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PRE 2010 DOCSCity of Fridley ' SUBJECT 1.18023 AT THE TOP OF THE TWINS BUILDING PERMIT r i >r _____ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 1 = i 1 CITY HALL FRIDLEY 55432 �'"'"11.If %j NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/3/85 JOB ADDRESS 1544 Osborne Road N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 Blomberg Estates SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Garjac Inc. 481 - 206th Avenue N.E., Cedar, MN =55011 434-7096 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PVnRVrj NSE NO. 5 ENGINEER MAIL ADDRESS ZIP R019TEPSWng ca11'foc�JE�hl�ties Fl 0j, 8 USE OF BUILDING /� 'LUI.�•. Residential !��� 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 38' x 24' Dwelling and a 201 x 22` Garage with an 8r x 10' Deck 9 CHANGE OF USE FROM TO STIPULATIONS Provide sod in the front and side yards.. Provide City with a copy of the verifying survey before capping.. Provide a, hard surface driveway. SEWER LOCATION ; (Approx. 11 Deep in Street) 107' W. of M.H. (Inc. 893.88 WYE ELEV.- 893.48 TOP OF FOOTING: 896.98 Minimum WATER LOCATION: 77.31 E. of Stop Box Serving 1524 Osborne Road DRIVEWAY DEPRESSION: N/A 9EPARATE THE CITY OF FRIDLEY DOES NOTOT GUARANTEE TPERMITS REQUIRED FOR ACCURACY OF U•TIL,[TY LOCATIONS ANDELEVATION °U'3 V �, HEATING, PLUMBING AND SIGNS. THIS DATA IS FOR INFQRMATIBN PURPOSE$ ONLY, AND PERSONS USING THIS INFORMATION ,StJOULD. VERIFY IT ON THE SITE. 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 80 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 $29.58 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $59,150 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIO OF ANY OTHER STATE OR LOCAL LAW REGULATING. CON- $343.00 $425.00 S TION R THE PERFORQgANCE CONSTRUCTION. PLAN CHECK FEE TOTALFEE $ 85.75 $ 883.33 SIGNATURE OF CO TRACTOR ORA HORIZEDAGENT (DATE) - WHEN PROPERLY VA ATED THIS IS YOUR PERMIT i SiGNATUREOF OWNERIIF OWNERBUILDERI IDATEI BLDG NSP AT 01 e7JA S1 ( 91a NEW E6/ City of Fridley Effective 4/1/84 ADDN. [ ] R-1 AND R-2 ALTER. [ l Building Permit Application Construction Address: 1;S �M 121V r Iroh 6 Legal Description: I- C7 x/ l c 7 - '9'/ d 6 41 '�e o Owner Name i Address: I Tel. i Contractors 6"41py - `/V�_ Tel. d Address:— Kik 1 ,70 � ;t/� tit 1714F, <e P/fk /14L, rT() / LIVING AREA: GARAGE AREA: DEC[ AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT r Length Width o Height Length Width 2 2 Height Length b Width _L_ Hgt/Ground Sq. Ft. q�U Sq. Ft. 1)qd Sq. Ft. _ �0 Corner Lot [ ] Inside Lot Ft. Yd. Setback .r Side Yard Setback Type of Construction: e Estimated Cost: 8 Approx. Completion Date: s Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: 8 See Back Page for Explanation DATE: Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: U Tel. APPLICANT: CITY USE ONLY- 8Fee Schedule on Reverse Side 8 AS ,� 25% of Building Permit Fee 8 _Q $.50/81,000 Valuation 8 8425 per SAC Unit 8 Fee Determined by Engineering 8 V MW i LLA 7 V� rt u Agreement Necessary [ ] Not Necessary [ 7 fes` Surveyor's Certificate CONISTOCIC & DAVIS, INC. Consulting Engineers and Land Surveyors 1446 County Road J, Minneapolis, MN 55432, (612) 784-9346 SURVEY FOR: ; 4• t< +'- B S G Investments C211 C211 ,��� 961 Hillwind Road atfore diggin 8 Fridley, Minnesota 55432 01+jE-ElECTP+�"f''a" .EGUIRED CY COUNTY ROAD NO. /08 N 89' gtlka aI } - �i 3 .20 Cn 0 a 0 M T1T PlTTT T 7]T T A1�T OSBORNE ROAD) 07' 0+"\V - 100-ar' 11 1 � I s 59' 07' 01-11 E - Cl 9, 93" 4 0 0 z Lot 2, Block 1, Blomberg Estates, City of Fridley, Anoka County, Minnesota. SCALE: 1" - 40 0 Denotes 1/2" diameter iron pipe monument set and capped No. 10832. I hereby certify that this survey, plan or report was prepared by me or under my direct supervision and that I am a duly Registered Land Surveyor under the laws of the State of Minnesota. (� 10832 Nov_ 17, 1940 4278 9 y Reg. No. , Date Job No. Book No. 14 IY L; z« �O CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL ` Furnace Shell and Duct Work, Burner (Also replacement furnace) Gas Piping (piping needed with new furnace) Gas Range Gas Dryer RATE TOTAL $ 20.00 $ 10.00 $ 10.00 $ 10.00 • Air Conditioning (all sizes) $ 10.00 All Others/Repairs and Alterations It of Value of Appliance or Work COMMERCIAL/INDUSTRIAL It of Value of Appliance or Work State Surcharge TOTAL M Reinspection Fee ($15.00) Rough Insp. Date Final Insp. �`—bate Approval for Permit MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00 - PLUS $.50 STATE SUB V�- *Air nditioners can not be placed in side wri�n permission from adjoining S S Job Address 0 -e5z4�Z n5i)cu rne- + 1 cacl Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Tel. 0571-3450 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 a and correct. Fridley, Minn. -'?ti-t4,Jt -171eE�u::e� l-wa, OIiNER1� n F �4arc n Coo K KIND OF BUILDING ih rn I r USED AS �j TO BE COMPLETED ABOUT ^^ / -( ESTIMATED COST Ix so OLD - NEN BUILDING PERMIT M0. PERMIT NO. Fill out back side for stack verification on replacement furnaces DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Stem, Not Nater, 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 p� Company Iart 44q Signed By �► 1 I.L{` Yee X�� �'I 1 `��'ilt.f 1 Tel. No. Fill out back side for stack verification on replacement furnaces CHIMNEY AND STACK VERIFICATION 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 !_ole requirernents for size and total BTU connected Yes ( ) No 6. Has Tota 1 heating BTU's of All other BTU's TOTAL Rema rk s Company Signed By Da to 01 SUBJECT - R -- City of Fridley 9 81 1 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. y�y�,I � PROTECTIVE INSPECTION SEC. 1 � NUMBERREV DATE PAGE OF APPROVED BY i 1---1 CITY HALL FRIDLEY 55432 612-571-3450 910-F15 7/2/99 JOB ADDRESS 1544 Osborne Road NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 2 1 Blomberg Estates SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Bernier 783-1639 3 CONTRACTOR MAIL ADDRESS 55120 ZIP PHONE LICENSE NO Valley Investments Const. 2401 Lex 691-454-S191 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 0 ADDITION O ALTERATION IRx REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reside house and garage 9 CHANGEOFUSEFROM TO STIPULATIONS Call for building wrap inspection before covering. 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 80 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $8000 $4.00 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- FireAS ST ON OR THE PERF ANCE—OE CONSTRUCTION $153.25 $8.00 _ 2— PLAN CHECK FEE Licen $5 TOTA FE $ .25 IGNATURE OF CON" CTO. OR AUTHORIZED AGENT IDATEI N O ALIDAT FrIHIS IS Y UR P MIT 1 — S-GNATURE OF OWNERoF OWNER BVILDERI IDATEI IK—Dgr INS AgAfE 01 NEW[ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: v 59 qS1 a Owner Name & Address: �_ fob 6��!«� /sKY r�,edy j%MTeI. # A2- Contractor: V113 MN LICENSE # Address:0'6 fCtlOo' -f VA) 471E S. t hP.,AJ,00TA 9-91-!j AJ Tel. # �S/- Attach to this application, a Certificate of Survey of the q -V .10 lot, with the proposed construction drawn on it to scale. DESCRIPTION OF DIPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: ao Construction Type:&�, )J / A1)6 Estimated Cost: $ � CaO Driveway Curb Cut Width Needed: DATE: '? ` `)-^ � % APPLICANT: + 6 Ft = Ft x `$ CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ 0.00 .001 of Permit Valuation (1/10th%) State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Tel. # $ 00 $.50/$1,000 Valuation $ $1050 per SAC Unit $ -S�C7 $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 [ ] s o,o?S SUBJE& P City of Fridley 3 i 762' AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT _ COMMUNITY DEVELOPMENT DIV. ------ . PROTECTIVE INSPECTION SEC. �4 �� N�. f off I CITY HALL FRIDLEY 95432 NUMBER REV DATE PAGE OF AVPROVED BY 612-571-3450 910415 4/24/01 JOB ADDRESS 1544 Osborne Road NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 2 1 Blomberg Estates SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dale Lawrence 1544 Osborne Road NE 612-667-6503 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 JJ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE 7 REMOVE 8 DESCRIBE WORK Remove existing 8' x 10' Deck; Construct a 16' x 14' Deck 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan. Before digging call fol - all utility locations 4540002 REQUIRED BY LAW SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST, OCCUPANCY GROUP OCCUPANCYLOAD 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,464 $1.23 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- SC $2.46 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $83.25 Vire PLAN CHECK FEE TO AL FEE 86.94 ATURE OF CON'RAC OR OR AUTHORIZED AGENT q P� ��/,DA724V �l it �! Z i HEN PR P LD ,NSP VALIDA E THIS IS YOUR FRIT G/\/„"' 1 f)ATE -T ATURE OF OWNER❑F OWNER BUILDER, ,0 TE, NEW [ ] ADDN [ J CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Effective 1/1/2001 (763) 572-3604 Bldg Insp 601, Legal Description: Owner Name & Address: 'D cA-L K La -w vse� C -x— Tel. # 71,3- 7 g5=ct 5 - Contractor: Contractor: fuli;I>�C��F��3 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 LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height /� Sq. Ft. DECK AREA: Length I ` Width l ` Hgt/Ground !4q. Ft. q OTHER: *k N Construction Type:Wooda Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: i APPLICANT: Tel. # CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application Fee Schedule on Reverse Side - $ .001 of Permit Valuation (1/10th%) $ 1.3 $.50/$1,000 Valuation $ $1150 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 [ ] Building BUILDING Permit No.: Inogoi qif Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Dat;WodJUL 2 763-502-49277 FAX EFFECTIVE 1-1-08 DATE 3 ©S YOUR E-MAIL ADDRESS SITE ADDRESS /26Y1-1 ©-SAORme- A0 THIS APPLICANT IS: ❑ OWNER IeONTRACTOR PROPERTY OWNER/ NAME: ADDRESS: CITY STATE ZIP TENANT PHONE: NAME:- / � q eAXV ADDRESS: D%I K IR/CK d4Lho *A/ CITYINif STATEA&kIPJ"09' CONTRACTOR SUBMIT A COPY OFPHONE a�9 r FAX YOUR STATE LICENSE y STATE LICENSE # 9 1799 3 EXP DATE PROPERTY TYPE 91SINGLE FAMILYINEW CONSTRUCTION SIZE 00 ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH 9<0OF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION f?%AINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE:0%1,14 IIT - D poe SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY WiOUSE & GARAGE BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used. PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ADDITIONS & PORCHES SUBMIT: ❑ Vinyl ❑Soffit 1. Site Plan/Survey showing the existing structures ❑ Aluminum ❑Trim and proposed project. ❑ Other 11 Fascia 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: SING T 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ _�0��) OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1825 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21 =$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach 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 on site; that the work will be in accordance with the approved m the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT,.. . ^� PRINT NAME��iQ� ���//U DATE_? APPROVED BY _ DATE From: 763 576 5172 Page: 212 Date: 10/12/201012:13:06 PM Building MECHANICAL Permit No.. Inspections RESIDENTIAL APPLICATION Received By: � 763-572-3604 CITY OF FRIDLEY'�' � 763-502-4977 FAX . - EFFECTIVE 7-1-2010 DATE ® 1 i L I in YOUR EMAIL ADDRESS _ _ C (1'16 r . SITE ADDRESS i54q - 0-,,baraP. Rnnd1 Fri die ".14 THIS APPLICANT IS: O OWNER MCONTRACTOR PROPERTY Nom: OWNER/ TENANT ADDRESS: CITY STATE ZIP PHONE: CONTRACTOR COMPANY NAME:��-I- SUBMITA COPY OF CONTACT PERSON: On 1 C1 5. YOUR STATE STATE LICENSE it_ 33C) (D EXP DATE LICENSE WITH APPLICATION A ADDRESS: 33q Aya C111- Cmf1 �iY1 STATE rvr"ZIP 5531 iry PHONE (9)�i-Ciq()---79710 FAX 7b3'�7 Z PERMIT TYPE SINGLE FAMILY iI TWO FAMILY O TOWNHOUSE TYPE OF WORK: o NEW PVLEPLACEMENT O ALTERATIONIRENIODEL DETAILED DESCRIPTION OF WORK f nS d-ct 1 ? N e W Ftxrn C C hn mertA4 FEES ARE BASED ON S10.00 PER FIXTURE, EXCEPT WHERE TOTED. FIXTURES! (INDICATE TOTAL NUMBER OF EACH BELOW) PROVIDE HEAT LOSS CALC'S PER MANUAL d 2006 ASFn1AE HANDBOOK. Equipment Installed MFG: ArnericAn Sjnnelar� MODEL: AUH A &Q46 O AqV SIZE/BTU 60.000 MFG: Anricknd-MayArd MODEL: it A 7 &5 o a t{ 1E SIZEMTU •l T. MFG: MODEL: SIZEMTU . Zi A/C S2S.00 FIREPLACE (GAS) $15.00 GAS RANGFIOVEN $10.00 AIR TO AIR EXCHANGEER $15 _FMEPLACE(WOOD)$35.00 NEW GAS GRILL $10.00 BOMER $35.00 ') FURNACE $35.00 __,_GAS UNIT HTR $10.00 CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER 533.00 _DUCT WORK $10.00 GAS PIPING $10.00 —VE MATOR $15.00 Number of fixtures ® $10.00 _ _ - x $10.40 = $ Number of fixtures a. S 15.00 x $15.00 = $ Number of fixtures @ $25.00 � j x $25.00 = $ Z,00 Number of fixtures® $35.00 i x $35.00 = $ 35,06 State Surcharge = $1 5.00 FEE $40.00 Total = $ 1p6 oa THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby apply for a building permit and 1 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; Mat l understand this is not a permit but only an application for a permit and work is not to without a permit; that the work will be in accordance with the approved plan in the case of ark which requires review and vol of ans. SIGNATURE OF APPLICANT WN7 gOn M oQ d l e DATE 10 1 ZO t) APPROVAL INSPECTORS SIGNATURE - DATEzal� Ilv PLEASE NOTE: SEPARATE PERMITS.ME REOUERED P01t BUILDING, ELECTRICAL AND MECUAMCAYWORK City of Fridley ,ilding Inspections Department 6431 University Avenue NE, Fridley, NN 55432 763-572-3604 FAX: 763-502-4977