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PRE 2010 DOCSPERMIT . 13'763 M SUBJECT City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT � RECEIPT N • COMMUNITY DEVELOPMENT DIV. 1 �y-------� r � � PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 %`� NUMBER REV. G DAI9/16�7V PAGE OF APPROVED BY ---- 612 -NO -3450 910-F15 JOB ADDRESS 5180 3rd Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION JJjj SEE ATTACHED DESCR. 2 Carlson's Summit' Manor tJA AJ_x )L �tl� SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE James Lund Construction, Inc. 2417 148th Avenue N.E. 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 residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK ` construct 241 x 40'4" House with 26 x 22 arae �""� VIA 00 CRY * ° � DIM NOT WAI MM TH8 � 9 CHANGE OP USE TSREMOY 4°:��°rimemY � �" STl`PULATIQ�NS Sewer: Approx 9' Deep 1. Provide truss design 140' North of manhole (Inv. 832.33 2. Provide vapor barrier in the Ceiling Wye Elevation 832.61 3. Call for insulation inspection Top of Footing 835.90 (Minimum) 4. Provide a verification survey before capping 5. Sod the front and side yards 6. Provide a hard s urface driveway WATER: 10' North of sewer service IN+ f�+ ON*` T � PERMITS , F(EgN. C� .11WR tIRIMe � � ,_ ` �° _ SVS LA ��lE�� P� Q�iRE�gY TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. wood framp 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 COMMENCE;@� OFFSTREET PARKING NO. DWLG. UNITS 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 4? C WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT Not .27.5, 16.14 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. 99.44 350,0.0 %b� AN CHECK FEE 24, TOTAL FEE 490.44 86 SIGNATUR CONTRACTOR R AUTHORIZED AGENT IDA 1 '� WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT � BLDG INSP DATE IGNATUREOF WNERIIF`� ERBUILDERI DATE I PERMIT . 13'763 M Ca o0V5 E 0V Z J 1 f E V FOR: LVttd Cons--ruc-} ion, Inc. 118.14 iF--- �2z 11S° 14 791 FA o Dertar!- S iron monumenA- WrR G ..�� ` THE 6RIDL�I ENG MeftVRECTIKOQASQC� A` CIlI heal utilit<es TIFY RB �VISI®N F �Q�LA�E ENS�� BYfi �ygWAY QpEN1 at c�scrip-'cion = lob 2, BfoclZ - LAW 2, CARLSO'M'S SUMMIT MANOR ° ANNEX SECOND M)M'TIMA, Anoka. Cou e,-�-y , M inneso�u. • UM Coy apMooDogS "of GUAR/ .THE AND ELE1IOON& ' ACCt� OF' MW ��pNLY ANJ IM > VM004A Lkwo f SM0 VMT IN RNU!►1t0�1 GIN tNE Si18 . I hereby certify that this is a true and correct representation of a survey of Job Pdo_ the boundaries of the above described land and of the location of at! buitdinc;, Q�iw-...5 " C;APPt�L if any, thereon, and all visible encroachments, if any, from dr on said land. L; �t'1D CURVE ,'C)nS INC. Bo :k — Page As surveyed by me this 1 '{- day of SSP + . , i3�a - �C rJ Harbor Lane MU 55441 �r-.r-.�-�-�:E _ .�1 �.��:��. scale Minn. Rea. ado. in C,qf,p.eo,y, A). F /;?, tj, YO 9 0 7-f l 0 ' I� , o F' � �w � X, ,eviec V , �Ut Al 4% L9 APPLICATION FOR RESIDENTIAL, ALTERATIONS OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINN9SOTA 041NFR,'S NAM: JAMES LUU2 CQ ST-,Twr, BUILDER:. JAMES LUUR CONS:,, JUS.,, ADDRESS : 2417 14Uh..ag n- o. - �a ADMWS: 2117 ld&th Ago- U- F- Av►eba Minn. 55303 CORM LOT :IM LOT;x x . , S ETBACK: ;51 SI DEYARD : AptjvAmt attach to tbU f4j= io Certificates of Surv2X of Lot and proposed .IdUS location drwa 4= the" Certificates, DESCRIPTION OF BUILDING 9rw y dweZting ?=Wotl 24' Depth: 4014 0 jeL&ht: 12' Square Feet; � 9J7.92 Cubic Vveti ( x nceude6 a 6o yeA o6 6' x 10' ) GaAagg Front: 26' Depth; 22' Height: 8' S""jt�1.w e i■ a - 'ware Feet; 572 Cubic Feet: Tyfe of Constructions FA=m Estimated Cost:, $ 37,000.00 To So ikPm Igted; 1L tZ 7 7 ,,.. The undersigned hereby makes application for, a permit for the work herein *pecifiad„ agreeing to do all [pork in sttict accordance with the O ty of 41. or4tpances 404 XUUASS of the Department cif Buildl.ngs, mW hereby slareo tj4at all the facts and representations stated In this application axe true =4 correct, DATS's 1 2/ 14476 SIGNA i (gee Rawwoe Bite For Add#tlonal. `f y 9: yzl S 14<: 39-01 e v 1 ) gri/u 4 4ridW 3 d Maji®E �f-s peoeg'-j 7WZ CSE[<ciJC, 3-) a� it i x 4 — — -- -- -- 1000 ,I it 6 kop Y --j 1-0 YP -t- CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FI'TTIN'G PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. m m U N=ber Fixtures y U $3.00 Water x $2.00 Nf-w Fixture, Old Opening x ~+ c ox m o $5.00 J e, w c 100,000 BTU to 199,000 BTU Heater x $10.00 water Softener x $7.00 New Ground P -n Old Building r, J $5.00 n s x $5.00 .vi U V u t, .moi L G WC U Eel o o " `r' ro roa $4 ' oe N roc 1� N m VI M Uf -+ N m .0 v 4 � •c+ 0 rL w .4 w rd v q .t X 0 � 0 0 ,as 'lee (a to M is let l 1 2nd 3rd -th (R) = Future Connection Opening Connected with Sewer (*) _ New Fixture, 0'_d Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE N=ber Fixtures x $3.00 Future Fixture Cpening x $2.00 Nf-w Fixture, Old Opening x $2.00 Catch B."in x $5.00 Water Heater - to 99,G00 BTU �_ x $5.00 100,000 BTU to 199,000 BTU x $10.00 water Softener x $7.00 New Ground P -n Old Building x $5.00 Electric tsater HeAter x $5.00 GAS FITTING FEES: 1st 3 fixtures 1 x $3.00 Additional Fixtures x $1.00 Gas Range to 199,000 BTU x $10.00 REPAIRS $ ALTERATIONS First $100.00 $5.00 each add. $100.00 or fraction $2.00 State Surcharge TOTAL FEE $ J_00 $ REINSPECTION FEE ($10.00) ��^ Job Address J / ' Departmont of Buildings ' City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and tereby declares that all the facts and representations stated in this application are true and correc Fridley, Mn. /,0//7 -, 19 KIND OF BUILDING USED AS L TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERvIT NO. PERMIT NO. 6720 Company Signed By Tel. No. `" J ROUGH INSP. Date FINAL INSP. ��- 3O Date APPROVAL FOR PERMIT a1-11?, MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARIM AIR: RATE TOTAL Furnace Shell & Duct Mork $12.00 $ :e: lac_ ant of Furnace 7.00 $ Repairs & Alterations-up•to $500.00 7.00 $ Repairs & Alterations each add. $500.00 4.00 $ NIECI-UNICAL iiARM :LIR: Furnace Shell & Duct Work to 100,000 BTL' $12.00 $ each ad--. 50,600 BTU 4.00 $ Replacement of Furnace 7.00 $ %�e. airs & Alterations -up to $500.00 7.00 $ Re: irs & Alterations each add. $500.00 4.00 $ STck�1 OR i i. T 1tiATi:R SYS i 01: Boiler & Lines up to 100,000 BTU $12.00 $ each ad: :n. 50,000 BTU 4.00 $ Boiler only up to 100,000 BTU 7.00 $ each addn. 50,000 BTU 6.00 $ OIL BURNER- to 3 gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $ Q p0 GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $ (over 199,999 B:J see Fee Schedule) $ GAS FITTING FEES: Ist 3 Fixtures x` $ 3.00 $ J Additional Futures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00 $ AIR CONDITIONING �! $ FAX HEPATING SYSTEMS See Fee Schedule $ VENTILATING SYSTEMS $ ALTERATIONS & REPAIRS- � $ State Surcharge $ .50 TOTAL FEE $ V 5-6-0 ROUGH INSP.- Date F na-, I\SP. : j� - '? 7 Date �1_1 1101 APPROVAL FOR PERMIT REINSPECTION FEE ($10.00) MI\L%XX FEE FOR ANY HEATING PER.v'JT IS $7.50 Job Address -6-,l v el Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work, in strict accordance with the City Cedes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. n OWNER L KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST ®/ OLD - NEW BUILDING PERMIT NO. PERMIT NO. J DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, arm Air No. �y -• �� 7 Trade Name i Size No � Capacity Sq. t. EDR BTL' �j H? Total Connected Load 7 j &CC) _ Kind of Fuel / /f: I'. BURNER - Trade Name L+ Size No. J Capacity Sq. Ft. EDR BTU F.? Compan,y/_ Signed By � • Tel. No. !Z1? /7// SUBJECT PERMIT City of Fridley 18598 AT THE TOP OF THE TWINS BUILDING PERMIT _ RECEIPT NO. i L'_ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 55�� i i1 ` "1,� CITY HALL FRIDLEY 55432 NUMBER REV, DATE PAGE OF APPROVED BY ..•_� L 612-571-3450 910-F15 18/15/86 JOB ADDRESS 5180 - 3rd Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 2 Carlson`s Summit Manor Annex 2nd Addn. SHEET 2 PROPERTY OWNER MAILADDRES$ ZIP PHONE Gary Hargreaves 5180 - 3rd Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Aladdin Pools 3901 - Central Avenue N.E., Mpls. 55432 781-5041 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 QX B DESCRIBE WORK Construct a 16' x 18' x 33' Kidney Shaped 1`n -ground Swimming Pool (171000 Gal.) 9 CHANGEOFUSEFROM TO STIPULATIONS See letter dated August 15F 1986 for stipulations. W=Nrj Mm i (��1j1�`g��itt i3�11 �Fy4�f M3UVTlL�';•ry�Lar.L4-1tY11V149��p��1[s�s' D BY UiREDFOR SEPARATE PERMITS�EMBING HEATING, P AND SIGNS. WIRING? 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 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 $12,000 $6,00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRIESME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS O AN OTHER TE OR LOCAL LAW REGULATING CON - $92.50 RUCTION T ERFO CE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $98.50 SIGNATURE OF CONTRACTOR OR Atr HORI2EDAGENT IOATEI WHEN PROPER VALIDATED THIS IS YOUR PERMIT BLDG INSP DAYE SiGNATU RE OF OWNER IIF OWNER BUILDER) (DATE) A � d.5 CIIYOF FRIDLI✓Y CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450 August 15, 1986 Aladdin Pools 3901 Central Avenue Minneapolis, M 55432 Re: Swimming Pool Construction at 5180 - 3rd Street N.E., Fridley Dear Sirs: This letter is to make clear this department's requirements for the swimming pool construction at the above address. 1. As indicated, one (1) skimmer approved by the National Sanitation Foundation will be provided. 2. As indicated, three (3) inlets of approved design for fresh and/or repurified water will be provided. 3. As indicated, a main drain of approved construction will be provided. 4. 7he filter and pump shall be approved by the N.S.F. and be of sufficient capacity to provide a minimum turnover of at least two (2) times in 24 hours. This department recommends a . turnover rate of 6 - 8 hours. 5. A deck of at least three (3) feet wide, measured frau the pool waters edge, shall be provided which extends completely around all private residential pools. Above ground private residential pools may be provided with decking of a minimum size of 4 feet by 4 feet at pool entry points and provided that such decking has the approval of the City. 6. The diving area will be acceptable provided there �s no overhead obstruction. 7. Fencing or other effective means including but not limited to walls or buildings, acceptable to the City, shall be provided to positively control all - access to public and private residential swimming pools. Fencing shall meet the following criteria: (a) The fencing shall prevent the entrance of children and be without hand or foot holds that would enable a person to climb over it. (b) The fencing shall be at least 6 feet high and entrances shall be equipped with self-closing and self -latching gates capable of being locked. (c) Self-closing and self -latching devices shall be placed at the top of the gate or otherwise inaccessible to small children. (d) The opening between the bottom of the fence and the ground or other surface shall be not more than four inches. August 15, 1986 Aladdin Pools Re: 5180 - 3rd Street N.E. Page 2 8. An automatic chlorinator should be provided with a suitable test kit. 9. All electrical and plumbing installations shall be inspected and approved by the City Inspection Department. 10. All overhead electrical lines must be a minimun of 10 feet horizontally from the pool surface, and 18 feet straight line distance from the waters edge. An alternative is to bury said lines. 11. The pool fill spout must be protected by a vacuum breaker or air -gapped. 12. Suitable safety equipment to include but not limited to a ring buoy and rope that is 11/2 times the pool diameter and shepherds crook pole must be provided and maintained with the pool at all times. Furthermore, these and any other requirements must meet the provisions of the Fridley City Code, Section 115, Swimming Pools. the building permit is approved contingent on final inspections and approval of the City. If any questions or problems arise frau this letter, please feel free to contact me at 571-3450. Sincerely, i DGC/mh CC: Gary Hargreaves 5180 - 3 rd Street N. E. NEW [ ] City of Fridley Effective 4/1/86 ADDN. [ ] �R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: Legal Description:_ Owner Name & Address: Tel. # Tel. 4 14 / Contractor: - - Address: / � 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 • Le Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [ ] Inside Lot [`] Ft. Yd. Setback _ Side Yard Setback '14 Type of Construction: Estimated Cost: $ Approx. Completion Date: �,-Z'5G)ZZ6 Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation DATE: %y APPLICANT. � � � Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL Tel. L` 's 6 6f /1 CITY USE ONLY 4so Fee Schedule on Reverse Side $ 0 ' 25$ of Building Permit Fee $ &,00 $.50/$1,000 Valuation $ $475 per SAC Unit $ Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ STIPULATIONS: �;�,r� 10i (, 6a SUBJECT ER2 City of Fridley 6 6 0 0 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV./� _ b PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBERREV DATE PAGE OF APPROVED BY 612-571-3450 910415 98 JOB ADDRESS 5180 3rd St. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 2 lCarlson's Summit Manor Annex 2nd Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gary Hargreaves 5180 3rd S 572-1087 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Owner 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 CR REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house and Rarapze 26 SO 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 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 216$ $1.08 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. $74.75 Fire SC $2.16 PLAN CHECK FEEL FEE GN uRE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI E VAL ED THIS IS YOUR PERMIT PROY E OF OWNEROF OWNER BUILDERI IDATEI G INSP �1�TE NEW [ J Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY -AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION CA W ConstructionAddress: :5-11 P<D -3� -51,-Ff, J ke Yl -.j Legal Description: Owner Name & Address: &-2�:j HCLA6RecLuE 5 -5126 5r Tel. # 5--2,-)_-16d97 Contractor: wv KUB MN LICENSE # Address:. Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: ' Length Width Height ` Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: �-5e -Ir-rG��.�e (e�20�t o2�o SAu�� l Construction Type: QOO Estimated Cost: $ -. (Fee Schedule. on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 7" _9 APPLICANT: Tel. # 3 (4-9fg?S' CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ % .001 of Permit Valuation (1 / 10th %) State Surcharge $ 1 D $.501$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 [ J Not Necessary [ ] TOTAL $ r��22 STIPULATIONS: - Engineering WATER AND SEWER Permit No.: 763-572-3551 PERMIT APPLICATION Received By: 763-571-1287 fax: CITY OF FRIDLEY DateRec'd: —7 ( Def EFFECTIVE 6/9/09 APPLICTATION DATE: YOUR E-MAIL ADDRESS: G d THIS APPLICANT IS: ❑ OWNER CONTRACTOR JOB ADDRESS: S - t SO ` `� S- ¢ . C NEW CONSTRUCTION PERMIT# (IF APPLICABLE): PROPERTY NAME:�.% .1la r S OWNER/ TENANT ADDRESS: �CITY STATE ZIP PHONE: CONTRACTOR NAME:' 4__V4 444Z SUBMITA COPY OF YOUR STATE ADDRESSCITY `" STATE e"IP Di-!rjr : 3� ? `� %�"^ �r 3 LICENSE WITH PHONE W z" % Y1- s 7.?7 CELLPHONE: 2-7"-( APPLICATION STATE LIC # STATE BOND: EXP DATE: 1. Narrative/written description: �r 2. Please attach sketch showing curb line, utility line, building, etc. with distances. PERMIT TYPE ❑ SEWER CONNECTION PERMIT $50 ❑ WATER CONNECTION PERMIT $50 ATER LINE REPAIR $40 t ❑ SEWER LINE REPAIR $40 ❑ ADD STATE SURCHARGE $.50 ❑ SAC CHARGE @ $2000 OTHER CHARGES (IF APPLICABLE) PAY TO UTILITY BILLING NEW WATER METER COST — SEE UTILITY BILLING SPECIAL ASSESSMENTS — SEE FINANCE WATER TAP — SEE ENGINEERING NOTE: WATER METER REPAIR, INSP OR SHUT-OFF / WEEKENDS & HOLIDAYS $125/HOUR-BILLED THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a water or sewer (new connection or repair) permit and I acknowledge that the information above is complete and accurate; that the work will be in conform ce with the ordinances and codes of the City of Fridley. I understand this is not a permit but only an application for a permit and s not to without a permit.-Ih / C� SIGNATURE OF APPLICANT PRINT NAME: DATE: APPROVED BY: `' DATE: COPY GIVEArTO: ❑ UTI4ITY BILLING (only if new meter) ❑ PUBLIC WORKS ❑ ENGINEE ING City of Fridley 22 - Engineering Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3551 FAX: 763-571-1287 .. .r, ^ t 1� �.v� 1.:. "u�" :?4,: \'+�' ._.ems' ,.. - �3•'i>�-t. ;::� .. �M "°sF ,r 'vR"' +.:�.. A rig' x:: .. �.r+- y, .. .•JL4.:' ,',. S�i r,i^:.+frS� �`"r.,� ,-.f .h, „ ::r* .,... ..:..:.r r „c :rs w , �,� , .'F,. k• ,..y...-., � ,�. y�.,c•:ia h i. 3� 4 v.. ,•� •�` Y s5 ^M n ylw. � �� ,.,v ,Y+�'' > h .2.cx,. ��, "1 �" ^� �r �f, •J `K . i � lt. ii' i. �• w+ sky, tza, ,-�., ,+. :fL +,Y S,z. 1 •jy{ < , r. t� 4 r n _ S" -:pit . 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