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AF - 42914. �* * * PION��A * ane near * * �* SURVE70RS • qVIL ENpNEERS LAND PLANNERS . IANDSCApE ARCHIlEC75 Ceriificate of Survey for: Ho use Ad dress: House Model: 2422 Enterprtse Drive Mandota Helghts, MN 55120 (s�z) ss�-1914 FAX:681-s4es 625 Highway 10 N.E. Blatne, MN 55434 (612) 783-1880 FAX:783-1883 THE RO TTL UND COMPANY _ 167-177 Christenson Court Gab�e TownhomP 81.3 61.8 _7.87L S89 3 � op N 0 M� � � 23 ii � '� N 1'FV. V V 0.5X 59.3 -- — �$�'46'40"W --�- / - �" CHRISTENSON CO URT ,-- ----------------------------- �------ _�---- ---z_ ------� i i ' � i � x 900.o Denotes ExJsting E/evot�� � Denotes Proposed Elewotlon —�- Denotes Drolnoge Flow Direction — Denotes Drolnage d� UtilJty Easement —o– Denotes Monum�t –+– Denotes Offset Iron Becrings shown are assumed i------� i � P�POSED BUII.DING ELEVATIONS Garoge Slab Elevotion: 860•91 (at door) N07E: Propoa�d buBding slt� gradfng � tn aecordancs �rith ths 9►a�9 P�s aPProveA by the dty anqineer. NOTE: Contractor muat verty ap dbnendons Q� drlveway deelgn. LOTS 24-29 . BLOCK �2 CHRISTENSON CROS5ING ANOKA COUNTY. MINNESOTA We hereby certify that this aurvey, plan or report was prepared by me or under my direct supeMsion and that I a duly licensed Land Surveyar under the laws of tha State of Mtnnesota. Dated this l, S�_ day of Uc'��b�� A.D. 19� Signed: PIONEER ENGINEERING� P.A. �—� Scale. 11 �h = 30feet By. ��.Q � � Q� Robert B. Sikich, L.S. Reg. No. 14891 or I 3 16190063 TeRence E. Rothenbacher, L.S. Reg. No. 20595 sue�ecr PERMIT NO. City of Fridley � � � AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ���`�� r � � RECEIPT N . � • COMMUNITV DEVELOPMENT DIV. � ; V ������, r � � PROTECTIVE INSPECTION SEC, q�� � � , � ' � ����1 � CITY HALL FRIDLE� 55432 NUMBER AEV DATE VAGE OF APPROVED B� �""� � ��' 612-571-3450 910-F15 10/14/96 � / J08 ADDRESS 177 Christenson Court NE t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 29 ,�, Christenson Crossin SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE The Rottlund Co. 2681 Long Lake Rd, Roseville NIN 55113 638-0500 3 CONTRACTOR MAILADDf;ESS ZIP PHONE LICENSE NO Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO. Timothy Johnson 2681 Lon Lake Rd Roseville MN 55113 223 0 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. ETS Inc 220 S Ma.rion Rd Sioux Falls SD 57107 19015 6 USE OF BUILDING Townhouse & Gara e 7 CLASS OF WORK � IdEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Construct a Townhouse & Gara e 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Paid Park Fee of $375.00 per unit =$2,250 Total.' SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING, HEATING, TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV IOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT AUTHOFIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS ypLUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WI�L BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT Se2 167 Christenso Court NE DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHAfiGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMAN(�E OF CONSTFUCTION. Se2 167 Christenso Court NE PLAN CHECKFEE TOTALFEE � c�'�- � a/ `� See 167 hristen Cou NE SIGNATURE OF CON�AACTOA O AUTMO IZED AGENT IDA E� qOPERL V ATED TH S VOUR PERMIT • '/c5/�S'� SiGNATURE OF OWNEA��F OWNER BUiLDEAi iDATE� INSP pp7E Prepaid Plan Check $ Fstimated QoSt $ os ��t # � ��_ _� � � .� � ���«. : � �� , . . i� � � � ��� �i � ry .♦ -. ���.� • • •�• - J � \ _ �\ -._ �- « • • S ��• ► y . _� � �L!� � � •.�• ' ■�_ ���r .►I _ _I � 111�. _ . •_ ��. �1 w'� a�V'I'RACIt�R & ADDRES.S �.t� � �aa�ss . Ehgineer � Address _ Effective 3/1/96 . ��� b� 7AI1]11CJ S�lo� Tei . # <03� � O�,�cao Tel.# �.# 2rL3�c� �.# lqol5 • �' �, - •.. . - _ . �- « .- � ►. •!� ► ��! :..L� � � � ; ► � � r � � , '. � `� � �. � . _ � � �, ' •'• - • - � - �i _ /� _IL.I � ' � I , � _ iL - � i r� �� �: - .� _/ � � BUQ�IlQG DIl�I�S Length 1,3� �- �� Width �- 01 Height.� , A V(s Sq . F't . a.,��j g # of Stories� oFC. AREA: TPr,�th �T.SE AREA: Length aIT�R AREA: I�ength Width Height Sq. Ft. Width Height Sq. Ft. Width Height Sq. Ft. VALiTA'1'ICB�T Sq. Ft .�, q � S x$ �� J'c Cost/Sq. Ft .= Valuation $,�,-rj •�7" sc�. �t . 1 �R� x � �st/sc�. �t . = valuation � ,�, 7 �$ .� _ � �o � �.0� D� %, °t' Sq. Ft. x$ Gost/Sq. Ft. = valuation $ ) Z�l�L VALUE Builcling Use��l�l'C1AL Construction 'I�pe " Occ�1cY GrouP �' � Air Conditioning �Yes [] No Fire Protection Pravided ❑ Yes �No -�'mvNNlbnn�y Perforn�ance Band Amotmt $ See Reverse for Schedule Received [] Yes [] No Permit Fee $ Plan Check $ Fire Surchazge . $ State S�rcharge $ SAC CharSe $ Erosion Control $ Park Fee $ spec. Assessn�nts $ DriveHray Escsow $ Z�OTAL $ See Fee Schedule on Reverse Side In �ccess of Prepaid Amr�unt - See Reverse Side .00l x Pesmit vatuation (1/loth %) $.50/$1,000 Valuation (See�Sched. for > $1 Million) $900 per SAC Unit (Plans to NdnTCC for detexmi�ation) $450.00 Cbnservation Plan Review F@E DEtEY'[TL'1112C� Bj7 FY�� naPri r�r Agreem�nt rTecessazy [] .Not Necessazy [] feet x $13.50/foot $1 to 500 501 to 2,000 2,001 to 25,000 25,001 to 50,000 SO,QOl to 100,000 100,001 to 500,000 500,001 to 1,000,000 1,OU0,001 anc� up $1 to 2,000 2,001 to 25,000 25,001 to 50,000 50,001 � to 100,000 100,001 to 356,000 Over $356,000 BUILDING PERNYiT FEE SCHEDULE $21 (Nlinimum Fee is $21 plus surchazge) � $21 for lst $500 plus $2.75 for each addn'1 $100 or fraction, to and includ: $2,000 $62.25 for lst $2,000 plus $12.50 for each addn'1 $1,000 or fraction, to a including $25,ppp $349.75 for lst $25,000 p1us.$9.00 for each addn'1 $1,000 or fraction, to a including $50,000 � -• .:. _ $574.75 for lst $50,000 plus $6.25 for each addn'1 $1,000 or fraction, to a including $i0p,ppp $887.25 for lst $100,000 plus $5.00 for each addn'1$1,000 or fraction, to a - including $500,000 - � � $2887.25 for the lst $5�0,000 plus $q.,25 for each addn'1 $1,000 or fraction, and including $1,ppp,pOp . $5012:25 for the lst $1s000,000 plus $2.75 for each addn'1$1,000 or fraction PREPAID PLAN CHECK FEE SCHEDULE $29.25 $29.25 for lst $2,000 pla�s $5.85 for each addn'1$1,000 or fraction, to and including $25,000 . $163.80 for lst $25,000 plus $4..225 for each addn'1$1,000 or fraction, to and including $50,000 � $269.43 for lst�$50,000 plus $2.925 for each addn'1$1,000 or fraction, to and including $1pp,000 $415.68 for lst $100,000 plus $2.275 for each addn'1$1,000 or fraction, to and including $356,000 $1,000 (Balance due with issuance of building permit) PERFORMANCE BOND POLICIES When a building permit is issued for a commercial, industrial or a multiple dwelling residential project which require outside improvements,a Performance Bond or a Letter of Credit shall be submitted to the Ciry. The bond will cove all outside improvements, including but not limited to landscaping, irrigation, curbing, blacktopping, screeni.ng fence� lighting, and storm drainage systems. � Calculation of bond amounts will be determined by the building permit values. The bond amount will be 3% of th building permit value up to a 2 million dollar project or a$60,000 bond. Actual amounts will be rounded to the neares $100. The City reserves the right to require greater or lesser bond amounts based on unusual circumstances. Project. with no outside improvements, generally will not require a bond. Bonds must remain open until the project is fully completed. All bonds will be held over one winter and through the next growing season to insure the survival of all landscape imstallations. The City will then inspect these propertie: in August of the year following the in.itial pla.nting, Bonds may then be released in October of that year if al improvements are satisfactorily completed. � )� � � r. � ;. • i �; ;, � � �JI'07 G'1 7� � JF�0�2�19�7 � .1ed .i TTUHe , ., � A678F � ' F6 � �pe�ar Yn�► a 6�m� : ; 2.8-4 �i . iV•VW'71� uvr�*.ru��.... .��.. —•— 15123 6UPAaIQR TRiJ95 ��T� .�.., . � � . . ��� 1 . i �.� . ......�..�., „ . ' ' a.� t � �'' �'X �`l�-C�" � � '�`� t�N�,,'SrG�' t�p 7ap GH��d , ��.c�E ��li �l�klr.r,�t Pr�kid �A:I,1 1,p���. S� �N d'1•C . 0 P.001/���L ' ..��e...... �.. . —� .- .. .•� ��t��tlern �nne11 � 1,_ 1�„ 1.1i �=t�4 /�J �" A1�s-: �+� '� "�i� ..� ..., ,t3. �.,,,�I� � I; . � . ,„ k , • :� , y�w • . �` ' �% �� p�UII� �'��� � . � � � oN��a�d$ ��' • 9`' =� , ,�+ :" . �. � _ ,g,x�a I �; � • � � . p ' '' I bereby Cort P�i��� �. ,' � �-� p� E �1•��C , � r� � ; �nnd thAs ( a+n +• otossi Lit�t+tdeot•unde. t . I. �' S�ako � and Ihof t am � �•'•' . . 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U � tG = �. c � o ... � O � c C O O } � O O � � � o � U � � � Q 3 x 9 c 0 CHIlVINEY AND STACS VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefiilly examined Yes () No () 2. Is fr�e from rust or deterioration Yes () No () 3. Has no foreign objects lodged within Yes () No () 4. Is securelY �PP�� Yes i) No i) 5. Meets all current Code requirements for size and total B1'U's conn� Yes () No () 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes () No () 8. Has combustion air been provided for water heater Yes () No () Remarks: List ALTERATIONS B�ing Done: HEATING CO: Signed By: Date: r MttY,.?,_ o � Z 1�tNAi1[D BT OFl • .�►,�E o� �o���+.��m - ���eo OG4TION �iL.^i(y � ��N' �� r�eR ustn ie• - — ,�u. x � I 2e .' • ITtM A�4 O� SYM WIM O� OnwrTirr Tpl►.O�/I. 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JIiION�I HEAT GAINS o�n F w,►rn x �.� x x x Su� x x i- Su� � ►lf �Y�►�� T DuC1 /a� T G��■ �6 + lc�R. lo�t 9C + N, � r000� Als Crr X F EFFECTIVE ROOM SEM: LATEtiT' M8J►T O�TIONA� H��T GAI»i � i Yo vnu rtrT: 'Y�� :f .� Ca�• e � C �/t � 0 � �.o� � E{71MATL /0A ������{ � I rNR LOAO j� L D1 G, Dt�rc�[scc � I x X X I x x z � x X x I ouTOOO� w�e YtMTb �orat X Cni►t�w• — LAT1or � /t X Cr�/N fr �_ Ct/ Yt11T1U1T10� ■ �tro����� DOO�! �wrtt X Ci//r��W� _ — O�LN D0o11t Ooort X C�+/Oea� __ lan�. E1r�u�1 F�■ f YTIO� GAC< <LL7 X C►�/1T = � Lr� � ��tr�►r�or �1 CFY OVTDOOR AIR TMRU APPARATUS ■ A►►ARATUS D[WV01MT crrccti•• E��ccrivc Roo■ Sc�s� Nc.r [SHF �Rwt Mc�r = E►sttt�rc Aoor Torat Nu� — r,►cto� AD) INOtGATED AD/ - F SEIECTED ADP =� DEMUMIOIfltO AIR QtJANY1TY j�jj� f1•— BFI Y tT„ F—T,e� F) �_ pC�� , E��tcr�rt Roor S[•�. Mcwr _ 1.0a X F •tr�. u�a Out�tT Roor StMS. Hc�T Ttr►. — F1��.��.� D�//. � ew x [rr _ SUPrIY ,.�a QUANTITY Su►►�1 Roor SCMS. H[�r CFII - 1.Ob X F �iuu� ��i► er.+�i _ CFM Cfr„ - CFY,,, _ QESULTIliG [M'! b LVG CONDITIONS .►T I�PPAR EDB T..—F+ Ccra. x fTa��-7.,,.�...F) =T Clri �oe T.or—F'i" ��BF X(rts�—F � T►a�_F) � T EROY PSrCM. CNART: T�„� F, T��� f ��q.� �05.5 � l�107Lt �o�: (O �a'c . pz4 x S� = 1 � 3 (v �e,�AcV L' L�`� �J�t � p L f Z�.. ��= �� l?�% v�sS: z4L,� . �� x ✓ �i = lZ� �v ��,nv� : z4� e� . � p�- �'F Zt t Z P6� ; q� � . 13x � � � 4�� �vY-; 600x t.o�j� ��v " ��r 4 2� C� Z°1 c�. 3 Mf31�1 OUTQOOR AIR M�/1T , ' � Cr� X F X(1— �f I X I.o� �1 � C►s �v�. X(1 — bFl X e.n (i�7/�0� Rtro��t SY� i0T11 h/ Mn �� q�r �w, �n��.��� ��•w► t� •�• a��•�� rrr��uc� �r � O�Ct M� • Ot.��. � «uu� �•...u. 1 1���. Cur 1 �v�• :� hN le�� �..�• �������� � �uN�� .. •��wo� ��� .�r.�. .��, •�a ��s.�• cr.. G 4 A N O T O? A l M E� T Z�j �':i ••�� �•••••�•� �mu u� a.... .0 .�...�..�. i... A1R COND1710NING LOAD ESTIMATE -- FORM E-20 (3-69) iNtli� � aF Z ' � £ a�od il� � �_ C�A�1� �xaTlor+ f'''tlIVN �'1"(7h1✓_/� � S�ac[ U�w Fo� ` -:'-?:�[ X Q � lTSr A�LA o� SVI1 G41M o� 0u��tin T[rr.O�ir. � f SOL.� fiAlfi----�.LAfs ?i°� SofYx r�cnRi��cR�cnuR. OLG fGL O��G �.vc — � .ttr C.sll�ts.i.r Gor�� — OAT[ sr�N f�A� ~~ �ieo� Mo-?�' "��`O�'13�os No � `! - •N M�r'�' � AIIROYEQ fACTO\ x (• � x I�� s��inwf SO R X X SOIJ1� 6 7MNS. GAIl�-WALLS b ROOf �� w�« S/�i so Fr x Z,g x- O�L �iw.�t 4D'�, so Fi x 1'J' x,� A'L �w.« 3�-� �F.x �Z x.o4z 1KAl� s0 Fi x iC OOI-�UM �� SO FT X �� X►QT/�' oor—SM�oto Sa Fr x x TR,►NS. G,wltt—[XCEt7 WwLLi b tOOF « Gu� 3/� su Fr x !I X• S� ci u. a so s�t x x .00. �Z � so Fr x� O x• INTEANAL NL►? :o.�t G� ►coru x �.�„ ►+� o. xw x , 1 . wwrrs x �.. x '►�I�NCLi. ETC. X �o�rra�•�� HEAT G.1ief Y �E�7 FACTO� •r�t �v►rtl CT GYCT I�• .r c.�■ � + tt.�. �o.r % + N. • �*000� Alll CtN X F EFFECTIVE AOOM SEN! U►7ENT NEAT rwrCrs. ETC. anoM�� H[�T G��Ms Y�� :} �w ¢ . � � a.it. x Su� ..x Fs*���ra roa �'OC` T'•` �uc �o�o Cu iT ��� b�l �ru�Noua v�.n�cMCC � r x z x I x x x � x: i r � OUTDOOR AIR � YtNYI. �ont x �G.�ls.�s. c .� L1110M /t X CirtN If = — Crr v�«�iut�or ■ 7�ua�a �[�e����� D0011! ��erU X C�tl/1c�w� _ Zr/v Ot[N DOO�� Ooo�• X C/�/Oeo� .: _ I�nb. ►,1M�Y�f F�■ TYTIM C�AC< <[R X C►r/IT = r Crr 1 tiar��no• � CFM OUTDOOiI AIR TMRU AIPARATUS � A�►ARATUS DEWPOIAJT I ttertt►rt En�Ctrv� Roor S[rs. Ht�r ESMf �[w� �[�r � _ r•croa Erracr�rc Roo■ To��� M[�r AD► tN01GATE0 ADI = F SEIECTEO AOP =__ p[HUINIDI/IID l►IR QVAIdT1T7 R�is (}'-- BF1 Y lT�• F— T.o. F� _— DCFM � E/►(CTI�L ROO■ Stw�. N��T L t.oe x F ,�... .,.. ^ Ourtct Roor ScMi. M[�►� Ttt►. = FI■■��r� �I��. t AA Y P�r . • SU�tIY A1R QVAIiTIT7 SC%Yti Roor SC■1. Mt�T _ I.Oe X F ��„�t� ►�r� er,�ia CFM <<�.. — Crr„ _ RESULTING LNT b LVG COPi01T10NS J►T APPAA. E09 T��—F a- CFra� X(Te��F � Ta�F1 = T Crrt lDS T.o►----f �-_8F X(Tce�—F — T•o.—F1 = T FROM PSYCH, CHAIiT: T�� F, ?��� F I�P'Y l'o5'S noru rv t2-oo�: �'j5Z X.p24���8= l�5`] WA VV� ��ilv � o� • o�'z- °C SP� v�'(o� � C9�'�' � t"7 � . �� X !%` � ����� F��i2� 3zOx . l c7 u�Sa = lC000 P��- �� X. 13 x g°� � (�co4' ��N`�' l�o X. �,o�jx ��! �� ��L� 77 53/��� ouT000R ��R NL►r , C�r X F x ll — df) X �.o+ �rti xZ �u�� X(1— siI x e.�• �'� 2�� TV ri ILTYI• Su� ToT�� •u �•I 0� p�w �.w. w��.��.• ••►.�• w�.• wo.�• wnnuc� �• • MIC7 M1 • O��Y�. • AMAe� NM�V. lt�� Ca�■ i ►v�• } �irt leo fu�� �.�uu� � u�rr�� �. �•.ro� ... �u.�. .u. •�� ���.ar er�. G N A N D T O T A L M E A T '� •��� �n���w �n.0 u� n��t. •�� n....n�. <�r AIR CONDITIONING LOAD EST(MATE --- FORM �-20 (3•69) _ _ CI�tY OF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FR[DLEY, MN 5543? •(612) 571-3450 • FAX (612) 571-1287 April 15, 1997 Rottlund Homes 2681 Long Lake Rd Roseville, MN 55113 Re: Final Inspection at 177 Christenson Court NE, Fridley, MN � Dear Sirs: A final inspection was conducted on April 15, 1997 for the above noted townhouse. We found that the construction of the building unit 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 unit. If you have any questions on this matter, please feel free to contact me at 572-3602. Sincerely, RQN JU ��WSKI Chief Bu' ding Official RJ/mh SuB�ECT c�ty of Fr�a�ey AT TFIE TOP OF TME TW�NS g � � L D I N G P E R M I T r � � � • COMMUNITY DEVELOPMENT OIV. ' j V �•'..'� f � � PROTECTIVE INSPECTION SEC. � . • � � �"'� � CITY NALL fRIDLE� S31J2 NYMeEn pEV DATE �""� � �'' 612-571-34b0 9to-Fts 3/5/99 109 ADDRESS 167, 169, 171, 173, 175, 177 Christenson Court NE 1 LEGAL ��T N0. BLOCK TNACT OR AODITION DESCR. 2!} to 29 2 • Christenson Crossing 2 PROPERTY OWNER MAII AODRES$ Z�P `Rottlund Townhomes PAGE Oi / / PE . 28984 RECEIPT NO. SEE ATTACMED SNEET 3 CONTRACTOR MAIL ADORESS Z�P PMONE LICENSE NO Town � Country Roofing 7910 12 Ave S, Bloomington, MN 55425 545-4233 � ARCMITECT OR OESIGNER MAIL AOORESS 21P PMONE LICENSE NO. 545-4233 S ENOINEER MAIL ADDRESS IIP PMONE LICENSE NO <�Townhomes 7 CUSS OF WORK � O NEW O ADDITION O ALTERATION �7 REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof Building (90 Sq.) Tear-off 9 CMANOE OF USE FROM STIPULATIONS Underlayment must comply with the State Building Code. ,; . . , ,.�ii4a_ riPE Of GON; SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING, MEATINCi, VENTILATING ON AIR CONOITIONING. TMISr PEFIMIT BECOMES NULL AND VOIO IF WORK OR CONSTIiUCT10N 20NING AUTMOR12E0 IS NOT COMMENCED WITNIN 80 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANDONED fOR A PERIOD OF 120 OAYS AT ANY TIME AFTER WORK IS COMMENCEO. NO. DWLG. l I NEflEBY CERTIFV 7MAT I HAVE iiEAO AND EXAMINED TMIS APPLICATION ANO KNOW TME SAME TO BE TRUE ANG CORFIECT. ALL PqOVIS10NS Of �AW$ yp��pTION ANO OROINANCES GOVEiiNING TMIS TYPE Oi WOiiK WILL BE COMP�IED WITH WMETMER SPECIPIEO MEREIN Oii NOT. TME GRANTING OF A PERMIT $�, 713 DOES NOT PqESUME TO GIVE AUTMOii1TY TO VIOIATE Oii CANCEL TNE pEpMITfEE PROVISIONS OF ANY OTMER STATE OR LOCAL lAW REGUTATING CON- STRUCTION OR TME PERFOqMANCE OF CONSTRUCTION �137.25 PLAN CMECKI 3 v�`��_ Lice S�GNAtUpEO�CON:AACTQ A�UTMOp�LEO�GENT IOATE� F� �D�iE� OCCUPANCY GROUP OCCUPANCYLOAO SO. fT CU. FT. OffSTAEET PARKING STA�LS GARAGES SURTAX $3.86 SAC CNARGE Fire SC $7.71 T :EE 5 0 153.82 vauo o rMis�rou�=� i Building PLUMBING Permit rTo;��9 - � �/ Inspections RESIDENTIAL APPLICATION Received By: � 763-572-3604 CITY OF FRIDLEY � vate R�'d: �-13 — c� 763-Jr�2-4977 FAX EFFECTIVE 1-1-09 DATE " 13 �O � YOUR E-MAIL ADDRESS SITEADDRESS ��1 e��,�e..�s7"�v�se��J Gov�- �C Lo� U��. R'S9� THIS APPLICANT IS: ❑ OWNER �ONTRACTOR PROPERTY NAME: OWNER/ pDDRESS: CITY STATE ZIP TENANT PHONE: CONTRACTOR NAME: a- C-t � Wj � f v t��"s i r•� 4� I-�.-e.. ��' �� q 1 w� SUBMIT A COPY OF STATE LICENSE # (0 3 C�� (�� EXP DATE Io� '.3 /' �% YOUR STATE LICENSE, BOND AND STATE BOND # aZ LI �¢ EXP DATE �02 - 31 �� J. CERTIFICATE OF pDDRESS: v�� �,p zTi(� I J�'1� ��t. CITY_ �j �� �O STATE 1V� � ZIP 533 i INSURANCE pHONE ��3" �a�� - �(�l� FAX �(o�J" N�S - �3RD PERMIT TYPE � SINGLE FAMILY ❑ TWO PAMILY �7'OWNHOUSE TYPE OF WORK: � NEW �jtEPLACEMENT DETAILED DESCRIPTION OF WORK (�-�p �✓.�L L,D V� ti41 VJ S 1-E (..7'f� �� t� �i� I V 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 fixtwe, 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.OS = plus .50 surcharge OR FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVi�. MINIMUM FEE $15.50. BATH SMK/LAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($3�) CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15) DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION WATER METER OTHER ,n . . � � . '.� �� �� ' ����:: �.� ,..� ' � � �.�����"�� F°x� a�:r �e-,„� ;.. 'n � _._ � S-- . r ��r � . �.� ,. , . ., . ,� �- . �,�o, . , .,,.. ,. .� ., . __ ..>-�__.,. .. . n:..�: , ..,., � ;._.. , a��i. . a ..;�a� ..., ' � ��u�,,,�'�. � �� '_ Permit Fee $��. oo Number of fixtures @$10.00 x$10.00 =$ Surcharge .50 Number of fixtures @$15.00 x$15.00 =$ TOTAL DUE $ �. ,� Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 IMLTM $15.50) (MINIMUM $15.50) Tota1= $ THIS IS AN APPLICATlON 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 th e o all work requires review and approval of plans. SIGNATURE OF APPLI PRINT NAME N�� J� � ATE_ ,�- I��O�I _ �j �"v�_.'_ ��Mclr�,�����.._�. ..� .����'���.a. _. .S .„�.'� e° �!����r�s"5,���:���;�, ��� �,� �,.�'�;� E__: s , � _ . . <. �_, ___.,..����� _. -. ... .�'�.._ . City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977