PRE 2010 DOCSv . _r
Date ! .. Il . ... .
Owner Builders .....
Address 'X./ , ..� Address . .
II;
LOCATION, QF: BUILDING. "
No....v j .. Street . �? . !° : .. .. Part 'of Lot . .
Lot ....... .. I ' Block : , . Addition or Sub-Division° ! `... ; .. .
Corner-Lot . I Inside Lot --two'
Setback !" Sideyard `�°`"�
�I.. ....
DESCRIPTION .OF, BUILDING>
To be . Used 'as
'
,„
11 '
Front ` :. Depth :.. . Height ..:• Sq. Ft.. Cu. Ft.
......�.. , ..... `T Front. , . Depth ,Height. ..... Sq. Ft.. Cu. Ft, .:..... .
Type of Con sixu 'onll `"�`� Est. dos' To' be Completed . �.. . .
. I
III
In consideration 0 the issuance to me of a permit to construct the building described above, I agree to do
the proposed work. in �ccgordance with the description above set forth and in compliance with all provisions of
ordinances of the village of Fridley:
>. .4.. ..........
Ia% c n of�I�Ithe payment of a fee of $'.. .. , permit is hereby granted to ....
' I' to construct. the building or addition. as described above. This permit is granted upon
the .express condition t the person to whom it is granted and his. agents, employees and workmen, in all work
done in, around and un 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 with-
in the village limits' an4, this permit may be revoked at any tune upon violation of any of, the provisions of said
ordinances,
".. Building Inspector
NOTICE:
This permit Aces lnot cover the construction, installation or alteration for wirings plumbing, gas heating,
sewer or water. Be re to see the Building. Inspector for separate ,permits for these items,
SUB.;ECT
RMIT NO.
City of Fridley
29483
AT THE TOP OF THE TWINS
BUILDINGr PERMIT [R
IT
RECEIPT NO.
� ` y COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
��®�
r PROTECTIVE
iF = �
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED By
--•.R,e�"'f:'�
L 612-571-3450
910-F15
5/18/99
JOB ADDRESS 840 West Moore Lake Drive.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
Shorewood #2
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Chuck Hayes
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Steven Woods Construction 8164 Zenith Ct Bkl n Pk 55443
537-R2664 6810
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 �9( REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (25 S) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICALr, 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 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
$2142
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1.07
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC
PROVISIONS OF ANY OTHER STATE O LOCAL LAW REGULATING CON•$83a25
TR CTION OR THE PERF MANCE OF STRUCTION
7GE
F1Ci
$2.14
PLAN CHECK
TOT FEE
Li a $5 0
$ e46
SIGNATURE OF CON"RA OR OR AUTHORIZED AGENT tDATE,
HEN P.A V LI
HIS ISY PE
SIGNATURE OF OWNER,IF OWNER BUILDERI IDATEi
Bl IN -1P01
NEW[ l Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name & Address: Tel. #
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
MN LICENSE #-6'910
�T�Tel. # foC2 S'"3 7a!
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIMON OF IMPROVEMENT
Length Width Height' Sq. Ft.
Length Width Height Sq. Ft.
Driveway Curb Cut Width Needed:
Estimated Cost: $
Ft. + 6 Ft = Ft x $
=S
DATE: j APPLICANT: ���� �� Tel. #
/' / V -t
Permit Fee
$
Fire Surcharge
$ �y
State Surcharge
$
SAC Charge
$
License Surcharge
$ O
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $ l' L%�
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 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 [ ]