings
upon violas" any of the provisions of said
NOTICE:
Ub pensh don not amw the construction, huftflafto for whdeo, phmbieo, oa hestiee,
the Buildhm hspestor for sopmft perdu for thea hemm
Inspector
or water. as euro to see
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Name Builder
0
Address tel) / Address
L LOCATION OF BUILDING
Street
Lot B1ock__,V Addition or Subdivision
Part of Lot
Corner Lot Inside Lot Setback Side -Yard
I
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To be used as:
DESCRIPTION OF BUILDING
Front Depth Height
Sq, Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
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 stated in this application
are true and correct. A ZI-)
DATE SIGNATURE
l�
(Schedule of Fee Costs can be found on the Reverse Side).
4 � �
La d P/onnin9(fU&T 07S-Nfomy #Cf N.E.
Laid Sta'veyi� Minneamfi 21,
,;Oil Testmy ENGINEERING, INC. m`71w.oi°
Civil & mfficipivl Sy"iIf-6066
% r — En yineers Sur vecyors --
certificate of aimve I for D.L. A%DF-1ZSOM b3 -PER-
N
Sc -ale-, `1,_ �,.o'
Ir ON
rxai�lAge- EIA-50%le4,i
fa
Z
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a
ie
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P'otl
91 -Da --2 DD Peo ADD)TI4,)
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herby4 OW hi is a true and mrZcf rep resen%fikW7 'fo sr�^v y 4'�
aliva bormdories q�'/Ire. oba►r desu+►6ed /mid, and
OpIk /sOraff drgldar9s, l6vw, and mf/ risible immis , ��' . �m or arum d /md. As surveyed by me Ai - doy
Ag SUB RBAN ENGINEERING , INC.
&*errs fr Sury ors
SUBJECT
NO.
City of Fridley
26898
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
' COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
l J` 612-571-3450
910415
7/29/98
'AMPierce
St
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
r5
2
Don's 2nd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Wayne Hitchcock
571-1724
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
J.I. Builders P.O. Box 667 Forest Lake 55025
433-44048
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 [I REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garageV27 S Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with 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 80 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
2251
$1.12
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 05 THE PERFORMANCE OF CONSTRUCTION
$74.75
Fre SC $2.25
PLAN CHECK FEE
L FEE
4SIRTURE
Lice Sc
5 0
983.12
i6F79ACTOR OR AUTHORIZED AGENT (DATE)
H P
8 G INS
Y VALI
D THIS IS YOUR P RMI
L GATE
SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ��
BUILDING PERMIT APPLICATION
ConstructionAddress: _J
Legal Description:
Owner Name & Address: J Tel. # sem/ — j 7 s<
Contractor: J` MN LICENSE # � 7 4
Address: Tel. # 41.3 3
Attach to this application, a Certificate, of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE`AREA:
DECK AREA:
OTHER:
Construction Type:
DESCRIPTION OF EWPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
iwQVM�M
Driveway Curb Cut Width Needed:
DATE: 7 APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Ft. + 6 Ft =
Estimated Cost: $��
(Fee Schedule on Back)
Ft x $ _ $
I .-
$ `l 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 [ ]
a
el. # zl3--? — f -
Building
BUILDING
Permit N
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd: D a�
DATE �6 L� 0'3�
YOUR E-MAIL
Tl
SITE ADDRESS �� 3 c J qtr ,,,
THIS APPLICANT IS:
❑ OWNER KCONTRACTOR
PROPERTY OWNER/
NAIIM; / (z.L.Cdc<–
ADDRESS: kg- 3�Z' pi 2 °A J\IkCITY rc J- e y
STATI;MgIP -T Z
TENANT
n/
PHONE: l 3— % l l 7 a4
CONTRACTOR
NAME:
STATE LICENSE # 1165 EXP DATE 3Oaf
-
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: 2 l ? 6J01 �S - CITY v
STAT�ZIP
WITH APPLICATION
PHONE -7–/-/2-7-7-46 FAX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH OROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING Tr
[3SWIMM[I IG POOL Bd f–re
TYPE OF WORK:
❑ NEW ❑ ADDITION
MAINTENANCEIREPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:, r Cts nn el a CI Less d?Id --
f ✓� GIGj�
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
2.
Existing Floor Plan
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1.
Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS ❑Yes []No LOCATION OF WINDOWS
3.
Energy Calculations
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee $ See Back Page for Fee Schedule
Plan Review $ `? 65% of Building Permit Fee
Surcharge $ (.0005) times the total job valuation – Minimum $.50
Fire Surcharge $ / 9 .001 x Permit Valuation (1/10%)
License Surcharge $ $y $5.00 (State Licensed Residential Contractors)
SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft + 6 ft = ft x $20 = $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( )
Total Due $ �y� 7_ y-$— Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work whi rec ires review and approval of plans. f
SIGNATURE OF APPLICANT ` PRINT NAME. Y \ DATE
%��
r lsg('C�ld