AF - 46376�
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City of Fridley, Minn.
BUILDING PERMIT
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oWrae�: �'• �gma B� llan C�atru�tioa Ine,
waaress 5024 Hu,ahea Street N. E. A� 4$5� �achsry Lane �. ���apolis
L�►TION OF BUILDING
Na _��2�.� Street �es 3treet �. �. Part ot Lot
r.o�c ��—__ sioc�c ? Additioti or Sub-Dlv3sianCalZSflII � a 3ea�m4it �or, 1 Add.
Carner Lot — Ineide Lot Setbsck �_ Sideyard
3ewer Ele�vatian � _ Fotmdatian IIevation
To � v,�a �:
��scr��oN oF Bui��N�
Frcnt � Depth Height Sq. F'k
F�ant ._._ Depth Height ._._.. 5q. Ft. �.�.
Type o! Qaostruct[on FF�t. Cost ���+.� _ To be Comgleted
Cu. F't
C�. 1�`k
3'1'A27� �8�8$e �6p8�T
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In coodderatbn o[ the iasuance to me of a perinit to canstruct tLe building deacri abave I agree to do
the Pro�w�ed w�ork in acaor�anoe with the deecrtptiaa above set f anfl in �n an with af l p�vleions ot
o�iinanaes a� the dty o! Fridley. G!2������7/ /
In cooddezattm at f,he pnymeat o! a iee �; �-� , pe�rmit is hez�ebs► gi�nted r�.l�.arl Ct�at. InC.
the esp�+e� c�oaditiau tl�at t��p��eo� to�wh� granted and his aSer►ts, emP1o� y�ee�sand w��sll w�
dooe ia. ai+nund and nPon eaid buildin�, ar auqpar thereo� shall canfacad ia all r�perb to the o�+dtnaaoes d
Fr1d3eY. Mi�me�ota regaNin� lccx�tiaR camalructiaqt alteratl�q maiat�aa�o� rePafr and mavin� a[
wi� dty limib and tlua pe�mit may be rrv� at auy �ne upon violatlan o! aay aE the p��
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NOTICls
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O�R'S NA1� Mr�_ Droe�es BUILDER Alan Construction Inc. ��
ADDRESS ` .
� �, 024�Hu�hes �tr�;;t � F.: .,,,,_�,�ADARL$S, � 48�,� ,Zacharv. Lane N,o�. , M,inneat�olie
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LOCh1'YON OF E ING : ,: r - _ ; , ,
No.
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Lot � Biock Addi:��ql or;; S�bd�it►�f��;Qn ,���� .�
Coraer Lot Inside ot _ _:,_Se�tiBtk .: . � $#�e�-Y�i ., ' t : - ,
SSWLR �EVATIQN FWNAATION EL�'V'g`l'ION
�►PP1tCant..attach_ Co thi� �ora� Two �e�tifica�g8 �af,, ,�Surx��Y� Q� �4#� �aQd.-.�,raposed .;6ctild� .
ing loc�tion'd���ta ot► these CBittificaCes . ' . , . • , .. . ,
DESCRIPTiON OF BiJILDING
�1`o be used 8s : , .
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Sq.. Ft . .. ; : . _ . . Cu:. ,Ft., . � ::� . . � : '
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. ' �rronc ` . �epth ,.._ _ xeight .
Sq. Ft. �i , Cu. Ft.. � .
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1`ype af Coastructioii ' { . " E$Cia�sted,: �o$�. $1..�.,�0� ". . .
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The undersi d hereb makes a 1%¢ation for a ' ' '
8'� Y PP permit f,p� ,�he �iro�k herei�.,�pecii€i�d, :
agreei�g td c#o all work ii� atrict accordaace with the City of Fridley Ordinances and
rulings i� tkte Depa;tment" of $uilding�, , and ;hereby .d�c,7.ares :that �� the .�f�cta �and.; ;
represeatatioas stated in this application are true and corte��•. �
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,�Schedu�-e� ef Fee Coats cen be fouad an the Reverse Side) .
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� Seetian 2. The Inspector- bf' �i�iii�i.bgar` •s�i�l�,' b"s,��r� �; iswi�lg aaY Perait for
„ the erection of any buildiag or stru�t�.ure� Qr for aay add�.ti� t• any exiet-
, iag building or atructure, or for, •atiy e�;C�ratt4�s�'..repats� to any exiatiug .
buildimg or structure, upon applicat��x �¢er;efor, �eQ�ire the paymetet by �i►e
applicaat for such permit of fees •tb xlie amouat ��er�iu�� below s�t �forth• a�d
� �ia the mannei herein provided to-wl.ts� `
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•• --- 2.1. Fs�r any �uch permit for the eseqt,�on •a�� en� fire*�pi�oai buildipg, other
� ; ;� �an a ..g�r,Age� yrasei:ou�e,-- :facta�r-. q�r .g�`ji�La' .�ex�;�c,;, -� ti� - Lha a��i�en sf _
._ � any firs-��pof eddi�i�, faz ai��:ar'�ocy�4P8ucY� *a e�y pacis�i�►g ba�il-d� ���:: ....
�ha11 be at the rate �f $1.4Q for e�t��,.,a� tko�,s&�d �bie feet, or� �ra�.t�ff,oa
�r•- .. ,thereof, ia such cubical cont�a�a:� :` . . , . � �
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�'� 2. �. F,�r e�►y` '�ucb' pe�tmi� f�-,�pe.=-Q�ac�iba p� any< firarptob� g�r�aQ.:.+:;�o�....•-^,.,, .
��Y � 8�1,n aZev�ator, �or f,�ar� the, er�e�tion �,f. e�a �[� `•. •x.
f�r _�i.lar_-s�caup��.,: � ��jr.exiat- '" �
• ii� ��idi�►g` sha3:� �ba a� .t ' �
. ::.,�fo�f"�aeh cme .ehOnsead cvbic_.feeC;�.,classiiied ,p.e,,�firep7roo�" h� Si _
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the Minneapoi.3.s: _ S�sf�,dfiig' Ce��. '',�er�n. ' __ _
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. �. 2 �5:. �Fe�r �F=-��ut�h' Per�:�. ftir. the' `er.actic►n of '�ny non=iirep}osf b'uiidi�eg o�ttq�e ,
than a gar�ge, warehouse, factory or, grain elevato�, or auy stoa-ifrep�of� ��'•;
additian, for aim#.�ar oc�up�acy, to say eitistidg �uiidiqg - pe�it $�.�00 for
each �oae thou8ap� csbi�, feQt.. . �
GA�BA�`s_8S . . . � ' �,
2.4. For aay auch pes�i,t for the erection of any non-fireproof �ara��,
warehouse�_ f�ctos�r' .,or• grai�.el.evatcr, br.. for _tha •erertioe� of auy� aoa�firept+oaf'� . .
�ddit�.op, -€ar-aimila� occupancy, te anx exiating buildin� dr for asci� such '
._.,,.�;..-�i.lding or addition .- ntnety centn _(�a.9Q3 for -aetcti dne thousaed cubic feet
` or fi�a�tian thereof, ia the cubical� contents thereof, with a minimum of $4.OQ..�
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For the purpose �of caanputiag fees for building perm�ts, kh�e. cubical cot�teats�
of anp building or _addition �ta.. a uaiform .h�igiit througho4t �'by muLtir2ying tiie .: ..
_ _._.
8rouad srea tmrered #�om a�point six (6) iachoA bel�v the �loor li.pe tt�..xbe;,_, �� -
baaemeat or ca.11ar to the •�►ver�ige � tieight--.af --t,h� �-ri�per_ �euriEace or to �tlse
average height of the r�of �e:rface of the main gable of a,p�tched roof. ��
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� 2,_.5,:,• For repaise or alterations to aa existi . . � �"�
ri$ sCructutarls �� £ee s2�1►1 be ...�' t:
,. at the rate of $3.00 per esch Fi�e �uadred. Doila�s ,($�Ob's�� pz, fsec,tfaa
.' thexebf i� the e� :�l��(11 pro�iosed" �ro�ck. • - < . . . � . _
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2_.6 .`� . In. aa: caae a.ball t1�e _ � - , ;£or .aaY f�snti� � set f�i�th in � �' .
� Sectian _.2 be .lea�_.�han.,.�4..08. . � , . ,: ,
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Work done.to date for: Mr. Droeges
: . �024 Hughes St.
l�moved arxi replaeed �hingles
R,�painted exterior
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City of Fridley, Minn.
BUILDING PERMIT
��: � SEPTBr�ER 7, 1965
30 ��
N° 8433
�. L. J. DROGE g��, MODERN �ABAGB BUILDERS
A� 5024 Sughes_Avenue A. B. A� 9240 Lyn�ale Av_enue S�uth
Fridley 21, Minnesota Minneapolis, Minneseta
Na ..� 5 024
Lot�.._._..___
Cadner Lot
3ewer IIevatlaaz
LOCATION OF BUILDING
street ._._�HiT(�IES AVE1Q[TE N.E. ___..__.._._.._.._ Part ot Lot _
. Blodc _.�__�..—..�_�_ Addition or Sub-Division ____—.�
.._._.... Inside Lot _._._._... Setback _� �..._ Sideyard
Foundatiom IIevation
DESCRIPTION OF BUILDING
To be Uaed as:
D,L GARAGE �t 22 �p� 22 g�t 10 gq. �, 484_ �, �, 4,.840
�i+ont DePth Height �.. Sq. F't. Cu. Fk
Type o! Caostructioa Frame F�� Cost _. 1 5 ...Q� .__ To be Coonpleted
in condderatb�t od the issuanoe to me of a pexmit to building ibed abwe I e to
tbe pa�opo�ed w�o�k in acoordance with the d�ptiaa abo�v f and o aace wlth a
anliaan�oes o! tLe city of F�idley. ,, „
In c�nddezatiaa at ti�e pa,ym�ent of a tee o2; 5.00 �p� is hereb�► gi�aated tRi MODER'l�tt .�A�E
BUILDERS to eonatruet the buildin6 or addition as described above. Thiap� t is granted upon
the ex�+e� oonditian that thepera� to who� it is granted and his aSex►ts, esnPloYees ead w�r� in all wo�lc.
done in, aramd and upan said M�iliin& ar aqy thereof, shall oontacm ia all rESperts to the ordinsnoes af
wit�hin the� b� permi�t may�a�� �at aqY �me uPm�� o! � � o! se�d
a�dinaaces.
ALLEP G. JENSEN g�,� �
NOTICES
1W pewR deM �ef eewr 1fn � wabq�dee ler wi�. �bi�, N� �. w�r�e er waha M win te s�
tlw �rNdiy I�e1K frr s�pr� �e�i�s tor fMM 11��.
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APPLICAIZON FOR BVILDING P&R1�IIT
� CI1Y �OF FRI�EY, M�SS@TA
OWNER'S
ADDRESS
N0. dr2
LOT BLOCR
CORNER LOT iNSiDE LaT �SETBACR SIDE-YARD -
�-.__..
SEWSR ELEVATION 1�OUNDATION ELEVATIO�
Applicant attach to this form Two CerCificates of 3urvey of �,ot and proposed
building location drawa on these Certificates.
. DBSCRI�TIOA bF BUiLDIPG
To be us d as ;���' � .
Front�_Depth���Height O /
. Sq. Ft.- ,,��� Cu. Ft. ��T �.
Front Dept _� Height
Sq. Ft. Cu. Ft..
Type of Construction Estimated Coet �7 D2��--�+� •
To be campleted— - ,� � �S" � ✓ '
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The undersigned hereby makes application for a permit for the work he�ein
specified, agreeing to do all:work in strict accordance with the City of
Fridley Ordinances aad rulings of the Department of Bui.l. ng$,..a;►d hereby
declares that all the.facts gnd representa,,t,���f etated `t�his a l�.c a
are true and correct. �:=�y��Y.��.r/ �P���
DATE '' — �J� SIGNATURE
(Schedule of Fee Coste can be found on
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BUILDING PERMIT FEB SC�iEDUL$
SBGTIOA 2. The Inspector of Buildings sha�.l, before iseuing any permit for
the' erection of any building or`s�r+�L�ire,� o� for any�addition to any existing
building or etructure, or for any alterations or repairs to any exiating
building or stxucture, upon applic�tiou therefore, require the payment by the
applic�nt. fwc .s.nch permit of _f�ee' to the .amount .herein �ielaw s.et forth. and in
the mauner herein.�rovid� to�wit;
_... ..._ __ _ ..._.. .. . _ _
2` 1. For any auch permit for the erection o� any.�ire-proof building,
othei than a garage, waiehouae, factot�y or:.�rain elevatqr, or for the erection
of any fire•proof addition, for similar xcupancy, to any esieting building,
shall �e at._,the .xatis � of $1.40 for each one. thoueaad cubic feet, q�c fraction
thereof, in such �cubical contents. -
2_.2 For any.s.uch permit for the erectio� of any fire-p=oof�garage,
warehouee, fectory�or`g�cain e�evstor, or for the erectioa of any fire�proof
addition, for similar, xCU���ancy,, :ta apy �sistin� building sha1l be at the .
rate-of--$�:�=�or eaeh one�thousand cubfc feet, clsasifisd as`"fireproof"
by Section 5.02 0�, the, M�.nneapox'is Suil,d�ng Code. .
HOIISSS � � � - �
2.3. For any such permit f.pr..t� erectioa of.any non-fireproof
building, other than a garage, warehouse,�factory or grain elevgtor, or
any non-fireproof addition, for similar'occupancy, to any existing build.ing •.
permit $1.00 for each.one thousaad cubic feet,
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GARAQB3 _ _ _. . _ - - _
2:4. --gor any such�permtt for the erection of any non•fireproof garage,
warehouse, f�ctory or grain.elevator, or for the erection of any non-fire-proof
additton, for similar occupancy,-�ta any eaieting buildisg or for each such
building or addi.tion - Ainet�r cents ($0.90) for each one thous.and cubic feet
or fraction thereof, fn the cubicai cantents thereof with the minimum of $4.00.
. . . .: .. .
For t�he--p�pose of-computing feee � for buii�i�rg `�iermits, the cubical contents
of any building or additioa to a unifos�n height,throughout. by multiplyin� the,
ground area-covezed from-a-poiut six-(6) in�ches below the floor line of the
baseaaeat or cellar to the average h�ight of tha upper surface or to the average
height of t}�e xopf .e,utr,fa�e af the,.aae�.n gable of a pitched_roof.
2,_;,5_ For repaira ox alt�rations to an:exist.ing atructt�re, the fee,ahall
be at the rate of $3.,00 �8r eacfl Five Aundred �oliara ($5�+�.GJ} or fraction
thereof ia`�the c"osr of all proposed� work: . -
2.6, In no case sh811 the fee charged for any per�ait as set forth in
Section 2 be legs than $4,C0... .
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STORM REPAiR� DAMAGE ?�rFS ; . ,
Residenti.al; Esti:n.�ted Cost of work up to $50�.00 •$S.�JO •.
Esti�ted Cost of work over y.) j4;, �� -$�.0.00 �
.. .
Commercial; Est�rr+.a.ted�st, .of wor.k up t'�;;��??�a0 -$10,�C�I
Estimated ,st of woric over `$5�0:00 �-$�0� i
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FRIDLEY MUMCIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1387
March 26, 1990 PW90-88
Mr. Leroy Droegie :
5024 Hughes Street
Fridley, MN 55432
SUBJECT: Curb Repair
Dear M�. Droegie:
This Iet�er is in response to our recen� conversatibns regarding
the bacl�fil�.fng be�Zind the repl.acement curb in fron� of your
property.
The City will provide you some black di�� this spring when we are
accomplishing our boulevard repair with the understanding tha� you
will s�read the dirt along. th� curb� seed or sod it, and be
responsible for wate�ing for proper grow�th. We also understand
that the p�acemen� of this dirt behind the curb ma� resul� in som�
ponding of water xn your' front �ard. Th�s si�ould be m3:nimal and
only occu� during major rain events.
� hope this satisfies �rour concerns and will take care of p�oblem.
If you have any ad�litional issues on this subject, p2eas� fee�. free
to contac� me. -
Sincerely yours,
�-�%�,�j�--. �
�'` V-
`. = �ohn G. Flora ,
bireetor of Public Works
J�F/ts
C� C'; �
�
sue�ecr PER .
c�cy of Fridley 2 0 8 3 7
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
� . � R .
� � �
COMMUNITY DEVELOPMENT �IV. "�
v PROTECTIVE INSPECTION SEC. I�O✓
� _
, � .'__-�
r , ;
� � /"'1 � CITY NALL FRIDLE� 55d32 NUMBER REV. OATE PAGE �OP APPROVED BY
�""�' �'� 612-571-3450 910-F15 5/22/91 / /
J08 ADDRESS 5024 Hughes Avenue NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3 7 Carlsqn �s Summit Ma.nor South Addn. SHEET
2 PfiOPERTY OWNER MAIL ADDRESS ZIP PHONE
Leroy Droege 5024 Hughes Avenue NE 572-1654
3 CONTRACTOR MAIL ADORESS ZIP PHONE UCENSE NO.
D& D Home Im.provement 7401 Central Avenue NE, Fridley 784-7543
4 ARCHITECT OR DESIGNEH MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDFESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK � �
O NEW O ADDITION ❑ ALTERATIOA �1 REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Remof Dwellinc� (19 Squares)
9 CHANGE OF USE FROM TO
STIPULATIONS g�ofing can be 2nd layex but not 3rd.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEAT�NG,
VENTILATING OR AIH CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. fT. CU. FT.
AUTHOHIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPIICATION �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT '+��$8 ' $ e SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROV�SIONS ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTIO O THE PERfOR CE OF CONSTRUCTION. y�2�J,00 Fire SC yS.��
/^ PLAN CNECKfEE TOTA EE
— 1 � x49
51GNAT O ONTRA TORORAUTHORIZEOAGENT IDATE� WH N PROPER V I A D IS S VOUR PERMIT
_ —�` �=o?�-°�!
SiGNATUREOFOWNER1iFOWNERBUILDERI � �DATEI G iNS� ��aTE
� [ l
� � �
�� [ ]
Gb�.structiari Addres.s:
7�ega1 Descriptioal:
owner N�ne s
ooa�►tractor:
I�1 AND I�2
Hui.l.dir�q Permit Applicatian
Aaar�: _ �ys9� ���f/'�,C'� i'�� _ ��_
Effective 8/16/90
�e1. � s%� /;Si�
-�i : �s
Attach to thi.s applicati�, a Oertificate of SuYVey of the
lot, with th�e prq�osed vonstructioai drawn � it to scale.
D�(�tIP'1'IaN � IIY�VEI�Tl'
L1YII�1G AREA: Ieiigth Width Height Sq. Ft.
Q�iR�,�GE Ait'@�: Iength Width Heic,�t Sq. Ft.
D�CR ARF�: I�ngth Width Hgt/Grau�d sq. F't.
ORi�R:
Cbrner Lo�t [ J Inside Iat [] Ft. Yd Setback Side Yard L�tbacxs
Zj�pe of Construction: � Fstimated Oost: $ %�x�
Approx. �letiari Drate: — Iq � !
PY�q�osea nriveway wiath If rrew oper,ir�g Is nesirea: Ft. $ S
Width + 6' See Hack Page
n�: �-Z2�� �r�c�ar: rne�. #
PeYmit Fee $ �S. !3 O
Fire surd�arge S � 99
state suzrharge $ 5D
SAC Ctlarge $
Driveway Esc�ro�w $
Park Fee $
sew�ex rlain criai�ge $
��•��j�
sr�v���s:
s ��-y9
N� ��n- .: i
Fee Sci�edule an Revers� Side
.001 x Piermit Valuati� (1/10th �)
$.50/$1,000 Valuatioal
$600 per' SAC Unit
Alt. nAn or Alt. ngn AbOVe
Fee �let�smined bY II�gineerirg
A4� ��rY [ J Nat Neoes��Y I]
..- �
:�/ M �� t ' �i'. � ` �I` _�r:1�1��1
Zhe Chief Buildir�g Official shall, before issuing permits for the erectioai of ariy
h,; � dir�g or st�re, or for ar�y ac�ditioa� to ariy existir�g buildirg or �, or
for ariy alteration or repair to arYy existiryg buildir� or stzvcture, � application
therefo�+e, require the payment by the applicant for such permit of fees to the amaant
herein belvw set fozth ar�d in the aanner herein provided t�o-wit:
� Z�OTAL VAIUE
$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
� �.
$15 (Minimtm� Fee is $15 plus surd�arge)
$15 for fixst $500 plus $2 for each additicrial $100 or
fraction thereof, to ar�d incl� $2,000
$45 for fiYSt $2,000 plus $9 for each additianal $1,000
or fraction thereof, to ar�d inclwding $25,000
$252 for first $25,000 plus $6.50 for each additional $1,000
or fraction thex+eof, to ar�d includir�g $50, 000
$414 . 50 for fizst $50, 000 plus $4 . 50 for eac3� aclditi�al
$1,000 or fraction thereof, to ar�d incl� $100,000
$639.50 for fiYSt $100,000 plus $3.50 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additim�al
$1, 000 or fraction th�ereof, to and includir�g $l, 000, 000
$1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for eacii additional
$1,000 or fraction th�ereof
DLtIVE�iY DEPRF'SSI� ffiC�W
(G�or�crete Curb Streets On1Y)
Alternate ��p,��; R�emoval and replaoement of curb and gutter only - Driveway width plus
6 feet times $13.50.
Alternate "B": Removal and replacx�nent of curb arxi gutter and install a 3 foot wide
approach with 6 ir�ch depth - Driveway width plus 6 feet times $15.75.
� ]I' ■ M� •; • ' "�'11 I� • •�.
P�etznits for oon.stxuction will be issued a minim�m� of 24 hours from the time of
applicatioaz to allaw for proper review of the prq�osed stn�ure ar�d of the
aonstiv�ction site. �
A Opxtificate of Survey of the lot, shaaing the location of the fotmdati� onoe it has
it has been vrnlstrvcted will be requir�ed before prooeeding with the framing.
� ' �:
From: Ciiy of Fridle}� Tc 763?542908 Page: 4/4 Date: 4/16/2009 11:00:10 AM
Buiidiu�
�I �nspections �
76 �-�7^-36C�� �
� %b �-J��-4�i�,' ;�F�..�n' i .
UATE ✓ v- i
SITt AllDIZ�,S� � � 1�
' H15 APPLICANT lS:
PROPER'�'1' ! NAMt:
OWIVER/ �
TENANT "lluizt
I PHONE
P�,C11te��Ih1�
i��S���l°�T'��-4.� �.PP�,���.�'��l_�l
���� �� �������
trr•r:cTiv� ?-is,�i„
YOUI: �,-MA1L AUllK�S>
.— .7t n — �
❑ OVJNtR �,C:ONTRAC7Ol:
CONTRACTOR NAMt: 1�^�1�i
SUBM[T A COPY OF
YOU R STATE STAT�. LIC�.NS�. r�
LICENSE, BOND AND STATE BONU t!
CERT[FICATE OF ADllIZ�,SS:��
[NSURANCE 2
PNONt ��'/ �
PERMIT TYPE
TYPE OF WORK:
�SINGLti NAMILY
❑ N�W
DETAILED DESCRIPTION OF WORK
� �I 1y
❑ TWO HAMILY
$I RtPI.AC�MtNT
�„
1'd ile�'i on � rt'.�
CITT'
' " • /..�1 ' � .r�
Received B��:�
D�$��d�1AY 2
A
�XP UAT�
tiXP UAT�.
TY 1'� STAT��.�'LIP S /�'
r•Ax
❑ TOV✓NHOUSE
�
Nt�S AR� HAS�ll ON $10.Q0 P�R HIXTUR�, �:XC�.AT WHtRE NOT�D. 1^IXTUR�S: (INllICATt TOTAL NUMBtiIt OH tACH BtLOW). MINIMUM Nt�
$35.50.
BATH SINKiLAV }%LOOK llRA1NS SHOW�R WAT�:R PIPING
BATHTUB GAS PIPING (N�ED CITY LIC) SWiMMING POOL VJAT�R SONTNER ($35)
CLOTHES WASHEK KITCHEN S1NK WATtRCLOSET BACKFLOW PREV. ('$IS)
_ U IS H W AS H�K _ LAU N URY 'TRA Y �W AT�,1t H�ATER ($35} FOR Ili1tIG ATIO N
WATtIi M�.T�Ii OTHtR
0
THIS IS AN APPLICATION NOILA PEIZMIT-NQT VALIll UNTIL PIZQCtSSfill
1 hcrcby apply for a plumbing permit and I acknowlcdgc that thc information abovc is complctc and accuratc; that thc work will bc in �
conformancc with thc ordinanccs and codcs of thc City of Fridlcy and with thc Minncsota Construction Codas; that [ undcrstand this is ,-
not a permit but only an application for a permit and work is not to start without a permit on sitc; that thc work will bc in accordancc ',
with thc approvc;d plan in thc casc of all work which rc;quires rcvicw and approval of plans.
SIGNATURtnNAPPLIC,aNT %/iWK� L�ry�p'L P1ZINTNAMt ��L/� C��j�v llATt 520 09
T-
City of Fridley
Building I.nspections Department
6431 Universiry Avenue �IE, Fridley, ivIl� � 5432
7b3-�72-3b04
FAX: 763-�Q2-4977