PRE 2010 DOCSt
Village of Fridley, Minn.
BUMI)ING PERMIT
NU 802
U2 Ofce of INSPECTOR OF BUMDMGS
Architect Fridley, Minn., g�r t:c meg,. P' 19 ro ""
Builder
LOCATION OF
OF BUILDING
NO. '�%lI Street _ �1� x� Part of Lot
Lots Block Addition or Sub -Division
DESCRIPTION OF BUILDING
r
Front L L- Depth '' Height Stories Manner of Construction
To he used as .. �. e . : r y . �d ",,.�_ �? 0
To be completed _fir Estimated Cosh
Permit is hereby granted to
the building �'�_Z-- 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.
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.
Subscri ed and sworn to before me at Fridley, Minnes;a, this I
day ofD. 19-
0 4P
BuilderOwner ...........
�"'F�'�` �'............................
p
Address Address .. .... ....................
n
I�
LOCATION OF BUILDING
No. Street ,.
...:°$:'9........ ... Partof Lot ........................
1
Lot ..::............ Block ................ Addition o� Sub -Division ...... . „............................
i
Corner Lot ...... Inside Lot ............ Setback Sideyard .�.�.�?r:............
DESCRIPTION �OF � BUILDING l
To be Used. as:
&t l
.. , . ....... Front f.. Depth
.' �!'': Height �i ' .. Sq . Irt. , Cu. Ft........ .
................... i Front .. Depth . eight ....... Sq. Ft......... Cu. Ft........ .
jobit
Type of Construed o . Est. Cost ... i. ..... To be Crompleted
qJoe
vvz;
II
I�
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In consideration the issuance to me of a permit to ,construct the building described above, I agree to do
the proposed work in ccordance with the description above set forth and in compliance with all provisions of
ordinances of the vill a of Fridley. !i
... ........................
S erati O
the payment of a fee of $':':.... ,rmit is hereby ted to ..............
�n Y t
.... .'.rn
.. to construct the building or ad dition as described above. ;This permit Is granted upon
the express t the person to whom it is grant and his agents, employees and workmen, in all work
done in, arosaid building, or any part tbereo t shall conform in all respects to the ordinances of
Fridley, Minding location, construction, alteration, maintenance, repair a�d moving of buildings with-
in the villagn this permit • may be revoked at anyl'tlme ' upon violation of any of the provisions of said
ordinances...
I
Building Inspector
NOTICE:
This permit dof
sewer or water. Be
l
not cover the construction, installation or alteration for wirih
ire to seethe Building Inspector for'separate permits for the"
q, plumbing, gas heating,
e Home.
A
01
SUBJECT
PE
City of Fridley
2 6 4 G
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
_
1 --
~
PROTECTIVE INSPECTION SEC.
I
NUMBER
REV
DATE
PAGE OF
APPROV D BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
6/30/98
JOB ADDRESS
4763 - 3rd Street
1 LEGAL
LOT NO. BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
26 & 27 8
Plymouth
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Dan Kishish 4763 - 3rd Street Fridley.
-
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Dan Kishish (same as
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION j7 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Bim$ Replace siding.
9 CHANGE OF USE FROM
TO
STIPULATIONS Install building wrap and call
for inspection before covering.
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 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
700
50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING -OF A PERMIT
•00
•
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-
$26.SO
Fre SC $.70
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
T AL FEE
27.70
SIGNA URE OF CONTRA TO RAUTHOAZEDAGENT IDATEi
HEN R
VALI T THIS IS YOUR PERMI
e
.14 p
I i
iGNATURE OFOWNIEFjoF OWNER BUILDERI IDATEI
B-06 INSP
GATE
01
NEW [ ] Effective 1/1/98
ADDN [ ]
CITY_
FRIDLEY
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:�(l� �T
Legal Description:
Owner Name & Address: l j n Tel. # Z.771—Contractor: MN LICENSE #
Address • 1�3:_o lW rk "-, ('.t Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF EUPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
fl 1 1
Construction Type: Estimated Cost: $ �(
(Fee Schedule. on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: APPLICANT:
t� �j (� Tel.
CITY USE ONLY
Permit Fee
$ cZ,
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
$iz h
STIPULATIONS: