PRE 2010 DOCSBUILDING PERMIT
Village of Fridley, Minn. N° 2374
7 _00
Date ,A............... .
Owner .... Builder ..
Address.� . / ... Address .......... ............................ .
LOCATION OF BUILDING
No. .. Street....'u.. ............................ Part of Lot .......................
Lot ... ~,%�'.I, Block ... .......... Addition or Sub -Division ,p16-Js�[.. ......
Corner Lot ............ Inside Lot ........ Setback j. •`♦ . ... Sideyard............ .
DESCRIPTION OF BUILDING
To be Used as:
. .... .. Front4i4 .... Depth .1.$V Height
Front ........ Depth ........ Height ..........
Type of Construction Est. Cost .........
Sq. Ft...... . Cu. Ft. ........
Sq. Ft......... Cu. Ft.........
To be Completed do. 4W O.
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 forth and in compliance with all provisions of
ordinances of the village of Fridley.
... ..a:'.10-:.�: .............
In consideration of the payment of a fee of $,44.7k."... pern-J is hereby granted to .........................
.................. .... 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 with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
7o w:.... Building Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
.n
SUBJECT
P R
City of Fridley
29958
AT THE TOP OF THE TWINS
P,RECEIPT
B U I L D I N G P E R M I T
I
NO.
COMMUNITY DEVELOPMENT DIV.
/
r PROTECTIVE INSPECTION SEC.
��
NUMBER
REV
GATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
IL' %.1
-"11.0
612-571-3450
910415
7/29/99
10B ADDRESS 5604 5th Street NE
1 LEGAL
LOT NQt. 12
YY
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
3
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Connie Burton
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Right -Way Roofing 1200 E 79th S
-
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
O NEW ❑ ADDITION ❑ ALTERATION REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage 19 S Tear -off
8 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with the State Building Code.
Permit Inspection Cards
Will Be Mailed
To Homeowner To Post
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIREO 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
1 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
1661
.83
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
$60.10
Fire/)SC $1.66
PLAN CHECK FEE
TOTA EE
License $5..90/
.59
SIGNATURE OF CON 7RACTOR OR AUTHORIZED AGENT IOATEI
EN ROP ALIDAT
THIS I UR P/E/RMMJIT
S,GNATURE OF OWNERoF OWNER BUILOERI (DATE,
BLor,INSP )ATE
l
NEW [ ]
ADD1V ' [ l
ALTER [ ]
ConstructionAddress:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
10�1-- (�T �
(--, .
Effective 1/ 1/98
Legal Description:
Owner Name & Address: �1�� ��� Tel. # Gs
Contract14. - MN LICENSE #
Address: RIGHT -WAY ROOFINO
1200 E. o nth treat
EEO
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Tel. #
ion, a Certificate of Survey of the
construction drawn on it to scale.
OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Construction Type�SG E Estimated Cost: $ W \
— SQ AR.P"jc (Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE:
APPLICANT:
Tel. #
TOTAL
STIPULATIONS: �'
CITY USE ONLY
Permit Fee
t \J
$
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
$ S dQ
T
$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
STIPULATIONS: �'
n -_ s
Building
PLUMBING
Permit No.:
InspectionsRESIDENTIAL
APPLICATION
Re'ei°ed By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd:
DATEI YOUR E-MAIL ADDRESS
SITE ADDRESS .1. . 5 n
THIS APPLICANT IS: O OWNER OCONTRACTOR
PROPERTY
NAME: P10 -f-6 Ih A LV A M L
OWNER/
ADDRESS: 29&_'6!z 5 S T CITY '01�17-/ L Sy STATEN+ 22P 15'r /3 X
TENANT
PHONE:
CONTRACTOR
NAME:
STATE LICENSE # S/ Si V P n EXP DATE tZ/3,, /0 6
Cry Al A r,'F
SUBMIT A COPY OF
YOUR STATE
ADDRESS44 Z If us ay d CITY '01g STATEA J_ZII '��9l
LICENSE WITH
PHONE -/_ 2 .5 7Z dP"V FAX '74.4 S72 lfe* f
APPLICATION
PERMifT TYPE
G6I NGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE
TYPE OF WORK:
0 NEW A7REPLACEMENT
DETAILED DESCRIPTION OF WORK /i aA::&& &'ey
PER MS 168.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor). .
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 =
FOR PROJECTS WHERE LABOILEXCEEDS.$500 SES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL ::.
NUMBER OF EACH BELOW)
—BATH SINK/LAV _FLOOR DRAINS WATER PIPING
—SHOWER _
BATHTUBGAS PIPING (sm cnrucewss) SWIMMING POOL _ WATER SOFTNER ($35)
CLOTHES WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREY. ($15)
DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
WATER METER OTHER
Permit Fee $ 5' Number of fixtures @ $10.00 x $10.00 = $
Sure a .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Total = $
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 and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
r
SIGNATURE OF APPLICANT Ap Alu, PRINT NAME _rAG� • �"0 DATE 4,
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
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