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AF - 47849%� � Caty of Fridley, Minn. � �� BUILDING PERMIT A r� �^ , N. .639� nat�: � �° � � ow� _ s,�a� ,��.� �-.� Address Address �l � L T F BUILDING � + P f Lot No. �S� St�+eet ;��, ' � � � � � I�ot `°' �"° Biock Addition or Sub-Divisfa�n r.,���Z�L�� Corner Lot _ Inside Lot �� Setback .,ma��r--__._ Sideyard .! � 3ewer IIevattaai Foundation IIevation DESCRIPTION OF BUILDIIVG To Used Front "� _G.__. Depth .�� Height .��� S�l. F� P'�°' �. r�a`�"'� Deptls � ITeight � Scl. Ft. Cu. Ft Type of Constructi � FF�t. Cost y�� '� To be ComPleted in consideration of the isauance to me oP a permit to construct the bwllding described above, I agree to do the proposed work in accrordance with the d�script3on above set forth and in lian wi all ona of ordinances oE the citq of Frfdley. In camafderation of the payment of a fee of $.g�,�� , permit is hereby granted to to construct the building or addition as desc�ibed above. This permit is granted upon the egpress c�ndition that the perafln to whom ft is gi�anted and lus agents, employees and worlunen, 9n all work 8one in, around and upon eatd build9ng, or anypart thereof, shall conform in all respecta to the or�►anc� of Fridley� Minnesota lacation, consiruction, alteration, maintenance, repair and moving of bufldiugs 0��� dty limits� permit may be revoked at any/� �violaj3Qp of aay of the Provi�tona oE said / l ��_ �� n NOTICEz 11� perm� doa rtot eevsr t6s we�lw�ii�, 6at�toe fee wirtae, pinm6leg, Aa h�aftae, aara or wNsr. B� wre to as tl» Boildin8 Ie�te� he Mpnab � Por �na Ham�. V ov�mer' e Addresa APPLICATI0�1 FOR SUILDINQ PER�IIT CY'I'� OT' �RIDI�EEY� NLT�TNESOTA LOCATION OF SUIi�DI1TG ex • ��--� ss !„�-� No o (�, � Street �,�,�� art of Lot Lot 1-}�,� `�� lock � Addit�.on or sumcliv�.s�o = / p Corner Lot inside Lot�_____Setback. �-f .Side Yar� � SE�'ilE� ELEV�iTION �'OUNDATION ELEVATiO1�T Appl3cant attach to this �orm Certi�icate of Survey o�E zot �nd propoae� build3ng location. DE�CRIPTION OF BUILDTNG To be used aso , � �--`'� �'ront� epth � � �Teigh�t e7� s r t ��.f ° �.. � � \rK • Ft • �'ront�,_,_ Dep•�h , _eight Sq. Ft. Cue Ft. Type oE Conetsuc�ion � _,_, Est�raated Cos•� � 3 a��� _ � n �% TO b� The undersigned here�y makes application �or a permit �or the wosck herei� specif�,ed, agree�.ng to do all work �.n stric� accordance with the City of FridlOy �brdinancea and �rul'ing o� tlie Depar�►ent of euilcl- ings, and hereby declaras that all the fac�s and represen�a�iona s�cated in this ap�lication e true and co��oct. ��� �� D�T'�'S � � 3yQ�AJ^.�ii'. � e (schedule oiE Fee cosica can be �ound on the Reverse Siae} . ; x � sCi�h/" .. / �' � ' � �` _;•. - .^� � _ �:� . � BUILDING PERPRTT FEE SCHEDULE Sec�ion 2. The Inspector o� Buildincs shall, lbefore isauing any pe�:3ni•� �or the e�ec-�ion o� any build�tng or structure, or for any addi�cion to any ox�.s�ing building or s�truc�ure, or for any altarations or repairs to any exis�ciny building or si:ruc�ure, upon application �here�or, require �he payment by the a�plicant �or such permit of fees �to the amount herein belodv set forth and in the manner herein provided to-wita 2.1. For any such pa�nit for the erection of any fire-proo�f building, o�her than a garage, waYehouae, �acto�cy or gra3n eleva�or, or for the erec�ion of any f�:e-p�oof addition, �cor s3.milar occupancy, to any exisi�ng building shall be at the rate of $1.�0 for each ono thousand cu�1c �eet, or f�action thereof, in such cub ical contents. 2.2. For any such permi�t �or the erection o� any fire-proof c�arage, warehouse, �Eac�olcy or grain elevator, or �or the erection or any �ire- proo� addition, �o� siYniiar occupancy, �o any existir�g bui�.ding shall be at the ra�te oi $3..25 �or each one thousand cubic fceet, classi�ied as "�ireproo�" by Sec�ion 502 of the i�.i.nneapolis Building Code. HOUSES 2.3. For any ing other tha non- siaceproo� Pe�cmit $1.00 � GA'E2AGES ,_ such permi� for the escec�ion of any non-f3,reproof build- n a garage, warehouse, yac�ory or g�ain elevator, or any addi�jon, for s�.lar occupancy, to any exis�ing building or each onc: thousancl cubic feet. 2sa. For any such perm3�t for the erec�ion o� any non�fireproog gag'age, warehouse, �actory or grain eleea�or, or for the erection of ar�y non-�ireproof addition, for similar occupancy, to any existing building or �o� each such building or additione Ninety Cen�ts �or each one �housand cubic �eet o�c fraction thereof, in the cub3cal contents �thereo� wi�ch a minj.muYa oc $4,00. For the purpose oc compu�ting fees for building permits the cubical con- tents o� any builclinc� or addition to a unifo�m height throughou� hy rnultiplying the ground aTCea covered �rom a point six (6) �nches �elow the floor line o� �the basement or celiaar to the �verage height of the upper surface or �o 'che average heigh� of the roof sur�ace o�E the ma�.n gaTole of a pitched roof. 2; For repairs or alterations to an exist3ng atructure, the fee shall be at the rate of $3.00 per each Five Hundr�d Dolla�s ($500.00} or �action �hereof in �the cos�t o� all proposed worl�. 2.6. in no case shall t�ie' �r�e charged for any perm3t as eet forth in Section 2 be less th� $4.pp. � ' ,� � !"\ � ,�.�. „ c�• c• ��Oc«�ti1 C�U�G� v4SSOCcCx��S, �C• Cz � LAND SllRVEYORS Anc�ka, Minnesota CERTI�IC/,TE OF SI�RIlEY: Ralph Luna L �J't• �55-g27-�3 � +'`" � �L �--�_�� , , 0 e��,� pN #7�,6 0 ��.o -, �� �, , 1 \N i ,� �' 1c� � ' ,�1 � I ! 10 � ���- ��Nm �, � � '�o � �G � . /"�" .� 1 Ezes`"�t � ` ` � u , , �ir ' � � O `O � ` —. -2• 1 1 .�� �. o � , � �,5-5 3 g ! `2.� SNEo A��E�( �O LCi�sB �.�-�s° y �}�` i �ile �� P i+� <)�'!i �t`� i RIVL�VTE6� H�I��IT:�, Anoka Cour�t�r, i�?�ran��:,t� Tele�ahone 421-6340 --� DENO�s 12oNs I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OP A SURVEY OF THE BOUPIDARIES OF TNE ABOVE DESCRIBED LAND, AND THE LOCATfON OF AU BUIIDWGS, THEREON, AND ALL ViSIBLE ENCROACHMENTS, IF ANY, FROb1 OR ON SAID LAND. AS SURVEYED 8Y ME THIS.,.,,l�,t,`,VAY OF .,,FBF�,rU;ffif'�, �3 .. .. . .. .................... ................. A.D. 19 ..... ..... N. C. HOIUM AND ASSOCIAT�S, IP�C, -f LAND SUItVEYORS � .�;� �.� , z- t�� � �� . . . . _ ,. , . . :. � ............ ................. �.................. .............. • ...................... ........ ......................�.... ,� �, � . � �x�� � � :� ..,-.�,�,. � va ,._ r. � .,.... , . . _ .. .. . .. .,., ..�.. . .,. , .. ,., . . . ... . s t n.,._.� , _...,,. . , -,�.� . .. .. . . . -rrs: .. _— -- --� a , o � c' e ;� '!� •r � �'�t �r�F-� �. � Li .i d��°`, �/ $, � � f, 9 • �!," � � ,.� a., r ' ;�, r�' �i,'� w' � ,�# � e ��• ����,�-���, ��Li�:� �. �'��'1��;�.`L�.��..��� � ��tCe Tele},h�ne 421-f�340 � -- _ ' � "� � �'� � � ' � L A � d D S l,► � V E�° O��___--- --------�_-_-�--_ _.__ __ ____. _ _ ,. ;. An;,�4;a, hlirtr+esotC C�E�7ir1C�iE OF Sl'��E o': R�3�t; �,��z�j � � ��' ' t�5;�-�?,�aL�3 u�� 13 �'' 1" Jr. J-l- �' � ��/J� -� �.O :�� . � , �A �N �� . �o ���,T. , , at� �� �� �- � , � w . , �'cr ,� � ; . l � � �1� � 0 � " //A� : ' ;' .' N �/ ` f / ; I, :�`,- ,�,� . , �.' �/ a� . � � � � �� , � P���Q , �� J�pEFgu� � �f' � �u ` �r � ` � ! '_.-- ti �.� � ' , =� �, ' .� / 0 a ,y � �_�-� ..v g �, ° ' ,`.r �u-o �- �-,�' �� �� ,, Z�^v5 �'r,�, .t. r il�:�: ?,�'t :. >,"'.' i c „�_. �.i�,���':�ois'.,d �._.1�' -._a � ' � fi:j`�'.r�'4 l,i?'•1-ti4��� . i.'.'�."j:� !a D E l�4 OT�S I 2�t-� s I HE:EBY CEc�"IPY TH.4i THiS IS A TF!,`E AND CCR%EC7 FEFAc5:KT4��•'.�`+ 1F .s SUF':'EY OF THE BOU'dDARtEi OF TH'c ADqYE DESrF98:D IAND, AN1 THE CCCA.iION OE All "otl�:DitiGS, 7N�fcCN, .4Np t�:� 'i:�t3:E °.'�C�=�CHV_ENiS. IF ANY, FF.�?`n OR Q?� S�ID LANO. t �}�„���. �: i , � ., �. ,.. AS SURYEY�D BY ME iH�3 _' 1t`�U.4Y Gf ''� ` '� _. A.D. 19 ,�,. k�l. C. !i0'U:.� AN,� :\SSr;,�,� :_y 1•:� -- LG!`dD SU:�'/EYGP.S ,� `� ' �'�1, �� R=��o7 �.as s� �. �u��`�rc,. �t� �o� p� 5.:���� 2as �g�� "��.� .,�. ��� � �� G Ci:JT7.Jc`�. s, t"� IT�'�s as�� Qu uT • �° Z �•?{��N� t:j7uO��f�'�'T 7Tri �e'n �rn�. ....... _ J d �. b 0 p o� � . � • � ` � ^ � � 1 �. N �' 4� � � �+ !'� � � � � � p � �� � � � � � �a • O • O � . o . � : : � � � � � � � � O O O � ea fs 4n � � �� � 0 0 � � t�q 3 � � � w cxa � z 7. 8 � � � � � i� y � � � � � � G� a���� � �o��� �y 'd . p' � � � a o : � `° � M �.��:� a� o : �• °� : � � � . : o : . . : � : : ' : x 0 �a oa x �a �e x W n� w r� ►� � �l C7�i p C�7� O O O �' tn t» in tss �» tH � � � 0 � H �`J � � 0 Q x � � � C � � � r�— � � m � n _ m C r m O � 0 I � � z � � � � b � s�- � � �' w � g � � '�� o � N � �� �■i�1 : ■.., � i ■.�1 � � ■■��, _ ,'. ■��, :� ����� ����� � � 8� y � � � �. 00 5 ai � �s � I� I��� � , �� , s WATER aos�s URINALS e�rH � ews�t�s SiNl6 W� rnnvs DRtNK. FOUNT. sr+wRS. FLOOR DRAINS uTa ��� nuro w�e GAS APPL G1S RANGE GAS OPENINGS � • z • �y in D m A m � p o.a� � M M �y Q' � y � � �o a � � � �• � � �o � � � ��� � � ����a � ��� � � � b ��� � � 'd Fx � � � m p � p1 p� � � p � � ro F � � ~ � fD��w ` a'`�.�� � � � � � �� �� �� � ��o �aa' � � � �o �� � � �. a rGe � � C � � M x� � � aM �x % �°n p � �� �� m � � �. Oi a � � � � � . � °' � � � � �A ��/ O O � \ �o � `� �. � � �� � a �� � V O � s � � � � � 'd �i o ''� p � . M . 7i . � . Q • M • O . a . m 0 ' � � � • � � N � � � r � � � w � � p � �' � � � O • o • o : O . O . . �a : : �r � . � �E k i4 [v1 ►�+ � O O O � � � � H . � ��� � � C' � � m � w m � � �: 8 � � � n � A � � � � � � � � � � 64 � . � � � F� b ¢ � � � 'a � � � : � �- : � � • Gi „o°o : �' . � � � . . . ' � . . . . : � ' : : : 0 k p: iC DC >C y4 � � W N W r+ t+ ►+ C�ii p C�7� O O O � � �n r» t�n �» tss � y � �H � 6 � 0 Q x `� � � D � 1'� � -� m � n 2 m C r m O � Q � � � � � � a � � '� � � eT � � � � g � � � I .x, . � w � bd � p. p, � � m �� � p � � p � � I ` � � � � � 8� �� � m �. � � � b�i � QQ � � ., "' bd �o q m `� � � � � �� � o '� � � a � � e o � � r � � � e WATER aosErS URINALS �TM rues BAAS11�6 SiNKS wasH TH11Y5 DRINK. FOUNT. SH1NR5. FLOOR ow►iNs U� BASINS �uro WASHER �� APPL GAS RANGE GAS OPENINGS a • z • N D m A m n p aa� � ���� � � a� � y � � ���� � � � � � �• Y � ��a�� ��� � � � � � �a � ��M Ti � b ��� ���� p �y m o � p„ o p �' o � � � p w � � Q'� �y �. �`��y ���� m �oo �p.a' .. � p5�' x I y� p M � 3 `� w � � o' N � � A � � � ro a0 �� C� �°n p � M � �� � � � � � 0• � i � � � � � �� �� 1� r d O. �- o m � � � � M � � � �. ' > O w N � A Gb �• r�. A V _ o f � �� �� M � � a � x I < � O c�i x � N � � � w � p � � � �7 r t� Y � � Y y x x � N � .h�d 'y' '�' n w b0 �-"ji H y� w R. � w 7 O'" ''" M v' R: w 7. t+l xw � � O d d � � �d ���� � �� � '� �1 y � n p � � V� O , �eJ � � � O � y O O n'� O iA O �' � a, � � � : : --•y : : � : : : : � : o � � � m �a �e � o : � N .. � °o 0 0 � o �, � �, � �, o ( \r \ Z � � � r � � � z z m m D D � � m � � m � G) C] ❑ 'd w ',C � � � d � � b � O Nn � � [�] 'J � rp � � � � f! M . p. a � � z m � �� � � � � � �� °� � > � � ;� a � � � o � � b O r bd � M C. � � I w W w� � � � x � o �. �o �� m m . m � �. m: � �: �. w w p' �' ,a�'. a 00 � � � � � � x� �. � �� � � ►�i � m � �� � � o ���1j °7 �n' � � � ~ N � fD � � � v� p it° R° � � � � � �° y ���' � � � � �' °, � � �d � � O O � F � �y o `�'. t(� FA Q �. � � � � 0 � �� ��' : �� g� �,�� �o �, a � : � � o . : � c�n � ' 0 s� g $ ; ; o � ° � : : °° �� � �a . : : : � � � : : : � : : : : : � � N � � 0 0 0 0 0 f» �n tn rs r� H �� c�'o y � N �cp � I y 0 1 i- 8 � �� o � �o � �. � �" � b x M 0 � N � � N � 0 0 0 0 0 t�, v, b, a+ � O � a � z � ° � �C� � y � � � � W � g ro � �. � z O � m � 0 � � � � � � � � O "i tb � m � � � � b S m w � � � � y � !9 � � � R° R° � � � � o � � � � � ro � � �0 0 0 ���� �, � � o � : � m ��►:: �„ . . � o : : 0 0 . . o . . $ : : : N � � � � 0 0 0 0 � � � O t' � � b f� R. O+ n �C mGK°•� °M ���� � �, � _ � �� � a w � M �C Of�D C�l� �• y d�� �� �b � �� ° � � p p �'C �� y ��O'! � m bd�'c� '� � � w w�i� wy�� p� �� � �'tW�� �� �o H ���w �� �� a� �.� a��� �yI�DM :���� ��o �. �. �� .,, cr � S� 5' D �"' � � � m � 2 m C m d 'd M � � C1' � b ' A � � ' O ,� '0 -o. � � � O � � �o O � d � O� � ;� _ � � .�� � O' � � 0 � o. =o v� �• �. � �Gi 0 � 7v � � �' D 0. � `" � � � 0 City of Fridley, Mi.nn. BUILDING PERMIT .: � .,. �: Sheldon Stoeckel B„�� Samg ��� (Z2 0 K i mh a 11 S t N � Address � - -- - ����� N° 10456 LOCATION OF BUILDING No. 6 2 0 s�t K i.mb a 11, S t L�_�_ Part of Lot LOC�i S 4�_7 B10Ck p Addition or Sub-DIViSfOII A� �Tpr�ri a� H81,�},j,rS Corner Lot _ Inside Lot Setback � Sideyard 5ewer IIevat3on Foundat3on IIevai3on DESCRIPTION OF BUILDING To be Used as: C�,�.g,�— Front � Depth � Height —.1.� Sq. FL _-�2..�- Cu. Ft S � R 0 Front Depth FTeight Sq. F't. Cu. Fk Z�,ie of Construction F r am@ Est, Cost —�.r 0 0 Q...OSL_ To be Completed 1/4t' per foot elevation over �urb £ox drainage. Hard-surfaced driveway reauired. In consideration oE the fssuance to me of a permft to construct the building descrlbed above, I agree to do the ProPosed work in accordance with the description above forth and in comp wi�rovisions oP ordinancea oP the dty oP Fri�ey. � � ° �� In c�afderation oP the payment of a fee of $�Sl.Q�-, permit fs hereby granted to Sh .1 on S'� A.e �� e 1 to construct the building or addition as deacribed above. This �rmit ie granted upon the expresa condition that the person to whom ft is granted and his agents, employees and worl�en, in all work done in, around aad upon eaid building, or any gart thereof, shall conform in all respects to the orainances oi Fridley� Minnesota regarding location, construct�on, atteration, maintenance, repair and moving of bufldings within the dty ]imits and this permit may be revoked at aqy time upon violation oE any of the provlaions oP said ordivancee. � �� �, Nonc� 1 Tl�s psrmit does eof eava f6s eomlrucHoe, testatlatioe to� wUtae, plumbtee, Ba 6e�ine, sswu er watsr. B� an to � �6a BuiWlue Inipxtoe for aparaf� parm(fs for tha� Ihma. � : � APPLICATION FOR BUILDING PERMIT CITY OF FRLDLEY, MINNESOTA OWN�'c'S NAME �� � �� � IV J�J �Cl�� � BUTLDER � ��- � ADDRffiS ��� � � n% � - ADDRF�SS S A— � 'C LOCATION OF BIIILDING xo .��- a sTx�r l�/ �iL-� �-l/ S T- ��LOT�� � BLOCK r 9DDITION OR SIIBDIVISION �/ � �_ � �L % � CORNER LOT INSIDE LOT�+SE1.'BACK SIDEYARD .3 / SEWII� ELEVATION TOP OF FOOTING Appliaaut attach to thia form Two Certificates of Survey of Lot and proposed building location drawn on these Certificatea. DESCRIPTION OF BIIILDING To Be IIsed ge: G��- Front v� i" Depth �- Z Height 1� . Squaxe feet ��� Cubic Feet ,� v2 � o Front Depth Height Squaxe feet Cubic Feet Type of Conatruction � Estimated Cost �/ �� � To Be Completed %-�� �1 � � �� The undersigned hereby makea application for a permit for the work herein epecified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and ruli.ngs of the Department of Buildings, and hereby declares that all the facts and repreaentations etated in this application are true and correcte / •�� DATE ! � '� �� �� SiGNgTURE i' w (Schedule of Fee Costs can be found on the Reverae Side.) y� �� -� . , � ���� � , �._ �� , ,�3 `� .� �,� � � - �' '� � � � , . . �, t��,�, �; �' �; } _�' •=� � ��"- � __ �� �, f"� c� ����� � %�� %� i�%S .� �� r_� y BIIILDING PERMIT�FEE SCHEDIILE SECTION 2. The Inapector of Buildi.nga shall, before ieauing germits for the erection of any building or structure, or for any �ddition to any �xiating structure or building,.or for any alteration or repaire to an.y egieting building or structure, upo.n application therefore, require the payment by the applicant for such permit of feea to the amount he�ein below set forth and in the manner herein provided to-wit: IIniform BuildinA' Codes Type 19 29 8e 4-�1e75 for each one thousand cubic feet, or fraction thereof, in such cubical c.nntents. Type 3& 5- �1e50 for each one thousand cubic feete For the purpose of computirt� fees for building permits, the cubical contents of any 'build.i.ng'ag�addition to a uniform heigirt �throughout �by multiplying the ground area covered from a poi.nt siu (6) inches below the floor line of the baaement or the cellar to the average height.of the upper surface or to the avera.�e hei�ht of the roof eurface of the main gable of a pitched roof. For repaira or alterations to an existing atructure, the fee shall be at the rate of $3.00 per each five hundred dollaxs ($500.00) or fraction thereof in the cost of all proposed work. In no case shall the fee chax�ed for arsy permit ae set forth in Section 2 be lese than $5.00. NSSSD Connection Chax�ea based on loeation - Area 1 or 2. � r�"1 y. �yH•_ . .:.-..... -,...,. ...r . . .�..�,;. ....._.�.��.. m.._. . n�-�.v. �._ . -�.� . +� � � . . . ...: . • "'.... ..,. ..�: - .- ... ;r�- . .... ... � .i..r..;. . .. . w_ . .. . .. .. .,.^r: -. . - . r�' "^ __ —_—_--._. . + CJ��. ��. �-,�. � d ' t � y � � �� ��� 1� �� -w-jb{'I , �, � �- . 6 ��i{ 11 t� � �a� � �- r ,� � ,� �-• � ��t��. � -1 :��idJ�i�.�'�.��.`��� ��L���,. Telenhc:�e�•.21-6340 ' c ; g'� F"' f � _ �,� L �i �� D rJ U `t'Z V � 4° � � J � �'N_a,� � � , /� f� �� - q r, � An,,��;p, hlir.r��sota C�i�i1�I�AT� OF S�!;�l�F o': 2Z'�3.�i1 iLII7C� � �4' , � f3�j�,.i?l4�� � r/1 � � � � ` "---��� . ��� � � \ __- .� �,o . �, � � � �, �� � �� ,---�-�' ► '`; ��'7, � � � � fl � `� � �� � � '; � � 1, � � �' � , �i�i ' � i; ', '� '� ; � n.�, C? , i� . �� ��/�� � ;� : ';',� 6�, � � � C) D�t.s OT'ES ti . �j. �, ; y, . ,' ,�� � � 1►z�r1s _ `� %�a,.o; �; / � v `�� / ��°---� � �' � . �5� � � p���1� •GE � �,,�". �j �,�LY �� ���j-oT � � �Z.� � '.� U � � � % ,���� �—� . ,, � � � , �v � _� � � � % .� S � � � � ' �� � • ��� Z � K � �`�� _ 1;� �� d'� � 1 � \ Z� ��� G, � / �, � � `„ � ' dJ �t�, 3'� ` ��4.1 �.t.t�D ��J � �� � �( :f--, � � rt i t�� �� � �.` . � G� � L � t s � r � s � � : + -, :< : •, , ' � � �` � _ «-. .�...�--. _ - a..s, s- _ �. . . r �. .� i "� .' a RT;:...�:r::�:e ._.� _..�, /�`,� _ �" �'_ ��� � � . �,.� _ tl:l`'1F<�1 �,?`.7:? �J � ,�x>'�f 3:.:..s I HE2E9Y tERTIFY TNA: THI5 IS A 7FUE ANU COf?BEC� R�P�'K5c!:�4; `•+ '?F A SUA.`:EY OF 7HE BO'�rdpa=JE� C�F 7H" ABOVE DFSCY.lBED LAND, G.ND THF LCCATIOti OP Atl 2U'iG:iv��5, TH:'c�CN, A.ND s:C v:ji':E _'1Ci!?�CHtitENiS. je v, ,n pg � 4 . :.N. FRJ O.� S:.ID LAND. . .- . r t 6'� ;. ° •_'';]'_::'" . AS .`�URrEY�`J BY M.E iH�= ....+..:U4Y GP .` ................... ........... ... A.G. 19 V'' ' N. C. HO:U:.1 AN� �5':,r'_'A��:S, �t?�. CAN� �J^"EYC�F,S /—� " r—i - 'iT �.�v � V ix'� u���� �a� sr� �zu.��. �iuE .zo� p�bt�q� aaJ v�c� � ii��s asea o,� ��.�F���S . . � . . ►p ___ ° Z •StTc9Pn t9�sc,c?n-�.-? TTn ..� _ `4T �• Building MECHANICAI. Inspections RES�ENT�L APPLICATION 763-572-3604 CITY OF FRIDLEY 763-502-4977 FAX EFFECTIVE 1-1-2010 DATE C� - a 0- I � YOUR E-MA1L ADDRESS SITE ADDRESS _ THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR 0 OWNER .�nnxESS: 6�-° � �� b�,l l S� PHONE: ��.� , 7�6 > 3 3 Q 6 COMPANY �t� �l No.. � �_�� Date Rec'd: -r� � �� � � STATE �� ZIP•SJ ��? i SUBNIIT A COPY OF CONTACT PERSON: D_ In ✓�.1 V c/�_w�no YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH pDDRESS: �d °10 P1 p� �..� �- ti� CITY F�2 r A� l sTA� hc-� � SJ � 3 i APPLICATION pHONE % 63 -�S� - r� l� Pj FAX pERNIIT •I•YPE �'SINGLE FANIILY ❑ TWO FAMII,Y �rE oF woRx: I °1�`' ��Pi.p,�"�r"' DETAILED DESCRII'TION OF WORK ..._L✓►:,� A( ❑ TOWNHOUSE ❑ ALTERATION/REMODEL �Q ec�'t�1 �l.��r�A�z. FEES ARE BASED ON $10.00 PIIt FIICTURE, EXCEPT WS�RE NOTED. FIItTURES: (INDICATE TOTAL NUMBER OF EACH BELOVf� PROVIDE HEAT LOSS CAI.C'S PER MANU J 2006 ASH1tAE HANDBOOK. Equip,nent Installed MFG: r A MODEL: �SS (� RJ U 4�0� � SIZEBTU �O U� MFG: MODEL: SIZEBTU MFG: MODEL: SIZEBTU A/C $25.00 _FIItEPLACE (GAS) $15.00 _GAS RANGF/OVEN $10.00 AIIt TO AIIt EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 BOILER $35.00 �FURNACE $35.00 _GAS UNTT HTR $10.00 _CiIDVINEY LINER $10.00 _GAS DRYER $10.00 POOL HEATIIt $35.00 DUCT WORK $10.00 GAS PIPING $10.00 VENTII,ATOR $15.00 THIS IS AN APPLICATION FOR A PIItMIT-NOT VALID UNTII. PROCESSED I hereby apply for a building permit 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 Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT � � 'r � J 1 �- ��I� PRINT NAME �° �.a /`( � I%� v )O� DATE � - a � - r �y APPROVAL INSPECTORS SIGNATURE DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977