AF - 37964City of Fridley, Minn.. ���� /
BUILDING PERMIT NO 7320
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LO TIO , OF BU LDING
No. ������ Stt�eet _�� .r. � ���Part of Lot
Lot —,� f—•-- Block _—._a� Addition or Sub-Divi �� �ill.�` - �.� .��
Corner Lot _ Ins3de Lot �� Setback _��._ Sideyard � ���
Sewer IIeval3on ..��Q� � _ � IIevation � � � • ��.6
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DESCRIPTION OF BUILDING
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�- Front -�� Depth � Height � S4. Fw �J�=-l-� G�. F't ���
t� Depth � fTeight .� Scl. Ft _�,,�.5 C�. F't �
7.j►pe of ctton� F�t. ��� To be Completed
In c�anaideratlon of the fsauance to me of a permft to ���uilding descri to do
the P�P� work in accordance with the d�scription above t f aad in com ons of
or8inances of the dty of FricIIey. � /_
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In con�fderation of the paqment of a Pee oE ��`� , Permit is hereby granted to
to conatrvct the buflding or addition as deacrlbed above. Thia permit ia grant,�d uPon
the express condition that the peraon to whom ft ia granted and his agenta, employees and worl�en, in all work
done fn, around and upon said building, or anypart thereof, shall conform in all respects tfl the orrlinanceg of
Fridley, M3nnesota regarding lacation, conatructfon, alteration, maiatenauce, repair and moving of bufldinge
within the dty ]imiffi and thia permft may be revoked at aay time upon viol�i,on oP any of the provlaiona of seid
ordinaac�s. .-� _ �°D / /
SuilciinS Inspector
NOTIC�
'16b � dea eot cersr f6s coesfrudi�, I�allaNee to� �ririne, plumbing, en huftne, aw�r w vrnar. 8� sure to a�
Nro Btttldiep lesp�eter fs� aputlr pum6s /er f6a� tt�ms.
Owner's
lddresa
9PPLIC�TION FaR BIIILDING PERMIT
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BIIILDING
No. ��r��„L_,Street.( %�.���� / %��• �/ Part of Lot
1��'....��.��
Lot �� Block _ ,� Addition or Subdivision —
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Corner Lot � Ineicle Lot 3etback ��'g -� 3ide-Yarci f� : O�" /�,—O
SEWEA ELEVATION F�IINDATION ELEVATTON
�pplicant attach to thia fo=°m Gertific�.te of Survey of I�ot and proposed build�n�
location.
DE.SCRIPTION OF BUILDING
Type of
To be Completed
� . /� �� Cu.. Ft.
v Sq. Ft.
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FrantfZ��,Depth,�,�S� Height_ �—/1 _
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sq. Ft. S� 5 Cu. Ft.
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The undersigned hereby makea appl3cation for e pern�.t for the work herein specif3ed,
agreeing to do all Work in strict accorda.nce with the City ardinances and ruling of
the Departmeat of Build9.ngs, and hereby declares that all the facts and re entations
stated in thie a lica on are true and correct.
DAT� SIGN�ATUI��
(A Schedule of Fee Costs can be found on the Reverse S3de.)
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BIIII�IlVG P�I�T F� SG�DDI�
4ec-tion 2e Tho Inspe��or of Bu�.].cling� ohall, before issuing at�y perm3t for the
e�'^ection of ar�► building or structure, or for any a.ddition to sn�r exi.s'rit� build-
3.ng or struc�ture9 or for_ an�r �ltsrationa or repairs to arig �xiet� building or
s'�:ucture, upon a�+plic�tian thorefo� , require the pa,yment by the applic�at for
such permit of feas to the �ount herei� below aet forth and ia the maaner berei.n
provided ta-wit:
2e1. For a�g such par,�t �ar tL� e.rection of a.ny f3re-proof building, oth� t.�e,n
a garage, ware?�ou�e9 Sac�ar� �r ��i� olevator, or for the erection of any► fir�-
proof a.ddi-tion, far s��:i1�.r occ•�;��.nc�r, to �ny existing buildin� shall � at the
ra�te of �1 olf0 for eaoh ox�e� �:���;:�.�r_:� c:a��c fe� �, or f'ract3on thereof � 3n such
cubi��1 cont8ats.
2�2, Fcr s,�y st:..�.:� p?r��-t �'�:� �u� e::',3c;•t��.�:1 af any fir�proof garage, w�rehouee�
f�.eta� os° gr�.:�.n �le�afi,ar; ^� f:��� -,ha FT��t s��± o:.' a�� f°3.ro�roof addit3oi�� �os
s�i3ar occup�ne�, to ��:�is��ng ?�:ulc�ing s}lsl]. be at the rate of �]..a5 �or
eae!� one. thcu,a�d cabic feEt, elas�'"=i`°ied a� "fir�proof" by Sectiot� 502 of '�he
M:.nneapolis Euild3xtg Goda o ;
�i�U��,i
2 e 3 a Fo�° �.ny such pe..+°�.it for the
::i�=.�1 � `�u 3A'89 w�*2�10us9� faC't01'�
F::.: � ifi�, c::j � fcr sirl:.la.: occup�.ncY�
e:>.+:�. e�.�� t::ou��.nd cubic foete
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erection of a.r�r non-fireprooi bui].ding other
or grain elevat�r, or aqq non-fireproof
ta any existing vui7.ding. Perm3t �]..QO Sor
��.�o �'�r �ny s�ach pErmit for the eraction of ex�+ no�f'�reprooi garage� wasehon�e,
�'� �;to� �r or �raa.0 eleva �oP y or for the erection of an� non-fireproof addition, fa�
��s�ilex occup�n�� , to F,.n� existing build3ng or for 88Ch 811Ch �.ZCI3.L� OP 8.dti�'F.�1.
:a:.�.e'cy Cant3 for e�.�h o�e t�ousand c�ib�c feet or f`.raction thereof, 3n the cubicxt'1
�a��ents tharc�of w=�h a z�:L-��.mi�a of �/.��OOe
For the purpr.:.,� ��" coriputin;; fees for building permits the cubic�7. c.ontente of atc�
�'ai.l.ding or a�dition to a����ara hoight throughout by mult3ply3ng the ground areei
covered from a point srx (6) in�ches b91ow the floor line of the basement or aeller
t,o tice avo�age ho3�ht oi tho up;�er surface or to the average hei�ht of the roof
eu.rface of the main �able of a pitched roof,
2e5e For repairs or alteratio�s to an existing structure, the f�e shael7. be at the
rat9 of �3°00 for each Five Hundrod D�llars �(�500e00), or f�°act�.on th�reoY in the
cos� of all proposed works
2a6. In no case shall the fae cha�ged for any permit as set �orth in �c'C9.on 2 be
less than �4.00.
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cests�icate o� su,��� fo: - E E. M DEYELO�MF.I�IT CO
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O DENOTES IRON —UENoTES DRAINAG�. � UTILITY EASEMENT
LOT 1� BLOCK 2 MELODY MAI�OR 2'''—D ADDITIO�I
t'�noka Coun}� – Minn¢�o-�-a�
/ hvpGy cerfi�i� � Ihis �s o frue �d mrrtcf re�esenfofian o�'a srNwttf �'1Mt dnrm�o�es �'�e a�a►r aEur�bed /an0, and
o�lYx lawt"iu� u�'a/f 6vildin9s , fltiean , m�dd! ris'�6/e oxrnodimarfs , i!'an�, {rnn or crrsaid /and. As surreyed by nae Phis _ cby
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SUBURBAN ENGINEE2/NG , /NC.
0 E� ��3 E Sur-r�oi's
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"ty of Fridley, Mirm.. N° 7708
BUILDING PERMIT
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Owaer: �Jnhn TnhnvtnII g�� �,`lemron�, TZiC.
Adaress �3�1 Concerto Cu.rve A� 701 Col�b3a Bl�d.
LOCAT�AN OF BUILDING
x�. 73�1 s+�t con�erto t� .�. Part of Lot
Lat 17 _ Block 2 Addil3on or Sub-Divisi�► --MeZE3d,� M�riOr� ?..nd Add.
Corner Lot — Inside Lot Setback Sideyard
�� II�'8�� Fotmdal3on IIevation
DESCRIPTION OF BUILDING
To be vsed es:
Front DePth Height Sq. F't. Cu. Ft
Front Depth ITeight Sq. Ft Cu. Ft
Type of C.onstruct!ton F.�t, Cost ��,__ To be Completed
Storm Damage Re�sir: Hebuild oa egtsting Fo�andat3on
In cron�deration oP the issuance to me of a permit to constru bwllding descri e I agree to do
� P�Posed work ffi accordance with the d�scriptton above o aad in all pra�viaiona of
ordinaaoes oP the dty oP Fridley.
In consideration oP the paqment of a fee oE $ 10.Q�� �t �s hereby �aate� to Clemroa, IAC.
to construct the building or addition as described above. Th�lapermi t is giaated upon
���o�d � that the person to whom it is grantQd and hia agents, employees an� worl�►en, fn a11 work
upon eaid building, or anypar� thereo� shall coaform in all reBpects to the or�linances of
FridleY� Mfnnesota regarding location, construction, alteralion, maintenance, repeir and moving oP buildiuga
ordinan� d� �ts and thia permit may be revoked at arp► time upon violatlon of aqy of the provi�lona oE said
�.8Y1 JEII88II B��S �
^ NOTICBs
'1hb psemlt doa eot �rar t6s �es�alloe, � Mr trhte8, P�+�& ib
����din8 �r ter qW►+b p�emhs tor t6a� h�ms. �°� pwu or wtlsr. B� ane �o as
O�R' S
AIIDRESS
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APP°LTCATION FOR BUILDING I'E^'�]IT
CITY OF FRIDLEY, MINNESOTA ,
LOCAZ"ION OF BUII.DI.�TG
No. �
of Lot
Lot � Block �� AddiCioa os Subdlvision �
Corner Lot`�Iaside Lot � Setback Side Yard ����.s( �-�'� —'�
SEWER ELEVATION FOUNDATION ELE9ATTON
Applicant attach to tbis form Two Carti�icates of Surveq of Lot-aad preposed i�ui�.d-
ing location drawn on these Certificates.
DESCRIPTION OF SUILDING
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To be used as; � �� .�����' �ia�
Front lG�s.th Seight
Sq. Ft. Cu. I�t.
Front Dapth Hei�ht
_ Sq�. Ft. Cu. Ft.
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Type of Constructian Eatimated Cost , ���-,_�
To be Completed
The unders�gned hereby �akes appiication for a perm�tt for the work herein specified,
agreeing to do all work�in atrict accordance with the City cf Fridley Ordinaaces aud
ruiings of the Department of 8uild3ags, and hereby declares that all_the facta and
repsesentatioas stated in this appl3cation are�ti-ue and correcC. �,� :
./
DATE
��5chedule of Fee Costs caa be found on tbe Reverse Side).
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BUILDING PE:@N�T FEE S(�lEDULE
Sec�ion 2. The Insgector of Buildings shall, before issui�g anq ne�ni.t for
the erection of any buildin� or atructure, or for say addition to any �aiat-
ing building or strucCure, cr for any alterations or repa3ra to any exis�izag
bu3lding or s�ructure, upon applicaeion therefor, require the pa3ament by ehe
applicant for such permit of fees ta the amount herein below set fortiz ard
in the manner hereia provided to-wit:
2.1. For any such permit for the erection o.f any fire-proof building, otiner
than a garage� warehouse, factory or giain elevator, or £or the erectiora of
a,ay fire-proof addition, for aimilar occupaacy, to any esisting building
ehall be at the rate of $1.40 for each one thousend cubie feet, os fraction
thereof, in such cubical contenta.
- 2.2. For any such permit for the erect3oa of any fire-proof garage, warehou8e�
factory or grain elevator, or for the erectioa of say fire-proof edd�Cion,
for aimilar occupancy, to anq ex3ating building shall be at the raCe of $1.25
for each one thousand cubic �eet, classified as 11f3reproof" by Sectiea 5G2 of
the Minneapolis Building Code.
HOUSES
2.3. Eor any such permit for the erection of any noa-fireproof buildir..� s�¢i�er
than a garage, warohouae, factory or graia elevator, or aaq non-firep�c��
addition, for similar occupancy, to any esisting building - permit $�..0p for
each one thousand cubic �eet.
G�3
2_,4_, For aay auch permit for the erecr.'�-: �: �st� �.�n-�:�,.?�rc�o€ gaxa�e,
warehouse, factory or grain elevato�, c�•� r;,� �-,.,;. �.�F;:-�;:,��;, �� ��� nou-���r. pYCOf
additioa, �or�-s3milar occupsacy, to =,-,,; ;�;::�, �, ::tr.; ; i��: :..F.�;,_�g o.: �or each such
., _ -bni.7,ding or add3tioa • ninety rP�;::; ��;�; ,^�,��; ��.� �,..: ; Q�e tihc��and cuUf� feet
or fraction thereof, in the cc��bcG� ,.;��� :.�:��� r;�a�,��� with a minimum of $4.00.-
For the purpose of caanputiag fees f�i ��_:�.r,i;n� pprr�a��8� the cubical caxateats
of any buildiag or addition to a un��c�.�a ��a•W�fzlt thr:��:�,hout by multipiy�ng the
ground area covered from a point six (6) i:m+�:3es bQ]. sca the floor liue os .:�he
basement or ceZlar to the av�rage height of i.:,�� e�i�cler su�-�ace or to the �
average height of the roof surface of Che main �aule of a pitched roof.
2.5. For regairs or alteratioaa to an exiating sCructure, the fee shall be
___�t ttie�rate of $3.00 per each Five Hundred Dollars ($500.00) or fraction
thereof in the coat of all propoaed work.
2= Ia no case sha�.l the fee._char�ed_.for,.aay perm�t ,� eet forth in
Sectioa 2 be 1esa. thaa $4�pp�
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8431 UMIYER�I7Y AVENUE N.E., PRIDLEY� MINNESOTA 55a32
, 7�LEPHONE ( 612)S71•'s450
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Lot Block Addition
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P�COP.n OF OO�i�I;1:,IC�TIO��:
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sue�ecT PERMI
City of Fridley ° 1612 2
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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� � R CEIPT NO.
� `L _ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. � �Q
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� � ����1 � CITY HALL FRIDLEV Sb432 NUMBER REV. DATE PAGE OF APPROVED BV
�""'� � ,�� 612-571-3450 910-F15 4/16/81 � /
JOB ADDRESS 7381 Concerto Cnrve N. E:
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ],% 2 Melody Manor 2nd Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Robert Vogel 7381 Concerto Caxve N.E. 786-5318
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Dolphin Pool & Patio 8832 - 7th_Avenue North 542-9000
4 ARCHITECT OH DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS Z�P PHONE LICENSENO.
8 USE OF BUILDING
RG'S1.CZP.S1.'tl�. �.
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
X
8 DESCRIBE WORK
Construct an In-ground �ing �ool C16' x 34'� '
9 CHANGE OF USE FROM TO
STIPULATIONS
See letter dated 4/16/81 Yay Enviro�ental Officer for stipulations.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 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 COMPLIEO �S`%� QO� $3. �JO
WITH WHETHER SPECIFIED HEREIN OFi NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF NY OTHER STATE OR LOCAL LAW REGULATING coN- $42.00
STRUCTION HE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
� �," „� `� l�� '� � $45. 50
SGNATUREOFCONTRACTORORA OR12EDAGEN7 IDATEI ay1J N PRO E Y A IDATED THIS IS YOUR PERMIT
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SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI BLOG INSP �ATE
O
. cxrv or �«io���r .
, � A('PLIC11TI0'd FOR Rl:SIf)l:IdTIl1i_ QUILDItlG ('EF��IITS
(tJEw, 1111er.�tions, lldditians, or Repairs)
� 44JI�E R : �O�L�� �/O�',��
ADDRESS: �.�?�'� G4NC��TO CUlZJ��
r�� n;o: 7�G� �31�
�UILQER: ,QOGPyf'J�C + ��o
/tDDRESS: �.�o? ��./� /'Va .
r�� r�o: �SS�oz - 90 0�
Construction Location '
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LoT: / �% . si.oc�c: �� AnnzTZOrr : ���OQy .LI/?� �?'`� �
_
Corner Lot: /' Insicle Lo�: SetbacY.: Sideyards:
..�,.�..
Ap�Zican'� at�.ach to this form tcoo Cer�ificates of Survey of lot and
. proposed building location drawn on certificates to scale. �
� ,�U1M. M►'19� �°Ol DESCRIPTIOtd OF CQFISTRUCTION - �
��'h � T, Tront: • Depth: Heiqht: .
Squane. Feet: ,j � Gtil�ic Feet:
, Front: Depth: � Height:
Square� Feet: � Cubic I'eet:
�.'ype of ConsLruction :-5����1�'� /'"9� L Esi.imaL-ed Cost: $%DQ� 9�
Rb $e Oor,�p2eted: ��% � /�a � � . .
` . . � Alt. A Alt. B
Propvsed Drive��ay Ldidth if New Opening Is Desired: $' $
, . .. SEE Re^,VERS�; SIDE OF SHEET
7.iie undexsigned hereby :nakes applic�tian for a permit fcr the �:ork� hexean specifi.ed,
agreein� to c?o ,all wark iri str�ct accardance with the City of I'ridley Ordinances znd
rulings ot i:lte Depzrtme.��t of IIuildings, and hereby declares that all tlie iacts and
representatioi�s stated �i th.�s applicatian are�rue and correct.
D:iT�: � ���`�) SIGN7ITUFJ::
SLii�u].ations : �
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:;),C'1'xO1J 2. � 7.'l�� 7n�.:��ccL•c�r. of' )3ua.lc?a.�u�.^. ::1i:i7.]., betor.c: i.;�.ui�ic� ��ennit;� !.'or �hc arr.cL•i.on
uf ��.»y 1�u:i.J.�l.in�� az :�t:�•uct:urc, �r. fo�: [xny adcli.t:i.��n +�o a>>y cr,i::L•i.»� l�uilding oi :;tzucL•ur.r_,
, c»- l:��� t�ny tll.t.cr�ti�;�i nr. r.c��air.:; lo •..zny c:;i.r.t:iiicJ J�ui.).di.Jt:J ox st�:ucttirc, u��wi ar>J�1i.catS.o�l
�t}icr.�for.c, r.cqu.i.i:c tJ�� na}►mcr�L• by t]�c app].i.cant: �or. such per.mi.L- or f-ecs L-o thc arn�unt-
hcruit� bcJ.oa� sct f•or.th �u�d �.ii �lic �aannc�: hc�:c.i.n ��rovi.dc:cl L•�-�:5.t: - •
I�11:1•I COIJ�`P}:UC'xIOt�: Sing7.e l:'�zmil.y Ilorac:� and Gar.acres: Y4.00/),0�� cul>xc �ec�:. •
�'LAt� CII):CI:: ?.5 l�r.r.cei�t: ot bu�.laing j�cr.mii: iee.
D1tT��1:I:RY llL•'L'P1:5SXOi•l: (CvncrcL•q GZirb SL-reei:s Only} � �'
' A].t-einat:e A: Itc:moval and rej�lacentent of concrete cuxb and
yuL-L-er only; I�riveway �•�idth plus 6€eeL• x$13. �0
117.i:ernaL•e II: Removal and replacement of concrete curb and
. guL-ter and iii�tall a 3 foot wi.de approach c��ith �'
' ,� 6 inch depth; Driveway �•�ic:th plus G feet x$15..75
• � . AnDi �� onn�. 1 n�ro►���n-r r os�
For the purl�se of compuL-i.ng tees for building permits,• the cubiea� coi;tents of any
build5.ng or. addition, a.s determi.ned by rnultiplyir►g the ground area covcred fro� a
p�S.nt six (G) inches belo;v the i'loor 7.]_ne of the basement or th� cellar to ti�e
average hei.ghts of the •upper sur.face or L-o ihe average i2eight af the roof surface
of the nain gab].e of a pitched rooi. �
Fox repa3.rs or al.terations to an existing stntcture, the fee shal]� be at the rate
of $3. QO �ier. each five hundred dollars -� ($500.00) or fraction tliereaf in the cost
of all proposed wor.k. . , -
Yn� �no case sha.'.2 the fce cliargeci fc�r any pennit as set iorth i.n 5ection 2 be less •
than $7.50 pl.us $.50 state surcharge. � ' • '
• � VERIFIC�TIO� OF F(1U;�[l7�TI0fd
NOTE: Permits �or construci:ion ���ill be issued a minimtun c,i 24 hours from tlie time
of aYplication to al.�.o�v for �ro�er revie�� of the pro�sed sixucture and oi ihe
construction site. �
; ,
A Certificate � of Survey of the lot, sho�va.ng the locati.on o� �he foundation once it
has been cons�nictcd ��*ill be required bef�re }�r.ocecdi�ig ��ith the framinq.
�RT I F I CI�TE �F OCGUPAI��C� ' '
' Arplicati.c+n for a Certificate oi Occu}�ancy shal.l be mad:� ten (10) days prior to the
u; e or occura►icy oi any siructure for �ahich a?.iui.lcliiig permit }zas been �ssued; and
s:�id struct:u�-c : ha].l �iot be LLSed or. occu�ied L:iiL-il a Cert�.fica'�e of Occul�ancy has
bcen xssucd.
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`� jt� ��� � TELEPHONE ( 612)571-3A50
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�L� � f�`�� �, April 16, 1981
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Golden Va1Zey, N.�T 55427
' Re. Swiwming Pool Construction at 7381 Concerto Curve N.E.
Dea.r Siss :
This letter is to make clear thi:s department's requirements for the swimming
pool construction at the alinve address.
1. As indicated, two (2). skit�ers approved by the National Sanita.tion
Foundation will be provided.
2. As indicated, three (3) inlets of approved design for fresh and/or
repurified water will be provided.
3. As indicated, a main drain of approved construction will be proaided.
4. The filter and ptunp shall f�e approved by the N. S.F. and be of
sufficient capa.ci:ty to provide a minimum turnover rate of at least
two (2j_ times in 24 hours. This department recommaends a ttirnover
rate. of 6- 8 hours.
5. A deck of at least three (3} feet wide, measured from the pool waters
edge shall be provided rnrhich extends completely around all private
residential pc�ols. Above ground private residential pools may be
provided with decking of a minimum size of 4 feet by 4 feet at pool
entry points and provided that such decking has the approval of the City.
6. The diving area will be acceptable provided there i,s no overhead
obstruction.
7. Fencing or other effective means including but not limi.ted to walls
or buildings, acceptable to the City, shall be provided ta positively
control all access to public and private residential swimming pools.
Fencing sha].1 meet the following criteria:
(a) The fencing shall prevent the entrance of children and be without
hand or foot holds that would enable a person to clir.►b over it.
(b) The fencing shall be at least .6 feet Yv.gh and. entrances shall be
� equipped with self-closing and self-latching gates capable of
being locked.
(.c) Self-closing and self-latching devices shall be placed at the top
of the gate or otheYwise inaccessible to small children.
(d) The opening between the bottom of the ience and the ground or
other surface shall be not more than four inches.
8. An automatic chlorinator should be provided with a suitab�le test kit.
9. All electrical and pliunbing installations shall be inspected and
approved by the City Inspection Department. .
Dolphin Pool & Patio�
April 16, 1981
Re: 7381 Cancerto Curve N.E.
Page 2
10. All overhead electrical lines must be a minitntun of 10 feet horizonta�.ly
from the pool surface and 18 feet straigfit line distance from the waters
edge. An alternative is to bury said lines.
11. The pool fill spout must be protected by a vacuum breaker or air-gapped.
12. Suitable safety equiganent to include but not livaited to a ririg buop
and ro,pe that is l� times the pool diameter, and shepherds crook_pole
must be provided and maintained witEi the pool at all ti.mes.
Furthena[ore, these and any other requirements must meet the provisions of
the Fridley City Code, Section 115, Swi�ning Pools. The building pe�n�t is
approved Gontingent on final inspections and approval by the City.
I� any questions or problems arise from this letter, please feel free �o
contacfi me at 571-3450.
Sincerely,
STEVEN J. OLS�T, R.S.
Ertvironmental Of f icer
SJO/mh
CC:. Robert Vogel
Z381 Concerto Curve N,E.
Fridley, N1N 55432
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:fi/ btfeby cufi�i� f,� fhis is o Irue Q.d corrrcf ��Presenfofion r.�'a sra�-r�i/ 4r','Yx Sa,►,do�ies o,('f/ie oborr ot_srr�oed ;a?d, ond
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Aprrl A.0�9b2_ y ���� _cfilf
, � SUBUR6�J'J ENG/NEE.QlNG, INC.
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EQUIPMENT SPECIFICATIONS
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POOL DATA:o
R �,` Pooa Size & Shape ��.s'�~ Turnover Rate � Hour�
c�� '�urface A�►ea Sqo F�e Rate of F1ow GI'M
" � Capacity Gallons Perimeter LineFt.
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.": B07PTOM MAT�F�IAL ,��
:; � �: F�LTER �°- oo � e�"� �
-, `` ;`` PUMP & MOTOR �' /'� .e�� �'
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r.. ANCHOR .CUPS � � ESCUTCHEONS ,�,n�
� ``' ' I�IVIN(� BOARD �'
" '� ST�IDE . ��s.�',.�,�� ,sC'��st�.�C"/�,.�a�'��
'� ,. FOOL I,IGHT °�`°�= ____,,,,'°� ECK BOX s �
`'' �� � MATNTENANCE KIT .�� TEST KIT �
' . iT,ACUUM KIT �,� WALL BRUSH �aS
� l�UTO �OOL CLEANER WALL FITTING ��
bdINTER C OVER �` r��..�,. S OLAR REEL —
SOLAR COVER - -
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CONCRETE FOOTING _
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The Auto-Skim — a truly versatile, large capacity precision auto-
matic skimming mechanism fior residential and commercial pools
— manufactured to Hayward's high quality standards.
The Auto-Skim is molded of 3/16" thick rugged Cycolac and has
no joint below waier level ... it's non-corrosive, non-conductive
and virtually indestructable in any clima�e!
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SP-1084
FOR VINYL, F. G., STEEL,
ALUMINUM and WOOD
POOLS
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MODEL PIPE �{ MODEL PIPE
NO. SIZE DESCRIPTION �1 NO. SIZE DESCRIPTION
SP-1082 2" Cycolac Body, adjustable cover ; SP-1084 2" Same as SP-1082, but with 8�/z"
collar. Tamper-proof cover, besket, Ij throat, Cycolac face rim (white),
SP-1082-1 1�/z�� Weir, Flo-control sllde plate. �:I SP-1084-1 ���z�� mounting flange for wood poollsed
SP-1082-1R 1�/a" dj meter ROUND co ert oit ll u�st/ f� SP-1084-1R �'�a�� d ameter ROUND cio ert oithl ust//
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Sfendard screws are for 3/16'� maz. wall thlckneas
SP-1082-1, SP-10841 have 1%�� pump outJet and 2"equelizer/main drain outleL SP-1086 Wide Track Auto-Skim and PT Seriea
Skimmer illustrated on separete page insert
�EATURES:
Constructed of Rugged Heavy-Duty CYCOLAC
Totellv Non-Corrosive
SQUARE or Round, Temper-proof Cover
Cover Collar Allows 1'f�" Vertical Adjustment ��
Snap-in Weir Adjusts Automatically to 4h" Veriation in Water I.evel
Optional Ext�sion Collar ellows 2Y�" Additionei dertical Heigi�t
163 Cubic li�ch Ftlpld CYCOLAC 13askat
1'h" or 2" FIP Thrends Offer Piping Versatility
� Integral Flo-Control Slide Plate
Optional Skimmer•M�in Drsire Velve l�ssembly
Optionel Sprinp�Loade�l ByRa�/Equaliaer Valve
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CGoldlen Val9ey, �v1N 55427
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�HI� ��—�I6�A ���s�� ���LR P�JMPTM
A new dimension in swimming pool pumps, combining
strong, corrosion-proof space age materials and high per-
formance into one efficient, engineered unit. The result of
extensive research and development, the self-priming
Super Pump has all the features and qualities you expect
from Hayward. From "see thru" easy access strainer and
Service-Ease design to extra electrical integrity and safety,
� the Super Pump sets a new standard of excellence.
Serpvmp: I
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MEDIUM HEAD HIGH HEAD
MODEL HP SIZE DIM."A" MODEL HP SIZE DIM."A"
SP-18� 1/3 1'h" 17-1/4" SP-1808 3/4 1'h" 11-7/8"
S'P-1605 1/2 1'f�" 11-5/8" SP-1811 1 2" 12-1/4••
SP-1607 3/4 1'h" 11-7/8" SP-1818 1'f, 2" 131/4••
SP-1670 1 1'h" 12-1/4" SP-1621 2 2" 13-3/4••
SP-1816 1'h 2" 131/4•,
�oDEPENDABLE. HIGH FIOW PERFOI�MANCE
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GALLONS PER MINUTE
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� Heavy-duty high performance motor with air-flotRr veniil�tion ,
for cooler operation and maximum dependability. Built-in
automatic thermal overload protection. Electrically isolated
and insulated from pool water for extra safety.
� All components molded of rugged, corrosion-proof fiberglass-
filled resin for extra durability and long, long life. This mate-
rial gives high strength and heat resistance characteristics
and is immune to all types of pool chemicals and water. Inte-
gral super-size pump-strainer housing has extra air handling
capacity to assure rapid priming and continuous operation,
even under extreme conditions.
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parts. Motor and entire drive group assembly can be re-
moved, without disturbing pipe or mounting connections, by
disengaging just four bolts.
� Heat resistant industrial size ceramic seal. Long wearing
and 100°/a drip-proof.
� Totally balanced corrosion-proof IVoryl impeller has smooth,
wide openings to prevent fouling or clogging. Engineered
for maximum performance-tuned efficiency.
� Unique mounting base provides stable, balanced, stress-free
support for motor and pump, plus versatility for any installa-
tion requirement.
� Super-size 110 cubic inch capacity hair and leaf strainer
basket gives longer time between cleaning. Rigid Cycolac
construction and load-extender ribbing assures free flowing
operation for even the heaviest debris loads.
� t'� Exclusive, Swing-Aside hand knobs make strainer cover re-
moval easy. No toois required ... no loose parts ... no
clamps.
�Clear Lexan� Full-View strainer cover lets you see when
basket needs cleaning ... eliminates guesswork. Tab-Lock ^
design and special self-adjusting seal assures positive seat- ' 1
ing and dependable sealing.
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900 FAIRMOUNT AVENUE, ELIZA�tETH, NEW JERSEY 07207 / Phone: (201) 351-5400
Super Pump !s a trademark ol Haywerd Manulacturing Co., Inc. Noryl and Lexan are reglstered trademarks ot General Electrfc Company.
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A high performance totally
corrosion-proof filter series that
combine superior filtration and
features with ease of operation.
Designed with the pool owner
in mind, the S-200 and S-240
filters produce clear, sparkling
water with only the very least
attention and care. From "see-
thru" dome and maintenance-
free construction to convenient,
easy-to-use control valve, the
S-200 Filter Series is the ulti-
mate in high rate sand filtration.
� Averue No�
oone bahiu�l Perlci0i�
900 FAIRMO�N�
, �.� ,�� :s `��� v
�. � .r
�iAR9d1A� AIR ��LIE� for easy, safe manual re- �
lease of air from system. �
e
FULL VIEW LEXAN° DOME. Clear 6" threaded
inspection dome lets you see operatfon of filter
and provides convenient access to top of filter. /"�
� �
TOP DIFFUSER, Assures even distributlon of water
over the top of the sand media bed. All lnternal pip-
ing is 2" to give smooth, free-flowing performance.
s4UTOMATIC AIR RELIEF. Automatically purges
filter of any entrapped air during operation of the
filter system.
CORROSION-PROOF, HEAVY-DUTY FIL�fER
iANK. Injection molded of tough, durable Cycolac�
for dependable all-weather performance with only
minimum care.
[80LTED CENTER FLANGEo Provides extra
strength and securely and safely fastens tank top
and bottom together. Allows for future service ac-
cess to all filter components without disturbing
plping and connections.
(�-POSITION HAYWARD VARI-FLO CONTROL
dALV� with easy-to-use lever action handle to let
you "dial" any of the 6 valve/filter functions. FIL-
TER, WASTE, BACKWASH, RINSE, CLOSED or
RECIRCULATE.
�1NION LOCKNUTS make assembly or disassem-
bly of the control valve easy.
I�FFICIENT IIAl9��B-�ii���� �lN������aIN AS�
SEMBLY. These precision engineered, corrosfon-
free, self-cleaning laterals give totally balanced �
flow, even when backwashing. Laterals individu-
ally thread into center collector hub to assure
posittve sealing, and allow for fast, easy servicing.
SUPPORT SKIRT. Rugged and attractively styled
to provide strong, stable support for the filter as-
sembly. Totally corrosion-proof, too.
DRAIN PIPE ASSEMBLY allows for total draining
of filter for winter or service. �/a" garden hose con-
nection thread for easy hose attachment. Drain
assembly is replaceable from outside of filter.
ALL FILTER COMPONENT� are serviceable using
only a screwdrfver and wrench.
The S-200 and S-240 High Rate Sand
Filters ere available with two base options:
1. Standard pump mounting base.
2. Deluxe pump/filter platform base.
The System I I Series is furnished complete with
Hayward UL Super Pump and clear Lexan union.
All components factory assembled on deluxe
platform base.
System I I Series available with '/e, 1, 1'h and
2 HP pumps. Your dealer will recommend the
model with the pump horsepower that will
provide optimum performance, at the lowest
operating cost.
* System II separate components system also available with
choice of Super or Max-Flo pumps, %a thru 2 HP.
CTURING COMPANY, INCo
H, NEW JERSEY 07207 / Phone: (201) 351-5400
Printed in U.S.A.
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CHIMNEY AND STACR VBRIFICATION
The undersiqned hereby verifies that the existing chimney or stack:
• 1. 8as been carefully examined � Yes (� No ( j
2. Is free from rust or deter�ioration ,� Yes () No ()
� 3. .Has no foreign objects lodqed within Yes () No ()
4. Is securely supported Yes (�) No ()
5. Meets all current Code requirements for
size and total BTU�s connected
6. Has total heating BTU�s of
All other BTU�s
TOTAL BTII�s
Remarks
List Alterations Bein Done:
�i
Yes ( j No ( )
. . .
2619 COQN RAP�D� �QULEVARD a [�; ;:, ,;`
HEATING COMPANY
S igned By� �`?
�, .._.
Date . � `.� �:
f=�:
0
, .� .
/., F�OUSE�IEATING TEST RECORD
. � � n �. !',•--'
ADCRESS � APT. fL00R C1TY SUSURd '�� '��'�
OCCUPANT � '� OMNER r,.
i
HEAT LOSS . DATE MTG INST. ` '
� ;
SOLO dY ,�; iNS?ALLED SY .�'.G�_' t,_; �.'[�:: C..x._ �.T ..� !
:
EI.c+.ie.� w«k br � � G.s L��,. Br
TYPE OF MEAT GA fA HM STEAM SPACE MTR. UNIT HTR. OTHER
GAS DESIGM CONVERSlON
MAKE AAAKE Of BURNER �^�"'���^�
Mei�l MbMI -�"��
f /.J�.� --- —Ilif�;-QTli-itifi-�j- — — — - - — —
---Sair6t- - � .
INPUT "�!�G' �� MA�KE OF FURNACE•
t�d�l
Co�yrao� s `� i �
r►+eRMOST� � ��1��»e P�,h v.�� s�:.
Velv Y� KINC Of LIHER SIZE�NONE
Liiw�t � � � 0►�h Me�I �4/�l�i� RN�I�nr
Lin�i1 S�M�n� Fil►«s Sis• f�� y� S w��� I
Fee S.K;n� � G���.r Loe.ri�e inai��_Out�i��
,� , �
Pc1et Tr�. Ci+i�n.r Gonsnve�ion
P�i.� wk. Spillaqe
Pi1N Abd�l Sw»k� s.�► w�.���
Pilof Tin�in� D►oft T��r T��
L.1M. Cut Off r, �^ Dew Pr��aur• Li�A�in� Insr.
Pr��sw� �•; P��e�wr CO2 Do+� T�sad
InN�� CfH Pwe�nt OZ Ce�.nr T•.�in4
Saek T�w�P. `-% PMaet CO New� �f T�s�w
Certificate of Compentency_ �
a
c�ty of F��a�ey
AT THE TOP OF THE TININS
i �
� �
� `y ����� COMMUNITY OEVELOPMENT DIV.
f � � PAOTEC7IVE INSPECTION SEC.
L"-'� ��'�' �. J CITY NALI f RIOLEV 3.SIJ2 Ni
i 612-571-3460
�oe nooaess �381 Concerto Curve NE
1 LEGA� LOT NO. BLOCK TRACT OR
DESCR. 17 2 Melod
2 PROPERTY OWNER MAIL AODR�S$
Bob Vogel
3 CONTqACTOR MAIL ADDRESS
Dahl Builders � Rem. 451 Ma.ple S
a AFiCHITECT OR DESIGNER MAIL AODRESS
5 ENGINEER MAIL AODRESS
8 USE OF BUIIDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION
8 DESCRIBE WOfiK
9 CHANCiE OF USE
STIPULATIONS
»��.
�UIIDiN� PERMIT
IBEii pEV OATE PAGE O�
s�aF�s g/g/gg / /
21P
30194
��
rED Br
SEE ATTACMEO
SHEET
LICENSE NO
50777
LICENSE NO.
LICENSE NO
O ALTERATION G97C REPAIR O MOVE O REMOVE
Call for building wrap inspection before covering.
Provide smoke detectors in all sleeping rooms and on all levels of theyl dwelling
SEPARATE PERMITS ARE REOUIFED FOR ELECTRICAL, PLUMBING. HEATING. TYP� OF CONST.
VENTILATING OR Alq CONDITIONING.
TMIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION. 20NING
AUTHORIZED IS NOT COMMENCED V�IITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED Oq ABANDONED FOR A PERIOO OF 120 DAYS AT
ANY TIME Af7ER WOFK IS COMMENCED. NO DWLG. UNITS
I HEREBY CERTIFV THAT I MAVE READ AND EXAMIN�D THIS APPLiCA710N
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VA�UATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPIIED
WITH WHE7HEii SPECIFIED HEFEIN OF NOT. TNE GRANTING OF A pERM1T .��.�.�OOO
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL TME pEpM17fEE
PROVISIONS OF ANY OT q TAT OR IOCAI LAW REGULATING CON-
STRUCTIO O THE PE N OF CONSTRUCTION $195. ZS
�/,J �/�I PIAN CMECK fEE
C /
Licen C
S�G AEOFCON A TOQOp4UTNOAIZEDAGENT � 10ATE� N �
S�GNATUAE O� OWNEp��� OWNEpBU4DEAi �DAfEi Bi� iN�
OCCUPANCYGROUP OCCUPANCYLOAD
SO. fT CU FT
OFFSTqEET PARKING
S?All$ IGARAGES
.SU
;CMARGE
re SC 11.00
AL FE
is u ae�r
/ � �
06TE �
� , �
r�w � �
ADDN
ALTER
Effective 5/10/99
[ l CITY OF FRIDLEY
[] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUII..DING PERMIT APPLICATION
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RN� ,(�
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Construction Address: 7�j � I C(°j,(,�� �j �� �Q/ '
Lega1 Description:
Owner Name & Address:
Coniractor: !� 1 � (f�
Address:
LIVING AREA:
GARAGE AREA:
DECS AREA:
OTI�R:
Construction Type:
.��
�
�
�
Tel. # %� (� -S�l�
MN LICENSE # o2G�:?,Sd ?77
Tel. # 7��� e/8.j0'
Attach to this application, a Certificate of Survey_o€ the ._
lot, with the propased construction drawn on it.to s�ale:� .:
DESCRIPTIQN OF IMPRaVEMENT ' _._
Length Width
Length Width
Length Width
� r _ .
Height Sq. Ft.
Height Sq. Ft.
Hgt/Ground Sq. Ft.
Estimated Cost: $ �/, d�'G
�
Driveway Curb G�t Width Needed: Ft. + 6 Ft = Ft x$
_$ -
DATE: � ���� APPLICANT: ,�D�(� ���'� Tel. # 7�y"���
,o
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
5TIPULATIONS:
CITY USE ONLY
$ � 9, '�S ~ Fee Schedule on Reverse Side
$ �% 0 � .001 of Permit Valuation (1/lOth%)
$ � .�� ; $.50/$1,000 Valuation
$ $1050 per SAC Unit
$ � OC� $5.00 (State Licens�d Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ oil�, ��
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 $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
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.SU for first $SQO plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,OOQ plus $14.00 for each additional$1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional$1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1, 000 or fraction thereof, to and including $100,000
$993.75 for first $100,0� plus $5.60 for each additiona.l
$1,GD0 or fraction thereof, to and including $500,(�0
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1, 000 or fraction thereof, to and including $1, 000, 000
$5,608.75 for the first $1,(�0,0(� plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Remova.l.and�replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
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 Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing.
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COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existina furance, the undersigned hereby verifles that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely suppo�ted and firestopped where required. Yes () No ()
The venting system is plastiGPVC and meets all cuRent codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () IVo ()
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 existina combustion air is sized and installed to meet the current 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 installinct a new ventina system, the unde�signed hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specfications. 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 cuRent codes. Yes () No (}
A�pliance Tvpe 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
Appliance #1 Vent Connector Height ft Length ft
Appliance #2 Vent Connector Height ft Length ft
Appliance #3 Vent Connector Height ft Length ft
i/
Diameter inches
Diameter in Type
Diameter in Type
Diameter in Type
HEATING CO: � .2.2� Of/F �. � ��-���. �1.�`' .
Signed By: - �-[.�e�- D��e.� / .�.1� Date : 's/e fv �
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Buildillg PLUMBING Permit No.•�� �-�� 1
Inspections - RESIDENTIAL APPLICATION Received By:�_
763-572-3604 CITY OF FRIDLE� Date Rec'd: �- 5- ��
DATE Y�UR E-MAIL ADDRESS
sr[�aDDxESS $�� Q.s ��+��✓ Robert Vogel �
THis APPLtCaNT IS: ❑ OwNER �ONTRA 7381 Concerto Curve
PROPERTY N,y�,�: � Fridley, MN 55432
OwNER/ �D�S. 7637865318 _�STATE zII�
TENANT
• PHONE:
CoNTRACTOR N,�t,,�: � --- - -- - --- - --- --
SUBMIT A C{JPY OF STATE LICENSE #�Ci� _ EXP DATE
YOUR STATE �AR.�SS' t�6� S CITY i' D//1 STATE�GIP SfyO�
LICENSE WITH . PHQN� $2%- �IO�� FAX Z �'
APPLICATION � '
PERMTT TYPE �SINGLE FAMILY ❑ TWO FAMII.Y O TOWNI-IOUSE
TYPE OF WORK: � ��'' ��LACENIENT
DETAILED DESCRIPTION OF WORK %
PER MS 16B.665 the permit fee is a mfnimum of $15.00 ar 5% of the total cost up to $500.00; whichever is greater, for the
impro�ement, insta.11ation or replacement of a residential fixture, excluding the fixtures. (This.shouldreflect only.the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 � cost of labor x.OS =
.: �•FOR�,'ROJEGTS WI�RE LABOR EXCEIDS•$i00;�EES ARE BASED ON $10.00 PER FIXTURE.'EXCEPT:W�REN�'CEH :FIiCTt3I�ES: ,(INDIC�TE TO�TAL �
NUMBER OF EACH BELOVi� '
- - - -- - ' - -
_ B?.TH SIlVS%l.AV _FLOOR DRAINS _ SHOWER _ WATER PIPII�iG
_ BATHTUB _ GAS PIPING Rr�eo ctrruc�sE) SWIMMW G POOL WATER SOFfNER ($35)
_CLOTE�S WASHER _KITCHEN SII�iIC WATER CLOSET BACKFLOW PREV. ($IS�
_DISHWASHER _1.AUNDRY TRAY ,LWATER i 'GATER ($35) FOR IRRIGATION
_ WATER MEfER OTHER
^Permit Fee $ � � �� Number of fixtures @ $10 00 �x `$10,00 = $s
Surchar e .50 Number of fixtures @$I5.00 x$15�.00 =$
TOTAL DUE $ Number of fixtures @$35.00 � x$35.U0 =$ 3S.Oo
� ... . State Surcharge = $ .50
Total ° $ , p
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UIVTIL PROCESSED '
I hereby apply for a building permit and I aclrnowledge that the informarion above is complete and accurate; that the work will be in
conformarnce with the ordinances and codes of the City of Fridley and with the Minnesota Construetion Codes; that I understand this is
not a permit but only aa applic ' n for a germit and work is not to start without a permit; that the work v�ill be in accordance with the
approved plan in the case 1 o w' r uires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME �e'� /l/pI'�IOi�YI DATE �/ `D
,
__ � ..: . .
� � . � �,
�4. . �,
. City of Fridley
Building I�aspections Department
6431 University Avenue NE, �ridley, MN 55432
763-572-3604
FAX: '763-502-4977