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PRE 2010 DOCSSUBJECT P IT NO. City of Fridley ~ 16465,, AT THE TOP OF THE TWINS BUILDING PERMIT _ r RECEIPT NO. • _____ COMMUNITY DEVELOPMENT DIV. L• e �� r PROTECTIVE INSPECTION SEC. 3 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 11/17/81 JOB ADDRESS 6865 Si Verts Lane N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. S. 1381 o Lot 1 Alts. Sub. #10 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jesse Priem 1300 - 67th Avenue North, #302, Brooklyn Park 566-0414 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Priem Construction Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESSSEPERATE PERMITS S REJOIRED jou yrh NO. i 6 USE OF BUILDING HEATING, PLUMBING AND _ . Residential 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 38' x 32' Duelling and a 22' x 26' Garage 9 CHANGE OF USE FROM TO STIPULATIONS provide City with copy of verifying survey before capping. Provide sod in the front and side yards. Provide a hard surface driveway. SEWER LOCATION: (Approx. 11.5' Deep In Street) 15' N. of M.H. (Inv. 873.08) WYE ELEV: 873.02 TOP OF FOOTING: 876.02 Minimum WATER LOCATION: 50' N. of P.P. , 26' E. of San. M.H. DRIVEWAY DEPRESSION ESCROW: N/A WARNING Paid $500.00 Park Fee Before digging call local Iutiiifies TIDE CITY OF FRIDLEY DOES NOT GUARANTEE TME TELEPHONE ® ELECTRIC ® GAS Elia,, ACCURACY OF UTILITY LOCATIONS AND ELEVATIC._. , REQUIRED ►� THIS DATA IS FOR INFORMATION PUPPOSES OINLY �AYda LAW PERSONS USING IT SHOULD VERIFY THE INFORMATION ^•N THc SITE. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, 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 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 $49,900 $24.95 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITFEE SACCHARGE PROVISIONS OF ANY OT R STATE OR LOCAL LAW REGULATING CON- $283.00 $425.00 STRUCTIOA OR THE PE RMANCE OF CONSTRUCTION. CHECK FEE TOTAL FEE \'VPLAN �'0�� $70.75 $803.70 SIG 01URE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT BLDG INSP I DA E SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATIM FOR RESIDENTIAL BUILDING PER4ITS (New, Alterations, Additions, or -Repairs) OWNER: Tey � @ PSI e4_v° ADDRESS: 13oo 6744 Ave 4(, "3oa2 TEL NO: 566-0 w BUILDER: ADDRESS: 1.40: Construction Location • STREET NO: QZ40 STREET:' n LOT: !3"( 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. DESCRIPTI0N OF CONSTRUCTION Front: 3e Depth: - Q Height: Square.Feet: Cubic Feet: Front: Depth: Height: N� Square' Feet: Cubic Feet: _ j �Mmop Type of Construction: Estimated Cost: $ 7b Be Completed: re 6 � �� . ttNq ®AJLq A Alt. Proposed Driveway Width If New Opening Is Desired: $ N$ SEE REVERSE SIDE OF SKEET The undersigned hereby makes application for a permit for the %.,ork' 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. DINE: /17Z L)�z r/ SIGNATURE: Stipulations: P. P. V 5440 Pate Oft 2 9ZI.00 00 C P41S.0 4 V Z2 Z c z S7Z. or -d ca -r) T le C, r Gol 461,`s"C'4 Mlti lg°ti'Lc) (4398.02? (14114.14 SUBJECT PE City of Fridley 1714 2 AT THE TOP OF THE TWINS BUILDING PERMIT rp RE COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. e i CITY HALL FRIDLEY 55432 NUMBERREV. DATE PAGE OF APPROVED BY ,.j 612-571-3450 910-F15 5/16/83 JOB ADDRESS 6865 Sivert's Lane N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. S. 138' of 1 Aud. Sub. #10 Revised SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ray Hermanson 6865 Sivert's Lane N.E. 572-8882 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 xp ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 16' x 201 Deck 9 CHANGE QF USE FROM 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 VALUATII� SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED r 800 $• 90 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITFEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $29.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL F�E $30.40 SI ATUR 0 CTOR OR AUTHORIZED AGENT (DATEt WHEN PROPER ALIDATED THIS IS YOUR PERMIT A' �/� � zan S ATU OF IF OWNER BUILDER) ATE) BLDG INSP DAT CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATION F014 RESIDENTIAL, BUILDVIG PERPUTS (New, Alterations, Additions, or Repairs) OWICR: d::�e Idle 2c1 Off" BUILDER: -r4,-? ADDRESS: _' Ss` Q ADDRESS: TEL NO: _-S-7.2 e e e z TEL NO: Construction Location - STRMT NO STREET: S4<414 ,y�c IAT: 2 1-38 , Cit L.Oi I BLOM$ ADDITION: 6 � /6 `j L04 Corner Lot: Inslae Lot: Setback: Sideyards: Applicant attach to this fora two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF MNSTRUCTIN 6 Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Peet: 'type of Construction: Estimated Cost: i 1b Be Completed: 30 a -r Alt. A Alt. B Proposed Drivmray Width if New Opening Is Desired: B _ SEE MVERSE SIDE OF SHEET M:e undersigned hereby ma);ea application for a permit fcr the %rork herein specified, agreeing to do ,all work its strict accordance with the City of Fridley Ordinances and rulings of the Delynrtment of Duilaings, and hereby declares that all the facts and representations stated in this applicat Mare true and correct. D.ITEs 6F-3 SIGNAT)= s Stipulations: hOrt M.m ws _ 0% k H k 60 YSYItRRM 6875 gln.►p /W d5 'tlR..-.- _ _ �� M.rcitlptNaa, Mw�aN 55332 _ S.wt9t)tr.ca 1)80810 ® t lnai at !lsrw'4pa( Lnpntaww� D a Pwtws< ladQ Sr rw yW f�Q •moi 1141 Cdtl V.iww . hyly 61332 - DESCRIPTION SkET[N !or ,, 00DCO INVESTMENT - REALTy, INC. Alorlh lige 1�1 eeu Rud. Srib. No: l0. p �-- I t b �a1ti leaf it G� before't�E� E e Ei.E�1'�iC - '�EL�.PHOfiIE • � � 00 WA _. 97.0 COUNTY R04o Z) PARCEL 0 �+ 8 0 3 0 Com, O r 00 97 I I ' Zt A ca . A — P aCEL. The �oulh 13 8.041 of oto a o �o %hal part oil" Lof 1, Revised Auditors Subdivision Alo.lo, a M r A L gnoka Counly, NJlnnesota, described as follows: Cge'innin� a/ a point on the north line Merea/� ClWanf 642 f eef East of the northwest corner 1' o� lot lei ;aid ,Qevrsed Audi lor's Subdivision zo4d Ifo. l0 thence East, along¢ The Alorth line tasemen f " 1 thereof 9 7. 0 eef ; ,�hence� �oulh, pa rvllel _97,n_ with the k/esl line lhereVorlh .308.0+eef; thence C me parol el wi>lh 14e „vrA West, ora llel with the line Vhe re o �' Cline �' %lev Rud Sub. I✓o. /0. 9 7 f • 1tienee North, Parallel wi lh Ae West ii0e �lhereo, 300 eef lo {he oinf � P or he inn !n / accprot in ho lhQ ma yr play lherepl on /e and w 'recferd i hl lee o the ,Qe 4Irar Ti les In ano1j,or Anolra ounl AIA'nesofa. lu6 eel lo the so u lh ,'eef for rovdwoy pram s a. AA /0 4,7nb v r V 1 'tet► O OF LOC.36C1NS k� d► ,. AND � �>aaA �s�:� 'Nr�`�.�P4N �Y�os�s c %SONS U'tIr'� r' 3 6 NFO..... �(�VtSCKI�S� I1 ] `c ti s 00 WA _. 97.0 COUNTY R04o Z) PARCEL 0 �+ 8 0 3 0 Com, O r 00 97 I I ' Zt A ca . A — P aCEL. The �oulh 13 8.041 of oto a o �o %hal part oil" Lof 1, Revised Auditors Subdivision Alo.lo, a M r A L gnoka Counly, NJlnnesota, described as follows: Cge'innin� a/ a point on the north line Merea/� ClWanf 642 f eef East of the northwest corner 1' o� lot lei ;aid ,Qevrsed Audi lor's Subdivision zo4d Ifo. l0 thence East, along¢ The Alorth line tasemen f " 1 thereof 9 7. 0 eef ; ,�hence� �oulh, pa rvllel _97,n_ with the k/esl line lhereVorlh .308.0+eef; thence C me parol el wi>lh 14e „vrA West, ora llel with the line Vhe re o �' Cline �' %lev Rud Sub. I✓o. /0. 9 7 f • 1tienee North, Parallel wi lh Ae West ii0e �lhereo, 300 eef lo {he oinf � P or he inn !n / accprot in ho lhQ ma yr play lherepl on /e and w 'recferd i hl lee o the ,Qe 4Irar Ti les In ano1j,or Anolra ounl AIA'nesofa. lu6 eel lo the so u lh ,'eef for rovdwoy pram s a. AA /0 4,7nb v r SUBJECT � City of Fridley 700'74* 4 AT THE TOP OF THE TWINS PERMIT t.7®360 BUILDING NO. COMMUNITY DEVELOPMENT DIV. /vim r E PROTECTIVE INSPECTION SEC E . � CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By ' 612-571-3450 910-F15 12/16/98 JOB ADDRESS 6865 Siverts Lane NE 1 LEGAL LOS N0138 T BLOCK JTRACT OR ADDITION SEE ATTACHED DESCR.of Lint I ARev, SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Herman Heineck522-076 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Renewal by Ander502-4777 200406in 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION a REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace 1 window and 1 door in home 9 CHANGEOFUSEFROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on each level of the dwelling. 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 1 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 $3000 $1.50 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 $74,75 Fir SC $3.00 PLAN CHECK FEE TOT L EE Licen C .25 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI EPR VALID T THIS IS YOUR PER IT B& INSP TjATE S-GNAiuRE OF OWNER�IF OWNER BWLDERI IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: _U,8& 5 &4,A 4>Lne ?? b Legal Description: Owner Name &Address: �,Q�} �jqx/D_ 8& � ,z fs .17 el. # 52 a 'U 9710 Contractor:, fZ,�1t�'c IL y �,�$ MN LICENSE #c3�LIC-)Co� Address: , xg i�,� 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: 'r�n la t -e _ I u) l z A) d I d an 1� `=►1.=._ $1000 per SAC Unit Construction Type: $ Estimated Cost: $ 3T(, $5.00 (State Licensed Residential Contractors) Driveway Escrow $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: o? APPLICANT: $ Tel. Permit Fee Fee $ 7 L4 -IS" Fee Schedule on Reverse Side Fire Surcharge $ 3 •Do .001 of Permit Valuation (1/10th%) State Surcharge $ Sa $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ G-00 $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 $ STIPULATIONS: i 1/�O� �. yt� C `% % �� <'-V 01 SUBJECT IT NO. City of Fridley 30403 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. r COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. �� ^ f PROTECTIVE 1 � a NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 10/14/99 / 108 ADDRESS 6865 Siverts Lane NE 1 LEGAL LOT NO. S 138 BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Of I Rev. Auditnrlg SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Herman Heineke 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Amek Construction 140 W 98th St #103 Bloomington 55420 941-7844 20164402 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 NN REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage 24 S Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CON T. QCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED 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. OWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT 1 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 $2098 $1.05 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THF_PERFORMANCE OF CONSTRUCTION 83.25 Fira SC $2.10 PLAN FEE TOT FEE L2CHECK �c�Licens 5 1.4 6g.14TURE OF CON' A OR AUTHORIZED AGENT E P OG IN VALID THIS IS P� IV rr de naTt SIGNATURE OF OW NER dF OWNER BUILDER i IDATEi 01 F NEW[ pv—. --] ADDN ALTER Effective 5/10/99 [ ] CITY OF FRIDLEY [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name & Address: Lk LP 1-2. a�� %f 1n=gLe— Tel. # Contractor: MN LICENSE # 1 �o �-- Address: Tel. #h 4 '7 Attach to this application, a Certificate of Survey of the lq,(, goo � l lot, with the proposed construction drawn on it to scale. ,C,J� 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: 17e-4+,eeJr4 Estimated Cost: $ Q Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $. DATE: vAPPLICANT: Tel. # `Z 730 Ycf `/(1ff� TOTAL STIPULATIONS: CITY USE ONLY Permit Fee $ CR>3. �S� Fee Schedule on Reverse Side Fire Surcharge $_ cl (6 .001 of Permit Valuation (1/10th%) State Surcharge $ Qd~ $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge _ $ s, d O $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: F7 •- G SUBJECT t P City of Fridley 4i� 5 AT THE TOP OF THE TWINS BUILDING PERMIT r 16 RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. 7,36 r PROTECTIVE .�7 I = : CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/13/00 JOB ADDRESS 6865 SIVERTS LANE NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 381 of 1 Rev. Auditor's Sub. #10 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Herman Heinecke 6865 Siverts LaneNE 763-572-0976 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Renewal By Andersen 350 -73rd Ave. NE, Fridley, MN 55432 763-502-4777 20130983 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 ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK frame windows Replace 3 full in home within existing openings 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Sec. 310.9.1.2 1997 Uniform Building Code. Permit Inspection Cards Will Be Mailed To Homeowner To _Post 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 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3,615.00 $1.81 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 $97.25 FirAC C $3.62 PLAN CHECK F $5 0 e SC TOTA FEE jr 107.68 SIGNATURE OF CON TRACTOR ORAUTNORIZEDAGENT IDAttI c EN PRO ALID ED HIS IS Y tOMIT,�� ,R IJi�J�.✓Vl BLO -NSP' qa�E S-GNATURE OF OWNEROF OWNER BUILDER. IDATEI •- G NEW[ ] Effective 5/10/99 ADDN [ l CI7.'Y OP FRIDLEY ALTER ,[� SINGLE FAMELY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION o Construction Address: .k Legal Description: Owner Name & Address: �gs'{`S -wm vve� n Qh (I Tel. # Contractor:, RENEWAL BY ANDERSEN MN LICENSE # 350 -73RD AVE. NE Address: FRIDLEY, MN 55432 Tel. # (612) 502-4777 LICENSE #20130983 a of Survey. of the yawn on it to scale. DES . ON OF UUMHOVENWANT LIVING AREA: GARAGE AREA: DECK AREA: Construction Type: Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Estimated Cost: $ J, Lo �JV� Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ ZI CITY USE ONLY M1 Tel. # 9S9, SV•agS-q *1q 7 - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1050 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 [ l STIPULATION S�v/ola- /6ZVW-C 4-0.00 '�'L-�� .. Flo• � / �-- /�'��' �.� C. CITY OF FRIDLEY INSPECTION 6431 University Ave NE Fridley, MN 55432 (763) 572-3604 FAX (763) 571-1287 RATE SCHEDULE DIVISION APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES 47E-C`� JOB ADDRESS a 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. Effective January 1, 2003 OWNER 7�4 Ir(/YJC r I�C.CC- TOTAL BUILDING USED ASS ESTIMATED COST PERMIT NO. � DESCRIPTION OF FURNACE AND�611 BURNER No. of Heating nits Circle One (Steam) (Hot Water) rm' $ Trade Name L 172LZrSize No. ts BTU ® HP EDR $ Fuel 4 STotal 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 an $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true an corr t. DATE '7 a� HEATING CO STANDARD HEATING & AIR CONDITIONING 0- 410 WEST LAKE STREET Signed ,n AMINEAPQLIS, KII 4-2995 61 E BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE a APPLICATION WILL BE RETURNED When rapine -Ann an axictingftirapn-P, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes.(U"K0 ( The venting system is plasdc1PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes( ) No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes (Wo ( ) TheY�Ccnmti isHnn air is sized and installed to meet the current codes and manufacturer's specifications. Yes (4 No( ) When required to install a nm nombustion air it will be sized and installed to meet the current codes and manufacturer's specifications. Yes (L4/No ( ) When jpgtaJJ nn a new `►anfing Syfijem, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does in AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes (VNo ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes (,,)/No ( ) Appliance #1 Type Rk BTU Input 8! ® 0 D Fan Assisted or Nat Appliance #2 Type j� BTU Input ®ca v =an Assisted or Nat N l�-T Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input IZ c Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Heighi 3 .. Length i Diameter __�_'_in Type Appliance #2 Vent Connector Height 3 ft Length/ 't Diameter—q in Type UT" Appliance #3 Vent Connector Heie+ / f+ !_--.igth y ft Diameter in Type Al TFRnTroRs- (Dasraibe�- v HEATING CO: 27 o l Signed 13y: Date: GNOE FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 June 22, 2004 Mr. Herman Heinecke 6865 Siverts Lane NE Fridley, MN 55432 Re: Final Inspection at 6865 Siverts Lane NE Contractor: Standard Heating & Air Conditioning Co. Dear Mr. Heinecke: A mechanical permit was issued on July 17, 2003 to install a furnace and an air conditioner at your address. According to the 1991 Uniform Mechanical Code a final inspection shall be conducted on the work authorized by this permit. As of this date the inspection has not been requested. The permit fee that was paid covers the inspection to make sure the work was completed according to the Codes. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will mark the permit "no inspection called for by homeowner after notification" and the permit will be expired. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. Sincerely, CITY OF FRIDLEY PERMIT NO.: 2004-01280 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 08/06/2004 ' (763) 572-3604 FAX: (763) 571-1287 ADDRESS 6865 SIVERTS LN NE PIN 133024120023 LEGAL DESC UNAVAILABLE LOT BLOCK PERMIT TYPE HEATING PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL GAS FIREPLACE. # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 0 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 0 APPLICANT HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK 15.00 0.00 FIRESIDE HEARTH & HOME 2700 N FAIRVIEW AVE GAS RANGE FEE 0.00 ROSEVILLE, MN 55113 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 607468 0.50 15.50 OWNER HEINECKE HERMAN E & GAYLE T 6865 SIVERTS LN NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions any o r state or local law regulating construction or the rform ce of construction. Applicant Date fFWORK Bldg InsW D SEPARATE PERNIITS Q D OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY BUILDING INSPECTION 6'431. University Ave NE :"i Fridley, MN 55432. 763-572-3604 FAX 763-5711287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furn ce�ireplace, ert) Gas Range Gas Dryer *Air Conditioning -AII Sizes All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fee Total $35.00 $ $10.00 $A_106 $10.00 $ JOB ADDRESS 60 �'&5 S a y er-� 4,n. Owner Werc `_e�, ge lie ke- Building Used As ESTIMATED COST PERMIT NOC�>� DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name 1-� i talo '7 50>R _5' :7�2Y Size No. $25.00 $ BTU 30 HP EDR Fuel At Z., : Total Connected Load Commercial/industrial/institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR $ Burner Trade Name BTU Size No. 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 $ and rulings of the Building Division, and hereby declares that all the facts *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE and representations stated in this apli .cation are true and correct. dba Fide Hearth &moo HEATING CO 1 Psevft MN 66113 6511633-M Tel #_ FAX # Date 0 Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category 1 Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes () No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS:. (Describe) j2rnoyef e)tf.s Zero ef/ee'✓G.ti '_ V-- MW e MW Fireside dba Fbeside Hwih & Mom eaeen9e NS998EID1a - - - - - - 2M K FaIpMw Ave. HEATING CO: ResWW, MN 55113 6i.51/�9.9.581 Signed By: Date : ��/Le i,/ From: 651 3791991 Page: 2111 Date: 1/28120091:22:54 PM M11-40-ua is;41rm rrtum-rtntiturattun rruieviwildiv ooi-Oru-1vol t-toc r.uuctuii r -e44 o- -� ti11dI7.Di'x Pe:i7nit Na.: —t76�7C3 Inspections RESIDENTIAL APPLICATION Received By 763-572-3604 CITE' QP FRIDLE Y bete Rec'd' L =100 E l 763-502-4977 FAX EFFECTIVE 1-1-08 DATE YOUR. E-MAIL ADDRESS�k19 SITE ADDRESS 690 N it rtl �/ THIS APPLICANT IS; ❑ OWNER XCONTRACTOR PitOP'ERTY OW NJZP! NAME: lei e ✓ 91,60 U e I "c if2 TENANT ADDRESS; (� b 7 V�� L M Nr-.- CITY r- FZt_0 LG It _STATE M -ZIP -�, 1U - PHONE: 612 - `def 7 & NAME! 12nra-ELL NA-L'K CONTRACTOR ADDRESS' 52 41,ArNi-Eu'A11A AVE W CITY 57:. ELL. STATEALZIP 45103 SUBMIT A COPY OF PHONE 651- 7 !94.- S'31) z FAX (051 -379 -IM/ YOUR STATE LICENSE STATE LICENSE #_y3 1-1 G 1 EXP DATE --T I e: I'l O �Y TYPE IHSINGLE PAMILYINEW CONSTRUCTEON SIZE„„ , ❑ TWO FAMILY/NEW CONSTRUCTION STORMS YPE 7i—ADDITION ❑ GARAG.E/STiED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK d SIDING [ROTIIER ❑ SWIMMING POOL TYPE OF WORK:` 13NEW ROMP CONSTRUCTION l7 ADDITTON At MAENTENANCEWPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: L� Dft: }rs c11.+�. -a we- SIZE v'e-SIZE OF IMP LENGTH_ wtD'li1 ROdFINO )6HOUSF. ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE [;ARAC S PROPOSED SUE;� _ PROPOSED HEIGHT; r, 611MG 0 Vinyl Cl Aluminum Q Other WINDOW�t IN EXISTING OPENINGS ❑Yes ONo OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE. OF WINDOW TO BE rNSTALLED_ ._ ❑ ATTACHED GARAGE 0 DETACHED GARAGE 4 BASEM d r RFl.QODELIDK' SUBMIT: 1. &iSting Floor Plan 2. Propossd floor plats 3, I.ist of struzW l members to be used FOR NEW ZONSTRUCTION INCLUDINfr DECKS, ALD -Q •IOKC & PU.It_ M..S UB—UB MI- L ❑Soffit 1, site P:mVSurvoy showing tho oxi alas struetuMS ❑ Trim and proposed project ❑ Fascia z. Two sats of consttnction plans 3, 1?aerg,•.C.'slculsdons LOCATION OF W INDOWS ALX,, ES ARE BASED ON VALUA'I rOTAL JOB VALX Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge CuTb Cut Escrow Erosion Control Park Fee Scwer Main Charge (USING $ GUDIING THE COST O)F]L• F1::E 3CHED'iTIrE) OCCUP See Back Page for Pee Schedule 65% of Building Permit l=ee .001 times the total job valuation ,0005 x Permit Valuation Minimum $.50 $5.00 (Slate Licensed Residential Contractors) $1825 per SAC Unit (Plans to MWCC for detcrminition) F+6ft=—ft x$21= S— $450 Conservation Plan Review Fee Deterrnined by Engineering Agreement necessary ( ) Nora Necessary ( ) THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED kil I hereby apply for jt building permit and E acknowledge thus ibe information above is complete and accurate; that the work will )a in. onfonnance with rbc 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 applicarim fora permit and work is not to Stan without a permit on site; that the work will be in accordance with th ppr ved plan in the case of ail work which requires review and approval o F plans. SIGNATURE OF APPLICANT c, _PRINT NAME !/Gik, DATH ! ' Z`l aq APPROVED BY DATi- Building $ BUILDING See Back Page for Fee Schedule Permit No.: Inspections $ RESIDENTIAL APPLICATION 65% of Building Permit Fee ReceivedB%?./ 763-572-3604 _$ ?_, 5 -5 .001 times the total job valuation na U 0 0 Surcharge $ CITY OF FRIDLEY .0005 x Permit Valuation Minimum $.50 DATE CRO t�50.d@ C,cm� V� YOUR E-MAIL ADDRESS a e SITE ADDRESS (0 5 65 �j � \j'9,< h5 r02— owl oc THIS APPLICANT IS: ❑ OWNER PICONTRACTOR PROPERTY OWNER/ ` NAME: yt< �`(�C m-:' LV -e i n -L cIt $ $ TENANT ADDRESS: 111*1 CITY STATE_ZIP Park Fee PHONE: ? (O ?J 6% -'CP 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 WITH APPLICATION PHONE License #20130983 ❑ SINGLE FAMILY/NEI ROT PROPERTY TYPE A ch Sti relations 13 TWO FAMILY/NEW G 651-264-4_777 ❑ ADDITION ❑ GARAGE/SHED J'WINDOWS PERMIT TYPE ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE:C LO e 3 l.`n I d, �) as i s4 i /`Q, / � - ewi �1?S cp= i SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE I. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2. Proposed floor plan PROPOSED HEIGHT: 3. List of structural members to be used SIDING ❑ Vinyl ❑Soffit FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Aluminum ❑ Trim ADDITIONS 1. & PORCHES SUBMIT: Site Plan/Survey showing the existing structure ❑ 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 r>r. &a ARE BASED UN VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) JOB V. Permit Fee $ 153 Q -.3- See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge _$ ?_, 5 -5 .001 times the total job valuation Surcharge $ 3, -�----) .0005 x Permit Valuation Minimum $.50 License Surcharge $ 5,00 $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow Erosion Control $ $ ft + 6 ft = ft x $21 =$ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering �(^ IW Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ ROT Make checks payable to: City of Fridley A ch Sti relations 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 ii 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 approver plan in the case of all work whic re/q�u�We�s/ view and approval of plans. / _ /�Q SIGNATURE OF APPLICANT vvt (%I u � PRINT NAME,pt 1 Ci,,. Y�L 1r1S tf�7 DATE 6? V / N