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AF - 42798�,� a���.� City of Fridley, Minn. ^ BUILDING PERMIT N� . 7 0 3 0 ��: ��� � � � �: .� ..._.. B�� ._ ____._. _ r.. _ Address .— _..___..__.—.. n n � � TIO F BUILDING No. 1�..�=? Sts+eet � �._.�.,(�..L._. Part o! t ._.�.� Lot ...� � __ Block _—r._.,�.—._..._..__ Additiaa or Sub-Divlsio�, ._. _ _.._.._.° Corner Lot .___..___...._ Inside Lot __.._ 4� ._...._.._ Setback __��.._____.... Sideyard __.__._.�.Q _....,,�s6�! ._.._ Sewer Elevatiaai __.____..__...______._.�._.._�._.._._..___.._ Foundation Elevation � DESCRIPTION OF BUILDING To Uaed Front ��.. Depth �� Height ..,��_. Sq. Ft �=lQ.L� Cu. Ft .l�,c.E',�' � ..�..� Fro t_._. Depth _____� H t._..__.� Sq. Ft � Cu. FL _ Z�►pe oi Construcl3� FBt Cost ..�!��(�� �o be Completed _.�.. OUTSIDE Ar PEAR�NCE OF TNlS E'UILDIf��u F.'UST BE OF APRROVED VA�IAhCE WITH OTHER BUILDINGS IN THIS BLOCK. - In co�nsideration of the issuance to me of a permit to canstruct the building described above, I agree to do the proposed work in accordance with the descrlption abave set forth and in compliance with all praviaions of o�dinances o! the dty of FridleY• � „ Ia cansideratioa o! the PsY��t o! a fee o! ��_°/ ., pennit is herebY Sranted to� to c�struct the building or additi� as described above. This permit is granted upon the exPresa condition that the P� to whom it is granted and his agents, employees and worl�en, in all work dane in, around end upoal said building, or ax�y gart thereof, shall oontorna in all respects to the ordinances o� FridleY, Minn�Ota re8ardi�►8 locatt�y construction, alteratio�, maintensuoe, repair and mavin8 of buil� within the dty limits aad this permit may be revoked at aqy time upon violatiar► of aqy � the P�visians a[ sa�d o�inancea. � . � �1 Butldin8 inspecta� NOTICEs 'INs p�e�it do�s eet cewr tla eaahwqie�, faMqMie� Mr vrkMO. P��W fas hwNp, s�ww e► wMa. !� wn M sN 1b� �uildip 6ap�lor for s�pwlr p�whs fer fl� 11�. •�r• t , .... . , ....�f l��i .:� .w;i�.a.'P'l � .. ..,�:�::.� .rr.� _�;� ... . , ep�?�?�:���!1���]R�g:,�� .s ���:,:,_.z , , ;.. . , • -:, .,�.. , . :;1. .:.' ;�:i� 3o r:�z���. . , �,i � , , . _ . . `. � �. _. 'r . . . C�; AF� Y�LI�, �v��S4��.y r ��� s�n�.`�.E.-L�'�' --- ,. ; ., ._- _ . � ...rr� . . . . r:._ . , r: - _ _ .. r:i: �1'�'<. `Sa u �;.:�4.�G'� . :.,. �,.3�'C:'_ . . � ., ;:i. ... . _, _ .... .,. ..: �_.., . , . .i. • �:::.�fti: xi�i :r�$•:33•! ;it;' Oi�ll�ER' S �aF M �}C � i4 S �.�' � BUILDBR . , � : �'�rc�r:�.�- _. �: ., k;..r � � � :. � . . . .. „ . . _ . ,. � ; a` 71�A . , ,.; !t ��� C: �1�,`1�� .+ � � .. (y`/'� '��� �..1 )/ . •. � . : J I �� � . . ; J : . ' .l ` J .< � 1 . li. . � � \ Y\ .i �'SK��.� `1 `J V,w ������i i � a ��.i�i���; .. i....1� � }n.i.�,��7 �� ��l .. . . .. M��i��rli/�q� ` ". � . � . _ , , . . r't t. j?iT _. . t).. £"' _ _ . . _ . . ... . . . . . - . . , . .. .. : _ . , . . - :r . �. . , . . , � .� .. ..4.� ...: r .. ,. LOCATION OF : ��A�,A�i . . . ;� . , :.z � � � . � �: � I�A. .r...10..�4:•���� �. -�:;.. �s.,S�zee� _ .�. ,� a�z�;of.�Qt,__ . , , _. .: - - . . . . .. . Lot� Y. Y 9 � si���,� ,� 'a�. , _ .. ���. �� . ��..r,�..� ��� - , s., .- , r_ _ . .., -�. - . . �ic�; �r � � ,b_ h,,�,y_ t�, �• _ b I� � •.�. : r ,.. � � f ;,�: .c,::i'* �.!i t� •. � corner+ Lot�_Inside "bot� (� . serback � { $ ,_ �� �: .�: ����Y�.xt ���-i�.�, i�� , SBWER EL�VATtON �. � _ FOUNDATION ffi.EVA1't0� •. - • �+ � � , .. . � ,_.� - - A�pli,�aot .attach ,�P..�1��,s ;�os�n :Tao �a;t���catlra�, of:�S��eY�;c�:�Lot=;�ad:Yp�'opp:Od build- ing�qg�t�on drawg_on.•�l�e!�.�t�if��gs , . , . , . , _c � -, . . ,. � .. ._. . � ,:; r . . - .. - . _ . . ; . . . . . . �. . . . ..... � � J �+ ' . : . , -1 . ? .� �.�'�.�_t�y: ' ..... �..'. 7 • -i �.. . "' . � 1/:._ . . ti . ...... . w �4 � . ....,. . . , ,_ . . . . . .. . t , � 4 . � . .. ... . .i. ' 1�' . f._�...a :'.lil. :.a ...i'..,.) !1'):.. _ DESCRIPTION OF BiJILDI�IG %r.�"^.rJ.n J.'T f 3'^� To be used as : . ._. .� � I,_ �.. � :,..; ..,. �. .. , .'4.J J..;.;�;J ..,r ( �i`J Y.i'3t ! tav.,'tr ti ':' �e?'' �3� 7 � t1 .� ,.. . ,. , 3. ' . .. .. . . '. f, j�� �r �'- �''n.w ��j.F � � L .� }Tr�, � ' �� t:i�irYrr.i:i.ii.� °�' "'' 2' �r:.' �+B+N�r _t. i' ;IrCti �:� . ! i r i �r�e' i I�i.^r ir �� r'�rr:�+. � � �ii.ii�.+�r� , ' •1 _, � r( � ; � , . ••t. ; '_, , . �. �, � r K�O • . . . . .. . ., . " . � � �'� $�, i� r i 1 �7i1 Q.�, �t . rrrw�-+v�F+� �lJ� � i?I : � te� - r ' � , 1 ji t i: F3tj S � -• r� . - , .. . . . . . � . �. . � . , ., ., .. . .. . � i. .. . , ... . . . .. .. . .. . Froat �, �.Dspth Height +, : t . t .. t�t _. , Y / '� . _ a � , � , s � �� �. ��'u i • ' .�'::,i ��i��,... . � t �t�. u .1.� .'V��1 �rr • �la. .' �'1�<"'I: .i � . _ . . . • _. c. . . � � . � . �. / ] f „�. • . ; .. ... ..... . .�� . . _ ; (.>' � , .�. , T � o Cons �ruct . k � ��,• � � ' � � YPe � � �!R .,.;,. �i �� ':L ,.._:..�:�'t�wa��d �a�C � ��r�O�.Q � . . To be 'Ccmpleted , � ,. :t .. ,.,��.a � c:� � � _ � .. .. �_ _ . �� , . ; . , . .� - �. � - . . > � . . , . :i - _ ,i�. ;') ';? � e.;•�' . . . .., . .. I1�i:" _. .. . . . t •7;,. .�: • ..:� i..'; � � , .i . . ' '.:'�.: "._,;.; I,�t.i�� i:l _i 1. ..:iw -.. The undersignec� hereby ms'kea applicat�o�, �cL,�4,��,�., fp� t.#.e►.,�t3� �r��r,�acified, agreeing to do all �ork in strict accordaace �rith the City of Fridley Ordinsnces and ruliags. �f, the D�p,�r�Oep�„�p£;By,�d�„�8s�,_ aa�;��'�Y:;�tc��,�,r �irt �lr,:zhe facts and representacions atated in this applicatioa sre t�te, �dr-,c�acr�sa�.; �>c� �•f � �. � �Schedule of Fee Coats caa be found o�n the Boverae Side). . . � � /1 -� , . /""� . . � • a BUII.DI�TG PBRMIT FSB S(�EDULE � Sectian 2. The ��gC� �er�'- �af�'�'��s s��l�l, ��efore issuing any permit for the erectioa of nt�p building or structure, or for aay addition to aay exiet- iag building or att�t�`�;-=�r< � e�a�► g'lteta�ions or repaira to any euistiag building or structure, upon agplication therefor, require the payment by the applicant for such permit of feea tv the amount herein below set forth and ia the mannex here�a provided to-wit: . _ __ ___.....__ �_�_.,_._.. . ---_.. _._. _ _ _ . . _ _ 2.1. For any such permit for the erection o.f any fire-proof buildinga, other �., , � : _._._..Cl�...a.�r��, _r��r�ha�e.e,�-�act+o�`�.flt::.graia.elevr$tac,..or_._£or t#�e -erecti�dn �of any fire-proof additioa, for similar occupancq, to aay exiatiag building shall be at the rate oi $1.40 for each ane thousaad cubic feet, or fraction thereof, in sucb cubical��'cbtiE�ei�s . ' ` _. _ 2�y�. F��t"e�Y-. �b..p����_...Chs..e.rettioa-of..an�_ fir.e�»proof- garag�,� wareha�se,_ factory or grain eleaator, or for th� erectioa of say fire-pr�oof addition, .. ._..�for_.$��7lc _+�s�P�z���: 'to�-ti��t��exi��titig=buf�diag._sha11--.be at the rate of $1.25 fQr each one thousand cubic feet. classified as "fireproof" by Section 502 of .. . ., ; , , , . _ _._ ti�_��_.g+o�����a���a�s�ae� _ . , _ . . _ „ . .; } � ,. , ;. �,;3; �<��t�r' +�y:%stitc��pgi�t� fa� .��e- e=�ctfau o�' 'ett�r noa�ifreproof building o�hez � than a garage, warebouae� factory or•g�atn el�iator', -or� auq noa-ffr�proof additiea, for aimilar occupancy, to mny exieting building - permit $1.00 for each one thousead cubic feet. ,;_,-� __ , GAxAGBS �_ 2.4. For any such �ermit for the esectiaa of any aon-fireproof garage, _---. _war�hqus�;.;�f��cL�t,.�r_.g�cmitii `+�'�es�atnr., :ar._..fa�r �the_ .e�ect,ioa _ o€• an,� �-€t�aof additio�, €or--similar occupancy, tp any existiag building or for each such � -���8., ��__��iott�--_.�at�ty r.e�s �$.0.90� fcYr� each one thousand cubic feet or fra�tiai thereof, in the cubical coatents thereof with a minimu�m of $4.OQ�- .. . . ,._�... ._._... _ _ _. . _ _._. For the purpose of camputiag fees for building,permits, the cubical conteats of auy_ buildiag� o� acid�.t.i.�oi ta, a...uniiorm_ h8ig1� throughout by uultiplying the ground area cavered from a point eix (6) iache8 below the �loor line of the bos.0ment or cei� �t=�+��he� �v�zs,�_.�e#�t..� ..the t�Pper_..sRUrtace or to the nverage height of the r�of surface of the main gable of a pitched roof. _ _ . . .. _ _ _. 2.5. For repairs or alteratioas to an eacistiag structnre, the fee shall at the rate of $3.00 per each Five Huadred Dollars ($500rfl0) or frnction � � ti�es+ebf=�i �e a�t �e�#� a1�"�r"oFos�' �lork.��� : : � _ � _ . . ,. .. , . . . , . ,. �. _i . j _., "' 3�6� .=lalao 4�� s�a��^��.;���. 'ahas�ed-�or''a�►-permit, i�.p set forth in Sectioa 2 be l�s� �ian� ��l►.�;; :� ,. ,. . � -. � . . . _ ^ . . .d ^ 6 � • K ?�. . .� be J�. C. c�oiu�1 a�d v4ssoecates, ��e. LAND SURVEYORS Anoka, Minnesota �, � Telephone 421-6340 CERTIFICATE OF SURVEY: JnSEPN M'AC 1 ASZEK ((2�`� I;�O�Ei�?2 . . � ' �,,, � � I � DENOTEg IRON8 W .J O fY � VACANT 3 5' � I 27.93 � F.�,s. -129.4 Pu.r o _ � �,, S 9 � v_ � . �2�.92 M�s.- �29.o P�n,- I-S-F t�o�-s 12 � t3 LOTS S AND 9 B�ocrc i, OAK GP.OVE A001TtON, ANOKA COUNTY� M�hNESOTA � w x w � O � a � } p W � J � I FIERE6Y CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION Of A SUItYEY Of TF� �OUNDAICES OF TME A�OVF DESCWiED IAND, AND THE LOCATION OF All BUILDWGS, TMEREON, AND AlL VIS�LE ENCROACHM9dTT5, IF ANY, FROM OR ON SAID LAND. AS SURVEYED BY ME THIS .....I.S..T..... DAY Of ...................M.AT.......................................... A.D. 19..��j.... N. C. HO{UM AND , SS�IATES, — LAND SURVEYORS � '� . � . � � ` � ' � '� � �""` � .......................�..�..�..� �. .. .... ` . - ' „ ���'� ��' �' �:, �,- - � M d � y � ff R7 r � y � � . � � o x :r m . m • M � O . a � . � : � a +n � N � � y m a � 7d €.': `� 4� � m � �n � .r t�l o � ��"' .��'. � � . O ' O ' o . 0 o. �: � . . � k iC i4 n� � �I °o 0 o y � � � L+1 a � � � M � ay a1 � z � � x � � x/� C� �y' A C � •� N � � � � y � � � y � A u�, � � � H a� � W � �* � � �,. k � o � � � � '� p^' 0 y '� � � � � : � �o: ����: � � . � . . ' � . o� : : � : : : : 0 k k i4 k k k w N w ►� � � '�I e�'i� o � o 0 0 �r� !�l tn sn t�n +� �n tfl H O O Q� � A x D '_'1 � D '�'' m �/'� � I 2 T v � m � y O ¢ �-�' a� � � � o � �' � � A a '� a � � A� � � �. 0 W d 0 � V � � ,,, . �. w � � �, � a a � � x� � 9 � � � � i � � o� a p � � w � � I � d� 8 �� � ❑ m m A. � � a w bd a on � � �s . WATER ca.o�rs URINAIS s�rH Tuas ews�Ns SINKS wws�+ T�„� ORINK. FOUNT. SHWRS. FLOOR DRAINS GTCFI BASINS AUTO WASHER GAS MPL. GAS RANGE �� OPENING$ w • z • � i A _ n p �. p. � �' 0 ,d �, � � ►�a ��ya � y � � ����C � � � � � �. �, y ;e o e�o 5' �' y � O � � Pt p, 'J ¢ � � ~ � � � � a' � � � ���� b �p,d �' �' 'd m � �: ����p w m o A� p, o p t ('� � M �� �� � ���� � � �b a � �.�E� ���: fyD � f�D 'O7 e,Ai � � � � � r� M � � � � � � � � � � � � � �.. C �(� „ � �� � � wM Rx �s. �°n � � M � � � K 4 a � ) �o � �� �i � � n `'G � � � � C 0. 0' � � � �• � M ui ��,.9 � '� 10 O O � � Q � rV. V O ♦ `� � ��..�'_ City of Fridle�, M'inn. 6431 Univeraitty Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT ��� a�aa Z33-1�7i QRy,�; _ Dotig,las Rtdol� g�� Susse�j. �_ Addrees -��� F�i alP� � treet N_ F. _ Address �-1850 Como Avent1e — LOCATION OF BUILDING �q, 664,� Street -�rid7ey Street N.B. __— ---_.... Part of Lot ±+o�t ---Q��,-.-T.— 81ock - 1 Addition or Sub-Division Oa3r, Gtove Corner Lot ..._________ Inside Lot ,� Setback __._ __.__.__ Sideyard ______.�.. $evve� IIe�vatian � Foundati� Elevation DESCRIPTION OF BUILDtNG To be vsea as: n_�,-��� F`ront _22—. Depth _.22-_ iieight _.1.0�.- Scl• F� _.�$.Q.__ Cu. Ft 1�.�.$II11 Front ._ Depth Height —._..�.. Sq. F't ....___..._._M Gti. F� 'j'ypg p# �� Frame �, �t .,,�1� 500 To be Completed $�� 1 Set slab elevation 4" above existing driveway. 7n ea�aideration of the issuance to me o# a permit to construct the building described above, I agree tq do the P�P� work in accordance with the d�txiption above set forth snd ia compliance 'th all provisions at at�ances a� the dty of Fridiey. In caa�gideration of the payment of a fee of $.$�QQ_ , permit is hereby granted to h to construct the building or addition as described above. This permit is granted-tipa�i the express coadition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects •to the ordinanc�s o�t` 1�ildley, Minnesota, regarding location, construction, alteration, maintenance, repair aad moving of buildirigs W3�� dty limits and this permit may be revoked at any time upon violation of any of the provisions o! said i �� ��n Q� Buildit►B Inspecto� CI�ARENCE BELISLE NOTICE: This p�rmit dws not eowr fh� eonsfrudion, instapdion fo� wiriny, plumbin9. yas h�aBng, twvK or waNr. 6� wn b aN ib� 6uiWfn� Inspedo� fo� s�paraf� p�rmifs foe th�s� iNms. � ..+� ti. w � � d APLICATION FOR RESIDENTIAL, ALTERATION, OR AllllITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA ��S �:�����i�� ����.��, BUILDER: � ��ss , annuss :_�� �12 t 0�.-�� ST. ��,� � an�ss : � �SC� ��.�` �Y1c ��� . ,,/ � NO :.��p L-��) , STREET :�� I. I� L� Y ST •- Iv •�_ LOT: S(-� G BLOCK: I ADDITION:��� �VQV� CORNER LOT: INSIDE LOT:�_SETBACK: SIDEYARD: Applicant attach to this foxm ltao Certificates of Survey of Lot and proposed building location drawn on these.Certificates. DESCRIPTION OF BUILDING To Be Used As: ar� Front:_ �� � Depth: �-�.t Height: /b - - - Square Feet:�_g� Cubic Feet: '�/ c�Op Front: Depthr Height• Square Feet; Cubic Feet: Z�►pe of Construction: � � n � �����_Estimated Cost: $ � � � �Q�.�S a0.00 To Be Caapleted: I ST AJ� � � The uadersigned heraby makes applicativn for a permit for the work herein epecified, agreeiug to do all work in attict accordance with the City of Fridlay Ordinances and rulings of the Department of Buildiags, and hereby declarea that all the facte and repreeentations stated ia this applicatian are true and correct. • V �} F • . ( ►'� DAT�. � �3 � � � I SIGNATURE . (Sae Rrvar�e Side For Additional nformation.) r � K � O 1 r ��-e /2 ti.� � , U 0 U z� � a^� t�J f� c� � e G� .�-e �;. � q. .+� ! S�t S�� E� � j t s v .� � ; ;, � --P {� `�° `�. 1 �s � c..� � . 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 existing building or structure, or for any alteration or repairs to any e�cisting building or structure, upon application therefore, require the payment by the applicant for such pes�it of fees to the amount herein below set forth and in the manner herein pravided to-wit: UIVIFORM BUILDING CODE: 1j�pe 1, 2& 4-$2.15 for each one thousand cubic feet, or fxacbion thereof,>in such cubical contents. Type 3& 5-$1.85 for each one thousand cubic feet. ADDITIONAL INFORMATION For the purpose of computing fees for building pez�its, the cubical contents of any building or addition, is deterniined 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_ �f $-3.�4.pe� eseh -€�.-ve hundred duiiars ($5�0.00) or-fraction thereof in the cost of all proposed work. 1� 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: Pe�nnits for construction will be issued a minimum of 24 hours fram the ti.me of application, to allow for proper revie�a of the proposed structure and of the canstruction site. A Certified Survey af the lot, showing the location of the iouadation, once it has beea constructed, will be required before proceedi�Q with the framing. CERTIFICATE OF OCCUPANCY Application for a Certificate of Occupaacy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said atructure shall not be used or occupied until a Certificate of Occupaacy has been issued. - $ • � ♦ � �.. -. 5.� � ��'�x p��f,� 5E� .� x� �} .�{F 6 � Wr .�::t' � s^ ... � . .; ?.b .�'J� ��"`... .. � .. ,,.�. �, �,� ,v . � .,'�i84 :?�a�'fs.��. � 1ix 4 .,&,.� �i''�: � < �"'...a�� �` � � � �� � �,�� n . r_ � , { ' � , , �n �_ � 3� � � . �-�'.�-'�� � � -. � �; ,� . . :����1M � � fi a. .� .. . r.�'a:'� .u._.=' � �,. . . _ . �` .�. ' �� .e., ":7' . , � s . �.s.i�'`r�� ,<�. ,:: � . { �, � � ��` � �� �? ,,{ ,� � ; �� � s..3. �:+K* `RM� ' X, . a � a,F -ytn., is' � � ,�'�y '# E '." �. 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'. .�.t . ... . _ _ . . . 4 _ �_ _ __. __ _ ._._ , ._ ._ _,. _ �- t._�._�a__l..%._.a_..�-_... _ . � _ �. _. __ _' __._._ �. , . .�. _�__'_.�1 ' �Prt �REV_ � . . .� . � . . ' . __ . SUBJECT P City of Fridley 15 2 6 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � r � � RECEIPT N � ; y _ COMMUiJITY OEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. D 9 1 � 1 l.--_ � �r���,,� CITY HALL FRIDLEY 55432 NUMBER REV. DATE � PAGE OF APPROVED BV i• �� 612-571-3450 9t 0-F15 6/18/79 � / JOB ADDRESS 6645 Fridley Street N.E. 1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE AT7ACHED oesca. 8, g 1 Oak Grove Additioaz SHEET 2 PROPERTYOWNEH MAILADDRESS ZkP PHONE Douglas Rudolph 6645 Fridley Street N.E. 533-0352 3 CONTfiACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Sawhiors! Inc. 6325 T�ieloome Avenue 533-0343 4 ARCHITECT OR OESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAI� ADDRESS Z�P PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Construct a 25' x 20' Hause Additi.on 9 CHANGE OF USE PROM TO STIPULATIONS ���aTE ��n�rs R��� �� v��c,; HEAtING� �'IU�Ir1���iG �t� Si�+1�. �AR�G � �t �1! l�cat vtiiitics ��NE • �tECTRf�. � �tc. RFQUr�FO BY cAw TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PIUMBING, HEATING, VENTILATING OR AIR CONDITIONING. WOOC� Fi�CIE 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 ABANDONEO FOR A PEfiIOD OF 120 DAYS AT SOO ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION 1 STALLS GARAGES � AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VAlUAT10N SURTAX AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $�.2�700 �G.3S OOES 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. �%S.00 PLAN CHECKFEE TOTALFEE / �l ��.��.� $19.50 $93: 8S , D �.e�� SIGNATUAEOFCONTRACTOFlORAUTHORIZEOAGENT IDA EI WHEN PFiOPERLY VALIDATED THIS IS YOUR PERMIT ��Cl C N SIGNATUREOFOWNERIIFOWNERBUILDERI IDATEI � BLDG WSP DA CITY OF FRIDLEY � APPLICATION FOR RESIDENTTAL BUILDING PERMITS �� � (New, Alterations, Additions, or Repairs) ' OWNER: i]ou���n s�v�o���-1 BUILDER: S��/Kc�LZS� I�'uL, ADDRESS: f�O 4-� �t►��-CY ST N�ADDRESS: �3z►-� �`zc�t.�t� TEL N0: s3-3-o3`�z TEL N0: �33-��43 Construction Location ST3�T NO s��j 4'� STREET: �rZ'( � L L y S I i�I �; LOT: �� Q� BLOQC: ___L__ ADDI.TION: �� �,e�(f�, �-.UQi�J . Corner Lot: Inside Lot: Setbacle: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTIOtJ OF CONSTRUCTION ' j-� C� L^ i , � �1 �� �1 i"� D � �i0 � Front: Z.S — � , \ Depth: ZD —C� Height: lZ—c� Squa�e Feet: u Clibic Feet: Front: Depth: Height: Square Feet: Cubic Feet: � � Z ��0� Type of Construction: v�cvva �'jZ,q,�t�l� Estimated Cost: $ � Zb Be �mpleted: 1 ���l�19��+ A1t. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET , Zize undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Departmerrt of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: �o���f7� SIGNATUF�: Stipulations: P� _ v+ � � ZS .35 x�'a �= I 2, C.S� •�, t�x �z i$.00 I �i • � ♦ - � �r��� IZ, ��� 1 � � BUILDI(dG PER��iIT FEt. SCHEDULE SECTION 2. The Inspector of }3uildings shall,,before issuing pennits £or the erection of any building or structure, or L-or any additi.on to any existing building or structwre, or for any alteration or repairs to any exis ting 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: NEW CONSTRUCTION: Single ramily Homes and Garages: $4.00/1,000 cubic feet. PLAN CHECK: 25 percent of building permit fee. Dk2IVEWAY llEPi2ESSION: (Concrete C�rb Streets Only) • Alternate A: Removal and replacement of concrete curb and gutter only; Driveway width plus 6 feet x��'��.75 Alternate B: Removal and replacement of concrete curb and gutter and install a 3 foot wide approach with � 6 i.nch depth; Driveway width plus 6 feet x$17.85 � ;11 � ; ► �'► : �1■ £or the purpose of com,puting fees for building permits, 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 th� 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 5ection 2 be less than $7.50 plus $.50 state surchaxge. ' VERI.EICATIO� OF FOUNDATION NOTE: Permits for construction will be issued a minimwn 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 been constructed will be required before proceeding with the framing. _► : � ':1 Application for a Certificate of Occupancy shall be made 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 occupied until a Certificate of�Occupancy has been issued. .r , �% . . _ ,_�r. �.i �.. / M' /� y� 9 ' � "' '.�R< L `.tV' Y � � �•: �.� �� � +� QCAIIL� f f NCN _ +._:�.;pC;Y �� ' . • � i� O�' PROF'f:.:RTY OF1 � � , � � , . ,::. . # . � . 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HOUSE HEATING"TEST RECORD .� � ..v,,.. �}.A�'�t �'l1'�t.� '�.t• ' .. Y '�� , —5%�"/� f J ,.� ' �L ADDRESS �'� �J '�� �� � '� c �' � �` CITY � � / � OCCUPANT ���; e S /� v�:J':� i/� nwNER HEAT LOSS DATE HTG. INS . SOLD BY � --��%� `� �� �'� INSTALLED BY ' r � �- � Electrical Work By -� �� Gas Lioe By ` -- �- TYPE OF HEAT GA_ A_ HW_ STEAM SPACE HTR. UNIT HTR. OTHER �� GAS DESIGN CONVERSION MAKE !��Y Y ^ �� � Model � ?� ;� ° ' � � Serial C � INPUT � � G U� � u % if' �� � t �' CONTROLS THERMOSTAT f"' � �"'�' Heat Plug Valve � k 3 N�""2.�,,1i'S X/.�. Limit 'J� � .=' f,,; �-,,- Limit Setting � � � Fan Setting L/b Pilot Type �'�'�"'+"'�"F" Pilot Make _5���r` r(,,% —� .::� K � f o 6�' Pilot Model _Trn��' '" � •�� " -�,. y Pilot Timing -r t � ` r! L.W. Cut Off Pressure � ' � � � ��` � � - Perce�t CQz � Input CFH ��- p Percent 02 � Stack Temp. r� f' F Percent CO r� �� Form 235 MAKE OF BURNER _ Model Max. BTU Rating — MAKE OF FURNACE Model Vent Size KIND OF LINER SIZE NONE Draft Hood --' " � ' �"� RegWatar Filters Size Number � Chimney Location Inside L' Outside �' � �.�y -' . Chimney Construction �-�' Smoke Bomb Wiring Draft Test Tag Door Pressure Lighting "Inst. ) . ; � _. -- --- pate Tested - �e �'� , Company Testing � '" ' ��i i !' r Name of Tester a�'' ' ��� '' �` `t Y � City of Fridley AT THE TOP OF THE TWINS r � � � � � ; L ___.�_ COMMUNITY OEVEIOPMENT OIV. r � � PROTECTIVE INSPECTION SEC. � _ �"'1 � CITY HALL FRIDLE� 55432 �""'�'� �'' 612-571-3450 J08 A�DRESS 6645 Fridley Street NE SUBJECT BU ILDING PERMIT � NUMBER REY. DATE PAGE OF 9t0-F15 �/26/�3 � / 1 LEGAL LOT NO. BLOCK TRACt OF ADDITION DESCR. H� � 1 Oak Grove Addition 2 PROPERTY OWNER MAII ADDRESS 21P Doug Rudolph 6645 Fridley 5treet NE 3 CONTRACTOR MAIL ADDRESS Z�P Richard H.astings Contr. 6331 Rivervi.ew �rr NE, Fridley d AHCHITECT OR DESIGNER MAIL ADDRESS Z�P 5 ENGINEER 6 USE OF BUILDING R�s identia 1 7 CIASS OF WORK MAtL ❑ NEW ❑ ADDITION O ALTEFIATION 8 DESCRIBE WORK Reroof House (28 Squares� 2nd Layer 8 CHANGE OF USE FROM TO ZIP [� REPAIR 21994 NO. �,3 � � APPNOVEO 8V SEE ATTACHED SHEET PHONE LICENSE NO. 574�9966 4051 PHONE LICENSE NO. PHONE LICENSE NO. O MOVE O FiEMOVE STIPULATIONS goofing can be the 2nd layer but not the 3rd. Install smoke detectors as per UB.0 121Q adjacent to all sleepi.ng areas and in basement. Provide adequate attic ventiiati.qn. TYPE OF CONST. OCCUP/ SEPARATE PERMITS ARE REQUIRED FOR ELECTHICAL, PLUMBING, HEATING, VENTIIATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK Oii CONSTRUCTION ZONING SQ. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WOFK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS I HEREBY CERTIFV TMAT I HAVE READ ANO EXAMINEO THIS APPLICATION �- STALLS AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED $2 � 3QQ WITH WHETHER SPECIFIED HEfiEIN OR NOT. THE GRANTING Of A PERMIT DOES NOT PRESUME TO GIVE AUTHOiiITV TO VIOLATE Ofi CANCEL THE pERMIT FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN- $54.00 STR CTION OR THE PERFORMANCE OF CONSTRUCTION. � PLAN CNECK f EE , �� �J� License SC $5.00 SiGNATURE OF CONTRACTOR OR AUTMO ED AGENT OATEI WHEN PE VA iDATE� P IOCCUPANCVLOA CU. OFFSTREET PARKING GARAGES SURTAX $1.15 Fire SC $2,30 $62,45 NEW ADDN AL1'ER [l [l �J CITY OF FrRIDLEY SINGLE FAMILY AND DUPLFJC�.S R-1 AND R-2 BuiWing Permit Application Effective 5126/93 c�av�;�, aaa�: _ GG Ys rR � d z�y s�. I,egal nescdption: 4wner Name & Address: A o 4 q �. u d c L p i, Tel. # Coahactor: R► L��a � il ,C�,4S f� iv' 6 S MN LICENSE � pS Address: � 3,31 R i VE� v i� � �!Z Tel. � S��/^ 9�� � LIVING AREA: Length GARAGE AREA: Length DECK ARBA: Leagth � �� Attaeh to this a�lication, a Certificate of Survey of the lot, with the pnoposed �on drawri on it to scate. DESCRIPTION OF iMPROYEMENT W�th Height Sq. F� W�tt Height Sq. Ft. W� HgtlGrc�uid Sq. F� Cotner Lot [ l Insi� Lot [] Ft. Yd Sed�ck Sic� Fard Set�acks. TyQe oi G�sav�tion: R�� v� �" Es�nated Co�: � Z 3 0 0. o 0 Approx. Co�l�tion Date: 8��4/9_3 �.� s� . {Ca�t � Back) �►e�y c� t�r w� Nee�t: F�. + 6 Ft = Ft x S =� DA1'E: 7 i� 93 APPLICANf: ,�i����� Tel. # S7 �^P�.�� Pe,rmit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion (:ontrol Park Fee Sewe,r Main Charge TUTAL S � , od � �� .� O � f ��� $ � �-U� S $ S S � ������ � M ' 1 .1 Fee Schedule on Rew�rse Side .001 of Ptxmit Vah�ation (1! itkh %) S.SO/�i,000 Valuation $750 pex SAC Unit �s.00 (StaLe iace�ed Resici�ential Contractors) Alt. "A" c�r A1t. "B" Abave - Conseavation Plan Review 5450.00 Fee D�mi�cl by Engineering Agreemart N�r [ ] Not Necessary [ ) STIPULATIONS: i � � � :�� i • :�� .i� � The C6ief Building Official shall, before issuing pernit� far the erection of any building or structure, or for any addition to any eais�ting bnilding or structure, or for atty alteration or repair to any existing building or st�ucture, upoa application therefore, require die paymeAt by the applicant for such permit of fees to the amount herein below s� forth and in the manne,r he,rein provicled to-wit: TOTAL VALUE Sl to 5500 $501 to $2,000 $2,001 to $25,000 �25,001 to 550,000 - . $50,001 to �100,000 5100,001 bo �500,000 5500,001 to $1,000,000 � S��,OOO,OQ1 and up FEES a15 (Minimum Fee is $15 plus s�mcharge) �15 for first SS00 plus S2 for each a�ditional $100 or fiaction thereof, to and including $2,000 S45 for fust �'2,000 plus $9 far each additional $1;000 or fraction thereof, to and including $25,000 �252 for first� 525,000 plus �6.50 fvr each add�itional �1,000 or fiac�ion tl�eof, to and including 550,000 - �414.50 for first �50,000 plus 54.50 for each additional $1,000 or fraction thereof, to and incltuling $100,000 �639.50 fo� first �100,000 plus $3.50 for each additionat 51,000 or fraction the�eof, to .anc� including �500,000 �2039.50 for the first �500,000 plus $3 for e�ch additional $1,000 or fracti�► thereof, tn and iacluding $1,OOO,U00 $3539.50 fo� tl� fnst 51,000,000 plus $2 for each addifional S1,U00 or fraction �thereof . DRIVEVI/AY 13EPRESSION ESCROW (co� ct� S� o�y) Altemaie "A" : Removal and replacement of cu�fi and gut� only - Driveway width plus 6 feet times $13.50. Alternate "B": Removal and replacement of curb and gut�er and install a 3 foot wide. approach with 6 inch depth - Driveway width plus 6 feet times $15.75. VERIFICATION OF FOUNDATION Permits for constructioa 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 constnuction site. A Certificate of Survey of the lot, showing the loc�adon of the foundation once it has it has been coastcucted will be required before proceeding with tfie framing. - -� �� 3uilding nspec�tions �63-572-3604 BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY �A7� YOUR E-MAIL ADDRESS ITE ADDRESS 'HIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATTON PROPERTY TYPE PERMTT TYPE TYPE OF WORK: O OWNER ❑CONTRACTOR NAME: STATE LICENSE # % FJtT DATE l'1 Permit No.: Received By: Date Rec'd:/ � �� �� ADDRESS: CITY S'TATE ZIP PHONE FAX_ O BASEMENT F[NISH O DECK DESCRIBE WORK BEING SIZE OF NUMBER pF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: Vinyl Aluminwn ❑ Other WIIVDOWS IN EXISTMG OPENMGS DYa ❑No OR FOR NEW OPENWGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WDdDOW TO BE INSTALLED ___ �O OOF SIDING ❑ SWDvIMWG ❑ ADDTfION P,� o �oD�a.n -�4CE�E.rr'T a � LENGTH � HOUSE ONLY O HOUSE dc GARAGE O ATTACHED GARAGE 0 DETACI-�D GARAGE Soffrt Trim Fascia LACATION OF WINDOWS �i 1,�1: ; • � DRAIN TILE 0 OTHER � � D ti i+� G C) �f I-E�w�.E — t,v'R.F}-1� �—r'K.i v� FL �ASEMENT REMODELMG SUBIvIIT: 1. Existing Fio� Plan 2. Proposed floor plen 3. List of slructural members to be used FOR NEW CONSTRUCTION INCLUDI1iG DECKS, ADDITIONS. � PORCI�S SUBMIT: I. Site Plan/Survey showing the cxisting structures and proposed project 2. Two sett of construdia� plans 3. Energy Calcutations ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (LTSIN ,'T�IE� 7 U„�.0 FEE SCHEDULE) TOTAL JOB VALUATION $ f7`t� � r�'� OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Sutchazge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ t�(• a`S' See Back Page for Fee Schedule � 65% of Building Permit Fee $ �( ,(� .001 times the total job valuation $ �,c.E�j .0005 x Permit Valuation Minimum $.50 $ $5.00 (State Licensed Residential Contractors) $ �1550 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftxS21=S $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ 1 l?� S� Make checks payable to: City of Fridley Attach THIS [S AN APPLICATION FOR A PERM[T-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and cndes 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; that the work will be in accordance with the approved plan in the case of all ich require ' w n approval of plans. SIGNATURE OF APPLI i PRINT NAME����-�S��pDt"P` � DATE I°Z I a D � b Page 2- Building Residential Application .,_ � � BUILDING PERMIT REE SCHEDULE The Chief Building Official shall, before issuing pernuts 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 permit of fees to the amount herein below set forth and in the manner herein provided to-wit: VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for pmper review of proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Only City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 . CITYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER �, �`���5 2'�'C�o LP�- understand that the State of Minnesota requires that atl residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemt� ion from the licensing requirements. As the owner of the property at h6 �� '�u��� � 9'fi • Y�1lE . , Fridley, I am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund in the event that any contractors I hire are unlicensed. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all appticable building codes and city ordinances in connection with the work being pecFormed on this property. Name � Date � � � °� � � 0 � � �� 1��� Building Inspections 763-572-3504 763-502-4977 FAX DATE �� 3 v �� r� C S[!E ADDRESS � � L/_S 1�II3 A?PI.ICANT IS: OWNER/ TENAIV'T suHMrr n c�orv or YOUR SfATE LiCENSE, BOND AND cs�tr�cn� oF INSURANCE PERMIT 1'i'PE From: 612 822 5408 Page: 2l2 Date: 7/16/20101:1734 PM �'�3�(5`.�� � PLUMBING RESIDENTIAL APPLICATION CITY OF FRIDLEY � YOUR &MAiL ADDRESS F�;G//e;. Sf ✓v� O OWNER � �ANTRAGTqR `t.5 i-.. c�lP si /Y' -S%t��d�7 .�rn.,: s � f. _ . � _.Ol� � ����o• ac� ; PT� .�b �'p' ne���a 8�:. STATE LICENS6 i{ � CJ S'r/ �� � SXP DATE _/.� '�/-/ i+ 5TATE BOND �Y �c� o� r 3�'� I P.7CP DATE , ADDRBSS= ��I.a �( � ralr J� CffY �I'�'J .N�S STATE/l�'LIP i� PHONE G%at -$'.�.�. — 5'_j �'1'�+ FrVC 3IIJGLG PAMfLY ❑ TWO FAMILY ❑ TUWNHOUS� TYPE OF WORK: I � � DETAiLED DESCR�P'I'ION OF WORK • ' ' M I� '3 r� Afi� BAS'k.D ON SiU.00 PER FfKRJRH, �[CF.PT WyE[Z� Np'fEp, FDC�URES: (DVD[CATE TOTAL NLlMfiF.R OF F3ACH BELOWj. M1NiMUM FEE S35�0. _ BA1'H SIIVIUL.AV RL,pQR DRAIN$ $F�OwER WATER PtPlNC _ BATH'fUB GA5 PIPING (N�RD Ci['Y LFG7 _ SaRMM[NG n00T, WAT6li SOr i'N�lt ($3s� _CLO'fHI:S WASHk�R K17C;HFIVSINK WATERGIASET BACKFLOW Pltr,V. ($15) _ �rst�w,►sHee =[,�,�7Np�y �y j�VyATER jjEA'IER (j35) ' FOR IRRIGATION _ WATER MCfER 0'I�iF.R � v� r, nt ��� ;►��5,,� . �•':�t! . � ;. � .yM ����,.�t '��,�;�''���' ' ',�„'h:y�y;,,'' {. `, :,i ��AVG+NS�i. ,��`r� �1�� ..i. .i .n . ' !i" :�'� •.�: .'.��i�i+{� ' �f�i4I1� � 1 {{:••:. • � � �'. i:.•''':: _.. .�ir. � ;';� i�� � .. � � v •:::: :. :• �,:� :; �.;+.`.:., �[::;:;i;•, �•; :•i.::1*.>,p, �: • `. ,+ p :r,� : : �;y_ ' ' ' •'r.•;1d • � � : �:., ..: .. . .. . , � : •:i��, . , �'� �.. �y. i::��:. •: r'inti'i:r:!�: '•. .":; � f� ,aT :�i •�. _:.yr !�'+r.#y '::•t;,: t:,;�.,�. ••g:;�:+.�.� ����" a..: �:�f�'� �, ..... . .�.:; '';{ - - •• ;� y..>:.:> •. � ;: ,� .,�...:. s: . �� .•..:.. .. •�.� ., • ; .. �':.: :�..: .,zy.�..::..�. 4?' * �����i.�`7���fx s '��^'..• L :•:•1.; _, ''•.+_: ,..•:.• _ ��ta'; ' ;., ,�. � _ ��?r_�:.���fi` ; a �; ,im ' �'': :. .. _ . ...��.`!•' ;�';r, •..�!M'i.•::;;.,: :•. i �.... r:.:� :' �s�u!.i�L���7V/'Tt'ltYi.'r<;. _, ..::� � "�W7cii=� :i'S5@:•: �4.Pi!✓�...,_,..,;.. � .�y � .•�"�{�� : � THIS IS AN MPLICATION FOR A PERMff-NOT VnLID UNTII. P1i0CESSED I h�reby epply far a plumbing ptamit end I aclrnowlcdgc that thc information above is compIctc a�►d accmrete; that the work wilt be in c�1fo[inaziCe with tif� oordinauets and codes of thc City af Fridley and with the Minnc�ota Constudiaat �odcs; d�at I undastand this is not a pamit but only an spplicsaam for a pGraiit azid work is not to �art without a perneit on �itc; that the wa�k wi!! be in aceordancx with the eppro'�ed pl�ut in the ca�c of all work which roquires review and appmval of plans. SIGNATURfi QA r City of �idley Building Inspections Deparhnent 6431 Univ�rsity Avenue NE, Fridley, MN 55432 � 7G3-S72-3604 �AX: 763-502-4977 �v�