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A
BUILDING PERMIT
Village of Fridley, Minn.: NO 2436
Date .� A
4 1. _....... ... .
Owner
Address �Y.P•
Btzl'der;
..
'
'"� .;';. Address
LOCATION OF BUILDING
No., 1 ...
Lot .4- ... J
Street >°, .. Part of Lot ...............
.. Block . jo ............ Addition or Sub -Division
Corner Lot ..
Inside Lot ............. Setback .... Sideyard" .. ,,,. .. ........ ..
r
s
DESCRIPTION OF BUILDING
Front. a Depth ` .1 .W. .Height , + � sq. Ft Cu. Ft. ........
............. ....
. Front ........ Depth ........ Height ........ Sq. Ft.... .. Cu. Ft. . .
Type of Constructi
Ar
ne "W IAV , ... Est. Cost 92 .. To be Completed
N
In consideratio
the proposed work
ordinances' of the
of the issuance to me of a permit to construct the building described above, I agree to do
accordance with the description above set forth and in compliance with all provisions of
age of Fridley.
.... .. .. . .. .. .
ideratio
the express• conditio
done in, around an4l
Fridley, Minnesotaegarding
in the village limits
ordinances,
of the payment of a fee of $.. .., permit is' hereby granted to .: ::'. ,�:. '
to construct the building 'or addition as described above. This permit pis granted upon
. that the person to whom it is granted and his agents, employees and workmen, in all work
upon said building, or any part thereof, shallconform in all respects to the ordinances of
location, ponstruction, alteration, maintenance, repair and moving of buildings with-
t. this permit may be revoked at any time upoh violation of any of the provisions of said
n.
Building Inspector
NOTICE:
This permit
oes not cover the construction, installation or alteration for .wiring, plumbing, gas heating,
sewer or water.
a sure to see the Building Inspector for separate permits for these Items.
NOTICE:
This permit doi s not cover the construction, installation or alteration forwhin plumbing, gas heating,
sewer or water. Besure to see til( ldtng Inspector for separate permits for Items.
r �.
Building
BUILDING
Permit No.
Inspections
RESIDENTIAL APPLICATION Received By:
763-572-3604
Fire Surcharge
$ Ate'
.001 times the total job valuation
CITY OF FRIDLEY Date Rec'd: �-
763-502-4977 FAX
.0005 x Permit Valuation Minimum $.50
License Surcharge
EFFECTIVE 8-19-09
1
DATE
`
YOUR E-MAIL ADDRESS C0V lb I �(®a S;T 0n 1 -COP--
COt--SITE
SITE ADDRESS 59 )'-7
n 011re-C4- V'R- LES a.J
5S L/3 2 -
THIS APPLICANT IS:
THIS
��
❑ OWNER WONTRACTOR
$
PROPERTY OWNER/
NAME: ^Dv o !�lg c, :ac fc-os H
$
TENANT
ADDRESS: "SG 1- 2-'4 S Tr<t t
CITY STATE Y)4V1ZIP S
Agreement necessary ( ) Non Necessary ( )
PHONE:
$ c,C { I V5
CONTRACTOR
NAME:
SUBMIT A COPY OF
STATE LICENSE # AL 2 0-? �SOO
EXP DATE -
YOUR STATE LICENSE
AND CERTIFICATE OF
a
ADDRESS: 22 IV d qewp ocl ol,®i In
CITY MIDL1 1 0; <c.✓ STATE,-P7A ZIP SrV /
INSURANCE
PHONE -?Q-370-62-qq
FAX -----
PROPERTY TYPE
)iC$INGLE FAMILY/NEW CONSTRUCTION
SIZE
(❑ TWO FAMILY/NEW CONSTRUCTION
STORIES_
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHEDZINDOWS
13BASEMENT FINISH ❑ ROOF
❑ DRAIN TILE
❑ DECK g3IDING
❑ OTHER
SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCEIREPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:-e - Si SC 60r o
P /OC 1C &Il H ®4S
SIZE OF IMPROVEMENT
1
O'/N <gaVt LENGTH W
TH HEIGHT SQ FT
ROOFING
NUMBER OF SQUARES
❑ HOUSE ONLY
11 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,
+I
`�offit
ADDITIONS. & PORCHES SUBMIT:
• Aluminum
Aluminum
A
❑Trim
1. Site Plan/Survey showing the existing structures
❑ Other
Fascia
and proposed project.
2 Two sets of construction plans
WINDOWS
IN EXISTING OPENINGS)des ON, LOCATION OF WINDOWS
3. Energy Calculations
FOR WINDOWS - PROVIDE U -VALUE AND
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED P NUMBER OF WINDOWS
TOT.
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
ATION $ / S;� 66. ® Z) OCCUPANCY
Permit Fee
$ I
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$ Ate'
.001 times the total job valuation
Surcharge
$ L
.0005 x Permit Valuation Minimum $.50
License Surcharge
$ E1190
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $22 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$ c,C { I V5
Make checks Davable to: Citv of Fridlev Attach Stipulations
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 perm' d work is n t to start without a permit on site; that the work will be in accordance with the
approved plan in the case work w c r ui s r e �wj approval of plans. J RO � j
SIGNATURE OF APPLICANT PRINT NAME �W IC! U �� DATE44- ,Q