PRE 2010 DOCSlst;e moblie homes,
Folv.
&�� 6279 university avenue n.e. ® fridley, minnesota 55432 ® phone 566-6600
December 22, 1972
City of Fridley
6431 University Avenue N.E.
Fridley, Minnesota 55432
Attention: Nasim Qureshi, Engineering Dept.
Dear Nasim:
Re: 8141 Ruth Circle
With reference to your telephone conversation of December 21st,
with Roy Lund, the following footing and block construction will
be followed.
1. Footing width will be 30" and depth to
be 8" on edges to 12" in center with two
continuous steel rods running throughout.
2. Two courses dura -wall in block wall. One
1/3 of the way up and the other 2/3 of the
way up from the.footing.
We will provide drain the around perimeter to be drained to the
outside and not to the sanitary sewer.
S inc6rely,
Dav d` H. Rott
Division Manager
Castle Homes, Div of C.M.H. Inc.
DR/ j b
113111
City of Fridley, Minn. ^ 11840
6431 University Ave. N.E., Minneapolis, Minn. 55432
PUJ ENG PERMIT
-Date: remember 1.9, 1972
Owner: - rast-le Homes Builder Sam
7613 Central Avenue N.E. Address
LOCATION OF BUILDING
I1To 814,1 _ Street Ruth Circle N..E. part of Lot
Lot 6 Block 5 Addition or Sub -Division Bourdeaux's Spring Brook Addition
Corner Lot Inside Lot X Setback - 35-' Sideyard . 15' & 11 '
,4** mevation . 849.42A tjbW]y4AfAg%j 852.42 Minimum
Wye Top of Footing
To be Used as:
Dwelling_ Front 42' Depth 26' Height 20' Sq. Ft. 1092' Cu, Ft s 21,840
Front 221 Depth _:22 1 Height _ 101__ Sq. Ft. _ __484' Cu. Ft. _ 4, $40'
Type of Construction - Wood Frame EffL Cost -- $20, 812 To be Completed Aug. 1973
Stipulations: Provide a verifying survey before capping. Provide a hard surface
driveway. Submit truss details indicated on plan.
WATER LOCATION: 10.6' N. of Sewer Service
SEWER LOCATION: 132' N. of Manhole (Inv. 847.97)
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. / . ^, /--�
State
In consideration of the payment of a fee of $ 50.00 , permit is hereby granted to._.._. Castle Homes
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 allwork
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 a time upon violation of any of the provisions of said
Building Inspector
DARREL CLARK
NOTICE:
y This permit does not cover the construction, installation for wiring, -plumbing, gas heating, server or water. Be sure to see
the Building Inspector for separate permits for these items.
APPLICATION FOR RESIDENTIAL. ALTERATIM
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Rtc "C- L
L(XK1 AWITION1
61, a e-> U �- j a Au )_e '�S
--p z:
CORNER LOT: IMUE LOT; SIDEYARD: Y6-' 141
AffttvAmt attach to th1m fo=b Certificates of Survff of Lot and proposed
U1141mS location drwR on tbeft Certificates,
VESCRIPTION OF BUILDING
To Be US" AS: E/' 9/e
square Feet;. /0 5 2- cubic Poet;
tv Depth; Z Z. Height: 0
4
Square Feet Cubic Feet; V , Y
We of Constructions Fru - :L Estimated Cost: C!d 5.er
To Be "toted;
The mdarvigne4 hereby oak** appltcat1va for. a Pe .t for the, work herein
#po0jfW, agreeing to do all work im stftct accordance with the City of
Mdt,ey Ovd$*ances 4u4 -suMp pf Oe Department of ButWass, arA hereby
dpolaref oat all the facts and representations stated is this application
are true =4 vmrrect,
Z2- /5 - /22- SIGNATURE#
" f- T /Xr' S
(Foe Rorerve tide For Additional Info mation.)
C'\
v
BUILDER:
CAS-7-,Ze
Z/�L - 1 e...
AD1DnSS:&/ 3 a/J0aJrCA
I
aw --pmss:
�2 if/a
- A u
Rtc "C- L
L(XK1 AWITION1
61, a e-> U �- j a Au )_e '�S
--p z:
CORNER LOT: IMUE LOT; SIDEYARD: Y6-' 141
AffttvAmt attach to th1m fo=b Certificates of Survff of Lot and proposed
U1141mS location drwR on tbeft Certificates,
VESCRIPTION OF BUILDING
To Be US" AS: E/' 9/e
square Feet;. /0 5 2- cubic Poet;
tv Depth; Z Z. Height: 0
4
Square Feet Cubic Feet; V , Y
We of Constructions Fru - :L Estimated Cost: C!d 5.er
To Be "toted;
The mdarvigne4 hereby oak** appltcat1va for. a Pe .t for the, work herein
#po0jfW, agreeing to do all work im stftct accordance with the City of
Mdt,ey Ovd$*ances 4u4 -suMp pf Oe Department of ButWass, arA hereby
dpolaref oat all the facts and representations stated is this application
are true =4 vmrrect,
Z2- /5 - /22- SIGNATURE#
" f- T /Xr' S
(Foe Rorerve tide For Additional Info mation.)
C'\
v
rf/- City of Fridley
AT TNg TOP OR TwuTWINS
L
trtil"+a•�•••� C01wrA JNITV DEVELOPMENT DIV.'
1 i PitoTECTtVE NVECTION DEPT.
i PTV NAIL PRIDLRY 55432
BUILDING PERMIT FEE CALCULATION
Builder Total
Address - Fee rtj
Permit Fee-
= length x width x ((number.of floors, includ. bsmt. x 8) + 4) x $1.85 Res./1000
$2.15 Comm./1000
X x (( x 8) 44)x ® :
Plan Check Fee
= Permit Fee /2 •
/2
Valuation
= length x width x average cost per square foot (taken from chart)
Do separately for basement, each above grade floor and garage or
accessory building.
a
X xx
(No. of above grade floors)
® x x a m,
Surtax
= Valuation.x $.50/$1000.00
x.$.50/$1,000.00
for Power Ptanft and HeathiS Coolings Veogadons Re/1geretion ®nd
Air Ce eni Sptem wd Devices �'`�
PARTIAL RATE SCHEDULE Dept. of Bldgs. Phom 56"M
- A
GRAVITY WARM AIB: RATE 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
MECR. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ... ..$10.00 10.00
each add. 60,000 BTU .................... .. 8.W ;-
Replacement of Furnace .. ....... .... 6.00 $
Repairs & Alterations—up to $500.00 6.00 $
Repairs & Alterations each add. $500.00 &W $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $.
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $_
Each add. 200 sq. ft. EDR Steam 3,0(1 $ __
Each add. 320 sq. ft. EDR Hot Water 3,00 $_
OIL BURNER—to 3 gal. per hour 6,00 $ _
over 3 gal, per hour—wee Fee Schedule
GAS ffi (up to =,Q()0 BTU)
&00
over 199,000 BTU See Fee Schedule
GAS FIITTINC .
NO RATE
1st 3 Fixtures
x$ x.00
gg`TOT'AL
$ GX� 0
Additional Fixtures
x .76
$
Gas Range to 199AW
a$ 5.00
$
AIR CO ITIONENG
$
FAN HEATING SYSTEM see Fee Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
TOTAL. FEE
ROUGH
FINAL
(SURCHARGE
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 correeL
A Ridley, Minn- i 1g
Cai'+ri'r= 1J!:,WAr'1m510off"VIM
Kind of Building
Used as - _ ---
To be completed about
Estimated Cost,
Ol Ne) Building Permit No. Permit No. (0
DESCMIPTION OF WORK
HEATING or PO P team, Hot Water, arra Air— o—L— -
Trade Name �•) Size Na- 'ft
Capacity Sq. Ft. E.D.R- BTU
1S.P.
Total Connected Load- �e ®®� d of �'ue
BURNER — Trade Name Size No
capaci Sq. I t. EM.R BTU .
(REMARKS—OYER)
8, AIR CONN. CO.
141NNEA OLI;, MINN. 55416
HEAT LOSS CALCULATIONS
A/�77,D
4// 3 e)
H EATI NG & AI R CONDITIONING CO. / MINNEAPOLIS, MINN.
Weatherstrips
A.S.H.V.E.
Guide
Reference
19
Construction No.
Insulation
Windows
Doors
Out. Wall
Int. Wall
Ceiling
Roof
Floor
Kind
How Applied
Yes—No
Yes—No
j FI.111 6=- Room Length Width
Height
FILength Width
Height
Windows and Doors—Crackage and Area
Windows and
Doors—Crackage and Area
Height No. of Lineal ft. Area
of pane lights of crack sq. ft.
a� r
Width Height No. of Lineal ft. Area
No. of pa�nye of panelights of crack sq. ft.
Width
NO' of panne
" 3 El / 117 f�
—2 O
Coef Btu
ICoefl
Btu
Infiltration
Infiltration
Glass Lall
A v
Glass
Exp. wall
Exp. wall
Net.exp. wall
Net exp. wall
Int. wal I._ 45111V IYC
Int. wall.
Ceiling /�
��
Ceiling /� j�
�®
Floor
Floor
Total Btu.
Total Btu.
73 2
Required sq. ft. E.D.R. or sq. ins. W.A. Lea r area
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FI I�'a// , Room Length �� Width/� Height
FI Ae Room
Length J Widths Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of ane of pane lights of crack sq. ft.
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef Btu
Coef
Btu
Infiltration
`
Infiltration
Glass
522 V
Glass
900
Exp. wa 11
Exp. wa I I
Net exp. wall /
Net exp. wall
Int. wall.
Int. wall.
Ceiling
Ceiling
Floor
®
Floor
-2
Total Btu.
Total Btu.
Iz
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
�F1./fo M Room I Length Width
Height
F1. AfRoom Length Width
Height
Windows and Doors—Crackage and Area
Windows and Doors—Crackage and Area
Width Height No. of
No.) of pane of pane lights
Lineal ft.
of crack
Area
sq. ft.
Width Height No. of Lineal ft. Area
NO' of pane of pane lights of crack as f
®
r/ X
Ly
Coef Btu
Coefl
Btu
Infiltration
E
Infiltration
Glass
Glass
Exp. wall
Exp. wall
Net exp. wal l
Net exp. wal I
Int. wall
Int. wall
Ceiling
Ceiling M15
V
119
Floor
Floor m
Total Btu.
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Cify of Fridley
Pli Ag and Sm 11111011" Pan*
Dept. of Bldg@. Phone MD -3490
DESCRIPTION OF WORK
Number, Diad and Location of Fixtures
�1 lill i lfdiill l'W l� l l� � lv I :1 N 1 G SM
TEN LEC.
PARTIAL RATE SCHEDULE
Sewer
Cesspool n
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ................
_� x $2.00
$
Future Fixture Opening ...........
x $1.50
$--
-New
New Fixture Old Opening ..........
. x $1.50
$
Catch Basin ....................
x $3.25
$
Water Heater :Up to 99,000 BTU) ....
x $3.00
$�
New Ground Run Old Bldg.........
x $3.25
$
Electric Water Heater ..............
a $2.00
$
GAS FITTING FEES.
NO. RATE TOTAL
ist 3 Fixtures x $200 :-
Additional Fixtures .................. x $ .76 $
Gas Range to 199.000 BTU ... ,............ x $5.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description .............. , ........... , ....:............... a R /)
TOTAL FEE
6
.21-56
City of Fridley:
The .undersigned hereby snakes 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 alt the fact
and representations stated in this application are true and correct
Fridley, Mixon 7 % 19-23
Owner 2 z4P/VY a2
Kind of Building pp" gr,i
Used as
To be completed about _.S, - 7 3
Estimated Cost, $ / S d (1
Old ew. Building Permit No. Permit No.�
Signed.
Business Phone No '� All e 3 � y
ROUGH
-53-84-S-915.5
j , 1
1to, 11 1 1 @A I, - s r " 3 S g-91
Q f3 GA4 [LEC
Base
PLUMBING FIETURE RATES-
NO. RATE TOTAL
Number Fixtums ................
x $2.00
$
Future Fixture Opening ...... • ... •
x $1.50
�
New Fixture Old Opening ..........
x $1.50
$
Catch Basin ...... ............
x $3.25
�
Water Heater (Up to 99,000 STUD....
x $3.00
$
New Ground Run Old Bldg.........
x $3.23
S
Electric Water Hfttom..............
s $2.00
$
GAS FITTING FEEM
NO. RATE TOTAL
lot 3Fixtures •••.. ••••••...•••
x$2.00
$
Additional Fixtures...... , .........
x $ .Ts
$
1
5.00
Gas RMe to 190,000 BTU ............
x $s oo
$
State Surcharge
$ .50
REPAMS a AL TIO ter to Cc&_
>aipfla,...........................................
TOTAL FZE $ 5.50
city of Fridley:
The undersigned hereby makes application for a permit for the vrork herei,
specified. agreeing to do all work in strict accordance with the City Ordinance
and raling of the Department of Buildings. and hereby declares that all the fact
and representations stated is this application are true and correct
Fridley, Mira 4-19-73Owner
Castle Homes Inc.
&Geed of Building Frame
Used w Res.
To be completed about 4-26-73
Estimated cost, $ 10.00
XMPLNew. Building P'errnit No. Permit No.
Signe ...,
p'
By 5-9 ..wEnn
Business Phune No
ROUGH
F3NAL rte✓ .
titM wA--MWWge 1.50-
?°T.:,,� -eCT E' '`:7 n^ C.. el t7'.". �..-?F�..."''.a �•?a T.'%. ^$ �9"T `"°C.eq "'-i"0r.a� ,� k�"' �°='ry'+ r-�v .L�.`4%.y� e�ag�g� �/
'u'tiv od u _. _ �.. �... •s3 i�� a. .: ��1����^^ u,,�®®99 u�J �L.e _s. •t ....;�t,J� E. �4ra:. i:'e�•,v�L.:.: "..a:ra. �i.:.w`�
-a�b 'gt,p.�+.tz;, � Y: nn l Gal^� . .
.1�7viil t•i ci.L L" �r �.:•1a :v 4sa
PARTIAL MTE SCHEDULE tet. 02 B919M. norle MUM
Cil AVM VIAMM AM."M
Furnxce Shell & D•,tct Work ... ... . .....
.. $10.00
Replacement of nrnaee
6.00
Repairs & Alterations—up to $500.00
600
$
Repairs & Alterations each add. 5500.00
3 *W
$
CZ -L WARE.? &M
Furnace Shell & Duct Work to 120,000 BTU .. ..
$10 00
$
add.. 60,000 BTU . .........
3.W
b
Replacement of Furnace
6.00
�
,Repairs & Alterations --up to $500.00
6.00
$
izpairs & Alterations each add. $500.00
3.00
$
STEAM oa HOT WATE'll', SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.46 $
Puynace Shell & Line- -to 640 sq. it. EDR Hot Water 10.00 $.
Each add 200 sq. ft. EPR Steam
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
GAZ BURNER (up to 1..r2`?,COO BTU) 6M $
0'"2r 1S9,000 VIM Zoe Too Schedule
GAS FITTING FuO RATE TOTAL
1st 3 Fixtures x$ 200 gam"
Additional Fsxtures — x .76
Gas Range to 1M.M au 5.0 g
Alit CC-'.M1TIC• 1Mz
FA's
""-1 u•'Sa./':sYYLZtJ i:. 6i6.yvliG�':riY
State Surcharge .50
I311* pea O 0
sem, a� g qaifw.`3Lo �
:. S= v
L V/ �'/ . ef, "Y (�'�-2f I
City of'Trldley:
The undersigned hereby makes application for a permit for the work here..: � .
specified. agreeing to do all work in strict accordance with the City Ozd:cancer
and ruling of the Department of Buildings, and hereby declares that an the faer
and representatiuns stated in this application are true and correct.
Fridley, Minn—
Owner
tfainn
Owner J sedp Y D v C'
Kind of BuildingOy E
Used as _ ,�� 5 - /J _— /E",
To be completed about—
Estimate d
bout_
Estimated Cost:, $ C) 0
Old --New. Building Permit No. _—_ parmit No.�
DI -.21"C7=02114 0? T702=
&i AMG or POWER I'Z i tarn. Not Water, Warm Air—No
Trade Name Si -e No
-Capacity—_— _ Sq. F,. E.D.R B3TT gll�
Total Connected L=d Mnr1 of l
DURlErM -- Trade Nance Size No
capecity Sz
i�aatss—otie�l
Building
MECHANICAL
Permit No.• ' — Q® (®[
—4—
Received By
Inspections
RESIDENTIAL APPLICATION
_
7.63-572-3604
CITY OF FRIDLEY
nate Rec'd:
DATE I-0 J YOUR E-MAIL ADDRESS
l
SITE ADDRESS l L
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY
OWNER/
NAME;
ADDRESS: G CITY STATE ZIc'
TENANT
PHONE: ✓�
CONTRACTOR
COMPANY NAME: i
SUBMIT A COPY OF
CONTACT PERSON: l
YOUR STATE
STATE LICENSE 0 /, EXP DATE
LICENSE WITH
ADDRESS; (/ 624LZ1,4CITY SCJ i��.aIi STATF✓��`IP
APPLICATION
PHONE FAX
PERMIT TYPE
❑ SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK'
❑ NEW ❑ REPLACEMENT ❑ ALTERAnoN/REMODEL
DETAILED DESCRIPTION
�O'F, WORK � ` � ���/C� ���1'1��/' ��/�,�� �� Z 7�
PER MS 1613.665 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 laboj`�SJ 66 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: MODEL: SIZEIBTU
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZEBTU
A/C $25.60 (GAS) $15.00 GAS RANGE/OVEN $10.00
_FIREPLACE
TO AIR EXCHANGEER $15 (WOOD) $35.00 NEW GAS GRILL $10.00
_AIR _FIREPLACE
$35.00 $35.00 _GAS UNIT HTR $10.00
_BOILER _FURNACE
LINER $10.00 a�GAS DRYER $10.00 _POOL HEATER $35.00
_CHIMNEY
DUCT WORK $10}.00 GAS PIPING $10.00 _VENTjI-LATOR $15.00
�r
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 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Total = $
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 APPLICML,� PRINT NAME DATE
��� ' r 'ER %!I1'S ARES..... 7iKED 1rQI BL7iLT7IN r; E CTI C 5AN. DfWOAW QQ O "
LT
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building
MECHANICAL
Permit No.:
Inspections
RESIDENTIAL
APPLICATION
Received By.
Dat d. o
.763-572-3604
CITY OF FRIDLEY
763-502-4977 FAX
EFFECTIVE 2-19-09
DATE s
YOUR E- DRESS
SITE ADDRESS
THIS APPLICANT IS: ❑ WNER
ON CTOR
PROPERTY
NAME:
ADDRESS:
CITY
STATE ZIP
OWNER/
TENANT
PHONE:
�" ��LL
CONTRACTOR
COMPANY NAME:
CONTACT PERSON:
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
STATE LICENSE #
I U.XP DATE
STATE�ZIPI�
ADDRES
CITY-ch
APPLICATION
PHONE 4PI�l
'-'� � FAX
PERMIT TYPE
AS INGLE FAMILY
❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW PLACEMENT ❑ ALTERATION/REMODEL
D TAIL D DES PTI N OF
X
if
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
Equipment Installed MFG:
MODEL:
SIZE/BTU
MFG:
MODEL:
SIZE/BTU
MFG:
MODEL:
SIZE/BTU
$25.00
(GAS) $15.00
GAS RANGE/OVEN $10.00
_A/C
TO AIR EXCHANGEER $15
_FIREPLACE
_FIREPLACE (WOOD) $35.00
NEW GAS GRILL $10.00
_AIR
$35.00
$35.00
_GAS UNIT HTR $10.00
_BOILER
LINER $10.00
!FURNACE
GAS DRYER $10.00
_POOL HEATER $35.00
_CHIMNEY
WORK $10.00
_
GAS PIPING $108.00
VENTILATOR $15.00
_DUCT
J
�` (%+'f'a ' qq tx 4' b , ~Y
,D C\V P" 3 2#r ➢,"; __�k� y{ti,l
.Yr NW
'' '�
�
he � i' a 'M' � gC'
� �£.
i�^J��ru����T4'�� .'
Sy,��F 4•C�`Ai,""" `4.�'.
Y�4y�i'df4
oY, ^' t
a
� °� �.t � _"R� �,_
P�¢x. •:5i k �,�' �
�i&k`��,�'k; � k �,:i���U:Nt y �,t �
�(.' t� � ....e "�
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 allAvork which requir review and approval of pI s.
r p
SIGNATURE OF APPLICANT
PRINTNAME C_-l'1V
DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977