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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Date: ...e: �.........C ..................... Owner ....................................... Address ...................................... N® 3708 Builder ............................................. Address ............................................. LOCATION OF BUILDING �1-... No. . J.. . c: Street ......0 :..'. .:...:..... .....o....... Part o Lot ........... . . ............ Lot .... 1....... Block ....( 3............ Addition or Sub -Division ... Corner Lot ............ Inside Lot X ......... Setback Sideyard.l.{d.:.�. ..'............... DESCRIPTION OF BUILDING To be Used as: <, ✓�:: 6u:ti .41L.:z Front ..�.°. /,6bepth Height Sq. F`t.✓.t:�� l . Cu Ft.� . �� .................... Front ........ Depth ........ Height ..... Sq. Ft. ........ Cu. Ft. ........ Type of Construction ................... lat. Cos �.� l .-J..f:... To be Completed ................... - !� -� /�� .�1�i�-C� L C L '1 •"� !�- E� Hyl .� ::. 6�. � �� -. _ �.0-z 2 _ - In consideration of the issuance to me of a permit to construct tie bull g desrib above, I agree to do the proposed work in accordance with the description above set fo�h an�Iin� wig all provisions of ordinances of the city of Fridley. / / / / }4�6 - In consideration of the payment of a fee of $.... .., permit is he by 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. , i. . .... .... Building Inspector 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 separate permits for these Items. 13M APPLICATION FOR BUILDING PERMIT .CITY.OF FRIDLEY, MINNESOTA Owners Name 4!!�'- *4`. � Builder Address ..._rte Address _ LOCATION OF BUILDING No. � Street 16 "Part of Lot Lot: Block Addition or Sub.. Div.. Cornu Lot Inside Lot Set Back Applicant attach to this form Certificate of Survey of Lot and proposed building location, DESCRIPTION -OF BUILDING To be used as Q iA Front. 46 10 Depth Height 2 Ft �® Cu Ft - Sq. . Front Depth H- fight Sq. Ft. Cu. Ft. �.�... Type of Construction/ Estimated Cost_... To be completed 157 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 Buildingsp and hereby declares -that all the facts and representations stated in this application are true and Corr ct. 3® C v-� Date .Signature � (A Schedule of Fee -Costs can be found on the Reverse Side) • r 1 u City of Fridley, Minn. • BUILDING PERMIT N° 6697 Date: Owner: -� Builder- Address uilder_Address Address LOI`O�Nf O BUILDING No. Street �.�i� `–= �// [�--� PartA Lot Lot ___ _Block Addition or Sub- on -" • Corner Lot _ Inside Lot —� aback �� Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING T U _ Front 14-r Depth Height Sq. Ft. Cu. Ft. t Depth -Height ____ Sq. Ft. Cu. F' Ft11 Type of Construction Fst. _ 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 compliance with all provisions of ordinances of the city of Fridley. d // X „ , Di 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 uponviolabton of any of the provisions of said ordinances. — _ / 1 NOTICE: gbh► permb doss not cover the construction, installation for wiring, plvobing, gas boding, sewer or water. Be ane to see the Bsiidlog Inspector for separate permits for thus boors. M APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAM ADDRESS 5-',D 6, S°f A16 - ers, L" ADDRESS /69- S -c) "e S� LOCATION OF BUILDING No. Street Part of Lot Lot -3 Block lo 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 build- ing location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as: .c _P_4 ,_keJ Front Depth a Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction To be Completed �a Estimated Cost 5--0' 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 — /9& _ S TONATtTRE �fr.1s p 'Z _Z Z_94' (Sebedule of Fee Costs can be found on the Reverse Side). I- 0 LOT NALE 12„A? SIZE .7,q X� BLOCK 0DRESS -f 9 6"0 VALUATION ADD, 0'(Y TYPE ........................«.................«.......... . ... . ...................... . . .................. ............................................................... .. .. A 0 -IP ----------- 7 f IV rt7- IC A/ . . ............... ............ . ..... ................«.............. I . ................................. ............. ...... . .............. ... sueJEcr PER City of Fridley 16670 AT THE TOP OF THE TWINS BUILDING P E R M I T ' ' R • ___ COMMUNITY DEVELOPMENT DIV. 16U �� �� r PROTECTIVE INSPECTION SEC. HALL FRIDLEY 55432 NUMBER REV, DATE PAGE OF APPROVED BY j 612-571-3450 910-F15 17/12/82 JOB ADDRESS 5850 - 6th Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 6 Bennett Palmer SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Floyd Finlayson 5850 - 6th Street N.E. 571-1284 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 1 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK a 12' x 12' Deck -Construct 9 CHANGE OF USE FROM TO STIPULATIONS wm" 'u t-,usiol sEPERATE &Aa. duos ul� pr , TS RE TELEt�F 04 ELECTRIC.-GAS Et. pLV� ��� ANDFolMROM REt UIRE� BY LAV1�' SiG�S TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ma-dwood 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 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 $720, $.50 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- $15.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $15.50 SIGNA URE OF QONTR ROR THQRIZEO AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT ' BLDG INSP Z D E a SIGNATURE OF OWNER' OWNER BUILDE - ID TE) CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATI94 FOR RESIDbMAL BUILDIIIG PEFU4ITS (New, Alterations, Additions, or Repairs) 0 OWNER: ADDRESS: �. TEL N0: BUILDER: ADDRESS:g TEL NO: Construction Location M • STREET NO: STREET- U/ aC LOT: BLOCK: (D ADDITION: Corner Lot: Inside 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: 02 Depth: Square.Feet: Cubic Feet: Front: Square - Feet: tqq s z "7zv Type of Construction:- 7b onstruction:7b Be Cbrapleted:LZ.,Z 0 2 Height: c2 4,t Depth: Height: Cubic Feet: � 2m ad Estimated Cost: $ ' Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET . Tile undersigned hereby makes application for a permit for the %-mrk' 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 ue an correct. DATE: � 12— SIGNATURE: Stipulations: /4519 D City of Fridley SUBJECT P 18672 AT THE TOP OF THE TWINS BUILDING PERMIT r O. IPT N `W ....... COMMUNITY DEVELOPMENT DIV. ?0pf PROTECTIVE INSPECTION SEC. 1 � = 1 1 CITY HALL FRIDLEY 55432 ".j NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 9/30/86 JOB ADDRESS 5850 - 6th Street N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 ( Bennett Palmer SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Floyd Finlayson 5850 - 6th Street N.E. 571-1284 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 Alter Bay Window 9 CHANGEOFUSEFROM 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 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 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 $650 $.50 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $15.00 PLAN CHECK FEE TOTALFEE $15.50 SIGN TUREOFCCONTR 0 uTHOR ED AGENT (DATEi WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT SIGNATURE OF OW NER OF OWNER BUILDER iDATEI BLDG INSP aTE r NEW I ] City of Fridley Effective 4/1/8( ADDl; . I ] R-1 AND R-2 ALTER-r6d Building Permit Application Construction Address: Legal Description: Owner Name i Address: Contractor: Se- i -f Tel. # Address: ' LIVING AREA: GARAGE AREA: DECK AREA: OTHER. Corner Lot [ ] Attach to this application, a Certificate of Survey of the lot, With the proposed construction drawn on it to scale. DESCRIPTION OF iKPROQEMEL"r Length Width Height Length ____ Width Height Length------ Width _ Hgt/Ground 'ice Inside Lot [ ] TY pe of Construction: Sq. Ft. Sq. Ft. Sq. Ft. Ft. Yd. Setback Side Yard Setback Estimated Cost: S �® Approx. Completion Date: Alt. A Alt P Proposed Driveway Width If New Opening Is Desired: $ --.--- See Back Page for Explanation DATE: ?/So - �G APPLICANT :" - Tel. #��—� Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer !lain Charge TOTAL STIPULATIONS: CITY USE ONLY S $ Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $475 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] su9jEcr �IT NO.2 City of Fridley 9265 AT THE TOP OF THE TWINS BUILDING PERMIT COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC / 1 D 1 CITY HALL FRIDLEY 55432 NUMBER REV DATEPAGE OF APPROVED BY ti_._.11.' '•� 612-571-3450 910-F15 4/21/99 � JOB ADDRESS 5850 6 Street NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 6 Bennett Pal er Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Floyd/Bonnie Finlayson 5850 6 Stree NE 571-1284 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 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 0 NEW Cj ADDITION O ALTE ATION jU REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Construct a 12' x 241 Three Season Porc ; Reroof House & Garage (26 Sq) Tear -off; Reside House 9 CHANGE OF USE FROM O STIPULATIONS Underlayment must comply wit the State Building Code. Call for building wrap inspection before coverin See notations on plan. wARINrAw- Before digging call for all utility locates 44.0002 REQUIRED BY LAW 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 Z NTNG 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. N . DWLG. UNITS OFFSTREET PARKING 1 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 VA UATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $12,169.44 $6.08 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PEMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $199.75 Fire SC $12.17 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PL N CHECK FEE TOTAL FEE $218.00 I NATURE COVqCTORORAUTHORIZEDAGENT IDATEI WHEN PROPERYY VALIDATED THIS IS YOUR PERMIT BLD -NSP GATE S-GNA URE OF OVONER,IF OWNER BUIL RI IDATEI NEW [ l ADDN [ ] CITY OF FF ALTER [ ] SINGLE FAMILY AND DU BUILDING PERMIT ConstructionAddress: — Legal Description: Owner Name & Address: Contractor: Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: /I4 t✓TT — (� fh � S t Attach to this application, a lot, with the proposed const DESCRIPTION OF Length Width Length Width Length . Width J 4*0 Construction Type: bJ c9 t4 Driveway Curb Cut Width Needed: Ft. + 6 Ft = ' DATE: APPLICANT: R-1 AND R-2 ►TION r-k,'d /-P- Effective 1/1/99 A d d, ' T , 'O n Sc Tel. MN LICENSE # Tel. # :ate of Survey of the drawn on it to scale. Height Sq. Ft. Height Sq. Ft. r Hgt/Ground a 0"' Sq. Ft: X �1,, ��I qq .imated Cost: Fee Schedule on Back) "t x Tel. # TOTAL $ 2-1 � STIPULATIONS: CITY USE ONLY Permit Fee $ 9 " %J Fee Schedule on Reverse Side Fire Surcharge $ 7.001 of Permit Valuation (1/10th%) State Surcharge $ �/�,�r� $•50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ $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 Engincering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ 2-1 � STIPULATIONS: yI1,� SIZE a N N � � QT TTA BLACK LDDR:�S SSSO —4 St. /d/ F VALUATION //SC e F/ .'c� /c� y TYPE ADD. _ 102 .k K FA f%P17 &0'" 11 Pi to � % � i ! Dr i. :� -4W Building PLUMBING Permit No.: )7 Inspections RESIDENTIAL APPLICATION Ref'vj ByATO 763-572-3604 CITY OF FRIDLEY Date ec'd`: 0 DATE 2-15-07 YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: ❑ O R ❑CONTRAC ' PROPERTY NAME: ADDRESS: OWNER/ TENANT PHONE: ���— CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE ADDRESS: CITY STATE ZIP LICENSE WITH PHONE FAX APPLICATION PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW REPLACEMENT DETAILED DESCRIPTION OF WORKyz�'e PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) BATH SINK/LAV DRAINS SHOWER _ WATER PIPING _ _FLOOR _ GAS PIPING a&w ciT}'trcrosE) SWIMMING POOL _ WATER SOFTNER ($35) —BATHTUB _ _ CLOTHES WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15) _ _ _ LAUNDRY TRAY HEATER ($35) FOR IRRIGATION —DISHWASHER _ _WATER WATER METER OTHER Permit Fee $ .�} Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00. = $ TOTAL DUE $ . State Surcharge = $_____10 Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building 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 d work is not to start without a permit; that the work will be in accor ce with the approved plan ' e case all ver r esview and approv 1 . r Sao `% SIGNATURE OF PRINT N i' F-0 OWN�. City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 01 Building PLUMBING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: 763-502-4977 FAX EFFECTIVE 1-1-05 DATE e – YOUR E-MAIL ADDRESS SITE ADDRESS 5O50—% KE THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY NAME: OVVNER/ ADDRESS:(All, 0F CITY STATE IP TENANT _505n � S-71 )Q;4 PHONE:7_, CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE STATE LICENSE # lJ��'-t L�j - PI"\ EXP DATE LICENSE, BOND AND STATE BOND # I-7S EXP DATE — —� CERTIFICATE OF ADDRESS: `�� �iry CITY i Q _ STATE. 21P INSURANCE FAX JlA® PHONE i PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑NEW ARREPLACEMENT DETAILED DESCRIPTION OF WORK PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 = plus .50 surcharge OR FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $15.50. BATH SINK/LAV DRAINS SHOWER _ WATER PIPING _ _FLOOR _ _ GAS PIPING (NEED CITY LIC) _ SWIMMING POOL _ WATER SOFTNER ($35) —BATHTUB CLOTHES WASHER KITCHEN SINKWATER CLOSET _ BACKFLOW PREY. ($15) _ _ _ DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION _ _ WATER METER OTHER PERMIT FEE PROJECTS - FOR UNDER $500 PERMIT FEE FOR PROJECTS OVER $500 Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ OR Number of fixtures @ $35.00 L x $35.00 = $ 35- SState TOTAL DUE $ StateSurcharge = $ .50 MINIMUM $15.50(MINIMUM $15.50 Total = $ 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 butonly an a for a and work is not to start without a permit on site; that the work will be in accordance with the approved plan in a of all which •equires review and approval of plans. '^ � r SIGNA O LIC'L'N G Y► l .I DATE – APPROVED BY DATEtj 5-tQb PLEASE NOTE EIARP.TE PERMITS ARE REQUIRED FOR BUILDINGELECTRICAL AND MECHANICAL WORK \�1 City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-5024977 06/27/2008 00:22 7637834566 ERICKSON PHC PAGE 02/02 Data. 6/27/2008 Revision Date: 6/27/2008 Site Information Address 1: 5850 6TH STREET NE Address 2: City: FRIDLEY County: ANOKA Application Information Business Name: Erickson PHC Contact Person: Ron Erickson Existing Construction: Pre 1994. Project #: Lot: Block: Subdivision: MN Contractor License #: Office Ph': 763-783-4545 Fax: 763-783-4566 Cell Ph: Address 1: 1471 92nd Lane NE City: Blaine State: MN Zip Code:. 55448 Combustion Appliance Water Heater: Natural Draft - Input BTUs: 40,000 Independently Vented Combustion zone 2 Combustion Zone 2 Furnace/Boller: Power Vent Input BTUs_ 70,000 Independently Vented Make -Up Air No Make -Up Air Required by Code Combustion Air Combustion Zone One: Minimum Combustion Air Requirements Met. Minimum Combustion Air Requireme is Met. Applicant !Name (print, ,11 —��� �c '�_ Signature/D Code Official (print): Signature/Date: 0 2004 Cense rPoW Energy M megasco. 2004 Mcchw9cal Code Guidelincs. Page 1