AF - 40664sue�ecr PE O.
City of Fridley 16 9 0 4
' ` AT THE TOP OF THE TWINS g U I L D I N G P E R. M I T �E�PT N�
�
� ; L ____ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. � a�
�
i . �
1
� � r"'1 � CITY HALL FRIDLEY 55432 NUMBER REV OATE PAGE OF APPROVED BY
�'----� • •`� 612-571-3450 910-F15 12/22/82
� �
JOB ADDRESS 5463 E�st Brenner Pass N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 3 Innsbruck North. Townhouse Plat 6 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Da.rrel A. Farr Development Corp. 4600 Lake Road, Robbinsdale, NIl�i 55422 536-9936
3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
RES1Cleri't].d.�.
7 CLASS OF WORK
O� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Oonstruc t an 18' x 2 8' Townhouse Uni t("D" �
9 CHANGE OP USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. TATOOCI FidlCie
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR 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 CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVEFNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �`3%�GSO yS`ZS.S3
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 O TH ' PERFORMANCE OF CONSTRUCTION. y5`229.00 $4iS.00
r � y PLAN CHECKFEE TOTALFEE
i � iC <�-d�
SIGNATUR OFCON RACTORORAUTHORIZEDAGENT � �onre� -= WHE PROPERLY T �� S YpUR PERMIT
����� ��---
SIGNATURE OF OWNER IIF OWNER BUILOERI IDATEI BLDG INSP �l.TE
� . , � , . ., - •- -�
APPLICATIOiJ FOR RES1DEt1TIAL BUILDIi�G PER��iITS
CItEW, ALTERATIONS, ADDITIONS, OR REPAIRS) . .
. Oh?7ER: DARREL A. FARR DEVELOPMENT CORP. BUILDER:• S�
Address� 4600 LAKE ROAD" Address: �•
R B ,
� - Tel. No_: 536-9936
No.:" 5463 - Street: East Brenner Pass
. .
L�T: 2 BI�OCK: 3 ADDITION: 6th
CORNER LOT: � INSIDE IAT: x S::TBACK: SIDEYARDS:
Applicant attach to this form Zt,�o Certificates of Survey of Lot and proposed
building Iocation drawn on these Certificates.
. - -. . -
. � . ..
� - DESCRI PTION OF BUI LDI NG �.
To Be Used As: M - _ uDn . ' � ' .- -
' � - � - . - . .
� HO Front: 1$ Depth: 28� Height: 28 '
. � Square Feet: 1440 Cubic Feets �' '
.' -
Front: Depth: � Height:
. Square Feet: Clabic Feet:� .
• Type of Construction: WOOD FRAME Estimated Cost: $ 32, 250 �� ��a •
� • . • - _ .
-4b Be Completed: APRIL 1983 ' � �
• /Alt_ A � Alt. B
Proposed Driveway �aidth If New Opening Is Desired � $� $ ' '
� � _ . . (SEE REVER.,E SIDE OF SHEET) .
The unaersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley �Ord?nances and rulings of the Departme�t of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct_ See reverse side for additional information_
DATE: ( /� f� L SIGNATURE:
Stipulations: . � '
� ���,o� � .' ' �
! & •&� ix - - -
����v� - - - - " --
� ���•�� _ - " � -
sus�ecT PERMIT
City of Fridley 17 3 6 4
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ' .
r
� � RECEIPT NO.
� ; L ______ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. /n�
�
� i , -�
� /��'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BV
�""'"� � ,�� 612-571-3450 910-F15 1/17/84 / /
JOB ADDRESS 5465 East Brenner Pass� N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. lO 3 Innsbruck North 'lbwnhouse Plat F) SHEET
2 PROPERTYOWNER MAIIADDRESS ZIP PHONE
Darrel P,. Farr Development Oorp. 4600 Lake �td. Mpls.., N.¢�i 55422 536-9936
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
S amne
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRE5S ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential To�tnhouse Ga�age
7 CLASS OF WORK
❑ NEW ❑ ADDITION 0 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
x
8 DESCRIBE WORK
Cons truc t a. 10 � x 22' Gara e
8 CHANGE qF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. Wi�OCI Fl"3iRe
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT ZZO ZZOO
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTFEET PARKING
I HEREBY CERTIFY THAT I HAVE fiEAD AND EXAMINED 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 2 349. GO $�-.�-7
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- 3H . SO
STNUCTION OR TH PERFORMANCE OF CONSTRUCTION. �
_ � n PLAN CHECK FEE TOTAL FEE
� %'O $3�a67
SIGNATUREOF TRACTORORAUTHORIZEDAGENT IDATEI WHEN PROPERLY IDATED THIS IS YOUR PERMIT
w
� �
SIGNATURE OF OWNER IIF OWNEF BUILDERi IDATEI BLDG iNSP � E
Effer�iv� Aug, l, 1�61
�l��Y �T �it1��CY '
tirfLg�n7ICX� FOrt ��S1DL��71P.� �U)LDI�:G PLf���1TS ,
((�c�►•�, i11 Ler�tion�, �dditions. �r Rc�airs)
�Ftf�ER: Darrel A. Farr ��v� elopment Corp. •�UIL�ER: SAME
�1DJRESS: 4600 Lake Rd. Mpls., MN 55422 �iD�ZCSS:
'�EL ��; 536-9936 i�l I�O:
r
�onst�vction LocatiDn
STRITT A70: 5465 �`��-�T� Faat RrannPr PaGc
3,07': 10 �IA�C: 3 33DAIT�Oai: 6th
Corncr I.ot: Insic3c %ts . �etba�ck: Sideyards:
Ap, licv�t attach t.o this �or�n �b Certificates of Stizvcy of lot and
p_opo:,ed buil�ling locatioe� elra:+n on ccrtificates �o scale.
DESCRIPTiO�� OF eO;tST��JCTTON
Garage Fz�nt: 10 �pth: 22 �ieight: 20
Squarc �'��: C�abac Fcet:
Front: �epth: lieight:
Square Fe�t: C�bic Teet:
:��pe of Co .�tructien: Wood Frame Estfmated Cost: S 1.80�_
aD Bc Cbr.:plcted: ^ Ma� 1 q��
AIt. A �lt. �
�ropos�d Drivc+�ray i;idth If New Opening 'as De;Siged: $ S
. . Si� PiVF.R;L' SIDi OF S1)F.�T ,
1i��► unclersaoned 1�ereb�� m�l:e� �Pplic�ticn �or a p^rr_3t ic: the �ork he-ein sp�cified,
agreein3 to cb ,all bork ira strict accozdsnce arith the Ci�y of I'sidle�• Ordi��ances eiid
rulin�� of tlie Del�.�rt�nc��t of Dui:clinrs. and h�cby decl�res �hat all �)�e fact� and
re�resc�G�tiens s�a�ed :.n �his applic�tion are �rue �nd sosarsct.
D: �z: 1- 13-�y sic�t�7vrs: ,��� � �
dtil�ulatacns:
v 3 r r
sue�ccr PE ,
City of Fridley 310 8 6
�
AT TME TOP OF TNE TWINS � 6 U I L D I N G P E R M i T
� � RE E PT NO.
� `y ����� � COMMUNITY OEVELOPMENT OIV.
r � � PNOTECTIVE INSPECTION SEC. �• �
� _
l-_-- = �'��,', CITV NALL fRIOLEV ��3i NUMBiN pEV DATE � PAGE O� AVPROVEO BY -
L J\ 612-571-34b0 gt0-F15 6/27/00 � �
JOB_ADORESS
5457 59 61 63 65 67 East Brenner Pass
t LEGAI �OT NO. BLOCK TRACT OR ADDITION SEE ATTACMED
oescA. 1-6 3 Innsbruck North Townhouse Plat E) S►iEET
t PROPERTY OWNER MAIL AODRES$ 21P PNONE
Innsbruck Townhome Association 651-224-5482
J CONTRACTOR MAII AODRESS 21P PMONE LICENSE NO
Garlock-French Roofing, 2301 E. 25th St. Mpls., NW 55406 612-722-7129 00001423
� ARCMITECT OR OESIGNER MAIL AOORE33 ZIP PNONE LICENSE NO.
5 ENGINEER MAIL ADORESS 21P PHONE LICENSE NO
8 USE OF BUILDINQ
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION C� REPAIR p MOVE O REMOVE
8 DESCRIBE WORK
Reroof Building (Townhouse) (TearOf�
9 CNANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
Permit InsR � : � ! : � a �? Car��
� wttr ��� .l��o�i��a
To Homeo���; � � � r� �',� Post
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBIfdG, MEATINa, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY �pAO
VENTILATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NUII AND VOIO IF WOFiK OR CONSTRUCTION ZONING SO. FT CU FT.
AUTHORIZEO IS NOT COMMENCEO WITNIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONEO FOR A PER100 Of 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. N0. D1NLG. UNITS OFFSTREET PARKING
b
1 MEREBY CERTIfY TNAT I HAVE READ AND EXAMINEO THIS APPLICATION STA�4S GAiiAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAW$ yqLUAT10N SUIiTAX
ANO ORDINANCES GOVERNING THIS TYPE OF WOqK WI�L BE COMPUED
WITM WHE7MER SPECIfIED HEiiE1N Oti NOT. TNE GRANTING OF A PERMIT y�ZI.,631.00 a��.O. HO
DOES NOT PqESUME TO GIVE AUTMORITV TO VIOIATE OR CANCEL TME pERMIT fEE SAC CMARGE
PROVISIONS Of ANY OTMER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OF TME PERFORMANCE Of CONSTRUCTION $349.25 Fire .SC .�21.63
PLAN CNECK FEE TOTA� FE
$38 .68
S�GN�TUpEO�CON•AACTOAONAU�MOp�2ED�GENi iD�rE, EN OPER IOA7ED T IS YOUp PEpMtT
�� ' . .L� _ViI
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COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION '
When replacinq an existina furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required.
The venting system is plastic/PVC and meets ail current codes and manufacturer
specifications including sizing, length, number of elbows and termination.
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
Yes � No ( )
Yes � No ( )
Yes � No ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturers specifications. _ _ Yes � No O
UVhen required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications. Yes (�( No ()
When installina a new ventina svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes � No ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes � No ()
Apaliance Tvae and Size/Common Vent and Vent Connector Infonnation
i
Appliance #1 Type v,�(' ( BTU Input Sc2� Fan Assisted or Nat _1�
Appliance #2 Type (, �,�LVs�� �,(�,r BTU Input _�'� Fan Assisted or Nat .,,c��
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input o CYY�
Common Vent Type Vent Height Diameter _ inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
�
r�
ii L.G
HEATING CO: u� C
Signed By: � Date : �`�% —"' � l
_
_
C[lYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
March 29, 2002
Mr. Scott Roettger
5465 East Brenner Pass NE
Fridley, MN 55432
Re: Final Inspection at 5465 East Brenner Pass NE
Contractor: River City Sheet Meta1
Dear Mr. Roettger:
A mechanical permit was issued on April 9, 2001 to install a furnace at your address.
According to the 1991 Uniform Mechanical Code a final inspection shall be conduct� on
the work authorized by this pernut. As of this date the inspection has not been requested.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. We will keep your pernut open for another 30 days and if we do
not hear from you within this time to set up the inspection, we will mark the permit "no
inspection called for by homeowner after notification" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Sincerely,
DJ/mh
CITY OF FRIDLEY
6431 IJNIVERSITY AVENUE NE
FRIDLEY, MN 55432
57Z-36U4 1+'AX:
ADDRESS : 5465 E BRENNER PASS NE
PIN : 243024440205
LEGAL DESC : INNSBRUCK NO T H PLAT 6
: LOT 6 BLOCK 3
E.�71� ��►�:�ll
PERMIT NO.: 2004-01452
DATE LSSUED: 09/Ol/2004
PERMIT TYPE : ELECTRICAL
PROPERTY TYPE : TOWNHOUSES
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL SAVERS SWITCH.
# INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
ST PAUL, NIN 55114-
OWNER
RENEE LEVESQUE
5465 E BRENNER PASS NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
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 ordina.nces goveming this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of a.ny other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date
ELEC PERMIT FEE - NIIN (RESn
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 117431
��raxAi�r�tuvui�x��uuc�lirux wuxKVinr;x itiaN li��c;x��1�.�t3c�v�.
20.00
0.50
20.50
���w�� IV� LVV/ IL� IL���� ,v� ������) •��v� vVIL IVi"VJVVV v�w��.v��v�rvvv •r.��.dv� ��� ��v� JIV/
$uaXdlrig
�riSp�C�I011S
763-572-3604
���-�az-4977 FAX
nn�ra �J � 'Z�
SITE ADDRESS �
Tl�S A]'pY.CCANT I9:
I'1tOPERTY
UOVN�R/
m�xArrr
PLUM�ING
�ESID�IYTYAY. APPLYCATIUI�
CITY C1F ��I,EY
EFFECTIVE 2-1409
YOU�t. E-MATT. ADri1tPSS
�1WNER GfCONTRACTQR
_ �.rrs_��3o
Aermit No,;
nate
� L
C011iTAACT101t NAMB: -_
SUBMIT A COPY OF srars �sca�xsB � g}�p ppTg
Y(�UR STATB
T,TC�13�, $OI�1'b AND STA7'B BO%(1] {! EXP DATE
C�itTYFYCA'Y'� OF ADDRESS: CY1°'tt' 9TA,T� Z1P
INSURANCL p�O1VB
FAX
1'�12MYT TYPE
�rr� oF woRx�
❑ SINI(31.E FAMILY
O NEW
(] 1�V0 FAMII.Y ,�.T�WNHOUSE
�YjAC�1�N'T
DETAIL$DDBSCRIPTrONt��"@V'O�C f�.c�av�. n Id i,.�a,�-e✓ k�,�' nK r`�S�t,� 1
�
C��S AYt� �AS�A OIQ $10.00 PER FD(TLTRE, EXCEPT OVfiERENOTED. FIXTUClES: (�IDTCArfi TOTAL MYIV�BR OF BAC� BBl`.OVI�. M�IMUM T�BE
�5.50.
BATH 3IIdIULAV FLOOi! ])�2ATN'S 9HOWSR WATER PlPINQ
�►T�� GAS PIPING {NEFD CITY LIC) SWIIVII�TO POOL WATER SQFr1V'BCi {$35)
,_ CiOr�T�+S V'i'A3iikR _ KITCI�NN SINI{ WATER CLOSE7' � BACTK�i4W i'�`U'. ($15j
_ DI9HR►A3HER _ LAUNDR'Y'1RA'Y �'A�`EYt. Y�BA��BIt ($35) FOR IRRIQAT101�i
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'4, Y�.
�of•�fxtur�s (a� $10.00 x $10.00'd
• '�p� �
�g C��is.oa x sis.00 = s ����� S :_ .: . .
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Num6er of fi�ture� (a� $�5.00 : it �35.00 ° rp LL t{ � ,
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LTM �35:50 : � �'otal =•�^ ° �� ��:' . � _ :. �;. . �� o
TFIIS IS AN APPYxCA1'TON FO� A riBT�T 3q'pT'V'AT.Yb �J�P171. PRO�E55ED
I bereby apply for a plumbing permit and Y aoknowledge thaC tho informatian abo�re is comptete and accurate; that the work will be in
confonmence wlth ihe ordinances and codes ofthe City �fFridley and wath the 3VI'uinasota Construction Codes; that Y understand this is
not a, permit but o�ly an applicatPon for a parmit and work is not to start without a permit on site; that the �vor� will ba in accordance
wlth the appaoved plan in the c�ase of all�vork whiah requires re�view and appro�val of plans. , ,
$T(}�A'i'U1tB OF APPLICANT
City af Fridley
�uirding Ynspectioas Ae�►�trttnent
6431 i�niversity Avenus N'E, Fridl�y, MN 55432
763-572-3604
FA�: 763-502-4977
I;��l�
��
Building
Inspections
763-572-36U4
763-502-49?7 FAX
SITE ADpRFSS _,�
TFIIS APPI JCANT 1S:
owN�' �
TEIYANT
From: unknown Page: 2/2 Date: 8/4/2009 5:34:27 PM
MECHANICAL p�rn,�t No.: � o
ENTIAL APPLI�ATION R�"'ea �':�=
RESID
CITY OF FRIDLEY nat� �
gFpL+CI'!VE 2-]9•09
__ YOUR U�9L�IL ADDR&SS , I r��
❑ OWNSR
CON1'liA(:ICJK COMPANYNAMB: ,• • —
CONTACT PERSON � S eV�►P1��
SUBMIT A COPY OF 1� �p �.�.�
YOUR STATE STATE UCBNSC�
LICENSE W1TFi ADURESS. � CITY STA
APP'I..ICATIf)N p���'',, �p7� � ^
PERMIT'L'YPG
TYPE O� WORK: �❑ N�
DET
FAMILY � TWO FAMILY D TOWNHQUSE
o ni.Tew►�orv�ou�.
1�ES ARE BASED ON $lU.QO PER FIXTURE, EXCEP'C WHERE N�1'ED. FIX7'URE3: (iNDICATE TO'CAL iVUMREltS ��� BEL�V1�}
Fqtiipment Inalal{ed MFCi: MODEL:
MFG: �.+.._
MODEL: SIZFIBTU
MODEI. SIZFJB'I'11
MFQ: OAS RANdF/OVEIY 510.00
AtC S7S.M FIREPiACE (GAS) SI3.00 EW GRS aRlLL $1 �.00
AIRTO /�LR EXCHANOSER $15 ,_._��P�C� ��p� ��•� � �� �� $10.00
BOILPdt Y3S,00 FURNACE $3S.Q0 � _pppl. HEATER $35.00
CHfMNLY LTNER $lO.Qb QAS DRYFR $10,00 VEIdTILATUR $i 5.00
�pUCT WOItK$10.00 GAS PTPiN(i$IO.OQ
Number of fixtursa (a� $ i O.Op x $l O.Op = � _ _ _ . .�
Nwribsr of fixtures Q�'15A0 ,,,� g$75.b0 �$
N'umber of tiRwres (a� $Z5.00 x $25.00 — $�,-_._-
Number oiiu�tures @ �35.00 � x $�5.00 = $�.�
S`tate Surchargo = ��. �
INIMUM FEE S33.SQ Total = � . •,� �•
TIiIS IS AiV APPLICATIOAI FOR A PERMIT-NOT VALID UNI'IL PROCESSL�D
I hereby apply for a building permit e►nd I ecknowledge that the information abave is complete and accurate; that the work will be in
conformance with the d ces and codes of the City of Fridley and with the Minnesota Construction Codes; that I understend this is
not a parmit but anly n app 'cation for a perrnit nd work is nat to start without a permit; that the work will be in accordance with the
approved pisn in the c e of I wqr�c which r�sr �view d�oval of p�ans. n ,p n ��
A . e �\ 1�. n� 1 I I/ :Sl,�. /� 1/ 1"1 `Y�i
S(GNA'1'UURB OF
V City of Fridley
Baildiug Inspections Dep�rtment
6431 University Avenue NE, Fridiey, MN SS432
763-572-3604 FAX:763-502-4977
Building
Inspections
763-572-3604
S1TE ADDRES3
THIS APPLICANf IS:
PROPERTY
owxEiv
TENANT
CONTRACTOR
� PLUMBING
RESIDEI�TTIAL A.PPLICATION
CI'I'Y OF FRIDLEY
��
O OWNER �CONTRACTOR
Permit
�- -, :
11 � ! wr ai
,��._ �._ ,
SUBMIT A COPY OF STATE LICENSE # x � i r� v-r �v� � DATE 10'� �►' 1 V
YOUR STATE ADDRESS: a��n n...a.� o� CTT� STATE ZIP
LICENSE W1TH PHONE Ea�n, MN 5�$ '
• TTT T/� A TiA1T
PERMIT TYPE
�rE oF wo�:
I�SINGLE FAMII,Y
o rrEw
DETAII..ID DESCRIPTTON OF WORK
� TWO FAMII Y � TOWNHOUSE
. q� xErr,,�c�mv�r
�
PIIt MS 16B.665 the pe�it fa is a minimum of $15.00 or 5% of the total cost np to $500.00, whichever is g�ter, for tb
improvemen� inrstallation or replacemeirt of a nesidP�l fiamu�e, excluding the fix�s. ( This shonld reflect oniy the cost of
Iabor cost under $300 =$15.00. I,abor cast between $300 to $500 = cost of la't�r x.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500. FEES ARE BASED ON $10.00 PER FIXT[JRE, EXCEPT WHERE NOTED. FIXTURE3: (INDI�
NUMBER OF EACH BELOR�
BATH SINK/LAV ' FLOOR DRAINS � 3HOWER � _ WATER PIPING
BATATUB GAS PIPING (NB� caYl.�v�) SWII+�A'�TQ POOL _ WATER 30F1N]
CIATf�S WASHER ffiTCHEN SINK WATER CLOSET _ BACKFLOW PR
DISHWASHER LAUNDRY TRAY �WATER HEATER ($3� FOR IRRIGATI(
— ' WATER METER _ OTI�R
PEKIVZTT FEE PROJECI S FOR T7NDER $5� r�tuvL.i rr.� rvn r�v�y:••• i ��
Pemut Fee $ ov ' Number of fixhues @$10.00 x$10.00 =;
S ,gp Number of fixdmes @$15.00 x$15.00 =;
TOTAL DUE $�_.�O Numbsr of fixtu�es @$35.00 x$35.00 =�
State Smrcharge =
Tota1='
THIS IS AN APPLICAITON FOR A PERMIT NOT VALID UNTII. PROCESSED
�
SS
TOTAL
($35)
. ($IS)
I��Y �PP1Y for a building pe�ut and I acknowledge that the i�ormation above is complete and accutate; that th,e wo will he in
co�ormance with the ordinances and codes of the City of Fridlep and with the M'innesota Constiuction Codes; that I this is
not a permit but only an application for a permit and work is not to stazt without a pe� that the work will be i.n acco with the
approv� plan in the case of all work ch 'ew and approval of plans.
� . � _ � _ __ r �/1n .,. ��. / I _ I l� I /l
SIGNATURE OF APPLICANT
PLEASE ATOTE:
City of Fridley
� Bnildi�ng Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
t� � v. ^�G� cn� A(1^l'f
�