PRE 2010 DOCSSUB�EC`t
.
City of Fridley
8
AT THE TOP OF THE TWINS
BUILDING
PERMIT
�
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
I PROTECTIVE INSPECTION SEC.
r
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1
1
NUMBER
REV
DATE
PAGE OF
AdPAOVEO BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
3/30/00
JOB ADDRESS 379 79 Way NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4,5,6
2
Spring Brook Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Moneywise Homes 2518 Hillsboro Ave N, Golden Valley,
MN 55427 250-2231
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
20179738
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION J7 REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof House (10 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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 OWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS 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
$874
$
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
.50
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 -
ON•
$35.70
Fire SC $ .87
TR CTI N OR THE PERtORMANCE OF CONSTRUCTION
Apr
=
PLAN CHECK FEE
TOT EE
Licen5seTC $5.00
$42.07
SIG E OF CO RACTOR OR AUTHORIZED AGENT iDATE.
HEN (PROPE A E HIS IS UR PER
LO iNSp
�ALI
gAtE
S,GNATURE OF OWNER,tF OWNER BUILDERi iOATEi
e
NEW [ l Effective 1/1/2000
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 n
BUILDING PERMIT APPLICATION n l
O l `fir\
Construction Address: VT f7f- P Cc I�, vU
Legal Description:
Owner Name & Address: Tel. #
Contractor: D Rf-MN LICENSE # Z.r�] -7`j'7 3 cL
Address: Tel. # (r,I L - ?-5o - -Z Z3 I
2s c� N , CCs 1�ro 611 4" VA c 4=y MAJ-Q5'yz?
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: Lenth Width Hgt/Ground Sq. Ft
OTHER: ��OU,4 f 9 Z7S `G / Q Sq /7"
Construction Type:Estimated Cost: $ Zsa�-
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT: Wes 2a Tel. #
CITY USE ONLY - Call (763) 672-3604 for Permit Fees if mailing in application
Permit Fee $ - b Fee Schedule on Reverse Side
Fire Surcharge $ .001 of Permit Valuation (1/10th%)
State Surcharge $ D $.50/$1,000 Valuation
SAC Charge $_$1 100 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 $ �10
STIPULATIONS: