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PRE 2010 DOCSSty ®f Fridley, Minn. 0- - ' -1 . �. Date: �--- a' Owner: e2mj Builder gtfl�&- Address Address — L TI® B WING No. Street ° _ _ Part of Lot Lot --- _ Block Addition or Sub -Division .— Comer Lot _ Inside Lot tf Setback II —_ Sideyard Sewer Elevation Foundation Elevation To as: Front Depth Height / Sq. Ft Cu. Ft on Depth ei t _ Sq. Ft. Cu. Ft Type of Construction _ Est. i � 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 ordinanc ews of the city of Fridley. 4-7 In consideration of the payment of a fee of $_ 4 , permit is hereby granted to the express condition thto construct the building or addition as described above. This permit is granted upon at 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 pari 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 limits and this permit may be revoked at any time upon violatiott of any of the provisions of said ___ NOTICE.- " OTICE:" permit don not cover the construction, installation for Wiring, plumbing, gas heating, sower or wafer. Be sure to we the Building Inspector for separate pwndit for these Bomm City of Fridley sueaEcr PE ®14213 AT THE TOP OF THE TWINS PERMIT r BUILDING RECEIPT NO. COMMUNITY DEVELOPMENT DIV. 1 PROTECTIVE INSPECTION SEC. 1 = � "1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY %.J 612-560-3450 910-F15 7/3-377 JOB ADDRESS 6171 Starlite Boulevard N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 19 2 Sylvan Hills Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Len Steiner 6171 Starlite Boulevard N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Lloyd's Home Improvement 4909- 49th Avenue N.E. 560-4857 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 X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE El❑ - 8 DESCRIBE WORK Construct a 16' x 18' Addition to Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS Provide vapor barrier in ceiling. Provide 3� inch anchor bolts 6 feet on center in sill plate. WARNING Before digging telt local utllitlet foR WIRING1 TELEPHONE - ELECTRIC - GAS Etc. PERMITS REQUIRED PE SEpERA1 SIGNS- REQUIRED BY LAW PlU��64NG AND I EA'TINf�, SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood }?Tame 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 R-1 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 $6,508 $3.25 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- STRUCTIONOR THE PERFORMANCE OF CONSTRUCTION. $13,82 NONE PLAN CHECK FEE TOTAL FEE 3.46 20.53 SIGNAfUftOF CON ACTOR OR UTHOR(ZEDVVT (DATE) WHEN P OPERLY VALIDATED THIS IS YOUR PERMIT e n� )If BLDG. )NSP is —r DATE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: J3 � BUILDER: Address: 6 O Address: iTo 9 — T Tel. No. No. dv 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 these Certificates. To Be Used As: DESCRIPTION OF BUILDING ` %-2 Front: �� Depth:Height,:/ Square Feet: cam' ® Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: Aa To Be Completed: Estimated Cost: $ Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) 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 all the facts and representations stated in this application Aare true and correct. See reverse side additional info cation. DATE: SIGNATURE: ®1-- Stipulations: 3 ®� , Y BUILDING PERMIT FEE SCHEDULE SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection of any building or structure, or for any addition to -any existing building or structure, or for any alteration or repairs to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet. PLAN CHECK: 25 percent of building permit fee. DRIVEWAY DEPRESSION: (Concrete Curb Streets Only) Alternate A: Removal and replacement of concrete curb and gutter only; Driveway width plus 6 feet x $11.75 Alternate B: Removal and replacement of concrete curb and gutter -and install a 3 foot wide approach with 6 inch depth; Driveway width plus 6 feet x $15.40 +"F G ► I 1014 For the purpose of computing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or the cellar to the average heights of the upper surface or to the average height of the roof surface of the main gable of a pitched roof. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 ]jer each five hundred dollars ($500.00) or'fraction thereof in the cost of all proposed work. In -no case shall the fee charged for any permit as set forth in Section 2 be less than $7.50 plus $.50 state surcharge. VERIFICATION OF FOUNDATION NOTE: Permits for construction will be issued a minimum of 24 hours from the time of application'to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has been constructed will be required before proceeding with the framing. CERTIFICATE OF OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. SUBJECT PERMIT City of Fridley o AT THE TOP OF THE TWINS BUILDING PERMIT RECE `y ______ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 35 -© , it i ��'�'f,•� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY ---. L 612-571-3450 910-F15 4/3/90 f JOB ADDRESS 6171 Starlite Boulevard N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 19 2 Sylvan Hills Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Leonard/Avellene Steinert 6.171 Starlite Boulevard N.E. 571-3397 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 X❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 6 DESCRIBE WORK Construct a 161-x 16' Deck 9 CHANGEOFUSEFROM TO STIPULATION .S See notations on plan, Before digging call -for all utility 10cations SEPARATE PEWMTS REQUIRED FOR 454-0002 WIRING, KrTI��, Pl.11MlIrvGt:n;i'. 140 REQUIRED �Y LAW 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 SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION 256 OR WORK IS SUSPENDED OR ABANDONED FORA 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 $1' 850 $, 93 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 TOTALFEE $43.93 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATA W WH N PRO ER V IWAstED THIS IS YOUR PERMIT 4C j -�iGNATURE OF OWNER IIF OWNER BUILDER) IDATEI pG )NSP rjA TE NEW [ ] Effective 1/1/90 ADDN [ ] R-1 AND R-2 ALTER [ ] Building Permit Application Construction Address: Legal Description: /-07- / ,� e uLl✓✓�'!� ft/� S G T �!� �T Owner Name & Address: �A4�f- / A C �%2 ` //� /' Tel. # v Contractor: slr6c Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DeESCRIPrION OF MOROMEMENT LIVIM AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DDCR AREA: Iength Width Ila Hgt/Ground Sq. Ft. OTBER: Corner Lot [ ] Inside Lot [ ] Ft. 1 12� Type of Construction: Approx. Completion Date: k Side Yard, Setbacks Estimated Cost: $ d Proposed Driveway Width If New Opening Is Desired: Ft. $ $ Width + 6' See Back Page DATE: 3 -%'90 APPLICANT: Tel. # 'S Permit Fee $ ®V State Surcharge $ SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOTAL $_ STIPUTATIONS: USE ONLY Fee Schedule on Reverse Side $.50/$1,000 Valuation $600 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] /960 C-® 0, 11)1-01' MS SUBJECT P ^AMI I NO.. City of Fridley 24628 AT THE TOP OF THE TWINS BUILDING PERMIT Ir? RE O. COMMUNITY DEVELOPMENT DIV. / r PROTECTIVE INSPECTION SEC. 1 ; i NUMBER REV DATEPAGE OF APP OVED BV CITY HALL FRIDLEY 55432 612-571-3450 910-F15 10/7/96 JOB ADDRESS 6171 Starlite Blvd NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 19 2 1 Sylvan Hills Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Leonard Steinert, 6171 Starlite Blvd NE, Fridley, MN 55432 571-3397 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. John Harty, Inc., 9403 Minnesota Lane, Maple Grove, MN 55369 545-4233 9387 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 M REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Tear-off and Re-roof 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must meet State Building Code. 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 $1,980.00 State SC$ .99 WIT H TH SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DO S NO P SUMS O IVE THORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE P OVISIO F ANY OT ERS TE OR LOCAL LAW REGULATING CON- $62.25 Fire SC $1.98 S RUCTI R THUERAFr RMA CE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE /? -� License Fee $5.00 $70.22 SIGNATURE OF ORO AUTHORIZED AGENT (DATEI WH E I PROPS VALIDATED THIS IS YOUR pyPERMIT e �✓ BL G INSP �4T f(Z"" DATE _ S.GNATURE OF OWNER dF OWNER BUILDER) IDATEI NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: 1/' / Legal Description: Effective 3/1/96 Owner Name & Address: Tel. # 32 i Contractor: MN LICENSE # 6C?I Address: ,,,' ZA/lQ ZD �,�� Tel. # _24,S7- . Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EUPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: @ r,6t� ®6Gi::-Estimated Cost: $ c� �, Approx. Completion Date: 10- �? ,d (Cost on Back) Driveway Curb Cut Width Needed: t. + Ft = Ft $ _ $ DATE: APPLICANT: Tel. # CI'T'Y USE ONLY Permit Fee $ 62, Fee Schedule on Reverse. Side Fire Surcharge $ 0 .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $900 per SAC Unit License Surcharge $ ) r $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: $ a, Z 0- jCITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2002 6431 Jniversity Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE - Residential Rate TOTAL'" Furnace Shell and Duct Work, Burner- urner-Also AlsoReplacement Furnace $ 3.0.00 (Side Vent'. Fill Out Back) t Gas Piping (Needed with new. furnace, $ 10.00 $ but not replacement) Gas Range $ 10.00 $ Gas Dryer ry $ 10.00 $ *Air Conditioning - All Sizes $ 25.00 $ All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work $ �� Commercial/Industrial 1.25% of Value of Appliance or Work $ State Surcharge $ 50 TOTAL FEE $ P - 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. J.OBADDRESS I% I 51AAI-l7"2�;: Ati✓ice OWNER 4 a -1-251� C -Pe. BUILDING USED AS Tk-L)-`'""r_ ESTIMATED COST_�� PERMIT NO.:.- DESCRIPTION 0."DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units - Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. - BTU HP EDR Fuel Total Connected Load Burner Trade Name Size No. BTU HP EDR The undersigned hereby makes application for a permit .for the work herein specified agreeing to do all work in strict accordance with the City Codes an rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. SOE-;eOB F3€F.AOB�a d'` 592'8DAVENUE NO. DATE TAI.161H HEATIN 0 Signed TEL #(��� FAX # r. Approved BY -4 Rough -In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON VFNT, VENT CONNECTOR ANIS COMR11STION AIR VFRIFICATION When re lacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration,, obstructions, and is securely supported and fitestopped where required. Yes O 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 -LAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes ( ) No ( ) The Pxic ing cnmh ,stion air is sized and installed to meet the current codes and manufacturer's specifications. Yes ( ) No ( ) When required to install a new rnmhimtoon air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes No( ) When installing] a new ventingcyc, tpm, 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 Ix 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 #1 Type ku "'r:> BTU Input-2Sj7dEZ Fan Assisted or Nat FA--�j 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 HEATING CO: 3,ttpF,RjOR CQRTRACTOR IMC. Signed By: C Date (jll-v 2- t CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1993. APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater —Electric $ 7.00 Water Heater — Gas $10.00 Gas Range $10.00 Gas Dryer $10.00 Back Flow Preventer Required ( )Yes () No Type -$5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance State Surcharge JOB ADDRESS � 11,I �!°�ir��4 13(. a m d 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 are true and correct. Owner �"�C'/�ld��• Building Used As S'ir� �ia'a Estimated Cost -U PERMIT NO. I . PLUMBING COMPANY SIGNED BY Approved By Rough—in Date $ .50 TOTAL FEE $ , 2-) PLUS THE $.50 STATE SURCHARGE TEL N0. _7(7 ffs9 Final DatZ4k f j8U Building Equipment Installed MECHANICAL Permit No.: �O IU,�-UO Inspections MFG: MODEL: RLESIDENTIAL APPLICATION Received By: 763-572-3604K, SIZE/BTU CITY OF FRIDLEY ec�� 9 n 763-502-4977 FAX EFFECTIVE 2-19-09 (WOOD) $35.00 DATE P I S"— 16 YOUR E-MAIL ADDRESS _FIREPLACE $35.00 SITE ADDRESS _BOILER LINER $10.00 _FURNACE GAS DRYER $10.00 POOL HEATER $35.00 _CHff,4NEY DUCT WORK $10.00 _GAS PIPING $10.00 THIS APPLICANT IS: ❑ OWNER _XONTRACTOR PROPERTY NAME: L O A A R - CN S� Ir I , 60,+ ADDRESS: G i -7 (- St" -6+4, r +4, Pat 164 PfCITY E4.I STATEi I C)ZIP S'S q3�_ OWNER/ TENANT PHONE: i 6 CONTRACTOR COMPANY NAME: CONTACT PERSON: Ck "4 00 SUBMIT A COPY OF YOUR STATE LICENSE WITH STATE LICENpSE®# EXP DATE ADDRESS: O 7 ® �°–l'+ �Z P45 CITY E1 STATETIC' ZIP APPLICATION PHONE 'If 'S -7 S `1 -.)I N FAX PERMIT TYPE EA NGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 0 NEW AGEMENTLTERATION/REMODEL DETAILED DESCRIPTION OF WORK I've s&A (l FEES ARE BASED ON $10.00 PER FIXTURE, CEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: �t MODEL: x`41 A-- SIZE/BTU MFG: MODEL: SIZE/BTU MFG: \ MODEL: SIZE/BTU $25.00 ACE (GAS) $15.00 GAS RANGE/OVEN $10.00 _A/C TO AIR EXCHANGEER $15 (WOOD) $35.00 NEW GAS GRILL $10.00 NEW _AIR $35.00 _FIREPLACE $35.00 UNIT HTR $10.00 _BOILER LINER $10.00 _FURNACE GAS DRYER $10.00 POOL HEATER $35.00 _CHff,4NEY DUCT WORK $10.00 _GAS PIPING $10.00 _VENTILATOR $15.00 THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of allworkwhich requires review and approval of plans. SIGNATURE OF APPLICANT 1�j V _ PRINT NAME /DATE 117tIN,..ITII. City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977