AF - 39062City of Fridley, Minn.
BUILDING PERMIT N� � `4ss�
�: � �' �
Date: .. y�����`.� _._ ...........
7 "'
Owner: t� . Builder ...._ � _.......... . __... .._ ...
� �� � /�
Address ��._.. . � �- y�.� : "' � ��L. Address .����-'Yf�'...
/ LOCA I{^yrN pF BUILDING
No. .. � �. /([� Street _�� .4 �/.. . �C / .. . . .. Part/of� Lot ... ._.._. __.
I.ot 3Qy�.J � Block Addition or S�u/b-p id ion �,/G.C(i`'e/L(/-�t�'..[.!J �� --
Corner Lot . Inside Lot �� . 9etback4f..7� SideYard . .,3 � . ... .__.
�
Sewer Elevation . . . . . . . FSGndation Elevation . .. _.... ... .. ...
DESCRIPTION OF BUILDING
To �g Used as:
.(J,�,�� . .. Front ../....]. Depth �- �Height �D Sq. Ft. JJ r�. Cu. Ft.�� "'..O
✓� Fro . /�jJepth Height �I Sq. Ft. Cu. Ft. _. ..._. ''
Type of Construction ✓;` ..�"L./� Est. Cost �� . ...... To be Completed _... .. ... . _...
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley. �
._.._.._ .._.__ .__..
In wnsideration of the payment of a fee of $. r7 .._.�... , permit is here6y granted to . .. __. .___.
.. ......_....... ._ .... .. ......._. ......._._. . to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in al] work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding ]ocation, construction, alteraUon, maintenance, repair and moving oC buildings
within the city limits and this permit �nay be revoked at any hme upon violation of any of the provisions of said
ordinances. i///J '
. _�'��i� .:.;T<�__._.1...... Building Inspector
NOTICE:
Thia permil doaa nol <ever eha �onshuc�ion, ins�allalion for wirine. Pl�mbing, gaa heafinp, sewar er waf�r. Ba �ura le aaa
�he euilding Inspealor for sepante permit: for ehe:e i�ems. �_ __
�q r�� . i �—i_
• � NUT AUTHORIZE Vln'_AT-
; ' I � :nND CUVENa�J'TS AND
��� �_. tE 5TF;1�'TION�.
Ownere Name
Address
No . h "Z �/
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINI3ESOTA
�_ �h�� � . , .,,<_ BuildE
,
.. � : / � Addre:
IACATION OF BUILDIZ
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Iot �i i�1 5/ Block L Addition
,�- �
Corner Lot Inside Lot `' Seet Back�
SEWIIi ELEVATION
��/
�
. %/! , .
_Part of Lot
/� � �
S�1b.Div. /� c I �c �,1ti�tel ' � _
r
,. . ..�e.�a.. v.,,,� .
ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDIIJG
To be used�s �
� �- � y--�-c ��_ti���> �
< < < FY�on't �Df
Sq. Ft. >� F�� Cu. Ft. l 5 C�
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Cottstruction �i � ^ '' - ��� Estimated Cost / ! � _���� �`-
To be comple
/�'
2he undersigned hereby makes application £or a permit for the work herein speci£ied�
agreeing to do sll work in strict accordance with the City Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representa-
tions stated in this application are tsue and correct.
J i
DATE � __ ,/ '- � � � SIGNATURE i��/4 ��=_ ,V" /.� Ltc-�-.
(A Schedule of Fee costs can be £ound on the Reverse Side.)
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F3uilding
II] S]� eCil O Tl S
7E3-�72-3604
nnrF 11-
SfTt ADDRESS .
l-HIS AFPLICAIQT I5�
PROPERTY
OWNER/
TE�A)AT
CONTRACTOR
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR &MNL ADDRESS
❑ OWNER I�COMRACTOR
NAME: 1� l,k)0�� �l `� �>L�'l��l
ADDRESS+:-7 `1 Cl u 7 l� . 2 CiTY
PHONF.: Ih�7J..�1�7J)" ���♦l� J
Permit No.:
. ,; ���
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�'•��_;) ;! � I1
SUB'�1IT A COPY OF I ST.4TE UCENSE � C1121IIpIpf1 O(Z�Zf�X� k��pATE _ I.) (i —I
l'OUR STATE ADDRESS: B5�-�G5'��O CiTY ST.4TE ZIP
LICENSE N'I"IH pHV,�E . 10p — �
APPLICATION --{89�-: tv1N-5�?2`��— F.�
PERMIT TYPE I�SINGLE FAMII_1' ❑ TWO FAMILY ❑ TOWNHOUSE
T} PE OF NORK: I❑ v�vr
DET�ULED DFSCRIPTION OF WORK
o.aEr�o.ce�.T
PER'�tS 16B.665 the permi[ fee is a minimnm of 515.00 or i"/o of the to[al mst up [o $500.00, whichever is _reater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (Ihis should reflect only the cost of labor )
Labor cost under 5300 �= 515.00. Labor cost between $300 to $500 = cost of labor z.OS =
.1-
FOR PROJECTS N�'HERE LABOR EXCEEDS 5500. FEES ARE B.4SED ON $10.00 PER FIX7'l1RE, EXCEPT W}iERE NOTED. flXTURES: (INDICATE TOTAL
NUb4BER OF 6ACH BELOWj
_ BATH SIhK/LAV FLOOR URAINS SHOWER WATER PIPMG
_ B.ATHTUB G.4S PIPING ar�C1n'uCCVSEj SV+9MbIING POOL WATER SOFiNER (535)
_ CLOTHES WASHER _ KITCHEIJ SINK W'ATER CLOSET BACKfLOW PREV. (515)
_ DIS}RVASHER _ LqUNDRY TRAY � W'qTER HE.ATER ($35) FOR IRRIG.4TION
_ N'.4TER MFTHR OTHER
' FLE PROJECTS
Pcrmit Fee
TOTAL DUE
PERMIT EEE FOR
V� Number of fixmres @$10.00 _ x SI0.00 =$
50 Number of fixtures @$]5.00 x 515.00 = a
S� Number of Fixtures @$35.00 = x 535.00 = S��
\ State Surcharge = $ 50
Total = � �i � ,.7?
THIS IS AN APPLICATION 1'OR .4 PLRMIT-NOT VALID UM1TIL PROCESSED
I hereby apply for a buildin� permit and I acknowledge Iha[ the information above is complete and accurate; that the work will be in
confonnance with the ordinances and codes of ihe City of Fridley and with the Minnesota Construction Codes: that I understand this is
not a pennit but only an application for a permit and work is not to start u�ithout a permit that the work will be in accordance with the
approved plan in the case of all;WOrk w�hich reqpires review and approval of plans.
SIGNA fURF OF ?.PPUCANT
NAME�� �,v j
C..hX��-� � �_il � � DATE �� � _
FOR
City of Fridley
Building Inspections Department
6431 Univcrsity Avenue NI?, f�ridley, MN 5�432
763-572-3G04
1'AX: 763-502-4977
�j,IjI77
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