PRE 2010 DOCSLaity of Fridley, .Minn.
BUILDING PERMIT N°50 33
Date:
Owner:
Address Address` -•.-•-.•_--
LOC a
OF BUILDING
J7 4
No. St4
reet ' _ _ aL_ Part t
Lot _ _r Block _ Addition or Sub -Division
Corner Lot --- Inside Lot SetbackSideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To��'[?sed � j
Front Depth _weight Sq. Ft. �� Cu. Ft.1
Front _ Depth—,,,HI t meq. Ft. _ Cu. Ft. _
Type of Construction w� Est.^C' _ •_ 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 a'll provisions of
ordinances of the city of Fridley.
d
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,.whozn 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, cot."Oructiony " alteration,,- maintenance, repair and movingof buildings
within the city limits and this permit may lwvevoked at any time. upon violation of any of the provisions of said
ordinances.
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
APPLICATION FOR BUILDING PRUM
CITY OF FRIDIEY, MINNESOTA
Owner's Name Builder
Address Address
LOCATION OF BUILDING
No. Y/ d
of Lot
Lot Block Addition or Subdivision
Corner Lot Inside Lot _ Setback 4, Side -Yard /®
SEWER ELEVATION FOUNDATION ELEiTATION as ..,,;
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
To be used as:
DESCRIPTION OF BUILDING
z Haivht / ,'
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of ConstructionEstimated 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 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. :,p9.
DATE SIGNATURE-�--�� . �✓> ��
(A Schedule of Fee Costs can be found on the Reverse Side.)
4
V
Application for Power Plants and' Heating, Cooling, Ventilation, .Re%gerai�on and
Air Conditioning Systems and Devices
GRAVITY WARM AIR: RATE TOTAL,
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 $
NECK. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ 8 •
each add. 60,000 BTU ........................ 2.00 $ _.
Replacement of Furnace fj,.00 $
Repairs & Alterations—up to $500.00 5.00 $
Repairs & Alterations each add. $500.00 .......:...... 2.50 $
Furnace Shell & Lines—to 400 sq. ft. EDR Steams........
8.00
$
Furnace Shell & bine—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
5.00
GAS BURNER (up to 400,000 BTU) ............. I .........
5.00
$
GAS FITTING FEES:
NO RATE
TOTAL
1st 3 Fixtures ......................
x $1.50
$ It. 50
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
$
14.50
ROUGH
FINAL!t-
Dept. of Bldgs. Phone STI', 4-7470
Location 810 Rias Creek -Terrace
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, Minn -1-3-60 , 19 —
Owner
Frame
Kind of Building
Used as Res •
To be completed about 1-5!mbu
Estimated Cost, $ 450-00
Old—New. Building Permit No. _V 12 Permit No.
HEATING or POWER team, Hot Water, Warns. Air—No—
Westinghouse
Trade Name Size UF -100
Capacity Sq. Ft. E.D.R BTU 1FAM H.P.
Total Connected 45Loa Kind of Fuel rs—.
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS—OVER)
Signed
By FRED VOGT & CO.
HEATING & AIR CONDITION
IN --3
° 4Z 21N 7:59 Business�}a��nVs a e t. a. q_51
St. Louis Pally Minnesotan
P
City ®f Fridley, Minn.
BURDING PERMIT N® 6723
Date:�� �. � Owner: arf Builder
-.�
Address Address
10 OF BUILDING
No. Street6V'IffP
Lot __�_ Block Addition or Sub -Division
Corner Lot Inside Lot _ f— � Setback — _ Sideyard — Z6
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
12V4. 0rSVZ:'II . e:
Front Depth _d Height Sq. Ft - Cu. Ft
Fro Depth eight Sq. Ft Cu. Ft
Type of Construction
,,._ Fast __ 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. v A,) i L, ( -
In consideration of the payment of a fee of$...*� , permit is hereby granted to
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota reg location, construction, alteration, maintenance, repair and moving of buildings
within the city limits anad s permit may be revoked at any
upon violati of the provisions of said
ordinances. �, a
Building Inspector
NOTICE
" permit does not cover the cond. cdom, tmtatl an for wWng, phmnhimg, Sea heatho sower or wafer. Be sure to see
the Building Inspector for separate permits for these hems.
City ®f Fridley
AT THE TOP OF TH9 TWIN$
f`
r rL----- COM"VNITY,I)EVRLOMENT DIV.
1 PROTRCTIVE VtCTI" IZPT,
�. CITY NALL MOLRY D R
'es s
;Co�ntractor
y
Buildinp-
ompleti�
Y71�
u
CE u
L W
J
W
W
3 0
aoNva
eve
'lddv
eve
•saa-t
I MNtva
d
w SNt8Y8
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C aoo1d
o
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ion
b iwno�l
,p HNtaa
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-.� sAvat
exN18l
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w
SNlevel
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� I
I
Plumbing Fixture Rates:
NO.
RATE
TOTAL
Number Fixtures
-3
x
$2.00
Future Fixtures-
x-$1.50
New Fixture -Old Open.
x
"vNlan (
I
Catch• Bas to
x
$3.25
etaeo»
Water Heater -99,000 BTU
x
$3.00
U3LvM
x
I
I
E1ec. Water Heater
x
$2.00
Gas Fitting Fees:
a
1st 3 Fixtures
x
$2.00
Additional Fixtures
x
$ .75
Gas Range -199,000 BTU
x
$5.00
Repairs &- Alterations
GT -
Permit No._L_
PLUMBING PERMIT APPLICATION
ss Phone
s YA)nG
se
I TOTAL FEE
I
!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 rulin
of the Department of Buildings, and hereby declare that
all'the facts and representations stated in this
application are true and correct.
ey
-Signature Dade
1
�I �stima.tea cost
Plumbing Fixture Rates:
NO.
RATE
TOTAL
Number Fixtures
-3
x
$2.00
Future Fixtures-
x-$1.50
New Fixture -Old Open.
x
$1.50
Catch• Bas to
x
$3.25
Water Heater -99,000 BTU
x
$3.00
Ground Run Old Bldg.
x
$3.25
E1ec. Water Heater
x
$2.00
Gas Fitting Fees:
1st 3 Fixtures
x
$2.00
Additional Fixtures
x
$ .75
Gas Range -199,000 BTU
x
$5.00
Repairs &- Alterations
See
Description:
Code
State Surcharge
.50
I TOTAL FEE
I
!The undersigned hereby makes application for a permit
for the work herein specified, agreeing to do all work
in strict accordance with the City Ordinances and rulin
of the Department of Buildings, and hereby declare that
all'the facts and representations stated in this
application are true and correct.
ey
-Signature Dade
1
SUBJECT
PERMIT NO-----
City of Fridley
jIf� �� 2 7
AT THE TOP OF THE TWINS
UILDING PERMIT
BUILDING
R CEIPT NO
COMMUNITY DEVELOPMENT DIV.
r , PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
0 30 73
JOB ADDRESS -810 RICE CREEK TERRACE N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR,
8
4
BROOKVIEW TERRACE SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
CAROL GUZY 810 RICE CREEK TERRACE N.E. 560-6415
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
WAHLBERG BUILDERS INC. 1323 SKYWOOD LANE N.R. 788-1025
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING RESIDENTIAL
7 CLASS OF WORK
❑ NEW M ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK CONSTRUCT A 6 FOOT ADDITION ONTO THE GARAGE
I
9 CHANGE OF USE FROM TO
STIPULATIONS PROVIDE A FIRE WALL ON THE GARAGE OUTSIDE WALL
R
PE
Ep,ERp,T+E AND SIGN$`
AND
pLUMBING
���,TINGs
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, 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
SQ. 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
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.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,700.00
.85
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-
$12.00
STRUCTION OR THE PERFORMANCE OF ONS RUCTION.
PLAN CHECK FEE
TOTALFEE
310-
$12.85
SIGNATURE OF CONTRACTOR OR AUTHORIZED NT (DATE)
WHEN PROPERLY VALLIIyD�ATE9 IS YOUR PERMIT..
THIS
(/ /(D -J® -Q.1,
BLDG! INSP DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
T-1 C10ty of Fridley
JECT
_
Permit No.
AT THE TOP OF THE TWIMS
BUILDING PERMIT APPLICATION
�
Receipt No.
�gm------o COMMUNITY DEVELOPMENT DOV.
t i PROTECTIVE 04SPECTION CREPT.
1 e �
CITY HALL FRIDLEZY 55432
PAGE OF
APPROVED By
•
910-F14
0
1 115/73
1
800
Job Address:
Legal
Lot No.
Block
Tract or Addition See Attached
Descr>
y
7-,ezL Sheet
Property Owner Address
� �
Zip Phone
/L%b
.ems 5 i
ontractor Address
Zip Phone License No.
n/ 2 y'� UJa � e i~ 2 b 7-
Architect or Designer Address
Zip Phone License No.
Engineer Address
Zip Phone License No.
Use of Building D6S1,6E 7-/AL—
/ LClass
Class of WorkRemove
®
New Addition
Alteration Re air Move
Describe Work
Ov
7 f -D
Change of Use
From
To
;SPECIAL ASSESSMENTS:
If lateral assessments have not been placed on this property, an agreement mast be
signed, agreeing to assume such lateral assessments
before a permit will be issued
Agreement Necessary:
Agreement Unnecessary:
Finance Director
bUTSIDE UTILITIES:
z
Sewer Elevation:
Water Elevation:
®
Stub Location:
Stub Location:
�a
BUILDING INSPECTION
�-
Plumbing H.V.A.C. Electrical Fire Insp.
�
Signature &
Date Approved
0
U-
Registered Engn. Stamp.
Legal Description Check
Exterior Devel. Check
Performance Bond Check
Easements, R/W, Special Agreements
Final Approval__
Date
Certificate of Occupancy
Date
��i�® 3�.�513
of Fridley
SUBJECT
1
Pewl
124971
?City
AT THE TOP OF THE TWINS
PERMIT
r
BUILDING
1 0 COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
'7
CITY HALL FRIDLEY 55432
REV.
DATE
PAGE OF
APPROVED BY
612 -HO -3450
INUMBER
910-F15
4/ 22/74
I
JOB ADDRESS 810 Rice Creek Terrace N.E.
1 LEGAL
LOT NO. BLOCK
TRACT OR ADDITION SEE ATTACHED
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Edward Basis 810 Rice Creek Terrace N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Wayn Roy Inc. 8507 Rose Manor Golden Valley
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
residential
I
7 CLASS OF WORK
11 N EW 0 ADDITION ALTERATION 0 REPAIR 0 MO VE 0 REMOVE
remodel basement
HEATINGF PLUMS' R WIRING
INGAND, SIGNS.
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.0T.
CU.FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60DAYS, 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 IGARAGES---
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALLPROVISIONSOF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED *
$4,500
2.25
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
PROVISIONSOF ANY OTHER STATE OR LOCAL LAW REGULATING CON.-
$27.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
ToTALFEE
29.25
VNATUAEVFCONTRACT(5ROfUTHO AGENT
FOP D THIS IS YOUR PERMIT
F
�=r -
DATE -
-
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
01,
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
ADDRESS: ADDRESS: i1SQ-77 69e;
NO:. /O STREET:
LOT: IF, BLOCK: ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
0
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Front: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth:
Square Feet; Cubic Feet:
Type of Construction:
To Be Completed:
Height:
Estimated Cost:
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 ali'the facts and representations stated in this application
are true and correct.
a
DATE: SIGNATURE : A,e- y-1
i
(See Reverse Side For Additional Information.)
53-84-9915051' ay�y
:ZI
-)opt. of Bldoz• Phona SZO.34W . ••
w:SCRIP—LI021 Cr:' VJC?I�Io • µ 810 Ric® C7=k Terr nd
Numim-r. -rind 6-nd Leer!kn o3 F'txt'srss.
$ Rva F i:ct•.:rv. Old 03nincs
PARTIAL RATE Sr:HEDULE
cer cwt p
City of Fridley:.
The undersigned hereby makes application for a permit for the- vdrk herei
specified, agreeing to do all work, in strict accordance with the Cid
and ruling of the Department of Building;, and hereby declares that all the fact
and representations stated in th.-z application are true ar.d correct'
Fridley, Minn 4-15-76 19....
Owner -
frame
Kind of Building
Used as x 49
7•o be .completed about
-22-76
Estimated Cost. S 10.00---
Famil NO.
Old . Building Permit NO. .
L�Y8Y?fG iYXTJY?e. YtATES:
No. RATE
TOTAL
•
Signed
• A'urr.ber Fixtures . .. . .. • .. . .. • . o . �a
x $2.GD. $
—
o
wRTt4 HTk.
V
�►
By tMIN tFr,A - --
x
`
.k
'p� 0
x $1.50 3 ....:__
s
Catch Basin ........, .......... a .
— x 53.25 $
to
-
Water Heater *Cp to 6-9.000 BTU). • o
x $3.00 S
-- 1
gOUQH
Run 13 E.
New Ground R n O g
x ;1.25 S.--
®—
_
E...ct::.c Water 1:osl.ar, .DD.D
$2.0
-
FIYRI,
, , ..:... �...�
Z S FITTING FEES:
No. RETE
TOTAL
-
%32.G3 S
Ist3Fixtures ....
,
Addidcnal Fixtures ............... a-------
x S 75 S
Gas R;,aar to 193.000 BTU ........- ------ P.
---- x $5.60 a
State
Surchar qe
a TQ.50
xLT ERRT1OifS—P.sfsr to Cod*
Xxzcripdon . ®............. o .................«.....
Class
tw�'rFsa�b� :5�a
TOT1ti,. F'T.:.F. S
��
2nd
3rd
$ Rva F i:ct•.:rv. Old 03nincs
PARTIAL RATE Sr:HEDULE
cer cwt p
City of Fridley:.
The undersigned hereby makes application for a permit for the- vdrk herei
specified, agreeing to do all work, in strict accordance with the Cid
and ruling of the Department of Building;, and hereby declares that all the fact
and representations stated in th.-z application are true ar.d correct'
Fridley, Minn 4-15-76 19....
Owner -
frame
Kind of Building
Used as x 49
7•o be .completed about
-22-76
Estimated Cost. S 10.00---
Famil NO.
Old . Building Permit NO. .
L�Y8Y?fG iYXTJY?e. YtATES:
No. RATE
TOTAL
•
Signed
• A'urr.ber Fixtures . .. . .. • .. . .. • . o . �a
x $2.GD. $
—
o
Future Fixture Opening ... • • • • ®• •
x $1.50 3
By tMIN tFr,A - --
Businv= Phone No -
few Fixture Old QyerSng......•. D .. ._.—.—
x $1.50 3 ....:__
Catch Basin ........, .......... a .
— x 53.25 $
—
•'
-
Water Heater *Cp to 6-9.000 BTU). • o
x $3.00 S
-- 1
gOUQH
Run 13 E.
New Ground R n O g
x ;1.25 S.--
®—
E...ct::.c Water 1:osl.ar, .DD.D
$2.0
-
FIYRI,
, , ..:... �...�
Z S FITTING FEES:
No. RETE
TOTAL
-
%32.G3 S
Ist3Fixtures ....
,
Addidcnal Fixtures ............... a-------
x S 75 S
Gas R;,aar to 193.000 BTU ........- ------ P.
---- x $5.60 a
State
Surchar qe
a TQ.50
xLT ERRT1OifS—P.sfsr to Cod*
Xxzcripdon . ®............. o .................«.....
Class
tw�'rFsa�b� :5�a
TOT1ti,. F'T.:.F. S
��
�, 1 1 UI 11\1 UI_I..1
97 -h -U 16051 APPLICATION FOR PUMBING AND GAs FITTING PEN -11 F
PARTIAL RrdTC SCHHULE
A
RATE
ro
C
$3.00
NLtn ie Fixtury Opening
x
"
hav Fixture, Old Opening
X
a
Catch Basin
Hater
$5.00
sn
w
$5.00
1U0,000 BIU to 159,000 BTU
x
$10.00
rn
c
w
q
New GIUUn.i Fan Old Buildir.]
7
��
a
w
x
55.00
heater
.
G
y..
•�
�
�
C c
Gra h.11,gn w 199,000 BTU
X
$1.0.00
tEPA116 4 ALTEkATIONS
F1'iL 5100.00
55,00
each adj. 5100.00 or fraction
$2.00
U
W
'' H
N
,C
In
0
qw
c
In
L
m ro
UX
a ro
R 3
u�
1J
O
;as
aec
r
L
rer
d
d
h
R1 - I'uture Cunnactlon Opening
Connected with Sewer
') . New FixLuru, Old Opening
Water
PARTIAL RrdTC SCHHULE
'LUMBING FIXTURE RATES NO
RATE
4
11uak!�er Fixtures
x
$3.00
NLtn ie Fixtury Opening
x
$2.00
hav Fixture, Old Opening
X
$2.00
Catch Basin
x
$5.00
Nater hdAter - to 99,000 BTU
x
$5.00
1U0,000 BIU to 159,000 BTU
x
$10.00
Watur Suftenbr
x
$7.00
New GIUUn.i Fan Old Buildir.]
X
$5.00
GlecLrla Water 11eater
x
55.00
SAS 1�I I TING FEES;
1st l flxlklres
x
$3.00
A.Lltctonal Fixtures
X
$1.00 '
Gra h.11,gn w 199,000 BTU
X
$1.0.00
tEPA116 4 ALTEkATIONS
F1'iL 5100.00
55,00
each adj. 5100.00 or fraction
$2.00
SLAta Surcharge
TOTAL 1'G2
HEIIISPECTION FEE
TOTAL.
$
Job Address 810 Rice Creels Terrace
Deparunent of Buildings
City of Fridley
Tel. H571-3150
Ths undoralgnud hereby makea application for a pa rlctt for thw work hereln
specified agreeing to do all work in strict acccrdanoe with th1: City Codes
and rulings of Lha Department of Buildings, and hereby declare. that all
tiro facL•u and roprusuntilLions statud to this c:l plicaticn aro thio and corrucl
Fridley, htn. 10-23-79 19
01•INER DHJ11J
KIND OF BUILDING frame
USED AS res•
TO BE COMPLETED ALOU r 10-3079
A ESTIMATED COST
OLD - NEW BUILDING PE10.1IT NC, FEFu4IT NO. �;Q 00
Company
MINNEwn,CC0
Signed By
Tal, No,
ROUGH INSP.
Da to '
FINAL INSP.
Date
APPROVAL FOR PEW -11'r
MINIMUH PEE FOIL WY PLUKIMIG PEMIT Is 67.50 pLUS 5.50 51)ZE 6UR0UtiFtGB
Pr.
01
SUBJECT
PERMIT NO.
City of Fridley
° -15644
AT THE TOP OF THE TWINS
BUILDING PERMIT'
_
i
R
1 1r ______ COMMUNITY DEVELOPMENT DIV.
r i PROTECTIVE INSPECTION SEC.
���
"1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
4/4/80
JOB ADDRESS 810 Rice Creek Terrace N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
8
4
Brookview Terrace 3rd SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Ed Basil 812 Rice Creek Terrace N.E. 571-6415
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Dav-Ko Hare Improvement 1325 - 42nd Avenue N.E. 788-5850
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
❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install aluminum siding and trim
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REQUIRED
FOR WIRING,
HEATING, PLUMBING
AIV® SIGNS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. 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
$34,4QO
$1.70
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-
STRUCT) N O THE PERFORWqCE OF CONSTRUCTION.
$21.00
,�
PLAN CHECK FEE
TOTALFEE
11?10
$22.70
SIGNA URE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY ALI DATED THIS IS YOUR P •RMIT
In
c9/yy/��
6
BLDG INSP F)ATJE
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
01
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(New, Alterations, Additions*, or Repairs)
OWNER:
ADDRESS: �� /A)
TEL
TCL NO:
BUILDER: Gam --
k"
ADDRESS:2
TEL 110:
Construction Location
STRICT NO: �� STREET: �jC'c EG /<'�{fe,Ptl�<
LOT: � BLOCK: �_ ADDITION:
Corner Lot: Inside Lot: ,,-<' Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
Front: Depth:
Squane Feet: Cubic Feet:
Front:
Depth:
Height:
Height:
Square - Feet: Cubic Feet:
�a
Type of Construction: �� � � _ Estimated Cost: $ 5/00. i
Zb Be Cbmpleted: 7 -
Alt. A Alt. B
Proposed Driveway Width If New Opening is Desired: $ $
SEE P�EVERSE SIDE OF SHEET -
The undersigned hereby makes application for a permit for the Fork 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 rect.
DATE: `7 " !3 SIGNATURE
Stipulations:
O� �- D
ps
SUBJECT
PERM)
City of Fridley
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
ECEIPT N
�
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
%
1 �
`
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
j
L 612-571-3450
910-F15
6/19/81
JOB ADDRESS Ed Bas:U 810. Rice Creek Terrace..
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR,
g
4
Brookview Terr. 3rd Add. SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Ed Basil 810 Rice Creek Terr. N.E. Fridley 55432 571-6415
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Owner
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
❑ NEW IX ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof
9 CHANGE QF USE FROM TO
STIPULATIONS
Roof can be second but not third.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Asphalt
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. 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
R-1
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
$1,400.00
$.70
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMITFEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STf?j1QTION OR THE PERFORMAN E OF CONSTRUCTION.
$9.00
e 6 — /7
PLAN CHECK FEE
TOTAL FEE
(/
$9.70
SIGNATURE OF CONTRACTOR OR AUTHORIZED GENT (DATE)
WHE14 PROPE LY D TE THIS IS YOUR PERMIT
SIGNATURE OF OWNER OF OWNER BUILDER) (DATE)BLDG
WSP OATE
ps
CITY OF FRIDLEY
APPLICATI01 FOR RESIDENTIAL BUILDING PERMITS
(New, Al aerations, Additions, or Repairs)
OWNER: J� at J64 S / / UUI LDE:R
ADDRESS. zoLPrP ADDRESS: :I jD �C� Gi"�� _ ��
TEL NO: 7 K� �1®�! TEL EJO: ��7f
Construction Location
STRE'E'T. NO: A7 STREET:
LOT: BLOCK: ADDITION:
Corner Lot: Inside Lot: Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building .location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
Front : Depth: H eight :
Square.Feet: Cubic Feet:
Front: Depth: Height:
Square -Feet: Cubic Feet:
Type of Construction:
Ta $e Completed:
r -
Proposed Driveway Width If New Opening Is Desired:
Estimated Cost: $
Alt, A Alta B
SEE REVERSE SIDE OF SHEET
Mie 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.
MTE: �o % q ' l SICNATUF.E :
Stipulations
bi�� q. 0v
TK 10
I
suB�ECT
ERMI
City ®� Fraley
25337
AT THE TOP OF THE TWINS
BUILDING PERMIT
R T NO.
� e COMMUNITY DEVELOPMENT DIV.
e s PROTECTIVE INSPECTION SEC.
r
e
1 . �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 85432
�'� 612-571-3450
910-F15
7/31/97
10B ADDRESS 810 Rice Creek Terrace NE
1 LEGAL
LOT No. -BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
8 4
Brookview Terrace 3rd Addition SHEET
2 PROPERTY OWNER MAIL ADORES$ ZIP
PHONE
Joseph Capra 810 Rice Creek Terrace NE
571-2638
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
❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct an 18' x 24' Garage Addition
9 CHANGE OF USE FROM TO
STIPULATIONS provide a hard surface driveway. See notations on AIRM plan.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. 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
$7,988
$3.99
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-
W
SC
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$149.23
SIGN .TUR F CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERLY ^LIDATED THIS IS YOUR PERMIT
BLDA INSP
GATE it
TUkF O NER OF OWNER BUILDER) 00' AATEI
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Owner Name & Address:
Contractor:
Effective 1/1/97
Tel.
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
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length i,a r Width Height lo Sq. Ft. �13�
DECK AREA: Length Width Hgt/Ground Sq. Ft. Y/
OTHER:
Construction Type:_, Q Estimated Cost: $ �
(.Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft!x $ _ $
9, '9 el-�
DATE: APPLICANT: „ Tel. # JW— ad .m
STIPULATIONS:
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$ 9
001 of Permit Valuation (1/10th%)
State Surcharge
$3112;tf
$.501$1,000 Valuation
SAC Charge
$
$950 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 [ ]
c
TOTAL
STIPULATIONS:
CITY OF FRiDLEYINSPECTION DIV, Effective On January 1;,1993
6431 Universky'Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES * -
Residential
Furnace Shelf and Duct Work, Burner -
Also Replacement Furnace
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Condkloning - AR Sizes
All Others/Repalrs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercllal/Industrial
1 % of Value of Appilance or Work
JOB ADDRESS
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 correct,
,199
$10.00 $
OWNER -AP
$ 10.00 $
BUILDING USED AS,
$10.00
ESTIMATED.COST d9�®� PERMIT NO. / �)
$10.00 $
DESCRIPTION OF FURNACrE 6NQ OR BURNER
$ No, of Heating Units, _ Circle One (Steam) (Hot Water �r(W�armAlr)
Trade Name �fSize No.
BTU HP EDR
$ Fuel ;11— Total Connected Load
State Surcharge x_50 Burner Trade Name Size No.
to <-.a- BTU HP EDR
TOTAL FEE �
MINIMUM FEE FOR ANY HEATING/COOLINGlVENTII A, ION
REFRIGERATION/AIR CONDITIONING PERMIT iS 115.00
PLUS THE 5.50 STATE SURCHARGE
REINSPECTION FEE $30.00
*Air Conditioners, can not be placed In a side yard without
written permission from adjoining property owner.
HEATING C2OMPA
Signed By Tel No. �/ �i
Approved By Rough -In Date Final Date��
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHIMNEY AND STACK VMUPICATXON
The undersigned hereby verifies that the existing chimney or stack:
.1. Has been carefully examined Yes (fQ
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 ( )
S. Meets all current Code requirements for
size'and total BTU's connected Yes r00
No ( )
6. Has total heating BTU's of C2,
All other BTU's��®®�
TOTAL BTU's
Remarks
List Alterations Beinq Done:
-------------
HEATING COMPANY lf��
Signed By
a
Date
U
CITY OF FRIDLEY INSPECTION DIVISION
Effective On January 1, 1998
6431 Unive" Ave NE
REFTIGERATION AM AS cmiJOB noNm
SYSMMS AND DEVICES
RATE §OEMJLF-
permit for♦ . herein
Residerdial
Rate.
TOTAL
,..,._ accordance ith the City ♦ ♦cam. and
spedfied agreeing to do all workstrict
Rmace Shell and Duct Wok &mw —
nAngs of the BtdIding Division, and hereby deckm thtt all the bcls; and
Also Replacement Fmace
$30.00
$
representations, stated in this application are. Ma and correct.
(Side Vent — Fill OtA Back)
.:
Z /
Gas Piping M•^ •
10.00
Oe—
Gas Range
$10.00
BULDING
Gas'Dryer
$10.001,:.
ESTIMATED COST
%tr Conditioning — AN Sizes
$25.00
$_425�_OZ
QESCRIPTION OF R)HNACE AND OR BURNER
All Ott millepairs & Alterations (LIST ON BAC!'()
1% of Value of App]Wm or Work
Commercialfindtistrial
1.25% of Value of Appliance or ftrk
_. State Surcharge
TOTAL FSE
$ No. of Heating knits Circle One (Stearn) (Not Water) (ftrm AR)
Trade Name Size No.
BMTU IP EDR
$ Fuel Total Conneded Load
. r •`fit • •rte • cr ,•:c • .-( •_,
Bumer Trade Name Size No.
BTU 14P EDR
0•s"f c•:
1 31111 M- IT
FRE "0
Rough -in Date Final Date
VERIFICATION ON
GI MMY AND SIACK '4K9fflJCAJJ0N
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes () No ( }
2. is fit a from rust. or deterioration Yes () No ( )
a
3. Has no foreign objects lodged within Yes ( ) No ( )
4. Is securely supported
5. Mei ets all current Code requirements for size
`total BTU's connected
6 Hai AoW heating BTU's of
Al of er BTU's
TOTAL BTU's
7. Hasa liner been provided for water heater
S. Has combustion air been provided for water heater
Remarks.
List A"T RATIQNS 1king s
HEATING CO:
Signed By:
Date:
Yes( ) No () ..
Yes ( ) No ( )
Yes
No
Yes (
}
No
( )
Building
BUILDING
Permit No.:G
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
e L
�� B ® �SO%,`asS � WDA
- C
DATE
SITE ADDRESS b
YOUR E-MAIL ADDRESS
a C. -P C (4- e—K ��i (K
-0C -
THIS APPLICANT IS:
❑ OWNER ❑CONTRACTOR
PROPERTY OWNER/
NAME: --solo f a�"
ADDRESS: 1^ CITY
STATE ZIP
TENANT
a
PHONE:94'�afJL'
NAME:
Renewal By Andersen
CONTRACTOR
SUBMIT A COPY OF
STATE LICENSE # 1920 County Road "C" West
YOUR STATE LICENSE
ADDRESS: Roseville, MN 55113
STATE—ZIP—
TATEZIPWITH
WITHAPPLICATION
PHONE License #20130983
❑ SINGLE FAMILY/NEI _
651-264-47.77
PROPERTY TYPE
❑ TWO FAMILY/NEW G
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq: Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
2.
Existing Floor Plan
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS
& PORCHES SUBMIT:
❑ Aluminum
❑ Trim
I.
Site Plan/Survey showing the existing structun:
❑ Other
❑ Fascia
and proposed project.
WINDOWS
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:
(USINTHE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 1. 0 on .' 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
-- l 1 l . -.a�S-
$ S.®®
$
$ C�t�
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)
$1550 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 savable 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
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not
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 approve
plan in the case of all work wh�t/aA
res review ana oval of plans. 0� I �y
SIGNATURE OF APPLICANT %) a �nGA v�'� DATE 4 TO tC J"10