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PRE 2010 DOCSf� Village of Fridley, Minn. BC LDING PERMIT N° 64110 Office of INSPECTOR OF BUIIMMG6 z owner - �- Architec Fridley, Minn., Builder # y LOCATION OF BUILDING% No. I Street WC}}0Part of Lot Lot Block Addition or Sub -Division ' DESCRIPTION OF BUILDING FrontDepth ,r + Height Stories `'- Meaner of Construction y' r To be used asi - To be cAmpleted ° ° Estimated Com li ,I Permit Is hereby ganted to, ° to n:< the bunding— upon the express c the work done in, nances of Fridley, within the city lie ordinances. described in the above' statement. This permit is granted ition that the person to whom it is granted, and his agents, employees and workmen, in all )und and upon said building, or any part thereof, shall Conform in all respects to the ordl- Inn., regarding the construction, alteration, maintenance, repair and moving of buildings and this permit may be revoked at any time upon violation of any of the provisions of said a F, —Inspector of Buildings. GR A EEVIENT AND SWORN STA T'p;ME14T II In considers pion of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permit, I hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby,sstate and say that the facts stated by me and contained in the above permit are true as therein :Mated. �I Subscribedail sworn to before me at Fridley,. Minnesota, thl day of F._ ,_ F -,_ A.D. 19:: i 'ii 53 -8h -S-915.51 City of Fridley Applicoka ftr Pk,=dAn end Gm FaVang Dept. of Bldgs. Phone SM -3450 DESCRIPTION OF 'WORX Number, Kind and Location of Fixtures qp S F n ;.�. O� Z_aj U� <S t�! UO o ► W WATER MTS. GAS ELEC. Base Ist rnitall Gas 3zriLl 2nd 3rd 4th • future Connection Openings * New Fixture, 014 Openings Connected with >$•ewes ❑ Ccespool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ......... .... x $2.00 $ Future Fixture Opening ........... x $1.50 $ _. New Fixture Old Opening. x $1.50 $ Catch Basin ...........:........ x $3.25 $ Water Heater :Up to 99,000 BTU) .... x $3.00 $ New Ground Run Old Bldg......... x $3.25 $ Electric Water Beater .............. : $2.00 $ 3AS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ............... x $2.00 $ Additional Fixtures .................. x $ .75 $ Gas Range to 199,000 BTU ... ,.......... x $5.00 $ Loca,ion 6095 N. `E. Woody Lane 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, Blinn 7-30-74 19_ Owner George 0. Lohmer - Kind of Building Frame Used as Res. To be completed about 8-6. 7% Estimated Cost, $ 10.00 Old—NW. Building Permit No. Permit Signed �" By MIINMEGASCQ - Business Phone No ROUGH FINAL -2:- ' 7�- REPAIRS & ALTERi6TIONS—Rete: to Code .50 State Surcharge Install Gas Grill 5.00 . Description .............................................$ TOTAL FFE $ 5-50 �jaA aur_charge..500 SUBJECT - PERM City of Fridley 14921 AT THE TOP OF THE TWINS BUILDING PERMIT r ECEIPT N COMMUNITY DEVELOPMENT DIV. INSPECTION PROTECTIVE SEC. ! 3/ 3 1 � NUMBER REV. DATE PAGE OF APPROVED BY = CITY HALL FRIDLEY 55432 612-560-3450 910-F15 9/18/78 JOB ADDRESS 6095 Woody Lane N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 3 Moore Lake Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE George Lommer 6095 Woody Lane N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Summit Construction Co. 6301 Winnetka Avenue North 537-3573 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 9 CHANGE OF USE FROM TO STIPULATIONS Install ridged galvanized valleys. Roof can be second but not third roof. 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 AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING 1 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. $1,500 $.75 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT - DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $9.00 PLAN CHECK FEE TOTAL FEE q' \6�"tiFi $9.75. SIGNATURE OF CON ACTOR OR AUTHORIZE GENT (DATE) Y WHEN PROPERLY IDATED THIS IS YOUR PERMIT i 9-rid- BLDG INSP DATE SIGNATURE OFOWNER (IF OWNER BUILDER) (DATE) CITY OF FRIDLEY APPLICATION FOR RESIME-14TIAL BUILDING PE11MITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWIJER: Ge BUILDER: Andress:e�®� Wo�p� �� o�•eca Address: �s� � Tel. No.: No.Street: W ©oV�.2 LOT: ';�b BLOCK: ADDITION: CORNER LOT: INSIDE IAT: SETBACK: SIDEYARDS: Applicaht attach to this form T.00 Certificates of .Survey of Lot and proposed building location drawn on these Certificates. i DESCRIPTION OF BUILDING , To Be Used As: Front: Depth: Height: Square Feet: Cubic Feet: 'Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: Estimated Cost: $ To Be Completed: -�> b \F>\q\qb 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 representations stated in this application are true and correct. See reverse side for additional information. DATE:SIGNATUF.E: Stipulations: rl b 97-84-416051 APPLICATION FOR PuPHI G tiliA GAs FITTING PE*,,i r ., 1 n ►�. c; b �, _; dater � e � � I F• !.` a I :.I e w a: ! i.' iit:acer .. •� • r` 1 � I 1 1 _ __I ' I Gl.::rtr j ....:.cCtc1 with Stover 't •-r•c. t 1•tt.te, Gld O1ar,:r,J Nater i t'r.KT�r.L --.. •ts1-.,..',t: lltE i.r.T[j tiu. RATE TOTAL. x x 52.00 S ':rt x -1, tlaalll --__ s 55.00 s i .at•t taaccc - to $3,C3G bTux $5.00 $ - tt•J,VJJ LIU W Ji C:0 6:L IL•t.c $10.00 $ a.ftcn.r �_ x 47.00 -"�--- 5 �:+. r:t...In.t RIn Oltt b,.ildirq __-x 45.00 5 —� ile:tt r.: Nal er 11�•ltr �� $5.00 5 S tl I tlt;C htES: x 53.00 ; •.LIttlNaat ti�turas x $1.00 �'r-- ; \• e•\ -•I• L. 1S9,00u 6IU x S10.00 5 tAlki L ALt':RA716,N5 tr..t I1Ju.uu ;c trazual, 5L -L4 �. rzr.aria .,-tr.L ,.,L $5.00 • ; i:.CO S 5 8.00 Job Addre:js 6095 Woody Land Dtpartmert ct City at 1'rrdl.y Tel. 1511-1450 Thd'undt;rnlgn,:d t:.:rt y r.akco argli:ac:o- .• opacified a.7rtln.t•, -r ° :•.t rt 4r tt�5 ..otk Lettlr. L.1 dr: a\- work Jr. stria t;ur]sr.:a .let, tLI Ctty Le,dcv and rulings of thec Gc;:argent of 8�1:�rn7s. •:c.:later ttat All MIG facLU1 a,td r:1 rJc,.ctat lona etatud 1^ [l.1. ,, .:call:,,. aro t•u0 •nd �,.• \..,;, Fr:11ey, ::r.. 5-9-80 1 CIINCR LOMI ER �— KIND OF QUILL:::,; frame -. USED AS I't's. To Be CO3•ir'Lj:5-16-80 il.'u t.L.... r ESTIMAT•LD COS•; 50®00 OLD - uCFI uClLta:1J 1 Lh,at: :;;. F::`•:: - 5t;nc.l By - d `ft-4NEG,ASC0 -a:. I.Q. ROUGH 1115P. Da La PlIM • Iusp. /I - 3 - Date API•liGVAL 10t I•L}tr1l r MINIHUrI 1'L'C },.p 1„y iLt :u:h;, FC1u.Ir SS S%.:J FLUS ;.:G ;:�.7C fUkL7u.ttf.t SUBJECT TDE City of Fridley - 16220 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. t � ! I CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/3/81 JOB ADDRESS 6095 Woody Lane N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 3 Moore Lake Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE George Lohmar 6095 Woody Lane N.K. 571-5495 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Milton L. JohnsonCo. 2513 Central Avenue N.E. 781-9548 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 Ij ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install aluminum trim 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. 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 $1,000, $• 5Q 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- $7.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $8.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEt ` WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT BLDG INSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) CITY OF FRIDLEY Mie 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- DATE: orrect DATE: ( - 3 _=L SIGNATURE: Stipulations.- APPLICATION FOR RE:SIDLNTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) OW14ER: �r � gLyft 2 BUILDER: '0j � • J6t1A1 So'J ( � ADDRESS: A /v 6 ADDRESS: c, / 3 ���r 74,C TEL NO: 5171 — SY� TEL 140: Construction Location STRUT NO: (p ® �/ STREET: 141610 �� .� b /V G' LOT: BLOCK: ADDITION: Corner Lot: Inside Lot: Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and . proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: Depth: Height: Square:Feet: Cubic Feet: Front: Depth: Height: Square -Feet: Cubic Feet: Type of Construction:- /U /I, Estimated Cost: $ /0 To $e Completed: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SKEET Mie 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- DATE: orrect DATE: ( - 3 _=L SIGNATURE: Stipulations.- SUBJECT PE NO . City of Fridley )4� AT THE TOP OF THE TWINS BUILDINGPERMIT RECEI COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OFAPPROVED BY 612-571-3450 910-F15 8/6/84 JOB ADDRESS 6095 Woody Lane N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 3 Moore Lake Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE George Lohmer 6095 Woody Lane N.E. 571-5495 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Milton L. Johnson Co. 2513 Central Avenue N.E. 781-9548 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 Install aluminum tram 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. 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 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 $600 $.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $15.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $15.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)WHEN PROPER VALIDATED THIS IS YOUR PERMIT BLDG INSP I 061TE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATEr CITY OF FRIQLCY Effective Aug. 1, 1981 ' APPLICATIM FOR RESIDENTI/tL BUILDING PEW411TS (New, Alterations, Additions, or Repairs) (� OWNER: ADDRESS: - 00 10 a IjCd TEL NO: ADDRESS: f --7)j-/,,-) Cr u 7Kg ` /V C� TEL NO: -) �/ -/' � z S, Construction Location STREET NO: C STREET: �� �a 0 10 4 �119 rj 6 LOT: BLOCK: ADDITION: Corner Lot: Inside Lot: Setback.: Sideyards:. Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. Type of Construc 'Ib Be (bripleted: .DESCRIPTION OF CONSTRUCTION Front: Square Feet: Front: Square- Feet: Depth: Height: Cubic Feet: Depth: Height: Cubic Feet: Proposed Driveway width If New Opening Is Desired: a� Estimated Cost: $ Alt. A Alt. B SEE FZVERGE SIDE OF SHEET 9.9ie 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 Delwin -moot of Buildings, and hereby declares that all the facts and representations stated in this application are true and co`' 7 DATE: J-4 o SIGNATUItE: Stimulations: PSA^ -.,A / �s I () o City of Fridley AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT PERMIT NO. ® 18330 r • _ __ COMMUNITY DEVELOPMENT DIV. L PROTECTIVE INSPECTION SEC. r ; CITY HALL FRIDLEY 55432 j 612-571-3450 RECEIPT NO. NUMBER 910-F15 REV. DATE 2/27/86 PAGE OF APPROVED BY JOB ADDRESS 6095 WOODY LANE N.E. 1 LEGAL DESCR: LOT NO. 8 BLOCK 3 TRACTOR ADDITION Moore Lake Hills SEE ATTACHED SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE George Lohmer 6095 Woody Lane N.E. 571-5495 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Lehmann & iones Custom Design & Const. 557 Glendale Street 4 ARCHITECT OR DESIGNER MAIL ADDRESS St. Paul, MN 55104 ZIP PHONE LICENSE NO. 645-0843 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW CA ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 15' x 12' Living Area Addition to Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS SEPARATE RERO-Tt�U1RLbbk HEATING, PLyG AND SIGNSa BOOM digging call local utilities sTELEPHONE ELE:�FRiCWIRIVGg e GAS "[c,N " IR SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frain THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION ZONING SO. FT. CU. FT. OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT VALUATION $7,950 SURTAX $3.98 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION F ANY OTHER STATE R LOCAL LAW REGULATING CON- STR CTI THE P F RMANCE OF CONSTRUCTION. PERMIT FEE $68.50 SAC CHARGE J/APLAN z i GH CK FEE 1� $:?7.13 TOTAL FEE $89.61 S906T&E OFCONTR T R AUTHORIZED AGENT D EI WHEN PROPERLY VA IDATED T IS IS YOUR PERMIT BLDG INSP id y DATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI NEW[ ] City of Fridley Effective 4/1/84 ADDN. [ L R-1 AND R-2 j ALTER. [ ] Building Permit Application Construction Addr Legal Description Owner Name & Address: g - o le6ge e Algk g� L& 4 m gx Tel. # Contractor: &4127��®sv.� G`'z� �-c� �� 57` . T�1. # Address: (;Zar,( ®�G,t rS0`� 4e?�a�C yY, v6—jd _-- Attach to this application, a Certificate of Survey of the lot, With the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT e ) LIVING AREA: Length Width Height Sq. Ft. / GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: r Corner Lot [ '] Inside Lot Ft. Yd. Setback ✓ d Side Yard Setback -3 Type of Construction: �� ��� Estimated Cost: $ .� Approx. Completion Date: ��/` S� ') , 9�gj LN, II -%'9 'q5- Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: �� _ $ $ ee Back Page for Explanation DATE: -1�-� APPLICANT: _ Tel. # Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge r t��� STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] a ® C' G— sae SUBJECT PERMIT City of Fridley 2'7 9 2 7' AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. a. ----- COMMUNITY DEVELOPMENT DIV. �� PROTECTIVE INSPECTION SEC sff ^� 1 1 � NUMBER REV DATE PAGE OF APPROVED BY � I---1 CITY HALL FRIDLEY 55432 612-571-3450 910415 9/22/98 JOB ADDRESS 6095 Woody Ln NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 3 Moore Lake Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lohmer 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Gates Roofing 4640 Ximines Ln Plymouth 55442 550-0043 6793 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 ❑ ALTERATION Q REPAIR 0 MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house & garage (25SQ) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 $2,142.00 $1.07 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PRO I IONS OF &NYOTHER STATE OR LOCAL LAW REGULATING CON- $74.75 ire SC $2.14 STR C ION R T AFFORMANCE OF CONSTRUCTION PLAN CHECK FEE TO FEE W L e SC .00 $82.96 IGNATURE OF CONTRACTOR OR AUTHORIZED AGENT 40ATEi EN R P VALI T�j THI$ I UR FERMI S-GNATURE Of OWNERoF OWNER BU4DERi DATE, BL -NS qA TE NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 -1 BUILDING PERMIT APPLICATION �`� ConstructionAddress: l�0'6S �ond L4i Legal Description: I j Owner Name & Address: Tel. # Contractor: ats to LOA MN LICENSE # Address: Mo Tel. # 5S®®��U3 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: Y, 61-r r Construction Type: Q� X06 �� b Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. 6 Ft = Ft x $ _ $ DATE: �'�iAPPLICANT: ` Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL . STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 763-572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE 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/Industria-I 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $ 10.00 $ $ 10.00 $ $ 10.00 $ $ 25.00 $ 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 $ .50 $ '�O'sv Effective On January 1, 2001 JOB ADDRESS 6Q!?15- X-4) OWNER__&;-i@G6 BUILDING USED ESTIMATED COST e50_'C� PERMI No. of Heating Units 7 Circle One (Steam)1; ter) (Warm Air) Trade Name 42" eaA Size No Ave"01 BTU_ 000 HP ED Fuel ®U� ate' _Total Connected Load " Burner Trade Name Size No. BTU HP EDR 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. _ GM 41MAIME HIM DATE '2 %NMI L.UN rAn HEATING CO Signed TEL # 9&3 `S3`i-W/ t4 *Air Conditioners can not be placed in a side yard without Approved By Rough -In Date Final Date S-a9-ot written permission from adjoining property owner. BACK SIDE MUST BE FILLED IN ON VENT SIZE, VENT CONNECTORS AND COMBUSTION AIR VERIFICATION 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 () 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 assisted and natural draft appliances. Yes (,,�`No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes (�) No ( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes (fNo( ) 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. Yes (.-�No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( )No( Appliance Type and Size/Common Vent and Vent Connector Infonnation Appliance #1 Type BTU Input Fan Assiste o _Nat Appliance #2 Type BTU Input Fan Assistet Appliance #3 Type BTU Input Fan Assiste 6f at Total Appliances Total Btu Input Common Vent Type Vent Height ItC Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter _ 116' Type t' Appliance #2 Vent Connector Height ft Length . ft Diameter _ rrt4 'Type Appliance #3 Vent Connector Height ft Length ft Diameter 4in Type ALTERATIONS: (Describe) d/J.5'T�'u R' HEATING CO: CROM'M OM Signed By: Date: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMRFR OF FDM IRFS TO RF INSTAI I Fn M1 RArru 9=1 nnO Effective On Jan 1, 2000 �_ ® a •CR ® ] �R / •.• A 3i; Fyn ® R PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS_._fMMIE- Ott, 6(,3t)1EI2— New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range"* Gas Dryer" Back Flow Preventer Required ( )Yes () No $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 Type $15.00 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 Building Division, and hereby declares that all the facts .and representations stated in this application are true and correct LOHMER, GEORGE A1 1 6095 WOODY LANE // s 2002 FRIDLEY, MN 55432 - (763)571-9724 Owne1 Building Used As1=at�Ai C 00 LJ Estimated Cost r PERMIT NO. E PLUMBING COMPANYO1'��G�iI�L.tJI►��R�Cr Reinspection Fee $47.00/Hr SIGNED BYG� c TEL NO. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliancel� `�� Approved By Rough -In Date Final Date State Surcharge $ .50 MINIMUM FEE FOR ANY PLUMBINGIGAS PERMIT IS $20.00 TOTAL FEE $M-� PLUS THE S.60 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When reMacina 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 ( )..No( ) The venting system is, plastic/PVC and meets all current codes and manufacturer specifications :including sizing, length, number of elbows and termination. Yes O No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturers specifications. Yes ( ) No ( ) When required to Install a new combustion air, it will be sized and installed To meet the current codes and manufacturers specifications. Yes ( ) No ( ) When installina a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and ventconnectors sized and installed correctly after an appliance;has been. -removed from the common vent and vented separately asper current codes. Yes( ) No ( Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type 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 ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO Signed By: Date:. , CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 763) 572-3604 FAX: (763) 571-1287 ADDRESS : 6095 WOODY LN NE PIN : 133024430071 LEGAL DESC : MOORE LAKE HILLS : LOT 8 BLOCK 3 PERMIT NO.: 2004-01044" 5� 1' DATE ISSUED: 07/06/2004 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL AIR CONDITIONER. # INSPECTIONS 1 APPLICANT POWERHOUSE ELECTRIC 1661 WEXFORD LANE SHAKOPEE, MN 55379 OWNER LOHMER GEORGE C & NATALIE J 6095 WOODY LN NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date ELEC PERMIT FEE - MIN (RESI) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 4186 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 763) 572-3604 FAX: (763) 571-1287 ADDRESS 6095 WOODY LN NE PIN 133024430071 LEGAL DESC MOORE LAKE HILLS LOT 8 BLOCK 3 PERMIT TYPE HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMITO.: 2004-00936 ` DATE ISSUED: 7/2004 , VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL AN AIR CONDITIONER. # A/C UNITS # FURNACES # GAS RANGES APPLICANT RON'S MECHANICAL INC 12010 OLD BRICK YARD SHAKOPEE, MN 55379-2942 (952)445-8585 OWNER LOHMER GEORGE C & NATALIE J 6095 WOODY LN NE FRIDLEY, MN 55432 1 VALUE OF APPL OR WORK 0 0 # GAS DRYERS 0 0 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 regula ction or the performance of construction. Applicant Date Bldg HEATING PERMIT MINIMUM FEE 0.00 FURNACE SHELL/DUCT WORK 0.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 25.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 25.50 PAID WITH CHECK # 34461 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY BUILDING INSPECTION Effective 4/1/2004 .•6431 Oniversity Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION 763-572-3604 FAX 763-571-1287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough -in Date Final Date JOB ADDRESS 6095 WOODY LANE RATE SCHEDULE Fee Total Residential Owner GEORGE LOHMER Furnace Shell and Duct Work, Burner & also Replacement Furnace $35.00 $ Building Used As /1 r� ESTIMATED COST �V " PERMIT NO Gas Piping (New Furnace, Fireplace, Insert) $10.00 $ Gas Range $10.00 $ DESCR TION OF FURNACE AND BURNER Gas Dryer $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. *Air Conditioning - All Sizes $25.00 $ (20• BTU HP EDR Fuel Total Connected Load All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Burner Trade Name Size No. Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EDR Improvement whichever is greater The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/Industrial/Institutional and representations stated in this application are true and correct. State Surcharge $ HEATING CO RON' S MECHANICAL, INC. Tel TOTAL FEE $iso Signed REINSPECTION FEE $50.00/HOUR FAX # 952-445-50=n Date *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, 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 () 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 assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No( ) 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. Yes () No( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes () No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type 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 ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date : Building BUILDING Permit No.: -2 Inspections RESIDENTIAL APPLICATION Received By 763-572-3604 X�ec,gR 3 2007 CITY OF FRIDLEY DATE C \ YOUR E-MAIL ADDRESS W�aJ C 1"c - Q C'cyon1 SITE ADDRESS THIS APPLICANT IS: ❑ OWNER ONTRACTOR PROPERTY OWNER/ NAME: TENANT . ADDRESS: , CITY STATE—ZIP ^y PHONE: NAME: Renewal By Andersen CONTRACTOR SUBMIT A COPY OF STATE LICENSE # 1920 County Road "C" West YOUR STATE LICENSE ADDRESS: Roseville, MN 55113 t STATE ZIP WITH APPLICATION PHONE ❑SINGLE FAMILY/0License #20130983 PROPERTY TYPE ❑ TWO FAMILY/NEW G 651-264-4777 ❑ ADDITION ❑ GARAGE/SHED WINDOWS PERMIT TYPE ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: St �(�((SOfil qPe1n1'_Ak§=2 SIZE OF IMPROVEMENT LENGTH WIDTH Sq. Ft. RO-OFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2. Proposed floor plan PROPOSED HEIGHT: 3. List of structural members to be used SIDING ❑ Vinyl ❑Soffit FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structure ❑ Other ❑ Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS Oyes ❑No LOCATION OF WINDOWS 3. Energy Calculations 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 TW�_- U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION S 5, OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Due $ o?_q $ 5�.00 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) $1550 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City 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 ben conformance with the ordinanand codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not, permit but only an applicatio or a permit -Ad work is not to start without a p it; that the work will be in accordance with the approve( plan in the case of all work w h requires r iew and appro f plans. C 16V- rJ SIGNATURE OF APPLICANT INT NAME Building PLUMBING Permit No.: axftnj Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY DatR% - L 5 DATE- ✓ YOUR E-MAIL ADDRESS SITE ADDRESS �� THIS APPLICANT IS: 13 OWNER EeO' NTRACTOR PROPERTY NAME: Coeore_ O rK ev-z_ OWNER/ ADDRESS: a(CITY -iSTATE LJZIP MYs'Z TENANT PHONE: CONTRACTOR NAME: SUBMIT A COPY OF STATE LICENSE # U C_ EXP DATE Ze - V-617 YOUR STATE �6') ADDRESS: r CITY AO -N S fP f STATE E?2�1 & LICENSE WITH PHONE %> 3 l V FAX APPLICATION �� f/ &91NGLE ❑ PERMIT TYPE FAMILY TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW 131 PLACEMENT DETAILED DESCRIPTION OF WORK t cJ,¢;•i-F{Pym PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 =cost of labor x.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) _ BATH SINK/LAV _FLOOR DRAINS_ SHOWER _ WATER PIPING GAS PIPING (rem cirrcrc�) SWIMMING POOL _ WATER SOFTNER ($35) —BATHTUB _ _ _ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15) _ —DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION WATER METER OTHER ,.,., .y ter .111 ANE Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ State Surcharge = $ .50 Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which reauires review and approval of plans. SIGNATURE OF APPLICANT -•-. - PRINT NAME C it (1 /CD ATE ` _� _07 City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977