PRE 2010 DOCSSUBJECT
PERMIT NO
City of Fridley
® 3141
AT THE TOP OF THE TWINS
I
E ®I N I
D[ R M I T
PERMIT
r
Dv I v
BUILDING
T
f
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
1 �
1 . �
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
L J \ 612-550-3450
910-F15
8-13-75
JOB ADDRESS
5901 WEST MOORE LAKE DRIVE, FRIDLEY, MINNESOTA
1 LEGAL
LOT NO.
BLOCKTRACT
OR ADDITION
SEE ATTACHED
DESCR.
1
1
DONNAY'S LAKEVIEW MANOR SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
EDWARD HOLLAND
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
LLOYDS HOME IMPROVEMENT 4911 - 4TH ST. N.E.
MINNEAPOLI5 MINN.
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
RESIDENCE
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION XX REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Re -roof
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.
SHINGLES
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,
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$560.00
450
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHA GE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$5.00
PLAN CHECK FEE
TOTAL FEE
� -1 —
�''�► 7�0
5.50
SIGNATUREO ONT AC OR ORAUTH Z ADEN IOATEI
WHEN PROPER VA (DATE THIS IS YOUR PERMIT
BLDG I
8-13-75
If DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
f
1
•APPLICATION FOR RESI'DENTIAL., ALTERATION,
OR ADDITION.BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S �!&16:a2,B-UILDER' >
ADDRESS: ADDRESS: w—
NO:. STREET:
t!
LOT: BLOCK:ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDE -YARD:
foam Ta ..
o Certificates -if Survey -of -Lot of Lot and.proposed
Applicant attach to this
building location drawn on these Certificates. '
To Be Used As:
DESCRIPTION OF BUILDING
Front • Depth
Square Feet: Cubic.Feet:
Height:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: Estimated Cost:_ $ 4 014z. --le/
To Be Completed:
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
are true and correct.
DATE: % SIGNATURE
(See Reverse Side For Additional Information.)'
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES / 1
JOB ADDRESS
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work
Residential Rate TOTAL herein specified agreeing to do all work in strict accordance with the
Furnace Shell and Duct Work, Burner - city codes and ruling of the Building Division, and hereby declares
Also Replacement Furnace $ 20.00 00 that all the facts and representations stated in this application are
true and correct. -? ,1991
Gas Piping (Needed with new furnace) $10.00 $
OWNER k-1) �
Gas Range $ 10.00 $
BUILDING USED AS �� ,,q
Gas Dryer $10.00 $
"Air Conditioning - All Sizes $ 10.00
TO IV
All Others/Repairs & Alteratiolfs (LIST ON BACK)
1 % of Value of Appliance or Work $
Commercial/Industrial
1 % of Value of Appliance or Work $
State Surcharge $ .50_
TOTAL FEE $�
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
"Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
ESTIMATED COST
PERMIT NO./ O %(OL
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units_ Circle One (S
Trade Name 2co 4�J
BTU HP
Bam) (Hot Water) arm Ai
Size No.
_ EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
HEATING COMPANY
Signed By �6/022�ZaII` AIS ® Tel No. M - 6-�OC
Approved By Rough -In Date Final Date 7-167 F/
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
Yes
( )
No ( )
2.
Is free from rust or deterioration
Yes
( )
No ( )
3.
Has no foreign objects lodged within
Yes
( )
No ( )
4.
Is securely supported
Yes
( )
No ( )
S. Meets all current Code requirements for
size and total BTU's connected Yes ( ) No ( )
6. Has total heating BTU's of
All other BTU's
TOTAL BTU's
Remarks
List Alterations Being Done:
HEATING COMPANY
Signed By
Date
^
SUBJECT
PEWIT NO. _
City of Fridley
2 �. 5 0
AT THE TOP OF THE TWINS
PERMIT
BUILDING
r
RE NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
CCl6 /
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
j 612-571-3450
910-F15
9/29/92
JOB ADDRESS 5891 West Moore Lake Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
1
Domay"s Lakeview Manor SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
David/Maryann Pohl .5891 West Moore Lake Dr NE 571-1462
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Midwest Fence Mfg 525 E Villaume Ave, So St Paul 451-2221 4739
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 JO ADDITION O ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 161 x 1V Three Season Porch.Addition
9 CHANGEOFUSEFROM TO
STIPULATIONS See notations on plan.
WARNING
Before diggin¢ u!f for
SEPARATE PERMITS
RE eq utility�.to�:aii^�s �
WRING, H���"eNG� ®R
PLUMBING //��aap��+
® SIGNS. Q54'f 1�4;
REQUIRES _
.111
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
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I 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
SHUR $5 169.92
$2, 58
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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.
PLAN CHECK FEE
TOTAL FEE
License SC $5.00
$93.75
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEi
EN OP LY VAL kTfig THIS IS YOUR PERMIT
LDL -INSP MATE
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
NEW [ ] Effective 3/1/92
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: IS 941 % %A - MOMIL C^AC f
Legal Description: .,S" - 1C t "C.�w.s�,.r ,[ 3 �►kb•VlI�.W +AD VO[
Owner Name & Address: "tww t b it "ICVaNN L. Tel. # S`t►- Act -
Contractor: IJ %U%M*9r t=Co X t. %+1V;C► MN LICENSE # 40641%'1
41%'1
Address: !q7z S' %e Vt L.L Avort�, �►/. "�.'��• VWt. Tel. # 4X% -Z LI
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
�• %0^40* t Oft= y 0 1 a
LIVING AREA: Length lu 4D Width 14 0. Height Sq. Ft. Zz 4
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback _
Type of Construction: '3- �•�N VOU-64
Approx. Completion Date: Nagar 3O
Driveway Curb Cut Width Needed: Ft. + b Ft =
' iAVW^4 i4 sa
Side Yard Setbacks 4641T!°'
Estimated Cost: $ `�
(Cost on Back)
Ft x $ _ $
DATE: APPLICANT: 'ngN !�, a G+►at �w K.
Tel. # 4X%'-ZZ%l
TOTAL
STIPULATIONS:
Ed
CITY USE ONLY
Permit Fee
$
5/00'
Fee Schedule on Reverse Side
Fire Surcharge
$
001 of Permit Valuation (1 / 10th %)
State Surcharge
$
-2• 5
$.50/$1,000 Valuation
SAC Charge
$
$700 per SAC Unit
License Surcharge
$
5-,00
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary ( ]
TOTAL
STIPULATIONS:
Ed
OCT -28-1992 12:18 FROM TO 5711287 P.01
'v �✓, �4 �..Y.K:.`'d ;t,�'•r,'�•r, •'i. ��< .r V
v is .�.: �.. .�.. F. ./�. .< •i ' i. '.�C
.� _rte j��'r,'+��, f�/*�f �� 1�.'1^Y,�D� M�`F/`� �}�Y,�C��C.• •' `\ \ � {"
FAX # (612) 451.693.9
FACSIMILE TRANSMISSION COVER SHELET
DATE d ?OA
TIME i� r
TOTAL NUMBER OF PAGES �.
ATTENTION: 9titA-tjlJ6 1NSPAf r0 ,
FROM: 161c Y /-j
MASSAGE =..�►. t ? 4�'Cr► /ri,
� rj u T t 0/i 1-a `f M-14-" -
cr
�, !(d Tea
a
12:19 FROM TO 5711287 H'me
�
�
�
-
`
TOTAL P.02
0
SUBJECT
City of Fridley
26408
AT THE TOP OF THE TWINS
P,
BUILDING
PERMIT
r
ZRf_4&p_T_�.
:
v ____'_ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
�/ �/
j
314" /
REV
DATE
6/30/98
PAGE OF
APPROVED BY
I CITY HALL FRIDLEY 55432NUMBER
�""�
612-571-3450
910-F15
JOB ADDRESS 5901 West Moore Lake Drive
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
1
Donnay's Lakeview Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Ed Holland, 5901 West Moore Lake Drive, Fridley 55432
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Brad Holz, 28981 River Ridge Rd, Isanti
444-9987
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 (tear -off)
9 CHANGE OF USE FROM TO
STIPULATIONS
,
b'
Underlayment Must meet State Building Code.
TYPE OF NST.
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 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
%.
SURTA)
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
ITATI
, 40
.67
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-
$45.75
Fire SC $1.33
STRUCTION OR THE PERFORMANCE OF CO TRUCTION.
LAN CHECK FEE
TOTA
�( A*, -e o
License $5.00/f$52.75
TU c CO C R AUTHORIZED AGENT IDATEt
EN OPER
'SLD tNSP
Y LIDAT IS IS Y UR PERM
�.��i
- DATE
S,GNATUREOFOWNER iIFOWNER BUILDER) tDATEt
0
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [jC] SINGLE FAMILY -AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION �� b
ConstructionAddress: , 10l (fL%5�- Moore ('K' top.
Legal Description:
Owner Name & Address: � `� Ho (61nd — Tel. #
Contractor: &\c.c� 40 C 2 MN LICENSE #
Address: l l�,`vQr /�d`� ec�,�<���P 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: c
Construction Type: 900 < rt CA,
61 Estimated Cost: `I • i
(Fee Schedule, on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft Ft x $ = $
DATE: APPLICANT: Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
$ s' -7<
$ /.33
$ . (a 7
Park Fee $
Sewer Main Charge $
TOTAL
STIPULATIONS:
< ®o
1
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%) �U S "�AJ C
$.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 [ ]
Jar ", 4
CITY OF FRIDLEY INSPECTION DIV.
Effective On January 1, 1999
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
572-3604
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
New Fixtures $ 7.00 The undersigned hereby makes application for a perm it for the work herein
Old Opening. New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin $ 7.00 and representations stated in this application a true a correct. -I#
� �,t
Catch Basin $ 7.00 0 X
Rain Water Leader _ $ 7.00 11,114,
0®
Sump/Receiving Tank $ 7.00 %
Water Treating Appliance $10.00 Owner✓ / �d
Water Heater -Electric $ 7.00
Water Heater - Gas** $10.00 Building Used As
Gas Range** $10.00 J
Gas Dryer** $16.00 Estimated Cost PERMIT NO. C ��
Back Flow Preventer Required ( )Yes () No
Type $15.00 PLUMBING COMPANY McGuire & Sons
Reinspection Fee $42.00/Hr SIGNED BY 605 -12th Ave So. _ HAD_, kind, QNI(55343 ��� a31 q47�0
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.596 of Value of Fixture or Appliance
�Approved By z6 Rough -In Date Final Date j
W—CQ
State Surcharge $ .50
MINIMUM FEE FOIII ANY PLUMBING GAS PERMIT IS $20.00
TOTALFEE $r•6e'N-) PLUS THE $.50 STATE SURCHARGE
"COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES.
Wash
Dank
Floor Catctr<
Auto.
Gas'
Gas
M�sc Water Heater
Stories Closer:
Urinal Tub
Shower
Sink Tray
Fount ;`
Drain Basin ..:
Washer Appl
:;
Range
Fixt :. Gas Elec
Basement
Floor 1
Floor 2
Floor 3
:..
Floor 4
FOTEi�
PLUMBING FIXTURE RATES:
NO. RATE TOT
JOB ADDRESS. ��� �
-
,✓�) 6� �iL.
/ / r��✓°�
New Fixtures $ 7.00 The undersigned hereby makes application for a perm it for the work herein
Old Opening. New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin $ 7.00 and representations stated in this application a true a correct. -I#
� �,t
Catch Basin $ 7.00 0 X
Rain Water Leader _ $ 7.00 11,114,
0®
Sump/Receiving Tank $ 7.00 %
Water Treating Appliance $10.00 Owner✓ / �d
Water Heater -Electric $ 7.00
Water Heater - Gas** $10.00 Building Used As
Gas Range** $10.00 J
Gas Dryer** $16.00 Estimated Cost PERMIT NO. C ��
Back Flow Preventer Required ( )Yes () No
Type $15.00 PLUMBING COMPANY McGuire & Sons
Reinspection Fee $42.00/Hr SIGNED BY 605 -12th Ave So. _ HAD_, kind, QNI(55343 ��� a31 q47�0
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.596 of Value of Fixture or Appliance
�Approved By z6 Rough -In Date Final Date j
W—CQ
State Surcharge $ .50
MINIMUM FEE FOIII ANY PLUMBING GAS PERMIT IS $20.00
TOTALFEE $r•6e'N-) PLUS THE $.50 STATE SURCHARGE
"COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES.
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-3604 FAX: (763) 571-1287
ADDRESS 5901 W MOORE LAKE DR NE
PIN 233024140001
LEGAL DESC DONNAYS LAKEVIEW MANOR ADD
LOT 1 BLOCK 1
PERMIT TYPE ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
PERMIT NO.: 2004-01793 ( `
DATE ISSUED: 10/05/2004
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL A SAVERS SWITCH.
# INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
ST PAUL, MN 55114-
C411A9�1 04:7
HOLLAND EDWARD J & JANET M
5901 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 the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg ]nsp Date
ELEC PERMIT FEE - MIN (RESI) 20.00
STATE SURCHARGE, ELEC FLAT 0.50
TOTAL 20.50
PAID WITH CHECK # 118132
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.