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PRE 2010 DOCSCity of Fridley, Minn.. BUILDING PERMIT Date: ..... ................................. ......... ..._ ............._............._- Owner: Address IeT° 4311 Builder ol",e_m ... „��� .i LOCATION OF BUILDING No. _........ Street .... .. V ........--------------- Part of Lot ....._.....------.._... .... -------------- _ Lot ...... .................... Block ----._.-...-------....._......._........ Addition or Sub -Division t� . ....................... �.._. Corner Lot .................................... Inside Lot .......................... Setback .........................------......--...... Sideyard ...�r......._....... ......................... .... _.......... Sewer Elevation To be Used as: . �..;............. Type of Construction Foundation Elevation DESCRIPTION OF BUILDING Front Depth�'�1.....'®� Height- .-: y Sq. Ft_ Cu. Ft. /- Front- - ............. Depth .............._.. Height ...................... Sq. Ft. _ ..................... Cu. Ft. ............................................................ Est. Coit....... T. ....�® _... 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 all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $.../...✓....... ........... I 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 agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Building Inspector 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. APPLICATION FOR BUILDING PERMIT --CITY OF FRIDLEY MINNESOTA owners. Name Builder der AZA, -JOA -1- a I Ad 6"* Address -3 LOCATION OF. BUILDING No. Street;: Fart t 0 f 4-6, t J Lot Block Addition or SaboDivs. ye, Porner Lot Inside Lot L' /�Set Back... Si"-Yaid SMR ELEVATION M ...10UNDATION ELEVATION. Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING Front Depth Height Sq.Ft. Cu 9 Ft., Front.- Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost, Tq.be,completed 6 Th4"Andersigned hereby makes application for a permit for the work herein specified., agi, . ing;.to..-do all-york in strict accordance with the City -Ordinances and ruling of the Department of Buildings, and hereby declarei that all the facts and representa- tions stated in this application are true and correct. SIGNATUAE DATA (A Schedule of Fee costs can be found on the Reverse Side.) q City of Fridley, Mian.. BUILDING PERMIT Date: _ June 27, 1967 Owner: _ Milalow Builder Address _5411 Madisonl`c. Address No. 5411 Lot ._._ 3 Corner Lot Sewer Elevation n Same Same "W-3 01-5 No 9339 LOCATION OF BUILDING Street Madison St. Part of Lot Block 2 Lyndale Blders 4th Addn. Inside Lot _ _ x Addition or Sub -Division .__ Setback --- Sideyard — Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Garage Front 24' Depth 26' Height 10' Sq. Ft. 6240 Cu. Ft. Front Depth Height Sq. Ft. — Cu. Ft. Type of Construction __ _ Frame Est. Cost __ 55 0.00 __ 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 all provisions of ordinances of the city of Fridley. I In consideration of the payment of a fee of E 9.00 , permit is hereby granted to JosepA Mi,lalow 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 asci his agents, employees and workmen, in aII work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota reg location, construction, alteration, maintenance, repair and moving of buildings within the city ]units ands permit may be revoked at any time upon violation of aay of the provisions of esaaiid ordinances. CLARENCE BELISLE Building tor NOTICE: This permit does not cover the construction, installatlon for whing, plumbing, gas heating, sewer or water. Be sure to sue the Building inspector for separate permits for these hems. AMLICA'_'Z.Mi FOR BUILDING T'� s tT CMI OF FrICK E-11, 1111 'NESGTA OWNER'S NAME Ll (Q w B3.; si DER ADDRESS SIS ��.e�ro o ADM, SS LOCATION OF BUILDING N0. 3f II _ STREETS S a Y1. PART OF LOT ti LOT 3 BLOCK 2 ADDITION OR SUBDIVISION e!�& ��C%a yadd CORNER LOT INSIDE LOT SETBACK IDE -YARD SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To Be Used Ad: DESCRIPTION OF BUILDING Front —Depth Height Sq. Ft. 1�,��/O Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. 5l%Oa_ Type of Construction Estimated Cost d 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 of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE SIGNATURE (Sch ule of ee Costs can be found on the verse Side). 7f" 4�C � City of Fridley App ication for Plumbing and Gas Fitting Penidt Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK 21 Number, Kind and Location of Fixtures Location PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: 3 x $1.50 $�' C� Number Fixtures ...................... Future Fixture Opening ................ p Z �0 Z i� w ? • • N WATER HTR. GAS ELEG C New Ground Run Old Bldg . ............ aj $ 3F o0 1st 3 Fixtures .......................... x $1.50 $--Z.- Additional Fixtures .................... Additional x .50 $ 0 F ¢ Base t 1st j ? 2nd _ 3rd _ 4th • Future Connection Openings I Connected with Sewer New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL x $1.50 $�' C� Number Fixtures ...................... 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) ...... Z_ x 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $--Z.- Additional Fixtures .................... Additional x .50 $ Gas Range to 200,000 BTU .............. x 2.00 ¢ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $Z ' 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 t e and correct. c // /1 ��ey, mina _ � . P, 19� Kind of Building Used as To be completed about — Estimated Cost, $ Old—New. Building Permit i ROUGH DEC 30 1960 FINAL 42 2M 749 By --J-64 CM Business Phone 1 SUBJECT PER O. City of Fridley C 18219 AT THE TOP OF THE TWINS BUILDING PERMIT _ r RECEI • ______ COMMUNITY DEVELOPMENT DIV. �' f PROTECTIVE INSPECTION SEC. /g 3 b 1 = � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY l 612-571-3450 910-F15 9/23/85 JOB ADDRESS 5411 Madison Street N.E. 1 LEGAL LOT N0. 3 BLOCK 2 TRACT OR ADDITION Lyndale Builders 4th SEE ATTACHED DESCR. SHEET 2 PROPERTY OWNER MAIL ADDRESS Joe Mihalow 5411 Madison Street N.E. ZIP PH E 5720 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. 6 USE OF BUILDING Presidential 7 CLASS OF WORK ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct an 18' x 9' Living Area Addition 9 CHANGE OF USE FROM TO STIPULATIONS Meet with contractor prior to commencement of any construction. Change walls to 2 x 6 studs. Provide fire wall at the existing common garage wall. WARNING Beforedi ging 0811 1ICaIGAS'tte, SEPARATE PERMITS REQ( IRR-- D FOR TELEPHONE WIRING, HEATING, PLUMBING Alin SIGNS, BY LAW 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 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 $7,150 $3'58 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- $68.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $17.13 $89.21 ATURE OF CONTRACTOR OR AUTHORIZED AGENT )DATE) 001, •_ WHEN PROPERL VALIDATED THIS IS YOUR PERMIT . SIGN URE OF OW ER(IF OWNER BUILDER) IDATEI BLDG INSP JATE 1 i `7 r/ i.. , ..! , HARVEY A. C E CM� G� & OLSOH ANOKA COUNTYY SURVEYS YS M[NN COUNTY SURVEYS LAND SURVEYORS MINNEAPOLIS SURVEYS 8410 PALM STREET N W REOISTRR[O UNDER LAWS OF STAT[ OF MINNESOTA SUN4ET 47655 LICENSED BY OROINANC9 Of CITY OF MINNEAPOLIS 1K NCR 326 PLYMOUTH BUILDING FEDERAL 8-8721 INDUSTRIAL - JUDICIAL HENNEPIN AT SIXTH • MINNEAPOLIS 3. MINNESOTA BUS'NESS - TOPOGRAPHICAL *urbepor's Certificate CITY LOTS - PLATTING i I 3S' COMBININGTHE RECORDS OF J. E. HILL. Civil. ENGINEER ESTABLIBNED /BN C. F. SANDHOFF CIVIL ENGINEER ESTABLISHED IBOB JAMES NELSON SURVEYOR ESTABLIDN90 1942 METROPOLITAN LAND SURVEYORS. L»ABLISNEO tP�I L©t 3 , t&Lor_K 2., Ly n,*A .e $ui. Iders qtH Addie, i on SIGNED F C. W HT AND OL LST wTE FOR JS2 &,D &?£� 3I 2ZUW 12 Ja ! & 2x10 JO ST 6 2 1- y. SIJ 6' Qa ill niuLT s�?ROCK (TAPE J I& rLIJRE) 0 a L,3-7. 700.00 Q :2 ZIG i3 wI 5 : OW Cz FOR <4)SIxo ELi�c , yIXTUarIs a,«,CO I L 3 eQa 2c'-L=�IJ &C 2 2 J Ea z22: � S,CO >wI�I e } oxo DLS 2aQk. 400.00 >a� ±S No STUCCO . £aCZ. /4)0.00 I ' SRL 5 � & 2 g } . ��2- NEW [ J ADDN. [ej ALTER. [ J Construction Address: Legal Description: Owner Name s Address: Contractor: Address: ✓`�/ < < City of Fridley R-1 AND R-2 Building Permit Application C Effective 4/1/84 Tel. # 5-7--A .� 3 0 Attach to this application, a Certificate of Survey of the lot, With the proposed construction drawn on it to 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: Corner Lot [ ] Inside Lot Ft. Ft. Yd. Setback Side Yard Setback Type of Construction: (Alt» T-A'01� Estimated Cost: $ Approx. Completion Date: .114s t' that' Proposed Driveway Width If New Opening Is Desired: Alt. A Alt B See Back Page for Explanation DATE: APPLICANT: Tel. # CITY USE ONLY Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge T STIPULATION Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering OTAL Agreement Necessary [ J Not Necessary [ ] 5 Cr S_ C-7) 0jM' -'J4 54tv J2 'Mie r SUBJEtY City of Fridley 30720 AT THE TOP OF THE TWINS BUILDING PERMIT r 1 v 6. .......COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r E CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 9t0-F15 3/13/00 JOB ADDRESS 5411 Madison Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 2 Lyndale Builders 4th Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Agnes Mihalow 5411 Madison Street NE 572-9230 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Advance Home Products 3770 West Broadway, Robbinsdale, MN 55422 521-9211 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 2332 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION Q REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Replace 6 windows; soffit/fascia' aluminum trim 9 CHANGEOFUSEFROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Replacement bedroom windows can not reduce the clear openable area to be less than what was existing or 5.7 square feet. Provide soffit ventilation to meet the State Building Code. 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 SO. 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 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 $2.90 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $5,800 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PR ISIO OF ANV O MER STATE OR LOCAL LAW REGULATING CON• Fre SC $5.80 S CTION R TME PE ORMANC OF CONSTRUCTION $125.25 PLAN CHECK ETO AL FEE /3 Li e C $ 0 $138.95 SIGNATURE OF CO ACTOR OR AUTHORIZED AGENT IDATEI H PRO Y VALI T THIS `��RMIT S-GNATURE OF OWNEROF OWNER BUILDERI IDATEI B Ipsp MATE/v^%�/) r NEW[ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY �O f ALTER ['�' SINGLE FAMILY AND DUPLEXES R-1 AND R-2 l� BUILDING PERMIT APPLICATION Construction Address: Sy/ f J"ja s m h 54. Legal Description: Description: Owner NamM&ess: _ & Tel. #5' 702 - 22 3a Contractor: v MN LICENSE # d 3 3,k Address: D - moa cvu �s �j Tel. # 5 d.L % l l Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EIAPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: . Construction Type: A,-, 1 >1s ., - Si��ws Estimated Cost: $ 5�?O 0- 0 D Driveway Curb Cut Width Needed: Ft. + 6 Ft = F x $ _ $ DATE: - ® U APPLICANT: Tel. # 5 d11- CITY USE ONLY Permit Fee $ ARS- oZ5�- Fee Schedule on Reverse Side Fire Surcharge $ s ey 0 .001 of Permit Valuation (1/10th%) State Surcharge $ a , q Q $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ 5; '-0 D $5.00 (State Licensed Residential Contractors) n Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ 132. STIPULATIONS: Building Permit Fee BUILDING Permit ROO Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604CITY $ .001 times the total job valuation OF FRIDLEY Dat o DATE s� •/ YOUR E-MAIL ADDRESS �1�19 $ / SITE ADDRESS g Ti 11 V7✓I*b i,5 dd Jr— iCA Ili $ THIS APPLICANT IS: ❑ OWNER CONTRACTOR $ PROPERTY OWNER/ NAME: $ $450 Conservation Plan Review ADDRESS: CITY STATE ZIP TENANT $ PHONE: Total Due $ CONTRACTOR NAME: 140 '�, T�jili/di4/�y cSmet STATE LICENSE # 2Q �c31f 75r' EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADD : /b 7d / ! AJ AWE, At CTFY��Z (,14 c-4 STATE`'ZIP SsJ"` WITH APPLICATION pH0 Ileo FAX /c l PROPERTY TYPE SING F Y/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE%EP ❑ REMODEL DESCRIBE WORK BEING DONE: 0 y SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARESO 'HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Frosting Floor Plan 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim I. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project - 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE CHEDULE) TOTAL JOB VALUATION $ y®� 8� OCCUPANCY TYPE Permit Fee $ ! 2s , ? See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ 141 .0005 x Permit Valuation Minimum $.50 License Surcharge $ 00 $5.00 (State Licensed Residential Contractors) SAC Charge $ �$1675 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ q-7, Make checks payable to: City of Fridley Attach Stipulations 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 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 wor�eq eview and approval of plans. SIGNATURE OF APPLICANT PRINT NAME >u DATE 2 Building Inspections 763-572-3604 763-502-4977 FAX DATE q . k 6 — ( O MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 2-19-09 YOUR E-MAjL ADDRESS Permit No.: Received By:— SITE ADDRESS SLA 1 t xA8 (SO V-\ zry I\7Cr THIS APPLICANT IS: ❑ OWNER 11CONTRACTOR PROPERTY NAME: 0.Y o h OWNER/ ADDRESS: O✓1 t N�' CITY STATEPNZIP SS/4;21 TENANT PHONE: a% U t 7— - (9 -6 Lo CONTRACTOR COMPANY NAME: CENTERPOINT ENERGY SUBMIT A COPY OF CONTACT PERSON: JOANN ZINKEN -2009 YOUR STATE STATE LICENSE # BOND 22013346 EXP DATE LICENSE WITH ADDRESs:9320 EVERGREEN BLVD NW SUITE B cITY COON RAPIDS STATE NZN ZIP 55433 APPLICATION PHONE 763-757-6202 FAX 763-757-6701 PERMIT TYPE (MINGLE FAMILY 0 TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 0 NEW ]r REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK FEES ARE BASED ON $10.00 PER FIXTURE, XCE,� PT WHERE NOTED. FIXTURES: I ICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: r i �e'e1C MODEL: C 0 S]ZE/BTU iD o� f70� MFG: t l!� "e MODEL: O� W Q �-1 oZ� SIZEBTU 2 4ory 13s-ee MFG: MODEL: SIZEIBTU J�A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 BOILER $35.00 TFURNACE $35.00 _GAS UNIT HTR $10.00 _CHIMNEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00 DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15-00 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 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 all work h re�c�u�eview approval of plans. A� PRINT NAME ROGER HOFF ! DATE S l!o I DSIGNATURE OF APPLIC City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977