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AF - 38064sue�ecr P , City of Fridley 2 5 E 51 AT THE TOP OF THE TWINS B U I L D I N G P E R M I T � ; � RECEIPT NO. • COMMUNITV OEVELOPMENT DIV. i ♦y ��'� r � � PROTECTIVE INSPEC710N SEC. , �j �!-�'/ � � v .� � � � `---- w �'�';.� CITY HALL FRIDLEV 55032 NUMBER REV o3��30/97 PAGE OF AVPROVED Bv L �� 612-571-3450 910-F15 / / JOB AODRESS 6406 Christenson Lane NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 31 1 Christenson Crossing sHeer 2 PROPERTY OWNER MAIL ADDRESS ZiP PHONE The Rottlund Company Inc ��X�� 2681 Long Lake Rd, Roseville, MN 55113_ 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 638-0500 1335 4 ARCHITECT OR �ESIGNER MAIL ADORESS 21P PNONE UCENSE NO. 5 ENGINEER MAIL ADDRESS 21P PHONE LICENSE NO. 6 USE OF BUILDING Residential Townhouse & Garage 7 CLASS OF WORK �1 NEW ❑ ADDITION O AITERATION ❑ REPAIR O MOVE O REMOVE 8 OESCRIBE WORK Construct a 42'6" x 25' Townhouse and a 22' x 20' Garage 9 CHANGEOFUSEFROM TO STIPULATIONS � See notations on plan. Paid $375.00 Park Fee. �� Before Q�ggp�8 calt fa �� pE�� REQUiREfl 1�`Ci� at! �►tr�ity locations �IRING, HEATiNG,�PLl�I�tBlNC AND�$iG1� REQUIf��p 2 _ . . . , BY 1„q1�C TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OF AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. fT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OF If CONSTRUCTION OR WORK tS SUSPENDED Oi; ABANOONED fOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFfSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX Fire SC AND ORDINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMPLIEO WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �ILO,074 $60.O�F �],20.0% DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE $AC CHARGE PROVISIONS Y OTHER STATE OR LOCAL LAW REGULATING CON- STRUC OR TH P FOR NCE CONSTRUCTION. �992,.2,5 $950.�� >""` PLAN CHECK FEE TA� FEE �� — 0` Licens SC $.00 $2,127.36 + PF SIGNATU E OF CONTRACT R OA AUTNOAIIEO AGENT IDATEI E P LV VA TED THIS �IS VOUR PERMIT f � � _ � S�GN4TUAEOFOWNEa��fOWNEFBUILOE�7i �OATEi B G iN riaiE NEW A.�LN ALTER x� [l [) ConstructionAddress: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION � G��/s � � Effective 1 / 1 /97 Legal Description: �'��/s'j��j`/,5��/ ��j�f a Owner Name & Address: � U� }�� (�,� -�� t� � N�„ Tel. # �n��p0 Contractor: S� �� NiN LICENSE # I 3�� Address: �'l�,g � j„�� F '� � �,EJ 1 LI.E , Mf� 51 ! Tel_ # !� �$ � O JG�p LTVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Cert�cate of Survey of the lot, with the proposed construction drawn on it to scale. ab . DESCRIPTION OF IlVIPROVEMENT �\�I� � Length 2 � (p �� Length 22=0" Wi@th �� j�� Width Zo�-a" Length Width t ` �. Height �/�' S� Sq. Ft. /g � � p Height �57= 3 3/q.�� Sq. Ft. �� S,a V . Hgt/Ground Sq. Ft. —� ,S � �.Z�r 49 . Constniction Type:��j-n�L Estimated Cost: $ , � (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ �� DATE: _ j0- a{-q i APPLICANT: �. �.w Tel. #�� '3 - 4 v� $Z Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: �� $ �.O , D $ .D � gso. � � 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 $ �%t� Fee Determined by Engineering $ � �s-o�.3G Agreement Necessary [ ] Not Necessary [ ] 4 • HOUSE HEATiNG TEST RECORD �� '�'� �� ,� � !'..�' ,': � ,, ; j ) , y R� ��,r�� `' � r � , APT. FLOOR CITY �SUBURB P1►I�"T�'- OWNER T LOSS DA E TG. INST. '"" " �--- �i BY � �. INSTALLED BY > -'"�� hieol Work By Gas Lin• Br f> fi�QF HEAT GA FA HW STEAM SPACE HTR. UNIT HfR. OTHER . � . . GAS DESIGN CONVERSION E rl INPUT �/ THERM057AT,,L Valvs L Limit Limit S•tting _ Fan Settin9 Pilor Tppe �� Pilot Moks Pilot Modal Pilot Timing _ � l..W. Cur Off — ;tti . , ✓�, Prossure , � �Psresnt C0� � Date Tested "'� Input CFH Psre��t '.Q2 Company 7estin Stbck Temp. Perc�nt C0 � Name of Tnstsr �✓ Form 235 �'`��"�:� � ,; ,, � v. . . � � .'...: .c_ TROLS MAKf OF BURNER Modei Maa. BTU Rati�g MAKEOFFURNACE Model �� Vent Sita KIND OF LINER SIZE �NONE Draft Hood / R• uloro�G�� / ' �r� ""� Filters Siz�f Numb�r T� ^T_ Chimnsy Location lnsid�' Outs� Chimaey Construetion Smoke Bomb �Miring � DraFt T.st Tay Door Pressuro Ligh 'n 1nsL r .. � _ ��iu��o CITY O R(pLEY INSPECTtON OIV. 6931 4lniversi�y Ave NE Fridley, MN 55432 572-3604 RATE SCHEDUL� APPLICATION FOR POWER PLANTS AND HEATING� COOLING, VEN711.ATION, REFRIGERATION AND AIR CONOITIONING SYSTEMS ANO OEVICES Residentia( Furnace Shell and Duct V+brk, 8urner - Also Replaceme�t Furnace (Side Vent - Fill Out 8ack) Gas Piping (Needed with new lurnace) Gas Range s Gas Oryer *Air Condiiioning - Ali Sizes Alt OiherslAspafrs � A�era!lons (LlST ON 8AC1� t% of Value ot Appliance or Wo�C Commerciai�tndustri�! 1.25°,b ol Value ot Appliance or Work Rate TOTAI /� .� • $ 30.00 $ U / $f0.00 �C� $10.00 � $ IOAO $ �-� � $ 25.00 $L�_ State Surcharge TOTAI FEE �C��.S� Ef(ec ive n anuary i, 1997 JOB ADORESS_ �O ��D G� I�I S�'l �S�/Yl C��,(�(�-�. The undersigned hereby makes application (or a perm"rl for the work herein specilied agresing to do all work iR strict accordance with tt�e Ciry Codes and rulings of the Building Oivlslon, and hereby declares ihai ail the facts and represenialions stated in Ihis application are true r� carre�� `.1997 owrv�R� � � fi � I,(�1�1-G� BUIl.DING USED AS Fsr��r�� cosr ��000 � D O P�RM�r nro. �' �" , �� . � DESCRIPTIOty OF FURNACE AND OR BURN�R $ No. of Heating Un�s � Circle One (Steam) (Hot MNater) �arm � Trade Name C.d�l'{� !��°if�' Size No. 5��(J I-- �' i� 6TU_ �o (�� Q D Hp EDA � �., Fuel j1 �,�'if/ui,Q C��_ To�al Con�ected Load $ .50 Burner Trade Name �� B7U MJMIMUM FEE FOA ANY HEATINGLOOLINGNEN71t.A710N REFRIGERA'TION/AIR CONDITIONING PEAMI7 iS $25 00 PLUS THE $.50 STATE SUflCHARGE REINSPECTION F�F $42.00/Hr *Air Cond�ioners can not be placed in a side yard without written permission from adjoining p�ope�r owner. _. . :.i.� _ . HP HEATING OOAIIPANY �� I,VG � � . , -----�- Signed Approved By FILL OU7 BACK SIDE a�pu�cEMENT Fu� Size No, EDr� �n��.i� Tel No. �'7 �l � � � �o _ Rough-in Date Finai Oate �� STACK VEAIFICATION ON �� °`� 0 Client: Address: City: Phone: Fax: Comment: Rottlund Homes 2681 Long Lake Road Roseville, Minnesota 55113 638-0500 638-0501 YOUR BUILDER FOR LIFE Project Name: Halston Reference City: inneap Daily Temperature Range: Medium Latitude: 44 Degrees Elevation: 834 Feet Outdoor � Bulb Winter: -20 Summer: 95 Company: Representative: Address: City: Phone: Fax: Comment: is. Minnesota Outdoor Indoor Indoor Grains Wet Bulb $��,. � Bulb Difference N/A N/A 72 N/A 75 50% 75 36 _ ._ _ . f-��-�� G l� Flare Heating & Air conditioning, Inc. Randy 9303 Plymouth Ave. N. Golden Valley, Minnesota 55427 542-1166 542-3101 YOU CAN FEEL THE DIFFERENCE � � �4:v y� '� �' � Total Building Supply CFM: 664 CFM per square foot: 0.323 Square feet of room area: 2,054 Square feet per ton: 1,197.276 . � , . w� ��. � �. � �` Total heating required with outside air: 41,498 Btuh 41.498 MBH Total sensible gain: � 14,608 Btuh 74 % Total (atent gain: 5, f 47 Btuh 26 % Total cooling required with outside air: 19,755 Btuh 1.646 Tons (based on sensible + latent) � � 1.716 Tons (based on 75% sensibie 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. I � ��:fi c Component Area Sen. Lat. Sen. Total Description Quan Loss Gain Gain Gain 4A Window Double Pane & Storm Clear Glass Wood Frame 189 5,929 0 5,389 5,389 11 C Door Metal Polystyrene Core 40 1,730 0 444 444 121 Wall R-19 + 1/2" Asphlt Board(R-1.3) 1,495 7,564 0 1,940 1,940 15B Wall 2-5' Below Grade 8/12" BIk+R-5 530 3,608 0 0 0 16H Ceiling R-38 Insulation 1,Q27 2,457 0 1,175 1,175 21 A Basemt Floor 2' or More Below Grade 1,027 2,268 0 0 0 Subtotals for structure: 4,308 23,556 0 8,948 8,948 Active People: 4 0 920 1,200 2,120 Inactive Peopie: 0 0 0 0 0 Appliances: 0 0 600 1,200 1,800 Lighting: 0 0 0 Ductwork: 0 0 0 0 0 Infiltration: Winter CFM: 87.3, Summer CFM: 58.2 229 8,834 1,424 1,280 2,704 Ventilation: Winter CFM: 90.0, Summer CFM: 90.0 0 9,108 2,203 1,980 4,183 Sensible Gain Total: 14,608 Temperature Swinq Multiplier: � X1.00 Buildinq Load Totals: 41,498 5,147 �14,608 19,755 . \y ;d,.. `� • ' ,. . : ' . `' �, ti •ah., :••` ' . � :��`'�.'�.`,.,.,'ti� 4 '�. ., +S, •,��i� � �'v.•', �`•k;�C�i\Z+.., L : ..,. `� fbtal Building Supply CFM: 664 CFM per square foot: 0.323 Square feet of room area: 2,054 Square feet per ton:. 1,197.276 Total heating required with outside air: 41,498 Btuh 41.498 MBH Total sensible gain: 14,608 Btuh 74 % Total latent gain: 5,147 Btuh 26 % Total cooling required with outside air: 19,755 Btuh 1.646 Tons (based on sensible + latent) 1.716 Tons (based on 75°/a sensible capacity) ��. „ � Y ,� •^�� ;e;,��i�,�,�.,. ;;� �� F � ,��,�;<:;,:: ,��:'>; ��,� �. • s � =: 3f :. .,�. � � ` `�a�'� � � �,; �.��.^s.�� ;� ��.�i��\�� Calculations are based on 7th edition of ACCA Manual J. AI( computed resuits are estimates as buifding use and weather may vary. Be sure to select a unit that meets both sensible and latent loads. � Component Area Sen. Lat. Sen. Total Description Quan Loss Gain Gain Gain 4A Window Double Pane & Storm Clear Glass Wood Frame 189 5,929 0 5,389 5,389 11 C Door Metal Polystyrene Core 40 1,730 0 444 444 121 Waii R-19 + 1/2" Asphit Board(R-i.3) 1,495 7,564 0 1,940 1,940 156 Wall 2-5' Below Grade 8/12" BIk+R-5 530 3,608 0 0 0 16H Ceiling R-38 Insulation 1,027 2,457 0 1,175 1,175 21 A Basemt Floor 2' or More Below Grade 1,027 2,268 0 0 0 Subtotals for structure: 4,308 23,556 0 8,948 8,948 Active People: 4 0 920 1,2C0 2,120 Inactive People: 0 0 0 0 0 Appliances: 0 0 600 1,200 1,800 Lighting: 0 0 0 Ductwork: 0 0 0 0 0 Infiltration: Winter CFM: 87.3, Summer CFM: 58.2 229 8,834 1,424 1,280 2,704 Ventilation: Winter CFM: 90.0, Summer CFM: 90.0 0 9,108 2,203 1,980 4,183 Sensible Gain Total: 14,608 Temperature Swing Multiplier: X1.00 Zone Load Totals: 41,498 5,147 14,608 19,755 � �\. 'V4qvU�:-'?\\\\.'i...:.�L}.�'l:\�.A\C:�'v'i<L\�4C�,....'h-�:v�kVi�.hv._k�vi.^L�. �t��ia� ��' Supply CFM: 664 Square feet of room area: 2,054 �� CFM per square foot: 0.323 Square feet per ton: 1,197.276 Total heating required with outside air: 41,498 Btuh 41.498 MBH , Total sensible gain: 14,608 Btuh 74 % Total latent gain: 5,147 Btuh 26 % Total cooling required with outside air: 19,755 Btuh 1.646 Tons (based on sensible + latent) 1.716 Tons (based on 75% sensible capacity) � � ::_ 1 CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITT1NCa PERMIT MARK NUMBER OF FIX7URES TO BE INSTALLED ON EACH FLOOR Effedive On January 1, 1997 PLUMBING FtXTURE RATES NO. RATE TOTAL New Fixtures `arf O!d Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater — Electric Water Heater — Gas** � Gas Range** / Gas Dryer** Back Flow Preventer Required OYes O No Type $ 7.00 �� -� $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 �0.� $10.00 `Q, � (� $10.00 $ 4 5.00 JOB ADDRESS �� `�2'1��5d� •� �- The undersigned hereby makes application for a permit for the work herein specified agreeing to do atl work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. Owner Building Used As �� `�l/�..�/ /S�Di� �f S�� /—.� D . i ss8 Estimated Cost PERMIT NO. J��/�' 7 PLUMBING COMPANY !/�,��`"��e � /`5 Reinspection Fee $42.00/Hr SIGNED BY _�G��/,�� TEL N0. ��iz��'a'/ ALL OTHERS AND/OR REPAIRS AND ALTERATtONS 1.596 of Value of Fixture or Appliance / Approved By Rough—In Date Final Date /"� �� State Surcharge $ .50 L�f� MINIMUM FEE F ANY PLUMBING GAS PERMIT IS a20.00 3 . TOTAL�EE $�� PLUS THE �.50 S ATE SURCHARGE **COMBUS710N AIR SHAIL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 S(1 INCHES. _ _ C�TY C�F FRIDLEY FRIDLEY MUNIC[PAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN SS43? •(6!2) 57l-3450 • FAX (612) 571-1287 February 10, 1998 Rottlund Homes 2681 Long Lake Rd Roseville, MN 55113 Re: Final Inspection at 6406 Christenson Lane NE, Fridley, MN Dear Sirs: A final inspection was conducted on February 10, 1998 for the above noted townhouse. We found that the construction of the building complies, to the best of our knowledge and belief, with alI 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, r BARRY ESCH Building Inspector BR/mh sue�ecr PE • '-- City of Fridley 6 6 � 2 AT THE TOP OF THE TWINS g U i L D I N G P E R M I T � � � R � � ' � • COMMUNITY DEVEIOPMENT OIV. � / � ; .: ----- , 1 r � � PROTECTIVE INSPECTION SEC. 1 ; � � � �"'1 � CITY HALL FRIDIE� 55432 NUMBER REV DA�E PAGE Of � APPROVED BV �'""�' �'' 612-571-3450 9�0-Ft5 7/16/98 � � 10B ADORESS 6406 Christe nson L n t IEGAL LOT NO. BLO K TRACT OR ADDITION SEE ATTACMED DESCR. 31 1 Christenson CrOS �Il SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ma - 3 ONTRACTOR MAIL ADDRESS ZIP PHONE IICENSE NO. 4 ARCHITECT OR DESIGNEq MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PMONE LICENSE NO. 8 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION �7 REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PIUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. fT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 60 OAYS, OR IF CONSTRUCTION OR WORK �S SUSPENOED OR ABANDONED FOR A PERIOD 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 STAILS GAqAGES ANO KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WOf;K WILL BE COMPLIEO WITH WHETHEF SPECIFIED HEREIN OA NOT. THE GRANTING OF A PERMIT SOO �.SO DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEfiMIT FEE SAC CMARGE PROVISIONS OF ANY OTHER STATE R LOCAL LAW REGULATING CON- STRUCTION PER ORMA ONSTRUCTION. �Z]..00 Fire SC �.SO PLAN CNECKFEE TOT FEE 7 Lice 5.0 .00 I NATURE OF C � RAC?OR OR AUTMORIIED AGENT IDATEI EN O VALID THIS IS V UR PERM � i � SiGNnTUREOFOWNEAi�%OWNERBURDERi �OATEi BlD �NSP qoiE l JUL-16-1998 11�08 FROM CITY OF FRID�EY TO 1DDN [ J ;, , ; ; ; : . .: CITY. OF ��tIDLEY . . . . . ILTER [] SYNGLE FAMII.Y �AND � DUPLEXES R•1 AND R-2 , � _,. . . , . _ : BUILUING PERMIT APPLICATION -,; , . ..:.. . , :onstructionAddress: �.'q �� 'Jr.,.� s�� lo,�,t.� _ �,c�l.c� 4933689 P.02i02 �� 0•7c�� 9�� a'�� -: . egal Description: � . , �wner Name & Address: 1� Tel. # S'O�I-�� 4 omtxactor: i�l.Zuu�sr+r�•�. l'x�,�r�c.ir`3',F,4,� . MNT.rCENSE� C�'�1�77 .ddress: � �,�_��_►�sr� .�� (�Sc_er� ��36�! Tel. # �3�S�SG'i0 . [VIlVG AR��►: ARAG� A1�A: LCS AREA: THER: �` `�' Attach to �his application, a Certificate of Stuvey of the lot, with the proposed construction dra.wn on it Eo scale. . : . . . . ... DFSCRIPTION OF IlKPRO'V�MENT �>< .. _.� . . .. . � _ . . . � . . . , Length W idth � H�ight � . , � � �Le�th .. � � . - � width � Height � Length � '� � � � � Width � " � HgtlGmund : � Sq. Ft. Sq. F� � . Sq. FG �nstruction 1�ype: 5 Estimated Cos� $ �� .. --..• s'..;� ... . � . � � . � . � (Fee Schedul e on Back} . . : � iveway Curb Cut Width Neoded: � .: �.. � : Ft:� � + 6 Ft = � � x $ � _ $ , ►�: "7-16-�.g � �,pri�car�r: � � � T�. # ��g/-�'�'/�' � . . .. CITY USE ONLY �it Fee $ � �< o i� Fee Schedu]e on Reverse Side e Surchacge $ �� .001 of Perinit� Valuation (I/i4th°b) te S�ml�arge $ � $.50lS1,OOO�VaJuation C Charge $ $i.00U per SAC Unit � �nse Surcharge $ �� C� $5.00 {State Licensed Residenual Conuacton) :veway Escrow $� AIt. "A"� or Alt. "B" Above �sion Conuol $ $450.00 Conservation Plan Review ic Fee $ Fee Determined by Enginee�ing .. �er Main Cb,arge $ Agrtement Necessaiy j J Not Necessa.ry j J Tor�. �'ULATTONS: $ �7 D� , � . ' TOTf� P . 02 Building PLUlVIBING Inspections RESIDENTIAL APPLICATION 763-572-3604 CITY OF FRIDLEY 763-502-4977 FAX EFFECTrvE�-�-20�0 DATE IiJ 1 l5 !l v —�--�— � S1TE ADDRESS _ THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMTI' A COPY OF YOURSTATE LICENSE, BOND AND CERTIFICATE OF INSURANCE I � � �i� 1��!'��_� YOUR E-MAIL ADDRESS � �� ❑ OWNER ONTRACTOR NAME: P-�rf ✓f � G� � ADDRESS: � O�? �D �CITY�� PHONE: ��Z � TLID - �% � b NAME: WIVIiL �(�a O�K/V�r/lYl,(e _ STATE LICENSE # STATE BOND t! ADDRESS: �Z"GD Nu�t,c 1�,� ��y CITY �d4) PHONE l (L ,�i- �,5��'" /��y FAX � f�SINGLE FAIvIILY O TWO FAMILY ❑ TOWNHOUSE �rE oF woxx: I � NEW DETAILED DESCRIPTION OF WORK �REPLACEMENT Permit No.' Received By: STATF�ZIP EXP DATE EXP DATE � STATE_�i ZIPSs�32 ,��.1- �A'r�� FEES ARE BASED ON $]0.00 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) SWIMIvIING POOL WATER SOFTNER ($35) CLOTHES WASHER KTfCHEN SINK WATERCLOSET BACKFLOW PREV. ($15) _ DISHWASHER _ LAUNDRY TRAY �WATER HEATER ($35) FOR IRRIGATION WATER METER OTHER 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 wark will be in accordance with the approved plan in the all or �}c�h� requires review and approvI,a� ,�f/plansG- SIGNATURE OF APPLICANT � ��'��/'�-- PRINT NAME /�ll �K �G�� DATE �D�f7/( J APPROVALINSPECTORSSIGN T RE 1 City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: '763-502-4977 i