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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N® 4 4 5 5 Date: ..._.._..........._........ ____....... .__a.__ ........... .............. Owner: _.... .._.......... _ - . Builder -----------------........-...._._.__..._._... _ Address............. ......._.._...... Address .................. --._............. - - :...._......_.... /'`j J-- 1.096 -TION. OF BUILDINGNo. I7...../. ,, -.. Street _......rte........._.V. I:...... A --- - Part ;fLot . - ...................... _ Lot ........ _ ................. Block ..... ... .. ................... Addition or Sub -Division .. _.. - - .. ------_------------------ Corner Lot- .................................. Inside Lot ..... _.....�............... Setback ... ..........-... ideyard....._..y�.._---------..._.......--•-------------------------•- SewerElevation .._._ ................ _............................. .............................. ................ - Foundation Elevation----------••------------------------••------------.........................._......._...._.. DESCRIPTION OF BUILDING To be Used z % y� ------------ Fro t ��_1q.a.�,.7 Depth %/?. �V Height ., 1�..__.. Sq. Ft.�A _'Cu. Ft.1/ ..............------ --......................_..........Front ........................ Depth ........... ... ei ht ... ...... Sq. Ft. .....__._........_.. Cu. Ft. .................... ... .... Type of Construction ........ �llZ� , .. �— �..... Est. Co'st...._.........._®...._........... To be Completed .................... ........................... TI THIS PEFdFMT DOES NOT AUTH.00:IZE V(OLAT- ION OF ANY PRLVATE LAND COVENANTS AND BUILDING RESTRI.MRS. 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 inco liance with all provisions of ordinances of the city of Fridley. ......._....... !'�-'......_.... _.............................. _ --- In consideration of the payment of a fee of. ._.....-....:.., permit is hereby granted to ..... ............ ................._......................_.. ...�.�.......... .._........... _..._.._....... -._ to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of 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 vioT of any of the provisions of said ordinances. /") J?/1 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. City of Fridley, Minn. BUILDING PERMIT l� Date: ....._. _.._ - - _...... Owner: ...�.. _. ..............."....�1'".�... Address ....---...._..----__.__...._.............. .................. .._._.__. .._._._.__�.... N® 4456 Builder.......�lC.-1......... X.t ............. -.... _...... _ ............ .... ...... _........ Address ............. _....... ................................................ _...... --•.................... - -- LO T O OF BUILDING No.f /11 - . Street. - - ��••.••.........................._.............. Part of t1.2 ............-- --.... - - Lot..../.. `�..._.__....... Block ........_.._........ _..............._.. Addition or Sub -Division ._.. CornerLot .................................... Inside Lot ....................................... Setback ... ._.................... Sideyard ............_............._-............_... _..._.. Sewer Elevation....._............._............._........_..._..........................................._........ Foundation Elevation DESCRIPTION OF BUILDING To be Used as: - -- Front �� Depth.7. ..1e Height .. .�......... Sq. F , 5.' Cu. Ft.`%.`���.... . ..... ............................................ ...... Type of Construction Font ....._.......................Depth .............. H i�/ht .............. ®® � �... ................__.................. st. Cost_. _.._...._....._..... Sq. Ft......................... To be Completed ..... Cu. Ft. ........................ _............. -....................... CAUTION THIS PERMIT DOES NOT AUTHORIZE VIOLAT- ION OF ANY PRIVATE LAND COVENANTS AND BUILDING RESTRICTIONS.. 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 compl$ance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $..... ......................, permit is hereby granted to ..... ............ ................. _......... ............._. ______.___.........._....._................. ......... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of 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 e provisions of said ordinances. -I A n 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. 4 City of Fridley, t t Date: June 15, 1965 Owner: Bradley Builder General Improvement AddressX916& St. N * E. Address LOCATION OF BUILDING No. Street Part of Lot Lot 10 _ Block 10 Addition or Sub -Division ode Park Corner Lot Inside Lot Setback Sideyard Sewer Elevation Foundation Mevation To be Used as: Front Depth Height Sq. Ft Cu. Ft Front Depth Heiglit Sq. Ft Cu. Ft Type of Construction Est Cost _. 1500000 To be Completed Repair Storm Damage 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 comp - ce with all provisions of ordinane�a of the city of Fridley. > In consideration of the payment of a fee of $ 10 00 , permit is hereby granted to Geneml Iffiprovemen't, to construct the buil _ the express condition that the person to whom it or addition as described above. This permit is granted upon work done in, around and upon said building, or any pargranted the a f, shall coonfformhis agents, inin all respeec.�tsd to tthhe ordinaen, in nces of Fridley, Minnesota location, construction, alteration, maintenance, repair and moving of buildings �city limits and permit may be revoked at any time upon violation of any of the provisions of said Alen Jensen - Building Inspector NOTICE: Uls permit doss not ower the construction, butallation for wiring, plumbing, gas booting, seww or wator. Be are to no tb• Building impeetor for separate p•rmHs for tbow Hems. OWNER'S APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, NMMSOTA �- - - - BUILDER ADDRESS ADDRESS � a "!��— 'LOCATION OF BUILDING No. Street Part of Lot. LOTSBLOCKADDITION 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: Front Depth Height Sq. Ft. Cu. Ft. Front Depth �Height Sq. Ft. Cu. Ft. Type of Cdxtstruction_',el Estimated Cost���' To be coriiplet6d-- The undersigned hereby makes:application for a permit for the work herein specified, agreeing td`do all work in strict accordance with the City of Fridley Ordinances and rulings of the Departnient'of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATES® ,SIGNATURE (Schedule of Fee Costs can be found on th Reverse Side). 4 0 r37//0 City of Fridley, Minn.. iN° 9165 BUILDING PERMIT MARCH 23, 1967 Date: Owner: FLOYD BRADLEY Builder FRANKLIN CONSTRUCTION CO. $ INC. Address _ r Address 2611 EAST FRANKLIN AVENUE MINNEAPOLIS, M MSOTA LOCATION OF BUILDING No. 5916 Street — Zi Street N. E. _ _ Part of Lot 11, all Qf Lot 12 and part of Lot .___.13 --- Block 10 Addition or Sub -Division ... - XM HYDE PARR Corner Lot _ Inside Lot Setback — Sideyard -- Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: REPAIRS AFTER Fnt _ Depth Height Sq. Ft. _ _ Cu. Ft' Front Depth Height Sq. Ft. Cu. Ft Type of Construction FRAME Est Cost _ a 000_ __ To be Completed In consideration of the issuance to me of a permit to eruct the building described above I agree to do the proposed work in accordance with the description abov t forth and in compliance with a'II ovisions of ordinances of the city of Fridley.17 In consideration of the payment of a fee of $ 6.00 , permit is hereby granted toii"K6111 CONSTRUCTION CO, 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. CLARENCE BELISLE Building Inspector NOTICE: This permit does not cover the conatrucdon, installation for wiring, plumbing, gas heating, sewer or water. Be sure to nee the Building inspector for separate permits for these item. APMICATION FOR BUILDING PERMIT CITY OF FRI.DLEY, MD MiSOTA OWNER'S NAME . ADDRESS ADDi.Ess 26 14 - LOCATION 0# BUILDING NO. ®�r S REET �/�� PART OF LOT LOT_ A-� -/ # LOCK ADDITION'bR SUBDIVISION S 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. To Be Used Ad: DESCRIPTION OF BUILDING Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. o � Type of Construction : � , stimated Cost /a To Be Completed � �;; -23 The undersigned hereby makes application for,as rmit 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. �� � -3 DATE SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). I CITY OF FRIDLEY INSPECTION DIV, Effective On January 1, 1995 6431 University Ave NE Fridley, MN 65432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance 16,0-0 State Surcharge $ .50 I C' I-, SIGNED By TEL NO.Se4 (o -W4 8, — Approved BYO— Rough–In Date Final Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 TOTAL FEE $ PLUS THE $.50 STATE SURCHARGE -(/ ZaT Wa%r Stories Urinal Basement Floor 1 Floor 2 lath Vii-giiii.411111" Shower Wash T ray M11, JI Floor Auto. r Washer N Wfil 5;_ IN Gas Range Water M er ater Gas Elec 7 Floor 3 Floor 4 PH MIN MW I fl: i:. 1, MIR PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 561 I LP Z'/ -Z New Fbdures $7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, Now Fbdure $4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $6.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $7.00 and representations stated in this application are true and correct. Catch Basin $7.00 4 - 2,q Rain Water Leader $7.00 1199< Sump/Receiving Tank $7.00 Water Treating Appliance $10.00 Owner Water Heater –Electric $7.00 Water Heater – Gas $10,00 1ID'o-O Building Used As Gas Range Gas Dryer $10.00 $10.00 Estimated Cost PERMIT NO. Back Flow Preventer Required )Yes No nn Type $5.00 PLUMBING COMPANY :jjpp] u� Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance 16,0-0 State Surcharge $ .50 I C' I-, SIGNED By TEL NO.Se4 (o -W4 8, — Approved BYO— Rough–In Date Final Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 TOTAL FEE $ PLUS THE $.50 STATE SURCHARGE -(/ ZaT CITY OF FRIDLEY INSPECTION DIV. Effective On August 1. 1!_,9S 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Residential Rate TOTAL Furnace Shell and Duct Work, Burner - Also Replacement Furnace $ 30.00 $ (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace) $ 10.00 $ Gas Range $ 10.00 $ Gas D yer $ 10.00 $ *Air Ccnditioning - All Sizes $ 25.00 $ All Otl•ers/Repairs & Alterations (LIST ON BACK) 1% o! Value of Appliance or Work $ Commercial/Industrial 1.25% of Value of Appliance or Work $ 26.25 Install owner furnished rane hoods vent caps and range exhaust tate Surcharge $�50 ducts TOTAL FEE MINKQM FEE FOR ANY HEATINGICOOLINOIVENTILATION REFRIGERATION/AIR CONDITLONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSFECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. JOB ADDRESS 5916 2 1/2 Street N.E., Hyde Park #1 Units 1, 2, 4 and 7 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 ar:, rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. 10-2-95 t OWNER Anoka County Community Action Program BUILDING USED AS dwelling ESTIMATED COST 2100.00 PERMIT NO. C-� f DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU . HP EDR Fuel Total Connected Load Burner Trade Name Size No. BTU - HP EDR HEATING CO P NY B ' ine Heating, Air Cond & ELect 3 Central Avenue N.E. Anoka Signed. By_ `No. 757-6200 Approved Rough -In Date Final Date FILL OUT BA IDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE SUBJECT PERMITNO�. City of Fridley 792 AT THE TOP OF THE TWINS BUILDING PERMIT r _ COMMUNITY DEVELOPMENT DIV. L PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-Ft5 10/10/95 JOB ADDRESS 5916 2 1/2 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9110,11 10 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Anoka County Community Action 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Hunerberg Construction 13705 26 Ave N, Plymouth MN 55441 553-0062 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Apartment 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Building 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 7 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 $2,900 $1.45 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THEPERMIT FEE SAC CHARGE PRO ISIONS ANY OTHER STATE OR LOCAL LAW REGULATING CON- $74.7r5 `Y Fire SC $2.90 STR N O HE FORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE $ 79.10 SIGNATURE FCO .RACTORORAUTHORIZEDAGENT (DATE) WHEN PROPER VALIDATED THIS IS YOUR PERMIT BLD99 INSP DATE S.GNATURE OF OWNERIIF OWNER BUILDER) (DAT EI Prepaid Plan Check $ Estimated Cost $ Receipt # �37 7 7 R-3, (7OMMERCWi & MUSM AL BUIi])INC PERWffT AIPPUCATION () ./ Construction Address k 1 r mal Tlacrri rst-i nn Effective 8/1/95 TYPE OF WORK [] New [] Addition �[] Alt�r� n -Describe .0 Applicant Signature ffiUQDING DIMENSIONS op / Width Height Sq. Ft -3b # of Stories r & Length - OFC. AREA: Length Width WHSE AREA: Length Width OnM AREA: Length Width Height Sq. Ft. Height Sq. Ft. Height Sq. Ft- VATITInnCK Sq. Ft. X $ CAst/Sq. Ft. = Valuation $ ) c� �o Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) _ $ /®®i i Sq. Ft. X $ Cost/Sq. Ft. = Valuation $ ) IOIAL VALUE Building Use Construction Type Occupancy Group Air Conditioning []Yes []No Fire Protection Provided []Yes []No performance Bond Amount $ See Reverse for Schedule Received []Yes Permit Fee $ Plan Check $ Fire Surcharge State Surcharge $ S SAC Charge $ Erosion Control $ Park Fee $ Spec. Assessments $ Driveway Escrow $ SAL $ []No See Fee Schedule on Reverse Side In Excess of Prepaid Amount - See Reverse Side .001 x Permit Valuation (1/10th %) $.5o/$1,000 Valuation (See Sched. for > $1 Million) $850 per SAC Unit (Plans to MKCC for determination) $450.00 Conservation Plan Review Fee Determined By Engji rneri M Agreement Necessary [] Not Necessary [ ] feet x $13.50/foot City of Fridley SUBJECT 2382 AT THE TOP OF THE TWINS BUILDING PERMIT • _ COMMUNITY DEVELOPMENT DIV ~ PROTECTIVE INSPECTION SEC r NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 10/19/95 JOB ADDRESS 591.6 2 1/2 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9-11 10 1 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Anoka County Community Action Program 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO- Hunerberg Construction 13705 26 Ave N, Plymouth, MN 55441 553-0062 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. Darwin Windahl 535-3007 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING 7 Unit Apartment 7 CLASS OF WORK ❑ NEW ❑ ADDITION CK ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Interior alterations 9 CHANGE OF USE FROM TO STIPULATIONS See notations on spec sheet. SEPARATE PERMITS REQ1 SIRE AF ®SIGNS° HEATING, PLU. rVIB1NG WIRING,. 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 MOT. 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 7 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 @ $50,100 $25.05 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 $377.65 $1,033.80 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) eJ WHEN PROPERL ALID TED THIS IS Y{qOUR+ PERMIT ' BLD INSp / y GATE SIGNATURE OF OWNER IF OWNER BUILDER) (DATE) Prepaid Plan Check $ L -7 6--timated cost $ Receipt # Construction Address Legal Description R-3, MWARCIAL & INDUSHUAL WIN TYPE OF WORK [] New [] Addition Alteration Effective 8/1/95 --50Y Applicant Signature -JZ� Tel # Date BUILDDU DIMENSIMS Lezrfth WidthHeight­_ Sq- Ft- #.Of Stories OFC. AREA: Length Width WHSE AREA: Length Width OTHEP, AREA: Lexrfth Width Height Sq. Ft. Height Sq. Ft. Height Sq. Ft. A VAUFMCK L, Sq. Ft. x $ Cost/Sq. Ft. = Valuation Sq. Ft. x Cost/Sq. Ft. = Valuation Sq. Ft. x $ Cost/Sq. Ft. = Valuation TOTAL VALDE Building Use—Af h5 Construction Type jz:4, � Occupa a -ow Alr Conditioning []Yes [ ]No Fire Protecti-on Provided []Yes []No Performance Bond Amount $ See Revexse for Schedule Received []Yes []NO Permit Feed -100 - Plan $ Fire State &=charge$ SAC Charge $ !!nv Erosion Control Park Fee $ Spec. Assessments $ Driveway Escrow -;IUM $ &_:, E 5-1, � /03.3.4a0 See Fee schedule on Reverse side In Excess of Prepaid Amount - See Reverse Side .001 x Permit Valuation (1/10ta %) $.50/$10000 Valuation (See Sc4ed. for > $1 Million) $850 per SAC Unit (Plans to MWOC* for determination) $450.00 Conservation Plan Review Fee Determined By &q�ring Agreement Necessary [ ] Not Necessary feet x $13.50/foot Building PI.,UMBING. Permit No.: W F -0000 q Inspections COMMERCIAL APPLICATION Rei B : 0 763-572-3604 CITY OF FRIDLg�EY Da e 1 y� DATE Q YeUR E-MArL ADDRESS SITE ADDRESS 110 a 4"I e e t,) &, TENANT SUITE NO. PROPERTY NAME: OBER/ TENANT ADDRESS: CITY STATE ZIP PHONE: CONTRACTOR NAME: SUBMIT A COPY OF STATE LICENSE #_ EXP DATE L� YOUR STATE ADDRESS: c� 0 1!54-m /Or,CITX r STA ZII �t LICENSE WITH PHONE 65 -, FAX (fit APPLICATION PERMIT TYPE O INSTITUTIONAL 0 MULTI -FAMILY ❑ SWIMMING POOL ❑ TOWNHOUSE )ff­COMMERCIALNDUSTRIAL ❑ OTHER TYPE OF WORK.' ANEW 0 REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK P - P7- aJve _ W, I L III -it 0r Iir V,_ c ig—e . est r FIXTURES: (INDICATE TOTAL NUMBER OF EACH) CLOTHES WASHER _ FLOOR DRAINS RPZ VALVE —URINAL DISHWASHER GAS PIPING BACKFLOW PREY. WATER HEATER DRINKING FOUNTAIN T GREASE TRAP —ROOF DRAINS _ WATER METER —FAUCET _ KITCHEN SINK _ SHOWER _„ WATER PIPING FLAMMABLE WASTE TANK — LAUNDRY TRAY — SLOP SINK —WATER SOFTENER —LAVATORY _ SWIMMING POOL _ WATER CLOSET Total Job $143(-oj 00 All fees are based on valuation, including the cost of labor and materials. Valuation Permit Fee $ 35, M (1.25% of Job Valuation / Minimum fee: $35) Surcharge $ 03-3 Valuation X.0005 Total Due $ Make Checks Payable to: City of Fridley 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 reequmfeview and approaval of plans. O e, I if / `_ L`S I I/l NAME OF APPLICANT) / �f v� DATE + SIGNATURE OF APPLICANT A111a4,P f PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR BUILDING ELECTRICAL AND MECHANICAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-5024977 V W