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PRE 2010 DOCSCity of Fridley, Minn.. BUILDING PERMIT (:4:9:7:p Date:°`p'....,_......._..._.._._................ 4 Owner:_ :.�j:.... s Builder _. .... _............................ �_ . .......... _ _..._-•_... _••_.. - fes. Address... ....... ..... _..... ._.._..._..._.._...____..__.. __ .... Address _� '!'r�'............ ......_..._._..._.._........ No. ' ,O.0 TION OF BUILDING .............. street __ .........r.... ..._ �!.._......................... _..-----..... Part q t .....__......., .........._...._... ......_......._..._.. Lot ........... ...._................. Block ............. .,f..•......-------•--- --- Addition or Sub -Division Corner Lot ......... .........:............ Inside Lot .... - ................. Setback...� .... �! ..........._........ Side } / Setback........ yard..._.....-....�irr. --................... Sewer Elevation---------------------------------_......_.....__----....-_----- -------- ._............ _........ Foundation Elevation DESCRIPTION OF BUILDING Tore Used as• { .�`, :.... Front .. Depth .... -, Height' Cu. Ft.' _77 * . p....." ... Front ...,........ Depth ....... F1ieight ..... Sq. Ft ..�?` . Cu. Ft. ' Type (�f Construction .�.-.� t — ...-........ Est. cost ,�i .f�{.�'r�+ !'o 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. --_-----_-_-_------ In -----_-..-_--....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 regarding location, construction, alteration, maintenance, re r and moving of buildings within the city limits and this permit may be revoked at any time upon violation 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. .01W4 „.. APPLICATION FOR BUILDING PERMIT CITY OF.FRIDLEY. MINNESOTA Owners Name Builder• -p CV Address Address ®? a 7 LOCATION -OF BUILDING ' No.®/ ry Street Part• of Lot Lot Block / Addition or Sub,Div;-.�.:�.� C) r� Corner Loth side Lot�_,,Set Back :Side -Yard /4o - SE M ELEVATION.- FOUNDATION ELEVATION ® , Applicant attach to this form Certificate -of Survey of Lot and proposed building location. DESCRIPTION OF BUIMING To be used as: Front ` 0 �Depth =E 0 � H�Ight Sq. Ft. CU. Ft. oQ � ont 0 `e, Depth -- 0 ” Height/, o Sq. Ft. Cu, Ft, Type of Construction-°— Estimated Cost To be completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representa- tions'stated in this application are true and corr DATE --- SIGNATURE (A Schedule of Fee costs can be found on the Reverse Side.) CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Job Address Zr �� �--- �-�-�` / ���- CA—" Department of Buildings City of Fridley Tel. #571-3450 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 true and correct Fridley, Mn. / 0 — / Z , 19 76 OWNER KIND OF BUILDING 14/dam^ USED AS TO BE COMPLETED ABOUT PARTIAL RATE SCHEDULE ESTIMATED COST PLUMBING FIXTURE RATES: NO. RATE TOTAL OLD - NEW BUILDING PERMIT NO. PERMIT NO. Number Fixtures x $3.00 $ Water Future Fixture Opening x $2.00 $2.00 $ $ Company I vp� New Fixture, Old Opening N La i1 o-,) Catch Basin x $5.00 Heater N 4J ) m `4 x N N E fd i 3 x N o rq rd o {�]� Water Softener x $7.00 $ New Ground Run Old Building x c $ ROUGH INSP. C g Date Electric Water Heater x $5.00 $ roU m 3 Awo E[n UMC 0 Date 0 o as lec UI U a W x $1.00 $ Gas Range to 199,000 BTU x $10.00 $ APPROVAL FOR PERMIT REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7,50 State Surcharge $ ,50 1st TOTAL FEE $ 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water Job Address Zr �� �--- �-�-�` / ���- CA—" Department of Buildings City of Fridley Tel. #571-3450 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 true and correct Fridley, Mn. / 0 — / Z , 19 76 OWNER KIND OF BUILDING 14/dam^ USED AS TO BE COMPLETED ABOUT PARTIAL RATE SCHEDULE ESTIMATED COST PLUMBING FIXTURE RATES: NO. RATE TOTAL OLD - NEW BUILDING PERMIT NO. PERMIT NO. Number Fixtures x $3.00 $ Future Fixture Opening x $2.00 $2.00 $ $ Company I vp� New Fixture, Old Opening x Signed By o-,) Catch Basin x $5.00 $ ,/ L/ 2— Water Heater - to 99,000 BTU x $5.00 $ Tel. No. 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ New Ground Run Old Building x $5.00 $ ROUGH INSP. Date Electric Water Heater x $5.00 $ GAS FITTING FEES: FINAL INSP. Date 1st 3 fixtures x $3,00 $ Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $10.00 $ APPROVAL FOR PERMIT REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7,50 State Surcharge $ ,50 TOTAL FEE $ REINSPECTION FEE ($10.00) CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE Effective On August 1, 1995 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, _ REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESSS�Pi��U�r Residential Furnace Shell and Duct Work, Burner — Also Replacement Furnace (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Alr 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 TOTAL $30.00 oy $ 10.00 $ 0, oa $10.00 $ $10.00 $ $ 25.00 $ 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 Building Division, and hereby declares that all the facts and representations stated in this application re true and correct. ,1995 BUILDING USED AS J ESTIMATED COS;06 f' c) PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units Circle One (Steam) (Hot Water (Warm Air) Trade Namee Size No. BTU " o n"o HP EDR $ Fuel Tot Corinected Load State Surcharge $ .60 TOTAL FEE D;�Z MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Burner Trade Name Size No. BTU HP EDR HEATING COMPANY Signed By i Approved I�y FILL OUT BACKSIDE FOR' REPLACEMENT FURNACE Tel No. Rough—in Date STACK VERIFICATION ON Remarks: list ALTERATIONS Being Done: HEATING CO: Signed By: Date: I?- /a - 9 s" CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes &A No ( ) 2. Is free from rust or deterioration Yes AA No (, ) 3. Has no foreign objects lodged within Yes No ( ) 4. Is securely supported Yes No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes No ( ) b Has total heating BTU's of CDy All other BTU'sS,y� v TOTAL BTU's 7. Has a liner been provided for water heater Yes ( No ( ) 8. Has combustion air been provided for water heater Yes ( No ( ) Remarks: list ALTERATIONS Being Done: HEATING CO: Signed By: Date: I?- /a - 9 s" lj SUBJECT City of Fridley 26104 AT THE TOP OF THE TWINS BUILDING P RMIT i RECEIPT NO. ------COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 5/29/98 JOB ADDRESS 811 Rice Creek Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 1 1 Brookview Terrace 3rd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jay Lowinske 811 Rice Creek Terrace NE 571-7463 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 X 8 DESCRIBE WORK 16' 32' Above Ground Swimming Pool and a 44' x 7' Deck Install a x 9 CHANGE OF USE FROM TO STIPULATIONS See stipulations in letter dated May 28, 1998. WARN I Before digging caR for all utility !ocaticrs 454-0002 REQUIRE® BY LAVA 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 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 1 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 $S 272 $2.64 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- $ STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $120.16 CONTRACTORO UTHORIZEDAGENT IDATEI WHEN ALID TED THIS IS YOUR P RMITATURE ,ASIGNATUREO PROPER F OWNER OF OWNER BUILDERI IDATEI BLZG I SP f1ATE lj NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Y// l_ �ffective 1/1 8 Legal Description: Owner Name & Address: v Z &V Tel. # J-7/ - 7Y � 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. LIVING AREA: Length GARAGE AREA: DECK AREA: OTHER: Construction Type: DESCRIPTION OF BIPROVEMENT Width Height Sq. Ft. Length Width Height- Sq. Ft. Length Width Hgt/Ground Sq. Ft. Estimated Cost: $��� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: _ Tel. # f 71-,7K6_3 . 02 $ Permit Fee $ -ire Surcharge$ State Surcharge,?. W$ SAC Charge $ License Surcharge $ Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: S� CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 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 [ ] CIlYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 May 28,1998 Mr. Jay Lowinske 811 Rice Creek Terrace NE Fridley, MN 55432 Re: Swimming Pool Construction at 811 Rice Creek Terrace NE Dear Mr. Lowinske: This letter is to make clear this department's requirements for the swimming pool construction at the above address. 1. As indicated, one (1) skimmer approved by the National Sanitation Foundation will be provided, 2. As indicated, one (1 ) inlet of approved design for fresh and/or repurified water will be provided. 3. The filter and pump shall be approved by the N.S.F. and be of sufficieAt capacity to provide a minimum turnover of at least two (2) times in 24 hours. This department recommends a turnover rate of 6 - 8 hours. 4. A deck of at least three (3) feet wide, measured from the pool waters edge, shall he provided which extends completely around all private residential pools. Above ground private residential pools may be provided with decking of a minimum size of 4 feet by 4 feet at pool entry points and provided that such decking has the approval of the City. 5. Fencing or other effective means including but not limited to walls or buildings, acceptable to the City, shall be provided to positively control all access to public and private residential swimming pools. Fencing shall meet the following criteria: a. The fencing shall prevent the entrance of children and be without hand or foot holds that would enable a person to climb over it. b. The fencing shall be at least 6 feet high and entrances shall be equipped with self-closing and self -latching gates capable of being locked. c. Self-closing and self -latching devices shall be placed at the top of the gate or otherwise inaccessible to small children. d. The opening between the May 28, 1998 Mr. Jay Lowinske Re: Swimming Pool Construction Page 2 6. An automatic chlorinator should be provided with a suitable test kit. 7. All electrical and plumbing installations shall be inspected and approved by the City Inspection Department. 8. All overhead electrical lines must be a minimum of 10 feet horizontally from the pool surface and 18 feet straight line distance from the waters edge. An alternative is to bury said lines. 9. The *pool fill spout must be protected by a vacuum breaker or air -gapped. 10. Suitable safety equipment to include but not limited to a ring buoy and rope that is 1 1/2 times the pool diameter, and shepherds crook pole must be provided and maintained with the pool at all times. Furthermore, these and any other requirements must meet the provisions of the Fridley City Code, Section 115, Swimming pools. The building permit•is approved contingent on final inspections and approval by the City. If any questions or problems arise from this letter, please feel free to contact me at 572-3603. Sincerely, ALI- /�Z_ /' I 0 RIES Building Inspector BR/mh CITY OF FRIDLEY INSPECTION DIVISION` Tc Effective On January 1; 1998 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Pipingeeded with Tw furnace) 0 0©L 9W E_R- 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 TOTAL $ 30.00 $ $10.00 $ l0.06 $10.00 $ $10.00 $ $ 25.00 $ The undersigned hereby makes application for a permit for the work herein specked 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 representations stated in this application are true and correct. 2-&- ,1998 OWNER BUILDIN ESTIMATED COST J �0- GJ PERMIT NO. 3.)-3 DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating U its Cir e OZ (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU 065,000V HP EDR $ Fuel AAM64,1, Total Connected Load State Surcharge $ .50 Burner Trade Name Size No. TOTAL FEE FEE FOR ANY HEATING/COOLI IS PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. BTU HP EDR �S HEATING COMPANY SO 64emia Signed By Tel No. 7 Approved By Rough -In Date Final D FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CHIM11gEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes O 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 Code requirements for size and total BTU's connected Yes () No ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes ( ) No ( ) 8. Has combustion air been provided for water heater Yes ( ) No ( ) Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: SUBJE& I NO. City of Fridley 28694 572T-3604 THE TWINS BUILDING PERMIT RE • COMMUNITY DEVELOPMENT DIV. L------, INSPECTION SEC. . /I % r � � PROTECTIVE UQyK/o./ 616 1 , NUMBER REV GATE PAGE OF APPROVED BY = CITY HALL FRIDLEY 55432 612-571-3450 910-F15 12298 10B ADDRESS 811 Rice Creek Terrqrp 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 1 I SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Joy R. Lowinske 63 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 ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (25 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 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 @ $2142 $1.07 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• STRUCT1 OR THE P RFORMANCE OF CO TRUCTION $74.75 `P F SC $2.14 �m PLAN CHECK FEE TL FEE 77.96 rAfiftOF&OW-AnTOR ORAUTHORIZEDAGENT MATEIE P Y VAL ED •THIS ISS VPERMY� s S,GNATURE OF OWNEA.IF OWNEABUILDERI IDATEI B GINS /AtE NEW' [ ] Effective 1/1/98 ADDN [ J CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION �a (p ConstructionAddress:1'� Legal Description: Owner Name & Address: Contractor: Tel. # �, /�L-�--2/- 7e/ 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 Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: &v- ��U T r 0 1Est ted Cos 0 �l / #°u -se 4 ����� `� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ DATE: - 2 APPLICANT: L� lo CITY USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation Tel. # -�y $1000 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 [ ] ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE VALUATION NOTE: WIRE HOT TUB # INSPECTIONS CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 �UrAMiZiL N Mlklv : 811 RICE CREEK TER NE : 143024110048 : BROOKVIEW TERRACE 3RD ADD : LOT 8 BLOCK 1 : ELECTRICAL : RESIDENTIAL : ADDITION/ALTERATION APPLICANT LOWINSKE JAY 811 RICE CREEK TER NE FRIDLEY, MN 55432 OWNER LOWINSKE JAY 811 RICE CREEK TER NE FRIDLEY, MN 55432 1 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 wort 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 ,071-lzbl PERMIT NO.: 2004-00755 DATE ISSUED: 05/20/2004 ELEC PERMIT FEE - MIN (RESI) 20.00 ELECTRIC FORM FEE 1.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 21.50 PAID WITH CHECK # 2920 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.