PRE 2010 DOCSS
rage 1 o= 4
EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION
OWNER:ATE -,)0 -77
SITE ADDRESS: Z 3 tt)( t C , PHONE: 5q, 6 -
V
CONTRACTOR: 1CAGa U Gl (k 'Z g " r
�
Determine working square footage of each
1. Total exposed wall area...... 9 `/ 2� sq. ft. x .17 = 0?/-/C� , 76
2. Toal roof/ceiling area ...... sq. ft. x .05 = 5-46
Total exposed wall area above floor = 2—
a. Total wall window area ................................. q T/
b. Total door area.......................................E
c. Total sliding glass door area .........................
���
d. Total fireplace wall area .............................
e. Total. wall framing area (average 10%) ..................
f. Total rim.joist area ..................................
g. wall area above floor ..........................
h. wall area above floor ..........................
i. wall area above floor ..........................
j. wall area above floor ..........................
Total exposed foundation area =
k. Total foundation window area.* .......................... IS - 56
1. Total net foundation area above grade .................
a.
Determine "U" value of each wall segment
(`e/.g. window, door, each separate wall section)
/7 74 / X "U" • � v = Y0 • C /
3-7,
C. X "U" _
d. X "U" _
P
f. .23a OE X
g. /4c) X nun o _
X nun
k. X "u" _
1. X nun =
3 . ............................. Total =11a
If item #3 is the same as,
or less than item #1, you
have met the intent of
SBC 6006 (c) 2.
,Exterior Envelope Average "U" Computation
Total exposed roof/ceiling area = O 32
M. Total skylight area ............................
n. Total roof/ceiling framing area (average 10$)...
o. Total net insulated roof/ceiling area...........
Determine "U" value for each roof/ceiling segment
Page 2 of 4
M. X "U"
n. X "U" 0 _ % -3
o.
4 ........................... Total
If total of #4 is the same as, or less than #2, you have met the intent of
SBC 6006 (c) 1.
Alternate Building Envelope Design
To utilize the total envelope system method, the values established by the sum of
items #3 and #4 shall not be greater than the sum of items #1 an��d #2.
1. n + 2 . �� _ ?o 4
3. + 4. 4(2- 2P7
WALL SECTIONS
,NOTE: Use 10% of opaque wall area for
Brame construction
FIG. #1 TOPVIEta OF
- FPJM, IIALL
FSG. #3
o
Page 3 of 4
Total
#4 f - a lit
-
It r
Y, litf
NOTE: Indicate type, "R"'value, depth and
placement of insulation.
Construction
R -Value
1.
Interior
air
film
0.68
2.
3.
4.
5.
6.
Exterior air
film
0.17
Total
1.
Interior
air
film
0.68
•
2.
3.
4.
5.
6.
Exterior
air
film
0.17
Total
e�
Interior
air
film
0.68
3.
4.
=
5.
=`--�
6.
Exterior
air
film
0.17
•
Total
lJ
1.
Interior
air
film
0.68
3.
4.
S.
6.
Exterior
air
film
0.17
Total
#4 f - a lit
-
It r
Y, litf
NOTE: Indicate type, "R"'value, depth and
placement of insulation.
ROOF/CEILING
VERT/.Sut�l�iL:-t�1�ilttii(i�t�tt;14/!�
�� 1 -
Vented Heat fl ow
up
FIG. #5
p le�_'�:1 =L^. `yi/W nc.
tEN-%- •.P•^_t-.G �7Cte1 ..
Heat flow up. Vented
- -FIG. #6-..
0. af.
Heat ,
f low up
?XG. p7
rage 4 or 4
Construction R -Value
1. Interior air film 0.61
2.
3.
4. Exterior air film (still) 0.61
Total
1. Interior air film 0.61
2.
3.
4. Exterior air film (still) 0.61
Total
1. Inside air film 0.61
2.
3.
4.
5. Outside air film 0.17
Total
Note: Use additional sheets if more space is
needed for details and calculations
• /�� - v C
Malt, Office 571 6066
UBURBAN 6875 Highway No 65 N E
NOINEERINO -- - -- — —_ _ _ _ M I'l-i nln. htinnesula 55432
'1Stl1h Office
8906510
!tu A lfuntrtpn110O-IfRoad
. M,nnesula. 55337
L: 1M
LA
l` qtr 1 T "
Mortgage Loan Survey for H (jk! E LALE �:�?. J1 L i J,
i' ! 1 o f f 2
*rlher/y line o� of 1
�' line
..., . _-. o..._Mo, dole on corner
�as�ef weal f pneP on —75.32
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000000
1 MRWY FRAME GAIV .. i[i,;vVT FUuklrn is �r6 1 STORY FRA
I
135 ri Y u1�Ll:Z +.�.ch.+`,
ry
10
l +, !J 12.
r 1
1 S'cal'e: I nch_'go4 r
—75.00— -�
R `
k X03 �?D V VQ N �- o
JUNE 1977
LOT 17 , BLOCK 2
E VA ERI C1�S 0 N rl VER MANOR _
ANOk'R COU"TY
This is a true and correct representation of a survey of the boundaries of the land above described and of the
location of all buildings, if any, thereon, and all visible encroachments, if any, from or on said land. This survey is
made only in connection with a mortgage loan now being placed on the property and no liability is assumed
except to the holder of such mortgage or any other interest acquired by/the reason of such mortgage. It is
understood and agreed no monuments hove been placed for the purpose of establishing lot lines or boundary
corners. Dated this day of A.0. 19_
SUBURBAN ENGINEERING, INC.
Engineers Surveyors
by
Not Published: All Rights Reserved
3
/� s
Oeoerm - c1 S, eI c'e�
-12
160.0
IIA
mi
,l s . o
i
M
0
)z�
E6 STreet �j,p
I
MEMO FOR FILE
MEMO FROM: Ronald Holden, Building Inspector
MEMO DATE: June 22, 1977
REGARDING: Permit Limitations for 123 - 63rd Way N.E.
I've attached a letter requesting a delay in the beginning
of construction at the above address.
I hereby approve the extention of the beginning time limit
for permit #14,025 until July 25, 1977, before which
construction is to begin.
RON HOLDEN
Building Inspector
a-2w. golden;
per
--- — -- -_wa - +CL-k_ ,e K o
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--- ------------------- ---
h�es�fe�� Cor2��wuc�i®�
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
.AIR CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
RATE
TOTAL
Furnace Shell & Duct Work
$12.00
$
Replacement of Furnace
7.00
$
Repairs & Alterations -up to $500.00
7.00
$
Repairs & Alterations each add. $500.00
4.00
$
MECHANICAL WARM AIR:
Furnace Shell & Duct Work to 100,000 BTU
$12.00
$ l •® b
each add. 50,000 BlU
4.00
$
Replacement of Furnace
7.00
$
Repairs & Alterations -up to $500.00
7.00
$
Repairs & Alterations each add. $500.00
4.00
$
STEAM OR HOT WATER SYSTEM:
Boiler & Lines up to 100,000 BTU
$12.00
$
each addn. 50,000 BTU
4.00
$
Boiler only up to 100,000 BTU
7.00
$
each addn. 50,000 BTU
6.00
$
OIL BURNER- to 3 gal. per hour
$10.00
$_
each add. 3 gal. per hour
10.00
$
GAS BURNER- from 100,000 BTU to 199,999 BTU
$10.00
$16.0o
(over 199,999 BTU see Fee Schedule)
$
GAS FITTING FEES:
1st 3 Fixtures x $ 3.00 $ 3.00.
Additional Fixtures x $ 1.00 $
Gas Range to 199,000 BTU x $10.00• $
AIR CONDITIONING $
FAN HEATING SYSTEMS See Fee Schedule $
VENTILATING SYSTEMS $
ALTERATIONS $ REPAIRS $
State Surcharge $ ..50
TOTAL FEE $ o?5 . 50
ROUGH INSP. REINSPECTION FEE
Date ($10.00)
FINAL INSP.
Date
APPROVAL FOR PERMIT 0-4
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
Job Address A23 ' 134 22 X.
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
i�� aye Fridley, Minn. , 19-22
OWNER --
KIND OF BUILDING t—
USED AS
TO BE COMPLETED ABOUT \.\
ESTIMATED COST V
OLD - NEW BUILDING PERMIT NO. PERMIT NO. / Ue';)-d
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water,-� �No. ss��
Trade Name - Size No. j'go
Capacity Sq. Ft. EDR BTU `OVO HP yJ
Total Connected Load 51.(1'76 Kind of Fuel 91d. A410
BURNER - Trade Name I.. . el& - Size No. 6y ® o
Capacity Sq. Ft. EDR BTU 4Z&DVV HP
Company RAY N. WELTER HEATI
Signed By 4637 Chicago Ave.
nneao a 55407
Tel. No.Us-&W
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PARTIAL RATE
SCHEDULE
PLU,BING FIXTURE RATES:
NO.
RATE
N-=ber Fixtures
r. $3.00
Future Fixture Opening
y
o
Now Fixture, old Opening
Water
x $2.00
atch Basin
A
Water Heater - to 99,C00 BTU
�_
L
c
of
o
water softener
i
a
w
r. $5.00
Heater
j
r
=
H
r L
j
$4
~
..V�
4
;.
_
,C
..a
7.
.0
=
S
0
N
O1
u1�
4
L
L3
•.1
r0
%� U
.0
rU/
aUi V
,J M
N N
7 R1
N
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••-1
�!
.0
L
'lee
y
u
v
M
m
S
o w
m
w
U ra
It
c�
c�
O
,as
Ylst
I
I ,
2n3
�
1 3rd
4th
(R) = Future Connection Opening
Connected with Sewer
(*) = :.ew rixture, Old opening
1
Water
PARTIAL RATE
SCHEDULE
PLU,BING FIXTURE RATES:
NO.
RATE
N-=ber Fixtures
r. $3.00
Future Fixture Opening
x $2.00
Now Fixture, old Opening
x $2.00
atch Basin
x $5.00
Water Heater - to 99,C00 BTU
�_
x $5.00
100,000 BTU to 1.99,000 BTU
x $10.00
water softener
x $7.00
New Ground Ran Old Building
r. $5.00
Electric :-rater Hefter
x $5.00
GAS FITTING FEES:
1st 3 fixtures x $3.00
;"Iditio :al Fixtures x $1.00
Gas Range to 199,000 BTU x $10.00
REPAIRS & ALTERATIONS
First $100.00 $5.00
each add. $100.00 or fraction $$2.00
State Surcharge
TOTAL FEE
REINSPECTIO:; FEC ��
$
$ .50
S
I A �
Job Address / O1 c 3
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, M1. 19�
OWNER
KIND OF BUILDING
USED A
TO BE COMPLETED ABOUT
d .
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. ERMIT NO.
Company
P --,-
Signed By
Tel. No. 930► 7
ROUGH INSP.
Date
FINAL INSP. /0 :5' ^ 7 7.
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PErUMIT IS $7.50
lir rLlbhI lull roll 1 Wrlalllu P,llu u/1i I 1 I 1 {nu 6w79 ,
97-84th16051
•
a
PLUMBING FIXTURE RATES; NO.
%
a
TOTAL
q
x
U
.
Future F!xture Opening •
U
$2,00
Water
New Fixture, Old Opening '�
x
•�
S
Catch Basin
x
$5.00
$
l Water Haater - to 99,000 BTU,
x
$5..00
$
w
�
510,00
Itoator
J
•?
$7,p0
$
New Ground tarn Old Building
x
� a
c
$
Electric Water Heater -
x
'cU
$
GAS FITTING FEES; '
1st 3 fixtures
x
o o
$
.Uditional rixturee _--x
��
$1,00
$
a
b
S
m
REPAIRS 6 ALTERATIONS
o
lec
$
each add. $100.00 or fraction
All
c
V1i
'.,e
Q
$ .50
w
K x
3 10"50
na
2nd
3 rd
r--
,_ (R) - Future Connection Opening
Connected with Sauer
i(•) - New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES; NO.
RATE
TOTAL
}.fiber Futures
x
53.00
$
Future F!xture Opening •
X
$2,00
$
New Fixture, Old Opening '�
x
$2.00
S
Catch Basin
x
$5.00
$
l Water Haater - to 99,000 BTU,
x
$5..00
$
^_-
100;C00'BTU to 199,000 BTU
x
510,00
5
Water Softener
x
$7,p0
$
New Ground tarn Old Building
x
$5.00
$
Electric Water Heater -
x
$5,00
$
GAS FITTING FEES; '
1st 3 fixtures
x
$3.00
$
.Uditional rixturee _--x
x
$1,00
$
Cas Asnge to 199,000 BTU
$10.00
$
REPAIRS 6 ALTERATIONS
First $100.00
$5.00
$
each add. $100.00 or fraction
$1,00
$
State Surcharge
$ .50
TOTAL. FEE
3 10"50
Job Address 123 63 Way NE
Department of Buildings
City of Fridley I
Tel. N571-3450
The undersigned hereby makes application fora permit for the worl
specified agrooing•to do all work in strict accordance with the Cit,
and rulings of the 0apartmont of Buildings, and hereby declaxas the
the facts and representations stated in this application Ara true a
Fridley, Mel, 1.0-28-77 , 1
OWNER HOMEDALE BLDRS
KIND OF BUILDING frame
USED AS res
11-4-77 ,
TO BE COMPLETED ABOUT
ESTIMATED COST 2000
OLD - NEW BUILDING PERMIT N0, PEfjjiIT 110. 2int
44 0
Company
NEQAW(fGASCO
Signed By'
l
Tal. No.
ROUGH INSP.
Data
FI144L INSP.
Data '
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUKBING PERMIT 19 $7.50
nrrr-rt.h. rury runt rr.�umclriu Art una r r r r,rtu • ewe, r
97-8h-879001
PARTIAL RATE SCHEDULE
KIND OF BUILDING frame
PMM ING FIXTURE RATES; NO,
RATE
TOTAL
tbe.r Flxtuxas -
x
53.00
U
Future F!xtura Opening
1�(
U
$
Water
x
$2,00
�"
'F•
x
$5.00
E'
Ad
x
55..00
$
100;C00 -BTU to 199,000 BTU
pp.
$10.00
$
Water Softener
Hester
$7,90
u
New Ground-Ra>n Old Building —�
x
C
r
Electric Water Heater -
X
$5,00
$
GAS FITTING FEES;
12t 3 fixtures
x
$3,00
$
3.dditional Fixtures
x
$1.00
$
;Cas Rings to 199,000 BTU
x
$10,00
9
REPAIRS & ALTERATIONS
'
First $100.00
$5.00
$
each add. $100.00 or fraction
$1.00
Li
r: U
D
O
• TOTAL FEE
to
:c
A k
W
w
Ci rn
K
O
ist
,
' n
Ct
clrvlr
2 ,dd
4 L
'
. (R) - Future Connection Opening
Connected with Sawar
(•) - Ilaw Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
KIND OF BUILDING frame
PMM ING FIXTURE RATES; NO,
RATE
TOTAL
tbe.r Flxtuxas -
x
53.00
PE[VIT 110.
Future F!xtura Opening
>2
$3.00
$
New Fixture, Old Opening `�
x
$2,00
S
Catch Basin.
x
$5.00
S
r water Heater - to 99,000 BTv,
x
55..00
$
100;C00 -BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7,90
$
New Ground-Ra>n Old Building —�
x
$5.00
$
Electric Water Heater -
x
$5,00
$
GAS FITTING FEES;
12t 3 fixtures
x
$3,00
$
3.dditional Fixtures
x
$1.00
$
;Cas Rings to 199,000 BTU
x
$10,00
9
REPAIRS & ALTERATIONS
'
First $100.00
$5.00
$
each add. $100.00 or fraction
$1.00
$
State Surcharge
$ .50
• TOTAL FEE
$ 8•00
Job Address 123 N:� 63 wa�u,�i,
Department of Buildings
City of Fridley I
Tel. N571-3450
• The undersigned hereby make$ application fora permit for the wort
specified agraoing•to do all work in strict accordance with the Cit;
and rulings of the Department of Buildings, and hereby declare$ the
the foots and rapresantations stated in this application ars true a.
Fridlay, Men, 10-31-77 , 1
OWNER MARV ESHELIMAN
KIND OF BUILDING frame
USED AS res.
TO BE COMPLETED ABOUT 11-6-77'
ESTIMATED COST 2 •QO
OLD - NEW BUILDING PERMIT NO,
PE[VIT 110.
Company'''
't1i&
GASCO
Signed By*
Tole No.
.
ROUGIi INSP.
Data
FIN4L INSP. _ 40
Dato
'
APPROVAL FOR PERMIT
MIIIIMUM FEC FOR ANY PLUMBING PERMIT 15
57.50
City of Fridley
SUBJECT
AT THE TOP OF THE TWINS
BUILDING PERMIT
ZE
`v _ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
y8 �--
� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910-F15
1/3/90
JOB ADDRESS 123 - 63rd Way N.E.
1 LEGAL
LOT NO.
17
BLOCK
2
TRACT OR ADDITION
Eva Erickson River Manor SEE ATTACHED
DESCR.
SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Larry Overby 123 63rd Way N.E. 572--1069
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 C}¢ ADDITION [2 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct an 18" x 1W Three Season Porch.; Finish basement/bath-
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations: on plan. Provide fixe alarm on both levels of existing
house. Provide combustion air to existing furnace.
On all new roofs or tear-offs and replacement roofs.
State Code requires that 2 layers of 15 lb. felt,
mopped together, be installed to a point 24 inches
SEPARATE PERMIT�;���Df�6� FORup from exterior wall line, or the use of other
WIRING,E �l�r -4eF��, PLUe�,j BIND AND SgGI�tS. approved uncierlayment membrane.
WARNING
Before digging call for
all utility locations
454-0002
RE1011IR971) OVA AW
SEPARATE P RMITS ARE REQUIRED P(5R 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
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
$6,200
$3.10.
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-
$90,00.
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$93,10.
SI ATUREOFCON TOR OR AUTHORIZED AGENT IDATEI
RMI.T
WHEN PROPERLY VA A ED THIS S YOURATE
t.,�
SI TUR OWNER IIF OWNER LDERI IDATEI
BLDG INSP
NEW [ ] Effective 1/1/90
ADDN [ ] R-1 AND R-2'
ALTER Building Permit Application
construction Address:
Legal Description: 10c-
Owner Name & Address: r. f� rV- Sq C2 Le. r"� Vi Tel.
Contractor: � Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIM G AREA: Iexq h Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DBCR AREA: Length / Width /K ' Hgt/amend Sq. Ft. ��
OTHER: S
906,00
39.71 Z3 CIA
Corner Lot [ ] Inside Lot [y] Ft. Yd Setback -35 ' Side Yard Setbacks /b ��-
Type of Construction: WO,Q T-RtA-4,4b Estimated Cost: $ (.07-00. 00
Approx. Completion Date: Q M 6 A jCWZ
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
Width + 6' See Back Page
DATE: r- -Qgla APPLICANT': Tel. # 571- /®,f,! '
Permit Fee $
State Surcharge $ 3 �O
SAC Charge $
Driveway Escrow $
Park Fee $
Sewer Main Charge $
O
CITY USE ONLY
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above }
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS:
P��, «� �',�� O � X41
� u"j OF,
o�
Pcuwaat C ®m ays'w �1� rib Eva,
610c)
2000--- 4r°,cd
SA 4S''ov
�0,®d
r-9
0
gitkef �vtovt �tncr an fent �., X75.32 --- ^�
SrORr FRAME
9 135
i=Ole on ;corner
or �L
r ---*l Z) --
N
+ S� �e �4= POTS
et
t--+i ^ 1 c.o r cr el
o- d �ata+lk o It-
A'A75 X0
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CITY OF FRIDLEY
APPLICATION FOR PWMBING AND GAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
New Fixtures
$
5.00
m
Future Fixtures
$
3.50
U
Old Opening, New Fixture
k
N
$
Water
$
4.00
$
Blow Off Basin
$
5.00
E
d
to
HA
$
k
$
P4�
$
Hydraulic Valve
Heater
W
M
ro
$
M
$
Water Treating Appliance
,lI
al
s�oi
q C
$
�
$
Gas Range
$�
10.00
N
O
$
y9
$
!m�
N
•'i
Type
$
iBfd
$
N
N
1% of Value of Fixture or
Appliance
O
o
•�
State Surcharge
Nro
R
O
O
•N N
•V N
N
.0
In
U
D
PO
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3
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w
81 Ped
9
O
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lst
2nd
3rd
4th
(R) = Future Connection Opening
Connected with Sewer
(*) = New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
New Fixtures
$
5.00
$ zo
Future Fixtures
$
3.50
$
Old Opening, New Fixture
$
1.50
$
Beer Dispenser
$
4.00
$
Blow Off Basin
$
5.00
$
Catch Basin
$
5.00
$
Rain Water Leader
$
5.00
$
Hydraulic Valve
$
5.00
$
Sump or Receiving Tank
$
5.00
$
Water Treating Appliance
$
7.00
$
Hot Water Heater
$
5.00
$
Gas Range
$
10.00
$
Gas Dryer
$
10.00
$
Back Flow Preventer Required.
. . Yes ( ) No (
)
Type
$
5.00
$
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1% of Value of Fixture or
Appliance
$
State Surcharge
$ .50
Reinspection Fee $
,
($15.00)
TOTAL FEE
$ ,
Effective Date May 1, 1988
Job Address 2 )
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. , 19
OWNER
KIND OF BUILDING l a � S
USED AS
TO BE COMPLETED ABOUT
ESTIMATED COST
N
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
Company
Signed
Tel. No.��
ROUGH INSP.
Date
FINAL INSP.
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE