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PRE 2010 DOCS. H a CITY OF FRIDLEY NOTE: Applicant should obtain building permit r from Building Inspection BUILDER: Approved Contractors, Inc. V Department Secretary. ADDRESS: 1052 Osborne Rd. N.E. Fridley 554N�: A Certified Survey of the lot, — Street City Zip Code showing the location of the foundati n, TELEPHONE: 786 3680 once it has been constructed, will be Home Business required before proceeding with the f naming. PROPERTY ow=(S) _ Roger W. Larson -)�, Dona1d M. Wehlast James E. Wiensch /* We? v/lc-gE $5 West R$. Circle Pines, Minn. 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: Multiple 141 units Each unit BUilding Dimensions:„ Front 20 Depth 32 Height. Square Ft. _ 1213, Cubic Ft. Type of Construction: Wogd Frame each unit Project Estimated Cost 1.000.00 To Be Completed 7 -1 - DATE; j �e o' oo APPLICANT'S SIGNATURE, '� rrtir r- 7 3 ©® IVT�'I C /T y r e -e PE)V UAIT ' 15G4� 7Co 5� .SQ i 71 9a � el Gy° 4 � 2- AS Pt' R 0 l7 3 93,0�r s"-' �-F " 7 a 7 Y�4L U4 -e,CA/ % L j 0 -0i,GL/Al ?' �y e*R - 0 4" 2'Y3 00 -36 = y Q -v o sq Fr --- = J9q F7- 2 'Y3 - ug//f 41vlNG 1+4x5 3 ® Y .5-0 7-vr"-,4 549 Fr 6-' MA61-3 R 13 �O r b C / 7` Y^��� �o/� /-�L L �r .� 1 I Cn SK F �4v�1-h�rAs.,�a2 �vT sr.a-rte -y/ 7. A , o 7 -or -A-4 1/,4-Lv e o F AAL 644?,46Es ------!-Cl a ,94.923c� S 7-47�-�J .4v4 e -b �,PL'e Cp &. 97 NON-RESIDENTIAL BUILDING PIRMIT CITY OF ,FR.TL-1 EY ADMINISTRATIVE PROCESS I 14G AND PLAN CHECK ZONING: ,/&:7 VARIANCE REQUIRED: SPECIAL USE REQUIRED: PLOT PLAN: TOTAL AREA GRADE ELEVATION SFT 0/t/ s1 T.= 4/-9V/Iau.41 ADDRESS :16 ®v 194 - G 9''' �U� Al LEGAL DESCRIPTION: sect T-3 BACKS: FRONT YARD SIDE YARD REAR YARD SUBMIT TO: BUILDING BOARD BOARD OF APPEALS PLAN. COMM. COUNCIL /T- ;-/--/ 5--?/ °e H APPROVAL DATE: _ _F -21 - i 7 20 REMARKS: FIRE REQUIREMENTS: FIRE MARSHALL FIRE MEVENTION BUREAU EXITS (dates App) H r� v Cyd INSIDE UTILITIES: PLYING VENT & HEATING ELEOTRICA �- EMS., ca Date Approved s r --. bhp /-on H �A OUTSIDE UTILITIES & SITE DEVELOPMENT: Date Approved City Evineer WATER SEWER ELEV CURBING DRAINAGE SCREENING & PLANTING /-5 Pel I -FS peq fl 5 nL R /-1414A� SPECIAL ASSESSMENTS: IF LATERAL ASSESSMENTS HAVE NOT BEEN PLACID ON THIS PROPERTY, AN AGREMW2 MUST BE SIG AGREEI G TO ASSUME SUCH LATERAL ASSESSMENTS BEFORE A PERMIT WILL BE ISSUED" AGRERMU NECESSARY Finance Director AGREEMENT UNNECESSARY Regietexed Engineer's Stamp �• Legal Description Check ray (A) FOUNDATION PrERMIT FINAL APPROVAL �• illaing Official Building Official (B) FINAL APPROVAL G -a - NOT.: Easements, R/W, Special Agreements City Engineer DATES oa CERTIFICATE OF OCCUPANCY: PARTIAL: DATE: FINAL: DATES c� REMARKS: REKARKSs 1, ot 4 Lf. L+ e` 0 /— -S 7 0 ✓ . L /�s _ , c�ji�y � r� S y ��®_ /'�fe✓_ — 13, Tc;, -4 ' L,44 Sewer Connection Charge Receipt No. Permit Fee & Plan Check(o 5 3, o Receipt No. , ,76, .� 13s4 Less Deposit S�� �c.�. , a: 7' Receipt No. 5`1 o�J 7, Net Permit Fee Due / Receipt No. , .� SPECIAL ASSESSMENTS: IF LATERAL ASSESSMENTS HAVE NOT BEEN PLACID ON THIS PROPERTY, AN AGREMW2 MUST BE SIG AGREEI G TO ASSUME SUCH LATERAL ASSESSMENTS BEFORE A PERMIT WILL BE ISSUED" AGRERMU NECESSARY Finance Director AGREEMENT UNNECESSARY Regietexed Engineer's Stamp �• Legal Description Check ray (A) FOUNDATION PrERMIT FINAL APPROVAL �• illaing Official Building Official (B) FINAL APPROVAL G -a - NOT.: Easements, R/W, Special Agreements City Engineer DATES oa CERTIFICATE OF OCCUPANCY: PARTIAL: DATE: FINAL: DATES c� REMARKS: REKARKSs 1, ot 4 Lf. L+ e` 0 /— -S 7 0 ✓ . L /�s _ , c�ji�y � r� S y ��®_ /'�fe✓_ — 13, Z,1 cjn / <z S -� :tea v CC,v✓� 7�rc �. �'}0 >-C� c -e 7a.0 % y'C- / 4 ,, ) 04 �,7,y Re v y 62 TX NI P�� o ,I IMti - (OAJ06 C 0 AlON � G � �- f P,4,4 /V %fJ%AL C /gQi4665 �7v d p L'X;am C,, `� Permit Fee paid on Permit #11,315 for 1560 - 1570 69th Avenue N.E. City of Fridley, Nffima6 1319 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT Owner:Rico Builder Approved r^ntreeters-slaw---- Address __ 85_Wea •Address --In 2,Qrv,-r&V o vva':a rTai, Pr v sey + 786-3680 1650,1652,1654, LOCATION OF BUILDING 1656,1658 No..._._.....__..._....._... Street Part of Lot Parcels 10 & 200, Section 3' Lot --- Block _ ... ___._ _ _ Addition or Sub -Division Corner Lot ___ _ Inside Lot Setback Sideyard Sewer Elevation ._._ Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Each Unit 5 , Tow house Units Front 20' Depth 32Height 21' Sq. Ft. 1213 Cu. Ft. Front . — Depth Height Sq. Ft. Cu. Ft. Type of Construction . WGG4- a Est. Cost See #111, 315 To be Completed 1 yezz In consideration of the issuance to me of a permit to constru the building described abov , I agree tg do the proposed work in accordance with the description above se and in compli ce wi provisions of ordinances of the city of Fridley. d� In consideration of the payment of a fee of $ See 11, 315permit 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 building wpithin the city limits and this permit may be revoked at any time upon violation of any of the provisions of Said ordinances. /1-7 / d a CLARENCE BEEISLE NOTICE: This permit does not cover the construction, installation for whing, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. ti . for Power Plants and Heatln% Cooling. Ventilation. Rs igeration and Air Conditioning 3"an and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ..... .. $10.00 $ Replacement of Furnace 600 $ Repairs & Alterations—up to $500.00 6.00 $--_ _ Repairs & Alterations each add. $500.00 3.00 $----- MECK WARM AIA ,, Furnace Shell & Duct Work to 120,000 BTU .... S .. $10.00 s- M v U each add. Q0,000 BTU .................... .. 3.0o i Replacement of Furnace 6.00 $ Repairs & Alterations—up to $500.00 6.00 $ Repairs & Alterations each add. $500.00 &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 3.1N1Each 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) .....'!�- . &00 $ �S� oU over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x$ 7.00 $--ZA % • d b Additional Fixtures a .75 $ Gas Range to 199,000 a$ 6,00 $ AIR CONDITIONING�� /Q . ® 0 FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM o7-. $ SS U d ALTERATIONS & REPAIRS TOTAL FEE ® G1 ROUGH FINAL., (SURCHARGE $_,50) Iq0- S0 Dept. of Bldgs Phone 590.3480 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. Owner Kind of Building Used as To be completed about Tz- Estimated Cost, Old-�5 Building Permit No. Permit No. DESCRIPTION OF WORK HEATING or POMR PLANTS..—Steam, Hot Water, Warm No—S— Trade Name_ I7//M'�� Size NeCIODD? -2— Capacityl2ppQ' Sq. Ft. EAR BTU Hp Total Connected Load Kind of gym !% BURNER — Trade Name Size No Capaci - Sq. Ft. EAR BTU Em. .' (REMARKS -OVER) RUWAAA F For,I PACE ENGINEERING, INC. 7200 FRANCE AVE. SO. • MINNEAPOLIS, MINN. 58435 • 612-920-9590 • SUITE 231 May 16, 1972 Village of Fridley 6431 University Avenue N. E. Fridley, Minnesota RE: Rice Creek Townhouses Weirs ch Construction Company Gentlemen: We have reviewed the underground utilities installed on this site including water, sanitary sewer, and storm sewer and find that they have been installed substantially as shown on the original drawings. I am instructing the Contractor by copy of this letter to encase the first length pipe south of Existing M.H. #S-1 in 4" of con- crete to preserve the pipe in the event of failure of the pipe arch. 'a Reproducible "As -Built" drawings are being prepared by the Contractor for your records. Very truly yours, z Glydewell Burdick, Jr. GB :ml c.c. Mr. Frank Reese Mr. Skip Durrand r 'CONSULTING ENGINEERS { til IAN''DVES Development Corporation September 28, 1972 City of Fridley 6431 University Avenue Northeast Fridley, Minnesota RE: Timber Ridge Water and Sewer Hook-up Dear Sir: Landvest Development Corporation has an agreement with the Rice Creek Townhouse Association to pay them $3,000 hook-up charge to the existing water and sewer lines between properties. This money will be paid when the first construction draw is made on the water and sewer. This letter is notification to the City of Fridley that we have conform with your stipulation to make this agreement.° j Sincerely, LANDVEST DEVELOPMENT CORPS Robert L. McGregor Vice -President RLM/gl 2828 FIFTH AVENUE SOUTH MINNEAPOLIS, MINNESOTA 55408 612-F324,2611 Cil fy Of FTldley Appficuffm for Pkmbktg and Ccm RM" ' Dept. of Bldys. Phone 580-M DESCRIPTION OF WORE Number, Kind and Lockdon of nxtur" � Location ^ { City of Fridley: � = � .� it � � • o 1 pa 13 - . w GAS ncG The undersigned hereby makes application for a permit for the work herei ;. s s specified. agreeing to do an work in strict accordance with the Qty Ordinance Base 5 S and ruling of the Department of Buildings. and hereby declares that all the tact and representations stated in this application are true and correct 1st 2nd �" 5 _ Fridley. Mina 19. 3rd Owner 4th Kind of Building CSC C}yU9�t?t� 0_9-°�J �S .�✓L.L�/ - . Fpm Commecdon Openings Bawer wlf5 • No��, Old O�ainpa New �i sUsed as .Qj 'vl c To be completed about � °-b / PARTIAL RATE SCHEDULE PLVM81MG F1XTUM RATES: NO. RATE TOTAL Number Fixtures ................ x ;200 s ®U d Future Fixture Opening ............ x $1.50 5 New Fixture Olt Opening .......... x ;1.50 : Catch Basin .................... x ;3.25 ; Water Beater 'Up to 99.000 BTU) .... x $3.00 t /s. U O New Ground Run Old Bldg......... x ;3.25 $ Electric Wates Mosler .............. s $2.00 5 GAS FITTING FEEM NO. RATE TOTAL 1st 3 Fixtures • ............. • 11 x $100 ; U 0 Additional Fixtures ............... cl' x $ .75 ; s Gas Range to 199,000 BTU............ x $5.00 6 �� State Surcharge $ .50 REPAIRS A ALTERATIONS—Refor to Codo _ Description .......................... .................; TOTAL FEE ; 1o24i. U O Estimated Cost. $ Old—New. Building Permit No. Permit o. Signe By Business Phune No ROUGH FINAL PS ) &L M Rayco Construction, Inc. 211 St. Anthony Parkway • Minneapolis, MN 55418 Phone: (612) 781-6092 • MN License #3396 • Fax: (612) 781-8778 M 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 650-1658 — 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. 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. \\Server02V-drive\Proposals\Proposals - 2005\Ray 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 T11 AVENUE NORTH 8162 BLOOMINGTON AVENUE SOUTH 1650-1658 — 69TH AVENUE NORTH BLOOMINGTON, MN 55425 FRIDLEY, MN DATE: 09/26/05 PRICING: Ve R� 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. 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 Raycds 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. Owner's sole remedy for breach of any and all warranties by Rayco, whether expressed or implied, shall be limited to repair or replacement, at Raycds 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 Raycds 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 rete, or one and one-half percent (1.5510) per month will be added to past due accoypts_ _.B Authorized are satisfactory and arV ereby accepted. You are dt as specified. Payment W 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 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. \\Sen M\f-drive\Proposals\Proposais - 20051Ray Ellis - 2005\1579.1589 - 68th.1650-1658 - 69th Avenue North.SH.re.slAoc Page 2 of 2 City of Fridley Building Inspections Dept. PPh' 763-572-3604 FAX: 763-571-1287 6431 University Ave NE Fridley MN 55432 i i Mechanical Permit# 00005-b) ®90 Residential Application City of Fridley See Back Side For Required Information Date 6 Site Address: The applicant is: (cirl a one) Owner Contractor �- Property Owner: Address:/6✓�� f ✓ed' City State: AA1 Zip: Oxy . Phone: Cell: Fax: Contractor Info rmati n Company Name: - Contact Person: -r Address A1ZVU,-- City; AerW State: AYA/ Zip 5-b2S Phol Cell:" X190 [(EW Fax: 61.4a Email: a Gt- MN Bond# & Exp DateA i, Type of Work (circle one): New Replacement Alteration/Remodel Detailed Description of work: /Z- 4W W_&_ 6 IILaa Jr 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 $35.00 _Pool Heater $35.00 _Air $35.00 _Furnace _Gas Dryer $10.00 Ventilator $15.00 _Boiler Liner $10.00 _Gas Piping $10.00 cP. _Chimney Duct Work $10.00 Gas Range/Oven $10.00 , Permit Fee $ (Total from above -Minimum fee $35.00 Surcharge $ $ 0.50 0 Make check payable to City of Fridley Total Due .� A This is an application for a permit- not valid until processe 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. Signature of Applicant: Date: Approval Inspector Signature: Date: Please Note: Separate permits are required for Building, Plumbing, and Electrical work n - - J I'A A 1^^r%r REQUIREDI ORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMESIADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEWIEXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or PropaneUGC 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 P. 02/04 �c�S� ®14l`� Permit Number Received By Date Received NOTE: IF PROPERTY 13 NOT OWNERIOCCUPIED- A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT. DATE U YOUR L ADDRESS SITE ADDRESS THE APPLICANT IS: (CIRCLE ONE) OWNER CONTRACTOR �— NAME PROPERTY OWNER/ ADDRESS TENANT CITY STATE ZIP PHONE # NAME CONTRACTOR ADDRESSV CITY PHONE # PERMIT TYPE S, TYPE OF WORK O NEW DETAILED DESCRIPTION OF WORK Y TWO FAMILY W REPLACEMENT FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED FD(TURES: (INDICATE TOTAL NUMBER OF EACH) BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING (Need Co License) SWIMMING POOL WATER SOFTENER ($36) CLOTHES WASHER KITCHEN SINK ATER CLOSET BACKFLOW PREY. ($16) DISHWASHER LAUNDRY TRAY.. HTR ($35) FOR IRRIGATION WATER METER OTHER 00 Permit -Fee $ MINIMUM:- $15,00 or 5% of -cost of the improvement -whichever is, Plan Review $ greater on work less than $300 Surcharge $ ,50 TOTAL DUE $ i Make cheeks payable to: City of Fridley r ncs Is AN APPMIGATION FORA 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 the one of all work which requires review and approval of pIgns. NAME OF APPLICANT4ZM4���_DATE da ) ,JrJ PiPaGQ tvno or riot SIGNATURE OF APPLICANT P 6931 UNIVESITY AVENUE NE. FRIDLEY. RAN 59432 AUG -09-2005 13:34 CITY OF FRIDLEY P.03iO4 City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287 6431 University Ave NE Fridley MN 55432 Mechanical Permit# 2005-.01,J01 Residential Application City of Fridley See Back Side For Required Information Date Site Address: The applicant is: (cirice one) Owner Contractor Property Owner. Address: City: State: Zip. Phone: Cell: Fax. Contractor Informat���p� � � , ��JJ Company Name: Contact Person: ff429�z 92 Address:Z City: State: AZ f— Phone:_ 1<1 24P Cell: 617 lr® nP z Fax: ,07-0VZ412-r Email: CO&A 1 a qoAndh, on MN Bond# & Exp pate T e of Work (circle one): New Replacement Alteration/Remodel Detailed Description of work OA/111,�i�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 A1C $25.00 ,Fireplace (wood) $35.00 _Gas Unit HTR $10.00 Air to Air exchanger $15.00 _Furnace $35.00 —Pool Heater $35.00 Boiler $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 bu (Total from above -Minimum fee $35.00) Surcharge - ,Total Due Make check pgyable to City of Fridley This is an application for a permit. not valid until processed I hereby apply for a mechanical permit and I acknowledge that the Information above is complete and aerate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that 1 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: Dater Approval Inspector Signature: Date: