AF - 43393n
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Date:
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Caty of Fridley, Minn..
BUILDING PERMIT
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N° '7418
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Addresa ' ' Addrese
�O ION , F BUILDING
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No. � �� �� Street __'� , , �' +�. ' �-,�—�-,�=_.;�. Part oP
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Lot ����_ Blocic � '' Addition or Sub-Dfviaion s =
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Coraer Lot _ Inaide Lot —..�� Setback �� _._._ Sideyard _ . � -
Sevver IIevat9an �y� ° -� / _ n�atio$ � � <�
DESCRIPTION OF BUILDING
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�I Framt � Depth eL�..� Height -�--�—. &1• F't. ��..�:"� G1. F���.����
A Depth 'r ght Sq. Ft Cu. F'L
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Type oP Construction°� �.�' E�t. / � � � � � `;'..._,� �o be Completed
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In consideratlon of the fssuaace to me of a permit to construct the bufldiu descrit�d above I agree to do
th� proposed work fn acxardance with the d�s�iption above set in ce with a�l provisions of
ordinances oP the dtq oE Fridley. � �
. �9
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In consfderation of the Pa3'm�t of a, fee of ,��% � , P�rmit ia hereby granted to
to caonatruct the building or addition as d�cribed above. Thlspe rmit is granted upan
the eapresa condition that the person to whom ft is granted and his agenta, employees and worl�en, in all arork
done in, around ead upon said building, or anypart thereof, shall conform in all roeapects to the ordinanc� of
Fridley, B�innesota location, conatrttction, alteration, maintenance, repair and mov3ng of bufldings
within the dty limita�� permft may be revoked at any t3rne upon violation of any of the Provie�lona of esid
ordinancea � ., _ �-.
E-�ir{iT� , ,•jT�:^y'T..Ta
Nonc�
1'hb psemtt doa nei tewr fia ceasfeneHoe, Imhllation hr �inW P��e, 6a 6u8ne, awu or wat�r. 8� an to m�
i6o BnUdieB lesp�eter far aparalr p�rmha hr Hna Num.
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APP�ICATION FOR BUILDING.PERMIT
. CITY,OF FRIDLEY, MINNESOTA
OWNER' S NAME� l� /��'S i/-= /� i�J �/ /� S 2F�BUILDER 3�/� /�.�
n�D�S w� ��(�/�/ � t',% s�.11,� D�SS � s/}�� � r. � _
� � LOCATION OF�BUILDING �
No. � �,� .-� r .-'� . S�reet : � t �C � � �a'rt.� of Lot �—
�
Lot �' :�- �lock o� . .�,Additiot� or &ubdiv:ision_ G�,aK �r�Ql�o� .
Coxner Loe_Ineide Lot � Setback ��'" Side Yard� /� �.�p!
��
SEWER ELEVATION FOUNDATION ELEVATION �
Appl�eant at.Cach.to this form Two Gertificates of Surveq of;Lox.and propos:ed�build-
ing locatioa drawa on these Certif3cate�. � .
0
DESCRIPTION OF BUII.DIATG
To be uaed as;
5i/llm G-��' � /./�G✓��'� //��-_, Front� , AepCh � �_� Height �D
. Sq. Ft • , � f � Cu .,• Ft . . �� � �-c�
Froat Depth Aeight
• . Sq,� Ft.� Cu.. Ft. .
,
Type of Consfruct�aa� l�%CJ4'/� /=�f�,�i�-. Eatimated �oet ��/�— .
�..
To be Completed �/� G`' %��F 1�S - . .
The undersigned hereby m�kea application for,a.permit fo� the wor.k herein;epecified,
agree3ng to do all work ia strict accoidaace with the City of Pridleq Ordinances and
rulin�s vf th� D�p�rtmen�,of Suildings,..aad.hereby declar.es that all the facta and
representatio�is etaCed fn this application are true amd:correct. �•
�(Schedule of Fee CosCa can be found oa the Severse Side).
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BUILDING PEP.NaT FEE SCHEDULE
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Section 2. The Inspector of Buildings shall, before issuing any permit for
'' , the erectioa of any building or structure, or for any addi.tion Co any �xist-
ia� building os structure, or £or any alteratioas or repa3ts to any existin�
bu3ldiug or atructure, upon application therefor, require the payment by the
appl3cant for such permit of fees to the amount hereia below set forth and
in the manner hereia provided Co-wit:
2.1. For any such permit for the erection o.f anq fire-proof building, other
than a garage� warehouse,.factory or grain elevator, or for the erection of
aay fire-proof addition, for similar occupancy, to any existing build�ing
shall be at the rate of $1.40 for each oae thousand cubic feet. or fraction
thereof, in such cubical contents.
2.2. For any such permit for the erection of any fire-proof garage, waretiouse,_
factory or grain elevatos, or for the erectioa of aay fire-proof eddition,
for. s3milar occupancy,'to any exietin� building shall be at the rate of $1.25
for each one thousand cubic feet, cla�aified as "fireproof" by Sectioa 502 of
the Minne,apolie Building Code. -
HOUSES ' -
2.3. For �q such permit for the�-erection of any non-tireproof buildiag othe=
than a garage, warehouse, factorq ar grain elevator, or anq noa-fireproof
addit�.na, far sim€Ia� oc�3pancy, �o--a�y -e�i:sCi�n� f��uf�rYiag= � germit $],,�0 for
each oae thousand cubic feet.
GARAGES
2� For any such permit for ehe er�ctioa of any aon-fireproof garage,
warehouse, iactory or grain elevator, er for the erectioa of aay non-fireproof
additi�, €or-s3m3,lar occupancy, ta any existiag buildiag or for esch such
___ -building or addition - aineCy centa ($0.90) for each one Chouaaud cubic feet
or fraetion thereof, in the cubical coatents thereof with a miafmum of $4.00.-
For the purpose of camgutiag fees for building perm�its, the ct�bical cautents
of any building or additioa Co a uniform hei�ht throughout by multip�ying the
grouad area covered from a poine si� (6) iachea below the floor line of rhe
bas�meat or cellar to�the average height of the upper surface or to the
average he�Lght of the r@of surface of the mai� gable of a pitched roof.
2.5. For repa3rs ar alterations to a=n existing structu.xe, the fee shall be
at the rate of $3.00 per each Five Huadred Dollars ($500.00) or fsactioa
thereof in the cost of all propoaed work.
2.6.. In no case shall the fee..charged #or.aap-permi� � set forth in
Section 2 be 1ess.than $4.00. �
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• �.�?$ ��Atp ?� BLOGK 2� Ci�K GRQVE ADDtiE�iN�, AAtOKA COISNTY�
i`� I NA1�8�TA. '
1 herebyc�y t� thi� survey. �Sa. or e�port
wae inep� cip r by me or undei ariy direct snper.
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REGISTERED
LANQ
�, SURVEYOR
�y �2a o�"�
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u �c� � ��� :� �______
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SUBJ ECT P E R
City of Fridley O 13113 %�
, ` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T RECEIP .
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� `L _ COMMUNITY DEVELOPMENT DIV. `//i/���
r � � PROTECTIVE INSPECTION SEC.
1 = �
�� �'�i � CITY HALL FRIDLEv 55432 NUMBEP REV. DATE PAGE OF APPROVED BV
'-"� � ,'� 612-560-3450
910-F15 ��2$%�5 � �
JOB ADDRESS 6654 Fridley Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oescR. 6& 7 2 Oak Grove SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Frank J. Barsokine, Jr. 6654 Fridle Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
SAME
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS • ZIP PHONE LICENSENO.
6 USE OF BUILDING
�d
7 CLASS OF WORK
❑ NEW I�1 ADDITION ❑ ALTERATION � REPAIR ❑ MOVE � REMOVE ,
8 DESCRIBE WORK Construct a 24 x 26 detached garage
9 CHANGE OF USE FROM TO
STIPULATIONS
,
1. Provide a hard surface driveway.
� �t�ATE P�RMITS REQUtRED FOR �t1�1N�, �
s�P� A�,����
�1�ATIN�, P�U�BING AND S1GN.S• � ��1 u��l`�1�
dig�m� �'11 �a ��t�r
getoce g ���C�RIC - GA ��
����pHON 1R�� �� �
�E�V
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
dENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION O G SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION 6Zq. 6�Z�iO
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 I HAVE READ AND EXAMINED THIS APPLICATION 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 �p
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �P`�' �6�7.60 Z.3O
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- �� 2� OO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �
PLAN CHECKFEE TOTALFEE
�4.so
SIGNATUR OF ON RAC ORAUTMO' EDAG N IDATEI WHE PROPE LY ll D IS YOUR PERM�T
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° SIGNATURE 0 NER F OWNEii BUILDERI / IDA 1 iNSP pATE
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' . . , ' . . .
�. . • •APPLICATION FOR RLSI'DL'NTIAL, ALTL'ItATIOIV, �
OR AllllITION. BUILDING P�RI�IIT
. • CITY OF FRIDLEY, � I�IiNNESOTA • . �. .
, � � � �Qo � . .. � . � � .
O�dNER'S NA1�1E:,�i� �C1/C � �A'�SOKiIV� BUILU�R: ��-�i� ' � .
� ` • � ' .
• ADDRESS : ��5� �/� I DL�I/_ S�. �, �. ADDRESS : �
. , . .
N0: . �v iP� STREET : �!2 I D L�.� (/' � f /� a �, • .
7•OT : �'F BLOCI:: � ADDITI01� : �!$ K l�i� 01� ��
CORNER LOT: INSIDE LOT: i� SETBACK: __ SID�YAP.D:
Applicant attacr. to this for� Z�wo Certificates. �f Survey -of Lnt and .pxoposed ,.
building location drawn on these Certificates. . '
HESCRIPTION OF BUILDING
0
• . .
Ta Be Used As : . . �
. • \�"/��f��r� Front: � � Depth: � �� � Height: %
. - - Square Feet:� Cubic.Feet: �l �-��
� • Front: Depth• . Height•
�.. . . Squaxe Feet; Cubic Feet�: � �
• . �jipe� of �Con�truction: �po9D F�2-A11'I� Esti.ma.ted Cost: � � � .
Tc� Be Completed: � . • . . • . .
The undersigned hereby makes applicativn for a pernc►it for the work herein
specifiec�, a�reeing� to do all worlc in stiict accordance ��ith the Cit}• of
' Fridley Ordinances and rulings of the Dc�partment of Buildings, and h�r�by
' declares that all the tacts and reQresentations stated i.n tliis application
8re txue and correct. � •.
. , . . .
• • � lIATE: o�� S� SIGNATUItE: . � .
�See l�everse Side For Additional Information.)' . ,
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BUlLll1N(s L'.L•IU�IlI rl�'.L' b1.111:LU��
� S�CTION 2. Tlie Inspector of Buildings shall, before issuing permits £or the
c�cecCion of any buildin� or structurc, or tox any addition Co any exis�ing
building or structurc, ox for any a1L-eration ox rcpairs to any existing
� bua.lding or structure, upon application theretore, require the payment by the
applicant tox such pennit of fees to Che air.ount herein below set forth and i�t
the manncr licrcin provided to-wit: . , •
UI�IIrORM BUILDII�G CODL: Type 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. 1�pe 3& 5-$1.85 for
each one thousand cubic feet. �- �"
ADDITIONI�L INFORI�iATION
For the purpose of computing fees fox building permits,�the cubical conten;;s
of any building or addition, is determined by multiplying�the gxound area
. covexed from a point six (6) inches below the floor line o� the basement •
ox the cel].ar ta the average heights of the upper surface or to the average�
height of the•roof surface of the main gable of a pitched roof.
• Far repairs•or alterations to•an eYisting structure, the fee shall be at the
° xaCe of $3.00 per each five hundred�dollaxs ($500.00) or fraction thereof in
�the cost of all proposed work. ' . - .
�� � In no case shall the fee chaxged for any pennit as set forth i.n 8ection 2 be
" ].ess than $5.00. �. � ' . .- '
.
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VERIFICATI�N OF FOUNDATION
. ..
. � ,
I�OT�: Permits for construction will be issued.a minimum of 24 hours fxom the
time of application, to allow for proper rev iew of the proposed structure and.
of the constxuction site. . . � . �
A Certified Survcy of the lot, showing the loca�ion of the foundation, once it
has been constxucted, will be required before pxoceeding.with the framing.
CERTIrICATE OF�OCCUPANCY '
Applieation for a Certiticate of Occupancy shall be made ten (10) days pxior
to the use or occupancy of �ny sCructure for which a buildin�; permit has been
issued; �nd said structure shall not be used or occupied until a Certificate
of Occup�ncy has been issued.. . a .
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PROPOSAL $UBMITTED TO PHONE
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STREET ' "' `- ' • JOB NAME
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CITY, STATE AND21P COD �, '� �«:+ JOB LOCATION
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ARCNITECT
DATE
of
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DATE OF PIANS JQS PHONE
We hereby submif specifications and estimates for:
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�P �llt}1�Sp hereby to furnish material and labor — complete in accordance wi .,above specifications. for the sum of:
,,' �
. � =�i�-�. "�-�
Payment to be made as follows:
dollars ($ --= . ).
All material is guaranteed to be as speeified. Ail work to be completed in a workmanlike
manner according to standard preetices. Any alteration or deviation from above specifica- Auth0�i22d �
tions involving extra costs will ba executed only upon written orders, and will become an SignatUte
extra eharge over and abave the estimate. All agreements contingflnt upon strikes, accidents
or delays beyond our control. Owner to carry Nre, tomado and other nacessary insurance. Note: This propos3l may be
Our workers are fully eovered by Workmen's Compensation Insurance. withdrawn by us if not aCCepted within dayS.
.C:L����.Q 11f ��li�ili$� —The above prices, specifications
and cortditions are satisfactory and are hereby accepted. You are authorized Signature
to do the work as specified. Payment will be made as outlined above. � •-
Date of Acceptance: Signature � �_
r.,�, • a
RORM 11H•� COPtiiIOMT 1980 � NHW ffN�LANO HU91NE849BRVICE. INC., TQWNS&ND. MA93. '
�
SUBJECT MI .
c�ty of Fridley °- 15 4 7 9
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � RE .
� ; L __�___ COMMUNITY OEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. � 901 �•1 O�
t . � � O�
i-_-- � ��'���,,� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
i �� 612-571-3450 910-F15
9/25/7� � /
JOB ADDRESS 6654 Fridley Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oESCR. 6, 7 2 Oak Grove Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Frank J. Ba.rsokine, Jr. 6654 Fridley Street N.E. 571-7416
3 CONTRACTOR MAII.ADDRESS 21P PHONE LICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
RE51f�Ell'�Ydl. '
7 CLASS OF WORK
❑ NEW 4 ADDITION � ALTERATION O REPAIR ❑ MOVE ❑ REMOVE
8 OESCRIBE WORK
Cflnstruct a 16' x 1Q' Addition to hack of structure
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERAA{TS R�QUtRED FOR VI(IRtL��,
HEATiNti, P1i�111�JBING AND SiCNS,
`�V�RHIHC
Before digging ceA locai utilf�(�s
tELEPH9NE - ELECTRIC - GA5 Etc:
REC�UIR�� � `:` � r�`JV
SEPARATE PERMITS ARE REDUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ], STAL�S GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL 8E COMPLIED y�`3OO �`.SO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHAFGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 'J�SO
STiiUCTION OR THE PERFORMANCE OF CONSTRUCTION. $
PLAN CHECK FEE TOTAL FEE
$8. ��
ATURE CO TR Cr RnurH RIZEDA r IDA7E� WHEN PROPER�L� VALIDATED THIS IS YOUR PERMIT
d?� ` C�Jth� l.,�Cd�zJ �S
NATURE OF O E 1 OWNER BUILOERI '� IDA 1 BLDG INSP
CITY OF FRIpLE�Y •
ARPLICATIOP� FOR RESIDENTIAL BUILDIPJG PERMITS
' (�Jew, Alterations, Additions, or Repairs)
�^ .
OWPdER: ��J(C �1� Q�t2S0�111C-. �iL BUILDER: - SI�N'��
ADDRESS: ��Sy' F1210i� ST IUC _ ADDRESS: �
TEL N0: S� I— ��F�� TEL N0: '
Construction Location
S��T No: �TREET: S,�mF �-c� �Qov �
LOT: � - � BLOCK: �, ADDITION: ���n�.C1li �� .
Corner Lot: •- � Inside Lot: Setback: Sideyards:
Applica.nt atfiach to this form two Certificates of Survey of lot and
proposed building location drawn an certificates to scale.
�
DESCRIPTIOtd OF CONSTRUCTIbN �
r r 8, .
I-�`�Q�U Fronts �G Depth: fd Height: .
��O < <
Squ�e Feet: Cubic Feet: �
Front: Depth: Height:
Square• Feet: Cubic . Feet:
Type of Constructionc
� p�� Estimated Cost: $ � �•-�'1C
Zb � Be Wmpletec� : ' SOR ( � Cf � -1 � � .
�- Alt, A A7.t. B '
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET
The undersigned hereby makes application for a permit for the work herein specified.
agreeing' to do all work in stric't accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated an this application are true and correct.
DATE: � 9 SIGNATURE:
Stipulations: . �
u e , � ; � u�""�'� .
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. BUILDI(JG� PCRt�IIT �`Et� SCHEDULE�. � _
S�CTION 2. The inspacL-or. of 13ui1Qin�s shall, Y,efore i.ssuing }�ei�niL•s £or the erectiion
oi any bui].ding or �LrucL•ure, or tor any addiL•a.on to any oxisL-i�ig building or s�ructure,
or for any .alterzt•ion or rel�air, L•o •any existing building or :;t:ructure, upon apl�licatian
thc�eior.c, require the paymeiiL• by the applicar�t ior sucli pez-►nit of tces to, the amount
herein below set forth and in the manner herein provided L-o-wiL-: •
NEW CONSTRUCTION: Single I'ami].y IIomes and Garagcs: $9.00/1,000 cubic teet.
PL1,N CIiLCY: 25 pezcent oi' bui.lding permit fee. ,
DRIV�WAY D�PIt�SSION: (Concrete, G�.irb Streets Only) � � .
• AlternaL-e A: Removal �iud replacement of concrete curb and
gutter orily; Drive�vay width plus 6 feet x$3,�.75
Alternai:e B: Remoual and replacement of concrete curb and
,' gutter and install a 3 foot wide approach with
• • 6 inch depfih; Drivea�ay width �plus 6 Eeet x$17.85
;11 � :. ► �' G �1
For the purpose of computing fees'for building per.mits, the cubical contents of any
buildi.ng or addition, is determ�.ned by multiplying ihe ground area covered from a
point six (6) inches below ti�e floor line of the basement or the cellar to the
average heights of the upper surface or to the averaqe height of the roof sur�ace
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 pxoposed work.
In -no case shall the fee charged for � any permit as set forth in Section 2 be less �
than $7.50 plus $.50 state surch«rge. �
� V�RIFICATIO� OF FOUNDATION �
�
" P�OTE: Permits yor construction will be issued a minimum of 24 hours from the tilne
oi application to allow for proper review of the proposed structure and of the .
canstruction site.
A Gertificate of Survey of the lot, showing the location of the foundafii.on once it
has been constructed wi].1 be required before proceeding with the framing.
CERT'IFICATE OF OGGUPANCY �
Applica�ion ior a Certificate of Occupancy shall be made ten (10) days prior to the �
use or occupancy of any structure for which a buildiiig permit has been issued; and
��id structure shal7. no� be used or occupied until a Certiiicate of Occupancy has
b�en i.ssued.
, � .
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D�UO� �s Z2o�s cr.3' E'r1 i a� � -�- 3s" °
135°r-130-��'o$7S :
C-5 -� �
LEGAt, .DESGR 1 P')'t O1V ; ����� ti� � �
LOiS E� AtVD 'j' E3LOCK 2� OAK GROV� AD(3FTt�R1� ANOKA COUPdTY�
�INNESOTA. ' -
�
t hereby certify fh�Y thi� surveq, pl�ts, ��r s-��r�t
a!� PI'�'Uflc'�.'d by me o�r eancier my dicect s�a�r-
. . c�si<>n arad ihQt I a�rn �� duly e�;i�t�r�d Land
Surveyar u th •,�vs c� S+t�t� c�f �'linn-
esc►t.n.. � " �
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r�t� � �i � -(� �,.�,�. �o �-_ � � 7
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REGISTE�tEJ '`�
�A�iQ
St)n"VEYO(2 �
,�,�� 4427 �"�.� i
�� �.�' j�S.�'��'.� �,
.C. ��u � A�� 5�.��;�c��r� �c._ . �__.______ ,-- _.
. � �_
.__ __
� -
c�ty of Fr�a�ey
AT THE TOP OF TME TWINS � � I L D 1 N� P E R M I T
r
� �
� `y _ COMMUNITY DE�ELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
� j �"'1 � CITY NALL FRIOLE� SSIJ2 NuMBEa REV
�"""'�" �'' 612-571-3450 g�aF�s
10B ADDRESS �,654 Fridley Street NE
t LEGAI LOT N0. BLOCK TRACT OR ADDITION
oescR. 6, 7 2 Oa.k Grove Addition
2 PROPERTY OWNER MAIL ADDIiFS$
Donna Medin
3 CONTiiACTOR MAIL AOORESS
Tabor F� Sons Inc. 1OS47 Terrace Rd NE Blaine MN
a ARCHITECT OR DESIGNEii MAIL ADDRESS
5 ENGINEER MAII ADDRE$3
8 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW O ADDITION O ALTERATIpN
9 DESCRIBE WOFiK
Reroof �ara�e (8 Sal Tear-off
9 CHANOE OF USE F
STIPULATIONS
O�TE
IIP
/ /
29930
PT NO.
����
PROVEO BY
SEE ATTACNED
SMEET
PMONE
PMONE LICENSE NO
2Q014248
E LICENSE NO.
E LICENSE NO
� REPAIR ❑ MOVE 0 REMOVE
Underlayment must comply with the State Building Code.
SEPARATE PEIiMITS ARE REOUIRED FOR EIECTfi1CAL, PLUMBING, NEATINf3. ''r ��• vv•�.
VENTILATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULI ANO VOIO IF WORK OR CONSTRUCTION ZONING
AU7HORIZEO IS NOT COMMENCED VtIITHIN 60 OAVS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OFi ABANDONE� FOR A PERIOD Of 120 DAYS AT
ANY 71ME AFTER WORK IS COMMENCED NO DWLG. UNITS
I MEREBY CERTIFY THAT I MAVE REAO AND EXAMINEO TNIS APP�ICATION
AND KNOW TNE SAME TO BE TRUE AND CORFECT. ALL PROVISIONS OF LqW$ VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WpRK WILL BE COMP�IED
W17M WMETMER SPECIFIEO MEREIN Oli NOT. TNE GRANTING OF A PERMIT 699
DOES NOT PRESUME TO GIVE AUTMORITV Tt� VIOIATE OR CANCEL THE pEFiM17fEE
PROVISIONS OF ANY OTHER STATE OFi LOCAL LAW REGULATING CON•
STRUCTION OR THE PERFOfiMANCE OF CONSTRUCTION 29.(O
PLAN CNECK FEE
�� 7`"73��' i �
S�GN4TUaE OF CON'aALTOp Oi1 nUTMOpiZEO AGENT IOATpr �, D�
SO.
STAILS
P �OCCUPANCVLOAD
OFFSTREET PARKING
IGAiiAGES
TAL
� t
�L J
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRIDLEY
[] SINGLE FA1V�Y AND DUPLEXES R-1 AND R 2
BUII.,DING PERNIIT APPLICATION
��
�� �
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b � � � ,S / �� �
Construcdon Address: ,S `� ��, �f / ,�
Legal Description: _ � �� a.. ,s /e ��� �., .` /��
Owner Name & Address: ,�o, � ,� ,�, � ecl ; o� Tel. #
Contractor: �� /�,50 NS MN L,ICENSE #�� l��o?�%�
Address : /0 � �i � �'CP��� e ��✓ � /<.a✓e° �s l� Tel. # �U � � �9d a
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTI�R:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IlVIPROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Width HgtlGround Sq. Ft.
�
� " - " -}��� a �i
Construction Type: Estimated Cost: $ �
Driveway C�rb G�Zt Width Needed: Ft. + 6 Ft = Ft x$ _$ -
DATE: '� .�'�` � APPLICANT: 6��•�� Tel. # � �� � % ��
Permit Fee
Fire Surcharge
State S�rcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ , G
$ �
r--
$ � �
$
$ -DD
$
$
$
$
� .�.s=o0
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 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 PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing germits 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:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $1�,000
$100,001 to $500,000
$500,�1 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,(�0
$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 $500,000 plus $4.75 for each additional
$1,Q00 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
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.
Alternaxe "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.
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CHIlVIlVEY AND STACS VERI�ZCATION
The undersigned hereby verifi�s that the �existing chimney or stack:
1. - Has been carefiilly examined � Yes (�o i)
2. Is free from mst� or detenoration Yes i �l �o ()
3. Has no foreiga objects lodged within
4. Is securely supported
5. Meets all cuirent Code requirements for size
and total BTU's cc�nnected
�
7.
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Has total heating BTU's of ,� �o��, v��
All other BTU's e `� � . � �- �
TOTAL BTU's � �/
Has a liner been pmvided for water heater
Has combustion air been provided for water heater
Remarks:
Yes (°�No ( )
Yes �No ( )
Yes ( �Na ( )
Yes (+�No ( )
Y� (E-y'No ( )
HEATING CO:
Signed By:
Date:
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CIIYOF
FRlDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
March 16, 2001
Douglas Rudolph
6645 Fridley Street NE
Fridley, MN 55432
Re: Final Inspection at 6645 Fridley Street NE
Contractor: Mr Rooter of Anoka County
Dear Mr. Rudolph:
A plumbing permit was issued on August 3, 1999 to install a water heater at your
address. An inspection on September 20, 1999 was conducted and the following
corrections were noted:
1) Provide combustion air to water heater per Uniform Mechanical Code.
2) Replace old gas valve to water heater with an approved AGA valve.
We have not been called back to inspect these corrections. The permit fee paid covers
the inspector's time to make sure the appliance was installed correctly.
You will be given thirty (30) days from receipt of this notice to respond. If we do not hear
from you, we will expire the permit and any further inspection on this installation will
require a new permit. "
Any questions can be addressed to me at (763) 572-3603.
Cinnorolv
sua�etr E IT NO.
c�ty of Fridley
AT THE TOP OF TNE TWINS � � i L D 1 N G P E R M I T
r
� � RECEIPT NO.
� ; L __�___ COMMUNITY OEVELOPMENT OIY.
� PROTECTIVE INSPECTION SEC �G�� /
� �
1 . �
l---.� ��'�'�'i CITY MALL fRIOLEV SS132 NUMBE:1 REV DATE VAGE OF AOPROVED 8Y
L 612-571-3450 g�p_p�s 8/3/00 � �
JOB ADORESS 6654 Fridley Street NE
t LEGAL LOT NO. BLOCK TRACT OR AODITION SEE ATTACNED
DESCR. (),7 2 Oak Grove Addition SMEET
Y PROPERTY OWNEp MAII ADORES$ 21P PMONE
Donna Medin 6654 Fridley Stree� NE
3 CONTRACTOR MAIL ADDRESS ZIP PMONE IICENSE NO
Quality Contracting 361 76 Avenue NE, Fridley, MN 55432 (763) 427-7733 7035
d ARCHITECT OR DESIGNER MAII ADORESS IIP PMONE IICENSE NO
5 ENGINEER MAILADDRESS 21P PHONE LICENSENO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O AODITION O ALTERATION � REPAIR p MOVE O REMOVE
B DESCRIBE WORK
Reroof House (14 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR EIECTqICAL, PlUM81NG, FIEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV �OAD
VENTILATING OR AIR CONOITIONING
TMIS PEFMIT BECOMES NULL ANO VOIO If WORK OR CONSTRUCTION 20NING SC. FT CU FT
AUTNORIZED IS NOT COMMENCED V�(ITHIN 80 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED fOR A PERI00 OF 12p OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OfFSTREET PARKING
I HEREBY CERTIfV TNAT I HAVE READ ANO EXAMINED TNIS APPLICATION I. STALLS GARAGES
ANO KNOW TME SAME TO BE TRUE AND COFREC7. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED @
WITH WHE7HEN SPECIFIEO MEREIN Ofi NOT. THE GRANTING OF A PERMIT y�1�22�F �.C)1
DOES NOT PRES ME TO GIVE AUTMORITV TO VIOLATE OR CANCEL TME pERM1T FEE SAC CMAFGE
PROVISIONS ANY 07HEFi STATE OR LOCAL LAW REGULATING CON-
STRUCTIO PERFORMA E OF CONSTRUCTION ��F7.9O Fi e SC �I.ZZ
�' �' �� �� PLAN CNECK FEE TOT L FEE
Lice $5 0 $54.73
S�GN4iUAE0FCON'AACTOAOpAUTMOAl2EDeGENT IDATE� ME P OP VAl,lOA E 7H1S IS UA MIT
S�GNATUAE O� OWNEp ��� OWNEp BWLD@Ai iOAfQi r�
Bl �h5� � q�tE
e
NEW []
ADDN []
ALTER [ ]
Construction Address:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
c� c� �` �
�
�F� l� � � �
Legal Description:
Owner Name � Address: �� +� �-� %�� i �- Tel #
Contractor: ( v" �.� a.-1 � % U
Address: � � i % 4� � �`
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
� is�'� 1�' �. P' f i� �-�
l;
�
� 6
Effective 1/1/2000
(763) 572-3604 Bldg�sp
�� c� �
�� � �a
MN LICENSE # � �-� � S�
Tel. # 2 � �i -ya � - 7733
P�2-r a� L� S—s��(3�
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.
Length Width Hgt/Ground Sq. Ft
/ � 5' � S
Construction Type: �� `� `� c� � `� � � �v � � ��� /
� Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � � � � APPLICANT: � � Tel. # 7 � � " yZ ? — 7 � ��
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ '�7�'�% 9C� Fee Schedule on Reverse Side
Fire Surcharge $ %.� a .001 of Permit Valuation (1/10th%)
State Surcharge $ • �i $.50/$1,000 Valuation
SAC Charge $ $1100 per SAC Unit
� License Surcharge $ 5- Dd $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ �'� 7.�
, _-
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 applicarion 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 $SQO
$501 to $2,OQ0
$2,Q01 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,(}UO
$500,001 to $1,000,000
$1,OQ0,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 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 $500,000 plus $4.75 for each addidonal
$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
DRIVEWAY DEPRESSION ESCROW
(Concrete Cbrb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15 .50.
Alternate "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
�
Building BUILDING Permit No.: � -c��S
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date Rec'd: 2� �
DATE 02/19/07 YOURE-MAILADDRESS estherd@probuiltam. com
SITEADDRESS 6654 Fridley St
THIS APPLICANT IS: ❑ OWNER OCONTRACTOR
PROPERTY OWNER/ Na�E: Donna Medin
TENANT �D�ss: s ame a s s i t e crrY STATE zir
PHONE: 763) 574-0350
CONTRACTOR Na�E:ProBuilt America
SUBMIT A COPY OF STATE LICENSE # B C- 2 0 3 5 6 8 4 7 EXp DATE U.i / U�/
YOUR STATE LICENSE ADDRESS: �� 11 11Lri AV2 � C�y NOYth Stp STATE ZIP �� l�
WITH APPLICA'ITON pHONE 6 51- 7 7 0- 5 5 7 0 Fn�c 6 51- 7 7 0- 0 4 9 5
PROPERTY T'YPE ❑ SINGLE FAMII,Y/IVEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE ❑ �DITION ❑ GARAGF/SHED �WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWINIMING POOL
TYPE OF WORK: ❑ NEW ❑ ADDITION
❑ MAINTENANCF/REPAIIt ❑ REMODELING
DESCRIBE WORKBEINGDONE: Replacinq 2 window, not chanqinq sizes
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S. Ft.
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
GARAGES ❑ ATTACHED GARAGE 1• ��6 ��r Plan
PROPOSED SIZE: ❑ DETACHED GARAGE Z• �I�� floor plan
PROPOSED HEIGHT: 3. List of struchual members to be used
SIDING FOR NEW CONSTRUCT[ON INCLUDING DECKS,
❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim l. Site Plan/Survey showing the existing shuctures
❑ Other ❑ Fascia � P�P�S� ProJ�
WINDD�,VS 2. Two sets of construction plans
IN EXISTING OPENINGS �Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF W[NDOW TO BE INSTALLED doubl e� NUMBER OF WINDOWS 2
[u.i. rr,r,� a1cr. nA��ll Vl� vALUAl1ViV, liV(;LULll�ili 1t1L (;U,�l Vr� LAI3UKA1Vll MA'1�1:KlALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 618 OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surchatge
SAC Chazge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
� (� See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ ip .001 times the total job valuation
' $ .0005 x Permit Valuation Minimum $.50
$ 5, $5.00 (State Licensed Residential Contractors)
$ $1675 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ �; �� Make checks payable to: City of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; 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 _�� �' _ PRINT NAME E S't Y12 Y Dahl DATE 0 2/ 19 / 0 7
Buiidin��
inspe�tions
76.;-�i2-�604
76� -�0�-'! � i % F.a L
_,
DA"I'L �S � L —
SITL ADDRESS _�
THIS �.PPLlC:�NT 15:
PROPE�T'�l
��1VNE�t/
TEN��T
❑ c�WNEP
�� ��8� �
�:�����.� _�.��'����_ 1'����
�� �% �� ����.�
EFFECTIV� 1-i 7�
YO�Zt L-MAIL .-1DDRESS
p°IIrili �o.:
Rec�ived BT�:
1.��� Ft r-� ,u
��PJ
ADDRESS: CIT`I STATE ZIP
PHONE:��`f — 0�(�
CONT�CTOR Nq,v�E:
SUBMIT A COPY OF
YOUR STATE sTa�1.IC�s���9�r� � ai�e� d� �„ �_ E,`iP DATE
LICE�ISL. BOND AND STATE BOND �: �,� pp�� � �� �--°°°°"����
CER'TIFICATEOF ADD[tESS: G=�'n"�i�� a�,,��1_�i_r��,,, CITY STATE ZIY
INSURANC� PHONE ����,D �'��,�;���� �e ����� Fr1X
PEiMIT TYP�+ � SINGLE FAMILY ❑ TWO FAMILY 0 TOWNHOUSE --, —
TYPE OF WORK: I � �'
DETAII.,ID DESCRIl'TION OF WORK
�LACEMENT
PER MS 16B.665 the perrnit fee is a minimum of �15.00 or 5% of the total cost np to S50Q.00, whichever is �eater, for the
impmvement„ installation or replacement of a residential fixture, excluding the fixtures. (This should reIIect oniy the cost of labor )
Labor cost under $300 =�15.00. Labor cost between $300 to $Sfl0 = cost of labor x.OS = plus SO surchaxge
OR
FOR PROJECTS WFIERE LABOR E7{CEEDS $500, FF.FS ARE BASED ON �I 0.00 PER FIXTLJRE, EXCEPT WFIERE NOTED. FIXTURES: (IIdDICATE TOTAL
NUMBER OF EACH BELOV+�. IvIINIMUM FEE � 15.50.
BATH SIIVK/LAV � _FLOORDRAINS SFIOWER WATERPIPING
_BATHTiJB GASPIPING(NEEDQTYLIC) SWIIvIMINGPOOL WATERSOFINER(�3�
_CLOTI�S WASHER _KTTCi�N SINK WATERCLOSET BACKFLOW PREV. ($1�
_ DISHDVASHER, _ LAUNDRY TRAY � �WATER HEATER ($35) FOR IRRIGATION
_�1VATER METER _ OTi�R
Permit Fee
TOTAL DUE
�15
� �� C-� Number of fixtures (� $10.00 x $10.00 = $
.50 Number of fixtures (c_,� � 15.00 x$15.00 =�
$ ,�,_� OR Number af fi.,ttures @, �35.00 � $35.00 = $
- ' State Surchar�e = $ .50
� (MINIMUM �I S.SO) Total = �
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
�� [ hereby apply for a piumbin� permit and I acknowledee that the information above is complete and accurate; that the worlc wiil be in
I� �:onformance wiCh lhe ordinances and codes ofthe Ciry ofFridley and tivith the N[innesota Cunsnvction Codes: ehat [ understand this is
�� not a permit but aniy rsn anplication for a permit and �,NOri: is not to start �.�ithout a permit un site; that the' �,vork �viIl 'be in accoraance
�� �.vith the approved plan in cl�e case of ;.11 �,voric �vltich i•equires revietiv and :ipproval of� pians.
:; ���/ _. . /� q
I� :IGidAT[1P�L• ij .\ IC.'� T�%�fi{l.LL -,ii "D1rIT'lAt�4�� (/��',� Q 4%Q� 7`1TL• � 6—�
�PPROVGD (31' ?.�TL•�^ � ....
:r �-_�i:?,!�rTr:
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: :
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