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PRE 2010 DOCSCity of Fridley SUBJECT W71 '84 7 4 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO • COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 1/24/85 JOB ADDRESS 7630 Lakeside Road N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 18 1 Blomberg Estates SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Garjac Inc. 481 - 206th Avenue N.E., Cedar, MN 55011 434-7096 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK P NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK �! Construct a 38' x 24' Dwelling and a 25' x 20" Garage '0 ndml saljyptn leaol Iiia �ui��l�a ajol; 9 CHANGE OF USE FROM TO� H '.. Ea STIPULATIONS Provide City with copy of verifying survey before capping. Provide sod in the front and side yards. Provide a hard surfaced driveway. SEWER LOCATION: Approx. 10' S. of Water Service. M.H. Inv. 893.74 TOP OF FOOTING: 896.74 Minimum WATER LOCATION: 35' W. of M.H., 100' S.W. of Power Pole DRIVEWAY DEPRESSION COST: 16 + 6 = 22 x $13.50 = $297.00 THE CITY OF FRIDLEY DOES NOT GUARANTEE THE ACCURACY OF UTILITY LOCATIONS AND ELEVATIONS, SEPARATE PERMITS REQUIRED FOR THIS DATA IS FOR INFORMATION PURPOSES ONLY i`x.P' PLUMBING AND � AND PERSONS USING THIS INFORMATION SHOULD. VERIFY IT ON THE SITE. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG: UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS 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 $54,800 $27.40 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $298.00 $425.00 STRUCTIO R THE PERFORMANCE CONSTRUCTION. PLAN CHECK FEE TOTALFEE $7 50 $824.90 SIGNATURE OF CO TRACTOR OR AUT RIZED AGENTIDATEI EN PROP R I T D THIS IS YOUR PERMIT LOG INSP DATE SYGNATURE OF OWNER UFOWNER BUILDERI IDATEI I NEMC [/] ADDN. [ ] ALTER. [ ] Construction Add Legal Descriptio City of Fridley Effective 4/1/84 R-1 AND R-2 Building Permit Application Owner Name & Address: Tel. # Contractor:_ Q} RT P1 / N L Tel. # L/39 - -701t Address: Hj 1 z0[P 14y� N G P 0�1 mN �S� ► I -- LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length._ Length Length Width AJ Width 20 Width e Height Height q Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. _— Corner Lot [ ] Inside Lot [,� Ft. Yd. Setback 33- Side Yard Setback Type of Construction: F%��M-e Estimated Cost: $ y gc3c1 STIPULATIONS: Approx. Completion Date: 4 "Xe / 36 Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: ' $ ';A1.00 $ See Back Page for Explanation DATE: s_APPLICANT: C Tel. CITY USE ONLY Permit Fee Plan Check State Surcharge SAC Charge $ UU $'s® $ Bio $ Lia` • Park Fee $ Sewer Main Charge $ TOTAL $ STIPULATIONS: Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] ri Surveyors Certificate COMSTOCK & DAVIS, INC Consulbinig Engineers and Land Surveyors 1446 County Road J, Minneapol.6, MN 53432, (612) 784-9346 f14E fff-V ff FRIDLEY DOES NOT GUARANTEE THE A@9041 OF UTILITY LOCATIONS AND ELEVATIONS. THM DATA Is FOR INFORMATION PURPOSES ONLY, AND PERSONS USING THIS INFORMATION SHOULD SCAM: 1" 40 VERIFY IT ON THE SITE. 0 Denotes 1/2" diameter iron vine monument set and canned No. 10832. I hereby certify that this survey, plan or report was prepared by me or under my direct supervision and that I am a duly Registered Land Surveyor under the laws of the State of Minnesota. 10832 -W, 1980 4278 9 Keg. No, bate job No. Book Na 77:11 7,J j SURVEY FOR: [-QUIP B & G Investments C 10 AL AND 961 Hillwind Road DR E W Ay opr �4 Fridley, Minnesota 55432 L 33' 510 oil 091, O alo F 0 to, 0 ta 0-41 10 -S of 09" x .33' L41 DESCRIPTION Lot 18, Block 1, Blomberg Estates, City of Fridley, Anoka County, Minnesota. f14E fff-V ff FRIDLEY DOES NOT GUARANTEE THE A@9041 OF UTILITY LOCATIONS AND ELEVATIONS. THM DATA Is FOR INFORMATION PURPOSES ONLY, AND PERSONS USING THIS INFORMATION SHOULD SCAM: 1" 40 VERIFY IT ON THE SITE. 0 Denotes 1/2" diameter iron vine monument set and canned No. 10832. I hereby certify that this survey, plan or report was prepared by me or under my direct supervision and that I am a duly Registered Land Surveyor under the laws of the State of Minnesota. 10832 -W, 1980 4278 9 Keg. No, bate job No. Book Na s4wze Apflic�)Ik, / 0 .1 4"//, _Zvt/. T4 -T 4;::7F 35' � 7-171 F;�7- / AJ 6- w /9 loov � 014 CP-�) -------------------- r. W4 �, . o of ,V,�y /Uoc A)eG,03 CITYOF FRIDLEY CIVIC CENTER • 6431 UNIVERSITY AVE. N.E., FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450 April 24, 1985 Mr. Gary D'Aigle Garjac Inc. 481 - 206th Avenue N.E. Cedar, MN 55011 Re: Final Inspection at 7630 Lakeside Road N.E. Dear Mr. D'Aigle: A final inspection was conducted on April 22, 1985 of the above address and the following items were noted which must be completed before the structure can be finaled out: 1. Provide sod in the front and side yards by June 1, 19B5. 2. Provide a hard surface driveway by June 1, 1985. 3. Provide the City with a copy of the verifying survey by May 1, 1985. 4. Secure the patio door so that it will not open more than 6 inches by May 1, 1985. 5. Complete the firewall in the garage by May 1, 1985. We will expect the above items to be completed by the scheduled dates when reinspections will be made to determine compliance. If you have any questions on these items, please feel free to contact me at 571-3450. Sincerely, ("J(Wz'-� DARREL G. CLARK Chief Building Official DGC/mh CITY OF FRIDLEY APPLICATION FOR PWMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer NO. 9 RATE S 5.00 S 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance Reinspection Pee $ State Surcharge ($15.00) TOTAL FEE TOTAL $ -3.9.00 $ /b.sZ) Ettective Aug. 1, iytll Sl')t-- -4 Job Address �(�_ 0 1 a e Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. J Zi /" , jg� OWNER C KIND OF BUILDING USED AS R �- S TO BE COMPLETED ABOUT ESTIMATED COST / / OLD - NEW BUILDING PERMIT NO. PERMIT NO.r� Company S / A Af zvc c f Signed ey Tel No. ROUGH INSP. Date N m FINAL INSP. �" t'LK�I -- eM U Date APPROVAL FOR PERMIT t x e Water q e O N w w d` Heater 4 l� ..1 Y F .9 v o U3 o W wC u ig 3 O lec to o� o� wo 40 t3 t� ff t let 2nd 3rd 4th (R) a Future Connection Opening Connected with Sewer (�) a New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer NO. 9 RATE S 5.00 S 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance Reinspection Pee $ State Surcharge ($15.00) TOTAL FEE TOTAL $ -3.9.00 $ /b.sZ) Ettective Aug. 1, iytll Sl')t-- -4 Job Address �(�_ 0 1 a e Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. J Zi /" , jg� OWNER C KIND OF BUILDING USED AS R �- S TO BE COMPLETED ABOUT ESTIMATED COST / / OLD - NEW BUILDING PERMIT NO. PERMIT NO.r� Company S / A Af zvc c f Signed ey Tel No. ROUGH INSP. Date FINAL INSP. �" t'LK�I -- Date APPROVAL FOR PERMIT t MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2000 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES - PLUS THE $.50 STATE SURCHARGE-.- Signed TEL # REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without Approved By Rough -In Date Final Date written permission from adjoining property owner. JV JOB ADDRESS JT��P RATE SCHEDULE OWNER Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED AS __&,;gYZ6,d�� Also Replacement Furnace $ 30.00 (Side Vent - Fill Out Back) $ ESTIMATED COST a4 PERMIT N0. Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Gas Dryer $ 10.00 $ Trade Name Size No. BTU HP EDR *Air Conditioning - All Sizes $ 25.00 $ Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial /Industrial 1.25% of Value of Appliance or WorYC $ The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes an State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and AS representations stated in this application are true and correct. TOTAL FEE DATE MINIMUM FEE FOR ANY HEATING/COOLING/VE , S� HEATING CO �NTON PLUS THE $.50 STATE SURCHARGE-.- Signed TEL # REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without Approved By Rough -In Date Final Date written permission from adjoining property owner. JV COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes O No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( )No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches i Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date : P.M SUBJECT IT NO. city of Fridley31363 AT THE TOP OF THE TWINS BUILDING P E R M I T r ` ____�_ COMMUNITY DEVELOPMENT DIV. - INSPECTION SEC. f PROTECTIVE 1 � � l A '�';,� CITY HALL FRIDLEY 55432 REV DATE PAGE OF APPROVED BY -_-• L J` 612-571-3450 rMOER 9t0-Ft5 I 9/5/00 / / JOB ADDRESS 7630 Lakeside Road NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 18 1 Blomberg Estates SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Pat Barret 7630 Lakeside Road NE 763-795-8992 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO A E Wallen Homes Inc. 4571 North Rd, Circle Pines, MN 55014 763-780-8812 1950 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW 7 ADDITION jJ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Construct a 14' x 16' Addition; an 8' x 6' Deck; Kitchen alterations; Replace windows Remove existing 8' x 6' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. "I' m G SEPARATE PERMITS REQUIRED FOR: Before digging call for WIRING, HEATING, all utility locations PLUMBING AND SIGNS 4540002 REQUIRED BY LAW SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING 1 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 SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $60'000 $30.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF Y OTHE ST TE OR LOCAL LAW REGULATING CON- S RUCTION @ Fire SC $60.00 RF E OF CONSTRUCTION $713.75 PLAN CHE TOFEE .Licen $5 08. 75 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IOATEI EN RO E ALIO THIS IS PE MIT _ S�GNA TUBE OF OW NERof OWNER BUILDER IDATEI' Bl IN50 F1AIL P.M NEW [ ] Effective 1/ ADDR [ ] CITY OF FRIDLEY (763)572-3 dg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �j BUILDING PERMIT APPLICATION Construction Address: ;7,6 36 T1 /a Legal Description: L;T fg I scinnk l Owner Name & Address: ?A�L Lj- Contractor: A -P-, MN L Address: &,4-o GUd� 1 l� &,4-o CtXce.e- a l e-3 mks" S --Ur Y Attach to this application, a Certificate of Survey c lot, with the proposed construction drawn on it to DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height GARAGE AREA: Length _ Width Height DECK AREA: Length _ Width L Hgt/Ground OTHER: le-- (—'C f+e�v 'Z l �d Construction Type: 1770 X/ Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $, —Z Z `-0d APPLICANT: / SATE: / �� CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in applica Permit Fee Fee Schedule on Reverse Sidi Fire Surcharge $ 6Q,00 .001 of Permit Valuation (1/1 State Surcharge $ 30,00 $.50/$1,000 Valuation SAC Charge $ $1100 per SAC Unit License Surcharge $S : 64 $5.00 (State Licensed Resider Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Re Park Fee $ Fee Determined by Engineedr Sewer Main Charge $ Agreement Necessary [ ] Not TOTAL $ STIPULATIONS: Tel. #763-7f -1 --Of ENSE # 19Z Tel.# 76Y- 7 - the the Sq. Ft 27- Y 1CV4"— Sq. Ft Sq. Ft 7K Tel. # lZ 38?�� Contractors) Surveyor's Certificate COMSTOCK 8t DAVIS, INC. Consulting Engin and Land &wveyon 1446 County Road J, Minneapolis, MN 33432, (612 7849346 SURVEY FOR: Gar -Jac Construction 481 206th Avenue NE. Cedar, Minnesota 55011 9 I t SCALE: O ... Denotes 1/2" diameter iron nine monument set and capped No. 10832. s cr l a P'` ^-r OF f3t_oNeVC RG sz cru s, Mer Fa.. Twt s 3%'Pmv¢r. I hereby certify that this survey, plan or report was prepared by me or under my direct supervision and that I am a duly Registered Land Surveyor under the laws of the State of Minnesota. 10832 - o�T. 16, 14e5 4830 9D Reg. No. Date Job No. Book No I 3.3' ale ols(Ndic ?.&.3o 100 O 10 N �>O.Se% 71 C tE S 84' or• Oq"' R — /36.88' A ,o L& zz-�tS'-r/ 3 U Lo NLS t r, •-, 33, C'3'1 DESCRIPTION Lot 13, Block 1, Blomberg Estates, City of Fridley, Anoka County, Minnesota. SCALE: O ... Denotes 1/2" diameter iron nine monument set and capped No. 10832. s cr l a P'` ^-r OF f3t_oNeVC RG sz cru s, Mer Fa.. Twt s 3%'Pmv¢r. I hereby certify that this survey, plan or report was prepared by me or under my direct supervision and that I am a duly Registered Land Surveyor under the laws of the State of Minnesota. 10832 - o�T. 16, 14e5 4830 9D Reg. No. Date Job No. Book No Building Inspections 7.63-572-3604 SITE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERN UT TYPE TYPE OF WORK: MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS 0 OWNER CONTRACTOR tvw►tIZ: Ly, ADDRESS: 2 3" PHONE' COMPANY NAME: CONTACT PERSON: _ db� e STATE LICENSE 'e;G' DATE _ A PHONE FAX ANGLE FAMILY O TVVO FAMILY ❑ TOWNHOUSE evf'kmw ❑ REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK F Permit No.. Received By: Tate Reed: STATE ZIP C. the PER MS 16B.665 the permit fee is a minimum of $15pfo�eo excluding ththe fixtures.UP to. $500.00, hould reflect only the cost rof labor improvement, installation or replacement of a residential X.05 Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor KATE TOTAL FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: ([ND6✓tAT NUMBER OF EACH BELOW) MODEL: Perms e X� SIZEBTU Equipment Installed MFG: { i et�1'�y SIZEIBTU _�— MFG: MODEL: __ SIZE/BTU MFG:MODEL: GAS RANGFJOVEN 510.00 �S FIREPL A/C 525.00 ACE (GAS) $15.00 NEW GAS GRILL $10.00 —AIR TO AIR E}CCHANGEER $15 FIREPLACE (WOOD) $35.00 _GAS UNIT HTR $10.00 —AIR IRE _FURNACE $35.00 POOL HEATER $35.00 —CHDANEY LINER $10.00 GAS DRYER $10.00 ,ATOR $1500 —DUCT WORK $10.00 GAS PIPING $10.00 �� ermit Fee $ Number of fixtures @ $10.00 �_ x $10.0 = t D P permitr e $ 50 Number of fixtures @ $15.00 1 x $15.00 = $ f-' g Number of fixtures @ $25.00 x $25.00 = $,__ $ TOTAL DUE Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in -Constructi t I s is conformance with the ordinances and codes of the City o Fsidley and not o startlth the withouMinnesota permthat the worCodes; be in accordance with the not a permit but only an application for a permit and work approved plan in the case of all work which requires review and approval of plans. d�ris �e DATE % y o = = PRINT NAME Lev t n SIGNATURE OF APPLICANT rz�- w.xr.assTgra.w sorati-ica-xm a�am.J.vv,.rra.�asr�u�nw.c.-a.waaeann�ri �a a�i�.h �mvravivassx�en City of Fridley Building Inspections Department . 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977