PRE 2010 DOCSCity of Fridley, Minn.. N° 10551
BUILDING PERMIT
Date: _ February 18, 1970
owner: Mr. F. Ellerbusch Builder Tri -Co Builders, Inc.
Address Address 7561 Van Buren Street N.E.
93 q9 At O 101T ?N OF BUILDING
No. C Street — _ Part of Lot
Lot .._.__1.5 __ Block 4 Addition or Sub -Division . Melody Manor 3rd Addition �
Corner Lot .__X _ Inside Lot _ Setback 35' —_ Sideyard 14.5'
ARWEievation — 874 03 _ Foundation Elevation 877.07 (Approx)
WYE
DESCRIPTION OF BUILDING
To be Used as:
Dwelling Front -406 Depth 41 Height 20
Sq, Ft, 1236
CLL Ft
12.688
Garage „ Front 20 Depth 24 Height 10
Sq. Ft. 480
Curt
4800
Type of Construction Wood .game Est. Cost _ 25 000!00
__.. To be Completed
May 1,
1970
WATER LOCATION: 30' South of Manhole SEWER LOCATION: 41 ' South of Manhole.
In consideration of the issuance to me of a permit to construct the building described above I agree to do
the proposed work in accordance with the description above set forth and in compliance with a'll provisions of
ordinances of the city of Fridley. v7 f- "Y
In consideration of the payment of a fee of $ 45.0.0 _, permit is hereby granted to Tri -Go Builders
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees an workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Wnnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of d
ordinances.
Building Inspector
HANK MUNICH
NOTICE:
Uls permit don not cover the construction, hntalldtion for whine, plumbing, on boding, sower or wd or. Be are to as
the Building inspector for separate permits for then Nems.
V, -
APPLICATION FOR BUILDING PERMIT
7 �.
CITY OF FRIDLEY MINNESOTA
OWNER'S NAME BUILDER��� Cr'<t-�
ADDRESS ADDRESS
LOCATIONOF BUILDING
N0. 73!g
STREET
LOT BLOCK v ADDITION OR SUBDIVISION -
CORNER LOT X INSIDE LOT SETBACK .36- SIDEYARD
ELEVATION TOP OF FOOTING &�. O �APP,2ok
Applicant attach to this form. Two Certificates of Survey of Lot and
proposed building location drawn on these Certificates.
DESCRIPTION OF BUILDING 0JHr&2
S6w�� Lae Nl S.
To Be Used As:
Front Depth �� Height
s=,
Square feet /oi ", Cubic Feet 1,7.6
Front ZO Depth .0 - I/ Height
Square feet31 Cubic Feet
Type of Construction fad, 0®�. �, ,e Estimated Cost ,,a Oee
To Be Completedf
The undersigned hereby maks application for a permit for the work
herein specified, agreeing to do all work in strict accordance with the
City of Fridley Ordinances and rulings of the Department of Buildings.,
and hereby declares that all the facts and representations stated in
this application are true and correct. Tri -CV. Builders Inca
DAT A, .✓', 6 '� SIGNATURE Byt%,%
(Schedule of Fee Costs can be found on the Ret4rse Side.)
f'
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560-3450
Cit'y of 'yr, le
ANOKA COUNTY
6431 UNIVERSITY AVENUE NE July 30, 1970 FRIDLEY, MINNESOTA 55421
Minneapolis Post Office Department - -
Superintendent of Delivery - -
lst & Marquette Avenue '
Minneapolis, Minnesota 55402 .
.RE: Change of Address
Gentlemen: City of Fridley
We are listing the following change of address in the
City of Fridley:
e
$ NAME _Mx. & Mrs. F. Ellerbusch "
FROM 7890 Jackson Street N.E.
TO 7399 Memory Lane N.E.
LEGAL DESCRIPTION Lot 15, Block 4, Melody Manor 3rd Addition
We have notified the occupant of this change and we would
appreciate it very much if.you would change your records accordingly.
Yours very truly,
HENRY F.;MUHICH
Building Inspector
HM/bks
City of Fridley
. _
cc: Columbia Heights Branch Office
Coon Rapids Branch Office
Minneapolis Gas Co.- Brooklyn Park Office
- --. Northern States Power Co.
Northwestern Bell Telephone
�I
PERMIT for Power Plants and Heating, Cool-
ing, Ventilation, Refrigeration and Air
Conditioning Systems and Devices
DESCRIPTION OF WORK
No. of_- I Aeating Plants to be installed—altered—repaired
Make d O ,Size 6 A �/®`1- �/�•� ;
Oil fired—,- Coal fired Q2..Q.Q� ; Gas fired �L ; Gas Authorization No.
Remarks �,¢ h _/A1n �P_ XL�� I 11-b
Approved
Final Inspection
19_
Inspector
Permit N° 4690
Fee $ �%
Office of the Inspector of Buildings
City of Fridley
City of Fridley, Minn., %� �C J , 19.21
Owner — ]fi'/ L ,e.S
Location ® 4)
Kind of BuildingF am 6.
IHow Occupied Li � 6, LL) Ki C,
Work to be Commenced—, 19—
To be Completed ,19_
Estimated Cost, $
Old ew, uilding Permit No
Permission is hereby granted to to install—erect—use the material and devices described in the
above statement. This permit is granted upon the express coedit' that the person whom it is granted, and his agents, employees and workmen, in all the work
done and materials used under this permit, and in the operation o f he devices herein Vnentioned shall conform in all respects to the ordinances of the City of Fridley
relating to or governing the work to be done and the operation of the devices herein named, and to the specifications set f th in the approved application for this
permit on file in the office of the Inspector of Buildings.
®f, Inspector of Buildings
.11�42 sen 1147 v
Permit for PLUMBING AND GAS ATTING
No 5101
#-- 5-1037
N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for Feet�� Q D
inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit.,
DESCRIPTION OF WORK
Number, Hind and Location of Fixtures
m ,: m m m City of Fridley /h�lRet1
Stories
fid. m
3 U
Z
7
= m
a?
m F
2
<
m
Y
Z
m
m>
Q
3 F
Z Z
D
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0 W
3
O
I
(p
O Z
O<
J K
LL O
U Z
t o
d 6
U m
Z m
W
< O
K J
U
0 X
£ 4
.1
m J
d a.
tl d
O
m Z
d d
O K
WATER HTR.
GAS
ELEC.
Basement
ist
2nd
3rd
4th
Connected with Sewer -Cesspool Gas Piping for Openings
Permission is hereby gran tedP to do the plumbing and
gas fitting in the building described in the statement hereto attached, u on the express condition that
the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing
or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and
this permit may be revoked at any time upon the violation of any of the provisions of said ordinances.
By Order Of The Inspector Of Buildings
Roughing in Inspection Date
Inspector.
Final Inspection Date
jnspector.
Owner 721- L -O aeS
LocationtCaj
Kind of Building -F-g
Used as Au) `— LL I iQ C,
To be Completed _f u Il, f . / , I9y--O-
Estimated Cost $ /.do 0
Old- � Building Permit
Date
Inspector of Buildings.
my 8, 1981
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432
r. Francis Ellerbusch
7399 Memory Lane Northeast
Fridley, Minnesota 55432
Dear Mr. Ellerbusch:
TELEPHONE ( 612)571-3450
It has just recently come to our attention of the alteration performed
to our City owned concrete curb and gutter adjoining Memory Lane on the
two driveways entering your property.
In 1977, the City of Fridley adopted a policy prohibitingrip •vate altera-
tion of concrete curb and gutter on a City right of way. Each year, an
annual contract is let for the type of maintenance required to correct
and maintain uniform concrete curb and gutter within the City. Driveway
openings are available under the contract, for every property owner in
the City. The cost of concrete curb and, gutter is $13.75 per lineal foot.
The curb altered at your residence has been determined to be obstructing
drainage, and not conforming to City standards. The curb will be removed
and replaced within the next two weeks. Forty-two lineal feet is the
footage necessary to be replaced, with a cost to you of $577.50 (42' x
$13.75)
A check for $577.50 should be paid promptly to the City of Fridley. In
the event payment is not received, the City of Fridley will hold your pro-
perty assessable for the above mentioned amount, along with a standard
annual percentage rate.
Your cooperation regarding this problem will be greatly appreciated. If
you should have any questions or comments, please feel free to call me
from 8:00 a.m. to 5:00 p.m. at 571-3450.
Respectfully submitted,
MARK L. BURCH
Assistant Public Works Director
MLB/DZ:ijk
City of Fridley
AT THE TOP OF THE TWINS
SUBJECT
B U I L D I N G P E R M I T
PE
- 176'A 8
r
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
CITY HALL FRIDLEY 55432
612-571-3450
RE O.
1_3PROTECTIVE
/3
NUMBER __T_REV.
910-F15
DATE
7/23/84
PAGE OF
APPROVED BY
JOB ADDRESS 7399 Memory Lane N. E.
1 LEGAL
DESCR.
LOT NO.
15
BLOCK
4
TRACT OR ADDITION SEE ATTACHED
1 XX14PMKXXXNOX Melody Manor 3rd Addn SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Lois Ellenbush 7399 Memory Lane
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Wren Builders 9218 11th Avenue South Bloomington 888-4952
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION j REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
install new aluminum siding
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
TYPE OF CONST.
al uminum
OCCUPANCY GROUP
OCCUPANCY LOAD
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
VALUATION
2,700.00
SURTAX
1.35
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR TH PERFORMANCE OF CONSTRUCTION.
38.50
10 '01PLAN
,C �°�'1 7
CHECK FEE
TOTAL FEE
39.85
S N TUREOFCONTRACTORORAUTHORIZEDAGENT IDATEITHEN
PROPE Y VALIDATED THIS IS YOUR PI=RM1T
BLDG INSP DATE
SIGNATURE OF OWNER 0F OWNER BUILDER) (DATE)
Y�'
NEW [ ]
ADDN. [ ]
ALTER. [ ]
Construction Addr,
Legal Description
Owner Name a Address: r i 35 Tel. # 2 9 4 -
?3.>
Contractor: Z� '� ,� ivti� � Tel . # IL-2
Address:
City of Fridley Effective 4/1/84
R-1 AND R-2
Building Permit Application
Attach to this application, a Certificate of Survey of the
lot, With the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback
Type of Construction: d42 � - - ^- Estimated Cost: o� �
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
DATE: % �L APPLICANT: ,,/�7�°��� Tel.
d CITY USE ONLY
Permit Fee $ �Q°�Fee Schedule on Reverse Side
Plan Check $ _ 25% of Building Permit Fee
State Surcharge $ / 5 $.50/$1,000 Valuation
SAC Charge $ $425 per SAC Unit '
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
Agreement Necessary [ ] Not Necessary
TOTAL $ [ ]
STIPULATIONS:
I
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1993
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS. _ -7,359 na:e=rndrLie
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work herein
Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and
Furnace Shell and Duct Work, Burner - rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace $ 20.00 $ �0.0c, representations stated in this application are true and correct.
(Side Vent - Fill Out Back) a j 994
Gas Piping (Needed with new furnace) $10.00 $
OWNER
Gas Range $ 10.00 $
BUILDING USED AS t�orne.
Gas Dryer $ 10.00 $
ESTIMATED COST tsC.i� U® PERMIT NO. iJ
*Air Conditioning - All Sizes $ 10.00 $
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water) ar�Air)
Trade Name Size No. -N_UA b�(�
Commercial/industrial BTU 20, o uy HP EDA
1 % of Value of Appliance or Work $ Fuel M. C -,o_$ Total Connected Load
State Surcharge $ ,50 Burner Trade Name Size No.
iEP BTU HP EDR
TOTAL FEEo$ b �� S y &'S7
HEATI G COMPANY:v-
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATIONJAfR CONDITIONING PERMIT IS $15.00 �Q(� Signed By PTel No. LA3 Ll i II D
PLUS THE $.50 STATE SURCHARGE 1 y
4
REINSPECTION FEE $30.00 Approved B Rough -In Date Final Date
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
NOTE: #1 through #8 required when using a side vent furnace.
Remarks:
HEATING CO:
Signed By:
Date:
CHIMNEY AND STACK VERIFICATION
The
undersigned hereby verifi that the existing chimney or stack:
1.
Has been carefully exa ined
Yes ()
No
(
)
2.
Is free from rust or det rioration
Yes ()
No
(
)
3.
Has no foreign objects 1 Led within
Y (}
No
(
}
4.
Is securely supported
Yes (}
No
(
)
5.
Meets all current Code req irements for size
and total BTU's connected
Yes ()
No
(
)
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7.
Has a liner been provAwater
Yes ()
No8.
Has combustion aireater
Yes ()
No
(
)
Remarks:
HEATING CO:
Signed By:
Date:
01
SUBJECT
City of Fridley2
�<
4 1 1
AT THE TOP OF THE TWINS
B U I L D I N G
P E R M I T
Ir
RECEIPT NO.
�• COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
5/16/96
JOB ADDRESS 7399 Memory Lane NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR-
15
4
Melody Manor 3 Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Lois Ellerbusch 7399 Memory Lane NE
462-2022
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ MOVE ❑ REMOVE
S DESCRIBE WORK
Reroof House 182nd Layer
9 CHANGE OF USE FROM TO
STIPULATIONS
Roofing can be the 2nd layer but not
the 3rd.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
@
$1,080
$.54
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
$39.12
SIGNATURES OFF CONTRACTOR OR AUTHORIZED AGENT ID/.A,TEI
WH PROPERLY V IDATED THIS IS YOUR PERMIT
Ste✓ L lJ. ..E� co, / A �1� S ��`.
�
E
SiGNATU RE OF OWNER iI OWNER BUILDERI (DATE
�'�
BLD , INSP
f )a E
01
NEW [ l Effective 3/1/96
ADDN [ l CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application 0Z�47
ConstructionAddress:
Legal Description:
Owner Name &Address: e�-0%Sel. #
Contractor: ,�� ��' MN LICENSE #
Address:''
�`=���_J'"."-� ",�-�� -�� Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK AREA: Length Width Hgt/Ground
OTHER:
Corner Lot [ ] Inside Lot [ ]
Type of Construction:
Approx. Completion Date: _
Ft. Yd Setback
Sq. Ft.
Sq. Ft.
Sq. Ft.
Side Yard Setbacks
Estimated Cost: $ i
= Q
STIPULATIONS:
(Cost on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT:
�:2 '' ,��G. Tel. #
CITY USE ONLY
Permit Fee
$ 3 7,
Fee Schedule on Reverse Side
Fire Surcharge
$ ®;
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$900 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
$ 3
STIPULATIONS:
City of Fridley
TO: William W. Burns, City Manager PW96-219
FROM:J Flora, G. Flor, Lic Works Director
DATE: October 9, 1996
SUBJECT: 7399 Memory Lane
The resident, Mrs. Lois Ellerbusch, at 7399 Memory Lane, has requested an extension of
the sump pump participation cost to 1997. She is a retired individual and cannot afford
to install a sump pump detention basin this year. She is requesting that the City's
contribution to the sump pump installation be extended to the year 1997. -Currently, she
is pumping her sump pump water to her front yard and letting it drain across the yard.
As a means of assisting the individual, I have told her that we would extend the City's
policy of contributing up to $475 for a sump pump disconnection for her property until the
fall of 1997.
JGF:cz
61
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
______ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
s' ��
r
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
7/14/97
JOB ADDRESS 7399 Memory Lane NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
15
4
Melody Manor 3rd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Lois Ellerbusch 7399 Memory Lane NE
784-8833
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
Rite Way Waterproofing 448 Lilac St, Lino Lakes, MN 55014 786-0550
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION] REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install interior basement drain tile system
9 CHANGE OF USE FROM TO
STIPULATIONS
Electrical extension cords can not be used as part
of the power source
to the pump.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$1,958
$.98
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
License y)
V$65.19
SIGNATURE OF CONTRACTOR OR RIZED AGENT IDATEI
EN QP VAL1 A D THIS IS YOUR PE IT
BLD1 11
r
qAT
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
61
NEW [ ] Effective l/ 1/97
ADDN [ ] CITY OF FRIDLEY
ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2�7� �-
BUILDING PERMIT APPLICATION
ConstructionAddress: r73qq M e-7Tio 'c -t,/ VWe 0E
Legal Description:
Owner Name & Address: Lo ( S E L� Le�Z a U 5 CO � �Liw ?to -q Tel. # 14 3 3
Contractor: MN LICENSE #
Address: LAY% L11A0, Lim LP -K(_>, "6 SSpI � Tel. # f786 - 0 SS®
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF E"ROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type:1 A)TO21oe -?5L-� (D(2Ar �3 Estimated Cost: $ �o , g .
-
—11 C'G S - (Fee Schedule bn Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: r/ -q - q q APPLICANT: Tei. # r7 2 6 -O S SD
(M, I LAi4
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ V--
$.50/$1,000 Valuation
SAC Charge
$
$950 per SAC Unit
License Surcharge
$ E,KG 1 -r
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [
TOTAL
$
STIPULATIONS:
SUBJECT
P
City of Fridley2
9 9 3 5
AT THE TOP OF THE TWINS
BUILDING
(:�:;
P E R M I T
r
O-
COMMUNITY
i COMMUNITY DEVELOPMENT DIV.
V ____-
r � � PROTECTIVE INSPECTION SEC.
I
NUMBER
REV
DATE
PAGE OF
APPROVED BY
= CITY HALL FRIDLEY 55432
612-571-3450
910-F15
17/26/99
JOB ADDRESS 7399 Memory Lane NE
1 LEGALLOT
NO.
BLOCK
rRACT OR ADDITION
SEE ATTACHED
DESCR.
15
4
lod Manor
3rd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Lois Ellerbusch
784-8833
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Eagleview Construction Inc. 2937 174th InA
Andover 55304 -20067043
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION WC REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof house and garage (22.S Tear -off
9 CHANGEOFUSEFROM
TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
ISTALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1923
$.96
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC
ARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$69.25
FlC
SC 1.92
PLAN CHECK
T A FEE
Lice S ' S
7.13
SIGNAPTuRe OF CONTRACTOR OR AUTHORIZED AGENT ID EI
HE FPR
VALID
THIS IS YOUR
SIGNATURE OF OWNEROF OWNER BWLDERI I ATE,
BLCt INSP
DATE
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: 1?3 % 9 740rd
Legal Description:
Owner Name & Address: �-4 i 5 r& &A6 % k.3/i Tel. # 79y - 9 �3 3
Contractor: e!�a� A-e� .. MN LICENSE #��%d
Address: (3 7 / Tel. # ?-S'3
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: % z oV ,$ ?t v o-� Estimated Cost: $ 19,23
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $
DATE:% APPLICANT: Tei. # 7 S"-3
TOTAL
STIPULATIONS:
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$ -9
.001 of Permit Valuation (1/10th%)
State Surcharge
$ 9L
$.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC Unit
License Surcharge
$ S-,,00
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS:
SUBJEtT
PENO.
City of Fridley
d
" 3 0647
AT THE TOP OF THE TWINS
BUILDING PERMIT
f
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.��
INSPECTION SEC.
r 1 � PROTECTIVE
1 �
= I CITY HALL FRIDLEY 55432
%.j
NUMBER
REV
DATE
PAGE OF
APPROVED By
612-571-3450
910415
1/28/00
JOB ADDRESS 7399 Memory Lane NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
15
4
1 Melody Manor 3rd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Lois Ellerbusch 7399 Memory Lane NE
784-8833
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Norling Exteriors 341 79 Way NE, Fridley, MN 55432
784-8936
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION 0 ALTERATION REPAIR
0 MOVE O REMOVE
8 DESCRIBE WORK
Reside House & Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Call for building wrap inspection before covering.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$6, 100
$3,s05
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$139.25
Fire SC $6.10
STRUCT I OR 7HE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL EE
Licens C $5.0
153.40
AIZNATUREOFCON: RACTORORAUTHORI AGENT tOATEI
EN R P L VALIDAT D�HIS IS YOUR
BL I NSP
b
gAfE
S-GNATURE OF OWNERJf OWNER BUILDERI IOATEI
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMELY AND DUPLEXES R-1 AND R-2 r
BUILDING PERMIT APPLICATION Ai
J
Construction Address: XtiI)e
Legal Description:
Owner Name & Address: .o S Tel. #
Contractor: o//r11a ��el o l S MN LICENSE # ,gam S7 Zoo
Address: 3 V I -)q//, C -1A:4 ��. Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF BIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Len /Width Hgt/Ground Sq. Ft.
OTHER: -e� f S i ID L &Y , d —
Construction Type: Ae �We o''G% -Aa X g, /4,,, ,9,t Estimated Cost: $ 6 /Uy O 0
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $
DATE: o o APPLICANT:A�Tel. # 41a
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ , �� ^
Fee Schedule on Reverse Side
Fire Surcharge
$ , /Q
.001 of Permit Valuation (1/10th%)
State Surcharge
$, 0.�
$.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
$ IY3- e
STIPULATIONS:
u
SUBJECT
City of Fridley
3 33m^2 5 3
AT THE TOP OF THE TWINS
BUILDING PERMIT(:
r
______ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
j r
r '
NUMBER
REV
DATE
PAGE 0:
APPROVED BY
CITY HALL FRIDLEY 55432
763-571-3450
910415
11 /13/02
JOB ADDRESS 7399 Memory Lane NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
15
4
1 Melody Manor 3rd Addition SHEET
2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE
Lois Ellerbusch 7399 Memory Lane NE 763-784-8833
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Wellington Windows 3938 Meadowbrook Rd, St Louis Park MIND 55426 952-933-6300
a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
City License
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW 0 ADDITION 0 ALTERATION 0 REPAIR 0 MOVE O REMOVE
X
8 DESCRIBE WORK
Replace two windows within existing o-peninjzs
9 CHANGEOFUSEFROM TO
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.
permit Inspection Cards
Will Be MITIalled
. 11omeowner 11pon Post
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$1,900
$.95
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$66.20
Fire SC $1.90
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE TOTALFEE
$69.05
PROPERLY VALIDATED THIS IS YOUR PERMIT
S-GNATURE OF CONTRACTOR OR AUTMORQEO AGENT tOATE, _
ZAHEN
Aft
INSof�T�
S-GNATURE OF OWNER,IF OWNER BUILDERi (DATE.
u
NEW (] CITY OF FRIDLEY Effective 1/1/2002
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: 7211 Lle-1-io ry AIS
Legal Description:
Owner Name & Address: L -O` E L I 2 Tel. #%L- %01_W3?
Contractor.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
MN LICENSE #ta-clem h9
Tel. #06 GY
Attach to this application, a Certificate of Survey o the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
Length Width Hgt/Ground Sq. Ft
Construction Type: PeQl 6 Estimated Cost: $ �G% L9
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x/$ _ $
DATE: !! 7 d APPLICANT: t f.�[ 4� Tel. #
Call (763) 572.3604 for Permit Fees If mailing In application or Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS:
CITY OF FRIDLEY PERMIT NO.: 2006-00009
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 01/04/2006
572-3604 FAX: (763) 571-1287
REPRINTED ON 1/12/2006
ADDRESS : 7399 MEMORY LN NE
PIN : 113024140046
LEGAL DESC : MELODY MANOR 3RD ADD
: LOT 15 BLOCK 4
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : X ALTERATION
VALUATION : $ 8,000.00
NOTE: REPLACING 2 WINDOWS WITH EGRESS WINDOWS AND FINISHING BASEMENT
APPLICANT
SIDNEY HANDLOS
735 PARKSIDE DR
ST PAUL, MN 55127-3650
(651) 262-1369
,IT,`Wro :7
ELLERBUSCH LOIS R
7399 MEMORY LN NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp.
BUILDING PERMIT FEE 153.25
PLAN CHECK FEE 99.61
FIRE SURCHARGE 8.00
STATE SURCHARGE, VALUE 4.00
TOTAL 264.86
PAID WITH CHECK # 10895
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
Building
BIUILDING
Permit No.:_gz6&-- 6000
Inspe tion"S
RESIDENTIAL APPLICATION
Received By:
763-572-3604CITY
OF FRIDLEY
Date Rec'd:
I
�p
ADDRESS ��� \�/'
DATE
YOUR E-MAIL
SITE ADDRESS �� `iYIfJJ+�
l�� ( A� bJ Z
THIS APPLICANT IS:
'.OWNER ❑CONTRACTOR
PROPERTY OWNER/
NAME: Jew alk -1204k- VUldL'K"-
TENANT
ADDRESS:13°tel nk/! cfiN1 'n r y CITY T nAev STATENZIP 32-
PHONE: I& SDA -Z093
CONTRACTOR
NAME; fji
STATE LICENSE # :2D3(01 S�Z EXP DATE
SUBMIT A COPY OF
"& pr CITY Sk ��'t STATE ZIP �SIz7-36S®
YOUR STATE LICENSE
ADDRESS -:125-
WITH APPLICATION
PHONE SI - U3 _ FAX
PROPERTY TYPE
INGLE FAMILYINEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED "WINDOWS
ASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR` .BREMODELING
DESCRIBE WORK BEING DONE: 12wJ aU hh - VV{ 1(V oyK W& ��1L VV 1 Vt OY61f VUf —` •d lr1
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1. Existing Floor Plan
2. Proposed floor plan
PROPOSED SIZE:
O DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT -
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soft
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1. Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
WINDOWS
2. Two sets of construction plans
M EXISTING OPENiNGSs21�es ❑No LOCATIQN OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF �R�I / Yf 15w xS4 � �d��; S x 4# Iva( f rt wA)
3. Epergy Calculations
OPENING CHANGES & 2
TYPE OF WINDOW TO BE INSTALLED
Me t) NUMBER OF WINDOWS
ALL FEES ARE BASED O1V VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ c� 0.) C--3, 6� OCCUPANCY TYPE
Permit Fee $ [ 5 3. a 't;See Back Page for Fee Schedule
Plan Review $ qq , (0 ( 65% of Building Permit Fee
Surcharge $ L1, t (.0005) times the total job valuation — Minimum $.50
Fire Surcharge $ , 00 .001 x Permit Valuation (1/100/0)
License Surcharge $ $5.00 (State Licensed Residential Contractors)
SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft + 6 ft = ft x $20 = $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( )
Total Due . $ Q [oJ4. 6 to Make checks payable to: City of Fridley Attach Stipulations
* W6 THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building 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 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 wh rcquil' =roval of plans. � A ➢ �� �p � 2
SIGNATURE OF APPLIC PRINT NAM 0�;1 �y V i IMS' DATE [ 'J ✓ d�
ril
pro P&X
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ff-W
L
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nth qat.4-
prvp.Az -6-
INAll nye 4rvak-,(
It
olli
MC 4o (y4L
REVIEWto,""
FOR CODE
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