Loading...
PRE 2010 DOCSPermit Fee paid on Permit #11,315 for 1560-1570 69th Avenue N.E. City of Fridley, NUmn. 1=337 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT Date: February 22, 1972 Owner: Pit --p Crp-ek U.eVelspmen Company - Builder Approved Contractorne Tne- Address ....85 _W s#Road, C cle pines.. Minn. Address 1052 Osborne Road N_E-, grid ay 786-3680 163821636, LOCATION OF BUILDING 1634!1632 68th Avenue N.E. No. _ Street ._.._._ _.. Part of Lot Parcels 10 & 200, Section 13 Lot Block _____ _____..__..___ Addition or Sub -Division —_ Corner Lot Inside Lot, , Setback Sideyard Sewer Elevation Foundation Elevation _._.._. DESCRIPTION OF BUILDING To be Used as: Each Unit 4 Townhouse Units Front 20' _ Depth _ _ 2' Height 21' Sq, Ft, 1213' Ct, Ft, Front ._ _ Depth Height Sq. Ft. Cu. Ft. Type of Construction Wood Frame Est. Cost dee X11,_315 To be Completed 1 year In consideration of the issuance to me of a permit to constru the building described a e !1agree to do the proposed work in accordance with the description above se and in comp ance wi isions of ordinances of the city of Fridley. In consideration of the payment of a fee of $fie #11.3 ,permit is hereby granted to Rice -Greek Dev. Co. 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 bwlldinggss p�ithin the city limits and this permit may be revoked at any time upon violation of any of the provisions of Said ordinances. - CLARMCE BELISLE 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. C SUBJECTTO T Nb----:---, City of Fridley 2 2 5 AT THE TOP OF THE TWINS BUILDING PERMIT r ` O. • COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. qqq(l 1 . � NUMBER REV DATE PAGE OF APPROVED BY I ` /'►'� CITY HALL FRIDLEY 55432 612-571-3450 910415 8/6/98 JOB ADDRESS 1632-38 68 Ave NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Parcels 0 & 100 1 Section 13 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Rice Creek Develo ement 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO AAAmerica's B707-0100 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING XXXXXHUM Commercial 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION XX REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof 4- lex 37 S Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with 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 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 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 3085 $1.54 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PR VISIONS O ANY OTHER STATE OR LOCAL LAW REGULATING CON- ' ST CTION TH PERFO ANCE OF CONSTRUCTION. $87.25 Fire SC $3.08 / PLAN CHECK FEE TOTALFEE sh w 1 $91.87 GNATU EOFCONTRACTOR THORIZED AGENT ATEI WHEN PROPERL ALIDATED THIS IS YOUR PERMIT _ ],6, v ,NSP ryATE SIGNATURE OF OWNER,IF OWNER BUILDER, IDATEI Prepaid Plan Check $ Estimated Cost $ Receipt # Effective 1/1/98 CITY OF FRIDLEY R-3, COMMERCIAL & INDUSTRIAL S BUILDING PERMIT APPLICATION�D construction Address / 9.3 a _?9 6f1" ZZ oe�oe_ k �, Zoning Legal Ace Cree®die e Owner & Address Tel# OOZE?MCMR 8c ADDRESS A14 A•i yrr i ce lS � 'S l/9®/ �a�e 7..j 13fia�i. Tel# 70;;' 0/00 o�s'.r�.e S•5 3 Architect Reg.# Engineer BUILDING CONSTRUCTION TYPE OF WORK [] New [] Addition [] Alteration -Describe r D OFC. AREA: Length Width Height Sq. Ft. y,HSE AREA: length Width Height sq. Ft. 0mER AREA: Length Width Height Sq. Ft APPLICANT � Tel # 20;2 D/ Oa Date �!16 s VALUATION Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) ,� Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) TIAL VALUE Building Use Construction Type Occupancy yup Air Conditioning [] Yes [] No Fire Protection Provided [] Yes [] No Performance Bond Amount $ See -Reverse for Schedule Received []Yes []No Permit Fee $ C9/ • v� �� Plan Check $ Fire Surcharge $ 3_ C PCO - State Surcharge $ S� SAC Charge $ Erosion control $ Park Fee I $ Spec. Assessments $ Driveway Escrow $ TOTAL $ See Fee Schedule on Reverse Side In Excess of Prepaid Amount - See Reverse Side .001 x Permit Valuation (1/10th %) $.50/$1,000 Valuation (See Sched. for > $1 Million) $1000 per SAC Unit (Plans to MWCC for determination) $450.00 Conservation Plan Review Fee Determined By Engineering Agreement Necessary [] Not Necessary [] feet x $13.50/foot ATTACH STIPULATIONS a 0 Effective 1/1/04 CITY OF FRIDLEY MOVING [ ] WRECKING 0 PERMIT APPLICATION 6431 University Ave NE� Fridley MN 55432 (763) 572-3604 FAX (763) 571-1287 Job Address: 163Z - v "'Lf- /VL Legal Description: Owner & Address: jifi''" 8ER-#s 04&P%kT C-0 Tel. #y5Z ^9'5Y-77gY Contractor: ANNuCLE Cc tffluY WS Tel. # Address • Lg6D auVok- 14eia State License # y`A..3 DESCRIPTION OF BUILDING HOUSE: Length 3� Width 2 %-/ Height I(P Sq. Ft. NLIO Cu. Ft. 10'7-0 GARAGE:Length Width OTHER: Length Width Estimated Cost $ Height Sq. Ft. Cu. Ft.A�_ Height Sq. Ft. Cu. Ft.� Approx. Completion Date 4/9 CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. CALL ALL UTILITIES FOR DISCONNECTS BEFORE WRECKING MOVING STRUCTURE. Water Bill Paid: Yes [zor Collect [$ Moving Route: ] Signature The undersigned hereby makes application for a permit to wreck/move the building described above, agreeing to do all work in strict accordance with the City Ordinances and rulings of the Building Division, and the State Code which requires any water well on the property to be sealed by a State licensed water well driller, and hereby declares that all facts and representations stated in this application are true and correct. ALL Movin Wrecking Principle building into Fridley .... $300.00 For each 1,000 cubic feet or fraction ...... $1.25 Accessory building into Fridley ... $ 42.00 For structures which would be impractical to Through or within the City ...... $ 20.00 cube, the fee shall be based on the total cost Move a building out of City....... $ 20.00 of wrecking at the rate of $6.00 for each $500.00 or fraction. PERMIT FEE: �6-9 — MINIMUM $20.00 STIPULATIONS: CITY OF FRIDLEY INSP. DN. 6431 University Avenue NE Fridley, MN 55432 (763) 572-3604 R HYDRANT RENTAL AGREEMENT (Effective April 1, 2004) XJOB SITE: 163 Z- 4 3Lf 6�-6 �'(�(� Nc-� Applicant: AL)Aoca CCW AKI U (Pc- Tel. #: 76 3 - 5 ?Z -?-CM Address: U'LlCo CO-Tv� h" P( - RENTAL CHARGES Service Charge: $50.00 Water: Minimum $10.00, $1.25/1000 gal. with meter Tanker: $10.00 per fill TOTAL CHARGES Receipt # $ 5O,00 $ l2, 5o $ 62 a EQUIPMENT USED & DEPOSITS HELD Meter Deposit: $200.00 Meter # $ Meter Reading: Start TOTAL GALLONS End Equipment Deposit: (wrenches) $150.00 List Equipment Borrowed: Above Equipment Returned to: x $1.00 = TOTAL DEPOSIT CHECK E1 Signa - r._ - I/We agree to make the above deposits and pay the water and service charges for the use of hydrant connections and equipment borrowed. In the event that the above meter or equipment is lost or damaged, the cost of repair or replacement shall be made by the applicant stated in this agreement before the deposit is refunded. Date Deposit Check # Signature Deposit Amount Returned By Date CONSTRUCTION WATER & EQUIPMENT RENTAL Application is filled out, deposits are held and charges are paid at City Hall, Building Inspection Division. i r Application is then taken to filtration plant. • .All equipment is picked up at Commons Filtration plant at 601 - 61st Avenue from Water Department personnel. Water Department will list on application what equipment was borrowed and the meter reading on the meter if used. Application is left at filtration plant until equipment is returned and the final meter reading is pa{ on application. EQUIPMENT MUST BE RETURNED IN GOOD CONDITION TO GET DEPOSIT BACK. Call City, Hall before bringing equipment back to insure that. someone will be at the filtration -plant to receive it. Bring signed application back to Building Inspection Division, City Hall to get deposit back. ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE VALUATION ADVANCE COMPANIES INC 6400 CENTRAL AVE NE FRIDLEY, MN 55432 (763)572-2000 PHILLIPS LEVI F 1632 RICE CREEK RD NE FRIDLEY, MN 55432 1632 RICE CREEK RD NE 133024440002 UNAVAILABLE LOT BLOCK HYDRANT RESIDENTIAL DEMOLITION Ir.. 2005-00952 06/21/2005 WATER LINE REPAIR/RELOCATION 50.00 WATER PERMIT FEE 12.50 TOTAL 62.50 PAID WITH CHECK # 98126 Building BUILDING PermitNo.: + D Inspections COMMERCIAL/INDUSTRIAL Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: / DATE YOUR E-MAIL ADDRESS SITE ADDRESS 16,9Z, 241 3(ol 3 K G0-" Act ti ? TENANT Suite No. PROPERTY OWNER NAME: T-, Sc -go /Wf,wT Co, 1' - -".. ADDRESS: 91 �4 �CfJ�1Ftc NCS (Ux� AJ& S CITY /&I)gff"Z1t�"STATEMLZIP — $ $450 Conservation Plan Review PHONE: L7>Z - 8 -Sy- ?7 &-�- ARCHITECT NAME: LAmktr ARSIT T-C:CTS Special Assessments ADDRESS:13r3 ? 6ouCccv-% 5T- AJ` -CITYA�*141ca STATEMZIP 953 CONTRACTOR NAME: WAOC6dJPL-3 we ADDRESS:64M G_-VT)1 - M& t, s CITY ALL STATF�INZIP5Z ft + 6 ft = ft x $20 = $ Total Due PHONE:? 63 - 5 -7?- - ZCzfc FAX 763 - 572 - X1 ?3 3 Make checks payable to: City of Fridley Attach Stipulations *NOTE: CITY LICENSE REQUIRED FOR MULTI FAMILY/COMMERCIALANDUSTRIAL JOBS PROPERTY TYPE ATOWNHOUSE ❑ COMMERCIAL/INDUSTRIAL ❑ INSTITUTIONAL ❑ MULTI -FAMILY PERMIT TYPE ❑ ADDITION ❑ NEW CONSTRUCTION ❑ OTHER ',REMODEL ❑ ROOF ❑ SWIMMING POOL PLEASE SUBMIT: SETS OF DRAWINGS 5. CONTRACTORS LICENSE OR 6. SPECIAL INSPECTION 2. SURVEY/SITE PLAN LICENSE APPLICATION SCHEDULE 3. LANDSCAPE PLANS 7. PERFORMANCE BOND 4. ENERGY CALCS AMOUNT $ BUILDING TO BE USED AS: SME SF VMS SF'OTHER SF TOTAL SIZE: STORIES FIRE PROTECTIOAC(Y )-?'— DETAILED DESCRIPTION OF WORK 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 I 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 work whish requirel r w and approval of plans. -7 SIGNATURE OF APPLICANT d� V D PRINT NAMEDATE c ALL FEES ARE BASED ON VALUATION Sq. ft. x $ Sq. ft. x $ Sq. ft. x $ TOTAL JOB VALUATION, USE. Cost/sq. ft. = Valuation $ Cost/sq. ft. = Valuation $ Cost/sq. ft. = Valuation $ OCCUPANCY TYPE " Permit Fee $ ` S' See Back Page for Fee Schedule Kan Review $ boo 65% of Building Permit Fee surcharge $, �Q (.0005) times the total job valuation -Minimum $.50 ?ire Surcharge $ CO .001 x Permit Valuation (1/10%) 3AC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) 3rosion Control $ $450 Conservation Plan Review ?ark Fee $ Fee Determined by Engineering Special Assessments $ Agreement necessary ( ) Non Necessary ( ) -urb Cut Escrow $ ft + 6 ft = ft x $20 = $ Total Due $ Make checks payable to: City of Fridley Attach Stipulations (&06-k cn-u b A41J1x;- of Fridley Building Inspections Dept, 643 1 University .Ave NE Frid:ey,MN 55432 Ph: 763-572-3604 FAX: 763-571-1287 7 Me ch a niGal RGsidential Application City of Fridley See Rack Side For Reauired Information D�5 hermit #'3Dos - &A ea Date • Site Address: The ap licant is: (cirf a one) Owner Contractor Property Owner: • -- `"� Address: City: Af State: AA Zip: Phone: Cell: Pax: Contractor Informati n - Company Name: Contact Person:r Address: 8 qy:_4ii� City: Ar&r-/ Zip:,I,- -� Phone: Cell: -010 4(Fax..: Email:a a.- . MPJ Bond# & Eyp Date Type of Work (circle one): New Replacement Alteration/Remodel .d--"" _ Detailed Description of work: /Z OV n 4QC? Equipment Installed: MFG: Model: SizelBTU MFG: Model: 5tzINSTU' MFG: prnrlta� SizF'CTt t - - -- Please chuck all that apply: Firpnl?r e tr?,�S J 1..nn A1C $25.00 Fireplace (=food) $35.00 _has Unii NTi= '� !n.nn Air to Air exchanger $15,00 _Furnace $35.00 �rr,rtf Heater X35.00 Boiler $35.00 _Gas Dryer $10.00 Venlitator $15.00 Chimney Liner $10.00. _Gas Piping $10.00 Duct Work $10.00 Gas Range(Oven $10.00. Permit Fee (Total from above -Minimum fee $35.00 Surcharge 0.50 r Total Due $ Make check payable to City of Fridley This Is an appiica(lon for a permit- not valid unfit processed c, �Pee I her9hy apply for a meehanieat permit and I sv nowiodge that the information above: is eompleten and accurate; that the work will be in confo-manc0dth 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 application for a permit and work Is not to start without a permit; that the work will be in accordance with the approved plan it case of all work which requires review and approvel of pians. 144211 Cv�� Signature of Approval Inspector PIZ -d!NoCti90'oyatepermits are req t. uJa �;� pu u�iqu�n`ld^�-_`aa',to��'alw(Nb'1b 0: SOOZ 9l'das Building MECHANICAL Permit NO.: Inspections RESIDENTIAL APPLICATION Received By: 7.63-572-3604 CITY OF FRIDLEY Date Rec'd:_ DATE 10 — 21 O S YOUR E-MAIL ADDRESS SITE ADDRESS 3 " AA -v -- THIS APPLICANT IS: ❑ OWNER 0edNTRACT0R PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK: NAME: ADDRESS: CITY STATE ZIP PHONE: COMPANY NAME:_ CONTACT PERSON: STATE LICENSE # EXP DATE ADDRESS: �D Z -� • AJ' CITY 51 �^ 1R� STATE��Z1F PHONE 7t0 3' y�"- 20.3/ FAX ❑ SINGLE FAMILY ❑ TWO FAMILY ❑ NEW M46LACEMENT DETAILED DESCRIPTION OF WORKG INHOUSE ❑ ALTERATION/REMODEL PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor y3-6' 0 x .OS = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) MODEL: SIZEBTU Equipment Installed MFG: SIZE/BTU MODEL: SIZE/BTU MODEL: _A/C $25.00_FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00 _AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 _BOILER $35.00 _FURNACE $55.00 GAS UNIT HTR $10.00 CHIMNEY LINER $10.00 _GAS DRYER $10.00 POOL IiEATER $35.00 DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $1500 s a a net arthien _ _ ilk �.,,,�. Permit Fee $ Number of fixtures @$10.00 x $10.00 = 50 Number of fixtures @ $15.00 x $15.00 = $ Surcharge $ TOTAL DUE $ • 5 0 Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .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 I 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 %work which requires review and approval of plans. SIGNATURE OF APPLICANT / \ PRINT NAME �'� � �DATE `C �'�3 City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propan&UGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new construction IMC 1346.0312 5. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. RCCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make up air calculations Building PLUMBING Permit No.: Inspections RESIDENTIAL APPLICATION Received B . 763-572-3604CITY OF FRIDLEY Date Recd: DATE I Q "- Z I- 0 S YOUR E-MAIL ADDRESS SITE ADDRESS 1103(0 (,, ,'t-1 A,,)-P,- ,vimTHIS THISAPPLICANT IS: ❑ OWNER UP0 TRACTOR PROPERTY NAME: ADDRESS: CITY STATE ZIP OWNER/ TENANT PHONE: CONTRACTOR NAME: _ 44 STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE ADDRESS: 1 (0 50 t CITY TATE /"NZIP Y LICENSE WITH PHONE -76 i3 ' qg/7-2G 2/ FAX 74-? -4/97- 7r/' 7C) APPLICATION PERIVIIT TYPE 0 SINGLE FAMILY ❑ TWO FAMILY D'TOWNHOUSE TYPE OF WORK: 0 NEW REPLACEMENT DETAIL D DESCRIPTION OF WORK PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) 1 BATH SINK/LAV DRAINS SHOWER _ WATER PIPING _FLOOR _ 7 BATHTUB —GAS PIPING mw cn Ljc&vz) _ SWIMMING POOL _ WATER SOFTNER ($35) CLOTHES WASHER _ KITCHEN SINK J_ WATER CLOSET _BACKFLOW PREV. ($15) _ DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ _ WATER METER —OTHER P1 1 1k ' l~ PR is"; lrbk. l?Q .... x , �., `` ti P. ..:.,.`. t.� ... Permit Fee $ Number of fixtures @ $10.00 -ax $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ State Surcharge = $ .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 I 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 work which requires review and approval of plans. SIGNATURE OF APPLICANT -.r-^ PRINT NAME J % / �► /�f /a/✓��� DATE 7® - 2� 'n S 4t AND CALF iItK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 City of Fridley Building Inspections Dept. NE G�W, Ph- 783-572-3604 FAX: 763-571-12 6431 UnlversityAve Mechanical Fridley MN 55432 Commercial Application City of Fridley Permit # Date i2 _Ir Site Address: 1636 8' Theapplicant is: cirlce one Owner Contractor Architect/Engineer Property Owner: Address: CRY: State: Zip: Phone: Cell: Fax: Contractor Information Company Name: `''� °� D r/6Z d` WI -4 Contact Person: - D6J W,7 Address: t to26+'--' 5i} r -,T City: 5d , w.. tC i r/ -EL State: Zip: 6-537 (o Phone: O9 1 -2a3 / Cell: Fax: Email: MN Bond# & Exp Date Permit Type (circle one): Multi -family Commercial Institutional Condo building Industrial building Swimming pool Other: Type of Work circle one): New Replacement CAlteration/Remod Detailed Description of work: Coll s L •^�5 tom rK�� w fe✓G'' Equipment Installed: MFG: Model: Size/BTU:- MFG: Model: Size/BTU: MFG: Model: Size/BTU: Please check all that apply: _Duct Work _Roof Top Unit (RTU) A/C Furnace _Refrigeration _Boiler -VGas Dryer _Stearn/Hot Water Heat _Class I Hood 3 XGas Piping _Swimming Pool _Class II Hood _Gas Unit Heater _Temporary Heat Commercial Kitchen _Pool Heater Other All fees are based on valuation, including the cost of labor and materials: �� al Job Valuation: $ f1?v ®, ®® Permit Fee $ (1.25% of Job Valuation / Minimum fee $35.00) Surcharge $ SD <0 =to $1000: $ .50 surcharge OR >$1000: valuation *.0005 Total Due $-=-&2) Make check payable to City of Fridley This is an application Tor a permit- not valla untn processes I hereby apply for a mechanical permit and j 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 application for a permit and work is not to start without a permit; that the work will be in accordance with the approved pl n in qase of all work which requires review and approval of plans. Signature of Applicant: Date: Approval Inspector Signature Date:%%72­e-� Please Note: Separate permits are required for Building, Plumbing, and Electrical work Revised 6/14/2005