AF - 45481�
�
City of Fridley, Minn. "
BUII.DING PERMIT N� 3 2 3 4
nate: ......1`. :. �.....-..:�.� ................
r!'
Owner....................................... Builder �:�.....................:::..:................
Address ...................................... Address .............................................
� , LO�CATIO�V OF BUILDING
/ y� w�°� /�.. �
,
No �l.'� ,� Street l:. � -. :` : ::............� �Par��of Lot � , . ° R .
.... . � , : -
Lot . . . . . . . . . `.�. . Block . . . .. . . . .�. . . . . . . . . Addition or Sub-Di\ on - ' . : �: . `. . .� n . .,'''�. . . . . . . . . . . - ^',
n' � — r ,
eyard �:_...... �
Corner Lot ............ Inside Lot ............ Setback .:.......... Sid ..:...............
DESCRIPTION O� BUILDING
5-
Tol� b�e Used as: �. ` . . �
/ � � � � -
�, � ... Front A Depth �: �.•... He3ght ... �:.. Sq. Ft. .�....�. Gti. Ft. �� P�,
. ............ . ........ . `' ..... ..
. . . . . . . . . . . . . . . . . . . . o Front . . . . . . . . Depth . . . . . �.�,; Height . . . . . . . . Sq. F't. . . . . . . . . ;G�. F`t. . . . . . . . .
��. � .- ,� . , '
Type of Construction ' : ` . . . . . . . . . . . . . �St. Cast. ` ` . . . To be Completed - . . . . . . . . .
,,;,,�.,./. . . . . . . . . . . . . . . . . . . . . .
,� ; � � . .-•T
i ,., i �,(�,-� �
� .��.. , _ v
.^
R�1q�' ;�.�' �
. " �
�/ !y ' ,F � �
f
^ , ,, r,� .., : �
, ` ` .�-�-�-
��
, �
` +.,s_
���.. T f � � F / S.! , �
�; . . ,...�_. _ _ . . �- �� -. _
�� ,
,_.. ,.. _ _,,,..
t - �. _�
f �
• In c�nsideration of L'he iss�uance to me of a permit to construct the building desribed above, I agre� to do
the proposed work in accordance witli the descrlption above set forth and in compHance with all provisions of
ordinances of the dty of Fridley.
...................................................
,� � � �
In consfderation of the payment of a fee of $.` : :. .. . -`"., Permit is hereby granted to i.A-. ' .. .: :. . .. . . :. : . . =' '�
....... .. ................ to construct the buflding or addition as described above. Tliis permit is granted upon
the express condition that the person to whom ft is granted and his agents, employees and worlmzen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location. construction, alteration, maintenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at any time upon violation of any of the pmvisions of sa3d
ordinances.
, ��. ...........��..:� . B�ing Inspector
NOTICE:
Thla permlt does not covar the construatian, Installa#lon or alteration fo� wiri� plumbing, gas heating,
sewer or watar. Be su�e to see the Bullding Inepector for sap�a�ate par�mits fo� theso items.
iNnusraia�
BUBINE88
CITY LOTB
TOPOQRAPNIC MAPPIN6
� U �--° -
B«c,� 3, �i���V,��r� �r'�'�c� rs Aoo i r`oN�
,
:... `_
r C. E. COULTER
LAND SURVEYOR
REC318TERED UNDER LAWS OF STATE OF MINNESOTA
LIGENBBD BY ORDINANC6 OP CITY OF MINNfiAPOLIo
3300 LYNDALE AVE..SO. MINNEAPOLIS 8. MINN.
TAYLOR 4-0370 _
SuR vE-y •�orl ,(�F�vs�vrv Coivsr•eucrioN
�u�rargac'� fdr�rlt#�+#�e
Se��E,'
tiA r,�r,��✓,� � �,��v�
_ --76 =- _
� ` i �
p � . 0
� � M \
--38=- �
/d;
.�
; � �i�o�vosed
l� tV ��si'o��nce
�
�
�
�
�
i
.i
�
�
� � � � �_ � l
� � D.ei�ay'e a° U/i%idfi Ease�nent � �
-- -_ --76=- ---
vum�o
F�eb suFevers
uKEeHOae
ruotcu�
/�=�d`
3
� �
I hereb� certi£y that the above is a true and correct plat of a survey of:
Lot Five (5 ), Block Three ( 3), PARKVIE�V HEIGHTS ADDITIOPd, Anoka County �
Minnesota.
As survey,ed by me this 6th day of August 1958 A. D.
Signed ,f� �� .-� �ar-��,����t�.,�
- - .
ppproved by Bui6d�ng
Inspector �.nnesota Registration IVo. 2584
a
�,. � - � .
� �� �
5288
n - � ,� y
�
��
�ity of Fridley, inn
BUIL.DING PERMIT
N°
5946
Date: ,1�—,_"'"' ,� .�.' ��.�!�,,,
� ,�}
Owner: — ���� � Builder _ ''� -� _•�^ �/�•�' �',
Adciress Address
,, ���CATION O ILDING
No. �' � �' street __._. � �.�,G-�'��I _�;�. p�,rt Lot
Lot —_,�.__ Block �� Ad '13on or Sub-Di on .��..�"� ��;�,�`—��� ,���='��`
�� �
Corner Lot � Inaide Lot � �aeEback �' "_' �_ Sfdeyard ��
Sewer IIeval3on — Foundation IIevation
DESCRIPTION OF BUILDING
To �e U as:
�
"�..�� Front ��� Depth �,�� Height � Sq. Ft �� Cu. Ft „L�� �
F�ont� Depth Hei� Sq. Ft Cu. F't
,�er t`.3 �
Type of Construction _...���� �' `'� .- Es� st�t�.,�_.. "'�'"".r.... To be Completed
In consideration oP the issuance to me of a permit to .consiruct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all prov�isiona of
ordinanc�s o4 the dty of Fridley.
�`
� ,�. �3�
In consideratioa of the payment of a Pee oE $ � , permit is hereby granted to
to construct the bufldiag or addition as desc�ibec� above. Thispe rmit is granted upon
the express condition that the person to whom it is granted and hfs agents, employees and worl�nen, ia all work
d�e in, around and upon said building, or any part thereof, shall conform in all respecta to the ordinances of
Fridley� Minnesota regard9ng location, construction, alteration, maintenance� repair and moving of buildiugs
within the city limits aad this permit may be revoked at any time upon violation oE any of the provisions of said
ordinancea /�, "., ,�'°��,�
�::'� BuildinBInspector
NOTIC�
'Ihis parmit does not eover the consfrueHon, instaqatioe for wiring, plumbiag, ga� 6eaHng, sewer or watea Be sure to ses
ths Buildle8 Inspector for ssparate permite for th� ttema �
/�'\ . a �`,
�, ;-� �- �':.
� -� ,: .. -
APP?�ICATa0it1 FOR BUTLDTNG PERPRIT
CiTY 0� FRT.DLEY, NL�I�lESOTA
• _ - +� _ � �.,.L...�.r.�..0 1 j . - �j ,�1., � �
� �, .
. . a - �i,. �:[!� '_a:L.z..�. � ,r/a�:�c�r_�' . . - /.�:.�� �[..- �.�..�c..:...:" �� �
r '
Loc�iTao� oF eva�n=N�
No. 3�treet Part c� Lot . �
� � "L-�L �n--�..i -�c t-J
Lot �. Block � Addition or Subcllvis�.on _"�� �'
Corner �ot �r�side Lot � Setback_�, Side-Yard
SEWEgi ELEVATION ' �'OULVDATaON ELEVATYOiV
Applicant attach to thie form Ce�tiiSCSte Of �urvey o� Lot anal
�raposea building location.
i o Ioe used as o �
�/Q x�t.�.�-`z
DE�CRZPTYOI�i OF SUILVII�(G
�
I
Sc�. Ft. � � � Cu. Ft. •
� r ��.���..
�'sont____�� e��h �, �3eight
�q . I�t e Cu e Ft .
lype o�E Construction_„��.,��� _ ,_ Estimated Cos•�
�o be Compl
1
The uriclersigned here�y makes appl�.cation for a p�rmit for the work
h�cein epecified, agroe�.ng to c�o all work in strict accordance with
�h� City of Fr�tdloy O�cdinances and ruling o¢ the Depar�nent o� eu31d-
�.ngs, and hereby declaree that all the fac�s and .repre+�en�altiona
stated in this ap�l�.cation are true and coicrect. �
Dt'�TE � `?� SIGNATtR3E X°��P�L,�,-����. p�. �"=--
(Schedule of �'ee Cost� cas� be �ound on tlle R�verse Side) .
�``, �1
����
_ . .� � -
`:1
�
�UYLD�LVG PERMiT I'EEE �S�IEDULE
Sec�ion 2. The Inspector o� Buildin�s shall, before issuing any
per3ni� �or the erec•�ion o� any build3ng or structure, or for any
add3�ion to any exis�ing �uil�ing or s'r.�uc�wce, or for any altera�tions
or �epa�.rs to any �xis��.ng bu3.ld3ng or si:ruc�u�e, upon application
�h��exor. require iche pay�tent by the a�plicant �or suclz per�ait of
fees to the amount herein belaw set gorth and �Ln the manner herein
pgov�.ded to w3to
2.3,. For any such po�an3.t �Eor the erection of any �Ei.re-proq:� building,
o�cher than a garage, waTCOhouse, iacto�cy or grain elevator, or �or the
erec�ion of any ��i�e-p�oo� aadition, �or similar occupancy, to any
exiaic�ng building shall be at the rate o� $1.40 for each on� thousand
cubic �eet, or �raction thereo�, ia such ctabical conten�s.
2.2 . For any such permi�t �or the erection of a�ny f3.re-proo c garage,
wascehouse, gacfio�cy o�c gra�.n elevator, or �or the erection,, or � any fire-
proo� addition, ior si�ni.la�c occupancy, ��to any existing build3ng sha11
be at the ra�e of $1.25 �or each one thousand cu'�ic �eet, classi�ieci
as "Zireproo�° �y Section 502 of the Minneapolis Building Code.
FiOUSE�
2.3. For any such permit for the e�ec�ion of any non-fi�ceproofc build-
ing other than a ga�ac�e, warehou�e, �ac�ory or grain elevator, or any
non-r"ixeproor additjon, for similar occupancy, to any ex3.s�ting building�
Perm3t $1.00 �or �ach ono thousand cubic feet.
Gt'�iRAGES
___..�_
�.a. For any such �ermi� for �he erection or any non-fireproo�
garage, waxehouse, racto�y or gra3n �].eva�tor, or for the erection �of
any non-�ireproof addi�ion, for s�l.inilar occupancy, to any existing
build3.ng or �or each such buildin� o�c adrlitione 1Vinc3ty Cen�s for each
one t�housand cubic �ee� or fraction ichereo�, in the cubical contents
�thereof wi�,h a min�anum o� $4,00.
�or fihe purpose o� co�q,ou�ing fees for building pegmits the cubical con-
ten�s o� any buil�ing or addition �o a uniform height throughou� by
multiplying the ground area covered frora a po3nt six (6) inches below
the floor line`° o� �tYie basement or cella:r to t2ze average heighfi of the
uppe� aur�ace or �co 'che average heigh� of the roof suriace of the �►airi
ga:ble of a pitched rooy.
2.5. For repairs o� alterations to an existing atructure, the ree
shall be at �he rate of $3.00 per each Five Hunclred Dollars ($500.00)
o�c :�action �hereoi in ihe cos� o� all proposed work.
2� in no case shall �he fee charged for any permit as e�t �Eortla in
Section 2 �e less t�i $4.00. ,�
_� �
� � .� �
N
��
� F`
, � ��
`�� �
;�
r y �
� x�
�
� � �
Oy`
W � � �
� � � �
� �' � p
�
w�
�
�
H �
� °
�
r'
��
�
6� �6� O � � 4�
��� ��� ���� ��b� s
ro � � � � N � � � ' � � �
� o � a c� co � � � c� � � � ro
�� ^ d � N o � � y R° R° �° � � � R° R° � � �
'C� C � �' o o G � � � � � � � �
� � 5� � �' � a � �° �' � � � R' R� � � w �" R°
�° wp o � � � s� 6 6 � ° a� � o ° � �
� �o � � � � �a� � � ��
o��Q �,'� ����� ���o� �ro��
�i � � � � � o � o o m� �' : � �' a. � : �
: � � . � � ;c � Fa' c�i� : � " g' o ' :
. . ,� o . � t� o :
; ' � : � . � � � o : : � � � ' :
. . � � $ . . � � . . .
. . v,: : : � o. . . t� �. . .
: : �: ' � ° � � � � : � � : : :
: : � : : : � � : : : : ' : : : :
: : ' : : � : : : : . : : : : '
���, �, ���� ����� N����
2n o c o cn en c c en o c c c ea c o c`�
0 0 0 0 0 0 0 o c o 0 0 0 0 0 0 0
� � O
,� � �
r �y �d pd ° b
� � a � �.
. �� � � � �
� •'� � � �
� "� ° � �
� � �'
� z m
� �
�
�n
�X
� �
�,• �
�
�'
.�'• ���
�::
:�� �`,
,a � �Q
� ��, � �
b � b
'� � � �d
` �
a� �
Q� �
s►;t� �
� `; �
j `��� �
��.
� �
�
� �
=� �. � �
��,y`� � y �
�n , �
�bd ��. V� ►� bd �
�Q o � G o �
_ � � z
�� �� � ��
rv?.
_ � ��
� ' ����"a
� � �� c��
` , '� b
�
�
O
�.
�
e z
� � �
� �
�
� f
7i
'��l %1
o �
�
0
�
�
�
�
�.
� � �
� ° ,
r
�
�
r+
m
I
�
�
r
�
�
�'. a� �
� �� �W
���� �
�' �q� `�° �
�
° ����
� d�
��"bo`�'
����
O
�
�' � ��
�°O�.
�!
b ��'� �
�- y �Ci
� � �
py��
w
��iaop
�ao
�� �.�
���
���
�a���
����y
�m��
��o
� �
�
N��y
�' � �'
� `
� � �� _
�
D
�
r
�
m
N
_
m
C
r
m
v
w
M
�
`�
g
m
b
a
�
0
'O
'��
�•
�
�
�
�
��
n�
�'�
�._
�.
��� ;
��a
�'
��
��
o. =o
A �
e� �ii
��
�
�o
�
`�
�.
�
i�.
�
e
�.
0
p
� '
� .
� �
�
N
0
N
� ��
� oa
c� a� � pz � m z� x x
� � � � �c� " � � � � �
00 �
�
� ����� � �� ��
����°���:o ��
��
CD � • � � 'tl R' � m �i
S : : � a � : � �_ : �
�y ' ' G1 � : �' � '
"' . . On � . . .
' : ' : Gd : : : :
. . . . � . . . .
Q �
�a ae aa " aa k x k x �e
� � � N W W W h�+ N N �
g n�i � � � �6�i � � � o °o „y�
, +
� � � �� � �n � � � � � �
a �
� �
�1
�
)
�
O
�
x
D
�
r
�
m
�^
`I
_
m
C
r
m
O
�
8
�
�
�
�
! z
0
z
Z
�
'�
O
r m
��
� o
n •
�
1 �
�
�
....'
: ���1
: : �NI
� : ■■■.,
�• r. ■�F7,
� ■��1
���i:l��
� �
$ �
��
�A � y �
� a. a
� � � O 1-�!
a � bd
'� �
o ; a
M ¢ ►� �' �
� �
g w �
N h m �
o " � � �
o� � �
I
WATER
�
�a��
enrH
�
BAS�NS
SINKS
was►+
rRnvs
DRINK.
FOUNT.
sHwas.
FLOOR
DRAINS
GTCti
BAStNS
AUTO
v/�s►�En
cns
APPL
GAS
RANGE
GAS
OPENINGS
� �
z •
�
� �
A
m
n p
M i.� � �
c.a�D
� �'�d � cD H'
., a �
p O � p. �
�'�� y �C
����
� ,tl �'
��O Lj
�
����
�.
�`'� �
�o
�
b��b
�
b
m �
o- ��
p � o
�ti ¢' o p
� �
�'�,o
���w
�
°'� ��.
� � � y
� � �
A�
�yOy
DG�
A � ?
ro �
�
3 � w
C
�
� �
�A
� ro
a�
d �
& �°n
p �
M �
hI Dd
�
m
�
�
�
�
�D
�
,�a
�;
�i
�
�
��
� �
� u'�7
� �
1
•
M � �
V �/
� � \
».
� �
� �i
x �
0
o A
� �
�
City of Fridley, in�n
6431 University Ave. N.E., Minneapolis, Minn. 55432
BUILDING PERMIT
.��: August 31, 1972
�� Norman L. Abel B�d� Same
��� , 1050 Hathaway Lane ,�d�� Same
��� �� �
1.63 � �
LOCATIOfV OF BUILDIN.G
No 105 0 g�t Hathaway Lane _ _ part of Lot
%0� �= Biack 3 Addition or Sub-Division Parkvi ew Hei g ts
Coruex Lot Inside Lot X Setback Sideyard .—
8ewer IIevaf3csn Foundal3on IIevation
DESCRIPYION AF BUILDING
To be vsed as:
B as emeat Remode�i��� �P� Height
Front
Depth Height
Sq. Ft
Sq, k't.
C;u. Ft
Cu. Fi.
Type oE Constructioa �ood frame �, �.,� 5Q.QQ To be Compieted — 8-�? -7�
. —
In con�tderation of the issuance to me oE a permit to construct 'the building described above, I agree tq do
� proposed work in accordance with the descr�ption above set forth and ffi compliance with all provisions oE
�ances of the dty of Fridley. /,���� �� � ��
��6
— :�A S�a�e S��e���ge
In considerat3on of the payment of a fee of $ 5. 00 ���.� � hereby granted to Normah L. Abel
to construct the building or addition as described above. This permit is granted upon,
the e�press condition 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 respecta •to the ordinances o1
I�`ridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildiIIgB
��� city limits and this permit ma.y be revoked a t any time upoa viola.taon of any of the provisions of saici
Buildfng Inspector
NCE BEL�SLE
NOTICE:
This permif does aot wver the eonatrveHon, instaqafion fo� wirmg, plumbtng, ges heafing, sewar or water. Be mn fo tas
ths Building Inspector fo� aeparate permhs for these items.
.�
-s
. �
�P.P�ICATIO� �OR RESIDENTIAL, A�TEItATION,
OR AllllITION BUILD�NG p��JIT
CITY QF FRIALEY, MINN�SOTA
OWl'�EIi � S �JAME t � � G' r� � � �� �, , L� � � a BUILDER : � �� v' r�-� � �,, � , � � �'� ��
�
,' �
ADD1tES S 3 „�,�%� �`� � ���� ; - � � , , ,; } � i` ; , , , � ADD�tES S : ,�° � - =� � .�� � �� � �a � ;� � ,� ,�- � ;�
1�0 :;,�� �� �ei` a�' STREET • �,�� �°l � �t_ > � �6 � '� G� �. .^ ,�-
�✓' ' �
�,01'; � BLOCK: � ADDITZONi/ � /r �✓� v a �-° �'� ��,�, �',��' �;� 7�
CORNER LOT : INS IDE LOT :�_SETBACR: SIDEXA1tA q�,,,�„�
�pplicaat attach to thia form ltao Certificates of Survey of Lot and pxop��e,d
building location drawn aa these Certificates.
HESCRIPTION OF BUILDING
0
,
� �
�o �e Used As : � °� �°� �, � r� .� � �t ,� _ �� � -
�
�- -r -
Front• Depth• Seight:
Square Feet; Cubic Feet:
' Front: Depth:
Height ;
Square Feet; Cubic Feet:
� ' � .�.�� �
� - --- ,� F .�_ �'
pe qf Construction: �/,�' ��_„� �,� Estimeted Coet: $ �" `-a °°�'
������
�a ae Completed: ,� �� � ��
The undereigaed herebq malces applicativn for a pes�nit for tt�e .wc��ck '����
spec�f�,ed, agreeing to do all work in attict accordance with the C��r q�
F�cidley► Osdinaaces and suliage of the Department of Buildiags, and �e�ebT
d��1��es that all the facte aad represeatations stated in this ap���,��t��,�
a�e tsue and correct.
� �� �� � � .
�� : � 3 � -- / �' �.�=-sicpn� : �' n�� ._ _ — � �. _ �,-
;�� .2 �!� s;�. _f/
f " �w� if�AlR��l�lp
(�e� Rever�e Side For Additioaal Infos�nation.)
�
,
, �j -- ,
_. ..v.r��----=`.�,..m+..�--__ .
���> �� '
�
'-
i
�.
%
A
�UILD�NG PERMIT FEE SCHEDULE
aECTION 2. The Tnspector of Buildings shall, before issuing pexm3.t� fox the
exection of aay building or structure, or for any additioa �o any existi.n�$
building or structure, or for any alteration or repairs to any ex�stiag
bu3,lding or structure, upon application therefore, require the paymet�� by �h�
appliaant for such pesmit of fees to the amount herein below set forth aud �.�a
the maaner herein prwided to-wit:
UNIFORM BUILDING CODE: Type 1, 2� 4-$2.15 for each one thousaad cubi,c
feet� ox fraction thereof, in auch cubical contents. 1j►pe 3� 5-��.�5 fQr
each aue thousand cubic feet.
ADDITIONAL INFORMATION
For the purpoae of computing fees for building permits, the cubical contents
of any buildiug or addition, ie determined by �ltiplying the ground area
covered from a point �ix (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 mnin gable of a pitched roof.
�'or repairs or alteratione to an exieting structure, the fee shall be at the
rate of $3.00 per e�ch five hundred dollars ($500.00) or fraction thereof ia
the cost of all proposed work.
�u ao case ahall the fee charged for a:►y permit ae set forth in Sec�ipt� � b�
less than $5.00.
VBRIFICATION OF FOUNDATION
NOT�; Permits for eonstruction will be iaeued a mini�um of 24 houxs fxotp th�i
time of application, to allow for proper review of the propoaed �tructu�ce aud
o�' the conatructioa eite.
A Ce�tified Survey o� the lot, ehawing the location of the foundat�p�� q��� �,C
ba� been canst:vcted, will be required befo�e proceediarx with the f�tea�ug�
CERTIFICATE OF OCCUPANCY
Application for a Certificate.of Occupaacy ahall be made ten (10) days piCl.��
tA the use or occupancy of aay structure for which a building permit has ��sA
iseued; and said etructure ehall not be used or occup�ed until a Certifi6at�
oi Occupancy has beea iseued.
�
� -
. �
'- � y
`J y
�M
:� �
� H
Jz°
�
0
.Ayi �
t! �
� �
��
m
��n w�� � �
" �n v� • r N t�� i�; .. ,,, ., f r
(�� r• � r ro a w� rt; c� ' �
.7 N � y N � •(� f�l � fD N f�l �: � if �
�' �� � � N �' i � �{ �s �� �t a' M �i � r-�
p, !n f O � U� � �. � Gi
[L O � � .1 � H p � 1 . ,.�
� �'• n�� n. n �:�• � c r.�
� b',�� " � �°M � ��n �
o� M �' �� N M ►�t �►fDi j � b iu m "'�
o Y `� M V� N � n o a Kt N �7y
M �"'� c�i � � bf r m �� �• Y A
M Vf �y W O O �� � M �
fWI C y �""�
n• � �y � r
C �
m
N
S
z ec
I •° m
N V�i
00
O O
N V! N N
�
°oo
�
�
�
O
�
�
�.
�
��j
H
H�
N
N
v
N
0
tb+
�
N
N
O
H
�
tv
c
�
�
�a x x x x x x x x ac x x
N N
Y N N N VI Vi F-� N tA N tn 4l �
O F� W Vt VI J O U1 N N �J W
0 0 0 0 0 0 0 0 0 0 0 o H
O O O O O O O O O O O O �
N t/� N N N N N N N�A N N
H
0
. a
r
�
C
k+
�
�
H
v
� �.
� �
z
ro ro
`
�
� � a
� �
G��
1
�
H m �
O � '�G
. m
r. w �, r� + Stor. io3
r� �� � �
� ;� � w w �� �
9 0 S r�;
h C1oGOte
ID �
ti` Urinals
�• �
� o Ratl� Tub$
�
� Ba�ina
� �r
a � � sinks
�m w Wasli Trays
� �. � � Drinkinq
,q P•oun L-ai n s
� ' Showers
�
� Floor Dra3
� Catch
� � Basins
� Autcmatic
p' ��asher
W
� Ga3 Appl.
Misc. Fixt
E m � � Gas Range
m �
tr E
�° K Other
m Ww
� �n
�
� � � � d �
1 $ p] � � SO
� �� A
d M C
H
�
� �
� y o � �
� o m
tbN H N
H � • �
O
O O (D
O �,
N
N
1
W
F"�
�
�
H
H
O .
�
o w� f' K� b'
ro w � � � ro �
� � ►"'..a NM� a
�`� aa ►�'-��� m�
� �'�a m aao m
0+o rt w u�r ro
o�fDm ���
n o w p' � 1�-�
� N� � M O
�%a� � O
G H O '< �+
��
m � ~ X �j
� ��y m O O
�. u �" x ;�
� �' Fw+ � t�`i W
r W m W �
7 j H � �
� rt � t� O
�v,na
m � `� ro
p y Q M
roQ'oa
r :r �t
►» m c1 'n
F � � �
µ� � H
y � � �
M r � M
� w � �
. A���
r a � r M
�c an�x
I � b� �µ .
8 �n.nry
� y A
n
rn
w
1
�
�
�
�
O
N
n
v
�o
r
n
D
�
O
`G
'�1
O
�D
�
E �'
t �r�
� o
. �
T
Z
C9 �
� ►-r
- D C�
cn r
m
T -G
�
2
c�
-v
m
�
� 7
� vi
,. M
(
i �
_�
�
0
H y
H �
� �
� �
w
�
m
�' � �,
n
� h� � � I?l. N tn 1 % r -• ry �+ n 1 ["
) �
C
� N � v+ `� r► �„ n E ► i n i �r (i •
rr ,t1 �1 r► w ►-� rt ��S �j �, m � ��� �` (J �
RI tn � 't p►A ;,� H• O m u•�s W�� � P %
a° �'" � a x �'' � � ° o w ai rr h� �n �
N• u �, b rn�j � c � t�. ; o � � �t �: r'+ ►h7-�
o �-. [,
O �. � 1-+ it .N M � ,� � b� ' �< ry H
O N �o
o° y o� � a�r n o a� N �ri
n o � `° � � � D �� �, �° a
a � � � o o �� `4 r�n �
(/� ►�-�
y � Oyd C �
O �
m
N
Sm
y c
I •° m
x x x x x x x x x� x x
N N f-! H N fA i/1 {A N N N N N N �
tv u� o r w u, tn .� o tn tn n� r� w
0 0 0 0 0 0 0 0 0 0 0 0 0 o y
O O O O O O O O p O O O O O [rJ
N :A N N
� o
0
0
�
�
�
O
�
�
�
�
�
�
�
V
N
O
r
N
N
N
0
H
�
ro
�
M
N iQ N
ro
�y
t'�
'A
�
H
' V
N N N N N N Vl N fA
� O
. a
r
H i� •
� �
H M
2
roro
� d
� � n
� � �
�
�
0
r• �' �� �' stoeion
� xt �� ii a i �
9 d �W.i Ei+�.
„ Clo�i�ta
m c� - —
� t Urinals
r• �
nj O I�d t�l 'li,ll)S
W
� IIa a in:,
o .. —
a � Sink�
� � Wasi� Trays
'"' y Fi Drinkinq
w a
.q FounL•ains
WShowcrs
� Floor Drai
�
�y � Catch
�D 'L1 Basins
n
ap� Automatic
� 4Jasher
E �
�" Gas np��l.
x
� Misc. FiXt
� y ' Gas Range
K E
�° K Other
a x�
� N K
� � �
�
�����
�H � N '�0
t+f
� tl(Q'� � H(�
H�+ N � C7
t� y G Z
�
� o
M �
H U1 f] � fA l�
m w o .
� �' ►� � ° �
• � p
I i O ;
I� � a?
_' ` �
. �.
K
' " � o
�
�
�
'�
�
r
n
o w� � ~� ro �
s�,'�rro� �eo � �
q W C 1,i M
�c y A, w !J-� �i a iD
a ma rKn ao.o W
M � !�D � � `�C �
ro�'S'a �
o ° `° �' a I-'
�eg� w o
��a� w o
uno'<
��~x u�
C� K �
a� �Nt O O m �y
W u M T � �
�°'-. o � w r 'j�
� °'r� n �4
r w m m
o �• i w t�
� tt U 1� O Pl
r W f� a �
W {b M
C 7 n M
�p'oa.
r ;t ►t
w�tiro
�n�iw �o
1 y �o y �
j� p � � �
� 7 � E M
p n rf O .
D NN�'M
K N 1�p fi
� � h n �
w � r � x'
I � r o � .
„,+� �
R �
n
O�
W
1
�
�
pF-��
v
N
a
v
-v
r
f�
a
�
O
L
'�t
O
�
`O
F �'
� �W
c� o
l T
G
d �
G� '--+
y d
� �
m
T -G
�
�
2
�
"�
�
�
,. , r: . . . _ _
..... . ... , :. .. .
.
,, . ,; ....
_ ... . .. ,.
�
� D
� �
O
� n.
� O
� �
�. �
o �
3 �
a �
o m
3 �
tfl cmi
� fl.
a �
� �
� y
��
�
� Q
�
z
0
�
��
s�
O
��
� �
rnn
� ��
+ v i� (/i
� � �
�m
�
� m�
x �
�' n
�
� �
�
� �
� O
`� Z
�, O
� z
�
�
m
Z
�
-o
m
�
O
z
m
m
�
N
3
1
�
°<_
N
�
3
m
a
�
�
v
�.
�
Z
0
�
c�
�
�
2
�
z
�
cs
�
�z
�
�
�
0
�
m
m
�
i
�
�
C
A
s
m
cQ
�
� W
�
�
Q.
m
�
s�
.�m
2
�
�
�
z
0
rn�
v
�
r n
(V �
o �
°, c�
� �
�
� a
°, c
� ��
�
A
�
O
�
�
� �
� O
0
o. �
< �D
c 7�
m$
o �,
�N
�
� D
e m
� m
O "�
� '
tn
o �
� �
�
z
n
n
3
t� r�►
�� 1 �
mo
� �,
m �
� �.
c� �
�
c
�
w.
_
o � n
� �
m
n �
7 �
m
m �
� y �
o � 3
� v o '°
�- _
o.
�
m
m
�
�
3
D
�
n
0
�
�
�
0
�
�
�
I
�
m
N
�
�
�
v
m
�
�
01
�
�
�
�
�
�
� y C y
�' 0 7 a;
� ^ � � �D
�• � � � �;
� � � s w
Z � m �
� r. � �
Q I � Q
a-_"•� v
c
�0��
3 � �
m ao � o
� n �
c � m
o �
� �
�
� � � � �
c"'i� o 0 0 0 �
� � � o � �
� �
� �
�S
m
-��i
�
�
m
v
�
�
G
G
��
�
"0
rn
z
�
z
O
�
�
I
ao
6
�
�
c
�
m
0
�
`
�
� �
O
�
o m2�-�
� s
�s
� ��mQ
� o, s �
� ����
p ? W � 'm
�,_�a
� �' a � 3
c.m ° �
� � �o�
� �� �=3
�
� � o u
� � � �
�n �' �
� 3 �
� �
� S w �
� � '� A. 7
m O O
c n Q �
,� m �, �, �
Al` m A �
� �, �
�,��e���
o � `��, ��.,
o s
\� � r« fl
� ����
� m c�
�� o
� o '�
1 �' a m
� Q. � m
� �
�
Q
�
�
�
n
2
rn
0
�
v
v
a
m
�
�
�"i
�
�
�.
�
�
���
�
� � rn n
V �. ,A
N Q W �
Qwi�j Q
'<' T
Z � �
cn �• �
�� �
N �
. Z Z
rnN
�
m
�
�
Z
v
<
m�
��
m�
�
-� O
O�
Z �
��
��
��
v�
��
�y
z�
�
�v
_
��
��
�o
�O
m�
��
m
Z
�
�
Z
�
z
m
O
7
v
_
m
c
w
j
�
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes () No ()
2. Is free from rust or deterioration
3. Has no foreign objects lodged within
4. Is securely supported �� .
5- 1Vleets all cuirent Code requirements for size
and total BTLT's connected
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liaer t�n provided for water heater
8• Has combustion air been providai for water heater
Remarks:
List ALTERATIONS Beiq� Done•
HEATING CO:
Signed By:
Date:
Yes()No()
Yes ( ) No ( )
Yes (. ) No ( )
Yes ( ) No ( )
Yes()No()
Yes()No()
C�`
�
�
�
'�
Z
D
�
�
_
D
r
r
�
m
�
z
O
0
m
0
�
m
�
C
�
C�
�
m
�
0
z
�
g
D
D
2
O
�
D
�o
r
m
o�
D
O
�
�
m
m
�
°:
�
�
c
�
d
�
�
�
w
_ o
�
D �
J � �
�
� O �"
� �
�' m
d � �
C T
0 2 c�
C � �
.`° m �
$ D �
�N
� �
Rv
�
�
2
�
$ D N
K �
� # O
I� �
m �
o n � itr
� �{ � �
� �
N
Z C �
�
� r �. - I
m2'� A 3 v
-.I • � �
O .. , rn ,.:
1• � .
2 { 1, � . '
� �,',�� � .. ,�
� .:,;.,� a.� ':;.�- - �
m N �
-� �.� � d d d 3 j��� � �
� � � � _ _ -�� � � T
��`� �� � -,��.��� �
t � � � r ;. '.� �
1
.� �,��y�� '�eZg
�, 01 �7 -a � i
� � � � ' �
� �
� �
� A
..
�°
z
�
tn
..►
�
S
I I I I( i I I I
��� t�+ .�.► �r► tn t� � i�► vi v+
O O O v O V V V V �Jf A�I
�8�g$��$�S$g
C y
Z �
� �
8 �
�
�
�
�
� �
� �
a
C
�
. u;? o.,:. . . f . .r , �
.: . ::u. o. :. �- . !�J'
° �:r-.'. '!' � :, �'*:
f:: �::►%•._ r, s.. ... �
,.-
�� ���� .a:a�t ��'��-� �, ' `
�� M}- . ..�����r:�.��,�f� ����;::�.�.�►�..
_. :.�' _ _.: ?... ._ _ �' � :�.�.. ::':�.
� �} o �Q�� �uu��.r �-. . �. .
-�4 T. i i-,� "'i p �^+
Sry� �.%ri.'� . . .. . �. ...�1 . .
�i�'�, 1 ..s':+q , �4° �'�? J .— ..
�
�
�
I�
�.
m
a
�
N �
�
�
N
�
��
N
�
�
�
,0�1 .
A
�
�.
��p
A�
N �
' � ?
m
c
' � a
�1 �
.��.
� �
I �'
! O fR
� o�g
! � d
, � N
� �
��,, v
;�'�
� �
� O
N
� �
��
� �
� �
�
�
'D
r
c
�
z
�i%
�
�
C
�
m
�
�
z
O
�
�
O
a
r
L
�
O
v
�
m
N
N
�
D
�
�
Z
�
�
m
�
�
�
�
�
n
n
�
�
�
n
z
n
�
D
1
7
�
�
n
D
�
C
n
�
)
�
W � .J J
���c
N 'S
W Z fJ _
O L� N ti
� � ,� C
c^' D "
v < ..
Z L
,,, _
�
�
� r
�
W �
�; a
�c
ti
THE BELOW MUST BE FILLED IN VVHEN REpLqCINO FUEL BURNING APPLIANCES OR THE
APPLICATION VVILL BE RETIJRNEp � ; -;- _- �
- - :,
CnMMC�N VPIUT� VFI��T [`AI�I`F[`TAR el�� (`Ati'RI ISTIAI� OIR <�RIFI � d►TIAR r.
�Nhen � ia _��� a.,�a R��� �e �dersigned hereby verifles that the
venting has been examined and is free from rust, deteriora�on, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plas�GPVC and meets all current codes and manufacturer
specfications including sizing, length, number of elbows and terminatlon. Yes () No ()
The undersigned aiso verifies that the replacement unit is a Ilsted assembly
and meets the cuRent codes and manufacturers specificadons. This does
include AGA-GAMA Category I Central Fumace VenUng Tables for fan
assisted and natural draft applfances. �
The pYictin9_romhuctien �tr is sized and installed to meet the current codes
and manufacturers specificadons.
Wher1 �equi�2d t0 inctall a npw �emhustien air�,i� will be sized and installed
to meet the current codes and manufacturers specifica�ons.
�Nhen inctallinA a npw vpntinfl�c pm, �e undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances.
�s the common vent and vent connedors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes.
Yes ( ) No ( )
Yes( ) No( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes( )No( )
�.. .. .- .�. - .����.� -� .�. -� ...-.,. . ..��. .�
Appliance #1 Type BTU Inp�t Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Asslsted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type
Vent Height Diameter inches
.
Appliance #1 Vent Connector Helght ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Helght ft Length ft Diameter in Type
� : � •► .- ..-
HEATING CO:
Signed By: Date :
r;
ADDRESS .
PIN .
LEGAL DESC .
PERNIIT TYPE .
PROPERTY TYPE .
CONSTRUCTION TYPE .
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
57"1-36U4 1+'AX:
1050 HATHAWAY LN NE
243024310041
PARKVIEW HGHTS ADD
LOT 5 BLOCK 3
PLUMBING
RESIDENTIAL
ADDITION/ALTERATION
5%1-1"Lif %
PERMIT N • 2004-01035 e
i__ �
DATE ISSUED: 07/02/2004
VALUATION : $ 500.00
NOTE: COMBUSTION AIlZ SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER
HEATER.
# ELEC WATER HEATERS 0 # NEW FIXTURES (EXIST OPENINGS) 0
# GAS WATER HEATERS
# GAS RANGES
VALUE (FOR MIlVIMUM CALC)
APPLICANT
NORTHWOODS MECHANICAL
BOX 1085
FOREST LAKE, MN 55025-
(651)257-4951
OWNER
ABEL NORMAN L& ALICE M
1050 HATHAWAY LN NE
FRIDLEY,IVIN 55432
1 # GAS DRYERS
0 # OF NEW FIXTURES
500 # WATER TRMT APPLIANCES
AGREEMENT AND SWORN STATEMENT
This permit becornes null and void if work or construcrion
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
applicarion and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
�Tu ati�c�nstruction or the performance of constr�cti4n.
Bldg
Date
SEPARATE PERMITS
PLBG PERMIT MII�TIMUIVI FEE
PLBG FIXTURES (NEW OPENINGS)
PLBG FIXTURES (EXIST OPEI�TINGS)
WATER TREATMENT APPLIANCE
WATER HEATER - ELEC
WATER HEATER - GAS
GAS RANGE FEE
GAS DRYER FEE
STATE SURCHARGE, PLBG FLAT
TOTAL
PAID WITH CHECK # 6208
FOR WORK OTI�R THAN DESCRIBED ABOVE.
0
0
0
0.00
0.00
0.00
0.00
0.00
35.00
0.00
0.00
0.50
35.50
�
/
,
0
N
a
0
�
�
oa
'a
O
�
m
�
�
�
m
�
0
�
O
n
�
-a
�
0
m
�
�
- � --
0
c
�
�
v
�
m
�
�
v
v
°�'
m
�
�
� �
� �
CD �p
�
3 �
'+ �
m �
N N
� �
O
N
i�
N
0
0
O
c
�
�
�
O�
� °o
m �
m
3 N
�. UN7
C °
� °,
� d
� c
�D
� '�"�
o -o
oa
0 oi
o �
� o
� o
oi �
\ r
a �
� �
e=i' oWi
� �
� v
rt
r+
c
�,;
0
�
�
� � N �
.� = o _
O � -�i+ �
� �< m
� 1
m � � m
�' N O �
3 � D N
� U�1 � O
m � ni D
� o � �
.�
oNa � � o
� �
rt Q; o m
m � � r-
O rt �-
� °� o
�o �
�
o � �
� ° �-
� �
�
� o
�
� "
�f
�i
C31
0
0
0
Q _
� � � �
�
to °
0
�
�
�
N
�
O
L
�
x
�
Z
�
a a m m
-, � �? c
v � m Q
� � a �
�N�N
� O � 0=R
, v,sm m
� � a
tN17 C O N
� �QO�
� Q� � �
. v - �
7 C � �
� � . O
� � N. �
� � � � �
v, _
� � � �
•Q �
rt � � o
� � �
3 �- o 0
Q
����
� � � �
����
� �' � �
�
� �- �- '+ °
o °* m �
� � n �
'� o
rt � o �
� p. 3
N y (D
�
c �
�
m
�
v
Q.
N
z
v
�
�
s
�
v�
�
� o
D v
� �
o ,Z
�
a �
0
�
�
0+4
D
v_�
�
� ?� G)
N � �
� � _O
� � a
fD �
m � oa
y Z
m �
� �
�'I
C
�
�
m
_n
N
$
�
n
m
�
m
�
� � �
O -' �
� N
� � a
a � �
� s =�
� � n�
N �
7
� Q
� v
� c
� �
mo� �
0
�
m
c
�
m
�
� � ��� �
_w o- o.c�i� o- �
°o °o °o °o °o °o
� � ��� �
c�
lo
�W��
m cQ�,
rn =
z�
�� �
��
c
�
�
o � cu
c = o
o �° �D
�
� �
m �,.
� �
� �
Q �
0
� _
Q o
o � �
� � �
o '
n�
-t
�
D
�
�
-�
�
�
m
v
O
�
O
�lo
0
-�
m
�
�
�
Z
0
�
a
�
oa
�
N
Q
r�r
�
C)
2
m
v
c
m
I�
m
4
-�
�.
�
`o
W
D
v
v
�
�
�
�
W
U7
�
N
w
rn
.°p
X
�
�
�
�
N
N
Oo
�
� � n
O. �� �
c �
7
Z � TI
c� u�. il
� � �
N � �
z �m
�
C
i
Z
�
�
'�
m
�
O
Z
� �
m 'v
� r
� a
m ,�
� z
°z o
z�
�
v o
D '�c'
� m
�
C� -�
v z
-� �
O D
Z Z
�v
_
� �
,:.; z
� �
n
Z O
v r'
v z
� <
rn r"
� Z
-_I
�
Z
�
C�
v1
m C
m �
� w
< �
m �
�
�
N
O
O
�P
_�-g���
�
:�(8 pauBis
�j�� �O� JNIlH3H
. aqu�saa :SNOLLH2J31�d
ad�l ui �a�aweiQ }� y�6ua� � �yBiaH �o��auuo� �uan £# a�ueyddy
ad�(1 w �a�aweia �� y�6ua� � �y6iaH �o;�auuo� �uan Z# a�uei�ddy
ad�(1 ui �a�aweiQ � y�6ua� }� �y6iaH �o}�auuo� �uan �# a�uei�ddy
say�w � �a�aweia � }y6iaH �uan � _ adrSl �uan uowwo�
�ndul n�8 I��1 sa�uei�ddy le�ol
�eN �o pa�sissy ue,� ;ndul f118 ad�1 E# �uei�ddy
�eN .to pa�sissy ue� �ndu� �l9 ad�l Z# �uei�ddy
c.�Q ,,� rr9 -,�v� ^�a,�' }eN �o a�sissy ue p� �c-� �ndul f118 a. ��,/�ln ad�(1 6# a�uei�ddy
( � oN
uoi�euuo�u� �o;�auuo� �uan pue �uan uowwo��azig pue a 1 a�uei� d
� sa� •sapo� �ua�n� �ad se �(�a�e�edas
pa�uan pue �uan uowwo� ay� wo�� panowa� uaaq sey a�uegdde ue
�a}}e �(���a��o� pa��e�sui pue pazis s�o��auuo� �uan pue �uan uowwo� ay� s�
() oN ,� sa,� •sa�uei�dde �e�p �e�n�eu pue pa�sisse ue� �o} sa�qel 6w;uan
a�eum� �e��ua� � tio6a�e� yWy�-y�y apn��ui saop siyl •suoi�e���ads
s,�a�n��e�nuew pue sapo� �ua��n� ay� s}aaw pue �t�qwasse pa;si� e si �i
�ey� sa�u.an �(qa�ay pau6is�apun ay� 'wa�s s ui�uan a►au e ui���su� uayM
( ) oN � sa,�
( ) oN � sa�
( ) oN
( ) oN
,•suoqe�i�i�ads s,�a�n��e�nuew pue sapo�;ua��n� ay�;aaw o�
pa����sui pue pazis aq ��w► �i aie uoi�snqwo� nnau e ��e�sui o� pa�mba� uayM
•suoi�e��i�ads s,�a�n��e�nuew pue
sapo� �ua��n� ay� �aaw o� pa��e�sui pu� pazis si aie uoi;snqwo� ui;s�xa a�,
�j sa� •sa�uei�dde }�e�p �e�n�eu pue pa�sisse
ue� �o} sa�qel 6w�uan a�ewn� �e��ua� � tio6a}e� ywy�-y�y apn��ui
saop siyl •suoi�e��i�ads s,�am��e}nuew pue sapo� �ua�na ay� s�aaw pue
�(�qwasse pa�si� e si }iun �uawa�e�da� ay� leu� sa�uan os�e pau6is�apun at�
� sa� •uoi�euiw�a} pue snnoq�a �o �aqwnu 'y�6ua� '6wzis 6uipn��w suoi�e���ads
�a�n��e�nuew pue sapo� �uaa�n� ��e s�aaw pue �nd/�i}se�d si wa�s�(s 6w�uan ayl
() oN J�a,� •pa�inba� a�aynn paddo�sa�� pue pa�oddns �f�a�n�as si pue
'suoi��ru�sqo 'uoi�e�oi�a�ap '�sru wo�� aa�� si pue pawwexa uaaq sey 6ui�uan
ay; �ey� sa�i�an �tqa�ay pau6is�apun ay� 'a�eu�ry ui;sixa ue u��e� a� uayM
NOIld�I,�R13A 211b NOIlSf18W0� dNd a01�3NN0� 1N3A 1N3A N WWO�
SlIW213d 3�Nbl�ddt/ JNINaf18 �3f1� 1td3W3�H"1d32� 210� J1�313�dW0� NI l"11�
Building
Insp�ctions a
7b3-572-3604
From: 7637121835 Page: 2/2 Date: 3/29/201012:14:01 PM
B'�JIIIDING
I��IDE�TIAL APPLICATION
CITY UF FRIDLEY
Perniit No.
�xV�
� � �
r : s ��� ;��� �11� �� ` ��
DA.r� 3• 2`1 � I 0 y�� g.MqII, pypDg�, Y11 � CMe 11e � e xt81 m n. c o m
srt� qDD;�S ,_i OS Ca H c�, Yhc�w uy_,I.n N� �
'£FTIS APPLTCANT IS: 0 06UN81t �CONTRACTOR
PROPERTlr OWNER! HA�; Nor r►�,Qv► A b � t _
TENA3'V'T Ewntr;�ss: 1050 if A�rhnwa►� I.�, N� crrY Fri d 1� sTA1�M?�z� 5543Z
PHONE: '710 3� 5' l' rl ti L±"7 • ,
CONTRACTOR NaN�: �xce ! Co mpw�+e s
SUBri�IT A COPY OF �AT� �rc�x� �o � 12" 8 � nax'� 313 � 1 I 0 j�, 55363
YOUR STATE LICENSE nr>DC�ss• "t o 0 gu ri Ke � L K g t vd Nv+l c��r o K A sra�s,�.
V�ITFi APPLICATlON O]J!i 7 l0'�S •�I I Z•� 7 S 7 FAX •�112 •
PROPERTY TYPE _ saror,� �wa�a.��ev co�trcTTOx sz�
PL+RNYCT TYPE
�a cTF:+�����— . �� �-�
i i •
DESCRIHE WORK BEINC� DONB: Ye _ Y oo•f-
sper�s 13. 2 sq
�]�,AC�S
PROPOSk77 SIZE:
P�.OPOSED HBIC;Hf:
�
� Virryf
Q Alumim►m
L7 Othcr _
❑�
a xovs�e oxLx
❑ HOUSE dt CfARAGE
❑ AfifACHED C�AAACDE
❑ DETACFFED GARP.CiB
�Sof�it
Ci Trim
� Fasaa
� .
IN fi7QST1NGf OF'6TFlNG3 �Y�s QPIO LQCATIOi�i OF WTNDQWS
OR FORNh"DV OPENINQS-DESC1tTBE SIZE OF
OFENIIdCi CI�IANCr'�S &
ALI,
TOTAL JUB `
Penttit Fez
Plan Review
Fae Surcharge
Surch��e
Z,icense 5urcharge
SAC Charge
Gtitrb Cut Escrow
Erosion ConCrol
Park Fee
Sewer IVIain Chexga
l3 DRAlid 1TLE
❑ OTF�t
OI�i VALUATION, IltiTCLUUIlYG THE CO3T 4F
(USSICiG THE 1�97 U.B.0 FEE SCHEDULE�
1TION � 7. 30 O OCCUPAI�'C
Q e eve„c�•,m j�'�1�:ODFt jN[� 4tti3?!A� i'_
1. Ba�isting Floor Plaa
2. Proposed f�oor platt
3. LIsi of si►uctura! membecs to be usexl
FOR NE6Y CONSTRUCTtON INCLUDING DECKS,
n.JiDiiiONS dC r, , rT.
i. Sfte Pian/Sfiney showigg the existiag ssrnctures
and �opnsed project.
2, Zivo sets af coostrustion plans
3. Eaer&y Calculattocis
$ See Back Pap,a foz Fee 3ohadulz
$ L b5% of Btaildiug Permit Fee
$ �� .00I t'uuea tize totel job valnatian
$ �� �t3 .0045 x Permit deluation IVI'vnimum �.50
$ " $5.00 (54aCa Licen�ed Rasidantial Conlzacto�'s)
$ �l 675 per SAC Unit (Plans to A�iWCC %r dete+rmiaation)
� ft+6ft= ftx�2i @S
$ $450 Consazvation 1'l�n Reviaw'
$ Fee Dete�nined by Enginaering
$ Agreament necassary ( ) Ncm Necesaary ( )
!S �10° ,'�— Make checks uavab[e to: Cit!r of' FridiPry A��
TEZiS IS A1V APPLICATIOIV FOR A PFsRMIT NOT VALID LINTIL PROCE$5ED
I hereby apply for a bailding permit axid I acltt�owledge f,l�t the a2formatac� above is camplete and acaurate; that the work wiil be i
conforcnanee with ihe ardinan�es and �des of tba C'sty of Fridley and wit3x the Mirn�esota Co�tsblxction Cod.es; th� i�ds�►d this is not
p�r�nit btit only an applicatian for a permit e�d work is not La start without $ permit; that t�e �oric w�7] ba, in aacordance with the agpxove
plan in the casa of all ork wh' a uires review an8 approvat of plans. '
SICsNATtTRE OF APPLICA � pxnv� rr� M� �h e t te G'i�rz e h DAr� 3�Z 9 I a _