The URL can be used to link to this page

AF - 36110sua�ecr P MIT City of Fridley 18417 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � i � ' � CEIPT N � ; v ___�� COMMUNITY DEVELOPMENT DIV. �� r � � PROTECTIVE INSPECTION SEC. ` 1 � , 1 `._-_ � �r��;,, CITY HALL FRIDLE� 55432 NUMBER. REV. DATE PAGE OF APPROVED BY L J\ 612-571-3450 910-F15 5/7/86 � / JOB ADDRESS 6680 Central Avenue N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCF. L�D 1�11C1. SLlU. #2�. SHEET 2 PROPERTY OWNER MAIL ADDRESS 21P PHONE Michael V�hhite 6680 Central Avenue N.E. 571-2688 3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO. Same 4 AHCHITECTORDESIGNER MAILADDRESS 21P PHONE LICENSENO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 8 USE OF BUILDING Residential 7 CLASS OF WORK 0 NEW 0 ADDITION � ALTERATION ❑ REPAIR ❑ MOVE � REMOVE B DESCRIBE WORK FlI11S�1 BaSBII1P.I],'� 9 CHANGEOFUSEFROM TO 'STIPULATIONS See sti�aulati�ns on plan for egress v�rindows. ��E�I��TE PER�ittiS REQU��I� �FOR' W�E�tI��, �iE�°E'i��, PLf11��3��VG AfV� S1GN� SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHOFIZED 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 ], STA�LS 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 OF NOT. THE GRANTING OF A PERMIT yS%OO �. SO 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 OF THE PERFORMANCE OF CONSTRUCTION. �.rJ.00 PLAN CHECK FEE TOTAL FEE $15. 50 SIGN TURE FCON7 CTORORAUTMOR12E AGENT �DaTEi ° WHEN PROPERLY A IDATED THIS IS YOUR PERMIT �%�.�� `� 7-8� � SiGNATUFE OF OWNER �IF OWNER BUILDERI IDATEI 9LOG iNS� 1)pT 0 0 ( �l 1 ! � ! j ; �- i � i r r � � h � � � , � � . � , ; � � ___ � ' � . � •4 � � � �, \_ � ,\ � � � \ � �� , c �� . z `{ '�_ ` -�' va i � �� 0 a�r � W -•--� � 1 -- , ', , ( � \- ^ �� ;�� a� ( .T, .�: r.. `: � i � ` ' � � � � �\ "� � iY � 1' � ,`1 . -- — — ;� --� �- �� N m '' x � -; r v� �• o � O � � �� I � 3 ° �J 3 �� n t " 2 Z. � � • � -� � � � A� - � o I I� { a `�, a R T �� .� � c �� , E � � �- , . � `� F _ i� � H � �l _ �Z � � _ _: ? . Z.. Z —� ' NEW [ ] ADDN. [ ], ALTER. [ j�� Construction Address: Legal Description: City of Fridley �R-1 AND R-2 Building Permit Application (O (J �� 1..� �'�t�v-cc. l � V � �!/ � J" U`t � �� Effective 4/1/86 Owner Name & Address : �«��°-'� / �� "! � �`� Tel . � � 7� 2 �' 8 � Contraetor: ��I '�y' Tel. # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROYEMENT LIYING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECR AREA: Length Width Hgt/Ground Sq. Ft. OTHER: � ,��,�,�� s � liCc�Z sY1 �e /�i %— � fi`"U� �d�.�� C.�A6�1 �O � Corner Lot [] Inside Lot [] Ft. Yd. Setbaek Side Yard Setback Type of Construction: Estimated Cost: $�� ` �� Approx. Completion Date: � ��5 Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation c DATE: J � ^ �� APPLICANT: /�� Tel . � `� � �-2 G �� Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY IISE ONLY � l�l�U $ �� $ , J� $ �_ $ c"'�- � g l S, �t� Fee Schedule on Reverse Side 25� of Building Permit Fee $.50/$1,000 Valuation $475 per SAC Unit Fee Determined by Engineerin� Agreement Necessary [ ] Not Necessary [ ] P a E T BIIII.DING PERMIT FEE SCHEDIILE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or strueture, or for any alteration or repair to any existing building or structure, upon applicatio n therefore, require the payment by the appliCant For sueh permit of fees to the amount herein below set forth and in the manner herein pravided to-wit: Total Valuation Fees $1.00 to $500.00 $10.00 (Minimum Fee is $15.00) $501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for eaeh additional $100 or fraction thereof, to and including $2,000. $2,001.00 to $25,000.00 $32•50 for the first $2,000 plus $6.00 for eaeh additional $1,000 or fraction thereof, to and including $25,000. $25,001.00 to $50,000.00 $170.50 for the first $25�000 plus $�.50 for eaeh additional $1,000 or fraetion thereof, to and including $50,000. $50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each additional $1,000 or fraction thereof, to and including $100,000. $100,001.00 and up $433•00 for the first $100,000 plus $2.50 for eaeh additional $1,000 or fraction thereof. DRIVEHAY DEPRESSION ESCR�i (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13•50 Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approaeh with 6 inch depth - Driveway width plus 6 feet times $15.75 VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, shoWing the location of the foundation once it has been constructed will be required before proceeding with the framing. _ _ -° zP :. % V SURVEYtNG & ENGINEEAlNC; (,`Q. 5300 HIGHI'vAY 101 SOUTH, MINNETQNKA, MINNESOTA E,5343 EXPLQRATQRY SUIL BORINGS FOP�: JerrS� 4Yest1t2nd on Lot 4D, SECOND hEVISION AliDITORS StiBDIVISIOi�' `=21 ��r fr1 � ��0.c�� I � ! (f " �7 a. O � ' "' ) � l�� aY ' 7�� - 1�2� L % . SUHVEYING R ENG/NEFRlNG CO June 17, 1983 Jerry jtiestlund 12164 I�4ississippi Drive Champiin, Mn 55316 Gentlemen: (612) 474-G°:)S 1 530U HIGHWAY 101 SOUTH, MINNCTOPJKA, M{NNESOTA �i53•;3 ftE: Lot 4D, SECOND REVISION AUDITORS SUBDIVISION #21 At yaur request we have conducted a preliminary investigation of soil c.onditions in Lot �D, SECOND REVISION AUDITORS SUBDIVISION �21. The investigation consisted of ex�loratorq soil borings taken to aid identiiying soil and water conditions. The borings were taken at the locations indicated on the attached la,y-out. Surface elevations are k�a�ed on i,he ti'orth American Datum. I?�TtiESTIGaTI�N hiETHODS: �: total of t«�o test borings as shown on the attached layout �vere taken on June 16, 1983 with a truek mounted auger drill. :1lineral soils encoun�:E�x�ed in the borir�gs were texti�rally classified in accordance �uith the L.S. Buieau oi Ghemistry and Soi1s Classification S5=stem. �1 cap�= of that cl:a.rt is att�;ched. The borings �4ere �r�.hed irr.meciiat�Ty after completion for the presence of ground cvater. RESULTS: The borings encountered sand underlain by firm silt. iYater was encountered at 11 and 18 feet in th� b orings. REC014I92ENDATI QN S : The soils encountered are suitable for the support of single fa��ailv residential constructioa. - Of necessity, the area of the borings in.re.lation to the area of the site and the.depth of the borings are limited. Suggestions and recommend.ations of tnis report are opinions basecl on data �btained from the borings. ADVAidCE Si7RTTEYII�TG�$;,�I,NGINEERING CO. � , __.--� r_� �{� �� -(��! Jam�s H. Paz•�c�r; I�r•esici��nt: P'E: �, I:.S. _i i% J s. r. -;� ;.- ._. ...,. ! -��. �� '�! � � �� -�` .� W 4�� f��> SURt�fY/NG 8 ENGlNFER�NG CR. �� N;;u�tCT – — EXPLORATORY SOIL BOR�NGS FOR: �, Jerry �Vestlund at Lot 4D, SLCOND REVISIO�V' AUDITORS �:_�,�:. S UBD I V I S I ON ,= 21 . -�. - �l,:v. Depth DescriprlQn �� MQterials :,�..., .�. � ; � T�psoi � 4 � 7.5 11 13 17 1 Sand, Damp �aizciy loam, B ac " Sand Sa:nu"�`v loam �w-�lac �' �9h ite f ine, sand, I►?oist Fine Si.lty snad, hioist Firm Gre1- Gl�;�eyT Silt , Gray C1a.V . Fixm ; B o R f N G T. x.�1 __�,°°�� LOCATION See site plan DATE �/17/83 SCALE 1'�=3� • BPF WL�Tests or Nop�s e Water enc:ountQ��F:cl � at 18 Ft. F • � �,�' };� � � , [� !�i,/% � �t �. y� , „�� .d��,.��, E� �.d _.;�.'� A�t:1 'ti1.i ,��.� � `E,.� 3 � C �� 8 �' �,�., �a� p � SUR NG 3 FNGtNEER1NG CO. Fa � tl� '.,..-s,� _ j � � '�' . �. �..,,� ��•.�s.+..,�..,.,�.,..r.: e �� R� � E C i — EgpLORATORY SOI L BORIPdGS FOR : �_� � R 1 N G T. H. .#2 x k - -- o�� Jerry �'Jestlund at , Lot 4D, SECOND REVISION AUDITORS SUBDIVISION #21 `�'''�`r. D�F�� Description of M�te; ia(s .. � .� � 3.5 4.5 ■ � 1� 14 .� � ,� � � 6 � _ � � _ .. Sand Sandy- loani, Black Sand; I�iottlec� Silt , ZOCATIOP,! See site plan �--a- — ____ DATE6 17 $3 SCALE 1"=3' � �_ BPF ',NL Tests or- Notes �� a--.��. � Water encountered � at I1 Ft. � 8 �� °I �. 1"=�0' SIT� PLAN r--- --._._ _ __�__ �_ __.._.---..__. `__ � I � � T.H. �1 i ; � � � � i � i T.H. �2 I � i �� l I i w � z �a � � a � x E� � w U � ' '�� . � a g . . _ _'_'___—"_-___ f� .. __ __. _ . . . . t � � (�� 9G � �? � V O p O J C� !�� / D Q .� `�o � `� 70 s'. r � . � �F � � ' � .c� �� 6 0 }1 _ . ¢v so � C L AY j,; . / �'��► � ' \ • _I , �sc° , � _I � '� �' ; �� r , '� ei► � '\ � � '� �� \ � � \ f I ; �0 i �o A1�DY \ ;' / S! L�° �o F� �' C LAY � Ct.A`l �� P p 30 '�.+� SANDY CLAY � SILi� �L�Y � ; o LOAAA �LAY L(JAP� L��/ a �o � �.oa� �� , , . . 20 � : �o ' ��- SAN D Y` LO A�A ��, S� LT LOA M - O� � \ � O \p �p �p a h� �� o �o � 0 SILT-StZE FR4CTIOM IN PER CEMT � �� 'EXT�R�►L �L.��SiF'i�ATi�� H�R�' ADAPTED FROM U.S. BUREAU OF' CFiER+IiSTRY �4ND �DIL.S S1��S �F Spf�. S�PARAT�$ F�AGi101d �At�ilCL� DIA�IET�R SAN�.- __------ F'ROh! 2.0 TO k9. 0T4 �kl. g t� T_.. _,_.---- F�q0A8 Q.07� T� O.00i� A��.�. C�s�: ___._` _� ��38 TfWAB� O.t90� �dOd. . :. SuBJECT City of Fridley AT THE TOP OF THE TWINS g U I L D I N G P E R M I T f � � i � ; �L _ COMMUNITY OEVELOPMENT DIV. r j � PROTECTIVE INSPECTION SEC. 1 � i l.-_.��"" �'� CITY HALL FRIDLE� 55432 NUMBEH aEV DATE i 612-571-3450 sio-F�5 8/31/94 J08 ADDRESS 6680 Central Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION DESCR. (�,D Auditor's Subdivision 4�21 2 PROPERTV OWNER MAIL ADDRESS Z�p Mike/Barb White 6680 Central Avenue NE 3 CONrRACTOR MAIL ADDRESS Z�p D& B Home Improvements 1568 Ballant e Lane NE, Spring La 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP 5 ENGINEER MAIL ADDRESS ZIP 6 USE OF BUILDING Residential 7 CLASS OF WORK PAGE OF / / PHONE Park 554 PHONE PHONE ��3� EIPT NO. � � �� APPROVED BV SEE ATTACHED SHEET UCENSE NO. 784-0922 LICENSE NO. 7773 LICENSE NO. � NEW � ADDITION CJ ALTERATION p REPAIR ❑ MOVE ❑ REMOVE A 8 OESCRIBE WOHK Reroof House (20 Squares) Tear-off 9 CHANGE OF USE FROM STIPULATIONS TO Underlaym.ent must comply with the State Building Code. SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOO OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNIT I HEREBY CERTIFV THAT I HAVE READ AND EXAMINEO THIS APPLICATION 1 AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �1�SOO DOES NOT RESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMIT FEE PROVISIONS OF ANV OTH TE OR LOCAL LAW REGUTATING CON- TRUCTION OR TH F MAN OF CONSTRUCTION. $3S.00 j � � �/ � PLAN CHECK FEE icense SC SIGN URE OF CONTR CTOR OP AUTHORIZED AGENT -f TE� . ,�,,,�„ „� - ��r r,c�. � � ��Z SiGNATURE OF OWNER UF OWNER BUILDEii1 IDATEi o� nc �..�e OCCUPANCYGROUP SQ. FT. OFFS'. STALLS OCCUPANCVLOAD CU. FT. f PARKING GARAGES $.75 SAC CHARGE Fire SC $1.50 TOTALFEE $42.25 D T� VOU ERMIT � ^ � f)b7F NEW ADDN ALTER �l L1 [l CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Effective 1/i144 �� Construction Address: � (� �U Cj �� t' �._�� Legal Description: Owner Name Address: �G �C� � {�� t° `� � Tel. # �7 / r Z � � Contractor: � � �� Y��' �/��. `�ti' � S MN LICENSE #% 7 7� Address: f Sb`� �� %Gi.�+.1 �,�� ' � � Tel. # 7��i1—�' r' � � LIYING AREA: GARAGE AREA: DECK AREA: oT�x: Attach ta this application, a Certificate of Survey of the 1ot, with the prt�posed conshvctian drawn on it to scale. Lengfih Length DESCRIPTION OF iMFROVEAIIENT Width Width R�idth �� J Heigttt Sq. Ft. Height Sq. Ft Hgt/Ground Sq. Ft. Comer Lvt (] Inside Lot (] Ft. Yd Setback Side Yard Setbacks Type of Construction: °'� ,�- � � Estimated Cost: $ ' , � � L�� Approx. Completion Date: — � � �� (Cast on Back) Driveway Curb Cut Width Need�: � Ft. + 6 Ft = Ft x$ =$ _ DATE: � , / � APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL � ��.L1� $ l•�C� � S �7� $ $ �• C�� $ � $ $ $ ,�, � S Tel. # _�! � � Fee Schedule on Reverse Side .001 of Permit Valuation tl/10th%a) $.50/$1,�Q Waluation $8� per SAC Unit 55.�? (State Licensed Residential Contractc�rs) Alt. "A" or A1t. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agr�ment Necessary [ � Not Necessary [] STIPULATIONS: t _, - I3U[LUCNG PERMI�' FEE SCHEDULE "i'he Chief [3ui[ding Ofticial stiall, t�efore issuing pecmits for ihe erection of any building or stzucture, or for any addition tc� any cxisting building or siructure, or for any alteratioa or repair to any existing (�uilding or siructure, upoa aPplication therefore, rt;quire tite payment by thc applicant fnr such permrt c>f tu:s to the amouni l�erein below set tc>rtif and in thr. manner hereia provideci ta-wit: "I'O"I'AL VALIIG $1 to $S00 $SO1 to $2,000 $2,OOi to $25,000 $25;001 to $50,000 - $50,001 to $100,000 F�ES $15 (Minimum Fee is $15 pius surcharge) � 15 for Crtst $SOp ptus $2 for each additional $100 or frac�ion thereof, to and inciuding $2,000 � $45 for first $2,ppp plus $9 for each addit[onal $I;000 or fraction thereof, to and incluiiing �25,000 � $252 �for first-$25,Opp pl�.s $6_SO for each additional $1;OOU or fraction th�eof, �o. and including $50,000 -- $414.50 for fiist $SO,OpQ plus $q._Sp for each additional $1,000 or fraction thereof, to and including $i00,000 $1(30,001 to $500,000 �$639:50 for f-ust -$100,ppp p1us� $3_50 for each addifional� � � $i,000 or fractiou thereof, to and including $SUt3,000 . $500,001 to $1,000,000 $1,000,0p1 and up $2039.50 for the first $500,000 plus $3 for each additional �1,000 ar fracfion thereof, to and inciuding $i,000,000 e $3539_SO for t�►e firs� $1,000,000 plus $2 for each additiouai $1,OOQ or fractioa thereof - DRIVER/AY DEPRESSION' ESCROW (Concrete (�uri� Sireets On1y) Alternate "A": R�moval and replacement of curb an.d gutter oniy - Driveway width plus 6 feet times $I3.50_ Alternate "Q": Removal and replacement of curb and gutte,r and install a 3 foot wide approach with 6 inch depth - Driveway width pius 6 feet times �15_75_ VERiF[CATiON OF FOUt�tDAT[ON Permits for constzuction will be issued a minimum of 24 hours from the time of a�plication to allow for proper review of thc proposeci stnuciure and of the construction site_ A Certificate of Sun+ey of the loi, sfiowing the location of the fouc�ci.ation once it has it has been consUuctui wil! be rc;yuireci before proceeding with ttie fram�ng_ .,_ _ b., �, Building PLUMBING Permit Ivo.. 6 Inspections COMMERCIAL APPLICATION Rece� ed By� ��° `. Q 0 763-572-3604 CITY OF FRIDLEY Dat�`Y��d: 763-502-4977 FAX EFFECTIVE 1-1-2010 DATE YOUR E-MAIL ADDRESS �+ � a�I�� ` 1' p't�J SITE ADDRESS �C�� }��,� N�' - TENANT �� SUITENO. PROPERTY NAME: �B OWNER/ ADDRESS: �t� C��P IV'�-s CITY ��,,�:,� STAT ZIP�� TENANT PHONE: CONTRACTOR NAME: 1/�!tl T ��,p 9�4� SUBMIT A COPY OF STATE LICENSE # EXP DATE YOURSTATE LICENSE, BOND AND PLUMBING BOND # EXP DATE CERTIFICATE OF ADDRESS: � I��D�j��7B CITY ��: �� STA ZIP INSURANCE PHONE � I'�f�pT ' I�'` FAX It�'�b' �I"I%� r�i�� PERIVIIT TYPE ��STITUTIONAL ❑ I�YJLT[-FAMILY ❑ SWIMMING POOL 0 TOWNHOUSE �'COMMERCIALJINDUSTRIAL � OTHER TYPE OF WORK: �' "EW CI REPLACEMENT � ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK '� � � i� � � � ' � FIXTURES: ([NDICATE TOTAL NLJMBER OF EACH) CLOTHES WASHER � FLOOR DRAINS _ RPZ VALVE _ URINAL �� DISHWASHER GAS PIPING BACKFLOW PREV. _ WATER HEATER DRINKING FOUNTAIN GREASE TRAP ROOF DRAINS _ WATER METER FAUCET _ KITCHEN SINK �SHOWER y�,E�. _ WATER PIPING FLAMMABLE WASTE TANK LAUNDRY TRAY _ SLOP SINK _ WATER SOFTENER LAVATORY SWIMMING POOL _ WATER CLOSET Total Job $��1 ��`��• � All fees are based on valuation, including the cost of labor and materials. Valuation ---- - Permit Fee $��v, (1.25% of Job Valuation / Minimum fee: $35) Surcharge $� Valuation X.0005 or Minimum .50 Total Due $�� Make Checks Payable to: City of Fridley THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all work which reyuires r iew and a proval of plans. SIGNATURE OF APPLICANT � � P N AME ,�v �, �'�,�- I�� I�A� DATE: ��T 0 APPROVAL INSPECTOR SIGNATURE: DATE� G�� PLEASE NOTE: SEPARATE PE UIRED FOR BUILDING, ELECTRICAL AND MECHA1vI W City of ridley Building Inspections Department 64 University Avenue NE, Fridley, NN 55432 763-572-3604 FAX: 763-502-4977 Building Inspections 763-572-3604 763-502-4977 FAX DATE� SIT'E ADDRESS _ T'HIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND CER'fIFICATE OF INSURANCE PERNIIT TYPE TYPE OF WORK: PLUMBING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 7-1-2010 YOUR E-MAIL ADDRESS ❑ OWNER �CONTRACTOR PHONE: �6.3 �.'��%� ��Z� Permit No.: �V� � 3 ��' Received By: � � D��°��U G 1 2 2010 � STATE LICENS�#��/' �, ±�/y EXP DATE � �/� STATE BOND # EJ� DATE � ADDRESS: CITY � �/j'�P�� STATE ZIP�� PHONE r��--��-�- �� F,� ,��- s�� SINGLE FAMILY ❑ NEW DETAILED DESCRIPTION OF WORK ❑ TWO FAMILY ❑ TOWNHOiJSE �1 REPLACEMENT FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOV�. MINIMUM FEE $35.50. BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($35) CLOTI3ES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15} _ DISHWASHER _ LAUNDRY TRAY �,WATER HEATER {$35) FOR IIiRIGATION _ WATER METER _ OTHER THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I aclrnowledge that the information above is complete and accurate; that the work will be in confortnance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a pennit but only an applica n for a ermit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the c of rk �' ,c� requires review and agproval of SIGNATURE OF APPLICANT l� ,:L�rQY// PRINT NAME .'�O�SriC�YP� IE�___ DATE D��.7/f� City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building Ins�crions 763-572-3604 763-502-4977 FAX STfE ADDRESS l 2\O �3 ( 1T�S APPIdCANT IS: 0 PROPERTY OWNER/ TENANT CONTRAC°i'OR NOTE: SEPAI2A1'E CI'I'Y LICENSES ARE REQUIRED FOR GAS � xvnc. Si1BMIT COPY OF BOAID PER1191T TYPE TYPE OF �VORK: I � MECHAI�TICAL RESIDENTIAL APPLICATION CITY OF FRIInII.,,E� a PermitAio.:c�' ��'� `�� Re,ceived YOUR E-MAII. ADDRESS �,y,.,Y ) Y1-P Yl Q�� I• CC� YYl n n i An r/_ .,� r_ �� l�_9J'�� J "U�� N,�: �s et(�a r�asoN: ��,°��r � h� ENSE k G � DO - �� FAMILY O TWO FAMII,Y DETAILED DESCRIPTION �)F WORK I h S� (� � I a E7►P DATE S 1�► � V C[TY� (_/ i�I�� STAIE��Z[P �5�� F� 'I t� °3 - °� 3 �1 � �25s ❑ TOWNHOIISE ■ �� ►:� PER MS 1 bB.565 ths germit is a minimnm of $15.� or 5°/a af the t�al cost np ta SS(H! OU, whichever is geater, for the improvement, iuistallation or placement of a residential fixture, eacluding the fiYtUres. (This should retIect only the cast of labor ) OR Labor cost under $3(Hy =$ I 5. U. Labor c�st between $300 to $5(m = c�st of labor x.OS = FOR AROJECl'S Vlti-IERE I.ABOR NUMBER OF EACEI BELOL� Equipment Instalkd �DS 5500, FEES ARE BASID OA1 SIO.� P'�R FIXTURE, E.YCEPT Wffl&RE NOTED. FIX7VRES: (1NDICATE TOTAI. H9FG: ��f'tvnal� � A40DEL: C� IM �1� � iZ G SIZFIBTU �_ IvIFG- MODEL• SIZFIBTU A9FG: MODEL: SIZFIBTU A/C $25.00 FIREPI.ACE (GAS) �15.�1 _GAS RANGFIOVEN $10.00 AIR Tp AIR EXCHANGEER Sl FIREPLACE (WOOD} $3�.00 _AIEW GAS GRIL.L $10.00 _BOILTR $35.00 �FIJRAIACE $35.00 _GAS lJNff i�'fR $10.� CIIIMNEY LIAIER $10.00 GAS DRYER $10.00 POOL HEA7ER �".+5.00 DUCT �QRK $i0.00 GAS PIPING $10.00 VERTfII.ATOR S15_� PERMIT FEE PROJECTS F R UNDER $500 PERNIIT FEE FOR PROJECTS OVER $5� Pertnit Fce $ Nwnber of fixt�ues t� $l0.im x$I O.ilO =$ Surcharge $ .50 Nwnber of fixtures (a� $I5.00 x $15.00 = $ TOTAL DLTE $ OR N�unber of fi��tur�s @$ZS.� s$25.00 =$ Number of fixt�es �a $35.(� x$ 5.00 = S State e = $ 50 IMiJM 515.50 MINIMUM S Tota1= $��q_ TI-IIS IS AN APPIdCA1IOAI FOR A PERMIT-NOT V AI.ID UN17L PROCFSSED I heteby apply far a me�hnnical pemi t artd I acknowtec�e that the inf'ormation above � camplete �d accnrat� that the maak wiil6e m ca�o� wNh the ord'mancc� and codes of the City of Fridley and ith tlte eaota Canstruction Codes; d�at I undeistand tbia is aot a permit but only � a�lication for a peimit and work is not to start without a petmifi that the worlc ill be ' with ap�oved p�n in the case of all wotk whid� requ'ves rLroiew mui approval of plaaa. SIGAiATURE OF APPLIC T �'�f�' PRIAIT NAME�-e�t�er Cho� � r�r�DATE APPROVED BY DATE PL�ASE NOTE: S�P ATE PFRA9ITS ARE REQUIl2ID FOR BUILDING, ELECTRICAL AND MECHANICAL WORK City of Fridley Building Inspections I}epartment 6431 University Avenue NE, Fridley, M1�1 55432 763-572-3644 PAX: ?63-502-497?