AF - 43225�v
City of Fridley "
Ap�ic�ution for P'�umbing and Gas Fitting Perm�t
Dep3. of Bldgs. P ne SU 4-7470
DESCRIPTION OF WORK
Number, Kind and LxaYian of Fixiures Locatio�_
U�' WATER HTR.
� � V1 OC N VI W W ? � #
ul K
W,� =N Z S} ZZ � QZ UZ O= � <� W
� �J a < � � Z < � � O 2 � � � � < 3 <U' ` �U' K U�' O R N GAS EIEC.
3 u � b�- VI 3 1-� � LL Vl LL 0
Base
1st /
2nd __
3rd
4th _ ^
• Futurs Coanectioa Openings
� New Fixlure, Old Openings
Connected
PARTIAL RATE SCHEDULE
Sewer �
Cesspool n
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... � x $1.50 $--y��-
Future Fixture Opening ................ x 1.20 $
New Fixture Old Opening . . . . . . . . . . . . . . x 1.00 $
Catch Basin .... ....................... x 3.25 $
Water Heater (Up to 200,000 BTIT) ...... x 2.00 $
New Grouad Run Old Bldg . . . . . . . . . . . . . x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
lst 3 Fixtures .......................... x $1.50 $
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .... .......... x 2.00 �
REPAIRS & ALTERATIONS—Refer !o Code
Description ...........................:. ...........$
. . . . TOTAL FEE $ � � �
City of Fridley:
.
a�C
G�"`�
The undersigned hereby makes application for a perxnit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
, Fridley, Minn. � � � / , 1�`°
Owner
Kind of Building ��� <G`'��o
Used as t �
To be completed about (' � � d
_.......___._
Estimated Cost, $ � "
Permit No. ��G �
Old—New. Building Permit No.
Signed_—��� �� ,�E c;�
gy ! 7-�-zz.P
Business Phone No.�s� J- �-�� z�`
ROUf3H
FINAL
a z 4M 7-s9
_
_
CITYOF
FRI DLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. 'v.E. FR[DLEY, MN 55432 •(61?) 571-3450 • FAX (612) 571-1287
June 3, 1994
Steven J. Dank
American Family Insurance
7040 Lakeland Avenue, #102
Brooklyn Park, MN 55428
Dear Mr. Dank:
This is to confirm that 641 Dover Street lies within Zone A as
identified in the Flood Insurance Rate Map, community panel
number 270013 0003B effective March 2, 1981.
Should you need further information, please feel free to contact
me at 572-3590.
Sincerely,
Barbara Dacy, AICP
Community Development Director
: � .�,1
C-94-147
' Fri le SUBJE" 2 6 8'�
c�ty of a y
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T --�
� . RECEIPT NO.
� �
� • COMMUNITY DEVELOPMENT DIV.
r � � � PROTECTIVE INSPECTION SEC. a�� �
� �
� � /"�1 � CITV HALL FRIDLE� SS432 NUMBEfi fiEV. DATE PAGE Of APPROVEO BY
�""� � ,'' b12-571-3450 9t0-F15 7/7/94 � �
108 ADDRESS 641 Dover St NE
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. SHEET
8-12 V R'
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Dawn Marth 641 D 783-7240
3 CONTRACTOR MAIL AODRESS ZIP PHONE LICENSE NO.
Same
d ARCHITECT OR DESIGNEF MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BU�LDING
Residential
7 CLASS OF WORK
❑ NEW �7 AODITION O ALTERATION ❑ REPAIFi ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 10' x 28'S" and an 8'8° x 17'8" Deck (430 SF)
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan. Provide smoke detectors adjacent to all sleepin
areas and in basement.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY IOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOF A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFS7REET PARKING
I HEREBY CERTIFY THAT I HAVE FEAD AND EXAMINED THIS APPLICATION 1 STAILS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �3,504 �I.7S
DOES NOT PRESUME TO GIVE AUTHORI7Y TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS Of ANY OTHER STATE OR LOCAL LAW REGUTATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �63. OO Fire SC �3. SO
PLAN CHECKfEE TOTALfEE
$68.25
SIGNATU:7E OF CONTRACTOR OA AUTMOAIZED AGENT IDATEI WHE PE V ATED THIS IS YOUR PERMI
L
S�GN/+TURE OF OWNEFlUF O�NNER BUILDERI IDATEI OG iNSP f�FTE
NE.W : ( j Effective 1/ 1/94
ADDN ( � � CITY� OF FR[DLEY �
` ALTER (� S(NGLE FAMILY AND DUPLEXES R-1 AND R-2 ��j �j 7
. � Buiiding Permit Application
Co.nstructicin Adclress: _ _ � �, _�����_ -�-
, ..�,----- ----
Legel Description:
Owner Name 8c Address: �� � {\_�� �-� N �y � ,�1 �� � 5�- �,�, � Tel. # � 8 � - � �L� (�
Contract�r: . � � MN LICENSE # ' �
Adciress: � � � . � , � � Tel. # � . . .
Attach to this application, a. Certificate of Survey of the
lot, with the proposed construction drawn on it to sc�le.
� : .� � � � �.�.. DESCRIFTIUN �OF,.IMPROVEMENT . "� . . . �. . - : � .
LIVING. AREA:
GARAGE AREA:
DECK: AREA: . �
OTF�ER: . D��:-k
� �Length . � � � . Width � � Height Sq. Ft.
� Length � � Width � � � I�eight. _� Sq. Ft.
. '� Length i �d � � Width a � �' HgtlGround. �.�.' . Sq: Ft. �����.-,.�.'' .
�, . .
� �,,. ��, �,,. �/.,, I:S��
Comer Lot [] Tnside Lot Ft. Yd Setback . ���Side Yard Setbacks . �� 3 b .
�)
Type of Construction: �� —T � Estimated Cost: $ 3 S 0�•�`C�
Approx. Completion Date: `j�� 1�zh ��
jCost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: /- � � APPLICANT: ��� �� f� � � � Tel. # �� `� %� ���
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY
$(� �. � Fee Scheduie on Reverse Side
$ � , .� C'� .001 of Permit Vaivation (1 / l Oth %)
$ � i $.50/$1,000 Valuation
$ $800 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 ( ]
��g���
STIPULATIONS: �
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