Fillable 311 Commercial Plumbing Permit Application (City of Fridley, MN)

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311 Commercial Plumbing Permit Application (City of Fridley, MN)

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Building
Inspections
763-572-3604
763-502-4977 FAX
PLUMBING
COMMERCIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2018
Permit No.:____________
Received By:__________
Date Rec’d:____________
DATE_____________________________________________ YOUR E-MAIL ADDRESS ____________________________________________________________
SITE ADDRESS _________________________________________________________________________________________________________________________
TENANT ___________________________________________________________________________ SUITE NO. __________________________________________
PROPERTY
OWNER/
TENANT
NAME:______________________________________________________________________________________________________
ADDRESS:___________________________________________CITY____________________________STATE_____ZIP________
PHONE:_____________________________________
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
INSURANCE
NAME:________________________________________________________________________________________________________
STATE LICENSE PM #_________________________________________________ EXP DATE _______________________________
CONTRACTOR # (PC OR PB)___________________________________________ EXP DATE _______________________________
ADDRESS:___________________________________________ CITY__________________________STATE______ZIP___________
PHONE ______________________________________________ FAX ____________________________________________________
PERMIT TYPE
INSTITUTIONAL MULTI-FAMILY SWIMMING POOL
TOWNHOUSE COMMERCIAL/INDUSTRIAL OTHER
TYPE OF WORK:
NEW REPLACEMENT ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK ___________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________________________________________________________________
FIXTURES: (INDICATE TOTAL NUMBER OF EACH)
___ CLOTHES WASHER
___ FLOOR DRAINS
___ URINAL
___ DISHWASHER
___ GAS PIPING
___ WATER HEATER
___ DRINKING FOUNTAIN
___ GREASE TRAP
___ WATER METER
___ FAUCET
___ KITCHEN SINK
___ WATER PIPING
___ FLAMMABLE WASTE TANK
___ LAUNDRY TRAY
___ WATER SOFTENER
___ LAVATORY
___ WATER CLOSET
Total Job
Valuation
$ ___________
All fees are based on valuation, including the cost of labor and materials.
Permit Fee
$ ___________
(1.25% of Job Valuation / Minimum fee: $35)
Surcharge
$ ___________
Valuation X .0005 or Minimum .50
Total 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 on site; that the work will be in accordance
with the approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT : ___________________________________ PRINT NAME:__________________________________ DATE: _________________
APPROVAL INSPECTOR SIGNATURE: _____________________________________________________________________________ DATE: _________________
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK
City of Fridley Building Inspections Department
7071 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
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311 Commercial Plumbing Permit Application (City of Fridley, MN)

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Completed 23 January 2021

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