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PRE 2010 DOCSQ City ®f Fridley, Minae 112 3 5 ., 6431 University Ave. N.E., Minneapolis, Minn. 55432 BUHMING PERMIT ..Owner: View ggm incgrporated Builder Same - Address _..5.2.0.1 3=k yah 3ouleyaEd Address Same LOCATION OF BUILDING No. 5522 Street West Bavarian Pass . part of Lot Lot ,1___ Block 11 ____ .._. _ Addition or Bub -Division Innsbruck North Twhg - Ri tP Corner Lot __ _ Inside Lot ___X_ 1_ Setback Sideyard Sewer Elevation Foundation Elevation 161*161-11141 Indio i�dua�' Townhg se ni,t Front _. 0 Depth . 31'_ Height 20' _ Sq. Ft. 1,2401 Cu. Ft 12,40 Garage --- Front 9-01 Depth ,221 _ Height —1,0' Sq. Ft. _440' Cu. Ft. 44QQ' Type of Construction Wood Frame Est. Cost $19-6 039.20 To be Completed UP 15672 Stipulations: Provide 10 foot wide plato at elevation 857 for future walk around the lake. All street grades must be greater than .6% (also parking lot grades). Area to be platted and filed before occupancy of units. 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. �a 9-52 RI-alra crur^'havao -... In consideration of the payment of a fee of $ 32 on , permit is hereby granted to Viewcon. Inc. 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, repair and moving of buildings 'Mthin the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Aiti4_7 1 Building Inspector HANK. MUNICH (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. .0 a ("F" Unit) APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME: VIEWCON, INC. BUILDER: VIEWCON, INC. ADDRESS: 5901 Brooklyn Blvd. ADDRESS: 5901 Brooklyn Blvd. NO:. 5522 STREET: West Bavarian Pass LOT: 1 BLOCK: 11 ADDITION: Innsbruck North Townhouse site CORNER LOT: INSIDE LOT: X SETBACK: -- SIDEYARD: -- Applicant attach to this form Two Certificates of Survgx of Lot and proposed 'wilding location drawn on these Certificates, DESCRIPTION OF BUILDING To Be Used As: Individual Townhouse unit Front: 20Depth: 31' Height: 20' -71 11 Z ; 6-t_� ---) Square Feet: 1,240 Cubic Feet: 2 ®. Garage Front: 20' Depth: 22' Height: 10' qZ.`7, Z& --> Square Feet; 440 Cubic Feet:_ 4.400 Type of Construction: wood frame Estimated Cost: To Be Completed: 25, January. 1972 The undersigned hereby makes application for a permit for the work be -rein specified, agreeing to do all work in sttict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations st tic iare true and correct. /IL�� DATE: _jQZj3Z2j SIGNATURE (See Reverse Side For Additional Information.) Application for Power Plants and Heating. Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ........................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ each add. 60,000 BTU ....................... Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 ................. Repairs & Alterations each add. $500.00 .............. STEAM or HOT WATER SYSTEM 8.00 $ 30-00 0-002.00 2.00 $ 5.00 $ 5.00 $ 2.50 $ Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq, ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ...... 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ 5.00 GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ 2.00 Additional Fixtures x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ 27.50 ROUGH FINAL / b - - 7 Dept. of Bldgs. Phone SU 4-7470 Location 5522 W. Bavarian Puss City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. December 131 1971 , 19 — Owner Vieweon, Inc. Kind of Building Frame Used as Residence To be completed about january,-197'2 Estimated Cost, $ Old—New. Building Permit No, Permit No. I-ly DESCRIPTION OF WORK HEATING or POWER PLANTS --Steam, Hot Water, Warm Air—No 1 Trade Name Bryant Size No 393.-80 Capacity Sq. Pt. E.D.R 80 t 000 BTU H.P Total Connected Load— 45 900 Kind of Fuel Nat.—gas BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P (REMARKS—OVER) Signed Advana&lv b44 .. :. •• City of Fridley Application for Plumbing and Gas Ming Permit DESCRIPTION OF WORK Number, Kind and Location of Fixtures Dept. of Bldgs. Phone 860-3450 SZ7---< Location z - 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, 1971 Owner i x-", Kind of Building eA'a »2z") Used as To be completed about PARTIAL RATE SCHEDULE 3 Uc Estimated Cost, $ /000 Old -j geBuilding Permit No Permit No./ S V< 3 U�' nd �U' Si 0 0 O R N WATER HTR. GAS ELEC. Base $ f • 0 B y New Fixture Old Opening .............. x $1.50 $ Business Phone No_ ,, 4n2 Catch Basin ...... .................. .. x $3.25 $ Water Heater (Up to 99,000 BTU) ...... x $3.00 $ 1st New Ground Run Old Bldg. ............ x $3.25 $ ROUGH Electric Water Heater z $2.00 $ FINAL GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $2.00 $ 2nd Nil Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTUj- � . x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code .-S70 Description ................................................$ P 3rd TOTAL FEE az 4th • Future Connection Openings New Fixture, Old Openings I Connected with Sewer El Cesspool El Dept. of Bldgs. Phone 860-3450 SZ7---< Location z - 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, 1971 Owner i x-", Kind of Building eA'a »2z") Used as To be completed about PARTIAL RATE SCHEDULE Estimated Cost, $ /000 Old -j geBuilding Permit No Permit No./ PLUMBING FIXTURE RATES: NO. RATE TOTAL O �'' �✓ Number Fixtures ....... 43 x $2.00 $ Signe ` " Future Fixture Opening ................ x $1.50 $ f • 0 B y New Fixture Old Opening .............. x $1.50 $ Business Phone No_ ,, 4n2 Catch Basin ...... .................. .. x $3.25 $ Water Heater (Up to 99,000 BTU) ...... x $3.00 $ New Ground Run Old Bldg. ............ x $3.25 $ ROUGH Electric Water Heater z $2.00 $ FINAL GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $2.00 $ Nil Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTUj- � . x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code .-S70 Description ................................................$ P TOTAL FEE az Base I; 1 i I 1 I I I fl F O I C s d V s• w� „� City of Fridley: I a s it gs 19 ® a cis tut The undersigned hereby makes application for a permit for the vrork herei� sp*�cified, agreeing to do all Work M strict accordance with the City fh-dinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application aretrue and correct Fridley. Minn —amZLt . 1s '. ; 1972 ,18� owner Darrell Farr Dev. �—j-- bind of Building frame sever Cesspool �° Used as residence 7'o be completed about Septo 18, 1972 PARTIAL RATE SCHEDULE Estimated Cost. $ 10.00 Old- New. Building Permit No. �� Po, Wait No. PLUMBING FIXTUM PATES- NO. RATE TOTAL Number Filatures ................ x $2.00 $ Signe. Future Fixture Opening .... ® ...... x $1.50 $ By 11 N N EG -`,SCO New Fixture Old Opening .......... x $1.50 t Business Phune No Catch Basin .............. ®. ®... x $3.25 : Water Heater 'Up to 95,000 BTU) ®. • - x $3.00 E ROUGH New Ground Rua Old. Bldg......... x $3.25 $ Electric Wates Heater .............. a $100 $ i'INlLi. GAS FITTING FEES; NO. RATE TOTAL let 3 Fixtures . • . e ..... • • • • .. 1 x $2.00 $-2.00 le'I — Additional FIxtum x $ .?b : M.f................ Gas Range to 199,000 BTU o s.... o . s ... x $5.00 6 3.00 (]j-) gaslite State Surcharge $ .50 REPAIRS A AL TIO fer to QWie_ Description ............. ®.... o ........................ ; TOTAL s.— 5.50 SUBJECT PERMIT NO. City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT � RECEIPT NO COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. , �a 1 � 1 •••t�'� CITY HALL FRIDLEY 55432 i NUMBER REV. DATE PAGE OF APPROVED B ---. L 612-571-3450 910-F15 5/18/94 JOB ADDRESS 5522 West Bavarian Pass NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 11 INnsbruck North Townhouse SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Dicks Fire & Storm 864 19 Ave SE, Minnea olis. MN 57RI-6170 94R1 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 ❑x REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Garage (Tear-off); Install gutters 9 CHANGEOFUSEFROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 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 1 HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1.06 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,109 PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $54.00 Fire S PLAN CHECK FEE TOTALFEE L cense SC 5.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) Y V IDATED THIS IS YOUR PERMIT AEN= SIGNATURE OF OWNER OF OWNER BUILDER) (DATE) INS BATE NEW (� ADDN CITY OF FRIDLEY ALTER [ ( SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Legal Description: — Owner Name & Address: Tel. # Contractor: Dicks Fire and Storm MN LICENSE# 2481 Address: 864 - 19th Ave S E Mpls.. Mn 55414 Tel. # 781-6170 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. 5522 - West Bavarian Pass Effective 1/ 1/94 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: Remove and rPp_nce rnnfing on garage InAtall gutters Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Roofing /gutters Estimated Cost: $ 2.109.00 Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft= Ft x $ _ $ DATE: 5-/15,/94 - APPLICANT: Dicks Fire and Storm Tei. # 781-6170 CITY USE ONLY Permit gee $ .CO Fee Schedule on Reverse Side Fire Surcharge $ r C ( .001 of Permit Valuation (1/10th%) State Surcharge $ t + $.50/$1,000 Valuation SAC Charge $ $800 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: SUBJECT NO. 1 city of Fridley 31043 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT � V V ......I COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. �� 7 /� r / . r NUMBER REV DATE PAGE OF APPROVED Br CITY HALL FRIDLEY $5432 612-571-3450 910-F15 6/8/00 JOB ADDRESS 5502, 06,10,14,18, 22 W. Bavarian Pass 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1-6 11 Innsbruck North Townhouse Site SHEET 2 PROPERTY OWNER MAIL ADDRES$ ZIP PHONE Innsbruck.Townhome Association 651-224-5482 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Garlock -French Roofing Corp. 2301-B. 25th St...Mpls., MN 55406 612-722-7129 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 00001423 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION O ALTERATION xE] REPAIR D MOVE O REMOVE 8 DESCRIBE WORK Reroof Building 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. Permit Inspection Cards w ifl Be mailed To Homeowner To Post TYPE OF CONST. OCCUPANCY 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 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 6 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 $16,674.56 $8.33 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 304.25 SIGNATURE OF CON:RACTOROR AUTHORIZED AGENT 10ATEI HEN R P VALI A70 THIS IS UR PIMIT SLOC.11P.Sp // rlarE S.GNA TURE OF OWNER of OWNER SUILDE RI IDATEI Building BUILDING Permit No.:( `7 Inspections RESIDENTIAL APPLICATION Received By: 763-572=3604 CITY OF FRIDLEY Date Rec'd: DATE — YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: ❑ OWNER 160NTRACTOR PROPERTY OWNER/ NAME: TENANT ADDRESS: CITY STATE ZIP PHONE: CONTRACTOR NAME: SUBMIT A COPY OF STATE LICENSE # 3r 3 > EXP DATE ' G YOUR STATE LICENSE ADDRESS: c CITY STA IP �� l WITH APPLICATION yHONF a_ FAX PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ O FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ROOF ❑ DRAIN TILE ❑ DECK SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAJNTENANCEIEP4a kREMODELING DESCRIBE WORK BEING DONE: CIO- i ` e - e - SIZE OF IMPROVEMENT L NGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. 2. Existing Floor Plan Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: ING FOR NEW CONSTRUCTION INCLUDING DECKS, inyl ❑Soffit ADDITIONS, & PORCHES SUBMIT: ❑ uminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USIN THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ (06 0 6 OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ Le _ DO .001 times the total job valuation Surcharge $ -3• (TD .0005 x Permit Valuation Minimum $.50 License Surcharge $ 5,6-D 6-D $5.00 (State Licensed Residential Contractors) SAC Charge $ $1675 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ / ?jG/', ,� Make checks payable to: City of Fridley Attach Stipulations 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 all worXUcr u' es review and approval of plans. �] ,� SIGNATURE OF APPLICANT PRINT NAME/� 1 r ��AoL_DATE OCT -12-2005 16:19 Building � Inspections 763-572-3604 DATE Df .Cb 0 � SITE ADDRESS c THIS APPLICANT IS: ` PROPERTY OWNER/ TENANT CONTRACTOR SUBMrr A COPY OF YOUR STATE LICENSE WnH APPLICATION PERMIT TYPE TYPE OF WORK: CITY OF FRIDLEY MECHANICAL RESIDENTIAL APPLICATION YOUAP-MAU !� E®i Ci.�p' � ver Pb2 s O OWNER 460MACTOR NAME: ADDRESS: PHONE:_ 6 - e 3 i -L COMPANY MAME: g. CCINTACT PERSON: STATE LICENSE 0 ADDRESS:, iii EPl�er ��' PHONE &qi - 4Aq_ C�-7-7A 4INGLE FAMILY O TWO FAMILY O NEw REPLACEMENT DETAILED DESCRIPTIOP7 OF WORK ADDRESS EXP DATE CITY FAX - 431- 0 TOWNHOUSE 0 ALTERATION/REMODEL WIA PER MS 16B.66S the permit fee is a minimnm ofSIS .00 or $% of the total cost n to X0.00, whichever is improvement, installation or replacement of a residential fntture, exelud the fiucaues. gra, for the (This should reflect only the cost of labor ) Labor cost under 5300 = $15.00. Labor cost between $300 to $SOD -cost of labor x .OS = FOR PROJECTS WHERE LABOR EXCEEDS SSW. MS ARE BASED ON 510.00 PER FIXTURE, EXCEPT k NOTED . FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) WHERE Equiptam Installed MPG: MODEL: SIO ®xt a MFG MI2WM 9 MFC: MODEL: S XA 526.00MODEL: SIZEAM _AIR TO ALR EXCHANGEF.R SIS iIREPLACE (GAS) S 15.00 _GAS RANGE/OVEN 510.00 BOLE801LfiR 535.00 FIREPLACE (WOOD) $35.00 NM CTAS GRILL SL 0.00 S LINER 510.00 „,FURNACE S3S.00 GAS LM HTR $10.00 CLAS DRYER $10.00 Du�WtK S„0.00, _„OAS PIPING S10.0o —POOL HEATER $35.00 Surcharge+.uow ON mttures (S 519.00 _ x $10.00 = S TOTAL DUE xm "50 Number of funwas (c� S 15.00 _,x SI S.00 m S S --(.� Number of fixtures 525.0 , x W.00 - $" Number of fixates ® $35.00 x S35.00 - S ` State Surcharge S,So Total $ THIS IS AN APPLICATION FOR A PMMIT NOT VALID UNM 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 aanfortrAnce 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 per and work is not to start without a permit; that the work will be in accordance with the approved plan in tate case of ork wb' xpares review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME_ dE Ct t . QOM „DATE City of Fridley Building Inspections Department 6431 University Avenue M Fridley, MN 55432 763-572-3604 FAX: 763-502-4977