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PRE 2010 DOCSCity of Fridley, Minn. BUILDING 'PERMIT Date:1�....._.-_5­1"' _ a Owner: f uilder Address — Address No :5:769)( L� L NG No�- Street ° _ Pari t -- Air It* f Lot _d& __ Block * -. _ Addition or Sub -Division . Corner Lot _ _ Inside Lot _ Setback -d.._ Sideyard -A Sewer Elevation - - _ __ _ _ __ Foundation Elevation DESCRIPTION' OF BUILDING To Used �, : � /� Front Depth Height w 4 Sq. Ft. / Cu. Ft. Depth __ eight Sq. Ft.._ _ u. CFt. Type of Construction *�-___._ Est. 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. it 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 thatperson to whom it is granted and his agents, employees and workmen, in all work done in, around and upon the 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 y�olation of any of the provisions of said ordinances., , �e"�r Building L Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to am the Building inspector for separate permits for these items. 4 Owner ' is No APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA LOCATION OF BUILDING Lot �dock, Additio or ivis or, . Corner Lot Inside Lo _„"_Setback„.'Side-yard SEVMR ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building 'location. DESCRIPTION OF BUILDING To be used as Front„ Depth Height Sq. Ft, 1,3eo -----.cu. Ft ... 4t�qo ,.. Front ----.Depth , Height Sq. Ft. Cu. Ft. Type of Constructions<Estimated Cost es To be Compl( 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 ruling of the Department of Build - and hereby declares that all the facts and representations ststed, in this application are true and correct. .DATE ;� SYGNATURE�-_ (Schedule of Fee Costs can be.found.on the Reverse side). (- 0- . 3 Application for Power PI1 nits and Heating. Cooing. Ventilation, AeMgera tion and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU. 4-7470 GRAVITY WARM AIR: RATE TOTAL, Location 5.11:E1 Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 Repairs & Alterations—up to $500.00 .................. 5.00 Repairs & Alterations each add. $500.00 ............... 2.50 MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 each add. 60,000 BTU .... . .................. 2.00 Replacement of Furnace .............................. 5.00 Repairs & Alterations—up to $500.00 5.00 Repairs & Alterations each add. $500.00 .............. 2.50 STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ r Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ �� Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) 5.00 $ R �� GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... * $1.50 $ /• Sd Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ ROUGH 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 true and correct. Fridley, !!Kinn_ 19 Owner Kind of Building��--� Used as A To be completed about -- �,� ✓�� Estimated Cost, $ !ou®tea Oldew uilding Permit No. (/0 Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS --Ste of Wa Warm Air—No- Trade Name Size No Capacity ep Sq. Ft. E.D.R BTU H.P. Total Connected Load ®®a Kind of Fuel BURNER — Trade Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) Signe By w 42 2M 7-59 Business Phone No NAME �r�} H Z;C : - COO N T R . [ADDRESS`/ FL. ROOM LENGTH WIDTH HEIGHT WINDOWS AV DOORS-CRACKAGE AND AREA N0. I WIDTH I HEIGHT No OF LINEAL FT AREA LIGHTS OF CRACK SQ. FT COEF.1 BTU INFILTRATION GLASS EXP. WALL NET EXP. WALL CEILING FLOOR TOTAL BTU. FL. ROOM LENGTH WIDTH HEIGHT WIND WS AN DOORS-CRACKAGE AND AREA NO. WIDTH I HEIGHT I N0. OF LINEAL FT. AREA LIGHTS OF CRACK I SO..I' COEF. BTU. INFILTRATION GLASS EXP. WALL NET EXP. WALL"24.C;2142-40 CEILING COEF. BTU. DATE J O B [ADDRESS- FL.1AtZ,45��R M LENGTH ,�, WIDTHJ HEIGHT WIND WS AND DOORS-CRACKAGE AND AREA N0. WIDTH HEIGHT N0. OF LINEAL FT. AREA LIGHTS I. CRACK SQ. FT I I I I I I COEF.I BTU I INFILTRATION I BTU,, I I'7- V GLASS GLASS pp / t� TOTAL'BTU. C) EXP. WALL r� 6 a, FL. ROOM LENGTH WIDTH HEIGHT WINDOWS AND ORS-CRACKAGE AND AREA 4L6 _0 ! NO. WIDTH HEIGHT N0. OF LINEAL FT. L ITS OF CRACK AREA So.. FT. CEILING L) C4° . gGH �y VX),3,O COEF. BTU. DATE J O B [ADDRESS- FL.1AtZ,45��R M LENGTH ,�, WIDTHJ HEIGHT WIND WS AND DOORS-CRACKAGE AND AREA N0. WIDTH HEIGHT N0. OF LINEAL FT. AREA LIGHTS I. CRACK SQ. FT I I I I I I COEF.I BTU I INFILTRATION I BTU,, I I'7- V GLASS GLASS pp / t� GLASS C) EXP. WALL r� 6 a, EXP. WALL NET EXP. WALL NET EXP. WALL NET EXP. WALL 4L6 _0 ! CEILING CEILING ✓ a Jj CEILING L) C4° . FLOOR VX),3,O FLOOR 12 TOTAL BTU. TOTAL BTU. TOTAL BTU. FL. D ROOM LENGTH FL. d� ROOM LENGTH ® WIDTH DOORS•CRACKAGE AND AREA HEIGHT N0. OF LINEAL FT. AREA LIGHTS OF CRACK SQ. FT. HEIGHT WINDOWS AND DOORS-CRACKAGE AND AREA -N0. WIDTH HEIGHT NO. OF LINEAL FT." LIGHTS OF CRACK AREA SQ. FT. 43 - 1) I I 1 1 1 1 COEF.I BTU. INFILTRATION COEF. BTU,, INFILTRATION GLASS pp / t� GLASS GLASS r� 6 a, EXP. WALL EXP. WALL NET EXP. WALL NET EXP. WALL 4L6 _0 ! CEILING ✓ a Jj CEILING L) C4° FLOOR FLOOR VX),3,O FLOOR 12 TOTAL BTU. TOTAL BTU. FL. D ROOM LENGTH WIDTH WEIGHT WINDOWS AND NO. WIDTH I DOORS•CRACKAGE AND AREA HEIGHT N0. OF LINEAL FT. AREA LIGHTS OF CRACK SQ. FT. STEAM TOTAL SQ. FT. H.W.-4G I I 1 1 1 1 COEF.I BTU. INFILTRATION INFILTRATION GLASS �° GLASS r� EXP. WALL EXP. WALL NET EXP. WALL 4L6 _0 ! NET' EXP. WALL CEILING ✓ a Jj CEILING L) C4° FLOOR FLOOR 12 TOTAL BTU. TOTAL BTU. TOTAL BTU. HEAT LOSS ®® ® HEATING UNIT TOTAL E.D.R. STEAM TOTAL SQ. FT. H.W.-4G COEF.1 BTU COEF. BTU INFILTRATION lqoINFILTRATION �) GLASS, EXP. WALL NET EXP. WALL CEILING FLOOR I I I I I COEF.1 BTU. COEF.1 BTU. INFILTRATION � GLASS NAME ' DATE NAMI�� H I G. C'a N T R �7 p TOTAL BTU. J O B [ADDRESS FL. LADDRESS d /�'492, FL. C) JFL. I ROOM LENGTH WIDTH HEIGHT FL.$OOM N0. I WIDTH I LENGTH ,;„ WIDTH cAaDikEIGHT WINDOWS AND DOORS-CRACKAGE AND AREA WINDOWS AND DOORS-CRACKAGE AND AREA NO. WIDTH HEIGHT No. OF LINEAL FT4 AREA L I GHTS OF C,R+A�CK SQ. FT NO. WIDTH HEIGHT N0. OF LINEAL FT. AREA L I GHTS OF CRAACC SQ.. �i ! per. RsL /l /_ —4P % / Z/ i --,2O X -b COEF.1 BTU COEF. BTU INFILTRATION lqoINFILTRATION �) GLASS, EXP. WALL NET EXP. WALL CEILING FLOOR FL.� Z ROOM I LENGTH WIDTH HEIGHT 6 FL. ROOM LENGTH WIDTH HEIGHT WINDOWS AND DOORS•CRACKAGE AND AREA WINDOWS AND DOORS-CRACKAGE AND AREA N0. WIDTH HEIGHT LIGHTS OIF CRACK SQ. TAREA . NO. WIDTH HEIGHT LIOGHTS OF CRACK SQR FT. INFILTRATION 62/4 GLASS EXP. WALL NET EXP. WALL CEILING COEF. BTU. I I I I I COEF.1 BTU. COEF.1 BTU. INFILTRATION � GLASS GLASS f NET EXP. WALL TOTAL BTU. EXP. WALL TOTAL BTU. GLASS FL. NET EXP. WALL d /�'492, FL. C) ROOM LENGTH WIDTH HEIGHT CEILING WINDOWS AND DOORS-CRACKAGE AND AREA N0. I WIDTH I 4) FLOOR EA NEZ FT. RFT. HEIGHT �OIGH�S OF CRACK SO. FLOOR OF CRACK SQ FLOOR TOTAL BTU. _. TOTAL BTU. TOTAL BTU. FL.� Z ROOM I LENGTH WIDTH HEIGHT 6 FL. ROOM LENGTH WIDTH HEIGHT WINDOWS AND DOORS•CRACKAGE AND AREA WINDOWS AND DOORS-CRACKAGE AND AREA N0. WIDTH HEIGHT LIGHTS OIF CRACK SQ. TAREA . NO. WIDTH HEIGHT LIOGHTS OF CRACK SQR FT. INFILTRATION 62/4 GLASS EXP. WALL NET EXP. WALL CEILING COEF. BTU. I I I I I COEF.1 BTU. COEF.1 BTU. INFILTRATION GLASS EXP. WALL NET EXP. WALL TOTAL BTU. CEILING FLOOR COEF.1 BTU. FLOOR INFILTRATION INFILTRATION TOTAL BTU. TOTAL BTU. GLASS FL. ROOM LENGTH WIDTH HEIGHT FL. EXP. WALL ROOM LENGTH WIDTH HEIGHT WINDOWS AND DOORS•CRACKAGE AND AREA WINDOWS AND DOORS-CRACKAGE AND AREA N0. I WIDTH I HEIGHT ��GHTS ET. N0. WIDTH EA NEZ FT. RFT. HEIGHT �OIGH�S OF CRACK SO. FLOOR OF CRACK SQ TOTAL SQ. FT. H.W. COEF.I BTU. COEF.1 BTU. INFILTRATION INFILTRATION GLASS GLASS EXP. WALL EXP. WALL NET EXP. WALL NET EXP. WALL CEILING CEILING FLOOR FLOOR TOTAL BTU. TOTAL BTU. TOTAL BTU. HEAT LOSS HEATING UNIT TOTAL E.D.R. STEAM TOTAL SQ. FT. H.W. COEF.I BTU. City of Fridley Application for Plumbing and Gas Fitting Porn* DESCRIPTION OF WORK Number, Kind and Location of Fixtures I_x SCHEDULE 12 ING FIXTURE RATES: Z Number Fixtures ..................... y zy u°fi O x J w O Z z f H WATER HTR. x 3.25 $ 4-O 3C3 $cro �� x 3.25 $ �+� C� SO �.m Q3 d �4c (�90 F 'N GAS ELEC. m Base (a 1st 2nd 3rd — 4th • Future Connection Openings I Connected with Sewer New Fixture, Old Openings I 1 Cesspool � PLUMB GAS FI n PARTIAL RATE SCHEDULE ING FIXTURE RATES: NO. RATE OTAL Number Fixtures ..................... 16 . x $1.50 $ Future Fixture Opening— x 1.20 $ New Fixture Old Opening .............. x 1.00 $ latch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $cro New Ground Run Old Bldg . ............ x 3.25 $ TTING FEES: NO. RATE TOTAL 1st 3 Fixtures .........................._—� x $1.50 $ d Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................ TOTAL FEE $` Dept. of Bldgs. Phone SII City of Fridley: The undersigned hereby .makes application for a permit for the work herei specified, agreeing to do 411 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. Fridley, Minn 1 19— Kind of Building Fa, Used as Z)%&/ To be completed about Estimated Cost, $ Old—New. Building Permit No 69 Permit No. cZ=2– �– Signe i Business Phone No m/r� - C 11 -�� ROUGH r � FINAL 01 sue.;E& MIT City of Fridley 30694" AT THE TOP OF THE TWINS I I L D I A� G BUILDING D[RAA e PERMIT r ©' v v 'Y1 R T NO. COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r PROTECTIVE 1 i CITY HALL FRIDLEY 55432 NUMBERREV DATE PAGE OF APPROVED I3Y 612-571-3450 910-F15 3/1/00 JOB ADDRESS 5517 Regis Trail NE 1 LEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 2 Parkview Oaks 1st Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Scott Solz 5517 Regis Trail NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Sela Roofing & Remodeling Inc 4100 Excelsior Blvd, St Louis Park, MN 55416 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 823-8046 1050 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION fel REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof House & Garage (24 Sq) Tear -off 8 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,098 $1.05 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 - Fir SC $2.10 OR THE PERF RMANCE OF CONSTRUCTION $83.25 Q� PLAN CHECK FE TOT FEE XSTRUCTION, /� _L Licens $5.0 $91.40 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGE IDATEI E IS YOUR PERMIT OPROnVALIDAFTEOFTHIS BL G INSF' T1AfE SIGNATURE OF OWNERIIF OWNER BUILDERI IDATEI 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: Owner Name & Address:&l Z. S( `� ,� �� Tel. # LLF--- S%40 Contractor: SELA ROOFING & REMODELING, INC. MN LICENSE #41M EXCtEsIuR BLVD. �� S Address: ST. LOUIS PARK, MINNESOTA 5541s Tel. # Atta,C.T,to®thils® application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: �L(.s� � � Construction Type: I�0q 1�n e- Sab� Estimated Cost:. . 0— Driveway Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ '3 DATE: Z L -CC •- 6-t) APPLICANT: Tel. # (—C? - CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ �- �� .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ E; , 0 o $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 [ J TOTAL $ 0 STIPULATIONS: CITY OF FRIDLEY PE M kIT NO.: 200 $� 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 05/14/2004 571-36U4 FAIT: (763) 571-1287 ADDRESS 5517 REGIS TRL NE PIN 243024310055 LEGAL DESC PARKVIEW OAKS 1ST ADD LOT 2 BLOCK 2 PERMIT TYPE BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 9,294.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CONSTRUCT AN 18'X 12' UNHEATED THREE SEASON PORCH ADDITION. STATE LICENSED CONTRACTOR 1 APPLICANT AL -KO HOME IMPROVEMENT (1927) 8090 4 AVE LINO LAKES, MN 55014 SOLZ SCOTT A 5517 REGIS TRL NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of r y other state or local law regulating cpp cyq9or th e ance of constructipnl Bldg BUILDING PERMIT FEE 181.25 PLAN CHECK FEE 117.81 FIRE SURCHARGE 9.29 STATE SURCHARGE, VALUE 4.65 LICENSE SURCHARGE 5.00 TOTAL 318.00 PAID WITH CHECK # 9890 x SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. NEW [] CITY OF FRIDLEY earlll Effective 4/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION `�) . 7i Construction Address: Legal Description: Tel. # Owner Name ddress- Contractor. 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 LMNG•AREA: Length Width / Height Sq. Ft �( Orr GARAGE AREA: Length Width Height Sq. Ft l DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: Construction Type: Estimated Cost: 1 00' Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$ DATE: APPLICANT: Tel. &� r-211 17631 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 NLY- „Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ $ fol Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 per SAC Unit $5.00 (State Licensed Residential Alt. "A” or Alt. "B" Above $450.00 Conservation Plan Reviev► Fee Determined by Engineering Agreement Necessary [ ] Not Nec STIPULATIONS: 0 `2"& 2�L ASSOCIATES, INC. VIEW- ROAD• ENGINEERS &'. LAN.D.SURVEYORS, WE 9-7590 MINNEAPOLIS 124, MINN, CERTIFICATE OF SURVEY Ber L De:- Builders, Inc.Jile No. Book ZS 7__Page _LL /90, Z—VC AIR 199 L0 7134 I hereby certify that this is a true and correct representation of a survey of the boundaries of Lot 2 Block 2. Parkview Oaks tl First Addition, Anoka County, Minnesota and of the location Of 41k 4j M` all buildings thereon, and allvisible encroachments. if any from or on—said land. Surveyed by 'this 9th Day of February 1962 la x''61 6 iJ.' 'mss. e f v+ & .­�. r WARE���_ , 125__- *00*0 j�� 0991 eq Z Q91'20 0U­U%1,1._177z.1�%. CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 N'AX: (763)571-1257 ADDRESS 5517 REGIS TRL NE PIN 243024310055 LEGAL DESC PARKVIEW OAKS 1 ST ADD LOT 2 BLOCK 2 PERMIT TYPE ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-009384;2 DATE ISSUED: 06/18/2004 VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. # 0-100 AMP CIRCUITS 2 APPLICANT ELEC CIRCUIT FEE (0-100 AMPS) SOLZ SCOTT A ELEC AMP SERVICE FEE 5517 REGIS TRL NE ELECTRIC FORM FEE FRIDLEY, MN 55432 STATE SURCHARGE, ELEC FLAT TOTAL OWNER SOLZ SCOTT A 5517 REGIS TRL NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 12.00 30.00 1.00 0.50 43.50