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PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn.? 2591 Date ►• �i''!" • . ..... Owner ... 052V ........ Builder .. .. .... ...... Addr .< .....,. ddress LOCATION OF BUILDING .. No. �. Street . ��. .... ..... Part of Lot. ...... ......... ... . .. Block ..... Addition or Sub -Division o Lot .. .,.�j, ... .... Corner Lot ............ Inside Lot ............ Setback +p: Sideyard ................. DE6CRIPTION OF BUILDING To be Used as: . Front . Depth ... Height Sq.FL •/ ...... Front �� .. Depth. r.. Height Sq. Ft......... Cu. Ft. Type o nstruciIon .. Est. .. , .. To be Completed r In consideration of the issuance to me of a permit .to construct the building described above, I agree ' to do the proposed work in accordance with the description- above set forth and in compliance with' ail provisions of ordinances{ of the village of Fridley. J In consideration of the payment of a fee of $... , permit is hereby °ranted to ....... to construct the buii83 ig� addition an hiseagenbts, employees d kworUmen,grx�&n condition that the person to whom it is 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 buildings with- in the village limits and this permit may he revoked at any time upon violation of any of the provisions of said ordinances. uu-weari. Building-uspector W 7 NOTICE: R. This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure. to see the Building Inspector for sepaftto, permits for these Items. 3, 1. r= NOTICE.- This OTICE:This permit does not cover t4-,on struction, installation or alteration for w�'plumbing, gas heating, sewer or water. 8e •sure to see ildIng' inspeotor for separate permits for items.` Application for Power Plants and Healing. Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... $10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 $ Each add. 320 sq. ft. EDR Hot Water .................. 3.00 $ OIL BURNER—to 3 gal. per hour ........................ 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTU) ....................... 5.00 $ '62) 0 over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ..................... x$ 2.00 oo}} $ Additional Fixtures ................ x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE ROUGH FINAL Dept. of Bldgs. Phone 560-3490 City of Fridley: The undersigned hereby makes application for a permit for the work hereir. specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true d correct. Fridley, Minn -> 19 Owner v a� Kind of Building To be completed about Estimated Cost, $��cJ�°- Ol New. Building Permit No. Permit No. A� 3 5 - DESCRIPTION OF WORK BEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No Trade Size Capacity Sq. Ft. E.D.R. BTU H.P. Total Connected Loa /2w , '/ Kind of Fue PVRN'ER.— Trade Nam Size No 5&j 50 41 d. DO 0 Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) -.,Business Phone No - susdEcr PERMIT - NO. City oFridley .. -- 12121 AT THE TOPP OF THE TWINS BUILDING PERMIT r ECEIP LU ____._ COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. �J�( CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-580-3450 910-F15 15/8/73 JOB ADDRESS 6550 Lucia Lane N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 Lucia Lane Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dean Thomas 6550 Lucia Lane N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Reynolds Consgruction 3223 Flag Court 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residentail 7 CLASS OF WORK ❑ NEW $I ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Convert existing garage to living area and add on attached garage 9 CHANGE OF USE FROM TO STIPULATIONS FOUNDATION ONLY until as built survey submitted. SEPERATE PERMITS REQUIRED FOR AIRING. HEATING, PLUMSIN.G AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. 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 R-1 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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. $S OOO.00 2.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 17.44 STRUCTION OR THE PERFO ANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE f aa S-'? - %V 19.94 SIGNATURZO CONT 'OTORORAUTHORIZEDAGENT (DATE) r HEN PROPERLY VALIDA THIS IS UR PERNUT 44�"DATE SIGNATURE !DOWNER IIF OWNER BUILDER) IDATEI D SP APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME:IDE,gH, I& h� nr�A BUILDER:_�Y o _J �e�� f ADDRESS:_C,-® ,� _, �:,( d�nr /yE ADDRESS: �a�3 '/�"e- L'>; NO • . STREET °_ L, J c / A LANE 61 LOT • o, BLOCK •` - — - ADDITION: CORNER LOT: INSIDE LOT: V/_ SETBACK: --,3,a � S I DEYARD •2.7- /7 Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: AODI -r n N Front: / Z_ Depth: Height : ' Square Feet: Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: 1-7;E4M Ir Estimated Cost: _$ 6_6W-,-7, C -e To Be Completed: Je'ly / . / 7� The undersigned hereby makes application for a permit for the work herein specified# agreeing to do all work in stfict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. �� DATE: _ SIGNATURE: ; (See Reverse Side For Additional Information.)N ' a' -{ :� .° - �` ; �; a .fi CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARAf AIR: Furnace Shell & Duct Work 'Replacement of Furnace Repairs & Alterations -up to $500.00 Rapairs & Alterations each add. $500.00 2-1ECHA.NICAL UARM AIR: Furnace Shell &,-Duct Bork to 100,000 BTU each add. 50,000 BTU *?.arlacenent o5 Furnace Repairs & Alcerations-up to $500.00 Repairs & Alterations each add. $500.00 ='n -1 OR HOT UER SYST51: Boiler & 1.7 -nes up to 100,000 BTU each adds. 50,000 BTU Boiler only up to 100,000 BTU each addn. 50,000 BTU OIL BURNER- to 3 gal. per hour each add. 3 gal. per hour RATE TOTAL Job Address --- 'G' `� F�C� 2— - . $12.00 $ 7.00 $ 7.00 S Department of Buildings 4.00 S City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein $12.00 $ specified agreeing to do all work in strict accordance .with the City Codes 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the 7.00$ facts and representations stated in this application are,true and correct.. '7.00az- 4.00 $— Fr' Y, Dunn. , 19 dPc7 OWNER $12.00 $ 4.00 $ 7.00• $ 6.00 $ $10.00 10.00 GAS BURNER- free 100,000 BTU to 199,999 BTU $10.00 (over 199,993 BTU see Fee Schedule) GAS FIiTI`:G FEES: 1st _3 Fixtures x $ 3.00 "ditio :al Fixtures x $ 1.00 Gas Ra.age to 189,000 BTU X. $10.00 R CO\Di i 105_q • . SYSTEJIS See Fee Schedule VENTILATING SYSTEMS ALTERATIONS & REPAIRS State Surcharge TOTAL FEE ROUGH IZZP. REINSPECTION FEE Date ($10.00) S FI::AL 1..SP. 4 - Date APPROVAL FOR PER.12IT FZ.% --U`4 FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE *Attached stack verification form KIND OF BUILDING USED AS TO BE COMPLETED ABOUT°J ESTIMATED COSTG OLD - NEW BUILDING PERMIT NO. PE&VIT NO. DESCRIPTION OF FURNACE/BUR`EER HEATING or POWER PLANTS, Steam, Hot Wate2 Air . Trade Name Size No. i/l' Capacity Sq. Ft. EDR BTU HP Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company. Signed By Tel. No. APPLICATION FOR HEATING REPLACEMENT CHIMNEY AND STACK VERIFICATION THIS FORM MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PEP14IT FORM. LOCATION 4f DATE z �� OWNER 4� �- o56- - /`® ADDRESS C�.Y��a The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined 2. Is free from rust or deterioration 3. No foreign objects are lodged within 4. That it is securely supported 5. That it meets all current Code requirements for size and total BTU gonnected 6. Total Heating BTU All Other BTU REMARKS HEATING PERMIT # TOTAL 't SIGNED Licensee by Address �'� /� � �Ve Telephone Fridley City License # / li CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND 4.00 AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE 7.00 Repairs & Alterations each add. $500.00 4.00 STEAM OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU $12.00 GRAVITY WARM AIR: RATE TOTAL Job Address Furnace Shell & Duct Work $12.00 $ $10.00 * Replacement of Furnace Repairs & Alterations -up to $500.00 7.00 7.00 $� $ De:partment of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 Repairs & Alterations each add. $500.00 4.00 $ C:.ty of Fridley. Teal. #571-3450 MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU $12.00 each add. 50,000 BTU 4.00 *Replacement of Furnace - to 100,000 BTU 7.00 Repairs & Alterations -up to $500.00 7.00 Repairs & Alterations each add. $500.00 4.00 STEAM OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU $12.00 each addn. 50,000 BTU 4.00 Boiler only up to 100,000 BTU 7.00 each addn. 50,000 BTU 6.00 OIL BURNER- to 3 gal, per hour $10.00 each add. 3 gal. per hour 10.00 GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 (over 199,999 BTU see Fee Schedule) GAS FITTThG FEES: `lst 3 Fixtures x $ 3.00 Additional Fixtures x $ 1.00 Gas Range to 199,000 BTU x $10.00 AIR CONDITIONING FAN HEATING SYSTEMS See Fee Schedule VENTILATING, SYSTEMS ALTERATIONS & REPAIRS State Surcharge TOTAL FEE ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT pfd REINSPECTION FEE (.$10.00) $ -oo $ 14INIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS -.$.So STATE SURCHARGE *Attached stack verification form The ,uider-signed hereby L.auP- appli caticn For a per -:it for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. 12-13 , 19 OWNER KIND OF BUILDING USED AS �Q TO BE COMPLETED ABOUT ESTIMATED COST - NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, xm Air No. Trade Name ,/'� Size No. Capacity Total Connected Lo$Ld BURNER - Trade Na e No. HP Capacity Sq. Ft. EDR BTU HP Company Signed By WW Tel. No. SUBJECT R City of FridleyIr 19546 AT THE TOP OF THE TWINS BUILDING PERMIT REC - COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. ® ®2 i cxai i1 ` /"'I CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY ----� L 612-571-3450 910-F15 6/20/88 JOB ADDRESS 6550 Lucia Lane N. E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 2 Lucia Lane Addition SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Dean Thomas 6550 Lucia Lane N.E. 574-0457 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK Cj NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Construct a 101 x 121 Shed 9 CHANGE OF USE FROM TO STIPULATIONS Shed must be 31 from side lot line. Shed must be anchored by ties or tied to a foundation. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CO ST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. 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 CERTIFY THAT I HAVE READ 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 $900 $, 5O WITH WHETHER SPECIFIED HEREIN OR 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- $23.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $23.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLY BLDG WSP VALIDATED THIS IS YOUR PERMIT DATE SIGNATURE OF OWNER OF OWNER BUILOERI IDATEI NEW [ J ADDN [ ] ALTER [ ] Construction Address Legal Description:_ City of Fridley R-1 AND R-2 Building Permit Application C -J ' Effective 5/1/88 Owner Name & Address: "10::A) IM . X Tel. U S74 b5�S% Contractor: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposoed construction drawn on it to scale. DESCRIPTION OF IM ROVEM12U LIMN; AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. ' DECK AREA: Length Width Hgt/Ground Sq. Ft. ` ODrner Lot I I Inside Lot I I Ft. Yd Setback Side Yard -Setbacks Type of Construction: Estimated Cost: 5 •®® Approx. Completion Date: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: I $ $ II,` + 6' See Back Page ,ATE : APPLICANT: 0. Tel. Permit Flee DU State Surcharge 5 SAC Charge 5 Driveway Escrow 5 Park Flee 5 Sewer Main Charge 5 TOM 5 31'I PMMIONS: CITY USE CHLY Flee Schedule on Reverse Side $.50/51,000 Valuation $550 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary I I Not Necessary [ J SUBJECT PER Fridley City of Fr \ 27944 AT THE TOP OF THE TWINS ? BUILDING PERMIT r RECEIPT NO. : • - � _____ COMMUNITY DEVELOPMENT DIV. � V PROTECTIVE INSPECTION SEC sT/ f . .4 i A ;"',•j CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY _--- L J` 612-571-3450 910415 9/23/98 JOB ADDRESS 6550 Lucia Ln 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 Lucia Lane Add. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dean Thomas 574-0457 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Dingmann Construction 22134 Patch Lake Rd Cold Spring 56320 320-685-8586 2718 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATION 0. REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof house & garage (20SQ) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the StatfBuilding Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING. HEATING. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 80 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 CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ISTALLS 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 $1 714.00 $.86 WITH WHETHER SPECIFIED HEREIN OR 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEETOT FEE -iw ,•.ts,,•��--�_ q-�3 9�' L s SC $ . 00 $64.32 V SIGN RE Of CON'RACTOR O UTHORi2E0 AGENT IDATEi EN ROP VALIOA E THIS IS UR PER 1 r1fI _ SIGNATURE OF OWNER.IF OWNER BUWLOM iDATE. BLO iNSR FAfE NEW [' ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION �� a ConstructionAddress: /� j� D �� c� Lgn -e �1'�i� /e � /-1 Al Legal Description: Owner Name & Address: -i70t77 et.S Tel. # Flyo o ; Contractor: MN LICENSE# �2 7/ S' Address: �� 1'Cp%`C % G�i�71 �� /�(a0%d_ ff,&Z7 t5�e fyAl jel. # y2® -fes Fs' 0�`f Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF E%IPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width �--� Hgt/Ground _ Sq. Ft. OTHER:' Construction Te: yp R tf/'0 p'E Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ l '? / .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ 0 0 $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, IV1N 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Water j Bath Wash � Drink Floor Catch Auto. Stories Closet Urinal Tub Shower Sink Tray i Fount.. ' Drain Basin Washer Basement j f Floor 1 Floor 2 Floor 3 Floor 4 i r PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater —Electric $ 7.00 Water Heater — Gas** $10.00 Gas Range** $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes () No Type $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE $ .50 Effective On January 1, 1997 Gas Appl. I Gas Range Misc. Fixt. `: Water Heater Gas Elec i i JOB ADDRESS 'jrD U�l� 411 /►5 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. 4 co 05 O 1997 Owner 7W/MAS r 7 '-1 - O y/ 5-7 Building Used As ��s/�G- Estimated Cost c ��® �© PERMIT NO. PLUMBING COMPANY_," 01 SIGNED BY TEL N0, 04% Q Approved By� Rough—in Date Final Date MINIMUM FEE POR ANY PLUMBING/ $ 2, —o PLUS THE $.5o STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES.