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FROM : PIDNEER ENGII�ERING, PA
PHONE N0. : 612 783 1�3 Oct. 14 1997 04:�4PM P1
�* *„K r Ale[id0 Ot�ts. MN 5$120
'* (812} 881-181� FAX:881-9488
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ANOKA G�1NTY, NlNNESOTA ,
We hareby ceR�fy+ � th� �irvsY. Plan o� � xa� Pre�ed by ma or unQ�► my dlrect miperWelon and that i a duly Ikensad ,
� Sutveyor under !hs taws of the State af Mtnnes�ta boRed thts �gt da�► of dul�► AD. 19�!. •
Re�Tsqd� Atkl �►evvttoMB 7/29 97 Signed: P10I�EER ENGINEERIMG.' P.-A. .
e
R� t�� �tif� f0 4/97 i'.d►'�4�oY-r�► ,��..,
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sue�ecr Pf�+ll'f NO. y
City of Fridley `
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �����
r
� i • RECEIPT NO.
� • COMMUNITV OEVELOPMENT DIV.
� Vy �����'�
r � � PROTECTIVE INSPECTION SEC. p j��
1 . � '.� (<
� _ �'�'1 � CITY HALL FRIDLE� 55432 NUMBER i1EV DATE PAGE OF APPqOVED BV
�.__.1�-� '•� 612-571-3460 91aF15 10/24/97 / /
JOB ADORESS 142 Christenson Court NE
1 LEGAL LOT NO. 9LOCK TRACT OR AOOITION SEE ATTACNED
DESCR. 9 1 Christenson Crossing SNEET
2 PROPERTY OWNER MAIL ADDRES$ ZIP PNONE
The Rottlund Company Inc 2681 Long Lake Rd, Roseville, MN 5511� 638-0500 1335
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR OESIGNER MAIL ADORESS ZIP PHONE IICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDIN(3
Residential
7 CLASS OF WORK
� NEW ❑ ADDITION O ALTERATION ❑ REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Construct a 48' x 25' Townhouse and a 21' x 20' Garage
9 CHANGE OF USE FROM TO
STIPULATIONS See notations on plan. Paid Park Fee of $3.75.00.
w���! ��
Before d�g�ing� �}t tof
311 utility Ip�s�atts�
454-0002 _, , .
REQUIRED �BY LAVV
SLrPARi4TE PERl�i1TS . i�tl��p� F�
WIR1I�IG� WEATtNG, �PLUMBtNQ AND SiGI�,
TYPE OF CONST. OCCUPANCY dROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE FEOUIRED FOF ELECTRICAL, PLUMBIN(i, MEATING, .
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NINd SO. FT. CU. FT
AUTHOF;IZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOFi A PERI00 OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCEO. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STAILS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF IAWS yALUATION SURTAX Fire SC
AND OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �79�990 ��FO.00
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TNE pERM1T FEE SAC CHARGE
PROVISIO Y OTHER STATE OR LOCAL LAW REGULATING CON- @
S� OR TFj P FO ANC OF CONSTRUCTION. W762.25 $950.0�
( PLAN CHECK FEE TOTAI FEE
�-,� y� G�� License SC $5.00 $2,212.25 Inc. PF
iG ATUR oFCON�p CTORORAUTNORIZEDAGENT �DATEi WFIEN PROPE V VALIDATED THIS IS YOUR PERMIT
.e - P V �
S�GNaTUAEOFpWNEA��%pWNERBU40ERi �OATE� OG �NSP ��
NE�V
AJT�N
ALTER
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ConstructionAddress:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMII,Y AND DUPLEXES R-1 AND R_2
BUILDING PERMIT APPLICATION
�2 G�-i
S
��=
Effective 1 / 1 /97
� �� �
Owner Name & Address: 1 U� ��� l, ti;� �, ��� �L� ���„ . '
Tel. # /�, _ g-- _�p _
Contractor: 5���. MN LICENSE # 1?��� �
Address: �'�og � � ��� -���� ��v � L�E , Mi� 5511 Tel. �# _(� 3$ -- p�G�p
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: �
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IlVIPROVEMENT
� ZZy, 22
� d, , 7
Length �-� Width �� D� Height 2l ° Z�� Sq. Ft. ^���'��„ ,�
Length Z� ��� Width �� l� N Height I���o �� Sq. Ft. '9�'�,�/�; yq
Length a- Width — Hgt/Ground -- Sq. Ft. �- 7i 7C ��J
_ � � �9 qy � �2
Constniction Type: ��5/Q��J`Tj� Estimated Cost: $�,, f�,3P��
(Fee Schedule on Back)
Driveway Curb C�t Width Needed: Ft. + 6 Ft = Ft x$
_$
DATE: /D �-!� � z APPLICANT: _ � �� Tel. # �03� OvSZ
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Chazge
TOTAL
STIPULATIONS:
�� Z�
$ ��.
$ '�� �
$ � b��—
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$
$
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$ �
$ �, � / � . �S✓
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$950 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering �� � o-� 3�7
Agreement Necessary [ ]
Not Necessaty [ )
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Client:
Address:
Ciiy:
Phone:
Fax:
Comment:
Rottlund Homes
2681 Long Lake Road
Roseville, Minnesota 55113
638-0500
638-0501
YOUR BUILDER FOR LIFE
Project Name:
Reference City:
Daily Temperature Range:
Latitude:
Elevation:
Winter:
Summer:
Outdoor
� Bulb
-20
95
Company:
Representative:
Address:
City:
Phone:
Fax:
Comment:
Fuito slab on grade)
inneapolis, Minnesota
Medium
44 Degrees
834 Feet
Outdoor Indoor Indoor Grains
Wet Bulb HBLHuD1. �Bulb Difference
N/A N/A 72 N/A
75 50% 75 36
"Total Building Supply CFM: 878
Square feet of room area: 2,085
�ti��iU (�
Fiare Heating 8� Air conditioning, Inc.
Randy
9303 Plymouth Ave. N.
Golden Valley, Minnesota 55427
542-1166
542-3101
YOU CAN FEEL THE DIFFERENCE
CFM per square foot: 0.421 '
Square feet per ton: 971.676
Total heating required with outside air: 59,658 Btuh 59.658 MBH
Total sensible gain: 19,312 Btuh 77 %
Total latent gain: 5,812 Btuh 23 %
Total cooling required with outside air: 25,124 Btuh 2.094 Tons (based on sensible + latent)
2.146 Tons (based on 75°/a sensible capacity)
Calculations are based on 7th edition of ACCA Manual J.
All computed results are estimates as building use and weather may vary.
Be sure to select a unit that meets both sensible and latent loads.
�
�
-•'���d
>�.;�
Component Area Sen. Lat. Sen. Total
Description Quan Loss Gain Gain Gain
4A wndow Double Pane & Storm Clear Glass Wood Frame 202 6,336 0 7,110 7,110
8M Glass Door pouble Clear Glass Wood Frame 40 2,028 0 1,200 1,200
11 C Door Metal Polystyrene Core 38 1,643 0 422 422
121 Wall R-19 + 1/2" Asphlt Board(R-1.3) 1,858 9,402 0 2,412 2,412
131 Part R-19 + 1/2° Asphlt Board(R-1.3) 162 410 0 134 134
161 Ceiling R-441nsulation 1,114 2,357 0 1,127 1,127
20J Floor Over Open Crawl Carpet + R-30 14 45 0 7 7
23C SIabM/arm Duct 11/2" Edge Insulation(R-8) 26 2,392 0 0 0
23D SIab/Warm Duct 2" Edge Insulation(R-11) 130 11,123 0 0 0
Subtotals for structure: 3,584 35,736 0 12,412 12,412
Active People: 8 0 1,840 2,400 4,240
Inactive People: 0 0 0 0 0
Appliances: 0 0 300 1,200 1,500
Lighting: 0 0 0
Ductwork: 0 2.666 0 0 0
Infiltration: Winter CFM: 120.0, Summer CFM: 60.0 280 12,148 1,469 1,320 2,789
Ventilation: Winter CFM: 90.0, Summer CFM: 90.0 0 9,108 2,203 1,980 4,183
Sensible Gain Total: 19,312
Temperature Swinq Multiplier: X1.00
--•9uildinq Load Totals: 59,658 5,812 19.312 25,124
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Total Building Supply CFM: 878
Square feet of room area: 2,085
CFM per square foot: 0.421
Square feet per ton: 971.676
Total heating required with outside air: 59,658 Btuh 59.658 MBH
Total sensible gain: 19,312 Btuh 77 %
Total latent gain: 5�812 Btuh 23 %
Total cooling required with outside air: 25,124 Btuh 2.094 Tons (based on sensible + latent)
2.146 Tons (based on 75% sensible capacity)
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:3�•'i•.o o�.. ♦':E �\ . 1 . �.�\. \.....,;�., •• .h�.}.., }.a.. v..vS. ��� \ 4;a.�`�� •`.\`. .. .c�.}..�: 3. .`4. . �:� ..4 . V�\.R1
.,.... ,.». �..�, ;...:. ��tit`.;..�:• ..y;�.•.�. •. . '�� .`'3-...�,�.x,.�.. .. '�v.� a �'•..i.. .. ti.. ,.+.+.%:.,,...... �+> .. ti�\ w..�.. ��;�.:....�...�ti.1.,•� .
�:�:::::``.`1:::�a\.:.,•�.:.. t.. �\ � �\>��•��, \.. tti . • :?,\ . � . . .. :. • +. . . ?..c...,..+..a. � t�s:t•:•'..• � +..r., .
;:y}:•;}Q,y;ti:\�:y;.;•�;.;;.;•�\';\\\•�\��\ �\•T,.;��`;:\� ���'��.}`,:`iv�i�:;'A ::�'tiv�::�t`�.,'k,'$,�;. r�:,i.'�.,\:i`•'�.\�.\�\v}:\ �-�'�\��:��:��:��:���\Y,'t.�+.����h:+v:.+x.•.•.•,:v. ��,,.�.�. �.1 ��.\��'•\`��:�.? : ��.•, A•;•,y\\`
Calculations are based on 7th edi�on of ACCA Manual J.
All comp.uted results are estimates as building use and weather may vary.
Be sure to select a unit that meets both sensible and latent loads.
p
�omponent Area Sen. Lat. Sen. Total
Description Quan Loss Gain Gain Gain
4A �ndow Double Pane � Storm Clear Glass.Wood Frame 202 6,336 0 7,110 7,110
SM Glass Door pouble Clear Glass Wood Frame 40 2,028 0 1,200 1,200
11 C Door Metal Polystyrene Core 38 1,643 0 422 422
121 Wall R-19 + 1/2° Asphlt Board(R-1.3) 1,858 9,402 0 2,412 2,412
131 Part R-19 + 1/2" Asphlt Board(R-1.3) 162 410 0 134 134
161 Ceiling R-44 Insulation 1,114 2,357 0 1,127 1,127
20J Floor Over Open Crawl Carpet + R-30 14 45 0 7 7
23C Slab/Warm Duct 11/2" Edge Insulation(R-8) 26 2,392 0 0 0
23D Slab/Warm Duct 2" Edge Insulation(R-11) 130 11,123 0 0 0
Subtotals for structure: 3.584 35,736 0 12,412 12,412
Active People: S 0 1,840 2,400 4,240
Inactive People: 0 0 0 0 0
Appliances: 0 0 300 1,200 1,500
Lighting: 0 0 0
Ductwork: 0 2,666 0 0 0
Infiltration: Winter CFM: 120.0, Summer CFM: 60.0 280 12,148 1,469 1,320 2.789
Ventilation: Winter CFM: 90.0, Summer CFM: 90.0 0 9,108 2,203 1,980 4,183
Sensible Gain Total: 19,312
Temperature Swinq Multiplier: X1.00
:�one Load Totals: 59,658 5,812 19,312 25,124
Suppiy CFM: 878
Square feet of room area: 2,085
CFM per square foot: 0.421
Square feet per ton: 971.676
Total heating required with outside air: 59,658 Btuh 59.658 MBH
Total sensible gain: 19,312 Btuh 77 %
Total latent gain: 5,812 Btuh 23 %
Total cooling required with outside air: 25.124 Btuh 2.094 Tons (based on sensibie + latent)
2.146 Tons (based on 75% sensible capacity)
�
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a.� HOUSE HEATING TEST RECORD
�1
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ADDRE55�, �" °' _ APT. FLOOR CITY ._C�_SUBURB
OCCUPA�!QT �� �;?— - OWPtER
HEAT LO'e�'i5 • D T - G. INST. '� ,
SOLD BY �°° INSTALLED
El�ahical Work Gos Line Br
TYPE OF HEAT. GA FA H1N STEAM SPACE HTR. UNIT HTR. OTHER
GA DESIGN CONVERSION
MAKE ' - MAKE OF BURNER
Mod.l � � Modsl
Ssriab� � � Max. BTU Rating _
INP�IT `� � MAKE OF FURNACE
• Modsl
CONTROl.S
THERMOSTAT '� Heat�P� "��
Valve
Limit --.a
Limit Settiny
Fan Setting
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KIND OF LINER SIZE� yoNE ,,��
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Filfers Size umbsr �
Chimnay�Location Inside Outsids
Pilot Type � `y,.._" ��-� °° Chimnay ConstruNion
Pilot Maks ; �
Pilot Model Smoks Bomb �Mi►ing `
Pilot Timing '' D►oft ' `i Tsst Te� '� `
L.W. Cut Off Doo� Pressuro Li htinp l sf. �
Preaaure � 'Psrtsot COT � � Dote Tsstsd
lnput CFH Peresnt OZ Company Teating ��
Stack Temp. Percent CO Name of 7estsr
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C�TYOF
FRIDLEY
FRIDLEY MUNIC[PAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 •(612) 571-3450 • FAX (612) 571-1287
January 28, 1998
Rottlund Homes
2681 Long Lake Rd
Roseville, MN 55113
Re: Final Inspection at 142 Christenson Court NE, Fridley, MN
Dear Sirs:
A final inspection was conducted on January 27, 1998 for the above noted townhouse. We
found that the construction of the building complies, to the best of our knowledge and belief,
with all the requirements of the building codes of the City and the State of Minnesota relating
thereto, and permission is hereby given for the occupancy of said building.
If you have any questions on this matter, please feel free to contact me at 572-3603.
Sincerely,
e /
��s � ���
: .�' ' '
Building Inspector
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sue,;etT T NO.
City of Fridley 3 0 044
AT TNE TOP OF TME TWINS g � I L D I N G P E R M I T
r
S i. RE NO.
� `v __�_� COMMUNITY DEVELOPMENT DIV. ����
r � � PROTECTIVE INSPECTION SEC.
�
1 i �
' �"'1 � CITY MAI.L FFiIOLE� SS132 NUMBEA pEV DATE PAGE OF APVROVED 8Y
�""�" �'' 612-57�-3450 s�aF�s 8/11/99 / /
lOB ADORESS 142 Christenson Court
1 IEGAL L.OT NO. BLOCK TRACT OR ADOITION SEE ATTACHED
oescR. g 1 Christenson Crossin SHEET
2 PROPERTY OWNEfi MAIL ADORESS 21P PMONE
Carol Tranby 571-2721
3 CONTRACTOF MAIL ADDRESS ZIP PHONE LICENSE NO
Midwest Restoration F� Const 6319 H 65 NE Fridle 55432 502-1082 4267
d ARCNITECT Oii DESIGNER MAIL AODRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAII ADDRESS IIP PFIONE IICENSE NO
8 USE OF BUIl01NG
Residential
7 CLASS OF WOfiK
� NEW O ADDITION ❑ ALTERATION � REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Reroof East side onl 1
9 CHAN(iE OF USE FROM TO
STIPULATIONS
Underlayment� must comply with the State Building� Code.
riPE OF CONST. OCCUPANCY GROUP OCCUPANCV IOAD
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL. PIUMBING, FIEATING,
VENTII.ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANO VOID IF WORK Oii CONSTRUCTION 20NING SG. fT CU fT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTqUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 pAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTfiEET PARKING
I HEREBY CERTIFV THAT I MAVE READ ANO EXAMINEO THIS APPIICATION STA�LS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILI BE COMPLIED
WITM WMETHER SPECIFIED MEREIN Ofi NOT. TME GRANTING OF A PERMIT 1224 . GI
DOES NOT PRESUME TO GIVE AUT OiiITV TO VIOLATE OR CANCEL THE pEqMIT fEE SAC CMARGE
PROVISIONS OF ANY TMER OCAI LAW REGULATING CON-
S RUCTION OR 7ME AN CO TRUCTION L�.%.90 Fl e SC 1 22
PLAN CNECK FEE TOT FEE
� P�
S�GN4TU:�E OF C CR C A Op 4UTNOAIjED AGEN1 IOATE� ME P VALIO TMIS IS R P�IT
L � • —
S�GN4IUAE O� OWNEp��� O�NNEA BU4DEpi iD�iE� B G�NSo ��`Tt
�
NEW � �
ADDN
ALTER
�
Effective 5/10/99
[ l CITY OF FRIDLEY
[] SINGLE FAMII,Y AND DUPLEXES R 1 AND R-2
BUII.DING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner r
Contract�
Address:
LIVING AREA:
GARAGE AREAo
DECS AREA:
OTHER:
D �
� ��
P�
�
Tel. # �j'/ --�7Z/
NIN d�ICENSE # S'� �'
Tel. � _=.�bG' •% � �
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IlV�ROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft:
Width Hgt/Ground Sq. Ft.
� ,� � � _ r ,��- �� - ��a� _ �� � � �_�� � � _
, �
Construction Type: m/� ^ � s� timated Cost: $ Q
Driveway C�rb Cut Width Needed:
DATE: /
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Ft. + 6 Ft = Ft x$ _$
$ � ��
$ , .� �
$ �/
$
� �L C� 6
$
$
$
$
� � '�.�
CITY USE ONLY
Tel. # �� /`��8' �-
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,OQ0 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential -Cont�actors�
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
1. '�
BUII.DING PERMIT FEE SCHEDULE
The Cluef Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or structure,
upon application therefore, require the payment by _ the applicant for such permit of fees to the amount herein
below set forth and in the manner herein provided to=�vit:
TOTAI, VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
a r FEES
$23.50
$23.50 for first $SQa plus $3.OS for each additional $100 or
fraction thereof, to and including $2,Q�
$64.25 for first $2,0� plus $14.00 for each additioz�al $1,OOQ
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $1U.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $1�,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction ttiereof,=�to and including $1,000,000
$5,608.75 for the first $1,000,0(� plus $3.15 for each additional
$1,(�0 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and replacement af curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet tunes $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the tune of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundadon once it has it has been constructed will
be required before proceeding with the framing.
■
; �uild.ing L��`��
Ins�►ectian5�" ����
763-572-3604���
; 763-502-4977 FAX
�
�
S1TC ADDRFSS
7'HlS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CpNTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CFRTTIFIICATE OF
INSURNINC6
From: 612 822 5408 Page: 2/2 Date: 10/1 M2010 3:53:10 PM
� PLUMBIN�
��ESID�N'TIAL APPLICATIO
CITY OF F1�D��X y,
ADDRES$
O OWNER
NAA�—�rro� �
ADDRIiSS:�
rHOxE: �- 5 ..
NAME: � r� �
STATE L10ENSB � %
STATE BOND �t DZ�
Permit �To.c�� ��-� �' �1��
FJtP DATC
F,XP bATE
.
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l �.
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-y y. i
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ADDRESS: L�Z ��rV rS�L /i.� C1TY�i�I� S9`A'fE /j' _i.�L1P S.J���I
PHONE (P�Z '�ZZ ' �Zg'Z FAX �'S�`%3�'%� �.�
PERMITTYPF I!�°"'GLEFNvIILY
� oF woztx: I a rrsw
DETAII.,ED DESCRIP7'YON OF WpRK
❑ TWO FAMiLY O �OwNH0U5E
�E.PG4CEMENT
F&ESAREBASEDON$10.00PERFDCCURE,E7KCEP7'WHERENQ'fED, FiXTURES; (1NDICATETOTALNUMBBROFEACHBELOW}. MM[MUMFEB
i S35S0.
BATH SIIVK/IAV _FLOpii URAllVS SiIOWER WATER PIP�IG
; BATHTIJB (3AS PiPCNG (N�ED C1TY 1dC) � 3 WIl�IlV@TG POOL WATER SOFINER ($35)
i _ CLOTHER WA$HER KITCHEN S1NiC WATER CLOSEf _ BACKPLOW PREV. ($I�
DiSHWASHER _LAUNDRY7RAY 1 WA'fERHEATER($35) FORTRR7QATfON
R►ATBR MB'I'ER OTAER
_ _
I 1 � ` t� a i�':? ' . 6�t1#�'.i �' S i�{ �dt�:.,r.� > � , ��"a�" .'�:�:'r� ��i ��i�Ii1�R� i`�t�fl��1�9E1��3f ':�. � � , : �.H?�:;� ' �' � :• -`-
THIS IS AN N+PLICATiON FOR A PERMIT Af01' Vpa.ID UNTII. P�tOCFSSED
I hereby �gply for a gl�m,bing permit and I acknowledge that t6e informs�on above i�c complEtc and acc�aate; that the work will be in
conformence with the ordin�nces and codes of th City of Fridl�y and with the Minnc•.wra Can.�;truction Cadrs; that I understs�d this is
not a permit but amly an applicstion fo rmit d work is not to stsrt without a pe�mit an site; that the wark will be in accordence
with the appnoved plan in ttse �f^IiI—wo w� requires review end appra�v 'f plans/. ��
SIGNATURE OF APPLICANT ' r� � �_ PR[N'f' NAME �!•� G ^7 _ I bA'�B %Lf/I�/lb
City of FridIey
Build,iag Ynspections De�artment
6431 University Avenue NE, Fridley, MN �5432
763-572-3604
FAX: 763-SOZ-4977