PRE 2010 DOCSSUBJECT , -y'
PER O.
City of Fridley
1331
AT THE TOP OF THE TWINS
BUILDING PERMIT
.
r
RECEIPT NO.
� • ______ COMMUNITY DEVELOPMENT DIV.
L
r PROTECTIVE INSPECTION SEC.
����
I . �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
s..... 612-560-3450
910-F15
111/12/75
JOB ADDRESS 1541 Rice Creek Road N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6
3
Harris Lake Estates SHEET
2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE
Willard Kastenson, Mpls.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Brickner Builders, Inca 6245 Ben More Drive N.E., Fridley
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
NEW ElADDITION ❑ ALTERATION ❑ REPAIR ElMOVE 11REMOVE
X
8 DESCRIBE WORK
Construct a 37' x 27' Dwelling and a 22' x 24' Garage
9 CHANGE OF USE FROM TO
STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before
capping. Provide sod in the front and side yards.
SEWER LOCATION(Approx. 9' Deep) 231' East of Manhole (E. Inv. 887.37)
WYE ELEV: 891.48
TOP OF FOOTING: 894.48 Minimum
WATER LOCATION: 11' East of Sewer Service
SEPERATE PERMITS REQI�IIRED MIRING. Before digging call local vulmes
; IEUPHONE - ELECIRIC • GAS .Etc
HEATING, PLUMBING AND; iiGl1i$., —'IMPORTANT--
REQUIRED BY L
NOTIFY THE FRIDLEY ENGR.
DIVISION REGARDING CURB
REMOVAL AND REPLACEMENT
AT DRIVEWAY OPENINGS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
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
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.
17.58
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$35,160
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-
CONSTRUCTION.
$40.36
$325.00
STRUCTIOHE PERFORMANCE
/�
P�N CHECK FEE
TOTAL FEE
Z
/HORIZED
$382.94
SIGNATURE9F CONTRACTOR AGENT (DATE)
WHENPROPERLY VALIDATED THIS IS YOUR PERMIT
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
BLDG. INSP DATE
'.'
-APPLICATION FOR RESI'DENTIAL., ALTERATION,
OR ADDITION.BUILDING PERMIT
CITY OF FRIDLEY,'MINNESOTA
OWNER'S NAME :1WZ k111,0 BUILDER: A L ok s //i/ C
ADDRESS: ) Z S ADDRESS:- e A) 114 0
NO:. ��� STREET: / C e Cil ` e -e lY 9 - -
i3OT: BLOCK: DITION
CORNER LOT: INSIDE LOT. SETBACK: %1 S SIDEYARLD:
Applicant attach to this form Two Certificates. -if Survey of Lot and .proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
�S
Front: `� Depth: % Height:
Square Feet: Cubic.Feet:
Front: Depth : `� Height : i
Square Feet; Cubic Feet:
Type of Construction: �i�/�� Estimated Cost:_
TO -Be Completed:
The undersigned hereby makes application fora 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.
• DATE: / J %S SIGNATURE: �l1 � �i✓i✓/
(See Reverse Side For Additional Information.)* .
4
Jl� Sol ion,
40
t � � gatz a ra i ura m aw ata
E.:.. •
b
�Wvy/,41' ",
tr ll'�,,
ty
231
/7
ley
�J* 7
9
ANOKA COUNTY
6431 UNIVERSITY AVENUE NE December 2, 1975 FRIDLEY, MINNESOTA. 55432
D. W. Construction Inc.
8804 Lexington Avenue
New Brighton, Mn. 55112
Re: Grading Between 1521 and 1541 Rice Creep Road. N.E.
Gentlemen;
It has come to the City's attention that there may be a grading problem
between the houses at 1521 and 1541 Rice Creek Road. The problem.may exist
because one house is a rear walkout and the other is not.: The City's stand
on this matter is that the maximum allowable slope.is 2:1 and we would.
prefer a maximum of 3:1 for ease of maintenance, in lieu of this, a retaining
wall would have to be constructed.
At this time, the City is only bringing this matter to all parties involved
and recommends that those involved confer on this matter and resolve the
grading problem in the.spring.
If we can be of any assistance to you or if you have any questions, please-
feel free to call me at 571-3450.
Sincerely,
DARREL G. CLARK
Community Development Adm.
DGC/mh
CC: Ray Williams
1521 Rice Creek Road N.E.
L7
Cid I�idlay '
Appli ion for Pie�> bil-1-9 end' Gas r-1111 •0 PO -
--- Dept. of Bldgs. Phorte SM -34W
DESCRIPTION OF V,'OrZr. Locatl�
Hum!>er, Kind vnd Loerllva of Fixtures .
City of Fridley:.
w
G
En
NO. RATE
�
TOTAL
Y2.00.
$
Number Fixtures ................
Future Fixture Opening ............
x $1.50
$ .
-•
WATE4 MTA.
x $1.50
Catch Basin ....................
x $3.25
$
x 53.00
$`
Water Beater 'Up to 99.000 BTU) • • • •
few Ground Run Old Bldg.........
x $.3.25
$
Voctric Water Haatnr..............
Bast
$—
AS TITTING FEES:
NO. RATE
TOTAL
`
1st 3 Fixtures ......••••••••••••
�G.__ X $2.00
$
Additional Fixtures ................
x $ .75
$
I st
x $5.00
b
JLI-•
2nd
—
3rd
4th
• Futu:a Ccaaac:i:n G,-Qria.:s
i }tans F1r:urv. Old 0;4nirgs
PARTIAL RATE SC.HEDULE
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinarce
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, Minn ,C — I9Z
Owner
Kind of Building
Savar Used as
Cesspool (].
LUMBING FIXTUIRE RATES:
NO. RATE
TOTAL
Y2.00.
$
Number Fixtures ................
Future Fixture Opening ............
x $1.50
$ .
-•
New Fixture Old Opening..........
x $1.50
Catch Basin ....................
x $3.25
$
x 53.00
$`
Water Beater 'Up to 99.000 BTU) • • • •
few Ground Run Old Bldg.........
x $.3.25
$
Voctric Water Haatnr..............
r $2.00
$—
AS TITTING FEES:
NO. RATE
TOTAL
`
1st 3 Fixtures ......••••••••••••
�G.__ X $2.00
$
Additional Fixtures ................
x $ .75
$
Gas Range to 199.000 BTU ...........
x $5.00
b
To be completed about
Estimated Cost, $
Old -=New. Building Permit
ROUGH
ALTERATIONS—P.afer !o Code .50 State .Surcharge
.I3e TI;tlon........................................$
TOTA'Lr $
Signed
��±.veP° r^?a^A.., P.qt r+. t•. p F �^?^+11s ,,}f;; iTAtt..-s$ �i,,,,� F?k,.•-•p4cR' ...R%n. Izw�@ »�.�..+.,n£,..�,
K ¢Jam wt;�-.:.9� £ti'� 8 �e,�,;, a r.r•.m.a �:<s�i S'a•:,.�.;a..�.+�,q '6�wPz�aL't.-fit iTCttu6:k:wIIY•�i37ij aa4..�:,�.�.�:e�,a6l,uer� md
G"iit3 �n�att+.iau.,s4� dp6eaDbJ a.ci:,8 De'V1=3 -
PARTIAL !ATE SCHEDULE
GPtAVM WARLX AIR: Ri a TOTAL
F.,aace Shell & Duct Work $10.00 $
Replacement of Furna+•e 6.00 $
Repairs At Alterations— up to 5500.00 is, oo S
Repairs &: Aiterations each add. S500.00 3 ti $
DMCI- . WARM AM
Furnace Shell Duct Wnrlc to 120,049 BTU
eu:h add. 60.000 BTU 3.i7U E
Replacement of 11%rnece 6.00 3
Repairs & Alterations --up to $590.00 6.00 $
Repairs t Alterations each add. $500.00 3.00 $
STEAM oz HOT WATER SYSTEX
Eternise Shell Rc Lines --to 400 sq. ft FDR Stearn
V0.00
$
Furnace Shell do Line- to 6-40 sq ft. EDR Not Water
1000
S.
Each Add 200 sq. ft EDR Steam
i m
$
Each add. 320 sq. ft EDR Hot Water
3.00
$
OIL BURNER—to 3 gal. per hour
6.00
S.
over 3 gal. per hour—See Fee Schedule
GAS BURNTR Cup to Lo9,W0 BTU)
5.00
$ 0(%
ower Ig3.000 BTU See Foe 3-chsdti:lo
GAS i ITTING
I:•O .RATE TOTAL
Ist 3 fixtures �zb 2.00
S
Additional Flrtures ,'
A .75
Cas Range to M.=
zS 5.0D
3
AM COQ 1_T1OICnzGr
P'aLTI r'I�.�e'I.`3g3 ST37=2
ALL �F.A'3'FCRB & FtEP.�Ii�
State Surcharge .50
t3
Soo Foo SCW,=%6
ToTaL rzzm, f7
Npt. of Bid'so. ph*ria .�i.�i�S33
• t
City o4 Fridley:
The underQigned hereby makes application for a permit for the worst herds
specified agrc�tng to de 21I work :n strict accordance with the City Ordinance;
and n:ling of the Depa: tment of Buildings, and hereby declares that all the fa`-ta
and repr,.-sentatiuns stated :n this application are true and correct.
.s
Fridley. M --n Iw7
Owner
Kind of Building
Used as
To be completed about
Al
Estimated Cost;
Old—New. Building Permit No. __ _ Per:ait Pio. Y I
%r''''�r.�7 Q1`T OF wo"ai
HEATING or PGW teF Hot mater. Warm ,Psir—Na
Trade Name Size
Capacity - Sq. Ft. E.D.R BTIIi=Al_�
/�� igTotal Connected Ls�d mad cf Fs
BURNER — ,Ywde Nam- Size NO
capaci Sq. FL EDR- = L
(CMAaas—o"a)
I �N
W-0 ,(.fs/�' :/�� / I FCS%�
a
560-3450
Cit`pf
4
U
ANOKA COUNTY
N3.1 UNIVERSITY AVENUE NE
March
2, 1976 FSIDLEY, MINNESOTA 55432
Brickner Builders,. i dere,. Inc-
nc
6245
6245 Ben More Drive N.E.
Fridley,, Minnesota 55433
Re: Final ,Inspection at 1541
Rice Creek
Road H.E.
Dear Sirs
A final inspection was made on February 23, 1976 of the above address. The
following item were noted and must be completed before the construction can
be finaled out;.
1. Complete garage floor and steps to back door.
2. Complete wood, steps to deck.
3. Complete grading to agreed upon specifications with neighbor to the west.
4. Sod front and side yards.
5. Provide a hard surface driveway.
We will expect the above items to be completed on or before June .1, 1976.
Ifany problems arise that will prevent you from completing these items by
the appointed date, please contact us..
A,.reinspection will be conducted on or about June 1, 1976 to determine
compliance.
Sincerely,
RON HOLDER
Building Inspection Officer
RH/mh
CITY OF FRIDLEY
Effective Date May 1. 1988
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
RESIDENTIAL `
RATE
TOTAL
Furnace Shell and Duct Work,
Burner (Also replacement furnace)
$ 20.00
$
Gas Piping
$ 10.00
$
(piping needed with new furnace)
Gas Range
$ 10.00
$
Gas Dryer
$ 10.00
$
* Air Conditioning (all sizes)
$ 10.00
$
All Others/Repairs and Alterations
1% of Value of Appliance or Work
$
COMMERCIAL/INDUSTRIAL
1% of Value of Appliance or Work
$
State Surcharge $ .50
TOTAL FEE / $
Reinspection Fee ($15.00)
Rough Insp. /
Date
Final Insp .
Date
Approval for Permit I Y/
MINIMUM FEE FOR ANY HEATING PERMIT. IS $15.00
PLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
Job Address���
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
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 ,ltrue and correct.
Fridley, Minn. /1/U . 19�
OWNER
KIND OF BUILDING
USED AS AVL(
TO BE COMPLETED ABOUT
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
DESCRIPTION OF FURNACE/BURNER
`L 1 HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Total Connected Load Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
a
CompanyC�&
✓';�
Signed By
Tel. No.
Fill out back side for stack verification on replacement furnaces
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
I.
Has been carefully examined
Yes (,)
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
total BTU connected
Yes ( )
No ( )
6.
Has Total heating BTU's of
All other BTU's
TOTAL
Rema rk s
Company
Signed By
Date
O
CIlYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (6 1 2 1 57 1-3450 • FAX (612) 571-1287
March 25, 1994
Dolores Kastensen
1541 Rice Creek Road N.E.
Fridley, MN 55432
Dear Ms. Kastensen:
As you are aware, the City of Fridley has been reviewing the
possibility of amending Fridley City Code, Chapter 506 (Vehicle
Parking), to prohibit parking of large commercial vehicles on
residential properties. (Currently, this restriction only applies
to such vehicles parked on residential streets.) Based on a
previous conversation with you, it is my understanding that you are
interested in expressing your concerns when this matter comes
before the Fridley City Council.
On April 18, 1994, the Fridley City Council has tentatively
scheduled a public hearing on the enclosed ordinance amendment
proposal. This meeting will begin at 7:30 p.m. in the Council
Chambers at the Fridley Municipal Center (6431 University Avenue
N.E.), and you are invited to attend. If you are unable to attend
this meeting but would like to express your viewpoint on this
issue, please submit a letter to the City Manager or contact
members of the City Council prior to this meeting date.
Feel free to call me at 572-3595 if you have questions regarding
the proposed ordinance.
Sincerely,
Steven Barg
Planning Assistant
SB:ls
CE -94-92
SUBJECT
City of Fridley(
2468
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r
1 � i
NUMBERREV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
1.J
612-571-3450
910-F15
10/16/96
JOB ADDRESS 1541 Rice Creek Road NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
3
1 Harris Lake Estates
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Willard Kastensen 1541 Rice Creek Road NE
574-9459
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 ❑ ALTERATION J] REPAIR
11��
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (20 Sq) 2nd Layer
9 CHANGE OF USE FROM TO
STIPULATIONS
Roofing can be the 2nd layer but not the
3rd.
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
@
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,240
$.62
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 $1.24
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$43.00
PLAN CHECK F
FEE
Y7AL
$44.86
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
N P P
LY VA ID THIS IS YOUR PER IT
LDG INS
GATE
SIGNATURE OF CWNER 0F OWNER BUILDERI IDATEI
NEW [ ] Effective 3/1/96
ADDN [ ] CITY OF FRIDLEY
ALTER f SINGLE FAMILY AND DUPLEXES R-1 AND R-2�"� a
Building Permit Application
ConstructionAddress:
Legal Description:
Owner Name & Address: ,E Tel. #
Contractor: MN LICENSE #
Address: Tel. #
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: v
Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback
Type of Construction:
Approx. Completion Date:
Side Yard Setbacks
Estimated Cost: $ / -2
STIPULATIONS:
(Cost on Back)
Driveway Curb Cut
Width Needed:
Ft. + 6 Ft = F x $ " _ $ .
DATE: 10 ^ (l¢ -- q 4 APPLICANT:
_ Tel. #
CITY USE ONLY
Permit Fee
$ , 00
Fee Schedule on Reverse Side
Fire Surcharge
$ , a _
.001 of Permit Valuation (1/10th%)
State Surcharge
$ . ��,
$.50/$1,000 Valuation
SAC Charge
$
$900 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 [ ] Not Necessary [ ]
TOTAL
$
STIPULATIONS:
1=
CITYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287
October 2, 2000
Willard Kastensen
1541 Rice Creek Road NE
Fridley, MN 55432
Re: Final Inspection at 1541 Rice Creek Road NE
Contractor: KCJ- Mr. Rooter
Dear Mr. Kastensen :
A plumbing permit was issued on May 24, 2000, for the above noted address,
to install a gas water heater. According to section 4715.2800 of the State
Plumbing Code, a final inspection shall be conducted on the plumbing authorized
by this permit. As of this date no inspection has been called for.
You will be given thirty (30) days from receipt of this notice to respond. If we do
not hear from you, we will expire the permit and any inspections on this
installation will require a new permit.
Any questions can be addressed to myself at (763) 572-3603.
Sincerely,
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Effective On Jan 1, 2000
MARK NUMBER
OF
FIXTURES
TO BE INSTALLED ON EACH FLOOR
. .. Urinal
..::....:.
Shower
.
Wash
TraSto
O 1 -;:. Floor IrEt::::?:
Drain
Auto.
Washer
.....GasJim@
..... >:::::::::�:
Ran e
<h Water Heater
'es
Gas Elec
Basement ent
Floor 01
I
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES; NO. RATE TOTAL
New 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*`
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
Type $15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge $ .50
TOTAL FEE $
0
JOB ADDRESS /a
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..
®� 204-D
Owner �✓� �� 3 A
Building Used As
Estimated Cost ✓�� A`�
PLUMBING COMPANY A'�Cj_
SIGNED BY
Approved By
PERMIT NO. /0?C%COD
TEL N0. +
Rough -In Date Final Date
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE