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PRE 2010 DOCSDecember 23, 1985 Richard Malecek 7136 East River Road Fridley, MM 55432 RE: Deferred Street and Utility Assessments Dear Mr. Maleoek: On December 169 1985 the Fridley City Council formally approved the final plat called Riverwood Estates. As you know the Council was concerned with a street access for your lot should it ever be subdivided. In order to provide for the potential access and utilities for the future, the Council has determined that the plat should provide a 25 foot of right-of-way adjacent to your property (see map). with this provision it was determined that your property would carry a deferred assessment charge for 1/33 of all the street and water line assessments and 1/34 for sanitary sewer assessments. An additional assessment of 1/34 of the sanitary sewer assessment will be charged to you at this time for the service extended to your existing house and property. With the exception of a 1/34 sanitary sewer assessment, the remainder of the assessments are deferred and you will not incur costs for then until such time as the property is actually subdivided. At the time of subdivision approval, a park fee and the assessments will be charged to the property along with accrued interest equal to the plat's assessment rate. If you have any questions regarding this matter please feel free to call me at 571-3450. Sincerely, ah B. - o 'L James L. Robinson Planning Coordinator JLR/dm Encl. C-85-355 FR�IN�EY CIVIC CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 - PHONE (612) 571-3450 September 9, 1986 Chuck Cook 12093 Ilex Street Coon Rapids, MN 55433 Dear Mr. Qook: At your request I am writing to explain the City's vosition on two points related to Richard Malecek's lot split; assessments and the lot area of Tot 1. Rlock 3- Riverwood park. Mr. Malecek's two lots will be assessed for the street and utility improvements to Riverwood plat in the following manner: Parcel A 1/33 cost cf sanitary sewer Parcel B 1/33 cost of sanitary sewer 1/32 cost of water line 1/32 cost of street Regarding Lot 1- Block 3- Riverwood Park, on May 5, 1986, the City Council approved the Malecek lot split with the understanding that the approximately 670 square feet of Lot 1- Block 3- Riverwood Park split off as Parcel C and added to the Malecek Parcel B would reduce said Lot 1 to about 8.800 square feet. It is understood that a variance for lot area is not necessitated due to this action. The transfer of the Parcel C will take place when you and your development partners acquire Lot 1- Block 3 Riverwood Park frau the school district and prior to any building permits are issued for said Lot 1 - Attached is the survey which illustrates the proposed splits. T trust this information meets your needs. Sincerely,- j�1 Janes L. Robinson Planning Coordinator cc: Richard Malecek Plat file Jahn Flora Mark Burch C-86-320 rffective,Aug. 1. 1991 _ CITY OF FRIDLEY. APPLICATION FOR PONER PLANTS AND HEATING, COOLING, -VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES = RATE SOFMI1 iESIDENTIAL BATE TOTAL Furnace Shell and Duct Mork, - Burner (Also replacement furnace) $ 20.00 �> Gas piping $ 10.00 $ !piping needed with new furnace) Gas Range $.10.00 S Gas Dryer $ 10.00 $ ® Air Conditioning -(all sizes) $ 10.00 $ All Others/Repairs and Alterations 11 of Value of Appliance or Mork S COMMERCIAL/INDUSTRIAL 11 of Value of- Appliance or Mork $ state Surcharge $ .50 L 3pEE $ Reinspection Fee ($15.00) $ Rough Insp. Date Final Inap. % a Z$-" ate o Approval for permit a MINIMUTA FEE rOR ANY NBATING PERMIT IS $10.00 PLUS $150 STATE SURCHARGE - Attach slack verification fors with replacoment furnace lw'rmits *Air Conditioner% can not lm- placed in endr yard without written lm -mission frm adjoining nrxghlw.r. Job Address Department of Buildings 6431 University Ave. N.E.• Pridley, NN SS432 city of Fridley Tel. OS71-34-So The undersigned hereby waked application for a permit for the work herein specified agreeing to do all work in strict accordance with the City (odes and rulings of the -Department of Buildings. and hereby declares that all the facts and representations stated in this application are true and correct. rridley. Minn. //� • 1! Omit RIND Or BUILDING LA.7L USED AS TO BE COMPI2:TM ABOUT ESTIMATED COST OLD - NEW BUIL M PEIMIT NO. PERMIT No. DESCRIPTIO/ or FUMACE/Bi/mn NEATING or POwn P1AM, Stem, Not Mater, Wars Air- Ib. Trade Name 41e // flee No. i /a 7 ¢"A i= Capacity 6.y Sq. rt. EDR BTU ® NP Total Connected load ® Rind of Peel 1 6147 ljz!� BURNER - Trade Now Bite ft. capacity Sq. Ft. EDR BTU Company Signed -ey Tel. mo. CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE trrective Aug. It lyUl Job Address '2139 Department of Buildings City of Fridley Tel. #571-3450 a 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 and rulings of the Department of -Buildings, and hereby declares that all the facts and representations stated in this application are -true and correct Fridley. Mn.'.= 14 OWNER DA: / L C. KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST PLUMBING FIXTURE RATES: NO. RATE TOTAL OLD - NEW BUILDING PERMIT NO. PERMIT NO. p, w 5.00 $!75 tk of m Water vS c Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 eo Signed By a w Beer Dispenser $ Beater ., M m 0 ca[ Blow off Basin $ 5.00 - m .,K� a+ -.ci a3� O wO 8 C: a+. w tertt3 u w $ w w m $ 5.00 $ u -A 0 Hydraulic Valve w in $ a a v a� aR $ chi o $ lec W FINAL INSP. zD'�`0 / All / $ 5.00 3� w vii Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ APPROVAL FOR PERMIT G ° ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ 9®^60 State Surcharge $ .50 1st MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 TOTAL FEE $ PLUS THE $.50 STATE SURCHARGE 2nd 1 3rd 4th (R) - Future Connection Opening Connected with Sewer (•) - New Fixture, Old Opening Water RATE SCHEDULE trrective Aug. It lyUl Job Address '2139 Department of Buildings City of Fridley Tel. #571-3450 a 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 and rulings of the Department of -Buildings, and hereby declares that all the facts and representations stated in this application are -true and correct Fridley. Mn.'.= 14 OWNER DA: / L C. KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST PLUMBING FIXTURE RATES: NO. RATE TOTAL OLD - NEW BUILDING PERMIT NO. PERMIT NO. New Fixtures I $ 5.00 $!75 tk CLQ Companyr vS c Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Signed By Beer Dispenser $ 4.00 $ Tel. NO.�� Blow off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ ROUGH INSP. Hydraulic Valve $ 5.00 $ Date Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ FINAL INSP. zD'�`0 / Hot Water Heater / $ 5.00 $oj Date Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ APPROVAL FOR PERMIT G ° ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ 9®^60 State Surcharge $ .50 Reinspection Fee $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 TOTAL FEE $ PLUS THE $.50 STATE SURCHARGE ;r s_$U4 CITYOF FRIDLEY CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450 October 21, 1987 Dailey Homes_ 8510 Central Avenue N.E. Blaine, MN 55434 Re: Final Inspection at 7139 Riverwood Drive N.E., Fridley Dear Sirs: A final inspection was conducted on October 19, 1987 of the above address and the following items were noted which must be completed before the structure can be f inaled : 1. Provide City with copy of verifying survey by November 6, 1987. 2. Provide sod in the front and side yards by June 1, 1988. 3. Post house number on structure by November 1, 1987. 4. Solid block two floor joist in basement by stair by November 1, 1987. 5. Remove plywood form from under fireplace hearth by November 1, 1987. we will expect the above items to be completed by the scheduled dates when a reinspection will be conducted to determine compliance. If you have any questions on these items feel free to contact me at 571-3450. Sincerely, C : - DARREL G. CLARK Chief Building Official DGC/mh 8510 CENTRAL A -VENUE N. E. o MINNEAPOLIS, MINNESOTA 55434 o PHONE: 784-3910 October 26,1987 City of Fridley 6431 University Ave. N.E. Fridley, MN 55432 Attention: Darrel Clark RE: Final Inspection at 7139 Riverwood Drive Fridley, MN In regard to your letter of October 21,1987 regarding the above address all items have completed as of October 26,1987. If you have any questions please feel free to contact Jeff . Sincerely, DAILEY HOMES,INC. Nadene Ande son Secretary CERTIFICATE OF FOR Dk\L-r-y CQU-21, I HEREBY CERTIFY THAT THIS SURVEY, PLAN, OR REPORT WAS PREPARED BY ME OR UNDE MY DIRECT SUPERVISION AND THAT 1 AM A DULY REGISTERED LANA SURVEYOR UNDERI-HELAWS OF THE STATE OF MINNESOTA. MINN EGISTRATION NO. 53;:52- SURVEY KURTH SURVEYING INC. 4002 JEFFERSON STREET N.E. COLUMBIA HEIGHTS MINNESOTA 38421 612-7418-9769 DATE 10 -Lb -$7 SCALE In- .20I �iov�C --OC/ 'C10}1 O=IRON MONUMENT FOU.t,ID 0E�4�-1 Nhs I�Z�r1G0 9 r' 0 a ?4 e�,tc - `10,00 — — - 3l5 . toy — — Tho Wast 90.00 feet of that part of Lot 28. Reviaed Auditor's Subdivision No.. 77. Anoka County, Minnesota, lying easterly of a line described as follows: Beginning at a point on the south line of eald lot, distant 715.64 feet westerly of the southeast corner of said lot; thence North, at a right angle from the south line, to the, north line of said lot and there term tna[ing. PROPOSED HOUSE LOCATION FOR TOLLEFSON CONSTRUCTION ► Lie ocr, T-70 J 77 rt River!Ogd Drive q Bim° Z o q s X8.32 �- Drainage S Utility. Easement .S 07-5'3 2 E SCALE : 1 inch = 40 feet Lot 1, Block 3', Riverwood Park. Anoka County. Minnesota. elevations shown are assumed. HOUSE LOCATION ONLY — NO FIELD SURVEY, PERFORMED I hereby certify that this survey, plan plat, prclimirrary plat or report was prepared by me or under my direct supervision and that i am a duly Registered Land Surveyor under the laws of the State of Minnesota. Rcg. No. Date Job No. Book No. M W,.� 01 SUBJECT City of Fridley 19144 AT THE TOP OF THE TWINS BUILDING PERMIT rp � REGEI COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. /crJv_ � �� CITY HALL FRIDLEY 55432 L NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-Ft5 g�2fg� JOB ADDRESS 7139 Riverwood Drive N.E. 1 LEGAL LOT N0. - BLOCK TRACTOR ADDITION #77 SEE ATTACHED DESCR. Parcel B, art of Lot 28, Revised Aud. Sub. SHEET 2 PROPERTY OWNER MAIL ADDRESS 21P PHONE Dailey Homes 8510 Central Avenue N.E., Blaine 55434 784-3910 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 .q NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 37' x 34' Dwelling and a 221 x 22' Garage SEPARAT7 n,"^I ITS REQUIRE® FOR• 8 CHANGE OF USE FROM WIRIW, 81 i r' PtUMSING AND S1TN-QK— STIPULATIONS provide a hard surface driveway. Provide sod in the front and side yards Provide City .with copy of verifying survey before capping. See notations on plans. Paid Park Fee of $750.00.. Paid Driveway Escrow for 16" + 6' = 22" x 13.50 = $297.00 SEWER LOCATION: 25' N.E. of Manhole INV: 848.07 MIN. TOP OF FOOTING: 851.07 WATER LOCATION: In same trench. ac OF FRIDLEY DOES NOT GUARANTEE THE aa Before digging call ITral UtiWin ACCURACY OF UTILITY LOCATIONS AND ELEVATIONS. Efc. TELEPHONE-'11EC7 RIC - ISISTHIS, DATA IS FOR PURPOSES AND PERSONS USINGFORMTHIS INFO RMATION SHOULD REQUIRED EY LA VERIFY IT ON THE SITE. 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.0T. 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 $122 300 $ 61.15 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONSFANY CON- $ 490.50 $525.00 ORT E PE FORMANCE OF CONSTRUCTIONEGULATING PLAN CHECK FEE TOTAL FEE $ 122.63 $1,199.28 + DW & PF &QI`NATUI91EkFCO TRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY BLDG )NSP LIDATED THIS IS YOUR PERMIT BATE SiGNATUREOF OWNERIIF OWNER BUILDER) (DATE) 01 1 NEW [ City of Fridley Effective 4/1/86 ADDN. [ ] R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: % *39 K 9"v30Gd Legal Description: Y arl� R P A 'L �� N Owner Name & Address: Tel. # Contractor: �'()"�' Tel. # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IMPROVEMENT Width Height Vq4 Sq. Ft. 0 (01 Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Corner Lot [ ] Inside Lot [A Ft. Yd. Setback Side Yard Setback Type of Construction: Ll! M3 ' Estimated Cost: $ Approx. Completion Date: 6 CJ- l e5 t-1.1 _ l a2,,30d ad , a & 1+8r) C_ Z-2) It. A Alt B Proposed Driveway Width If New Opening Is Desired: o y"(5, $ 9") CKJ $ See Back Page for Explanation DATE: r APPLICANT: �- 29 I Tel. # `3�0 CITY USE ONLY Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL s. -1549 -at STIPULATIONS:- WL UJ6-\ 7.0V 00. aa4-w Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $ 525 per SAC Unit Fee Determined.by Engineering Agreement Necessary [ .] Not Necessary [ ] SUBJECT ERMIT City of Fridley 2�46 AT THE TOP OF THE TWINS ry BUILDING PERMIT i , v RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. ti' �; PROTECTIVE INSPECTION SEC. •7 y� r CITY HALL FRIDLEY 55432 "IL""'�'� NUMBER REV, DATE PAGE OF APPROVED BY �`, 612-571-3450 910-F15 7/6/90 JOB ADDRESS 7139 Riverwood Drive N.E. I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt. 28 Aud. Sub.. #77 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Harris Ratnayake 7139 Riverwood Drive N.E. 572-8306 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 C]X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 161 x 16t Deck Addition 0238• sf) 9 CHANGEOFUSEFROM TO $TI PU LATION S See notations on plan. WARNING Bef"Ore (digging Call for all utility locations SEPARATE PtRMITS454.0002 REQUIRED 13Y LAW REQUIRED WIRING, HEATING, pL19FOR NG AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,730 $.87 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $41.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $41.87 7Z 6 I C/O SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI PRO RL VALIDATED THIS IS YOUR PERMIT SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI BLDG )NSP DATE q 3 .'l 3 NEW [ ] Effective 1/1/90 ADEN [ ] R-1 AND R-2 ALTER [ ] Building Permit Application Construction Address: Legal Description: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTICK OF Il VENNI' LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length ® Width ° Hgt/Ground _LL Sq. Ft. O7HER: Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: 7p7/lh Estimated Cost: Approx. Completion Date: ,r? -Y/- IFO Proposed Driveway Width If New Opening Is Desired: DATE: 716 10 Permit Fee State Surcharge SAC Charge Ft. $ Width + 6' ''►► See Back Page APPLICANT: Tel .# S-72-- S 3® 6 Driveway Escrow $ Park Fee $ Sewer Main Charge $ SITIPUTATIONS: CITY USE ONLY Fee Schedule on Reverse Side $.50/$1,000 Valuation $600 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CERTIFICATE OF FOR DAtILcy CANS -r. I HEREBY CERTIFY THAT THIS SURVEY, PLAN, OR REPORT WAS PREPARED BY MEOR UNDE MY DIRECT SUPERVISION AND THAT I AM A DULY REGISTERED LA SURVEYOR UNDERHE LAWS OFT E SIATE OF MINNESOTA. �i SURVEY KURTH SURVEYING INC. 4002 JEFFERSON STREET N.E. COLUMBIA HEIGHTS MINNESOTA 58421 612-7841-9769 DATE SCALE Ina i MININV E A REGISTRATION 140. 57?j2. 0 -IRON MONUMENT FOu.ND �ou�C �oC�-T1ot-1 beAv- NhS 14B,-.AxACO G�� - '�o - 00 -- -- 315;64 - I 9 r' 0 ` r r 0 2 d� A d P Jn 7 of 0 J � s � S.uue, t,oT La The West 90.00 feet of that part of Lot 28. Revised Auditor's Subdivision No.. 77, Anoka County. Minnesota, lying easterly of a line described as follows: Beginning at a point on the south line of said lot, distant 315.64 feet westerly of the southeast corner ofsaid lot; thence North. at a right angle from the south line, to ehe.-north line of said lot and there terminaling. SUBJECT P T City of Fridley 2 0 4 9 5 AT THE TOP OF THE TWINS BUILDING PERMIT ', O i � • COMMUNITY DEVELOPMENT DIV. ^� ______ r PROTECTIVE INSPECTION SEC. 131 CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910415 7 30 90 JOB ADDRESS 7139 Riverwood Drive N.E. 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1. pt, 28 7 SHEET Rev. Aud. Sub, #77 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Harris Ratnayake 7139 Riverwood Drive N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. D & H. Remodeling 2201 Elliot M 1 874-1673 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 6 DESCRIBE WORK Basement Alterations 9 CHANGE OF USE FROM TO STIPULATIONS See notatar>,s on plan, SEPARATE PERMITS RE0j'IRCr) ROR WILING, HEATING, PLUMING AND SIGN TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED p WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2 0Q.0 k)&25 PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $45.00 STRUCTION THE PERFORMANCE OF CO S UCTION. PLAN CHECK FEE TOTALFEE o � $46,00 SI ATURE OF CONTRACTOR OR AUTHORIZED AGENT I ATEI WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT LDG INSP ryAT SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI N [ 7 Effective 1/1/go ADDN [ ] R-1 AND R-2 ALTS [ ) Building Permit Application Construction Address: / 3 � �� e Legal Description: Owner Name &mss : c,�f''f Y'g M il0>/,* 4-c eTel. # 5 72 - �i 3 (3(, Contractor: es o Tel. Address: 2 0 / f " , Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESC,RT CK OF LIVIM AREA: Length � � i Width 3 � � Height �� Sq. Ft. GARAGE AREA; Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Corner Lit [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: 's s",17 Estimated Cost: $ 50 Approx. Completion Date: -/6) 94:D Proposed Driveway Width If New Opening Is Desired: Ft. $ $. W5 + 6' See Back Page DATE: % -3 C-.)~ `//0 APPLICANT: Tel. # ey,79e /d 7 5' CITY USE OMY Permit Fee $ 0 Fee Schedule on Reverse Side State Surcharge $ feC� �% $.50/$1,000 Valuation SAC Charge $ $600 per SAC Unit Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Marge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ �V STIPULATIONS: (7K 96aj SUBJECT PERM N City ®f Fraley 12 4' AT THE TOP OF THE TWINS P, BUILDING PERMIT Ir ECEIPT NO. COMMUNITY DEVELOPMENT DIV. I - _ PROTECTIVE INSPECTION SEC. Cj Q S NUMBER REV. DATE PAGE Of APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 2/24/92 JOB ADDRESS 7139 Riverwood Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 28 Revised Aud, Sub, #77 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Harris Ratnayake 17139 River0ood Drive NE 572-8306 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Lighthouse Construction 2556 Westview Terrace, Minnetonka 542-9430 2772 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 ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Addition under.porch. 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan, iu v` Before digging call for all utility locatiol�s 454.0002 SEPARATE PERMITS REQUIRED FOR REQUIRED '03Y LAW MIRING, HEATING, PLUM ING AND SIGNS, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION l STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $4r700 $2,35 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $72,00 SC R. 70 STRUCTION OR THE PERFORANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE AF �s $79.0 IGNATURE OFC NIRA OR OR AUTHORIZ AGENT t0 EI WH PR ADT HIS IS Y1 WURER fA IT G INSP f1ATE SiGNATURE OF OWNER IIF OWNER BUILDERI IDATEI ' NEW [ ] , Effective i/1/92 ADDN (] CITY OF FRIDLEY ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Legal Description: Owner Name & A Contractor: l g Address: Z --S-.5- , �el� Tel. #.r 7Z- F3 v MN LICENSE # 6V 0 2- 7 7 -2— Tel. # ��2-- 9113 v 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 [ ] Ft. Yd Setback _ Type of Construction: -� �e� Approx. Completion Date: Sq. Ft. Sq. Ft. Sq. Ft. Side Yard Setbacks _ Estimated Cost: $ 'K-7 e-0 (C* on Hct) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: Z- ` APPLICANT: Tel. #z - 9 2.-N Permit Fee $ za cc Fire Surcharge $ s� _ State Surcharge $ i SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOTAL $ 7 STIPULATIONS: Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $700 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 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 Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace Gas Piping (Needed with new furnace) Gas Range Gas Dryer Rate TOTAL $ 20.00 $ $ 10.00 $ $ 10.00 $ $ 10.00 $ *Air Conditioning - All Sizes $10.00 $ All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work $ L's enn Commercial/Industrial 1 % of Value of Appliance or Work $ State Surcharge $ .50— TOTAL FEE $ SZ' MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. JOB ADDRESS %j � 2 Rt ' "" W da N f 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 and ruling of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. 2 ,1991 OWNER BUILDING USED AS 116yvl 11 ESTIMATED COST PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) Oarm Air) Trade Name BTU HP Size No. EDR Fuel Total Connected Load Burner Trade Name Size No. BTU HP EDR HEATING COMPANY Dp Signed By DJ""�' ►"°'`"Z Tel No. Approved By Rough -In Date Final Date -7' FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE CHIMNEY 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 Remarks List Alterations Being Done: HEATING COMPANY Signed By Date SUBJECT T City of Fridley 2 9 3768 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. SEC. r PROTECTIVE INSPECTION `7 /�f 7 I , CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/30/99 10B ADDRESS 7139 Riverwood Drive NE 1 LEGAL LOT NO, BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 28 1 1 Revised Aud. Sub. 477 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Harris 7139 Riverwood Drive NE 572-8306 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Ralph's Exteriors 5048 Washburn N, M ls., MN 55430 529-5258 9309 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 O ADDITION O ALTERATION .0 REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof House & Garage (26 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. 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 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 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 $2,228 $1 • 11 DOES NOT PRESUME TO AUTHORITY LATE OR CANCEL THE PROVISION F N OTHER S ATE IO O LOCAL LXK REGULATING CON- PERMIT FEE SAC CHARGE TRUCTI OR H PERFORM NCE O CONSTRUCTION $74.75 Fir SC. $2.23 PLAN CHECK FEE TOTA E Li e C $5.0 $83 9 SIGN4TURE OF ONi CTOM R UTNOAIZED 4GENT I HE PR P L ALIDAT HIS I V�IT I S-GNATUAE OF OWNEA.IF OWNER BUILOERI IOATEI OL05 INSP orBATE NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: _ Owner Name & Addr Contractor: _ Address: 4 D (H LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Effective 1/1/99 36g TeL # 2 — C% , MN LICENSE # �) Tel. # / t �. c' " _5 � Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Length Width Height Length Width k - Sq. Ft. Sq. Ft. Sq. Ft. L-1--1 Construction Type: Estimated Cost: (Fee Schedule on Back) .Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: 1 �� CITY USE ONLY Tel. #&2 Permit Fee $ / _ Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ l( $.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 $ 83 d STIPULATIONS: m University Ave NE Eley, MN 55432 i3) 572-3604, FAX (713) 571-1287 APPLICATION FOR PLUMBING AND GAS FITTING OF 9 Floor 1 Floor 2 Floor 3 Floor 4 LUMBING FIXTURE RATES: NO. RATE TOTAL $ 7.00 ew Fixtures $ 4A0 fld opening, New Fixture _ $ 5.00 eer Dispenser_ $ 7.00 _ low off Basin $ 7.00 ,atch Basin $7.00 %in Water Leader_ $ 7 00 .urnp/RecelVing Tank $10.00 Vater Treating Appliance $ 7.00 Vater Heater -Electric $10,00 j Vater Heater - Gas"* --� 410.00 _ Sas Range'* $10.00 sas Dryer** lack Flow Preventer Required ( )Yes () No $15.00 Type TO BE INSTALLED ON JOB The undersigned hereby makes plication for a permit for the work herein - specified agreeing to do all work strict accordance with the city codes and rulings of the Building Divisic, and hereby declares that all the facts and representations stated in th' pplication are true and correct. Ownerg - f�211-� � Building Used As Estimated Cost PLUMBING COMPANY SIGNED BY J�' teinspection Fee $47.0011-lr �L.L OTHERS AND/OR REPAIRS AND ALTERATIONS 1 1.5% of Value of F'ucture or Appliance Approved Bq - I State Surcharge �- .50 MLlM FEE FUZZ 1 TOTAL FEE $ PLUS THE $.60 STA ~,OMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. CC a (0*7 . 20 PERMIT NO. r =? f a Ej 0� EN . j � N M Date Final Date INFO ON BACK SIDE a APR -04-2003 12:13. FROM CITY OF FRIDLEY TO 6513651332 P.02/02 'I°HE BBLOw MusT BE FfLLi=D IN WHEN REPLACING FUEL BURNING APPUANCES OR THE APPUCATION INILL BE RETURNED When Mdacing an Mdonn fixMI)rA the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and Is securely supported and f7irestopped where required. Yes( ) No( ) The venting system is pleactPVC and meets all current codes and manufaomr specifications Including suing, length, number of elbows and termination. Yes( ) No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current nodes and manufacturer's specifications. This does include AGA-GAMA Category I Cental Furnace Venting Tables for fan assisted and natural draft appliances. Yes( ) No( ) The fWs*m nnmhwsfiou air is sized and installed to meet the current odes and manufacturer's specifications. Yes( ) No( ) When required to iill. a"Aamb.6monn ab tit will be sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When , the undersigned hereby verges that it Is a fisted assembly and meets the current codes and manufacturer's specifications. This does include ACA -LAMA Category I Centrai Fumace 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 #9 Type BTU input„® Fan Assisted or Nat, Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type Tnf..tl AnnRonrao, Total BTU Input RM inniit Fan Assisted or Nat - - Common Vent Type Vent Height Diameter____ inches Appliance 01 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter In Type Appliance #3 Vent Connector Height ft Length ft Diameter _ln Type HEATING 00: Signed By. Date: TOTAL P.02 CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MIN 55432 ►63) 572-3604 FAX: (763) 571-1287 ADDRESS : 7139 RIVERWOOD DR NE PIN : 103024420082 LEGAL DESC : AUD SUB NO 077 (REV) : LOT 28 BLOCK 0 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-00233 DATE ISSUED: 02/19/2004 VALUATION NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A INSTALL GAS WATER HEATER # ELEC WATER HEATERS # NEW FIXTURES (EXIST OPENINGS) # GAS DRYERS 0 VALUE OF FIXTURE/APPLIANCE 0 # GAS WATER HEATERS 0 # GAS RANGES # OF NEW FIXTURES 0 ENTER VALUATION # WATER TRMT APPLIANCES 0 APPLICANT H P PIPEWORKS 3670 DODD RD STE 100 EAGAN, MN 55123- (651)365-1340 F11", JR, -I HOLERIDGE, JAMES 7139 RIVERWOOD DR 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 wort 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. mi -cant-, / �y1 Date Bldg PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) PLBG FIXTURES (EXIST OPENINGS) WATER TREATMENT APPLIANCE WATER HEATER - ELEC WATER HEATER - GAS GAS RANGE FEE GAS DRYER FEE PLBG REPAIR/ALTERATIONS STATE SURCHARGE, PLBG FLAT TOTAL PAID WITH CHECK # 8241 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0 1 0 200 20.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.50 20.50 Building MECHANICAL Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604CITY OF FRIDLEY U N DATE "- I — 19 2 YOUR E-MAIL ADDRESS SITE ADDRESS 7--36 1? c `y'2Py�yyC� D1" THIS APPLICANT IS: QTER OCONTRACTOR PROPERTY NAME: 47,- tf ADDRESS: .3 J a, , Iden k. ,& a al /Q'UTY STATE ZIP OWNER/ TENANT PHONE: °2z9 !i -- Z !S- 3 4 CONTRACTOR COMPANY NAME: tj., fan-, 6,,1- J CONTACT PERSON: 2 ek.� A:.'s SUBMIT A COPY OF YOUR STATE STATE LICENSE #19j70, EXP DATE LICENSE WITH ADDRESS: " iy y Crry zl-, TATE,!!k4tP . APPLICATION PHONE FAX %S 2 P PERMIT TYPE INGLE FAMILY O TWO FAMILY O TOWNHOUSE . TYPE OF WORK: O NEW 06_REPLACEMENT O ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK P e%: �� I� �ae^h j- 14/;!f- - - PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: '7"k4a -C- MODEL: SIZE/BTU a V2 MFG: 'V-4o:( MODEL: 7't/,Q e.;? C/ SIZE/BTU MFG: MODEL: SIZEIBTU A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 _AIR TO AIR EXCHANGEER $15 (WOOD) $35.00 _NEW GAS GRILL $10.00 . _FIREPLACE $35.00 URNACE $35.00 _GAS UNIT HTR $10.00 _BOILER LINER $10.00 DRYER $10.00 _POOL HEATER $35.011 _CHIMNEY _GAS DUCt WORK $10.00 _GAS PIPING $10.00 VENTILATOR $15.00 �. _:... = i.. c—L6 k 40V �, -.s a •i+a ",; . Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ Number of fixtures @ $25.00 _t x $25.00 = $ S Number of fixtures @ $35.00 ( x $35.00 = $ State Surcharge = $ .50 Total = $0, SZ' 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 which requires review and approval of plans. SIGNATURE OF APPLICANT a ' PRINT NAME 10142 e,11 y2 DATE _ . . ..... . _.. .. __ .ll r City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977