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AF - 43880n �� ^ Caty of Fridley, Mi�.. BUILDING PERMIT nat�: _.� � �-� �- � �� Owner: - ..��OL.. +. /� c er _..� �Q'�� Adaress Addreas �� N° '70'S2 � LO TI OP BUILDING No. �_.�� Street —.��,�1`_.��_ Part of Iw I�ot �_ Block .1 . Addition or Sub-Div3sian _ Corner Lot _ Ine�tde Lot � Setback ��. �_ Sideyard �� Sewer IIevat4on �� ' , ca� w.ov�i e.! �� t��.��a^ Foundal3on IIevation ,. e a � C9an.P��.a'° � d � DESCRIPTION OP BUILDING To vsed o � FYont �,�� Depth �c��. Height �� Sq. F't. .�'�..� Cu. P't �� _ 0 t_�� Depth FTefght �� Sq. F� �� Cu. FL _�� 7j►pe of ctfon FF�tt,� �_ To be Com eted � P1 In conaideration of the issuance to me of a permit to construct the building described above, I agree to,3o th� P�P�� work in acc�ordance with the deacript3on above set�. rth and in with provisi of orriinanc�ea of the dtq of Fridley. � In caa►sideration of the payment of a fee of ��. ,� �, peraift fs hereby granted to to conatruct the buflding or addition as de�cribed above. This permit fs granted upon the egpress condition that the perafln to whom it is granted and his agents, employees and workanen, in all work done in, around and u�n said building, or anypart thereof, shall conPorm in all respecta to the ordinances of Frldley, B}linaesota regaraing la:ation, conatruction, alteration, maintenance, repair aad movYng of bufldiuga �� dty ]imit� and this permit may be revoked at ar�► time upon ^ on of any of the proviaiona of said BwllaiaS Ins�ctor NOTICEs Thb pqrmb deas �wf eorer �6s w�eoadon, imhllaHoa hr wlrteg� plumbiee, ea haNeg, aw�r or wats�. B� son fo su da Butldlee les�etoe hr apvat� parmNs Por fkas hems. � . , „ • .-* �y � �- 4 �� •:_�� ,.;��. .... - ..� . .. . �: i'i. �'e..Y � Y.i . ., ..,.. . : i", , ,: !, � ?<: . . . , . .. - .:.. � �e �- : . . . .. �:. - . - •. . . .��. . .'5... .. . �' � . � _ , . _. .. . _T. 'i APPLICATION F'OR BUILDING; PER�� ::°�`; a �:;�- ;.� •.,,_ ^ .. .. ' . . d, , ,� �;-.� ; � � . ._,. . _. " , \itii�. ��C ritilDY'��, aaLarLtii'JS7'QI.,�+; 8.. : ";,"r '. . _ , ' .' � .:�,�.....1,� _ :i� i9' � .� . ., � � . �iP�': �� ._ lJ.. ... ' . ' ...�4��.. . .ir1.37: �.k . ' . .. OWNLR�S N�: BUILDER . . . . ,. , . � . � . ,. ,.. . _ ,,., . . . . - , :� .. ADDRESS: , .. . .. : � ; ADDRESS. . . •� :, . , _ . . :� ;� - . . . . . . . . . , a ' . : �_ ._ . . LOCATION 0�' SU�LDI•NG; : - . , , � � , � . , . No. ��j� � .1.1 �,..,� • o , , S,treet / ��.=�C��l�'_. ; ParC of Lot Lot� . Block. ,. Additicn.ar SubdivisAioa . . . ., � . _ ,. � . . ., . Cbsner Lot`Inside Lot Setback '.:Side=Yard SEWER ELEVATION � FO�UNDATION ELEVATION A�plieamt attach ;to �his form Twq Cer�ificatea of.Surveyof Lot�end propos�d build- ing location drawa oa these Ge;tificates. , ,. ,... �'� _ . . • . . , � �. � , ° ' . _ _ . . .. � �-. � � . _ . . _>,. ., . DESCRII�IZON OF BUILDING .,�, To be used ae: . . �. � , . , . , . , Frod� � Depth � . H�ight .; .�. . r. _ -. • ' � .. � � , . . - Sq. •Fe.. Cu : F� : . �� J �. � �• . , .. ��.. � • Front IIepth Height _ � � . . ; . . �� : � , , , . , � , �S.�I• Ft . � _ : � . . Cu ,. Ft . Type of;Coast�uctioa�, �. - y �Eatimated Coet ' r � . . . �. To be `Completed . . � , - . . - . . . , , �, , � ;� ,�� _ �3 a , . . Tha underei�gn�d hereby �makes applicati�n for a'permi�t for th.e work :lierein specified, agreeiag to do all work ia strict accordance with the C�ity of Fridley Ordinaaces and ruliags of;the. Departmeat,of Buildings, and her�by'decl�ares that all the facte and representatione etated in this�application are true anci.�eerrect. / DATE �� Schedul� ef Fee Coats can be rounu on tne xeverse s�ae�. .. . . . , �"� 7�"� � - . t.. e �� Fi ��°.._� !'1 BUILDING I�ERMIT FEE SCHEDULE � , Sectioa 2. The Inspector of Buildin�s shall, bc:fore issuing any pes�it for the erectioa of any buildiag or structure, os for any addiCioa to any ex3st- iag building or etructure, cr for aay alterations or repaite to anq existing building or BCructure, upon application therefor, require the paymeat bq the applica�at for such permit of fees to the amount her�ia below aet forth and ia the manner herein provided to-wit: 2.1. For any auch permit for the erection oE any fire-proof bu3lding, other than a garage� warehouse, facCory or grain elevator, or for the erection of a�ay fire-proof addit3on, for similar occupancy, to aay existing build3ng shall be at the rate of $i.40 for each oae thousand cubic feet, or fraction thereof, in such cubical coatents. 2.2. For anq such permit for the erectioa of anq fire-proof garage, warehouse,. factory or grain elev�tor, or for the erecCion of aay fire-proof edditfon, for similar accupancy, to any existing buildiag sha11 be at the rate of $1.25 for each one thousaad cubic feet, claseified as t1fireproof" by Sectien 502 of the.Minneapolis Building'Code. AOUSES , . 2.3. For any such permit for the erection 'of any non-iireproof buildiaeg othex than a garage, warehouse, factory or graia elevator, or aay aoa-firegroof addition, for s3milar occupancy, to any esisting building - permit $1.00 for each one thousand cubic feet. GES 2.�►. For aay such permit for the erectioa of any non-fireproof garage, warehouse, factory or grain elevator� or fo� ehe erection of. any non-fira�roof additian, -for--sim3lar occupaacq, to aay existiag building or for each euch ._.. -build3a� or addition - ni�ety centa ($0.90) for each one Chousand cubfc feet or fraetion thereof, in the cubical coneeats thereof c,�ith a minimum of $4.00.- For the purpose of comgutiag fees for building permite, the cubical contents of any building or additioa to a uai£orm height throughout by �ltiplying the ground area covered from a point�si� (6) inches below the floor line of the basement or cellar to the average he3ght of_the upper aurface or to the average height oE the r@of surface of the maim gable of a pi.tched roof. 2.5. For repaira or alterations to aa existing structuxe, the fee ahall be at the rate of $3.00 per each F3ve fluadred Dollars ($500.00) or fraction thereof in the cost of all progoaed work. 2.6 . In no case shall the fen�_chargec�.#or _aay -permit. a�s set forth in Section 2 be less. than $4,.D0. i"°; . �� - ��. _ /—", ,� � . �. � � ��` � � •� a m � � C a � � � 0 �` a m m � � a � o+ 0 � .� E U � � C 0 � 0 0. Q �� m M � � O o 3a� � � oa H �a w� a� z � � 0 U .�� d a x �, F� O � .-� 3 + �� U� w° � � (��. Y CTa ��b � ��, ��. a�b� ��a �� a � `° .� � a � �"�� o p .o � a� '� d � '� `,g � � � y �a�a� o .F,�� 6'a o � c0 bp y �� c� � C j � W � 3 < � s z • � S'JNIN3d0 �� 3JNVN �� '�ddV sv� tl3HSYM o� SNIS��B Ii�lY� SNIV2IC aoo-� •sae+ws •LVno� 'JINI110 SAVM1 HSVM SYNIS �i15Ye 58fl1. HlV9 sivwian siaso� U31VM � � .. ro � � o � O �C � � ❑C � 4 p� d c� � � � �' �' i: O �Q {�, U 9� �� m y ,� � w sG � 00 � cn e � ar • '�' � p � �� .� � a G4 pq � �Q a ro �� Y � � � U 'd � � ; � z � � E° c� O W J � W U � W � J Q � � x � °a � � .� o � N O ° s�r v3 ssr va vs �sa � � N O N O N a � � H M N M �C �C iC iC � aa O z : � � � � : : : : o � 04 ,., : � � : o � Vd • � N N '�O � : �g� s0 � � O � a � � ; � � � � � � 7 � �'�'+ «t W � W � x � v � B � � B x z w z �� z oa � � � Ey va� s�r Eo- _` o- � �� u�9, O � N fF} � � � � z : � � 0 :% O � O : � o O N � � � � � � q z M " �� Y � � � � . � : H �QO � V : m : w . iri • Z ; 0 � . � O � � � � � P� A �� ,-� � �� City of Fridley, Minn. BUILDING PERMIT Da�: Oct. 27, 1967 p��; Ted Schna�le B��r Asphalt Driveway Ad� 6053 Central A�e. A�� 1195 East Hwy. 36 N� LOCATION OF BUILDING No. 6053 s�t � Central Ave. _ Part of Lot — Lot � 1—__ Block 1 Addition or Sub-Division ....�Adele First Addn. Coraer Lot , Inside Lot ._.._ Setback ��_ Sideyard .__ Sewer IIevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Blacktop Repair�nt Depth Height .� Sq. F't Front Depth I�eight ._.._.. Sq. Ft Type of Construction �...A.�.Yeway ��, �� _.___.�300.00 ..__ To be Completed 3�� f:u. FL Gtii. F't. �J2J In conaideratfon o4 the issuance to me of a permit to construct the bui}ding described above I agree to do the proposed work in accrordazice with the description above anci�3n compliance with afl provlaiona of ordinances of the dty of FrYdley. i' '�� ; __ � �. �. �� ' In conadderation of the payment of a fee of $ 5. 00 ��t � h��, �� ,� Asphalt Driveway Co. to construct the buflding or addition as described above. Thispe rmit ia granted upon the express candition that theperson to whom it ia granted and hia agents, employees and worlQnen, in all work done in, around and upon said bu9lding, or any part thereof, shall conform in all respects to the orainancee of Fridley, M3naesote reg location, conatruction, alteration, maintenance, �peiir and mov3n� oE bufldings within the dty ]�imit� an� permit may be revoked at any time upon violation of any of the proviaions oi ea�d ordinancea CLARENCE BELISLE $�� r NOTICE: Tids peemit d� eof sowr ths eomteueMoe, tmtalFaMee ter wiries, Pimebiee, ea heaHes, prr�r or water. B� sun to � tha Bnildle8 le�pecla� fe� �perat� parmtts Po► t6as it�mt. r � Ei�PT��Ai`��J:7 1� Olt �i��,b��;i�lG ��I��1�' CI a'� f�� fi.�i��,�`7� M�I�2d�5(}'xl! ,�/�� o�� s r��.� � c/�'�IG Cr�� su��,�� r� � �� y ��ss ...� �3 ��'��.,��n��ss �,��% � .3� .. ,.. � I,oC��'1�.4?t� Or �StTI��J?'TiG �� s D �� . . 5�1�.E�'i ��/V .L ��,PAP� 0� �� i�� __ �--!� �I�oc:x -� -- - - - �gl�r.�� o�y sii��'�s�c�� ,/��C��c✓q� COR.�ER T�+D't It�3g�� &�� SFe'��Ci� SIDEmYARD f, •� . 5�6,�� ,Et1��'pi� ' .� .. ��J��T��'.3:�XC7i� ��il'��E��I . ., _. «� - - �� p��ie�nC �t��ch La �hzs �c��n �cvv C��ti��es o£ S��ve� v� Tas,� �.x�c� ��apc�sed l�uil�ing �oc�rL-i�� d�aw�x� o� the�e Ce�: �ificate� o , . DES�R��T�N �t� �U"ti�1��T� �m Ee Used Aa; l°I �%� �� l l� l�l'1 ��;z� . D4pth xeigl�� Sq. I�°g .� _ .�,m _ Cu. F'�.. __ 1��°a�i� Dep�i� ileigh� Sq. �'t. �� Cuo I='�, Tyge oi Constr�ac�iora Es�im��ed Ca�� r To �� Co�u;�Ie�ec� � �'he unde�s�g�ed herebv m�kes apglicatioa fo� a pe�mit io� the war% herein s�e�z�iPd, ag�°eeing ta do aIZ woxk �xz st�tat accoxdar�ce wi�h �t�e C3 ty o� F'�idley prdin�nc�s and �uii�g� af the D��a�tment of Building5, and he�sby e�ec�.ares tha� ai3. ti�:e fac�s ax�d �ep�e�er�t�tiorz� sta�e� in this ��plica�.3c�n ��e ��°ue �nd coxrec�. DATE I� ? SIGZ�A'�(i�.E (Sch�dvle of kee Cnv�s cai� be f��xa� az, the F.e�i:;.se Side�. ��c� � � � � � � � � �_._ d.�� .... _ 4 � e \ � ��ixr,»r.��c, ��f�.FC,�ixr r��; sc;}rt:r�vr.F, S�;CT70\ 2. Thc� Tiispc�etor a� t;�l�.1_din�s st�a11, bef:��rc� i�ssuing permits for t«� erect�oa oi any bui.Lc;i.ng o; structtzre, vr. {aY any addition �0 2I1y P_XJ SLl.il'� builc�zn�_ or strticture, or f.ar aiiy aiterata.on ar r�:ga�.rs to any E'Y,].S�lll°, bui.ldino or �st:ructure, up�il ap�?J:S.caLion t:iier.ef:ore, rec�ttire the payment: by the applicatit � for st:ch peri�li_t of f:ees to ttic anto��t�t iler-ei.n bel�t•� set forth and in the manner herein F�rovidr.d to-�•:i_t.: � Ur.i.iorm Euil.d�_n�Cadc:; 7'y�,E 1;?_, & 4- $1.,75 fo-r. each on� Chousand cub�.c .f�et, or fracti.oi� tl�erEOf, i_n such c��i.cai content� . Tvpe 3�� 5-$Z .SO for. c:acn one thousanJ cu'�ic feet, � For the pur.pose of con�puting fees �f'c�r buil.dir.� pernits, the cubi.cal cont�nts of any bt}z ].CilT.t.��, or additioi� to a uni.forrn hei.�ht tnr'ou�hoi�t by mul.tipluzn� t�ie �i'OL'EIC? area cover�c? from a point si_x (6;t inci�es bela��z the f1_oor line of the b�sentnt or Ce11�1' t0 t�tG 84eraU2 ilel��?C Of the tirn��r SltY'i2.C� OZ' t0 ttl2 av4ra�e hc.].�;ili: O� t�1t: rooi surfac� of the main. gnblr� of a pitctLed roof . . For repairs or alterati.o��s to an ex.i.stiu� str«cture, the fee shall be a.t the rate of $3.00 per eacn Fi:ve H�_inc;red Dollars ($500.00} oz- fraction rtieraof in the cost of a11. pro��osed work. . �n no case shall th� fee char�ed f.or a_zy��ermit as s�t fortn in Secti.on 2 be less than �S.Ot�. ' . �. • �ISSSD Connectioa Charges based on locati_on- Area � or 2. .. _� � �"� , � ._ . � __ �. ¢ ,.. - � sue�ecT P MI O. City of Fridley o 18018 ATTHETOPOFTHETWINS gUILDING PERMIT r � �� R EIPT NO. � ; � _ COMMUNITY DEVELOPMENT DIV. /� `, r i �� PROTECTIVE INSPECTION SEC. V 1 . , l•--. � ��'��,'� CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY i �� 612-571-3450 910-F15 5/31/85 / / lOB ADDRESS 6053 Central Avenue N. E. t LEGAL ��T NO. BLOCK TRACT OR ADDITION DESCR. �. 1 Adel's lst �dditian SEEATTACHEO SHEET 2 PROPERTYOWNEF MAILADDRES$ ZIP PHONE Roger Tsang 6053 Cent�al Avenne N:E, 572�0534 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Durabilt Associates Tnc. 7343 An n Court, Eden Prairie 55344 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 938�9350 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 8 USE OF BUILDIN(3 Residential 7 CLASS OF WORK � NEW �7 ADDITION ❑ ALTERATION ❑ REPAIFi ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 24� x 24 � 3-5eason P��ch. �dditi,on 8 CHANGEOFUSEFROM TO STIPULATIONS Porch; c�n not be. hsated unle.�s it �eets. ths St�te. Energy xequi.rements. �' EPARATE PERMITS RE(�U��D FOR w�RNI�� S Before digging call lo�at �+��sties WIRING, HEATIN�, PLUMBIN� AiVD SIGIVS. ��PHO�v�-ELECTR(C.c,�� ,� � R��lJll�'Ei� �`� ��i��' SEPARATE PERMITS ARE RE�UIRED FOF ELECTRICAL, Pl.UM81NG, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING 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, 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 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 $].Q HO,Q ySrje�iO WITH WHETHER SPECIFIED HEREIN OF NOT. THE GRANTING OF A PERMIT � DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVIStONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- S U TION �R TH ERFORMANCE O CONSTRUCTION. �8r0. SO None � j�� p PLAN CHECK FEE TOTAL FEE E'� ,�' j��Q � $ 21. 63 $113 , 53 SIGNATUREOFCONTRACTORORAUTNORI2EDAGENT IDATEI WHEN PROPER ,yALIDATED THIS IS YOUR BERMIT - 6 �r SiGNATURE OF OWNER�IF OWNER BUILDERi �DATE� BLDG �NSP � p E NEI�I [ ] ADDN. � AI,TER. �Q Constructioa wddress: a�� Legal Description: Owner Nane & Address: Contractor: .11J �[ lei�� Addresa: ��5�� /� � LI9II�1G AREA : GARAGE AREA: City oP Fridley R-1 AYD R-2 Building Permit Applieation �.e Effective 4/1/84 _/ � u� S �� Tel. # �� f Tel. # — �� Attach to this application, a Certificate of Survey of the lot� vith the proposed conatruction drar�n on it to s�ale. DESCaIPTIOB OF IIdP80YEMENT Length �'� Width � Height � Sq. Ft. � Length Width Height Sq. Ft. DECB AREA: Length � ilidth Hgt/Ground Sq. Ft. 0'PHER : �'�� za�.- � � S�` �o ��2 =10 , � �� .�`,� Corner Lot [] Inside Lot I l Ft. Yd. Setback Side Yard Setback �'i Type of Construction: �� Estimated Cost: �.��_ Approx. Completion Date: �� /�� gO� Alt. A Alt B Proposed Driveway Width If Ne� Openiag Is Desired: � � See Back Page for Explanation ��co ,r�.Q � DATE: �� `� �� APPLICANT: Tel . # /� � �/�� Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sever l�ain Charge ?O�AL � �� o � � �. �/v � � a � � � � CITY DSE ONLY Fee Schedule on Reverse Side 25i of Building Permit .Fee �.50/#1�000 Valuation a425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ j No� Necessary [ 7 STIPOLATIONS: � � � /�� . �t � .��..� ,�� ¢� . u e BBII.DING PBRMIT FEE SCHSDIILE The Chief Building Official shall, before issuiag permits for the erection of any Duilding or structure� or for any addition to any existiag building or structure� or for any alteration or repair to any existing building or structure� upon application therefore, require the payment by the applicant for such permit of fees to the amount herein beloW set forth and in the manner herein provided to-�it: Total Yaluation a1.00 to '500.00 , �501.00 to �2�000.00 �2�001.00 to �25,000.00 �25,001.00 to �50,000.00 Feea �10.00 (Minimum Fee is �15.00) �10.00 for the first a500 plus additioual �100 or fraction thereof� �2�000. �1.50 for each to and including �32•50 for the first �2�000 plus �6.00 for each additional �1�000 or fraction thereof, to and including �25,000. �170.50 for the first �25�000 plus �4.50 for each additional �1,000 or fraction thereof, to and including �50,000. �50,001.00 to �100,000.00 a283.00 for the f.irat a50�000 plus �3.00 for each additiional �1,000 or fraction thereof� to and including �100,000. �100,001.00 and up �u33•00 for the first �100,000 plus �2.50 for each additional �1,000 or Praction thereof. DRIIIEHAY DEPRESSION ESCROii (Conerete Curb Streets Only) . Alternate "A": Removal and replaeement of curb and gutter only - DriveWay Width plus 6 feet times �13.50 Alternate "B": Removal and replaeement of curb and gutter and install a 3 foot wide approach �itb 6 inch depth - Driveway Width plus 6 feet times �15.75 VERIFICATION OF FOIINDATION Permits for constructioa Will be issued a minimum of 24 hours from the time of applioation to alloW for proper revieW of the proposed etructure and of the coastruction site. A Gertificate of Survey of tbe lot, shoWing the location of the,foundation once it has been oonstructed �+ill be required before proceeding with the Praming. /O, 8'40 �oG�f c� � � �r �.�� .SY•a� � �� v � ., . sueaecr PER c�ty of Fridley 2023 4" AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � � � RECEIPT NO. � `L �_��_ COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. ��—�� i i � � /'�'1 � CITY HALL FRIDLE� 55432 NUMBER REV. bATE PAGE OF APPROVED BY �'"""� � ,�� 612-571-3450 910-F15 1/25/9� / / JOB ADDRESS 6053 Central Avenue N.E, 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. I. 1 Adele lst Addition sHeer 2 PFiOPERTY OWNER MAIL ADDRESS ZIP PHONE K. Roger and Elizabeth_ Tsa,ng 6053 Central Ayenue N. E, 572--0534 3 CONTRAC70R MAIL ADDRESS Z�P PHONE LICENSE NO. Same 4 AHCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE IICENSENO. 8 USE OF BUILDIN(3 Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION C}� REPAIR ❑ MOVE ❑ REMOVE 8 OESCRIBE WORK Reside Dwelling 8 CHANGEOFUSEFROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. St2@Z THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTHUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WOHK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. N0. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �. 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $%�OOO $3. SO DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. yfiQQ. QO LAN CHECK FEE TOTAL FEE $�3.50 SiGNAT REOFCONT C'OROR FIZEDAGENT IDATEI � cn HEN PROPERLY IDATED THIS IS YOUR ERMIT G, `` ' " ' - / :� � � / iGN RE OF OWN R iIF OWNEF BUILDER� 1 TEI BLOG �NSP � TE �1 [ ] Effective 1/1/90 �1 [ J R-1 AND R-2 ALTER [�] Buildirig Piermit Application Construction Addre�.�s: � � � � Legal De�cription: �� ►� � r e�� a 1 e �s �' �G��'/ 7-i � ah owner Name & Address: �. r4o �� N a �, �Q _ �� z a l� e Th / S�r �� Z�e1. #,S 70? � OS '/ Contractor: C� �„J � e� Te1. # Addr�s.s: Li�lnac� �: H�' ' N- s i131� .,a ,,,. . �•��• Attach to this application, a Certificate of SuYVey of the lot, with the proposed construction drawn on it to scale. i� :� �: M�M �� . �„ia;.��/a+��+.� Iength width Length Width Lengt�i Width Height Sq. Ft. Height Sq. Ft. Hgt/G�nd Sq. Ft. Corner L�t [] Inside LAt [] Ft. Yd Setback Side Yard Setbacks Z�pe of Construction: .�-� � P � Estimated Cost: $ 7� v U Approx. Cc�npletion Drate: /`x� v r. f� Proposed Driveway Width If New Openirig Is De.sired: F't. $ $ + 6' See Bacac Page L1A'I'E: �.-, � �� APPLICANT: � � � Te1. #, 5 i',? - C S S� i � Pnxmit Fee $ ��, � � State S�ircYiazge $ � . � � SAC C�arge $ Driveway E.scrvw $ Park Fee $ Sewer Main Chazge $ • v S'1'IPfJIATIOI�LS : $ � .� , s �. CITY IISE �iI,Y Fee Schedule on Reverse Side $.50/$1,000 Valuation $600 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by ErxJ��1 Agreement Necessary [ ] Not Neoes.saYy [ ] :+�1r � �,_ ��+;�„�4 �;�- _ �.:i�+. �1 � �he Cizief Building Official shall, before i�s�?m permits for the erection of ariy �; � ding or stnicture, or for ariy ac�dition to ai�y existing building or structure, or for any altexation or repair t� any existing building or structure, upon ap�lication therefore, requi.re the payment by the ap�licant for suc� �r++; t of fees to the amo�nt herein belvw set forth and in the manner herein pravided to-wit: ZO►I'AI.� VAIIJE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 E�� $15 (Minitman Fee is $15 plus surcharge) $15 for first $500 plus $2 for each additional $100 or fraction thereof, to and i.tzcl� $2,000 $45 for first $2,000 plus $9 for each additional $1,000 or fraction thereof, to and iriclwding $25,000 $252 for first $25,000 plus $6.50 for each ac�ditional $1,000 or fraction thereof, to a�l incl� $50,000 $414.50 for first $50,000 plus $4.50 for each additional $1,000 or fraction thereof, to and incl� $100,000 $639.50 for first $100,000 plus $3.50 for each acklitional $1,000 or fraction thereof, to and ir�luding $500,000 $500,001 to $1,000,000 $2039.50 for the fizst $500,000 plus $3 for eac� acklitional $1,000 or fraction thereof, to and including $1,000,000 $1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for each acklitional $1,000 or fraction thereof DRIVEW�,Y DEPR�SSION ESCI�OW (Concrete Curb Streets On1Y) Alternate "A": Removal. and replacement of curb ar►d gutter only - Driveway width plus 6 feet times $13.5d. Alternate "B" : Re2noval arid replac.e�ent of curb a�xl gutter arid install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet tin�es $15.75. � r• � v� •; • � • �i u • •� P�ermits for construction will be issued a mini,m,M of 24 hou�s fra� the time of application to allow for praper review of the proposed structure and of the constYUCtion site. A Certificate of SuYVey of the lot, show.ing the location of the foundation onoe it has it has bees� constructed will be requirecl before p�dirig with the framing. " ° -.,s A. " oa SUBJECT City of Fridley AT THE TOP OF TNE TWINS g U I L D I N G P E R M I T i� � � � • COMMUNITY DEVEIOPMENT DIV. � VV � �� r � � PROTECTIVE INSPECTION SEC. 1 � � i---.� ��"' �,� CITY HALL FRIDIE� 55432 Nu�BER t 612-571-34b0 910-F15 JOB ADDRESS 6053 Central Avenue NE 1 LEGAL �OT NO. BLOCK TRACT OF ADDITION DESCR. 1 1 Adele lst Ac 2 PROPERTY OWNER MAIL ADORESS Donna Wojciehowski 3 CONTRACTOi; MAIL ADDRESS Tabor & Sons Inc. 3716 St Francis Blvd Anc < ARCHITECT OR DESIGNEfi MAIL ADDRESS 5 ENGINEER MAIIADDRESS 8 USE OF BUILDING Residential 7 CLASS OF WORK AEV DATE PAGE O: 8/17/98 � / 27243 O. �� S.J APPqOVEO BY SEE ATTACNED SHEET Z�P PMONE LICENSE NO. 7RA_19U� �001� ZIP PMONE UCENSE NO. ZIP PHONE LICENSE NO. ❑ NEW O ADDITION ❑ ALTERATION � REPAIR ❑ MOVE � REMOVE 8 DESCRIBE WORK 8 CHANOE OF USE FROM TO STIPULATIONS Underlaymaat must comply with the State Building Code. SEPARATE PERMITS ARE REOUIqEO FOR ELECTRICAL. PIUMBING, HEATIN(3, � �rc �r wna�. YENTILATING OF; AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 20NIN(i AUTHORIZED IS NOT COMMENCED WITHIN BO DAVS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS I HEREBY CERTIFY TNAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION AND ORDINANCES GOVERNING THIS TYPE OF WOfiK WILL BE COMPLIED WITH WHETHEFi SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1668 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEfiMIT FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION �S�F.00 PLAN CHECK FEE _ ��'�O4'� ��/�' %� License SC SIGNATURE OF CONTRACTOR OR AUTMOR12ED AGENT IDATEI P SiGNATURE OF OWNER �IF OWNER BUILDER� IDATE� n� n �..eo occu STALLS .00 OCCUPANCY�OAD OFFSTREET PARKING I GAFiAGES $.83 SAC CHARGE Fire SC $1.66 TOTALFEE $61d+9 N�V� . ADDN ALTER [l [l [l CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1 / 1 /98 �� ConstructionAddress: 1% � S' � C-es, �� i�4 �� Legal Description: �,r; S,}'�� /r / � ' �� , Owner Name & Address: ��,,,�oq e,c�o-�Sc << f�o,,• S,� � Tel. # S�y-f2 e/� Contractor: �� r � So�� MN LICENSE# Address: � 7 % �' S f ��.. r P, � �� 7 Tel. # `�% �� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length DESCRIPTION OF Il�ZPROVEMENT Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: � � �� . Construction Type:�� e �� Estunated Cost: $ �C�� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: � ' � � -S � APPLICANT: ��--�~( a�� Tel. �{ Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL . STIPULATIONS: CITY USE ONLY $ ��Q� Fee Schedule on Reverse Side $ � (o � $ �� $ $ ��%C� $ $ $ $ $ �l �q .QO1 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation $1000 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] ' ' • :a BUII.DING 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 application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: TOTAL VALUE $1 to $5(?0 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $21 (Minimum Fee is $21 plus surcharge) $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $349.75 for first $25,Q00 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,0{}0 $2887.25 for the first $500,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5012.25 for the first $1,0(30,000 plus $2.75 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Altemate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Altemate "B" : Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of 5urvey of the lot, showing the location of the foundation once it has it has been constructed wi11 be required before proceeding with the framing. Z D v� n ON �v �rn �� O � z D W m �T � r �rn T � n Z �O Oz Z < � D .-�i� � � O v � a cD � � �• � N � N � �N � � j o = � p Q� 0 �•-o �• n> oa " m v °' � _. m °1 `� fl- m 0 � � � Q . � � 0 C .+ v 'a 'D 0 < m o. � � -a � Oq � � � � � N < ?� � � 0 C� O � Z Z n � O `� � � � m z � � m n =i O Z � m m � � v 0 0 � _ -� 3 C � Z �'�3 =mc 3 ��m 00 '+7 aa°� m�z �i ..( O Z v _ � -�_i aoz � Z � m�0 � O � � 3� -�I � < Nm Z �� I �O Z � 2 D --I '-� m r � � � �- '�1 � � � � � � rn � a N � o � o � oi d � m a °, .��,+ D _, � °—' �' � � m 0 0 � O � � D � r � c m � m � � m D N = � O o � <� -. d � � m m � O � D -�' -0 N d' a � � m � o .± � o � � N �i N � O Z � D n � D C7 0 � Q � � oa D N m � G7 Ct � 0 m -. G� G� D -n � N N y � N N N O � C. � _vr,�� v_,cnm � � m p�q m� cn ni n � p- � < � m �� Q , > > O, � � '+ fl. � � = C � "� � � � .C��r °' �- ,-' °' � �=oo�o � i � �- v � v � � � m � - +� -� � � � � o 0 0 0 � O O O O O '�'' fD %H %A 69 �f1 6�1 Ef� {A {fl ll'� O ll .I� o � ��s �� m '� � � �' � C � � � �� o�� = m � �� m N � � a� � d m °-' � � �' � m �' o -. � aa � � �°`3�� .� fI�•_�..�`'� �•?• � y �� ' �°-. � ° F �' � � (D � � �' =� � � n � � co Q c� --� N' � � � � � a n� z m �' � -o 0 m � N � � a�� °� � �, � o �+�a � �' � � � 3 m � � m c� � � � 0 v o '� �, a � m a y f�D � � � -n: oo --� z �-��,o _ c °- o m ._,, � � � °' m � o� C � � _ - � � n m n n � o p > > � (p fD � � � Q- fn N r rv . �, fl°, rnz3 a p �o,� 2 � � � m � � � D .� m � � D � m � � O Cn � 1 '� rn � � � Z O � � � m N c� _ . m v C r- m � � `o W � � o Z � � c r^ � � m � � � � N` � f/'+ � �u � � � (`^ V �'1 dl (7 W Q W � � N� � O w��•� �Zc�o � O y p � �� m wn� N m Z z� m� m � O z � y O � Z '� r �� O rnz �O -�i � � � Z O Z � v� a� �Z OH vz .� v o= Zm Z� �Z Nn "� O m 30 y Z a z� vrn vZ C �c� N O Z � m � <' m O � � � � c � � N O O � COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No () Ttie venting system is plastic/PVC and meets all cuRent codes and manufacturer specifications including sizing, length, number of elbows 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 existing 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 manufacturer's specifications. Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) When installing a new ventina svstem, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacture�'s speciflcations. This does include AGA-GAMA Category I Central Fumace Yes No Venting Tables for fan assisted and natural draft appliances. () �� 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. Yes () No () A liance T e and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input ' Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat _ Total Appliances _ Total Btu Input Common Vent Type Vent Height _ Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: Describe HEATING CO: Signed By: Date : Building PLUMBING Perrnit No.• -exa�� Inspections g��jj�]��-�j�j1 �ppj,j��10� Received By: � 763-572-3644 CITY OF FRI�.DLEX Date Rec'd: ��- �� DAT$ ZI9IO% YOIiR B-MACL ADDRESS wnelson[a�larsonplumbing.com s«aDDx�ss 6053 Central Avenue NE �er�s aPruc,�.�r is: ❑ owrra� �corrr�iacraR PROPERTY N�;_ Samuel Larson �� nn�tt�ss: 6053 Central Ayenue �E ctr�r Fridle 1TNANT �_ STATE INZIP 'rJrJ" �Z PHONE: 7%�I�J71-% 'rJ%4 coNr�►c�rolt �:_ Larson Plumbinq, Inc. SUBMIT A COPY OF STATE LICENSE tl 3341 PM EXP DATE 12/31 /2QQ6 YOUR STA'I'E .wn�ss: 3095 -162nd Lane NW c�r�r Andover STATEMN ZFP S�O4 t,ic�vsE wrx� pxor� 763/427-7680 Fnx _ 763/427-944£� ,�rrz.zca�arr PERMFF TYPE � SAIOLE FAMILY O TWO FAMILY ❑ TOWNf�OUSE TYPE OF WORK: ��W l8l REPLf+CEMbM DETAILED DESCRIPTION OF WORK 1Nater Heater Replacement PEIt MS 168.665 the permit fee is a minimum of $15.00 or 5% of the toial ctrst up to SSOU.04, w�hic:iever is greater, for the improvement, installation or replacement of a resiQential ftxture, excluding the �ixtures. (This should reflect only the cost of labor ) Labor cost under $30d =$15.00. Labor cost t�tween $300 to $500 a cost of tabor x AS = F4R PROJECTS W HERE LJ+BOTL EXCF..EDS $iOD� FEES ARE BASED ON $10.00 PER FIXTURE, EXCfiPT WHERE TIOTED. FIXi'URES: (QQDiCATE TOTAL NUMBER OF EACH BELQV� BATH SINK/f AV FtAUR DRAWS SHOWER WATER PiPING BATH7'IJB GAS PIPINQ �m cmucExs� SWIMtvIlNO POOL WATER SOFINER ($35) _ CLOTHES WASHEIi �KI'FCHEN S1T}K _ WATER CLOSBT BACKFLOW PREV. ($15) DISHWASHER _ LAUNDRX TRAY WATER T�EA'CER {$35) � FOR IiiRIGATtON . _ WA'fER ME'FER ", OTHER . .. :.. ............... ......:...- - . . . . ,. . .. - - � *�> -;n r;�, yUlY.y�s ..y.... . . . ... �.. . . � rr . 3:' ' ''« . cr :f ,�` �... �.�: � � .Z�....p, . , : �J��1?�:�` %�Z.r• ��(��':;, ��...z`�; %%;�:. �.•�:,sL <,..�.;::�- ti a...�w• .;�; • r.: :� . . � i�� ....�..>...... �. •flair�`..!x,;.:F�;,'•??:-:..:i'+ya '�;;��d �Y&Sw:r1.� �'i�tr� C•"�P . .. . .. r , .,� �� .. . >: .. ..:. .a...-�. :�..:.:. . .. ... .°��: �: .. . � � � �� : t. ��=P�� ......: : :,�`.'O�?:,�R;��O`;: : � ........... ...... .........- ...<>. ... . ,.;. .. ..... ...... . .. ... . . . ..:.... . . . .. . Permit Fea . $ 35 .Q� Number of fixtures @$10.00 x�10.00 �$ Surchar e .50 Number of fixtures @$15.00 x$15.00 =$ T�TAL DUE $ 35 .�Q Number of fixtures @$35.00 x$35.00 =$ State Surchazge = $ .SO Total = $ i'HiS iS AN APPLFCATIOAI FOR A PERMIT NOT VALID UNfIL PROCESSED T hereby apply for a building permit and T acknowledge that the information above is coraplete and accurate; that the work wiil be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Consfruction Codes; that I tuiderstand this is not e permit but only an application for a permit and work is nat tt� start without a penmit; that the work will be in accordance with the approved plan in the case of a v ork wliich uires review and approval of plans. SICiNANRE OF APPLJCANT �� PRINP NAME Wendy Nelson DATE tig��7 .::. ,.� , _._ .., ..... ;. ._ _ . - - - • - ..... - : s- - , :::t''.'.::. ; Yc �,'�i.L�'. : ��1 �, .;. •. � '�� 3 . D �rc''.'�yq�i„ s :y�;�-�:+y�� Y�,r.��.Y•�;..'; r�g��u:' �.,.t>�r'�a ::.i��?.� :..Sy' ..'n ' . .�.:".s �t''.�.�. .i��'� ��.� '.��' ��Jr'�.:.,,..�2�,r' i k�% ;;1vl�lyil7i.�d.l`r'1,19:+ :;�;x' � . . . , , . . . . . .. . . . . .. . ... .. . .: S ... �y i . . .... .. . . ...... . . ' . : . .... ... .. ... .. . � . �• 'i'� _�l City of Fridtey Buiiding Inspections Department 6431 University Avenue NE, Fridley, MN 55432 '163-572-36t� FAX: 763-502-4977 „,, , � �� , , , , ,�, , , ” From: 6127246656 Pa�e`2/2 ,�v�Date: 10/6/2008 9:47:09 AM �` , � , , Building MECHANICA�., Permit No.:_ Inspections RES�DENTIA.L APPLICATION �ceived Sy: 763-572-3604 S1TE ADDRES5 � TH1S APPLICANT !S: OWNER! TENANT O OWNER CITY OF FRIDLEY YOUR �•MAIL ADDRESS TF�Z{P .�3' I:Vlrricw�: a a.rn �pMPANY idAME: : •. SUB1t�IIT A COPY OF �NTACI" PERSOIV' /' � YOUR STATE STATE WCENSE # � EXP DATE /�" '+� L10E1�5E WITH AADRF.SS: 35�� S+N �� I t'� CRY ��S"�'A'r6%�1L��'e APPL1CATlOId PHONE C�/�. •�d9- S�4r FAX �• 7" % Ld'��i - PERMIT TYF� 5�� F�wnLV CJ 1W0 FAMILY TYPE OF WORK: � �W �p�CEMENT DETAILED DESCRIPTIO,TIOF WORK ❑ TOWNHOUSE O AL'f�RAT[ONtREM4DEL PER MS 168.665 the parmit fee is u aoiaimam oP SI5.00 or S% of the total cost np to $500.00, whichever is greater, for the improvement, instaliation ar replacement �f a residantial fixwrd� excluding the fixtures. (This should reflect only the cast of labor ) Labor cost under $300 �$15.00. Labor cost between $300 ta $500 m cost of labor x.OS � FOR PR�J�CTS WHER� LABOR EXCEE�S 55�. FEES ARE BASED QN $lO.OD PFR FIXTIJRE, SXCEPT WFiERE T!O'fED. FIXTUR&S: (iNDICATE 1'�TAI. NUMBOt OF EACH BELAW} ;�� p�L: s� g� y�g� �p� �quipment 1�tatfed MF(3: �i�A�- S12ElB'TU MFG: ,T„_,_.� MOD6l.: ___r_.,__ MpC3; MODEL: SIZF,/BTU —..---� ac �s.00 �R��F.PLACE ((3AS) 515.00 ons �nrta�rav� sia.00 �A1R TO A1R EXCHANtiEER 515 FIREP4ACE (WOOD) S3S.00 _NEW OAS OR1LL 510.00 �SOiLERS35.00 lFURidACE $35.00 =GAS UNIT HTIt SI0.00 �C1iTNIWSY LII�tER 510.00 4AS DRYER �10.00 POOL N£ATER 535.00 DUCT WOR1C 510.� CiAS P1PM0 $IO.QQ VENTILATOR SIS.00 ---�� -_ _ ! N Permit Fee $ __ Number of fixtures � 510.00 x$10.00 =$ _ Surcharge $ : •5� Number of fixtures Q$l 5.00 x$15.00 =$ TOTAL DUE $_,,,_;,_. Number of fixtures aQ $25.d0 x$25.00 =$ Number of fixtures Qa $35.00 � x$35.00 Q S� State Surcharge = $�.� • Total � $, 3�. ,.5� rHts r� Ar1 APPLtCATtON FOR A PERMIT•NOT vALtD UNTIL PROCES5ED I,hereby apply for a building permit snd 1 acknowled�e that the infprntation above is completc and accurete; that the vaortc w�11'be in coaformance wi�► the ordinances and cqdes of the City of Frtdley and with the Minnesota Construction Codes; that 1 und�rstend this is not a permit but oaly an application for a permit and work is not to start without a permit; that the work wiU be in accardance with the appmval plan in the case of all work which re ires r,eview and approval of plans. SIQNATURE OF APPLICA1dT PR1NT NAME �I��v�to�'I �s4r l�a DA'I'E �:.� '�� ; ' � ��ity of Fridley 6�31 Inspections Department � Avenue NE, Fridley, MN 55432 763-572-36d4 AX: 763-502-4977 �