PRE 2010 DOCSSUBJECT
PERMIT NO.
City of Fridley
® 13020
AT THE TOP OF THE TWINS
PERMIT
r
BUILDING
RECEIPT NO.
i
COMMUNITY DEVELOPMENT DIV.
�� I
r PROTECTIVE INSPECTION SEC.
t �
=
t �---I CITY HALL FRIDLEY 55432
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NUMBER
REV.
DATE
PAGE OF
APPROVED BY
"-' 612-560-3450
91.0-F15
6/16/75
JOB ADDRESS XXXXXXX 4717 2 1/2 Street N.E.
1 LEGAL
LOT NO.
BLOCK
TR ACT OR ADDITION
SEE ATTACHED
DESCR.
19, 20
1 7
Plymouth Addition
SHEET
2 PROPERTY OWNER MAILADDRESS
ZIP PHONE
Alice L. Fi ere 4717 2 1/2 Street N.E.
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Same
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 X
11NEW ❑ ADDITION ❑ ALTERATION `n
REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
9 CHANGE QF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
hing1
amad
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
SQ. 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
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
$400
.50
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.
PLAN CHECK FEE
TOTALFEE
5.50
SI AT RE OF CONTRACT OR HORIZEDAGENT (DATE)'>WriEN
t
PROPS Y VA TED THI IS YOURP RMIT
BLDG INSP
/
- DAT
SIGNATURE OF OWNER -OF OWNERS E (D AT
•APPLICATION FOR RESIDENTIAL., ALTERATION,
OR ADDITION.BUILDItiG PERMIT
CITY OF'FRIDLEY, MINNESOTA
OWNER'S NAPIE : i " �' ' BUILDER:
ADDRESS: �� �� lY K ADDRESS:
STREET: S
LOT.: /f ole+ rot Z BLOCK: ADDITION°
CORNER LOT: INSIDE LOT: V SETBACK.: SIDEYARD:
Applicant attach tl, this form Too Certificates of Survey of Lotand.propose'
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
T e Used As:
Front : Depth-
Square
epth:
Square Feet: Cubic.Feet:
Front: Depth:
Square Feet; Cubic Feet:
Height:
Height:
D e.
Type of Construction: Estimated Cost: $ ell 0a
To Be Completed: 4J1
.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 Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE: SIGNATURE ,% F
(See 1�everse Side For'tional Information.),
r
J
SUBJECT
P .
of Fridley
18-8 1
AT THE TOP OF THE TWINS
B U I L D I N C P E R M
Ir?City
� • COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r � �
i ) CITY HALL FRIDLEV 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
5/26/93
JOB ADDRESS 4717 2� Street NE
1 LEGALLOT
NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
Pt. 19-21
7
Plymouth Addition SHEET
I
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Maurice Fugere 4717 211 Street NE 379--7209
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same 241 Cecil Street S'E, Mpls,, MN 55414
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
B DESCRIBE WORK
Reroof House & Garage C1.4 Squaresj. Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply, with.the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
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
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
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
$756
$A 50L
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-
$21.0.0.
Fire. SC $.76
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$22,2.6
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
HEN PROPD THIS IS YOUR PERMIT
.
OMT,
BLDG NSP GATE
SIGNATURE OF OWNER)IF OWNER BUILDER) (DATE)
J
NEW [ l
ADDN [ ]
ALTER[ ]
Construction Address:
Effective jwa-i
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
.Building Permit Application
*-1 -7 )(®
Legal Description: o 2/ '7 _. �� �� i12 C,z.6
Owner Name & Address: )C I& P 114 Tel. # 37�Z-
Contractor: MN LICENSE #
Address: L P c 215: Mme' -� 5 `tl Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft. _
DECK AREA: Length Width Hgt/Ground Sq_ Ft.
OTHER: A/v vs5�r0-
Corner Lot [ ] Inside Lot TAI
Type of Construction:
Approx. Completion Date:
Ft. Yd Setback Side Yard Setbacks
Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + b Ft =
(Cost on Back)
Ft x $ = $
DATE:y - / - APPLICANT: °� - Tel. # & 7 9 - 7,� o
ITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
$ 2/. CG'
$ (c,
$ S
License Surcharge $
Driveway Escrow $
Park Fee $
Sewer Main Charge $
TOTAL
STIPULATIONS:
�e
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$750 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]