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PRE 2010 DOCSCity of Fridley, Minn.. BUILDING ]PERMIT Dale: .. v; 0 , Owner: --= Builder Address Address L F BUILDING, No. Street T P f Lot Lot _ _ __ Block _ A dition or Sub-Diviaio� a /+ Corner Lot __ Inside Lot 0 Setback _ __ _ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Usedias• f' t Depth s. fir' Height Sq. Ft. Cu. Ft. F= Depth Height Sq. Ft. Cu. Ft. Type of Construction _ ,., Est Costt�'� To be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do the promised work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. .� 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- qf any of the provisions of said ordinances. -.-% Im.. . l Building Inspector NOTICE: This permit does not cover the construction, instaWon for wiring, plutnhing, gas heating, sewer or water. Be sure to age the Building Inspector for separate permits for these hems. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, WMNESOTA Otw-aer Is Name LMdd E. Carlson & Son., Inc. Builder thrid E. Carlson -& Son, Inc. Address .3200 France Avenue South Address 3200 Franee Avenue South LOCATION OF BUILDING No. 5231 Street 3rd Street N. E. That Part of Lot 4_ lying o. of the No. 27' thereof as measured along the West line thereof and the No. 87' of 'Lot 5, as = measured along the West line thereof/g$ %Rtw In rt the right of way of State Trunk Highway No. 56, in Block 1, Carlson's Summit Manor Annex Corner Lot Inside Lot XX Setback 35' Side -Yard 44'-10" & 44'-10" SEWED ELEVATION 8' below basement floor FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: Apartment Dwelling Front 77 Depth 36 Height 23 Sq. Ft. 2,772 Cu. Ft. 76.000 Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Frame & Brick Veneer _Estimated Cost $60.000.00 To be Completed Aujzust 1961 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 tha all the facts and representations stated in this application are true and correct. DATE November 160 1960 SIGNATURE e (A Schedule of Fee Costs can be found on the Reverse Side.) APpr Y Bui+disg Inspector Application for Power Plants and.. Hea ft, Cooling. Ventilation, ReMgwafon and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ........................ 2.00 $ Replacement of Furnace . §.00 $— Repairs & Alterations—up to $500.00 ... :............. 5.00 $ Repairs & Alterations each add. $500.00 .......:..... . 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam...... 8.00 $ Furnace Shell & Line—to 640 sq, ft. EDR Hot Water ... 8.00 $ �• Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTL) ....................... 5.00 $ O GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS 8c REPAIRS TOTAL FSE ROUGH FINAL Dept. of Bldgs. Phone SII. 4-7470 Location XFA •31 ' &-Veal City of Fridley: 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. Fridley, Mfnn Q 2 19 Owner z� Q.! Kind of Building�I�1 Used as /��• To be completed about Estimated Cast, $ JR -00-00 Old—New. Building Permit No.���Permit DESCRIPTION OF WORK HEATING or POWER PLANTS --Steam, of Water Warm Air—No Trade N!w1 c.4ne° S*A4A Size No D Capacity Sq. Ft. E.D.RBTU H.P. Total Connected Load „I—rz %G V Kind of Fuel_ BURNER — Trade NameX f/ Size No Capacity Sq. Ft. E.D.R-! D ®® BTU H.P. (REMARKS—OVER) Signed—�+ -- �-O a az 7M 7-59 Business Phone No- �� 01 SUBJECT RMIT City of Fridley 1 18332 AT THE TOP OF THE TWINS BUILDING PERMIT r • ___ COMMUNITY DEVELOPMENT DIV. INSPECTION r 1 PROTECTIVE SEC. 1 i ` CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED By 612-571-3450 910-F15 3/3/86 .JOB ADDRESS 5231 - 3rd Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 4,5 1 Carlson`s Summit Manor Annex SHEET 2 PROPERTY OWNER MAILADDRES,5 ZIP PHONE Helen Bigos 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. North Side Roofers 10128 South.Shore Drive, Plymouth 55441 545-5427 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Apartment 7 CLASS OF WORK ❑ NEW ❑ ADDITION] ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroo£ Building 9 CHANGE OF USE FROM TO STIPULATIONS 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. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 11 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 $5,000 $2..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. $50.50 PLAN CHECK FEE TOTAL FEE X 1 $53.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY V DATED THIS IS YOUR PERMIT BLDG )NSP aXi(\ D TE (�9 SIGNATURE OF OWNER)IF OWNER BUILDER) IDATEI 01 Prepaid Plan Check $ Estimated Cost = Receipt # City Of Fridley R-39 COMMRCIAL a INDUSTRIAL Building Permit Application Construction Address: ..,S -),i l Effective 4/1/84 Legal Description:_ Property Owner A Address:j, '^�'�r� �' � ,2LSo,u`S ,� , 4u� Tel . # Contractor & Addres. Architect & Address Engineer A Address: ° �IS- q4-/ / Reg. # Type of Work [ New [ ] Addition 0 Alteration 1=11_�_�� State Surcharge - ,/_� $ "Maw Park Fee $ Sewer !lain Charge SE OF BUILDING: Driveway Escrow $ APPLICANT SIGNATURE: - Tel. # ate: �10 BUILDING DIMENSIONS Size of Structure Length Width Height Sq. Ft. # of Stories OFC. AREA: Length _ Width Height Sq. Ft. WHSE. AREA: Length Width Height Sq. Ft. OTHER AREA: Length _ Width Height Sq. Ft. VALUATION Sq. Ft. % $ Cost/Sq. Ft. = Valuation $ ) Sq. Ft. B $ _ Cost/Sq. Ft. = Valuation $ Sq. Ft. _ $ $ ________ Cost/Sq. Ft. is Valuation $ ) Total Type of Building Construction Air Conditioned [ ]Yes [ ]No Permit Fee $ S ,S�o Plan Check $ ®•� State Surcharge $ SAC Charge $ "Maw Park Fee $ Sewer !lain Charge $ Driveway Escrow $ TOTAL $ SIA no STIPULATIONS: �10 Occupancy Group Class. Zoning Fire Protection System [ ]Yes [ ]No. See Fee Schedule on Reverse Side In excess of Prepaid Plan Check -See Back Pg. $.50/$11000 Valuation (See Sched. for > $1 mil) $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] d O. 6623 SuBjECT PER City of Fridley AT THE TOP Of THE TWINS BUILDING PERMIT R CEIPT N Ir COMMUNITY DEVELOPMENT DIV PROTECTIVE INSPECTION SEC CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 9/2/86 JOB ADDRESS 5200 - 5291 3rd Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Various j- Bl. 2 & -6, Bl. 1, Carlson ' s Summit Manor Annex SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bigos Properties 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Twin City SThrm Sash Co. 2641 Louisiana Avenue South, Mpls. 55426 927-6534 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO • 6 USE OF BUILDING Apartments (8 Buildings) _7_CLASS OF WORK ❑ NEW ❑ ADDITION GA ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace windows 9 CHANGE OF USE FROM TO STIPULATIONS 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 S0. 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 $100,000 $50.00 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- $433.00 K CTION OR THE PERFORMANC7OFNSTRUCTION / PLAN CHECK FEE TOTALFEE $483.00 SIGNATURE OF CONTRAC OR AuTmORiZED AGENT iDATE, WHEN PROPE RLYAALI DATED THIS IS YOURIPE MIT I S. DG �NS� t/ IATE S,GNA'URE DC 0�.%ER 11 OWNER 8W DER -DATE O. 6623 SUBJECT PE, MfT-40-__ City of Fridley 5 AT THE TOP OF THE TWINS BUILDING PERMIT _o r RECEIPT NO. i • COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. I NUMBER REV DATEPAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 3/28/95 JOB ADDRESS 5231 3 Street NE i LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR, 4,5 1 Carlson's Summit Manor Annex SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bigos Properties 6868 E%celsior Blvd 938-6325 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Four Seasons Builders & Remodelers 1410 Quant Ave N, Marine of St Croix MN 55043 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 433-4846 6334 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Apartment 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Structure (Tear -off) 9 CHANGE OF USE FROM TO STIPULATIONS 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 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 @@ $6.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT `P13,000 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- $144.00 Fire SC. $13.00 CITHE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE e-'j``,r�J�N�-� $163.50 SIGNATURE OF CONTRACTOR OR AUTHORIZE AGENT (DATEI WHEN PROPER Y VALIDATED THIS IS YOUR PERMIT r G INSP DATE _6�1411, SIGNATURE OF OWNER) IF OWNER BUILDER) IDATEI Effective 1 / 1 /95 NEW [ l � � , /"Y�,�-E'-�GY�� ADDN (] CITY OF FRIDLEY ALTER (J D DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Legal Description: Owner Name & Address: &ip f-.01,1 Tei. # Contractor: ` o'%)01"5 & AW) %' MN LICENSE # 613 9 Address: �`�16 Q� �� Q�� _ N-W`e' Gr Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to sc ------- DESCRIPTION __ _ DESCRIPTION OF IMPROVE T 611,11/ LIVING AREA: Length Width 3;z� Height Sq. Ft. GARAGE AREA: DECK AREA: OTHER: Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. f Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: L G+� Estimated Cost: Approx. Completion Date: ky 1,1 (Cost on Back) Driveway Curb Cut Width Needed: Ft+�6 Ft = Ft x $ _ $ DATE: 3/a -4s Itis APPLICANT: 1,pJ'c{,���� S��`�'a�V`� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee $ CITY USE ONLY Tel. #. Ll n. �� 4 Fee Schedule on Reverse Side .001 of Permit Valuation (1 / 10th %) $.50/$1,000 Valuation $850 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 [ ] 4,411, ► TOTAL , STIPULATIONS: FRM1 :City of Fridley FAX N0. :7635711287 Apr. 11 2006 03:34PM P1 ..� �errlyit Na.: �' ]wilding BUILDING Inspectians Ct71�MERCIA►.L/INDUSTRIAL Received BY�..... . _..._ ........_ 763-572-3604 CITY OF F' LEY Date Rec'd.: d� DATE � �s®Jb� YOUR E-MAIL ADDRESS _w_..,�.7��`OS� SITE ADDRESS __.... 2j7ifinl 57--• TENANT __..._ ,L. _Suite No. on PROPERTY OWNER? NAM.: _ �._ - '� � `ADDRESS: 5/�- C'T1'Y �7 d �0 sTATFZIP � PHONE ... - �'�? — ._ 9 ARCHI•TECI' NAME; _ _ ._..__.... ADDRESS: C:1TY STATE,_ 1ZIP.....- CCJNTRACT'OR NAME;— - -7 �--...__-....,..... tt�st'—�1,✓ 3-Si� P257 7 PHONE: V - A s� FAX S/ — �� / 7t �_� *NOTE- C, TY JJCFNSF RFQTJEIk3 FOR MULTI FAMU:Y(C01V WRrULee DUSTRIAL JOBS PROPERTY TYPE D TOWNHOUSE O WfAMERCIAL NDUSTRIAL D INSTMJ ONAI, JLTT-FAM.1LY PERMIT TWE M n.DDITION - -� -CJ NEW CONSTRUCTION 13 REMOURL p ROOF ❑ SwiMMING POOL PLEASE SUBMIT: 41.4 SBTS oFDRA'1 rNc,� S. coo-ZAC"rURS LICENS13 OR 6. a'PECIA.L INSPECTION 2. SURVEYISM FLAN LICENSE APPLTC:ATION SCHEDULE 3, LANDSCAPE PI•.ANS 7. PERFORMANCE BOND 4. LNERGY CALCS .AititO 3UILDTNG TO BE USED AS:_ OFFIC.F, .,,..„ sr WNS � OTHER _sr TOTAL SIZE:_........__._..._.y... $TO »SY.. � FIRE T;c�� IONLY/N).. F16 OF ....,. AC(Y1N)............. DETACL il) DESCRIF1.. [6kK _ JrO j �'✓�.�L "1�/'Zr THIS 1S AN APPLICA710W FOR A PFPMrr-NOT VALID UNTIL PROCaSED I hereby apply for a. building ;pKrmit and 1 acknowledge that the luforreation above is complete and accurate; that the work will be in, conformance with the ordinanccs and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a pemit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. i SIICNATURBOF APPLICANT PRINT NAN1R ALL FEES ARE BASED ON vA.LUAnON Sq. ft. x$ Cost/Sq.11.=Valuation $ Sq. ft. . ___ .,, ...a �x $� Cost/sq. ft. _ V'aluation $ Sq. A_ X$ Cost/sq. ft. = Valuation $ TOTAL JOB VALUATION: $ USE OCCUPANCY 11'PL _--_........_.... Permit Fee -f --- - Plan Review Fire Surcharge Surcharge SAC Charge Erosion Control Park Fee Spacial Assesssnaerlis Curb Cut Escrow $ $ Sec Back Page for Fee Schedulc 65% of Building permit Fee .441 lames the total job valuatioa .0005 x Permit Valuation Minimum $.50 $1550 per SAC Unit (Plane to MWCC for determination) $450 Conservation Plan Review Fee Detennined by Engineering; Agreeinant necessary ( ) Non Necesstiry ( ) ft •I.6 ft = .,- ft x $20 = $ to: .... _ • .. _ r From: 612 521 1765 Page: 2/2_ .,,Date: 7/23/200812:04:17 PM , .... Building PLUMBING Permit NO.: Inspections COMMERCIAL APPLICATION Receivedsy: � 763-572-3604 CITY OFFRIDLEY Date Rcc'd-7 � 763-502-4977 PAX DATEI rri YOUR 0 -MAIL ADDRESS SITE ADDRRSS �,'F►� I ra -C - - TUNANT SUITE NO. OWNER/ TENANT CONTRACTOR sTA9 L LICENSE P_ 81313MIT A COPY OF YOUR STATE PLUMBING BOND # LICENSE AND BOND 1ADDRV-,';:_1J5D1 EXP DATE EXP DATE r•� PERMIT TYPE 0 INSTITUTIONAL CI MULTI -FAMILY O TOWNHOUSC 0 C OMMCRCIALIINDUSTRIAI. 0 SWIMMING POOL 0 OTHER TYPE. OF WORK: O NEW 0 REPLACEMENT 13 ALTCRATIONIREMOI)EL WORK '�' LZin_• DETAILED DESCRIPTION OF — rD=REs: (INDICATE TOTAL NUMBER Or EACH) CLOTHES WASHER _ rLOOR DRAINS _ RPZ VALVE _ URINAL _ DISHWASHER _ GAS PIPING (CITY LIC RL'Q'D BACKFLOW PREY. L WAT1:R 11CATER _ DRINKING FOUNTAIN GRL:ASE TRAP _ ROOF DRAINS _ WA'PCR MRTRR FAUCET ^ KITCHEN SINK _SHOWER _ WATER PIPING _ FLAMMABLE WASTE TANK _ LAUNDRY TRAY _ SLOP SINK _ WATER SOFTENER _ LAVATORY _ SWIMMING FOOL _ WATER CLOSL 1' Total Job $ -4 Ql fees are based on valuation, including the cost of labor and materials. Valuation Permit Fee r $ Q1.25% of Job Valuation / Minimum fee: $35) Surcharge $ Valuation X .0005 ($.50 Minimum) Total nue $ inimum $35,50 Make Checks Payable to: City of Fridley THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a mechanical 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 case Om i work w:17icerL6d approval of pI s. SIGNATURE, OF APPLIC .—,4BNT NAME l GyATB APPROVED BY DATJ57Z� of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 W Building PLUMBING Permit No.: Inspections COMMERCIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: 763-502-4977 FAX EFFECTIVE 1-1-09 DATE YOUR E—MAIL ADDRESS �QAi�. '° ✓�� SITE ADDRESS�yy� TENANT C`.� w�� I^ e.—SUITE NO. PROPERTY NAME: ADDRESS: CITY STAT"rW ��S5 OWNER/ TENANT PHONE: CONTRACTOR NAME: y -C STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND CERTIFICATE OF PLUMBING BOND # 0EXP DATE STATEiP� ADDRESS: INSURANCE PHONE FAX PERMT TYPE 0 INSTITUTIONAL VMMULTI-FAMILY [3 SWIMMING POOL 0 TOWNHOUSE 0 COMMERCIAUINDUSTRIAL 0 OTHER TYPE OF WORK: 0 NEW V,] PLACEMENT 0 AI-TERATION/REMODEL oj( DETAILED DESCRIPTION OF WORK FD=RES: (INDICATE TOTAL NUMBER OF EACH) _ CLOTHES WASHER _ FLOOR DRAINS _ RPZ VALVE —URINAL —DISHWASHER _ GAS PIPING BACKFLOW PREY. _ WATER HEATER _ DRINKING FOUNTAIN _ GREASE TRAP _ ROOF DRAINS _ WATER METER —FAUCET _ KITCHEN SINK _ SHOWER _ WATER PIPING _ FLAMMABLE WASTE TANK _ LAUNDRY TRAY _ SLOP SINK _ WATER SOFTENER LAVATORY _ SWRA IING POOL _ WATER CLOSET Total Job $ All fees are based on valuation, including the cost of labor and materials. Valuation Permit Fee $ (1.25% of Job Valuation / Minimum fee: $35) Surcharge $ Valuation X.0005 -S), Total Due s35 Make Checks Payable to: City of Fridley 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 case of al work hich requires review and approval of plans. —�~— NAME OF APPLICANT DATE SIGNATURE OF APPLICANT PLEASE NOTE: SEPARATE PERMITS ARE RE UIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977