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PRE 2010 DOCSCity of Fridley SUBJECT =34� AT THE TOP OF THE TWINS BUILDING PERMIT Ir � RECEIPT NO. • ______ COMMUNITY DEVELOPMENT DIV PROTECTIVE INSPECTION SEC � r 3 t CITY HALL FRIDLEY 55432 NUMBERREV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/16/95 JOB ADDRESS 1436 Royal Oak Court NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 1 Totino Grace Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Imperial Homes Inc 4196 Lexington Ave, Shoreview MN 55126 483-5518 20014230 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 XCJ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Construct a 38' x 41' Dwelling (Two Story) and a 34' x 24' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide the City with verifying survey before capping. Provide sod in the front and side yards. Provide a hard surface driveway. See notations oil plan. Paid Park Fee of $1,500.00 SEWER LOCATION: See Engr. Dept. �� G WATER LOCATION: See Engr. Dept TOP OF FOOTING & WYE ELEV: See Engr. Dept. Be"d�l alli�•nIg�tjoh� 454.002 = REQUIRED BY LAW Dnp VM WIR1 e''. so ::..i s i in' .PL1j,(Ai.7j{'46 AND SIGM , 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 1 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 $194,448 $97.22 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 $1.067.00 $850.00 PLAN CHECK FEE TOTAL FEE Fire SC $194.45 $2,208.67 + PF '6G `k REOF ONTRACT O AUTHORIZED AGENT IDATEI WHEN PROPP LY VALIDATED THIS IS YOUR PERMIT SIGNATURE OF OW A oF 407NE"Fr")NILDER) IDATEI OG INSP E NEW P1 Effective 1/ 1/95 ....:.EI -TY .OF : FR1DLEY .. . ALTER j ] SINGLE FAMILY AND DUPLEXES R-1- AND R-2 333 Building Permit Application ConstructionAddress: 14 3 (o ROYAL D A K CT • R10 5"1 not ' Legal Description: RSO BOK- ®T� LN 4"C-6 Owner Name & Address: Sic. Tel. # 483 " � 13 Contractor �' M-PEPJA tN .0 MN LICENSE # Z®� l Z D Address: LEY-igToo AyE 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 35 Width 41 Height Two s q. Ft. Z57-0 _ GARAGE AREA: Length Width 7 Li Height ___Lo_ Sq. Ft. !101 DECK AREA: Length N A Width Hgt/Ground Sq. Ft. OTHER: /A — Corner Lot [ ] Inside Lot t Ft. Yd Setback Side Yard Setbacks r 5.17 1/ • °� Type of Construction: Wow. FAAntiE Estimated Cost.: Approx. Completion Date: Seer 1 5,: 9� (Cost on Back) Driveway Curb Cut Width Needed: 14 Ft. + b Ft = 22- Ft x $ 13 s = $ DATE: S� APPLICANT: Tel. # 1,q�f 32 s.A CITY USE ONLY =X19 2 s� /lo 4 = /31 ?17.13 Permit Fee $ 06-71; ee Schedule on Reverse Side �l ®1r g(,�yr- tirj 57j, I/?- Fire aFire Surcharge $ /qz% 4K .001 of Permit Valuation (1110th%) State Surcharge$ 7 Z_ $.50/$1,000 Valuation SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: E1 $850 per SAC Unit $5.00 (State Licensed Residential Contractors) $ -- Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ ('500.00 Fee Determined by Engineering _ $ Agreement Necessary [ ] Not Necessary R . 6`t� S�� SUBJECT PERMIT NO. City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT Ir I RECEIPT NO. �` ______ COMMUNITY DEVELOPMENT DIV I ~ PROTECTIVE INSPECTION SEC i / r NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/22/95 JOB ADDRESS 1436 Royal Oak Court NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 1 Totino Grace Addition I SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Imperial Homes 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Fireside Corner 2700 N Fairview Ave, Roseville MN 55113 638-3304 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 ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install gas fireplace 9 CHANGE OF USE FROM TO STIPULATIONS Install according to testing agency's specifications. 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 1 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 $1,100 $.55 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. $37.50 Fire SC $1.10 PLAN CHECK FEE TOTALFEE License SC 5.00 44.15 ROPE LY V (DATED THIS IS YOUR PERMIT BLDG 16p DATE SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEIEN SIGNATURE OF OWNER OF 0WNER BUILDER( IDATEI NEW ADDN j CITY OF FRIDLEY ALTER j) SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Effective 8/1/95 Legal Description: Owner Name & Address: Tel. # Contractor: FIRESIDE CORNme _ MN LICENSE # (/ 2700 N. FAIRVIF1/i AVE. Tela # Address: ROSEVILE,n—.9 N &54ia (614ANI s 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: _ Corner Lot [ ] Inside Lot [ ] Ft. Yd tback Side Yard Setbacks �� / �, Estimated Cost: $ % Type of Construction: � 1%�' ,� _ Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: �f APPLICANT: /. Tel. #_ 633 ' � 7 S� CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ 4/0 .001 of Permit Valuation (1/10th%) State Surcharge $ , �S ^ $.50/$1,000 Valuation SAC Charge $ $850 per SAC Unit License Surcharge $ ('c> $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: SUBJECT P - City of Fridley 24023 AT THE TOP OF THE TWINS BUILDING PERMIT Ir RECEIPT NO. � • COMMUNITY DEVELOPMENT DIV. i I PROTECTIVE INSPECTION SEC �� CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY ".j 612-571-3450 910-F15 3/20/96 JOB ADDRESS 1436 Ro al Oak Court NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 1 1 1 Totino Grace Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Imperial Homes Inc 4196 Lexington Ave Shoreview MN 55126 483-5518 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 ❑ REPAIR ❑ MOVE ❑ REMOVE % x 8 DESCRIBE WORK Construct an 11'10" x 1' and an r" r n Garage Addition; Remodel basement 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. WARNING Before digging Call f6l all utility locations 454.0002 SEPARATE PERMITS REQUIRED FOR REAUIRED BY L -AW WIRING, HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 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 $16,343 $8.17 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL 7HE PERMIT FEE SAC CHARGE ROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $249.75 Fire SC $16.34 TRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE Cl@fl�J� �� License SC $5.00 $279.26 SIGNATU OF CONTRACTOR OR AUTHORIZED AGENT ID,A,T ) WHEN PAOPERA VALIDATED THIS IS YOUR n�PERMIT S)GNATURE OF OWNER IIF OWNER BUILDER) IDATEI BLD )NSP BATE NEW [ ] Effective 3/1/96 ADDN CITY OF FRIDLEY ALTER SINGLE FAAMY AND DUPLEXES R-1 AND R-2 f Building Permit ApplicationIF( I ConstructionAddress: 3 (a } OYL OAK el tZf Legal Description: S O T q r'AcE A 0 ti Owner Name & Address: T M PEYZ t & L W-0 ALE Tel. # Contractor: p Ep, I'& L, [ fl� 5 IN C • MN LICENSE # Address: I L.. EX Q ojQ Te)W AVE S C -V l E W M Tel. # L133 - S,-19 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF 1WR0VEMENT e a LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length H lv" ` " Width ,(�� Z Height Sq.F0llq � 3 DECK AREA:I Length Width Hgt/Ground Sq. Ft. - -A-0XV7,744 e OTHER: SASEMEAIT RE'MOPEL aAA46t ,4®® 'Al I �a Comer Lot [ ] Inside Lotti] Ft. Yd Setback Side Yard Setbacks a Type of Construction: K631,06P7,4 Z. Estimated C t: $ erAgA6E A0,0 W L/ S 0 c) Approx. Completion Date: �� � ®5 46SrA7' PAPSW /21 S®® 'D®�U 751 110 (Cos ® on Back) %®%C e 17 ®o Driveway Curb Cut Width Needed:Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire. Surcharge $ /�. S'`i .001 of Permit Valuation (1/10th%) State Surcharge $ /7 $.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 $�2G STIPULATIONS: A MAR -21-1996 1558 FROM E.G. RUD & SONS TO 1 1.wr SLIM 146 -BU MEOW IffiPw Far. Imperial domes — , W , ffW'- • � N w 483 5642 P.01 6' �6-t( ��3 �L I Lot 4, Block 1,Totlno Grace, Anoka County County, Miinnescto Scale.. ® Denotes Iron Mon. Book: XXX PW: XXX I .lob No. 5259 'S Dar .b 50 Disk We hereby certify that this is a true and correct representation of t, FN. o survey of the boundaries of the above d ribe d and of the locaticir► of att buildings, if any. thereon, and aii sib ts, L��t py, if any, from or, on said land.hil4"14-3620 M. t' p�iCi1', Doted t?is s da of �- Im Minn o i2 . Y es to Lic. No.�,� TOTAL P.01 CITY OF FRIDLEY INSPECTION DIV. Effective On August 1, 1995 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATI N, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES �, JOB ADDRESS t i -193r./ C RATE SCHE12= The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner - rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 30.00 $ 0 representations stated in this application are'true and correct. (Side Vent - Fill Out Back) f, ,1995 Gas Piping (Needed with new furnace) $10.00 $ 11 OWNER���rF�� Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work $ 10.00 $ $10.00 $- $25.00 $25.00 $ Z' $ State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. /t BUILDING USED AS '�i 14`IZ FVVW ESTIMATED COST _ b,Ooo PERMIT NO. No. of Heating Units A-- Circle One (Steam) (Hot Water) arm Air Trade Name �QW� Size No. 'SX tO VZS,000 BTU k2 -%,U00 HP EDR Fuel Total Connected Load J5239% Burner Trade Name Size No. BTU HP EDR HEATING COMPANY .L \I\A �,�QHVVIJ(CAL- Signed By Tel No.� Approved y� Rough -In Date Final Date! s FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes ( ) No ( ) 2. Is free from rust or deterioration 3. Has no foreign objects lodged within 4. Is securely supported 5. Meets all current Code requirements for size and total BTU's connected 6 Has total heating BTU's of Yes () No ( ) Yes () No ( ) Yes No Yes ( ) No ( ) All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes () No ( ) 8. Has combustion air been provided for water heater Yes () No ( ) Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE APPLICATION FOR- POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Residential Rate TOTAL Furnace Shell and Duct Work, Burner — Also Replacement Furnace $ 30.0Q.:$ (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) $ 10.00. $ Gas Range $10.00 $ Gas Dryer $ 10.w $ *Air Conditioning — All Sizes $ 25.00 $ All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work tr Commercial/Industrial 1.25% of Value of Appliance or Work State Surcharge TOTAL FEE Effective On August 1, 1995 JOB ADDRESS t L -No P\0L_,1, 4i, LAS C—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. YV)oa� 199C OWNER '�. 2gE�- PaL.MIND-A BUILDINGUSEDAS ESTIMATED COST -1,y�clr�' PERMIT NO. e�2�/ DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) 'Trade -Name Size No. BTU HP EDR Fuel Total Connected Load MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property, owner. Burner Trade Name Size No. BTU HP EDR HEAPING COMPANY Signed By L" A "4'.A Tel No. Approved By Rough—In Date Final Date G46wS-164 FILL OUT BACK SIDE OR STACK VERIFICATIO ON REPLACEMENT FURNACE CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. 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 O No ( ) 5. Meets all. current Code requirements for size ' and total BTU's connected Yes () No ( ) 6 Has total heating BTU's of All i)ther BTU's :: TOTAL BTU's 7. Has a liner been provided for water heater Yes ( ) No ( ) 8. Has combustion air been provided for water heater Yes ( ) No ( ) Remarks: HEATING CO: Signed By: Date: FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 March 22, 1996 Mr. Richard Riemersma Imperial Homes Inc. 4196 Lexington Ave Shoreview, MN 55126 Re: Final Inspection at 1436 Royal Oak Court NE, Fridley Dear Mr. Riemersma: A final inspection was conducted on March 21, 1996 of the above address and the following item must be completed before the building permit can be finaled: Complete final grading and sod by June 1, 1996 We will expect this item to be completed by the scheduled date and a reinspection called for. Occupancy of the structure is approved. If you have any questions on this matter, please feel free to contact me at 571-3450. Sincerely, &6e, �4j' X2��/ BARRY W RIESCH Building Inspector BWR/mh CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1995 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: 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 Type NO. RATE TOTAL JOB ADDRESS �j� y� UA- LrsUi )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 $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance t State Surcharge .50 TOTAL FEE $�_` 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. ,199 Owner. v�nfi�i A 5 Building Used A9�9 Estimated Cost 7m, c(PERMIT NO. PLUMBING COMPANY SIGNED BY V/ i� TELU �%l WW o i -t Approved Rough—In Date�F nal Date pp B Y Rou 9 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE I. i. T;.La:�6 , Ijll ➢h�lll�lll'll �luii ilii 6"�:..':�i� VIi.: 111 �:; ;'ili' .. �.�I'• �'r;;�!:1 �illl rl�!!�� � • • aa''L ?;'. ,W'. s� P.g3;( • r:. 1�1�.4 W� iiia �.. all _ • s _ _ •!1 �� 1 Iri i�dGl�ilil i . nig; i; ij' I dr �iil l� hj�Wuil�� I � ill . • _ � .$'t: Li � m U {{ 41 Ij Gr �i � ^� 51iii i ' i :.ha;t, �L'� "'�"� :8 1'':c'� _ t " I�� ®�^ia � �� • _ l� �'I`i'llii6 ©III'r6�, %�IV!ri�i ii�mmil' �l11p _ • • � NId6 ' i �'� � ij!' I'I I li -��� IIIY��Nq ���`!IliuiililJ�il6�illl�; �:ll�_@�illi �ia� � l l��1,61 i��� �'ikl�ii � ii�l4 i •q . ' I ' PLUMBING FIXTURE RATES: 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 Type NO. RATE TOTAL JOB ADDRESS �j� y� UA- LrsUi )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 $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance t State Surcharge .50 TOTAL FEE $�_` 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. ,199 Owner. v�nfi�i A 5 Building Used A9�9 Estimated Cost 7m, c(PERMIT NO. PLUMBING COMPANY SIGNED BY V/ i� TELU �%l WW o i -t Approved Rough—In Date�F nal Date pp B Y Rou 9 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE