Loading...
PRE 2010 DOCS0 Village ®f Fridley, Minn. BUMI)ING PERMIT N? 1772 Date: h ... .% ..:_ .........j f Owner....................................... Address...................................... Builder Address ......° �a �. .......i! ......... LOCATION OF BUILDING No. ..�..... Street ... � ./- a e� ft... v g:....... Part of Lot ......... .. .. ........... . Lot .... �3........ Block ...... ........ Addition or Sub -Division .. SA A,- ! ^!!/'1 11? dY . !4,' ................ . Corner Lot ........... Inside Lot ........... Setback .. Sideyard ..-�- e ...................... DESCRIPTION OF BUILDING To be Used as: ✓ ®,�' J.°-/' . .. Front.. Depth Height . .. Sq. Ft. - .. Cu. Ft. ........ ..................... Front ........ Depth ........ Height ...... Sq. Ft. ........ Cu. Ft. ........ Type of Construction ...... Est. Cost .. ............. To be Completed .................. In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the village of Fridley. ..................................................... In consideration of the payment of a fee of permit is hereby granted to f. i. °�!,:�...... � "d'17 to construct the building or addition as described above. This permit is granted upon /the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- ;, . in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. ............ ...•. �� �� ... Building Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. Date: July 2, 1965 Owner: Vernon Fredin Builder Address -129 Ventura. Avenue N. E. Address N° 8102 t Vernon Fredin 129 Ventura Ave. N. E. LOCATION OF BUILDING No. ��9 Street Ventura Avenue N. E. Part of Lot Lot 1,_ _ __ Block 5 Addition or Sub -Division Ca. Aron Sumit Kmor Corner Lot Inside Lot Setback Sideyard Sewer Elevation ` Foundation Elevation DESCRIPTION OF BUILDING To be Used as: House rebuild Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. n Type of Construction Est. Cost $5,880.00 _ To be Completed Storm dsmage: rebuild In consideration of the issuance to me of a permit to construct the building described above I agree to do the propoxd work in accordance with the description above set forth and in compliance with all provisions of ordinanoas of the city of Fridley. In consideration of the payment of a fee of $ 10, 00 , permit is hereby granted to Vernon Fredin to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work. done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings withinor� city limits and this permit may be revoked at any time upon violation of any of the provisions of said Allen Jensen Building Inspector NOTICE: TIS permit doss not serer the soeafrucAm, fnmtaffWae for wiring, phm hlee, gee heetlsg, sewer or wdw. 8s are to we the Wding isspester for sepwdo pmWft for these items. A APPLICATION FORING PE PIM CITY OF FRIDLry, , NNESOTA OWNER ` S NAME �7 / , '� . 6 a/1.4BUILDER ADDRESS . ADDRESS h LOCATION oF' B f ING NoyStreet // " "., /s4`' Pa X; of Lot Lot- ? Block Addit.ioat or Subdivision, ( 13 Corner Lot Inside i,otet k Side =Yard SEWER ELXVATI¢N FOUNDATION ELE�Al'ION Applic.pt attach to thin form, Two Certificates of Survey of Lot and proposed-build— ing; roposed build-ing location drAwn on .these Cirtificates . DESCRIPTION OF BOILDING Tsar be, — se As •° groat Depth Height , Sq, Ft. Cu. Ft. _,Front Depth Height Sq. Ft. Cu. Ft. Type of Construction A\ Estimated Cost _ The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work iit strict accordance with the City of Fridley Ordinances and rulings 0 the Department -of Buildings, and hereby declares that all.the ftcts and representations stated in this application are true and correct. _Ochedulzlof Fee Costs can be found on the Reverse Side). F BIVILDIM PERMIT FEE S Section 2. The Inspector of Buildings so�ill, f6ra issui4g any permit for the erection of any building or structure, •or' or any add,itiV to any exist - Ing building or structure, or for.any A&teratt "&,t- i`repa1rO to any existing buildipg or structure, upon applicat;l;ba met;e r, tegviie the pa"out by the applicant for such permit of fees -to the amour •hereia- below. set 'forth -and in the manner herein provided to -wit: For any ouch permit for the eregttofi-4�*` y firepSprq�vf butxdipg, other ,�;F--toa a garAges .. warehouse, factory . or. min' Oej.. ., for the ex tion, of Any .fire-p3mof addition,. for. Oi%1laV'b.%UPanCy, tb: aq exi iati(1i buil- Shall be at the rate of $1.40 for Bash. t And ewbie feet, or•fr4a" ..:thereof, in such cubical conteas. an 2.2.. For any such permit :fe?,:.the -erection of..,a`y firerproof mac ory or grain elevator, or fnw•the erection anyt-fi&.tt Y a for lar.occupancy to. am exiet>i ' n a ldi g shall -'be at- t `e �»=f tach one .thousand cubic .feetv'..classified -As Pfirep f" by-. S, the-.Minaeap�t,�,3.ra...gu��d3•tl$- C�ia�+.�nr�:., •• ':. HOUSES 2gra:. Fdr any such permit for the erection of• than a garage, warehouse, factory or, grain ele addition, for simildr ocoupeucy, to any e&iat each •one thougaiat) •C460. feet.,, ,GARAGES 2A. For any such permit for the erection o4th i warehouse, factory or grain elevator, or for a�i�r---€oi similar' occupancy, t© any exist or addition - ninety cents ($0.90) f or f�setion thereof, in the cubical• contents. the For the purpose of computing fees for building of any building or addition to a unifo height ground area tovered.from a point six (j cache basement or cellar to the average hei t of the average height of the roof surface of the main g . 2,2.5. •_ For repairs or alterations to an existidS ...at the rate of $3.00 per each Five guadred• Doll' thereof in the cost.,'bf:all proposed work, 2.to no case shall ' the .Sectieu...2 'be .less_ y► non-firep f building tar,' br any Ston• -fief' 'bui:EdU4 - pezmi.t $1.:00 for ky non -fireproof garage, erection of. any noa•firaprm.r, building tr for each such tach one thousand cubic feet •eof with a minimum :of $4.0QL.-- Xmits, the. cubical crt:itentr' hroug'hoot .* multiplying the �.- elow the floor line 'of -087I.- . pper surface -or to -the ble of a, f4tched roof. tructui. 'Oke fete sWl►1 b9`," = : set ' fb t'th In J City of * Fridley, mn BURDING PERMIT Date: July 7s 1965 Owner: Vernan Fredin Builder Address 129 Ventura Ave. I.E. Address LOCATION OF BUILDING No. Street Part of Lot Lot _ Block Addition or Sub -Division Corner Lot Inside Lot Setback — Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Det. Ga*VM 241 _ Depth 221 Height 101 Sq. Ft. ca. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction frame Est. Cost — 1020 _ To be Completed Au'. 5,71-9-637 In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 4.00 , permit is hereby granted to V ernan Frees to construct the building or addition as described above. This permit is granted upon the express condition that the peon to whom it is granted and his agents, employees and workmen, in all work. done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. NOTICE: Tide permit doss not sorer the sondtroation, IndaMon for whfng, p1 mhhng, gas heating, sewer or water. Bo win to an the Badding Mgmter for separate pwoft for thele item. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME BUILDER ADDRESS., tf:F7p c �ADDRESS LOCATION OF BUILDING NO. STREET PART OF LOT LOT BLOCK ADDITION OR SUBDIVISION CORNER LOT INSIDE LOT SETBACK SIDE -YARD SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates'of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as;.��, B D Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction .-rr_ Estimated Cost To be completed The undersigned hereby makes application fora ,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. DATE, SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side)., r � W BUILDING PERMIT FEE SCHEDULE SECTION 2; The Inspector of Buildings shall, before issuing any permit for the erection of auy,building or structure�."br 'for any addition to any existing building or structures or for anyalterations 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 hereinbelow set .forth. and in the manner herein provided to -wit: 2.1. . For any such permit for the erection of any fire -proof building, other than a garage, warehouse, factory or grain elevator, or for the erection of any fire -proof addition, for similar occupancy, to any existing building, shall be at the rate of $1.40 for each one thousand cubic feet, or fraction thereof, in such cubical contents. 2.2 For any such permit for the erection of any fire -proof garage,, warehouse, factory or grain elevator, or for the erection of any fire -proof addition, for similar occupancy, to any existing building shall be at the rate of $1.25 for each one'thousaud cubic feet, classified.as,-"fireproofQ1 by Section 502 of the Minneapolis Building Code. HOUSES 2.3. For any such permit for .the erection of any non -fireproof building, other than a garage, warehouse, factory or grain elevator, or any non -fireproof addition, for similar occupancy, to any existing,building » permit $1.00 for each one thousand cubic feet. GARAGES ' ' 2.4. For any such permit for the erection of any non -fireproof garage, warehouse, factory or grain elevator, or for the erection of any non -fire -proof addition, for similar occupancy, to any existing building or for each such building or addition - ninety cents ($0.90) for each one thousand cubic feet or fraction thereof, in the cubical contents thereof with the minimum of $4.00. For the purpose -of computing fees for building permits, the cubical contents of any building or addition to a uniform height throughout by multiplying the, ground area covered from a point six (6) -inches below the floor line of the basement or cellar to the average height of the upper surface or to the average height of the, roof surface of the main gable of a pitched roof. 21.5. For repairs or alterations to'an existing structure, the fee shall be at the rate of $3.00 per each rive`Hundred Dollars ($500.00) or fraction thereof in'the cost of all proposed wotk. 2_6. In no case shall the fee charged for any permit as set forth in Section 2 be less than $4.00. STORM REPAIR DAMAGE FEES: Residential: Estimated Cost of work up to $500.00 - $5.00 Estimated Cost of work over $500.00 - $10.00 Commercial; Estimated --ist of work -up --to $500.00 - $10 -1 Estimated st of work over $500.00 - $20F - City of Fridley, Minn. WELDING PERMIT N® 3357 C ' �. Date: ... ... .... ..... Owner ......... Builder .......:.............................. Address ...... Address ............................................. LOCATION OF BUILDING No. ��e' . �....... Street . ...fid .... .... Part of Lot ....... ...... . Lot Block ....... ........... Addition or Sub -Division Corner Lot ............ Inside Lot ... ..... Setback ............ Sideyard ........................... DESCRIPTION OF BUILDING To be Used as: ., o elf a ....... From V 0 -! ...... Depth .: ® Height ./ .. Sq. Ft. $/�/o cu. Ft. . . Y.0-0 .................... Front ........ Depth..:. , ... Height ........ Sq. Ft......... Cu. Ft. ........ IType of Construction ................... But. Cost. I.CM. ..... To be Completed ................... In consideration of the issuance to me of a permit to construct the building desribed above, I agree. to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of . !d.. .., permit is hereby granted to ................... f ......................... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it Is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the city limits and this permit may be revoked at any time upon violation of of the provisions of said ordinances. ... .............. Building Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Item& 97-8h-9915051 APPLICATION OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE.SCHEDULE PLUMBING FIXTURE RATES: NO. RATE w Number Fixtures ro $3.00 o Future Fixture Opening x d $ water x $2.00 $ w x $5.00 $ Water Heater - to 99,000 BTU x $5.00 $ 100;000 BTU to 199,000 BTU x $10.00 $ Water Softener Heater $7.00 $ •wl x $5.00 $ E+ C L $5.00 $ GAS FITTING FEES: d 1st 3 fixtures x $3.00 $ Additional Fixtures x $1.00 G w x , $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction 0- J T C .0 ••i $ .50 TOTAL FEE G 3 S �Vi 'w 1.7 w N w .0 fd 0 as lec cn U a m r cn !n FS - U 1St CO 1 e 474 2nd 3rd 4 th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water PARTIAL RATE.SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $3.00 $ Future Fixture Opening X $2.00 $ New Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU x $5.00 $ 100;000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ New Ground lawn Old Building x $5.00 $ Electric Water Heater - x $5.00 $ GAS FITTING FEES: 1st 3 fixtures x $3.00 $ Additional Fixtures x $1.00 $ .Gas Range to 199,000 BTU x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ 8.00 REINSPECTION FEE ($30.00) n Job Address 12'9 VENTURA AVE. ,? Department of Buildings City of Fridley Tel. #571-3450 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 correc Fridley, Mn. 1-11-77 19 OWNER RICHAID - JOACHIM KIND OF BUILDING frame USED AS res. TO BE COMPLETED ABOUT 1-18-77 ESTIMATED COST 10.00 OLD - NEW BUILDING PERMIT NO. PERMIT NO. 261 V Company a i Y Signed By MINNECASN Tel. No. ROUGH INSP. Date FINAL INSP. 6 `; y " ( L Date APPROVAL FOR PERMIT s J MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 199S 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES , JOB ADDRESS 1 Aq V rA f A.Ira_ A� RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner — rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 20.00 $ representations stated In this application are true and correct. (Side Vent — Fill Out Back) .._..Pl 91. Gas Piping (Needed with new furnace) $10.00 Gas Range $10.00 $ () W BUILDING USED AS Gas Dryer $10.00 $ ESTIMATED COST j 231 ., PERMIT NO. *Air Conditioning — All Sizes $10.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/ lepairs & Alterations (LIST ON BACK 1 % of Value of Appliance or Work $ No. of Heating Units! Circle One (Steam) (Hot Water)(Warm Air) Trade Name rni-y6I Size No. Commercial/industrial BTU —1615, Mo HP EDR I% of Value of Appliance or Work $ Fuel NA -4- Q Q,S Total Connected Load State Surcharge $ ®5500 Burner Trade Name Size No. �9r, BTU HP EDR TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATiON REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 A *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. 6-pcm� ckoui Aard) Approved By Rough—In Date Final Date y dr Y '� FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE NOTE: #1 through #8 required when using a side vent furnace. The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes( } No ( ) 2. Is free from rust or deterioration t 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 ? a/G-V C.-) TOTAL BTU's / e- 71 e,, , c-) 7. Has a liner been provided for water heater Yes(A No ( ) 8. Has combustion air been provided for water heater Yes (-,-) No ( ) Remarks: HEATING CO: Signed By: Date: l SUBJECY c P City ®f Fridley 30471 AT THE TOP OF THE TWINS BUILDING PERMIT R EIPT NO. ` COMMUNITY DEVELOPMENT DIY. INSPECTION SEC. —7 (•C/ / r � � PROTECTIVE K®"/ CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY L 612-571-3450 910415 11/3/99 JOB ADDRESS 129 Ventura Avenue 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 5 Carlsons Summit Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jeff Cramble 571-3091 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Advance Alum. Supply Inc. 7701 Main S571 -A440 7983 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION 0 ALTERATION X® REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house (15 Sq.) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Permit Inspecti®n Care Will Be Mailed '100 Homeowner To Post 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 80 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $1311 $.66 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 $50.95 Fire SC $1.31 PLAN CHECK FEE TOT FEE Licens-Sr 5.0 .92 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDAYEi ENfPROP VALID HIS IS YOUR PER s 10 B G WSP OArE S-GNATURE OF OWNER,1F OWNER BUILDERI IDATEI l itir: l J ADN [ AL C l a 612 571 2260 l ADVANCE ALUMINUM CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION 0 01 Efjfective 1/1/98 4e Lega Description: U Owner Name & Address: -Tel. # r Con actor: /Jl.�igi�-c,.� [.v�'��v� dP.v4 �-LICENSE# Addr ss: 7 7d 1 A op iN Tel. # S /~- 3 Y a Attach to this application, .a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Co DA Permit Fire St State S SAC C Park] Sewer DESCRIPTION OF IMPROVEMENT 3 AREA: Length Width .�. Height Sq. Ft. 3E AREA: Length Width Height Sq. Ft. AREA: Length �Width Hgt/Ground Sq. Fr. etion Type:_f(�y:-���jYryk M6Lte Fstimated Cost: (Fee Schedule on Back) Ly Curb Cut Width Needed: Ft. + 6 I=t = Ft x $ _ $ APPLICANT: Tel. # CITY USE ONLY ?ee $ (,62,�— charge rcharge $ arge $ Surcharge $ y Escrow $ Control $ lain Charge $ Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary ( , 4v -vv t i ADDN [) ALTER [ j Construction Addr Legal Description: Owner Name & Ai Contractor: _ LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Driveway Curb Cut DATE: V 19J US._ Call (763) 572-3604 you for card numb Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surchan Curb Cut Escror Erosion Control Park'Fee Sewer Main Cha TOTAL 6431 University Ave NE, Fridley, MN 55432 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION �v�� OS (763) 572-3604 Bldg Insp (763) 571-1287 Fax C C� 6�.v1\ Tel. #f� MN LICENSE # Tel. # 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 Sq. Ft. Length Width Height Sq. Ft Length Width Hgt/Ground Sq. Ft c -\ CA , \J� l \?-,� � C V -S e ated Cost: $ G.10 OCA Needed: Ft + 6 Ft = Ft x $ _ $ APPLICANT: eves � Cf Tel. #(17-6 7�/ "`- x'`71 Permit Fees if mailing in application. Fax to 763-571.1287 if using credit card and we will call CITY USE ONLY - $ Fee Schedule on Reverse Side $ 65% of Permit Fee` .001 of Permit Valuation (1/10th%o) $:50/$1,000 Valuation $ $1,50. per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering e- $ Agreement Necessary [ ] Not Necessary [ $ . STIPULATIONS: BUILDING PERMIT FEE SCHEDULE The Chief Building Oficial shall, before issuing permits for the erection of any building or structure, or for addition to any existing building or structure, or for any alteration or repair to any existing building structure, upon application therefore, require the payment by the applicant for such permit of fees to the amc herein below ;set forth and in the manner herein provided to -wit: TOTAL VALUE FEES $1 to $500 $23.50 $501 to $2,000 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 - $391.25 for first $25,000 plus $10.10 for each additional $1,000 _ or fraction thereof, to and including $50,000 $50,001 to $100,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 to $500,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $500,001 to $1,000,000 $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 $1,000,001 and up $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof CURB CUT ESCROW (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determine( rate Permits for construction will be issued a minimum of 24 hours from the time of application to allow for prope review of the proposed structure and of the construction site. VERIFICATION OF FOUNDATION A Certificate of Survey of the lot, showing the location of the existing foundation will be required befor proceeding with the framing. New Houses Only 3uilding BUILDING Pern-At No. • - �4_'/ Inspections RESIDENTIAL APPLICATION Received : 763-572-3604 CITY OF FRIDLEY Date Recdd: )ATE iM/ W /btA YOUR E-MAIL ADDRESS JTEADDRESS Int 11 eVAvcCt NIM- TIM I 'HIS APPLICANT IS: i$OWNER ❑CONTRACTOR PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION ADDRESS. I I4t U e-0 +U --C Q M Q CITY. ,,..­ /''W _ 71 C- 7 ) ? rr e72 1 STATE LICENSE EXP DATE TEAp/ZIP 5_S�C z I ADDRESS: CITY STATE ZIP PROPERTY TYPE 12 -SINGLE FAMILY/NEW ❑ TWO FAMILY/NEW CC PERMIT TYPE ❑ ADDITION U UAKAUWS iW u wuNLury ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING 0A �A VK— DESCRIBE WORK BEING DONE: t,2- 6ex& d- iA-tel �- SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other LENGTH WIDTH HEIGHT Sq. Ft. ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE 19 DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS, & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ONo 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 MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ SS, —10 See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ , .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ Make checks payable to: City of Fridley Attach Stipulations 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 wo k is not to start without a permit; that the work will be in accordance with the approved plan in the case of all wok ch regi( es view d approval of plans. VG�SIGNATURE OF APPLIC 'PRINTNAME 0 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 1"` $50,000 plus $7 for each additional $1,000 or fraction to and including $100,000 $100,001 to $500,000 $993.75 for l- $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 ls'$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 BUILDING Permit No.:-� Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604CITY OF FRIDLEY Date Rec'd:_ DATE54P /—Ob-- IL YOUR E-MAADDRESS SITE ADDRESS i9q \P—+" rim._. N �- THIS APPLICANT IS: ' IaOWNER ❑CONTRACTOR PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION ADDRESS: 12,0,���� ��— CITY fit` i JL4 STATEfftZIP G 2l PHONE:(,R)STI — 309 1 STATE LICENSE EXP DATE ADDRESS: CITY ATE ZIP PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE: 9--7. 5- ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE Fire Surcharge ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION 1. `� 3 ❑ MAINTENANQVREPAIR ❑ REMODELING License Surcharge DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft, OQ NUMBER OF SQUARES GARAGES PROPOSED SIZE:_ PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS, &PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF W ]SOWS r OR FOR NEW OPENINGS -DESCRIBE ((QQ'' OPENING CHANGES &?-DE TYPE OF WINDOW TO BE INSTA 3 ER OF WINDOWS ALL FEES ARE BASED ON V CLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ 9--7. 5- See Back Page for Fee Schedule Plan Review 65% of Building Permit Fee Fire Surcharge 001 times the total job valuation Surcharge $ 1. `� 3 .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ / fJ Make checks payable to: City of Fridley Attach Stipulations 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 whic. rewires eview and approval of plans. 1111 ,�A r:, ..v SIGNATURE OF APPLICANT` ��'�✓�11 VJ" PRINT NAME �— ` rOLI-^" DATE_✓ 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 1s` $2,000 plus $14 for each additional $1,000 or fraction, to and including $$25,000 $25,001 to $50,000 $391.25 for 10 $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 1" $50,000 plus $7 for each additional $1,000 or fraction to and including $100,000 $100,001 to $500,000 $993.75 for l- $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 1s` $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 1- $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 1 1-4 2- - I r Z 6T n 455 2.,x Ix I? I Ir .10 17 1 LO INDUSTRIAL C. E. COULTER PLATTING SUSINEse /Aar wavers GIrY L07>� LAND SURVEYOR LAK[[NORt rr �I+�I/A►►IN6 REGISTERED UNDER LAWS OF STATE OR MINNESOTA JUDICIAL • LICENSED Or ORDMANCt Of CITY O/ MINNeA►OLW 3300 LYNDALE AVE. SO. MINNEAPOLIS B. MINN. Nf LOCUST 0370 It f?1tYorgas"m (IrrutuittP Ira 5calct J I hereby certify that the Abov e i a a true and correct plat of a survey of: Lot Three (3), Block Five (c'), C—AaSON1:3 MMIT MAMR NGRTH AMMON, Anoka Ccunty, Minnesota As surveyed by me this 9th day of January 1956 A. D. Signed C1 ZA_- f.Lr t Mnnesota Registration No. 2581 Building BUILDING Permit No.:9'0l O (M Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY r 763-502-4977 FAX EFFECTIVE 1-1-2010 DATE • YOUR E-MAIL ADDRESS ® Ct. o® • SITE ADDRESS �� �.YI �'� e���� THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: Chi- 01�1n� o=-Pk4 TENANT ADDRESS: J Z cl 6!c -el% CITY i e- STATEAk-uIP PHONE: Z63 s71- 30? r CONTRACTOR NAME: et0`(-- it e r" n _5 A `.-:�-- SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # Q ® G EXP DATE D � I / AND CERTIFICATE OF ADDRESS: 30 5�3 `" _ CITY MW— STATE 04ZT INSURANCE PHONE 6 % Z •- -' e2 ^ 47 79-1 FAX 76 — '71a-1162 PROPERTY TYPE KSINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR REMODELING . DESCRIBE WORK BEING DONE: r tc rwt aft 51 W 45 c lbel.6 ok -Th /P - SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING NUMBER OF SQUARES ❑ HOUSE ONLY ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 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: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project 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) COTAL JOB VALUATION $ Z Q 6. — OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ 13("/1CO See Back Page for Fee Schedule $ d 5I 65% of Building Permit Fee $ �% (�_ .001 times the total job valuation $ 7250 .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 ( ) $ r Make checks oavable to: Citv of Fridlev 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 o%����alll w whit quires review and approval of plans. l SIGNATURE OF APPLICANT 1li6�,� PRINT NAME 6i!/ 1i �'l DATE " j 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 l' $2,000 plus $14 for each additional $1,000 or fraction, to and including $$25,000 $25,001 to $50,000 $391.25 for 1s` $25,000 plus $10.10 for each additional $1,000 or fraction, to and inc!uft $50,000 $50,001 to $100,000 $643.75 for 1"` $50,000 plus $7 for each additional $1,000 or fraction to and including $100,000 $100,001 to $500,000 $993.75 for 1s` $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 1' $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 srwse5r7� E'q�:P� C.LJlJOA3S R3t0 ° l� Te4a� g� t42kYZL"Al,d�,`� vvt i �► 117�A t 4:izI w a j 064s" vc m ."Oea*A F Za- c'.o fz6ohj s+ -k V40kE D 5igfow �o `ki des 1 _( N �G ins c p� WCCA4r �, e _ From: 651+439 2720 , Project Location: Uniformly Loaded Floor Beam 2 Uniformly Loaded Floor Beam [2006 International Building Ccde(2005 NDa')1 (3j#3 IN x 7z IN -x 6:75 -FT 02 - TMpruae-PIne-Flr - Dry Use Section Adequate ey: 10.60/9 PaOe:Y1/1 . , , Date: 15/4/2010 11:28:38 AM �CAUJION . Laminations are to be fully connected to provide uniform transfer of Ioade to i ELECTIONS Cenier Lure Load 0.11 IN L172.3 Iliad Load 0.04 In Total Load 0.15 IN U551 Live Load Deflectlon Creeds: Ll4a0 Total Load DeflectIon Criteria: U360 REACTIONS Live Load 1620 Ib 1620 Ib Dead Load SW Ib508 lb Total Load [2126 lb 11 2128' lb Bearing Length 1.11 in 1.11 in BEAM DATA Center Span Length 6.76 ft Unbraced Length -Top 0 ft Floor Duration Factor 1.00 Notch Depth 0.00 MATERIAL PROPERTW #2 - 8pruce-Pine-Fir Bending Stress: Base Fb = Values 876 pal Fb' = 1208 pal 38.42 in3 07.00 CFd7.20 Cr=7.15 32.63 fn2 Shear Stress: Fv = 136 psi Fv' = 135 psi 3967ft-lb Cr>=i.0o -1786 lb 2936 lb a pif Modulus of Elasticity, En 1400 ksi IT = 1400 ksi Min. Mod. of Elasticity: E_min = 610 ksl E_min' = 510 ksl Comp. -I- to Grain: Fr ---L- 426 psi Fo -1' = 425 pal Controlling Moment: 3586 &lb 3.375 ft from left support Created by combining all dead and Ove loads. Controlling Shear: -1788 lb At a distance d from support. Gated by combining all dead and live loads. Comparisons with required Sections: Read Provided Section Modulus: 35.66 in3 38.42 in3 Area (Shear): 19.84 fn2 32.63 fn2 Moment of Inertia (detier21on): 94.88 fn4 142.9 im Moment 3588 ft -lb 3967ft-lb Shear. -1786 lb 2936 lb X21 l�� Arrow building Center 111 Stillwater, MN 55082 Strucalo Version 8.0.100.0 514/201011:25:08 AM ,FLOOR LOADING Side 1 91492 Floor Live Load FLL - 40 psf 40 psf Floor Dead Load FDL = 12 psf 12 pif Floor Tributary Width FTW = 6 It 6 ft Wall Load WALL = a pif OFAM LOA©[ Beam Total Live Load: wL = 480 pif Beam Total Dead Load: wD = 144 plf Beam Seff Iftight: SSW = 6 pH Tota] Maxlmum Load: WT = 630 pff Building PLUMBING , 5-1 Permit No.: Sol Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Da 763-502-4977 FAX EFFECTIVE 1-1-2010 DATE, c;? / YOUR E-MAIL ADDRESS SITE ADDRESS �oZ C! ve o✓ jrL kP( THIS APPLICANT IS: ❑ OWNER ACONTRACTOR PROPERTY NAME: OWNER/ q n ADDRESS: /02 / l e -AT t/ k 0 CITY STATE ZIP TENANT PHONE: CONTRACTOR NAME: • (.1 e- •2 SUBMIT A COPY OF STATE LICENSE EXP DATE YOUR STATE LICENSE, BOND AND STATE BOND # 1ip 3 20 EXP DATE CERTIFICATE OF f ADDRESS: l �og6 Y / lo -157 Sy,S'C- CITY/d��C{ STATE -5/k- ZIP $ 3� INSURANCE PHONE � 2 $7U —' 1/3-0 2 FAX �9 J'— 7 ��� 15 -7 2 PERMI.r TYPE XrSINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW REPLACEMENT DETAILED DESCRIPTION OF WORK 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 _WATER HEATER ($35) FOR IRRIGATION WATER METER OTHER � '�- � ci, , �- { 'i43'r ,�''�, Q � ^� � A h �.'Z ZT �2 4✓x�^i � t '� { � fi � � i A Y � Aye ��" n `r �' c i'`4���"'•2� °�� b � s'�L v' S �f � ��h Stz" gA 7 1 �u� � �i` -� •4 .L'`� �` �P £eR \ b d p 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 inase of all I c which requires review and approval of plans. % Q SIGNATURE OF APPLICANT ,J PRINT NAME U e _DATE/011 #110=1 WAS City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977