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PRE 2010 DOCSN° 24' Village of Fridley, Minn. WELDING PERM" Office of giTSPECTOR OF BIIILDINGS owner - Architect Fridley, Minn. . 19 Builder ate. --a LOCATION OF BUILDING No.—L--3 0 Street Part of Lot +V Lot lock Addition or Sub -Division + • i DESCREPTION OF BUILDING Front9 Depths_ Height Stories Manner of Construction ,r. e1 To be used as To be completed ? ! �-' 1 Estimated Cost Ad, ,I II I Permit is hereby ted to Y ' y �� i }. the building—r 1-.1_1`,;1-4#__1_+y ° 'a's`? � described in the above statement. This permit is granted UPC the exp ss con tiod n that tho' person to whom it is granted, and his agents, employees and workmen, in all 'the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, regarding the construction, alteration, maintenance, repair and moving of buildings within the city limits, 7 and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. ?+ T spector of Buildings. AGREEIMNT AND SWORN STATEMENT In considerati In of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permit, hereby agree to do the proposed work in accordance with the description above set forth anI according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby'� to and say that the facts stated by me and contained in the above permit are true as therein sta ed. Subscribed and �orn to before me at Fridley, Minnesota, this. day of - ;i n D. 19':; , _`, E'S��:.*.. i Application for Power Plants and Heating, Coding, Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIRS RATE TOTAL Furnace Shell & Duct Work .......................... 8.00 Replacement of Furnace ............................. 5.00 Repairs & Alterations—up to $500.00 .................. 5.00 Repairs & Alterations each add. $500.00 ............... 2.50 MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 each add. 60,000 BTU ....................... 2.00 Replacement of Furnace ............................. 5.00 Repairs & Alterations—up to $500.00 ................. 5.00 Repairs & Alterations each add. $500.00 .............. 2.50 STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. IDR Steam ...... 8.00 Furnace Shell & Line—to 640 sq. ft. IDR Hot Water ... 8.00 Each add. 200 sq. ft. IDR Steam ...................... 2.50 Each add. 320 sq. ft. IDR Hot Water .................. 2.50 OIL BURNER to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ �• �� GAS PIPING (Up to 3 Fixtures) .......................... 1.50 $ Sh (Add 50c each over 3) AIR CONDITIONING FAN DATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS See Fee Schedule $ TOTAL FEE _ Dept. of Bldgs. Phone SV 4-7470 City of Fridley: The undersigned hereby makes 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 that all the facts and representations stated in this application are true and correct. Fridley, /Iffln Owner195— Sind of Building Used as 195— To be completed about 5k9l'- - Estimated Cost, $ 42ea Old ew. Building Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Not Water, Warm Air—No Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load A 1 Sind of Fuer BURNER — Trade Nam �y l0A /I U%/IX-91,e No—a ® ® /fA e Capacity Sq. Ft. E.D.R H.P. Siga 11oQljo-POST IM -8-58 Business Phone NO ✓ s Application for Power Plants and Heating. Cooling, Ventilation. Remrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. IDR Hot Water .. 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water ........... . ..... 2.50 $ OIL BURNER—to 3 gal. per hour 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,Q00 BTU) .......... ............ 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 Additional Fixtures ............... x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL See Fee Schedule TOTAL FEE Dept. of Bldgs. Phone SW -3480 City of Fridley: The undersigned hereby makes 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 that all the facts and representations stated in this application are true and correct. Kind of Building Used as Cho To be completed about Estimated Cost, $ ld ew. Building Permit No. Permit No. g / DESCRIPTION OF WORK 160 HEATING or POWER PLANTS -Steam, Hot Water arm No Trade Nam Size No Capacity Sq.�iFt. E�/DR / BTU H.P. Total Connected Load 3O / 5�� f� Kind of Fuel BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) Y. %�. 42 Businem Phone �' r SUBJECT P City of Fridley 33662 AT THE TOP OF THE TWINS BUILDING PERMIT r 1. RECEIPT NO. 1. � tr __---_ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC.. �� / 1 NUMBER REV DATE PAGE OF APPROVED BY CITY MALL FRIDLEY 55I32 763-571-3450 910.F15 7/1/03 JOB ADDRESS 1320 69 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DIE 17 1 Rev. Auditor's Subdivision #10 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Larry Reese 1320 69 Avenue NE J CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Tabor & Sons Roofing 10547 Terrace Rd, Blaine, MN 55434 612-789-1902 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20014248 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION j] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (14 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 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 1 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 @ $1,621 @ $ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .81 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 W PLAN CHECK FEE TOTAL FEE - -® Lice se SC $5.00 $67.53 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI N INVHEN PROPERLY VALIDATED THIS IS YOUR P RMIT P S-GNATURE OF OWNER.IF OWNER BUILDERI IDATEI "50 rpAlt r NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: 20 Legal Description: Owner Name & Address: Tel. # Contractor: MN LICENSE #oma/�/� Address: l d S Y n _R'�% ,a '�//.!� Tel. # 2 :z a!9' LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Construction Type:, Estimated Cost: $ .?*moi Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 7" Z -Q APPLICANT: Tel. # CL,/ �- Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $ 6 ,/& $ $ t/ TOTAL $ 4* 1/7-55 CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 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 [ ] CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: (763) 571-1287 PERMIT=20001234'�� DATE ISSUED: 08/02/2004 ADDRESS 1320 69 AVE NE PLBG FIXTURES (NEW OPENINGS) 0.00 PIN 133024120011 WATER TREATMENT APPLIANCE 0.00 LEGAL DESC AUD SUB NO 010 (REV) WATER HEATER - GAS 35.00 GAS RANGE FEE LOT 17 BLOCK GAS DRYER FEE 0.00 PERMIT TYPE PLUMBING STATE SURCHARGE, PLBG FLAT 0.50 PROPERTY TYPE : RESIDENTIAL PAID WITH CHECK # 28783 CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 400.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER HEATER. # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 1 # GAS DRYERS 0 # GAS RANGES 0 # OF NEW FIXTURES 0 VALUE (FOR MINIMUM CALC) 400 # WATER TRMT APPLIANCES 0 APPLICANT NORBLOM PLUMBING CO 2905 GARFIELD AVE S MINNEAPOLIS, MN 55408-2173 (612)827-4033 OWNER REES LARRY R 1320 69TH AVE NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulatinnsLctionhe performance of construction. Applicant Date p _ Bldg Insp Da BO PLBG PERMIT MINIMUM FEE 0.00 PLBG FIXTURES (NEW OPENINGS) 0.00 PLBG FIXTURES (EXIST OPENINGS) 0.00 WATER TREATMENT APPLIANCE 0.00 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 35.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 PLBG REPAIR/ALTERATIONS 0.00 STATE SURCHARGE, PLBG FLAT 0.50 TOTAL 35.50 PAID WITH CHECK # 28783 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. ,ITY OF FRIDLEY INSPECTION DIV. 431 Uriiversity Ave NE Adley, MN 55432 763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR :::::.:::::; �.�'<•;.= er ................'................ Tray ................................ Floor Drain Au a S Range Water HeaterWash Stories :=:•:fi.<r>': :Urinal Gas Elec Basement Floor 1 Floor 2R. Floor Floor 4 'LUMBING FIXTURE RATES: dew Fixtures )Id Opening, New Fixture 3eer Dispenser Slow Off Basin ,atch Basin lain Water Leader Sump/Receiving Tank Nater Treating Appliance Nater Heater -Electric Nater Heater - Gas*` Sas Range** 13e�o 6-0 4cyel X � NO. RATE TOTAL JOB ADDRESS Swnn.2 .0-s. 01A-) KxJy- Sas Dryer** Sack Flow Preventer Required ( )Yes () No Type $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 $15.00 Reinspection Fee $50.00/Hr kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE $ .6D $ 3s z 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. REES, LARRY %/z3 .2001 1320 69TH AVENUE NORTHEAST FRIDLEY, MN 55432 OWNER _ (763) 571-8620 BUILDING USED AS$I ESTIMATED COST qoopo PERMIT NO. 0 cPV PLUMBING COMPANY O (_\k 0VA Lai1M IQT SIGNED BY TEL N0. C t2 g -q-033 Approved By Rough -In Date Final Date loq MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existina furnace, 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 installina 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 BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type 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 CITY OF FRIDLEY PERMrr �2004-01879 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 10/14/2004 ' (763) 572-3604 FAX: (763) 571-1287 ADDRESS 1320 69 AVE NE PIN 133024120011 LEGAL DESC AUD SUB NO 010 (REV) LOT 17 BLOCK PERMIT TYPE HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL A FURNACE (WARM AIR, CARRIER, 60,000 BTUS) AND AN AIR CONDITIONER. # A/C UNITS 1 # FURNACES 0 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALL) 5900 APPLICANT HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK 35.00 0.00 SUPERIOR CONTRACTORS INC 612142 AVE N GAS RANGE FEE 0.00 CRYSTAL, MN 55422 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL PAID WITH CHECK # 16849 35.50 OWNER REES LARRY R 1320 69TH AVE NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the pe rf finance of construction. Applicant Date Bldg hasp**, ' D,0do 2444 SEPARATE PERMITS FMQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY BUILDING INSPECTION %,14 4 Effective 4/1/2004 ,6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION 763-572-3604 FAX 763-571-1287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES I3c;� 0 &'7 JOB ADDRESS RATE SCHEDULE Fee Total Residential Owner Furnace Shell and Duct Work, Burner & also Replacement Furnace $35.00 $ 3So Building Used As Gas Piping (New Furnace, Fireplace, Insert) $10.00 $ ESTIMATED COST PERMIT NO QbO4/ J Gas Range $10.00 $ DESCRIPTION OF FURNACE AND BURNER Gas Dryer $10.00 $ # of Heating Units Circle One (Steam) (Hot Water)Warm Air Trade Name 4fAJZ1 2 Size No..Sr//1JrCZ-0 *Air Conditioning -All Sizes $25.00 $ 095 D BTU /,4.0 ®,*> HP EDR Fuel .0f7- Total Connected Load All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Burner Trade Name Size No. Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EDR Improvement whichever is greater ' The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/Industrial/Institutional e and representations stated in this application are true and correct. State Surcharge $ HEATING CO 50,p ALL c2 TOTAL FEE $ Signed J�� Tel # 7,63 -S3� REINSPECTION FEE $50.00/HOUR FAX # Date /&/D2"Dy *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, 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. Yesy 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 GcJ BTU Input 401-1170D Fan Assisted o�Q Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height �§L ft Length -�7—ft Diameter '� in Type CLA--6s 0 -- Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) Nc- <—IbZ V 19;F ' f EueV x) Ae-6-i D® c) AJ Ti -Z25 Z:7406- . - / AJ G ---k -7-T // ,;5-oje OJ14 HEATING CO: Signed By: SUPERIOR CONTRACTORS INC 6121 42ND AVENUE NO. CRYSTAL, MN 55422 Date: Building PLUMBING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604CITY OF FRIDLEY Date Recd: t DATE I Z-0% — O6O YOUR E-MAIL ADDRESS iGK-G PI Ut�✓I�I N6 I /l%C `� �++� • C�c�" SITE ADDRESS f Z O &1)4) / L-LLL V /`R /b 1 ±�4 443 1 THIS APPLICANT IS: 0 OWNER PrCONTRACTOR PROPERTY NAME: Ly13r22.4 Res ADDRESS: 6 Vh %I vL /t/L CITYSTATE _X1�ZIP 1� Z OWNER/ TENANT PHONE: CONTRACTOR NAME: 4Q(, P)V111b-,1)c 1 c STATE LICENSE #S Z f'r N P m EXP DATE 1-2-31-o& SUBMIT A COPY OF YOUR STATE ADDRESS: /8//y 91V&11- 03 CITY A / ✓ STATEm/lLIP 5 "3 L% LICENSE WITH PHONE JLLI Z - ZqZ-- SU`"/ / FAX 7413 - 4/Zo- O&3 Z APPLICATION PERMIT TYPE SINGLE FAMILY 0 TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 0 NEW REPLACEMENT DETAILED DESCRIPTION OF WORK L.vSTPr I1/tc..J -P x�-vit&3 i,v 4/ -JG PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should- reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x .05 = =°FOR:PROJECTS WHERE LABOR EXCEEDS4500;7FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WIRE NOIED-> FIX'R1RES _.(INDICATE TOTAL NUMBER OF EACH BELOW) t BATH SINK/LAV DRAINS _ SHOWER _ WATER PIPING _FLOOR BATHTUB _ GAS PIPING ovEm crrrummss) _ SWIMMING POOL _ WATER SOFTNER ($35) CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ BACKFLOW PREY. ($15) _ DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ _ _ WATER METER —OTHER a Permit Fee $ Number of fixtures @ $10.00 _ S x $10.00 = $_S Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ State Surcharge = $ 50 Total = $ o •' o 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 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 'ch re es review and approval of plans. / SIGNATURE OF APPLICANT �� PRINT NAME_,&e--,--,-' ✓Or/i�cW DATE / Z -U1- O Co City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977