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PRE 2010 DOCSCity of Fridley, Minn.. N? 10034 BUILDING PERMIT Date: Nov. 21, 1968 Oar: Gerald Glenn Corp. Builder 0 Same Address 1202 Hathaway Lane Address M Same LOCATION OF BUILDING No. 5601 Street _—$egg Driye Part of Lot Lot - 17 _ Block 2 Addition or Sub -Division — '2aZktri .w &q1ka,, l a j -:–,p, d r3 n Corner Lot X Inside Lot _ _ Setback Sideyard Sewer Elevation _ _ _- 945. 85 gpp mjiNgo 949,52 rpm= of 'Wnn-F.i-nm_ DESCRIPTION OF BUILDING To be Used as: Dwellijig Front ___48'_ Depth 2812.ft Height 20, Sq. Ft.-----L3.44Cu. Ft _26,990 • Front Depth Height Sq. Ft. Cu. Ft. Type of Construction _ _Frame Est. Cost _�22 Tnnr) To be Completed SEWER LOCATION 661W East of Manhole on Regis Drive WATER LOCATION - 76.5' East of Manhole on Regis Drive In consideration of the issuance to me of a permit to construct the buildiu�g described above, I agree to do the proposed work in accordance with the description above set forth and in ��o\mpliance with all provisions of ordinances of the city of Fridley. ® � In consideration of the payment of a fee of $-",Opermit is hereby granted to (, ara.l d r l gall Corp . 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 Building Inspector I E . NOTICE: 'This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be son to we the Building Inspector for separate permits for these home. N? 4813 Original Permit r PLUMBING AND GAS FITTING N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for Permit inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit., Fee & DESCRIPTION OF WORK Number. }find and Location of Fixtures City of Fridley ,19 Stories H Z j � m t m m Y 10 N a}a 3 F Z O O t, O O d Z F N W z a iK J 2 4. m j a U' ¢ OW m Z ¢ ¢ b C WATER HTR. GAS ELEC. Basement / 1st 2nd 3rd 4th Connected with Sewer -Cesspool Gas ]Piping for Openings Permission is hereby granted Q-Xt ',- Hl - to do the plumbing and gas fitting in the building described A the statemeA hereto allached, upon the express condition that the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and this permit may be revoked at any time upon the violation of any of the provisions of said ordinances. By Order Of The Inspector Of Buildings Roughing in Inspection Inspector. Final Inspection Date Inspector. 42 IRA -6-69-V Owner � Location Kind of Building Used as To be Completed ,19— Estimated Cost $ 42 " a Old -New. Building Permit No. I Q... 0 3 S4 Date Inspector of Buildings. PERMIT for Power flants and Heating. Cool- ing. ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of ® I7eating Planto be anstalle ltered—repaired Make 15 ®da , Size_ Oil fired ; Coal fired—,- Gas fired � ; Gas Authorization N Remarks Approved Final Inspection 19_ Inspector Peru f 7. No 4373 Fee $ ' Office of the Inspector of Buildings City of Fridley City of Fridley, Owner Location Kind of Buildin; How Occupied V Work to be Commenced 2477 a ,19 To be Completed—, 19— Estimated Cost, $ 76& .,=e Old -New, Building Permit No. Permission is hereby granted to Y-- a4� &,,� , to install—erect—use the material and devices described in the above statement. This permit is granted upon the expr s condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the specificatio�f set forth in the approved application for this permit on file in the office j°ice o f the Inspector of Buildings. ,Inspector of Buildings 42 zM 1147 v APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNEE'i 'S NAME BIIILDER UI ADDRESS ADDRESS % `Z 0 a LOCATION OF BUILDING NO. -5 G O 1 STRKU: LOT BLOCK �_ ADDITION OR SUBDIVISION COR'N'ER LOT INSIDE LOT SETBACK SIDEYARD SEWER ELEVATION TOP OF FOOTING Applicant attach to this fors. Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To Be Used As: DESCR.IPTION OF BUILDING Front41' 1 Depth - e Height 'Square feet3 Z!4 Cubic Feet G, �{ Front Depth Height Square feet Cubic Feet Type of Construction To Be Completed Estimated Cost &e --d The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accor ce with the City of Fridley Ordinances and rulings of the Department f Buildings, and hereby declares that all the facts and 1,.z..presertatio stated in this application are true and correct. % n DATE ; (Schedule of Fee Costs can be found on the Reverse Side.) Application for Power Plants and Heating. Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: 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 $ NECK. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ each add. 60,000 BTU ....................... Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 ................ . Repairs & Alterations each add. $500.00 .............. 8.00 $ 2.00 $ 5.00 $ 5.00 $ 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 $ GAS 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 $ 17.00 ROUGH FINAL Dept. of Bldgs. Phone SII 4-7470 Locam- 5601 Regis Drives •' 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. I Fridley, A in i� 19� Owner Gerald Glenn Bldrs. Kind of Building frame Used as dwg To be completed about Estimated Cost, $ -/41)-00 Old—Building Permit No. C ® �`f Permit No._ 475 DESCRIPTION OF WORK HEATING or POWER PLANTS --Steam, Hot Water, Warm Air—No- Trade ir—No Trade Name AFCO Size No GB1104–OHD Capacity. Sq. Ft. E.D.R_ EL 14"1 BTU H.P. Total Connected Load 44.,260 Kind of Fuel Nat. Gas BURNER — Trade Name AFCO Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) Signed Mill City Heating Co. By &f�� �/ , , 4 2 Business Phone No 544-1501 City of Fridley AppIcation for PWRIMng and C= o Dept. of Mdgs. Phone 980-3480 DESCRIPTION OF WORK Number, Kind and Location of Flzhves PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: , � M�" Number Fixtures ...... .. ......... x $2,00 somm Future Fixture Opening .... .... ...... x $1.50 $ New Fixture Old Opening . ....... .. x $1.50 $ Catch Basin ... . I ....... ...... x $3.25 $ Water Heater (Up to 99,000 BTU) . .. x $3.00 $ New Ground Run Old Bldg. .... .... x $3.25 $ Electric Water Heater = $2.00 $ CAB FITTING : MENIMEM 1st 3 Fixtures ...... ................... _—� x $2.00 $—(A • ®c� Additional Fixtures . .................. x $ .79 $ ME x $5.00 $ HUMEMENIMMINIM mom M11010011001 MEMO PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...... .. ......... x $2,00 $ Id, 00 Future Fixture Opening .... .... ...... x $1.50 $ New Fixture Old Opening . ....... .. x $1.50 $ Catch Basin ... . I ....... ...... x $3.25 $ Water Heater (Up to 99,000 BTU) . .. x $3.00 $ New Ground Run Old Bldg. .... .... x $3.25 $ Electric Water Heater = $2.00 $ CAB FITTING : NO. RATE TOTAL 1st 3 Fixtures ...... ................... _—� x $2.00 $—(A • ®c� Additional Fixtures . .................. x $ .79 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description................................................$ TOTAL FEE — 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. Fridley, 14finn _ owner � Kind of Buildings -dam Used as To be completed about Estimated Cost, $ X02 00 Old--� Building Permit No. P®sffiie ®- g Signe By Business Phone No. l7�- — ROUGH FINAL v '3 City of. Fridley, Minn. i 1 5 o 64''311 University Ave. T� N�E., Minneapolis, Minn. 55432 Mate: .dune 14, 1972 Owner: Richard Harris Builder . Same Address 5601 Regis Drive Address No 5601 Street Regis Drive N.E. Part of Lot Ut 17 Block 2 Addition or Sub -Division Parkview Oaks is t Corner Lot inside. Lot Setback _ r _ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: open wood deck N.E. Corner Front 14' 15' Depth Height _-____ _ Sq. Ft __21Q Cu. Ft Re .7C Front 10 ► Depth 24' Height Sq. Ft _____..240 Cu. Ft Type of Constriction Redwood &Pine ,stCost 6.00.00 To be Completed June 30, 1972 Stipulations: 1. 7' minimum to property line 2. Concrete piers 3'6" below grade. 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 ax compliance with all provisions of ordinances of the city of Fridley. P .56 State Sureharge In consideration of the payment of a fee of $ 6.00permit is hereby granted Richard Harris 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 buil�ng� theme city limits and this permit may be revoked at any time upon violation of any of the provisiordinan ons of said Building Inspector CLARENCE BELISLE NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas hosting, sewer or water. Be sure to sea the Building Inspector for separate permits for these items. r APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING P.tRMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME : 21 C rl A (Q - CT A I BUILDER : �'� L� A Vka ADDRESS: Qa®I ^ Ree [ S 'b y ADDRESS: NO • . -6-Z 6'1 STREET LOT: j BLOCK: �2- ADDITION: 6zg�� G1 14 0 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. DESCRIPTION OF BUILDING To Be Used As: 0 Pr- 0 - W d COD ^ -b ecle ^ E� $P S'r -I V3 0 • c'AS1'� N©. ' CoQ° Front • °tom Depth • J Height • ~ Square Feet: Cubic Feet: Q 10tt,. -Front: 8 Depth: Height: Square Feet; d Cubic Feet: Type of Construction: �E.�W�t9 �IJ� Estimated Cost: $ �®®�r-- To Be Completed: &Kie- E 9° '7Z 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: G - - V y Z. SIGNATURE: (See Reverse Side For Additional Information.) V. V SUBJECT I P — City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. i LL ......, COMMUNITY DEVELOPMENT DIV. . PROTECTIVE INSPECTION SEC. 4,// %® r � / NUMBER REV DATE PAGE OF APPROVED BY i - CITY HALL FRIDLEY 55432 A o/"",•; +--- 1 J ` 612-571-3450 910-F15 7/31/92 JOB ADDRESS 5601 Regis Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 17 2 Parkview Oaks First Addition SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Dan Wynia 5601 Regis. Drive NE 571-7163 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. D & D Home Improvement Inc 7401 Central Ave NE, Fridley 55432 784--7543 4840 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 O ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling (15 Squares) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS PpQfi,ng can be 2nd laxer but not 3rd. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. 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 1 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 $795 $.50 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- $21.00 Fire SC $.80 STRUCT OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE License SC $5.00 $27.30 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI HE ERY TED THIS IS YOUR PERMIT /PJypN�'}�� pAL G.- BLDG INSP 1 f1ATE SIGNATURE OF OWNER OF OWNER BUILDER) (DATE) NEW [ ] ADDN [ J ALTER [ ] Construction Address: Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Effective 3/1/92 Owner Name & Address: Tel. # 5ZZ-j-� Contractor: D & D Home Improvement, Inc. MN LICENSE # 4840 Address: 7401 Central Avenue N.E., Fridley, MN 55432 Tel. # 784-7543 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Length Length Length DESCRIPTION OF IMPROVEMENT Width Width Width Height Height Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [) Inside Lot [ ] Ft. Yd . Setback Side Yard Setbacks Type of Construction: -4/ e d(14 /glen Estimated Cost: $ `� � Approx. Completion Date: 6 l� Cost on Back) Driveway Curb Cut Width Needed: Ft. + b Ft = Ft x $ = $ DATE: APPLICANT: 0&1Tel. # Permit Fee $ /, D o Fire Surcharge $ An State Surcharge $ SAC Charge $ License Surcharge $ oo Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOTAL Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $700 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Fee Determined by Engineering. Agreement Necessary [ ] Not Necessary [ ] STIPULATIONS: . . r r SCOTT B. ERICKSON FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287 September 3, 1992 PW92-162 Jim and Colletta Legatt 5601 Regis Drive Fridley, MN 55432 Dear Jim & Colletta: It is my understanding that a new section of driveway and a retaining wall may be installed at your residence in the near future. There is some concern that the established drainage channel along the side of your lot may be blocked by the installation of a retaining wall. If a retaining wall is constructed for the driveway, it should not block or restrict the drainage from the back of the lots. Also, driveways cannot be installed any closer then 3 feet .from the property line without written consent from the adjacent property owner. If you have any questions regarding this, I would be happy to talk or meet with you at your convenience. Sincerely, Scott Erickson Assistant Public Works Director Assistant Public Work Director Engineer 6Professional ri Municipal Center 6431 University Avenue Northeast V l V I l �F Fridley, Minnesota 55432 ��ONC (612)572-3551 jJLL-1 F�TL EY FAX (612) 571-1287 I FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287 September 3, 1992 PW92-162 Jim and Colletta Legatt 5601 Regis Drive Fridley, MN 55432 Dear Jim & Colletta: It is my understanding that a new section of driveway and a retaining wall may be installed at your residence in the near future. There is some concern that the established drainage channel along the side of your lot may be blocked by the installation of a retaining wall. If a retaining wall is constructed for the driveway, it should not block or restrict the drainage from the back of the lots. Also, driveways cannot be installed any closer then 3 feet .from the property line without written consent from the adjacent property owner. If you have any questions regarding this, I would be happy to talk or meet with you at your convenience. Sincerely, Scott Erickson Assistant Public Works Director Building AND MATERIALS: BUILDING IN THE 199 (USTOTAL Permit No. 0 —CO(� Inspections OCCUPANCY TYPE RESIDENTIAL APPLICATION $ %7. �j� Received By: 763-572-3604 , f/ CITY OF FRIDLEY Fire Surcharge Date Rec'd: DATE YOUR E-MAIL. ADDRESS $ct�- C SITEADDRESS X56®f ��G//S Z)i Fi°dleti �� ES413� $ THIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR $ PROPERTY OWNER/ NAME: C'In.1f'1 S ' �Ow h So n $ TENANT ADDRESS:S Q>0\ ' 4� , 15 r— CITY d I -e STATE I� >P 65 3Z11 $450 Conservation Plan Review PHONE: % 63 SO2 01 93 $ CONTRACTOR NAME: $ STATE LICENSE # EXP DATE Total Due SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX PROPERTY TYPE JM SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE yzf DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ANEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: A /w C✓e.'e-4 ®0 /700-OV7 &TV/ Pov O e `- G/occS - SIZE OF IMPROVEMENT t°�as rlvGP�°N LENGTH WIDTH HEIGHT ?3 S . Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. 2. Existing Floor Plan Proposed floor plan PROPOSED SIZE: ❑DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: IN THE 199 (USTOTAL U.0 FEE JOB VALUATI N OCCUPANCY TYPE Permit Fee $ %7. �j� See Back Page for Fee Schedule Plan Review , f/ 65% of Building Permit Fee Fire Surcharge _ $ .001 times the total job valuation Surcharge $ct�- .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1675 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ f 5, Hifi Make checks navable to: Citv of Fridlev Attach Stinulations 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 pequires review and approval of plans. 0 SIGNATURE OF APPLICANT �'' �; PRINT NAME �J/�l.S�1��P�' DATE J _-07 ";0 CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1999 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater —Electric $ 7.00 Water Heater — Gas** t $10,00 Gas Range** $10.00 Gas Dryer** $10,00 Back Flow Preventer Required { )Yes () No Type $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS CIO 1.5% of Value of Fixture or Appliance (1 e JOBADDRESS The undersigned hereby makes application for a perm it for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. s��/tom Owner Q Building Used As a® Estimated Cost PERMIT NO. PLUMBING COMPANY '(YV_Q),,,jm a -Soy.,% SIGNED B TEL N0. — i4 Approved ByA Rough—In Date Final Date ' 6 "l `y/ State Surcharge $ .50 n�yye� 17D MINIMUM FEE I ANY PLUMBING/GAS PERA TOTAL FEE PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES.