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PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn. Date / .k ........................... Owner Address Ate' Ido 2144 Builder........................................... ess...... ..... ........• H LOCATION OF BUILDING 'I No. � .. Part of Lot ,'9. r ... .�.'. .... ....................... Street �' ...... Lot ............... Block ................ Addition or Sub -Division ....................................... SII. Corner Lot ....... ... Inside Lot ............ Setback ............ Sideyard .. °. ... • .. . H, DESCRIPTION OF BUILDING To be Used as: rz':� : e ! Front. Ail... Depth ..24.. ffeight ,�"s� Sq. Ft......... Cu. Ft. ........ ................... `1I Front ...... Depth ........ Height ..... Sq. Ft......... Cu. Ft. ........ Type of Construction, , `, +, .. Est. Cost . °............... To be Completed In consideration bf the issuance to me of a permit to construct the building described above, I agree to do the proposed work in'i"I accordance with the description above set forth and ` "'(! s lance with all provisions of ordinances of the village of"Fridley. • ....... c side tion the payment of a fee of $. ,permit is hereby grante to 1�_•�� ....1.. to construct the building addition as described above. This p t is granted upon express dation that the person t6 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 with- in the village limits and this permit may be revoked at .,any time upon vlojAUT of any of the provisions of said ordinances. .° ... B din F •�•• uil g Inspector NOTICE: This permit does not cover the construction installation or alteration for wiring, plumbing, gas heating, ;a sewer or water. Be, , sure to see the Building Inspector for separate permits for these items. I SUBJECT PE City of Fridley N_ 20109 AT THE TOP OF THE TWINS BUILDING PERMIT r REC I L I r.L ______ COMMUNITY DEVELOPMENT DIV. p� r I PROTECTIVE INSPECTION SEC. G "I CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910_F15 9/12/85 JOB ADDRESS 5830 West >M Moore .Lake Drive N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 6 4 DonnaY' S SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Joanne Gammelin 5830 West Moore Lake Drive N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE L CENSE NO. Western Remodelers 2520 West Larpenteur, St. Paul, MN 55113 645-14 1 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 S DESCRIBE WORK Reside Dwelling 9 CHANGEOFUSEFROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION Z 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 $4,500 $2.25 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^Y O ER STATE OR LOCAL LAW REGULATING CON- $72.00 ST CTION OR P O M NCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $74.25 SIGNAT RE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLY VALIDAM THIS IS YOUR PERMIT INSP �A E SiGNATUREOF OWNERIIF OWNERBUILDERI IDATEIBLDG NEW [ ] ADIV [ ] ALTER [ ] Cornstruction Address: Legal Description: _ Ln i Owner Name & Address: so mob ORM PF-l"M�40-FAM14 R-1 AND R-2 ft l d n � * t Application cH Effective 5/1/88 t, Tiel. # Tel.. #_L" Attach to this a]plication, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. J DESQtIPTIC 4 of noremm .SIM AMM: length Width Height Sq. Ft. GAPJM AREA: Length Width Height Sq. Ft. LEM AREA: Length Width Hgt/Grouxi Sq. Ft. 07HER: Corner Int [ ] Inside [ ] Ft. Yd S tback Side Yard Setbacks Type of Construction: Estimated Cost: $ (� Approx. Caanpletion Date: Proposed Driveway Width If New Opening Is Desired: Ft. $ $ Width + 6' See Back Page DATE: _ "�- APPLICANT: # (.`- ��--� Tel. Permit Fee $ '%2. 0 State Surcharge SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ STIPUI.ATIMS: $�� 3L- / o �" ';� L^ /6�',';-�7 CITY DBE CMLY Fee Schedule on Reverse Side $.50/$1,000 valuation $575 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Emjineering Agr—ht Necessary [ ] Not Necessary [ ] CIIYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 April 7, 1994 Joanne Gammelin 5830 West Moore Lake Drive Fridley, MN 55432 RE: Property at 5830 West Moore Lake Drive Dear Ms. Gammelin: On May 6, 1992, I sent you a letter (copy enclosed) regarding the use of a pipe to direct water from your sump pump down to the curb on West Moore Lake Drive. As indicated in that letter, this use is prohibited by the Fridley Zoning Code (see enclosed copy for further information) since it creates runoff to the City right-of- way. On April 6, 1994, I once again observed a pipe directing excess water from your sump pump down to the curb. This creates a special hazard at this time of the year since the water tends to freeze at night causing slippery conditions on the public right-of-way. In fact, I observed ice at this location while on my April 6th inspection. As indicated in my May 2, 1992, letter, there is another method of moving the water away from your home and percolating it into the ground where it should not return back into the groundwater table. I have enclosed a diagram of this process for your review. I will conduct another inspection of your property on or shortly after April 18, 1994, at which time full compliance is expected. Feel free to call me at 572-3595 if you have questions or wish to discuss this further. Thanks for your cooperation. Sincerely, Steven Barg Code Enforcement Officer SB:ls CE-94-ln G7YOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 . FAX (612) 571-1287 May 6, 1992 Joann Gammelin 5830 West Moore Lake Drive Fridley, MN 55432 RE: Property at 5830 West Moore Lake Drive Dear Ms. Gammelin: It has come to our attention that you are using a sump pump and a lawn pipe to direct excess water down to the curb on West Moore Lake Drive. Such alteration is prohibited by the Fridley Zoning Code (see.enclosed copy for further information) since it creates run-off to adjacent properties and the City right-of-way. It is important that you cease this activity immediately. An alternative that might meet your needs, while not creating a hazard on the public right-of-way, is to install a sump pump tank in your rear yard. This tank will allow the water to percolate into the. soil where it should not return back into the ground water table. (I have enclosed a diagram of a typical sump pump installa- tion for your review.) Please call Mark Winson, Assistant Public Works Director, at 572- 3551 if you wish to further discuss this drainage issue or the alternative I have outlined. Thank you for your cooperation. Sincerely, Steven Barg Code Enforcement Officer CE -92-168 "- SUBJECT City ®f Fridley ®tQ ETWINS BUILDING PERMIT 2818' 81s RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. - CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 10 9 9 / / JOB ADDRESS 5830 West Moore Lake Drive ' 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 4 IDonnays SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Joanne Gummelin 572-0402 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO L & M Roofing 593 Berwood Ave Vadnais H is 55127 484-2197 6341 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 ®x REPAIR ❑ MOVE : ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (20 Sq) Tear -off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. I SEPARATE PERMITS ARE REOUIRED 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 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 $1714 $.86 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- STRU OR THE PERFORMANCE OF CONSTRUCTION $56.75 Fire S $1.71 �® PLAN CHECK FEE TOTAL FE License -2"C5.0(1 $64. 2 SIGNATURE dF CONTRACTOR OR AUTHORIZED AGENT IOATEI T N POPPAOPFq V ID T $ I$ Y�1J� PE10 S-GNATURE OF OWNERIIF OWNER BUILDERI IDATEI B—L 07 INSF ATE • ti NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: ,j Legal Description: i Owner Name & Address: e6pi Tel. # 272, p 2— Contractor: Contractor: le— "C&,, MN LICENSE # Tel # '/� 2� �7 Address: . .— Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IMPROVEMENT Length Width Length Width Length W;rltl, Height Sq. Ft. Height Sq. Ft. Sa. Ft. Construction Type: % k- 9#"/dg- kVtimated Cost: $�_ � (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: �OL,= T Cf APPLICANT: Tel. # �� % ZJ Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1 / 10th %) $.50/$1,000 Valuation $1000 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 [ ] ' SUBJECT NO. City ®i Fridley 2 512 ATTO THE TWINS BUILDING PERMIT TE E 1 O `�® • COMMUNITY DEVELOPMENT DIV. sy e_oe_ INSPECTION SEC PROTECTIVE CJ 156 E , NUMBER REv DATE PAGE OF APPROVED BY _ ",-I CITY HALL FRIDLEY 55432 612-571-3450 910-F15 11/4198 JOB ADDRESS 5830 West Moore Lake Drive I LEGAL BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ILOTNO. 6 4 iDonnays SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Joanne Gammelin72-0402 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Western Remodelers Inc. 25 651-645-1411 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS YIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK NEW ❑ ADDITION O ALTERATION ! REPAIR O MOVE 0 REMOVE 8 DESCRIBE WORK Replace siding on garage 9 CHANGE OF USE FROM TO STIPULATIONS Call for building wrap inspection before covering. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 GOV NING THIS TYPE OF WORK WILL BE COMPLIED WITH WHET PECIF E HEREIN OR NOT. THE GRANTING OF A PERMIT 3000 1,50 DOES NOT UME '(Q/GIVE AUT ITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISION O ANY O HER S AT O LOCAL LAW REGULATING CON- ST UCTION O THE FOR F CONSTRUCTION 74. 7 j. FjXe SC $3.00 L&U14— PLAN CHECK FEE Y TAL FEE – T. 4 S, $5 84.25 ' SIGNATURE F CONTRACTOR OR AU ORIIEO AGENT IDATEI EN(PR BL -IG INSP AL 0 THIS IS Y U PERMIT✓ I TIAtE SIGNATURE OF OWNERIIF OWNER BUILDERI IDATEI NEW [ ] ADDN [ ] ALTER [�] CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: -5-0 36 w• MdwR.6 LAlLE ,DQ Legal Description: Effective 1/1/98 Owner Name & Address:; JtoA.­6' GgMm!g ;A., Tel. # Z Contractor: w E'S-Eh'iv jZE'M�d 6G E-�t S iNC MN LICENSE # 3 6-t 7 Address: 2-5720 u,,, I_0RPCr4TE'&'k -st, PAt c� M^— TV13 Tel. # 65 -1 -lo -Off' 1,411 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: Construction Type: 6 f D iN G GA PA 6 F Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width -Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: � fJ APPLICANT: h` ' Tel. #6 ,S^% `�S' / 9e_// CITY USE ONLY Permit Fee Fire Surcharge $ 3,o6 State Surcharge $ I. S� SAC Charge $ License Surcharge r - $ d(1 Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ r TOTAL $ © s - STIPULATIONS: Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 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 [ ] CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 H'AX: (763) 571-1287 ADDRESS 5830 W MOORE LAKE DR NE PIN 233024140041 LEGAL DESC DONNAYS LAKEVIEW MANOR ADD LOT 6 BLOCK 4 PERMIT TYPE BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT O.: 200401328 DATE ISSUED: 08/17/2004 VALUATION : $ 850.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. KITCHEN REMODEL. STATE LICENSED CONTRACTOR 1 APPLICANT JANSICK INC (8618) 6480 SQUIRE DR NE FRIDLEY, MN 55432-5243 (763)574-9679 GAMMELIN JOANNE R 5830 W MOORE LAKE DR 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 th provisions of any other state or local law regulating co on or the perfo glance of construction. A Bldg Insp K h A BUILDING PERMIT FEE 35.70 PLAN CHECK FEE 23.21 FIRE SURCHARGE 0.85 STATE SURCHARGE, VALUE 0.50 LICENSE SURCHARGE 5.00 TOTAL 65.26 SEPARATE PERMITS RE�UIR&D FOR WORK OTHER THAN DESCRIBED ABOVE. r NEW [] ADDN [] ALTER [ J Construction Address: CITY OF FRIDLEY 6431 University Ave NE, Fridley, MN 55432 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION dt Effective 4/1/2004 (763) 572-3604 Bldg Insp (763) 571-1287 Fax Legal Description: Owner Name & Address: J o AA1NE G ,4 Nt rN E L rA,/ Tei. # '743 -5'7,A- O V'o-Z Contractor. J a ri s a,V Z04/+l5 C MN LICENSE # �!o Address: [PO S0 S Q U (fe Jl�--r - OE' 9,- i d 11, MAI Tel. # 24' 5711- 91079 LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. , Length I Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. ��h, e in Construction Type: M)o of Estimated Cost: $ Driveway Curb Cut Width Needed: Ft ;,6 Ft 4—Ft x $ _ $ DATE: -1 - APPLICANT: Tel. # A 5174 967Y Call (763) 572-3604 for Permit Fees if mails n application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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 [ ] TOTAL $ '� 6' g o STIPULATIONS: WORK TO BE DONE: NEW CABINETS NEW COUNTERS NEW FLOORING NEW LIGHTS NEW PAINT NEW WINDOW TRIM Step down to table Ht. 6480 SQUIRE DRIVE FRIDLEY, MN. 55432 e (763) 574°9679 • LIC. NO. 8618 KITCHEN REMODEL AT: 5830 W. MOORE LK DR FRIDLEY, MN 763-572-0402 71-511- 1 EXISTING 4LAYOUT CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 VAX: ( 763) 571-1257 ADDRESS 5830 W MOORE LAKE DR NE PIN 233024140041 LEGAL DESC DONNAYS LAKEVIEW MANOR ADD LOT 6 BLOCK 4 PERMIT TYPE ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-0140210 DATE ISSUED: 08/23/2004'7' VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL FOUR KITCHEN CIRCUITS. # INSPECTIONS 2 APPLICANT MELLAS ELECTRIC INC 16901 XYLITE ST NE HAM LAKE, MN 55304 OWNER GAMIVIELIN JOANNE R 5830 W MOORE LAKE DR 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 wort 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 of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date, ELEC PERMIT FEE - MIN (RESI) 40.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 40.50 PAID WITH CHECK # 28635 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. oqoq - -4 1 LP I kDO.SQ11 Building I nsp ections 763-572-3604 763-502-4977 FAX CITY OF FRIDLEY DATE. ._4- -.- YOUR E-MAIL ADDRESS i0tQ SITE ADDRESS _ n.,�-_e, '�1 _ . THIS AFFLICANTIN: 0 OWNER VC-ONTRACTOR PROPERTY NAME: Tc"Pop--ot- jokv\mor-�-Ito OWNER/ ADDRESS: l5cb'aC� tZ.010CWIL CITY TENANT rini No.: Xel, fed B T L1 CONTRACTOR COMPANYNAME:._ '�r-t-AVL- -LOC. - SUBMIT A CO1'Y OF CONTACT PERSON: YOUR STATE STATE LICENSE ff EXP DATE LICENSE WITI-1 ADDRESS:. _9RO3 ?ajjA-0i-A _AQ -C- 0. CI -1Y LDW QA4 STATFMD ZIP E;'Sq 2-4 APPLICATION PHONF PERMIT TYPE XIIN6LF, FAMILY 0 TWO FAMILY 0TOWNHOUSF, TYPE OF WORK: M NSW XREPI,ACEMFNT 0 ALTERATIONIRFMODEL DETAILED DESCRIPTION OFWORK R1k.PtA.C-cLMt I o A--) - FEES ARE BASED ON $19.00 PER FIXTURE, FXCEPT WHERE NOTmFIXTURES:INDICATE T(YFAk,NtJMBER OFEAC14 BELOW) Equipment Imnlicd MFG; Q, KVLi'LK MODEL: . 6 1 ILI SIZL/B '(j LC�,OCK5 wi: C-P,9.)p'a MODEL: '?-1jA9A,57-14 SP4. A/C$25,0() MI:G: MODFI..: —TIREPLACL-. (OAS) $15,00 DR 0 V E N $ 1 (X)- 'CHANOFFN $15 AIR TO AIR EX B011'ER slmyj FIREPLACE (WOOD) $35,N) Tj'IJRNACF _GAS Vo --1- 10.00 $35,00 S 0. —CHIMNEY —GAS DRYER $10.00 HEATER 5,35.00 DUCT WORK $10.00 (iAN IJIPINQ $10.00 —13(.X)L VIINTI 1,ATOR $ 115.00 THIS IS AN APPLICNI ]ON FOR A PFRMIT-NOT VALIV UNTIL PROCESSFD I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes not a permit but only an application fora permit and work is not to start without a pennit; that the work will b approved plan in the case of all war hnich eqe ices review and approval of plans. SH)NATURF OF APPLICANT(,_j PRINT NAME btt'Wi'S kI-%QVnFSS) tJ DK City of Fridley Building Inspections.Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 iat the work will be in hat I understand this is in accordance with the Td WUTT:OT 600E 80 'yin 2'-SETTc.=,L: 'ON ;;UJ A3-laidj JO Aiio: W06J