The URL can be used to link to this page

PRE 2010 DOCSM CITY OF FRIDLEY NOTE: Applicant should obtain building permit procedure i nf-w®nt�iin 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, 7$ 6 3 660 once it has been constructed, will be TELEPHONE: Home Business require framing. PROPERTY OWNER(s) Roger W. Larson 'Donald �ehlast ) James E'. Wiensch MiL w a vl 85 West R$. Circle Pines, Minn. d before proceeding with the ADDRESSES) $$04 Lexington New Brighton, Minn. 55112 Street City Zip Code 614 W. Brown Deer Rd. Milwaukee, Wisc. Street City Zip Code TELEPHONE NO -(S) Rome Business Property Location on Street or Exact Street Address (if any): County Rd. H or 69th Ave:: 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 Classification! DESCRIPTION OF BUILDING Proposed Building Use: Mult e 141 units Each unit 1%xilding Dimensions:,, Front 20 Depth 32 Height .21 Square Ft. Cubic Ft. Type of Construction: WQQ Frame each unit Prg3ect Estimated Coot ^,16.000.00 To Be Completed 7-1-73 DATEt ; '• le ` APPLICANT'S SIGNATUREt `� tl c/yr T 7- ate Ay, 15G4� 5� SQ %/ /,V, � 5 q 4 r/ 4s,4y,�y 1 73 y3, ®��- 17 3 9 3,®�r s r•P 7-,G j I o w o 5 Y�►L. v�T��/�/ %/ G j SC HF_ Ovl.H 3- v � z � � �kuf �,�� t g osq Fr s-- F / 30 �1� ?ur s sq ter , fc c�1-3 z 3 ° ®� r 9 1�5 i� ``-7oT,¢'� e! y^�� o� /-tieL fir' s o gra S4' FT il Sr�¢TE IoAGIl�h�N.,��rd For.T r .7 $7`•470 3v�C ,d0 o j;-® •�4.�g�o�c�•q�p,FS ACp /f`�4L� "'7-4-4 , r SD %-0 7- 4-4 144 1 u C ea � A A L �/�A6�s /c �n �. 9 � 25 2 5 0 D• NON-RF,SIDENT1A1, BUILDING PEaMIT ZONING: X/--7 VARIANCE REQUIRED: SPECIAL USE REQUIRED: PLOT PLAN: TOTAL AREA GRADE ELEVATION SFT 04/ -5/ 7-15 CITY OF FRIDLZf ADDRESS:16 ®& /.?C - G 9'`411A� 11/r LEGAL DESCRIPTION: 7=3 BACKS: FRONT YARD SIDE YARD REAR YARD SUBMIT TO: BUILDING BOARD BOARD OF APPEALS PLAN. COMM. COUNCIL 91 /T - / H APPROVAL DATE: - - y -�j 4 _ 3 Q?�" S- /4 -7/ o REMARKS: U FIRE REQUIREMENTSa FIRE MARSHALL FIRE :REVENTION BUREAU EXITS (datos App) Pri w e� yU� INSIDE UTILITIES: PLUMBING VENT & HEATING ELEOTRICA14 Date Approved H H A OUTSIDE UTILITIES & SITE DEVELOPMENT: Date Approved City Engineer WATER SEWER ELEV CURBING DRAINAGE SCREENING & PLANTING fE5 pg /? � 74 5 Pr -,q PA A V Pr-4AI Sewer Connection Chargee Receipt No. 6 L` Permit Fee & Plan Check5 1, o Receipt No. 3- 3 �i �' J Leas DepositS4_ �. d c; 7 Receipt No. 51 c6J (7 f Net Permit Fee Due � � / • Receipt No. SPECIAL ASSESSMENTS: IF LATERAL ASSESSMENTS HAVE NOT BEEN PLACED ON THIS PROPERTY, AN AGRENWE MUST BE SIG AGREEI G TO ASSUME SUCH LATERAL ASSESSMENTS BEFORE A PERMIT WILL BE ISSUED-. AGREEMIXT NECESSARY Finance Director AGREEMENT UNNECESSARY Registeted Engineer's Stamp Legal Description Cheok (A) FOUNDATION pERNIIT FINAL APPROVAL =��.:.OT ing Official Building Official (B) FINAL APPROVAL, E:Easements, R/W, Special Agreements" City Engineer DATE: ca CERTIFIGATE OF OCCUPANCY: PARTIALi DATE: FINAL: DATE: c.� . Rawles s REMARKS: �o 6� ell _s = is �� h 17"11C � �e / f��lVC: tY' is ,-f-L�- >�' �-.a� � /'�s� 3 7 0c ��e_ a/JJT��—LIF/J r c +- Pr f C,. E71614� f7P yrs ly,e l/f tO 1 r �4-1 Cer e a 7—t715 --7y /2G% 2 ye2o 9, c)"6 707> .X F Cl Tv AI..-�-�R ( /lvlA?6 I1AlM am VIV C L 0 Al ON 14 31 Ira ,?U7-,41- 'e ?U%4L'e //P/syG VAlaTs (o — Permit Fee paid on Permit #11,315 for 1560 - 1570 69th Avenue N.E. City of Fridley, Iffin-n. -1131 _. 6431 University Ave. N.E., Minneapolis, Minn. 55432. BUILDING PERMIT ate; February 22. 1972 C)Wna: _ Rice Creek D V-1npment Cmmijany I _Builder App�rnved Cnn ractOri3, Znn. Address West Road, Circle Pines. Minn.Address - 1052 Osbnrne Road_XU RF 2 T+ridlecy 786-3680 164031638216363 LOCATION OF BUILDING 016342163221A&t 69th Avenue N.E. Part of Lot Ldarcels 10 d� , Section 13 Addition or Sub -Division Corner Lot Inside Lot Setback —__ _ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Each Unit 6 T Front 90t _ Depth 391 Height ._ 2? r Sq. Ft. -.._3 23 31 Cu. Ft Front Depth Height Sq. Ft. Cu. Ft Type of Construction Wood Exame 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 set and in com fiance 'th all provisions of Ordinances of the city of Fridley. In consideration of the payment of a fee of$i�l _ 315 permit is hereby granted to ice Cxeek 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 ofbuAIAS-- n� city limits and this permit may be revoked at any time upon violation of any of the provisions ofordinsaid v CLARENCE BELISLE NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these hems. AppRcatia� for Power Plumb and Heating, Cooling, Ventilation, Raidgeration and Air ConMoning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATz 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 $—_ __ MEc*L WARM Ant Furnace Shell & Duct Work to 120,000 BTU ..... tCr. ..$10.00 $ (o 0. 00 each add. 80,000 BTU .................... .. 3.W i Replacement of Furnace 6.00 $ Repairs & Alterations—up to $500.00 6.00 $ Repairs & Alterations each add. $500.00 .... 3,00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $. Furnace 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 $ Dept. of B/ld/q.. Phone6 -3480/ 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 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. N N -1 WIN,y , , , ,1410-5 I_��S/ 1111111 4, Kind of Building ._�. Used asTo be completed about _ Estimated Cost, Old -0. Building Permit No. Permit No. S.41S*O" AIR CONDITIONINa FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL d4V ® ' o / 6 Q Q Capacity Sq. FL EZJt BTU EM schedule Soe Foe schedC� (p �-�v1XJ $6G6.c)6 TOTAL FSE C) (REMARKS -OYER) DESCRIPTION OF WORK OIL BURNER—to 3 gal, per hour 6,00 $ _ over 3 gal. per hour—See Fee Schedule EMATING or PO PLANTS --.Steam, Hot Water Warm8.00 —�+No GAS BURNER (up to 199,000 BTU) ... PP (a.. D ,� 0 $ �� D . AD Trade Name �� Size No_C=: z _ � L over 199,000 BTU See Fee Schedule Capacity �Q� Sq. Ft. E GAS FITTING FEES: NO RATE TOTAL DS BTU—Hp. 1st 3 Fixtures 2 x$ Zoo $ y0 -U Total Connected Load Sind of Fuel Additional Fixtures x •75 $ Gas Range to 199,000 a$ 8.00 $ BURNER — Trade Na.nn Size No AIR CONDITIONINa FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL d4V ® ' o / 6 Q Q Capacity Sq. FL EZJt BTU EM schedule Soe Foe schedC� (p �-�v1XJ $6G6.c)6 TOTAL FSE C) (REMARKS -OYER) City of Fridley so " for Pkmbbg and Giiw t btbg Pwmb Dept. of Bldoe. Phone SSMMM DESCRIPTION OF WORT[ Number, Kind and LocaBou of it xturev ' PARTIAL RATE SCHEDULE PLVMBING FIXTURE RATES- NO. RATE TOTAL q8 r� q ` 0 0 Number Fixtures ............ • • .. x ,42.00 $ _ - Future Fixture Opening .... :...... x $1.50 = New Fixture Olaf Opening .......... x $1.50 = Catch Basin .............. 0 ..... x $3.25 : UO Water heater Mp to 99,000 BTU) • • • • x $3.00 $ New Ground Ruga Old Bldg......... x $3.25 $ Electric Water Hoater.............. a $2.00 $ GAS FITTING FEES-. NO. RATE TOTAL 1st 3 Fixtures ............ • • • : $2.00 $ � . 0c, Additional Fixtures ................ 2 x $ .75 $--2- " S; L _?® . () Pias Range to 190.000 BTU ............ z $6.00 $ State Surcharge $ .50 REPAIRS It ALTERATIONb-Rader to Cedc Dessrlption ... .... . .. ... . . ....... . . • ... • . ....... - . 4S_ _ TOTAL F'SE 8 1419191c, lama., rC.Y®- .31'-36- Zq -,?9 -30 City of Ridley: The undersigned hereby makes application for a permit for the work hemi.. specified, agreeing to do all work in strict accordance with the CIt1 Ordinan" 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, Mine I9,_ Owner /fc 1= Kind of Building Zz24&&a Used as To be completed about Estimated Cost, $ Old—New. Building Permit No. Permit N Signed By. Business Phune No ROUGH MIAL t'1._ SUBJECT RUMIT NO. City of Fridley (( 27026 AT THE TOP OF THE TWINS BUILDING PERMIT f RECEIPT 1 �• COMMUNITY DEVELOPMENT DIV. ------ QNO. ��w r � � PROTECTIVE INSPECTION SEC. / 1 . � NUMBER REV DATE PAGE OF APPROVED BY I ` ..'-'1 CITY HALL FRIDLEY 55432 � 612-571-3450 910415f' 8698 JOB ADDRESS 1630-1640 69 Ave NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Parc 1 & 200 Section 13 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Rice Creek Development 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO AAAmerica's Best XURNM 2400 Interlachen Drive #222 Spring Park 99384 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 707-0100 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Commercial 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATION ja REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof 6- lex 57 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD 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 4753 $2.37 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 PERFORMANCA OF CONSTRUCTION. 99.75 4.75 Fire SC PLAN CHECK FEE TOTALFEE 6 106.87 siG AT REOFC NTRACTORORAU RIZEDAGENT Ir ATE) WHEN IDATED THIS IS YOUR PERMIT �PRROOPERLY BLU iNSP BATE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI Prepaid Plan Check $ Estimated Cost $ Receipt # CITY OF FRIDLEY R-3, COMMERCIAL & INDUSTRIAL BUILDING PERMIT APPLICATION Effective 1/1/98 construction Address -a `/� bq�� v �� zoning Legal e Cre,-X e P, zz � --7 Tel# Owner & Address C109MCIOR & ADDRESS �� % �l i0/Tel# ? 0 7 0 /610 Architect Reg • # Engineer �'` f/P S� 3� Reg. # BUILDING CONSTRUCTION TYPE OF WORK [] New [] Addition [] Alteration -Describe leer,06 r"' 6 `444 OFC. AREA: Length Width Height Sq. Ft. WHSE ARFA: Length Width Height Sq. Ft • OTIC ARM: Length Width Height Sq. Ft. Tel # X07 D/DD Date . E V ALUA I IVN Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) _ $,__-- Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) TOTAL VALUE Building Use Construction Type Occupancy yup Air Conditioning [] Yes (]No Fire Protection Provided [] Yes [] No Perfonyonce Bond Amount $ See Reverse for Schedule Received [] Yes [] No Permit Fee Plan Check Fire Surcharge State Surcharge SAC Charge Erosion Control Park Fee Spec. Assessments $ Driveway Escrow $ 7072%L $ `! See Fee Schedule on Reverse Side In Excess of Prepaid Amount - See Reverse Side .001 x Permit Valuation (1/10th o) $.50/$1,000 Valuation (See Sched. for > $1 Million) $1000 per SAC Unit (Plans to MWCC for determination) $450.00 Conservation Plan Review Fee Determined By Engineering Agreement Necessary [] Not Necessary [] feet x $13.50/foot ATTACH STIPULATIONS 97-811-8.79001 CITY OF FRIDLEY , • APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: • RATE a Nu=ber Fixtures x $3.00 U Future Fixture opening " e $ water x $2,00 $ • C ..c, • $5.00 $ 4g a w U' 100,000 BTU to 199,000 BTU Heater „� u 'C x $7.00 $ H .SC� u I.1 b $ .t0 � ue � •� $ 9 O , •••� 7A ,y1�� C 1x71 •.i pN 8 -0 O u aNi a O u 0 A t� w 3 § c w° vii w a� u oen 41 of 3 U N � o as lec idt 2nd 3rd 4 th (R) . Future Connection Opening Connected with Sewer (•) - New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Nu=ber Fixtures x $3.00 $ Future Fixture opening x $2.00 $ New Fixture, Old Opening x $2,00 $ • Catch Basin x $5.00 $ Water Heater - to 99,000 BTU x $5.00 $ 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ New Ground Run Old Building x $5.00 $ Electric Water Heater x $5.00 •� $ GAS FITTING FEES: lst 3 fixtures x •$3.00 $ Additional Fixtures x $1.00 S Gas Range to 199,000 BTU x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ 8.00 REINSPECTION FEE Job Address 1630 NE 69 Ave, 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. 0-9-78 , 19 OWNER EIRANZ KIND OF BUILDING frame USED AS res, ` M TO BE COMPLETED ABOUT 10-16-78 ESTIMATED COST 20.00 OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company Signed By MINNEGASCO Tel. No. ROUGH INSP. Date FINAL INSP. - A Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATS kup= ►= n City of Fridley Building Inspections Dept. �� `° Ph: 763-572-3604 FAX: 763-571-1287 6431 University Ave NE 3 Fridley MN 55432 32 4� G� � �i 9S � ,�' ` 130' Mechanical Permit#��' DI Residential Application City of Fridley D....1, c-4- c. r, Dnnnirarl Infnrma#inn 9 This is an application for a permit- not valid until processed )e� 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. O / CY4 s � Signature of Applicant: Date: Approval Inspector Signature. Date: a Please Note: Separate permits are required for Building, Plumbing, and Electrical work 07 r 11b 11, 1/7/ Date77;Z/--oQ_q5 Site Address: The applicant is: (cirl a one) Owner Contractor Properly Owner: Address:/6�2 City State: /lit/ Phone: Cell: Fax Contractor Info rmati n % - Company Name: Contact Person. -� Address* City. State: /LIN zip: •Si"b2� PhoneCell:" A/40 [(fW Fax: Email: a MN Bond# & Ex Date Type of Work (circle one): New Replacement Alteration/Remodel Detailed Description of work: A-' 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 _Furnace $35.00 _Pool Heater $35.00 _Air $35.00 _Gas Dryer $10.00 Ventilator $15.00 _Boiler Liner $10.00 _Gas Piping $10.00 , .= _Chimney Duct Work $10.00 Gas Rang Oven $10.00 Permit Fee $ (Total from above -Minimum fee $35.0 Surcharge 0.50 Total Due $ Make check payable to City of Fridley 9 This is an application for a permit- not valid until processed )e� 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. O / CY4 s � Signature of Applicant: Date: Approval Inspector Signature. Date: a Please Note: Separate permits are required for Building, Plumbing, and Electrical work 07 r 11b 11, 1/7/ REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new construction IMC 1346.0312 5. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make up air calculations RUG -09-2005, 13-34 CITY OF FRIDLEY PLUMBING RESIDENTIAL APPLICATION City of Fridley P. 02/04 ,ko S fel41q Permit Number Received By Date Receivvad NOTE: IF PROPERTY IS NOT OWNER/OCCUPIED- A LJCENSED CONTRACTOR MUST OBTAIN THE PERMIT. DATE YOUR §MAIL ADDRESS �®%i.� a�1,$)r° _ •� SITE ADDRESS THE APPLICANT IS. (CIRCLE ONE) OWNER CONTRACTOR NAME PROPERTY OWNER/ ADDRESS TENANT CITY STATE ap PHONE # NAME®�1 ENSE It 2 CONTRACTOR ADDRESS 2 7 vo CITY Qx�i STATE /� ZIP PHONE # PERMIT TYPE TYPE OF WORK I O NEW DETAILED DESCRIPTION OF WORK _ ®e _ FAMILY TWO FAMILY FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED FD(TURES: (INDICATE TOTAL NUMBER OF EACH) W REPLACEMENT TOWNHOUSE BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING _BATHTUB GAS PIPING (Need CV license) SWIMMING POOL WATER SOFTENER ($35) CLOTHES WASHER KITCHEN SINK _-WATER CLOSET -, BACKFLOW PREV. ($15) DISHWASHER LAUNDRY TRAYi WATER HTR ($38) FOR IRRIGATION WATERMETER OTHER Permit Fee $ ®v Plan Review $ Surcharge $ .50 TOTAL DUE $ —25�� MINIMUM: -..$45.00 or 6% of cast of the improvement whIjchever-is greater on work less than $300 Make checks payable to: City of Fridley 1 ruz rs 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 vmn 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 worts is not to start wlthout a permit; that the Work will be in accordance with the approved plan in the case of all work whim requires review and approval of plons. NAME OF APPLICANT Z ,M DATE= �J Please type or orint SIGNATURE OF APPLICANT 6431 UNIVESITY AVENUE NE. FRIDLEY. NIN 55432 RUG -09-2005 13:34 CITY OF FRIDLEY City of Fridley Building Inspections Dept. 6431 University Ave NE Fridley MN 55432 P.03iO4 Ph: 763-572-3604 FAX 763-571-1267 Mechanical Permit# Residential Application City of Fridley See Back Side For Raniidrarl Infnrmafinn Date Site Address: The applicant is: (cirlce one) Owner Contractor Property Owner. Address: City: State: zip. Phone: Cell: Fax: Contractor Informatipr�� , Company Name: ((- Contact Person: Address 2 - City: State: Zip: Phone:. iE/ ?A Pf- Cell: 61-7 f 9® fLZ Fax:��s�� OLU Email: ~/7, MN Bond# & Exp Date 7 &gv ��So, jypeof Work (circle one): New Replacement Alteration/Remodel Detailed Description of work ��,�%l,�i �P/1. vim- �►� �7� (moi, x4 P, 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 _AIC $25.00 Fireplace (wood) $35.00 _Gas Unit HTR $10.00 Air to Air exchanger $15.00 _Furnace $35.00 ^Pool Heater $35.00 —Boller $35.00 _Gas Dryer_$1II,0(L Ventilator $15.00 _Chimney Liner $10.00 _✓Gas Piping $10.00- Duct Work $10.00 °—a: As-Range/Oven $10.00 Permit Fee $ " X00 (Total from above -Minimum fee $35.00) Surcharge - .—.. - - - 0:50_ ---- - _ ---.:. ... _ -_._ Total Due Make check payable to City of Fridley u nis ss an appimamon Tor a pert- not vaso unto 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 Construetion 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. Signature of Applicant:® Approval Inspector Signe � _r