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AF - 47137/ � f �`'"� Village of Fridley, Minn. BUILDING PERMIT �°• 18 6 4 D te: . . . . . . . . .�% .`. . `� � . . .. . . . . a �� r�� ,� . . . Owner .................. Builder �c7"j2.� ..is%Q�!'�:.................. Address............................ ........ Address ........ �.............................. ✓ � % �CATfON OF BUILDING No. . . �.�/. . . . . Street . . . . . . . . . ��: .. ��•9G.C,. . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . .. . . .. . . . Lot . . .,j.�.� . . . . . . . Block . . . . . �. . . . . . . . . . Addition or Sub-Division . . .. . . . . . . . . . ... .. . . . . ... . .. ...... . . � /' � Corner Lot . . . . . . . . . . . Inside Lot . . /!�. . . . . . Setback . .�.s .�. . Sideyard . � � . . . . . . . . . . . . . . . . . . . . . . . DESCRIPTION OF BUILDING To be lised ��f.t�-�� �. . . . . Front . ��. . Depth . �3f � Height � . . :r. Sq. Ft. . .. .. . . . Cu. Ft. . .. .. . . . � ..................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........ Type of Construction �i. z"y�rY.4-. . . . . . . Est. Cost � :� . � � t� . . . . . . . . To be Completed . . . . . . . . . . . . . . . . . . Tn 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 village of Fridley. �!p . s �.. /� ��� Tn consideration of the payment of a fee of $. �.'�.. .. ., permit is hereby granted to .d`:!.4?�!?�'�t�.. ���� !�-t.._ ......................... to construct the building or addition as described above. This pernut is granted upon the express condition that the person to whom it is granted and his agents, employees and worl�nen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of F'ridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the village limits and this permit may be revoked at �� time upon violation of any of the provisions of said ordinances. �'"," �/_ _ .......... ...... ........... . Building Inspector N0710E: This permlt does not oover the construction, instalia,tion or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. � City of Fridley, 1dlinn. BUII.DING PERMIT Date: .... J.'.'�. �':"..J..�? ........... � Owner �G%����!"�'� : �!! . . �.�. . . ' . . Builder Address . . (P �.�....� . . .. .. ... .�� �! `Address � N° 3i55 ........... �Cl�.......... ........... L CATIQ�I OF BUILDING No. . \SJ. .%. �. . . . Street �Y�� . � . .. . . . .. . . . . . . . . . Part o# Lot . . . . . . . �. . . . . . .. . . Lot . ... ........... !�!........ ...�.. . . ..��• .�.3.�.. Block .�. � Addition or Sub-Div,irsion Corner Lot . . . . . . . . . . . . Inside Lot . . . . . . . . . . . . Setback . .� S �. . . . Side�. .� .• . . . . � � ����" DESCRIPTION OF BUILDING To e Used as: � . . . . . . . . . . . . Front . �� . Depth . L .v . Height . . . � . . Sq. Ft. . �.T. 0 Cu. F't. . . . . . . . . . .. . . .. .. . . . . . .. .. . ront . . . . . . . . Depth . .. .. Height �. � . . . Sq. Ft. . .. .. .. G�t. Ft. . . . . . .. . Type of Construction . . . . . . . . . . . . . . Est. Cost. r� �.Q w. . :'-.'.'. . To be Completed .� . .� :�! �. . . . . . . . y'l0 = Ct,i�� ' ���.�l,• a� /6 " O C�. � �� �zG�.� , , . �� « �,�.,,��,,�,� I�.�, • a,,t,�P � �!��, �k � In consideration of the issuance to me of a permit to construct the building desribed 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. , '�, 1/'<=� . . . .���'!. .✓. . . .✓ - . . . . . . . . l. . �� O � ���� / In consideration of the payment of a fee of $. .. i.. ..'. .., permit is hereby granted to ���iC�lG�.�(.J ..... .. .... ....... ....... to constxuct 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 buildings with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. � � / . ���i`� ��� . . +Building Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspeetor for separate permits for these itema sue�ecr PERMIT c�ty of Fridley 2 21 �'� ' , AT THE TOP OF THE TWINS g U I L D I N G P E R M I T RE O. r � � COMMUNITY DEVELOPMENT DIV. � , • � C� V PFOTECTIVE INSPECT�ON SEC. , � ._.'—� r , ; � � �'�'1 � CITY HALL fRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BV �---•� � ,'� 612-571-3450 910-F15 9/17/93 / / JOB ADDRESS 671 Helene Place NE t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO oescR. 13 7 Donnay's Lakeview Manor SHEET 2 PROPEHTY OWNER MAII ADDFiESS ZIP PHONE Barry/Mary Jo Seaberg 671. Helene Place NE 572-9713 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO. Panelcraft of Minnesota 3118 Snelling Ave S, Mpls., MN 55406 721-6628 2179 4 ARCH�TECT OR DESIGNER MAIL AODRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASSOf WORK ❑ NEW � ADDITION ❑ ALTERATION �1 REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Reside House; Iz�stall aluminum soffit &�ascia, trim, gutters & downspouts 9 CHANGE OF USE FROM TO STIPULATIONS �aroyide smoke detectors as per UBC 1210 adjacent to all sleeping areas and in basement, provide adequate attic ventilation. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING, HEATING, VENTiLATING OH AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTAUCTION ZONING SQ. FT. CU. FT. AUTHORIZEO IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION 1 STALLS 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S6�QQO $3.00 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMiT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW FiEGUTATING CON- $$l.00 Fire SC $C.AO STRUCTION OR THE PERFORMANC OF NSTRUCTION. r + P�AN CHECKFEE TOTALFEE � �� � 3 License SC $5.00 $95.00 SIG FCONTRACTOAOAA OA�2EDAGENT IDA EI WHEN P VA ATED THIS IS YOUR PERMIT .y ,�- � SiGNATUREOFOWNERUF-0WNEABUILOEAI iDATE� B�DG INSP / OAiE NEW [ ] ADDN { ] ALTER [ ] Construction Address: Lsgal Description: Effective 1/1/93 CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 � j��b Building Permit Application / Owner Nam� Address: Contractor: Q. � Address: ,,�'�"°�""�°"°'�Ltac-ti _�o.�t�li� lot, with the proposed �,;� s���9�/3 Te1. #, MN LICENSE # _ Tel. # a Certificate of Survey of the struction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height GARAGE AREA: L,�ngth Width Height DECK AREA: Length Width _. Hgt/Ground OTHER: Sq. Ft. Sq. Ft. � Sq. Ft. Corner Lot j[� Ins��ie Lot [] Fi. Yd Setback Side Yard Setbacks Type of Cons�tru�c�io�i� ' w �i�y ����mat.ed cost: �./e�.�r`� . R �^ . r+N/►�t � ���'. Approx. Completion Date. � ��- � ��,'�7� (Cost on Back j Driveway Curb Cut Width Needed: Ft. + b Ft = Ft x$ _$ DATE: APPLICANT: Tel. #_��� ` � Permit Fee $ � Fire Surcharge $ ,� State Surcharge $ � ,�(',� SAC Charge $ Licease Swcharge $ �t � � Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOTAL $ ��� �� CITY USE QNLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth9o) $.50/$1,000 Valuation $750 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt_ "B" Above . F� Determined by Engineering �rgreement Necessary ( ] Not Necessary ( � STIPULATIONS: � _ _ � ;.. sue�ecr �- � City of Fridley 4� ,� � �6 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T f i � � �` COMMUNITY DEVELOPMENT DIV. RECEIPT NO. r � ~ � PROTECTIVE INSPECTION SEC. , � � �a _ y � ' /'��1 � CITY HALL FRIDLE� 55032 NUMBER FEV DATE PAGE OF APPROVED BY �'""�" ,�� 612-571-3450 910-Ft5 10/28/94 � � JOB ADDRESS 671 Helene Place NE t IEGAL �OT NO. BLOCK . TRACT OR ADDITION SEE ATTACHEO DESCR. 13 7 Donnay's Lakeview Manor SHEET 2 PROPERTV OWNER MAII ADDFESS 21P PHONE Barry Seaber 671 Helene Place NE 72-9713 3 GONTRACTOR MAILADORESS Z�P PHONE UCENSENO Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PMONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK �✓ � �C. � Construct an �' x 20' � Addition � �� /'�-�/ 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan. Provide a hard surface driveway. TVPE Of CONST. OCCUPANCY GHOUP OCCUPANCY LOAD SEPAfiATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING Oii AIR CONDITIONING. THIS PEFMIT BECOMES NULL AND VOID IF WOFK OR CONSTRUCTION ZONING SQ. FT. CU. fT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OF ABANDONED FOR A PERIOD OF 120 OAVS AT ANY TIME AFTEF WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAI( � ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED WITH WHETHER SPEGIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT 3.03 �'� DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE � SAC CHAiiGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- /D(�^� ��D STRUCTION OR THE PERFORMANCE OF CONSTRUCTION 90.00 Fire SC G.OJ �- PLAN CHECKfEE TOTA�FEE j �99. io /ao./.3 5�� ruaeovcoN,� CTOROR THOa4EDAGEN� IOATEf WHEN PFOPERLV LIOATED THIS iS YOUR PEFMIT � v `i ` C ���� �/j / S�GNaTU:7E0: WN R�60WNER i ATE__-� 8L iNSP qaY�� s �..i. � ��� NEW ADDN ALTER i� [l {] CITY OF FRIDLEY SiNGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Effective 1 / i /94 ConstructionAddress: �°��/ /��L�if/C- �� �l/ Legal Description: ICLT / 3 ��� � � .1�.���i/��v �/-Tit�� Owner Name & Address: �f,�,e 5/ .�����r- Tel. #.5 7� - 9�/3 Conbractor: Address: MN LICENSE �` Attach to this application, a Certificate of Survey of the lot, with the proposed consiivction drawn on it to scale. Tel. # . DESCRIPTiON OF IMPROVEMfiNT LIVIATG AREA: Length Width Height Sq. Ft. GARAGE AREA; I.ength �_ Wicith �_ Height Sq. Ft, �_ DECB AREA: Length Width HgtlGround Sq. Ft. OTHER: Corner Lot [] Ynside Lot [] Ft. Yd Se�back Side Yard Setbacks Type of consav�aon: Fsaroa.ted cost: s G� �l, GU ; Approx. Completion Da�: ��'G', /,�,, l�{ .. ,�;; :; . (Cost on Back) .�� : Driveway Curb Cut Width Nceded: Ft. + 6 Ft = Ft x$ =$ DATE: APPLICANT: Tel. # Permit Fee Fine Surcharge State Surcharge SAC Chairge License Surchatge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: 5��,� U�E ONLY . , � �%D, � Fee Schedute on Reverse Side $ (', Q7 ..001 of Permit Valuation (1/IOth%) $ 3.43 $.50/$1,000 valuation $ �800 per SAC Unit $ $5.00 (State Lice�sed Residential Contractors) $ Alt. "A" or Ait. "B" Above $ 54�0.00 Conservation Ptan Review $ Fee ��ined by Engineering $ Agreeme,nt Nece�aty [ ] Not Necessary ( ] $�, 9 / , . ,�:�`�' �.� , \ { �... t � `� y .i�,. : � ��a ...• r x 1 , _ ,�, � �1VIINi� (�I���1-�.1N c� :�v.; �.� �. �� ' . � ���x�. �.• '� � q��y. �-. . . „, � . . .. � .. .: � i n, F �`ENGI NE�RS AND: SURV�EYORS , � � �, �, .� �� � ti LAND SUIIVEYINO. ` $OIL3 TE$TINC3 ClV4L !�. MUNIGtPAL ENO1NEEii1NG3 LANO PLANNINO ' 6418 —56TH AvENIJE N. � M�NNEAPOLlS 22,M1NN. /� . . . . OR T— 49t4 � ' . _ . :... e �!'. �� � � �� 11 � � �C�� 1� �C 1� IF �S � �`I1�' `� � ^ ; , � �{ -� .. `+�'' �,���_ � ._, � � �'�� ``r � �``'r ✓ j�?�i`� 3' � � / ,' J �J j�` �:._.~ '►`-��E..� :J� � Lf�� J"0�..�i` � ���� � �.e..�..e�....y�r.w...��w�.c .. . . . . . � � . .. � � �c -� .- s ' �. r > � � �., i� ,�'� °Qa t � � �; e� yt; �Ji'�� �� ��t M1i ���.. - � - �0 �' � %� �� ; ��' a � �. z �� : , � . : , . ' /�� "i, . � ' . . .,. ... 4 �1:3 _': �. � �. _ � .l � � � '�r i ! 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RAT� SCHEnULE Residential Effective On March 1, 1996 APPL{CATION FOR POWER PLANTS AND HEATfMG, COOIING, VEN7ILATION, REFRIGERATION AND AIR CONDITIONING SYS7EM5 AN� DEVICES Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace) GAS LINE TO FURNACE:IN�'ADDITIQN Gas Range �- Gas pryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BAC{� 1% of Value of Appliance or Work Commerciai/industrial 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $ $10.00 $ 10.00 $ 10.00 $ 10,00 $ 25.00 State Surcharge TOTAL FEE J06�4DDRESu 671 HELENE PLACE NE 7he undersigned hereby makes application for a permit for the work herein specified agreaing 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 siated in this application are true and correct, - _ - 3- --�0-� — -- --- _ � 1996 OWNER B�Y SEABERG $ BUILDING USED AS DWELLING $ � ESTIMATED COST 300 .00 PERMiT NO. �� ����� $ , x �� � � •i i i $ No, of Heating Units Gircle Ono (Steam) (Hot Water) (Warm Air) Trad� Name Size No. BTU HP EDR $ Fuel � Total Connected Load �� 2$ 5.50 MINIMUM FEE FOR AN�f HEATING[COOLII�C/VENTILATION REFR{GERATfON/AIR CONDlTJONING PERMIT 1S $25 00 PLUS THE $.50 STATE 3URCHARGE REINSPECTION FEE $42.00/Hr *Air Conditloners can not be placed in a side yard without written permission from adjoining property owner. Burner 7rade Name Size No. BTU HP EDR HEATING COMP NY B INE HEATING, AIR COND & ELECTRIC INC 62 CENTRAL AV UE N.E. ANOKA MN 55304 Signed 8y ` No. 757-6200 ApprovQd Sy Rough-In Date Final Date �(lr�/ FILL OUT BACK SIDE OR STACK VERIFICATION ON '�� REPLACEMENT FURNACE CHIlVINEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chunney or stack: 1. Has been carefully examined Yes (�) No () 2. Is free from rust or deterioration 3. Has `no foreign objects lodged within 4. Is securely supported 5. Meets all current Code requirements for size and total, BTU's connected 6 Has`'to�a1 heating BTU's of All oth�r BTU's TOTAL BTU's 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: List ALTERATIONS Bein� D� HEATING CO: Signed By: Date: � YesONoO Yes()No() Yes()No() Yes ( ) _ No ( ) Yes()No() Yes()No() , SuBJECT � P . City of Fridley �;>�; ;�p ; AT THE TOP OF THE TWINS g U I L D I N G P E R M I T f ; � RECEIPT NO. � • COMMUNITY DEVELOPMENT DIV. � � V___���', r � � PROTECTIVE INSPECTION SEC. J I � � � ' � /'��1 � CITV HALL FRIDLE� 55432 NUMBER AEV DATE PAGE UF APPROVED Bv �"""�"� �'' 612-571-3450 910-F15 3/12/97 � � J08 ADDRESS 671 Helene Place NE t LEGAL LOT NO. BLOCK THACT OR ADDITION SEE ATTACHEO DESCR. 13 7 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Barry Seaberg HX�X 671 Helene Place NE 574-9833 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO S 31Il@ 4 ARCHI7ECT OR OESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAII ADDRESS Z�P PHONE IICENSE NO. 6 USE OF BUILDING Residential 7 CLASS Of WOiiK ❑ NEW ❑ ADDITION � ALTERATION O REPAIR p MOVE ❑ REMOVE 8 DESCRIBE WORK Install interior wall 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan. TYPEOFCONST. OCCUPANCVGROUP OCCUPANCVLOAD SEPARATE PERMITS ARE REQUIRED FOR EIECTRICAL, PLUMBING, HEATING, VENTILATING Oq AIR CONDITIONING. THIS PERMIT BECOMES NUII AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHOFIZED IS NOT COMMENGED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WOFK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT ANY TIME AF7ER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEfiEBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �/+OO �.SO WITH WHETH�R SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $21.00 F�re SC �.40 STRU N OR TH ERFO ANCE OF CONSTRUCTION. l�� ^' PLAN CHECK FE T A FEE `% r 2 1• 7 � siGrv E OF CON�RA OA AUTHORi2ED nGENT IDATEi E pq LY VALIpA D THIS IS YOUA PERMIT ' �//� � SiGNATUREOFpWNEFUFOWNERBUIIOEfiI IDATEi -0G INSP q4T� NEW ( � ADDN [ ] ALTER [ ] CITY OF FRIDLEY SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: ��/ ,1��' ��,r,�.i � ;�',0 „�",� G f a Lega1 Description: Effective 1 / 1 /97 �C` / Owner Name & Address: ��� j''�..��.¢�� �'� ' Tel. # .5 �LI �`'�l�3�3 Contractor: �„,;,� MN LICENSE # �' Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Tel. # Attach to this app�ication, a Certificate of Survey of the lot, with the proposed consttuetion drawn on it to scale. DESCRIPTION OF IlVIPROVEMEN'f' Length � Width �_ Height � I.ength Width Hcight Length Width Hgt/Ground � Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: S ir'l�� �.�t �,� � G , Estimated Cost: $�/�d f (Fee Sch�dule ora Baciz) Driveway Curb C�t Width Needed:. Ft.:.>+ � F# �- rr Ft ��$ _$- na�: - - 7 arrLicarrr: /J���s� ���f��,�{ ' �ea. # � �' � � ��Yr3'3 . � Permit Fee Fire Surchazge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge $� , `� $ � (� � � $ $ $ $ $� $ TOTAL $ ��. q� STIPULATIONS: C1TY USE OA1I.Y Fee Schedule on Reverse Side .001 of Fermit Valuation (1/lOCh%j $.50/�i3ODO Valuation $950 per SAC Unit $5.00 (State Lice� Residentia� Contractors) Alt. "A" or Alt. "B" Al��e $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Ne�essary [ ] Not Necessary [ ] � , / v�\ l-ri :' \ � ��- � i � ! 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Effective On August 1, 1995 6431 UMversiry Ave NE Fridley, MN 55432 APPUCATI�?N FOR POWER PLANTS AND HEATING� COOLiNG, VENTILATION, . 572-3604 _ REFRIGERAiION AND AIR CONDITIONING SYSTEMS AND DEVICES : � Residential Furnace 3heil and Duct Work, Burner — Also Replacement Furnace (Side Vent — Fill 0ut Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer � r;�""' *AirCond�ioni� — Ali Sizes �'.F All Others/Re� & Afterations (LIST ON BACl� 19'0 of Value c��ipplia�e c�r_Work � � .� Commercial/In� � ria ' �''= �. �" . � �.• ,.. 1.2596 of Value of Appl3art'�e` or Work :�'d -�.�;": :"��;, � Rate $ 30.00 $10.00 $ 10.00 $10.00 $ 25.00 State Surcharge fiOTAL FEE JOB ADDRESS f.� � / f.LPp�� � ,�L /IO� The undersigned hereby makes application for a permit for the work herein TOTAL specifled agreeing to do all work in strict accordance with the City Codes arrd rulings of the Building Division, and hereby'declares that all the facts and $ representations stated in this application are true and correct. 9 -� �/ � ,��-- $ . OWNER �eaburc� � �ar rc,� �j $� � 9��� $ /�. c�C) . BUILDING USED AS $ . ESTIMATED COST ���0, o P� PERMIT N0. ����^ �� $ � � � • � • i � f i $ No. of Heating Units Gircle One (Steam) (Hot Water) (Warm Air) Trade Name Site No. BTU:' _ HP EDR $ Fuel Total Connected Load �� MINIMUM FEE FOR' ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PEHMIT IS 525.00 PLUS THE s.50 STATE 3URCHARGE REINSPECTION FEE $42.00/Hr . �. Bumer Trade Name Size No. BTU HP EDR MINNEGA5C0 AT1N: JUDt • 321-5282 HEATING COMPANY P.a BOX 11$5 _ �IPLS„ [u�155440-'1165 Signed By, Approved By Tel No. �� - ------- `. �,_ Rough—In Date Final Date *Air Conditioners can not be piaced in a side yard without FILL OUT BACK SIDE FO� STACK VERIFICATION ON vuritten permission from adjoining property owner, REPLACEMENT FURNACE � CHIMNEY AND STACK YERIFICATION The undersigned hereby verifies that tlie existing chimney or stack: l. Has been carefully exammed Yes O No O 2. Is free &o�us�.;or deterioration Yes O No O _,.. ��:� �"`'',,,��t�, �'�" ,; 3. Has no for �pb}ects lodged within Yes () No (). � r�.: 4. Is s ' ely f ,�,�rted " Yes ( ) No ( ) . . . :�. S_;: �� �' �x�� 5. Mee 1 c�re�3eode requirements for �size and 1.B'�J's�c�nnected _. .. - - - . . _ Ye� ( ) No ( ) : 6 Has t heating BTU's of � . a All other�TU's TOTAL BTU's � 7. Has a liner been provided for water he�ter 8. Has combustion air been provided for water heater Remarks: List ALTERATIONS Bein� Done: f i����Q � O l � HEATING CO: Signed By: Date: MINNEG�►S�A ATTN: JUD! - 321�b2$2 P.O. BOX 1t6�6 N�I.S.. MN 5544t�f f6�'.r Yes ( ) No ( ) Yes ( ) No ( ) (