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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N°4 5 6 9 Date: . _-1, ..� .._ ._.!�.........._.._.-....... ............ ....... ...... Owner: ...: _ �#::... �z.�.... ._..�.� .� .� Builder ... ...:. .:... ..... :.:. _.: a� ......�__...._ Address .._.....:._.. _ _. ''` ...: -4.... ..G Address .... ®�� LOCA �O®N OF BURDING ... No......_. ...,........ Street _.. .._............_.........._............._...........,.. Part of Lot .------.................. ..._........... _.... _... Lot ............a4::....._......_ Block ....._... ........ ............ Addition or Sub -Division . . 9 _. ... ... .. .._ ._. IL 1_01 Corner Lot ....._..._ ....................._- Inside Lot ....._.: ...._........ Setback ....- _ ............ Sideyard ....... ..._...._ ....... ..._........ _..._.... Sewer Elevation ..... ........ _.... _............. _............. _............. .............. _....................... Foundation Elevation DESCRIPTION OF BUILDING To be � Used as:AL , Front _ Depth ....._.. Height ..._.. Sq. Ft._ Cu. Ft...� ont .....i.._.. Depth _a�..ir_.. Height .....,� Sq. Ft.. ...I' Cu. Ft...._ . . . 00 Type o Construction Est. Cost ..1.7....: ..... ........ To be Completed ....._ .............___........._................. tH`IS PERMIT DJES N�� FAUTHORI7_E VIOLAT- ION OF ANY Pi-,{IVATE LANID COVENANTS AND BUILDING RESTRICTIONS. In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed 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 a 1.1 q payment of a fee of $ ._"` .........., permit is hereby granted to. ........................................ ......_..._.._.. .._._.._._.........._......._...._.I._..____..._... 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 f any of the provisions of said ordinances. r° _ Building Inspector 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 these items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owners Name ( L Z,+,ff Q t✓ Builder Address �gg 3 Address �v 5�3iP�/'�0 •�% /C/� 61 BUI�, � IIIG No. Street Part of Lot Lot Block Addition or Sub.Div Corner Lot Inside Lot __!L.Set Back 3 Side -Yard . SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: '/I�a /167w ��. Front Depth S Height Sq, Ft. .a j a. Cu. Ft. ZLC e - Front Depth Height Sq. Ft. Cu. Ft. Type of Construction��lf-�i C Estimated Cost To be completed -LIZ 7- '/ i C -C> 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 representa- tions stated in this application are true and correct. DATE / % SIGNATURE (A Schedule of Fee costs can be found on the Reverse Side.) 0 I:U# �_ 1�_tWmialusai5i Section 2. The Inspector of Buildings shall, before issuing any permit for the erection of any building or structure, or for any addition to any existing building or structure, or for any alterations or repairs to any existing building or structure, upon application therefor, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: 2.1. For any such permit for the erection of any fire -proof building, other than a garage, warehouse, factory or grain elevator, or for the erection of any fireproof addition, for similar occupancy, to any existing building shall be at the rate of $1.40 for each one thousand cubic feet, or fraction thereof, in such cubical contents. 2.2. For any such permit for the erection of any fireproof garage, ware- house, factory or grain elevator, or for the erection of any fireproof addition for 'similar occupancy, to any existing building shall be at the rate of J1.25 for each one thousand cubic feet, classified as "fireproof" by Section 502 of the Minneapolis Building Code. HO_ 2.3. For any such permit for the erection of any non -fireproof building other than a garage, warehouse, factory or grain elevator, or any non - fireproof addition, for similar occupancy, to any existing building, Permit $1.00 for each one thousand cubic feet. GARAGES 2.4. For any such permit for the erection of any non -fireproof garage, warehouse, factory or grain elevator, or for the erection of any non - fireproof addition, for similar occupancy, to any existing building�x' for each such building or addition. Ninety Cents for each one thouslInd cubic feet or fraction thereof, in the cubical contents thereof with a minimum of $4,00. For the purpose of computing fees for building permits the cubical contents of any building or addition to a uniform height throughout by multiplying the ground area covered fr*m a point six.(6) inches below the floor line of the basement or cellar to the average height of the upper surface or to the average height of the roof surface of the main gable of a pitched roof. 2.5. For repairs or alterations to an existing structure, the fee shall be° at the rate of $3.00 for each Five Hundred Dollars ($500.00), or fraction thereof in the cost of all proposed work. 2.6. In no case shall the fee charged for any permit as set forth in Section 2 be less than $4.00. City of Fridley Application for Plumbing and Gas Fitting Permit DESCRIPTION OF WORK Number, Kind and Location of Fixtures .yp0 0OM77 W 3Cf �� tl�?E� y� 3} Z eZ� K az Z S C UU y. O�j < z �d CyIY a0 U' Z o F N WATER HTR. GAS ELEC. Base Ist 2nd 3rd 4th • Future Connection Openings e New Fixture, Old Openings Connected with Sewer 0 Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures / x $1.50 $ , 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 $ New Ground Run Old Bldg. ............ x 3.25 $ GAS FITTING FEES: 1st 3 Fixtures ......................... Additional Fixtures ................... Gas Range to 200,000 BTU ............. REPAIRS & ALTERATIONS—Refer to Code NO. RATE TOTAL X $1.50 $ x .50 $ x 2.00 $ Description ................................................$ TOTAL FEE $ Dept. of Bldgs. Phone SU T.....sa..... -2 P 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 app cation are true and correct. fiMdley Minn :2 Owner ' " Kind of Building � A ef sv' Used as To be completed about Estimated Cost, $ Old—New. Building Permit No Permit No.0 Signe'l l� Busine hone o. ROUGH FINAL—j Application for Power Plants and Heating, Cooling, Ventilation, and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 m ® O each add. 60,000 BTU ........................ 2.00 $ _ Replacement of Furnace 0.00 $ Repairs & Alterations—up to $500.00 .... ............ 5.00 $ Repairs & Alterations each add. $500.00 .............. 1 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—ta 400 sq. ft. EDR Steam, ..... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 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 $ 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 FFE $ m ROUGH FINAL Dept. of Bldgs. Phone SU. 4-7470 /. - J."� 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, Minn 19�� Owner Kind c4f Building T Used as To be completed about . v Estimated Cost, $ v Old—New. Building Permit No. Permit No. DESCRIPTION OF WORN HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No Trade Name 0 1"1:& O P ` �� p Size No,/r,O a' le 0 Capacity 00 10 ® Sq. Ft. E.D.R BTU H.P. Total Connected Load_®l Kind of Fuel BURNER —Trade Name Size No Capacity. (REMARKS—OVER) s a z 2M 7-59 Sq. Ft. E.D.R BTU H.P. SUPERIOR FURNNCE CO, 6321 -42nd AVE. N. ned MPL$. 22, MINN. - KE 7.8441 Bc f l/y Business Phone No Ddb HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS FRIDLEY, MINN. Weatherstrips A.S.H.V.E. Construction No. Insulation Guide Windows I Doors Reference Out. Wall Int. Wall Ceiling I Roof . Floor Kind How Applied Yes—No Yes—No 19— F1 1 ° Room l Length Width Height , II / R -1_I Room I Lenirth 49 Width Height "' 1 otal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FJ A< r.74, Room I Length I--? Width S Height Windows nd Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. p Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. g Windows and Doors—Crackage and Area y A- Width Height No. of Lineal f . Area No. of pane of pane lights , of crack sq. ft. 00 Coef. Btu Infiltration `? c'' '' Net exp. wall Coef. Btu Infiltration' Exp. wall Exp. wall-� Ceiling Exp. wall 7 T) _775 Glass Int. wall Int. wall Exp. wall Ceiling Ceiling ra 0 > ', (" Net exp. wall Int. wall Ceiling iA 47 911 a Ceiling +� Floor 1 otal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FJ A< r.74, Room I Length I--? Width S Height Windows nd Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. p Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. g Coef.1 Btu Infiltratiott Coef. Btu Infiltration `? c'' '' Net exp. wall Glass r Int. wall Exp. wall Exp. wall-� Ceiling Exp. wall 7 T) _775 Net exp. wall Int. wall Int. wall Ceiling Ceiling ra 0 > ', (" Floor. Ceiling iA 47 911 a Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.l 77, P Room I Length 17 Width I � Heiaht ,V - Windows - Windows and Doors—Crackage 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 pane llghta of crack eq. ft. i1Z 2— Ap0� g Coef.1 Btu Infiltratiott ' 2 R Glassy Exp. wall, `? c'' '' Net exp. wall Z2 41 r Int. wall Exp. wall 4 Ceiling Exp. wall 7 T) _775 Floor 1 btal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 0,' Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane llghta of crack eq. ft. i1Z 2— Ap0� g Coef. Btu Infiltration Infiltration `? c'' '' Glass Glass x 5-� Exp. wall 4 3 r Exp. wall Net exp. wall e Int. wall Ceiling v ra e" Floor Ceiling iA 47 Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area /I Fl.l Room I Length Width Height er Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane, lights of crack sq. ft. g Coef. Coef. Btu Infiltration 12P 31 Glass Glass x 5-� 2- > 3 r Exp. wall Net exp. wall e Net exp. wall Ceiling Int. wall �'®1,12 4 6 Floor Ceiling 6 0 Floor 711 0 Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.l M rI Room I Length 0 Width % Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pass tights of crack sq. it. Coef. Btu Infiltration 12P Glass 0 x 5-� Exp. wall 7 2, Net exp. wall Int. wall Ceiling 0� � �'®1,12 4 6 Floor 6 0 Total Btu. Required sq. ft. E.D.R. or sq. ins. W.& Leader area jg D•56 n` P Width Height No. of Lineal f . Area No. of pane of pane lights of crack sq. ft. HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS FRIDLEY, MINk Weatherstrips A.S.H.V.E. Btu Construction No. Infiltration Insulation -7 P Glass Guide Exp. wall Net exp. wall -4-0 Int. wall WindowsI Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Yes—No Yes—No 19— 9_Fl.1_. F1.1,' Room I Lenstth , >_ Width A Fl.l Room I Lenath Width Height Windows Q Doors—Crackage and Area n` P Width Height No. of Lineal f . Area No. of pane of pane lights of crack sq. ft. q ,23 Coef. Btu Infiltration Coef. Btu Infiltration Infiltration Net exp. wall -7 P Glass Glass Exp. wall Net exp. wall -4-0 Int. wall Exp. wall Ceiling _ if Floor Floor Net exp. wall ®� Int. wall Ceiling Jac? 4 �!_o CPO Floor F 0 0 -1 otal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 16,, 10 F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of No. of pane of pane lights Lineal ft. Area of crack sq. ft. Coef. Btu Infiltration Glass Coef.1 Btu Infiltration Net exp. wall Glass Glass Exp. wall Exp. wall Net exp. wall Net exp. wall Int. wall Int. wall Ceiling Ceiling Floor Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width HeightNo. of Lineal ft. Area of pane of pane lights of crack eq. ft. Coef. Btu Infiltration Glass Exp, wall Infiltration Net exp. wall Glass Int. wall Exp. wall Ceiling Net exp. wall Floor Int. wall Tbtal 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 Noe of pane of pane lights of crack sq. ft. Width HeightNo. of Lineal ft. Area of pane of pane lights of crack eq. ft. Coef. Btu Infiltration Glass Exp. wall Infiltration Net exp. wall Glass Int. wall Exp. wall Ceiling Net exp. wall Floor Int. wall Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length Width Height Windows and Doors—Crackage and Area No. Width HeightNo. of Lineal ft. Area of pane of pane lights of crack eq. ft. Coef. Btu Infiltration Glass Coef. Btu Infiltration Net exp. wall Glass Int. wall Exp. wall Ceiling Net exp. wall Floor Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area Fl.l Room I Lensth Width Height 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 Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Original N? 5084 -:5--e4 O & N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for Permit spC7 f9 inection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit., F� DESCRIPTION OF WORK Number, Kind and Location of Fixtures City of Fridley�� u� ,19 % d Storxee f 0 3 u z ism m I- 'm m x m < 3 F z O o a O N O a Z K a o F m 4 6 u m Z X O , mX g u' O a 6 n p, a W m X a s a rc WATER HTR. GAS ELEC. Basement 1st .s 2nd 3rd 4th Connected with Sewer -Cesspool Gas Piping for Openings Permission is hereby granted (VAAtO do the plumbing and gas f `fitting in the building describe in the statement hereto at ched, upon the express condition that the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and this permit may be revoked at any time upon the violation of any of the provisions of said ordinances. By Order Of The Inspector Of Buildings Roughing in Inspection Date Inspector. Final Inspection Date Owner �-L - RV I-& Location deo SV L JA rJ i A rU Kind of Building F'e'9m L Used as b w LL/I r) C, To be Completed F68 /® ,19—U Estimated Cost $ 10 • cT O « New. Building Permit No. Inspector of Buildings. SUBJECT PER IIr�+.�+. ---�,- City of Fridley 13271 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPTWe--''r `y _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION #6 r i � SEC. l V /xJ ' �4 1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY %J 612-560-3450 910-F15 10/17/75 JOB ADDRESS 28.0 Sylvan Lane N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 2 3 Sylvan Hills Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Robert Davis 280 Sylvan Lane N.E. 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 3 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Re -roof house 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. Asphalt 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 P 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. $700.00 .5O 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- 6.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $6.50 SIGNATOR€ OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT wpl'a/ &�d `f LL� /D `) I- 7� / BLDG. INSP DAT SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) ' .APPLICATION FOR RESIDENTIAL -9 ALTL'RATION, OR ADDITION.BUILDING PEMIT CITY OF FRIDLEY,-NIINNESOTA OWNER S NAME�,L1��, �� ADDRESS :�� i/� ADDRESS NO:. STREET:�il�i�� G LOT: BLOCK: ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: f Applicant attach to this fora Two Certificates. -If SurveY.of Lot and.proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: Front • Depth: ' Height Square Feet: Cubic.Feet: • - Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: GPi�2��.� Estimated Cost: To Be Completed:2�� The undersigned hereby makes application fora permit for the work herein specified, agreeing- to do 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 application are true and correct. • DATE: /G / 7 - S SIGNATURE (See reverse Side For Additional Information.)' 0... �,U BU1LDiNU L';RM11 kL•L•-AJ1J;VU'1.1r SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repairs to any existing building or structure, upon application therefore, require the payment by the applicant foie such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: UNIFORM BUILDING CODE: Type 1, 2 & 4 - $2.15 for each one thousand cubic feet, or fraction thereof, in such cubical contents. Type 3 & 5 - $1.85 for each one thousand cubic feet. ADDITIONAL INFORMATION For the purpose of computing fees for building permits, the cubical content of any building or addition, is determined by multiplying• the ground area covered from a point six (6) inches below the floor line of the basement. or the cellar to -the average heights of the upper surface or to the averagee height of the -roof surface of the main gable of a pitched roof. • For repairs -or alterations to•an existing structure, the fee shall be at the rate of $3.00 per each five hundred -dollars ($500.00) or fraction thereof in .the cost of all proposed work. In no case shall the fee charged for any permit as set forth in Section 2 be • less than $5.00. VERIFICATION OF FOUNDATION DOTE: Permits for construction will be issued.a minimum of 24 hours from the time of application, to allow for proper review of the proposed structure and. of the construction site. A Certified Survey of the lot, showing the location of the foundation, once it has been constructed, will be required before proceeding with the framing. CERTIFICATE OF -OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure shall not be used or occupied until a Certificate of OccuppLncy has been issued. . CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On January 1, 1997 PLUMBING FIXTURE RATES NO. RATE 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 �y �yl�q� TOTAL JOB ADDRESS Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance 10, 00 State Surcharge $ .50 TOTAL FEE $A2 SO The undersigned hereby makes application for a perm it for the work herein specified agreeing to do all work in strict accordance with the city codes and ruling's of the Building Division, and hereby declares that all the fads and- representations stated in this application are true and correct. Owner JA//L A-�)ss 5"? 1 ® Building Used As Estimated Cost p �V � PERMIT NO. PLUMBING COMPANY O�T� ��%�` (17�� SIGNED BY ''� TEL N0. Approved By ISIff /IfRough—In Date Final Date **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. Building PLUMBING Permit NO.; - /0 - Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY nates: J U N 18 20 DATE 4 I(oro YOUR E-MAIL ADDRESS � � Yui .M �� l° f/` . ( 6 VVI / sITEADDRESS 9.%Q UayI 1.e�uO i b ., mA-) THIS APPLICANT IS: 0 OWNER WONTRACTOR PROPERTY NAME: Se, i S ADDRESS: a�60 S � U0.vA GCVK -e_ CITY Fes" Q STATE.m AAO ZIP 5sy 3 ;> OWNER/ TENANT � PHONE: -76 3 - �377 I - S Lf 5—S- P CONTRACTOR NAME: fU ti IG STATE LICENSE # CQ al T (� 10M4 EXP DATE l -a 3 i ? PC,, 5�7 SUBMIT A COPY OF YOUR STATE ADDRESS: 960S- eo'01,0("' /q V e CITY ST I STATEIM0 ZIP D LICENSE WITH PHONE Fj(o1-366-CPS-Or FAX 7263 %8•( %-7S-Z APPLICATION PERAHT TYPE QGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: ❑NEW PLACEMENT DETAILED DESCRIPTION OF WORK °�-W6 c PER MS 16B.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) _ BATH SINK/LAV _FLOOR DRAINS _ SHOWER —WATER PIPING BATHTUB GAS PIPING Rvam caa Lkwvm) SWIMMING POOL _ WATER SOFiNER ($35) _ _ _ _ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15) DISHWASHER LAUNDRY TRAY igWATER HEATER ($:35) FOR IRRIGATION _ _ WATER METER OTHER Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ �• 0O TOTAL DUE $ State Surcharge = $ .50 Total .= $ •SO 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 Cods; 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 rk w review and approval of plans. I SIGNATURE OF APPLICANT PRINT NAME Wu9 DATE 6IiO .0 �. pal t/�� k City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-5024977 )1