AF - 38334City of Fridley, Minn.
BUILDING PERMIT N° � 8 5
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Date- ---------- --------�•-�---...�.t...._.-•----•----_. _. .._..-----•-�--....-•---•--�----�---•-•-------...._....._
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Owner: .. . ......_ ._ ....._...... _.... .._ _.._....---.._ Builder
Address....._.-�-----.._� .! ................._...._...----...........---.....----�--.............. --............-�----...._...._ Address . - ......- -•--.......--•�-�--- ..... .........-----....---�-..... ............_...._....-�- ..............
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Lot .......... ......._...--.--....._.. Block _....---.......---.----..._......-.--..-.-.---..._..... Addition or Sub-Division ... ..:�
Corner Lot ...................._........ Inside Lot ....._...Y..........._..... Setback --.----•-, _!' ..Q..�..-------- Sideyard
SewerElevation ---�--......._-�----•--�----...--�-------�-�--�-•----- -.._...___..-----..........---�•---. Foundation Elevation -- ��- .................. .--...-�---..._...._........--�-----�------
DESCRIPTION OF BUILDING
To Used . �
- --• --...... Front _.�� �1.�..-...._.. Height --�-- Sq. Ft. � ..f�Cu. Ft .. �.�Q
.. --- - Depth
.._ ... . . ................_ Front --C�---_ Depth __..0��-. Height .....�,Gd_.. Sq. Ft. .... ..�� G�Z. Ft. ...��_li
Type o Construction ��..�1�.�..._.. Est. Cost .,���..-� 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 forth and in compliance with a11 provisions of
ordinances of the city of Fridley.
.!i_......_.------__....._......_.._._..._.__.._____.�_._
In consideration of the payment of a fee of $...f�.l� .._.._......._.., permit is hereby granted to....__.......___._.._.�._._..v__
....._ ............._............._......._....................._.... 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 buildings
within the city limits and this permit may be revoked at any time upon violatiqn of any of the provisions of said
ordinances. r-, ., n 1
Building Inspector
NOTICE:
This permit does not eover �hs eonsfruetion, installation fo� wiring, plumbing, gas hesting, sewar or wafer. Bs sun to ses
ths Building Inspecfor for ssparate permifs for thes� it�ms.
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APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
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Owners Name ,�,�/���Builder
Address Address � � � ♦
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No.
Lot
LOCATION OF BUILDING
Street �.'� ��T �� 11'���.�-,� �-`i.� I�'t of Lot
,
/ Block Addition or 5ub.Div. � �- Gt��-d
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Corner Lot Inside Lot fi'' Set Ba.ck C� O Side-Yard ,���, ,�____
S�'WER ELEVATION ,,,� 1; lT � FOUNDATION ELEVATION �� ,�O_ ______�_
Applicant attach to this form Certifica.te of Survey of Lot and proposed building
loca.tion.
DESCRIPTION OF BUILDING
To be used as:
� - ! �� -.�.� � F�ont Y�i� 4 �� Depth �_ y � � �� Height �`
��
Sq. Ft.,,,(o,�'�e. Cu. Ft.
�' � Hei ht �
� r`<, ��� Front�7 0' Depth ,� � g.�.,.
Sq. Ft. �I �/r� r� Cu. Ft.
Type of Construction_� �i�!�-F - Estimated Cost��,,,�_
To be
The undersigned hereby lnakes 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 declaxes that all the facts and representa-
tions stated in this application are true and correct.
DATE <���.Z,c.��_� � - ,,,� ,( SIGNATURE
(A Schedule of Fee costs can be found on the Reverse Side.)
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BtTILDING PERMIT FEE SCHIDULE
Section 2. The Inspector of Buildinga shall, before issuing any permri:t
for the erection of any buil.ciing or structure, or for any addition t�o
any existing building or structure, or for any alterations or repa.irs
to any existing building or structure, upon application therefor, require
the pa�ment by the applicant for such permit of fees to the amount herein
beiow set forth and in the manner herein provided to wit:
2.1. For any such permit for the erection of any fire-proof building, other
than a garage, warehouse, factory or grain eleva.tor, or for the erectip�n of
ar�y fireproof addition, for similax occupancy, to any existing building
shall be at the rate of .�1.40 for each one thausand cubic feet, or fx�action
thereof, in such cubical contents. '
2.2. For any such permit for the erection of any fireproof gai'ege, ware-
house, factory or grain elevator, or for the erection of any fireproof
addition, for similar occupancy, to any existing building sha11 be at the
rate of $1.25 for each one thousand cubic feet, classified as "Pireproof"
by Section 502 of the Minneapolis Building Code.
HOUSES
2.3. For any such permit for the erection of any non-fireproof building
other than a garage, warehouse, factory or grain elevator, or any non-
fireproof addition, for similax occupancy, to any existing building.
Permit �1.00 for each one thousand cubic feet.
GARAGES
2.4. For any such perinit for the erection of any non-fireproof garage,
warehouse, factory or grain elevator, or for the erection of any non-
fireproof addition, for sixnilar occupa.ncy, to any existing building
for each such building or addition. Ninety Cents for each one thousa�rid
cubic feet or f`raction thereof, in the cubical contents thereof with a
minimum of $4•00.
For the purpose of computing fees for building permits the cubical contents
of any building or addition to a uniform height throughout by multiplying
the ground area covered from a point six.(6) inches below the floor line of
the basement or cellax to the average height of the upper aurface or to the
average height of the roof surface of the main gable of a pitched roof,
2.�. For repairs or alterations to an existing structure, the fee shatl be
at the rate of �3.00 for each Five Hundred Dollar,,4 (�500.00), or fraction
thereo£ in the cost of all proposed work.
2.6. In no case shall the fee chaxged for any permit as set forth in
Section 2 be less than $4.00.
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City of Fridley
Ap�icatian for Plumbing and Gas Fitting Perm�it �
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Dept. of Bldgs. Phone SU 4-7470
DESCRIPTION OF WORK � d �_,�,�1�a�
Number, Kind and Location of Fixtures Locafion � �
y �n �n �j y, U' WATER HTR.
N W W < Z N = N Y Z K C(� Z= Z = ? � *�
•� ��J R' I� G Z � a' K � = J C t~ O< < a � Z N w
+' 3 V 7 00 �- m in 3� a u. �n a o U�< 3 (9 t(9 �� p F N GAS ELEC.
�
Base ♦ � �
lst � � � �
2nd t � �
3rd
4th � _ _ -- —
' Future Connection Openings Connected with
* New FixYure, Old Openings I Sewer �
Cesspool �
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TO'�AL
Number Fixtures . . . . . . . . . . . . . . . . . . . . . . � x $1.50 $ � 3 � -� �
Future Fixture Opening . . . . . . . . . . . . . . . . x 1.20 $
New Fixture Old Opening . . . . . . . . . . . . . . x 1.00 $
Catch Basin . . . . . . x 3.25 $
Water Heater (Up ta 200,000 BTLT) . . . . . . ,G x 2.00 $ � � G J
New Ground Run Old Bldg. . . . . . . . . . . . x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
lst 3 Fixtures . . . . . . . . . . . . . . . . . . . . . . . . . . /x $1.50 $�—� �
Additional Fixtures . . . . . .. ....... . . .. . . x .50 $
Gas Range to 200,000 BTU . .. .. . . . . .. ... x 2.00 $ _
REPAIRS & ALTERATIONS—Refer to Code
Description .... .. ........................................$
TOTAL FEE $� � � �
City of �idley:
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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.
Fridley, Minn � � 1 , 19�
Owner , 19—
Kind of Building , 19—
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Used as
To be completed about
Estimated Cost,
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'�d�-New. Building Perxnit No. � �
Signe �
By
Business Phone Na._ -S u u �` �o �
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11 POST iM-12-58
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�"''� A� Tkf TOP Ci� T►tE TWINS
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k..__.i�: �.J g�1-680-7a60
Job Address
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Permit No.
NCATIi��G PER��IT APPLICATIOi'�
��Jt A�V.
910-rl�n o
ress
2/15/73
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A�"f'RCVED fiY
1 � 1 I 800
ne
Contr ctor 0 �
/]'� A ress --7�- ho e (L�
� �/u-il. �T �iv�.(.Fi� �JLt,-,r� %�7 �ul I
I:ind of _Buildit;g , Use n , „
-� ��2rrt�.'"e- ✓ `Q-Q-L�
Comp etion Date imate ost ' -
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CttFi�'"• �`r.' E4! R ��� �a.��i: � ��°y' ''i'43i:;.L v
Heatin�/� o;aer P1anL-s =„�
; �"urnace Stie2t �u BuM <<ork ... ...... ..a14.b+� S Ste2.m Hot jJater ��7arni rlir �
Replac�ment ai �ernace ..... .... . . 6.00 $ �
Repairs & Alte�ations—up to $500.Ofl g.p� �______ _ ._�
Trade Name �
Repairs & Plteratious each ac'd. �50u.0�J , S1ze NO.
3cw b---- ---
y;,��;.� �p�� � Capacity Sq. r t d
F�rn�ce �reell t�i D1act Wc�rk to l�,efi� BTU ..310.00 $--- EDR BTU Ton.
eech add. ��,G�O B'1'i7 .. ............ .... .. 3.t� i Total Connected Load
Replacem2nt of r'�rnace . . 6.� $
Rep�irs & Aiterrations--up tv $50Q.Gc� 6.0�0 � � �v
Kind of I'uel
Rep�zirs & hlterations each add. .e.5�U.00 3.Q�1 y Burner
�i'gAP� or �07 ��TER SX:�'1'�R3 Trade Name
F�rr.ace She�l & Lires—to 400 sq. .*t. F.I1R Stetzm ??0.00 $______—_ ^
Size I�o.
�rnace She?I Sc I,ine--to 640 sq. ft. EDR fiot Wa't°r IO.�il S_ —__
Each add. ZO? sq. ft. �DR S'esm 3.(xl �_ ___ _�_ Capacity
Each add. 320 sq. 1t. EDR Hoi Water 3.00 ;�__
EDR BTCT
OIL HIIR1tiER—to 3 gal. per hour
over 3 gal, per hour—See Fee Sched;::e
GP:S �UF�P�;�k7i (up to 1r3,GTS4 P�TU7
ov�T iS9,(;!XJ �i'i(3 �ee ie�» 8tt?sdul�
GR5 f ITT'dP7G F"':.;ivS:
Ist 3 F1xtt!res . _
Additional Fizttzres _
. Gas Range to 19�,Ct�4 _
F:I� CQ�'� F'FS: .:E:<�
F7+.ti Fi��TI�*v f�'ii':."-,:"�
`fiS7'T'ILt.�PI�!G l�Y�.Tf!°3
1.L7�RA7IC."dS ft F,EPI�IF`,�
fi0ilv�y
%.Zfii, �� v� — ! %
6.00 a _
5.c�? i-
2d0 AATE TO'I AL
- x b 2 ��0 S --- ---
_ x .i5 S--_ _
_ s$ S.G� S
Sq.F±'
i OT7 .
.SO State Surcharge !
�ao k'so �c?��'t��e+ ���_ !
3� '
r�T.�..t. r- :; : g . J �
Suburban Air Conditioning Ca. �
8� ? �3 Center L7nve �
Mirmeapol�s, Minnesota 55432 4
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ignature !
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�iiy of Fridley _
. ,���i�:.�:ta �� t°'�.�� �� �s� e�m�� � �''.�r��
1?ept. of Bldqs. Phono 560-3,
D£3CRIPTION QF WORK
Numb�r, Kind and Lxalica oi Fixtures
� ��� � p � r Z�I� �=I�= o� � Z� �
� I� � � 1 � i �n 3 � O � � � '40 � l < 3 l� � V a u �
Base
l�t
2nd
3rd
4th
• Fuxur� Cona�cifoa O=»ninQs Coaaseisd with
i N•w Fixlurr, Old Op�ninys
PARTiAt. RAT� S�CHEDULE
WATEN KTII.
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I M GAS fIEC.
City oi FYidley:
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The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the CitJ Dedinance
and ruling o1 the Department of Buildings, and hereby declares that a3L the tact
and representations stated in this application are true and correct
PYidley, Minn 19.��/
Owtier ��/ / �/! . /
Kind of Building `d"L��"� .
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8iwir � Used as
Cesspool f1
PLIIMBINC FIXTURE AATES: NO. RATE TQTAL
(;r�
Number FYxtures . . . . . . . . . . . . . . . . � x 32.00 5—�—
Ftiture flxture Opening . . . . . . . . . . . x 31.50 S—.--
New Fixture Old Opening . . . . . : . . . . . x at.50 E,____
Catch Basin . . . . . . . . . . . . . . . . . . . . x a3.25 S
Water Heater ',Up to 99,000 BTUt .•.• x$3.00 ;
New Ground Run Old Sldg. ..... . x a.3.25 $
Elsctrle Wat�r H�atu. . . . . . . . . . . . : a2.00 S
;.AS FITTING FEE$: NO. AATE TOTAL
lst 3 Fixtures . . . . . . • • • • . • . . . • _ x 52.00 ;
Addit3onal Fixtures . . . . . . ..... . . . . . x = .76 5 .
Gas Range to 198.000 BTU ..... ...... x 35.00 6
To be completed about < v
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Estimated Cost, a � ?� � "
Old New. Building Permit No. P�rm�t No. ����
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Signed � -
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Business Phune No �����-�-'1�-�-��
ROUGH
FINAL t �. 7 - 7�
REPAIRS � 11LTERATIONB—R.i•r to Cod• .50 State Surcharge
Deacription ......................... ...................f
TOTAL FEE S / � S � '
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sus�ecr PERMIT NO.
City of Fridley � 266'7
AT THE TOP OF THE TW�NS g U I L D I N G P E R M I T •
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; � REC �
� • COMMUNITY DEVELOPMENT DIV.
r � � � PROTECTIVE INSPECTION SEC. �a�f �/^
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� � /"�1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BV
� ""�'� ,�� 612-560-3450
910-F15 8/8/74 � �
JOB ADDRESS
147 Chasne Wa N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 1 Chesne Acres SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Joe Meuth 147 Chesne Wa N E
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USEOF BUILDING
7 CLASS OF WORK
❑ NEW �l ADDITION C� ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 22' x 22' Family Room and a 30' x 26' Garage �
9 CHANGEQFUSEFROM TO
STIPULATIONS
Provide a hard surface driveway. East property line verified by
survey for 123 Logan Parkway(Lot 2, Chesney Acres)
SEPERATE PERM{TS REQUIRED FOR WIRING,
HEATING, PLUMBING AND SIGNS.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOC� FYaRIe
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. N0. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PFOVISIONS OF LAWS VALUATION SURTAX
AND ORD�NANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $15,446.SO %.%2
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PfiESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- L�]_.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �
PLAN CHECKFEE TOTALFEE
$48.%2 r
-� iGnln7uaE OF CON � R C Oa OR /+UT OaiZED nG T DATEI W HE PROPERLY VALIDAT T IS YO PERMIT
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SiGNATUREOF OWNERIIF OWNER BUILDERI IDATEI � BL�G iNSP DA7E
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APPLICATION FOR RESIDENTIAL, ALTERATION,
OR AllDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
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OWNER' S NAME : - � - BUILDER: . � ,� �> � � �
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ADDRESS : � � ADDRES S : _'3. �:`; �� – ��� .��t � c� /7, _-
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rro • . STREET • �! ' C � �a
— � �
LQT : BLOCK : ADDITION : � � -� � /(5/ � �s/ � C � � S
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form �tao Certificates of SurveY of Lot and proposed
building location drawn on these Certificates.
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BESCRIPTION OF BUILDING
To Be Used As : �,� ��� _ �-�_ �% � � , -�_' � �-i�-2 %
f �r s 2 ..y.
�� � . ��� �" ' ' / a--
> �-� ,
`� �.�,-y �__._ Front . ' Depth : /� � Height :
Square Feet: �' ��� Cubic Feet: �o � �� ��
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� - Front : �; Depth : � Height : ' �-�
� � � ,� /� 1.�./
Square Feet; - Cubic Feet: *%
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_\
€��
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�pe of Construction: Estimated Cost: ,�G; G c' �=: �}
To Be Completed: ��� j_> 7� ��
i ''- � �,� � . � �s'
The undersigned hereby ma.kes applicatian for a permit for the work herein
specified, agreeing to do all work in stiict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares ttiat all the facts and representations stated in this application
are true and correct.
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DATE: —�— `r ^- ` SIGNATURE � �= �
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(See Reverse Side For Additional Information.)
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�UILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any existing
building or structuxe, �r for any alteration or repairs 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:
U1�TIFORM BUILDING CODE: �pe 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORi�IATION
' For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
ox the cellar to the average heights of the upper surface or to the average..-
height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In no case shall the fee charged for any pennit as set forth in Section 2 be
l.ess than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours from the
time of application, to allow for proper review of the proposed stxucture and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
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ncrrn. �.ny ui rnv�oy �u. �u.�r ic in.�.r rayc, i�� vaac. v��c,���v� J.LJ.JJ i ir�
Building BUILDING P��t No.:
Inspections . RESIDENTIAL APPLICATI(JN Received By:
763-572-3604 �ITY 4F FRIDLEY R � � �
DATE (i" // OJ YOUR E-MAII. ADDRESS l� �i /< <•c l� � r fGr�ri.;r" �:� o.n ,,�r f -
— —,—�,--x �-T—
STI'E ADDRESS / / 7 C//��N��E __ --
/
THIS APPLICANT IS: ❑ OWNER �CONTRACTOR
PROPERTY UWNER/ �AME:_ 4l'�s �, �� —
TENANT � �,�� � r�,a/,�T STATE�sJZIP �}/3 `
nDn�ss: iy� cl�„u�y �-�,
PHONE: %�;�-67/�L.�?I � '
CONTRACTOR NAME: I^xc.�/ ;�r�_ _
SUBMIT A COPY OF �TATE LICENSE #��'/G� � lf`% _ E� DATE ���/�I���`' i'
YOUR STATE LICENSE nDDx&ss: 7�`c�� i/3`fr A�� _ ctzy �'Nf,1��/��� sTAT�NZ��S:�iG,
VJITH APPLICATTON rHOrrE � C'� �� z- e 5 7 F,�x '7c.": :' J, z- - z�
PROPERTY TYPE ❑ SINGLE FAM[LY/NEW CONSTRUCTION srzE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERNIIT TYPE � �DITION ❑ G�.�F/s� ❑ wIDrDOws
❑ BASE1�fINT FINISH �ROdF ❑ DRAIN TII.E
. � DECK ❑ SIDING ❑ OTI-IER
❑ SWIMMING POOL
TYPE OF WORK: ��� ❑ ADDITION
❑ MAINTENANCFJREP.SIIZ ❑ REMODELING
DESCRIBE WORK BEING D4NE: ���-�� s��� ( s�,k� � F�«sE' � c��.K'i1 >i1c,J�l /_'�/1,��
�
SIZE OF Il�'ROVEMENT LENGTH WIDTH HEIGHT S. Ft.
ROOFING � FiOUSE ONLY
NiIMBER OF SQUARES IG- _ ❑ HOUSE c� GARAGE BASEMEDIT REMQDELING SUSMIT:
GARAGES ❑ ATTACI�D GARAGE 1. ��n8 �QOr P{zn
PROPOSID SIZE: ❑ DETACFIED GARAGE 2• �'oP� �oor pian
3. List of structurdl members to be used
PROPOSFA HEtGIIT:
SIDIiVG � FOR NEW CONSTRi3CT10Ti INCLUDING DEGKS,
❑ ��m,{ ❑�{�t ADDITIONS c@ PORCHES SUSMIT:
❑ Alumimim ❑ Trim 1. Sitr Plan/Survey showing ttre existing structures
❑ Other ❑ Fascia and proposed project.
��0� 2. ltro sets of con�uction plar�s
IN ESQSTING OPEIVING5 QYes ONo LOCATION OF RRNDOWS 3. Ervergy Cakutations
OR FOR NEW OPETIINGS-DESCRIBE SIZE QF
OPEI�IING CHANG�S &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BAS�ll O1V YALUA"llolv, llv(;LUUltvu 1'ttr; t;u5i vr L�es�x �L n�1r�K������
' (USING THE�997����E SCHEDULE)
TOTAL JOB VALUATION S._1�.,�; `=J OCCUPANCY TYPE
Perniit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb (.,�ut Escrow
Erosion Control
Park Fee
Szwer Main C,`Yiarge
Total Due
$ � 3•d �j See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ .001 times the total job valuation
$ �. .0005 x Pennit Valuation Minimum $.50
$ �, O Q $5.00 (State Licensed Residential Contractars}
$ $1675 per SAC Unit (Plans to MWCC for determination)
� R+6ft= ftx$21 =$ _
$450 Canservation Plan Review
Fee Determined by Bngineering
Agreement necessary ( ) Non Necessary ( )
Malie checks payable to: Citr of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the wark will be in
conformance with the ordinances and eades of the City of Fridley and with the Mnznesota Construction Codes; that I understand this is not a
p�rmit but only an application far a permit and work is not to start without a permit; that the work will he in accordance with the approved
plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT �� % f'/-^ PRINT NAME `r l, C-��__ DATE (� %�%
7
Building PLUMI3ING Permit No' �_ — (? __ _
Inspections RESIDENTIAL APPLICATION Receivecl }3y: _
763-572-3604 Date IZec'd: �— J --��
CITY OF FRIDL�Y —
DA`I�E �� YOUR G-MAIL ADDRESS
SITE ADDRESS `� �Q���(_�__���_L� �V � _
'I'HIS APPLiCANT IS: ❑ OWNER ��ONrRACTOR
PROPERTY NAME: �i �
OWNER/ ADDRESS: I`-t � _ 6� Y�— �--� ( 1 STAT'E�I �7_1P���?i �
TENANT pHONE� `(�� �� t i_.L� L �
CONTRACTOR NnME: � l Jl 1 �� C2--- _
SUBMIT A COPY OF STATE LICENSE tl EXP DATE �� L.� _ 1
YOUR STATE ADURESS� �-1 CITY _STA" �� 7_IP�u I�
��cENSE wiTti �HOr,E71���1.e �L �o� Fnx-1 �`� ��LQ����
APPLICATION
PERMIT TYPE �NGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � NEW �EPLACEMENT
DETAILED DESCRIPTION OF WORK � � �y I � � ,Q �� � l� ��t-� � �
PER MS 16B.665 the pennit fee is a minimum of $15.00 or 5"/0 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.OS = _
FOR PROJECTS WHERE LAQOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTEU. FIXTURES: (WDICATE TO"i�nL
NUMBER OF EACH BELOW)
BATH S1NK/LAV FLOOR DRAINS SHOWER WATER PIPING
BATHTUB GAS PIPING Mr:r:ncnrucrNSr:) SWIMMING POOL � WATER SOF'1'NGR ($3.5)
CLOTHES WASHER KITCHEN SINK WATER CLOSET DACKfLOW {'REV. ($IS)
DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGA'iION
WATER METER OTHER
.PE`C�ITF��`PRdJE,�'�� F'+C7�t UND�R $5U0 � . : � . ' : .:;, r. =: - PERIvtIT F��'FOR"PROJ�C'�5 OUER�$500
Pennit Fee $ Number of fixtures @$10.00 x$10.00 =$ _
Surchar e .50 Number of fixtures @$15.00 x$15.00 =$
1'OTAL DUE $ Number of fixtures @$35.00 ____� x$35.00 =$
State Surcharge = $ .50
7�otal = $
THIS IS AN APPUCATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and 1 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 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 witli the
approved plan in the case of II �'ot c which requires review and approval of plans.
SIGNATURE OF APPLICAN� �� � � /� FRINT NAM� �-�-�'► �L"►t1��Al E
��;` ..�';I'T.LA�E;�TOT,�:�;��I��1�t"I'��PERIVIITS ARE'REQUTRED.FOR;BUILI�CI�iC�; E�EG'TRICAL:AND;IVIECHANIGAL�WOhK 7 ..''',
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 7C3-502-4977