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PRE 2010 DOCSCity of Fridley, ntinn.. BUILDING PERMIT 0 3 Date: Owner: Builder Address Address A OF BUILDING No. Street "�►'�. _ _ Part - . Lcyt, 41 Lot .�.,�—._�. Block � � Addition or Sub-Divisio�, _ �� 4# � Corner Lot _ Inside Lot Setback Sideyard d� Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To Used a • �U ont Depth Height rr Sq. Ft.) cu. Ft Front _ Depth , ei t _ Sq. Ft. Cu. Ft. . Type of Construction �,'G� Est. Cost __ To be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances' of the city of Fridley. In consideration of the payment of a fee of $'�4"�' , permit is hereby granted to IV - to construct the buildiing�orr 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 buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. », '49.007 /-1 Building Inspector NOTICE: This permit does not cover the construction, Witallation for wiring, plumbing, gas heating, sewer or water. Be sure to an the Building Inspector for separate permits for these herrn. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, KDWSOTA ra . wz�- TTTAr l-- c� ..4LOCATION OF BUILDING No. (0Street < -1-a 6--� Part of Lot Lot % Block_ Addition or Subdivision)61- 4 &-4 AG, )fee Corner Lot Inside Lot Setback Side -Yard /„ SEWER ELEVATION FOUNDATION ELEVATION, Applicant attach to this form Certificate of Survey of Lot and proposed building location. To be used as: e -A-1 DESCRIPTION OF BUILDING Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost�r-;'? Vie,,,:_„! To be Completed The undersigned hereby makeif application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares thata he facts a =representations stated in this applicare true and correct. a DATE _,;7 SIGNATURE , (A Schedule of Fee Costs can be found on the Reverse Side.) 0 Ci Fridley City of �O Application for Plumbing and Gas Fa ing Permit �O DESCRIPTION OF WORK Number. Kind and Location of Fixtures q �pZ 3 �Z O� J �� (9 �Z 00 Z "�a • F • N WATER HTR. GAS ELEG OLL ! LLD U < 3 cid o� Cho Base 1st 2nd _ 3rd _ 4th • Future Connection Openings I Conaected with Sewer � New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL ,1� y Number Fixtures ...................... x $1.50 $ 2 0 Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ......—�- x 2.00 $ �o C) New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ ---L-6-75-) C-) Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS -Refer to Code Description................................................$ TOTAL FEE $ Dept. of Bldgs.. Phone SU 4-7470 r—s:,... 1r.2 -a -j City of Fridley: ,2 The undersigned hereby .makes application for a permit for the work herein specified, agreemg 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 applicatipn are true and correct. 19-4/- Owner GL I Lt3a Kind of BuilAiinc®r Used as To be completed about — Estimated Cost, $ Old New. uilding Permit Business Phone ROUGH 40- ;�- 3 - �P/ FINAL .0�42 2M 7.59 77 ,- a�;,Rf City of Fridley, Minn. N° 3304 BUILDING PERMIT • Date: August 2, 1965 Owner: William L. Zaic Builder Same Adm 212 — 69th Ave. N. E. Address Fridley, Minnesota LOCATION OF BUILDING No. 242 Street 69TH Amu N. F • Part of Lot Lot 1 _ Block 2 Addition or Sub -Division Rice Creek Plaza Corner Lot _ Inside Lot Setback 35 Sideyard a, Sewer Elevation ____ Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Attached Gar g® Front 2_ Depth 22 Height 12 Sq. Ft..466.2 cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of constriction Frame Est. Cost _$900900 To be Completed F- 1 LJ • New Attached Garage In consideration of the issuance to me of a permit to const the proposed work in accordance with the description above set am Unaaces of the city of Fridley. above I agree to do 71th ail provisions of f, in consideration of the payment of a fee of $ 6.00 , permit is hereb ted to WILMAN ZAIC 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, M nnesota ung location, construction, alteration, maintenance, repair and moving of buildings within city limits � this permit may be revoked at any time upon violation of any of the provisions of said ordinan A ZN G. JD, NSEN Building Inspector NOTICE: M paadt dos not sera the eeesfmWw, hwhffldien for airing, phmbing, as hoe&& sewn or wda. Be sun to no the Buihliog bar for npsnM pamNs for thea Moms. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME ;'��-z. r�=�' BUILDER ADDRESS 'I / (� �- G !z�c _ADDRESS LOCATION OF BUILDING NO. � � STREET �^ ` '>` '�� /•�L PART OF LOT LOT BLOCK ADDITION OR SUBDIVISIONC� CORNER LOT LANSIDE LOT SETBACK �� / SIDE -YARD �Z SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To be used -o-- —Front— '2-1 Height Sq. Ft. Cu. Ft. es�� Front Depth Height Sq. Ft. Cu. Ft. Type of ConstructionEstimated Cost q(3 6 �"— To be completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this. application are true and correct. DATE 0�� SIGNATURE. (Schedule of Fee Costs can be found on the Reverse Sid ). P • M CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1995 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 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 )Yes () No $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance TOTAL State Surcharge .50 TOTAL FEE 5 JOB ADDRESS_ — f� a /y S 7 y ' Cr 5-.Ts— The 3S 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. % ,199 C'2 Owner Building Used As, N Cj Estimated Cost Q0 PERMIT NO. PLUMBING COMPANY G ,4 0 : SIGNED BY TEL N0. Approved By Rough—In Date Final D MINIMUM FEE OR ANY PLUMBING/GAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE 21HE SUBJECT P City of Fridley27319 AT THE TOP OF THE TWINS BUILDING PERMIT -RECIPT NO. _ COMMUNITY DEVELOPMENT DIV. ~ PROTECTIVE INSPECTION SEC. NUMBER REV DATE 18/20/98 PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 JOB ADDRESS 242 69th Avenue NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 1 2 Rice creek PlazaNorth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Joan Murphy - 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 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construction of a 22' x 10' deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. WARNING ° Before digging call for all utility locations 4.54-0002 REQUIRED BY LAIN TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1973.40 .99 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. $62.25 Fire SC $1.97 PLAN CHECK FEE TOTAL FEE 65.21 S NATUREOFCO T T RORAUTHORIZ AGENT IDATEI WHENN P�ROPE VALIDATED THIS IS YOUR PERMIT �/ olr P `i(/' B G NSP /--,' - '/ e GATE i AT E OF OWNEFI OF OWNER ODER . ATEi NEW - [ ] • Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION C g4 3/q ConstructionAddress. Legal Description: Owner Name & Address: U all A Ia jr� V Tel. # S ? Contractor: f) 6-(,G2 YL(""' 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 IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length,;L Width /(i Hgt/Ground /, y ' Sq. Ft. OTHER: Construction Type: �Q C a y, -Z? p7 0- Estimated Cost: $ %� L' 00 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: APPLICANT: rAQ / tZ Tel. # 2 Y CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ g .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 $ STIPULATIONS : Load Plwwo'y LandSurrpyin�. Mirneav�s 2t lst�y ENGINEERING, INC. /4 Civil b Mu�xipal suflot440" — En ineers 9 vu 10 " For celrti-Eicate e' . suirve)r mi ko s e m - G91 WNUE t Iron Iron 404 IV X DoT 1, 31_..O 14111. f I C & C2CE1� Iron Ron-\ ...9 5•tiz ,�,ti pLAZA i�l0��i't-1 AUD\i' 100 r,!1 'y Nifi /bis a o bW W d WrMd rePMsenfotran ord Arvet1 e* barm wits q(7&abd�r afesu�6ed /arid, aoad J� il: li loae/A7 vf#ff bt�s, lbarw, , aced ed ris4le m avorhmmis , lrrar y. fw or w Acid /ax/. As surveyed6rj nee /lits—.. doff AS SUB URBAN ENGINEER/NG , INC.. E�inerrs fr Surrufora 4W C r� 14 w (li �1 li i� 1�(I .22 n 2 rA G t'J i .IT �4 �i ;9 o c 3 s 8 S 46 40 o S CA (00 l le The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes} No ( ) Z. Is free from rust or deterioration Yea,} No ( } 3. Has np foreign objects lodged within Yes,) No ( ) 4. Is securely supported Yes) No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes No ( ) 6 Has total heating BTU's of _ -7 ) , Ob o All other BTU's `40, arc) TOTAL BTU's p 7. Has- a liner been provided for water heater Y�egsNo �(�� � ) 8. Has combustion air been provided for water heater Yes (N) No ( } Remarks: HEATING CO: Signed By: Date: 1 u SUBJECT P City of Fridley 29803' AT THE TOP OF THE TWINS BUILDING PERMIT r EIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. F = I-'-1 CITY MALL FRIDLEY 55132NUMBER REv DATE vAGE OF APPROVED BY 612-571-3450 s�aF�s 6/30/99 / / JOB ADDRESS 242 69th Avenue NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR, 1 2 Rice Creek Plaza, North Addn . SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Joe Murphy 574-9535 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Suburban Exteriors 9701 Penn Ave S Ste 107 B881-8232 4289 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 O NEW 0 ADDITION 0 ALTERATION 9( REPAIR 0 MOVE 0 REMOVE 8 DESCRIBE WORK Reroof house and garageTear-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 SQ. 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 ISTALLS 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 2010 $1.01 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 PERFORMAN OF CONSTRUCTION $83.25 Fir SC $2.01 PLAN CHECK FEE TOT EE SIGNATURE OF CO 'RACTOR OR AuiMOR12ED AGENT IDE E� Licea -27 EN PRO VALIDA E THIS IS YOUR P MI BL G ,NSP I 40 gAtE S�GNATUAE OF OWNER.IF OWNER BUILDER, IDATEI # y67 -(F( r r NEW[ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �S BUILDING PERMIT APPLICATION Construction Address: u 0A1e I Legal Description: Owner Name & Address:yE, o U/Yl U Tel. # 5 r S-3 S' Contractor: MN LICENSE # L%off Address: 9 ) U /xjy2 Qjy"'o- 2, -ya-w-0-/O' Tel. # S- 3 0% Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length GARAGE AREA: Length DECK AREA: Length OTHER: DESCRIPTION OF IMPROVEMENT Width Height Width Height Width, . WGround i Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: 6 - Q � "19 APPLICANT: 1� Ajtk . Tel. # F FS Q 3 c� TOTAL $ 91,21 STIPULATIONS: CITY USE ONLY Permit Fee $.� S� Fee Schedule on Reverse Side Fire Surcharge $ . 0 f .001 of Permit Valuation (1/10th%) State Surcharge $ Of $.50/$1,000 Valuation SAC Charge $ $1050 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 $ 91,21 STIPULATIONS: CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Effective On January 1, 2080 JOB ADDRESS. �L-Z !v9 All - OWNER yI x'0'4-1 TOTAL BUILDING USED AS Rif, ESTIMATED COST %'L-�S' ` PERMIT N0. — IVI�- V9 DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ Trade Name jYI A �Zv&c) Size No. Ar S✓Pg"4 BTU HP EDR $ Fuel Total Connected Load Burner Trade Name_ Size No. $ BTU HP EDR 04.5 f4pe �_u LIt-t-i: $ 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 an $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE 104.3 c) i HEATING CO n t5 �'% 11)7_62-5 Signe _. TEL # �Sf " k- �� 7 7 t Approved By Rough -In Date Final Date ��"�� �➢ FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE e-Acf 1;�'e Vie. # COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specifications. Yes( ) No( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( ) No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type Appliance #2 Type Appliance #3 Type Total Appliances Common Vent Type _ BTU Input _ BTU Input _ BTU Input Total Btu Input Fan Assisted or Nat Fan Assisted or Nat Fan Assisted or Nat Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date : Building PLUMBING PernTit No.: ' lG I' , Inspections 763-572-3604 RESIDENTIAL APPLICATION Received � � CITY OF FRIDLEY n 763-502-4977 FAX EFFb'E;ITVE7-I-2010 DATE YOUR E-WJL ADDRESS srrE ADDRESS -2 %A 6 W4: EA i DLPY MA; ,_( 302 THIS APPLICANT IS: K OWNER MONTRACTOR PROPERTY NAME:—."*" uRe'/K OWNEW ADDRESS: 2 Y 40 9° '6'A OE A✓E cnY FR /.ID LEE/ 5r'AT /1P�}�32 TENANT PHONT:_ 76.3%,57 `f- gs-3.5 CONTRACTOR NAME: SUBMIT A COPY (W YOUR STATE STATE LICENSE # EXP DATE LICENSE, BOND AND STATE BOND # EXP DATE (TRTIFiCATE OF ADDRINS: CITY STATE 21P INSURANCE PHS FAX PFAMITTYPE ASINGLE FAMILY 0 TWO FAMILY ❑ TOWNHOUSE TWE OF WOM 0 NFW CFMENI' DE'T'AILED DESCRIPPON OF WORK kM7M &AER7 22-A &- OL/4 e � i79E�JT FEES ARE BASED ON $10.00 Pim FIXTURE, EXCEff WHERE NOTED. FOCTURES: (MICATE TOTAL NU TAX Or EACH BELO% &UNMIM FEE $35.50. _RVFH SINKIJ AV 1:MXX DRAINS SHOt ER WATERPIPING —BATHTUB _ GAS }'tAi G {NEED CITY LIC) _ SWIiYlMI NG POOL —WATER SOF rNER ($35) CLOTHES WASHER KrrCHF.N SINK WATER CLOSET _BACKFLOW PREV. ($1 5) _ DISHWASHER LAUNDRY TRAY , X,�WATER HEATER ($35) FOR IRRIGATION WATER AIErM OTHER 1' umber of fixtares @ $10.00 x $1'3.1)0 = $ Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @$300 x $35. 0 ='$ 3 � State Surcharge $ 5.00 $40,00 Total = $ THIS IS AN APPLICATION 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 t-- Mknesoft CmstruMou Codes, dot 1 understand this is not a permit but only an application for a permit and work is not to suet without a permit on site; that the work will be in accordance with the rived plan in case of i vork +vhrc requims rtsvmw and oval ol7planti, 9- 16 SiGNAT'UREOFAPPLICAN'I' -d-.�, NUN•I NAhiE _T.0 &J /'L k"MY, DATE APPROVAL INSPEC'FORS SIGNXTUPE PLEASE NOTE: WARATE PMMITS ARE REQUIRM FOR anDING, E1. MICAL AND MECHAMCAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-5024977