AF - 47206N°. 871
t
� �
Village of Fridley, Minn.
BUII.DING PERMIT
Office of INSPEGTOR OF BUII.DINGS
.:. . , . ct o �_.. __
/
Fridley, M1nn.. � �t-QL r � , 19�=
LOCATION OF BUII.DING
.;i,
Addit[on or SubDivision
, �I DESCRIPTION OF BUILDING
of
:.�. . . . ..e�'. .
Front Depth '� �- Height Stodes_,,_ � � Manner of Constructio� �- !�'° •
To be used as �. �• � To be compieted � � EsUmated Cost �
."' �
�.t . ./ �.r ��.
�y". �
Permit ls hereby granted to � i' L -z. t_ -z = �: ..�-_� -. . . {p � � ! �< <• ��
the buildtng described in the above statement. This permit ie granted
upon the express conditlon that the peraon to wLOm it Is granted, and hie agents, employees and workmen, in all
the work done tR around and upon said building, or any part thereof, ehaR conform in all respects to the ordi-
nances of Fridley, Mfan., regarding the construction, altcration, maintenance, repnir and moving of buildings
wtthin the city limite, and this permit may be revoked at anp time upon violation of any oY the provtsions of said
ordinancea.
� X �-� � Inspector of Buildings.
AGREEMENT AND SWORN STATEMENT
In consideration of the issue and delivery to me by the Inepector of Buildings of Fridley of
the above permit, I hereby agree to do the proposed work in accordance with the description
above set forth and according to the provisions of the ordinances of Fridley, and, being first duly
sworn, I hereby state and say that the facts stated by me and contained in the above permit are
true as therein stated.
,
Subscribed and sworn to before me at F'ridley, Minnesota, , this -`'- �'�
�
A.D.19;. %,'�-aL�..._ �
day of ' —
•
•
�' , �
;�
Reference No. 601-95-0156
Request For Service Report
City af Fridley
Service Requested Inspect water line Date 5-12-95 Time 11:38 am
Department Public Works
Division Water
Location of Service need 6810 Hickory Street
Owner or Agent of Property Lavonne's Plumbinq ' Phone: (H) 623-2255
Name of Citizen Phone: (H)
�
Address
Details of Request
0
Request Taken By: Lois Witte
. . .. .. ...........................::..::::::::.�::::.�,:.�:: :..:::.::,.:::._:::::::.::::::::::::::.:::::::.:::.�:.�:.::::...:::.,:::::.:....:.............
............... . ............ ............ ..
.. .... ... .. ..
Department � �= �' ��
,
Person responsible for request ���' �S Title �� -
. �
action taken (include date $ communication with citizen) � �h
� � �5I / �S � �, .
��� « � � �"�
d� l
--� .
7�
�o�
f'C' �-C� �') � �► ✓ •'�� C2 �vv
Date Cleared - �� ,�. �'- : t .
� ,
,
Signature of person clearing request �
_ � �
.— �-� 1� �>
No
�:� �
CITY OF FRIDLEY INSPEC710N DN, . � Effe�ctive On: January 1, i:995 �: �'
6431 University Ave NE . . � . - .
Fridley, MN 55432 APPLICATION FOR PLUMBING AND� GAS FiTTING P�RMIT �� ;
572-3604 . �
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR �
Water Bath , Wash flnnk ', j Flaor Catch,� , Auto. Gas, ,; Gas Misc, ` Wafer He�ater
, ,,
Stories Closet ' Urinal 7ub Shower S�nk Tra !FouMt,; �' Drain '�asi q' Washer A;I,� . Ran e. F�xt. _ Gas. ' Elec '
Basement ' ;�;'� : „�,:. � ; � �,,.;
Floor 1 � � ��,; � ,
, ;
,, ��,:�, � ,
Floor 2 , ,� :' ; � � q��� ��iii;,; i� ;, ,; � � iii�,�; ' � G ,'
u,,,.!,.�,,: �;�: � �r+ , !; ! '.; „
; ,fi
Floor 3 � �
,
! ,. , � . :.i�i, : ,' ."' i..,: • '; I
Floor4 ,, �,�,����i,; ����; i���„����� �
; ,
; ; � ;
' - � .,� � i:. , ;,::; ��ti,,.�,,.:: , '
�. .
_,. �,,, : . ;
� � � r ., .. .
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDR SS ' I� '!�" .�� �. �. , �.
E U/ � /7" , �'"� �� , �
New Fixtures $ 7.00 The undersfgned hereby makes application for a permit, for ttie. work� he�ein . �
Oid Opening, New Fixture $ 4A0 spec'�'ied agreeing to do.all work in strict accordance with�the city codes• .' :
Beer Dispenser $ 5.00 and rulings of the. Building Division, and hereby decl�res that alFthe facts ,, �` �
Blow Off Basin $ 7.00 and representations stated in this applicatian afre true and correct: �
Catch Basin $ 7.00 . . . ' . ' �
Rain Water Leader $ 7,00 • . . � - , t995
SumpiReceiving Tank $ 7,00 � :
Water Treating Appliance $10.00 Owner � J ' •
Water Heater —Electric $ 7A0 ,/�� , • .
Water Heater — Gas $10.00 Building Used As ��./o�'� . � �
. �
Gas RanJ� $10.00 . � � � �
Gas Dryer $10.00 Estimated Cost PERMIT ND, / J: �
Back Flow Preventer Required ( }Yes ( ) No � ` � � .
TYPe $5.00 PLUMBING COMPANY �"`� �, . .
Reinspection Fee $30.00 SIGNED BY � . : � � :TEL NCt. �Z�• � / /
ALL OTHERS AND/OR REPAIRS AND ALT RATIONS . . . . �
1% of Val Fixture o Appli e ' -
� _ _ �rx ��� � Approved B • Rou h—In Date � � . �inal Date �• .'�� � �
p . 9 .�. .. �f-
State Surcharge .50 � . . . . . .
MINIMUM FEE O NY PLUMBING GAS ERMIT IS 15.00 .? .�- �
TOTAL FEE $ %��� PLUS THE. $.5 STAITE SURCHARGE � � �. � . . �
sue�ecT , P
City of Fridley 2852
AT TME TOP OF TME TWINS g � i L D{ N� P E R M I T
� �.572-360�
RECEIPT NO.
� � _ COMMUNITY OEVELOP�ENT DIV. � � �
� ~ � PROTECTIVE INSPECTION SEC.
�
1 �
�"'1 � CITY HA�L FFIDLE� SS�J2 NUMBEp AEV O�TE P�GE O% •vvROVED Br
�----�'� ,'� 612-571-3450 910-F15 11/4/98 � �
JOB ADDRESS
6810 HIckor Street NE '
t LEGAL �OT NO. BLOCK TRACT OR AODITION SEE ATTACMED
oescR. 4 1 Ostman's ISt SNEET
2 PROPERTV OWNER MAIL ADORESS Z�P PHONE
Rub Koenen 571-8052
3 CONTRACTOR MAIL ADDRESS ZIP PMONE �ICENSE NO
Town & Countr Roofin 7910 12th Ave S Bloomin ton 4 545- 2 200 1282
4 ARCHITECT OR OESIGNER MAIL ADOFESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADORESS 21P PHONE LICENSE NO
6 USE OF BUIIDING
Residential
7 CLASS OP WORK
O NEW O ADDITION � ALTERATION � REPAtR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and ara e(20.66 S Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TVP� OfCONST. OCCUPANCV GROUP OCCUPANCV�OAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING. HEATING.
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOIO IF WOFiK OR CONSTRUCTION 20NING SO. FT CU FT
AUTHOFIZEO IS NOT COMMENCED WITHIN 60 DAYS, Ofi IF CONS7qUCT10N �
QR WORK IS SUSPENDEO OR ABANDONE� FOR A RERIOD OF 120 OAVS A7
ANV TIME AfTER WORK IS COMMENCED. ' NO DWLG. UN17S OfFSTREET PARKING
I HEREBY CERTIfV THAT I HAVE READ ANO EXAMINED THIS APPLICA710N STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECi ALL PROVISIONS OF GAWS VALUATION SURTAX
AND ORDINANCES GOVEqNING THIS ?VPE Of WORK WILL 8E COMPI,IEO
WITM WMETHER SPECIFIEO HEREIN OFi NOT. THE GRANTiNG OF A PERMIT $1799 $.9O
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEpM1T f EE SAC CMARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON-
STRUCTION OR TME PERFORMANCE Of CONSTRUCTIQN $56.75 Fire SC �1.HO
PI,AN CMECK FEE TOiAL F
- �L� �7 � /� —�' °'� Licens $5.00 $64 45
S�GNATUpE O� CON'RACTOQ Op AUTH AiZEO �GENT —r iO�iE� N P OP LI AiE ISJ IS� ��
'�' J
S�GaniuAE O� OwtiEQ��� OwtiEpBw�OER� �d�iE� � � B�OG� a5� �� � � �+FrE
. �
AUG-13-1998
...... � �
ADDN j �
ALTER [ ]
Consnu�cionAddre
I.egal Description:
Own�r Namo & Adaress:
Contractor: ,h, .'�,n s�
_ _ _
08�42 FROM CITY OF FRIDLEY
TO
CITY OF FZtIDLEY
SINGLE FAMYY,Y AND DUPLEXES R 1 AND R-2
BUiL�7ING PERMIT APPLICATION
8589320 P.01i02
rriwuvC ii uya
. ,
l9,'
1
Address:
LIVING AREA:
GARAGE AREA:
DECK AIi,EA:
OT'SER:
Y-h
Tel. N�''7 � —_ �l_O � �
MN I.jCENSE �#�� C� � �a_
TcI. #� � �_
Attach co this applicatioa, a Certificate of Svrvey of the
lot, with the proposed const�ction drawn on it to scale.
DESC�'YON QF ID�IP'RO��N�'
� r
Y.es�gth =
�8�
'w�h _ Height Sq. Fc.
� _
Width � Height Sq. Ft.
Width � HgVGround Sq. Ft.
��� � � %/ ���
Consavccion Type: � l�'�oo-� Fscunated Cosc: $_ �—/ //�� 1�
(Fee Schedule on Back)
Dnveway Curb Cut Width Tieeded; _Ft. + 6 Ft =_Ft x$ = s
DA1'E: f i APPLICANT: 1'el. �� �1��, =�i�� �
�1_M. . `} 1 U
Peraut Fce $ ,� Fce .Schcduk on Reverse Side
Fire Surcharge $�C� .0p1 of Permit Valuation (l/ltkh46)
srate surcharsc $_ , i'U $.SO�SI,000 vatuuioa
SAC Charge $ �1000 per SAC Unit
Licen.Se Seu�charge S •- � 55.00 (Statc Licensod R�sidential Contractors)
Driveway Esctow $ Alt. 'A" c�r Alt. "B" Above
Emsion Control $ $450.00 Coaservadon Pian Review
Park Fee $ F�e Aetermined by En8�8
Sawer Main Chu�ge $ Agroe�cnt NocessarY I J Not Necess�rY I)
TOTAL
STIPULATIONS:
$ �
�.
Building PLUMBING Permit No.: CC) - J
Inspections j�SIDENTIAL APPLICATION Re�ei�ed By:
763-572-3604 CITY OF FR�DLEY Dat� '' : �
DATE YOUR E-MAIL ADDRESS
SITE ADD1tESS �O I
THIS APPLICANT IS: ❑ OWNER ONTRACTOR
PROPERTY Np,�„�: QP�
OWNER/ qDDRESS: CITY STA"t_t�1�IP����
TENANT 7�
PHONE: bT S '
CONTR.ACTOR N,�:
STATE LICENSE����_,�n � EXP DATE la -E7'1
SUBMIT A COPY OF *
YOUR STATE ADI3RESS:_��n r,� oa ��nn CITY STATE • ZIP
LICENSE WITH pHONE �a�ap� �(� �513.1339 FAX �
APPLICATION
PERMIT TYPE �INGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: ❑ �w S�tzEPt,.aCEMErrT
DETAILED DESCRIPTION QE WORK
PER MS 16B.665 the penmit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE> EXCEPT WHERE NOTED. FIXTURES: (iNDICATE TOTAL
NUMBER OF EACH BELOV�
BATH SINK/LAV _FLOOR DRAINS SHOWER _ WATER PIPING
BATHTUB GAS PIPING n✓� cmuc� SWIMIvIING POOL WATER SOFTNER ($35)
CLOTI�S WASHER KITCHEN SINK WATER CLOSET � BACKFLOW PREV. ($15)
DISHWASHER LAUNDRY TRAY =WATER HEATER ($35) � FOR IRRIGATION
— _ WATER METER , OTHER
Permit Fee $ .� Number of fixtures @$10.00 x$10.00 =$
Surchar e .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ Number of fixtures @$35.00 x$35.00 =$
State Surcharge = $ .50
Total = $
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a buiiding permit and I acla�owledge 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 Constntction 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 PR1Nf NAME�D I DATE
�r�� �
City of Fridley
Building Inspections Department
6431. University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
ag�se
�.