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AF - 43216City of Fridley Appfication for Plumbing crnd Gas Fitting Perm�t Dept. of Bldqs. Phone 560-3� DESCRIPTION OF WORK � � 5 � Number, Kind and Location of Fixtures Location u� �U' WATER NTR. pC � � F- C N S N W Z � � W =� � Y x} ZZ �a QZ Uz Ox�1 � (9 Z < � y ` � � Z � � � p = j � < � j c < a � < � a F N GAS ELEC. ; t� � .6 VI 3 H � LL UI LL O V m < 3 C9 < (9 oc C9 O Base lst 2nd 3rd �th L_ i I I I L I I I I I ► J___1- I I ) • Futu:s Conasction Openiags Connected with * New Fixlure. Old Openings I Sewer � Cesspool � PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ....... ............. F'uture Fixture Opening ................ New Fixture Old Opening . . . . . . . . . . . . . x $2.00 $ x $1.50 $ x $1.50 $ Catch Basin ... .......... x $3.25 $ Water Heater (Up to 99,000 BTIA . . . . . . x $3.00 $^—� •. '{, � New Ground Run Old Bldg . . . . . . . . . . . . . �� x $3.25 $�— Electric Water Hsater s $2.00 $ GAS FITTING FEES: NO. RATE TOTAL lst 3 Fixtures .......................... Additional Fixtures .................... Gas Range to 199,000 BTTJ . . . . . . . . . . . . . . REPAIAS Sc ALTERATIONS—Refer io Code x $2.00 x $ .75 x $5.00 $ $ � City of Fridley: �': '� � The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the facl and representations stated in this application are true and correct. Fridley, Owner � Kind of Building ��'i e 19(� Used as " To be completed about f�/`' ��' _ �.>-r Estimated Cost, $ � � � Old—New. Building Permit No. Permit No. �� ° 1 /' � + Signe �' - By ��Z�� Business Phune No. '7 �� - 3..� /`� a ROUGH FINAL �l' � '-(!� 4 Description ............................... ..........$� TOTAL FEE $ ` • z sua�ecr PER . City of Fridley , 12'760 AT THE TOP OF THE TWINS B U I L D I N� P E R M I T r ; � EIP . � `L ____ _ COMMUNITY DEVELOPMENT DIV. ` _�� r � � PROTECTIVE INSPECTION SEC. � 1 � � � /'-�l � CITY HA�L FRIDLEY � 55432 NUMBER REV. DATE PAGE OF APPROVED BY �----� • •'� si 2-5so-sa5o 910-F15 � � JOB ADDRESS 625 $�ii€ Dover Street N.E. 1 LEGAL LOT NO. B�OCK TRACT OR ADOITION SEE ATTACHED DESCR. 1�2 V Riverview Heights Addition SHEET 2 PROPERTYOWNER MAILADDRESS ZIP. PHONE Edwin Johnson 625 Dover Street N.E. 3 CONTRACTOR MAILADDRESS 21P PHONE LICENSENO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE UCENSENO. 6 USE OF BUILDING Residentiai 7 CLASS OF WORK ❑ NEW ❑ ADDITION q{ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK 9 CHANGE QF USE FROM TO STIPULATIONS S�PERATE. PERMITS RE�UIRED �OR VV1R1f�iG, H�AT1��, �L��BiNG Ai�D SlGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. WOOCI FY'dM2 THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTfiUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 OAYS, OR IF CONSTRUCTIOtJ OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WOFK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION }- STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2QQ�OQ .SO WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 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- $S.QO STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $5.50 VGNATUREOFCONTRACTOROFiAUTFi0131ZEDAGENS IDATEI WHEN PROPERL VALI ATED THIS IS YOUR PERMIT I � ° �� l o �S` , , � � SIGNATUREO OWNERIIFOWN U ERI IDATEI B�DG WSP DA1 OWNER'S ADDRESS: APpLICATION FOR RESIDENTIAL, ALTERATION, OR AllDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA . � � i , � _.s� �_ � �. . � � i � � • •;_r � _ _.. . � � _ � / � � ._ -�:�i. '��' � .. - , . �� i _ � NO • . �4 a-S S TREET : ,(�� ,`, „ _ .S, �— �� _ � LQT:_,��_BLOCK: ADDITION: CORNER I.OT: � INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form T�ao Certificates of Survey of Lot and proposed building location drawn on these Certificates. bESCRIPTION OF BUILDING To Be Used As : ("� � ��(,�„[�y��ont :� Depth : Height : Square Feet: � Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: • , Type of Construction: Esti.mated Cost: $'�, C9(`01 . To Be Completed: f� �. . The undersigned hereby ma.kes applicativn for a permit for the work herein specified, agreeing to do ail work in st=ict 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 app2ication ara true and correct. DATE : (f'LPsT' � S IGNAT[1RE : � (See Reverse Side For Additional Information.) �...� , ;.. ,� ��._ • r.._ .,, . � � _ _ _ __-s� , ,. 3 � .z � . � � � ,� � �. � �� , � � 3 � °� —� �� ti 3 �� b � ., � � °� � � � �. ? �- � � .�� s L "J � �// � �� ' - o� � � .� � � � � � � �,�. � °� .� . � ,� �� , .�,' ��,s�,� i � � � �� _ � �� Q 0 3 � � � � ,� � � � ; ; � � ,� `� �3.► � �� M�X� �� o� °�"� a"��° , �� ,3 �no � � , �, � .� � � � _ � � .� � �:.�'i 4 � � � � SUBJECT � � P , City of Fridley . 14893 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r � � R EIPT NO. � • COMMUNITY DEVELOPMENT DIV. 98 � ; V �� r � � PROTECTIVE INSPECTION SEC. � . � �` � /"'1 � CITY HALL FRIDLEY 55432� NUMBER REV. DATE PAGE OF APPROVEO BY L��'� � �'� 612-560-3450 / / 910-F15 9 1 78 JOB ADDRESS 625 Dover �S Street N.E. 1 LEGAL �OT NO. BLOCK TRACT OR ADOITION SEE ATTACHED DESCR. jy2, 3 j �/ Ri.verview Heigh.ts SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Edwin 5. Johnson 625 Dover Street N.E. 784-5231 3 CONTRACTOR MAIL ADDRESS ZIP PHONE �ICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDHESS ZIP PHONE UCENSE NO. 5 ENGINEER MAILAUDRESS ZIP PHONE LICBNSENO. 6 USE OF BUILDING Re.SIC�@Il't1.d1 7 CLASSOF WORK � NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Reside dwellin insulation new sheetroalc windows 9 CHANGE OF USE FROM TO STI'pULATIONS . S�pFRq TE pE NEAT�NG. �P�� '�E4e�t,��Q F ��Q ��NS, Q� WIR��. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR 1F CONSTRUCTION OH WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEFiEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ]. STALI,S GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPUED $l� HQO �. �O WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � $�-2.QO , PLAN CHECKFEE TOTALFEE $12.90 �Si ATUREOFCONiRACTORORAUTHO DAGENT IDnTE� WHEN PROPERL VALIDATEO THIS IS YOUR PERMIT . � - -�-� SIGNATUREO ERIIFOWNERB 1 IDA 1 BIDG INSP � DATE _. . .. . • CITY 01= f=iZ�l)LCY , � , • AI'1't_�C�TIC�Id I�0(t ftLSllat:t�Til�L T3U1LD1r1G hrlZf�fITS , ' (i�LY�,- �LTL"fZ/1TI01'�S, �1?llITIO�JS, OR RC('AIf2S) � . � • � ; . :,�'- ,j�l,�-�� -d �1�' :. : ' c�rti��i�n: ��s.,.,� r�uzz.u��z: Addr.ess . �;,� � 'r='s�'�-` ��- j� � �daress : Tel. No. %�'�/-��3 % � ' No. : s;,l � - - — Street: �r��,,,�`,�� J.�': !%9 � -- - , . LOT : / " � -'� 13TACY.: �'.�`' J�DDITIOP] : ��,�1.,�'� �'L=r'' �� CORNER LOT: ✓ II�SIDE I�OT: S::T}311CY.: SID�YI�RDS: Appl�ca'r,t attach �to L-h.is foi-m �ao Cer+�iticates of Survey of Lot and rropos�d bu�.lding �.ocati.an draym on these Certificates. • �)ESCRI PTIOPd OF BUI LDI I�G .•, To IIe Used �s: /I, . , � :+� �i , � • � .. '/ �' �,��5 �ie.�u�-,,j4�r-f ��ront: _�l� � Depth: �� y Heigr�t: �1D . �`'��°�"s Squaxe Feet: D 5;•' Cu�ic Feet: , . I'ront: � Depth: � �leight: ' Square I'eet: :Cubic Feet: � � '' ~ EstimaL-ed Cost: $ ``�- Ty�e of Construction: :! .� � y.�. -L - �Y-�.,,� ��--- 7.b ne l:am�ieted: �"� `�� I�lt. A Alt. B Froposed Drive�aay tr'idL-� If New Opening Is Desired $ $ ' • (SE� 12�VERSE SIDE OF SHf.ETj The undersigazed hereby makes application f.or a permit for the wark herein specified, agreeing to do all eaork in strict accordance with the Cit}* or Fxidi.cy Ordiizances a�Id rulings of tlie DcL�artnie�lt of Buildir�gs, and liereby declares that all thc facts and representations stated iti t}�is applicat:ia:. are L-rue and correct. See xever.se sa.de for aQdit-ion 1 infonnation. , DAT�: .��> /�7'� STGNATUI�E: :.-� -� - Sti,��n1 atio»s : . � • . � j�_�� - . . �o 9d _. . � �a . 0 . • CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1995 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERA710N AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner — Also Replacement Furnace (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning — All Sizes All Others�iepairs & Alterations (LIST ON BACl� 1% of Value of Appliance or Work Commercial/I ndustrial 1% of Value of Appliance or Work Rate $ 2o.oa JOB ADDRESS �rp � �//c��_ ��° The undersigned hereby makes application for a permit for the work herein TOTAL specified agreeing to do all work in strict accordance with the City Codes ar rulings of the Buitding Division, and hereby declares that all the facts and $ representations stated in this applicatio ue and correct. ��-�— �� g9s $10.00 $ $ 10.00 $ $ 10.00 $ $10.00 $ /D� State Surcharge TOTAL FEE D`t � < <--� � J u-� BUILDINGUSEDAS 7�✓� C--e �-,�� (�� ESTIMATED COST ��j c�� -f PERMIT NO. �l :3 DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR $ Fuel � Total Connected Load �•50 �1 :�./ MINIMUM FEE'FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner, Burner Trade Name Size No. BTU HP EDR HEATING COMPANY �G� �' 6� �--�� lo' � . Signed Approw �� .C,�i.�.�Tel No. ��l'� �% ��(✓ <� � Rough—In�Date Final Date � � �� FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE &�ilding Inspections 763-572-3604 BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY Permit No.; Received By: (.. Date Rec' d: � a � DATE � • � � ' � � YOUR B-MAIL ADDRESS r �e c� g � e �'f..� , �.31SS � ' C� o��•y,cr�c. . Co � SITE ADDRESS � z s� o✓ v.• s�- w C � �;�� < �, M n/ S�' � T i- THIS APPLICANT IS: �OWNER ❑CONTRACTOR PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE ADDRESS: b 2.�5 � o✓ ¢-✓ S�` u E� CITY PHONE: �s s �- S� 9 .2 • � � / y G //,,. � o.,v� STATE LICENSE # EXP DATE ADDRESS: PHONE FAX INGLE FAMILY(NEW CONSTRUCTION SI2 ❑ TWO FAMILY/NEW CONSTRUCTION ST� ❑ ADDITION ❑ BASEMENT FINISH ❑ DECK TYPE OF WORK: _� �W ❑ ROOF ❑ SIDING ❑ SWIMMING POOL � � r , a( /c� STA' CITY ? c a S� [ES �L ❑ WINDOWS ❑ DRAIN T[LE ❑ OTHER i c.c �� sf t'3 L STATE ZIP DESCRIBE WORK BEING DONE: 12�,. �� c� t�,•,o vr... -1-a L,� L, ., o/r� �o-..., L% r.., �: o� SIZE OF IMPROVEMENT OF SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: LENGTH ❑ HOUSE ONLY ❑ HOUSE 8c GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE HEIGHT BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used Ft. SIDING FOR NEW CONSTRUCTION INCLUD[NG DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ' � Trim 1. Site Plan/Survey showing the existing structures ❑ Other � Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS �,Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS-DESCRIBE SIZE OF / k' ;�L v1Cr ,,, ��,�.. eLp � OPENING CHANGES & � TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 3.0 o v '= OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ $ $ $ $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1675 per SAC Unit (Plans to MWCC for determination) ft�-6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks aavable to: Citv of Fridlev Attach 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 wh' •equires review and approvai of plans. SIGNATURE OF APPLICANT � PRINT NAME � * /� .�, , l,.,r.,-�y DATE � �" �- �� `� � .� � �q n � h' � �� : , � ., _ ; �._....� � _._. ; �_ .. .---. , ; :; � � �� 1, i � '� � �� :� 1 f `s��r•—^—d ,�. 'rs�'iC- '. .f� , . � --�� ' � `�� ; �� :i i .� @ ., ._ . _ . . .. .. __i-.,_------ - .._.. - �� ="1. � , �, � � I �, .-:~, . .'�'�� . 1) � �► � Al 6.. -, . . . ,�� Zoo.r�-/ jc � 7'�- !� �E N � , ,; �; � . � ..: .. �xlST� NG J � ; �g. � . � Ofi ' # C�]�t')�'Y �� . . , , , �. . . . L� � •... ...:.::'.': -.._.f ._._._ ! y ; ... � ,' . "� ,� , :,' ' T►��wO�,- w :i ; . �� . i __ _ f : - I- t"�LR 1�J .. rp� ��r- � i0/ / .'. 1 7f I �i � O .lZc� v � � � y� . _ , � �r _. : . �.r . ��....._ �__.�_� ...:T.� ___._ -_ �� L i v � �r �- i� o o � �� r� . �� I�t'� � �, � � .� �u� � � � i . � � �7� V- : .� . "�,; j L.l�...,�,� � � ,; ��i,ry — : : , � � i t s $ �� + = •� ; �Y, • ; { � �D Roc�M A� 2� � ; .,� ;' �,, - f ; .: . � t � � : . , . 5 , s ` ---- ---- __ __�. . � . .. ----_ _ . ..___ ��-.., . �__. . : ...... ..._.._.. __ , , 1... 1_... _ �:.._ ......_ ...... . . . t. ._ _.. .� ---- �. �i � � �-� ; � � ;; �, C' i ; !i r R.oA1T I�o�2t H '; f; � � �� : � j; � ... , : � . __ _ _..._.._..._______ ..._____ ....r._..._ . � . . :.._._.. .:_. ._. _._. _. . . _----____i_� � S . � __.�.�_r,_.. � _.—__.____..._.._-_...._.:.._.`...__.__..�..,__.._.».,_..._...... .- .--•.• __....... _�_ ....._._..._......,...� . .. .., .. ... . 36� . �"` � � 'YY� 1 N� C �Ts1 � �P.P , `�Q �.. � i/ / �I �T . � O Cl l� . 1 ��. r��nt�o -�, � � c�� Pu�,r�GE �. . LD� i�ispec��r � _��' �Ro1uT �oxcJ,/ -- �Qt�t i�Vi�� C ., � ��, . .., �„� ( 1.� �t U �^'� , �� c. h , -�a �v�� e_ 1...�-?�4� x� ,��, ��-. y4� t �` 4 � � � . : f %dv�� i � � .� � �M � � � f �� . _ �� : : 5 1 � )� t Y '.�. . . "�.\ �4 ,: . 4 .��.�.rt _. _.��:.�,.__...__._... :' .-'-'�'_::._._�.._._"'.�"€ � } i� ; , .. � �' f� � / � i . � f � 12 DoH !� L. S � �' 1 �" �nno� C� �.'�tZ� �v �-� ,� . S��iuc� �a� 2� �- � : '�GI1� T��..1 � � ��- - . �� 3t'7' (. � � . i � .__� - �_..`......_...._ �._......�"i' ..�.._..__... ..._ . . . ... ..... _ . .::ij t . . , 1 -'..K. >, . .,,. _.. � . . -..�........._�-.�!_....... ....:,� . ..... . . .. _ . . . .... �� Building Inspections 763-572-3604 DATE �� SITE ADDRESS � THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK: � PLUMBING RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS O OWNER ,P�ONTRACTOR NAME: ADDRESS: CITY, PHONE: NA1vTF• �� Lwl I �7 _ STATE LICENSE # �g PHONE �SINGLE FAMILY ❑ NEW DETAILED DESCRIPTION OF WORK :�rD�.✓a ��' %99� – � TWO FAMILY XP DATE I Z� O Permit No.. -1- cX� Received By: � _ Date Rec'd: 1,5 �� ATE ZIP E o v�' — Ir'Jf� �r3 o y CITY STATE ZIP F,,,X �%6 3'7 _i�`� SY e 7 �REPLACEMENT . . ❑ TOWNHOUSE � f �L� 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.OS = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.0 ER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOI� WATER PIPING � BATH SINK/LAV FLOOR DRAINS SHOWER — Wp��R SOFTNER ($35) f BATHTUB GAS PIPING �v�cirrt�Ce�usc) SWIMMING POOL —BACKFLOW PREV. ($15) 1 CLOTHES W ASHER � KITCHEN SINK � W ATER CLOSET _ � DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION WATER METER _ OTHER Permit Fee TOTAL DUE .50 Number of fixtures @ $10.00 Number of fixtures �a $15.00 Number of fixtures @ $35.00 THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED �x$10.00=$ x$15.00=$ x$35.00=$-�— State Surcharge = �' � Total ° $l,0 5C� 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 f 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 wor 'ch re ires review and approval of plans 3�`�� SIGNATURE OF APPLICANT �C�� PRINT NAME �� DATE � City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building Inspections 7.63-572-3604 DATE ,3 • / g • a SITE ADDRESS _�� THIS APPLICANT IS: PROPERTY � OWNER/ TENANT' CONTR�►CTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERNIIT TYPE TYPE OF WORK: �- MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS �l'/1 i�__. ��' n ` �OWNER DCONT'RACTOR l � ) �� >S: J ?— L S / � +L� z- ' / / Permit No.. � Received By:� DateRec'd: 3' �T-�' ATE�ZIP �� COMPANY NAt�: . CONTACT PERSON: EXP DA7'E STATE LICEt I5E # CITY STA7"E ZIP ADDRESS: PHONE FAX ❑ TWO FAMILY ❑ TOV+'NHOUSE 1l9�SINCsLE FAMILY , 0 ��r �REpLACEMENT ❑ ALTERA'!']ON/REMODEL DETAILED DESCRIPTION OF WORK PER MS 16B.665 the permit fee is a minimum of 515.� fX�e" x luding tt►a fixtures� (Ths shou d reflect orily thercost of labor ) improvement, installation or replacement of a res�dentl � x.05= Labor cost under $3 =$1 . 0 abor cost between $300 to $500 = cost of labor I�� pTAL FOR PROJECTS WHEKKE LABOR EXCEEDS 550�, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT W�� NOTEDS�� i� �}�ER OF EACH BELOW) �,G. '_ MODEL: 5�� Equipment Installcd . . �G; —_ MODEL: __— S¢�� G: MODEL: .�.— G� �GFJOVE1d 510.00 � �5 � _pIREFLACE (GAS) $15.00 =�V,r C„qS GRII,L 510.00 FIREPLACE (WOOD) 535.00 G� �T � $10.00 AIR TO AIR EXCHANGEER 513 —F�ACE $35.00 '—pppJ, �p� $35.00 _BOILER $35.00 '—G,qg DRYER 510.00 ��igy L1NER $10.00 —GAS PIPTNG 510.00 VENTII.,°�TOR 515.00 _ . _ . �� ,E.� :��--"",.�,...M;�:r--�1�ta'�'i' *�., a Permit Fee Surcharge 'TOTAL DUE ., �^ _ . � - �a•r:.�.;,m�:...... .._ _._._ . . �Ti -, �� ' :b .: � k:.e.,�..�t ia s....;hv.c ... Number of fixtures @ $10.00 / x $10.00 = $ --��—' � Number of fixtures @ $15.00 x $15.00 = $ _ $ Number of fixtures @ $25.00 x $25.00 = $ $ —°?�–'�� Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Tota1= $ THI3 IS AN APPLICATION FOR A PERMIT-NOT VALID UNTI1- PROCESSED that the work will be in I hereby apply for a building perm�t and I acknowledge that the information above is complete and accurate> �at I understand this is conformance with the ordinances and coae e��and1workFs�not o startivvithou a permit; that the work w'll be in accordance with the not a permit but only an apphcation for p approved plan in t1�e case �of all work which requires review and approval of plans. 3_ lg J 7 ' )/ �/f/C� _ I � ��-"!'''' DATE�_, SIGNATURE OF APPLiC� " �'P�T NAME a s � �- . ...., y .. " "� --�{�'�"' _ ._. , . - _ .. . . . �'aivi�`t'i�"�T1`�G3�'��t3��'� . ,�.i��..� :�;;:,,�.a��`�'x�'��n�ax City of Fridley Building Inspections Department . 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977