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PRE 2010 DOCSSUBJECT LumTTO: - City of Fridley ®1510 AT THE TOP OF THE TWINS BUILDING PER IT r RECEIPT NO �y------- COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 1 r � � Cr5f L 1 '-',-� CITY HALL FRIDLEY 55432 NUMBER DATE PAGE OF APPROVED BY L J ` 612-580-3450 910-F15 7—y-] 4/5/79 JOB ADDRESS 5622 West Bavarian Pass N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 8 Innsbruck Villages SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Darrel A. Farr Development Corp. 7286 - 72nd Lane North., 55.428 560-8110 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 27' x 29' Townhouse and a 21' x 22' Garage (Hapsburg) 9 CHANGE OF USE FROM TO STIPULATIONS 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 20,200 Total 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. $ 25, 795 $12.90 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- $80.80 $425.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $20.20 $538.90 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) � K—WHEf OPERLY aL_ BLDG. INSP VA AtE YOUR PE IT DATE SIGNATUREOF OWNER(IF OWNER BUILDER) (DATE) A1'1'1.1CATION FOP, AL" E.P.ATION, Olt ADDITION BUILDING hEW4IT CITY U1 1I:1llI,liT, MINNESOTA Oz":iP.'5 NAtiE:��iri'L . /rGti!- Uc'tl.lb�O.EUILDFR: ADDRESS : /910/3 STREE.T • LQ.� LCT BLOCK: ADDITION: Ark ck, 1A i&ges CORNER LOT: INSIDE LOT: P0010 SETBACK: SIDL'}'ARD: Applicant attach to this form Ts7o Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIP UILDING To -Be Used As: e'Ln`iaase Front: c; Depth: ,19 Height: t3 Square Feet: ISXZ Cubic Feet: Ar&*T49 C3a1-,t;tige.. Front: 071 Depth: 072• Height: /d1 —T Square Feet; 47&#L Cubic Feet: —4&,z® Type of Construction: khoti Frame, Estimated Cost: To Be Completed: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stxict-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 axe true and correct DATE: SIGNATURE -. (See Reverse Side For Additional Information.) go" -rL� C� "IC) " °azc_t4 to � 67_49.9�1 _a A) 1'7- Ali)A -400 A4aA. CITY OF FRIDLEY • APPLICATION FOR PLUMBING AND GAS FITTING PERMIT .PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL 2%%L ber Fixtures V x $3.00 �m $® Future Fixture Opening x $2.00 mw New Fixture, Old Opening Water A V +� o .� •'o p� u H C h e k 4 N +� 0 11 Q, LL W 100,030 BTU to 199,000 BTU x Heater w Ll n ' $7.00 C 9 x x.1 C 3 Electric Water Heater u M 0 Q u ° d 1st 3 fixtures' x$3.00 v Additional Fixtures x •ac $ X r. $30.00 g REPAIRS & ALTERATIONS .0 First $100.00 W .0 a a $2.00 y owo (0 14 upd TOTAL FEE $ -3 a- o as leo is-- st2nd 2nd 3r3 4 t.°i (?) a Future Connection Opening Connected with Sewer M - New Fixture, Old Opening • Water .PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL 2%%L ber Fixtures V x $3.00 �m $® Future Fixture Opening x $2.00 $ New Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ Stater Heater - to 99,000 BTU �x --$5.00 $ 100,030 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ Nev Ground Iain Old Building x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: ° 1st 3 fixtures' x$3.00 $ a'® Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $30.00 $ REPAIRS & ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ -3 a- REINSPE:,'104 FEE — C.CC) Job Address .% Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this appl cation are true and correct Fridley, Mn. OWNER _ e EaI KIND OF BUILDING _ USED As ' TO BE COMPLETED ABOUT 7 ESTIMATED COST •OLD elElWAUILDING PERMIT NO. PERMIT NO.. Company - Signed By Tel. No. ROUGH INSP. Date • o ' FINAL 3.NSP.�/ l Date{ APPROVAL FOR PERMIT r MINSMUM FEE FOR ANY PLUMBING PM= 28 $7•$0 pygg $.Sp gT= SU1t=U= Nil LU 0 A f v� 3 .a �dys G1 fia � ,y ya N a � � �v�-40:2 C4 -ate 0 O � H C4�9 Gcil ba v c y a a 4; Prov UW7 Cc Cc a C c L va� 1� rc w O yW O w !v O z I g $ 8 8 8 $ cn ° �+ W � G� ' �VtotW s aQA Qj -1 Ilk ea lz CC �C°r voo IBJ W 119 rc G J 4 Qt V �y U h g $ 8 8 8 $ cn ° �+ W � G� ' �VtotW s aQA Qj -1 Ilk ea lz CC �C°r voo IBJ W 4;,-, ILI p 'j July 31', 980 F ..... J _4 f.7 TT.., 4 4-i-, EngineeruigAdministration 431 University, -Avenue: N*.E Fridley4 - Ms Mary Rnewtson of our th. there e pay,, son. -.h ave,-_;;i'­­�-----, hi Inns ..... ..... -rT le reason- exeques ed.-c onsiaeratioi-f6r-replat..,.,,, ' was. d uetO .- a-* survey ng; error- -.by­,-ouir'. registered surveyors --the" rrier,7W:Lnter and -. A ssuc,buildi was staked itic'orre citly �and,­' .nsequently, *,tuilt., off .the .:`.-boundaries of."*. the'..lot* on -the. initial plat.-,... This wase fiot._.__,-1"1 dis'covered.until .* ,.the was completely 'up -. with no i �--�:'hope of -:cFinn init Th 4C c: ore, the rep.Lat:+is required' g! 7' + We would -appreciate -the, appropriate'council -:apprec ZL .:gett ng-*, to planning commission meeting �-�. as.soon as_.:possible - and Vi from ll-.'be'wi 1^ ing-to help -end in any way, necessa'r'y.'-_" our. You..w any .1 further --inf lease --f feel ti2 if* �ed, ormation p free­�to me .:_,_contac ... .... .. Yours truly, DARRE — DAP L PENT"CORP ­* . ...... �iTORAS`C'-"' ON Pre ViceP -6 ide -TCJ:j'sg---..*.. an•�y rA `" TELEPFIONE _EARR .14 L%JPMEW 6 612/5136 9*93 46DO LAKE ROAD' ROBBINSDALE,- MINNESOTA 55429.1- Af•PLICATION FOR PUJMrJlNG ANS 6As FIT-rifiG fl1:K•11 F YrKTI �,L :.0 l►I I:i, . ' I 1 Jkl h -.TES tiu. RATE ,NjI :i,;t t.AL,lre' IUL111r. :.,,cure Gj,,r:r,I Leo 1, 1.L..Le, Old Gper.l:., C-%L.h La.151 OALat ho,tt:r - to 95,000 IYIZI IUJ,3J3 I&M to 1i CLO 6TU watur D-kenbr slew Lew»nd ft,n Old IS,,Lldlr.j l.lCt t►t•, t+,raC fla�tst 111;G FtES: iet 1 etawras ' ►. f.11LlJ.�a1 FL,,turaa 199 006 6111 r AI.TEKATIuNS hl,tl OU a1.11 all, SjJ�,JJ JC iCiCL1Jn L I FlsLer S Ilea tar u I c ;i -s Iaec Sewer Watar TOTAL. x $3.00 $ i � $2.00 In f4 $2.00 $ $5,00 $ x ;5.00 g x $10.00 $ —^--_• �- x J7. 00 g x 15.00 g x 65.00 g x 63.00 g Cjrrnc,;LIQr, Gpentr J C- ::.cctt:J with $ �— '1 w ne„ 114 t4r a, Cil.l Oj: t:n it.� YrKTI �,L :.0 l►I I:i, . ' I 1 Jkl h -.TES tiu. RATE ,NjI :i,;t t.AL,lre' IUL111r. :.,,cure Gj,,r:r,I Leo 1, 1.L..Le, Old Gper.l:., C-%L.h La.151 OALat ho,tt:r - to 95,000 IYIZI IUJ,3J3 I&M to 1i CLO 6TU watur D-kenbr slew Lew»nd ft,n Old IS,,Lldlr.j l.lCt t►t•, t+,raC fla�tst 111;G FtES: iet 1 etawras ' ►. f.11LlJ.�a1 FL,,turaa 199 006 6111 r AI.TEKATIuNS hl,tl OU a1.11 all, SjJ�,JJ JC iCiCL1Jn L I FlsLer S Ilea tar u I c ;i -s Iaec Sewer Watar TOTAL. x $3.00 $ x $2.00 $ x $2.00 $ $5,00 $ x ;5.00 g x $10.00 $ —^--_• �- x J7. 00 g x 15.00 g x 65.00 g x 63.00 g x $1.00 $ �— x SLALp c..rchargr $ .5u 7,:,r/.L t t.L S --10-,L5-0 Job Addi:r„ 5622 West Bavarian DcparLmr:nt cf U4L,.ijr;ly - CiLy at Frldl,:y Tel, 11571-3.150 Th a�undoralgnaJ I: rcCy rrakea applicetear r afzr. gk opacified agrecin� Lc dc' all work ir• SLricC ccccz j. r,.atWitt. o', City Cc.c als, and rulings of thu rn!::rLmcnL of B.111din15,.ie lore, flat a1: 010 faal.il n,ld r,:j,ruz t,taL1ons staLuJ is t1116 .lcsurn aro t,uo and x;,,it,,,;, OWNER FAPL R KIND OF IIUIL'ul::,i frame USED AS res. TO DE C0MPLETED 1d,CU r 5-5-80 ► ESTINATLQ COST 50,00 OLD - NEW ❑UILGIuZ PLj4'jII N.;. F: 11 iI Czmpery MINN A , si-pe.1 By ROUGH INSp. Da to FI11hi, INSP, sL9— d Ddtu- hPPRUVAL Full I-Lju,ll'r 11I11IMU11 I'LL ILIt L'jy I,LUI:uIII.: Fcrlt;Ir IS 67.;J PLUS ,::0 ':.VTC 6UR0u.11ft SUBJECT PERMIT NO. City of Fridley 41 4 - AT THE TOP OF THE TWINS BUILDING PERMIT 4 r RECEIPT NO. � • ______ COMMUNITY DEVELOPMENT DIV. ~ r I PROTECTIVE INSPECTION SEC. f �� CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY ' 612-571-3450 910-F15 5/7/96 J08 ADDRESS See Below I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR.II Variou I SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Various 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Columbus Exteriors - 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Townhouses 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside 44 Units (11 Buildings) 9 CHANGEOFUSEFROM TO STIPULATIONS 5600,5602,5604,5606 West Bav ian Pass; 5601,5603,5605�,,,5607 West Bavarian Pass; 5610,5612,5614,5616 eat-$evarlen-Peas; 5620,5622,5624,5626 West Bavarian Pass; 5620,5622,5624,5626 North Innsbruck Ct; 1521,1523,1525,1527 Trapp Court; 5650,5652,5654;5656 West Bavarian Pass; 5660,5662,5664,5666 West Bavarian Pass; 5661,5653,5655,5657 West Bavarian Pass; 5671,5673,5675,5677 West Bavarian Pass; and 5681,5683,5685,5687 West Bavarian Pass SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO_ DWLG. UNITS OFFSTREET PARKING 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 44 STALLS I 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 $114.40 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $228,800 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- $1,532.25 Fire SC $228.80 STRUCTION R THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE b License SC $5.00 $1,880.45 SIG OF CONTRACTOR OR AUTHORIZED AGENT iDATEI WHEN PROPERLY IDATED THIS IS YOUR PERMIT S,GNATURE OF OWNEROF OWNER BURDERI IDATEIBLDG SP OATS SUBJECT PE City of Fraley [�3 AT THE TOP OF THE TWINS BUILDING PERMIT r? RECEIPT NO. COMMUNITY DEVELOPMENT DIV. %� v� r PROTECTIVE INSPECTION SEC. 1 CITY HALL FRIDLEY 55432 NUMBED REV DATE PAGE OF APPROVED BY 761571-3450 910-F15 10/17/03 JOB ADDRESS 5620, 5622, 5624, 5626 West Bavarian Pass NE 1 LEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR, 1,2,3,1} $ Innsbruck Villages SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Innsbruck Village Association 5612 N Innsbruck Ct, Fridley, MN 55432 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO John A Dalsin & Son Inc 2830 S 20 Ave, Minneapolis, MN 55407 612-729-9334 9178 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE I LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION O ALTERATION REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof Four Units (townhouse building) 9 CHANGE OF USE FROM TO STIPULATIONS Follow manufacturer's specifications. Provide work spec for each address for inspection. Provide copy of all independant testing per section D1400. Replace all fire assemblies per original design. Insulate and seal bath fan duct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ire SC $95.50 OR THE PERFORMANCE OF CONST U TION PLAN CHECK FEE TOTAL FEE ©V171a- 2�9�1cen SC $5.00 $1,114.00 ATURE OF CON•AACTOFI OR AUym6qofD AG6Ve iDATE. IF EN PROPERLY VALIDATED THIS IS Y0R PER IT S,GN4IUREOFOWNEp.4OWNER BUILDER, iDATE. 111LOG iNSP OAft CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Fireplace insert Gas Range Gas Dryer Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOBADDRESS 5�—(.a.h�sr C Fee Total $35.00 $ $10.00 $ $15.00 $ $10.00 $ $10.00 $ *Air Conditioning - All Sizes $25.00 $ All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ o, Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater on work less than $500.00 Commercial/Industria,Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/institutional State Surcharge (if permit fee is over $1,000 multiply by .0005) TOTAL FEE 7 Building Used As ESTIMATED COST PERMIT NO DESCRIPTION OF FURNACE AND BURNER of bleating Units l Circle One (Steam) (Hot Water) (Warm Air) rade Name 6_'t- aL) G /,10'o0 Size No. BTU e3o. ��� HP • EDR Fuel 6"s Total Connected Load Burner Trade Name BTU Size No. 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 $ and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct Hearth & Home TedmokVes, Mc. dba Fireside Hearth & Home $ 0.50 HEATING CO License 20512060 =le. UN Al13 $ �� igfie 85116334" Tel # L7- 633. �)s61 FAX # Date *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 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 realacina 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/PVCd meets all current codes and manufacturer specifications including sizing, lens , number of elbows and termination. Yes (} No( ) The undersigned also vedfie§, at� replacement unit is a listed assembly and meets the current codes-' ($fanufacturer's specifications. This does include AGA-GAMA Categeiat Furnace Venting Tables for fan r, e assisted and natural draft Yes O No { ) The existing combustion 0 2461' and installed to meet the current codes and manufacturer's specifirla res. - 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( } n Vent and Vent Connector Information � c A) GCS Applidhce #1 Type 6 000 BTU Input %oo 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) HEATING CO: Signed By: Date Building MECEANICAL Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY 763-502-4977 FAX EFFECTIVE 2-19-09 DATE f / - AO SITE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT YOUR E-MAIL ADDRESS ❑ OWNER *CONTRACTOR ADDRESS: r L :12 C.yt2 1s_,4 J&L{ CTI Y r12� STATE P' N ZIP, PHONE: Wa- ?:3S— 25#6 t% b CONTRACTOR I COMPANY 11 SUBMIT A COPY OF CONTACT PERSON: YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH ADDRESS: 8-oibCITYsTATEW ZIP Sy31 APPLICATION PHONE & (-J- - "(S S 3 b FAX PERNM TYPE 0 SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW -,g REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK yI 5 i CR L IO (C�e . •-t ti .. vet n r- — FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG:( .�ry� u� MODEL: r p t. cT? ct- t- i 1 SIZE/BTU 7 0 tl oS �� MFG: MODEL: SIZE/BTU MFG: MODEL: SIZEBTU $25.00 _FIREPLACE (GAS) $15.00 GAS RANGEIOVEN $10.00 _A/C TO AIR EXCHANGEER $15 (WOOD) $35.00 NEW GAS GRILL $10.00 _AIR $35.00 _FIREPLACE FURNACE $35.00 _GAS UNIT HTR $10.00 _BOILER LINER $10.00 DRYER $10.00 POOL HEATER $35.00 _CHIMNEY _DUCT WORK $10.00 _GAS _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 all work which requires review and approval of planes. P, SIGNATURE OF APPLICANT 0 (� /� . r, l �. �-u0 PRINT NAME k- �'� Qtl-lo tal DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977