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PRE 2010 DOCSCity of Fridley, Minae BUILDING PERMIT No 45 Date: Y Owner:....�". f' Builder ... `' Address .. 7'•••.4f . _ ... .._. Address' LOCATION OF BUILDING No. -- ( ' _. street +`.r � QE_�G.._:..... ....... _..._..._._._. Part of t ...._.._. ...__. _.__._.__....___...._ /� +o► Lot ------ /:tO ............... Block ....._....... ....._........... Addition or Sub -Division _._... _ _... _....._� Corner Lot ....._..................._........ Inside Lot ------......_....-----..._ ........ Setback .....+, ' •• ._............ Sideyard .....�le..... L-Af ..._...........--- Sewer Elevation ............. _....................... _.._.._..._---....._..._.._..._...._........ Foundation Elevation DESCRIPTION OF BUILDING ToAm Used as:i �►1 - ........_... Front ... t._.. Depth j .. Height .... .. Sq. Ft. # Cu. Ft. .i is . ......_...- .... �..... Front . __.. DepthHeht Sq. Ft. -gr V ' .-..... ..... .. Cu. Ft. . � - Type o Construction .... - . Est. Cost . �P.... � -..-. To be Completed ............ ... ................................. A TO®NI THIS PERMIT DOES NOT AUTHORIZE 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 $..0... __.`'' ., permit is hereby granted to. .................. _.... _....--•-•---•--_•-- -• _. r�.._...._.._._..._...___..._.._... 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 violatioany of the provisions of said ordinances. '/� . A A 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. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owners Name 9%ft3%* Stahl -Builder. Swanatrda Co.! Inti. FYI. J. T•I f • .. R ' ----- `f Address 044M Central Ave.:. i; E.Address .l3�C — 5 A4'e: i�. E. Iy#O� 3IQN OF BUILDING No. l r Street 5 Part of Lot, . Lot Block G '. 1 r:t ld Addition or Sub.Div. S�TBn,amf s Ce�rt Addition Corner Lot Inside Lot Set Back F®®' Side -Yard lU t'�:33� E89 SEWER ELEVATION, FOUNDATION::ELEVATION Applicant attach to this form Certificate -of Survey of Lot:and prop6sed,building location. DESCRIPTION OF BUILDING To be use as: , Front Depth Height,' Sq. Ft. Cu. Ft. Front Depth Height 77 Sq. Ft.. Cu. Ft. Type of Construction `Prime Estimated Cost 915.000 To be completed A %.S't l1960 The under8igned hereby makbb-application for a permit for the work herein specified, agreeing,tq'do all work" =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 A.pi-11 25, 1964',. SIGNATURE (A Schedule of Fee costes can be found on the Revbrse'Side.) w • � City of Fridley Application for Plumbing and Gas Fitting Pennit Dept. of Bldgs. Phone SU 4-7470 DESCRIPTION OF WORK Location Number, Kind and Location of Fixtures !0gg �J N Y E2 Z Q �Q W Z , N WATER HTR. GAS ELEG 3U �� 1 a 3� log 00 F Base 1st o� 2nd 3rd 4th • Future Connection Openings Connected with I Sewer JR New .Fixture, Old Openings Cesspool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures ........... .......... folRATE x $1.50 Future Fixture Opening ................ x 1.20 New Fixture Old Opening .............. x 1.00 Catch Basin ............................ x 3.25 Water Heater (Up to 200,000 BTU) ...... Z x 2.00 New Ground Run Old Bldg. x 3.25 GAS FITTING FEES: NO. RATE TOTAL_ 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ..... • .........................................$- TOTAL FEE $, S� 5 U 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 arde true and correct. Owner nd of Building✓rf Used as 1w To be completed about U Estimated Cost, $ 1.2 o m Old Building Permit No- '"�� Permit No._Z2 Pfj BY . Bu ess Phone No ROUGH JUN 8 1960 FINAL 42 2M 7-59 194 Application for Power Plants and Heating. Cooling, Ventilation, ReFrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, 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 $�`y�� ,r each add. 60,000 BTU .... . .................. 2.00 $ Replacement of Furnace ............................. §.00 Repairs & Alterations—up to $500.00 ...:............. 5.00 $ Repairs & Alterations each add. $500.00 ......... I .... 2.50 $ STEAM or HOT WATER SYSTEM NO RATE TOTAL 1st 3 Fixtures ...................... 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 $ 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 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 S� $— Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM it ALTERATIONS & REPAIRS TOTAL FEE $ ROUGH FINAL Dept. of Bldgs. Phone SII. 4-7470 Leon /3 *e' 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. Owner Kind o, Used a: To be c Estimated Cost, $ / A6— Old—New. Building Permit No. ` Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTTS. —Stean36 Hot Waster, Warm Air—No Trade Namee�ZZ' J� Size No Capacity Sq. Ft. E.D.R I BTU H.P. Total Connected Load Kind of rue BURNER — Trade Name Size No Capacity. Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) N M 4 z 2M 7.59 Business Phone No — " G a+„, pp!!** r� .Si... �� ��n.�<.F? m. ,.....t°'A ..a, r^ -p .!. —:? 3?'� �:� aJ ..Y .r. L'•- � ... a. ...i � w.... :u.:, '4•..+i dww. ..... � `c�'Orv%-... �� ���.:�.. �...��_•..ir'ly �.:::. sa. ��..'>..:.; e.6 CA � v' � pz• .rb.a:l �.rd�w.�.:u.:14v�.1.:.,'� or�rJ�oC.r�oa� �:ai�v.-: '•a:'.;4t.rF.i:aD PARMAL RATE SCHEDULE f'3M14"lM W : i:•'1 AIc.: MTZ `iOTLL . rrumzce She.l a 'Dari Work ... ... ..... .. Club -t Replacement of TNzrnaca 6.00 }� Repairs & Alterations -up to $500.00 600 a Repairs be AWrations each ad.9. 5500.00 300 $ IMCM WF:r-M Ai rurnace Shell & Duct Work to 123,000 BTU ..$1003 $ c=h add. 80,V00 BTU . 3. W tf ®® T' : ^'_ ac?tnet�t of r'urn: ce 6.00 $� Alterations --up to $500.00 6.00 $ Z12 -pairs & Altera tion each add. :500.0 3.00 $ furnace Shell & Lines --to 400 sq. ft, MR Steam $10!00 $ Furnace Shell & Line• -to C40 sq. ft. EDR Hot Water 10.00 S. Etch add 2DO sq. ft. EDR Steam aw) $ Each add. 320 sq. ft. EDR Hot Water 3.00 OIL 2:UDREP-to 3 gaL per hour 6.03 over 3 gal. per hour -See Fee Schedule GAS 23UMER (up to M4,03 ETU) 5m $ 0vZz 19?,000 BIV See Fee Mc -1 adula GAS FITTING vT N0 RATE TOTAL 1st 3 Fixtures xe a BOJ 3 Additional Fix -tures .71.9 Gas Range to 199=0 btu $ — IM CaOC x-:19 ?M7 G • �"SiL v SYL TM4 A[. ;YOx23 a REPAIRS MUCK State Surcharge .50 i Dapt. of B11G3. shams EM"'130 Lo=Z= / -5 3 -3 - Is-, A' -Y a,,, -)-). 4. City of F r ciley: The undersigned hereby makes application !ora permit for tte work here°.&- specified. agreeing to do all wore in strict accordance with the City O dist a e: and ruling of the Department of Buildin'-s, and hereby declares that an Me fast and representations stated in this application am true and correct /) Fridley, 11`ian Ess Owner EMAPMR-M Kind of Building Used as To be completed about, � "- �� % . Estimated Cost; $ 02 F'O_'#--)New. Building Permit No: _-_ Permit No.— 1✓a'w 11-11 17`iO3 of VIO.a 4TINGsdr POWER PLakNTS-S--St wa, Not Water, W�~ No � Trade Names ,tea? s = = - Sint NO Capacity___ SQ. M E.D.R0 t' c� i"sTU H P Total Connected Loa t 42 1rfM of FVe • C BURNER - Tru& NaSime Capacity sq. Ft ZZR $s'U E3:"_ tray ARM-ovsal r NEW ADDN [ ] CITY OF FRIDLEY Effective 1/1/2004 6431 University Ave NE, Fridley, MN 5,9432 ALTER [ ] SINGLE AA MIL AND DUPLEXES R-1 AND R-2 (763) 571 - Bldg (nsp BUILDING PERMIT APPLICATION (763) 571 -1287 1287 Pax Construction Address: - Legal Description: Owner Name & Address; 9E!_q �0OpINQ BEHOOF -L iN(3, I Contractor: e # 1 ��30 8'F- LBUIS PARK, n "�B MN LICENSE Address: 1D+M00010So Tel. # _ G/Z - rY23 �4}� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION 01: 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:' �Q Estimated Cost: $ 5 q © 0 Driveway Curb Cut Width Needed; Ft, + 6 Ft = Ft x $ DATE: ` J APPLICANT: _ !C'C Tel. # � © % Call (763) 572.3604 for Permit Fees if mailing In application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL z�t'd 10 * oN CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1110th%) $.501$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[ ] STIPULATIONS: S37US ONIJ008 d73S WaEE : 8 5002 ' 02 * AUW Building $ej BUILDING Plan Review Permit No.: Inspections Fire Surcharge RESIDENTIAL APPLICATION .001 times the total job valuation Received By: 763-572-3604 �, °�.S .0005 x Permit Valuation Minimum $.50 CITY OF FRIDLEY $,5'� Datei6i:J U L 3 0 200 DATE C�78 50kVj 0 6� YOUR E-MAIL ADDRESS �SC ,.y\cL t7 ��D��LGl C • C.0 yn � g SITE ADDRESS �'�J 5 3 , ` s $ ft + 6 ft = ft x $21 =$ Erosion Control $ THIS APPLICANT IS: ❑ OWNER $ PROPERTY OWNER/ �NTRACTOR NAME: --yo-0—CCA -d � SCw-i $ ADDRESS: n CITY PHONE: — 541 - NAME: Renewal By Andersen STATE ZIP TENANT CONTRACTOR SUBMIT A COPY OF STATE LICENSE # 1920 County Road "C" West THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED YOUR STATE LICENSE ADDRESS: Roseville, N 55113 r M STATE ZIP WITH APPLICATION PHONE License #20130983 ❑ SINGLE FAMILY/NEI 651-264-4777 PROPERTY TYPE ❑ TWO FAMILY/NEW C -- ❑ ADDITION ❑ GARAGE/SHED -.R WINDOWS PERMIT TYPE ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ REMODELLING_ -ZkdAINTENANCE/REPAIR DESCRIBE WORK BEING DONE- ,� I,�11P(S SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. RSI G ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. 2. Existing Floor Plan Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS & PORCHES SUMMIT ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structure ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION S 1 L-1. — OCCUPANCY TYPE Permit Fee $ej I. See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ �, °�.S .0005 x Permit Valuation Minimum $.50 License Surcharge $,5'� (�� $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ Make checks payable to: City of Fridley Attac THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not permit but only an application a permit and work is not to start without a permit; that the work will be in accordance with the approve plan in the case of all work whi requires r9lew and approval of plans. SIGNATURE OF APPLICANT NAME�(y`° Ja4_tnSC%1ti7 / DATE [ 45 Building PLUMBING Permit No.:2d P Inspections RESIDENTIAL APPLICATION Received By:% 763-572-3604 CITY OF FRIDLEY Date Rec'd: La 763-502-4977 FAX EFFECTIVE 7-1-2010 DATE 2 Z / YOUR E-MAIL ADDRESS SITE ADDRESS _ /_� J 3 S.7 1�'• k -e_ - THIS APPLICANT IS: �WNER ❑CONTRACTOR PROPERTY NAME: TU e- %/ql S 01>u ENAEN�I' ADDRESS:/.3.3 3 s 3 ! �d✓� CITY r!� ! el l� STATE�ZIP s�yz PHONE: CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE STATE LICENSE # EXP DATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PERNIIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: NEW ❑ REPLACEMENT DETAILED DESCRIPTION OF WORKQ!/4 a FEBASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES* (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE ATH SINIULAV _FLOOR DRAINS HOWER _ WATER PIPING BATHTUB GAS PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($35) _ _ _ CLOTHES WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15) —DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION WATER METER OTHER r i i 3k a MM, a�?' k-_ "i I�j�YI� � `'. ����t � - 3 4 j �g�bi'§✓it�.. � u� �� �r,�'. �x� �, wi*-{�. E� p � 1 Y� �_ �- Y"��Y b3 ��h(e' �yk :..} ;?- TM � {J1a1� f D,+g iK mss• "`�- �': 5`�' `�'��. T dF �«l ,,�g��'2" l x�', x"'45 % 1`h y �. � ��,,.,,c..,. 7..fi��.�.., �.-.,-� .. •. �., ., >n.c� .-- .;,�'..� � ,�,.:. _...-.,-. �"`�� Y. ,..."_ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an app ' tion a p .t and work is not to start without a permit on site; that the work will be in accordance with the approved plan in e c e a w which requires review and appr1 of laps2 l SIGNATURE OF APPLICANT PRINT NAME �JOt SSV, `' DATE 2 y APPROVAL INSPECTORS SI City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 a ` r Thi✓ Vl,9 e J4e,-101 fe K1 Building $ BUILDING Permit No.400MV Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By: 763-572-3604 Surcharge CITY OF FRIDLEY DabWM. OCT 00 763-502-4977 FAX EFF KIM 7.1.2010 $5.00 (State Licensed Residential Contractors) DATF• f YOUR E-MAIL ADDRESS W- �r Ca-�O L� CC�G�. �.'"b 5 r. SM ADDRESS 13 3 S" � G" � /'I✓! f'-.� d /' , ..._� M. , /`� S� S- S� { THIS APPLICANT IS: 0 OWNER QCONTRACTOR $ PROPERTY OWNER/ NAME �Jt" - /fU �.. $ TENANT ADDRESS:/172,V7 r " CITY _ ,.,, _,�,.STATFiti►J'LiP .SS `rte / Agreement necessary ( ) Non Necessary ( ) PIJONE,,�%a $ ® CONTRACTOR NAME: STATE LICENSC kEXP DATE - - SUBW A COPY OF YOUR STATE LICENSE AND CERTM- CATE ON ADDRESS: STATE ZIP INSURANCE ILPHONF, FAX PROPERTY TYPE 473INGLE FAMILYINE W CONSIAUCTION SIZE 15 TWO FAMILY/NEW COMfIXICTION STORIES P1E;RIKIT TYPE ADD O 13 GARAGEMHED Q WINDOWS tWASEMENT FINISH 0 ROOF O DRAIN TILE E3 DRCK O SIDING O OTHER 0 SWIMMING POOL, TYPE OF WORK: O NEW HOME CONSTRUCTION Q ADDITION 17 MAINTENANCLYREPATR MODEI ING DESCRIBE WORK BEING DONE: 4" -.Wv / SIZE OF IMPROVEMENT LENGTH WIDTH / HEIGHT F1' Q HOUSE ONLY BASEMENT REMODELINO SWUM NUMBER OF SQUARES B HOUSE do GARAGE 1. Eatietirrg Fkar Plan QRAM Q AXTACIJED GARAGE 2. Proposed floor plan PROPOS M. SIZE; O DETACHED GARAGE S. List of structural mwnbM m be used PROPOSED HEIGHT: SIDEffl FORNEW CONSTRUCTION INCLUDING DECKS, Q f7Sotfit ADDITIONS. PORC1iFS SUBMIT: 1. Site p imA vcy shoving the misting stM cUm Q Aluminum 0 Trim end proposed t Q Ostia 0 2. Fascia nstru Two sds of wuwtruetian piens 3. Em-gyCalcWations IN EXISTING OPENINGS OYes CINo LOCATION OF WINDOWS FOR WINDOWS. -PROVIDE' UWALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING TSE C05T OF LABOR A1NI1 IWA I SIUA>.Z: ,2 ,,, IuMfi TAE 1997 U.D.0 FEE SCHEDULE) Permit Fee $ See Back Page for Fee Scheftle Plan Review $ 65% of Building Permit Fee Vire Surcharge $ A.001 times the total job valuation Surcharge S &Tn .0005 x Permit Valuation Minimum $5.00 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ TR + 6 ft = 8 x $24 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Dae $ ® Make cbeeks payable to: City of Fridley Attach Sti Mations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and acmate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an appli for a ee�mmit work is not to start without a permit on site; that the work will be in w=rdancx with the approved plan in the f we v�iiich uires review and approval of p SIGNATURE. OF APPLICC��C �� PRINT NAN�.._.111C Cf 1.1�...... .DATE IG�Z 01/) Wd K:9041 01,0Z/9Z/0L :918G t/1 :a6ed 6£0EZL9Z69 :wad cg v C6 It. From: 6126723039 Page: 1/1 Date: 10/25/2010 3:37:08 PM ' VPSt/y jo - 6" Fsi� IVAV 30 1 L /4T7 -/u/ 0,.41e je-0-1 Building MECHANICAL Permit l inspections RESIDENTIAL APPLICATION d 13 Received $y. 763-572-3604 CITY OF FRIDLEY 763 -sot -4977 FAX EFFECTIVE 7-1-20 10 BATE �19 ?- It la YOUR E-MAIL ADDRESS SITEALIDRM 123.3 S lie r'lle- THIS APPLICANT IS: WNER 13CONTRACTOR PROPERTY NAME: LC 5 >✓ ADDRESS: /-03 S 3 ` sa'ly� CITY &&ATF rim 1 OWNER/ TENANT PHONE: /& 3 S "? / �� 9 '?+ 9 — CONTRACTOR COMPANYNAMR SUBMIT A COPY OF CONTACT PERSON: YOUR STATE STATE LICENSE. * _ EXP DATE LICENSE WITH ADDRESS: CITY APPLICATION PHONE - FAX PERMIT TYPE kSINGLE FAMILY O TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK:__. 0 NEW 13 REPLACEMENT *'ALTERATION/RF.MODEL 1. DETAILM DESCRTPTTON OF WORK lZI s' 1'`v� 4ee—% x•M- FEES ARE BASED ON $10.00 PER FDMURE, EXCEPT WHERE NOTM FIXTURIS: (INDICATE TOTAL NUMBER OF EACH RFLOW) P'ROVIDF BEAT LOSS CALC 5 PER MAMIAL J 2006 A',fflRAE HANDBO01L EquipnWt Indalled MFG: MODEL: S1ZEJETU . MFG: MODR.: SIZEIWrU MFG: MODEL: SIZEMTU $25.00 kEPLACE (GAS) $15.00 OAS RANGFJOVEN $10,00 _ TO AIR EXCHANGRER $15,, FIREPLACE (WOOD) $35.00 ��^ GAS GRILL $10.00 _ LER $35.00 FURNACE $35.00 r' UNIT IiTR $10.00 C MNEY LINER 510.00 _GAS DRYER 510.00 r HEATER $35,00 UCT WORK $10.00 GAS PTPTNG $10,00 Vks 'tLATUR $15.00 umber of fixtures @ $10.00 1 x$10.00=$- 110.00 Number of fixtures Q $15.00 _ x $15.00 = $ Number of fixtures @ $25.00 _ x $25,00 = $ Number of fixtures ® $35.00 _ x $35.00 = $ state Surcharge $ 5.00 INiMUM FEE $4Q.00Total = $ THIS 13 AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and 1 acknowledge that the information above is complete and accurate; that the work will be in es and of the City of Fridley and with the Minnesota Construction Codes; that I understand this is conformanee with the ordiJEl', not a permit but only an on f it wW work is not to start without a permit; that the work will be in accordance with the approved plan in the f or ho ulras review and approval of plans. PRINTNAME&Trlt, (�dr I'S DATE 101'2 SIGNATURE OF APPLIC APPROVALINSPECTORSSIG TURE DATE PLEASE NOTE: WARAT9 PE ' T$ ARE RE UIRED FOR BUILDING ELI: Rh AL AND MECHANICAL WORK City ofFridley ilding In spections Department tment643 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Wd VO:K: L L 0 LOZ/6Z/O L :6180 L/L :a6ed 6£0£ZL9ZW .ulad