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PRE 2010 DOCS• City of Fridley, Minn. BUILDING PERMIT No 7428 Date: Owner: AY _�'��'� �� r Builder -l! Address '` Address L CA N OF B �DING No. -' Street -°' Po Lots r— Lot _ ___ Block Addition or Sub -Division V,77 7 4-L= 'd Corner Lot Inside LotSetback ._ _Ja ._____ Sideyard Sewer Elevation —Rg� e $& _Elpyation z � DESCRIPTION OF BUILDING TVI o Used P ,� T '4 Front Depth Height ' Sq. Ft. 4-1 CM MAM/4-0- 404 11 ^�--- Depth `' awl' Height Sq. F4 Cu. Ft. 4A_5._ - Type of etion _ Est. �- To be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set and in compliance with all provisions of ordinanctas of the city of Fridley. n P In consideration of the payment of a fee of $ 6 �� , permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that the peon to whom it is granted and his agents, employees and worl�en, in all work done in, around and upon said building, or any part thereof, shall coffiorm in all respects to the ordinances of Fridley, 11Rinnesota regarding location, construction, alteration, maintenance, repair and moving of buildings wit city limits and this permit may be revoked at aqy time upon violatie�► of any of the provisions of said ordinances. �' y • NOTICES Me permit don not cover the construction, h ataMon for wMng, plumbing, an hea8ng, awn or wafer. Be sore to o e the Bulldbw brspeder for aparalo permits for thea Ueda. Application for Power Plants and Heating, Cooling, Ventilation, Refrigeradon 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 $ NECK. 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. EDR 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 400,000 BTU) ....................... 5.00 $ O GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ So Additional Fixtures ............... x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $— ALTERATIONS & REPAIRS TOTAL FEE $—(� ROUGH FINAL Dept. of Bldgs. Phone SM -3450 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 area true and correct. Fridley nn_ '/%G/ �rf y 194?9 Owner Kind of Building Used as To be completed about Estimated Cost, Building Permit No. Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS Steam, Hot Water, Warm Air—No Trade Name Size No Capacity Sq. Ft. E.D.R BTU--H.P. Total Connected Load A,iLl� Kind of Fue BURNER — Trade Name Size No_ /) '/ M Capacity y Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) SignedLzAi Business; Application for Power Plants and Heating. Cooling, Ventilation, RalWigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SM -3450 ® J GRAVITY 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 AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ 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 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. IDR 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) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x$ 2.00 $ Additional Fixtures ................. x .75 $ Gas Range to 199,000 x$ 5.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL 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 are true and correct. Owner Kind or, Used a: Fridley, Minn_ 0! 19 '?-7 To be completed about "" 0ey Estimated Cost, $ Old—New. Building Permit No. Permit No. 4 CI DESCRIPTION OF WORK HEATING or POWER PLANTS -steam, Hot Water, Warm Air—No Trade Name M;WSize No Capacit 0 Sq. Ft. E.D.R BTU I.P, Total Connected Load Kind of Fuel BURNER — Trade N Size o a /6"� o O Capacity Sq. Ft E D.R BTU H P. See Fee Schedule $ • eS Z) $ TOTAL FEE $ /o. A (REMARKS -OVER) 00, Signe mr V ' E of f�o6•`'e. 0. � INC, By r 671 11 %` �e 6� jtjj .E B�, �Nnn uio1��So a Phone: 935-7753 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser $ 4.00 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range �_ $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Required. . . Yes ( ) No ( ) Type $ 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ /S'pp Reinspection Fee $ State Surcharge $ .50 ($15.00) TOTAL FEE $ 5-, 5-b Effective Date May 1, 1988 Job Address 65-- 75- " i4 Y N F 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. 5-- 02 / -,19120 OWNER S7"�ZAP— � PD&EICT A. KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST & OLD - NEW BUILDING PERMIT NO. PERMIT NO. Com � Signed By PAINHEGASM Tel. No. B 3% ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE N >. N 0 U K w Water d ah a rd Np 4 m m `o' m ro M na w Heater b 'q� 3 wo Nw vei -.mni .see x uroni .�c u w u o ro o N g U 3 U o lec ra a1 3i [oc, c0 as 1st 2nd 3rd 4th (R) Future Connection Opening Connected with Sewer (R) New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser $ 4.00 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range �_ $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Required. . . Yes ( ) No ( ) Type $ 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ /S'pp Reinspection Fee $ State Surcharge $ .50 ($15.00) TOTAL FEE $ 5-, 5-b Effective Date May 1, 1988 Job Address 65-- 75- " i4 Y N F 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. 5-- 02 / -,19120 OWNER S7"�ZAP— � PD&EICT A. KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST & OLD - NEW BUILDING PERMIT NO. PERMIT NO. Com � Signed By PAINHEGASM Tel. No. B 3% ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE SUBJECT City of Fridley TRM 9 6 AT THE TOP OF THE TWINS BUILDING PERMIT r �• _ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. 7j ry �/ 3 r 1 CITY HALL FRIDLEY 55432 NUMBER REV.DATE PAGE OF APPROVED BY ,'J 612-571-3450 910-F15 7/31/90 JOB ADDRESS 65 - 75th. Way N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3,4 Nieman Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Robert Stannard 65 -• 75th Way KZSN N.E•, Fridley 571-8568 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Sawhorse Construction 4740 - 42nd Avenue North., WIMINK Robbinsdale, MN 55422 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 533-0352 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION [g ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Basement Bathroom 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS I GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED$5,000 $2 . 50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING COW $72.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE F 11 h 3I$v $74.50 �,+ �� WHEN V LIDATED THIS IS YOUR PERMIT GNATURE OF CONTRACTOR OR AUTHORIZED AGENT I ATE) pPROPERLY BLDG INSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) NEW [ ] ADDN [ l ALTS [ ] R-1 AND R-2 Building Permit Application Effective 1/1/90 Construction Address: r] �U �9 legal Description:r`�T 3 4 1�1(6��nJry 6G}Ot?�1 Owner Name & Address: tiJ N 4-94i Tel. # :5-2/- >A-68 Contractor: �5 4 w %�5 6- Tel. S� 3 0 35 Q Address: g -74(D Z -fa 0--F 4 VP dl • $--5y -->•--I Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. .; ".1• .1 .) Am I 1• •.. 5w I]1 LIVMG AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. 07HER: S 14S �t ��" 1l 4-rw Corner Lot L ] Inside Lot Type of Construction: Approx. Completion Date: B-15 L ] Ft. Yd Setback Side Yard Setbacks Estimated dost: $ :9, Ooo Pry Driveway Width If New Opening Is Desired: Ft. $ $ Width + 61 See Back Page DATE: r] 0'1 90 APPLICANT: Tel. # CITY USE ONLY Permit Fee $ 100 Fee Schedule on Reverse Side State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $600 per SAC Unit Driveway Escrow $ Alt. "A►► or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Criarge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ e�� STIPUTATIOM : ii. � A OZI j � N .D �y��y►tj Ir Mky v n j < �o Effective 14ay 1, 1990. CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rsin Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer Back Flow Preventer Required. Type NO. RATE $ 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 $ 5.00 S 5.00 S 5.00 S 7.00 $ 5.00 $ 10.00 $ 10.00 TOTAL S . Yes ( ) No ( ) S 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of value of Fixture or Appliance Reinspection Fee $ State Surcharge (515.00) TOTAL FEE $ .50 Job Address Department of Buildings City of Fridley Tel. 1571-3450 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. 1g 96 OWNER KIND OF BUILDING / !/�C/✓ � USED AS ��l�G r//9y TO BE COMPLETED ABOUT ESTIMATED COST eco cx, J OLD - NEW BUILDING PERMIT NO. PERMIT N/�0. / � / Compo ./1�- Signed ZY Tel. No. ROUGH INSP. Date FINAL INSP. 4e Date APPROVAL FOR PERMIT !1INIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE a a e u x ar Water m 0 .ei e NNa. F � w y �" S Heater v Go `c� k ~ u C L C u o� w P � Hca o � (A u ani oQ i uoo. H 4 u a� 4 3 � � o as lec A 1st 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (•) - Now Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rsin Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer Back Flow Preventer Required. Type NO. RATE $ 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 $ 5.00 S 5.00 S 5.00 S 7.00 $ 5.00 $ 10.00 $ 10.00 TOTAL S . Yes ( ) No ( ) S 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of value of Fixture or Appliance Reinspection Fee $ State Surcharge (515.00) TOTAL FEE $ .50 Job Address Department of Buildings City of Fridley Tel. 1571-3450 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. 1g 96 OWNER KIND OF BUILDING / !/�C/✓ � USED AS ��l�G r//9y TO BE COMPLETED ABOUT ESTIMATED COST eco cx, J OLD - NEW BUILDING PERMIT NO. PERMIT N/�0. / � / Compo ./1�- Signed ZY Tel. No. ROUGH INSP. Date FINAL INSP. 4e Date APPROVAL FOR PERMIT !1INIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE All Others/Repairs and Alterations 11 of Value of Appliance or Mork $ COMERCIAL/IHDUSTRIAL 11 of Value of Appliance or Work State Surcharge TO7AL TEE Reinspection Fee 15.00) Rough Insp. Final Iosp. Date Approval for Permit IT F S $ 5050 SLI- L OWNER 1 �0 �i'Ib� � MIND OF RUL ING 1 -' t_r7 USED AS -.J To BE CWFI 'TFJD JIB(XUT 2i> ®Li ESTINaTED COST /ll Ota - NF]/ 71UILDIHG PBRMI? N0. P6B117? NO. _ $ DESCRIPTICH OP FURNACE/BURNER HEATING or POWER PIANT", Steam, not hater Warn A -Ir No. �' Tr)S rob Name 1Sf�-e Size no. r � Ute/: 1 // J e capacity Sq. Ft. JAR 8117®�- NP --__r eJ lbtal Connected Load �` Kind of Dual RURN¢R - Trade Nana Size No. MINIIWN FEE FOR ANY HEATING PERKIT IS 514.00. PLUS $.SO STATE SURCHARGE *Air Gonditionars can not be placed in side yard without written permission from adjoining neighbor. Capacity sq. Ft. Eon BR7 _ NP ccapany Signed e Tel. No. Fill out back 'side for stack verification on replacesent furnaces LI IT 111- I-KIIJLLI APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCNEDi1LE -I /�!Z H RESIDENTIAL ` AT O JoJ9dre3s r fT7 Furnace Shell and Duct '(fork, $ 20.00 Ti�� $ �V Department of Buildings, 6431 University Ave. N.B., Fridley, HN SS432 Burner (Also replacMent furnaon) City of Fridley Gas Piping $ 10.00 $ Tel. #571-3450 (piping needed with naw furnace) $ The undersigned hereby wakes application for a par.lt for the work herein Gas Range $ 10.00 specified agreeing to do all work in strict accordanoa wlth the City Codes $ 10.00 $ and ruliaga of the Department of Buildings, and hereby declares that all the Gas Dryer facts and representations etatad in this application are true and ourrect�.% Air Conditioning tall sizes) S 10.00 tt , S Id Fridley, (Minn. _ �� _ 19 l / _ A 0 F- All Others/Repairs and Alterations 11 of Value of Appliance or Mork $ COMERCIAL/IHDUSTRIAL 11 of Value of Appliance or Work State Surcharge TO7AL TEE Reinspection Fee 15.00) Rough Insp. Final Iosp. Date Approval for Permit IT F S $ 5050 SLI- L OWNER 1 �0 �i'Ib� � MIND OF RUL ING 1 -' t_r7 USED AS -.J To BE CWFI 'TFJD JIB(XUT 2i> ®Li ESTINaTED COST /ll Ota - NF]/ 71UILDIHG PBRMI? N0. P6B117? NO. _ $ DESCRIPTICH OP FURNACE/BURNER HEATING or POWER PIANT", Steam, not hater Warn A -Ir No. �' Tr)S rob Name 1Sf�-e Size no. r � Ute/: 1 // J e capacity Sq. Ft. JAR 8117®�- NP --__r eJ lbtal Connected Load �` Kind of Dual RURN¢R - Trade Nana Size No. MINIIWN FEE FOR ANY HEATING PERKIT IS 514.00. PLUS $.SO STATE SURCHARGE *Air Gonditionars can not be placed in side yard without written permission from adjoining neighbor. Capacity sq. Ft. Eon BR7 _ NP ccapany Signed e Tel. No. Fill out back 'side for stack verification on replacesent furnaces CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; 1. Has been carefully examined Yes (�) 2. Is free from rust or deterioration Yes (� 3. Has no foreign objects lodged within Yes 60 4. Is securely supported Yes ()U 5. Meets all current Code requirements for size and Yes' total BTU connected 6. Has Total heating BTU's of All other BTU's TOTAL ------- No ( ) No ( } No ( ) No ( ) No ( ) 1 Company Signed E Date HOUSE HEATING TEST RECORD ADDRESS —APT.,._FLOOR CITY _SUWRB_�---� OCCUPANT OWNER - HEAT HEAT LOSS DATE HTG. INST.ti� SOLD BY INSTALLED By Electrical Work By Gas Line By" ­— TYPE OF HEAT GA FA HW —STEAM SPACEHTR. —UNIT HTR. —.OTHER GAS DESIGN CONVERSION. MAKE ---MAKE OF BURNER Model Model Serial Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS THERMOSTAT Heat Plug Vent Size Volvo 7 KIND OF LINER SIZE—NONE— Limit Draft Hood Regulator Limit Setting Filters size —Number Fan Setting Chimney Location Inside Outside Pilot Type Chimney Construction Pilot Make Pilot Model Smoke Bomb Wiring Pilot Timing Draft Test Tag L.W. Cut Off Door Pressure Lighting Inst. Pressure Percent CO2 Date Tested Input CFH Percent 02— Company Testing Stack Temp. Percent CO Name of Tester Form 235 Building PLUMBING Permit No. 7 5 Inspections RESIDENTIAL APPLICATION Received By: ; 763-572-3604 CITY OF FRIDLEY D�'�► DATE YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY Nps: OWNER/ ADDRESS:_�Q CITY �Ff (dCew STAT RLtk_IP TENANT PHONE: `1b3 S 21 - 0526 CONTRACTOR NAME: (a ' STATE LICEN r X10(1 O01B927E&N EXP DATE O SUBMIT A COPY OF YOUR STATE ADDRESS _70 d dd RJ #100 CITY STATE ZIP LICENSE WITH PHONEzagan, MN 55123 1339 FAX APPLICATION PERMIT TYPE NO SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW 2 REPLACEMENT DETAILED DESCRIPTION OF WORK %ea&CRE k1 QA-er VV a,4-eC PER MS 16B.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 EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) BATH SINK/LAV DRAINS —SHOWER _ WATER PIPING _FLOOR —_ BATHTUB GAS PIPING (mw cm'ucva4 _ SWIMMING POOL _ WATER SOFTNER ($35) _ CLOTHES WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15) -(-WATER _ _ DISHWASHER LAUNDRY TRAY HEATER ($35) FOR IRRIGATION _ WATER METER _OTHER V AR Number of fixtures @ $10.00 x $10.00 = $ Permit Fee $ 35 Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ P7 . o State Surcharge = $ .50 Total = $ 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 which requires review and approval of plans. r- �1 �7 SIGNATURE OF APPLICANT40 PRINT NAME R OYJeL � b ISP DATE � - 26" u 1 City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 HP