PRE 2010 DOCSl
ji
Village of Frlffley, Mhm.
it BUILDING PERAM
No
8&4 Office of INSPECTOR OF BURDINGS
Fridley, Minn., 1
Builder
LOCATION OF BUILDING
No. Street d Part of Lot
Lot r Block Addition or Sub -Division `
j DESCRIPTION OF BUILDING
4
't,�,.
Front s Depth Height Stories / ' Manner of Constpetion_
To be used as L'` ` To be completed Estimated Cost;'
Permit is hereby (ranted tc"' :� F �.r , }A, ..
�f
the building ,� � described in the above statement. This permit is granted
upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all
the work done in„" around and upon said building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley, Minn., regarding the 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.
T, J � f�Z21'` ' Spector of Buildings.
AGREF21ENT AND SWORN STATEMENT
In consideration 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 state and say that the facts stated by me and contained in the above permit are
true as therein i', stated.
�I
Subscribed acid sworn to before me at Fridley, Minnesot%, this
day � 03 ")
City of Fridley, Minn.
BUILDING PERMIT N® 4120
Date:
Owner: ........1._. ........... Builder - --...._.............__..._...._......_..._..
Address
Address
LOC TON OF BUILDING
No..... s L_ Street ....._.. _ - .......... .............. Part of t --------------
----
-......... -..........._..........._......._...._
Lot ....................................... Block ........... -....................................... Addition or Sub -Division . . .. ..........._._..��... ........... _........ ......
CornerLot .................................... Inside Lot ....................................... Setback ..................... --................... deyard........------...._......._.........------------.................... ..
SewerElevation ................... -............ ... -......... _.................................................... . Foundation Elevation _ ................................. -............. -............. _............. _........... --
DESCRIPTION OF BUILDING
To be Used as:
344eC- .....u...---4. � - Front - s ..' Depth/_0 Height �.�...........- Sq. Ft k�. Cu. Ft. 447P
...--.............. _...................................... Front ............... Depth ...................._.. Height ........................ Sq. Ft. ........................ Cu. Ft ..................... ...
Q �"l�,".'.�. To be Completed ...__........-•---.........----
Type of Construction............................................................ Est. Cost .........................-........... ......_........
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
P �.....-� 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
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. e
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
.QW4
�7
City of Fridley, Minn. X9 10249
BUILDING PERMIT
Date: May 23, 1969
Owner: L. M. Thielen Builder Same
Address 4820 2 i St. N. E. Address Same
LOCATION OF BUILDING
No. 4820 Street._ 2 . St. N. E. Part of Lot
Lot __ Block
Addition or Sub -Division
Corner Lot Inside Lot — Setback -- Sideyard
Sewer Elevation -- Foundation Elevation
q 410 A lialf•
To be Used as:
Addn . Front 23 Depth 4' Height 12 ' Sq. Ft. 92 Cu. Ft. 1104_
Front Depth Freight _ _ Sq. Ft. Cu. Ft.
Type of Construction Frame Est. Cost _ �3 000.00 __ 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 tit all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 5.00 , permit is hereby granted to L. M. Thielen
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 reg location, construction, alteration, maintenance, repair and moving of buil�iags
within the city limits andthis permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Clarence Belis
NOTICE:
Ibis permit don not cover the construction, installation for whdng, plumbing, en heating, sewer or water. Be sure to we
the Building Inspector for separate permits for these Items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNS ' S NAME BUILDER
.AADDR +ESSo� /j/. �'- ADDRESS
LOCATION OF BUILDING
NO. STREW s-/, fil.
LOT BLOCK ADDITION OR SUBDIVISION
CORNER LOT INSIDE LOT SETBACK SIDEYARD
SEWER ELEVATION TOP OF FOOTING
Applicant attach to this form Two Certificates of Survey.of Lot.and
proposed buildi.ug.location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Front --�3 , Depth Height
Square feet �� Cubic Feet
Front Depth Height
Square feet Cubic Feet
Type of Construcrtion �iicv�✓r�� Estimated Code3401® C..
To Be Completed '/ /g -
The undersigned hereby m9Aes application for a permit for the work
herein specified, agreeihg 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 SIGNA
Irl IIA YII I11 III P 1 1
(Schedule of Fee Costs can be found on the Reverse Side.)
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SUBJECT
PER
City of Fridley
15.6 2 2
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
"1 CITY HALL FRIDLEY 55432
APPROVED BY
NUMBER
REV.
DATE
PAGE OF
612-571-3450
910-F15
3/18/80
/
JOB ADDRESS 4820 - 21� Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
11,12
3
Plymouth Addition SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Georgia Kramer 4820 - 2-2 Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Viking Home Improvement CJD. 4832 - 2;1� Street N.E. 560-3794
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
Install siding and reroof house
9 CHANGE QF USE FROM TO
STIPULATIONS
SEPERATE .PERfv11TS R>EQU]RED FOR WIRING.,
HEATING, PLUMBING AND SIGNS.
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
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
$5,805
$2.90
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-
STRUCT101 OR THE PER OR NCE OF CO TRUCTION.
36.00
PLAN CHECK FEE
TOTAL FEE
�` �� ��
$38.90
SIGNAT RE OF CONTRA RORAUTHORI ,AGENT SDATEI
WHEN)) PROPERLY YALIIDAA�TED THIS IS YOUR PERMI
BLDG WSP DAT
SIGNATURE OF OWNERtlF OWNER BUILDERI (DATE)�'
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(New, Alterations, Additions, or Repairs)
OWNER: �j Pd/lr,� /f /�%���/� BUILDER: ev
ADDRESS: �� a' a ��- ST,tl�C ADDRESS:
TEL AVO:.� �d TEL NO:
Construction Location, /
�
STRiT NO: Z O STREET: �v
LOT: ' I Z BLOCK: ADDITION: J% / V m ay ii+ A4 d _i6 "2
Corner Lot:
Inside Lot: �4
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: go,, 1i ,.
Estimated
Cost: $
To Be Completed:
/01�
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.
n n
Stipulations:
G
SUBJECT
PERMIT NO�•�,
city �� Fraley
� -_ 1-5�9 7 2
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
�
RECEIPT NO.
1 COMMUNITY DEVELOPMENT DIV.
r e PROTECTIVE INSPECTION SEC.
1 i �
I CITY HALL FRIDLEY 55432
L
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
10/14/80
JOB ADDRESS
4820 - 2h Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
11,12
3
1 Plymouth SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Georgia Kramer 4820 - 212 Street N.E. 560-1286
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Sussel Ccmpany 1850 Como Avenue St. Paul 645-0331
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 20' x 24' Detached Garage
9 CHANGE OF USE FROM TO
STIPULATIONS provide a hard surface driveway. Garage can never be connected to
the house unless frost footings are put in under garage.
m
SEPERATE PERMITS
REQUIRED Before .
FOR WIRING, to dlgg�.>�g call .lecal ��R1_t��
HEATING, PLUMBING
A�� SIGN&
REQUIRE ay . ,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame
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
48O
4800
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
$4,228
$2.11
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.
PLAN CHECK FEE
TOTAL FEE
1.
$21.31
SIGNATURE OF CONTRACT ORO AUTHORIZEDAGENT IDATEI
WHEN PROPERLY VALIDATED THIS IS. PERMIT
Ifo
YOUR
BLDG WSP D T
SIGNATUREOn OWNER IIF OWNERBUILDER) IDAT I
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PER11ITS
(New, Alterations, Additions, or Repairs)
OWNER: �d� ����u� BUILDER:
ADDRESS: Pic-, ADDRESS:
TEL NO:,� TEL NO:
Construction Location
STMT NO: d STREET: 2— y
LOT: � � Q BLOCK: 3 ADDITION: `1' L.q rn ( -Ti-L
Corner Lot: Inside Lot: /\ SetbacY.: 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: 2-® Depth: Iiei.ght: ir
Square. Feet: Cubic Feet:
Front: Depth: Height:
Square - Feet: Cubic feet:
Tape of Construction.` m Estimated Cast: $
To $e Oorapleted: -6 .
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 tnrk* herein specified,
agreeing to do.all work in strict accordance with the City of Fridley Ordinances and
rulings of the Depart -meat of Buildings, and hereby declares that all the facts and
representations stated ii this applicati=C'
and correct.
DATE: OC �A � f - �� S IGN ATU M.' : —
Stipulations
/9,ao
SUSSEL WAGES SUSSEL COWANY, INC.
Permit by �"`----
Legal Description—
Lot —
Blk
Add'n
Value _
Type Const.
WORK ORDER
HOME PHONE:
NAME BUS. PHONE:
JOB ADDRESS—
BLDG
DDRESS BLDG CODE AREA ,Cs
R. P. L.
Alley
House
F. Str .t
Other ' � ►'�' • -� '9'li �?s 'i
i
I
Ae/'
[]Square With
❑ Sod Rem. - By
A.B.U. .2 "
t] 0 Grade Point
C_o_n_d_u_i3 ----------7E
___ _ _ __ __
BY Owner ❑By Sussel
12WU ❑
paw By `Own. ❑By Sus.
❑BaG By Own. ❑By Sussel
D Maintain 8' Total Wall Height
Including Blocks OR
❑ Maintain 8' Wall Height on
Top of Blocks
Block Size (Top course)
Wall Height other than 8
Frame with full wall height
sold OR
I Cut studs as required for
OHD clearance
Q.H. Dr Offset
X S.D. Location
Windows
D r a Vrj_xw.attaGbAed pic to res
Existing garage: No ❑
je Detached []Attached YP%
Size of existing:–I_`__x_,2_
Existing garage will be:
i_1 Left as is
Converted to L.S. - By owner
,,Z Removed By: Owner X
Sussel ❑
Junk A4tjst Be Removec✓By Owner
Specify removals by Sussel or
Owner - trees, bushes, etc.
1 Show approx. dist. garage to
house and all prop. lines
Stakes visible - J Yes ❑ No
Survey available -,'� Yes ❑ No
. J Special instructions from
owners:
AC ESS
L ood
❑ air
❑ Poor
CONTRACT DATE
IA -a. 00
— FOR OFFICE USE ONLY
SIZE e"r" ,�
Blocks
D.W.
SLAB:
S.W.
,By SUSSEL
Ftg.
❑ By Owner Approx.
Slab
❑ In
ABU
2 -STARTING POINTS ONLY
Sod Removal
S.P.L.
S.S.P.L.
Sand Fill
R. P. L.
Alley
House
F. Str .t
Other ' � ►'�' • -� '9'li �?s 'i
i
I
Ae/'
[]Square With
❑ Sod Rem. - By
A.B.U. .2 "
t] 0 Grade Point
C_o_n_d_u_i3 ----------7E
___ _ _ __ __
BY Owner ❑By Sussel
12WU ❑
paw By `Own. ❑By Sus.
❑BaG By Own. ❑By Sussel
D Maintain 8' Total Wall Height
Including Blocks OR
❑ Maintain 8' Wall Height on
Top of Blocks
Block Size (Top course)
Wall Height other than 8
Frame with full wall height
sold OR
I Cut studs as required for
OHD clearance
Q.H. Dr Offset
X S.D. Location
Windows
D r a Vrj_xw.attaGbAed pic to res
Existing garage: No ❑
je Detached []Attached YP%
Size of existing:–I_`__x_,2_
Existing garage will be:
i_1 Left as is
Converted to L.S. - By owner
,,Z Removed By: Owner X
Sussel ❑
Junk A4tjst Be Removec✓By Owner
Specify removals by Sussel or
Owner - trees, bushes, etc.
1 Show approx. dist. garage to
house and all prop. lines
Stakes visible - J Yes ❑ No
Survey available -,'� Yes ❑ No
. J Special instructions from
owners:
AC ESS
L ood
❑ air
❑ Poor
CONTRACT DATE
IA -a. 00
— FOR OFFICE USE ONLY
SIZE e"r" ,�
Blocks
D.W.
Blks. Delivery
S.W.
Waterproof
Ftg.
Back Fill
Re -bar
Other
>L
f
M11 1011'
TOTAL
`I
PURCHASER'S INITIALS:
'RoDIRECTION
�X 1.30
s;fs
e�
`I
PURCHASER'S INITIALS:
'RoDIRECTION
�X 1.30
1" x 8 Ridgeboard
ROOF:GABLE D REVERSE GABLE HIP
EAVE OVERHANG:
RAKE OVERHANG:
SEAL DOWN SHINGLES WITH PLYWOOD OR ASPENITE
ROOF SHEATHING AND 15 LB. FELT
k 6'•
Rafters Roof Sheathing
Seal Down Shingles
2" x 6" 3/8" Plywood Trim
Cross Ties Gussets
Fascia
1" x 6" W -Bracing 2" x 4" Double 1" x 4" Sub
when applicable Top Plate Fascia
per Minn. State Code
Soffit
NOTE: 3/4" Cove
1) Roof approved by Minn. State Building Dept. as meeting Minn. '
State Code Requirements of 30# snow load. Refer to State
Building Code Letter Number 35. 2" x 4" Studs
2) Trusses set 48" O.C. (Gusset 3%8" Plywood).
3) Intermediate rafters are 2" x 6" 's braced with 2" x 6" collar ties.
4) On 18' and narrower garages, eliminate the W bracing and collar Siding
ties.
5) Hip roofs consist of 2" x 6" rafters, 2" x 6" cross ties 48" O.C.,
2" x 8" hip rafters and no plywood gussets are used.
RAFTERS: 2" x 6" 16" O.C. O.C.
STUDS: 2" x 4" O.C. , 24" O.C.
WALL SHEATHING: —1`2 Zg C-� 'tL►�-1
SIDING: %0
OVERHEAD DOOR HEADER: Double 2" x 12" or
Gluelam beam x
Slab on grade construction approved per Minnesota State Code. Refer �I
to State Building Code Letter Number 11.
x 7" Anchor Bolt
per U.B.C.
2" x 4" Treated Bottom Plate
® SLAB: 4" WITH MESH 6" x 6" # 10 Gauge
Grade Line
0045T()L
f
SUBJECT
0E
City of Fridley
WRECKING
®� 15 97 3)
AT THE TOP OF THE TWINS
P E R M I T
.
yy6U& X
RECEIP
�
• _ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
� �
i �
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
f ---L CITY HALL FRIDLEY 55432
612-571-3450
910-F15
10/14/80
JOB ADDRESS 4820 - 23i Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
11,12
3
Plymouth SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Georgia Kramer 4820 - 231 Street N.E. 560-1286
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Res :dentia l
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE I� REMOVE
6 DESCRIBE WORK
Wreck 141 x 22' Detached Garage
9 CHANGE QF USE FROM TO
STIPULATIONS
Wrecking of Garage completed
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frame
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
308
3080
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
NONE
NONE
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.
$10.00
NONE
PLAN CHECK FEE
TOTAL FEE
$10.00
SIGNATURE OF CONTRRA,CITOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
SI!NATUFYEIOF OWNER 0F OWNER BUILDER) (DATE)
BLDG INSP E
City of Fridley
�u�d�cT
Permit No.
AT THE TCP OF THE TWINS
WRECKING PERMIT APPLICATION
Receipt No.
COp4P, HITY DEVC4DPMENT DIV,
IPROTECTIVE R VIZCT4ON MUT,
CITY FALL PRcIPLMV 0002
tj
N1ER
IR=MPATE
PADS OF
APPROVED ®Y
Job Address Ay
Legal
Lot No.
Block Nom
Tract or Addition
Desco
`/ / _�_ 1
3/('aC
I Ymo"rt W
Property Owner (-;vJ'+ 2C*rA ✓����,»Ca Address �a ��a aP�hone
T 0 ^
Contractor
Address Phone
Description
Front
DepthHeights
1
Sq. Ft.
Cu. Ft.
of Bldg.
1-Z
':::2 ��
G
3o &�
301 0
No, of Dwelling Units
Taxes Paid
Tax Receipt No,
Estimated Cost of Wrecking
To Be Completed
CDA,C
Utilities Notified: State whether
notified and date
Minneapolis Gas Company
Engineering Department
372-4850
Northern States Power Company
Customer Business Office
330®5540
Northwestern Bell Telephone Co.
Business Office
332-4112
Approved By Water & Sewer Department:
All Bills Are Paid
Services Are Disconnected
The undersigned hereby makes
application for a permit to wreck the building
described above, agreeing to do all work in strict accordance with the City
Ordinances and rulings of the Department of Buildings, and hereby declares that
;all facts and representations stated in this application are true and correct.
Contract (`
ZC-
Date
SUBJECT '
City of Fridley
26391
2 6 �► 91
AT THE TOP OF THE TWINS
BUILDING PERMIT
f
`
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
_
L
(�
PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
12-571-3450
910-F15
1/29/98
JOB ADDRESS 4820 2 Street NE
I LEGAL
LOT NO.
BLOCK TRACT OR ADDITION
SEE ATTACHED
DESCR.
11 12
3 1. Plymouth
SHEET
2 PROPERTY OWNER MAIL AD S$
ZIP PHONE
Kozlak 4820 2V S972-8170
3 CONTRACTOR MAIL AD RES
ZIP PHONE LICENSE NO.
Viking Home Improvement
4 ARCHITECT OR DESIGNER MAIL ADDRE
ZIP H L1 N 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
Peak Repair - Storm damage
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
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
$700
$0.50
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.
2?-
PLAN CHECK FEE
TOTAL FEE
j -
Licens $5.0
$wn70
SIGrfATUREOFCONTRACTORORAUTHORIZEDAGENT IDATEI
EN OP VALIDATE 'THIS IS YOUR PER T
BLD INSP ( DATE
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 l
BUILDING PERMIT APPLICATION
ConstructionAddress: df a & ,P7 % -� 7, A t k
Legal Description:
Owner Name & Address: 6W P---' S lee ?- G% le Tel. # 3',72 - 9 3 � 6
Contractor: MN LICENSE # e77 2 --
Address:,
Address: %P3 Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF INIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Le gth Wid Hg t/ ound q. Ft.
Construction Type: SP -r—'&
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
DATE: 01-lz y ` -� k
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License .Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Estimated Cost: $
7®!te oc,
(Fee Schedule on Back)
Ft x $ = $
APPLICANT: A Tel. # 5-72-
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 [ ]
SUBJECT
City of Fridley
26747
7NO.
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECE
COMMUNITY DEVELOPMENT DIV.
__ _
4
r i PROTECTIVE INSPECTION SEC.
'�6y
�
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
7/22/98
JOB ADDRESS48202 1/2 St NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
11,12
3
Plymouth
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Chris Rozlak
572-8370
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
Viking Home Improvement 4832 2 1/2 St M is 55421
572-1820
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
4772
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 house 17 S • Reside House
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building
Code.
Call for building wrap inspection before covering.
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
$10,836
$5.42
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY O HER STATE OR LOCAL LAW REGULATING CON-
STR CT N O THE E FORMANCE OF CONSTRUCTION.
$174.75
Fire SC $10.84
PLAN CHECK FEE
TOTAL FEE
6f.1NATuVm-,a4e0'kTRACTOR
License SC $5.00
1 1196.01
OR AUTHORIZED AGENT (DOE)
WHEN PROPE VALIDATED THIS IS YOUR PERMIT
SAG INSI
pXl
GATE
SIGNATURE OF OWNER OF OWNER BUILDERt IDATEI
NEW [ ] Effective 1/1/98
ADDN [ J CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION �P
ConstructionAddress:
Legal Description:
Owner Name & d
i%J LSdress: l`S Tel. # 5x%2-92 70
Contractor: o e'r, ��mQ MN LICENSE #
Address: ���^ ��,Sl= U SS��r Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlYR OVE NT
LIVING AREA: Length Width 9ii Sq. Ft.
GARAGE'AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: 4 ® Si' 41�.7 �0
Construction Type: Estimated Cost: $/�cO5/
(Fee Schedule ,, -
0 c
Driveway Curb Cut Width Needed: - Ft. + 6 Ft = Ft x $ _ $
DATE:��
APPLICANT: Tel. # 20
CITY USE ONLY
Permit Fee
$ % W `%�
Fee Schedule on Reverse Side
Fire Surcharge _
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
B /
6 /L/ � ��
TOTAL
$ / O' L
STIPULATIONS:
Vr
7
CITY OF FRIDLEY BUILDING INSPECTION
6431 University Ave NE
Fridley, MN 55432
763-572-3604 FAX 763-571-1287
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
Gas Dryer
*Air Conditioning -AII Sizes
ro
All Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work
Minimum Fee $15.00 for Residential or 5% of cost of
Improvement whichever is greater
�— Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS -'� 8 ,L' -z ST
Fee Total
Owner�"?A a U '"Df2-c- '(?-::,L-0 \aj
$35.00 $ Building Used As
$10.00 $ ESTIMATED COST PERMIT NO
$10.00 $ DESCRIPTION OF FURNACE AND BURNER
$10.00 $ # of Heating Units_ Circle One (Steam) (Hot Water(Warm
Trade Name Size No.
$25.00 $ BTU -i0, Qbi--� HP EDR
Fuel f-- Al GAS Total Connected Load
Commercial/Industrial/Institutional
1.25% of Value of Appliance or Work (List on Back)
Minimum Fee $35.00 for Commercial/Industrial/Institutional
State Surcharge
TOTAL FEE
REINSPECTION FEE $50.00/HOUR
$ Burner Trade Name
BTU
HP
Size No.
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
$ and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
*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
FAX #- Date o
Tel #-7k3 - W1 -&%®r
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 04 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 (;I
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 -v) 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 Pf
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 --k) Fan Assisted or Nat r-tJ
Appliance #2 Type Q�M ttt- BTU Input 35,E Fan Assisted or Nat N)q-r
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances 9 --Total Btu Input ®:
Common Vent Type V-( Vent Height Diameter 6 v 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)
NEW [ ] CITY OF FRIDLEY
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
-4-1 4 &- -1_0 -)-'/'L _ft-�
Construction Address: IT
? Legal Description: / us-�e'
Owner Name & dress: L-- ( breva (®L---' Tel. # Sj r 3
T
Contractor: MN LICENSE #
Address: y t�� Tel. #
Attach to - application, a Certificate of Survey of the
lot, 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:
Construction Type: y Estimated Cost: $ :� 4---7) 0
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT: G & Tel. #
Call (763! 5�4 for permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
CITY USE ONLY -
$ � , T--6 Fee Schedule on Reverse Side
$ 65% of Permit Fee
$ .001 of Permit Valuation (1/10th%)
$ $.50/$1,000 Valuation
$ $1450 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 [ ]
4
TOTAL $ ��� STIPULATIONS:
§",5 W -L-
r A ((&t w(vd-4LJ
Deft ����T - % 4v.. --n�
T cNl1 l�
i.^ranee / r
ci f
V
Building
BUILDING
Permit No.: �fG
Inspections
RESIDENTIAL APPLICATION Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd: 74ql,)f
763-502-4977 FAX
Fire Surcharge
$
EFFECTIVE 8-19-09
Surcharge
DATE 11- 4 ' O`i
YOUR E-MAIL ADDRESS��,���C9?Zii�s1'�t�S�dy�1
c
SITE ADDRESS Li V OLO
C5A 3C -
SAC Charge
THIS APPLICANT IS:
❑ OWNER 2kCONTRACTOR
Curb Cut Escrow
PROPERTY OWNER/
NAME: V oa. `\ 3 _rAbl�
Erosion Control
ADDRESS: if'A M- cwt c`3. ZA'�A CITY �: OCA STATE r-I-JZIP
TENANT
Park Fee
PHONE: � G ZI — � 71 - S S61
Fee Determined by Engineering
CONTRACTOR
NAME: 72�P-M��•s,�v.�a
Agreement necessary ( ) Non Necessary ( }
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # 45 1 O EXP DATE 3 aa 1® '
AND CERTIFICATE OF
ADDRESS: cSP-13k o car ,=. jZc� CITY C_nrtMn,,, STAT9yV-3 ZIP SS1*3
INSURANCE
PHONE ', S d -;� UI CO 9d FAX
PROPERTY TYPE
ER SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH PROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:ry\t,,a
SIZE OF IMPROVEMENT
LENGTH WIDTH
HEIGHT SQ FT
ROOFING
❑ 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:
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)
11L)IALJUI3VALUA1lUIN3
UUUUYAINUY 1Yrh
Permit Fee
$
"-so 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
$
Sad _ $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $22 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( }
Total Due
$
A, 1. Make checks Davable to: Citv of Fridlev 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 iti
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 all w k w�ick-r uires review and approval of plans.
SIGNATURE OF APPLICANT• PRINT NAME irr to DATE I i ' ZI -®c)
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE /e
SITE ADDRESS
THIS APPLICANT IS:
From: 763 571 5331 Page: 1/3 Date: 1017120091:30:52 PM
�- .... ... � .. _ .... 2 � � � L?d ... — ... gvwu% Permit No.:
�CHANICAL Received By:
RESIDENTIAL APPLICATION p ,
CITY OF FRIDLEY
EFFECTIVE2-19-09 J
YOUR £ MAIL ADDRESS
OWNERI ADDRESS:
TENANT PHONE 7 G 3
CONTRACTOTADDRM MEERSON:
SUBMIT A COPYNSE# EXP DATE
YOURSTATE TE ZIPLICENSEWfl APPLICATION FAX
PERMIT TYPE
J�1 SINGLE FAMILY O TWO FAMILY O TOWNHOUSE
0 REPLACEMENT M ALTERATION/REMODEL
TYPE OF WORK: P-NLryyt
DETAILED DESCRIPTION OF WORK zolf /e,
OF EACH
FFXS ARE BASED ON 510.00 PER FDCnME, EXCEPT WHERE NOTED. FIXTURES' {INDICATE TOTAL Ni3MBERSI7,&I$TU BELOW)
Equipment Installed MFG:
MFG: ��.
MODEL: SiZElBTII
MODEL: SIZEfffm
MFG: GAS RANGE(OVEN $10.00
A/C x.00 FIREPLACE (CiA3) $15.00 NEW GAS GRILL $10.00
AIR TO AIR EXCHANGEER $15 „FIREPLACE (WOOD) $35.00 -GAS UNIT HTR $10.0D
—BOILER $35-00 FURNACE$35.00 POOL VATER$35.00
CHMUCY LINER $10.00 GAS DRYER $10.00 -J?VENTILA• OR $15.00
GAS PIPING $1000
Number of fixtures @ $10.00 x $10.00 = $
Number of 8xhm @ $15-00—Lx $15.00 = $ � 00
Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ ('
A v+ N•iC GM T -+.i
TMS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I admwledge that the information above is complete and accw-Ac; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that l 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 else of all work• ich ices review and approval of plans. d
SIGNATURE P^/ We4lalo DATE
OF APPLICANT
ARMECHANICA WWORK.
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX-. 763-5024977
From: 763 5715331 Page: 2/3 Date: 10/7120091:30:52 PM
... .... .._.. r r...__ _ .–– _.. _ -- - �--
B
uilding
PLUMBING Permit No. N �
g
spections RESIDENTIAL APPLICATION Received By
CITY OF FRIDLEY
763-542-4977 FAX svRz-»
DATE /G� fr _ fj_
YOUR E-MAIL. ADDRESS
SITE ADDRESS 2" rL
THIS APPLICANT IS: DOWNER OCONTRACTOR
OWNER/
TENANT
CONTRACTOR NAS;
SUBMIT A COPY OF
EXPDATE
STATE UCENSE #
XOUR STA 1T
EXP DATE
I,iCENSE, BOND AND
STATE BOND p STATE'
CERTIFICATE OF
ADDRESS:
INSURANCE
PHONE FAX
PERMIT TYPE 1 1,yWNGLE FAMILY ❑ TWO FAMILY C7 TOWNHOUSE
TYPE OF WORK: 1 o NEW
DETAILED DESCRIPTION OF WORK
Number of fudum @ $10.00 2-x $10-00 = $ iD
Number of fixtures @ $15.00 _ x $15.00 = $
Number of fmWm @ $35.00 x $35.00 = $
State Surcharge
(AGNUMM $:iS.SO "rota! = ai .
THIS IS AN APPLICATION FOR A PE RwT--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
and o � Fridley
and with the a start wltho�pelota on site•, mat thon e work will be er acndd this
rdan is
not a permit but only an application a permit Of plans.
with the approved plan in the 1 ich res review and appro/ DATE_I
�
SIGNATURE OF APPLICANT
PRINT NAME l�GR, �/� r
Xj I AtJ
City of Fridley
BWIding Inspections Department
6431 University Avenue NE, Fridley, UN 55432
763-572-3604
FAX: 763.502-4977
TOTAL NUMBER
OF EACH BELOW) MS M FEE
FEES ARE BASED ON $10.00 PER FOC1iIRE. EXCEPT WHERE NOTED_ FD=RES: (INDICATE
$35.50.
BATH SINK"V
—FLOOR DRAINS
SHOWER
— SW[Ml�G POOL
WATER PIPING
! WATER SO ($35)
�
BATHTUS
— AS PIPING (]NEED CITY LIC)
WATER CLOSETT
PER
__ BACKFLOW PREY. ($15)
CLOTHES WASHER
—G
KITCHEN SINK
TRAY
WATER HFATE(5'35)
FOR IRRIGATION
OTHER
DISHWASHER
—LAUNDRY
WA7 ER METER
Number of fudum @ $10.00 2-x $10-00 = $ iD
Number of fixtures @ $15.00 _ x $15.00 = $
Number of fmWm @ $35.00 x $35.00 = $
State Surcharge
(AGNUMM $:iS.SO "rota! = ai .
THIS IS AN APPLICATION FOR A PE RwT--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
and o � Fridley
and with the a start wltho�pelota on site•, mat thon e work will be er acndd this
rdan is
not a permit but only an application a permit Of plans.
with the approved plan in the 1 ich res review and appro/ DATE_I
�
SIGNATURE OF APPLICANT
PRINT NAME l�GR, �/� r
Xj I AtJ
City of Fridley
BWIding Inspections Department
6431 University Avenue NE, Fridley, UN 55432
763-572-3604
FAX: 763.502-4977