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PRE 2010 DOCSCity of Fridley, Mm. BUILDING PERMIT(:419 7� Date: 0. Builder Address Address No....Street._ Part of Lot Lot Block . ....................... Addition or Sub- on Comer Lot ............ ............. . ........ Inside Lot ...._.....A-___............. Setback .. ............... 11ideyard Sewer Elevation _ ........... __ ........... . ..... - ---------------_--- --- ---- . ............ . ... _ Foundati Elevation _... DESCRIPTION OF BUILDING ;o jased a Depth Hel t Sq. Cu. Ft3 .... . ............... ............. ........ . .............. Front Depth ..... .... .... el . ......... .................... . Cu. Ft. .. . ................. tion_X Est. 6st. Type of Construc .......... Est. st be Completed 4 . ... .... . .... ......... 7r ..--•---•--..._.__....---_- -- u.1 f/��3 �ti In consideration of the issuance G"moo—e—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 all provisions of ordinances of the city of Fridley. ..e —------------ - - In consideration of the payment of a fee of permit is hereby granted to . ....... ... ........ 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 ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. 1,10 NOTICE: This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for $operate -permits for thesis hems. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner Ia Name VBuilder / Address / e/g Address �,OCATION OF BUILDING No. Street Part of Lot Lot Block Addition or Subdivision e' A"� u Corner Lot Inside Lot V Setback 3 �� Side -Yard SEWER. ELEVATION FOMMATION ELWATION Applicant attach to this form Certificate of.Survey of Lot and proposed building location. To be used as: DESCRIPTION OF BUILDING Sq. Ft. Z 7 le Cu. Ft. 4 S 7 of %� Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost �0 To be Completed - 7-a4-. 1-741 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. DATE dq C'f- !�'� % 176.0 SIGNATURE (A Schedule of Fee Costs can be found on the Revdrrse Side.) Approved by Bu` g inspector City of Fridley, Minn. BUILDING PERMIT N° 5175 Date: Owner: r" / • ...��r ,...+ Builder x a a � Address 0 Address - - LOCATI F BUILDING No. Street _ Part f t Lot Block Addition or Sub -Division Corner Lot Inside Lot &.!e Setback S deyard as!`- Sewer Elevation .— Foundation Elevation DESCRIPTION OF BUILDING To be �Y , Front Depth Height Sq. Ft. Cu. Ft. Front Depth Het_ Sq. Ft. Cu. F't. Type of Construction Z- _ Est. Cost A,;;i To be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do lite 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 $ "", permit is hereby granted to_._. to construct the building or addition as described above. This permit is granted upon the express condition that the meson 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 within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. "1 'Building Inspector NOTICE: This permit does ,pot cover the construction, installation for wiring, pfumhing, gas 'heating, sewer or water. Be sure to we the Building Inspector for separate permits for these Itemsi APPLICATION FOR. BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner's Name �d � �/'�- >� �, 13 0 r� S� Builder s= /; t� t� X/!e ,Lis Address �33 J alcc- �2d 0 Address LOCATION OF BUILDING No. -a,,Q Street R,14 / A) Part of Lot Lot °/5 Block Addition or Subdivision Corner Lot Inside Lot Setback Side -Yard b � "'- SEWER ELEVATION FOUNDATION ELEVATION, Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: FrontDepth r� Heigh Sq. Ft.V Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction„ . Estimated Cos 6e.ems', z) To be Completed / 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. DATE�SIGNATURE &-,- to Schedule of Fee Costs can be found on the Reverse Side.) • :1' {� : ��� : S,".. dot !� :,� �� � 1 s 9 „� ", .d � , i� `. Application for Power Plants and Heating. Cooling. Ventilation, ,Rehicjma on and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: p RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ........ 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ....................... .................. 2.00 $ Replacement of Furnace .............................. §.00 $ Repairs & Alterations—up to $500.00 ..... ............ 5.00 $ Repairs & Alterations each add. $500.00 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam, ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ................... c/L... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... 'fix $1.50 $ Additional Fixtures ................. x .50 $� Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM ALTERATIONS & REPAIRS TOTAL FRE ROUGH F VAL r Dept. of Bldgs. Phone SU. 4-747T —.69— me�1.11 ,&- /-�7 City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict act ante with the City Ordinances and ruling of the Department of Buildings, an h reby declares that all the facts and representations stated in this application a and corrept. ^ Fridley, Minn 4� 19 Owner Kind of Building—' l Used as To be completed about Estimated Cost, $ Old ew. uilding Permit No. Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS -Steam, Hot Water, Warm Air—No Trade Name Size No Capacity&6 &WV Sq. Ft. EM -R BTU H.P. Total Connected Load //(/�' _ ��e -d r BURNER — Trade Name �>,�./YV Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) Signe �- By 42 2M 7.59 Business Phone No- lit/ S—� City of Fridley Application for Plumbing and Gays Rthing Permit Dept. of Bldgs. Phone SII 4-7 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location /`'01 ' q �i 3 i RN 3 o °`z �Z oo UN' z O • .oe • N WATER HTR. GAS ELEc Base 1st 2nd 3rd 4th • Future Connection Openings New .Fixture, Old Openings Connected with Sewer ro Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE T �AL Number Fixtures ......................17. x $1.50 $ ^® Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................:•..�� x $1.50 '$�i 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 Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this applic on are tr and correct. 10-111% Fridley®•lUfinn e- 1 1 A e Owner Kind of Building Used as e -Z IF - To be completed about Estimated Cost, $ Old—New. Building Permit No �� Permit No. ROUGH FINAL 42 2M sifiess Phone NoALA 0 s 5 t F r & Application for Power Plants and: Heating. Cooling. Ventilation, .Rehiciffiaand Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, 4 Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duch Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ........................ 2.00 $ Replacement of Furnace ............................. #.00 $ Repairs & Alterations—up to $500.00 .... ............ 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam_ ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $� Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ C%A S • FITTING FEES: NO RATE TOTAL ~; 1st 3 Fixtures ...................... x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS &REPAIRS TOTAL FEE $ ROUGH FINAL Tian•_ t%s n:ann- Phnna sa A.TAWI 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 are true and correct. Fridley Owner Kind of Used as To be completed about Estimated Cost, $ = Q Q �� Old—(j�uilding Permit No. Permit No. 19,92 DESCRIPTION OF WORK HEATING or PO PLANTS—Ste %of Wat Warm Air—No . Trade Nam Size No —-92 Capacity i�5i / -f (,-3o A�aE > 630 �Eit S� Total Connect�d Loa Sind of Fuel BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) az ZM 7-59 Business PKone N 7-� NAM H T G. -C O N 1 t4 ADDRESS L. ROOM LENGTH WIDTH HEIGHT K66OWS AND D .CRACKAGE AND AREA N0. WIDTH HEIGHT No OF LINEAL FT AREA LIGHTS OF CRACK SQ. FT DATE [ADDRccc NAMEJOB - /- / FL. ROOM LENGTH // WIDTH HEIGHT WINDOWS AND DOORS-CRACKAGE AND AREA N0. WIDTH HEIGHT NO. OF LINEAL FT. AREA LIGHTS OF CRACK SQ. FT ga FL. ROOM I LENGTH WIDTH HEIGHT WINDOWS AN OORS•CRACKAGE AND AREA NO. WIDTH I HEIGHT NO. OF LINEAL FT.1 AREA LIGHTS OF CRACK I SQ. FT. COEF. BTU BTU. COEF. BTU INFILTRATION 45 INFILTRATION Q GLASS EXP. WALL NET EXP. WALL GLASS EXP. WALL GLASS eAq EXP. WALL FLOOR NET EXP. WALL CEILING L NET EXP. e/ LL -� CEILING FLOOR 3 FLOOR CEILING FLOOR T22!L BTU. TOT L BTU �� Q TOTAL BTU. ga FL. ROOM I LENGTH WIDTH HEIGHT WINDOWS AN OORS•CRACKAGE AND AREA NO. WIDTH I HEIGHT NO. OF LINEAL FT.1 AREA LIGHTS OF CRACK I SQ. FT. TO L BT!L F - _ ROOM LENGTH WIDTH HEIGHT WI DOWS AND DOORS.CRACKAGE AND AREA NO. WIDTH HEIGHT N0. OF LINEAL FT. AREA LIGHTS OF CRACK SO. FT. FL. ROOM LENGTH WIDTH - HEIGHT2 WINDOWS AND DOORS•CRACKAGE AND AREA N0. I WIDTH I HEIGHT I N0. OF LINEAL FT. AREA t t/�YTC AC /.0 ♦I.M CA CT COEF. BTU. INFILTRATION BTU. 45 GLASS b C EXP. WALL NET EXP. WALL GLASS CEILING GLASS eAq FLOOR O NET EXP. WALL CEILING TO L BT!L F - _ ROOM LENGTH WIDTH HEIGHT WI DOWS AND DOORS.CRACKAGE AND AREA NO. WIDTH HEIGHT N0. OF LINEAL FT. AREA LIGHTS OF CRACK SO. FT. FL. ROOM LENGTH WIDTH - HEIGHT2 WINDOWS AND DOORS•CRACKAGE AND AREA N0. I WIDTH I HEIGHT I N0. OF LINEAL FT. AREA t t/�YTC AC /.0 ♦I.M CA CT COEF.1 BTU. COEF. BTU. INFILTRATION 1001-0 G b INFILTRATION GLASS D GLASS eAq EXP. WALL O NET EXP. WALL CEILING /o NET EXP. WALL CEILING FLOOR CEILING FLOOR FLOOR �� Q TOTAL BTU. Q. TOTAL BTU. HEAT LOSS TOT L BTU. FL. ROOM LENGTH WIDTH HEIGHT WINDO S AND DOORS•CRACKAGE AND AREA N0. I WIDTH I HEIGHT N0. OF LINEAL FT. AREA LIGHTS OF CRACK SQ.FT. COEF.1 BTU. I COEF.1 BTU. INFILTRATION 1001-0 G b INFILTRATION GLASS EXP. WALL D GLASS eAq EXP. LL O NET EXP. WALL CEILING /o NET EXP. WALL CEILING FLOOR D 3 FLOOR TOTAL BTU. TOTAL BTU. Q. TOTAL BTU. HEAT LOSS TOTAL E.D.R. STEAM TOTAL SQ. FT. H.W. HEATING UNIT COEF.I BTU INFILTRATION GLASS EXP. WALL NET EXP. WALL CEILING FLOOR FL. I ROOM I LENGTH WIDTH HEIGHT WINDOWS AND DOORS-CRACKAGE AND AREA NAME DATE NAM4294TG NET EXP. WALL EONTR. CEILING JOBADDRESS [ADDRESS i L J /_ FL. ROOM LENGTH WIDTH HEIGHT FL. ROOM LENGTH WIDTH HEIGHT 777�ww,OWS A DOORS-CRACKAGE AND AREA WINDOWS AND DOORS-CRACKAGE AND AREA N0. WIDTH I HEIGHT No. OF LINEALFT AREA NO. WIDTH HEIGHT NO. OF LINEAL FT. AREA D LIGHTS OF CRACK S0. FT FL. LIGHTS OF CRACK SO. FT COEF.I BTU INFILTRATION GLASS EXP. WALL NET EXP. WALL CEILING FLOOR FL. I ROOM I LENGTH WIDTH HEIGHT WINDOWS AND DOORS-CRACKAGE AND AREA NO. WIDTH HEIGHT NO. OF, LINEAL FT. LIGHTS OF CRACK AREA SQ. FT. NET EXP. WALL �0 CEILING O O FLOOR .(�® I I I I I I COEF.I BTU INFILTRATION I INFILTRATION Oc O �� GLASS I COEF.1 EXP. WALL d� NET EXP. WALL �0 CEILING O O FLOOR .(�® p 5r�� I I I I I I COEF.I BTU INFILTRATION I _V Oc O �� GLASS EXP. WALL I COEF.1 BTU. OOV NET EXP. WALL �0 INFILTRATION O O CEILING .(�® p 5r�� FLOOR EXP. WALL EXP. WALL NET EXP. WALL L/70 16 TOTAL BTU /j0 D CEILING FL. ! 30 ROOM LENGTH WIDTH NET EXP. WALL HEIGHT WINDOWS AND DOORS-CRACKAGE AND AREA ' N0. I WIDTH I HEIGHT NO.�OF LINEAL FT. cAREA CEILING COEF. BTU. I I I I I COEF,.l BTU. I COEF.1 BTU. INFILTRATION �' �0 INFILTRATION O O GLASS .(�® p 5r�� p EXP. WALL EXP. WALL NET EXP. WALL L/70 16 ` ®o /j0 D CEILING A57 ! 30 O NET EXP. WALL FLOOR CEILING O CEILING 7 /O Q TOTAL BT J FLOOR FL.I ROOMI LENGTH X WIDTH HEIGHTp FL. ROOM LENGTH WIDTH HEIGHTLT WINDOWS AND DOORS-CRACKAGE AND AREA WINDOWS AND DOORS-CRACKAGE AND AREA N0. I WIDTH I HEIGHT LIHTSOF CRACK FT-Is0. FT. AREA I N0. WIDTH HEIGHT LIGHTS OF CRACKOF ILINEAL SQ O. COEFij BTU. I I I I I COEF.1 BTU. INFILTRATION �' / d INFILTRATION .(�® GLASS 5r�� p GLASS EXP. WALL 1.41 EXP. WALL NET EXP. WALL `Q O NET EXP. WALL CEILING O CEILING 7 /O Q FLOOR FLOOR TOTAL BTU. TOTAL BTU. TOTAL BTU. HEAT LOSS TOTAL HEATING UNIT E.D.R. STEAM TOTAL SQ. FT. H.W. I TOTAL BTU. HEAT LOSS TOTAL E.D.R. STEAM TOTAL SO. FT. H.W, HEATING UNIT COE.F.1 BTU NAME DATE NAME( BTU H T G iEE Ole! T [ADDRESS J O B [ADDRESS D INFILTRATION gg� a CJ GLASS FL. ROOM LENGTH WIDTH HEIGHT FL. ROOM LENGTH WIDTH �� HEIGHT WINDOWS AN DOORS-CRACKAGE AND AREA WINDOWS AND DOORS-CRACKAGE AND AREA N0. WIDTH HEIGHT NO. OF LINEAL FT. AREA NO. WIDTH I HEIGHT No. OF LINEAL FT AREA LIGHTS OF CRACK SQ. FT LIGHTS OF CRACK SQ. FT TOTAL BTU. HEAT LOSS TOTAL E.D.R. STEAM TOTAL SO. FT. H.W, HEATING UNIT COE.F.1 BTU I COEF.1 BTU INFILTRATION D INFILTRATION gg� a CJ GLASS GLASS-1-16Do EXP. WALL EXP. WALL NET EXP. WALL / AQ NET EXP. WALL 109- /D CEILING /� D CEILING o G FLOOR FLOOR TOTAL BTU %,3 TOTAL BTU. FL ROOM LENGTH WIDTH HEIGHT FL. ROOM LENGTH WIDTH :5— HEIGHT WINDOWS AND DOORS-CRACKAGE AND AREA NO. WIDTH HEIGHT NO. OF. LINEAL FT. AREA LIGHTS OF CRACK SQ. FT. v // p . V WINDOWS AND DOORS-CRACKAGE AND AREA N0WIDTH HE NO. OF LINEAL FT. AREA . LIGHTS OF CRACK SQ. FT. /40 COEF. BTU. COEF. BTU. INFILTRATION Q o INFILTRATION o �} GLASS o 'o GLASS 'QO EXP. WALL r I EXP. WALL NET EXP. WALL o D NET EXP. WALL ® t CEILING/ O CEILING ® o 6400 FLOOR FLOOR TOTAL BT TOTAL BTU FL. ROOM LENGTH WIDTH %3 HEIGHT FL. ROOM LENGTH ® WIDTH S HEIGHT% WINDOWS AND DOORS-CRACKAGE AND AREA NO. WIDTH HEIGHT N0. OF LINEAL FT. AREA LIGHTS OF CRACK SQ. FT. .2, WINDOWS AND NO. WIDTH ORS-CRACKAGE AND AREA HEIGHT NO. OF LINEAL FT. AREA LIGHTS OF CRACK SQ.FT. D COEF BTU. COEF. BTU. INFILTRATION O INFILTRATION O oln GLASS EXP. WALL 04 ® GLASS f EXP. WALL NET EXP. WALL 4, NET EXP. WALL a 1,90 CEILING FLOOR CEILING _o FLOOR TOTAL BTU. �b e) TOTAL BTU. TOTAL BTU. HEAT LOSS TOTAL E.D.R. STEAM TOTAL SO. FT. H.W, HEATING UNIT _ � r $opt_ rr i Cyt* _ ipLii� - to*t , t MA so NA APPLICATION FOR PLUMBING AND UA9 r•ITTING ''EFQ^IT 97 8h-41605 , PARTIAL RATE SCHEDULE ' PLUMBING FIXTURE RATES: NO. RATE TOTAL Ager Flxtuses x $3.00 U Future Fixture Opening • 41 $2.00 $ Wator x $2.00 S A x $5.00 S c Water Heater - to 99,000 BTU, x $5..00 $ 4J x �., $ Water Softener heater w J .t Nev Ground -Fun Old Building x •.�/ M Electric Water Heater - r d N -GAS FITTING FEES; , 1st 3 fixtures x $3,00 $ Additional Fixturas x $1.00 a .Gas Range to 199,000 BTU Ln $10.00 1A A ' w Ul 1A K x $5.00 ug o as lec 0u' r cAi TOTAL FEE 'Ax 15.50 jlsc elders a �• 2nd 3rd 4 th v -- I.. (R) - Future Connection Opening Connected with Sawer (•) - New Fixcure, Old Opening Water PARTIAL RATE SCHEDULE ' PLUMBING FIXTURE RATES: NO. RATE TOTAL Ager Flxtuses x $3.00 S Future Fixture Opening • X $2.00 $ New Fixture, Old Opening , x $2.00 S Catch Basin x $5.00 S c Water Heater - to 99,000 BTU, x $5..00 $ 100;000 $T11 to 199,000 BTU x $10.00 $ Water Softener x $7.90 $ Nev Ground -Fun Old Building x 45.00 $ Electric Water Heater - x $5,00 S -GAS FITTING FEES; , 1st 3 fixtures x $3,00 $ Additional Fixturas x $1.00 $ .Gas Range to 199,000 BTU x $10.00 $ �_• REPAIRS d ALTERATIONS ' first $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE 15.50 Job Address 6021 NE Main Street Department of Buildings City of Fridley 1 Tal, 9571-3450 The undersigned hereby makes application for .a permit for the work specified agreoing•to do all work in strict accordance with the City and rulings of the Departmont of Buildings, and hereby declares that the facts and rapraeantations stated in this application are true Ar. Fridley, Ki,9-9-77 19 OWNER RM Waara KIND OF BUILDING frame USED AS res. TO BE COMPLETED ABOUT 9-16=77 ESTIMATED COST OLD - NEW BUILDING PERMIT N0, PE(jf4IT N0. Come MINNEGASM Signed By' Tel. No. ROUGH INSP. Data ' FINAL, INSP. ` Dato APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT 19 37.50 SUrcharRe .ro( • 53-94-9915051 cai-i Ai`►plic "tfan for Plumbs ,z: .,� 'as u I'l* , a CTe :is , .....m..•....-..... «- w. ---- Dopt. of Bldgs. Phono ".x-'•3550 . •• DESCRIPTION OF Vf01`.e, • Y.ocai.'a•+ 6021 main Street NE -_-- Xurnb,*% Y.i: d hnd Lecr`Irn of 1 S etures. . • Fu :::o Cc�aa.:.a Gj:.a:r.:. ••,. ---- ...� uc•war � t }{av Tmaura. Old 0'e-smins Ccc, pool [j PARTIAL RATE SvHEQULE LUMSITIG FIXT-WnE RATES: 1i0. RATE TOTAL Number F1XiUrtS .... • • • • • . • .. • .. X v2•a�• v4 — Future Fixture Opening ....... • • • • -- x $1.50 S , -• 1L. Fixture Old Oyelling.. • . +- +• • • • • X p$1.50 C21ch Basin . • ........... • a • .. a • x $3.25 City of Fridley... The undersigned hereby crakes appllcation for a permit for t1he' work herei specified, agreeing to do all Mork in strict accordance Wlih tre Citi O:••diran:e and ruling of the Department of Buily.'ngr, and hereby declares that 211 the fad and representations stated in this app'tcaion are true and correct' Fridley, 2111rn. h-23-76 19� Owner Lynn Waara ' Kind of Building frame -- -- Used as res. To be completed about 4-30-76 - Estirn*at.ed Cost. $ 0 - ' Old --2I Building Permit No.— Sin. 'o. - - Water Ifeater 'Up to 59.000 BTU) • • . • x $3.00 $ ROUGH few Ground Run Old Bldg....:..:. x ;1.25 S -- Elactrlc Mtar Hastot.....:.. < ..... �_ _ $? W - FINAL Lo -g& sJS FITTIXG FEES: No. RhTE TOTAL Ist3Fixtures •••••••••••••••••• — x$2.00 # . Additicnal Fixtures .......... • r too ---- x w 75 $ Gas R.^: ae to 299.000 BTU .,;.,....... x $5.00 d . 5.00 ALTIERATIONSofor to Codd .50 State Surch re —P. .rkzcri7,Uoz1..........•.r.•i•...r.•.r.....••.......�5� A' TOTAL FEES � By Businvu Thune 1` v= Q J • p N W XYta MY1l. ILIC • Fu :::o Cc�aa.:.a Gj:.a:r.:. ••,. ---- ...� uc•war � t }{av Tmaura. Old 0'e-smins Ccc, pool [j PARTIAL RATE SvHEQULE LUMSITIG FIXT-WnE RATES: 1i0. RATE TOTAL Number F1XiUrtS .... • • • • • . • .. • .. X v2•a�• v4 — Future Fixture Opening ....... • • • • -- x $1.50 S , -• 1L. Fixture Old Oyelling.. • . +- +• • • • • X p$1.50 C21ch Basin . • ........... • a • .. a • x $3.25 City of Fridley... The undersigned hereby crakes appllcation for a permit for t1he' work herei specified, agreeing to do all Mork in strict accordance Wlih tre Citi O:••diran:e and ruling of the Department of Buily.'ngr, and hereby declares that 211 the fad and representations stated in this app'tcaion are true and correct' Fridley, 2111rn. h-23-76 19� Owner Lynn Waara ' Kind of Building frame -- -- Used as res. To be completed about 4-30-76 - Estirn*at.ed Cost. $ 0 - ' Old --2I Building Permit No.— Sin. 'o. - - Water Ifeater 'Up to 59.000 BTU) • • . • x $3.00 $ ROUGH few Ground Run Old Bldg....:..:. x ;1.25 S -- Elactrlc Mtar Hastot.....:.. < ..... �_ _ $? W - FINAL Lo -g& sJS FITTIXG FEES: No. RhTE TOTAL Ist3Fixtures •••••••••••••••••• — x$2.00 # . Additicnal Fixtures .......... • r too ---- x w 75 $ Gas R.^: ae to 299.000 BTU .,;.,....... x $5.00 d . 5.00 ALTIERATIONSofor to Codd .50 State Surch re —P. .rkzcri7,Uoz1..........•.r.•i•...r.•.r.....••.......�5� A' TOTAL FEES � By Businvu Thune 1` City of Fridley SUBJECT P ERM lT-, ® 14'786\ AT THE TRP OF THE TWINS BUILDING PERMIT r • COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 812-580-3450 RECEIPT N NUMBER 910-F15 REV. DATE 6/28/78 PAGE OF APPROVED BY JOB ADDRESS 6021 Main Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 24� 25 8 Hyde Park SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Rod Waara 6021 Main Street N.E. 571-8733 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. 8 USE OF BUILDING Apartment 7 CLASS OF WORK ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Reroof apartment 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be 2nd but not 3rd roof. Install ridged galvanized valleys. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Asphalt THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION ZONING SQ. FT. CU. FT. 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 1 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 $800 $.50 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 PER ORMANCE OF CONSTRUCTION. $7.50 PLAN CHECK FEE TOTALFEE d $8.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (D) WHEN PR PERLY VALID TED THIS IS YOUR PERMIT BLDG )NSP r GATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: "t�—V77 BUILDER: ✓ �`� Address: �� / `.1 ���Y JT 4%' Address: No. LOT: CORNER LOT: Tel. No.: Street: O ' '���t� ✓ 5-�,% BLOCK: ADDITION: INSIDE LOT: SETBACK: SIDEYARDS: 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: Front: Depth: Height: Square Feet: Front: Cubic Feet: Depth: Height: Square Feet: Cubic Feet: Type of Construction: Estimated Cost: $ ®t To Be Completed:t.Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict 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. See reverse side for additional information. DATE: SIGNATURE: Stipulations: p „ u� /Pd ,'`� "6 ale-& 7a`b'�� Y R f June 26, 1979 8431 UNIVERSITY AVENUE N.E.. FRIDLEY, MINNESOTA 66432 Mr. Lowell L. Hancuh 2093 Fairways Lane Roseville, 144 55112 TELEPHONE ( 812)671-3460 Re: Repair & Maintenance of the Rental Property Located at 6021 Main Street N.E., Fridley, Minnesota (SECOND NOTICE) Dear Mr. Hancuh: Enclosed please find this department's letter dated May 24, 1979 that brought to your attention various housing maintenance violations in the apartment building located at 6021 Main Street N.E. A subsequent reinspection on June 26, 1979 has determined that although some items of the original letter have been. abated, the following items continue to be in violation of the City Residential Maintenance Code: EXTERIOR 1. Provide and maintain stripping for the parking lot to designate individual parking stalls (10' x 20'). 7_71 ;�__ 2. Repair and maintain the loose handrail for the west steps. 3. Repair or replace any broke windows: North wall, 1st floor, 2nd from west. '7_W -?'1 d 4. In addition, it was noted that the grass was in need of cutting and routine maintenance. 7 _te-7q G K - COMMON AREAS In addition, the inspection on June 26, 1979 detemined .that the fire extinguisher was missing and must be replaced. Questions should be directed to the Fridley Fire Department as to type and proper location. --7_ /�,-lel v APARTMENT #1 1. Replace the flexible connector for the gas range with approved piping. 7-1e`,?,9 O /v_- 2. Provide and maintain an anti -siphon ball cock for the toilet.] Therefore, the City must require you to correct the above listed items on jF or before July 16, 1979. A reinspection will again be conducted on the above date to detemnine compliance. We are confident in your cooperation and desire to correct these violations and if any questions or problems arise, please contact me at 571-3450. Mr. Lowell L. Hancuh June 26, 1979 Re: 6021 Main Street N.E. Page 2 Failure to abate these violations may result in this matter being turned over to the City Prosecutor for his legal consideration. i Sincerely, , /Y STEVEN . OLSON Environmental Officer SJO/mh ENC: 1 CC: Mr. Richard Anderson AAA Properties 140 Charles Street N.E. r FH May 24, 1979 � t1, T- S 1,111114 8431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 85432 Mr. Lowell L. Hancuh 2093 Fairways Lane Roseville, MN 55112 TELEPHONE ( 812)571.3450 Re: Repair & maintenance of the Rental Property Located at 6021 Main Street N.E., Fridley, Minnesota Dear Mr. Hancuh: It was confirmed by a routine on-site inspection on May 21, 1979 that the above listed rental property.was being maintained in violation of Chapter 220, Residential Maintenance Code, of the Fridley City Code. The inspection on the above date found the following list of deficiencies which must be corrected. Any repairs or improvements must be completed in a workmanship like manner. It is the City's hope that similar or other deficiencies in apartments that were not inspected will be corrected as needed. EXTERIOR 1. Provide and maintain a screened enclosure to conceal the refuse container.from view by August 1, 1979. In addition, a hard surface base should be provided for easier handling by the hauler. 2. Provide and maintain stripping for the parking lot to designate individual parking stalls (10' x 201). e -Z t-7 a 44, ® 3. . Repair and maintain the loose handrail for the west steps,2% ?G% 1W ® 4. Repair or replace any broken windows: North wall, lst floor, 2nd from west. C -Z e-74 A 5. Remove and dispose of at an approved location the old couch,( and the 55 gallon barrel found in the rear yard. .6-T-6-7'? c 6x4dj. COMMON AREAS ® No orders this date LAUNDRY/FURNACE ROOM 1. Repair and maintain the broken window casing above the dryer so that it works in the proper manner. 9 Z t�-7-7 bra-,,., JV) -l1011/1 2. Provide and maintain a closer for the fire door, so that when the door is released, it will self -close completely and latch. 6_Zg,jr?a�L APARTMENT #1 1. Replace the flexible connector for the gas range with approved piping. 6-Z4-717` iota 2. Repair and maintain the leaking cold water faucet for the kitchen sink. 6 • Z $` 7l m �. Provide and maintain an anti -siphon ball cock for the toilet.6'_Z,�''-74t Av�- Mr. Lowell L. iiancuh May 24, 1979 Re: 6021 Main Street N.E. Page 2 A reinspection will be conducted on or about June 18, 1979 to determine compliance. We are confident in your cooperation on these matters and if any questions or problems arise, please feel free to call on us at 571-3450, extension 164. Failure to abate these violations may result in this matter being turned over to the City Prosecutor for his legal consideration. Sincerely, STEVEN J. OLSON Environmental Officer SJO/mh CC: Mr. Richard Anderson AAA Properties 140 Charles Street N:E: -14 Z/" w 8431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 TELEPHONE ( 812)571-3450 November 20, 1980 Mr. Richard Feist 5117 - 6th Street N.E. Columbia Heights, MN 55421 Re: Repair & Maintenance of the Rental Property Located at 6021 Main Street N.E., Fridley, MN (SECOND NOTICE) Dear Mr. Feist: Enclosed please find this department's letter dated October 15, 1980 that brought to your attention various housing maintenance violations in the apartment building located at 6021 Main Street N.E. A subsequent reinspection on November 20, 1980 has determined that the following item continues to be in violation of the City Rgsidential Maintenance Code: APARTMENT #4 �' J Repair and maintain,the damaged wall and ceiling in the bathroom./`/9-�/ Therefore, the City must require you to correct the above listed item on or before December 22, 1980 when a reinspection will again be conducted to determine compliance. We are confident in your cooperation and desire to correct this violation and if any questions or problems arise, please contact me at 571-3450. Failure to abate this. violation may result in this matter being turned over to the City Prosecutor for his legal consideration. Sincerely, STEVEN J. OLSON, R.S. Environmental Officer SJO/mh ENC: 1 r CI'T'Y OF FRIDLEY 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 TELEPHONE ( 612)571.3450 October 15, 1980 Mr. Richard Feist ' 5117 - 6th Street N.E. Columbia Heights,* MN 55421 , Re: Repair & Maintenance of the Rental Property Located at 6021 Main Street N.E., Fridley, MN Dear Mr. Feist: M It was confirmed by a routine on-site inspection on October 14, 1980 that the above listed rental property was being maintained in violation of Chapter 220, Residential Maintenance Code, of the Fridley City Code. The inspection on the above date found the following list of deficiencies which must be corrected. Any repairs or improvements must be completed in a workmanship like manner. It is the City's hope that similar or other deficiencies in apartments that were not inspected will be cc: meted as needed. EXTERIOR Repair and maintain any brokep windows: North wall, 2nd floor, second from east. COMMON AREAS No orders this date. LAUNDRY/FURNACE ROOM No orders this date. APARTMENT #4 Repair and maintain the damaged wall and ceiling in the bathroom./1-P C, l A reinspection will be conducted on or about November 17, 1980 to determine compliance. We are confident in your cooperation on these matters and if any questions or problems arise, please feel free to contact me at 571-3450. Failure to abate these violations may result in this matter being turned over to the City Prosecutor for his legal consideration. Sincerely L STJ. OLSON, R.S. Environmental Officer SJO/mh ENC: _1_ /Z —Z2- c910 City of Fridley0, SUBJECT AT THE TOP OF THE TWINS BUILDING PERMIT f 1 7 RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. L r ;PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 7/20/95 JOB ADDRESS 6019-21 MAIN STREET NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 20-23 8 Hyde Park I SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard/Sue Feist 6021 Main Street NE 572-9435 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. L J Roofing 10151 Foley Blvd, Coon Rapids MN 55448 767-1587 9036 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING 4-Plex 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Building (29 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 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 4 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 $2,175 $1.09 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- Fire SC $2.18 STRUCTION O HE PERFORMANCE OF CONSTRUCTION. $54.00 PLAN CHECK FEE TOTALFEE ��RACTOR SC 5.00 $62.27 rLicense SIGNATURE OF OR AUTHORIZED AGE NT (DATE) WHEN PROPS Y VALIDATED THIS IS YOUR PERMIT /' `V A� 3W SIGNATURE OF OWNERI)F OWNER BUILDER) (DATE) BytG INSP DATE 11 NEW [ ] Effective 1/ 1/95 ADDN [ ] CITY OF FRIDLEY ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: 1�7 0 2/ /27 A, 0', S Legal Description: Owner Name & Address: f /cl�teid e e l 5-�- Tel. # S' 72- Z?j Contractor: LT ��© F� �C, MN LICENSE Address: /D/j-/ J-V1-G� '9/ull Tel. # '76 7-1,rf 7 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length —Width H�gtt//Ground Sq. Ft. OTHER: - -� I G Comer Lot [ ] Inside Lot [ J Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ /'%�L��� Approx. Completion Date: q�- (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: ' _ Zb APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY _ Tel. # $ Fee Schedule on Reverse Side $. / .001 of Permit Valuation (1 / 10th %) $ $.50/$1,000 Valuation $ $850 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 [ J Not Necessary [ ) a CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On August 1, 19% APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTel_t Fri nN FAn.w F'1 nnR a PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS as $ 7.00 Floor + �t Auto, N. !,. Water Heater Stories %,: Urinal f„ Shower 2 Tra and rulings of the Building Division, and hereby declares that all the facts Drain Y ; Washer` ��t�: Ran w� fi ;Gas Elec Basement �zM.n,' r - t! 4 P i:.P . , Rain Water Leader $ 7.00 ^' 5 Sump/Receiving lank 1 .P; ell Floor 1 _'1995 Treating Treating Appliance $10.00 Owner Water Heater —Electric $ 7,00 Floor 2 $10:00 Building Used As - Gas Range** $10.00 Gas Dryer** $10.00 Floor 3 Estimated Cost � PERMIT NO. Back Flow Preventer Required ( )Yes () No j Type w- `I 0 $15.00 fQ0' PLUMBING COMPANY_ Reinspection Fee $42.00/Hr SIGNED BY TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS Flow 43 1.5% of Value of Fixture or Appliance Approved By Rough—In Date Final Date , a PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fbcturs $ 4,00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 ^' 5 Sump/Receiving lank $ 7.00Water _'1995 Treating Treating Appliance $10.00 Owner Water Heater —Electric $ 7,00 ii Water Heater —Gas** $10:00 Building Used As - Gas Range** $10.00 Gas Dryer** $10.00 Estimated Cost � PERMIT NO. Back Flow Preventer Required ( )Yes () No j Type w- `I 0 $15.00 fQ0' PLUMBING COMPANY_ Reinspection Fee $42.00/Hr SIGNED BY TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved By Rough—In Date Final Date State Surcharge 50 TOTAL FEE $ /Eo, .� PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES. Building PLUMBING Permit No.: � Inspections RESIDENTIAL APPLICATION jivedBy:ffll� 763-572-3604 CITY OF FREDLE+ Y D d - ., 763-502-4977 FAX EFFECTIVE2-19.0 DATE UR ADD SITE ADDRESS THIS APPLICANT is., O OWNER ONTRACTOR PROPERTY N: ' OWNERI ADDRESS ll CITY STA ZIP TENANT PHONE: CONTRACTOR NAME SUMMA COPY OF STATE LIW�q E3 P DA YOUR STATE Win EXP DATECERTIFICATEOF LICE ISE, BOND AND STATE BU2 ADDRESSl CirY STATE z PiNSURAidCEPRONE FAX P$ . TYM 0 SINGLE FAMILY El TWO FAMILY TOWNHOUSE TYPE OF WORRc © NEW REPLACEMENT DETAR ED DESCRiP'T ON OF WORK- ~Y7 c i FEES An BASED ON $10 oo PER FormRE, EXCEPT WHERE NOTED. FUMIRES: (INDICATETOTAL NUMBER OF EACH BELOW) FEE $35.30. BATH SRRUI AV FLOORDRAtidS SHOWER .r.t. WATER PIPING —13ATHIIPB GAS PIP1NCi {NEED CITY LIC) _ SWIM TG POOL WATER SOF IN Rt ($35) +� CLOTHES WASHER _ YTTCHE N SINK ____. WATIRi CLOSET g BACK LOW PREV. ($15) _LAUNDRY _ —DISHWASHER TRAY WATER HEATER (S35) FOR IRRIGATION s MATER. METER _071M a. .:.r �.,� i .r § Ja � ps :'�-�''S s.�T�`�✓�i`� � :v�.a�� �a's�:`' �u �"Ps� �'"`z`-��� ` �� �„�"-�'r-' :. fir`- �'• 'Y d�'e ire � L3R'v� 5't `'?fl aj'F ��� N` t� A'�tT � S�3' �S � 2+�[ :�� , i3' � Yxrf � +�,�'i��i5�. .� �3'�jk1M ��'s�5i}�,�'L. ���� .�33%�" +Yf �^�•� f i� "�4�`,i �x,�(u��A y��N`�£ �#fR,-w�1F"�'H �'.r�t i%�`�,.�'.a�3.. x ;�y?% �¢�4TSY S' ���� 9 �} 3i� h. � %U. SF �}9��i�"v�'��`f'.� Y3��" �� k��•'la 5 6 1� °,� ' . � ��+` � ''Jk� � ''- �5 t , ,,,,� Y �:, �.�.�rt->' ' ���Y� S "'� 'r LZ`3.��`�'� Y �i 4`�"' s S't ,.�,F�._, ,� Y• �3'� 3 �T THIS IS AN APPLICATION FORAPERMIT-NOi VALID PRISED I hereby apply for a plumbing permit mil I acknowledge ibex the infonnafloan eve is complete and agate; that the work will be in conformance with the ordinances aqui conies of the City of Fridley and with the h4ftmesote Construction Codes; that I understand this is. not a permit but only an application for a permit and work is not to stout without a permit on site; that the work will be in accordance with the approved pian in the case of all work which requires review and approval ofpllarrm SIGNATURE OF APPLIC PRii�T IdA�e DATE�� � City of Fridley Bow Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-5024977