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City of Fridley, Minn..
BUILDING PERMIT
Data: v-1 L�z
Builder
Address Address
zCoe.*-/ -� 40 7.--P1
N° 69'79
3LOCATION O BUILDING
40 No. _� Street s _ ��4 ..,�_ Part of Lot
Lot Block .,/ sF Ad tion or Sub -Division .
Corner Lot Inside Lot — Setback -� / �_ Sideyard
Sewer Elevation __ _ -- Foundation Elevation
DESCRIPTION OF BUILDING
TUAsed • i
o
Front Depth Height Sq. Ft.-- CtL r '•+
Fron Depth Height t�Sq. Ft. Cu. Ft.
Type of Construction 4.9,14 02_ Est. cosi 1-� -------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 forth and in compliance with all provisions of
ordinances of the city of Fridley. ---,% c i tfa A
c�
In consideration of the payment of a fee of $ �W permit is hereby granted to
to construct the building or addition as described above. This permit is granted upon
the eFregsditlon thatdone andFridlota rewithin tlimits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances
Building Inspector
NOTICE:
Thb permit does not cover the construedon, Inift ation for w1rhM phtmbine, ga heaffA& sewer or water. Bo are to ase
the Building hapmer for separate permits for those hems.
•
-2 "`-"la/
City of Fridley, Mi
BUHDING PERIMT
Q7064
.:
AddressOwner: Builder
Address
A LOCATION O MING
No. Street _ Part of Lot
Lot _ _ __ Block Ad on or Sub -Di n
Corner Lot _ Inside Lot
k ideyard
Sewer Elevation FOV
tion Elevation
DESCRIPTION OF BUILDING
..=410 -4
_��}} Lgam�_
Front Depth Height Sq. Ft. A:.1 Z Cu. ral:90
n .� Depth Est. 0-4
H-�K� Sq. Ft. Cu. Ft.
Type of Construction _. _ Est. ��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 forth and in compliance with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of 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 paw thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, constructti0 alteration, maintenance, repair and moving of buildings
ori. city >i is and this permit maybe revoked at any ti u�po�violatieY any of the provisions of said
• NOTICE:
fids peen* don not cower the condrodlon, InsteRWon for wWng, plumbing, gas heating, oawor or wafer. Be sure to see
the Building hmpector for separtle permhe for these Items.
Building
See Back Page for Fee Schedule
BUILDING
Permit No.
Inspections
.001 times the total job valuation
RESIDENTIAL APPLICATION
Received By:
763-572-3604
$5.00 (State Licensed Residential Contractors)
CITY OF FRIDLEY
Date Recd: 47199
763-5022-4977 FAX
ft+6ft= ftx$22=$
$
$450 Conservation Plan Review
$
EFFECTIVE 8-19-09
$
- v
$ _
7
DATE 4/
YOUR E-MAIL ADDRESS�l�1_� Cwt) YP7all),e�
l
SITE ADDRESS 10- Ce'�
��) c>!M� i V er—
THIS APPLICANT IS:
OWNER ❑CONTRACTOR
PROPERTY OWNER/
NAME: G/k--"'
TENANT
ADDRESS: "/- U - !i litRA4 dy �L- CITY 1 -"
_STATF&JQ ZIP 5JIg
PHONE:
CONTRACTOR
NAME:
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # EXP DATE
AND CERTIFICATE OF
ADDRESS: CITY
STATE ZIP
INSURANCE
PHONE FAX
PROPERTY TYPE
`ffMINGLE FAMILY/NEW CONSTRUCTION SIZE bU -e--
❑ TWO FAMILY/NEW CONSTRUCTION STORI S 7
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH 91440OF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
CX,MA ANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING ❑ HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES_
❑ HOUSE & GARAGE
1. Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Nitryl
❑Soffit
ADDITIONS.
& PORCHES SUBMIT:
❑ Aluminum
E3 Trim
1. Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
FOR WINDOWS - PROVIDE U -VALUE AND
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
07:1191,11;11 CoJU
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
UCC U PA1NC Y
$ %e®57
See Back Page for Fee Schedule
$
65% of Building Permit Fee
7,3W
.001 times the total job valuation
$
.0005 x Permit Valuation Minimum $.50
$
$5.00 (State Licensed Residential Contractors)
$
$2000 per SAC Unit (Plans to MWCC for determination)
$
ft+6ft= ftx$22=$
$
$450 Conservation Plan Review
$
Fee Determined by Engineering
$
Agreement necessary ( ) Non Necessary ( )
$ _
Make checks savable to: City of Fridley Attach
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 applicationrape it and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of work r wires revi w and approval of plans.
SIGNATURE OFAPPLICAN PRINTNAME&,014 DATE