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R T NO. r � � PROTECTIVE INSPECTION SEC. �,Q / 0 9 , i ; �� «� ' �� CITY HALL FRIDLE� SS432 NUMBER REV DATE PAGE OF APPROVED BY �""� � �'� 612-571-3450 810-F15 10/18/85 � � J08 ADDRESS 510 Cheri I�ane N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION DESCR. �- 2 ML1Z'C�]-X Park SEE ATTACHED SHEET 2 PROPERTYOWNER MAILADORESS ZIP PHONE William Remarke. 510 Cheri Lane N,E. 572-9279 3 CONTqACTOR MAIL ADORESS ZIP PHONE LICENSE NO. Satae 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDINO Residential 7 CLASS OF WORK C� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 24' x 26� Garage 9 CHANGE OF USE FROM TO STIPULATIONS provide a hard surface driveway. Rear Yard setback approved 10/15/85. r, . M5 T G u 3 _ 6 . �EfQ ' cY,. , , ;, ,- '_; TE�£P ��''�g�� `.y;,��,'.:,,, r� rJi . ��// � ,. ��(� �NEe f�f��ICr"��.n l`-�„�'�,'" S�P/�R�AT�F° P� ��p� .,�., ��-s P _ � a'�� r�V �t�.�. ��'7"l�1�dd1`I� C7�/r�� 9L�9� F" �� F�R (,,� �,.� , ��1��1s�� iQ�v"� ��G�1�. SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBINO, HEATING, TYPE OF CONST. OCCUPANCY OROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. WOOCZ FL'dIDC,' 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 SUSPENDEO OR ABANDONED FOR A PERIOO OF 120 DAYS AT 624 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �. STALLS GARAGES AND KNOW THE SAME TO BE THUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX AND ,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S7/6OG.SG $`3.BO 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. �`G8 . rJO PLAI�CHECK FEE TOTA� FEE $7 .30 SIGNATURE OF CON i RACTOR OR AUTNOR12ED AGENT IDATEI WHE PROPERI.Y ID T D T IS YOUR PERMIT SiGNATURE OF OWNER iIF OWNER BUILDER� IDATE� G SP Ey��p � ___��T�[.1.��L NEW [] City of Fridley Effective u/1/84 ADDN. [ ] R-1 AAD R-2 AI,TER. [ ] Building Permit Appl3cation Construetion Address: .�� '"''%`�%�C� �� P��°�� " 4� _ °��- l Legal Deseription: Ll,% � 6�� 0��'R° .,� ��.�,�' ��,�t�✓� ��,��.� � Owner Name & Address : �� `� ,�i��,'�%'�'�6 �� .�'��' �,�r��' C-l� 6�'�r" r��Tel . � .�'A��' ° s�� Contractor: ��"�Cf��,��' .,� ��, �:�� Tel . � �e��' � •� �� Address: ��,�c�+ ��*�"f.�'�,�.�3,,� y��r� �' ��'",� � � � ,_.� �' LIVING AREA: GARAGE AREA: DECR AREA: OTHER: Attaeh to this applieation, a Certificate of Survey of the lot, With the proposed construction drawn on it to scale. Length DESCRIPTION OF IMPROVEMENT Nidth Height Length o� � Width � Height _ Length Width Hgt/Ground Sq. Ft. Sq. Ft. � Sq. Ft. Corner Lot [� Inside Lot [] Ft. Yd. Setback �� Side Yard Setbaek �� Type of Construction: ��°'� � Estimated Cost: $�� Approx. Completion Date : �,�'�� 6� Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation � DATE: � �'�'� '�� APPLICANT . �� `r, ,_ ° . �-��-_�� -- Tel . � � � �' �� Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge �OTAI. STIPULATIONS: r � CITY IISE ONLY $ �O� , �, o � $ '3�8C) $ � $ $�� Fee Schedule on Reverse Side 25� of Building Permit Fee 5.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement ldecessary [ ] Not Neeessary [ ] s._r� BIIII,DIAG PERMIT FEE SCHEDIILE The Chief Building Official shall, before issuing permits for the erection of any building or structure��or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon applicatio n therefore, require the payment by the applicant for sueh permit of fees to the amount herein below,set forth�and in the manner herein provided to-Wit: Total Valuation �1.00 to $500.00 �501.00 to $2,000.00 Fees $10.00 (Minimum Fee is $15.00) $10.00 for the first $500 plus $1.50 for each additional $100 or fraction thereof, to and ineluding $2,000. $2,001.00 to $25�000.00 $32.50 for the first $2,000 plus $6.00 for each additional $1,000 or fraction thereof, to and ineluding $25,000. $25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $�1.50 for eaeh additional $1,000 or fraction thereof, to and ineluding $50,000. $50�001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each additional $1,000 or fraction thereof, to and ineluding $100,000. $100,001.00 and up $433•00 for the first $100,000 plus $2.50 for each additional $1,000 or fraction thereof. DRIVEfiAY DEPRESSION ESCR�i (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Drive�ray width plus 6 feet times $13.50 Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 ineh depth - DriveWay width plus 6 feet times $15.75 VERIFICATIOH OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to a11oW for proper revieW of the proposed structure and of the construction site. A Certificate of Survey of the lot, shoWing the location of the foundation onee it has been eonstructed will be required before proceeding With the framing. � s � a h � ,�'_' $� D �� o � � . � � � � � v� �. N � � .,C � � � J 3 �D � . � �n ��: . �� n.' W � \ �! , ,� � lJF .�� ' • N � � O � P � n � �� o� N � \ � � � � � . �} �IPo. 0 � � �� x•� O � w� � b �,� N _� O N � I . � � �� Q• � �� . � P9 , ;..��.._-. ;=�:' Z �.ST��-T . - . W w. . ,, � N 3 sua�ECr pE . - � City of Fridley o � ATTHETOPOFTHETWINS gUILDING PERMIT -19�73 r � � R . COMMUNITY DEVELOPMENT DIV. � � L � � PROTECTIVE INSPECTION SEC. � � '!1 r , , � i , pa l•-_.� ��"��,`� CITY HALL FRIDLE� 55432 NUMBER HEV. bATE PAGE OF APPROdED BV i 612-571-3450 910-F15 6/30/89 � � JOB ADDRESS �j1O C11P.r1 Lane N. E. t LEGAL LOT NO. BLOCK TRACT OR ADDITION DESCR. 2 2 M11Y'CIlX Park SHEETTACHED 2 PROPERTYOWNER MAILADDRESS 21P PHONE William Remarke 510 Cheri Lane N.E. 572-�279 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDHESS ZIP PHONE LICENSE NO. e USE OF BUILDING � Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTEAATION � REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Rer�� and roo� repair & xeconstruction 9 CHANOEOFUSEFqOM TO STI PU LATION S SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTII.ATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFV THAT I HAVE READ AWD EXAMINED THIS APPLICATION �. STA�LS 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 � 5QO $. 75 WITH WHETHEH SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OF LOCAL LAW REGULATING corv- $35.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PL N CHECK FEE TOTAL FEE i $35. 75 SIGNATUREOFCOJTRACTOROR ORIZEDAGENT IDATEI WHEN PROPERLY VAL TED THIS IS YOUR PERMIT � ✓•Tn f / ,1 Si A E OF OWNER I�OWN R BUILDEAI^ IDATEI ~ BLOG iNSP pATE � r� � [ ] AL��R � � R�l AND R-2 Builciing Peanit Applicatiaa� Effeetive 5/],/88 ooaLStn�ctian Addr�s: /Q i� �,Z /.�°/Y� /Yi� �1/� �y . ,� I�gal De^�criPtian• � - . Owner Name & Adcir�ss: ��_ � .= 11e1. #,�72 9 2 T' �� '�- # Addres.s: 0 LIPII+X' ARFA: �RA� !�: D�7C'R AR�: o�: Attach to this applicatiaai, a Certificate of S�rvey of the lot� wlth the pro�osed oo�ttv�fi3a�1 dr�m oa� it to saale• L4�C�TIG�T OIF II�RD�n' ��1 Width _ Heic�t _ Sq. F't. _ ��'1 Width __ Heic�t _ ScI. Ft. ��at�i �— �� •�t . __ �- �1��K �o� —� ncL.��_�d' O�rner Iot [] Inside Iot [ j F't. Yd Setb�ack Side Yard SetbaGcs � �f �°�: F:st3matea aost: S_ 1sZq�i � �Q Apprcoc. oompletion Oate: Ptv�osed Drive�ray Width If New Opening Is Desired: Ft. $ $ Wiclth + 6' See Back Page DATE: APPLTCANr: 'l�el. � Peimit Fee S � oC� State S�u�d�zge S , °) �� S DriveWay Esau„i $ �� S � � �� S �, $�3� . f sr�r�,�a�s: r S`LTY �E �Y Fee Schedule aa� R�ve�e Side $.50/$1,000 Valuaticn $575 per SAC Unit , Alt. pAn O� Alt. °B" Above ' Flee Determirred by �i r,�r; 7 ��Y t ] ��y [ ] a ' C�ov,�J . . � ��►c� . � �— 1e�x � ) S,c�o � �.�C,/ :�� . . � • �•. � if= = �:ir. n s �e �ief Buildirig Official shall, before f5�3Tg permits for the er�ectian of any ,; � ding or stn�cture, -ar for any additiaai to any existir�g buildirg or stn��e, or for any altetatian or repair to any e�d.stin� building or stn�ture, up�n aPPlicatia� therefore, require the payment by the applicarit far suci� permit of fees to the amotuit i�erein belcw set forth ard in ti�e mar�er %erein pmovided to-wit: _ Z�!'AL VAIUE ' $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 !?��a. $15 (Minim� F'ee is $15 Plus s�uvt�*�) $15 for first $500 plus $2 for each aclditianal $100 or , frdckion thereof, to arni iiCludir�g $2, 000 $45 for first $2,00o plus $9 for eac3i additiomal $1,000 or frackicai ti�ereof, to and including $25, 000 $252 for first $25,000 plus $6.50 for each additional $1,000 o,r fraCtiCa� thel-eof, to and includ].iig $50, 000 $414 . 50 foac first $50, 000 plus $4 . 50 for each aciditional $1, 000 ar fracticn the�f, to arrd including $100, 000 $639.50 for first $100,000 plus $�.50 for each additional $1,000 or fraCtion thet�eof, to and including $500,000 $500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additic�nal $l, 000 oz' frdctian thet�eof•, to ar�d including $1, 000, 000 $1,000,001 and up $3539.50 for the fizst $1,000,0(�J plus $2 for each additional � $1, 000 or fractia� �f �$tIVEi�Y �RESSI�T ffiC'1i0W (�ete Gtirb Streets Only) � Alternate "A" : Removal ar�d re�lao�ent of ca� and guttQr oa�ly A- Driveway width plus � 6 feet t,itoes $13.50. Alternate "B" : Re�noval and replaaelne� of curb ani gutter arid install a 3 foot wide appYVac3z with 6 irxii d�ttz - Driveway width plus 6 feet tia�es $15.75. ' :�' �` �+_ •: •1` "•�U i�`. •; Permits for oo�tn�ctiaai t�rill be is��ed a minimmn of 24 hairs fram the time of application to allcw for p�oper review of the pr+o��osed stn� ard of the ow�structian site. � A Oertificate of SZuvey of the lot, st�owing the locatioaz of t�e fan�datiam anoe it has it has been wnstn�ct�ed will be required before p�+�o�dir�g with the fr�aing. ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF FRIDLEY 6431 UNIYERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 FAX: : 510 CHERI LN NE : 233024430052 : MLJRDIX PARK : LOT 2 BLOCK 2 : ELECTRICAL : RESIDENTIAL : ADDITION/ALTERATION 571-1Z87 r PERMIT NO.: 2004-00747 �a� � DATE ISSUED: OS/20/2004 VALUATION . NOTE: ELECTRICAL PERNIIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. REPLACE FURNACE AND AIR CONDITIONER # INSPECTIONS 1 APPLICANT CENTERPOINT ENERGYMIINNEGASCO 13562 CENTRAL AVE NE ANOKA, MN 55304- �� .L�L : REMARKE WII.,LIAM M& M A 510 CHERI LN NE FTtIDLEY, MN 55421 AGREEMENT AND SWORN STATEMENT This pemut 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 wor� 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 ELEC PERNIIT FEE - MIN (RESn STATE SURCHARGE, ELEC FLAT TOTAL PAID WITH CHECK # 5629 .».:r cuv-� i i: r�ivvu i o 1�n� u 11�L r vA W Vl(11 V 1 tl�l( 1 t1A1V L�Jl,K1tSL" 1J AIiU V�. 20.00 0.50 20.50 v ��n "�l ' � � � • 1 � � N � > d w Z O � N W CWj 3 � Ue' W Z � O ¢ U u� � � Z W � � �� Z 0 Z � z Q O � � H Z � � � � O U � � Wa 00 a. z ¢ O � O d H � W U � �� 4 � O U a 2 � � Z � Q � � � m t��o Ci` � � � �o¢m � � � � a � � � � ti � � rl d � i 1 r!1 li � ' 7G1iTG1 •.J D �I 2 � ,� � � � -� O,^ � J "/ � � Q�. 0 Q � ao 0 0 J � �� °z r � � W a W Q 08 � � � � � V+ '�7 U � W � Q _ � �o m w 0 r ;` � Q l`0 3 �z � � 0 3�w o .o _ � ,,,� J E � �o �d � c � a tg � T � i � U a� r' � CC� y O ? O � C £ Y � = Qi w � � d ��mu�. � o c� ° � � �° � � � tA N► tA V! � o 0 � O � � � J C _ � G pp U '' � o W � � v o � �- C C �� _� RO =, U � � C � q. � � �� N p: li R TOU.QJ.CJ. � N � U co � i� U c � � � � z c 'a c. H � CO S o 0 a�-1 ��-1 N � � � � G ca � � l6 C7 ni � 0 � :.'f � Q � G .o U � C U _ -�p R Y O � � � c' s S°3 �'= ni � Qo� �y °' � V ZW�OL'�� w t " C N ^ 3 y� c� u� � v c`a � Q, c a"i '' l0 � � � v �. co �o Q � c f�= Z� � � �o r � � ',�� ° •- o-\' `�a _ � � C O t13 � - tA s N :� �,Y � o � �_ �� ,Q .°o �o .� � �� ~ m' c E s � y o C � •` � •� r � � �� Q �" R ,�..�.��,,� � EO � � � � C Ca � �� ; w � � E � � o� a�i �v � Ci1 m �H N f0 ftl � � d �� o° � m ,� � � � � � � � U .r � y m c o � -� o � �4 � o � � m o � C v � � '"' � i. O ►V.. � L � L Y � G y � � � N O '� a ° o � � � � U « c0 t�_a O � � o �� .` . � 0 m H a p � C¢. � _ � O M � Q{i� N� ' o � a��° "�>� �,>>� E�� s��a ��_ N Q � � � � !'I .� .l'�1RT?I-I -In AI i'"l � N. . E� e�o `m CS.1 � � :: � � N � �, � w � H O � � � S g � � W Lwi_ Z 0 U w � Z W � �� 4 �-� �� o� � � � � 0 c ..t � � .Q N � �' 0 � 8 d c > 0 d O �. � c 'c 'o b R C 0 � � ¢ z � � � �- Z W W g n. w � z 0 Z O Q U � � W � � Q N a O W O N � Q m I-- � � J �L Wrl?I� br�.: TZ b0FJ2-LZ-cJdl� 2� ' d 'It1101 FILL IN COMPLETELI( FOR REPLACEIVIEN7 FUEL BURNING APPLIANCE PERMITS COMMON VENT VENT COiVNECI'OR AND COMBUSTII�N A1R VERIFICATION When replacin� an existina fnmace, the undersigned hereby verrfies that the venting has been examined and is free from nast, deterioration, obstructi�ns, and is securely supported and firestopped where �equired. 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 () i The undersigned also verifies that the replacemenf unit is a listed assembly and meets the current codes and manufacturer's.specifications. This do�s include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft applianc�s. The existin combustion ai� is sized and installed to meet the current codes and manufacturer's spec�cations. When required to install a new combustion air, it wlll be sized and installed to meet the current codes and manufacturer's spec�cations. Yes � No ( ) Yes¢� No ( ) Yes (� No ( ) / When installina a new venting svstem, the undersigned hereby verifi�:s that it is a listed assembly and meets the current codes and manufacturer's specifications. This does incfude AGA-GAMA Category I Central Fumar,� Venting Tables for fan assisted and natural draft appliances. Yes � Is the common vent and vent connectors sized and installed correctly a�ter an appliance has been removed from the cammon vent and vented separately as per current codes. No ( ) Yes� No ( ) Appliance Tvpe and Size/Common Vent and Vent Cunnector Information Appliance #1 Type � BTU lnput Fan flssisted or Nat f� Appliance #2 Type r BTU Input �� Fan ihssisted or Nat N� Appliance #3 Type BTU lnput Fan �lssisted or Nat T�ta1 A�pliat�ces Tckal Btu Input �� - � .. Common Vent Type �� Vent Height a r Diarr�eter ,,, �`'� inches . . .. . Appliance #1 Vent Connector Height 3 ft Length �_ft Diameter �_m Type e' Applianc� #2 Vent Connector Height �ft Length �' ft Diameter �in Type �/- G. Appliance #3 Vent Connector Height ft Length ft Diameter �in Type ALTERATIONS• Describe) HEATING CO: Signed By: Date J 1�-4� �A.'�R '�I S PI1.9J.SL Ol J,3'1Q 1�I� �0 .11 1� Wn�l-I S� : T i b00Z-L�-�Idd �R �"_ p ADDRESS PIN LEGAL DESC CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 1+'AX: : 510 CHERI LN NE : 233024430052 : MLJRDIX PARK : LOT 2 BLOCK 2 PERMTT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION 571-1287 PERMIT N: 2004-007 6 a' DATE ISSUED: 05/20/2004 VALUATION : $ 5,500.00 NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERNIISSION FROM ADJOINING PROPERTY OWNER COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. REPLACE FURNACE (WARM AIR, CARRIER, 66000 BTUS) AND AIR CONDITIONER # A/C LINITS 1 # FURNACES # GAS DRYERS APPLICANT CENTERPOINT ENERGY/MINNEGASCO 13562 CENTRAL AVE NE ANOKA, MN 55304- .� .I�1 : REMARKE WILLIAM M& M A 510 CHERI LN NE FRIDLEY, MN 55421 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction aut�orized 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 exa.mined this application and know the same to be true and conect. All provisions of laws and ordinances governing this type of wor� 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 regula�constru�tion or the performance of construction. Bldg 0 # GAS RANGES HEATING PERMIT MIl�TIMUM FEE FURNACE SHELL/DUCT WORK GAS RANGE FEE GAS DRYER FEE AIR CONDITIONII�TG FEE STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 5629 � 1 0 0.00 35.00 0.00 0.00 25.00 0.50 60.50 � �� .,.- _"_,_�� — — — � �I�1�0�/1�� _�� Minnegasco ADDRESS �� l� � �,� � c.- � "`o �� OCCUPA►NT G�or �� HEAT LOSS Yes DAT� HT4. INST. ':� m`j SOLD BY Electrical Work By TYPE OF HEAT FA SPACE HTR. Q (1AS DESI(3N MAKE � c °�' Model �d � Serial � C� � � o� /��) - NPUT e CONTROLS THERMOSTAT 1 � ,_ Heat Plug Value t'`��'�� ^� Limit �- �[ti �. Limit Settin ` Fan Setting �' �- Pilot Type � �l Pilot Make Pilot Model Pilot Timing Pressure � � � Percent CO2 nput CFH Pe�t �z � Stack Temp. � �! � Percent CO � HOUSE HEATING TE�T RECORD � � APT. FLOOR CITY 1 J�i,��-- OWNER r� �- ' ' �' INSTiALLED BY CenterPoint Energy Minneaasco ��L— (3es Une By UNIT HTR. OTHER ? � CONVERSION '� . r /� ; �`. Vent Size � ' `�' KIND OF UNER �-�' � SIZE �`' .� e�� NONE - - -- " Draft H�v �'� � Regulator Filters Size �X �� F r Number / ,_ Chimney Locatlon Insfde _ � Outside _,.�,__ Chimney Construction ��<<- � Wiring `� Test Tag Ughting Inst Date Tested � � �h Compeny Testlng CenterPoint Energy Minnegasco Name of T�ter � NEW ADDN ALTER [ j CIIY OF FRIDLEY �v�-� s��fF�'ve al1/2o04 [] 643� Universiiy Ave NE, Fridley, MN 55432 (763) 572-3604 eldg Insp [] SINGLE FAMI�Y AND DUPL�XES R-1 AND R Z (763) 57'1-1287 Fax BUILDING pERIVIITAI��LICATION _,_ � . - n � ---- _ Construction Address: ;'_� � �� V � _ ., - - - Legal Description: Owner Name 8� Address: % LL ��,�,�� __ Tel. # ��p.3�� Contractor. MN LICENSE # ��% � � Address; .a��;F s�OR y�. � Tel. # ��-�� 2 5T. LOUIS PARK, MN 55416 . AttachliD�►�ilic�tion, a Certificate of Survey of the bt, with the proposed constr�ction drawn on it to scale, LIVING AREA: GARAGE AREA: DECK AREA: OTHER: D�SCRIpT10N OF IMPROVEMEN7 Length r___,______ Width Height 5q. Ft Lehgth Width Height Sq. Ft _ Length Width HgUGround Sq. Ft Construction T e: � (� r �� imated Cost: $ � � Gf: �5 � �� YP Driveway Curb Cut Width Needed: �Ft + 6 Ft = Ft x� _� SELA ROOFINd & REMODEI.ING, lNC. DATE: `G `� APPLICANT: 4'100 �XCEISIOR BWD. Tel. #� � 55418 Call (763' 572�36a4 for Permit Fees if mailing in application. Fax td4��1�7 if using credit card and we will call you for card number. ' CITY USE ONLY - Perr�it Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge � TOTAL � �� $ J �1 � $ �� e � $ $ �� $ $ $ $ - Fee Schedu{e on Reverse Side 65% of Permit Fee .001 �f Permit Valuation (1/10th°�o) $.50/$1,000 Valuation �1350 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Aft. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering A�reement Necessary [ ] Not Necessaty [ ] . s �� a� � �' . . . . . � ti�t'd 06S'ON STIPULATIONS";, , � , ' S3�dS �NI �G�G�I d�3S WHEO : L 520Z ' b'�,dlJ