PRE 2010 DOCSPermit Fee paid on Permit #11,315 for 1560 - 1570 69th Avenue N.E.
City of Fridley, Minn. 11312
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
Date: February 22, 1972
Owner: _. Rice Creek Development Company Bider Approved Contractors. Inc.
Address _.__$5_WesSt:.Road, S,irnla Pines,Minn.Address 1059 0shorne Road. NSR., Rrirll%
786-3680
15793158021583, LOCATION OF BUILDING
1585,1587,1 89
No. �_._..___treet — 6th Avenue N.E part of Lot
Parcels 10200, Section 13
Lot _�_.» Bock ___�_. ._ Addition or Sub -Division —_
Corner Lot _.__._...._.____ Inside Lot __.._ Setback Sideyard
Sewer Elevation .____ _ - Foundation Elevation __.....
DESCRIPTION OF BUILDING
To be Used as: Each Unit
6 Townhouse Units_ Front 20' Depth 32' Height 211 Sq. FL 12131 Cu. p.
Front . _ Depth Height Sq. Ft. Cu. Ft.
Type of Construction Won ei 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 accordance with the description above rth and in compliance th all provisions of
ordinances of the city of Fridley. _ ,
In consideration of the payment of a fee of $ Sea _#1? , 31 permit is hereby granted to Rice Creek Dev. 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 ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buttdi�$�
within the city limits and this permit may be revoked at any time upon violation of any of theprovisions of Said
ordinances.
CLARENCE BELISLE
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas beating, sewer or water. Be sure to we
the Building Inspector for separate permits for these items.
Application for Power Plants and Hea&% Cooling, Ventilation. Re�lgeratioa and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAV*TY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ..... .. $10.00 $
Replacement of Furnace .. . ..... . 6.00 $
Repairs & Alterations—up to $500.00 6.00
Repairs & Alterations each add. $500.00 3.00 $—_
MECH. WARM ADR
Furnace Shell & Duct Work to 120,000 BTU .. (� . .. $10.00 $ QLD
each add. 60,000 BTU .................... .. 3.00 ;
Replacement of Furnace .. I . . .... 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
FurnaceShell & Line, --to 640 sq. ft. EDR Hot Water
10.00
$_
Each add. 200 sq. ft. EDR Steam
3,0n
$ _
Each add. 320 sq. ft. IDR 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 199,000 BTU) .. .6
5.00
$
over 199,000 BTU See Fee Schedule
GAS FIT'T'ING FEES: NO RATE TOTAL
1st 3 Fixtures
x$ 200
$1.2
Additional Fixtures
x .75
$
Gas Range to 199,000
x$ 5.00
$
AIR CONDITIONINa
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINkL `-'A-A-- he
Sae Fee SfltoduTo l $ 6 6 , O C)
TOTAL FEE
.�?c;2(/ S®
(SURCHARGE $_.50)
Dept. of Bldgs. Phom 560-3490
QJO LQ�ss ��try
City of Fddley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinancft
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Kind of Building
Used as
To be completed about_��/
Estimated Cost, $.___....._
Ol . New Building Permit No. Permit NO.— ---V2
- l2 % �g
DEdCRD*TION OF WORK
HEATING or P74�-Zuz'-OX
PLANTS—Steam, Hot Water, Warm Air—No�
Trade Name Sin N - L
Capacity tQf () 0 C.7 Sq. Ft. E.D.R BTU gp
Total Connected Load Kind of Fue
BURNER — Trade Napne Size No
Capadty Sq. Ft. E.D.R BTU TW
(REMARKS—OYER)
F
SEP -29-2005 09:39 CITY OF FRIDLEY
i
Building
BUILDING
Permit No.
Inspections
COMMERCIAL/INDUSTRIAL
Received By:
763-572-3604Date
CITX OF FRIDLEX
Rec'd:
DATE G�6/�O� YOUR E-MAIL ADDRESS rr I O n
SITE ADDRESS 7 % '' f''J e �rJ O �'
TENANT Suite No.
PROPERTY OWNER
NAME: r1 11 eo4
ADDRESS: S1
Srosion Control
$
PHONE: 01:5-3 ~ 85 W ~ '7 % $
ARCHITECT
NAME:
ADDRESS: CITY STATE—ZIP_
Special Assessments
CONTRACTOR
NAME: _ 11.C,
ADDRESS: 21 1 51 Prr4'101�t P�Gt TY STATEaMIP 5�
$
ft + 6 ft = ft x $20 = $
PHO)' -TE: I �(Q O 9 Z FAX f�K7 % P
$ 4%'% 7 D
'NOTE: CITY LICENSE REQUIRED FOR MULTI FAMILY/COMMERCIAL/INDUSTRIAL JOBS
PROPERTY TYPE
9 TOWNHOUSE V COMMERCIAL/INDUSTRIAL 0 INSTITUTIONAL
0 MULTI -FAMILY
PERMIT TYPE
D ADDITION 0 NEW CONSTRUCTION 0 OTHER
0 REMODEL IR ROOF 0 SWIMMING POOL
PLEASE SUBMIT:
1.4 SETS OF DRAWINGS 5. CONTRACTORS LICENSE OR 6. SPECIAL INSPECTION
2. SURVEY/SITE PLAN LICENSE APPLICATION SCHEDULE
3. LANDSCAPE PLANS 7. PERFORMANCE BOND
4. ENERGY CALCS AMOUNT $
BUILDING TO BE USED AS: OFFICE sF WHS sF OTHER sx
TOTAL SIZE: STORIES FIRE PROTECTION (Y/N) AC(YIN)
DETAILED DESCRIPTION OF WORK - U 5 i rZ '� i rl
tid4-a i -,
THIS IS AN APPLICATION FOR A PERMrr-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
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 the case of all work w ' vires review and approval of plans.
SIGNATURE OF APPLIC. PRINT NAME Jevl I L1' i DATE �r
_
ALL FEES ARE BASED ON VALUATION
Sq. ft• x $ Cost/sq. ft. = Valuation $
Sq. ft. x S Cost/sq. ft. = Valuation $
Sq. ft. x $ Cost/sq. ft. = Valuation $
TOTAL JOB VALUATION: $-%,Q(-)-USE OCCUPANCY TYPE
?ermit Fee
$ 391.
See Back Page for Fee Schedule
?Ian Review
_- $
65% of Building Permit Fee
Surcharge
$
(.0005) times the total job valuation -Minimum $.50
-ire Surcharge
$ RLf- 3D
.001 x Permit Valuation (1/10%)
3AC Charge -$+at-2
- $ I a?. /
$1450 per SAC Unit (Plans to MWCC for determination)
Srosion Control
$
$450 Conservation Plan Review
0iois
?ark Fee
$
Fee Determined by Engineering
Special Assessments
$
Agreement necessary ( ) Non Necessary ( )
:urb Cut Escrow
$
ft + 6 ft = ft x $20 = $
Total Due
$ 4%'% 7 D
Make checks pavable to: City of Fridlev Attach
1)
' Pte. F) &L rte, D,n Rayco Construction, Inc.
211 St. Anthony Parkway • Minneapolis, MN 55418
VI)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 1 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.
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`s ROYAL SOVEREIGN® FIBERGLASS SHINGLES. NAIL IN PLACE USING A MINIMUM OF FOUR
ROOFING NAILS PER SHINGLES
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-drlve\Proposals'Proposals - 2005U2ay Ellis - 2005\1579-1589 - 68th.1650-1658 - 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 — 68" AVENUE NORTH
8162 BLOOMINGTON AVENUE SOUTH 1650-1658 — 69TH AVENUE NORTH
BLOOMINGTON, MN 55425 FRIDLEY, MN DATE: 09/26/05
PRICING:
S%Vv'',n /A W�fe .
kgt7�
BUILDING
NUMBER
RE -ROOF
PRICE
1579-1589
$13,888.00
1650-1658
$ 10,409.00
TOTAL
1 $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 shell 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 Reyco, whether expressed or implied, shell 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
Owners 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 accqyAts,a 1,'
Authorized
ACCEPTANCE OF PROPOSAL: The above prices, specifications and conditions are satisfactory and ar er y accepted. You are authorized to do the
work as specified. Payment ill be made as outlined above.
DATE ACCEPTED: SIGNATURE:
i
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.
\\Servero2lf-drive\ProposalslProposals - 2005\Ray Ellis - 2005\1579-1589.68th.1650-1658 - 69th Avenue North.SH.re.sl.doc Page 2 of 2
W
P -T , Rayco Construction, Inc.
n 211 St. Anthony Parkway • Minneapolis, MN 55418
1 ' V-) . 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 — 68T" AVENUE NORTH
8162 BLOOMINGTON AVENUE SOUTH 1650-1658 — 69TH AVENUE NORTH
BLOOMINGTON, MN 55425 FRIDLEY MN DATE: 09A
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.
UServer02U-Irive\Proposals\Proposals - 2005\Ray Ellis - 2005\1579.1589 - 68th.1650-1658 - 69th Avenue Nmth.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 — 68TH AVENUE NORTH
8162 BLOOMINGTON AVENUE SOUTH 1650-1658 — 69TH AVENUE NORTH
BLOOMINGTON, MN 55425 FRIDLEY, MN DATE: 09/26/05
PRICING:
Av�-
J e ��� all
ale �
BUILDING
NUMBER
RE -ROOF
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.
-A c�K � res r�411�
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 ell 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 accoyats_ �11
Authorized
and conditions are satisfactory and arVtergby accepted. You are authorized to do the
* 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 properly 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.
\\Server02\f-drive\Proposals\Proposals - 2005\Ray Ellis - 2005\1579-1589 - 68th.1650-1658 - 69th Avenue North.SH.re.si.00c Page 2 of 2
le r t
FIRE DEPARTMENT MEMO
TO: BUILDING INSPECTION
ASSESSING
SUBJECT: FIRE DAMAGED STRUCTURE
FIRE HAS OCCURRED AT
DATE: Feb: 23, 1981
1589 NE 68th Ave. - Paul H. Medenwaldt 571-7303
ADDRESS
Feb. 23, 1881
(FATE OF FIRE
NOTE: occupant stated light had been dimming & bulb burning out in kitchen.
Sparking from outlet. Little dama .
FPB -6
AUG -09-2005 13:34 CITY OF FRIDLEY
PLUMBING
RESIDENTIAL APPLICATION
City of Fridley
V5-Qo?0/aZ,
Permit Number
Date Received
NOTE: IF PROPERTY 13 NOT OWNER/OCCUPIED. A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT.
DATE YOUR L ADDRESS
SITE ADDRESS
THE APPLICANT IS: (CIRCLE ONE) OWNER CONTRACTOR
NAME
PROPERTY OWNER/
ADDRESS
TENANT
CITY
STATE �p
PHONE 0.
NAME
94 gem0 Z r}
ADDRESS2 40"
CONTRACTOR
CITI(
STATE /f DP 59VU—
PHONE #
FAX# Z
PERMIT TYPE SINGLE FAMILY
SINGLE
TWO FAMILY ✓TOWNHOUSE
TYPE OF WORT( 0 NEW
� REPLACEMENT
DETAILED DESCRIPTION OF WORK
Z4 ki&gfAt—
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED
FD(TURES: (INDICATE TOTAL NUMBER OF EACH)
BATH SINWI.AV FLOOR DRAMS
SHOWER WATER PIPING
BATHTUB GAS PIPING (Need Cft' L'Cense)
SWIMMING POOL WATER SOFTENER ($M
CLOTHES WASHER KITCHEN SINK
--,,WATER CLOSET BACKFLOW PREV. (SIS)
DISHWASHER LAUNDRY TRAY
WATER HTR ($35) FOR IRRIGATION
WATER METER OTHER
00.
fVfI �IVIl1M:—$'F5:90-or B'fo-Of mt-of the improvemiG.—n -whicheverTs-
Plan Review $ greater on work fess than $300
Surcharge $ .50
TOTAL DUE 3s-�:O Make checks payable to: City of Fridley
1 "0 w AN ArrIJUATrON FOR A PERMIT – NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and 1 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 oNy, an
application for a permit and work Is not to start without a permit that the work wig be in accordance with the approved plan in the rise of all work which
requires review and approval of Pjans.
SME OF APPLICANT -�� , DATE
Please type or print
SIGNATURE OF APPLICANT
.
6431 UNIYESITYAVENUE NE, FRIDLEY. MN 55&32
City of Fridley Building Inspections Dept.
6431 University Ave NE
Fridley MN 55432
Mechanical
Ph: 763-572-3604 FAX: 763-571-1287
Residential Application
City of Fridley
C .,., Q.-ir QlAgm Gnr Rnnidrarl Information
Permit #
Date t7jl,3 Site Address: L
Theapplicant is: (ciri a one)
Owner Contractor
Properly Owner.
Address
1ZW
City:
State: all Zip: jc�r-W-14'7
Phone:
Cell: Fax:
Contractor Informati n
Company Name:
Contact Person:
-r
4F zo
Address: 8
City:
State: /LIA/ T-iP
Phon
Cell:" WO 66EW Fax:
SS b1.4o
Email: E
ataA.C42Q3 MN Bond# & Exp Date a
Type of Work (circle one): New Replacement Alteration/Remodel _
Detailed Description of work:
/2�Agf6lkftft 12r J
lei
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 Furnace $35.00 _Pool Heater .$35.00
_Air
$35.00
_
_Gas Dryer $10.00 Ventilator $15.00
_Boiler
_Chimney Liner $10.00.
_Gas Piping $10.00 -7 f
Duct Work $10.00
Gas Range/Oven $10.00.
Permittee $
(Total from above -Minimum fee $35.001 j�A
G(�
Surcharge $
0.50
Total Due $
Make check payable to City of Fridley
I
This is an application for a permit- not valid until processed
1 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 il�JlX>
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 I f�
approved plan in case of all work which requires review and approval of plans. o_Y CY4
Signature of
Approval Inspector Sign
Please Note: Separate permits are required for Building, Plumbing, and Electrical work
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City of Fridley Building Inspections Dept Ph: 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
Mechanical Pennit# 6�,00.--66?�,�®
Residential Application
City of Fridley
See Back Side For Required Information
Date Site Address: J%r®pais® I
The applicant is: (cirice one) Owner Contractor
Property Owner.
A
City: State: Zip:
Phone: Cell: Fax:
Company
Contact P
City;
Cell: 617 Vet Fax: t
MN Bond# &
Type of Work (circle one): New
Detailed Description of work -
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
V/C $25.00
,Fireplace (wood) $35.00
_Gas Unit HTR $10.00
Air to Air exchanger $15.00
_Fumace $35.00
_Pool Heater $35.00
_,Boller $35.00
_Gas Dryer $10.00
Ventilator $15.00
_Chimney Liner $10,00
_✓Gas Piping $10.00
Duct Work $10.00
Gas Ranpe/Oven $10.00
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Permit Fee $ �c�b (Total from above -Minimum fee $35.00)
Surc-barge.:.._:-
Total Due $ Make check payable to City of Fridle
This is an application for a permit. not valid until processed
I hereby apply for a mechanical permit and I acknowledge that the Ifformation above is complete and
ama,rate; 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 pBrrnit 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
Approval 1 ns