AF-R - 47089City of Fridley, 1V.�inn..
BUILDING PEI�MIT N� 5 3 0'7 :� 9
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Date: � '"�' "'�
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Ovvner: �• � �!,�''�` � � Builder � �' __._—
Address Address
L�C�4TION OF BUILD9NG
No. �j"s � � r � ' _ -� j ,� : .
.�L„�.s Street —��:..��� ._._.�..;;,,�' �,� Par�._o�»I.ot �
Lot �--- Block — Addition or Sub-Divi�g�, - � �� �r'' ���"'' '-�' `� % �--
f ,� E ra � � �' �, �
Coraer Lot —�^''� Inside Lot —` Setback Sideyard - r,� �___._�' !
Sewer IIevation
Founda.tion IIevation
DESCRIPTION OP BUILDING
Tc � Usea as: , � � �� �r �....•k��,�' ,� ff �� .:•� �+,/ !, /; `�' :., �t
: r, r ' �"'" p �� g �� q. ` '` � ~` Cu. Ft �—f'f 4• w;� .�
.,� `' �:.�...�f.. `�._ " ont �� De th ,.�.. Hei ht .::.� S
�nt Depth Hei�ht __�,,� Sq. F't G�. Ft
� `,,+��� `�� T �f jr � ..��--.
Type of Constructioa�-�=- !��,�-':rF..�-_ Es�k Cost,,,,�,,,� �,:_,�:�- yw,__ To be Completed �.
In consideration oi the fssuance to me of a permit to consi�uci 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 oE
ordinances of the dty of Fridley.
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a�'.:.'.:�
In consideration of the payment of a fee of $" � , percnit is hereby granted to�
to construct the building or addition as described above. This permit is granted u�n
the express condition that the person to whom it is granted and his agents, employees and worlunen, in all work
{ione ui, around and upon sa3d- building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding loca.tion, construction, alteration, maintenance, repa.ir and moving of bnildinga
within the dty limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. ,�y �
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� ��� � � � t 9� � � ` ��'��'{`� Bwtidfng Inapector
NOTICE:
ihfs permN doee nof eover the eoestruction, testallafion for wirine. P����B+ 6� b�8. �er or water. Be sure to see
fha Buildiag laspeeto� for separate permita fo� theae (tems.
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APPLICATION FQR BIIII,DTNG PERMIT
CITY OF FRTDLEY, M�Il�NESOTA
� ' �_
Ownere Name Ea�t Ri��r Est���� Bu3ldar _w�rd E. Wood� ,�"r____
Jl�dress 3��5 �era Cruz A�r�, No�th 9ddress 3325 v�ra Cruz Ave. No.
LOCATIOPi OF BIIILDING
No. 7-97- Stree� 592 W�Y Nort�.eas � P4rt oi Lat
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Y�ot 3 Block . 1 Addition or 5ub.Div. ��St �R���� E��a��,_�,_
3 0,.�'rom We s t �` `.
Corner �t �,Inside Lot Set Back 3�" Side-Yard �-� t 1 i ne .
SEki�R II,EVATION FOUNDgTIDN ELE�IATION
Applican� attach to this form Certif3.cate of 5urvey of Lot and proposed build3ng
location.
DESCRIPfiIOIv OF BIIILDING
To be used as: , Multiple Dwellin�
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� � � ont DBF
Sq. Ft. Cu. Ft.��D .7 . �
s
F'ront Depth He3ght
5q. Ft. Cu. Ft.
Type of Construction ��a�e-briek & s'eocco �x��timated Cost 9�,000.00
�-
To be completed ���t��ver is 1961
The undersigned hereby makea application for a permit for tha work herein specified,
agree�.ng to do all work in strict accordance with the C3ty Ordinazices and ru].ing of
tY,►se Depart�ent of Bui7.dings, and hereby declares tha.t a17. the facts and representa-
tions sta.ted 3.n this appiication �re tru� �n�orrec�g � �� �
DATE ��ri 1 27 � 1961 SIGNATt]RE
(A Schedule of Fee cvsts c�n be found on the Reverse S�de.)
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B�fILDING pERMIT P'EE �ULE
Sect� ion 2. The Inspecior of Buildin�s shall, before iasuing an�r perndt
for the erection of any builc£ing or atructure, or for.any addit�.on to
an� exiating bu3.l.din� or structure, or for any alteratione or repaira
to.any e�dsting�buildin� or structure, upon application therefor, require
the �►ment by the applicant for such permit of fees to the amount hereia
beiow set forth and iri the manner herein provided to�wit:
2.1. For any such permit for the erection of any fire-proof buildin��.other
than a garage, warehouse� fac'tory or grain eleve.tor, or for the erectian o�
an�r i�-reproaf addition, for sim3�.ar occupancy►, to any sxistin� buildin�
shall be`at the rate of .�1.40 for each one thousand cubic £eet, or i"raction
thereof, 3.n such cubical content�.
�.2. For,en� such permit for the erectian of any fit�eproof garage� ware-
housQ, factory or grain elevator; or for the ereotion of an� fireproof
addition, for sim3lar occupancy, to any existing building shall 'be at the
rate of �1.25 for ench one thousa.nd cubic feet, classified as "f3reprooPn
by �Section 502 of the Minneapolis Bu3.lding Code. •
OUS
2.3. For any such permit for the erection cf any
other th�n a garage, warehouse, factory or grain
fireprooP addition, for s3.mi].ar occupancy, to any
Permit �..00 fcr ea.ch one thousand r,ubic feet.
GARAGE3
non-f3reproof buildS.ng
elevator� or any rion-
existing buil.ding. '
2.4. For any such permit for the erection o£ any non-f3.reproof garage,
warehouae� faotory or gra3.n elevator, or for the erection of any non-
f9.reproof addition, for similax occupe.ncy, to any existing building
for each such building or addition. Ninety Cents for each one tho�d
cubic fee� or fraction thereof, in the cub3cal.contents thereof with a
minimum of �4.00. �
� For the purpoae of computing fees for building permits the cubicel contents
of any building or addi�ion io a uniform he3ght throughout by multiplying
the ground. area covered f�om s, point�six.(6) inches below the floar line of
the ba.aement or cellas to the average height of the upper surface or t,o the
�aeerage height of the roof surface af the ma�n ga.ble of a pitch�d roof.
2.5. For repairs or alterations�to an exiating structure, the fee shail bg
' at the ra.te of �3.00 for each F3.ve Huncls°ed Do11ar„� (�►500.00), or fraction
thereof in the eost of all propo�ed work.
2.6. In no
Secti�2� be
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case sha].1 the i'ee charged for any permit e.s set forth i.r�
lesa than �lr..OQ.
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MINDER ENGINEERING CO.,INC.
ENGINEERS AND SURVEYORS
LANO BURVEYINO 901L8 TESTINO
GIVIL m, MUNIGIDAI ENOINBERIN3 LANp pLANNINO
6418-56T" AVENUE N.
MIhINEAPOLIS 2'f, MINN. '
(+i KE T- 3637
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WE HEREOY CE2TIFY THAT THIS �S A TRUE ANO CORttEGT REPRESENTATION OF A SURVEY OF THE BOUN�ARIES OF TME
LAND ABOYE OESCRItiEp AND OFTNE LOGATION OF ALL BUIIDINGS, IF ANY, THE2EON, AtJO Al.l VlSIBLE ENCROAtHMENTS,
�F �w,r, FQOM ORON sA�o aNO. M1ND�R ENGlNEERING CO., INC.
DATEO TM15 QPY oF ��� `= A.OJy�o�
EtdG�N S A1JiD � SURVEYO 5
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February 1, 1962
Gopher Blectric C�pany
1410 Coon $�apide gou�.ev8rd �
Co�n �tap�ds, Minnesota , - -
� Gentlemen: � ,
�ie aice returning herewith your checic� �1299 8ad ,�l�ill in the .
emoaa�ts of $83.00 �acd $109.00, along with your Affidavits �102812 aad
° �10282i, cov��i� furnace per�its for various a;aartment bu�l.dings.
We are listixeo b�low the cos�rect p�rmit fee £or the various
sparts��at buildi�s au.d pu��house. � .
151 �- 59'� 61ay N. E. - 12 Fura�eces -• $Zy.QO �
D iso�_ � w� u. E. _ i2 �u���es _ s z�.00 �
���lr`�- 59?� bl�y H. E_.� • 12 Furnaces -$2�5.00
- S j a S: E. - 12 Furnaces -$24.00
; Total - $96.00 . .
. ���� - $72.00
Ri�dly seacl us �our check for �96.00 to cover fura�.ce pesrgits
in the above� apart�at buildin�s, aloan, �►ith a sep�xate af£idavit for
each address. Also � check in the �ount of $72.40 to cover the puaa�►house
affid�vit which we ere holdiag ia our files. �� ,
Thaak you for yo�sr coopegation ia this matter.
; Yours very truly, '
• LEOFi1�D EICa�YIi,LE�
� � Blectrical Inapector
LE:cks
� City of Fridleq
Enc. ; ' .
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;:' June 29, 1979
'r ,�-
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8431 t�6V!VERSITY AVENUE N.E., FRIDLEY, MIPdNESOTA b6432
Tropicana Co.
6250 Wayzata Boulevard
Mi.nneapolis, NIl�T 55416
TELEPFiOF�IE ( 812)571-3450
Re: Repair & Maintenance of the Rental Property Located at 191-59'� Way
N. E. , Fridley, t�2innesota
Dear Sirs:
It was contizmed by a routine on-site inspection on June 29, 1979 that
the above listed rental property was being maintained in violation of
Chapter 220, Residential Maintenance Code, of the Fridley City Code.
Although the general condition of the property was good, rhe inspection
on the above date found the following lis� of deficienci:es which must be
corrected. Any repairs or improvements must be completed in a worlaaan�hip
like manner. It is the City°s hope �hat similar or other deficiencies in
apartments that were no � inspec-ted will be correcied as needed.
EXTE PIOR
1. Provide and maintain a screened enclosure to conceal the refuse
container from view by August l, 1979. In addition, a ha.rd surface
base should be provided for easier handling by the hauler. j L��° � Q �
2. Provide and maintain strippirig for the parking lot to designate
indiviclual parking stalls (10' x 20' ) . � _� �,+-7� -��
3. The painted wood surfaces of the windows and tr�m are chipping
and flaking and should be scheduled for refinishing in the stunmer
of 1979.
COMMON AREAS
No orders this date.
WATE R HEATER ROOM ,
No orders this date.
LAUNDRY ROOM - FIRST FLOOR ,
1. Adjust and maintain tl:e closer on the fire door that will �mp etely
self-close and latch the door wlien it is released. �,�v-�� �
2. The wall receptacle behind the dryer has the polarity reverse and
must have the wiring corrected. ����,� e J
cL
LAUNDRY ROOM - SECOND FLOOR
No orders this date.
;�a
�
_ Tropicana Co.
,.' June 29, 1979
Re: 191-59� Way N.E.
APARTMENT #5 ,
No orders this date.
Page 2
APAR�iENT #12
1. Provide and maintain an anti-siphon ball cock for the toilet.
2. Provide and maintain a moistureproof seal around the bathtub
e.g. silioone caulk.
A reinspection will be conducted on or about July 30, 1979 to determine
aompliance. We are confident i.n your cooperation on these matters and
if any questions or problems arise, please feel free to call on us at
571-3450, extension 164. '
Failure to abate these violations may result in this matter being turned
over to the City Prosecutor for his legal consideration.
Sincerely,
STEVEN J. OLSON
Environmental Officer
SJO/mh
CC: Ms. Connie Hallin
191-59� Way N.E., Apt. #5
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TROPICANA C�i'�PANY
6Z50 WAY2ATA �OULEVARD
MINNEAPOLIH� MINNEBOTA 55414
APARTMENT MANAGEMENT
Ju.1y Twenty-Sixth 19 79
r4r . S teven J. O ls on
CITY OF FRIDLEY
6431 University Avenue Northeast
Fridley, Minnesota 55432
Dear Mr. Olson:
This letter is to acknowleage your letters dated June 29, 1979
with respe ' ' spection of our apartment buildings
located a 190 59� Way Northeas� and 191 59� Way Northeast and to
further confir o-ar ne conversations relative to the repair
and maintenance of these properties.
As of this date, we have completed the following work: Installed
new heavy-duty door closers on all laundry room doors; Corrected
the problem with tTze electrical outlet in the laundry room at the
191 building; Installed a new anti-siphon ballcock for the toilet
in the 191 building, apartment #12 and caulked the bathtub;
Tnstalled new anti-siphon ballcocks for the toilets in the 19Q
building, apartment� �#6 and �11.
We understand that any subsequent toilets neeciing repair work in these
buildings will be serviced with new anti-siphon ballcocks. We have
contracted with our remodeling contractor to build wood enclosures
around our refuse dumpsters and he has assured us that tiiis cvork will
be completed by mid-August. We are also making arrangements to
further blacktop the dirt portion of the parking lot at the 190
buiiding and then will have both parking lots stripped for individual
parking stalls. We will notify you as soon as this work is completed.
As you have indicated, we maintain these buildings in an attractive
and safe condition and are continually making updated �nainten�nce
and improvements, You can be assured of fair and reasonable
cooperation from us in complying with the city's Residential
Maintenance.Code. If you have any questions please contact the
undersigned at 546-4700.
Ver
TRO
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NiBL:EH: jas �J' � � BY=
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a���February 6, 1981
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�431 URlIVER�IYY AVEPIUE N.G., FRI[bLEY, bAIIdWESOTA bb432
! Mr. Marshall Lebow
�'`! Tropicana Co.
;�:
.��,.� 6250 [aayzata Boulevard
./' Minneapolis, MN 55416
TEL�PHO(dE ( 812)571-3450
Re: Repair & Maintenance of the Rental Property Located at 191 - 59�
Way N.E., Fridley, MTJ
Dear P�Ir. Lebow:
It was confirmec� by.a routine on-site inspection on February 5, 1981 that
the above listed rental property was being maintained in violation of
Chapter 220, Residential Maintenance Code, of the Fridley City Code.
The inspection on the above date found the following list of deficiencies
which uiust be corrected. Any repairs or improvements must be completed
in a w�rlananship like manner. It is the City's hope that simi].ar or
other deficiencies in apartruents that were not inspected �vill be corrected
as needed.
EXTERIOR
Provide and maintain caulking for S�� �oint where the brick and
stucco meet. ��-�°o -ac9 f'�, � p-�r� �S�2ti�
coi�oTa A�s
1. Adjust and maintain the third floor hallway fire door to completely
close when released. j_/o�j � �F'
2. Provide and maintain weatherstripping for the north and south
entry doors to prevent cold drafts and excessive heat loss.��/�j G�
LAUtVDRX ROOM - 2nd floor
Provide and maintain a cover on the open stack hole in the chimney.�t'!�/� �
WATER HEATER ROOM
Repair and maintain the leaking drain faucet for the wate?- hea.ter.�'- o%�.j'1G E.
APARTMENT #1
T�o arders were noted during this inspection.
APARTMEIIT #2 �
Pdo orders were noted during this inspection;
' Mr. Marshall Lebow
' Tropicana Co.
February 6, 1981
Re: 191 - 59� Way td. E.
Page 2
A reinspection will be conducted on or about P4arch 9, 1981 to determine
compliance. We are confident in your cooperation on these matters and if
any questions or problems arise, please feel free to contact me at 571-3450.
Failure to abate these violations may result in this matter being turned
over to the City Prosecutor for his legal consideration.
Si.ncerely,
STEVEI J. OLSON� R.S.
Environmental Officer
SJO/mh
CC: Ms. Connie Hallin
190 - 59� Way N.E., Apt. 5
F
r '
0
/ J�
�
� ��� ��� L
Re: Repair & P4aintenance of the Rental Property Located at
, Fridley, MN
Dear
~ e
���'- � �� L.
�
It was confirmed by a routine on-site inspection om ���� that
the above listed rental property was being maintained in violation of Chapter
aao, Residential Maintenance Code, of the Fridlej City Code.
The inspection �n the above date found the following list of deficiencies which
must be correct�d. Any repairs or improvements must be completed in a workmanship
like manner. It is the City's hope that similar or other deficiencies in
apartrnents that were not inspected will be corrected as needed.
EXTERIOR ��`�� '
, , � ��s ��/
.-°� � � f /c • ��..� °,,__ � ' l�-� L�i � � �;. 9l� �' ,� �i' , �`;';.%a,:�''�!
[MON ARf'�AS . � `� v 3' /1 � ., �� � � �
'�� e-r ./'�-f � s�9r.•.�. ��`-. _ � r/ A�'� -.' 1.9 �..�' (// .'v^v � � s�"X= t-ti�L� �
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. �, � _
^��, •- ra�,..,
fi�TDRY ' � / �a�„„ S/�'i.� k�,F' �
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APARTMENT # /�/,�•
s'� /4 __..�„ �!/J?.�w
9
,a.
M
. Q �� �- �'- o ^y.',�sf•�
A reinspection will be conducted on or about � �`�`�� to determine
co�pliance. V7e are conf ident in your cooperation on these ma,tters and if any
questions or problems arise, please feel free to contact me at 571-3450.
Failure to abate these'violations may result in .this matter being turned over to
the City Prosecutor for his legal consideration. .
ENC•
CC: �
I
w �.. _
�. .
V-
�� O`
F[Z(DLEY
CIVIC CENTER • 8431 UNIVERSITY AVE. N.E.. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
,
June 21, 1984
Mr. Marshall Lebow
Tropicana Company
6950 Wayzata Boulevard
Minneapolis, NaJ 55426
Re: Repair & Maintenance of the Residential Rental Property IACated at
191 - 59� Way t1. E. , Fridley, NIN
Dear Mr. Lebow:
In order to insure the quality of the residential rental housing within the
City of Fridley and to prevent its deterioration, the City Council adopted a
housing maintenance code in March, 1978. As part of the City's coanprehensive
housing progr�n, an on-site inspection was conducted of the above listed
property on June 6, 1984.
The inspection on that date f�nd the following list of deficiencies which
are in need of corrective action. Any repairs or improvements must be
completed in a worl�anship like manner. It is the City's hope tha t similar
or other deficiencies that were not noted will be corrected as needed.
EXTERIOR:
1. Enclosed you will firxi Section 220.10, of the Fridley Housing Maintenance
Code. These are City adopted, manditory State regulations for all
residential rental properties. It is expected that all windows and doors
will be brought into compliance by caulking and weatherstripping where
needed. In addition, the rest of the building must be brought into
compliance with the remaining energy requirements if applicable to this
property. It is expected that the property will be brought int�o
comPliance with all energy requirements prior to the start of the 1984
heating season. d�,.�,� ���
2. The painted wood surfaces of the windaws and doors are chipping and flaking
and in need of refinishiag. This should be accomplished during the su�er
of 1984. /�.�-,� � ��
INTERIOR:
There were no deficiencies noted during this inspection.
l�� s2,�..� � ��,-��-t��� .�,� ���
, � Mr . Ma,�shali Lehow
� Tropicana Company
' June 21, 1984
Re : 191 - 59�5 Way N. E.
Page 2
The City must require you to correct the above listed items on or before
Sep tember 1, 1984, at which time a reinspection will be conducted t� determine
co�pliance. We are confident in your cooperation on these matters and if any
questions or problems result froai this letter, please feel free to call on
me at 571-3450. ,�
Failure tro abate these violations may result in this matter being turned over
to the City Prosecutor for his legal consideration.
Sincesely,
S EN J. O , .S. ,
Environmental icer
SJO/mh
ENC: 1
5 CITY OF PAIDLEY. SUBJECT
6431 UNIVEABITY AVB. NE.
FqIDLEY. MN. B843e LB'PP� 571-3450
RESIDENTIAL RFIQTAL PROPERTY
IlVSPECTION REPORT
DATE: � � �' ,�`���� � �° ,ADDRFSS: .v � � � .t���, '�'�._�n � ,..
�p �'"� � =° -
UNIT II�ISPECTION: # ��'� HIDR00�lS I''1 f' t2`( 3 EFF. Missing N�bar on Door
of
ICITCiiIId
21. Sia1c -(1)no running water (2)poor repair (3)leaking hot/cold faucets (4)waste not vented or lesking
22. Walls, Flooz, Ceiling -(1)not clean (2)poor repair (3)holes (4)cracka (5)peelim3 paint (6)sffiins (7)miasing
tile _,_-�-:.
23. Electrical - LIGHTS OI�'OUTLETS.i (1)inadequate (2)poor repair (3)non-working (4)improperly wired or qrounded
24. Stave/Refrigerator -(�i}nst�`provided (2)poor repair (3)non-workinqp GAS COIJNECTION: (4)no shut off (5)flexible
pip3ng
BATHRDOM ,...-:-: - - _ , .. _. _�:;,. .� , , T,_.
25. Hand Sink & Bathing FacilitY -(1)not preaent (�2)poor repaii'(3)Yeaki� hot/cold �Eaucet� (4)�o running water
(5)waste not vented or leaking ---._ _--- .,_
� - - --
26. Toilet -(1)non-functioning (2)leaking (3)no mm�i� water (i4jno anti-siphon ball_ cock ;(5)no seat �
__ - ,-=
27. Walls, Floor� Ceilirg -(1)not clean (2)poor repaix' (3)holes �4jcra`cks (5ipeeling paint (6)stains (7)missing
tile J
28. Eleotrical - LIGHTS OR OUTLE`TS: (1)inadeqvate (2)Pobr repair (3)non-workirn3 (4)improperly wired or grounded �
29. General -(1)not within the apartnent (2)access through bedroo� (3)no d�r (4)no mechanical oz natural vent
SEDROOMS
30. Walls, Floor Cei13r►q -(1)not clean (2)poor repair (3)holes (4)cracks (5)peelir� paint (6)stains (7)missing
tile
31. Electrical - LIGHTS OR OUTLETSt (1)inadequate (2)poor zepair (3)norrworking (4)improperly wired or grounded
32. General -(1)no doorp ESCAPE WIAIDOWs (2)too small (3)tao high off floor (4)obstructed
LIVING ROOM/HALIIn1AY5
33. Walls, Floor, Ceilinq -(1)not clean (2)pc�or repaiz (3)holea (4)cracks (5)peeling paint (6)stains (7)missing
tile
34. Electrical - LIGHTS OR OUTLETS: (1)inadegua�e,_(2)poor repair (3)non-working (4)improgerly wired or grounded
35. Smoke Detector -(1)not provided �(2jriori-worlring (3)improper location
-* _..�.�
GENEEt�L - � - - ��"
36. Dcors, Wircdowa. Screens -:11)loose-fitt3ng�'(2)holea (3)not caulked or weatherstripped f4)windows not openable
(5)no screen�s (6)broken glas's''(7Jlocks'flon't work
37. Insects/Rodenfs-- (1)easy access (2)harborage (3)food eourcea (4)psesent (5)exterminate
38. Heat -(1)inadeqvate (68°F. at all timea) (2)not provided ; �, �-•.
-� - ' i , I �� ` y
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UNIT IIJSPECTION: p BEDROOMS 1 2 3 EF�F'. Miasinq Number on Dooz
KITCHEN ! .
21. Siak -(1)no running watez (2)poor sepair (3�leaking hot/colc� faucets (4)waste not vented or leaking
22. Walls, Floos, Ceilinq -(1)not clean (2)poor repair (3)holes (4)cracks (5)peelim3 paint (6)stains (7)misaing
tile
23. Electrical - LIGHTS OR OUTLETS: (1)inadequate (2)poor repaiz (3)non-working (4)improperly wired or grounded
24. Stove/Refricierator -(1)not provided (2)poor repaiz.(3)non-workingt GAS CONNECTIONc (4)no shut off (5)flexible
piping
HATHR0�1
25. Hand Sink & Bathing Facility -(1)not present (2)poor repairi(3)leakir►g hot/cold faucets (4)no running water
(5)waste not vented or leaking
26. Toilet -(1)norrfunctioning (2)leaking (3)no nu�ning water (d)no anti-siphon ball cock (5)no aeat
27. Walls. Floor, Ceilinq -(1)not clean (2)poor repair (3)holes;;(4)cracks (5)peelinq paint (6)stains (7)misaing
tile '
28. Electrical - LIGHTS OR OUTLETS: (1)inadequate (2)Poer zePair (3)non-working (4)improperly wired or grounded
29. General -(1)not within the apartment (2)accesa through bedroomi (3)no door (9)no mechanical or natural vent
--------------- -��--- -
_ -__._-- --- --- _.
-B�- �- - �
30. Walls, Floor Ceilinq -(1)not clean (2)pooz repair (3)holes (4)cracks (5)peeling paint (6)stains (7)missing
tile
31. Electrical - LIGHTS OR OUTLETSz (1)inadequate (2)poor zepair (3)no�workim� (4)improperly wired or grounded
32. General -(1)no dooxr ESCAPE WII�IDOW: (2)too emall (3)too high off floor (4)obstructed
LIVING ROOM/fiALIi�AYS
33. Walls, Floor, Ceilinq -(1)not clean (2)poor repair (3)holes (4)cracks (5)peeling paint (6)etains (7)miasing
tile
34. Electrical - LIGHTS OR OUTLETSa (1)inadequate (2)poor repair (3)non-working (4)improperly wired or grounded
35. Smoke Detector -(1)not provided (2)non�aorking (3)improper location
GF.�tER�1L , . .
36. Doors, Windaas, screens -(1)looaeifittisig (2)holea (3)not caul;ked or westl�erstripped (4)windows not openable
(5)no screens (6?broken glass (7)locka don't work '
37. Insecta/Rodents - (1)easy acceas (2)harborage.(3)food sources (4)preaeat (5)extarminate
38. Heat -(1)inadequate (68°F. at all tim�) (2)not provided
COMMEIJ'� t , _ '
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GITY OF PAIDLEY� SUBJECT ggSIDENTIAL RII�ITAL PROPERTY
B431 UNIVERSITY AVE. NE. INSPECTION REPORT
FAIDLEY. MN. 6843e [B'123 671-3460 ____
�y ,�.. � !i .0.+ � �� 6F ���
DATE: i „=fl-1i.�) �'� ADDRESS s � � �� �
6� �-��
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UNIT INSPECTION: N ;� �-_� HIDRO�IS 1�'2 1�� 3 EFF. Missinq N�bar on Door
� >,..
of
KITCHIIO
21. Rin4 -(1)no xunninq water (2)poor repair (3)leaking hot/cold faucets (4)waste not vented or leaking
22. Walls. Floor, Ceilinq -(1)not clean (2)poor repair (3)holes (4)cracks (5)peeling paint (6)stains (7)misaing
tile
23. Electrical - LIGHTS OR OUTLETSa (1)inadequate (2)poor repair (3)non-working (4)impmperly wired or grounded
24. Stova/Refzigerator -(1)not provided (2)poor repair (3)non-workinqt GAS CONNECPION: (4)no shut off (5)flexible
piping
$ATHRO�i
25. Hand Sink 6 Bathinq Facility -(1)not present (2)poor repair (3)leaking hot/cold faucete (4)no running water
(5)wasie not vented or leaking ,
26. Toilet -(1)non-functioning (2)leaking (3)no nuining water (4)no anti-siphon ball cock (5)no aeat
27. Walls, Floor. Ceilix�g -(1)not clean (2)poor repair (3)holes �4)cracks (5)peeling paint (6)stains (7)miss3ng
tile
28. Eleotrical - LIGFITS OR oUTLETS: (1)inadequate (2)poor repair (3)n.on-working (4)improperly wired or grounded �
29. General -(1)not within the apartment (2)access through bedroo� (3)no door (4)no mechanical or natural vent
BEDR(�MS
30. Walis. Floor Ceil3nq -(1)not clean (2)poor repair (3)holes (4)cracka (5)peeling paint (6)etaina (7�)miaeing
tile
31. Electrical - LIGHTS OR oUTLETS: (1)inadequate (2)poor repair (3)non-working (4)improperly wired or grounded
32. General -(1)no doorp ESCAPE WINID�Ia (2)too small (3)too high off floor (4)obstr.ucted
LIVING ROOM/HALISIAYS
33. Walls, Floor, Ceilin4 -(lynot clean (2)poor repair (3)holea (4)cracke (5)peeling pa3nt (6)etains (7)missing
tile
34. Electrical - LIGHTS OR OUTLETS: (1)inadequate (2)poor repair (3)non-working (4)improperly wired or qrounded
35. Smoke �tector - (1)not provided (2)non�working (3)improper location
GENERAL
36. D�ors, Windowa LScreens -(1)looae-fitting (2)holes (3)not caulked or weatherstripped (4)windows not openable
(5)no screens (6)broken glass (7)locks don't wozk
37. EasecEs/Rodente - (1)easy access (2)harborage (3)food sourcea (4)present (5)e�cterminate
38. Heat -(1)inadequate (68�F, at all times) (2)not pmvided ;
�_Y VI]I� ti .
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UNIT II�ISPECTIONa k HEDitOOMS 1,�`�2� 3 EFF. Missing N�ber on Door
��
KITCHFl�I �
21. ,,iDlc -(1)no running water (2)poor repair (3)leakirg hot/colcj faucets (4)waste not vented or leakinq
22. Walla� Floor, Ceilina -(1)not clean (2)poor repaiz (3)holes �(4)cracks (5)peeli� paint (6)staina (7)misaing
tile .
23. Electrical - LIGHTS OR OUTLETSa (1)inadequate (2)poor repair (3)nor�-working (4)improperly wired or qrounded
24. Stave/Refr3gerator -(1)not provided (2)poor repair.(3)non-workingt GAS CONNECTION: (4)no shut off (5)flexible
piping
9ATHROGI�! �
25. Hand &ink & Hathing Facility -(1)not present (2)poor repairj(3)lealcir►g hot/cold faucete (4)no running water
(5)waste not vented or leaking
26. Toilet -(1)norrfunctioning (2)leakinq (3)no running vater (d)no anti-siphon ball cock (5)no aeat
27. Walis, Floor, Ceiling -(1)not clean (2)poor repair (3)holes;(4)cracka (.5)peelinq paint (6)stains (7)missing
tile �
28. Electrical - LIGHTS OR OU7Y,ETS: (1)inadequate (2)poor repair (3)non-working (4)improperly wired or grounded
29. General -(1)not within the apartment (2)access through bedroaaa (3)no door (4)no mechanical or natural vent
BEDROOMS - - - - - ---- -- - -- - - ---- ------ -- - - -
30. Walls, Floor Ceilinq -(1)not clean (2)poor zepair (3)holes (4)cracke (5)peeling paint (6)atains (7)missinq
tile
31. Electrical - LIGHTS OR OUTLE75r (1)inadequate (2)poor zepair (3)nor►-workinq (4)improperly wired or qrounded
32. Geaeral -(1)no doori ESCAPE Wi2�IDOWs (2)too emall (3)too high o£f floor (4)obstructed
LIVING ROOM/IiALii�AYS
33. Walls, Flooz, Ceiling -(1)not clean (2)poor repair (3)holes (4)cracke (5)peeling paint (6)stains (7)missing
tile
34. Electrical - LIGHTS 03t OUTLETS: (1)inadequate (2)poor repair (3)non-working (4)improperly wired or grounded
35. Smoke Detector -(1)not provided (2)non-�working (3)improper location
G�uc�osr. _ _-
36. Doors, wiadows� Screei�s -(1)loose-fitting (2)holes (3)aot caulked or weatherstsipped (4)windaws not openable
(5)no screens (6)brokeri`-g�ess (7)locks don't work
37. insecte/Rodenta - (1)easy accesa (2)hnrborage (3)food aources (4)preseat (5)extesminate
38. Heat -(1)inadequate (68°F. at all timea� (2)not provided
CQM[+�IaS:
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CI�iY OF
FRIDLEY
FRIDLEY�MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
August 19, 1994
,
Mr. David Baune
4960 St Albans Bay Rd
Excelsior, MN 55331
Re: Street Name Change For Your Building Effective Immediately
Dear Mr. Baune:
The City Council approved your request for a street name change on
August 15, 1994. We are able to notify the businesses listed in
the enclosed letter but we are unable to change your tenants
listing with US West which in turn updates the 9-1-1 database. We
are enclosing a form letter that should be distributed to each
tenant in your building.
If you have any questions on this matter, please feel free to call
me at 572-3602.
Sincerely,
oc���
JO PA CIO
Chief Building Offic�al
JP/mh
ENC: 1
RESOLIITION NO. 67 - 1994
RESOLIITION RENAMING 59 1/2 WAY N.E. TO ISLAND
PARR DRIVE N.E.
WHEREAS, 59 1/2 Way runs generally in an east/west direction
between East River Road and Anna Avenue; and
WHEREAS, there are six lots that front on 59 1/2 Way, with four
using 59 1/2 Way as their address street and two using East River
Road as their address street; and
WHEREAS, the owners of the four 12 unit apartments that use 59
1/2 Way as their address have petitioned for this change of
street name; and
WHEREAS, the name change could assist in locating Islands of
Peace park; and
WHEREA�, the Police and Fire Departments of the City of Fridley
have no objections to the street name being changed.
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of
Fridley:
1. That all of 59 1/2 Way be renamed to Island Park Drive;
and
2. The City of Fridley's Finance Director is hereby
directed to register said street name change with the
appropriate authorities of Anoka County and the United
States Postal Service as well as other affected
parties; and
3. That this change will take effect immediately.
PASSED AND ADOPTED BY THE CITY COUNCIL OF THE CITY OF FRIDLEY
THIS 15TH DAY OF AUGUST, 1994.
ATTEST:
WILLIAM A. CHANIPA - CITY CLERK
WILLIAM J. NEE - MAYOR
N
� �
�
I
Community Development Department
PLA►NNING DIVISION
City of Fridley
DATE: August 11, 1994 `
,�ry
TO: William Burns, City Manager �
FROM:
SUBJECT:
Barbara Dacy, Community Development Director
Resolution Renaming 59 1/2 Way N.E. to Island Park
Drive N.E.
The property owners along 59 1/2 Way N.E. have signed a letter to
request a street name change from 59 1/2 Way N.E. to Island Park
Drive N.E. The property owners believe that the name "suggests
that the street is an alley, somewhere between 59th and 60th
Street". In addition, they explain that 60th Street "is really
Charles Street", apparently compounding the problem. Finally,
the owners believe that the new stre�et name is more appealing and
provides a name recognition with the Islands of Peace Park
nearby.
The request has been routed to all City departments. Upon
approval by the City Council, the Public Works Department will�
order and install new street name signs. The Building Inspection
Department will notify the post office and public utilities.
Recommendation
Staff recommends the City Council approve the attached resolution
as presented.
BD/ dn
M-94-464
�
_ - , : ---.}
_ ;.,�
� -
July 22, i994
Ms. Mary Hintz
Inspections Department
City of Fridley
6431 University Avenue N. E.
Fridley, MN. 55432
Re: 591/2 Way Street Name
Dear Ms. Hintz:
Pursuant to our recent telephone conversation, I am writing to request
that the street name of the above street be changed to: "Island Park Drive".
1 purchased the small apartment at 150 591/2 Way in 1984. Rece�tly, I
have been having a progressively more difficult time attracting and keeping good
renters. There are several rea�ns for this, but one of the problems that I have always
faced is the street name. The current name suggests that the street is an alley
somewhere between 59th and 60th street. To compound the geographic probiem,
what should be 60th street is reatiy Charles Street, so trying to e�cplain to someone
whers 591l2 Way is can be very difficult.
Of even more importance than geography, the name itselt suggests that
everything connecfed with this street is shoddy and second class. I have always been
kidded about the name trom acquaintances and tenants, and t do think it is a deterrent
to prospective renters even coming out ta look at my units, to say nothing of not renting
them. It was a very paor selection of a street name in the first place, and ihe problem
will not go away with time. With the difficulties of the currerrt rerrtal market to deai with,
the poor street name is one of the factors 1 would like to see addressed.
There are only four properties on the street who currently have the 591/2
address, and the o#her three are twelve unit apartments like mine. I have discussed
this problem with all of them, and they are in unanimous agreement that the street
name should be changed. Due to the proximity of Islands of Peace Park just to the
west of our property, I would suggest the name of °Island Park Dr'Ne", since many
people enter and leave the Park on 59 1/2 Way. That is a lovely name that connects
this short street to the Park from a geographic standpoint, whiie making for a classy
address that owners and residents can be proud of.
12C
m
I am mailing this to you this date, and am mailing a copy to the other
owners so they can mail their agreement and acquiescence to you. Please act on this
request as soon a possible.
C' Very truly o rs,
/- �
. �l�s ;:
J n H. Ward
5916 Hansen Road
Minneapolis, MN. 55436-2513
We have read the above letter of John H. Ward. and as the other three property
owners with a 591/2 Way Address, we unanimousty support the change in street
name to Island Park Drive.
Curt Bos#rom
190 Buiiding
Fit-Bar Enterprises
S#even Fiterman
151 Buiiding
12D
David Baune
191 Building
I am mailing this to you this date, and am mailing a copy to the other
owners so they can mail their agreement and acquiescence to you. Please act on this
request as soon a possible.
Very truly yours,
John H. Ward
5916 Hansen Road
Minneapolis, MN. 55436-2513
We have read the above letter of John H. Ward, and as the other three property
owners with a 591/2 Way Address, we unanimously support the change in street
name to Island Park Drive.
1
� ��� � /�
���� . �� �
Curt Bostrom
190 Building
------------------------------------------------------
Fit-Bar Enterprises
Steven Fiterman
151 Building
------------------------------------------------------
12F
David Baune
191 Building
♦ '
i am mailing this to you this date, and am mailing a copy to the other
owners so they can mail their agreement and acquiescence to you. Please act on this
request as soon a possible.
Very truly yours,
.lohn H. Ward
5916 Hansen Road
Minneapolis, MN. 55436-2513
We have read the above letter of John H. Ward, and as the other three property
owners with a 591/2 Way Address, we unanimously support the change in street
name to Island Park Drive.
Curt Bostrom
190 Buiiding
�
�
Fit-Bar Enterprises
Ste�en Fiterman
151 Building
12E
David Baune
191 Building
i am mailing this to you this date, and am mailing a copy to the other
owners so they can maii their agreement and acquiescence to you. Please act on this
request as soon a possible.
Very truly yours,
John H: Ward
591 fi Hansen Road
Minneapolis, MN. 5543fi-2513
We have read the above letter of John H. Ward, and as the other three property
owners with a 591/2 Way Address, we unanimously support the change in street
name to Island Park Drive.
Curt Bostrom
190 Building
Fit-Bar Enterprises
Steven Fiterman
151 Building
12G
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� /'�'1 � CITY MALL FRIOLE� SS�,Z NUMBER flEV DAT@ VAGE OF AiPROVED BY
�""�' �'� 612-571-3450 910-F15 11/20/O1 / /
108 AODRESS 191 Island Park Dr NE �
t LEGAI �OT NO. 9LOCK TfiACT Ofl AODITION SEE ATTACHED
oescR. 3 1 East River Estates SMEET
2 PiiOPERTY OWNER MAIL ADDFiES$ ZIP PNONE
Midwest Investment Co, 1107 Hazeltine Blvd ��535-M, Chaska, MN 55318 952-448-8818
3 CONTRACTOF MAIL ADORESS Z�P PMONE LICENSE NO
Castle Roofing & Siding, 3639 Nicollet Ave S, M 1s, MN 55409 612-827-3948
4 ARCMITECT OR DESIGNER MAII ADOFiESS ZIP PMONE LICENSE NO.
20007187
5 ENGINEER MAII AODRESS ZIP PHONE LICENSE NO
8 USE OF BUIIDING
Apartments
7 CLASS OF WORK
O NEW ❑ ADDITION � ALTERATION �J REPAIR O MOVE • O REMOVE
8 OESCRIBE WORK
Install rubber membrane roof over existing roof.
9 CHANOE OF USE FROM TO
STIPULATIONS
1. Provide structurai approval prior to overlay.
2. Provide roofing specs for membrane and requirement for overlay.
3. Roof slope min 1/4"/ft.
SEPARATE PERMITS ARE RE�UIRED fOR ELECTRICAL. PLUMBING. MEATINa, TYP� O� CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULL AND VOID IF WQRK OR CONSTRUCTION 20NING SO. fT CU fT
AUTHOfl12ED IS NOT COMMENCEO VjIITHIN 80 DAYS. OR IF CONSTpUCTION
OR WOFiK IS SUSPENDED OR ABANQONEO fOR A PERIOO OF 120 OAY$ A7 "
ANV TIME AFTER WORK IS COMMENCED. ° NO- DWLG. UNITS OFFSTREEI PARKING
I HEfiEBY CERTIfY THAT I HAVE fiEAD ANO EXAMIN�O THIS APPLICA7IQN STALLS GARAGES
AND KNOW THE SAME TO BE TflUE ANO CORRECT. ALL PROVtSIONS OF LAW$ yq�UA?ION SURTAX
AND ORDINANCES GOVERNING TNIS TYPE OF WORK WILL 9E C(�MPLIED @
WITM WMETHER SPECIFIED NEREIN Oii NOT. TME GRANTING OF A VERMIT �S � J89.00 �p�F.39
DOES NOT PRESUME TO GIVE AUTMOqITY TO VIOLATE Ofi CAMCEL TMp pEqM17 FEE SAC CHARGE
PROVISIONS OF ANY OTMER STATE OR LOCAL LAW REGULATING CON-
STqUCT10N OR THE PERfOFiMANCE Of CONSTRUC710N $167.25 Fire �8.79
PLAN CMECK FEE ; TOTAI F
$1 .43
S�GNATUAE 0� CON'AACtOA Op AUTNOAIZED 4GENT 101TE� EN P PEp �OATE IS IS VOU PEpM1T
��'�-�
S�GNOTUAE O� OWNEp��� OWNEA BULLDEp� iOATE� . ' BL -�NS� ��htE
�
11/19/2001 22:02 6128227818 CASTLE ROOFING A PAGE 04
ltotinsse�d Caat S�� CITY' OF FBmZ+RY Elt�Qtive 1/�,/,�001
Recai�t � 6763)Si�=_3604
—..,.._ it-� . �R
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So
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6vidt� �' Pt'--„�,_
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—~� �.�_� ?CT'A% �IA[,tT�
auilding p8e corastruct,�o�, �
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`ma�ar. a R�S9
S@=1�liE P6eg ;,� �iS �
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s I� Bxce� of Pr
�"ix� suro� S_ e� ,% dAsid A�I1our�t -�a� Ravars� $1�e
eteto �u�r �d �- . 00l x Permit VB,l{3�ti0G3 f=/10Cb i)
� � �I . SO/$1, 000 Val.vatie►�y gg� �
sAC Ck�arga, � t �: for ��3 M317.xon)
�ros�,on Wntroi � �=150 S�r 9AC tli�.f.� (,pl.aaa to A1o►CC for d@teste�,r�seio�)
Paz4c Fop ��b0.00 Co�sesv�C3c� Plass IItvvle+w
S � Fe� Det
�C. A��aCD�l]Lb � RY1�1�� B�' $=��Sr171g
�i°eW�Y E�craw ASrv�messb ��cemaASy [� : aPot N�ces�ary []
f
�`�]►L s� ' �� '-»�.�_ te�t x 8•lb.lO/�'oot
..�� •G'��' �Ct�< A,TZ'�C� S
. l%� ��R � �� �b� T=�vr.��oN�
� ��a-I � � d o� Q�6,I�'�
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v�) ��d� �o�°� /1'1 i-�1. � ��/�� °
sua�ecr P .
c�ty of Fridley 3 3 2 6�
AT THE TOP OF TNE TWINS g U I L D i N G P E R M I T
�
; � RECEIPT NO.
� • COMMUNITY OEVELOPMENT DIV. � �� �
� � ti: —
r � � PROTECTIVE INSPECTION SEC.
1 .1 �
� 1 �'��1 � CITY MAL� FRIDLE� SS�32 NUMBER pEV DATE PAGE OF APPROVED BY
�"'"� � ��� 763-571-3450 910-F 15 11 / 18 / OZ / /
J09 AODRESS 191 Island Park Br NE
t LEGAL �OT N0. BLOCK TFACT OR ADDITION SEE ATTACHED
oescR. 3 1 East River Estates SNEET
2 PpOPERTY OWNER MAIL AODRES$ 21P PNONE
A,T investments PO Boa 270-262, Vadnais Hei hts, 1�'IN 55127 612-414-0397
3 CONTRACTOR MAIL ADORESS ZIP PHONE LICENSE NO
MN Rusco Inc 5558 Smetana Dr, �Iinnetor.ka MN 55343 952-935-9669
4 ARCNITECT OR DESIGNER MAII ADORESS ZIP PHONE LICENSE NO.
S ENGINEER MAII ADOiiESS ZIP PNONE IICENSE NO
8 USE OF BUILDING
12 Unit Apartment
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION q_ REPAIR O MOVE O REMOVE
1l
6 DESCRIBE WORK
Rep�ace 56 wizdows within existia�g o enings
9 CHANGE OF USE FROM TO
STIPULATIONS
�e���� � ������on Card�
i�� �� ailed
�� To Post
„�,� �-�-�a�
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, MEATING, TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONOITIONING
TMIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTAUCTION ZONING SO. FT CU FT
AUTMOR�ZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONEO fOR A PERIOD Of 120 DAVS AT
ANY TIME AFTEF WORK IS COMMENCED NO DWLG. UNI7S OFfSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION STA��S GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUR7AX
ANO OROINANCES GOVEpNING TNIS TVPE OF WORK WILI BE COMPLIED
WITH WHETHER SPECIfIED MEREIN OR NOT. THE GRANTING OF A PEqM1T �Z7sSOO �13.75
DOES NOT PRESUME TO GIVE AUTMORI7V TO VIOLATE OR CANCEL THE pEqMIT fEE SAC CMARGE
PROVISIONS OF ANY OTMER STATE OR LOGAL LAW REGULATING CON• $421 .5S � 7. SO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CMECK F T AL FEE
$462.80 �
S�GNATUAEOFCON'AACTOAOp4UTMOp�2E0AGEN� iD�iE� HEN PR Y VALI A D TMIS IS YOUR PEiiMIT w —
/• ����/
S�GNYTU�7E O� OWNEp��f OWNEp BU�LDEp� �D�iE� Bl �h5 ���tf
�
�
OCT-30-2002 10�19
C1fY OF FRIDLEY
643`1 University Ave NE
Fridley, MN 5543Z
(763) 572-3&04
CONST.
Legai
Owner
CONTRACTOR & ApDRESS _�J1V (LI.SL�O . �I'le •
FROM CITY OF FRIDLEY
TO
R-3, COMMERCIAL & ZNDUSTRIAL
BUILDING PERMIT APPLICATION
9529359544 P.02iO3
Effective 1/1/200Z
�Il� d��'�� � � c'���
..,n,n / .��i�^��
Te1# (R�Z) 935' I!�(�i
Architect Reg.# Enginesr Reg.#
rYPE oF wo�K �� rre,�
.1��Qr�.s c.;n� �ci
BuiLOZN� caNSrRUCTroN
C7 Additian [] Aiteration -Describ
0
0
, ,
�•.L�J �L
� � �
�
1 � �� �..� � '� � / I /
OFC. AREA; �ength Width Height `�Sq. �t. �
WHSE AREA: Length Width _, Height Sq. Ft.
OTHER AREA: Length Width Height Sq. Ft.
APPI.ICANT; I � � Tel d# � ' �.7J � `'1C� ! Date � � " �
�/i�
VALUATION
Sq, Ft. x$ Cost/Sq. Ft. = Valuatian $ )
Sq. Ft. - x� Cos't/Sq. Ft. - Val uati on $ � T$���QD . o0
Sq. Ft. x$ Cost/Sq. Ft. = Valuation $ ) TOi'AL UALUE
Building Use • �Construction Type Occupancy Group
Air Conditionin [�Yes [ a Fire Protection Provided []Yes []No
Performance Bond Amount $ See Reverse for Schedule Received []Yes C]M1fo
Permit Fee ���
Plan Check $_.
Fi re Surcharge $ 0?7•�50
State Surcharge � /3 •7�
SAC Charge $
Erosion Contro1 $
Park Fee $
Spec. Assessments $
Drivewdy Escrow $
T47AL $ ��� ' $�
PERMIT FEES . �
See Fee Schedule on Reverse Side
In Excess of Prepaid Amount - See Reverse Side
.Oq1. x Permit Valuation (1/30th Y)
$.50/$1,000 Valuaiion (See Sched. for > $1 Million)
$1?.00 per SAC Unit (P1ans to MWCC for determination)
$450.00 Conservation Plan Review
Fee Determined By Engineering
Agreement Necessary [] Not Necessary []
� feet x $17.Q0/foot
`� `` D�
ATTACH STIPULATIONS
PLUMBING
COMMERCIAL APPLICATION
City of Fridley
����� �-�'� �
P it Num r
�e �i� �� {�.
Date Recei.vsd
DATE �° 2� �� YOUR E-MAIL ADDRESS
SITE ADDRESS � i ���4'1 � �J�-�C
TENANT ' SUITE NO.
NAME C� a'-��° 7 1 ��o I A
PROPERTY OWNER/ qpDRESS
TENANT
CITY STATE ZIP
PHONE #
NAME � � � �� J` � � ` UCEPISE #
' ADDRESS "'� 2 � 17�c n �j' � ��
CONTRACTOR CITY C���. n!�� STATE /�'�i.N ZIP�%!6
PHONE # °7. % � % ( � o a 5�L FAX
PERMIT TYPE ❑ INSTITIJTIOIdAL ❑ MULTI-FAMILY ❑ SWIMMING POOL
❑ TOWNHOUSE ,� COMMERCIALIINDUSTRIAL ❑ OTHER
TYPE OF WORK p NEW ❑ REPLACEMENT � ALTJREAAODEL
DETAILED DESCRIPTION OF WORK �
� `C sl S . Gl q/ L 'T� "�/ �U ` d �
FIXTURES: (INDICATE TOTAL NUMBER OF EACH)
�F ES BASED ON $10 PER FIXTURE, EXCEPT WHERE NOTED URINAL
CLOTHES WASH FLOOR DRAINS RPZ VALVE/ ($15)
DISHWASHER GAS PIPING BACKFLOW PREV.
WATER HEATER ($35)
DRINKiNG FOt1NTAtN GREASE TRAP ROO� DRAINS �ATER METER
FAUCET KITCHEN SINK � SHOWER �ATER PIPING
FLAMMABLE WASTE �LAUNDRY TRAY SLOP SINK �ATER SOFTENER ($35)
TANK Z LAVATORY SWIMMING POOL ��ATER CLOSET
Permit Fee
Plan Review
Surcharge
Total Due
$ �/ U . �
S °
$ � .��
S ,�/ �. ,So
Minimum: $35.00
$.50 on permits less than $1,000
Make Checks Payable to: City of Fridley
THIS IS AN APPLICATION FOR A PERMR— NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work wilt be in conformance with the
ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that 1 understand this is not a permit but anly an application for a
permft and work is not to start writhout a permi� that the work will be in acxordance with the approved plan in the case of all wrork which requires review and
approval of plans.
NAME OF APPLICANT_ �, �� �6 �^ DATE lo / 2�[ 4 6
SIGNATURE OF APPLICANT
CITY OF FRIDLEY COMMUNITY DEVELOPMENT DEPARTI
6431 UNIVERSITY AVENUE NE, FRIDLEY, MN 55432
(763) 572-3604
From: 612 782 9772 Page: 1/1 Date: 10/11/200610:42:50 AM
FROM : PIPERIGHT PLUMBING FAX N0. : 612 782 9772 Oct. 11 20�6 11:
$uildi�g
���
i��-s����
�����x�
►��C� APPLI+�A'T`IQ►N
�C�'.��' �F ��
Permit
�� ��
Date Rec'd:.� �-�.
naTe _ _ Yau� �artaa nnn�ss. CENL�CTONiAS�USFAIVII�.Y.NET
srrEn��ss �' �1 -- �� 9�r�.1,rt�. '� t�h -- -. �
'�� � Y' �,'z . _,__ _,... __ � xa. �. �. - - -
ROPE�t�'X �. t i'�tld�totf �
aV1+N�/ ���: 3�1 Cai�l.pq� Ave .,�Mill VBlley Calif. 94941
'� p��: pha�te MN 763 �aI�4 '7�01 P��e Catif. 4iS �$8 Ul � 1
&t78� A CO�°Y pF
YQ[1R iAZ�
� vvix�
kE�tM[i' TYPE
1''`°i°�' -- -- PIPERiGi�'r'
Sl'A1E LICS�SE �F ;S'� 1tC�L188 #
� �0'7101V,�issitss,i'
� 61286�9174 �
•�. .
. � � : .� �-�
T7lP'E OF R+OBKt I � �►
n�� n�sc��rr t� wo�c _.._,
r�tru�s: �ccn� raxa�. rn�oF �
..,,_�.a�wn�
..�DIS�FVA��
.,D�FOIJA�TTAIl�T
_FAUCEf
^FLA�ABLEaiA9rERANS
Tot�1 Job
Ya�o�
FE�mit Fc►.0
Sm�cl�e
r� �
0
�
INC.
3�ii' , Caon Rapids ,1NN 55433
�x 18afl 604 241Q
Cti �4 � � ��� .V � f� �
:
�.�� .
# � �.�.,,� �.�
� ► ���•
��n�ro�t�g.
�.aa�e�nn�s ! �arzvnz.vs _u��t.
�tiA3l'�'�N'(i BACBFLOW PRBY. .� WA�'Ftl�A1'Stt
�.[� TliA�' ,,,_ BUOF DRAINS ._. WA7Y�dt A�7ER
,^ffil�d$II� i ,�$$QV� _WATERP3PII�(ir
�. [.A�lNi3�Y'i�AY � _... � � ...._ WAT�t &�QP7'i�
^LAVAIOBY � �S�it3i+40L _. WAIERCLO�T
�
$-- PO S-� Ail feea are ��sed o0o va�uaet�rn, �ng tbe c�st of' i�hor ar�d �ts.
i
$ �-� tl,zs'�o a�f J�!b valuactoa� � M�mi�m fee: �35}
s a �� vai�mat�o xl.�s
$�..-�._ M�ca C�c�t� payebie t�o: t� �aFrld�+y
�rs nr� n�ca� � a � xarvu�t�u�.r��
1 I�c�► a�plY � a��it � I eck�owle�ige that � alsoove is coa�lete aad accm�te; �at the ��v�ill bo in
�o� with tba o�aa m� cqd�s of 8� Ci�y vf Fridi, �ad with ti� Mimnesrn� C.�uceion Cade�; t6�t I u�atamd tms is
ao! a peeffit b�at a�aly ��on fa� e}�it aad arork is ac�t b smet wilhoart e p� ti�at t�e wo�ie witl be ��� � the
� gl� in t�o r�te +a�all wask wbial� �s raview and I�navel af pl�s.
���
BIGNATI�BE OFAPFLI
�i►�..__ )�� 11. ' �? �— -
� af �Ttdley �diil� �e�tio�s Ile���ent
+6R31 'C3nivexs3ty Avenfae I�� Fric�ley, NY�T SS432
763-572-36#1�4 FAX: 76� 5f�2�r4977
Building
Inspect�ons
7�3-5"�Z-36Q4
SITC ADD[iT58
TENAjd'f
OW NER/
TEh1AN'C
From: 6514235677
Page: 1/1 Date: 1�J27J2007 3:35:02 PM
PLUMBING
C�NIIV;[EktCLAL A:PPLICATIUN
CITY �O�' F�DLEX
��' � ��� YOU�F•NfAI[.. AI31?R �---,..___._._..... _,. ---
2�In.n� a�� 17r,. N.
SU�Ad►7' A t.OPY OF g7A7E LICENSE
YOUR STATE AADRESS�
LICENSEWI7.H pHpNS_ 1?.
PFRNllT TYPE I ❑ 1N3'rtTUT[ONAL
a �rawnt�ravag
0
TYPE OF WORK: � � �
Received Hy:_
$[.JIT'6 NC7. _ ....._._
Mw� «► �+a trA sTn� �i.�P 'S�', e3 k
� �'t' � � `Itt tc+ '�7
�
�� � �� EXP UATE � � ~ :
x 1a5 °'° S'� W• c��rv�+�a^
p 'a'�I� ��_ FAX �,� 3 Z � .
��•Tf.FAMfT..Y
❑ COMI4�RCIALTNDUSTRlAl.
�I�P��1CC{V�TS�
UE'CAILED DESCRIPiION OF WORI� � rr:
fiW�a �1.A,wed �'4eV�.'�"°. f' ��
FI7(TURF.9; (tWpT6,4TE TUTAL NUib�L•1t OP CACrn
�
�I+��ZIP ���
'��i-
� 5WIN�NINC3 POOL
� oT11T:R
❑ AL7ERAT(ONrREMUDL'L
o. _ _ � _ .
� CLOTFiE9 WASHETt FI,QpR 1�RASNS � RP7. VALVB _ U.R1N�1L
_Df91lWASHBR �CiAS P7PtIY0 DACI�'LOW PREV. _wn7RR F�a'ra�
� DRINKfNCr FQZ7IVTAIN _ CiREASE TRAP __, RC)C}F DRAINS _ WAT�E� ME'j'ER
'�%AUCE'f _ KTfC.7-!EN SINK _ SHOW ER _ WA'fER PIPING
_ FI.AMMAB4B WA8'C� ThNK _ LAUNARY TRAY _ SiAT' 91NK __ wA7ER SOPTBNER
_LAVATORY _5WIMMINGPQOL _WAT5RCL09FT
. .. . . . .. . ... . .. .
�'pfp��,►p� $ � a� ��- "'�'A,]) feev Are based pn valuatton includ(ng the cost of Iabor �d matcrials.
Valuetion �
PcKmit Frx
Surah�rge
7'otal Due
$ ��� D6 ��,Z�%ofJob Valaation / Minimum f�: $35)
$ ', Gs - -.-_. Vnlua�ion X .0005
$. �^ ,� Mmke Checks Payable to: City of Fr�dlcy
THI5 t9 AN APPLICA'ftON FOR A PGRMIT NOT VALIp UNTTL PR�r3.SFn .
I hereby apply for a building permit and I acknowlcdgc th3t the information �bave is complete and acotvatie; that the work will bc in
confomtarn,s widi tlio or�iina►t�s and �ics af tl�o City of Pridloy and with thc Mini�osoto Conatrucc,an Codcs; that I undeesta�d this is
imt a permit but only an application for s pern+it ond work ie noY to st�rt without a nennit; 4hat thc wtltk will be in ACCOrddnce with the
�pprove� plan in the wsc of all work whiclt requfres riwfcw and appmeal of plans.
NAMC Or /�PLICANT /� 4Q: Y�� � �� � Lf S DATti I Z,�_ 7..� a�"
3T(iNATUR.fi OF APF'�TCANT �,� • �w-+ �...,..
PLEASENOTE: SEPARATE PERMITS ARE RE TJIRED FOR BUILDIATG ELECTRICAI. ANI7 Mt?CiiA1V�CAL WORK
�ity o�' F�riidley �a�Ud�g �pspections Departm�nt ,
6431. University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-�977 �
' V1C�� �� �.�/ �?G-� � ��� �� ���-�--��
�� ¢�.� �r,���',�i � �1�,! �=��`T� 5�`�'�GL-- i` �� � �� T �= �
��n �i✓��~'��C� ��/L-�l�i��
Building MECHANICAL Permit No.:a � �4�
Inspections COMMERCIAI. APPLICATION xeceivect By:
763-572-3604 CITY OF FRIDLEY Date Rec'd. � D
763-�02-4977 FAX ����,-,�s
DA� �°-,t �— O�' YOUR E-MAIL ADDRESS l�'I�T l��a ��oo /(� ���� A ec��
S ITE ADDRESS I � I ��[% �✓N' 1f ��^ 0 , !� � � L'J �! � '1"'
THIS APPLICANT [S: �CONTRACTOR
PROPERTY Np�:
�wNER/ ADDRESS: CITY STATE ZIP
TENANT
PHONE: CELL: FAX:
CONTRACTOR COMPANY NAME: Gc9 Flr�i �1 �
NOTE: CONTACT PERSON: %%il4/`�C ��d✓► � c�
SEPARATE CITY
LICENSES ARE STATE BOND #� f�� �� EXP DATE: IaZ ���� �
REQUIRED FOR GAS `/
AND HVAC. ADDRESS: K a2 % v t• �►. � I/� i/` CITY ��i8/��e� � STATE/�ZiP �Sa3 4
PHONE: � S/°�3 �' �i S S`/ CELL: F� S� ' 3a� �' C�S `� FAX: fr.s� �/ �' o��ri c1
SUBMIT COPY OF BOND
AND MSURANCE CTfY GAS LICENSE # CITY HVAC LICENSE # EXP:
PERMIT TYPE � MULTI-FAMILY ❑ COMMERCIAL ❑ INSTTTUTIONAL ❑ CONDO ❑ INDUSTRIAL ❑ SWIMMING POOL
❑ OTHER
TYPE OF WORK: � NEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK:
� tYe� � Fv�'n��� , 13�.�� N v� I�o C�a� i/�J� �vt ���Ju. oa ����,
EQUIPMENT DVSTALLED MFG: , MODEL: SIZFJBTU
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZEBTU
A/C DUCT WORK ROOF TOP UNiT (RTU)
BOILER FURNACE REFRIGERATION
CLASS 1 HOOD GAS APPLIANCE STEAM/HOT WATER HEATER
CLASS II H�D GAS PIPTNG SWTMMING POOL
COMMERCIAL KITCHEN POOL HEATER OTHER
ALL FEES ARE BASED ON VALUA N, CLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION: $ f
PERMIT FEE $ 1.25% OF JOB VALUATION / MINIMUM FEE $35.00
SURCHARGE $ VALUATION x .0005 / MINIMUM .50
TOTAL DUE $ MINIMLJM $35.50 Make Checks Pa able to: Ci of Fridle
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTiL PROCESSED
I hereby apply for a mechanical permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that i understand this is
not a permit but only an application for a permit an ork is not to start without a permit on site; that the work will be in accordance
with the approved plan in the case of all work whic requires review and approval of plans.
SIGNATURE OF APPL T PRINT NAME DATE
/ �
APPROVED 8Y DA �
� ° � � �: �� � �,°' .�. " �; ��, �: r: ° � �� �_ ��
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�.iiy vi ri iuicy
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
7b3-572-3604 FAX:763-502-4977
Building MECHANICAL Permit Ivo.: ? � � �$
Inspections COMMERCIAL APPLICATION Received B•
763-s�2-3604 CITY OF FRIDLEY na �a
763-502-4977 FAX EFFECTIVE 1-1-OS � 6
DATE � }� o''� \ � • �jO '' %(��jYOUR E-MAIL ADDRESS I��'`� �a ��Z �YG'�t�i�.v w� ..n a-�
srrE,�nv�ss � av `'T s1ow•� �o��-'�- �, . �v , �. -^F r � �.l - �� N 5 SC-t�
THIS APPLICANT IS: '�CONTRACTOR
PROPERTY N,�:� i �I C� (� ;,�1
OWNER/ ,,�DRESS: CITY STATE ZIP
TENANT
PHONE: CELL: FAX:
corrr�►cTOR co�� N�: E��� � �-�'�`9
No�: �.�t o� 1 � o.
SEPARATE CTl'Y CONTACT PERSON: � S
LICINSES ARE STATE BOND # �-C'�C� �'`��' EXP DATE: � � O
�AND HVAC.G� a�nnxESS: �� 3 � 5��S ��V-'� �� ��t,wto��-L. STATE 0'"p�ZIP'�5 oC'�
PHONE: {, !05 �� � Z Z"��o� CELL: C;� tZ� Zt C7 "`E 'O gj � FAX: � S � 2-� �%�
SUBNIIT COPY OF BOND
AND INSURANCE CTfY GAS LICENSE # � C j� �(j � 5 CTl'Y HVAC LICENSE # EXP: I
PERMIT T'YPE M��TI"FAMILY ❑ COMIVIERCIAL ❑ INSTITUTIONAL ❑ CONDO ❑ INDUSTRIAL ❑ SWIMNIING POOL
❑ oTxEtt
TYPE OF WORK: � N� ��CENIIIVT ❑ ALTERATION/REMODEL
DETAILED DE CRIPTION OF WORK:
��s�tt ae..5 S\-� �'�j C v�c�-�-� '� t� t o.....�.�� �,,,.._- i�
c��'� � �� r�.co ��a G c� (iv�, ` o.� � d.,.�..
F lv�a..-
EQUIPMENT INS°fALLED MFG MODEL: SIZEBTU
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZEBTU
A/C DUCT WORK ROOF TOP UNIT (RTIJ)
BOILER FURNACE REFRIGERATION
_ CLASS 1 HOOD � GAS APPLIANCE STEAM/HOT WATER HEATER
CLASS II HOOD GAS PIPING SWIMNIlNG POOL
COMIVVIBRCIAL KTfCHIN POOL HEATER OTf�R
ALL FEES ARE BASED ON VALUATION INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION: $ 5�� � ��
PERMIT FEE $ �/ ��� 1.25% OF JOB VALUATION / MII�TIMiJM FEE $35.00
SURCHARGE $ • VALUATION x .0005 / MINIMUM .50
TOTAL DUE $ a MINIMLJM $35.50 Make Checks Pa able to: C of Fridle
THIS IS AN APPLICATION FOR A PERNII'P-NOT VALID UNTIL PROCESSED
I hereby apply for a mechanical permit and I acknowledge that the information above is complete and accurate; t�►at 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 application for a pemut and work is not to start without a permit on site; that the work will be in accordance
with the approved plan in e case of a11 work which requires review and approval of plans.
SIGNATURE OF APPLIC NT '�✓�`"� PRINT NAME � C2•rlo� �,t t cs S DATE ! 3�
APPROVED BY � DATE � �
' PLEA�uE'i`�+�?T�: S�'";F11t� P_. '� �I� R,E I.i[�,LiS FtJ� B�.J�:,D�IC"r, PI.,�,7MBi1�+SC'ir A�Ti7� �CTi�tC� "4N{�RI�.
c;ity ot r�ridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX:763-502-4977
?f r .
6
Furnace
Installed Date:
Installed Byot�er f� fi.
Tested By �
Manifold Pressure�
Sta.ck Temp a �l3
co2�io �,
o2�io �
CO ppm_ �'��m_
Limit Stting �.?� - va
Ignition�ar� Glow
Pilot main �
Liner size �/3
Return temp ?o
Supply Temp /�
AC
R22 410
Suc 'on press
Disc ge Pr ss
SH
SC
Return t
Supply em
TXV AXV Fixed
draw
G ounding
reaker size
C���-�ti A,�- a
�
�1 KI f! {�M,'rj�1
�+c 6 CO�CIIiG/
� oil
� Serial#
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. �
�0 �
.� . a
�� 4�. �
Make: �{e,.�
Model:l/l0�"C���� Fi��►1
Seria1:�C�o 11 �y.�l 7
BTU: S°D, Dp p
Vent size $" �
Stack size 5°°
Water heater vent size�
Condensate line �/'�}
Condensate Pump �'�}
Electrical�„'¢td s.� Z•�--e,�
Gas: �t/at
Liner installed: ,�d'�
Access: �, lc
Stat: T�'c'��4 r,bu, fl..,.,f�...._,A
Filter p C;
installed AC ke:
Model:
es No Serial:
Pad insta
Size Lin et installed:
ip installed:
����
� �(
I
� �T�d'a►•,�,. ,�� Qeav,�- ,�o e�G}' �" �'(3 QO P, �'v l�
House Heating Test Record
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�AJ� t�e�� �
,�r_�% p`cr��fi
3�`z,c
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Address / c1 % �''s�s�d ���C �� All Climate Heating & Cooling
Customer Name 2520 Coon Rapids Blvd, Suite 120
Date 7� Time %,� Contact �,,,, � Coon Rapids MN 55433
Phone Fax Tel: 763-548-8095
E-Mail _ Fax:763-421-1927
S
Furnace
Insta,lled Date:
Insta.11ed By o�t,�, �o,,,�;
Tested By
Manifold Pressure�
Stack Te �' `� a
CO2%
02% . �
CO ppm��.n
Limit Stting � 70
Ignitio par Glow
Pilot main �
Liner size
Return temp�
Supply Temp � �C
AC
41
SH
SC
Return t p_
Supply emp.
TXV AXV
Am dxaw
size
�
��o
e �
3�
T��-��
Filter
installed
� No
Size
��
�\
�1�CCl� IFf�
`7t��ac a co inc
Coil
Serial#
Make: � �
Model: /�/`7'� �0,� F'��
Serial: L,�1$'y,�SC�j ��3
BTU:_SC)p C�� O
Vent size „S
Stack size �
Water heater vent size�/
Condensate line /r/'�}
Condensate Pump
Electrical,,�,�� �� �.�
Gas:_�'�7`
Liner installed: l��4
Access: O�C
Stat:�ol,e��"s�.r Co+��
PV C • ,N.�i
A �e: /'
Model:
Serial:_
Pad inst�
Line set
�o���,sf�b,� A,(.o ��� �`' �ti�'s�� A�v� a
House Heating Test Record
i��t�� C�sfr,,•.�s��P�l1 a4sr�z� /�`� Lcaw�.
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�� ��
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Address � P'j % �S�h� �4v �C �/�, / All Climate Heating & Cooling
Customer Name 2520 Coon Rapids Blvd, Suite 120
Date� Time Conta.ct ��,,,,�e,� Coon Rapids MN 55433
Phone�l�.°���.-`/d7� Fa�c Tel: 763-548-8095
E-Mail Fax:763-421-1927 e
,,.
�� C
A�✓ r
f
Furnace
Installed Date:
Installed By r� Cc
Tested By �
Manifold Pressure�
Sta.ck Temp �30
CO2% t,-� �� ?
02% �1, �
CO ppIri �
Limit sttin� � ?o �,;r
Pilot maui �
Liner size i✓�.
Return temp ?D
Supply Temp�
��'f� B�`�
AC
R22 41 A
Su ion press e
SH
SC
Return t p
Supply e
TXV Fixed
Am draw
size
GCl���j�5�i'G�'J A P S- o
lv�h�rCe �°�
Address ( i/ �
Customer Name
Date� G'�Time
Phone��
E-Mail
��
(rJk! ()�q i.f1
T,:;G 5 CO�FIN"GI
°nr� o-F- �sral „u�rr T�f�,e�s
� Coil
,�..�ct.� Serial#
Filter
installed
es No
Size
��%��S-�
Make: Ne i I
Model:/t/ C �`� F
Serial: �.� ��� p$6�
BTU: �°Q, QO�
Vent size ,�"
Stack size �'y
Water heater vent size�
Condensate line /✓¢�
Condensate Pump /V�
Electrical �. ;�c, fi � o /c
Gas: /l//�}7"
Liner installed: NA
Access:
Stat: C% yO i9 �y�ff
PVC: /�/�
AC m
Model:
Serial:
Pad install :
Line installe .
W ' installed:
sOu JrCe —��f'e�°'i a c- S/��e Hlov'� �
�a ��a�e�
House Heating Test �ecord
Cont�
d ?�Fax
a %��f`neh �r� IO�D
R��'v�rn
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a
,�oc�6o'� �P��" Pev 1�Go
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All Climate Heating & Cooling
2520 Coon Rapids Blvd, Suite 120
,'�'�v Coon Rapids MN 55433
Tel: 763-548-8095
Fax:763-421-1927
Buildi�
Inspec� ` � . �
763-572-3Gt� - , : � ."
'i63-S02-4977 FAX
e
�Ij�,�.1�jC�I, Pem�itNo.: ������
`-���VI�RCI�L �'�i,�CA�"�i�►N �+�sy: (1�'
CITY OF FRIDLEY na�a:� � C� �
n�.� YavR�-�rnu. nnnx�ss
SITE ADDRESS 1� l f�urasc�� i�- �i'i 11D��,�A
7HISAPPLICAIVTIS: �CONfRACfOR —
O�VI�TERI
TENANT
��� • '
IYOTE: C8N?'ACf PERSON: �1� 1� a � �C� `i ✓(J � � �"�
SEPARAT� CLTY
I.ICffi�SEA AR8 3TATE BOND � E3� DATE:
REQUIlZEDFORGAS pDDRESS: � CfTY STATE�ZIF ° �.i
AA1D HVAC. � a _ S ��: PA}C:� - ,3S e�- :S� .% �
P J '
APID INS YURANCE� C17Y GAS LICENSE fl CITY HVAC LICENSE # �
PERNIIT TYPE �,M�'TI-FALVm.Y ❑ C01�1�lERCIAL LJ IAiST1TUTIONAL ❑ CONDO 0 II�TI}USTRIAL ❑ SWIlLIMINC3 P(30L
O OT�lt
TYPE OF WORK: I❑ x�v '�.�ri.ac�mvT ° ai.xe�►�rcorvx�aonr�.
DETAILED DESCRIPTiON OR �VURK:
1n��c _\1ci�;c� d�' �����c� --
�
�BOILER
CLASS 1 TfOOD
�cLnss uxoon
ALL FBES ARE BASED ON V,
TOTAL JOB VALUATION:
MFG:
�:
nucr�voRx
�FURNACB
GAS APPLIANCfi
GA3 PIPINC:
PaOL AHATER
MODBL: �
a�an�:
COST OF LABOR AND
� s�.�s-rv
3tZRJBTiT
R�F'COP UN1T (RTU}
�xE�tuc��tox
3TEAMlHpT �VA7ER 3�ATER
�SRi111�1�iQ P�L
—'or�
a
pEgMIT FEE $ �` � 125%UF JOB VALUATION 1 MINIMUM FEE $35.00
SURCHARQE $ � VALUA'iTON x.0005 ! MiNIMUM SO
TQTAL DUE $ `"�S` _�� MIl�111M $35.50 Make Checks Payable ta: City of F
TAIg I$ AiH APPLICATIOI�i FOR A PERa1IT-NOT VALID U1�iTIL PRpCESSED
I hcreby apply for a mechanicat pra�nit and I ackna�viedge that the information above is camplete and acaurate; that the tivork �vilt be in
conformance with the ordinancos and codes of the City of Frtdley and tirith the Minnesota Construction Codes; tl�at I ucsderstand this is
uot $ pem�it but oniy an applic;ation for a pem�it an �vork ' b statt without a permit on site; that the work will be in aecardaace
with the approved plen in the 1� c ietiv and approv�l of . ��
SIGNATURE OF APPLI PRIAtT NAM� � �0 �A� .�,��/��
APPROVED BY
����
City of Fridley
Bnilding Inspections Department
6431 University Avenue NE, Fridley, MN 55432
, �7G3-572-3604 F :763-502-4977
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