PRE 2010 DOCSSUBJECr
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City of Fridley
28702
572-35®4 THE TWINS
BUILDING
PERMIT
1 ,
• COMMUNITY DEVELOPMENT DIV.
� VV _____
r � � PROTECTIVE INSPECTION SEC.
YM13
1 4
NUMBER
REV
DATE
;AGE OF
APPROVED BY
;
11 1 CITY HALL FRIDLEY 55432
L J \ 612-571-3450
910415
98
12/3198
JOB ADDRESS
4977Roman Road
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
9
3
1 Carlson's Summit Manor S.
SHEET
2 PROPERTY OWNER MAIL ADORES.
5
ZIP PHONE
Gladys Christopher596-94191
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
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house 15 S Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING,
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
1285
.64
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
$43.00
Fire SC $1.28
PLAN CHECK FEE
TOTAL FEE
2
SI FC • ACTOAORAUTHORIZEDAGENT DATE I
WHEN PROPERL ALIDATED THIS IS YOOUR. PERMIT
AMYkA TUBE 01F OW NERSIF OWN BWLDERI AT I
INSp
BATE
NEW ` [ ]
ADDN [ ]
ALTER [ ]
ConstructionAddress:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
0
r��Ie
Effective 1/1/98
Owner Name & Address:', 0? i( ®�J� Tel. #
Contractor: ���✓��/� . MN LICENSE #
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: Leno Width Hgt/Ground Sq. Fj .
OTHER:
Construction Tyre: eE timated Cost: $ S
�'
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: APPLICANT: ` Tel. # �S`�� gyc— I
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
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 [ ]
3rd.
3200 FRANCE AVE. S0.
STREET
N.E.
ROMAN
I hereby oertify that the above is a survey of tats One (1) through Twenty (20)0 Block
Three (1).. CAK50N 8S .SU*UT MANOR SIOhPl4i ADDITION, Anoka County, Minnesota. shoving the
location of the houses on said lots.
As surveyed by sa this 18th day of April 1955 A. D.
Si Rnek.3TiL'
Hinneecta Wfdatration No. 2K84
ROAD
4i
Z
W
0
Z
W
' i'
CITY OF FRIDLEY PERMIT NO.: 2004-00086
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 01/22/2004
572-36U4 FAX: (763) 571-1257
ADDRESS : 4977 ROMAN RD NE
PIN : 263024230058
LEGAL DESC : CARLSONS SUMMIT MAN SO ADD
: LOT 9 BLOCK 3
PERMIT TYPE : ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE.
INSTALL XCEL ENERGY SAVERS SWITCH
# INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORP
2300 TERRITORIAL RD
ST PAUL, MN 55114-1614
(651) 646-2911
OWNER
CHRISTOPHER GLADYS M
4977 ROMAN RD NE
FRIDLEY, MN 55421
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date.
ELEC PERMIT FEE - MIN (RESI) 20.00
STATE SURCHARGE, ELEC FLAT 0.50
TOTAL 20.50
PAID WITH CHECK # 113375
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.