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PRE 2010 DOCS• • Village of Fridley, Minn. BUILDING PERMT Office of INSPECTOR OF BUILDINGS Fridley, Minn19 LOCATION OF BUILDING No. Street''' fir'p Part of Lot Lot I'Block �� Addition or Sub -Division DESCRIPTION OF BUILDING J,,+� Front"� Dep Height Stories .°�' Manner of Construction To be used as "' ' z To be completed "' °� Estimated Cost. a� t II Permit is hereby granted to w•t..r.+€,:-s,.,T tor., c" w the building (LF f described in the above statement. This permit is granted upon the express con tion that the person to whom it is granted, and his agents, employees and workmen, in all the work done in, and and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, ., regarding the construction, alteration, maintenance, repair and moving of buildings within the city llmi and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Inspector of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permit, I I hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby to and say that the facts stated by me and contained in the above permit are true as therein stated. Subscribed and sw, day ' �Wai...4.. to before me at Fridley, Minnesota, this ,r 0 City of Fridley, Minn. BUILDING PERMIT Date: _.._.. l` Owner: ........... _..:: . ', ,:.:� ...... ..Y Builder Address ....._..._.._..._......__..__. ..___. ..___ _ _ _ Address ✓f L Tff OF BUILDING No.._ Ll-_!� ' _.. Street _. __ ............_......._. _. .. part o t jard Lot ., C?..: Block ............ ../-------------------------- Addition or Sub- I]i ion ...._ - :.x .... _...... �_ Corner Lot .....- ..................._........ Inside Lot....................................'%tback d •:...-` . Sid -----_......._...._. . SewerElevation....._............._............._............._........_..._...-........._.._..._.............. FoWidation Elevation .................... .............. ... _......... _.......................................... DESCRIPTION OF BUILDING To be Used as:f Front ..d_ f.��+% f - �---� Depth.. _..---.. HeightlL:'.-- Sq. Ft. /...._.. Cu. Ft. X, i .................... _...................................... FrontEst. C Depth .........-- Height .. .. Sq. Ft. ..... _................. Cu. Ft. Type of Construction ....._............._.. ! ........-----.... To be Completed ....._............._............._.......- ..... ....,. �,r.yt.�!°,:� t..,� �,,�--....r.�...4,.:�........ ....... 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 all provisions of ordinances of the city of Fridley. a. In consideration of the payment of a fee of $......._........:_' , permit is hereby granted to. ......... :....... _........... 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 time upon violationo any of the provisions of said ordinances. / ., .1 11 40-'-/Aa wilding Inspector NOTICE: This permit does not cover the construction, Installation for wiring, plumhiog, gasheating, sewer or water. Be sure to a" the Building Inspector for separate permits for these Items. 4 TW PER',' _ y APPLLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner's Name -__,—Lc _ ®� Builder Address 4fG3— .? ® < �V,�� Address LOCATION OF BUILDING No. Street Part of Lot Lot9� Block / Addition or Subdivision e. Corner Lot Inside Lot Setback Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: el e H 4Z& 6 6 I -�-i b Al Front _ 1c� ! Depth J' I Height . Sq. Ft. / J�� _Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction�7- Estimated Co - /1 ey 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 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. DA7B SIGNATURE (A Schedule of Fee Costs can be found on the Reverse Side.) • City of Fridley, Minn. BUILDING PERMIT N° 6937 Date/ Owner: \ Builder — — Ad lAddress-- TIN SOF BUILDING No. Streets Lot .2 6 Block _— Z____ Addition or Sub -Division Corner Lot _ Inside Lot _ _ Setback --- Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To sed as: � Front , Depth Lc� Height Sq. Ft. JW Cu. Ft j, O Fro DepthHeight Sq. Ft. _ __ Cu. Ft. Type of Construction :t.• C �_ __ To be Completed -_._.- 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 compliay�e with all pr ons of ordinances of the city of Fridley. / - ( l .7 In consideration of the payment of a fee of permit is hereby granted to 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 time upon violation of any of the provisions of said ordinances. n d) ---"% • NOTICE: This permit does not corer the construction, Installation for wMh& phnnbing, gas heathen savor or water. Be sure to see the Building b gmbr for separate permits for thea hems. 53-84-5915.51 City of Fridley Appliaalou for MmMag t Dept. of Bldge. Phone SM -3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures 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 $ Water Heater (Up to 99,000 BTU) ...... x $3.00 $ WATER NTR. x $8.26 $ Electric Water heater : $2.00 $ GAS FITTING FEES: NO. RATE TOTAL let 3 Fixtures .......................... x $2.00 $ Additional Fixtures . .......... , ....... —x$-75 $ 1 •00 Gas Range to 199,000 BTU .............. x$5.00 N GAS ELEC. Base lst 1 2nd 3rd — — :4 _ a Puture Connection Openings Connected with e NOW Fixture, Old OpeningsI Bawer ❑ 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 $ Water Heater (Up to 99,000 BTU) ...... x $3.00 $ New Ground Run Old Bldg. x $8.26 $ Electric Water heater : $2.00 $ GAS FITTING FEES: NO. RATE TOTAL let 3 Fixtures .......................... x $2.00 $ Additional Fixtures . .......... , ....... —x$-75 $ 1 •00 Gas Range to 199,000 BTU .............. x$5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ......................... TOTAL FEE $ 3.00 Le�atzan 4863 N E 3rd St 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, Blinn 6-23-70 19_ Owner J R.askob frame Kind of Building Used as res To be completed about 6-28-70 Estimated Cost, $ 10.00 Old—New. Building Permit N . P4 i i e _ By— Business Phone No ROUGH MMMGASCO. 53-84-S-915.51 City of Fridley Appliccvicn for Plumbing and G= r ling, Permit Dept. of Bldgs. Phone 360.3450 DESCRIPTION OF WORM Numb -or, hind and Loce_lon of Fixtures N � $ .New Ground Run Old Bldg.......:. x $° "5 1� Electric Water Heat.ar.............. N Y g�;s 7 7< NU' 2 7 a N WATfit HTR. cAs ncC Additional Fixtures ............... x $ .75 S Gas Range to 199.000 BTU ........... x55.00 $ e' st 11 Sp ce Hea to _ Siegler SV --35-,E- _ F% * Coanoctku Oponings I Saver C3 Now Fixtura. Old Openinzs Ccrspool C] PARTIAL RATE SCHEDULE UMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ x$2.00 $ Future Fixture Opening ............ x $1.50 S _. New Fixture Old Opening ..... a .... x $1.50 S --•-- Catch Basin .................... x $3.25 $ a Water Beater 'Up to 99.000 BTU) • • • • x $3.00 $ .New Ground Run Old Bldg.......:. x $° "5 $ Electric Water Heat.ar.............. a $2.00 5 '.S FITTING FEES: NO. RATE TOTAL Ist 3 Fixtures ............ • • • • • • x $2.00 $ . Additional Fixtures ............... x $ .75 S Gas Range to 199.000 BTU ........... x55.00 $ LMM 4863 N. E.* 3rd. Street City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, ag eeing 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, Minn 5-145 19, Owner Jerome J. Raskps Kind of Building Frame Used as Res. To be completed about 5-8-75 Estimated Cost, $ 10.00 Old—DiA07Bullding Permit No. Permit Signed=_ By MINNFUSN) _. Business Phone No ROUGH FINAL '3 - /Y - 2 ( . :PAIRS a ALTERATIONS—Rafor to Code .50 State Surcharge Deacriptioa Install wS�a oe Heater ......... � 8.00 SV -35-E-2 TOTAL FEE S 8.50 Ctass "P Sirrdiarge .50¢ SUBJECT P®R Cit of Fridle y y 130'7 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT 1 L -------COMMUNITY DEVELOPMENT DIV. 7& 9 y r PROTECTIVE INSPECTION SEC. 1 � � 1l NUMBER REV. DATE PAGE OF APPROVED BY /•"1 CITY HALL FRIDLEY 55432 ,'j L""A 812-560-3450 910-F15 7-7-75 JOB ADDRESS 4863 - 3RD STREET N.E., FRIDLEY, MINNESOTA 1 LEGAL LOT NO. BLOCK TR ACT OR ADDITION SEE ATTACHED DESCR. 1 PLYMOUTH SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerome Raskob 4863 - 3rd Street N.E. 55432 560-7691 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 Dnt. Garage 7 CLASS OF WORK ❑ NEW 1 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Det. Garage 24 x 22 9 CHANGE OF USE FROM TO STIPULATIONS PROVIDE HARD SURFACED DRIVEWAY TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Frame 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 484 4840 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 $3581.60 $1.79 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- STRU NOR THE PERFOR NCE O ONST UCTION. � $9.00 > P ECK FEE TOTAL FEE c �%/i 10.79 16NATURE OF CONTRACICRO AUTHORIZED AGENT (DATE) WH N PRO ER Y A D THIS IS YOUR P ERMIT J "/q BLDG )NSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION.BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME: < %/o /V/2 / -S/c!�, /3 BUILDER: ADDRESS (7 7 J� .3 - 3 S"/. /V ADDRESS: NO:. STREET: LOT: a(- k 97 BLOCK: ` ADDITION:�L 7 c) -e CORNER LOT: INSIDE LOT: G"� SETBACK: SIDEYARD:` Applicant attach to this form n.7o Certificate. -.of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: Qfr-r(;vVZAGrL- Front: Depth: Height: Square Feet: 4 ?'4 Cubic Feet: 442,40 Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: PQAy,nff* Estimated Cost: $ �� 1, Loa To Be Completed: Mo. The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stfict 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. 0. x DATE: �� i SIGNATURE: � - (See Reverse Side For Additional Information.) City of Fridley SUBJECT P ® 1509'7 AT THE TOP OF THE TWINS PER M r BUILDING JT RECEIPT NO COMMUNITY DEVELOPMENT DIV. 9 r PROTECTIVE INSPECTION SEC. 1 . � NUMBER REV. DATE PAGE OF APPROVED BY "1 CITY HALL FRIDLEY 55432 612-580-3450 910-F15 3/29/79 JOB ADDRESS 4863 - 3rd Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 26 1 Plymouth SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerome J. Raskob 4863- 3rd Street N..E 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Denesen Company, Inc. 2836 Colfax Avenue South 827-2941 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 ❑ ADDITION ❑X ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE � 8 DESCRIBE WORK Reside house and garage 9 CHANGE OF USE FROM TO STIPULATIONS SEPERATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SiG:l1(S; WARI41j OdW digging cell 1001 ufilig" i'40HONg - ELECTRIC - , RGWUIRED SY SAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Vinyl VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 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. $6, 26O $3.13 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- $39.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $42.13 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT (JLaJC./V BLDG. )NSP NTE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) • CITY OF FRIDLEY APPLICATION FOR RESIDCNTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS,' OR REPAIRS) OWNER: J e •v -e l�a s tad BUILDER: e n •e S -ems Gdi '0%." C a Address: 3 3-,W •sfIY� Address: A36 Co/%,,- Tel. No.:77 No.Street: 3 -a LOT: a BLOCK: ADDITION: CORNER LOT: INSIDE IAT: SETBACK: SIDEYARDS: 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: �eSide 1-4,k5e4"� Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction:/� „t� Estimated Cost: $ To Be Completed: .3— 0 Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (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 DATE: 3'2� %/`' SIGNATURE: Stipulations: SUBJECT PE IT NO. City of Fridley 5 E 6 3 AT THE TOP OF THE TWINS BUILDING PERMIT r ` RECEIPT NO. ______ COMMUNITY DEVELOPMENT DIV. I L PROTECTIVE INSPECTION SEC. �^�o r vy CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY L 612-571-3450 910415 11/4/97 JOB ADDRESS 4863 3 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 26,27 1 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mary Lou Raskob 4863 3 ST NE 571-7691 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. MCR Roofing 829 20 Ave NE, Minneapolis MN 55418 788-5749 20063096 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 O NEW 0 ADDITION 0 ALTERATION Ij REPAIR 0 MOVE 0 REMOVE 8 DESCRIBE WORK Reroof House & 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 80 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 $1,584 @ $ 79 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- $51.25 Fire SC $1.58 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE License $5. $58.62 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI N ROP VALIDAT THIS OUR PERMIT B G INSP (' z GATE S,GNATURE OF OWNER of OWNER BUILDERI IDATEI NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ) SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION / ConstructionAddress: f �cr 3 Legal Description: 7 a � Owner Name & Address: %/ , y k i ./,,. X--"? A Contract Address: Effective 1/1/97 a� a Tel. # S 7 / • /7�' �✓/ ENSE # .x o4 &0,0 4� Tel.# Z, /, :2�r-�7y� 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 GARAGE AREA: Length DECK AREA: Length .�� OTHER: /'� Width Height Sq. Ft. Width Height Sq. Ft. Width Hgt/Ground Sq. Ft. Construction Type: ; n o r - G Estimated Cost: $ /101151 6 --��_,rQ 9-e (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: ZZ l/- APPLICANT: 221-C. C /?C/o . , a r, Tel. # STIPULATIONS: CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ A .001 of Permit Valuation (1/10th%) State Surcharge $ , °%% $.50/$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge $ C 'O� $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: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR, PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURtS TO BE INSTALLED ON EACH FLOOR Effective On Jan 1, 2000 .:........... i€< Urinal Shower ...:.::::::: Wash .: »:<:::;::: : :#�i»::..::. Floor �n ::::>::: Auto. :::.:.. ��I�1#ti� Washer :.,_::.:.�.:.Ii;� Gas Ran a : X111 Water He Stories `::> Gas Elec Basement t Floor 1 `s Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: NO. RATE New Fixtures Old Opening, New Fixture 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 TOTAL JOB ADDRESS V90 9 ' 67- 41- C. Z/ 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. Zf 20�� Owner Building Used As Estimated Cost PERMIT NO. $15.00 PLUMBING COMPANY Lj — Ae Reinspection Fee $47.00/Hr SIGNED BY 6wel( l �a4161_V TEL N0. — ®��S ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 06j•�'��/,�/g� 1.5% of Value of Fixture or Appliance ZQ_ l Approved By Rough -In Date Final Date to `` State Surcharge $ .50 MINIM M FEE FiR ANY PLUMBINGIGAS PERMIT IS $20.00 TOTAL FEE $ PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE CIIYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 September 18, 2000 Mary Lou Raskob 4863 3 Street NE Fridley, MN 55421 Re: Final Inspection at 4863 3 Street NE Contractor: KCJ- Mr. Rooter Dear Ms. Raskob: A plumbing permit was issued on May 8, 2000, for the above noted address, to install a gas water heater. According to section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the plumbing authorized by this 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 (763) 572-3603. Sincerely, Building PLUMBING Permit No. 03 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 zu CITY OF FRIDLEY Dat dJ 763-502-4977 FAX EFFECTIVE 2-19-09 DATE 49 YOUR E-MAIL ADDRESS SITE ADDRESS _? t THIS APPLICANT IS: R ❑CONTRACTOR PROPERTY NAME: & OWNER/ ADDRESS: 63 Y CITY '17741C V STATE IP =5 T -I 1 PHONE: �0 L - 019-1 y �j 1(f CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE STATE LICENSE # EXP DATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PERMIT TYPE INGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW PLACEMENT DETAILED DESCRIPTION OF WORK `50+ —1 e - FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE 35.50. BATH SINK/LAV _FLOOR DRAINS SHOWER WATER PIPING _ _ BATHTUB _ GAS PIPING (NEED CITY LIC) —SWIMMING POOL WATER SOFTNER ($ _ CLOTHES WASHER _ KITCHEN SINK _ WATER CLOSET _ BACKFLOW PREV. $1 DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION WATER METER —OTHER ss „.�• 4'3� �� A '^� �4� � g� �' `�,'� F�.,. } � ? ��J '..� � ��ti* b�' 1' f �� J�' 'IIS � � � ,3• � 't8,�' � � 4 ked f � � � � �.+;i'. � ._ ��, � •. � �"r,T �� S� Y��21 aY2� � Y t� �� 4 'a3`� � � �' 4 �£ �,m.„`5 Cyx, '� Y �, ..; i �, 4�` f� J i �7��• k Ffr{ �,�; ? .: ” ryr i r.,za 4.. , x€ x,E: Ht 'A'r v i # qs-:, �,h.=ar 0.• i' +. vy':� by ». >L W. f.�*Y.t < 4 .'�_-hF ` i. 1_ Yy v`f'"',}.5?. ..'•' f " raF �°•Ei h" rf ,�"A 'L"•Ri J ,y+S' rs'x i+z^2 '•t S �' '{< 'y' 1.1i'F� �'"L � �^ '.'ar"� � �' � �;y� � '"'w3• u� `3_ '� X P h.. F t �-. 2 {,�,€ `� `^ -k•�:�. � •d 5 iF S ni�c� Y t � .,e` 'F4 : l � d • #t'P8 � k�k� Y S � �h "£'� 5 <'t i•E*_ x. ' � �E �R� fi��i '..... Se�ii ��x�- '� iR R r Y' �i i"�5, MVI i'••: �,, .eh bfl j �.'. � � ,.,�'{ !`i:� •} �YF ., ''k 1��F it ��.. �, i<�g � � *d�� W.' :A��'e �� N'6�3 �&. G � �' "3�+�`+ �5: Y?�5.»�'�`�' `� � 3 ,.y : Sa •�:r '�' � � nd `' '�, 'r i d 2 Sax <, ,s�,fl %k�'3 yy ;' � Sr4'4 .� u�� 4 �'X� ,� ry � t 5 '� �¢Y $ a', ,a #R�'a�fl {, .. i t �W � �:: f :- : 2 £ 3•;. ,� a '`i h^<' 7 .� � ✓-;� `� "� : '`.c �"^ S'. � a � � Ts4S' i `i _ � � �� x. � �J ,,., t` } 1 � -,zM '� F''1"��•,,a S" e" 6 � Y £ � y�� !"+.. � �' f� �{ � � Mkxb�".$� � �,� ➢ zz`'�.A - �� fa.. ?. �' €; is t r 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 withthe approved plan in the ca_W of all woo is requires review and approval p ns. SIGNATURE OF APPLICANT '� PRINT NAME ` DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977