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PRE 2010 DOCSC CITY OF FRIDLEY NOTE: Applicant should obtain building permit procedure i nformaI i nn_ from Building Inspection BUILDER: Approved Contractors, Inc. V Department Secretary. ADDRESS: 1052 Osborne Rd. N.E. Fridley 554 NOTE: A Certified Survey of the lot, , Street City Zip Code showing the location of the foundati n, TELEPHONE: 1 786 368o once it has been constructed, will be Home Business required before proceeding with the.. framing. PROPIItTY OWNER(S) Roger W. Larson 9 Donald Ivi. Wehlast James E. Wiens c h miz W 2 v /La,E 85 West RC Circle Pines, Minn. ADDRESSES) 8804 Lexington New Brighton, Minn. 55112 Street ' City Zip Code 614 W. Brown Deer Rd. Milwaukee, Wisc. Street City Zip Code TELEPHONE NO -(S) Home Business OF Property Location on Street or Exact Street Address (if any): County Rd. H or 69th Ave...•: N.E. Legal Description of Property: The East 3/4 of the NE 1/4 of the NE 1/4 of Section 13 T-30, R-24 City of Fridley, County of Anoka, State of Minnesota Total Area of Property sq. ft.c7,, Present Zoning ctassivicatiion DESCRIPTION OF BUILDING Proposed Building Use: Multiple 141 units Each unit ftilding Dimensions: ,. `'_Front 20 Depth 32 Height .21 Square Ft. 1-21-3 Cubic Ft. Type of Construction: Wngd Erame each unit Project Estimated Cost .,,16.000.00 To Be Completed 7-1_-73 DATE t La. 4e ` APPLICANT'S SIGNATUREt `� PC -,q UN/ r 0 ® -T %O a c/ti/T pe y X2/`7` /Ce ('LO r 04// T vL % e 3 00 C/TY F�e Pei UAlI /2-5,2 ff l5 G4 � 7/ va S� SQ GT PGS �� // e� o — 1 r' qv° A0 o �zf, y i l 73 U AI I I ,C /10jG AA!!� /7 3 9 3: ©�r s r�r7-F �/ �` °� 7 SC HF_ Ovd.�' i S T�4 �L• S vol c,�/-¢,P� � � 3;-,e o =y20o -5 d? -LO C6'9 -- r v y x g d= yQ--o 0 Sa FT -- - 2 �w r ` 30 5-0 ?u7 -t/ sq r -T �,&A3 C,g 0 � 5� yoo 2L(36 00 �� sera _� 333-oo5� yo I S4' F AGv4Ti�Ai.,��a Af/ r-err.1' _St�4TE 7�38'i5'� 7br,+4 14*LVe Doc A A Z 642,41ES 3o .r 9 13 �o 00 ,dam®.5 �f1,9�9238 �� D• /,G"�ccS N0?q-RF,S1DENTIA1, BUILDING PfiMMIT ZONING: - CITY OF FRILL.:' [: G1 III RIf ILTAN ON'ct .&I 1119 EN9411"N VARIANCE REQUIRED: SPECIAL USE REQUIRED: PLOT PLAN: TOTAL AREA GRADE ELEVATION SF 04/S/T/_' -4/-1/'/Ivv. I / ,/ Aws ay C,r / fka. ADDRESS:1G as 9'``' Aele /V,c LEGAL DESCRIPTION: E X BACKS: FRONT YARD SIDE YARD REAR YARD SUBMIT TO: BUILDING BOARD BOARD OF APPEALS PLAN. COMM. COUNCIL °g H APPROVAL DATE: -5-- 3 Q 9 REMARKSS-/4 -7/ : U FIRE REQUIREMENTSs FIRE MARSHALL FIRE :RETENTION BUREAU EXITS (dates App) INSIDE UTILITIES: PLUMBING VENT & HEATING ELECTRICAL E-4Date Approved : H A OUTSIDE UTILITIES & SITE DEVELOPMENT: Date Approved City Engineer WATER SEWER ELEV CURBING DRAINAGE SCREENING & PLANTING 75-7N i /t 5 nF-R P,4 4W SPECIAL ASSESSMENTS: IF LATERAL ASSESSMENTS HAVE NOT BEEN PLACED ON THIS PROPERTY, AN AGREEKW2 MUST BE SIG AGREEI G TO ASSUME SUCH LATERAL ASSESSMENTS BEFORE A PERMIT WILT, BE ISSUED, )C� AGREEMENT NECESSARY Finance Director AGREEMENT UNNECESSARY Registeted Engineerle Stamp Legal Description Check (A) FOUNDATION PERMIT FINAL APPROVAL it ing Official Building Official ' (B) FINAL APPROVAL � G C� NOSE: Easements, R/W, Special Agreements. City Engineer DATES oa CERTIFICATE OF OCCUPANCY: PARTIAL: DATE: FINAL: DATE: ai c� 'RIIvIARKB s REMARKS i P �i 3, 70 57 Ir -c rF_ n c v, �`rt sr�'cIc 'jL %*/_`%//' /?'�- ,/l�./_�4-ii•R•.^%-/-f F " -, Pa= /-,/- -( - Sewer Connection Charge Receipt o . No. 141 /4 � ' �°f- y`H�/'� � Permit Fee & Pla Check (pf'3, �-o Receipt - No. J? 3,1-, 4-01 Less Deposits�p� , 4- Receipt No. 5-11 a,J 0 7 ,Y' Net Permit Fee Due Af � / ' Receipt No . SPECIAL ASSESSMENTS: IF LATERAL ASSESSMENTS HAVE NOT BEEN PLACED ON THIS PROPERTY, AN AGREEKW2 MUST BE SIG AGREEI G TO ASSUME SUCH LATERAL ASSESSMENTS BEFORE A PERMIT WILT, BE ISSUED, )C� AGREEMENT NECESSARY Finance Director AGREEMENT UNNECESSARY Registeted Engineerle Stamp Legal Description Check (A) FOUNDATION PERMIT FINAL APPROVAL it ing Official Building Official ' (B) FINAL APPROVAL � G C� NOSE: Easements, R/W, Special Agreements. City Engineer DATES oa CERTIFICATE OF OCCUPANCY: PARTIAL: DATE: FINAL: DATE: ai c� 'RIIvIARKB s REMARKS i P �i 3, 70 57 Ir -c rF_ n c v, �`rt sr�'cIc 'jL %*/_`%//' /?'�- ,/l�./_�4-ii•R•.^%-/-f F " -, Pa= /-,/- -( - F *fir' Y �, % �'� � •'� a i S14ia l,V1 iV 6 ©c 7, /Allo V�A%- y�-- /� z; L'A'"d g Y �`,�i f✓s �'/'i'.~/'�./a' yam- � �" C /%� j-� P,L�iri e �cc/% 0 Al cl Rey V I' / 0 Al ON Z O� ��Y�✓i f �P s �'aL /�(/ (/No rs A� 4269 7- 7-,v Ty /'AIl/ r�R / f t / 1111416 ilANTS /P-4,Qf1/7 PLO ro r,¢ Z -?,� 7P17 -,4L Permit Fee paid on Permit #11,315 for 1560 - 1570 69th Avenue N.E. City of Fridley, Minn. -1131 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT Mate; February 22, 1972 OWner; Rice. ,r _ k Development rompany _ $uIjder ApprnyPcl rnntracfnres Tnc - Address 85 West Road, Circle Pine- sMinn.Address .—.10 2 OsUnrnP .Rnad 11T.E_. FricllP3 786-3680 164021638,16362 LOCATION OF BUILDING 01634,16322ljet 69th Avenue N.E. part of Lot ydarcels 10 SD, Section 13 Addition or Sub -Division _ Corner Lot inside Lot – Setback _ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Each Unit 6 T Front __?.A!___ Depth ___,32_! Height 231, Sq. Ft. ___123t Cu. Ft. . Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Wood F raise Est. Cost See #1433 5 __ To be Completed ._.L year In consideration of the Issuance to me of a permit to construct the building described Bove, I agree t9 do ft proposed work In accordane with the description above se/�/ and In compliance th all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $See #1��315, permit is hereby granted to Rice Creek 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 buildings the city limits and this permit may be revoked at any time upon violation of any of the provisions of said v CLARENCE BELISLE NOTICE: This permit does not cover the construction, installation for whing, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. AppRcatia� for Power Plants and HeathiS CooRag, Ventikdon. ReftigerMen and Air Conditioning Sys and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: 11ATE TOTAL Furnace Shell & Duct Work ........ I ....... .. $10.00 i Replacement of Furnace . . . ..... .. 6.00 i Repairs & Alterations—up to $500.00 6.00 Repairs & Alterations each add. $500.00 3.00 MECHL WARM AIR Furnace Shell & Duct Work to 120,000 BTU ..... (0. ..$10.00 $ 0 each add. 60,000 BTU .................... .. 3.00 i Replacement of Furnace .. .. .. .... 6.00 $ Repairs & Alterations --up to $500.00 .. 6.00 $ Repairs & Alterations each add. $500.00 .... &W $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $_ Each add. 200 sq. ft. EDR Steam 3.00 Each add. 320 sq. ft. EDR Hot Water 3.00 $— OIL BURNER—to 3 gal. per hour 6.00 $ _ over 3 gal. per hour—See Fee Schedule PP GAS BURNER (up to 189,000 BTU) ...... (O.. . 6.00 $ D . D O over 199,000 BTU See Fee Schedule Dept. of Mdg& Phos. 880-3490 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 Ordinance_ and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and corret. Jc I c FWdley,,,J2A / # I W - 11 riL�l IrIIlI/r�el!I� Kind of Building Used as To be completed about Estimated Cost, Old -0. Building Permit No. Permit NO. Sl: 'L ' V DESCRIPTION OF WORK HEATING or FOrM PLANTS Steam, Hot Water Waren —No Trade Name lwo2� Size Noj GA8 FITTING FEES: Capacity R) e) 0 V Sq. Ft. E.D R BTS H.p_ //� NO RATE TOTAL 1st 3 Fixtures —(0 x$ 200 Total Connected Lead Kind of Fuel �✓�-� Additional Fixtures a •7 $ BURNER — Trade Name Size No Gas Range to 199,000 ;$ 6 ou $ ' o / AIR CONDITIONTIta CO a (a ® Q Capacity. FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM o% eet ()1MAJ i ALTERATIONS & REPAIRS TOTAL FEE &W6 C) ROUGH F1NRL d ;2 16. (REMARKS -OVER) Sq. Ft. E.D.R BTU Hap City of Fridley plic�ion for Pkmbbg aid Cvm Dept. of Bldge. Phone 5600-3 '4� DESCRIPTION OF WORK . /6 yo - 3 8' - 3 Ca "' 3 =l - 3(g - 3 0 Number, Kind and l ocafion of Fixtufts N wet City of Fridley: i ea I z v g s o p eAs ncc The undersigned hereby makes application for a permit for the work herei. Fj I Ia $ a a " 3 3 speeified, agreeing to do all work in strict accordance with the City Ordinance Base 6 and n ging of the Department of Buildings. and hereby declares that all the fact and representations stated in this application are true and correct !st p (a Fridley, Minn I9. 2nd 6 3rd Opener /-C 4th bind of Building ninon �slt6 � / XQW Co QO Used as - o %loG Fiske. OlSover d � '7 P - PARTIAL be completed about - PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES. NO. RATE TOTAL Number Fixtures ................ g "Woo ; Future Fixture Opening .... :...... x ;1.50 : New Fixture Old Opening .......... x $1.50 ; Catch Basin .... . ............... x $3.25 ; � UO Water Rester fUp to 99.000 BTU).... x $3.00 $ New Ground Run Old Bldg......... x $3.25 S Electric Water Heater .............. a $2.00 $ GAS FITTING FEES-. NO. RATE TOTAL lot 3 Fixtures ............ • • • • • x $2.00 ; C) O Additional Fixtures ................ ---� x $ .75 $__2--.21S- 2 .21SGas &0 - Gas Range to 199.000 BTU .. ,......... x $5.00 ; State Surcharge $ .50 REPAIRS & ALTERATIONb--Refer to Codo Deacription .... ... . .. .... .. .. . ... .. e.- - - w ...... -... 4 _ TOTAL YZIC 6 14 8, 9S Estimated Cost, $ Old—New. Building Permit No. P•rmtt N Signed By Business Phune No ROUGH FINAL k SUBJECT NO. City of Fridley 27026 AT THE TOP OF THE TWINS BUILDING PERMIT r ` RECEIPT NO. COMMUNITY DEVELOPMENT DIV. _ L PROTECTIVE INSPECTION SEC. r / qyy NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8698 JOB ADDRESS 1630-1640 69 Ave NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. Parcles 1 & 200 Section 13 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Rice Creek Development 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO AAAmerica's Best XXXIBM 2400 Interlachen Drive #222 Spring Park 953R4 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 707-0100 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof 6- lex 57 SO 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 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 1 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 4753 $2.37 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 PERFORMAN OF CONSTRUCTION. 99 ]5 4.75 Fire SC PLAN CHECK FEE TOTAL FEE 6� 106.87 SIG AT REOFC NTRACTORORAU RIZED AGENT Ip ATE) IDATED THIS IS YOUR PERMIT A�WHEN�PRROOPERLY off SP /ter DATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI Prepaid Plan Check $ Estimated Cost $ Receipt # Effective 1/1/98 \� CITY OF FRIDLEY R-3, COMMERCIAL & INDUSTRIAL BUILDING PERMIT APPLICATION T Construction Address & �� �� �� Zoning Legal ,(rte CreeX Q ,, e Owner & Address Tel# eairRACIOR & ADDRESSaQ% � �•; � � s ,�� %`- �j 00/ Tel# ;>O7 0/00 Architect Reg. # Engineer ` ".�`�`Reg. # BUILDING CONSTRUCTION / TYPE OF WORK [] New 0Addition 0Alteration -Describe teerob 6 ��/�', OFC. AREA: Length WHSE AREA: Length AP Width Width Width Height Sq. Ft. Height Sq. Ft. Height Sq. Ft. Tel # X07 6V60 Date��,9 VALUATION Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) TOTAL 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 $ 9 s Plan Check $ Fire Surcharge State Surcharge SAC Change $ Erosion control $ Park Fee $ Spec. Assessments $ Driveway Escrow $ TOTAL $ `7 See Fee Schedule on Reverse Side In Excess of Prepaid Amount - See Reverse Side .001 x Permit Valuation (1/10th o) $.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 City of Fridley Building Inspections Dept. o� 6431 University Ave NE Fridley MN 55432 Mechanical 763-572-3604 FAX: 763-571-1287 Residential Application City of Fridley See Back Side For Required Information Permit # Date '%,10f Site Address: The applicant is: (cirl a one) Owner Contractor ,�- Property Owner: Address:/6✓r2 �►re�� City State: Reit/ Zip: Phone: Cell: Fax: Contractor Inform t' n Company Name: Contact Person: -i Address City:60% State: /1?N Zp:��� C 5l 46 Phone: 6-s_/ 4664(_ �� Cell:" X190 66.x _Fax: MN Bond# & Exp Date S 06/06, Email: a Type of Work (circle one): New Replacement Alteration/Remodel Detailed Description of work: /?,I' ."- - allk- J & 6 h2i A1124�- &a�n -h - 0 Equipment Installed: MFG: Model: Size/BTU: MFG: Model: Size/BTU: MFG: Model: Size/BTU: Please check all that apply: _Fireplace (gas) $15.00 New Gas Grill $10.00 A/C $25.00 _Fireplace (wood) $35.00 _Gas Unit HTR $10.00 to Air exchanger $15.00 $35.00 _Pool Heater $35.00 _Air _Furnace $35.00 _Gas Dryer $10.00 Ventilator $15.00 _Boiler _Chimney Liner $10.00 _Gas Piping $10.00 2 Duct Work $10.00 Gas Rang Oven $10.00 -' t%--,' s! all, Permit Fee $ 35.0 (Total from above -Minimum fee $35.001-1/— Surcharge $ Surcharge 0.50 �J ' Total Due $ Make check payable to City of Fridley I This is an application for a permit- not valid until processed I hereby apply for a mechanical permit and I acknowledge that the Information above Is complete and iratw 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 case of all work which requires review and approval of plans. A - Ph: Signature of Applicant: Date: Approval Inspector Signature: Date Please Note: Separate permits are required for Building, Plumbing, and Electrical work n - - J n!A / f 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 Propane/IFGC 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. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make up air calculations AUG -09-2005 13:34 CITY OF FRIDLEY PLUMBING RESIDENTIAL APPLICATION City of Fridley P.02iO4 Permit Number Received By Date Received NOTE: IF PROPERTY 13 NOT OWNER/OCCUPIED- A LICENSED CONTRACTOR MUST OBTAIN THE PERMCT. �._ DATE YOURL ADDRESS_ ' ��Y sa.�"I�� SITE ADDRESS v THE APPLICANT IS: (CIRCLE ONE) OWNER CONTRACTOR NAME PROPERTY OWNER/ ADDRESS TENANT CITY STATE ZIP PHONE # NAME '® CENSE# 'z 2�.0 CONTRACTOR ADDRESS '7 v4 CITY STATE /4f ZIP PHONE # FAX# &' G��p 1 (ll* PERMIT TYPE SINGLE FAMILY TWO FAMILY TOWNHOUSE TYPE OF WORK ❑ NEW W REPLACEMENT DETAILED DESCRIPTION OF WORK FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED FD(TURES. (INDICATE TOTAL NUMBER OF EACH) BATH SINK/LAV FLOOR DRAINS BATHTUB GAS PIPING (Need City License) CLOTHES WASHER KITCHEN SINK DISHWASHER LAUNDRY TRAY Permit Fee$ 0 Plan Review $ Surcharge $ .50 TOTAL DUE $ 5-�:O- SHOWER WATER PIPING SWIMMING POOL WATER SOFTENER ($35) ATER CLOSET BACKFLOW PREY. ($15) WATER HTR ($36) FOR IRRIGATION WATER METER OTHER MINIMUM: ---$15.00 or 5°/u of -cast -of the improvement -whichever Is greater on work less than $300 Make checks payable to: City of Fridley • •.•� .v ti ru- r ` §-r A"Im rwl% h r1r-MVM — Nv 1 vAUIu UNTIL PROCESSED - 1 hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit that the work will be in accordance with the approved plan in the case of all work which requires review and approval of p p�s.// NAME OF APPUCANT Z—OlM DATE PI se type or print SIGNATURE OF APPUCANT OF FRIDLEY COMMUNITY DEVELOPMENT DEPART U31 UNIVESMY AVENUE NE, FRMLEY. MN 65432 RUG -09-2005 13:34 CITY OF FRIDLEY City of Fridley Building Inspections Dept, 6431 University Ave NE Fridley MN 55432 P.03/04 Ph: 763-572-3604 FAX: 763-571-1287 Mechanical Permit# ' 005. OIL -11& Residential Application City of Fridley See Rack Situs Fnr Ranriiraell 1nfnnrft4;nr, Date Site Address: The applicant is: (cirlce one) Owner Contractor Property Owner. Address: City: State: Zip: Phone: Cell: Fax: Contractor Informat� , d , ((��JJ Company Name: Contact Person: Address: State: Phone:_ fas!(1621P!ice Cell: 6(7fO P ?$ �.y �/Z Fax: ! VZC1 _ Email: CAA&MjE go-~h-w2MN Bond# & Exp Date Type of Work (circle one): New Replacement Alteration/Remodel Detailed Description of work OA02& how. d.4' ' Equipment Installed: MFG: Model: Size/BTU: MFG: Model: S1ze1BTU: MFG: Model: Size/BTU:- Please check all that apply: _Fireplace (gas) $15.00 New Gas. Grill $10.00 _AIC $25.00 ,Fireplace (wood) $35.00 _Gas Unit HTR $10,00 Air to Air exchanger $15.00 _Furnace $35.00 _Pool Heater $35.00 _Boiler $35.00 _Gas Dryer $10.00 $15.00 _Chimney Liner $10.00 �Ventilator _✓Gas Piping $10.00 Duct Work $10,00 Gas Range/Oven $10.00 Permit Fee bu (Total from above -Minimum fee $35,00) Surcharge Total Due Make check payable to City of Fridley P u1.3 w Oil wr a Nrrnuu■ nus vanu unsn processes I hereby apply for a mechanical permit and I acknowledge that the information above is complete and accurate; that the work wig 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 apprication for a permit and work is not to start without a permit that the work will be in accordance with the approved plan in case of all work which requires review and approval of plans. Signature of Approval Inspector