PRE 2010 DOCSCITY OF FRIDLEY
• APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
.PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures
x
$3.00
,
$ �c
Future Fixture Opening
Y.
4
0
flew Fixture, Old Opening
Water
v
$
A
.C1
• '�
A
1k,
H
T.,4
•.i rS
of
14
N
N
41
Sa
a
LL
w
100,000 BTU to 199,000 BTU
x
Heater
$
Water Softener
x
t
1
flew Ground Fain Old Building
N
$5.00
O
S
J
N
a
N
w
1st 3 fixtures
O
O
.i
ai
x
$1.00
$
'^ O
Nwe
x
w
• N
L
N
O
lee
14
3u
each add. $100.00 or fraction
a
r
�n
�°.
State Surcharge
vii
$ .50
obiga3
TOTAL FEE
as
�.OV
REIySPECTION FEE
1st
d
2rd
3rd
4th
(F?) a Future Connection Opening
Copnected with Sewer
(•) - New Fixture, Old Opening
Water
.PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures
x
$3.00
,
$ �c
Future Fixture Opening
Y.
$2.00
$
flew Fixture, Old Opening
x
$2.00
$
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTU
x
45.00
$
100,000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7.00
$
flew Ground Fain Old Building
x
$5.00
$
Electric Water Heater
x
$5.00
$ �^
GAS FITTING FEES:
1st 3 fixtures
x
°$3.00
$
Additional Fixtures
x
$1.00
$
Gas Flange to 199,000 BTU
x
$10.00
$
REPAIRS & ALTERATIONS
First $100.00
$5.00
$
each add. $100.00 or fraction
$2.00
$
State Surcharge
$ .50
TOTAL FEE
�.OV
REIySPECTION FEE
�,) ��
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 da 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 application are true and pecorreet
Fridley, Mn.
OWNER /C G l Z,4 /<
KIND OF BUILDING
USED AS I� to --e
TO BE COMPLETED ABOUT 41
` ESTIMATED COST
OLD - BUILDING PERMIT NO. PERMIT NO.,
I
r �
company--•% L e �' • rJ�
�Ww 4 e+iccie I�
Signed By `2 R.
Tel. No. v� (.aln�
ROUGH INSP..
Date '
e '
FINAL INSP. �/ ...
.0 Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING T SS Veft Soso SORClUAGE
SUBJECT
PE NO.
City of Fridley
15 9.8 9
AT THE TOP OF THE TWINS
BUILDING PERMIT
'
RECEIPT NO.
rrL _ COMMUNITY DEVELOPMENT DIV.
INSPECTION
r i PROTECTIVE SEC.
1
i
i � � '��`•� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
__--
L J ` 612-571-3450
910-F15
10/30/80
JOB ADDRESS 705 - 59th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
1
2
Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Margaret Zak 705 - 59th Avenue N.E. 571-7602
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Professional Roofing 7257 Yucca Lane 425-7841
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
X
8 DESCRIBE WORK
Reroof Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
Roof can be second but not third roof. Install ridged galvanized
valleys.
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
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
I
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
$975
$•50
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-
RUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$7.50
PLAN CHECK FEE
TOTAL FEE
^� � �� �' � � /01e:'-
2
$8.00
SIGN RE OFCONTRACTORORAUTHORIZEDAT �- (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
Op o mo
BLDG INSP I DAYE
SIGNATURE OF OWNER OF OWNER BUILDER) (DATE)
CITY OF FRIDLEY
APPLICATION FOR 11ESID17NTIAL BUILDING PERMITS
(New, Alterations, Additions, or Repairs)
OWNER: A 172 A �_ 7� i / -,-BUILDER: /�
ADDRESS:, ,� -� ADDRESS: `7;5-7`r.
TEL N0: —�1 •�(� TEL id0:
Construction Location
STRIMT NO: _ 7 6? STREET: Lq 4 �
LOT: BLOCK: ADDITION:
Corner Lot: Inside Lot: Setback.: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
Front: Depth: Height:
Square. Feet: Cubic Feet:
Front: Depth: Height:
Square - Feet: Cubic Feet:
Type of Construction: _ r _ y- a 04 Estimated Cost: $ 92�L ed
Rb Be Completed: /_L9
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET
Mie 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: r/—�� SIGNATUM:
Stipulations:
")r P -r
VIIIj S 0V Apse
9-/, 4,0r..,
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES q
JOB ADDRESS
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work
Residential Rate
TOTAL
herein specified agreeing to do all work in strict accordance with the
Furnace Shell and Duct Work, Burner -
city codes and ruling of the Building Division, and hereby declares
Also Replacement Furnace $ 20.00
$ Q -W
that all the facts and representations stated in this ap ication re
true and correct. ,1991
Gas Piping (Needed with new furnace) $ 10.00
$
OWNER
Gas Range $ 10.00
$
'
BUILDING USED AS
Gas Dryer $10.00
$%�/��®�
Op
ESTIMATED COST PERMIT NO. / � l
*Air
�Jl✓
Conditioning -All Sizes $ 10.00
$1-�
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1 % Value Appliance Work
$
No. of Heatin nits Circle One (Steam) (Ho Water arm Air)
of of or
Trade Name Size No.16
Commercial/Industrial
BTU HP EDR
1 % of Value of Appliance or Work
$
Fuel Total Connected Load.'!d _z ww✓L'-'�
State Surcharge
$ .50_
Burner Trade Name Size No.
BTU HP EDR
TOTAL FEE
$��
HEATING CrPANY !MJ
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
iydREFRIGERATION/AIR
CONDITIONING PERMIT IS $15.00
Signed By Tel No.
PLUS THE $.50 STATE SURCHARGE
c� p
(�
REINSPECTION FEE $30.00
Approved By Rough -In Date Final Date
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHIMNEY 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
List Alterations Being Done:
HEATING COMPANY
Signed By
Date
SUBJECT
PERMIT NO.
City of Fridley
I
AT THE TOP OF THE TWINS
?
BUILDING PERMIT
I
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
_
tr PROTECTIVE INSPECTION SEC.
r ;
CITY HALL FRIDLEV 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
9t0 -F15
5/17/94
JOB ADDRESS 705 59 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
1
2
Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Margaret Zak 705 59 Avenue NE 571-7602
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Milton L Johnson Co 525 Lowry Avenue NE, Minneapolis MN 55418 781-9548 2083
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 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House (15 Sq) Tear -off; Aluminum soffit & Fascia
9 CHANGE OF USE FROM TO
STIPULATIONS Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 80 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
$1,125
8.57
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 F CONSTRUCTION.
$29.00
PLAN CHECK FEE
TOTAL FEE
SIGNATURE OF CONTRACTOR OR HORIZED AGENT IDATEI
bk�WHEVPROPE Y IDATED HIS IS YOUR PERMIT
�S -SIGNATURE
SP 0ATE
OF OWNER IIF OWNER BUILDERI IDATEI
NEW
ADDN CITY OF FRIDLEY
ALTER j J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: 705 59th Ave. N.E.
Legal Description:
Effective 1/1/94
Owner Name & Address: Margaret Zak - same as above Tel. # 571-7602
Contractor: Milton L. Johnson company MN LICENSE # 2083
Address: 525 Lowry Ave. N.E. Mpls. 55418 Tel. # 781-9548
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Tear -off, re -roof, alum. soffitEstimated Cost: $ (�
Approx. Completion Date: 6/30/94 &fascia (15 sq.)
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: 5/17/94 APPLICANT: 9��' Tel. # 781-9548
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Ree
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ Fee Schedule on Reverse Side
$ - .001 of Permit Valuation Q / 10th %)
$ $.50/$1,000 Valuation
$ $800 per SAC Unit
$ J� $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ l
80 k
01
172
OA
336'
SuB.,ECT
City of Fridley
77
AT THE TOP OF THE TWINS
BUILDING PERMIT
Ir
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
C.
l�®
CITY HALL FRIOLEY 55432
NUMBER
REV
GATE
PAGE OF
APPROVED BY
612-571-3450
910415
9/17/98
JOB ADDRESS 705 59th Ave NE
T LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
2
1 Donna 's Lakeview Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Zak
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Panelcraft 3118 Snelling Ave S Minneapolis 55406
-6628 2179
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
O NEW ❑ ADDITION ❑ ALTERATION ! REPAIR
O MOVE O REMOVE
B DESCRIBE WORK
Reroof house & garage (22SQ) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING. HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
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
$1,885.00
SURTAX
$.94
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-
$59.50
ire SC $1.88
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOT L FEE
d
Lice SC 0
$67.32
5 REOFCON.RACTOAORAUTHORIZED AGE NT IDATEI
NPR VALID THIS IS UR P IT
S-GNATURE OF OWNERIIF OWNER BUILDERI 1 AiEI
BL INSP
�z;:2A
T+A�E
01
172
OA
336'
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: —) () -5— �5— 9 /lu'e PJ `,-
Legal Description:
Effective 1/1/98
Owner Name & Address: 2A V- Tel. #
Contractor: Pte. n�Q C 9a- E : 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 51PROVEMENT
LIVING AREA:
Length
Width Height Sq. Ft.
GARAGE AREA:
Length
Width Height Sq. Ft.
DECK AREA:
Length
Width Hgt/Ground Sq. Ft.
OTHER:
e2 02
ca t7—
Construction Type: Pe Rn r
Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
DATE: i FYAPPLICANT:
Tel. # I' CP ca
CITY USE ONLY
Permit Fee
$ 0
Fee Schedule on Reverse Side
Fire Surcharge
$ /. &
.001 of Permit Valuation (1/10th%)
State Surcharge
$ C y
$.50/$1,000 Valuation
PG1
SAC Charge
$
f
$1000 per SAC UnitG�
0
License Surcharge
$ CO
$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
$�- J'
STIPULATIONS:
SUBJECT I
RMIT
City of Fridley
31176
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
pT NO.
r.
COMMUNITY DEVELOPMENT DIV.
v __
r I PROTECTIVE INSPECTION SEC.
�T 69
�
NUMBER
REVDATE
PAGE OF
ACPROVED By
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
7/13/00
10B ADDRESS 705 - 59th Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
1
2
I Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Margaret Zak 705 - 59th Avenue NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Panelcraft of MN, TNc., 3118 Snelling Ave. So. Mpls., MN 55406 612-721-6628 2179
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
O NEW O ADDITION O ALTERATION CX REPAIR 0 MOVE 0 REMOVE
B DESCRIBE WORK
Re-roof & Tear Off House and Garage 20 S
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE 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 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 ISTALLS
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
$1,748.00
$.87
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-
SIOR THE PERFORMANCE OF CONSTRUCTION
$63.15
Fire SC $1.75
RU'TION
PLAN CHECK FEETOTAL
F
Licen C 5
0.77
SIGNATURE 0/ CONTRACTOR OR UTMORiZEO AGENT iDATE,
ENPERI LIDATED T S IS R P MI
.1000.10*71,J
S.GNATURE OF OWNEA0F OWNER BWLDERI iDATE,
BIOG iN$p v Ti fE
NEW []
ADDN [j
ALTER [ j
-u5
Construction Address:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
IVE
Effective 1/1/2000
612-572-3604 Bldg Insp
Owner Name & Address: _/yh zf-4r, Tel. #
Contractor: o /1% 1;2A MN LICENSE # .217 9
Address: .3//8 5ne /1i -n9 Ave. 6. Ao fS mAl 554 D6TeI.# &1A-7Al -%6.2 $
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft
Length Width Hgt/Ground Sq. Ft
/ / c v
Construction Type: �o S Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: �3 ' 00 APPLICANT: -�✓L� Tel. #
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (612) 572-3604 for Permit Fees If mailing in application
Fee Schedule on Reverse Side
.001 'of Permit Valuation (1/10th%)
$� $.50/$1,000 Valuation
$ $1100 per SAC Unit
$5.00 (State Licensed Residential Contractors)
"A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ J Not Necessary [ ]
$ 0-70
NEW [ ]
ADDN [ ]
ALTER(
Construction Address: _
Legal Description:
XOwner Name & Address:
Contractor.
CITY OF FRIDLEY
6431 University Ave NE, Fridley, MN 55432
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION '
— STV, Ave- N
Effective 1/1/2003
(763) 572-3604 Bldg Insp
(763) 571-1287 Fax
e # qlw
Tel. #1t3-S1r"0"1401,
MN LICENSE #
Address: Tel. #
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Estimated Cost: $
Driveway Curb Cut Width Needed4Ft. + F� = % Ft x $ _ $
XDATE:'Z-6--�t?-r-:LAPPLICA Tel. # A6 3
Call (763) 572-3604'for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ Fee Schedule on Reverse Side
$ .001 of Permit Valuation (1/10th%)
$ $.50/$1,000 Valuation
$ $1275 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$
F.ow. 1a 40 lb'
)=uN w;N' OF
G PMofW
6
in/• Moots 1,A1Lv- Dr•
City of Fridley
SUBJECT
(.
ERMI _-
3 9 7 2
?AT THE TOP OF THE TWINS
BUILDING
P E R M I T
`
-
R T NO.
I
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.T63
I
1
NUMBER
REV
DATE
PAGE OF
APPROVED BY
�•� CITY HALL FRIDLEY 55432
l J ` 763-571-3450
910-F 15
10/14/03
JOB ADDRESS 705 59 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
2
Donnay's Lakeview Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Denise Mitchell 705 59 Avenue NE
763-571-2242
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Same
I 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
Construct a 12' x 16' Shed
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
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
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
$1,800
$
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
•90
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
TOTALFEE
$65.85
SIG o AC AOR mo EDAGENT tDATE,
MEN PROPER Y VALIDATED THIS IS YO R PERM T
IONA
R O� OWNER, -F OWNER BUILDERS (DATE.
g ,N
r�Ait
61 y <LIV
NEW [ ] CITY OF FRIDLEY Effective 1/1/2003
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: S— '4cl 0Vr
Legal Description:
Owner Name & Address-,T_�') Tel. # '77 -S`7) - y�
Contractor: SE 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: 16 S
Construction Type: F/ v� �i/1/ i SAiA Estimated Cost:
Driveway Curb Cut Width Needed: Ft. + 6 = Ft x
DATE: AQ -9-®--5,1 APPLICA T: r Tel. # 763 -57/ "" 29-10
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY - - e
Permit Fee $ t4o3. 15 Fee Schedule on Reverse Side � Ad
Fire Surcharge $ .001 of Permit Valuation (1AOth%) �`,
State Surcharge $ $.50/$1,000 Valuation M
SAC Charge $ $1275 per SAC Unit
License Surcharge $ $5.00 (State Licensed Residential Contractors)
Curb Cut 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 $ &
,r,- . F 0
(?-'3-,3 /414 Leh rye r y
GumEToASSIST YOU WITH YOUR
E,wZ FRAME YARD BARN
COPYRIGHT, MENARDS INC. AUGUST 1999
Window Not Included.
as an Option.
1. GENERAL
Prior to beginning construction, the area selected for the shed
location must be leveled and cleared of obstructions.
2. INVENTORY
Separate all lumber, hardware, etc. into individual stacks of like items.
3. FRAME PREPARATION
Unfold each frame, setting aside
two frames to be used as end Figure 1.
walls. From 1"x4" Pine boards, cut
Gusset plates 6" long
• 24 pieces for a 12' building
• 32 pieces for a 16' building
• 40 pieces for a 20' building N�
Apply gusset plates on each side ��
of the top and bottom fold
locations. Frames to be used as
end walls require only one gusset �$
plate top and bottom on the side
opposite of the metal plate, and to
the inside of the building. Use
four 8d nails on each plate. See
Figure 1.
PLEASE NOTE: This shed construction aid Is Intended
solely to provide general knowledge as to one of the ways a
shed ma be constructed using materials available from
. We suggest you check with your local
building officials regarding site location, permit
procedures, safety regulations and specifications of
materiels used to construct your new storage shed.
Builders who utilize this aid must proceed at their own
risk and are solely responsible for complying with all �.
b�n�i�ld��in�gc�od�es which pemein in their community.
hereby disclaims aB liability for any damages
W
hether rnnnaaeegqaential, Incidental, sppeeccial or otherwise,
witch may res:dt from following this d _It yourself aid.
You may need more or
fess maten'aIs deper ft
on holo you buad If you
need more ux,1 sell you
MGM YYML fi� �t
Doers, bring it bark!
Lumber listed as nominal sizes
5.112.
High Roof
1 "x4"x6"
long gusset / Low Roof
plate at top
2"x4" Upper fold location12'
and Lower Overhang
Roof Frame
Member I 11'
2"x4" Side Wall
Frame Member
E -Z BUILD BARN FRAME
ShecL Pkhs -765- 59pi &,e- IUE
1-1/2"
13. FASCIA TRIM
Nail 1"x6" to exposed ends of roof overhang using 8d nails. Top edge of fascia board should be 1/2"
above the top of the roof frame member. This will cover the exposed edge of the roof sheathing.
X12' Building Eave Fascia: ---Use two 1"x 6"x 12' trim boards. NOTE: Tack gable end trim into place
•16' Building Eave Fascia: ---Use two 1"x 6"x 16' trim boards.and check fit. Make any required
•20' Building Eave Fascia: ---Use four 1"x 6"x 10' trim boards. adjustments in the cuts prior to nailing ini.
From 1x 6 Pine boards, measure and cut remaining trim to fit Gable Fascia. Attach to building.
14. ROOF SHEATHING.
Nail roof sheathing in place using 6d nails every 8" on center. Stagger sheathing end joints from frame
to frame whenever possible.
• 12' Building: Overhang: from one 4'x8' sheet of roof sheathing, cut two 8"x 96" and 8"x 48" pieces,
leaving a piece 24" wide by 96" long. "
72" Low Roof Using the 24"x 96" piece, cut two 24"x 48"
pieces. From one 4'x8' sheet, cut two pieces 48"x48". Cut
another 4'x8' sheet into two pieces 24"x96". You'll also need
two full, uncut 4'x8' sheets.
45-1 /2" High Roof Cut three 4'x 8' sheets to 45-1/2" wide.
From one of those pieces cut two 45-1/2" wide by 48" long
pieces.
•16' Building: Overhang: from one 4'x8' sheet of roof
sheathing, cut four pieces 8" wide by 96" long.
72" Low Roof From two 4'x8' sheets, cut four pieces 24"
wide by 96" long. You'll also need two full, uncut 4'x8'
sheets.
45-112" High Roof Cut four 4'x 8' sheets to 45-1/2" wide by
96" long.
•20' Building: Overhang: from one 4'x8' sheet of roof
sheathing, cut four pieces 8" x 96" long and two pieces 8"x 48".
72" Low Roof From two 4'x8' sheets, cut four pieces 24"
wide by 96" long. From one 4'x 8' sheet, cut two pieces 24"x
48". From one 4'x8' sheet, cut two pieces 48"x48". You'll also
need four full, uncut 4'x8' sheets.
45-1 /2" High Roof Cut five 4'x 8' sheets to 45-1/2" wide by
Figure 10.
1-13 16"
r
P 1 11/16 *1-3/4.
Hot.
1-13/16" 1-11/16"
59-9/ 16" 4 pcs. req'd.
1"x6" frame
I�1-11/16"
" 1"x4" X buck
1= 4"
44-1/4-
1-;3/16" 25"
8 pcs. req'd.
T
2" 94"
44-I/4"
Typical
6: Miter
2 pcs. req'd.
,
96" long. From one of those pieces, cut two 45-1/2"x 48" long pieces.
15. DOOR FRAMING
Cut two 4'x 8' sheets of siding to 48" wide by 94" long.
Cut 2"x frame members as shown in Figure 11. Attach
to door siding pieces and attach hasp and hinges. Cut
and attach 1"x door trim and crossbucks as shown in
Figure 10.
16. TRIM
From 1 "x 4" trim boards, measure and cut 8 corner trim
pieces. Place (2) 94"-1 "x 6" on each outer side of door
opening. Mark and cut (1) 1 "x 6"x 12' running across
the top of the door opening and extending out to meet
the lower roof trim. Nail to building and hang doors.
17. FINISHING ROOF
Apply roof felt. Apply shingles using 3/4" roofing nails.
Follow instructions found on the bundles.
18. FINISHING BUILDING
Paint/stain to finish.
Figure 11.
BARN DOOR DETAIL
Inside View --
1°
1-1/2" H
i ;
i
�
; H
i
g0
,
'g
e
;
e
S
i;
;s
;i
e
e
Flush floor I
sheathing.
Verify
,
distance. i
2X4
a�I
48" -'1
Figure 2.
2"x 4"x12'
endwall studs
_
3-1/2
cut to fit.
2"x 4"nailers, cut
to fit.
2"x 4"x 10' Endwall
95-1/a•
studs, cut to fit
Toe nail studs into
place
22-1/4• 20-1/2' 20-1/2. 20-1/2•
20-1/2" 22-1/4-
2-1/4•12'-0"
12'-0"
3-1/2•4t 5-1�4�
// Ad
214/2.1 1 12'-0"
45-1/4"
E
ny areas building not required for small buildings, but it's bestth your local q�icials."
4. BACK WALL FRAMING
Using one frame selected as an end -
wall, measure and mark stud
locations according to dimensions
shown in Figure 2. Place the proper
length 2x 4 studs at those locations.
Mark required length and angles
and cut to fit. Toe nail studs into
place using (2) 8d nails top and
bottom. See Figure 2. Cut 2x4
nailers and install at dimensions
shown in Figure 2.
5. FRONT WALL FRAMING
Using the remaining endwall frame,
repeat Step 4, using Figure 3 as a
guide.
NOTE: When using a roll -up door, the door
2"x 4" Gable studs opening must be framed to the exact size of the
cut to fit at door. Example: 8x7 Roll -up door will have a
locations shown ftntshed opening of 96"x 84".
2"x 4"x lo' 6. SIDING BACK WALL
fit
Header cut to Cut two 4'x 8' sheets of siding into four
48"x48" pieces. Use three full 4'x 8' sheets and
three of the 48"x 48" pieces. Cut each piece as
2"x 4"x 8' required. Nail siding pieces onto back wall
door frame, frame with 8d nails every 8" on center. See
cut to fit Figure 4.
7. SIDING FRONT WALL
Cut one 4'x 8' sheet of siding into two pieces
48"x 48". Cut one 4'x 8' sheet into two pieces
24"x 96". Cut each piece as required. Nail
siding pieces onto front wall frame with 8d
nails every 8" on center. See Figure 5.
NOTE: (for step 7) In order to keep moisture
om wicking into the siding, keep the bottom
of the siding I" above the bottom of the
treated bottom frame member.
:96"
cut
Own
13. FASCIA TRIM
Nail 1"x6" to exposed ends of roof overhang using 8d nails. Top edge of fascia board should be 1/2"
above the top of the roof frame member. This will cover the exposed edge of the roof sheathing.
•12' Building Eave Fascia: ---Use two 1"x 6"x 12' trim boards.NOTE: Tack gable end trim into place
6'
•1Building Eave Fascia: ---Use two 1"x 6"x 16' trim boards. and check fit. Make any required
•20' Building Eave Fascia: ---Use four 1"x 6"x 10' trim boards. jadjustntents in the cuts prior to nailing in
From lx 6 Pine boards, measure and cut remaining trim to fit Gable Fascia. Attach to building.
14. ROOF SHEATHING
Nail roof sheathing in place using 6d nails every 8" on center. Stagger sheathing end joints from frame
to frame whenever possible.
• 12' Building: Overhang: from one 4'x8' sheet of roof sheathing, cut two 8"x 96" and 8"x 48" pieces,
leaving a piece 24" wide by 96" long.
72" Low Roof Using the 24"x 96" piece, cut two 24"x 48" Figure 10.
pieces. From one 4'x8' sheet, cut two pieces 48"x48". Cut 1-13 1s"
another 4'x8' sheet into two pieces 24"x96". You'll also need T 1-11/16"1 3/4
two full, uncut 4'x8' sheets. p sot.
45-1 /2" High Roof• Cut three 4'x 8' sheets to 45-1/2" wide. 1-13/1s" 1-11/16"
From one of those pieces cut two 45-1/2" wide by 48" long 5s -s/ 1s° 4 pcs. req'd.
pieces.
916' Building: Overhang: from one 4'x8' sheet of roof 1-11/i6" 1"xs"sramex4"xbuck
sheathing, cut four pieces 8" wide by 96" long. I 113/4"
72" Low Roof From two 4'x8' sheets, cut four pieces 24"
wide by 96" long. You'll also need two full, uncut 4'x8' 44-1/4"
sheets. 1-13/16"
25"
45-112" High Roof- Cut four 4'x 8' sheets to 45-1/2" wide by 8 pcs. req'd.
96" long. T1 ' 2" s4"
•20' Building: Overhang: from one 4'x8' sheet of roof
sheathing, cut four pieces 8" x 96" long and two pieces 8"x 48".
72" Low Boof• From two 4'x8' sheets, cut four pieces 24"
wide by 96" long. From one 4'x 8' sheet, cut two pieces 24"x' ical
48". From one 4'x8' sheet, cut two pieces 48"x48". You'll also 6: Mi r
need four full, uncut 4'x8' sheets. 2 pcs. req'd.
45-1 /2" High Roof Cut five 4'x 8' sheets to 45-1/2" wide by
96" long. From one of those pieces, cut two 45-1/2"x 48" long pieces.
15. DOOR FRAMING
Cut two 4'x 8' sheets of siding to 48" wide by 94" long.
Cut 2"x frame members as shown in Figure 11. Attach
to door siding pieces and attach hasp and hinges. Cut
and attach 1 "x door trim and crossbucks as shown in
Figure 10.
16. TRIM
From 1"x 4" trim boards, measure and cut 8 corner trim
pieces. Place (2) 94"-1 "x 6" on each outer side of door
opening. Mark and cut (1) 1 "x 6"x 12' running across
the top of the door opening and extending out to meet
the lower roof trim. Nail to building and hang doors.
17. FINISHING ROOF
Apply roof felt. Apply shingles using 3/4" roofing nails.
Follow instructions found on the bundles.
18. FINISHING BUILDING
Paint/stain to finish.
BARN DOOR DETAIL
Flgure
.1
Inside View --
V.
X 4
2X4
1-1/2" H ;
H
n ;
1-1/2"-��n
It
i
e i
e
S1
S
i;
d�
Isi
d
VI
e1
e
Flush floorsheat/ing.
rify
distance. 1
48" —�
Building
$
BUILDING
See Back Page for Fee Schedule
Permit No.: IttA —0 l
Inspections
RESIDENTIAL APPLICATION
Fire Surcharge
Received By:
763-572-3604
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
CITY OF FRIDLEY
�j'U
Da &AUG
763-502-4977 FAX
$
$2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
EFFECTIVE 1-1-09
ft + 6 ft = ft x $22 = $
Erosion Control
DATE //Ia /d IYOUR
E-MAIL ADDRESS
JP
$450 Conservation Plan Review
SITE ADDRESS SGS S 9
& ,4 V -P--
THIS APPLICANT IS:
❑ OWNER XCONTRACTOR
$
PROPERTY OWNER/
NAME: J1_ RC i,
Total Due
TENANT
ADDRESS: -70S 5'� �- � ,.-� CITY
STATE ZIP
PHONE:
CONTRACTOR
NAME: GcrS%vC�jcti ,.oi J�� �e. �; o SS 61 C
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # EXP DATE
AND CERTIFICATE OF
ADDRESS: %D S S�� e 'e CITY STATE 1 W ZIP SS c 3
INSURANCE
PHONE % 6 - NI " I S SS FAX
PROPERTY TYPE
-MSINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK SIDING ❑ OTHER
SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
RIMAINTENANCE/REPAIR ❑ REMODELING
S�
DESCRIBE WORK BEING DONE: Q pl s Liti % of of Sc >rg 3 -
�—
SIZE OF IMPROVEMENT
SIZE
LENGTH WIDTH HEIGHT s -Q FT OZ J
ROOFING
❑ HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
13 HOUSE & GARAGE
1.
Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
13 Vinyl
f�Sotiit 6
ADDITIONS. & PORCHES SUBMIT:
13 Aluminum L
"e
t .� �;. � ❑Trim �
0 TriFas
1.
Site Plan/Survey showing the existing structures
and
13 Other / t�re 5 ✓`i 0
'� �
is y
proposed project.
2.
Two sets of construction plans
WINDOWS
3.
Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE ORWINDOW 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 $ 1. or7o OCCUPANCY TYPE
Permit Fee
$
*6_6 of 10
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
1 00
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
�j'U
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $22 = $
Erosion Control
$
$450 Conservation Plan Review
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 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 on site; that the work will be in accordance with the
approved plan in the case of a work which requires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME , wi /�L %/ 7 DATE '�