AF - 42548�
City of Fridley, Minn.
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
Da�;- nPramhar �h: 19Z2
i �
� � �
� �
e��
�p,x; narrPl A F�r T)PtrPl n mPnfi r.� _ $uildeT _._.._.SStu2.._� __W_. .____.__.
gddresa 5901 Brookl�n Boulevard �, Address .�Same _ _� __�,
LOCATION OF BUILDING
Na - r2.�.4.�. Street �...E38.t_B.r3..u.7x.iaxl....Ea.S.S_.Nr.E...._____.._-------. Part of Lot
Lot 1 Block �_�__.�_.__.,.....___. ABdition or Sub-Division ._ TnnGhriirk.Nori-h_.T.,,g�, .3r� Arldi tion
Corner Lot — Inside Lot _._..._X......_.._..._.._ Setback _..._.._....____.__..___ Sideyard ___._.__� ._._.._
Sewer Elevatian
Foundation Elevation ____..�
DESCRIPTION OF BUILDING
To be vsed as:
T ownh ou �� _ F'ront 2�. �. Depth � Height •--..�-�• �-••–
.�.�Y�... ..___.... Front 1 ��,.�..� Depth _.�.2 � __ Height ._ 10 � _._..
1200'
Sq. Fk _..�Q9 � Cu. Ft ..�.}.6.Q9 �
Sq. Ft. _.:.2.�.1..'_ Cu. F� __.�.,.�.19'
Type of Construction __JJ.o.atL��ar,ne.,_,_._.. Es� Cost _._...$2.0.�..Q1.0._._____.._ To be Completed __.._,],..��ear
Stipulations : ��� SS�'J / � : `
In consideration of the issuance to me of a permit to construct the buiiding described above, I agree to do
'fhe proposed work in accordance with the description above rth and in compliance with all provisions oE
prdinances of the city of Fridley.
10.01 St' e Surcharge
—
In consideration of the payment of a fee of $ 3� 00 _.:_._., permit is hereby granted to Darrel A. Farr �evel .
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 all woxk
$one in, around and upon said building, or any part thereof, shall conform in all respects •to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and lnoving of buildings
��ce� city limits and this perniit may be revoked a t any tim e upon violation of any of the provisions of said
Buildin8 �P��
NOTICE:
This psrmif doas nof eover the construetion, installation for wiring, plumbing, gas heating, sewer o� water. Be sun to sN
t6s Building Inspeetor for separata psrmits for these items.
�
r\P�'LICATIO�ti F�OR RESIDENTIAL, AL�'rF:.AI'IO�t,
OR AllllITIOi� BIJILDIi�JG ��R.�1I�'
CITY OF FRIDLEY, T-iIN�'�'�:SOTE�
0 ��t�R' S N!�:� : „%���i-t�e'/ � ���-�' ��v��. C��. Bt3IL��i : SZt �+^r �,
ADD�SS : S9o/ .C��'oolt0y» �/v�l • AllDR :SS : S Gt a�a �,.
I�0 : . s��•� STP.EEi : .�Q.t� .�AC/Cl'/�'i �Trs f � SS
L;)''� ; � BLOCK: 3 ADDITZO�T :.r`i�s.t�r.+c.+� /Vorr{dr T. /�i. .� =.�/�=1e/i'��o dR
CflR.:°�'t L((7�: I�dSID� LOT: 6� SE�CK: SIDEYA�t�,,,�,�„
.'�pali�ant 2¢tach �o this sor� ��o C��tifi�ates o$ Su�*J°y o� LoL �nd p�capqse�
bu3l�ing location drawn o� Zh�se Certific�t�s. �
�o �� U�sd As :
✓� �dr s��c✓s�.
llESCRIPTION 0� BUILDING
�'�ont .��� r.opth. .�Z'�� H�i.���: .�Z�s��
/.Z�O
S�ua°s� rent: ��� Gubic .��e�: /S. C�l�O
�' `�"��� ' �'t�nt: /lioS� �epth: .�-� � HYzg�.t: /� �
Squs�:� �p��; .� s/ Gubic �����: .Z3/a�
i`��� oi Const�uction: �.�;�o� Ot/-'�-��� s�s�iLa��d ����: ���� �/�.ota
. r' _ _'^" .
`i0 .�3v-"' ��DI����: 7'���J
':.�: Lnd��;�i�;;ad h�x��,� �:�'c�� a�ol.�.ca�i�n �o� a p��xai�t �o� :�'�� ,�oz?� hea���
;�t)2v'!.��.��._'.�7 :ioY-�s+i�� �O 'a0 ��� �70T4: li 3L'.:�:'i. 2i�C0'..rL�i3.. �'"',. Tr1�,;..�'3 .i.�'?y'�3.'�jr f)..�r�
;�'r�d�-tiy fl'd:�na:.�c�-: ar.3 :��?�?��.:�� o� �iz�� �-��3���� o� ��.,uJ.lcli���, ai-�.�3 i4v�r��y
dw>c1����,3 Lz:a� c;ll �s�� 'ra��� r�?� rvpx����n���ions �c:z��d 1-.n ���� �Dp�.��c�'��?an
=�.�.'8 �:.'ll� �P.d. CO�"!'°C�.
L.��?',. . �� � �G � %�r � 7't�
°1 . J .Yd.'.7 i �ttirmJ Ali�. ; �
� )'_''v ??:.�'!L?'s3'? J1C�� w"O?" c�'�i��.�iOT13.� ��1C�J:�=';!:3"�j.t?:ia. j
.
c
�
J
�
City of Fridley
r �T TMI; TOP Q� TME TM�INY
i`
r �'L-�-��'-� GOMMVNITY OEVEi.O�MENT OlV.
� � � MOTECTtyR wt�CT10N OiK,
�l 1 r"' i pTtl MAII fR10LRY ���
i..._.J`.� �.J N�' 6�0' 3�s0
ss
�v� � �
�tractor //
���t{R.,�i�t. � "�R�CO%1.��-
i�i of Bui,,,�di.�nQ
etion Date
. . �- s-���
iw�EGT
�
�LUM� I ��r, PERf1 I T APPL I CAT I����
se
�
ress Phone
ss Phone
;:11
Plumbing Fixture Rates: N0. RATE TOTAL
Number Fixtures � x $2 .00 �$ �.0 0
Future Fixtures x $1.50
New Fixture-Old Open. x $1.50
Catch Bastn x $3.25
Water Heater-99,000 BTU ,(+ x $3.00 �.�30
Ground Run Old Bldg. x$3.25
Elec. Water Heater x $2.00
Gas Fitting Fe@s:
lst 3 k'ixtures _� x$2.00 ��?. U 0
Additional Fixtures x $ .75
Gas Range-199,000 BTU x $5.00
Repairs & Alterations
^ See
Description; Code
State Surcharge .SO
TOTAL FEE $ a?e3.S�
The undersigned hereby makes application for a permit
for �he work herein apecified, agreeing to do all work
in strict accordance w ith the City Qrdinances and rulin
of the Department �af Buil.dinga, and hereby declare that
a11'the facte and repxesentations atated in this
application are true and correct.
���� -�.��C�= - �' - � / -- � 3
'Sianature � Date
6�� �
f
.
i�C�Oi! �Of � �! a11� � �O�Oi�ll�f YM�OA� Rl��f01�0A �
� �.OA�OA� S�K OIld �l11�CK
�/IR�iI�L R�4rE SCHEDULE
a�� �r�►� arn: zura mru.
r�n�n� �rr a r� wo� .. sio.oa �
Replscement of Fvmace 6.U0 �
Repairs dt Alterations--ug to =508.00 6 00 E_ ___ ._
Repairs d� Alteration� esch add. t540.OQ . 3 UU �—_ . __ _
�fLL7i. Wlll11[ �Ilt �
Plunsce SheII d� Dtut Wari� to 1�O,OQO B1V
eaeR add. AO,OOQ BT'IT . . . . . . . .
Replans�eat of Fttirnace
Repairs d� A}terationa--up to =500.00
Repairs k Alteratioos each add. =500.00
. E10 00 :—.l U , v�
3.W ;
6.00 =
6.00 �_
3.00 =— -- _
STEA![ or HOT WJITER SYSTEN
iiirnace ShetT 3c Lines—to 400 sq. tt. f.DR Steam �20.�J0 �__- -- _-
Furnace Shetl d� Line,—to 640 sq. ft. EDR Fiot Water 24.00 S- -- -____ __
Each add. 200 aq. tt. EDR Steam A.tN► __ ___.
Each add. 320 sq. ft. EDR Hot Water 3.00 i----_--
QIL SIIRI�IEA—to 3 gaL per hour 6.0� i._---- —
over 3 gsI. per hour—See Tee Schedule _
GJ18 sIIR1fER tup to 199�OOp BTU}
over 198,OQ0 B'!`[T � FN seh�dul�
G118 g'I1TIPiC FEEar
Ist 3 FZxtures _
Add'etiaaai Ti:tvrea _
Gas Rsn�e ta 198.000� _
�
r�t� a�T� sTSi�e
�Tll.a'17/�6 �
1kL'��'IC�lq� ! RttJlt�i
�,, � ��:
s
I 3,
6.00 = .� � ��
I�Q RATE TO?AL
- xi 200 t---a-�! �
_ x .7b t--- --
- :i 6�00 = —
:� � U ` 4�
s« r« s�.t�.
� ��1�l�� � J��
�i. !i6 � � rf . 09
S�
a.�. � siaa.. rs.a.,. seo.�eo
� I_� . .. !�` � <
ctcy � Fiidle�:
The undersigned hereby makes application for a permit for the worl� t►erdfi :
speciiied, agreeing to do all work in strict aecordance with the City Ordiaancef=
and ruling of the DepartmFnt of Buildings, and hereby deelares that aIl tbe fac3€
and representatiuns stated in this application are true and eprrect.
F`ridiey, Minn_---- -----� 14 �
Clwner --�LL�--",���12 �2� l k-,.N.rl�'" �
Kirid of Building �s�'� � _
it"
�Jsed ag _ __ `/ .�y
- --- - ✓ --- —
To lye completed about _ - -- --.-- ----- -
Estimated Cact, E _ __ ._. _. ._--. ---
Uld—Nerv. Building Permit No. _—_ P�rmit No. _ .588�
D�RIPTIOIf OF i1011][
iiEATTNG or POWL�R PLAN18—$te�tn, Hot Water, Warm A1r—No
T'rade Tiamr�� --+-�--�� gg� �,�,��/r�, L 3—//
Capacity_..L-�-�--- S4. !'t. E.D.R BTU g,g
Total Conrncted I.o�d — lUad ot �Le ,
BURNER — Ttade Namp 31se N10
GDacitY 39. !t. E.D R $'TtJ $�
fMMMMts-OMlR)
i f �_ �.� - �, i ✓L /_ '
/. � ��
, �
�
53-81�-s-915, 51
City of Fridley �
. ���4��� �� ��.���g ea�d � ���� ��� � .
z��. oE aiaq.. phon. sso-saso ---
D�scatprtorr oF wo��e ' S5�5 East Bavarian Pass N. E.
Idumb�r, Kind at►d Locaiion oi Ftxtu:es LO��°II
3� I � I I � I • I N I� �• I p �
Base
in
2nd
3rd
4th
• Futuz� Cona�clion 4D+ninQs
+ N�w Fixlur�, Old Oy�ni�qs
� I� � IU � I< S IU' � IU' � I(J � I I I N I GASTEA KTEG.
tall �asiGr
S�w�s
Ccsapool
P�4RTIAL RATE SCHEDULE
pLQMBING FIXTUAE RATES: NO. RATE TOTAL
Number Ptixtures . . . . . . . .. . . . . . . . . x $2.00 $
Future Fixture O��ening . . . . . . . . . . . . x a1.50 ;
New Fixture Old Opening. . . . . : . . . . . x a1.50 a�-.-_-
Catch Basin . . . . . . . . . . . : . . . . . . . . x a325 S
Water Heater :Up to 99,000 BTU) .... x$3.00 $
New Ground Run Old Bldg. ... . x a3.25 $
Electric Wst�r ii�atu�. . . . . . . . . . z a2.00 S
3Jr.8 FITTING FEEB: N0. RATE 'TOTAL
ist3Fixtures ••••••••••••••• • xS2.00 ; .
Additional FYxtures . . . . ..... . . . . . x = .?b 3 '
Gas Ran�e to 199,000 BTU .. . ,.. . . . . ... . x 35.00 `
City o1 FYidley:
The undersigned hereby makes application tor a permit for the vrork herei
s peci fie d, a g ree in g to do a ll wor k in s t r ic t acco r dance w i t h t he Ci t� O r d i n a n c e
and ruling oi the Department oi Buildings� and hereby declares that aii the tact
and representations stated in this application are true and correct�
6-17-74
F�idley, Minn 19,.,
Owner
?�axrel A. Farr Developement-
Kind of Building Frame
Res.
Used as
To be completed about 6-2Lt�7�
Estimated Cost, a 10.00
�i�-New. Building Permit No. P�rmit t�o. '� ' _
= r�---4
Signed _,+�,L.�arv �%i' -�f "''
' BY R?ct_r'.`",Mr� •- �
Business Phune No
ROUGH
FINAL �-%- 7C •
REpAIRB dr 11LTERATIONS—R.i•s !o Cod• .50 State Surcharge
. Description . . . Inst�ll. Gas, Grill. . . ... . . . . . . . ... . � 5, 00
Tarwi. � ; � _ Kn •
,
C(ass °iA°� Surcharge .50�
0
�
SUBJECT . � P �� •
c�ty of Fridley 2 2 0 6 6
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
� ` RECEIPT IVQ_-
COMMUNITY OEVELOPMENT DIV. Q
r � v � PFiOTECTIVE INSPECTION SEC. �� I�
� �
i
+ � /'��1 � CITY HALL FFiIDLEY 55432 NUMBEFi REV. OATE PAGE Of APPROVED BY
�""'�' ,'� 612-571-3450 910-F15 8/26/93 / /
108 ADDRESS 5545 East Bavarian Fass NE
t LEGAL ��T NO. BLOCK TRACT OR ADOITION SEE ATTACHED
DESCR. ]_ 3 Innsbruck North. Townhouse 3rd Addn SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Robert Baker
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
58�� Dicks Fire & S.tarm 864 19 Ave SE Minnea olis MN 55414
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Res i den tia 1
7 CLASS OF WORK
O NEW ❑ ADDITION O ALTERATION O REPAIR O MOVE O REMOVE
8 DESCRIBE WOFK
Reroo� Ga,�a e (.Tear--o�f�
9 CHANGEQFUSEFROM TO
STIPULATIONS
Provi_de smoke detectors as per ITBC adjacent to alI sleeping areas and in
b as ement .
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. fT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OF IF CONSTRUCTION
OR WORK IS SUSPENDEO 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 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WII.L BE COMPLIED �`48O � OO y�. r'JO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $IS�OQ Fire SC .4S
PLAN CHECK FEE TOTA� FEE
License SC $5.00 $20.98
SiGNATURE OF CONiRACTOA OR AUTHOAIZED AGENT IDATEI �I�IH EFiL IDATED THIS IS Y�R��
SiGNATUREOFOWNERUFOWNER9UIL0EAi �DATEi G i �� � pTE
NEW
ADDN
ALTER
[�
[l
tl
Consb�vction Address:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
East Bavarian Pass NE
Owner Name & Address:
COriiI'dCtOF: Dicks Fire & Storm (Richard J. Williams
Atl�t'eSS: 864 19 Ave SE, Minneapolis , MN 55414
Attach to this application, a Certificate of Survey of thE
lot, with �e proposed conshvction drawn on it to scale
DESCRIPTION OF IMPROYEMENT
Effective 5/26l93
� ���? �
Tel. #
MN LICENSE � 24 sl
Tel. # �$i--6i�o
378-2880
LIVING AREA: Length Width Height Sq. Ft.
GAR.AGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length � Width Hgt/Ground Sq. Ft.
OTHER: Reroof Garage I tfl lt � C?.j^i`� �
Corner Lot [] Inside Lot [] Ft. Yd SetUack Side Yard Setbacks
'Type of Construction: Estimated Cost: S y�a --="
Approx. Completion Date:
(Cost on Back) .
Driveway Curb Cut Width Nceded: Ft. + 6 Ft = Ft x S =�
DATE: 8/26/93 APPLICANT: �� ��� �,�YY Tel. # �si-61�o
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Qriveway Escrow
Erosion Control
Park Fee
Sewer Main Ch�'ge
$
$
$_
$
$_
$
$
$
$
n
TOTAL $
�,
Fee Schedule on Reverse Side
.001 of Permit Valuarion (i/lOth%)
$.50/$1,000 Valuation
$7S0 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Abave
Conservation Plan Review $450.00
Fee Determined by Engineezing
Agreement Necessary [ ] Not Necessary ( ]
STIPULATIONS: '
.
Sus�ccr
c�ty of Fridley
AT TME TOP OF THE TWINS g � I L D I N G P E R M I T�
i �
� �` ���� COMMUNITY DEVELOPMENT OIV.
; r :� � ~. , � PROTECTIVE INSPEC710N SEC.
1 i ,
� �•�'1 � GTY MALL FRIOLE� 53�32 NUMBEp REV O�iE �AGE Oi
' ` �� `` �....'�'�' ' •,, - 612-571-3450 910-F15 3 / 17 / 00 % /
10B"ADDRESS `"�5541, 5543, 5545, 5547 East Bavarian Pass NE
1 IEGA� � LOT N0. BLOCK TiiACT OR AOOITION
oescR. 1-4 3 Innsbruck North Townhouse 3rd Addn
ACTOR MAIL ADOFiESS
North Central Builders Inc 7401 4
1 ARCMITECT OR DESIGNEfi MAIL AOORESS
S ENGINEER MAIL ADDFESS
6 USE OF BU0.GING
' Residential Townhouse
7 CLASSOF.WORK
, , . O NEW O ADDITION
8 DESCRIBE WOpK
Reside Townhouse Building
O ALTERATION
9 CMANOE OF USE f ROM TO
21P
iope, MN
ZIP
21P
C� REPAIR
STIPUTATIONS
Call for building wrap inspection before covering.
�? .
E; . , , �.,�..., ., .
TYPE OP CON$T.
SEPARATE PERMI7S ARE REOUIRED FOR EIECTii1CAL, PLUMBING, HEATING.
VENTI�ATING Ofl AIR CONOIT�ONING.
TNIS PERMIT. BECOMES NULL ANO VOIO If WORK Oq CONSTiiUCTION 20NING
AUTMORIZEO IS NOT COMMENCEO WITMIN 60 OAVS. Ofi If CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONEO FOR A PER100 Of 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO OWLG. UNIT;
I MEpEBY CERTIfY TMAT 1 HAVE REAO ANO E7fAMINEO THIS APPUCATION 4
AND KNOW TME SAME TO BE TFUE AND CORRECi. ALL PROVISIONS OF �AWS yA�UA710N
ANO OROINANCES GOVERNING 7MtS TYPE OF WORK WIL� BE COMPLIEO
WITN WHE7MER SPECIFtEO MEiiE1N OR NOT. 7ME GRANTING OF A CERMIT �IH�J9%
DOES NOT PRESUME TO GIVE AUTMORI7V TO VIOIATE OR CANCEL THE pEqMIT cEE
PROVISIONS OF ANY OTMER STATE OR IOCAL LAW REGULATING CON• A3O7.25
STpUCTION OR THE PERFO MANCE OF CONSTiiUCT10N .p
PLAN CNECK fEE
.3 �7 � License SC
S�GN�TUAEO�CONCA , A0�1�Ui�+ iZED�GENt . iO�TEi WMEN iI
� w �
•TUpE O� OWNEA i�� OWNEp BU�IOEN� �OAif�
� "
30740
EIPT NO.
A►/ROVED e�
SEE ATIACME�
SHEET
PHONE LICENSE NO
27 533-6168 3763
PMONE IICENSE NO.
PNONE LICENSE NO
O MOVE O REMOVE
OCCUPANCVGROUP IOCCUPANCV�OAO
SO. f T
STA�LS
.00
CU
OiFSTREET PARKINC
IGARAGES
$9.40
�C CMARGE
Fire SC $18.80
�iAL FEE
$340.45
TMIS IS VOUR PERMIT
3-20-�
qUE
SuB�ECT ,
City of Fridley 3109
AT THE TOP Of TME TWINS g � � L p I N G P E R M I T
r
; � RECEIPT NO.
' COMMUNITV OEVELOPMENT DIV.
� � ~ � � PROTECTIVE INSPECTION SEC. �Q �,�
r , �
,
� _ �'�'1 � C�7Y HALL fRIOIE� SSIJ2 NUMBEN NEV O�TE v�GE Oi �PVAOVEO Sr
�----�: �.� 612-571-3450 910-F15 6/27/00 � �
JOB AOORESS 5541, 43, 45, �l7 East Bavarian Pass
t IEGAI �OT NO. BLOCK TRACT OR AO�ITION SEE ATTACHEO
DESCR. 1-4 � Innsbruck North 'Townhouse 3rd Addition s►+eer
2 PiiOPERTY OWNER MAIL AODRESS 21P PHONE
Innsbruck Townhome Association 651-224-5482
J CONTfiACTOR MAIL AOORESS ZIP PHONE LICENSE NO
Garlock-French Roofing Corp., 2301 E. 25th St., Mpls., MN 55406 612-722-7129 00001423
� ARCHITECT OR OESIGNER MAIL AOORESS 21P PHONE LICENSE NO.
S ENGINEER MAIL ADDRESS ZIp PMONE LICENSE NO
6 USE OF BUIlO1NG
Residential
7 CLASS OF WORK
❑ NEW O ADDITION O ALTERATION L� REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof Townhouse.Building (Tear Off)
9 CHANGEOfUSEFROM TO
STIPULATIONS
Underlayment must,comply with ihe State Building Code.
P��mit Inspection Cards
iNill Be Mailed
°�o Homeowner To Post
SEPARATE PEFiMITS ARE REOUIREO FOR EIECTRICAI, P�UMBING, MEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANGV lOAO
VENTI�ATING OR AIR CONOITIONING
TNIS PERt�N1T BECOMES NUII ANO VOIO IF WOiiK OR CONSTRUCTION ZONING SO. FT CU FT.
AU7HOR12E0 IS NOT COMMENCEO WITMIN 60 DAYS, Oii IF CONSTqUCTION
OR WORK IS SUSPENDED OR ABANOONED FOF A PERI00 OF 120 OAYS AT
ANY TIME AFTEii WOpK IS COMMENCEO. N0 DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV TNA7 I MAVE FEAD AND E%AMINEO THIS APP�ICA710N 4 S1A��5 GAfiAGES
ANO KNOW ?ME SAME TO BE TRUE ANO CORfiECT. ALl PROVISIONS Of IAWS VAlUA710N SUFiTAX
AND ORDINANCES GOVERNING 7MIS TVPE OF WOFK WILL 8E COMPUEO �S � IO%. 34 $2 . SS
WITM WME7NER SPECIFIED HEREIN Oii NOT. THE GRAN7ING OF A PERMIT
OOES NOT PRESUME TO GIVE AU7MORITV TO VIOLATE OFi CANCEL THE pEpMIT FEE SAC CHARGE
�ROVISIONS Of ANY OTMER STATE OR LOCAL LAW REGUTATING GON• Q 12S . ZS Fire SC �S . IO
STqUCT10N OR TME PERFORMANCE OF CONSTRUCTION w
PLAN CNECK fEE TOTA� FEE
32.90
-_ S�GN�TUpEO�CON'NACTOQOp�UTHOp�ZEOAGENT iD�TEi _ E PpO VAUD D THIS�IS VO�Up P�p=1T �,
/ ' Cl1
V �� f
S�GN�TUpEO�OWNEA���OwHfa8ULL0EAi �O�TE� �p5o � � r�stE �
Building PLUMBING
Inspections RESIDENTIAL APPLICATION
763-572-3604 CITY OF FRIDLEY
763-5�2-4977 FAX EFFECTIVE 2-19-09
DATE
SITE ADDItE S
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
INSURANCE
PERMIT TYPE
TYPE OF WORK:
YOUR E-MAIL ADDRESS
❑ OWNER QCONTRACTOR
ADDRESS: �A��� � CITY
NAME:�Q
STATE LICENSE #
STATE BOND # ,
PHONE �`1,���/+Q � FAX
O SINGLE FAMILY
❑ NEW
DETAILED DESCRIPTION OF WORK
❑ TWO FAMILY ❑ TOWNHOUSE
E�EPLACEMENT
Permit No.:
Received By:l/\,l.
Date � MAR
EXP DATE
EXP DATE
TATE ZIP,
r�Z!
��t
�STA�i��i��� �
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING
_ BATHTUB GAS PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($
_CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. $1 j
_ DISHWASHER _ LAUNDRY TRAY �WATER HEATER ($35) FOR IRRIGATION
_ WATER METER _ OTHER
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL 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 will be in accordance
with the approved plan in the cas al ork w ic re uires review and approval of lans.
SIGNATURE OF APPLICANT PRINT NAM G � DATE�
City of Fridley
Buildi�g Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977