AF - 40772Caty of Fridley, Minn.
6431 University Ave. 1�. E., Minneapolis, Minn. 55432
BUILDING PERMIT
��� May 85 , 1972
�� Viewcon Inc. B�� Same
� 5901 Brooklyn Blvd. Ad��g Same
�/�
�11458
LOCATIOiV OF BUILDING
No 5569 s�t East Oberlin Circle part of Lot
Lot 1 Block 8 Addition or Sub-Div3sion Innsbruck North Townhouses lst
Corne�r Lot ..�
Sewer IIevation
.
Inside Lot Setback Sideyard
Foundation IIevation
DESCRIPTION OF BUILDING
To ue vsea as: r �
Townhouse �'ront 20' �P.� 31' g��t 20' Sq, �, 1240 �� �12,400
Garage � �n� 20' �p� 22� Heipht 10' �• � 440 �� 4,400
� o� ��q� Wood Frame �.� �� 19 , 7 00 .40 To be Completed 12 / 1/7 2.
�.
Stipulations:
1. They wi11 see that fire protection is provided to the construction area, water
is available through the hydrants and good access provided to the construction site.
2. It is the responsibility of Suburban Engineering and Viewcon to see that the
¢rade elevations of the units is satisfactory to connect to the utilities.
3. Occupancy of these units wi11 not be made until a11 utilities have been checked
and approved by the City.
In consideral3on of the issuance to me oi a permii to consiavet the buiiding described above, I agree tp do
'$he proposed work in accordany with the desc�Ypiaton abov prth and in�mpli� with all provisions of
ord�hanc:es of the city of F'ridle . /�
� � v� v .......... v.......�°.�.. b�
In consideration of the payment of a fee of $
32 .00 , pQ�t is hereby granted to Viewcon, Inc .
to construct the building or addition as described above. This permit is granted upori
the express condition that the person to whom it is granted and his agents, employees and worlunen, in all work
$one in, around and upon said bui.lding, or any part thereof, shall conform in all respects •to the ordinances oP
Ir`ridley, Minnesota regarding location, construction, alteration, maintenance, , repair and moving of build3ngs
��th�e dty limits and this permit ma.y be revoked at any time upon violation of any of the provisions oP said
� r
� �.
CE BELIS
NOTICE:
This permlt doea hof eover the wnstruetion, installatfoa for wiring, plum6ing, gas heatTmg� aswer o� water. Be wn to ue
ths Building Inspector fo� aeparate permits for theae hems. �
i
� _ s
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME .�+��N �IV � BUILDER:_ ��
-....
ADDRESS :__QT,iG_/LKJVF-1��M ,.VD ADDRESS : ,..
—�._
NO • . :/.�(p S TREET • f� � � �1
LOT: BL�K: ADDITION:� �
�
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
""�
Applicant attach to this form �o Certificates of Survey of Lot and proposed
building location drawn on these Certificates. �
➢ESCRIPTION UF BUILDING
To Be Used As:
� � ��
% %O�I•,ZO Front : �+� Depth : Aeight :
Square Feet: Cubic Feet: /07��/�s
P
��g�'a� Fxont : � Depth : , Height :� V'
Square Feet; °�</D Cubic Feet: ��/00
- - /9, %'60 - </'�'
Zj►pe of Construction: (,�np�� �/Z(� /y)�.p� Estimated Cost: $
.�
To Be Completed:
The undersigned hereby makes applicativn for a permit for the work hexein
specified, agreeing to do all work in stfict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hexeby
declares that all the facts and representations stated in his application
are true and correct.
I .
DATE : 1 t S IGNAT[TRE :
(See Reverse Side For Additional Information.)
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BUILDING PERMIT FE� SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for ��he
erection of any building or structure, or for any addition to any exis�ing
buildixig or structure, or for any alteration or repairs to any �xisti�g
building or structure, upon application therefore, requ.ire t&n� pa3rm��a� �.-��_;� a i^,-.
applicant for such permit of fees to the a.moun� h�geia� be��s,� ��� n���� ����{
the manner herein provided to-wi�:
UN�FORM BUILDING CODE: 1j�pe 1, 2& 4-$2.15 for each one thousax�d cubic
�eet, or fraction thereof, in such cubical contentso �pe �& 5�$1,�� �o�
��ch one �hous�.azd cubic feet.
' ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contenLs
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor linc of the basemr�nt
o� the cellar to the avexag� hei�hts of the upper surface or to the average
h��ght o£ th� roof �urface of the main gable of � pitched rouf.
For repairs or alterati�ns to an exicting st�ucture, the fee �hall be ai 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 FOUNDAI'ION
NOTE: Permits for construction will be issued a minimum of 24 hours from the
ti.me of application, to allow for proper review of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
ha� been constructed, will �+required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be �a.de ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or eccup�ed until a Certificate
of Occupancy has been issued.
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` ,�' " June 18, 1976
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? Mr. Jim London
� ..� i�s �� ¢ ��r r �`
�:
8431 UNIVERSfTY AVENUE N.E., FRIDLEY� MINNESOTA 55432
Darrel A. Farr Development Corp.
7286 - 72nd Lane North
Brooklyn Paxk, Mn. 55428
Re: 5569 East Oberlin Circle N.E.
Dear Mr. London:
TELEPHONE ( 612)571-3450
We have received another letter with reference to the water seepage in
Block 8, this one being 5569 East Oberlin Circle N.E.
You will recall that I spoke to you on this on June 15, 1976. You
again stated that it was your intention to obtain the services of a
firm with experience on these types of problems. You also reported
that you to date had not contacted anyone, however had added a person
to your staff that would have more time than you to spend on matters
such as these and that you would have him give high priority to this
project.
Mr. Hektner, occupant at 5569 East Oberlin Circle N.E., also complained
of a frost build up in the outside corners of his lower level in the
winter time,in addition he also occasionally gets water during rains
from the east that comes in over his patio unit.
Would you also answer Mr. Hektner's complaints on these two items.
If you have any questions on this matter, please feel free to contact
me. �
S' ce ly,
DARREL G. CLARK
Coimnunity Development Adm.
CC: Mr. Hektner
5569 East Oberlin Circle N.E.
Mr. Elroy Berdahl
Building Code Consultant
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STATE OF MIIVNE30TA
DEPARTMENT OE ADMINISTRATION
SAINT PAUL
eu��uva cone
DIVISION
June l, 1976
Mr. Darrel Clark, Building Official
6431 University Ave. N.E.
Fridley, MN 55421
Dear Mr. Clark:
Per o�r phone conversation this A.M. I am forwarding
a copy of the letter from the owners of a townhouse
in Fridley re: water problems.
I attempted to contact the owners by phone this A.M.
but received no answer.
Yours very truly,
�' j/ >-
�i�'��� - �:.���c��=
ElroylBerdahl
Building Code Consultant
Building Code Division
EB/jc
enclosure
,
UU o � �� �' �.r C�
�--/(�-'�(� � � �� �►�z� � � �„� Z'
AN EQUAL OPPORTUNITY EMPLOYER
0
.
5569 E. Oberlin Circle
Fridley, Min�.. 55432
May 26,1976
Dear Sir,
I am wri �is�b J�u in reoarci.� �o a�ratez problem
we have had in our ne� Ta�.house since moving in June
l,1g73. The �ou�h �est corner in our dinino area leaks
�rater eqery spring �d heavy rainfall. U'de have lost
many hours of �leep day and night �DpPin��� water and
salvaging fur�iture.
Mr. Londan at the Farr Delvelopment have been
contacted by phone and also by my attorne�, but to no
a��rail, not e veu a re turned p:z�ne call.
�le are no�v pleading ti�ith your bureau and your
authority to take the aecessar9 �roceedure to help
us carrect this injustice.
Thank you!
Ne�man `�. e t er 5?4-1352
,;
, ' ,/,-�;y ���`v� � /�
� �,. r �. �..�
D
� �
�,� �/:; �.. Grace Ann iNest�rich 574-�.352
'`� `' ' .�
a;e � �-`�• `��• �..�� ,/,fj� � ,% �� e
� �,-:4� ,f�.� P �i:��9 �p r" /.'� ..o /, . i n� i
•��' r
..�1 ^~ `F `�y 5 � �.�
�� �� ���`' � � �` •..�+' t� - --- ._
� 1�. � This pr�perty is o�,m.ed inder
_ , _ ,- , _ !
�° � :- ._' - _- r:'' joint ownership.
` �_, . ..
sue�ecT PERMIT NO.
City of Fridley � . � T�
AT THE TOP OF THE TWINS
�.e�, 2 3 2
; ` BU ILDING PERMIT
REC R�_NQ---'
� • COMMUNITY DEVELOPMENT DIV.
r � v � � PROTECTIVE INSPECTION SEC. �a
� i
� t � (O
� 1 /"'1 � CITY HALL FHIDLE� 55432 NUMBER REV. DATE � CAGE OF APPROVED BY �
�""'�'� �'' 612-571-3450 910-F15 5/18/94 / /
J08 ADORESS
5569 East Oberlin CIrcle NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 1 8 Innsbruck North Townhouses ]. SHEET
2 PROPERTYOWNER MAIIADDRESS 21P PHONE
3 CONTHACTOR MAILADDRESS ZIP PHONE LICENSENO.
Dicks Fire & Storm Minnea olis MN -
4 ARCHITECT OR DESIGNEH MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS 21P PHONE LICENSE NO.
8 USE OF BUILDING
�a��ga Residential
7 CLASS OF WORK
� NEW � ADDITION 0 ALTERATION � REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof flouse & Gara e• Install utters
9 CHANOEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBINO, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTHUCTION ZONING S0. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OH ABANDONED fOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCEO. 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 ANO CORFECT. ALl PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANGES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED @
WITH WHETHER SPECIFIEO HEREIN OR NOT. THE GRANTING OF A PERMIT y�1�890 � 1.45
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 OP THE PERFORMANCE OF CONSTRUCTION. ��F3.00 Fire SC �I..89 .
PLAN CHECK FEE TOTAL FEE
License SC $5.00 51.34
SIGNATUflEOFCON7RACTORORAUTHORIZEDAGENT IOATEI w N Y V DATED THIS IS YOUR PERMIT
. ���
SiGNATUREOFOWNEP�iFOWNER8UILDERi �DATEi BLOG �NSP ��pTE
\�
NEW fl
ADDN ( � CITY OF FRIDLEY
ALTER j j SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Cc>nstruction Address: 5 5 6 9 - E a s t 0 b e r 1 i n C i r c 1 e__
Legal Description:
Owner Name �Yc Address:
Tel. #
Effective 1 / 1 /94
��p��
CUntrSCtOC: D i c k s F i r e a n d S t o r m MN LICEIVSE �i 2 4 81
Adciress: 864 - 19th Ave. S.E., Mpls., Mn. 55414 Tel. # 781-6170
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREEi:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Leng�th Width Height Sq. Ft.
Length Width Height Sq. Ft:
Length Width HgtlGround Sq. Ft.
Remove and re�lace roofing� On garagP Tnetall o+ittcra�
Remove and replace roofing on house.
Corner Lot [) Inside Lot [] Ft Yd Setback Side Yard Setbacks
Type of ConStruCttotl: R o o f i n�/� u t t e r s Estimated Cost: $ � 1, 8 9 0. 0 0
Approx. Compledon Date:
(Cost on Back)
Driveway Curb Cut Width Ne.eded: F� + 6 Ft = Ft x$
DATE: 5�/ 15/ 9 4 APPLICANT: D i c k s F i r e a n d S t o rm
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
('ITY USE ONLY
_$
Tel. � 781-6170
���
$ , Fee Schedule on Reverse Side � .�
�
$ , .001 of Permit Valuation (1/lOth%) 1 l� �
$ � � �� $.501$1,000 Valuation � � �
c��
$ $800 per SAC Unit � � `
$ �� � � $5.00 (State Licensed Residential Cont�ractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ F� Determined by Engine�ring °
$ _ Agreement N�ry [ ] Not Necessary [ ]
� �� , �
BUiLDING PERMIT FEE SCHEDULE
The Chief Buiiding O�cial shall, before issuing permits for the erection of any building or structure,
or for any add.ition to any existing building or structure, or for any alteration or repair to any existing
building or st�ucture, 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:
TOTAL VALUE
$1 ' � to $500
$501 to $2,000
$2,001 to $25,000
FEES
$15 (Minimum Fee is $15 plus surcharge)
$15 for fiist $500 plus $2 for each additional $100 or
fraction thereof, to and including $2,OOQ �
$45 for fi�st $2,00p plus $9 for each additional $1;000 �
or fraction thereof, to and including $25,000 .
$25;001 to $50,000 ' .$252 for first� $25,00p p��s $(.50 far each additional $].;000
� or fraction thereof, t,o. and including $50,000
$50,001 to $100,000
$100,001 to $500,000
$SOO,OOi to $1,000,000
$1,004;001 and up
$414.50 for fiist $SO,OOp plus $q..Sp for each additional
$1,000 or fc•a�ion thereof, to and including $100,000
$63950 for fnst -$100,0� plus� $3.50 for each additional�
$1,0� or fradion th�eof, to and including -$500,000
$2039.50 for die first $500,000 plas $3 for each additioaal
$1,OQ0 or fiactron thereof, to aad including $1,00O,OOQ
$3539_SO for the fust $1,OQ0,000 plus $2 for each addifional
$1,OU0 or fractioa thereof -
DRIVEWAY DEPRESSION' ESCROW
(Concrete Ctirb Streets Oniy)
Alternafe "A"; Removal aad replacement of curb and gutter only - Driveway width plus 6 feet 6mes
$13.50.
Alternate "B": Removal and replacement of carb and gut� aad install a 3 foot wide.
approach with 6 inch depth - Driveway wid� plus 6 feet times $15.75..
VERIFICATION OF FOUNDATION
Permits for construction will � issued a miaimum of 24 hours from the time of appiication to allow
Eor proper review of the proposed structure and of the constr�uction site.
A Certi6cate of Survey of the lot, showing the la�tion of the foundation once it has it has be�
coashucted will be r�uired before proceeding with the framing.
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CHIA�IlVEY AND STACK VERII+�CATION , .
The undersigaed hereby verifies that the �existing chimney or stack:
1. � Has been carefiilly exam�d �- ., _ '`_ ti-::Yes (, ): No i)
. , x -
2. Is fi�ee from nist �or de�eriaration � � � Yes O� No O
3. Has no foreign objects lodged witLin Yes (-): No O
4. Is securely supported Yes O No O
5. Meets all current Code reqair+ements for size
and total BTU's connect�ed Ye.s () No ()
6 Has total heating'BTU's of
All other BTiJ's
TOTAL BTLT's
7. Has a liner been provided:for water heater Yes O" No O
8. Has combustion a�r been provid� for water heater Yes (.,;) No O -
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Remarks: , . � -
* �a ,.�:. _ <> . 4
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
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:x��s .�o �Caum[q� �ar�snta� aq� � sa�an �Cqaraq pan�isiapun aq,L
l�iOI.L'���3IZI�A }I�'(�ZS Q1�iV ��iL1tII��
SuB�ECT '
.t -. �City of Fridley 31039
��`�� AT TME TOP OF TNE TWINS g � I L D I N G P E R M I T
s , RE o.
i� �• COMMUNITY DEVELOPMENT DIV. � � �
Vy �����'�
r � � PROTECTIVE INSPECTION SEC.
i•-_-� �'�' �'� CITY MALI FRIOLEY SS1�2 NY►�BEA pEV DATE pAGE O� AVVFOYHO B�
ti __ ,� 612-571-3450 g�aF�s 6/8/00 / /
�oe �ooaess East
��:�� � F 5549, 53 57, 61, 65 69,-' Oberlin Circle
1 LEOAL . LOT N0. BLOCK TiIACT OR ADOITION , SEE ATTACNEO
oescn: 1_6 g Innsbruck North Townhouses lst s"EET
2 PROPERTY OWNER MAIL AODRES$ _ 21P PMONE
Innsbruck To►,tnhome Association � 651-224-5482
J CONTRACTOR MAII ADDRESS . Z�P PNONE LICENSE NO
Garlock-French Roafi:n Co 2301 E. 25th St. � ls. NIN 55406 612-722-7129
� ARCMITECT OR DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO.
� OU001423
S ENG�NEER MAtL ADDfiES3 21P PMONE LICENSE NO
B USE OF BUILOING
Residential
7. CLASS OF WORK
O NEW O ADDITION O ALTERATION � REPAIR O MOVE O REMOVE
� 8 OESCRIBE WORK
Reroof Building
9 CNANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
.,i 4�.
SEPARATE PEiiMITS ARE REGUIRED FOF ELECTiiICAL, PLUMBING, MEATING. �PE OF CONST. OCCUPANCY GROUP OCCUPANCV LpAD
VENTILATING OR AIR CONOITIONING
�TFIIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTiiUCT10N ZONING SO. FT CU FT.
AUTMORIZEC IS NOT COMMENCEO WITMIN 80 DAYS. OR IF CONSTRUCTION •
OR WORK IS SUSPENDEO OR ABANDONED FOii A PERIOD OF 120 DAYS AT
ANY TIME AfTER WOAK IS COMMENCED. NO DWLCi. UNITS OfFSTREET PARKING
1 MEREBY CEFiTIfY TMAT 1 NAVE REAO ANO EXAMINEO THIS APPLICATION 6 STALIS GAAAGES
ANO KNOW TME SAME TO BE TRUE ANO CORRECT. ALl PROVISIONS OF LAWS yp�UAT10N SUATAX
ANO .OROINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPUED �11 7O4 %1 �rJ . HS
WITN WNETMER SPECIFIEO MEREIN Oii NOT. TNE (iRANTING Of A VERMIT > >
OOES NOT PpESUME TO GIVE AUTMORITV TO VIOIATE OR CANCEL 7HE pEpM�7 FEE SAC CMARGE
PROVISIONS OF ANY OTFIER STATE OR IOCAI lAW REGULATIN(1 CON• d�2O9.2S Fire SC ��.�.. %O
STRUCTION OR TME PERfORMANCE Of CONSTtiUC710N �P
P�AN CMECK FEE TOTA� FEE
$ 26.80
$�GNAtUpEOfCON'Q�CTOAOp�UfMOp11E0AGENT �OATE� N ROPE ALIO T TNIS IS V UR PEpMIT A
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S�GN�TU�iE O� OWNfA��� OWNEpBU�LOEp� �OAiE� Bl �hSO qptt
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City of Fridley
AT TNE TOP OF TME TW�NS
�
� �
� �• COMMUNITY DEVELOPMENT OIV.
� j V ��.•���
r � � PROTECTIVE INSPECTION SEC.
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� � "' � � CITY MAIL FRIDLE� ��
SuB�LCT
BUILDING PERMIT
NU1AB@R AEV OATE pAGE O�
3�
RECEIPT NO.
�` � �
�°--�' ` '' 612-57�-3a5o s�o-F�s 11/14/00 / /
�
�oenooaess 5549, 5553, 5557, 5561, 5565, 5569 East Oberlin Circle NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
DESCR. 1-6 8 Innsbruck North Townhouses lst SNEET
� PROPERTY OWNEfi MAIL ADOFiE3$ IIP PNONE
Innsbruck North Townhomes
Columbus Exteriors Inc 2131 111 Lane NW, Coon
4 ARCMITECT OR OESICiNEfi MAIL ADORESS
s
8
MAII
6 Unit Townhouse Building
CLASS OF WORK
p NEW O ADDITION O ALTERATION
8 DESCRIBE WORK
Reside Building; Install trim
9 CNANGE OF USE FqOM
TO
ZIP PNONE IICENSE NO
s, MN 55433 763-757-7530
21P PMONE LICENSE NO.
PNONE LICENSE NO
�] REPAIR O MOVE O REMOVE
STIPULATIONS
Per Section 1402, 1997 Uniform Bui3ding Code, requires that a weather
resistive barrier be placed over exterior shesthing to protect the interior
wall cover�ng. Exceptions for this provision would be if sheathing is an
approved weatherproo� panel or when the siding is an approved weather
barrier. Vinyl siding is not a weatherproof covering unless the manufacturer
states this in their application guidelines. Cal]. for inspection of wrap
before covering.
SEPARATE PERMIT$ ARE REOUIRED FOp ELECTRICAI. PLUMBING, MEATIN(i,
VENTILATING OR AIR CONDITIONING.
TNIS PERMIT BECOMES NUII ANO VOIO If WORK OR CONSTRUCTION ZONING
AUTHOR12ED IS NOT COMMENCED WITHIN 80 OAYS. OR IF CONSTRUCTION
OF WORK IS SUSPENDED OR ABANDONEO FOR A PERI00 OF 120 DAYS AT
ANY TIME AFTER WOqK IS COMMENCED. NO OWLG. U
1 HERE9Y CERTIfV TMAT 1 MAVE READ AND EXAMINEO THIS APPLICATtON 6
AND KNOW TME SAME TO BE TRUE AND CORRECT. AlL PROVISIONS Of LAWS VALUATION
'` ANO ORD�NANCES GOVERNING TFIIS TYPE OF WORK WILL BE COMPLIED
WITM WMETMER SPECIFIED HEpE1N OR NOT. THE GRANTING Of A PERMIT �3H � 167
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pEqM17 FEE
PROVISIONS OF ANV OTMER STATE OR LOCAI L�►W REGULATING GON-
ST CTION OR ME PERfORMANCE OF CONSTRUCTION $532 . E)S
PLAN CMECKI
� �/j�QO
S�GN• E OF CON7i� TQA Op AUTMOp�2ED �GENT �D�TE� � �
OCCUPANCV(iROUP OCCUPANCVlOAO
SC. fT CU. FT.
OFFSTREET PARKING
STAILS GARAGES
SURTAX
$19.08
SAC CMARGE
Fire SC $38.16
OTAL FEE
$589.89 �
Lr v i TED THiS iS r0 � PEP���
1 � � y
r�ait
._..�-•-- --� ..
�uildin� ��, �� Permit No.: ��i ,?'}
Inspections ����i �'�'�� ���,��;�"�'Y�� Received By
763-572-3604 ��� �� ��� D g
76�-502-4977 F.AX E�c�v� 1-�-os �
DATE � I rL0�0$ YOUR E-MA1L ADDRESS
SITEADDRESS 75�D �yf' �sb�Y�j/�, Ll�/
THIS APPLICANT IS: ❑ OWNER I�CONTRACTOR
PROPERTY NAME: C71�LLL-G 17�i'�.�VI'C.�/L
��E� ADDRESS: �'! 7� �7 % �� �7 U �ie �/'II ✓t G � V CITY �i �{ It'�.! STATE�/ ZIP �p ,S�`7'3Z
TENANT PHONE: 31v �—��'� S� �
CONTR.ACTOR N,aME: u.f�/ev �iitil �IW!vL�1.1rLLi �•
SUBMTT A COPY OF STATE LICENSE # T— EXP DATE
YOUR STATE . .��.�.. .
LICENSE, BOND AND STATE BOND # �CP DATE
CERTIFICATE OF ppDRESS: S�O iU%lti� S-F NE ��✓r% CITY ���FeV STATF�1/ ZIP ✓rS Z
INSURANCE pHONE � 12%f � '��� � %iI %� FAX �' ��J' �57 ` Z /G�,$
PERNIIZ• .l�.,PE �SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: 0 NEW `� REPLACEMENT
� .;
DETAILED DESCRIPTION OF WORK ��j��j rs7•1 . rfr 4���l�.ev►.�11!t� �.P./l.f�'' -
PER MS 16B.665 the permit fee is a minmtnm of 515.00 or 5% of the total cost np to $500.00, whicheyer is gteater, for the
improvement, installarion or replacement of a residential fixture, ex�luding 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 EXCEIDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT Wf�RE NOTED. FIXTURES: (INDIC,ATE TOTAL
NUMBER OF EACH BELOVi�. MINIMUM FEE $ I5.50.
BATH SINK/LAV FLOORDRAINS SHOWER WATERPIPING
BATHTUB GAS PIPING (NEED QTY LIC) SWINIMING POOL WATER SOFTNER ($3S7
CLOTF�S WASHER KITCi�N SIMC WATER CLOSET BACKFI.OW PREV. ($15)
_ DISHWASHER ,_ LAUNDRY TRAY ' �WATER HEATER ($35) FOR IIZRIGATION
WATER METER OTF�R
�x
., � �r � . ��� �+�,y�q
� J ;�� ,...� , �"�,�,� ...,,r1._ ft t...,.pat. � i,yk5�.�.'�...�..i�d+%�,�,. .ri"�:�:�..i� �k��`���..GPrm.`t17.^��1M2i��� ...� yi .�:
� .. .. .. ,_ . ,_ . ;.. . . . .... .. . ... . :. .... .
Permit Fee $_ Number of fixtvres @$10.00 x$10.00 =$
Surch e .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ _ � OR Number of fixtures @ $35.00 _� x $35.00 = $ 3 �•�v
State Surcharge = $ .50
(MINIMLTM $15.50) ' " (MINTMUM $15.50) Total = $ '�i�• d
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acicnowledge 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 case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT /(��' (tiL'f%%�iC PRINT NAME� N I G�L c�z`,j�� DAT'B L(�Zr��l SI I
�� �
� APPROVED BY , pAT� �I
I,
' PLEA�E N�T'E'.. SEi'�KATE PERMFTS"AI�'REQIJIRED'FOR'.S.UIIiDING;:ELE.CTKICAL. A1�D'°1V1E�FiA;MCAL._4�fl7RIf.
��ty af �rflc�ley ,
�uilding Iaispe�tions �e�ar�ent
ti�3 ] LTniversitv Avenue �E. °ridlev. NIN � ��S<.
'63-� ;'�-�604 ' -
:'.�n: %6�-�02--i4l7