PRE 2010 DOCSSUBJECT
PE
City of Fridley
18323
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEI N0.
1 _ tr COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
�Q
i a "'f;.� CITY HALL FRIDLEY 55432
JAI,
\
NUMBER
TREV
DATE
PAGE OF
APPROVED BV
_-_.
612-571-3450
910-F152/13/86
JOB ADDRESS 1491 - 66th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
5-5A
1
Creekridge SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
John Truckenbrod
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Brickner Builders Inc. 6199 Heather Place N.E., Fridle 574-9871
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
l NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 50' x 30' Dwelling and a 30.66" x 27.5' Garage
SEPARATE PERMITS REQUIRED
9 CHANGE OF USE FROM 1RIM, FILA I ING, PLUMBING AND SIGNS.
STIPULATIONS provide sod in the Front and side yards. Provide City with copy of
verifying survey before capping. Provide a hard surface driveway.
SEWER LOCATION: 120' N.E. of M.H. WYE ELEVATION: 884.51
TOP OF FOOTING: 887.51 minimum
WATER LOCATION: Same trench as sewer
= SAC credit from school razing. Park Fee of $1,500.00.
Before di yin, . I Fi6� CITY OF FRIDLEY DOES NOT GUARANTEE TFiC
r�lJ
1`"'aj 1'�` ;? =: ACCUhACY OF UTILITY LOCATIONS AND ELEVATIONS,
TELEPH ELEG-
�� _
�"! G � t'1iS ("r� TI IS DATA IS FOR IfJFt .. !ri T :C)IJ PURPOSES ONLY,,
RF0L1�,ip"=a
,r AND I'E4? L?NSUSING Ti IIS INFORMATION. SHOULD
!PI,„
- �� ,
�'��IT= � w s ON TiHE SITE.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
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
R-1
1335 + 761
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
$118,200
$59.10
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT ME TO GIVE AU ORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIO S ANY OTHER STAT OR LOCAL LAW REGULATING CON-
$480.50
Credit from School
STRU 0 HE PERFOWO,NCLf OFC NSTRU�TION.
LAN CHECK FEE
TOTALFEE
120.12
$659.72+ P•F
51 NATURE OF CONTPYCTORORAUTHORIZEDAGENT IDATEI
WHEN PROPER VALIDATED THIS IS YOUR PERMIT
d a11.3A0
BLDG WSP ATE
SIGNATURE OF OWNER 0F OWNEFIBUILDERI (DATE)
NEW] City _of Fridley Effective 4/1/84
Arm; krl j R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address: - ✓�� • Z
Legal Description: Lo -/s '-s *- e
Owner Name &Address: L%l-llv �� i/GiE'�/✓d�'j �� °� Tel. #
Contractor: h-X1c/!/yC- JZ tlr L0FXS INC TEl. #
Address AleX71/C,41 Joe _
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 5D Width 30 Height ? Sq. Ft. a
GARAGE AREA: Length Width J%•S Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot Ft. Yd. Setback 3j -ol
S� Side Yard Setback /0 + S�
Type of Construction: �i9n%'E Estimated Cost: $
LOv
Approx. Completion Date: A;��" it's
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: �� APPLICANT: Tel . #
CITY USE ONLY
Permit Fee $ q r'"o).Sb Fee Schedule on Reverse Side
Plan Check $ rZ.V. - -' 25$ of Building Permit Fee
State Surcharge $ 5-9.1d $.50/$1,000 Valuation
SAC Charge � �� qf)&O(1 $425 per SAC Unit-
Park
nit-Park Fee $ NSOO. [ta Fee Determined by Engineering
Sewer Main Charge $
1FOTAL $ Agreement Necessary [ j Not Necessary [ ]
STIPULATIONS:
RONALD F. MEYER
LA,..*M SURVEYOR
LAND SURVEYING SU®OIVISION 063IGN
TELL PmCN` 771-4588
*5815 JKssiK ST. ST. PAUL. MINN. 515101
I hereby certify that this survey was prepared by me and that I am a duly
Registered Land Surveyor under the laws of the State of Minnesota.
Reg. No. 9051 Date: ov. /9d'¢
T
`%
5 'd-
l
GE cp..
Q ��oJ �,� �� cA o •
c ,a `� IWC F l7 y► �
Scales 1" = 30'
o Indicates iron monument placed
0
Lots 5 and 5A Block 1, CREDMIDGE, I
Anoka County,�Minnesota. -� / y.00
�! I
s
i --S-' t7 � 2 4 -,1'? 1J ,-4 � /M
49 /v 1-O *--j
f ..Z ° lel ) vl
i --S-' t7 � 2 4 -,1'? 1J ,-4 � /M
EXTERIOR ENVELOPE AVERAGE "U COMPUTATION
10
OWNER
SITE ADDRESS
CONTRACTOR
DA TE PHONE
Determine working square footage of each.
1. Total exposed wall area ft. x 17
2. Total roof/ceiling area . . . .1310 sq. ft. x - _0.!rl '�S00"
Total exposed wall area above floor
a. Total wall window area .............. *'* .........
b. Tctal. door area .............................
c. Total sliding glass* door area ................. *0•4�r
d. Total firepla&e wall area ........................
• e. Total*wall'framing area (average 10%)...........
f. Total net wall area above floor .................
g. Total rim joist. area.... ..... 00 ... 0* .....
• Total exposed foundation area
• h. Total foundation window area
i. Total net foundation area above grade........... GJ -110
Determine "U." value of each wall segment.
a. 7-1 SO'O - X flu I
-b. X flu It
C. X flu 11
d. X Btu 11 �2-
Btu of
111110
V, S1,01/
X #full
t V
9. X slu 11 j 6
flu It 5
X
3 . ........... .................... Total
I
If item #3 on previous page is the same as, or less than item
you have met the intent of SBC 6006(c)2.
/3/0
=
Total exposed roof/ceiling area I
j. Total skylight area..........................
k. Total roof/ceiling framing area (average 1096)
1. Total net insulated roof/ceiling area........-
• I
Determine "U" value for each roof/ceiling segment. j
k. X oU o _
• i
1 X •uUn =
Total
If total of #4 above is the same as, or less than #2, you have Timet
the intent of SBC 6006 (c) 1.
Alternate Building Envelope Design-
To
esign-To utilize the total envelope system method, the values established
by the sum of items #3 and #4 shall not be greater than the sum
of items #1 and #2.
1.• +2. -
3. +4. _
n
k
I
JAOI a,,� .7�
2•/3 = V7
,�j 4"; , "?.a, , � p C,.Y/
J -j 4AIwa , X�r
14 0, A,�
11
zo 'o;
'o
JAOI a,,� .7�
2•/3 = V7
,�j 4"; , "?.a, , � p C,.Y/
J -j 4AIwa , X�r
14 0, A,�
11
G7YOF
FRIDLEY
. CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
July 10, 1986
Mr. Tran Brickner
Brickner Builders Inc.
6199 Heather Place N.E.
Fridley, MN 55432
Re: Final Inspection at 1491 - 66th Avenue N.E., Fridley
Dear Mr. Brickner:
A final inspection was conducted on July 9, 1986 of the above address and
the following items were noted which must be completed before the structure
can be finaled:
1. Provide a handrail on the stair to the basement.
2. Install joist hangers on outside of deck joist.
3. Secure a solid cover on the drainage sump.
We will expect the above items to be completed and a reinspection called for
on or before July 28, 1986. If you have any questions on these items, please
feel free to contact me at 571-3450.
Sincerely,
DA G. CLARK
Chief Building Official
DGC/mh
CCiYOF
FRIDLEY
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
July 25, 1986
Mr. Tom Brickner
Brickner Builders Inc.
6199 Heather Place N.E.
Fridley, MN 55432
Re: Final Reinspection at 1491 - 66th Avenue N.E., Fridley
Dear Mr. Brickner:
A final reinspection was conducted on July 25, 1986 to note completion of
all items listed in our letter of July 10, 1986. The inspection found all
items completed and the construction has been finaled.
If you have any questions on this matter, please feel free to contact me
at 571-3450.
Sincerely,
DARREL G. CLARK
Chief Building Official
DGC/mh
CC: Walsh Title Co.
10299 University Avenue N.E., #102
Blaine, MN 55433
SUBJECT -
PE
City of Fridley
3 2 010
AT THE TOP OF THE TWINS
BUILDING PERMIT
`
RECEIPT NO.
• v ______ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
��®�®
�
r E �
NUMBER
qEv
DATE
PAGE O:
APP ROVED By
1 _
1 '- CITY HALL FRIDLEY 55432
I'J
612-571-3450
910415
7/18/01
�
JOB ADDRESS 1491 66 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
5, 5A
1
Creekridge
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
John Truckenbrod 1491 66 Avenue NE 763-572-9774
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION X❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (30 Sq) Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE 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
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 09 COMPLIED
@
@
$1'53
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$3,068
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-
$97.25
Fire
C $3.07
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL EF
$ 1.85
S�GNA AE O� COPY -PAC i2E0 AGENT iDATE.
HEN PR P ALIDATED T 1 JR P RMIT
7'/9 O�
GNATUAE OF OWNEAdo OWNER BUILDER. iDATE,
_BL -NSP
PATE
NEW
ADDN
ALTER
I l Effective 1/1/2001
[ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
[ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name & Ai
Contractor.
MN LICENSE #
Address: Tet. #
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.
(7i0 0� 4 0G1 -C-2 2L G�XT/1�4�2 - 'So f� /P��✓
Construction Type: Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x
DATE: fd'� APPLICANT- Tel.#-7ol—�7�
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ -Z-- Fee Schedule on Reverse Side
Fire Surcharge $ 3,0q .001 of Permit Valuation (1/10th%)
State Surcharge $/, $.50/$1,000 Valuation
SAC Charge $ $1150 per SAC Unit
License Surcharge $ $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ Bs
STIPULATIONS:
0 , 'S766si
CITY OF FRIDLEY BUILDING INSPECTION
6431 University Ave NE
Fridley, MN 55432
763-572-3604 FAX 763-5711287
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
Gas Dryer
*Air Conditioning -All SizesO�,l/L�
All Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work
Minimum Fee $15.00 for Residential or 5% of cost of
Improvement whichever is greater
;®®� Oa9yo
Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Fee Total
$35.00 $�
$10.00 $
$10.00 $
$10.00 $
$25.00 $
Commercial/Industrial/Institutional
1.25% of Value of Appliance or Work (List on Back)
Minifnum Fee $35.00 for Commercial/Industrial/Institutional
State Surcharge
TOTAL FEE
REINSPECTION FEE $50.00/HOUR
JOB ADDRESS _Z411 1 66 '�L4 ( A5
Building Used As���
ESTIMATED COST 7Jk PERMIT NO
DESCRIPTION OF FURNACE AND BURNER
# of Heating Units Circle One (Steam) (Hot Water) dMrm Airlv
Trade Name .Z'a_A n6x Size No V C/10
BTU HP EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
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 tru d Wct.
sawK HfUa tf
$ r �6 HEATING CO
$!l1 Signe ,aa Tel
*Air Conditioners can not be placed in side yard without written approval
from adjoining property owner - copy to City
FAX #
Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
Rough -in Date Final Date
Approved W
9'O
FILL IN COMPLETELY FdR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes No( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No(
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. YesNo ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. y" w i -t) rt# 'W j I v ti. Yes X No( )
tt,I"v VL--'
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes () No ( )
When Installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes (NAY" No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes No ( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type FV r vvcl BTU Input / ®v®® Fan Assisted or Nat
Appliance #2 Type rn BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type I®6S 13 Vent Height � Diameter inches
Appliance #1 Vent Connector Height 1-4-5 ft Length :;2 ft Diameter in Type GAS
Appliance #2 Vent Connector Height 2. ft Length—P--ft Diameter in Type �5
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
CO-
SignedHEATING
Building
Permit Fee
BUILDING
i ` See Back Page for Fee Schedule
Permit No. ¢ U 1'
Inspections
65% of Building Permit Fee
RESIDENTIAL APPLICATION
Received By:
763-572-3604
Surcharge
CITY OF FRIDLEY
Date
763-502-4977 FAX
$
5t_C $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2100 per SAC Unit (Plans to MWCC for determination)
EFFECTIVE 1-1-2010
$
ft + 6 ft = ft x $24 = $
DATE 10 — 10
tt
YOUR E-MAIL ADDRESS Cly
V In C v v C
SITE ADDRESS
] I ve
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
THIS APPLICANT IS:
❑ OWNER ONTRACTOR
Make checks payable to: City of Fridley Attach Stipulations
PROPERTY OWNER/
NAME: J CA,,, 1, 1 _ o, CJ
ADDRESS: 149 1 S? /V C CITY
✓% Lt:= STATEA!LkZIP SSS/��
TENANT
PHONE:
CONTRACTOR
NAME: f� 1 GC K W L D
STATE LICENSE # -3 "1 '10
EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
103
_ S
— %%
AND CERTIFICATE OF
ADDRESS:
CITY STATE]q&W
INSURANCE
PHONE 103 — 5 V/ FAX 6 —
PROPERTY TYPE
❑ SINGLE FAMILYMEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ' ❑ 'RAGE/SHED
❑ WINDOWS
❑ BASEMENT FINISH ROOF
13 DRAIN TILE
El DECK ❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: M C.'/ O C7 --SI►
SIZE OF IMPROVEMENT
LENGTH WIDTH
HEIGHT SQ FT
ROOFING OUSE ONLY
NUMBER OF SQUARES HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
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:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
E3 Nitryl
[]Soffit
ADDITIONS & PORCHES SUBMIT•
E3 Aluminum
13 Trim
I. Site Plan/Survey showing the existing structures
13 Other
❑ Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
FOR WINDOWS — PROVIDE U -VALUE AND
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
$
i ` See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
30 .001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
5t_C $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $24 = $
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 all w9rk which requires r view and approval of plans.
Ia
SIGNATURE OF APPLICANT PRINT NAME) C In A -J , 1 C to c `DATE JO -1 8' J 0