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AF - 47645BUILDING PER�IIT Village of Fridley, 1'Iinn. N° 2727 . - Date ,.-r. .�....r.-. .�,C .' / . . . . .. .. . . . . .. . . . . . . . Owner � / � ' - Auilder ..... ,I...9 r t (,( .. .. . .... . . .. . . . .... . ..... . •l`'�tL!f.,�..}�,,..,.�':.._rr'FCYc......... - Address .:".� �t' • . ,��<: �.f.....r...,,......,.;.�1...,�.V.._.�, .lddres., LOCATION OF BU[LDING \o. . /...��. �.l-.... itrret ..... �. i,�.:.,�a�.f .. �i�i�/ .................. Part of Lot ....................... r Loi . ..�l.� . . . . .. . . . Block . .. l:b., . . . . .. . Addition or Sub-Division ,��. .. T..,� ........................ _ � � � , Corner Lot ............ Inside Lot ..�......... Sctback ,�•�.. /hy� Sideyard .�Q.'fy�,!"r, DESCRIPTION OF BUILDING To be Used as: ��. ;yl� . . Front �. ;Z, . . Depih . �: c±. . . IIcight � �S. r.. . . Sq. Ft. �/,�'G� . Cu. Ft. . . . .. . . . � �,�p�q�...... Front .�.�... Depth .yt �,.IIeigiit /C.�.... Sq. Ft. �d�. Cu. Ft. ........ Type of C�onstruction �* �� }� �y��.,,dt,�... Est. Cost �`.��0� .............. To be Completed �.�/Cir{:�.. In consideration of thc issuance to me of a permit to construct ffic building described abovq I agree to do the proposed work in accordance with the description above set forth and in compliance with all Provisions of ordinances of the villa�e of Fridley. i In consideration of the pa3'ment of a fee of $. s�. , permit is hereby granted to . � �b ... . t's.r{�6„1sty..... �� ........... to construct thc buildin r addition as descri6ed above. Th�`.s �perm�t �s granted upon - h��espress condition that the person to whom it is granted and his agents, emploYecs and worlcmen, in al] 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 buildings with- in the cillage limits and this permit may be revoked at any timc upon violation of any of the provisions of said ordinances. � Building Inspector NOTICE: This permit doe5 not cover the construction, installation or alteration for wiring, ptumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. � � J Application I�or �owsr Maef�s and H�aNng. Cooling, Yenh'tation� R�raMon �d Air C:�indit�oning S�n�s ond Devic�s . PARTIAL RATE SCHEDULE GlIAY!TY WAAM AIR: �� T��y lhuaace Shetl & Duct Work . . . . . . . . . . . . . . . . . . =10.00 � Reptacement of P�tnace . . .. . . ..... . . . . . . . .. . . 6.00 � Repairs & Alferafions—up to =50d,00 g pp ; ____ Repairs 6c tUteraUona each add. f500.00 . 3.W �----- w�cx. w�►nx un Furnace Shell da Duct Worg to 1�0,000 BTU ........ . a10.00 ;� dch add. A0�000 BTU ............. ... .... 3.W i RepLcrment oi Fwrnace . . . 6.00 ; Repain dc Alterations--up to t500.00 6.00 ; Repairs & Alterations each add. :500.00 3.pp = STEAbt or HOT WATER SYSTE�t F�rnace $he}l & Liaes--to 400 sq. it. EDR Steam $l0.00 $. __ riirnace Shell & Line—to 640 aq, ft. EDR Hot Water 20.00 a_ Each add. 200 sq. ft. EDR Steam g,�(1 �__ ___+_ Each add. 320 sq. ri. EDR Hot VPater 3,0p �_ OIL BURNER—to 3 gal, per hour g,pp s _ over 3 gal. per hour�ee Fee Schedule GAS BIIRliEA (up to 199.000 HTU) ... S 00 = over 199,000 BT[7 S.e F« 8ch�dul• GA8 FITTING FEE$: 110 RATE TOTAL Ist 3 F�xtures . xE Z00 S Additiona2 PSatures .. _ .76 ; Gas Rang�e to 198.000 . zf 6.0� _ AIA COl�DI'ROlII11a �j • � �/� FAN HSATIIEG 3T�?a1! S� pN Se�dub v��.�►ru�a svsrcM � 11LTERATIOIfs � REPAIA3 TO?LI. FEE { �� ROU(3H .iINAL /� -/ - %/ n.,�. � siaq.. r�►. eeo-�o �- 3 C� 1�� . � Ciey o� �idley: The undersi�ed hereby makes appllcation for a permit ior the worl� hereir specified, agreeing to do all work in strlct accordaace with the City Orditiance: and ruling oi the Department of Buildings, and hereby declares that aI} tbe facts and representations stated in this application are true aad correct, F1�caley. Minn � / � � 18 � ��L Owner �-�-'�� '�.� � " r -� Kind of Building _L_ _ w`-�`� — � Usec� as -- _ _ - ��j- - - To t�e completed about __�� --- � Estimated C�t, S__��_._ ��___. � C� � _I/ Old—New. Building Permit No. P�rmit No. /�S-� -- �_: � .� �� „ i ^ DBdCAIPTiOIf OF WOAS �o C�'� HEATING o� POWER PI.�jNT��team. Aot Water� Warm Air—No Trade Name �� Size N�- C�/ �% �, CapacitY Sq. F`t. E.DR BTU Z�> �� ii.P. Total Connected Load � of �� BURNER — Trade Name 3ise Aio CaDadty 3q. !'t. E.DR g�l IiiP. � (tEMARKf•-OYER) sl�.,rd �'-�-�C_ .�- '��-�e.��i i�C �--%L� -c-� ,�----� es— � - � . 1/�c�.�--��`..: Budness Phone x�- 7 �v — /` / � (� sue�ecr P !T NO. City of Fridley ° 16221 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � r ; � ECEIPT NO � ; L____��_ COMMUNITY DEVEIOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. a� � � , (__-- =;/'��1,,� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV i J\ 612-571-3450 9�0-F15 6/3/81 � � JOB ADDRESS �230 Jt�tpiter Road N. E. t LEGAL LOT NO. BLOCK TAACT OR ADDITION SEE ATTACHED DESCR. ]_O 2 Sylvan Hills: Plat 3 SNEET 2 PROPERTY OWNER MAtL ADDAESS ZIP PHONE K.�ith.E. Hart 6230 Jupiter Road N.E. 3 CONTRACTOR MAiL ADORESS Z�P PHONE LICENSE NO. Goltz Construction (G�ONTRACTOR NOT LICENSED IN CITY OF FRIDLE3�) 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIA PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW � ADDITION [� ALTERATION ❑ REPAIR O MOVE ❑ REMOVE 8 OESCRIBE WORK Reside dwelling 9 CNANGE QF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCURANCY LOAD 5EPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUM8ING, HEATING, VENTILATlNG OR AIR CONDITIONING. Md.50Illt@ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTFiUCTION OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS APPUCATION 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 �`6OO $. rJO WITH WHETHER SPECIFIED HEREIN OF NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $7� rJO STRU TION OR THE �OR NCE OF NSTRUCTION. PLAN CHECK fEE TOTAL FEE $8. 0� SIGNATU OFCONiRACTORORAUTHORIZEDAGENT � IDATE) WHEN PROPERLY VAUDATED THIS IS VOUR PEFMIT r. , � SiGNATUREOFOWNERIIFOWNERBUILDERI IDATEI BLDG iNSP DPTE 0 CITY Oi' f=ItIDI_CY • Af'C'L.l.(:11'CIt);d �'Uft RL.SIO(:i1T1/1�.. LUIt_DIiIG I'[:f�tlT'(S (��G►•r, /11 Lerai:�ions, /1cldii:ioi�s, or Rcpairs) � O�.t(1�R: ��1-r1-� � � i--�P�-� non�;�ss: 1�2�� ,c_�� l? , �c� �;o. S�j ( 2� t I �l� �uz �p��:. C� I�TZ co U� c�,ON- nudr�css: �'-��—� —�� _..�U� L�S} � ,'L.C� 1�;�� M� �`��-� �c�� rc� r�o: y.� r� _ �,�: �, � Construction Location ' . s�.cr�c� , rio : Z sx��r:�r: _ , �( .�,�; T —. R �.'� �V. � C � L07.': �^ $LOCK: `�^ 11DDITIOi3: ��v�lV � �\\ �,`��i'_.iZl_�_l._ Corner Lo�: Znside Loi.: SetuacY.: Sideyardss 0 Ap�Zicant attach to tl�is form twa Certificates of: Survey of lot and _ propo�ed building .location clrawn on certifica�es �o scale. . QESCRIPTIOi� OF COP�STR►JCTIOPd • �L; --�(�� I'ront: � Depth: Iieightc Squa�e. Fee4: GU.bic Feet: _ r roai� : Depth : H eight: Squai:e� I'e�t: Glzbic I'eets . �J lJ O � ^—.-. Type of Coi�s�ruction: ��_� ��'�� Estimated Cost: $ �.b Be Oor,�pleted: —��l� al.�.��..0 . ' . . Alt. A Alt. B Propased Drive�•�ay Width If New Opening Is Desired: $� $ , . S�� REVERSE SIDE OF SiIEET , �.iie undez sianed l�ereby n�a):es ap�lic�-tticn �or a permit fcr the �:�ork� hexei.n s,�eci,fied, agr.e�a.TZ� to c?o ,all work ir� s'�r.ict accordance �•rith the City of I'ridle�T Ordinances znci xulii�gs of i:l1e De��artment. of J31axl.dings, aiid hereby declares thlt all t2�e �acts and zcpz-esen�iti.eiis stated iii this application aze true anc3 correc�. f � I,Y ,� D.':TF: �� , SXGNIITUF�`r.s '��J ..cit:l�)UZc1{:].OI�S : �° �` • r `� U'� t sue�ecT PER City of Fridley � 1952�5 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r i � � � . � • COMMUNITY DEVELOPMENT OIV. � ; ,: ----- . � �9// r � � PROTECTIVE INSPECTION SEC. 1 . � ' � �'��1 � CITY HALL FRIDLEv 55432 NUMBER REV. DATE PAGE O: APPROVED BY � �'""'� � ,�� 612-571-3450 910-F15 6/13/88 / / �oe Aooaess 6230 �'�i,��X� Jupiter Road N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. lO 2 Sylvan Hills Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS 21P PHONE Keith Hart 6230 Jupiter Road N.E. 571-2311 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW � ADDITION ❑ ALTERATION O REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Canstruct a 14' x I6' Deck and a 13' x 14' De.ck. 9 CHANGE QF USE FROM TO STiPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTFiICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCV GROUP OCCUPANCY LOAD VENTII.ATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. fT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINEO 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 $2 �800 $1.[�O WITH WHETHER SPECIFIED HEREIN OF NOT. THE GRANTING OF A PERMIT DOES N07 PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMl7 FEE SAC CHAfiGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING corv- $54.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. AN CHECK FEE TOTAL FEE $55.40 NATU 0 ' ORO A 7HORIZE IDATEI � . WHEN PROPERLY VAL TED THIS IS VOUR PERMIT � � � I� Si nTURE WNEfii OWNER UIL i0A7E� G�NSP lk7E 1�V [ l City of Fridley EEfective 5/L88 A�DN [ l R-1 AND R-2 ALZER [ 7 Glonstruction Address I,�Cil D2SCr1�1Q1 Buil.ding Permit Ap�Zication Q owrie r Namae & Acldress : K� ��1-�- `�'=_ �(�.'�-( `�' S(� Wl � Tel, 5 � cF- 31 � (bntractor : _ _ -.-�1� �� Tel. # Address: Attac3i to this appl ication, a Certif icate o� Sluvey of the lot, with the prop�soed aonstructio�n drawn on it to scale. �ION OF Il�ROi�F�9� LIViL� AREA: Length Width Heic,�t �. Ft. cC�RAGE AREA: r,ength wiath Heic,�t sq. Ft. � DF3C[c ARE'A: Length width Hgt/Gro�a St�. Ft. � %�1� I� � i3 2�% ' b�. � _ �- n� (brner Lot [] Ins i at�[ � Ft. Yd Setba� k�� Side, Yar� d�Setbacks Type o� �nstructian: (4R ��2'F�X6S1 + �^, r,r, �+• 71 _ o —�1 Estimated Cost : S � . l�C� � � �� Approx. Compl e�ti� D�ate : 2 Propo�d Driveway Width If New Opening Is Desired: S Width + 6' n�E : �O i 3 � �x�zc�xr: , (�TY �SE �,Y Ae=mi.t Plee state surc�iarye SAC Charge Drfveway Escraw Park F�ee Sewer Hain Q�arge TOT1�L �I�LS: ��, •� $ �. �f v Alt. A Alt. B S See Back Page Tel. � S'7 �—�.� I � Ppe Schedule on Reverse Side 5.50/51,000 Valuation $550 per SAC Unit Al� '�" or Ait. '�" Above l�he Determired by Ehgir�eering Agreemerit Nec�essary [ ] Nat Neaessary [ ] � �� , �lS��tJ �o�� t�� 5�.�. � sue�ecr PERM City of Frid�ey 21515 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r � � . � � � • COMMUNITY DEVELOPMENT DIV. 1 � V � � PROTECTIVE INSPECTION SEC. ��'� � . � � ��"1 � C17Y HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OP APPROVED BV �""'�'� �'� 612-571-3450 9t0-F15. 8/26/92 / � JOB ADDRESS Fj23O JUplt2Y' Road NE t IEGAI �OT NO. BLOCK TRACT OR AODITION SEE ATTACHED DESCR. �-O 2 Sylvan Hills Plat 3 SHEET 2 PROPERTY OWNER MAIL ADORESS ZIP PHONE Keith Hart 6230 Jupiter Rd 571-2311 3 CONTRACTOR MAII ADORESS Z!P PHONE LICENSE NO. Williams Painting & Const. 12044 TCT River Rd, Champlin 55316 723�3416 6660 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE IICENSE NO. 5 ENGINEER MAII AODRESS ZIP PHONE IICENSE NO. 6 USE OF BUILDING Residential 7 CIASS OF WORK f� NEW � ADDITION O ALTERATION �I REPAIR O MOVE O REMOVE 8 DESCRIBE WORK 23� x 22° Garage Roof Framin Re air 9 CHANGEOfUSEFROM TO STIPULATIONS See notations c�n plan, Provide a hard sur�ace driveway. TYPE OF CONST, OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIA COND1710NING. THIS PERMIT BECOMES NULL AND VOIO If WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WI7HIN 60 DAYS, OR IP CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFS7REET PApKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STAI.�S GAHAGES AND KNOW THE SAME TO BE TfiUE AND CORRECT. ALL PROVISIONS Of LAWS VAlUAT10N SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. 7HE GRANTING OF A PERMIT $S �OOO $2 . SO DOES NOT PRESUME TO GIVE AUTHpRITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY 07HER STATE OR LOCAL LAW REGULATING CON- $81.OQ Fire SC ySS.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PIAN CHECKfEE TOTALFEE L�,cense SC $5.Q0 $93.50 S�GfYATUAE OF CON7RACTOR OFi AUTMOAIZED AGENT IDATEI 1� P ERI.Y A�I TED THIS IS YOUR PERMIT 8z�-�'�-. SiGNATUREOFOWNER��FOWNERBUILDERi �OATE� BIDG �N P npTE NEW ( ] ADDN [ J ALTER [ ] CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Buiiding Permit Applicadon Construction Address: �?� �C-�,d/��Q �� Legal Description: Effective 3/ 1192 Owner Name & Address: 3� B � Tel. #,ST/�?3// Contractor: � /LL/,iyY r� l•vG'-� MN LICENSE #�a�v,�i�i1i �°'`J �a3- 3 �i� Address:��/��/� �/� �_��Y��.�/ SS'3�L Tel. # Attach to this application, a Certificate of Suivey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IMPROVEMENT Le�ugth Width Height Length �_ Width � Height �, Length Widtfi Hgt/Ground Sq. Ft. Sq. Ft. � Sq. Ft. Comer Lot [] Inside Lot [] Ft. Yd Setback Side Yard Sed�acks Type of Construction: �L �,q,y�,c/G �i2 Estimated Cost: $ Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + b Ft = Ft x$ _$��°� . ` . . ..`5 . . . 1 DATE: � �-- APPLICANT: � Tel. #��`- ! . : 7�3 3�/G T.P�IC,� Permit Fee $____�� r < <� Fire Swcharge $ .S • �� State Surcharge S Z� J`yC� SAC Charge $ "�'°" License Surcharge $ �� d � Driveway Escrow $ Park Fee $ Sewer Main Charge $ r ! TOTAL $ � STIPULATIONS: f _, _ Fee Schedule on Reverse, Side .001 of Permit Valuation (1/lOthR'o) $.50/$1,000 Valuation � °,�;; � $700 per SAC Unit $5.00 {State Licensed Residential Contracfors) Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary j] Not Necessary (] � . � � ,. . i ; ; � � ; -- _ i� E= .,` ��=��= _, � i�i. ii ` q � � � � �� i �� •��"� �� .�`�i � � � �� Q � � . � v �� `t1 ^ � � �:. N . � ,7 0 �. ~ , — � �o �� !�� o� � v ��" � `� h� 0 '�� o��@ �� ' �� `� � ;� � � � ,h , �� h h�� in� �� , .. �, �� • . . ' Q � � � � . �� . � --...:� '��I�' ii`—r�.l�II �� 1�� _�_..._ ��+1 ` , �� ; ---M � ; .w �. ; � , o�� "~ � o � , � � �o� � ��3� �aC� :� � �V� �j ��y� � � � �� .�� ,� � 'h � , �, � � �`-r � `�3�� .� � °� � �� ' �° � y � � �� - . . CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 57Z-36U4 1+'AX: (763) 571-12tf7 J""' _.'___, . PERMIT NO..f 2004-00692 � -___ , DATE ISSUED: OS/12/2004 ADDRESS : 6230 JUPITER DR NE PIN : 143024330076 LEGAL DESC : SYLVAN HILLS PLAT 3 : LOT 10 BLOCK 2 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 200.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A.INSTALL A GAS WATER HEATER. # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 1 # GAS DRYERS # OF NEW FIXTURES APPLICANT H P PIPEWORKS 3670 DODD RD STE 100 EAGAN, MN 55123- (651)365-1340 OWNER HART KEITH B& SIGNE N 6230 NPITER RD NE FRIDLEY, MN 55432 0 0 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and lrnow the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law re� s ion or the performance of construction. Applicant�� Date a Bldg Insp ��4 # GAS RANGES # WATER TRMT APPLIANCES PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) PLBG FIXTURES (EXIST OPENII�iGS) WATER TREATMENT APPLIANCE WATER HEATER - ELEC WATER HEATER - GAS GAS RANGE FEE GAS DRYER FEE PLBG REPAIR/ALTERATIONS STATE SURCHARGE, PLBG FLAT TOTAL PAID WITH CHECK # 8783 t_ SEPARATE PERMITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE. 0 0 0.00 0.00 0.00 0.00 0.00 35.00 0.00 0.00 0.00 0.50 35.50 ,* �31 University Ave NE -idley. lVl�f 55432 63) 572-3804, FAX (763) 571-1287 Urinal Basement Fioor 1 Floor 2 Floor 3 Fioor 4 LUMBlNG FIXTURE RATES: APPLICATIC}N FOR PLUMB#NG AND GAS FITTING PERMIT MARK NUMBER Of FIXTURES TO BE INSTALLED ON EACH FLOOR ,:::: �::; .::,.;::s;�::; Aufo. i, ��fi� �:�::,�:�;<r<: Wash �:::::>:�:>�':�': Ffoor � .,��: N��..:<;;;><:::::. �'�':;�':: ".,;�: :�...: ,::'•;,; . . . . ::.,.:.:�:. : �v`< Sh�v�rer �`1'E%;��::: Trav '..:��<<:><:;:>j> Drain ��€>;;r>� WBSher �:.;. �� 7 � Water Heater Gas Elec NO. RATE TOTAL JOB ADDRESS�„�(��c-d!-�� iZ �'°. .Z�� %}?f1. ew Fixtures ►id Opening, New Fixture eer Dispenser �low Off Basin :atch Basin ;ain Water Leacter :umplReceiving Tank Vater Treating Appliance Vater Heater -Electric Vater Heater - Gas'+ _,�,__ 3as Range`" 3as Dryer"* 3ack 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 $90.00 $10.00 $10.00 $15.00 .� �a, va The undersigned hereby makes applicatio� for a permit for the work fierein specified agreeing to do alt work in strict accordance with the city codes and rutings of the Buikiing Division, and hereby dec(ares that al1 tP►e facts and represeniations stated in tfiis application are true and correct. � '" � 20�� • - �__/� i / Building Used As � � , Estimated Cost ��r9.D0 PERMIT NO. � ''"�� '` ,�i?'� -':=::= PLUMBING COMPANY fi� S� �.-�.��tJe.tl�dJ teinspection Fee $47.00IHr SfGNED 8Y � e�- �il �� TEl NU. /— �— � z% 1LL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved By Rough-ln Date Final Date J�U L'� State Surcfiarge � .50 - MINIM M FEE OR ANY PLUMBING/GAS PERMiT IS 20.00 TOTAL FEE $�.5b, PlUS THE 5.50 STATE SURCHARGE �OMBUSTION AIR SHAIt BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VETdT INFO ON BACK SIDE ,