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AF - 47863� � � i� �� City of Fridley, Minn. BUILDING PERMIT � : _ ei 9 /l / � -� � J/ . � �� _,�� - �� ,.� �i�� . � ,� - - .,. � � s�� N° 63�92 �1.0 TI�i UILDING No. S t� �� ___... Part t '_"_"'_"'7".. Lot ' ' Block 1`� Addil3on or Sub-Division� ��;'�-L--f��e�a' � Coraer Lot _ In�tde Lot �� Setback Sideyard �� Sewer IIevation ._ Foundation IIevation DESCRIPTION OP BUILDING To vsed � Front -�� Depth .��.[� Height � Sq. FL �� Cu. F't�� Fron Depth � I�eight � Sq. Ft Cu. F� Ty�e of Construction �._._ F�t. Coat ��°�o be Completed In consideration of the issuaace to me of a germit to construct the building the proposed work ffi acc�rdance with the d�scrip�ion above set fo�rh and in ca �1nsnCes oP the dty of FrYd1eY• /A .1 n 1 � In conafderatton of the payment of a fee oP ��_ , permit is granted to I agree to do �ovisions of to canstruct the building or addition as de.acrlbed above. This permit is granted upon the elcpress conclition that theperaon to whom it ie granted and his agents, employees and workmea, in all work doae in, around and upon said buildiag, or anypa� thereof, shall conform in all reapects to the ordinaac� of ��Y, �sota g location, conatructtfTon, aiteration, maintenance, repair and moving of builclings �� dty ]imits��an�this permit may be revoked at any time upon violaL�oa of aay of the provisiana of said / 1 BI1f1ti1IIg' InBpectOr NOTICEa 'I�s peneN dea not eorer t6s eom�rneHon, Imtapallon �or �rtr�ng, plumbiee, ea h�adeg, swer er waM�. B� wn ts sss titi &ritdteg lespsatar hr apartlr parm6s h� tkas h�. ar�� V APPI,ICATIO�T FOR BUILDiNG PERMIT C�TY O� r'ItID�+EX� MiNNESOTA Owner's Name L Huilder-- . „�°';`� '�_...,�,. Aaa=e$$ �' I �'-- �`�1 � � , "°�.'��1 aa� �8 .�� .._.� _ LOCATION OF BUI�DING Noe_,,, �, �� atreet ,�„� 1r �� Part oi Lat �� 3—�F a Lo�t Li � �Block � Addit�ton or Sub ivision,_� �..._ . ._ � 1 9 Coraer� Lot �asicle Lot Setback�Side-Yard �' S�TEEt �ELEVAT�ON FOUNDATIOLIT ELEVATYON � Applicamt a�ttach to th3s rorm Certificate of Survey of Lot and proposed build3.ng location. To be used aso DEfiCRIPTTON OF BiJILDZNG � Depth � � �3eight s��s �'�r• / 4 / � �e Ft• Front_______��ep•�h _____,_„�eight 0.7� • F� • � a Type o� Construction �� Est�.mated TO be Ft. cos� � 3 � � � ��r.....� T�he undersigned hereby makes application �or a permit �or the work herein speci�ied, agreeing �o do a11 wo�k in strict accorda�nce with the Cit� og Fridloy Ordinances and ruling o� the Departme�t of Hui7.d- ings, ar►d hereby declares t,hat all the fac�s and represeni:ations s�cated in this application are true and co�crect. D�TE '�� ° ° °-- � 1 � SIGNATUIiE ��J \ l� � �� (Schedule of Fee Costs ea� be found on the Reverse S de). _� � _ � „ ,r"1 �1 �, - BUILD�NG PERNLIT FEE SCE�DULE Sec�ion 2. The Tnspector o� Buildi.n�s shall, be�ore issuing any pe�:�ni� �or the e�ec•�ion o� any building or structure, or for any addi�ion to any oxis�ing �uild�..ng or s�t�uc�ure, or for any alterations or repa�rs �o any exis�iny build�.ng or strucicure, upon appiicatiora �h��efor, require �he pay.nent by �he a�plican�t ior such permit of rees �to the amount herein belaw set �orth arid in the manne�c herein provided to-wito 2.1. Fo= any such pe�init for the erection of any fire-p�oo� build�.ng, o�1ne� than a galcag�, warehouse, factoYy or grain eleva�tor, or for �he erec'cion of any f�re-��oo� addit3on, �Cor similar occupancy, to any - ex�.s� �ing buildlnc� shall be at the rate of $1.40 for each on� thousand cu3�ic �eet, or frac�ion thereof, in such cubical contents. 2.2. �or any such p�rmitc �or the erection of any fire-proor garage, warehouse, �ac�tory or gra�.n elevator, or �or the erection or ariy iire- proo� addition, �og sim�i.lar occupancy, �to any existing building shall be at the ra�te oi $1.25 for each one thousand cubic feet, classi�iecl as "�lreproo�" by sec�ion 502 0� the M3.rrneapolis Building Code. FiOUSE , 2.3. For any such perm�lt for the eYec��.on of any non-f3reproo� build- i;ng other than a gaicage, v�arehouse, fac�ory or grain elevator, or any non-�ire��coo� addi�:�.on, �or similar occupancy, to any exis�cing building e Permit $1.00 for each one thousand cubic feet. r�c�s 2ea. �or any such �ermit for the erection o� any non�fireproof garage� warehouse, �actory or grain eleva�to�, or for the erect3on of any non-fireproofc addition, �or aimilar occupancy, to any ex3sting ° building or �or each such bu3lding or add�.tione Ninety Cen�s for each one �housand cuTaic �eet or fraction �chereof; in the cubical contents thereof wi�h a miniznum oc $�.00 0 For fihe purpose of compu�ting fees for building permits the cubical con- tents of any builaing or add3.tion to a unifo�m height throughou� by rnultiplying the g�ound area covered �.rom a point s�i.x (6j 3nches below �the floor liae o� the basement or cellar to the average height of the upper sur�ace or to 'che average heigh� of the roof surgace o� the main gable of a pitched roof. 2.5. For repairs or alterations to an exist3.ng structure, the �ee shall be at �he ra�e of $3.00 per each Five Hundred Dolla�s ($500.00) o�c �raction �thereor in i:hes �o�� o�E a11 proposed work. 2.6. �n no case sha11 the fee charged ror any pesmit as set forth in Section 2 be less tl�.� $4.00. � a . V � - -a --.,- --- __ _ . .. __ . >. _ c�I. �. ��ocuUVt �.�� SSOCi�.t �.74 es 4 �e. �4 LA�ID SURVEYORS Anoka, Minnesota C@RTIF[Ce4TE OP SURVEY: Ralph Ltt�id �`M OALV Jt �� LL��t r��e�no�� 4a�-634Q 855- �27-53 � � --� DENO-rEs I RoNS _ _ . -_ -_ � _ . Lotg 42, 43 �a 44, �lock P, RTVERVIEW HEIGHTS, Anoke Coimty, �fnnesota 1 HEREBY CER'i7FY THAT THIS IS A TRUE AND CORREGT REPRESENTATION OP A SU&VEY OP THE BOUNDARIES OF THE ABOVE DESCRiBED IAND, AND THB LOCATIOPi OF ALl BUILDINGS, THEREON, AND ALL VISfB1E ENCR�ACHMEIdTS, IF ANY, FROM OR OP1 SAIp LAND. AS SURVEYED BY ME TtUS ._.1.�..'�"l:�i. DAY OF Febr�}�r�....._ .................. a.u. 19.�`� N. C. HOIUM AND AS�OCIA,�jES,�N�. c..LAMD SURVEYORS � �er - ................. _ _ � � ...»� ............. .... �_— -- � .. � --- ---- -�_ � _ _-- - - - �H- ......... ......:. - � �.:,�,.,�..--_. - ,�..=�,r � .. .��_�_�. ° � M b y � � � � o '� p ��,, : H . 7i : Y ' M . p : o . � . m � : � : � ' es � N �' fA r. "�'� ►� � � W � � � � f0 � o � � � N • O • o � : o . o . o . . Gd : : � . . s x 0 � x � � � � O Q Q � {� {p � � � � � � � � � � � m �� z z 8 � � � � n � � � � � � �i �� : � � � � � 'd � � � � 0 0 � � : � ¢ N : � � : � W o : 04 : OQ � . � . . � . . . . : bd : : : : : � : : : : � O x �e x k x �e CA N W t+ t+ � .� C�7� O � O O O � fA fA {A {f! {f! {fl � � '9 Q � � L O A x �`1 � � � � � � � w � � � � r � �"1 m �^ `I 2 m C r m O � z � a a M n W � � o; � a�a � �. z 0 � � ► � �, .m , a� �: z O i 0 � N O � e�" m w g �. � • � Q, p � � x � a `�' � St01$� 8 � w��n �@ � � � URINALS e�rH o � a sw�� t I SINKS � � W�, ra�rs DRINK. FOUNT. sHwas. FLOOR DRAINS U7CFI � BASINS Au'ro V✓� GAS APPL � GAS RANGE GAS i OPENINGS � • z e �y � in D � Q m A $n I , n � y a. � a �A � � i%+ a � � a. �j !� � �% � � �p O' M � ~ a� � �° 04 m � �b�� y � � ... � fD o�a � � ��o�. � , � �� °°°� �� b �� o � �, m �, � p i� �'�,o m ti ,�� . � � ¢� �� f�p � f�p M � T n � � � fD � Q ►+ �7 �p'! � � �+ A � 'J' t0 ��3 � � � �� w � � � � A �ro w� A � & h°n p � M � � � � �► 0 � � �. ' � , I � � � � � � G 0. 0' ro � » � � M `� � b � o � g 'v � A. � �� ..�° � � O � x r t� Y � � x x � y r � o w y � °x x x � � � � O � � � � �� fA � � o � � � m � � � �j � � w a d � <e �° �� F � � � � � W 9�j � (° 2 I�d � � � � ❑ � � C � m � � � A � � m � � �-F i� b � Q b � � � � a � y � ¢ �' � ��W� � � k � o k � N N y o�o � O y • � : : � : : x ,a x ,e o N � 0 0 0 � � � � � �o r � � o� � � � � � 0 rP 0 0 0 0 0 my G � 0 0 � \ W H A H � � � � � � � o � z � p � � � � w � � x � � � � � o b � � � � � ` ' � a � m '�+ � � o � � o J � ►�i � p O r o� c '�d z < ° `�° � w � W �� y O � � � . f�D 1D • n � • �: � z � ►�! 0 � � 0 0 � W � � °x M O � _� � w w R � � � � � �� ,a�". a ° ° �C w w � � y 0 0 � � � �� °�� o � K x �� oo �' o ��;�� M ' '� � . . � � . . O � ' : � � : : � : : N N � � 0 0 °o o° � �, �, O � a. � z � � � �i y � � � � �. � z � O � tl � � � m � x 0 � � � 0 cr � 0 � � � g � I� � �° ,� � � � ��' � t� R^ � � �,.n � ��o �'� b � � � �o � � -° � � �' � � $ � o� m � : y o . � � ; G '. o . ' � p $ ; : O O O O ' ' • � N en en N po en o 0 0 0 0 0 0 0 0 in t�, en �ew � ¢ � � y o y M � � \ a a �� m �� b � S �m� � � y � � � � �ap�� ° �� o . � a � � - a �' . . �„ . . ot�i ,°o : : O $ . ; QO . . O : . . � en ci oo � en c o 0 0 0 0 0 � H H � n�.a� � n �� ro ry � � m - �°°w� w�'"H �C �'.�:4.�, y d� °� o� �. �, �b o ��c� °}u�� ppR'CC � y� �O�y � � � ��'� � �� $�"'cc m �ao p ]'�,o �y ro �p��m �� ' ar''�,� �� yI�DM s�� [� � �7 M � p'' � � � � � 5' D � � � � m � 2 m C m y � � b d ,. � � M � � W � � � � a A � • V O � � � � � � ' � O � �' �'�O � 0 O � D 0 0. O� � ;, i � �' 3 � � 0 � �� v< � ' • � � �. � 70 � m � ', d � , . �►T� ��ss �v..cu�►noNS �/, � ��` ��a�°rr�° U. Weatherstripa A. Guida Gonatruction A Windowa Doora � Reference Out. Wall Inc. Wall Ceiling e1l a—No ( Yes—No 19_ � . Fl.� � Rooma L.ength ` �Width . � °Height Q • Wiadows am! Doora—Crackage and Area � .• \Vldth Helght No. o[ Llneal t Area . 1VO. ot paoe - ot Dsne Ilghts ot craCk ap. !G . . �� / � �. . L � � � Coef. sn, Iafiltratioa. � Glaaa �' Fsp. wall }( � � Net eap. wal! � � . � . � �� Int: wall Ceiling y�: �° Floor- - . . � Total Btu. �,j . Required aq. k. E.D.R. or aq. ina. W.A. L.eader area �� / F7:� , Room � Length � � Widt6 ' � Height � . Windowa and Doora-Cracicage� and Area WlGth Helgbt No..of Lfneal �, eea • No. of ppne ot paae .11�bb ot craek p. te. ,� � / /� � I c�a� � . . � � � � . — . .�1�• W� d � l� . - � Net exp. wall � . � � / � �� Iat: wall � Ceiling. '�. >! • � � Floor � � � �'l Total Btu. . �, � Required aq. k. E.D.R. or aq. ine. W.A. L.eader area P F7• e� �. t��t� Ik� Gd -�+'� �-=N� � Windowe and Do�Te—Craekage and Area WiBtd Hef�Dt No. ot Ltnaal tt • Area No. ot pans ot psn� • It�bt� ot�orack p: 1R . � � f�� . %� r . , Coef. • $tu In6ltration � � � � Gla�s ' . � " Eup. waU � . Net esp. waU . � � ,� . Inc. well ' . • � . � . . Ceilin8 � % . X� /. � • . Q . l��oor . . . f� � .."To'tat �tn. • . . . .. . . � �� : Required �q. k.. E.D.R. or =q. ins. W A. L-sader uea _ � - �;p• ?1�. " � '. -, , . . . - .. . � 0�' �$U�I.DAV�S ° lo, . . �iaaulation _ . Roof . Floor Kiqd l�ow AppGed � Fl.� �� rs �°n Room Length �' � Width /� _ Heig6� � Windows and rs—Crackage and Area WIAtA Hei6ht �ir, ot Llneal it Aee� . No. o[ paoe . o[ pane Ilghts ef crack p. [L . • ' � o� � 6 �'� � � s . • A �/, � �rs i d � D � � � � , �f B� Infiltration f? � . p Glaas � �, . F�p- wa11 � Net e�p. dvall � � . � ' � � 1n� waU o Ceiling dL . . �. . � ./ � Floor . . _ Tata! Bt�. � � Requaed W. h.� �E.D.R. or sq. inw W.A. Leader area� • F7.1 Room I i.e�gth � w',dch �. Height �.�� . Wmdc�wa aod Doo»—Craekage and A�ea � . ' WWeQ S�fsht Na oi Llneal [�. Area Na ol psa� . ot pano ItSAta ' ot crack �. tL _ . . a �� . � . , . . . �� . c��.: C' �• M/3U � ,� Net e�. wall - In� wall Ceiling J� Floor Totat Beu. (� % v Reqnired aq. k. E.D.R. or aq. ma. W.A. Leader area Fl.� Room I t.ength. �. �Widch � . _I-teishc — Wind�we and Doorr–Cracicage am! Area WIdtQ 8s1�6t Na of Llnaal tti Are� Na . o! yane o! pans 1�=ht� .ot crsck p. tt .�; - !�.� ;� fj .�i • �l � �% �/ E. " In6ltradon � Gla�e � � �c _ _ Net eap: wap Inw wall Ceiling � F1oor 'fotal Btu. . � Required i � 1 1 �,�►� � �� F' � �i� or sq. m�. w.n. �,eaaer area � � � �.��o ry y �'� p ' n. �p C A � lr' Q (� N y $ �o�� . �, �• < � C �. � �. F�o'� � � r�. �� , �, � � ��,~�„�,��..F'a'A bH��,p�� A�. oo��' o �O ` � '''a �� —� �� r, �. �� b o� �. � � �� o � �'' o R' .. � M � � � � � � C � n. �• N� �y `� Vi � V �� ' � � o � � � ��'S�. ,�� s � �• r ip c� A O y � � r. � y �� r.� A �.. A �' � � � � ��•� , � �� n. b � �� ti �� ' o ,� �. �'� � � b �A A , o��. �� A►��, �' r. r► � � �� Q�� ~� �'� � � �, ��,M� �. o ��'� � ��.��• �' � R o ��+. °�°� �'��lo � � � � �S�' � I� � � � � , , � � � o � � � � � � �. � �i @ O b 0 f:. 0 � � � I � � s � 0 � R. � � � � q O �' � °� -r. � ,.. � � � � � a � a. o � �. �� S�' � � � � a� � � o � � � O o � � � � I 0 � � � � t'o�' �i � � c0 �� f3. � � �, � �' � � � � y O Z � � � � e � n m � ; °�' � � A d 7 � �+ � � _. — � � � � � � � 7 w� � 70 - = � � ■ ■ � � .j '°'� 0 3� � o � � ' � _ � � � 0 i� 7v � � � � y � � � !� 3 � � � � � � � � � � y � � �• ": � � O 0 ■ � � ro � �, � � ,� , o`�o o� c�� ' HOUSE HEATING TEST RECORD �,�N_____T � � � ':° � ,�` �-' �° � ,� , �, ` ^ �� ADDRESS � s -� '' � �� %-�.s� ��-' �s:�,, APT. FLOOR� °� CITY SUBURB �``'�� OCCUPAN,"�'_,��s" °.-�.�ti: .�'> -,.r�d�% r�=�,Q OWNER r/ HEAT LOf�S •`� DATE HTG. INST. GAS C0. METER BADGE #r, , SOLD Bl�� INSTALLED BY ��'� , r,,�.y�::t ��;-� .¢„x� ✓�' � ��--- Eleetrieal Work By Gas Line By ' TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER �,� GA� DESIGN CONVERSION MAKE �"'� `-r "`�° "- `� -- MAKE OF BURNER Model °t^� �y~ ° .- ` � Model Seria) Max. BTU Rating INPUT � �' �`" � °�' MAKE OF FURNACE Model �, CONTROLS � !,/ _ THERAAOS 3A'� "�i� ` Heat Plug ,� Vent Size �'' � -- Val_ve �� .s'�.�'� .� _:4 , o . i �_ — KiNI3 �F-C(NER�-��o.�� SIZF ..¢:s NONF Limit Drah Hood Regularor _.�°��%' Limit Setfing Filters Size Number � � Fan Setting -- Chimney Loeatio'n I� "�"�� de�, �^_ � Fr i x "t��'� ,• i�.... G:;a � Pilot Typa +�� x Chimney Construdion / �.%'�.,.�..��''�`T—� �� Pilot Make Pilof Model `��-�" � `: Smoke Bomb- Q�;: Wiring Pilot Timing A ` Draft Qd �� • Test Tag �� ' 1.W. Cut Off Door Pressuro— ` Lightirtg InsT. �� '�"� �° �� Tr percent CO2 Date Tested �� " �� 6 Pressure � , Input CFH �,-��= �� Percent 02 Company Testing a�,: -- x,_7�" �%''�� --' ��'� ° .`� Staek Temp. Pereent CO Name of Tester � �' _- �^`' "° _ Form 235 � City of Fridley, Minn. 6431 University Ave. I�. E., Minneapolis, Minn. 56432 BUILDING PERMIT ��; June 18 1971 p�• Norris Stenaon g�� Same Address ___bi�-Ki mha 11 S tr p M.E Addre3s S.Bme ��5:�). _ ., _ F�� LOCATION OF BUILDING No. __._63_4.._____. Street ._. Ki��get N_ F. : Part of Lot Lot �43t44___. Block P __—. Addition or Sub-DivisioII �? � YP� �?Gl 13Ai gh ia A A d i t i nn Coraer Lot __ ..� Inside Lot X Setback Sideyard Sewer IIevation ._ Founiiation IIevation DESCRIPTION OF BUILbING To be Used as: � r�,P_ __ .Front � Depth � Height _1�.., Sq. Ft. �� Cu. Ft. 5� 760 r Front Depth Height Sq. Ft Cu. F� Type of Construction Frame ��, ��*,�0�.00 To lx Completed P�- 197__? .._ Stipulations: Not to be built� over any easement. 30" above existing driveway. ��¢l�. grade wi11 be ok. In consideration of the issuance to me of a permit to consiruc� the the pro�sed work in accordance with the description above��orth� Ordinances of the city of Fridley. in I agree to do provisions of In consideration of the payment of a fee of $ 11. 00 � permit is hereby granted ta Norris Steneon to construct the building or addition as descxibed above. This permit fs granted upvn the express condition that the person to whom it is granted and his agents, employees and worl�en, in sII Work done in, around and upon said building, or any part thereof, shall conform in all respects •to the or8in�nC� Of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and mov3ng of buildin�s �g►ithiu the city limits and this permit may be revoked at any time upoa violation of any of the provi�ions of eaid o�rdiaancea � 1'��-�-�- n,��g �tor HANK MUIiICH NOTICE: This permit does eot eover the consfrucfion, installaHoe fo� wirfee, plumbtng, 8as heaNng, sewer or water. Be wn to sN the Building laspeefor for aeparafe permifs fo� these Nems. , r � t •. a - APLICATION FOR RESIDENTIAL, ALTERATION, OR AllllITiON BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER' S NAl� :__ �' wri � �/ e'/+/S 6 s�/ BUILDER S � t%�'" ADDRE�S : �j?�_ � .�� ,� . �r� ��'� � ADDRESS : •.-�� '�%!✓ NO•. STREET: LOT : �;;,,�BLOCK: � ADDITION :� �`vt . Y . � P.� � r,e; %� ; i CORNER LOT: INSIDE LOT: i�`/ SETBACK: SIDEYARD; �— Applicaat attach to thia form ltao Certificates of Survey of Lot and propoaed building location drawn on these Certificates. To Be Used As: ➢ESCRIPTION OF BUILDING Front: Depth• Height: Square Feet: Cubic Feet; (�- �Y,°l�Front:,�-��epth' �T �' Height• ,��,� —� Square Feet; � Cubic Feet: ��cv � - � 6 � ��, Z�►pe of Construction: f��f�� Estimated Coet: (,>�Q To Be Coaipleted: �,%.�� sA` � =—T— The uadersigaed hareby makes applicativn for a permit for the work herein epecified, agreeing to do all work in sttict accordance with the City of Fridley Ordinances and sulings of the Department of Buildings, aad hereby declares that all the facts and repreaentations stated in this application are true and correct. - UATE : � ��-- i' `% %f . S IGNAT[TRE : � ..�-�r�w� �� = � , __ (See Rev�rse Side For Additional Informatioa.) � i( lv�v f L' ��I ``� f.i� �"i ✓ Li �' j'/`? '!�/�� `f':_i_%0� �� T�'�" !' ;�� i ? i' � " '" -_- �/ /� � �.=' � _f%j's- G'� ^ G-`J /� j�'� �f /�°i`i /_ �' �' j��_--r-/� `_ ' � �-,�, �� -. ` _,.�_ .�° !�_ ,T� � �l ? � ; ', � r= ; / ,_ � �`n�! � /"_ l /�' �; , c' ` ` �-�� > , , ;= �`�! � `Ti �� ,� �J"/p � �'�= r,L, , j-�� ' --� =-��- `C c�-��-��'�_ ��%i ti L � i� _�� ---_ r �C��- %� �� /�C� r � �? ' � � � � _ � �G, 0 i� = 5 i�_0 ,%� / �� " � � � , � � � � BUILDING PERMIT FEE SCHEDULE * SECTION 2. The Inspector of Buildings sha11, before issuing pernnits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repairs 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 aad in the ma.aner herein provided to-wit: UNIFORM BUILDING CODE: �►pe 1, 2& 4-$2.15 for each one thousand cubic feet, or fxaction thereof, in such cubical contents. �pe 3& 5-$1.85 for each one thousand cubic feet. ADDITIONAL INFORMATION For the purpose of computing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the ground area covered from 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 aurface of the ma.in gable of a pitched roof. For repairs or alterations to an. existing structure, the fee shall be at the rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost of all proposed work. Ia no case ahall the fee charged for any per.mit as set forth in Section 2 be lesa than $5.00. VERIFICATION OF FOUNDATION NOTE: Pe7rtnits for conatruction will be issued a minimum of 24 hours from the time of application, to allow for proper review of the proposed structure aad of the coastruction site. A Certified Survey af the lot, showing the location of the foundation, once it hae been constructed, will be required before proceediag with the framing. CERTIFICATE OF OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) da,ys prior to the use or occupancy qf any structure for which a building peninit has been issued; and said structure shall not be used or occup�ed until a Certificate of Occup�cy has been issued. • �` : � � �'� ,t • � .g--�- � � :, � ; .. � �, �,>� �' �t� ► t++cae . 4� r�c+ . �Oi MQ. - , � �� , �, L��'�Y �"�. �%��'� � . . , �. �� . ` . : � ;�< �.:��Ir t..../ f1�r �t w«„N.,h , . , , �! 1IMCs. r • ,u+p,t�. M� _ :. rww+e �raow �- �:w � � _ . ��:�..,,.. ��►tf '�F �ti��r -� a�� . � � � of' ��eo��r oF.�� "�JOR�T � sT�s�st�i % - � " �,.�o .�. «..a�,w�.,,,�,�:_�. I�� s . �2 , ' �+ � �r #4 � Hl v�k P � R'i rsr� i � H3e� �ht s , , A��tr�a Ct�atT, l��t+��at! . , . , ,_ _ , - �;, : � . =� � �� , �. . .1 . � . :. : . .. . .. , , � � ' � � � �m. e, . . � � .' � ' . � � . . � . � � . . 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' - . .. - � . . .. _ .... _. �� . ��_ . .. _ ... , — _ 1�° � 16360 Building Job Report ADDRESS �[� ��}dry � G LL . � s _ s a _ - --- - OWNER �C� ��%�"(��-G��i �Q �^ � BUILDER � DATE�� —�� PERMIT NO. l� � �� DESCRIPTION � � y-�p � }.. �'�� . �y� S� , INSPECTION RECORD DATE REPORT �� , � tn I r _ � "��"Vr�� - � f i, �� / '� ��l OWNER - REP. INSPECTOR n � f � i. �.� __ �� f ^ I�f' 11 �. 1 6� -- � " ' '' ' � � � , r � : r� / ,;_�;. � � �1 �y.—r � .}� e.. _i ��',! �,�.�� Y.1 p1 "�� .1.�°9 ; "_ �, � �.-7 G"`'s�s �.:�: ��^ ��,�� _`�� x _ ' �f�",-��b'� ; >. • uN,��, .r , ,.,.;�. �, � �'<� � ' � /` DBS-2722 (9-85) PZ-02722-02 � �9�� STATE OF MINNESOTA DErARTMENT Or NUMAN SERVICES 444 LARAYETTE ROA� `/�� ST. rAU�. MINNE30TA sdfOt U Date i� �,, �i � 1 �� i �� _ � � . , F' . . � � /// � �� • • - � � '— ��.�� - ' �/�!/ — � - . ..- RE: ZONING NOTIFICATION OF APPLICATION FOR LICENSURE Subject: � ame Da C Home Applicant . treet Address City State Zip Code Type of License: Family Day Care Group Family Day Care Licensed Capacity Phone No. %�� /�� This is to inform you that we are in receipt licensure under Minnesota Rules, parts 9502.0300 Rule 2)� Family Day Care and Group Family Day Care this license is subject to compliance with the Statutes, Sections 245.781 to 245.812 and 252.28, the Public Welfare Licensing Act and the rules of Services. of an application for to 9502.0445 (formerly Standards. Issuance of provisions of Minnesota subdivision 2, known as the Department of Human You should note that under Minnesota Statutes� Section 245.812, Subvision 3, a licensed day care facility serving 12 or fever persons shall be considered a permitted single family residential use of property for the purposes of zoning. Subdivision 4 of the same section indicates that a licensed day care facility serving from 13 through 16 persons shall be considered a permitted multi-family residential use of property for purposes of zoning. If we do not hear from you within will consider the above-mentioned your local zoning code. Sincerely, r /, ,� , I.�,�'�_ �, �, v..c�c_�i. � � - - . • - / / Street Address 30 days after receipt of this letter, we day �8�j��,�� ;_to , F�e r�.� :•CO'�ipl iance wi th SERVIC�� G�rA�Ti•�.iEfdT COUNTY OF ANOKA COURTHOUSE� FOURTH FLOOR ANOKA� MINNESOTA 55303 Name of Agency/Organization City State Zip Code AN E�UAL OPPORTUNITY EMPLOYER City of Fridley AT TME TOP OF TME TWINS i� � � � ; v _�_�_ COMMUNITY DEVELOPMENT DIY. f � � PROTECTIVE INSPECTION SEC. 1 = � � �""1 � CITY NALI FfiIOLE� SS1�2 �""'� � �'� 612-571-3450 JOB ADORESS 634 Kimball Street NE �U ILDiNG PERMIT � �� NUM9EN REV OATE PAGE Oi s�aF�s t LEGAL �OT NO. BLOCK TRACT OF ADOITION oesca. 42,43,44 P Riverview Heights 2 PFOPERTV OWNEfi MAIL ADORES$ Steve/Judy Luppino 634 Kimball Street NE 3 CONTRACTOR MAIL ADDRESS Windows America 7928 University AVe NE Un.it C, 4 ARCHITECT OR DESIGNER MAIL ADDRESS 5 ENGINEER Residential 7 CLASSOFWORK � NEW MAII ADDRESS � ADDITION ❑ ALTERATION B DESCRIBE WOFK Replace Windows Within Existing Openings 9 CHANGE OF USE FROM TO 9/26/O1 � � 32200 RECEIPT NO. �� VVROVEO Br SEE ATTACHED SNEET 763-786-2183 21P PNONE LICENSE NO , MN 55432 20248265 21P PNONE LICENSE NO 763-786-8115 ZIP PNONE LICENSE NO � REPAIR O MOVE O REMOVE STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all exterior openings. P�rmit Inspection Cards WIII �� Iailed . To Wom�nwr�er To Post SEPARATE PEfiMITS ARE REOUIREO FOR ELECTRICAL. PLUMBING. MEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV �OAD VENTILATING OR AIR CONOITIONING. THIS PERMIT BECOMES NULL AND VOIO IF WORK Oii CONSTRUCTION ZONING SQ. FT CU FT AUTHORIZED IS NOT COMMENCEO Vj11THIN 80 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OF ABANDONED FOii A PERIOO OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS 1 HEREBY CERTIFY THAT I MAVE REAO AND EXAM�NEO THIS APPLICA710N 1 STALLS ANO KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS VAIUATION ANO ORDINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMP�IED �5,430 W�TH WMETHER SPECIFIEO MEREIN Ofi NOT. THE GRANIING OF A PERMIT DOES N07 PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL TNE pEqMIT FEE PROVISIONS OF ANY OTNER STATE OR LOCAL lAW REGULA7ING CON• � 12S . ZS STRUCTION OR 7ME PERFORMANCE OF CONSTRUCTION $5 SiGNATUAEOFCON:FACTOpOp4UTNON�ZEOOGENi IO�TEi ��OWNE�IBU4O@p� �bAT�� ' r OFFSTREET PARKING IGARAGES SURTAX �2.%2 SAC CMARGE Fire SC $5.43 TAL FEE $138.40 D TNIS IS VOUp PERMi �/��iib. Af�?-24—� 25 � 34 FRtIM C I TY OF Fl?I DLEY TO 1�}E1N [ ] , ADOM { j C17'1f IDf �11 FY ��R �, su� F Y ac� cu�t�s R z A�p R a BUIlP3iNG PERN1lT�PLdCAiION • ti i «� .. �. . . a. - ► �. r - ��r , a'� . � [►, i�1.?. �i +: •, 'i; EJ:a. i�. ��:., � � a 'T�B125 P. �2�03 Ef�+e 111�2QQt? (763► ST2� �!� �sp �1 ��. _ � i` �� o.:, _ �s � 1 :.�� A�: �.��1 ��l � .�. �i ��G� 0.��1 �t�1--..-__� �---_v... +�. �. 4�CiC �EEA: Lertgth i!�'�dtfn Ftgt/Gt�ound Sq. Ft OTHER; �onstruction TYI�= D�.;� Estima�i Cast: $��3 4 �rnreway Curb Cut Vif't�h N�t�ted: F�. t 6 Ft = Ft x$ _� . �i i �_ .� Z��.� ��,� - Ctl'Y USE �� - Cal1 {7�631 b7�� ftsr Pee�rt� Fe� � � Perm� Fee $_1�� ee sd�edule an �erse side Fice Surcftarge $ .� ,�� .0�1 of Permit Vaivation (1/1�t�o) �ate �wr�targe $ ,�,, 7d �.&Q/�1,�►o va� , ,, «- .� , - . - ,, .� . . . . :�- $ �fi10a per �AG lJnit $ . ,!�(7 $5.00 (State L�d Resid�ntial Contrac�ors) tra ., �. - '.i t�ti .� .. �� ,�, � �� - - s- - -. . . - .. �ewer �Aain c;harge $ P�gre�tr�ent Pte�+ C] lVot Ne�s�y I l TOTA� � c��, � STIPULATIO(dS: �� / �D6 L/� � I / "� �� r �/�I �� P � / /�% �� . �i�c�L/�j.�,r ��.�� ///•��" ��, � �'`�`� � _r a. Building Inspections 763-572=3604 DATE____R"1 / �i / SITE ADD �S ( THIS APPLICANT IS: � PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERNIIT TYPE BUILDIloTG RESIDENTIAL APPLICATIOIiT CITY OF FRIDLEY YOUR E-MAII, ADDRFSS ��_a ❑ OWNER �CONTRACTOR ,annxESS:� �.( ' ctnr. Pxor�:__`7� 3 if�'s� �-/ S `� Pemut No.: G'7 -Q/� Received By: Da�t�-R�c'c�:r 4n ., ..a A�j�z�Ss-�3 � NAME: �U��`o /�/o sr�, � ��J�B U 2�hn e..rr f S STATE LICENSE #�_U S S /�(s 7 EXP DATE ADDRESS: � 3 S�i/l+�./> R=- L .S� CITY �iP��D /_ � STATE%±� �IP S SY� 3 2 PHONE �6 3�% 8'� � I�B / 2 FAX SWGLE FAMILY/NEW CONSTRUCTION SiZE O O FAIvIILY/NEW CONSTRUCTION STORIES ❑ BASEJvIENT FlMSH 0 DECK TYPE OF WORK: � ��' ❑ MAlP DESCRIBE WORK BEING SIZE OF IMPROVEMENT_ ROOFIIVG p NUMBER OF SQUARE,S O GARAGES PROP05ED SIZE: PROFOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminvm ' ❑ Other . �4.ROOF ❑ DRAIN TILE ❑ SIDING ❑ OTHER ❑ SWII�G POOL ❑ ADDITION ❑ REMODEL.ING �( �i GAR.AGE OJl/�x ❑ ATTACHED GARAGE ❑ DEfACHED GARAGE OSoff t ❑ Trim ❑ Fascia wnvnows 1N EXISTIIdG OPENINGS ❑Yes ONo L�ATION OF WINDO�VS OR FORNEW OPENINGS-DESCRIBE STZE OF OPE1�iWG CHANGES & • WID'TH HEIGHT BASEMII�IT REMODELING SUBMTT: 1. Existing Fioor Plan 2. Proposed floor pfan 3. List of struchual membas to be used Ft. FOR NEW CONSTRUCTfON tNCLUDMG DECKS, ADDI7'lONS. 8c PORCHES SUBMIT: 1. Site Plan/5urvey showing the existing struciures a�►d propnsed projeck 2". Two sets of conshvction plans 3. Energy Calculations TYPE OF WII�TDOW TO BE WSTALLED NUIv1BER OF`VJIIJDOWS � ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: TOTAL JOB VALUATION ING THE 1��U�.B.0 FEE OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge S�uchazge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Tota! Due $ �g, vf � � See Back Page for Fee Schedule $ 65% of Building Permit Fee $ �� .001 times the total job valuation $ � -�j .0005 x Permit Valuation Minimum $.50 � i,�} $S.QO (State Licensed Residential Contractors) $ $1675 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$21=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ �� _� Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMTf NOT VALID UNTIL PROCESSED I hereby apply for a building pemut and I acla�owledge that the information above is complete and accurate; tha.t 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 pemut 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 ch reqwres review and approval of plans. • a P SIGNATURE OF APPLICANT PRINT NAME DATE_ _� O �D a� Page 2- Buildi.ng Residential Applica.tion BUII�DING PERNIIT FEE SCHEDULE The Chief Building Official shall, before issuing permifs for the erection of any building or siructure, or for any ad.dition to any existing building or structure, or for any altera.tion or repai.r to any existing building or s�tructure, 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 FEES $� to $500 $23.50 (Minimum Fee is $23.50 plus surcharge) $501 to $2,000 $23�50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and including $2,000 � $2,001 to $25,400 $69.25 for 1�` $2,000 plus $14 for each addidonal $1,000 or fi-action, to and �cludin $$25,000 ' $25,001 to $50,000 $39125 for 1�` $25,0� plus $10.10 for each additional $1,000 or fiaction, to and including $50,000 $50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional S1,OOO or fraction to and includffig $100,000 $100,001 to $SQ0,000 $993.75 for 1�` $100,000 plus $5.60 for each additionai $I,000 or fraction to and including $500,000 $500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,000 or fraction to and including $1,000,000 $1,000,001 and up $5,608.75 for the 1� $1,000,000 plus $3.15 for each additional $1,000 or fraction 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 proposed str-ucture and of the construction site. A Certificate of Survey of t�e lot, showing the location of the exi.sting foundation will be required before proceedi.n.g with the framing. New Houses Onlv City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 " � Building BUILDING Permit No • � � Inspections RESIDENTIAL APPLICATION Received By 763-572-3604 CITY OF FRIDLEY Dat�c�F `� 0 200� 763-502-4977 FAX EFFECTIVE 1-1-08 DATE �'� v D' YOUR E-MAIL ADDRESS SITE ADDRESS �0�7 �+ - Z-�� s� THIS APPLICANT IS: O OWNER �GONTRACTOR PROPERTY OWNER/ �pME: � v„� �e �, � n o TENANT pDDRESS: . 3 �1 ,�� CITY � /-e.� STATE �i�/ZiP S> �� PHONE: �(%� — %lrG� — 02% �'-3 tva,ME: s'd�� c_. .� �.� �� CONTRACTOR ADDRESS: SoZ / S %%/ S-� �-L y�� CITY �h ov �-�' STATE�t�ZIP S S.�d re' SUBMIT A COPY OF pHONE 6/�- ��]c� -O� v�- FAX �6 3- Y2 7—�j`��/ YOUR STATE LICENSE STATE LiCENSE # c� y/o`� �.Si/ EXP DATE /�r �/ �� PROPERTY TYPE �SINGLE FAMILYMEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCT[ON STORIES PERMIT TYPE ❑�DITION ❑ GARAGE/SHED O WINDOWS � BASEMENT FINiSH ❑ ROOF ❑ DRAIN TILE ❑ DECK �'SIDING � ❑ OTHER ❑ SWIl�IMIIVG POOL TYPE OF WORK: ❑ NEW HOME COIdSTRUCTION ❑ ADDITION ❑ MAMTENANCE/REPAIIt �1tEMODELING DESCRIBE WORK BEING DONE: /Z-O%jo(/ c � G'� ��/f�''Ill� ��✓/� — ��'�� v` � ��,Z � SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1, Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SiZE: �%�xr� � +�DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, Vinyl 9�'Soffit ADDITIONS. & PORCHES SUBMTf: ❑ Aluminum ❑ Trim 1• Site Plan/Survey showing the existing structures ❑ Other �--FFascia and proposed project 2. Two sets of construction plans WINDOWS 3. Energy Calculations iN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WIN�W TO BE INSTALLED NUNIDER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING TTiE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ .3GUo , oc� OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ "/ $ �� $ I�SU $ ��-- $ $ $ $ $ — - See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1825 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks oavable to: Citv of Fridlev Attac6 THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a build' 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 w� the ' esota Con ction Codes; that I understand this is not a permit but only an application for a pertnit and work is not to start without a pertnit on site; that the work 1 be n darice with e ap ed plan in the case of all work which requires review and a proval of plans. SIGNATURE OF APPLI , T ' PRINT NAME ��D-� ��✓ DATE � a'U -OG . . . . • � : ; �i<I1,//�; �� . Page 2- Building Residential Application , , ' � BUILDING PERMIT FEE SCHEDULE T`he Chief Building 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 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: VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of applicati�on to allow for proper review of proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Onlv City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 " 763-572-3604 Fag: 763-502-4977 From: City of Fridley To: 651-203-0554 Page: 4/5 Date: 7/26/200612:02:13 PM �� -L%v Building BUILDING Permit No.: `1t� Inspections RESIDENTIAL APPLICATION Received By. 763-572-3604 CITY OF FRIDLEY Date�e��: � DATE ��I2� �C��I YOUR E-MAIL ADDRESS SITE ADDRESS �9� �I�YYl�C1 �1 - ��J� THI3 APPLICANT IS; ❑ OWNER �ONTRACTOR PROPERTY OWNER/ NpME; ��-P k � TEN'�1�TT ADDRES3: �� CITY STATE ZIP PHONE• �(0� - (.�10 =Z�Q"�j CONTRACTOR �ypME: ��,� W�,y�� lL� SUBMIT A COPY OF STATE LICENSE # Z.��-E.�Z�� EXP DATE �Ji`�L�?JUICI YOUR STATE LICENSE ADDRESS:�qOGI V`(- A.�Y��LA �£� - C CITY �VlfJ�CJ12t�1� STATE�IP S�l?�0 WITH APPLICATION pHONE C� ��Z��'U �,�-iG FAX PROPERTY TYPE 1NGLE FAMILYMEW CONSTRUCTION SIZE ❑ TWO FAMILYMEW CONSTRUCTION STORIES FERIVIIT TYPE ❑ �DITION ❑ dARAQ�F/SHED 1NDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDINa O OTi�R ❑ SWIMMING POOL TYPE OF WORK: � ��' ❑ �DITION � MAINTENANCFJREPAIIt ❑ REMODELING DESCRIBE WORK BEING DONE: `P'tiPJI�� (� t�lYl(�.�5 SIZE OF IlvLPROVEMENT LENGTH WIDTH HEIGHT S. Ft. p�t OFING O HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GAR.AGE BASEMENT REMODfiUNG SUBMIT: GAItAGES ❑ ATTACHED (3ARAGE 1. Existing Floor Plan PROPOSID SIZE: ❑ DETACHED GARAGE 2• Proposed floor plan 3. List of swcWral membets to be used PROPOSID HEIGHT: ID G FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Alumirwm ❑ Trim 1. Site Plan/Sucvey showing the existing sWctures ❑ Other ❑ Fascia and proposed projecL ��0� 2. 'I`wo sets of construction plans IN EXISTINC3 OPENIN(3S �I'cs ONo LOCATION OF WINDOWS 3. Enargy Calculations OR FOR NEW OPEIVINGS-DESCRIBE SIZE OF OPEMNd CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL 1�'1'�.151 A1d1S J3A,.�L Vl�l VALUAl1V1�1� 1LVl;LULilrtr lar. �.vai vr LHDVl� Hl�L 1�'iLi1G`� •�+••v: TOTAI �ermit�ea - Plan Review Fire Surcharge Surcharge Licanse Surcharge SAC Charga Curb Cut Escrow Erosion Control Park Fae Sawer Main Charga (USING THE 1997 U.B.0 FEE SCHEDULE) JOB VALUATION $ 2. �� •�� OCCUPANCY TYPE $ "� �� See �ck Page for Fea Schadula $ 65% of Building Permit Fae $ .001 times tha total job valuation $ (� .0005 x Permit Valuation Minimum $.50 $ $5.00 (Stata Licensad Rasidential Contractors) $ $1550 per SAC Unit (Plans to MWCC for datarmina.tion) $ ft+6ft= ftx$21 =$ $ $450 Conservation Plan Raview $ Fee Determined by Enginaering $ Agreament necessary ( ) Non Necassary ( ) � ' Make checks aavable to: City of Fridley Attac THI3 IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hareby apply for a building parmit and I acknowladga that the information abova is completa and accurata; that the work will ba in conformance with tha ordinances and codes of the City of Fridley and with tha Minnesota Consiruction Codes; that I understend this is not a permit but only an application for a parmit and work is not to start without a permit; that the work will be in accordance with the approved plan in the casa of all work which quiras review and approval of plans. SIdNATURE OF APPLICANT �Ua .. J.� � PRINT NAME�!/iD.f v�DATE ��/I��_