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