PRE 2010 DOCSs
'City of Fridley, M
BIAIL-VOING PERMIJ N? 6600
r
Date:
AddressAddress
CgvTl Ny LDING
No. Street Part of Lot
Lot _._ Block _ ddition or Sub -Division .
Corner Lot._ Inside Lot Setback 2J Sideyard :2
Sewer Elevation _ _ Foundation Elevation
DESCRIPTION OF BUILDING
TUsed3 p� rt
Front Depth �_ Height Sq. Ft Cu. Fh�J
Front Depth eight Sq. Ft. Cu. Ft.
Type of Construction tom___ _ 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
ord9nanc:es of the city of Fridley.
In consideration of the payment of a fee of $��f , permit is hereby granted to
thto construct the building or addition as described. above. This permit is granted upon
e 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, repair and moving of buildings
within the city ]units and flus permit may be revoked at any time upon violation of any of the provisions of said
ordinances. 11 _ ��
k MM,11M70iTi ^�
NOTICE:
Tho penntt does not cover the construction, Installation for wiring, phanhing, gas heating, sewer or water. Be sure to we
the Bending Inspector for separate permits for these items.
U
City of Fridley
Application for Plumbing and Gas Fitting Permit
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK '
Number, Kind and Location of Fixtures Location
v7
N
RATE TOTAL
Number Fixtures ......................
x
$1.50
3�
c�
--x
o0�e
S�
<3
U�' °j
�GSa
Z
�U' O
f
R
N
WATER HTR.
GAS
EIEC
Base
3.25
$
Water Heater (Up to 200,000 BTU) ......
x
2.00
$ '� P
New Ground Run Old Bldg . ............
x
3.25
$
GAS FITTING FEES:
NO.
RATE TOTAL
Ii
Ist
i
1
2nd
3rd
4th
• Future Connection Openings
New Fixture, Old Openings
Connected with
Sewer E]
Cesspool EJ
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
N
RATE TOTAL
Number Fixtures ......................
x
$1.50
$
--x
Future Fixture Opening ................
1.20
$U
New Fixture Old Opening ..............
x
1.00
$
Catch Basin ............................
x
3.25
$
Water Heater (Up to 200,000 BTU) ......
x
2.00
$ '� P
New Ground Run Old Bldg . ............
x
3.25
$
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
Additional Fixtures ....................
Gas Range to 200,000 BTU .............
REPAIRS & ALTERATIONS—Refer to Code
x $1.50 $
x .50 $
x 2.00 $
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all 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_
Owner �n cor__
Kind of Buil�g A- et- �
if I A P/
Used as
To be completed about
Estimated Cost, $ /� �• e
Old—New. Building Permit No tl,0 Permit No. ®� S1 c)
Signe 13
By
Business Phone No ff-1E! - — 7 4r 0 set -
ROUGH
FINAL
Description ................................................$
TOTAL FEEd2 zM
Application for Power Plants and Hewing, Cooling, Ventilation, Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
Dept. ci Bldgs. Phone SU 4-7470
%GRAVITY WARM AIR: RATE
TOTAL
Locatia
Furnace Shell & Duct Work...........:..
8.00
>
Replacement of Furnace ......... ... , .........
5.00
City of Fridley:
Repairs &Alterations—up to $500.00
5.00
$
The undersigned hereby makes application for a permit for the work herein
..................
specified, agreeing to do
all work in strict accordance with the City Ordinances
Repairs &Alterations each add. $500.00 ::.......:.:..
2.50
$
and ruling of the Department of Buildings, and hereby declares that all the facts
.,
and representations stated
in this applicatiozi are true and correct.
MECH. WARM AIR
FrJdley Minn �� _ , 19 _
Furnace Shell & Duct Work to 120,000 BTU ............
8.00
$—
'
each add. 80,000 BTU ........
2.00
;
Owner 40�A!,X
Replacement, of Furnace .. , ....:......... ... ,_...-.....
5.00
$
Kind of Building
Repairs & Alterations --up to $500.00 .................
5.00
$
,
Repairs & Alterations each add. $500A0 ..............
2.50
Used as
STEAM or HOT WATER SYSTEM
To be completed about
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ......
0:00.
$
Estimated Cost, $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ...
8.00
$tg2.
wilding Permit No. Permit No.7`
Each add. 200 sq. ft. EDA Steam ......:..'...... ......
2.50
$
Each add. 320 sq. ft. EDR Hot Water ............"..... ,
2,50
$
DESCRIPTION Of WORS -
OIL BURNER.—to 3 gal. per hour ..........................
5.00
$
HEATING
`
Warm Air—No,
over 3 al.
g per hour—See Fee Schedule
o
;
Trade Name !
Size No ' /
GAS BURNER ftp to 400,000 BTU) ..
5.00
$
Capacity
Sq. Ft. E.D.R BTU H.P.
GAS FITTING FEES: NO
RATE
Tp'l'1►h
1st 3 Fixtures .......:.............. x.'T---
$1.50
$=
Total Connected Load 44&
Kind of Fue
Additional Fixtures .........:. x
.50
-$
BURNER — Trade Name
40 Size No-
o
Gas
Gas Range to 200,000 BTU ..........,. x
2.00
$
Capacity
Sq. Ft. E D H.P.
AIR CONDITIONING i
FAN HEATING SYSTEM See` Fee
$
f �
:aTiiYG gT8_ Ti�c3r tsar COavn.m
6409 GOGDRIC i AVE. S.
4chadule
�;
VENTILATING SYSTEM
ALTERATIONS &REPAIRS TOTAL FEE
$ Z-/''
Signe
By
- ROUGH
e
a 4 z 2M
Business PhoneNo-
FINAL
(REMARKS—OVER)
iyss _
4I -IF .OSS CALCULATIONS DEPARTMENT OF BUILDINGS
W .. erstrips A. Guide E, Construction No.
Guide
Insulation
Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor �I Kind .e How
Yes—No Yes—No 19—
171.1 ;o Room I Length Z 3 Width Height g F1.1 ?�/2 Room I Length Width
Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area
Width Height No. of Lineal f . Area Width Helght No. of L(neai !t. Area
No. of pane of pane lights of crack sq. ft. No.` of ane of pane lights of crack eq. ft.
1 otal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
1 1 A
-`� Q(get_ 'rwrw I i nns+l, / -7 W;A,.L ). -� -m-1./
Windows and Doors—Crackage and Area
95
Width Height No. of Lineal ft. Area.
No. of pane of pane lights of crack eq. ft.
�®® 2-4 Z—
Z -_Q ,
56 E,,', 2-S
Net exp. wall
2,0
1 e
Infiltration
Glass
Coef.1 Btu
Infiltration
Exp. wall
Glass
Exp. wall
8 Z j
Glass
..L° 3
Int. wall
176,50
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Exp. wall
Room I Length 13 -�- Width
Height
af
dT
wall
Net exp.J
Coef. Btu
Infiltration
Floor
Ne'�
y�
C 00
Ceiling
2,
Floor
1 otal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
1 1 A
-`� Q(get_ 'rwrw I i nns+l, / -7 W;A,.L ). -� -m-1./
Windows and Doors—Crackage and Area
I Y
Width Height No. of Lineal ft. Area.
No. of pane of pane lights of crack eq. ft.
�®® 2-4 Z—
Net exp. wall
Coef.1 Btu
Infiltration
Glass
Coef.1 Btu
Infiltration
Glass
Exp. wall
Glass
Exp. wall
3,91etrg
C --
0 Ca -0
Exp.
Exp. wall
..L° 3
Int. wall
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Net exp. wall
Room I Length 13 -�- Width
Height
Floor
dT
Int. wall
Coef. Btu
Infiltration
Floor
Ceiling
C 00
Floor
2,
Total Btu. 149. °®
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area -
F1.1 /_ F - D "*Room I Length / 7 Width <9 Heiarht
Windows and Doors—Crackage and Area
I Y
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Exp. wall
Net exp. wall
Coef.1 Btu
Infiltration
Glass
Infiltration
98 2 Z,
(D
Exp. wall
Glass
Exp. wall
Net exp. wall
Total Btu.
Int. wall
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Ceiling
Room I Length 13 -�- Width
Height
Floor
dT
7'
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
�,_M�._ EN
I
Infiltration
yoef. Btu
,P 8 a
Glass
I Y
ks q 5 a
Exp. wall
Net exp. wall
Coef.
Int. wall
Infiltration
Ceiling
Glass
Exp. wall
Floor
Total Btu.
Net exp. wall
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1
Room I Length 13 -�- Width
Height
Windows and Doors-Crackage and Area
Width Height No. o! I Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
3 2-
Ceiling
Coef. Btu
Infiltration
Floor
1318
Glass -- - � ® o�
Exp. wall m ®�
Net exp. wall ;
Int. wall
Ceiling
Floor 2__ AiL6;��,,
Total Btu. G 56Y
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area . r
t1I / /- n XA �) R.V.... l t inmlh / Width / A Height
Windows and Doors—Crackage and Ana
/!
Width Height No. of Lineal ft. Area
Na of pane ot•pa�n°e lights of crack sq. it.
Coef.
Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
C 00
Total Btu. 1 b 6
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
I
tr
G .,->75 _
.OSS CALCULATIONS DEPARTMENT OF BUILDINGS
W rtersGuidetrips A..H. a Construction No.
WindowsI Doors Reference Out. Wall Int. Wall Ceiling Roof Floor
Yes—No Yes—No 19—
/ 171.1 d-`' /i,t .')Room I Length // Width 0 (, Height A II Fl.l
Windows and Doors—Crackage ana Area
Jam,
Width Height No. of Lineal ft. Area
No. of pane of lights of crack aq. it.
pane\
C�
Coef.1 Btu
Coef.1 Btu
Infiltration
Glass
2el 1 G RV
Glass
0
Exp. wall
Int. wall
Net exp. wall
,�91
Floor
Int. wall
Ceiling
Floor Z // , c
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I L.en fth Width Heiaht
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane llghts of crack sQ. ft.
Coef.1 Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Lenath Width Heiaht
Windows and Doors—Crackage and Area
Width Rol ht No, of Lineal ft. Area
No. of pane of pane lights of oraok eq, ft.
Coef.1 Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Tbtal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Kind How Applied
r
Rnnm I Lenath Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft Area
No. of pane of pane lights of crack ea. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp: wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl.l Room I Length Width Height
Windows and Doors--Craekage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Reem I Lenath Width Height
Windows and Doors—Crackage and Area
Width No. o Lineal ft. Area
No. of pane et.paas lights of oraok sq. it.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
per, � �� � k b n - t+* _ p � r Z _
�,: 'xlf��. 'Fr"'.�r {� s. �� his w c i a r ^5s'+ a �-- � i.� f ,y+
u
•+
.1
e :' �„v,. .:: ,-,- .''� .. :-. ..�. r ,1✓,� .v.'_: ..r,4 ,. '.;, :w.r yqe 4 .. ,.,. _... �,. .. - �. .. .. ..., �_f sr�' .. _......
S
SUBJECT
PE
City of Fridley
1,12 19028
AT THE TOP OF THE TWINS
BUILDING PERMIT
Ir?
• COMMUNITY DEVELOPMENT DIV.
r 1 PROTECTIVE INSPECTION SEC.
�
i1 {
�'-'1,� CITY HALL FRIDLEY 55432
NUMBERREV.
DATE
PAGE OF
APPROVED BY
•---
L 612-571-3450
910-F15
6/25/87
JOB ADDRESS 5197 St. Moritz Drive N. E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
5
1 Innsbruck 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE,
Engquist 5197 St. Moritz Drive N.E. 571-2237
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
D & D Home Improvement 7401 Central Avenue N.E. , Fridley 784-7543
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 ❑g REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reshingle overlay, aluminum trim
9 CHANGEOFUSEFROM TO
STIPULATIONS
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
$3,175
$1.59
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-
$44.50
TRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$46.09
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
HEN ALI TED THIS IS YOUR PERMIT
PRP
BLDG )NSP f1ATE
SIGNATURE OF OWNER (IF OWNER BUILDER) IDATEI
NEW [ ] City of Fridley Effective 4/1/84
ADDN. f R-1 AND R-2
ALTER.] Building Permit Application
Construction Addre
Legal Description:
Owner Name & Address: EAS Tel. # `'�7"aoZ37
Contractor: M --T7r1PPdVejn*nt I Tel. # " 75-41
Address: i40i �dl�'r� �61C' OFRic����
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:
Corner Lot [ ] Insides Lot 0(] Ft. Yd. Setback
Type of Construction: R - hi - 1 d oVe&5
44 (4m /A 'A m 1 N!
Approx. Completion Date: -?
Proposed Driveway Width If New Opening Is Desired:
Side Yard Setback
Estimated Cost: $ 231r'7 5, Or -
Alt. A Alt B
See Back Page for Explanation
DATE: � APPLICANT: ' Tel. # 71� 75Y3
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
fbTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$425 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
2a1..0,5-
Building
BUILDING
Permit No.am_cb�7
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY(UT
R
763-502-4977 FAX
EFFECTIVE 1-1-08
DATE 2171Z009
YOUR E-MAIL ADDRESS �<<���/IUMn
COt�
SITE ADDRESS 7
�IUI(iZ �riV2
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY OWNER/
U
NAME;�Lfl[
TENANT
,�
ADDRESS: JI�7 - Ilofd� of. CITY
il(,tSTATE 90 ZIP S542-'
PHONE: -1(0 3 — 571 - -1 34 3
NAME: l) 00LIS vlOrl
CONTRACTOR
ADDRESS: Z � b S COQ y 011 VEL
CITY UUMiU STATE ZIP J S ( l
SUBMIT A COPY OF
PHONEl' -1-1 (0 �Jt@[O FAX �a Si - -Il ie -
YOUR STATE LICENSE
STATE LICENSE #
EXP DATE
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE
43 TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHEDWINDOWS
❑ BASEMENT FINISH ❑ ROOF
❑ DRAIN TILE
❑ DECK ❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ ANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: ��[� S
SIZE OF IMPROVEMENT
LENGTH WIDTH
HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
❑ HOUSE & GARAGE
1. Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
ING
ADDITIONS & PORCHES SUBMIT:
Vinyl
❑Soffit
1. Site Plan/Survey showing the existing structures
Aluminum
❑ Trim
and proposed project.
❑ Other
❑ Fascia
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS Yes []No LOCATION OF WINDOWS
OR FOR NEW OPENING -D SCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COPT OF LABOR AND MA'1 URIALS:
(USING THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
.Sewer Main Charge
Total Due
3,200 --
$ r 231. Z S,
$
$ (0.a o
$ 5.00
2,0
ANCY
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1825 per SAC Unit (Plans to MWCC for determination)
-ft +6 ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks savable to: City of Fridley Attac
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I ac wledge that the inf ation above is complete and accurate; t work will be inJa
ce with the ordinances and codes
of the City of Fridley and with the Minneso onstruction Code ; I understand this is not a permit but my application foand work isnot to start without a
permit on site; that the work will be in actorththe appro pl in the case of all work which requir revs dapproval
SIGNATURE O I NT PRINT NAMEDATE -21-710Y
APPROVED BY DAT194 0
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
RESIDENTIAL RATE
Furnace Shell and Duct Work,
Burner (Also replacement furnace) $ 20.00
Gas Piping $ 10.00
(piping needed with new furnace)
Gas Range $ 10.00
Gas Dryer $ 10.00
* Air Conditioning (all sizes) $ 10.00
All Others/Repairs and Alterations
1% of Value of Appliance or Work
COMMERCIAL/INDUSTRIAL
1% of Value of Appliance or Work
State Surcharge
TOTAL FEE
Reinspection Fee ($15.00)
Rough Insp.
Date
Final Insp. 2 — 9—
Date q
Approval for Permit
MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00
PLUS $.50 STATE SURCHARGE
TOTAL
$
$
S
$ .50
Attach stack verification form with.replacement furnace permits
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
Effective Aug. 1, 1981
Job Address. 9� S/—. Z!Za�' zz "O G /e-/" Z'
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
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 applicati re `true and correct.
z
Minn.
KIND OF BUILDING
USED AS �!
TO BE COMPLETED ABOUT 7 ` /,0'"' 7
CP v
ESTIMATED COST �/4vr
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
DESCRIPTION OF FURNACE/BURNER
r
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Trade Name Size No.
Capacity Sq. Ft. EDR BTU O HP
Total Connected Load Kind of Fuel /t�—
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Company �j��G �'/^^i%r� �j��''�%�'✓ fo
Signed By
Tel. No.