PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date: `- -
-- ...� .........- _ ----- -
Owner:
Address
Builder ........... - -..... -......... ...... ........
_._....._.._......__.._...
Address..... .......... - _....-•----... --- .....
LOCATION OF BUILDING
No....r71,3.. ........ Street... -//...... - - - .c-u�-ems.........------------.. Part of Lot ........ ........... ........ ............................ -•-------
Lot ............................ Block ..... -..........tom. .......... ................. Addition or Sub -Division ... ................... _.. � .�_`��.
CornerLot .................. ....... -........ Inside Lot ...................................... Setback ....-. ................... Sideyard ..... . ..d......._ -Q...........................---..._ ....... _..
SewerElevation ------ ------------- ------------ --------------- ---------- .... ........................................ Foundation Elevation ................................... - ............. .... --............. -........... --
DESCRIPTION OF BUILDING
To be Used as:
- ..........- ' ........ Front !.'-
�... . Depth .... Height cyl-_,_... ' Sq. FL / ®.�?Cu.
............... _...................................... Front ..... - ............ ......Depth .................. Height ........................ Sq. Ft....................... Cu. Ft. ..... -.................
_...................
Type of Construction ........... ........................ Est. Co4cm �-.9.10...7.x....®0.-... To be Completed ..... .............. .............. ..................
In consideration of the issuance to me of a permit to construct the buil ' g described above, I agree to do
the proposed work city
accordance with the description above forth /7mco fiance with all provisions of
ordinances of the of Fridley.
LI
In consideration of the payment of a fee of $.._iL.b.. — - , permit is hereby granted to ...... .............. ...... ...............................
___.._._.......... ....... ......... _..._................. 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 and 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, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any upon violation of any of the provisions of said
ordinances.
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these hems.
4
City of Fridley, Minn.
BUILDING PERMIT
Date: AUGUST 182 1965
RUSSELL L. HOUCK
30,,--)06
N? 8381
Builder SUSSEL COMPANY
Address 750 OVERTON DRIVE N.E. Address 1850 Como Avenue
Fridley 32, Minnesota St. Paul. Minnesota
LOCATION OF BUILDING
No. 750 Street OVERTON DRIVE N.E. Part of Lot
Lot 7 _ Block 6 Addition or Sub -Division BROOKVIEW TERRACE, 3RD ADDITION
Corner Lot , Inside Lot Setback Sideyard
Sewer Elevation — Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
ATT . GARAGE Front 18'6' Depth 25'6" get 10 Sq. Ft. 45 0 Cu, Ft 4,500
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Est. Cost $1.600.00 — To be Completed
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 21 provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of5S .00 , permit is hereby granted to SUSSELL GARAGE
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 and 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, Minnesota location, construction, alteration, maintenance, repair and moving of buildings
withinord the city limtta � permit may be revoked at any time upon violation of any of the provisions of said
ALLEN G. JENSEN
Building Inspector
NOTICES
'lids pumb don eel eowe #6 com eudion, bdagdlm for whey, plumbing, gn 6a h"j, awa or waw. Be aro is sa
*0 Bumbas kwectw tar $spud* pwa6a ler Uaw hum.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME m�e c, 5S c
/k v r,�E
BVILDER
�, S sS'
Q c
ADDRESS_ 7S 0 CPae r i
y-
ADDRESSl
S'U
LOCATION OF BUILDING
a -Ma _ Street Part of Lot
LOT R ADDITION OR SUBDIVISION
Corner Lot Inside LOT Setback Side -Yard
SEWER ELEVATIOly FOUNDATION ELEVATION,� w
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:
7"/d ��. -� �- Front �J6 �� ` Depth,— Height
�� Height d
Sq. Ft._ �/,5—Z- Cu. Ft._
Front Depth �r -Height
Sq. Ft. Cu. Ft.
Type of Construction P
Estimated Cost ( �
To be completed i®
The undersigned hereby makes 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.
DATA / C-
(Schedule of Fee Costs can be
a
found on the Reverse Side).
LOT
NAME
SIZE
i3ASEMC.tJT
SS LL- L. Hooc,4
N.
BLOCK
ADDRESS
VALUE
_ //��
%t50 Ouem-roo Ct
40
r(DOD
ADD'N.
AREA
TYPE
M/�TGt-1 TUB cDF O a� �i o u s
�1ZIL7LE
�SZ.AM�
N
MosT ZE
CC
AT LEAsr
rev
RJ L_tx v
Le
�-----
W t r" Hoose
tt�� Y�
a LI -JE: t7MOA-3T I� nIJC> QEAlZ (,t= G&mt caE, CJ1 ,-r,-, TRoalT Au® rzeA.m
®F Nouse As st-4o4_00
® 4 L=am2� �fw 2 F_ a� _� �l
oI2S(%40 E �TopP STEP
�I
5
--
KEM uE LOe tC, OF, Z-
.s
i3ASEMC.tJT
(-Aj uavw5.
N.
G)
4z••
4Z"
O�vSTe.t_l:
�.. �t�C7Gle; S AS
iV SCE sSAl2`/
Q� �Ui� ®F SL/Ap TO
M/�TGt-1 TUB cDF O a� �i o u s
�► .� S+ c F s. At s S, -10,0#j
TtJ SLA,6
0'7P20V
OT.rs-rA
LLL 1-4'
XT" C)oor2
OF Ho -3s= 1u Qft mb c:z F—
NS vNOf-Aj 0
r
e
�
CITY OF FRIDLEY INSPECTION DIViSION
�
���
Effective On January 1, 2001
6431 University Ave NE
Fridley, MN 55432 APPLICATION
FOR POWER
PLANTS AND HEATING, COOLING, VENTILATION,
763.572.3604
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS NtV-ip Y'\
CLV-
RATE SCHEDULE
OWNER
Residential
Rate
TOTAL
Furnace Shell and Duct Work, Burner .
BUILDING USED AS
Also Replacement Furnace
(Side Vent •Fill Out Back)
$ 30.00
$
�� u-17 ��
ESTIMATED COST PERMIT .NO.L L
Gas Piping (Needed with new furnace,
$ 10.00
$
but not replacement)
DESCRIPTION OF FURNACE
AND OR BURNER
Gas Range
$ 10.00
$
No. of Heating Units • Circle One
(Steam) ' (Hot Wi tdr) (Warm Air)
Gas Dryer
$ 10.00
$
Trade Name
Size No.
'Air
BTU H.P EDR
Conditioning - All Sizes
$ 25.00
$
Fuel Total Connected
Load
All Others/Repairs & Alterations (LIST ON BACK)
Burner Trade Name
Size No.
1%, of Value of Appliance or Work
$
BTU HP
EDR
Commercial/Industrial
1.25% of Value of Appliance or Work
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VEN
REFRIGERATION/AIR CONDITIONING PERMIT I $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
'A r Conditioners can not be placed in a side yard without
wr«tten permission from adjoining property owner.
$ .50
$ 'T
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE
INC.
Rough -In Date Final Date 1
elft. / t
fies that the
When replacing an existing fura free from rustrsdetenorationy obsttructions,
and is
Yes No( )
venting has been examined
and firestopped where required.
Appliance #1 Type
and is securely supported
Fan Assisted or Nat
The venting system is plastic/PVC and meets all current codes and manufacturer
of elbows and termination.
Yes No ( )
specifications including sizing, length, number
Appliance #3 Type Total Btu Input
nufacturer's specifications This does replacement unit is a listed assembly
The undersigned also verifies nd the
Total Appliances
and meets the current codes
AGA -LAMA Category I Central Furnace Venting Tables for fan
` [
Yes'( No( )
include
assisted and natural draft appliances.
^^
on air is sized and installed to meet the current codes
Yes No ( )
The
and manufacturer's specifications.
ft Diameter _in Type -
ft Diameter in Type -
When required to install a new combustion ° iwill and installed
Yes No( )
to meet the curre nt codes and manufacturer's specifications
Appliance #3 Vent Connector Height
When installing a new venting syetCu� n modes and manufacturdersigned hereby er's that
it is a listed assembly and meets th
This does include AGA -LAMA Catego I Central Furnace
Yes No ( )
specifications.
Venting Tables for fan assisted and natural draft appliances.
BLAINE HIS A/C
' L A INC.
from the ommanv vent ainstalled nd vented correctly after
Is the common vent and vent connectors
HEATING CO:
an appliance has been removed
Yes ( No ( )
separately as per current codes.
_ L
BTU Input
Fan Assisted or Nat
Appliance #1 Type
BTU Input
Fan Assisted or Nat
Appliance #2 Type
BTU Input
Fan Assisted or Nat
Appliance #3 Type Total Btu Input
Total Appliances
Common Vent Type
Vent Height
Diameter in . ches
Appliance 91 Vent Connector Height
Length
ft Diameter _in Type -
ft Diameter in Type -
Appliance #2 Vent Connector Height
— ft Length
Length
-
Diameter __in Type
Appliance #3 Vent Connector Height
ALT1=FtATIONS: Describe
BLAINE HIS A/C
' L A INC.
HEATING CO:
N 553M
Signed By: =�
Date:
.
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Effective On January 1, 2001
Fridley, MN '55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
763.572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE yA
Residential Nov
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
"Air Conditioning . All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
10/0 of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate TOTAL
$ 30.00 $
$ 10.00 $
$ 10.00 $
$ 10.00 $
$ 25.00 $
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
"Air Conditioners can not be placed in a side yard without
written -permission from adjoining property owner.
JOB ADDRESS___—7w D
OWNER �� let / soh 9) pak-)
BUILDING USED AS C�lG4,�CC
ESTIMATED COST _ U� PERMIT.NO. 1
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating UnitsCircle One (Steam) ' (Ho Wator
) arm '
Trade Name C� l'l Size No. 7U
BTU HP EDR
Fuel Total Connected Load
Burner trade Name Size No.
BTU HP EDR
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes an
rulings of the Building Division, and hereby declares that all the facts and
representations slated in this application are true and correct.
DATE
BLAINE HT4. A/C ELECT INC.
HEATING CO i358AM�VA RMAM AVE. I.E.
Signed
—7-2_-�-0/
TEL # _Jr_1IDW-
Approved By A
Rough-In Date Final Date
BACK SIDE MUST BE FILLED IN ON VENT SIZE, VENT CONNECTORS
AND COMBUSTION AIR VERIFICATION
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes No( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes No( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes No ( )
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yeso No ( )
When installing a new venting system, the undersigned hereby verifies that
'it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA -LAMA Category I Central Furnace
,Venting Tables for fan assisted and natural draft appliances. Yes No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes ( No ( )
Appliance #1 Type AL n (I % BTU Input `c r�Fan Assisted6 Nat _
Appliance #2 Type BTU Input ® Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances ® Total Btu Input
Common Vent Type Vent Height Diameter _ inches
Appliance #1 Vent Connector Height ft Length ft Diameter , in Type_
Appliance #2 Vent Connector Height ft Length ft Diameter in Type:'
Appliance
ype 'Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
BLAINE HTd. A/C ELECT., INC.
13582 CENTRAL AVE. N.E.
HEATING CO: AMgKAjfiN 58304
e
Signed By: n. Date: -::
w
Is MA INE HEATING
AIR CONDITIONING
AND ELECTRIC, INC.
ADDRESS -7`. o Ove -4yvI 'by -
OCCUPANT V Ri4ki S v" SY'-PA AmA
HEAT LOSS DATE HTG. INST. 19 - -O
SOLD BY CO kc t (O at/ s
Electrical Work By j PC.
TYPE OF HEAT GA—FA Y - HW STEAM SPACE HTR.
GAS DESIGN
MAKE Foli n e
INPUT o (e.,0&—
zz. t% Percent CO2
Percent Oz 9
3 -76 Percent CO
HOUSE HEATING TEST RECORD
APT. _
OWNER
FLOOR CITY SUBURB
INSTALLED BY & i r m
Gas Line By S C. -.e
UNIT HTR. OTHER
C*3a4:c31•U
Vent Size
KIND OF LINER 1+1W4,% SIZE NONE
Draft Hood '771.o Uc Regulator
Filters Size Number
Chimney Location Inside �--XOutside
Chimney Construction C
Smoke Bomb Wiring --.L
Draft Test Tag ^
Door Pressure Lighting Inst. %C
Date Tested
Company Testiaa /3 W A h!_ . e4 _g e e -
Name of Tester
Pressure Percent CO2
Input CFH Percent 02
Stack Temp.
Percent CO
AW
G7YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
November 26, 2001
Mr. Jamison Stepan
750 Overton Drive NE
Fridley, MN 55432
Re: Final Inspection at 750 Overton Drive NE
Contractor: Blaine Htg AC Electric Inc
Dear Mr. Stepan:
Permits were issued on July 12 and August 1, 2001 to install a furnace and air conditioner at
your address. According to both the 1991 Uniform Mechanical Code a final inspection shall be
conducted on the work authorized by these permits. As of this date, no final inspection has been
called for.
The permit fees that were paid cover the inspections to make sure the work was completed
according to the Codes. We will keep your permits open for another 30 days and if we do not
hear from you within this time to set up the inspection, we will expire the permits and no further
action will be taken.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
.gmrPrAv
"I f „ 1
ATY OF FRIDLEY INSPECTION DIV.
431 University Ave NE
( UM. MN 55432
y 763) 572-3604. FAX (763) 571-1287
L
Effective April 1, 2004
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
(DARK NIIMRFR nF FIXTLJRFS Tn RF INSTALLED ON EACH FLOOR
Wash
-LUMBING FIXTURE RATES NO.
... ....
JOB ADDRESS
levy Fixtures
$10.00
Floor
3Id Opening. Now Fixture
Auto.
=_. `Gas
:,� vvaler heater
Stones
,...'
Urinal
Shower
.
" `
- -n -
.r„ e.<
* ;
Tra Dram
-_�x
Vii»: _e
Washer
_
= Range
><iZ
Gas flec
DATE: O ��1 20 Zo
a :ump)Receiving Tank
$10.00
E2 Vater Treating Appliance
$35.00
OWNER(
Vater Heater -Electric
$35.00
Basemen
$x.00
BUILDING USED AS �
Z Sas Range"
$10.00
3m Dryer—
$10.00
ESTIMATED COST PERMIT' NO.
lack Flow Preventer Required ( )Yes () No
Type
$15.00
PLUNGING COMPANY
TEL N0.
nk
Floor 2
SIGNED BY
G
1 25% of Value of Fbdure or Appitance
Floor 3�-
u
oory
Fl4
ia83wa -Y^.
xa'-xo
o.>L...?�v..x._
c N. `..
a7?S:R'`z.HaCRsx!:!•
..3 _ L"w..-'3Y'.:
Tgj45Si
-LUMBING FIXTURE RATES NO.
RATE TOTAL
JOB ADDRESS
levy Fixtures
$10.00
The undersigned hereby makes application for a permit for the work herein
3Id Opening. Now Fixture
$10.00
spec ced agreeing to do all work in strict accordance with the city codes
mer Dispenser
$10.00
and rulings of the Building Division, and hereby declares that all the facts
dow Off Basin
$10.00
and representations stated in this application are true and correct.
;atch Basin
$10.00
Cain Water Leader
$10.00
DATE: O ��1 20 Zo
a :ump)Receiving Tank
$10.00
E2 Vater Treating Appliance
$35.00
OWNER(
Vater Heater -Electric
$35.00
.1
Vater Heater - Gas"
$x.00
BUILDING USED AS �
Z Sas Range"
$10.00
3m Dryer—
$10.00
ESTIMATED COST PERMIT' NO.
lack Flow Preventer Required ( )Yes () No
Type
$15.00
PLUNGING COMPANY
TEL N0.
ieinspection Fee $50.0011 -Ir
SIGNED BY
d -L OTHERS AND/OR REPAIRS AND ALTERATIONS
1 25% of Value of Fbdure or Appitance
Awl By
9 State Sumt1arge $ .50
MKMUM FEE FO
TOTAL FEE $ OF THE IMPROVE
n :OMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 5"A) AND TABLE 6-A.
Rough -In Date Fatal Data ___
"112ROVIDE COMMON VENT INFO ON BACK SMT`
Budding
BUILDING
BASED
Pemit ,
Inspections
RESIDENTIAL APPLICATION
Permit Fee
Receiv
763-572-3604
CITY OF FRIDLEY
$
Date R
DATE cS O
YOUR E-MAIL ADDRESS
a. ® .001 times the total job valuation
SITE ADDRESS
_
$ ` .0005 x Permit Valuation Minimum $.50
License Surcharge
$�.�'1�
$5.00 (State Licensed Residential Contractors)
SAC Charge
THIS APPLICANT IS:
ONTRACTOR
Curb Cut Escrow
PROPERTY OWNERI
50WNER
NAME:TENANT
Erosion Control
ADDRE�� � OV i ovx O f', K) F CITY
$�
Park Fee
$
PHONE: ��lDc3U
Sewer Main Charge
CONTRACTOR
NAME: r O�
Total Dae
STATE LICENSE EXP DATE S -J IQ
Make checks parable to: City of Fridley Alt ch
SUBMIT A COPY OF
—"' CITY
ADDRESS:6-0/% ffikauir iI &.l /V
1�'
YOUR STATE LICENSE
WITH APPLICATION
PHONE j 9. FAx2 62
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SSE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION❑fTARAGF/SHED ❑ WINDOWS
[3 DRAIN TILE
11 BASEMENT FINISH
❑ DECK /'73 SIDING ❑ OTHER
❑ SwMMMlNG POOL
TYPE OF WORK:
❑NEW ❑ ADDITION
ANCFIRBPAIR ODELING
DESCRIBE WORK BE
G DONE: %a`�f� QA /��
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT
iROO❑ HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT
REMOD ELI
I.
Existing Floor J
GARAGES
❑ ATTACHED GARAGE 2.
Proposed floor
PROPOSED SIZE:
❑ DETACHED GARAGE 3.
List of structur.
PROPOSED HEIGHT:
FOR NEW CONSTRUCT
SIDING
❑.vinyl
QSof it ADDITIONS
I.
& PORGFR
Site Plan/Surve
❑ Aluminum
❑ Trim
❑ Fascia
and proposed p
❑ Odw
2.
Two sets of col
�IlV�OVVS
3.
Energy Calcula
IN EXISTING OPENINGS ElYes []No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WIDOW TO BE INSTALLED NUMBER OF WINDOWS
I By:
;, d:
I E ZIP
TA��a
Sa. Ft.
T SUBMTT:
3t
I �
tembers to be used
I INCLUDING DECKS,
M13M :
howing the existing structures
uction plans
I v5
ON VALUATION, INCLUDING THE COST OF LABOR AND AN I S;
ALL FEES ARE
BASED
(USING THE 1947 U.B.0 FEE SCHEDULE)
TOTAL JOB
VALUATION $ —970c"00 OCCUPANCY TYPE
Permit Fee
$'7j.
S See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
a. ® .001 times the total job valuation
Surcharge
_
$ ` .0005 x Permit Valuation Minimum $.50
License Surcharge
$�.�'1�
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1550 per SAC Unit (Plans to MWCC for determinati )
Curb Cut Escrow
$
ft + 6 ft = ft x $21 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Dae
$
Make checks parable to: City of Fridley Alt ch
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; lat the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; the t _ understand this is not a
permit but only an application for a permit and work is not to start without a permit; th the work will be in acG ., lance with the approved
plan in the case of allwork w requires vied approval of plans.�4MII
//
SIGNATURE OF APPLICANT W) /(� Pi ////1�L PRINT NA�L14411 DATE_ _