PRE 2010 DOCSCity ®f Fridley,
BUILDING PERMIT
�T® '7211
Date:
Address
)LOOYMNOF BUILDING
No. Street -'R Part of t
Block Addition or Sub -Division -
Corner Lot Inside Lot Setback _ Sideyard -� ® o
Sewer Elevation Foundation Elevation 9�4 - J
%®9 or � a
DESCRIPTION OF BUILDING
Front Depth Height Sq. Fi. o cu.
t Depth eight Sq. Ft.Cu. Ft.
Type of Construction �� _ Est. Co V " To be Completed
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
twork In accordance = r
he city of Fridley.with the description above set fo and in compliance with provisions o
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, 30nnesota regarding location, construccttTon, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. _ �, A /
NOTICE:
This parnk does not corer the construction, installation for vdrtn& phnnbiug, on heatiae, sewer or webr. Be acre to we
the Building Wspecter for sopor" pannus for these item.
a
..APPLICATION FOR BUILDING PERMIT
•.CITY.OF FRIDLEY, MINNESOTA:
OWNER'S NAME, l r��'S" .; BUILDER
ADDRESS .. r. ' - `
" <4'..'_ ADDRESS �(. a-�...4%
y
LOCATION OF.BUILDING
No. Street _Il. r'�1 (s.kart. of Lot
Lot . ..Block Additlou or Subdivision.A 7 ' lq'�J-
Corner Lot _Inside Lot Setback ¢ .. Side -Yard._ . — L .
SEWER ELEVATION FOUNDATION ELEVATION
Agplitantt,tach., t.o .t_his. form ,Two Certificates. of Survey of:Lot and proposed build-
ibg Iodation OrAwli on;these .Certificates.
DESCRIPTION OF BUILDING
To be/used as:
e'c � Front ,Depth f ,Height
3q.
Front Depth Height
Sq. Ft. Cu..Ft.
Type of Construction 1,041L, Estimated Cost .� . 43, //-Vv
• .riwT
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,.Buildin,gs, and hereby.declares that, all the facts and
representations stated in this 'application are true and correcto
DATE
1'e'5
,,(Schedule of Fee Costs can be found on the Reverse Side).
r . . 0
B. H. BRADLEY
CIVIL ENGINEER AND SURVEYOR
8829 - 24TH AVENUE SOUTH
MINNEAPOLIS, MIPMMWrA 88409
PAFtKWAv.4-2189 - -
�FV'mroy Vic*
td A�_#%.
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R � f.
SUBJECT
PERMIT NO.
City ®f Fridley
22167
AT THE TOP OF THE TWINS
BUILDING PERMIT
COMMUNITY DEVELOPMENT DIV.��
_
PROTECTIVE INSPECTION SEC.
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
J 612-571-3450
910-F15
10/11/93
JOB ADDRESS 1160 Regis Lane NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
1
Lakeland Heights SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Dave Thibault 1160 Regis Lane NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Richard Hastings Contr. 6331 Riverview Tex' NE Fridley -
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 REPAIR ❑ MOVE ❑ REMOVE
D
B DESCRIBE WORK
Reroof Dwelling (.18 Squares) 2nd Layer
9 CHANGE OF USE FROM TO
STIPULATIONS Roofing can be the 2nd layer but not the 3rd. Install adequate attic
ventilation, Provide smoke detectors as per UBC 1210 adjacent to all sleeping areas
and in basement,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
VALUATION
SURTAX
AND KNOW THE SAME.TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$1,400
$.70
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$33.00
Fire SC $1.40
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
loll t Q
License SC $5.00
$40.10
SIGNATURE OF CONTRACTOR ORJJTHORIZED AGENT BATE)
P RLY VALIDATED THIS IS YOUR PERMIT
BLDG I f7ATE
SiGNATUREOFOWN ER OF OWNER BUILDER) IDATEI
NEW [ ] Effective 5/26/93
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: // ® L ! Ll�
Legal Description:
Owner Name & Address: 12AL�6: 7�� �i Arc Tei. #
Contractor: N c` P - j) �-1 ", -S t i MN LICENSE # r� S
Address: K3-31 Z R c- Z Tel. # 57 - F
LIVING AREA: Length
GARAGE AREA: Length
DECK AREA: Length
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Width
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback
Type of Construction: R r2 cm F
Approx. Completion Date: 1 u o Z7 3
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Sq. Ft.
Side Yard Setbacks
Estimated Cost: $, /,{o o P 66
(Cost on Back)
Rx $ =$
DATE: APPLICANT: Tel. # S ;f�'
Permit Fee
$
() ()
Fee Schedule on Reverse Side
Fire Surcharge
$
1�0
.001 of Permit Valuation (1/10th%)
State Surcharge
$ °20
$.501$1,000 Valuation
SAC Charge
$
$750 per SAC Unit
License Surcharge
$
- fJ Q
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
Conservation Plan Review $450.00
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
$--
-
STIPULATIONS:
��D , U
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