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PRE 2010 DOCSCity of Fridley, Minn.. BUILDING PERMIT iv® 6685 Date: Owner: Builder ,tL Address _ Address IOC F LD NG No. Street f2 Parw Lot Lot __ Block Addition or Sub- on . Corner Lot Inside Lot —� Setback- - Sideyard E, Sewer Elevation �_ Fo dation Elevation DESCRIPTION OF BUILDING T y Front Depth Height ®Sq. FtGfJ!!ij r Cu. Ft DepthHeight Sq. Ft. Cu. Ft Type of Construction - - Est.. C4-h� To be Completed In consideration of the issuance to me of a permit to construct the buildin described above, I agree to do the proposed work in accordance with the description above set f rth and in pliance 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, re and moving of buildings within the dty limits and this permit may be revoked at any time upon vio n of any of the provisions of said ordinances. NOTICE: Thk pem* don not cover the construction, hutatlation for w1dog, plumbing, gee heating, sewer or water. Be sure to we the Building Inspector for separate permits for than flame. 00 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA - OWNER'S NAMEf �v/ ��7 /ld BUILDER ­rv.s s e /`e e ADDRESS (o %'© a$i- AW P ADDRESS J Xgo Co, ,o A-i_ - S LOCATION OF BUILDING No. Street Part of t f Lot Block Addition or Subdivision Corner Lot Inside Lot Setback Side -Yard if SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as; je� c." Front Depth a a, Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction I-, rdcne Estimated Cost To be Completed _(oo clays .900,0-0 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___ /S'fo SIGNATURE ,d11 (Schedule of Fee Costs can be found on the Reverse Side). 4 A 7 LOT Nplm Pd Vl F sIrii a `10 SIZE /6 X 3 2 BLOCK L;DDMS 6 70171' '0 2 _1 cl 7,e ry,.7c @ VALUATION , ADD. TYPE _............. ............... ........... ............. ........ ............. _....._................. .„...,........... ........... ,......... .... ................. _............................................. ...... ............................. _.... _................. i i � U dt e e c9/ Calle 0; , CAFrie CreVe ✓PP Cr?PFJ�G4/� /aV/: -- .. .•-0 �JC/Cst 'a, City of Fridley, Minn. N9 9756 BUILDING PERMIT Date: May 22, 1968 owner: _ Paul Schu to Bides Blanske Construction Co. Address 670 Marigold Terrace Address 4029 Silver Lake Road LOCATION OF BUILDING No. —670 _ Street __ Marigold Terrace_ Part of Lot Lot 14 Block 4 Addition or Sub -Division .._._.._Donnay'a Lakeview Manor Corner Lot —_ Inside Lot Sewer Elevation Setback --- Sideyard Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Addu. to KitchenFront _12' Depth 14' Height 12' Sq. Ft 168 Cu, Ft 2016 Front Depth _ _ Height ._ Sq. Ft. Cu. Ft. Type of Construction Frame Est Cost—9z000------- To be Completed July la 1968 Subject to providing 1 hour fire protection where addition laps garage. 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 a'll provisions of ordinances of the city of Fridley. / In consideration of the payment of a fee of $----5 .00 ., permit is hereby granted to Blanske Coast. Co. 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. Clarence Belisle NOTICE: This permit does not cover the construction, hntallatien for wiring, plumbing, gas heating, sewer or water. Be am to as the Building Inspector for separate permits for these hems. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, k SdTA OWNER'S NAME `/�� _.. BUILDER_ .� C�kt ®�� ADDRESS_ADDRESS ��� LOCATIONi,PF BUILDING LOT _ BLOCK ADDITION OR SUBDIVISION CORI3ER LOT --..2-INSIDE LOT SETBACK SIDEYARD SEWER ELEVATION TOP OF FOOTING Applicant attach to this form Two Certificates of Survey of Lot and proposed building locatiovn .drawn] bn'. tbe"i Coit.tif%eitte.w-, . , :^ • " . _ d,.. -i, l.:i'w: Y� ,; is ' J. , i .. ,.' .. .. . :DESCRIPTIonT.:Of:: BU-ILDILqG ` "• To Be Used As: 0 Front - --- .Depths Height �' Square feet•:f:wiz �'.� Cubic Feet Front Depth Height Square feet Cubic Feet ' Type of Cons truction—ZI Z-- Estimated Cost • DOo s=o To Be Completediz�"'l 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 �'L.., _ _SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). 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 ...........................$10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6,00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECIL 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. EDR Hot Water .. 10.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 $ Each add. 320 sq. ft. EDR 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 199,000 BTU) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: 1st 3 Fixtures ...................... NO RATE x$ 2.00 $ TOTAL — ,Additional Fixtures ................ Gas Range to 199,000 ........... x .75 x$ 5.00 $�— $ AIR CONDITIONING FAN HEATING SYSTEM VENTILA AlNG SYSTEM ALTERATIONS & REPAIRS R6uGH FIIk4L See Fee Schedule $ p TOTAL FEE $� Dept. of Bldgs. Phone 560-3450 City of Fridley: The undersigned hereby makes application for a permit for the work hereir. 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. Fridley, Minn- - , // /& , 196-d Owner l,Z-�GLt-rX �r �`t rte± L'e U Kind of Building Used as To be completed about Estimated Cost, Old—New. Building Permit No. Permit No. 4lq(a DESCRIPTION OF WORK HEATING or POWER PLANTS -Steam, Hot Water, Warm Air—No Trade Name_ Size Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load Kind of Fuel - BURNER , 7 BURNER — Trade Nam Size No-; '0 /j Capacity Sq. Ft. E.D.R BTU 62 // H.P, (REMARKS—OVER) Signe . _ _ �i _ L114 — ._./.�f �i i i Business i „ ' i SZa8 City of Fridley, Minn.." 108 3 3 BUILDING PERMIT Date: __ September 16, 1970 Owner: Mr. Paul Schullo Builder The Sussel Company Address 670 Marigold Address 1850 Como Avenue, St. Paul LOCATION OF BUILDING No. �67.0 Street _.__ Marigold Part of Lot Lot — 14 --- Block 4 Addition or Sub -Division .—_Donnay',s Lakevi-ew Manor Corner Lot ---- Inside Lot _ Setback -- Sideyard Sewer Elevation ___ — Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Alter BRS.Pmanf Front _ _ Depth _ Height — Sq. Ft. Cu. Ft Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Frame Est. Cost ­t3z350.00 __ TobeCompleted Nov. 1. 1970 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 abovet• and in pliance with a'll provisions of ordinances of the city of Fridley. o') �,Kk In consideration of the payment of a fee of 21. 00---...._., permit is hereby granted to us s e 1 Company 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 thereof, shall conform in all respects to the ordinances of Fridley, Bsinnesota reg d�n� location, construction, alteration, maintenance, repair and moving of buildings within the dty limits and this permit may be revoked at any time upon violation of any of the provialons of said Ord NOTICE: Me permit don not cover the construction, installailon for wbbg, plumbing, gn hosting, sewer or water. Be sets to no the Building Inspector for separate pennih for these hemm APLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME :1 C �� BUILDER: � Nom. �ySS�--` Ctz ADDRESS:- V2r®� ADDRESS : NO:. �9� STREET: Cj®�_D LOT: BLOCK: ADDITION'-.' \�Qj(,JWVs�-f S ""-�0« 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. DESCRIPTION OF BUILDING To Be Used As:. DePth• Height Square Feet: Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost: -$ To Be Completed: N�00 1 r �C�) _� (1) The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stfict 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 : * --C- K�:3 SIGNATURE : p (See Reverse Side For Additional Information.) �2 % Original Permit for rLUMBING AND GAS F® ® TING N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for inspection shall be phoned in to the plumbing Inspector, 560-3480 giving number of this permit.. Number, Sind and Location of Fixtures Stones tW m Z S m z Y m r Z Z 3 O Z U z z r; U .1 O WATER HTR. .1 U rc O Q 7 m F Q m Z 0 a K 3 F R O O LL I (A OJ rc LL O 4¢ u m 6 0 E J m x E 4 Qp4, O Q a s OAS ELEC. a E; Basement 1st 2nd 3rd 4th Connected with Gas Piping for Openings Permission is hereby granted - �upon todotheplumbingandgas fitting in the building descr�7ied in the statement hereto at hedthe express condition that the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and this permit may be revoked at any time upon the violation of any of the provisions of said ordinances. By Order Of The Inspector Of Buildings Roughing in Inspection Date Inspector. Final Inspection Date N° 5195 X3413 IPermit Fee $_ _L f2 0 City of Fridley 1916- 1 Owner s Q j • ,J� Location �') Q Kind of Building=.�2-�✓►'v�fc Used as L'i 111-t �-A- A To be Completed co -"e ,19-"—,-o Estimated Cost $96re% Qej Old -New. Building Permit No. Date Inspector. Inspector of Buildings. 42 ���9-y City of Fridley APpiiearlan for Plumbing and Gas FM ing Permit Dept. of Bldgs. Phone 560-3450 DESCRYPTION OF WORK - Number, Kind and Location of Fixtures N1 �n ZZ o� N 8�p= UZ Ox J C7 Z Z —0 . . WATER HTR. o� !2 F N GAS ELEC. Base f / 1st 2nd ' 3rd ' Future Connection Openings Connected wiib I Sewer New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...... ............... — x $10 $ 9 • U ° $2.00 Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin .... ................. I... Water Heater (Up to BTU) ...... New Ground Run Old Bldg . ............ Electric Water Heater GAS FITTING FEES: 1st 3 Fixtures ................................ Additional Fixtures . nn ........... Gas Range to BTU .............. — REPAIRS & ALTERATIONS—Refer to Code X. V35, $ $1.50 x 6& $ $1.50 x 3.25 $ x 3M $ $3.00 x 3.25 $ City of Fridley: 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 are true and correct ' n OwnerFridley, Minn g 19Zo ��"'t'� Kind of Building. Used as To be completed about Estimated Cost, $ 9 Old—New. Building Permit No Permit No. Signed Business Phone No ROUGH NO. RATE TOTAL $2.00 FINAL x $lex $ $2.00 X xffic $ .75 x mac s- $5.00 Description ...............................................$ TOTAL FEE $-S-. 6 o X42 sueJEcrP-R City of Fridley 13130 WI AT THE TOP OF THE TNS BUILDING PERMIT r RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. INSPECTION r � � PROTECTIVE SEC. 7 3�� 1 NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 IL , ,`J L---- 612-560-3450 910-F15 8-5-75 JOB ADDRESS 670 MARIGOLD TERRACE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14 4 1 DONNAY'S LAKEVIEW MANOR SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE PAUL SCHULLO 670 MARIGOLD TE CE FUDLEY, 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING RPSTDENCE 7 CLASS OF WORK ❑ NEW XX ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK PORCH ADDITION 9 CHANGE OF USE FROM TO STIPULATIONS SEPERATE PERMITS REQUIRED FOR WIRING, IDEATING, PLUMBING AND SIGNS. WARNING Before digging call local ' utilities TELEPHONE - ELECTRIC - GAS Etc. REQUIRED BY LAW. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. FRAM 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 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 $4,200.00 $2.10 DOESN PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PI NS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRU ION OR THE PERFORMANCE OF CONSTRUCTION. $25.20 PLAN CHECK FEE TOTALFEE W NATURdEOFCO NTRACT RO THORIZED AGENT (DATE) WHEN PROPE LY VALIDAT D THIS IS YOUR PERMIT AUG- 5, 1975 BLDG )NSP DATE SIGNATURE OF O ER (IF NER BUILDER) (DATE)' -APPLICATION FOR RESI•DL'NTIAL., ALTERATION, OR ADDITION.BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA 01?NER' S NAME : BUILDER: G ADDRESS : Ve�DRESS: STREET LAT: BLOCK: ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this fors Two Certificates. If Survey .of Lot and .proposed building location di•iwn on these Certificates. DESCRIPTION'OF BUILDING To Be Used As: Front: Depth:• Height: Square Feet: Cubic.Feet: • Front Depth: Height: Square Feet: Cubic Feet: Type of Construction: Estimated Cost: To. Be Completed: U - 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 th4a,cation are true and correct. • DATE: V SIGNATURE. .(See reverse Side For Additional Information.)' A) • q2 Cis/ .-,Sb — Z, )-o / { a 53 11 SUBJECT PE City of Fridley 21917 AT THE TOP OF THE TWINS BUILDING PERMIT r • COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. I� r i � NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 6/17/93 JOB ADDRESS 670 Marigold Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14 4 Donnayts Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Paul Schullo 670 Marigold Terrace NE 571-6693 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. M.R.E. Construction 10928 Jersey Ct, Champlin MN 55316 42.4-5083 2902 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 ❑ ADDITION J] ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE S DESCRIBE WORK Conversi®n of Three Season porch to Four Season Porch 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan, Install smokecbtectors as per UBC 1210 - adjacent to all sleeping areas and in basement. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $11000 $5,50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT r PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $126.00 Fire SC $11,00 STRUCTION OR THE PERFORMANCE OF CONiTaucnON PLAN CHECK FEE TOTAL FEE License SC $5,00 $147,50. SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI WJE"PTERrALI DATED THIS IS YOUR PERMIT K DG DATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI 11 NEW [ I Effective 5/26/93 ADDN [ I CITY OF FRIDLEY / -7 ALTER [ I SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: X70 Legal Description: Owner Name & AddPw, Contractor:�% '��&. N LICENSE #r 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 .10 �0 Width 3!�6 `( Height Sq. FL e GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: awye tl, S $kMoN A 0?c 7--, y Corner Lot [ I Inside Lot [ I Ft. Yd Setback Side Yard Setbacks Type of Construction: /iia a eom Estimated Cost: $ Approx. Completion Date: 6-20-13 Driveway Curb Cut Width Needed: Permit Fee (Cost on Back) Ft. + 6 Ft = Ft x $ 77iO -93 APPLICAM: )6& F� AM`L Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $750 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $ Conservation Plan Review $450.00 $ Fee Determined by Engineering Agreement Necessary [ I Not Necessary [ I STIPULATIONS: M CITY OF FRIDLEY INSPECTION DIV. Effective On January 1;1993 6431 University Ave NE / / , Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 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 — Ali Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commerciallindustrial 1% of Value of Appliance or Work JOB ADDRESS 7.0 '00 lQ r i Zip %-e r r a The undersigned hereby makes application for a permit for the work herein Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and rulings of the Building Division, and hereby declares that all the facts and $ 20.00 $ representations stated in this application are true and correcp. 11993 $10.00 $ OWNER iia u, L S' $ 10.00 $ BUILDING USED ASo $10,00 $ ESTIMATED COST .3o o. ® e PERMIT NO. S � $10.00 $ DESCRIPTION OF FURNACE AND OR BURNER State Surcharge TOTAL FEE $ No, of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR $ Fuel Total Connected Load $ .50 MINIMUM FEE FOR ANY HEAT] NG/COOLINGN NTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS 115.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed In a side yard without written permission from adjoining property owner. Burner Trade Name BTU HP Size No. EOR HEATING COMPANY 54- &_J a-� f eti R _ -,t- A C� Signed By/c% Tel No. F7,P— Z 3,41e Approved By Rough—In Date_ Final Date FiLL OUT BACK SIDE FOR STACK VERIFICATION'ON REPLACEMENT FURNACE CHIMNEY AND STACK VERIFICATION Y The undersigned hereby verifies that the existing chimney or stack: .1. Has been carefully examined Yes ( ) No ( ) 2. Is free from rust or deterioration Yes ( ) No ( ) 3. Has no foreign objects lodged within Yes ( ) No ( ) 4. Is securely supported Yes (-) No ( ) 5. Meets all current Code requirements for size and total BTU'cnnected so Yes ( ) No ( ) 6. Has total heating BTU's of All other BTU's TOTAL BTU's Remarks List Alterations Being Done: HEATING COMPANY Signed By Date Building PLUMBING Permit No.:,'_)1Q_ 000110 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY IwA 763-502-4977 FAX 06 W EFFECTIVE I-1-2010 DATE � I ' SITE ADDRESS & 70 I L V_ THIS APPLICANT IS: ❑ OWNER NTRACTOR PROPERTY NAME: OWNER/ ADDRESS: �� STA IP TENANT PHONE: '� CONTRACTOR NAME: .sem SUBMIT A COPY OF YOUR STATE STATE LICENSE # �yI EXP DATE AX X I ''4:7d I! LICENSE, BOND AND STATE BOND # D EXP ATE CERTIFICATE OF ADDRESS: Z,2j rDt9/f� CITY 2;0,-tr4eW- STATE IP INSURANCE _ PHONE FAX l �Z FAX_S�^�D� affil PERMIT TYPE eINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE ibs TYPE OF WORK: ❑ NEW PLACEMENT DETAILED DESCRIPTION OF WORK.74!v� n4y S FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $35.P.- 35.P.-BATHS BATH SV DRAINS SHOWER WATER PIPING _FLOQR _ _ T BATHTUB iI or G2 _ GAS PIPING (NEED CITY LIC) _ SWIMMING POOL _ WATER SOFTNER ($35) _ CLOTHES WASHER —KITCHEN SINK _ WATER CLOSET _ BACKFLOW PREV. ($15) DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ WATER METER OTHER _ x 2rv'i .1��-. THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I acknowledge t the information above is complete and accurate; that the work will be in conformance with the ordinances codes of th Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an appli for a pens' ork is not to start without a permit on site; th the work will be in accordance with the approved plan in the fall work 1 requires review and approval of plans. SIGNATURE OF APPLIC PRINT NAME /LI- DATE 40-0 q _ City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977