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PRE 2010 DOCSCity of Fridley, Mm. NO 9699 BUILDING PERMIT Date: April 29, 1968 Owner: Robert flyer Builder Rodney Billman Inc. Address Address 151 Silver Lake Road New Brighton. Minnesota LOCATION OF BUILDING No. 1456 Street _ Windemere _ Part of Lot Lot 4 Block 3 Addition or Sub.Division _ Innsbruck 5th Addn. Corner Lot Inside Lot x Setback 351 Sideyard — Sewer Elevation ____977,.66 n 983.66 Top of Wye- 979.66 Top of Footing DESCRIPTION OF BUILDING To be Used as: Dwelling Front 32' Depth 26' Height 28' Sq. Ft, 832 CtL Ft, 23.296 Garage Front 22' Depth 223611eight 10' Sq. Ft. 792 Cu. Ft. 7920 Type of Construction Frame Est est w $29,000 _ To be Completed July 1, 1968 SEWER LOCATION - 10' West of Manhole WATER LOCATION - 20' West of Manhole 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 fo and in compliance with a'll provisions of ordinances of the city of Fridley. r 'e In consideration of the payment of a fee of $ 47.00 , permit is hereby granted to Rodne Billman Inc. 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 Mme upon vi of t provisions of said ordinances. i \ .7\ /I and NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be core to no the Building Inspector for separate permNs for them hems. V4 APPLICATION FOR BUILDING PERMIT CITY'OF'FRIDLEY,-MINNESOTA L OWNER'S ADDRESS ,M _ 'ADDRESSJ.T t„�ri' U c di 0 .: . - •�2z-may � � — _ ...,LOCATION OF BUILDING N0. 145 C STREET LOTS BLOCK ADDITION OR SUBDIVIeION� CORNER LOT�INSIDE L - SETBACK �' a SIDE`iiARD _ SEWER ELEVATION TOP OF FOOTING ,.Applicant_ attach,.,to this form Two Certificates of Survey of Lot and proposed building lccatiow4rawn on these COrtificates. DESCRIPTION OF, BUILDING To Be Used As: Front Depth �gight S Square feet Cubic Feet _ �^ Fromm ' Depth"Height Square feet Cubic Feet Type of Construction P;1 Estimated Cost JI, - To To Be Comple 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 Q, are true and correct. /'2��. DATE SIMTU&E-X,��_"-z-- � (Schedule of Fee Costs can be fouWon the Reverse Side). -t V f -ems 1V 5-7 r:,C, City of Fridley Application for Plumbing and G= Fitting Permit DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... ;uZi �3� MIR g°a`Zc x $1.50 $ Z 0-OF �Uzw O tN WATER HTR. GAS ELEC. yZC93 Catch Basin ...... ..................... x $3.25 i r ` t~v3 6�i3ii Uda nw 9 $ New Ground Run Old Bldg . ............ Base x $3.25 $ �' z $2.00 GAS FITTING FEES: 7— RATE TOTAL 1st 3 Fixtures .......................... x $2.00 $ Ist x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ 2nd 1J 2 tz 3rd 4th • Future Connection Openings C°aaected �3h e New Fixture, Old Openings Suver � Cesspool � PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $2.00 $ Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. x $1.50 $ Catch Basin ...... ..................... x $3.25 $ r ` Water Heater (Up to 99,000 BTU) ...... x $3.00 $ New Ground Run Old Bldg . ............ x $3.25 $ Electric Water Heater z $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 ................................................ TOTAL FEE $ �E Dept. of Bldgs. Phone 560-3450 Location 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 facl and representations stated in this application are true and correct. Fridley, Minn- /� � —, 19_ �y � Owner (,6,]..� -1,1 z. �-,1 Kind of Building'-"� f� Used as To be completed about r Estimated Cost, $ �1 Old N�. Building Permit No �' �/ Permit No. Signe ,— By� Business Phone No ROUGH FINAL • Application for Power Plants and Healing. Cooling, Ventilation. ReFrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone 560-3430 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 ; TOTAL 1st 3 Fixtures x$ 2.00 $ Additional Fixtures x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL $ See Fee Schedide TOTAL FEE St Location I A � 6 �� a i�]`� ka- M L—�t�E- 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 Ordinance. 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 of Building-� Used as - To be completed about Estimated Cost, $ r- Old—New. Building Permit No. Permit No. -1-156 DESCRIPTION OF WORK BEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No Trade N am Size No--- Capacity o-Capacity Sq. Ft. E.D.Ra 9� BT�iT� V� H.P. Total Connected Load �' . ® Kind of Fuel BURNER — Trade Name Size No.'j- Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) SUBJECT PE . City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT Ir � ' RE • COMMUNITY DEVELOPMENT DIV _ v PROTECTIVE INSPECTION SEC r ; c CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 10/11/94 108 ADDRESS 1456 Windemere Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. (F 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lori Scheller 1456 Windemere Drive NE 574-9157 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Sela Roofing 4100 Excelsior B1823-8046 1050 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 O ALTERATION � REPAIR El MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House 24 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building 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 SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. N0. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1'800 $.90 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISION,S OF ANY OT ER STATE OR LOCALJLAW REGULATING CON- $41.00 Fire SC $1.80 STUCTIO OR THE P F RMANCE OF TRUCTION. PLAN CHECK FEE TOTAL FEE l License SC $5.00 $48.70 SIG URE OF CONTRACTOR OR AUTHORIZED AGENT i0 TES WHEN PAC VA (DATED THIS IS YOUR PERMIT 8 DG iNSP TATE SIGNATURE OF OWNER OF OWNER BUiLDERi iDATEi NEW 11, Effective 1/1/94 ADDN [ ] CITY OF FRIDLEY ALTER [) SINGLE FAMILY AND DUPLEXES R-1 AND R-2 4 Building Permit Applications 7,1) r ConstructionAddress: 1� fJ ��� c� C72-1 Legal Description: Owner Name & Address: -1-6 10 -or Sc 16 C (_ ee Tel. # 5-7 Y" %/S- 7 Contractor: 5&7/—* MN LICENSE # Address: �o o 6-n C Sid S Twv b S A/< Mk 5-5 516 Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: �2 .S . r.z..S E -- Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: 7846Ar- .f AeAef &oj r Estimated Cost: $ Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed:. . + 6 Ft = Ft x = $ DATE: ,b ll APPLICANT: -61 _ / Tel. # 6,17 3 - fir' oa Permit Fee $ 4( 00 CITY USE ONLY Fee Schedule on Reverse Side Fire Surcharge $ 1,30 .001 of Permit Valuation (1 / 10th %) State Surcharge $ 90 $.50/$1,000 Valuation SAC Charge $ $800 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary TOTAL $ �l • 7 STIPULATIONS: CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1 1998 6431 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 512-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOBADDRESS_ 27 RATE SCHEDULE ' The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner - rulings of the Building Division, and hereby declares that all the facts and Also Replacement Fumace $ 30.00 $ representations stated in this application are true and correct. (Side Vent - Fill Out Back) ,1998 Gas Piping (Needed with new furpace) $10.00 ��-�� $ d �-,o�� !�S OWNER Gas Range $10.00 $ BUILDING USED AS Gas Dryer $10.00 $ ESTIMATED COST X00, cK' PERMIT N0. L *Air Conditioning - All Sizes $ 25.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work $ No. of Heating Units Qircle One (Steam) (Hot Water) (Warm Air) Trade Name a Size No. Commercial/Industrial BTU � HP EDR 1.25% of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge $ .50 Burner Trade Name Size No. TOTAL FEE BTU HP EDR � .. HEATING COMPANY_ > 2 � MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed By�.� Tel No. PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr Approved By Rough -In DateFinal Date *Air Conditioners can not be placed in a side yard without FO FILL OUT BACK SIDE STACK VERIFICATI N ON - written permission from adjoining property owner. REPLACEMENT FURNACE List ALTERATIONS Beim Done: HEATING CO: Signed By: Date: COY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes () No ( ) 2. Is free from rust or deterioration Yes () No ( ) 3. Has no foreign objects lodged within Yes () No ( ) 4. Is securely supported . Yes () 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 1 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 Beim Done: HEATING CO: Signed By: Date: ®r SUBJECT73� O.City of Fridley 35 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. � COMMUNITY DEVELOPMENT DIV. SEC. j PROTECTIVE INSPECTION I , �'� CITY HAIL FRIDLEY 55432 NUMBER pEv DATE PAGE OF APPROVED BY l 612-571-3450 910 -Fl 9/20/99 JOB ADDRESS 1456 Windemere Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 3 Innsbruck 5th Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Thomas A. Scheller 574-9157 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 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 MC ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Sheetrock above kitchen cabinets & change plumbing 9 CHANGE OF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE REOUIREO 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 MANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING 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 4$500 4$.50 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 $23.50 Fire SC .50 PLAN CHECK FEE TOTAL SIGNAT E OF CONTRACTO JAJTDRIZED AGENT IOATEI N P OPE IDAT HIS Is P IT �GNATURE OF OW NEA iiF OWNER BWLDERi IDATEI BL INSp DAtE ®r NEW1 l ADDN [ ] ALTER [ ] Construction Address: Legal Description: Effective 5/10/99 CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION °� Owner Name & Address: Contractor: Address: Tel. # k42 -5K�4Z MN LICENSE # Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT_ LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Groufnd Sq. Ft. OTHER: 'A� Sys A� � — 7S #, -2e3'0 _'i Construction Type: Driveway Curb Cut Width Needed: DATE•APPLIC Ft. + 6 Ft = Estimated Cost: $ Sb O Ft x $ ME Tel. # TOTAL STIPULATIONS: CITY USE ONLY Permit Fee $ -P?3 LD Fee Schedule on Reverse Side Fire Surcharge $ '�O .001 of Permit Valuation (1/10th%) State Surcharge $ S6 $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit :License Surcharge $ $5.00. (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: m 60 a Y� CD re) CD 0 i n 0 o— U 0 u. 9 \1 CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-5714267 Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Fee Tota Residential Furnace Shell and Duct Work, Burner & also Repiacement Furnace $35.00 $ 3J5 1 Cc Gas Piping (New Furnace, Fireplace, Insert) $10.00 $ Gas Range $1O.D0 $ Gas Dryer $10.00 $ *Air Conditioning - All Sizes $25.00 $ All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater on work less than $300.00 Co m me rc is Vi nd ustria I/I nstitut(ona I 1.25% of Vaiue of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/institutional State Surcharge TOTAL FEE JOB ADDRESS) H 5 1 W 1 nr.1 eyyieye t?� - N Owner f—P-Vx- C C CL Building Used As �2�s i G�v1l Gt,l ESTIMATED COST 1 PERMIT NO � : � � ► r 1 :.: �il`►L�71I:Tl�:� # of Heating Units ' CIrcde One (Steam) (Hot Water (War Am ir) Trade Name T RAID E TUD I(9ORCI VA Size No. BTU ) 00 i000 HP EDR Fuel CAS Total Connected Load Bumer 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 $ and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. 135,S0 ;D REINSPECTION FEE $50.00/HOUR CS) *Air Conditioners can not be placed in side yard without written approval N from adjoining property owner - copy to City U) z FILL OUT BACKSIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE ti HEATING CO T ®TAt COktPOfT Signed l WCC Tel # 763363-63$3 FAX # Date Approved by Rough -in Date Final Date JUN -15-2004 16:49 FROM CITY OF FRIDLEY TO 3838500 P.03iO3 1�eB EC � yo [, "� FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT`CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required, F() No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () The undersigned also verifies that the replacement unit is a I14ted assembly and meets the current codes and manufacturer's specifications. This does include AGA GAMA Category I Central Furnace Venting Tables for fan P assisted and natural draft appliances. es () No( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. es O No( ) When required to install a new combustion air, it will be sized and installed 1"" to meet the current codes and manufacturer's specifications. es 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 -LAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. 0 --( No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. es No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type ��caQ&g= BTU Input \0®, n Ass r 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. C-`�Vent Height - 30 Diameter (�D inches Appliance #1 Vent Connector Height ft Length L� ft Diameter in Type Appliance 02 Vent Connector. Height ft Length ft Diameter in Type Appliance 93 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS-. (Describe) HEATING CO: 1 0-FA1, Signed By: Date TOTAL P.03 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, 1999 PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures &_�� Old Opening, NewFjurek-�0/ ,4 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 JOB ADDRESS 1 -1 S� (1e't lv � e n-l�V' '- ��^ ti U' 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. /( _ 45 .1999 6 Owner j� ti ,� �� � l2 Building Used As (,til C, Estimated Cost C Ci• PERMIT NO. 1,2 65,9�, PLUMBING COMP k at) Reinspection Fee $42.00/Hr SIGNED BY TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved By Rough—In Date Final Date State Surcharge $ .50 MINIMUM FEE FO ANY PLUMBING GAS PERMIT IS $20.00 TOTAL FEE $ '?)Ufzl PLUS THE $.50 SkATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES.