PRE 2010 DOCSSUBJECT
'
Cit of Fridley
F THE TWINS
BUILDING
PERMIT
28538
COMMUNITY DEVELOPMENT DIV.
�
r v PROTECTIVE INSPECTION SEC.
� 6
1 . �
,'; CITY HALL FRIDLEY 55432
NUMBER
REV
OATS
PAGE OF
APPROVED BY
L J` 612-571-3450
910-F15
JOB ADDRESS
6151 Rainbow Drive
1 LEGALLOT
NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
12
2
Sylvan Hills — 1
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Merlin White
571-2888
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Seal Guard Systems 9199 Central Ave NE Blaine 55434 717-0700 20093688
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 0 ADDITION ❑ ALTERATION 3c REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage (26 Sq) Tear -off
9 CHANGEOFUSEFROM 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
STALLS 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
$2168
$1.09
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
$74.75
Fire SC i. $2.17
PLAN CHECK FEE
TOTAL FEE
License SC $5.00
83.01
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERLY VKVDATED THIS IS YOUR PERMIT
G"
SIGNATURE OF OWNERIIV OWNER BUILDERI. IDATEI
8L0 NSP
1 TE
•••••• L J
ADDbT [ ] .; _ CIT -OF FMLEY
ALTER e [ ] SINGLE FAMILY AND' DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: ((fit E)1 rx k
Legal Description:
Owner Name & Address:
Contract
MN LICENSE # o���q 3Ct1
�q Tel. #
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: (� D
Construction Type: �Q Estimated Cost: $ J - 40
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE:APPLICANT: Tel. # I I I 0-7 W
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
s T4 -1G
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 [ ]