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PRE 2010 DOCS• • A/ aa53� City of Fridley, Minn.. BUILDING PERMIT N? 6873 Date:" AOwner: Builder Address Ad LOCATIOq OF BUILDING No. Street Part of Lot Lot _ _ __ Block Addition or Sub -Division Corner Lot _ Inside Lot Setback . _ Sid, Sewer Elevation__._ _ _ Foundation El evation DESCRIPTION OF BUILDING To V Front Depth Height Sq. Ft. / Ca. Ftcq yze—v t Depth ,� Height Sq. F't. Cu. Ft.9�.-0 of nstructio Est.. Copt;—L/LSr . _ To be Completed Type r 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 a'll provisions of ordinances of the city of Fridley. , "of A* In consideration of the payment of a fee of $ �'..4 " , 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 anypart thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. NOTICE: ihhs permh dose not cover dw condroetlon, hwfallafion for whing, Plumbing, gse heath►g, sewer or waNr. Be sure to see the Bulhiing Inspector for separate permits for these hems. APPLICATION FOR BUILDING PERMIT CITY '0F FRIDLEY, NIMS&A OWNS. P Is NAME r � kwe, BUILDER ADDF.ESS %r% ,?e=, P Q, ADDRESS LOCATION OF BUILDING No. �d� StreetG� Le,, Part of Lot Lot Block Addition or Subdivision Corner Lot Inside Lot Setback ��',� Side Yard ,0V SEWER ELEVATION �°�� N 'ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. a DESCRIPTION OF BUILDING To be used as: Front JC,77 Depth Height -12 (&AlT Sq. Ft l/, 5—e' Cu. lot, Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated tost�0!5e'0d c�e To be Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares, that:all the facts and representations stated in this application are true and correct. DATE_ SIGNATURE (schedule of Fee Costs can be found on the„Reverse Side). Application for Power Plains and Heating. Cooling, Ventilation, ReFrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ........................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ F. () C) each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam .... 8.00 $ Furnace Shell & Line—to 640 sq. ft. 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 $ �^ ® d GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ /• -:C® Additional Fixtures x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ ,Lg:l- ` �% ROUGH FINAL Dept. of Bldgs. Phone SII 4-7470 Location iS g/ I G C) T" A (JE- No - dE . City O - 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 ®1 .4 AJ • `LLZ , 19 Owner I- A9 d; Z E Y " P LT) t' P—S ®-'V es - Kind of Building ZE 2 A e-12 (K Used as V LAJ E L- L- ► n.) C� To be completed about Estimated Cost, n0 Old ew uiiding Permit No. Permit No. C'12— DESCRIPTION OF WORK BEATING or POWER PLANTS- Steam, Hot Water, OjjAir No. Trade Name ! / S o Size No- s/ I -7 - I 0 Capacity. Sq. Ft. E.D.11f Q ®• 0 0 0 BTU H.P. Total Connected Load j � 3 -3 :2 Aa ELL Kind of Fuel G AS BURNER — Trade Name Size No Capacity. Sq. Ft. E.D.R I BTU H.P. Signe GEO. SEDGWICK HTG. & AIR-COND. CO 4 z 2M Business Phone No-- +(+�.)(enee Ay. Minneapolis 16, Minn. (REMARKS -OVER) LI. 54611 D•16 7 s HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS WeatherstripsA.S.H.V.E. Construction No. Guide Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind Yea—No J Yes—No 19_ f F1.1 ooQLength Width i -,7 Height �f Fl.k a C,, Room 1 Windows and Doors—Crackage and Area Windows and Doors--Cr Width Height No of pane of pane Width Height No. of Lineal ft. Area No. of pane of Dane lights of crack eq. ft. No. 118 Total Btu. a,• r Required sq. ft. E.D.R. or sq. ins. W.A. Leader area / FI.1 .Room I Lenstth $ —,, Width .o/ Height 21' Windows and Doors—Crackage and Area Btu Infiltration ` Coef. Btu Infiltration Coef. Btu Glass L/ 7" s Exp. wall. 3P m e 0 v Net exp. wall F in r� Int. wall e Ceiling �^ Floor Int. wall Total Btu. a,• r Required sq. ft. E.D.R. or sq. ins. W.A. Leader area / FI.1 .Room I Lenstth $ —,, Width .o/ Height 21' Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of Dane of pane lights of crack sq. ft. Btu Infiltration ` //7 Coef.1 Btu Coef. Btu Infiltration I Glass 3P m e 0 v Glass Exp. wall �� e Exp. wall '3 3 �^ �. Int. wall Net exp. wall- Ceiling a Int. wall Floor Total Btu."' 6 Ceiling 2:Z W f Required sq. ft. E.D.R. or sq. ins. WA. Leader area Int. wall Floor Ceiling Total Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area / F1.1 x; K R Room I Length el Width (; Height 91 Windows and Doors=Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Btu Infiltration ` //7 Coef.1 Btu Infiltration Glass e) I Glass Net exp. wall Exp. wall Net exp. wall Int. wall Glass Net exp. wall �^ �. Int. wall Exp. wall Ceiling Floor Total Btu."' 6 Total Btu. ft. E.D.R. or sq. ins. W.A. Leader area MINNEAPOLIS. MINN. Insulation How Applied I , `'ter` Width s e and Area Lineal ft. Area of craok eq, ft. FI.I -5 % fw: ,. , Room I Lenath / u Width / -), Height R° Windows and Doors—Crackage an Area Coef. Btu Infiltration ` //7 Glass -•; Glass e) Btu Exp. wall�- Net exp. wall Net exp. wall Int. wall Glass Ceiling Ceiling ,s5• lel Exp. wall Floor Net exp. wall Total Btu."' 6 +' Required sq. ft. E.D.R. or sq. ins. WA. Leader area Int. wall FI.I -5 % fw: ,. , Room I Lenath / u Width / -), Height R° Windows and Doors—Crackage an Area Width Height No. of of pane of pane lights WMAreaNo. Coef. Btu Infiltration en 1 3-,,rV 0 Glass e) Btu Exp. wall Net exp. wall Int. wall Glass Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area i F1.1 Aa r ez Rooth I Length ,, Width /- .HeiKht 91 Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. ofpaneor pane lights of crack sq. ft. Coef. Btu Infiltration v 1;> t Glass Exp. wall Net exp. wall 6 5- Int. wall Ceiling Floor o Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area suB,lEcr PERMIT NO. City of Fridley ®(1-2-9 8 AT THE TOP OF THE TWINS PERMIT r BUILDING RECEIPT `� _ _ COMMUNITY DEVELOPMENT DIV. `63� ,, ^ 'Y- {J r PROTECTIVE INSPECTION SEC. �l "1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY %j 612-560-3450 910-F15 6-4-75 JOB ADDRESS 1541 - 60th Avenue N.E., Fridley, Minnesota 1 LEGAL LOT NO. BLOCKMarry's CT OR ADDITION SEE ATTACHED DESCR. 3 1 First Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE JIM ALLEN, 1541 - 60th Avenue N.E., Fridley, Minnesota 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. CUSTOM POOLS 701 E. Excelsior Hopkins, Minnesota 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING SWIMMING POOL 17 x 35 7 CLASS OF WORK ❑ NEW E:k ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK CONSTRTICT SWTMMTNG POOT, - GALVANIZED SMI, WITH VINYL 9 CHANGE OF USE FROM TO STIPULATIONS SEE LETTER OF JUNE 4, 1975 TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Steel W Vin 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 R-1 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $5,000 $2.50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR P FORMANCE OF CONSTRUCTION. 30.00 PLAN CHECK FEE TOTALFEE 06— 32. A o R11015TAMhtf AG T IDATEI WHEN PROPERYW VALIDATED THIS IS YOUR PERMIT BLDG )NSP June 4. 1975 DATE v SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) •A?PLICATION FOR RESIDENTIAL., ALTERATION, OR ADDITION.BUILDING PERMIT CITY OF-FRIDLEY, MINNESOTA OWNER'S NAM: BUILDER : ADD SS • J.r°� ® ADDRESS • D �l/iIs NO:. STREET: LOT: BLOCK: ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach .to this form Two Certificates of Survey.of Lot and.propose. building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: �/ Front: Depth: Height: Square Feet: Cubic.Feet: Front: Depth: Height: ,^ '71 d Square Feet; Cubic Feet: Type of: Construction:dowi, Ll/elei—WZL//&ZEstimated Cost: X04 To Be Completed: 6 -76 L� The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stfict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. i (See Peverse Side For Additional Information.)' a3�,�0 � .hp' Y�4 ., Y� }"�, 11— cc%i. �a %,� �4T' �iC�. ,t' �; � g `F k �' l'N yam•. r` .i.:� t t \ �F �r3 y11�t�iiy, �/�+4.{ �J„ - ]^�//����- 11. g". � wUff-V .�117M w7 i/l, ti!� 1�1 r A 7"'� -4 z 1�pp0 [ I1Yi1 AX�MlIl� SIT j �,• ., -' ti ,` '� rr z v I ,� 1 ,: x PMM �� I4 , �` - I 1 [ "�.. r £p z 1.: illrM-k✓ fy'� i 1C�Ee +� 4-6tvey foes • a� Y �F� - u� . .:''—w [(,r 4.� f .t TY 1.�'-`— s, ,,, '4 jl I�IELFiS CtJ IRf�,gu �T .� .(ji• �'rt [> t: r Ill�i,L WNNESOT� S, ' x �, 1 § a 1 1 1 4 �.,. 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'YR�I� u7 A, m �., C,h, /YT .,r,h M X X rc7. �!* C 'ru -' i..w t3'$ .t<_f ,A ti v r, �,# ',. r: 4 � rel 1 1 , { r . q F hi[, Wis 'p.n Ye�fKef , 0 t hekeby ca �e;fy eha of p; sur.'pY of Owe and�df Tb� Jot�evda i aecl corti�hi r��p�Fe 440 �i d pi rhw #b§�`4�4Ci 6tl �blk4� i 54 b'Ft¢rh�sd RNkr ail.^+a Y 49f��risrb 1 ` , �'i6�: r N" , r , ' '� I-- #s "` L Rj ' ei}trq�ykhtwn�� rf* " I `,'t"' if5p $h �tf�N tsAd 1 er a 2� 1 1 1 1 f i 1 �' � ,� 's , b y fI 4' + - I �'�Ib�„udPk� b ti�> # I are. psi k�,v• e ,. q ` „ et -J,qm e s (b, A l/eec1 -h-ie-,y AJAJ 71r- /%/# G OIA R Z AN T ' 'V , , � �'_W G 7 YAW I 74YZJ kl A 7 Y a�7 C/ June 4, 1975 Custom Pools Ln c 701 E. Excelsior Avenue Hopkins, Minnesota 55343 0 co Re: Swimming Pool at 1541 - 60th Avenue N.E. N r l0 o Gentlemen: N This letter is to reiterate my conversation with Mr. Tim LO Ln Hannan of Custom Pools on June 4, 1975 and to make clear Fq. this departt's requirements for the swimming pool construction O at the above address: w 1. As discussed, one (1) skimmer approved by the National Sanitation Foundation will be provided. ': 2. As discussed, two (2) inlets of approved design for LU fresh and/or repurified water will be provided. J 3. As discussed, a main drain of approved construction will be provided. © 4. The filter and pump shall be approved by the N.S.F. and be of sufficient capacity to provide a minimum q turnover of at least two (2) times in 24 hours. LU This department recommends a turnover rate of 6-8 hours. O 5. A deck, a minimum of 3 feet wide and sloped away from z the pool must be provided around the entire perimeter w of the pool. w 6. The diving area will be acceptable provided there is no > overhead obstruction. q 7. A fence or other suitable barrier, a minimum of four (4) feet high, that affords no external hand or foot holds and which is impenetrable by toddlers, must be provided > around the entire perimeter of the pool. All gates and Z other accesses shall be equipped with self-closing and latching devices which are capable of being locked. 8. An automatic chlorinator should be provided with a e° suitable test kit. 9. All electrical and plumbing installations shall be Uiinspected and approved by the City Inspection Department. z 10. All electrical lines must be 10-20 feet or more away U from the pool surface. U_ 11. The pool fill spout must be air gapped or protected by _> a vacuum breaker. 0 Swimming Pool 541 - 60th Avenue N.E. Page two. 1 �7 OA� 12. Suitable safety equipment to include but not limited to a ring buoy and rope that is 112 times the pool diameter, shepards crook pole, must be provided and maintained with the pool at all times. Furthermore, these and any other requirements must meet the provisions of the Fridley City Code, Section 115, Swimming Pools. The building permit is approved contingent on final inspections and approval by the City. If any questions or problems arise from this letter, please feel free to contact me at 571-3450, ext. 41. Sincerely, STEVEN J. OLS Environmen 1 Officer SJO/cs cc: Jim Allen 1541 - 60th Avenue N.E. G r f- SUBJECT City of Fridley 17 6 2 1 AT THE TOP OF THE TWINS BUILDINGPERMIT r RECEIPT COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. �� 1 � i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 7/19/84 JOB ADDRESS 1541 - 60th Ave. N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 3 ] Larry's First Add. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE James W. Allen 1541 - 60th Ave. N.E. Fridley 55432 574-1718 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Owner 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residental 7 CLASS OF WORK ❑ NEW 133 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Const ct roof 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. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,500.00 $.75 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 - ,A1 OR THE PERFORMANCE OF CONSTRUCTION. $25.00 PLAN CHECK FEE TOTAL FEE ''�� cc�� .. l ," l�7 ,n..i �`1 /' � $25.75 SIGNATURE OF CONTR COR OR AUTHORIZED AGENT (DATE) HEN P O(RWTED THIS IS YOUR PERMIT �' -6 ! w BLDG INSP GATE SIGNATURE OF OWNER IIF OWNER BUILDER) IOATEI NEW L ] City of Fridley Effective 4/1/84 ADDN. [ ] �R-1 AND R-2 ALTER. L ] Building Permit Application Construction Address: ISVI 6404 A16 Ju c Legal Description:�sr /9/J/.1l 7-1 o;L/ .46-r '? A-ock - - Owner Name & Address /9LLE/t/ 16-Lll 60 t4 -,40F AIE' Tel. #�LI`171k Contractor: 'D'o �%%��"'"�^ Tel. # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: 00&1 ST9U(-7 /?,O®p- OVER E)(15 i 1A1-- DEC)< Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Type of Construction: GLJD�)2 Estimated Cost: $ S( Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation l' / / �J / ���✓ - Tel DATE: APPLICANT: P J CITY USE ONLY �ems' Permit Fee $ Fee Schedule on Reverse Side Plan Check $ 25% of Building Permit Fee State Surcharge $ Pi S $.50/$1,000 Valuation SAC Charge $ $425 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ a / Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: �r -- c• :•..r - , .. ... . •, -*-►• '':.�. � ;a: is - , �-yt.r . . MINNESOTA VALLEY SURVEYORS & ENGINEERS CORP. 12m IIIb AeSW! wal" t BW$ftlnLLI.MNWd WTA SUN IF&— warn Certificate of Survey for: DAMES LLE/1 — 7,5'/,) _ .IMA r h h I 4--jp 1� � � 1 TB.9 6 O TH A VE. , Curb LOT .3 , fz— OC/f ZARRX-'s /sT AaolT-10N olpI USI /=40' I hereby certify that this is a true and correct representation I Minnesota Valley Surveyors & of a survey of the boundaries of the obove described fond, C' O u!lr�9.,C ar, and of the location of all buildings, thereon, and all visible / �r^—r . RLS S by .0 - encroachrnents, if any, from or an said land. As surveyed b me th., TN da of93 y y _6-_ y /LQ/�.rr'CH A. w%3. Minn.411Rei. NO. • • 01 SUBJECT NO. City of Fridley 24709 AT THE TOP OF THE TWINS I N BUILDING PERM RECEIPT NO. ' ' ______ COMMUNITY DEVELOPMENT DIV. v r - PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 10/22/9 JOB ADDRESS 1541 60 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 I Larry's First Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Victoria Friedman 1541 60 Avenue NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Tomco Company Inc 1425 Andover Blvd Andover MN 55304 434-1522 8747 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 Replace sheetrock in upstairs bathroom 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors as per State Building Code. 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 I 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 $6,400 $3.20 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONSOF Y OTHER STATE OR LOCAL LAW REGULATING CON- SC STRUC R THE P RFORM NCE OF C TRUCTION $124.75 Fire $6.40 R PLAN CHECK FEE TOTALFEE �— License SC $5,00 139.35 IGNATUREOFCO 'RA R AL311HORIADAGENT IDATEI WHEN PROPE VALIDATED THIS IS YOUR PERMIT 0 BLD INSP n G GATE _ SIGNATURE OF OWNERUF OWNER BUILDERI IDATEI 01 NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ l SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: 1,<4 / /10 Legal Description: Owner Name & Address: U`e-le)i^,PA 4ta A 14 Tel. # Contract Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Effective 3/1/96 ENSE #—'Y % ,q 7 Tel. #�-- LIVING AREA: Length Width Height Sq.. Ft. GARAGE AREA: Length ' Width Height . Sq. Ft. DECK AREA:n Width Hgt/Grou�nd" Sq. Ft. OTHER: f' Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback 17 Side Yard Setbacks Type of Construction: , ,�, g�/, �� � j; CITY OF FRIDLEY INSPECTION DIV. 6431 Unlversity.Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER nF MYTI IRPR Tn RG IAI.QTeI I Cn not cornu e, ono Effective On. March 1, 1996 PLUMBING FIXTURE RATES: • NO New Fixtures Old Opening, New Fixture kFloor. :r •::< Auto >... Water Heater »:.: Gas S rte ..... Urinal >:..•......... Shower � l Y O�tDrain Water Treating Appliance Range Gas:.:.0 Washer ?� Basement n Water Heater - Gas** Gas Range** Gas Dryer** Floor1 () No Type Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: • NO 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 RATE TOTAL JOB ADDRESS 0 t4 Aye $ 7.00 The undersigned hereby makes application for a permit.for the work herein $ 4.00 specified agreeing to do all work in strict accordance with the city codes $ 5.00 and rulings of the Building Division, and hereby declares that all the facts $ 7.00 and representations stated in this application are true and correct. $ 7.00 $ 7.00 1��02S $ 7.00 $10.00 Owner �— '�7 , 199`6 C13 / 1 / L` /i9 N t` a �a� e .� r�2� L $ 7.00 $10.00 Building Used As %N $10.00 $10.00 Estimated Cost , PERMIT NO. $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of. Fixture or Appliance State Surcharge $ .50 TOTAL FEE $ '—_�L2 PLUMBING C PANY G -L. cA q SIGNED BY� �C' TEL N0. % 3__ Approved By 6Rough-In Date Final Date 3� 6 MINIMUM. FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 4U4 PLUS THE :50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. SUBJECT City of Fridley 24817 AT THE TOP OF THE TWINS BUILDING PERMIT' ERMIT r RECEIPT NO. � _____ COMMUNITY DEVELOPMENT DIV. I L PROTECTIVE INSPECTION SEC. r , NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 ,.j 612-571-3450 910-F15 12/6/96 JOB ADDRESS 1541 60 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 1 Larry's First Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Victoria Friedmann 1541 60 Avenue NE 541-4396 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Tomco Co Inc 1425 Andover Blvd NW Andover MN 55304 434-1521 8747 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 Install basement a ress windows 9 CHANGE OF USE FROM TO STIPULATIONS RX163i%" Replacement egress windows in bedrooms must meet the State Building Code. 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 I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,460 $.73 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- STRUCTIO THE P FORMANCE OF CONSTRUCTION 48.50 Fire SC $1.46 PLAN CHECK FEE TOTAL FEE --�4e License SC $5.00 55.69 SF6NATURE OF ONTRACTORORAUTHORIZEDAGENT IDATEI WHEN PROPERLY VWeIDAZE THIS IS YOUR PERMIT zvzzll 0 BLD INSP MATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI NEW [ ] Effective 3/1/96 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: S �� z Legal Description: Owner Name & Address: U<< �R � Tel. # 6-q I=L/3 g (� Contractor: _��— MN LICENSE #el 7 «� � Address:I I — .140— tt, Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ Approx. Completion Date:, ,- R catty: iM1%'a: _ • ori Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft — Ft x $ _ $ DATE: 4 APPLIC Q,L Tel. #3%� Permit`Fee DESCRIPTION OF EMPROVEMENT Fire Surcharge LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA:' Length Width Hgt/Ground Sq. Ft. OTHER: 4fl, __ _ e _I_ _ V-1 . Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ Approx. Completion Date:, ,- R catty: iM1%'a: _ • ori Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft — Ft x $ _ $ DATE: 4 APPLIC Q,L Tel. #3%� Permit`Fee $ J,2 Fire Surcharge $ State Surcharge $ j SAC Charge $ License Surcharge $ _GIS Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $CC STIPULATIONS: CITY` USE " ONLY Fee Schedule on Reverse Side 001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $900 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 [ ] Receipt # Fee: $' ® " APPLICANT Address �® NAME Address NAME Address CITY OF FRIDLEY LAND ALTERATION PERMIT Effective June s, 1995 Tel. # j2' -�%% -- PROPERTY OWNERS Tel. Tel. # Tel. # LEGAL DESCRIPTION OF PROPERTY Lot Block Addition DESCRIPTION OF LAND ALTERATION Value of Work: Starting Date: CompletionDate `— Source and Composition of Fill: n d PURPOSE OF LAND ALTERATION ATTACHMENTS TO APPLICATION The following plans, drawings, calculations, bonds and/or statements maybe required by the Public Works Department: (] Half/section map or sketch of property showing all adjacent property indicating the existing buildings and/or structures. [ ] GT`ading plan showing existing and proposed finished contours and evaluations. () lorainage plan showing existing and proposed drainage structures, stabilization walls, retaining walls, ¢nbbing, dams, or other. protective items. [ ] /Calculations for and approximate quantities of excavation and/or fill required. Signed statement from the property owner accepting responsibility for the operation and granting permission for land alteration/mining operation. Statement to be attached to deed advising of potential need for soil tests prior to any construction on lots where additional fill material has been placed.. ] Rice Creek Watershed District Approval. [I Soil Borings [� Other STIPULATIONS READ BEFORE SIGNING APPLICATION 1. A surety bond or certified check in the amount -of $ . 77-0- (5% of value of work to be completed) must be submitted after approval of application and prior to any work commencing. This bond or check is to ensure satisfactory -performance -and compliance with the below stated stipulations. The surety bond or check shall be kept active until the completion of work and/or expiration of permit and can only be released by written notification of the City after a satisfactory final inspection has been performed by the City. 2. All access and street frontage of the land alteration site must be controlled by a fence, a minimum of four (4) feet in height All entrances must have gates that are capable of being locked. 3. Only rock, sand, gravel, dirt, or similar natural earth fill is permitted. No concrete, asphalt, or demolition wastes will be permitted as fill unless a demolition landfill permit is first obtained from Anoka County. 4. Operations shall be limited to daylight hours and shall not interfere with the .health and safety of surrounding residents and the premises shall be maintained at all times so as not to create a nuisance. Stipulations Continued 5. Any explosives used must be done so in accordance with Chapter 212, subsections 212.07.5A, .5B, .SC, .SD, and .SF. of the Fridley City Code and any other applicable standards, e.g. Federal, State, Industrial, etc. 6. At the end of each season's operations and no later than the last day of December each year, the site is to be left in a neat and orderly condition, with maximum slopes of 2:1 with no overhang or vertical banks and with a level bottom. 7. On the Friday of each work week, or when required by the City, material from this operation that is found to exist on City streets shall be cleaned to the City's satisfaction by the applicant S. Upon completion of land alteration operations, the land must be left according to the plans and contours submitted with this application and planted with suitable vegetation to prevent erosion. 9 Upon completion of land alteration operations or expiration of this permit, an inspection will be made by the City of the premises and adjoining streets. Any damage found to have been caused by these operations will be corrected by the annlicant unon notification by the City. Property Owner's Signature FOR CITY USE ONLY Date: Date: Date: Recommended for Approval By: Date: Approved By: Date: ��Z�67 PERMIT EXPIRATION DATE:- Lk �� CITY OF FRIDLEY PERMIT NO.: 2004-02334 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 12/29/2004 571-36U4 FAX: 1763) 571-1287 ADDRESS : 154160 AVE NE PIN : 243024110066 LEGAL DESC : LARRYS 1 ST ADD : LOT 3 BLOCK 1 PERMIT TYPE : ELECTRICAL PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. # INSPECTIONS i APPLICANT ROYALTON HEATING & COOLING 4120 85 AVE N BROOKLYN PARK, MN 55443 (763)424-8333 OWNER CORY GENUNG 1541 60TH AVE NE FRIDLEY, MN 55432 STATE SURCHARGE, ELEC FLAT 0.50 ELEC PERMIT FEE - MIN (RESI) 20.00 TOTAL 20.50 PAID WITH CHECK # 40564 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wort 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 provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY PERMIT NO.: 2004-02336 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 12/29/2004 (763) 572-3604 FAX: (763) 571-llif"/ ADDRESS 154160 AVE NE R n p n 6 PIN 243024110066 LEGAL DESC LARRYS 1 ST ADD : LOT 3 BLOCK I PERMIT TYPE HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES I # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 1300 APPLICANT ROYALTON HEATING & COOLING 4120 85 AVE N BROOKLYN PARK, MN 55443 (763)424-8333 OWNER CORY GENUNG 1541 60TH AVE NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application 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 does not presume to give authority to violate or cance the provisions of any other state or local law regulating cons ction or the performance of construction. Ann i-canN. Date r 1 Bldg HEATING PERMIT MINIMUM FEE 0.00 FURNACE SHELL/DUCT WORK 35.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 35.50 PAID WITH CHECK # 40564 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY BUILDING INSPECTION Effective 4/1/2004 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION 763-572-3604 FAX 763-571-:1287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES f �4/�JIJ�', AU E JOB ADDRESS �� � RATE SCHEDULE Fee TQM Residential Owner Furnace Shell and Duct Work, Burner & also Replacement Furnace $35.00 $� Building Used As Gas Piping (New Furnace, Fireplace, Insert) $10.00 $ ESTIMATED COST 1360,00 PERMIT NO Gas Range $10.00 $ DESCRIPTION OF FURNACE AND BURNER Gas Dryer $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) Wa m A' Trade N me Size No. *Air Conditioning -All Sizes $25.00 $ BTU HP EDR Fuel Total Connected Load All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Burner Trade Name Size No. Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EDR Improvement whichever is greater The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/Industrial/Institutional and representations stated in this application are true and correct. State Surcharge $ �� HEATING CO ('iia! ' iQ p,5ih AVEINUE NORTH TOTAL FEE $35,56 4120 - Signed W C+rt w SIV PAW, MN 55443 Tel # 763-424-8333 REINSPECTION FEE $50.00/HOUR FAX # Date t? *Air Conditioners can not be placed in side yard without written approval jfA from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough -in Date Final Date e FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS When replacing an existing furnace, the undersigned hereby verifies that the been examined and is free from rust, deterioration, obstructions, Yes( No ( ) venting has and is securely supported and firestopped where required. The venting system is plastic/PVC and meets all current codes of elbows and narrni termination. Yesz No( ) specifications including sizing, length, number The undersigned also verifies that the replacement unit is a listed assembly codes and manufacturers specifications. This does and meets the current include AGA-GAMA Category I Central Fumace Venting Tables for fan Yes No( ) assisted and natural draft appliances. The existing combustion air is sized and installed to meet the current codes Yes A / No ( ) �jl and manufacturers specifications. When required to install a new combustion air, it will be sized and installed Yes No( ) to meet the current codes and manufacturers specifications. When installing a new venting system, the undersigned hereby verifies that codes and manufacturers it is a listed assembly and meets the current This does include AGA-GAMA Category I Central Furnace No( ) specifications. Venting Tables for fan assisted and natural draft appliances. Yes Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented Yes ( No( ) separately as per current codes. AnylIlance Tvve and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted BTU Input Fan Assisted or Nat or Nat— Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type Total Btu Input Total Appliances Common Vent Type Vent Height ___ Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter =n ft Length ft Diameter Type in Type Appliance #2 Vent Connector Height Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: Describe HEATING CO: ° � l l i 4120 - 85th AVENUE NORTH Date Signed By: , M 55443 763-424-8333 ATY OF FRIDLEY INSPECTION DIV 431 University Ave NE ridley. INN 55432 763) 572-3604, FAX (763) 571-1287 I Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES Tn RF MISTAI I Fn nw r-Ar`N Gi nna 'LUMBING FIXTURE RATES NO. RATE TOTAL levo Fixtures ltd Opening, New Fixture :eer Dispenser gout Off Basin :atch Basin r tail Water Leader a;umpJReceiving Tank Y 1i'atwTreating Appliance ;l Vater Heater 43ectrtc Vater Heater - Gas' - Sas Range" Sas Dir— tack Flaw Preventer Required { )Yes () No Type $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 $15.00 teinspection Fee $50 001Hr +LL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Valvae of Fixture or Appliance JOB r S. .ate ij The undersigned hereby makes application for a permit for the work herein specifced 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 DATE: 20 OWNER BUILDING USED AS LJkrl _ ESTIMATED COST -- —�c�� PERNBT NO. — — TEL N0. COS-t_�—,% v A�oved BY State Surcharge $ .50 MMMUM FEE F F TOTAL FEE OF THE IIMIPROVEIii! u n :OMBUSTION AIR SHALL BE PROVIDED PER LLMC SECTION 504(A) AND TABLE 6-A '"PROVIDE COMMON VENT INFO ON BACK SIDE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 PLUMBING - °'� Permit NO.: 2Building Inspections RESIDENTIAL APPLICATION Received B AM'�A 763-572-3604 CITY OF FRIDLEY DATE 1-30 -2a J 1 YOUR E-MAIL ADDRESS _ SITE ADDRESS 6 S¢ AVE X111" I= 0 1DLt 1 01 OJ 3 Z THIS APPLICANT IS: OWNER ❑CONTRACTOR PROPERTY NAME: M pT T tt£w GRA",' ADDRESS: S`9 l s+ /�Vc 4yE CITY l' 2 ADL' STATE M�/ ZIP S>`1 ��- OWNER/ TENANT PHONE: '� S - S7L( -10660 CONTRACTOR NAME: SUBMIT A COPY OF STATE LICENSE # EXP DATE STATE ZIP YOUR STATE ADDRESS: CITY LICENSE WITH PHONE FAX APPLICATION PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW IN(REPLACEMENT DETAILED DESCRIPTION OfWORK Ad m, a-., a1v 64 ��j ,,Je, 14e_•jer re-�"i Ik J _k` t d� N A P d/Y-1 c e,, rn.at PER MS 16B.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. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to POO= cost of labor 1360 x.05= FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) WATER PIPING BATH SINK/LAV _FLOOR DRAINS _SHOWER WATER SOFTNER ($35) _ _ BATHTUB _ GAS PIPING (NFEv c�rruc�) _ SWIMMING POOL _ KITCHEN SINK _ WATER CLOSET — ACKFL CLOTHES WASHER E V. ($15) _ _ IRROW DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR WATER METER —OTHER E _ Permit Fee $ OG P Permitr Number of fixtures @ $10.00 x $10.00 = a 50 SurchTOTAL Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 X.$35.00 = $ DUE $ _b 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 f° a permit d work is not to start without a permit; that the work will be in accordance with the approved plan in the case hich-rte preview and approval of plans. _ E ,MTi h1 ri TE �- 3 O rib SIGNATURE OF APPLICAN PRINT NAMDA City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977