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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N° /1(--4-739 Date: Owner: ............... .... _._._.__._.__..__._..... _.... Builder _... _ W__r°�.-`+tl:� ✓ ' AddresAddress. ................... ...... L1mrION BUILDING No........... street _.._ .... . •........... - ............ _ Part Lot ,,rr ....... B Lot ...•,�:i,G±._.........._........ lock ........ ................................. Addition or Sub -Division Corner Lot ......---..._ . .................... Inside Lot ............... .............. _........ Setback .......... Sideyard ...t'' .................. ......... ... ........... ..._.._------- Sewer Elevation....._............._..._........_.._..._...._.............•........_...._....................... Foundation Elevation .......... ......... ..... ............ DESCRIPTION OF BUILDING �� r To . Used as*' Front ....._...... _..... .. _. Depth .. Height .-- Sq. Ft.,fit�'�,!i�� Cu. _.............._.............---------........... Front .._..........----.. Depth ....._.....---- eight ..-............... Sq. Ft ...................... Cu. Ft. _.. .............. �' _a Type of Construction .......... ,.,,a±?tr�t�...:... Est. Co ......... ......_........ To be Completed ..... .............. _............... N THIS PERA4I1 L .._E _ r; is l' AUTHORIZE VIOLAT- ION OF ANY P,fl,AYE LAND COVENANTS AND BUILDING RESTRICTIONS, IONS, In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. In consideration of the express condition done in, around and u Fridley, Minnesota n within the city limits ordinances. e payment of a fee of $.�.,,►(.................. permit is hereby granted to ................. _ to construct the building or addition as described above. This permit is granted upon the person to whom it is granted and his agents, employees and workmen, in all work said building, or any part thereof, shall conform in all respects to the ordinances of Sing location, construction, alteration, maintenance, repair and moving of buildings I this permit may be revoked at any time upon violation of, any of the provisions of said Inspector NOTICE: This permit does n t cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector f r separate permits for these 'Items. s,, ._ • .. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owners NsmeG%r9� Builder Address ..$,L1�� d._ Address LOC ION OF BUILDING No. Street _�: L _Part of Lot 0 s Lot � Sub Block . Addition or Div. , Corner Lot Inside Lot Set Back Applicant:attach to this form Certificate.of Survey of Lot and proposed building.)., tion. DESCRIPTION OF BUILDING To used a Front �� Depthight Sq. Ft. Cu. Ft: Front Depth Height •13rpe of C6 truction Estimated Cost To be completed - The undersigned hereby makes.application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling.of the Department of Buildings, and hereby declares that all the facts and representations stated in this appli " are ttue and torr ct. Date Signatur �;: (A Schedule of Fee Costs can be found on the Rever Side) City of Fridley Application for Plumbing and Gas Fitting Perndt DepL of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures ...................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin ............................ Water Heater (Up to 200,000 BTU) ...... New Ground Run Old Bldg . ............ NO. RATE TOTAL — x $1.50 $ x 1.20 $ — x 1.00 $ — x 3.25 $ — x 2.00 $ — x 3.25 $ GAS FITTING FEES: NO. RATE /TOTAL 1st 3 Fixtures .......................... x $1.50 $ I, •570 Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE %02$ , 5� City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, •Minn /6/ / 3 19� 0O Owner/I ®�� C- , 19 Kindof Building 19— Used as To be completed about Estimated Cost, $ / -Building Permit No 3! ,g v Signed By Business Phone No r T 10 -21 -(OC) 0?6-<-� . % ""e. 11 POST 1M-12-58 Qa Z4c O� LLC a ISE 3 U' Q OaC U' O N WATER HTR. GAS ELEG Base j 1st 2nd 3rd 4th • Future Connection Openings I New Fixture, Old Openings Connected with Sewer JR Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures ...................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin ............................ Water Heater (Up to 200,000 BTU) ...... New Ground Run Old Bldg . ............ NO. RATE TOTAL — x $1.50 $ x 1.20 $ — x 1.00 $ — x 3.25 $ — x 2.00 $ — x 3.25 $ GAS FITTING FEES: NO. RATE /TOTAL 1st 3 Fixtures .......................... x $1.50 $ I, •570 Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE %02$ , 5� City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, •Minn /6/ / 3 19� 0O Owner/I ®�� C- , 19 Kindof Building 19— Used as To be completed about Estimated Cost, $ / -Building Permit No 3! ,g v Signed By Business Phone No r T 10 -21 -(OC) 0?6-<-� . % ""e. 11 POST 1M-12-58 Applimflon for Power Plants and Heating, Coding, Ventilation, .ReFrigeration tind •J Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU. 4-7470 GRAVITY WARM AIR: RATE TOTAL, Location /1 o 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 $ NECK. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ .y each add. 60,000 BTU ..... . .................. 2.00 $ Replacement of Furnace ............................. §.00 $ Repairs & Alterations—up to $500.00 ... . ............ 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam....... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal, per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 v $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ 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 FF,E $ It ROUGH FINAL 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 applicationaretrue and correct. F—ridley, Minn `�— / 19 LO Owner Kind of Building Used as To be completed about Ai&�' / O Estimated Cost, $ Old Ne . Building Permit No. Permit No. DESCRIPTION OF WORK HEATING or PLANTS- SteeayL, Hot WaQ C,W:jarm�3 Air o / Trade Na- Size No 7� Capacity. Sq. Ft. E.D.R mac% BTU H.P. Total Connected Load `41' Kind of Fu BURNER — Trade Name Size No Capacity Sq. It. EM.R BTU , H.P. (REMARKS -OVER) RAY N. WELTER HEATING C® Signed 4637 CHICAGO AVE. MINNEAPOLIS 7, MINNESOTA By 42 2M 7.39 Business Phone I • City of Fridley, Mian.. BUILDING PERMIT Date: October 21, 1969 N9 10462 Owner. Joseph Vance Builder Imperial Garage Buklders Adds 801-681h Avenue N.E. Address 12483 -73rd Ayp-,n,iP North Osseo LOCATION OF BUILDING No. 801 _ get _ 68th Avenue N.E. Part of Lot Lot ._ _ 6 --- Block 2 _ Addition or Sub -Division .__....Brookview TPYYarp Corner Lot Inside Lot —X Setback --_ Sideyard _ Sewer Elevation To be Used as: Foundation Elevation DESCRIPTION OF BUILDING • Sideyard Variance granted October 15, 1969. Hardsurfaced Driveway. 0 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 aboveseZorth and in compliance with a11 provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 7.• 00 , permit is hereby granted to Imperial Garage Bldrs . to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of building limits s within the city mits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. r CLARENCE BELISLE NOTICE: We permit does not cover the construction, installation for wiring, plumbing, an heating, sower or water. as sure to see the Building inspector for separate permits for these items. Front �3 61 Depth -22-L— Height IQ , Sq. Ft. 352 Cat. F3520 ,Garage �s��ly 894_ _ Front _ 16' _ _ Depth 16' Height at _ Sq. Ft. _ 25_ 6 Cu. Ft. 1079 Type of Construction Frame _Est.Cost . 5 500.00 To be Completed Nov. 1, 1969 • Sideyard Variance granted October 15, 1969. Hardsurfaced Driveway. 0 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 aboveseZorth and in compliance with a11 provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 7.• 00 , permit is hereby granted to Imperial Garage Bldrs . to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of building limits s within the city mits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. r CLARENCE BELISLE NOTICE: We permit does not cover the construction, installation for wiring, plumbing, an heating, sower or water. as sure to see the Building inspector for separate permits for these items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER 'S NAME �J�S�. !y�%✓e� BUILDER /*&,gC ADDRESSQ% �- /B 4e���' inn �"• ADDRESS a % 3--!3 a,e A , LOCATION OF BUILDING NO. STRMjE ? ti. Z2` LOT (Q BLOCK ADDITION OR SUBDIVISIONoo/ll/>E�,�t�.P.�,r1 CORNER LOT INSIDE LOT P' SETBACK SIDEYARD SEWER ELEVATION TOP OF FOOTING Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To -Be Used As: Front Ile Depth Z Z Height Square feet 35- 2 Cubic Feet,L `9 e ll0010 Front Depth -(4 Height Square feet 25-4 Cubic Feet - ? J 77 o Type of Construction A0,0W&" Estimated Cost d0- ® 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 �. 3 -If 4" f SIGNATURE _�/2�P/4 % • (V�� (Schedule of Fee Coats can be found on the Reverse Side.) land Plairniny 370Af5siss#i.RNE. Wsurveyny Mirrnc !s 21 . soils Tcst;ny E N G I N E E R' O;' INC. M;nnrsoto Civil &kfunkilvl ll,,�neeriny En yineers Surveyors Certificate of su CLEMRON INC,. l � �`�►.�,. �y ,O � -- Sole (''=3�' va - •- 14 x s t ,r/o �• 5 E - ERa KV IES- TE RULE, t v I n7 Allsiv9E 1 . lh"ty urli�cy fhal this is a True and ea-red represenla on Ord survey a�'fhe boundor;es roe abar o6cr;itd and, and of'llx 1=A17 of o/' ba;ldln9s , IhefVon, &-;doll risWe elxrnorhmeds , i;ry y, f 'ran or 07said land. As surveyed by me Phis—_ Eby gr ®ea8 ��• A.019-c3. SUIOURBAW ENGINEERING , INC. , . E yncers urreyor �, - -- ----------- ----------------------- ----------------- vwAotea a 664& 12483 73rd AVENUE NO. RT.2 OSSEO, MINNESOTA lei PHONE 425 2818 SUBJECT PER�Ifl City of Fridley 21339 AT THE TOP OF THE TWINS BUILDING PERMIT i RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC.`q�/ i CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910415 5/15/92 JOB ADDRESS 801 68th. Avenue NE LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED 16 2 B:rookview Terrace SHEET DESCR. 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Joseph Vance 801 - 68th. Avenue NE 5711685 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 jJ REPAIR q MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (20. S(�uaXesl Tear-o;'f 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment -gust cojWly with. 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 I 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 $i if, Oho $,53 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 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. $27,00 Fire SC $1.06 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $28,59 $ GNAT E OF CONTRACTOR OR AUT ORIZED AGENT (OATEi r IrPE�VA ATED THIS IS YOUR PERMIT >� 9 Z BLDG 'NSP DATE Si a URE OF F OWNER BUILDER) 'DATEI NEW [ j Effective 3/1192 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: g/� y+" Legal Description: Owner Name & Address: 794,f Tel. #�/ Contractor: � or., ! 1k MN LICENSE # Of Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. , 2- DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [ ] Inside Lot Ft. Yd Setback _ Type of Construction: d Approx. Completion Date: Driveway Curb Cut Width Needed: Ft. + 6 Ft = Side Yard Setbacks Estimated Cost: $ /O &® '60 Ft x $ (Cost on Back) = $ DATE: y 2 APPLICANT: Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Park Fee $ ';� '), 06 Sewer Main Charge $ TOTAL STIPULATIONS: 1 �L Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $700 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1993 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES "MINIMUM FEE FOR ANY HEAT] NG/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. HEATING COMPANY .Sharp Heating and Air Qonditioning Signed By �°�`ar � � 6 I No. 612-572-0459 Approved By Od Hough -In Date Final Date/ -7 `� FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE JOB ADDRESS 801 68th Ave. NE RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Bumer - rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 20.00 $ 20.00 representations stated in this application are true and correct. /® ,1993 Gas Piping (Needed with new furnace) $ 10.00 $ OWNER_ Joseph D. Vance Gas Range $ 10.00 $ BUILDING USED AS Residence Gas Dryer $10.00 $ �� ®®� ESTIMATED COST PERMIT NO. *Air Conditioning - AD Sizes $10.00 $10.00 • DESCRIPTION OFF FURN6QE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work $ No. of Heating Units_,_,__ Circle One (Steam) (Hot Water) <2 arm A r Trade Name Comfortmaker Size No. GUA060 83% Commercial/Industrial 1% of Value of Appliance or Work $ BTU ®®v HP EDR Fuel 7 Total Connected Load State Surcharge $ 50 Burner Trade Name Size No. TOTAL FEE � �� -' BTU HP _ EDR � � a� � � ®� "MINIMUM FEE FOR ANY HEAT] NG/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. HEATING COMPANY .Sharp Heating and Air Qonditioning Signed By �°�`ar � � 6 I No. 612-572-0459 Approved By Od Hough -In Date Final Date/ -7 `� 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 Remarks List Alterations Beina Done: HEATING COMPANY Signed By Date CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1993 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: 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 NO. RATE 3 Gas Dryer Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4:00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $5.00 TOTAL JOB ADDRESS Sd 1 (0e—' ova- "F_ 21.0 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work In strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS I% of Value of Fixture or Appliance State Surcharge $ .50 TOTAL FEE $ 21 S o *11 ';� -1 .1993 Owner Orb VA -)C6 Building Used As Hnm£ Estimated Cost t 4 Se •00 PERMIT NO. /1/6_� PLUMBING COMPANY_ QuALIT.j PLum.9i4b SIGNED BY TEL N0. 6.1OTS ll" Approved Rough—In Date nal Date �3 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE Wateril> .. ':��tFi.`•i>� `..... S ower ' Wash T aY Ftoor Drain � Auto. Washer `.....Ran9Stories Gas e �.`.......Water . eater Gas EeUrinal c Basement Floor 1 Floor 20. Floor r 3 0 Flo r 4 PLUMBING FIXTURE RATES: 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 NO. RATE 3 Gas Dryer Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4:00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $5.00 TOTAL JOB ADDRESS Sd 1 (0e—' ova- "F_ 21.0 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work In strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS I% of Value of Fixture or Appliance State Surcharge $ .50 TOTAL FEE $ 21 S o *11 ';� -1 .1993 Owner Orb VA -)C6 Building Used As Hnm£ Estimated Cost t 4 Se •00 PERMIT NO. /1/6_� PLUMBING COMPANY_ QuALIT.j PLum.9i4b SIGNED BY TEL N0. 6.1OTS ll" Approved Rough—In Date nal Date �3 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE /Z — lob -Ve 3uiiding :nspections 763-572-3604 )ATE 6 _ ;TIE ADOMS C� I WS APPLICANT IS: PROPERTY OWNEW TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PMkMff TYPE TYPE OF WORK: CITY OF FRIDLEY 13UMDING Permit No.: RESIDENTIAL APPLICATION Received By: CITY OF FRIDLEY Date Reed: YOUR Ei ADDRESS NAME: � (74lz— V OL v. <-e— ADDRESS: CifSi �A PHONE: STATE LICENSE DESCRIBE WORK BEING SIZE OF OF SQUARES015 5C0 GAYtAGES PROPOSED S='— PROPOSED HEIGHT: .1%3NGG o Vmyl ❑ AlumtauM 0 Other WINDOWS IN EXImG OPENINGS ❑Yes ONO OR FOR NEW OPfiI11 OS -DESCRIBE SIZE OF OPENING CHANGES & TYPI: Air WINDOW TO BE DISTALLPD O ON VALUATION, INCLUDING THE COST OF LABOR ,AND MATERIALS (USIN X 7 U.B.0 FEE SCMULE) DATION $ i OCCUPANCY TYPE $ See Back Page for Fee Schedule 65% of Building Permit r ee (.0005) times the total job valuation — Mire $.50 .001 x Permit Valuation (1/100/4) $5.00 (State Licensed Residential Cofactors) $1450 per SAC Unit (Pians to MWCC for determination) _ii+6ft= ftx$20=$ $450 Conservation Plan Review $ ]Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ 16 t., $ Make checks payable to: Ci q of FridleY Ate, W DATE SIZe IR100F to DRAIN TILE 0 SIDD40 ❑ OTM ❑ SWDW)AlNG POOL EJ ADDITION O ODI IG 72e r t O LENGTH WIDTH CHH—OUSE QNLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE 0 DETACHED GARAGE Osom ❑ Trim ❑ Fascia LOCATION OF WDWWS Pt. BASMADff IVIII: 1. Exk&B Flour PhM 2 Naposed Boor plan 3. List of 090bu-211 members to be used FOR NEW coNSTRUCTION INCLUDING DECKS, AODMONS.&POROAMMM 1. Sim Pland showing the Misdnp sftcbx & and PMPoNd PfQ.1Kt 2. Two scb of =Wffictim Ph= 3. Saaw CaiPAW00 V Permit Fee Plan Review Surcharge Fire Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Pee Sewer Main Charge THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESS 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 Minnesm Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work w ' ;r s review and approval of plans. Q / SIGNATURE OF APPLICANT PRINT NAM£ / e � � "DATE