AF - 40716SUBJECT PERMIT NO.
City of Fridley _ - T-
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T� '± �2g��
r �
� � RE�EfiFT�ND:`� _
� • COMMUNITY DEVELOPMENT DIV.
� �.: ------, 7 ��0��1
r � � PROTECTIVE INSPECTION SEC. .�/
1 = �
�� /"'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BV
•"'� � ,�� 612-580-3450
910-F15 2-21-75 � �
108 ADDRESS 5564 East D� Road
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
DESCR. 2 2 Innsbruck North - 2nd Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
John Suhrbier
3 CONTRACTOR • MAIL ADDRESS ZIP PHONE LICENSE NO.
Robert Lau en Homes o ated- -
4 ARCHITECTORDESIGNER MAILADDRESS Maple Grove, Minn. Z�P PHONE LICENSENO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
es de a
7 CLASS OF WORK
�4 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE 0 REMOVE �
8 OESCRIBE WORK
� 3, � � �
9 CHANGE OF USE FROM TO
STIPULATIONS provide a hard surface driveway. Provide a verifying survey before
capping.
SEWER L�ATION: 60' 5outh of Manhole (Inv. 946.74)
Wye Elev: 947.55
7:+op of Footing: 950.55 Nlinimum
WATER LOCATION: 3' South of Sewer Service
��'�ERATE PERMIiS R�Q�9�RE� ��R t�'it�ifi��:
�"���tT��`��s; �9...�d��l��a �aN�i J�`i�ii�s.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOCl fi8.II1(:
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R�1 1926 26 856
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 WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �FO 7GO.00 LO.3S
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. C7O.00 325.00
PLAN CHECK FEE TOTAL FEE
05.38 :+
SIGNATUREOFCON7RACTORORAUTHORIZEOAGENT IDATEI HEN PRO E LID TE THIS IS YOUR PERMIT /
�{l ,� c�� ��7 � �
n SIGNATURE OF OWNERIIF OWNER BUILDERI IDATEI BLDG iNSP DATE --
AP.PLICATION FOR RESIDENTIAL, ALTERATION;
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNEP.' S NAME :�� ��•a •��t �1 iL F� a�1� BUILDER �aQ T�r91,t ��'i•e �'�/�vtSS a1 iv L
annxESS : annxESS : 8�66 �. e�s.� ,Lg k,� �,
�
���Cf ��+u�J ��iu�► . S S` 3 � e',-
NO •.SS� � STREET: L��ci J T ,U/3 �v u
LOT: � BLOCK: � ADDITION:�N�� ��or�►� �'`�'v
CORNER LOT: NSIDE LOT: SETBACK: �7. So SIDEYARD: �S- /3
Applicant attach to this form �tao Certificates of Survey of Lot and proposed
buildi.ng location drawn on these Certificates.
HESCRIPTION OF BUILDING
To Be Used As:
��z � 7`�1 Nr� � �/ rC��Front • .� � Depth • � � `�" '' � I Height •
` �
Square Feet:-' - _.� Cubic Feet:
�- A2,y Front : � � Depth : � 'Z- Height :
Square Feet; Cubic Feet:
7.j►pe of Construction: �,�i��� Estimated �Cost: $ i�7o�o--*�
� � ��',-I . � , / � � . � _x
To Be Completed; � - 1- ?S- -
- . ,- , = ... . � �
The undersigned hereby ma.kes appl.icativn for a permit for the work herein
specif ied, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representati�ns stated in this application
are true and correct.
DATE: � � 13 � ? � SIGNATtTRE d� �o
(See Reverse Side For Additional Information.) -�
l�]
_ s-1
_ _ _ �_
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 any e�cisting
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 permit of fees to the amount herein below set forth and in
the manner herein provided to-wit:
tJNIFORM BUILDING CODE: 1j►pe 1, 2� 4-$2.15 for each one thousand cubic
feet, or fraction thereof, i:n such cubical contents. �ipe 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building pernutts, 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 main 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
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for eonstruction will be issued a mi.nimum of 24 hours from the
tima of application, to allow for proper review of the proposed structure and
of the construction site.
A Certified Survey of the lot, showiag the location of the foundation, once it
has been constructed, will be required before proceedin� with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the uae or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occup3ed until a Certificate
of Occupancy has been issued.
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6917 IDPiH4 AVE. N.
GOI.Q�N YI�1.EY, MlNIV. ' :' ' BROOKl1fRt PARK, MINRf.
, M1Ni�F. R�Q. h10. 4741 . LAND S�' ''YQ�S
MlNN, REG, NQ b743
BE�T$B�g tJNDBB LA'qt8 OF �TA`F� OF 1�3H�OT� .
ucnvs�n asr axnnvsxc� oF crr�. o� ��a�oa.is �; iNyG�e� lVO; 4��� -
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• INQUSiR1At -- JUDICIAL Mi»neapotis, Minnesota',65428 � �b � : ��"e`-"'."""
CObAMGR�tAI -- tOROC�B/VBHICAL , �,,} _
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fwm or on said laad. . �_`'�.�-" "�`�-�"" �£ � p, � -
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. MINN. RE6. t+t0. 4741 L�D S���� M1NN. REG. NO. 6743 �,;.
�8(i18T��iD IIZID�R I,►O8 Ot BTA�S O! ]ON1iR811TI1 .
- trcexesa $i o�x;�xcs o� crrx or �NS�,►ro�s t�to� wa ' �463 7– !' '
574�" W. 8roedway 533-99Z2 q�, Np, 1�.i7"��� �
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INDl15TRf�1l -- JUDICl/�l Minneepolis, Minnssota 55428 4� �'�r
COMMHtCU1L — T�P�GR/1PH1Gll . �� �" s
CiTY LOTS — PLHTTiNG ���p�jtr� ��'�u�� O — DENOTES IRON
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WOOC� HU�S
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Weatheratrips A� Guide � �natruction No. Inn�tlstion -_
Windowa ( Doors Rekreace . Out. Waq 1nt. Wall Ceiling Roof F7oor Kind How
Yes—No Yes—No 19_
1 Fl.� ,•', .,��^ . Room Leagth /' Width / Height `� �' J_Fl.� ��.�C �; Room � Length /,� Wideha
Windows and Doors—Crackage and Area Windows an� Doore—Crackage and Area
Nldth Helght -No. ol Llneal tt. Are� { Wldth Ha16bt No. o[ Llnesl tt. Are�
� No. ot p�ne o( Dane Ilghta ot crack �q. tt. P�.� 1 No, of Daoa ot pane ilght� ot crack �C. tt.
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Coef. Btu
Inbltration .� � �. � - ;^"-, %
Glass . !� � �'y �, �°
Eup. wall : ,%' �
Net c:p. wall _p ,� �- �% `'
Ins. wall
Ceiling f/ ,�t f,.�
FI•�or � "" �
' Total Btu. � `� � � ' �
Required sq. ft. E.D.R. or sq.'ins. W.A. l.eader area
�: FI.V"''. -� Room � L.eagth �-! Width Height �s 4%�
Windows�and Doors—Crackage aed Arca �
Width He1�At No. ot Llneal tt. Are�
No. of pane o[�D��e ll�ht� o[ cr�ek sp. tt.
� `7 P � �� . +7 / � ° e4 •
� Coef. Btu
lnfiltration � ` ��"� `%' �;.
Glaaa � � 6� �� P �., ,
Ezp. wall ,� 1+ �
Net ezp. wall i°c.e) i� p. G�
Int. waU
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Ceiling ....'-. � �J 1 ' '�' ;,�
Floor f; �� �. l�.. p
Toeal Bcu. �' - , - '3.�°
Required se�. ft. �.D.R. or sq. ine. W.A. l.eader area 0
' Fl. ,�'_, • - �'�; ��oom Lengeh Width �= ° Height - � t='.
Windowa and Doora—Craekage and Area
Wldth Hd�bt - No. Ol Linaal tt. Acea
No. of pane ot Dsne Il�ets ot cnck W tt.
% .�/S i� �+� � .� oY . a:,'-..
lnbltration
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Fsp. waU d� , �, s
Net acp. wall
lnt. wall
Ceiling -� ,�' "
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. Total �tu.
Required sq. ft. E.D.R. or
. ��Y'i e ..� v�,r� -F��
� Windows and Doora-1
w�ein H�li�l 1
, No. ot yans ot pane I
t��
Coef.� Btu
Inhitration � �
Glass '°►
Exp. wall � � �° � �°a .
Nec e:p. wall `� � �
Int. •+all
Ce��ing y-/ Z- . 1 tl�'
Floor
7�otal Btu. �
Required sq. ft. E.D.R. or aq. ina. W.A. Leader area
FI.I (,�a•_e(� °�� �Room I Leagth,,-�? _. Q/idth/-�
Windows and Doors—Crackage and Area
Width Helght No. ot Lfneel tt. Ares
No. ot Dans ot Dane ltB�t� ot crack eQ. [t•
, � . ' �4� � c�" � . � "� ,� E_
Infiltration
GlBSa
Exp. wall �� - �
P �
Net exp. wall
Int. wall
I Cei�ing . ,� .
Floor
�� Total Btu.
Coef. Btu
,� ^,. ,� �" + . ✓ �� �' �
p '°�' `r
° `:;_ • , �
.- —��'
�(�'t y, i�' ,k p� ,
15 ` /U �
�, ias. W.A. L.eader ares 1 p f
su�th _.� V�Iidth _/. Height r' F' " �
�ckage and Area I
o[ Llneal tt. Are�
U� ot crack ��p. ft.
, Infiltration � ,� � f F' �
�
Glaa " /
Eup. wsll � ` ° / r
Net exp. waU / ` "'"
`�` Int. wall
`t � Ceiling ! / - ,�"�'f
Floor � `
Total Btu.
Required aq. ft. E.D:R. or aq, ina. QI.A. L.eader area
�
'� .
'ar,i �.. . . . . . .
.l'k�.___ _ —' _—__— _—
�3� _
�..�..:�. . . � . ..
Btu
�... ,
�.�
+? �
�„_ � � !:.
�-
� t!-; z°�, / s�° �
�
,°� �'� a �- �
�: � � .� �a
h � �7 C
Required sq. ft. E.D.R. or eq. IDl. W.A. Lssder ares �/ _
� F7•� �;L.�,.:.:�.,' Room I Length Width /�� . He�gae ,�
Windowa and 'boora—Cracicage and Area
WIdtD He1QAt No. at Llae�l ft. Area o,
No. ot Dgne ot D�ne Ilght■ ot crack tp. tt• -� ��
� �'�s� F" � r �}� p+�+ •��'
� 1 � � �` 1 �, ��
i �!�
� �'` �
Goef. Btu
CJaa�
Exp. wall °' �`
Nee exp. wall
Int, wall
I Ceiling .;a: a� �^-�,
Floor
� ;°
� _ � _.
_ % �...- �°�
Total Bcu. /, �a �,/`�
I Required sq. ft. E.D.R. or aq. ins. WA. Ltatkt area %
Fl.�,%; ' fRoom I Length ,:�, Rlidth Height .� '
Windows aad Doore--Cracicage amd Axs —
Wldth He1QAt No. ot � Llneal tt.� Are�
No. ot Dane o! D�ne Il�ht� o[ 0raek �p. tt•
l � � i ! D
�' 9� ..�`f; � � ��
? !O ; � � c
Coef. �3tu
Infiltration � � � � >
Glaes �
Exp. wall ='�:�," m
INec exp. wall
Int. wall �
Ceiling �..,� �
Floor
`� ..,-;w .
�f � :� � i
���
II Total Btu.
Required aq. ft. E.D.R. or sq. ina. WA. L.eade� area
� _ E i,�
I� • :� , �.
�r
'' ` �Hfa►T lASS �l�C1Jl�1TlON9 .
;; .��
Weather�triq G�� � Construction No.
Windows Doo� Referertce Out. Wall Int. Wall Ceilins RooE Floor
Yss—No I Yes— 19_.
% E7•� ' ` Room Lensth a Width,/ _ Hei�ht �' FI.�
KIAd
Room I I
Wmdows and Doors—Crackage and Area Window� and Door
�Vldth Hel��t No. �[ Llnul tt. Arc� � � � WIGtd Helsht
��� � No. ot p�ne ot p�n� � Il�ht• of crack sp. tt. � No. ot pan� ot Dan�
� r C.� S?'-
Coef. Bcu
lnfil '
� �..:,
.
ln�ulation
How Applied �
ength Width
ckage and Area
ot L1nw1 ft. Ana
t� ot crack M. tt.
trahon
Infiltration
Glass c�,-S �;
Glaas
Exp. wall �� '�' � , Exp. wal)
Net exp. wall L � Net e:p. wall
Int. wall •
Int. •+all
Ceiling Ca�ing ,
Fl:,or � Floor
Total Btu.
Total Bm. •
Required sq. ft. E.D.R. or p: ins. W.A. L.eader area � Required sq. ft. E.D.R. or sq. in�. W.A. Leader are�
Fl.� �.,,�.., : Roou+ I Len�h ;. . W;d�h He�Ehc i"'�-- Fl.I Room I L.ength Width
� Windo � and Doo�t--Crackage and Area Windows aad Door�—Cncka�e and Area
� � WIAth N�l� t Ne. el Llneal ft. Are� � WIdtA Hel�ht � No. ot Llnpl ft. An�
�� �� No. of pane ot p�n• � � Ilt�t• ot cr�ck p. tl. - � No. ot paes ot pan� U�Ab ot cr�cA p. tt.
� •� � � � �
�
�'!', ` COtF. Bt1t (
� . In6ltration ""' In6ltration
�' Caiass
�,� •`-'� c:r. Glasa
�; �� Fsp. wall -+ � ' r"- Ezp. wall -
� t Net e:p. wall �, /' C" Net exp. wali
Iet. wall
��t lnt. wall
,...� Ceiling �• Ceiling .
�� ci,..._ .. ...� __,
?�'i ` : �ou� n�u.
�' Required sq. ft. E.0
4 '
. ,�'f �'� 'G' � �1/ �
Windows and Db
� wiain x:i�
-- s� No. ot ptn� . ot D�
+' 7
or �q, ins. W.A. Leade� area
m l.ensth,��' ; Width; ',„. ,
—Cnckage and Area
Np, ot L1nea1 tt. Are�
� II��t1 ot crack �a. [t . �
a ''� O �
�,
�
�
In6ltratioa
�, Glaa
� Etcp. waU :,, `
�, _Net exp. wall
lat. wall
Btu
x.= .,�������
�� hloor
� �
�1 �
�'` Total Btu. '
�" _ Required aq. ft. E.9.R. or �q. ias. W.A. Leader area /�
�� �• --�m �� Width Height
�'` � Windows snd Doorr-Crackage aad Ana
�� - � Wldtn Htlsht No. ot L1ntal�tt. Are� . , �� � �
, No. ot pae� ot D�n• U�At• ot er�ck �p• tt.
.� - . . . . . � .
:��
:�
�� COlI. B�U
s?; , �Qll�t�at100 '
�' Glau
�- . Fap. wall .
''�# Net e:p. vraq -
i� :
Int. wall �
� Ceiling
�'±� " floor
� " Total Btu.
� Required �q. ft. E.D.R. or p. ia�. W.A. Ltader area
�
, ,�, , -
a a . �.,.r 1�--'-� •�•n � �..R.�
�'� .i ,k . d . .
, �
•:�.. . , , . , ,
Floor
Tota! Btu.
Required �q. ft. E.D.R. or �q. iris. QI.A. Le�der are�
F7.� Room I L.enath Qlidth
Windows and Doors—Cnekage and Area
�Wldih Hel�ht No. ot Ltn��l ft. Art�
No. ot pan• ot D�n� IIiYt• o! c�atk p. tt.
&a
Height
BW
Glaae : .
Esp. wall
Net exp. wall
Int. waU
Ceiling
Floor
Tota) Btu.
Required sq. ft. E.D.R. or sQ. in�. WA. l.eadu area
� Fl•I Room I L.ength Width Height
Windows and Doon---Cnckase and Area
WIdRh Hal�ht No. ol Llnaal ft. Aro� � �
.. No. ot Dan� o[ D�n• Il�bt� o! craclt a. tt. . �.
COtE. HtY
Infiltration .
Glass E
Exp. wall
Net exp. wall
Int. wall '
Ceiling
Floor _
Total Btu.
Required sq. ft. E.D.R. or �q. in:. WA. Leadc� �oea
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560-3450
if � ���t��
� �
ANOKA COUN7Y
6431 UNIVER5ITY AVENUE NE FRIDLEY, M{NFI�SOTA 55421
June 18, 1975
Robert I�augen Homes, Incorporated
6866 East Fish Lake Road
Maple Grove, Minnesota 55369
Re: Finals Inspection @ 5564 East Danube
Gentlemen:
After making an inspection at the above captioned �ddress,
the followinq corrections must be made before a Certificate
of Occupancy can be issued.
l. Joist Hangers on header off floor joist by
stairwell..
2. Nail up bridging on east side.
3. Sod front and side yards.
4, House number missing.
After making these corrections, please call for a re-
inspection. �
Thank you.
, � -�����
�ti�.
DARREL CLARK
Community Development Administrator�
Building Official
DC/cs
�
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6431 UPIIVERSITY A!/EPJUE td.E., FFtIDLEY, MIPJNE30TA 5543F
TELEPHOfdE (612)57f-3450
Apri1 30, 1981
TO WHOM IT MAY CONCERN:
We were called to i.nspect the basement of a house at 5564 East Danube
Raad N.E. to determine the cause of a damp basement. .
On November 1Z, 1g80 we inspected the si.te and there was evidence of
moisture stains along the front wall of the basement. The most
probable cause of this comes from improper grading alorig the front of
t�he house. The grade is lower at the foundation, causing surface
water to run toward �tlie founda.tion when it rai.ns or thaws�.
�f you have any further questions on th:i.s matter, please feel free to
contact me at 571-3450.
Sincerely,
DARREI, G. CI,ARIC
Chief Building Official
DGC/mh
sus�ecT PER O.
City of Fridley -16 3 4 0
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � R IPT .
� `� _ _ _ COMMUNITY DEVELOPMENT DIV. �o �
r � � PROTECTIVE INSPECTION SEC.
� _ �
� /"�1 � CITY HALL FRIDLEY SS432 NUMBER REV. DATE PAGE OF APPROVED BV
�""'� � ,`� 612-571-3450 910-F15 / /
8/1�4/81
JOB ADDRESS 5564 East Danube Road N•E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 2 Innsbruck 2nd SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
�� Daniel G. Kordiak 5564 East Danube Road N.E. 571-5419
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
5ame
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
R@S].a@lltl.�l
7 CLASS OF WORK
❑ NEW ❑ ADDITION 0 ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
X
8 DESCRIBE WOFiK
ConstruCt a l6° x 6° + a 9' x 6' + a 20° x 16' DeCk
9 CHANGEQFUSEFROM TO
STIPULATIONS
�,� y�+�'
f �ARNING
���u�� ���e ����1 �a�� r�
�1'is �N� 5�� �EIEPtl�iyE. ElECt1tle � utilt�ies
�� ���,� �,�� C�S Ebc.
��p ��NG, e�� IRE� $y Z,�1�1i
��.P
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OFi AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT f HAVE READ AND EXAMINED THIS APPLICATION l. STALLS GAiiAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT yS`3 OOO �`�.. 'rJO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEHMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. .,53$. rjO NONE
PLAN CHECKFEE TOTALFEE
' 9.63 49.63
SIGNATUHEOFCONTRACTORORAUTHORIZEDAGENT IDATEI WHEN PROPERL ALIDATED THIS IS YOUR PERMIT
c���' ��;�-'/� � ��' �/' s (�%.�Q � � G�L�� � � �` �°
�f�F,.� /I /3w Y ,.---
SfGNATUAEOFOWNER�IFO NERBUILDER� IDATEI BLOG iNSP �AT
S
CITY OF FRIDLEY Effective Aug. l, 1981
APPLICt1TIa� FOf; RCSIDLf�TIRL QUILDItiG PEFti�iTTS
(�de�•r, Alter.�tions, Additions, or Repairs)
ONJ��ER: ,g�ei �� �- /�ro�!��
ADORESS: ,a ,��/y ,� ,�'�.��� ��, �(�
[3UI LDER : �,�%� �
ADDRESS:
TEL N0: S 7/— S�/g' TEL ��d0:
Construction Location
STRI�T NO: 3-S�y STI2EET: � 4� ,��i,�a., �i �s�
LOT: � BLOQC: ,� ADAITION: �...s�r�, � �s, �
Corner Lot: Insicie Lot: � SetbacY.: Sideyards: /S��}�
Apglicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
� DESCRIPTIOid F C4��S P•U TIOPa � �Q
( �, : � � t,� � �3� :
� Front: � Detth: Height: a� ��
Square. �'eet: �u Qibic Fcet:
� / �U
�L� � � �?� �LA-SS Front: Depth: Height:
��1 Square� Feet: Cvbic I'eet:
�� �� `�.� -� �� �c��9 '� ��� e�-
Type of Construction: ����,��c_�r,�r Estiunated Cost: $,3�Qp�'
Zb Be Oor.�pleted:
' Alt. A Alt. B
Proposed Drive��ay Width If New Opening Is Desired: $ $
, SE� i�VER�E SIDE OF SHEET ,
Riie undexsigned hereby ma};e� application for a permit for the �:ork� herein specified,
agreeing to do,all work in strict accordance with the City of I'ridley Ordinances �id
rulings of �the Departmc�nt of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
D�7T�: G, % �� SIG1Q11TUitE: i� �� /1
Stipulations: �s
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BtJILDING PE�RMIT F�EE SCHEDU�LE
The Inspector of buildings shall, before issuing permits .for the
erection of any building or structure, or for any addition to any
bxisting buildinq or structure, or for any alteration or repairs
to any existing building or structure, upon application therefore,
require the payment by the applicant f or such permit of fees to the
amount herein below set forth and in the manner herein provided to-wit:
'PO'PAL VALUATION
$1.00 to $500.00
$501 t�o $2, 000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 and up
FEES
$10.00 Minimum Fee $15.00 plus surcharge
$10.00 ior the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and
including $2,000
$32.50 for the first $2,000 plus $6.00 for each
additional $�,000 or fraction th.ereof, to and
including $25,000
$170.50 for the first $25,000 plus $4.50 for
each additional $1,000 or fraction thereof, to
and including $50,000
$283.00 for the first $50,000 plus $3.00 for
each additional $1,000 or fraction thereof, to
and including $100,000
$443.00 for the first $100, 000 plus $2.50 for
each additional $1,000 or fraction thereof
PLAN CHECK: 25 percent of building pennit fee
DRIVEWAY DEPRESSION ESC�tOW: Concrete C�rb Streets Only
Alternate "A": Removeal and replacement of curb and gutter only
Driveway width plus 6 feet x$13.50
Alternate "B"; Renoval and replacement of curb and gutter and install a 3 foot
wide approach with 6 inch depth
Driveway width plus 6 feet x$15.75
VERIFICATION OF FOUNDATI�ON
Permits for construction will be issued a minim� of 24 hours froan the time of
application to allow for proper review of the proposed structure and di the
construction site.
A Certificate of Suxvey of the lot, shawing the location of the foundation once it
has been constructed will be required before proceeding with.the framing.
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6ERALD T. COYNE
300 BRUNSWICK AVE. S.
60LDEN VALLEY, MINN.
MINN. REG. NO. 4741
tNDUSTRIAI — JUDICi/1l
COMMERCIAL — TOPOGRAPHIGNL
CITY LOTS — PV►TTING
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�OT SURVEYS COMPANY
LAND SURVEYORS
QBfil8TS8SD UNDEB LAWS OF BTATS OF I�NNE80TA
UCBNBED BY OSDIN�IVC6 O! Ci7'Y OF lQNNEAPOLlB
5747 W. 6roedwsy 533-9922
Minneepolis, Minnesote 55428 "
�urnp�nrs �rrtifu��e
��B�:.T iAUJ�;tJ HOT�'::,� I?�C.
RAYMOND A. �RASCH
6917 IDAHO AVE. �:.
BROOKLYN P/1R K, M � ra N.
MINN. REG. NO. 6743
iNVOicE ao. 46� 7
F. !. NO. 'r+ _ �
SCAIi 1" � �' � , ,
Q — DENOTES IRON
C7 — Denct es
'vlood Huts
�'or
Ex�avatior.
Only
Eleva:.ion datum assti:med.
.� sb � .� � �---� ��C r.
LoL ?. � Bloc�c 2, IhAISIIRUCk NORTH 2ND �JDITI�iV
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pr�e;.oe� ta ::!�io� foundatior. I�arch 1J. l�i?�7 �
We Aereby cerfify Met this K a hus eed conecf ropresentation f . �
of a �urvey of fha bounderies of fhe ebove described lend end � / �� /
fh� locetion of aN buildings end visible encroachmsnh, if eny, /,��� 1 � �
from o� on ssid lend. 5.�� ` � ����.%,i`' . �' . �f -" �� �••'' �
Sunsysd by �� +��:�dey � Deceaber 19 74 LO'P�SURVEYS COMPANY
��
TO:
FROM:
DATE:
SUBJECT:
En9meenn9
SewCr
WelCr
Parks
Slreets
Mainlenancc
William W. Bums, City Manager
John G. F1ora,�Public Works Director
June 19, 1995
Sump Pump Chazges
�J(�� � .�raNV��
F� �- -� � -�. ,��-
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PW95-161
We have been mailing out letters to properties of known sump pumps plus those adjoining
properties to advise them of the need to inspect their property and disconnect the sump
pumps from the sanitary system. In that process, we have been scheduling a number of
appointments to verify the existence or disconnection of the sump pump system.
We have currently received two requests for exemption to the July 1 date. One is from the
property at 556�East Danube. The male resident is out of the country until August and,
therefore, they aze requesting an extension of the disconnection completion until the end
of August. The second is for the resident at 5435 East Brenner Pass, who is contracting the
work which is to be completed by July 15.
Unless the Council has some concems, we will be honoring these requests and delaying
submittal of a sump pump fee until these properties have been inspected and based upon
the dates provided.
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CHI EY AND STA K VERIFICATION
The undersigned hereby verifies that t�e existing ciumney or stack:
i. Has b�n carefully examined Yes () No ()
2. Is free &om rust or deterioration Yes () No ()
3. Has no foreign objects lodged within Yes () No ()
4. Is s�urely supgort,ed � Yes () No ()
5. Meets all current Code requirements for size
and tohai B i U's conn�ted i'es () ltio ()
6 Has total heating BTU's of �
All other BTU's
TOTAL BTU's
7. Has a liner b�n provided for water heater
S. Has combustion air been provided for water heater
Remarks:
List ALTER.ATIONS Bein,g Done-
HEATING CO:
Sign� By;
Date:
�A�'��RQ HEATIII�� AND AIR CON�mONING C0.
�... ...- � i LF1[{E ST���=T
�E�'��`"-.`.; :;�I�, PriN 5�40�-29$8
PFiOfVE �j4-2656 �
�
Yes()No()
Yes()No()
�
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Ha.:
410 W. LAKE ST.
MINNEAPOLIS, MN 55408-2998
612/824-2656
' ° ' -. E,, ' -� " - t , , .. = c <.�;�,,-ia.hp,«.-N -.. . _ , . . .
HEATI .NG AND �Ih �ONDI,'�QNING CO
iServinP 77te Twin Cities �ip�i�38"
ORSAT TEST RE�CQ�tQ
1072 PAYNE AVE.
ST. PAU L, M N 55101-3892
612/772-2449
�
ADDRESS .SS'��f �p�-�� ,���_ CITY ����Sl � „�. ---
OCCUPANT - '"`�'°"' � pWNER ,P d
;,
DATE HTG. INST. /�--S'� INSTALLED BY . �
GAS LINE BY �,�s�
TYPE OF HEAT: GA F� HW STEAM SPACE HTR. UNIT HTR. OTHER `'�'"'°�
GAS DESIGN
MAKE MAKE
MODEL �,�' l.�Q / G- ,�! MQDEL
SERIAL ��-'Q Y��'�..�" 7l�''`,,�'� MAX.
I NPUT �/��O ��' MAKE �
OF BURNER
BTU RATI
CONVERSION
CONTROLS "°""
THERMOSTAT HEAT PLUG��v��'�f��Gt�,L�/ENT SIZE `,r'�
VALVE �,P KINO OF LINER �/p�-� SIZE �a NONE
LIMIT ��,�--,.�r DRAFT HOOD - - REGULATOR
LIMIT_ ES TTING i'� OG CHIMNEY CONSTRUCTION
��./'���
FAN SETTING r� ,� DRAFT ��1�,Q���c�'EST TAC p� �s G%�o
PILOT TYPE � � LIGHTIN� TNST.�,,7 �D��-- ����
P I LOT MAKE r----��
PILOT MODEL '�
PILOT TIMING ������'�,�
PRESSURE � r,� � PERCENT
INPUT CFH /�/� � PERCEN?
STACK TEMP.,�„�"C PERCENT
CO2 �� / DATE
�2 �i .3
C �� NAM E
� .�� .�.
�
� ��,:� _ .��:_
_, ���
�r-
sua�ecr
c�ty of Fr�a�ey
AT TNE TOP Of TNE TWINS � �� L D 1 N G P E R M I T
;,
,�
� ; y __��� COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
1 . i
� j �"'1 � CITY MALL FRIOLE� SS�32 NUMqER pEV O�TE
�""'� � �'' 612-571-3450 910-F15 3/22/O1
JOB ADpRESS 5564 East Danube Road NE
t LEGAI �OT NO. BLOCK TfiACT OR AODITION
oescR. 2 2 Innsbruck North 2nd Addition
2 PROPERTY OWNER MAII ADORE$$ 21P
Christopher Menon 5564 East Danube Road NE
3 CONTRACTOR MAIL AODRESS ZIP
Same
4 AHCHITECT OR DESIGNER MAIL ADDRESS ZIP
5 ENGINEER MAIL ADDRESS ZIP
� �
3 i 696
�e� / �
sA
6vnovEO Br
SEE ATTACMED
SNEET
PNONE
763-572-9659
PHONE LICENSE NO
PMONE LICENSE NO.
PNONE IICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WOqK
O NEW O ADDITION O ALTERATION C� REPAIR O MOVE O REMOVE
8 OESCRIBE WORK
Reroof House & Garage (24 Sq) Tear-off
9 CHANOE OF USE
TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
SEPARATE PERMITS ARE REOUIRED FOR ELECTfiICAL, PIUMBING, HEATING,
VENT�LATING OR AIR CONDITIONING,
THIS PERMIT BECOMES NULI ANO VOIO IF WORK OR CpNSTRUCTION 20NING
AUTHORIZED IS NOT COMMENCED V�!ITNIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANOONED FOR A PERIOD OF 120 OAYS AT
ANY TIME Af7ER WORK IS COMMENCED. NO DWIG. UNITS
1 HEREBY CERTIfV THAT I NAVE READ AND �XAMINEO THIS APPLICATION 1
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND OROINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMPLIED
WI7H WHETHER SPECIFIEO MEREIN OF NOT. TME GRANTING OF A pERM1T �Z,454
DOES N07 PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME pEFiMIT FEE
PROVISIONS OF ANY OTMER STATE OR LOCAL LAW REGUTATING CON•
STRUCTION OR 7ME PERFORMANCE OF CONSTNUCT�ON �S3 . LS
PLAN CMECK FEE
� � �_ .
S�GNATUaE CO�N'QnC Op AUTMOp�ZEO AGENT 910�TE� e
E�I�i
FT
STA�LS
OCCUPANCVLOAO
OFFSTREET PAiiKIN(
IGARAGES
$1.23
SAC CMAFGE
Fire SC $2.45
TOTALfEE
$86.93
IDATEO THIS IS VOUR PERMI'
NEW [ ]
ADDN [ ]
ALTER [ ]
Construction Address � S �
Effective 1/1/2001
CITY OF FRIDLEY (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Legal Description:
Owner Name & Address: � (�ZI S �� �1�� � AP� r^� Tel. #_ 7� . '-� '7 2- " �J 6 5 �
Contractor. � �n� �J�V'` MN LICENSE #
Address:_ � (�ll„V�n� Tel. # � � 3 �--� �� -��, � �'
LNING AREA:
GARAGE 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 Sq. Ft..
Length Width Height Sq. Ft.
DECK AREA: Length
OTHER:
�
Width Hgt/Ground Sq. Ft.
�i e.9,-e_ � Ci S' G% � .-'�-��g�v"
Construction Type: Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft $ _$ �'�� �7
.
DATE: � APPLICANT: Tel. # 7�b .� �� �" � G � P�
I
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ �O
- a�� Fee Schedule on Reverse Side
$ . �Sr .001 of Permit Valuation (1/10th%)
$ 1 _ a 3 $.50/$1,000 Valuation
$ $1150 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 [ ]
$ ��-�.�
�
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official 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 such pemut of fees to the amount herein
below set forth and in the manner herein provided to-wit: �
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,OOO,Q00
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $1(}0 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $SOO,OQO plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,OOO,Q00
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Altemate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
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 Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv
�
NEW [ j CITY OF FRIDLEY Effective 4/1/2004
ADDN [] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [] � SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
REC'D � C T 1�0 2007
Construction Address: S� �� �'.• � ^��� 1�C-1 �� / � l � � �
Legal Description:
Owner Name 8 Address: �o��a� aM�.�c9� Tel. �7co3� �� Z-rl�oS�7
Contractor. (��. n. �,� ►>..cS.o w�� , MN LICENSE # Z� .�i �% Z—
Address: �IfX`� t���v.A.��� ( �o y � � �-�� �� �IU SS�(2� Tel. #(���� ���� Z�°�
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Cert�cate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRiPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft
Length Width HgUGround Sq. FL
Construction Type: 5����iCc� ` Estimated Cost: $ ��2� ���
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: c0 �� � APPLICANT: Tel. ���r��ZZS —�(�C(�
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-5T1-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ �•��
$
$
$ ���
$
.� ����
$
�
$
$
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 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 [ )
TOTAL $ (1� ,�� STIPULATIONS:
BUII..DING PERNIIT FEE SCHEDULE
The Chief Building Official sha,llll, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteradon or repair to any existing building or
structure, upon applicadon therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 �o $Z�,� - --
$25,001 to $50,000
$50,001 to $100,OQ0
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEF,S
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
-$6� ���#i��t-$''t,t�0 plus�i�flQ for�aciradditi6naY��;888-----
or fraction thereof, to and including $25,�0
$391.25 for first $25,000 plus $10.10 for each additional $1,0�
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each addidonal
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $5�,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
CUi� ��J'��S�CR�
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate
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.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Onlv
Building
Inspections
763-572=3604
DATE I O � ( S �
SITE ADDRESS _�
THIS APPLICANT 1S:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERNIIT TYPE
�rE oa� wo�c:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
❑ OWNER
ADDRESS
�
No
Re d
Date ec'
YOUR E-MAIL ADDRESS 5 P1 �P,(SO � iIC�N,�, ��(��p.�,�p r� ��,QGT •CoN-
r1
STATE LICENS� # 7 ��1�.1 Q�� Z EXP DATE
ADDRESS:� 100 l�l�oln _wQ4 Iv� �J
❑ BASEMENT FINISH
❑ DECK
�
❑ RQOF
❑ SIDING
�ri `l2 `-�( STATF�I+�IP�3Z
Cfi'1' N�CW L'FOD'� STATEI�I�LIP SS4,Z $�
7�-'20 U �
� DRAIN TILE
� OTHER
DESCRIBE WORK BEING DONE:_ P�2 olq c.i..•. c t�1 ...e L�e� .� c(�� r-� o n.l �� �
SIZE OF .. .. ....... ..... .� ._ ' .
SQUARES
GARAGES
PROPOSED SIZ.E:
PROPOSED HEIGHT:
SIDIIVG
O Vinyl
❑ Aluminum '
❑ Otl►er .
WINDOWS
IN EXISTING OPENINGS I�tYes CINo
OR FOR NEW OPENINGS-DESCRIBE STZE OF
OPEND�G CHANGES &
V►'ID7'H HEIGNT
U HOUSE ONLY
❑ HOUSE & GARAGE
O ATTACHED GARAGE
� DETACHED GARAGE
IJSog'it
❑ Trim
0 Fascia
LOCATION OF WINBOWS
SLQpt r l•ea.g� rQq. �- p� h o.�t.1-Q_
BASEMENT IZFMODELING SUBMiT•
I. Existing Floor Plan
2. Proposed fl�r pian
3. List of structural members to be osed
F�
FOR NEW CONSTRUC'['ION MCLUDING DECKS,
ADDITIONS & PORCliES Ct��•
1• Sitc P1an/Survey showing the existing srrucmres
and proposed project
2. Two sets of construction plans
3. Energy Ealculations
TYPE �F WIt�TBUW TO BE IIJSTALLED NUMBER OF'WINDOWS I
�.
.�u.L rr.�� tuc� �pia�D UN VALDATION, INCLUDING THE COST OF LABOR AND MATERIALS;
(USING TIiE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ � 20'1. o J OCCUPANCY TYPE
Permrt l�ee
Plan Review
Fire Surchazge
Surcharge
License Swcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ /, � �
$ .��
$ ��,Ul�
$
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuatian
.0005 x P�rmit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1675 per SAC Unit (Plans to MWCC for determination)
ft+6g= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridlev Attar
THIS [S AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
ulations
I hereby apply for a building permit and I aclrnowledge 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 a pe and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work whi�requi��review and approval of plans.
SIGNATURE OF APPLICANf ������,�jj/�i�— p�T Nq� ��a ���.e�j„� DATE lo I�S 2�� 7
LL6�b-ZOS-£9L ��3
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