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AF - 45464N° 892 Village oi Fritlley, Minn. BUILDING PERMIT Oifice of INSPTGTOIZ OF BUILDINGS Owner �..�.�°�� ��� � �.�,�'°•-�m�,� -R. _.��..,�,,., r Architect Builder �,,.., ; �� . �,,�.. �,,, . �,,, Frid�ey� Mi2lri. I ,.�- ....�,,,.,a_ .t � .., � � lg ....,t t= �"' � r.'�" ` �.z LOCATION OF BUILDING No. � . -•,F t, ,r' :..,� Street � .�' ?� �...�,�r �-�,,� �:.. ,. Part of Lo+ -- Lot Block,_ Addition or Sub-Division DESCR,IPTI�II�TT OF BUILDING Front� Depth� Fieight�_ Stories_�L BRanner of Construction � �%'�-�' �.. To be used as �'�� ��'(j.��di1E t�{� To be completed 1 �� �stim�,teci Cost ��,�: F( � � �► �►�,, � ., , a . . , � � . r . � r;..., �'" s �»:�: k �.. Permit is h�ereby granted to � �.,� f �= �. . , . �.. r . E. _. �� .. , � ,��« , : _ „� ,. � :,, �_ ., . , -*-�-- � the building '�� "' described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, a.nd his agente, employees and workmen, in all the work done in, around and ugon said buildfng, or any part thereoP, shall conform in all respects to the ordi- nances oP Fridley, Minn., regarding the construction, alteration, maintenance, repair and moving of buildinga within the city limita, and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. ,_ , '�ti � �"'`�^,�° ' ° ,�'r �°� �;w,�� ° -P 8' r` � �� 3:.. �+'° : Tiis ector'of Buildin s. �_.—°,...� - �AGR,EF'MFN'�' AND SWORN STATEMENT In consideration of the issue a,nd delivery to me by the Inspector of Buildings of Fridley of the above permit, I hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein stated. Subscribed and sworn to before me at Fridley, Minneso�a; this �=� . � �" "' � '��_,._ ,�, ; day of �..°�,,��-�. .�..�. A.D 19".�-: ..�-r....�.r ,�:.. �'. � �r:,�<�..� .�_......... r- , =-�_ ��°`�.°- ;a :� �'� � ".��,. �.,. .,.�°" � 0 � � � � � � � � � � � � � � W � � � ,�^ u \ � � .r, a b � �� � � m a � �o . � � � '� � ._ � � � � � 4 � � j ��y F, bi i � . s� t' 1 Ai �i t� ;� 'z, ; ... .._ - I�� $�' v t� �- a s �' . ���; s; �`,3 � m. 'ri ., l`x y ; , 1"�� �i � .� 5� -- J �'. Y' � <i � j '�4 `a af� s�? . ,, xa . �; )`b P t' �s 3.� rN� a � �, � 5 9 � �-' � � �� .� � i Y1 x x�,w � a •� �' b � ^r`i 1 �„' ` '� � ,�., :. i. � � k ��, � z.. . x i ���� � � , �. � � ..__ � � _ �__ � '. � a �,... � � ��,� , � ._ . � j .�* � R � �' ` � � �� ��� � �t i '� . � 1 :_ � a _........ . . . . � f � N 1 , i � � � ' � � � « � � a � E o : � � � � ��� � � ,� � �;u �_ � � .. .�... rv..� . ..� � �.,_ a� � � d� � �g S ry . � � i ' aC �._.__._< f �.� � � ,� ' i � � ._m � � e_. �� � � � � ! � , � .�._� � ,- - - � �C ' �� � � �.� � $"'i 4uasx' ' � � � s ����s t> � f,... ..� � � aa `� , �, ti �; ,1 r�� �� � �-, . .-ti � "J � • � � � � M �� � � � � C � �° � '9 C: � � � �o 11J � � i.1J � � � � � .J � oC � i ti . O � ,� . o � � m � � � � � o � � I i E' M � : g� i I N N M N N V! � °S F�i �s � A A ".� �"► � �i �► .'R • �,a,] � . It it x It � �t It M M K 1t • ` . � � � . � � � . � 3 � �. v . . . . . . 4� �• . . . . e . . p� . e . P . . . . . a � � . . . . �{ . . .a . . E�rp . . . • �' � . ��. n � . W • • "�' �N � • e . � • v � . • . � �.' �% • vi " � 2 � � �o ' : . � tn ' F�1 � � � n Q Q � . �s � , � ab � , .• � . � c . o • . �� : � p : � � � ' K " � . � �' � �, � .. � S � . � ��' •e� � rv � � i w � � a� � K � �' � � w � .. r a � ,'�ei � �'' � � � o � i� � � � � f � � � X � � ' � • � z � � �a 9� � � � � � 1p � � � � �� V l 1��F1, Building Inspections 7. 63-572-3604 DATE ��', �'�'7 S.ITE ADDRESS ��J� THIS APPLICANT IS: .... MECI3ANICAL RESIDENTIAL APPLICATI()N CITY OF FRIDLEY YOUR E-MAIL ADDRESS O OWI�IER d�L°•OTITRACTOR Permit No Received By � Date Rec'd: t`�`� PROPERTY NpME: �� �� OWNERJ �DxESS: �SIQS C`���:��, F''�� — CITY �� � � � ' + STATPi�1Al ZI�� TENANT PHONE�t -�Z `9 S7 CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WI'TH APPLICATION PERNIIT TYPE TYPE OF WORK: COMPANY NAME: ' "' " _ . CONTACT PERSON: � � STATE LICENSE # EXP DATE CITY � ��=�-� STA7$��% ZIP�'U3 �+nDRES s� 4�i f� 1.�� r�,e iJ✓ PHONE � t03° �%3 �y'1 S�I ? FAX �i4� � 3-i� � - 0iSI1�3GLE FAMILY ❑ 7W0 FAMILY �j �W �L�.$EPLACENCENT ❑ TOWNI-10USE ❑ qi,TERATI0N1REt�iODEL DETAILED DESCRIPTION OF WORK �� t ��` ��' PER MS 16B.b65 the pernnit fee is a minimum o aen5'� fxture� xcluding the fixtw-es� (Ths Ohouldlreflect only there st of labor ) improvement, insta.11ation or replacement of a resa � Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost af labor Y_____ x.05= FOR PROJECTS WFIERE 1.ABOR BXCEEDS $500, FEES ARE BASED ON 510.�0 PER. FIXTURE, EXCfiPT WHERE N�T�DSI �rUU�U �� VATE TOTAL TIUNBER OF EACH BELOW) �,G. �� MODEL. �)�������± Equipment Installed . , MODEL: 5��� --�— MFG: �— SIZE/BTL3 _,� �G: MODEL: FTREPLACE (GAS) $15.00 GAS RANGElOVEN $10.00 AJC $25.00 _FIREPLACE (WOOD) $35.00 _NEW GAS GW1-L $1D.00 _AIR TO AIR EXCHANGEER $15 LF�yACE $35.00 GAS UNlT HTR $10.00 BOILER $35.00 _G,qg DRYER $10.00 ^POOL HEATER $35 �0 _CHID4NEY LINER S10.00 �AS pIpING $10.00 VENTILATOR $15.00 — nUCT WORK 510.00 �.x:���� �4.,.�,�.T,.,�:: �`��'���� <. �����������"�� _ _.._.,..�,., _ - � y� z. ��.. . . _.. _ q . .�'b.� _........ � � � . .+R.:'��t•.v Y.�. k ta:.....'.'.J.�:... . - �. . Ja�. J�.,, ,� i�. f.,x.'.....,.<. . r. . .. . .. ,. ..�.:.. .. Permit Fee $�_• Number of fixtures @$10.00 x$10.0o-; — Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = � TOTAL DLJE $ Number of fixtures @$25.00 x$25.00 =$,__ Number of fixhues @ $35.00 (, x $35.00 = �_ State Surcharge = $ Total = $,_ -5v THIS IS AN APPLICATiON FOR A PERMTT-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 �and1workFslnot o startlw thou a permit; th t theCVaork w 11 be�'in� ccordance withlthe not a permit but only an application for a permit approved plan in the case of all k w ich r uires review and appro��al of pl s. f pRiNT NAME DATE � � SIGNATURE OF APPLICANT , ...�,.,. :�,-.�:;�.>�.a��:.�-,..�. ,.�;;�T�,7,.��-�� City of Fridley Building Inspections Department . 6431 University Avenue NE, Fridley, MN 55432 763-572-360A- � n v• ��'�_5n7-4977