Loading...
PRE 2010 DOCS(o City of Fridley, Minn. Z- 11509 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT Date: Jixnp _ 15, 1979 - Owner: Vern Donngy Realty Inc. Builder Same Address ___7.300_._.-._36thy -nuQ North Address Same 533-2741 LOCATION OF BUILDING No. 1401Street— Mt-.qdowmonr nrive N:F',} part of Lot Lot — 18._ Block 2 -_-_ Addition or Sub -Division Meadowmoor Terrace Corner Lot ___._ _- _ Inside Lot X Setback 35 - 5' r.. Sideyard 10-51 AA*AiElevation _An -A6 Min_ nf.._3._feet above water table wdye Ton of Footing CWater Table - 894.3 APPLox.) DESCRIPTION OF BUILDING To be Used as: 1we11 ing Front q21 Depth —24..xHeight _20' _ Sq. FL 777 -61 Cu. Ft. x.S. 5 2' Garage._ ____ Front __141 _ Depth _ 22' Height 101 Sq. Ft. q08 Cu. Ft. g080 Type of Construction_ T ►�„ � �•� _rr a Est. Cost __031 0 To be Completed Sept -1972.__ WATER LOCATION: 10' E. of Sewer Service SEWER SERVICE: 48.5' W. of E. property line. Stipulation: This permit issued subject to stipulations in 'Mutual Agreement" signed by Vern Donnay Realty, Inc. and dated June 14, 1972. In consideration of the issuance to me of a permit to construct the building described above, I agree tg do the proposed work in accordance with the description above set forth d in compliance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 34.00 , permit is hereby granted to Vp-rn nn -n -nay Realty Inc. to construct the building or addition as described above. This permit is granted upon 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 ordingnCeS Of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildi�sga 'within the city limits and this permit may be revoked at any time upon violation of any of theprovisions of0—.e Y�. .10 Said ordinances. r TT.. ...vect�� or rLAREN .E RF.T.TST.F. NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we the Building Inspector for separate permits for these items. A r Load Rlammy��'� / II 687'5 N -mq ME, iiirrr ` � iZ Laid Surwylny !4finnealx+lis 32, -6/s 7oMw ENGINEERING, INC. .tlin�es�to C i',16- Mw clpa/ An et 4-604 byfrer t y jl n l' d ee I' S Jur veycis certificate of surveir for NORTH 7.5 LOT I8 75 MEADOWU00I2 DR oDENOTES IRON --- p,EjypTES UT/L/TY e QQA/NgG6 .F.45fMENT Zor-j BLOCK 2 ACADOWN00,q A -RRA CZ- coeur T Y OF AAVgA /h&VAY Cerit y 401615 15 o hW dfd QorMi npl?507 dh% n o�a RrV8y elk bPVW*Mf 4("& 466M 4WVbrd I7d,and ICA? IWA47 afa# hwidmjr s , flVV07 , and d/ risALF evwchffleals , if my. (nm or wswd lad- As wrve.4ed by me 1fi� y� fEe A -O SUBURBAN ENWNEERINO, INC. En�rteers /Fr SCALL -1 G 40' hS F- Z//Z) oy r- G6)� T� /2 �v;�'�' �� Applicaftm for Power Pkm and Cooling. Vemikfi%n. ReMpi a and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AYR: 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 $ 1CH. WARN AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ I0� 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 & Famines—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 ' $— Eaach 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 .� , r •r No q/ Dept. of Ridge. Phone 880 -MM City of Fridley: �-19'194 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 are true and correct. . A Fridley, Minn- !_- I&IV Owner V6CA0ffl/'% Kind of Building Used as —A To be completed about Estimated Cost, $ Oldf—'NewJhuilding Permit No. Permit No. DESCRIPTION OF WORK HEATING or PO PLANTS -Steam, Hot Water W Air No Trade Name = • a) Size No- Capacity Sq. Ft. E.D.R Un BTU H.P. Total Connected Load "I (a Kind of Fuel BURNER — Trade Namj► Size No - Capacity Sq. Ft. E.D.R BTU HP: BY— Business PIRO,4$ rWQK X- AIR-ieONDM 1001 Xenia Av. S. - 545-1611 Wn110apoiis, Minn. 55416 (REMARKS -OYER) GAS BURNER (up to 199,000 BTU) ..... ............... .. B.00 over 199,000 BTU See, Fee Schedule GAS FITTING FEES: NO RATE 1st 3 Fixtures ..... ................ x$ 2.00 gqTOTAL $ Additional Fixtures ................. x .75 $ Gas Range to 199^0 ........... s$ 600 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedulo VENTILATING SYSTEM ALTERATIONS do REPAIRS TOTAL FEE .� , r •r No q/ Dept. of Ridge. Phone 880 -MM City of Fridley: �-19'194 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 are true and correct. . A Fridley, Minn- !_- I&IV Owner V6CA0ffl/'% Kind of Building Used as —A To be completed about Estimated Cost, $ Oldf—'NewJhuilding Permit No. Permit No. DESCRIPTION OF WORK HEATING or PO PLANTS -Steam, Hot Water W Air No Trade Name = • a) Size No- Capacity Sq. Ft. E.D.R Un BTU H.P. Total Connected Load "I (a Kind of Fuel BURNER — Trade Namj► Size No - Capacity Sq. Ft. E.D.R BTU HP: BY— Business PIRO,4$ rWQK X- AIR-ieONDM 1001 Xenia Av. S. - 545-1611 Wn110apoiis, Minn. 55416 (REMARKS -OYER) Cil fy Of Fridley and Cvm ' DW. of Bldg& Phos 980-3450 DESCRIPTION Or WORE Number. Rind and Location of rlxtiusQe NAT" NM. PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES- NO. RATE TOTAL Number Fixtures ................ x $200 $ Future lftture Opening .... a ...... x $1.50 $--- New-. New Fixture Old Opening .......... x $1.50 $ Catch Basin ..... ............. x $3.28 $ Water heater !alp to 99.000 BTU) .... x $3.00 $ New Ground Pun Old Bldg......... x $3.25 $ Electric Water Hester .............. a $200 $ GAS FITTING FEES-. NO. RATE TOTAL lot 3 Fixtures x $200 $ A"Itional Flatuaes ................ x $ .75 $ Gas Range to 199.000 BTU .. ,......... x $5.00 $ State Surcharge $ .50 REPAIRS a ALTERATIONS.—Rater to Co& _ Description o 0 . . 0 ... o • ... a . e .. e . w.... .. -... . .... * a" ..S TMAL TEE 8 City of FVidley: The undersigned hereby makes application for a permit for the work herei. specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the tact and representations stated In this applicatio n are true and correct Fridley. Mion z/z� Owner P� Kind of Building Used as 1'2 To be completed about _ %e.S~ .'z _ Estimated Cost. $ ---V C -J r C-42— Old-7f wilding Permit No. Permit No. r Signed By Business Phune No & ROUGH FINAL City of Fridley APPgcaMn for Plug and Gas Fbdng Prn k Dept. of Bldgs. Phone MD -3490 DESCRIPTION OF WORD Number. Kind and Location of Fixtures N ill M0012V 7 : WATER MTR. MIC Base 1st 1 2nd 3rd 4th • Future Connection Openings * New Fixture. Old Openings Coaaeebd with Sewn Cesspool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ x $2.00 $ Future Fixture Opening ............ x $1.50 ;- New Fixture Old Opening .......... x $1.50 $ Catch Basin .................... x $3.25 $ Water Heater (Up to 99.000 BTU) . • .. x $3.00 $ New Ground Run Old Bldg......... x $325 $ Electric Water Heater .............. x $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ................ x $2.00 ;- Additional Fixtures ................. —x$.75 $ Gas Range to 199,000 BTU ............. 1 x $5.00 $ 5'00 REPAIRS k ALTERATIONS—Refer to Cate Description ............................................. TOTAL FM $ (SURCHARGE $_.50) 53-84-s-915.51 Lasa 1401 N. E. Meadow Moore Drive City of Fridley: The .undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct r971 -171n Findley, Mnn 10-13-72 19_ Vern Donnay Homes Inc. Frame Kind of Building Res. Used as To be completed about 10-20-72 Estimated Cost, $ 10.00 OW—New. Building Permit No. Permit o. Signed. ° By hniNNEGASCO ROUGH FINAL /10- - y �j Uf`>'�aage .5� �1�5` a. Business Phone No CITYOF ` f FRIDLEY CIVIC CENTER • 6431 UNIVWITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450 March 12, 1985 Eugene M. Mathiason 1401 Meadowmoor Drive N.E. Fridley, Mn 55432 ,*Dear Mr. Mathiason: It has come to our attention that fences Which run along your side lot lines encroach on a drainage easement. These fences extend to the ground and prohibit water run-off from flowing as intended. In .past years, the flooding in this area has caused damage to surrounding properties. Plgase help prevent flooding this spring by raising the bottom of the fences in the described easement area to permit proper water flow. Thank your for your prompt attention to this matter. An inspection will be conducted on or about March 26, 1985 to verify that the proper alterations have been made. If you have any, questions regarding this matter, please contact me at the Fridley Civic Center, 571-3450. Sincerely, Philip S. Dommer Planning Assistant PSD/de Coo- 2 3/5/19/5 C-85-31 load plewwiwg sefIf*?/W.*,� f 6575 Highway "a. 65 "A. ut" Surveying Minneapolis, Solis yasti ill e l' �''Vw'.4�Qy •/���a Mina 5513= Civil Itow -ofiwg C/ �J Telephone 754-6066 Municipal fr4obwerimg Engineers & Surveyors Ares C 612 Mortcace Loan Survey for VE Q N CYCAAH ki kT-ALTY, INc. 7S I o K p LOT 18 I 'I p I 32 — onc1E f 1 a Eslock i (MI ^'� 32 ►/ l l 75 -- /yo/ MEADOWMOpR pit n Scale 1►��h= 4c Feet — — — GFr,Ot�cS �, o,ns♦.QC� :STI I�ty �,� LOT 18 GLOCli( MEWOV�Ih TE12'� ACS cOL.n y oc Al,c.l� This is a true and correct represewtatiow of a awrvey of the beuwdaries of the land above described and of she lecatiaw of all buildings, if way, tbereaw, and oil visible awcroaclawewts, if any, from or on said land. This survey is etada o.ly is cowwectiow with a wsortyage loam wow being placed on the property and so IiabiNty is essomed eeceps to the holder of $web wwrtgage or any other interest acquired by the roasow of swch taergago. It is understood ow/ agree✓/�a w,er.w r bare ►e Q. QI�ced {aa the purpose d establishing let Naos r boundary carom noted tbis V ht 0 A.O 1• SUBURBAN ENGINEERING, INC. Engineers tui yer. a Q r W Q sidewalk shelf M11 provide the: owner with an approximate finish grade for a sidewalk. P. Easements for bicycle ways shall be provided on those lots designated along trail corridors as noted in the City's Bicycle WW Plan. The City will designate the required width of __;,sements and elevations for grades at the time a building is bonstructed on the property. The bicycle way shelf will provide the owner with an approximate finish grade for a bicycle way. G. Where the front yard setback of existing buildings is within a distance of 100 feet on both sides of a structure to be erected and is more than the minimum front yard setback required, then the setback for such a building can be six (6) feet more or less of this mean depth but in no case shall it be less than the required front yard setback. H. In oanputing the depth a rear yard for any b ( ding where e the rear line of the lot adjoins an all /o width of the alley may be included as rear yard depth, provided that the actual rear yard depth on the lot shall not be less than twenty (20) feet in any residential district and not less than twenty-five (25) feet in any other district. I. No land shall be altered and no use shall be permitted that results in water run-off causing flooding, erosion_ or deposits of minerals on adjacent properties. -;j Stormwater run-off from a developed site will leave at no greater rate or lesser quality than the stormwater run-off from the site in an undeveloped condition. Stormwater run-off shall not exceed the rate of run-off of the undeveloped land for a 24 hour storm with a 1 year return frequency. Detention facilities shall be designed for a 24 hour storm with a 100 year return frequency. All run-off shall be properly channeled into a storm drain water course, ponding area or other public facility designed for that purpose. Any change in grade affecting water run-off onto an adjacent property must be approved by the City. J. The standards established herein serve, among the other purposes of this Chapter, to provide each structure located on any land, a building site suitable to its particular needs as well as adequate areas of open space between that structure and any adjacent building, and as deemed suitable or appropriate to each building or structure and their respective uses. It is also deemed a purpose herein to provide standards which encourage uses of land and the erection of buildings and structures in areas which are open, unplatted or without any substantial number of buildings located therein, as are of a type, size, style and design as are deemed by the City and its Inhabitants to meet the needs and the purposes of residential inhab purpo , cpm rcial or industrial uses; and, to enable an owner to make a reasonable use of a parcel of land recorded or approved prior to the enactment of this Chapter and is therefore, smaller or different in type, size, style or design from that otherwise required herein. 205.04.4. 205-13 M SUBJECT PERMIT NO. City of Fridley j 22482 AT THE TOP OF THE TWINS BUILDING PERMIT i NO COMMUNITY DEVELOPMENT DIV. L LREEIPT r 1 PROTECTIVE INSPECTION SEC. 1 � 1 I NUMBER REV ATE PAGE OF APPROVED BY = 1 "1 CITY HALL FRIDLEY 55432 612-571-3450 910-F15 5/5/94 r / / JOB ADDRESS 1401 MEADOWMOOR DR NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 18 2 Meadowmoor Terrace Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Leonard Eiler 1401 Meadowmoor Drive NE 784-2598 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 ❑ NEW J3 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 12' x 22' Garage Addition 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. See notations on plan. Provide smoke detectors in dwelling adjacent to all sleeping areas and in basement. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION I STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $4,224 $2.11 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $7200 Fire SC $4.22 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $78.33 VSIGNAT EOFCONTRACTOR RAUTHPRI DAGENT tIDATEI J� 7 W PROPER Y IDATED THIS IS YOUR PERMIT - � �// BLDG INSP DATED URE OF OWNER(IF OWNER B ILDERI IDATEI M NEW ( ( Effective 1/ 1/94 ADDN CITY OF FRIDLEY ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: — 149 / Me �, ��v wr pA---- Legal -- - - _-- --_-- --- _-- Legal Description: _z 0 7� l eu v �. ®a t -e ✓ i-ae dL�C:�tf»"� v 7��/ - 5' cl Owner Name & Address: ec, �, u -e �� !e Tel. # 2 Contractor: Address MN LICENSE #may ©'--'0 e Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Tei. # DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height /0 Sq. Ft. a6 DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Comer Lot [ ] Inside Lot j ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Wood Estimated Cost: $ Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = t x = $ DATE: 61—,26 "`l -f APPLICANT: Tel. # CITY USE ONLY Permit Fee $ 7 a. 0 0 Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ ( $.50/$1,000 Valuation -- SAC Charge $ $800 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) b If 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: P CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 r'AX: (763) 571-12137 ADDRESS : 1401 MEADOWMOOR DR NE PIN : 123024120069 LEGAL DESC : MEADOWMOOR TERRACE : LOT 18 BLOCK 2 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : GARAGE, DETACHED PERMIT .: 2004-01294 DATE ISSUED: 08/10/2004 VALUATION : $ 10,600.00 NOTE: CALL GOPHER STATE ONE AT 651454-0002 FOR UTILITY LOCATIONS. PROVIDE HARD SURFACE DRIVEWAY. SEE NOTATIONS ON PLAN. CONSTRUCT A 24'X 14' DETACHED SECOND GARAGE. APPLICANT EILER LEONARD D 1401 MEADOWMOOR DR NE FRIDLEY, MN 55432 r11i.•NI p) � EILER LEONARD D 1401 MEADOWMOOR DR 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 cancelpe provisions of any other state or local law regu#aconstion or the performance of constructign. Bldg Insp BUILDING PERMIT FEE PLAN CHECK FEE FIRE SURCHARGE STATE SURCHARGE, VALUE TOTAL PAID WITH"—++I+ 61 r dJ SEPARATE PERMITS REQVJIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 195.25 126.90 10.60 5.30 338.05 [) CITY OF FRIDLEY lek4 Effective 4/1/2004 NEW NEW[) 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ADDNALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name & Address: lq ®1 rM e, M Moog' 'DC- (C a - (f.0 V' - Tel.# -76-3— TW`/-; A Contractor. ® w P, e--lk,'- MN LICENSE # Address: Ste- Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVINGAREA: Length Width _ Width Height Sq. Ft. HeigAT 43 1 Sq. Ft 33 6 _ GARAGE AREA: Length _. DECK AREA: Length ------- Width = Hgt/Ground Sq. Ft 9THER: Construction Type: WOO CI C2 k Estimated Cost: $-4p J I Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x z =$ ► J o @ �` �� DATE: PPLICANT: Tel. # Z3 y Z� Call (763) 57J)604 for Permit Fe ' mailing in p . ation. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee $ /� -oZS— Fee Schedule on Reverse Side Plan Review $ /e6 , qb 65% of Permit Fee Fire Surcharge D .001 of Permit Valuation (1/10th%) State Surcharge $ �, �3O $.50/$1,000 Valuation SAC Charge $ — < s $1350 per SAC Unit License Surcharge S $5.00 (State Licensed Residential Contractors) Curb Cut 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 [ J TOTAL $ 3 3�..6%5 STIPULATIONS: Building PLUMBING Permit No,. G� Inspections RESIDENTIAL .APPLICATION Receiv4B 763-572-3604 CITY OF FRIDLEY Dfin ' . t' 20 1 FAX 1763-502-4977 EFFECTIVE 1-1-2010 r2010 LD CN Q7 2ef DATE 4� 1 ��s " YOUR E-MAIL ADDRESS 10".5 9V O, SITE ADDRESS z%D / /' 4 a We , H r c a Y- P r Ao-F' THIS APPLICANT IS: ROWNER ❑CONTRACTOR PROPERTY NAME: r Ong ort ADDRESS: ya QR o". 0 0 v CITY STATE AlAZIP OWNER/ TENANT PHONW'6 f 796 e / 7 6r-5 - 3 -2% -., Z/ S� CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE STATE LICENSE # EXP DATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PERMIT TYPE ,- SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW ❑ REPLACEMENT DETAILED DESCRIPTION OF WORK V je FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $35.50. BATH SINKILAV _FLOOR DRAINS _ SHOWER _ WATER PIPING _ GAS PIPING (NEED CITY LIC) _ SWIMMING POOL _ WATER SOFTNER ($35) —BATHTUB _ CLOTHES WASHER _ KITCHEN SINK _ WATER CLOSET _ BACKFLOW PREV. ($15) _ _ DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION. WATER METER OTHER 'aZa y $ kb� , � & .. .j�3➢ ty " l m �� � I� iC �Y 0. +� d' 2 �1 4M � tai'� � 3uf- . �c�: y� yr 1 r ..^ S• `sv' yW £�' ��¢ u%,�'gr �� iT j' T� ?x �� way"£ '�`�, ��" 'fi`"Y 5.g. Sn ` �"",'� �•3 § F rV �. v' E y" �r k� k'' S RUAd "44 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 case all work w/hic'l rgquires review and approval of plans. �G'!? h ©�f DATE SIGNATURE OF APPLICANT PRINT NAME /` I City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 x