PRE 2010 DOCSPermit Fee paid on Permit #11,315 for 1560-1570 69th Avenue N.E. �
City of Fridley, Mian..13
6431 University Ave. N. E., Minneapolis, Minn. 55432(�()
BUILDING PERMIT
nate: February 22, 1972
OV"W: _-R- e- Greek Dobai opme t Compapur Builder . ,, ,App Contat-toXS,, Inc.
.Address 85 Wester Road, Cir&,1 a Pines, Minn. Address 1052 Osborne Road N.E., Frd.
786-3680
1578211 1580215822
No 158421586,�8�
Idot Parcels 10 003
LOCATION OF BUILDING
68th Avenue N.E.
Section 13
Part of Lot
Addition or Sub -Division
Corner Lot Inside Lot Setback
Sewer Elevation
To be Used as: Each Unit
Sideyard
Foundation ,Elevation
DESCRIPTION OF BUILDING
h mow ho,a . j1 its Front _ 20' Depth 32' Height 21' Sq. Ft. 1213' Ct, Ft
Front Depth Height .—._........_ Sq. Ft _.._ Cu. Ft.
Type of Construction Wood Frame Est Cost See #11, 315 To be Completed 1_ year
In consideration of the issuance to me of a permit to an
construe the building described aibo, I agree to do
the proposed work in accordance with the description above i�th and in comVl ��w� provisions of
Ordinances of the city of Fridley.
In consideration of the payment of a fee of $ See 1411.31�erm�t is hereby granted to Rice Creek Dev. Co.
to construct the building or addition as described above. This permit is granted
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
V.1tWn � city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordbian
CLARENCE BELISLE
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to a"
the Building Inspector for separate permits for these Hems.
X7 579cm m-2 MeAcw
PAIM�AL RATE &r,pZ��1
iTMA VARM ASR: MTZ ToraL
nrnaoz Shell & Dud Werk ....... ..... ..3$10.00 $
replacement of Twwce ..... . 0.00 $
Repairs Or Alterations --up to $5W.00 6.00 $
Repaivfs dna Alterations each add. $M.00 3.00
mcm WAM ALR
7urnace Shell & Duct Work to 120.000 BTU ...... ..$10.00 $
each add. 60.000 STV ............... .... &W
Replacement of Furnace 0.00
Repairs & Alterations --up to $300.00 11.00 {
Repairs & Alterations each add. $900.00 &W ;
eaTSAM or HOT WATER SYSTEM
+rnace Shell & Lines—to 400 sq. tL EDR Steam $10.00 $,
--
Furnace Shell & Line—to AMA sq. ft. EDR Hot Water 10.00 $_
Each add. 200 sq. ft. EDR Steam &noEach add. 320 sq. ft. EDR Hot Water 3.00
OIL SURNER—to 3 gaL per hour
over 3 gaL per hour—See free Schedule
GAS BURNER (up to 19k000 BTU)
over 199,000 BTU goo Fee schedule
GAS FITTING FEES:
1st 3 Fixtures _
Additional lfttures _
Gas Range to 199.0(0 _
,ko9 . DCS
NO RATE TOTAL
_X$2.00 $1 0U
_ x .75 $
_ _$ &00 ;
AIR CO>(IDITIO111>NO $ ICU. L'.) L"
FAIL HEATING SYSTEMria OdmAnle,t
WENT1LATIMIO SYSTEM ;7 4rio� .eeti U d
ALTERATIONS & REPAIRS TOTAL. rZZ�D
Timm
City of Fddley:
The undersigned hereby snares appllcafAen for a permit foq the work hesela
specified, agreeing to do all work in strict with fhe City Ckviblamm
and ruling of the Department of Buildinpfs, a9d hereby declares thatrail Me 2b
and representations stated in this application an true and eorrecL
/a31175 .
Kind of Building.
Used as _.
To be completed about
Estimated Cost,
uilding Pewit No. Permit Ho.
Or WOW
HEATING or Hot Water 40arat Air NoaAg,—'
Tirade Name //-' Size No 91 Q 7 - y ��
Capacity,R?-XAQ(Sq. Pt. E.Dy BTV H.P
Total Connected Load Riad of tit
BURNER — Trade Nam Size No
Capacity Sq. IR Emit- STV MP.
(1tWAia5_oVrna
T
glk
ri
of Fridley
�plic�!%a for Ptq sad Gat Rlhiq Pamil`
Drpt. of Bldoa. Phone SO -345D
&FILM I Man or WORK
Number. KwA and Location of nxtm"
PARTIAL RATE SCHEDULE
PLVMIXG rMUM RATW:
NO. RATC Tar"
ffwwb r Fixtures ................ -NUN N :
rutu:e Pasture ....:...... It Sim s
New risture am Opti.......... Nam t
Cate% JMMMW .............:...... : i33S f
Water Heater "Up to W9 W RM ....
= i3.itid i
New Graaad Run OM Bldg ........ r PSR !�
nMww1vw*twUMB%G�
a�..............
GAS
a u' •
f� `i i . MQ TEM- IM B&TC TM"
M3 Fixtum .............. a .. _ZUW 6
A/�d�., r dy.! e�............ry_ 6.75 S J�
On Range to 199.000 BTU .......... ® Z IM - • 00
State Surcharge $_ •50
> "AM f ALT®ilTIOMB-41sfor Is Batt
TOTAL I= � �'
City of 71rid1ry:
The undersigned hereby makes application for a permit for the work here%lk.
specified. agreeing to do all work in strict accordance with the City Osdinaaary
and ruling of the Department of Buddin" and hereby declares that as the tasiz,
and representations sated in this applicatioo are true and correct
Kind of Building �--� —
Used as /� •. z��.:
To W costed about
Estimated cost.
OW-Plew. Building Prrrmit >rio i'.csu i�
Wowd
.,�
E
.................
PARTIAL RATE SCHEDULE
PLVMIXG rMUM RATW:
NO. RATC Tar"
ffwwb r Fixtures ................ -NUN N :
rutu:e Pasture ....:...... It Sim s
New risture am Opti.......... Nam t
Cate% JMMMW .............:...... : i33S f
Water Heater "Up to W9 W RM ....
= i3.itid i
New Graaad Run OM Bldg ........ r PSR !�
nMww1vw*twUMB%G�
a�..............
GAS
a u' •
f� `i i . MQ TEM- IM B&TC TM"
M3 Fixtum .............. a .. _ZUW 6
A/�d�., r dy.! e�............ry_ 6.75 S J�
On Range to 199.000 BTU .......... ® Z IM - • 00
State Surcharge $_ •50
> "AM f ALT®ilTIOMB-41sfor Is Batt
TOTAL I= � �'
City of 71rid1ry:
The undersigned hereby makes application for a permit for the work here%lk.
specified. agreeing to do all work in strict accordance with the City Osdinaaary
and ruling of the Department of Buddin" and hereby declares that as the tasiz,
and representations sated in this applicatioo are true and correct
Kind of Building �--� —
Used as /� •. z��.:
To W costed about
Estimated cost.
OW-Plew. Building Prrrmit >rio i'.csu i�
Wowd
.,�
E
SuBjECT
RMI
City of Fridley
29659
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
SEC.
r PROTECTIVE INSPECTION
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
L j\ 612-571-3450
910415
6/10/99
JOB ADDRESS 1578 - 88 68th Ave NE
1 LEGAL
I LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
par. 10&20J
Section 13
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jim Bern M mt 8162 Bloomington Ave. Bloomington
55425 854-7788
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Horizon Exteriors 1333 Larc Industrial Blvd
Rurnsvillp 5S337 8911-3WO
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
S ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION O ALTERATION XI REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof Townhomes (50 S Tear -off
9 CHANGE OF USE FROM
TO
STIPULATIONS
Raffixfox
Underlayment must comply with the State Building
Code.
Permit Inspection Cards
Will Be Mailed
To Homeowner To Post
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
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
$4370
$2.18
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
111.25 + $83.25 IF
Fire SCj$4.37
PLAN CHECK FEE
TOTAL
Z1201
X
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT [DATE.
EN OPv2ffiix��
S-GNATURE OF OWNERoF OWNERSUILDERI iDATEi
BLD 1NSP
v
NEW [ ] oZ p , D� Effective 1 / 1 /98
ADDN [ ] CITY OF FRIDLEY �A
ALTER [)(J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �6q
BUILDING PERMIT APPLICATION dA
ConstructionAddress: 16:1-9— 92; to S th AVE,
Legal Description:
Owner Name & Address: rnn /%2. B[ , el. # 9574— 7199
Contractor: i�bl'12�'D,r1 f t�E'.i� orS ��M�n� MN LICENSE # oldp
Address: /333 orc. (ndL S-lria1 .�1yolT,[�' Vi ll e SS 3 Tel. # X 10 '3Q0o
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: 1COr---)U
�'0. a�
Construction Type: nc� Estimated Cost: $4Na45:0Zt
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: (O Z- aJ APPLICANT: G�C�•L��+e Tel. # 8170 -39Oo
53,
_ CITY USE ONLY
Permit Fee $ _ ee Schedule on Reverse Side
Fire Surcharge $ t .001 of Permit Valuation (1 / 10th %)
State Surcharge $ $.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 $ C W1 dOubli f Fee)
STIPULATIONS:
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
572-3604
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
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
Gas Dryer
Back Flow Preventer Required
Type
NO. RATE TOTAL JOB AD
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
)Yes ( ) No
$5.00
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS��
I% of Value of Fixture or Appliance
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.
„nd,196'
Owner
Building Used Ash ', C
Estimated Cost PERMIT NO. Z D 222
PLUMBING COMPANY e C-!:�
GASCO c
Approved42713oughn Date Final Date Z "Z� ^ 7 Z
State Surcharge $ .50
65 �l MINIMUM FEE FOR ANY PLUTABING/GAS PERMIT IS $15.00
TOTAL FEE $ I �Jv PLUS THE $.50 STATE SURCHARGE
Water
Closet
Urinal
Bath
Tub Shower
Wash Drink.
Sink Tray Fount.
Floor Catch
Drain Basin
Auto. Gas
Washer Appl.
Gas Misc.
Range Fixt.
Water Heater
Stories
Gas jElec
Basemen
Floor 1
6
Floor 2
Floor 3
Floor 4
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
Gas Dryer
Back Flow Preventer Required
Type
NO. RATE TOTAL JOB AD
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
)Yes ( ) No
$5.00
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS��
I% of Value of Fixture or Appliance
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.
„nd,196'
Owner
Building Used Ash ', C
Estimated Cost PERMIT NO. Z D 222
PLUMBING COMPANY e C-!:�
GASCO c
Approved42713oughn Date Final Date Z "Z� ^ 7 Z
State Surcharge $ .50
65 �l MINIMUM FEE FOR ANY PLUTABING/GAS PERMIT IS $15.00
TOTAL FEE $ I �Jv PLUS THE $.50 STATE SURCHARGE
RU135-09-2005 13 34 CITY OF FR I DLEY
PLUMBING
RESIDENTIAL APPLICATION
City of Fridley
E�X
Number
Received By
Date Received
NOTE: IF PROPERTY 13 NOT OWNEPUOCCUPIED. A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT.
rJ ,F� �,
DATE YOUR L ADDRESS% O���7/� - z,p�
SITE ADDRESS
THE APPLICANT IS: (CIRCLE ONE) OWNER CONTRACTOR
PROPERTY OWNER/ NAME
TENANT ADDRESS
CITY STATE 27p
-
PHONE 0!
NAME
CONTRACTOR ADDRESSZ
CITY9 Q.Et�
STATE /� 27P
PHONE -n VZo/Y-4,A'� twv.0 L /// i eAiied
PERMIT TYPE SINGLE FAMILY TWO FAMILY TOWNHOUSE
TYPE OF WORK O NEW E e REPLACEMENT
IETAILED DESCRIPTION OF WORK
FEES ARE BASED ON $10,00 PER FIXTURE, EXCEPT WHERE NOTED
FIXTURES (DIDICATE TOTAL NUMBER OF EACH)
BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING
BATHTUB GAS PIPING (Need Ci(d License) MMMINO POOL WATER SOFTENER ($3,1
CLOTHES WASHER KITCHEN SINK ATER CLOSET BACKFLOW PREY, pis)
DISHWASHER LAUNDRY TRAY WATER HTR (535) FOR IRRIGATION
WATER METER OTHER
-of-cost-of
�IIIIFfIMUIIiI:-$1S:f1p or gfo o-ccost-of the improverfieft Wfiicheveris-
Plan Review $ greater on work fess than $300
Surcharge $ ,50
TOTAL DUE $ q54:e Make checks payable to: City of Fridley
THIS IS AN APPLICATION FOR APERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge that the information above Es complete and accurate; that the work will be in contormance with
the ordinances and codes of the City of Fridley and wlih the Minnesota Construction Codes; that 1 understand this is not a penriit but only an
application far a permit and work i5 not to start without a perrrr that the work will be in accordance with the approved plan in the Mse of all work which
requires review and approval of p
! ME OF APPUCANT ��� 4004 pct- DATE
P1 ese �Pe or print
SIGNATURE OF APPLICANT
OF FRIDLEY COMMUNITY DEVELOPMENT DEPART
0431 UNIVEP.SITY AVENUE NE, FRIDLEY MN 55432
City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
Mechanical Permit#
"°'2I0
Residential Application
City of Fridley
C..., Q"►Ir Clrls Gnr Ronviirarl Infnrma$inn
Date Site Address:
The applicant is: (cirl a one Owner Contractor rte'
Property Owner-
Address:/6-51Z 4q -l^ �✓�
City:
State: A141 Zip:.C5r'401_;'2,
Phone: Cell: Fax:
Contractor Informati n
Company Name:
-
Contact Person:
-r
Address. 8
City: State: /LIN Zp:.Z� L�
57
Phone: ��! �1 ?A�� Cell:&&
y4C! c�� 9 Fax:
Email:- mMN
Bond# & Exp Date .�s
Type of Work (circle one): New
Replacement Alteration/Remodel _
Detailed Description of work:
099WPJ 6 J
d.Y�itr ,
Equipment Installed: MFG:
Model: Size/BTU:
MFG:
Model: Size/BTU:
MFG:
Model: Size/BTU:
Please check all that apply:
Fireplace (gas) $15.00 New Gas Grill $10.00
$25.00 _Fireplace
(wood) $35.00 _Gas Unit HTR $10.00
_A/C
to Air exchanger $15.00
$35.00 _Pool Heater $35.00
_Air _Furnace
$35.00 _Gas
Dryer $10.00 Ventilator $15.00
_Boiler
_Chimney Liner $10.00. _Gas
Piping $10.00
Duct Work $10.00 _Gas
Range/Oven $10.00'
Permit fee $
(Total from above -Minimum fee $35.001
Surcharge I
0.50
Total Due $
Make check payable to Uity of Fridley
This is an application for a permit- not valid until processed
I hereby apply for a mechanical 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; that the work will be in accordance with the ,
approved plan in case of all work which requires review and approval of plans. hy �y�C
Signature of Applicant:
Approval Inspector Sig
Please Note: Separate permits are required for Building, Plumbing, and Electrical work
I
HUU-177-e1OIOZ> 1,5; 34 l.1 I T Ur r K 1 JJLt T
City of Fridley Building Inspections Dept
6431 University Ave NE
Fridley MN 55432
Mechanical
tyiil
H . W/704
Ph: 763-572-3604 FAX: 763-571-1287
Residential Application
City of Fridley
See Back Side For Required Information
Date _L� Site Address:
The
Owner-
City-.-
wner
C=1 -I
r
City: State: Zip:
Contractor
Company t
City;
Detailed
of work -
or ..State: `Li(J Zip:
Cell:,617 OTO yP41-7
Permit # c2oo!� O;��
MFG:
Model:
Size/BTU:
MFG:
Model-
Size/BTU:
Please check all that apply:
_Fireplace (gas) $15.00
New Gas. Grill $10.00
A/C $25.00
Fireplace (wood) $35.00
_Gas Unit HTR $10.00
Air to Air exchanger $15.00
_Furnace $35.00
_Pool Heater $35.00
_Boller $35.00
_Gas Dryer $10.00
$15.00
_Chimney Liner$10.00_✓Gas
Piping $10.00
_Ventilator
Duct Work $10.00
Gas Range/Oven $10.00
Pemut Fee bu
(focal from above -Minimum fee $35.00)
Surcharge.: - .. -_. -- _ _—_:. _ _ ----- _-:.::.:- --_ _ z-" -.- -
Total Due SL Make check payable to City of Fridley
This is an application for a permit. not valid until processed
I hereby apply for a mechanical 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 Codas; that 1 understand this is not a permit but only an apprication
for a permit and work is not to start without a permit; that the work will be in accordancB with the
approved plan in case of all work which requires review and approval of plans.
Signature of Applicant: c Date: /
Approval Inspector Signature: Date:
Building
PLUMBING
Permit No.
Inspections
COMMERCIAL APPLICATION
Re By
763-572-3604
CITY OF FRIDLEY
Date e,, O
763-502-4977 FAX
EFFECTIVE 1-1-08
t��jj��jj
DATE �a:22 –0 ir YOUR E,-/MAIL ADDRESS
/ ,p
SITE ADDRESS 0 D�'
,�'
TENANT
SUITE NO.
PROPERTY
NAME: A+ - &A__T
ADDRESS: C14Y STATE ZIP
OWNER/
TENANT
PHONE:
NAME: GAO /K–fZ C 1 L G — C
S/&-
�'H-�[LE # �Z� ��A-� EXP DATE
CONTRACTR
SUBMIT A COPYOOF
YOUR STATE
O # EXP DATE
LICENSE AND BOND
ADDRESS: CITY ST/ATE ZIP
PHONE FAX
PERMIT TYPE❑
INSTITUTIONAL ❑ MULTI-FAMILY ❑ SWIMMING POOL
OWNHOUSE ❑ COMMERCIAL/INDUSTRIAL ❑ OTHER
❑ NEW 'REPLACEMENT ❑ ALTERATIONIREMODEL
TYPE OF WORK'
DETAILED DESCRIPTIO OF WORK
waw ;z5., br, t. s...
.i.ti ., c. <. ,
_ CLOTHES WASHER
_ FLOOR DRAINS _ RPZ VALVE _ URINAL
_ DISHWASHER
_ GAS PIPING (CITY LIC REQ'D BACKFLOW PREY. _ WATER HEATER
_ DRINKING FOUNTAIN _ GREASE TRAP _ ROOF DRAINS _ WATER METER
—FAUCET
_ KITCHEN SINK _ SHOWER _ WATER PIPING
_ FLAMMABLE WASTE
TANK _ LAUNDRY TRAY _ SLOP SINK _ WATER SOFTENER
LAVATORY SWIMMING POOL _ WATER CLOSET
i�,�
All fees are based on valuation, including the cost of labor and
Total Job g materials.
Valuation
Permit Fee
$ ✓`/ (1.25% of Job Valuation / Minimum fee: $35)
Surcharge
$ Valuation X.0005 ($.50 Minimum)
Total Due
'7J
$� S Minimum $35.50 Make Checks Payable to: City of Fridley
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a mechanical permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and des of the C' of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application a pe it d wo is not to start without a permit on site; that the work will be in accordance
with the appro d plan
' the case 11 wo h' re Ires review and approval of plans.
�-
PRINT NAME cS -r7
SIGNATURE OF AP
A
APPROVED BY
DATE
\vity of Fridley Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977