PRE 2010 DOCSViusge of Fridley, Minn.
BU WING PERMIT
N? 1034 Office of INSPECTOR OF BUMDMGS
. .
Owner!! . � • t-���
Architect Fridley, Minn
Builder
�LOCATION OF BUILDING
No. -S �'� Street rG
16l Part of Lot
Lot q.v Block Addition or Sub -Division 46L, k * s
DESCRIPTION OF BUILDING
Fro �
nC��!J # r ,
Depth..�� � Height Stories��-�2anner of Construction-'�''''�"�"`'`- C—
To be used as--.� To be complet / % PIC . Estimated Cost
Permit is hereby granted to
the building 4?: described in the above statement. This permit is granted
upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all
the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley, Minn., regarding the construction, alteration, maintenance, repair and moving of buildings
within the city limits, and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
.�rnspector of Buildings.
AGREEMENT AND SWORN STATEMENT
In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of
the above permit, I hereby agree to do the proposed work in accordance with the description
above set forth and according to the provisions of the ordinances of Fridley, and, being first duly
sworn, I hereby state and say that the facts stated by me and contained in the above permit are
true as therein stated.
Subscribed and sworn to before me at Fridley, Minnne, to thi ,ll
day
Of A.D.19�
BUILDING PERMIT
Wage Of I+ridle , .Minn. N° 2029
R. • ,
Date ...... .... .. ....... . ...
i
Owner .�.
. ' ..! �": .. Builder ., r"F:.. . .. .
. ....
Address .e.. .,�'.�c Address ..
LOCATION OF BU LDING
No..� 0�:' Street . fir..: r:. ' s. a .. . Part of Lot .................... .
Lot .......... Block Addition or Sub -Division..... . .. .. ... ...... .
Corner Lot Inside Lot Setback ... Sub -Division..........
. ...... .. .
DESCRIPTION OF BUILDING
Toa $Used as:
�... Front 4 ......'. Depth- ........ Height ... Sq. Ft.. .. Cu. Ft........ .
...... .. . Front . , . Depth ........ Height ....... Sq. Ft. ... Cu. Ft........ .
Type of Constru on IAAPrnl E.st. Cost .. :................ To be Completed ...................
In considers n; of the issuance to me of a 'permit to construct the building described above, I agree to do
the proposers work in accordance with the description above set forthand -its compliance with all provisions of
ordinances of the villageof Fridley.
Pa3'tn $. • .,.. , siermit is hereb 4ted to ................
in considerati of the payment. of a_ fee of ,
.:. A .. ... ' to construct the6 building or addition as describer) above. This permit is grant upon
the express condi on that the; person to whom it is granted and his agents, employees and workmen, in work
done in, aroundw d. upon :said building, or any part thereof, shall conform in all respects -to the or ces of
Fridley, Minn "regarding location," construction, alteration, maintenance, repair and moving of buildings with-
in the village lima and this :perra tmay be revoked at any time upon violation of any of the provisions of said
ordinances. I
Building Inspector
' NOTICE:
This Perin( does not oovec the ,construction, inatailation'or a116 an for wiring,"plumbing, gas heating,
sewer or water "Be,a, 06 to see the Building Inspector for separate permits for these )isms. ,� °
*City oFridley, f FMinn. •
BUILDING PERMIT N® 4446
Date:.... . ~ .� .'"....11 -.(1_.._...._._.._....---------........•---._..
Owner: ....._. ... .. .... .... .. .. ... ...... Builder .... _ ..... ........................
- _ - - -- -
Address ....� . �..._.... ._� r ---- Address r
q�
LO TIO F BUILDING
No. ��J-p.. Street -c 1 ------ _ ..�.._...._..... 4 ..... 'eI..... -............. Part of Lot
Lot
Corner Lot.
as:
Addition or
Sideyard
DESCRIPTION OF BUILDING
Depth
Front ...................... ... _...... Height ................ _ Sq. Ft... ... ................. Cu. Ft.
Type of ConstruCtion}�......... ............. ...... ............ Est. Cost..............
CANUTION
VIOLTAT
THIS PE. P;..T L _'
ION O _ f ., �.. D CJ's —NANTS AND
BUILDING R i,,,:0TiON3.
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 complia}�ce .th all provisions of
ordinances of the city of Fridley. i, �//
In consideration of the payment of a fee of $.... .........., permit is hereby granted to
... _...... ..._.......... ................. _....................... to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violatio any of the provisions of said
ordinances. /7 / e
Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing] Bas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
4
Ci of Fridley, Minn.. 3 81 ,.
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
Date: - `April 18, 1972
Owner: Joseph Schuur Builder. SamP
Address ___....562 - 5th-Stzeet. N.E. Address 9sma
LOCATION OF BUILDING
No. Street __ 5th, Street X.E. part of Lot
Lot 94.25 Block - 2--.—._.._..__ Addition or Sub -Division $amI ville
Corner Lot _ __. _.__ _ Inside Lot XC Setback Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Additim_....___.... Front 241- "Depth 1 1- "Height . 101_ Sq. Ft.3� 02 Cu. Ft 3020
Front . _ Depth Height Sq. Ft. Cu. Ft.
Type of Construction _..._-Fri Est. Cost $4, 000.00 To be Completed 6 months
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 ab�M�
in compliance with adl provisions of
ordinances of the city of Fridley.
2.00 State Surcharge
In consideration of the payment of a fee of $ 6.00 , permit is hereby granted to Joseph Schuur
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 buildlags
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
i
A " kung Inspector
CLARENCE BELISLE
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to no
the Building Inspector for separate permits for these hems.
or,
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
a - '5-9 O 6
OWNER'S NAME:_J�;s'aPN �Gh'v✓f BUILDER:
ADDRESS: 24 A) F ADDRESS:
NO:. S (o -z 9 STREET: S
LOT: -2 f a S BLOCK: ADDITION: Ham; I -L o r S ¢b� �75 1 • I roc h cc n tips i ��
CORNER LOT: INSIDE LOT: i,'\ SETBACK: SIDEYARD:
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:
ajjo r- Front: �'� � Depth: �� � � Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: Tf-a rx, a Estimated Cost:_ $ �� Z9U o
To Be Completed: 6 /L/0' ,
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in stfict 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:-�, / 9 7 z SIGNATURE:_azz�'•
(See Reverse Side For Additional Information.)
o
V
,k
o
V
STATE OF MINNESOTA
DEPARTMENT OF HUMAN SERVICES
444 LAFAYETTE ROAD
V /`Z,-7 ST. PAUL. MINNESOTA 55101
Date
11� �0' i
F ..K
reet Address
S
City State Zip Code
RE: ZONING NOTIFICATION OF APPLICATION FOR LICENSURE
Subject:
Name of Py Care Home Applicant
Street Address
&4146�
City State Zip Code
DHS -2722 (9-85)
PZ -02722-02
..5-- 9,-eI9
Type of License:
Family Day Care 11
Group Family Day Care
Licensed Capacity 14
Phone No. srw9
This is to inform you that we are in receipt of an application for
licensure under Minnesota Rules, parts 9502.0300 to 9502.0445 (formerly
Rule 2), Family Day Care and Group Family Day Care Standards. Issuance of
this license is subject to compliance with the provisions of Minnesota
Statutes, Sections 245.781 to 245.812 and 252.28, subdivision 2, known as
the Public Welfare Licensing Act and the rules of the Department of Human
Services.
You should note that under Minnesota Statutes, Section 245.812, Subvision
3, a licensed day care facility serving 12 or fewer persons shall be
considered a permitted single family residential use of property for the
purposes of zoning. Subdivision 4 of the same section indicates that a
licensed day care facility serving from 13 through 16 persons shall be
considered a permitted multi -family residential use of property for
purposes of zoning.
If we do not hear from you within
will consider the above-mentioned
your local zoning code.
Sincerely,
i
"I . wn F=
FA7 R -, -.,, f', - _' W
ibensfng worker Or/
Street Address
30 days after receipt of this letter, we
day eappv"i op tIi:q`.dd pliance with
SERVICES D:i:,ArRP.,-1ENT
COUNTY OF ANOKA
COURTHOUSE, FOURTH FLOOR
ANOKA, MINNESOTA 55303
Name of Agency/Organization
City State Zip Code
AN EOUAL OPPORTUNITY EMPLOYER
n
AGREEMENT made this day of September, 1989, by and between James
Evanov, his heirs, successors and assigns, and Bernie Stroh, P.E. (the
"indemnitors"), and the City of Fridley (the "indemnitee").
WHEREAS, James Evanov, as the owner of the structure located at
117 53rd Avenue N.E., legally described as Lot 7, Block 2, Carlson's Summit
Manor North Addition,rlocated in Anoka County, has requested a building
permit to repair the structural problems which have developed on the structure,
and
WHEREAS, the City of Fridley has conditioned issuance of a building
permit upon the preparation of a structurally sound foundation design,
and
WHEREAS, James Evanov has hired Bernie Stroh, P.E., to design the
new foundation to withstand the soil problems which originally caused the
foundation damage.
NOW, THEREFORE, James Evanov, his heirs, successors and assigns, together
with Bernie Stroh, P.E., hereby agree to defend, indemnify and hold the
City of Fridley harmless from any and all claims or actions arising out
of the design and construction of the foundation and footings on the property
legally described as Lot 7, Block 2, Carlson's Summit Manor North Addition,
located in Anoka County. The indemnitors shall, within thirty (30) days
of notice by the City of any such claim or action, retain competent legal
a
representation approved by the City to represent the City's interests or
the City may retain independent counsel to represent its interest at indemnitors'
expense.
' Subscribed and sworn stn
before me this 2,? day of
1989.
1(JCZ-40�
Notary Publ c
Subscribed and sworn to
fbfore me this /Z7'4 day of
1989.
UbI1C
Ja s Evanov
1vAli �, ..LahiFe
�
WTARN %': siNNESo
sTEARNs RUNTY
w=maw up= 3"
Bernie Stroh, as president of
Bernie Stroh, P.E.
------------
CLYDE V. MORAV07
ff-- -------- "°� C "
ANOKA ��EWMLaklaw
BUILDING DIVISION MEMO
MEMO
TO:
Virgil
Herrick, City Attorney
MEMO
FROM:
Darrel
Clark, Chief Building OffiCfaZ
MEMO DATE: September 21, 1989
REGARDING: 117 - 53rd Avenue N.E. Foundation Correction
The City has on record a log of two soil borings and an engineer's
design for the corrective footing to replace the old footing and
foundation that failed. Given the experience of viewing this and
other failures in the area, and the witnessing of the corrective
construction of two other homes in that area together with the
reviewing of other soils reports also in that area, we do not
believe that the type of soils reports that was conducted on this
site was comprehensive enough for the City to approve the
engineer's design of the corrective footing.
We are willing to allow the construction to continue only if the
engineer and the homeowner sign a hold harmless agreement drafted
by your office.
In our opinion the new foundation system must bear on sand that
underlies the fat clay presently at the footing elevation unless
more soil tests are performed on the site. The new tests must then
be reviewed by the structural engineer for consideration in his
corrective footing design. The soil tests must indicate the
bearing capacity of the soil at various levels, the type of soil
and laboratory test consisting of Atterberg limits, shrinkage limit
and dimensional swell test.
DGC/mh
a
awn is st-oh 10� F
JL"-) ,:
!N -
�
81r
Brom -Iyo T !me=lt r
nralrv-A
5-rlt.4-
51r�'cturat Enu!npe'm
Fr 1 �1 `7. Cr' S 0661;#
STROHENGINEERING
St Anthony Main
Suite 406
219 Main Street S.E.
MinneWp S, Minnesota
55414
1'.7 53rd Ave. NL, Fridley, MN
Dear Jiluia
I have mtrplet an in -Vection of the fC)�
fn' romti,x WE l r.t t-1-je �_ . referenced dwelling. The PUrPOSS
tr r aC+-=ai e<ra_lua*jor. of t ate
�. idence and to advise m the PZTWged
ec�a�,Y tib
a . ; _arz ami?^acl-m :n the corners of the foundatim walls which
Items j -j ge=aily indicative of
q =ittl* T,f ft�ngs. Noit7_; an vie eta of the
fry or the foundation walls front inside the house. It iS W
� rstasu�,g that ice. ision has been made to replam entirely the
st :kg f --�ti w!il lfs aro foortings. I have reviewed the 50i l boric
LN -s iAiic; wuL-, taken &2-ound. tnri house earlier this rmnrrh. 7t* borings
off`�c 9 .fi; �d si7 !3+3Tid s i►
BL , -'LL. t tj_ s�,=l:, ar 4� tz 6h ft, delyth in 'Cate a possible
athat at hat elevation. The Y,dfa�rrn Bu iding (1995)
7%- ble No.® 29-B a? is it beArirq pmss=e of 1000 tO 1500 gsf far a s
qaaculationst the net fa74.u', tim px6sst=V-- Will -
a mm-izrata.11y 750 psf if a rmaRv f„ " 30" in width is used around tha
rimte . lig rrrl +..I prcruor increased footing width provides a4
arTle factor of safety a-j&L-irc di vfet-ential settlement. Plea
zelar 4.n-, attachW recr-nrer4,atimis regarding the
nierk" ixq l ",met—' (��t max:=`
If there cum any Tiaa'�� t� �. _ � �s i ; �� ti.a report, or if z can
be
of any � ��.�F '-- _ - k°lam feel free to tadtltdot tns.
Sir>cr�y,
Bernie Stroh, P. P.
if Steil B;:yin s
7,^1 0661;# 3
v, k., p � i
-7S5"%- q.2.�4
` =�- ;;;A ;ird AveNE ridley, MN
LGLOtion or Projr-U
bcrings made bg_6/12/§9 _
USDA -SCS x Unified : other _
Flight or bucket,: othera•P.t' Used ^':��`f� �w� ; �•-�1 : +��Ill� `, , or Powere g
1`,e t Boring 1 K lr�� Depth, , Boring number
in surface a lw%a:ion_ in Surface elevation
feet feet 4
�2
3
i ne -, c r.�t. ;: ,,ind
mid. -o'nr, top sol,
silty sd.lr, sl i gktlt of ock,y str- t r.
same as s, a, g�,# !fix' date on
strew
s'aIrle a3 -!'`Ove
„rky strut r1
`_...Gaye,
arnvel, i
same as aoove
1121 grey/grange fine sand, mottled.
Orin 1�cfeet,
End of boring ar. ._ � . ' 1
Standing water :able:
%resent at feet of depeh,
hours after boring: I
Not present in 'goring hole A
Mottled soil:
Observed at 6 112 feet of depth.
Not present ir, ti;.ring hole
Obaurvatione and commants,
mottling at 6 1/2, may bo �P 8 nc�-r.�'Pd w.t .
condition of underly`'
colo 7
�'I+gysan�C�Jth slight mixing of
es
grey s11*y clay, dense, tight
May, brown/grey
same as above
lend of boring at
Standing grater table:
epa:t at feet of depth,
hours after bori.nx.
Wlct present in boring hole
Aer,•ed at feet of depth.
r
' pr-taent in boring hole
Obsar•+.stions and comments:
SErl-
5"1 0661;# 4
POT n'S
aerins made- bv0
StP
Jt if ied, b other
Ili tit
Dopth,
in
flat
surface
loamy sand brown top soil
SaMe as WXV?
same "'S above
San,p aS aVv,q *oy-tj -liglit blocky
blocky
samE 65 jjbcv,., ,-jith neay",er bl,:,Ck)
structure ref si!ty clay
1 .Dan�f 5 !-'P P—i TIC- pard -
Depth,
in
feet.
Boring "Utober —
Surface elevation
8 11W samp- as a+ 81 level
9-1 sarlp as 00ve
9 1 �'
I grey wity clay
Ifeet.
of, -ar1+111c aL
at
-1 e. 0 after boring.
"Iic 1, zo;.' sent
mottled soil!
Observed at *P-eof depth.
4o%- prootnt in burinF - 016
QIurvaticna and =QnfteRts:
ONQvved at feet of depth.
�NCO; Proarvnt ifs boring h6149
Observations and comments:
SUBJECT
P M O.
City of Fridley
o 20127
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
D
1 . ,
l �� "I CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
-•-.
L •/� 612-571-3450
910-F15
9/25/89
JOB ADDRESS 5629 - 5th. Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
24,25
2
Hamilton's Addn. to Mechanicsville SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Doug/Marge Hutton 5629 - 5th Street N.E. 574-0909
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Patio Enclosures 6319 Cambridge Street, St. Louis Park, MN 55416 920-1575
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
Construct a 10' x 14' Three Season Porch Addition
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
WAr IF"?IN 1116 SEPARATE PERMITS Rry"NAM) F®R
Before digging call for WIRING, HEATiNG, PLUMBING AND SIGNS,
all utility locations
454.0002
REQUIRED 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
GOVERNINGAND ORDINANCES THIS TYPE OF WORK WILL BECOMPLIED
$3,000
$1.50
WITH WHETHER SPECIFIED HEREINOR NOT. THE GRANTING OF APERMIT
DOES NOT PRESU E T IVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF NY T ER S OR LOCAL LAW REGULATING CON-
$54.00
ST UCTION 0 H PE NCE OF CONSTRUCTION.
LAN CHECKFEE
TOTALFEE
�"
$55.50
SIGNATURE FCONTR CTORORAUTHORIZED AGENT (D9 El
WHEN PROPERLY V ATED THI IS YOUR PERMIT
a
SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI
BLDG INSP ATE
NEW [ ] Effective 5/1/88
ADDN [ ] R-1 AND R-2
AIM [ ] B i 1 di 7r Permit Application
Orion Address: -f25'4171 9 /J
legal Description: L07-5 �! e2Si D : ,[�Q „� 11 it L i e, 5 ���OaJ . J ja Z /
Owner Name & Address: �O✓y v- /�Ia v v.,
- � Teel. # .!;"7
Contractor: Summa.'C9,04 /% %� �..�/f�.�r Tel.
Address: 63 �% GUfi6�5 e Sfi
Attach to this application, a Certificate of Survey of the
lot, with the proposed constriction drawn on it to scale.
ARF: Length za,_
GRPPM AREA: length
EECK AREA: length
Width iv
Width
Width
Height 7
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [ ] Inside Lot Ft. Yd Setback Side Yard Setbacks 3.? ' 4
7YFe- of Cm tnrction: _ /v..� , o- G lEstimated Cost: $
Approx. Cmpletion Date:
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
Width + 6' See Back Page
DATE: 1P APPLICAM: ��- 9��0�� # lr7f
Teel. Sza-
l/
Permit Fee
C)
State Surcharge
$
/r J�
SAC Marge
$
Driveway Esc row
$
Perk Fee
$
Sewer Main 0=ge $
TOTAL
ST'IPMAT CNS:
QTY USE CMLY
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$575 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by IIq]neer]ng
Necessary [ ] Not wry [ ]
f�Ie IDOIsJ./�.9.t'tIG y��ill
,d2� aj- ,s -s ate:
N-�
�I
r � 0
E:,tf,
3v,
Sf•Gc-e.f
� r
yr/
/6-
,
0
t� h
:o
.y
�A H
m�� �
"� �
n�� � n
--
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective On January 1, 1998
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas**
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
Type
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
$ .50
JOB ADDRESS 541 a.9 S—` ST Alt
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.
911' _'1998
Owner _ AARGE Hurra.]
Building Used As 14 0."A
Estimated Cost W000—
PERMIT NO. ! c 3SJ ,_
PLUMBING COMPANY CK 6,4 101-64
SIGNED BY- TEL N0.
Approved By _� Rough -In Date Final Date
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00
$ olD.S'd PLUS THE $.50 STATE SURCHARGE
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES.