AF - 34917�
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3�6 9�
City of Fridley, Minn. N° 8844
BUILDING PERNIIT .
��; MAY 20, 1966 �
�: R. STANFORD 1QYQ'DIST �� ZUEFILRE CONSTRUCTTON COl�.'ANY
� 990 RIGE CREER TERRACE R,S� A� 6495 Pi�cce street N. E.
FRIDLEY, NIINNESOTA 55432 Fridley, Minnesota 55421
�ocar�oN oF Bui��n��
No. 7880 �t ALDEN WAY N.B. Part oP Lot
Lat 4 Slock 4 Additt� or Sub-Divlslo� PEARSON' S CRAIGWAY ESTATES, 2ND
Coraer Lot instde Lot S. �tback 35' sideyard ]5' & 10' ADDITION
3ewer IIevatlua 53..�-78 IIAVaatlon 841.78
TOP OF FOOTIlQG
DESCRIPTION OF BUILDING
To be vsed es:
DW13LL]�G �t 53' �� 37' &��t 18' g�. � 1,590 �� 28,620
ATT. GARA�E �t 22' �� 24' g�t ].0' gq, � 528 �, �, 5�280
Zj►pe oP Construct[oa � F�t. Cost _�28.�� To be Cflmpieted
WATER LOGATIOIQ — 19' North of Nlanhole
SEWER LOCATIOP' • 8' North of Manhol�
In c�nadderatlon of tbe i�uan�ae to me of a permit to co�struct the ciiug de�cribed abov I a�ree to do
��proPo�e� �� � wlth the dr�crlptlon ebove f wl p�ovislons of
.
Ia c�deratloa oP t]�e payment of a fee of 3$- 4�.��---, permit is hereby► granted ta ZIIEflLRE
C01� TRUCTION C0. to �et the bnil�ing or additta� ae descrlbed above. This gera�it is �anted upaa
the e�pre� c:ontiitioa tl�at the�p�eo� to whom it is gi�aatsd and his agettLa, e�p��y� aad workmea, in all woTk
8o�e ia� eraa�ad and upan eaid fiiilding� or arp► part thereo� ahaII c�n4orm in- a11 r�pect8 to the aa�Iinanc�s of
F`�d�� �offi loc�tlon, conatructlon, alteratton, maintenanoe, repair ead moviag oE buil
wl� dty liffits� permit m�► be rsvaked at a�p► tifine upaa violatloa oP aas► oP tve pmvleiaais oY�
WI�LTAM H. SANDTla' g�6 �
�"`� NOTIC� ,
16b p�d! doa aw ao�n Ha c�a, � lar ,�, P�Y� W� �► a�nr or wata�. a� an to a�
Na 6� Im�a' lbr ppual� paedb hr t6� �. y
. ...: . ,, _- - ' ._
• , . . : � APPLICATION. FOB; BUII.DII�G.,],'ERMIT�� ,- � _
�- .:. . ,.. ,, . . ,. . .,
� _ : CITY OF FRID�Y;: •MYNNESQTA . • .
.
• . .
. ., , . .- ,,� -
. . . , .. . . . � _ :
. _ .D ��,,''�
OWi9E8' S N�11►� �. BUILDER ������ _ ' ��
. .� � � a ���p
ADDS�SS . . � QrDDRL3S � ,�'�,� ��t�P� �-P"' � � �� �I
. - rt �
, : • � � •
� LOCATION � OF _ �OILDING . ; , ,, :,� , � ' '
.�
No. ���� _. Stre�t G����� G� ��axt _of Lot
, . _.. .. : .
. •. . �r�•�_ _ � . ,.,� _ . ..�_
. . . . . ..,�
Lot , ' � ` Bio�k��� Addit�,on ;ar .:Subdivisioa���4, . � ��
� . 1 ��, , :: �. ��
Corner Lo't�_Inside Lot_�_Setback� �� = Side-Yard . /� : %�
3EG168 LL�VATION FODI�IDATIOH LLE9ATION
APRlieant,,�tCach Cp`, Cbie.;f,orm� Two Certi,f3cates of Survey of Lot, aad•..pra�.ed;,buitd-
ing.locatio,n;.d�awn�on the�e..GertZf3cates. , - ."
-� ,. ; - � �_,
DESCRIPTiON OF BUILDTNG ��
,� � 9
,..
To be used as; �� .
�•r��-rC� _ . � � � ; , � � .,. /
_ . . _ . _ � � . nepth ��`� �F �-�% a��ght,f
��z �� 8';
� . � � sq. �c« ���. �,��� cu. �t.. ��� l �
. (����� . � � ,. . : � - _ _ .
i �-r, , .. ��
I�ront' .�� '. Dspth ��-- Height . ��: /t�
. - � ': . ` :i , ", _� �f.� . . `'-�
� ; . , �. . : ..,.
.. .' �J. �
. � . .. . �-. . _. � ♦. ��• e,����.� .. �Va�•_��t��r�.�'�. ��.. �
� . �. � '-•- .. . . -' - - , - �
Tqpa of Coastructian_ �„ ,�� Est��e�,,Coak�c��\ � G.
' . • ... - . . ..m
��� ���,��J . _, �..
To be Com�leted ���ta�`, i=' '/�la�
. , , .�. r ._ _ -. . -:. . � ..
The under8ign�d hereby makea`application�far � permit for;the�wark�hereia.speciiied,
a�reeir� to do all work in etrict accordanae �i.�b th� City of Fridley�Ordinances aud�
ruli.ags af tile Degartment-. of, �uildinge,; �d ;h�seby decia�es that , a�.�. the fac�s and
representatiooe atated ia'Chis applicaCion are true; aAd corre�t. . .
n� 6�� �%, l%�� s��� G� � ��:�� ��o
� , � — �-'���C�� �
�Schedule of Fee Costs cea be fouad � Che rae Side). �
�1 �
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�`� �G�*
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a
BUILDING PEIU9IT FE1� SCEiEDULL
�
Sectioa 2. The Inspector of Buildin�e sh�ll, before issuing suy perlmit for
the erection of aay buildia� or structure, or for aay addition to anq exist-
iag building or atructure, or for any alterations or repai=s to any es3stiag
building or structure, upon application therefor, require t6e payment by the
applicaat for such permit of fees tv the aanouat hereia below set forth and
ia the manne= herein provided to-wir: �
2.1. l�or anq sucb permit for the erection o.i aay fire-groof building, other
than a garage� warehouae, factory or gra3n elevator, or for the erection of
anq fire-proof addition, for simila� occupancy, to any existing building
shall 6e at the rate of �1.40 for each one thousand cubic feet, or fraction
thereof. in such cubical coateate.
-� - • 2.2. gor any such germi..t: for. the esectioa of aay -#ise�-proof garage, warehduse,...
factory or grai,a..el�v��or,' or �for the erection of any fire-proof •eddition,
� for"similar occupancy, to-any existia� buildiag sha.11 be at the rate of $1.25
for each one- t�f�ui�aad • cubic feet� classified as "fireproof" bq Sectioa 502 of
the . �13nuea,polie Build3ag ,�od�.. - .
. . '.'.i: .�..
_. H�IYSE� . . . . � .
. i' .
2.3. For a�g such perm�.� for the erection of any ac►n-fizeproaf buildiug ather
�� than a gasa�e, warehouse, factory or grain elevator, or any non-fireproof
additien, for similar- aecupancy, :to any exietiag building - permit $1.00 for
each one thous8ad cubic feet.
GARAGES
2.4. For any such pes�mit Eor the erectioa of aay noa-fireproof garage, -
. ware ouse, iactory_ar:�raia elevator, or-for the erectlon of•anq non-fireproo�f�
�d�t�.oa, -€or-�3mi.iar occupancq, t� anp exiatiag building or for each such
�,_. --�vi],din$ or addieion - aiaeey ceats-'t$0.90) �or each one thousafld cubic feet
or fr�etioa thereof, in the cubical coatents thereof w�tth a minim�um of $4.00.-
For the purpose of cam�utiag fees for build3ng permita, the ciabical canteste
of aup buildiag or addition to a uniform height�thrcugh�t by �Ltiplyia� the
�round area crnrered from a point si� (6) iache8 below the floor line of.rhe
basement or esllar to t�e average height-of the upper aurface or to the �
average hraight of the rQOf surface of the maiA gable of a pitched roof.
2.5. For repairs or alteratione to an eaciatia� structuxe, the fee ahall be
at the rate of $3.00 per each Ffve Suadr�d Dollare ($SQ0.00) or fractioa .
theseof 3a the cost of a11 progosed work. ��' �
2.6 .' In no case sha].1 the %Q .char�ed., ior..aay-permi� _a,� set forth ia
Sectioa 2 be 1ess.. fhan $4,.00. -
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SuB�ECT PE
City of Fridley 5 6�
AT THE TOP OF TNE TWINS g U 1 L D i N G P E R M I T
�
S � RECEIPT NO.
� ; L �_��� � COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. ����
� . �
i-_-- � ����',,� CITY NALL FRIDLE� SS432 NUMBER REV OATE� PAGE OF APPROVED BY
L �� 612-571-3460 910-F18 10/30/97 / /
108 ADORESS �$g0 Alden Wa NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACMED
oesca. 4 4 • Pearson's Crai a Estates 2nd $HEET
2 PROPERTY OWNER MAIL AODRES� ZIP PHONE ,
Steve Hremchysh 7880 Alden Wa NE � 571-1407
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO
�B & B Roofin 6760 Madison Street NE Fridle Mn 55432 71- 4 9042
4 ARCNITECT OR OESIGNER MAII ADORESS • ZIP PMONE LICENSE NO.
r
5 ENGINEER MAILADDRESS ZIP PMONE LICENSENO.
8 USE OF BUILDING �
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION �. REPAIR O MOVE O REMOVE
8 DESCRIBE WORK �
Reroof House & Gara e(32 S) 2nd la er
9 CHAN(iE OF USE FROM TO
STIPULATIONS
Roofing can be the 2nd layer•but not the 3rd.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING, �PE OF CONST. OCCUPANCV OROUP OCCUPANCY LOAD
VENTILATING OR AIq CONDITIONINO.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONBTRUCTION 20NIN(i SG. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTpUCT10N
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WOHK IS COMMENCED. NO. DWL(3. UNITS OFFSTREET PARKINCa
I HEREBY CERTIFY THAT t HAVE READ ANO EXAMINED TNIS APPLICATION 1 STALLS GARAGES
ANO KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIOMS OF LAW$ yALUATION SURTAX
AND ORDINANCES GOVERNING TFIIS TYPE OF WOAK WILL BE COMPLIED '
WITH W ER SPECIFIED MEREIN OR NOT. TFIE ORANTING OF A PERMIT �2sOOJr �1.00
DOES OT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TMH pERMIT FEE SAC CNARGE
PRO SIO S OF ANY OTH STATE lOC L LAW REOULATING CON-
STR CTI N OF THE PER RMA E CO TRUCTION. ��%�F.75 Fire .�lC. �2.��
�o � PLAN CNECK FEE TOTAI FEE
License SC $5.00 $82.75
SIGNATUR FCONiRACTORORAUTM 2EDAGENT IDATEI NEN PNOPERLY VALI ED THIS IS YOUR PERMIT
�
StGNATUpEOFOWNEpacOWNERBUILDEiii � IDATEI g�pG I P qaiE
rrEw � �
ADDN [ ]
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ConstructionAddress:
CITY OF FRIDLEY
SINGLE FAMII,Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
t�
Effecrive 1l�/97
/(p tilD
a�h �53
�
Legal Description: ��-S�/%�F`t %i�'L..
Owner Name & Address: � /�l/�' ��f/y�L',y�/� y,� Tel. # � 7�� / �7�C� �
� '
Contractor: ��jj° .�D o� dt (.s-- MN LICENSE �t �'O �1�
Address: �%� i��/9�%1.�/Y� v j Tel. # S%�� Z��
LIVING AREA:
GARAGE AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
Length Width Height Sq. Ft.
Length � Width Height Sq. Ft.
DECK AREA: Length
OTI�R:
Width Hgt/Ground Sq. Ft.
Construction Type�:�Z S(.�% z�li .L�i �L: �— Estimated Cost: $ � L%�� �
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ � _$
�
DATE: �D�� APPLICANT: � Tel. #_ 5���—O Z S��
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Fscrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �`7. ����
$ �_ �� �
$ / - C} ��
$
� �- ����
$
$
$
$
� c��?. %�
CITY USE ONLY
Fee Schedule on Reverse Side
.�1 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$950 per SAC Unit
$5.00 (State Licensed Residenrial Contractors)
Alt. "A" or Alt. °B" Above
$450.� Conservation Plan Review
Fee Determined by Engineering
Agreement Necessazy [ ] Not Necessary [ ]
� •w
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided tawit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,(�1 to $100,000
$100,001 to $500,000
$5�,001 to $1,OOO,Q00
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for fust $5(� plus $2.75 for each additional $1� or
fraction thereof, to and including $2,Ot30
$62.25 for first $2, 000 plus $12. 50 for each additional $1, 0�
or fraction thereof, to and including $25,000
$349.75 for first $25,i�0 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,� plus $6.25 for each additional
$1,000 or fraction thereof, to and including $1�,000
$887.25 for first $1�,000 plus $S.QO for each additional
$1,� or fraction thereof, to and including $5�,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,�0
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,� or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Pernaits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
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CITY OF FRIDLEY PERMIT NO.: 2004-02231
6431 UNIVEItSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 12/02/2004
� (763 572-3604 FAX: 763) 571-1287
ADDRESS : 7880 ALDEN WAY NE �(� � Q�
v
PIN : 033024340039
LEGAL DESC : PEARSONS CRAIGWAY ESTATES 2
: LOT 4 BLOCK 4
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
# A/C iJNITS 1 VALUE OF APPL OR WORK Q
# FURNACES 1 # GAS DRYERS 0
# GAS RANGES 0 VALUE (FOR MINIMUM CALC) 4000
�p�C�T HEATIl�TG PERMIT 1�IINIMUM FEE 0.00
RIVER CITY SHEET METAL INC F[JRNACE SHELL/DUCT WORK 35.00
9929 BLUEBIltD ST NW GAS RANGE FEE 0.00
COON RAPIDS, MN 55433 GAS DRYER FEE 0.00
(763) 7542199 AIlt CONDITIONING FEE 25.00
HEATING REPAIItS/ALTERATIONS 0.00
STATE SURCHARGE, MECH FLAT 0.50
OWNER TOTAL 60.50
HRENCHYSITYN MYRA PAID WITH CHECK # 14016
7880 ALDEN WAY NE
FRIDLEY, NIN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes nu11 and void if work or construction
authorized is not commenced witin 60 days or if consiruction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and l�ow the same to be true and correct. All
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or no� The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating conslauction or th performance of construction.
Applicant Date
Bldg Date
SEPARATE PERMITS REQUIItED FOR WORK OTI�R THAN DESCRIBED ABOVE.
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£0 ' d '1ti101 �
FILL IN COII/PLETELY FOR REPLACE�ENT FUEL. BURNING APf'LIAt�iCE PERNNTS
COAA9MON VENT.1tENT�CONNECTOR AA1D CO�BUSTiON A1R 1�RI�CATIOPI
When �a�itKa an �x�stin tumace, tF�e undersigned �y v�fles that the
ver�ng has been exam&�ad and is iree i�om rust, deterioratian� obsfnu�ians,.
and is sec�rely supported a� 'fi�tap�d where requl�. Y� � �()
The ventb�g system is pJas�rJPVC and meets ali cxment oodes and manufachuer
speaficat�ns induding sizing. IenSth, rwmber of �Ib�vvs �d t�mi�n. Yes () �I/� No ()
Tt� w�dersigned also vetifiss t!'ISt the re�acem�t uNt ls a I'�ted assembiy ,
- — �a'td�neets tfie : �is tlt� -- - ----
includs AGA GAMA Categay I Cenh�l Fumace Ve�ting Ta�bles fat' fa+i ; ,
�sisted and riatural dratt �c�s. Ye� �j ' No (}
The existl� combust�on air is sized a� installed to meet the curret�t a�es,
and m8�lvtaciure�"s specl#ications. Yes � No ()
When requmecl ta ietstali � n_ caamtwstton air i� v�li be sized and inst�ed
to meet the ctursr�t coc�s and manufa��uer's sped6cations. Yes � No ()
When ir�,statlit� a r�ew ventinA svstem. #ha under�igr�d hereby �rifies that
�� a list� assembty aa�d meets � current c�des a�d ma�nufachut�'s
sp�fit�tions. Tl�is da�s indude AGA GANU�► Ca#egory ! Ce�al ��
Vianting T2�les for fan assis#�d t�d naturai �aft �iiances. Yes No (}
is the c�nm� verrt and v�t cont�ectors si�ed and �led �l �'
an ap�ce has b�n r�nared irom �e connm� v�t �nd �ed
SEPardt�Y as per curre�t aodes.
Yes� No( )
Auclianae �1roe n�i Si�etCommon Verrt and Yent Connedor inf�matlon
Appliance #1 Ty� �✓h�G,�' BTU tnput ,/�� ��� � N t
AQplfance #2 Type r/ w� BTU (t�sut �� F�
Appliance #3 Type BTU )r�ut ��„ Fan Assisted � at
Tot� App�nces T�I Btu tr�ut ��'7
/ K
Common ve�t Type 8� n�°' vent I�eight � Dlameter G ir�hes
� �
Appqance #1 Vent Conc�cr HeigM � ft Length �,ft �e#er _�,in Typs
ApPHance #R2 Verrt Connector H�ght �ft Length ,��ft �ne�' �°° in Type w/
APpliance �i3 Vent Connector Height tt Length ,^ ft[�l�n�er �in Type
a„�,��aNS: cn�c���
r�n�tvc� co:
Signed ey:
£0/£0'd Jl�"Kfi?I-I -It'1 Jll t7 J.�:?L �-�'[-nllN
PIEW
ADDN
ALTER
l I Cl'IY OF FRIDL.EY
I l 6431 University ave NE, Fridley, MN 55432
t] StNGLE �'AMI�Y ANb DUPLEXES R-9 �IIVD i�-2
�UILDING pERMiTAPPLICATION
Consiruction Address„
Legal [�escription:
Owr+er Name 8 Address;
�� ��
�INt� &
��oo�'-a����
Effective 1l9J��04
(763) 572-3604 Bldp Irtsp
(763) 579-9 Z87 Fax
Tel.
ContracEor: �fi: l.OUIS pA�K, �a i `v�'' � MN LIC�NS� # � � °
Address: _ � �Q �0001050 Tel. # 6/�. - �'Z.� �'a �`6
Attach to this application, a Gertificat� of Survey of the
bt, with the proposed construction drawn on it to scale.
D��CRIF'i(�Pl OF IMpR�V�MENT
LiVIF�G �REA: Length �� Width �, Height Sq. Fi,
GAItAGE AREA: Length Width ,� Neight -- -__ Sq. Ft. --
DECK �IR�A: Length � Width �, Hgt/Ground Sq. Ft �
OTH�R:
ConsEruction Type: (� � �� Estimafed Cost: $ ' � ��� / �S�
Drivev��ay Curb Cut WidEh PJeeded: Ft, �- 6�r = �r �� o�
DATE: '��'fj �IPPUCANT: � Yei.# ���"t �%�OZ,j
Ca(i (763) 572-3604 for Perrnit Fees !f mailing i applicaGoh. Fax to 763�571-9287 if using credi� card and we witl cail
you for card number. •
Permit �ee
Fire Surcharge
State Surcharge
SAC Chatge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charc�e
TOTAL
�_ c�.� �?s
� _ 5�f�
� �
�
$ �`�pv
$
$
$
$
S �
CITY USE ONLY -
�ee Scheduie oh Reverse Side
,001 of Permit �Ialuation (1/10th°/a)
,$.50!$1,000 Valuation
$1354 per SAC Unit
$5.00 (State Lic�nsed R�idential Contractors)
Alt, "A" or Alt. "B" Above
$450,Q0 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [) Not Neccssary C]
STIPIJ�tI�RlS:
.
E�'z'd 9t�'UN S37dS �NI�OC��! F1�3S WH�b:6 S00z'0Z'1�0
Building PLUMBING Permit No.• `�'
Inspections RESIDENTIAL APPLICATION R�i��t By:
763-572-3604 CITY OF FRIDLEY Daxe Rec'a: ��
DATE Z �G YOUR E-MAIL ADDRESS
SITE ADDRESS '� � '�°gv �
TEIIS APPLICANT IS: O OWNER N1'RACTOR
PROPERTY �,�: JN� ,q. P S �
owlv�lv �►nnxESS: 7 �0 - �}-C�,,.�' t� �-�. crr5r � G � _ STAT6X,�ZIP �{,�Z
TEATANT � j _ � t/� %
PHONE:_ _
co�v�ncTOR ,�: �! � �� t,c��� �
SUBNIIT A COPY OF STATE LICENSE # `Er�H u� C. EXP DATE � 2- � 31 ' U� I
YOUR STATE ADDRESS: � — CITY G� ^� STATE G'�✓�p� �
LICENSE WITH pHONE FAX ��
APPLICATION
PERNIIT TYPE '�a""GLE FAMILY � TWO FANIILY ❑ TOWNHOUSE
�rYrE oF woRx: °1`'�w ��c�
DETAILED DESCRIPTION OF WORK �Q,r y�L��,Q �5��.,;p�
� PER MS 16B.665 the permit fee is a minimnm of $15.00 or 5% of the totat cost ap to 5500.00,-whichever is greater, for the
: impro�ement, installation or replacement of a residential fixture, excluding the fixt�res. .(This shauldreflect only.the cost of labor )
Lalwr cost under $300 =$15.Q0. Labor cost between $300 to $500 = cost of labor x.OS =
..: �°,ROR�'ROJEC'TS Vi�RE LABOI€ EXCEED��500;�FEES ARE BASED ON $10.00 PER FIX�'URE,�EXCEP�':�RE'�i� :F[�EB',..(A}DI�ATE TUTAL �
NUMBER OF EACH BELOVi�
BATH SIlVK/1.AV _FLOOR DRAINS SHOWER WATER PIPING
_ BATHTUB _ GAS PIPING (n�o crrruc�) SWINIMDJG POOL �, WATER SOF'TNER ($35)
CLOTi�S WASHER KITCHEN SIIJK WATER CLOSET BACKFLOW PREV. ($IS�
DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
WATER METER OTf�R
�
Permit Fee $ . p Number of fixtures @$10.00 x$10.00 =$
Surc e .SO Number of fixtures @$15.00 x$15.U0 =$
TOTAL DUE $_ C�.� Number of Sxtures @$35.00 x$35.00 =$
State Surcharge = $ .SO
Total = $
THIS IS AN APPLICATION FOR A PERNIIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge 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 l� in accordance with the
approved plan in the case of all work ��' h requires review and approval of plans.
SIGNATURE OF APPLICANT � PRINT NAME ' t(/ '� /' o DATE l Z� ��
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977