AF - 43400n
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City of Fridley, Minn.
BUILDING PERMIT
Date: � ,� f � Ef`' :� �
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Owaer: �� ��, �� ;� � � �� � �„�
�a� �'� Addrese �
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NA 7417
�. , TIO ,, �P , ILDING
No. �� Street �i.�' .�. %, Part � Lot
Lot ��w..._ Block - � • � � Addition or Sub-Div3sion �� �� , .�r� �
Coraer Lot _ Inaide Lot �'� Setback .�� .� � Sideyard �`� f
Sewer IIevation � % � , / � evation ( �
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DESCRIPTION OF BUILDING
F'ront �°� Depth �`' Height .�L� 84• F`t. �� Cu. Ft ����
t DePt�► I� ght _.�1., Sq. Fk Cu. F'�
Zwpe oP Construction _������ �� F�,�� �� � J
-�7� _ To be Completed
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In consideration of the issuaace to me of a gerinYt to cbnstruct the building described above �agre� � do � C/
'� P�P�� work in accondance with the d�scription above set and ia p� with a'll provisions of
ordinaac�s oP the dty oP Fridleq.
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In con�deration oP the �yment oP a fee of $ '"�
� � � , Permft fs henebY �ted to
to conatruct the building or addition es described above. Thiapern� t is granted upon
the eupress condit%n that the person to whom ft ia gre.nted and hia agents, employees an� workmen, ia all work
done in, around and upon satd building� or anYpart thereof, shall conform in all respecta to the ordinancea of
FridleY, M9nnesota location, conatruction, alteration, mafatenance, repa3r and moving of bufldinga
o��� dtiY ]imits�� permit may be r�voked at any time upon violation of any of the pi�ovl�iona of eaid
Buildin8 Inspector
�.,� NOTICE:
ihb psneh deu ao� ee�sr t6s westeucH�, IeuaQallon �e� �ridae, p1um61nB. On 6aNne, awar er water. B� sun to �
tha Boildio� Insp�etor [o� nparai� p�rmh� �e� 16� �.
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. . ; APPLICATION FOR BUILDING PERMI� -..
. . ` �.CI'�Y OF FRIDLEF, MINNESOTA � '
tNaNER' S NAt��/-=s �� f��A �/s� �,�.��c stJII.DER ��{��_
ADDRESS. . � „i ��_. (� fJ`1 l�'C / � % /tl��= �iDDRESS S�//�i�i �' �
' LOCATIOFI. OF � �UILDING
No. �.T / �� °� �� 3trest .. $art of Lot —
Lot�� �__ gl�k � Addition or Subdivi.sion__ Ci4y� �(; JQ��` ,.
�Corner LoC � Inside Lot_Setback � �S� : • Side-Yard / D ` � Q �
SEWk;R ELLVATrpN F'OUNDATION ELEVATION —
Applicant attach to this form Two Certificatas of Survey cf Lot and proposed build-
i�g loaation.drawn oa Chese Certificatea. �
DESCRIPTIBN OF BUII.DING
To be used as;
�/ N �� F' �t,o�?� c >�G- Front- Y_�� � D�ptb _ � <�a $e�ght _�� �j
Sq., Ft.-- ��� � Cy. .Ft. �G/ -2 �
��ti Depth Aeight
. , � gQ. F't.� Cu. Ft. . .
Type of Construction �.� 6 0� �,�=���1/� Estimated ,Cost_ f C/ c`�`�
�
To be Completed / � D f],¢ y
The undersigned hereby makes'application for a perm3t�fox �he work herein specified,
agreeing to do all work in strict accordance with tha Citq of Fridley Ordinances and
rulin�a of.the.Depar�ment of Buildin,gs, and hereby declares that all the facts and
representatiotis stated�in th3s applicatioa are true aad correct.
I
DATE_ 1/%j� ���' SIGNATURE
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�(Schedule of Fee Costa can be found on Che Reverse Side).
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BUILDING PEI�T FEE SCHEDULE
Section 2. The Inspector o£ Buildin�s shall, before issuing any pert�it for
the erection of any buildiug os structure, or for any addition Ca any exiet-
iag bu3lding or atructure� or for any alterationa or repai�ce to any existing
building or s�ructure� upon application therefor, require the payment by the
applicant for such permit of feea tv the amount heraia below aet forth and
ia the manner herein provided to-wit:
2.1. For any auch perm�it for the erection of any fire-proof building, other
than a garage� warehouss, factory or graia alevator, or for the erection of
aay fire-proof addition, for similar occupancy, to eny existing building
shall be at the rate of $1.40 for each_one thousand cubic feet, or fraction
thereof, in such cubical conteats.
2.2. For any auch permit for the erection of anq fire-proof garage� warehouse,_
faceory or grain elevator, or for the erection of any fire-psroof addition,
for similar accugancy, to any exietin� building ahall be at the rate of $1.25
for each one thousand cubic feet, cla�aified as t1fireproof" by Section 502 of
the Minneapolis Building Code.
HOUSES � � �
2.3. For aa►y sucfi permit for the erection of any aon-fireproof buildiag other
than a garage, warehouse, factory or graia elevatar, or aay aaa-firegroof
addieion, for similar occupancy, to a�y existing iau�1.].d3ng - permit $1.00 for
each one thousand cubic feet.
�
2.4. For any such permit for the erection of any non-fireproof garage, .-
warehouse, factory or grain elevator, or for the erectioa of any non-fireproof
additioa,-€or-similar occupaucy, to emy exiating building or for each such �
v_ -bvil.ding or addition - niaety cents ($0.90) for each oae thousand cubic feet
or fra¢tian thereof, in the cubical cmntents thereof with a minimum of $4.00.-
For the purpose of computiag fees for build3ng perrm�Lta, the c�abical contents
of anq building or addition to a uniform height throughout by multiplyin8 t1�e
gr�ouad area covered from a point six (6) inchea below the floor liae of r.he _
basement or cellar to the average height of the upper aurface or to tha
average height of the r@of surface of the maim gable of a pitched roof.
2.5. For repairs or alCerations to an eacis�ing structuxe, the fee ahall be
at the rate of $3.00 per each Five Hundred Dollars ($500.00) or fraction
thereof 3n the cost of all progosed work.
2.6. In no case shall the fee._clzarged .f.or-any permit,-as set forth. in
Sectioa 2 be less.than $4.00: �
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L��Ai. DE�CR { Pi I ON ; .��S
L�i� � ANb 'T� 8l.00k �� �Ai� GROVE AODi7"If�N� AiRtOMA CpUl�TYf
ts�1�1NESOTA,
� hereby certifa► that this survey. �t�a. or rnport
' was �pre�►r�d by me or under my direct super.
vision and that I em a du13* Re�iscesed I.snd
��eYar �►e t1�a 3tateof Nimu-
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REGISTEREO
lAR1D
SURVEYOR
,�'9►� 4427 �a'�,'�'
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City of Fridley, Mi�nn..
BUILDING PERMIT
Date: Oct . 14 , 1969
i
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N° 10451
pWner; _ Harnld T.»gni�6 Bu9lder T C K.�..QSet�i
�� 6655 Fridley�St. N. E. Ad��g 4230 Central Ave. N. E.
LOCATION OF BUILDING
lvo. h h S S street - F r i dl ey S t. N. E. Part oP I.ot
Lot 6 _ sioc� 1 Addition or Sub-Divisfon Oak Grove Addn .
Corner Lot _ 7n�de Lot
Sewer IIevatian
Setback � Sideyard
�.— Foundation IIevation
DESCRIPTION OF BUILDING
To be vsed as:
G ar a� e �t 2 2� Depth 2 2� xei�t 10 '�. � 4 8 4 �� 4 8 4 0
Front Depth I%ight Sq. Fk Cu. Ft,
Type of Construction ---F��ilie F�t. Cost —.� 2 50 ..a(L�__ To be Completed
r--� �/C ��
' Surfaced driveway reauired. . �� ��
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Set garage floor elevation 2 inches above existing driveway "
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In cansideration oP the issuance to me of a peraiit to onstruct building described abov , I agree to� do
the proposed work in accordance wlth the descriptton abov set and in compliance wi all proviaiona of
ordinancsa oE the dty of Frfdley.
� _ � �—�1.. ��
Ia conafderation of the payment of a Pee of $ 8• 0�_, permit fs hereby anted to T. C. K j e s e��
to canstruct the buflding or addition as described abo e. Thi.aperm� t is grant� upan
the express condition that the peraon to whom it ia grented aad his agente, employees an� worl�en, �tn a11 work
done in, around and u�n said building, or anypart thereoE, shall conform in all respects to the ordinance� of
FridleY� Minnesota regarding lacation, construction, alteration, maintenance, repair and moving of builti9ngs
within 'the dtY lfmi'ts and thia Permit may be revoked at any time u�n violation oP aay of the provfsiona oP eaid
ordinances.
�G�� � �
'�-�R„i,� �
Hank Muhich
NOTICE:
Yi� perm(f d�s eot eevar f6s coestrudioe, iestaQ�}oe ier �ne, plumbiee, en 6eaHng, avn�� or �y�taa g� wrs to aos
tha Bofldieg W�setor fo� aparah pormNs fo� t6as tt�s.
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APPLICgTION FOR BUILDING PE�MIT
CITY OF FRIDLEY, MINNESOTA
,�✓ �
OWNF.�t 'S NAME BIIII�DER v /r .�
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ADDRESS � � �J'� d � '° . - e ��- � ADDRFSS �� � � ��, : ��! � ,� � ° � � ,
,
LOCATION OF BIIILDING
NO . �,� �'�°S "� STREET ��, �'� Q � �%� �
°" ` �F �:..���
LOT BLOCI{ ADDITIOId OR SIIBDIVISION
CORNER LOT INSIDE LOT SETBACK SIDEYARD
�_
SEWER ELEV'6TION TOP OF FOOTING
Applicant attach to this form Two Certificates of Survey of Lot and
proposed building location drawn on these Certificatee.
DF�CRIPTION OF BIIILDING
To Be IIsed As:
�-a� Front_ � `Z Depth �_ �- Height �'�
�
Square feet_ ��t� � Cubic Feet �� ��
Front Depth Hei�ht
Sque,xe feet Cubic Feet
Type of Conetruction ,r� ,�,���_ Estima,ted Cost��,;� �'°" ��,,� b'�
To Be Completed
0
The underaigned hereby makes application for a permit for the work
herein epecified, a�reeing to_._d.�_all work in strict accordance with the
City of Fridley Ordinances and rul' of the Department of Buildings,
and hereby declares that all the facts d representationa stated in
thie application are true and correcto r� �
D�TE
(Schedule of Fee Coets
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on the Reverse Side.)
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BIIILDING PERMIT FEE SCFiEDIILE
SECTION 2e The Inspector of Buildings shall, before issuing permite
for the erection of any building or atructure, or for any addition to any
existing structure or buil'dit�y.or for any alteration or repairs to any
egistin$ building or structure, upon application therefore, require the
payment by the applicant for such permit of fees to the amount heTein
below set forth and in the ma.�ner herein provided to-wit:
IIniform Buildin� Codes Type 19 2, & 4-�1075 for each one thoueand
cubic feet, or fraction thereof, in such cubical c.ontents. Type 3& 5-
$1050 for each one thousand cubic feeto
For the purpoae of computisig fees for building permits, the cubical
contents of any 'buil3in� �g�addition to a uniform height �thraughout �by
multiplying the ground area covered from a point siu (6) inches below
the floor line of the basement or the cellar to the average height.of
the upper eurface or to the avera$e hei�ht of the roof surface of the
main gable of a pitched roof.
For repaira or alterations to an exiating atructure, the fee ehall be
at the rate of $3.00 per each five hundred dollara ($500.00) or
fraction thereof in the cost of all proposed work.
In no case shall the �ee char�ed for any permit as set forth in Section
2 be less than $5.00. .
NSSSD Connection Chax�ea based on location - A.rea 1 or 2.
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LOTS � AN� '7t E'iLC+CK I � OAK GROVE A On! T f 0*�t� �,PlOt{A Cc�t,ItdTY
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vicic>n snd th�tt ? P:n a dul; �;�:,*ist,�r=si 1_�::d
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SUBJECT P ,
City of Fridley ° 15 4
' ` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ECEIPT .
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� �L __�___ COMMUNITY DEVELOPMENT DIV. � ���
r j � PROTECTIVE INSPECTION SEC.
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l--_-� ����,,� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
i 612-571-3450 910-F15 / /
9277�
JOB ADDRESS 6655 Fridley Street N. E.
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. rp�% 1 Oak Grove Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Steven A. Stark 6655 Fridley Street N.E. 571-4961
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Install chi.mne
9 CHAN(3E OF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED 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 SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
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 $2SO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT y�. SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OFi LOCAL LAW REGULATING CON-
STRUCTION OF THE PERFORMANCE OF CONSTRUCTION. +�7.50
PLAN CHECKFEE TOTALFEE
�8.00
SIGNATUREOFCO TRACTORORAUTHORIZEDA ENT IDATE) WHE ROPER Y I T THIS IS YOUR PERMIT
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tGNATURE OF OWNER iIF OWNER BUILDERI IDATEI INSP '�
�aTE
' B. H. BR1�IDLEY
CIVIL ENGINEF.R P.NU SUkVEYOR
8829 • T4TH AVCNUE SOUTH
� MINN6APOLIB, MINPI8507A 35{0$
724-2169
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• , � CITY OF FRIDLEY � ., �
. � . ,. ; ,
� APPLICATION FOR RESIDENTIAL QUILDIP�G PERMITS � � � p
' � �. � (t�ew, Alter•�tions, Additions, or Repairs) ,
. , .
� � 041P�ER: m/'. � rn�S � S�evP,�Y� �i-�fl-��G BUILDER: � �.P"Vl-iL �
AODRESS: i0%�� �rr°dl.��,, �� . �� ApQRESS: • �
TEL N0: 'J�� I-��(o � � TEL N0: " .
� • ° � ' Construction Location . . ..
. STREf�T NO: STREET: ".`. " .
IAT: _ � � BLOQC: �` ADDITION : � ►� �-- �f�d l�� .
Corner Lot: � Inside Lot: Sefback: Sideyards: •
- Applicant attach to this form two Certificates of Survey of lot and
. ' proposed building location drawn on certi.ficates to scale. '. �,
� � � DESCRIPTIOt� OF CONSTRUCTION � . � � , .
� h�l ilil Vl Front: � Depth: Height: .
� , • � Squa�e. Feet: C�bic Feet: � �
. Front: Depth: � Height:
� � Square- Feet: � Cubic Feet: � .
Rjipe of Construction: � � ' � � � Estimated Cost: $���,
�
Rt� Be Cbmpleted: � L(��.fLS � , � . . � .. .
• , - , . � Alt. A Alt. B .
. Proposed Driveway Width If New Opening Is Desired: $' $ � �
� � • •. , . � . SEE REVERSE SIDE OF SHEET
•.Tlie undersigned hereby malces application for a permit for the work� herein specified,
agreeing to do all work in strict accordance with the City of I'ridley Ordinances and
rulings of the Department of Buildings, and hereby declares that aTl the facts and �
representations stated in this application are true and correct.
DATE: �l f � / l � � SIGDIATURE : ._'���7�'°'' � , � ' '
Stipulations: . • �
' � �'� . . _. , .
. / �'� . . ' . .
V ' . . '
. � ��� �- - � � , ,
� . . •
aiv���anv � a_f\��� i i LL. J�.I7GLVL.G �. .
S1:'CTION 2. T}�e xn�;pector of 13ui].dincJ� L}�a].l, "bctore i�suing pernit� for the erecL-ion
oi any buildinc� or �L•ruct:ure, or for any addi.L•i.an L-o any cxi.�tinc� buildi.ny oz strucL•urQ,
. ox' tor any �zltcratio�i or zcl�aira , L•o •any exi�L•i�ig building or sL-ructure, upan app�.ication
'L•hezefoze, requirc the payment- by Uie applicanL• for. such permiL of fces to the amount
hcrein below seL- forL•h and in L-hc manner herein provided L-o-wiL-: . •
, , � . .
. • .
Nl3VJ COt7STRUCTION: Single ramily Ilomes and Gaxayes: $h.00/1,000 cubic feet. •.
PLAN C1iL•'CY.: 25 percent- of bui.lding permiL- fee. ' '
DItIVEt�JAY D�PRH:SSIOII: (Concrete, Curb Streets Only) � �'
' AlternaL•e A: Itemoval and repl.accment bf concrete curb and
gutter only; Driveway width plus 6 feet x Y1S,75
-• Altcrnate B: Removal and replacement of concrete curb and �
• � � . gutter and inst-all a 3 foot wide approach �vith ''
` . .•• . 6 S.nch depth; Driveway width �7�lns G ieet x$17.85 �
:11 d_ �' : �►
For the purpose oi computing fees for building permits, the cubical contenLs of any .
bua.lda.ng or addition, is dcL-ermined by multiplying ihe ground area cavered from a
paint six (6) inches below the floor line of the basement or the cellar to the
averag� heights of the upper surface or to the average height of the roof suriace
of the raain gable of a pitched rooi. � �
. .
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 fractiqn tYiereof in the cost
of�all pxoposed work. . , , , '
_In •no case sha].l the �ee charged for any pezmit as set forth in Section 2 be less •
•tharb $7.50 plus $.50 state surcharge. , . � ' �
• . .. �_. ._ ._F . , _ , VERIFICATIO� �F FOUNDATIO(J � : �
' NOTE: Permits €or construction will be issued a minimtun of 24 hours from the time
oi application to allow for proper revie�v of t}ae proposed structure and ot the .
construction site.
A Cert.i.ficate of Suxvey of the lot, showing the location oi the foundation once it
has Ueen constructed t,rill be required before proceeding with the framing.
� � � � - � CERTIFICATE OF OCCUPANCY �. '
' Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occupancy of any structwce for �ahich a bu�ldi.ng pernlit has been issued; and
said structuxe shall no� be used or occupied until a Certiiicate of Occu�,�ancy has
been issued.
.
� • .
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:_. • • �
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sue�ecr PE
City of Fridley 219 6 O
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
� � •
� ; y �___� COMMUNI7Y DEVE�OPMENT DIV.
r � � PqOTECTIVE INSPECTION SEC. �I'7 /
� � �
� /'�'1 � CITY HALL FRIDLEv SJ43P NUMBER REV. DATE PAGE OP APPROVED BV
�----� � `.� 612-571-3450 910-F15 7/8/93 � �
J08 ADDRESS 6655 Fridley Street NE
t LEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 6i 7 1 Oak Grove Additi� SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
5teve Stark 6655 F�idle Street NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO.
Stock Roofing Inc, 289 Li.bert St ee 780-3361
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION [� REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof Iiouse (19 Sc�uares� Tear,o�'�
8 CHANOEpFUSEFROM TO
STIPULATIONS Underlay�ient ulust comply with the State B.ui.lding Code. Install smoke
detectors as per UB.0 1210 adjacent to all sleeping areas and in basement. Ice and
water protection at eaves and valleys. Provide adequate attic ventilation.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATINCi, �PE Of CONST. OCCUPANCY CaROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION
OR WOF;K 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 1 STAILS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVEFiNING THIS TYPE OF WORK WILL BE COMPLIED �,y�,�,p��, �`]„�O'�Fj .}`er31
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �3i�X
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PqOVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $27.0� Fire SC ySl.O3
PI.AN CHECK FEE TOTAL FEE
License SC $S.aQ $33.54
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI y ROPE Y VALIDATED THIS IS YOUR PERMIT
- ��� � � `�,.�
S�GNATUREOFOWNEPiiFOWNERBUILDERi �DATEi^- DG � qaTE
ATEW
ADDN
ALTER
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CTfY OF FRtDLEY
SIN(�LE F�IMILY AND DUPLEI�S R-1 AND R-2
Building Permit A�lication
Effective 5126i93
�a1� 1
eo�►��►A�: � ��5� �,�-�le� s;
I.egat De�cription:
Ovvner Name & Address: S7�fJe 5��9/z/� ��.�� �� ��r �S� Tel. #
Co�actor: 57��� ��s�i � �/-�- 11�Il�1 LICENSE # 3/�z
Address: � �'1 � �� ,�P��� S-� ��. �� Tel. # �,�G=.�.�6i
Attach to this application, a Certificate of Sunrey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlIRPROVEMENT
LIVING AREA: L�gth Width Height Sq. Ft
QrARAGE AREA: Length Wi�h Height �. Ft.
DECK AREA: i.engt�t� � V�dth HgtlGrcwad �. Ft.
OTHER: o � � C� C7 � � 1 � 5��� / �"-� �o�
�
c� r� t� �a� ��� F�. �a s�k
� o� c����:
�1�tOR. Cat�1�i0II �iBtC:
I �'
.�- :, � a��.:. :� �
;�
�i i� .� �.i � , r'r� � � /' j�
{GO.SL On BSCIC�
Driveway (�nfi Cut Wi�h Needed: F�. + 6 Ft = Ft x$ _$
DATE: ��/9 APPLICANT: .��%i� Tel. # 2�� T� 5'�
Peimit Fee
F'�re Surcharge
State Surcharge
SAC Charge
License Surcharge
Drieeway Escrow
Erosion Control
Park Fee
�wa Maia. Charge
TOTAL
��! _M. ' � .,1_ .
$ c� �, 0� F�e Schedule on Reverse Side
$_ /�f�; .001 of Permit Valuation (111(�h�)
� � � / $.SLi/$i,00U Valuation
� $750 �r SAC Unit
$ ,�^. O U$5.00 (State Licensed Residential Contractois)
$ Alt. "A" or A1t °B° Above
� Cons�rvation Plan Review $450.�
$ Fee D�mined bY Engincering
$ Agreemeat N�y I 1 Not Na�ry [ I
� °�3 S s�rrnrnur..��orrs: � --
r� a
. ,_.: _ - �
BUII,DING PERMI�' FEE SCI�EDULE
'The Chief Building Official shall, before issuing permits for the erection of any building or structure,
or for any addition to any existing bnilding or stru�re, or for a�► aiteration or repair to any existing
building or st�ucture, upon application theiefore, require the pay�ent by the applicant for such permit
of fees to the amoum herein below s� forth and in the mianner herein provided to-wit
TOTAL VALUE
$1 to $500
$501 to �$2,000
$2,001 to $25,0�
$25;001 to $50,000 '
$50,001 to $100,0�
;
$100,001 to $500,000
$500,001 to $1,000,0� .
$1�,UOi?,001 and up
FEF..S
$15 (Minimum Fee is $15 plus sorcharge)
$15 for first $S00 pins $2 for each additional $100 or
fiaction thereof, to and including $2,000
$45 for first $2,000 plus $9 for �ch additional $1,000
or fraction thereof, to and including $25,000
$252 �for first $25,000 pl�s $6.50 for each additional $1,000
or fraction thereof, to and including $50,000 -
$414.50 for first $50,OOQ plus $4.50 for each additional
$1,000 or fraction th�'eof, to .aad including $100,000
$639.50 for first $1�,000 plus $3.50 for each additional
$1,000 or fiaction ther�f, to aad including �$500,000
$2039.50 for the f� $SOO,OQO plas $3 for each additional
$1,OOU or fraction thereof, to and including $1,000,000
$3539.SU for the first 51,0�,000 plus $2 for each additional
$1,000 or fraction �thereof �
DRIVEWAY DEPRESSION ESCROW
(Concrete Ct�rb Stre�ts Only)
Altemaie "Ap: Removal and repla.ceme� of curb and gutter only - Driveway width plus 6 fec� times
$13.50.
Alternate "B": Removal and replacement of curb a�d gutter aad install a 3 foot wide.
approach with 6 inch depth - Driveway width plus 6 feet tim� $15.75.
VERIFICATION OF FOUNDATION
Permits for constcuction will � issued . a minimum of 24 hours from the time of application t�o allow
for proper re�iew of the proposed structure and of the coastruction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been
coastructed will be required before proc�ding with the framing.
� _�
� � sue�ecT PERMIT NO.
c�ty of Fridley 2 710 7
AT THE TOP OF TME TWINS g U I L D I N G P E R M I T
i � .
�
RECEIPT NO.
; `L �_��� COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. � ��
�
i = �
�.---� �����,,j CITY HALL FRIDLEr 55432 NUMBER REV DATE PAGE Oi APPqOVEO BY
612-571-3460 9t0-Ft5 8/11/98 / /
JOB ADDRESS
6685 Fridle St NE
' 1 IEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACNED
DESCR. Z� 3 1 Oak Grove Addition SNEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PMONE
James Steinmetz 6685 Fridle St NE 71-7883
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO.
� Owner
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Res dent al
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house 15 S Tear-off
9 CHAN(3E OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL. PLUMBING, HEATING, TYPE OF CONST. OCCUP�
VENTILATING OR Alp CONOITIONING.
THIS PEfiM1T BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT.
AUTHORIZEO IS NOT COMMENCED WITHIN 80 OAYS, OR IF CONSTRUCTION
OFI WORK IS SUSPENDED OR ABANDONEO FOH A PERIOD OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION STA�LS
ANO KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WI�L BE COMPLIED
WITH WNETHEF SPECIFIED HEREIN OR NOT. TFIE GRANTING OF A PERMIT �].251
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OF; CANCEL THE pERM1T FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERfOfiMANCE OF CONSTRUCTION. ��F3.00
PLAN CNECK FEE
IGNATURE OF C 1 7RACT0 A FlOfil EDAGENT IDATEI
N p Y VAI
S NATURE OF 0 EA ii O BU4 ERI � r�/�� C/Ei��
IDATE� BL iNSP
�� m
�
CU. FT.
)FFSTqEET PARKING
GARAGES
SUHTAX
$.62
iAC CHARGE
Fire SC $1.25
'0�1L FEE
�44.87
I TNIS I�( OUR P Ay,
1 yJ__ /�r
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�ConstructionAddress :
Legal Description:
� Owner Name & A
Contractor:
Address;.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
<
�
Effective 1/1/98
�
��� ���
Tel. # ��%'%���
MN LICENSE #
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.
� g ' wi� Groun Sq. Ft.
�� ( /�, Si � 7 �-.� ��,�C
Construction Type: S r�p��� 6y�v�� Estimated Cost: $ � D %�i
,
(Fee Schedule�on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ —$
DATE: � //- �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS :
CITY USE ONLY
$ ��� Fee Schedule on Reverse Side
$ � ��� .001 of Permit Valuation (1/lOth%)
$ �o� $.50/$1,000 Valuation
$ $1000 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 [ ]
$ i .�
'el. # s �s ��'� 3
BUII..DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such 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 $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 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 $13.50.
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 $15.75.
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.
.,, . _ r
Building
Inspections
763-572-3604
DATE�_
SIT'E ADDRESS _
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WI'i'H APPLICATION
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-Ix(A.IL ADDRESS
❑ OWNER
ADDRESS:
PHONE:
NAMF.� � . i � . �.�. i
STATE LICENSE
PROPERTY TYPE ❑ SINGLE FAIvIII,'
❑ TWO FAMILY/f
PERMIT TYPE
❑ BASEMENT FINISH
❑ DECK
�E o� wo�:
DESCRIBE WORK BEING
SIZE OF Il��PROVEMENT
xvvruvu �
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
� Other
Permit No.:
Received By:
Date Rec'd:
CITY STATE ZII'
EXP DATE
= CI'�' STAT�IP S.7 J 7/
�OOF
� SIDING
❑ SWA�IIvIIl�TG POpL
� ADDIT'ION
❑ REMODE II�TG
� �i � �
❑ HOUSE ONLY
❑ HOUSE 8c GARAGE
❑ ATfACHED GARAGE
❑ DETACI�D GARAGE
❑ DRAIN TILE
❑ OTf�R
HEIGHT
BASEMENT REMODELING SUBMTT•
I. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft.
FOR NEW CONSTRUCTTON INCLUDING DECKS,
❑Soffrt ADDITIONS. & PORCHES SU�MIT.
� T� 1. Site PlanlSurvey showing the existing structures
❑ Fascia and proposed project
«'INDOWS 2. Two sets of construc[ion plans
IN EXISTING OPENINGS ❑Yes �No LOCATION OF BJIIVDOWS 3. Energy Calculations
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WII�TDOW TO BE INSTALLED NUMBER OF WWDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(ITSING 19 7 U.B.0 FEE SCHEDULE) .
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
Plan Review
Surcharge
Fire Surcharge
License Surcharge
SAC Charge
Cwb Cut Escrow
Erosion Control
Park Fee
Sewer Main Chazge
Total Due
$ See Back Page for Fee Schedule
$ 65% of Building Pemut Fee
$ .�. (.0005) times the total job valuation — Minimum $.50
$ .001 x Permit Valuation (1/10%)
$ Q $5.00 (State Licensed Residential Contractors)
$ $1450 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$20=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ � Make checks payahle to: Citv of Fridlev Attarh
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a pertnit; that the work will be in accordance with the approved
plan in the case of all work w ch requires re and approval of plans.
SIGNATURE OF APPLICANT �-�.,( (�(�� �Q��^/�� p�T N,qMg DATE
Page 2- Building Residential Application
BUILDING PERNIIT FEE SCHEDULE
The Chief Building O�cial shall, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or structure, or for any alteration or repair
to any existing building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
provided to-wit:
VERIFICATION OF FOUNDATION
Pemuts for construction will be issued a minimum of 24 hours from the time of application to
allow for proper 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 Onlv
City of Fridley
Building Inspections Deparlment
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
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1. 6x;s�.ing Floer Pl�n
2. AtDpor�lloorpl�n
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1. S;� Plani�ur.•_y si;a��.•ln� the ptisting saucmmA
xn4 p»p��.d pr�j� „l�
2. 1'�n sets of wux4uc.iion ptans
3, &l��ry Calculnl;ans
't!�#E �4�ST O�' LA�4R e1.N� MA
E S��ia�J:�ls")
�cr YacY k�e; C�� Fct �c:li�dule
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Building
Inspections
763-572-3604
763-502-4977 FAX
llATE�P� ' J � '
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERNIIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE I-1-09
'■ • .A! .
STATE LICENSE
Permit No.
. _ . � ; �■
< ii �
,�- � ��, �.
�, •1., ,� ���� �II'
YOUR E-MAIL ADDRESS � 1 C.I�t-� � e, 1�. C'g1�Vl,.
�
PHONE I� S° e-i Z L� �,3 _I �
�SINGLE FAMII.Y/NEW CONSTRUCTION
O TWO FAMILY/NEW CONSTRUCTION
❑ ADDITION ❑ GARAG
❑ BASEMENT FIlVISH ❑ ROOF
❑ DECK ❑ SIDING
❑ NEW HOME CONSTRUCTION
❑ MAINTENANCE/REPAIR
�XP DATE � ' � I � �� 1 �
CITY ��MSE� STATE�ZIPC
FAX � � � � �°f ��• `° 1 � � (�
SIZE
STORIES
�D WS
❑ DRAIN TII.E
❑ OTf�R
POOL
�❑ DITION
MODELING
❑ HOUSE ONLY
� HOUSE & GARAGE
❑ ATTACHID GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
0 Fascia
FT
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS_ & PORCHES SUBMIT•
1. Site Plan/Survey showing the existing structures
and proposed projeck
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS �yes ONo LOC TION OF �VINDOW
OR FOR NEW OPENING9�DESCRIBE SIZE OF /���,�j�► ���,� ,��/��syi.
OPENING CHANGES & '
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING TI� COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $���� -s OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$
$ �-
$ �b0
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2000 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: Ci of Fridley Attach
THIS IS AN APPLICATION FOR A PERNIIT NOT VALID UNTIL PROCESSID
I hereby apply for a building permit and I acknowledge that the informarion above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of 1 o h h re uires review and approval of plans.
SIGNATURE OF APPLICANT �1 PRINT NAME ��� ,�('j,,(,� �,� DATE �o : O (�)
PLEASE NOTE: SEPARA E PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHAMCAL
�
From: 612 822 5408 Page: 2/2 Date: 1?J2?J2009 9:51:49 AM
Building p�,�MgIN�. Pennit No_:��
Inspectioris �s�����,�, �FPLICATI4N Received By
7�3-572-3604 CITY OF �'�D�.�Y vac� R����!'y y
763 �502-4977 F�,X .,,,�.,,,�,,,� . . _ ....
SITE ADDRE4S `j fi
7'liiS AYYLiC:ANT IS:
PROPER7'Y
OWNER!
TENANT
YO�nt &MAII. ADDR�SS
0 OW1VflL �(CON7RACTOR
1
SUBMIT A COPY OF �A,�,� f,[CENgE N�r � �
YOUk S'1'ATE
LiCENSE,BONDaI� SrnTEDOND� 33��_
CRRTfF1CA1� OF pp�jR�,S9: (�1i I �r'+ �3t� i�
llVSUR�INCC PHONF,�pI r}- lA_JU�'� �i GK��
PERMIT 7'YPE ��Ot.t: i�AM1LY ❑ �rw0 FnMT[,Y
FAX
O 1'UwNH0U3L
E7i1' DATE
T:XP DnTC
f7Il"� STATC�ZIP �S�I�
TYAE OF WOKIC� O NEW �li1'YLACEMENf �
f.)L'1'AiLED DES,GRIPTf ON OF' 1WO K1C � L� I {�..s` �f V.aC.`,c�?.(`,,. ~
�• '�C�. '�flvi�—O�' �` �!f�C}. -. , ..... ..
FEES AFtE BASR17 ON 310,00 Yl:k 1�IXIURE, EXCEPT WHR.R$ NOTED. PIXTURI�: (1NL�iCAL'E 1'UTAL NUMBEA UF EACH BELOV�. MiNIMUM FF.fi
S35�SU.
_ F3A'IH SUVKJLAV ._PL(70R DRAlNS SIIOWCR wP:l'LiR P1P1NG
_ fSA'1'H'1'UB � (;AS piYWCi (NBED CTTY 1.tC� SWIIbIINWG POOL WAi'liR 501=1'N1iH (S35}
_Gi07'1lliSWASHER • KITCILL:N5IN1{ WM1TERCLOSfiT fiAGK.L�WWYltl:Y.($IS)
_ DISIIWAS11LiK _ LAUNURY 'l1iAY �wn�R r�n� c�s� — rot� �u�cnrruN
,__ wa'r� n�'r�t u��crc
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'1'H15 l5 AN APPI.ICATTON FOR A PERMi1=N0'1' vpLlU UNTIL PRCH:ESSBD
I hereby apply Ior c� plumbing permii and 1 ocknowlcdgc that th� inform�tion avpve is complete t,irrd t�ccurttte; �hat the work will bc in
conf�nnan� wil,h 6hn c�rdincinccs stnd cod� of the �ity of Fridlcy �d with the Minne.sota ConsWCtion Codes; that l understand tkus is
not a permit laut pnly Hn nppl' n for a permit end work is not to stmt without a permit pn site; th�t the work will be in per,prdttnce
with the approved pl�n ia thc cts of sil] wprk which r�uiros revicw rmd approval of plana. �
Sl(iNA1'Uli1'. UF APPLIGANT pR� � �� � �.�.� �'�
r
t .f �{ .��N.-a'1):...� s�......� s.i�....w . ..__ _... . � � . . . .
City of FrYdley
Building Inspections T�epartmont
6431 lh�iversity Avenue NE, Fric�ley, MN 55432
763-572-3604
FA,X: 763-502-4977
�
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i
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Btl�.ldirig
.�n.spe�tip�ns
763-572-3604
763-502-4977 k',A�
From: 7637537540 Page: 2/2 Date: 12/30/201011:02:09 AM
�ECHA�C,AL
.�,ES�DE�T'I'LA►L A,P�LI�ATIQN
SITEAADRIESS C$10"�7 �"i'"1
7'k1XS APPLICANT I3: ❑
PROPER�'X NAlv�:
OWNER/ � AdD�RESS:
TENANT '
SUBMTT A COPY OF
Y(7UR STAIE
LICENSE WITH
APPLICATION
��z�ax xx��
COMPANY NAN�:
COhiTA.C�' P�RSOTf:
C�'�'X OF ���LEY
XpUR E-NWL ADDRESS
0
C���? SI°7
Permi� No..
���xV� ���
Date ktec' d:
ST,t#'T� T.dCk.NSE � EXP DATE
A,DDRBSS: n+Y� C1T1' Ti►1�� S'��l,��"'2IP��
PHONE �IQ �` � �J` � �.A� ��+P.� �r°J� �— 1'� �
FAMILY 0 TWO FAMII�Y
�'XP� OF WORK: � [] �w 1�1R�EIP�,A.C��1'f
DETAII.ED D�SCR�`�OTI Clk' WO�
C] TOWNiIOUSE
❑ pL'fERpT101V/REMdDFL
PEES ARE SA.S�' A� UN 510.00 �xt kZX�JP,Fy ExC:EPT �YHERE PQbTED. P'1�CTLTRE5: (IIYbICA'T'� TdTA.1L iv r!:►�B��t Ok' �.A.C� ��'.I.OR�
P�tOVIDE �AT k.USS CALC'5 PER MAN[JAL J Z006 A�sF HANDBOOK.
Eqaipment Installed MF'G "'j'y"Q-tt.� _ MOBEL: 'TIt'1'f 2� �lDO ��7i IPi{�51ZE/BTU iD U)�CX[5
�G� MODEL: SLZF/BN
�'c*: MODEL; S�£/g�'�J
.vc azs.00 ���.�,c� ��.�s� $�s.00 cAS R atvo�ov�rr s�o.ao
AIR TQ AIIt EXCHANGBbR S15 k�It�PLACE (WO�D} $35.00 NEVV GAS QRILL $10.00
_B{?XL,EIt $3i.� �LTRNA,C� 535.00 _tiA5 UN�'C F1'1'R S1U.W
_�X �.WER 514.00 � GAS DRYER 510.00 P00�. HF�t#'�It 535.00
�UcT wo�x $io_oo _ _GA�S PIPING 510.00 vsNTt[.a,TOR ais.00
flilS IS AN APPLICATICiN ROR A PERMIT•'NOT VAd.iD UNTi�. PROCE5S.ED
T hereby apply for a buildiuo,g paimit and I a�lsnvw3cdge that tho �ion Eibove i� complcte and nu;urat,�; Lhst tl� work will � in
c�nfr,rmattce widi the ordinmices and es of the City of Fridley and with the Minnesota Construction Codes; that I underst�nd ttus is
not a permit but on�y aa a��icat�o:a ;Fo;c wark �s not to stea�t �w�tti�out a permit; th�t the workc ll be �► accardaace with the
approverT plan in the case of all work whic review and a�roval of �lams.
SIGN,ATU� 0� APP�.�CAN'!' PRINf N.4ME�1 _1' T� � 1�[AL�LI ) �DATE 1�{ �V 1� V
City of �'ridley
BuildYng Inspe�ctions I�epaxt�ar�e�t
6431 U�iversifiy Avenuc NE, Fz�ci�ey, MN 55432
763-572-�6Q4 k',A,X: 763-502�4977