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AF - 46308City of Fridley, �Minn. BUILDING PERMIT nat�: ._._�'�`�_.�' .""°'_-�..._� .______..____._ .�a }� ` �'' f� Owner: �„�� ° i� t� .;a �._ �__ --i��4 ---�-=�` �,�`r�.� �'"!!� � A . ' `�:.' Address .,�,,�.'�.�..~�_�.._.�...__.}.�._:�...:..�_�:�..,�;--=.i 1...��i N° 4525. _, � �� , � ,� ° Builder _ �'s �''�".t��• • ' __ ��'�s+�J ��.� Addresg ....��..C�......._ ._.. .�. ��L:.��°:_.�.�_.,�e._..__ �, �,� �, �, IeOCAT ON F BUILDING _� No. �.../�"�, �.� Street .��!`._`:_� . q �.,� :..:!� �...�� ............--••-----_. Part of Lot ---- .� �� Lot ._..._ ................:. .:..... . Block ....._............_......._...........--........ Addition or Sub-Division ----�--......_....._.............. Corner Lot .....- ......----- ---•--.... Inside Lot ....._....:.. - - -...._..._...... Setback ....._...... -- -----�--......---�---.... Sideyard Sewer IIevation To e Used� , -�- --�.-� -�f%�-...... Foundation Elevation DESCRIPTION OF BUILDING x� � .� Front .--�-�--__.. Depth _.�.�.,.,[�.. Height ...,�!`�,�:'�.-.... Sq. Ft.,�,.%�:. Cu. F� ,�2_:�� ...._........... -...._-� - ............._........ F�ro ..-----............... Depth __........... � Height .._.....- . Sq. Ft� :..__...-----..__.. Cu. Ft ,�� , ., ,.r, t`�7 Type oP Construetion ._�..,-~_.......�:-�-C�-- Est. Co t:.,��..�..:�.........�'�".'.-•--- To be Completed ...-------•.-----_ In conaideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. .1.�--------_____.. .._.._.__._.---_..._.. ._�..__..__.__. . .. In consideration of the payment of a fee of .��......__.�__. _._ . ' $ .. _ ..., pernut is herebY �ted to �-----�--�-•--�---�---.......---......----�---.._..._.. ._____.._._....--_•---•---.....--_--_.._....-------. to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and worlanen, 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, maintettance, repair and moving of buildings within the city limifis and this �rmit may be revoked at any time upon violatxon of any of the provisions of said ordinances. ,+'"r Ea �'i d a Building Inspector NOTICE: This permif does no! eover the conafruetion, insfallation for wirin8, Plumbing, gas heafing, sewer or water. Be sure fo see fhe Building Inspeefor for separafe permits for these items. /'�, 4 �'`. _ _` -.: '>" . - - -:. tr _ - > 0 _� � �� f� � �PPLICATION FOR BIIILDING PERMIT CITY OF FRIDLEY, M�NNESOTA Owners Name _ ��c:� �/�.�"��°��-- Bu3lder --� -��'� -�s �' , _ � .� � . =.__._ �cldrass ��;,��,�-�'h N:��,�,9ri Address d � �� v' �'A��`,,,�i- LO�ATION Or No. -� /��`� � Stree�_.��'��`��°�°�� 1'art of Lo� Lot B].ock A�ldition or S�b.Div. Corner Lot___'_Inside Lot�Set Back S3de-Yard 3�'WER ELEVATION � � � FOt1NDATION ELEVA�ION ' Applicant attach to this form Certificate of Sux�vey of Lot and proposed building location. DE5GRIPTION OF BUILDYI�G � To be used : . � �,.�,�sf'.��-- s � s f, � Front _ � ; � ^ Depth � � Height � � Sq. Ft. �,�� ,`�.� Cu. P't. . � Froni � Depth. He3ght Sq. Ft. Cu. Ftr . �rpe of Coastruction� ��1„��=s- Sstimated Cost ,�'� �°'� c �wn.��w.�.�� To be completed� The underaigned hereby makes applica.tion for a permit for the work herein specif3ad, agreeing to d+o a11 work in strict accordance with the City Ordinances end ruling of the Departmerrt of Bu31d3ngs, end hereby declarea that all the facts and represents- tions stated in this application are true and correct. � � � � �� DATE � �-' �� ' . SIGI�ATIktE � � .� / ��L�� s' � � e (A Schedule of Fee costs c�n�be found on the.Reverse Side.) :� : � n e R � "� ,,, BUILDING PERMIT FEE SCI�DUI�E Sect3.oa 2. The Inspector of Buildings shall, before issuing any permit for -�he arection of any building or structure, or for any addit3on to an�t existing building or structure, or for any alterations or repairs to any existing building or structure, upon application therefor, require �ho pa,y*_�ent by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: ; 2.1. For any such permit for the erection of any fire-proof building� other tha.� a garage, warehouse, factory or grain elevator, or for the erection og anJ fireproof addition, for similax occupa.ncy, to any �isting huild3.n� sha.11 b� at the rate of �1.40 for each one thousand cubic feet, or fraction thereef, in such cubical contents� 2.2. For any such permit for the erection of any f3reproof gere�ge, ware- Y?ousa, factory or grain elevator, or for the erection of any fireproof edd3tion, for similar occupancy, to an�r existing building shall be at the rate o� �1.25 for each one thousand eubic feet, classified as "fixeprooin . }�� S�r,+,ion �02 of the Minneapolis Building Code. T� �1�Z^F_S � �: �o::�� Por any auch permit for the erection of any �,i=:�r than a garage, warehouse, factory or grain F'i��;r� oof addition, for simil.ar occupanc�, to any s'�.�•:ai ��l .00 for each one thousand cubic feet. * � l�lin � �.te. 6I norrfireproof building elevator, or any non- exist3.ng building. 2,L�. For any such permit for the erection o£ eny non-f'3rreproof garage, warehouse, factory or grain elevator, or for the erection of any non- fireproof addition, for simi].ar occugancy, to auy exi.ating bwtld�ng er for each such buildin� or add3.tion. Ninety Cents for each one thousand cubic feet or fract3on thereof, in the cubical contents thereof �aith s minimum of �L�.00. � For the pL-'pose of computing fees for building permits the cubical contents of any building or addition to a uniform height throughout by multiplying the ground axea covered from a point s3x.(6) inches below the f'loor line of the basement or cellar to the average height of the upper avrface or to the aeerage height of the roof surface of the main gable of a pitched roof. 2.5. For repa.irs or alterations to an exiating structure, the fee ahal.l be at the rate of �3.00 for each Five Hundred Dollars.(��00.00), or �action thereof in the cost of all proposed work. 2o6a In no case shall the fee charged for any perm3t as set forth in Seotion 2 be less than �4•00• ^ n. _ - _. ..��-.� A i � � � .� P�1 � ��a � � m rn � "�ai AVE�dUE ta+� � � � —� � m � � � , � � s �: :;�. �: � ?:; �.A� � � C� C � � �� C s ... - '- � � , ...��'�'. _ � � '" - ��' .__.��.._._._._.� h�l�?E � ��-��..n� �o �e�%.�,,,, � /(,� }t `� � � — � � ��cK e��s `��.� ,��=a�� f� ..�',L�� v��zorr'�' �"�� - gDD, �'_,��'.�'., �, F-�''�.�.�.t_.,r �,. u ,�� '�� , � —t f�--�-- i � -�x-�.°•� e � P�operty 7,ine � �� __ t��.m.—.�_�a-��- .� .. A_. . ...- � � � � 1 � � ,� . O i . •w.+ria.o � . i ��, j' ra , �� „ �: e'�' � �y�� r j� �7_ p�� `� i ,�� 't; ', � � � �� `, �..l�I�T� �� `�� o �.� -� �r 7" ,I .�1 ,� �`. �1- �.,.�_'.��"�„�� ''2`�dA'� j �,� ' I��. '@AeT'�'Y AT•� .. . _ .� �. , � ,. �ity of Fridley, Minn. 6431 University Ave. l�. E., Miuneapolis, Nlinn. 55432 BUILDING PERMIT �8t@0 - A�ig,�et 9 � lAZ2 i � � :� / � , � � p�; Robert Stramberg g��r Merl's Construction ��eSB 51 L:�. _jiori zon ilrive N_F. _ Address LOCATIOiV OF BUILDING �o, 5144 s�t Horizon Drive N.E. � part of Lot � 13 glock 5 Addition or Sub-Division C�,,xlson�s Sv.�it Ma.nox Somth Addition Coraer Loi Ins�ide Lot Setback Sideyard �Sewer Elevai3ctn Foundation IIevation DESCRIPTION OP BUILDI�IG To � Used as: Reside House �nt Depth Height Sq. F� _.� Cu. Ft �Yont Depth Hei�ht Sq. Ft. Cu. Ft. �@ pp L+png�lC�pn Al„min�tm Egt, Cpg� S1 OOQ,�O To be Completed .��n3itII.$1L.^.,. Stipulation: Caulk butt ends of siding. In cronsYderai3on of the issuance to me of A perm4t to construct 'Fhe bwilding described above, I agree to do � proposed work in accordance with the. desc�3ption above set forFh and mpliance wi a]1 provisiona oE Ordinances oE the dty of Fridley. --//1 „ �/% i_ � �I . /% _ In consideration oP the payment of a fee oE $�h...D.�_ , peimit is hereby granted to Mra _$fpamhca �a to construct the building or addition as described above. This permit is granted upon. the express 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 respects•fo the ordinances oP I�'rfdley, Minnesota, regarding location, construction, alteration, maintenan , repair and moving of builcliIIgB ��th�e diy limits and this permit may be revoked a time upon vi ati n of any of the provisions of ssetid Bwilding Inspector DARREL CLARK NOTICE: This permPi doea not eove� the eonatruetion, imtallaHon for wlring, plum6ing, eas heating, sewer or water. Be mrs io ses t6e Buildine laapeeto� fo� separate permits fo� ihese items. _ »� __ � , � AP.P�ICATION FOR RESIDENTIAL, ALT�RATION, OR AllllITION BUILD�NG p��IT CITY QF FR�ALEY, MINN�SOTA ow�tt's � s,�C�,B� � i �i��I�l�� suiLn�x: �J ��L�'S �o�/Si e e s eee��q Ann�ss : � y� s�%�2 i 2 c� � ,� � � �,n�ss : �t�ca ��/y sTREE`r: s�/c��iZ�� .� .��. .., � ;�° /� BLOCK :, �� ADDITIOAT t �-�� d 4� 'S �� '1 / % SU� I I � , �, �,..�.�. CORNIIt LOT: INSIDE LOT: SETBACR: SIDEX�RDt� �pplicaat attach to thie form Z�o Certificates of Survey of Lot and prop4�sd buildiag location drawn an these Certificates. HESCRIPTION OF BUILDING �o �e Used As: , „�,S 1 1 Front : Depth : Height : Square Feet: Cubic Feet: ' Front: Depth: Height: Square Feet; Cubic Feet: '�►pe o Conatruction. . /(�vd • U f • ��,1 (�"1 l �lic�l� Estimsted Coet• $ „ C� ,��s �o Be Completed: The undersigned hereby mslces applicativn for a peslmit for ti�ie .wc�7cic '�47��t► �pec�f�,ed, agreeing to do all work in sttict accordance with the G�tyi+�� F�id�.ey► O�dinances and sulings of the Departmeat of Buildiugs, and'�e�ebT d��la�ee that all the facte aad representations atated in thie ap�'��,g��,� a�re tsue and correct. �A,�i : ,� � ��% oZ SIGNAT[TRE : (9ep �teveree Side For Additioaal Information.) •�j /rj)� ��S( (p �� ts ��{�.�� . °' �. j -•. $UILDING PERMIT FEE SCHEDULE aECTION 2. The Inspector of Buildings shall, before issui�tg permit� fox the exection of any building or structure, or for any addition �o any existi.ng building or atructure, or for any alteration or repairs to any existing bui,lding.ox structure, upon application therefore, require the paymem� by �h� �pplicant for such permit of fees to the amount herein below set forth r�d i.�a the manner herein prwided to-wit: UNLFORM BUILDING CODE: Z�►pe 1, 2� 4-$2.15 for each one thoueaad cubi,c #est, ox fraction thereof, in such cubical contents. Zj►pe 3� 5-$1.$5 for each oae thousand cubic feet. ADDITIONAL INFORMATION For the purpoae of computing fees for building permite, the cubical contents o£ any building or additian, ie determined by multiplying the ground area covered fram a point aix (6) inches below the floor line of the basement or the cellar to the average heights of the upper surface or to the average� height of the roof surface of the main gable of a pitched roof. �'or repaira or alteratioas to an exieting etructure, the fee shall be at the rate of $3.00 per each five huadred dollars ($500.00) or fraction thereof in the cost of all proposed work. T�a, no case shall the fee charged for any pe:mit as set forth in Sec�iot� 2 be� lees than $5.00. VBRIFICATION OF FOUNDATION NQT�; Permita for eonstruction will be isaued a miai�um of 24 hours f�ap4 th� �ime of application, to allow for proper review of the proposed structure and of the construction aite. A Ce7ctified Survey of the lot, ehowing the location of the founda��,A�1� q�c��+ ��, 1�s� been coastructed, will be required befo�e proceeding with the fx�amin�, CERTIFICATE OF OCCUPANCY Ap�licatioa for a Certificate.of Oceupancy ehall be made ten (10) days pl��,�� p the use or occupancy of any structure for which a buildiag permi� �as �� iseued; and eaid atructure ehall not be used or occup�ed until a Certifica,�a o� Occupancy has beea iseued. � :� - sue�ecr PERMIT NO. City of Fridley 15 7 2 5 AT THE TOP OF THE TWINS B U I L D I N G P E R M I r � � R . � • COMMUNITY DEVELOPMENT DIV. � �ti:— 9 � r � � PROTECTIVE INSPECTION SEC. � � � � ` � � /'�'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV �----� • •�� 612-571-3450 910-F15 5/15/80 / / JOB ADDRESS 5144 Fiorizon Dri.ve N.E. 7 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ].3 5 Carlson's Siunmi.t Manor $OLl't�1 SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Leon Pelti.er 5144 Horizon Drive N.E. 560-7029 3 CONTRACTOR MAIL ADDHESS ZIP PHONE LICENSE NO. Professionsl Roofing S�,rvices 7257 Yucca Lan - 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS 21P PHONE LICENSENO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION C� ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof structure 9 CHANGEOFUSEFROM TO STIPULATIONS . TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OF 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 �- STAILS 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1►2OQ $.�Q 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � $�.00 � PLAN CHECKFEE TOTALFEE � �' / �'°l� $�74� $ 9 . 60 SIGN UaEOFCOtv'Ra TOR RAUTHORIZEDAG Nr IDATEI WHEN PFOPER VALIDATED THIS IS YOUR PERMIT � �� .�� SIGNATUREOFOWNER�IFOWNERBU�LDERI IDATEI BLDG iNSP �ATE CITY OF FRIOLEY • ARPLICATION FOR RESIDEi�TIr�L QUILDIPdG PERMITS (PJew, Alter�tions, Additions, or ftepairs) OWPJER: ��J ��'_ `�'r e j�" ADDRESS : �� C%' k -i �� aJr--- TEL �10: �( (� %C��L� 0 � ; BUI LDER :- v- }�e S� � a�.� l r� ApDRESS: � � 7EL N0: L/c�.S= �� 3 Construction Location ST�T NO: � ST?2EET: � LOT: I � BLC?CK.: �_ s�. 0 , ADDITION: � � f c 0�.�.� � �� - � � �� Corner Lot: � Insicle Lot: Sntback: Sideyards: Appla.cant attach to this form L�,vo Certificates of S�rvey of ].ot and proposed building location drawn on certificates to scale. DESCRIPTIOId OF CONSTRUCTION _ � Front: � Degtn: Height: Squa�e. Feeta GUbic Fcet: Front: Depth: Height: Square• Feet: Cubia Feet: Type of Construction: Y'� —�' �@� Estimated Cost: $�oZV(�.�� 7.b Be (bmpleted: �'— � • Alt. A Alt. B Proposed Driveway Width If New Opening Ss Desired: $� $ SEE REVERSE SIDE OF SHEET , 7�ie undersigned hereby makes application for a permit for the work�herein specified, t agreeing to � all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this applica'-�^^ �r° �-Y.,p a„� �nrrect_ DATEs .S � �^ � SIGNATURE : Stipulations : �� //•�, S, — . � L�- �� r ra . � �G ,�� q �o / 1.- � r--�'�' � � /� -�-�CI�7'' � ��d +. Y , � _ ... .. ___ . __._ _ _._.. . . � ._ . BU1LD1(JG P�Rt�IIT fCk SCHEDULE� . SrCxION 2. T}ie 7n:;pect;or o� l3uilcling� stiaJ_x, before �. ,suinq penniLs for the erecLion oi any buitding or :�i:r:uat:ure, oz tor any addi.ti.on to any er,i�i:ing buildiny or strucL•ure, . or L•oz any alt-eration or repairs to •any exi��i»g }�uilcling or s�ructure, upan application �L-he�eforc, requirc the paymen� by tlie applicant L-or. suc:h permiL of fees to, t•he amount hercin belaw set fori:h and in tlie manner herein �rovicled Lo-wiL-: �. 1JT:VJ C'�NSTP.UCTION: Single 1'ami].y iIomes and Garages : $�! e 00/l, 000 cubi.c te�et. PLAN CIiLCY.: 25 percent of bui.lcling Pexmi.t iee. • . DktIV��7AY D�PRI:SSIUi�T: (Concrete, Curb Streets Only) ' • AlternaL•e A: RemUVal arid rep].acemenL- of concrete curb and gutL-er only; Driveway width plus 6 feet x Y�l�o?5 AlternaL•e B: Removal and replac-r.ment of concrete c�rb and . ' gutter and a.nstal.l a 3 foot taide approach with �' ' .. � 6 irych dept.h; Driveway width �plus 6 feet x$17.85 • . ADDI T IONAL I NC'Of.3�'�AT I OP� ror the purpose of aomputing fees for building permits, the cubical contents of any building or addition, is de�ermined by multiplying the ground area covered from a . paint sir. (6) inches below the floor line of the basement or th� cellar L-o tlze averag� heights of the upper surface or to the average height of the rooL- surface of the riain gabl.e of a pitched roof . • For repairs or al.terations to an existing structure, th� fee shall be a� the rate of $3.00 �iEr each five hundred dollars --($500.00) or fraction i:hereof in the cost ai-' all. proposed work. . _ ' In �no case sha].1 the fee charged for any permit as set zorth in Section 2 be less � than $7.50 plus $.50 state surcharge. • � VERIFICATIOV OF FOUND�TIOld NOTE: Permits �or construction will be issued a aninimtnn of 24 hours i'rom the t,irne of application to allow for proper review af the proposed structure and of the . construction site. 1l Cert:ificate of Survey of the lot, showing the location of the foundation once it has been constructed will.be required before pr.oceeding with the £raming. _CCRTIFICATE OF OCC�I�'ANCY � Rpplication for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structuLe for wilich a buildi�ig permit has been issued; and sa.id structure sha17. not be used or occupied until a Certificate of Occupa�icy has been issued. � , � _ i ! y► � . .._... . .. . ..., . . .. ..};. . r�.+s....y . . . ,.. .. .." HOUSE fHEATING TEST RECORD ADDRESS �'�� o ��d`� ��°° / � � APT. FL�OR CITY SUBURB ' ��'`"�•'�` � OCCUPANT ��° g �� %"�B'� �° OWNER ' HEAT LOSS DATE HTG. INST. SOLD BY INSTALLED BY Eleetrieal Work By Goa Lins By — TYPE OF HEAT GA FA 4d�� HW STEAM SPACE HTR. GAS DESIGN MAKE �� MAKE OF BURNER Model � -��3°� �� a � �"' Model Serial �° � �u � 3-� '�' °'� � �� Max. BTU Rating INPUT '�`�°�r�� `'��"►>1;9• MAKE OF FURNACE — Model CONTROLS yf THERMOSTAT '� Heat-Plug -' -/ ` � Vent Size � � r Valve ��e`�3' KIND OF LINER Limit �-' �a �d"�•` =, ��u� d� � Droh Hood Regularor � Limlt Setting �� o Filters Size ��-� d�`� `� � �dumber UNIT HTR. OTHER CONVERSION SIZE NONE Fan Setting g Chimney Loeation Inside Outaide Pilot Type f A'� �-- Chimney Construetion �A��- Pilot Make Pilot Model _ Pilot Timing L.W. Cut Off Smoke Bomb Wiring Draft �°'��`� Test Tag 1�'� - Door Pressure Lighting Inst. Pressure -�-y • � Percent CO2 �' ` �� Date Tested �'- //A �"� �'� Input CFH �=� 3 Pereent 02 �� "' Company Testing w�'+� %°�`' �� Staek Temp. '� �`` Pereent CO �L Name of Tester �� °"'��:�� -`° Form 235 `"'�� » n � w rs � �g � � �o m m o � a n ' � o tf o � wro � m a w � �W� K m w � r�. � � rt NN �z �� o �t! H� �� N � �� x �� ro t� � H � � w 0 0 m w Q r � ro o °' k . m � � I � � � � M � W °c ~ � rw► � � o ro ro M ro m K �• w w � N frtD �' � o �' � � � � � � � x � i � � � �� x a � �o � � ro a '� • � � c� rt � � R � H z � M � °z x � t�l fi � � � w K � W w � � S � � � a o0 0 � ° a � � � � i ~ O � � � � � � 7d � � m ro m 0 rt w � � m m tA � � 0 0 � N rt a � � � N � M � �m fS W � tn ia tn c 0 O � � c � Fw, r � � � 0 M y ro �ro � n � K 0 M x � � � � ' � Ga C � � � � M G � bd � � � � � � c� � o � � � H d/'� � � � � � � � H O �I � * � �r �o 0 r°n � a a� w r �o O fD a �� MN a �� w �a ~ � � N �� mn Mrt o� X� N r 0 0 0 tn tn � � 4� G� Od �+J N � m�v� m n rct e o �roroW � � � W � a 'o � n � �w �x � .� � � K � W � aa � .� � � r� rt rt �+ � �'a 0 � wx :: c� . i/� -L� d.'s �v: 0 0 0 0 �+ . . . . y 0 0 o Q � tn in in in O � b �R �, � rta� � ��ro � � G M� qk O Lt a r r� � tn M F� a� a. a ��n� � ro o rWt iw u�, w r°n (� m M fD C7 �� bJ N � � ,� a r �ro � " w ��io� '� � � � � g � � �r � r �a i.a 'R � rt m ~ � � a�°n��a w � '��C p FG,, p W M �a�ram w Y. m � F�i r '�e a m rt � � m � �r� a o , � a °i M z w � K ro i� �� w�m� � � m a� rt a fD F'� M �'' � w � � -a � m m� � � A'�w� � , �M�e7".- w N n w � � � ��n I rt�m�� 0 b' � � m w �r ..� � � � � �� rn cn c� x � � t _i h ► v � � r c� a � 0 z � 0 � O � m � a� � � z c") -�i O (� Z C D � Z � C O 2 � a � � z � � � � N m� n 3 O N r C � m m < � C'f �+ m � � � 0 z a m � � � m � m � O z D z C f"� � 0 T 'll � C I"' � m � m � � �� CHIMWEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; 1. Has been carefully examined Yes (,) 2. Is free from rust or deterioration _ Yes () 3. Has no foreign objects lodged within . Yes () 4. Is securely supported Yes () 5. Meets all current Code requiremen ts for size and total BTU connected Yes ( ) 6. Has Total hea ti ng BTU' s of All other BTU's TOTAL � _ Rema rk s No ( ) No ( ) No ( ) No ( ) No ( ) Com pa ny Signed By Da te � � , . . . . � i ,,. � �'� � ��L-►, n 7 � � i , ; ' ' £� t-� � ��°� � r � � � ,. � — — _: � g: J" �. � ~ ' . � � � � — ; , f g, �S � n � � p�. ;S # .> M 4 y 4 �. — — — tl • o. ,:+! � � i � — � i � y : � t. � � �e�'� �, ' :� ;: . � ; ;.�' -- ,—;n �' g .. 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"'j 'c� ►.. u M m � m � R V7 � a x c n M . � � � � • m K m <'N'1 S i ^ . 1 � I � I v I O r Z ��'I� � � m 0 N� N N N N t/� N N N N N V1 N N { r r � v� " o o tn +i tn cn u+ �n tn a r t� tn „aj 0 0 0 0 0 0 0 0 0 0 0 �n �n o � 0 0 0 0 0 0 0 0 0 0 0 0 0 N N N N N N (A N N N N N N N N N iA �„3 � o �P) , (,J� > � � � r � : H C Z y ►� a j [9 '7 v+ m n � O H� �-3 Z P] •C N 7 cr n3 m > � n cZi P7 '� [9 � H M N � � O 0 > � a '�O 2y C C t' X '� 1-1 M r y y O � � A 'Q � � � y „ _� A s l .� �c� � � �� J � � � n � � � � �� m w O ..�� '� • m "cA1 _J a�r '�' ^� �' Stozies • A 7 O. O. R � n n eL z C1052t5 E �Urindl5 % � G O Bai�l 1Vb5 h � � m BSS�AS � f� �' � S�[1�CS $ '� wash Trays � � Drinking � Fountains Showpss � Floor Drai O � Catch r Basins aAutanatic s Washer � Gas Appl. Misc. Fixt � � Gas Aanqe r* E �° n Other � �d a n r � n n � � � Z C 7C � � M m O O M !+f A � � O y � � 'O C r � � � ►+ � CI Z I �v n m � � � �] � \ � ° ��.�� o MA N a O \ i � `1 i � O. 1�D �3 � n � C ro M v� fD � r�t y n ��c n°�� a � �a � o. O. rJ- �] n t�p � m� m a a 0 y O. O n�'• tn r n � T 1p � O fD n m � �c m n � °o °" .r.- �) � R ° � .a' � W n�r O '< � w g 0� 3 p cp r 0+ . 7 7 r )c' � R � +� w O O !� 0� � 7C 'O rd- m c r.•°� � � r � n . r� O. m Oi � ►�- R T � rr � r� O � m � � � 0 R MI b � O m �=� cv p � � R � w� � w � � m w M m n rr o � � S ^f R f�D S 7 m W W . � � W � F+ W W R M � �0 7 rt 'C 7�' li.(l � � r~- o. � � m _ R D � � r ci � -� 0 z � O � � E " 3 ---� m -� G'1 O T D Z d T � � D C7 N r m T -G -� "'1 2 � � m � � �-- �\ m � ro n � < � a r^o 3 � �O � � SUBJECT City of Fridley 2 719 7 AT THE TOP Of THE TWINS g U I L D I N G P E R M I T r � � RECEIPT NO. � • COMMUNITY DEVELOPMENT DIV. . �,: ------, �� /� r � � PROTECTIVE INSPECTION SEC. � � , � � �"'1 � CITY HALL FRIDLE� $S43Z NUMBER REV OATE PAGE OF APPROVED BY �""'�'� �'' 612-571-3460 910-F15 8/14/98 / / JOB ADORESS 5144 Horizon Dr 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED oescR. 13 5 Carlson's Summit Ma.nor South SNEET 2 PROPERTY OWNER MAIL ADDRES$ 21P PHONE Inez Peltier 572-8729 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO. Viking Home Improvement Co 4832 2 1/2 St NE Minnea olis MN 55421 572-1820 4772 a ARCHITECT OR DESIGNER MAIL AODRESS ZIP PNONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION O ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 8 DESCRIBEWORK Reroof house and garage (16.79 Sq) Tear off; Reside house and garage; Fascia 9 CHANOEOFUSEFROM TO STIPULATIONS Call for building wrap inspection before covering. � Underlayment must comply with State Building Code. SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, NEATIN(i, TMPE OF CONST. OCCUPANCY (3ROUP OCCUPANCV LOAD VENTI�ATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON3TRUCTION 20NING SO. FT. CU. fT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOO OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEfiEBY CERTIFY TNAT I MAVE 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 TVPE OF WORK WILL BE COMPLIED WITH WHETHEfi SPECIFIED HEREIN OR NOT. TFIE GRANTING OF A PERMIT $8517 ��F. ZS DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEHM1T FEE SAC CHARGE PROVISIONS OF ANY OTHEFi STATE OR LOCAL LAW REGULATING coN- �149.75 ire .Si�i �8.51 STRU ION OR THE PERFOR ANC OF CONSTR CTION. PI.AN CNECK FEE TOTAL FEE a �-�� l�� Licens $5.0 $167.51 1GNA E FCONTFACTO RAUTNORIZED GENT 10ATEI EN RO LIDA ED T I IS V UR PERMIT � S�GNATUREOFOWNEAUiOWNERBURDEN� � IDATEI BL �NSP pqTE NE�V � [ ] ADDN [ ] CITY OF FRIDLEY ALTER [] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: �� f-f-l) � K 1°7 �`�A 1� 7� L,egal Description: Owner Name & Address: Contractor: (�C `Lv� Address: e 2 /�g � �! e (Z. LIVING AREA: GARAGE AREA: DECK AREA: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Length Length DESCRIPTION OF IMPROVEMENT Effective 1 / 1/98 �� /�� 'a� � Tel. # ��Z-�%Z� 'ENSE # Z- Tel. # _ �%��ZFJ , Width Height Sq. Ft. Width Height Sq. Ft. Width Hgt/Ground Sq. Ft. OTHER: �� o ea�.- �- l�e ��'' , �'7/ao .v� �� •n�q �j�t .e,v�� 141u n� �v 11.�-p ,�f` �/�-s c r A� � 2, A�-.� �,v+<,wsa J'/�� / `/ Construction Type.�� ` Estimated Cost: $ °%/��J (Fee Schedul e on Ba ck) �/ % ! � � �` Driveway Curb Cut Width Needed: Ft. + 6 Ft = , Ft x$ _$ DATE: `� - � � — � � � APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPIJLATIONS: Tel. � �7 � - �� $ ��/9� 7s Fee Schedule on Reverse Side $ :� .001 of Permit Valuation (1llOth%) $ -� Sf $.50/$1,000 Valuation $ $1000 per SAC Unit $ �f C�� $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ J Not Necessary [] � 1� �S / • ,� BUII..DING PERMIT FEE SCHEDULE The Chief Building O�cial shall, before issuing perinits 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) Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet tunes $13.50. Altemate "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 $15.75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. 3uilding rnspections 763-572-�604 BUILDING L��L�b RESIDENTIAL APPLIC�@N CITY OF FRIDLEY �ATE YOUR E-MAIL ADDRESS ;rre aDnxESS a'l��i �� J�� r� t°� tz. ,%� � iHIS APPLICANT IS: O OWNER �ONTRACTOR PROPERTY OWNER/ TENANT CONTRACTOR PHONE: %� � `�'%�.�Ci� � L D � i�4' Cs Pemut No.: Received By: Date Rec'd: �� SUBMIT A COPY OF STATE LICENSE # J� �� EXP DATE 3)2ra i YOUR STATE LICENSE ADDRESS: �� 2f� I�'a �%G !� CITY �TP,�L(L STATE��IP�� WITH APPLICATIOAT PHONE �'��' C)� 3I FAX� S� �-�SLS� �� 7� PROPERTY TYPE PERMIT TYPE �rYrE oF woRx: O T6V0 FAMILYMEW CON � ADDTfION o sas�ur Fn�isH O DECK NEW ❑ �an��v,v�c�,� DESCRIBE WORK BEING SIZE OF SQUARES �_ GARAGFS PROPOSED SIZE: � X �? PROPOSED HEIGHT: � ❑ ROOF ❑ SIDDVG n LENGTH O HOUSE ONLY O HOUSE & GARAGE O ATfACHED GARAGE J$,PDETACI�D GARAGE D DRAIN TILE ❑ OTHER POOL �G �f�� I /�7at )�� /V �Z� < ��-1 9JIDTH � Z� P HEIGHT BASEMENT REMODELING SLJBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of strucdual members to be used Ft' SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, � Vinyi OSoffrt ADDITIONS. & PORCI�.S SUBMTf: ❑ Aluminum O Trim 1. Site Plan/Survey showing the existing strucUues I,�'Other �L- O Fascia end pmposed project WIIVDOWS Z. Two sets of construcYion plans IN FJQST'ING OPENWGS DYes �No LACATIOI�I QF WINDOWS 3. Energy Calculations OR FOR NEW OPENWGS-DESCRIBE SIZE OF (�%� JV b R°t-?-4 V�J� �L OPEND�IG CHANGES Bc TYPE OF WWDOW TO BE INSTALLED� � NIJMBER OF WAiDOWS � ALL FEES ARE BASED ON VALUATION, INCLUDING TI� COST OF LABOR AND MATERIAIS: TOTAL JOB VALUATI N IN`T�HE��9�97�U.B.0 FEE SO �D�� PE Permit Fee Plan Review Fire Stuchazge Surcharge License Sutcharge SAC Charge Curb Cut Escrow Erosion Control Pazk Fee Sewer Main Charge Total Dne $ $ $ $ $ $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuaxion .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contraetors) $1550 per SAC Unit (Plans to MWCC for determination) ft+68= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach TFIIS IS AN APPLICATION FOR A PERMIT-NOT VALID UM'IL PROCESSED I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and 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 requir review d approval of plans. SIGNATURE OF APPLICANT � � PRIN7 NAM��—� SC��_DATE Page 2- Building Residential Applica.tion BUII.DING PERNIIT FEE SCHEDULE The Cluef Buildi.ng 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 altera.tion or repair to any existing buildi.ng or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein beYow set forth and in the manner herein provided to-wit: VERIFICATION OF FOUNDATION Permits for construction will be issued a min;rr,um of 24 hours from the time of application to allow for proper review of pro�sed structure and of the constru.ction site. A Certificate of Survey of the lot, showing the location of the existing founda.tion 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 ° - � PLOT PLAN . � ! ,' k •� _ y� - . -�' � '. }:. .t ..� N �"'-i`,-- -r--.-a. -Y '. �_ . ( ' � k � � n @ �- ',_ _ - .. _ _ ' " _. . ., .. :.. -k . _ . _ .� � .. .k . ..,,, 4._.� ¢ F � � � i � . _ . x � A � � �� _ � _ ; _ �� ; _ � _—� � . o-� � e _ ; � . ' � : � > . � ' F � � .. ' __...w. _ : d." � -..._. .� .. � ; ; � . � � ,' � ' j .�_: � � „ � � � � � � � � , � .�: � � � � � � , 5 � �.. � � � , � � ....� t ; � � i � A , � . �. � ! � � , ., � �. � , � . . � �; ; � . � ; ; -�---- � � � � � i �; �. ; ��,.� '�"� z, , � � Ms. Jeanette Mondeng ` . ' . ` � ` _ „ � a � 5144 Horizon Dr. NE � � � � � � '` kt ( � `� � � _ � $ Fridley, MN 55421 �� £ �j � �� — � - _ °�. � `�� . � t: � e ' � � � _ ° k ii . � n � .��- � ' � f £ - � µ . . $ . _«. . a e d� � �, 3'' ry @ . .'z�.s �'.um � u�� A: . -a . � � � � I. � < �.,... �. ,r. .: 4 .... . � �� b.`. �. i i � � � ' � � 1 ' « � � ppp � ! � , � � � , , � . fi n � � � ' r � , > ; , . .- � , ... y . �. t . � cin �-� � � �. �._-�._ �> � .,. : �,. �_ �.�.� � � �� . � � --�---� - ��' : �-- $ � � � ; ; � ; � ; � d� _ �� _� Tr�rs J �Qe �� ! E � � -� � ; . : ; � � � ¢� LEGAL DESCRIPTION t � � � ��TEA �� _�{,�i� �,' s LOT. � � ��y � � � _. y�� A . �� , I PE� ' N �� j; � r � ; _ � p � , 3 w �._� 4 _.. � � ' .�,� j �_�_ � �� ' :.. '_ � ` , � ..� � y � � 5 ,_ � ` �-, . i "�� , � � � -- { _. " ...; 1� � , .., ._ . �-...--. � . . . ...q. r . �„_y.. .. _ i 3 +' � i Y°°"'€ t >„. � , � ... ' � � ; � � < ,� .. � ` t ` � � . � .�. ..� � , �. �f_.� � . . •, a " �..� : �° ( ¢ • � � , � � i ,... { __� B LOC K : � � �� - � _ _ �b - � -�-� -��- � � �� ,.-�. � : ' _ � _ a—. . . ....� , .. t �i . � a� e i . � �i i � � _._,(... � w : . ; . ; ; � s ; ".a_".� t _e. . �. _.. e . { .. � ,.., . t --4 * _ -4 _ , " � ; � ; , . , _-� � f t_. a � T �.. i � ADDITION: � t� � ) �.a_...�. 1 _� '_. �. ,� � � i � � . : � `� , � - .P-..>. , p ' } ,n �.. 1 ' � 1 { �. .i_..p..�..- . .<.. i_.. .-e �. .,. �..,.. �� : �, � .� 1 �.p � ' j `� '1--� �.�,- �.�. _.1_ _..t..._ ..� � F � £ ".i 4 ¢ S 4 k d' i 1 i k � � ' gg (t ._.-. i. _,-- > .. � . , , . ; , -¢p « .. ..t ^.--k-- _ � t d . h� ' ' z + � � ,i � � � �� i j � - � � � � � �_� ; , ; , � / � � �-� _' ' t.. .� _ � �' _y� 1 -.;...- --� 7--d-- —� = � '�'�'-- -� i _ � � L �� LOT SIZE: -��--_. + ..� � _ . � _�-E- ' -9-.-•--� ' ' -,-�p � `_ ; �� -�-- r ' -+—� � J.? _,_.a�._ �.�_ __.>..-�. _+—x__. . ..} --r--�� — 6 -�- i �� r �_ �..�-. a _ �.�'_.� �.i E r... �� ! � f I � � ' � �.. x � � -� -�-�-i-'v- -� � .� , i .. �, i � a I a_.' � � # • _d_ �... 4 ' � ' � � � � � � I ¢ }.^�- � , � > . ; .�..- '� -'+---. . � ..�, -s-. : .� ..�_ , _�.. , «.. , {. .g.. _ _ .. i 1 w i HOUSE SIZE: ` �._v_. _. , , . _ , ; +_}_ _ ,� ; i , , -� a�.. 7�--J--�,`- (- � . i a--'f; t � -<-- � � � �. -,._.1. �� v SQ. FT. � -'- `--i- - ` -" �`" � � � b - - 1� � � ? � ,. -� ,- t--;—,-- ; _ �._c.-.; -+ � �_.�__.--� _ � j ' . r�i : : � ; : � - �: .� ; :�..�. � - � - -i.. s; y � . � Tx d c ; � � , ._..h_ ._° . ._;--r_ ,_... -_._.._s.._ �._ _r_ _. _ 5 . 1. _,� , z i _, ¢ CROSS STREETS: � � i i � � ; s� ; � � . � ' f - F � �� ~� ' ; ! ; i ; i � � i , � � i � .� �-�- �- - _ � : � ! .� .. . -r- . .� _ } � y�„��}- �, �r AN D -i-- j ---�_ � � � _�� i `� � 0 4 � � --°--�-- � -b-- I�.�1. � -.L _ A x .a <_.. �.� _R �' DI RECTION _._ � ' ..; ; _ � ` _ -� -�p_.f .� � i--:- _..a _+� ..y- - � �. � - `-e- . ...x. ( j i � , : -i � �i � i_ ' 1 �k t �: ' -� � -�i' 3 ' ti -- -f,- k....._y _ � �_ 4 � -?— � i— . . i � .."� �' �-P—'r 1 f .. i i ..--{-- � _. _ _g_ "{, _� � � ^c�..�,°° � SUSSEL GARAGES 12 _ . Manufactured Trusses ROOF: GABLE�� REVERSE GABLE HIP 4r EAVE OVERHANG: � �- � RAKE OVERHANG: �� SEAL DOWN SHINGLES WITH PLYWOOD OR WAFERBOARD ROOF SHEATHING AND 15 LB. FELT. �� s� Roof Sheathing - �, Seal Down Shingles 2" X 4" DbVTdple - Top Plete ^ �y �� P10TE: � � 1) Roof approved by Minnesota State Buliding Dept. as meeting Code Requirements of 40# snow load. State RAFTERS: Trusses @ 24" O.C. STUDS: 2" x 4" 16" O.C. WALL SHEATHING: � �(�s�s � SIDING: � OVERHEAD DOOR E Double 2" x 12" - Micro Lams x 2"x 4" studs 2" x 6" Treated Bottom Plate Sill Sealer 6" Concrete Blocks � �N`.'� ��r 1 Y \`N l ,� \ . � `' � �C - 1fY1�� '�� 4° � �� Ice and Water Protectlon � Trim \ 1"x4" — Sub Fascia \ Fascia `Soffit � 3/4" Cove 2" x 4" Studs �—Siding 5/8° Gyp. Shts. 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O � = t�+ o � m � � o -� "�a D � O � �1 -+. � m ,�, a 1 � � . � � � r' � 0 � r« � 0 a ss O � � � � � � N -�r. N � C 1 � � C � � � From: City of Fridley To: 651-645-8371 Page: 2/3 Date: 8I28/2006 9:28:32 AM �� `%� � �,�� Effective 1/1/04 CITY OF FRIDLEY APPLICATION 6431 University Ave NE Fridley MN 55432 MOVING [ ] (763)572-3604 FAX (763)571-1287 WRECKING ��j �� Job Ad d r e s s:__ �% ��_-,��,D,►� � R. I�i � ---- Legal Description: Owner & Address: ��N{,�--� �(�J�'��j�� S'J�.�j �1��/�l � l�� Tel. #��°�?��OD3� Contractor: ��S�L �� Tel. #�S7-,��833� Address :�� 6/� �/� State �� License # ��- �->I � DESCRIPTION OF BUILDING HOUSE: Length Width Height Sq. Ft. Cu. Ft. GARAGE:Length � Width _�� Height �� Sq. Ft.�� Cu. Ft. OTHER: Length Estimated Cost $ �L/�� Width Height Sq. Ft. Cu. Ft. Approx. Completion Date CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. CALL ALL UTILITIES FOR DISCONNECTS BEFORE ARECKING MOVING STRUCTURE. Water Bill Paid: Moving Route: Yes [ ] or Collect [$ ] Signature The undersigned hereby makes application for a permit to wreck/move the building described above, agreeing to do all work in strict accordance with the City �rdinances and rulings of the Building Division, and the State Code which requires any water well on the property to be sealed by a State licensed water well driller, and hereby declares that all facts and representations stated in this application are true and conect. ALL DEMOLITON DEBRIS, INCLUDING FOUNDATION & SLAB, SHALL BE REMOVED FROM SITE. Date �e�� , �� r' �. .