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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT � ®4'796. Date: -----.._._.__._._._...._._..... - __ — �__._..._.... Builder Owner: �� Address Address __.__ .---..._.--- .._......_ OF BUILDING No1F..i%yltStreet ._..�'rS,� i=cep:_.,r��*, ...._.......... Pari of Lot ...._._....._ Lot .....,�- ----------- .... Block ............. __:_.....__........ Addition or Sub-Divisi-_ .,_2 ,. 7 ._. _.- -- - Corner Lot .-----------.......... _........ Inside Lot ........... �.._.... Setback .--j•�•-....._.__..._._ Sideyard....._.y..�:�.._.------------ ._---- _.------ -- SewerElevation _..._..._........_.--_-_..____. _-•-_--------_. _.._..---..._.._._ Foundation Elevation _ ................................ _.._._..._...._.__...._...._..._._..._.. DESCRIPTION OF BUILDING To,,, Used a ," Y2* Front Depth.°......._. Height . Fro...................... Depth ................... Height .........{.� � Sq. Ft. ................ _.. Cu. Ft. ...................... Type of Construction , ... -r,,.IZ7:�e*"40i ... Est. Co 7":, . V -4;f.. _ To be Completed .............. ___.._........_......_...._- THIS PERMIT DOES, [rIOT RUTH RIZE VIOLAT ION OF ANY PRIVATE LAND COVENANTS AND BUILDING RESTRICTIONS. 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 ---.....--_-_..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 the city limits and this permit may be revoked at any time , upon. olatiow- of any of the provisions of said ordinances. Jr'�/ " Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to Seo the Building Inspector for separate permits for these items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owners Name Builder AddressAddress /n�ww�i°' LOCATION'OF BUILDING No. ''9 (Qf Street y .ST•% C . Part of Lot Lot q Block 11- Addition or Sub.Div.6L,=A" Corner Lot Inside Lot �Set Back Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach, to this form Certificate of Survey of Lot and proposed building location: " DESCRIPTION OF BUILDING 393 To be used As: Front Depth Height Sq. Ft. Gu. Ft. Front Depth. Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost 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 Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representa- tions stated in this application are true and correct. DATE SIGNATURE Mc. (A Schedule of Fee costs can be found on the Reverse Side.) / C APPReation for Power Plants and Heating. Coding. Ventilation. Refrigeration and Air Conditioning Systems and Devices j PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU 4-7470 GRAVITY WARM AIR: RATE 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 ............ 8.00 each add. 60,000 BTU ....................... 2.00 Replacement of Furnace ............................. 5.00 Repairs & Alterations—up to $500.00 ................. 5.00 Repairs & Alterations each add. $500.00 .............. 2.50 STEAM or HOT WATER SYSTEM 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 TOTAL $ $ 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 $ X_ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $_ Additional Fixtures ................. x .5o $ Gas Range to 200,000 BTU ........... x AIR CONDITIONING FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM P, ALTERATIONS & REPAIRS TOTAL REMARKS: 0 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 '" f 1949�0 Owner 195— Kind of Building ��� 195_ Used as To be completed about / 1,!5-- 46 Estimated Cost, $ ® C) Old—New. Building Permit No. 2! DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water arm o �/�� Trade Name Size No_ 6T Ieod Capacity Sq. Ft. E.D.R `�o ® O 6 BTU H.P. Total Connected Load Kind of BURNER —Trade Name Size No Capacity, Sq. Ft. E.D.R BTUA— • . - . �I ����:.!� � ��� �=.'sir =r= Phone r o HEAT LOSS CALCULATION DEPARTMENT OF BUILDINGS Weatherstrips uide A.SG.H.V. Construction No. n ows rs Reference Out. Wall Int. Wall Ceiling Roof Floor I Yes 19— FI.I o®ate/�Roem I Lenath--.k®-'/ Width /Heiaht ql II if Fl.l l9 - Windows and60ors—Crackage and Area Coef.1 Btu Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. O�� o7q • ®f� ®.e,35 2 .26Z e ° Glass C f Btu Coef. c:,Wd Coef. Btu Infiltration Net exp. wall Glass Exp. wall ®� Net exp. wall Glass 9 Glass Net exp. wall Ceiling 169110 PI'S An 16V Exp. wall Floor Net exp. wall Total Btu. 467 /® Net exp. wall pr sq. ins. W.A. Leader area 9 41- o Room I Length A57/ Width /P Int. wall -70 7 Floor Ceiling ,-.o (J Floor ��✓ Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.k6 /� ° oom I Length 9'?/'Width / /' Height / Windows and boors—Cracka$e and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Wi rows:M Doors—Crackage and Area 01 Coef.1 Btu Infiltration 07 ' Glass C f Btu Coef. r Exp. wall c;2 ®` Infiltration Glass Glass Net exp. wall Glass Exp. wall ®� Net exp. wall Glass Int. wall ��'C) Exp. wall =2,0 / Net exp. wall Ceiling 169110 6 72-5 Floor /b Floor Net exp. wall Total Btu. /0 8V 6 /® Requir s ., �. .D. pr sq. ins. W.A. Leader area 9 41- o Room I Length A57/ Width /P Heisdit Wi rows:M Doors—Crackage and Area 01 Width Height No. of Lineal ft Area No.of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area Noq of pane of pane lights of crack sq. ft. Ac CM i A /e, 2 77.z Coef. Btu Coef. Btu Infiltration Glass Glass 17J Glass Exp. wall ®� Net exp. wall Glass y ��'C) Exp. wall =2,0 / Net exp. wall /600 Exp. wall 6 Inc. wall % 4 /b Floor Net exp. wall Int. wall /0 8V 6 /® Int. wall /©d / Floor Ceiling -70 7 Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Insulation Kind How Applied Rnnm I Lanath 7,/Width P ° Height / Windows and Doors—Crackage and Area 01 Width Height No. of Lineal ft Area No.of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane of crack sq. ft. �liig�gjjh''ts Coef. Btu Infiltration Z Id Glass Glass 17J Glass Exp. wall ®� Net exp. wall Exp. wall 17 ` •, y ��'C) Exp. wall =2,0 / Net exp. wall �'� 6 Inc. wall % 4 /b Floor Ceiling Int. wall /0 8V 6 Floor Ceiling Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I FI_I Rnnm l Length //"Width ,/%''Height s'/ Windows and Doors—Crackage and Area Width Height No. of Lineal ft Area No.of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. ;!z .7014 196 Coef. Btu Coef. Btu Infiltration Id Glass 17J Glass Exp. wall ®� Net exp. wall y ��'C) Exp. wall =2,0 / Ceiling Net exp. wall % 4 /b Floor �%6 Int. wall /0 8V 6 Ceiling /©d / Floor -70 7 Total Btu. �-_A Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI_l Rnnm I i.enath AJ Width ✓®? eight / Windows and Doors—Crackage and Area Width Height No. of Lineal ft Area No.of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Id Glass / A� Exp. wall ®� Net exp. wall / 0 Int. wall Ceiling % 4 /b Floor Cab /0 8V 6 Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area tii6 � v HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS. MINN. Weatherstrips A.S.H.V. Construction No. Insulation Guide Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How. Applied Yes—No Yes—No 19— M I 44L nnnn I i .Pnoth 1Ad W;r1th /�® eioht ®II iFI I T Y Oa sem I Length ldth le Height Windows and Doors—Crackage and Area Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal f . Area No. of pane of pane lights of cracksq. ft. Width Height I No. of Lineal t. Area No. of pane of pane Ilghts of cra sq. fL gWidth 7-17 Coef. Btu Infiltration • 9 lCoef.1 Btu Infiltration Infiltration Net exp. wall jj, I /% Glass Ceiling f ®' 5Z I Exp. wall �® AQ Exp. wall ,/® Net exp. wall Int. wall 919 Int. wall Floor" Ceiling O Floor Ceiling e -- Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 _Room I Lenitth Width .SC® Height 411 Windows and Doors—Crackage and Area Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Height No. of Lineal ft. Area No. of pane lights of crack aq. ft. Width Height I No. of Lineal t. Area No. of pane of pane Ilghts of cra sq. fL gWidth 7-17 Coef. Btu Infiltration • 9 Glass Btu Exp. wall Infiltration Net exp. wall 7=-).. Int. wall zr Ceiling f ®' Floor 7 6 F Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FU O N1 A p sem I Length .7® ® Width �2 -V Height ?,' W' do s a Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Height No. of Lineal ft. Area No. of pane lights of crack aq. ft. Width Height I No. of Lineal t. Area No. of pane of pane Ilghts of cra sq. fL gWidth 7-17 a Z e • 9 lCoef.1 Btu Infiltration Infiltration gill 7=-).. Glass zr Glass Exp. wall 7X o% �® Net exp. wall Exp. wall ,/® / 'e) Int. wall Net exp. wall Ceiling Floor" Int. wall Total Btu. /--L Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Height No. of Lineal ft. Area No. of pane lights of crack aq. ft. gWidth 7-17 a Z e • 9 /7..,? Coef. Btu Infiltration Net exp. wall Int. wall zr Glass Floor �® Exp. wall Net exp. wall Int. wall Ceiling Floor % �® Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.l Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. iris. W.A. Fader area F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane tights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area City of Fridley, Minn. BUILDING PERMIT Date: 110 1965 Owner: J. X. Lampert Builder N° '7602 �Ps©,C-0 -7W J. E. Foos Construction Co. Address 5965 4th. Street N. E. Fridley Address 1909 Rice Creek Rd. Now Brighton LOCATION OF BUILDING No. 5965 _ Street 4th • St. N. E. Part of Lot Lot 19 _ Block 2 Addition or Sub -Division Emmett Palmer Corner Lot , Inside Lot $ Setback Sideyard Sewer Elevation — Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth Height Sq. Ft. Cu. Ft Front Depth Height Sq. Ft Cu. Ft Type of Construction Est.Cost _ To be Completed X6,500.00 • Storm Damage Repair • In consideration of the issuance to me of a permit to c ct building des above I agree to do the proposed work in accordance with the description above t fo and in p ce th a'11 provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 100 , permit is hereby granted toJ• E. Duoos Const • G949=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 aII work done in, around and upon said building, or anyctirt thereof, shall conform in all respects to the ordinance�snof Fridley, Minnesota regardina otn, revaked� t a time upon1cea13on off any of throe provisions of said ordinance. city limits and this Allen Jensen Building Inspector NOTICE M pump deft not corer rhe condrU ion, koft0 Tien for rrb M pinm6ing, an haring, asru or wder. Be sura to ae the Bedding InWedar for apards pumps for thea hems. r APPLICATION FOR BUILDING PE CITY OF FRIDLEY, MSOTA INNE OWNER'S NAME BUILD ADDRESS '� 4 ADDRESS LOCATION OF BUILDING No._ ��� Street Part of Lot LOT BLOCK 2- ADDITION OR SUBDIVISION NO Corner Lot Inside LOT Setback Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. r DESCR PTION OF BUXLDING To be used as:�� Front DepthHeight Sq. Ft. Cu. Ft. Front Depth Height } Sq. Ft. Cu. -..Ft. Type of Construction Estimated Costo To be` compleied The undersigned hereby makes application•fvr'•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•Departiient of'Buildings, and hereby declares that all•the facts and representations stated•in this application are true and correct. DATE�J ,3 SIGNATUR&- (Schedule A£ Fee Costs can be founq an tie Reverse Side). s QUOTATION Rom J. E. CUQ®S flflil.DER OF DISTINCTIVE HOME; 1SG9 R'CE CREEK ROAD NEW BRIGHTON, MINN. 55112 .633- 4478 F To L We are pleased to quote as follows. Your inquiry w� Inquiry No Date Terms Prices quoted are F.O.B Delivery J Quantity I Description I Price I Amount r. . B Ah.9 TOPS FORM 448 LITHO IN U.S.A. 0 . . r .11 QUOTATION F Rom J. E. � U001)" BUILDER OF DISTINCTIVE HOMES 1909 RICE CREEK ROAD NEW BRIGHTON, MINN. 55112 633 : 4478 F To We are pleased to quote as follows. Your inquiry Inquiry Date Terms Prices quoted are F.O.B Delivery Quantity I Description I Price ' I Amount c TOPS FORM 3448 LITHO IN U. S. A. • < , w By d 97-81,416051 CITY OF FRIDLEY • APPLIcATION FOR PWMBING AND GAS FITTING PEWIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures K $3.00 • x $2.00 New Fixture, Old Opening to $2.00 u Catch Basin L w d a Water Heater - to 99,000 STU Water Heater .$5.00 100,000 BTU to 199,000 BTU x $10.00 ' Water Softener x $7.00 New Ground Run Old Building e. $5.00 a x a GAS FITTING FEES: 1st 3 fixtures —4 Le 0 9 Pja� x $1.00 Gas Range to 199,000 BTU x $10.00 WW es a go CS ec a u ani 8 V) U4 r 0 as lec lei r lLa- zze an e 2nd 3rd 4 tti (R) a Future Connection Opening Connected with Sewer (•) - New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures K $3.00 Future Fixture Opening x $2.00 New Fixture, Old Opening x $2.00 • Catch Basin x $5.00 Water Heater - to 99,000 STU x .$5.00 100,000 BTU to 199,000 BTU x $10.00 ' Water Softener x $7.00 New Ground Run Old Building x $5.00 Electric Water Heater x $5.00 GAS FITTING FEES: 1st 3 fixtures x •$3.00 Additional Fixtures x $1.00 Gas Range to 199,000 BTU x $10.00 REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction State Surcharge TOTAL FEE REINSPECTION FEE ($10.00) $5.00 $ $2.00 $ $ .50 $ 8.00 L Job Address 5965 4 Street N^E 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 application are true and correct Fridley, Mn. 9-28-78 , 19 OWNER LAMERT KIND OF BUILDING f'ra.7ne USED As -- ----- res, TO BE COMPLETED ABOUT 10-5-78 ESTIMATED COST 20.00 n , OLD - NEW BUILDING PERMIT NO. PERMIT NO. '71 Company MINNEGASCO Signed By . Tel. No. ROUGH INSP. Date FINAL INSP. U Date APPROVAL FOR PERMIT Y MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLUS $.50 STATE SURCWU= City of Fridley//4 SUBJECT P 159000 AT THE TOP OF THE TWINS BUILDING PERMIT ftQf EIPT N0. ------- COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBERDATE REV. PAGE OF APPROVED BY 612-571-3450 910-F15 8/22/80 JOB ADDRESS 5965 - 4th Street N.E. 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 19 2 Bennett Palmer Addition SHEET 2 PROPERTY OWNER MAILADORESS ZIP PHONE James Lambert 5965 - 4th Street N.E. 571-2374 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 8 DESCRIBE WORK Construct a 13' x 29' Gara a Addition 9 CHANGE OF USE FROM TO STIPULATIONS Side yard variance down to 3.5' was approved on 8/12/80. Any openings on the north wall be protective type wire glass windows. Self-closing fire door and exterior wall be 5/8" Type X gypsum sheetrock. Provide a hard surface driveway. WARNINS SEPERAfE PERMITS Ofta dtggina call 1oc�t utilities TELL HONE . ELECTRIC - GAS Etc. HEATING, A EpU ED � PLUMBING ND RtIM(, SIGIyS, REQUIRED BY LAW 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 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 377 3770 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 $3,321 $1.66 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 TOTALFEE $16.74 IG NAT URE OF CONTRACTOR AUTHORIZED AGENT IDATEI WHEN PROPER Y VALIDATED THIS IS YOUR PERMIT lk I 8 G ATURE OF-OWNeR IIF OWNER 8 ILD RI IDATEI BLDG INSP TE CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) - OWNER:_ ADDRESS: Sq (Q TEL NO: BUILDER: . • DD . Construction Location STREET NO: S°1tp� STREET: �-yo _ LOT: 1 BLOCK: ADDITION: w Qw-�w.x Corner Lot: Inside Lot: Setback: i(o.1S�' Sideyards: �. Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: Depth: a l Height: Squane. Feet: p Cubic Feet: 9 r7 Front: Depth: Height: Square - Feet: Cubic Feet: Type of Construction: Estimated Cost: To Be Completed: _ Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: to $ $ SEE REVERSE SIDE OF SHEET 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: t - \ l - g SIGNATURE: Stipulations: I/A I 0 k),, k_4"o op w�rv®6c&f' L•0. O CInS,MC' Fce_� hW6 #q/J0