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AF - 47819� � /� City of Fridley, inn BUILDING PERMIT ��: Julq 18, 1967 �� 3� 1�To 935�7 p�; Robert DeGardner g��,. North Suburban Slders. Ad� 2010 17th Ave. North �,d�� 3218 67th Ave. No. LOCATION OF BUILDING No. 528 S�t Kimball Part oP Lot � 55 & 56_ glock F Addition or Sub-Divisian _�Riverview Heights Corner Lot _ Ineide Lot .+x Setback 35 � _._._ Sideyard 15 � Sewer IIevation -- TOP OF FOOTIIVG DESCRIPTION OF BUILDING To be Used as: Dwellin� �t 40' �p� 24' g��t 20' �, � 960 �� 19,200 � Front Depth fTeight Sq. Ft Cu. F't Type of Construction �'ame ��, ��12, 000 __ __ To be Completed SEWER LOCATION WATER �OCATION In cans�ideration oP the i�uance to me of a percnit to construct the building des�Ibed above I agree to do the P�P�� work in accordance wlth the descrlption above set�rth and in compHance with afl provisions of or8inaaces of the dty of Fridley. /) � � r � %t?v . In consfderat[on oY the payment of a fee oP $__.�.��.2, permit is hereby graated to North Suburba Builders to construct the building or addition as d�cribed above. TY�i�pe rmft ia grant� upon the expr�s candition that thepers�n to whom it is granted and hia agents, employees and worl�nen, 9n all work done in, around and u�n said building, or anypart thereof, shall conform 3n all respecffi to the ordinauce� oP FridleY� Minnesota regardiup location, conatruct%n� alteration, maintenance, r+epair and moving of bufl wlthin ti�e dtY lianita and ttus Pernuit may be revoked at aqy tune upon violation of any of the provi�tona oP� ordinaac�s. CLARENCE BELISLE g�� NOTICE: 7'61s psrmt! dees eof eover ihs eo�eHoe, �Sla1Hltoe M� wirine, phrmbiee, en huHee, ssw�r ee waNr. B� am fo a� fha Bulldhee lespeetor for �paraM psrmtfs fe� l6�ss it�. � d � A_�L';��:��_'t.fi:a ~G� 3?J�"s�D�iLG °� s_iT � C;..'� 4� . i� kxil:�;.' i, ri � I�:iESC2'A ,.- _ _ . . • . _ . OHINER' S NA2•fE fi=.;::Y �t�ER�'T°�'!'�� AbDRESS ��lb"� l %�/_o� �� A��.ESS v�� .�i�'��Z�r°„�� . _ _ __ . __ LOCA��:orr er� BUII�DI.�G � � ' ZIO. ,��. . . - STt�EET_ �._,�yP� � PAFT 0�' LOT�'�� " LOT�S—� BLOCK � � AD�ITiON OIt SUi3Ds.VISi0i3 ~ '�. 9 CORNER L0� INSIDE LOT��SEI�ACY. �� S�DE�YARD �� SEWFR ��,E�lATXQN FOUNDAi�U�i EI,EVE�TION Applicaat attach to this form Two Certificates of Survey of Lot and proposed buil.ding location drac,m on these Certificates. To Se Used As; DESCRIPTIOa� OF BUILDXhG � ` Frant � Depth �ileight_ �� Sq. Ft. �(,� Cu. Ft. �� ,� - - - _. . . . . . . Front _ _• _ Depth Height . _ Sq. Ft. - Cu. Ft. Tqpe of Construction_ � � � �Estimated Cvst ��, � To Be Co�cpleted . . -. - -e:. .. . , -_ . _... . - The undersigned hereby makes ap�lication for a permit for the work herein spec3.fied, agreeing to do all work in strict accordance with the City of Frid?ey Ordinances. and rulings of the Department of Euildir_gs, an3 hereby declares th�t alI the facts and representations stzted in this appiication are true and correct. . DATE � � �' 4 SIGNATURE �� _- - . - - . � / � . . . . ('�� (Schedule of Fee Costs can be found on the;Reverse Side)o.� � � , ,� I� . ' i .� _, 3 _'a �, � �^ . ..� � !. �� B �+ a ^ � . � � � F . • � � s /�\ I I ' 1 / • qp' l�' ♦ � � BUiLDING PEF.MIT FEE SCHEDULE SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection of any building of structure, or•for any addition to any existing buildi.no:or'structure, or for any alteration or repairs to any existing buildin� or structure, upon application therefore,,require the paya�ent by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: . � .Uniform Building Code: Type-1;2, & 4- $1.7.5 for each one thousand cubic faet, or fraction thereof, in such cubical contentse Type 3& S-$1.50 for each ane thousand cubic feeto For the purpose of computing fees �for building permits, the cubical contents of any buildino or addition to a uniform height throughout by multipluing the ground area covered from a point six (6) inches belozi the floor line of the '�asement or cellar to the average height of the upper surface or to the average height of the roof surface of the main gable of a pitched roof. . For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 per each Five Hundred Dollars ($500.00) o� fraction thereof in the cost of all proposed worko In no case shall the fee charged for any�permit as set forth in Section 2 be less than $5.00. ' " . NSSSD Connection Charges based on location- Area 1 or 2, �, � M ; . / � . ' I / \ � l.. N K ,� � ` � 9' (a d I��S ___--� � � a v r�,S � �� .�(2S . -- j��_o�a � a j � .. � ,-- � V r"""' 1 Lrmd P/mtnin9 land Surveying Snils Teatin� �'r'vil Fi Murircrpat ' . � T�.. . .- � � � r��':� ,�� '� � d87`S-fli9ii� ��'S�iV.�, ; �f'mnevpnls3� . �NG 11�lE��1 N�►, I NC. ��f� : sunse�i1�066: � i En9ineermy —�-- F/1p !/7Z'Gt'S: � ' �(!/'Y�' l7r.S ---' � . 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I1�iC. Farqineer�� yrt��ors y �� `� '� � 7. e�_,:, �l�j�`'_� ,� � � � >�` ' �w..', ' . � ' �"� �s r „ � `r *"1' �_ � � . •�..._��"�"'�'",�: 'z � C � � � 'C .�i tz y p � • � � o : � :m : ~ . O . � � ' t" : � � 0 � N � � � � c� a� y p� �� z z � � W � � � y � 8 � � � o n � � ',� � " � �� C � � a y � � � �! � � � � � b ' ° O � � � � : � � : � � . a ° � � : � �: � °°�: � � . . . OII � . � . . . . . � � : ' ; ' : : : : � : : � : � � oa �a aa "�a oe �c k x �e � o�i � � � fn' � �n' �' g $ �' � � � � � � � � � � � H \ H �y , y �� o C� � o � � bd � � � � 0 � 0 D � � � '�"' m � _ m C r m o � � � � a � � � � � � �-'*� �� a a� � 0 � � A � g � * • � � a W to x � �x a a �' � Stori� 8 � WATER � @ T� �].OSETS �� URINALS � enrH • � rues �i �► BASII� 'O � � SINKS � � wnsF+ rRnrs ORINK. FOUNT. SHW/R5. ROOR DRA�NS GTCFi �i B�SINS � �uro WASHER � GAS APPL GAS � RANGE �� OPENIN65 +� • z � � � � � p 8 M m � 7❑ I i �, . [ y i�: p, � � � a �• �' tn ro y � fp� � M � ��p� � pa�� ;� p � �• �. ��a�� '�� p � `4 � $ � � ��o �' r� � � ro � � �m ��F�' b r � Ey� �w �� ' � m o �, ��oa x o � � p m 43 �.�� o�� `��y �� w : �o �aor � ��x � ~• � 3 '� � � � �'' d r'C � � � � �p. , A �. � � p � M � �� .'� � � • � � � �, � �i � r � p. a � �, � o � � � � � � � � � � m w 0 �' . HOUSE HEATING TEST RECORD ADDRESS -�� aC��=�c�C� �� ppT. F OOR CI SUBURB" -� OCCUPANT OWNER �� HEAT LOSS DATE HTG. INST. GAS C0. METER BA�D # SOLD BY INSTALLED BY /��'�� ., ��"� �' Eisetrleal Work By Gaa Line By �— TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER GAS �IGNa�'A�,. CONVERSION MAKE �� - - �� MAKE OF BURNER Model -�?/.� �/�IL�.S� !� i�� Modsl Serial ��_� ��'�!�.� Max. BTU Rating (NPUT ,l�-�°� MAKE OF FURNACE Model CONTROLS d� THERMOSTAT eat Plug V�nt Sizs Valvs "y�--*�� KIND OF LINER E_ ��9 NONE Limft �� "%�1 �� Draft Hood ��`--L Ra�ularor Limtt Sstfing � Fi Iters Sfze Number Fan Setting ��-!��-� Chimner Loeation Inslds � Outaide Pilot Ty� Chtmney Construeflon Pilot Make �� Pilot Model ��-z J°�'g Smoke Bomb Wiring �� Pilot Timing ✓r�� Draft .%� 1� Test Ta � e L.W. Cut Off � Door Prossuro Lighting Inst. �� Proaauro � � P��,��+ C � � � ��Date Tested — -�� Input CFH_,/�'J�� P�dr�e�'i�� ° ' Company Testing � � ' � Stack Temp. -�_! �' Percent CO � �s � Name of Tester Form 235 P/��,� �T/c'. ��9-s ��ia� �.�r�sa��-� � ��"lp ��f'.��- �� .`� City of Fridley, inn 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT Date: _ Ju 21,a 1971 Ovvaer: KPn y�1 1�,n Builder S.a,me Address �8 Ki.mball Street N E Ag�.�s Same 02--- �1101 � � �� LOCATIOiV OF BUiLDING No. � 5� S�t�et i mh 11 r N F Part of Lot I,pt P t_ 54 _ 5 5_�� --- F ____ Addition or Sub-DivisioII .�R i'V_P_iV i�+i—HB.i t�.Afl� i t i n„na_ Coraer Lot __ ____ Inside Lot X Setback Sideyard Sewer IIevation — F'oundation IIevation __ DESCRIPTION OP BUILDING To be Used as: GaBa�e_ Front 32 � Depth 20 � Height 10 � Sq• Fk 3—�� Cu. Ft 3, 520, Fx�ont Depth Hei�ht Sq.- Ft. Cu, Ft, Type of Construction Wood Frame F�t Cost -$1� 000 _ nn To be Completed ��eax Complete hard surface drive. Provide drainage to Kimball. The garage will have to stay 11 feet from Old House addressed on Janesville.(Dimension to be wall to wall). In consideration of the issuance to me of a permit to construct the b' ' sc�. '�he proposed work in accordance with the description above set forth comp]3ance Ord�anc;es of the city of Fridley. � ns of Ia consideration of the payment of a fee of $__7:�_.Q�—, permit is hereby gtanted to- Ken Wo11 n to construct the building or addition as described above. This permit ia graated u�n the express cottdition that the person to whom it is granted and his agents, employees and worlunen, 9n, a11 vPOr$ done in, around and upon said building, or any part thereof, shall conform in a11 respects .tp the ordinan� oF Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of bttilt3iag8 ��th�e citY ]imits and this permit may be revoked at any time upon violation pY any of the provisatons oE sedd �� CLARENCE BELISLE � NOTICE: This permiP do� not eover the eonatruefion, installaTioe for rririns, plumbing, 8as 6eafing, asvyer or vrafer. Be wrs to ses ihe Buflding Inspeetor fo� separata permhs for theae hems, a - APLICATION FOR RESIDENTIAL, ALTERATION, OR AllllITION BUILDING PERMIT CITY � �� . � ADDRESS NO : . � J ' ; �' STREET : �, ;, , DLEY, MINNESOTA s �2�/ � �- S: LOT: BLOCK• ADDITION• CORNER LOT: INSIDE LOT:� SETBACK; SIDEYARD; Applicant attach to this form 7.tao Certificates of Survey of Lot and proposed buildi.ng location drawn on these Certificates. BESCRTPTION OF BUILDING To Be Used As : �sa.c��9�� , � � , `. �� - �- � � �� ,� Front : �� P �� Heig / De th : Square Feet:�� Cubic Feet; � J—�� • � Front; Depth; Height: � � Square Feet; Cubic Feet; >>�' Type of Construction: �� Estimated Coat:_S �,G>��-� %�j��`�� To Be Completed: � ,E' /� � � � The undersigned hereby makes applicativn for a permit for the work herein specified, agreeing to. do all work in stiict accordance with the City of , Fridley Ordinances and rulix�gs of the Depas�tment of Buildings, and hereby declares that all the facts and repreaentations stated ia this application are true aad correct. L1ATE : IGNAT[TRE : � (See everse Side For Additioaal Information.) � .i`.. � � � ;, �` ,'� , � ,. .. �' � 4� � � � �� .:��- �� r� _ - - __ �., „ � _. . � �/ BUILDING PERMIT FEE SCHEDULE SECTION 2. The inspector of Buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any existing buildiag or structure, or for any alteration or repairs to any existing 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 pravided to-wit: iJNIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousaad cubic feet, or fractioa thereof, in such cubical conteats. �pe 3� 5-_$1.85 for each one thousand cubic feet. �'' - r_ -- --- ADDITIONAL INFORMATION `�. � � _�__ c� � �/" _' For the purpose of computing fees for building permits, the cubical contenta � of any building or addition, is determined by multiplying the ground area h, � covered from a point six (6) inches below the floor line of the basement or the cellar to the average heights of the upper surface or to the average� height of the roof surface of the main gable of a pitched roof. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost of all propoaed work. ° In no case shall the fee charged for any pexmit as set forth in Section 2 be lesa than $5.00. V�RIFICATION OF FOUNDATION NOTE: Permits for constsuction will be issued a minimum of 24 hours from the '" time of application, to allow for proper review of the proposed structure aad of the coastruction aite. A Certified Survey of the lot,.showing the location of the foundatioa, once it hae been constructed, will be required before proceedint� with the fra�►ing. _, CERTIFICATE OF OCCUPANCY Application for a�Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy qf any structure for which a building pernnit has been issued; and said structure �hall aot be used or occup�ed until a Certificate of Occupancy has been issued. • � � , � \ � . r. : � e.;, ��: ,. .. � - . . . . . . . _ . . . � - � - . _ Kbmd P(anning ' ��,��/�� 6875 1�Iighw� IVt�.b� N,E. land S�►rveying • /�� • ��JM Minaeagafis, � Seiis Testing ��Q�PiP/VIi��J V"/LC� Mian, $5431 -.'C#wit,[ngineering . �/ TelepNohe 784-6066 MYidcipo) Ettgineeri�►g Areo twie 614 Engineers & Surveyors ,�� Mort�a�e Loa� Survey for I<�.N �� W�LL�If�. � �� • • - ��" �'� �� • �` � �� '�"� : . . . ..� . ...- f;. .,. � � Q � �"y ,. 'J �� i �'g , �,5 , � .T� ` . f � J `r ` y f I D¢ \ . p�'t3•`'1. ! . � 2�,.�� , �� ', � o a - t fa�M� ° .S � 1 a ; � `�`�� ' �a , •� '�"' - � �.r ` ,I 1 w 3 ii � �5i y � � � 3y � �, n'S J� � ` , .- ��, �? L� 1� �I.I � , ` �- -,' � �� 9 0 Scale: �."- 34' . �",�i, i � ��,�r� 1�ne •5ov��`e � �'� �`�Q° L�� 1'�fi� �.� L�t� 5� and 5�, $lflc� E, af�d tha� �art ot Lot 54, C�Ir,ck �., ��,iv�v'v�eYV �--ieic��s Iyinc� t�lor�lnwes�erly ot �.he So��as�erl� � , .` tS.Q �;��:�. _��n�r� c�� nrsi<a �c�v+�"�t�°. � T �his Is o trve and correN re,presantation oi a survey ot'tbe 6nundories M the land: obeve described und qf.lhe locdtioe ot ult buitdings� if anyi-thereoe� ond all vibible encroaehmenls� i{ ony� lrera or on said land. T6is svrvay 1s rtta�e enly in eonnee►ion witb a mortgage looe eew being pinced on the property and na lio6ility is assymed exeept fo the holder of suth nrortgage or dny other interest qequired br the reason o{ seeh rtro►tgage. It is understood ortd agreed ng monuments hove been laced iqr the purpose of establishine bt lines or boundory eornera. Dot�d 'tRis i.4*�oy of �'uvte. A. D. 19� � � SUBURBAN ENGINEERING, INE. � Engine4� Su �ors � . �� r . � � ,r', � � M� , t�._._� �"=-� ,d ..,.�. � ��' � � � � � � � � � 0 � � � � a � � � v � �n � 0 � � � z 0 � � v 11'1 FEB-14-2002 13�36 �� o �� ,� � �� FRClM CITY OF FRiDLEY TO i i,�+ .�. yr Q•+ � y,y � � � �'�'�` oa �� __�' � � �� ' � � � � �� .� � � � � � �, � � � z 0 I II�Illllllll � � � � � � � � � � i �A'I � � � N N � ,� � T ��_�� 000�� aoo�o��$�� ' � � � � � o � C � � . ,� c� � �� i fi 1 � � � � � �� ' �; ' � �' �� ' � Z, 1°� , p � � � �� Q .� .� ,� ;� .� .� .� .� � : � . � � � � � �s � � � � 0 � � � � � � N °Q w � � � � 1 651636474� P. 03/fa4 �Q�� o �a � � �� rn� � a � 0 � m :'C� O o �Q 3 ..R- � � � � �p (� � N G �a r: � � O -o � � o H = N � O y � � � � o � � o Q � O� � � � � A cD 'v °' O � � �' N � Q o �D � � � Q ..� � � 0 c � a v 'o O < m � � � 0 c 00 � � v � � � � N � m z � _ ,� rn -�-I O z -n m m � v 0 0 � _ -a „ � � m r � � v \ � _ m -D_i z G� c� O �n � a�� m N � A -p Z�o � w �.� Smm Z� m� .� �o � --i m � � 0 D r � m m � N W tn c A � a� ov co �O D iv 3 '-' _ � 3 � � o � �` � c� -. < � � � o� � � � � p, O N -- � 1 D N -�a°—' ��' oi � � A � � o °' '� o O � N O x r � N � 0 Z � n v n c� 0 a 0 3 � QO a � N co N � d N 0 m � d d Dc H N d �� n � � �. � �D W � v � p�q caD N N a� Q�<� m rt � ��-r � N � a • > > �o-„'�v =c c�� c � ►i O � .�-r � � � � < �' W� o � f � � v � v � � � d � A � �D � 69 bq t�A 69 69 �. 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N � N m N �- fn D '9 I Z o m � � � .o a o z � 3 m ' �_o ,� � � ° O �� . �� . _ r► � v _ �� 'f , �I - - - " Cl _ _. _. _� -- .. _ . f`' a � m C r v_ Z L� C � rn v 0 - i 0 Z '� � _ 1�1 v C r b v� �n� ��-w�` � .wi �'p F° ° � �. �� c�� v � � o,,z`m � o��°r � �� m W D { N m Z Z� ' m� m ci � O z v_ � a � v Z � r �� O , L� Z m �, �O �� O� Z� Z� v� D� �Z ON za vz .� v o= z �+ W Z -�i a �Z �° N� n � m0 � yZ a � v< O � Z � C =� '~ � a I'� N O C/� ? � m m A < m 0 7 L 01 � C m � f+ N O O N a � T�i� BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE �1PPLICATION WILL BE RETURNED � ' � (`nti"ti".OI` VEI��? �R� COf�RECT(�R 4RD C_QMBlIST101` AIR �/�RIFICATIC�N When � �n a-inaan p�ctin8 �ran _, 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 plastiGPVC and meets all current codes and manufadurer speciflcations incJuding sizing, length, number of elbows and termination. 1(es (`� No () ihe undersigned also verifies that the replacement unit is a fisted assembly and meets the current codes and manufadurers speaflcations. This does indude AGA-GAMA Category I Centrai Fumace Venting Tables for fan assisted and natural draft appliances. The pY�e �ef*+ti !��n a�r is sized and installed to meet the current codes and manufacturers speafications. Whe�1 Pequi�ed to �n�t� a new cem6�c_tien air �it will be sized and installed to meet the current codes and manufacturer's speafications. When in�g� nPw�, vPr+t�ne.iy�, the undersigned hereby verifies that it is a listed assembly and meets the wrrent codes and manufacturers speafications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. Is thie common vent and vent connectors sized and installed correc:tly after an appliance has been removed from the common vent and vented separately as per current codes. Yes � No ( ) .. Yes � No ( ) Yes � No ( ) Yes (� No ( ) Yes�No ( ) 4eeli� ce T� and S' p/ _emmen V nt and V_r�t Cennectnr Ir►fermafien Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat AppGance #3 Type BTU Input Fan Assisted or Nat Total Appliances - 'Potaf Btu Input � Common Vent Type Vent Height Diameter � inches AppGance #1 Vent Connector Neight � ft�hgth ft Diameter in Type AppGance #2 Vertt Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type � - r•► .:- ..- - , �---- - -- Center Point Energy MGCO ` � 13562 Central Ave NE � HEATING CO: p`"o�, MN 55304 _ • Signed By. �' Date : � �� - �,. :� _.�_ ._ . --- - -- _.:__�______.----°---�- :- ---- --- - _ _ _ - HEATING AIR CONDITIONING AND ELECTRJC, INC. ADDRESS��O �v+ I , �/ �f/ � OCCUPANT �, +L HEAT LOSS DATE HTG. INST. // d SOLD BY �� .:,�� Electrical Work By " TYPE OF HEAT GA FA HW STEAMT_ SPACE HTR._^ (3A$ DESIGN MAKE Model � � Serial � � (� INPUT THERMO T T s� �5�� ROLS Heat Plua Value limi Limit Set�n Fan Settl PilotType�=y� Pilot Make Pilot Nbdel Pilot Timing L.W. Cut Off � — Pressure� �, �7 °/ra.9 �� Percent COz Input CFH Percent OZ Stack 7emp. Peraent CO FIOUSE HEATING TEST RECORD APT. FLOOR _T CITY SUBURB OWNER INSTALLED BY Gas Line By UNR HTR. OTHER CONVERSIQN Vent Size �/ ? � KIND OF LIMER _�/�`.*1il SIZE �� NONE Draft Hood _ Regulator ^t FilYers Size . � Number_„�_ Chimney Locaaon nside � Outside i� Chimney Conatruction Smoke Bpmb wring � '�-- Test Tag Do¢r Presaure Lightlrtg Inst. Date Tested � Company Tesdng � Name of Tester Pressure Percent COZ Input CFH Percent Oz St�ck Temp. Percent CO v � crn�oF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 May 4, 2004 Mr. John Koehler 528 Kimball Street NE Fridley, MN 55432 Re: Final Inspecrion at 528 Kimball Street NE Contractor: CenterPoint Energy/Minnegasco Dear Mr. Koehler: A mechanical permit was issued on February 18, 2003 to install a furnace at your address. According to the 1991 Uniform Mechanical Code a final inspection shall be conducted on the work authorized by this permit. As of this date the inspection has not been requested. The permit fee that was paid covers fhe inspection to make sure the work was completed according to the Codes. We will keep your permit open for another 30 days and if we do not hear from you witl�in this tune to set up the inspection, we will mark the permit "no inspection called for by homeowner after notification" and the permit will be expired. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. Sincerely, DJ/mh �ui'lciin� Inspe�tions %��-� %�-��L 7b�-�OZ-�=!97? F�:.�L SITL ADDRESS THIS .�PPLIC.4NT IS: ��..,�� ;��'�� _��.�z'�.'��T �� % �� .FFEC'I7V� ]-1 7� YOURL--�'vIAIL �DDRESS ❑ ��WNER jl�l�ONTRACTOP Permit �io.: Received B��• �.� Y� Daze � JUL PROPEItTY NAML-: �� C O '� I�II �f1L ��N�� ADDRESS: S�'VY�C° CIT`I STATE ZIP TEN�?TT pHONE: �75D �L03gU CON7CRACTOR NAME: SUBMIT A C�PY OF STATE LICL-NSE � �11iAi Li�1`V �IUI�`lb�f1 CQ E;CP DATB YOUR STATE T g . w,,,�.,...: . LICENSE,BONDe�1ND STATEBOND# �290 IVlain �$_ IV_F_, �� CPDAT'L '"" CERTIFICATE OF ,�Dx�ss: Fridlev,�� 5�� crrY sTa� z� INSURANC�. PHONE �%63) i54-2199 F�x (7�� ?554�-2g� PERNIIT TYP� TYP'E OF �ORK: ❑ SINGLE FAMILY ❑ NEW DETAII.ID DESCRIPTTON OF WORK ❑ TWO FAMILY ❑ TOWNHOUSE �PLACEMENT PER MS 16B.665 the pemut fee is a minimnm of �15.D0 or 5% of the totai cost np to T,500.00, whicheyer is �eater, for the improvement,, installation or replacemeat of a resideatial fixun'e, excluding the f�cl�ues. �(This should reflect only the cost of labor ) Labor cost Zmder $300 =$15.00. Labor cost between $300 ta $500 = cost of labor x.05 = plus .50 surcharge OR FOR PROJECTS WF�RE LABOREXCEEDS �500, b'EFS ARE BASID ON $10.00 PERFIXTURE, EXCEPT Wf�RRE NOTED. FTXTURES: (Il�IDICATE TOTAL NUMBER OF EACH BELOV4�. NIINIMUM FEE $15.50. BATH SINK/LAV ' FLOORDRAINS SFIOWER V✓ATERPIPING BATHTUB GAS PIPING (NEID QTY LIG7 SWIIvIMING POOL WATER SOFI'NER ($3� CLOTf�S WASHER KTTCi�NN SINK WATER CLOSET BACKFLOW PREV. ($1� DISHRIASF�R _ LAUNDRY TRAY '� �,WATER HEATER ($35) FOR II2RIGATION _ WATER METER _ OTHER Fee $ irae .50 TOTAL DUE $15 Numberoffixtures c`,r $10.� Number of fixtures cJr $15.0 OR Number of fixtures @, $35.00 , ►�IlUlrli/�i THIS I5 AN r1.PPLICATION FOR A PERMIT-NOT VALID UNTII.. PROCESSED 0 x$10.00=$ 0 x$15.00=� x $35.00 = $� State Surcharge = $ .50 �15.50) Tota1= � ��-�t [ hereby apply for a plumbing perrnit and I ac(cnowledge that the information above is complete and accurate; that the worlc will be in � conformance with the ordinances and codes ofthe Ciry of Fridley and tivith the N[innesota Construction Codes: that I understand this is '; not a perznit but only an anplication for a permit and wori: is not to start without a permit on site: that the �vork ��vill 'be in a.ccordance � ��.vith the anproved plan in the case of all �.vorlc �vhich i•eQUires revieiv and approval of plans. i ii , �,_ � -° • n � y ' � �IGiJATUP� (Jf ;\PPLIG�NT--��n'� °R1D(T?JAA+I�. /V /� Q$� i�DATG ' ` �� .'�I'PP,OVL-D Bl' '?-qTr i �I.E:::'SE�?•dC�T�: sEi?��.F.r`IZ=?E?i:Ditl?ti'.;RE'R'Lt7i;I1ZG� !��R3l1TI�1NG:..�i�:"":R1C:�L. ��i�1D'rv1E'��i1t�:iC.1L..�:d��RI� �.'�''.i '�l� :� �:�H�iT ;a.�a�ai�� as�e��oaas ��.a�� ,1= i -��.�i��er�i�� .;..venue �. iE. ��•iC110`.' :;�I1`•� :_-__ ��-. _-��.lfl:l .. . _. -:;� -� +!=--�,.