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PRE 2010 DOCS• City oFridley, f FMinn. • BUILDING PERMIT Date: ................. —...... Owner: 1�To 4095 Builder...2.{..... . !a fwd ._.. X. _ ..._. Address....... _....................... _................. _............ ............ _.._._.__.._.......... Address �TI N FBUILDING ._.. No. -!1..... Street _... ... .- --r.......A......... A ............... _....... -..... Part of Lot ..... ......... .......... .._...._.. Lot ....._..1,j .............. Block ............. ..fid............................. Addition or Sub -Division ............ 1 8 1 Corner Lot .................................... Inside Lot .................................... Setback .....3.'..................... Sideyard... .... Lf... -..4..................._.........._._...._.. i Sewe Elevation .... ....9._ -.:. ...7 ............................................... Foundation Elevatlontlr..."$G-c. ......../.6 ............................... ... ................ ?o'oe- S�' -C�'g zez. OF DESCRIPTION OF BUILDING To be Used as: / ...._ ........... Front -_ CR._. ®° �° ' �O - Hei ht r , q. ! �� ® ... p g / l.:........ S Ft. ...... Cu. Ft. .... .... .................. Front Depth vita..'_ H//e��ight/._O.......`.0` Sq. Ft. �. Cu. Ft. �0" Type of Construction ............................................................ Est. Cost ./-5t.1.1"-6 ...0-0 ._ ....... To be Completed .................... -...................... -........ In consideration of the issuance to me of a permit to constru the building described above, I agree to do the proposed work in accordance with the description above set4lrtharAJA co fiance wlt�} all provisions of ordinances of the city of Fridley. _ ., a � �/ // In consideration of the payment of a fee of `.... ... ..., permit is hereby granted ........ .......... __.......... _............. _....... ............... 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. , Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we the Building Inspector for separate permits for these items. RIM Application for Power Plants and. Heating. Cooling, Ventilation, ReMgerd4on and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, 4 Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ... �� .................. 2.00 $ Replacement of Furnace ,§.00 $ Repairs & Alterations—up to $500.00 ... ............ 5.00 $ Repairs & Alterations each add. $500.00 ....... :....... 2.50 $ STEAM or HOT WATER SYSTEM 5.00 Furnace Shell & Lines—to 400 sq. ft. EDR Steam, ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gaL per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $--mo d GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL F= $� � ROUGH— OUGH FINAL— FINAL Dept. Dept. of Bldgs. Phone SU, 4-7470 City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. F Fridley, inn Owner Kind of Building Used as To be 'completed about �9 Estimated Cost, $ Old—New. Building Permit No. 6 �Permit No. DESCRIPTION OF WORK HEATING or POWER PZJUM--Steam, Hot Water, Warm Air—No 167 Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load Kind of Fuer BURNER — Trade Name . Size No Capacity Sq. FL E.D.R BTU H.P. (REMARKS -OVER) Signe By r"427M 7:59 Business Phone No— Application for Power Plants and Heating. Cooling. Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM ATA Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. IDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ GAIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) .................... — 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ REMARKS: DepL of Bldgs. Phones SII 4-74477700 Loca3ion � �( �`` �° /e City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and,,hereby declares that all the facts and representations stated in this application aP6 true and correct. Fridley, 1 gqn 195 Owner _!��LG'uz' 195— Kind of Building Used as 195— To be completed about Estimated Cost, $ 0 �' G/ Old—New. Building Permit No.� DESCRIPTION OF WOR�;; HEATING or PO team, Hot Water, No Trade Name Size NoY� Capacity Sq. Ft. E.D.R Mlt- "� BTU HC.P. Total Connected Load 3! / Of Kind of Fuel Z121 BURNER — Trade Name Size No Capacity. Sq. Ft. E.D.R BTU H.P. 7 11 IM -12-58 POST call Business Phone No—(- • City of Fridley, Minn. N° 7781 BUILDING PERMIT 6 7-3 Date: Jane 9, 1965 Owner: Allen Montgomery Builder Maher and Bergren Address 5841 4th Street N. E. Address 1 West Rd. Circle Pines, Minn. LOCATION OF BUILDING No. 5841 street 4th Street N. E. Part of Lot Lot 13 _ Block 5 Addition or Sub -Division Bennett Palmer Corner Lot — Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth Height Sq. Ft Cu. Ft. Front Depth Height Sq. Ft Cu. Ft. Type of Construction Est. cost 6500, 00 __ To be Completed Storm damage: Reroof and reside 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 andpliance with ;Jl provisions of ordinances of the city of Fridley. r J In consideration of the payment of a fee of $-5,09--,&t is hereby ranted to B��d &her 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, Mr- ota location, construction, alteration, maintenance, repair and moving of buildings within the city limit uns permit may be revoked at any time upon violation of any of the provisions of said ordinances. Men Jensen Building Inspector NOTICE 11ds permit don net corer the candrudhm, hutaii on for whtng, phm►bing, gn henthm nwer or water. Be sure to ne the BWMh* Mqm for for separtle permits for then items. It APPLICATION FOR.BUILDING PERMIT CITY .OV . FRIDLEY, MINNESOTA OWNER'S NAME .� BUILDER ADDRESS_ y �,�! o ADDRESS F LOCATION OF BUILDING No. Street Part oof Lot LOT_ BLOCK ADDITION OR SUBDIVISION;, Corner Lot Inside LQT 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 Dept 4_ Height Sq. Ft. Cu. Ft, Front Depth�Height Sq. Ft. cu Ft. Type;of Construction_ Estimated Cost To be completed 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. DATE SIGNATURE�� (Schedule of Fee Costs can be found on the Reverse Side). 0 I c. y r sr Awls: 75. o �GFvool _ {y /3 .BLoe-,e a 0 �La'V 63, 7 SUBJECT PER City of Fridley 21313 AT THE TOP OF THE TWINS BUILDING PERMIT r _ COMMUNITY DEVELOPMENT DIV. ~ PROTECTIVE INSPECTION SEC. y� / �� NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 4/30/92 JOB ADDRESS 5841 -. 4th. Street NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 5 Bennett Palmer. SHEET 2 PROPERTY OWNER MAIL ADDRESSZIP PHONE Mary Schultz 5841 - 4th Street NE 572-3811 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Milton Johnson Co, 525 Lowe Ave NE, Mpis 55.418 571-9238 2083 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 (22 Squares] Tear -off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment r4uus.t 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. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED, I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,166: $,58 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $ 294 (�O Fire SC $1 17 ST UCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE •3u -� License SC $5.00 $35.75 IGNATUREOFCONTRACTOR OR AUTHORIZED AGENT IDATEI WHE PRORERLY V LID ED THIS IS YOUR PERMIT BLDG )NSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI NEW [ ] Effective 3/1/92 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: �"8 i/ — l ,yG %? • ^-� Legal Description: % /3, A L . S { �3 e ,j oL -z-7-�"iA L rh E- R Owner Name & Address: ii� �a��/�Tel. # S7.T - Sell Contractor: � MN LICENSE # ca?oa03 Address:Tel. # /- Arlo -r 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: o?• 7 .• 0-s A. - - - Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: -=ALr — -�tt " Estimated Cost: $ 3 7 Approx. Completion Date: 116161 Cie? Driveway Curb Cut Width Needed: Ft. + b Ft = (Cost on Back) Ft x $ = $ DATE: 5�'-3o -is- APPLICANT: r Tel. # %7/ -9-6"54dl Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Park Fee Sewer Main Charge $ TOTAL STIPULATIONS: $ 6 . '7 s Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $700 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] y SUBJECT PERMIT NO. City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT Ej- r 16 COMMUNITY DEVELOPMENT DIV. .7] _ L PROTECTIVE INSPECTION SEC. q-2 /'--1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/20/94 JOB ADDRESS 5841 4TH STREET NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 5 I SHEET Bennett Palmer 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Allen Montgomery 58S71-0564 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 B DESCRIBE WORK Heroof 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd layer but not the 3rd. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED, I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX 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 $1,100 • 60 PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $27.00 Fire SC $1.10 PLAN CHECK FEE TOTAL FEE SIG ATUREOFCONTR RA THORIZEDAGENT tDATEI NR01PUkY VALIDATED THIS IS YOUR PERMIT ,7-T skA F Ow OF ER B RI IDATEI BLDG W$p DATE y V NEW ( ) ADDN CITY OF FRIDLEY ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application \Construction Address: Legal Description: xOwner Name & Address: �LLSN S'. / tegrC �� y / �r /✓• Tel. # / XContractor: MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Effective 1/ 1/94 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: of S 6iy t SES / Corner Lot [ ] Inside Lot () Ft. Yd Setback Side Yard Setbacks x Type of Construction: 1?o o F / NG' Estimated Cost: / 1 Approx. Completion Date: (Cost on Back) Driveway C b t Width Needed:�-161pfx$ DATE: Ro APPLICANT: Tel. #-�?l a �� CITY USE ONLY Permit Fee $ o? %< U 0 Fee Schedule on Reverse Side Fire Surcharge $ ,'0 .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $800 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 [ ] TOTAL STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL FEE TOTAL $ 30.6c) 50 MINIMUM FEE FOR ANY HEATING/COOLINGIVENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $26.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr Effective On March 1, 1996 JOB ADDRESS .5-9'-f ( q4_1 GC VF, 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. _ 1996 OWNER BUILDING USED AS tto WLe— ESTIMATED COST a1 -1 0-6 PERMIT NO. 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 1 V-6LIv1_1 Size No. BTU HP EDR HEATING COMPANY S Signed By�C�2� Tel No. �� - Approved By Rough -In Date ``Aknal Datei(l::p *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOR STACK VERIFICATION ON written permission from adjoining property owner. REPLACEMENT FURNACE CF PI MY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 6 Has total heating BTU's of�� All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes ( ) No 8. Has combustion air been provided for water heater Yes ( ) No Remarks: HEATING CO: Signed By: Date: C) 1. Has been carefully examined Yes `P" No ( ) 2. Is free from rust or deterioration Yes,0 No ( ) 3. Has no foreign objects lodged within Yes No ( ) 4. Is securely supported Yes ( No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes () Noj 6 Has total heating BTU's of�� All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes ( ) No 8. Has combustion air been provided for water heater Yes ( ) No Remarks: HEATING CO: Signed By: Date: C) CITY OF FRIDLEY INSPECTION DIV.�'a %�' Effective On January 1, 1997 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, yjfl Z 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES - JOB ADDRESS Sgrl �" �kff RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner - rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 30.00 $ representations stated in this application are t ue and correct. (Side Vent - Fill Out Back) 1997 Gas Piping (Needed with new furnace) $10.00 $ OWNER_ 7q -,41)1 Gas Range $10.00 $ , ;, BUILDING USED AS VA. Gas Dryer $10.00 $ ESTIMATED COST t PERMIT NO. f o G -S �- *Air Conditioning - All Sizes $ 25.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1 % of.Value of Appliance or Work 4r J�vre_ - $ NoN of.Heatin9'Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name lei, C-.1-- Size No. t�� Commercial/industrial HP EDR 1.25% of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge $ .50 Burner Trade Name Size No. TOTAL FEE $aS-S`Z� BTU HP EDR HEATING COMPANY MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION Signed By��-L Tel No. C� L{- f REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr Approved By Rough -In Date Final Date *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE F STACK VERIFICATION ON written permission from adjoining property owner. REPLACEMENT FURNACE Remarks: . List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CHEMEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes () No ( ) 2. Is free from rust or deterioration Yes () No ( ) 3. Has no foreign objects lodged within Yes () No ( ) 4. Is securely supported Yes () No { ) 5. Meets all current Code requirements for size and total BTU's connected Yes () No ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes () No ( ) 8. Has combustion air been provided for water heater Yes () No ( ) Remarks: . List ALTERATIONS Being Done: HEATING CO: Signed By: Date: SUBJEty " MIT NO. --\ - City of Fridley WRECKING 30723 AT THE TOP OF THE TWINS PERMIT r i RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. --- O 1r « � INSPECTION SEC. r E PROTECTIVE ---I CITY HALL FRIDLEY 8.5432 NUMBER REV DATE PAGE OF AOPROVED By L 612-571-3450 910415 3/14/00 10B ADDRESS 5841 4 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 5 Bennett Palmer SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tom Chase 5841 4 Street NE 574-2114 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 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 j7 REMOVE 8 DESCRIBE WORK Remove 24' x 14' Attached Garage (New detached garage to be built in rear yard) 9 CHANGEOFUSEFROM TO STIPULATIONS All demolition debris to be removed from site. Existing garage slab to remain and be a part of the driveway to detached garage. New detached garage to be started by October 1, 2000 under a separate building permit. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OFCONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 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 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 TOT FEE 0.00 F NAT O RA(;TOR ON AUTHORIZED AGENT IpAiE ENP OPE ALIDATE MIS IS YOUR P,£RM II-[_0�1( ; SSG 4TURE OF OWNER JF OWNER BUILDER; IDATEI 81DG NSP TE CITY OF FRIDLEY 6431 University Ave NE Fridley MN 55432 (7 63) 572-3604 Job Address: Legal Descri Owner & Addr Contractor: Tel. Tel. Address: State License # DESCRIPTION OF BUILDING HOUSE: Length Width Height Sq. Ft. Cu. Ft. GARAGE:Length Width l Height1� Sq. Ft. Cu. Ft. OTHER: Length Width Height Sq. Ft. Cu. Ft. Estimated Cost $ Approx. Completion Date Effective 1/1/00 MOVING [ ] WRECKING PERMIT APPLICATION UTILITIES City Water/Sewer Minnegasco N S P U S West NOTIFIED: 572-3529 [ ] 372-4720 [ ] 330-5500[ ] Business -603-6000 Home -244-1111 [ ] Water Bill Paid: Yes [ ] or Collect [$ Moving Route: ] Signature The undersigned hereby makes application for a permit to wreck/move the building described above, agreeing to do all work in strict accordance with the City Ordinances and rulings of the Building Division, and the State Code which requires any water well on the property to be sealed by a State licensed water well driller, and hereby declares that all facts and representations stated in this application are true and correct. ALL Date Signature Moving: Principle Building into Fridley .... $300.00 Accessory Building into Fridley .... $ 42.00 Minimum Fee: $20.00 Through or within the City ...... $ 20.00 Move a building out of City ...... $ 20.00 Wrecldng: For each 1,000 cubic feet or fraction .. $ 1.25 For structures which would be impractical to cube the fee shall be based on the Minimum Fee: $20.00 total cost of wrecking at the rate of $6.00 for each $500.00 or fraction. /s ` 2(jc5 c C tj PERMIT FEE: �r" STIPULATIONS: r 9 Qtl� - 14% ' 07 a v � 1 - zL81/ Sall T. '� SUBJECT City of Fridley 30846 AT THE TOP OF THE TWINS BUILDING PERMIT ` RECEIPT NO. COMMUNITY DEVELOPMENT DIV. SEC. f PROTECTIVE INSPECTION NUM9EA REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 53432 L 612-571-3450 910-F15 4/19/00 JOB ADDRESS 5841 4 Street NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 5 Bennett Palmer SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tom/Bev Chase 5841 4 Street NE 574-2114 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 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 1 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Construct a 32' x 28' Detached Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. See notations on plan. WARNIG SEPARATE PERMITS REQUIRED FOR: Before digging call for all utility location WIRING HEATING PLUMBING AND SIGNS 4540002 REQUIRE® BY LAW 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 $17,338 $8.70 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT `P 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 TOT FEE 9.25 J IX �GNATURE CON' CTO O AUTHORIZED AGENT (DATE E P VALI THIS ISaI R ERMIT ��(( �//�'. SGNaiuRE OT NER OWNER BwLDER� IDATE� f vvv SLOG iNSP Balt NEW IfQ ADDN [] ALTER [ ] Construction Address: Legal Description: Effective 1/1/2000 CITY OF FRIDLEY (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Owner Name&Address: ( pw, + J� S -e— Tel. # (o L%- S'l '�- 04 Contractor: _ ( ) ttt►� er 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 IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft GARAGE AREA: Length Width a: go Height 9 Sq. Ft. in DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: q vwt) ® ll s -s KA aSj c&OA S4 -F! /-73.3 g Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: —Z�) APPLICANT021 Tel. #. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Call (763) 572-3604 for Permit Fees if mailing in application $ Q 93,J-5 Fee Schedule on Reverse Side $ /-7,510 .001 of Permit Valuation (1/10th%) $ . 70 $.50/$1,000 Valuation $ $1100 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: $ 1319.0-5 The Home Depot #2802, 5650 MAIN ST, NE, FRIDLEY, MN 55432, (612 Mon Apr 17 19:22:23 2000 The materials in this garage will cost $4261.24 This I ^ I P Price Ca -4'ot2 4-Q Vt (4 basedo(\ c� I Sa - 51R(o S(Z N x -11 q. :? s'= $ 17 S3 F File saved as: f:\dn\garages\4170104E.GAR Drawing: 3 -Dimensional View (aS _ k a2 E0uWaleit _ frt)vCjg f ropgk `Roa- (i i { Stag RggLNkem4FMT PEt ;4aVK1O4 u�z 4o&R4emJ ujo(3d/f*/E1 III I II11 fl S��' 0? t-�dfQ do' MJjV a aW40C5 Nee LOWS. OV%1 Ce MiN tall T=&W -Eva AA4 9 `WCV_Li M A x &' o e - aCr<< load' �k�1 *'4—�� .90/fS �1i�// �� 69 I w MUF w (A! alF P0244520.BMP 1 Wv ir_ Fode. -07 wq-mss e �LBY X5'3, 7 . rpPos�o err... az V11 - r. %-1ro •`e 45V 43, APR 18 2000 09:13 FR M M TRUSS SPECIAL 715 876 5565 TO FRIDLEY P.01i01 O, it 28S I FAN I 1 I 1 128- STOCK- TOP CHORD SPLICED 54703 a M a bivvtj m, n a usFWs-. ne. on -2-0-0 5-2-8 9-7-4 14-0-0 18-4-12 22-9-8 28-0-0 30-0-0 11I1180- 5-2-8 4-4-12 4-4-12 4-4-12 44-12 5-2-8 2-0-0 a STEPHEN W ••�^' • � �� e�eeeatent►s STEPHEN W,•z CABLER ' m = �.� r......•. 5 4.". ',414 10256 .. %�(S 4x4 t bac, �' 206 12 • '•� • • •'.`� W 5 = ' star 21x3 I I E OF 2)C6 II y/dr10 Att1L4 00 12 5X61:11 4 5x6 •• i-- ''.�N .�..01ANP to s '••....... 'i 3 t it N V j•��Ai1t� 1 to 2 g 9 .•� °R-179�0: `.f -+P 197j -q-' 9-10-4 18-1-13 28-0-0 _ , I) A 9-10-4 8-3-9 9-10-3 LOADING 1paf) SPACING 2-0-0 CS1 DEFL fin) lloc) I/dell PLATES GRIP TCLL 40.0 Plates Increal 1.15 7C 0.91 Ven(LU -0.32 12 >999 M20 197/144 TCDL 10.0 Lumber Increase 1,15 BC 0.97 Vart(TL) -0.61 1012 >545 BCLL 0.0 Rep Stmas Incr YES WB 0.74 Horz(TL) 0.14 8 n/a SCOL 10.0 Code SOCA/ANSI95 I 1 at LC LL Min Well - 360 Weight: 93 Ib LUMBER TOP CHORD 2 X 4 SPF No.2 BOT CHORD 2 X 4 SPF 1650E 1.5E WEBS 2 X 3 SPF Stud REACTIONS (lb/size) 2+1877/03-8, 81877/0.3.8 Max Hort 2-•22(lood case 2) Max Uplift2-•355(load case 2), 8--355(load ease 3) BRACING IPI TOP CHORD Sheathed or 1-9-11 on center purlin spacing. BOT CHORD Rigid calling directly applied or 6-10.1 on center bracing. tF�corC<�` 07 FORCES fits) • First Load Case Only TOP CHORD 1-2=31, 2.9a-3992. 3.4-•3336, 4-5--3336. 6-6m-3336. 6-7--3336, 7.8--3992, 8-9.31 BOT CHORD 2-12=3770. 11-12=2416. 10.11 =2416, 8.10=3770 WEBS 4.12--442, 6.10--442, 3.12--645, 5-12-1131, 5-10-1131, 7.10-•645 NOTES I This truss has been checked for unbalanced loading conditions. 21 This truss has been designed for the wind loads generated by 80 mph winds at 25 It above ground level, using 5.0 pzf top chord dead load and S.0 pit bottom chops deed load, 100 mi from hurricane oceanline, on an occupancy category L condition 1 enclosed building. of dimensions 45 it by 24 it with exposure C ASCE 7.93 per SOCA/ANSI95 If end verticals or cantilevers exist, they are exposed to wind. If porches exist, they are not exposed to wind. The lumber DOL increase is 1.33. and the plate grip increase is 1.33 3) All plates aro M20 plates unless otherwise Indicated. 41 Provide mechanical connection (by others)• o1 truss to beating plate capable of withstanding 366 Ib uplift at joint 2 and 355 Ib uplift at joint 8. 5) This tris; has been designed with ANSI/TPI 1.1995 criteria. LOAD CASE(S) Standard O QRpF ESst REG. N0. 4314 () STEPHEN W. CABLER 1111111 I I ii urrr, a..a ..a•�. a STEPHEN W ••�^' : CABLER �� • E-6200 O ON i 'r STEPHEN W � CABLER _ E-22534 : ST. LOUIS AWAR1 ..4.parart"t.. O.:J40MWfqjAffNTmsANDr1EvLR8@sinsBEFOmusE- (PROFESSIONAL A - 3074 0-%I NVL� P \TH DAK` I hereby certify that tnIs Dian. SW ncaribn or report was Q spar, by Me or undLA to' end that I i�R A" V- n lessionat Engineer unclip the tsar f the State of Minnesota. H t DATE NO 16383 Design valid fat use onry wish Mitek connectors. This detlgn Is based only upon patom*lers shown, and Is to on Inowtdual butdetg Camponenl to be Installed and boded verllco4 APpllcoblilly of de*Ign patomaters and ptop*r inoopoialbn of componenl Is tespont[tiMy at busdfna designer - nos truss dinignes, *toeing shown Is tits bletol support of Individual Wertz members only. Addslonal lompototy bracing to Insute stability eusIng eondnseslon Is the re;pon,JWNry of me *tecta. Addillanal permanonr etacing of the ovetaR tiluclwe Is m• sesponsibNly of the building deslgnet. Fol general guidance tpgardlna fabrication, auapy comics. *lata**, deUoent, erection and braetng, oontua 091.6% Gueilly Sigrid". *Se-ee treeing Sp.eaballon, and Nle -91 Handling Installing and tracing Recommo ddlon ovafotgo Isom Tluss Rale "flute, 393 O'Onodto oil". Madhan, WI 5771 e. ** TOTAL -ra® N1 MiTek® PAGE.01 *� 01 SUBJECT PERM City of Fridley AT THE TOP OF THE TWINS BUILDING PERMITRECEIPT • COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 �---- A- If "'' 612-571-3450 910415 5/1/00 JOB ADDRESS 5841 4 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 6 Bennett Palmer SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tom Chase 5841 4 Street NE 574-2114 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 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 O ADDITION O ALTERATION Ci REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof House (14 Sq) Tear -off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED 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 BO 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 $1 224 $.61 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 _ TOTA FEE $-4,OF.73 i OF CON CT�OR OR AUTHORIZED AGENT IOATEI N ROPE • ALIDAT D HIS IS Y PER IT YSIG � � 77��ft/ `• � �%�j S,G ATUREOFOWNEROFOWNERBUILDERI IDATEI Bl -NSP rIAtE 01 NEW [] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: Effective 1/1/2000 (763) 572-3604 Bldg In Owner Name & Address: dt.' LVl u.S-e: Tel. #_5-0 �[— (—1 f `1 Contractor: 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 IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft DECK AREA: Length --�-- Width Hgt/Ground Sq. Ft OTHER: Q"I—Sl/� w -'a ra P 1 Q -4'. ---T-.a i, r laft M u Construction Type: Estimated Cost: Driveway Curb Cut Ft. + 6 Ft = Ft x $ _ $ `Width '�Needed: DATE:tj 57,t —eVpPLICANT: _ _ � Tel. # CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee Fee Schedule on Reverse Side Fire Surcharge .001 of Permit Valuation (1/10th%) State Surcharge $ / $.50/$1,000 Valuation SAC Charge $ $1100 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 [ ] TOTAL $ -� -:23 STIPULATIONS: Building MECHANICAL Permit No.:- InspectionsRESIDENTIAL APPLICATION xece'.�e By: 763-572-3604 CITY OF FRIDLEY Date 763-502-4977 FAX IEFFECTIVE 1-1-2010 DATE -7 5 YOUR E-MAIL ADDRESS 'I 0Xqj SITE ADDRESS qT P THIS APPLICANT IS: ❑ OWNER ONTRACTOR PROPERTY NAME: Ajalen4140CL E' k9 h I e ADDRESS: 5gq% - r `7 c� 7,,ee_ CITYT 164 STAT4 IP i 5� OWNER/ TENANT PHONE:J& - 5 Is,N '�_ CONTRACTOR COMPANY NAME: C /t CONTACT PERSON: I PP 7I it ✓V - SUBNIIT A COPY OF YOUR STATE LICENSE WITH STATE LICENSE ## - EXP DATE _ a—I NATE%' ADDRESS: �� u;n j2r_ sM ITY &. ZIP'SS36 APPLICATION r/9 -�S / PHONE :1b-3 �I �! gUVCi FAX PERMIT TYPE INGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW LACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) PROVIDE HEAT LOSS CALC'S PER MANUA 2006 ASHRAE HANDBOOK Equipment Installed MFG: MODEL: �� SIZE/BTU 0 —D MFG: MODEL: SIZE/BTU MFG: MODEL: SIZEBTU A/C $25.00 FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 __ AIR TO AIR EXCHANGEER $15 (WOOD) $35.00 NEW GAS GRILL $10.00 _FIREPLACE $35.00 'XFURNACE $35.00 _GAS UNIT HTR $10.00 _BOILER _CHIMNEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00 _DUCT WORK $10.00 GAS PIPING $10.00 _VENTILATOR $15.00 Number of fixtures @ $10.00 x $10.00 = $ Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 1 x $35.00 = $ 3S State Surcharge = $ , -. (MINIMUM FEE $35.50 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 code of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for e d work is not to start without a permit; that the work will be in accordance with the approved plan in the case of al r qu' es view approval of plans. �i Q �� h SIGNATURE OF APPLICANT F PRINT NAME ATE / /6 APPROVAL INSPECTORS'SIGNA DATEAAC C NO : SEP RMITS D FOR BUILDING, ELECTRICAL AND MECHANICAL WORK ty of Fridley Buildi Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 10