AF - 47427�
City of Fridley, Minn.
BUII.DING PER�VIIT
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Owner..... ...........................
A�� .G. �-� ..........................
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3538
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Builder. . . .... .. ... .. .............
Address.............................................
LO�CATION OF BUILDING
No. ��� Street .. . . . ........ .. ... Part of Lot . ....... .. .............
Lot . . . � . . . . . Biock . . . � . . . . . . Addition or Sub-Dfvision . . . . � .� . . .
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Corner Lot . . . . . . . . . . . . Inside Lot . x. . . . . . . . . Setback ,�V. .'� . . Sideyard . f .�. - � . . . . . . . . . . . . . . . .
DESCRIPTION OF BUILDING
To be Used as:
' a�
� ` . . . Front Y.�. : �'.�. Y Depth ��.�/. Height � y %�.� Sq. Ft. ��� Gtit. F't. � � �
. . '�u��E. . .. :: .. .. . Front . . . . . .. . Depth . .. .. Hei ht . . . 5 . Ft. . .. .. .. G�. Ft. ..... .. .
... , g , q .
Type of Construction ................... �s� Co�t.�AG�� y Q�. To be Completed ...........:.......
In consideration of �he issuance to me of a permit to
the proposed work in accordance with the descaription ab�
ordinances of the city of Fridley.
above, I agree to do
with all provisio�s of
,. ....................
In consideration of the payment of a fee of $:��.�....., permit is hereby granted to ...................
. . . . . . . . . . . . . . . . . . . . . . . to construct the building or addition as described above. This permit is granted upon
the express condition that the person .to wham it is granted and his agents, employees and worlunen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinanoes of
F'ridley, 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
�/�J���,_�� �-l.' 1 -1�_• Ni.�_M
NOTICE: ��
This permit does not cover the construction, Installa#io� r alteration fo� wiriny, plumbin�, yas heatiny,
sewer or water. Be sure to see the Buildinn Inspector for aeparate permits for these itema
' ��`
Date:
Owner:
Address
�... ,. _
City of Fridley, Minn.
BUILDING PERMIT N° 4 s o s
Builder..................................._. -• ----�---......_......----..._........-•----._.........._...---•......_....._
Address..... . .....: .:........ . ... ....�'......_..---.._......._-•-�-----.......
,;,, �" LOC ION OF U NG
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No. ...�.. r'. �..��... Street --�-•- -. ..._ „�I�r,�':�... ...... ......�e... Part f Lot .......................--�---..:.....-----�---........------- ........_---•
�.._. Bloc _.. Addition or Sub-Dj�vis�' . . ......_ ............._,........ ......._.- •- �- --............. ... ........----�------
Lot _ -- ...-- ............. .......---.._..�.:._......
Corner Lot .- ..........................._ Inside Lot .._..._�..._...--..._.'�ltback ....:>`;J f...:i��IR�'l!!�. Sideyaxd .._..�...�......_.........................._......--.........
SewerElevation :............. ...................... �- � - ................ ................ � ...... Fou dation Elevation . ............................................._......................--��-------�--�-��-�-�-
DESCRIPTION OF BUILDING
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J '.7 � - ..4�!Q.r.� ........ Front .... ��.. .. . Depth ...,��.. �.�_"' Height ..._L...�.__ Sq. Ft. ., :.... ....�` Cu. F� .., ._�.f�./
fi � �
..._._.......�„� ............._....- -- . Fro ........................ Depth ._:...._...... ... Height .......... - Sq. Ft. ........................ Cu. F� ......... -� � -
Est. Cos ....._.. pleted ..........................��-�- � ..................
Type of Construction .... +�'�.���! �,�::�_�. To be Com
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed wark in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
s� _...,.r►
In consideration of the payment of a fee of $�„�........_ .................... pernut is hereby granted to.........................---......._......................_..
•--.-- .................................................................... to construct 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 confarm in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city Iimits and this pernut may be revoked at any time upon violati�of any of the provisions of said
ordinances. .�'i A/f ./
�::''��. Building Inspector
NOTICE:
This permif does no1 eever the eonsfwelion, installation for wiring, plumbing, gas heafing, sewer or wafar. Ba suN fo sss
the Building Inspeefor for separah permifs for fhese kema. .
- • °�°4 �
_,' `4�.
APPT,ICATION FOR HIII�,DING P�RMIT
CITY OF FgtIDLEY, MINi�}iySOTA
oG►n�� x�e ���=e �l M�>�� s�.a� sa ��
Address G�Sv cT�C/�so� %2��. 9ddress „ �„�,�;g.. _.
LOC�ATION OF BtTILDING
No. ��..��` St,ree'� � G/�S U,,,_/�/ S-?. %►�� , P�rt of Lot
L,ot � B7.ock ...3 Addition or Sub.Div.��� � ����
�-���..._....�.._�.-
/ -- _.
Corner Lot,�„�,Inside Lot Y Set Back Side-Yard _ �_;,_, �`' _
S�"WE� ELESTATION ' FOUNDAT7DN ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTIOIG OF BUILDING
To be used as:
, it/ , �l�e.�i� F�o�t � a / Degth. �.�"...,_ , �i�t �� ' � ��-
�
Sq. Ft. al% � Gtit. Ft. �'�� p
F'ront Depth Height
Sq. Ft. Cu. Ft.
Type of Constru�tion ��Q�r,,,,,,�,,.�„� R^, _________�stimated Cost
To be completed � ._ _ .__.,..�._......_---
The undersigned hereby makes application for a permit for t&e work herein �pec3fied,
agreeing to do al�. work in striet accordance with the City Ordinances and x�u].ing o�
the Department oF Buildings, and hereby decleres that all the facts and representa�
tions stated in this epplication axe true and correct.
DA � SIGNATtIRE i�� �n . i���r
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(A Schedule of Fee costs can be found on the Reverse Side.)
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City of Fridley, Minn.
BUILDING PERMIT
dvne 17, 1965
Date: ...� _.._.
�r: At.P. 3kolte Builder ._.._ `'�e�
8 SOIl . ��'`.
Addre�s ._._.___ _._. _...�.. Address �
N° '7941
6650 dacksaon �OCATION OF BUILDING
No. ....._ Street �...� _. _._...._..__._.._ Part o! Lot
Lot ._.._.. 2._._..__ Block 5 _._._ Additian or Sub-Divisiaa .���� ����g
Corner Lot _ ____ Inside Lot _.._.__.. Setback ._._.._�_._...�_ Sideyard �_ ____
Sewer IIevatioai ._._�____ _.__ Foundatia� IIevation ___._
To be Used as:
Type of Constrvction
DESCRfPT10N OF BUILDING
Fro�t Depth Height —. Sq. F�
Front Depth _..._ I�eight _.._... Sq. F't. ____._..
.__ ._._._. _.. Es� Cost ���•._..._._..__.____.._ To be Completed
Cu. F't
Cu. Ft
Repair Storm Damage
In co�sideration of the issuanoe to me of a permit to construct the building descrYbed above, I agree to do
th� p�rop�ed work in accordance with the d�scriptaon above set forth aad in ce with all pro�visfons o!
omdinances of the city of Fridley.
In coa�sfderati� of the payment of a fee o! � 10.00 ., permit is herebY S�� '�
N.P. 3kalte to co�struct the building or addition as described above. This �t is granted upo�
the exPress c�oaidition that the person to whom it fs granted and his agents, employees an worlunen, in all work
do�e in, around and upou said building, or any part thereof, shall oonforra in all respects to the ordinancee o�
FridleY. Minnesota regarding lacation, construction, slteration, maintenance, repair and moving of bufldings
within the dty limits and this permit may be revoked at ax�y time upon violation of a�y of the provisiona oi said
ordinanc�.
Al].�n Jensen B�� �
I NOTICE:
71ds p�it doq not eowr fh� eons�nKHoo, tn�hllMioe for wtrip. Pl�aabinW Yas hwlMq, s�w�r er wMrr. !� sun to aN
fh� duildiao Mtp�elor for s�p�ralr p�nsils for f6�a I1NSS.
_ . , "�
OWNER `5
APPLICATIOIQ FOR BUILDING PERMIT
CITY OF FRIDLEY, MII`�IESOTA
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ADDRI3SS� .� �a C 11 �e n�. �� ,ADDRESS
LOCATION OF BUILDING
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= �� _ Street Pert of LoC
...___:_..,..�
L� �Z— �I.00K ��r ADDITION OR SiTBDIVISION �
.__....__... ..... -
Corner Lot�Insid� L �Setback Side-�Yard
SS�IER ELEVATION FOitNDATION Ei,EDA7�'I011�, .' :
..._.....,.. » �_,__
Applicant attach to Chis form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To be used as:
DE3L'RiPTION OF BUILDING
Front pepth, HeighC
Sq. Ft. Cu. Ft.
Frcmt Depth i�eight
� Sq. Ft. Cu. Ft.
:�..�
�'ype o� Cou�truction Estimated Cost � a o rJ
,� �_.._._.._.
To be cc�mpleted
�'he undersigned hereby �kes application for a permit for the work herein apecified,
agreeing to do all work in strict accordaace with the City of Fridley Ox'din�nces
and rulings o€ the Department of Buildings, and hereby declares that all the facts
and representations stated in Chis application are true and correct.
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(�'c�Iedule of Fee 6sts can be found on the Reverse Side).
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Building Job Report � ��
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PERMIT NO. -
; DATB � TYPE �' / !! . ".
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� INSPECTION RECORD' �
. DAtE REPORT ,
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� COMPLETED 8� APPROVED �, '� '-' INSPECTOR .
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August 22, 1969
Nr. Lsrry Barnwa
: 6Q3�t? Jacl�aao 8tr�st �. 8.
�ridler, Hi�esota 55432 -
Dsar �ir: . .:
� � iaapactioo nn Augnst 28, 2969, i:dicat�s pa�ctioau of th� '
z,.
� retai�ti�g wa21 at the raaz of yaur propurty has be�n arodi�g oato
adjainiag prapertq. Thie office anggast re�irs be msde tc� this
aa11 to �arract this situetion. Poasibly tbe method ot r�pair cou2a .
bea done bX mut+ual agre�t x�,tD ycwz neighbor .
If you hav� aaq f�xthat qusstio� regnrdia�,g tbis pleaae do'aot
he�it�te to ccntact our v€�3ca.
Yc�ur s v�ry trurly, :
D .:
Has�k F. 2�hich -:
` Buiid#.n$ Official - : �
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t�it� ���: i!�tt1 .,
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6650 �kk�ott ���`+�tt �.�.
�el�dT+�,Y�. ���s�
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� itugu�� �0, I959�, E�► l�i�.Id�p�,g pt�ia#a►]. �7r' tah� �6ii� a! ��1'1+�► rr�t+o�!
you a 'letter +��.tix�g � �odiuu� oi �&+� �t�tiniAg +�31 �t# �W � ai y�o��: � ., "
g�oper�y etC bd5t3 :J�l�oa �sa�t 3�.�. �t t�hrt �� hr tc�gg��, th�t� p+a+uitii�ly
�'sn�t�od o� x�rg�iar cauld bw dcx�p►� b� �tu�t3 ;etgr�t �p#�th p�nt�c �+usf.�hbc►t.
t�t M�[s'+�h ?.9� 39�E?, t� �iZ4�ug ��ici,aZ and s 31�Ex�tng Ins�ta�
�b�ai€ed t.'� �rot�rtY Rgsi.n +e�d frnxnd ttra� xc►�Ci �� the ��at%a#z�g t�ail it�rlr
i+�lliz►� csn�o t,he a@juc�� p�aps��p a�t 7�-b7� Av�wa �►+� t3t+�y +R�r+e ��ea�� �
a �ie+me�.
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� c�e�k a� �� �tll shawed i�'h�tt �,t #.a ��d o� dtty �l�d �k+� t�� .
mc� ydaa�cta� b�.ncti.s�. Xt ac�id �pp�e �� �is t�tti ��ruld 'b� �+ts�c��''�+� tPta
+�u�,v�ti+rrit �� it+� p�vicww c�x�d3,�ion w��is�t �t�g �,,y �wcf� hait�a'� e�
az�yrn�r. ..
�C taa�ald s�i�.'� �r�n ptcrseible �t� �� a�t�tt3.c�a �c�ul� � ,a��t+�
�►i�tb�.y bet�va�► %�t 3��a�ea�Ct�t p�t���.a�c,
ii�+aa�av��c, i! tb�t �r#.l.�a�iott �e Yutt ao��aat�ds +�e i��.�.1 p�v�a�d �i� #l3� '
�a�,�i��l� h�ts� �� �ti�it��► a�ddi�icr�►1 �at�.aa �rhich a�eick �� #�r �-
x��e�r�a+�im�a �m t� tl�twwlu�#:c� �� r,t�� �i�t�C�.c�► �h9,�h �c� �i��s,
�aia€�tt�'�Itlg,
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�a�id3an� t��l�.al�tl-�p+��tc� `
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t�riaoat l�. Q���#.-�i�y �a►gi�c�tdr
. �rtic �ti�t-�ie�� 1!I�t�Ir�ia�g �tp�ra�c��' _
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SUBJECT .
City of Fridley � 15 2 3 0
ATTHETOPOFTHETWINS gUILDING PERMIT
r �
; � R IPT NO.
� • COMMUNITY OEVELOPMENT DIV.
' j L _"'_-�
r � � PROTECTIVE INSPECTION SEC. � �S
, ' r�'�1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE . PAGE OP APPROVED BY
�'----�•� `•� 612-571-3450 910-F15 6/4 � /
JOB ADDRESS 6650 Jackson Street N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 rJ BY'OO�CVI�N1 Terrace SHEET
2 PROPERTY OWNER MAIL ApDRESS 21P PHONE
Larry G. Farnham 6650 Jackson Street N.E. 571-1142
3 CONTRACTOR MAIL ADDfiESS 21P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAI� ADDRESS ZIP PHONE L�CENSE NO.
5 ENGINEER MAILADDRESS 21P PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION � ALTERATION O REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WOFK
Construct a 15' x 20' Garage Addition and a 14.5' x 15' Deck
9 CHANGE QF USE FROM TO
STIPULATIONS
W�RN[H6
SEPERA �' �ae d�g�n$ cs�� Ioc� �+�s
�a r,N�� p���M17'S � �I,EPt10NE • EIECTRiC - Gi1S E�•
�UM���� A �'QvtR�D F REQt�tREO gY �`VV
N� s�c�y� °� �i�„�
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAp
SEPARATE PERMITS ARE REDUIREO FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOCZ rdin
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. PT.
AUTHORIZEO IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONS7RUCTION
OH WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OPFSTREET PARKING
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ]_ 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 �`rjOO �. SO
WITH WHETHER SPEGIFIED HEREIN OR NOT. THE GRANTItVG OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OF LOCAL LAW REGULATING CON- ']� SO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $
PLAN CHECK FEE TOTAL FEE
�`8. ��
SIGN EOFGON7RAC anUSH iZEDaGEN7 IDATE� WHEN PROPERLY V DATED THIS IS VOUR PER IT
— �.. i'a'.J2iZQ� �� � <
iGNA7U E OWNE OWN BUILDER� IDATEI BLDG �NSP P E
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CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(New, Alterations, Additions, or Repairs)
dWNER: ,�j�I�2�� , ���.l�.� � BUI LDER : �',�j�y �
RDDRESS: ���-�`"��/�SIJ � 1j/�' ADDRESS:
TEL N0: �� � // g� TEL N0:
Construction Location
ST13�T NO: ��"� STREET:
LOT: � BLOQC: � ADDITION: ,� �—
Corner Lot: Inside Lot: %\ Setback: �! Sideyards: ��—
--�--���
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIO�d OF CONSTRUCTION
= � C�X•X Front: %� Depth: 'Z-� Height: �S� .
� �
Squa�e Feet: Glibic Feet:
i �
Front: f �. � Depth: /S Height:
Square Feet: Cubic Feet:
Type of Construction. �j1�j]'� ��{'r��� . Estimated Cost: $J �� �
7.b Be Dompleted: � �
_ Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET
The undersigned hereby makes application for a permit for the w�rk herein specified,
agreeing to cb all�work in strict accordance with the City of Fridley Ordinances and
rulings of the Departmerlt of Buildings, and h eby declares that all the facts and
representations stated in this application a true and c rrect.
DATE : ri-�`_�_�� S IGNATCT .
�
Stipulations: � �
�.1c^hv+�1 • /�'� ' -
�� �� .
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,
AGREEMENT
C/\ ` ,,
I, �%- / Zc.C_,�=�G , owner of the property
located at ��/U �,��,/'C.Soi 54. /VC� � , have no objection to the
; ��/
City al.lowing the construction of a/� �il�j�? c��%�fGldld vl, to be
located at
without the required
_,
certificate of survey that the City ordinarily requires for all new
canstruction. ��� C� � �
�U
` �
• Signature
���G �1�e �� S�� �/� '
Address
�
��
Witne
s� > .
��Ke 3, /��`� ..
Date
'�
3
sue�ecr
City of Fridley
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
i �
� �
� • COMMUNITY OEVELOPMENT DIV.
� ; V ����� ,
1 � � PROTECTIVE INSPECTION SEC.
� = i"'1 % C17Y MA�L FRIDLEV 55432 NuMBER REv
�"""�� ,'� 612-571-3450 910-F15
�oe aopRess 6650 JACKSON ST.
t LEGAL L07 NO. BLOCK TRACT OR ADDIT►ON
DESCR. 2 5 Brookview Terrace
2 PROPERTY OWNER MAIL AODRESS
Larry Farnham 6650 Jackson St. Fridley, MN
3 CONTqACTOR MAIL AODRESS
�wner
4 ARCHITECT OF; DESIGNER MAIL ADDRESS
5 ENGINEER MAIIADDRESS
6 USE OF BUILDING
Residential
7 CLASS OF WORK
DATE oAGE Of
�/tti/ost � �
26638
�_i
RECEIPT NO.
�a � 9
AVPROVEO BY
SEE ATTACHED
SMEET
ZIP PHONE
571-1142
ZIP PMONE LICENSE NO.
21p PHONE LICENSE NO.
ZIP PHONE tICENSE NO.
❑ NEW � ADDITION ❑ ALTERATION �fl REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
9 CHANGE OF USE fROM
TO
STIPULATIONS
Underlayment must comply with State Building Code.
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING, HEATING, �� �
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK Ofi CONSTRUCTION ZONING
AUTHORIZEO IS NOT COMMENCED WI7HIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WOFiK IS COMMENCED. NO. OWLG. UNITS
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1
AND KNOW 7NE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF IAWS yq�VATlON
ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL 8E COMPLIEO
W17N WNE7HEF SPECIFIED HEAEIN OR NOT. 7HE GRANTING Of A PERMIT 1834
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE
PROVISIONS Of ANY 07HEfi STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFOiiMANCE Of CONSTRUCTION. �59. SO
Of CONTRACiOR QfYAUTMOR�ZED gf�'iENT
IDATE�
OCCUPANCYGROUP
S�. FT.
OFFS'
STA�LS
SUpT
.9�
SAC C
Fire
_ Tora
OCCUPANCYIOAD
CU. FT.
PARKING
GApAGES
E
S IS �VOfUR �P/ER�M
� - /�/ / I
�
rrEw
ADDN
ALTER
[l
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ConstructionAddress:
Legal Description:
Owner Name &
Contractor: �
CITY OF FRIDLEY
SINGLE FANIILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
�
�
Effective 1/1/98
� ��� �
Tel. #��l%%—
MN LICENSE �#
Address: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE �AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length __ 1f�
Length _ ����
.
0
Width s��Z--� Height
Width �--C� Height
Wid �_ Hgt/G�
�� � ��� �
L
. Ft.
. Ft.
�. Ft.
r
Construction Type: Estimated Cost: $ � C.��
(Fee Schedule on Bac )
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: — � APPLICANT: Tel # r%� /����
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
�
CITY USE ONLY
$ �/- �� Fee Schedule on Reverse Side �
$ . � .001 of Permit Valuation (1/lOth%)
$ �- $.50/$1,000 Valuation
$ $1000 per SAC Unit
$ $5.00 (S_tate Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ ���
. '+
Building
Inspections
763-�72-3604
�ATc_�_'_��L
�iT� .4DDRESS �
Ti�IIS APPLICAI�'T IS:
PROPERTY
OWNER/
TENA.'�'T
' MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
�'OUR E-MAIL ADDRESS
y __ �c�l1 S� bw
❑ pWNER i�,CONTR.ACTOR
NAME:
ADDRESS:
CITY
PHONE: 1���S � I�" I ��
CO;�'TR4CTOR � COMPAIvY NAME:
Pennit No. � � �� �` ��' �'=��
Received By:
Dat�l�b�d:APR 1 20
A derson Heating and Air-Conditioning
A
CONTACT PERSON: ���� p
;�a�.ur .4 cop�- oF N/p 4347 Central Ave N.E. —
�'OUR STATE STATE L10EN5E � S7'A7'E ZIP
LICENSE R7TH ADDRESS: ' u
.�PPLICATION pHONE �71�-�'��� �5�� C��. � 1tS, Mn SS421 ���- -
PERMIT TYPE
T1'PE OF �'ORK:
'�SINGLE FAMILY � TWO FAMILY
r
p �W I� REPLACEMENT
DETAILED DESCRIPTION OF WORK a
❑ TOV�TIHOUSE
p ALTERA7']ON/REMODEL
�
PER ?�4S 16B.665 the permit fee is a m1° of artre� den5i o fixture� xcluding the futue s� (T7�o �Should�reflect 1 nl�y the c s�trof labor )
improvement, installation or replacement
Labor cost under $300 =�15.00. Labor cost between $300 to $500 = cost of labor ___
x.05=
FOR PROJECTS W}�R-E LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER F1X'I'URE, EXCEP? WI-IERE NOTED. FI URES: (INDICATE TOTAL
'vrLi1.%BER OF EACH BEL0�7 MODEL: ____,______— SIZ TU
�quipment Instalied j"�G ---- S1Z TU
�G MODEL: ,�_
MODEL: __._ SIZ TU
M�� GAS RANGEI VEN 510.00
�.q/C 525.GG _FIREPLACE (GAS) 515.00 =�W GAS G LL $10.00
.AIR T0.4IR EXCH.4NGEER S 15 , FIREPLACE (WOOD) $35.00 Gp� jJNJT $10.00
BOILER 535.00 �,FURNACE $35.00 _pppL }�qT R $35.00
CHIMNEY LfNER $10.�0 _GAS DRYER $10.00 V�I.TTILATO 515.00
— GAS PIPiNG $1000 — ;� . . . . ,
DUCT V✓ORK $10.00 — . ... .. ... .....: ,..z ,.�.c.:�x:��.�r.nri�:��.ie,a�.;�:K�:D,cvr;�r�ts����x �:i?��3��TS=�V;�R��50
permit Fee � __�- �«--
Surcharge i .50
TOTAL DUE �
Number of fixtwes @ $1�.00
Number of fixtures @ $15.00
Number of fixtures @ $25.00
Number of fixtures @ $35.00
TMS IS AN APPL]CATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge [hat the information above is complete and accL
conformance with the ordinances and codes of the City of Fridley and with the Mu►nesota Construction C
not a permit but only an application for a permit and work is not to start without a permit; that the work �
approved plan in the case of all work which requires review and approval of plans.
SIGN.4TL`RE GF P.PPLICANT C L(/i'��� � P�T NAME� • GC�'I i TT el�����
City of Fridley
Building Inspections Departme�t
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
x $10.00 = $
x$15.00=�
x$25.00=$
x$35.00=$
Surcharge = $ .50
Total = $
;; that the work will be in
s; that I understand this is
be in accordance with the
i� �