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PRE 2010 DOCSCity of Fridley, Alinn. BUIELDING PERMIT N° 5 4 8� Date: Owner: '� Builder Ad Address LOTION F BUILDING No. Street _ ` Part Lot Lot _ 81ock _ Addition or Sub -Division. _ Corner Lot ____ Inside Lot Setback —__ Sideyard Sewer Elevation Foundation Elevation — DESCRIPTION OF BUILDING To *am_S*V_Front �� Depth , Height Sq. Ft Cu.Ftl�^!Front'' Depth Height Sq. Ft. Cu. Ft e Type oEst!k ___ To be Completed _ In 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 afl provisions of ordinances of the city of Fridley. A. In consideration of the payment of a fee of $ 9 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 whom it is granted and his agenic, employees and workmen, in all work done fn, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of w i Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings city limits and this permit may be revoke at any time upon violation s�E any of the provisions of said NOTICE: This permit does not cover the Construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. 4 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner's Name Builder Address JO A A) �*. 84- / LOCATION OF BUILDING to Z No. Street ,og-le Z44!ec-- Part of Lot Lot Block Addition or Subdivisio Corner Lot +Inside Lot Setback Side -Yard_ SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. To be sed as: .6S L 1 DESCRIPTION OF BUILDING Sq. Ft. /G/ X Cu. Ft. I' Front depth Height Sq. Ft. i��► Cu. Ft. Type of Constructions _ Estimated Cost ed To be Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and re ntations stated in this appdZiacat�ion are true and correct. DATE SIGNATURE QMge— (A Schedule .",W can be found on the AppIlication for Power Plants and Heating. Coolling. Ventilation Refrigeration tind Air Conditioning System and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU 4-7470 GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ ✓s each add. 60,000 BTU .... . .................. 2.00 $ Replacement of Furnace ............................. §.00 $ Repairs & Alterations—up to $500.00 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam:...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal, per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ c" Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $$-�—*—'� ALTERATIONS & REPAIRS TOTAL FEE °1 ROUGH FINAL City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. rods -q , Minn- r / �L 19 (p1 Owner Kind of Used as To be completed about Estimated Cost, Old New. u�lding Permit No. �\ �` �S Permit No. Z76 v DESCRIPTION OF WORK HEATING or pq�m PL .47S—Ste Hot Wa Warm Air No Trade Name��'t -Q� �' P -c��- Size No . Capacity Sq. Ft. E.D.R �r `�� BTU H.P. Total Connected Load J-0 Kind of Fue BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R I BTU H.P. (REMARKS -OVER) SiY N- WFI TER HEATING (yQ . By 4637 CHICAGO AVE. MINNEAPOLIS 7. MINNESOTA -M4M -s9 Business Phone No- City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone SII 4-1 DESCRIPTION OF WORK ` Number, Kind and Location of Fixtures Locat"on / PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Zz O ;gz az oL �U' �U' 00 z 0 • F • N WATER HTR. GAS ELEG 4° 3 U x 3.25 a Water Heater (Up to 200,000 BTU) ...... o N LL S< 3 $ O NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ Base 1st r 2nd _ 3rd 4th • Future Connection Openings Connected with Sewer I * New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL 6. &F-0. Number Fixtures...... ........ ....... x $1.50 $1 Future Fixture Opening x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ...... ..................... x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE City of Fridley: a The undersigned hereby .makes application for a permit for the work here! specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application ! true and correct. Minn 19 �DOwner az4z of Building Used as -fig To be completed about — Estimated Cost, $ Old—New. Building Permit ROUGH --" FINAL 42 2M By-,-L� Business Phone No. of Make OHemal PERMIT for Power P ants and Heating. Cool- ing Ventilation, Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK Plants to be nstalle tered—repaired Oil fired—; Coal fired ; Gas fired t� ; Gas Authorization No. Remarks Approved Final Inspection 19_ Inspector Pennit N° 4643 Fee $ �® Office of the Inspector of Buildings City of Fridley City of Fridley, Minn. A e7 , 19-Ikt Owner 6LJ9ERT- R0 6ERG 1, Location `7'` .?l IV E Lyeid.- l.AtJ F Kind of Building How OccupC, Work to be Commenced—, 19 To be Completed 19-" Estimated Cost, $ ®New, Building Permit No. Permission is hereby granted to to install—erect—use the material and devices described in the above statement. This permit is granted upon t1W express condition that the son to whom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices Nrein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the specifications set forth in the approved application for this permit on file in the office of the Inspector of Buildings. � a.-(rp LA:APy/•� ��.= �! � ,Inspector of Buildings 42 2M 11-67 V Appkvftn dor Power PI=ft and Heat% Cooling, VeoffationR Reffigendion and Air Conditioning Srstettts and Devices PARTIAL RATE SCHEDULE ' rvRAVITY WARM AIR: RATE TOTM, Furnace Shell & Duct Work .......................... $10.00 f Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $300.00 ................. 6.00 $ Repairs & Alterations each add. $300.00 ............... 3.00 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60.000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ............. .. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam .... .$10.00 $ Furnace Shell & Line—to 640 sq. ft. IDR Hot Water .. 10.00 $ Each add. 200 sq. fi. EDR Steam ...................... 3.00 $ Each add. 320 sq. ft. IDR Hot Water . ........ ... 3.00 $ OIL BURNER --to 3 gal. per hour ... `... ... .. 6.00 $ over 3 gal. per hour --.See Fee Schedule GAS BURNER (up to 198,000 BTL) ........................ 8.04 f over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x$ 2.00 $ Additional Fixtures x .78 $ Gas Range to 199,004 ........... x$'8A0 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL— � — 51—Y�G-- See Fee Sehatnb TOTAL FEE $ nwnti of aldna_ Pknnw 98 -um City of Fridley: The undersigned hereby makes application for a permit for the work hereft specified, agreeing to do all work in strict accordance with the City Ordinance. and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true d correct. Fridley, Minn-- Kind of Building Used as To be completed about I "4i 46 Estimated Cost, $ Old New. Building Permit No. Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected LoaF:ind of Fue BURNER -- Trade Nam Size No. Capadty,L 64�=— Sq. Ft. E.D.R- ' BTU HF (REMURKs-OVER) CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, -COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work $12.00 $ Replacement of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $ Repairs & Alterations each add. $500.00 4.00 $ MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU $12.00 each add. 50,000 BTU 4.00 Replacement of Furnace 7.00 Repairs & Alterations -up to $500.00 7.00 Repairs & Alterations each add. $500.00 4.00 STEAM OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU $12.00 each addn. 50,000 BTU 4.00 Boiler only up to 100,000 BTU 7.00 each addn. 50,000 BTU 6.00 OIL BURNER- to 3 gal. per hour $10.00 each add. 3 gal. per hour 10.00 GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 (over 199,999 BTU see Fee Schedule) GAS FITTING FEES: 1st 3 Fixtures x $ 3.00 Additional Fixtures x $ 1.00 Gas Range to 199,000 BTU x $10.00 AIR CONDITIONING 2 FAN HEATING SYSTEMS See Fee Schedule VENTILATING SYSTEMS `` ALTERATIONS $ REPAIRS State Surcharge TOTAL FEE ROUGH INSP. REINSPECTION FEE Date C$10.00) FINAL INSP. APPROVAL FOR PERMIT _ &_ MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 C Job Address 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, Minn. , 1977 OWNER KIND OF BUILDING USED AS TO BE COMPLETED ABOUT �0 - ESTIMATED COST ;? - d Q OLD - NEW BUILDING PERMIT NO. PERMIT NO. 1p 7 DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company c Signed By'� /Jil 1,G, j oGG/ u1�CJ Tel. No. :5-7-1 SUBJECT PE City of Fridley 19 2 2 2 AT THE TOP OF THE TWINS BUILDING PERMIT r 411 CE . COMMUNITY DEVELOPMENT DIV. r , PROTECTIVE INSPECTION SEC. i � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 110/2/87 10B ADDRESS 7431 Lyric Lane N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 28 3 Melody Manor Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mr. Al Roberge 7431 Lyric Lane N. E. 784-4488 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Minnesota Exteriors Highway #55, Hamel, MN 55340 487-6001 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION 1 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Soffit/Fascia/Gutters 9 CHANGE OF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED 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 SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 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 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 $2,867 $1.43 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 P OVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- OR TH FORMANCE OF CONSTRUCTION. $38.50 LAN CHECK FEE TOTAL FEE ° Q � 7_ VIOGNATURE $39.93 OF CONTRACTOR RA THORIZED AG NT (DATE) HEN PROPERLY A I ATpED THIS IS YOUR P RMIT r BLDGY INSP K [/'l/'Jp DATE SiGNATURE OF OWNER OF OWNER BUILDER) IDATEI NEW [ ] City of Fridley Effective 4/1/86 ADDN. [ ] �R-1 AND R-2 I ALTER. [ ] Building Permit Application n_ ..... �- ....... 4 4 .. v. AAA - c a • '7c/3/ `- &/ ,eC. 41-1V � 13 K0C /C ,�� �e /c� / ( 19No,2 Legal Description: 41 Owner Name & Address: _ �� L o` b e aE'� — `��' t Tel. # �/`f�d' Contractor: f�/U X�e/� v �-f Tel. # 7d-6 ouJ Address: /-Ao 6 Attach to lot, with this application, a Certificate of Survey the proposed construction drawn on it to of the scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: J a ��Q •qSc�^r� �a mases Corner Lot [ ] Inside Lot [ ] Type of Construction: Approx. Completion Date: Ft. Yd. Setback Side Yard Setback 6' Estimated Cost: $ 02 67. D o Proposed Driveway Width If New Opening Is Desired: Alt. A Alt B See Back Page for Explanation DATE: e" ®"2-? % APPLICAN r Tel. CITY USE ONLY CJ Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge Q� STIPULATIONS: Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $ 525 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 'av .�- N - `/J . . s SUBJECT City of Fridley F'20098 AT THE TOP OF THE TWINS BUILDING PERMIT r � R COMMUNITY DEVELOPMENT DIV. INSPECTION r PROTECTIVE SEC. 1 � = CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 9/5/89 JOB ADDRESS 7431 Lyric Lane N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 28 3 Melody Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Al Roberge 7431 LyricLane N.E. 784-4488 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Byers Construction 8695 Nashua. Avenue, Elk River, MN 441-0860 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling (26 Squares) 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be 2nd layer but not 3rd. Install ridged Zgalvanized valleys. On all n^w r^nfs or tear-C'fs and raplarerrent roofs. State Code requires that 2 I.yers of 15 I:). felt, mopped together, to installed to a point 24 inches up from exterior wall line, or the use of otA4r_ approved underlayment membrane. SEPARATE PERMITS ARE REQUIRED 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 SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK 15 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 $1,300 $.65 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- $31.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. LAN CHECK FEE TOTALFEE C?���•-�� $31.65 SIGNATURE OF CONTRACTDO OR AUTHORIZED AGENT IDATEI WHEN PROPERLY V DATED THIP IS YOUR PERMIT BLDG INSP Al,9 �- SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI AT NEW [ ] ADDN [ ] ALTER [ ] R-1 AND R-2 Building d; n Piermit Application Construction Address: 7V31 Legal Description: Effective 5/1/88 Owner Name & Address: /�Z �oi�'�� Tel. Contractor: _ Zpe554S Tel. Address: _ �� �s� A�/S~,i� � �/.�' .�. ve*e- Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DFSQCM" OF inavrvEMM LTVnfG AM: Length Width Height Sq. Ft. G RAGE AM: Iexxjth Width Height Sq. Ft. DECK AMM: length Width �---� Hgt/Grotmo Sq. Ft. 07HER: �iG- �Oe1� i ll, / � N /� 4 Corner Lot [ ] Inside lot] Ft. Yd Setback Side Yard Setbacks lYie of Construction: z Estimated Cost: $_ Approx. CCUPletion Date: Proposed Driveway Width If New Opening Is Desired: Ft. $ $ -S Width + 6' See Back Page ME:APPUCAM. Tel. # 41 L d Permit Fee $ --3-J , Q State surge SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ CL'PY UBE OI�II�Y Fee Schedule on Reverse Side $.50/$1,000 valuation $575 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined byi rwari � ry [ ] Not Necessary C ] 4 14waT CITY OF FRIDLEY INSPECTION DIV, Effective On January 1, 1993 6431 University Ave NE Frldley MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 672-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Residential Furnace Shell and Duct Work, Burner — Also Replacement Furnace Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning — All Sizes � JI Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1 % of Value of Appliance or Work Rate TOTAL Y► 20.00 $ $ 10.00 $ $ 10,00 $ $ 10.00 $ $ 10,00 $ $ State Surcharge X50 TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLINGN:=NTILATION REFRIGERATION/AIR CONDITIONING PERMIT 1S $15.00 PLUS THE $.50 SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed In a side yard vdthout written permission from adjoining property owner. JOB ADDRESS S/ L The undersigned hereby makes application for a permit for the work herein specified agreeing io do all work in strict accordance with the vity Codes and rulings of the Building Division, and hereby declares that all than facts and representations stated in this application are true and correct. /a_y_�,1993 BUILDING USED AS ESTIMATED COST ��,�� PERMIT NO. I/ No, of Heating Un Circle One (Steam) (Hot Water)(Warm Air Trade Named Size No. 1 STU__!a®Daa HP CDR Fuel Total Connected Load 61 Burner Trade Name Size No. BTU HP EDR HEATING COMPANY S EDG - " ICK 8910 WENTWORTH AVE. SO. Signed By MINNEAPOLIS, MN 5542gga0a, d M Approved Bough—In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE