PRE 2010 DOCSE�JEGT
City of Fridley
AT TK TOP OF TME TWINS
PLUMBIM PERMIT APPLICATION Uri
'-'---e C0P91/VNITY D@VE60i9MENT O►V,
e
PROTECTIVE 01EftCTMM @OPT,
10, ---` CITY HALL FRIOL9V EaiE
.J 013-1100-3460 IRIIV. IDATff IDAAW rM RAA_W. od
ss
Aaares s Phone
�' rn e
Contractor Address P one
Kind of Building Use
r "Y-, . n1' a ®�
ompietion Date
9 — i .� —
Q_1,2 - %—
Ground Run Old Bldg. x $3.25
Elec. Water Heater x $2.00
Gas Fittin Fees:
1st 3 Fixtures x $2.00
Additional Fixtures x $ .75
Gas Range -199,000 BTU x $5.00
Repairs & Alterations
See
Description: Code O^ O
State Surcharge .50
TOTAL FEE $ —L2.A6
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 rulinj
of the Department of Buildings, and hereby declare that
all'the facts and representations stated in this
application are true and correct.
Signature Date
Plumbing Fixture Rates:
N0.
RATE TOTAL
Number Fixtures
_ x
$2.00 IZ2. el
Future Fixtures
j x
$1.50 1, 44
New Fixture -Old Open.
x
$1.50
Catch Basin
x
$3.25
Water Heater -99,000 BTU
J x
$3.00 3.3. ,0nn
Ground Run Old Bldg. x $3.25
Elec. Water Heater x $2.00
Gas Fittin Fees:
1st 3 Fixtures x $2.00
Additional Fixtures x $ .75
Gas Range -199,000 BTU x $5.00
Repairs & Alterations
See
Description: Code O^ O
State Surcharge .50
TOTAL FEE $ —L2.A6
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 rulinj
of the Department of Buildings, and hereby declare that
all'the facts and representations stated in this
application are true and correct.
Signature Date
VLBkl.VJ1YVJJ LliL 1u LL
1�
SUBJE '�
City of Fridley
(?"'12 119
AT THE TOP OF THE TWINS
DUILDI G ❑[D� A
BUILDING
r
v r L R'vt
R TN
` s COMMUNITY DEVELOPMENT DIV.
L ______PROTECTIVE INSPECTION
r SEC.����
i "1 CITY HALL FRIDLEY 55432
IL
NUMBER
REV.
DATE
PAGE OF APPROVED BY
s"" A,, ,'J 612-560-345091
5,17173
JOB ADDRESS 8120 Ruth Circle N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
3
4
Bourdeaux,s Spring Brook SHEET
2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE
James Mitchell 8120 Ruth Circle N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Castle Homes, Inc. 7613 Central Avenue N.E.
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Single family dwelling
7 CLASS OF WORK
$] NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct 26 x 41 House, 26 x 24 garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide Verification survey
Provide Hard Surface Drive
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
1126
21,320
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 1
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
21 470.02
10.74
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAqV REGULATING CON-
�
51.00
$275.00
STRU THE PERF MANCE OF STR ION.
OR
PLAN CHECK FEE
TOTAL FEE
336.74
V SIGN RE OF TRACTOR &AUTHORIZED GENT (DATE)
H N PROPERLY VALIDAT T S YOUR PERMIT
I P - DATE
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)G
VLBkl.VJ1YVJJ LliL 1u LL
1�
APPLICATION FOR REUDENTIAL, ALTEMTTOWN
OR ADDITION BUILDING PERMIT
CITY Of FRIDLEYs MINNESOTA
Com!S WM - TA AX:�,
Z& (1 1 G BUILMM.0 (714S 7 -)e i'.9•®
ADDRESS: ADMSS:_ 96 1-3 r Lkd�Zzte (-
< elk A I
-ADDTTION 113 e) u c --A L/X , S
00MM LOT: -XMIME LOT SETBACKt 3Z' SIDEYARD-.Aof W
Afft-jv,oat attach to 4*U fv=_fto Certificates of Survey of Lot and proposed
%1141ag 1;watL*u dr4wn on tbeso, Certificates,
PESCRIPTION OF BUILDING
-To
He
Z
O U S'--�o I —/'e– _Depth -, !e gO ight:—
Square Feet; //2-� Cubic Foeti
a2d 1-4e.:e Front: g-2 4 -Depth-1 1 2, Height*. * -
Square Yeet, 6 2-`fCubic Feet;
of Constructioul
Ty" Estimated Cost:, $ .3gj.0�,,O, 0 0
To ft "toted;
The uadaroftned hereby wakes applicatiim for. a perw4t for the voirk herein
pp if J* -d, agreeing to do all vpj* in stftct accordance with the City of
itt4t,ay olr4ipances gad zutftp ;►f Oe Department of Butdings, eW hereby
4041arev mat all the facts and representations stated is this appltcation
axe true av4 correct,
SIGNAV
17ATS;
(F" Ravarge Side For Addttjonal Infomation.)
,��.���,�x7
t g Lur' s �`N
Eo
NE K u
ING_
0 F C2'� v, E 1/ 7
, Fe- /,e,--
�), -
OFF ZZ50 7/4 2r
9 A/ 7, C/�5 �
9
W�/7, r
AppRca11 for Power Plants and H Cooling. Ventilations R �Won and
Air Conditioning Sys and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
RATE TOTAL
Furnace Shen & Duct Work ................
.. $10.00 $
Replacement of Furnace ... .....
6.00 $
Repairs & Alterations—up to $500.00
6.00 $
Repairs & Alterations each add. $500.00
3.00 $___
MECIL WARM AIR
Furnace SheU & Duct Work to 120,000 BTU ........
.. $10.00 $ (ago
each add. 60,000 BTU ....................
.. 3.W =
Replacement of Furnace .. .......
.... 6.00 $
Repairs & Alterations --up to $500.00
6.00 $
Repairs & Alterations each add. $500.00
3.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $. _
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $_
Each add. 200 sq. ft. EDR Steam 3.0(1
Each add. 320 sq. ft. EDR Hot Water 3.00 $
OIL BURNER—to 3 gal. per hour 6,00 $ over 3 gal. per hour—See Fee Schedule
GAS B (up to M,0W BTU) 6.00
over 199,000 BTU See Fee Schedule
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ..... x$ 2.00 $ 2+.00_
Additional Fixtures x .75 $
Gas Range to 119, x$ 800 $
ROUGH
FmAI. z1- 7
F
(SURCHARGE $_.50)
Dept. of Bidga. Phone 980-3490
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 Ordinancet
and ruling of the Department of Buildings, and hereby declares that an the facts
and representations stated in this application are true and correct.��
Fridley, Minn_ 18
Owner
Kind of Building
Used as .. ___ __._. L__
To be completed about
Estimated Cost,
Ol New. Building Permit No. permit No.
wj . e i
capaci Sq. PLED BTU
(REMARKS -OVER)
HEAT LOSS CALCULATIONS HEAPING& AIR CONDITIOP41MG CO. MINNEAPOLIS, MINN.
Weathterstrips
A.S. H.V.E.
Guide
Reference
19—
9FI.
Construction No.
Insulation
Windows
Doors
Out. Wall
Int. Wall
Ceiling
Roof
Floor
Kind
How Applied
Yes --No
Yes --No
F 1.
�� y� a Room I Length
- - -;
UJidth
- --
Height
FI e Room
,^/!5! � Zl)
Length Width /
Height
Windows and Doors—Crackage and Area
No. Width I Height No. of Levret ft. -- Aare
- of pane of pane Lights of �:ra� k sq. ft,
Windows and Doors—Crackage
No. Width Height
of pane of pane
and Area
No. of Lineal ft. Area
lights of crack sq. ft.
Coef
B u
Coef
Btu
1 Infiltration ?
1
Infiltration
Glass
3'� y
Glass
of
Ex wa I I
Exp. t)
4 L i
Ex wa I I y
P sl
%
O�
I Net exp. waIl
16, 3 Off)
®
Net exp. wall
Int. wall
Int. wall
ot
Ceiling ®�
t2
L2 919
Ceiling /
3 w
a
Floor
23
FloorQ
Total Btu.
®
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader
area
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
IF I./?I y! /jf Room Length ®
Width ®
Height
FI. �� Room
Length/-7Width
Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
J No, of�jpa a of pa lights of crack sq. ft.
Zig Y �i 1 .
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
NO' of pane of pane lights of crack sq. ft.
2
Coef
Btu
Coef
Btu
Infiltration
Infiltration
4
91.70
Glass
-0
C) L-)
Glass
li
Q
Exp. wall
4
Exp. wall
/
Net exp. wall
Net exp. wall
0
7/,
Int. wall.
Int. wall
Ceiling
®g
Q 9®
Ceiling
Floor®�
Floor
2113491-,
Total Btu.
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Required sq. ft. E.D.R. or sq. ins. W.A. Lea r area
FI Room. I Length
Width 7
Height
F1.4'p Room
Length Cl Width 6
Height
Windows and Doors—Crackage and Area
Windows and Doors—Crackage
Width Height
No. of p e of pa
and Area
No. of Lineal ft. Area
lights of crack sq. ft.
Width Height No. of Lineal ft.
No. of pane of pane lights of crack
Area
sq. ft.
Coefl
Btu
Coef
Btu
Infiltration
Infiltration
e 0
Glass fP
Exp. wall 7 _X
�
!L/ `/
Glass
Exp. wal l
f9 60
Net exp. wa I I
I Q
Net exp. wa I I
Int. wall
Int. wall
Ceiling/
V
"
j`
Ceiling
Floor
6 Q
^7
4Fluor
Total Btu.
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
--3,
/
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
City ®f Fridley
SUBJECT
0- 15771
AT THE TOP OF THE TWINS
BUILDING PER
i
1 >r -------- COMMUNITY DEVELOPMENT DIV.
52
r PROTECTIVE INSPECTION SEC.
5—
R 7 75—
CITY HALL FRIDLEY 55432
CITY
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910-F15
6/10/80
JOB ADDRESS 8120 Ruth Circle N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
3
4
Bourdeaux's Spring Brook SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
James Mitchell 8120 Ruth Circle N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Steve Kroiss & Sons Inc. 1295 Danforth 489-7384
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 a 14' x 10' Porch Addition
9 CHANGE OF USE FROM TO
STIPULATIONS
��PeAWARNG
,yATr pBefore digging call local utilitles
��407',STEL€PHONE - EUCTRIC - GAS Etc.
1104
RF4triRF REQUIRED BY LAW
POI?
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
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$7,500
$3.75
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,
$45.00
PLAN CHECK FEE
TOTAL FEE
I-
1
0 00
NATURE OF CON RACTOR OR AU HORIZED AGENT MATE)
WHEN PROPERLY VALIDATIHISIS YOUR PERMIT
oil
BLDG INSP - OAJE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
CITY OF FRIDLEY
APPLICATIOPd FOR RESIDENTIAL BUILDING PERMITS
(New, Alterations, Additions, or Repairs) �
OWNER: "4—
ADDRESS: , =
TEL NO:
BUILDER:
ADDRESS:
TEL NO
/LI1 i
i'
Construction Location
STREET NO: STYEET:
LOT: BLOCK:
Corner Lot: Inside. Lot:
ADDITION: B iC ���[ &') C.,
Setback: Sideyards: _
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to . scale.
U DESCRIPTION OF CONSTRUCTION
•/ j e
Front: Depth: (® Height:
Squa=re Feet:_ Cabic Feet:
Front:
Depth: H eight :
Square• Feet: Cubic Feet:
Type of Construction: ��,�� Estimated Cost: -----%✓
To Be Completed: zow
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $ —
SEE REVERSE SIDE OF SHEET .
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to c% 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 applica
DATE: SIGNATURE
Stipulations:
t
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1993
64>1 University Ave NE
Fridley, Me.' 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
JOB ADDRESS
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
Fumace Shell and Duct Work, Burner --
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Fumace
$ 20.00
$ - /p
representations stated in this application are true and correct.
,1993
Gas Piping (Needed with new furnace)
$10.00
$
OWNER a
Gas Range
$10.00
$
BUILDING USED AS
Gas Dryer
$ 10.00
$
ESTIMATED COST � � � PERMIT NO.•__��/
* e�
Air Conditioning _ n izes tri
$10.00
$ �®
•
DESCRIPTION OF FURNACE QNQ OR BU NER
All Others/Repairs.& Alterations (LIST ON BACK
-1% of Value of Appliance or Work
$
No. of Heating Un i Circle One (Steam) (Hot Water (Warm A
Trade Name Size No. l
Cq,mmercial/Industrial
BTU ���, HP EDR•
1% of Value of Appliance or Work
$
Fuel Total Connected Load
' State Surcharge
$ .50
Burner Trade ame Size No.
TOTAL FEE
. •��
BTU HP EDR
lk
MINIMUM FEE FOR ANY HEAT] NG/COOLINGNENTILATI ON
REFRIGERATION/AIR CONDITIONING PERMIT IS 115.00
PLUS THE S ATE SURCHARGE
REINSPECTION FEE $30.00
HEATING COMPANY HEATING & AIR CONDITIC,dI .G CO.
8910 WENTVgjRIH AVL. W.
Signed
Approved
Rough—In Date Final Date R -TJ
'• 1�
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
,�(�tiv � IMNEY ANO STACK VERIFICATION -
The undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
Yes
(:-r
No
( )
2.
Is free from rust or deterioration
Yes
No
( )
3.
Has no foreign objects lodged within
Yes
(✓f
No
( )
4.
Is securely supported
Yes
(Vy
No
( )
5.
Meets all current Code requirements for
size and total BTU's connected
Yes
No
( )
6.
Has total heating BTU's of 40.0no
All other BTU's �-
TOTAL BTU's .off
Remarks
r
. j
List Alterations Being Done:
HEATING COMPANY
Signed By HEATING & V,11
J E.- 41 ..+h .L. 5 .
Date MINNEAPOLIS: ®N 55420
I.
v
4ehf -
amlI
e i ao ugh Ci rd e, f YI(81 ey m N
A0 e 'I r
erml SS) on,
* A i 1 .4 A V
air 1, ) On I rl
-en�y-o
'boo-e , ktween
OUir two
�ne
an A,u9�s1 12)
CITY OF FRIDLEY INSPECTION DIV. Effective On August 1, 1995
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Rate
TOTAL
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace
$ 30.00
$
(Side Vent -- Fill Out Back)
Gas Piping (Needed with new furnace)
$10.00
$
Gas Range
$ 10.00
$
Gas Dryer
$10.00
$
*Air Conditioning — All Sizes
$ 25.00
$
All Others/Repairs & Alterations (LIST ON BACK a
of Value of Applianceo ork $
e°A/ ear s-
Cas mercial/Industrial
1.25% of Value of Appliance or Work $
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.06/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
• : ADDRESS r /'
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.
X ,1995
BUILDING USED
ESTIMATED COST1 S3 qto PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Wate-) (Warm Air)
Trade Name Size No.
BTU HP EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
HEATING COMPANY
Signed BOL22ta -_wTel No.
Approved By Ae6 Rough—In Date Final Date /
FILL OUT BACK SID OR STACK VERIFICATION ON
REPLACEMENT FURNACE
CITY OF FRIDLEY INSPECTION DN.
6431 University Ave NE
Fridley, MN 55432
572-3604
Effective On August 1, 1995
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
.. �
hi ie: :.a fu i;r. J'�# ...9i::+pci:e:l'. • •
�G
•
—
_ _
fi ti:P._r.;ME
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u
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st:FS,r�, �::, aa•=�.�.v_��axiJa:h::
'�-'��'� !f :
• • .!'.!i. �.. +'S�i 5f .;
��d,i :.a;"l �yppF +:yh,�`:; l�.:4!�7d'v .„t0i!.,,'.Ipzc: 5II 1 ��+.!,i:!i,j! ::y..:;ju.;!' .�'y.,.:.�{::4iISin,;ri!P!lx0�;j _10a
lr;- �
111N,: 1 0=_= __
... x :..
!; ,:
61
52:
! !':!; •5!,;':lr=z!j4:' ,;Pr:r,
�LLiS,.�:6'���s�6.p5I:!,!�::=s��i?��i��i��'���u`��.���m7!�
,h;,111
•r;5';'4:
=°rrnr :!r :;i. :�,;: t,;._ �:rr'
�'i;l!"�".�'_ll��'=��.`k-i''`t�'��
■ii"i�i�:� '�� �
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
Type
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10:00
$10.00
$10.00
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fbdure or Appliance
State Surcharge
TOTAL FEE
.50
JOB ADDRESS ,__2i E5 �' E LP L -J
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.MW
t
----1 ® -
Owner MITCHELL MARY
--� 9120 RUTH C I ROLE
FR I DLE'w' d MM 55432 -2 s tr o ��
Building U H 766-5033 W
Estimated CostPERMIT NO. d
PLUMBING COMPANY
SIGNED BY
Approved By
F_74 �
Rough -In Date Final Date
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00
$ 0 PLUS T -HE $.50 STATE SURCHARGE
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 80 INCHES.
i
ti