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PRE 2010 DOCSVillage of Fridley, Blinn. BUILDING PFJtMIT N? 263 Office of INSPECTOR OF BUM DINGS Owner Architect Builder Fridley, Minn., e C` � 19i:Q i LOCATE N OF BUILDING No. y Street "f` M N 11 1E , Part of Lot Lot Block Addition or Sub -Division �.,DI+;SCRIPTION OF BUILDING FrontDepth ; � Height Stories Manner of Construction To be used as To be completed �� rR � �k Estimated CostL- _ :- v' Permit is he granted tov�`V to`''m �. the building -described in the above statement. This permit is granteA upon the express condition that the rson to whom it is granted, and his agents, employees and workmen, in the work done in, around and upoNald building, or any part thereof, shall conform to all respects to the ordJ nances of Fridley, Minn., regarding the construction, alteration, maintenance, repair and moving of building within the city limits, and this permit may be revoked at, any time upon violation of any of the provisions of sat ordinances. 1 a dv��Inspector of Building AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley the above permit, I hereby agree to do the proposed work in accordance with the descriptio above set forth and according to the provisions of the ordinances of Fridley, and, being first did sworn, I hereby state and say that the facts stated by me and contained in the above permit ar true as therein stated. 71 Subscribed and sworn to before me at Fridley, day of Village of Frlidl.ey, HIM - BUILDING PEli.AM N° 218 Office of INSPECTOR OF BUILDINGS Architect Fridley, Minn., a 19 Builder LOCATION QF BUILDING Street ,�"" art. of Lot Lot Addition or Sub -Division .�., "` "' $t'�}�C�RIPTIOTeT OF BUILDING Front Ug th geight Stories Manner of Construction t i F To be usedas �� To be completed Estimated Cost e sw a A -i[ � is✓J/.4�1 M _�,i ..�, ,u pa®1.�, p ➢. ¢G ,� �''�.�..a'W`%'tiZs�nc�"d�," 9, ' Permit is hereby granted to the buildings described in the above statement. This permit is granted upon the express condition that the i4rson �o whom it 4's granted, and his agents, employees and workmen, in all the work done in, around and upon said b lding, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, Minn., regarding the 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. ti of 9ti r � AJW ' inspector of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by theInspector of Buildings of Fridleyof the above permit, I hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me a 7ntained'in the permit are true as therein stated. Subscribed and sworn to before me at Fridley, day of r°J°`,;' � �i.D. 19 -- M City of Fridley, Minn. BUILDING PERMIT No63z Date:i Bufluder LOCATIO F BUILDING No. - F - 3 �. Street' � � � _._ .._...... . ......— Part of t-----.._� Lot ------------------------------------ Block . .... _... ...................................... Addition or Sub- ' o ,..._.....---..".)U...0....�. Corner Lot ............................. _... Inside Lot ....._......._...._......._. 2 -...... Setback .... .. ................. Sideyard-•---o,:.�.... ............................. .............. ... _....... Sewer Elevation ----- ------- Foundation Elevation DESCRIPTION OF BUILDING To U as: / // _.. _..._._.._.._--•-•--....__.._ Front -./T ..... Depth-_�...---- Height ..1......_.. Sq. Ft.Cu. Ft. - ..........._................. no...Cu. Depth ...................... Height --t ......... Sq. Ft... -......_ ....... Cu. F't. Type of Construction...---------_--- -• `— A. Est. cost_................._......._.... To be Completed .............. .... ...... THIS PERM,, CAU p� — ��N i ION OF R`OT NAUTHORIZE VIOLAT- BUILDINGRESri I� ITE LAND COVENANTS AND 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 $... _......._.._........_...... 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 u n violation of any of the provisions of said ordinances. it /� 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 Z -A 1 Builder_�.r. /�/ Address /�i�V s�, /V Address � - q1 �- 0 • i LOCATION OF BUILDING No. StreetW art of Lot l - Lot Block Addition or Sub.Div. Corner Lot Inside Lot Set Back Side -Yard , SEWER ELEVATION FOUNDATION ELEVATION „�� Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: �r <-P- -Front �r�- �t /� D4 Sq. Ft. Cu. Ft,�..... Front Depth Height Sq. Ft. Cu. Ft. truction Estimated Cos �• Type of Cons _. 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 representa- tions stated in this application are true and co t. DATEC . SIGNATURE (A Schedule of Fee costs can be found on the Reverse Side.) r . r C City of Fridley AT TNI TOP OF TN[ TWIN* r'L-'-~--COMMUNITY p[V[L0PMINT DIV. 1 PNOT[CTIVI INM[CTION K". CATV MALL FRIOLIV bMs 53-%-S-915.51 $U8,♦ECT PLUMBING PERMIT APPLICATION Job Address -"- N. E. Main Street Owner Joseph Kocur Address Phone Contractor Address Phone Kind of Building Use Frame Res. Completion Date Estimated Cost 10-31-74 10.00 (I Plumbing Fixture Rates: NO. - RATE^ TOTAL I � � . W W I Number Fixtures x $2.00 �_ 3InI Future Fixtures x $1.50 ae�Nral I I I � New Fixture -Old Open. x $1.50 O! '7ddYI ovs I ; I I Catch Basin x $3.25 i Water Heater -99,000 BTU x 'I $3.00 'DBIN� i I Ground Run Old Bldg. x $3.25 I I j 'MNrval t I f Elec. Water Heater x $2.00 H�1YD1 1" I Gas Fitting Fees: - �O 0 >INlvaa I I I I 3 o aOo'AI •� a 1st 3 Fixtures x $2.00 Ou o,3 l saaMalgl Additional Fixtures x $ .75 d '1Nfl0dl I I I I ( NNIaG Gas Range -199,000 BTU x $5.00 IqU BAral NSYMI I I .r Repairs & Alterations .NNIS V I I I � I . Install Gas Grill See I Description. Code 5.00 I Class N' Surcharge .50¢ State Surcharge g .50 I TOTAL FEE $ 5.50 I I NtYY I I I! !The undersigned hereby makes application for a permit 1P1YN1'I�I for the work herein specifiedo agreeing to do all work eapr`M in strict accordance with the City,_ Ordinances and Tulin I of the Department of Buildings, and�*hereby declare that all'the facts and representations stated in this application are true and correct. -Signature AfilMM f;ARN) Date 16 SUBJECT City of Fridley 12329 AT THE TOP OF THE TWINS BUILDING PERM -IT �r? • COMMUNITY DEVELOPMENT DIV. r <: ------� INSPECTION Q (Q 1 � PROTECTIVE SEC. �O v 1 � NUMBER REV. DATE PAGE OF APPROVED BY I CITY HALL FRIDLEY 55432 �•--- ,-J 612-560-3450 910-F15 9/24/73 JOB ADDRESS 4120 Main Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 Aud. Sub. #39 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Joanna Kaczor 4120 Main Street N.E. 3 CONTRACTOR MAILADDRESS 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 U10 Residential 7 CLASS OF WORK X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBEWORK Construct a 261 x 301 Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide frost footings. Provide a hard surface driveway. PERMITS REQUIRED FOR WIRING, S EPERATE HEATING, PLUMBING AND SIGNS% TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, 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 60 DAYS, OR IF CONSTRUCTION R-1 780 10 920 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 I 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, $3s533 1.77 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 20.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE 21.77 SI A RE OF TRACTORO AU ORIZEDAGENT (DATE, HEN ROPERLY VALIDAT D TH 'IS OUR RMIT q_ � 73 IGNATURE OF OWNE IIF O NER BUILDE (DATE) DG I SP DATE c,' 16 I� .. ft_ APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER' S NAME • i not ILDER: ADDRESS: ~� �O rn A l ry k� ADDRESS: NO:. STREET: LOT BLOCK: ADDITION � 9 CORNER LOT: INSIDE LOT:�_SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To Be Used As: DESCRIPTION OF BUILDING Front : Depth • _3 0 Height: ! Square Feet: Cubic Feet: l p, -Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost:_$ To Be Completed: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict 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: (See Reverse Side For Additional Inf 7 10 The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict 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: (See Reverse Side For Additional Inf 7 10 P`-�"fi'aw?'YO n N ��.6.'saaS�ufii 2.fW P0,17Z7 b friis.W.. �,+.....� ¢r ...��:..T (i�!'f.,e`rw�TT� pP M1ew��w^e� ��—'.e•,..*ro��Oio /r« 4..��•ri ls.:..•t._...� � wcar:iaaw�g �lr+fl'easasn+t+d,.n� i•s•«ro��:t`r•:ard'� AQ 6"dfY(mow R�?�«�=�� .'e. •.+r��-C R �? �vR�a's+2 ��o>�L"«�SoCLre.awaa..� e;-� JJ:JiJ •ml iw'r:cr� 0mr �:i 4. 9vvi„8 PARTIAL RATE SCHEDULE GitA V= WARM AM: lit°.—A xo TOTAL itiazce Shell & Durt Work $10.00 3 Re, :acernert of Furnace 6.00 $ P.rpa:-c & Alirrat.rns--up to 3500.00 611kl S Rr .airs & Alterations each add. 2500.U0 3W $ NXCX WARM AM, Ftrnace Shell do Duct Wnrk to 120,000 BTU etch add. 60,000 BTU Replacement of Flirriacr Re, airs & A!tPration---up to 5500.00 ftc;airs & Alteradoos each add. $300.00 STEAM ex HOT WAT R SYSTEM .S1o00 E 3.W a pol. ori $ 3.00 $ Pi—mace Shell & Lines— to 4,010 sq. ft ?.DR Stearn V0.00 S Furnace Shell & Line --to 640 sq ft. EDR Hot Water 1000 S. Each add 209 sq. ft. EPR Steam -4 on $ Each add. 320 sq. It EDR Hot Water 3.00 S OIL BUF.NEP.—to 3 gal per hour 6.00 5 over 3 gal. per hour—See Fee Schedule GAS BURNER (up to IE9,000 BTU) 8.03 $ m-tr 1,000 BTU Sae Fee Scheduler GAS FITTING FEES: no RATE TOTAL lst 3 Fixtures x$ 200 S Additional Fixtures z .76 Cas Ra, - to 09.mo x$ 6.00 8 _ � ec�rPto�l-r6= /A State Surcharge � � .50 TAN fay Fee Iac�-• .1� ALT__n LT70K3 S REPAIRS IRS TOTAL a g L IKd.FYl`J Dopt. of 21-11x'3. Ph23 a S:N-:•Nir City of Fridley: The +indersig;ned hereby makes application for a permit for the work here specified agr��-ir.g to do all work ,n strict accordance With the City Ord:nare and ruling of the L'.epainnent c,° Buildings. ",nd hereby declares that ail the f and rel;resPntativas slated in this appbcatiun are true and correct. Fridley, 14tinn � 11) �! Owner _ -) . / Kind of Building Used as V L To be completed about ® -�- 26 Estimated Cast, S _ Old ens. Buil7 Building Permit No. Permit No. /V or won= hMATING or POWER PLAIN 175—Steam, Hot Water, Warm Air—No Trade Name `tom a � � 1_ r r�6�P.�� Size FdoA,le 9 U Capacity Sq. TL E.D.R F3TU $ Ili Total Connected Lasd_�s?wa � Riad of Fuel f C� BURPdER — Tzz-de Name �t•c�� Site I+ie- Capacity— � � ! Sq. F. EJ) -R- BTU N; tmrCnaztaa—erect HEAP L03-3 CALCI ►SIOF qP-PARTMENT OF INSPECTION Weatheratriga _ Guide Conatruction No. Windows I Doors Reference out. Wall Int. Wan Ceiling Roof Floor— Yes---No— loorYee- o Yes o Rooth I Lenath 1. -� Width Height °�' II Fl•� Windows and Doors—CrackaCe and Area WIdtA HoigA6 No. of Lineal ft. Area NO. of pane Of pane 1 liable I of crack I no. ft. ,? 65, 1l 6 Coef-I Btu Infiltration ®F? �. Glass Exp. wall y` COef. Net exp. wall Coif. Btu leaf. meal) i1JG'.' / Ceiling ) e Net exp: wall Floor Net eup. well Total Btu. Int. wall Required sq. ft. E.D.R. or sq. ins. VIA. Leader area 2 Z9 'Lit. wall ' indow9 and Doo;;l raegae and Area rye. Width Height Noo of pane of pane No. of lights Lineal ft. Arca of crack 94. ft. ®F? % _ Infiltration COef. Btu Coif. Btu Infiltration Glass Exp. wall A i1JG'.' / 6) 40 Net exp: wall 2`.'alp. wall Net eup. well ' Int. wall Ceiling 'Lit. wall a. tiling �A loor Floor otal Btu. rtitequired sq. ft. L.D.R. or eq. ins. VIA. Laa&r area 65 I otal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl -1 Room ILenoth Width misht _ Windows and Doors--Crachaee sad Area rye. Width Height No. Of Lineal CL of pant of pa a lights of crack Arta w. ft. �` gi �-0 _ Infiltration COef. Btu ,':Il�ltiatl®m r� Glass Cod. Btu Infiltration .1899 Ems. wall 2`.'alp. wall Net eup. well Nat cap. wan lag. wan Ceiling let cup. wall Ceiling 'Lit. wall a. tiling �A loor otal Btu. rtitequired sq. ft. L.D.R. or eq. ins. VIA. Laa&r area MMMAPOLIS. R" iaaulation Itiad HOW Room I Lennth Width - 146he Windows and Dcaro---Crachage and Area Width Height No. of Lineal It. No. of pane of pane lig77hts or crack Are sa, IL P945 J�g� off- A"7 �` gi �-0 Cod. Btu Infiltration -7�2 .?d Infiltration Glass Cod. Btu Infiltration Exp. wall Ems. wall E,up. wall Net eup. well Nat cap. wan lag. wan Ceiling Inc. wall Ceiling Floor 1 otal tutu. Required sq. ft. EAR. or aq. ins. W.A. Leader area FU Ream I Lend Width Height Windows and Doors—Crachaira ih nd Arm No. Width Holaht• of pane of pan. No, of lights Lineal ft. Of crack Area sp. fL Hefaht Na Of Lineal fL Area Of pans lights of crack on. fL Coef. Btu Infiltration Cod. Btu Infiltration Exp. wall Glass E,up. wall Net eup. well Inc. wall Ceiling Floor otal Btu. Required sq. ft. ED.R. or sq. ms. W.A. Leader area F1.1 Room I Lenfrth Width Height Windows and Doom—Craelmee and Area No. —width— of pane Hefaht Na Of Lineal fL Area Of pans lights of crack on. fL Coef. Btu Infiltration Glean Exp. wall Net eup. wall JUL wall Ceiling Floor hotel MO. Required sq. ft. EDA or sq. ins. W.A. Lear area FORM J-1 �- ,. WORKSHIEET—MEAT LOS 1 Name of Room ENTIRE HOUSE 1 3 3 4 5 2 Room Size /4. X X X X X X 3 Running Ft Exposed Wall ��;;' 2 4 Ceiling Height, Ft Rear �1, J 5 1 Room Compass Directions TYPE OF EXPOSURE Const. No. HTM Area or Length Btuh Area or Length Btuh Area or Lengt Btuh Area or Length Btuh Area or ngth Btuh Area or Length 6 Gross Exposed Walls and Partitions- a — — — — — — — — — — — — — 15 b — — �? — — — — — — — — — — - c -- --- -- -- -- -- 7 Windows and Doors a 16 Warm Ceilings ' b 17 Warm Floors c ' 18 Infiltration rs 'r I 8 Net Exposed Walls and Partitions a 19 People k/ @t300 liances 0 / �rA b c d 9 j Cold ' Ceilings a b 10 Cold Floors a b 11 Infiltration Length of Crack a b c 12 Sub Total Btuh Loss — — t 0 TJ non..e�n ('.�n�ri4v if nemirm 14 ---- Windows and Doors Front Left �.;" ��;;' 2 Rear �1, J '✓ ,;' Right U } Doors 15 Net a Exposed b Walls and c Partitions d �? 16 Warm Ceilings ' 17 Warm Floors 18 Infiltration rs 'r I 19 People k/ @t300 liances 0 / �rA 20 Sensible Btuh Gain — — 21 Total Btuh Gain 1.3 22 Btuh for Air Quantities i SUBJECT City of Fridley 17, 24890 AT THE TOP OF THE TWINS BUILDING P E R M I T r COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. �L CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 3697 JOB ADDRESS 4120 Main Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt g Auditor's Sub. 439 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Stanley Kaczor 4120 Main Street NE 789-8188 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Master Remodeling Inc 32 10 Ave S Hopkins MN 55343 932-9311 20012916 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 Q El NEW ❑ ADDITION El ALTERATION X REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (15 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,237.50 $.62 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- Fire SC $1.24 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $43.00 PLAN CHECK FEE TOTAL FEE License SC $5.00 $49.86 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PPROPERL ALI DATED THIS IS YOURPERMIT SIGNATURE OF OWNER I iF OWNER BUILDERI IDATEI .BLD INSP MATE MAR -05-1997 15:46 CITY OF FRIDLEY 612 571 1287 P.01i02 NEW { j Effective 1/1!97 ADDN { j CITY OF FMLEY 3� ALTER [ j 61.0 SINGLE FAMILY AND DUPLEXES R-1 AND R 2 % , Z c4 BUILDM PERMIT APPLICATION , Ce IL- ConstructionAddress: yia Legal DescrVd0u: Owner Name 8t Address: �••r 'I ..g v�G '2p o2 Tel. -F— P, Contractor: WASMR nMODEILMG, INC. MN LICENSES cAOO / 2- 32 1 enth Avenue South � / Address=_ HODWns, iv�innesota 5534' Tel. # 312 �.l (61A%NRr%Wjpp1icafion, a Certificate of Survey of the lot, with the proposed comt rucdon drawn on it to sole. DESCRWMN OF EMMGVENM14T LIVING AREA: Length Width Height . Sq. Ft. GARAGE AREA: Length; Wift . Height Sq. Ft. DECK AREA: Length Width Hgt/G`rround Sq. Ft. OTHER: Permit Fee Mire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Fee Schedule on Reverse Side 'm. of;Peru Valuation (1/10th%) $.501$1,000 Valuation $950 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt.. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determincd by W�miag Agent Nem i Not Necessary- I j Building MECHANICAL Permit N Inspections RESIDENTIAL APPLICATION Recei 763-572-3604 CITY OF FRIDLEY Date RA 763-502-4977 FAX EFFECTIVE 2-19-09 DATE /O -F- D YOUR E-MAIL ADDRESS SITE ADDRESS q1 oZ ® rleL4 n N t THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ TENANT CK�7�M MTdl30Iq SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION i,"OA" ADDRESS: W Io10 1 jt• -L�t- Nc CITY 99-!QIt., STATE MtJZIP. PHONE: -74 -Is- q a. s -4 3 3Y COMPANY NAME: CONTACT PERSON: LL STATE LICENSE # EXP DATE ADDRESS: D 0 C9 O p'(�� . , 's'� N Aff CITY jFj STATE rf- ZIPS S �`' t 3 i - PHONE '14 3 ? S L( cl ( C1 'N FAX PERNM TYPE '- 64NGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW CAEPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK .T r% Zi�A FLA- C 11 'A FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: C&A -e 1,,- MODEL: 5 8 H V C. B ICU SIZE/BTU k 0 . dG / MFG: MODEL: SIZE/BTU MFG: MODEL: SIZEIBTU $25.00 (GAS) $15.00 GAS RANGEIOVEN $10.00 _A/C TO AIR EXCHANGEER $15 _FIREPLACE FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 _AIR $35.00 ,FURNACE $35.00 _GAS UNIT HTR $10.00 _BOILER LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00 _CHIMNEY 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 of all work which requires review and approval of plans. n SIGNATURE OF APPLICANT PRINT NAME CtIt DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977