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PRE 2010 DOCSVMage of Fr%d.ey, MMum. lel ® 4 9 ®face ®f II1QT�P CTOR OF B UGi S Fridley, Minn., 0en � 18 i} / LOCATION OF BUILDING 4 Street �o , tb Part of Lot Block --]--Addition or'Sub-Division DESMIPTION OF BUILDING Front De Ith Height11— Stories Manner of Construction To be used as Q, ! e To be completed+irlsatimated Costy, % c Permit is here axted t a to 1� the building -L q .46scribeq in . the: above statement. This permit , is granted upon the express c6 m9don t the. pe i to whom it is granted, and his agents, employees and workmen, in all the work done in, around and upon 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 ts, and this permit may be revoked at any time upon'.violation of any of the provisions of said ordinances. `` �� 1k rl D:?a9,1°%4n spector of Buildings. AGREEMENT_AND SWORN STATEMENT in consider tion of the issue and delivery to. me by the In^pector of Raildings of Fridley of the above pe t, i hereby' agree to do the proposed work in accordance w`th the description above set forth and according to the provisions of the ordin.ance�-, of ciley, and, being first duly sworn, I here b state and say that the facts stated by me and co fined the above permit are true as therein 5tated. Subscribed a1ld sworn to before me at Fridley, Afinne-ota, this / p day o .D. 19 j l 1 sueJEtr(oPERMITNO. ! City of Fridl 30196 AT THE TOP OF THE TWINSey BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. _____ r PROTECTIVE INSPECTION SEC. I /w 1 DATE PAGE OF APPROVED BY 1 ..'.9 CITY HALL FRIDLEY 55432 �'j ....... 612-571-3450 rIBEF1TWEV 910-FlS 9/9/99 JOB ADDRESS 515 66th Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 1 Rice Creek Terrace Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE H. B. Martin 571-1828 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 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 )a REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house 18 S Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS gjjdxf 61LA Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1000 $.79 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 57,05 1 FireAC $1.57. PLAN CHECK FEE TOTAL E 1 _._'W� // $ 1 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI EN ROPE ALIDAT HIS IS R PEMITT B G )NSP gA1E S,GNATURE OF OWNEROF OWNER BUILDER) IDATEI l 1 NEW[ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name & Address: Contractor: Address: n Tel. # .--v W MN LICENSE # 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: Lemth 470 Width 6/ Hgt/Ground Sq. Ft. OTHER: FO — lQ't© - (�PS, j 6',Utj on t 6 SQ Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: DATE: APPLICANT: Ft. + 6 Ft = Ft x $ Tel. # STIPULATIONS: CITY USE ONLY Permit Fee $ • 05— Fee Schedule on Reverse Side Fire Surcharge $ . .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1050 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 $ .� STIPULATIONS: