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PRE 2010 DOCSCity of Fridley.170.1..9 SUBJECT PE AT THE TOP OF THE TWINS BUILDING PERMIT ®a r RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 l NUMBER TREV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/24/83 JOB ADDRESS 1480 Rice Creek Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 Heather Hills 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Star Homes LTD 7691 Central Avenue N.E. 780-5500/786-3054 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 ClX NEW ❑ ADDITION ❑ ALTERATION ❑ o REPAIR ❑ MOVE ❑ REMOVE S DESCRIBE WORK Construct a 52' x 24' Dwelling and a 24' x 22' Garage 9 CHANGE OF USE FROM TO .STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side yards. Provide City with copy of verifying survey. SEWER LOCATION: (Approx. 10' Deep In Street) 108.5' E. of M.H. (Inv. 920.05) WYE ELEV: 916.81 TOP OF FOOTING: 919.81 Minimum WATER LOCATION: 11.4' W. of Sewer Service, 87.8' E. of San. M.H. 50.4' N.E. of 1411 Cottonwood DRIVEWAY DEPRESSION COST: N/A a •� cify Q' �� � �S NOT - GUARAKTRE T�_• WAR t . I #VACv CW UTIUW IOWIONS AND REVAh' ���� I�tli OAIA (S 1'OR IIVfp1lMA�ilCii�1 PURpo= ON4Y AM- Before di tEt�'HONE . g cap total utfl�tlea R �" 1�t" ng Q�1/ATIC>wv ELECTRIC + 6,S Etca SEPARATE PERMITS ARE FI Q IR ,R JAWA ,PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frame 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 1250 OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1 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 $76,850 $38.43 WITH WHETHER SPECIFIED HEREIN OR NOT. T.HE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITFEE SAC CHARGE PROVISI OF ANY OTHER STATE OR LOCAL LAW REGULATING CON - $364.00 $425.00 SR ION R THE PER MANCE OF CONSTRUCTION. f3 PLAN CHECK FEE TOTALFEE V/ $ 91.00 $918.43 SIGNAT OF CONTRACTOR OR AUTHORIZED AGENT (DATE) HEN PROPE//R{{LY V IS YOUR PERMIT �ID/AyT,EgD �THIS SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI -4 Effective Aug. 1, 1981 CITY OF FRIDLEY APPLICATIM FOR RESIDENTIAL BUILDING PEW41TS (New, Alterations, Additions, or Repairs) OWNER: SF/ e 110mrzf ADDRESS: 7�y/ e1Q� CF',.Z-444- TEL A0: U69- S'�S-®e - 7 kc -33 BUILDER: I-A/vte-s C ,'t, ADDRESS: TEL 110: Construction Location STRICT NO: �® STREET: 10" e,' LOT: BLOCK: ADDITION:-�'7�®' Corner Lot: Inside Lot: Setback: .0 Sideyards : Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONISTRUCTION [ >F— Front: ��� Depth: Height: 2-o Square Feet: /c2z fo Cubic Feet: �,�}�� Front: `1 Depth: `z - Height: Square Feet: Cubic Feet: .ype of Construction: Estimated Cost: S To Be mropleted: P - r Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: SEE mVFR,,i.' SIDE OF 8MEET Mie undersigned hereby makes application for a permit for the work herein specified, agreeing to do .all Mork in strict accordance with the City of Fridley Ordinances and rulings of the Depzirt7nent of Buildings, and h by declares that all the facts and representations stated in this applicatio ar true and coact. DATE: � � � "-'SIGNATUrc : l Stipulations: 4 . (V ---1 Q41 �Q '- , / g tai ql �'� SUBJECT r P City of Fridley 2 81G6 0 AT THE TOP OF THE TWINS BUILDING PERMIT i R NO. k72COMMUNITY DEVELOPMENT DIV. �S.�I�ECTIVE INSPECTION SEC. Y�/CITY HALL FRIOLEY 53432 NUMBER REV DATE PAGE O: APPROVED BY L 612-571-3450 910415 10/8/98 10B ADDRESS 1480 Rice Creejj 1 LEGAL LOT NO. BLOCK I TRACTOR ADDITION SEE ATTACHED DESCR. 2 2 Heather SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard Reese571-9669 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO All Am. Roofing - 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 O ADDITION ❑ ALTERATION gx REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage 30 S Tear -off 9 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 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 2571 $1.29 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- STRUCTION OR THE PERFOR F CONSTRUCTION $74.75 Fire SC 2.57 / PLAN CHECK FEE TOTAL FEE (•fad` /�� �^ - License 5.00 83.61 RE -CONTRACTOR OR AUTHORIZED AGENT IOATEI WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT I!fl,- S,GNATUBE OF OWNER.1F OWNER BUILDERI IDAiEI BL INS r)ATE NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ 1 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION 9((Oo e ConstructionAddress: 141&-Q f L C - le Cr e e �C 1t) (Z Legal Description: Owner Name & Address: cykaV' A VP- eS e Tel. # 571- SoG T Contractor: ALL Am ei2 i e - A k) 6Z u D � % n (, MN LICENSE # 51(-0 Address: 4 < < -, q -1 } L&' 1%j e . Tel. # 4 - LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. (-ecoe-- Of F �Z -e-yooJ�? sO S� Driveway Curb Cut Width Needed: DATE: [ 6-�- --i "d *'6 v �-9/ Estimated Cost: $ Cc (Fee Schedule on Back) Ft. + 6 Ft = Ft x $ = $ APPLICANT: ALI 19C2 z ajL Tel. # CITY USE ONLY Permit Fee $ " ?S Fee Schedule on Reverse Side Fire Surcharge $ �. �'7 .001 of Permit Valuation (1/10th%) State Surcharge $ A $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ S-,60 $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 $ to t STIPULATIONS: -'ITY OF FRIDLEY INSPECTION DIVISION 5431 University Ave NE . =ridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 372.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES • P JOB ADDRESS i I � '\1C � C--e-k-'- '1r i OWNER ;aJ.I�\���� _ RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range. Gas Dryer "Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate $ 30.00 . $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr "Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. TOTAL Effective On May 10, 1999 BUILDING USED AS ESTIMATED COSTt PERMIT N0. / DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot - Water) r arm Trade Name 71 1 7Size No. J - $ - BTU `1Cf�`�_ HP EDR $ Fuel,_ �— Total Connected Load Burner Trade Name Size No. $ BTU HP EDR $ 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 ar $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. 'FC'C'! 61 Of3A1 RAPQS C N RAPIDS, MN 0433 :EAT I NG f2 757-5040-d.> �� $ E- : - Approved By Rough -In Date Final Date al. OUT BACK SIDE F CEMMI AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes 66 No ( ) 2. Is free from rust or deterioration 3. Has no foreign objects lodged within 4. Is securely supported 5. Meets all current Code requirements for size and total BTU's connected Yes (.. No ( ) Yes) No ( ) Yes . -�No ( ) Yes. No ( ) 6 Has total heating BTU's of� All other BTU's TOTAL BTU's I '� 7. Has a liner been provided for water heater Yes y) No ( ) 8. Has combustion air been provided for water heater Yes O.Wo ( ) Remarks; .hist ALTERATION-Being�Done• "� a irk c, , Z;.0INZ t n it ml HEATING CO: Signed By: Date: rl N 4V aa. at eti 49 DEPENDABLE INMAIRQUALITY, INC. , � COON RAPIDS eoulFvwm COON RAPIDS. MN SEi433 � g (612) 757-5040 11/2072000 16:57 ADDRESS eQZ OCCUPANT HEAT LO SOLD By Elocnritol wwk TYPE OF HEAT GA 7637575751 DEPENDABLE INDOOR PAGE 02 HOUSE HEATING TEST RECORD 4' APT.FLOOR CITY �Lv___.eSUEURR�._,�,�,m OWNER V;—,*MT T. INSTALLED BY —Co. Line 91 FA H STEAM _.,SPACE MTR, UNIT HTR. 0TME'R A E SIGN MjkKE MAKE OF BURNER _ Serial WAx. HTU Rating INPUT HAKE OF I'URN4CE• Model CONVERSION CONTROLS TTiERM057AT Vert Sise Volvo KIND OF LIR" __ _ SIZE NONE Limit Drok Haod lover Limit Boning Fiitws $ise z Ga rlluwyer Fen Sorting — Chimney Location In Ovtsitle Pilot Type Chimney construction Pilot "mks $pillage Piles ►iodal S,.eke Bomb Pilot Timing Draft Test Tag L.W. Cwt off DealPreuur. L; gitling Inst. Presses.' —7 Percent CO' Dote Tested Input CEN Pere.nr 02 Company Teating Sruet Temp. ® Percent CO No -.a of Tester Certific:at® C pentency_ FMM :City of Fridley Building Imspections 763-572-3604 TM3 AFTLTCANT i$: P76FR*KUte TMIWE -3, 5`71-~ 12 8"7 FA v, Ha ; 7635-711287 lir. 07 W06 10 -' a?. A4 P2 BUILDING RESIDENTIAL APPLICATION MY OF . IDLES' Permit Wn.. Recdvcd Date Reed; TATE .. CONTRACTOR NAME � •�... c5 � -- j S'ShT� t,�f'�RhiS� �1,� � � 87cp' FyA7Te Wj�jLS ,11aix1coPYog * t $.zEL 'CTnT IIs - YOM STA". LICEN&S ADDYM W1,1 f3' APA�,ICA,l10N ri8tiN8 PAX. ` sm . 1�Cii. PAT ++ni.Yi t; Q1`3'R i'RiiC!"fC� `T'icl� - -�— Q TWCIFAfi�IL YtI 1W-C�)NSTRUCT1UN S'PIORWA bows. .� P>181KFP'1'iti'� A,pD17'�AN � (;ARACT�i� DRAIN ,1,� 0RASiiMBAIT FDaL�Ii 0 Roof II fimm O OTHNK [a SUUIMRAii�t3. C1UL r— 'ifft OP` �GiYORL{: ❑ 4 _ C] a siTlf3Ori- ❑NIAITdi�IAl+1 Wa>ztc �rrlua nam:._ —..�,p u -m, arr .ria. Ft. SQUAM — am PROPOSED SF"- �T Mtn ClY ©AhgAiMm O ottsa_— G n011SM 4a UARACM L) A-M-AC3-M CA3A4CJE C1 DETACfMD t3ARAC9, C9ao}3'it D Trim O Vdad# �(aQp1ihTlkdGS EP ©IQo TOCATIGN�1N{plWWS OR iaDki.mw opwMas- S OF - OPEfiiINC, CHANEW & . _ /'M .t 4W 0A. a a,rt mina rrF tit9N1M9W3 A.` i ON YI1ir5TAT()N. V4CLUDING 1W, COST OF "ftlrn��i X3ASr+AdF3d't'.R�QDRt' nur„ filifa14ti7': !. Exisft Fkor Mrs - - -- 2. 1'apoeod floor pia* 3. Ust of "un-aF rFmd— to be usai FOR 1_wI CONSTRtJMt'iiJ WtAMW D=, Amo... rt: } . lte i 1asltSs�rvcT showing the e.xistusgstroettM sssd Ps 6P Prniaat. IVO tm ¢fbtatl{7udion AIMS 3.Pzma Cowuhtiou ME PCYF4'17 lope" ••s' g - �� '� See $jKk Page for Fee 5e )adore PW i GNiBW _ ^ bm/o of 13i}lldin.S ft] a Flit Fed '— _ .001 times tim total job VgLlmti m NO SUMI ax9a lo. qv $ -000S x Permit Valugtjeu A, nimum 5.50 Swcbwgr. S'- 16- SAC CbAT%& � . � � ••. $ ^ �._.... _.. $1550 Pv S.II.+C th it M=s to MWCC for 461.1-1 instioa) C-`�lr,b Cyst Es"" � _ +b itx$20-S $450 Conumvaacm PIfin 1tb%'vw HarkF4pe pt# (:ot13Y41 �-.�- Pee I]cftrP incd by ung ark �.....-�-� Nrn NetxsgarY i, ) Ses Main ' Mike Agncmetcetss�e me; C of.Ft^ dl w Att rie .^stiptttl ##blas TOW One M L^, AN APPLtCATjOt4 >tO1t it pERdd4'I,r4oT V/tUQ iJN In,,, thog workhe 1 } c=by irpply t'ar a tmjfds=a4 •}mit =,A T vA&Y nwledW-- +T,et fhO ivlorFxs ,,on above is eomtaicxo mWt►atrT est I »A4terstte lisiasTi�t r�otta 4=ful'� mme With The oWkacce4 anti OW" of th+e City Of Eridiq and witt! a Minpc.!ltalts CollBi ction Codm; t tho wcTk will Tats m sccordencs with the approv0d P� but only axn, applirzsttctn fore }aGtmet Wvro*k is not tostart ahtheut A permit; 'the pinffi ftua of oil work w spptov&i of 012M. .."�} '-� .( .._ SMA71 Building BUILDING Permit No.:` - i /L- Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY DatRK�dJ- % �- l� - DATE YOUR E-MAIL ADDRESS SITE ADDRESS NXD 1 �+ \ lc�e C .6`�/ r . THIS APPLICANT IS: ❑ OWNER AtONTRACTOR PROPERTY OWNER/ NAME: • TENANT ADDRESS: 149Y10 Kir-e- Cr e e /C * CITY fir ley STATBg ZIP PHONE: / l• j "1,r` + !1/7 —1,-', CONTRACTOR NAME: SUBMIT A COPY OF STATE LICENSE #_ -;2(��� 3 c/ 7 13 U EXP DATE 9 /L�LV g YOUR STATE LICENSE ADDRESS: 0 .1 (0 • h b n &J CITY f ,° c-e 1 STATE�°isvZlP S_ S �i/ WITH APPLICATION PHONE .7 FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAW TILE ❑ DECK AkSIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: Via- �, e S ; SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. FL ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1- Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2. Proposed floor plan PROPOSED HEIGHT: 3. List of structural members to be used SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum "— E3 Trim 1. Site Plan/Survey showing the existing structures ❑ Other ;' >x ❑ Fascia and proposed project wIINDOWs 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations 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: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ Z43 3 -/, OCCUPANCY TYPE Permit Fee $ .� ej, �� See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ Z23 .001 times the total job valuation Surcharge $ S� l V .0005 x Permit Valuation Minimum $.50 License Surcharge $ ( $5.00 (State Licensed Residential Contractors) SAC Charge $ z $1675 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ 0- ° -5 Make checks payable to: City of Fridlev Attach Stipulations 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. �a G SIGNATURE OF APPLICAN'� PRINT NAME � (� L►��' c3- DATE 6 Building Inspections 763-572-3F MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY SITE ADDRESS THIS APPLICANT IS: PROPERTY NAME; OWNER/ ADDRESS: TENANT PHONE: ,. CONTRACTOR rowANy SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PEP0M TYPE TYPE OF WORK: CONTACT PERSC. STATE LICENSE PHONE C _ 410 SINGLE FAMILY D TWO FAMILY D NEW >IEPLACEI IENT DETAILED DESCRiP'1`ION OF WORD Ate a" MN.�I5 MEET, Permit No.`s Received By� Date Rec'd: ICS IC3.9". 6 STATE ZIP FAX D TOWNHOUSE D ALTERATIONA"ODEL 01 1Y1Ct ft/ G'► � PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost upto $590.00,. whichever is greater, for the d reflect only.the cost of labor ) improvement, installation or replacement of a residential fixtuxe, exclucling.ihe es•..(Tlus.sh... Labor cost under $300 = $15.00. Labor cost between $300 to $5.00—c . ost oflabor . 'x.05 FOR PROJECTS WHERE LABOR EXCE 3VS., $500 FEES i4RE BAS ON •$10.00 PER FIXTUKB,_E)(C"T WHERE NOTED. FMfL M,: MMICATE TEOAL NUMBER OF EACHBELOW) 3�J SIZEBTU 6 d J. Equipmentlnstalled MODEL MFC: MODEL MODEL: SIZ.I�lBTU SIZFIBTU �A/C $25.00 (GAS) $15.00 GAS RANGE(OVEN $10.00 NEW GAS GRILL $10.00 AIR TO AIR EXCHANGEER $15 (WOOD) $35.00 FURNACE $ (WO GAS UNIT HTR $10.00 BOILER $35.00 CHW4EY LJNER $10.00 GAS DRYER $10.00 POOL BEATER $35.00 VENTILATOR $15.00 DUCT WORK $1000 BAS PIPING $10.00 Permit Fee $ Number of ftlures @ $10.00 x $10.00 = Surcharge $ 50 Number of fixtures @ $15.00 x $15.00= $ TOTAL DUE $ Number of fixtures @ $25.00 x $25.00 = Number of fixtures @ $35.00 x $35.00 = State Surcharge = $ .50 Total = $,69ft- THIS IS AN APPLICATION FOR APERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building perplit and I acloaowledge that he information above is complete and accurate; that the work will be it conformance with the ordinances and codes of the City of Fridley and with the N[irmesota ConstrUction Codes; that i understand this is not a permit but only as a work is not to start without a permit; that the work will be in ce th+ approved plan in the ccs o w 'ch view and approval of plans. _CC '!'Yl f�� BATE SIGNATURE OF APPLI _ �I City of Fridley Building Inspections Department 6431 University Avenue NE, FrOcy,MN 55432 763-572-3604 FAX: 763-502-4977