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PRE 2010 DOCS:7 0 City of Fridley, Minn. BUR DING PERMYr N° 3953 Date: .. �9~... ....`. 7...... Owner ..... Builder .....:. ...... Address ...................................... Address ............................................. LOC ATI OF BUILDING No. .. / p..... Street ..: .. .. ..... ...... ......... Part of Lo ... .. ...... ....... ...... Lot .. /. O ...... Block ....../ ....... Additi Sub -Division .. , .. .. . ....... ... ... Corner Lot ............ Inside Lot ..?(........ Setback ............ Sideyard ........................... DESCRIPTION OF BUILDING To Used ��g j �J Q� %�/ s� Fro�� Depth .T/ Height ./.. �: sq. Ft. .!..'�t l �of ........... .. Cu.cu. >+ t....... . .................... Front •.•.:..... DeZj, H ght ........ Sq. Ft. ........ Cu. Ft. ........ Type of Construction ....... ....... 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. AW 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 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. M�� IjG.73 93Zc��' [ 3Z-0 1 39.19 cC `off i r Nr M r ll), -)3 s x . s \ 1. l-�AR ARV Ati.. •�IRT1VRIti `iT Kik.. *.,,_.,-_ CON.SININ,•i14E RE'aRDS mF 4N�KA COt)NT�' SVRVE:' .`.R ..—�.a•::y.. a..+a»+- - . .. .s..��o: , t- .c,.,, - ) atl _ /� 6°/ j �^'�[y !. E- HILL. ESYABLISITYO 196 ,. 34TH AVE. N. t..&:%3T-fi1Va ftp LAND SURVEYORS: RS: - - - , n STER,.ING•28Q1 - • _ - 1 - `' - '- - ' C. F. SANOV-OFF. ESTABLISHE 19Clt + •, - REGISTERED UNDER LAWS OF-s�A-rF-OF MIINNESOTA - JAMES Nh-LSON, ESTq 8LT5H-r 1922 - L1CcN5Eb BY Ori C11NANGE Off" CITY OF A7INNEAVOLtS g- - i ),` • :1•iAROLD R OLSON _ ,. .. _ .: _ - _ INDUSTRIAL_ ,. a !' ,i COY. --17c; ROUTE.1,✓- - , tiC;SINESS T ' 340 PLYMOUTH BUILDING Llsc rt.•4 p72i + wEsrIVOOLt SIjy7's>-p�{ - _ _ • _ t_oT SURVEYS VEYs F r } MOUND. MINNESOTA . a � - - � � - LAKES HORS ' I .€ a5ilthQ)a 5 L,C''t1 iCiitQ t '>, 16'oumo-mQ4;. \\ ` - - .PLATTING ' Jf .. got 1 t r �� - = I. T.Y U 3 4.0 .t.1.. ---. _ r .t i j - t ..�. • r t . ,C; .ke!'als... -%I .__ y,1. _ . . i / r . r '� t' (yl r c/, 4ee rrJ� tU �� :3 1. C> 't T[ f t ♦ 1 kr'� y s T �. 3 ,� ,� .. ► ' ,'c, , .2 ' f t �� _ `r L f t i Or -, Z .f p ,i j Yt i � Ah � I` 1 "i -1 { t `V? �' V V 1 f A t, T `% 1 4 3 2 t L ..zm� . �I / }( ..3 � -.1 r.1 I .t i.I ti t jr t L , 11. � .1 i { Yth :y T i YT. til h�.. `� - , I- /`. : mil 4 ,i t I ..� L �`�• aA.- ( �.� i Y !*."..,.t -l --A .::,-.,. {- - f 1 y L. 1 :� ,a 1 -,Z`,';,,'i tI it 14:1 r I s �- a�+, s s I , 7 1 ;. .. , .�.,,:'4. -* - ---', -�-Z�, . , . ,:L !. '. . .l.. I . .1 . ; , 6 Lt�- ? - y} t - t - T j.- 1 f S f rr 1 Y 7 w*�,, , ... 4 L n R r �v._',Z"' .1 1 r F ;• �l -k I `3 rix 'T. ht t >•` - , .? .I,�. rtf ...) i 7a + z f v , - •t a� c { T .� �. + is y � 1. cff• j y - - . r'...: -.;:f ,:---..'-;4 'zI �, fl I I °'1 p >.. 11 F �. ' I X .t . �, Y } e•.; :x t' - - r r t7. _ y i , at. ya _ ` 2 X 's r' t T.., tt i R. 7 f S s• ti t .. ;_ ; a t k i t 1 t I Y tr i l l'JE FiERSBY C$RTIFY YHA '. TNS ABOVE t!a A rRaJ£ a1ND CORF2EG"T PLAT OF A SURVEY O� -� Pn , "'T '_ �- t., .,i i 1f YK f i • lit; ty r _r s G (a - {� �. tt ty r li ¢ ' Y L rf ! c x i Ia a :1 is i "S 4 Y't 7 ➢ - - - t V Z •'t i NI r1�7 s y"ts 4 f '? '.. ! i d rr t d i l -{ t j t i... ry l {•f i k' e. t w ..,- IX. t, tf h., w �tl} 2 is ,:9 i i '�1 '' V, c ; t r 4 {"i.r d _ _ 4, f / I / f t }1 I 5 i ,4 , `- ,. .t ;I Lots -15, lb, r. %arra �8 i t i > rt' L t {.� {{ 4. t n .` P� V,.t '� i 1 Y.I .ZT31�,- -5 t, T t I Ii9 -i- i 2 tr L - -- rt ¢ t r N f rt T l i i Y - t --4 t er3d7 �r .� alk i _ T -% �, T y - VA6'6k.i- CCUi�k"��7� l�.Clfi'�SGto� t �. ' + - :.9 t-' Y -41, =Ilvi _t `� 'tom 1 ! - .. i f ,z M1 R *, r ; . : - ...t y .... ,� � ," .,.',;' ;,-� �:,: * * , , - � {+ rrppk ,•� '. .- :I -ItIr li A� 4 r 1 J •+ I `� � .".;- IT�JA . --: .1. 7 ` � - , . .. I . Y Us THIS .0 — I DAY pF J -u � .s . _ .. _ « / A D. �_ ... `d .•: I - , J-, ' A Y f - S a I. / .J ' I •" , { ' .. £ �k TF'i WR{GT7 -D �OLSON : . .,�. - ...-.. ... - ... i. ._. . _-"...... 4 r --. . ♦J_.i _ _I!" tom_ _ � - CH -j of Prialay APPiica.`i'azs for P1umblsz y. �Pen jit J 1 . Dept. of Bldgs. Phone SW.3450 DESCRIPTION OF WO11P. Numbrr. Kind omd Loctliva of Fixtures � Lotaii�' + • NO. RATE TOTAL Number Fixtures .............. x $2.00 S Future Fixture Opening ........... x $1.50 New Fixture Old Opening.....:.... N 8� <z a o M x $3.25 $ $2 WATEQ "TR. _x5&" New Ground Run Old Bldg......... x $3.25 S Electric Water Haatar..... ......... a $2.00 S SAS FITTING FEES: NO. RATE TOTAL Ist 3 Fixtures ............ • • • • • • o ee � $2— x $ .75 $ Gas Range to 199.000 BTU ........... x $5.00 $ Base 1st _ 2rd _ /3rLd 7 N7 tT- FuW* Coaaeciica Oponings e Xew Fls.•ture. Old Openings PARTIAL RATE SCHEDULE Saws � Ccxrpool PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures .............. x $2.00 S Future Fixture Opening ........... x $1.50 New Fixture Old Opening.....:.... x $1.50 Catch Basin ................... - Aj � - .00 a a �J x $3.25 $ $2 water Beater 'Up to 99,000 BTU).... _x5&" New Ground Run Old Bldg......... x $3.25 S Electric Water Haatar..... ......... a $2.00 S SAS FITTING FEES: NO. RATE TOTAL Ist 3 Fixtures ............ • • • • • • x $2.00 ee � $2— Additional Fixtures .............. x $ .75 $ Gas Range to 199.000 BTU ........... x $5.00 $ City of Fridley: The undersigned hereby makes application for a permit for the work here! specified, a„reetng to do a1 work in strict accordance with the Citi C dinarsee and ruling of the Department of Buildings, and hereby declares that all the fact and representations stateed in this application are true sed correct Fridley, Wan `i � `7 19�� Owner I Kind of BuildingUsed ash To be completed about Estimated Cost, $ Old—New. Building Permit No. P•Tmit No. CG Ao_ z ROUGH FINAL P.EPAIRS h ALTERATIONS—Refer to Code .50 State Surcharge Description ......................... ................s TOTAL FEE k Jr-� Signed By _.. Business Phvne No r 4 % v SUBJECT of Fridley j<ERCity 963 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION � '9y 9y j SEC. 1 CITY HALL FRIDLEY 55432 L•_-' ' '•J NUMBER .DATE 7—v� PAGE OF APPROVED BY 612-560-3450 910-F15 5-27 -75 / / JOB ADDRESS 1 LEGAL LOT NO. BOCK TRACT OR A (TION SEE ATTACHED DESCR. 18 15 Fridley Park Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE JAMES LANGENFELD 79 - Minnesota 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Hank Duevel 9307 - 5th St.N E Baine Minnesota 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residence --i—CLASS OF WORK ❑ NEW Ek ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install Redwood Deck & Patio Doors 9 CHANGE OF USE FROM TO STIPULATIONS PERMITS .REQUIRED FOR AIRING, gpER ATE PLUMBING AND SIGN . 01 HEATING, leoo!w11 sa!'�!1!�n TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood 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 I 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 $1,500. 00 $.75 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. $9.00 LAN CHECK FEE TOTALFEE - � 9.75 SIGNATOR OF CONTRACTOR OR AUTHORIZED AGENT ID EI WHEN PROPERLY V.4LIDATED THI IS YOUR PERMIT J1. Aa \.3— BLDG INSP • DATE SIGNATURE OF OWNER IIF OWNER BUILDER( (DATE) r 4 % v APPLICATION FOR RESIDENTIAL., ALTERATION, OR ADDITION.BUILDLNG PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME: ��t-l(7S�eA BUILDER: !f'iV -P ADDRESS: 79 C- 3 ADDRESS: . 93 o 7 131Q1N--, 1, NO:. STREET: 3X: LOT: BLOCK: / S ADDITION: ,� D✓U CORNER LOT: INSIDE LOT:SETBACK: SIDEYARD: Applicant attact to this form.Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To Be Used As: DESCRIPTION OF BUILDING Front: Depth: Height: Square Feet: Cubic.Feet: Front: Depth: Height: Square Feet; Cubic Feet: _ GC) Type of Construction: li-e Estimated Cost: $ /� To Be Completed: �S 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: ,57 - z- SIGNATURE: (See Reverse Side For Additional Information.) Id. 1 O clvc 3 Eri.dley �ar.It - - " Anc', ccty6. Sst';-A- _ 1 _ AS SURVEY£O sY US THIS __�_ LZ � DAY OLSON .. _ ..i w0isn7 (� n . _e ........ u'Pmol 'elosai. :mina v SUBJECT PERMIT NO. City of Fridley ® 1 2964 AT THE TOP OF THE TWINS PERMIT r BUILDING RECEIPT NO. `___•__ COMMUNITY DEVELOPMENT DIV. L r � PROTECTIVE INSPECTION SEC. 0��1 1 � _ CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY �•""�'� ,'J 612-560-3450 910-F15 JOB ADDRESS 79- 6311 Way N.E. Fridley , Minnesota 55432 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 18 15 Fridley Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE J. H. LANGENFELD 79 - 63112 Way N.E. Fridley, Minnesota. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Camper dty North, 9890 Highway 65 N.E., Fridley, Minnesota 7—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 ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install Above Ground Pool, 16 x 32 x 4 Steel & Plastick 9 CHANGEOFUSEFROM TO STIPULATIONS r d' ��fl 10081 Ui 03 JIL[CIRIC -GAS EM Vam av 11-11-0 PERMITS REQUIRED FOR WIRING, SEPERATE HEATING, PLUMBING AND-.51GNS. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Frame 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 R-1 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 VALUATIONSURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. �� WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT JT a 1$`1.14 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 TOTALFEE 16.14 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY PLIDATED THIS IS YOUR PERMIT 5-27-75 BLDG INSP DATE SIGNATU EOFOWNER IIF WNER BPILDERT (DATE) v APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA 8�1-a)8l/ /(6) c'6-) OWNER'S NAM: . H, �� le BUILDER: V � �T tf I l/n ADDRESS : �� ,6 3 i� /� Y ADDRESS: A 4 iJAY NO:. `% ,11) STREET: /Q LOT: BLOCK: ADDITION: . I �� li r �Q l' k CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Ttao Certificates of Survey of Lot and proposal building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: y' & (�v c,t M19�ront: /46 Depth: 32—* Height Square Feet: Front: Depth: Square Feet; Cubic Feet: Cubic Feet: Height: Type of Construction: .q-�e- e / 4'P/4Sr,C Estimated Cost: $ a To Be Completed: 4Z' G) e- V A , i The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict 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: 3 - 7 SIGNATURE: (See Reverse Side For Additional Information.) )� .Do ..CAMPER CITY. -NORTH -41 - 9890 Hwy. 65 N. E. Phone 786-9430 - AAINNFAPOI IS_ MINN_ 55434 P ONE. roO-...DATE Jov SOLD TO ADDRESS. �� STATE C/1t�� ZIP- Subject to the terms and conditions stated on both sides of this 499ement Seller agrees to sell anall the Purchaser agrees to purchase the following described property. '. MAKE I _ _. YEAR MODEL SIZE SAL A _. _ . . VEHICLE IDENTIFICATION NO. ❑ COLOR PROPOSED STOCK NUMBER NEW DELIVERY DATE USED r_ - CUSTOMER MAY CHOOSE COMPANY FROM WHICH INSURANCE IS OBTAINED: -z: _ 6 ; -.:: PRICE OF UNIT 5 ! (fd INSURANCE COVERAGE , NO. COVERAGES EXCEPT AS SHOWN BELOW OF MONTHS $ OPTIONAL EQUIPMENT - ❑ FIRE AND THEFT -COMPREHENSIVE COST OF SET-UP PARTS ❑ COLLISION— $ DEDUCTIBLE 'SUB -TOTAL ' ❑ LIFE-= zi ;-.-.. _.•. _- ❑ ACCIDENT — HEALTH _..�. P -;-a - b-, mop �.� -..._. i• .-. .: ,.. AAAA AAAA �. ❑-'ie : +` t. CASH PRICE" $ .. v,,��.y ht:..✓:.r<irr P a.:. ^• ._n,+°:_ f $E i. ,.•;.c"'{; 4. - C �+: "_,. fc� _ TRADE-IN $.. ALI WANCE LESS BAL. DUE _ N-TRADE-IK��< $ - O7. ❑ 0}her instNOnce (Describe) TOTAL PREMIUM fnr insurance coverages.ar+ the_ a a, -•d6 $ 'k' xy z..--•,. ft commodity if obtained from at throng seller ---------- Please purchosahe coverages checked above. „ "'• NET ALLOWANCE • a --.....: '•.ia .2!*11`s'tb ,y *" F.t: 1 t aL; StGN EDX .a;�.b,r ,' :. �`vr yr f irk 4� .re. - DASH S DIFFERENCE" ' Purchaser hasapaschosed required lnsuronce•-through-..•i,.=- J Ci<a'�-:`.+rt-:• ;. Q'- DASH DOWN.;.- - PAYMENT Z: LESS TOTAL CREDITS - 3. UNPAID BALANCE OF CASH SALE PRICE S - (AGENT'S ADDRESS) 4. OTHER CHARGES - Official Fees (Specify) $ Sax Exempic ]' '' 1NAME OF,a1NSURANCE COMPANY? a. q Sales Tax $ z. kwr OPTIONAL EQUIPMENT, LABOR AND ACCESSORIES b. Insurance on Commodity $ 3- , t�'yf 't A 2z Ir c. Credit Life Insurance $ E y ' # -L_r d. Credit Accident& Health$L11, e. Taxes (Not incl. above)- G �. (.License Fees$ + g f Regist. Fees (Totolj ..-,:17 `s- ._ .. Certif. of$ $ Title Fees"aC� TOTAL OTHER CHARGES (a+b+c+d+e+f) _ 5.`AANPAID BAL — AMOUNT FINANCED (2 + 4) $ ` 5�. Y.,r _ <c:. .. _ 6- flNANCE`CRARGE=----`-='---=-= - $ t _: F:,. _ r r . r •, . _ 1r ANNUACFERCENTAGE RATE REMARKS: = : _.: , • -. 8._ TOTAL -OF -PAYMENTS, (5 + 6) --;-- ---- .'' c; `j�.:.. •: ' • ?.. L:-; Tr -g.-TOTAL DEFERRED PAYMENT PRICE (1 + 4 + 8) - - -. Payable in monthly installments of.Sr ` ', each and one Cana) installment of S oll,pay oble-the like date _ of -each suecessive month -commencing BALANCE CARRIED TO OPTIONAL EQUIPMENT:_ '; $ THRu SANK DESCRIPTION OF TRADE-IN YEAR - _ ADDRESS' MAKE- MODEL. •' . - _ BEDROOMS-> _ _ - - y'•IT'IS MUTUALLYUNDERS7000 THAT THIS AGREEMENT ISSUBJECTTO e NECESSARY CORRECTIONS, AND ADJUSTMENTS INCLUDING CHANGES -�•-.. ': IN NF:j PAYOFF TO BE MADE AT. THE TIME OF SETTLEMENT. IZYl&6f} NO. '" .- --- - .• . - TITLE NO. VEHICLE (DENT. -COLOR TRADE-IN DEBT TO E PAID BY AMOUNT OWING: TO WHOM ❑ DEALER CUSTOMER P., heser(s) certify that- (p1 I fwe) hove read the moire, primed —,he back heroof mrd agree wit as o Portal this agreement, the soma as rf it rove pr ted above my (our) signervres;: (bl f (w�) - -- am (ere)2l yews of,age oe olden; w have beew oHyemaerclpoted- (a) k (We) hove-veluntmilp purchased the above described -recreation vehietay the eptionol equipment and' aceessorf es thareow, bee hem all encumb,ances rhos so er, eseept as noted the inswance as described and have agreed to SIT the terms of the fin—Orig ew6ngemenM; 4That the property is if thereof is invalid I' (wet am (ore) trad7 ng in is the remaining portion shall, nerarehelsss, remain in full fence ewd effect. -above. Purchaser agrees each paragraph mod provision of thu contract severable; one portion ale +5";y i 3' e d.it ^ `.r OR' WE,=HEREBY ACKNOWLEDGE RECEIPT OF'A CIPY OF THIS7ORDER: .. •ti .: . •: ;. � � R-VE:CCORP. DEALER ,I - ' � Not Valid Unless' Signed and Accepted by:an Officer of the Company SIGNED CHASE �2 - BySIGNED RCHASER Approved, Subject to acceptance -of finarreing by bank or finance• company, s 1 CUSTOMER COPY A x11.7 Oy1Gr.Y1IW11l ID IV$ Iriv plulC611u11 VY &JU11L'LIUY=f OnQ 3eller.1 IVO cndnUeS PerFT)IlleQ: —.. .. - - ... q c:x: r^a ,•,,,.^a; � 4 w �cae a a:s, : �v..s.. _n, � N. .:�.: . , - ADDITIONAL .TERMS AND CONDITIONS:.a'° t ,�•r _ u L x!`:_,;14 � .b> ,.J a�#-..� �'�. ---lt is further understood and --g I w- ----- —� ^�a--�- g o^<the following terms and Conditions all. of ,whicb''have �, ., ___ _-The purchases reement on reverse side fiereol'is sub ect t been mutually agreed upon x _ traded in as partia'T-payment, along-wi h the del very-of-the`said property to dealer's --premia s, and does trailer, halt -s 5le3 4 The urciaser gees to deliver. the ora ins[ gall :ofaale or;the title to,a dealer's premises, and does warrant that sucFr car,. boat, trailer or vehicle toy be his property, free -and clear of all liens and encumbrances except as otherwise noted on, . -- >the; face of -thi -instrument:' Isordiaser warrants -that -alt --taxes of every --kind levied against the -used unit traded: in --have--; 4 been fully paid.. Should any government agency- levy or claim a tax lien or demand on or against such property; Seller .'% at-hiszoption- pay the same,-=and=-Purchaser=agrees_.to-:pair_.the-.amount thereof -immediately, uport_demand,.or, Seller•_- :May at -itis -option,-. add such: amount to the conditional .sales: contract _covering the unit ordered herein with the same -effect -':as though originatlyincluded therein-----;-----_-- .. �a; _ } J-_, � --- 2. off-lhe +�sed�ttnit traded -in -is -regi oFr licensed -in --any place other than Mirinesata, Purchaser-agreesioammede ate4 securer istration for such vehicle and -to- a ;an and-alL_ex enses�nd,re istration.fees inddenta{-hereto:_=Should " Seller assume, or be;put to, expense in connect}orti with.such. registration,:.Purchaser_will pay Seller_the amciunt fihereof, , 4° tri --demand-or-Selfermay add; at- his- optiorr; the-same,io-the; cond}tional_sales. contract covering. the property_ordered hewn ,a° 1 gh._o 'g �rnclud.ed the�etn :�:_ _ lam: • If the used"equipment is not delivered to the dealeG at theturie_of ociginaLappra►sal,_and if later, _on_its_dehv_crry, if ap- i t I ; p�earts?to t , dei ear dere Have'" een maferia%�ia; ges adeiethe fct nishings or_ es thereof, or in its -general physrcal�e nd►horr, be. ieafepshaH #hen Erave3 rigft tnmakeia reappraisal This Tater appraisal value will then determine the allaw�3� tq&,,anc,,- ore rhade� QG SlJCh _USeCi.pippertj[ i��4i Upoat#arure or the refusal.o the-}purchaserto_'complete said'r,purchase within thirty days of contract'date#e;t°or"r inn atr ru agreed extenswn. tfiereof;`fa� any reg`ssoit �otkae�ihap,•cancellatiomorraccount of increase in price) the 6a Kdeposat marhave i suchportaororetained-as-v�ill�reirbirse�#ie_selte for expenses and other losses occasioned by purchases failure to w y complete said :purchase. In the event; a.used car; boats traiier.or other unit has been taken in trade, the- purchaser�fi' ieby:', authorizes tfie'dealer to sell said property; atNpublic,or private sale, and to deduct from the proceeds thereof,asuriequal,to -~the-ezpenses=-an&Iosses incurred; or suffered,, 6�'f6;es seller_by .reason of purchaser's failure to complete_the-aranSai Be le . ,hal�iAV. g the .rights.. of -,,a. --se upo beach of contract, under the Uniform" Commercial Code 2-70$ or the x k Uniform Sales. Act (as -applicable) provided the tot amount of liquidated damages shall not exceed twenty -1=3/ -pement u"' -=of-ihe-cash--sal- rice: i.,era h..�.' ` 3+i - _,.. ,, *Jhe.-manufacturer-has. the right to -make any -,chi i' ges "in the model', or the designs or. any accessories`ancFparts of any _ subsequent production, at any time, without creating.ari obligation on the part of either the dealer --or the -manufacturer tom= _z make corresponding changes in the herein unit described and. covered .by this order either before,.. or subsequento, tie livery of, such equipment to the purchaser. A�t &,Seller shall not be liable for delays caused by the manufacturer, -accidents, strikes, fires or -any other cause beyond" his control. 7. DISCLAIMER OF IMPLIED WARRANTY. It is mutually agreed the buyer takes the :new, recreationai'-,r�ehiele�pr�* other described unit, "as is" and that there are no warranties, either expressed or implied, made by the -dealer The seller specifically makes no warranty as to its merchantability or of its fitness for any purpose. _ L On new units the manufacturer's own warranty, _will. apply,. -together with such other separate. and andividi�a warranties of the various makers of the accessories and equipment furnished. Each will be for' -its own pe- riod of time and will cover such usage as is --specifically outlined in each separate warranty and, to-wrt cl�tl _-`�-buyer-is-directed. - ' -- The -purchaser further represents he has =examined• the product and found it suitable for his particular:rieeds, that it is. of acceptable quality;_ and that'he di&rely-on his 'own judgment -and -inspection and -not-ow',-a warranty,..expressor implied,.on the part of_tbe seller, except. such as_may,be expressly written herein, or " P Y _ _._ .� ,�. in a separate,writinq-at the- date of purchase. it is further agreed that there have been no description =samples or. mode{s.used or regarded as a part of -this contract: ---- -�A-Used unit is sold}:"as is" without-guarantyt 8c -warranty'. eithe[ expressed or_implied,_as to its condition, or > ' � the. condition of any part thereof, including sits quality; suitability for purpose, the year of manufacture, it size of the particular model it may be, unless such-exceptions--are-specifically-mentioned; in- writing,--or+-�l' - z ' 'face of the order, or in a separate instrurnent;,furnished to the buyer by the seller. y , �P In the event the transaction referred to in this order -is not a casFi transaction -;,the purchaser herein"before, of"af'the _..time. -of delivery -of -the -unit ordered; -and -in -accordance with.the terms and conditions of a Ment indicated on the face of..-. this order, will execute a conditions{ sales contract, or such "other form of time sales agreement as may be r'e- -,ed-byZ',- )2y , 9. It is. understood that Purchaser, is- not covered'' -by insurance. until accepted by Insurance _Com`pa'ny; and --Purchaser •,,, agrees to hold Seller harmless from any and all claims due-to-lossordamage pnor-to acceptance -of insurance-coverag"IVI- 6 _Insurance Company— This- agreement contain' entire understanding -,between. buyer a. a 7& -seller. and no'otfter y� i 4 representation -or inducement,-verbaf or written, rias been made which is not set #ort feerein. �+ • .__� '__. " r _ .. ,,... .Y -� :9 r W� 6y't� s Fit` .5 nr� "s. ! >; 13-2098 (BACK) NORICK- OKLAHOMA CITY' -'- :ncy�sf-asow,...--.3.rt9q g -I ,t� ;r ? '�' :1,:g u a a� cNc'•'-...' a -^ ;:�.'' 7 77 - �... ti HARVBY A. �kRTWR142-i •�. a �.,, .y am_ COMBINE ,THB RE�i�RDS 4N0 KA COUNT+ SURVE' .:R LAND S Yl URVEYOEy�S"•'!° E. HILL. ESTABLISHED Igse L, a7 V STERLING, 2.301 : _ C. F. SAN OHOFF• ESTABLISHES T988r_ V' . REGISTERED -UNDER LAWS OTT STATE OF MINNESOTA TAMES Nt:LSON, ESTABLISH E -R22 �9 LICENSED BY ORDINANCE OF CITY OF `n INNE:APOL IS. HAROLD R. OL'SON , - INDUSTRIAL w ' •� BOX 174, ROU -E t 340 PLYMOUTH BUILDING Ltxc• > u 8721 • _ Bt�SINE'S + WESTWOOD Sno-yS+�,°� � LOT SURVEYS MOUND, MINNESOTA., LAKESHORE5 ZrrtficateMOUND .3481.1 urbevor s m PLATTING - ,zr• ? I _ - ,.E A'r,. i p � 1 e r 7 C t\ x WE HEREBY CERTIFY THAT THE A13OVE IS A TRUE AND' CORRECT Pt Ai OF A SURVEY OF - - Lots ?5) 167 17 and 18 81 a. cit 75 F r i.�11 ey pa e^ i< AS SURVEYED BY US. THIS _____. LZ c _DAY O -F A.'1. . - ".•.__ �.1'�•"' � .,g�. .mfr ? . . Cj CiaR ; h r?iGlir� ' OLSON r .q dc C 111 its {N 0 -Ls itO �/� y n ---.___.._... ._. . _..r`'� _ .. a.� - . ��•�c....�...a� cemullll +IlB81U�1d11 _: � +¢M0� r OS8 Y(/ 7�': • w PLWMING.FIXTURE RATES; NO. "I w TOTAL qU K $3,00 • future e -I ttura Opening •• u ;2.00 Hater ■ ■ .e $ Catch B1# 1n • A .. 0. C c ..+ a I water Heaur - W 99,000 BTU,• `• X $5..00 rl QQ, w 01 $10,00 Iloator J . C $7.90 'N ' ltcv Grour•d• fain Old Building x ;5,00 i Elocc.ric Niter Neater - x 55,00 5 0 r a 071 i u' c� n '03e A ti w ri ai t"'c nS L e o ist . rye 2. ;1 d (R) - future Contraction Opening Connectad with Suuor (•) - How Fixwre, Old Opening Wa.tar PARTIAL, RATE SCHEDULE PLWMING.FIXTURE RATES; NO. RATE TOTAL 1%Nj=ear FLxtuxes •� _ K $3,00 i future e -I ttura Opening •• ;2.00 $ New Fixture, 01d•Opaning x ;2.00 $ Catch B1# 1n • x $5,00 $ I water Heaur - W 99,000 BTU,• `• X $5..00 i �- 100;C00 11TU to 199,000 BTU x $10,00 $ Water Sof caner �- x $7.90 �� ' ltcv Grour•d• fain Old Building x ;5,00 i Elocc.ric Niter Neater - x 55,00 5 .CAS FITTING FEES; 12t ] fixture# )Jd1ticlal Fixtures X-11 Rsn9e to 1990000 BTU REPAI RS d ALTERATIONS rlrst 5100.00 each eel. 1100.00 or fraction X $3,00 X ;1100 x 510.00 :5.00 12,00 S.tAte Surcharge TOTAL FEE Job Address So 8b.-879001 79 IM_631 Avg Department of Uui dinga City of Fridley I Tal. 1571-3450 Tho �indarsigned hereby makers application for d permit for the U apeoif%ed agrueing•to do all Work in Strict accordance with the C and rulings of 0a Department of Building#, and hereby declare# t the faatu and raprgeuntation# stated in this application Ara trot Frtdloy, M•'1, 1-16-78 OWNER LANGENFELD KING OF bUILDINO frame USED AS res • ' TO BE COMPLETED ABOUT .1-23r7$ ESTIMATED COST 20400 OLD - NEW UUILDIIIG PERMIT 140, f EfY1IT 110. L Company MINNEWRWEGASCO Signed By' Tel, No, p001( INSP. ' Dnto , • FI144L INSP. : Dato ' ' APPROVAL FOR PERMIT ,/ J : MINIMUM NEI: FOR A11Y PLUM1lING PERMIT 15 11.50 J 8-o0 : 01 SUBJECT City of Fridley eR 618 AT THE TOP OF THE TWINS BUILDING PERMIT rp RE IPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. �r1 � I i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L J` 612-571-3450 910-F15 7/19/84 JOB ADDRESS 79 - 6321 Way N. E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 18 15 Fridley Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jim Langenfeld 79 - 6331 Way N.E. Fridley 55432 571-3191 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. B & L Home Improvement Inc. 1161 - 79th Ave. 780-4533 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 K ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof, reside, soffit, fasia and three windows 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be second but not third. Install galvanized valleys. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Asphalt/steel 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 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 $6,000.00 $3.00 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 0,R THE PERFORMANCE CONSTRUCTION. $56.50 PLAN CHECK FEE TOTALFEE �- tin$59.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI W N PRO R V I AT THIS IS YOUR PERMIT ��'*��G INSP f)ATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) 01 NEW [ ] City of Fridley Effective 4/1/84 ADDN. I ] �R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: 7% & 3 wlipl- Legal Description: Owner Name 6 Address: Ji Vr-% / }r, b1 � / 7 5 (0 3 1/2 Tel. # Contractor: �� 'v�� L - Tel . # Address: We) 7�7�"` �� r^�� L ky� - 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: d2 2�cs ' t`G��s S®� � d --c- F•�Sir �'��®c.� 5 .� Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Type of Construction: (� �� '� Estimated Cost: $ Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation DATE: APPLICANT: ^ '�— Tel. CITY USE ONLY Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ 5'i5" �' Fee Schedule on Reverse Side $ 2% of Building Permit Fee $ $.50/$1,000 Valuation $ $425 per SAC Unit ' $ Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] Y. RESIDENTIAL CITY OF FRIDLEY 1 Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE ` RATE Furnace Shell and Duct Work, Burner (Also replacement furnace) Gas Piping (piping needed with new furnace) Gas Range Gas Dryer * Air Conditioning (all sizes) All Others/Repairs and Alterations 1% of Value of Appliance or Work COMMERCIAL/INDUSTRIAL 1% of Value of Appliance or Work $ 20.00 $ 10.00 $ 10.00 $ 10.00 $ 10.00 State Surcharge TOTAL FEE Reinspection Fee ($15.00) Rough Insp. Date Final Insp. Date Approval for Permit MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00, PLUS $.50 STATE SURCHARGE *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. TOTAL Job Address/- (� .� tt � t $ ' (), oo Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 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. $ /0' &0 Fridley, Minn. --5—' / , 1929 $ .50 OWNER KIND 0 USED AS TO BE COMPLETED ABOUT J Ems---� ESTIMATED COST a __ OLD - NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water,arm Air- No. / Trade Name Size No. Capacity �.� u Sq. Ft. EDR BTU 0 d'-L� HP Total Connected Load Kind of Fuel BURNER BURNER - Trade Name �Size No. `G ® e e� "' Capacity Sq. Ft. EDR BTU HP Company Signed By PP Tel. No. Fill out back side for stack verification on replacement furnaces CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; 1. Has been carefully examined Yes (e.Y 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 connected Yes No ( ) 6. Has Total heating BTU's of g C), G All other BTU's ®o d ev i TOTAL Rema rk s _ r-- Com pa ny -.r Signed By Da to ® �'_ � CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: (763) 571-1287 PERMI O.: 2004-01274 DATE ISSUED: 08/06/2004 ADDRESS 79 63 1/2 WAY NE PIN 153024410086 LEGAL DESC UNAVAILABLE LOT BLOCK PERMIT TYPE BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING VALUATION : $ 1,789.00 NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE. REROOF HOUSE (15 SQ) TEAR -OFF. APPLICANT LANGENFELD JAMES H 79 63 1/2 WAY NE MPLS, MN 55432 OWNER LANGENFELD JAMES H 79 63 1/2 WAY NE MPLS, 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 worl will be complied with whether specified herein or not. The granting of a permit doe4sns t presume to give authority to violate or c�l the prof an o er state or local law reeulatine ons ction ce of construction. Bldg Insp. BUILDING PERMIT FEE 63.15 FIRE SURCHARGE 1.79 STATE SURCHARGE, VALUE 0.89 TOTAL 65.83 PAID WITH CHECK # 3070 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. NEW [ J CITY OF FRIDLEY �:tt 14aS Effective 4/1/2004 s ADDN [ J 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg p ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: 7q & 3 % Z-] r- 2' - Legal Legal Description: Owner Name & Address: Tel. # 7� 'S5 �' / Contractor. C k� A' f /' MN LICENSE # Address: 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: R L' %i 4�0'r Y e' U5 ./S / e f- 0 e -P Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $Z./Z DATE: ®`� APPLICANT: Tel. # P/ �� °� Fax to 763-571-1287 if using credit card and we will call Call (763) 572-3604 for Permit Fees if mailing in application. you for card number. CITY USE ONLY - y Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL .15— Fee Schedule on Reverse Side $ 65% of Permit Fee $ - .001 of Permit Valuation (1/10th% $ $.50/$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 [ ] $ Z4�;- 1S STIPULATIONS: Building MECHANICAL Permit No.:' Inspections RESIDENTIAL APPLICATION Received By: 1 763-572-3604 CITY OF FRIDLEY 763-502-497�7q FAX EFFECTIVE 2-19-09 DATE U YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY NAME: OWNER/ TENANT ADDRESS: CITY STATE—ZIP— TATEZIPPHONE: PHONE: CONTRACTOR COMPANY NAME: ROYALTPN i HEATIAI(_ Q. COOLING SUBMIT A COPY OF CONTACT PERSON: 4120 uF;tn ,A * VG11A G ORT YOUR STATE STATE LICENSE # BROOKl YNI ARk: l A_;U443 LICENSE WITH ADDRESS: 763-424-8323 CITY STATE ZIP APPLICATION PHONE FAX PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK' ❑ NEW REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (RDICATFTOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: _ MODEL: IRMPOO%S SIZE/BTU MFG: MODEL: SIZEIBTU MFG: MODEL: SIZE/BTU _A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 1<- TO AIR EXCHANGEER $15 (WOOD) $35.00 _NEW GAS GRILL $10.00 _AIR _FIREPLACE _BOILER $35.00 �.4URNACE $35.00 _GAS UNIT HTR $10.00 LINER $10.00 DRYER $10.00 _POOL HEATER $35.00 _CHIMNEY _GAS DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00 Number Of'fiifi res @ $10,00 x $10.00 = $ Number.of fixtures @ $15,'00 x $15.00' = $ Number of fixtures @ $25.00 x'$25.00 = $�_ Number of fixtures @ $35:00 x $35.00 = $ 31-0 State Surcharge = $ r�+r INUVIUM FEE, $35.50 Total = $ 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 in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that 3 understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all whichInirrev!and aapproval of plans.SIGNATURE �ll DATE f Uhl OF APPLICANT PRINT NAMEQ �1 PLEASE NOTE:' SEPARATE PERMITS ARE REQUIRED FOR BUILDING, ° ELECTRICAL AND MECHANICAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977