PRE 2010 DOCS0
City of Fridley, Minn.
BUILDING PERMIT
Date: .... K0. ...... .
Owner
Address ............ ... .....................
•
No 3959
Builder
%
................................ ........
Address
.............................................
LOCATION OF BUILDING
No. !.... StreetPart of Lot ...............................
Lot ............ Block .................. Addition or Sub -Division Al .................. ?....y............. .
iv
Corner Lot ............ Inside Lot Setback .. Sideyard .. �..
.. . ....... .................
DESCRIPTION OF BUILDING
Used as:
4
... ..... Front a�.Q .:.� Depth:. Height®.. ia. Sq. Ft. l .4! Cu FL 7 y®
.. .
... ... Front A t!r oP Depth .Height J.�... �� rSq. Ft. Z g. P. Cu. Ft.
pp L�
of Co on ................... Est. cost... .46;5.10 .?. To be Completed ............
In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do
the proposed work in accordance with the description above set f and in mpliance with all provisions of
ordinances of the city of Fridley. y
In consideration of the payment of a fee of $.Ar.... .., permit 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 city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. .01 --ly
.:.:y�� ✓%.i ../dB�lding Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating,
sower or water. Be sure to see the Building Inspector for separate permits for these Iteme. -
SUBJECT
RM) -
City of Fridley
2 2 214
f
AT THE TOP OF THE TWINS
BUILDING PERMIT
' ,
Ir?
o
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1——
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
1
JOB ADDRESS 721 58th,'Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
22
4
Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
E. R. Jacobson 721 - 58th Avenue NE 56i-4633
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Knutson Roofing & Siding 5744 Bryant Ave N, Brooklyn Center 561-4633 2501
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
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (20 Squares.) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code. Provide adequate
attic ventilation. Provide smoke detectors as per UBC 1210 adjacent to all sleeping
areas and in basement.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SQ. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
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
$2, 400
$1.20
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 OT R STATE OR LOCAL LAW REGULATING CON-
$54.00
Fire SC $2.40
E ORMANCE OF CONSTRUCTION.
T UCTION OR THE PEI
PLAN CHECK FEE
TOTAL FEE
__
License SC $5.00
$62.60
ALIDATED THIS IS YOUR PERMIT
OWATV�( _ �W
4 1:lATUREOFCONT RACTOR THORIZEDAGENT IDATEI
9J§bG 140SP bf DATE
SIGNATURE OF OWNER dF OWNER BUILDER) (DATE)
NEW [ ] Effective 5/26/93
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application s -y
Construction Address:
Legal Description: do y) � (-CA- , G Me `
Owner Name & Address: — �G `G b SG Tei. #
Contractor./' MN LICENSE #moo 7 S{
Address:�r Tel. #
�/C��/f /J�Y�' /�� �rcU�lur� ��
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTIONPF IMP OVEMENT
-Tea r o � � Sh� %i �/�°-5 �� ha" SC f �� cyi����c0�
LIVING AREA: Length • Width Height Sq. Ft.
GARAGE AREA: Length9 Width
DECK AREA: Length Width
Corner Lot [ ] Inside Loth[ ] Ft. Yd Setback
Type of Construction:
Approx. Completion Date: /� Z
Height Sq. Ft.
Hgt/Ground Sq. Ft.
Side Yard Setbacks
Estimated Cast: $ Z� L1 UU
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
=S
DATE: APPLICANT: Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ ��j� d �� Fee Schedule on Reverse Side
$ .001 of Permit Valuation (1/10th%)
$ / 0 $.50/$1,000 Valuation
$ $750 per SAC Unit
$ ��� �' $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ Conservation Plan Review $450.00
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ STIPULATIONS: