PRE 2010 DOCSSUBJECT
PERMIT
City of Fridley
11 ����
AT THE TOP OF THE TWINS
BUILDING PERMIT
•
r
NECEIPT
r COMMUNITY DEVELOPMENT DIV.
( ---- --
�:
PROTECTIVE INSPECTION SEC.
� �
ggLlgoe/
1
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
=�
�'--1 CITY HALL FRIDLEY 55432
612-560-3450
910-F15
2/24/75
JOB ADDRESS 201 Mercury Drive N. E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
1
2
Sylvan Hills Plat 5 SHEET
2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE
Milo J. Mannino 2818 Northway Drive
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Pendzimaz-Hallen Construction Co. 5740 Brooklyn Boulevard
-7-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
X
8 DESCRIBE WORK
Construct a 25' x 411 Dwellinci,and a 28' x 24' Garacie
9 CHANGEOFUSEFROM TO
STIPULATIONS
Provide a hard surface driveway. Provide a verifying survey before
capping.
SEWER LOCATION: 51' East of Manhole (E. Inv. 837.64) 0-ji's
Wye Elev: 838.71 ® Ca,q-
Top of Footing: 842.71 Minimum 0 r,!
WATER LOCATION: 10' East of Sewer Service V
(Services off Satellite Lane)
5OR WRING,
PERMITS REQ! IRED
SEPERpfiE
AND SIGNS.
"FATING, PLUMBING
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame
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
R-1
1066
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
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
$27,908
13.95
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.
$53.00
$325.00
PLAN CHECK FEE
TOTAL FEE
$391.95
GNAT RE ftONTRACTORO�THORIZEDAGENT (DATE)
WHEN PROPERLY ATED THIS IS YOUR PERMIT �.
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
BLDG. INSP DATET-
i
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME: Milo J. Mannino BUILDER: Pendz imaz-Hallen Construction Co.
ADDRESS: 2818 Northway Dr. ADDRESS: 5740 Brooklyn Blvd
NO:. 201 STREET: Mercury Drive
LOT: 1 BLOCK: 2 ADDITION: Sylvan Hillsi�P pct 55
CORNER LOT: X INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As: Single family dwelling
house Front:_ 2 • Depth: 411 Height: 12•
Houses 8528
Square Feet: 1066 Cubic Feet: Basements 8320
garage Front: 28' Depth: 24, Height: 8'
Square Feet; 672' Cubic Feet: 5376'
Type of Construction: wood frame Estimated Cost:_$ 40.270.00
To Be Completed: 120 days
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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.
� sGam/
DATE: 9 / ,/ ?A�5SIGNATURE •
(See Reverse Side For Additional Information.) 6 �+
..Oe i
y' P
L
AGREEMENT
DATE
i/.4:fx� the owner of the
following described pro erty ,`
� �/. Of
Hereby agree to pay in cash $ , "� � ?!f ,`
to the city of Fridley to cover ' my proportionate
share of the utility system, or in lieu thereof agree
to have the City levy an assessment against the
property described above to cover the cost of my
proportionate share of t6 utility system as pro-
vided in Section 2 of Ordinance No. 113, passed
by the Council of the City of Fridley on December
11 1958. 007 --.0p
FR'S SIGNATUR
�.'40
Tapping Permit No.
a
• � A
9
CHERRIER WWER & ASSOCIATES INC.
REGISTERED PROFESSIONAL a LAND SURVEYORS SUITE 306 I
VILLAGE NORTH P0104S$IONALOLDG
7420 UNITY AVENUE NORTH
BROOKLYN PARK. MINNESOTA 55 43
Certificate of Su
T 4.r
PROPERTY OF Pendzimaz Hallen ConstructCo,
.. .......... .... . ..r... .. T.... ,.
described os bllorrs..............�•4t.. ....� O.C.M..�..:. SXI�V.A ..Iii S.-FLA,T..5,..:Oaunty....of..
................... _...... Anoka�..State. o.,.n�i4Boti�....... ... .. ...............:...........
................................................... .. ..... .............. ... . ....... .�..• .... r
--- -
SATELLITE L ANS
N 89 S2 1#04t
--MI. 78—
T=30
'8_T=30
'�. y �` pRoPo�l►� Hot-L�,i; ` �' f�
tt�i�►';cx.� � I�F}�+2 846.5
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6 �
•� ai•SS _ 7 vc� I ,•'aV
QQ
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I hereby certify that, this survey, plan, or report was prepared by me or Scold: i ink
under my direct supervision and that I etn a dint RpisNred Land Surveyor • — In~" holy Mommnt Set
under, the J�ws of the State of Yirnneaota. O — bdioetes Irm Nomriftext Fb"
/ ., '......................................................... eoeR.......Page .......... No.. 320
Date..t .' ..... Rog. No.,9dtii
- -
(..5� l�v�c es
�i OF � /Y/,
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0
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9
N
City of Fridley
pQiccNaam hr SumMag and G= �NOung Permft
Dept. of Bldgs. Phone 560-3490
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
• Future Connection Openings
+ New Fixture, Old Openings
PARTIAL RATE SCHEDULE
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all; the fact
and representations stated in this application are true and correct
Owner
Kind of
sppool
Cesser � Used as
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
8111mmuMMMMMM1111
x $2.00
$ 6
Future Fixture Opening ...........
x $1.50
$ .
New Fixture Old Opening .....:....
. x $1.50
Catch Basin ....................
x $3.25
$
Water Heater :Up to 99,000 BTU) ....
J x $3.00
$
New Ground Run Old Bldg. ........
x $3.25
$
Electric Water heater ..............
s $2.00
$
3AS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ...................
�_ x $2.00
; ,-2
Additional Fixtures ................
x $ .75
$
Gas Range to 199,000 BTU.. . ,........
x $5.00
;
• Future Connection Openings
+ New Fixture, Old Openings
PARTIAL RATE SCHEDULE
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all; the fact
and representations stated in this application are true and correct
Owner
Kind of
sppool
Cesser � Used as
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures .................
x $2.00
$ 6
Future Fixture Opening ...........
x $1.50
$ .
New Fixture Old Opening .....:....
. x $1.50
Catch Basin ....................
x $3.25
$
Water Heater :Up to 99,000 BTU) ....
J x $3.00
$
New Ground Run Old Bldg. ........
x $3.25
$
Electric Water heater ..............
s $2.00
$
3AS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ...................
�_ x $2.00
; ,-2
Additional Fixtures ................
x $ .75
$
Gas Range to 199,000 BTU.. . ,........
x $5.00
;
To be a
r
Fridley, Minn o 1��
Estimated Cost. $�=✓/�� ''
Old—�� Building Permit No. Permit No. (0457
SignedBy
i
Business Phone
ROUGH
FINAL
REPAIRS # ALTERATIONS—Roter to Cod* .50 State Surcharge
Description ............................................ ;
TOTAL FEE
A-iF--
8t -
ro for Power Pkwh and HeathM Cooling. Ventilations Refdpration and
Air Conditioning Sydems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: HATE TOTAL
Furnace Shell & Duct Work ........ . ..... .. $10.00 $
Replacement of Furnace ..... ..... 6.00 $
Repairs & Alterations—up to $500.00 6.00 $
Repairs & Alterations each add. $500.00 3.00 $---- —_
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ..... .
..$10.00
$ la f Z
each add. 60,000 BTU ....................
.. 3.00
i
Replacement of Furnace
... 6.00
$
Repairs & Alterations—up to $500.00
6.00
$
Repairs & Alterations each add. $500.00
&00
$
STEAM or HOT WATER SYSTEM
$
AIR COlfD1T=ONENG
Furnace Shell & Lines—to 400 sq. ft. EDR Steam
$10.00
FAN HEATING SYSTEM See Fee
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water
10.00
$_
Each add. 200 sq. ft. EDR Steam
3.00Each
ALTERATIONS S REPAIRS
add. 320 sq. ft. IDR Hot Water
3.00
$
OIL BURNER—to 3 gal. per hour 6.00 $ —
over 3 gal, per hour—See Fee Schedule
GAS BURNER (up to 199,000 BTU)
6.00
$ v
over 199,000 BTU See Fee Sehsdnb
GAS FITTING FEES:
NO RATE TOTAL
1st 3 Fixtures
x$ 200
$
Additional Fixtures
x .75
$
Gas Range to 199.000
x$ 5.00
$
AIR COlfD1T=ONENG
$
FAN HEATING SYSTEM See Fee
Sehadale
VE ITILATING SYSTEM
$
ALTERATIONS S REPAIRS
TOTAL FEE
a
ROUGH
FINAL f - al - Z�
(SURGHARGE $_,.50)
Dept. of Bldgs. Phos 8804480
Locafiea 201 Mercury Drive
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinance:
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley, Minn lg
Owner Pendzimaz & Hallen
Kind of Building .�Framt%
Used as
To be completed about
Estimated Cost,_-
Old—NewXBuilding Permit No. Permit No. L3
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam. Hot Water, Warm Air2LNo 1
Trade Name Lennox Size Ne G1203-.110
Capacity Sq. Ft E.D.R_ 110 , 0 0 0 13
..ff H.F..
Total Connected Kind of Flet Nat.Gas
BURNER — Trade No size No
Capaci Sq. Ft. EMD R- BTU
SIP:
(REMARKS -OVER)
Sim Mill City Heating Co.
Bladness Pti=e pa 544-1501
e q'
1}96
HEAT L®SS CALCULATIONS DEPARTMENT OF cNsprx;"iloN
Construction No. Insulation
Weatlasrstrips , *� � How Appli
lindawe' 'Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind
19 Width Height
t�bte �e gth Widt fight ' Fl. Dom Length
it�• �' racks e and Area
Windows and Dots—C g
Windows and Doors—Crackage an Area R,Idth Height No, of Lineal ft. Area
width Height No. of Lineal ft. AreaJA No ° e of Ights of crack sq.
No of pa of pane —:— 11 hts of er4ck sq � Oe
_
Infiltration
Glass
Exp. Vw
�"' ,
Net eall
Int.wallp---
Ceiling
Floor
Total Btu.
Requir sq. ft. E.D.R. or sq. ins. W.A. ader area `
Fl / Room Length Width Height t
Windows and oors—Crackage and Area
MelWidth of,
Linoal ft. Are
e o t N to of crack sq. t.
ATa oe
Coef. Btu
Glzw:a:::�_
Net exp. wall
Int, wall
Ceiling
F•lnnr
AVW1;n1dows
. ft. E. R. or sq. ins. W.A. Leader area
aom Length Width
and Doors—Crackage and Area
C" Infiltration
O Glass
ew-ap, wall `✓C�
9 Net a:p. wall
Int. w 11
Ceiling
Floor
a
Tot 1 Btu.
Required aq. ft. E.D.R. or sq. ins. VA. Leader area
in ! Room I Length width
Windows and Doors—Crackage and Area
eal ft. Ar
width ° Helgnte tlshts of crack SQ. f
No. of pa e I I
Infiltration
t 9W
Gla5s
Earp, wall
Net exp. wall
Inc. wall
Ceiling
Floor
Total Btu.
Required sq.
D R. or sq. ins. WA. der area
Fl.
m 1 Lengt ® .o°1Width Height
Windows and
Doors•--Crackage and Area
Width
No. of p e
HatBOe It�ht0 Ll of cr l ft-
►//�/
j/
V.
IJ 96
HEAT LASS CALCULATIONS DEPARTMENT O� INSPECTION
Insulation
Construction No.
Weatiteratrips _ GuideHow Applied
Wind ivs Doors Reference Out. Wall Int. Wall Coiling Roof door Kim
es-- e
ngth Width He' t F1•I
Room Length Width Height
Windows and Doors.–Crackage and Area ,.
Windows and Door rackage and Area Width Height No. of Lineal ft. Area �p
lYldt He1Bht No. of Lineal tt. Area No of a ne 11 Eta of crack aa• t•
No. 0f pane o ne ieshee of cra aA t f
s �J
Infiltration
Glass
Exp. wall
Net exn. wall
Total Btu.
Rte' ed D . or sq. ins. W.A. ader area
oom Length idth 'Height
Windows and Doorackage and Area
Width Height No. of Lineal ft. Arei /)
Na oY pan a ll�hts of crac
(40 r _
::j_-
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling -o
Floor /097
Total Btu.
Wutdows and
Infiltration
Glass
Exp, wall
Net exp. wall
Int. wall
Ceiling
Floor 91�-
Total Btu.
Requi d sq f
E.11-11. or sq. ins- WA. der area
Fl
I Length /...Width 'fle►ght s
Windows and Doors—Crackage and Area
Width
No. of Dane
Hefgbt 1 hoof Leal
o ta of crack SQ.
8 Infiltration
ffjoAb� Glass
r_ Exp. wall
p ("e i ::7 ::1 ' Net
exp. wall
Int. wall
Ceiling
Floor r"
Total Btu. f
ins. W.A. ader area equir ft. E.D. . or aq. ios. W.A. der area r
ngth Width —Height FI.
mn I Length idth Height
.kage and Area Windows and pooh—Crackage and Area 1
K Lineal ft. Area %%/.''��� Width Height No. of Lineal ft. Area
0 of crack e0• No. of Dalle s 11 fits of e k M.
Infiltration
Glass ��--�--
Exp. wallNet exp. wall
Int. wall
Ceiling 0
Floor
Total Btu.
SUBJECT
MIT NO.
City of Fridley
5089 089
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
• ______ COMMUNITY DEVELOPMENT DIV.
L
^ �(7'
r 1 PROTECTIVE INSPECTION SEC
,,[� Jj�
i
CITY HALL FRIDLEY 55432
✓��_ v
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
5/23/97
JOB ADDRESS 201 Mercury Drive NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
2
Sylvan Hills Plat 5
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Virgil Voeller 201 Mercury Drive NE
571-3103
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
O NEW ❑ ADDITION O ALTERATION j7 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (23 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. 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
1
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
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$1,897
$.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
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
T AL EE
$ .35
SIGNATOR ON'RACTORORAUTHORIZED AGENT IDATEI
rp Q
VALI THIS IS Y UR PERMIT
SiGNATU OV OWNER BUILDERI IDATEI
BL INSP
GATE
NEW [ ] Effective 1/1/97
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 'ZC1 /q e r4
Legal Description:
Owner Name & Address: 1,ll� 0 e Ile /' Tel. # S 7/- y -3
Contractor: A MN LICENSE #
Address: 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 Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: Re- to o 'c Te 4 r' - Z 32
�y
Construction Type:
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Estimated Cost: $
(Fee Schedule on Back)
Ft x $ _ $
DATE: S- 2 3 - 9
7
APPLICANT:
�/,',-•� ' / Ilele Ile L Tel. # S' 7/ --3
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$950 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
$
STIPULATIONS:
Building
PLUMBING
Permit N ►' ��
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
763-502-4977 FAX
"p
EFFECTIVE7-1-2010
DATE ® YOUR E-MAIL AWRESS
SITE ADDRESS 01 Me C "IC- V ('- t
THIS APPLICANT IS: ❑ OWNER CONTRA OR
PROPERTY
NAME; s
ADDRESS: CA. ` /ey STAT /VZT�
OWNER/
TENANT
PHONE:
CONTRACTOR
NAME; ` LL
STATE LICENSE # C% G� EXP DATE I /
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
STATE BOND # EXP DATE
CERTIFICATE OF
SIP
ADDRESS: � CITY �Sc��s TATE i�_ZS_S3
INSURANCEFAX
PHONE J0-3—,571- ® S 1-) 7G 3 ` !:t 5—L-5 — 7 'h&
PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑'REPLACEMENT
DETAILED DESCRIPTION OF WORK!s c
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
BATH SINIULAV DRAINS —SHOWER _ WATER PIPING
_ _FLOOR
GAS PIPING (NEED CITY LIC) _ SWIMMING POOL —WATER SOFTNER ($35)
—BATHTUB _
KITCHEN SINKWATER CLOSET _ BACKFLOW PREV. ($15)
CLOTHES WASHER _
_ _
LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
—DISHWASHER _
WATER METER OTHER
Number of fixtures @ $10.00 x $10.00 = $
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge $ 5.00
0Ll
$40.00 Total = $ ().100
THIS IS AN APPLICATION FOR A PERMIT -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 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 on site; that the work will be in accordance
with the approved plan in the Se of all w wh q1 review and approvfplans.
SIGNATURE OF APPLICANT PRINT NAME ATE
APPROVAL INSPECTORS SIGNA
PLEASE NOTE: SEP TE PtMTS ARE RE U1RED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-5024977
3,-3k,
91