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PRE 2010 DOCSCity of Fridley, Minn. 6431 University Ave. N.E., Minneapolis, Minn. 55432 BUILDING PERMIT nate: - .T,,,, . g, 11490 Owner: David Listoner Builder Shamrock Construction .Address Address 3913 Shamrock Drive LOCATION OF BUILDING No. __ .7301 Street - Melody Drive part of Lot Lot 12 Bloch 3 Addition or Sub -Division Melody Manor 2nd Corner Lot Y Inside Lot Setback Sideyard Sewer Elevation 5R' N_ of M Nol a Foundation Elevation Wye Elevation 864.17 Top of footing 867.14 Approx. Water Location 10 N. of Sewer Service DESCRIPTION OF BUILDING To be Used as: House Front 52'6" Depth 30'6"-25'Height 1��Storigq, Ft, _ 1365 Ct, Ft, 24,104 Gar p_._ Front � `._ Depth 23' Height 10 Sq, Ft, 506 Cu, Ft, 5060 7hx of Construction Frames brick veriStrCost 22,706 To be Completed 9-15-72 1. Provide Hard Surfa a Drive determined 2. Water table to be I my Engineering Department to establish footing elevation. 3. Provide verification survey. 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 all provisions of Ordinances of the city of Fridley. 1.1.-36 Stars Suvchaxsa .. In consideration of the payment of a fee of $ 45.00 , permit is hereby granted to Shamrock Construction 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 anthee. city limits and this permit may be revoked at any time upon violation of any of the provisions ofordinsaid CLAMCE BELL 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 separate permits for these Items. D� APPLICATION FOR RESIDENTIAL, ALTERATION, .1 OR AllDITION BUILDING PERMIT pq CITY OF FRIDLEY, MINNESOTA OWNER'S NAME ; zDq&'V BUILDER: Sy4��2�e"r 6,06-7- ADDRESS: ,06-T'ADDRESS: ADDRESS: ,Z%Tzifie eq NO • .73a STREET: .d: LOT: BLOCK: ADDITION /4eat- --2�� CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To Be Used As: DESCRIPTION OF BUILDING e, -Front: `5o2 Depth :.56 � �5 Height: Square Feet:Cubic Feet: _ %�, U llx e Front : Depth: Height: Square Feet; ���� Cubic Feet: - Type of Construction: F�f�iv7� Ze' le& a,-Welffistimated Cost: $ O To Be Completed: N 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.) Load Plinflaq 4�I r��l/ / t� 6875 gjyhwo4 OGS NEE Sods Teshl'Itj ENGINEERING, INC. t-yneering Enyineers E Surveyors certificate of surveV for - T 0VT)--T�k' A. WEE 9 771! 7-7 2,nt o 0 DENOTFIS IRON DF-tiorEs DRAINAGE L UTILITY EASEMENT LOT 12 BLOCK 3 MELODY MANOR 2.OD ADDITION &noka couni-x — minncem�m) hweby cerhPy &W 65 is a kw and wrred mpresentehw oj'a survey orAr bmndvr;es�'& 46ow de avkd land, md opAe 1w416n oral/ j*ilWyms, #rmw, cid atl risible mawrhme,71.t 'rfmy, fnw or wsold lwd. AS surveyed by1W Nus- 9(' 66�( A I D r i I A.D 19WO. SUB URBAN ENCWNEERINCI, INC. Enn S F,- Stirm pr5 SCALE Wz-30' City OT Frlil®y - Dept. of SUkpL Phos 560-3455 DESCRIPTION OF WORK Number, Kind and Lmail®n @4 Mtuw" 0� Now E, 'moos PARTIAL RATE SCHEDULE City of Fridley: The undersigned hereby makes application for a permit for the work herein speeified, 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 to this application are true correct Fridley. Mi 18? Owner Kind of Building �- Used as To be completed about Estimated Cost, $ itEPAVlW & ALTERATIONS—Refer to Code Description...........................................f TOTAL FEE $ . Old—New. Building Permit No._ PLUMBING FIXTURE RA`Z'ES. NO. RATE TOTAL Number Fixtures ................ x $2.00 $ f ? ' Signed Future Fixture Opening ............ x $1.80 $�a °� By New Fixture Olaf Opening .......... x $1.80 $ Bus Catch Basin .................... x $3.25 i Water Heater ;Up to 99,000 BTU) • • • • x$3.00 ROUGH New Ground Run Old Bldg......... x $3.25 S Electric Water f%ater.............. a $2.00 $ FINAL GAS FITTING FEES. NO. RATE TOTAL lot 3 Fixtures ................ • • _ x $2.00 $ oda Additional Fiaatures ............... z = .76 $ (las Range to 199.000 BTU .. ,......... x $5.00 $ State Surcharge $ .50 itEPAVlW & ALTERATIONS—Refer to Code Description...........................................f TOTAL FEE $ . callb 1 for Power PtoMs and Heating, Cooling, Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of BldgL Phone 90"M GRAV*TY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ... .... ..... .. $10.00 $ Replacement of Furnace 6.00 $ Repairs & Alterations—up to $800.00 6.00 $___ Repairs & Alterations each add. $800.00 3.00 $—_ _ MECI'L WARM AIR Furnace Shell & Duct Work to 120,000 BTU .. .. . ..$10.00 "® c o o each add. 60,000 BTU .................... 3.00 i Replacement of Furnace .... 6.00 Repairs & Alterations—up to $500.00 6.00 $ Repairs & Alterations each add. $500.00 .... &W $ 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 198,000 BTU) 5,O0 $ (� over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures _1_ x$ Zoo $ 2 _ 0 (� Additional Fixtures x .75 $ Gas Range to 199,000 X$ 600 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAID TOTAL FEE ROUGH (SURCHARGE FMAL Z- 2 ?- 7.5' 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 facts and representations stated in this application are true and correct. Owner Kind of Building Used as . To be completed about�— yy Estimated Cost, Old ew Building Permit No. Permit No. �® DESCRI MON OF WORK HEATING or PO R PLANTS—Steam, Hot Water,*;; A_ 04200 Trade Name Size Ndl; �-%, Capacity_L.Y�Sq, Ft, E.D,R, BTU HB. Total Connected Load Kind of FuelL BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU » 4 1, (REMARKS -OVER) CRONSTROMS HTG. & AIR COND., INC. JoL, Name O Cd` kff r D% `4410 Excelsior Boulevard, Minneapolis 16, Minn. NEAT LOSS CALCULATIONS Job Addres Weatherstrips A.S.H. Guide a Construction No. 1 Insulation V I Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor ( Kind How Applied Yes—No Yes—No 19— / R-1 3P; Room I i moth ,4/ Width l e9 Height II D FI_I , e® p Room I Length `A ,® Width B,% Height V 74 Windows an Doors—Crackage and Area Width Height No. of Lineal ft. Area No. or pane of Dane lights of crack sq. ft. v� 0 TrCoef. M r Glass Coef. Btu Infiltration Btu Infiltration 1/, ® 0 Glass --/,0z' oo e 0 Exp. wall 1457c; e P Net exp. wall Net exp. wall ! / Exp. wall Int. wall Net exp. wall 1,"00 �+ Ceiling s I VC' 47 Floor le, Floor Ceiling Floor' Total Btu. U' al n Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.l Ar -R-.- Room I Lenath OW Width Ott Height f7 Windows and Doors—Crackage and Area Coef. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. TrCoef. M r Glass Coef. Btu Infiltration 141410 --/,0z' oo Glass V ' 1457c; J/2 o x-> Net exp. wall Exp. wall ! / Exp. wall Int. wall Net exp. wall 1,"00 �+ ` 6 d Int. wall le, Floor Ceiling Floor' Total Btu. Required sq. ft. E.D.R. or q. ins. WA. Leader area F1.1 Room I Length /0 Width ,, 0 Height Windows and Doors—Crackage and Area Width Hetght No. of Lineal tt. Area No. of pane of Dane lights of crack eq. fL Btu Infiltration I D Glass Exp, wall Net exp. wan Int. wall Ceiling Floor Tbtal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. L mider area Windows and Doors—Crackage and Area Coef. Width Height No. of Lineal ft. Area No. of pane of pane Iighte of crack+ sq. ft.) n�' M r Glass Coef. Btu Infiltration 141410 'Vo 6 Glass Exp. wall V ' 1457c; J/2 o x-> Net exp. wall Ceiling Exp. wall Int. wall 1,"00 �+ Ceiling Total Btu, le, Floor Int. wall Total Btu. Required sq. ft. E.D.R. or . ins. W.A. Leader area A F1_I / o .% .,,.- Roam I Len>rth Width 12 -z Heiaht 77 Windows and Doors--Crackage and Area Coef. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. n�' M r Glass Coef. Btu Infiltration Net exp. wall / 'l l Glass Int. wall Ceiling Exp. wall 1,"00 �+ Net exp. wall Total Btu, le, Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Int. wall Ceiling m, Floor Total Btu. N-�J Required sq. ft. E.D.R. or sq. itis. W.A. Leader area Fl.l f �c q, Room I Length 4' Width s' Height ; Windows and Doors—Crackage and Area Width Hetght No. of Lineal ft. Area No. of pane of.paae lights of crack sq. ft. Coef. Btu Infiltration' r Glass Exp- wall / 7 Net exp. wall w, 7-7 Vii, Int. wall Ceiling Floor �+ Total Btu, Required sq. ft. E.D.R. or sq. ins. W.A. Leader area CRONSTROMS IPTG. St AIR CON D., INC. Job Nome ' 4%410 Excelsior Boulevard, Minneapolis 16, Minn. a� n sb NEAT LOSS CALCULATIONS Job Address s -z `� ' ' 7 't• °' '� a Weatherstrips A.S.H.V.E. Construction No. I Insulatio ,- - Guide I Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor I Kind How Applied Yes—No Yes—No 19— / F1.1 d -/ Room Length V Width Height II Fl.l Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of Dane of Dane lights of crack sq. ft. Width Height No. of Lineal f . Area No. of ane, of pane lights of crack sq. ft. ani Coef.1 Btu Infiltration Coef. Coef. Btu Infiltration 14,00 �,o Ti- Glass W00 Exp. wall Floor 200 Exp. wall Net exp. wall Net exp. wall Ceiling Int. wall l Floor Ceiling s� Floor E Total Btu. Required sq. ft. E.D.R. or sq'. ins. W.A. Leader area I / F1.1A- Ai i _� Room I Lenath ,S!17 Width 9' Height . Windows and rs—Crackage and Area Width Height No. of Lineal ft. Area No. of Dane of Dane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of Dane of pane lights of crack sq. ft. Coef.1 Btu Infiltration Coef. Btu Infiltration ®40 14,00 Glass Int. wall W00 Exp. wall Floor Net exp. wall Int. wall Ceiling y ® l Floor Total Btu. 1 '" 41 C, Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.l Room I Length Width Heiaht Windows and Doors--Crackage and Area Width Height No. of Lineal ft. Area No. of Dane of Dane lights of crack sq. ft. Coef.1 Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl,l Room I Lenath Width Height Windows and Doors--Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall ---Ceiling Floor I Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I Fl.I Room I Lenath Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of -pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader arra APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE %oc*nvcTiaL RATE Furnace Shell and Duct Work. Burner (Also replacement furnace) $ 20.80 Gas Piping $ 10.00 (piping needed with ewer furnace) Gas Range S 10.00 Gas Dryer $ 10.00 Air Conditioning (all sizes] S 10.00 TOTAL Job Address V / V" " $ RD, W Department of Buildings. 6411 university Ave. M.E.. Fridley, lei 55432 City of Fridley $ Tel. 4571-3450 $ The undersigned hereby makes application for a peruLt for the work herein Specified agreeing to do all work in strict accordance With the City cades $ and rulings of the Department of Buildings, and hereby declaras that all the facts and representation& atatad in this applicationaretrue and correct.t.JPridlaY. Minn. 19 M A .. All Others/Repairs and Alterations OWNER It of Value of Appliance or Mork KIND OF BUILDING COMMERCIAL/INDUSTRIAL USED AS1-1 if IS of Value of Appliance or Work S To BE 001WIXTED ABOUT Y-01 r � D State Surcharge S .50 ESTIMATED C06T NO. P9Ri1IT NO. / co FEE 6-0 ow -NEM BUILDING PZPMIT T07AL Reinapection Fee ($15.00) S =,CRIPI'IOeI OP FUAMJI[T/BUAtER Rough Insp. I� Q�►� HEATING or POWER PIANT". Steam, Hot Yater Yams Air- (��D 1 r 110 Date 'T' Trade Name UD nt�U Final Insp. E nOR B� f tb, UP Datecapacity 54• • -,J Approval for Permit C Kr 16tal Connected Load '� kind of Wei Size SUMER - Trade name • Capacity Sq. rt. EDR HTU�»1 VW MP D MINIMUM FEE FOR ANY HEATING PERKIT IS $15-00- cOn"nr PLUS $.SO STATE SURCHARGE slgo.d by i y�� .J Tal. eAir OonditioMra can not be placed in Side card withoaL T written peraission from adjoining neighbor." Fill out back 'side for stack verification on replacement furnaces �. 1 CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; I. Has been carefully examined Yes j 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 Yes No ( ) total BTU connected 6. Has Total heating BTU's of All other BTU's TOTAL ` °- CompanyU64 d - Signed By Da to City of Fridley AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT (795283 PERMIT NO. r • COMMUNITY DEVELOPMENT DIV. T � PROTECTIVE INSPECTION SEC- CITY HALL FRIDLEY 55432 612-571-3450 RE %/� �j / ��/ NUMBER 910-F15 REV DATEPAGE 7/15/97 OF APPROVED BY JOB ADDRESS 7301 Melody Drive NE 1 LEGAL DESCR. LOT NO. 13 BLOCK 3 TRACTOR ADDITION Melody Manor 2nd Addition SEE ATTACHED SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dave S" Lissner 7301 Melody Drive NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Peak Roofing 11506 S Oakvale, Mtka MN 55305 938-8150 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 ❑ ADDITION ❑ ALTERATION JJ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (23 Sq) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd layer but not the 3rd. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 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 I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT VALUATION $1,441 SURTAX $.72 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE O LOCAL LAW REGULATING CON- STRUCTIO R HE PERFOR CE F CONSTRUCTION $ 48.50 Fire SC $1.44 �..-- PLAN CHECK FEE License SC $5.00 TOTAL FEE $55.66 SIGNATURECO RACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLY ALIDATED r BLD INSP THIS IS YOUR P RMIT DATE SIGNATURE OF OWNER qF OWNER BUILDERI - IDATEI NEW [ ] Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY. AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: 2DO Legal Description: ` Owner Name & Address: Contractor: MN LICENSE# X21© 48 Address: �� - � �� �S 3� � Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF RUPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Len Width HgtlGround Sq. Ft. OTHER: 4Vb) e1 p CN � /' - -4 ('\ / � od 1-'y - Construction Type: - ; , Estimated Cost: �` v� p/ / (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + b Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # " ��`U o� TOTAL STIPULATIONS: • CITY USE ONLY Permit Fee $ �, �Z) Fee Schedule on Reverse Side Fire Surcharge$ �,j .001 of Permit Valuation (1/10th%) State Surcharge $ '7 $.50/$1,000 Valuation SAC Charge $ $950 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 [ J Not Necessary [ J TOTAL STIPULATIONS: Building PLUMBING Permit No.: Received By:/"` Inspections P L APPLICATION RESIDENTIAL 763-572-3604CITY OF FRIDLEY Date Rec'd:3 d DATE 6 17 YOUR E-MAIL ADDRESS C1 Q l 1 S' -S' YL� 1"! IC�i / %1� S A- SITE ADDRE S THIS APPLICANT IS: WNER ONTRACTOR PROPERTY OWNER/ NAME: STA Zn�. ADDRESS: 7 -CITY TENANT PHONE: l CONTRACTOR NAME: !� SUBMIT A COPY OF STATE LICENSE EXP DATE YOUR STATE ADDRESS: CITY STATE ZIP LICENSE WITH PRONE FAX APPLICATION TYPE GLE FAMILY ❑ TWO FAMILY 0 TOWNHOUSE PERMIT TYPE OF WORK: 0 NEW PLACEMENT DETAILED DESCRIPTION OF WORK 0 PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) WATER PIPING BATH SINK/LAV _FLOOR DRAINS _SHOWER _ WATER SOFTNER ($35) _ —BATHTUB —GAS PIPING p+Eo cnTuc�) SWIMMING POOL _ CLOTHES WASHER KITCHEN SINK _ WATER CLOSET — IFLOW ($I5) _ _ FORI RRIGAT ON DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) WATER METER —OTHER Permit Fee $ X . Number of fixtures @ $10.00 x $10.00 = $ � Surcharge .50 Number of fixtures @ $15.00 —X$15.00=$ TOTAL DUE $ X!5 Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building 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; that the work will be in accordance with the approved plan in the case of all work which re es review and approval of plans. /� ° ' �s�E�DATE �✓ SIGNATURE OF APPLICANT PRINT NAMEf 011 .. IRONf City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building PLUMBING Permit No. t I!!��i Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604CITY OF FRIDLEY Dat �&$I; L E tj ` 763-502-4977 FAX EFFECTIVE 2-19-09 DATE 9111 I P Qry YOUR E-MAIL ADDRESS SITE ADDRESS -7 3 0 1 mac-OL4U, / i e. THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND CERTIFICATE OF INSURANCE PERMIT TYPE TYPE OF WORK: ADDRESS: /` � 4� CITY STA PHONE: "4 j - a is / NAME: STATE LICENSE #_ STATE BOND # ADDRESS: PHONE ❑ NEW FAMILY DETAILED DESCRIPTION OF WORK Terry Overacker Plumbing Inc 502 E Main St Anoka, MN 55303 (763)572-8880 0 TWO FAMILY ❑ TOWNHOUSE REPLACEMENT EXP DATE EXP DATE STATE ZIP .f- w3 EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE FEES ARE BASED ON $10.00 PER FIXTURE, $35.50. BATH SINKILAV DRAINS _ SHOWER — WATER PIPING — BATHTUB _FLOOR GAS PIPING (NEED CITY LIC) _ SWIMMING POOL — WATER SOFTNER ($35) CLOTHES WASHER _ KITCHEN SINK _WATER CLOSET — BACKFLOW ($I S) _ DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION ION — — WATER METER —OTHER Total $ ' 3 > S O 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 o' f all work which requires review and approval of plans. 4 tdf �-�/PRINT NAMEJA-(-/C! 5 IC 40 ' ' � DATE SIGNATURE OF APPLICANT FI City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977