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AF - 43344MINDERENGrINEERIN((��rr CO.,INC. ENGINEERS AND SVRVEYORS �wNO euav��nnio CIVIL d. MUNIGIOAL ENOINEEii1Np SOIL' TE8TINa LAND DLANNiNO 6418-56T" AVENUE N. M1AlNEAPOUS 2?, MiNN. KE 'T- 3637 � � �''� � {� 8 �� i � 4 lF �` [� �'►�! �� f�Y� �i ,, , (d.p�f ��. � / �� f., �..�) -: • �-, � � � ,,. �� J b�f� `� � � � � � `� �- �� "` ' �. � ' � i t.: !~� : � �" E �,�� m r�' a � [�� l � tt�f�Y � �i"f °�4�' � � : � �`p �' r'� � �* t� . W6 HEREBY CERTIFY THAT THtS IS � TRl1E. ANO CORRECT REPRESENTATION OF A 51lRVEY OF THE BOUNOARI�S OF 7lFE LAND Afl4YE OE5GR1BE0 ANO OF TNE LOCATION OF ALL �UIL�INGS, iF f�i1.1Y, TNEREQN , ANO ALL V1Sl6LE ENCROACHMENTS, +F �Y, FR�M oRON SA�� LRND. MINDER ENG�NEERING Co., INC. r ; O�TED TNtS O�Y oF a� �°.r: �*.'�'�'., G`' ,�°' �,^ A.O.1�*�9 ' "�'� EN6t�IB S At1D SyRYEY RS . . - i'"! f 1 py ./T ' f _ �I'� r � � i �. s� : r �� - - .�� - Ca.ty of Fridley, Minn.. BUILDING PERMIT N° 5922' � �- �. � �' � - Date: +k.r� � c'_ "� .� ��-•' � , �,! � ,,� ,r �+ Owner .'��:�f:: �j�"'� . �`,',�3 %a''�';+.rE`'��i ��;� Builder ��, �` � ^µ�"�� Address Address ,�r � � e � I�C�,TIO�F B ILDI(VG No. -�- °' ' �� r 5treet ,�`'� -�� ' � �r. ...�.... Part�,,q#�,Lot — Lot _.��_ Block __._. Addition or Sub-Division �-�'= �` Corner Lot � Ins�tde Lot — '�''� Setback �� ,�' Sideyard _�'�-__ *� '��-�,/ Sewer Elevation ..._._____ _.. Foundation IIevation DESCRlPTION OF BUILDING To Used � �r � , �� .,�,�, J�' �f� ,� � � � �+� +� �'�,�' �l� � � ': e.' Front .1..;:� Depth Height Sq. Ft Cu. Ft � Front r� Depth � Height �! Sq. Ft �� Cu. Ft __�� ,�� ,,,� s ,.w � �C Of L IIS�tlCi30II "°+'�O j� �•a ,Tr9t. C:OSL r I�ii �'�" _`�.-..� --�� „�..�;�� ... To be Cumpleted In consideration of the issuaace to me of a permit to construct the building descrlbed above, I agree to do the proposed work in. accordance with the description above set forth and in compliaace with all provisions of ordinances of the city of Fridley. �� In consideration of the payment of a fee of $.,�. permit is hereby granted to....._ to construct the building or additaon as described above. This permit is granted upon the express condil3on that the person to whom it is granted and his agents, employees and worl�nen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildinga within the city ]imits and this permit may be revoked at any time upon violation of any of the provisions of said ordinancea �5 � � �,,,o�,� i.':i'` _ �•_� _ suilding Inspector NOTICE: Thb parmif does eo1 cove� ths eoaslweHon, testellaflon fo� wtrie►g, plumbing, gas he�tleg, sewar or weter. Be wre fo �e ths Bulidfne Inspeetar for �parate permiis for these ttsms. �-`� —,.�' - �� 4 i`�.. - � �. � 1 = - �. ♦ APPLICATION FOR BUILDING PE�NLiT CITY OF F'RIDLEY, MTNNESOTA Owner's Name Builder /°��-,T--/, ��dUl� F,(��s 7�D �( Address /��—� Address�� .�/'�,�.rs . �`l /�t� LOC�iTION Ol� BUII�DING No. ' Street Part a�f Lot Lot �lock` .�o�Addition ar Subdivision j�F� naoy s��a, ��„�,� ��ih,� Corner Lot _inside Lot L/ Setback �� Side-Yard /D _�� r^rET+dSIi ELEVATION F.OiJ11IDATION ELEVATION Applicant atCach to Chis form Two Certificatea of Survey of Lot and proposed building location drawn on these Certificatea. DESCRIPTION OF BUILDING To be used as: � _Front ��,� Depth � ,� Seight � � Sq. Ft, //,�� , Cu. Ft. Front Depth He3ght Sc�. Ft. Cu. Ft. � Type of Construction �� Estimated Cost��,� a°�� To be Completed Z� � The under�igned hereby makes application for a permi.t for the work hexein specified, agreeing to do all �ork in etrict accordance wi�h the City of Fridley Ordiaances and rulings of the Department of Buildings, and hereby declazes tha� all the facts and representationa atated in this application are Crue and correct. DA �� L (Schedule of Fee Coete can be fouad on the Reverse 3ide). .. ,, e t= ^ i�`� � .. . �. � BLTILDING �ERMtT FFE SCHEDULE Section 2. The Inspector of B�ildin�s sha114 before iesuing any permit £or the erection of any building or structure, or for any addi�ion to any exiet- iag building or sCrucC�ire, or for a�ay alterati�oas or repairs to any exis�ing Uuilding or sicructure, upon application therefor, require the paymea� by the applicant for such permit qf feee to the amount herein below set fo�th and ia the mann�r herein paovided Co-wit: 2.1. For any auch permit for the erection of any fire�proof building, other Chan a garage� warehouse, factory or grain elevaCor, or for the erection of any fire-proof addition, for sim�.lar occugancy, to any existing building shall be at the.rate of $1.4D for each one thousaad cubic feet, or fraction thereof, in such cubical contents. 2.2. For any such permit fos �he erection of any fire-proof garage, warehouae, f�.ctory or grain elevato�, or for the erection of any fire-proof additioa, for similas occupancy, to any existing building sha11 be $t the r�te of $1.25 for each one thousand cubic feet, clasaified as °tfireproof01 by Sectioa 502 of the.Minneapolis 8uilding Code. ' L;OUS�S 2.3. For any such permit for the erection of any noa-fireproof building other than a garage, warehouse, factory or grain elevator, or any.non-fireproof addit3.oa, for similar occupmncy, to �ny existing build3ng - permit $1.00 for each one thousand cubic feet. GARAGES 2.�. For any such permit for ehe erection of any non-fireproof garage, war�hause, factory or grain elevator, or for the erec�ion of any non-fireproaf addieion, for similar occupancy, to any existiag building or fos each auch tiuilding o�c.addition - ninety centa �$0�90) for each oae thoueaad cubic feet or f�action thereof, in �he cubical contents thereof ��ith a minim� of $4.40. For the purpose of compueing fees for building permies, the.cubical con�tents o�E any building orc additioa to a uniform height throughout by multiplyiug the ground area covered fram a poine sis (6) inches below the fiaor line of tbe basemea� or cellar to the average height of the upper surface or to the avars.ge height of the roo£ surface of the main gable of a pitched roof. 2.5.� For repairs or alteratioas to an exis�ing structure, the fee shall be at the ra�e of $3.00 per each Five Hundred Dollars ($500.00) or fraction thereof in the cost of all psoposed work. 2.6. In no case shall the fee chaxged for any permit as set forth in Section 2 be less th�an, $4.00. �- _ _ � �1 � _ . ,�._ � �` •� .�'�, �I � � � a C • � � � � a �` a � 'p A .� C � O v+ O c � ; U ,� � �� Q m i� � O o 30 � � za o ,� a� �� Q � z w q � a� �+ .� y �o � �� ' aF°'��(y'o yy� Ci �� ' ��A� c� � � .° '� � a� a�� o � � q O � u v�" � a�� a a `° a �� B o � .� � � � a� � �� a � � � N A �+ '�° •� ,.�°', � � p? � 'a bb o y � � � � � �.�� F J T "' � < 3 � � z • 4 59NIN3d0 �� 3JN1/L �� ,ddV sv� M3HSYM o� SNISYB tOlYJ ��v�a a�-� � •�no� •�waa sAVai HSdM S71NI5 �,� �u ru.ve sm�►an �� tl31VM � rn � v O � � � o � � � � m m � ��H� = ,��■ • • �cc�� _ : �oc�� _ , '.... . �' 1�� ;, '�� 0 � � a�i a � � � H '�i 1,� 0 z p � � � � a i10 �s' ;� m '� U � � �� r� O w J � W U � W � J Q � a q � a � � � � Oq Gq � � �.3 � i � n O a � � > � � V F H `� e� va v} v� 1� � N O N O N Q�' .-� � ti M 6V M 69 x x oe �e �a o� d : : : : � : : : : : � : : � � : o � : yo .� : o fA 'r'7 • � g' � Y O E+ � � � � . � � � � � � � � ��x� � � � e � ro B x z� z �� z � a � � � If? � ` E+ � ��°n, �°n, °o � N � � � 0 z : : � 0 : ffi o O 0 0 pj N � �� a� M � O � � � C�7 � � �, ��. 1^♦p ff l � � . � : H b • ci : m : P�' � Z: 0 �a • �� a � �� A � W � � � � oe � .� . 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W : : : � � : ' � o 0 o � w � � � � � � o ' a e'4, � � � � � Q � � o 0 � ~A � � 4 aJ .., c`°. � � a � � � � � � � � � s��v� � x a x F =- � � 1 � � k+ O O � � Q \ z � �z a� � � i 0 a p� �� o q � . � a w � �+ � � �, N � a �� ; �,�� a � �d z .� � I. � a � � � �� ;� � � � o � • � � B � � � a � � � � � z � � � a�'i ° c° aUi `" d '� � �a (� c° '" r� O � 'J� Ei W �'i E� U E� G�4 � � � �� 0000� 00 N �U W N U ��.�. � oo�� o a0 OD N N u� : : : : : +�-� � ' : ' ° � b . p o° : : °o $ � � � � �° ,d � � : as �+ •O . ,� � L� 'CN .� °° : �, � � �I � S °' I ° a�i CJ I � � � � � � d � � � � � � � a � � � � � � �1� � � v � � � M V o � � a a a � � � � a� � � m : � �.� o �x � � �i w m � N M � m w w : '� : � u : � . y :w . �, .� � � � o F x" a � � �� M � � � ti �i � W � a� � �a a 0 �O 0 Z o � � � � � a ,� '^ �� V y � �— �C� . � � � � � O ,C e. ^ � � (� � a � � �, p a o� � �U � a � � � � � � �. �. � o ��o �-� � .� N � . o ►i ia ii m • � i I i � O 0 E� � G�a � .��. � O O 0 0 0 � ° � � � � 4 c� . . � : � o �, • y O � M O �� v'� i: W° � m a� a �� xm��, � O � O �w � � x y��, �p E, H O E � � � Z � 4 � �+ w � � U f. W � 4 W ?, 4 ¢__ ,.. � � � z w 0 � a g � S s - . _ '. .;.f' - �" �.�: . r.` T:'S 7 9 ' `'� ._. HEAT LOSS CALCiJL.ATIONS DEPAR�T OF' �LJIL.DINGS MINNEAPOLIS, MIMei. Weatherstrips A.S.H.V.E, Construction No. Insulation Guide Windows I Doors Reference Out. Wall Int. Wall Cxiling Roof Floor Kind How Applied Yes—No Yes—No 19— FI.� ./ �f `�Room � Length �^ Width j n:j �p Height �' FI.� �'�' �' " � Room Length �� Width �,-� H Windows and Doors—Crackage and Area Windows and Doors---�rackage and Area �Vldth Height No. ot Ltneai f. Area Wldth Hetght No. ot Lfaeal tt. Area Na. of pane of pane Ilghta ot crack aq. ft. � No. ot paae ot pane 116bte of crack eq. tt. �,� � � � � ,� .� �.- ��- �� .. � � �- � �' - �' �, � ! � �'-� Coef. Btu Coef. In6ltration �� Infiltration s3 � v�+;;!` Glass nv � „� �� Glass Eap. wall ,,�`",d d�' �' ��. F..Sp. wall ' � � ,� IVet esp. wall �.�. � � �� Net esp. wall T R�'? �" � � " � Int. wall Ceiling Ceiling Floor �� !�'�' �.�C:� �a�� Floor p� �c ��_ �� ,� Total Btu. �.�' � Z'otal Btu. Required sq. ft. E.D.R. or eq. ins. W.A. Leader area Required sq. ft. E.D.R. or aq. ins. W.A. Leader area F7.� ��" "` �' Room � Length /�., ' Width � Height �'' ��,� p�; �� Room j Length /, Width /,� � H Windows and Doors—Crackage and Area Windows and.Doora—Crackage and Area Wldtb Helght No. ot Lfneal ft. Area Wldth Helght No. of L1nea1 [t. Area No. ot pane ot pane Ilghte of crack eq. tt. No. of pane of pane Ilghte o[ crsek eQ. tt. e �� -n' � �-. � 1.�� ' ! � --� :�� , � � °� Coef. Btu � In6ltration � � � ;% Glaas � `. �+ � � � Eap. wall -- 1� , Net esp. wall `" � � � � Int. wall Ceiling Floor ,,, � �' °+� ' � � Total Btu. � Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl. ,� /�"F�,�,a °�Room � Lengt6 . ; Width �l � Height ' Windows and Doors—�rackage and Area Wldth Helght No. ot Llneal ft. Area No. ot pane of Dane Ag6te ot crack eq. fi. �':� *� � � .� �� `'a-�� 'R'� � *Cs1�. � �� .i�`_ Coef. Btu Infiltration � � �r ,� �' � Glass ,� y s � ;, t Exp. wall � ,' � a�"°' : � � . Net eap. wall P° �" / ' _� Int. wall Ceiling Floor � � ,d �'�� f'' ,i � � a Total Btu. �f °' Required sq. ft. E.D.R. or sq. ins. W.A. Leader area � I� Infiltration Glass Exp. wall ,� �?*' � Net esp. wall Int. wall Ceiling / � � �,� Floor Total Btu. � Required sq. k. E.D.R. or sq. ins. W.A. Leader area sJ F7.� %� ��,a s��; � Room I Length �°� � Width 1� Windowa and Doors—Crackage and Area Wldth Hetght Nu. ot Lineal ft. Area No. of pane ot.pene lighte of crack eQ. [t. . �y ��, �� !.� Infiltration Glass Fap. wall ,� '� Y, Net exp. wall Int. wall Ceiling � �, �' ,; 3 �� Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. Q/A. Leader ana Btu � � t `� � Btu � s t- iD-J6 H a� � s I HEAT LOSS CALCULATIONS DEPARTMENT � A.S.H.V.E. ' Weatherstrips Guide Construction P Windows Doors Reference Out. Wall Int. Wall Ceiling Yes—No I Yes—No 19— ;�;.Fl.� ',�,,,�e� f��$ Room � Length � Width t` ��' Height ,� Windows and Doors—Crackage and Area �Vldth Helght No. of Llneal f. Area No. o[ pane o[ pane lighte oP crack eq. ft. A � � ��; � � � Coef. Btu Infiltration � � �°' � � � '� c�agg � � � � �'�� Fap. wall � �c ,��' � Net egp. wall � '� `� �� Int. wall Ceiling �r'' � � - � .� � - d--.= ,.:�. Floor 1'otal Btu. ,�;4 �' ' �; Required sq. ft. E.D.R. or sq. ins. W.A. Leader area `" Pl.� � � �� Room � Length ��' Width ,�`a^� Height � Windows and Doors—Crackage and Area Wldth Helght No. of Lineal ft. Area No. of pane of pane llghte o[ crack eq. ft. � �° � / 1s3 � � Coef. Btu In6ltration � ��' � �,� � s: Glass � °� t� �.; a� ,� � Eap. wall � � °" ;� � ,� ,� Net eup. wall � '� �' ��°�' � Int. wall Ceiling � a � i� ,,`'� � � �'.a� �� r� Floor � Total Btu. "' 1� °��`. Required sq, ft. E.D.R. or sq. ina. W.A. Leader area ,�. F'1. ° '� �� .b� Room � Length � Width �,;, � Height � Windows and Doors—Crackage and Area Wldth HelgAt No. oL Lineal ft. Aree No. of pane of paae Ilghte of crack eq. ft. '�'' �' � �•' � �- ,6' ��' 4'- � c�.. f � d'' - -- _ Coef. Btu Infiltration �; � ^p Glaaa Eap. wall .�' �, 0.'� �: Net eap. wall Int. wall Ceiling ,0 � � r' Floor Total Btu. �� Required sq. ft. E.D.R. or sq. ins. W.A. L.eader area +�'�, M.� � : . :#ed . � Y .� OF BUILDINGS NIINNEAPOLIS. MINId. fo, Insulation Roof Floor Kind How Applied Fl.) Room Length Width Height Windows and Doors—Crackage and Area Wldth Height No. of Lineal tt. Area No. of pane of pane llghte of crack eq• ft. Coef. Btu Infiltration Glass E.�p. wall Net egp. wall ' Int. wall Ceiling ' Floor Total Btu. Required sq. #t. E.D.R. or sq. ins. W.A. Leader area F1.I Room ( Length Width Height Windows and Doora—Crackage and Area Width Hetght No. o! Lineal tt. Arae No. of psne of paae 116bLe ot crack eq. [t. Coef. Btu Infiltration Glass Eap. wall Net esp. wall Int. wall Ceiling Floor Z'otal Btu. . Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.� Room I Length Width Height Windowa and Daora—Crackage and Area W1dth Helght No. of Ltneal ft. Aree, No. of pane ot.pane Ilghte ot crack ep. tt. Coef. Btu Inhltratioa Glass Exp. wall Net exp. wall Iat. wall Ceiling Flaor 1'otal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. I.eader area .�- Building MECHANICAL Inspections RESIDENTIAL APPLICATION 7. 63-572-3604 CITY UF FRIDLEY DATE � (�' /� SITE ADDRESS � THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WTTH APPLICATION PERNIIT TYPE TYPE OF WORK: �ETAILED DE�CRI � e 00 R NAME:� ADDRESS: PHONE:� COMPANY NAME:_ CONTACT PERSON: STATE L1C SE q ADDRFS : • PHONE ' � �5WGLE FAMILY ❑ TWO FAMILY � NEW ❑ REPLACEMENT :ON OF WARK�I�Ye, , FAX O TOWNHOUSE ❑ ALTERA'!'ION/REMODEL � Pernut No. Received By: STATE ZIP 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 fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 =$I5.00.. Labor cost between $300 to $500 = cost of labor x.OS = FOR PROJECTS Wi�RE LABOR EXCEEDS $500, FEFS ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FlXTURES: (II�IDICATE TOTAL NUNBER OF EACH BELO� Equipment Installed , MFG: MODEL: SIZFBTIJ AiC 525.00 AIR TO AIR EXCHANGEER $15 _BOILER $35.00 _CHIMNEY LINER $10.00 DUCT WORK $10.00 Permit Fee Surcharge TOTAL DUE MFG: MODEL: MFG: MODEL: FIREPLACE (GAS) $15.00 _FIREPLACE (WOOD) $35.00 FURNACE $35.00 �GAS DRYER $10.00 GAS PIPING $10.00 SIZE/BTU SIZEJBTU GAS RANGE/OVEN $10.00 NEW GAS GRILL $10.00 _GAS UNTf }TfR $10.00 _POOL HEATER $35.00 _VEIdTiLATOR $15.00 $ � •�.� Number of fixtures @ $10.00 . x $10.00 = $ $ .50 Number of fixtures @ $15.00 x $15.00 = $ $ ___�,�_.� Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ � State Swcharge = $ .50 Tota1= $ THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclaiowledge 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 �Construcbion 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; that the work will be in accordance with the approved plan in the case of a work which req i�es review and approval of plan . � � ti SIGNATURE OF APPLICANT PRINT NAME � DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 x ...- REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC _ ❑ NEW HOMESIADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR p REQUIRED FOR NEWIEXISTING HOMES 1. Combustion Air (See note below) . . a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or PropanelIFGC Chapter 3 with MN Amendments � 2. Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments . - 3. Ven.ting a. Gas appliances IFGC Chapter 5 with MN Amendmen.ts b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a„ R,equired on n�w construction IMC 1346.0312 5. Ventilation . — �. �'ex NdN Energ3t Code 7fa70 or 7672 - -- __ _ _ _ 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NpTE: Cenfez-poi�nt Energy Mechanical Code Guidelines software may be used for combustion and make up air calculations �•, Building �j,��i�j� Permit No.!� � I`1c%3 Inspections �5��, �p�,ICA'�'IOl� Received By: � 763-572-3604 �;�►�� ' �.�.+'� ��e�� 1 � 200� 763-502-4977 FAX Er�c� 1-I-0s DATE IO � �fi YOUR E-MAIL ADDRESS SITE ADDRESS �S C GL� Yt�� IL VLKf I�I G THIS APPLICANT IS: ❑ OWNER � CONTRACTOR PROPERTY NAME: DQ.�GI H'�wi �� ADDRESS: I�'� GYCW�I �V�DlL �Q� {�� CITY �yi I�y STATE�ZIP S� �- �NaNr � y st� PHONE:�L9?i � 5 I ' CONTRACTOR N�E: SUBNIIT A COPY OF YOUR STATE STATE LICENSE # EXP DATE LICENSE, BOND AND STATE BOND # ' ''' EXP DATE CERTIF'ICATE OF ADDRESS: ' CITY STATE ZIP INSURANCE _� PHONE pERM1T TYpE i�SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE /" TYPE OF WORK: � �' '�I,�PLACEtv�tv'r /" DETAILED DESCRIPTION OF WORK h-5 �/� ��'► D l � - PER MS 16B.665 the permit fee is a minimnm of $15.00 or 5% of the total cost np to $500.00, whichever is greater, for the improvement, installation or replacemeat 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 = plus .50 surcharge OR FOR PROJECTS Wi�RE LABOR EXCEIDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVI�. MINIMUM FEE $ I5.50. _BATH SINK/LAV I'LOORDRAINS SHOWER WATERPIPING _ BATHT'UB GAS PIPING (NEED QTY LIC) _ SWIMA4ING POOL WATER SOFTNER ($35) _ CLOTf�S WASHER _ KTTCHIN SINK WATER CLOSEf BACKFLOW PREV. ($1� — DISHWA3HER _ LAUNDRY TRAY TWATER HEATER ($35) FOR IRRIGATlON _ WATER MEfER O'IT�R . �r — � � , ... . . ,.. _. `� . . � �� .�' . . . _,:. .� �� '�d� x�,'� �"�5�'�,i I�� 1.�. ;�' �s�»��.;.,.. �":�, a�t�'�4 �{�� , . , ..., 9,,. y • . . ..� ..;,,..... ' " " .."".. , ' .' „ . � ,, . . .._�. .. ... . �..-.... . _. : �.:. �,:.;. Permit Fee $ Number of fixtures @$10.00 x$10.00 =$ Surchar e .50 Number of fixtures @$15.00 x$15.00 =$ TOTAL DUE $ OR Number of fixtures @$35.00 t x$35.00 =$ 3S> � State Surchazge = $ .50 1VIINIMUM $15.50) (MINIMUM $15.50) Total = $ , � THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PRQCESSED I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in - conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT I`(�il'L PRINT NAME N. � f-�- l.rG,��/ DATE � 17 f 13/�� APPROVED BY DATE ::;��i�"�,��s.t�fl�� i��.�_F��3k��'�+�%� �'is;4'f.,#��yl�'4'1�.i?,':�� i"IW''tY'��,.n�r'�'r.�€�JM�,t'11:r..:Tr��r..:� .'�; City of I+"i-idley �uilding Inspections Departmeat 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977