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PRE 2010 DOCS49th. AVENUE N.E. W 1 F I Z I1 9 Date: City of Fridley, Minn. BUELDING PERMIT N® 3723 Owner ....................................... Builder &. 4 r. Address ...................................... Address ............................................. _ LOCATION�, OF BUILDING No. Street .....���.�.. �:Y: ... Part of Lot ........ ........ ... . Lot ...../..... Block .... .......... Addition or Sub -Division ����� .. ....... ..ra® Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ........................... DESCRIPTION OF BUILDING To be Used as: .................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........ .................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........ Type of Construction ................... Bat. Cost.. �� !. �..... 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. .. .... ...... ....... ... ....... In consideration of the payment of a fee of . Y%to..:., 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 azo► of the provisions of said ordinances. •........ 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. City of Fridley, Minn. BUILDING PERMIT N° 415 Date: -- ; Owner: Builder Address Address O(r WILDING NO. _ Street ��/ Lot Block Addition or Sub -Division Corner Lot — Inside Lot Setback Sewer Elevation ___ ._ Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth Height Sq. Ft. Cu. Ft. Front Depth :+ eight _, Sq. Fk _ _ Cu. Ft. Type of Construction Est. Cosh , '_ � To be Completed In consideration of the issuance to me of a permit to construct the ,building described above I agree to do ter work in accordance with the description above set forth and in compliance with 21 provisions of ordinances =work city of Fridley. 11 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 'l ol✓a j any of the provisions of said ordinances. Building Inspector NOTICE: This permit doer not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for those Nems. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY.. MINNESOTA a � Owner's Address Address - - -- LOCATION OF BUILDING No. Street Fart of Lot Lot Block Addition or Subdivision Corner Lot Inside Lot Setback Side -Yard SE6,lER. ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. CRIPTION OF BUILDING To be used Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. 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 Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. � _ a (A Schedule of Fee Costs can be found on the Reverse Side.) f l COMMUNITY DEVELOPMENT DIVISION CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NORTHEAST FRIDLEY, MINNESOTA 55432 NOTICE OF NON-COMPLIANCE Name �u���L.L �. C�i Date OCA. Z.3 Address 2 Z �= yg Gk1iT2� IV49'. Date & Time of Inspection 0:.30 Oma? Z-3 /?7? An inspection by this Department has indicated that you are in non-compliance with the following checked (x) sections of Chapter .113, Refuse Disposal, of the City Code. -You are hereby notified to take whatever action is necessary to correct any violations on or before IVO U. /9 Failure to comply with this notice may result in legal action by the City Prosecutor. (�) 113.02 Provide sufficient containers for the storage of all refuse (including garbage) accumulated on the premises between collections. ( ) 113.02 All refuse containers shall be water tight, have a tight fitting lid, be impervious to insects, rodents, vermin, and absorption of moisture, be fireproof, and not exceed 30 gallons in size (unless otherwise specifically authorized). ( ) 113.02 All refuse shall be stored in approved containers, with the cover in place. ( ) 113.08 Containers shall not be placed or maintained as to interfere with the use of adjoining property. For the purposes of collection only, the containers may be placed a maximum of 3 feet in front of the dwelling unit. ( ,'�) 113.07 ( ) 113.09 (�) Other The contents of storage containers shall be collected at least once every week, or more frequently if necessary. Containers without covers, in poor repair, corroded, or otherwise defective shall be repaired or replaced. If you have any stiofl `5 -rqW � ^ � 4eP9,,`ro �,4nq 82 y y q n�concer�iing this matter, please feel free to call on us at 571-3450, extension 164. By: •In$ji cAion 16pdrtment J M SUBJECT PER O. City of Fridley 19560 AT THE TOP OF THE TWINS BUILDING PERMIT _ r COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. a 1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/24/88 JOB ADDRESS 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Russell and Barbara Lind 572-8695 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Vikin�- 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 C ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside dwelling. 9 CHANGE OF USE FROM 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $4,200 $2.10 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- TRUCTI 1 OR THE PERFORMANCE OF CONSTRU ION. $72.00 C✓� PLAN CHECK FEE TOTAL FEE SIGNATU OF CONTRACTOR OR AUTHORIZEDAGEN ID Q4 10 WHEN PROP RLY�ADSVUR IT ,fin/ .E) - BLDG INSP f)ATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI MR I I City of Fridley Effective 5/1/88 ADDN I I R-1 AMID R-2 ALTER I I Building Permit Application ODnstruction Address: '2- �� Z/' F 9' t4u) /y C Legal Description Owner Name & Address: U -S r .e // -' 8 b iLA,4 L l Tel. #-s' ODntractor : V l i�� .� % *1 e tall ,yea Tel.. #� % 2-- Address: 3 2 N �� S71 /Ll�V 11 Rf,) r1// Z/ Attach to this application, a Certificate of Survey of the lot, with the proposoed construction drawn on it to scale. LIVING ARFA: Length Width Height S3. Ft. M AREA: Length Widt.l; — Height S3. Ft. DECK AREA: Length Width Hgt/Ground Sq. It. C,rner Lot I I Inside Lot I ] I Ft. Yd Setback Side Yard Setbacks Type of Oonstruction: ke,64 vV,4 �Iyljrlti X 4J- PeS i e& W )'t7y Estimated Cost: ad �J Approx. Completion Date: V I N si // ll m -o 6 o L V 7-/z uell j Proposed Driveway Width If New Opening Is Desired: $— + 6" DATE: 2 APPLIC,NP: CLTY USE ONLY Preroit Flee State Surcharge SAC Charge Driveway Escrow Park Flee Sewer !lain Charge ZEAL ST3PULATI M: 5 5 5 # `� ,10 Alt. A Alt. B S_ See Back Page Tel. # .3 7 2 - Fee Flee Schedule on Reverse Side 8.50/51,000 Valuation 8550 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary I I Not Necessary I ] 3 0) ,0 d SUBJECT P City of Fridley (J_33 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. v r 1 PROTECTIVE INSPECTION SEC. 1 � 4 1 i = CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 6/22/98 JOB ADDRESS 225 49 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 3 Carlson's Summit Manor South Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lind 225 49 Avenue NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Viking Home Improvement Co 4832 2 1/2 Street NE, Mpls., MN 55421 572-1821 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 4772 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING HKXR Residential 7 CLRSS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION Ek REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof XX M Garage (8 Sq) Tear -off; Replace Siding & Trim Repair 9 CHANGE OF USE FROM TO STIPULATIONS 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3,940 $1.97 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- STRUC N OR HE PERFORMANCE OF CONSTRUCTION. $87.25 Fire SC $ 3.94 PLAN CHECK FEE TOTAL FEE _f// $R $5.00 LC 1 $98.16 SIGN URE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPS V LIDATED THIS /Iis OUR PERMIT a 864bG INSP 11ATE 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�,o'� BUILDING PERMIT APPLICATION 22s' ConstructionAddress: Ll 5r (� 41 a 15 A/ • f Legal Description: Owner Name & Address: G2' iv Q S Tel. # 7z —,96,9,6' Contractor. co MN LICENSE # Y % Z - Address:.. Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: iee-bof 4442i;�: e- ny Ar Construction Type: 5rds.� ,/;w z, 12,��� F n— Estimated Cost: $ C3 (Fee Schedule Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: 9 f APPLICANT: Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: 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 [ ] SUBJECT PERM City of Fridley _ 2 8 6 881 THE TWINS BUILDING PERMIT ` 57�T566 COMMUNITY DEVELOPMENT DIV. INSPECTION SEC, IT73 r PROTECTIVE 1 � � ; CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OE APPROVED BY L J` 612-571-3450 910-F15 11/30198 JOB ADDRESS 225 49th Avenue NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 3 lCarlson's Summit Manor South Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Russell Lind - 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Viking Home Im r579-1820 4772 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 gk REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house (12 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 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 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 $1028 .51 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 $37.50 Fire AC $1.03 PLAN CHECK FEE TOTA EE -fZ LiceaaaAQ$5.0Q .04 SSG 4TUR OFCON 'RACTORORAUTHORIZED AGENT IDATE, ENMOPURLI 8L NSP AT HIS IS Yj3UR PERMIT (/`�j '/ - t% DATE S-GNATURE OF OWNEROF OWNER BUILDER. iDATE, NEW ` [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: Owner Name & Address: , l /1 v s s iL z- c- Tel. # Ss - Contractor: r/2 ic- p MN LICENSE # -/;77 z Address: /�� �, s T, 'r , 4 . -- Z -//-S - 2�s / z f Tel. #S�� 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. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: /Z� /Zed ®d F Driveway Curb Cut Width Needed: Ft. + 6 Ft = Estimated Cost: $ 1 C� (Fee Schedule on Back) Ft x $ _ $ DATE: 11--96 -; APPLICANT: ��,2 Tel. # _ S`7Z / �? ` 0 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: s10 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 [ ] CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective On May 10, 1999 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR nal 13 _ �Shower ower t. Wash Q� Floor rain .f..Washer Aut o. s< ;. �.. Gas Range is <. Water Heater ori St es .Uri < Gas EI ec Basement - Floor 1 r` FI 2 Floor 1 F o0 r4 M . . . . . . . . . . . . . . . . . . . . . . PLUMBING FIXTURE RATES: 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"' NO. RATE 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 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE TOTAL JOB ADDRESS 380 65 00015L bi�-MJ s20-50 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 rel and correct. LIND, RUSSELL 225 49TH AVENUE NORTHEAST 2—OW FRIDLEY, MN 55421 Owner (763) 572-8695 Building Used As Estimated Cost `V PERMIT NO. PLUMBING COMPANY L]Q &6LO [ SIGNED BY ��----i EL N0. X 12 (0/17;'Q3 [A 'q VQ Approved By Rough -in Date Final Date 42 '(0 -ya "COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. Building PLUMBING Permit No.: Inspections RESIDENTIAL APPLICATION R ' 763-572-3604 CITY OF FRIDLEY Date ec d: 763-502-4977 FAX EFFECTIVE 1-1-09 DATED E-MAIL ADDRESS A In h iYYI C YCYI %(tel ! w InDf If L ('V 1 _JL- NaUR SITE ADDRESS C1 CI- 1 V THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY NAME: Ir�nurc� i v�c� ADDRESS: < i fi= �N�i CITY j� STATEM, ZIP_Wq_W TENANT (o '& " PHONE:_j S CONTRACTOR Nom: ll+,(.F.�� ,c . SUBMIT A COPY OF YOUR STATE STATE LICENSEE # — ©L2 ( O L l P P Vl'l EXP DATE 3 l I B LICENSE, BOND AND STATE BOND #g c� s a �a EXP DATE a— 3 CERTIFICATE OF ADDRESS: �, i?'s67Z 3S CITY S STATE-MAL ZIP_5SnX INSURANCE PHONE (�,SI l �� -Dv 1 S FAX 6 M — 3,77 —6 Sl S PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW ts<R6LACEMENr DETAILED DESCRIPTION OF WORKo JQ — �a v� iCI(� c L) 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 = plus SO 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). M[ IIMUM FEE $15.50. _ BATH SINK/LAV FLOOR DRAINS _ SHOWER _ WATER PIPING —BATHTUB GAS PIPING (NEED CITY LIC) _ SWIMMIING POOL WATER SOFTNER ($35) _ _ CLOTHES WASHER I KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($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 $ (; . i Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ OR Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ State Surcharge = $ .50 $15.50 $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 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 all work which requires review and approval of plans. SIGNATURE OF APPLI PRINT NAME S DATE _b APPROVED BY DATE,// T.> PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED 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