PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
-
Date: ........... ._............ _..----...._...._._.._.......... � �_.._......._...._..
Owner:
Address
N® 4025(
Builder ......_. ..._... _�._.......
- .
Address_.._........._......._...._........_................._.._......._......._.._..._......._..._.._._...
LOCATN OF UILDING
/., ,
No. _.. - Street ....._......._..`�.__.... _..- - - ---...-- ... Part of Lot .................... -....... _.... _..........
-- _..............._ _
Lot ........ ... ............. Block ...__............. ....__................. A dition or Su Division .......fes-.�--
Comer Lot .......................... -........ Inside Lot ...K-.......... --- -------------- Setback .. C. T�'.- ..... Sideyard ... _.......---........ -- ........... .....
SCwer Elevation------------•...............------.._.........-.---•----.................................--..._.. Foundation Elevation .................... .............. _.............
DESCRIPTION OF BUILDING
To be Used as: �/'*D
® /
7`. Depth_Height.7..: ®� Sq. t. 496 Cu. Ft
.. ......_..... ......... ... _. Front . _.. ...
df
...... ....... ...:... _............. Front 9.:PDepth 57eight: Sq. Ft. o5cq..p. Cu. Ft.
Type of Construction................................................... Est.,Cost....l r .713_-.. 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 all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ ........ ........ ..., 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 time 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 items.
_QW4
GNATIFTY WARN ABR:
RATM
TOTAL
FUrnace Shell & Dud Work
$10.00
�---
Replacement of Furnace
6.00
Each add. 200 sq. ft, EDR Steam
Repairs & Alterations -up to $500.00
6.00
Repairs & Alterations each add. $500.00
300
NECIL WARM AIR
OIL BURNER -to 3 gal• per hour _
6.00
Furnace Shell & Duct Work to 129,M BTS ..
..$10.00
over 3 gal. per hour -See Fee Schedule
each add. 60, ......
3.UU
Replacement of Furnace
600
M to
Repairs & Alterations ---up to $500.00
6.00
$L-
as & Alterations each add. $M.00
&W
$ --
i!Y
Furnace Shell & Lines -to 400 sq. ft. %r.DR Steam
$10.00
-
Furnace Shell & Line -to 640 sq. ft. EDR Hot Water
10.00
Each add. 200 sq. ft, EDR Steam
1.00
Each add. 320 sq. ft. EDR Hot Water
3.00
--
OIL BURNER -to 3 gal• per hour _
6.00
over 3 gal. per hour -See Fee Schedule
GAS ]B(tip, to Mow BTU)
&00
$
�► �"f�
wer 199,000 BTU gee roe schedule
CTAS P77TING rEES:
No RATE
TOTAL
1st 3 nxtures _.
xS 200
$---
Additional Fixtures _
x .78
---._---
Gas Range to 199,W0
zS 6.D
a
Al061•, _ C
ROUGH-
FINALS-09
OUGH
FINALSv9 V- 26
State Surcharge .50
Fos schedlub
a
ToT" mma t
Dept. of
City of Fddley:
The undersigned hereby makes application for a permit for the work hereh
specified, agreeing to do all work in strict accordance with the City Ordhmmew
and ruling of the Department of Buildings, and hereby declares that an the factiv
and representations stated in this application are true and correct,
Fridley. Minn_ d 1p��
..
Kind r ,
, 9MMM
'robe completed about
Estimated Cost, $ 6", -y
Uld New. Btulding Permit No. permit No. , (9 91
HEATING or PO Mt Water, Warm "-No
Capacity- t7.5_tj___ Sq. FL E.D.R BTU
Total Connected Load-��� ' Kind of Fuel Of
BURNER - Trade 11TameNo--
Capacity---
ze f
Capacity, _ Sq. FL EMIL BTU
MEMARKf-OVER)
S4 Business
Pbaoef ML 7 Y U-// 0 Y
SUBJECT
PE�
City of Fridley
12772AT
THE TOP OF THE TWINS
BUILDING PERMIT
�
CEIPT N
• ______ COMMUNITY DEVELOPMENT DIV.
L
r PROTECTIVE INSPECTION SEC.
1 � �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
10/18/74.
JOB ADDRESS 136 River Edge Way N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
19
1
1 River Edge Addition SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Richard Hess 136 River Edge Way N.E.
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 EX NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
Construct a 141-x 10' Metal Shed
9 CHANGE QF USE FROM TO
STIPULATIONS Shed to be set on a permanent foundation
SEPERATE PERMITS REQUIRED FOR WIRING
HEATING, PLUM13ING AND SIGNS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Metal
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
R-1
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.
$150.00
•50
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-
$5.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$5.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
P � y
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
/p/
BLDG INSP DAT
SI ATUR W{ ER IIF OWNER BUILDER) IDAT
APPLICATION FOR RESIDENTIAL, ALTERATION.1—
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME: �' ��_S�� BUILDER:
ADDRESS: ADDRESS
NO • . 1,3 6 STREET:
LOT: / �%' BLOCK: % ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
-To Be Used As:
DESCRIPTION OF BUILDING
Front: Depth: /lJ Height: /
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction a Estimated Cost:
To Be Completed: Ae� /, / 77-"
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.
DATE: �% ��7�f SIGNATURE:
(See Reverse Side For Additional Information.)
,L1
0v .
(sone OR. 5-5631
Registered Professional Engineer and Land Surveyor v.
5722 Wayzata Blvd. Minneapolis 16, Minn.
OF PROPERTY OF. • - /-1,-q e,4'' Z
described as follows - E.�`' e ,�1 G!'a'i 1�0� 17
a n.
Scale: t Inch lob Plo. Boak----.-»-. Page
/3
WA
ka
44
� 6
"ce ri
1 '
:t 111"/�f
?—7."_.; x a W n c 'a 1
CERTIFICATE OF LOCATION OF BUILDING CERTIFICATE OF SURVEY
I hereby certify that orti✓_.__.._._._ _._..____ _�._, 19
thereby certify that on �� '' f'yY . `- , 19-4;L
I made a survey of the location of the building on the above I surveyed the property described above cnd that the above
described property and that the location of said building is plat is a correct eprrpi�.;tation of sold s y , •.
-,�
correctly shoyvn.a�' the above platREG.: NoV
G7YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER . 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
February 24,-1992
Thomas Olin
136 River Edge Way N.E.
Fridley, MN 55432
RE: Property at 136 River Edge Way N.E.
Dear Mr. Olin:
The Fridley Zoning Code prohibits operation of two family dwellings
in R-1 Single Family Districts. I have enclosed copies of the
Zoning Code's definitions of "family" and "dwelling unit" for your
review.
I have received information that you may be renting out the above
residence in a manner not consistent with the above referenced
Code. Specifically, this information suggests that you are
violating one or both of the following requirements:
1. More than five unrelated persons living in a dwelling
units shall not constitute a family.
2. Separate dwelling units must not be maintained such that
no individual living in the residence has access to the
entire structure.
At this time, I am requesting that you supply our office with some
information. I am specifically interested in the number of people
living in the dwelling unit, whether or not they are related, and
details concerning the facilities and physical layout within the
residence.
Please contact me at 572-3595 to discuss this matter as soon as
possible. Thank you for your cooperation.
Sincerely,
Steven Barg
Planning Assistant
SB:ls
CE -92-37
j
SUBJECT
P
City of Fridley
AT THE TOP OF THE TWINS
BUILDINGPERMIT
i �
RECEIPT NO.
b
� b COMMUNITY DEVELOPMENT DIV.
1 L - PROTECTIVE INSPECTION SEC.
B . �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
I =---1 CITY HALL FRIDLEY 55432
612-571-3450
910-F15
4/6/98
JOB ADDRESS 136 River Edge Way NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
19
1
River Edge
Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Harlander 136 River Edge Way NE
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Murphy Bros. Remodeling 1613 93 Ln NE, Blaine, MN 55449 780-3262
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS
ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Construct a 22' x 16' Addition to Dwelling
9 CHANGE OF USE FROM
TO
STIPULATIONS
See notations on plan.
WARN'wr
Before digging can for
all utility locations SEPARATE PERMIT'S REQUIRED FOR
454-0002 'W RING, HEATINGt PLUMBING AND SIGNS,
Rrr%ED
&QUIRSEPARATE
y LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
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 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
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
$10.66
WITH WHETHER SPECIFIED HEREIN OR NOT. TH GRANTING OF A PERMIT
$21,310
DOES NOT PRESUME TO GIVE THORITV T VIOLATE OR CANCEL THE
PERMIT FEE SAC CHARGE
PROVISIONS OF OTHE SAT OR L AL LAW REGULATING CON-
STRUCTION O ERF R N OF STRUCTION.
$312.25 Fire SC $21.31
PLAN CHECK FEE TOTAL FEE
Al� �ATU;V
License SC $5.00 $349.22
ONTRACTOR OR AUTHOR AGENT 10 EI
WHEN PROPERLY,ALIDATED,THIS IS YOUR PERMIT
L2
BL2n INSP GATS
S,GNATURE OF OWNER OF OWNER BUILDER) (DATE)
j
[ ]
1 b Effectry 1/1/98
NEW
ADDN CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION I
ConstructionAddress:
Legal Description: 0'0 -e--
Owner Name & Address: e -Ir 13c- Tel. #
41, J s
Contractor: Iev1 a &e- L -f MN LICENSE #
Address: i F. l 3 eA3 j- HE. 1 e kk-, �S�l 11 Tel. #
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length -Z �� Width G Height z zr Sq. Ft.. �j 2 X60-
Length Width Height Sq. Ft. ti -?16
Length Width Hgt/Ground Sq. Ft.
Construction Type: . eaQ Estimated Cost: $ Q1'.3%�, �
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: 3L-si(c, APPLICANT: Tel. # 7cO -73-7,G Z
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
. STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 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 [ ]
o
fIEY A, CARTWRIGFIT 'COMBINING TNI RECOROi Ol►
n x & O� J H. HILL.. GWIL ENW
CONNTr: BLMVErf URVE �/ tsrw�usMsa;tMt `. -
COYNTY-><t1RVErs li N0 w7 A / E. L.,OAS r Sr
MP1J� suby[rs C, F: 9ANOMOF'�
4U. fTRE[T. CIVIL
REGISTERED NNOER LAWS OF *TATE ,OR MINNESOTA , ENGINE ���
nswwulsp .Hb►
LICEMSEO av; OROINANCS bI CITr OF.:MINN(•p{.IS
e 4AMraB"NE f rsr t�
4i2d: PLYMOUT1.1 BUILDING F oRlel►I. E-6724 8uRVtr "� a ',' 4V
altA4 '. iiolcfAL.0immEPIN AT SIkTH.- MlNNSAPOLI9:3.:MiNNE A tes�watt>tase As h
E i9• 1000411AMICAL s�YYb Ot�� �ttitltKJltt :. MET(t0 " N
tR ;1M■AYTINi sumveromB, tssw y[p'yf r %yr
oi
"444
- t •j' j !l 9 a -3 tr
� arm 4��i �+^*.« n 'L �` ."`• 4"g�.p•�yi3'a.+�V+.; ,*-, 4 � #. fi�"�'-?�"';-" ,4F
n Mr9} K �a 'si 4
L � 41
CIE!
r;
Y I hereby cern fir _that .this is a true .and correct repreeentatiox> _o T4s r",v� C► t:�t �,'
Lot 19, Block 1, River Edge Addition
< �c xq
As surveyed by me this 18th day of June,19&2,,= /_ u
=44
/J 2
� z
CAWWRIGHT AMD OL90N 'V :� ;'' • '
CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1, 1997
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING'SYSTEMS AND DEVICES
RATE SCHEDULE
R6sidential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
due,- w&rL 46 a4fi xvl
Commercial/Industrial
1.25% of Value of Appliance or Work
JOB ADDRESS I3o 'R+ VZ✓ 1'_dj�± Wae M C
The undersigned hereby makes application for a permit for the work herein
Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and
rulings of the Building Division, and hereby declares that all the facts and
$ 30.00 $ representations stated in this application are true and correct.
�� ct t"'_ ? ,1998
$10.00 $
OWNER ��� r, S -�w'ri l c.. o(< /
$10.00 $
BUILDING USED AS C e- S r ok-e- V-1 �c-
$10.00 $
ESTIMATED COS (00-15D PERMIT NO. l r
$ 25.00 $
DESCRIPTION OF FURNACE AND OR BURNER
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 $42.00/Hr
No. of Heating Units
Trade Name
BTU
Fuel
Burner Trade Name
BTU
HEATING COMPANY
-Circle One (Steam) (Hot Water) (Warm Air)
Size No.
HP EDR
_ Total Connected Load
Size No.
HP EDR
Signed By v"', Tel No.
Approved By� Rough -In Date
*Air Conditioners can not be placed in a side yard without FILL OUT BACKSIDE FGR STACK VERIFICATION ON
written permission from adjoining property owner.: REPLACEMENT FURNACE
Final Date
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes ( ) No ( )
8. Has combustion air been provided for water heater Yes ( ) No ( )
Remarks: .
List ALTERATIONS Being Done:
w G+ We V A-0 -w \ ie1y1
HEATING CO:
Signed By:
Date:
CHIlVINEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1.
. Has been carefully examined
Yes ()
No
( )
2.
Is free from rust or deterioration
Yes ()
No
( )
3.
Has no foreign objects lodged within
Yes ()
No
( )
4.
Is securely supported .
Yes ()
No
( )
5.
Meets all current Code requirements 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 provided for water heater Yes ( ) No ( )
8. Has combustion air been provided for water heater Yes ( ) No ( )
Remarks: .
List ALTERATIONS Being Done:
w G+ We V A-0 -w \ ie1y1
HEATING CO:
Signed By:
Date:
LU
SUBJEI'T
PER
City of Fridley
31 1953
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
iw-
r T PROTECTIVE INSPECTION SEC.
672-360
79
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BV
612-571-34,50
910•F15
7/2/01
108 ADDRESS 136 River EdgeWay
I LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
19
1
River Edge Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Chris Harlander, 136 River Edge Way, Fridley, MN 55432
763-586-9648
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Chris Harlander
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
B USE OF BUILDING
Dwelling
7 CLASS OF WORK
C NEW Cl ADDITION ❑ ALTERATION O REPAIR
O MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See stipulations on building plans.
`DARNING
Before digging call f0jr
all utility location
4540002
ROWED LAW
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE' F 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
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
$2,024.00
$1.00
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
W Y -1Y
PLAN CHECK FEE
TOTAL FEE
$86.50
SIGNATURE OFC NTRACTOR OR AUTHORIZED AGENT - IDATEI
WHEN ROPERLV VALIDATED THIS IS YOUR ERM T
7/7-101 01
B;Ns, -
rlAiE
SGN4TURE OF OWNERIIFOWNER OERI IDA EI
LU
NEW [ ] Effective 1/1/2001
ADDN [ J CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION tT
Construction Address:
Legal Description:
Owner Name & Address: C r A'Tel. # -?(o3 596-9qY
Contractor: A OyLL MN LICENSE #
Address: l b)(n Q V Z w E d eR- W &V II Tel. # 5- a"
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 (0 Width Hgt/Ground ! ° P Sq. Ft.
OTHER: avlc\ n- 5'
1q, 1B )
ezov /�Ice_j IF(y C:)y1 S0 _4fz a 1i
Construction Type: Estimated Cost: $ �� 7
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$
DATE: l9 2 b APPLICANT: fl—a Y_ LTel. # 7� 3 -[J
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$ .001 of Permit Valuation (1/10th%)
State Surcharge
$ $.50/$1,000 Valuation
SAC Charge
'1.00
$
$1150 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 [ ]
TOTAL3(_c6
STIPULATIONS:
will be required before proce
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Building
PLUMBDiG
Permit No.: 4"
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FREDLEY
KMcJAN 2 5
763-502-4977 FAX
EFFECTIVE2-19-09
DATE 1 1 Z i4-0 YOUR E-MAIL ADDRESS
SITE ADDRESS 15b Q V41- W
THIS APPLICANT IS: ❑ OWNER I#ONTRACTOR
PROPERTY
NAME: C
OT�
ADDRESS: 11 b RLvu- �06� /V' CITY �V) STATE�iZIP -E� 4
I -U 3 . 5:p- C j0
PHONE:
CONTRACTOR
J
NAME: �-I VW Qf 14 V EWWYf%1 n�4!
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
STATE BOND # EXP DATE
CERTIFICATE OF
ADDRESS: Q I q D WOL St Ig E W 3,'1 CITY STATE -AL ZIP ✓is z y
INSURANCE
2
PHONE ��3 �S�i��I FAX L 1 +� ISD
PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW REPLACEMENT
DETAILED DESCRIPTION OF WORK VI/� %i
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBEROF EACH BELOW). MINIMUM FEE
$35.50.
BATH SINK/LAV DRAINS _ WATER PIPING
_ _FLOOR —SHOWER
GAS PIPING (NEED CITY LIC) _ SWD&vflNG POOL _ WATER SOFTNER ($35)
—BATHTUB _
CLOTHES WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15)
_ _
—DISHWASHER _ LAUNDRY TRAYWATER HEATER ($35) FOR IRRIGATION
WATER METER —OTHER
i"�P
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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 case ofall work which requires review and approval off
`plans.
SIGNATURE OF APPLICANT '�// ` e' PRINT NAME /�! / li/�GlffiffP�/ DATE
PL1�1k I; NQfi1 P AT :P AM , .7 X53 (l TIRED 1� G1R 3IiYT} F LEC3RICAL::f4ND SCI IAI7 CAL
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977