PRE 2010 DOCSJob Address
Permit No.
PLUMB)ING PERMIT APPLICATION
City o rid➢ey
r
AT THE TOP 0P TME TWINE
i
r r'L-------CcaNIVNITY DEVELOPMENT DIV.
Kind of Building
PROTECTIVE CG CT*M 69®T.
Completion DateLy��%
.-- i CITY HALL FMOLOY {b5$
Job Address
Permit No.
PLUMB)ING PERMIT APPLICATION
A-13-75-
7
-13-75—
Auuress Phone
f7 9-Q Al %F
Plumbing Contractor Address Phone
Kind of Building
Use
Completion DateLy��%
Estimated os
Plumbing Fixture Rates: NO. RATE TOTAL
—
W
i i�
Number Fixtures % x $2.00 S
i
Future Fixtures x $1.50
aostlDl
•�'
I
New Fixture -Old Open. x $1.50
--I —
'lddtll
I i I O
f Catch,Basin x $3.25
8YD
Water Heater -99,000 BTU_ x $3.00 3_®o
•791NI
I I i
(!
i
I
Ground Run Old Bldg. x $3.25
eaa,
II
'MN IYaI
I I t
Elec. Water Heater x2.00
$
sd. 8NI8Y9
I
N�1V�I
jmiz
f
I i I I •°
I _Gas Fitting Fees:
:M G $NIYLO
I OD
I
3 V00.4I
0.
lst3 Fixtures x $2.00
10
I I
Additional Fixtures x $
.75
d•1Nnod NNlaal
( ( ` I
Gas Range -199,000 BTU x $5.00
�
IIJ� � SAYal
I rr
..
A w HstlM
I I I
I Repairs & Alterations I
See
! sxNls
I Description: Code
11
I I I
State Surcharge .50
I
I I
TOTAL FEE $ O
NAY®
f B
i
!The undersigned hereby makes application for a permit
for the work herein specified, agreeing to.do all work
ola,lo,o
in strict accordance with the City Ordinances and ruling
Department
•a21YM
ISI I I
of the of Buildings, and hereby declare that
all`the facts and representations stated in this
a
application are true and correct.
-cell v
4
-Signature �. Date
A-13-75-
7
-13-75—
City of Fridley12435
SUBJECT
P
irO
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
CEIPT N.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 � i
i CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
•--_ �����,,�
L J` 612-560-3450
910-F15
2/20/74
JOB ADDRESS 6441 Riverview Terrace N.E.
1 LEGAL
LOT N0.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
4
1
Veits 2nd Addition SHEET
2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE
Leif Henriksen 6434 Riverview Terrace BE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
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
IX NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBEWORK Construct a 30' x 44' Dwelling and a 20.51and 26' Garage
9 CHANGEOFUSEFROM TO
STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before
capping.
WATER LOCATION: 10' North of Sewer
SEWER LOCATION: 69.0' South of Manhole Wye Elev: 827.70
TOP OF FOOTING: 830.70 Minimum
SEPERATE PERMITS REQUIRED FOR WIRING,
HEATING, PLUMBING AND SIGNS.
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
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
R-1
1572+533
36 770
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
I
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.
$33 l64
16,.58
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRE ME TO GIVE A ORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS ANY OTHER qTE OR LO L LAW REGULATING CON-
$69.00
$300.00
STRUCTION R T O CE OF TRUCTION.
a
PLAN CHECK FEE
TOTALFEE
$385.58
SIG NAT REO CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY VXOD ED THIry IS YOUR PERMIT
BLDG )NSP DAT
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
i
91
APPLICATION FOR RESIDENTIAL, ALTERA`]'I()N,
OR ADDITION BUILDING PERMIT
CITY OF I -R I DLLY , MINNESOTA
OWNSW S NAME: 'Zr BUILDER:
—T-
ADDRESSU`76�&— &pyt/i eW tY`e, ADDRESS: 10l%S'y�` 1L� ru �•erLk_) Vd`.
NO'S e �ti yf T STREET •
r
LOT: BLOCK ; / ADDITION: V C: f 5 "qAo'tf. .
CORNER LOT: )/ INSIDE LOT: SETBACK: SIDEYAFD;
Applicant attach to this form Two Certificates of Survey of Lot and proposed
buildiaig location drawn on these Certificates,
DESCRIPTION OF BUILDING
To Be Used As:
/ Front: Ilkdepth: Height:
Square Feet: Cubic Feet:
ta.
t
Front: ��7epth : Height:
Square Feet; Cubic Feet:_ (<
Type of Construction: 9 �!e ,v- Estimated Cost:$�1�?�LL
To Be Completed: 1
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that -ill the facts and representations stated in this application
are true and corrvct.
DATE:���SIGNATURE:
(See Reverse fSid+e For Additional Information.) lie
v
u
t
SCALE:
I"=3
�^- Q'
74IS WAYZATA OLVIL
MINNEAPOLIS, M-IN9IESOTA
CU °O.OR(MVE 05:MA711
For LEI F HENRI KSEN
M'
DESCRIPTION:
Lot 14, Block I, VE'iT'S 2ND ADDITION
We hereby certify that this is a true and correct representation of a survey of
the boundaries of the land above described and of the location ofall building4
if any, thereon, and all visible encroachments, if any, from or on said land.
Dated this 15th day of 3ctohor 1973. EGAiJ, FIELD & NOWAK�INC.
5urveyo
= i le No 230 Book No -a 2009- 0 by � �
-a
o
e
�y
I
�T
I;
4
N •
i
DESCRIPTION:
Lot 14, Block I, VE'iT'S 2ND ADDITION
We hereby certify that this is a true and correct representation of a survey of
the boundaries of the land above described and of the location ofall building4
if any, thereon, and all visible encroachments, if any, from or on said land.
Dated this 15th day of 3ctohor 1973. EGAiJ, FIELD & NOWAK�INC.
5urveyo
= i le No 230 Book No -a 2009- 0 by � �
W
7-14
ANOKA COUNTY
6431 UNIVERSITY AVENUE NE August 1, 1974
Mr. Leif Henriksen
6434 Riverview Terrace N.E.
Fridley, Minnesota 55432
Dear Sirs:
560-3450
FRIDLEY, MINNESOTA 55421
Re: Electrical Permit Shortage
The following is due for the electrical work done at 6441 Riverview
Terrace:
10 - 20 Outlets $6.00
Please remit the above within 10 days of receipt of this letter.
Sincerely,
LEONARD EICHMILLER
Electrical Inspector
LE/mh
AppEcafto Tw Paws Rom vrA, Heavilz2g.agn � ������ Rego,
Ajr coa-VONW.Ing Symons and ova
SARA WARM AIR:
RATE
MTAL.
PN=mce Shell & Duct Work ... .....
. $10.00
$
Replacement of Furnace
6.00
4
Repair-, & Alterations—up to $500.00
600
$
Repairs & Alterations each add. $500.04
3W
IMCIL WARM AIR
Furnace Shell & Duct Work to 120,000 RTU
..$10.00
$
each add. 60,000 VIV
3.UU
S
Replacement of Furnace
6.00
$
Repairs & Alterations—up to $500.00
6.00
$
Repairs & Alterations each add. $504.00
3.00
$
STEAM oY HOT WR'I'ER SYSTEM
Furnace Shell & Lines—to 400 sq. it. FMR Steam $10.00 $
Furnace Shell & Line --to 640 sq. ft. EDR Hot Water I0.00 $. 1
0.00
Each add 200 sq. ft. EDR Steam 3.Ot1 ;
Each add. 320 sq. ft. EDR Biot Water 3.00 $
OIL BURNER—to 3 ,gal. per hour 6.00 S.
over 3 gal. per hour—See Fee Schedule
GAS DURI R (up to M.000 BTW &00 5.00
over 193,0060 WM See roe Schedule
GAS FITTING r NO RATE TOTAL
1st 3 Fixtures 1 x$ Z00 i 2.00
Additional Fixtures x .76
Gas Range to 199.0W x$ 5.00 $
0 OWN
ow of
n.;.
li d �� / - ;7
State Surcharge .50
Fee
TOTAL F= 20.50
V i 4� :'1''
s's`„.a�. • i.. �-W. 1.
City of Pridley:
The undersigned hereby makes application for a permit for the work hereW.
specified. agreeing to do all work in strict accordance with the City Ordinancev
and ruling of the Department of Buildings, and hereby declares that all the fad
and representations stated in this application are true and correct.
Fridley, Mnn April 19 . 10 7�
Owner Leif Hendrickson
Kind of Building Frame
Used as Resident House
To be completed about. Jime 30s 1974
Estimated Cost $ 1,800'00
New. Building Permit No. _-- permit IQo.
DENCRLMON OF WOR
HEATING or POWER PLA Hot Wetwr Flo 1
American Standard
Trade Name size .hyo OPM -6
Capacity—?65 — rq. lit. ED.R 165,000 r, -
Total Connected toed 95,160 AM ot lit Gas
BURNER — Trade Nnm.American Standard M CHAR -6
Capacity 765 Sq. Ft. EDn165.1000BTU— ZVI
r
40MA S--0valt)
"
i" •;;w w '� :rte* ,� ?'F?,;a 7�" G
;-�- .�? cupl ,!`f `>!^r....i7.+� r. �+ �',.+....�: ,,►p ��rrr•+�� ear. Q,A f,-��,.-.` �1hm- TA•,.s-',_. Isotid
..a. d. r'y`a ¢rS 7'a.n '�' 8 m�a'.oi $ G•. -.y Li.a•..Y �0..2.eL,n. �:,a P ti�c�::ia� C'G6b ai�ir�a+Tet c�e Tr"a.u.: o��v3Yr:a6�' .
Ta ae, i.. p vgr J
b°gSd
PARTIAL RATE SCHEDULE
GRATM WAPW Rill:
F'aaaee Shell & Due, Work
Rep'scvmert of Films -e
P•cpa:r- & Alicrat.ons- up to 3300.00
Repairs & Alterations each add. S500.00
IMCI-L WAR14 AIM
Furnace Shell & Duct Work to I20,000 BTU
each add. 60,000 BTU
Replacement of Ftrnacr
Repairs & A'terations--up to $500.00
Repairs & Alterations each add. $300.00
TVZ i. TO _1 AL
6.00 $
6,10 S
3W $
..$1000
$
3. vi
S
6.00
S
6.00
$
3.00
$
STEAM cz HOT WATER SYSTEM
.F'r.-:ace Shell & Lines -to 400 3q. ft FDR Stearn $!0 on- S
Furnace Shall & Line --to 640 sq. ft. EDR Hot Water 1000 S.
Each add :00 sq. ft. EIIR Steam 31X1 $
Each add. 320 sq. ft EDR Hot Water 3.00 $
OIL BUP.NEP.-to 3 gaL per hour 6.00 $
over 3 gal. per hour -See Fee Schedule
GAS BURFTTZ11 (up to M,000 BTL) 5.00 $
mer 1^9.000 BTU Sae Few schedule
GAS FITTING FE -E 3. ILIO RATE TOTAL
1st 3 Fixtures x$ 200 S
Additional Fixtures a .76
Gas Range to M.Mo 235.00 $
gnat cONDrr ON FGT4 State Su�rcha Se /0.50
C � 1' L�7Y
V73;T Arizz 373T1.1.13 a
ALT`RATTOI S & F.t'PAin TOTAL sig A
lwAL 2.—.4- -2
Drt. of Bl3vs. M--nw 5'Z3 --334-M
City of Fridley:
The l:ndersigned hereby makes application for a permit for the worts here;
spec:fit-d agrt-vmg to do all work in strict accordance with the City Crdinaint
and rrl;rg of the Dep n trront of Buildirgs, a:.d hereby declares that all the fac
and repr'.-sontatiuns stated in this application are true and correct.
Fridley. Minn `/_- � Z__ ,��
Owner
Kind of Building
Used as
To tie completed about
Estimated Cost:, S
Old New. Building Permit No Permit No.-
��
Cyt✓.oma Or w onx
HEATING or POWER PLANTS -,Stearn, Not Water, Warm Air -No
Trade Name _
Size No
Capacity_. _._- __ Sq. Ft. E.D.R
BTU K
Total Connected Lard __—
Rind of Tuel
BURNER - Tri Name
Size No—
Capacity _ Sq. FI. EDR
BTU 1�
ts.£�smaas-.ovs�a,
��Sv o �
53-84-s-915.5. _
Cit-/ of Pridloy
PPICS:Iai fz7 Mumbling c..s G-=
'P-C+.i.
?
Dopt. of Bldgs. Phone M -3M
DESCRIPTION OF V10112; 6441. Riverview Terrace
Nuinb�or. KL -%d and Locclion of Fixtures .
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
IIuz
Number Fixtures ................
x $2.00
$
Future Fixture Opening ...........
x $1.50
$--
_New
New Fixture Old Opening.....:....
x $1.50
O� J
Catch Basin . . . . . . . . . . . . . .. . . . . .
H
$
WATER "TR.
x 53.04
$
.
x $.3.25
$
r2v-tris Vtntar Haatnr............ .
a $2.00
$
aAS FITTING FEES:
NO. RATE TOTAL
Ist 3 Fixtures ............ • .
.o,v
$ .
Additional F/xtures ...............
I
$
Gas Range to 199.000 BTU ...........
x $5.00
5
Base
ist
Ins
G
s
ri 1
3:d
• Furors Coo :e:Zi.,^a O'Poc:nra
Coa»cc:^.d• ctiiia
Cl
_ Xs.w Fis.turo. Old OPonin,a
Cc: l
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ................
x $2.00
$
Future Fixture Opening ...........
x $1.50
$--
_New
New Fixture Old Opening.....:....
x $1.50
$--
Catch Basin . . . . . . . . . . . . . .. . . . . .
x $3.25
$
Water Beater 'Up to 99.000 BTU) . • • •
x 53.04
$
New Ground Run Old Bldg.......:.
x $.3.25
$
r2v-tris Vtntar Haatnr............ .
a $2.00
$
aAS FITTING FEES:
NO. RATE TOTAL
Ist 3 Fixtures ............ • .
x 52.00
$ .
Additional F/xtures ...............
x $ .73
$
Gas Range to 199.000 BTU ...........
x $5.00
5
City of Fridley:
The undersigned hereby makes application for a permit for the. work herei
specified, arreeing to. do all work in strict accordance with the City Crdira-ct
and ruling of the Department of Buildings. and hereby declares that all Ole fact
and representations statcli in this appllcaton are true snd correct
Fridley, Minn 7-17-75
Owner Fred G. Foster
Kind of Building Frame
Res.
Used as
To be completed about 7-24-75 ---
Estimated C6st, $ 10.00
Old—TW Building Permit No. Porrait No. v -=5
Signet i' ) ✓✓�/® - ,f
A.� T .»� m
By
Businrss Phune bio
ROUGH
FIXAL 47 9 - 2 (.
P.EPAIRS & ALTERATIONS—Rotor so Code .50 State Surcharge
De cription ........TT)stall.c*as.Gsill...............5—cc— .
TOTAL FEES 0 .
G asp �A" 1–;urcNArge, 500 '
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 57 1 -1 -1M7
July 22, 1994
Kathleen Surratt
6441 Riverview Terrace N.E.
Fridley, MN 55432
RE: 6441 Riverview Terrace N.E.
Dear Ms. Surratt:
Recently, the City's Public Works Department informed me that you
have placed landscape materials adjacent to your driveway in the
boulevard area. Since this landscaping is extremely close to the
curb, it may be damaged by operation of the City's snowplows or
other maintenance equipment. Please realize that, if you keep this
landscaping at its present location, the City will not be
responsible for any damage caused by its street maintenance
equipment.
Feel free to call me at 572-3595 if you have questions or wish to
discuss this further.
Sincerely,
Steven Barg
Planning Assistant
SB:sb
CE -94-369
SUBJECT
City of Fridley�'
3 3 41
AT THE TOP OF THE TWINS
BUILDING PERMIT
`
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
______
r PROTECTIVE INSPECTION SEC.
/� ��
E
NUMBER
REV
DATE
PAGE OF
APPROVED BY
1 I CITY HALL FRIDLEY 55432
j 763-571-3450
910-F15
4/9/03
JOB ADDRESS 6441 Riverview Terrace NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
1
Veits 2nd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Craig Smith 6441 Riverview Terrace NE
763-571-8627
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
James K Zahorski Construction 6430 Riverview Ter NE, Fridley,
MN 55432 8902
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
612-269-7283
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION REPAIR
O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (28 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must meet the State Building Code.
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
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
1 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$3,242
$1.62
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 $3.24
STRUCT OR THE PERFOR ANCE OF CONSTRUCTION
$97.25
PLAN CHECK FEE
TOTA FEE
_
Lice C $5,f
1 07.11
G ATURE OF CONTRACT OR AUTHORIZED AGENT iDATE,
N PROP VALID
HE10
TED HIS IS YOU PET/J/
BLD IN P 00r
i yam(/
F)A1E
SIGNATURE OF OVUNER IIF OWNER BUILDERI IDATEI
NEW [ ] CITY OF FRIDLEY Effective 1/1/2003
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: e'k L)kou Q LJ [C. CQ
Legal Description: _
Owner Name & Address: Gxc-" �� "^� Tel. —7
Contractor: `1i Cc)r�+k�jcyMN LICENSE # t��l
Address: Gy 3a P—� J9((yk s L) Thi((Aa2 Tel. # L9la awl'
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: Len Width Hgt/Ground Sq. Ft.
f3 I
OTHER: O k L f�
Construction Type: 1�e��C O �� Estimated Cost: $
4,
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x�$ _ $
DATE: t a n APPLICANT: Tel. #
Call (763) 572-3604 for Permit Fees if maiion in application. Fax to 763-5714287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
$
, ,�7,/-'9� Fee Schedule on Reverse Side
Fire Surcharge
$
001 of Permit Valuation (1/10th%)
State Surcharge
$
' _ $.50/$1,000 Valuation
SAC Charge
$
$1275 per SAC Unit
License Surcharge
$
'r ' i, $5.00 (State Licensed Residential Contractors)
Curb Cut 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
$
STIPULATI®fi1S�
Building
PLUMBING
Permit No.�
InspectionsR]ESID]ENTIA.L
APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Recd: 2P __0
DATE August 25, 2006 YOUR E-MAIL ADDRESS wnelsonCa7larsont)lumbing.com
SITEADDRESS 6441 Riverview Terran .P_ NF
THIS APPLICAIN'T IS: Q OWNER IHCONTRACTOR
PROPERTY
Nom: Michele Smith
OWNER/
ADDRESS; 6441 Riverview Terrace NE CrrY Fridley STATE MNZIP55432
TENANT
PHoNE: 763/571-8627
CONTRACTOR
NAME: Larson Plumbing, Inc.
SUBMIT A COPY OF
STATE LICENSE P 3341 PM EXP DATE 12/31/2006
YOUR STATE
ADDRESS: 3095 -162nd Lane NW CITY Andover sTATEMN ZIP 55304
LICENSE WITH
PHONE 763/427-7680 FAX 763/427-9448
APPLICATION
PER.NQT TYPE
IR SINGLE FAMILY O TWO FAMILY Q TOWNHOUSE
TYPE OF WORK:
O NEW 2 REPLACEMENT
DETAILED DESCRIPTION OF WORK Water Heater Replacement
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whicnever 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 (NEw Cnrucwz) _ SWIMMING POOL WATER sOFTNER ($35)
_ CLOTHES WASHER KITCHEN SINK_ WATER CLOSET BACKFLOW PREY. ($15)
DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35)
_ FOR IRRIGATION
_ WATER METER —OTHER
.. .. _ .... y. v . r f, f iRi ..<F !-i : '"'Ir:+:•L i •: T.. ;xl � 8' ly r: ' 13 •'�-
£ �£•:���.1EC O;1Z< X00, a� � ,, .. , .: �. •:n .�',
Vit .......... ........ ., ..,.. <..., ...• ,�.r :;�r:. ..�,,.:. ;rn:�tr d1?E�� .1;%�O'R`� ��7E�FS=O
Permit Fee $ _ 35 00 Number of fixtures @ $10.00 x $10.00 = $
ie
Surchar .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE S. 35 .50 Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Total = $
THIS 1S 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 Ce all wo whi uires r view d approval of plans.
SIGNATURE OF APPLIC PRINT NAME Michael Malonski DATE 8/25/06
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City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977