PRE 2010 DOCS<,.40.w *
BUILDING PERMIT
Village of Fridley, Mina. N� 2 9
Date ��i►�". v . �. ............ ........... .
Owner a/. .1 ...............
Builder
Address 1.7.
Address.........................................
LOCATION OF BUILDING
No. ..,7. of ....... Street 'Ei� ! a. •,!l!m!.......... Part of Lot .......................
Lot ..... # ....... Block ................ Addition or Sub -Division eO�--!. .AIC�• .
s � L �
Corner Lot ............ Inside Lot ..F�...... Setback '!r� SideyardApe'- e............ .
DESCRIPTION OF BUILDING
To be Used as:
U110. .1 1 .... Front #f ... Depth;Z4.7....I1eight Sq. Ft.%SI-5�. Cu. Ft. ........
.................... Front ........ Depth ........ Height Sq. Ft......... Cu. Ft.........
Type of Constructio�/lO"s%??41G ... Est. Cost �. ®�f! .-110 ......... To- be Completed -or/
�r
In consideration of the issuance to me of a permit to construct the building desd above, I agree to do
the proposed work in accordance with the description above set forth and Nin com ance with all provisions of
ordinances of the village of Fridley.
A= Irl nsi ration of the payment of a fee of $,/j.`-. , permit is hereby granted to(y
......... to construct the building or addition as described above. This permit is . � anted 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 with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. A
Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
City of Fridley, Minn. N° 8338
BUILDING PERMIT -S e j v 9
Date: August lo, 1965
Owner: TOM DEAN Builder CHAS. JOHANSON
Address 729 Hississippi St. N. E. Address 160 Hartman Circle
Fridley, Nihnesota Ninneapol-is, Minnesota
LOCATION OF BUILDING
Na -729' Street MISSISSIPPI STREET N. E. Part
%/f Lot /
Lot _ Block Addition or Sub -Division LL- A r
Corner Lot _ Inside Lot Setback
Sideyard
Sewer Elevation — Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front Depth Height Sq. Ft. Cu. Ft.
Front Depth Height ' Sq. Ft. Cu. FL
Type of Construction Est. Cost $17, 000.00 To be Completed
Repairs – Due to storm damage
In consideration of the issuance to me of a permit to construct the building described I agree to do
the proposed work in accordance with the description above set f ao in cor Dann provisions of
ordinances of the city of Fridley. /� / / �/ �J
In consideration of the payment of a fee of $ 10.00 , permit is hereby granted to CHAS.. JOH NSON
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 paw thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, cronstruction, 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.
ALLEN G. JENSEN
NOTICE:
lots pem+tt des Be osvw die osmftsdm, hufamot for wWn& phmd&& an hafts, sewer or water. as Wn to see
tla •ending itspWw for separaN pwmifs for thea hum.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME
ADDRESS , /55 y; ADDRESS ��/f% . / f(/S� [ v �/q e
LOCATION OF BUILDING
NO, STREET, PART OF LOT
LOT BLOCK ADDITION OR SUBDIVISION
CORNER LOT INSIDE LOT SETBACK SIDE YARD
SEWER ELEVATION FOUNDATION ELEVATION
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;
Front Depth Height
Sq. Ft. Cu. Ft.
Front . Depth Height
Sq. Ft. Cu. Ft,.,.-,
&C,) ..
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 strict accordance with the City 11of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in thi application
are true and correct. 114
DATE ✓ iG SIGNATURE
(Schedule f Fee Costs can be found on the Reverse Sj�w. C
s
't
c,
CITY OF FRIDLEY INSPECTION DIVISION_
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Effective On January 1, 1999
JOB ADDRESS ---(�
All Others/Repairs $ Alterations (LIST ON BACK)
11% of Value of Appliance or Work $
Commercial/industrial
1.25% of Value of Appliance or Work $ �d
QC,- StateLcharge $ .50
TOTAL FEE
MINIMUM FEE FOR ANY HEATING COOLINGN 4TILAT11ION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
0
No. of Heating Units 1 Circle One (Steam) (Hot Water arm Ai
Trade Name r a rVr e \�(' Size No.
BTU W, GG> , HP EDR 7VA
Fuel JZ6
60S Total Connected Load
Bumer Trade Name Size No.
BTU HP EDR
HEATING CO
Signed B
Approved By
The undersigned hereby makes application for a permit for the work herein
Residential
Rate
TOTAL
specified agreeing to do all work in strict accordance with the City Codes and
Fumace Shell and Duct Work, Bumer —
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Fumace
$ 30.00
$ ° 4
representations stated in this application are true and correct.
(Side Vent — FII Out Back)
,1998
Gas Piping (Needed with new fumace,
$10.00
$
but not replacement)
OWNER
Gas Range
$10.00
$
BUILDING USED AS
Gas Dryer
$10.00
$
ESTIMATED COST 0-(2 PERMIT NO.
*Air Conditioning — All Sizes
$ 25.00
$
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs $ Alterations (LIST ON BACK)
11% of Value of Appliance or Work $
Commercial/industrial
1.25% of Value of Appliance or Work $ �d
QC,- StateLcharge $ .50
TOTAL FEE
MINIMUM FEE FOR ANY HEATING COOLINGN 4TILAT11ION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
0
No. of Heating Units 1 Circle One (Steam) (Hot Water arm Ai
Trade Name r a rVr e \�(' Size No.
BTU W, GG> , HP EDR 7VA
Fuel JZ6
60S Total Connected Load
Bumer Trade Name Size No.
BTU HP EDR
HEATING CO
Signed B
Approved By
C
y ..
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes/;40 ( )
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's connected((jj Yes ) No ( )
6 Has total heating BTU's of 29,00
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes ) No ( )
8. Has combustion air been provided for water heater Yes ) No ( )
Remarks:
v
CIIYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
March 23, 2001
Avis Soderstrom
739 Mississippi Street NE
Fridley, MN 55432
Re: Final Inspection at 739 Mississippi Street NE
Contractor: Pierce Refrigeration
Dear Mr. Soderstorm:
A mechanical permit was issued on August 13, 1999 for the installation of a furnace at
your address. According to Section 305(a) of the 1991 Uniform Mechanical Code, a
final inspection shall be performed on the mechanical permit. As of this date no
inspection has been called for.
The permit fee that was paid covers the inspector's time to check to make sure the
appliance was installed correctly. We also need to check for the installation of
combustion air, vent and connector sizing.
- — If you would like the installation inspected, please contact us within 30 days to arrange
the inspection. If we do not hear from you we will expire the permit and note that no
inspection were called for.
Any questions can be addressed to myself at (763) 572-3603.
Sincerely,
DAVE) NSEN
Buildo Inspector
DJ/mh
.1 /
01
SUBJECT
P '
City of Fridley
32234
AT THE TOP OF THE TWINS
BUILDING
PERMIT (�
Ir?
T NO.
� tV _ COMMUNITY DEVELOPMENT DIV.
-___ � PROTECTIVE INSPECTION SEC.
572-3S®
r �
'5771
E "'1 CITY HALL FRIDLEY 55432
11L"""�
NUMOER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
10/10/01
JOB ADDRESS 739 MISSISSIPPI STREET NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
4
1
Clover Leaf Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Avis Soderstrom 739 Mississippi Street NE 763-586-8086
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
RMA Home Services Inc (Home Depot) 3200
Cobb Galleria Pkwy STE 200, Atlanta, GA
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
763-542-8826 20268257 30339
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION? REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Replace 5 Windows Within Existing Openings
9 CHANGE OF USE FROM
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. Caulk
and flash all exterior openings.
Permit Inspection Cards
Will Be Wailed
To Homeowner To Post
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 BO 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
$4,920
$2.46
WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
ALFEE
Lice SC $ .00
7$123.63
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IOATEI
HE PR0'01VLY VALjDArED THIS IS YOUR PERMIT
� r
8 G IN MATE
S,GNATURE OF OWNERdF OWNER BUILDER. IDATEI
.1 /
01
NEW[ ] Effective 5/10/99
ADDN [ l CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUP.S R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:?j
Legal Description:
Owner Name & Address: IRy*1S Tel. # ;k*3=tea Inc
RMA HOME��1j
SERVICES INC. ` (
Contractor:, Home Depot Installed Sales MN LICENSE # � /
Address: 3200 Cobb Galleria Pkwy., Ste. #200 Tel. #
Atlanta, GA 30339
At 763-542-8826 arvey.ofthe
lot, ...— ,.,_ r,_..i..._� _.._.. r..._..,,......... .,il it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type: rsumawa t-osc: -�` i o&.j
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Driveway Curb Cut Width Needed:
Ft. + 6 Ft
Ft x $ = $
DATE: 506-Ok APPLICANT:j, Tel. #%a7= _ �004�
CITY USE ONLY
Permit Fee $ Fee Schedule on Reverse Side
Fire Surcharge $ =9 .001 of Permit Valuation (1/10th%)
State Surcharge $ 0.4(9 $.50/$1,000 Valuation
SAC Charge $ $1050 per SAC Unit
License Surcharge $ $5.00 (State Licensed Residential Contractors)
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 $ I a3= tv
STIPULATIONS: 5*-Ploxwe- Ar-72—V�x--,47— oWle-
3/d• /.
isjo� R7�Building Permit Service, Inc.
-o�l�iP„ (aid
1120 East 80th Street
Bloomington, MN 55420
Phone: (952) 345-6047
Fax: (952) 854-4909
To whom it may concern:
We at Elder -Jones Building Permit Service, Inc. are acting as an agent for RMA Home Services,
Inc. If there are any questions, or if the permit has to be picked up in person, please give us a call
at the number above. If the permit can be mailed back to us, we have enclosed a self-addressed
envelope for your convenience.
Thank you,
Kara Benson ext. 147
Elder -Jones Building Permit Service, Inc.
1120 East 80th Street " Bloomington, Minnesota 55420-1498
952-854-2854 1 FAX: 952-854-4909 `
)de.
SUBJECT
Efl33667
City of Fridley
AT THE TOP OF THE TWINS
I' I L D I� I G PERMI
BUILDING
�
`
Dv 'v
RECEIPT NO.
`COMMUNITY DEVELOPMENT DIV.
y______
PROTECTIVE INSPECTION SEC.
(�
r -
I .
NUMBER
REV
DATE
PAGE OF
I APPROVED BY
i CITY HALL FRIDLEY 55432
j 763-571-3450
1 910-F15
7/3/03
JOB ADDRESS 739 Mississippi Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
4
1
1 Clover Leaf Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Avis Soderstrom 739 Mississippi Street NE 763-586-8086
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
Residential
7 CLASS OF WORK ❑�
O NEW ❑ ADDITION ❑ ALTERATION X REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof House (27 Sq) Tear-off; Reside House; soffit/fascia
9 CHANGE OF USE FROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive
barrier be placed over exterior sheathing to protect the interior wall covering.
Exceptions for this provision would be if sheathing is an approved weatherproof
panel or when the siding is an approved weather barrier. Vinyl siding is not
a weatherproof covering unless the manufacturer states this in their application
guidelines. Call for inspection of wrap before covering or take pictures. Caulk
and flash all exterior openings. Underlayment must comply with the State Building
Soffit ventilation must 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
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
@
$5,526
@
$2.76
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-
$125.25
Fire SC $5.53
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTALFEE
$133.54
TURE OR AUTH aiZED AGENT ATEA
PROPERLY VALIDATED THIS IS YOUR PERMIT
aNA VCOTRACTOR
A�T_
)WIN
BNSR MATE
S-GNATURE Of OWNE
)de.
NEW [ ] CITY OF FRIDLEY
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432
ALTER [ ] SINGLE FAMILY AND DUPLEXES R4 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name & Ac
Contractor:
-A ""739 5-.ie-
Effective 1/1/2003
(763) 572-3604 Bldg Insp
(763) 5714287 Fax
SteTel. # -N 3 �-15�j�o -fo �%
MN LICENSE #
Address: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
EA- _ Length Width Height Sq. Ft.
5e`a
Length Width Height Sq. Ft.
DECK AREA:
OTHER:
Construction Type:
Hgt/Ground I Sq. Ft.
FF
Estimated Cost:
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
r
E APPLICANT:
l t%'�)k66Tel. #
DAT��'���'84��
Call (763) 572-3604 for Permit Fees If mailing in application. Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$� Fee Schedule on Reverse Side
$ .001 of Permit Valuation (1/10th%)
$ „c. $.50/$1,000 Valuation
$ $1275 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ j
Building
PLUMBING
Permit No. 1
Inspections -
RESIDENTIAL APPLICATION
Received By;
763-572-3604
DX 'P C 0
CITY OF FRIDLEY
DATE O 1 YOUR E-MAIL ADDRESS
SITE ADDRESS Snw.�L s s �ww,w
THIS APPLICANT IS: 0 OWNER NT Avis Soderstrolll
739 A4.* -ssi
PROPERTY NAME: Fridle P i Street
OWNER/ ADDRESS: y MN 55432 STATE ZIP
TENANT 6124180594
PHONE:
CONTRACTOR NAME:
SUBMIT A COPY OF STATE LICENSE # C% EXP DATE
YOUR STATE ADDRESS i CITY _' /S STATEAfAIP Sf'47Y
—
LICENSE WITH . PHONE &I Z 427— *033 FAX Z.
APPLICATION -
PERMIT TYPE
SINGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE
TYPE OF WORK:
0 NEW XREPLACEMENT
DETAILED DESCRIPTION OF WORK
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00; whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This-should_milect only, the cost of labor)
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 =
= FGRXROJECTS WHERE LABOR EXCEMSUft FEES ARE BASED ON $10.00 PER FDMME,-IXCEix-WHEAENGx'L£H;.: F.bMWS:-_. DMICATE TOTAL
NUMBER OF EACH BELOW)
_ BATH SINKII AV _FLOOR DRAINS _ SHOWER WATER PIPING
_
_ BATHTUB _ GAS PIPING p+remSWIMMING POOL WATER SOFTNER ($35)
_ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($1S)
_DISHWASHER -LAUNDRY TRAY WATER HEATER (S3S) FOR IRRIGATION
OTHER
Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $
Surcharge .50 Number of fixtures ® $I5.00 x $15.00 = $
TOTAL DUE $ Number of fixtures @ $35.00 _: x $35.00 = $ 35.00
State Surcharge = $ .50
Total = $
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.
% %
SIGNATURE OF APPLICANT PRINT NAME �e.[[' 1164 ON1 DATE
RN
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
Building
MECHANICAL
Permit No.. J '
Inspections
RESIDENTIAL APPLICATION
Received By: VW I
763-572-3604
CITY OF FRIDLEY
X01®
763-502-49777 FAX
EFFECTIVE 7-1-2010
1
DATEv YOUR E-MAIL ADDRESS
SITE ADDRESS %% efJ/ J'I-
THIS APPLICANT IS: WNER AONTRACTOR
PROPERTY
NAME: U J oN1
OWNER/
s�
ADDRESS: 729 Mij',r, I/ , f7, CITY ici%dIPV STATE l r"rt?2
TENANT
PHONE:
CONTRACTOR
COMPANY NAME: Netirle
SUBMIT A COPY OF
CONTACT PERSON: (jojA OnAK
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE WITH
q �y�
ADDRESS: 1 � Z� J�i/P,f CITY hd�CQ STATE w" ZIP°U�M.7
APPLICATION
PHONE X63 ` 5°Z�—��t1 FAX %��— �/2%�3204
PERNUT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALCIS PER MANUAL 2006 ASHRAE HANDBOOK.
Equipment Installed MFG: %Pr— 4,C MODEL: ZW r WO SIZE/BTU CGU
_?19
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZEBTU
/A/C
$25.00 _FIREPLACE (GAS) $15.00 GAS RANGEIOVEN $10.00
AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOILER $35.00 _FURNACE $35.00 _GAS UNIT HTR $10.00
_ LINER $10.00 GAS DRYER $10.00 _POOL HEATER $35.00
_CHIMNEY
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
E�$i s`
IN
h%dSte'= rY 'Y - U
0",? uX � i'f �� t✓ M y � � S
THIS IS AN APPLICATION FOR A PERMITNOT 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 w 1 w ' h requires review and approval of plans..
--��
SIGNATURE OF APPLICANT PRINT NAME V ® U DATE�� G
APPROVAL INSPECTORS SIGNA DATE
y F
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977