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PRE 2010 DOCSCity of Fridley, Minn. BUIIDING PERMIT N® 3660 Date: .. /.... • V....6..'6 Address ...................................... Address ............................................. LOCATION ATION OF BUILDING 37P No. 4F ... .Street .....ad..... ......... ......... Part of Lot.. .... . ........... ..... .. Lot ....... Block Addition or Sub -Division .. ... .... . ���. a - Corner Lot ............ Inside Lot ....�...... Setback ............ Sideyard j.....�.................. DESCRIPTION OF BUILDING To be Used as: if / /12114 . .... Front .IA` 6 Depth . f � ; (xeight . Sq. Ft. /12�t.1. Cu. Fk R d / % / .................... Front ........ Depth..... .. Height ........ Sq. Ft......... Cu. Ft......... Type of Construction ................... fit. Codi .� ��. ...... To be Completed .............. In consideration of the issuance to me of a permit to construct the building desribed 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. K.................................................. In consideration of the payment of a fee of $. A?®.' ., 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 with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for sspdrate permits for these items. r APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA A 60 Owners Name /, L,&Vt Builder Address �i�(�� $�� �`-�_ ass _ LOCATION OF BUILDING No, Street Part of Lot . LotIS��lock _ Addition. or Sub. Diu. �t' ��L a Corner Lot Inside Lot Set Back -3 �• Applicant attach to this form Certificate of Survey of Lot and -proposed building location. DESCRIPTION OF BUILDING To be used as.. _ e 'e � �)Front �' �' Depth G Height Sq. Ft. � Cu. Ft. r/ �...,. Front Depth ight Sq. Ft. Cu. Ft. �..._ Type of Construction 1 1�� a Estimated Cost To be completed Ad —R 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. � �.O ' ✓moi" C'ZZ4"_ Date �.'��' r � � ,. /� Signature (A Schedule of Fee Costs can be found on the Ro4rse Side Application for Power Plants and Heating. Coaling, Ventilation. Refrigeration 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 ............................. 5.00 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. IDR Hot Water ... 8.00 Each add. 200 sq. ft. IDR Steam ...................... 2.50 Each add. 320 sq. ft. IDR 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 BTU) ....................... 5.00 $ GAS PIPING (Up to 3 Fixtures) .......................... 1.50 $ (Add 50c each over 3) AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM ALTERATIONS & REPAIRS TOTAL FEE REMARKS: Dept. of Bldgs. Phone SII 4-7470 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 �aretrue// and correct. J Fridley, M®®inn S A -C r� — , 195 Owner (r2.� 195— Kind of Building 195— Used as To be completed about ! % Q �5z►�� Estimated cost, $ Old'--(�uilding Permit No.�(�L® DESCRIPTION OF WORK HEATING or POWER PLANTS -Steam, Hot Water, Warm No Trade Name C; `-� Size No. Capacity -' Sq. Ft. E.D.R r Total Connected Loan ' Z-V� ��21F Kind of Fue� BURNER - Trade Nar� — z No Capacity Sq. Ft. E.D.R BTU A.P. Sign By 1147 -Qjoll POST i M-8-58 Business Phone No / �6- "al 10 i 1* City of Fridley, Minn. BUILDING PERMIT Date: Jv].y 1, 1965 Owner: Richard Larson Builder Address 5861 5th St, N. X. Address N. D. Neff Co. LOCATION OF BUILDING N° 9099 No. 1861 Street th St. N. F. Part of Lot Lot _ Block 6 Addition or Sub-DivWon Brett Palmer Add, Corner Lot — Inside Lot Sewer Elevation To be Used as: Setback Sideyard Foundation Elevation DESCRIPTION OF BUILDING Front Depth Height Sq. FL Cu. Ft. Front Depth Height Sq. Ft. Cu. n Type of Construction Est.to 2.5,00.00 To be Completed �0 3,000.00 Storm Damage Repair 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 ab ov t forth and in compliance with ail provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 10.00 , permit is hereby granted to N - fl_ Neze 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 wiorthi ncesn the city limits and this permit may be revoked at any time upon violation of any of the provisions of said Allen Jensen Building Lmspector NOTICE: M puma deft MW even Nie comtrocdo, hien Mer Wk18& phnnW& aft hesthM nww or wdw. Be sora to no the BaMMS h*eeter for wpm" pem6s Mer thea hems, APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME BUILDER ADDRESS ,5�C / �� 1! /y' ADDRESS -�� '007�0 - LOCATION OF BUILDING Street Part of Lot ,yh LOT 4:3� ai.00R -4 ADDITION OR SUBDIVISION=- d Corner Lot Inside L Setback Side -Yard SEWER ELEVATTDN-,YOMATION ELE'�ATtok 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 Height Sq. Ft. Cu. Ft. Front Depth _Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost AV Tobe completed E 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. SIGNATURE p/l/ (Schedule of Fee Costs can be found on the Reverse Side �. City of Fridley, inn N° 8859 • BUILDING PERMIT Date: MAY 25, 1966 Owner: RICHARD A. LARSON Builder SUSSEL COMPANY Address 5861 - 5th Street N. E. Adm 1850 Myo Avenue Fridley, Minnesota 55421 St_ PaL1s MinnAsntA LOCATION OF BUILDING No. 5861 Street 5th Street N. E. Part of Lot Lot 15 _ Block 6 Addition or Sub -Division TIEWMT RAMM Corner Lot Inside Lot Setback — Sideyard Sewer Elevation :. Foundation Elevation DESCRIPTION OF BUILDING To be Used as: DET. GARAGE Front 24 Depth 24 Height 10 Sq. FL 576 Cu. Ft. 5, 760 Front Depth Height Sq. Ft. Cu. Ft. Type of Construction FRAME Est. Cost 1 5 25.00 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 acc ordance with the description above set forth and in compliance with ail provisions of ordinanoss of the city of Fridley. Inconsideration of the payment of a fee of $ 6.00 , permit is hereby granted to SUSSEL COMPANY 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 asci his agents. employees and workmen, is aII work. done in, around and upon said building, or any pert thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair sad moving of buildings city ]units and this permit may be revoked at any time upon violation of say oP the provisions of eatd WILLIAM H. SANDIN Building inspector NOTICE: ills pamb dos not aoru the sondtrustloe, indaDaden hr wiring, Plumbing, gas hearing, sewer a wales. Be am to ae do Building I gWftr hr separate permha for thea Mena. APPLICATION FOR BUILDING PERMIT CITY .OF FR4IDLEYs.MINNESOTA OWNER'S NAME �/ �..�[ aq 1► d.41.5cl,, BUILDER 4V 5-S 4 Cz ADDRESS A -5V& J. — ADDRESS hfclo Cee, LOCATION OF BUILDING NO, STREET PART OF LOT LOT BLOCK , ADDITION OR SUBDIVISION CORNER LOT INSIDE LOT­_,� SETBACK SIDE -YARD SEWER ELEVATION FOUNDATION ELEVATION 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 Height Sq. Ft. -Z6 Cu. Ft., Front Dept ` Height Sq. Ft. Cu.. Ft.. Type of Construction Estimated Cost /'l-3�� To be completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all.woik 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 w, 13P — SIGNATURE �' s (Schedule of Fee Costs can be found on the Reverse Side). f-- I --% - '7-1 -'2 AL LOT NAME SIZE- 24 A 24 -/-\. BLOCK ADDRESS VALUE J 63 G, I _5 -T 152-5 AREA TYPE F -f? P e -/-\me (Di :r;QUArr-e W I 1-1 C,2) Mc -- w ar C-cDNjoul Q " C)WNF--z Mbt> 't -SL L) f, Ina 24! 1 - e- Vt N SUBJECT PE City of Fridley _O 15637 AT THE TOP OF THE TWINS B U I L D I N G P E R M IT REC I O. `L ______ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. /57.9_ CITY HALL FRIDLEY 55432 NUMBER REV. DATEPAGE OF APPROVED BY j, J\ 612-571-3450 910-F15 4 2 80 JOB ADDRESS 5861 - 5th Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 6 Bennett-Palmer SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Richard Larson 5861 - 5th Street N.E. 571-2124 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Professional Roofing 7257 Yucca Lane Maple Grove 425-8233 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 ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof 9 CHANGEOFUSEFROM TO STIPULATIONS New roof can be second but not third roof. 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 STALLS I 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 $.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,000 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- $7.50 NONE STRUCTION OR THE P RFORM NC OF CONSTRUCTIO PLAN CHECK FEE TOTAL FEE e� t o $8.00 SIG A REOFCONTRACTOROR-AUTHORIZED AGENTDATEt WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT BLDG INSP ATE S{GNATUREOF OWNERIIF OWNER BUILDERI (DA-TE) ~ CITY OF FRIDLEY - APPLICATION FOR RESIDEN'rIAL BUILDING PERMITS (Neer, Alterations, Additions, or Repairs) OWNER: ADDRESS ��� % �� VE TEL NO: 7J BUILDER: ADDRESS: 7 , TEL NO: — 3 Construction Location STIMT NO: STREET: LOT: BLOCK: ADDITION: Corner Lot: Insia.e Lot: Setback.: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: Squane Feet: Front: Depth: Height: Cubic Feet: Depth: Height: Square -Feet: Cubic Feet: pv Type of Construction: Estimated Cost: $ Zb Be Completed: Alt. A Alt. B Proposed Driveway Width If, New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET The undersigned hereby makes application fora 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: "2— to SIGMA URE : Stipulations: pe� : 7. s0 CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1991 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL 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 $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance State Surcharge .50 TOTAL FEE 4E so JOB ADDRESS-,/ �g / �� o �..- 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. ' 199' Building Used As v I r Estimated Cost r PERMIT NO. COMPANYPLUMBING O Bbx 22409 MN 422 TEL NO. SIGNED BY 55 a Approved By Rough -In Date Final Date ' 3 0 -� -2- MINIMUM MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE SUBJECT City of Fridley =�5 AT THE TOP OF THE TWINS BUILDING PERMITC. r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. I ~ PROTECTIVE INSPECTION SEC. �y SSC' r , NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 6/24/98 JOB ADDRESS 5861 5 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 6 Bennett Palmer SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard/Judy Larson 5861 5 Street NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Quarve Contracting Inc 8427 Center Drive, Spring Lake Park, MN 55432 785-1472 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 6016 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO, 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (22 Sq) Tear-off; Repair Siding 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Install building wrap and call for inspection before covering. 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 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 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 $1,834 $.92 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- $59.50 Fire SC $1.83 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. /�(� � Id �d PLAN CHECK FEE TOTAL F E / O f' Licens SC 5.0 $ 67.25 d�C SIGNATURE OF CON' CTOR OR AUTHORIZED AGENT IDATEI EN PROP K ALIDATED IS IS YO R PERMIT r /7 G loll PATE SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ SINGLE FAMILY AND DUPLEXES R-1 AND R-2' BUILDING PERMIT APPLICATION ConstructionAddress: ®ter / dr AJ& Legal Description: Owner Name & Address: / 6( 4/ J 4AA X072 Tel. # Contractor:C�-n �� cfi n /�'1 C • MN LICENSE # Address: ��Ia 7 C � ��"l �S % /'7G� Lk K Tel. # 17X5-1'17'9, Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. _ Length Width Height Sq. Ft. _ Length Width Hgt/Ground Sq. Ft. _ Driveway Curb Cut Width Needed: DATE: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge t Evlr Ft. + 6 Ft = ,timated Cost: $ -3L (Fee Schedule on Back) Ft x $ _ $ APPLICANT: Tel. # 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 [ ] TOTAL $ 5� STIPULATIONS: .. T 131 University Ave NE idley, MN 55432 63) 572-3604, FAX (763) 571-1287 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT KAAGIr Ln AA0=0 nC MYTI IRFC Tn RF INSTAI I Fr) ON FACH FLOOR LUMBING FIXTURE RATES: ew Fixtures )Id Opening, New Fixture eer Dispenser low Off Basin :atch Basin lain Water Leader ;ump/Receiving Tank Vater Treating Appliance Vater Heater -Electric Vater Heater - Gas" ;as Range** NO. RATE TOTAL JOB ADDRESS Sas Dryer** lack Flow Preventer Required ( )Yes () No $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 fV $10.00 $10.00 Type $15.00 teinspection Fee $47.00/Hr kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE / - E;1j' S-� �'l e 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. I / —o A 701 Building Used As Estimated Cost PERMIT NO. PLUMBING COMPANY H. P. PIPE'trY,::,7-,' EAGAN, MN 512 SIGNED BY 1?EL N0. (651) 385 1340 Approved Byy j L Rough -in Date Final Date $ 50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 $ PLUS THE $.50 STATE SURCHARGE :OMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE `s: >::«:::<::• r Auto. Gas Water Heater rWash Gas EIe ctories Urinal Shower Tra Washe Ran e 41, Basement Floor 1 `:<;:-;; Floor 2 <<> :'•. <<: Floor3 iz:;Y: Floor 4 ,. ,::.::.:.. a'< LUMBING FIXTURE RATES: ew Fixtures )Id Opening, New Fixture eer Dispenser low Off Basin :atch Basin lain Water Leader ;ump/Receiving Tank Vater Treating Appliance Vater Heater -Electric Vater Heater - Gas" ;as Range** NO. RATE TOTAL JOB ADDRESS Sas Dryer** lack Flow Preventer Required ( )Yes () No $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 fV $10.00 $10.00 Type $15.00 teinspection Fee $47.00/Hr kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE / - E;1j' S-� �'l e 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. I / —o A 701 Building Used As Estimated Cost PERMIT NO. PLUMBING COMPANY H. P. PIPE'trY,::,7-,' EAGAN, MN 512 SIGNED BY 1?EL N0. (651) 385 1340 Approved Byy j L Rough -in Date Final Date $ 50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 $ PLUS THE $.50 STATE SURCHARGE :OMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE