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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N° 3606 Date: .1.�..I.- ....... Owner ....................................... Builder'��. r .. .. ��•GC�: Wil: �. ........ Address .......'. Address ............................................................... LOCATION OF BUILDING No. ' r y'x Street .. mss .... s!K!:. r..: d..�:..........: Part • of Lot ...... ..... ................ Lot rt�.�Block ...mac. ......... Addition or Sub -Division o ..�'............... 0 Corner Lot ............ Inside Lot .X ......... Setback o.3..J'" : t) 11deyard Al > J0 .I................. DESCRIPTION OF BUILDING To Used as: ..... Front .T..... . Depth . 0 Height .o Sq. Ft. 1Q.7..® Cu. Ft.z"® .............. V.... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........ ��qq Type of Construction ................... llbt. Cost. /97, ! . /. . '-'.. To be Completed ................... In consideration of the issuance to me of a permit to construct the building desribed 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. In consideration of the payment of a fee of $.R.tp... - , ,--..is hereby granted to ................... ......................... 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 with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. Date: Address City of Fridley, A inn.. BUILDING PERMIT Builder. Address �.. •- ;�. O O F BUILDING No. Street -'Jty- _ Part of Lot Lot : _ lock CX �—Addition or Su Corner Lot , Inside Lot — � �• ' Mtback Sewer Elevation — Foundation Elevation DESCRIPTION OF BUILDING ..d� D 1 f To, as _ 4077 ,F. Vit- _,. Front Depth Height Sq. n �'� CUL Font Depth Ceight t. r A_r_�-� Sq. Ft. — Cu. F Type of Construction Est. �� - 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 ordinances of the city of Fridley. In consideration of the payment of a fee of permit is hereby granted to 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 within � city limits and this permit may be revoked at anyordtime u gn iolatio 31 any of the provisions of said Building Inspector 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. Owner's Address No APPLICATION FOR BUILDING PERMIT CITY OF FRIDIEY, MINNESOTA LOCATION OF BUILDING Part of Lot Lot Block Addition or Subdivision Corner Lot +Inside Lot -4- Setback Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: k; 4 14 : 't,� Front�Depth 0 Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction rR Estimated Coat A -t— To be Completed +V 6 1 The undersigned ereby Y'akes 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. oil (A Schedule of Fee Costs can be found on the C 41 w . w City of Fridley Application for Plumbing and Gras Ruing Permit Dept. of Bldgs. Phone 550-3450 879.01 DESCRIPTION OF WORK Number. Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures .............. ...... Future Fixture Opening ............... New Fixture Old Opening ............. Catch Basin ...... .................... Water Heater (Up to 99,000 BTU) ..... New Ground Run Old Bldg. ........... Electric Water Heater GAS FITTING FEES: x $200 $ x $1.50 $ x $1.50 W 3 o � x $3.00 O 0 t) W < 3 � °1 �1zW (0 ? ' ' o F N WATER HTR. GAS ELEC. Base Ist re 1 1 2nd 3rd 4th • Future Connection Openings New Fixture, Old Openings I Connected with Sewer � Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures .............. ...... Future Fixture Opening ............... New Fixture Old Opening ............. Catch Basin ...... .................... Water Heater (Up to 99,000 BTU) ..... New Ground Run Old Bldg. ........... Electric Water Heater GAS FITTING FEES: x $200 $ x $1.50 $ x $1.50 $ x $3.25 $ x $3.00 $ x $325 $ a $2.00 $ NO. RATE TOTAL 1st 3 Fixtures .......................... x $2.00 $ Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. 1 x $5.00 X3,00 REPAIRS & ALTERATIONS—Refer to Code 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, Mmn- 15 mm 68 , 19— Owner Thomas Thompson Kind of Building fr Used as r'PA To be completed about 20 Nkat' Estimated Cost, $ Old—MM Building Permit Nps P it No By Business Phone No ROUGH FINAL Description .................................. ......... ...$ TOTAL FEE $ 3. 00 e4j00.42 0 Ln M O N Albert Campbell 5840 3rd Street N.E. ,Fridley, Mn 55432 - N M La L47 Ln Q F- 0 W June 20, 1975 City Council Planning Commission ACTION TAKEN NOTICE Z On June 16. 1975 the Fridley City Council officially approved the recommendation(s) of the Planning Commission on your request for const=tion of -a garage,in asommercial Zone. Ujwith the stipulations listed below. 0 cc LL If you have any questions regarding the above action, o please call the Community Development Office at 571-3450. U) Q W F - x O Z W M Z W Q F- STIPULATIONS: W It. Sincerely, Jerrold L. Boardman Planning Assistant z J. There must be a verification survey made of this lot before a building permit will be issued. s W z W U _U U City of Fridley AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT PER O. - � `y _ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 = � CITY HALL FRIDLEY 55432 612-571-3450 EIP NUMBER 910-F15 REV. DATE 10/4/82 PAGE OF APPROVED BY JOB ADDRESS 5846 - 3rd Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4,5 22 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Thomas Thompson 5846 - 3rd Street N.E. 571-3503 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 4' x 16' Addition to Garage 9 CHANGE OF USE FROM TO STIPULATIONS 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 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. OWLG. 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $650 $.50 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. $15.00 PLAN CHECK FEE TOTAL FEE $15.50 DAGENT (DATE) WHEN PROPER;A VALIDATED THIS IS YOUR PERMIT XSIGNA�NTRACTORROORAUTHORI BLDG iNSP t)A E SIGNATURE OF OWNER OF OWNER BUILDER) r (DATE) CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATICH FOR RESIDENTIX BUILDING PERMITS (New. Alterations, Additions, or Repairs) OWNER: ADDRESS: TSL N0: QUI LDER : ADDRESS: TEL NO: Construction Location • STREET N0: -f 3Se4 STREET: LOTS (4 `v BLOCK:2—)— ADDITION: JA -f10(C eb 0—/ Z -- Corner Lot: Inside Lots Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION �n ��Front: Depth: Height: Square Feets�oq Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: 19 Type of Construction: ��� 0V Estimated Costa S •oo Zb Be Completed: � �y•�J� Alt. A Alt. 8 Proposed Driveway Width If New Opening Is Desired: $ S SEE REVERIE SIDE OF SHEET . The undersigned hereby makes application for a permit for the viork herein specified, agreeing to do.all Work Its strict accordance with the City of Fridley Ordinances and rulings of the Delprtment of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE SIGNMIM: ✓ a a -_7 a r Stipulations: R/s�� F0 SUBJECT PER 0. City of Fridley 20240 AT THE TOP OF THE TWINS BUILDING PERMIT r RE_CE IP L ....... COMMUNITY DEVELOPMENT DIV.® r 1 � PROTECTIVE INSPECTION SEC. 1 ; � NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 2/9/90 JOB ADDRESS 5846 -- 3rd Street N.E. I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4, � 5 22 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Thomas Thompson 5846 - 3rd Street N.E. 571-3503 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Amre 3700 Annapolis Lane, Plymouth, MN 55447 553--0020 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 8 DESCRIBE WORK Reside Dwelling; install soffit & Facia 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. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING MOT. 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 I 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 $2,154 $1.09 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- $54.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE 55.09 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI WI+EN OPERL IS IS YOUR PE NSP r"RMIT DOTE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI F0 NEW [ ] _ Effective 5/1/88 ADEV e[�� R-1 AND 1-2 ALTS [ ] �i `/e Building Permit Application Construction =ddress:�1 7� ss "'� Iegal Description: t r--. °,/ t o .S i �? Owner Name & �en" llaj"G7tl_ Tel. # Contractor: Address:�dG? Tel. #�2o0zo ��W, 7 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVM AREA. length Width Corner Height Sq. Ft. GARAGE AREA: Iength Width Height Sq. Ft. length Width OTHER: ViHER: Hgt/Grow'�d Sq. Ft. Corner Lot [ ] Inside Lot [ ] Ft. Yd S cif Side Yard Setba Type of Construction: , s'-6W�® �- 2' � (Xatimated Cost: $ � Approx. Completion Date: ` vy Proposed Driveway Width If NewIs Desired. Ft. $ $ 7e 9� Width + 6' See Back Page DATE: APPLICANT: �r Tel. # C=Y USE O�II,Y Permit Fee $ Fee Schedule on Reverse Side State Surcharge $ $.50/$1,000 Valuation SAC Marge $ (� � $575 per SAC Unit Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main MirWAgreement Necessary [ ] Not Necessary [ ] STIPOIATICNS: l�inv�S �hP�OuP, U SUBJECT City of Fridley 6 2 6 4 AT THE TOP OF THE TWINS BUILDING PERMIT r R • ____ COMMUNITY DEVELOPMENT DIV. _ v - r PROTECTIVE INSPECTION SEC. � 7 1 . I d✓ � NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 I.J 612-571-3450 910-F15 6/16/98 JOB ADDRESS 5846 3 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4, pt 5 22 1 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Thomas Thompson 5846 3 Street NE 571-3503 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Owner 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 jJ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (17 Sq) Tear-off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the 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 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 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 $.71 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,417 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- Fire SC $1.42 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $48.50 PLAN CHECK FEE TOTE $;e. 63 NATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI PRO IS IS OUR, P R RLLIDAT.41 BLDG IN FATE SIGNATURE OF OW R II NER BUILDERI IDATEI l�inv�S �hP�OuP, U NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: j Y -C I r Legal Description:yD� _ Owner Name & Address: Tel. # . FF —� Contract Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF E%IPROVEMENT ENSE # Tel. # 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: Awl Estimated Cost: $ f % 20` r (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: cJ hey APPLICANT: /ro'yh Tel. # CITY USE Y Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee $ Sewer Main Charge TOTAL STIPULATIONS: P 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 AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT P NO. 2 8286 r , E • ___ COMMUNITY DEVELOPMENT DIV. V - r � � PROTECTIVE INSPECTION SEC. 1 I I CITY HALL FRIDLEY 55432 612-571-3450 R NO. y� C(/l� NUMBER 910-F15 REV DATE 10/16/98 PAGE OF APPROVED BY JOB ADDRESS 5846 3rd Street NE 1 LEGALLOT DESCR. NO. 4, 1/2-5 BLOCK 22 TRACT OR ADDITION Hyde Park SEE ATTACHED SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Thompson 571-3503 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Castle Bldg. & Remodeling 3323 Arthur St M is 55418789-8509 9697 a 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 O NEW 0 ADDITION ❑ ALTERATION JaK REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace 13 sash/inserts 9 CHANGEOFUSEFROM TO STIPULATIONS 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 AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION ZONING SO. FT CU FT 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 AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED VALUATION SURTAX WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3565 $1.78 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- STRUCTIO OR THE PERFORMANC OF C STRUCTION 87.25 Fire 3.56 0-0 SIG NA RE ON7 O_OR AUfAbAIZED AGENT ATE,EN PLAN CHECK FEE Lice e $5,00/ TOTAL F E RO Y ALIDATE T IS IS YOUR PERMIT A002409'0' SIGNATURE OF OWNERaO OWNER BUILDER, IDATEI BL INSP T, tE t NEW [ J Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION 1 ConstructionAddress: 5 �, 4 - s , �,�� -r N �, �-� ►}c �, s Legal Description: Owner Name & Address: TWcmpsotA Tel. # S7/- 35-o3 Contractor: MN LICENSE # S&s? Address: 3� 3 pjTH-urz �T, . r+9iNNF_R�'oL/S . AIAI SS4-_g Tel. # �/) 7B 9-8So Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF DIPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: f2Encr+c,c ��Nr ,�� i 3 ss�sN�,c�sE,�s Construction Type: Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: APPLICANT: Tel. # 78 91-9 ,57-0 9' CITY USE ONLY Permit Fee $ 9, Z- Fee Schedule on Reverse Side Fire Surcharge $ • ST .001 of Permit Valuation (1/10th%) State Surcharge $ f• 2,6 $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ 00 $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 $ Jzs9 STIPULATIONS: CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Effective On January 1, 200t Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS s NIP -3 /lam St- d1%' RATE SCHEDULE nn��,'� A4 OWNER me4 .5y -t o Residential Rate TOTAL Furnace Shell and Duct Work, Burner - Also Replacement Furnace BUILDING USED AS_ Pw tI'Lk rvF-- $ 30.00 $ (Side Vent - Fill Out Back) Gas Piping ESTIMATED COST oo J PERMIT NO. Needed with new furnace, p g ( $ 10.00 $ but not replacement) Gas Range DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ Gas Dryer $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. *Air Conditioning - All Sizes $ 25.00 $ as vv BTU HP EDR Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP ED Commercial/Industrial &I�� I ��2 3 7V" 3 .S-04 ru 3�-�( !�, oay 1.25% of Value of Appliance or Work $ The undersigned hereby makes application for a permit for the work herein State Surcharge $ 50 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 TOTAL FEE $ a�. co representations stated in this application are true and correct. 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. DATE HEATING CO SignedTEL # Approved By Rough -In Date Final Date