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PRE 2010 DOCSCity of Fridley SUBJECT PE 13704 AT THE TOP OF THE TWIN BUILDING PERMIT i COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC.p2� 1 . � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 8/17/76 JOB ADDRESS 6210 Rice Creek Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 1 1 Rice Creek Estates 2nd SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Pine Tree Builders 8535 Central Avenue N-E.,Npls. 55434 784-6013 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 6 DESCRIBE WORK j WARNIN" Construct a 48' x 25'6" Dwellin and a 20' x 24' Garage SEPERATE PERMITS REQUIRED FOR WIRING, Before digging call local utilltle 9 CHANGHFATIM PLUMBING AND TO REQUIRED B STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before capping. Provide sod in the front and side yards. Minimum front yard setback to foundation wall is 36.5 feet. Provide City with copy of truss design. SEWER LOCATION (Approx. 11' Deep) 79' North of Manhole (Rim elev. 920.17 approx. North Inv. Elev. 908.76) WYE ELEV: 909.08 TOP OF FOOTING: 912.08 Minimum —IMPORTANT-- WATER LOCATION:.9.6' North of sewer service. TIE iYOTIFY THE FRIDLEY ENGR, iiiE City OF FRIDLEY 'DOES NOT GUARANTE-1 ELEVATIC ,.. DIVISION REGARDING CURB, 'r,_UaACY OF UTILITY LOCATIONS AND REMOVAL AND REPLACEMENT ONLY POSES ANJ DATA IS FOR INFOpj"TION PUP- AT DRIVEWAY OPENINGS, FQRSONS jj%N0 IT SHOULD VERIFY THE INFORMATION SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL; PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. 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 R-1 1191+480 19,668-1-4800 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 VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. $34,370 $17.19 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 OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- S RU TI N OR THE PERFORM CE OF CONSTRUCTION. $97.87 ., �; $350.00 o PLAN CHECK FEE $24.47 TOTALFEE $489.53 WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT SIGNATURE OF CONTRACTOR ORAU7RORIZEDAGENT (DA;t) BLDG. INSP DATCo . r SIGNATLIKE OF OWNER IIF OWNER BUILDER) (DATE) ;PLICATION FOR RIiSIDEN'!`xAL, AJ.'1']iJ:Xi'IUN, OR ADDITION BUI]AYING PERMIT G CITY OF FRIDLI3Y, MINNESO'!A OWNERS. N#NE '14h A9 IS C 1iZ?d 1IUILDI R: �Of A/ RE 7 (4/&XV .. ADDRESS: ADDRESS Ck-Al 41- 01Z, lt,", NO:. 6240 STREET: P,(CF-- C/Fwk- i)/7tUeg LOT: I BLOCK.: I ADDITION: W z CORNED. LOT, INSIDE LOT: ETBACK: 9-!S' SIDL'1'ARn :� Applicant attach. to this form 1Nao Certificates of Survey of Lot and proposed building location drawn on these Certificates. ^ DESCRIPTION OF BUILDING To Be Used As: �O S� Front: 4 Depth: Height Square Feet: �l Cubic feet: �9 6 Mrp Front: Squd-i� Feet. Cubic Feet • M Depth: -2- V Height•Z® Type of Construction: IXJ"b Fg*'Ar Estimated Cost: _$ To Be Completed: ASA 0 The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all wort: in strict accordance- x ith the CiLy of. Fridley Ordinances and rulings of the Departtnent of Buildings, wd Hereby declares that all the facts and representations stated in this application are true and correct. DATE:. SIGNATURE: (Sed Reverse Side For Additional Information.) f2, g? r i �e a &e r J Fay Dlc;rM9- o ' 138:14 > r r LJ O 10 I • •!'''"Ut-ili�l-y �, Or¢inage Ease int �.._:;:;.... W ,t ... ,., 135.?2 -- • a Denotes iron monument -IM��TA�lT 1 . 1. tl e InIOTIFY THE-FRIDLEY ENGR. CURB- as o A DIVISION REGARDINO F?EMOVA REpLAC EMENT TN ,L..A AT LiRI�IEwAY"OPmINGS. PROVA Descriptions Lot 7, Blocic 1, RICE CREEK ESTATES F1 " ESTATES 2ND ADDITION,. Anoka County, Minn. THE CITY ,®F. FRI®LEY DOES-, NOT GUAI�APlTEE THE @#ofd. I I064U0li#'I ACCURACY ;,QF `UTILITY LOCATIONS AND:. EL EVA7101�So l HP&f�E T� ' .CASs fi; tI5 . DATA 15 FOR:IIdF®RMATI®Id PULP®SES ONLY ; ANa, ' t-RSONS USING ; ff , SROUL© ,VEOPY THE INFORMATION_ . 11U IED, PYA'-"AN-W' iy. 't H E SITE, 3 �` V014)n Ountr# I ht?wby celtify, Shat this is a'tmo and cotit:c? i !Lift ttnitition Of :i Sol t V hf land and of iht lociAtor, Of all buil,iiti!�.. ,•p�a�Ii if ;t .ems'' III,.. bountiac ies the above cb; cr rlx•d ifli uncivachineirts, if any; fibro br ear, �lifik I' Lancf Suit eYanc saP rte f'I tnni+ty f Y yu. _ As s i"e ed b we till's_ __,. ..._ 'jay of cc�N F ��, Civil engineering 3-arc ly o '4 3$>i i;7flilz"l)u: fi. ft 94 at t3oiiiir'Av. N 1 _. — -5e—il _ 5ra1fe aYbpt,iv i Pork, MPJ 5547$ Photur. 533 7344 Mirm. Reg. No r CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Job Address '2 Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. 19 OWNER=C KIND OF BUILDING USED AS TO BE COMPLETED ABOUT PARTIAL RATE SCHEDULE ESTIMATED COST PLUMBING FIXTURE RATES: NO.. x o OLD - NEW BUILDING PERMIT NO. PERMIT NO. Water x $3.00 ) $ 149, �" z+ a 14 y q ,ruture Fixture Opening j Q, Heater 0 sqi $ w Catch Basin E 5 16 � m Uc b O a $5.00 $ N TelNo. 23 . 100,000 BTU to 199,000 BTU x S4 J N G i .c ••0i V x0 C .0 N c rl O 3 O O O •11 41 M .0 4.3 N $5.00 a W N .c y u (d i i S o w W w vra a3 GAS FITTING FEES: 0 o as 1'ec 1st 3 fixtures � x $3.00 $ Date Additional Fixtures x $1.00 $ APPROVAL FOR PERMIT Gas Range to 199,000 BTU x $1:0.00 $ REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction $5.00 $2.00 $ $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7,50 1st State Surcharge / .50 —29 `j TOTAL FEE $ . 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer {*} - New Fixture, Old Opening Water Job Address '2 Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. 19 OWNER=C KIND OF BUILDING USED AS TO BE COMPLETED ABOUT PARTIAL RATE SCHEDULE ESTIMATED COST PLUMBING FIXTURE RATES: NO.. RATE TO/TX/AL� OLD - NEW BUILDING PERMIT NO. PERMIT NO. Number Fixtures x $3.00 ) $ 149, �" e $ Company ,ruture Fixture Opening x $2.00 New Fixture, Old Opening x $2.00 $ Signed By s Catch Basin x $5.00 $ Water Heater - to 99,000 BTU- � x $5.00 $ ..�'-� TelNo. 23 . 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ New Ground Pun Old Building x $5.00 $ ROUGH INSP. Date Electric Water Heater x $5.00 $ GAS FITTING FEES: FINAL INSP. 1st 3 fixtures � x $3.00 $ Date Additional Fixtures x $1.00 $ APPROVAL FOR PERMIT Gas Range to 199,000 BTU x $1:0.00 $ REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction $5.00 $2.00 $ $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7,50 State Surcharge $ .50 —29 `j TOTAL FEE $ . REINSPECTIQN FEE ($30.00) CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGER TION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: Furnace Shell & Duct Work Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 MECHANICAL WARM AIR: Furnace -Shell & Duct Work to 100,000 BTU each add. 50,000 BTU Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 STEAM OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU each addn. 50,000 BTU Boiler only up to 100,000 BTU each addn. 50,000 BTU OIL BURNER- to 3 gal. per hour each add. 3 gal. per hour RATE TOTAL Job Address $12.00 $ 7.00 $ 7.00 $ Department of Buildings 4.00 $ City of Fridley Tel. #571-3450 $12.00 4.00 7.00 7.00 4.00 $12.00 4.00 7.00 6.00 $10.00 10.00 GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 (over 199,999 BTU see Fee Schedule) GAS FITTING FEES: 1st 3 Fixtures x $ 3.00 Additional Fixtures x $ 1.00 Gas Range to 199,000 BTU x $10.00 AIR CONDITIONING FAN HEATING SYSTEM _ See Fee Schedule VENTILATING SYSTEMS -`, ALTERATIONS & REPAIRS_) ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT -- 7. r !� State Surcharge TOTAL FEE REINSPECTION FEE {$10.00) MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 The undersigned hereby makes ,plication for a permit for the work herein $ _ specified agreeing to do all wo in strict accordance with the City Codes $ and rulings of the Department oJ Buildings, and hereby declares that all the $ facts and representations statec in this application are true and correct. $/Q/%% $ 1 ley, Minn. ' F` , 19�� .d OWNER $ KIND OF BUILDING $ $ USED AS TO BE COMPLETED ABOUT $ ESTIMATED COST $ OLD -/& BUILD PERMIT NO. PERMIT NO. !� $ $ ' $ DESCRIPTIO P OF FURNACE/BURNER 1 HEATING or POWER PL4MTS, Steam,,Hot Water, Warm Air- No. $Trade Name �y Size No. $ $ Capacity Sq - Ft. EDR BTU, HP $ 50 $ � Total Connected Load Kind of Fuel 141-17-101 BURNER - Trade Name Size No. Capacity Sq. Ft. ELI BTU HP cc pany S ned By T No. suburDarl Ayr UUMU71088-5 8419 Center ®rive Minneapolis. Minnesota 55432 March 4, 1977 'PENT+.,.. Y f. g. R A. IIID -k. 6431 UNIVERSITY' AVENUE N.E., FRIDLEY, MINNESOTA 55432 TELEPHONE ( 612)571-3450 Pine Tree Builders, Inc. 8535 Central Avenue N.E. Minneapolis, Mn. 55434- Re: 5434 Re: Final Inspection at 6210 Rice Creek Drive N.E. Dear Sirs: A final inspection was made on March 3, 1977 of 6210 Rice Creek Drive N.E. and the following items were noted which must be completed before the structure can be finaled out; 1. Provide sod in the front and side yards by May 29, 1977. 2. Provide nuts on garage anchor bolts by May 29, 1977. 3. Fire stop under bathtub by May 29, 1977. Sheetrock all stud bearing walls and header in garage with ®CC 5/8.inch type -X sheetrock by March 10, 1977. �We will expect the above items to be completed by the scheduled dates when reinspections will be conducted to determine compliance. If you have any questions on these items, please feel free to contact me at 571-3450. Sincer , RUN -HOLDEN Building Inspector RH/mh Q�y0LUTIo .• e /00 U � � 2 u1 = ",-6.t91 '1Z a March 23, 1977 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 65432 Pine Tree Builders, Inc. 8535 Central Avenue N.E. Minneapolis, Mn. 55434 Re: Final Inspection at 6210 Rice Creek Drive N.E. TELEPHONE ( 812)571.3450 Dear Sirs: A final reinspection was made on March 21, 1977 of 6210 Rice Creek Drive N.E. and the following items were noted which must be completed before the structure can be finaled out; 1. Provide sod in the front and side yards by May 29, 1977. 2. Provide nuts on garage anchor bolts by May 29, 1977. 3. Fire stop under bathtub by May 29, 1977. 4. Sheetrock header in garage with 5/8 inch type X sheetrock by March 30, 1977. We will expect the above items to be completed by the scheduled dates when relAspections will be conducted to determine compliance. If you have any questions on these items, please feel free to contact me at 571-3450. Sincerely, RON HOLDEN Building Inspector RH/mh r ��ouunoy�� U m IL 2 l6 „a �l1s,19�0 City of Fridley15.4 AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT PERM 5 7 1 9 t L • __ ___ COMMUNITY DEVELOPMENT DIV. r L r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 i 612-571-3450 �q �(� �� NUMBER 910-F15 REV. DATE 9/14/79 PAGE OF APPROVED BY JOB ADDRESS 6210 Rice Creek Drive N.E. 1 LEGAL DESCR. LOT NO. 7 BLOCK 1 TRACT OR ADDITION SEE ATTACHED Rice Creek Estates 2nd SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Timothy D. Solberg 6210 Rice Creek Drive N.E. 571-4105 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 ❑ ADDITION J7 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install free standing fireplace Heatilator Model #3138 EP 9 CHANGE QF USE FROM TO STIPULATIONS SEPERATE PERMITS REQUIRED FOR WIRiNCS wAnNG, PLUMBING AND SIGNS* SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD 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 S0. 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 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK W14L BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT VALUATION $1,500 SURTAX $.75 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 PERFORMANCE OF CONSTRUCTION. $9.00 ' PLAN CHECK FEE TOTAL FEE $9.75 SIGNATURE OF CONTRACT O OR UTHORIZEDAGENT (DATE) 11 WHEN PROPERL V LIDATED HIS IS YOUR PERMIT .. ® 7_ .. BLDG WSP D T SIGNATURE OF O NE U ER BUI I 11*TE) M CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) OWNER: 1-y 1), 5o��,efg ADDRESS: Ria C-XeC'K_ fir. TEL NO: 5i1-4105. BUILDER: - S f } M E ADDRESS: TEL NO: Construction Location STREET NO: ��® STREET: LOT: BLOCK: !�� ADDITION: R�c� C�ee1< I✓S�CiS Corner Lot: Inside Lot: Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION ICr reDk Ce. Front: NkkT►LI Square. Feet_ ftdc I * 3+38 t - Depth: Height: Cubic Feet: Front: Depth: Height: Square - Feet: Cubic Feet: Type of Construction: Estimated Cost: $ 4.b Be Completed: 1 mpyym 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. a DATE: 01 //4-11 SIGNATURE : Stipulations: 9 too . City of Fridley AT THE TOP OF THE TWINS SUBJECT BUILDING PE MIT 1781 21781- r COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 612-571-3450 RECEIPT N0. NUMBER 910-F15 REV DATE 4/5/93 PAGE OF APPROVED BY JOB ADDRESS 6210 Rice Creek Drive NE 1 LEGAL DESCR. LOT NO. 7 BLOCK 1 TRACT OR ADDITION SEE ATTACHED Rice Creek Estates 2nd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Fred Haggar 6210 Rice Creek Drive NE 571-5796 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. D & D Home Improvement Inc. 7401 Central Ave NE Fridley 5 432 784-7543 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 ❑ ADDITION ❑ ALTERATION X REPAIR ❑ MOVE El REMOVE 8 DESCRIBE WORK Reroof Dwelling (16 Squarest Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 SO. 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $864 $450- PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIO OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCT ON R THE PERFORMANCE OF CONSTRUCTION. $23.001, Fire SC $.86 PLAN CHECK FEE TOTALFEE License SC $5.00 $29.36 SIGNATURE OF CONTRA TOROR AUTH ED AGENT (DATE) HEN PROP IILY YALrDAD THIS IS YOUR PERMIT � SIGNATURE OF OWNER, iF OWNER BUILDER) IDATEI Z7 BLDG INSP MATE NEW [ ] Effective 3/1/92 ADDN { ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: &jgo�CAS Legal Description: Owner Name & Address: Tel. #_%�'� 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: Length GARAGE AREA: Length DECK AREA: Length OTHER: DESCRIPTION OF IMPROVEMENT Width Height Width Height Width Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [ J Inside Lot { J Ft. Yd Setback Side Yard Setbacks Type of Construction: 7e; � � eS,h�,6v Estimated Cost: $ L/ Approx. Completion Date: ®�/�� W,i "s,Meld e A (cost on Back) Driveway Curb Cut Width Needed: Ft. + b Ft = Ft x $ = $ DATE: APPLICANT: Tel. # Permit Fee $ Q Fire Surcharge $ State Surcharge $ SAC Charge $ License Surcharge $ -f--00 Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: CITY USE ONLY 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 [ ] CITY OF FRIDLEY INSPECTION DiV 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On August 1, 1995 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE Now Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater —Electric Water Heater — Gas** V Gas Range" Gas Dryer** Back Flow Preventer Required )Yes No Type $7.00 $4.00 $5.00 $7.00 $7.00 $7.00 $7.00 $10.00 $7.00 $10.'00 $10.00 $10.00 $15.00 TOTAL JOB ADDRESS �u6 PLU- CVP -4 �rl'"- The undersigned hereby makes application for a permit 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. NQU,4w - "Lo I 49WKSl Owner � `'!q � ., -7 / - � ? 7 Building Used As KsJt1,-cQ- Estimated Cost —t 0, Tb PERMIT NO. PLUMBING OMPANY &(Ukit kSTAS Reinspection Fee $42.00/Fir SIGNEDSY TEL NO. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS V V 1.5% of Value of Fixture or Appliance Approved By Rough—In Date Final Date State Sur;harge $ .60 MINIMUM FEE FANY PLUMBING GAS PERMIT IS M.00 TOTAL FEE $ 20� PLUS THE 1.60 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 80 INCHES. nnal Urinal Wash r Shower Tray Floor Drain Q j Auto Washer r Water Heater Range Gas, Elec Stories Basement 'flirvlP -01 Floor I Floor 2 01 F Floor 3 nil HIM; EH Floor 4 PLUMBING FIXTURE RATES: NO. RATE Now Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater —Electric Water Heater — Gas** V Gas Range" Gas Dryer** Back Flow Preventer Required )Yes No Type $7.00 $4.00 $5.00 $7.00 $7.00 $7.00 $7.00 $10.00 $7.00 $10.'00 $10.00 $10.00 $15.00 TOTAL JOB ADDRESS �u6 PLU- CVP -4 �rl'"- The undersigned hereby makes application for a permit 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. NQU,4w - "Lo I 49WKSl Owner � `'!q � ., -7 / - � ? 7 Building Used As KsJt1,-cQ- Estimated Cost —t 0, Tb PERMIT NO. PLUMBING OMPANY &(Ukit kSTAS Reinspection Fee $42.00/Fir SIGNEDSY TEL NO. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS V V 1.5% of Value of Fixture or Appliance Approved By Rough—In Date Final Date State Sur;harge $ .60 MINIMUM FEE FANY PLUMBING GAS PERMIT IS M.00 TOTAL FEE $ 20� PLUS THE 1.60 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 80 INCHES. Building PLUMBING Permit No. Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604CITY (}F FRIDLEY D n� @ DATE _ a - OYOUR E-MAIL ADDRESS SITE ADDRESS c 1r, THIS APPLICANT IS: G OWNER PQONTRACTOR PROPERTY NAME: TOWNER/ ADDRESS:- �C�,�(Yl @,OF j CITY Fi1C��ILJ�,q STATE, g7_IP PHONE:v! 1 - r5 9 01 CONTRACTOR NAME: Cham on n , Q PYA SUBMIT A COPY OF STATE LICENSE SJR -365J-9440 00EXP DATE _ YOUR STATE ADDRESS: 3670 Rd. CITY STATE ZiP LICENSE WITH PHONE Eagan, FAX APPLICATION PERMrr TYPE It SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW VREPLACEMENT DETAILED DESCRIPTION OF WORK wacp 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) _ BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING _ _ —BATHTUB _ GAS PIPING wu) cn7ucFjao _ SWIMMING POOL SOFTNER ($35) —WATER _ CLOTHES WASHER _ KITCHEN SINK _ WATER CLOSET BACKFLOW PREV. ($15) _ —DISHWASHER _ LAUNDRY TRAY ,WATER HEATER ($35) FOR IRRIGATION WATER METER —OTHER PFiM .., _a.gxs +y y� " ,rz r s {�. �y ',, at. 2� f a: --'I RM Number of fixtures @ $10.00 x $10.00 = $ Permit Fee Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ State Surcharge = $ .50 Total = $ 7 HIS 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 requires review a ai of plans. SIGNATURE OF APPLICANT ---� + �45PRINT NAME ( DATE � O -0-0:7 A -MOM Im City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 imm