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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N9(:5j2jf Date: - Owner: Builder Address Address 1 LIPATIPNfEl BUILDING �-� NO. .�e - Street Partp#of Lot Z /2 _-Block Addition or Sub-Divisi- 0� Comer Lot __ Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING Tp,,* Used Front Height Depth Sq. Ft,' Cu. Ftje� Olt, I Depth Height Sq. Ft. 10 Type d/Construction 2 Est- Cb a*Mr. To be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do the ed work In accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of permit Is hereby granted 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 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 ,21 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 then hems. -0 ­ -,jk- APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner's Name Builder Address Address 01 OF BUILDING No. Street ,(___ Part of Lot Lot Block ,� Addition or Subdivvo isi Corner Lot Inside Lot ! Setback ffj— Side -Yard �C/ SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building. location. DESCRIPTION OF BUILDING To be ed as: Front 6 Depth Height -, Sq. Ft. Cu. Ft. FrontDepth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost w To be Completed 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 -arjepresentations stated in this application are true and correct. 1 C // DATE SIGNATURE.��f�( (A Schedule of Fee Costs can be found on the Reverse Side.) ,6 City of Fridley Application for P°lunmbing and Gas Fitting permit Dept. of Bldgs. Phone SII 4.7470 w r DESCRIPTION OF WORK Number, Kind and Location of Fixtures N n y Number Fixtures ...................... x $1.5o y vz� �. z ha a '� oQ z 3 Z u•i �jO J w 0 ZZ z R • N WATER HTR. GAS ELEG / ! x 2.00 $ 0 New Ground Run Old Bldg . ............ x 3.25 $ 00 NO. RATE TOTAL` Q U� Q dad $� - �O x .50 $ Gas Range to 200,000 BTU .............. m x 2.00 $ Base 1 1st 2nd 3rd 4th • Future Connection Openings Connected with I Sewer � New .fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.5o $ /� - 6 Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ...... ..................... x 3.25 $ Water Heater (Up to 200,000 BTU) ...... / ! x 2.00 $ 0 New Ground Run Old Bldg . ............ x 3.25 $ 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 $ 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. Owner Kind of Used as To be completed about — Estimated ost, $ Old— ew adding Permit ROUGH S � ;L � ' � I FINAL d2 2M By t!:�L�L Business Phone Application for Power Plants and Heng, Cooling, Ventilation, Refrigeration 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 ............... MECH. 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 .............. RATE TOTAL 8.00 $ 5.00 $ 5.00 $ 2.50 $ 8.00 $ 2.00 $ 5.00 $ 5.00 $ 2.50 $ STEAM or HOT WATER SYSTEM 3 Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ 'A' Each add. 200 sq. ft. EDR Steam ................. I .... 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 $�7 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 $ REMARKS: Dept, of Bldgs. Phone SII 4-7470 Location 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. Fridley,,1Vlinn. �� v � 19&rc Owner 195— Kind of Building - ¢ 195— Used as To be completed about - Wil? '- Estimated Cost, $ 19! New. Building Permit No.' -16 DESCRIPTION OF WORN HEATING or POWER PLANTS—Steam, Hot Water, WarmAir,—No `/-'tea Trade Name Size No- r j Capacity C Sq. Ft E .R BTU H.P. Total Connected Load Kind of Fuel BURNER — Trade Name (-( I , ° ;- ' �- Size No Capacity. 11 POST IM -12-58 Sq. Ft. E.D.R. ' BTU H.P. Signed' a ' y By J-1 Business Phone No_` ° - Farm ODS HEAT LOSS CALCULATIONS BUILDIN& UEPAIUMENT COLD.EN VALLEY, MINN. Weatherstrips A.S.H.V.E. Construction No. Insulation Windows Doors Guide Reference Out. Wall .Int. Wall Ceiling Roof Floor Kind How Applied Yes—No Yes—No 19 / FI. I'! __. Room I Leneth /f' G Width / Heieht FI.1 lC i -rriv-A- Pd Room I Length /_"41 Y&, Width l b Heieht B*,45 Windows and Doors—Cracka a and Area ~ Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. v' Go Coef. Btu Infiltration Btu 963 3 ry Glass P Glass Exp. wall 2 11b Exp. wall Net exp. wall /b (� Int. wall Net exp. wall 7*110 Floor 1171 Int. wall ®®q Ceil. /g'(, Floor f to Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI. I/ i tip. e.e Room I Length / 7/ Width /? G Height b Windows E nd Doors—Cracka a and Area Width Height No, of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No, of Lineal ft. Area No. of pane of p@n_p lights of crack sq, ft. Coef. Btu Coef. Btu Infiltration 3 ry Glass /, P Glass Exp. wall 11b Exp. wall Exp. wall Int. wall Net exp. wall 7*110 Floor 1171 Int. wall ®®q Ceil. 117 Floor Floor Ceil. A fff SAM Total Btu. 913 '?v Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI. I 24AMW Room I LengtV:V s � Width Height �o Windows and Doors—Crackage and Area Width Height NoofLineal ft. Area No. of pane of pane, lightsof crack sq. ft: Btu Infiltration & 0 e Glass Exp. wall Net exp. wally G Int. wall _Floor / Ceil. 2— 1l� 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 O Infiltration $ 3 ry Glass /, s�3- ing Exp. wall 11b Exp. wall Net exp. wall' Int. wall / D.� Floor 1171 f ®®q Ceil. 117 Floor Total Btu. Required sq, ft. E.D.R. or sq. ins. W.A. Leader area FI. I AYMi, K__ Room I Length l b ® Width A/ ,4 Heieht . Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No, of pane of pane lights of crack sq. ft. Coef. Coef. Btu Infiltration cl-D 6V a o Glass ing Net exp. wall 11b Exp. wall Int. wall Net exp, wall D.� Ceil. Int. wall f ®®q Floor Total Btu. 3� Required sq, ft. E.D.R. or sq. ins. W.A. Leader area b FI. I I4AI I'k,V Room I Length °, 4 Width /9 Vo, Height ° indoors 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 a cl-D 6V Glass Exp. wall 3 ing Net exp. wall 11b zboo Int. wall Floor Ceil. f ®®q Total Btu. 14% go Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I SUBJECTCr, City of Fridley 8638 AT THE TOP OF THE TWINS BUILDING PERMIT r CEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. NUMBER REV. DATE PAGE OF APPROVED BY /•"1 CITY HALL FRIDLEY 55432 612-571-3450 910-F15 I 9/10/86 JOB ADDRESS 435 Rice Creek Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 10 1 Rice Creek Terrace Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Harold Olsrud 435 Rice Creek Terrace N.E. 571-3077 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Lloyds Home Muprovement Inc. 1012 - 423�'Avenue N.E. 788-5602 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 1j. REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS 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 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 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 VALUATION SURTAX AND.ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $11400 $.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 OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $23.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE `r /r✓ $24.20 SIGNATURE OF-CONTRACTOR OR AUTHORIZE N (DA PC) WHEN PROPE RL ALI DATED THIS IS YOUR 7PEMIT n �J BLDG INSP r)AT _ SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI NEW [ ] ADDN. [ ] ALTER. [ ] ls� Construction Address: Legal Description: Owner Npme & Contractor Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: ss: City of Fridley �R-1 AND R-2 Building Permit Application Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Length Length Length DESCRIPTION OF IMPROVEMENT Width Width Width Height Height Hgt/Ground Effective 4/1/86 Tel. # %/- �3 of ? 7 Tel. # i d o2 Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Type of Construction: Estimated Cost: $ L.f�®� s G Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation DATE:� APPLICANT: Tel. Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS• CITY USE ONLY Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $475 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] DRAINAGE WEMENT The drainage easement 'Chu lot 10, bl�uk i, of Ries CreeR Tevvav,-- Plat 3, In see. 14, T-30, R.24, will j� Y;:<, most 10 feet of saK, lot 10. Yinden.Enyineeriny Co !no 6418 56th Avenue North hinnanpolis 22, Minnesota, II sueJEtTNO. City of Fridley 2 7 95 9 AT THE TOP OF THE TWINS BUILDING PERMIT P COMMUNITY DEVELOPMENT DIV. i PROTECTIVE INSPECTION SEC. r 3413 E i, I -"'1 CITY HALL FRIDLEY 55432 �'' NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910415 9/24/98 JOB ADDRESS 435 Rice Creek Terrace 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 1 1 Rice Creek Terrace, Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jim & Nancy Kell 574-9122 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Ron Miller Construction Inc 953 Mississippi St NE Fridley 55432 571-3514 6354 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE x 8 DESCRIBE WORK Reroof house & garage (24SQ) 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 ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 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 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 $2056.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1.03 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 PE FORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL E ®1 Li c e C $-,5. 0 $82.84 SII NA TU E OF G�� R AUTHORIZED AGENT jDATEi N P OPE ALIS BLD 1NSP PPR P R IT a � Kzdz Q E S-GNATURE OF OWNERdF OWNER BUILDER1 IOATEi II NEW [ ]t Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION A r ConstructionAddress: /C/Z L✓ e Legal Description: Owner Name & Address: J i eh d- ^1A,7 dY k1C L LI/ Tel. # 9/a r Contractor: < , ('L' MN LICENSE # Address: % 5 ,��, 5? 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. O'T'HER:i� �/2e- � � ���° � 19 4—Q sem, z 2/ $ 00 $5.00 (State Licensed Residential Contractors) Driveway Escrow $ 7z- Construction Type: $ $450.00 Conservation Plan Review Estimated Cost: $ e'70-�Z Fee Determined by Engineering Sewer Main Charge $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: &L—ZLAPPLICANT: ; % Tel. # STIPULATIONS: CITY USE ONLY Permit Fee $ ®7� Fee Schedule on Reverse Side Fire Surcharge $ 2,06 .001 of Permit Valuation (1/10th%) State Surcharge $ /,6-3 $.501$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ 00 $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: I 10 UkY FRIDLEY INSPECTION DIViSION Effective On January 1, 2000 643 ,University Ave NE Fridley, MN 554321 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS `tS,5_ Rl e -a RATE SCHEDULE OWNER Residential Rate Furnace Shell and Duct Work, Burner - Also Replacement Furnace $ 30.00 (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, $ 10.00 but not replacement) Gas Range $ 10.00 Gas Dryer $ 10.00 *Air Conditioning. All Sizes $ 25.00 All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. TOTAL BUILDING USED AS I -J i5�/'�` ESTIMATED COST PERMIT N0. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) arm Air $ Trade Name dA &P-t&k Size No. ,5 ? uH�l BTU 600W I— 4/3'oo-a HP RAy®Y-O $° ®® Fuel A­�q­ Total Connected Load Burner Trade Name Size No. $ �® BTU HP EDR $ .50 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 an rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. SUPERIOR 00AMTRACT 07`_ (DATE 6121 42nd Avonue No. HEATING-GO'n Crystcl, 1'Iln 5E Signed Approved liti��l�'i:� TEL # Rough -In Date Final Date COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes (N o ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No (� The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes � No The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specifications. Yes (,�,f`No ( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA -LAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes O No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type S9 U fit! a b 0 BTU Input 60-®®'0 F*ssis r Nat Appliance #2 Type alb QkJ 0 �® BTU Input oaz Far Nat Appliance #3 Type BTU Input Far Nat Total Appliances Total Btu Input Common Vent Type 64A:5S S • Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) hh) f4 1-01 1-- t Ete. �no' SUPERIOR OMMTRAO T 07' EMG 6121 42nd Avonue No. HEATING CO: -, /3 Crystcl, Mn 5;422 Signed By: Date: L/-'6 —,9 0 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 The undersigned hereby makes application for a permit for the work herein 4�f� IE::::>:::: �;:.:•:`;�� Urinal �#� Shower :: ;;:�rii��> Wash Tray ::::::: Int' ::�::>::::.�:. I��Iti.:..:. Floor Drain Washer .13B..:1::.:... :=::<> ter Heater Ran a �� .:::.::.;:. :: Gas Elec '' Stories :; .....::.:: t>rfi.:::.: Basement a $ 7.00 (� . 20 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner Water Heater -Electric $ 7.00 I F oor 1 Water Heater - Gas** $10.00 Building Used As Gas Range** $10.00 _ Gas Dryer** $10.00 Estimated Cost6 q PERMIT NO. Back Flow Preventer Required ( )Yes O No r Floo 2 (� Type $15.00 PLUMBING COMPANY Floor 3 I or 4 Floor PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESSL'1'.�#C-C New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 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 / r Rain Water Leader $ 7.00 (� . 20 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 Cost6 q PERMIT NO. Back Flow Preventer Required ( )Yes O No (� Type $15.00 PLUMBING COMPANY Reinspection Fee $47.00/Hr SIGNED BY TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved By Rough -In Date Final Date )-9- 60 State Surcharge $ .50 PL LU UM MINIM M FEE OR AN MBINGIGAS PERMIT IS $20.00 TOTAL FEE $ ° PLUS THE S.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE