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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N® 3576 Date: ........................................ 3 Owner ....................................... Builder .... ..... ................... Address ...................................... Address .........................................:... r� LOCATION OFF BUILDING No. A !. 4 ./... Street . .5K0.6 -94n..4 V.� .f . f.. Part of Lot . ..... Lot .....,Y..... Block ... Y............ Addition or Sub -Division . �" "�'L ..®. '� ....... . Corner Lot ............ .. Inside Lot . X ......... Setback A%..: b ... Sideyard X...`.... . 9.......... DESCRIPTION OF BUILDING To be Used as: �y e ..... Front �T .. � Depth c� Height �.' ��.�J Sq. Ft. [./ . Cu. Ft. Front °? `.� De , l el t .1.6.-.19 60 S Ft Type of Co cdon ................... Cosh /.� ....... Completed ..... 1 To be Co leted ................... In consideration of the issuance to me of a permit to construct the building desribed above, 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 city of Fridley. . ....:.4� :� :.... ......... . In consideration of the payment of a fee of $. f�.:., permit is hereby granted to ................... .......................... to construct the building or addition as described above. This permit is granted upon j the express condition that the person to whom it is granted and his agents, employees and workmen, 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 city limits and this permit may be revoked at any time upon violation of any of the provisions of said Vordinances. ...... Building Inspec�or "o NOTICE: This permit does not cover the construction, Inetallation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. N4xNDEnFaNGiwEERRqG COe-qlNce ENGINEERS AND SURVEYORS LAND euavEvlNo SOILS TESTING CIVIL 8,. MUNICIPAL ENOINEERINQ LANA PLANNING e I to im, 6418 -SGT" AVENUE N. MINNEAPOLIS rM MINN. KE 7- 3637 • u f 41! n � !i 11� ��►�! • LI QK3f'Y� ri i--it) I.0 , - - m L OT 7,n n i �' •" WE HEREBY CERTIFY THAT THIS 15 A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF THE LAND ABOVE DESCRIBED AND OF THE LOCATION OF ALL BUILDINGS, IF ANY, THEREON , AND ALL VISIBLE ENCROACHMENTS, IF ANY, FROM OR ON SAID LAND. MINDER ENGINEERING CO., INC. OPTED Te15 MY OF M•�;a �� 1�5 j EM0%N_9ER5 . AND SVRveYORS Nom- f F p f,. 0 �> � "; "' . � yrs � I - �' City of Fridley Applicatlon for Piambling and Gas RMncj Pon* DepL of Bldgs. Phone SII`, 4-7470 �a DESCRIPTION OF WORK Number. Kind and Location of Fixtures Location— Number. m K Y K Z sO w t�'1°d w Ua� Z (�90 F ® N WATER HTR. GAS ELEG Base 1st 2nd 3rd 4th • Future Connection Openings I New Fixture, Old Openings Connected with Sewer El Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures ...................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin ............................ Water Heater (Up to 200,000 BTU) ..... . New Ground Run Old Bldg. ........... . NO. RATE TOTAL — x $1.50 $ — x 1.20 $ — x 1.00 $ _ x 3.25 $ — x 2.00 $ — x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ 4_. Sro Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $� City of Fridley: The undersigned hereby makes application for a permit for the work herein 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 argue and correct. Fridley, Owner Kind of Building Used as To be completed about — Estimated Cost, $ Old—New. Building Permit 11 POST IM -12-58 r nAA By Business Phone Nc 197Z 19- 19— SUBJECT ERMIT NO. City of Fridley 25545 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. 1 `__���_ COMMUNITY DEVELOPMENT DIV. y f PROTECTIVE INSPECTION SEC. JOY 1 . � NUMBER REV DATE PAGE OF APPROVED BY 1 CITY HALL FRIDLEY 55432 ,6 612-571-3450 910-F15 9/26/97 JOB ADDRESS 6761 Madison Street NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 7 4 Rice Creek Terrace Plat 6 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bobbie Weaver 6761 Madison 2=1 NE 571-4393 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO B & B Roofing 6760 Madison Street NE, Fridley, MN 55432 571-0248 9042 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 ❑ NEW ❑ ADDITION ❑ ALTERATION IR REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (22 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING. HEATING, 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 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 $1,834 $.92 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PRO SI S OF ANY OTHE STATE OR LOCAL LAW REGULATING CON- $59.50 Fire SC $1.83 ST UCT N OR THE PERF ANCE OF DNS T CTION. h /�' —��°� PLAN CHECK FEE License SC $5.00 TOTAL FEE $67.25 SIGN AT UREJ CONTRACTOR ORAUTHOAIZEDAGENT IDATEI WHEN PROPERLY VA*ODATED THIS IS YOUR PERMIT BLD SP MATE SIGNATURE OF OWNER of OWNER BUILDERI IDATEI il NEW j ] ADDN [ J ALTER [ ] CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION r ConstructionAddress: /'/ Al/w/- Legal Description: Effective 1/1/97 Owner Name & Address: b0h91 L W L 411fAL Tel. # ,27/—. Contractor: b F1,4 & MN LICENSE # �� y Address: b /71�� 1�;yW/ ')ZIW ---) / Tei. #,-:5 71—,::::P62 y� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF 11"ROVEMENT LIVING AREA: Length GARAGE AREA: Length _ DECK AREA: Length OTHER: 1::--� Construction Type: Driveway Curb Cut Width Needed: -' DATE: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Width Height Sq. Ft. Width Height Sq. Ft. Width Hgt/Ground Sq. Ft. Estimated Cost: $ / I/ (Fee Schedule on Back) Ft. '+ 6 Ft = Ft x CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $950 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary j $ 9 01 M64 SUBJECT City of Fridley =46� AT THE TOP OF THE TWINS BUILDING PERMIT � RECEIPT NO. ►v .......COMMUNITY DEVELOPMENT DIV. f PROTECTIVE INSPECTION SEC. (Y 6Lf?q I . . CITY HALL FRIOLEY SS132 NUMBED pEv DATE PAGE OF APPROVED BY ,� L J\ 612-571-3450 910415 11/1/99 JOB ADDRESS 6761 Madison Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 4 1 Rice Creek Terrace Plat 6 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bobbie Weaver 571-4393 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 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 ❑ NEW ❑ ADDITION XX ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Built in as fireplace; Remove divider wall be bedrooms; Put in bay window: Move bearing wall 1511 in upper level; Other alterations 9 CHANGE OF USE FROM TO STIPULATIONS See stipulations on plan. Provide smoke detectors in all sleeping rooms and on all levels of the house. 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 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $5500 $2.75 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 $118.25 Fire SC $5.50 PLAN CHECK FEE TOT FEE .R 126.50 SIG" UAE OF CONTRA TOA OR AUTHOR4ED AGENT �O ATE HEN Bl NSP VALI D THIS IS Y U PF1�iMl r1ATE - S ATURE Of O E cif NEA BUR ERi i ATEA 01 M64 NEW[ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY �(' OL ALTER j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 << BUILDING PERMIT APPLICATION eo� rl Construction Address: J-7 :S'- VE u� Legal Description: Owner Name & Address: �ab�(� 1�0 Tel. #fg l� Si l 3�-3 Contractor: <t I �- MN LICENSE # Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVENTM Length Width Height Sq. Ft.. Length Width Height Sq. Ft.. Length Width Hgt/Ground Sq. Fgptp.4 j�; rnw.- ifty is" E011 b(fFeV, Estimated Cost: $ s:..90j- Driveway Curb Cut Width Needed: Ft. + 6 Ft = DATE: YO 9j APPLICANT,L : y Ft x $ Tel. # S? / -Y393 TOTAL STIPULATIONS: 11V CITY USE ONLY Permit Fee $ �� .[J Fee Schedule on Reverse Side Fire Surcharge $ 50 .001 of Permit Valuation (1/10th%) State Surcharge $ , % $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ $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: 11V CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Effective On May 10, 1999 JOB ADDRESS �o��/�nc.sz. �L OWNER 66%a, TOTAL BUILDING USED ESTIMATED COST PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER $ f No. of Heating nits Circle One (Steam) (Hot Water) (Warm Air) $ Trade NameAJULW .? Size No. BTU__a-5,L;L , HP EDR $ Fuel Gam/ Total Connected Load Burner Trade Name Size No. $ BTU HP EDR $ 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 an $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are'true and correct. $ ~'� ALLIED RRESME dba preside Center License # 20090911 HEATING CO 27M NI_ EaIndeiv An- AosetiriNe, MN 55116 Signed 651-M250 DATE Approved By Rough -In Date Final Dat CHDINEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes () No ( ) 2. Is free from rust or deterioration Yes () No ( ) 3. Has no foreign objects lodged within Yes () No 4. Is securely supported Yes () No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes () No ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes ( ) No ( ) 8. Has combustion air been provided for water heater Yes ( ) No ( ) Remarks: List ALTERATIONS Being_Done: :; es dd '0. - HEATING CO: Signed By: Date: CITY OF FRIDLEY PERMIT NO.: 200401544 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 09/07/2004 572-36U4 YAX: (763) 571-1287 ADDRESS : 6761 MADISON ST NE PIN : 143024130064 LEGAL DESC : RICE CREEK TERRACE PLAT 6 : LOT 7 BLOCK 4 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. REPLACE AIR CONDITIONER. # INSPECTIONS 1 APPLICANT HARRISON ELECTRIC INC 3440 KILMER LANE N PLYMOUTH, MN 55441 - OWNER WEAVER ROBERTA L 6761 MADISON ST NE FRIDLEY, MN 55432 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 know the same to be true and correct. All provisions of laws and ordinances governing this type of worl 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 regulating construction or the performance of construction. Applicant Date Bldg Insp Date ELEC PERMIT FEE - MIN (RESI) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 027762 SEFAKA E FEK WT6 FEQU1RED FOR wUKK OTHER THAN UKSUKLBED ABOVE. CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 763) 572-3604 FAX: (763) 571-1287 ADDRESS 6761 MADISON ST NE PIN 143024130064 LEGAL DESC RICE CREEK TERRACE PLAT 6 LOT 7 BLOCK 4 PERMIT TYPE HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PER O.: 2004-01877 DATE ISSUED: 0/14/2004 VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL AN AIR CONDITIONER. # A/C UNITS 1 # FURNACES 0 # GAS DRYERS 0 # GAS RANGES VALUE (FOR MINIMUM CALC) 2000 APPLICANT SUPERIOR CONTRACTORS INC 612142 AVE N CRYSTAL, MN 55422 OWNER WEAVER ROBERTA L 6761 MADISON ST NE FRIDLEY, MN 55432 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 know the same to be true and correct. All provisions of laws and ordinances governing this type of wort 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 regulating construction or the perfooance of construction. Bldg Insp. HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK GAS RANGE FEE GAS DRYER FEE AIR CONDITIONING FEE STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 16849 SEPARATE PERMITS REOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0 0.00 0.00 0.00 0.00 25.00 0.50 25.50 CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE t Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Cond' Tonin - All Sizes All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater ° 44 4 Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fee Total $35.00 $ $10.00 $ $10.00 $ $10.00 $ $25.00 $i JOB ADDRESS 6 ?& I & A'bl S0tiJ 511 xU 6 Owner /—g:b WL�&9 Building Used As ESTIMATED COST ' PERMIT NO DESCRIPTION OF FURNACE AND BURNER # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Burner Trade Name BTU HP Size A 919 The undersigned hereby makes application for a permit for the work herein Commercial/industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/Industrial/Institutional .65V and representations stated in this //E)application are true and correct. State Surcharge $ HEATING CO 50 l®�- k AJT-* A'CTMS TOTAL FEE $ Signed Tel REINSPECTION FEE $50.00/HOUR FAX # Date *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough -in Date Final Date From: unknown Page: 1/1 Date: 8/6/2010 10:46:58 AM City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 i IV Building PLUMBING� Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: 763-502-4977 FAX EFFECTIVE 7-1-2010 DRESSDATE YOUR %f SITE ADDRESS THIS APPLICANT IS: O OWNER CONTRACTOR PROPERTY NAME: we Ve C^ OWNER/ ADDRESS: C� 1 SO CITY G STATI� c TENANT �— PHONE: CONTRACTOR NAME: , STATE LICENSE # 600t tl 0 PM DATE A / 6 SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND OF STATE BOND # / EXP DATE % ITY L%SPO STATI ZIP �G CERTIFICATE ADDRESS: INSURANCE ) PHONE 7 &->3 -!5; 7 / S y FAX 242 ?,- PERMIT TYPE E3 SINGLE FAMILY O TWO FAMILY O TOWNHOUSE TYPE OF WORK: [3 NEW 0 REPLACEMENT DETAILED DESCRIPTION OF WORK �-+ i Wt c e Q V7 FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $35.50. BATF SINK/LAV FLOOR DRAINS — _ SHOWER WATER PIPING BATHTUB ^ GAS PIPING (NEED CITY LIC) — SWAMIIvIING POOL WATER SOFTWER ($35) CLOTHES WASHER +_ KITCHEN SINK —WATER CLOSET _ BACKFLOW PREY. ($15) — DISHWASHER LAUNDRY TRAY _-WATER BEATER (835) FOR IRRIGATION — — WATER METER —OTHER Number of f'vttures @ $10.00 —x $10.00 = $ Number of fixtures @ $15.00 _ x $15.00 = $ Number of fixtures @ $35.00 , x $35.00 = $ State surcharge $ 5.00 0' C> G (MINIMUM $40.00 Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED 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 c of all work ich � fires ' view and approval of ans. j_ (ti. �c ! fO&t SIGNATURE OF APPLICANT PRINT NAME riA APPROVAL INSPECTORS SIGNAYW PLEASE NOTE: SEPARATE'• P ARE UIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 i IV