PRE 2010 DOCS•
Village of Fridley, Minn.
BUILDING PERWr
N° 7918
Office of INSPECTOR OF BUILDINGS
owner. i"`t +
Architect Fridley, Minn. `A «; 19 4� •^,
Builder
LOCATION, OFF BUILDING
No. Street moi)2 Part of Lot
Lot ,%� �� 1,.. � ',� Block ,Addition or Sub -Division {
DESCRIPTION OF BUILDING
1--' -*.
Front, Depth Height Stories Manner of Construction -
To be used as To be completed Estimated Cost
I i ,
Permit is hereby granted tai •_° . _ c r:..#' .� w°. -,� .•- %:�-a ;,_ -i? yx _• :« i
the building described in the above statement. This permit is granted
upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all
the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley, Minn., regarding the 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.
Inspector of Buildings.
AGREEMENT AND SWORN STATEMENT
In consideration of the issue and delivery to • me by the Inspector of Buildings of Fridley of
the above permit, I hereby agree to do the proposed work in accordance with the description
above set forth and according to the provisions of the ordinances of Fridley, and, being first duly
sworn, I hereby state and say that the facts stated by me and contained in the above permit are
true as therein stated.
Subscribed and sworn to before me at Fridley,
day of a r, z r.,._ t ,M, , A.D. 19
Minnesota , thi "�' `
City of Fridley, Minn.. N9 9644
BUILDING PERMIT
•Date: —. March 26, 1968
0
E
Owner: J. Sinigaclio Builder Strand Const-,CQ,�
Address _ _47 5 3rd St. N. E. Address 9240 Lvnd_aJ—e Ave , Sguth
LOCATION OF BUILDING
No. 4715 Street _ 3rd St. N. E. _ Part of Lot
Lot 18 & 19Block 8 ____ Addition or Sub -Division ._ Plymouth Addn.
Corner Lot —_ Inside Lot ._ Setback --- Sideyard
Sewer Elevation __ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Garage Front 24' Depth —24' Height 10' Sq. Ft. 576 Cu. Ft. 5760
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction — Frame Est. Cost _—.$3..,000 To 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 foo^ ,andin compliance wi1 provisions of
ordinances of the city of Fridley. /
In consideration of the payment of a fee of $ 9.00 , permit is hereby granted to Strand C ons t . C o .
to construct the building or addition as described above. This permit is granted upon
the express condition 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.
f' r� ding Inspector
arence Belisle a.
NOTICE:
'fids permit don not corer the construction, hutallatton for wiring, plumbing, gas heating, sower or water. Be sun to no
the Building inspector for separate permits for thus hems.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MUMSOTA
OWNER'S NAME C*40*004940BUILDER- ; r ev
ADDRESSF�® �. r4 ro, Jo
ADDRESS _�_
LOCATION OF BUILDING
NO. STREET
1, OT; �P / BLOCOK _ ADDITION OR SUBDIVISION,
CORNER LOT INSIDE LOT SETBACK
SEWER ELEVATION TOP OF FOOTING
Applicant attach•: tp•;*this form Two Certificates of Survey . of Lot and proposed
building location'drawn on these Certificates:
'1 DESCRIPTION OF BUILDING ,.
To Be Used As t
Front� � � Depth t Hdight_
Square feet �!�! Cubic. $ee;�
r.:f Front Depth ... fleiglit'
Square feet Cubic heat
Type of Construction Estimated..,gost
To Be Completed��6m�
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, t
DATE ®� ® �® SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side.
53-84-S-915.51
City of Fridley
AppkoMm for Pkmbbg and Gos
Dart_ of BWkpL n%om 960-390
Macalmon or WORK
x • Kid mi Loce� eat MAB 4715 N. E. 3rd. Street
PARTIAL RATE SCHEDULE
VLVAOMQ rUCTUM RATM wo► BAre ?Or,13.
K"I ................ ��
E sm iN .
...i......
: Vie 6 .
ON C%wni.. o .......
Nm '4
I IM i
/
. .�.�. . ........
W& (V.p to 0 BMf !V b
fleas Gnmmd slue CW Bth..........
z S&Z 4
w&tw .............. -a
an i
m3 CYt . . . . . . ..... .. . . . ..
Zan
..............•
S $ M t
an ftw fo mon ..........M -s
no
State
State Surcha ne
.50
► f it.'rQ►?ZCMD-AV W b Gia
p ........ Install�Gas Light....�..�...�
5.00
TCWAZ.= S 5.50
Chi" W Surcharge .500
City of Fridley
SUBJECT
PE
13'76
•CEIPT
AT THE TOP OF THE TWINS
BUILDING PERMIT
i
`
NO.
______ COMMUNITY DEVELOPMENT DIV.
L
r PROTECTIVE INSPECTION SEC.
1 �
LLUJJ
`
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
9/16/76
JOB ADDRESS 4715 - 3rd Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
18,19
8
Plymouth Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Joe Sinigaglio 4715 + 3rd Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Miles Garages 4500 Lyndale Avenue North
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
J NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ EMOVE
mammal -
8 DESCRIBE WORK INSUPW
Construct a second accessory building (32' x 24') 1Utnw"
T,ELEPNONE • ELECTRIC =S M
9 CHANGE QF USE FROM TO
REQUIRED
STIPULATIONS
Garage is not to be used for a home occupation. Garage to be
compatible with the existing house as far as exterior appearance.
SNYN$ Special Use Permit approved by the City Council on August 16, 1976.
SEPERATE -PERMITS REQUIRED FOR ISI O%
HEAT , ' PLUM81NG AND SIG . --IM ORTANT—
• WM Y THE FRIDLEY ENGR,
CIMSION REGARDING CURB
REMOVAL AND REPLACEMEN
AT`MIV&VAY OPENING')
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
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
R-1
768
7680
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
I
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.
$5,683
$2.84
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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-
$22.73
STRUCTION OR THE PPPFORMANCE OF CONSTRUCTION.
/,w m
PLAN CHECK FEE
TOTAL FEE
$25.57
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PR PERLY VALI ATED THIS IS YOUR PERMIT
y'
9-1�
BLDG INSP DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATEI
ut i i ur rru.uLr.r
APPLICATION FOR RESIDENTIAL ALTERATION,
ADDITION, OR REPAIR BUILDING PERMIT
OWNER'S NAME : d O r ( / c= BUILDER:
ADDRESS: '® NI ADDRESS:
NO • C,"`7 i S STREET: Aj L
1.
LOT: BLOCK: ADDITION:
N
CORNER LOT: INSIDE LOT: SETBACK: SIDE71ARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To B Used As:
Front:
3:2
Depth : .? i
Height:
Square Feet: 168 Cubic Feet: ��&(;I()
Front: Depth: Height:
Square Feet; 763 Cubic Feet:
Type of Construction: Estimated Cost: $ S'%Tota
To Be Completed:
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.
' 4
DATE: F� ` SIGNATURE:
(See Reverse Side For Additional Information.)
' aLfS� Dr10�
s , Jnr r0 ,�,
�tc�xSEe �4s Fk, hS €x-re-ef0Z 1)Wcqk'ANC6_•
a,,
370 - 0,56
City of Fridley
SUBJECT
®
AT THE TOP OF THE TWINS
BUILDING PERMIT
�
R
• COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION
r SEC.
1 . �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-680-3450
910-F15
12/5/77
JOB ADDRESS 4715 - 3rd Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
18,19
8
Plymouth Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Joe Sinigaglio 4715 - 3rd Street N.E.
3 CONTRACTOR MAILADDRESS 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
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
6 DESCRIBE WORK
Renewal of Building Permit #13,762 for construction of second garage
9 CHANGE OF USE FROM TO
STIPULATIONS Provide a hard surface driveway.
SEPERATE PERMITS REQUIRED FOR WIRING,
HEATING, PLUMBING AND SIGNS.
WARNING
Before digging call foal utilities
TELEPHONE - ELECTRIC - GAS Etc.
REQUIRED BY LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
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.
$5,000
$1.42.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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-
$11.36
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$12.78
A
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) +
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
LOG INSP DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
• CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER: J ds� I M 1 G_ 13UILDEII:
Address: �% /�'� �(�( Address:
Tel. No.
No.: Street:
LOT: I� , a BLOCK: ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
� gpmC" Front: I Depth: Height: �Q /
Square Feet: Cubic Feet:
Front:
Square Feet: Cubic Feet:
Depth: Height:
Type of Construction: (.J608 F-P-Aa(f
To Be Completed:
Estimated Cost: $
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
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. See reverse side for additional information.
DATE: -,S - '% SIGNATURE:
Stipulations: ?aj o{J' E 4 im Z�Kk FlqC-,
M
SUBJECT PE
City of Fridley
®14965
AT THE TOP OF THE TWINS
BUILDING PERMIT '
REC€IP-T-NO.
• COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION
r � � SEC.
1 �
=
�l---1 CITY HALL FRIDLEY 55432
NUMBER --fRIEV*
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
10/18/78
JOB ADDRESS %!S
3rd Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRA CT OR ADDITION SEE ATTACHED
DESCR.
18-19
$
Plymouth SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Joseph Sinigaglio 4715 - 3rd Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
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
8 DESCRIBE WORK
Construct a-32' x 24' Second Garage
9 CHANGE OF USE FROM TO
STIPULATIONS Renewal of permit issued 12/77. Provide hard surface driveway.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
Wood Frame
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
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
1
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,
$3,960
$1.98
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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-
$30.72
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$32'.70
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN P OPERLY VALIDATED THIS IS YOUR PERMIT
BLDG )NSP DA E
IGN TURE OF O E F OWNE BUILDER (DATE)
M
• CITY OF FRIDLEY
APPLICATION FOR RESMENTIAL BUILDING PEMAITS
(NL" -W, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER: 6gek !S j" � BUILDER:
Address: 'g7lj 11-S_,+T 14F Address:
Tel. No.:
No.: Street:
LOT : % r L 9 BLOCY.: F 'ADDITION: �!%� G!►�
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
•
building location drawn on these Certificates.
DESCRIPTION OF BUILDING ,
• To Be Used As:
/l
• � Front: Depth: _ �„�,_ Height: Q
Square Feet: Cubic Feet: �G
'Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: — �ve� �°�—_� Estimated Cost: $ kwz�✓$� �• �',
TO Be Completed: �Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
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. See reverse side for additional iation.
-ZZZ� DATE: � Q r-! % � SIGNATUP.E:
Stipulations: �P
- 396&r
I -32,2'0
SUBJECT
PMIT NO. i
City of Fridley
0877
AT THE TOP OF THE TWINS
BUILDING
PERMIT
`
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
_ _ _
r PROTECTIVE INSPECTION SEC
1 �
NUMOER
REV
OATE
PAGE OF
APPROVED By
= CITY HALL FRIDLEY 55432
612-571-3450
910 -FIS
4/28/00
JOB ADDRESS 4715 3 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DES CR.
18,19
8
Plymouth Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Joseph Sinigaglio 4715 3 Street NE
572-8896
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
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION Cj REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (25 Sq) 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
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
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
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
@
$2,185
$1'09
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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
TOT FEE
$86.53
S.GNATURE OF 'RA ORORAUT ORiZEDA•GENT 1DATE,
N ROPEY ALIDA E THIS IS YOUR PERMIT
9l iN P
GNASLTUR O N BW DE i iOATE�
NEW [ l Effective 1/1/2000
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: 41 3 (2-`�) (, 1 l
Legal Description:
Owner Name & Address: aD&d' SIV1'-�4k�LCri`J�5-3STGIE Tel. # 617—S72- Wim.&
Contractor: MN LICENSE #
Address: 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/Groun Sq. Ft _
OTHER: _ / :mow '/ - - We v a ; `l) W
Construction Type: 12ag -f- Estimated Cost: $ 40 — lOd
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: � G� APPLICA T: Tel. # i�-12- S-72WIZ
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ 83.-S Fee Schedule on Reverse Side
Fire Surcharge $ c1,19 .001 of Permit Valuation (1/10th%)
State Surcharge $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
$_$1 100 per SAC Unit
$5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ _ $450.00 Conservation Plan Review
Park Fee $
Sewer Main Charge
TOTAL
STIPULATIONS:
$
481� -&3
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
r1
ALL FEES ARE BASED ON VALUATION, INCLUDING TtM tt:US-r Ur- JUADUK AIN" 1y1A r JN"mL' '
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
$
BUILDING
Permit No.:
Building
Inspections
Fire Surcharge
RESIDENTIAL APPLICATION
Received By:
763-572-3604
$ SU
CITY OF FRIDLEY
Date Rec'd:
DATE �/f ®�D
YOUR E-MAIL ADDRESS
SAC Charge
SITE ADDRESS�-
Curb Cut Escrow
THIS APPLICANT IS:
OWNER ❑CONTRACTOR
Erosion Control
PROPERTY OWNER/
NAME:--Te-60[t
Park Fee
TENANT
ADDRESS: 6a/ -V--3 R -0S f J E CITY � [ t'i A
_STAT) IKZIP css�Z/
$
PHONE: :Z 3 - Ja eej�w
Trtal Due
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
-0 -SINGLE FAMILY/NEW CONSTRUCTION SIZE
TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE -SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING '?.OTHER—
[3 SWIMMING POOL
Jct
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCEIREPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
NUMBER OF SQUARES
❑ HOUSE ONLY
13 HOUSE & GARAGE
BASEMENT REMODELING SUBMIT
I. Existing Floor Plan
GARAGES
El ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
❑Vinyloffit
ADDITIONS &PORCHES SUBMIT:
Aluminum
Trim
1. Site Plan/Survey showing the existing structures
and project.
❑ Other
❑ Fascia
proposed
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
sR TTT7 AT Q.
ALL FEES ARE BASED ON VALUATION, INCLUDING TtM tt:US-r Ur- JUADUK AIN" 1y1A r JN"mL' '
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$ `i lD
.001 times the total job valuation
Surcharge
$ SU
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1550 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Trtal Due
$ L(.
Make checks payable to: City of Fridle 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 permit andork is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all w tc ie and pproval of plans. AN���,
SIGNATURE OF APPLI T
PRINT NAME//�'t/�/G�1 r //!�%%�J�G10 DATELO �IP7496