AF - 47886sue�ecT PERMI
City of Fridley -17 3 4 6
AT THE TOP OP THE TW1NS g U i L D I N G P E R M 1 T �
r
; � CEIPT
� • COMMUNITY DEVELOPMENT DIV. �
' �1: _"�_- .
r � � PROTECTIVE INSPECTION SEC.
1 � �
( � /"�1 � CITY HALI� � FFIDLEV SS43Z NUMBER REV. DATE PAGE OF APPAOVED BV
� _.-_1LJ �'�
612-571-3450 910-F15 12/1/83 / /
JOB ADDRESS 6150 K,erry Lane N. E.
1 LEGAI LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. S 2 Heather Hills 3rd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Mark Sampson 6150 Kerry Lane N.E.
3 CONTRACTOR MAIL ADDRESS ZIP pHONE LICENSE NO.
Star Hocrtes Ltd. 7691 Old Central Avenue N.E. 780-5500
4 ARCHITECT OA DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER Iv1AIL ADDRESS I PHONE LICENSE NO.
HFATiNG. PLUMBING AN� SIGNS.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW � ADDITION Q ALTERATkON ❑ REPAIR � MOVE O REMOVE
8 DESCRIBE WORK
Construct a 64' x 51' Dwelling and a 32' x 28' Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide a hard surface driveway. Provide sod in the front and side �
ya.x'ds. Provide a hard surface driveway. Provide energy envelope calculations.
Front Yard variance approved 5/24/83.
SETnTER LOCATION: (_Approx. 10' Deep In Street) 4' S. of Water Service
San. P�I. H. at Kerry Lane and Rice Creek Road (Inv. 920.05)
WATER LOCATION: 13.3' E. of 12" Cottonwood 52.6' W. of San. M.H.
DRIV�WAY DEPRESSION ESCROW: NfA
�bI'1 /�� ,�Q� �t;� .GiY OF FRIDLEY D06S NOi tlti/�iiANTEE Tt-it
t.r .ti�'AC" OF 1!'[ILITY IOCAiIUNS AND Ei�`ifi�tit;•
���`�����l13313 �`n��� �: �7�;`.'s EaP INFORMATION P!lRPQS�S Or�tY .���:
���l If�a $�NONd��l �•�:.:�. ��. i�5►NG � Si�lOU1D NERIfV THE 1�F�xMATS�.-:�
����!A a� �� YH� -sfr�
��
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICA�, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOO(3 FY'dIR@
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTNORIZED IS NOT COMMENCED WITHIN 60 DAVS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WOFiK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION I. 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 COMPUED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S2O2 � ZOO $�.0�. . ZO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR GANCEL THE pEqM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OF LOCAL LAW REGULATING CON-
STRUCTION OFI THE PERFORMANCE OF CONSTRUCTION. $690� 5O $425.00
� PLAN CHECK FEE TOTAL FEE
�+K /�;-i` �3 $172.63 $1,389.23
SIGNATUREOF NTRACTORORAUTHORIZEOAGENT IDATEI WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
� I t
SiGNATUqEOFOWNERIIfOWNERBUILDEAr IDATEI � B�DG iNSP AT
' Effective Aug. 1, 1981
CITY OF FItIDLCY '
tit'PLICl1Tl.a� FO(i RCS10L'i�TIPw I3UlLD1i�G Pc('��ITS '�
i1�ch•�. Alterations. Additions. or Rep�irs) `"�'���� "
0�� NE R: /YI 1`� /� /� �AI� i�SO l'�
ADJRESS: � /�C' l��lQ lQ �% �1 �E
TEL �0: 5 � / - ia ��
E ��
�l3UI LDER : S%%�OQ %7G 1� E S L- r� ,
�Da2CSS: 7� �/ (� � � � �/✓7r/?�9 �. l9v ,
TEL I10: % g� - S� od
Construction Location
STJZI�T NO: � ST1tEFT= �
L07': � BLOtK: �!
L.A��
J►DAITIO:i: N�/�%��/?LLLS %/�lJ�D ��•
Corner Lot: `� Insii]e Let: � Setback: Sideyards:
Ap�lic.-u�t attach to this form ta+�o Certificates of SUrvcy of lot and
pzopo�ed building loc�tion drawn on certificates to scdle.
DESCRIPTIO�� OF C0�lSTF:UCT10t�
� ront: � y Dept}i: Height: � .
Squarc FceL: CZibic Feet:
Front: J� Depth: �` � Height: �
Square Fe�t: Clibic I'eet: _
.
'.7�pe of Co:,�truction : �� �/t-G�'�'�-�,
4b Be Cbr.�pleted: �" i•- g�
. ����
Estim�ted Cost: S �
Alt. A Alt. B
Proposed Drivc�•ray kidth If New Opening Is Desire8: $ S
, S�� PEVF.iL�.: SIDE OF S}IEET .
lile undersianed hereb�� mal:�� a�plic�ticn foz a pernit fcr the �:ork heYein sgc�cified,
agzeein3 to �.all �ork ir, strict accordance �ith the Ci:.y of 2'ridle�• Ozdi»ances tizd
zulin�� of tlie De2kirtment. of Bui2din�s, �nd hereby decl�res that all tl�c: facts and
represc-st.itiens stated � this applic.:tion are tzue and cozrect.
a.��: Ll -�� —�3 sic�rnTV� :
£tii�ulat' ns:
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2 ���2�
CITY OF FRIDLEY
APPLICATION FOR PWMBIN� AND GAS FITTING PERMIT
�, m �q n • k u Water
,q � w � ►b+ e�.�i m �i � a a. a Heater
�.�i W q C W E� K 3 ~ �•�i O.�C � U � 0~i
u�i u 5 r� o� � 3� o w v�i g v� a�' 3� � c� o s lec
� c �� � l /
�St f � �
2nd
3rd
4th
(R) � FUCUre Connection Opening Connected with Sewer
(*) � New Fixture, Old Openinq Water
PLUMBING FIXTURE RATES
New Fixtutas
Puture Pixtures
RATE SCHEDULE
N0.
�
Old Opaniag, New Fi:ture
Beer Dispenser
Blow Of! Baein
Catch easin
Rain Water Leader
Hydraulic Valve
Sump or Receiving Tank
Natar Trnating Applianca
Hot Nater 8euter
Gas Ranqe
Gas Dryar
l
ALL OTBERS AND/OR REPAIRS AND ALTERATIONS
li of Value of FiYture or Appliance
Rainspection Pee S
($15. 00)
RATE
S 5. 00
S 3.50
S 1.50
S 4.00
$ 5. 00
g 5.00
S 5.00
S 5.00
S 5.00
g 7.00
$ 5.00
$ 10.00
S 10.00
State Surchsrge
TOTAL PEE
TOTAL
S 57� •at�
S
S
S
S
S
S
S
S
Effective Aug. 1, 1981
�
Job Address � � � O � O�T�. ��
Department of Buildings
City of Fridley
Tel. k571-3450
The undersigned hereby makes application for a permit for the work herein
speciffed agreeing to do all work 3n strict accordance with the City Codes
and rulinqa of the Department of Huildings, and hereby declares that all
the facts and repreaentatia�s stated in thia t�pplicat�on are true and correct
/
F11d1eY. Mn. �P r 19�
�R 5,��- �..,, F �
KIND OP BUILDING �/Z./}.`� �
USED AS R,�'
TO HE COMII�I.ETED ABOUT �.- j"� &' j'
ESTIMATED COST �C � ° "
��
OLD - NEF1 BUILDING PERMIT N0. PERMIT NO. `�� ��
ROUGH INSP.
nnte
Oompany � G.rl�SF �-w.� (�-�-E�
Signed By G.,_
Tel. No $a ' // j%p
s FINAL YNSP. L � � - �`�
$ S OU nste
S
s APPItOV71L POR PSRMIT .
S
$ .50
S SS
HINIHUM FEE FOR ANY PLUMBING PERMIT IS S10.00
PLUS THE $.50 S�T4TE SURCHARGE
� - —
,. ,.
, - . Etfective J►uy. 1, 19H1
CITY OF FRIDLEY
.
APPIICATION FOR PowEa PLANTS AND HEATING, COOLING, VENTILATION. REFRlGERATION AND
AIR CONDITIONING SYSTEMS ANO DEVtCES
RATE SCHEDULE
4ESI0B!`TIJ1L
/� Furnace Shell and Duct Work,
J Hurner U►lso r�plac�went turnscs)
Gas Pipinq
(plpinq n��d�d vith nw► tusn�c�)
Ges Aenge
Ga� Dryer
� • Air Conditioning tsll sfzes)
RATE
S 20.00
$ 10.00
S 10.00
S 10.00
S 10.00
All Others/Repair• and Alterations
`lt oi Value oi Appliance or Nork
COMMBRCIIIL/INDUSTRIAL
1• o! Value of J►pplianca or lbrk
Stete Surcharge
TO?I1L �EE
Rein�p�ction 1'ee (515.00)
Ra�qh Insp.
Date
Pinal Insp. - - �
ate
Approvel ior Persit ���
MINIMUM FEE FOR ANY HEATING PEAMIT IS 510.00
PLUS S.SO STATE SURCtIARGB
�ro�r�L
s.� o.aa
s,�40
S
S
s�a
Job Address 6150 Kerry dane
Ue��artaent of Buildlnqs 6�31 Univecsity 11va. N.6.. E'rldley. MN 55��2
Cicy of Fridley
Tel. /571-3�50
Tha wdessiqned hereby n�ake� application tor a per�it for tha work heraln
specltied aqreetnq to do all vurk fn atrle! �ccordance with the City Code•
end rulinqs ot the Depart�ent �f eulldings. •nd hereby d�cl�re� that �11 th�
facte and repreee�tations stated tn thts application ars tru� and corr�ct.
Fr/dley, wnn. AUgUSt 29, 1984 19_
oMNeR Star Homes - -
S
KINO OF BUILDTNG Frame — -
useou Residence
s
S .50
�.����
S
Attach srick veri[lcscion Eocs vith replac�sent [urnace penafta
•J1ir Co�itioners: csn nnt Me placed in xid�• yard vit��t
�citten }x•cwisuion tra� adjoining nei9Nbor.
70 BE C�OMPLETED 11BOUT
PSTIlU1TED C061'
OLO - NEM BUI{DING P6NMIT N0. P6NMIT N0. 'C" l�
oescazaexa+ or Puan�►ce�eu�a 5 8 G S 12 5, E G 10 0- 2 31
NFJITING or POMER PLWTS� scsa�., xoc w.c.r, w�. �t�- rw. DR100121 BA
,�,a� ,� C a r r i e r s�:. +w.
2 , , 0
Capactty Sq. Ft. CDR s111 ,,�,+� Np
�notal Connected toad xlnd ot Tn�l g a s
BURNER - Trade Na�e Slss No.
Capacity Sq. Ft. EDR B7V Mp ___________
c��a„y Depe dable He tin and AIC
�
Siqned Hy
Te 1. tk� . 7��(1 LI A
2 Carrier AirCond. 1 38ER036
1 38ER024
? NEAT LOSS CALCULATION ° rtEMP. DIFF.
CurtoNNr N�n�t _�y y�e in� v� � TyW Comt►uctbn
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ONN► N� . Wsll� . Int.
SMNt _. _—__ Gilinq In�.
Floor �
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Wi�fow� snd Ooor:-Gscka� and A�a Windows and Door:-Gadcpt and ArM
� � W�M M�NM Ne. 01 ' LiM�I h. A►N WIdtA MNMt NO. 01 LIMN 1t. I��M
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Inf�ltntion Iniiltrstion •
Gis� G�,a 5�
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Nat exp. wall Net �zp. wsll a2
fnt. ws11 ' ir4. wsOE
' cei�ing 3 ceaing ,6 y 8
Fbo► F loor 3
� ToUI 8tu. Total Btu.
FI.) r Room I L h Width H�' t$ F I.� � �,�C,:`S�` Room � L h Width ' t$
Winebws snd Duors—Gsekag� and A►M Wind�ws and Oowt—Gadap� �nd ArN
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' ' NEAT LOSS CAICULATION ° rtEMP. DIFF.
Cu�toeN► Naen� _._._C.1���-�c� �-+..�� Typ� Corntructbn
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OMNr Nan+t . Wsll� . Int.
�►�t - ----- Gilinp tnt.
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r
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Win�lows snd Ooo�s-GsNcag� snd Ara Windows �nd Doort-Gaduq� ard ArM
�� Y11.OM � ►i�hM � Ne. e1 � �i�l i1, A►N � �WfOM iNl�ht NO. N LIMN ft. A�M
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intdtration `�� �f% ��"j�� Infiltntion • ���p !-[ ���i�
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Exp: walf
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lRt. wsli '
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F loo.
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Ne W'M� ~�'�^� Ne. o/ LNwI ft. Arw
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er •
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Net �xp. wsll
irt. wsll
Ceiling
F loor
total Btu.
F 1.��, Room � L h Width
Windows and Doa�-Gacksp� �nd ArM
I No. W� N��A1 Ne. Of LInMI h. A�M �
O� M N M � M �1 t►�N . I�.
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8tu
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Windows and Dows-CndcaN and An�
No. � a�w •/•Mh� L•. p L� w n: • n. � .
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•
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�
,
� } NEAT LOSS CALCULATION ° YEMP. DIFF.
Cwtom�r Namt _� .� YYW Co��buetion
�Y Windowt Statn Sah
OMNr Nank . Walls . In�.
�� ---- -- Gilinp Int.
�Y — Fbw �
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(M�It►ation Infiltntion .
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W.Mh M�.�m Ne. e1 �Nwl N, A�w � Wbeh MN�Nt Ne. M LIn�N M. �rM
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CIIYOF
FRIDLEY
CIVIC CENTER • 6d31 UNIVERSITY AYE N E.. FRIDIEY. MINNESOTA 55432 • PHONE 16121 571•3450
June 24, 1985
Star Homes Ltd.
7691 Central Avenue N.E.
Fridley, MN 55432
Re: Final Inspection at 6150 Kerry Lane N.E., Fridley
Dear Sirs:
A final inspection was conducted on June 21, 1985 of the above address and
the following items were noted which must be completed before the building
can be finaled out:
1. Post the address on the structure by July 15, 1985.
2. Provide sod in the front and side yards by July 15, 19.85.
3. Secure the sump piunp cover by July 15, 1985.
4. Correct bottoms of cabinet over kitchesz stove by ,3uly 15, 1985.
We will expect the above items to be completed by the scheduled date when
a reinspection will be conducted to determine compliance. if you have any
questions on these itens, please contact me at 571-3450.
Sincerely,
DARREL G. CLARI:
Chief Building Official
DGC/mh
CC: Mr. Mark Sam�son
6150 Kerry Lane N.E.
_
UTYOF
FRIDLEY
CIVIC CENTER • 6431 UNIVERSITY AVE N.E.. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
July 1, 1985
Star Homes Ltd.
7691 Central Avenue N.�.
Fridley, r�1 55432
Re : 6150 IGerry Iane N. E. , Fridley, I�IN
Dear Sirs:
Please be advised that we have inspected the house at 6150 Kerry Lane N.E.
and have found it to be in compliance with the City of Fridley's building
and zoning Codes.
If you have any questions on this matter, please feel free to contact me
at 571-3450.
Sincerely,
DARREL G. CLARK
Chief Building Official
DGC/mh
—_�
SUBJECT . PER (YQ..--_...
City of Fridley 2 0 3 8 3
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
i � RECEIPT NO.
� �
� • COMMUNITY OEVELOPMENT DIV.
� ; � ------. 3 � 3 ��
r � � PROTECTIVE INSPECTION SEC.
� � /'��\ � CITV HALL FRIDLE� 55432 NUMBER REV. DATE �AGE OF APPROVED BV
�""� � �'J 612-571-3450 910-Fi5 5/23/90 / /
JOB ADDRESS 6:15Q Ksrry Lane N�E,
1 LEGAI LOT NO. BLOCK TRACT OR AODITION SEE ATTACHED
DESCR. S 2 Heathe� Hi11s: 3rd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
. Charles B.urnside 6150 Ksrry Lane N.E,
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Rainlite Inc. 4357 Dunrovin Lane, Eagan MN 55123 688--2349
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENG{NEER MAIL AODRESS ZIP PHONE IICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW �I ADDITION O ALTERATiON ❑ REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a, 572 sq. £t, side deck �,nd a 135 sq, ft, b:ack deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on p1an,
�������
Before digging call for
aii utility lacations
454-0002
REQUIRED BY LAW
TYPE OF CONST, OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
TH1S PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OI9 WORK IS SUSPENDED OR ABANOONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK 4S COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBV CERTIfV THAT 1 HAVE REAO AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VALUATIOIV SURTAX
AND OROINANCES GOVERNING THIS TVPE OF WORK WIIL BE COMPUEO $S�ZSO $ZRSH
WITH WHETHER SPECIFIEO HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITV TO V�OLATE OR CANCEL THE pERMIT FEE SAC CMARGE
PROVISIONS OF ANY O?HER STATE OR LOCA W REGULATING CON• $81.00
STRUCTI N OR THE PER ORMANCE OF CO U TION.
/ PIAN CHECK FEE TOTAL FEE
, � �Zj �'� $83 .58
siG UFlEOFCONTRACTOAOAAUTHOF12ED GENr i TEi HEN PROPERIY VAI.I D THIS IS YOUR PERMIT
� � �
SiGNATUREOFOWNEA��FOWNEpBUILDEA� iDAT6 BLDG iNSP naT
N� ( ] Effective 1/1/90
� ] R-1 AND R-2
[ J Building Permit Application
construction .�ares_S : 6 j5 O�� rr ►� �,
Iegal De.scription:
owner rrame &�ddress: C�j�}r/� s /.��r^/�s.'d� �e1. #
cbntrac�tor: � ,:v • ��G T �c . �e1. # 6 8fJ -�?3 f/9
�dre.ss: ,�3✓ i �.✓,�o v; ..J Lit/ .�=�►g��tJ �/Y. �S"l.Z 3
Attach to this application, a Certificate of S�rvey of the
lat, with the pro�osed o�nstruction drawn on it t;o scale.
DESCRIPTIOTT OF
LIVIl�IG AREA: Iexigth Width Height Sq. Ft.
C�R�GE AREPi; Iength Width Heic�t Sq. Ft.
D�7C'R AREA: Le.rigth Width Hgt/Ground Sq. Ft.
a�: � � 5/0�. �G L � �2� �� OGCtL - %�CS�f'�b'
� � x�.a7 _ S r�'i,85
Corner Lo�t j] Inside Iat [] Ft. Yd Setback Side Yard Setbaaks
Z�pe of construction: ��.� f�r% �.¢,wG — �'ed.�✓o�� Estimated cbst: $ %e"i�3d2. � � I �D
Approx. c�aa�letion Date: �w,L,f f�n� g��,�'""
Proposed Drive�ray Width If New Open�ng Is Desired: Ft. $ $
Width + 6' See Bac3c Page
nA� : C��.1��.0 ��cArrr: %1�.`.✓ L : f� �� �r�l� � . # �� � .-t 3 r/,Y
Pezmit Fee $ � ���
State Sux�charge $ a ,�
SAC Charge $
Driveway ��crow $
Park Fee $
S�we.r Main Chat�ge $ �
Z�0►rAL
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S'!'IPCTI�TIONS :
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CITY OSE �Y
Fee Schedule on Revers� Side
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Det.exmined bY �l��J
Agree�ne,nt Neoessary [] Noit NecessaLy [ J
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DESCRIPTION:
Lot 5, Block 2, Heather Hills Third Addition, Anoka County,
:linnes o ta .
• ��np�es �roamo�►�,w�..� �d�,� ���.30, l�8�
I herebvi certifv t}�t this survev pl•an pl•at.prcliminarv pl•�t cx report ���zs prep�ared by me or under
my direet supervision snd that [ sm a dulv Rr�istrred L;�y�d Survr�-c�r under the law•s of chr Scste
of �tinnesota. �O / z /8 �'e ''y'
/�., Y�k,�.�yT_ /o �33 Z .S yS�S %� %: ff
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UTYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
May 29, 1990
Charles Burnside
6150 Kerry Lane N.E.
Fridley, MN 55432
Dear Mr. Burnside:
Enclosed is a copy of the 10 foot walkway easement centered on the
existing drainage easement on your Iot and Lot 4, Block 2, Heather
Hills Third Addition. Also enclosed is the vacation application
form. I have also included the schedule for the Planning
Commission and City Council action.
Please complete the application and arrange for your siqnature, as
well as your neighbor's (our records indicate that it is Allen and
Deborah Palmer), in the section entitled "Fee Owner Information".
Place your two names under the "Petitioner Information" section as
well.
Submit the completed application form and $150 to my office. The
Development Review Schedule identifies the application deadlines
far the Planning Commission meeting at which it would be
considered. For example, if you submitted this information prior
to 5:00 p.m. on June 8, 1990, the vacation would be considered by
the Planning Commission on July 11, I990. On July 23, 1990, the
City Council would establish a public hearing date regarding the
vacation on August 13, 1990. On August 27, 1990, the Council would
adopt the first reading of the ordinance vacating the easement if
the Council agreed with the vacation request. The second and final
reading of the ordinance vacating the easement would occur on
September 10, 1990.
Should you have any questions reqarding the process, p2ease feel
free to contact me.
Sincerely,
Barbara Dacy
Planning Coordinator �
BD:ls
C-90-316
CITY OF FRIDLEY
APPLICATION FOR PWMBING AND GAS FITTING PEIi�11T
1w� � w q u . x d Natei
,� u� a y w c a w � u o, a ��Cy Heater
r •-� F N [+ •,.1�( N N m m w � . OG
1+ N �a � Xa .0 C C � ~p U�•C/ � t � U N
o p •.i � a C a.r � p u w u a ui ul t
u"i u a u� oa y 7� a w � t�a u a� e x �� � ig o as lec
let
2nd
3rd
4 th
((t) • ELtur� Com�ction Opening Connected with Sever
l•) � llew F1xWre, Old Openlnq wates
RATE SCNEDULE
PLUMBING FIXTURE RATES: N0.
N�v listur�•
Putur• liatur��
Old Op�nlnq, N�v ilsture
Beer Di�p�n��r
Blow Ofl B��Ln
C�cch 6a�in
8aln Mat�r Leader
Hydraulic Valv�
Suwp or R�c�ivinq Tank
Mat�r Tr��tinq Appltance
Ilot M�tet N��t�i
caa R�nq•
G�a Drye[
�
RATE
g 5. 00
S 3.50
S 1.50
S 4.00
$ 5. 00
S 5.00
S 5. 00
S 5.00
S 5.00
S 7. 00
S 5. 00
g 10.U0
5 10.00
Back Flw PrevanCer I�quired, ,, Yes� No ( 1
e ��
1YP E��� ct ✓Y �,rc✓ ✓ nN f'� �P S 5. u0
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1� of Value of Flxture or Appli�ace
it��napection Fee S
. ; 1515, oo�
Stste Surchazye
TOTAL FEE
TOTAL
5
S
S
5
S
5
5
S
S
S
S
S
S
S��
5�
S . SU
S�_
Effective l�lay 1, 1990 .
Job Address ���� /�(����/ ��e
Department of euildinqs
City uf Fridley
Tel. N571-]450
The undcrsigned hereby makes applicatio� for a penit ior tha wrk heraln
specifted agraeing to do �ill work in strict eccordane� with the City Codas
and rulings of the Depart�aent of Buildinga, �nd h�r�by d�clares th�t �11
the facts a�d representat.ions stated in thle �pplication are trua �nd oorract
Fridley, Mn. � '� G� 19 ��
.
OWNER C �JG� �-�V C'n S((�
KIND OP BUILDING _ ,� �{�[ ( � �T� r� •7 j
USED AS U�G�SI(XCrt f�� �
TO BE COMPLETED 11BOU'P (7 ` � - �D
ESTI W1TED �pST � � V+ �O
OLO - NEYI BUILDING PEPMIT NO. PBRMIT NO. <�7 /�J
CasPsnY C� '� �� I"� 4J � �
/ �
Signed By l ,�„�� �
'r�l. No. _,%/
RWGH INSP. _
Oa[e
FINAL INSP. �
Date
APPR01/AL FOR PERMIT _��
!1INIHUM FEC FOR ANY PLUMBINC RM T IS 515.00
PLUS THE 5.50 ST4TE SURCHARG