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PRE 2010 DOCSCity of Fridley, Mim. BUEWING PERMIT N° (5::69 7 Date: /1 4 —. Owner: Builder — Address ____ Address — -- L?fAZO&O.ULDING No. ___ _ Street Inc' - �"` Part of Lot Lot _ Block Ad on or Sub -Division r _� Corner Lot _ Inside Lot � Setback Sideyard Sewer Elevation __ _ Foundation Elevation DESCRIPTION OF BUILDING Met %Used i* �;" ' Front s_ _ Depth J�__�"'= Height Sq. n Cu. Ft. -Lf'" Fran Depth Ieight Sq. Ft. _ Ca. Ft. Type of Construction '' =` Fant. Cost A fes.. 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. 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 viola any of the provisions of said ordinances. "'-� . A ;' I L17- Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we the Building hnpeetor for separate permits for these items. n- 0 Q0.4 0 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEX, MINNESOTA Owner's Name Address "1� �/� Address No. LOCATION OF BUILDING t !1/ 3 �� C�',17451 Part of Lot Lot Block Addition or Subdivision Corner Lot Inside Lot SetbacklSide-Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of trot and proposed building location. DESCRIPTION OF BUILDING To be used as: / / �j� M a �� n Al Front Depth Height Sq. Ft Cu. Ft. .v� Front ? y repth Height sq. Ft. cu. Pt. Type of Construction 4.P,&- --� Estimated Cost2�= 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 of Fridley Ordinances and ruling of the Department of Build- ings, and hereby declares that all the facts and representations stated in this application are true and correct. DA= 7 -A" 6- / SICKATME (Schedule of Fee Costs can be found on the Reverse Side). City of Fridley, Minn. BUILDING PERMIT NAs297� WT N F�' RUILDING No.Moc tilk�-O-- Fart of LOt k kA tion or Sub -Di on'�� Corn Lot — Inside Lo—. t Afff Stllback Sideyard Sewer Elevation ____ Foundation Elevation DESCRIPTION OF BUILDING To V as: IF OM4f Front Z Depth Height Sq. Ft Az Cu. Ft +X� _.___ Fro Depth Height Sq. Ft. Cu. Ft Type of Construction . Est. Cost — Apff 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 21 provisions of ordinances of the dty 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 past thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding laocons etioalatany time upon ovi lceati n off say of tmhoe provisions ofsa�td within the dty limits and this ordinances. �. Building Inspector NOTICE: This permit doss not cover the donskuddon, imatdlplon for wkb& plumbing, gn beating, sewer or crater. Be sure to coo the Building ingm for for aperals permits for thea Noma. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER ° S NAME �ed wA z j R. 5 BUILDER _ ,t ADDRESS _- �. _ & 3 W L ,0 LF ADDRESS $ No. LOCATION OF BUILDING Street Part of Lot Lot Block Addition or Subdivision Corner Lot Inside Lot -_Setback .,vY 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. To be used as: DESCRIPTION OF BUILDING Front 14e, Depth I 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 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 `SiGNATiTRE- 0 (Schedule of Fee Costs can be found on the Reverse Side). 0 QF SUBJECT MIT NO. City of Fridley �(i25763 AT THE TOP OF THE TWINS BUILDING PER IT r i v ______ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. / I . � NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 1/13/98 10B ADDRESS 70 63 Way NE t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6, pt 7 17 Fridley Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Daniel/Jaclyn Taylor 70 63 Way NE 572-3802 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 B DESCRIBE WORK Remodel bathroom 9 CHANGE OF USE FROM TO STIPULATIONS See plan. 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $500 @ $ .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. $21.00 re SIC $.25 WAL PLAN CHECK FEE FEE o -1:1 -9 $21.75 CONTR OR ORAUTHORIZEDAGENT IDATEI H'q, P 7F0 VOG INSVF Y V TED i THIS IS YOUR PE I MATE SIGNATURE OF OWNER, iF OWNER BUILDER, IDATEI Prepaid Plan Check $ Estimated Cost $ Receipt # Effective 1/1/98 CITY OF FRIDLEY R-3, COMMERCIAL & INDUSTRIAL BUILDING PERMIT APPLICATION bp#x 10 �b Construction Address 7y - 6 3 - d (,j a /1)Z7 Zomig Legal Owner & Address e Tel#5-7a CON'MCDOR & ADDRESS @ s Tel# Architect Reg.# Engineer Reg.# BUILDING CONSTRUCTION TYPE OF WORK [] New [] Addition jK Alteration -Describe �����e SLi4�vc OFC. AREA: Length Width Height Sq. Ft. WHSE AREA: Length Width Height Sq. Ft. OTHER AREA: Length Width Height Sq. Ft. APPLICANT S Tel #,:5-7,2 -3&og Date i -13 - 978"_ VALUATION Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) _ Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) _ $ 500 Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) TaIAL VALUE Building Use Construction Type Occupancy Group Air Conditioning [] Yes [] No Fire Protection Provided [] Yes [] No Performance Bond Amount $ See Reverse for Schedule 70 +Rceived [] Yes [] No Permit Fee $ See Fee Schedule on Reverse Side Plan Check $ In Excess of Prepaid Amount - See Reverse Side a� Fire Surcharge $ .001 x Permit Valuation (1/10th %) a � � ,, State Surcharge $ $.50/$1,000 Valuation (See Sched. for > $1 Million) SAC (urge $ $1000 per SAC Unit (Plans to MWCC for determination) Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined By Engineering Spec. Assessments $ Agreement Necessary [] Not Necessary [] Driveway Escrow $ feet x $13.50/foot TOTAL ATTACH STIPULATIONS N Lr) CITY OF FRIDLEY INSPECTION DN. 6431 University Ave NE &Z&,,j7,a Effective On January 1, 1997 nn Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR •li ..I fi.S)t€. Wash f` �}rllt,i�., z. Floor lG�t}, Ruta. ,:;h: :�£' ;,`'r'YkR'y. yr;, f.:::':..s...::r :Y `Gi..::r:, Gas {z:.. e f., <2r3:i'ti43.Y �:3 f ry }.?ifSC+� Water Heater Stori 9 S\Y }';A4C L�e-i�]�t:�i: f.:. �.: e�.s .: F..urri:.nSf.. :�10".s'e�tv�. Urinal �f� - x ...%,.: : ,.��� �t i►t, Tray :,: Drain f _ �x,.�:,f-. i Washer �. Efec RN Floor ,-2}.::. "i:•kfi.:. •. : �":'-�}^ah:�=3::,t;'•'. :Y:�yf }._:,;;<z: :;'•..:.:.r:.:.�.�. :xY+.fir• %5; }:.:'. '- .•..:: .:•. cif+4r.. .. r• <%i>aaY%F:y?:•;'.;: f,`::'.'. ;4hil�i,'X�`:: Floor 2 ^`�y5t '.''�S;r3+hr} ':k <$t;K: f•}; Y_.`rla;:e t.`4:% :1:;;::+x3.;}_ ira-arpkY; _.<K :{...<.. .3 .f,. �toi-?: .`c p�f t:. „ft:-.; ,c;.:- `:' ( ' Er., •- ' .•4-`ivtr}�•S _ 3Y: :'� .: Zi.%� �,:'CJ•.'.ii >:S??iS:vR':9`S Floor 3 '-�� Y�. :>���%�: ,�:•%_i.; ;.;:_a x.. Yf. 3 ..: :.,.s.:_;< i.^iir vc, �.%�.} FY: �S .£ •SSS. +i. l.tv.. - J Floor 4 .::: 1:. . ,0.<: Sr. Z r;x•xy '..3.:y ::. :1 c C. JOB ADDRESS 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, ,1997 Owner G Building Used As /76 4. Estimated Cost?/ o PERMIT CE 0 F- (/ 7bt I 7- �e-w PLUMBING COMPANY , S SICRNED 13Y TEL N0. Approved By _ Rough—in Date Final Dale 3l Db PLUS THE $,50 STATE SURCHARGE "*COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES. PLUMBING FIXTURE SATES: NO. RATE TOTAL E0 New Fixtures 3 $ 7,00 �• Old Opening, New Fixture 84.00 Beer Dispenser $ 5,00 Blow Off Basin $ 7.00 Catch Basin $7.00 Rain Water Leader $ 7,00 Lq Sump/Receiving Tank $ 7.00 a Water Treating Appiiance $10.00 LL Water Heater — Electric $ 7.00 LL o Water Heater — Gas** $10.00 Gas Range'* $10.00 U Gas Dryer- $10,00 —_ Back Flow Preventer Requited ( )Yes () No X Type— _ $15.00 LL Reinspection Fee $42.00/Hr M ALL OTHERS AND/OR REPAIRS AND ALTERATIONS -I 1.9% of Value of Fixture or Appliance vii State Surcharge $ .50 i TOTAL FEE $—. ti JOB ADDRESS 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, ,1997 Owner G Building Used As /76 4. Estimated Cost?/ o PERMIT CE 0 F- (/ 7bt I 7- �e-w PLUMBING COMPANY , S SICRNED 13Y TEL N0. Approved By _ Rough—in Date Final Dale 3l Db PLUS THE $,50 STATE SURCHARGE "*COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES. ctnroF FRIDLEY . FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 March 4, 1999 Lynn Taylor 70 63"d Way Ne Fridley, MN 55432 Re: Final plumbing inspection at 70 63'd Way NE Contractor: Bonfe's Plumbing and Heating Service, Inc. Dear Mrs. Taylor: A plumbing permit was issued on January 15, 1998 for the property located at 70 63' Way NE for new plumbing fixtures. According to Section 30.5(a) of the 1991 Uniform Plumbing Code a final inspection shall be performed on plumbing systems. As of this date no inspection has been called for. You will be given thirty (30) days from receipt of this notice to respond. If we do not hear from you, we will expire the permit and any inspections on this installation will require a new permit. Any questions can be addressed to myself at (612) 572-3603. Sincerely, '4' fir,10� Bary Riesch Building Inspector SUBJECT P City of Fridley 0464 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. _ _ r � PROTECTIVE INSPECTION SEC. qo3 � NUMBER REV DATE PAGE OF APPROVED BY ,' 11 CITY HALL FRIDLEY 55432 .� L f\ 612-571-3450 910-F15 11/1/99 JOB ADDRESS 70 63rd ay NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 Pt. 7 17 1 Fridley Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lynn Taylor572-3802 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO American Building Co - 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 ®x REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garageTear-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 $1398 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $.70 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- $50.95 Fire SC $1.40 S RUCTIO OR PERFO MANCE O NSTRUCTION / PLAN CHECK FEE TOTAL E Licen $5.00 $ .05 S�GNA uRE OE CON'RACTOR OR AUT i2ED AGENT iDATE� EN P OPE Y ALIDAT HIS IS YOUR P BLQK iNSP - L � garE S,GNATUAE OF OWNEROF OWNER 13U4DERi iDATE, NEW F] � Effective 5/10/99 ADDN [ ] ��� CITY OFTRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION to ®� Construction Address: �Io CZi-y W C Legal Description: Owner Name 8c Address: �y,7n ./l:,v�r- Sam ! Tel. li -.6 d'0� Contractor: /�,,�P,;�_ ., �,/„/,�.�����r MN LICENSE // Address: /-L-7-y7 /I_.!'cZ& ,�ve Tel. I/,6/-2 - ,7 o? -r- Z - Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. imso rriON OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width kigt/Ground Sq. Ft. OTHER: �s,2-- . , Construction Type: keladn>^ Mo jx C-G,���� Estimated Cost: $_3 2�s Driveway Curb Cut Width Needed: Ft. + G Ft = __Ft x $ _ $ DATE: 1/1 �yL APPLICANT: / v/ Tel. # CITY USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge $ � O.9r $ is $ .96 Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1050 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "13" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary ( ] TOTAL r STIPULATIONS: FA SUBJECT City of Fridley 32943 AT THE TOP OF THE TWINS BUILDING PERMIT r 1 , T NO. �`1 ____- COMMUNITY DEVELOPMENT DIV. v � PROTECTIVE INSPECTION SEC. 1 1 � 1 . � NUMBER REV DATE PAGE OF APPROVED BY 1 1 LL FRIDLEY 55432 CITY HA ��J 763-571-3450 910-F15 7/29/02 JOB ADDRESS 70 63 Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6, pt 7 17 Fridley Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Greg Sherwood 70 63 Way NE 763-502-1665 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Bainville Exteriors Inc 2434 Hillview Rd, Mounds View, MN 55112 763-783-3994 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 O REMOVE 8 DESCRIBE WORK Replace 6 windows and 1 garden window in kitchen within existing openings 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all exterior openings. 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 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 $4,760 $2.38 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OPINY OTHER STATE OR LOCAL LAW REGULATING CON. STRUCTIO E PERF09WANU OF CONSTRUCTION $111.25 Fire SC $4.76 ¢® PLAN CHECK FEE Lice SC $5 0 TOTAL FEE 123.39 SGNAT OF CON"RA�TQFi OR AUTHORIZED AGENT iDarE, H PR Y VALIDAT 9"'THIS IS YOUR PERMIT �(�1 - V`� S-GNATURE OF OWNER,1$ OWNER BUILDERi OATEi G NSP r'ATE FA NEW CITY OF FRIDLEY Effective 1/1/2002 ADON J 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: �7'0 �® �W�2 Legal Description: Owner Name & A LIVING AREA: GARAGE AREA: DECK AREA: 10t 12W7W -J 'C* Driveway Curb Cut Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width - Height Sq. Ft Length Width Height Sq. Ft Hnt/rmi ind � / � ,..�,---�• /i iii ry Needed: DATE: ' �' o- APPLICANT: Rn Ft w�r Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge CITY USE ONLY - $ ��• �S' Fee Schedule on Reverse Side $ .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $ _ $1200 per SAC Unit $o l� $5.00 (State Licensed Resideritial Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ . Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ . --� 4 STIPULATIONS: 79 Building FLLJN0EqG Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF F��MLEY Date Rec°d: 4 763-502-4977 FAX EFFECTIVE 2-19-09 gEC!D APR 2 9 DATE (i YOUR E-MAIL ADDRESS SITE ADDRESS to WAM THIS APPLICANT IS: ❑ OWAR CONTRACTOR PROPERTY NAME: -� OWNER/ ADDRESS: US CITY STATEAkJZIP S _,?— TENANT TENANT' q PHONE: � 3'� 0 .3 CONTRACTOR NAME: V'�/P tW444 bil'W STATE LICENSE# EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND STATE BOND EXP DATE CERTIFICATE OF ��# ADDRESS: KMD CITY STATE ZIP Y _ INSURANCE PHONE '16 3—nc— FAX PERNM TYPE 1�i_SINGLEFAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK [3 NEWREPLacEMENT DETAILED DESCRIPTION OF WORK FEES ARE BASED ON $10.00 PER FDCTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $35.50. SINK/LAV FLOORDRAINS _SHOWER _ WATERPIPING _BATH BATHTUB GAS PIPING (NEED CITY LIC) _ SWIlVb IING POOL —WATER SOFTNER ($35) _ —CLOTHES WASHER SINK _WATERCLOSET BACKFLOW PREV. ($15) _KITCHEN DISHWASHER _LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION WATERMETER _ OTHER a , T; . L�Q �.,_ '._�,__ ..�.. Q:{:idl �'+ �.. ,...af ..._. ... J C.u. � �"..„.: •k .�{'�!� �.: � .f... ..:. i.c 9 ._,..... +`h :, ., Iii. ru ..w..l . .... .: 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 eQoff all workwhic/h, requires review and approval of plans. SIGNATURE OF APPLICANT 45 4-e ' �i�– PRINT NAME /V/ DATE % ZZ l u PLEASE'NOTE.- SEPAR—ATE PERIvIlTS ,ARE RE(7UIRED FOR BUILDING:. EI:E:C.7RTCAL. AND 1N[E.G7IANICAL WORD. City of Fridley Building Inspections Department 6431 University Avenue N.E. Fridley, N1N 55432 763-572-3604 FAX: 763-502-4977 M