PRE 2010 DOCSPermit Fee paid on Permit #11,315 for 1560 - 1570 69th Avenue N.E.
"Ty of Fridley, Minns, 11 32
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
Date: February 22, 1972
Owner: Rice Creek Development Company Builder Approved Contractors, Inc_
Address _r852e1it_Road. Virctf Pines. Minn Address 1052 Oghn-rnp R��� �,>iExidlAy
786-3680
157921580,1583, LOCATION OF BUILDING
158531587,1589
No. ___.._.....__.—... Street 68th venae N.F�4 part of Lot
Parcels 10 200, Section 13
Lot _ ._� ��_ B ock — _ __.____.— _ __ Addition or Sub -Division
Corner Lot Inside Lot — Setback Sideyard
Sewer Elevation__ _ _____ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as: Each Unit
6 Townhoug a Units_ Front 201 Depth 32' Height 21Sq, Ft. 1213' Cu. F,
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 construct the building described bove, I agree to do
the proposed work in accordanwith the description above
�rth andwin copliance th all provision of
ordinances of the city of Fridley. 10
In consideration of the payment of a fee of $ Ree #11, 1, permit is hereby granted to Rice 1 r ek 1) . Co.
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 ordin4mces of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildimg8
}within the city limits and this permit may be revoked at any time upon violation of any of the provisions oP said
ordinances.
CLARENCE BELISLE
NOTICE:
This permit does not cover the construction, installation for whing, plumbing, gas heating, sewer or water. lie sure to we
the Building Inspector for separate permits for these items.
Application for Poorer Plants and Healing, Cooling, Ventilation, Reftigomb and
Air Conditioning SrOem and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ..... .. $10.00 $
Replacement of Furnace ... 6.00 $
Repairs & Alterations—up to $800.00 6.00 $ _
Repairs & Alterations each add. $800.00 3.00 $___
MECiL WARM AIA r�
Furnace Shell & Duct Work to 120,000 BTU .. (p. .. $10.00 1 L�
each add. 60,000 BTU .................... .. 3.W i
Replacement of Furnace .. . . .... 6.00 $
Repairs & Alterations—up to $500.00 6.00 $
Repairs & Alterations each add. $500.00 3.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $,----
Furnace
___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 8.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 198,000 BTU) .. (- CV . 5.00 $
over 199,000 BTU See iee Schedule
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures x$ zoo $1.2
Additional Fixtures x .75 $
Gas Range to 198,000 x$ 5.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS It REPAIRS
ROUGH
F *L & o 2-4-- ti tle
�o
see Fee Schodids
TOTAL FEE ,yy
(SURCHARGE
Dept. of Bldgs. Phone 560.3480
aIMFo�o.�e�syo
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 Ordihance:
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
1uT7,"T37MtJ--!/%/I/_I�%/1-I/%/�//ice/i�!
Kind of Building
Used as
To be completed about__ C �/
Estimated Cost,
Ol New Building Permit No. Permit NO._ r� %
DESCRIPTION OF WORK
HEATING or PO PLANTS -Steam, Hot Water, Warm Air—No—�_1
Trade Name Size N L
Capacity - _ () 0 Q Sq, Ft. E.D.R BTU H,P.
Total Connected Load Kind of Fue
BURNER — Trade Narnne size No
Capacity Sq. Ft. E.D.B BTU
Ham!
(REMARKS—OYER)
SEP -29-2005 09:3e CITY OF FRIDLEY
t
Building
BUILDING
Permit No.
Inspections
COMMERCIAL/INDUSTRIAL
Received By:
763-572-3604Date
CI'I'X OF FR.IDLEX
Rec'd: '.I J -A
—010
DATE Gia%/O�s— YOUR F, -MAIL ADDRESS r" (O n -' &ru
SITE ADDRESS/ -7 �/� � r2 AJ I 6e �J ' 'IqUan (XV
TENANT � a1 T-�, Suite No.
PROPERTY OWNERNAME:
2i r� L n 11 r} �►
ADDRESS: '91 lea JTY 91 cpmn� Lt'�rJ
Srosion Control
$
PHONE: C15-3 ~ 5 W ^ "7 i $
ARCHITECT
NAME:
ADDRESS: CITY STATE—ZIP
Special Assessments
CONTRACTOR
NAME: Sc�ov -C h.C,
:urb Cut Escrow
ADDRESS: 1;2 ,1 1 51, Iq'� on AL"TY h je. S STATFIJ� 5` - Y
ft + 6 ft = ft x $20 = $
PHO1vE: I �� D `7 Z FAX l;;' -7
$ y/2 -7 7 0
*NOTE: CITY LICENSE REQUIRED FOR MULTI FAMILY/COMMERCIAL/INDUSTRIAL JOBS
PROPERTY TYPE
X TOWNHOUSE 19 COMMERCIALIINDUSTRJAL El INSTITUTIONAL
❑ MULTI -FAMILY
PERMIT TYPE
O ADDITION ❑ NEW CONSTRUCTION ❑ OTHER
❑ REMODEL IR ROOF ❑ SWIMMING POOL
PLEASE SUBMIT:
1.4 SETS OF DRAWINGS 5. CONTRACTORS LICENSE OR 6. SPECIAL INSPECTION
2. SL"RVEY/SITE PLAN LICENSE APPLICATION SCHEDULE
3. LANDSCAPE PLANS 7. PERFORMANCE BOND
4. ENERGY CALCS AMOUNTS
BUILDING TO BE USED AS: OFFICE SF WHS sF OTHER sr
TOTAL SIZE: STORIES FIRE PROTECTION (Y/N) AC(Y/N)
DETAILED DESCRIPTION OF WORK
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
confortnance 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 the case of all work, w ' ires review and approval of plans.
OF APPLIC. PRINT Llgi-'')
SIGNATURE NAME jeO4I DATE
7 Ir
ALL FEES ARE BASED ON VALUATION
Sq. fL x $ Cost/sq. fL = Valuation $
Sq. ft. x $ Cost/sq. ft. = Valuation $
Sq. ft. x $ Cost/sq. ft. = Valuation $
TOTAL JOB VALUATION: $ 91 USE OCCUPANCY TYPE
permit Fee
$ 3q/.
See Back Page for Fee Schedule
?Ian Review
$
65% of Building Permit Fee
Surcharge
$
(.0005) times the total job valuation - Minimum $.50
-ire Surcharge
$ ADLf, 30
.001 x Permit Valuation (1/10%)
5AC Charge -$+J2
$ a?. Is-
$1450 per SAC Unit (Plans to MWCC for determination)
Srosion Control
$
$450 Conservation Plan Review
?ark Fee
$
Fee Determined by Engineering
Special Assessments
$
Agreement necessary ( ) Non Necessary ( ) \J
:urb Cut Escrow
$
ft + 6 ft = ft x $20 = $
Total Due
$ y/2 -7 7 0
Make cheeks payable to: City of Fridley Attach tipula ions
F,1z::>, F-) Rayco Construction, Inc.
211 St. Anthony Parkway • Minneapolis, MN 55418
1/� 5 Phone: (612) 781-6092 • MN License #3396 • Fax: (612) 781-8778
PROPOSAL SUBMITTED TO: DESCRIPTION OF JOB:
#95 PHONE: (952) 854-7788 SHINGLE RE -ROOF:
DIANA L. HOWEY FAX: (952) 854-0910 RICE CREEK TOWNHOMES
JIM BERN MANAGEMENT COMPANY 1579-1589 — 68TH AVENUE NORTH
8162 BLOOMINGTON AVENUE SOUTH 1650-1658 — 69TH AVENUE NORTH
BLOOMINGTON. MN 55425 FRIDLEY, MN DATE: 09/26/05
REFER TO THE ATTACHED ROOF DIAGRAM FOR ADDITIONAL INFORMATION RELATING TO THIS PROPOSAL. THIS PROPOSAL IS TO TEAR OFF
AND COMPLETELY RE -ROOF THE SPECIFIED TOWNHOMES AT THE ABOVE PROPERTY LOCATION.
ROOF PREPARATION:
1) REMOVE ALL EXISTING ROOFING MATERIAL FROM THE TOWNHOMES.
2) REMOVE ALL ROOFING NAILS.
DECK EXAMINATION:
1) CHECK THE DECKING AND REPLACE ANY THAT IS DETERIORATED WITH NEW DECKING. THIS WORK WILL BE COMPLETED ON A
SQUARE FOOTAGE CHARGE BASIS AT A RATE OF $3.25 PER SQUARE FOOT. THIS WILL BE IN ADDITION TO THE BASE CONTRACT
AMOUNT.
NEW ROOF:
1) INSTALL PREFINISHED METAL DRIP EDGE AROUND THE PERIMETER OF THE ROOF. NAIL IN PLACE.
2) APPLY GAF® WEATHERWATCH® ICE AND WATER SHIELD SIX FEET UP AT ALL EAVE LINES. NAIL IN PLACE.
3) COVER THE BALANCE OF THE ROOF WITH GAF® SHINGLEMATe FIFTEEN -POUND UNDERLAYMENT FELT. FASTEN IN PLACE.
4) INSTALL NEW PREFORMED GALVANIZED METAL VALLEYS. NAIL AND SEAL IN PLACE.
5) INSTALL NEW SHEET METAL LOUVERED VENTS. NAIL AND SEAL IN PLACE.
6) INSTALL NEW GALVANIZED METAL PLUMBING STACKS. NAIL AND SEAL IN PLACE.
7) INSTALL ONE COURSE OF MINERAL STARTER AT ALL EAVES. NAIL AND SEAL IN PLACE.
8) COVER THE ROOF WITH NEW GAF° ROYAL SOVEREIGN® FIBERGLASS SHINGLES. NAIL IN PLACE USING A MINIMUM OF FOUR
ROOFING NAILS PER SHINGLE
9) INSTALL BOSTON HIP AND RIDGE.
JOB PROCEDURE:
1) WHILE THE WORK IS IN PROGRESS, KEEP THE JOBSITE CLEAN AND NEAT. WHEN THE JOB IS COMPLETE, MAKE SURE ALL GROUND
DEBRIS IS CLEANED UP.
PERMITS, FEES, AND TAXES:
1) WE HAVE INCLUDED IN THE BASE CONTRACT AMOUNT ALL SALES TAXES AND PERMIT FEES TO COMPLETE THIS PROJECT.
2) MANY CITIES NOW REQUIRE A PLAN -CHECK FEE. IF THIS WERE ASSESSED AGAINST THIS PROJECT, THE COST WILL BE IN
ADDITION TO THE BASE CONTRACT AMOUNT.
\1Server02V-driveTroposals\Proposals - 20051Ray Ellis - 2005\1579-1589 - SM.165o-1658 - 69th Avenue North.SH.re.sl.doc Page 1 of 1
Rayco Construction, Inc.
211 St. Anthony Parkway • Minneapolis, MN 55418
Phone: (612) 781-6092 • MN License #3396 • Fax: (612) 781-8778
PROPOSAL SUBMITTED TO: DESCRIPTION OF JOB:
#95 PHONE: (952) 854-7788 SHINGLE RE -ROOF:
DIANA L. HOWEY FAX: (952) 854-0910 RICE CREEK TOWNHOMES
JIM BERN MANAGEMENT COMPANY 1579-1589 — 68TH AVENUE NORTH
8162 BLOOMINGTON AVENUE SOUTH 1650-1658 —69 TH AVENUE NORTH
BLOOMINGTON, MN 55425 FRIDLEY MN DATE: 09/26/05
PRICING:
I ty a: .57vz''n i4'/t 'W&Oe .
ls e olo� fill lic
e
/9,/ r Pe A P&7�
BUILDING
NUMBER
RE -ROOF
PRICE
1579-1589
$13,888.00
1650-1658
$ 10,409.00
TOTAL
I $24,297.00
We hereby propose to furnish labor and materials
complete in accordance with the above specifications for
the Sum Of:
AS SHOWN ABOVE
With Payments to be made as follows:
PAYMENT DUE UPON COMPLETION
NOTE: This proposal may be withdrawn by Rayco
Construction if not accepted within twenty days.
UK 1� Osig
All material is guaranteed to be as specified, and all work shall be performed in a professional
manner in accordance with the above specifications. Alterations or deviations from the above
specifications will be made only upon written change order, signed by both Rayco and Owner,
describing the change and stating what, if any, additional amount is to be paid by Owner. Owner
assumes the risk of concealed or unknown conditions. including, but not limited to, the presence of
asbestos, which delay or increase the cost of Rayco's performance, and Owner shall agree to pay
reasonable, additional charges resulting from those conditions before Rayco shall be obligated to
continue performance. Rayco is not responsible for delays resulting from strikes, transportation
disruption, weather, accidents, materials shortage, or other causes beyond its control Rayco is not
responsible for damages to the premises resulting from vibration caused neither by its
performance, nor for any incidental or consequential damages arising out of any error or omission
in performance by Rayco. Structural analysis, existing and future mold are excluded from this
contract unless otherwise noted. All materials shall be as specified above, and all work shall be
performed in a professional manner. All other express or implied warranties, including the implied
warranties of fitness and merchantability, are hereby excluded. Owners sole remedy for breach of
any and all warranties by Rayco, whether expressed or implied, shall be limited to repair or
replacement, at Rayco's option, of the portion of the work and materials, supplied hereunder that
are determined to be defective. Owner agrees to pay additional reasonable charges, including
hourly rates for idle equipment resulting from delays of Rayco's performance caused by Owner or
Owner's other contractors. Unless otherwise agreed, payment shall be due upon completion of the
work by Rayco, and invoices shall be payable within ten (10) days after receipt by Owner. A
service charge of the lesser of the maximum legal rate, or one and one-half percent (1.5%) per
month will be added to past due accggAts,, 11.'
Authorized
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and argreg&y accepted. You are authorized to do the
work as specified. Payment ill be made as outlined above.
DATE ACCEPTED: SIGNATURE:
PRELIMINARY LIEN NOTICE: Any person or company supplying labor or materials for this improvement to
your property may file a lien against your property if that person or company is not paid for the contributions.
Under Minnesota law, you must have the right to pay persons who supplied labor or materials for this
improvement directly and deduct this amount from our contract price, or withhold the amounts due from us
until 120 days after completion of the improvement unless we give you a lien waiver signed by persons who
supplied any labor or material for the improvement and who gave you timely notice.
\1Server02V-drlvelProposalslProposals - 20051Ray Ellis - 200511579-1589 - 68th.1650-1658 - 69th Avenue North.SH.re.sl.doc Page 2 of 2
IF
jeL m Rayco Construction, Inc.
211 St. Anthony Parkway • Minneapolis, MN 55418
P v-) -:3-Dz Phone: (612) 781-6092 • MN License #3396 • Fax: (612) 781-8778 0
PROPOSAL SUBMITTED TO: DESCRIPTION OF JOB:
#95 PHONE: (952) 854-7788 SHINGLE RE -ROOF:
DIANA L. HOWEY FAX: (952) 8540910 RICE CREEK TOWNHOMES
JIM BERN MANAGEMENT COMPANY 1579-1589 — 68TH AVENUE NORTH
8162 BLOOMINGTON AVENUE SOUTH 1650-1658 — 69TH AVENUE NORTH
BLOOMINGTON, MN 55425 FRIDLEY MN DATE: 091
REFER TO THE ATTACHED ROOF DIAGRAM FOR ADDITIONAL INFORMATION RELATING TO THIS PROPOSAL. THIS PROPOSAL IS TO TEAR OFF
AND COMPLETELY RE -ROOF THE SPECIFIED TOWNHOMES AT THE ABOVE PROPERTY LOCATION.
ROOF PREPARATION:
1) REMOVE ALL EXISTING ROOFING MATERIAL FROM THE TOWNHOMES.
2) REMOVE ALL ROOFING NAILS.
DECK EXAMINATION:
1) CHECK THE DECKING AND REPLACE ANY THAT IS DETERIORATED WITH NEW DECKING. THIS WORK WILL BE COMPLETED ON A
SQUARE FOOTAGE CHARGE BASIS AT A RATE OF $3.25 PER SQUARE FOOT. THIS WILL BE IN ADDITION TO THE BASE CONTRACT
AMOUNT.
NEW ROOF:
1) INSTALL PREFINISHED METAL DRIP EDGE AROUND THE PERIMETER OF THE ROOF. NAIL IN PLACE.
2) APPLY GAF® WEATHERWATCH° ICE AND WATER SHIELD SIX FEET UP AT ALL EAVE LINES. NAIL IN PLACE.
3) COVER THE BALANCE OF THE ROOF WITH GAF® SHINGLEMATe FIFTEEN -POUND UNDERLAYMENT FELT. FASTEN IN PLACE.
4) INSTALL NEW PREFORMED GALVANIZED METAL VALLEYS. NAIL AND SEAL IN PLACE.
5) INSTALL NEW SHEET METAL LOUVERED VENTS. NAIL AND SEAL IN PLACE.
6) INSTALL NEW GALVANIZED METAL PLUMBING STACKS. NAIL AND SEAL IN PLACE.
7) INSTALL ONE COURSE OF MINERAL STARTER AT ALL EAVES. NAIL AND SEAL IN PLACE.
8) COVER THE ROOF WITH NEW GAF® ROYAL SOVEREIGN® FIBERGLASS SHINGLES. NAIL IN PLACE USING A MINIMUM OF FOUR
ROOFING NAILS PER SHINGLE.
9) INSTALL BOSTON HIP AND RIDGE.
JOB PROCEDURE:
1) WHILE THE WORK IS IN PROGRESS, KEEP THE JOBSITE CLEAN AND NEAT. WHEN THE JOB IS COMPLETE, MAKE SURE ALL GROUND
DEBRIS IS CLEANED UP.
PERMITS, FEES, AND TAXES:
1) WE HAVE INCLUDED IN THE BASE CONTRACT AMOUNT ALL SALES TAXES AND PERMIT FEES TO COMPLETE THIS PROJECT.
2) MANY CITIES NOW REQUIRE A PLAN -CHECK FEE. IF THIS WERE ASSESSED AGAINST THIS PROJECT, THE COST WILL BE IN
ADDITION TO THE BASE CONTRACT AMOUNT.
\\ServerO2V<lrive\Proposals\Proposals - 20051Ray Ellis - 200511 5731 589 - 6M.1650-1658 - 69th Avenue North.SH.re.sl.doc Page 1 of 1
r
Rayco Construction, Inc.
211 St. Anthony Parkway • Minneapolis, MN 55418
Phone: (612) 781-6092 • MN License #3396 • Fax: (612) 781-8778
PROPOSAL SUBMITTED TO: DESCRIPTION OF JOB:
#95 PHONE: (952) 854-7788 SHINGLE RE -ROOF:
DIANA L. HOWEY FAX: (952) 854-0910 RICE CREEK TOWNHOMES
JIM BERN MANAGEMENT COMPANY 1579-1589 —68 TH AVENUE NORTH
8162 BLOOMINGTON AVENUE SOUTH 1650-1658 — 69TH AVENUE NORTH
BLOOMINGTON, MN 55425 FRIDLEY, MN DATE: 09/26/05
PRICING:
BUILDING RE -ROOF
NUMBER PRICE
1579-1589
$13,888.00
1650-1658
$ 10,409.00
TOTAL
$24,297.00
We hereby propose to furnish labor and materials
complete in accordance with the above specifications for
the Sum Of:
AS SHOWN ABOVE
With Payments to be made as follows:
PAYMENT DUE UPON COMPLETION
NOTE: This proposal may be withdrawn by Rayco
Construction if not accepted within twenty days.
All material is guaranteed to be as specified, and all work shall be performed in a professional
manner in accordance with the above specifications. Alterations or deviations from the above
specifications will be made only upon written change order, signed by both Rayco and Owner,
describing the change and stating what, if any, additional amount is to be paid by Owner. Owner
assumes the risk of concealed or unknown conditions, including, but not limited to, the presence of
asbestos, which delay or increase the cost of Reyco's performance, and Owner shall agree to pay
reasonable, additional charges resulting from those conditions before Rayco shall be obligated to
continue performance. Rayco is not responsible for delays resulting from strikes, transportation
disruption, weather, accidents, materials shortage, or other causes beyond its control. Rayco is not
responsible for damages to the premises resulting from vibration caused neither by its
performance, nor for any incidental or consequential damages arising out of any error or omission
in penbrmance by Rayco. Structural analysis, existing and future mold are excluded from this
contract unless otherwise noted. All materials shall be as specified above, and all work shall be
performed in a professional manner. All other express or implied warranties, including the implied
warranties of fitness and merchantability, are hereby excluded. Owner's sole remedy for breach of
any and all warranties by Rayco, whether expressed or implied, shall be limited to repair or
replacement, at Rayco's option, of the portion of the work and materials, supplied hereunder that
are determined to be defective. Owner agrees to pay additional reasonable charges, including
hourly rates for idle equipment resulting from delays of Rayco's performance caused by Owner or
Owner's other contractors. Unless otherwise agreed, payment shell be due upon completion of the
work by Rayco, and invoices shall be payable within tan (10) days after receipt by Owner. A
service charge of the lesser of the maximum legal rate, or one and one-half percent (1.5%) per
month will be added to past due accoWs_ ,1
Authorized
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory andr
y accepted. You are authorized to do the
work as specified. Payment ill be made as outlined above. `
DATE ACCEPTED: SIGNATURE: \X,�
PRELIMINARY LIEN NOTICE: Any person or company supplying labor or materials for this improvement to
your property may file a lien against your property if that person or company is not paid for the contributions.
Under Minnesota law, you must have the right to pay persons who supplied labor or materials for this
improvement directly and deduct this amount from our contract price, or withhold the amounts due from us
until 120 days after completion of the improvement unless we give you a lien waiver signed by persons who
supplied any labor or material for the improvement and who gave you timely notice.
\\Server02U-drtve\Proposals\Propmals - 20051Ray EAIs - 2005\1579-1589 - 68th.1650-1658 - 69th Avenue North.SH.re.si.doc Page 2 of 2
RUG -09-2005 13:34 CITY OF FRIDLEY P.02iO4
PLUMBINGPermit Number
O I RESIDENTIAL APPLICATION Remi
d rved By
City of Fridley hed
�� Re e
NOTE: IFPROPERTYIS NOT OWNER/OCCUPIED- A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT.
DATE v YOUR L ADDRESS % /% lir,X �4 �i/�Qf _ z
51TE ADDRESS ,�� =---�
THE APPLICANT IS: (CIRCLE ONE) OWNER CONTRACTOR
NAME
PROPERTY OWNER/ ADDRESS
TENANT
CITY STATe ZIP
PHONE #
k J
NAME D -.ICENSE P Z.3
CONTRACTOR ADDRESSZ
CITY Az•ti STATE / f AJ , 23p
PHONE /# FAX# A,5 G/ / t�
PERMIT ME SINGLE FAMILY TWO FAMILY
TOWNHOUSE
TYPE OF WOPJC---T p NEW REPLACEMENT
ETAILED DESCRIPTION OF WORK
44fP &A
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED
FDCTURES: (INDICATE TOTAL NUMBER OF EACH)
_BATH SINKRAV FLOOR DRAINS SHOWER WATER PIPING
—BATHTUB GAS PIPING (Need Cry License) SWIMMING POOL WATER SOFTENER WM
CLOTHES WASHER KITCHEN SINK ATER CLOSET BACKFLOW PREV, pis)DISHWASHER LAUNDRY TRAY WATER HTR ($35) FOR IRRIGATION
WATER METER OTHER
- $ NIIEfII{AllM:or 50/4-oftoovtof the improvement-Nhicheveris-
Plan Review $ greater on work less than $30t)
Surcharge $ .50
TOTAL DUE $ Make checks payable to: City of Fridley
rum w AN ArrUUAT ION FOR A PERMIT —NOT VAUD UNTIL PROCESSED
I hereby apply for a plumbing permit and 1 acknowledge that the infornmdon above Is complete and accurate; that the work will be in oonformance with
the ordinances and codes of the pity 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 the one of all work which
requires review and approval of p
jMEOFAPPLICANT
`
Phase type or orint
SIGNATURE OF APPLICANT
6431 UNIVESITY AVENUE NE. FRIDLEY. MN 56&V
City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
Mechanical Permit#
Residential Application
City of Fridley
RaA Rack side For Reauired Information
Date % Site Address:
The applicant is: (cirl a one) Owner Contractor
Property Owner.
Address:/6,5-?-
ddress:/6✓!2City:
city:
State: -Wk/ Zip:.C5ry?L
Phone: Cell: Fax:
Contractor Informati n
Company Name:
-
Contact Person:
-r
Address:
City: OS22V /�/ii_ State: /LIN Zip: �T-TD2-6-
S!' e{
Phone: 6V 4469 1A_ -it Cell:6U,-
640 60 G1 7 Fax:
Email: e m
MN Bond#
Type of Work (circle one): New
Replacement Alteration/Remodel _
Detailed Description of work:
J
Aft
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 $10.001
Permit Fee $
(Total from above -Minimum fee $35.0
Surcharge $
0.50
Total Due $
Make check payable to Cityof Fridley
Q
This Is an application for a permit- not valid until processed
I hereby apply for a mechanical permit and 1 acknowledge that the information above is complete and I
accurate; that the work will be In conformance with the'ordinances and codes of the City of Fridley and t&
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 G'
approved plan in case of all work which requires review and approval of plans.
Signature of Applicant: Date: W d
Approval Inspector Signatur Date:
Please Note: Separate permits are required for Building, Plumbing, and Electrical work