PRE 2010 DOCSLA I I U� I-HIULLY I NbHtL; I I UN U I v.
6431 University Ave NE
Fridley, MN 55432
572-3604
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APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER
OF FIXTURES TO BE INSTALLED ON
EACH FLOOR
Urinal
Shower
' X
Wash
r*
T ay
Floor
Drain
Auto.
Washer
Range
..... . .....
Stories
Gas Elec
Basement
Floor 1
FI
...........
..................
FI.................
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS &V/)
New Fixtures $7.00 The undersigned hereby makes application for a permit for the work herein
Old Opening, New Fixture $ 4= 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 $7.60 , 1A93
Sump/Receiving*Tank $7.00
Water Treating Appliance $10.00 owner
Water Heater —Electric $7.00
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
Type -$5.00 PLUMBING COMPANY,��L��t4- SLjLi2
Reinspection Fee $30.00 SIGNED BY hn'� TEL NO.
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
I % of Value of Fixture or Appliance
Approved By Rough—In Date Final Date
State Surcharge $ .50
MINIMUM FEE OR ANY PLUMBING/GAS PERMIT IS $15.00
TOTALFEE $ /91 5D PLUS THE $..So STATE SURCHARGE
SUBJECT
PER ,. NO.
City of Fridley
� � � � `2
AT THE TOP OF THE TWINS
BUILDING
PERMIT
-��
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�•
RECEIPT NO.
_ COMMUNITY DEVELOPMENT DIV
v PROTECTIVE INSPECTION SEC®D
r
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
2/28/95
JOB ADDRESS 6411 Pierce Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
Pt 15
Auditor's Sub. #88 SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Rose Demarais 6411 Pierce St NE
574-0824
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
R & M Associates 3482 Auger Ave White
Bear Lake MN 55110 770-9322 4391
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 REPAIR ❑ MOVE ❑ REMOVE
X❑
8 DESCRIBE WORK
Reroof Dwelling Tear-off • Doors; Soffit &
Fascia
9 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with
the State Building Code. Provide smoke
detectors adjacent to all sleeping areas.
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
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
$9,400
@
$4.70
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS F ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$117.00
Fire SC $9.40
THE PERFORMANCE OF CONSTRUCTION.
TRUCTIO _5TH
PLAN CHECK FEE
TOTALFEE
License SC $5.00
$136.10
IGT O CONTRAC RORAUTHORQEDAGENT- IDATEIWHEN
PROPERLy, VALIDATED THIS IS YOUR PERMIT
SZ NATO OF WNERIIF OWNER BUILDER) IDATEI
BLD INSP WreATE
NEW [ ] CITY OF FRIDLEY Effective 1/1/95
ADDN [ ]
SINGLE FA
ALTER [ ] MILY AND DUPLEXES R-1 AND R-2 CSD
Building Permit Application
Construction Address: i // P
Legal Description:
Owner Name & Address: G L D f r Tel. #✓�/— G/
Contractor: �+M f4 55C'C' MN LICENSE # Lle3a
Address: Gf e 2 u .2 f-,- ay f Tel. # 7 >e - �
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 Hgt/Ground Sq. Ft.
OTHER: J' d -d- i e. j6cd S i I a v%-% -y- -l- r
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: lel
L� 4 Ovc � � Estimated Cost. $
� � i5 c�: /=
Approx. Completion Date:
(Cost on Back)
Driveway Curb,Cut Width Needed: Ft. ? 6 Ft = Ft x $ _ $
DATE: 2-,2 S 9 f APPLICANT: .L ,
CITY USE ONLY
Tel. # ;7�� •- 2 3 2 `e--
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$ D
.001 of Permit Valuation (1 / 10th %)
State Surcharge
$ . �/ D
$.50/$1,000 Valuation
SAC Charge
$
$850 per SAC Unit
License Surcharge
$ C' ��
$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:
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