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PRE 2010 DOCSr a 4 CITY OF FRIDLEY NOTE: Applicant should obtain building permit proCeIre informatinin from Building Inspection BUILDER: Approved Contractors, Inc. V Department Secretary. ADDRESS: 1052 Osborne Rd. N.E. Fridley 554 NOTE: A Certified Survey of the lot, , Street City Zip Code showing the location of the foundati n, TELEPHONE: 786 368o once it has been constructed, will be Home Business required before proceeding with the. framing. PROPERTY OWNER(S) Roger W. Larson Donald Me Wehlast James E. Wiensch MiL We? elver= _ 85 West R$. Circle Pines, Minn. ADDRESSES) 8$04 Lexington New Brighton, Minn. 55112 Street City Zip Code 614 W. Brown Deer Rd. Milwaukee, Wisc. Street City Zip Code TELEPHONE NO -(S) Home Business OF Property Location on Street or Exact Street Address (if any): County Rd. H or 69th Ave.l." N.E. Legal Description of Property: The East 3/4 of the NE 1/4 of the NE 1/4 of Section 13 T-30, R-24 City of Fridley, County of Anoka, State of Minnesota Total Area of Property sq ft.,� Present Zoning Classificatlon DESCRIPTION OF BUILDING Proposed Building Use: Multiple 141 units Each unit ftilding bnimeneions: ,. wont 20 Depth 32 Height . 21_____ Square Ft. _121-3 Cubic Ft. Type of Construction: Wnodrame each unit Project Estimated Coat _16.000.00 To Be Completed 7-1-73 DATEs;-/a. APPLICANT'S SIGNATU1RAS `.A/ /-, U/!/fT — /�I. —19 51 arc V,44 poor ff .3 ® 7` ,C C/T Y r c -e 5,2 k0 15G�� r" v pr A/5 If 0/1/1 T 2 3 2 C) v�V0 A 2 5-�y� / 73 93,0 $ 11,¢4 fl � �L R 0 l7393,©�r srfr7-� " 7°27 c� ca o Y.►L.I/44Tecoll / /� 3C h'EOvA's Z Z /? vAll T C6'9 /0 C */d - 5a-4 X 0 ,P — X2.6 N,r = y o sa Fr -- �- 0 5 f 60� 2K3� OL -3� ,#a _ � 331�Sv 3 5 1i.4G�l�hbAs.r'�? �a�T .00 ® s 7. 9 8', 7-0 7-o+ U,4-c.v e o AC AA 4. 9 2 3 0 PT 6W.4O3 �Py,4it�` % 1fZ 2 b ALL !r'- 0$�a ' NON -RES IDEN-11AI, BUILDING PERMIT CITY OF F'RJDLirf ' ADMINISTRATIVE PROCESSING AND PLAN! CHECK G4 U ZONING: x/ -=i ADDRESS: f ( 00 84 - G 9" Ale iV r b4 INSIDE UTILITIES: PLUMBING VENT & HEATING EMTRICA14 NOTE: Easements, R/W, Special Agreements. VARIANCE REQUIRED: City Engineer LEGAL DESCRIPTION: E o f /1/6 k E., SPECIAL USE REQUIRED: t �" yr �� 0�/ /-F,4 u� PARTIAL: DATE: '-' PLOT PLAN: TOTAL AREA GRADE ELEVATION SF.T BACKS: FRONT YARD SIDE YARD REAR YARD N0IV �+ .917 41,8140:ft av C r v WATER SEWER ELEV CURBING DRAINAGE SCREENING & PLANTING ►tea 2-ka. �5 pEx �..,. 14 5 PC R P 646 1i SUBMIT TO: BUILDING BOARD BOARD OF APPEALS PLAN. COMM. COUNCIL pr_mN ,f�- 5 - 91 & -/s---77 City Engineer H APPROVAL DATE: Sewer Connection Charge Receipt No. Permit Fee & Pla Check 451, Receipt No. sa RE KARKS : 3 r 0 Less A " A - Deposit (;%�/��y�r r , c� J �.�.ri- Receipt No. w FIRE REQUIREMENTSi FIRE MARSHALL FIRE :REVENTION BUREAU EXITS (dates App) Regieteked Engineer'e Stamp Legal Description Check `— G4 U FINAL APPROVAL ilding Official b4 INSIDE UTILITIES: PLUMBING VENT & HEATING EMTRICA14 NOTE: Easements, R/W, Special Agreements. City Engineer DATE: E., Date Approved : t �" yr �� 0�/ /-F,4 u� PARTIAL: DATE: FINAL: DATE: � OUTSIDE UTILITIES REi�fARKB s REKARKS s �+ & SITE DEVELOPMENT: WATER SEWER ELEV CURBING DRAINAGE SCREENING & PLANTING ►tea �5 pEx AFS_ />.-,p 14 5 PC R P 646 1i ,LI,�, Date Approved pr_mN /-11-14.4 a City Engineer Sewer Connection Charge Receipt No. Permit Fee & Pla Check 451, Receipt No. 3 r 0 Less A " A - Deposit (;%�/��y�r r , c� J �.�.ri- Receipt No. ��5 ) e,J C7ff Net Permit Fee Due 7 5./ • Receipt No. SPECIAL ASSESSMENTS: IF LATERAL ASSESSMENTS HAVE NOT BEEN PLACED ON THIS PROPERTY, AN AGREEMENT MUST BE SIG AGREEI G TO ASSUME SUCH LATERAL ASSESSMENTS BEFORE A PERMIT WILL BE ISSUED, )C� AMM MENT NECESSARY j/� Finance Director AGREEMENT UNNECESSARY ' Regieteked Engineer'e Stamp Legal Description Check `— (A) FOUNDATION PERMIT FINAL APPROVAL ilding Official Building Official (B) FINAL APPROVAL Gam,z, NOTE: Easements, R/W, Special Agreements. City Engineer DATE: CERTIFICATE OF OCCUPANCY: PARTIAL: DATE: FINAL: DATE: REi�fARKB s REKARKS s •, „ 4 AcAl C-, ,LI,�, Y. eT r7`,� iTc-CcC S7 �`6 G� ' f'ir f« . �, e,Z ., /? S T ACr�//; c;• n! r5.e c�'�' t P' yj 0-2 j c -'r C-xl J "/ 07 -1 CL- O�u `��Ot cele15p C/ 1-:;f C17 -IV f�L"r1 Feel= 0-4 I-IPIN& t1419� if P7—L/ ,PAW ,P44-& 02 /�/ C//V/ rS A 2— y � � 9 � ToT�,c ,, C' %`Y A -05A- r-6 R / f ( / IIIIA?6 I1A,1 IS A -L-A 7v7-.*'4 �6 VAll � 7 e9 72 21 o q 70 7�11 Permit Fee paid on Permit #11,315 for 1560 - 1570 69th Avenue City of Fridley, Minn.. � _ 1.1316 6431 University Ave. N. E., Mbaneapolis, Minn. 55432 BUILDING PERMIT 'Date:y e r'ary2. 1972 Chmex: -Rice Creek Development Company Bider Approved Contractors„ Inc. Address -85 West Road, Circle Pines, Minn. Address 1052 Osborne Road N.E., Fridley - - 786-3680 x 1596215942 LOCATION OF BUILDING 1592,1590 No Street H A th Au ue N -E . Part of Lot Parce1A 10 & 200, Section 1 Block ___ _ Addition or Sub -Division Corner Lot Inside Lot Setback _ Sideyard *mower Elevation Foundation Elevation - R-3 Zoning 14.1 Acres DESCRIPTION OF BUILDING To be Used as: 4 Tgsanhouse Units Front 20' Depth 32' Height 21Sq. Ft. 1213' Cu. rt Front Depth Height Sq. Ft. _ Cu. F't. Type of Construction Wood Frame Est. Cost See #11, 315 To be Completed 1 yea r In consideration of the issuance to me of a permit to construd the building described abov I agree to do file proposed work accordant' with the description above and in comp/ re wigs provisions of Ordinances of the cityof Fridle . /v/ In consideration of the payment of a fee of $ ee IP143-1-5, 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 buildings Vithin city limits and this permit may be revoked at any time upon violation of any of the provisions of said CLARENCE BELISLE NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. lie sure to see the Building Inspector for separate permits for these Items. b Application fW Fewer Plants and ideating, Cooling, Ventilation! ROMSOM01on and Alr Conning Sys and Devices PARTIAL RATE SCHEDULE GRAVIT'l 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 AZA Furnace Shell & Duct Work to 120,000 BTU ......-'/ ..$10.00 • o Q each add. 60,000 BTU .................... .. 3.00 = Replacement of Furnace .... 6.00 $ Repairs & Alterations—up to $500.00 6.00 $ Repairs & Alterations each add. $500.00 &W $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines --to 400 sq. ft. EDR Steam $10.00 $. 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 6.00 $ _ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTU) .. I ...... q. 6.00 CJ O over 199,000 BTU See Fee Sch"We GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures =L_ x$ 2:00 $ 8 . ® O Additional Fixtures x .76 $ Gas Range to 199,000 x$ 5.00 $ AIR CONZ)ITZONIIO0 FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH Q� FINAL e V d �d 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 Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application a true andjeorrect. 1 Kind of Building . .4 Used as _ _-- To be completed about Estimated Cost, Old ew. uildintt Permit No. — 19 / 2 - Permit No. 4�q 3 DESCRIPTION OF WORK HEATING or PO PLANT5-steam, Hot Wa Warm ` —No— Trade give 10 ®Z Capacity 0 0 U Sq. Ft. E.D.R BTU H.P Total Connected Load Rind of Fuel . -,& BURNER — Trade Na*r+p Size loin Z/ °5 Capaci Sq. Ft. E.D R BTU IM Sae Fee Schedule �-� u,;,._j- 2 qq, 0 C) TOTAL FEE • S� �,� (REMARKS -OYER) City of Fridley Dept. of Bldva. Phone Mii DESCRIPTION OF WORK Number. Kind and Locafion of 71xtuv@v NO. RATE TOTAL Plumber Fixtures . a ........... a .. 32 .,%2.00 3 &-/, 66 Future Fixture Opening ........... x $1.50 i New Fixture Old Opening .......... x $1.50 t Catch Basin .............. 0 ..... x $3.25 f BTUD le�/ $3.00 - -a Water Heater (Up to 99.000 .... - x New Ground trued Old Bldg......... x $3.25 $ Electric Wates Heater .............. a $200 3 GAS FITTING FEES. NO. RATE TOTAL Ist 3 Fixtures • .......... • • .. x $200 $-A2. Additional ................. 7 -57 - Y TWIN Gas Mange to 190,000 HTV .. �......... x $5.00 $-:940, State Surcharge $ .50 M'NOMNI� PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES- NO. RATE TOTAL Plumber Fixtures . a ........... a .. 32 .,%2.00 3 &-/, 66 Future Fixture Opening ........... x $1.50 i New Fixture Old Opening .......... x $1.50 t Catch Basin .............. 0 ..... x $3.25 f BTUD le�/ $3.00 i Water Heater (Up to 99.000 .... - x New Ground trued Old Bldg......... x $3.25 $ Electric Wates Heater .............. a $200 3 GAS FITTING FEES. NO. RATE TOTAL Ist 3 Fixtures • .......... • • .. x $200 $-A2. Additional ................. 7 -57 - Y 60 Gas Mange to 190,000 HTV .. �......... x $5.00 $-:940, State Surcharge $ .50 REPAIRS a ALTERATIONS Refer to Ca& Ducription ... .. . . . .. ... a s e ... ..... . . $ �V TOTAL FEE $ �9' ((// City of Fridley: The undersigned hereby makes application for a permit for the- work herei• specified, agreeing to do all work in strict accordance with the Citar Ch mance and ruling of the Department of Buildings. and hereby declares that all the fact and representations stated in this application are true and correct Fridley. Mie 1g— Kind of Building ���+ �ti-s 'e Used as 2:u '� To be completed about en 76- r -?-'2 Estimated Cost. $ Old -New. Building Permit No. Permit Signed By Business Phune No ROUGH - RE PAIRS OUGH Application for Power Plaints and Heating, Cooling. Yentila&n. Refe�ige- ation and Air ConMonkg Sptem and Devices PARTIAL RATE SCHEDULE GRAYTTY WARM AIR: RATI;< TOTAL Furnace Shell & Duct Work ... .... ....... .. $10.00 $ Replacement of Furnace .. 6.00 $ Repairs & Alterations—up to $500.00 600 $__ Repairs & Alterations each add. $500.00 3.00 $____ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ..... �/ 1� . $10.00 each add. 60,000 BTU .................... 3.W $ 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 FurnaceShell & Line—to 640 sq. ft. EDR Hot Water 10.00 $_ Each add. 200 sq. ft. EDR Steam 3.00Each add. 320 sq. ft. EDR 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 198.000 BTU) LY . 8.00 ; 2 �' , U over 199.000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures 's zoo (� Q Additional Fixtures x .79 $ Gas Range to 188.000 x; 600 $ AIR CONDTPiONDfa FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL oSof Fee Schedule mot ,r.�ir .�/'00 TOTAL FEE f �E). 0 v sU � co (SURCHARG `�?� fv Dept. of Bldgs. Phone 810 -MM - z/ 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 Ordinance: and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and ,correct. 19/Z Owner Kind of Building Used as ` I i To be completed about Estimated Cost, Ol ew uilding Permit No. Permit DESCRIPTION OF WORK HEATING or PO PLANTS—,Steam, Hot Wate , arm No_C_/ Trade Name Size Ne- C_ 1,2 ,,2 -X 2— Capacity Sq. Ft. E.DR BTU Hp. Total Connected Load Kind of Fuel BURNER — Trade Name Size No Capadty Sq. Ft. E.DR BTU 1EP. (REMARKS -OVER) CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE. RATES: NO. RATE TOTAL Nj=,ber Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU !U0,000 BTU to 199,000 BTU Water Softener New Ground 11,in Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS & ALTERATIONS First $100.00 each ad;i. $100.00 or fraction X $3.00 $ 0 $2.00 $ a U) $ X $5.00 v X X O X Water $ X $7.00 A X $5.00 u q $5.00 $ x '$3,00 $ X $1.00 $ X a m N N a 4J p, w C Heater m F •a h u u: ro $4 a w a c c x c arz 3 e u •.+ o .c ci v O O •H 4J N C. N •'1 O 0 O •L) N 4J N N N N + C7 r+ U w U ro q ro W + fA ro► 3 o O G. x U) .4 6. ro 'j0 U CO ro .t 3 ro U' as leo est A. 2nd U^ 3 rl --T-r 4th (R) = Future Connection Opening Connected with Sewer (') = :G•_w Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE. RATES: NO. RATE TOTAL Nj=,ber Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU !U0,000 BTU to 199,000 BTU Water Softener New Ground 11,in Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS & ALTERATIONS First $100.00 each ad;i. $100.00 or fraction X $3.00 $ x $2.00 $ X $2.00 $ X $5.00 $ X $5.00 $ X $10.00 $ X $7.00 $ X $5.00 $ X $5.00 $ x '$3,00 $ X $1.00 $ X $10.00 $ $5.00 $ $2.00 $ State Surcharge $ .50 TOTAL FEE $ gj .()-C) REINSPECTION FEE (S10.001 Job Address 1 S 9 `, Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. , 19 OWNER -- L, y D -\ ` k4 KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company Signed By \ ,L� Q b-�i \ �� l►�6. 2� Tel. No. L, ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE SUBJECT P NO. City of Fridley 2 9 6 5 8 AT THE TOP OF THE TWINS BUILDING PERMIT r � P O. E T NRO. ►v ______ COMMUNITY DEVELOPMENT DIV. SEC. r PROTECTIVE INSPECTION � �wss 1 = � 1 I CITY HALL FRIDLEY 55432 %612-571-3450 mws I NUMBER REV DATE 16/10/99 PAGE OF APPROVED BY 910-F15/ / JOB ADDRESS 1590 - 96 69th Avenue NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. lPar.10&2001 Section 13 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jim Bern Mgmt 8162 Bloomington Ave Bloomin ton55425 854-7788 NUNN 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Horizon Exteriors 1333 Larc Industrial Blvd. Burnsville 55337 890-3900 20012795 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 Reroof Townhomes (35 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply witht the State Building Code. Permit Inspection Cards Will Be Mailed To Homeowner To Post SEPARATE PERMITS ARE REOUIgEO 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 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 $3059 $1.53 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 $97.25 Fire SC $3.06 PLAN CHECK FEE TOTAL F Lic S 5. 0 1 .84 SIGNATURE OF CON 7PAC TOR ORAUT«ORiZEDAGENT iDATEi ENOP AL DAT HIS IS YORPER IT SIGNATURE OF OWNER, IF OWNER BUILDERt iDATE, $P OA IE V A NEW[) Effective 1 / 1 /98 ADDN [ ] lob gy CITY OF FRIDLEY ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 A BUILDING PERMIT APPLICATION ConstmctionAddress:/ Legal Description: Owner Name & Address: Jim B n+2 fiVTel. # '77$8 Contractor: &ri on Q(kr-jorS IO�M�n I� LICENSE#020_0lo't 95. Address: /3-55 Lca r c- I n olw S-1 i Gl I Blvd �' Vi 11 L '55.33 Tel. # $90 -3900 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Y'e =F-- -35n2, Construction Type: RWfjhQ Estimated Cost: $Z T � 4n, (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 6-;Z '9 9 APPLICANT: Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY $ Fee Schedule on Reverse Side $ �„ .001 of Permit Valuation (1/10th%) $ $.501$1,000 Valuation $ ---- $1000 per SAC Unit $ s^�� $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 [ ] $ 10(o• n City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287 6431 University Ave NE Fridley MN 55432 Mechanical Permit # 9®®6- ' o1o?P7 Residential Application City of Fridley See Back Side For Required Information Date 7 Site Address: The applicant is: (cirl a one) Owner Contractor Property Owner. Address: 0/07 AIWI� City: &s44k% State: Zip: A Phone: Cell: Fax: Contractor Informati n ' Company Name: CC� Contact Person: -r Address: City:A 22r/ Za moi_ State: /d w Zip: ,jam_ „ZS Phone: 6V y ZW�'t Cell:A(/ `l Ems% Fax: �! �1 , AS Email: a MN Bond# & Exp Date S Type of Work (circle one): New Replacement Alteration/Remodel _ Detailed Description of work: al e� 6 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 A/C $25.00 _Fireplace (wood) $35.00 _Gas Unit HTR $10.00 to Air exchanger $15.00 Fumace $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 a Duct Work $10.00 Gas Range/Oven $10.00. .�' i� - •�;a' Permit Fee $ (Total from above -Minimum fee $35.0 Tal�v -6 ie Surcharge$ 0.50 Total Due $ 115 Make check payable to City of Fridley e This is an application for a permit- not valid until processed 16 I hereby apply for a mechanical permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in case of all work which requires review and approval of plans. m f Signature of Applicant: Date: Approval Inspector Signatur Date: DioocA KintA- gpnaratp nprmits are required for Building, Plumbinq, and Electrical work AUG -09-2005 13:34 CITY OF FRIDLE`r PLUMBING RESIDENTIAL APPLICATION City of Fridley Permit Number Received By Date Received THIS IS AN APPLICATION FOR A PERMIT --NOT VALID UNTIL PROCESSED I hereby apply for a plumbing 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 thecase of all work which requires review and approval of p s. NAME OF APPLICANT �( Z�M DATE ?/A/Jrj PI se type or print SIGNATURE OF APPLICANT , 6939 UNIVESMY AVENUE NE. FRIDLEY. NIN 55432 NOTE: IF PROPERTY 15 NOT OWNERIOCCUPIED. A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT. DATE YOUR AIL ADDRESS_ r��.� SITE ADDRESS THE APPLICANT IS: (CIRCLE ONE) OWNER CONTRACTOR NAME PROPERTY OWNER/ ADDRESS TENANT CITY STATE ZIP PHONE # NAME J60, ' �¢ENSE # 2. ADDRESSZ4 vo CONTRACTOR CITY STATE If ZIP_ PHONE # FAX#=j7G PERMIT TYPE SINGLE FAMILY TWO FAMILY TOWNHOUSE TYPE OF WORK p NEW REPLACEMENT DETAILED DESCRIPTION OF WORK FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED FD(TURES: (INDICATE TOTAL NUMBER OF EACH) BATH SINKILAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING (Need City License) SWIMMING POOL WATER SOFTENER ($35) CLOTHES WASHER KITCHEN SINK --WATER CLOSET BACKFLOW PREY. ($15) DISHWASHER LAUNDRY TRAY WATER HTR ($36) FOR IRRIGATION WATER METER OTHER Pormit Fee $ 5 00 .0 -MINIMUM: $15.00 or 6% of cast of the improvement-Whicheveris Plan Review $ greater on work less than $300 Surcharge $ .50— T DUE Make checks payable to: City of Fridley THIS IS AN APPLICATION FOR A PERMIT --NOT VALID UNTIL PROCESSED I hereby apply for a plumbing 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 thecase of all work which requires review and approval of p s. NAME OF APPLICANT �( Z�M DATE ?/A/Jrj PI se type or print SIGNATURE OF APPLICANT , 6939 UNIVESMY AVENUE NE. FRIDLEY. NIN 55432 RUG -09-2005 13:34 CITY OF FRIDLEY P.03iO4 Clty of Fridley Building Inspections Dept, Ph: 763-572-3604 FAX: 763-571-1257 6431 University Ave NE Fridley MN 55432 Mechanical Permit# Residential Application City of Fridley See Back Side For Required Information Date Site Address: AV The applicant is: (cirice one) Owner Contractor Property Owner. Address: CRY: State: Zip: Phone: Cell: Fax: Contractor informati�r�� , Company Name: Contact Person: Address:Z City: State: Zip: Phone:. «6il9� Pf-- Cell: 6d3 ?o VPtI-7 Fax: 6 Email: h• MN Bond# & Exp Date .0 &66k, T e of Work (circle one): New Replacement Afteration/Remodel Detailed Description of work A/ & .r,LrEtP/1. I?G �►.s� ��,.�s7.d. 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 _A/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 _Soller$35.00 _Gas Dryer $10.00 Ventilator $15.00 _Chimney Liner $10.00 _✓Gas Piping $10.00 Duct Work $10.00 Gas Range/Oven $10.00 Permit Fee $ c -b0 (Total from above -Minimum fee $35.00) Surcharge $.—_ _.. - _ _.. _ _0:50 - Total Due Make check payable to City of Fridley 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 with the Minnesota Construction Codes; that I understand this is not a permit but only an apprication for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in case of all work which requires review and approval of plans.