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Date: JIIDTE 5, 1967
�er: ROGER JONES
City of Fridley, Minv..
BUILDING PERMIT
� �� `�
�T� 9288
B�� BLAINES CONSTRIICTION COMPANY
Address NEW BRIGHTON, MtNNESOTA Address 10152 BU�ERNUT ST. N'. W.
COON RAPIDS, MCNNESOTA
LOCATION OF BUILDING
No. 185 S�t � CRAIGBROOR WAY N. E Part of Lot
�� 15 �__ glock 6 Addition or Sub-Div3sion ._._.. P�ON' S CRAIGWAY ESTATES � Z1aD
X 35' 10 Q� 6 �DITION
Coraer Lot _ Inside Lot — Setback _._._ Sideyard —
Sewer IIevation _____$3 $• 6 8 �� IIevation ___._ 841. 6 8
TOP OF FOOTING
DESCRIPTION OF BUILDING
To be Used as: 41 28
DWELLING �t � neptt� � Height ?0 �, � 1, 278 � � 25 , 560
GARAGE �nt 24' Depth 22 i�eight 1� Sq. �, 528 �� 5,280
Type of Construction F�' ��, �_$22, 000 __ To be Completed
SEWER LOCATION - 17' West of Manhole - 24' lead on it
WATER LOCATION - 6' West of Manhole
In cansideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in acc�rdance with the d�scrlption above aet�forth and in cpmpliance with all provisfona oP
ordinances of the dty oP Fridley. ,;
$100.00 SSSD SEWER CHARGE
In consfderation of the paymeat oP a fee of $ 3Z . 00 ���t is hereby granted to B�I�S
CONSTRIICTION COMPA'l� ���� .�e building or addition as described above. Thispe rmit ia granted u�n
the express condition that the person to whom it ia grented ead hia agents, employees and worlmzen, in all work
daae in, around and u�n said building, or anypar� thereof, shall conform in all reapecta to the ordinanc�a oP
Fridley, M3nnesota regardiug location, construct%n, alteration, maintenance, repair and moviug of bufldinge
within the dty ]imits and this permit may be revaiced at aTMy time upon violation of any oE the PT��� � esid
orciinan�.
CLARENCE BELISLE B�� �
NOTIC�
'19ds peroilt d� no� eover �hs eoastrnetioa, MshllaHon fe� rrtrL�a, plumbtee, 6p heNtne, ssws� er wa�u. B� wn to ss�
�6a Buildle8 laspeete� fer asparm parmtta Po� thas itsms.
, .. -,.
�
�
AP�.iCATIO� FOR BUILDiA1G PEIi�fi
CY3`Y 0� %RiDLEY, NII�1ESdTA
, � � �� ..
0�.$ �$� � e ��s�s�i�R /u/� f fi Ps ` l./1 ti�' /'/�fi AA / d It �
ADDRESS �.Qs�. �i..i e �T�. ADD�?.ESS �5�,.-�, .is-�v� .� fY�li
......�_'_..' `
. C.�a� /����s
� LOCATION OF BU?.�,DING �
�_�' ' :.
RO. -- - - - � ��' STREET N_ v� :�, %�i-.,� � K�w :
OF LOT.
LOT /� BLQCR � ADDITION OR SUBDIVTSiON�� �s �a
CORNER L� INSIDE LOT+,�_SETBACK .3� � SIDE-YARD ��
SEWER ELEVATION � �� � � � � ,�'°" . FOUNDATTOP ELEVATION � ��' -'�� �°� �
Applicant attach to this form Two GertificaCes of Surveq of Lot aad proposed
building location drawn on these Certificates.
a �' �-o� .: � �—��f � ��
�' �' �� � �L° DESCRIFT�ON OF BUILDING �� °�
L�^ — �� � � .
To Be Oaed A 1: �``� "� `�'� ` � - �
P� 9 � . �/'�r
�� _�; Front ` d% Depth .� •== flei�ht �" �'
._._...�.
Sq. Ft. �3,�9 Cu. Ft.
. �--
Front Depth Height
Sq. Ft. Cu. Ft.
Tppe of Construction �h.�„o. Estimated Cost � � �-a � � �
_.��.....�
� �
To 8e Completed . �p� �_ y /iG 'j � � �
.�.`.�.r r��� � r��n ��.��
The undersigned herebq makes application for a permit for tbe work herein specified,
agreeing to do all work in strict accordance with the Citq of Fridley Ordinances
and ruliaga of the Department of Buildings,,and hereby declares Chat all the facts
and repreeentatione,stated in th�s application are true and correct.
DATE „/ u y P !'�%�' �% SIGNATLiRE /���� 1 _ / .�'�h����,.� ,�sca-�-^ �.�,_.
(Schedule of Fee Costs can be found oa the Reverse Side).
��� � � _' � -- -
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;: � �� o � t -,��"°` �1
BUILDTItTG PERiKLT FEE SCHEDUL�
i - .
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SECTION 2'�� The Inspectos of Buildings shalli befo�e iasuing pesm3ts for the
erection of any buildiag or structure, or for any additian to any exiating
buildiag or structure, or for any alrerations or rep�ira to any eniating building
or $tzucture�..upon..applicatiom therefore, xequire the payment by the applirant
for such permit of fees to the amount bera�.n below aet fartih and in tbe ma�er
her�in. �rovided eo-wit; .� , . . , . . _. �
2._ 1. For any such permit for the esection of any fire•proof building,
oth�r than a�arage, warehouae.�factory oi'grain elevator, or for the erection
of anp fire-p�oof addition, for �imilar occupancy, to anq eacisting buiiding,
� sha3� 1be at t�ie rate of �$1.40 for �each ane thousand �eubic feet, or fraction
thereof, in such eub�eal.co.atents. ,
�. . ,
�,Z. For �ny such permit for the erectioa of.aay fire•proof $arage,
r wa�cehouse. factory or grain elevator, or for the erection of any fire-proof
addiCioa, far similar occupancy, tv anq ex�sting buildiag ehall b�a ae the rate
of $I.ZS for'each one thousend eubic fee�; clas�ifiad-�as "fireproof" by Sectiaa
502 of tbe Minneapolis Building.Cade. . .
flOIISES
2•3, For any eucti pes�cbf.G for the erection of aay non-fireproof bu3lding,
other thaa a garage, warehouse, factorq or grain elevator� or anq non-fireproof
addition. foz aimilar occupancy, to any esisting building permit fee $1:00 for
each oae Chousand cubic feet.
. . GARAGES _ . . . . . -
_.,_
2_ For aay such pes�ait for the e�ection of any aan-fireproof $arage,
warebouse, factory. or 'g�rain elevaxor,...+ar for the erection of. aay aaon-fireproof
addition, for similar occupancy, to anq existing building or for each such
i�uildiag p� +�dditidn �.ni�mety cepts ($0.90).for each cne thousand cubie feet
or fraction thereof, in the cubical cantente thereof �rith the minimum of $4.00.
For the purpose of computing fees for building permita, the cubical contents of
any.bu3ldia�.or_addit.iom.to � uniform.height throughaut by. multiplying the graund
area covered frem a point aix (6) inches below the floor liae of the basemeaC or
cellar to the average height of the upper surface or to the average height of the
roaf surface o� the main gable of a pitcbesl roof. ' �- �
� 2_ 5. �� For repairs�or alterations to an existing'structu�e, the fee shall
be at t6e rate of $3.00 per each Five 8undred Dollare ($500.0�) or fractiou
thereof in the coat of all propoaed work.
2,6.. . Tn uo _ca�e.. s�ha11 the fee chsrged for auq _p�rm3t as set forth in
Section 2 be less th� $4.00.
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THE r1INUTES OF TfYE SPECIAL PUBLIC HF.nRTNG ��jG OF MAY I.O�
�LEDGE OF AT,LEGIANCE :
1�layor Kirkh�m_ asked Serqe�nt Dav� M�urer of the Army to �ad fi.ise Pledge of
Allegiance to the Flsg. /
Mayor Kirkham called th� Speci,al Public Hearing Mee ing of May 10, 1971
to ordes at 7:30 P.M.
1iID7�Y, CAL�+:
M�ERS PRESENT: Kelshaw,. Ki�kham, 1, iiarris, Breider
ME�ERS �ABSENT s Npne
J?RESEDiTATTOAT OF F�T�►6S BY YFW:
�o flags wsre presented by Fridley eterarys of Foreiqn Ware Post 363 for
the ca�mu,nity. The representativ said that one was for City Hall aad the
other was for Eisenhower Square. He said that the VIaW's objectives were to
be of aervice to the ca�uaity Mayor Kirkham said that he was ever mir►dful
of the a�rvice tlie Poat prav�i s and thanked the Vi�f� � on behalf of himself,
the Council, and the citi� of Fridley.
9 - �Y 16 °WAC WEEK"t -
Mayos Kirkham sa3d May 14th was the 29th ar�uiversary of the idawea's
Arn►y Cozp�9 aad read e Procl�ttion proolaiminq D�ay 6- 16 "WAC Weeka.
Captain Kuqe1, 290 Colfax Avaaue South, eaid that on behalf of the �
Ulomen'�a A�rmy Co , ah� e�tend� their appreciation to the Mayor and the
Counoil gor th proclamation.
i�layos Ki am said that he would like-to add a Visit�ra portioz� to th�
��
MOT by Councilman iiarris to adopt the Ageada as amended. 3econded by
Co ciLaaA �reider. IIpan a voice vote, all ayea, Mayox Rirkham declared
a�otio�l Cai'7ri,ed unani�ously.
� VISI� t J
Ms,� er� Jones� 185 Craigbroak Way N.E., Swi�niag Pool:
Mr. Roqer Jonea expla�n�d that he is planning on put�ing in a ewianning
pool a� his t►va►e and he has co�lied with all th� requiremeate� oi the
�iealth In�pecto� until hs came to the requirement for a e�ctificate of
survey. He said that he has had his lot surveyed v�ithin the last three
yeaxa �nd the i�cons, cca�l$ be exposed. The �survey ia on file at �he City
Ha11. He woul,d like to hav� the aertificats of eurvey waived aa it wauld
cost hial $75 ++ �100.fos ths �urvey.
S��C�AT. CpUNCIL MEETING OF MAY 10, 1971
P�GE 2
Counci�nan Ha�r�s asked him if he had some sort of a,�icture or ma� ehowing
tYae locat.ion pf the swimming pool. Mr. Jones said ye� and showed the Counci�.
He said t�t►at all the property irons are in place. The City Enqineex
�lained �hat the question is that there is a survey of the lot but ;Lt
does not show the location of 1:he house on the lot. Z'his is a requixement
o� the City bx ordinance, to have a certificate of survey after the }�ouse
i� � th� four�dation. T'his is then kept on file and used in the future
if �i►are axe any adciiti�s made to the hou�e. Mr. Jorae� said that this
requireiae,nt is holdiaq up con�txuction arad i� a coa�iderable cost,
Councilmaln Ha�r'ris said that it appeared that the swi�aminq pc�ol would be
16° X 32°. i�. Jones said yes, and added that the aketch was not sscaled
in re�ation to the house. The City Engineer said that the ferice would
be on the c�aseiaent line. Councilman Breider asked if he met the ordinance.
7�e City Enqineer ssid yes, if the dimensions are correct. Mayor Ki�kham
said that the certificate of survey should be a anatter of record, but Mr.
Jones eaid �hat he is running short of time. He said the certificate of
survey ce�uld be done after the pool is d�ne if this would be agreeable
to the Council.
MoTION by �ounailman Harris to waive the requirement that the certificate
ofc eurvey be done prior to the coarmnencement of the con8truction of the
swi.auning pool �or Mr. Roqer Jones, but ttnat it is €o be on file at City
Hall�no later than June 15, 1971. Secon�ed by Councilman Kelshaw. Ugon
a voice vote, all voting aye, Mayor Kirktaam declared the motion carried
unanimou�lx.
t A BALLOON �P BY GRA
ON D�Y 12 . 1971:
MOTICi�T by cilman Harrie to approve the requeat for a balloon drop by
Graae High 3c 1 May 12, 1971 to advertise their production:of Li.'l
Abner as out],ine the letter fram Mary Gunderaeh, Publicity Head ior
the pr�duction of '1 Rbn�r, providing they meet the requirementa of the
F.A.A. Second�d by cilman Kel�haw. Upon a voice vote, all votiitg aye,
Mayos �irkham declax�e� motion carried unanimously.
FIDiAL PLAT, S. #71-01 SILVER QAK9 WEST
' OF LOT 7. AUD 'S SU�DIVISIOIJ NO. 22:
The City Engine�r reporteei that the Pl ing Com�i�sion recanuaended that
Lots 3., 2, 3, & 6 be platted and Lots 4& be left as an outlot as they
cannot be sserved with utilitie� at this time. Only the property along
Stinson �oul�vaatd and Rice Creek Road would be �loped. He suggeated
requirinq money in escrow for the drainags systeffi t would be put in
later pn. There are utilities in Rice Creek Rcad and nson Boulevard
no�.
MOTTON by Councilman Harria to closa the Public Hearing on the F� Plat
Silver Oaks West by Keith Har�tad. Seconded by Councilman Breider. n
a voice vpte, all votinq aye, Mayor Kirkham declared the motion carried
uaianiuwus ly .
City of Fridley, inn
6431 University Ave. N. E., Minneapolis, Minn. 5b432
BUILDING PERMIT
Date: MA�11, � g 71
s
�101�
pwner; ._ RoQer Jones g�d� White Oak Builders, Inc.
Addresa —.18.�_Cr.�gBrnok wa� N�F.� Addtggg 511G. T.nna T.akr� Rnarl_ Nnt± Rriol�d+n�n_
LOCATIOiV OF BUILDING
No. .—.�,.$.�.____ .Street •ra' Brook Wav N_E _ Part of Lot
Lot ._]..6_____ Block __.—..�._. .� Additivn or Sub-Dividan �
Corner Lot ._—...__.— Tnsfde Lot �� Setback
Sewer Elevation
Sideyard
Foundatton IIevation .._...
DESCRIPTION OF BUILdING
To be Used as: 16' x 32' x 8' Deep
Belotd Ground Pool � Front � Depth �_ Height .. - __ Sq. Ft Cu. Ft.
�
__._._ Front ._ Depth Hei�ht Sq. FL ' Cu. Ft.
Type of Construction Est Cost .�3�.OQQ.O�r, To be Completed June 1 l0 971
survey
Stipulation: Verification'�due in Building Inspection Dept. by June 15,1971.
In coa�deration of the issuance to me of a permit to cons ci the building cr3 above agree� to do
�he proposed work in accordance with the desaription above f and in aa with ravisi oP
ordinances of the dty of Fridley.
�� .
Ea cona�tderatioa of the payment of a fee of $�...��._, permit is hereby granted to �7�te Oak Builders
to construct the building or addition as described above. This perm3t is granted upon
the express condition that the �rson to whom it is granted and tus agents, employees and worl�aen, 3a aII woTk
done in, around and ugon said building, or any part thereof, shall conform in all respects •to the ort73nances oP
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and mov3ng of buil8irig8
o� � city limits and this permit may be revoked at any' time upou violation of any of the provisions of setid
Buildin8 Inspector
AL BAGSTAD
NOTICE:
�� 1`his pam�it does aot eover fhe eenairueHon, insfallaHon Po� wirfng, plumbing, eas heatieg, �x►ee or water. Be aure fo �
16s Buflding Inspeetor for aeparaie permita for theae itams.
APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME: �b a'C � 1�/��S BUILDER: (�vf21 �� D�I1� �jC,,�j S�/t%�>
�
annx�ss :1 F�3' /U �'. �'�9�G,B�� �,.,q y annx�ss : s�� ��ti L.� �,�o
/U�/� i T sv
NO : . g� STREET • � � • � 0 V�` /C �D �&�l�
LOT : � BLOCK: � ADDITION :`��7'QSoJ� /� Le9� �Sfii ��$ �/U.a ,
��DI��
CORNER LOT: INSIDE LOT: �SETBACK: SIDEYARD;
Applicant attach to this form 7.tao Certificates of Survev of Lot and propoaed
buildi.ng location drawa on these Certificates.
HESCRIPTION OF BUILDING
To Be Used As : 1��`�, 7� 2� x$ ����
�j��a� ��a�1b�i� �as � � 6. ,� � �
Front: Depth: � Height:
ScDf{s�AC�
�b��� Square Feet:__ _ Cubic Feet:
�-%�.S �-%�' d � _ Front : Depth : Height :
Square Feet; Cubic Feet;
Type of Construction: a v O
Estimated Cost: $ s �
To Be Completed: _�1,�/L� � J T f `?� �
The uadersigned hereby makes applicativn for a permit for the work herein
specified, agreeing to do all work in attict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildiaga, and hereby
declarea that all the facts aad representations stated in thia application
are true aad correct.
�TE � ' S IGNATIJRE :
(See Reverae Side For Additional Information.)
a�
�
� _' - _
,
BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to a.ny existing
building or structure, or for any alteration or repairs to any existing
building or structure, upon application therefore, require the payment by the
applicant for such pennit of fees to the amount herein below set forth and in
the manner herein pravided to-wit:
UNIFORM BUILDING CODE: Type 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 fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average�
height of the roof surface of the ma.in gable of a pitched roof.
For repairs 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 proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be
les� than $5.00.
VERIFICATION OF FOUNDATION
NOTE: 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 Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy qf any structure for which a building pern►it has beea
iasued; and said structure shall not be used or occup�ed until a Certificate
of Occupancy has been issued. -
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another fine product of ��
INCORPORATED �
T,ALM,ADGE R06LD. EDISON. IVEW JERSEY 08�17 (R,rea Code 201) 2�7-1000
from c��dsca.de /l�us�s
inventors of factory-built, vinyi lined
swimming pools —
• T.M. +
il-IE � �, �� LINE
,
The world's largest manufacturer of swimming
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offers it to you through a network of thor-
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netwark efficiently and at low cost.
Side-walls of this new factory-built pool are
of pressure-treated Wolmanized� wood. These
rugged panels are assembled at the site, in
the pool excavation. Because of their chem-
ical treatment, these side-walls will ,resist the
effects of ground moisture and insect attack.
Pools manufactured by Cascade using Wol-
manized� wood panels have been in the
ground for over 20 years and show no signs
of deterioration.
The vinyl liner used in the Villager line of
pools is of high quality, heavy gauge ma-
terial. A system of wrinkle-free application
has been perfected which makes this the
most attractive as well as the most practical
pool interior.
Among the optional methods of finishing the
pool is an extruded aluminum bull-nose
coping in gleaming white. This coping is de-
signed so that it will become an integral part
of the pool deck. Or you may choose vinyl
coping to frame your pool.
Although low in cost, the Villager line of
pools offers all the luxury of top-quality
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SAME PROVEN ENGINEERING PRINCIPLES AS POOLS
WHICH MAY COST UP TO TVUICE AS MUCH!
Installed by factory-trained authorized dealers...
AND COVERED BY FULL MAIdUFACTURER'S AND DEALER'S WARRANTIES.
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(�F�IAOSE XOUFi PAOL FROIUT AN1( �F �IV� �IZL��
°`llUf�STCFYESTER"
"SCOTTSDALE"
"�AN BERNARDIIVO"
06�{� �B2Pp99
a4 6 ed
"SHAKER HEIGHT�"
9�x24
..16x32'�
16st36
�0 A d�
20 x 40
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Recommended for small yards. Allows swimming
h as 12 swimmers. Average number of
swimmers recommen e — .
For average suburban yards. 20 swimmers may be
accommodated. Recommended average number o
swimmers-7.
Perfect where space permits. As many as 23 people
may enjoy the pool at one time, although recom-
mended average number of swimmers is 8.
The extra width of this pool permits 26 people to
occupy the water at one time. Because the length
is the same as the pool above, recommended aver-
age number of swimmers is also 8.
Ideal size for large suburban yards. Recommended
average number of swimmers is 11, but as many
as 32 people can be accommodated.
0
FI ush wal I
wide angle skir�rr�er
and rapid �and filter
Every Villager Pool is equipped with Cascade
filtration equipment as standard equipment. The
skimmer is of flush wall design. Nothing pro-
jects into the pool! Leaves and insects are
automatically skimmed off the surface into a
large leaf basket which is easily reached and
emptied through the circular deck plate. It is
not necessary to reach into the skimmer mouth
to empry the basket. The extra width of the
skimmer mouth increases its effectiveness.
Cascade's rapid sand filter is the most effective
and easiest-to-use filter available. A unique
overdrain and underdrain design permits in-
depth filtration at a faster rate. Single-lever
multiport valve is your pool control center. It
takes but a second to switch from filter, to
backwash, or to any other setting. Powertul
pump and motor are protected by hair and lint
strainer.
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AUTHORIZED DEALER
LADDERS
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VINYLCHLOR CHEMICALS
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CIIYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
August 23, 2002
Mr. Donald Giorgio
185 Craigbrook Way NE
Fridley, MN 55432
Re: Final Inspecfion at 185 Craigbrook Way NE
Contractor: River City Sheet Meta1
Dear Mr. Giorgio:
A mechanical permit was issued on June 21, 2002 to install a furnace and air conditioner at
your address. According to the 1991 Uniform Mechanical Code a final inspection shall be
conducted on the work authorized by this pemut. As of this date the inspection has not
been requested.
The permit fee that was paid eovers the inspection to make sure the work was completed
according to the Codes. We will keep your permit open for another 30 days and if we do
not hear from you within this time to set up the inspection, we will mark the permit "no
inspection called for by homeowner after notification" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspecdon Division at (763) 572-3604.
DJ/mh
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3Hl 210 S3�Mdl-lddti JNIN21f19 �3f1� JNI�Kld3?1 N3HM NI a3��1� 381Sf1W M0�38 3H1
CITY OF FRIDLEY PERMIT NO.: 2004-oo�s6 ��39
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSiTED: 02/10/2004
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 185 CRAIGBROOK WAY NE
PIN : 033024430027 �(°�
r
LEGAL DESC : PEARSONS CRAIGWAY ESTATES 2
: LOT 15 BLOCK 6
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
INSTALL A WATER SOFTENER
# ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0
# NEW FIXTURES (EXIST OPENII�TGS) 0 # GAS DRYERS 0
# GAS RANGES 0 # OF NEW FIXTURES 0
ENTER VALUATION 300 # WATER TRMT APPLIANCES 1
APPLICANT PLBG PERMIT 1�IlNIMUM FEE 20.00
SHII,OAH WATER CO PLBG FIXTURES (NEW OPENINGS) 0.00
7319 166 AVE NW PLBG FIXTURES (EXIST OPENINGS) 0.00
RAMSEY, MN 55303- WATER HEATER - ELEC 0.00
(763) 753-9244 GAS RANGE FEE 0.00
GAS DRYER FEE 0.00
PLBG REPAIR/ALTERATIONS 0.00
OWNER STATE SURCHARGE, PLBG FLAT 0.50
GIORGIO DONALD E& JOAN M WATER TREATMENT APPLIANCE 0.00
185 CRAIGBROOK WAY NE TOTAL 20.50
FRIDLEY, NIN 55432 PAID WITH CHECK # 9682
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and lmow the same to be true and conect. All
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions any other state or local law
regulating construction or the p rfo ce of construction.
Applicant Date
Bldg = D B
SEPARATE PERNIITS REQ D FOR WORK OTI�R THAN DESCRIBED ABOVE.
City of Fridley �� J U N��j 2�� ,
6431 University Ave NE -
Fridley MN 55432 ���.���
(763) 572-3604 or Fax (763) 502-4977
�i
Water and Sewer Permit Application '
❑ New Connection �tility Line Repair/Relocation 5 e`�-' ��
❑ Existing ❑Water and Sewer Connection
Date: (o � � � � 7
Job Address: � � �°r' � � � Y' u o � � p�
Name of Applica.nt (Plumber): � � � C �2 C � � � \ (�
Name of Property Owaer: r1 �� 1 �j
E�cisting Structure Pemut #
Permit Type: Sewer Fee: �
Water Fee•
Meter Fee:
Repair Fee:
Relocation:
State Surcharge:
SAC Charge:
Special Assessment Fee:
Total: $ �.SD
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Applicant Signa.ture:
Inspector approval: ����/L��!! '�,� '
Water Meter Repair — Weekend & H
Water Connecrions Permit
Sewer Connections Permit
Inspection Fee for Water/Sewer Line
Special Assessments
Cost of Water Meter
SAC Chazge
State Surchazge
Water Tan
$125/hour
$50
$50
$40
See Engineering
See Utility Billing
$1675
$ .50
See En�ineerin�