AF - 43711� Cit of Fridle Minn. �
Y Y�
BUILDiNG PERMIT No
Date : ............/.......!.. � 3 ,.. g �
� --� ...................._�.... -..... ....... - ......_............._.... � � ....
Owner:
Address
4338
Builder ..:'�a�y�;�...�.�..�C... f:..L�. ..
Address._ __ - ....... - -- - - .............................. � � ...........- - - .......... ----- -
� LOC�N"' �,.�JILDING
y� "� G�'e��-� -�'
No. ..... ...- --- - ....._ Street - - -.... .. .. .. -- - - - - .....t...........�....._' ...____ __...._... Part of t .....- - � ......... � -......_..... - � /j'�
...... ..,
............
Lot .._,,.�.._......___ _ Block ........--�..---,-----...... _..... Addition or Sub-Division __ ---- ....... ....:...- -----�...:!�0 �
i ' ti ! �
Corner Lot .. - ..............._...._.. Inside Lot ._,%!�____................ Setback .�.,5.. -. .-� ..... Side �.Q..' .Q -- ....... --........................
Sewer Elevation
To be Used as:
�.Gsrls���. ..
_ _.... . ___._-.--------
Type of Construction
Foundation Elevation
DESCRIPTION OF BUILDING
Front / � �a}Depth a...7...'rd,Height �/ '� Sq. Ft. �U.Q.�Cu. Ft.l.l.... !`S�'O�
- --
Front _.. Depth __ _ Height _.._ .. Sq. Ft. ._ _.... Cu. Ft.
�/ C�o
_...... _ -.....- - Est. Cost ���.�.Q .�.._ To be Completed ... ... . .......
Tn consideration of the issuance to me of a permit to construct the building described above, I•agree to do
the proposed wark in accordance with the description above set th and in co pliance with all provisions of
ordinances of the city of Fridley. �
.,%.. . .. ...... :......._... .._�......�.._.... _. .... ... .... .-- ---�-�---....
Tn 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, aroixnd 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
within the city limits and this pexmit may be revoked at any time ugon violation of any of the provisions of said
ordinances. _
Buiiding Inspector
NOTICE:
This permif does not cover fhe eonsfrucfion, installafion for wiring, plumbing, gas heating, sewer or wafer. Be surs 10 see
the Building Inapector for separafe permits for fhese ifems.
�
b��
Ciiy of Fridley �
�►PP�icafiion for Plutnbing dnd Gas Pitting Pernrit
/�
— Dep3. of Bldgs. Phone SU 4-7570
DESCRIPTION OF WORK �1 7�5Q able
Number, Kind and Locatioa of Fixluzes Location
� � � �U' WATER HTR.
� Z = y Y Z � y Z V Z O= wU' � • •
;� ? �> yc � .1(' �� � �Sy ~<� �'� �� �Z �l a f N GAS ELEC.
� �- m IA � F O LL N LL O {J m � 3 C) � C� � U� O
Base
lst �
2nd
3rd
4th
• Future Coanectioa Opeaings
* New Fixture, Old Openfags
ConnecYed
PARTIAL RATE SCHEDULE
Sewer �
Cesspool j',
PLUMBING FIXTIIRE RATES: NO. RATE TOTA�.
Number Fixtures ...................... x $1.50 $
Future Fixture Opening ................ x 1.20 $
New Fixture Old Opening . . . . . . . . . . . . . . x 1.00 $
Catch Basin ............................ x 3.25 $
Water Heater tUp to 200,000 BTLT) ...... x 2.00 $
New Ground Run Old Bldg . . . . . . . . . . . . . x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
lst 3 Fixtures .......................... x $1.50 $
Additional Fixtures . . .. . ..... .......... x .5Q $
Gas Range to 200,U00 BTU . .. .. ... ...... x 2.00 $
REPAIRS & ALTERATIONS—Refer !o Code
Description ........................... ..........$
�.._ �� c
TOTAL FEE $� °°
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do $ll work in strict accordance with the City Ordinances
and ruling of the Ilepartment of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley, Minn. DeC.21 1959 ls—
Owner DO31 AridBTeOD
Kind of Building �`r8ID6
Used as D�►ell ing
To be completed about
Estimated Cost, $ �.
�tl—New. Building Permit No. �� Permit No.��`�
�a�j►lOT & S8m�pe0II llell f`+O.
Signec�
By �� ��� �' --�
Business Phone No. �• �'• 5 �3S�
s.v. i 5
ROUGH
FINAL H
a z ZM 7-59
.-��E��`� �
� 10��,9
o�� `� Q�
G��� �E�c
� � �t�� N' .
(���
�1
�
Apptication for P�awer Pkntts and Hee�ing, Cooling. Ven#ilation, Refnigeration dnd
Air Conditioning S�/ste�ns a�d Device�s
PARTIAL RATE SCHEDULE
GAAVITY WARM AIR:
F�Zrnace Shell & Duct Work . . . . . . . . . . . . . . . . . . . . . . . . .
Repiacement of Furnace .............................
Repairs & Alterations-up to $500.00 . . . . . . . . . . . . . . . . . .
Repairs & Alterations each add. $500.00 . . . . . . . . . . . . . .
MECH. WARM AIR
F�irnace Shell & Duct Work to 17r6,000 BTIJ . . . . . . ...�� . .
each add. fi0,000 BZ'(T . .....................
Replacement of Furnace ............................
Repairs & Alterations—up to $500.d0 . . . . . . . . . . . . . . . .
� Repairs & Alterations each add. $500.00 . . . . . . . . . . . . .
RATE TOTAL
. a.oa $
5.00 �
5.00 $
. 2.50 $
. 8.00 $_� `
. Z.00 �
. 5.00 $
. 5.00 $
. 2.50 $
3� EAM or HOT WATER SYSTEM
Furnace Shell & Lines—ta 400 sq. ft. EDR Steam ...... 8.00 $
F'urnace Shell & Line—to 640 sq. ft, EI}R Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . . . 2.50 $
Each add. 320 sq. ft. EDR Hot Wat�r . . . . . . . . . . . . . . . . . . 2.50 $
OIL BURNER—to 3 gal. per hour . . . . . . . . . . . . . 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) . . . . . . . . . . . . . . . . . . . . . . . 5,00 $
GAS FITTING FEES: NO RA,TE TOTAL
lst 3 Fixtures ...................... x $1,50 $
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU . . . . . . . . . . . x 2.00 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $
ALTERATION$ & REPAIRS TOTAL FEE $T"' tl �
� c tl .
REMARKS:
Dept. of Bldga. Phoas 3V 4-7470
LacBtion _� �v n "� ��'��..�C�� ,�d/�'r
�
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City of Fridley:
The undersigned hereby makes applicatian for a permit for the work herein
specified, agreeing to da all work in strict accordance with the City Ordinances
and ru2ing of the Department of Bui2dings, and hereby declares that all the facts
and representations stated in this application are true and correct.
F`ridley, 1Viinn. , 19�
Owner �,K� � �y,�. � � 195_
Kind of Building _�� et -�t— �-�„ 195_
Used as �;,c.b� �-�� � ' � -
To be completed about � � � �
,.� ,G �...
Estimated': Cost, $ � � �
Old—New. Building Permit No. � � �
DE$CRIPTION OF WORK
HFATING or POWER P'I,ANTS--Steam, Hot Wate , Warm .Ai No. ��
�'rade Name��.!�.>-� . Size No. ( G' G� _� G�
Capacity Sq. Ft. E.D.R. ��= �� r�` � BTiJ H,p,
Total Connected Load ��_� 4� Kind of Fuel L a�,�_
BURNER — Trade Name Size No.
Capacity Sq. Ft. E.D.R. BT[T g,p,
�
G-.
Signed _
By ,�
11 pOST i M-t 2-ss Business Phane Nol T`�°�;i,, ,"`'� `: i',%
. _ __ _ _ _
. ,��- Gi��,.�.�,, - z�.�,�,� �l�
o-ss Z.: ..,�,.�,0„�.,6 . -� �! S o- 6 0- 7 0 Q.Q,�-�. �•
� NEAT LOSS CJALCULATtONS DEPARTaV1ENT OF BUILDINGS FRIDLEY, MINN. �
Weatherstrips A.S.H.V. . Conatruction No. 3" Iaaulation
Guide
Windows I Doors � Reference Out. Wall Int. Vi/all Ceiling Roof Floor Kind How Applied
e No es No �q 60 ,
j FI•� G� vi�v Room L.ength 2,3 Width � Height � Fl.� Room ngth Width Height
Windows an Doors—Crackage and Area Windows and Doora—Crackage and Area
� ��V1dth Height No. oI Lfneal tt.' Area � Width � Height No. 01 Linsal tt Area
No. ot pane ot Dane lighta ot crack sQ. tt. No. o[ Dane ot pane liebts of cracic p. [t.
/ �r b S O � \ 27 1� L'f Z� Z_
Coef. Btu
Infiltration 2-�"j �{ j3 p p
Glass � 53 ya a
Exp. wall S / z
Net exp. wall �d 0
�nt. wall
Ceiling 3 L F � / G O
Floor 3 b 8 F Z./ 6 a
Total Btu. p� �/ p a o
Required sq. ft. E.D.R. or aq. ina. W.A. L.eader area 10
R F1.� " f Room ( Length / Z Width Height
" Windows and Doors—Craclwge and Area
Wid h He1Bht No. ot Llneal it. Area
� No. ot Dana ot pane � Hshts o[ crack �q. tt..
/ Z� 16 L � 9
Coef. Btu
Z 00
Glaas � a 53 0 0
Exp. wall �
Nec exp. wall ? g do
�nt. wall �
Ceiling 0� �r b O d
Floor o$' � 6 O O
Total Btu. y� -�. q o' �• 3 3 o a
Required sq. ft. E.D.R.; or aq. ins. W.A. Leader area
� Fl. ' Room � Length Width �
. Windows and Doota--Crackage and Area
Width Height No. ot Llneal tt. Area
o. o[ Dgne ot Dsne IlBhts ot crack �q• fQ
�,.. 3 3. Zv Z 2
Coef. Btu
In6ltration � p UOG
:�ass 2 5 3 4 d
�cP. wall d
Net exp. wall � O G
Int. wall
Ceiling � S $ d
�loor q � Sb'�
Tbtal Bcu. ° 3� o d
Required aq. ft. E.D.R. or sq. ins. W.A. l.eader ar j?' 6
� � Coef. Btu :
Infiltration a ( Z D � =
Glaas $.3 b O =
Fap. wall C
N� �:p. W�ll T Z 6 0.
Int. wall
Ceiling 3 � d d
Floor
Total Btu
63 � 3od .
o• ��a
sa. ft. E.D.R. or ac�. ina. W.A. I.eader area Z 3/S
F1.1 Room I 1.engch ) 3 Widch �� He;�ht g�
Windows aad Doora--Crackage and Area
Wtdth Hei`ht No. of Lineal tt. Area
No. ot pane of pane 11[hts ot crack qQ. [C.
2. Z 2 v 2, 2
f. tu _
In&Itration � L � �04
Glasa 2 3 d D
Exp. wall
Net ezp. wall L OZ 0 Q d
Int. wall
Ceiling
Floor
'fota� Btu
VL F O
PL r Q O -
� ° � 0=
aq. k. E.D.R. or sq. uia. VfI.A. L.e � r area -7. 5 y 6
7.� Room I Length I O Width Height 8' �
Windowa and Door�-Crackage and Ana
Wtdth He1�ht Na ot Linesl tt. Area .
of D�ne Ot ptne Ilshtt O[ CriCk p. it.
. 3 2- a a 2, 2
Infiltration 6 p �.�,,, � �
Glasa z.. 5 ,
F.�cp. wall 7 6
Net ezp. wall 2 7
Int. waU
Ceilin8 / LO �
Floor
To�ai s��. ('�,,_ ._ ;�9 a s ��
Required �. h. E.D.R. or aq. ins. W.
,
ana �
Btu �
_a ��
?GO
'� 06
h.j�..
u•ss 2..Er� 6 � �
��IEAT LOSS Cl4LCULATIONS DEPARTINENT OF BUILDINGS FRIDLEV, MINN. �
Weatherstrips A.S.H.V.E. Conatruction No. 3" Insulation
Guide
Windows Doors Reference Out. Wail Int. Vflall Ceiliag Roof F1oor Kind How Applied
es No I es No 19�
Fl.� Room Length �,2 Width � Height � Fl.� Room Length Width Height
Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area
� �Vldth Height No. ot Ltneal tt. Area Wldth � Height No. ot Lineal tt. Area
No. � o[ pane oP Dane lighte ot crack sq. ft. � No. o[ pane o[ pane lights of cracic q. [t.
l 3� a-o a- / 3'
' Coef. Btu �
In6ltration ? � � / �- ^7 � O Infiltration
Glass 5 c� o Glass
E.lcp. wall 6 Eup. wal!
Net exp. wall 5 % 3 d d Net ezp. wall
int. wall Int. wall
Ceiling 9� � v v Ceiling
Floar E, � v d Floor
Total Btu. eo-,.�, , ° 2 5 �O 1'ocal Btu.
Required sq. ft. E.D.R. or aq. ina. W.A. L.eader area 3 Z,�6 Required aq. ft. E.D.R. or aq. ina. W.A. Leader ana
Fl.� Room � Length Width Height �,� �� (],,ength Width
Windows and Doora—Crackage and Area Windows and Doora--Cracicagt and Area
Wld1h Helght No. ot Llneal ft. Area Wldth Height No. ot Lineai tt. Aroa
No. ot Dane ot Dane Ilshts ot crack p. tt. No. o[ uans of pane liLhb ot crack W. tt
Bill
In6ltration
Glaaa
Exp. wall
�let exp. wall
Int. wall
Ceiling
Floor
?otal Btu.
Required sq. ft. E.D.R. or aq. ins. W.A. Leader area
F1. Room � Length Width
Windows and Doora--Crackage and Area
' Width Helght No. o[ Llneal tt. Ares
No. ot oane o[ vane Ilght� ot crack w. it.
Bt11
Infiltration
Glaaa
Exp. wall
Net exp. wall
Int. wall
Ceiling
�
7btal Btu.
Required sq. ft. E.D.R. or aq. ina. W.A. Leader area
Btu
In6ltration -
Glaas
Ezp. wall
Net ezp. wall
Int. wall
Ceiling
Floor
�
Total Btu.
' Required sq. k. E.D.R. or aq. uia. W.A. Leader ares
Fl.� Room I l.ength Widch I-kight
Windowa and Doora--Crackage and Area '
Width Hei�ht No. ot Llned tt. Area
No. ot nane ot.uane lisht� ot crack q. t� '
Infiltration
Glasa
Exp. wall
Nei exp. wall
Iat. wall
Ceiling
Floor
Total Btu.
Required �. k. E.D.R. or aq. ins. WA. l.eader area
Btu
City of Fridley
App�ication for Plumbing and Gas Fitting Pern�it
. - Depi. of BWgs. Phone SU 4-7470
DESCRIPTION OF WORK � ���� �
Number, Kind and Locatioa of Fixtures Locatio_—T
v� (� WATER HTR.
� Z. xo, 'z" � x} zz `82 8�z �z ox � i� z • •
� j � � � N 3 � p � �n u. � V � < 3 � °1 � � � °p f N GAS ELEC.
Base �
lst
2nd __ _
3rd _
4th
Connected wi3h
• Future Connection Openings I 3ewer �
* New Fixture, Old Opeaiags Cesspool �
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ....... � � d
. . ... . ... .. . . '� x $1.50 $ •
Future Fixture Opening ................ x 1.20 $
New Fixture Old Opening . . . . . . . . . . . . . . x 1.00 $
Catch Basin .... . ..................... x 3.25 $
Water Heater (Up ta 20Q,000 BTU) . . . . . . �— x 2.00 $ � • G O
New Ground Run Old Bldg. . . . . . . . . . . . . x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
lst 3 Fixtures .... .. . ..... .... . ...... ...--� x $1.50 $ .��
Additional Fixtures .................... x .50 $
Gas R.ange to 200,000 BTLT . ..... .... .... x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $� �)
__ �
City of Fridley:
���
�
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner
Kind of
Used as
To be completed about —
Estimated Cost, $
Old Ne uilding Permit
ROUGH
FINAL
e z 2M 7-s9
BY�
Business Phone
%
�,��
, Application �or P+o��wer P�onts and He�ating, Coding, Ventilc�ion, .Refrigerdtion dnd
Air Conditioning Systems and Device�s
PARTIAL RATE S�HEDULE
GRAVITY WARM AIR: RATE TOTAL .
Furnace Shell & Duct Work . . . . . . . . . . . . . . . . . . . . . . . . . . 8.00 �
Replacement of Furnace . . .. . . . . . ... .. . . .. . . ... ... . . . 5.00 �
Repairs & Alterations—up to $500.00 . . . . . . . . . . . . . . . . . . 5.00 $
Repairs & Alterations each add. $500.00 . . . . . . . . . . . . . .. 2.56 $
MECH. WARM AIR
Furnace Shell & Duct Work to 12A,Q00 BTU . . . . . . . . . . . .
, r
each add. 60,Q00 BTLT . . . . � . . . . . . . . . . . . . . . . . .
Replacement of F�rnace .............................
Repairs & Alterations—up to $500.00 . . . ` . . . . . . . . . . . . .
R.epairs & Alterations each add. $500.00 .. .. . . .: . . . . . .
8.00 $
2.00 & Y---
�.00 $
5.00 $
2.50 $
STEAM or HOT WA1'ER SYSTEM
_ Furnace Shell & Lines—ta 400 sq. ft. EDft Steam ...... 8.00 $
F'urnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . . . 2.50 $
Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 2.50 $
OIL BURIQER—to 3 gal. per hour . . . . . . . . . . . . . . . . . . . . . . . . 5.00 $
over 3 gal. per hour—See Fee Schedule
�
GAS BURNER (up to 400,000 BTU) . . . ., ..: . . . . . . . . . . . . . . . . . 5.00 $�
GAS FITTING FEES: NO RATE TOTAL
� ist 3 E�xtures ...................... x $1.50 $ � �
Additional Fixtures ................. x .50 $
Gas Range to 200,000 B'rU . . . . . . . . . . , x 2.00 $
AIR CONDITIONING �
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $�
ALTERATIONS 8c REPAIRS TOTAL F$E $� y�
ROUGH
FINAL
Depi. of Bldgs. Phone $U. 4-7470
L�B�o� �2-,y s C.� C�'��=+c/ ,;�% G-
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all wark in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner
Kind of Building .���`--Y-� � t
Used as _
To be completed about
Estimated Cost, $
Old—New. Building Permit No. Permit No. %Q O°'��
DESCRIPTION OF WORK
HEATING or POWER PI.ANTS--Steam, Hot Water, Wazm Air—No.
Trade
Size
Capacity Sq. Ft. E.D.R. BTU H.P.
Total Connected Load Kind of Fue�
BURNER — Trade Name Size No.
Capacity Sq. Ft. E.D.R BTiJ H.P.
(REMARKS-OVEk)
By.
�g:;�;��<Z TM 7-59 Business
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October 19, 1960
�'.r. Don�1d L. knderson
6061 �: ocdy Lane :d. E . �
l��inneapolis 21� �Iinnesota
Re : ReceQtacle s
Dear l��r. Andersona :
I Have already talked wi�h you re�ardin.� the �mou�t
of receptacles that ure needed on the busement floors
at the follcwing ac�dressES:
���-� trFet rd. L.
� Able Street i�:�:,
-_-_ _
Able Street N. E.
?�+�� Able Street Pi. E.
I have� also talked wit;h �,'i113Uj� s Eleetric Com;any� �the
Electrical Contractor on these houses, unc� it �.s the
conte�ition of all parties concerned tha� it is strictl.y
up to you io �ut in the corrECt am�cuni oi receptacles
that are needed. ThESe houses are not acce�ta�le as they
are� and I �rust insist that this �.at,ter b� taken care of
imnediately so th�t 2:�:ay finaliz� 'these 3nspectio�:s.
If' there are any further c,u<,stions� p�ease c�n�act m�
at the office .
� Yours ve: y trulys _ .
I:�O:aA.RD F:ICHt�:ILI�R
Electrical Inspector �
LE:cks
�
..... . ., . � . . . . . .. _ . -______ . _ _ . _._.. . .... . . . � � : .� . A
� � • � � � . � . � . . . � ��+
, ,.� • ' • . - � . . . i
, . :' . 1 ' . � ' ' ...
. ..^�� � . ' ' � ... ,
. . ,.'�./.: . . . � . .
� ' i
j
' February 7, 1962
Mr. D. L. 1�ndereoa
6051 Woody L�ne N. 8. • ' �
Mina�apolia 21,, Minneaote
; ' - 8e: Electrical Work �
; �11@ StYE3�t �. � .
3
De�r I�ix�. Aaderso:�:
°� Mr. Burt Willirams of tha Willie�a�s Electric Ccympany sad I have
' talkQd to tha hcsras o�acaera on Able Str��t, �ad it w�s a�recable
vith th�ru if s�frer�oad w�as used to provAds tha n�ceasarq out-
Dlats in the raar�ation ro�. . .
It wo�tld naw be necessary fos yau to coa�tect t�illi�a,s Electria
Comp�ny and authoxi�e them to do [he work. �
The home o�sn�rs and I are anxiaua to hav� Chis �aCter taken
. care of. .
I
- Yours vary truly,
.
. � � LEC'�A►�D EZCT?�'�[LI,Eft
; Blectricml In�pector '
LE:cka , .
CC: Williams Electric Company �
2312 Central Avenue N. E. �
Minneapolis, Minnesota
. • ,:
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, ` .`. � � � ^ - .;:1 . Decer:b�r 12! 1960 .
. .� .�. _ , ,
,' � , . � ,� �
P�"r. uc>n � L. 1�nderson -
6461. t,'oa�y I,� n� ��. E. � .
P�in�eurolis 21� P�innc�sota � �
De�r ;� r. e�nder�on: , _
:'� I tz�v� tal� ed to so� e of � iiae hc�r�eowz�ers at the follotrir� �
ti�,le S�;reet acldresses -?�+4� -?45� - 7460 - �470.
TY��e �ousc5 cIo not conforr� to Artic3o 21`�-�22� cf the :3ational
�1ECiric�T Ccc?e .
, T:�ey iiave stated that th�y n:ay sEttle tor wirer:old �xir.-nsions
of the� syster�. I thi:�c ii; i3 ux�: tc� you �o let them see tY�2
�a�Erial �er themselves? �and then let �:;:em decide.
DZ<�e hav� G,lready �ent ;��u � le��Ler �;it� reference to this
t�$t;tc� a�d �.�e su���fst tsiat yc�u �1.ve tl1�.s ��atter yot;�
prcier��d, �,ttentian so tha� lE�al �cf.ioxi �.��.11 no� have
to be taken . -
Ycurs very trul y�
i
. LF,G:�i��tD � IC�i:`ILI.�;� � `�
' Elec �rical I�is�ecto�
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City of Fridley, Minn.
BUILDING PERMIT
�
N° 65'70
nac�: _.. .�.-.� ._ 3 _ _ ._...._..._._ , � � �v /�
__�_.
1
Owner: . :_. __... . � .. .: �� Builder _ ._ _ _'�1...'��.........._ ............._.....__..._..._.__.._.._.
Address...._.._.._:.__.._..._.__..�..._.._.�...__._.._._..._..._._..._..___.._..___..._._. Address _.__....__._.__.
TI F BUIL NG
No. . _�,�.....,�...�.. "� Street ._. .. . . ..- -• •---t_<�`;���--1--•�--•�.=.yc.... Part ...... .. ...___._______._. ....._.... _
Lot .___.... � _...._...._ Block _.__..._._..7.....-•------•-----•---- Addition or Sub- . . .on _ ... .. _ .. ..�..._���..'=�����
�
Corner Lot ___._...._..._._._ Inside Lot .___..��...__.._�Jetback ._ ... .�� Sid
....._., . _.......___..._.. ___..__.___..._.._.._._.._
Sewer Elevatia�► __......_..._..._.._...._.._._...___.._._._...�.__...........__.._.._ Foundatioa E2evxtion ---.__.._._..._...._._...._.._._w..�..._..._.._�.�.
DESCRIPTION OF BUILDING
T U,
_ ..._.. ..... Front �� DePth � ..�.�._�. Height _...._/_.�. Sq. F� � .�L Cu. Ft ��
___.....__._........ ._......._.__.._._ nt __._......_.._.__ Depth _...__._. eight _---�--�._ Sq. Ft. _.._..._..._. Cu. F�. _..__.....__
Type of Constructio �!r
_,_ .._ ._. i��'S.a� . Es� C • --- - . ... .--•-••--•••---....._ To be Completed _...__.__.�_.._.__..._.__�_
In consideration of the issaance to me of a permit to c
th� proposed work in accordance with the description above
ordinances of the city of Fridley.
In carisfderation of the payment of a fee of
the btulding
h and in ca
�
ro�v si�s of
permit is hereby grauted 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 o�
Fridley, Minnesota regardfng lceation, construction, alteration, main pair and moving of buildinga
within the city limits and this permit may be revoked at ar�y tip� upoz� olatio of any of the provisions of said
ordinances. / \ �1
Building Inspector
• NOTICE:
Thfs p�rmM do�s not wwr fhe eonstrue�kn, inshllNien for rrteino. Plumbtn9. 0as b�affno, s�w�r or waNr. B� wn to sM
th� Buildiag In�p�r hr s�parat� p�rmits for th�a ihms.
•
•
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City of Fridley, Min.n.. N'° "1538
BUILDING PERMIT
Date: � 25� 1965 _..__—..__..._.._.._�
Orvner: Johxt MeIritosh __.._ suilder _._�'c.Q�?b_�.�..____--------_.__.....---.--_.._.._._�
Aaaress 745fl Able 3t . PT. E. _._.___._.__.____._.. Aeflress P. _ �. Boa _ 26�t .Z_ Nec�rr Bri.ghton.� �nn._.._,
LOCATION OF BUILDING
No. .._7�+50 __._. s�t __._A�le._S��_�z_..E! .....�..___....._......._...._......._.._. Part of Lot ...._.._.�
Lot .._.._.....� ._..........._ Block _..�___..._!t._...._.._..._...._. Addition or Sub-Division Sh8i�8P � S Subdiviaion__��_,__
Corner Lot _.___..._.._..__ Inside Lot ._.._....._...._..._._.-----_ Setback __..--------_._____.._ Sideyard �._....._.._.._ _.._
Sewer Elevation ..___..__�...__..___.�_.._..4._.�..._..�_.._____ Founda.tion Elevation
To be Used as:
Type of Construction
DESCRfPT10N OF BUILDING
Fi�ont _._�.� Depth _..___._.._.. Height .._._....____ Sq. Fk _____.._
Front _.....__...�_ Depth ____..._.._.. Height ._.._....._..___ Sq. Ft _.._..........
._...__.._....A__.__..__.___. Est. Cost _�.�2.LiQ....QQ..._..__....... To be Completed
Cu. Ft .___
Cu. Ft _
Storm D�geRepair
In consideration of the issuanoe to me of a permit to c
th� prnpoaed work in accordance with the description above
ordinanoes of the dty of Frfdley.
ding described above, I to
d com/ p�nce vv�6�l g� py!�
iI � �
_ �iAi.H.� i• e
In ca�sideratfon of the payment of a fee of �..1E�...CXL_...__.__, permit is he�reby grauted to_�`�i}3...T�.. �
to construct the building or addition as described above. This permit is grattted upon
the express condition that the person to whom it is granted and his agents, e�iployees and worlunen, itt all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances a�
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and movin� of bufl�
within the dty limits and this permit may be revoked at any time upon violation of a�y of the provisio�s of d
ordinanc�ea.
Building Inspecto�
NOTICE:
' 7hts p�endt do�s not eovK 11a eonstruefioe, imhilMioe 1or wieino. P��Y. Y� �Y. snww or wahr. M s�rn to s» ',
th� duildin� In�etot for a�p�eaN p�noils fo� 16�a hNns.
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APPLICATION:FOR ING YERrtIT
' CITY OF PRIDL�Y� �NNE30TA ±.
G`
OWN�R' S NAME d / �°_ �� T� BUII.bER �t� t 3� 3 .1 �< <�:
..
ADDRESS �!i5` L^ _ � � J. � ��: � � � ADDI�3S3 �_ v � /'�J �- �! 2 G �/ ? /fL.7.J �R. c G h % o •�/
y� .
+ LOC4TION OF B�ING .• �
No. $t%�e �_� � ��t,, �.:
-�-*u`-c �tc��r—_
Lot ��`' Biock Additio� or Subd�vi�iots �/ "
Goraer Lot Inside iot __,��et�'�k 5ide-Yard ..
SEWER E�.E�ATION FOUNDA3TON EL�VA'1'I0�- --- ---,.
Applicant atta�h to thi�.form,Two Certificates of Survey of Lot and propased��d�--
ing loc�tion dx��wn o�► these- �8�`tificatea . -� � S� Q.�
. /z�c= �2oc' �= J
f r%tc. /L i2�� 13���.. �
DESCt�IPTION OF B�IILDING �� �
tZ�- r3 e, .�. ,� if•e. �> l=�r.SrGc:�
_ 1b be used $8 : . � 2 � � � �t � �_ � ' � '� '-� �"
�'ronC Depeh i�eight, � ��
. gq. Ft. Cu. Ft.
_ Front Depth HeighC
St�. Ft . Cu . Ft .
Type of Constructian Estimated Cost ��
-.�.-be,�ompl.eted
The undersigned hereby makes appli¢ation for a permit for the work herein apecified,
agreeirrg �c� do ail work ii� strict accor�dance with the Citq of Fridley .prdinances and .
rulings i� tlae Department" of Buildings, and hereby declares that aIl the f�cts aad
represegtatioas stated in this applicatian are true and correct. �-
� �
��Sc3►�iule.of Fee Costs caa be fouad on the Reverse Side).
� � , .Y .� •
SuBJECT
City of Fridley 2 6 7 5.5
AT TH�1 TOP OF TME TWINS B U( L D I N G � E R M I T
r
� �' � COMMUNITY DEVELOPMENT DIV. RECEIPT NO.
r � V � PROTECTIVE INSPECTION SEC. L�L�7
� �
i•---�; �'�';'� CITY HALL FRIDLE� SS432 NUMBER REV OATE PAGE OF APPROVEO BY
Z 612-571-3450 910-Ft5 7/22/98 � �
J08 ADDRESS �450 Able St NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3 4 Shaffer's Subdivision No. 1 SHEET
2 PROPEHTY OWNER MAII AODRESS 21P PHONE
John D. Macln tosh
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Four Seasons Roofin & R m -
4 ARCHITECT OR DESIGNER MAIL ADDFiESS 21P PMONE LICENSE NO.
20138780
5 ENGINEER MAII ADDRESS Z�P PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CIASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION [� REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and ara e 32 S ea -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAO
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIF CONDITIONING.
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTFiUCTION
OR WORK IS SUSPENDEO OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTFEET PARKING
I HEREBV CERTIFV THAT I HAVE FiEAD AND EXAMINED THIS APPLICATION 1 STALIS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND OROINANCES OVERNING THIS TVPE Of WOHK WILL BE COMPLIED
WITH WHETHER CIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2668 $1.33
DOES NOT PRE RITV TO VIOLATE OR CANCEL THE pERMIT fEE SAC CMARGE
PROVISIONS ANY OTHER ATE LOCAL LAW FEGULATING CON-
STRUCT N THE PER R ANC CONSTRUCTION. �7�F. %S Fire SC �2. GC)
� � �^ PLAN CNECK FEE TOTAL FEE
r� License SC $5.00 $83.74
/` GNATUF�E OF CONTRACT Ofi qUTHOAi2ED qGENi �o E� WHEN PROPERLV V I ATED T IS IS VOUR PERMtT
_ `� ��" � a�--��
S�GNATUAEOFOWNEFiIFOWNEP$UILDEFi iDATE1 .,g�-0G S� DFTE
Effective 1/1/98
NEW [ ] . ;. CX�Y.:OF FRIDLEY . ��
ADDN � � ' SINGLE FAMI�Y,� AND D�LEXES R-1 AND R Z �
ALTER [ ] BUILDING �'ERMIT APPLICA'TION ;7: ��Y .�;.��, ��Q �,r� �
„ .�
.� '+ `
� " �"' � ,r �.����'�i'�i�4�0'� 3: �ii� .
,
,:
_ �
� ' � ;��L�'�.��wr��+-'�i k,a�r�,' . �. . . ' .
: �'; „ •
Address: ' `'�'' � � . r .
, A , , , ,. ; .. .
7 . . �
Construction „ . -� �
Legal Description: Tel: #� � `
r � /�/I dn . � aS
Owner Name & Address: _ ' MN LICENSE #-�� �� 7�
Contractor: t�-�U U � s e� � o��� � . : � �l �
,
_ • Tel. # '7g ���
Address: . C% 3 � ,4 ,.
. � '` Attach to .this"'apPlication; � a Certificate o�.Survey of the .
lot, with tlie�proposed con'struction drawn on it to scale.
DESCRIP'TION, OF IMPROVEMEN'r .
.,. W idth ______._ Height Sq. Ft.
LI�VING AREA: �ng� ----------' Height Sq. Ft. .
� Width �_____
GARAGE AREA: .�n�� . Width �' Hgt/Ground ,_ Sq. Ft. -
DECK AREA: �ng� -------- �—
{��.�� � �_� _^ ��,� ,� 3� � �, ,�-� � l� � ,�vl,� �
OTHER: . .. ..
� oc� 'r Estimated Cost: $ °� �°�Og �
Construction Type: �� �� � � ° � �•�.�/��e- �' - .
, . (Fee Schedul e, on Back): � .
_ .�.. . . _ Ft x $ _ $
Driveway Curb Cut Width Needed: ' Ft. �+ 6 Ft = .
� � Tel:°`� '��='�c1���
DATE: ��' � �T. APPLICAI�IT:f .
,,<, �.:,('ITY` E ONL , , , N ,;:1 .
. . �
' ' " � i . � :�:a:;Ft„ • ' "` ' ' . _��,,
,s . .
' Fee $� /`�' �%� � Fee Schedule on Reverse Side .
Permit �
Fire Surcharge $ --��-� -�� ����`f,�� "of Perinit° Valuation (1/lOth%) :
State Surcharge $ �• -�� �$•$Ol$���,v�uation _
,� ,,:$1000 per:SAC Unit . . . . : �:������r+ry� � � "��,���:,�� .. .
S AC Charge : $ ' �* � ,, : t . , � ,; . : ,
. . , � . ���,�' �"asu r �°��"���' '
��3� .;$5 00 (State Licensed Resident�l Contrac �,_
e $ � " "` `
License Surcharg � _. ��g�� Above � � `�t:�� � <, d 41�.; ` "
� � t � �� n; ,: .
Driveway Escrow $ "4'�''�'�'� Alt�;- A or�'Alt: � � 5�
�
Erosion Control $ �%��$45� � C��efl'�t�on Plan �eview :
.�� ,,..... ,; ... . :. {.� , . . : r � F �; €� :� :
$ Fee Determined by Engineering
Park Fee ' �^�� 3�'��ra ,��.�i �
.
',�� �Agre�ment Necessary [. ] �Not. Necessary� L� � � '
Sewer Main Charge' �$ ..' ' '`,` _
. . �"s��. ���� `.�� �a��i�^''�.� `�'� �
..., ;
' , , :� ;,
.� �
TO TAL . . $ � � � . � . . . _ ;�a��:t h� ��''� ��`�� '��3��;�v'
, . .��
. .. , �; , ,. .. ^
,�,��.�a.�;.�5. a
,
. . . . . . .. . .• . . .. �� . , �,- �..d�v.N:allYiji. .�i •�m.+;t .f�. .
S'I'IPULATIONS: F�.�
� � . , _ . , .;�� � �
. , ' . . . � ��. �yg;�y�. .
� ' .. � . . . . . � � ... . - .. � ; �.�- .
. . . .. . r: ..
Building
Inspections
763-572-3604
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
DATE �""— �' � 6 YOUR E-MAIL ADDRESS
SITE ADDRESS �� S Q � � � IJZ� ��� t L� l��
THIS APPLICANT IS:
❑CONTRACTOR
M f� � �
Permit No.: �-`� � '
Received By:
Date Rec'd: � . ' '
2
PROPERTY OWNER/ NpME:_-� � � �-vY�."I�J
TENANT pDDRESS: �% � 5 C7 �{- t'3 � L S � �� � �
CITY �I�Z �� l C �/ STATFH ZIP_�Lf� ��
PHONE:_- `7 � 3 " ^Z � � ��( oZ, �
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
NAME:
STATE LICENSE #
EXP DATE
ADDRESS: CITY STATE_ZIP.
PHOSIE pA}{
SRVGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW
❑ BASEMENT FINISH
❑ DECK
n
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
❑ GARAGE/SHED
❑ ROOF
❑ SIDING
❑ SWIMMING POI
O ADDITION
❑ REMODELING
❑ DRAIN TILE
❑ OTHER
TH WIDTH HEIGHT
O HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
WINDOWS
IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF 6!} y �l� �,� )(� p„J � l� Li V i W Ct
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED �y NUMBER OF WINDOWS�_
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floot plan
3. List of structural members to be used
Ft.
FOR NEW CONSTRUCTION [NCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of constn►ction plans
3. Energy Calculations
ALL FEES ARE BASED ON ALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ C s C� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ . �G
_$
$ • Co
$ . �Q
$
$
$
$
$
$ � � , S�
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID LJNTIL 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 al( work which requires review and approval of plans.
SIGNATURE OF APPLICANT C"'� L` �b-�V��I . PRINT NAME �c II�Cz�Y( � DATE C7 � 3 i'? �O �
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CI"iYOF
FRtDLE.Y
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
BUILDING PERMIT APPLICANT: PROPERTY OWNER
I, I�� ��'�/��% , understand that the State of Minnesota
requires that all residential building contractors, �emodelers and roofers obtain a state
license unless they qualify for a specific exemption from the licensing requirements. As
the owner of the property at `� �S"�Q A-�3 , Fridley, I
am exempt from the state licensing requirement only if I am not building or improving
this property for purposes of resale. By signing this document, I attest to the fact that I
am improving this house for my own use and do not intend to sell it. I hereby claim to
be exempt from the state licensing requirements because I am not in the business of
building or remodeling on speculation or for resale and that the house for which I am
applying for this permit, isl the first residential structure I have built or improved in the
past 24 months. I also acknowledge that because I do not have a state license, I forfeit
any mechanic's lien rights to which I may otherwise have been entitled under Minn.
Stat. 514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to perform
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is
a misdemeanor under Minnesota law, and that I would forFeit my rights to
reimbursement from the Contractor's Recovery Fund in the event that any contractors I
hire are unlicensed.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to the City of Fridley for compliance with all
applicable building codes and city ordinances in connection with the work being
performed on this property.
Name f ; 1�Cc-�y�P�.i
Date � ` � � � �
Building
Ins�ectio3ls
763-572-3604
763-502-4977 FAX
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-08
Permit No. • �
Received By:
Date Rec' d `�1 �1 <
DATE �� G� '- U� YOUR E-MAIL ADDRESS r�
SITE ADDRESS 71-�- 5�% /� 'i✓ � C 9 1 �_L'— '� j� i` �� 1- Z:� � l� �J � L{' J`%.�
THIS APPLICANT IS: '�OWNER ❑CONTRACTOR
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
1� C N � �%
ADDRESS: ��} S C.� /°� !g t� �! hrC CITY rY� I� �� t.,C' i/+ STATE� n%ZIP
PHONE: 7 C� 3 ? ��j. .°r] �1 %2 � �? C ( I � 1 % � e�- � �'f ;.� ot � vf
ADDRESS: CITY STATE ZIP
PHONE
STATE L[CENSE #
FAX
PROPERTY TYPE I I�INGLE FAMILYMEW CONSTRUCTION SIZE
❑ TWO FAMILYlNEW CONSTRUCTION STOR[ES
PERMIT TYPE
TYPE OF WORK:
EXP DATE
❑ ADDITION I�GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRA(N T]LE
❑ DECK ❑ SIDMG � OTHER
❑ SWIMMING POOL
❑ NEW HOME CONSTRUCTION ❑ ADDITION
($'14IAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: �� S i�� li� � %C t.� l7 F—f X 1 1�-t� S I r�'�2 v- �f±C�' r-�
_ . _ �
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
inyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENINGS ❑Yes ❑No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPF. OF WIND�W TO BE INSTALLED
LENGTH
❑ HOUSE ONLY
❑ HOUSE & GARAGE
� ATTACHED GARAGE
�--HETACHED GARAGE
HEIGHT
FT
BASEMENT REMODEL[NG SUBMIT:
I . Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
7C
FOR NEW CONSTRUCTION TNCLUDING DECKS,
❑Soffit ADDITIONS. & PORCHES SUBMIT;
❑ Trim 1. Site Plan/Survey showing the existing structures
❑ Fascia and proposed project. .
2. Two seu of construction plans
3. Energy Calculations
LOCATION OF WINDOWS
NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U�'Q FEE SCHEDULE)
TOTAL JOB VALUATION $ ��t')c � �� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
� Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ Ga��a�
$
$ ;;2 . U C
$ �. vv
$
$
$
$
$
$
$ ►��.�-
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1825 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21 =$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks pa_yable 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 1 understand this is not a permit but only an application for a permit and work is not to start without a
permit on site; that the work wi(I be in accordance with the appcoved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT " � O�l ,�� PRINT NAME "''��� �_�1Ct'Vy F' /" DATE �^ 2�
APPROVED BY � � � DATE
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