Loading...
PRE 2010 DOCSCity of Fridley, Minn. N9 9507 BUILDING PERMIT Date: October 17, 1967 Owner: Clemron, Inc. Builder Clemron, Inc. Address Address 701 Columbia Blvd. LOCATION OF BUILDING No. 7301 Street Temno Terrace — part of Lot Lot 9 _ Block 2 Addition or Sub -Division Melody Manor Corner Loth Inside Lot __ Setback 35Sideyard 10' -21' Sewer Mevation 861.74 864.74 Top XX of Footing DESCRIPTION OF BUILDING To be Used as: Dwelling Front 26' Depth 35' Height 20' sq. Ft 910 Cu. rt 18200 Garage Front 26 t Depth 22' Height 10' sq. Ft. 572 Cu. Ft. 5720 Type of Construction Frame Est. Cost $ 23x_000 To be Completed SEWER LOCATION 6101 North of Manhole WATER LOCATION 71' North of Manhole In consideration of the issuance to me of a permit to construct the building bed _ a I agree to do the proposed work in accordance with the description above et forth � and a 1 provisions of ordinanoea of the city of Fridley. 0 f In consideration of the payment of a fee of $ 36, 00_, permit is hereby granted to Clemron, Inc . to construct the building or addition as described above. This permit is granted upon theeFress condition that the pera�n to whom it is granted asci his agents, employees and workmen, in all work. doneridlMinnesota regarding location, construction, alteration, maintenance, repair and moving of build�ng� within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. CLARENCE BELISLE Building Inspector NOTICE: This permit doss not cover As construction, Installation for wiring, plumbing, gas beating, sewer or water. Be am to an the Building Inspector for separate permits for tbas Items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME C L. E- D L i N C. BUILDER C AF J4A 6 N -. N0 C ADDRESS ADDRESS '7 ®1 - C O L U M fii s , LOCATION OF BUILDING N0. STREET PART OF LOT LOT 9 BLOCK . ADDITION OR SUBDIVISION Q 7) N[ 0 CORNER LOT INSIDE LOT SETBACK SIDE -YARD % 0 Z J f SEWER ELEVATION ' FOUNDATION ELEVATION 36At'ej-4 61 Applicant attach to this form Two Certificates of Survey of Lot and proposed bui ding location drawn on these Certificates. �7 DESCRIPTION OF BUILDING To be used as; 01 r K 'PC S' t-- e- J -2 r -G Front , � Depth Height Sq. Ft.--F3-f== Cu. Ft. ' a est Front Depth �G r Height's Sq. Ft. s9s Cu. Ft. Type of Construction_ ,Z',)- e � 4a Estimated Cost e® To be completed The undersigned hereby makes application for a 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_ SIGNATURE. (Schedule of Fee Costs can be..:found on the R er Side). �. t r/` i frrX (. e BUILDING PERMIT FEE SCHEDULE 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 therefore, require the payment by the applicant for.such permit of fees••.to the amount.herein belowset 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 fire -proof addition, for similar occupancy, to any existing building, shall beat 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.fire-proof garage, warehouse, factory or grain elevator, or -for the erection of any fire -proof addition, for similar occupancy, to any existing building shall be atthe• rate of --$1.25 for each one thousand cubic feet, classified as "fireproof" by Section 502 of the Minneapolis Building Code. HOUSES 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 -fire -proof addition, for similar occupancy, to -any existing building or for each such building or addition - ninety cents ($0.90) for each one thousand cubic feet or fraction thereof, in the cubical contents thereof with the 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 from 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, thefee shall be at the rate of $3.00 per•each Five Hundred Dollars ($500.00) or frac�ion 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. STORM REPAIR DAMAGE FEES: Residential: Estimated Cost of work up to 5500.00 - $5.00 Estimated Cost of v%rk' oce: `,"+:.... �! - , 00 Commercial; Estimated st of Estimated at of WorX over Y..)CO. UU - $2. U. _ L' )v Application for Power Plants and Healing, Cooling, Ventilation, Refrigeration and 1 Air Conditioning Systems and Devices / PARTIAL RATE SCHEDULE Dept. of Bldga. Phone 560-3450 GRAVITY WARM AYR: RATE TOTAL Locatfon � � � r Furnace Shell & 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 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ 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 ..................... 3.00 $ 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 BURNER (up to 199,000 BTU) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE !OTA . � 1st 3 Fixtures ..... ................ x$ 2.00 $ Additional Fixtures ................ x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE ROUGH FINAL 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- Owner. Kind of Building��� Used as v. To be completed about Estimated Cost, $ �. a Old—^Ye�Ilding Permit No. ©7 Permit No. DESCRIPTION OF WORK HEATING or POWER —Steam, Hot Water, rm Air \�To Z ' Trade Name Size No_ Capacity Sq. Ft. E.D.R % ���'%� BTU A.P. Total Connected Load Kind of Fue � ✓� BURNER — Tradee ✓ i9� O?y , jo?a , Nam���� �-Jr. Size No-.— Capacity Sq. Ft. E.D.R/ s' BTU H.P. (REMARKS—OVER) Signe t/ N. W E L.TE R HEATING CO. 4637 CHICAGO AVE. By « Business Phone No.- (REMARKS—OVER) o. 0 '0rte` i r �-040- -� ,�--?Required sq. ft. E.D.R. or sq. ins. WA. fader area �, _ ` ..®s�� DEP ®F BURDINGS HEA ' ' > Fl.ength - .Width — Height Windows and Doorsr--'Crnc, Se and Area and Area Cineol 18. AreaNo of crock sq. ft. 2 + , yYAdth neighq No. of Line l tt. Area of Dane ' of Dane lights oe erack sq. ft. Widths 9oight No. of of Dane of Dana liethte 0 Weatherstrips A•S.H.V• Btu Constmction No. Glus rI iASe tk, , J hlsulatio� -. h :.Prep. wall Ceiling 2- Guide Reference Out. Wall Int. Wall Ceiling hoof Floor Kind How Applied Windows Heigh i o d 19— ` G'^ , omI Uneh Coef. Windows and Doors--Crackage and Area Inhitration Width lweisht . No. of Lineal rt. Area Ot Pone of Dune light" of crock Va. Pt. RooAnlength �-- Width ® 1miaht Tr F1.9 v Room Lent Width Heigh Windows and Doors—Crack&3e and Area :. mind®w� and�orr�cka�e end Aeea € No. iYAdth Height of Dane of Dane - No. of lights Pineal Pt. Area of crack a®. ft.No. 77 Width of Dane H"Irlit 111a. of of Dane lights Lineal ft. of Creek Area OCR. ft. et, wan Int. wall Floor 7 r, m Total Btu. Req�cired sq. ft. E•D.R. or sq. Inas. WA. leader area 3 d� } Coef. BtuCoef. Btu 'Infiltration i �° E �' Infiltration ".,Glass 1 ((.� ®5 b Glee Cf e®C7 . a ' F.xp. Well Fp.-wall� A ; Netexp. wall .. d Net exp. well 4, Q Int. wall �. "',,Ceiling P�%U__L4Ceiling / 3 x floor Floor 'Totafl 13tae. ' ' . ,�--?Required sq. ft. E.D.R. or sq. ins. WA. fader area + . ' ' > Fl.ength - .Width — Height Windows and Doorsr--'Crnc, Se and Area and Area Cineol 18. AreaNo of crock sq. ft. 2 + , yYAdth neighq No. of Line l tt. Area of Dane ' of Dane lights oe erack sq. ft. Widths 9oight No. of of Dane of Dana liethte 0 Coef. Btu =Ire66tration, 3 Glus rI iASe tk, , J &P. wall Net MP. Well Int. wall h :.Prep. wall Ceiling 2- " Net easy. waA ,. /J ' Int. wall Total Required sq, & E>D•R. or sq. ins. W.A. fader area Ceiling Al.{ ® Len —Width ` –floor ' Heigh Total 13tu, :` Required`sq.'-ft: E.D.R. or sq. ins. W.A. l.4ader area ` G'^ , omI Uneh Coef. Windows and Doors--Crackage and Area Inhitration Width lweisht . No. of Lineal rt. Area Ot Pone of Dune light" of crock Va. Pt. �' 3 Class 11r.SC) Exp. wall cif ®o. Not exp. wall' A :. Int. wall t c f. Btu infiltration ' . 77 77 _:: . wall LZX et, wan Int. wall Floor 7 r, m Total Btu. Req�cired sq. ft. E•D.R. or sq. Inas. WA. leader area 3 Total Btu. Required sq. ft• E.D.R. or sq. ins. W.A• Deader area + . o�w rft j Length Width z 1°leeghe ` Windows aniVoom—Crackime. and Area Cineol 18. AreaNo of crock sq. ft. 2 a Z, ,1 Widths 9oight No. of of Dane of Dana liethte Infiltration f. . Btn , Glus &P. wall Net MP. Well Int. wall Ceiling 2- Floor 3 9' Total Required sq, & E>D•R. or sq. ins. W.A. fader area Al.{ ® Len —Width �`-, Heigh Windows and rachage and Area Wldth Height No. of Lineal EL Aeaa ATo Of Dorno of peano /lutea® of emck ®q. Pt. ` G'^ , Coef. Btu Inhitration L �' 3 Class 11r.SC) Exp. wall cif ®o. Not exp. wall' :. Int. wall t c Ceiling Floor Total Btu. Required sq. ft. EM or sq. ins. W.A. Leader ma _:: V b Application for Power Plants and Heating. Cooling. Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & 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 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ 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 ...................... 3.00 $ 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 BURNER (up to 199,000 BTU) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOT 1st 3 Fixtures x$ 2.00 $ Additional Fixtures ................. x .75 $ Gas Range to 199,000 x$ 5.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $- ALTERATIONS & REPAIRS TOTAL FEE $ ROUGH FINAL Dept. of Bldgs. Phone 560-3450 P� City of Fridley: The undersigned hereby makes application for a permit for the work hereir 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. Owner Kind of Building Used as To be co Minn 19 — a- J'Ar"sfe s Estimated Cost, $ Old a Building Permit No. Permit No.G DESCRIPTION OF WORN BEATING or POWER PLANTS team, Hot Water, arm Air No Trade Name 4 w' Size No Capacity Sq. Ft. E.D.R.BTU H.P. Total Connected Loa ® Kind of Fuc BURNER — Trade Name Size No-.-- Capacity. Sq. Ft. E.D.Rr_ BTU H.P. dl (REMARKS—OVER) RAY N. WELTER H EATI N G C G. Signe AGO AVE. By!41NNE&C3TA az Business Phone No c`� �' Commliments of North Central Public Servic 0 BAT rLOSS CALCi7LMONS r �� DEPARTMENT OF Weatherstrips A.S.H.Va Construction No. Guide dows I Doors Referencia Out -Wall— I Int. Wahl Ceiling No No 19........ Fl. L oom I Lengt1i 1,q •-Width Height II Windows and Doors--Crackage and Area Width No. of pane Height of pane No, of UghU Linea] ft. of crack Area sq. ft. Height No. of of pane lights Lineal ft. of crack Area sq. ft. -fjon t/ No. Width Height Of pane of pane No. of Lineal ft. lights of crack Coef. Btu ' Infiltration Glass VrJ 10 .O Exp. wall Coef.1 Btu ` Infiltration 7F, � Glass 170 a O v Exp, wall Coef. Btu zlt Net exp. Wall Int. wall Glass Exp. wall _' Flowr Ceiling d elil 'Floor �a G :A-110 Totai Btu. - j Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl. JA cV, s Room I Length -y -Width Height Windows and Doors--Crackage and Area No. Width of pane I Height No. of of pane lights Lineal ft. of crack I Area I sq. ft. Height No. of of pane lights Lineal ft. of crack Area sq. ft. -fjon t/ No. Width Height Of pane of pane No. of Lineal ft. lights of crack Coef. Btu ' Infiltration Glass VrJ 10 .O Exp. wall Net. exp. wall Int. wall Coef. Coef. Btu Ceiling Coef. Btu zlt � Glass Exp. wall _' Flowr -7V d 400 Exp. wail Total Btu. ' Required sq. ft. E.D.R. or. ins. W.A. Leader area :A-110 Ceiling=f- Floor Net exp. wall Int. wan I� 011 1 TV Zz V 1. OF 11 Y AK "UU114 1 A. vlagut , z — auua d 0, ca6aao a Windows and Doors—Crackage anti Area _ NO. Width of pane Height No. of of pane lights Lineal ft. of crack Area sq. ft. Area sq. ft. t/ No. Width Height Of pane of pane No. of Lineal ft. lights of crack Area sq. ft. VrJ 10 Coef. Coef. Btu Infiltration Coef. Btu zlt � Glass Exp. wall Glass -7V d 400 Exp. wail ci I- :A-110 Ceiling=f- Floor Net exp. wall Int. wan I� !�;- S-' o Ceiling Net exp. wall Floor Lyle 12 1/ �- Total Btu. ( j Required sq. ft. E.D.R. or sq. ins. W.A. Leader area M s l ellq? CITY t —TOWN VILLAGE Floor 11 Kind , _.Room I Length jjr How App: V K ith/� ,2— Windows and rs Crackage and Area K Room No. Width of pane Height No. oY of pan�ey lights Lineal ft. of crack Area sq. ft and Area Area sq. ft. t/ No. Width Height Of pane of pane No. of Lineal ft. lights of crack Area sq. ft. VrJ 10 Coef. Btu Infiltration Coef. Btu zlt 77® ( l Glass Exp. wall Infiltration -7V Glass Exp. wall Net exp. wall Int. wall Ile :A-110 Ceiling=f- Floor 1.0 S"® Exp. Wall !�;- Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl. I ff (9 K Room I Length j,o Width ,rte Height Windows ind Doors—Crackage and Area Area sq. ft. t/ No. Width Height Of pane of pane No. of Lineal ft. lights of crack Area sq. ft. VrJ 10 Coef. Btu Infiltration Coef. d7 Infiltration -7V Glass Exp. wall _ l 5a Net exp. wall 1.0 S"® Exp. Wall !�;- S-' o Int. wall Net exp. wall Ceiling �' / �' 7 � Floor e IF ,3 Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area /Fl. I ! Room I Length "`Width eight 'S:rd Windows and Doo ckage and Area No. Width f pane Height of pane o. of llgghts Lineal ft. of crack Area sq. ft. Coef. Btu Infiltration _ _ l Glass 1.0 S"® Exp. Wall Net exp. wall Int. wall Ceiling y 3- '✓ e7350 Floor Total Btu. IIRequired sq. ft. E.D.#, .or sq. iti'is. w.a. L eager area 1, y City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone 560-3, DESCRIPTION OF WORK Number, Kind and Location of Fixtures pp NO. RATE TOTAL Number Fixtures...................... x $2.00 $ /' a Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. �a}vZ� O� � u�it� Uy' Z • • WATER HTR. New Ground Run Old Bldg . ............ x $3.25 $ Electric Water Heater a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL DOLL ag V m a3 U' (`9p �O F N GAS ELEG m Base / 1st 2nd 3rd 4th • Future Connection Openings Connected with New Fixture, Old Openings I Sewer Cesspool 0 PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures...................... x $2.00 $ /' a Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. x $1.50 $ Catch Basin ............................ x $3.25 $ Water Heater (Up to 99,000 BTU) ...... x $3.00 $ New Ground Run Old Bldg . ............ x $3.25 $ Electric Water Heater a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ...... ................... x $2.00 $• Additional Fixtures .................... —x$.75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................. 0 CT TOTAL FEE $ City of Fridley: q36 6 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 applicatiop are true and correct. Fridley, Owner Kind of Building Used as To be completed about 19t✓ Estimated Cost, $ Old—New. Building Permit No 06-0-7 Permit No.�` Y P Signe M By Business Phone No ROUGH_ FINAL 4x HOUSE HEATING TEST RECORD . ADDRESSOR TY SUBURB 4 OCCUPANT OWNED �X'��� HEAT LOSS DATE;HTG. INST. GAS CO. METER BA SOLD BY INSTALLED BY Electrical Work By Gas Line By TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER GAS CONVERSION MAKE MAKE OF BURNER Model _ �.P%6'°.��T Model Serial .JEY� 2S�`r ��„� Max. BTU Rating INPUT MAKE OF FURNACE M d l o e -- CO TROLS A/ THERMOSTATHeat Plug Vent Size Valve ® KIND OF LINER ZE NONE Limit Draft Hood Regularor Limit Setting Filters Size Nu bar Fan Setting Chimney Location Inside Outside Pilot Type Chimney Construction Pilot Make A!61 + = Pilot Model Smoke Bomb Wiring Pilot Timing Draft e Test Tag t../' L.W. Cut Off - or Pressure Lighting Inst. Pressure Pere ntCO �Date Tested Input CFH Pe2-'empany Testing Stack Temp. Percent CO ��� Name of Tester Form 235 SUBJECT P L-NQ City of Fridley - AT THE TOP OF THE TWINS BUILDING PERMIT( r RECEIPT NO. � COMMUNITY DEVELOPMENT DIV I L PROTECTIVE INSPECTION SEC r NUMBER REV GATE PAGE OF APPROVED B---[Y CITY HALL FRIDLEY 55432 612-571-3450 910-F15 6/6/96 JOB ADDRESS 7301 Tempo Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 2 Melody Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Harvey Benson 7301 Tempo Terrace NE 784-6778 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Gladstone's Window & Door 1870 English St, Maplewood MN 55109 774-8455 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 2110 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION �1 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace windows 9 CHANGE OF USE FROM TO STIPULATIONS Replacement windows in sleeping areas must meet the State Egress Code. 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 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 $11,176 $5.59 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- $187.25 Fire SC $11.17 N OR THE P ANCE OF CONSTRUCTION PLAN CHECK F TAL FEE L SC .00 $209.01 SIGNATURE OF CON'RACTOR RAU ORIZ (DATE) N P LY V I TED THIS IS YOUR PERM) , ,,,. DG NSFF GATE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI NEW [ ] Effective 3/1/96 ADDN [ l CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 .Building Permit Application ConstructionAddress: Legal Description: Owner Name & Address: O3F�'4 so'j Tel. #_ Contractor: ����� S l� ,n(�o„y �( �� S-ro rzZ_ MN LICENSE # Address: I �?5 -7 0 t s �4_ S'T Tel. # Attach to this application, a Certificate of S rvey $f the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT '? 8L/ -,:r,7 7R Z1 rc) % -7 L%S`fJ J LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: W�%rj'00.J Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ j ) j / % Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = F x $ _ $ DATE: G�`�� APPLICANT: Tel. # '77L/=3qs*� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $900 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] Q4_r1CV___ (0 ( 6 C BUILDING PERMIT FEE SCHEDULE The Chief Building Official 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 repair to any existing building or structure, upon application therefore, 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: TOTAL VALUE FEES $1 to $500 $21 (Minimum Fee is $21 plus surcharge) $501 to $2,000 $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $349.75 for fust $25,000 plus $9.00 for each additional $1,000 or fiaction thereof, to and including $50,000 $50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 to $500,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $500,001 to $1,000,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000,000 $1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. VERIFICATION OF FOUNDATION 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 Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1997 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 0ut 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) I% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work JOB ADDRESS ?MZ 2,,Od 7 (CKCS 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. OWNER�4fq2Ve� f('_',-E4Z_i (!>£.nJSc))-)' %'9`/ C 771' BUILDING USED AS -J)'W _;LC t f -S - ESTIMATED COST Ll (, o PERMIT N0. ) �8 DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units t Circle One (Steam) (Hot Water) (Warm Air) Trade Name jAr. ; Size No. /4T--,SLkP6ZCM5___ BTU 19. OV -0 HP EDR $ Fuel Total Connected Load State Surcharge $ .50 TOTAL FEE .1 MINIMUM FEE FOR ANY HEATING/COOLI�ENTILATION 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 ED HEATING COMPANY -4 Signed By Tel No.�� Approved By Rough -In Date Final Date FILL OUT BACK SIDE F R STACK VERIFICATION ON REPLACEMENT FURN CE Remarks: . List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CHENMY AND STACK VERIFICATION The undersigned hereby verifies that the -existing chimney or stack.- tack:1. 1. Has been carefully examined Yes () No ( ) 2. Is free from rust or deterioration Yes O No ( ) 3. Has no foreign objects lodged within Yes( No ( ) 4. Is securely supported Yes () No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes () No ( ) 6 Has total heating BTU's of 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: SUBJE& PER City of Fridley 2 8 8 9 2 AT THE TOP OF THE TWINS BUILDING PERMIT i � • ....... COMMUNITY DEVELOPMENT DIV. ter,.•0 � INSPECTION SEC. t � PROTECTIVE CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 2/3/99 JOB ADDRESS 7301 Tempo Terrace NE- I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 9 2 Melody Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Harvey Benson 7301 Tempo Terrace NE 784-6778 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Minnesota Exteriors Inc 8600 Jefferson Hwy, Osseo, MN 391-5514 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW Q ADDITION O ALTERATION JJ REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reside House 9 CHANGEOFUSEFROM TO STIPULATIONS Call for building wrap inspection before covering. SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 @ $4.42 WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT `1'89855 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- $149.75 Fire$8.85 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION //4C PLAN CHECK FEE TOTAL E License 5.00 1 8.02 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT ]DATE, N PR 0 EIVOG IN P ER IDAT T IS YOUR PERMIT BATE S,GNATURE OF OWNER SIF OWNER SUILDERI IDATE, INGw 1 I Effective 3/l/96 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 sl Building Permit Application / �0 � b ConstructionAddress: �^ ,�G— Legal Description: Owner Name & Address: Tel. # Contractor: MN LICENSE # Address: �s 7J Tel # 5W ch to this applicatio , a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Len � `' 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 Setback Side Yard Setbacks Type of Construction: Estimated Cost: Approx. Completion Date: (Cost on Back) Driveway C b t Width Needed: Ft. + 6 t = Ft x $ _ $ DATE: APPLICANT: Tel. # - CITY USE ONLY , ennit Fee $Y % ' S Fee Schedule on Reverse Side Fire Surcharge $ �- 157 S .001 of Pennit Valuation (1/10th%) State Surcharge $ Z71� $.50/$1,000 Valuation SAC Charge $ $900 per SAC Unit -icense Surcharge $J<', dV $5.00 (State Licensed Residential Contractors) driveway Escrow $ Alt. "A" or Alt. "B" Above ?rosion Control $ $450.00 Conservation Plan Review 'ark Fee $ Fee Determined by Engineering ewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ - ®� 7IPULATIOI sueJECT PER City of Fridley !!!f!!!. AT THE TOP OF THE TWINS BUILDING PERMIT 2 91 1 1 r /� E L'__�___ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r E PROTECTIVE 1 � � NUMBER REv DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 3/30199 JOB ADDRESS 7301 Tempo Terrace NE 1 LEGAL I LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR.9 1 2 Melody]Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Harvey Benson 7301 Tempo Terrace NE 784-6778 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Sela Roofing & Remodeling 4100 Excelsior Blvd, St Louis Park. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 823-8046 1050 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW 0 ADDITION O ALTERATION p X REPAIR O MOVE O REMOVE X B DESCRIBE WORK Reroof House & Garage (24 Sq) Tear-off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. 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 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 $1.03 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,056 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- $74.75 Fire SC $2.06 STRUCTIO TH PER ORMANCE CONSTRUCTION PLAN CHECK FEE TOTAL FEE License SC $5.OQ $82.84 \S1G_6dTUAF.OfCON-PACT OR HORIZED T MATE, WHEN PROPERLY] ALLIIIDATED THIS IS YOUR PERMIT BL G INSP OATE S-GNATURE Of OWNEAoF OWNER SUILDM IDATEI NEW [ ] ® Effective 1/1/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 \ /� BUILDING PERMIT APPLICATION -ConstructionAddress: Legal Description-.' . - Owner Name & Address: Tel. # �6t'(P-Mo Contractor: Aj MN LICENSE #SELIA N®& REMODELING, INC. _ Tel. # ee 3 � �Q Address: 4100 EXCFI qinR gIj.� ST. LO1 4' Fes, dation, a Certificate of Survey of the lot, with® a proposed construction drawn on it to scale. DESCRIPTION 0Y PUROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: ZA , Construction Type: -Estimated Cost: $ (Fee Schedule ,= Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft $ _ $ '30b o. DATE: .3APPLIC Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main`Charge TOTAL STIPULATIONS: S IN,7S $ 2.0C, r> i B�J«C—` rel. Y CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%). $.50/$1,000 Valuation $1050 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CITY -OF FRIDLEY INSPECTION DIViS10N ®0 Effective On January 1, 2000 6.481 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) 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 Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners. can not be placed in a side yard without written permission from adjoining property owner. JOB ADDRESS 1301 1411&W/�®i�Lp OWNER �u,V S 0-2 TOTAL BUILDING USED AS CLr1-fes �� ESTIMATED COST `7 Ll" ) PERMIT NO. / "10C5 DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units Circle One (Steam) (Hot Water) ( ar ir) $ Trade Name Size No.,3 VD'3D BTU o HP EDR $ Fuel Total Connected Load Burner Trade Name Size No. $ BTU HP EDR $ 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 an $ .50 rulings of the Building Division, and hereby declares that all the facts and $55,S-7) representations stated in this application are true) and correct. SLAINS HTS, A/C ELECIDAW i356A2 viENTRAL AVE NOgA, MN55:394N.E. HEATING 0 Signed TEL # 75-7 -to 2 -- Approved By Rough -In Date Final Dat• 1 6/ nr,o 1�t€et' COMMON VENT, VENT CONNECTOR AND'COMBUSTION-AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, z and is securely supported and firest4pped whace required. Yes N No(,) The venting system is plastictPVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes (� No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA -LAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes ( No( ) The existing combustion air is sized and installed to meet the current codes / and manufacturers specifications. Yes No l When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specifications. ' Yes 0 No( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes ( No ( ) Is the common vent and vent connectors sized and installed correctly after 1 an appliance has been removed from the common vent and vented separately as per current codes. Yes 4'No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input� Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in, Type-_ Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) BLAINE HT®, A/C ELECT., INC. 13562 CENTRAL AVE. N.E. HEATING CO: ANOKA, MA 55304 Signed By: Date r ADDRESS 7:301 7e m p® 7e -Y d a -c -e— OCCUPANT 2l,Y UQU 1jAA=jgt,= HEAT LOSS G S DATE HTG. SOLD BY 1/p D C -ESI Electrical Work ByL-� TYPE OF HEAT GA FA HW STEAM SPACE HTR— DESIGN MAKE -_ 1��' v CONTROLS THERMOSTAT --!Z , Heat Plu Limit Setting Fan Setti Pilot Type Pilot Make Pilot Model Pilot Timing J® sto—, a L.W. Cut Off Pressure Percent CO2 Input CFH Percent 02 < o Stack Temp. Percent CO % HOUSE H TING TEST RECORD ��jj t APT. FLOOR CITY'SUBURB INSTALLED BY Gas Line By UNIT HTR. OTHER ®t Vent Size Al KIND OF LINER SIZE r NONE Draft Hood if Lt& Regulator l� Filters Size [ 6 X ZSR Number Chimney Location Inside Outside Chimney Construction O—Lx%;, S A Smoke Bomb Wiring V.0 <. Draft Test Tag 11.E Door Pressure Lighting Inst. �S Date Tested Company Testing 61a 62,aV Name of Tester Pressure Percent CO2 Input CFH Percent 02_ Stack Temp. Percent CO_ CIIYOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287 June 29, 2001 Mr. Harvey Benson 7301 Tempo Terrace NE Fridley, MN 55432 Re: Final Inspection at 7301 Tempo Terrace NE Contractor: Blaine Heating AC & Electric Inc Dear Mr. Benson: A mechanical permit was issued on November 14, 2000 to install a furnace and air conditioner at your address. According to section 305 (a) of the 1991 Uniform Mechanical Code, a final inspection shall be conducted on the mechanical work authorized by this permit. As of this date, no inspection has been called for. The permit fee that was paid covers the inspections to make sure the work was completed according to the Mechanical Code. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will expire the permit and no further action will be taken. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. DJ/mh I f-'>' PLUMBING RESIDENTIAL APPLICATION City of Fridley NOTE: IF PROPERTY IS NOT OWNER/OCCUPIED- A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT. -0(0 DATE r li YOUR E-MAIL ADDRESS SITE ADDRESS Of -Yr -Cle THE APPLICANT IS: (CIRCLE ONE) OWNER CONTRALTO NAME V ek4 16,eosonl PROPERTY OWNER/ ADDRESS TENANT ? CITY �P.� STATE ZIP S5%J Z PHONE ## 7 �� NAME PIPPIPEWeRm LICENSE # SS Z4�n ADDRESS �7n RC1®1*`li CONTRACTOR E)ODD CITY EAGAN hAN 55123 STATE ZIP PHONE # j651 365 1 340 FAX# PERMIT TYPE SINGLE FAMILY TWO FAMILY TOWNHOUSE TYPE OF WORK71 U NEW � REPLACEMENT �� _ ► ,,3r AyVt" "`!�%' a C eo/l,Q•A4 DETAILED DESCRIPTION OF WORK V FEES ARE 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 WATER HTR ($35) FOR IRRIGATION WATER METER OTHER 00 Permit Fee $ ss . MINIMUM: $15.00 or 5% of cost of the improvement -whichever is Plan Review $ C -D greater on work less than $300 Surcharge $ .50 TOTAL DUE $ '5 -so 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 o the ordinances and des 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 fans. NAME OF APPLICANT \ DATE Please type nt SIGNATURE OF APPLICANT Wt, t fL I�Mit' Yf Y✓"_ � �t 'S �.: .: f 5. Y Y� 'SJi"f i "F � �. Oddi f� {' A, PLEAs,IOTf "11'Rllli�AREEQ1y1� x11 -x 7 ? �;f,°.. �`arandi� ,it�'�t3`. 7 "r� % �z,*z�"O�':31F ". �f� �'h ., s„ <:. sw�x .Y.,� as� ��.Nv. .<�a� , +:'�'�_ maz•,�.Eai�t , >i``�.�_�:. .inse,: Y� ? CITY OF FRIDLEY COMMUNITY DEVELOPMENT DEPARTMENT 6431 UNIVESITY.AVENUE NE, FRIDLEY, MN 55432 (763) 572-3604 ��