PRE 2010 DOCSCity of Fridley, Minn.
WELDING PERMIT N® 3280
Date: ...��. :5. K .....................
owner ....................................... Builder C;( `''.b.0 .:.......
Address...................................... Address .............................................
LOCATION OF BUILDING
No... 477.3.
Street
Lot .. c5� ....
.V ................................Part of t
Block .................. Addition or Sub -Division .. .... ..... ........
Corner Lot ............
Inside Lot .. ! ...... Setback ...... . ..
Sideyard .......�.�
.. ?... .
To Used as:
DESCRIPTION OF BUILDING
�''
C/ 'a'
.....
Front .'T.fes, f%.� .. Depths Height .... G ..
Sq. Ft .. ...
Cu. Ft.Am
oxrt ........ Depth ........ el ht ........ Sq. P ...... Cu. Ft........ .
Type of Construction ............ Bet. Cost.. . P...... To be Completed . �. �!: .........
nr�.�.:.
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 $......... ... permit is hereby granted to Pr )Vv
......................... 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.
j�
. ./. ¢ .. y .... ... .... Building Inspector
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.
0
Laity of Fridley, Minn.
BUILDING PERMIT N° 49 4
Date:
-7-4/ A^
Owner: y Builder - --
Address Address
'j..- OCA F UILDING
No. `� � , . Stroet R P t
Lot _ Block Addition or Sub- D vision q
Corner Lot — Inside Lot Setback ... Sideyard ---
Sewer Elevation ___ -- Foundation Elevation
DESCRIPTION OF BUILDING
To / 4
or NW4 Front Depth - - vE Height _ Sq. Ft. � Cu. Ft.
Depth Height_ Sq. Ft. _ _ Cu. Ft. —
de
Type of Construction " !', F-st.' --"'� To be Completed
xi -40
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
theproposed 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—
r I
to construct the building or addition -4r desmibed 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 violation of any of the provisions of said
ordinances.
ullding Inspector
NOTICE:
This permit does not cover the construction, inatailation for wiring,, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
APPLICATION FOR BUILDING PER)aT
CITY OF FRIDLEY, MINMOTA
• G _ Name---- �� 1' 1L _.�/ / U,:ii .? , a Builder
LOCATION OF BUILDING
No. Street n� , �° �1 • Part of Lot ,
Lot � Block Addition or Subdivision
Corner Lot Inside Lot Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
To be used as-.-----
n.1
s-.-----n.1
DESCRIPTION OF BUILDING
Sq. Ft. q Yo Cu. Ft.
Front Depth Height,
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost -7 277
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 representations
stated in this application are true and correct.
DATE tie L SIGNATURE
(A Schedule of Fee Costs can be found on the Reverse Side.)
0 0
City of Fridley, Minn.
BUILDING PERMIT
•
Date: July 29, 1965
Owner: DAVID PINKS Builder
-2 > 'op e, �'
N? 8280
DONIS CONSTUCTION COMPANY?
Address Address Route #5-
Anoka,
5.FiI)oka, Minnesota
LOCATION OF BUILDING
No. 5973 Street 5TH STREET N. E. Part of Lot
Lot 15 Block 4 Addition or Sub -Division Bonny Addition
Corner Lot _ Inside Lot X Setback 35' _ Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
How Front 44 Depth 24 Height 8 Sq. Ft. Cu. Ft.
New Addition Front 14 Depth 16 Height 8 Sq. Ft. 224 Cu. Ft. 1722
Type of Construction Pram® Fes. Cost $15#500-00 --To be Completed :L2-1-65
•
HM REBUILD FROM CAPP IIP AND NEW ADDITION
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 pliance with aft provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 10.00 , permit is hereby granted to DWS CONST, 0.
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 workonen, in all work
done in, around and upon said building, or any part thereof, shall conform in aII respects to the ordinances of
Fridley, Minnesotasing location, construction, alteration, maintenance, repair and moving of buildings
within
nthe city limps � this permit may be revoked at any time upon violation of any of the provisions of ssaa d -
ALLEN G. JENSEN Building motor
NOTICE:
'tido punk doer not cover tho construcAm, houliation for wiring, plumblng, ger hoafing, rawer or water. Be sun to ere
the Building Impedes for sopor to permits for those kerma.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME Pd �''�R !� ._� BUILDERS , ( ,ice
ADDRESS ADDRESS pl o kqs
LOCATION OF BUILDING
1
N0, fi P% 3 STREET �i) _PART OF LOT
LOT Ia BLOCK ADDITION OR SUBDIVISION
CORNER LOT INSIDE LOT__�L( SETBACK S 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.
DESCRIPTION OF BUILDING
To be used as ;1 I� Co'- "' T
,
�
d 1�I 2 1 �� Front/Depth
(J� Zl{ Height
Sq. Ft. Cu. Ft.
Front ` c Depth--/ C Height l�
Sq. Ft. pZP q Cu. Ft..
Type of Construction— Estimated Cost�,_U®
To be completed d
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
(Schedule of Fee Costs can'be found on the Reverse Side).
1
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
JOB ADDRESS --1!!L-)'3 -• S 1•. � .
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
$ Qe , 0C,
that all the facts and representations stated in this application are
true and correct. 1199-
Gas Piping (Needed with new furnace) $ 10.00
$ A.D—r-J
OWNER Dcvotld 1 ,Jaj
Gas Range $ 10.00
$
BUILDING USED AS
Gas Dryer $ 10.00
$
ESTIMATED COST `.' : L: PERMIT NO.
*Air Conditioning - All Sizes $ 10.00
$ i o, CC'
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water) arm Airy
Trade Name Size No.
Commercial/Industrial
BTU _8 c. ov ti- HP EDR
1 % of Value of Appliance or Work
$
Fuel Total Connected Load
State Surcharge
$ .50__
Burner Trade Name Size No.
BTU HP EDR
TOTAL FEE
HEATING COMPANY STANDARDHFJW,AORIAMMMO=a
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
Mli.,- %OLIS, ;4 b
P-n.540i3-Zn$
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
Signed By PHONE82+26Ed1 No. J
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
Approved By 2r Rough -In Date Final Date
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
2
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 ( )
5.
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
TANDARD At IN(i & AIif
SERVING THE TWIN CITIES SINCE 'gal)
HEAT LOSS CALCULATION
FOR PINKS
120192
CDS
----------------------------------------------
FIRST
LENGTH
25 WIDTH 43.5
HEIGHT 8
--------------------------------------------------------------------------
WINDOWS
& DOORS
- CRACKAGE AND AREA
WIDTH
HEIGHT
NO. LIN FT
AREA
NO. PANE
PANE
LIGHTS CRACK
SQ FT
1 14
;; 2
�' 16 ..'.
8.7
5 34
22
2 89.2
66
3 28
48
2 75
68
1 22
48
2 23.5
18.4
2 32
80
DD 61 .
71.1
1 32
80
p 18.7
17.8
185 R.FT
COEFF
BTU
INFILTRATION
.................
283.9
20
5678
250
48
12000
GLASS ..............................
EXP WALL ...........................
185
1230
12
147h0
NET EXP WALL
........................
1480
5
7400
BELOW GRADE......
8 ................
1325.5
10
13255
CEILING .............................
1325.5
2
2651
FLOOR ...............................
0
0
0
VENTILATION......
0
................
55744
TOTALBTU .................................................
55744
TOTAL BTU OF
ALL ROOMS/FLOORS.......................................
u
e
in
410 W. LAKE ST. 1072 PAYNE AVE.
MINNEAPOLIS, MN 55408-2998 FN ST. PAUL, MN 55101-3892
612/824-2656EATING ANDAIRCONDMONINGCO 612/772-2449
-SwviaQ The Twin Cities Siam 1930'
ORSAT TEST RECORD
ADDRESS 1!5r9,73 -i'
OCCUPANT
DATE HTG
CITY � i
GAS LINE BY
TYPE OF HEAT: GA FA HW STEAM SPACE HTR.
DJE SIGN
MAKE �`�& ® 'S
-�` z MAKE
MODEL/,2 MODEL
SERIAL �G t ?Za i M MAX.
INPUT �s��� MAKE
CONTROLS
all?
UNIT HTR. OTHER
CONVERSION
OF BURNS
BTU RATI
OF FONA
THERMOSTAT /-h/6 HEAT PLUG VENT SIZE -11, /
VALVE ,,��,� KIND OF LINER SIZEt/, NONE
LIMIT "--,17,0 DRAFT HOOD REGULATOR
LIMIT SETTING Wo CHIMNEY CONSTRUCTION
FAN SETTING DRAFT /%�5,�; �, F TEST TAG
PILOT TYPE �,-, ( LIGHTING INST.
PILOT MAKE
PILOT MODEL
PILOT TIMING
PRESSURE 3, PERCENT CO2 f DATE TESTED /2 --/0 -9
INPUT CFH <,f5- 0 PERCENT 02
STACK TEMP. PERCENT CO D NAME OF TESTER � �-
SUBJECT
PE
City of Fridley
2 6 5 3 3
AT THE TOP OF THE TWINS
BUILDING PERMIT
R
I `
COMMUNITY DEVELOPMENT DIV.
tr �_____
r PROTECTIVE INSPECTION SEC.
e/ 7
d
/
`
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
7/10/98
JOB ADDRESS 5973 5 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
15
4
1 Bonny Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Dave Pinks 5973 5 Street NE
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
Arntson Remodeling 4224 Lakeside Ave N,Brooklyn Center Mn
55429 535-0228
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5246
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION [� REPAIR
O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (29 Sq) Tear -off
9 CHANGE OF USE FROM 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
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
@
$1.21
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2,418
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS_QF ANY OTH ATE OR LOCAL LAW REGULATING CON-
STRUCTIWO11 THE ERF NTRUCTION.
$74.75
Fire SC $2.42
PLAN CHECK FEE
TOTAL FEE
X,
License SC $5.OQ
$83.38
SIG ATUREO CON"RACTORORAUTHORIZED -AGENT IDATEI
WHEN PROPERLfIALIDATED THIS IS YOUR PERMIT
AF
BLD INSP
( .I
GATE
_
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
NEW [ J Effective 1/1/98
ADDN [ ] ;;r4 CITY -OF FRIDLEY
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �p� ,
BUILDING PERMIT APPLICATION (�
ConstructionAddress: 737
Legal Description:
Owner Name & Address:
S9 7 3 S`t'4sT�,�c�.
Tel. #
Contractor: 1je/r7-T61A,1 MN LICENSE #
Address:. N /�� �. . flail/ S3`y� Tel. #�-4
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF E14PROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length ' Width Hgt/Ground Sq. Ftp
OTHER: _ �/� e` �s-� y c` C)
Construction Type:OGF_ Estimated Cost: $
(Fee Schedule, on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$
DATE: APPLICANT: Tel. #
CITY USE ONLY
Permit Fee
$ IV,
Fee Schedule on Reverse Side
Fire Surcharge
$e
.001 of Permit Valuation (1/10th%)
State Surcharge
$ �� ti
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$ CAD
$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 [ J
TOTAL
STIPULATIONS:
.0.
suedEcr
RMIT NO.
City of Fridley
24544
AT THE TOP OF THE TWINS
BUILDING
PERM
r
i
COMMUNITY DEVELOPMENT DIV
L
r , PROTECTIVE INSPECTION SEC
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
1'' 612-571-3450
910-F15
9/10/96
JOB ADDRESS 5973 5 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
15
4
1 Bonny Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
David Pinks 5973 5 Street NE
571-3298
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 0 REPAIR
❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof House & Garage (30 S) 2nd Layer
9 CHANGE OF USE FROM TO
STIPULATIONS
Roofing can be the 2nd layer but not the
3rd.
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
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
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
$.93
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,860
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
Fre SI;, $1.86
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$59.50
A
PLAN CHECK FE
T T LF E E
$62.29
SI C NT CTORORAUTNORIZEDAGENT IDATEI
Pq
LY VA ID D THIS ISY UR PERMIT
WRO
7V
DG Ir450f�FTE
S AOWNER OWNER BUILDER, IDATEI
NEW
ADDN
ALTER
[ ] Effective 3/1/96
[ ] CITY OF FRIDLEY
[ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress:
Legal Description:
Owner Name &
Address:
LICENSE #
s J
OL Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EWPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Lemeth Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: ��a�ted��S � �
Approx. Completion Date:
(Cost onRack)
Driveway b Cut W' th Needed: Ft. + = Ft x $ _ $
DATE:APPLICANT: Tel. # Z�
TOTAL $ -�
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ 5% S
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$900 per SAC Unit
License Surcharge
$
$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 $ -�
STIPULATIONS:
CITY OF FRIDLEY PERMIT NO.: 2004-02269
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 12/13/2004
572-3604 FAX: (763) 571-1287
ADDRESS 5973 5 ST NE
PIN 233024210065
LEGAL DESC BONNY ADD
LOT 15 BLOCK 4
PERMIT TYPE ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE.
# INSPECTIONS I
APPLICANT
EXCEL ELECTRIC LLC
6041 189 LN NW
ANOKA, MN 55303
OWNER
PINKS DAVID L & VELMA L
5973 5TH ST 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 Insp,
Date
CUD AD oma nnr,....,,.,-..,
STATE SURCHARGE, ELEC FLAT 0.50
ELEC PERMIT FEE - MIN (RESI) 20.00
TOTAL 20.50
PAID WITH CHECK # 5000
1 Vl\ vT v1An v i Tina i ntflN Uri0%-1UJ =) AbU V L".