The URL can be used to link to this page

PRE 2010 DOCSlaity ®f Fridley, Minn. BUR DING PERMIT Date: N® 6748 LOCAT N O BUILDING NO. Street - Part Lot P �� Lot ___ Block _ _ Addition or Sub- visions �.�� Corner Lot _ Inside Lot �� Setback Sewer Elevation _ — Foundation Elevation DESCRIPTION OF BUILDING U; z 0 Sq. .jJ Front Depth Height Sq. QL Ft Fro t Depth Height Ftir Type Of ction,°To be Est, Completed In consideration of the issuance to me of a permit to c the building descri above, I agree to do the proposed work in accordance with the description aboveaa�A in comp ce with all provisions of ordinances of the city of Fridley.1p 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 M Fridley, unesota reg location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time of any of the provisions of said ordinances. —, NOTICE: This permh does not corer the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we the BWWhrg hrspestor for separate parmits foe thus items. Application for Power Plants and Healing, Cooling, Ventilation, ReFrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ........................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ F- 022 each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam .... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ �o GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x $1.50 $ Additional Fixtures x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL See Fee Schedule Dept. of Bldgs. Phone SU 4-7470 Locatfon 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 Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn — CD cz 9 y 19 6.3 Owner---4/dCZ1;nOD 7' ST®NjZ' Kind of Building m zr Used as Du1'�r/-14�lE To be completed about 3 Estimated Cost, $ 0 - o Old New uilding Permit No. Permit No. ' DESCRIPTION OF WORK HEATING or POWER PLANTS --Steam, Hot Water, 1arm Air o i Trade Name Size No 111'7- / -7z- Capacity Sq. Ft. E.D.R. S�Z�2� BTU H.P. Total Connected Load S -2-,':2G7 Kind of Fuel GeV BURNER — Trade Name Size No Capacity Sq. Ft. EMM BTU H.P. TOTAL FE $ > S' O Signe CEO. SEDGWICK HTG. & AIR -GOND. CO By 1001 Xenia AV. S. Minneapo O.2MM. Business Phone No LI 5-1611 (REMARKS—OVER A14zr. Z- ::0 -767 HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDIWd MINNEAPOLIS. MIND. Weatherstrips A.S.H.V.E, Construction No. Insulation ' Guide Windows IDoors Reference Out. Wall Int. Wall Ceiling I Roof Floor Kind How. Applied Yes—No Yes—No 19— / F1.I /__ s v;fv r Room I Length / 9 Width o 3 Height 7 II , FI_I 110 -� la . - 0 Roam I Length A'3 Width /',o Heisht Windows and Doors—Crackage and Area Btu Infiltration ,dg- Width Height No. of Lineal ft. Area No. of pane of pane lights ofs k a,,. ®x( r 33 Exp. wall Coef.1 Btu Net exp. wall 0 Coef. Btu Infiltration 9 Floor 3'1 Total Btu. Glass Required sq. ft. E.D.R. or sq. ins. W.A. Leader area .S'0 i FI.I Room I Length Y'::? Width 1-7 Height f�' Exp. wall Net exp. wall Net exp. wall Int. wall Net exp. wall Ceiling 7 2 Int. wall Floor P�LIAI ,` 0 _T -3 Floor Floor Ceiling x -;,-3 Floor 1 otal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 1`11 Room ( Length // Width Windows and Doors--Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack aq. ft. L� Coef. Btu Infiltration ,dg- / Glass 7 0 Exp. wall Coef.1 Btu Net exp. wall 0 Int. wall Infiltration Ceiling /'/' ,r91 9 Floor 3 A e - Total Btu. G 3 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area .S'0 i FI.I Room I Length Y'::? Width 1-7 Height f�' Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. 3 _7L® 13 Height No. of Lineal ft. Area of pane lights of crack sq. ft. Coef.1 Btu Infiltration ® 39, -Coef.1 Btu Infiltration Exp. wall y 3 9 Net exp. wall 3 A e - Glass g,,3 Ceiling ®:3 y< 0 / 3 c;p .S'0 �. Exp. wall 7 3e Net exp. wall Net exp. wall Int. wall Int. wall Ceiling Ceiling/ a 3 Floor P�LIAI ,` 0 _T -3 Floor Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width No. of pane Height No. of Lineal ft. Area of pane lights of crack sq. ft. Coef.1 Btu Infiltration ® 39, Glass .`�_ ® ® 0 Exp. wall y 3 Coef. Net exp. wall 6, Int. wall g,,3 Ceiling ®:3 y< 0 / 3 c;p .S'0 Floor Exp. wall /' o >C Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.l ^ zscD Room I Length / Width /;L Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. Pt. Infiltration Glass -:�_ U I yo Exp. wall 9" Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. his. W.A. Leader area / FI.I 0,4rq +-L FARbom I Length d Z Width e Height e Windows and Doors—Crackage and Area Width No. of pane Height No. of Lineal ft. Area of pane lights of crack sq. ft. Coef. Btu Infiltration 3 F g,,3 Glass F .S'0 Exp. wall /' o >C Net exp. wall �- Int. wall Ceiling a 3 Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area niis F' , 9 y HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS. MINI' Weatherstrips A.S.H.V.E, Construction No. Insulation -_0 Guide Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Yes—No ;Yes—No 19_ B F1.I Diill�- r v K i -r Room I Lensth / q Width a -� Heiaht ?r II R-1 Room [Leni;th Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal f . Area No. of pane of pane lights of c ack sq. ft. 73 4t" 49, 1 2° 50. F1.1 A py v.n .. Room I Length S 0 Width Height 7 Windows and Doors—Crackage and Area Coef. Btu Infiltration Btu Infiltration No. of pane of pane llghts of crack Glass 3e -.:?- ,S-® Exp. wall 5 3 X -2, -0 ds cs r ®rte Net exp. wall /�- �y ®' Int. wall Net exp. wall Ceiling 0 Int. wall Floor Ceiling Total Btu. I �/ aP Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.I yc= YT Room I Lenath z -:? Width �j Heisht T/ Windows and Doors—Crackage and Area -7- r- G Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. d 3- 6 50. F1.1 A py v.n .. Room I Length S 0 Width Height 7 Windows and Doors—Crackage and Area Coef. Btu Infiltration No. of pane of pane llghts of crack s' 3e -.:?- Glass Ceiling -2, -0 ds cs r ®rte Exp. wall 5,1 /�- 3 ®' Coef. Net exp. wall 0 Int. wall Ceiling y - 3 Floor Total Btu. -7- r- G Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 50. F1.1 A py v.n .. Room I Length S 0 Width Height 7 Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area Exp. wall No. of pane of pane llghts of crack sq. ft. Int. wall Ceiling 3-3 Floor d� ® /�- ®' Coef. Btu nfiltration :;E - Glass -76 .S 3 0 Exp. wall 7 6 X 7- S � 7 Net exp. wall Int. wall Ceiling Floor �—, 0 x /3 G S-0 �7- Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 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 Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.I Room I Length Width Height 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 Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. his. W.A. Leader area I F1.1 Room I Length Width Height 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 Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK® Number, Kind and Location of Fixtures Location r < 3 Number Fixtures ...................... 2 N $� Z oO ha Z a Z OO 4� U �U' z 3 Z �G O • P • N WATER HTR. GAS ELEC. Base $ GAS FITTING FEES: NO, RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Z" Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ Ist TOTAL FEE ��-4 0 2nd 3rd _ 4th • Future Connection Openings New Fixture, Old Openings Connected with Sewer Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $� Future Fixture Opening ................ x 1.20 $ ®!2 6-16 New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... _ � x 2.00 $ A New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO, RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Z" Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE ��-4 0 City of Fridley: The undersigned hereby .makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Minn- iQ -4v 9— 19— Q Owner Kind of Building Used as To be completed about Estimated Cost, $ / 1-0 0 Old e . uilding Permit No Zo 7 Permit No. ROUGH/6-19 s 0 FINAL 42 2M reg rte 4 - By ' LM - y -P a,,L®" --- Business Phone No 101 f J F 21 - ROUGH --/6 - 19 1- Application for Power Plants and Hearing. Cooling. Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ each add. 60,000 BTU ....................... Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 ................. Repairs & Alterations each add. $500.00 .............. 8.00 $ 2.00 $ 5.00 $ 5.00 $ 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ..... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ Additional Fixtures x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING, SYSTEM See Fee Schedule / VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ ae.j m„e, el h" ROUGH Dept. of Bldg& Phone SU 44-7470 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 Ordinances and ruling of th�tment of Buildings, and hereby declares that all the facts and representations staled in this application are true and correct. 1944 0 Owner Kind of Building Used as To be completed about — /7 Estimated Cost, $ r Old—New. Building Permit No. � � Permit No. DESCRIPTION OF WORK BEATING or POWER PLANTS --Steam, Hot Water, Warm Air—No Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P Total Connected Load Kind of Fuel BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P Signe By m 42 Business Phone No ^ 7— 34 FINAL (REMARKS -OVER) - SUBJECT PERMIb City of Fridley AT THE TOP OF THE TWINS BUILDING PERM • r RECEI COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 i � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 812-560-3450 910-F15 7/26/78 JOB ADDRESS 211 Stonybrook Way N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 7 Pearson's Craigbrook Estates 2nd SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Robert Mastrian 211 Stonybrook Way N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Gary Lane 6190 East River Road N.E. 560-1519 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 8 DESCRIBE WORK Reside house 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Alum' num THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING 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. $2 $1.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �QOO 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. $12.00 PLAN CHECK FEE TOTAL FEE $13.00 S ATUREOFCONT:VROR�AUHORIZEDAGENT (DATE{I WHEN PRO ERLY VALIDATED THIS IS YOUR PERMIT �j BLDG. INSP DATE ATURE OF OWNER IIF 0 EL`DERI (DATE) CITY Qi= FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PEINITS (NEW, ALTERATM,,s, ADDITIns, OR REPAIRS) 01VINDR: Address: J/ ,S „vu Address: Tel. No. No.: Street: LOT: BLOCK: ADDITION: I 0 ieS a CORNER LOT: I14SIDE IAT: SETBACK: SIDEYARDS: Applicant, attach 't -o this form 1Vo Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION. OF BUILDING To Be Used As: PzS 10 ESS Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: • Square Feet: Cubic Feet: Lik�lnc 11LC,1I Type of Construction: F.5timated Cost: $ 0 cJ To Be Completed: F4 owe Alt. A Alt. B Pr6posed Driveway Wid',h If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) 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. See reverse side for additional information. DATE: �7 SIGNATURE: Stipulations: BUILDING PERMIT FEF SCHEDULE SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repairs to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet. PLAN CHECK: 25 percent of building permit fee. DRIVEWAY DEPRESSION: (Concrete Curb Streets Only) Alternate A: Removal and replacement of concrete curb and gutter only; Driveway width plus 6 feet x $14.50 Alternate B: Removal and replacement of concrete curb and gutter and install a 3 foot wide approach with 6 inch depth; Driveway width plus 6 feet x $17.20 For the purpose of computing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or the cellar to the average heights of the upper surface or to the average height of the roof surface of the main gable of a pitched roof. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost of all proposed work. In -no case shall the fee charged for any permit as set forth in Section 2 be less than $7.50 plus $.50 state surcharge. I M4 ►_ ` ►1., US NOTE: Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation .once it has been constructed will be required before proceeding with the framing. Application for a Certificate of Occupancy shall be made ten (lU) days prior to the use or occupancy of any structure for which a building permit has been issued, and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. cl a SUBJECT PERM City of Fridley ®1489 AT THE TOP OF THE TWINS PER M. L BUILDING NO. • COMMUNITY DEVELOPMENT DIV. U------ INSPECTION jRECEI;PT r PROTECTIVE SEC. �� 1 . � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L"'•'�'� ,`� 612-560-3450 910-F15 8/2/78 JOB ADDRESS 211 Stonybrook Way N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 7 Pearson Craigway Estates 2nd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Robert Mastain 211 Stonybrook Way N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Gary P. Lane 6190 East River Road N.E. 560-1519 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 x 8 DESCRIBE WORK Construct a 12' x 26' Porch Addition 9 CHANGE OF USE FROM TO STIPULATIONS Provide frost footings. Can not be heated until insulated. SEPMATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS.HIND Call 1001 WOO Befolre-dwing c. GAS Et- ��c�vIREa By LAW. or TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING 1 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. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,500 $1.25 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITFEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $13.00 PLAN CHECK FEE TOTALFEE $ 3.25 17.50 XURE OF CONTRACTOR UTHORIZEDAGENT (DATE) WHEN PROPERLY Y4LIDATED THIS IS YOUR PERMIT T REO W IF WN R UILDERI 1 TE) BLDG INSP. DATE a ,a N� -I ��I I� oil i all �I SII ■'� all NMI �9 i' /hP8 v s-le C. IF o0 - 4.0, • CITY OF FRIDLEY APPLIC/ITIOPI FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, /ADDITIONS, OR REPAIRS) OWNER: r°`j'',, l' zzt BUILDER: 01�-Ie_v_ P %L! Address: // .5 /--4, ,/U4 ,;%jkIc,4 U)h Address: Tel. No.�� No.: Street: LOT: BLOCY.: ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS: Applicaht attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING A- Be Used As: apGy �f d /7 Front: Depth: Square Feet: Cubic Feet: Height: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: f�ii/GP`�1 Estimated Cost: $ To Be Completed: y c% — .� Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) 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 refresentations stated in this application are true and correct. See reverse side for additional information. DATE: / j SIGNATURE:�� Stipulations: , v Q2o V Arc C6 AJ AJCA ®d Pea,��r- vJU In CA 3 z CISs' ° '04094-M) C 3 I. 14M onel TAJS0 c.~. BUILDING PERMIT FEE SCHEDULE SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repairs to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet. PLAN CHECK: 25 percent of building permit fee. DRIVEWAY DEPRESSION: (Concrete Curb Streets Only) Alternate A: Removal and replacement of concrete curb and gutter only; Driveway width plus 6 feet x $14.50 Alternate B: Removal and replacement of concrete curb and gutter and install a 3 foot wide approach with 6 inch depth; Driveway width plus 6 feet x $17.20 ADDITIONAL INFORMATION For the purpose of computing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or the cellar to the average heights of the upper surface or to the average height of the roof surface of the main gable of a pitched roof. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost of all proposed work. In no case shall the fee charged for any permit as set forth in Section 2 be less than $7.50 plus $.50 state surcharge. _VERIFICATION OF FOUNDATION NOTE: Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has been constructed will be required before proceeding with the framing. _CERTIFICATE OF OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. Co. 19 INCO ENGINEERS AND SVRVEY�RS La.No sVAv$YtNQ SOILS TESTING GIvtL h. MNNtC101h�. =BNOINB.$RINB LAND DLAt.1NINl! ,' G418-SGTw AVENUE N. MPNNEAPOLIS;=.'PT. MINN. KE 7- 3637 vim ►�'�` AN (loV 9 scALE 1=4 o Lk 0 Lo-T- I S BL r. 7 PER .SoNs CRAIGWAY E5TA:rA WE KEREBY CE=RTIFY THRT THIS IS A TRUE AND CORRECT REPUSENTATIOAI OF K SURYEY OF TIRE BOUNDARIES OF TETE LAND PZOVE DESCRIBED AND OF THE LOCATIOM OF ALL. BUtLOINGS, IF AMY, WEREON , AND NLL. VISIBLE ENCROACHMENTS, _. 1F ANY, FROM OR ON SKID LAND. MINDER B4GIMEEIZtNG C0.,1NC. SUBJECT P T O. Oi City of Fridley ® 42 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. 16y ...... COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L d` 612-571-3450 910-F15 9/1/87 JOB ADDRESS 211 Stonybrook Way N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 12 7 Pearson's Craigway Estates 2nd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bruce Hein 211 Stonybrook Way N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Irony-wood.Construction 3909 Central Avenue N.E., Col Hgts. 788-6902 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 C2 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install bay window 9 CHANGE OF USE FROM TO STIPULATIONS f 1/ J. 44) f iv 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 SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING 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 $2,500 $1.25 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- $38.50 CTION OR THE PERFORMANCE OF CONSTRUCTION. FA)", LAN CHECK FEE TOTAL FEE $39.75 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY/"LlDATED THIS IS YOUR PE MIT SIGNATURE OF OWNER IIF OWNER BUILDER) —I DATE)) BLDG INSP q7 NEW [ J City of Fridley Effective 4/1/86 ADDN. [ ] R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: g1j�n'��Y®�f� UAy Legal Description: 1',� ��. �. 61e�rSa ii�, Owner Name & Address: &14CO MelAl Tel. # Contractor: Z -d R'woo-( eow,s 7,ouc,,7t d,°-1 Tel. # WIP �d L Address: 3 %e % � xz,�-,4 �?/ Ld /vof- L L J -17'S Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: ZN57-4`L 30° �� (�y1A)&L4J Corner Lot [ 7 Inside Lot [Vf Ft. Yd. Setback Side Yard Setback Type of Construction: Jot Estimated Cost: $' � Approx. Completion Date: / j -7,47 Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: 4cz _ APPLICANT: /sem /rJ�ve� Tel. # % Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: t,'w CITY USE ONLY Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $ 525 per SAC Unit Fee Determined by Engineering Agreement Necessary [ J Not Necessary [ J BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: Total Valuation Fees $1.00 to $500.00 $10.00 (Minimum Fee is $15.00) $501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each - additional $100 or fraction thereof, to and including $2,000. $2,001.00 to $25,000.00 $32.50 for the first $2,000 plus $6.00 for each additional $1,000 or fraction thereof, to and including $25,000. $25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $50,000. $50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each additional $1,000 or fraction thereof, to and including $100,000. $100,001.00 and up $433.00 for the first $100,000 plus $2.50 for each additional $1,000 or fraction thereof. DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50 Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75 VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has been constructed will be required before proceeding with the framing. ft SUBJECT PE. City of Fridley �9�7R AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT ` _____ COMMUNITY DEVELOPMENT DIV. 1 L PROTECTIVE INSPECTION SEC. 1 , CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 9.10-F15 5/18/88 JOB ADDRESS 211 Stonybrook Way N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 7 Pearson's Craigway Estates 2nd SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Bruce Hein 211 Stonybrook Way N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Applied Roofing System Inc. 4575 West 77th Street, Edina, MN 55435 937-2529 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 8 DESCRIBE WORK Reroof Dwelling (28 Squares) 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be 2nd layer but not 3rd. Irstall ridged galvanized valleys. On all new roofs or teax-offs and replacement roofs, State Code requires that 2 layers of 15 Ib. felt, mopped together, be installed to a point 24 inches up from exterior wall line, or the use of othed approved underlayment membrane. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,400 $.70 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. $33.00 PLAN CHECK FEE TOTALFEE $33.70 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPER Y VALIpATED THIS IS YOUR PERMIT 18 9) SIGNATURE OF OWNER OF OWNER BUILDER) IDATEi BLDG WSP DA VE NEW ADDN I ] ALTER [ l Construction Address Legal Description:_ Owner Name & Address Contractor: APQ l ; e City of Fridley R-1 AND R-2 Building Permit Application .d1, , 191/ S Address: —JS Zs W ? 7� S+- e s EEfective 5/1/88 Tel., Tel.. # Attach o this application, a Certificate of Survey of the lot, wi, the proposoed construction drawn on it to scale. LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sg. Ft. DECK AREA: Length Width Hgt/Ground Sg. Ft. Corner Lot I ] Inside Lot [ l Ft. Yd Setback Side Yard Setbacks Type of Construction: le,,,u e 29,s,- Estimated Cost: $ b Approx. Completion Date: Alt. A Alt. B Proposed Driveway Width If New Opening.Is.Desired: $ Width + 6' See Back Page DATE: E -1-3-9S- ADPLIaM: _ n c-. h Tel. # OTY USE CHI,Y Permit Free State Surcharge SAC Charge Driveway Escrow Park Flee Sewer Main Charge TOTAL STIFULPSIONS: Fee Schedule on Reverse Side $ $.50/$1,000 Valuation $ '20 $550 per SAC Unit $ Alt. "A" or Alt. "B" Above $ Fee Determined by Engineering $ Agreement Necessary I ] Not Necessary I ] 3307® N Bruce M. Mari G. Hem OWNERS d?scrt• !n in deaf-rg with the land.. n L"'OAIVI*jS certificattrtie he S all5 � dcscrip. sheuidbe ex s tvritLQ herein, sCo., MINNE 4POL18 CITY OF FRIDLEY INSPECTION DIVISION d I Effective On January 1, 2001 6431 University Ave NE l ( o Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 763-572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS o�% S _CD12 E K Z'5 r 001'S' RATE SCHEDULE OWNER� ` _ A17 Residential 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) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $ // ` Uo BUILDING USED AS IKG� e- � ESTIMATED COST ®off PERMIT NO. $ 10.00 $ DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) �armAir) $ 10.00 $ Trade Name ��ids�L ®X (9Size No. Z` BTU -75-,UCDC HP EDR $ 25.00 $ Fuel /0a AYGie5' Total Connected Load Ir Burner Trade Name Size No. $ BTU HP EDR 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. $ .50 $ oo.&-D 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 l/�) —e �> HEATING CO 773 773 Sign TEL #763 Approved By / \.�:J— Rough -In Date Final IAND COMBUSTSD�I'AIR VERIDFICA�IONENT SIZE, VENT CONNECTORS I 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 0 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 draft appliances. Yes No ( ) assisted and natural The existing combustion air is sized and installed to meet the current codes Yes f No( ) and manufacturer's specifications. When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes � No( ) When installing a new venting system, the undersigned hereby verifies that it 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. YesK 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 O No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type A;Ilf–ky—lel BTU Input Fan Assisted or 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 It 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 in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date: 1 CCiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 February 28, 2003 Mr. Bruce Hein 211 Stonybrook Way NE Fridley, MN 55432 Re: Final Inspection at 211 Stonybrook Way NE Contractor: Peterson -Pinney Dear Mr. Hein: A mechanical permit was issued on September 7, 2001 to install a furnace at your address. According to the 1991 Uniform Mechanical Code a final inspection shall be conducted on the work authorized by this permit. As of this date the inspection has not been requested. The permit fee that was paid covers the inspection to make sure the work was completed according to the Codes. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will mark the permit "no inspection called for by homeowner after notification" and take no further action. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. Sincerely, DJlmh C sus,ECT MIT N O. City of Fridley 33547 AT THE TOP OF THE TWINS BUILDING PERMIT ` RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r � � NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 763-571-3450 910415 5/23/03 JOB ADDRESS 211 Stonybrook Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 7 Pearson's Craigway Estates 2nd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bruce Hein 211 Stonybrook Way NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO TJ Roofing Remodeling 50 118 Ave NE, Blaine, MN 55434 763-755-1444 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20271874 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW Ej ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Remove existing 12' x 26' Parch; Construct a 15' x 14' Deck 9 CHANGEOFUSEFROM TO $TIPULATIONS See notations on pian. AERATE PEO I` aRED F oWARNING P�,U I lNG A� G �� Before diggings call foir all utility locations 45.0002 qFMARED BY LAW SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 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 $2 6O8 $1 WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT .3O DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $83.25 Fire SC $2.60 STRU TI R THE PERFORMANCE OF ONSTRUCTION PLAN HECK FEE TOTALFEE a nse SC $5.00 $92.15 SIGNATURE OFC 'RACTO OR AUTHORIZED AGENT [DATE. WHEN PROPERLY VALIDATED THIS IS Y UR P RMIT BLDG iNSP I ri tF S-GNATURE OF OVVNEAoF OWNER BU4DERi iDATEi C NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION�� c � Construction Address: � � � S�O'n / ,� ✓'o o /C ,y Legal Description: � � �� Owner Name & Address: �'� v �e �� Tel. # Contractor. 7_f70 f707C7 Ali G e MN LICENSE #,,-2 Address: O 11f t" A Ala Tel.# 7G,,� 75-S 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 I Width Height I Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Lenge S ` Width % gt/Grou Sq. Ft. OTHER: Construction Type. Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ 0>77W7171_41�763 DATE: APPLICANT: Tel. # Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee $ 93,05 Fee Schedule on Reverse Side Fire Surcharge $ Q .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1275 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Curb Cut 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 $ BUR DING PERNUT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: TOTAL VALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 q $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $1,00,001 and up $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof CURB CUT ESCROW (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - driveway width plus 6 feet times $17.00. Permits for construction will be issued' a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. VERIFICATION OF FOUNDATION A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses 0nly `\ ENGINEERS AND SURVEYORS u.No +'UavevINo SOILS TESTING GIVII. 8i. MVNICIC►AL BNOINQERINd LINO PLANNIIVQ G418-SGTM AVENUE N. MINNEAPOLIS., 2T, MINN. �, > KE 'T- 3G37 rV4r jtblf AV . //1 �c=• 41 , Cdr .. SCALEIre- � J - / to ,� -;-E� NID ADD'N. Lr�-r BL �, . ��AP.�oN s �.�,IGvV."- ��'A WE itEREBY CERTIFY TART TW5 IS A TRUE AND CORRECT REPRESENTATION OF A SURYEY OF THE BOUNDARIES OF THE ! AND MOVE DESCRIBED AND OF TRE LOCATION OF ALL WILMNGS, IF AMY, TNEREON , N14D Ali.• vISIBLE ENCROACHMENTS, -._L,F A.NY' FqOtA CPL ON SAID LAND. MINDER ENGlt4F-E(ZING CO.,INC.- CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 kAX: (763) 571-12137 ADDRESS : 211 STONYBROOK WAY NE PIN : 103024120067 LEGAL DESC : PEARSONS CRAIGWAY ESTATES 2 : LOT 12 BLOCK 7 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 200400610,14 'D3 DATE ISSUED: 04/29/2004 VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. BURY ELECTRICAL LINE APPLICANT HEIN BRUCE M & MARILYN G 211 STONYBROOK WAY NE FRIDLEY, MN 55432 CII`.'/�I Di HEIN BRUCE M & MARILYN G 211 STONYBROOK WAY NE FRIDLEY, MN 55432 ELEC AMP SERVICE FEE ELECTRIC FORM FEE STATE SURCHARGE, ELEC FLAT TOTAL 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 worl 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. Applicant Date Bldg Insp Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 30.00 1.00 0.50 31.50 90q-05 ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIA 1.S: (USING THE 1997 JX.0 FEE SCHEDULE) TOTAL JOB V Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due See Back Page for Fee Schedule BUILDING Permit Bio. c7 �X�l Building .001 times the total job valuation $ ��. j .0005 x Permit Valuation Minimum $.50 $ 5, U-0 $5.00 (State Licensed Residential Contractors) Inspections $1550 per SAC Unit (Plans to MWCC for determinati , t) RESIDENTIAL APPLICATION Receiv d By: 763-572-3604 $450 Conservation Plan Review CITY OF FR.IDLEY Date R e'd: DATE 5NICC YOUR E-MAIL ADDRESS SITE ADDRESS eC I I chikY1ei�— Mabe checks payable to: City of Fridley Al t ich THIS APPLICANT IS: OWNER ;bNTRA TOR / v-1- PROPERTY OWNER/ NAME; Mar' —_ ADDRESS: CITY _ST TE __-ZIP-- TENANT PHONE:o CONTRACTOR NAME; Aawiural eana-r: )%/b — — _— SUBMIT A COPY OF STATE LICENSE # .� U. -p- iCg EXP DATE ,i --LI 0 A -7 ADDRESS:S411/7 lnemari& 4e. /V CITY_ STATW&kIP TY YOUR STATE LICENSE _ WITH APPLICATION PHONE (K- FAX fnS'/• � � • ® _ -- —._. 0 SINGLE FAMILY/NEW CONSTRUCTION SIZE PROPERTY TYPE CI TWO FAMILY/NEW CONSTRUCTION STORIES _ PERMIT TYPE CI ADDITION Cl GARAGE/SHED Cl WINDOWS 0 BASEMENT FINISH OOF CI DRAIN TILE ❑ DECK ❑ SIDING O OTHER CI SWIMMING POOL _ TYPE OF WORK: 0 C3 ADDITION ENANCEIREPAIR MODELING _ - DESCRIBE WORK BEING DONE: T k- - SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT_ Sq. Ft. ROOFING NUMBER OF SQUARES CI HOUSE ONLY 0 HOUSE & GARAGE BASEMENT REMODEL' G SUBMIT: 1. Existing Floor ; to GARAGES 0 ATTACHED GARAGE 2. Proposed floor • an PROPOSED SIZE: 13DETACHED GARAGE 3. List of siructur, � members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCT tN INCLUDING DECKS, CI Vinyl Eisoffit ADDITIONS & PORCILF ` S_ II B_MM. CI Aluminum O Trim I . Site Plan/Surve showing the existing structures CI Other 0 Fascia and proposed p ; ject. 2. Two sets of cot - ruction plans WINDOWS 3. Energy Calcula ; ms IN EXISTING OPENINGS CIYes CINo LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIA 1.S: (USING THE 1997 JX.0 FEE SCHEDULE) TOTAL JOB V Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due 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: hat the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; the' 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 acc, ,, dance with the approved plan in the case of all work Mch r�quuiires review d a Pr val of plans. �Q SIGNATURE OF APPLICANT )MA y `� � PRINT NAME ( VT [ �X � I jViC` ATE__ _ See Back Page for Fee Schedule $ 65% of Building Permit Fee $ .001 times the total job valuation $ ��. j .0005 x Permit Valuation Minimum $.50 $ 5, U-0 $5.00 (State Licensed Residential Contractors) $ $1550 per SAC Unit (Plans to MWCC for determinati , t) $ ft+6ft= ftx$21 =$- $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ qzt Mabe checks payable to: City of Fridley Al t ich 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: hat the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; the' 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 acc, ,, dance with the approved plan in the case of all work Mch r�quuiires review d a Pr val of plans. �Q SIGNATURE OF APPLICANT )MA y `� � PRINT NAME ( VT [ �X � I jViC` ATE__ _ Building MECHANICAL Permit No. Inspections RESIDENTIAL APPLICATION Received ByJAAL- 763-572-3604 CITY OF FRIDLEY Dat d: 763-502-4977 FAX 1-1-08 EFFECTIVE DATE A[ I ` N- Y UR E-MAIL ADDRESS SITE ADDRES %. Oe Ad THIS APPLICANT IS: ❑ OWNER )ICONTRACTOR PROPERTY NAME: P. , OWNER/ADDRESS: CITY STATE ZIP TENANT PHONE: CONTRACTOR COMPANY NAME: NOTE: SEPARATE CITY CONTACT PERSON:LICENSES 7TE STATE LICENSE # O X EX�+REQUIRED C ARE FOR GAS Y STA F�ZIP J ADDRESS: — AND HVAC. SUBMIT COPY OF BOND PHONE ' �' FAX ANDINSURANCE PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW REPLACEMENT ❑ ALTERATION/REMODEL IE 3 DETAILED DES RIPTION OF WORK tSC 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 ) OR 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: Qof MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU MFG: MODEL: SIZEBTU XA/C $25.00 (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 _CHIMNEY LINER $10.00 —GAS DRYER $10.00 POOL HEATER $35.00 T $ 00 OR IS VE ILA WORK $10.00 PIPING $1000NT _DUCT _GAS �. Permit Fee $ Number of fixtures @ $10.00 x $10.00 $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ aOR Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 MINIMUM $15.50 MINIMUM $15.50 Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a mechanical 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 wit4 the ap roved plan in the case of all work which requires review approval of plans. SIGNATURE OF APPLICANT PRINT NADATE APPROVED BY DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 City of Fridley Residential Mechanical Application Page 2 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APDL CAU0, N HVAC..- ❑ NEW HOMES/ADDITIONS ❑ EXISTINaHOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. I IMC Chapter 5 with MN Amendments. n 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new construction IMC 1346.0312 5. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make-up air calculations. Building V610 BUILDING $ 4 5 7 g Permit No.. $ Fire Surcharge $, Surcharge , Inspections $ RESIDENTIAL APPLICATI Rptlyd 763-572-3604 $ Erosion Control $ Park Fee $ Sewer Main Charge CITY F FRIDLEY Total Due Date o'd 763-502-4977 FAX EFFECTIVE 1-I-2010 DATE ° I YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: OWNER CONTRACTOR PROPERTY OWNER/ NAME: ADDRESS:Q11'. pa -y AiP3(i CITY ' STA ZIP TENANT PHONE: CONTRACTOR NAME: ,o U G 10 • ac SUBMIT A COPY OF DATE YOUR STATE LICENSE STATE LICENSE # EXP AND CERTIFICATE OF ADDRESS:M92 CITYS �P STATEZIPJMj�6 INSURANCE, Abla FAX PHONE 6M-�gt�- -� PROPERTY TYPE ✓ INGLE FAMILIM40V CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑EW HOME CONSTRUCTION ❑ ADDITION )LLMAINTENANCE'REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING p HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ADDITIONS. & PORCHES SUBMIT: ❑ Vinyl ❑Soffit 1. Site Plan/Survey showing the existing structures ❑ Aluminum ❑ Trim and proposed project. ❑ Other ❑ Fascia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes []No LOCATION OF WINDOWS FOR WINDOWS – PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ V610 Permit Fee $ 4 5 7 g Plan Review $ Fire Surcharge $, Surcharge $ LJ'(*' — License Surcharge $ SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ Total Due $ i i r_ 0)— S ANCY See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $2100 per SAC Unit (Plans to MWCC for determination) —ft +6ft= ftx$24=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach 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 on site; that the work will be in accordance with the approved plan in the case of 01 work which requires review and approval of plans. SIGNATURE OF APPLICANT J/ ili_ PRINT NAMEd��✓�J�`/!►.�/ 9 Page 2 - Building Residential Application BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: TOTAL VALUE FEES $1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge) $501 to $2,000 $23,50 for 1' $500 plus $3.05 for each additional $100 or fraction, to and including $2,000 $2,001 to $25,000 $69.25 for 1' $2,000 plus $14 for each additional $1,000 or fraction, to and including $$25,000 $25,001 to $50,000 $391.25 -for 1"` $25,000 plus $10.10 for each additional $1,000 or fraction, to and including $50,000 $50,001 to $100,000 $643.75 for V $50,000 plus $7 for each additional $1,000 or fraction to and including $100,000 $100,001 to $500,000 $993.75 for 1' $100,000 plus $5.60 for each additional $1,000 or fraction to and including $500,000 $500,001 to $1,000,000 $3,233.75 for the 1' $500,000 plus $4.75 for each additional $1,000 or fraction to and including $1,000,000 $1,000,001 and up $5,608.75 for the I' $1,000,000 plus $3.15 for each additional $1,000 or fraction VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Only City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 Building Inspections 763-572-3604 763-502-4977 FAX DATE f � - I ` K) SITE ADDRESS 3A t I THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND CERTIFICATE OF INSURANCE PERMIT TYPE PLUMBING .RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 7-1-2010 YOUR E-MAIL ADDRESS 0 OWNER (VCONTRACTOR 3: , t l S vis (drs� c NAME: (5®b STATE LICENSE # C GO0 CD( ` M STATE BOND # N k., 0 - L-3 0(� Permit No,(n --() I] z Received By: Date Rec'd• U All" J6 e -^a STATE i��IP SSKSZ EXP DATE 9 )L" 31 " 2_01 O EXP DATE 1 2 -3 1 - �-'Q O ADDRESS: �CJ &A'C ,S-rL� D®OL$I CITYSTATE,,AA±ZIP PHONE 6 ( 2 - S' "C'3 ! -- ! _? S-� FAX TYPE OF WORK: I 0 NEW FAMILY 0 TWO FAMILY 0 TOWNHOUSE DETAILED DESCRIPTION OF WORK #REPLACEMENT D-;-- vv'eo // "?, 0 L/ e— • '5 Hc cd C -P, — FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $35.50. _ BATH SINK/LAV _FLOOR DRAINS _ SHOWER WATER PIPING —BATHTUB _ GAS PIPING (NEED CITY LIC) _ SWIMMING POOL _ _ WATER SOFTNER ($35) —CLOTHES WASHER _ KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15) _ DISHWASHER _ LAUNDRY TRAY _ HEATER ($35) FOR IRRIGATION j _WATER _ WATER METER —OTHER 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 s all /or' qu review and approvAl of plans. SIGNATURE OF APPLICANT PRINT NAME a % Com" A� ► ( DATE APPROVAL INSPECTORS SIGNATURE ®'P �_ City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977