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AF - 36473City of Fridley, Minn.. 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PER.MIT �: ►. -��.- . . s�� % 112 7 4 Ownex: V; ewcon T,II,S��oX.�t �....___ ___._. Builder __S_�1�_._�_....._..�._..._.---...._._. Address �.L.B�Qk�n Boulevard��__ Address _.S�?.__....._--�--_..�.�.._..._._._.�._--- LOCATION OF BUILDING Na 51 Q Street �..�o�nhof.. .,�unction_�___....._._._......_-.-.-_----- Part of Lot _�..---...._.__ ___._..__ Lot 5 Block 6 ��_._.._.____ Addition or Sub-Divisian .Innsbruck North _Townhouse_ Site Corner Lot ._ __ Inside Lot _�.?�....------.____ Setback _..__.._._.---.---•-------_ Sideyard ....--•--..__.__. --•_-•--.. Sewer IIevatian .�.__...__� ._..___ Foundation Elevation __—_._�_.._...._...____ DESCRIPTION OF BUILDING To be Used as: 620 Unit Tgwnhouse __ Front _.._?� � -- Depth _ 31 � Height _..?_8 �....__ Sq. Ft. _1240' �. Ft .17�360' �ara€� __._ Front 20 � Depth 22 � Height .._ 10 �_._ Sq. Ft. .----440_'__ �. F�, _.4400' Type of Construction __Frame__�_._^___.�_ Est. Cost .__$21�416,.80. _, To be Completed _..__June..l� 1972 Stipulation: Owner and Contractor to be responsible for elevations and drainage for a11 structures. City shall be held blameless. "B" Unit - Same as 5506 West Bavarian Pass. In consideration of the issuance to me of a permit to constru e buil g cribed above, I agree ta do the proposed work in accordance with the description above set o comp 'ance with all provisions oP Ordinances of the city of Fridley. — 10 71 � i h r�ra In consideration of the payment of a fee of $ 41.00_____ ��t is hereby granted to Viewcon Incorporated _•_.•-.-_._..__._ ............._..._.__ 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, shali conform in all respects •to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of building8 vyithin the city limits and this permit may be revoked at any time upon violation of any of the provisions of said o�rdfnances. - /� � 1�_�/ _ Building Inspector Hank Muhich NOTICE: This psrmit does nof covar the construetion, installation for wiring, plumbing, gas heating, sewer or wafer. Be surs to sa� tf�s Building Inspacfo� for separata permits for these items. � � �� j� ' � O � (0(,��5 T �3�9 U'� rt'l � l� �1�..�.5 B, �� AM� � S � APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITiON BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER' S NAME :'� L' 1�1%C t� 1'� //i� C BUILDER : V/ L�'f� � c� X% d��. ADDRESS. ��OI U��d/��/U I��-U',� ADDRESS: ,�� ,�/L�O�j �YN I,��-UI� N0: .��J' �(�� STREET: Q L''f�I(il�c7 (� T�IU �-% I!j!V I.OT: � BLOCK: ,�' ADDITION�i!%i��Ti�GI�/UU�l��e(,J/U if'c�tISL S/ 1L CORNER LOT: INSIDE LOT: � SETBACK: — SIDEYARD; — A�pl�cant attach to thie form Z�o Certificatea of Survey of Lot and proposed bui�ding lvcation dxawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: l�/D�' lll s vi'�-L 7,(J i,�ilf � � , � rf�i�/S� (JNi% Front: � � Depth: �J Height: � � Square Feet:v�iv/��/�'? Cubic Feet: �/�.3E-O ��?��r'L Front; 2� � Depth; z2/ Height: �d/ Square Feet ; '�` �G Cubic Feet • ��vU Z�pe of Construction: (,��oQ�yn��IL� Estimnted Cost: $ , � -� --� L .�/, y/�, � To �� Completed; ' / The undexsigned hareby makes applicativn for a�ermit for the wozk herein apecitied, agreeing to do all Mo�k in sttict accordance with tha C�,ty af Fridley Ozdinance� and rulings of the Department of Buildings, and heraby decl.ares that all the facts and representatione stated in this application are true and correct. --. �� / DATE : ��' � Z. � �� S IGNATURS : �� (� '� '�� ,� ��,�'�"�'-- (See Ra�►eree Side For Additional Information.j / ; �r � "'f "'D'� � f � �..�.� ¢T,�. - ..'4y�' �`y � � �� . ._ - . r,��s. � f � �y .� -:r �" f �.t: ,�.�� .,. . � . � � BUILDING PERMIT FEE SCHEDULE SECTION 2. The Inspector of Buildings shall, before issuing pexmits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repairs to any existing building or structure, upon application therefore, require the payment by the appl�cant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: UI�TIFORM BUILDING CODE: �pe 1, 2& 4-$2.15 for each one thousand cubic feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for each one thousand cubic feet. ADDITIONAL INFORMATION For the purpose of computing feea for building permits, the cubical contenta of any building or addition, is determined by multiplying the ground area covsred from a point six (6) inches below the floor line of the basement or �he cellar to the average heights of the upper surface or to the average.� hei�ht of the roof surface of the mnin gable of a pitched roof. For xepaixs or alterations to an existing structure, the fee shall be at the rate of $3,00 per each five hundred dollars ($500.00) or fraction thereof in the cost of all propQSed work. In ao case ahal�. the fee charged for any perniit as set forth in Section 2 be leas tha,n $5, 00. V$RIFICATION OF FOUNDATION NOTE: �erm�.te for eonstruotion will be issued a minimum of 24 houxs from the �iae of application, to allow•for proper review of the proposed structure axtd of the construction site. A Cexti�ied Survey of the lot, ehawing the location of the foundation, o�►ce i� ha� been constructed, will be required before proceedinst With the framing. CERTIFICATE OF OCCUPANCY Application fox a Certificate of Occupancy ahall be made teA (10) days prior to the use or occupancy of �y atructure for which a buildi�g pennit has been isaued; and said etructure shall not be used or occupied until a Certi�icate of Occupancy has been issued. Application for Power Plants and Healing� Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE 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 . . . . . . . . . . . . . .. 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 1?A,000 BT[J . . . . . . . . . . . , each add. 80,Q00 BTiJ ....................... Replacement of Fixrnace ............................. Repairs & Alterations—up to $500.00 . . . . . . . . . . . . . . . . . Repairs & Alterations each add. $500.00 . . . . . . . . . . . . . . 8.00 $J•�� 2.00 � 5.00 $ 5.00 $ 2.50 $ 3TEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDft Steam ... 8.00 $ Furnace 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 BURhER—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 ' lst 3 Fixtures ..................... x $1.50 $�'7 � � Additional Fixtures . ............... x .50 $ Gas Range to 200,000 BTU x 2.00 $ AIR CONDITIONING a FAN HEATING SYSTEM See Fee Schedu}� VENTILATING SYSTEM ��'� ��'�� $ � � ALTERATIONS & REPAIRS TOTAL FEE $ � � % s c� ROUGH FINAL �— �� / Dept. oi Bldgs. Phone SU 4-7470 � _� U ,, J 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. „ / Fridley, Minn. / � �� 1 � , 19 � � Owner C Kind of Building =�/i�„!�rYt.l� Used as To be completed about �^��' �� / �� °�� Estimated Cost, Old—New. 'lding Permit No. Permit No._� DESCRIPTION OF WORK HEATING or POWER, PI.ANTS--.Steam, Hot Water, Wazm Air—No. Trade Name�2��'`tm� Size No�J "�— D' O Capacity Sq. Ft. E.D.R. �� v� BTLT H.P Total Connected Load �Cr y� � �7� - Kind of �e � ' � � BURNER — Trade N Capacity (REMARKS-OVER) ��, z Sq. Ft. E Size No. BTU H.P SignedL�U�"11�r��-f��^CY.,�nC • $}: i" / !/J.d . �i 11��1� G�/ ;�L!/1./rf� i �-+-- Business Phone No. �/� � " �� i4y of Fridley APPliceition for P1k�btng �d Gas Rei�i�eq Pe�it D�p�t. of Bld�. Phon� 580-3450 DESCAIPTION OF WOA1C , Humb�r. Kind and Location of Flxtur�s ` � Loe��tles ,[,,5 / �� s � �`' `'� ,`; ; % - / i ; �� f �� 1 N c� � � Y � �r =� i � i� � N�a� � Basc lrt 2nd / / / �rd 4th • F�� Co�o�elioa Op�niaps � N�w ii�ur�, Oid Op�ainQs M i � � w�rc� �.n. �, � � i3 � � � x � � � tl 4 / N GAS [LEG A V i o � Cit� of ZYidley: The undersigned hereby makes appllcation tor a peraiit lor the arork Rerei specificd, agreeing to do all work in strlct accordance with the CSt,� Ordinsnce and ruling of the Department of Buildings. and Aereby declares that att the fact and tepreser�tatlona stated ia this application are true and correct P�idleY. Hina � �' °� I9_ Owner '."�-' � . ; r-� � �, J �� , �, �-1-- Kind of Buildin� � �;"� ^ , , ' Srr�r Q Used as ��-' `-r�-�'l�-�''�� T -- CwsPn°I ❑ ' To be completed about . ' ^' ' - PARTIAL RATE SCHEDULE FLDNHING FIXTURE AATES: I(O. RATE TOTAL Number F`ixtures . . . . . . . . . . . . . . . . � x i2.00 : *'�, � PLture Fixture O��cning . . . . . . . . . . . �,2_ x 51.50 S . New Fixture Old Opening . . . . . . . . . . . x =1.50 i__ Catch Basln . . . . . . . . . . . . . . . . . . . . x a3.25 = Water Heater 'Up to 99,000 BTU) •••• � x i3.00 i �' New Ground Run Old Hldg. ........ x 53.25 S El�ctsic WaNr H�at�r . . . . . . . . . . . . . . : :2.00 = GA3 FITTING FEEB: NO. R11TE TOTAL lst 3 Fixtures . . . • • • • • • • • • • . • • �— x 52.00 ; �.(� Ci Additional 1�'[:turea . . . . . . . ... . . . . . a = .T6 : Gar Ran�e to 19��000 BTU . . ... . . . . ... . State Surcharge REPAIRS t 11LTERA?IOlfb-R�l�r to Cod� x i5.00 i $ .50 Descrlptlon . .... ...... .. .. ........ ....... ...........� s �> 1'O?AL �'EE Bstimated Cost, s � " — . _�r, Old—New. IIuitding Permit No. P�rmit No. ~� � . � - - Signcd �,-,_ ,� ��" = C __ _ ��' , -; �.. , By �� '- — Business Ph.,ne No �� 5 ! �� . Rouax i'INAL �' "" 53-8l�-S-915. S� Ci4y of Fridley � APP�ica�ion 1�'Iwnbitiq aNd C,as HMi�q hn�it - D�pt. of Bldq�. Phor►� 960-3�90 -- DESCIIIP?ION OF WOR1C 1510 Bohnhof Junction N. E, PTumb�r, Kiad and Locatfoa oi flxtuns 3 VI � IS�I i I� li►l� �� I�OIV il<�IU7' �IV �IC�l�I ►I NIG STEII MTEC. �� . .■■■.■I • ■��i � ��I ■■■■■.I . . .. 1 PARTIAL RATE SCHEDULE S�w.r ❑ �� n PLDMSING FIXTURE RATE3: NO. RATE TOT]►L Number Fixtures . . . . . . . . . . . . . . . . x a2.00 � Future Fixture Opcning . . . . . . . . . . . x a1.50 5---. New Fixture Old Opening . . . . . . . . . . _ x a1.50 ;__._ Catch Basin . . . . . . . . . . . . . . . . . . . . x a3.25 E Water Heater :Up to 99,000 BTU) .•.. x E3.00 ; New Ground Run Old Bldg. ........ x s3.25 S El�ctric Wat�r H�at�r . . . . . . . . . . . . . . : :2.00 = GAS FI?TING FEE$: NO. RATE TOTAL lst 3 Fixtures . . . • • . . • • . . . . . . . : 52.00 ; Additional Flxtures . . . . . . . .... . . . . . x ; .7b ; Gas Ran�e to 199,000 BTU ..... ...... 1 x a5.0� � 5.00 REPIIIRS i 11LTER�TIOI16—R�i�r !o Cod� Deacriptlon . . . . . . . . . . . . . . . . . . ,.. . . . .. . . . . ... . ... . ¢ Tarwr.. � � 5. o0 tSUKt,hhh�t �_,�� City of Plridley: The undersigned hereby makes application tor a permit for the work herei specified, agreeing to do all work ia strict accordance with the Ci� Ordinance and niling o! the Department o! Buildings. and hereby declues that atL the tacl and representations stated in this application are true and correct 1�iatey, Minn �-3—?2 19, Darrell Farr Dev. Company Owner Kind of Building F'Y'ame Res. Used as To be completed aboui B—ZO-72 Estimated Cost, a 10.00 ' —� v �, � New. Buitding Permit No. P�rmit No. `� L�} / Sign By MlNrvr�A�c�7 -- Business Phune No ROUGH Ci � � f'INAL G - ��s AA*. �rge �SQ � ► � SUBJECT City of Fridley AT THE TOP OF THE TWINS g U I L D I N G P E R M I T f 1 1 � � � • COMMUNITV DEVELOPMENT DIV. ' � �.------ � r � � PROTECTIVE INSPECTION SEC. � � �� ' �"'1 � CITY HALL FRIOLE� 55432 NUMBER REV DATE '---�.' `.� 612-571-3450 910-F15 11/16/87 JOB ADDRESS 1510 Bohnho� Junction N. E. 1 IEGAL LOT NO. BLOCK TRACT OR ADDITION DESCR. 5 6 Innsbruck North Townhouse Site 2 PROPERTY OWNER MAIL ADDRESS ZIP Dr. Byron Teska 1510 Bohnhof Junction N. E. 3 CONTRACTOR MAIL ADDRESS 21P Timco Construction 9421 West River Road, Mpls „ MN 55444 4 ARCHITECT OR DESIGNER MAIL ADDRESS Z�P 5 ENGINEER 6 USE OF BUIIDING Res idential 7 CLASS OF WORK MAIL ADDRESS ❑ NEW ❑ ADDITION �7 ALTERATION 8 DESCRIBE WOFiK Remodel and change windows 9 CHANGE QF USE FROM STIPULATIONS TO PAGE OF / / P IT NO. � 19269 RE . d`�61�% APPqOVEO BV SEE ATTACHED SHEET PHONE 574-1295 PHONE LICENSE NO. 424-8444 PHONE LICENSE NO ZIP PHONE LICENSE NO. ❑ REPAIR ❑ MOVE ❑ REMOVE S�PARATE PERMITS REQUIRED FOR� b'�'sF�!�!G, HEATiNG, PLU.MBING AND S1GNS. SEPARAI3E PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILA7ING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, Ofi IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWIG. 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 TVPE OF WORK WILL BE COMPLIED $9,500 S4.7S WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHOR�TY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCJJQN OR THE PERFORMANCE OF CONSTRUCTION. $SO. SO ��PLAN HECKFEE TOTALFEE �. ��'�L+2� �� "(n - $85.25 siGNntuReOF ONTRACTOROAAU7MORIZEDAGENT ionTE� yyH PR PE L I A ED THIS IS YOUfi PERMIT S��GNaTURE OF OWNERiiF OWNER gUiIDER� iDATE� G wSP qr.7E City of Fridley Effective �/1/8�� NEw L ] _....___ ADDN. [ ] R-1 AND R-2 ALTER. [ 7 Buildin� Permit Application r / � /o � . �. i3o �h�o,� i � � ------ ------ Construction Address: — --- �( ' S __1 i ,��s r'�e��.�/��_�r{.._!7� �.r �._ - - ------- Legal Description:_�._, /� r� �: %� S �t cl Tel .�� s"�K ^(2 R'� Owner Name & Address: ��- � -- - ---- J � �--- �'� � S �� Tel . �� f 2 `��y`�/'C� Contractor: �"� W _ - - — �"'J" G/ Y Z( �i.� fL r c- uc �b , i(i1,o �s' ��1 �j '�� !� [� �.,_,� Address: Y---- — +---`-- - 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• Length � Width , Hgt/Ground Sq. Ft. OTHER: ►"Lt fr►p�/laoYlo�t ti� •-r,vrtio�uwr _c�`�C ��,------------ Corner Lot [] Inside Lot [] Ft. Yd. Setback �____ Side Yard Setback _._._ Type of Construction: __ ______ Estimated Cost: $��"B � --- Approx. Completion Date: z� �.J �� -------- Alt. A Alt B Proposed Driveway 47idth If New Opening Is Desired: ___� $ -- $ ----- See Back Pa�e for Explanation / � cYl £- /�1 �lC-esz Tel . �k y 2 �-( ^ � �/��(�r DATE: ��% �� APPLICANT: � _ �.�� ________v� Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIOtdS : CITY USE ONLY � g�� $ �� - v� �� $ $ $ � ��5 �jU ,� G ,A��ti S E � � .4 �2 �, L � Fee Schedule on Reverse Side 25� of Fsuilding Permit Fee $•50/$1,000 Valuatior $ 525 Per SAC Unit Fee Determined by En�ineering A�reement Necessary [ ] Not Necessary ( ] �� p %7p�L.p L p�7 L C GL.f'�% / O�/1/ � � ° ' �� .. . an��—�, 4' � � `� a a, � BIIILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon applicatio n therefore, require the payment by the ap�licant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: Total Valuation $1.00 to �500.00 Fees $10.00 (Minimum Fee is $15.00) $501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each additional $100 or fraction thereof, to and including $2,000. $2,001.00 to $25,000.00 $25,001.00 to $50,000.00 $50,001.00 to $100,000.00 $100,001.00 and up $32•50 for the first $2,000 plus $6.00 for each additional $1,000 or fraction thereof, to and ineluding $25,000. $170.50 for the first $25,000 plus $4.50 for each additional $1,000 or fraction thereof, to and ineluding $50,000. $283.00 for the first $50,000 plus $3.00 for each additional $1,000 or fraction thereof, to and including $100,000. $433•00 for the first $100,000 plus $2.50 for each additional $1,000 or fraction thereof. DRIVEiiAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50 Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approaeh with 6 inch depth - Driveway width plus 6 feet times $15.75 VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 2� hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation onee it has been constructed will be required before proceeding with the framing. sua�ecT IT NO. c�ty of Fridley /� � �' � v'�;;'�;3 AT THE TOP OF THE TWINS g U I L D I N G P E R M I�_ !�' r REEEIPT NO. � � � � � � COMMUNITV DEVELOPMENT DIV. ' j \.- - r � � PROTECTIVE INSPECTION SEC �S� � � � �""1 � CITY HALL FRIDLE� 55432 NUMBER AEV OarE PAGE oc APPROVEO 8'/ �""'�'� �'' 612-571-3450 910-F15 9/9/94 � � J08 ADDRESS 1510 Bohnhof Jucntion NE 1 LEGA� LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 6 Innsbruck North Townhouse Site SHEET 2 PROPERTV OWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO Tabor & Sons Inc. 3716 St Francis Blvd, Anoka MN 55303 789-1902 20014248 a ARCHITECT OR DESIGNER MAIL ADDFiESS 21P PHONE LICENSE NO 5 ENGINEER MAII ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential Townhouse 7 CLASS OF WORK O NEW ❑ ADDITION p ALTERATION _D REPAIR ❑ MOVE ❑ REMOVE X B DESCRIBE WORK Reroof and Install Gutters 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING THI5 PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. 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 ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STA�LS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT ALL PROVISIONS OF LAWS VALUATION SURTAX AND OFDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,159.00 �1.OH DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL 7HE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFOFMANCE OF CONSTRUCTION $5�}.�0 Fire SC �2.16 � PLAN CHECKFEE TOTALFEE ��oL �l'-c/�i/1/' �'�7 � j,Y License S 5. 00 62. 24 S�GNAIUA OFCON7RACTOA0�7.4U1MOA�ZEDAGENT �DA7E� yy pq0 RLY UDATED THIS IS YOUR PERMIT c�1i�.��a�,e, ,! C�-�' S�GNaTUAE OF OWNEA �iF OWNER BU�LDERi iOATEi BLDG ' ��FTE r�Fw ADdN AI_TER [I �� i Constructi�n Address L,e�dl Description: CI1'Y OF FRI DLEY S[NGL� �AMILY AND DUPLEXES R-1 AND R-2 Quilding Permit Appfication 1510 - Bohnhof Junction Fridle Effet;tive 1 / i /44 ��s'C��/ Qwner Naine 8i Address: Tel. # ContractUr: Tabor and �Sons, Inc. MNLICEN�E# Pending AcidreSS: 3716 - St. Fsancis Blvd. Anoka 55303 Tel. # 789.-1902 Attach to this appiication, a Certificate of Survey of the lot, with the proposed constructian drawn on it to scale. I.IVING AREA: GARAGE AREA: DECK AREA: OTHER: t.,ength Length Length DESCRIPTION OF IMPROVEMENT Width Width W idth Height Height Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [] Tnside Lat [] Ft. Yd Setback Side Yard Setbacks Type Of COIIStruCtiOtt: r o o f i n g/ g u t t e r s Estimated Cost: $ 215 9. o 0 Approx. Completion Date: (Cost on �ack) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ DATE: 9/1/92 APPLICANT: Tabor and Sons, Inc. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge T'OTAL STIPUL.ATIONS: CITY USE ONLY _$ Tel. # 789-1902 $ J�%. v(` Fee Schedule on Reverse Side $ �. l� .�O l of Permit Valuation (1 / l Oth %) $ /, D�� $.50/$1,OQ0 Valuation $ $800 per SAC Unit $ .� , Cj (� $5 _ 00 (State Licensed Residentiai Contractors) $ Alt. "A" or Alt. "B" Abave $ $450_00 Conservation Plan Review $ Fee Determinecl by Engineering $ Agreement Necessary [ ] Nc�t Neces.s��-y ( ] $_ ��L_ � '�� ° �,q�l � 13ULLDING PCRMIT .FEE SCHEDULE i fic (;liict 13uildiub Ufticial sliall, i�ciore issuing perctiits for ttic erc:ction of any bui(din� or structurc, �►r lor arry additi<�ri [o any cxisting huilding or structure, or for any altcraiion or rc��air to aciy cxistic�t, (>uilclin�; <�r structurc<, uPon aJ�J�licatioa i,hcrcfore, requirc tttc �aymcnt hy tl�c al�plicant tor such {�crmtt <>f-��fc�s i<> tt�c amount ticrcin �bcl��w tiei .foctlt and iq thc manncr ��crci� �r�vidc:cl �to-wiL, � �� "1�O"I'l�L VALUI; t�i;f�S � 1 lo .. $500 . �501 ` to $2;000 $2,001 to $25,000 $15� (Mini�z�um Fce is $IS plus succharge) ' � - $15� for "fist $Sp(j pius $2 for each additional $100 or fraction thereof, to and including $2,000 . $45 for fust $2;ppp plus $9 for each additional $1; 000 or fraction thereof, to and includuig $25;000 � $25;001 to $50,000 - $252 for first $25,ppp pl�s $6.50 for each addi�ional $�1,Q00. or fraction thereof, to and including $50,000 .. $50,001 to $100,000 $100,001 to $500,000 '. 11 11 �'. 111 11 i $1,OOfl,0p1 and up $414.50 for first $50,000 plus $4.50 for each additional $1,000 or fradion thereof; to and including $100,000 $639_50 for first -$100,000 plus $3_SO for each additional $1,000 or fraction thereof, to and including -$500,000 $2039.50 for die fi�st $SOp,ppp p(ns $3 for each additional $1,000 or firaction thereof, to and including $1,000,000 $3539.5� for the first $1,000,00p plus $2 for each additional $1,000 or fractioa t�ereof - DRIVEWAY DEPRESSION ESCROW (Concrete Ctir� Streets Only) A(ternate "A": Removai and replacement of curb and gutter only - Driveway width plus 6 feet times $13_50. A(ternate "t3": Re�iioval a�id rep(acement of curb and gutter and install a 3 foot �vide ap��roach with 6 inch deptti - Driveway width pius G feet times $1S_75_ VERI[�[CA"C[OtV Or FOUNDATtOl�t Perrnits for cor�s[�uction will be issued a minimum of 24 hours from tile time of a{��(ication to allow for E>ro��cr revicw of tt�c E�ro�>osed stnicture and of the consiruction site_ A Ce:ititicate of Su�vcy of tlie (ot, showin� the iocation of the fout�dation ��nce it has it has heen conZ(ructcd will hc rcquirc;d t�eti�re ��roceecitn�; wi[h tt�e frarning- CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, �AN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES @ATE SCHE�ULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace) Gas Ra�ge Gas Dr��er Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 *Air Conditioning - All Sizes $ 25.00 fJ�'��i�-�'" 5(�3Cr1y-0 a-T All Othe�rs/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work CommeRCial/Industrial 1.25% af Value of Appliance or Work State Surcharge TOTALFEE Effective On August 1, 1995 �,... JOB ADDRESS��ohn h o-� � unc.�-, pY� ___ The undersigned hereby makes application for a permit for the work herein TOTAL specified agreeing to do all work in strict accordance with the City Codes ar�d rulings of the Building Division, and hereby declares that all the facts and $ representations stated in this application are true and correct _ �-�'q� ,1995 $ $ $ $ a�5 OD • �r� � � �� ! BUILDING USED AS ��1� �l a � , � , �. ESTIMATED COST I�Or U� PERMIT NO. ��`;��' �� ESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units Trade Name BTU $ Fuel _ Circle One {Steam) (Hot Water) (Warm Airj Size No. HP EDR Total Connected Load ��50 Burner Trade Name Size No. BTU HP a-S' � MINIMUM FEE FOR ANY_HEATING/COOLINGIVENTILATION REFRIGERATIONjAIR_CON.DITIONING_ PERMIT IS $25,00 PLUS THE $_50 STATE_SU_RCHARGE REINSPECTION FEE $42.00/Hr *Air Con�ditioners can not be placed in a side yard without written permission from adjoining property ovuner. EDR BLAINE HTl3. A/C ELECT, �NC, 13562 CENTRAL AVE. N.E. HEATING CO NY AN Signed By • No. %5 7�(D �-0O �-, . Approved Rough-In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPIACEMENT FURNACE ,s CH[MNEY AND STACK VERIFICATION The undersigned here�,V verifies that tHe existing chimney or stack: `�t ::� <� .. 1. Has been car�"�'�l� examined Yes O No O �., .- . 4i� 1..:. ". 2. Is free fromr� or deterioration Yes () No () _ ,��, 3. Has no for�eig�objects lodged within Yes O No O �. ,;. _ 4. Is secureIy�su�rted Yes () No () , � .., ; 5. Me��s all� nt C�de requir�rnents for size and totallB onnected Yes O No O 6 Has total eating BTU's of All other �'s TOTAL BTU's 7. Has a liner been provided for water heater Yes () No () 8. Has combustion air been provided for water heater Yes () No () Remarks: List ALTERATIONS Bein Done: HEATING CO: Signed By: r��+A • YIV. CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572- 3604 Stories Closet Urinal TuE Basement Floor 1 F loor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: NO New Fixtures _ Old Opening, New Fixture _ Beer Dispenser _ Blow Off Basin Catch Basin Rain Water Leader _ Sump/ReceNing Tank _ Water Treating Appliance _ Water Heater -Electric _ Water Heater - Gas** Gas Range** _ Gas Dryer** _ Back Flow Preventer Required ()Yes () No Type _ APPLICATION FOR PLUMBING AND GAS FITTINC� PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLO F Wash prink. Floor Gatch Auto. Shower Sink ' Tray Fount Drain Basin ' Wash r i�ATE $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10,00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS t.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE Effective On March 1, 1996 � F �� - �J�-O _ • .� �� Gas Misc. Water Heater � �� Range Fixt. Gas Elec � HOFFMAM !3 Q ln,n� t. o�' BREMaA 1514 B4N aFF JUNCTI4M TOTAL JOB ADDRESS �p � d��,�, +�� e�� H �71-20 2 W ?S 1-9331 The undersigned hereby makes pplication for a permit for the work herein specified agreeing to do all work n strict accordance with the city codes and rulings of the Building Divisi , and hereby declares that all the facts and representations stated in this application are true and correct. �� 2 � ` 1 ? , 1996 Owner ��!'i�,� �� . �E]c��f� �r�� 1 0 �� $ .50 $ O, b Building Used As Estimated Cost l�� ^ PERMIT NO. PLUMBING O PANY L-�0�1 SIGNED BY / v V- �� Approved By Rough�-In Date M FEE ATE SU HCH l/��/S� TEL No. � Final Date **COMBUSTION AIR SHALL BE PHOVIDED PER UMC SECTION 504(A) � D TAB 6� MINIM M SIZE SC] INCHES. `� �x��c�,a� ��, a ,�! s�� IT IS � Z tlj � � Q� J�"��V) g��-O ^�a m�C'3W --� Z O��Z Z�N� N ¢ J S. ►� � Uy �� Z N� � Z iz�Q� �JC�0�.1 �- G� .�.r %t r' 4''�' �1. �Qm�Q J O M� �.t ¢�" �z Zj c°n� ca a m G SuuccT E . City of Fridley 310 3 4 AT THE TOP Of THE TWINS g U I L D I N G P E R M I T r � ` RECEIPT NO. � `y � _ COMMUNITY DEVELOPMENT DIV. ��/] r � � � PR07EC71VE INSPECTION SEC. � i i , � � /"'1 � CITY MALI FRIDIE� SS�J2 NUMlEN nEV OATE PAGE OF A►PnOvEO !r �""'�" �'' 612-571-3450 910-F15 6/8/00 � � �oe �o�aess 1506 10 14 18 22 26 Bohnhof Junction 1 IEGA� �OT NO. BLOCK TiiACT OR AOOITION ;SEE ATTACMEO OESCR. 1-6 6 Innsbruck North Townhouse Site SHEET 2 PROPERTY OWNER MAIL AOORESS 21P PMONE Innsbruck Townhome i�ss��is.icz� Association 651- 224-5482 J CONTRACTOR MAIL ADORESS Z�P PMONE UCENSE NO Garlock-Fren ��oofin� Corp 2301 E. 25th St., Mpls., MN 55406 612-722-7129 � AfiCNITECT OR DESIGNER MAIL AOORESS ZIP PHONE LICENSE NO. C�0001423 S ENGINEER MAIL AOORE55 ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ AO�ITION O AtTERATION ;�7 REPAIR O MOVE O REMOVE 8 OESCi;IBE WORK Reroof Buildin� 9: CHANGE OF USF PROM TO STIPULATIONS Underlayment must comply with the State Building Code. ��RE RAT� pERNII�'�� P�rr�� l��tian Cards tNiR N� �� FQR: : I�liil �� b�lailed PLUINBI�'��q p $�� , , % Nam��t�� T� P�S$ �� TYPEOfCONST. OCCUPANCVGiiOUP OCCUPANCVLOAD SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING. HEATING. VENTILATING OF AIR CONOITIONING TMIS PERMIT BECOMES NULL AND VOID If WORK Ofi CONS7RUCTION ZONING SO. FT CU FT AUTHORIZEO IS NOT COMMENCED WITHIN 60 OAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 OAVS A7 ANY 71ME AfTER WORK IS COMMENCED. NO OWIG. UNITS OFFSTREET i�ARKING I HEREBV CERTIFY TMAT I MAVE READ ANO E%AMINEO THIS APPLICATION ,(� STAl,LS G�4iiAGES AND KNOW TNE SAME TO BE 7RUE ANO CORRECT. A�L PROVISIONS Of �AW$ VALUATION SUiiTA% AND OROINANCES GOVERNINO 7MI$ TVPE OF WOpK WI�� 8E COMP�IEO WITM WMETHEfi SPECIfIED MEREIN OR NOT. TME GRANTING OF A PERMIT IL 135. %1 �S.SG OOES NOT PRESUME TO GIVE AUTMORITY TO VIOIATE OR CANCEL TNE pEqMIT FEE SAC CHARGE. PROVISIONS OF ANV OTHER STATE OR IOCA� LAW FiEGULATING CON- STRUCTION OR TME PERFOfiMANCE Of CONSTRUCTION ZO9. ZS Fire SC �11. 13 PLAN CNECK FEE TOT L FEE 25.94 S�GN�TUpEO�CON'AA(;TOpOpAUTMOA�ZEDAGENT �OATE� EN FOP VAL AT D TMIS IS VCy,1R�Mli • G � �6a - S�GN�TUAEO�OWNEp��OWNEpBU�LDEN� ��TE� Bl0 �h$� ��tE CiTY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 200( �6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS I S �O �I�n hD"f Ju �, RATE SCHEDULE OWNER �f�icR, ttO�manti Residential Rate TOTAL Furnace Shell and Duct Work, Burner - Also Repiacement Furnace (Side Vent • Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work $ 30.00 $� �� $ 10.00 $ $ 10.00 $ $ 10.00 $ $ 25.00 $ $ $ N� . � State Surcharge W;ll sNh"'' � (apA�' C�. U�}� b r� _I� TOTAL FEE u.�-ad • �, P w� � MINIMUM FEE FOR ANY HEATING/COOLING/VCNTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25 00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr $ .50 � 3a ..�v BUILDING USEDAS_ I�lt,�l�l�tn�t � ESTIMATED COST I�OD PERMIT N0. /��/.� f-' `�' DESCRIPTION OF FURNACE AND OR BURNER No. of Heating,�Jnits Circle One (Steam) (Hot Water) arm Air) Trade Name ��GrrC � Size No. 8U BTU Sd, U[J� HP EDR Fue Burner Trade Nam BTU_ Total Connected Load HP Size No EDR The undersigned hereby makes application for a permit tor the work herein specified agreeing to do all work in strict accordance with the City Codes an rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE g 'oZ �- �� NEATING CO K/��L Signed «� it TEL # 75 � o� ) �I �% � � ��- t� *Air Conditioners can not be placed in a side yard without Approved B�� Rough•In Date Final Date �� ' �� written permission from adjoining property owner. ` COMMON VENT VENT CONNECTOR AND COMBUSTION AiR VERIFiCATION �S I D��pf� � When replacinq an existinq furance, the undersigned hereby verifies that the �.c,��le� �� venting has been examined and is free from rust, deterioration, obstructions, � and is securely supported and firestopped where required. Yes (}� No () � '� The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of eibows and termination. Yes () No () The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. The existinq combustion air is sized and installed to meet the cuRent codes and manufacturer's specifications. When required to install a new combustion air it will be sized and installed To meet the current codes and manufacturers specifications. Yes`� No ( ) Yes� No ( ) �, Ye ,) No ( ) When installinq a new ventinq svstem, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. Yes� No ( Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Ye�) No ( . � Appliance Tvpe and Size/Common Vent and Vent Connector Information Appliance #1 Type s`tSr� ��TC- BTU Input �� Fan sisted or at � Appliance #2 Type �� t<C� BTU Input an Assiste or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Gk�c� � �� Common Vent Type � Vent Height l�i�c Diameter � inches Appliance #1 Vent Connector Height i ft Length ft Diameter �_� ype Appliance #2 Vent Connector Height ft Length ft Diameter ��`�`:" TYPe Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: _ ��l% f�- / %� J �C E7 /'/ �%-� �- Signed By: _ _ ��_ Date : 0 9�a8'/va c�ty of Fridley AT TME TOP OF THE TWINS � � � � � � ; y �� COMMUNITY OEVELOPMENT DIV. f � � PROTECTIVE INSPECTION SEC. � � � � � �"'1 � C17Y MALI FRIOIE� SSIJ2 �'""�� '' 612-571-3450 SuB�ECT BU ILDING PERMIT G..,' `` 4 �c'i �.a� r`� Q� �i� 6raw�i.'H.s�� NUM6ER pEV OATE VAGE Of sto-F�5 9/19/O1 / / 2179 �y0 �i APVpOVEO OY �oe nooaess 1506 - 1526 Bohnhof Junction �j/�� t IEGAL �OT NO. BLOCK TpACT OR ADOITION SEE ATTACMEO DESCF. 1— H 6 Innsbruck North Townhouse SNEET 2 PROPERTY OWNER MAIL AOORES$ 21P PHONE Various 3 CONTRACTOR MAIL ADDRESS ZIP VHONE IICENSE NO Columbus Exteriors 2131 111 Lane NW, Coon Rapids, MN 55433 763-757-7530 4 ARCHITECT OR OESIGNER MAIL AODRESS ZIP PMONE LICENSE NO. 5 ENGINEER 6 USE OF BUILOING 8 unit Townhouse 7 CLASS OF WORK MAII ADDRESS ❑ NEW ❑ ADDITION O ALTERATION 6 OESCRIBE WORK Reside Building; Soffit/Fascia; Window Wrap 9 CHANGE OF USE FFOM TO � REPAIR PHONE LICENSE NO O MOVE O REMOVE STIPULATIONS Per Section 1402, 1997 Uniform Building Code, requ�res that a weather resistive barrier be placed over exterior sheathing to protect the interior wall covering. Exceptions for this provision would be ii sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering ur.less the manufacturer sta�es this in their application guidelines. Call for inspection of wrap before covering. TVPE OF CONST SEPARA7E PERMITS ARE REQUIRED FOR ELECTRICA�, P�UMBING, MEATING, VENTILATING OR AIR CONOITIONING TMIS PERMIT BECOMES NUIL AND VOID IF WOiiK OR CONSTFiUCTION ZONING AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PER100 OF 120 OAVS AT ANV TIME AfTER WORK IS COMMENCED. NO DWIG. UN I HERE9Y CERTIFV THAT I MAVE REAO ANO EXAMINEO 7H1S APP�ICATION 8 AND KNOW TME SAME TO BE TRUE ANO COF1iiECT ALl PROVISIONS OF LAWS yq�UAT10N AND ORDINANCES GOVERNING TMIS TVPE OF WORK WILI BE COMPLIED WITH WMETMER SPECtFIED HEREIN Ofi NOT., TNE GRANTING OF A PERMIT �4H, 265 DOES NOT PRESUME TO G�VE AUTMOi:ITV TO VIOLATE Ofi CANCEL TNE pEqMtT FEE PROVISIONS OF ANY OTNER STATE Oi7 LOCAL LAW REGULATING coN� �633.65 STRUCTION OF TME PERFORMANCE OF CONS7RUCTION PLAN CHECK FE -� � 9� -O/ S�GN�IUAEOF�ON'AA(;TOpOA�UTtiOA�ZED�GENT �DATE� Cu � N�TU�7E O� OwtiEQ�� OwtiEQ BV��DEp� �D�TE� OCCUPANCvGROUP OCCUPANCYLOAD SO. fT CU FT. OfFSTREET PARKING STA�LS GARAGES SURTA% $24.13 SAC CHARGE Fire SC $48.26 TOiA�FEE $706.04 R LIOATED IS I$ Y UQ PERMIT �a7a "�� /itlE Eng;,neering WATER AND SEWER Permit No.: 5 763-572-3551 pERMjT APPLICATION Received By� 763.-571-1287 fax CITY OF FRIDLEY �'�� 2d�� , EFFECTIVE 6/9/09 APPLICTATION DATE: l� � 3'"� / YOUR E-MAIL ADDRESS: THIS APPLICANT IS: ❑ OWNER �ONTRA TOR �7- JOB ADDRESS: � S/O (/ GT, NEW CONSTRUCTION PERMIT# (IF APPL[CABLE): PROPERTY NAME: G �O'�'a- OWNER/ ,r�DRESS: SIO Q �T CITY r STATE��ZIP TENANT PHONE: CONTRACTOR Np�E: q � �'occq �n,T�'n�g SUBMIT A COPY OF �DRESS: �( /S'O 6 4 rps�" CITY STATE ld.//.ZIP .f�� YOUR STATE � a LICENSE WITH PHONE CELL PHONE: (��. —�l �9 � 99 N 2 APPLICATION STATE LIC # O STATE BOND: EXP DATE: 1. Narrative/written description: n �J � (�� ,�a,%L S �2�.�� ,�►,�•.Q 2. Please attach sketch showing curb line, utility line, building, etc. with distances._ _ PERMIT TYPE 0 SEWER CONNECTION PERMIT $50 ❑ WATER CONNECTION PERMIT $50 ❑ WATER LINE REPAIR $40 ❑ SEWER LINE REPAIR $40 yG- � ❑ ADD STATE SURCHARGE $.50 . SQ � ' ❑ SAC CHARGE @ $2000 = � y�- � o OTHER CHARGES (IF APPLICABLE) PAY TO UTILITY BILLING NEW WATER METER COST — SEE UTILITY BILLING SPECIAL ASSESSMENTS — SEE FINANCE WATER TAP — SEE ENGINEERING NOTE: WATER METER REPAIR, INSP OR SHUT-OFF / WEEKENDS & HoL1DAYS $125/HOUR-BILLED TH[S IS AN APPLICATION FOR A PERMIT-NOT VALID UNT[L PROCESSED I hereby apply for a water or sewer (new connection or repair) 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. I understand this is not a permit but only an application for a perr�' and wor c is not start without a permit. SIGNATURE OF APPLICANT PRINT NAME: ct �� • /� q5P'�''� DATE: II —� 3�� APPROVED BY: - - ----- . DATE: �/ - ( � �� '% COPY GIVLN TO: ❑ ifTILITY BILLING (only if new meter) ❑ PUBLIC WORKS C ENGINEERING City of Fridley Engineering Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3551 FAX: 763-571-1287 �w