PRE 2010 DOCSD�
Application for Power Plants and Heating. Coding, Ventilation..n h iga wflo n 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 AIA
Furnace Shell & Duct Work to 120,000 BTU ............
8.00
8 W. 0 0
each add. 60,000 BTU ........................
2.00
$ _
Replacement of Furnace .............................
.0.00
$
Repairs & Alterations—up to $500.00 .... ............
5.00
Repairs & Alterations each add. $500.00 ...............
2.50
$ =
$TEAM or HOT WATER SYSTEM
v«'
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 BTU) .......................
5.00
$'�
GAS • FITTING FEES: NO
RATE TOTKL'
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 & REPAIRS TOTAL
FEE
$
ROUGH
FINAL
DepL of Bldgs. Phone SU. 4-7470
ow"j
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 she true and correct.
e
Owner
Kind of Building
Used as
19 k6
To be completed about / /�
Estimated Cost, $ 6 "% 6 ®
Old New. Building Permit No. /S 922— permit No.�"
DESCRIPTION OF WORK
HEATING or POWER PIANTS—Steam. Hot Water, Warm Air—No
Trade Nam Size No.
Capacity q. Ft. E.D.R BTU H.P.
Total Connected Load ��`� Kind of Fue elf
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS—OVER)
-B.az 7.M 749
Corm BD5
Coef.
Btu
Infiltration J
NEAT LOSS CALCULATIONS
7 Z --Z--
Infiltration m,
BUILDING DEPARTMENT
ml@lwK. MINN.
WeatherstripsA.S.H.V.E.
'? 10
Glass
Exp. wall
Int. wall
Construction No.
Insulation
Exp. wall 3
Net exp. wall
Guide
3 tz�
Net exp, wall
Int, wall
Windows
Doors
Reference
Out. Wall
Int Wall
Ceiling
Roof
Floor KindHow
Applied
Yes—No
Yes—No
19
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FI.0 Dom Length J
Width
/ ?i
Height
FI. Room Length Width
FI. I z/ • Room I Length e
Width
I
Height
/ FI. I Room Length / J, idth
Height S`
y�
Windows and Doors—Crackage and Area
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft.
No. of pa'ne/ of pane lights of crack
Area
sq. ft.
Width Height No. of Lineal ft.
of pane of pane lights of crack
Area
sq. ft.
7 "C 7i •
�N{o.
�I ?s
S L cF
ti
s
, ra
Coef.
Btu
Z
Coef.
Btu
Infiltration
3 IV
Infiltration
3 e
3 i
Glass
3
�f S®
Glass
d sv
®3�
Exp. wall702—Exp.
wall
Net exp. wall
a o
7Net
exp. wall
Int. wall
Int. wall
Floor
Floor
Ceil. ® 7 x r2---
r
7 S
Ceil. / 5 �C /0P
i
�t C>
Total Btu.
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
UP W
FI. 143Af� Room Length / y
Width
(
Height �
FI: °` Room I Length �Width
®
Height
Windows and Doors—Crackage and Area
Windows and Doors—Crackage and Area
Width Height No. of Lineal ff.
No. of pane of pa�ne/ lights of I
Area
aq. ft. _
Width Height No. of Lineal ft.
No. lof pane I of pane I lights I off crack
Area
'sq. 'ft.
crack
Infiltration
Glass
Exp. wall 2 r- �v
Net exp. wall AQ
Int. wall
Floor
Ceil.
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Coef. Btu
0W
Coef. Btu
IS- /7?�
ZO
Height
Winows an Dors— rac age an Area
Coef.
Btu
Infiltration J
Coef. Btu
7 Z --Z--
Infiltration m,
Glass
5
a
'? 10
Glass
Exp. wall
Int. wall
Floor
Exp. wall 3
Net exp. wall
3 tz�
Net exp, wall
Int, wall
Int. wall
Floor
Floor
Ceil. 4v x k®
/
Ceil.
Total Btu.
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FI.0 Dom Length J
Width
/ ?i
Height
FI. Room Length Width
' Windows and Doors—Crackage and Area
No. IWidth Height No. of Lineal ft. II
of Pane I of pane I lights l of crack j'
Area
sq. ft.
I
W' d d D C k d A
Width Height No, of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Infiltration
Glass
Exp. wall 2 r- �v
Net exp. wall AQ
Int. wall
Floor
Ceil.
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Coef. Btu
0W
Coef. Btu
IS- /7?�
ZO
Height
Winows an Dors— rac age an Area
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Floor
Ceil.
notal Btu.
Re,
ft. E.D.R. or sq. ins. W.A. Leader area
City of Fridley, Minn.
BUILDING PERMIT
Date: --�-'
2Owner: Builder
Address ___ Address
ONF BUILDING
No. _ _ _ Street Part f t
Lot Block , Addition or Sub-Divisi+o� _
Corner Lot — Inside Lot Setback �— Sideyard p
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
TznmIf �j ,A �^�
Front Depth Height Sq. Ft... Cu. Ft.
-ant Depth Height __ _ Sq. Ft. Cu. Ft.
Type of Construction _ Est. Cost 4 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..01
In consideration of the payment of a fee of It,s+ ,
permit 3s 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, o)r.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. --.
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items,
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name Po J • DE JA i q1*5 der_ Me 5
Addresses :r"7 3WO � T' r ./s�1 /S.. Address A% ;df S
LOCATION OF BUILDING
No., �/P Street, h�/�/��w._TI. Part of Lot
Lot Block Addition or Sub.Div.
Corner Lot_,,,_Inside Lot Set Back 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 Ased as:
0 A
Front 3V Depth____.
Sq. Ft. Cu. Ft.Z�,_,,,
Front Depth He.ght
Sq. Ft. Cu. Ft.�PK/ Cl?
Type of Construction 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 Ordinances and ruling of
the Department of Bdldings, and hereby declares that all the facts and representa-
tions stated in this application are true and correct. j
DATE�%� l� �� IGNATURE'�
(A Schedule of Fee costs can be found on the Reverse Side.)
53-84-s-915.51
CH -i of Fridioy
APPLIa ITTWI fQ7 PIuMMM311 S -d GOS P0=11lt
Dept. of Bldgs. Phone M-3450
DESCRIPTION 0? V70117, 10 N. E. 41st. Ave. _
Nuinl>er. Kind and LocrSfoa of F{xturea
jjj
..
TOTAL
yy
r.
r1st
p
j~
o Z IVz
O
: '40
�j
u a
o
3
I V
ul
u
i
4
o V
o
0
H
wATta MTN.
GAS
ticC.
Eaer
$
Water Heater 'Up to 99.000 BTU) • • • •
x S3.00
$
New Ground Run Old Bldg....:....
x $3.25
$
Voctric Watar Haatar.....:.........
a $2.00
$
1stInstall
NO. RATE
TOTAL
Ist3Fixtures ......••
$2.00
$
.
R, LngE
--- x $ .75
$
Gas Range to 199.000 BTU ...........
1 • x $5.00
$
5.00
2. d
..
3:d
1N7
• rutuso Cors cct'.:.a Opocir ,s
4 Xsw Fl=turv. Old Opoa.irrs
PARTIAL. RATE SCHEDULE
Ccaspool
PLUMBING FIXTURE RATES:
NO. RATE
TOTAL
Number Fixtures ................
x $2.00
S__
--
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 S3.00
$
New Ground Run Old Bldg....:....
x $3.25
$
Voctric Watar Haatar.....:.........
a $2.00
$
ZAS FITTI%(G FEES:
NO. RATE
TOTAL
Ist3Fixtures ......••
$2.00
$
.
Additional Fixtures ..............
--- x $ .75
$
Gas Range to 199.000 BTU ...........
1 • x $5.00
$
5.00
City of Fridley:
The undersigned hereby crakes application for a permit for the- work here!
specified, agreeing to do all wcrk in strict accordance with the C:t7 O diranea
and ruling of the Departrnent cf Build.'ngs, and hereby declares that all tate fad
and representations stated in this appL'caticc are true rxtd correct
Fridley, YJnn 10-7-75
Owner Darlene H. Austin
Kind of Building Frame
Used as Res.
To be completed about 10-14-75
Estimated Cost, $ 10.00
Old—!Building Permit No. P.rait No.
Signed
s
gy tnu..r+.wewA - --
Business Phune No
ROUGH
rix AI,J7-2`--i.j -
P.EPAIRS'k ALTERATIONS—Rafor to Code .50 State Surcharge
Destript#on........................................$
TOTAL r. -x 5. 0
• Class surcharge .500
6431
August 19, 1980
V� f'
��ll.
TI'�1
COTY OF FRIDL Y
U141VERSITY AVENUE N.E.. FRIDLEY, MINNESOTA 55432
TELEPHONE ( 612)571-3450
Minneapolis Post Office Department
Superintendent of Delivery
lst & Marquette Avenue
Minneapolis, MNI 55402
Re: Change of Address - Effective September 1, 1980
Dear Sirs:
We are listing the following change of address in the City of Fridley;
NAME: D. H. Austin
FROM: 10 - 41st Avenue N.E., Fridley, MN 55421
TO: 10 - 40331 Avenue N.E., Fridley, MN 55421
LEGAL DESCRIPTION: Lot 2, Block 1, Wilson Addition
We have notified the occupant of this change and we would appreciate it
very much if you would change your records accordingly.
Sincerely,
DARREL G. C
Chief Building Official
DGC/mh
CC: Minnesota Gas Company
Northwestern Bell Telephone
Northern States Power Company
City Water Billing Department
City Assessing Department
City Voters Registration
Homeowner
Minneapolis Star & Tribune
6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 65432
TELEPHONE (612)571-3450
AA August 19, 1980
D. 11. Austin
10 - 41st Avenue N.E.
Fridley, MN 55421
i
Re: Change of Address- Effective September 1, 1980
It has been necessary for this office to change the address of your
building;
FROM 10 - 41st Avenue N.E., Fridley, MN 55421
TO 10 - Wi Avenue N.E., Fridley, MN 55421
LEGAL L?ESCRIPTION Lot 2, Block 11 Wilson Addition
We have notified the Minneapolis Post Office, Minnesota'Gas Company,
Northern States Power Company, Northwestern Bell Telephone Company,
Minneapolis Star & Tribune, and various departments in City Hall of
the Change.
Sincerely,
DARRLL G. CLARK
Chief Building Official
DGC/mh
RE
SUBJECT
PEPM
City of Fridley
18602
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
�
ECEIPT
• COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
�/ a
i1 = �
�� "�•� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
---.�
L 612-571-3450
910-F15
8/15/86
JOB ADDRESS 10 - 401i ilii Avenue N. E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
1
Wilson Addition SHEET
2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE
Darlene Jennings 10 - 4012 Avenue N.E. 788-6011
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
X
8 DESCRIBE WORK
Construct a 24' x 24' Detached Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide a hard surface driveway. House & garage can not be attached
without providing frost footings under garage.
WA IM
Before digging
call local utrlifies
SEPARATE PERMITS REQUIRED FOR TELEPHONE - ELECTRIC
_ Las Eli,
WIRING, HEATING, PLUMBING AND SIGNS. REQUIRED
BY AW
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
$71 067
$3.53
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-
$68.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$72.03
IGNAT RE OF q'(5 T RACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY A IDATED THIS IS YOUR PERMIT
yam/ ��-�°.l�2'' ��
O ���� _
BLDG INSP FIAT
SiGNATUREO WNER I IF OWNER BUILDERI IDATEI
NEW [ ] City of Fridley Effective 4/1/86
ADDN. [ ] �R-1 AND R-2
ALTER. I ] Building Permit Application
Construction Address:
Legal Description: /
Owner Name & Address:
' Tel. # FZ 6 %�
Contractor: �2 Tel. #
Address:
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. 7�
DECK AREA: Length Width _ Hgt/Ground Sq. Ft.
OTHER:
Corner LotInside Lot [ ] Ft. Yd. Setback Side Yard Setback //
Type of Const\ruction: �� Estimated Cost: $ mon C(�% soZ
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
DATE: ��= � APPLICANT `!mac 1'"LL ? Z Tel.
CITY USE ONLY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$475 per SAC Unit
Fee Determined by Engineering
nt Necessary ( ] Not Necessary [ ]
STIPULATIONS:
Call
-1 "s CQJL4
SUBJECT
P
City of Fridley
27 1
AT THE TOP OF THE TWINS
BUILDING
PERMIT
f
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r
6o213
1
NUMBER
REV
DATE
PAGE OF
APPROVED BY
i CITY HALL FRIDLEY 55432
612-571-3450
910415
8/14/98
JOB ADDRESS 10 40 1/2 Ave N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
1
1 Wilson's Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
John jennin s
788-9045
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
Owner 10 40 1/2 Ave NE Fridley MN 55421
788-9045
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 ❑ ALTERATION a REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (12 Sq) Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with State 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 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
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
$.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.
PLAN CHECK FEE
TOT FEE
$36.25
SIGNATUREO, CONTRACTORORAUTHORQEDAGENT (DATEI
N�OMPALID,
E HIS IS Y R P MIT
1 6._,y 9�_
,
O OWNER pF OWNER BUILD ) IDATEI
BLD INS
BATE
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION Al / 12j
1 ConstructionAddress: JD 44y . e�, &�S
Legal Description:
X Owner Name & AddressVTel. #? $ �'/
���,� o y S`J
�( Contractor: MN LICENSE #
Address: jo - %� , /j/', E t F,kyV ,
Attach to this application, Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Construction Type:
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
A �
Estimated Cost: $ 1 Qa)
(Fee Schedule on Back)
Ft x $ = $
x DATE: 7- /1/ - 7-:? APPLICANT: Tel. # %a,9'
DESCRIPTION OF IMPROVEMENT
CITY USE ONLY
LIVING AREA:
Length Width
Height
Sq. Ft.
GARAGE AREA:
Length Width
Height
Sq. Ft.
DECK AREA:
Len Width
i�
t/Ground
/'?
S Ft.
OTHER:
�J
S-
CIS
Construction Type:
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
A �
Estimated Cost: $ 1 Qa)
(Fee Schedule on Back)
Ft x $ = $
x DATE: 7- /1/ - 7-:? APPLICANT: Tel. # %a,9'
TOTAL
STIPULATIONS:
$ 2e, .2s-"
CITY USE ONLY
Permit Fee
$ `- . r%S�
Fee Schedule on Reverse Side
Fire Surcharge
$ 160
.001 of Permit Valuation (1/10th%)
State Surcharge
$ !�-D
$.50/$1,000 Valuation
SAC Charge
$
$1000 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 Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS:
$ 2e, .2s-"
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
4,
Effective On January 1, 1997
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
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
Type $15.00
Reinspection Fee $42.001Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge $ .50
TOTAL FES
JOB ADDRESS l ® VO VZ !#-.-( /VFW"
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.
Owner �-O kn/
Building Used As dlve u�.✓ ti,
Estimated Cost 4`'%0 PERMIT NO. 3
PLUMBING COMPANY /n/�LQ-, -A, ,-✓ E166
SIGNED BY ./ TEL No. '76' 3
Approved �a Rou h—In Date Final Date
pp By �^ 9
MINIMUM FEE F4R ANY PLUM8ING/GAS PERMIT IS $20.00
PLUS THE $.50 STATE SURCHARGE
**COMBUSTION AIR SHALL BE.PROYIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 S® INCHES.