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AF - 45245Ci.ty of Fridley, Minn- BUILDING PE�T N� 5 5s � � ��Date: � � � � . � Owaer: �' Builder .— _,:` Address Address _.�.` .f � �� CA�10 F BUILDIIoIG r' .._.._ Pgtit f Lot —_ .. N . _ Street , — — Lot �-- Block Addition or Sub-Division ,� � r. Coraer Lot _�de Lot Setback y� "�� Sideyard _� �+- �� Sewer IIevation �. Foundation IIevation DESCRIPTION OP BUILDING T-�� Front �r� Depth .�� Height � Sq. F`ti. �1!��--� Cu. F`t�.��'r�.'�"' F'ront Depth eight —�..� Sci. F't. Cu. Ft �pe of Conatruction �' � Flst. Co ��"�To be Completed In considerat3on oE the issuance to me oY a permit to construct the building described above, I agree to do the proposed work in accordance with the descrlpiaon above sei forth and in comp]iance with a]1 provisione of prdinancea of the dty of Frfdley. , �� af .,' In conaideration of the payment of a fee of $�_ , Permit fe hereby granted to � to construct tt►e building or addition as descrlbed above. Thispe rmit is g�ranted uPon the exAress condition that the person to whom it is granted and his agents, employees and workmen, in all work done iu, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regar8ing locat3on, construction, alteration, maintenance, rePair and moving of buildings within the city lim�it� and thia permit may be revoked at anY �ne upon violatio�� of the ProvisioLa of said Ordfnancea ,/�"'� �t � sr r � Suilding Inspector NOTICE: This permtt does eo� eover 1he eonsteueHoe, insfallatioe Por wiriap, plumbin9, gas heaH°9, sewer or water. Be sun to sss ths Buildte8 lespeetor for aparate permiis ior t6m� thma • �� 4 ^ _ � - — � -.:; � � s-l.' • •'� v 9PPLIC�TION FOR BUII�DING PF�iMIT CITY OF FitIDLEY, MINN.ESOTA �`e ,,� , Pfh...�— � � a� IJ ��i4 1 r►-�+� Bu3lder h 4wrier s Name / �ddress �,�% %— Grocs� �� _ w_ dress %//7 — G�'�� fi�- �s� LOCATION OF BIIILDING No.� �� 3treet ��'�i� ��'� Part of Lot . ,� i�-3�- �t ��°'� Block �°�� 8ddition or Su'�linision ��►��ii ^ � Carner Lot �Inside Lot Setback ��/ Side-Yard �� s�' � t' � SEWER ELEVATYON F4UND8TION ELEVATTON ,_,..._ �pplicant attach tb location. To b used e.s : � ..��i _ this form Certificate of Survey of Lot and pro}�osed bu3ld�ng DESCRIPTION OF HIIILDING / . �' .3, s '� P Sq. Ft. �7�� Cu. Ft. �� r� Front� Depth Height Sq. Ft. Cu. Ft. T�pe of Conatruction �- Estimated Cost ,� �. 9� ___._ To be Completed The unde.rsigned hereby makes application for a permit for t&e work herei.n apecified, agreeing to do all work in sfia'ict acc�rdance with the City Ord3.nances and ruling of the Depsrtment of Bu3ldings, and Y�ereby declarea tha.t the facta and representa�tiona atated in this appl3cat3on are true and correct. � DA7� �� STGNgTURE �-"` ,. (A Sohedule of y" . .r _ can be found on tYte Rever � 3ide.) n 0 A ' ' � r: �, HiJILD�NG PERMI�''•'F'�E SCI�DUIE Section 2. The Inepector of Buildings shall, before issu3ng ariy perm3t for the erection of sx�r building or structure; �or ..for any .add3tion to e,ny existing bu31d- �,.r_ �ng .or. �s�o#�e; � or for � ariy �alterations or reloairs to sny exiating building or structure, upon applica.tion therefor,�require the payment 'bar the applicant for _$u�h_pa�3.t of fees to the �amount here3.n belmw aet forth and in the metmer herein provided to-wit: 2.1. For any auch permit for the erection of an�r f�i.rerproof building, other than a garage, w�rehouse, factor� or grain elevatar, or for the erect3on of an�r fire- proof eddition, for similar occupancg, to an� e�c�.st3ng building shall � e.t the re�t,e of $�.L�O for each one thousand cub3c feet, or fraction thereof, in such cubic.e,7. contenta. 2.2. For any such permit for the erection of any fireproof gar�,ge, warehouse, factory or grain elevator, or for the erection of any fireproof addition, for sim3ler occupancy, to any existing building shal.l be at the rate of �1.25 for each one thou.aand cubic feet, classified as "fireproofn by Section 502 of the Minneapolia Building Code. HO�.� 2.3. For any such permit for the than a �ara�e, warehouse, facto addit3on, for sim3lar occupaneg, each one thouaand cubic feet. GARAGES erection of an� nor�fireproof building other ry or grain elenat�r, or any no�fireprooi to any ex3sting buildin�. Permit �]..00 for 2.4. For any such permit for the erection of any norh-fireproof gsra.ge, warehouse, factory or grain elevator, or for the erection of any non-fireproof eddition, for simila.r occupancy, to any existing building or for each auch building or addition. Ninety Centa for ea.ch one thousand cubic feet or fract3on thereof, in the cubical con�ents thereof with a minimum of �4.00. For the purpose of computing fees for build3ng perm3ta the cubicel contenta of any building or addition to a uniform height throughout by multiplying the ground area covered from a po3nt s3x (6) 3nches below the floor line of the basement or cellar to the average height of the upper surface ar to the average height of the roof surface of the main gable of a pitcheci roof. 2.5. For repairs or alterations to an existing atructure, the fee shall. be at the rate of �3.00 for each Five Hundred Dollars ($5�.00), or f'raction thereof in the cost of all propoaed work. 2.6. In no case shall the fee charged for any permit as set forth in Section 2 be lesa than �L�.00. !"'� � ., � .�. . ,,� a GEORGE E. HOPKINS • Registered Land Surveyor and Civil Engineer Phoae SO. 1-8856 10701 Nicollet Avenue South Minneapolis 20, Minn. PLAT OF SV�tVEY sca�e � mcn 4o reet PROPffiiTY oF Q/d �h � f'c�/�n�r� 7//' � N/r1,r�J'�iera Dri'v'i► �1 /r. �'� .�,H. ��d � � LOT 1, (�LOCK 4, INNS�RUCK 15j ADDITION R=421•�81 _ . --�frt�k-Cf�— �� - — _« I °� o � M I 90 3S ' ' q 55.94 , H " N. t, az ,. ;o�_ W �"� '�,.aq; �'� �' s�e IdS �� e�c � ��C�d� � o� � L r.. M � M G / l O} / 5' u�il��y easemen� � � 30 —f-- — ilo.o °°' deno�es +ron rnonumeni� This survey wa! made and a cer�if�ca;�e �rePared for for �he purpas� of showing bouncJaries and u�ili�y easemen�s. There are na enc�oachmen;�s. Y N CERTIFICATE OF SURYEY I hereby certify that on NaJ. 18.�2 I su�rveyed the pmperty described above and that the above plat la a correct representation of said survey. ^ • 1� �� _ _ _ V �, v � � � �, C' o `� p � . M . 7i . � . m . m • M . O . � . m 0 ' � : � •- . ifl � � N � � � �i � � � � W � �O w � ia � �o � � m � N ' O ' o � : Q : . � • ' • � aa � � � �N ►'' O 4 O � � � \ � I� 0 z � Cro" � z� � z� z x a � n a � � � � � � � � � � a� �� : O � � � � � O y � �Q � 0 . � O 'LJ � a � � � : � a��. g : � � : � � . . . . : � � � � ' �x � � � � � x � W N G� r r N � w p e.N7� O O O � ffl 1fi {fl �f! i4� �fl v N y � � �) � e c 0 Q x o� 0 � � � � � r � m N^ l/ 2 m C r m o � a � w N � � a � � � � � 0 � 0 � � � � � � . �. ca p ►+ pd � p. R. � y x� � s �' �@ � �� O a p �li � � � � � � � � om � M � a. � �_ � C�'O WATER CLOSETS URINALS enn+ n�s suints SINKS WASH 7RAY5 DRtNK. FOUNT. s►�rRS. FLOOR DRAINS CATCH BASINS GAS MPL GAS RANGE OPENiNGS a • 2 � �y in D A � � �¢�� @�a� N�� ¢ � � � F+ ~• �y e'f' � w'a� �' ��°� � � p � �a � �°�° � m � b ��b � b �� o �a°p ]' �, o � a. � w � � � � m �. � o �i �h �`�`°" �� w � rQ M � � m � �'�' � °� � � � �M �� a� �x � � p � M � M C+� � -p m �� i � � 3 � � � � o �' . ro 4 m � � � M � � � � � �. � O � i � A � "' � �� ' � 5' � r'�' �!� L' � a � � 0 � [ E� � � � � � r �x x v� v� "� �'' A tii bd � x `j ''� � O w R�.� `� "� `� ZI ° x x � � � � � � ex*� o ]o �� 4� O p� a�� ,��, � � � � H � � � � e� � O �� ' iA � p � � �A O N 00. � � � � y 0 � � � O . O � .hi O (�A . � y � W O . O .�' �'7 G± ' ' � y O � : � � � . . . . m . . . . . m . : : : : � : y� : ; : : � : � : : : : � : � � � � . . � . �� 3 V � �� p z � � , � � � . H � �; m C4 �e 5a O : t� N t+ Cri O O Q � O CA {fl {fl � Vi � , y � O � �r � , � � � � �?`� 6� �� z c� n D w � � � � � � � b Od � � I a � o w �� A� � � A � � � � � �' � �� I � � � O �' � � � o� � b � � � h, �' �' � ,aa'. a " c o °o C � � � �� V d I e� � < x � o � � � � � � : t � : t : : s : : F . . � : : � : : i _ ,,. ,,� � � � � � n � �� bb° � � � � �� . � � � � �� - � � r� �, �� S � � y � � � � .� o �.e � y � °e P, �M � j O � � F � �� a� Q I � � �f� � � � � CT' . � r'i � o ►� W brt : � o R� � � �,, �` c a O . : � � � � o : ; o d v ° : : : H � � . • ; Q � . i . � ;M �, . . . . en [v t.7 0o Oo O O O O O ff! i� {A {�' f/� `'�! � m �p7 � � y . ol �� x° 0 0 � � ^� � � �\ � y � � Yaf/+ � � �. 1 � i O �, � m � 0 � 0 t3' � O � � g r�t- t.� cn �w� ns o0 O O G O O &f i/! � � � � y - �- , � � � � b � � � Sg w �' ` `�C �� m � � � RD R° � � 3 `► � �� ° R° � w 0 0 �G h0 �� ,'' �s ' ,.1 a � � � � fn . . en . . � o : : 0 0 : . � ; ' ; t� cn en m � p O O Q � 0 t" � � a+ a. � � ¢' y� o Q� �t �G�� M � ��,� � pFo,a� 'p�' � � �Q � Q ��•� � ii �p �� o �� ° � p�� p p, G`C O E �� a ` "rws � -� a o p �' �, o � y H �� a� �.� � �� y �� o �� m � � � �� D � r � � m N � m C � , d i � i �: � � M � � � � � � � c ( � � � o � � � � � � � � � � � � � 3' �o '��' - � N �� 0.� � � e• � � , �. � 70 � � 0. �� R � ` �, �.}- . . � . � - �_�� -�� ;� � �''��_' �J� ;� �� :� � `�/ � �°,�-� C`,�,�� ;�°� ,� v� �a�" � %'�.r�-„' {� � ��-�'�'`° � � n�ss �, ✓�`! �� ` a`"� � � � � , D � � HEAT LOSS CALCU�kTIONS DEPARTM�NT OF BUILDINGS �� ° - Weatherstrips A.S.H.V.E, ConsCruction No. ^ Insulation Guide W,�ndows 1�oors Reference Out. Wall Int. Wall Ceiling Roof F1oor Kind How Applied ��e's—No I '��Ye No 19_ Fl.� �' � g � e �, Room LenRth �' ; Width ,�'„� � Height � � Fl.� ' A'�:�° :' �'�'c�° Room Length � � �°Width ,J � '°Height Windows and �`oors—Crackage and Area Windows and Doora—Crackage and Area tYtdth Height No. ot Lineal f. Area W1dth HatBbt No. ot Ltneat tt Area No. ot Dgne of pane lighte ot crack eq. tt. No. of Dgne ot pane IfBbte ot crack eC. tt. ,� ,..-, � �3 tiL� / ._e �� A�s '�` 4 �, � "/,so� �' � � e� c7 , �% �' � COef. Btu In6liration � / < � � '� � � __ Glaaa �, y.;�' � �' � Exp. waU ;m� ':�" � � Nec exp. wall � ��` � �' Int. wall R ,�, � � ,-� � ?� ;�� Ceiling g� �-' �" a a�= ,',s,,; r� ,� � Floor ` Total Btu. � . Required sq. h. E.D.R. or aq. ina. WA. Leader area Fl,� °,, � r9;�a, � Room � Leagth �� Wid �°` Heisht , Windows and Doora—Crackage and Area Wld h HelBht No. oL Lfaeal Lt. Area No. of Dane o[ pene liahts ot crack W. tt .� t p � � 4a `�a � � � ... „�8 � (! • �r � � Y.T �� '�' � cf °� 6 � � � Ipri]�IBtIOD -P �r �r�s c,la� � r ` � E7Cp. WaU „� ;' � ✓" R'�% Net e:p. wall `� �� Inc. wall Ceiling � �'� -� � � � p*�f � Floor Total Btu. Required sq. ft. E.D.R. or aq. ins. W.A. l.eader ana ��,.�� Room �Length �_ '°"$ Width �; � Windows and Doors--Cracicage and Area Wfdth HelBht No. ot Llneal tt. Area No. ot Dgne ot Dsne UBti�e ot crack sq. ft. A cn .?�' � 6S ��'r&`� e`_dr �SY. "'� :§ Infiltration I �' �� Glaas �' �. Exp. waU "� �� "'� Net eup. waU �"'rtr '� 4 int. wall Ceiling � =�y :.� �`' ,J .�� Floor Total Btu. Required sq. ft. E.D.R. or aq. iaa. W.A. Leader area �� Infiltration � ' C�lass Eap. wall �/�� ,�r � - �% Net eap. wall Ia� wall Ceiling � �.� %'P> >�` =' � � �b Floor Total Btu. B� g� � �'�'� � � �° � � �° � �; > .� � :� `� r�'� �a�" *� � Required aq. ft. E.D.R. or sq. ins. WA. Lesder area F F'(•� -,� ,�a', e� ROOm ��WS�++.,t +'3' '"` Wlt�tll ;'�� Windows and Doora---Crackage and Area Wtdth HelBht No. o! Lineal tt. Aree Na ot pane of pane 11ghLs ot crack aa. tt. �� _ 'l �,d' � �i. H � `A � S A�- � k"• � "� Btll �_ �` �' � In6ltration �p. Wsu � Net exp. wall Iat. wall ,�° .� �`� Ceiling :� B� �� F �.'� Y. �Y Floor 'I�otal Btu. � � ��. � �. =r, .�t� ��-. ,� '`�-�'� <.. a° �z ,c •.�v � � =- � � ° �� R �� — Rec�uued aq. k. ED.R. or aq. ins. WA. Ltader area � I � �.� ;� t�m � �� r � w�a� � `� Hei�ht ' �' .; Windows and Doors—Crackage aad Area Width Helght No. of Lineal tt. Ares No. ot pene ot paae ligdts o! crack sQ. tt � Infiltracion B� f Eap. waU � � � �' �,� ; � � �r �" � Net eap. wall _ �wall�'�'�,��a,��>�.x - `�_�� F � �' � �' �Q �'� � F°' � � Ceiling �' Floor ��, ,�' �`� b��` �:, °',�-'�' � � "� Total Btu. _ �', �� Required aq. k. E.D.R. or sq. ins. WA. I.eader area a �� .� . � .- ,_ ` �,d'� � �-� �f�' l� �,� ��'��" �� r`a� ��,�";� �� . s 9 - n�s6 �� - - ' ` HEAT LOSS CALCULATIONS DEPARTNIENT OF BUILDINGS � �► � �� -� � �• A.S.H.V.E, Construction No. Iasulation Weatherstrips � ,��e Windows Doors Reference Out. Wal� Int. Wall Ceiling Roof F1oor Kind How Applied Yes—No I Yes—No � 19— Fl,� ��= � Room � Length /��'� Width Height A Fl. � �' Room Leagth ,y� Width -�i► � Height� Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area �Vldth HeiBht No. o[ Llneal tt. Area Wldth Hat6bt No. 01 Lineal ft Area No. ot Dane o[ Dane IiBhte ot crack eQ. ft. No. ot pane ot pane liBbte of crack eQ. tt. � � +�s. � �� Y+�P � � � � �P �� ' � � Coef. Btu Infiltration �,� ,� .� �� ,� �dES � � � �tr�:' ?� 5ia` �,•� Exp. wall /� .� �_ � �' . � � �;, ;<'. Net eap. wall i`` �+ �� `�-+�� Int. wall Ceiling �' w� �,�' ' a� � z �' � Floor Total Btu. �'� Required sq. ft. E.D.R. or aq. ina. W.A. L.eader area � � Fi.� ��:s��,� " Room � Length ,�:i - Width 0% --° Height °- Windows and Doors--Crackage and Area Wldth Helsht No. of Lfoeal it. Area No. of Dane ot pane li;Ata ot crack ep. tL � � r.� �,� ,�' � o � ; � /, � ,-� .� .� -� � � � � _� J � _� Infiltration �� Glaaa �' � � E�cp. wall v � X � � Net eap. wall � p ��j Iat. wall Ceiling /� �° �/ � � � Floor � Total Btu. Required sq. ft. E.D.R. or aq. ina. W.A. Leader area FI. ,� �- �: J Room � Length �� Width �'/ - Wiadows and Doora—Crackage and Area Wldth Hel6ht No. oL Llneal tt. Ares No. ot Dane ot pane Ughts ot creck sp. tt. i : P� �.� ,� ��° B2" �o � � 1n61tration Glasa Eap. wall .�' Net e:o. wall Ceiling Floor Tbtal Btu. Bcu , �� ' � �S� Coef. Btu '� a� �,�` ; a.� �_� . . �°. �� y'�p rl�. 4� � �:t' m W° �� ,�' '� � aq. ft. E.D.R. or sq. iaa. WA. Leader area � � InGltration �BSS Eap. wall �� Net eap. wall tpt. Wau Ceiling � �; � Floor Total Btu. � 1 � Coef. Btu �`�° �" '� � �' � � �. � �..� } �p � �a: �.�..� , k�:, r' , ,� 6 � �.� ce'e,Fi`' �-+a °e�%` -5��, s�.s �` s�' is� � � "� �= � � �� Required aq k E.D.R. or sq. ias. W.A. Leader area �"� � �.lF,..s' � i'=� r_:� [�WIn I +.^�"8"• �� ^ l�L[l :-�c Height Windows and Doors--Crackage and Area Wfdth HetBbt No. of Ltneai tt. Area Na of psne of pane Ilghts o1 crack eQ. tt. t/ ;�? � . � � /�r� � � � � � �,� � � � � �� /�e� In6ltration � ' $� ��'� �` � � Cdaaa °� � � �`� =�" �:; �'�` Fap. wall � '� � � ,ad a� ' Net eap. wall �� "� �''�� Int. wall � �° �f�� Ceiling �� ° ,�' d°��' ° ��° Floor <��` '"` � ' 'fotal Btu. '� ' Requued aq. ft. E.D.R. or aq. ins. W.A. L.eader area F7. ,� �� Room I L.eagth �� Width �''�+' �`" I„leighc =�' � Windowa aad Doors--Crackage and Area Width HefBht Na ot Llneal tt. Ares No. ot pane ot pane IlBbts oL crack ep. tL. erL � � _ � � �4 . �,� Y �*' ,Eg� I� Infiltration a ? �" ' � f ,,,� �,�. Glass s .:� � � Exp. wall ,� � 1� ,�'�`� � � � Net eap. wall -' � � Iat. wall a� Ceiling �A f ,�� o" =�` _�" � °� '�' Floor �3 e� � � �° ,��'�f �£� Total Btu. Required sq. k. E.D.R or aq. ins. WA. l.eader area Btu �> � � '�'',:�'.: � q ,�'►•I � � c Y 6�a��8��?I Wiadows and Door wia�n Hetght No. otyane o(Dane � � ' � d=i I� In6ltration Glaea Esp. W8ll N�t ��. W�u ��. Wau '� �� Floor I Total Btu. � � � ..� �e� /� �' Width � Height ,7 and Area � 1 �� Coef. Btu � ��— _ � � � �. �� —, _� - �� .�s� �1CITy �`- � � i Ml. �7�CS g��l O - � � ° � I �. 24140 � �W 4 'a � � ��*� �S' f Cert�f, No � � _?r `a :. ,`� � � �°4' e °{ St��n � Required aq. ft. E.D.R. or aq. ins. W.A. Leader area °j' Pant ` Fl.l ;�.�� Room ( Length � � Width /� � Height �� Windows and Doors—Crackage and Area Wlflth Height No. of Ltneat tt. Area No. o[ yane ot pane lights of crack sQ. tG : � °��a � ��'4� 0� ��, � � � � �_ .`� ��, � Coef. tu �es��bed �� Shall bep erveasa e��e ebyf � ihe a�t� . � °�dered ��dety In6ltratioa �`�' `� � � � Glaaa � ;�� Esp. waU � . a� � � �+� � �� ° � ? Net ezp. wall � � �� — � wall �� -� �. F' g-�° �',`,- p �' �� `� �, �fJ�B ',�'v�� > �`" :5 ° a?�� <� �� , .- ��-� �1'� � Floor Q � ,�' r'e° A�,;� �- � 7'otal Btu. �� r�° �`�:�.� �.� s�� ° A� <--A �' �,� "' �� . �:�� w;�a�«� a�a � Wldtb H o! psns ot �A 1� A � Infiltration C,laaa _Fap. waU �A�'' ��.�� Net ezp. waU � wa11� �.-, �„,� �,�'� _ � �`=�,�:F- Floor f A' � 'fOt81 Btu. � �,� � w�a� :rackage and Area Ha ot Llaeal It. Area /gdb ot crack sQ. tt �� f� � ��r �~� v -�-----� Coef. Btu '' �' � � �Per a � ,� � � nce. �uSt �eep t he ser�al aq. k. E.D.R or aq. ias. WA. L.eader area TO STATE BOARD OF ELEC. �MINNIESOTA STATE BOARD OF ELF�,1'RICITY sntuu �� 2 414 0 1954 Universit�i Avenue, St. Paul 4 = MI. 5-7703 • � � % a - v Date— � ; � 3 � / � � Certif. No c /' �' � Properry /� 00 �f � f 1 s[ s� .1 /� �/ ' : AddresQ / � � � Tow�T/"/ `'4 �/ Sectio� Range County �� Master Eledrician [f I� � Type of Structure p,, , ,�% % Owner t��1 n /�/ ii+� 'K �r Occupant Power Supplier CORRECTION ORDER To the Owner, Lessee, Master Electrician or Occupant of the above described premises: Pursuant to the authority vested in me by statute, you and each of you upon whom this order shall be served are hereby ordered under penalty of said law to comply within��days as followa: . dc% � Or�/I �♦� � J Z. D u� o<�e'< %, � r G ,�..�� ,t4 �cl � n � �de.> �° / L � � °- ,� /� = � O�S � � .3' — � �.S"" f -`�—.."_ .._.. -.._ � , ��,� Any certi#ieate or correspondence referring to this �oreection order must bear the serial number of this order. Sign and return to inspeetor upan compliance. Phonc� Inspector ��G�� /�� ID 30 A 3 � < �V b � Y � � � �. � � Q � , 0 0 � M � Q � 'ti � �b�,�. �� Qn �'' �. �o• � � ��`' Fp � � "' � C" ti � `� �.� d � �'�,' �� O � � A � �. `q i1. li A � c4 � ��'co• � n„ , �o��: � � . � ~ � � � � A � �. �� , �,�o' s�� ' � s ,� A s� �. � � � � � � � � c� �a� �' o�'�� a� � O � O � b ��s' � o��b � � � � � o �• �' b p �°' �' ° �' � R: � b � � � �� s � � � � � � � � � e � � 0 i.� � � � � �-r � � � O p � �P. w L� r � a. o, �' � � � WATER urt�Na�.s BATH TUHS BASINB i � i � , i B��,KB � � z .� ! 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Q t'y'� o C 7C � °' ` �, $ i, z m � p , .� �i e a' 9 Oti � ;� � � � ; �. �' � � a � — $ , � !� (� � � � ; I� �' ro ; � , i � i �z i i ° �i ' � � � � � �� 1) � ! �� . i � 0 � L C I � � � �° � � � � � � � Y �, � �;�� C � � � � � ��_- u �� ° � �� $ w o, oa o � � 8 � 8 � � � ' � i � 1 f �a� � ao,� ,e ��,�� a �� a � d c z ... �, .. y d� � ��o$ A � n. � �.� y� � �Mo � � � �� o��m � °' �ti m � ... � �' �� .�� ,o ti A�� a �� 5 � � � � � A � � � � n aC v � � �. � � � � � � � �� A � 0 � � �� HOUSE HEATING TEST RECORD ADDRESS , APT. _ OCCUPANT OWNER HEAT LO55 DATE HTG. INST. SOLD BY INSTALLED Electrical Work By Gas Line By TYPE OF HEAT GA FA � HW STEAM SPACE HTR. _ ? � �e � � . MAKE �� - MAKE OF BURNER _ Model ��'�.r %�'� C'9 � �i°/� ��,' f Model Serial Max. BTU Rating — INPUT MAKE OF FURNACE Modol CONTROLS THERMOSTAT ��''� Heat PI g Va Ive s Limit Limit Sstting ��-�'� Fan Setting Pilot Type � , ' Pilot Make Pilot Model Pllot Timing CITY A � UNIT HTR. OTHER CONVERSION i/ Vent Siza KIND OF LINE � ' SIZ NONE Drah Hood � Regularor Fi Iters Size Number Chimney Loeation Inside Outside Chimney Construction Smoke Bo bJ Wiring Draft �/ Test Tag ✓ L.W. Cut Off �� oor Pressure Lighting (nst. ` .r Prossure 6�� Pereent CO � �� ` Data Tested � � input CFH � � Pereent OZ � � ° � � � Company Testin ' • - Staek Temp. 1�—Percent CO " A Name of Tester Form 235 � , • . � . � � �� y �N ►�'s I� � ' . . �t p � �=i Iri. i: •1 ��storicy • � � x �' rwt�w • � � d ii fllri� t f �i � �r �i � �y ~ P � � 1� � 4 u n C � n � n va�wLt � u y, ,• L� � n � c � A C n 1' ^ 'f M � .� � �� u►�M r a M � n�„� p -• i: �vos � tl x••� � o �` x�. ,.,� • � ° ~M -r'� M � � � � ^ x � J . O �: awf�►et .j, .+c �p � p n � N � v p aA+ '� � � ^ C �'1 � � .,� �p O � .. r "p 4 �, •' s,..►s � .- . � r • .. � , � � . L � v. • �' ? '" � ; M�u+� � • ;, � M = � p � , g , = � � . � ry , Mrs ` tin' • • 4 ' '� � ;;� � Pau��. . . . • �f � t'�. ' (1 i� • • . • bi W • � � • � . /OU►R• �y :U � . . . r. • -- . . . . �� t,aa � . .c . . w srwRS. P M • • • . • � • • • � � � • • • � `� •IOOR � 0 � ' � • • • • • • • . �" � . w � � � _ � . � . . . . � . oawn,s � . . . . ., . . . . rn �ATCH ti . . . . . . . . . . .�p . . . . . . . . . . - (� G�'1 eAtuas ' 1 . . . •. .• . . . . . (/1 �+ p � . . . . . . . � �� I-�� wut o �. � • • . t I-� e. � MAW:7l O O � • ~ � ;; �'u '+f :Y fTl �, �rn.. v ,� . o o m �' �• x x K N x x x x x x W �'9 N � W :J G1 W r .� J � $.. w �j' ��+ cNi� .�S' in o '1 v C��9 t. � . .A N M N N N N H fA . � � , •I O �: n' . � � ,� s � ,, r _ N r • I 1 . �. � �a � , .� '_' �► �_� � ' '� � � . �� . � ;Y . • . , , • � ~ O x � � o j� x i 9 . � , 0 y �. . . ' o N o � x °' � c , a o. � . z � ' � » " . � o.ry . a . Ci • .o E. �M . N � a. ' � A � a a � . N H � ro � � V� 7. � • � ° I-� c� . � � R o h�--' Fi r e O O' W � � � � , :f n � x ° � : � '� �v � U 3� .: n .'1. O ' � . �.� . . . vZ � � � r-- 1 .� � . . �1�1 • vi N . 0 .c �c.�s . � � . .w�.ci s w . M • Y1 c� .r. onewurs � S.�t � O r — U - � ° , - 1 �A . M y _ � r � o.� I ' � `� �' � r � � � � • � - �'.;'' ''LP . :.'° E� . � -,'r. .� _ . • � � . � � � � � n � �• t� aaM c ' � � ` �� o �= - �s v " n " o Fit :a� aC � - � �j� � � � � � � a• �- w�n � a � � � �. r. :`- 9 :�` . y " � °� '� t'� � �' s � o y `� k •% u p„ 7 O o i� " ;1 O n "'3 a: �3nQ w 3 4, _ '��! '_'S ��q ~• � M?. p " ` FL' � a !s o g L 3 Lp` Q, p X x' �i. p 'v �. p � t� . �D t= �L '3 V o a � �- � . r. ^ ' i .- � . a � r O� :a n ° . a p �y � D I-' f� 7- � o . ' - � n � �, -� . • °� ^�n � . . �n�� , . O �,, � r ' Mq � � � M Y n . 9 � n' . � �7 a ; . q. r' il ie ' • •- ^ i±� 7 � .._ CITYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • fr331 UNIVERSITY AVE. N.E. FRIDLEY, MN SS�32 •(612) 571-3450 • FAX (6121571-1?87 October 10, 1989 � Stephen and Susan Smith �400 Glacier Lane N.E. Fridley, MN 55421 RE: Fences in City Right-of-Way Dear Mr. and Mrs. Smith: Recently I received information suggesting that a newly constructed fence in your neighborhood was built too close to the public street. Our records show that Matterhorn Drive is just 28 feet wide, but the City maintains a 60 foot right-of-way for this roadway. As a result, City property actually extends 16 feet from the curb onto adjacent property on either side of the street. While inspecting the subject property, it was discovered that other properties nearby also have fences which are in the City right-of- way. In order to keep this portion clear of any obstruction, it is necessary that you remove your fence such that it does not extend into the public right-of-way. I will be reinspecting on or about November 10, 1989, at which time full compliance is anticipated. Please call.me at 572-3595 if you have questions or wish to discuss this further. Thanks for your cooperation! Sincerely, Steven Barg Code Enforcement Officer SB:ls C-89-653 / � r � � � unroF F�a� DATE: TO: FROM: SUBJECT: COMMUIVITY DEVELOPMENT DEPARTMEIVT MEMOR.ANDUM October 11, 1989 William Burns, City Manager Jock Robertson, Community Development Director Barbara Dacy, Planning Coordinator Steven Barg, Planning Assistant Fences in Boulevards along Matterhorn Drive Last week I received two complaints regarding a newly constructed fence at 1401 Glacier Lane N.E. The complainants' main objection involved dislike for chain link fences in residential areas, but there is nothing in the City Code which prohibits such fencing mat�:rials. However, the complainants also indicated that the fence might be too high and/or too close to the street, and I stated that Z would check this site. Upon inspection, I met with the property owner and discussed fence requirements. He stated he had contacted our Building Department prior to construction and was given the following information: 1. 2. 3. Chain link was acceptable fence material. Fence must not exceed seven feet in height in side yard. Fence must be at least 30 feet from the center of Matterhorn Drive or at least eight feet from the curb. He informed me that he constructed his fence precisely as directed by the City employee. The fence is five feet high, and I measured it to be exactly eight feet from the curb. During our discussion, he pointed out that his neiqhbors on both sides have fences closer to the street than his own. I informed this individual that I would check further on this matter. The present width of Matterhorn Drive is 28 feet, and the City maintains a 60 foot right-of-way. As a result, the boulevard actually extends 16 feet onto the adjacent properties on both sides of this street. When Z spoke with the Buildinq Inspector Secretary, Mary Hintz, she confirmed that this person had called and she had provided�City Code information regarding fences. � Fences in Boulevards along Matterhorn Drive October 11, 1989 Page 2 However, Ms. Hintz states that at no time in this conversation did she say anything regarding building at eight feet from the curb as the property owner contends, but she merely informed him of the street width and right-of-way width. After reviewing this situation, it was determined that all three of these fences should be removed so that the City can maintain a clear right-of-way and eliminate the possible liability created by the obstructions. The notices were mailed to these property owners yesterday, and it was requested that the problems be corrected by November 10, 1989. It is quite possible that one or more of the affected parties will be contacting you or a Council member on this matter. Mr. Billings has been advised of the situation and our actions as this problem is in his ward. The property owners and addresses of those to whom letters were sent are as follows: Subject property (from initial complaint): Pete and Rhonda Korkunsky 1401 Glacier Lane N.E. Other properties in noncompliance: Stephen and Susan Smith 1400 Glacier Lane N.E. Clyde and Marlene Kane 5217 Matterhorn Drive N.E. Please let me know if you have questions or wish to discuss this situation further. SB:ls M-89-618 Building Inspections 763-572-3604 763-502-4977 FAX DATE STI'E ADD S � THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DFSCRIBE WORK BEING SIZE OF IMPROVIIVIDVT ROOFING NUMBER QF SQUARFS GARAGES PROPOSED SIZE: PROP(}SID HIIGHT: SIDING ❑ Vuryl ❑ Al�uninum ❑ Other i 1,Li� BUII,DING RESIDENTIAL APPLICATION CITY OF FRIDLEY YQUR �MAIL ADDRESS � �� OCONTRACTOR �� c� r P�� e�er _ �—r.i _ _ �, .� �. STATE LICENSE # ADDRESS: PHONE ❑ SINGLE FAMILY/NEW CONSTRUCI'[ON ❑ TWO FAMII.Y/NEW CONSTRUCTION ❑ ADDTIION ❑ GARAG �ASIIVIII�IT FINISH ❑ R�F ❑ DECK ❑ SIDING o x�w xoME coNS�rRUCTTOrr ❑ MAINfII�ttANCFIREPAIR EI� DATE _ CI1'Y FAX SIZE STORIES JS�n ❑ wINDOws ❑ DRAIN TILE ❑ OTHIIt ATG POOL ❑ ADDI1'ION ❑ REMODII.ING � �,.�.�r _ , _ � �� O HOUSE ONLY ❑ HOUSE 8c GARAGE ❑ ATTACHID GARAGE ❑ DEI'ACfiID GARAGE ❑Sofftt O Trim 0 FaSCia wnvnows IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS OR FOR NEW OPININGS-DESCRIBE SIZE OF OPINING CHANGES & � �� .7�/ �'�- TYPE OF WINDOW TO BE INSTALLID NUMBER OF WII�TDO' ALL FEES ARE BASED ON VALUATION, INCLUDING T � ��OQ� }� �rSING THE 1997� .0 FEE TOT JO VALUATION S� x� °%l�/'to��l s s, �,� � Pernrit Fee Plan Review Fire Surcherge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Dae Perifiit No.:�6�0 � �fd r� a � . �, ;. Received By: �i��. 0 7 TE ZIP BASII�IT REMODELING SUBM[T: I . F�cisting Floor Plan 2. Proposed floor plan 3_ List of strucdual members to be use�i FOR NEW WNSTRUCI'ION INCLUDING DECKS, ADDITiONS. 8c PORCHES SUBNIIT: 1. Site Plan/Survey showing the existing structures a� ProPosed Pro.l�. 2. Two sets of con4trucdon plans 3. Energy Calculations FOR WIN�WS – PROVIDE U-VALUE AAiD MANUFACTU�iE STICKIIt ON WINDOW. AND 1VTATERiALS: $ �� Se� Back Page for F� Schedule $ 65% of Building Permit Fce $ .�1 times the total job valuation $ .0005 x Permit Valuation Minimum $5.00 $ $5.00 (State Licens� Residential Contractors) $ $2100 per SAC Unit (Plans to MWCC for determination) $ f}+6ft= ftx$24=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ � I,� �y Make checks p�yable to: City of Fridley Attach THI3 IS AN APPLICATION FOR A PIItMIT-NOT VALID UNTII. PROCESSED I hereby apply for a building germit and I aclmowledge 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 Canstruction Codes; tl�at I understand tlus is not a permit but only an application for a pe 't and work is not to start without a permit on site; t�at the work will be in accordance with the approverl plan in the c�se all �� k lu i�e u' r, v'� and approval of plaqs. SIGNATURE OF APPLIC PRINT N.4ME �p (,� �� Q/,/� DATE �° APPROVAL INSPECTOR SIGNA PLEASE NOTE: S TE PERMITS ARE REQUIItED F�R RLUMBING, ELECTRICAL AND MECHANICAL WORK Page 2- Building Residential Application ' �° BUII..DING PERNIIT FEE SCHEDULE The Chief Building Official sha11, before issuing permits for the erection of any building or structure, or for any addition to any e�sting building or structure, or for any alteration or repair to any e�cisting building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: TOTAL VALUE FEES $1 to $500 $23.50 (Minimum Fee is $Z3.50 plus swcharge) $501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and includin $2,000 $2,001 to $25,000 $6925 for 1�$2,000 plus $14 for each additional$1,Od0 or frdction, to and includin $$25,000 $25,001 to $50,000 $391.25 for 1� $25,000 plus $10.10 for each additional $1,Q00 or fraction, to and includin $50,000 $50,001 to $100,OQ0 $643.75 for 1�` $50,000 plus $7 for e,ach additional $1,000 or fraction to and includin $100,000 $100,001 to $500,000 $993.75 for 1� $100,000 plus $5.60 for each additional $1,0(t0 or fraction to and includin $SQ0,000 $500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,000 or fraction to and includin $1,QOO,OQO $1,000,0()1 and up $5,608.75 for the 1� $1,0(b,000 plus $3.15 for e,ach additional $1,000 or fiaction VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of proposed structure and of the con�*- �n site. A Certificate of Survey of the lot, shaur� g foundation will be required before proceedine •��='' � � � � ,� � �� , z� � . �'� i� �-- ' � � � 7, , Building Inspections 763-572-3604 763-502-4977 FAX SI'i'E ADDRESS � Tt1IS APPLICANT JS: OWNER/ TENANT CONTRACTOR SUBMI'T A COPY OF YOUR STATE LiCENSE, BOA1D AND CERTITICATE OF INSURANCE � From: 7632417306 Page: 5/8 Date: 7/20/2010 3:05�29 PM --__ _.... ......�._. ...... ,_... PLUNI�3ING rer►nit �vo.:'�� i 1 �� RESIDENTIAL APPLICATION Received By: �` CITY OF FRIDLEY �'� � EFFEC7iVE 7-1 2010 YOUR E-MAiL ADARESS C. \ t� [�J�.��1��LC -p.�# �RCle✓ l.en� �[ O OWNER 37ATE L(CENSE H � s� ry_ - EXP DA'fE '�� STATE BONb !� RL I O.�W�C%+��-�/ EXP DA'fB ��'! �/ I/0 nnnxESS: 2f.nto �3 v� tv gSS,� S't ..E�> ct7�t 4 t�- ��r s'rA-rE nw zir s 3O PHONE �c�,-- a Sl- bva'�t ____ rnx 7(03 -dii ��73o1c pERNIIT •I.YPE � � SINGLE FAMILY TYPE OF WORK: �� DESCRIPTION OF WORK O TWO EAMILY O TOW1VHOiJSE O REFLACEMEN'C FEES ARE BASED ON $lO.Od PLR E7]CT'URE, EXCGPT WHERB NOTED. FIXTURES: (Il�iD1CA7E TUTAL N[JMBEIt OF EACH BEL09�. MINIMUM FEE $3550. BATH SII�K/1.AV FLOOR DRAiN5 SHOWF.R WATER PIPING HATHTl1$ GAS PIPIIV(i (i+fEED C11'Y LIC) SWIMMIN(i POOL � WATER SOF'ITTER ($35) �CLOTHFS WASHER � K1TCI-IEi�( STiVK W,ATIIt CLOSET _ BACKFLOW PREV. ($15) �G DISHWASHER _ LAUNDRY TRAY ��tVA1�R HEATER {$35) EOR IRRIGATION T WATER MEfER �COTHER Numbe;r oifactwes �7u, $10.00 ,�, x $10.Q0 = Number of fi�ures @ $] 5.00 Number of fixtures @ $35.00 Sigte Surcharga x$15.00=$ x $35.00 = $ $ Sr00 �r..b� — e � THL4 IS AN APPLICAT[QN POR A PERMIIT N(3i' VALiD t3NTIL PROCESSED I hereby apply for a plwnbin� permit and I aclmowledge that the information above is complete a�d accurate; that the work will be in conforn�ance with tha ordinances aad codes of the City of Fridiey and with tha Mim�esota Construction Codes; that I understand this is not a p�rnit but only an application for a permit and work is not to st�art without a pennit an site; that the work will be in acxordance with the approved plan in the c. of all � � whic� e�Yire.s review and approv of pEans. l � SIGNANRE OF APPLICANT Y�iY .e ._ PRINT NAME �o�{.�v° /�irD Gf I,_ I Q�TE?��/ / ° City of Fridley Building Inspections Departmeat 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: '763-502-4977 From: 7632417306 Page: 6/8 Date: 7/20/2010 3:05:29 PM ... _ _.. ... �._....... ,_... Building MECHANICAL Permit No.: �P�� RESIDENTIAL APPLICATIUN Received By: 763-5�2-3� CITY OF FRIDLEY ��'�. , 763-502-4977 FAX E�EC�v� �-i-zo�a DATE �/ ' ol� "' � _� YOURE-MAILADDRFSS C Jb�O��W:�a��°.JZG� srrE �nxESS 1`kt� �.slc.c. �� r l m.+�c� �.Ye� THIS APPLICANTIS: O OWNER �;ON7'RACTOR PROPERTY NAn�: OWNER/ ADDRESS: j'�E00 C-al4c��e✓ L�� G. ci� F��e.r s'rn� z��^c3� �� rxo�: i b3 - 5 � -�i ��g . CONTRACTOR COMPANY NAME:_ _ �i�4'b\l . �C. SUBMIT A COPY OF �NT^cr �ERSON: � t9�:. t> r Cp � YOUR STATE STATE LICEN$E # i�73�% � el ,�� i� EXP DATE /� 3% 0 LICENSE WITH ADDRESS: ��01� �J�.tY ��t � CITY �+Ci 1'Z R•t�t'✓ STATEtMn ZiP�� 30 APPLICATION �ox� c� � a-- a 5 h to U q Fax "% 63 - 2.y i-'7 3o co PERMTF TYPE SINCiLE FAMMh Y CI TWO FAMlLY O TOWNHOUSE TYPE OF WORKL � �� Gfi�T �►LTERA110N/REMODEL DE'TAILED DESCRIpTION QF WORK 17!'r,/,Or-� -- / n S�;iGi� �S FEE3 ARE BASED O1V 516.00 PER Fy7KTIlRE. EXCEPT WHERE NOTED. FLXTURES: (1PiDICATE TOTAL NUMBER OF' EACEi BLLON� PBOVIAE HEAT LO6S CALC'$ PER MANUAL J TAU6 ASARAE HANDBOOK. EquiPmeet [a�mlled MFG: MODEL: S1ZFIBN 1�lFG: MODEL: SIZFJBTU MFG: MODEL: SiZE/67U A/C S25.OD ,TFIREPLACE (GAS) $15.00 GAS RAAIGEJOVEN �10.00 AIft'�D AIIt E}CCHANGEER $15 FIRF.PLACE (WOOD} $35.00 1VEW GAS GRILL $10.00 BOILER $35.Q0 _,FURNACE 535.00 _GAS UN1T HTR $10.� CHIINNEY LINER �10.00 �GAS DRYER $10.00 _POOL tIEATER $35.00 DUCT WORK $10.00 GAS PIPINQ $10.00 VENTILATOR $15.00 Nwnber of fixdaes @ S 1 a� X$i o.00 =$ Number of fixtwres @� 15.00 x$15.00 =$ Number of fixtures @ $25.00 x $2SA4 - $ Number of fixtares Q$35.� x$35.00 =$ StStO $t1YCh8ig6 ° $ 5.0� FEE $40.a0 Total � $ " i "� THIS IS AN APPLICATION FOR A PERMiT-NOT VALdD UNTIL PROCESSED I her�by apply for a building permnit and I acknowledge that the informatioa above is complete snd accurate; that the work will be in coaformance with the ardinances and codes of the City of Fridley and witt� t3�e Minnesolg Construction Codes; that I �mderstand this is not a permit b�rt only � applic�tion far a pennit and work is not to sbrt without a pennit; that the work will be in accordan� with the approved plan in the c�se of�ork whic �guires review and approval ofplans. SIGNATUREOFAPPLiCANT `~� � PRINTNAME��J' l� DATE7� D APPROVAL II�SPECfORS SIQNATURE DATE PLEASB NOTE: SEPAR�ITE PERMITS RE UIItED FOR BLTII.DING ELE AND MECHANTCAL WORR Citv of Fridlev Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX:763-502-4977 � From: 7632417306 Page: 2/2 Date: 7/22/2010 2:58:10 PM �-- -..... ......�.. ........ �.� $U.l�djng �j Cj�I�� Pernut No.. Inspections RESIDENTLA.L APPLICATION R��d� By 763-572-3604 CITY OF FRIDLEY ��- 2�� 763-502-4977 FAX ��-, ��o DATE �_"a►�� .� YOURE-MAILADDRESS C\,O(��1 W:`tXb�K�.v�Q-� SITE ADDRGSS 1��,'Z �,r,t CcC. \�2 ✓ ` m_��,Q,� 1ifIS APPLICANT iS; O OWNER. �UN'FRACTOR PROPERTY Nq�: OWNER/ ADDRESS: i��4 ��4C� r" L TENANT �_ •�-v� .�i� CTfY�� STATE� ZIF�3� pxox�: Z b3 � �� °( S �.�_ CONTRACTOR COMPANiYNAME: OSO\� � SanG. SUBMIT A CAPY OF ��TACT PERSON: �� Cg.Z t� C" Cp i C' YOUR S1'ATE S't'ATE E.ICENSE �! �302�1;�Yh EXP DA'fE /� �% O LICENSE W1TH ADDRESS: �'%10 i� lA.��i `�+5� �� C1TY �Ct lZ R•Je✓ STATEwu. ZIPS�'s-�Q APPLICATION �a� � t�. a 5�'to Ll °I FAX �b3-�,`-1 l ��30 lo p��.r �pE SIWGLE FAMILY f] TWO FAMILY Q TOWNHOUSE �rrE oF woiuc: ❑ NEw 0 REPLACEMENT �.�xnTTON,�MOnE,. DETAILED DESCRIPTiON OF WORK �, 'S t�'t 5/tr �� T,��; FEES ARE BA3ED ON S1U.00 PER FQCTURE, k�CCEPT WHERE NOTFD. F'UC7'I1RFS: (INDICATE TOTAL NUMBEB OR EACH 13ELOW) PROVIDL HEAT L�,S CALC'S PER MANUAL J 20Qb a►►-CFrReR, gpry�gppg, Equipment I�lled Ml'G: MODEL: S12E/BTU I►9FG: MODEL: SIZE/RTU MFG: MUDEL: SIZEtB'fU _A!C E25.00 ��LAC6 (GAS) $15.�0 GAS RAN(iFIOVEN $]0.00 AIItTO AIRF�CCkIHNIGEE[i SIS FIRfiPLACE (WOOD) $35.00 1VEW GAS GRII.L 510.00 _BOILER $35.00 F[3RNACE $35.00 GAS UNff I�1R $10.00 CHiMNEY LINER $ I0.00 C�I�AS DRYER $10.00 POOL HEAT'ER $35.00 DUCT WORK $10.00 GAS PIPING $Ia.00 VIIYT'II,ATOR S 15.00 Number of fixhu+es @ $10.� 7: �D ��.a0 ° � �� Number of fixwnes (a� $15.00 � x $15.00 = $ � � N�ual�r of Sxau�es (a3 $25.00 x $25.00 = $ Number of fix�iues @ $35.� x $35.00 = $ Stat� Surcharge = � $ 5.00 FEE $40.� Total = $ �'� THIS IS AI3 APPLTCA170N FOR A PERMIT 1�IOT VAI.ID UN11L PROCFSSED I hereby apply for a building permit er�d i aclmowledga d� the information above is camplete aad asxurate; that the work will be in c:onforma�tce with the ordinance.s anci codes of the Ciry af Fridley and with the MinnesQta Construction Codes; that I understand this is not a pe�mit but only an applicatian for a perrnit and wark is not to slart without a permit; that the work vv�'II be ia accordance with the approved plan in dte c�se of ork w�c quires review and approval of plens. SIGNATUREOFAPPLICANT ��'� PRWTNAiV1E��/�� !'�� _DATE�� O APPROVAL 1NSPHCTOIt3 SICi1VATURE DATE � PLEASE NOTE: SEPARATE S ARE RE UIRED FOR BUII.,DING, ELE CAL MECHAIVICAL WORR City of Fridley uilding Inspections Department 6431 University Avenue NE, Fridley, MN SS432 763-572-36Q4 _ FAX: 763-502�9'77