PRE 2010 DOCSCity of Fridley, Minn..
BUILDING PERMIT
4412
Date: ........... ._�° .._..._.._ r__._._....---•
Owner:
----- ------------- ------__--- ------------------------ _--- _...___..._......._._.._..._........_. Builder
Address
Address
, LOCATIONOF BUILDING
No. -- - ..®......._...._...-._......_.._. of Lot
..... ® ....... .._s ...-,----.._..........
...
.. Street ....._..:: _- ............... Addition or Sub Division �' � a
Lot............. ................... Block ...__ :..........._-. .................. ........._......--..:.:..: ............ - .......... .._.....
Corner Lot ..... .............._........ Inside Lot ..... _...................... -........ Setback .: ............. Sideyard ..... ......._...... .
Sewer Elevation
To be Used as:
e
Type of Construction
Foundation Elevation
DESCRIPTION OF BUILDING
" " � O.'"Sq. Ft.°� & Cu. Ft. � ' �
Front .....- - — -.. Depth .... - Height_...........-- - -
s a � v
Front ..:... Depth Height ,o' '° Sq. Ft. ...-- Cu. Ft.
...................................................... Est. Cos..�.0 ..:...:.... o 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 expresscondition 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 time upon violation of any of the provisions of said
ordinances.
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
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APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners N r moulder =
Address
LOCANTTIION OF BUILDING
No., Street. / � Part' of Lot
Lot Block Addition or Sub.Div.
Corner Lotri Inside Lot Set Back' Side -Yard..
SEWER ELEVATION FOUNDATION ELEVATION
Applicant ittach to this form Certificate of'`Survey of Lot and -proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
Li-Y--�- Front . Depth �� ® Height
Sq. Ft. /5 f� Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Esti ted
To be completed
Cost
The undersigned hereby makes application fora permit for the work hereiri...
ipecified,
agreeing to do all work in strict accordance with the City Ordinances and ruling of .
the Department of Buildings, and hereby, declares tha all Ahe fadts and ' repreoenta
tions stated in'this application are true and corr..e_ y
14
/ L _ SIGNAT
:1
Building
BUILDING
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd:
DATE `0' 11 b
YOUR E-MAIL ADDRESS
SITE ADDRESS o
.S ��6sDo Z --N o 0 r.
THIS APPLICANT IS:
1W6WNER ❑CONTRACTOR
PROPERTY OWNER/
NAME: -rrt -E—
ADDRESS: Ia'q9 S k -t([ Xch Lm or CITY 42,J i lP-4
STATEmvZIP
TENANT
PHONE:
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
PHONE FAX
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
PROPERTY TYPE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH S IfOOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
El -NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: Qom" F- 00 -F T --e o; C' -FF ' a
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING 3 -HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2. 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
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ElNo LOCATION OF WINDOWS
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 UFEE SCHEDULE)
TOTAL JOB VALUATION $ r�'� OCCUPANCY TYPE
Permit Fee
Plan Review
Surcharge
Fire Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ 117's C9
$ T-+
See Back Page for Fee Schedule
65% of Building Permit Fee
(.0005) times the total job valuation - Minimum $.50
.001 x Permit Valuation (1/10%)
$5.00 (State Licensed Residential Contractors)
$1450 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
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 equires review and approval of plans.
SIGNATURE OF APPLICANT �/C PRINT
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