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PRE 2010 DOCSCity of Fridley, Minn.. BUILDING PERMIT �o 4 9 0 7 Date: _. _...... Owner: .. ---=-- _...._.-- Builder Address _. �, o _v Address V � U •,--....._ LrO BUILDINGO. FPar tro. �: �l street ..... Block ..........__................. Addition or Sub -Division ... -. .._.._....-.. _. y ........ __.. ... _!... _ ..... Corner Lot ...........l*'+.....---. Inside Lot ....._. Setback ._.._. ' ..... _...... __. Side Sewer Elevation _ ................. _......._....__..........._......._...._............._......_..........._. Foundation Elevation DESCRIPTION OF BUILDING To Used as:e ....... ... Sq. Ft. lvr••� • �� •- '- ------ Front ....��....,-. Depth .....%..._.. Height ...-- --_ Cu. Ft. _.............. ......... ........... ..:_ ...... Fro t ....._..:............ Depth ..._:..4_.jei ht ........:j.� Sq. Ft ....._............._.. Cu. Ft......_...............-- .._,.of Construction _... -------Est. ....... To be Completed ....._............._..._......__....._........ � ..:.......: - ,.fit-��--!-�=----- 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 $. :. ._....:_ ......, permit is hereby granted to. ............ _....-_-..._...._------_-----------._.. to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any ire upeny,gviolatiori-3f my of the provisions of said ordinances. f ��JJ,�/``� j Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas., heating, sewer or water. Be sure to "a the Building Inspector for separate permits for these items. APPLICATION FOR BUILDING PEDW CITY OF FRIDLEY, MINNESOTA Owners Name.0 0 /zBuilder �✓_✓�- a LiLre%, Address 'V Address s LOCATION OF BU=ING No. Street C-� S T IV A5� - - ----P$rt of Lot Lot Block. Addition or Sub.Div. Corner Lot _i ,_Inside Lot _LZ_: 8et Back .3 �S- �` Side -Yard, l �. SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To b used as: Frout 2 Depth 411/ Height 5-e . sq, Ft. Cu. Ft.� Front Depth Height Sq. Ft. Cu. Ft' Type of Construction4.4a�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 Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representa- tions stated in this application are true and o ect, DATE SIGNATURE �`- (A Schedule of Fee costs can be found on the Reverse Side.) r . ► 0 is w o s 4 e Application for Power Plants and Healing. Coding, Ventilation, Refiigeration 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 AIR 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 �• 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 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ t� 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 E . $ J� 1 ROUGH FINAL Dept. of Bldgs. Phone SII. 4-7470 4X6: Location`_ : � 94, . 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. Fridley. Minn. 6 " , 2J- 19 62-0 Owner Kind of BuilZ"-'tz' i Used as To be completed about Oma`'` Estimated Cost, $ o� d--® Old New. wilding Permit No. DESCRIPTION OF WORK HEATING or POWER PL ADTPS--SHot W r, Warm Air= /^/ Trade Name �2 iC/ , Size No Capacity Sq. Ft. E.D.R ``� 6'-� BTU H.P. Total Connected Load V / 7 of ef Kind of Fuel BURNER — Trade Name Size No Capacity Sq. It. E.D.R BTU H.P. (REMARKS—OVER) RAY N. WELTER HEATING C Signed 463!7 rlmaeAou Xve:. .By MINNEAPOLIS 7. MINNESMIA 4 z 2M 7s9 Business Phone No - Windows and Doors—Crackage and Area Al 4 Glass Width Height No f Lineal ft. Area No. of pane of pane IjWts reof crack sq* ft* Exp. wall 7 A 141 Net exp. wall HEAT LOSS QNS DEPARTMENT OF BUILDINGS '04 Coef.1 Weatherstrips A.S.H.VZ Guide Construction No. Total Btu. I Insulation lldows Doors Reference Out. Wall Int. Wall Ceding Roof I Floor Area 4 f Kind How Applied �=N—o I No 19— 1 1 Exp. wall f 1 I Fl.1 RomrLeripth/ lej --w S� Width Heiaht 7!�' 11 1 F1.1 Z Room I Length /.V Width Height Windows and Doors—Crackage and Area Glass Width Height No f Lineal ft. Area No. of pane of pane IjWts reof crack sq* ft* Exp. wall 7 Net exp. wall 4 Int. wall Coef.1 Btu Infiltration 30Y Total Btu. ; 9, Required sq. ft. E.D.R. or sq. ins. WA Leader area Glass Width Windows and Doors--Crackage and Area Helg.h.1 Lineal ft. f .. or, No. of No. lights of crack of Area 4 f Exp. wall __fL jai jai R rot", Exp. Wall $4t Net exp. wall Exp. wall f Af Net exp. wall Int. wall Net exp. Wall Ceiling TTV Floor Ceiling ,v, Total Btu. Required sq. ft. E.D.R. or F1.1 eldW^ Room Windows and Doors --4 No. Width Height Yf pane 171 0*156 W.A. Leader area h 9- " Width te and Area Height Coef.1 Btu Infiltration Glass Width Height No.oI Lineal ft. Area No. of pane ofrane light." of crack A. ft. Exp. wall 7 Net exp. wall 4 Int. wall Ceiling /�4 Btu Floor 30Y Total Btu. ; 9, Required sq. ft. E.D.R. or sq. ins. WA Leader area e Room I Length,/O 1 `RIA Width Windows and Doors--Crackage and Area Helg.h.1 Lineal ft. f .. or, No. of No. lights of crack of Area 4 f t/ e __fL jai jai R Btu Glass Exp. waU x Net exp. wall Int. wall Ceiling Floor Tbtal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area -411 MOMMi Windows and Doors—Crackage and Area Width Height No.oI Lineal ft. Area No. of pane ofrane light." of crack A. ft. e '01 ge ell JCoef. Btu Infiltration 30Y Infiltration ; 9, /P P Glass P t, e., 09 Ole" Glass Exp. wall p rot", Exp. Wall $4t Net exp. wan Exp. wall f Af Net exp. wall int. wall Net exp. Wall Ceiling 1,:Y,e 'ff TTV Floor Ceiling ,v, Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I M-1 ',, Room I Length 14, P Width a01 -,.' Height 0 - Windows auiVo—om—Crackage and Area Width Height No. of Lineal M Area qL No. of pane of pane lights of crack a. f pA '01 ge ell t X2' Coef. Btu Btu Infiltration 71 I el P t, e., 09 Glass vq rot", Exp. Wall $4t Exp. wall f x Net exp. wall Net exp. Wall Int. Wall Int. wall Ceiling ,v, Ceding .2 Floor Z Tl 9t, Total Btu. 49. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I ' I F1.1 eo A.:e',01"L. Room I Length It,/ -�' Width 9' W Heiaht Windows and Doors—Crackage and Ana Width Height No. ofI M Area Lineal No. of pane of -pans Ifshto of crack sq. ft. '01 ge t X2' Coef. Btu Infiltration 71 Xv P t, e., Glass vq rot", Exp. Wall $4t Net exp. wall Int. Wall Ceiling ,v, Floor Total Btu. Re4uired sq. ft. ED.R. or sq. ins. WA. Leader- area I " City of Fridley Application for Plumbing and Gas Fating Permit DepL of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK c Number. Kind and Location of Fixtures Location �� 02 Ojk �^ .. �� % Z 9 x p � ET3Z_ O < � �j 0 Z g • F • N WATER HTR. GAS ELEC x 3 $ � � x u� � o � x LL $ 3 !k NO. O lst 3 Fixtures .......................... x $1.50 $--L-6-10— fJ 0Additional m x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ Base 1st 1 w 2nd _ 3rd 4th • Future Connection Openings Connected with Sewer � New Fixture. Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL — Number Fixtures ............... x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ....... x 2.00 $ '�'y New Ground Run Old Bldg. ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL lst 3 Fixtures .......................... x $1.50 $--L-6-10— fJ 0Additional Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description................................................$ TOTAL FEE $1 ?. S d 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 �t ue and correct. Fridley, Blinn C� - 119-a Owner Kind of Building Used as To be completed about Estimated Cost, $ Old—New. Building Permit No Signe z _ f By � Business Phone No -" ROUGH I1 - `I'1400 FINAL az 2M 7-59 0 • Ll City of Fridley, Minn. BUILDING PERMIT 19W-�'� N® '7202 LOCATION OF BUILDING No. XWL Street — Part of Lot Lot ___ Block Corner Lot _ Inside Lot Sewer Elevation Addition or Sub -Di — Setback Sideyard — Fo tion Elevation DESCRIPTION OF BUILDING T U s Front Depth %� Height L Sq. Ft. Cu. Ft. j"/_Ja� Front Depth _ _ eight Sq. Ft. Cu. Ft. E Type of Construction st. ;FU _ 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 with aft provisions of ordinanoea of the city of Fridley. - /I 1 1. _ ,,-I evGY In consideration of the payment of a fee of $45� , 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 asci 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 oP Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at aqy tune upon violation of any of the provisions of said ordinances. Building Inspector NOTICE: Sk permit does not cover the commuction, hateMon for whin9i plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Nome. APPLICATION FOR:BUILDING•PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME- / BUILDER ADDRESS ,ra % ADDRESS LOCATION OF BUILDING No. ,street ;.Part., of Lot Lot Block Addition 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,build- ing location drawn;on these. Certificates. DESCRIPTION OF BUILDING To be usedd was: Front. Depth_ Pte— Height Sq. Ft. 2/Cu..Ft., O Front Depth Height S4 Ft Cu-. , Ft . , 4 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,Bu*ldings, and hereby declares that all the facts and representations stated in this appiication are 'true and.correct. DATE �,. jSchedule of Fee Costs can be found on the Reverse Side). SUBJECT PER City of Fridley O=5�i AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. • ____ COMMUNITY DEVELOPMENT DIV. (pv� r 1 PROTECTIVE INSPECTION SEC. 1 � = 1 "1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/15/79 JOB ADDRESS 5981 - 4th Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 29,30 14 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Leslie Berge 5981 - 4th Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Milton L. Johnson Co. 2513 Central Avenue N.E.- 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 X 6 DESCRIBE WORK Aluminum trim 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT 1 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 $2,000 $1.00 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. $12.00 PLAN CHECK FEE TOTALFEE $13.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT BLDG INSP TE SIGNATURE OF OWNER 0F OWNER BUILDER) (DATE) APPLI_iS*r;ON FOR Itl �rULN'rll,l_ BUJILDJNG C'EM11TS PluiLDER: A I Addre:;s. Te I. Noe Wo. LOT: BLOC]': A) 0- N Y- CORNT_`.'2 LOU.": INSIDE LOT: SETBACK: SIDEYARDS: tlpplicar�t attach to this form Too Certi.fieatE!, of Survey of Lot and proposed building location draem on these Certificates. DESCRI PTIOIN OF BUILDING To Be Used As: iron t : Depth: Height: Square Feet: ____ Cubic Feet: Pxont: _ Depth: � Height: Square Peet: Cubic Feet: _ Type of Construction: AItZNti � iz� � Estimated Cost: $ C)� "-V � To Be Completed: Alt. A. Alt. B Proposed Driveway Width If New Opening Is Desired $ $ _ (SEE REVERSE SIDE OF SHEET) The undetsigned hereby raa}:es 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 app .cation are true and correct. See reverse side for additional, information DATESIGNATURE':` � 64--o Stipulations: 0 CITY OF FRIDLEY 97-8L:416051 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL I&Mber Fixtures x $3.00 U Future Fixture Opening x v $ Water x $2.00 .0 Catch Basin x $5.00 $ c H a N 100,000 BTU to 199,000 BTU w W $ water Softener Heater .�W u ah x r� 0f�) Electric water Heater 41 og� $ .0a v �C 1st 3 fixtures ►� $3.00 $ Additional Fixturas 4 0 •.44 � x C IS A •.ri a b pW O � W4j I' 0 0 � M 0 each add. $100.00 or traction $2.00 O q N TOTAL FEE A N W U R 3 O ;as 'lec 1AU w uo. t� lst r ® n 2nd 3rd 4 thF . ..... 7 -.-FTT' (R) .. Future Connection Opening Connected with Sewer (') o New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL I&Mber Fixtures x $3.00 $ Future Fixture Opening x $2.00 $ New Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ water Heater - to 99,000 BTU x $5.00 $ 100,000 BTU to 199,000 BTU x $10.00 $ water Softener x $7.00 $ New Ground Run Old Building x $5.00 $ Electric water Heater x $5.00 $ GAS FITTING FEES: 1st 3 fixtures x $3.00 $ Additional Fixturas x $1.00 $ cis Range to 199,000 BTU x 40.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or traction $2.00 $ State Surcharge $ .50 TOTAL FEE $ 8.00 Job Address 5081 % Street A Department of Buildings - City of Fridley Tel. 0571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with tha City Codes and rulings of the Department of Buildings, and hereby declares that all tho factu and ropreaontations statod in this application aro true and correct Fridley, Mn. 8-21-79 , 19 OWNER BERG KIND OF BUILDING frame USED AS fes • TO BE C014PLETED ABOUT 8228-79 A ESTIMATED COST 40,00 OLD - NEW BUILDING PERMIT NO. �jPEERR14IT NO. Company Signed By Tel, No. ROUGH INSP. Da to FINhL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pbS $.50 STATE SURCHARGE w« REINSPECTION FEL' CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 3.50 A Old Opening, New Fixture m $ Water dl $ 4.00 m •Q $ 5.00 W C -1al O $ Rain Water Leader "•q M .xi ru q Hydraulic valve Heater •�U! $ b $ 5.00 of E ,f�� u {{y�� M al N N $ 5.00 $ g y14 $ 10.00 $ Gas Dryer O O •4 Back Flow Preventer Required. . Yes ( ) No M •.i y O g (�j +[I yl M .0 y1 rn U N S N vii v D w r vii 3 o w° w U m a 3 y $ J: V N ,C o UU) t�7 c� s lec Base - 1st 2nd 3rd 4th (R) Future Connection Opening Connected with Sewer (*) New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser $ 4.00 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic valve $ 5.00 $ sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Required. . Yes ( ) No 'type . ( ) $ 5.00 S ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of value of Fixture or Appliance $ Reinspection Fee $ State Surcharge $ .50 ($15.00) TOTAL FEE $ J: V Effective Date May 1, 1988 Job Address 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 Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this appy tion are true and torr Fridley, Mn. . 19 OWNER r -op 6 -P i C) KIND OF BUILDING / USED AS O(,(J-P ,1,17 9 TO BE COLLETED ABOUT �%�� / 7 0 Y ESTIMATED COST(/(/, d OLD - NEW BUILDING PERMIT NO. Compan Signed Tel. N ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE SUBJECT City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT 1f 1 � t • _ COMMUNITY DEVELOPMENT DIV. L PROTECTIVE INSPECTION SEC. -7 NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 612-571-3450 910 -F15 7/17/97 JOB ADDRESS 5981 4 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 29,30 14 1 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mary Berg 5981 4 Street NE 571-3682 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Rite Way Waterproofing 448 Lilac St, Lino Lakes, Mn 55014 786-0550 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 �p ❑ NEW El ADDITION X ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install interior basement drain tile 9 CHANGE OF USE FROM TO STIPULATIONS Electrical extension cords can not be used as part of the power source of the pump. Drain tile can not drain into the sanitary sewer. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 $2,967 $1.48 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- CON- $74.75 Fire SC $2.97 STRUCTION OR THE PERFORM NCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE y $79.20 --�,��� SIGNATURE OF CONTRACTOR OR AUTHORIZF AGENT (DATE, WHEN PROPERLY IDATED THIS IS YOUR PERMIT dr r BLDG NSP MATE SIGNATURE OF OWNER 0F OWNERBUILDERI (DATE) NEW [ ] Effective 3/1/96 ADDN [ ] CITY OF FRIDLEY ALTER [�.J� SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: _�j g j L4 TI! ST . M Legal Description: 5,11Owner Name &Address: /i'j /�-iLt� �C-�''C-� o (,�y MA1 Sy 3 Z Tel. #14� 5) 3 6 Contractor: -RITr::� _ j,{ J, is j 1A 1 �-rpg co F $ja MN LICENSE # Address: 2 L i A a Sr. &too LAJ��S , Rk) 55 014 Tel. # r781, 0 G50 Attach to this application, a Certificate of Survey of the on I U4O 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: Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: AW, , 'IC i Q2�W 0 Estimated Cost: $ ' o� , �, �'/ , o a Approx. Completion Date: --'?r7 (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: -7-/'7-- % -7 APPLICANT: ,� G `� Tel. # '17k6, - D SLS STIPULATIONS: CITY USE ONLY 7)) �/ Permit Fee $ `7 S Fee Schedule on Reverse Side Fire Surcharge $ 97 .001 of Permit Valuation (1/10th%) State Surcharge $ $.50,'/$1,OOa Valuation SAC Charge $ $9qq�r SAC Unit ,License Surcharge $ eXejM p -r $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 $ 0 STIPULATIONS: SUBJECT P City of Fridley 2 5 3 5 4 AT THE TOP OF THE TWINS BUILDING PERMIT r NO. COMMUNITY DEVELOPMENT DIV. i r I PROTECTIVE INSPECTION SEC.bin F I NUMBER REv DATE 8/7/97 PAGE OF APPR VED BY i CITY HALL FRIDLEY 55432 612-571-3450 910-F15 JOB ADDRESS 5981 4 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 29, 30 14 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mary Berg 5981 4 Street NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. New Roof Inc 30085 Fir Trail, Stacy, MN 55079 462-3232 20003381 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION Ck REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (17 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Work started before permit issued. SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $1,417 $.71 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 PROVISIQNS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $48.50 Fire SC $1.42 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE )115�_ License SC $5.00 $55.63 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLYTED THIS IS YOUR PERMIT BLAG INSP MATE SIGNATURE OF OWNER I IF OWNER BUILDER) IDATEI I NEW [ ) ADDN [ ] ALTER [ ] ConstructionAddress: — Legal Description: Owner Name & Address: Contractor: pair, Address: 00 CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION r r rS�� Tel. # Effective 1/1/97 6p,0'�63t> y MN LICENSE Tel. # 3Z? Z v 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: A2 — G� S�r `� 141 Construction Type: Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft. -x $ _ $ DATE: "7 ^ It i APPLICANT:Z -- Tel. # . � Z CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge $ C f ' $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: 04/28/2000 14:55 E H RENNER & SONS -i� 5711287 Q N C j (`y W ATEX NO.196 902 0 1 erouting Lwtoriol hem MINNESOTA DEPARTMENT OF HEALTH Minn we Mil and Wining boo troch d' as �RpN: LOCATIOrn • WELL AND BORING SEALING RECORD No.. H H �{�g Caarnrym" . Mitint600 unique Wen No. inion to n 1 ILefnrtpsat� Srelrotes. CAepter t 031 Cr W�atias No. yardis Ow N..eao�a.amam..IQ T Nome TO ftigho No. Reoge No SOcWto No.FracW (em y Ig.) Octe $salsa Date Well Or scone Co"Ort Pad 30 23 as 1-N APR 13, 2QW 196009 hpamnieal Stfw AddMs or Fae Number atr0 City at WON W BOruq LOMaoh "81 M STRM Depth Berm Seamnp a. Original Dow h show peal loeehOn Ol wffln Of pOnns Sk91U1 rtteQ oCpreq w tmnnp AOUIFER(S) STATIC WATER LEVEL aeec0009miamn•X`. 1o081ioa. mhornng mapany SlrtgteA4uilmr ❑ maieOul(er N fin", roada. attd otoldings• X\ WEt3/BogMG (�Mte85WO0 ❑ EaOrnatme m ( yaaterS4pry Well ❑ Menll. Well .�.. .{.. ❑ Env. Bore Mplp ❑Omar S. C&OetOw ❑ dborO Iortd 9uAOee W ••�•• •t . -. .1._ E CASINO TYPES) - (-- 4- JKS" ❑ 0118e90 ❑ Tito ❑ Omer ' o6mom .3 Dlanieter Oepdm Smt in mawsk d hole? ArtroularapaeO "dGatll+B S la..r'-, A tri, tram 0 to •12 a. ❑ Vas (jkNe ❑ res O No ❑ Untawwn in, tram 6 h. ❑ Pea ❑ No O vas ❑ me ❑ unfmman PROPERTY OWNERS NAME mlle S" -RTW PMPWW owwa Msihrq emso a dlNmm thin woo bmw address "matted Abow. in. IrOm to h, C3 Yes ❑ No ❑Yes ❑ No ❑ UnM+awn 12971 tS� . �Ret�uoPea NOLE M 55449 Sermon hem 12 to 15 N. Open Rote Uom to R P WELL OWKe 'S NAM ❑ R%wDrop Pipe 0 Chock Vat.e(al O Doris ❑ Fal ANaoes"lon SAME w.m o..ma+a elldate edarese It mderom emon ptopmy ow toea Typm al ObStr0lonm WoOprtbe) Obstructionsrmmovmd? El vee• ❑ No Deat:ribe PUMP Tyco SHAUM eDOr. AL MATERIAL COUNI HOURNS Or FROM❑: plww d §t No( Present E3 Other FQRLIATION MEMO USED•TO SML-MMULAR SPACE BETWEEN Z CASINOS. OR CASM4 00 OM HOLE o d rot limo rtr, anfictAs etdbngm0lormatlon log Itmn nmr6y.rell a CeN+g. �No Anttiler �pece Eyelets .. sum URCM ❑Annular epke wwmd -m treerds Ape OCeskj Pml&v endkmwd in. mann to h. ❑ poomtae ® FOtotaed tri. from to n. ❑ Pelto<oms ❑ Rarw.ed Typo Ol peQMetor ❑ . Ottter QROOM MATERW4S) Im N9 ot curoNt ■ e4 (49. ono b0 of bwtw Rs ■ eo W s 0 1 erouting Lwtoriol hem to TM y ft boo troch d' to e. yamm ape v from to n ytErd9 liege yardis Ow L. BOURCT OF DATA, WFICULnK IN 8t.".AUHG 0"MR.WELLSAMD BORINGS Oster wmmalee one anttsW woe w OoAng an wosi y? ❑ Yen No flow nt MO gMM. LICENSED ON REGMUMD CONTRACTOR CERTIPICAT10I1 R LEVEL IN ABPUR -VFXE. 3 15TNa well orawliqwas aeafed U amudenoe with Mmmnu Rocha. CateptatA725, The lreermteien oOrdeEneelnttRsreoon is '• *A = LEM' ids 12%�1�%9 troetoesotaaato my+tnorrteege. S 2ALED r�r+nst7orsudnaae llfmnre ,..,_ , w , Lkle ileo or Rtlretletr rYo. m� According to MN State Regulations �r. ti, . 'ArrMtor(ri.d & I+���SesBrno W��'—•"v—r LOCAL COPY I H ILS4898 a 04'28/2000 14:55 E H RENNER 8 SONS 4 5711287 b� Ck" W AIC K NO.196 1?03 14 S -1-(Z zj:z� _ or WELL OR 90MM LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Wall and BOrG19 (H 16372 5 Com WELL AND BORING SEALING. RECORD MlnnnmmUniquewagNO. I�i &-- — Mtnfrawra'srarures. Chaver 1031 or Wearies No. 8... tvnn l mtme.y Y Tewwo Ranoa�Nm. sec0orr F tires+► to Seale4 AM 17 A 21w Dale Well or Sm" Carotume0 19.601s 6 >i b' 3i a JDIWL b kTI� G�i�ibVr Mitme cal S11M AOOrass or Faro Number Ana CM of Well of 80nng wcalion $981 4w STAUM Death Aaron Sooting g R. or grtei Deo1n 8 n $item won IOG90oe of w80 Or Wng Sielwt mo of well w boring AONFER(S) STATIC WATER LEVEL in Odom grw w th •X•. 0011cm, snowing pammv S)Agle Apwtor ❑ MunisOwter line%. roe0e. and PUMMgs. N WELLA30A►NG ❑ MeoSured O Estin+stea r awatar Suaaly won ❑ Merit. well ❑ Env. Bore Holo ❑• Omar 11. ❑ below ❑ eeovo fond m dam w --r- •%- •�• E , CASINO TYPEIS) -+-••j • •�•• •• I-- (Steel ❑ Irisallc p Tila C3outer i9e19e •f•• -�-•-+ --�-- I CASIN M ' �, Olamelet Duo Sot in oversize MIB? Annular fm Ir, grm MO S 14mm ro R. ❑ Yes (Ar NO ❑ Yes ❑ Ne ❑ umatwwm vROPERTY owmm NAME in. Prem to IL ❑ Yea ❑ No ❑ Yes ❑ No ❑ Ummewn vrapantr amw ntavnp cod osa t Breen man" 1Ot91 Ort etldTe08 r1aCBled aeovo, in. Iran 10 R. ❑ •Yes ❑ No (3 Yeti C) No ❑ UnGrlOrrn 12971 CEMBOLN SVR=r BLAH, m 55432 SCREENIOPEN HOLE 60.01 Irom _ L-2 to 1Sn. Opo+ Hate Gem ro k 0111MUCr10NS ❑ AKWDfop Pipe ❑ Cheat vak*a) Cl Debris ❑ FW 51 No ODe0006M YM of Aairoad a-MascAOo) Obstructions removaoi ❑ Yes ❑ NO Dsserba f1ELL OWNER'S NAME Vmown►svrutmpaemsv a mnwnramen prepeny Owners aamms ut00 mord ebave• } PUMP Two � , •t pemewoo . ❑ No Prowl" ❑ Other : OQ>)CALiATFJUAL OOLOR . HAR OMCF .FAM . TO HS FORMATN no 19 6+rieia/ervimelbdbrrrtsllraila0uent•rtoa+oyrto0arbeAttg. stETMOO USED TOSEAL Alo SPACE B.ETWEEN Z CASINOS. OR CASINO AND BOREHOLE: �04o Annular Space adds Anwtnr apace gro,nea wlth.vemis plpe Caslrtg Pt9Ama6w1rtts11rotral In. hum h h. ., PeAM�ed ❑ msrltetoa In. l.OntIL 13RaegVtld 01, Type of perforator ❑ Dffaer 1 fl(ffltM' � CROUTM MATERWL(S) (Orate beg Of cemmi mx me, tarts bao Of baAm)M • 60IO>Ll Orouling Meteriaf hem is to ® k. Finaa from to R renes cepa from to IL rw0i eggs 9tom ro It. retch Oepa IEVARW4 =ME OF UTA, 0MCULTIES IN SEALING +� �: ,aCNAM WMTMA LLVM 3N ASME `l IML: 150 ii mm j� i/ C © 22 /"'1 � � � According to MN State Regulations OTHER WELLS AND SORMS . r uflm od so uriusad wen or OOMQ On proper iff (] Yee [ No NOW MW OR REGISTERED CONTRACTOR CERMCATION T ` rro11 Or borvW ws: Osaf90ln acD6rdones AIT MlrtReedia fluke. f�lg9lar 4T2b n+s 1mmrRfeOon oorpeirtoA 610119 mOorl b a tho best of mY knavNedpo. S.J YAC. 91815 con 111mrta , : trtimwe oTReotetiadonrlo, 100 a�Vale �re� PE "ALCOPY H 183725 Ksm "PersmfSdsBapw"OrBoartg Building BUILDING Pe>-�Iit No.: a� • ` Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: DATE YOUR E-MAIL ADDRESS�f�� / wti 'k v ' SITE ADDRESS THIS APPLICANT IS: ❑ OWNER AOftTRACTOR PROPERTY OWNER/ NAME: e f,&S -�, /-/,#/v- S �I dz sai Ale CITY •Cr`l'dP le ?e' STATE TENANTADDRESS: PHONE: CONTRACTOR NAME: c �C� STATE LICENSE H 75 -2®..3 EXP DATE Z-.� ke- 66ITY lCSwrS STATE s-S3d� SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS:_% 3-1 C� S�� sti WITH APPLICATION PHO 7 —S_0&w AX e _0 G --Q PROPERTY TYPE INGLE FAMILY/NEW CONSTRUCTION SIZE TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION -GE/SHED O WINDOWS ❑ G ❑ BASEMENT FINISH OOF ❑ DRAM TILE O DECK ❑ SIDING ❑ OTHER O SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ANCE/REPAIR O REMODELING DESCRIBE WORK BEING DONE: V,42 00 SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ��� O HOUSE ONLY fsr BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES O HOUSE & GARAGE GARAGES ❑ ATTACHED GARAGE I. 2• Existing Floor Plan Proposed door plan PROPOSED SIZE: O DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS. O Vinyl ❑Sotiit ADDITIONS & PORCHESSUBMIT• ❑ Aluminum ial ❑ Trim 1. Site Plan/Survey showing the existing structures O Other ❑ Fascia and proposed project 2. Two sets of construction plans WINDOWS 3. Epergy Calculations IN EXISTING OPENINGS OYes ONo LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Surcharge $ (.0005) times the total job valuation - Minimum $.50 Fire Surcharge $ .001 x Permit Valuation (I/10%) S License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ P' l Erosion Control $ $450 Conservation Plan Review ',v Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due - $ Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and 1 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 requires rcviemLand approval of plans. SIGNATURE OF APPLICANT /�� PRINT NAME/�� �I . / DATE 2 ® S Building PLUMBING Permit No. Inspections RESIDENTIAL APPLICATION Received By;_ 763-572-3604 CITY OF FRIDLEY YOUR E-MAIL ADDRESS DAT:DTS SITE Smog_ ds �.,"r�e�✓ Brian Onkst THIS APPLICANT IS: ❑ OWNER *NTRACTOR 5981 5th Street PROPERTY N, Fridley MN 55432 OWNER! ADDRESS: TENANT 7635719297 raTE zrP PHONE: CONTRACTOR- NAME: SUBMIT A COPY OF STATE LICENSE # EXP DATE YOUR STATE ADDRESS• t/- / CITY—"7 .' � �S STATE P SfY� LICENSE WITH PHONE % — 4/03 FAXa Z)122-112 APPLICATION 4 PERMIT TYPE INGLE FAMILY ❑ TWFA KS O MILY 0 TOWNHOUSE TYPE OF WORK: [3 NEW )(REPLACEMENT DETAILED DESCRIPTION OF WORK % PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. Mis.should-reflect only. the cost of labor) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 = `F0"ROJECTS WHERE LABOR EXCEEDS -%500; ARE BASED ON $10.00 PER FDi rURE; EXCEPT!'MMRENiMT£$l,:FEKT-IMOs..(INDICATE T.QTAL ' NUMBER OF EACH BELOW) _ BATH SR4KMV _FLOOR DRAINS _ SHOWER WATER PIPING _ _ BATHTUB GAS PIPING amwr. yammE) _ SWIMMING POOL WATER SOFTNER ($35) _ CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREY. ($15) _DISHWASHER _.LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION _.WATER METER —OTHER Permit Fee $ Number of fixtures @ $10.00 x $ I0.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15,00 = $ TOTAL DUE $ Number of fixtures @ $35.00 _/ x $35.00 = $ 3S.00 State Surcharge = $ .50 Total = $ THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work whit requires review and approval of plan's. / SIGNATURE OF APP LIC I PR1NT NAME Jeri" A/O/�D/0W DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 761-577-3604