AF - 40683�.�
sus�ECT PE O.
City of Fridley �� 9 6 0 9 2�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
r
; � RECE .
� `y _ COMMUNITY DEVELOPMENT DIV. �
r � � PFiOTECTIVE INSPECTION SEC. ,�� �
i' i '
__--� � ���,,j CITY HALL FRIDLE� SS432 NUMBER REV. DATE PAGE OF APPROVED BV
z 612-571-3450 910-F15 4/1/81 / /
JOB ADDRESS gee Bela�a
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ]_-5 15 Innsbruck North Tawnhouse 6th Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Darrel A. Farr Development 4600 Lake Road, Robbinsdale 55422 536-9936
3 CONTRACTOR MAIL ADDRESS 21P PHOWE LICENSE NO.
Same
4 ARCHITECTORDESIGNER � MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAIL ADDRESS , ZIP pHONE LICENSE NO.
6 USE OF BUILDING
Gara es
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
%
8 OESCRIBE WORK
Construct a 50'8" x 22' Gara e Unit
9 CHANGE OF USE FROM TO
STIPULATIONS
Lot 1- 5496 East Srenner Pass N.E.
Lot 2- 5498 East Brenner Pass N.E.
Lot 3- 5492 East Brenner Pass N.E.
Lot 4- 5488 East Brenner Pass N.E.
Lot 5- 5494 East Brenner Pass N.E.
Provide one rokr of concrete blocks under bottom plates.
SEPARATE PERMITS ARE RE�UIRED 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 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED 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 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED $g �349. ZH $4. G7
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- $4�.65
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
. PLAN CHECK FEE TOTAL FEE
$49.35
SIGNATUREOFCONiRACTORORAUTHORI2EDAGENT IDATEI WHEN ROPERLY T THIS IS YOUR PERMIT
� �I
SIGNATUREOFOWNERIIfOWNERBUILDERI IDAJEI BLDG iNSP �ATE
C 1�f Y U1= (= IZ I))I_CY �..
• /�rt�L)ci�Tloi� r-ori Itcstl�t_r•1T1I1L Pu)I_Dit�l� f�[_(tr�1T� .
' (�'�L"4!, ALT�RAT1 U(J�, nl?UI710(JS, OIZ RL:('/il RS) ��
. . . . .
ow�irR: , .ux >>>t: � � � �
. . .
_
Addr.ess: �/GdD , ��,,�.,�. Address: . '
� a � �%J%K/ � Tcl. r2o. : ' ' .
l�o. : Street: . �. � � -�' .
J,oT- ' / - � ar,ocr.: /y'� ,ADDi��czor2: l� �`"� /�l���� �%��
- _ . - . . �%�zcl,r.l�t?z.,e.�s� �C..4-T �
CO}21�2.it L�JT: IIJSID� IAT: � S;�T33AC}:: ' SZDL'XARD.�'a: '
Rpl�licart attach "t-o t-his iorm ��� Certiiicatcs of Survey of Lot ar�d proposed .
bu�.lvir�g locatian drawn on these Cex'tificates. � •
� DESCRI PTIOI'd OF BUi LDI hG � �- � �
To 73� Used As: - . . �. . . . � . _ ,
. �_ _ Front: S(� � � �� Depih: ."a2 2�' Height: _ ' '
�. -. Sg,uare Feet:. Cubic Feet: - _
- - � -17ont: Depth:. — �� Height: ' •
. ;.
SquaLe I'eet: �. GUbic Feet: '
. . _ 9, :3� . � �
�ype o� Construction: �%� �/Llil'X-2J �t�ated Cost: S
•.lb I3e Com�leted: G�I����_ � ,; Alt. A. Alt. B
%
' Proposed Driveway �9idtii xf I�eia Opening Is Desired S � -
. - • (SEE 1'.�VERSE SIDE OF SHi:ET)
The undersigned hereL�� makes application for a permit for the �aork herein
speeificd, agreeing to do all �.or}: in strict ace�r_dance �aiih the City of .
Fridley Ordinances and rulings of tlie DC1�:11i::11Cllt oi �uildings, and hcreby �
declare� th�t all thc facts and rek�rescni:ations stated in L-his application
axe true znd correct. �See xeverse side iar acldiL-io»al ii�f-ormation.
. . �-
DATE: / SIGt�A'PUI:I:.
' �2r�ui0� � Q,� .dF 'L�c.P�_;� BLoc,�s u�D��2
Stipulations: ,dc�i�rl �Lq;� - .
. . � �.OT / �s SH9� `
� ��, �� �,n �T ' � i °? ° ��f98 � . . -
�.O � .3 r �l 9� _ .
c/ (0 7 �.�zca1��, L,o 7"�/ - ��88 . . • '
� �
� .s �/9•.3� �..o: �'_ ��� ; . -
� � .. �• _ .
sue�ecT P
City of Fridley � 16 0 9 5
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � RECE
• COMMUNITY DEVELOPMENT DIV. �' � �
� j L �'��_ , .
r � � PROTECTIVE INSPECTION SEC. � �
� i �
� /�'�1 � CITY HALL FRIDLEV 55432 NUMBER REV. OATE PAGE OF APPROVED BY
�----� � ,'� 612-571-3450 910-F15 4/T/81 � �
JOB ADDRESS 5496 Eas.t Brenner Pass N.�.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. $ 15 Innsbruck North. 7.bwnhouse 6th Addn. SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Darrel A. Farr Development 4600,L�.ke Road, Robbinsdale 55422 536-9936
3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO.
Same
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE , ❑ REMOVE
X
8 DESCRIBE WORK
COI1S'tri3C't clil �.8 � 3L 28 � TONii1�lO11S2 (_�kll't B.)
9 CHANGE qF USE FROM TO
STIPULATIONS p�.� ��1 must be i�o separate 1 hour w�.11s fro�n bottom to roof.
Firestop soff its. Provide combustion air to furnace �rom ont�ide.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REDUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK Ofi CONSTRUCTION ZONING 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. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ' AND EXAMINED THIS APPLICATION �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPUED $23, 56Q $�.1. %8
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- $•47. Sl $425. OO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
11.95 $496.54
SIGNATUREOFCONiRACTORORAUTNORIZEDAGENT s(DkTEI � WHE PROP LY ID T THIS IS YOUR PERMIT
�� ��
SIGNATUREOFOWNERIIFOWNERBUILDEF:� IDATEI BLDG �NSP �ATE
CI�fY 01= 1=1t1))LLY . � .
• /�f'f'LIC/►T1U1� f0(2 Itl:�Tl)(:1•�T1/1L PUII_Dll•!G f'C(tI�iITS .
' (�'�L"41, �1L1'Lfi/1Tl Ut�5, %�I�ll1T10IJ�, OR R�I'�1 RS) �
. . . .
ott�trre•� � x r,uir,u�;�t: ��t� � � -
)�dclr.css : �GOO �,,�(1 �•�-�� -- — . A�dres� : ' '
� , . � • r
`�%I�v • z'c�.. r2o. : ,S'36 — 993
1 . - � ...
�ao. .S�9G str��t: f�.� f ,��� -- — - ��� � - -
7,oT: � R�cY.: � /t •.ADDZ�rzori: �� -
CO}tl�L•'it L�J7': �. II�SID� IAT: �. � S;sT}3AG:c �_ SiDL•'YARDSs -
T— '
APplica'r,t attach �o this form ��� Certiiic�,tc� of Survey of Lot ar�d proposcd .
bui.lclirig location drawn on these CertiLicates. - - �
- . . . . :� - • - , -
. ' DESCRI PTI OI'd OF BUI LDI hG � � -�
_ . . -� - . � - -. - . - �
To 73c Used�s: . . � - - . . . .,
���� Fronti % g Depi.h: �'� ' Height: �,Q _ � _'
. • . . . Sguare Feet:. �%33Z Cubic Feet: � //, 9�d2 � .
"£xonts Depthz., . : ' Neight: .
Square Feet: � GUbic Feet: �
- � ' �� ���
Typ� o� Construction: �[%� �/t�l�� ° = �t�ated Cost: $��_
'�ib I3e Comnlei:ed: „ � � � � � . ; Alt. A . Alt_ B
. � C -
Proposed Drive�aay 1•;idth If Nei,r Opening Is Desired � __ $ __
. - • (SEE 12�VERSE SIDE OF SHEET)
The undersigned heYeLy makcs application for a permit �for the �aork herein
specificd, agreeing to do all �cor}: in strict acc��_dance �aith tl�e City of _
Fzivley Ordinances and ruliiigs of the Dcnari:aient oi ruildings, and hereby -
dec�ares that all thc facts and re��resen -Lzti�ns stated in t}Yis application
are true and correct. See reverse side iar aclditional . i.i�io�nation. l _
DJ1TE: _� /e �f � SIGt�Ai'URE:
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GEO�' SEDGWICK HTG. & AIR COND. CO. �� � � �; � � "�
HOUSE HEATING TEST RECORD .
�' �a
ADDRESS T _ . E`.r, r�m�� s.��e� �- "' �'3 �'�'° CITY � � ; �. �,.�v A��i �"''-
OCCUPANT � OWNER I°' �°=' �z � �; 'r�� �� �`'� �:� �� � �
HEAT LOSS�� DATE�TG. INST. .-
SOLD BY -- - �`''`'� �£4"� • � �`�° '�'�'�"`� INSTALLED BY �-°'' ` r? t � ,� '`��
Electrical Work By _ �� �'`� Gas Line By _ �`f� ' � -�' � ° = s. � ' �
TYPE OF HEAT GA_ FA �HW_ STEAM SPACE HTR. UNIT HTR. OTHER "
, GAS DESIGN - CONVERSION
MAKE � �'- °t-- �=� -�'' MAKE OF BURNER
Model ��a° �� �° �=� '' ° ' � Model
Seeial �"° ,� � ? �_� "�-� � `' '`� Max. BTU Rating -
INPUT �'' `a- �'-;`� `a-° MAKE OF FURNACE
Model
, CONTROLS
�,
THERI'JIOST�1,°T ��'� �" Hea�i Plug Vent Size. °'° ,
Valve _ � ,`' -�- � �'„ � � .-� � � ._ `�" ,'�''' �° -�IE`IND OF LINER - SIZE NONE
Limit _ ` '' - � = Draft Hood " �" �a � �_' Regulator_
Limit Setting � 1'`� ��9 Filters Size �� Number
Fan Setting ` ` ` ` �� '^'� � ' Chimney Location Inside- " Outside,
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Pilot fl9ake � n. , .- _ _
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SuB�ECi
City of Fridley 3108
AT TME TOP OF TME TW�NS g � I L D I N G P E R M I T
i ` RECEIPT NO:
• COMMUNITY OEVELOPMENT DIV. ud Io��
� j ti ��...�� �1
r � � PROTECTIVE INSPECTION SEC.
i .1 �
i•__•� ��'��,'� CITY MALL FRIOLE� SSIJ2 NUMBER pEV OATE . PAGE OF APVROVED B�
L 612-571-3a50 9�aF�5 6/27/00 � �
JOB ADORESS 5488,90,92,94,96,98 East Brenner Pass
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACFIED
oesca. 6-11 15 Innsbruck North Townhouses 6th Addition SMEET
2 PROPEi1TY OWNER MAIL ADORES$ 21P PMONE
Innsbruck Townhome Association 651-224-5482
3 CONTRACTOR MAIL ADORESS 21P PNONE LICENSE NO
Garlock-French Roofing Corp., 2301 E. 25th St., Mpls., NIN 55406 612-722-7129 00001423
4 ARCNITECT Op DESI(4NER MAIL AODRESS ZIP PFIONE LICENSE NO.
S ENGINEER
MAIL ADDRESS
21P
LICENSE NO
8 USE Of BUILDING
Residential
7 CwSSOFwOaK � N� O ADDITION � ALTERATION [� REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof Townhouse Bui
9 CNANOE OF USE FqOM
STIPULATIONS
Tear-Off )
TO
Underlayment must comply with the State Building Code.
��rmit Inapection Cards
Will �e Malsed
To Homeowner To Post
SEPARATE PERMITS ARE REOUIRED FOR ELECTfi1CAL, PIUMBING, HEATINCi,
VENTILATING OR Alp CONOITIONING
TMIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTFUCTION 20NIN(i
AUTMORIZEO IS NOT GOMMENCEO WITNIN 80 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONEO fOR A PEFi100 OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWl G. UNITS
�)
I HEREBY CEiiTIFY TNAT I MAVE READ ANO E%AMINEO THIS APPLICA710N
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAW$ yq�VAT10N
AND OflOiNANCES GOYERNING THIS TVPE OF WORK WILL BE COMPLIED �j31.00
WI7N WMETMEq SPECIFIEO HEpEIN Oti NOT. THE GRANTING OF A PERMIT �2,' �
OOES NOT CRESUME TO GIVE AUTMORITY TO VIOIATE OF CANCEL TNE pEpMIT fEE
PROVISIONS OF ANY OTMER STATE Op IOCAL LAW REGULATING coN• �349. ZS
STqUCTION OR TME PERfOflMANCE Of CONSTRUC710N
S�GN�TUAE OF �ON'aACTOA Op �UTMOp�ZEO �GENt �DATE�
SO.
OCCUPANCV�OAD
T.
OFFSTREET PANKING
S7ALLS GARAGES
SUtiTAII
$1U.80 ,
SAC CMARGE
Fire SC$21.63
T A� FEE
� 381.68
� ' �'-n�rrso- - - �� qar
sue.,ecT PEFIMI_LNO.
City of Fridley 3 3 0 4 2
AT THE TOP OF TME TW�NS g � I L D I N G P E R M I T
�
� ♦ .
� ��
COMMUNITY DEVELOPMENT DIV. ���
V PROTECTIVE INSPECTION SEC.
� � _�" ,
r ; -;
� . ,
� � �"'1 � CITY MALL FRIDLE� SSIJZ NUMBEN REV DATE PAGE Of APVROVEO BY
�'""� � �'' 763-571-3450 910-F15 9/4/02 / /
J09 ADDRESS 5496 East Brenner Pass NE
t IEGAL LOT NO. BIOCK TRACT OR ADDITION SEE ATTACMED
oescA. 8 15 Innsbruck North Townhouse 6 Addn SMEET
2 PROPERTY OWNER MAIL ADDRESS 2�P PHONE
William McArthur 5496 East Brenner Pass NE 574-0836
3 CONTRACTOR MAIL ADDRESS ZIP PMONE IICENSE NO
Her�del Construction 4997 Page Ave NE, Ro ers, MN 55374 763-428-7992 20192308
4 AqCMITECT OR �ESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDFiESS ZIP PHONE LICENSE NO
8 USE OF BUIIDING
Residential
7 CLASS OF WORK
O NEW O ADDITION 0 ALTERATION � REPAIR O MOVE O REMOVE
8 OESCRIBE WORK
Rebuild chase - add firestops to meet code - reside chase
9 CHAN(3E Of USE fROM TO
STIPULATIONS
Firestop as needed - floor/ceiling or 10 foot maximum.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIRED FOR EIECTRICA�, PLUMBING, HEATING.
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL ANO VOIO IF WORK OR CONSTRUCTION 20NING S�. FT CU FT
AUTHOR12ED IS NOT COMMENCED WITHIN 80 �A�S. OR IF CONSTRUCTION
ON WORK IS SUSPENOED OR ABANDONED fOii A PERIOD OF 120 OAYS AT
ANV TIME AF7ER WORK IS COMMENCED. NO OWLG. UNITS OfFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE REAO AND EXAMINED THIS APPLICATION 1 STA�LS GARAGES
AND KNOW TME SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS yA�UATION SUR7AX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMP�IEO
WITM WHE7HER SPECIFIEO HEREIN OF NOT. TNE GRANTING Of A PERMIT �3fSOO �1.75
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEqMIT fEE SAC CMARGE
PROVISIONS OF ANV OTNER STATE OR LOCAL LAW REGULATING CON- $97.25 Fire SC y�3.SO
STRUCTION OR T E PERfORMANCE OF CONSTNUCTION
PIAN CHECK fEE TOTAL F E
Licens SC $5.0 $ 7.50
SiGN4TUpEOFCON�AACTOpOpAU ORi2EDoGENi iDATE� WM PRO VALIDATED HIS IS VOUR PERMIT��
Lo- 9--�=0
S�GNnfuaE O� OWNEa�i� O�NNEp BU0.0EAi �DATE� OG �NSP � ���tE
NEw (J
ADON (j
�.�R Il
Construction Address:
Legal Description:
Owner Name 8 Address:
Contractor.
CITY OF FRIDLEY Eftective 1/12002
6431 Univer�ity Ave NE, Fridley, MN 55432 (763) 5T2�604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R 2
BUILDING PERMIT APPLICATION
`l6 `°' �r��•��
���
�
Te�. # �7'�� �g��
MN UCENSE # � f gv°�-3 ��
Address: ��� P-��r�1n� � t ��� ��.� �� Tel. # �3 °e-l�if�6'i 2
Attach to this appiicatian, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTiON OF IMPROVEMENT
Length Widttt - Height Sq. Ft
Length Width _ Height Sq. Ft
Length Width HgUGround Sq. Ft
Construction Type: � owv Estimated Cost $�� •��
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: ��� �� APPLICANT: � ��I Tel. # b I Z—'"( l� °'ll��
Call (763) 572�604 for Permit Fees if mailing in application or Fax to ?63-571-1287 if using credit card and we will
call you tor card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
�
$
$_.__,�..,�—
$ /. iS�'
$ _
$ _ vv
$
$
$�
$
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th°!o)
$.50/$1 �000 Valuation
$1200 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 [ ]
TOTAL $ ��%�Sd STIPULATIONS:
�i��'�� D�'� .� � n- C��Gi-.��
�-� l!`j ' /yt•QaC
�
BUII.DING PERNIIT FEE SCAEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing build.ing or structure,
upvn application therefore, require the payment by the applicant for such permit of fees to the amount herein
below set forth and in the ma.nner herein provided to-wit:
TOTAL VALUE
� 1 to $500
S�O1 to $?,000
52,001 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
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000 �
$69.25 for first $2,000 plus � 14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
�$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCRDW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - Driveway width plus 6 feet�imes $17.00.
VERIFICATION OF FOUNDATION
Permits for consiruction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be
required before proceeding with the framing. New Houses Onlv
s
w
�
�
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE l ' L '
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
INSURANCE
i
❑ OWNER
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDF
r {�aS✓ �
TOR
; V l,i�'
�. �Ye� hP.�P
Permit No.• b `
Received By:
Da��id�EP �
NAME: �V Y 0.11� �rp � I U w+l� �rvo
STATE LICENSE #� ID O�O �� ��j EXP DATE
STATE BOND # EXP DATE
PHONE `l� / `
PERMIT TYPE ��GLE FAMILY
TYPE OF WORK: � NE�'s'
❑ TWO FAMILY
�REPLACEMENT
FAX
❑ TOWNHOUSE
DETAILED DESCRIPTION OF W ORK 1�`.�� � I�D Q Q�, f� Ci S�U 0�� I r�R. Q�'/r
A
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 = plus .50 surcharge
OR
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOV�. MINIMUM FEE $15.50.
BATH SINK/LAV _FLOOR DRAINS SHOWER WATER PIPING
_ BATHTUB _ GAS PIPING (NEED CITY LIC) SWIMNIING POOL WATER SOFTTTER ($35)
_ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
_ DISHWASHER _ LAUNDRY TRAY �WATER HEATER ($35) FOR IRRTGATION
_ WATER METER _ OTiIER
Permit Fee $ a�5� .� Number of fixtures @$10.00
Surcharge Number of fixtures @ $15.00
TOTAL DUE $ . 5� Number of fixtures @$35.00
.50
$1
OR
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
x $10.00 = $
x $15.00 = $
x$35.00=$
State Surcharge = $ .50
$15.50) Tota1= $
I hereby apply for a plumbing 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 applica ' for a permit and work is not to start without a permit on site; that the work will be in accordance
with the appmved plan in the e f all work w' requires view and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME �/ �C. ,''n iC5 �..� DATE -�`tJ
APPROVED BY
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
DATE