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AF - 40769City of Fridlep, Minn. 6431 Univeraity Ave. N. E., Miuneapolis, Minn. 5b432 BUILDING PERMIT D$�; May 25, 1972 Owner: Viewcon Inc ��r Same ,A�.� 5901 Brooklgm B1vd. Ad�� Same �i�� 1461 No. 5557 �� 4 Coraer Lot LOCATION OF BUILDING Street East Oberlin Circle past of Lot . Block 8 �_._...._ Addition or Sub-Divis�ton Innsbruck North Townhouses lst Inside Lot Setback Sideyard Sewer IIevation _ Foundation IIevation ..-_— To be Used as: Townhouse ,Garage Type of Construction DESCRIPTION OF BUILdING FSront 20 � nentt� 31' Height Z� � sq, Ft, 1, 240 ��..� 12, 400 Front ..�,� Depth 2..�._.__ Height l�._ Sq. F� 3Q�_ Cu. Ft. �.-Q80 Wood Frame �.� �� 19,102.44 To be Complet�ed 12/1/72 Stipulations: 1. They will see that fire protection is provided to the coastruction area, water is available through the hydrants and good access provided to the construction site. 2. It is the responsibility of Suburban Engineering and Viewcon to see that the grade elevations of the units is satisfactory to connect to the utilities. 3. Occupancy of these unite will not be made until all utilitea have been checked and approved by the City. In con�tderation of the issuance to me oP a permit to construct the building described above I agree tp do � proposed work in accordance with the description above set forth and in compliance with provisions of Ordinances of the city of Fridley. � y �, ,/ ate In caaasideration of the payment of a fee of $� .��., permit is hereby granted t�+ Viewcon, Inc . to construct the building or addil�on as described above. This permit is granted ugon the express condition that the person to whom it is granted and his agents, employees and worl�en, 3a aII work done in, around and upon said building, or any part thereof, shall conform in all respects •to the orc�inaaces of Fridley, Minnesota regarding location, construction, alteration, ma.intenance, regair and movfng of bwtldintgB vyithin the dty limits and this permit may be revoked at any time upon violatioa of any of the provlsions oE 8aid ordinances. . P NCE BELISLE RIOTICE: 9'his permit does aat eover the wnstruelion, inataUstlon for wfrieg, plvmbEne. eas 6eaties, �x►ar or water. Be u� fo �s t6s Buildiae lespae�or fo� aeparate permits for fheae itee�a. � .� - � " � APPLICATION FOR RESIDENTIAL, ALTERATION, OR AllDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER' S NAME • N t11/ BUILDER:�� 4^ ADDRESS• � ADDRESS• NO:. �� STREETt 1�� IV I�� .�: LOT : BL�K: � ADDITION : I � � CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: "_"�,...�'° Applicant attach to thia form �tao Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION UF BUILDING To Be Used As: ` t � /7� rJp'J,,2Q , Front: � Depth: Height: ' Square Feet : �o7yQ Cubic Feet : /a'/�O O m / , �CJ,S ; �cf Front : � e Dep'th : � fi' Height : � 1,,,/ � . Square Feet ; �O � Cubic Feet : ��c� C9 , Type of Cons truction : �.(�O�p ��/} �'i•?�l D Estimated Cos t: $/��/Oo!• '`i`� F To Be Completed: The undersigned hereby makes applicativn for a permit for the work herein specified, agreeing to do all work in st�ict accordance with the City of Fridley Ordina.nces and rulings of the Department of Buildings, and k�exeby declares that all the facts and representations stated in this application are true and correct. DATE : I � S IGNAT[1RE : • (See Reverse Side For Additiona.l Informa.tion.) .�1 °�9�� ' � �S y �S,S , � _ _ _. t ` BUILDING PERMIT FE� SCHEDULE SECTION 2. The Inspector of Buildings shall, before issuing permits for ��e erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repaigs to any �xisting building or structure, upon application therefore, require �h� p�}�n�� =�c. applicant for such permit of fees to the amoung h�xein below �e� �� r�?�. the manner herein provided to-wit: iJNiFORM BUILDING CODE: 7.j►pe 1, 2& 4-$2.15 for each one thousas�d cubic �eeg, or fraction thereof, in such cubical contentso �rpe 3& 5�$le�� for ��,�h oxae thous�.nd cubic feet. ADDITIONAL INFORMATION For the purpose of computing fees for building pertnits, the cubical content� of any building or addition, is determined by multiplying the ground area covered from a point six (6) inches below the floor lina of the basemf�nt o� the cellar to the avex�.g� hei�hts of the upper surface or to ttae avera.ge height of the roof surface of the main gable of a pitch�d rovf. For repairs or alteratiuns to 3n e�;icting st�ucture, the fee shall be ai: the rate of $3.00 per each five hundred dollaxs ($500.00) or fraction thereof in the cost of all proposed work. In no case shall the fee charged for any permit as set forth in Section 2 be less than $5.00. VERIFICATION OF FOUNDAI'ION NOTE: Pertnits for construction 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 Certifiad Survey of the lot, showing the location of the foundation, once it has been constructed, will be required before uroceedint� with the framing. CERTIFICATE OF OCCUPANCY Application for a Certificate of Occupancy shall be ma.de 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 ox accup�ed until a Certificate of Occupancy has been issued. � � ' i' ' a � , � � �;; 1 .� � � � � 1 � r` � 1 i r� (-7 l 17 i ``� �S o !" �� 1 �` f. 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I � � i eri � �a a g g �'�, $ � M � � r� � � � � q � �O � a a � °� � xN �� m O w 0 O A � � � �, x � �a � x � � N M �� w �i � z � �! � � s M0 w � � � � � � I � 8 � � � W � o `" � o �� mW �� s `" � � ' 0 � a 0 � � � x � � � paC � � Wr �' J � � � U F � a � � � F ' � 4 w .i► w g � g � 8 �C !d 10 � p o� �e �ii � � : � : � . � � $� � � �.. � � �� s ? n"�y � R A �xM�� <� aa � � � > � � � � N � w �� a � � � �� o � � � � � o� � w � i � .� � � � �) w � ce � � J cm � � � n � � � > 0 1 a at � t i W � SUBJECT City of Fridley AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r � � i �• COMMUNITY DEVELOPMENT DIV. �' PROTECTIVE INSPECTION SEC. � _�� r � " ; � . , � = i�'•1 � CITY HALL FRIDLEY 55432 NUMBER �"-'� � ,'� 612-571-3450 910-Ft5 JOB ADDRESS 5557 East Oberlin Circle NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION DESCR. /�, g Innsbruck Nc 2 PROPERTY OWNER MAIL ADDRESS 3 CONTRACTOR MAIIADDRESS Dicks Fire & Storm 864- 19 Ave SE._ 4 ARCHITECT OR DESIGNER MAII ADDRESS 5 ENGINEER MAIL ADDRESS 8 USE OF BUILDING Residential REV OATE 5/18/94 7 CLASS OF WORK � NEw ❑ ADDITION ❑ ALTERATION � REPAIR 8 DESCRIBE WORK Reroof House & Garage (Tear-off); Install gutters 9 CHANGE OF USE FROM ro PAGE OF i i PHONE 781- PNONE PHONE PERMyL�4A-�_ � 22535 A � APPROVED BY SEE ATTACHEO SHEET LICENSE NO. I 2481 LICENSE NO. LICENSE NO. ❑ MOVE ❑ FiEMOVE STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF COI SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING AUTHORIZED IS NOT COMMENCED WITHIN 80 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. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION 1 AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF IAWS VALUATION AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT � 1� S9O DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. _�F3.�OO SIGNATURE OF CON i RACTOR OR AUTHORIZED AGENT IDATEI --- --��-----.....�.......,.�.��oo��unco� �DATE� .. )CCUPANCY(3ROUP 50. FT. OPFS STALLS OCCUPANCYLOAD CU. FT. f PARKING GARAGES FEE _ iL� IS YOUR PERMIT �� NEW � I ADDN ( � CITY OF FRIDLEY ALTER ( � SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Con.structionAddress: 5557 - East Oberlin. Circle Legal Descriptic�n: Owner Name & Address: Tel. # Effective 1 / 1 /94 CUntraCtOi: Dicks Fire and Storm MNLICENSE# 2481 Adc�'ess: 864 - 19th Ave. S.E., Mpls., Mn. 55414 Tel. # 781-6170 Attach to this application, a Certificate of Survey of the Lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq• F�- DECK AREA: L,ength Width Hgt/Ground Sq. Ft. OTHER: Remove and replace roofing on garage. Install t�utters. Remove and replace roofing on house. ��a� Corner Lot [] Inside Lot () Ft. Yd Setback Side Yard Setbacks Type O� COIISt[uCtiUa: R o o f i n g/ g u t t e r s FStlmSted COSt: $-` 1, 8 9 0. 0 0 Approx. Completion Date: � (Cost on Back) Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _� DATE: 5� 1�94� APPLICANT: Dicks Fire and Storm Tel. # 781-6170 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY $ �,3Ft�� Fee Schedule on Reverse Side $ - � � .OQ1 of Permit Valuation (1110th%) $ ' � �{� _ $.501$1,000 Valuation $ $800 per SAC Uait �' $ �P �� $5.00 (State Licensed Residential Co�ract�ors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determin� by Engineering $ _ Agreement N�y [ l N� Ne��e�uy [ l $ /..�` - �-, BUILDING PERMIT FEE SCHEDULE The Chief Building Official shalt, before issuing permits for the erection of any building or structure, or for any addition to any existing building or stxucture, or for any alteration or repair to any existing building or stn.iclure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set fotth and in the manner herein provided to-wit: TOTAL VALUE $1 � t0 $$00 $501 to $2,000 $2,001 to $25,000 FEES 0 $15 (Minimum Fee is $ i5 plus surcharge) $15 for fiist $S00 plus $2 for eacfi additional $100 or fraction thereof, to and inciuding $2,OOU � .$45 for fiist $Z,000 plus $9 for each additioaal $1;000 _ or fraction thereof, to and including $25,000 $25;001 to $50,000 - $252 for first $25,000 pi�s $6.50 for each additional $1;000 - or fraction th�eof, to. and including $50,0(?0 $50,001 to $100,000 $414.50 for fir� $SO,OOU plas $4.50 for each additional � .$1,Q00 or fraction thereof, to aad including $lOD,000 � � . $100,001 to $500,000 $fi39.50 for fnst �$100,000 plus- $3.50 for each additional� - ° $i,000 or fractioa �eof, to and including -$500,000 $500,001 to $1,000,000- $1,QOU,001 and up $2039.50 for the first $SOO,OOp plus $3 for each additionai $1,OU0 or fraction thereof, to and including $1,OQO,OOU $3539.SQ for the first $1,000,000 plus $2 for each additional $1,000 or fradioa tfiereof - DRIVEWAY DEPRESSION ESCROW (Coacrete (�rb Streets On1Y) Altemaf.e "A": Removal and re�lacement of curb and guf�ea� only - Driveway width plus 6 feet times $13.5Q Alternate "B" : Removal and replacement of curb and gut�� and install a 3 foot wide . approach with 6 inch depth - Driveway width plus 6 feet times $15 _ 75.. VERIFICATiON OF FOUNDATION Permits for conshuction wiil l� issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the coash�uction site_ A Certificate of Sucvey of the lot, showing the la�6on of the foundation once it has it has been constructed witl be required before proceediag with the framing. � � � � � � 0 � U � w C, � C� � � W > C'� � � (;�j �� z � ,d � W � � d � �� W U � � � � �` OZ O � � � a W $ � �+ � � O U a z� � �� Q '� lp � a �:: � t� ��C� (a � a ``+� �T�c� U � ci � n� . �Y/ . ., `� � � � � c � 1 � .� � � , . � .�� Y V � `o�,� a.� � m � �=� L �r— � s r� �. 4� L �' � �r .�c � (� w ;, . �.� �� . .., v � �Q o � � a �a'S � ,p �a � � �' �' o �� _ � U .Y � � � S�' O N E � � � .G�O = �o�,� , �� w�c � � � � � c—`n � � "f C � v> � � � �y � S� � � �-- � � m � °'-�' N � � � � n z � � � � w � . / a% � �> e°4 1]/ � � � � � � � U � p !St W � � � D � �- C�.� m w ,.= �a � �� m� � �- � Tt� Q t�t1 r� � t].i O N � � � y � N � ' � ti � � m � � a 4� � i 8 � Ca II. I-° _ � _ � � a � � C �� c m � � � z z �` � � 4 C� � � � m � � z�= o� am a � � � �. O �t- ' �s � � � � � � m � o � '`�°, c�i, v � C! O O � b9r tf3 � 69 fli � C � CD � � � Y 3 b � � c ' �� o �.,_ ��. G3 u" u'- m ,. � � � � _ � e � � � Z � � Q� S � ,� � a �.�a�. � � ti � � C� Uq m � '� ;�l � Q `'' � � v� � - �, c p R! }' p; � � � v� �+ � _ e�a a .� � �. Q °� � � B � �� ; 9 a a3 �- 'a . Q. d C m = a� m �. ? � ;� �' '�� ..,, .. �' � � ,�o-, � O. O � :r O C� E �° � ! � P� � N c� � �� s � � � � � � � � . r�lrtil�'d u�=ti Z�� Z9 ;�.��f�:I::�� l7 1,1I� 4 ?� � i� � � O � � c � � � � � � Y � d � � � � ri. � O � � � d � m �� t Z� , �i �^ �h t�c. � Y F� o d � � j U o� �a � � _ a° � �3 W u.. d r W � Z w � o' t ,� a i � � � � o N �� O m � � G C!. C � � �� c c � '� Ln o Q N . � o � U m �� Z�:>•'[ abGS-�Z-Jfld HUU-2�-1'3'�b 1 S: i2 �:� I T''r' � �F F�' i ULE'r �� ` L ��1� . � The �iersigned here�y veri��s that th� ex�istin� chi�rYSy or stack: � 1. 2. 3. 4. 5. c. �Ias been c.axefitll� �kamined. Is fr� fram n�st ar deterioratio� Ha.s no foreiga objects Iodged withis Is secur��y support�d 1V�ee#s aIl eurr,reent Code ��quir�ments �pr si�e and totai k3�'U's connected b1� �71 1c87 P,tj2/47< Yes-�} riio ( ) Yes `� Na ( ) Y�s `� No ( } Xes�)Na{) Yes � Nu { ) b �Ias tot�il �eating BTU's of _� � • ,�„ All othex $TU's . U C� � TOTA,L BTU's ► � ,�', n � �j 7: TTas a liner becn provided for water heate�r e��6a�'�� Yes (: j No {) 8. Has combusixon air been gravi�i�d fc,z water h�t�z Yes � lYo { j Remarks: e� � � C`��C �. List .A, RA�`ION'S Being an�• HEATT�G CO: Sigae� By: e Date: � TOTAL P.02 sue�Ltf �. �� c;ty of F��a�ey 31039 - S `�� AT THE TOP OF TME TW�NS g � I L D I N G P E R M I T RE O. � ; L �� COMMUNITY DEVEIOPMENT OIV. � � � r � � PROTEGTIVE INSPECTION SEC. � . . � _ �"'1 � CITY MALL FRIOLEr 53192 NuMBEp nEV O�TE p�GE O� APVnOVEO 6r �'""� � �'' 612-571-34b0 9t0-FtS 6/8/00 / / �oe �ooaess ! ' East -� 'S549 53 5Z',61,65 69 Oberlin Circle t IEGA�,• �OT N0. BLOCK TAACT OR ADOITION .. SEE ATTACNED OESCR:-, 1-6 8 Innsbruck North Townhouses lst SFIEET 2 PFOPEtiTY OWNER MAIL AOORES$ , ZIP PMONE Inaisbruck Townhome Association 651-224-5482 9 CONTRACTOR MAIL ADORESS 21P VNONE IICENSE NO Garlock-French Roofin Co 2301 E. 25th St. . ls. NIN 55406 612-722-7129 � ARCMITECT OR DESIGNER MAII AOORESS ZiP PMONE LICENSE NO. • OU001423 S EN(iINEER MAIL AODRESS 21P PFIONE LICENSE NO 8 USE OF BUILOINd J `�Residential � 7 •. CLASS OF WORK '' O NEW ❑ ADOITION O ALTERATION � REPAIR O MOVE ❑ REMOVE ` 8 DESCRIBE WORK Reroof Building 9,, CNANOE OF U8E f ROM TO STIPULATIONS �. 5 . Underlayment must comply with the State Buil.ding Code. � ,..s�', .. .,. rr, �, ��;-,�: SEPARATE PERMITS ARE'f1E0UIRED FOR ELECTRICAL, PLUMBING,'MEATING, TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAO VENTILATING Oii AIR CONDITIONING. .TMIS PERMIT BECOMES NUII AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU fT AUTMOR12E0 IS NOT COMMENCEO WITNIN 80 DAYS, OR IF CONSTRUCTION • 01t WORK IS SUSPENOED OA ABANDONEO fOR A PERIOD OF 120 DAYS AT ANY TIME AFTEq`WORK IS COMMENCED. NO DW4G. UNITS OffSTREET PARKING I HEREBY CERTIFY TNAT 1 MAVE READ ANO El(AMINEO TMIS APPLICATION 6 57ALLS GARAGES AND KNOW TME SAME 70 9E TiiUE AND COqiiECT. A�L PROVISIONS Of LAW$ VALUATION SURTAX AND ORDINANCES' GOVERNING THIS TYPE OF WORK WIIL 8E COMPLIED ,�11 7O4 %1 .�rJ . SS WITN WNETMER SPECIFIEO HEREIN Oii NOT. TNE GRANTING OF A PERMIT > > OOES NOT VRESUME TO aIVE AUTMORITY TO VtOlA7E OR CANCEL TME pEpM�T FEE SAC CNAiiGE PROVISIONS OF ANY OTMER STATE Oii LOCAL LAW REGUTATING CON• d�2O9. ZS Fire SC .�11.. %O SfRUCTION OR THE PERFOflMANCE Of CONSTRUC710N W P�AN CNECK fEE TOTA� FEE $ a6.so S4.N�TUpEO�CON•�1ACTOpOp�UfMOp�iEO�GENT �O�tE� N ROPE A110 T TMIS IS Y UF PERMIT A � �� f S� N�TUAEO�OWNEp��OWNEpBU�LOENi �D��E� BL �NSo ppti Su9JECT City of Fridley 3 i 5 6 AT TNE TOP OF TME TW�NS g U I L D I N G P E R M I T � RECEIPT NO. � �• COMMUNITY DEVELOPMENT OIV. �� j V ��.��'� r � � PROTECTIVE INSPECTION SEC. � : �•"1 � CITY MALL FRIOLE� SS�J2 NYMBEN pEV O�TE P�GE OR AnvqOVFO Br �� '' 612-57 �-3ab0 e�aF� s 11 / 14/00 / / IOBADDRESS 5549, 5553, 5557, 5561, 5565,.5569 East Oberlin Circle NE t LECiAL �OT NO. BLOCK TpACT OR ADOITION SEE ATTACMED oescR. 1-6 8 Innsbruck North Townhouses lst SFIEET 2 PROPERTY OWNEfi MAIL ADDRES$ Z�P PMONE Innsbruck North Townhomes 3 CONTiiACTOR MAIL ADDRESS Z�P PMONE LICENSE NO Columbus Exteriors Inc 2131 111 Lane NW, Coon Rapids, MN 55433 763-757-7530 4 ARCMITECT OR DESIGNER MAIL ADDRE83 ZIP PMONE LICENSE NO. 3 ENGINEER MAII ADDRESS tIP PMONE LICENSE NO 8 USE OF BUILDINO 6 Unit Townhouse Building 7 CLA3S OF WORK O NEW O ADOITION ❑ ALTERATION � REPAIR O MOVE D REMOVE B DESCRIBE WORK Reside Building; Install trim 9 CNANdE Of USE FROM TO e STIPULATIONS Per Section 1402, 1997 Uniform Buiiding Code, requires that a weather resistive barrier be placed over exterior sheathing to protect the interior wall cover�ng. Exceptions for this provisior. would be if sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in their application guidelines. Call for inspection of wrap before covering. SEPARATE PERMITS AqE iiEOUIRED FOii ELECTRICAL, PLUMBING. MEATINO. �PE OF CONST. OCCUPANCY (iROUP OCCUPANCY LOAO VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL ANO VOIO IF WORK Ofl CONSTRUCTION 20NIN13 SO. fT CU fT. AUTMORIIED IS NOT COMMENCEO WITMIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDEO OR ABANDONEO FOFI A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING I MEREBV CERTIFV TMAT I MAVE REAO AND EXAMINED TMIS APPLICATION 6 S7A�LS GAFIAGES AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yp�UATION SUFTAX AND OROINANCES GOVERNING THIS TYPE OF WORK WIIL BE COMPLIED WITM WMETMER SPECIf1ED HEREiN OR NOT. TME GRANTING Of A pERMIT �3H� LE)% �I9.OS DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEI THE pERM1T fEE SAC CMAFGE PROVISIONS OP ANY OTMER STATE OR LOCAL LAW REGULATIN(3 CON- ST CTION Op NE PERfOiiMANCE Of CONSTRUCTION $532.65 Fire .5�.' �38.16 PLAN CMECK FEE OTAL FEE �� %�� $589.89 S�GNA E O� CON:A ?Op 0�i AUTMOaiIED �GEN1 �D�TE� N P P LY V I TED TNIS IS VOUF PER IT � �f�/�y�l� � S�GN��UpE O� OWNEp�� OWNEpBwtOEa� iDATE� �ps ��`Tt Building pI,UMBING Permit No.� ' � Inspections RESIDENTIAL APPLICATION Received . 763-572-3604 CITY� OF FRIDLEY Da�� DATE � YOUR E-MAIL ADDRESS SITE ADDRESS f �1 THIS APPLICANT IS: ❑ OWNER J�CONTRACTOR PROPERTY NpME; �w�� D� : � CITY STA � a �N� PHO�: a�.� - o��— CONTRACTOR N,�; ° SUBMIT A COPY OF STATE LICENSE # EXP DATE — _, YOUR STATE ADDRESS: � � CITY 1 STATE�IP '�J �7.��7 LICENSE WITH PHONE ��j c� ��..,°7.�j' '�.7 I� F C ' • � APPLICATION PERNIIT TYPE ��GLE FANID.Y ❑ TWO FANIILY O TOWNFiOUSE TYPE OF WORK: � ��''' ��PI'p'�� DETAILED DESCRIPTION OF WORK ' PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the to�ial cost up to �SOO.OQ, wluchever 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.U0. Labor cost between $300 to $500 = cost of labor x.OS = FOR PROJECTS WI�RE LABOTt EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FDCCURES: (INDICATE TOTAL NUMBER OF EACH BELOV� BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING (n�o crtrtrc�s� SWIDRvdNO POOL WATER SOFCNER ($35) CLOTHES WASHER KTfCHQJ SINK WATER CLOSET BACKFLOW PREV. ($15) DISHWASI�R _ LAUNDRY TRAY ,LWATER HEATER ($3� FOR IRRIGATIOAT WATER METER OTi�R .,.. a. . . . ,� �. . � �� _ � 5;.:.t" .�yxt i �`�a�� kr;� � `�,' 9�.,'� , �` ;s4� , s a��h �'�,�'"F t�� ':E' �.. Permit Fee $ . C�� Nuxnber of fixtures @$10.00 nx $10.00�= $ Surchar e .50 Number of fixtures @$15.00 x$15.00 =$ TOTAL DUE $�.� Number of fixtures @$35.00 x$35.00 =$ State Surcharge = $ .50 Tota1= $ TFIIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a build'usg permit and I aclrnowledge 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 ork which requires review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME ��,�� I( 7 1�ATE �O �''� � e � ��. '` ' .� r i '�' � z �� "�� ``�, � ��`� ,� ��' :� City of Fridley Building Inspections Depa.rtment 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Klir