PRE 2010 DOCSx:
BUILDING PERMIT
N° 2502
Village of Fridley, Minn,,
rl
Date , ..
... ;:
"
Ownerp
r Builder ........ .. ..........................
Address ..
... .... Address .....iw.. ..... ..... ....
LOCATION OF BUILDING
No.
Street Part of Lot .......................
Lot .............
Block, ..... Addition or Sub -Division .. .. .......... .
•
Corner Lot
Inside Lot Setback Sid yard .. ...... ..... .
DESCRIPTION OF BUILDING
Tai '° Used as:
m ..
......sC:;
-
Front ... Depth . Hei .. .... ........
p ght . � Sq. Ft. � Cu. Ft.
.. .:.. ..... ......
, .
....... ,. ....
ant Depth i eight .. Sq. Ft. Cu, Ft, ........
Type of Constru
on .... To be Completed ......... ...
..:......,.. Est Cost ................... ,..
In tonsideration.of
I`
the issuance to me of a, permit to construct the building described above, I agree to do
the proposed worl:
in accordance with the- description above set forth " �. d i' compliance with all provisions of
ordinances of the
age of Fridley.
hl
y ...
In considerat
:.,
:.
bn of the payment of a fee of$...... , , , permit is hereby granted to ......... :.......... .
...... , ......
....... to construct the building or addition as described above. This permit granted upon
the express condition
done in, around a
that the person to whom it is granted and bis agents, employees and workmen, in all work
ad upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Winnesot
in the village Ifinj
ordinances.
x regarding location, Construction, alteration, maintenance, repair and moving of buildings with-
: and this permit may be revoked atany time ' orf , ` 'at on of any of the provisions hof said
Building ... u�ld g Inspector
NOTICE:
This perm
t does not cover the oonstruotion, Installation or alteration for wiring, plumbing, gas heating,
sewer or Ovate I'
Be sure to see the Building l'nspeotop for separate permits' for these items.
1
SUBJECT
P
City of Fridley
o 19218
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
IP
�
COMMUNITY DEVELOPMENT DIV.
r I L ______PROTECTIVE INSPECTION SEC.��/
1 . �
CITY HALL FRIDLEY 55432
NUMBER
REY.
DATE
PAGE OF
APPROVED BY
L J` 612-571-3450
910-F15
10/1/87
JOB ADDRESS 4590 - 21i Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
2
Plymouth Addition
SHEET
2 PROPERTY OWNER MAILADDRESS ZIP
PHONE
Henry Igelsrud 4590 - 231 Street N.E.
572-1554
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
zneri:can Remodeling 3700 Annapolis Lane, Plymouth
55441 553-0020
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 ❑X REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
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. D1LG. 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
$7,500
$3.75
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 OTH STATE OR LOCAL LAW REGULATING CON-
ST ORT E P O8.50
ANCUCTION.
$6CKFEPLAN
CHECK FEE
TOTALFEE
$72.25
SIGNATURE 6FCONTRACT OR AUTHORIZED AGENT (DATE)
'•.,WHEN' PROPERLY VALI ATED THIS 15 YOUR PERMIT
SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI
LDG IN5P
DATE
1
NEW [ ] City of Fridley Effective 4/1/86
ADDN. [ ] R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address: f� 4 '-2 t;� s;:
Legal Description:
Owner Name & Address: Tel. #
Contractor:��® C �-i � Tel . #
Address: �� �® ���r� �•�` ��'�/
LIVING AREA:
r.ARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length
Width
Length
Width
Length
Width
Height
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [ ] Inside Lot ] Ft. Yd. Setback Side Yard Setback
Type of Construction: Estimated Cost: $
Approx. Completion Date: ",*00
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: /G-/ 0'7 APPLICANT: z Tel. # ®
CITY USE ONLY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$ 525 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
SUBJECT
City of Fridley
2693 6
AT THE TOP OF THE TWINS
BUILDING
R
I I
1`
RECEIPT N
1 _ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r ;
0 e 1
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
7/31/98
JOB ADDRESS 4590 2 1/2 St NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
2
Pl outh
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Julia I elsrud572-1554
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
Minnesota Ext. Inc. 8600 jefferson-awy Po Box 266
is-469 2877
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 Ck REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside
9 CHANGE OF USE FROM TO
STIPULATIONS
Call for building wrap inspection before covering.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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
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
$1950
$.97
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.
$62.25
F e SC $1.95
PLAN CHECK FEE
L FEE
Lice $5-,0/17
770.
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI 1,,nE
PROP
SAG INSP
ALID
T D THIS I OU PE M
r TE
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
NEW
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress:�`�
Legal Description:
Owner Nan
Contractor:
Address:
Effective 3/1/96
ewrdl G
L�it✓ Tel. # 39�Ste/ Z
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
GARAGE AREA: Length
DECK AREA: Length
OTHER:
DESCRIPTION OF IMPROVEMENT
Width
Height
Width
Height
Width
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimated Cost: $ /.gE� -
Approx. Completion ate: Af
(Cost on Back)
Driveway urb ut Width Needed: Ft. + 6 Ft = Ft x $ _ $
�r —
DATE: APPLICANT: Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY
$ Fee Schedule on Reverse Side
$ I. 9 j� .001 of Permit Valuation (1/10th%)
$ a,9�7 $.50/$1,000 Valuation
$ $900 per SAC Unit
$ 6-, d?'b $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 [ ]
STIPULATIONS: �U✓� �!rL���® r
GNOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
May 17, 1999
Julia Ingelsrud
4590 2 Y2 St. NE
Fridley, MN 55421
Re: Final inspection at 4590 2 Yi St. NE
Contractor River City Sheet Metal
Dear Ms. Ingelsrud:
A mechanical permit was issued on May 18, 1998 for the property located at 4590 2 Y2
St. NE for a new furnace. According to Section 305(a) of the 1991 Uniform Mechanical
Code a final inspection shall be performed on the mechanical permit. As of this date no
inspection has been called for.
You will be given thirty (30) days from receipt of this notice to respond. If we do not
hear from you, we will expire the permit and any inspections on this installation will
require a new permit.
Any questions can be addressed to myself at (612) 572-3603.
Sincerely,
Bary Riesch
Building Inspector
CITY OF FRIDLEY INSPECTION DIV.
Effective On January 1, 1997
6431 University Ave NE
1J,
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
'
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS 149c) 0 c;L l kt 1)
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 Furnace
Vent Fill Out Hack)
$ 30.00 $� D
representations stated in this application are true and corn
�1 9 �1
(Side —
Gas Piping (Needed with new furnace)
$10.00 $
3Li _LnO -eAs J'uO
OWNER i 0.
Gas Range
$10.0 $
BUILDING USED AS
Gas Dryer
$10.00$
I
ESTIMATED COST 1 PERMIT NO. / 3f �
*Air Conditioning —All Sizes
$ 25.00 $
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK-e-�P�c�
1% of Value of Appliance or Work
S
No. of Heating Units Circle One (Steam) (Hot Wate �Ki
Trade Name T.ern��c., Size No. 'jam
Commercial/Industrial
BTU E&O I HP EDR
1.25% of Value of Appliance or Work
$
Fuel Total Connected Load
State Surcharge
TOTAL FEE
$ .50
s 3d•D
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
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
BTU
HP
Size No.
EDR
HEATING COMPANY R1 UPW 111' dad
Signed By L—A,2," Tel No. _7�y_'2zfi
Approved By Rough—In Date Final Date
FILL OUT BACK SIDE F41 STACK VERIFICATION ON
REPLACEMENT FURNACE
Remarks: .
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CHIMNEY AND STACK VERIFICATION
The
undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
Yes *03CNo ( )
2.
Is free from rust or deterioration
Yes (zf No ( )
3.
Has no foreign objects lodged within
Yes ((/" No ( )
4.
Is securely supported .
Yes ( t,)'" No ( )
5.
Meets all current Code requirements for size
Yes ( )
and total BTU's connected
(dNo
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:
SUBJECT
P
City of Fridley
3 0 2 6
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
�
RECEIPT NO.
� • ____ COMMUNITY DEVELOPMENT DIY.
j PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV DATE
PAGE OF
APPROVED By
L 612-571-3450
910-F15
9/22/99
10B ADDRESS
4590 2 1/2 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
2
1 Plymouth
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Julie I elsrud
572-1554
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
DuAll Service 636 39th Ave NE Col. Heights 55421
788-9411 3478
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 MK REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage.(19 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code
SEPARATE PERMITS ARE REQUIRED 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
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
WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT
$1661
$.83
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING COW
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$60.10
hire S $1.66
PLAN CHECK FEE
TOTAL F
Lic SC
5.0
$67 9
SIGN 4TURE OF CON'RACTOR OR AUTHORIZED AGENT iDATE.
FOR PE (DATED IS P MI
BIL i p
4
gAfE
S,GNATURE OF OWNEROF OWNER BUILDER( 1OA1E1
NEW I Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER f 1 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 r
BUILDING PERMIT APPLICATION
Construction Address: 7f -XT Cr0 (V /off 5 7—. -,V z J
Legal Description:
Owner Name &Address: Tel. # 57,R -
Contractor:
%,R -Contractor: bv-411 S -e A U Pc a MN LICENSE # J7 f 7cP
Address: ( 3 ( 3,9 Y -z! e W 15� Cyfg 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:
Construction Type: �� ^ i°®®�got 6� (tq,�je ) ,7�, �//;
Estimated Cost: $ a v
Driveway Curb Cut Width Needed:
DATE:
APPLICANT:
Ft. + 6 Ft = Ft x $
CITY USE ONLY
Permit Fee 10 Fee Schedule on Reverse Side
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ .001 of Permit Valuation (1/10th%)
$ 3 $.50/$1,000 Valuation
Tel. #
$ $1050 per SAC Unit
$ 0 Q $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
7071UNIVERSITY AVENUE NE
FRIDLEY, MN55432-
//
ISSUED:01142010
(763)572-3604FAX: (763)502-4977
Permit #2010-00046
4590 2 1/2 ST NE
ADDRESS:
PIN:263024330101
LEGAL DESC:REAR BL 13,14 & 15 PLYMOUTH
:LOT 1 BLOCK 2
PERMIT TYPE:PLUMBING - FIXTURE BASED
PROPERTY TYPE:RESIDENTIAL
CONSTRUCTION TYPE:WATER HEATER
NOTE: CALL FOR FINAL INSPECTION
COMBUSTION AIR PER CHAPTER 7, 2006 I.M.C. AND STATE AMENDMENTS.
MAKEUP AIR PER 1346.0501 IMC STATE AMENDMENTS
VENTING OF EQUIPMENT PER 1346.5503 IFGC STATE AMENDMENTS
CALL FOR FINAL INSPECTION WITHIN 10 DAYS
INSTALLATION OF REPLACEMENT WATER HEATER.
WATER HEATER FEE35.00
APPLICANT
STATE SURCHARGE, PLBG FLAT0.50
RIVER CITY PLUMBING
TOTAL 35.50
8290 MAIN ST NE STE #39
Payment(s)
FRIDLEY, MN 55432
CHECK624035.50
(763) 754-2199
Minnesota State License #: 065655-PM
OWNER
CARLSON, MELISSA
4590 2 1/2 ST NE
FRIDLEY, MN 55421-
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction authorized
is not commenced witin 180 days or if construction or work is
suspended or abandoned for a period of 180 days at any time after
work is commenced.
I hereby certify that I have read and examined this application
and know the same to be true and correct. All provisions of laws
and ordinances governing this type of work will be complied with
whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any
other state or local law regulating construction or the performance of
construction.
Applicant____________________________Date________
1/14/10
Bldg Insp____________________________Date ________
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY
7071UNIVERSITY AVENUE NE
ISSUED:01/14/2010
FRIDLEY, MN55432-
(763)572-3604FAX: (763)502-4977
Permit #2010-00046
4590 2 1/2 ST NE
:
ADDRESSPERMIT APPLICANT:
PIN:263024330101RIVER CITY PLUMBING
LEGAL DESC:REAR BL 13,14 & 15 PLYMOUTH8290 MAIN ST NE STE #39
:LOT 1 BLOCK 2FRIDLEY, MN 55432
PERMIT TYPE:PLUMBING - FIXTURE BASED
PROPERTY TYPE:RESIDENTIAL(763) 754-2199
CONSTRUCTION TYPE:WATER HEATER
BUILDING INSPECTION RECORD
24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS.
CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 4:30 PM
INSPECTION TYPEDATEINSPECTORCOMMENTS
PLUMBING FINAL02/16/10PDAVE
INSPECTION COMMENTS:
IN ACCORDANCE WITH CITY ORDINANCE, NEW OR SUBSTANTIALLY REMODELED BUILDINGS SHALL NOT BE OCCUPIED UNTIL ALL
WORK HAS BEEN APPROVED, AND A CERTIFICATE OF OCCUPANCY HAS BEEN ISSUED BY THE BUILDING DEPARTMENT.
THIS CARD MUST BE POSTED AND VISIBLE AT ALL TIMES UNTIL WORK IS COMPLETE.
Building
PLUMBING
Permit No.:-=(0
Inspections
RESIDENTLALL APPLICATION
Received By%,
763-572-3604
CITY OF FRMLEYN
c
763-502-4977 FAX
EFFECTIVE
e
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS AND 2 tz St BJ H
THIS APPLICANT IS: ❑ OWNER ONTRACTOR
PROPERTY
NAME: ,-wk
OE
,y
ADDRESS: L100 i C /'f_ , 1 IJ CITY �� lvLb'�// STATE_&ZIP_11J 2-'
I
T�
T
PHONE: �' ���- 16 54
CONTRACTOR
NAME: P4vtv O
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
STATE BOND # EXP DATE
CERTIFICATE OF
ADDRESS: X*110 W01 Pt CITY P � STATE_&LZIP
INSURANCE
PHONE '9U q5- f1 FAX GL6
PERMIT TYPE
',SINGLE FAMILY 0 TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
E3 NEW REPLACEMENT
DETAILED DESCRIPTION OF WORK
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
BATH SINK/LAV FLOORDRAINS _SHOWER WATERPIPING
BATHTUB —GAS PIPING (NEED CITY LIC) _ SWIMMING POOL —WATER SOFTNER ($35)
_
CLOTHES WASHER KITCHEN SINK _ WATER CLOSET _ BACKFLOW PREV. ($I5)
_ _
LAUNDRY TRAY _LWATER HEATER ($35) FOR IRRIGATION
—DISHWASHER _
WATER METER OTHER
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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 without a permit on site; that the work. will be in accordance
with the approved plan in the e of all work which requires review and approval of plans.
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SIGNATURE OF APPLICANT / /✓'^' _ `”' "" `'I ui PRINT NAME I (* &' 10- DATE {AI ID
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City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, N4N 55432
763-572-3604
FAX: 763-502-4977