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The undersigned hereby makes application for a permit for the work herein
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and rulings of the Department of Buildings, and hereby declares that all the
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State Surcharge
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Reinspection Fee ($15.00)
DESCRIPTION OF FURNACE/BURNER
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CITY OF FRIDLEY
Effective Date May 1, 1988
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
RESIDENTIAL ` RATE
Furnace Shell and Duct Work,
Burner (Also replacement furnace) $ 20.00
Gas Piping $ 10.00
(piping needed with new furnace)
Gas Range $ 10.00
I
Gas Dryer $ 10.00
* Air Conditioning (all sizes) T&VI $ 10.00
All Others/Repairs and Alte a ions
1% of Value of Appliance or Work
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00,
PLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
TOTAL
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Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
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COMMERCIAL/INDUSTRIAL
$
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
$
and rulings of the Department of Buildings, and hereby declares that all the
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1% of Value of Appliance or Work
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say
OWNER
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KIND OF BUILDING
USED AS
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State Surcharge
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CMD
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TOTAL FEE
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
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$
00
Reinspection Fee ($15.00)
DESCRIPTION OF FURNACE/BURNER
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/Date
Final Ins is
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Date
Approval for Permit A&S19
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00,
PLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
TOTAL
I
Job Address p �.Z
$4D.
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
City of Fridley
$
Tel. #571-3450
$
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
$
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
$ to . 0 ®
Fridley, Minn. �/ ' , 19soo
OWNER
$
KIND OF BUILDING
USED AS
$
TO BE COMPLETED ABOUT
ESTIMATED COST 4.3 ew
$ .50
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
$ o-&
$
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. 1
Trade Name J 9/,i� Size No. Je, I'4bgwo.3&& &o
Capacity Sq. Ft.-,EDR BTU 6 HP
Total Connected Load Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Company
Signed By a _
Tel. No. J Wt
HEATING & AIR CONDITIO!%!!� 7
8;1,0 lNENTVJO ATF
Fill out back side for stack verification on rep] ac@t Wh,'f1ft 9ces'
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes ( )
2. Is free from rust or deterioration Yes ( )
3. Has no foreign objects lodged within Yes ( )
4. Is securely supported Yes ( )
5. Meets all current Code requirements for size and
total BTU connected Yes ( )
6. Has Total heating BTU's of
All other BTU's
TOTAL
Rema rk s
Company
Signed By
Date
No ( )
No ( )
No ( )
No ( )
No ( )
-T
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CITY OF FRIDLEY
APPLICATION F®R, .HEATING REPLACEMENT
CHIMNEY AND STACK VERIFICATION
THIS FORM MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM.
LOCATION 1Z DATE
OWNER..,A ADDRESS
..
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined
2., Is free from rust or deterioration
3. No foreign objects are lodged within
4. That it is securely supported
5. That it meets all current Code requirements
for size and total BTU connected
6. Total Heating BTU
All Other BTU
400
TOTAL (®Q�
REMARKS
HEATING PERMIT
SIGNED
Licensee
by
Address
Telephone
Fricll.ey City License
Building PLUMBING Permit NoIL A29
Inspections RESIDENTIAL APPLICATION Received By'
763-572-3604 CITY OF FRIDLEY Date Rec'd:5-�
763-542y-4977 FAX EFFECTIVE 1.1-08
6
DATE 30 %0 j,&YOUR E-MAIL ADDRESS
SIADDRESS ►.3 f 7-A, Wir y 6 k-
T£
THIS APPLICANT IS: O OWNER 'kCONTRACTOR
PROPERTY
NAME: R c 14.40-a V'E'2 s 'D a 2 r -`,e
OWNER/
_
ADDRESS: 2.1 -rA I A/ J)- .P FA 6 y STATt� ZlP f s Y L
TENANT
Vf_� —CITY
PHONE: '71i3 .f' 7 1 7
NAME:
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
STATE LICEN£XP DATE
Terry Overacker Plumbing, Inc.
LICENSE, BOND AND
STATE BOND 502 E Main Street EXP BATE
CERTIFICATE OF
1NSURANCE
ADDRESS:_.. STATE ZIP
Anoka, MN 55303
PHONE X
PERMIT TYPE
O SINGLE FAMILY O TWO FAMILY O TOWNHOUSE
0 NEW I (REPLACEMENT
TYPE OF WORK:
DETAILED DESCRIPTION OF WORK '44-OtAt-1.. 44
PER MS 168.665 the permit fee is a minimum of $15.00 or 5% of the total cast 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 = plus .50 surcharge
OR
FOR PROJECT WHERE LABOR DCCEEDS $SM. FEES ARE BASED ON $10.00 PER FIXTURE. EXCEPT WHERE NOTED. FIXTURES: (MiCATE TOTAL
NUMBER OF EACH BELOW). MINIMUM FEE 515.50.
SHOWER WATER PIPING
BATH S[NK1LAV FLOOR DRAINS r
_
_ BATHTUB �_ GAS PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFIINER (S35)
—
! BACKPLOW PREV. (SIS)
_CLOTHES WASHER _ KrrCHEN SINK WATER CLOSET
DISHWASHER LAUNDRY TRAY HEATER ($35) i FOR IRRIGATION
_WATER
- - WATER METER r OTHER
t
Permit Fee $ Q2 Number of fixtures @ $10.00 x $I 0.00 = S
Surchar a 50 'number of fixtures Ig S 15.00 x Sl 5.04 = $
TOTAL DUE $ OR Number of fixtures @ $35.00 x 535.00 - $
State Surcharge =
MINIMUM $1550 MINIMUM $15.50 'total = $
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start w' bout a permit on site; that the work will be in aeoordanee
with the approved plan in the case of all work which requires view and proval of plans.
�/�
PR T AME1&C1Ct F IC,R.0 ,J I< DATE 0"16
SIGNATURE OF APPWCANT _
APPROVED BY ' DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
_ __ _
..- WY 06V:6 900VO£/q •84130 Z/Z .0 Ed ... 6MzL5£9L :Woj=j
Building PLUMBING Permit No.:
Inspections RESIDENTIAL, APPLICATION Received By:
763-572-3604 CITY OF FR.IDLEY Date On P
763-502-4977 FAX EFFECTIVE 2-19-09
DATE 9/1/09 YOUR E-MAIL ADDRESS wnelson@larsonplumbing.com
SITEADDRESS Trinity Dr NE
THIS APPLICANT IS: Q OWNER MCONTRACTOR
PROPERTY NAME: Richard B ersdorfer
OWNER/ ADDRESS:_ 6121 Irinitv Dr NF CITY Fridle
TENANT PHONE: 763-571-7703 — _. .....•_..—STATEMNZIP 5555432
CONTRACTOR NAME: Larson Plumbing Ing,
SUBMIT A COPY OF STATE LICENSE # 58757 (3341)EXP DATE
YOUR STATE
LICENSE, BOND AND STATE BOND # EXP DATE
CERTIFICATE OF ADDRESS: 3095162nd Lane NW CITY Andover s-rATE MN ZIP 55304
INSURANCE PHONE 763-427-7680 FAX 763-427-9448
PERMIT TYPE IN SINGLE FAMILY ❑ TWO FAMILY O TOWNHOUSE
TI TE OF WORK: 0 NEW IN REPLACEMENT
DETAILED DESCRIPTION OF WORK Replace Water Heater
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
BATH SINKILAV FLOOR DRAINS SHOWER WATER PIPING
BATHTUB _ GAS PIPING (NEED CITY LIC) _ SWIMMING POOL WATER SOFTNER ($
CLOTHES WASHER _ KITCHEN SINK WATER CLOSET BACKFLOW PREV. $1 )
DISHWASHER _ LAUNDRY TRAY 7WATER HEATER ($35) FOR IRRIGATION
WATER METER _OTHER
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A 1:+ �. ..��G.�i:rvtrJ•�•e:'iCvn:.uv
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
1 hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance
with the approved plan kirte case of all t c which requires review and approval of plans,
q
SIGNATURE OF APPLICA PRINT NAME Michael Maloniski DATE 9/1/09
'F?.: :���•!�� s����.ia7'rfliiG� .r y ,�.' .,x ,'.,, sh... ..�. ."tti �;:.
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
1'