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PRE 2010 DOCSH a 4 491 CITY OF FRIDLEY . NOTE: Applicant should obtain building permit PrOC )re i nfgTms±i z1 - 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: 786 368o once it has been constructed, will be Home Business required before proceeding with the. framing. PROPERTY OWM(S) Roger W. Larson Donald a ast James E•. Wiensch Ali w a v/lre: 85 West R$. Circle Pines, Minn. ADDREss(ES) 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 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.,Co Present Zoning classiricatiion DESCRIPTION OF BUILDING Proposed Building Use: Eac h unit ftilding Dimensions:; ont 20 Depth _• 32 Height ,21 Multiple 141 units Square Ft. 1213 Cubic Ft. Type of Construction: Woad Frame each unit Prgject Estimated Cost 1000.00 To Be Completed 7-1-73 APPLICANT'S SIGNATURIPs `. 5 2=7� CU FT ��� r/tirT /tee r- % e 3 a T% -,( C /T Y Fc?e PES UA17- /9-s.2 15G4� ' v r 3p 5 �4y° a 4)s'4y,� y c s y a 2- 7 3 -73 S PER l% 3 9 3: ®�r s r�-rF li day a ca o s Y,+4- v4Teelxl SC HF_ Ove L j s � � Z � � v k u e 7 0S 7-,4 7`L S ae? cl-1.4,PG Al o zAll 7- s- s- V Lo C619 l G y �(o = y O of 2. uo 3;?, �X ' 0 _ 2- — 52 C,4 R 2L(36 00 30 s� 43L3�d �'= 5� �- %� 57�4TE ls�4Gv-9ha�fs.,��a fro�i 7-07-A-1- HALL/ a ego' AAL X+4-/J.46FS ® y�� W 7X-1- i 3 0 913s� /PPysffi`r 1-7o J-;,¢ .c /.ALL !' ��41 I 0 0 /-.? "�, 7.0 6. >—u ,0001 LS1,969250 (p &- 97 Nn!J-RF9IDENTIAI, BJILCING PERMIT VARIANCE REQUIRED: SPECIAL USE REQUIRED: PLOT PLAN: TOTAL AREA GRADE ELEVATION SF90 - 04/-9/re 4/�PAW44 ,� ley c,ry e-ka, CITY OF F'RTLLirf ADDRESS :1G ®U 194- LEGAL 94-LEGAL DESCRIPTION: E BACKS: FRONT YARD SIDE YARD REAR YARD SUBMIT TO: BUILDING BOARD BOARD OF APPEALS PLAN. COMM. COUNCIL APPROVAL DATE: , - - .-,F -21 REKARKS: U pq FIRE REQUIREMENTS: FIRE MARSHALL FIRE :REVENTION BUREAU EXITS (dates App) f� U W INSIDE UTILITIES: PLUMBING VENT & HEATING ELECTRICAL��---- E-4 U Date Approved cn .g OUTSIDE UTILITIES & SITE DEVELOPMENT: WATER SEWER ELEV CURBING DRAINAGE SCREENING & PLANTING ,E5 pelf 745 PP- R /-I/-r4� H Date Approved Pr-4A� A City Engineer SPECIAL ASSESSMENTS: T IF LATERAL ASSESSMENTS HAVE NOT BEEN PLACED ON THIS PROPERTY, AN AGRENWE MUST BE SIG AGREEI)fG TO ASSUME SUCH LATERAL ASSESSMENTS BEFORE A PERMIT WILL BE ISSUED. AGREEMENT NECESSARY Finance Director AGREEMENT UNNECESSARY Registered Engineer's Stamp Legal Description Check (A) FOUNDATION PrERMIT FINAL APPROVAL �• it ing Official Building Official (B) FINAL APPROVAL, � NOTE: Easements, R/W, Special Agreements City Engineer DATES aq �J IN,R y7iiir' Sewer Connection Charge Receipt No. PARTIALs DATE: y Permit Fee & Pla'n Check(o 5 3, Receipt No. 7° 3-,i6, Less De ost Receipt No. REMARKSs - o J C � 7,Y Net Permit Fee Due / Receipt No. , i1,�'! 7"�' �- w sV � �.r�= 5 ,%�- v ✓_ SPECIAL ASSESSMENTS: T IF LATERAL ASSESSMENTS HAVE NOT BEEN PLACED ON THIS PROPERTY, AN AGRENWE MUST BE SIG AGREEI)fG TO ASSUME SUCH LATERAL ASSESSMENTS BEFORE A PERMIT WILL BE ISSUED. AGREEMENT NECESSARY Finance Director AGREEMENT UNNECESSARY Registered Engineer's Stamp Legal Description Check (A) FOUNDATION PrERMIT FINAL APPROVAL �• it ing Official Building Official (B) FINAL APPROVAL, � NOTE: Easements, R/W, Special Agreements City Engineer DATES aq CERTIFICATE OF OCCUPANCY: ' PARTIALs DATE: FINAL: DATE: ca REMARKSs REMARKSs - i1,�'! 7"�' �- w sV � �.r�= 5 ,%�- v ✓_ 7 � ' r',� c �_ ���'r � ,� •L=rr?y ,r ��, r �r,,r: S -� � / =>/2�_ /'� � � ,�> 3 L G` S'6i✓I�n_'LS 7r_' 57,,, '//e. /15711G rF_ in 5 s L'cc c- -,- 17 /'C�G'S i C j� �7P y r 'Y t'✓/' F eL{ %Lc, 1 P i4J a 33` 4 l`a''�`�/.L'/ A/t� ems✓ e� .'92y�Ole'%t/ v ✓— 7�2y���L� ��✓/�'/,f�®,P✓� �/�/.����. � 7, ��� v� Pe:s ���,��� /���� Gtr <.yy b%� Z� ✓) �� ,i�;°��/"�`�✓ C' _ ✓���aTC�= S' 9 Y Pte% �j4w cb�rcc,(-- /� cj� -"0/ P7,VAWILI-17- 74-A& ON -)V/- &I L ����s �-6fl /f ( 1/11/AJ6 IIAil rs P/,q 9U7',4i- f -1/O/NC, I�AOOTs Ca Permit Fee paid on Permit #11,315 for 1560 - 1570 69th Avenue N.E. City of Fridley, Minn, 3 6431 University Ave. N.E., Minneapolis, Minn. 55432 BUILDING PERMIT -ate: _ February 22. 1972 .. objW-11y" elk 786-3680 164021638216363 LOCATION OF BUILDING No16349163231hat 69th Avenue N.E. Part of Lot L.Farcels 10 , Section 13 Addition or Sub -Division Corner Lot inside Lot Setback Sewer Elevation Sideyard Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Each Unit 6 T Front - 901 Depth 321_ Height2? 1, Sq. Ft. ___3 j 31 Cu. Ft. Front Depth Height - Sq. Ft. _ Cu. Ft. Type of Construction Est. Cost See—#11,, 315 __ To be Completed __1 In consideration of the issuance to me of a permit to construct the building described bove, I agree to do the proposed work in accordance with the description above se.�/ and in compliance 'th all provisions of =% of the city of Fridley. _ In consideration of the payment of a fee of $.5, 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 buildino .Within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinan0 CLARENCE 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 hems. Application 4�Or Power PtanK and FteaNngR Cooling, YentilatioeR IN" 1 notion and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work $10.00 $ Replacement of Furnace ..... .. 6.00 $ Repairs & Alterations—up to $.500.00 6.00 $ Repairs & Alterations each add. $500.00 3.00 $____ MECH. WARM Alli Furnace Shell & Duct Work to 120,000 BTU ..... & .. $10.00 $ �o 01 60 0 each add. 10,000 BTU .................... .. 3.W i Replacement of Furnace 6.00 $ Repairs & Alterations -up to $500.00 6.00 $ Repairs & Alterations each add. $500.00 ... &00 $ 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 Each add. 320 sq. ft. IDR Hot Water 3,00 $— Dept. of Bld//ga. Phone 59"M 4 y� Locmgkm 5L 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 an the facts and representations stated in this application are true and correct. _ , FNdley, Minn _ lg�Z Kind of Building Used as To be completed about Estimated Cost, Lj C.001, Old -0. Building Permit No. Permit No. hwv AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL fir �1 ' o 4 a Q Q CapacitySq. Ft. E.D.R BTV EM. Sea Foo Schedule TOTAL FEE .S0 (REMARKS—OVER) DESCRIPTION OF WORK OIL BURNER—to 3 gal, per hour 6,00 $ 61 over 3 gal. per hour-- Fee Schedule STING or PO PLANT��Steam, got Water Warm —�+No GAS BURNER (up to 199,000 BTU) �. 6.00 Trade Name �� Size Ne_C-t:&D over 199,000 BTU See Fee Schedule Capacity 'RQy e) �_ Sq. Ft. E.D.R GAS FITTING FEES: NO RATE TOTAL BTS H.P. 1st 3 Fixtures K$ zoo p% Total Connected Load Kind of Fuel Additional Fixtures x .78 $ Gas Range to 199,000 x$ 8.00 $ BURNER — Trade Name Size 1070 AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL fir �1 ' o 4 a Q Q CapacitySq. Ft. E.D.R BTV EM. Sea Foo Schedule TOTAL FEE .S0 (REMARKS—OVER) Cify of Fridley plication for Phi and Gag q Past Dept. of Bldgo. Phone 560-3450 DESCRIPTION OF WORK PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES-. NO. RATE q8 O 2LOO Number Fixtures ................ x -$2.00 = y1` Future Fixture Opening .... :...... x $1.60 3 -- New 7ixture Old Opening .......... x $1.60 =- Catch Basin .................... x $3.26 $ I S • UO Water Beater (Up to 99,000 STUD .... _� x $3.00 $ New Ground Run Old Bldg......... x $3.25 $ Electric Water Heater .............. a $2.00 $ GAS FITTING FEES. NO. RATE TOTAL lot 3 Fixtures ............ • • • ... x $2.00 $ C) O Additional Fixtures ............... x $ .76 $ -2- S' &0-00 Pias flange to 199.000 BTU ............ x $5.00 $ State Surcharge $ .50 REPAIRS h ALTERATIONS—Refer to Cado Description ........ .. ...... .... .. v.... - .... ..- ... • 3 _ TOTAL 1!'EE 6�� -30 City of Fridley: The undersigned hereby makes application for a permit for the work hemi, specified. agreeing to do all work in strict accordance with the Cl%y Ordnance and waling of the Department of Buildings. and hereby declares that all the fact and representations stated in this application are true and correct Fridley,/Mina 19,_ Kind of Building Used as To be completed about Estimated Cost, $ Old—New. Building Permit No. Permit N Signed By Business Phune No ROUGH FINAL h— SUBJECT NO. City of Fridley 27 026 AT THE TOP OF THE TWINS BUILDING PERMIT ` RECEIPT NO. COMMUNITY DEVELOPMENT DIV. Al qyy_ r PROTECTIVE INSPECTION SEC. 1 NUMBER REV DATE PAGE Of APPROVED BY CITY HALL FRIDLEY 55432 �j 612-571-3450 910-F15 8698 JOB ADDRESS 1630-1640 69 Ave NE t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Parc 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 XXS 2400 Interlachen Drive 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 707 0100 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Commercial- 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof 6— lex 57 S Tear—off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 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 PERFORMANCA OF CONSTRUCTION. 99.75 4.75 Fire SC PLAN CHECK FEE TOTALFEE A $106.87 SIG AT RE OFC NTRACTORORAU RIZEDAGENT I ATE( WHEN PROPERLY (DATED THIS IS YOUR PERMIT SL INSP — 7—�7( PATE _ SIGNATURE OF OWNERIIF OWNER EIUILDERI IDATEI Prepaid Plan Check $ Estimated Cost $ Receipt # Effective 1/1/98 CITY OF FRIDLEY R-3, COMMERCIAL & INDUSTRIAL Q BUILDING PERMIT APPLICATION 1,430 _ Construction Address %�i �/� �v /U� Zoning Legal 6cc CrEei< Deo, owner & Address Tel cmnRAMR & ADDRESS Ai/ f? r� was ,�� i` �l "0 L��czrx AW Tel# 7 07 o fo 0 Architect Reg . # Engineer ` ` �',, ffP S6 3 i.rr Reg . # BUILDING CONSTRUCTION / TYPE OF WORK [] New [] Addition [] Alteration -Describe kal-rob .6 -,o%,c leo e 0 Y41 OFC. AREA: Length Width Height Sq. Ft. mm Ap,: T angth Width Height Sq. Ft. OTHER ARFA: Length Width Height Sq. Ft. $ TIAL $ C) Tel # �2,07 6V60 Date APPLICANT , VALUATION Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) 'ICTAL VALUE Building Use Construction Type Occupancy Group Aix Conditioning [] Yes [] No Fire Protection Provided [] Yes [] No Performance Bond Amount $ See Reverse for Schedule Received [] Yes [] No Permit Fee $ (95' '7S Plan Check $� Fire Surcharge $ S® State Surcharge $ - SAC Charge $ Erosion Control $ Park Fee 1 $ Spec. Assessments $ Driveway Escrow $ TIAL $ C) 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. 6431 University Ave NE Fridley MN 55432 Mechanical Ph: 763-572-3604 FAX: 763-571-1287 Residential Application City of Fridley 9-1 n- 1, Q Am Co%r Rnmillrarl Infnrm:%f!nn Permit # -�®®§'®/U--'? This is an application for a permit- not valid until processedOci3i joeV' I hereby apply for a mechanical permit and I acknowledge that the information above is complete and n 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 case of all work which requires review and approval of plans. 0y N a � Signature of Applicant: Date: Approval Inspector Signature: Dat? 40S� Please Note: Separate permits are required for Building, Plumbing, and Electrical work n - - J -IA A 1^^f%r r 140V1 � r�°1/-7l Date Site Address: The applicant is: (cirl a one) Owner Contractor a� Property Owner: 1 Address:/0'7- 1,9 Or City:G!"Salus State: Reit/ Zip: j51r4-M Phone: Cell: Fax: Contractor Info rmati n Company Name. Contact Person: -� Address: City: ofizW Lauri - State: /11N Trp: EW -ZS /AX'- Phone: �s�_ �/ _ �� Cell:" Wo 44e&7 Fax:—& 57 IF!6y f/ S 6/Ao Email: c a- MN Bond# & Ex Date e T pe of Work (circle one): New Replacement Alteration/Remodel Detailed Description of work: /Z cor Equipment Installed: MFG: Model: Size/BTU: MFG: Model: SizeBTU: 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 Fumace $35.00 _Pool Heater $35.00 _Air $35.00 _Gas Dryer $10.00 Ventilator $15.00 _Boiler Liner $10.00 _Gas Piping $10.00 _Chimney Duct Work $10.00 Gas Range/Oven $10.00 Permit Fee $ (Total from above -Minimum fee $35.0 e Surcharge 0.50 Total Due $ Make check payable to City of Fridley This is an application for a permit- not valid until processedOci3i joeV' I hereby apply for a mechanical permit and I acknowledge that the information above is complete and n 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 case of all work which requires review and approval of plans. 0y N a � Signature of Applicant: Date: Approval Inspector Signature: Dat? 40S� Please Note: Separate permits are required for Building, Plumbing, and Electrical work n - - J -IA A 1^^f%r r 140V1 � r�°1/-7l 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/1FGC 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.02Z04 oo�, o 1 9 Permit Number Received By Date Received IF PROPERTY IS NOT OWNER/OCCUPIED- A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT. DATE /Z YOUI SITE ADDRESS i L THE APPLICANT IS: (CIRCLE ONE) OWNER CONTRACTOR j, - NAME PROPERTY OWNER/ ADDRESS TENANT CITY 3TATl: ZIP PHONEit NAME® ENSE9 S CONTRACTOR ADDRESS'Ivo CITY Q STATE ZIP �® PHONE # FAX00 PERMITTYPE SINGLE FAMILY TWO FAMILY ME OF WORK p NEW W REPLACEMENT DETAILED DESCRIPTION OF WORK FEES ARE BASED ON $10.00 PER iFIXTURE# EXCEPT WHERE NOTED FD(TURES: (INDICATE TOTAL NUMBER OF EACH) ,BATH SINVJLAV FLOOR DRAINS SHOWER WATER PIPING _BATHTUB GAS PIPING (Need City License) SWIMMINQ POOL WATER SOFTENER ($317 CLOTHES WASHER KITCHEN SINK — , jiV ATER CLOSET BACKFLOW PREY, ($15) DISHWASHER LAUNDRY TRAY !�fWATER HTR ($35) FOR IRRIGATION WATER METER OTHER Permit -Fee $ , 3, MINIMUM; $15.00 or 5'/6 of cost of the improvement-Whicheveiris Plan Review $ greater on work less than $300 Surcharge $ ,50 TOTAL DUE $ Make checks payable to: City of Fridley THIS IS AN APPLICATION FOR A PERMIT — NOT VALID UNTIL PROCESSED 1 hereby apply for a plumbing pemlit 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 Fridiey 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 r all work which requires review and approval of plans. NAME OF APPLICANT Z DATE t?Z�LlfJ PI se type or print SIGNATURE OF APPLICANT 6931 UNIVESITY AVENUE NE, FRIDLEY. NIN 55432 AUG -09-2005 13:34 CITY OF FRIDLEY P.03,104 City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287 6431 University Ave NE Fridley MN 55432 Mechanical Permit# �Zm-! 01 q1S Residential Application City of (Fridley See Back Side For Required Information Date j ' Site Address: The applicant is: cirice one) Owner Contractor Property Owner- wnerAddress: Address: Cly: State: Zip: Phone: Cell: Fax: Contractor Informat 11, Company Name: 66 "'h e Contact Person: Address:Z- City: State: &42 zip: Phone:_ Cell: 6t7 efo fn�z Fax:, Email: cAd&%r= 4 andh. CMN Bond# &Exp Date 60 G/�4 T e of Work (circle one): New Replacement Alteration/Remodel Detailed Description of work &IV W 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 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 Ventilator $15.00 _Chimney Liner $10.00 ►Gas Piping $10.00 Duct Work $10.00 Gas Range/Oven $10.00 Permit Fee bu (Total from above -Minimum fee $35.00) Surcharge - $ — --- - _ ._...0:50 -- _. - --- _ - .-:::. . _ --- - :. _ . --- ._ :.- Total Due Make check payable to City of Fridle 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 accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codas; that 1 understand this is not a permit but only an application for a permit and work is not to start without a pennik 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 Applicant: Date Date: Approval Inspector Sign 7 �