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PRE 2010 DOCSBUILDING PERMIT DESCRIPTION OF BUILDING To be Used as: d6 t�sn...... Front Depth 3` . Height Sq. F'i.......... Cu. Ft, ........ �r Front .f.. Depth .. ,;... Height ......... Sq. Ft......... Cu. F , ........ Type of Construction .,,-:d:a... Est. Cost ...°'. ; , . To be Completed In consideration of the issuance to me of a permit to construct the building described above, I aIgee to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the village of Fridley. a.. ( ry In consideratiptiof the payment of a fee of $.., permit is hereby grantedf fo r:.'- ,•.tp 1. i� to construct the building oaddition as described above This permit is grated upon the express condition that the person to whom it is granted and his agents, employees and workmen,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 with- in the village limits and this permit may be revoked at any time upon volation..any of the provisions of said ordinances. .� ' �� Y :'_ uilding Inspector NOTICE: This permit does not cover the construction, installation or alteration for wirings plumbing, gas sewer or water. Be sure to see the Building Inspector for separate permits for these items. Village of Fridley, Minn. N? 2 � 5 4 Date:............................. Owner �;p;t a '..��� ;': . Builder ................................ i. ....... . Address YV ....... ... ...... Address li......... . LOCATION -OF BUILDING !. 7 �/ No. .... ... .. Street` . .. ................ rt of Lot ..... .......... Loi .............. Block :. .... Addition or Sub -Division .4 d'.. . , , , , , , ,�, Corner Lot ..."..... .14 Inside Lot ............ Setback�f� Sideyard DESCRIPTION OF BUILDING To be Used as: d6 t�sn...... Front Depth 3` . Height Sq. F'i.......... Cu. Ft, ........ �r Front .f.. Depth .. ,;... Height ......... Sq. Ft......... Cu. F , ........ Type of Construction .,,-:d:a... Est. Cost ...°'. ; , . To be Completed In consideration of the issuance to me of a permit to construct the building described above, I aIgee to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the village of Fridley. a.. ( ry In consideratiptiof the payment of a fee of $.., permit is hereby grantedf fo r:.'- ,•.tp 1. i� to construct the building oaddition as described above This permit is grated upon the express condition that the person to whom it is granted and his agents, employees and workmen,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 with- in the village limits and this permit may be revoked at any time upon volation..any of the provisions of said ordinances. .� ' �� Y :'_ uilding Inspector NOTICE: This permit does not cover the construction, installation or alteration for wirings plumbing, gas sewer or water. Be sure to see the Building Inspector for separate permits for these items. City of Fridley r` Application for Plumbing and Cas Fitting Porn it Dept. of Bldgs. Phone SU 4-1 DESCRIPTION OF WORK Number. hind and Location of Fixtures 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. FGa idley, Mien Owner Kind of Building Used as Tabe completed about PARTIAL RATE SCHEDULE Z ui e -G °L Z iTQj 2 �j J (93 N U' Z 0 t R • N WATER HTR. GAS ELEC. Base $`;;, Sil 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 Axb ` $ New Ground Run Old Bldg. 1st $ ROUGH FINAL GAS FITTING FEES: NO. ;RATE TOTAL 1st 3 Fixtures .......................... 1.50 $ Additional Fixtures .................... x :::; 50 $ Gas Range to 200,000 BTU .............. 2nd $ REPAIRS & ALTERATIONS—Refer to Code Description c .... ............. U. ..G .......$ / 'rr�yv�TAL FEE Lj $ 42 �i 3rd 4th • Future Connection Openings I New Fixture. Old Openings I 11 Connected with Sewer Cesspool 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. FGa idley, Mien Owner Kind of Building Used as Permit No. ner, Bye Business Phone No 2 Tabe completed about PARTIAL RATE SCHEDULE Estimated Cost, $ Old ew. Building Permit Nc PLUMBING FIXTURE RATES: NO. RATE TOTAL - Number Fixtures ...................... x $1.50 $`;;, Sil 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 Axb ` $ New Ground Run Old Bldg. ............ x 3.25 $ ROUGH FINAL GAS FITTING FEES: NO. ;RATE TOTAL 1st 3 Fixtures .......................... 1.50 $ Additional Fixtures .................... x :::; 50 $ Gas Range to 200,000 BTU .............. "I.00 $ REPAIRS & ALTERATIONS—Refer to Code Description c .... ............. U. ..G .......$ / 'rr�yv�TAL FEE Lj $ 42 �i Permit No. ner, Bye Business Phone No 2 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective Hay 1, 1990. j P Job Address 9 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 thisApplication are true and correct Fridley, Mn. 3 " cjt 3, 19a p� OWNER ,a ) " _J^i /-I 0-A&I KIND OF BUILDING USED AS TO BE COMPLETED ABOUT RATE SCHEDULE to41 H� y ESTIMATED COST Wr" X�W d RATE Water Heater OLD - NEW BUILDING PERMIT NO. PERMIT NO. a�e New Fixtures _ $ 5.00 $ " T "� U .cm m Sc $ Company i g $ 1.50 $ Beer Dispenser 00 y 3 § a [i O w qr N Lj m d 3 S YI WO .Gu o $ 5.00 $ Tel• No. Catch Basin $ w° $ croi w Rain Water Leader $ 5.00 as Eaec 1st S 5.00 S ROUGH INSP. Sump or Receiving Tank $ 5.00 Date Water Treating Appliance - $ 7.00 $ 2nd Hot Water Heater $ 5.00 FINAL INSP. $ Date Gas Range $ 10.00 $ 3rd Gas Dryer $ 10.00 $ APPROVAL FOR PERMIT Back Flow Preventer Required. . . yes ( ) No Type ( ) 4th $ 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance (R) m Future Connection Opening Connected with Sewer (*) m New Fixture, old Opening Water Effective Hay 1, 1990. j P Job Address 9 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 thisApplication are true and correct Fridley, Mn. 3 " cjt 3, 19a p� OWNER ,a ) " _J^i /-I 0-A&I KIND OF BUILDING USED AS TO BE COMPLETED ABOUT RATE SCHEDULE ESTIMATED COST PLUMBING FIXTURE RATES: NO. RATE TOTAL OLD - NEW BUILDING PERMIT NO. PERMIT NO. New Fixtures _ $ 5.00 $ Future Fixtures $ 3.50 $ Company i Old Opening, New Fixture $ 1.50 $ Beer Dispenser Signed By S 4.00 S Blow off Basin $ 5.00 $ Tel• No. Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 / Hydraulic Valve S 5.00 S ROUGH INSP. Sump or Receiving Tank $ 5.00 Date Water Treating Appliance - $ 7.00 $ Hot Water Heater $ 5.00 FINAL INSP. $ Date Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ APPROVAL FOR PERMIT Back Flow Preventer Required. . . yes ( ) No Type ( ) $ 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance $ �`,� ® MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE Reinspection Fee $ State Surcharge $ . SO ($15.00) TOTAL FEE re-d'ey STATE OF MINNESOTA DEPARTMENT OF HEALTH ABANDONED WELL RECORD 1. LOCATION OF WE II MINNE(leSOTA TAblaNIQUE WELL NO. County Nage An o ka ✓� 71 Township Name Township N. Ra"e Number Section No. Fraction 4. WELL DEPTH (completed) Date sealed iridleyF`` N E 4 4of 1g 6/5190 or or it. S Numerical t Address and Ci. of Well Location or Oistance� rue Road S. DRILLING METHOD (if known) laLe o" 7941. ivervi eco Terrace 10 Cable tool 40 Reverse 70 Driven 43 Dug Frley, 14n. 55423 20NollowRod 60Air 6p Bored 110 Show �tlo-cats,6w of well � A 30 Notary 60 Jetted 90 Power Auger (t I d with `X•) Sketch map of rel oc&ties 8. OBSTRUCTIONS - N Yell W ENEE fl Obstructioonss removed de0O ❑ No If obstructions cannot be Nailing Address if different than S. CASIRG(S) Jeff & Cindy removed. contact Mai ®®MM Lundgren Same before sealing. ®®NO 7. USE HARDNESS OF 3. FORMATION LOG COLOR FORMATION FROM TO If not knam, indicate formation log from new well or nearby well. in. to ft. IIRDomestic i0 Monitorial; 60 Neat Loop ®EMO 20 Irrigation SLJ Public 90 Industry ►--1 ,dt� --+ fl Obstructioonss removed de0O ❑ No If obstructions cannot be Nailing Address if different than S. CASIRG(S) Jeff & Cindy removed. contact Mai 10 Black 4® Threaded 70 Lundgren Same before sealing. Toruc 7. USE HARDNESS OF 3. FORMATION LOG COLOR FORMATION FROM TO If not knam, indicate formation log from new well or nearby well. in. to ft. IIRDomestic i0 Monitorial; 60 Neat Loop T' h 20 Irrigation SLJ Public 90 Industry `C 30 Test Well 60 Municipal 1110 Commercial ►--1 ,dt� --+ fl 7p Air Conditioning 11[] 2. PROPERTY OWNER'S NAME Nailing Address if different than S. CASIRG(S) Jeff & Cindy property address indicated above 10 Black 4® Threaded 70 Lundgren Same 2N caie. s0 Welded 30 Plastic U Stal"Uts Steel % 4 in. to 18 ft. HARDNESS OF 3. FORMATION LOG COLOR FORMATION FROM TO If not knam, indicate formation log from new well or nearby well. in. to ft. 9. SCREEN O Screened well tram - ft. to _ ft. (it known) 0 Open Role from _ ft. to _ ft. 10. STATIC fER LEVEL ft. 10 below 0 above land surface Date Measured 11. WELLHEAD COMPLETION 10 Pitless Adaptor 40 Found Buried 2SBasement offset m i 30 Well Pit 16. REMARKS, ELEVATION. SOURCE OF DATA - CASINGS REMOVED. CASINGS PERFORATED, ETC. 12. GRDUTING INFORMATION 0 Neat Cement 20 Bentonite 3D i'Iell located basement offset- Groat material portlandfrm%qto 0 it. cu, yds south side of basement. Removed 13. !NEAREST SOURCES OF CONTAMINATIOR from well 12ft 3/4in. drop pipe. feet direction type seatingt Weil d,ainfacted betere ®Te: Well had plug in top of % 4in . 14. PuMP 0 Removed a Not Present pipe cut off 6in. of 14in, and Type: 10 Submersible 30 L.S. Turbine 50 Reciprocating 20 Jet 40 Centrifugal 60 removed 3/4in. Second well on 15. EXISTING WELLS (Mom sketch locations of abandoned and active webs in remarks section or on back.) Other onosed.wmlI(s)--am, propertyt 1B Yes ft on property Sin. also sealed Abandoned* 0 C1TemporaryOde�sealed Measurements taken from floor. 17. VATER,WELL CONTRACTORS CERTIFICATION This wall was sealed under my -jurisdiction and this report is true to the best of my knowledge and belief. seperate report filed on 3in. well Johnson 8, Sons Drilling 27530 Licensee Business Name License No. Address n Signed [late 4 d Donn ,Tohnson at. 0 now of DMiler FFICIAL ABANDONED WELL RECON (May be used for Property Transfer) Iti %WANT a PZLN talW DX2W V,`� STATE OF MINNESOTA DEPARTMENT OF HEALTH ABANDONED WELL RECORD 1. LOCATION OF YELL MINNESOTA nk UNIQUE WEnot LL NO. County Name Anoka Township Name Township Number Range Number Seetion No. Fraction 4. WELL DEPTH (completed) Date sealed (! Fridley ;r or '`°f " 80 ft. 6/5/90 S W Numerical Street Address and City of Well Location or Distance from Road S. DRILLING METHOD (if known) Intersection 7941 R iv erV i ew Terrace 0 `able LOOT 40 Rever'fe 7❑ Driven IO❑ Dug Fridley, Din.. 55432 2[3Hollow Red S❑Air 43 Bored 11❑ Show exact location of wellAAA 3E]Rotary 6❑ Jetted 9❑ Power Auger (in section grid with •K') ketch map of well location Nf 6. 085T011ICTION5 N W MENU 7❑ Air Conditioning 110 2. PROPERTY OWNERS NAME Jeff & Cindy Lundgren Nailing Address if different than property address indicated above Same 6. CASING(S) 4k Black 40 Threaded 7❑ 213 Gale, V dolma 313 Plastic 613 Stainless Steel 3 in. to 8 0 ft. in. to ft. so 9. SCREEN NONE Well obstrucObstructions re ov Yes ❑ No SObstructions removed Eyes 13 No If obstructions cannot be removed. contact NDN E F before sealing. 7. USE T za, 0Domestic 4❑ Monitoring 8❑ Neat Loop 213Irrigation U Public 0Industry 7 3❑ Test Wall An Nmicipal 1LQ Coaaerci 1 I— L mi to r: (a •�B ®- 7❑ Air Conditioning 110 2. PROPERTY OWNERS NAME Jeff & Cindy Lundgren Nailing Address if different than property address indicated above Same 6. CASING(S) 4k Black 40 Threaded 7❑ 213 Gale, V dolma 313 Plastic 613 Stainless Steel 3 in. to 8 0 ft. in. to ft. HARDNESS OF 3. FORMATION LOG COLOR FORMATIONFRO11 TO ' If not known, indicate formation log from new well or nearby well. 9. SCREEN ❑ Screened well from a ft. to ft. (I! known) ❑ Open Note from _ ft. to _ ft. 10. STATIC HAT LEVEL ft. iff below ❑ above land surface Date Measured 11. WELLHEAD COMPLETION 10 Pltless Adapter q] Found Buried 20 Basement offset - 5[3 313 Well Pit 16. REMARKS. ELEVATION. SOURCE OF DATA - CASINGS REMOVED. CASINGS PERFORATED. ETC. Well located southwest side of 12. GROUTING INFORMATION 4WNeat Cement 20 Bentonite 313 Grout materia l7n,.i�1�vir� fromEj0_to__a ft, cu, yds .basement. Removed pump and 18ft. 13. NEAREST SOURCES OF CONTAMINATION lin. drop pipe and check Vavle. _ feet direction type Well disinfected before sealing? JUYes Second well 1 =din. on property 14. PUMP ® Removed ❑ Not Present also sealed. S eperat e report filed. Type: 10 Submersible 30 L.S. Turbine N7 Reciprocating 4ff Jet 40 Centrifugal 6❑ Measurements taken from -floor. IS. EXISTING WELLS (Please sketch locations of abandoned and active wells in remarks section or on back.) Other unused wells) on property? ® Yes ❑ No Abandoned: ■ Permanent ❑ Temporary ❑ Not sealed 17. WATER WELL CONTRACTORS CERTIFICATION This well was sealed under my jurisdiction and this report is true to the best of my knowledge and belief. Johnson & Sons Drilling 27580 LicenSusines Name L1 n - Avenue. south Address 'xrn PaAo I i S Signed gate ('017? _ conn JKli n on Date 6 0 Name of Driller FFICIAL ABANDONED WELL RECORD (May be used for Property Transfer) rHIPOR'11Rls 27L8 Mr= 1)S6D G7YOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6331 UNIVERSITY AVE. N.E. FRIDLEY, MN 55132 • (612) 571-3450 • FAX (612) 571-1287 December 1, 1999 PW99-146 Ms. Julie Ruhlow 7941 Riverview Terrace NE Fridley MN 55432 Subject: Riverview Heights Improvement Project Dear Ms. Ruhlow: The City of Fridley has completed the Riverview Heights Improvement project. As part of that project, you agreed to have your driveway paved by the City contractor. Per the agreement, you were to have escrowed funds for this work with the City. In order to expedite construction, we did not hold you to that part of the ;agreement. Please remit payment of $986.19 to the City of Fridley by January 31, 2000 to cover the cost of your driveway installation. After this date, a 5% administrative charge will be added to the cost and the total charges will be placed on the tax roles to be assessed against your property at 7% interest for 5 years. If you have any questions, you may call me at (612) 572-3551. Sincerely, '—JO Jon H. Haukaas Assistant Public Works Director JHH:cz DRIVEWAY PAYMENT OPTIONS Please mark an "X" next to the option which indicates your method of payment. Also, please complete the Information at the bottom of the page. 1. I hereby agree to have the City pave my driveway and assess the cost against my property. I understand that the cost will be assessed at 7% interest over five years with a 5% administrative charge. Name: Address: Signature(s): Date: 3. 1 hereby agree to have the City pave my driveway and will escrow funds with the City to cover the cost of constructing my driveway by July 30,1999. 1 also agree to sign an agreement with the City regarding pavement of the driveway. 4. 1 do not wish to participate in the paving project. Zee--- 14 C4 2 '4",a C (2 Wil- Z3-'�<7 M SUBJECT NO. City of Fridley 4 0 4 AT THE TOP OF THE TWINS BUILDING PERMIT 2 r "RRE-EEI COMMUNITY DEVELOPMENT DIV PROTECTIVE INSPECTION SEC (Ila r CITY HALL FRIDLEY 55432 NUMBER REV DATEPAGE OF APPROVED By 612-571-3450 910-F15 4/22/96 JOB ADDRESS 7941 Riverview Terrace NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DEscR. 15,16 I A Riverview Heights SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Julie Ruhlow 7941 Riverview Terrace NE 784-7034 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Royal Construction 28222 96 St, Zimmerman MN 55398 576-1721 PENDING 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 0 NEW El ADDITION O ALTERATION REPAIR O MOVE 0 REMOVE 8 DESCRIBE WORK Reroof Structure/Reside Structure/Replace Windows 9 CHANGE OF USE FROM TO STIPULATIONS Replacement bedroom windows must meet the State Egress Code. Provide smoke detectors as per State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANC 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 $16,000 $8.00 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- $ 237.25 Fire SC $16. 0 TRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEETOTAL FEE Lice e S $5.0 $266.25 SIGNATURE OF OR AUTHORIZED AGENT IDATEI N P 4;�DG — LY V ATED THIS IS VO R PERMIT SIGNATURE OF OWNER IIF OWNER BUaDERI IDATEI INS' TATE M NEW [ ] Effective 3/1/96 ADDN [ j CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (�9 Building Permit Application ConstructionAddress:. Legal Description: Lo5 /s� 14 Owner Name &Address: v V.e, 9yk ip W Tel. # ZR -4/- 702 Contractor: Address: MN LICENSE # M/V Tel. # ✓��(re ' 7oZ. 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: Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbac Type of Construction:. �rC�� G2/ J,�f ��Estimated Cost: $ Approx. Completion Date: (Cost on Back) Driveway Curj) Cuts Width Needed: Ft. 6 Ft x = $ DATE: x/1,_22 6 APPLICANT: ®i ce Tel. # CITY USE ONLY Permit Fee $ Z 2,--2�_ . Fee Schedule on Reverse Side Fire Surcharge $ /6-06 .001 of Permit Valuation (1/10th%) State Surcharge $ 8,06 $.50/$1,000 Valuation SAC Charge $ $900 per SAC Unit License Surcharge $ �5_, O Z) $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 $ ':'?_ & 6 , STIPULATIONS: W /7 ajT /�l�' L���� G✓�•✓4� �, PLUMBING RESIDENTIAL APPLICATION City of Fridley Perms er ece' Date Received 1p NOTE: IF PROPERTY IS NOT OWNERIOCCUPIED- A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT. DATE Z — Z "- e9 UR E-MAIL ADDRESS SITE ADDRESS 171 �Z f y ll era & e lr) THE APPLICANT IS: (CIRCLE ONE) OWNER CONTRACTOR� NAME C PROPERTY OWNER/ ADDRESS TENANT q CITY j �0' STATE &A9 ZIPS a- � PHONE # NAME ay9-/7/ �ZQX) 1,4622!��� LICENSE # ADDRESS ©CJ _:2 CONTRACTOR CITY STATE , &)_ ZIP 4=— 1" PHONE #aal — FAX# PERMIT TYPE SINGLE FAMILY TWO FAMILY TOWNHOUSE TYPE OF WORK ❑ NEW REPLACEMENT DETAILED DESCRIPTION OF WORK FEES ARE BASED ON $10.00 PER FDCTURE, EXCEPT WHERE NOTED FIXTURES: (INDICATE TOTAL NUMBER OF EACH) BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING (Need City License) SWIMMING POOL WATER SOFTENER ($35) CLOTHES WASHER KITCHEN SINK ATER CLOSET BACKFLOW PREY. ($15) DISHWASHER LAUNDRY TRAY,WATER HTR ($35) FOR IRRIGATION WATER METER OTHER Permit Fee $ -4—, t9 6 MINIMUM: $15.00 or 5% of cost of the improvement -whichever is Plan Review $ greater on work less than $300 Surcharge $ .50 TOTAL DUE $ g-> 'C'o Make checks payable to: City of Fridley THIS IS AN APPLICATION FOR A PERMIT — NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I acknowledge that the Information above Is complete and accurate; that the work will be In conformance with the ordinances and odes 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 and approval qfjlans. NAME OF APPLICANT DATE ,f����,=DTa Please e r pdn SIGNATURE OF APPLICANT ':- 'y _p :�*�'.! r� `� `' .,r f - C �3'"t'k' �5 daj'N�A5-� sl4i S a d 4a xU`�AFr\� ....a�.' u.°:-' .. .: t..�... 3xa..� n ....�.�.,. ,�t�`f.._. .M: ,�?.� CITY OF FRIDLEY COMMUNITY DEVELOPMENT DEPARTMENT 6431 UNIVESITY AVENUE NE, FRIDLEY, MN 55432 (763)572-3604 PLUMBING RESIDENTIAL APPLICATION City of Fridley it mbar keaDd By Date Received NOTE: IF PROPERTY IS NOT OWNER/OCCUPIED- A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT. DATE v(,= YOUR E-MAIL AQAESS SITE ADDRESS i v2 ✓rJC2 f Qr� THE APPLICANT IS: (CIRCLE ONE) OWNER ONTRACTOR 1 NAME PROPERTY OWNER/ ADDRESS TENANT CITY STATE ZIP PHONE#_!W NAME& �� 0) u✓� VV tin/✓v ,C AffS LICENSE # AS -92 Pill ADDRESS "Cr" (Z e2 S CONTRACTOR CITY 90J tiSy STATE ✓l ZIP SV33-2 PHONE# ss7-jr5ir"7QfjCJ FAX# 957—dR-z^o2lc", PERMIT TYPE SINGLE FAMILY TWO FAMILY TOWNHOUSE TYPE OF WORK ❑ NEW ,-REPLACEMENT DETAILED DESCRIPTION OF WORK FEES AR&BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED FIXTURES: (INDICATE TOTAL NUMBER OF EACH) BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING (Need City License) SWIMMING POOL WATER SOFTENER ($35) CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREY. ($15) DISHWASHER LAUNDRY TRAY ATER HTR ($35) FOR IRRIGATION WATER METER OTHER Permit Fee $ �� MINIMUM: $15.00 or 5% of cost of the improvement -whichever is Plan Review $ greater on work less than $300 Surcharge $. 50 TOTAL DUE $ 3r Make checks payable to: City of Fridley THIS IS AN APPLICATION FOR A PERMIT – NOT VALID UNTIL PROCESSED I hereby apply for a plumbing 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 and approval of planes. NAME OF APPLICANT "' dr S� DATE 1'23^V Plea e e o ri SIGNATURE OF APPLICANT l� ts s a, ��€aOTf�'r�t Tli- krs'.7 ..' ..,.. r, a a.�:., ., o.:, +'^ ...t,.. 9_.., '', .�.,,.w. .,-aY 4 , c4 {...,v... ,,:; -`?"9..,y �:• fir__-s.x 3 ', .�-','+..s.3w� CITY OF FRIDLEY COMMUNITY DEVELOPMENT DEPARTMENT 6431 UNNESITY AVENUE NE, FRIDLEY, MN 55432 (763)572-3604 Date: 4/1/2006 Revision Date: 4/1/2006 Site information Address 1: 7941 Riverview Terrace Address 2: City: Fridley County: United States Application Information Business Name: Contact Person: Office Ph: Fax: Cell Ph: Address 1: City: State: Zip Code: Existing Construction: Pre 1994. Project #.- Lot: :Lot: Block: Subdivision: MN Contractor License #: Combustion Appliance Water Heater: Natural Draft Input BTUs: 40,000 Common Vent Furnace/Boiler. Natural Draft Input BTUs: 100,000 Common Vent Other Combustion Appliances Gas Fired Direct Vent Fireplace(s): No Gas Fired Power Vent Fireplace(s): No Gas Fired Natural Draft Fireplace(s): No Solid Fuel Appliance(s): One Exhaust Equipment Continuous Exhaust Ventilation Capacity (cfm): NA Clothes Dryer (cfm): 135 Exhaust Fan Rating (cfm): 200 Make -Up Air No Make -Up Air Required by Code Combustion Air Minimum Combustion Air Requirements Met. Applicant Nar Code Official Signature/Date: :9 aceto - 3ignature/Date: r) IMA (#nt,-rPnint P"ormr WAvuu-nown ')MA Adwr hem;rnol i'nA- (:nirinlinac PwnP 1 Building PLUMBING Permit No.: -zrx, -O! Inspections RESIDENTIAL APPLICATION Received BY: j 763-572-3604 CITY OF FRIDLEY Dat dO ff 1 0 , DATE OO - 1 'Z- YOUR E-MAIL ADDRESS SITE ADDRESS Y i1%@-{0'✓I e 10 I-P_rV-a-C THIS APPLICANT IS: ❑OWNER ❑CONTRACTOR PROPERTY NAME: 1d%L A d I e. "A ADDRESS: CITY STATE ZIP OWNER/ TENANT PHONE: CONTRACTOR NAME: STATE LICENSE # 3 (V 4 L PA4 EXP DATE 11, ^'31 - d 7 SUBMIT A COPY OF YOUR STATE ADDRESS: ! S� 7�d -M✓i S S CITY �k iPeY STATF.10-A"'ZIP3 �® LICENSE WITH PHONE L/ Zi - Z 3 t FAX APPLICATION PERMIT TYPE J9 SINGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: 0 NEW aREPLACEMENT g D DETAIL DE CRIPTION OF WORK s 'ac�r, �� - S r.�w.� L���. ro� ;y w, 6W4K % �' % -om as ll w� �� PER MS 1613.665 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) 1 BATH SINK/LAV DRAINS SHOWER WATER PIPING _FLOOR _ _ BATHTUB —GAS PIPING rroF*1:1) c lrrur�:x.�r:) _ SWIMMING POOL _ WATER SOFTNER ($35) —CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15) DISHWASHER LAUNDRY TRAY HEATER ($35) FOR IRRIGATION _ _ _WATER WATER METER OTHER x i�'-" � MMUM Number of fixtures @ $10.00 -_3_ x $10.00= $ 30 Ob 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 = $ 060 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 casewhhiichh requ• es review and approval of plans. �w� SIGNATURE OF APPLICANT��a}aa� —' R PRINT NAME�v e L . DATEgt a City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977