PRE 2010 DOCS•
Date:
City of Fridley, Minn.
BUILDING PERMIT
April 26, 1968
Y
€f
Owner: Thomas E. Sullivan Builder Same
Address 2611 Central Ave. N. E. Address Same
Suite # 100
LOCATION OF BUILDING
No.. _§Q15 Street ..—_ 2 2 S t . N. E. -- Part of Lot
Lot 20 Block 6 Addition or Sub -Division .___ Hyde Park Addn.
Corner Lot Inside Lot w Setback __ _ - Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
Y��6 ,'
9694
To be Used as:
Remodel Hazardous Front _ Depth Height _ Sq. Ft. Cu. Ft
Building_ Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Frame Est. Cost `... $ 2. 000 To be Completed duly 15
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 a'il provisions of
ordinances of the city of Fridley.
100.00 Sewer Connection Charge
In consideration of the payment of a fee of $ 12.00 ., permit is hereby granted to Thomas
Sullivan 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 mo g of buil�ngs
within the city limits and this permit may be revoked at a�time u ony/ of the revisions of safd
ordinances. //
NOTICE:
This psrmh does not cover the construction, Installation for Whing, Plumbing, gas heating, sewer or water. Be atro to see
the Building inspector for separate permits for than home.
•
4 yy.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MD=SOTA
OWNER'S NAME Gtiail)AN)BUII,DF
ADDRESS ,a A);t�Lsr� /�� ADDREss
LOCATION -O#'BUILDING
NO. STREET
LOT _ 20 „BLOCK _ c� ADDITION 0$ -SUBDIVISION s
CORIlER LOT INSIDE LOT ,SETBACK , SIDEYARD
SEWER ELEVATIO
TOP OF FOQTING
rte_ � , . v- •
Applicant attach to this form Two Certificates'of Survey of Lot and proposed
building location drawn on -these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
.Front ='Depth _ �:..11eight�
Square feet Cubic Feet
Front: rs Depth Height
Square feet Cubic Feet
Type of Construction ltlrt __Estimated Cost
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__T _SIG-
�' 1�LATiE
(Schedule of Fee Costs can be found on the Reverse Side).
City of Fridley
Application for Plumbing and Gas Fitting Permit
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
3
Number Fixtures .....
1-
$ / D
i
V1
; F�
Y
z
e'z�
N
ZW
Q
'z
O
J
c�
!Z
Z
z
d
0 O
R
t
N
WATER HTR.
GAS
ELEC.
Base
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
$
REP IRS & ALitRATIONS—Refer to Code
1st
Descri ti ................
TOTAL FEE $
2nd
3rd
4th
• Future Connection Openings
* New Fixture, Old Openings I
Connected with
Sewer
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures .....
x $2.00
$ / D
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
$
REP IRS & ALitRATIONS—Refer to Code
Descri ti ................
TOTAL FEE $
Dept. of Bldgs. Phone SM -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 fact
and representations stated in this application
are true and correct.
Fridley, ��Min��n J lg—
`
Owner
Kind of Building
Used as D�
To be completed about
Estimated Cost, $ �®
Old—New. Building Permit No Permit No. / 5
Signe
By �t �J-
Business Phone
ROUGH Q�
FINAL fr !�
42
.w .
CITY OF FRIDLEY
APPLICATION FOR RESMENTIAL BUILDING PERMITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER:' ZO& BUILDER: ;
Address: 60/6 Z,'?� /U6 Address: // �/
.
Tel. No.: -52Z - I7 1-3
No.: Street:
LAT: BLACK: ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS:
Applicant attach 'to this form lWo Certificates of 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:
Estimated Cost: $
To Be Completed: Alt. A Alt. B
c
Proposed Driveway Width If New Opening Is Desired/22,4-6 -/6 $ - $
(SEE REVERSE SIDE_OF SHEET)
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. See reverse side for additional information.
DATE: SCfil. � ��(0 SIGNATURE. A
—T'
Stipulations:
0
72
4
6431 University Ave. N.E.
Fridley, Minnesota 55432
Tel. 571-3450
RECEIVED OF
$ �•3�•
ADDRESS
FOR
AOL)
FUND
CODE
AMOUNT
oMarvin
C. Brunsell
Treasurer
By
6?- 19
-ff
CRC 22
No.
93272
CA
SUBJECT
ER IT NO.
City of Fridley
26651
AT THE TOP OF THE TWINS
BUILDING PERMIT
�
, COMMUNITY DEVELOPMENT DIV.
REC IPT NO.
_
L PROTECTIVE INSPECTION SEC.
1 ,
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
7/16198
JOB ADDRESS 6015 2 1/2 St. NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
20
6
1HYde Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE
LICENSE NO.
Solomon & Sons 12211 Olive St NW C754-5875
20055664
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
O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house (8 S Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with 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
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
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
1000= $667.20
$.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-
$26.50
Fie SC
$.67
ST TI N O THE PERFORMANCE OF CONSTRUCTION.
/
? %/i
PLAN CHECK FEE
TO AL FEE
�o
` / Q(/
Licen $5.
32.67
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT OATEI
EN ROzm&/
DTHISOUR
PER7SIGNATURE
OF OWNER OF OWNER BUILDERI IDATEI
B INSP
qA TE
CA
NEW [ ]
ADDN [ l
ALTER [ ]
V
ConstructionAddress:
Legal Description:
Owner Name & Address:
Contractor: '5,An
Effective 1/1/98
CITY..OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Tel. #
MN LICENSE #
Address:. 1262= 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. , ' Z; - 6� 4-"=
Construction TypeTo �-CL Estimated Cost: $ a -
s
(Fee Schedule, on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: l _li� _�� APPLICANT: Tel. #
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
$1000 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 [ ]
SUBJECT
PE
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
PERMIT
3 11-1464
t
r `REC
O.
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.a
f PROTECTIVE
1 �
NUMBER
REV
GATE
PAGE OF
APPROVED BY
i
i A ; �'���;'CITY HALL FRIDLEY 55432
�
__-•
L J\ 612-571-3450
910-Fl5
10/10/00
JOB ADDRESS 6015 2 1/2 Street NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
20
6
Hyde Park
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jim Lehnen 6015 2 1/2 Street NE
532-8030
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Norling Exteriors 341 79 Way NE, Fridley, MN 55432
763-784-8936 20098700
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 C:k NEW 0 ADDITION Gj ALTERATION ❑
REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Construct a 16' x 8' Deck and install a 6' x 7' Patio
Door
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on
all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building
Code.
SEPARATE PERMIT8
REQUIRED FOR:
HEATING,f11IN
WIRING, G,
PLUMBING AND SIGNS
Before digging call for
all utility locations
4540002
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST.
CCY 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
$3,100
@
$1.55
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE
AC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
L FEE
Licens
$5.0/ 7$106.90
SI ATURE Of CONTRACTOR OA AUTHORIZE ENT IDATEI EN rROPE IDA 0 THIS IS YPUR PERMIT `
•WNSP
S-GNATURE Of OW NERof OWNER BUILDERI IDATEI BLD
NEW I ] Effective 1/1/2000
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES RA AND R-2
BUILDING PERMIT APPLICATION
Construction Address: /a -s
Legal Description:
Owner Name &Adddress: � � �e A sl �.- Tel. #
Contractor: --AO �� a el(oMN LICENSE# a ®o X97 ®O
Address: `l ei wt /-, rG �-� �,�a®y Tel. # 7&1,_:?
LIVING AREA:
GARAGE 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 Height Sq. Ft.
Length Width
Length Width
0 00 12
Height Sq. Ft.
Hgt/Ground -�-� Sq. Ft.
A r
—)rea t e P( Go,-nb-er'
Construction Type:dw2ma
Estimated Cost: $ / 70
000doo.-
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE:
APPLICANT: Tel. # /7�
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee Fee Schedule on Reverse Side
Fire Surcharge $ . lO .001 of Permit Valuation (1/10th%)
State Surcharge � $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
$ $1100 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ]
TOTAL $
STIPULATIONS��I�� �� Lam.. ���
� /d
.Sz C-
'''e 'pot #2802, 5650 MAIN ST, NE, FRIDLEY, MN 55432, (612
Zp 25 09:30:20 2000
saved as: f:\dn\decks\9250846 .
ck Dimensions for Deck 1
r
�5
y o4
6 1 ° --16'
o n L e v, fe
qx PnSfS
a 0 Ce�qq�r boara
e tsC�l,41LZO
I
De
,&, /, ® -f' f7-/6 q S e
i
W%
Joist Spacing = 16 in. o.c.
tailpost Spacing = 96 in. o.c., Baluster Spacing = 3 in., Toe Spacing = 3 in., Railing Height =
>tair 1: Rise = 6 in., Run = 11 in.
6 0 1�5-- -
Ift
.ZOi
2
SUBJECT
P
City of Fridley
3 1418
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC
r PROTECTIVE
i =
CITY HALL FRIDLEY 55432
NUMBERREV
DATE
PAGE OF
APPROVED BY
612-571-3450
910415
9/21/00
JOB ADDRESS 6015 2 1/2 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
20
6
Hyde Park SHEET
2 PROPERTY OWNER MAIL ADORE" ZIP PHONE
Jim Lehnen 6015 2 1/2 Street NE 763-571-4351
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Norling Exteriors Inc 341 79 Way NE, Fridley, MN 55432 763-784-4223
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 O ADDITION ❑ ALTERATION REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Reside House & Garage; Replace windows; Install soffit & trim
9 CHANGE OF USE FROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather
resistive barrier be placed over exterior sheathing to protect the interior
wall covering. Exceptions for this provision would be if sheathing is an
approved weatherproof panel or when the siding is an approved weather
barrier. Vinyl siding is not a weatherproof covering unless the manufacturer
states this in their application guidelines. Call for inspection of wrap
before covering. Install soffit ventilation to meet the State Building Code
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code.
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
$89300
$4.15
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-
$167.25
Fire$8.30
TR CTION OR THE PERFORMANCE OFCONSTRUCTION
,/SC
Q A
PLAN CHECK E
TOTAL EE
2J!Cr
Lice e $5. 0
$ 4.70
Na E OF CON 7RACTOP OR AUTHORIZED Ado T IDATEI
HEN P P Y ALIDAT T IS IS YOUR PERMIT
S,GNATURE OF OWNEROF OWNER BUILDER, IDATEI
gL ,NSP IIA It
NEW
ADDN
ALTER
I l Effective 1/1/2000
I l CITY OF FRIDLEY (763) 572-3604 Bldg Insp
[ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name & Ai
i
• • - LVAi " r� .L�I1A3'TRAIME 2►Z�7� - t'J��t:LiC7VS►X
LIVING AREA:
GARAGE 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 Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Construction Type: Estimated Cost: $ 9300
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$
DATE: 1 ,21-00 APPLICAN . 9_ -422-3
CITY USE ONLY - Call (763) 572-3604 for Permit Fees If mailing in application
Permit Fee $ !p /, o2S Fee Schedule on Reverse Side
Fire Surcharge $ .001 of Permit Valuation (1/10th%)
State Surcharge $ '` , /S�- $.50/$1,000 Valuation
SAC Charge $ _ $1100 per SAC Unit
License Surcharge $ 6,0() $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 $ 7. /
STIPULATIONS:
�d s
From: 651 2810358 Page: 212 Date: 101201200911:45:46 AM
Building - PLUMING Permit No. - ?P
Inspections RESIDENTIAL APPLICATION Received By: -
763 -572-3604 CITY OF FRIDLEY D d
763-502-4977 FAX EFFECrIVEz-r9 dS
DATE YOUR E -MAL ADDRFAS ' Y
SrrE ADDREss 11
THTS APPLICANT I9: 0 OWNER �COXTRAr_ M-1
OVVNER! ADDRESS:in%IT
TENANT
SUBMIT A COPY OF STATE LICENSE 4 1 :4. -ate-(
YOUR STATE F: 7 DATE
LICENS% BOND AND STATE BOND a M :P DATE
CERTIFICATE OF ADDRESS:ri 07
WSURANCE %_STATE P
PHONE �' FAX
PERNRT TYPE I %SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WWORIQ ! o NEW
DETARm DESCRIPTION OF WORK KJPCTAC 2�,'e+,'�
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHI RE NOTED. FIXTURES: (INDICATE TOTAL NUMI1ER OF EACH BELOW). MINIMUM FM
$35.50.
,_,., BATH SINK4 AV FLOOR DRAINS
_ SHOWER
WATER PIPING
—BATHTUB _ GA$ PIPING (NEED CITY LTC)
_ 5w[MIMIING POOL
SOFTNEIt ($35)
_ CLOTHES WASHER _ KITCHEN SINK
WATER CLOSET
`WATER
_ BACKFLOW PREY. (S15)
_DISHWASHER _LAUNDRYTRAY
WATER HEATER ($35)
FOR IRRIGATION
_ WATER METER
1 OTHER
TEIIs Is AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCES SEO
I hereby apply for a plumbin p k and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinakmaniAcodes of the City of Fridley and With the Minnesota Construction Codes; that 1 understand this is
not a permit but ody an apWfton r a permit and work is not to start without a permit on sit-; that thew k will be in rdance
with the approved plan inretqo�,which requires review and vol of Plans
t
SIGNATURE OFAPPUCANT PRTNTMA..; �11111��C� GfT t 1 �11V i! i�
City of Fridley
Building Insnectinna Denartment
l�
0.