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$ �nc2�sta� �h�rt a� �f t'i��a� %�e'h, e�ie a��r�'
e��itga i�ts ��n c�r �� �pp���ima�e�,y a�s�. $ h�v� bee� �ry�n�
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BtiI? �ATSER
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Ci of Fridle Minn.. � � �� � �
tY Y�
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,
OF BUIL ING
No.����'� Stceet �..� � Part of t
/ � -� �°
Lot _,..�'".�.___ Slock � Addition or Sub-Divisio�n ��.�
Coraer Lot � ✓ Inaide Lot Setback ' 0��____ Sideyard d �
3ewer IIevat9on ��� s � �IIeval3on � � SQ � �
rt °l' <!= 1=c=� y"�`n� [�
�, DESCRIPTION OF BUILDING
To Used
Front `�=.�.. Depth Height �E� �i� �1. F't. C.u. �
�„ P'�������—�
Front __�,�� Depth ._,�� FTefght y�� Sq. Ft. n(.u, Ft, u���.kr�-�
7.�►�e of Co ct3on F�t. Cost '' T be Completed
In condderation oP the fssuaace to me of a permft to construct the bufldfng described a}�ve I agree to do
th� proposed work in acmrdance with the drescrlption above forth aad 9n liance th a'tl provisions of
or�iinancea of the dtq of Fridley.
�
In consideration oP the payment oP a fee of $.�.`,�.� , peraiit is hereby granted to
to construct the buflding or addition as d�cribed above. Thispe rmit ia grented upon
�he express c�nditfon that theperson to whom it fs granted and his agents, employees and worl�nen, ffi all work
done in, around and upon said building, or anypart thereof, ahall conPorm fn all respects to the ordinance� of
Fridley, Mfnnesota reg lacation, conatruction, alterablon, maintenaace� repair and movfug of bufldinga
wio��� dty ]imits and� permit may be revoked at aqy� �p,�n viol�Qn of any of the Provisiana of said
�'I / 0
���'�\,"�''-"'�_-,K ,��,
� NOTIC�
ild� peneM doss ao� eo�sr t6s coasleuellee, ieshUallea fer vr6dne, p�umbtnA, An 6eatine, minr or vvalsr. B� san �o ae
Na Buildta8 le�etor tor ieparafa p��ita Mr fh�» tt�a.
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APgI,ICATION FOR BIIILDING. P��.1�1TT
CITY OF FRIDLEY, MINNESOTA
� � �
' �� � � .� �. �i� �:��_ � � /,�:�, < '
�� ��� �_� � ��� .�i; ,1� �� ._ ��.... �. ,��.. �
�.00ATIAPT OF BUILDING
No. �J �� ���� , Street �„��� ���v�P ,. Part af LoC
Lot Block Addition or Subdivision �
� o .S� ���/.
Corner Lot�_Inside Lot Setbac'k / Side; Yard �% �
SEWER ELEVATION FOUNDATION ELEVATION
Applicant atCach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates.
DESCRIPTIOPT OF BUILDING
To e used as:
Front�_ �Ls.th c� Height
Sq. Ft. Cu. Ft.
�t---� Front B�pth a- Height
Sq. Ft. Cu. Ft.
Type of Conseruction � Estimated Cost
To be Completed
The undersigned hereby makes application for a,'permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildiags, and hereby declares,that all ehe facts aad
representations stated in this appl3cation are true aad correct.
DATE SIGNATURE. �
� ,
�(Schedule of Fee Costs can be found on the Reverse Side).
/�'\
�
n
4
BUII.DING PERNi:T FEE S�DULE
Section 2. The Inspector of Bu31d�.n�a shall, beiore iasuisg any pea-�ni.t for
ehe erection of any building o� structure, or for any addi�ion to a�y �d�at-
ing building or structure, or for any alCeratioas or repa3.rs to any existi•��ag
building or structure, upon applicaeion therefor, require the pay�eat bq the
appl3cant for such permit of fees to the amounC herein below set fost� and
3n the manaer herein prov�Lded, �to-wit: .. �
2,1. For any euch parmit for the erectlon n.� anq fire-proof building, oeher
than a gara�e� warehouae, factorq or grain elevaror, or for the erectiota of
any f3re-proog addiCion, for si.milar occupancy, to any existing buildir.g
ahall be at tt�e rat� of.$1.40 for each one thousaud cubic feet, or fract��a
thereof, in such cubical contents.
2.:2. For any such�permit for the erection of any fi�re-proof garage, warehause,_
factory or grain elevatos, or for the c:rectioa of any fire-proof add3tion, .
for similar occupancy, to any exietiag bu�tlding shall be at Che rate of $1.25
for each one thousand cubic feet� clasaified as 11fireproof" by Section 5C2 of
tbe Minneapolia Build3ng �ode..
.. HOUS.ES _ . ..
2.3. �For anq such permit for the erection of 'e.ny non-fireproof buildir.g ol:�ea
thaa a garage, warehouse, factory or grain elevator, or aay non-fireg.cco�
addition, for aim3lar occupaacq, to any exi�ting building - per�it $�.�0 £or
each one thousand cubic.feet.
GARAGES
2.4. For aay such permit for the erer_r��r �" s�r;�� r.�r.�f:!..?�zc�n� gar.a�e,
w ra �hause, factory or grain eleveatos, !g3, rC?`,: F-.�3�, =•-,E::��.i.�a� cs� �r�y n�.�g���{
additioa, -€or .s3m31ar .occupancy, to r_,-,�� ,�,�:� s.�sr_;_ �::..;. ��.�a;.�,; or for each s�.ch
„_. .� bu�.ldiag or addition - ninety rF•�� � E:'x;; � j4i4% $�s e,ta: :� a�e thou�and cu4�_� feet
or fraction thereof, in the cu��cG�. �:a�r� �r�•� t.�ae��:c. w�itb a miuimum of $4.OQ�-
For the purpo�e of cam�put�tag fees �v� _1v.' :c�ing per�?i�s, the cubical contents
of �.ny buiLding or addition to a unifc�.� 's.•��;;I�t t�roL�heut by multiply�ng the
grouad area covered from a poinC sis (6) iachAs be�:,w the flaor liae of_',-.�'�e
basement or cellar to the average height of C��r c��:�er eu.f-ace or to the -
average height of the roof suriace of the maiu �ai�le of a pitched roof.
2.5. For repairs or alCerations to an exiating sCructure, the fee �hall be
at the rate of $3.00 per each Five Huadred Dollars ($500.00) or fraction
thereo� in the cost of all propo�ed work.
2.6. In no caee �hall the fee:.charged..for.ariy permit:a� set forth in
Sectioa 2 be 1esa.thaa $4.0�.
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6431 U�:lVERSITY fsVEFlU� N.�.. ��110L�Y, �tPd�BE*��'f� 85�32
`' �+��August 18, 1980
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Dolphin Poo1 & Patio
�832 - - 7th Avenue I�iorth
Golden Valley, MN 55427
iELEPHfSf�E ( �9?.};,71-��160
12e : St�virmnirig Pool Construction a� 7501 C�ntral Avenue N. �.
Dear 5irs: '
This let�t�er is- to make clear this d�epartment ° s requ�.renents far the
swim�ninq pool constzuction at the above address.
l.
2.
3.
4.
5.
6.
7.
8.
9.
As indicated, t�ao (2) . 5k�mmers approved by the Iaational Sanitation .
Foundation will be pro�Ticiede
As indicated, three (3� inlets of approved design for fzesh and/or
repurified water will be provided. �
As indicated, a main drain of approved construction will be,�rovided..
The iilter and pump shall be approved by the N.S.F. ar_d be of
sufficient capacity to provide a minimum turnover af at least two ���;
timES in 24 hours. 'l�his departmerat rec�mmends- &'C1YTI�VPS rate of
6 - 8 haurs.
A deck of at least three (3� feet wide, meas-ared from the pool waters
edge, shall be provided which extznds camplet�ly around all private
re�idential poals. Above qround privata resiclential pools may be
provided with decking af a�a:ni:mimt size of 4 feet by 4 ieet aL- pooZ
entry points and provided tFiat such.. decking has. the approval of the
Ci.ty .
The diva.ng area wi11 be accepta.ble provided there is no o��erhead
obstruction.
Fencing or ohher effective means inoluding but nai limited to walls
or buildirn3s, acceptable to the City�, sha11 be provided to positively
controI. all aceess to public and private residential swinaning pools.
Fencing shal.l meet the fallowing crite�ia: ' .
(a) The fencinc,� shall pr:event the entrance of children ar.d be witY:out
har.d or foot no�ds tliai. would enable a person to cliunb over it.
(b? The fencing shall be at least 6 feet high and e�itxances shall be
, equipped wath s�lf-closi� and self-latchinc� gates capable or
bei.ng loc}:ed.
(c� Self-closing and self-�.atching devices shall be placed at the top
of the gate or othexwise inaccessibl.e to small children. .
(d) T?le opening between the bc�ttom uf the rence and the ground or
other surface shall be not naore than four in:hes.
I�n aut�omatic c?ilorir:ator sh+�uld be providec� with a suitable L-est kit.
All elec�tric�l. anc3 plumi�ing installations shall be inspec�ed and
approved by the City Inspection i�parfcment. .
� . .
Dolphiri Pool & Patio • �
_ August 1$, 1980
Re: 7501 Central AUenue NeE. Page 2
. 10. All electric�l iines must be_greatex� than 15 feet away from the pool
surface. An�alternative is ta bury said 19n es.
11. The pool fill spflut must be ,protected by a vacuum breal:er or air-gapped.
�• 12. Suitable safety ecsuapment to include but not limi�ed' to a ring buoy
and ropa that is 1'� times �the pool diameter, �.ncl shepherds crook pole
must be provided and maintained with the pool at all times.
Fur�lzermore, t'iese and any ottzer requirements must meet the provisions of
the Fridley City Code, Section 115,.Swi�ning Pools. The building permit is
approved contingent on final inspections and approval by.the City.
• �
I£ any questions or problems arise frc�n this lett�r, please feel free to
contact me at 571-3�50.
Sincerely,
0
5TEilEN J OL,SOIQ, R. S.
Envi ronmen ta. �. O�f icer
SJO/mli .
CG: Jerry Keene ' � ' •
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DATE � " l �`�O
EQUIP�IF.�;T SPEC�FICATIONS
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sus�ecr PER
City of Fridley � 15 8 8 8
�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
� i RECEIPT NO.
� ; L _.____ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
1 = �
� /�"1 � CITY HALI FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�'.---� • •�� 612-571-3450 910-F15
8/19/80 � /
JOB ADDRESS 7501 Central Anenue N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. �.rJ 3 Don's 5th Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Jerry Keene 7501 Central Avenue N.E. 784-0824
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
Dolphin Pool & Pati.o 8832 7th Avenue North 542-9000
4 ARCHITECT OR DESIONEH MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
RBS1C12I1't].,3�.
7 CLASS OF WORK
� NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Cons.truct a 16' x 32' Inground Pool
9 CHANGEOFUSEFROM TO
STIPULATIONS
5ee stipulations on letter dated 8/18/80 by Environmental Officer.
SEPARATE PERMITS ARE REQUIRED FOR EIECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR i�IR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHOAIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TtME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEFiEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF IAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $��QOO $3.00
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 OFi THE PERFORMANCE OF CONSTRUCTION. �3'C).00
PLAN CHECK FEE TOTAL FEE
$39.00
SIGNATUREOfCONTRACTORORAUTHORI2EDAGENT IDATEI s WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
F. .
� �� � �� ����� �
SiGNA7URE OF OWNER iIF OWNEF BUILDERi �DATEI BLDG iNSP DAT
CITY OF FRIULEY
ARPLIC�ITIO�� FOR RESIDCPJTII�L QUILDIP�G PEF��IITS
(P�ew, A1 tier�tions, Addil;ions, or. Repairs.)
OI�JWER: c����Z,�/l�,�h/,�
ADDRESS : 754/ ��`�Z /}U� /� �
TEL N0: %S17'� ' DR�
BUI LDER : ,�9G/'�t'/til �O40L .�'h1.'� P/11%J '
ADDRESS: �� 7��1'e l�o.
TEL N0: .Si�a?' ���� �
Construction Location
• STR}�T NO : / S� � STREET: ����y� �� /� �,
�
I�OT: �� BLOCK: � ADDITION: �`(� � �� � • .
Corner Lot: Insicle Lot: X Setback: Sideyards:
Applicant attach to thi,s form two Certificates of Su'rvey of lot and
proposed builcla.ng location drawn on certificates to scale. �
�6,� 0 ��'/ DESCRIPTIO�J OF CONSTRUCTION - •
�,� ." , rg k � Z " � e aa° �' � c��
Front: � 1 D�pth: Height:
Squane.Feet: Cubic Feet:
Front: Depth: . Height:
Square•Feet: Cubic Feet:
Type of Construction: i/� /d O���Z- Estimated Cost: $ � f�%a
Zb Be Onmpleted: � 7` a a
_ . � A1t. A Alt. B
Pxoposed Drive.aay Width If New Opening Is Dasired: $' $
. . S�E REVERSE SIDE OF SHEET'
7�e undersigned hereby ma.kes application for a permit for the work�herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in this application a true and correct.
DAZ'E : /O� �P�/S�r�.S / '� S iQVATU RE : o�✓+ �`�'
5tipulations ;
��` � 3 � �
�� �•�
..��, �v
U- - - --_ ---
�_ < � .
. BU)LD11JG P�Rf�I�' IFE� SCi�GDULE� , .
srcxxo�a .2. T}ie 7n:.�pectoz �L l3uilc�ing� :s}i�7.7., be�oxe i.s�u�ng pcnniL-s £�ir �he ercet•a.orr •
oL- any bui.J.ding or struct:ure, or �'or any ��dditi.on t:o any cr.isL'ing building oz s�ructure,
. Uz for. any a1L-erat-ion or r.epairs to •at�y exa.::�ing bui.lding or Sti.YllCtiUrCr tij)G7� a2�plicatic,n
'L•h�zetore, req,uzze the �ayment• by the aPplicaiit for. such p�rmii: of iees to, L•1ie arnount
herein below seL- forth and in �L-hc inanner herein providca t-o-wiL-: �
N};47 CONS'1'RUCTION : Single �amily iIomes and Gar.ages : $4 . 00/1, OOQ cubic ieet. - - - " - ' - - � �-� -
PLli21 CH1.CY.: 2S percent of bui.lding pexmit fee. .
DRIV���JAY .D�PRL•'SSYOId: (Concrete, Curb Si:reets On1y) �
• Alternat-P T,: Removal and replacement o£ concrete curb and
guL-ter only; Dra:vewa.y width plus 6 f.cet x Y��.75
Aliern�te B: Removal. and repl.acement o£ cancrete curb and
.' • gutter and install a 3 foo� wide approach with ��
' . 6 inch depth; Drivcv:ay wi_dth �plus G feet x$17.85
fsDDITI(}NAL INFOR�1/1TTON—
I'or the purpose of computing iees for building p�rmits, the c:ubical conL-ents of any
buildi.ng or addition, is dctermi.ned by multiplyang ihe ground area covered from a
point sir. (6) inci�es below the floor line of L-he basement or th� cell.ar to the
average heights o£ the upper surface or to the average hcight o� the roof surf:ace
ot �d:t�e main gable of a pitched roof . �
For repairs or alterations i:o an existanq structuxe, the fee shal�. be at the rate
of $3.00 Per each five hundred dollars-($500.00) ar �raction.ihereaf i.n the cost
of all proposed work. . . �
Tn •no case sha].1 the i�e charged for any permit as set forth in Section 2 Ue less �
than $7.50 plus $.50 si:ate surcharge. � �
� j��R T F I CATI O,V OF FOUPdD�T I �I�
2�OT�e Permits for construcL-ion will be a.ssue.� a minimtmn of 24 hours fr.om the time
oi application to a].low for proper review of i:l-re proposed structure .a.nd of the
canstruction site. '
1�. Certificate. of Sux'vey of the lot, showiYYg the location of the foundation once i�,
has been constnicted wi11 be required before pr.oceeding with the iramirig.
- GtRi I F 1 C/�TE OF �OCGUPA�!CY
Application ior a Certii'icate oi�Oceupancy shall be made ten (10) days prior to the
us� or occupancy� of any structuLe f.or which a building perntit has been issued; and
said stxucture shall not be used or occupied wnL-il a Certifi�a�e oL OecuPancy has
been zssued. ' �
0
0
/ ..
— ' s. ir
sue�ecT PER
City of Fridley 5� 2 5
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � RECEIPT NO.
� ` .�__ COMMUNITY DEVELOPMENT DIV.
f � � � PROTECTIVE INSPECTION SEC. �n( �nJ
� , % /
� � 1 W +� •
l_--.�; �"',,� CITY HALL FRIOLE� 85432 NUMBER REV DATE PAGE OF APPROVEO BY
t 612-571-3450 910-F15 3/2/98 � �
JOB ADDRESS 7501 Central Avenue NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oESCR. 15 3 Don's 5th Addition SNEET
2 PROPERTY OWNEH MAIL ADDRES$ ZIP PNONE
Jerry/Carolyn Reene 7501 Central Avenue NE 783-8711
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO,
Builders & Remodelers Inc 3517 Hennepin Ave S, Mpls., NIlV 55408-3830 1100
4 ARCHITECTORDESIGNEH MAILADDRESS ZIP PHONE LICENSENO.
827-5481
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION �7 REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Soffit & Fascia; trim windows (Vinyl)
9 CHANGE OF USE FROM TO
STIPULATIONS
Install ventilation to meet the State Building Code in soffits.
SEPARATE PERMIT$ ARE REQUIRED FOR ELECTRICAL, PLUMBING, NEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OH AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 6D DAYS, OFi IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GAFAGES
AND KNOW THE SAME TO BE TRUE AND CORHECT. ALL PROVISIONS OF LAWS yq�UATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOFK WILL 8E COMPLIED
WITH WHETHER SPECIFIED HEREIN OFi NOT. THE GRANTING OF A pEFiM1T �3s 111 �Z.S6
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OF THE PERFORMANCE OF CONSTRUCTION �S%.ZS Fire SC �3.11
PIAN CHECK FEE O AL FEE
Lic e SC $5 00 $96.92
SIGNATURE OF CON � RACTOA OA AUTMOAIZED AGENT IOATEI E PR Y VA D THIS IS OUR PER
- ,
_Z ' g
S�GNnTURE OF OWNEa �iF OWNEA BU4DER� iDATEi � - LDG iN5 pqi
NEW [ ) Cffective 8/1/95
t�D�N ( ] CITY OF FRIDLEY
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �
Building Permit Application ���,,rr�l ��,U\
n �J
��d
ConstructionAddress: �I '�'r QI �enlfR,4� �e I1�C F.ec�l�,/ Yhti SS'432
Legal Description: /9�
Owner Name & Address: �err.� � �A92a�.u.v �eQ.ua` �o � Tel. # �t2-?83- $�'l�
T
Contractor: _� �pp� & REIIAODELERS, W� _ MN LICENSE # O//DD
3b171�W AVE S0.
Address: ? 14l�Yt�.s. Mw s�s-3B� Tel. #��2- �2�5�8�_
Attach to this appGcadon, a Certificate of Sutvey of the
lot, with the proposed conshvction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING A.REA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
-
OTHER: (.'ovev��of�i f-- �i4scrAr ia �,� A.��_ -(`R.I�irn LJt/l�c�or�,cs' _
Corner Lot [] Inside Lot [) Ft. Yd Setback Side Yard Setbacks �� 1 l f
Type of Construction: Estimat,ed Cost: $
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Ne,eded: Ft. + 6 Ft = Ft x$ _$
DATE: 2-2jo�9`$' _ APPLICANT: ��d� d Rp�rnodP.�eed Zilc Tel. #(,12- 2-548'1
Permit Fee
Fire Surcharge
state surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ 8?.2s
$ 3.rf
$ �. 5�
$
� 5.00
$
$
�
$
$ �7(0•9�
CITY USE ONLY
Fee Schedule on Reve�se Side
.001 of Permit V�luati�n �1110th%)
$.50/$1,000 Valuation
$850 per SAC Unit
$S.OD (State Licensed Re�sidential Contra.ctors)
Alt. "A" or Alt "B" Above
$450.00 Conservation Plan Review
Fee netermined by Engineering
Agreement Necessary► [ ] Not Nacessary [ ]
�/' ��
t
�� - ��
2, ��
BUILDING PERMIT FEE SCHEDULE
'Ti�e Chief Building Official shall, before issuing permitt for the erection of any building or structur�, or for
any addition to any existing building or stnicture, 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 provid� to-wit: '
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000 �
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge) .: � � +` `° ` '� ':�
� _�:c��
. _ . . , .�<,�
$21 for first $500 plus 52.75 for each additional $ l IXl or
fraction thereof, to and including $2,000
$62.25 for first $Z,OOO plus $12.50 for each additional $1,000
-o� �c-t�c�n �h���, to �d i�cl�flii�g $25,Q�
$349.75 for first $25,000 plus $9.00 for each additioaal $1,Q00
or fraction thereof, to and including $50,000 .
$574.75 for first $SO,OQO plus $6.25 for each addi6onal
$1,0� or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each add.itional
$1,OQ0 or fraction thereof, to and iacluding $500,000
$2887.25 for the first $5�0,000 plus $4.25 for each additional
$1,000 or fraction there�f, to and including $1,0�,000
$5012.25 for the first $19000,000 plus $2.75 for each additional
$1,000 or fraction thereof '
DRIVE�f1AY DEPRESSION ESCROW
{�� � �t��s ��+)
Alternate "A°: Removal and replacement of curb and gutter vnly - Driveway width plus 6 fe�t times $13.50.
Alteraate "B": Removal and replacement of curb and gutt�er and install a 3 foot wide
approach with 6 inch dept6 - Driveway width plus 6 feet tim�s $15.75.
VERIFICATION OF FOUNDATION
Pe�mits for constiuction will be issued a minimum of 24 hours from the time of application tro allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of dle foundation once it has it has been const�ucted
will be required before proce�ing with the fiaming.
sue�ecr MIT NO. .-
City of Fridley 2 7 0 5'6
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � RECEIPT NO.
� i y_____ COMMUNITY DEVELOPMENT DIV. ��� �
r � � PROTECTIVE INSPECTION SEC.
i . �
� � /"'1 � CITY HALL FRIDLE� SS432 NUMBER NEV DATE PAGE OP APPROVED BY
�"'"� • •�� 612-571-3450 910-F15 8/7/98 � �
JOB ADDRESS
7501 Central Ave
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. iS 2 Don's 5th Addition SNEET
2 PfiOPERTYOWNER MAllAODRESS ZIP PHONE
Jerr & Carol Keene -8
3 CONTqACTOR MAIL ADDRESS Z�P PMONE LICENSE NO.
Seal Guard S stems 717-0700 20093688
4 ARCHITECT OR DESIGNER MAIL ADDRESS tIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PMONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW ❑ ADDITION O ALTERATION � REPAIR p MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and ara e 20 S) Tear-off
8 CHAN(iE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBINO, NEATINa, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAO
VENTILATING OR AIR CONOITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OF CONSTRUCTION ZONING Sa. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR If CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERI00 OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION STALIS GARAGES
AND KNOW TFIE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION SUf1TAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIEO
WITH WNETHER SPECIFIED HEREIN OF NOT. THE GRANTING OF A PERMIT 1668 .$3
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEFM1T FEE SAC CHAAGE
PROV�SIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION S�i.00 Fire SC 1.66
PLAN CHECK FEE TOTAL FEE
Lic nse SC 5. 0 61.49
SIGNATUREOFCON7RAC70ROAAU7MOA�ZEDAGENT ,onre, WHEN PROPERLY VA ATED THIS IS YOUR PERMIT
— r — /�
$iGNATUFE OF OWNEA�IF OWNER BU�LDERI �DATEi BL �NSP ��pTE
NEVv
ADDN
��
[l
[]
I]
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
constructionAddress: �� � I
. � rd. I� � �y 3
Effective 1/1/98
���
�o aa�
4� �
Legal Description:
Owner Name & Address: J�,� Y � �� �,(�Q ��� {��i@�'I.e ���� �6�'i I'� �� Tel. � �I �,3 � � �' �
Contractor. � � _L�/�� ,�, u ���-,� � MN LICENSE # ,� �� 3 � �i �
Address:� � q� �6'�.-�,L�.� �1�1�� �,�� IC�.�n�- �� �5�3� Tel. # � ��i ��� ��
LIVING AREA:
GARAGE AREA:
DECB AREA:
01'HER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height �
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft. •
1r ` �"� � � I �fo�`
Construction Type: �"��td" �( �� TI�Y`il. Estimated Cost: $ .
�
� (Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � I �' � APPLICANT: Tel. # � ��I ° L� � � �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPLTL.ATIONS:
$ . ��: (S�
$ I.(ofo
$ � ��
$
$ 5- �
$
$
$
$
� (�le �'
$ �
CITY USE ONLY
Fee Schedule on Reverse Side
. 001 of Permit Valuation (1 / l Oth %)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
0
- . BiJII.DING�'PERNIIT FEE SCHEDULE ` �
"-.�j --�'' _. a.�yY , __ . _ _.:F.�.
The Chief Building Official shall, b�fore issuing permits for the erection of any building or structure, or for
any addition to any existing building or stzucture, 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 to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,�
$2,001 to $25,000
$25,001 to $SO,OOQ
$50,001 to $100,000
$100,001 to $SOO,OOQ
$5�,�1 to $1,0�,�0
$1,000,001 and up
FEFS
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $1� or
fraction thereof, to and including $2,000 �
$62.25 for firsi $2,OD0 plus $12.50 for each additional $1,OQ0
or fraction thereof, to and including $25,0�
$349.75 for first $25,� plus $y.W tur each additional $1,�0
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1, 000 or fraction thereof, to and including $1, OQO, 000
$5012.25 for the fir�t $1,�0,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION FaSCROW
(Concrete Curb Streets �nly) -
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
Permits for construction will ix issued a minimum of 24 hours from the time of application to allow for proper
review of ihe proposed structure and of the construction site.
A Certificate of S�rvey of the lot, showing the l�ation of the foundation once it has it has been. constructed
will be required before proceeding with the framing. �
- - ,�- _.-_� � - - � � - .. -
._ _ . _ =�T . ...... __.. . � .
SUBJECT NO.
c�ty of Fridley 2 714 0�
AT THE TOP OF TME TWINS g U I L D I N G P E R M I T
�
� � RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV. �/� �
' j L �'���',
r � � PROTECTIVE INSPECTION SEC.
l' i '
_-_• A �r"','� CITY HALL FRIDLEV $5432 NUMBER REV DATE vAGE OF APCROVED 8Y
i �� 612-571-3460 g10-Ft5 8/12/98 / /
J08 ADDRESS
7501 Old Central Ave NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACNED
DESCR. 1S 3 Don's 5th Addition SNEET
2 PROPERTY OWNER MAIL AODRESS IIP PNONE
J rr & Carol n Keene 783-8711
3 CONTRACTOR MAIL ADDRESS ZIP PNONE LICENSE NO.
Seal Guard S stem e A E 717-0700 20093688
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PMONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PNONE LICENSE NO.
8 USE OF BUILDING
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION � REPAIR � MOVE O REMOVE
8 DESCRIBE WOtiK
S Te r-off• fascia & trim
9 CHANOE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, MEATING, �PE OF CONST. OCCUPANCY aROUP OCCUPANCV LOAD
VENTIIATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WOFiK OI; CONSTRUCTION ZONINO Sa. fT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTFiUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF /20 DAYS AT
ANV TIME AFTER WOqK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I NEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS ypLUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED NEREIN OR NOT. THE GFiANTING OF A pERM1T 3845 �1.9L
OOES NOT PRESUME TO G►VE AUTHORITV TO VIOLATE OR CANCEL THE pERMIT FEE SAC CMARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION 8] , 2S Fire SC �3. H�F
PLAN CMECK fE TOTA FEE
Lice S 5 0 8.01
SIGNATURE OF CONiRACTOp OR AUTNORIZEO AGENT IDATEI EN R LI A NIS IS Y R PER IT
�
SiGNATUREOFOWNEAUfQWNEABUILDENi IDATEI BlD INSP puTE
t
1�TEW
ADDN
��
[l
[l
Il
construcaonAaaress:
Legal Description:
Owner Name & Address:
Contractor �
Address: q� q q l- D
LIVING AREA:
GARAGE AREA:
DECS AREA:
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION -
Eff�tive 1/1/98
�
. ���e �
�. ��o
MN LICENSE # � ��i �f�J��
�Tel. # � I � ° C�� ��
Attach to this application, a Certificate of Survey of the
lot, with the pro�sed construction drawn on it to scale. �
DESCRIPTION OF IlVIPROVEMENT
Length Width Height �
Length Width Height �
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft. •
01'HER:
�'� • °
Construction Type:�� (J�-�f ,�-�-�1�, � �C� d-Estimated Cost: $ ��� � �� . o
� �� (Fee Schedul e on Back) -°�� � � �
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
,
DATE: � APPLICANT: Tel. # � �- �� �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ � ��
$ _, . �
$ I�G�
$
$ � ��
$
$
$
�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.so/$1,000 valuation ,
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ) Not Necessary [ ]
$ •�
,g�
��� �
-1�
3
_ BUII.DING PERNIIT FEE SCHEDiTI.E
_ _ � ,.. .
The Chief Building Official shall, b�fore issuing permits for the erection of any building or struct�ue, or for
any addidon 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 to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,0�
$SO,QO1 to $100,000
$100,001 to $500,�0
$500,001 to $1,�O,Q00
$1,000,001 and up
FEFS
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000 -
$62.25 for first $2,�00 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $y.(rJ iur each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,(�0
$887.25 for first $100,� plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,Q00,�
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION _ESCROW
(Concrete Curb 3treets Only)
Alternate "A": Removal and replacement of curb and giatter only - Driveway width plus 6 feet times $13.50.
Alternate "B": Removal and replacement of curb and giatter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION �
Permits for construcdon will be issued a minimu� of 24 hours from the time of application to allow for proper
review of the proposed stYUCture and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been. constructed
will be required before proce�ding with the framing.
,. . . ,
. .. ' -a- �r��-+--r--�-} . � - � • - • ,.
SueJHtT
c�ty of F��a��� 32542,
AT TME TOP OF THE TWINS g� � L D I N� P E R M I T
r
; � RECEIPT NO.
� ; y _ COMMUMITY DEVELORM�NT DIV.
r � � PROTECTIVE INSPECTION SEC. �py'� � �
�
� . ,
' � �'��� � CITY HALI FRIOIE� SSI,$ NUMBEii NEV DAT6 VAGE OF AVPROVED BY
�""�' �'' 612-571-3450 s�aF�S 4/26/02 / /
�
JOB ADDRESS 7501 Centa�al Avenue VE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACNED
DESCR. LS 3 Don's 5th Addition SNEET
2 PROPERTY OWNEFi MAIL ADOR�,S$ 21P PHONE
Jerry Keene 7501 Central Avenue NE 763-783-8711
3 CONTRACTOR MAIL ADORESS ZIP PFIONE IICENSE NO
Builders & Remodelers Inc 3517 Hennepin Ave S, Mpls., MN 55408 612-827-5481
d ARCNITECT OR DESIGNER MAIL ADDRESS 21P PMONE LICENSE NO.
ll��
5 ENGINEER MAIL ADDRE$S ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK -
O NEW O ADDITION ❑ ALTERATION �7 REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Replace windows within existing openings
9 CHANOE OF USE FROM TO
STIPULATIONS �
Provide smoke detectors in all sleeping rooms and on all levels of the dwelling
per Section 310.9.1.2 of the 1997 Uniform. Building Code.
P��m�� 1ns���.��c�� Card�
Will �� N�ailed
To Homeowner To Pos�
" TYP�OFCONST. OCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTfiICAL, PLUMBING. HEATING,
VENTILATING OR AIR CONOITIONiNG.
THIS PERMIT BECOMES NULL AND VOIO If WOFK OR CONSTRUCTIOM ZONING SO. fT CU FT.
AUTHOR12ED IS NOT COMMENCEO V�IITHIN 80 DAYS. OR IF CONSTRUCTION
OA WORK IS SUSPENOED OR ABANQONED fOR A PERIOD OF 120 DAVS A7 '
ANV TIME AFTER WORK IS COMMENCED. ` NO OWLG. UNITS OFFSTpEET PARKING
I MEREBY CEqTIFV THAT I HAVE REAO ANO EXAMIN�O THIS APPLICATION 1 STALLS GARAGES
AND KNOW TME SAME TO BE TF1UE AND CORRECI. ALL PROVISIONS OF lAW3 VALUATION SURTAX
ANO OR�INANCES GOVERNING THIS TYPE OF WORK WILI QE CpMPLIE�
WITH WHETMER SPECIFIEO HEREIN OR NOT. THE GRANTING OF A PERMIT �4', I53 $2.O%
OOES NOT PRESUME TO GIVE AUTMORI7V TO VIOLATE OR CANCEL TME pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTNER S7ATE OR LOCAL LAW REGULATING CON-
STRUCTION Ofi THE PERFORMANCE OF CONSTRUCTION �111.25 Fire .SC, ��F.15
PLAN CMECK FEE TOTA� FEE
Licen C $5 0 122.47
SiGNATUpE O� CON'RACTQR OA AUTMOA�ZED OGENT IDATE� N PROP VALIQ ED THIS IS YO P RMiT
�
S�GN4TUAE O� OWNEA��� OWNEpBU40Eii� �DA/E� � G�NS� � aTt
APR.26.2002 11�04AM HUILDERSfREMODELERS
N0.214 P.2�3
��� �] CITY OF FRIOLEY Effective 1/1/2002
ADpN [ j 643� Urliversiiy Ave NE, Fridley. MN 55432
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R 2 ��63) 5T2�604 Bldg Insp
, BUILDING,PERI�ITAPPLICAT�ON
Constructian Address:
Legal Descrip6on,
Owner Name 8� Address;
Tel. #
w
Contractor: � MN �ICENSE # (�D d
Address: BuILDERS & REMODELERS, I "
, , Tel. #
MPLS, M . 55 0 (fi12,•827-5481) , '
��g� � f���pplication, a Certi�cate af Survey of the
lot, with the propased cor�strvction dr2wn on it to scale.
DESCRIPTION OR IMPROVEMENT
LNING AREA: Length UVdth � Height�,w, =Sq. Ft �
,._
GARAGE AREA: Length Wdth Height Sq. Ft
DECK ARFA: Length Wi�th Hgt/Ground � Sq, Fk
OTHER:
�•
Corlstruction Type; Estimated Cost: �_ ��j �j�
Driveway Curb Cut wdth Needed; Ft, + 6 Ft = Ft x =$
DATE: APPLICAN . ' /
Tel. �i [ � —Cj� r
Cajl (763) 572-3604 for Permit Fees if mail g in applicatio� o� Fax to 763-571-q2$7 'rf using c�edit card and we will
call you for card number.
Permit Fee
Fi�e Surcharge
State Surcharge
SAC Charge
License Surcha�ge
Driveway Escrow
�rosio� Cor�t�ol
Park Fee
Sewe� Main Charge
TO7AL
$ ��
�
� �� a 7
$
$ •
$
$
$
$
s �2a - �
C1TY US� ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.501$1,000 Valuation
$1240 per SAC Unit
$5.00 (State Licensed Residential Contractars)
Alt, "A" or Alt. "B" Above
$450.00 Conservatiorl Plan Review
Fee Determined by Engineering �
Agreement Necessary [ ] Not Necessary [ ]
� 2� D�
sr�PU�a,r�oNS:"
�
�t/S�l (rr/oo �/� �
0' Z> � /��i�z..
From: City of Fridley To: 7634980006 Page: 4/5 Date: 10/13/2009 3:32:00 PM
Building MECHANICAL Permit No.. ` _ �
Inspections RESIDENTIAL APPLICATIQN Received By:�_
763-572-3604 CITY 4F FRIDLEY '
763-502-4977 FAX sHr•�cTiv�.2-i9-o9 R�e j;���.
19
UATE �� YOUR '-MAIL llllRESS
S1T� AllURESS � �
TH1S AAPLICANT 1S: ❑ OWN�K CONTIZACTOR
PROPERTY NAME:
OWNER/ ADllR�SS: CITY S7'ATE 'LIP
TENANT
PHONt: ZO � '" �, Jr
CONTRACTOR COMPANY NAM�: S
SUBMiT A COPY OF CONTACT Pti1LSON:
YOU R STATE STATE LICE it EXP UAT�: j
L[CENSE WITH ADUR�SS: �� V�l� � CITY �� ��vr STAT�IP��"�1
APPLICATION ��`�_ �Q�� ��"l � p FAX
PHONE
PERMIT TYPE SWGLE NAMILY ❑ TWO NAMILY ❑�'OWNHOUSE
TYPE OF WORK: � N�W �R�PLACEM�NT ❑ ALTERATION/REMODtiL
DETA[LED DESCRIPTION OF WORK
F�E5 ARE BASED OV $10.00 PER FIXTURF., N.XCEPT WHN:RN: VO'1'�.D. FIX7'URN,S: (LVDICATE'1'OTAL VUMBN:R OF �ACH BELOW)
PRUYIDL� HL�A'1' LOSS CALC'S PL�R r1AVUA 2 6 HRAN, HAVDBOOK. fl�
Equipment Installed MI�'G: _� 1" MQUEL: �� Sl'LH/BTU � 1� �
MrG: MODtL: SI'LF:/k3TU
MNG: M011�L: SI'G�/STU
A/C $25.00 NI1t�PLACE (GAS) $15.00 GAS IiANG�lOV�N $10.00
AIRTO A1R tiXCHANGEEK $IS REPLACE (WOOU) $35.00 N�.W GAS GR1LL $10.00
BOILtiR $35.00 �'URNACE $35.00 _GAS UNIT HTR $10.00
CH1MNtY LINtiR$]0.00 GAS llRY�R$10.00 POOL H�ATER$35.00
UUC'f WORK $10.00 GAS PIPING $10.00 V�NTILATOIt $15.00
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TH1S IS AN APALICATION h'OK A PERMIT-NOT VALIll UNT1L P1tOC�.SS�U
1 hcrcby apply for a building permit and I acknowlcdgc that thc information abovc is complctc and accuratc; that thc work will bc; in
conformancc with thc ordinanccs and codcs of thc City of Fridlcy and with thc Minncsota Construction Codcs; that I undcr.�tand this i.�
not a permit but o an application for a perrnit and work is not to start without a permit; that thc work witl bc in accordancc with thc
approvcd plan in t c casc of al r� hich rcx�uires rcvicw and approval of lans.
SIGNATUR�: ON APPL AN'C PRINT NAM� � UAT� � V `� V�
APPROVAL INSP�CTOILS SIGNATUR� DATE
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........................................................................... .................................................,...........................................................................5i�?`ffl�,::::::::::.
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977