The URL can be used to link to this page

AF - 38024�� ,� n Date: J�.ne �.,� 1g68 � City of Fridley, Mirm. BUILDING PERNIIT B��r Clem'ron, Inc . 1�a 9'7'71 Address . Addre�s 701 Columbia Blvd� LOCATION OF BUILDING No. '�44� s�t concerto Curve � part of Lot Lot 3 _ Block _�'.L Addition or Sub-Diviaion Melod.y Mano� 3rd Corner Lot __ Inside Lot ....._.. � . Setback �'..._�..�_ Sideyard 1.�� 0� Sewer IIevati� 881 .11 �3,� 11 l��rnx. �. Top Of Footi n�g DESCRIPTION OF BUILDING To be Used es: 121s?e» � r Front �2'____ Depth �_ Height 20' Sq, Ft, 1000 �, �, 20 , Om0 g-��..—��.— Front 29! Depth 2� � �Teight _.�..Qi _ Scl• F�k _1�2 Cu. FL ,q., 6no Type of Construcl3on _._.. �ame �� _ $22 , 500 . 00 _ To be Completed 6 Montha SEWER. LOC�TION - 78.5' W. of Manhole WgTER LOC.ATION - 67.5� W. of Ma.nhole In cons�tderal3on of the fssuance to me of a permit to co building the proposed work fn accor�dance with the descrlption abov aet fo and 3a co ordinances oP the dty oP F'ridleY• i. to do ns of In consideration of the payment oP a fee of $� 37 • 00 , permit is hereby graated to to construct the building or addition as described above. Thispe rmit ia granted upon the express c�ndition that the peraon to whom it ia granted and h3a agents� employees and workmen, in ell work dane in, around and u�n said building, or anypa� thereo� shall conform in all reapect� to the ordinaace� oP Frldley, Minnesota regardinp locat3on, conatrucctiTTon, alteration, mainteneace, repair and moving oE buil�g� �� dty limita aad tbis pernnft may be revoked at any time upon violation of aay of the proviaiona of sa�d � �.. �� 6'�4� �r �+ wonc� 'flds psndt� d� aot eover t6s eonstroetioe, in�falHNoe fo� wirlag, plumbles, gn hssNee, sewe� er wNe�. B� suro h� fha BuIWieB leipxtue for aparaia p�nnN� foe thas h�m�. APP`LICATIbN FOR BV�DING PERMIT � - �: � � �i � � � /�� / � � I I' �i/.�(.l fl.r� / / r � �I' 1 �%/ // /!� / �� .11• ,�� l' ,.� /�� . LOGATI OF BUILDI . N0. `%��/%� STREET � : PAItT OF LOT__ ,� BLOCK �� ADDITION OR SiJBI CORNER LOT INSIDE LOT� ACR__ �� SEWER I• � /D . ��/� ' '�Di� ` � � -�f� ��j Applicant attach eo this form Two Certific�Ces of Survey of Lo� and propoaed building location drawn bn �hese Certificates . �. L a ��• S� 1� • o,�. � o� I i7 ffNH o L� �. L—, (0 7. S� �� n� � RNNO� �. DESCRIPTIOR OF BUILDING To be used as; / � Front��Depth ��Height �--�^ � f Sq. Ft. �� Cu. Ft. ,�Q, oo� � t r o � �Front �j� /Q � � Depth�Height� � b . Sq. Ft.� l'� Cu. Ft. �%i4�C� �� Type of Construction�j�� , Eatimated Cost_�,�� 5��' ,.�jG —�-- , To be completed The undersigned hereby makes application for a permit for the wo*k herein epecified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Degartment of Buildings, and hereby declares that all the facta and representations stated in this applicati,on are true and correct. DATE � ' � ,� (Schedule of Fee Costa can be found on the Reverse Side). �� -� � �� -° o:� . �`��t?:, F /r`1 �r . , 4�- (;,� .�, �l �-�, � • - s/ .� � � � _ BIIZLDING PERMIT FEE SG�FIEDULB SECTTON 2. Tha Inepector of Buildings �hall, before issuing a.ny permit for the erection of any building or structurm, or for any addition Co any existing building or etructure, or for any alterations or repairs to any exiating 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�wit; 2�1. For any such permit for the erection of any fire-proof building, othei than a garage, warehouse, factory �or �rain elevator, or for the erection of any £ire-proof addition, for similar occupancy, to any exiating building, ehall be at .Che rate of $1.40 #or each one thousand cubic feet, or fraction thereof, in such cubical contente. . � 2.2 For any such permit for the erection of any fire-groof garage, warehouse, factory or grain elevator, or for the erection of any fire»proof addition, for similar occupancy, to any existing building shall be at the rate of $1.25-for each one-thousand cubic feet, ciassified as "fireproof" by Section 502 of the Minneapolia Buildiag Code. HOIISES 2.3. For any such permit for Che erection of .any non•fireproof buildiag, other than a gar'age, warehouse, factory or grain elevaeor, or any non-fireproof addition, for eimilar occupaacy, to any existing buiXding - permit $1.00 for each one thousand cubic feet. GARAGLS 2.4. For anq such permit for �ho erection of any.non-firegroof garage, warehouse, factory or grain alevator, or for the erection of any non-fire-proof addition, for aimilar occupancy, to any existing buiiding or for each such building or addition - niaet.y cents ($0.90) for each one thous�nd cubic feet or fracCion thereof, in the cubical contents thereof with the minimum of $4.00. For the purpoae of c�puting fees for building permita,' the cubical contenta of any buildiag or additioa to a uniform height throughout by multiglying.the grouad area covered fram a point six (6) inches below the floor line of the baeement or cellar to the average he��ht of the upger aurface or to the average height o£ the roof surface of th� mafn gab],e of a pi,tched roof. 2.5. For repaira or aiterations •to an existing atructure, the fee sh�ll be at the rate of $3.00 per each Five Huadred Dollars ($500.04) or fractivn thereof in the cost of all propoaed work. � ' � 2.6. . In nb case e'hall the fee charged £or any permit as aet forth in Section 2 be less than $4.00. STORM REPAIR DAMAGE FEES: Residential: Estimated Cost of work .up to $500.0� - 55,.!30 Estimated Coat of work. over :SS ��.:.. �'�:"� �' "' r�0 � � . 'c y�.. .. ..... . Commercial; Estimated,�qst o€ wogk i��• �:�, ':L :�;;, ;.�•) '>, ;j?.:�`� ' �, Estimated ��sC of woz`_; o;��;:r ;;�i;i.°.U:.' - t�e'- � "�, � �� Loird PJmin�r� c��y�� Sn�is &strir� cN,r fr M�ea,pal �1J�lldfQfYiA� , � ' �� r "� 68'f3 -�1� +�5 N�. Mn�pv/s37. � Et�GtNEERING� ��C. �'�^�Ja .tl�r�f d-tP�C�; � --� En9ineers � Sur�ec��rs -- ces�t��sca►te o� sszs�e �os ��''Y1 O�V£�t�OP11'1�n i� � . CONCERTO CURVE � � a NORiH � D�NOT�S tRON_pEMpTEg OQAINAGE AND L3TILiTY EAS�MENT Lo�r�r__��o�rc 3�„_ME�oaY MA�to� 3aQ Aoo�T�oN AI'+fQttA C TY / htnby �erlijy l�rii �firs � o h�r� �`aorrt�f ��,-e.tenfa�i�n �'a su�y �'flh �s � �o,� �brd lald, ar�d nj'1i� /n�o�i a�al/ dmfdin� ,�dlrrta� , �ad d1 risidrl� o�navJrmtnts , rl'� ,� ar �rt �sid lrrid As .wrreyt,d � �rx �llrs�_ a� ,�('_:.,Auyu,s� a.o.r�. 3t/8v/�'8AN EJYG1MEtR/NG. IM�. . ��rrrs �r s�'�.s , S��ole: l`-40 6y°��;�' ` ,-t. _.� -: �.,:. �"'�'"'� . ; �►�a� � _ y� a _ ;s' . �' � ' . }. � f� � *�;: � �� ., ✓ � �y� .l'J _ � ,. v,, ,,,_. �� . � . . _ : : �, '� 4 y� r � i � �: � � � � � n��pz�� x � " � m � �' � �� W x �a �- � � •.. � p � � o � �,°�' �� C � � � � N � � �' ��a�� . � � . � � b � � C�. `A y G ' � � � ' f0 � : � . � � : : . m �. . a��. � : m : : �.�. �: , � o : : : . �: : � : • � . . • • � . � . . . : � Q : � � � � � � � � � � , $ o � .�� 8 � $ � S �° ' �� W � Q► a o o y G�: o o�" '. � �_ � � � ,.. ?�"r� . �, . �- � t r fi,� , �� _ ,� `�� m , � I� I A , ( / � � � � 0 � I D � � � --�1 m � 2 m C r m. ' II � . �P w p � �p x � w p, �' � 3tOries 8 � WATEB M m a,O�TS �t � � uaiN� � \ .OATH ` .. , o �� a � �, e�sirs Z � � � � � siNKS ° � � I �WASH � � : ., iRAYS `y j�.fA �� 8N J❑ O p i � � z 8� a g � � b � a � � � ro g � x � 0 � � � � � � b � � � � � li � � � �� F�i y . y � � ; ORINK,� �.� � , � . �FOUNT. �°.. �a � .. . sf+wrts. � y - FLOOR O oaniws. ,.r x �,T� R o �� s. �n � � _ �,TO ; a � . w�s►+es o� O �. � .. � G0.5 �� S C] .��. � � �'APPL �� G� �RANGE � c�s " '�, _ .. � �OPENINGS. �. . .: � �� .. . . w. � o' Z. � � > �. A � � � � �� ' �` � � � �� J 3. r O. A-_ a�.� �� ° � � b ��,� , �°�,�a � a�~, � - a�x • �. � `� , '°"• `�� o �' '� a x i a A � ��M � � � �' d � � � � �Op� ' � p �.ro� bi w � b � �b O � ,� . _ O y � � � � � � n ��p,oa �o � � o �j �1 �. �� w �'. . . . _ � . � � � � .. , . � ^ y V (ryp � f�D M � � � � j w : po � � � � _ � � �`J � � � . n''r' .�+ /C r�. � � � : � � � � � � � � O � x � N .P � � � � � r � � � y x x � �r��y �' y' o x � � N � � 0 ��x �� N—�" ►n � � o � � � m � � a� m � n _ > � � < �n \ I� m � � � � � Z �D � . 4� 4� O � y r M w W � a�i a � "3 � 7., � � x �, ° W � � o a�o e a � � � � ;� I � ~ c e�*1 � G' w o � � y o � N � � � � w O y . O � �' o � o � O � � p �, y O � � ' � � O � : : � � y . _ . m . . . . fD . . : ' � . . . . : � : : : : : �. � : �: : � : � � k o : : N � � � 0 0 0 � °o °o ffl {� -Cfl � fA ffa Q r � � � � � � � � � � �d o `e �' Z i � � y � � � � � �z � � � �� . �: � � � � � 0 a � °° � � � � � � � � � � � o � � o �z � � � � ro °1 � � x ° 0 � �� a a 00 �� x� � � � � M ' r� �� x x y � R° y � � �� P � 0 0 ,`°o � � � � � � N � � 0 0 0° o° {f� iA f!D � ° � e�i� � � �� O • ^� � , m �, 0 a � � 0 �T W g � � � x ��.� � �' � ; � � � � � � ��'�� bp,�, 0 0 �' � � � � f� �� °� a � � y� o Q, � : G .. � ,°o : : � O � . . � � ' � ' � a N � � N � o °o °o °o °o � � � � � \ �ll � � � t�i� O "'� �n �a � QQ � � � o � � 1 � � � � � b � b � S �m '" � ' �' � °' � � � � � A � �a�� eo .y .b R° � � �. � � �. � # � � �� ° a � � � Q, v► . . en . . � ,°op : : Oq O . . P : : : a N � � � � � o o a p o o O � 0 � c.a� � � �� y � W y � � p�� .�. � ,qdo�. b P+�p y �p � � pC�� e* � ��M � :C � aJ �' �'��b o�� p�m� �� ° M y � ��m b �. �, � � `° � �� o cr •. � �x � � � S� 5' D � r � � m � 2 m C m � M � � � � m � � � �. � � � O � �� o � Y� � 0• ;. � � � 3 � �, � � o. =� A .r s. � � � 0 a � �i. � �, � 9 o. sue,,ecT PER . City of Fridley 19820 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r � � REC . COMMUNITY DEVELOPMENT DIV. r � ~ � PROTECTIVE INSPECTION SEC. ? g � � �✓ � / / 1 ` � � /"�1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY �----� • •�� 612-571-3450 910-F15 4/7/89 / / JOB ADDRESS '7447 Concerto Curve N. E, 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 3 Melady Manor SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Hollis McKinsie 7447 Concerto Curve N.E, ?80-7319 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Tri-Co Builders Inc. 7350 - 15Qth Avenue N.W., Ramsey, MnT 553Q3 753-4222 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PFIONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW X ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct an 18' x 14� AdditiQn and a 12� x 14� Deck Free-standing �ireplace in addition (Secu,rity Chimneys - 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan. �� .d��gmg c�ll loc;� �9�:iti�ias S�P��ATE P�RI�I�`S �� 1��P�c�raE-�G«r?, ;,.� ��r�rr�;. QU9R�� 'b�' �INIR�I�G, HE�4T9(VG, PLUIVi�IYV� AIetD S9G�V$� ��"" ' _;�,�;� �f� ''';� ;. ' . � SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY (3ROUP OCCUPANCV LOAD VENTI�ATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCEO. NO. OWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS APPLICATION 1 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 $13�'�OO $G.HS WITH WHETHER SPECIFIED HEREIN OH NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN- 153.00 STFUCTION OR THE PERFOFMANCE OF CONSTFUCTION. $ PLAN CHECKfEE TOTALFEE $159.85 SIGNATURE OF CONiRACTOR OR AUTHORIZED AGENT IDATEI a •s WHEN PROPERy� VALIDATED THIS IS YOUR PERMIT E3�1z� ('�!��a -� SiGNaTURE OF OWNER ilG OWNER BUILDER� �DA7E� BLOG INSP ria E � .� [ � AD�i � ) �'1'� [ ] I�l AND R-2 ��ildi�g Permit Application oorLStruction Address : � Z �% / ( " Leqal �escription: �,o on � 3 ��e lo Effective 5/1/88 r� o� rr� & �: �, llrs �Vl � ,��vsi � , S�,r.i� �.. # ��d - �3� f oontractor: ��!/ ~ � �/�ti.s ��• � Te1. # 7�3 -y��z� lriJfiiC�: ��.7 ✓ C �� L Car e �71 S'e�t'I � �� v �� O � Attach t�o this application, a Certificate of SZuvey of the lat, with the pro�osea c�.structiar► drawn on it to scale. �IPTI�T � II�iOVH�3� % LZVII�G AREA: iength I� Width � Height $ Sq. Ft. � S� GARAGE ARF�i: Length Width Heic�t Sq. Ft. D�3CR AREA: �_ Width �,� Hgt/Gr�nd � Sq. Ft. /� 3� o►�: /L�� %�-�PJ� � (� = � r L%.0 i�:.�j �%33(a - �� v ZUrc�t�r'L�y � Qt,e��C� Carner L�t [] Inside Iot [� Ft. Yd Setback Side Yard Setbaaks Type of Oo�struction: Estiaiated Cbst: $ `��.:� ��, .7 �� Approx. Caanpletion Date: Proposed Driveway Width If New Openirig Is Desired: Ft. $ $ Width + 6' See Back Fage L1A'I'E: � APPLICANT: Z�el. # '�'�S - Y�'— ��` .� Q'1'Y II8� �II,Y . , Permit Fee $ ,� State Stilrcharge $ �., �� SAC Qzarge $ Drive�ray Escrow $ Park Fee $ Sew�er Main Chazge $ . �. 5-riRrr�za�s : S- � � e �� s , vd Fee Sd�ule an Revers� Side $.50/$1,000 Valuation $575 per' SAC Unit Alt. °A° or Alt. "B" Above Fee Determined bY Engineer'ing Agr�ent Neces.sary [ ] Not Neoessary [ ] � c �-.�s �. ��'�'-'r. i - - � - s ..��, _`. ^�,� 1 ' %�`�� / qy v :�� . . . • :.�•. � - �- :�.�:�:�. � - The Chief Building Official shall, before ; CQ11 *� �*�+++; ts for the erection of any buildirig or structure, or for ar►y additia� to ariy e3dsting buildirig or structure, or for any alteration or repair to ar�y PY7 �+1 r� �; i ding or stru�ture, upon application therefore, require the payment by the applicant for s�cfi �*�; t of fee.s to the an�unt herein belcw set forth and in the manner herein provided to-wit: TO►I'AL VAIIJE $1 to $500 $501 to $2,000 S2,00i to S25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 t� $500,000 i��a.� $15 (Mini�aa Fee is $15 plus s��hargei $15 for fixst $500 plus $2 for each additional $100 or fractiaa� ther+eof, to and includir�g $2, 000 $45 for first $2,Q00 plus $9 for each acklitional $1,000 or fzaction ther�eof, to and including $25, 000 $252 for first $25,000 plus $6.50 for each aclditional $1,000 or fraction thereof, to and iricludirig $50, 000 $414.50 for first $50,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $100,000 $639.50 for first $100,000 plus $3.50 for each additional $1,000 or fraction thereof, to and including $500,000 $500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional $1, 000 or fraction thereof, to and i.uzcluding $1, 000, 000 $1,000,001 ar�d up $3539.50 for the first $1,000,000 plus $2 for each additional $1,000 or fraction ther+eof L�t1�lY D�P�SI�T ffiC�OFT ((b�rete C�rb Streets On1Y) Alternate ��A�� ; Remaval ar�d replaoenent of c�rb arid gutter only - Driveway width plus 6 feet times $13.50. Alternate "B" : R+emoval aryd replaoement of curb ar�d gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. ��/:�; ■;� a+;��M •;�� •)' a�Ui�i�: 4 •l�l Piermits for oo�Ctioai wi11 be issued a m�*+�m►� of 24 ho�urs fraan the time of application to allaw for prc�r review of t� praposed structure arid of the oo�struction site. A Certificate of S�vey of the lot, s�ing ti� location of the frnu�idation orxre it has it has been vonst�uL-tred will be required before prooeeding with the fiaming. 0 w 0 .e�' l� � �.►u �,�it, � � �, � � b� (�, . � 4yi��'`I�fte�l / �l Zi � = 1 �. � � � , i'3 z' 1, 1�ti. � f3,�1��`' r�, '�o� �. o��, �5,� 1 LK� I �g�no / �� L � � � ,' - �,.� �" . � c-� \ �1 01 � \�, . - -- - � _ rv � _. . � � � �z , ; S � �. � , � = D � �: 3, rn I r= � ' ,� i- �; �\ ,� . � � � . `� z 2 I � n� ' � . � G7 � '� ' � - , � ` � � 3 `a � � �--- ._ -_----- - y�` - -- � — f� , , . _. << .-. . ; ' . . � � � ; x — ; i ! 1.,, �. . ._. _ --- ._ . -'- � �/ . - - - � , �1--- , - - - - - --- -- -- _-� -- _.. _ J ` i � � � r' � � � �. I `� =v � i.. � � � � � �� '�l, 1 � . ie o � eo � '�^ � � 04 � " r -� G. !�D � � � - , so _, � a o �/� - = o � c °. � . O/ � � � y. r- -- •� 'a �-' � • �� "3 � � N Q N `_ ; ! � � � - .� .� �l I i � . �� — y � 1 \ n� � � I ' � � � N � � � A y � w e� � 7 �. N rt"'r -�D• 7 (/� ' I i � i Tl .� �� y G. ^ - � O -� � � •�'1 N o r � Q _� � „ � � �• � A , ' � .��i. '�' � �D J Y I:. `i • i i' � � O p CO _: , , 5 T i C' . .... —jt� - . � -• � , _ � _ •� �. ' _ `_ '_ � ' . .qA ��,, „�, -+ �� ' �'� ,�_� t� � �''6 � o � .. �� : � � �_, �� N =' - l---�'� _ . ! - - - --- ---- - -- - �,� � ( � ` �,� �f; z. S x Z6 � � `1 �- �1 '� ` � . i- �•\� , � � ( r_ v � � -- -,- ----- -�;--�'---- , _, � .?�' .._� _ __� -• \ • - l � •, . t� � , �. _ �: �_ _ _ ,. . �� _, r,, � _ , ___ �1 ` .,,; � � � �: � � V • � \ � \ v 3 ' m c� �z � . � �= a v �_,..� ; � i �' . f.� I� � �'. ''t � i• � --'! �_` � � ` ``^\Q-- f� ;�� -. .,� .-- c- - "- "s: �; —�:_ ,� -_ c� . � _- ? � ' � 4� _ � . W� � C - . .` � ^' \ • _ _ . . C � ' \` � �1 ... y ' � � � `, � T \'" � � . --{ �1. � ;�_.._�.�.��.1'�_.��_ —.—t�.��--r,� ('` __ ; R� j� , , , `- � ,- • � ,.; . _ , . - _. �: � , � � �. ` . � � � �� , v � N� �� r~ � �.. � J \ � , � �� , . � � y � � �1 � � = � 3 � � � �Xw° �° � �: � , 1 ,a �i � � C. � ��• c� � � � H O � �' � iv � 3 -� ^ � 0 0. r�. u'> d � .... m d � �• � , iD � y � N'� !�D° � � � � r�w � tD � a Q � � � � _ i� � � � � , l � �,? !r • C�.%'j / �. ?L/`f / �V, � L U N � �` '��r,� l. �A /iU �'_ Cl��l�'� � � ti` � � ` \� �I `<< � V • _ .. � - --. . _._ _ _� �: 1 � .l � E� Y � � z �1+� �1 ��= : 7 �:�r �1 � � i f� a � a- . 2 -t,� 0 � :�1�lv " � 1.�cT � �� e -�`�''�"'� c�. 1 � `� , �; �� I `! -----�--� -�- ---- / I L� 0 � � , �. �� r � r � .�._ -•- --- - � _ _ �\ (, .. ... .._ .y .. ._,._.-.�..._...,� IC�O Evaluation Service, Inc. Asubs�diarycorpo�ario�ofthe International Conference of Building Officials � �� , � - ��. RI(ng Category: FIREPLACES MODEL BIS FACTORY BUILT FIREPLACES SECURITY CHIMNEYS LTD. 2125 MONTEREY LAVAL, Q�JEBEC, CANADA H7L 3T6 I. Subject: Model BIS Factory-built Fireplaces. II. Description: General: The Model BIS, wood-burning factory-built fireplace is designed for installation at zero cleazance to combustibles. The fire chamber heazth, sides and back are constructed of aluminized steel covered with I�/z-inch-thick refractory material. The top of the fire cham- ber is also constructed of aluminized steel but without the refractory mate- rial. The metal fire box is within a galvanized steel jacket which maintains specified clearances at the front, reaz and at each side of the unit. 1'he fireplace is essentially a double-wall box with a single heat- exchangerpassageway sunounding the fire chamber. Air space between the firebox and jacket permits the intake of room air, by gravity circulation, around the �rebox and back into the room through two S-inch-diameter warm air ducts connected to the top of the unit. T'he ducts are also connected to wall registers, at least 6 inches below the ceiling. The air ducts are installed with minimum 2-inch clearance to combustibles. Combustion a'u is provided from the outside through a 4-inch-diameter flexible fiberglass insulated aluminum duct connected to an outlet at the lower left side of the. firebox The fireplace is equipped with factory-installed glass doors consisdng of '/�6-inch-thick neoceram glass panels in a brass or cast-iron frame. The fireplace opening must be a minimum 18 inches from combustible walls perpendicular to the opening. A combustible mantel may be installed a minimum of 48 inches above the base of the fireplace o�ning. A heacth extension must be applied to protec[ combustible floors 8 inches beyond each side and 16 inches in fmnt of the fireplace opening. The hearth extension must be a minimum .O18-inch-thick galvanized steel. All joints A��o� �o. �s t�ay,1986 between the hearth extension and fireplace must be sealed with a noncom- bustible material. The units must be installed with an 7-inch-diameter Model ASH.T double-wall insulated chimney with 2-inch clearance to combustibles. Overall size of the unit, heartt► extension and chimney details are shown in Table No. I. Descripdve information is shown in Table No. II. Additional information on dimensions and installation details are noted in Figures Nos. 1 and 2, res�ctively. Identification: All factory-built fireplaces bear a permanent label con- taining the manufacturer's name and address, model and serial number, clearance to combustibles, details of chimney and hearth extension, ICBOES evaluation report number, type of fuel and the name of the quality control agency, Warnock Hersey Professional Services Ltd. (NER-219). III. Evidence Submitted: Report of tests conducted in accordance with Underwriters Laboratories Inc. Standard No. l27, quality control manual and installation instructions. Flndirog� IV. Findin�s: That the Pactory-built fireplaces describ� in tl�is re- port conform with t6e 1985 Uniform �utlding and M�hanica! Codes, subject to the foUowing condittoas: 1. They are fabriceted, identlfied and installed in acsordance witlr t6is report and manufacturer's instructione. 2. Combustion air is prov[ded as set tort6 in C6apter 6 of the Uniform Mechanical Cwte. 3. The top of the profile terminat[oa is at leaet 3 feet above the adjacent r�f and not l�s than 2 feet above tbe 61�best remf port[oa wlt6ln 10 feet, w6lchever 6s �re�t�e This report ts sub,�ect to re•examl�Non Im one year. TABLE IdO. I (BUILT IN FlREPLACES) pusrauEo OYERALL S¢E OPENINO S¢E EI(TENSI�ON SREt �F{pb�y FlREPLA�CE AND (��1 (�hea) Mehes) S¢E—LD. CHIeuP►El� (Feetl NO. AlODEL Wldth Depth Helght Wldth x He1gM Wldth x Depth �� 1�,2 �, RE�qpKg 1 BIS 33 24 48 224z x 15 38�/z x 16 7 124z 24 With security ASHT double-wall chimney. •ncarin enicnawn �cwu oe o� ma[enais speclt �CU �n JeCttoll J/U /(1) OI th¢ U�Iltoim BUlldtag Cod¢ OT eS RotCd In [he nlartUfeCtUtiCl''s installation instructions, whichever is more restrictive. 'Minimum chimney height shown is without elbows or offsets. See manufacturer's instructions for other details. NO. MODEL 1 BIS GENERAL SHAPE Plan Vlew) D MATER(AL Trapezoid steel TABLE NO. II (DESCRIPTIVE INFORMATION) �os � 000r�s r�oor FlREBOX Wldth Depth He1gM Number p�hee) Number iype UNING Badc 81d� Bottom 33 I 24 I 48 r No No Z Glass Precast No No No Evaluat:on reports of ICBO Evaluation Service, Inc., are tssued soledy to provide information to Class A me►nbers of ICBO, r�tiliung the code upon which the report is based. Evalualion reports are not to be co►astrued as represenling aesthetics or any otherattributes notspec4j'tcaUy addiessed nor as an e�rdorsement or recommendation for use of the subject report. This report is based upon independent tests or other technical data submitted by the applicant. ThelCBO EvaluaHon Service, Inc., technical st�jf has reviewed the test results and/or other data, but does not possess test f¢cilities to make an independent ver�j"scallon. There is no warranty by ICBO Evaluation Service, Inc., express or irreplied, as to any "Finding" or oBher lnatter in the report or as to any product covered by the report. This disclaimer includes, but is not limited to, merchantability. Page 1 of 2 �g� 2 of 2 Report No. 4336 // � � ,�� fC� i�: �� r •- TABLE NO. A (Inches) MODEL A B C D E F O H BIS 224z 33 23�/z 334z 48 33�/z 24 103/a ROOF FLASHIN� ATTIC RADIATION � H —�{ � , �� ' F .� SIDE VIEW FlGURE N0.1 CEILINO f� i j� E .--, � �' � D � \ C y � . : � B -�{ FRONT 1/tEW NOTE: SEAL CRACK BETVYEEN FlREPLACE AND FIEARTH EXTENSION WITH A NONCOMBU8TIBLE MATERIAL SUCH A9 MORTAR, OROUT, ETC. HEARTH EXTENSION � s " � ° FlCURE NO. 2 � ! J SuB�eGT City of Fridley AT TME TOP OF TME TWINS g � I L D 1 N G P E R M I T r � � � ; y __��_ COMMUNITV DEVELOPMENT OIY. r � � PqOTECTIVE INSPECTION SEC. � = i"'1 � CITY NALL FRIOLE� 53��2 NuM6Et+ �-��' �'' 612-57�-34b0 e�aF�s 10B ADDRESS �447 Concerto Curve t LEGAL �OT NO. BLOCK TRACT ON ADDITION DESCfi. 3 3 Melod Manor 2 PROPERTY OWNEF MAII ADOii�S$ Kevin Schwartz 3 CONTRACTOR MAIL ADORESS Top Gun Inc. 5014 Parrish Ave. Rogers M a ARCHITECT OR DESIGNEIi MAIL ADDRESS 5 ENGINEER MAII AODiiESS 8 USE OF BUIIDING Residential. 7 CLASS OF WORK D�TE 8/20/99 21P J , 3009 PT NO. �� Oi AvvROVEO Br / SEE ATTACMEO SHEET PHONE PH��ONE IICENSE NO LICENSE NO. LICENSE NO O NEW O ADDITION � ALTERATIpN XaC REPAIR p MOVE O REMOVE B DESCRIBE WORK Reroof house and �ara�e (27 Sql Tear-off 9 CHANCiE OF USE fROM STIPULATIONS ro Underlayment must comply with the State Building Code. �s�d o,� a�uMOawoH ol �ell�W �� IIl14� s�a�� uoi�a�d�u� }iwa�� SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL. PLUMBING, MEATINti, �� VENTI�ATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOIO IF WORK Oii C(JNSTRUCTION 20NING AU7HORIZED IS NOT COMMENCEO WITHIN 80 OAYS, Op IF CONSTpUCTION OR WORK IS SUSPENOED OR ABANDONEO FOR A PERIOO OF 120 DAVS AT ANY TIME AFTER WORK IS COMMENCEO NO. DWLG. UNITS I HEREBY CERTIFV TNAT I MAVE READ ANO EXAMINED THIS APPLICATION AND KNOW TME SAME TO BE TRUE ANO CORREC7. ALL PqOVISIONS Of LAWS VALUATION AND ORDINANCES GOVERNING TMIS TVPE OF WOAK WILI BE COMPLIED WITM WMETMER SPECIFIED HEREIN OH NOT. THE GRANTING OF A PERMIT 2360 OOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL TME pEi7M1T FEE PROV�SIONS OF ANY OTMER STATE OF IOCAL lAW REGULA7ING CON- STRUCTION OA TME PERfpqMANCE OF CONSTRUCTION ,�',g3_2S SO. S7ALLS CY GROUP OCCUPANCVLOAD CU FT. OfFSTFEET PARKING GARAGES SUR7AX r fi SAC CMARGE TOTA EE S�GN4IUAE OF CON'RACTON Op eU�MOpi2ED AGENT IOATEi ENv RO v v ALIOAT / ��GN4TUAE O� OWNEp�� OwNEpBU4DER� iDATE� a�D �NSO � MAR-25-1999 16�14 FROM CITY OF FRIDLEY d t l� /�I n ADDN ALTER � / [l �� TO C1TY UF FRIDY.EY . SINGLE FAMII,Y AND DUPT.E7[ES R-1 AND R-2 BUII.DING PERMTT APPLICATION 428�26 P. 01i02 �C�IV� 1�1%� . b�� . 3 ��I � Jv construccionAadress: Legal Description: Owner Name & Addre�s: � �C✓�LL�� _ Te1.11 ��— �SS � Contraccor: TOP OUN, iNC. Mx LICErtSE� ,2�/S'S � 30 RISH AVENUE � '` Address: ROGERS MN�S��a Tel. � /� y� �` 7-�� ' Actach co chis application, a Certificace of Survey of the lot, witt� che proposed construction drawn ott it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DESCR,ff'TION OF IlNPROVEMENT Le�gth Width Height Sq. Ft. �.eAgth 'Width Height Sq. Ft. Length Width Hgt/Gtound Sq. Ft. . �° i.S� 3 �D- Construction TY�:�__ � �C� Estimsted Cost: $ .�'C� ��° lFee Schedule on Back) Driveway Curb Cl�t Width Needed: Ft. + 6 Ft � Ft x$ =$ DA'�'E: �/J l��G% APPLICANI': �� '� Tet. � � � � �SS� C1TY USE ONLY Permit Fee Fir� Surchazge State Surcharge SAC Charge License Siucharge Driveway Fscrow Erosion Coatrol Park Fee Sewer Main Charge TOTAL STIPUI.ATTONS: .$ Fee Scl�ecfule on Reverse Side $_� 3 � .001 of Pexmit Valuation (1/lOrh�) $ /_ �� $.SO/$I,�O Valuation $ �— $I050 per SAC iJanet . � $s�d o $5.00 (Stace Licensed Residential Concractors) $ A[t. "A" or Alt. "B" Above $ $450.00 Co�servation Plaa Review $ Fee Deteranined by Engi�ring $ Agreement Necessary [ ] Not Necessar�► [ ] $ �� 9 � . „ sue�ee. 'F�iaO.. City of Fridley 3 0 31 1 AT TME TOP OF TME TiNINS g � i L D I N G P E R M I T r ; � RECEIPT N . � • COMMUNITY DEVELOPMENT OIV. /l ' `y - V f � � Pf10TECTIVE INSPECTION SEC. 1 = � ' �� CITY NALL FRIDLE� SS13$ NUM�EP NEV OATE PAGE OF AVPROVED BY �'"'"� � �'� 612-571-3450 8/0-F15 9/29/99 / / J08 ADDRESS �447 Concerto Curve t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 3 Melody Manor 3rd SHEET 2 PROPERTY OWNER MAIL AOOR�S$ 21P PMONE Kevin Schwartz 783-7866 3 CONTRACTOR MAIL ADOFiESS ZIP PHONE LICENSE NO Top Gun, Inc. 5014 Parrish Ave Ro ers MN 55374 428-4559 20155030 4 ARCHITECT OR OESIGNER MAIL AODRESS ZIP PMONE LICENSE NO. 5 ENGINEER MAII ADDRESS ZIP pHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATIpN �c REPAIR O MOVE � REMOVE 8 DESCRIBE WORK Reside home 9 CHANdE OF USE FFOM TO STIPULATIONS Call for building wrap inspection before covering. Refianded $2.00 credit from past overpayment to Rollie. SEPARATE PERMITS ARE RE�UIREO FOR ELECTRICAL, PLUMBING, HEATINa, TYPE OF CON T. pCCUPANCV GfiOUP OCCUPANCV LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOIO IF WORK Oii CONSTRUCTION 20NING SO. FT CU FT. AUTHOR12E0 IS NOT COMMENCED V�1ITHIN 80 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANDONEO Fpii A PER100 OF 120 OAYS A7 ANY TIME AF7ER WORK IS COMMENCED NO DWLG. UNITS OFFSTREET PARKING I MEREBY CERTIFY TMAT I HAVE READ ANO EXAMIN�O THIS APPLICATION STALIS GARAGES AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING TMIS TYPE OF WORK WIIL BE COMP�IED WITH WHETMEfi SPECIFIED HEqEIN Op NOT. TNE GRANTING OF A pERM1T 3000 �I.SO DOES NOT PFiESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL TNE pEWMIT FEE SAC GMARGE PROVISIONS OF ANY OTHER STATE OR IOCAL lAW REGULATING CON- STpUCTIpN OR TME PERF RMANCE OF CONSTRUCTION 83.25 Fire SC �3.00 � � PLAN GMECK FEE TOTAL E License 5.00 9 .75 S�GNATUpE F ON'NGCTOa UTMOp�ZEOoGENT iDATE� N P PER LIDAT p�MIS IS �MIT /� u � � �y S�GNOTUAE O� OWNEp �� OWNEA BURDEA� IDAtE� BIOG NSP � q fE :.... ... .... ... ... .:.:. .:.:. . ..... . ... . . .... .......... ... .:. . . . . . ...........:... . ....�. . . . . . . . ""' , c NEW (1 ADDN 11 ALTER ( ] CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: � � Legal Description: Owner Name & Address: , Effective 8/1/95� `�\\ b 9�b �� 1 Tel. #�• �� — � �� Contractor: _ MN LICENSE # Address: 5014 PARRISH AVENUE Tel. � `l �`��, � � � Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION QiF I�IiPItOTii'EA+iEPd'T LI�ING AREA: Length . .. � Width � Height . . . GARAGE AREA: Length Width Height DECK AREA: Length ��_ �Width � Hgt/Ground OTHER: Sq. Ft.� ' Sq. Ft. Sq. Ft. Corner Lot [] Inside Lof ] F� Yd Setback Side Yard Setbacks � � � Type of Coa�truction• c �' F.slimatai Cost: $�� — Approx. Completion Date: � � � �- � (Cost on Back) Driveway Gtirb Girt Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE• APPLICANT: �rp� � Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Fscrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ �� S $ � $ $ � $ � $ $ $ $ �` �� !. � �!_ Fee Schedule on Reverse �� C '�2� �� i� 1 � l�c��.�.2�- .001 of Permit Valuation (1/1 $.SO/$1,000 Valuation $850 pea SAC Unit . � J� � $5.00 (State Licensed Residential Contractots) Alt. "A" or Al� "B" Above $450.00 Conseavation Plan Review Fe� Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] , . � . � Aa .�/� � � � � � D �� 7 O � � m Q- � � �' � N � y. � O y � n � � o � � � 0 � � a� `o_ �• � �' � oa � m � � o � � � � y `G Q- o � � � m g � � 0 c � a � � 0 < � a � � � 0 c 00 � � v � m � m z N � rn n � � Z � m rn � V 0 0 � 2 � v� oq � m a n � m _n d � � ' � �� nd \ .1 N � O h N � .. :- D fD f � � ' r�n � :;._r^ ? iil 1 �q : fp 2 m � z � ►-' o D y ►r = �• �3 �o n O e�'� o � � < `�° Q- � ni c� � ,� N \ � � _. � � _ O � 0=U -�i, t=d D �� D 'C — a>' D N C� � � y cu o h 0 O � N � o� o �- r � � � O Z � D � �J 64 ifi . � � 0 � � N � � �• c�o � c� m � o � a �o n.� � ,� � y N � �. fD N c, � a .-r QU � �=a`� a � �. � 3•vo� ,� < °—' � �; �n' — � � � o N �� '� � � 'O n� Q N � � � � �. � � h =� 0 �� N O- n O � � O � � Q. c� c��'�� m � � N � � Q 3 � � � � � � h � o��a 1 � r.p '� � � � � � � � A �^ � � \ / � y O � � �- �, c� a� � � �. �W C � � m � � a m Z o� (�D _ "O v� N cD z 0 m' � � da�i n�i D c u�i N N Uf N � Q O 0 Zl � � � 0� �D � � '� N� (�D � � m or�o��= s � z � � fD � � � � � Q, � � O � T rt a � �-=�o —c � � � � � C p� ��o � � � � v � v � � � a� � c�o � � � � E� � (Ti O O O O � °o °o °o o° °o h co ft� 4J9 {fl EA tfl -� � o � � � p�- � � C� � n N � � � > > m fD � �� Q- cn m .� � n'1 � � Q'�o .'i7 • d � v .. m N � � � m 0 n O � � I �� m � � Z O �..tJ ��lJ � � � � � 2 �1 � � r m ■. • • .. . - . . . ► • � � . ii .' � \ , � ► w� " - �� tn-n�(7 N O_ W � � O� � O �z� � �� m �- W � � . iv m z z� m � m '-i O Z v < vi > � � Z � r �� O L� Z 1t1 � � O �� O� Z� Z � v� a� �Z oN �� -� � o= Zm Z � � Z �� m� O N r a� %i v< v "' z <� n� N O Z � c� � c�D O � � � � � � � � CHINIlNEY AND STACK VERIFICATION The undersigned hereby verifies that.the existing chimney or stack: 1. Has been carefully examined Yes () No () 2. Is free from rust or deteriora�ion 3. 4. 5. 6 Has no foreign objects lodged within Is securely supported Meets all current Code requirements for size and tot� B'TU's connecfed Has total heating B'fU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater 8. Has com�ustion air been pro :�ided for water heater Remarks: List ALTERATIONS Bein�one: HEATING CO: Signed By: Date: Yes()No() Yes ( � No ( ) Yes ( ) No ( ) Yes ( ) - No � ) Yes ( ) No ( ) YesONoO � � � c -�1 �. � `° m � m m t� � � ci � � z f71 Z "'� z � O z D n � � v m �� r� ° � c��D � �G�o c � -� m o � -* v �� 0 m 0 o � 3 v � �°—, � °� D � �v � � 0 z � �� g� N� � W W o z � -i c�i a, v�, �. °' °;. � ?�• � ° � °. � C � � � � c�n c'�u c'�� ' �' O � ,v 'Ti � � � .� � = 2 � � � �° �t v; �. � W p � � � � � � � g' o� � � N G� t ' r v► N � � � m c� ��i 3� Z � � � �, � � � � .. � -n � .`S� �� ; m c_ . �.... . m � -. ., . o. . , _ . .. .. .�. .._. � m � z 0 I ( I�I I I I I I I I( � � � � � � � � � � � � � cn o 0 0•� o �•� y v a, a� 0 0 0 0 0 0 0 0 o co 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 n cn -o a m � " ° z � � � n � � 'O .� O � � � a N � � � � Z v ° �.r �V � t 0 � . N 3 °;, . �i N .�► �p � m � � � � �o a � � C � �' � � � '\v � �, � � � O I > > -NO � aac� cu m 2 3i � ��• a a N � � � � � '. O -: � �� 4'! � � f?p � n, a Q. � �' � � � � � � v d � ? ° � � N � p1• �• �. 'a '0 � (/l � � a � �i o � � 3 � m � -ti m `�' a a rn o. � o� c� � v m m w � � � � � a�,�o 8�.�,� �� `� o m �. -* m N N (�p 7 z 0 � m O D r h � .••. � � � � 0 COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When realacina an existins� furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No () The venting;,system is, plastic/PVC and meets ail current codes and manufacturer �" specifications :including sizing, length, number of eibows and termination. � Yes ()� No (� ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer"s specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. The existina combustion air is sized and installed to meet the cuRent codes and manu�acfiurers specifications. When required to install a new combustion air. it will be sized and installed To meet the current codes and manufacturer's specifications. Yes ( ) No ( ) `� ��-�- �- �;a i g-- Yes ( ) No ( ) When installins� a new ventin� svstem, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does inctude AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. Yes () No () Is the common vent and vent connectors sized and installed correctly after an appliance�has been-removed from the common vent and vented separately as::per current codes. Yes () No (). Aapliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU input Fan Assisted or Nat� Appiiance #2 Type BTU Input Fan Assisted or Nat _ Appiiance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS• (Describel >� ' � . . HEATING CO: ' : . Signed By: � Date : Building Inspections 763-572-3604 S1TE ADDRESS _ THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMTf A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE MMC �_ : � ._� PLUMBING RESIDENTIAL APPLICATION CITY OF FRIDLEY �� - � ��`% � OWNER I�I2f � NAME: i ADDRESS: � PHONE: � NAME: � � STATE LICENSE # U' ADDRESS: � PHONE �r� �/��I ❑ NEW FAMII..Y DETAILED DESCRIPTION OF WORK YOUR�MAIL ADDRESS �.c_ �,-u � 0 TWO FAMII.Y Pernut No.: ; Received By: ,�� ,� � l � � CITY FAX 0 TOWNHOUSE L9�PLACEMENT PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the totai cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = FOR PROJECTS WI-IERE LABOR EXC$EDS $500, FEES ARE BASED ON $10.00 PER FDCTURE, EXCEPT WI�RE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVi� BATH SIIQK/LAV FIAOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING �eo crrrirc�vss) SWIMIVIING POOL WATER SOFI'NER ($35) CLOTf�S WASHER KTfCHEN SINK WATER CLOSET BACKFLOW PREV. ($15) _ DISH�VASI�R _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ WATER METER _ OTI�R Permit Fee TOTAL DUE $ Number of fixtures @ $10.00 x $10.00 = $ .50 Number of fixtures @ $15.00 � x $I5.00 = $ 6� $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ 50 Tota1= $ 5 � �i THIS IS AN APPLICATION FOR A PERMTT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclmowledge 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 appli 'on for a permit and work i ot to start without a permit; that the work will be in accordance with the approved plan in the case - rk w i ires rev' and approval of plans. SIGNATURE OF APPLIC PRINT NAME DATE � City of Fridley Building Inspections Departmeat 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977