AF - 46167-,,,-,,.,�„F. , _ , ..�
}� ,�. � ..�,,�, . ��
�., -�
BUILDING PERMIT
Village of Fridley, �n, No 2� y�
Da� •,�1.--..1[�:-: �.-7.' .........................
,Qw[cer ,�/ .����.��2"�T..Y."' Builder/..".�.:..- ..............................
Address �3ptO.� .. : JM. l�i.T� . GA'Efp.l.�� . . . Address
.........................................
LOCATION OF BUILDING
No. .C�.�gjs...... S4eet �'tli.�!l.'1!�.. .... �"'� ..... Part of Lot . ......................
-/ a
Lot . . . . . or�.� . . . . . . Block . . . !� . . . . . . .. . Addition o r Sub-Division . . . `K<4e4�!!. . �� . . . .
.�-i � .
Corner Lot ... ...... ... Inside Lot . ...✓. ....... Setback �. /J17s.�. SideYard �� All� . .. . . .... .. .... ...
DESCRIPTION OF BUILDING
To be Used as:
�I�N�GG44[f.k Front ff�%!.. DePth �r.ry�:...:ieight !w$.t.... S4. F't.�QQES• Cu. F't. ........
�....
�/�LCLl.�„� ....... Front �i4�.... Depth .': �. .. . Height . .. ... . .. Sq. F't. :v['�'.. C�. Ft. ..... ...
��
Type of Construction .............. Est C�� �� �......... To be Completed ...................
In consideratian of the issuance to me of a permit to mnstruct the b� described above, I agree to do
the prop�ed work in accordance with the descriytion above set forth and in compliance with all provisions of
otdinances cf the village of Fridley.
. ...................................................
��y-..... . . .....
hsidaration of the payxnent of a tee of 5�:�.. , peraut is hereby granted to .
�.F.�.�..... .. to construM the building or addition as described above. This permit is granted upon
the express cOndition that the perSOn to whotn it is granted and his agents, employees anfl worlvnen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Mvfnesota regarding location, conshvclion, alteration, maintenance, repair and moving of buildings with-
in the village limits and�this permit may be revoked at ar�y time up0] violation of any of_the provisions of sald
ordinance8. // /j _ /%.
4.Y.L.� . . . . Building Inspector
NOTICE:
This permik dod not cover the cDnatruction, installation o� alteralion for wiring, plumbing, gas heatiny,
cewer or waler. Be wro to aee the Building InapeCtor for separale permits 4or Lhese itema
sueaec. � � P . -
City of Fridley i � " 17356
,��. . ATTMETOPOFTNETWINS � BUILDII \G PERMIT
� � CEIPT NO.
� COMMUNITY OEVELOPMENi DIV. /_
. � � � � PROTECTiVE INSPECTION SEG. �� W�o
�
L,--- A�'�'1,,� CITY HALL FRIPLE� SS032 NUMBER AEV ONTE CAGE Oi AGPqOVEO BY
t ��� 612-571-3450 9i0-F15
12/27/83 � �
106 ADDRESS 5786 Hacl�tann Averrue N, E.
1 LEGAL ��TNO. BLOCK TAACTORADDITION SEEATTAGHE�
oESCa. 21 4 Parkview Manor sHEET
2 PNOPERTYOWNER MAILADORESS 21P PMONE
William Eckland 5786 Hackmann Avenue N.E. 571-8185
3 CONTRACTOR MAILA�DRESS Z�P PHONE IICENSENa.
Same
4 ARCHITECTORpESIGNER MAILADDRE55 LIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
e USEOiBUILDING �
�S1f12IItld1
7 GLASSOFWORK
❑ NEW ❑ ADDITION ❑ ALTERATIQN ❑ REPAIR ❑ MOVE ❑ REMOVE
R
B DESCRIBEWORK
Install a Preway Model 5136 SEM CIC80 #2736) Wood Burninq Stwe
9 GHANGEOFUSEfROM � i0
STIPULATIONS
Provide combustion air to existing furnace area. Install fire alarms
in all �� levels o� dwellixtg.
SEPARATE PERMITSARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONSL � OCCUPANCY GPOUP OCCUPANCV LOAO
VENT{LATING OR AIR CONDITIONVNG.
THIS PERMIT BECOMES NULL AND VO10 IF WORK OR CONSTRUCTION ZONING SO.FT. CU.FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 �AVS, OR IF CONSTRUCTION �.
OR WORK IS SUSPENDED OR AeAN0�NE0 POR. A PERfOD Of �20 DAYS AT
ANV TIME AFTER WOfiK IS COMMENCED. � � NO. OYYl6. UNITS OFFSTREET PAPKiNG
I HEBEBY CERTIFY iHAT I HAVE READ AND EXAMINEO THIS APPLlCAT10N 1 STALLS GARaGES
ANDKNOWTNESAMET08ETRUEANDCORRECT.ALLPROVISIOMSOFLAWS VALUATION SURTAX
AND ORDINANCES (30VERNWG THIS TVPE OF WORK WILI BE-COMPLIED
WITH WHETHER SPECIFIED HEREIN OF. NOT. THE GRANTING OF A PEFMIT SBSO �S. SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TNE pERMITFEE S/+C CMARGE
PROVISIONS Of ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE �ERFORMANGE OF GONSTRUCTION. 5�-7•SO
PLANCHECKfEE T07ALFEE
��.8. ��
S�GNATUREOFCOr+TAncsOaoaqJTHOai2EDAGEH� �DATfl WHEN PROPERLY VALIDATED THIS IS VOUR PEFMIT
SVGN4�pFEOFOWNEaU%OWNEFBU�I�EPo �Da1Ei B�DG �ry5� / �
CITY Of FRIDLCY
kPPL1CATIU� FOk 1'.CSIDL'i�Tli'w DU1LDI;;G Pcfu4lTS
(tic,�, Alterations. Additions. or Rcpairs)
Ot7N£R: '/�lLGii9.j'( �C�GCc�i1/1i _
AD9RES5: 1�%D�i �Yr�/�.�'1/gnr�e �Y'�`?�
TEL IiO: ���� �/ 8S�
�DUILD£R:
ADDitCSS:
TEL ND:
Conziroction Location
sTruxr Ho: �?�i(p - sr�r: _ P��qG,C'yrmviv ��/G.
s.o��:
si.00c: �niTia�:
Effective Aug. 1, 1981
Cozner Lot: Insidc Lot: � _ ictbaek: Sideyards:
Ap, lie.vit attaeh to tl�is fonn bro Certificates of S1�rvcy of lot and
p_oposed building location dra:+n on eertificates to seele.
DESCRIPTIO�d OF CO::STF:UCTIOt�
���l,G�'} ��(%litL Front: �P��
�/ 3� �`�c//% Squarc Ycetr q�bic Fcet:
l�� �oZ /�h Front:
Square Fcat:
;ype of Co:struction:
�P�=
Rb Bc mr.�plcted: �t / L�
�
CUbic Peet:
Height:
Neiglit:
Estimated Cost: ^S �� �O�
�lt. A 1►lt. B
Proposed Dzivc�ray Kidth If Nev Opening Is Desired: S S
_ SEL PiVF.R;E SIDi OF S3IELT .
95�e undersianed hereb;� mal:�� arplie�tica for a pernit fcz the �ork hezein sp�cified,
egrccin3 to do.all vork ie� striee aceozdsncc vith thc City of rr=ai��• oza����n�es and
z�lings of tlm Del�.irunr��i o£ DuilJinys, and hrseby declares Yhit all ttie fact� and
represc�Giticns stased in this appli u.tion arc trae and cozrect, �
D.�re: ��j �� �3 sica�nzvF: �%���������
Etipulatior�s: lod�� �.Tf�'i'S (,t)i77� .57���L-�i�7o�S �
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� SuBJECT ����
� c�ty of Fridley 2 7 4 5 0
.
, ATTMETOPOFTHETWINS gUIIDING PERMI TNO.
� �� COMMUNITV OEVELOPMENT DIV. �
� � �� PROTECTIVE INSPECTION SEC. %�
% � �
�
� � �'�'\ • CITY MAI.L FRIDLE� 55�32 NUMBEP MEV D�TE o�GF Oi �VFMOVED BY
�°"� � �'� 612-571-3450 9�0•F15 � �
8 28 98
JOB ADDRESS
5786 Hacl�an Avenue NE
1 LEGAL LOTNO. BLOCK TRACTORAODI110N SEERTT�CHED
DESCP. Z1 4 Parkview Manor SMEET
3 PROPERTYOWNER MAILAODRESS ZIP PMONE
Karen Brown 574-2351
J CONTRACTOR MAILAODRESS Z�P PHONE LICENSENO.
Vikin HOme Im rove n 572-1820
< ARCHITECTORDESIGNER MAILADDRE55 ZIP VNONE UCENSENO.
5 ENGINEER MAILADDRESS I�P PMONE LICENSENO
8 USE OF BUILDING .
Residential
7 CLA55OFWORK
❑ NEW ❑ AUDITION ❑ Al?ERATION �� REPAIN ❑ MOVE ❑ REMOVE
8 DESCRIBEWOHN
Reroof house and ara e(23 S) Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPEOFCONST. OCCUPANCVGROUP OCCUPANCYLOAD
SEPARATE PERMITS nRE REOUIRE� FOR EIECTRICAL, PLUMBING. NEATING.
VENTILATING OR AIR CONOITIONING.
THIS PERMIT BECOMES NULL AND VO10 IF WORK OR CONSTRUCTION ZONING SO.FT. CU.FT.
AUTHOFIZED IS NOT COMMENCED WITMIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT .
ANY �IME RFTER WORK IS COMMENCED. - NO. DWLG. UNITS OFFSTREEi PARKING
1 HEHfBY CER7IFV THAT I MAYE READ AND EXAMINED THIS RPPLICATION STALLS G�RAGES
ANOKNOWiHESAMETOBETRUEANDCONREC7.ALLPROVISIONSOFLAWS yALUATION SUpTA%
AND ORDINANCE$ GOVERNING TMI$ TYPE Of WOFK WILI BE COMP�IED
WITH WHETHER SPECIFIED HEi7EIN ON NOT. TNE GR�NTING OF p PERMIT 1918 .96
�OES NO� PRESUME TO C�IVE AUTHORITV TO VIOLATE OR CANCEL THE pERMITFEE SACCHRRGE
PROVISIONS OF ANY OiNER STATE OF LOCAL LAW REGULATING CON� @
STHUCTION OR THE PERFORMANCE OF CONSTRUCTION. GZ.�LS Fire SC y�1.JZ
��1 PLANCMECKFEE TOTRLFEE
/��''OZ ��-�- �-� y�'Y License SC 5.00 70.13
SiG�+niunE Co�u:Aac10AOA�aTNOn�ZEDnGErvi iDeTEi WHEN PROPEFl VRLID�TED TNIS IS YOUR PERMIT
SiGNPtUREO�OWNEAtlfOWNERBV�L�ERI �D�iE� B �N50 �✓�•�k
a
NEW
ADDN
ALTER
�• �
[l
tl
CITY OF FRIDLEY
SINGLE EAMILY APiD DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConsuuctionAddress: ,� 7�6 i`//f c/c,.,�� �u,T .
Legal Description:
Effective 1/1/98
��� �
n ��
0�
Owner Name & Address: kAP�2 E� �/t�•r,� TeL # S 7�/� z 3S l
Contractor: �,Z/ss,., y��,� �,wp . c o. MN LICENSE # ',� i� 2
J
Address: ���� a j-Z ST, �rC_ iE - Tel. # s 7 z-lFsZo
LIVING AREA:
GARAGE AREA:
DECB AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
L.ength
I.ength
Length
DESCRIPTION OF IMPROVEMENT
Width Height
Width Height
Width Hgt/Ground _
Sq. Ft.
Sq. Ft.
Sq. Ft.
R iE /2ooF 1q Q
Construction Type: �3p Estimated Cost: $ !/ �U
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: ��,p -� 8' APPLICANT: �,�1% Tel. # Sh '�� Z p
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
$ �S
$ 1-9�-
$�
$
$ �.��
$
CITI' USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
TOTAL
STIPULATIONS:
$ �0, l3
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
PERMTT NO 2004-01962
DATE ISSUED: 10 004
763} 572-3604 FAX: (763) 571-1287
ADDRESS : 5'786 HACKMANN AVE NE
PIN : 24302423�017
LEGAL DE5C : PARKVIEW MANOR
: LOT 21 BLOCK 4
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION : S 25,445.00
NOTE: SEE NOTATIONS ON PLAN.
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTII.ITY LOCATIONS.
PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS. CONSTRIICT AN 18' X 18']0" ADDITION TO DWELLING.
STATE LICENSED CONTRACTOR l
APPLICANT BUII,DING PERMIT FEE 40135
CONSTRUCTION PLUS, INC 20269501 P1-AN CHECK FEE 260.88
1300 INDEPENDENCE AVE S FIRE SURCHARGE 25.44
ST LOUIS PARK, MN 55416 STA1'E SURCHARGE, VALUE 12.72
LICENSE SURCHARGE 5.00
TOTAL 70539
PAID WITH CHECK # 6887
OWNER
ROSS-BROWN CHRISTOPHER & KAREN
5786 HACKMANN AVE NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or consWction
authorized is not commenced witin 60 days or if cons�uction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify thai I have read and examinQd this
application and ]mow the sazne to be true aqd correct. All
provisions of laws and ordinances govemiug this type of work
will be complied with whether specified herein or not. The
ganting of a perntit dces not presume to give authoriry to
violate or cancel the provisions of any other state or local ]aw
regulating construction or rmance of construction.
Applicant Date
Bldg Insp �
;
SEPARATE PERMITS QUI I3 pCGR I�VORIC OTHER THAN DESCRIBED ABOVE.
.
..
an wre
TOt0011APM�G M�PP�NO
Iron
i +�
� ,
i �
�
...
C. E. COULTER �,,�
IAND SURVEYOR
REOIS7ERE0 UNDER LAWS OF STATE OF MINNE60TA
LICEH6HD !V OROIN�NCE OF CfTY 0I Y INN[�IOLIG
3300 LYNDALE AVE. 50. MINNEAPOLIS 8. MINN.
TAYLOR 4A370
�urnPgar's �'ierftticatr
/
/
Ironi%-� /
/ \
/.
�� ���� �0 T
ti��'i
^s, 2l
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��
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oso
i�SO
, / \�p
I�1
SC ALE I 1��°'�0`
�� V r� \ ♦ /�
j' a..�v�?v� . �
� p�� l t i� ,'�-� `� �
e���-�y'�` ti 3s � i
� y , ..r \ron
'i �'
� ,• � , • �/. fr���: � ��� ,•
�° . 9 3y.. ��" ���i
, 'e `e �{'
\aH \ � ^('O �
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I hereby certify that the above ia a true and correct plet of a sur�ey of:
Lot 'h�renty-one (21). Block Four (4). PARKVIEW NiANCR, Anaka County, N�nneaota.
Aa aurveyed by me this 7th dey of November 1957 A.D.
/ /,� I
,°ilgAed_ • io �r'+-u (-{e?.ci
Ndnnesota Regiatretion No. 2554
4090 AR�1'�.�J C(�(?',_S��C:1 �l. 2�2� n C�Q
NEW [ J CITY OF FRIDLEY Effective 4/1/2004
ADDN [] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMITAPPLICATION
�$63�
Construction Address: .5�% �o �X {'�li �'� � /U- � - -
Legai Description:
Owner Name & Address:
Contractor.
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Tel. # %Ln� -.i'-'7y' o� 3S�
MN LICENSE # „?f� (84 SU 1
�'aC� Tel.# o�a—a6�-1360
Attach to this application, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT p<O � `f —O � � � �
' � n
Length �_ Width 1 Ff 10 Height �_ Sq. Ft. 3 y�
Length
Length
Width
Width
Height Sq. Ft.
HgUGround Sq. Ft.
Constn�ction Type: �dd�t��� o� �Q- Estimated Cost� S��O� ��5���'- �
Driveway Curb Cut Width Needed: _Ft. + 6 Ft =^Ft x$ _
DATE: IO - 13-0�-( APPLICANT: ��L.t�l.�-. Gc�, �Tel. # iol2� - a�a� - r3GQ
Call (763) 5723604 for Permit Fees if mailing in application. Fax to 763571-1287 if using credit card and we will call
you for card number. ;
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
$ �-ID I . 35
$ a�o 8�
$
$
$
g 5 , 00
$
$
CITY USE ONLY - � C �i
Fee Schedule on Reverse Side —�����N
65°!o af Petmit Fee �
.001 of Permit Valuation (1/10th%) �
$.50/$1,000 Valuation
$1350 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ J Not Necessary [
TOTAI $ �� STIPULATtONS:
OCT-13-2004 20:51 FR01�1: 9525950730 70:4256427 P.002�803
REScheckCompliance Certificate
2000 Minnesota Energy Code
RESehrcfcSoftw�e Version 3.6 Rele�e ]
Dafa filemme: Unritlod.rck
PRO]ECTTiTLE: ROSSBROWW
COUNiY: Anoka
STATE: Minnesom
ZO1VE: 2
CONSTRUCl70N TYPE: Single Family
WINDOW / WALL RATIO: 0.21
DAl'E: 10/13/04
DATE OF PLANS: 10.13-04
PROJECT DESCRI➢TION:
A SMA1.L 18' X IS' 10" ADDITION OF L[VING SPACE TO 1ilE
REAR OF'I}II? HOML.
DESIGNER/CpNTRACI'OR
CONSTRUCTtON PLUS, iNC.
COhIl>LL4NCE: Passa
Meximwn UA = 87
Your Home UA = 80
&0'/e Better 17�prt Code (UA)
Ceiling 2: Flat Ceiling a Scissor Tnus
Wall 1: Wood F7mne,16" o.c.
Uoor l: Gless
Wa112: Wood 1^rame, 16^ ac.
Wi�ow 2: Abovo-GredC Wood Frame:Double Pane with Low-E
Watl 3: Wood F*mnq I6" o.c.
Ctnwl I: Masonry Block with Empty Cells
Well height: 4.3'
Depth below gxade: 3S'
lasulation dcpth: 2.0'
Furnaa 1: Pom�ed Hot Air, 92 AF�
Pemiit Number
Checkrd By/Dntc
Gross Glaang
AreaM Cavity Cpnt. orDaor
Psnmr�[ �Yal� �alu€ -31� 11A
360 19.0 25.0
144 19.0 0.0
40
151 19,0 0.0
52
144 19.0 0.0
192 D.0 19.0
Proposcd and Masimum U-Factor Avcrsgef
Proposed Maximwn
0330
0330
a
6
13
6
17
8
22
OCT-13-2004 20:51 FROM:
Abavo-Giade Windows and Glavs Doors
o- ad
factuda Frnmdetion windows> 5.6 ffi
9525950730
Average U-Factar
0330
T0:4256427
Allowed U-Facta�
0.370
- .i. •..
CAMPLIANCE STATEMEPIT: �e proposed build'mg design drscribed here is wasistrnt with the building plaac,
spacffica4ons, and od�cr calculations submitted with tLe permit �plicatim. Thc qoposed build'mg has 6�n designed to
maet the 2000 Minnesota Energy Code �uiranmts in RES checkVersion 3.6 Rcicau 1(fomierly MEC chec� end co
comply with the mendatory raquiiemmtt listed in the RES chenkL�speUion Chaklist.
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LAND SURVEYOR
REGISTERED UNDER LAWS OF 6TATE OF MINNESOTA
LICENB[D!Y OHOIN�NCE 0/ CITY OI MIMN[AIOI.IY
3300 LYNDALE AVE. 50. MINNEAPOLIS 8, MINN.
TAYLOR 4-0370
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I horeby certify thet the above is a true and correct plat of a sur�ey of:
Lot �enty-one (21), Block Four (4). PARKVIL'W MaI3CA. Anoka County, Ndnnesota.
Aa aurveyed by me this•7th dey of November 195 7 A.D,
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, �igned b -(�r.c� l�C.?.c...
Ndnnesote Regietration No. z,55q
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ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCfION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
163) 572-3604 FAX: (763) 571-128'7
: 5786 HACKMANN AVE NE
: 243024230017
: PARKVIEW MANOR
: LOT 21 BLOCK 4
: HEATING
: RESIDENTIAL
: ADDITION/ALTERAT[ON
PERMIT NO.: 2004-02147
DATE ISSUED: 11119I2004
R612.4
VALUATION •
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROV[DED PER UMC SECTSON 504(A) AND TABLE 6-A.
# A/C UNITS 1 VALUE OF APPL OR WORK �
#FURNACES
# GAS RANGES
APPLICANT
SUBURBAN AIR
I290-B OSSORNE RD NE
FRIDLEY, MN 55432
(763)784-6100
OWNER
ROSS-BROWN CHRISTOPHER & KAREN
5786 HACKMANN AVE NE
FRIDLEY, MN 55432
�
7
AGREEMENT AND SWORN STATEMENT
This permit becomes null and vnid 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 cead and examined this
application and Imow the same to be trve and correct. All
provisions of laws and ordinances goveming this type of wor4
will be complied with whether specified herein or not. The
granting of a permit does not presurne to give authoriry to
violate or cancel the provisions of any other state or Iceal law
regulating bonstruction or the p�rformance ofconshvction.
Bldg
SEPARATE PERMITS
# GAS DRYERS
FURNACESHELLDUCT WORK
GAS RANGE FEE
GAS DRYER FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
AIR CONDITIONING FEE
TOTAL
PAID WITH CHECK # 2807
FOR WORK OTHER THAN DESCRIBED ABOVE.
0.00
0.00
10.00
0.00
0.50
25.00
35.50
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JOB NAME:
ADDRESS:
YI1CIlfG 90lf6 ZxpAOp�l1'P OQ.
ROOFIRG DIVISION
4832 2 1/2 ST, NE
MItiNE1�POLIS, MN 55�21
612-572-t@2Q
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