PRE 2010 DOCS` Mage of Fridley9 Mm.
lel . 5 omee of WSPECT01% OF ISUM DINGS
r
Front Di
To be used as_.,_
Permit is hereby
Fridley, Minn.,
LOCATION OF BUILDING
4
._._ _ Part of
Block J� . Addition or Sub -Division
C'% Va DE'SCIRIPTION OF BUH_,DING
'
'$'0 r
rr
Height Stories Manner of Construction i "1;'i*
't Estimated Cost E` :w*+ i':k«' 'M
To be completed �
i
the building tri ,w" described in the above statement. This permit is granted
upon the express c6ndition that the person to whom it is granted, and his agents, employees and workmen, in all
the work done in, around and upon said building, or ar.y part thereof, shall conform in all respects to the ordi-
nances of F'ridleyl Minn., regarding the 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.
io` Inspector of Buildings.
In consider
the above perp
above set forty
sworn, I hereby
true as therein
Subscribed
day
AGREEMENT A1TD SWORN STATEMENT
tion of the issue and delivery to me by the Inspector of Bui3.f!ings of la'ridle�7 of
it, I hereby agree to do the proposed work in accord.ence with the description
and according to the provisions of tn.e oxdina nces of Fridley, and, being first duly
state and say that the facts stated by me an' contained i >t e above permit are
sworn to before me at Fridley,
A.D. 19-
for Fewer Plants and Heating. Codings Vewilaf o, R e sed
Air ConcIftning Systennz and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIB: RATfi TOTAL.
Furnace Shell & Duct work .. $10.00 $
Replacementt of Furnace 6.00 $
Repairs & Alterations—up to $500.00 6.00 $_
Repairs & Alterations each add. $500.00 3.00 $—_ _
NECK WARM AER
Furnace Shell & Duct Work to 190,000 BTU ........ .. $10.00 $—
each add. 60,000 RM .................... .. 3.00 i
Replacement of Furnace .. .... 6.00
Repairs & Alterations—up to $500.00 6.00
Repairs & Alterations each add. $500.00 .... .. .... &00 $
STEAM or HOT WATER SYSTEM
Size No
Furnace Shell & Lines—to 400 sq. ft. EDR Steam
$10.00 $.
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water
10.00 $_
Each add. 200 sq. ft. EDR Steam
3.00
Each add. 320 sq. ft. EDR Hot Water
3.00 $,
OIL BURNER—to 3 gal. per hour 6,00 $ —
over 3 gal. per hour --See Fee Schedule
GAS BURNER (up to 196,000 VM .. ...... &00 $
over 199,00013'M See Fee Schedule
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures .. . ..... xE 100 $
Additional Fixtures x .76 $
Gas Range to 199.000 i= 600 $
AM FAN HEAMG
` i
� '� �
TING SYSTM Sea FM Scbadub
T ITIlAJ1T1NG SYSTEM
ALTERATIONS & REPAIRS TOTAL. Vide
ROUGH—
it
/
FINAL - % ' -7 7
Dopt, of Bldya. Phone M04M
City of Fridley:
The undersigned hereby makes application for a permit for the work hereir
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.
Fridley, Minn_ /-/
Owner
Kind of Building
Used as .. -7-Z_ Z)
To be completed about --J/::_
Estimated Cost, $agL� _
61 New. Building Permit No. Permit No. i)
DATION OF WORK
HEATING or POWER PI.ANTS-,Steam, Biot Wats, Warm Air—No
Trade Name
Size No
Capacity Sq. Ft. E.D-R
BTU HP.
Total Connected Load
Kind of Fuel
BURNER — TYade Nance
Size xs-
Capedi Sq. Ft. E.D R-
BTU Em
i
(nMwRas-ovis)
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PEWIT
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Job Address 7J
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Department of Buildings
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City of Fridley
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Tel. #571-3450
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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
1st
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
tad
Fridley, Ma. 3 U , 197( -
3rd
OWNER �/�I12 O /+J
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KIND OF BUILDING—
(R) = Future Connection Opening
Connected
with Sewer
(*) = New Fixture, Old Opening
Water
USED AS J -4y h2 Lr
z
TO BE COMPLETED ABO tjT '4�7e�� --
PARTIAL RATE SCHEDULE
ESTIMATED COST
PLUMBING FIXTURE RATES:
N0.
RATE
TOTAL
oLD NEW BUILDING PERMIT NO. PERMIT NO. C»J�
N mber Fixtures
x
$3.00
O O
e d '�
Future Fixture Opening
x
$2.00
$
of •G b
Company
New Fixture, Old Opening
x
$2.00
$
Signed By
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTU
x
$5.00
$
Tel. No. /
100,000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7.00
$
New Ground Run Old Building
x
$5.00
$
ROUGH INSP.
Date
Electric Water Heater
x
$5.00
$
GAS FITTING FEES:
FINAL INSP.
Date
1st 3 fixtures
x
$3.00
$
Additional Fixtures
x
$1.00
$
��
APPROVAL FOR PERMIT /�/i�
Gas Range to 199,000 BTU
x
$10.00
$
REPAIRS $ ALTERATIONS
First $100.00
$5.00
$
each add. $100.00 or fraction
$2.00
$
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50
State Surcharge
$
.50
TOTAL FEE
$
f
Y
REINSPECTION FEE
($30.00)
CINOF
FRIDLEY
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
August 18, 1986
Mr. Roger Harmon
388 - 66th Avenue N.E.
Fridley, IST 55432
Re: Construction of Deck Without a Building Permit at 388 - 66th Avenue N.E.
Dear Mr. Hannon:
An inspection on August 12, 1986 determined that a deck was being constructed
without first obtaining a building permit frau the City. It was also noted
that the shed in the rear yard could possibly be closer than three feet from
the side lot line.
Construction sketches and or plans for the deck must be brought into our
office for approval before a building permit can be issued. We will expect
this to be completed by August 25, 1986.
The shed in the rear yard must be relocated to be a minimum of three feet
from the side lot line if it is determined that it is located closer than
this requirement. We would expect this to be completed by August 29, 1986.
If you have any questions on these matters, please feel free to contact me at
571-3450.
S'
DA G. CLARK
Chief Building Official
DGC/mh
M
sueJEcr
RM_
City of Fridley
18621
AT THE TOP OF THE TWINS
BUILDING
PERMIT
CEIPT NO.
Ir
16U• COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
,•j CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910-F15
I
8/26/86
I
JOB ADDRESS 388 - 66th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
31 4
3
Rice Creek Terrace Plat 2 SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Roger Harmon same
IN 571-5880
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
R-1
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
15' x 14' deck and 19' x 12'
deck
9 CHANGE OF USE FROM
TO
STIPULATIONS
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 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
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
$2 750
$1.35
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-
38.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$ 9.63
$49.51
SI FCONTRACT OR AUTHORIZED AGENT (DATE)
VALIDAT T SIS YOUR PE IT
01
jEpjY
rE
SiNAT rE 01-CMNNKIP OWNER BUILDERI (DATE)
M
NEW [ ] City of Fridley Effective 4/1/86
ADDN. [ ] R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address: 3s--
Legal
s Legal Description: �-° 3 -z-
Owner Name & Address: Tel. #
Contractor:�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.
DECK AREA: Length Width_ Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback _—
Type of Construction: r� � � �� Estimated Cost: $ 0
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
DATE: APPLICANT: Tel.
CITY USE ONLY
Permit Fee $ s00 Fee Schedule on Reverse Side
Plan Check $ �A - 25$ of Building Permit Fee
State Surcharge $ lA $.50/$1,000 Valuation
SAC Charge $ $475 per SAC Unit
Park Fee $ '� Fee Determined by Engineering
Sewer Main Charge $
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $
STIPULATIONS:
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0
0
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U 14
STATE OF MINNESOTA DEPARTMENT OF HEALTH
ABANDONED WELL RECORD
1. LOCATION DF WELL MINNESOTA UNIQUE WELL NO.
(leave blank if notnot==
County Nam'ANOKA
Township Raab
Township Number
Range Number
Section No-
Frkctionof
4. WELL DEPTH (completed)
Date sealed
FRIDLEY
30 W
23 or
14
k
SWSENW
80 ft.
SEPTEMBER 19,1990
If not known, indicate formation log from new well or nearby well.
S
CLAY LL
0
5
9• SCREEN
Screened well from.= ft. to 88 0 ft.
Numerical Street Address and City of Well Location or Distance from Road
5. DRILLING METHOD (if known)
Intersection
Cable toot 40 Reverse 70 Driven 100 Ouq
188 -66th AVE. N.E..
20 Hollow Rod 50 Air BO Bored 110
MUDDY SAND BLUE
30 Rotary 60 Jetted C Power Auger
Sho exact location of well
(in section grid with 'X')N Sketch map of well location
CLAY , SAND , GRA /BR WN
6. OBSTRUCTIONS
—11 aw
N' 'x'11
W
MEER
a---1 or;za I
7O Air Conditianing I ]
014
Mailing A ifferent than
S. CASINGS)
ROGER & DEBBIE
property address indicated above
Plack Threaded 70
HARMON
388 -66th AVE. N.E.
20Galy. C1 Welded
FRIDLEY N MN . 55432
30 Plastic 60 Stainless Steel
3 1n. to 77 ft.
(b a obstructed I] Yes No
Obstructions removed [3es 0 No If obstructions cannot be
removed, contact MON
E before sealing.
7. USE
y l�Domestic 40 Monitoring 80 Heat Loop
I r 213 Irrigation 50 Public 9[3 Industry
1
3E3 Test Well 60 Municipal 100 Commercial
� l
a---1 or;za I
7O Air Conditianing I ]
2. PROPERTY OWNER'S NAME
Mailing A ifferent than
S. CASINGS)
ROGER & DEBBIE
property address indicated above
Plack Threaded 70
HARMON
388 -66th AVE. N.E.
20Galy. C1 Welded
FRIDLEY N MN . 55432
30 Plastic 60 Stainless Steel
3 1n. to 77 ft.
HARDNESS OF
3. FORMATION LOG COLOR FORMATION 'FROM TO
If not known, indicate formation log from new well or nearby well.
in. to ft.
CLAY LL
0
5
9• SCREEN
Screened well from.= ft. to 88 0 ft.
SANDY CLAY YELLOW
5
14
(If known)
❑ Open Hole from _ ft. to _ ft.
MUDDY SAND BLUE
14
40
10. STJ1TjC WATER LEVEL
J j ft. below 0 above9 —1 9— 9 0
land urface Date Measured
CLAY , SAND , GRA /BR WN
40
93
11. WELLHEAD COMPLETION
10 Pittess Adapter 40 Found Buried
offset a�
FINE SAND
185
193
Ca.silit
16. REMARKS, ELEVATION. SOURCE OF DATA - CASINGS REMOVED, CASINGS PERFORATED, ETC.
12. GROUTING INFORMATION
xHeat Cement 20 Bentonite 3D 4 BAGS
THE GEOLOGY WAS TAKEN FROM THE WELL AT:
FRIDLEY TEST WELL #3
Grout material PORTLANDfrom80 toSIIRFJ1jC1?ds
69th AVE. N. (EAST SIDE OF HWY.#47)
NEAT
FRIDLEY, MN.
13. NEAREST SOURCES OF CONTAMINATION
8 5 feet N direction CITY SEWED
WATER LEVEL IN THE WELL ABOVE: 34'
Well disinfected before sealing? Yes MAIN
DATE WATER LEVEL WAS TAKEN: 2-27-69
14. PUMP Removed 0 Not PreseAt
Type: 10 Submersible 30 L.S. Turbine 50 Reciprocating
)9Jet 40 Centrifugal , 60
1s. EXISTING WELLS (Please sketch locations of abandoned and
SEP 19 1990
active wells in remarks section or on back.)
Other unused well(s) on property? 0 YesNo
Abandoned:
0 Permanent 0 Temporary E3 t ealed
17. WATER WELL CONTRACTORS CERTIFICATION
SEALEDis
This well was sealed under my jurisdiction and this report
true to the best of my knowledge and belief.
According to MN State Regulations
15
E.H. RENNER & SONSInce
Licensee Business Name License No.
No.
15688 -TAP—VT qT- NW— ELK RIVER
Address1-612-427-6100
F.- 11a -
Signed to 9-21-90
STEVE L ND Date 9-19-90
Name of driller
FFiCIAL ABANDONED WELL RECORD (May be used for Property Transfer)
zW0t2W r: pzze wzas Dmw
WAYNE B.
CITY OF FRIDLEY INSPECTION DIV. /
6431 University Ave NE 6
l0
Fridley, MN 55432 1 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
572-3604
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective On March 1, 1996
P d) _T_
PLUMBING FIXTURE RATES: NO.
RATE TOTAL
New Fixtures
$ 7.00
Old Opening, New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater —Electric
$ 7.00
Water Heater — Gas** I
$10.00 / .00
Gas Range**
$10.00
Gas Dryer**
$10.00
Back Flow Preventer Required ( )Yes () No
Type
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
$ .50
HILL RUTH
388 66TH RJENUE NORTHEAST
JOB ADDRESS_ FR I CILE4' , 554::
H 571-5418 W 33-12-4181
The undersigned hereby makes application for a perm it 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.
.1996
Owner JI %/
Building Used As
Estimated Cost
PLUMBING CO
SIGNED BY
Approved By
PERMIT NO.
:I[5LoM _U IM 0jAJK r,
TEL N0.
MASTF-R L.I , 5
Rough—In Date Final Date 1 /2 � ej
$10.56 PLUS THE $.50 STATE SURCHARGE
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES.
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SUBJECT
P
City of Fridley
0 2 88
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
CEIPT NO.
-- COMMUNITY DEVELOPMENT DIV.
_____
r �� PROTECTIVE INSPECTION SEC.
"t -P L70,
I �
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
9/21/99
10B ADDRESS 388 66th Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
3, Pt. 4
3
Rice Creek Terrace Plat 2
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Brian A. Hill
571-6418
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
Owner
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 X® REPAIR
❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof house and garage (27 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
S0. 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
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
2360
$1.18
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
$83.25
e SCA. 36
PLAN CHECK FEE
OTAL F
86.
SIG/NAA��T URE,OAFFCC CONTRACTOR ORAUT140RIZEDAGENT IDATEI
N ROPER IDATE T IS R PERMIT
YOU
4/� 16 /L/
BL INSP
PATE
SIGNATURE OF OWNER SIF OWNER BUILDERI IDATEI
NEVV[ ] - Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION Q ;4Y
0 0
Construction Address: 13&18- (dj -(� LAA N�
Legal Description:
Owner Name & Address: �(.P (U �._ � `%, Tel. # 600
Contractor: MN LICENSE #
Address:
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EWROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: 5 C.---- a - d
Construction Type: - Estimated Cost: $� 3(,
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE:q lz� APPLICANT: 'IZ(P N \ I Tel. # 66? - S 71LkZIT
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge.
Driveway Escrow
Erosion Control
Park Fee $
Sewer Main Charge $.
TOTAL
STIPULATIONS:
r r.
CITY USE ONLY
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. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
Building
PLUMBING
Permit No.:" (D
Inspections
RESIDENTIAL APPLICATION
Received B -
763-572-3604
763-502-4977 FAX
CITY OF FRIDLEY
DaMMAIP 192
EFFECTIVE 2-19-09
DATE 8 / Z,
YOUR EMAIL ADDRESS
SITE ADDRESS
3 F P 6 (o
THIS APPLICANT IS:
O OWNER %C-bNTRACTOR
PROPERTY
OWNED/
NAME: 1 HP -1 a 1J At' , L L
ADDRESS: B % L i E CITY FR • a L 6 y
sTATE� ZIP 5iS w3'X
TENANT
PHONE: 'oto 3- S 7d - a 0 b y
CONTRACTOR
NAME -
SUBMIT
OPY of
STATE LICEN TAY Overacker Plumbing
s
LICENSE, BOND AND
Itic _EXP DATE
STATE BOND 502 E Main St
CERTIFICATE OF
EXP DATE
ADDRESS:_ Anoka, MN 55303
INSURANCE
PHONE {763} 572-8880
SINGLE FAMILY E] TWO FAMILY ' ! - O TOWNHOUSE
STATE ZIP
PERMIT TYPE
TYPE OF WORK:
O NEW REPLACEMENT
DETAILED DESCRIPTION OF WORK
FEES ARE TEASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
—BATH SDWAAY FLOOR DRAINS —SHOWER — WATER PIPING
BATHTUB —GAS PIPING ([PEED CITY LIC)
CLOTHES WASHER —SWIMMING POOL WATER SOFTNER ($33)
DISHWASHER
_ KITCHEN SINK WATER CLOSET —_ BACKFLOW PREV. ($IS)
— — LAUNDRY TRAY WATER HEATER ($3S) FOR IRRIGATION
_ WATER METERro17iER
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♦' C' "v.,:/g+»i•� a•S:.df.,'. C�'sv i.: �k:,..:'!_t.'.'::. ••l�.f'+y� ..�.. {.•;
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f 6 I h 2
1 �SSId 7i' •f6"t 'f''ay' i` e
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THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I Be Eby apply foo.=it plumbing permit and I acknowledge that the information above is complete and accurate, dug the work will be in
caafO'I arsctswilh 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 APPLICANT PRINT NAME_ .TA C t F �( f1.a a1 E DATE J4L
Ad
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
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