AF - 43301_ __ _._ .
sua�scr PER .
City of Fridley � �$$ 6
AT THE TOP OF THE TWINS B U I L D I N G P E R M I T ^
f
' ' RE
, � •
� ; y _ COMMUNITY OEVELOPMENT DIV.
r � � � PROTECTIVE INSPECTION SEC. ��/Q �
� . �
� � /"'1 � CITY HALL FRIDLEY 55432 NUMBER i7EV. DATE PAGE Of APPROVED 8V
�""'��� ,'� 612-57 f-3450 910-F15 4/1/85 � �
JOB ADDRESS 1405 Creek Park Lane N. E.
1 LEGAL ��T NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCFi. ].S 2 Creekridge Addition SHEET
2 PROPEFTYOWNER MAILADDRESS Z�P PHONE
� Mark Shaw 5955 - 3rd Street N.E. 571-8220
3 CONTRACTOR MAIL ADDRESS Z�P PHONE UCENSE NO.
Same
4 ARCHITE�T OR DESIGNER MAIL ADDRESS ZIP PHONE �ICENSE NO.
SE�
5 ENG�NEER MAII ADDRESS Ir�,r,r'�r�,��` �'' ,� � UlREDP��R LICENSE NO.
� � J-���T1� ���.7 �� � �
6 USEOFBUILDING �'��?p►S.
!y
Residential
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOFiK
Construct a 52� x 26' Dwellin and a 24' x 22' Gara e
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide a hard surf ace driveway. Provide sod in the front and side yards .
Provide City with copy of verifying survey before capping.
SEWER LOCATION: "Y" 105' West of Manhole,
WYE ELEV: 880.51 MINIMUM TOP OF FOOTING: 883.51
WATER IAC�ITION: Same trench as sewer
Paid Park Fee of $1500.00
�����§�����
��f�� di�'�ing call I�cat �
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T4-ic: CiiY C�F ; r+Cjt rY CC��'� i�e^v�f G�';",�,`�.I:,;�;�� � t_,— H�1�IE-ECE �P� c
� = �T�° fx��,> .;:
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.
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�ANL� P�i=<u���•�5 l�;>;�iC� ;i-it5 ft`dFORMATION SHOUL.i1
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTI�ATING OR AIR CONDITIONING. WOOC� Frame
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHO(i1ZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUC710N
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 OFDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OF NOT. THE GRANTING OF A PERMIT $103,800 $51.90
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OF THE PERFORMANCE OF CONSTRUCTION. �S`443.00 CREDIT .
AN CHECK fEE TOTAL FEE
108.2 03.15
SIGNATURE OF CON'RACTOR OR AUTHOR12E0 AGENT IDATEI �NHEN PiiOPERLY V ATEO THIS IS VOUR PERMIT
3�GNATURE OF� ER UF OW�R� 1 A i BLDG iNSP nA E�
N� � City of Fridley Effective 4/1/84
ADDN. ] R-1 AND R-2
pLTER. [ � Building Permit Applicatfon
Construetion Address: ���� l'���� � r�� � �t-� -
Legal Description���� � >��� � � �� � e%- ��;fa � C
Owner Name & Address: i%����" `��-'-� S��S- �'��1" /U E Tel. # v 7"�~_S�Zz c.0
Contractor: � Tel. # -
..,,.-
Address• �-
LIVING AREA:
GARAGE AREA:
DECH AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construetion drawn on it to scale.
. DESCRIPTION OF IMPROYSMEAIT
Length � Width �s.� Height _=�
Length � Width Z Z Height h�
Length � Width � Hgt/Ground �_
Sq. Ft.
Sq. Ft.
Sq. Ft. �_
Corner Lot [] Inside Lot [] Ft. Yd. Setback Side Yard Setback _
Type of Construction• �,;� ° � ��"`'G� `' Estimated Cost: $ %��"��°
� l U��Bou
Approx. Completion Date: f� ��' �
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: - See Back Page for Explanation
DATE: �2 " Z 7 APPLICANT : �� Tel . # �� ` �ZZ `�
5'� i - �$ w'�I
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY IISE ONLY
� �l �l 3� o �--
$ � 0�,2�
$ J �. �
$
$ I�oO �
� �—
-�,, . /
�
Fee Schedule on Reverse Side
25$ of Building Permit Fee
$.50/$1,000 Valuation
�425 per SAC U nit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
r s • � - ��
a �
BOILDING PERMIT FEE SCHBDIILE
The Chief Building Offieial 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 sueh permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
Total Valuation
�1.00 to �500.00
�501.00 to $2,000.00
�2,001.00 to $25,000.00
Feea
$10.00 (Minimum Fee is �15.00)
$10.00 for the first $500 plus �1.50 for eaeh
additional �100 or fraction thereof, to and ineluding
$2,000.
$32•50 for the first $2,000 plus $6.00 for eaeh
additional $1,000 or fraction thereof, to and
ineluding $25,000.
�25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $4.50 for each
additional �1,000 or fraetion thereof, to and
including $50,000.
$50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for eaeh
additional $1,000 or fraction thereof, to and
including $100,000.
$100,001.00 and up
3433•00 for the first �100,000 plus �2.50 for each
additional $1,000 or fraction thereof.
DRIVEiiAY DEPRBSSION ESCRO�W
(Concrete Curb Streets Only)
. Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus
6 feet times $13•50
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approaeh with 6 inch depth - Driveway width plus 6 feet times $15.75
VERIFICATION OF FOUNDATION
Permits for constructfon will be issued a minimum of 2u hours from the time of
application to allow for proper review of the proposed structure and of the
construction site.
A Certificate of Survey of the lot, showing the location of the foundation onee it
has been constructed will be required before proceeding with the Praming.
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(+ )wner _ # L % �. � . .
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�`��, Suilding Classification:` Type Al� (Single� Fa:��i1y 5 DUplex) ",'� 7ype A2��� Residential' '`y�
, �____
.it; �3 stories or.�ies:
;�
;.; :a - ,
1,:..,1 . . . . ' •
' EOther) � (Over 3 staries) �______.�__ �
�GNE�AL INF�IitMATION
1.
7
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Building Perimeter �.r'��' ft.
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Wall height (qraund to eave} �`�'� �'r �{ ft ::,�^` x�':�t }" ��~.'� �_;`: f�
, .� �
2
1. x 2. (abovej gross wall �r.g�,.t�!�' � 1�' ft.
�� � f � ' �' ' � a ���''��� ft.2 roof & flaor area
BuiTding dimensions (L)� +��:�-'.� �°�" x (�)�'�{�'��>--- � "�` .
, .
Square fcot �rea of rim joist •�loor jolwt s1�e (2 x i��':',���,_,) r�., .��{t2 � '
I(� ? x Perimeter a Rim �o�st area ■���
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6 � Ooars � r�rea� ��
°� 7hickness � �
Type of Construct on
rlanufacturer
�tS'�a c Lo r ; �+r"`f�,� - .,
�. . Perimeter '�,;; ..`�.,' ft.
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7. Total door's perimeter �� �� rt
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TYPE
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SIZE
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State apprave� �°�� '�.:'-'�
r1UMEER OF
UNITS
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��i ,'��'��1�t; f;�,ire 1:d� ���rea: Width x heiaht = '��,i :�.._.�.� .`` x �' �: � F.
, ,�;i� I �;� :�� � �� ,. , . , --- � . , .w.
�� � � ��1f ���!�i��'xpo�����0�irtclation: Neight x Perimeter %_._�_�_._x��..__','�._.._ ''���
�� ,� i� , �, �, ,, �
+'�i���, ;�;)FiRLETION iO,F� �TNIS FORP� IS R�QUI�£� FOR ALL t;E1J COitfi`inUCTI�1,�, MaJOR .REt•100�
i3;�,', q'�V:J SdF'ERE',EI�ERGY, �THER Tf111y TNE t•1INI1'il1L C.�C�E �f�LL4'rlf1tlCE, I5 11SE0.
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' rt�aming �araa � 10X o1',, �n e�ss wA11 area.• . , ' '� �;���
R ,.��>
13• Gr.�ss wall area �.?"��'���'�,�.., ft.2 ��
' r.' �,;.. _/ ,, � . ' � w..�! •� s� �:
Wi ndow a rea A,� �.a �� ���.1� f t. U v+i ndows � t1 x A �.� �
...
Rim joist area A fi^����"J ft.z U rim jolst � i��r- •�_ U x A���� i � a�',
� ,,� � � ► t4 �
Door area` A�,� f t. � U door� area a_� ����- U. x A=��4<
...
Fi repl ace, area A���,,� f t.` U f i repl ace =��� � U x A• i���{
� � �� Exposed founda�ion ��� ft.` U foundatinn =��� U x A•�j � y
-"�~�.- :,.�"""�
� Framinq area A`1�,r,;,�� ���- ft.� U framing area ■ 1 .� U x A■ �� ��
,.., .�. �,,� � `
Ne t�va 11 a rea A ��.,o%l.� ,"���'� f t. U wa 11 � i� ra� k� U x A ����_;�„
- — - - - — r "" t t��vG►'
(13B ) TOTAI. . . . • • . . . . . ll X A a � ,�--- - `
:v+�
I4. Grvss wa11 area x 0.11 (A-1 single famtly b Guplex = allowable U x A/Code .,�:�
(13 . above ) . .`��
x 0.23 A-2 other resldential) ' `
x .23 Other buitdings) 3
x .28 (Over 3 stories) k�;
BTUH Must be 1arger ti�
A'�'��,� ��� x U Co�e, 1� e ��� .i�-..��`��',�.,_ "—°�. 136 above�,_._.,,,".',
! � -- -
. +t
C, or the. same as) �
15. Ceiling framing area (Af) equals lOx of ceiling area .t,;-a
15A. Gross ceili�ng area � (L)'��•��,��'��,��•�"�' x (w)'�'�(� `° �'��'� �• �_�'�� � ft.� �»;
�
f58 Joist ar�a (A.�j = 10� ceiling are� s �f�'. �''�'�' ft.2 r`
� . 4� 2 � �,
15C. Net ceiling area (A�) (15A - 158) • ifia,�' r`"� ��°.�+� ft. t�r
U r° ei l i n i� A �"` �',��� p �i� x {r.""., ��•� .,� �� �'1
9 C A 'a„ � (', �,!� ` � ' � ,',. a � '�� ' � �
� /,� ,,- � • , r.•,r �� � `�M
U framing x A f� l !'; �;� � �� X� , '- ' n ' �-,} �_�
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t6. Ceiling area (15A) x 0.026 (A�1 single family b duplex - code allowable U x A =���'��o
x 0.033 (A-2 other residential ) , � -.}:�.;}
:,
' :'f;�t
x 0.06 (other) "�'�
; �, �
'.,�;+ i, a �. ;' ; � ,�, � , , , a�'UN Must be larger than 150 (aboVe)�;
�`{ `, �t �;) A l a��! �''��t„ <<��� x�._Ls�1.� � r'.:; a- F ( o r t h e s a m e a s) ,�
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�'; �' �� �' � NOT,E Use U and A val ues �btai ned from ops 1, 3 and 4.
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SUBJECT � P O.
City of Fridley 20253
AT THE TOP OF THE TWINS gU I L D I N G P E R M I T
r
; i, R E O.
� • COMMUNITY DEVELOPMENT DIV.
' � ti: ---•--�
r � � PROTECTIVE INSPECTION SEC. ����$
i �
� � /"'1 � CITY HALL FRIDIEv 55432 NUMBER REV. DATE PAGE Of APPROVED BY
�""'�� ,�� 612-571-345Q 910-F15 3/13/90 / f
JOB ADDRESS i405 Creek �ark I�ane N.E.
1 LEGA� LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ZS 2 Creekridge SHEET
2 pROPERTYOWNER MAILADDRESS ZIP PHONE
Daniel/Holly Arnold 1405 Creek Park Lane N.E. 571-8218
3 CONTAACTOR MAIL AODRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PHONE IICENSE NO.
6 USE OF BUILDING
Re s ide nti al
7 CLASS OF WORK
�7 NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 14 � x 12 ^ S�ied
9 CHANGE QF USE FROM TO
STIPULATIONS
SEPARATF F�'n;,�(T,� �r�U�RED FOR
WIRiNG, HvATl;,�i�, �'�i,�E�,;LING Ati!p S
IGNS.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. FT. CU. FT.
AUTHORVZED 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 (30VERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIfIEO HEREIN OR NOT. THE GRANTING OF A PERMIT S�-iOOO $.SO
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $ZS.00
PLAN CHECKFEE TOTA�FEE
$25.50
SiGNATUAEOFCONTRACTOAOAAUTHOAIZEDAGEN7 IDATEi � HEN PROPERLY V IDATED THIS IS VOUR PERMIT �
�--I 3 -� �
$iGN TUREO NE OWNERBUiLDER� iDATE� BL�G �NSP AT
� []
� � �
AI��t � �
CITY OF FRIDLEY
R-1 AND R-2 �
Buildir�g P�ermit Applicati�
EffeCtive 1/1/90
Ooa�.stni�ctiaa� Adcjr�ss.s: � j �.� l., ���,� �c,�..-� L Cc v� �
Zegal D�e��criptio�: ..._� o f iJ l� %c�c,� �� _ �� ��,� !� �' Q.�P
Owr�er N�ne & Addr+es.s : �� a v� � � -�- o r►'1 u 'Pel .#
cor�tractor: - �, �
�:
Attach to this application, a Certificate of Stiarvey of th�e
lot, with the prq.�osed canstruction drawn on it to scale.
�SCRIPTIatd OF
LIVII�IG Ait�i: Length width Height Sq. Ft.
Q�R�GE AREA: Length Width Height Sq. Ft.
DDCR AI�: Lerx�th Width Hgt/GYrotu�d Sq. Ft.
o�: ��e� j � x [2-
Oorner Iot [] Inside Ir�t.� [) Ft. Yd Setback Side YaYd Setbacks
W �� t=ruVri $
Type of O�nstruction: S� �.� �����. � r� Estimated Cost: � i� �•�
�
Approx. C�q�letion Date: '� -���}, 4 v
Pro� Driveway Width If Ne�a Opening Is Desired: Ft. $ $
Width + 6' See Bac3c Page
nA�: 3 - ).3 - `� � �cArrr: � C;l�•, �. # �s� 7 / �`� I g-
CITY OSE �II,Y
Pezmit Fee $ � j� �
State �arge $ �Z:
SAC Charge $
Driveway Fscrow $
Park Fee $
sewer r�ain cl�azge S
� •. �- ,
T�OTAL $ � � � � �+
S'!'IP[JI.ATIaNS:
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" I�Uwe
Fee Determined bY �9�r�9
Agreement xeoessary [ 7 � N�lY I l
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.� CITY OF FF: _EY INSPECTION DIV.
6431 University Ave NE
Effective On January 1, 1991
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
Rate TOTAL
$ 20.00 $_�._�
$ 10.00 $�._�
JOB ADDR
The undersigned hereby makes application for a permit for the work
herein specified agreeing to do all work in strict accordance with the
city codes and ruling of the Building Division, and hereby declares
that aIl the facts and representations stated in this application are
true and correct. � � ! � ,t 991
OWN
$ 10.00 $ � '
BUILDING USED AS �^����+-- D�
$ 10.00 $
ESTIMATED COST � /�-t�-f� � � PERMIT N0. � � ����
*Air Conditioning - All Sizes $ 10.00 $
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work $
Commercial/Industrial
1% of Value of Appliance or Work
� v , „ �'` � �c-c�v�. � �
.�---
, S ate Surcharge
� Uf
TOTAL FEE
$
� .50
$ v sa
MINIMUM FEE FOR ANY HEATINGICOOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
"Air Conditioners can not be ptaced in a side yard without
written permission from adjoining property owner.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
Fuel Totat Connected Load
Burner Trade Name Size No.
BTU HP EDR
, I-- � � / �� � ' ('�,,.,
HEATING COMPANY�L.Q�_b��.9� G+��— """`°'�
�
Signed By �!� a �� ��'el No. jo 3�����
Approved B������ Rough-In Date Final Date �� �
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
......
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IFY A NEAT-N-0Lp —
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OME ENERGY NEEDSI CQ� ' S/NCE 195!
HEAT-N-GLO Fin S7AifCONTRACrOR(ICENSf/f06B (612) 633-1042
,; �6 27pp N. Fairview Ave. (at Co. Rd. 'C') • Roseviile, MN 55113
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sue�ecT PERMIT NO.
City of Fridley � ���;i
AT THE TOP OF THE TWINS g� { L D I N G P E R M I T 4 lA ���
r
� �
i �` COMMUNITY DEVELOPMENT DIV.
r � v � PROTECTIVE INSPECTION SEC. �Q7�
� � -
� � �"'1 � CITY HALL FRIDLE� 55432 NUMBER REV DATE vAGE OF nPaROVED Br
�""�'� �'' 612-571-3450 910-F15 10/4/94 / /
JOB ADDRESS 1405 Creek Park Lane NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 1S 2 Creekridge Addition SHEET
2 PROPERTY OWNER MAIL ADORESS 21P PHONE
Holly Arnold 1405 Creek Park Lane NE 572-8199
3 CONTRACTOR MAIL ADDRESS 21P PHONE UCENSE NO.
Skyway Quality Homes 8025 Garfield St NE, S rin Lake Park MN 55432 784-5464 3005
4 ARCHITECT OR DESIGNEFi MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIIADDRESS Z�P PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Raise front house roof to be 4/12 pitch
9 CHANGEOFUSEFROM TO
STIPULATIONS
See notations on plan.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYIOAD
SEPARATE PERMiTS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCT�ON ZON�NG SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTqUCTION
OR WORK IS SUSPENDED OR ABAN�ONED 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 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUFTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOfIK WILL 9E COMPLIED
WITH WHE7HER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �3 � OOO 1. SO
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEqM1T FEE SAC CHARGE
OVISIONS O NY OTHER STATE R LOCAL LAW REGULATING CON-
S CTIO R T PERFORMA F CONSTRUCTIO . �S�F.00 Fire SC 3.00
PLAN CHECK FEE TOTAL FEE
�%9 ��l � 9 License SC 5.00 63. 50
IGNATU�:EOFCON'PACTO 0�7P.UTHORIZEDAGEN �DATE� WHEN PfiOPE Y VALIDATED THIS IS YOUR PERMIT
� �v. � " J�-s-qy
SiGNATUREOfOWNER�iFOWNERBU�LDER� IDATE� Bl �NSO � ��°TE
NEW
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-I AND R-2
Building Permit Application
Effective 1/i/94
ConstructionAddress: / ��� �,Q£ff� ��iP/�l �/U
Legal Descripdon: �l�.S �iQPf � f �,Q/� L •v �
Owner Name 8c Address: o� �}- �,v oG S� �I � Tei. #�7� -�! Q 9
Contractqr: S 1< r� G✓/�_ S! �(/ /�- L t 7� ��� ��' � MN LICENSE # 3 4 D 5�
Address: � �'r� .� �� � /= i � � � S �" /�/- �- Tel. � �� ��" �`�� �
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Width Hgt/Ground Sq. Ft.
OTHER: I�7i � S� �2 C?�v %�/z� c.�s � c�� Z� �� 5� /� i��
,
Corner Lot j] Tnside Lot ( j Ft. Yd Setback _ Side Yard Setbacks
Type of Construcdon: � aoF ��i°/f iiQ Fstimated Cost: $�DO o> o
Approx. Completion Date: /�- � � �'�
(Cost on Backj
Driveway Curb Cut Width Needed: Ft = $ _$
DATE: - 3U - � APPI.ICANT: • Tel. # %�`/- S�� �
Permit Fee
Fire Su�charge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Controt
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ a�y � Fee Schedule on Reverse Side
$ � .001 of Permit Valuation (1/lOth%)
$ �, �� $.50/$ i ,000 Valuation
$ $800 per SAC Unit
$ �. C�C� $5.00 (State Licenseci Residential Contractors)
$ Alt. "A" or Alt. "S" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary ( ] Not Necessary [ �
(�3. s�
$
.
. ;
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SuBJECT • ~Z
City of Fridley 25 92 7
' , AT TME TOP OF THE TW�NS g U I L D I N G P E R M I T NO.
r
� �
�• __._ COMMUNITY DEVE�OPMENT OIV. � , I, ,, /
� � L � PROTECTIVE INSPECTION SEC. ��;��
� _ �
� �"'1 � CITY HALL FRIDLE� 55432 NUMBER REV OATE PAGE OF APPROVED BY
�""� � �'' 612-571-3450 910-Fi5 4/13/98 � �
J08 ADDRESS 1405 CREEK PARK LANE NE
t IEGAL �OT NO. BLOCK TRACT OF AOOITION SEE ATTACHED
DESCF. IS 2 CREEKRIDGE ADDITION SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Ho11y Arnold 1405 Creek Park Lane NE 572-8199
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
a ARCHITECT OH DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGtNEER MAII ADDRESS ZIP PHONE UCENSE NO.
6 USE Of BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION �1 REPAIR O MOVE D REMOVE
8 DESCRIBE WORK
Reside House; Soifit & Fascia
9 CHANGE OF USE FROM TO
STIPULATIONS
Install soffit ventilation to meet the State Building Code. Install smoke
detectors in dwelling to meet the State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY �OAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANO VOIO If WOfiK Oii CONSTqUCTION ZpNING S�. FT. CU. FT.
AUTMORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK !S SUSPENDED OR ABANDONE� FOR A PERIO� OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV TNAT I HAVE REAO AND EXAMINED THIS APPLICATION 1 S7AlLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDItJANCES GOVERNING TMIS TYPE OF WORK WILL 8E COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF q PERMIT �S�OOO �Z.SO
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVtSIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �99.75 Fire SC �S.00
PLAN CHECK FEE TOTAL FEE
107.25
SiGN TUAE OF CON'RACT R OP AUTMOR12ED AG t ATEi WHEN PROPERLY LIDATED THIS IS �OUR PERMIT
�
����
i
NATUFl 0 OWN U OWNERBURDEAi E� BL �NSP � qpTE
NEW [ l
ADDN [ ]
ALTER �
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: �� �`"Z' � C y���'�'/� lL'�� •" � � �`��
Effective 1/1/98
� �q a--'�
�'
Legal Description:
Owner Name & Address: �%� %y �i� v � � � Tel. # S -7 � <k- % F i
Contractor: � � � / -� � MN LICENSE #
Address: Tel. #
LIVING AREA:
GARAGE AREA:
DECK AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
OTHER:
. � ,�� ��`�rf����_
�- o v
Construction Type: �'- , G. Estimated Cost: $��--�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ =$
DATE: �% /�' �`l APPLICANT: �_ ' e � � r.;,, ti!� Tel. # S" 7 a- k'% 5 S
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ q `7 �
$ 5 �'
$ 7�
$
$
$
$
$
$
$�_1�G��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 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
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
�
' " �� SuB�ECT . � � .
c;ty of Fridley
AT THE TOP OF TME TWINS g � I L D 1 N G P E R M I T
r
� .
� ��
� ; L,_____ COMMUNITV OEVEIOPMENT OIV.
r � � PROTEC7IVE INSDECTION SEC.
1 �
� � �"'1 � CITY MA�L FRIDLE� 55�52 NuMBER
�"""�"� `'� 612-571-3450 9�0-Ft5
JOB ADDRESS
1405 Creek Park Lan
t IEGA� ��T HO. BLOCK TRACT OR AOOITION
oesca. 15 2 Creekrid e
2 PROPERTY OWNER MAIL ADDAES$
Holly Arnold
3 CONTAACTOR MAIL ADDRESS
Abbacare LLC 550 Orono Orchard Rd Wa��,�2at
4 ARCNITECT OR OESIGNER MAIL AODRESS
S ENGINEER MAIL ADORESS
6 USE OF BUILDING
Residential
i1EY
9/25/98
ZIP
vAGE O�
� �
PHONE
PHONE
PHONE
27968
EIPT NO.
�6 36 7
PROVEO 9r
SEE ATTACHED
SHEET
LICENSE NO
�2h98
IICENSE NO.
IICENSE NO
7 CLASS OF WOF1K
O NEW O ADOITION O ALTERATION � FIEPAiR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage (30 Sq) Tear-off
9 CHANGE OF USE FROM
STIPULATIONS
TO
Underlayment must comply with the State Building Code.
TYPf OF CONST.
SEPARATE PERMITS AqE RE�UIFED FOF ELECTRICAL. PIUMBING. NEATING,
VENTILATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NUII AND YOID If WORK OR CONSTRUCTION zONING
AUTHORI2ED IS NOT COMMENCED WITMIN fi0 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR A9ANOONED FOFi A PERIOD OF 120 OAVS A7
ANY TIME AFTER WORK IS COMMENCED. ' NO DWIG. UNITS
I HEREBY CERTIFV THAT I HAVE REAO AND EXAMIN�O THIS APPLICATION
ANO KNOW TNE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VA�UATION
AND ORDINANCES GOVERNING THIS TVPE OF WOFK WILL BE COMP�IED
WITH WHETNER SPECIFIEO MEREIN OR NOT TME GRANTING OF A PERMIT $2571
DOES NOT PRESUME TO GIVE AUTHORITY TO v10lATE OR CANCEI THE pEfiMIT FEE
PROVISIONS Of ANV OTMEFI STATE OR LOCA� LAW REGUTATING CON-
STRUCTION R TME PERfOiiMA E OF CONSTRUCTION �7�F.7S
P�AN CMECK FEE
Q i� License
S�GN RE � CON'RACTOA N 4UTNOR� N ID E� pq
S�GN47UQE O� OH'NEA�iF OWNEABUiLOEQ� �DATE� � B�OG w5� �
OCCUPANCVGROUP
SO. f7
OFfS'
STA�I,S
5.
I �A
OCCUPANCVLOAD
CU FT.
f PARKING
GAFAGES
$1.29
SAC CHARGE
Fire SC $2.57
�OTAI F
$8 .61
�S IS PQPA
��C �
�
qa�E
.,
NEW [ + ]
ADDN [ ]
ALTER [ ]
ConstructionAddress
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
� ��s ��
Effective 1/1/98
�P�
��a
rJ ���
����� W
Legal Description:
Owner Name & Address: �� r��JJ C� Tel. #�% �--' �)
Contractor: � L MN LICENSE #� 1 �`'2 �
Address: ��� ��r i�-c � Tel. # G 12-' ti' 7 6`�'� 7 2
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK AREA: Length Width Hgt/Ground
OTHER: ��..�a c= � � r,..� C. � �.� .�q _
Construction Type:
Driveway Curb Cut Width Needed:
DATE: ��
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Sq. Ft.
Sq. Ft.
Sq. Ft.
�� �� 9
Estimated Cost: $ �S / �
(Fee Schedule on Back)
Ft. + 6 Ft = Ft x$ _$
CITY USE ONLY
Tel. # �O� Z � �%G �Z i2—
$ ��,'/ S� Fee Schedule on Reverse Side
$ �!. s' % . 001 of Permit Valuation (1 / l Oth %)
$ /_ � �} $.SO/$1,000 Valuation
$ $1000 per SAC Unit
$ �- C,' C� $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 [ ]
� �3���
�'
��
, Building MECHANICAL Pe�it No.:: - �
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date Rec'd: ��"
DATE [ �. "�� YOUR E-MAIL ADDRESS
SITEADDRESS (�(US C-feClG I�flG LG/�
THIS APPLICANT IS: ❑ OWNER �7CONTRACTOR
PROPERTY NAME: "'��/� UPS�►/
OWNER/ pDDRESS: I�US Cf�P�PGlK L.Lrl� CITY �/'��(te�/ STA
TENANT T �ZIP 'JrS�I3�
PxorrE: � 6� — 57 f—G1t�3 X
CONTRACTOR COMPANY NAME: CENTERPOINT ENERGY
SUBMIT A COPY OF CONTACT PERSON: 'TOANN Z INREN
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH ADDRESS: �32Q EVERGREEN BT,VD $TE �ITY �Cdd� �PID$ sTa�MN zir�5433
APPLICATION PxoNE 763 — 757 -- 6202 FAx 763--757�-6701
PERMIT TYPE ��GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK• � NEW ❑ REPLACEMENT � ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK i/�5�/� l`Gc�!'iC'r 5� v(/� — U6 �O, lX� �TU �✓nuc�.
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fi�ctures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PR07ECTS WI-IERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXNRE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
Equipment Installed MFG: �`�,��/e�' MODEL: � K U(/ 3 D� SIZE/BTU �J� 0007
MFG: MODEL: SIZEBTU
MFG: MODEL: , SIZEBTU
A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGEJOVEN $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00
BOILER $35.00 �c FURNACE $35.00 GAS tJNIT HTR $10.00
CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR$15.00
— � � . �� _„ ___s �� ,�. —
# _ , .�.::: - ,
.
. � .
� � E . �. . , ' �
t,
x< < « :
w, " `
� �: . .�. . _� a ..�, w; .
. . . . . . . ,.. . .. . ,: _
Permit Fee $-����/.l'?'p Number of fixtures @$10.00 x$10.00 =$
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DIJE $_y(��1�'�C7 Number of fixtures @$25.00 x$25.00 =$
Number of fi�ctures @$35.00 � x$35.00 =$� S, v0
State Surcharge = $ .50
Tota1= $ Z S • S(7
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowtedge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the cas � all work which requires review and approval of plans.
SIGNANRE OF APPLICANT L �� �' � wr�ttrrT rrnME ROGER HOFFHE IN DA� � o� '0�-6 �
�';,' FL��;i��t '� .:,. '� , .'>. ,` w. `__� ";.i g,`� � ,,.�� � .�? �� � f �
.�: .
.: - , ,
. � ,�
City of Fridley
Building Inspections� Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
,
City of Fridley Residential Mechanical Application Page 2 `
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS ��'EXISTING HOME ❑ MAKE-UP AIR
REQI7IRED �OR NEW/�XISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312 �
5. Ventilation
a. Per NIN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.
Building PLUMBING Permitrlo.: `(����
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY' OF FRIDLEY vat�d:
763-542-4977 FAX EFFECTIVE 1-1-08
' � lc �� �. .� c� l� �� �-� L n v� �� : f c v:-�---�
DATE % /YOUR E-MAIL ADDRESS l�
SITE ADDRESS (�I� � �✓� � / � �� '�` '� Z-
THIS APPLICANT IS: �7 OWNER ❑CONTRACTOR
PROPERTY NAME: ...-� ` �` r
OENANT �DRESS: I`�US C: 'tcGC ,��. iGC G-'� CITY T�r- ��`� STATE�'�ZIP S f J�Z
PHONE: iG' 1 Z " % ( � ` S/ �f �
CONTRACTOR NAME:
SUBMIT A COPY OF STATE LICENSE # EXP DATE
YOUR STATE
LICENSE, BOND AND STATE BOND # EXP DATE
CERTIFICATE OF qDDItESS: C1TY STATE ZIP
INSUR.ANCE pHONE F�
PERMIT TYPE �StNGLE FAMILY O TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � �'��'' ��pLACEMENT
DETAILED DESCRIPTION OF WORK " c / i i- ' [ C'� :'� Y't=�` ��' � L' -�'
i/�G�It�t'_ S �e'� �`r/t
PER MS 16B.665 the permit fee is a minimum of �15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, instatlation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = plus .50 surcharge
OR
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $]0.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (iNDICATE TOTAL
NUMBER OF EACH BELOV�. MINiMUM FE� $15.50.
BATH SINKILAV _FLOOR DRAINS SHOWER _ WATER PIPTNG
^ BATHTUB GAS PIPTNG (NEED CITY LIC) SWIMMING POOL _ WATER SOFTNER ($35)
CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($IS)
DISHWASHER LAUNDRY TRAY WATER HEATER ($35) � FOR IRR[GATiON
— WATER METER � OTHER
. . � , ,. .
_ ,, , .
� . _ - _ � �..
�.
Permit Fee $ .� Number of fixtures @$10.00 x$10.00 =$
Surchar e .50 Number offixtures @$15.00 x$15.00 =$
TOTAL DUE $ OR Number of fixtures @$35.00 x$35.00 =$
State Surcharge = $ .50
(MINIMUM $15.50 (MINTMUM $15.50 Total = $
THIS IS AN APPLICAI'ION FOR A PERM)T-NOT VAL1D UNT1L PROCESSED
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit on site; that the work wil! be in accordance
with the approved plan in the c of all w k hich re r s review and approval of plans.
SIGNATURE OF APPLfCANT -ti PRINT NAME Ci � l�f' '��` � DATE � �/�
APPROVED BY DATE
, � �.. �
.. :�.� <a:
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building � PLUMBING I Permit No.`. O �
Inspections RESIDENTIAL APPLICATION i;��,y� `
763-572-3604 CITY OF FRIDLEY vate Rec'd:
?63-502-4977 FAX EFFECTIVE2-19-09
DATE �/ � `i� YOUR E-MAIL ADDRESS
SITE ADDRESS % Y U 5� ('��!' M_,%r� ✓��t.'�.'� :�-*=c.
THiS APPLICANT 1S: ❑ OWNER �ONTRACTOR
PROPERTY NAME: ri � � i , �/
OWNER/ ADDRESS: � /yC .S L�2.CZ �� %�s..�k .7� CfTY �/L�-c�ti( _ STAT "ZIP -t-► t/-� �
TENANT �r
PHONE: � Lfi 1.Z � 1 1� ` S' y�
SUBMIT A COPY (
YOUR STATE
LICENSE, BOND Al
CERTIFICATE Ol
INSURANCE
PERMIT TYPE
TYPE OF WORK:
Terry Overacker Plumbing, Inc.
502 E Main Street
Anoka, MN 55303
License# 061945PM
763-572-8880
� SINGLE FAMILY
❑ NEw
DETAILED DESCRIPTION OF WORK
❑ Tw0 FAMILY
�EPLACEMENT
CITY
FAX
❑ TOWNHOliSE
EXP DATE
EXP DATE
ATE Z1P.
FEES ARE SASED ON 810.00 PER F[XTI�RE. EXCEPT WHERE NOTED. FIXTIiRES: (1!JDICATF TOTAL NI;MBER OF EACH BELOW). M[NIMliM FEE
$35.50. WqTER PiP[NG
BATH SINK/LAV FLOOR DRAINS _ SHOwER —�ArATER SOFTNER ($35)
� BATHTliB GAS PIPING (NEED CITY LIC) _ SW1MM[NG POOL — gACKFLOW PREV. ($15)
CLOTHES �YASiiER KITCHEN S1NK _ WATER CLOSET _
� DISHWASHER LAL'NDRY TRAY WATER HEATER (S35) FOR ]RRIGATION
— — WATER METER _ OTHER
..•. M1.
i M"�5�; r �'�P" 7
.' �4� ..�.:_ ;:r . M ,. �{.., .. .._ r�
,�y� (���y, X 3ZM:�'�' `7' R R �y' �� w�, .�
' ,.�3 �W�'�D'i`V iN7� . . �
.� 1��- :� .. . , . . . �'. T
� ... • . .. . . . . . . J � .�.
�y;� �.� ��'F��Q :. X�SaQ=$
'i�� „ � ' . . : . .. 4 t w, Y��N ('��.4
' t�. .: . . : . - . � J � r . �i, 1
;�4}� ?C�, ! " .:. . . •' ' . . .. . '
+�:�i' 7G'�'Svc�Q=$. .
a v^ t'� .. . .. �>
����} _ . .. . . $ �S. . . . . . . � � ~, S rti,,.1r5 s
�
'�y�Iy+—r' p +la
��I�,�iiL�7i1 Y�W�L � �D ��\ � L 1\ � . . ~ ..�;t�,�1.:
THIS tS AN APPLICATiON FOR A PERMIT-NOT vAL1D [:NTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge that che information above is complete and accurate; rhac the work will be in
conformance with the ordinances and codes of the City of Fridfey and with the Minnesota Construction Codes; that 1 understand this is
not a permit but oniy an apptication for a permit and work is not co stan without a permic on sice; that the work witl be in accordance
with the approved plan in the case of all work which requires review and approval of plans.
I SIGNATURE OF APPL[CANT �7Lfti.%i ��„��,elZ� PR[NT NAME •J i�' (`, �, !' i� �?.-�i DATE ��/��l` �''
City of Fridley
Building Inspections Department
6431 Universiry Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977