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AF - 40817r_, a � �,,Z t � � � :_�:_� .�.uL°--E�n� "�� ti"„�'A'za �� r,�»�`°�'�� ' � �� e:��°� � � s�'�" �.�- ^� �`'� ,��. � ,� ��°° �`�"`� �� C�� : „BM � , �- �� ' �' �' Vnl1S e of �iti�e l�nn. * ��s�:� i �: „� � y� N° 331 1��= , �1 L: 1' '. �'�I'. 1 O�� of IN�P��O� QDF ��DYNGS �'! .�� ' ��fo; �'� ''",..° ,�it y� f ��'. B ��'�� ;;' � � �$ fi �� ' �'��k.� :�.�`,�,�. Owuer "` g '6� ��+-� - ,+c � � " r Axchitect � FrldIey, 1Vlinv.. `'' `�:�° ��_� 19� �>.z � Buiider �'�r°`�'i»'A;.� �al� � �� . �cA�`oF Bvar� G �:. � . ,� �_: 3 �� ; � `� 9 '? � N0. �,.m >a" Street �`" ° ' `�`"�� `°� �"�"`�` �`t Part Of Lot � - k. �:� _�� Lot � .�- Slock Addition or Sub-Division "�"`" � D�'�d;�IPTI01`eT O� ��TIIdl�T1�TG � �' � � �°�"'�r Front `�,..,_ -Depth ��° Height� Stories .` 142aaner oP Conetruction ( I' `��'��`�'�`h��, � �. r � � �.3 ' _ - � " ' � .� .�F ; �c �4.�' Estimated Cost '� � To be used as �"- �¢: To be �ompleted `"" �� ' * g .__ .9 o b : � �+�: �. _ . ra_. �� t �.. t -' , l�°i ?i _ �na , . , s � ,ar. .. t_... "�,�''r.� ,.,. . . n 4 5 � +ae; Permit is hereby granted to '``�� '�;�'"�� ' � f � '' «�� ''� to ��`'�°�° Y ° �''- �r'� $ d ' �F ' . the buildin ; e_ �_ �` ��,:�„"%�' describ : r the abova statement. This permit is granted upon the expreas coadition the p son to w it is granted, and his a.geats, employees and worl�en, in all the work done in, arovnd and upon said building, or any part thereoP, ehall conPorm in a11 respects to the ordi- nancea oP Fridley, Mian., regarding the construciion, alteration, maintenance, repair a,nd moving of bwtldinga within the city limitss, and this permit may be reeoked at any time upon vi ation �. any of the provisions of said ordinances. �'., , � ,. ti � *� � ��r � "�"°��epectar of Buildings. AGI�„EEMET@TT A1VD SWOgt,1V �TA�/�EI�T In consideration of the issue a,nd delieery to �.e b� the �.pector o� Euui��din�;� of I+'ridlev of the' above germ.it, I hereby agree to do the pro�osed �ork �n a�cordamc$ �i�h tb.e d.escription above set forth and accordiag to the provisions of �he ord.in�.ances af F�idley, and, beix�.g first duly sworn, I hereby state and say that the facts atatecl by me and conta,iaed in t�.e abo�*e per�it a,�e true as thex�eein stated. � v,��---- mP�?:.� - Subscribed and sworn to before me at Friclley, Min�ne�ota,, �;�is �� da,y pf :� ' �- � t`..��« -.�:� A _D. 19� � �- � -�`-�� $ � �'-�"� �'`�� ,,.. ;�►, \* / � sue�ECT P . City of Fridley 17 6 8 9 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � r ; � RE . • COMMUNITY DEVELOPMENT DIV. ; �,:- - - /ya3� r � � PROTECTIVE INSPECTION SEC. 1 i � � �'��l � CITY HALL FRIDLEY SS432 NUMBER REV. DATE PAGE OF APPROVED BV �----� • •�� 612-571-3450 910-F15 8/27/84 � � JOB ADDRESS 6266 East Ri.ver Road N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. pdrCH], t�3 � j.jU,C1. ,,S'll�]. �23 SHEET 2 PROPERTY OWNER MAIL ADDRESS 21P PHONE Peter DiCarlo 6266 East Ri.ver Road N.E. 571-2959 3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO. Wandrei Constructi.on Co. 95 Suzanne Avenue. Vadaais Hei hts 483-6766 4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS 21P PHONE LICENSENO. 8 USE OF BUILDING Residenti.al 7 CLASS OF WORK ❑ NEW � ADDITION C� ALTERATION ❑ REPAIR ❑ MOVE � REMOVE 8 DESCRIBE WORK Reroof Dwelling/Gexage 9 CHANGE QF USE FROM TO STIPULATIONS Roo� can be 2nd layer but not 3rd. Install ridged galvanized valleys. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, 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 OAYS, 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 1 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S3 � OOO S�-• 5O 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- 3S.SO ST CTION OR THE PERFORMANCE OF CONSTRUCTION. $ PLAN CHECK FEE TOTAL FEE � ' �,,�� $40.00 GNATUREOFCONTRAC� RORAUTMORIZEDAGENT IDATEI � WHEN PROPER�Lj�(ALIDATE THIS IS YOUR PERMIT � �� '� .4�i�� ,�1 �� SIGNATURE OF OWNER tIF OWNER BUILDERi �DATEI BLOG iNSP �pT I�EW [ ] ADDN. [ � �,T�tt. I ] City of Fridley �R-1 ABD R-2 . Building Permit Applioation Construction Addresa:� � L �� ' � "` Effective 4/1/84 Legal Description: Owner Name & Address . � � �' ��''° �°-s� �' G' � �'p �°-'' �' --T Tel . # � � % °�� . ^ �� Tel. � �$3 -6 7�G Coatraetor: �!� � � � �� L°e q B . /1 P . - _. . _ Address: LI9IflG AREA: QARAGE AItEA: DECS AREA: OTSER: Attach to this application, a Certificate of Survey of the lot, With the proposed construction draWn on it to scale. DESCRIPTIOA OF IMPaOYEl�N'r Lengtti _ Yidth Height _ S9. Ft. _ Length Yidth Height Sq. Ft. _— Length __ Width _ _ ` � Hgt/Ground'�r�Sq. Ft. ______— � Corner Lot [] Inside Lot [] Ft. Yd. Setbaek Side Yard Setback _ d� Type of Construction: Estimated Cost: � �� Approx. Completion Date: " - Alt. A Alt B proposed DriveWay Width If New Opening Is Desired: See Back Page for Explanation � Te�. � �83--�'7GG DATE: � "� �-g�� APPLICANT: I J� Permit Fee Plan Check State Surcharge 3AC Charge Park Fee SBVer Nain Charge TOTAL STIPULATIONS: CIT7f QSE OALY � �G .5.� Fee Schedule on Reverse Side � _ 25x of Building Permit Fee � /. S.� �.5o/a�,000 vaivation � �u25 per SAC Unit ' � Fee Determined by Engineeriag � � �� Agreement Necessary [ ] Not Necessary [ � � �� U � BIIn.DING PBRI�IT FEE 3Ci�DIILB The Cbief Building Official ahall, before issuing permits for the erection of any building or structure, or Por any additioa to any euisting building or structure, or for any alteration or repair to any existing building or atructure, upon application therefore, require the payment by the applicant for auch permit of fees to the amount herein belora aet forth and ia the manner hereia provided to-xit: Total Yaluation :�.00 to a5oo.o0 �50,.0o to a2,000.00 Peea � 4 �10.00 (Minimum Fee is a15.00) �10.00 for the first �500 plua �1.50 for each additional �100 or fraction thereof, to and ineTuding �2,000. a2�001.00 to �25,000.00 �32.50 for the firat a2�000 plua �6.00 for each additional �1�000 or fraetion thereof, to and including a25,000. a25�001.00 to a50,000.00 �170.50 for the first additional �1�000 or including �50,000. a25,000 plus ��1.50 for each fraction thereof, to and E50,001.00 to a100,000.00 ;283.00 for the first �50,000 plus �3.00 for each additional �1,000 or Praction thereof� to and including a100,000. �100�001.00 and up �433.00 for the first �100,000 plus �2.50 for each additional �1�000 or fraction thereof. DRIYEiIAY DEPRBSSION ESCRO�i (Concrete Curb S�reets Only) Alternate "A": Removal and replaeement of curb and gutter only - DriveWay �aidth plus 6 feet times �13.50 Alternate "B"; Removal and replaeement of curb and gutter and install a 3 foot wide approach With 6 inch depth - DriveWay Width plus 6 feet times a15.75 YTsRIFICATIOA OF FOIIpDATION Permits for construction Will be issued a minimum of 24 6ours from the time of application to al1oW for proper reviex 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 been aonstructed Will be required before proeeeding with the freming. vs ' � 4 � �� _ .._, SuBJECT City of Fridley AT THE TOP OF TME TWINS g � I L D i N G P E R M I T � � � COMMUNITY DEVELOPMENT DIV. � PROTECTIVE INSPECTION SEC. � ` _ � "' r ; " "; � � �""1 � CITY HALL FRIOLE� 55432 NUMBER �""� � ,�� 612-571-3460 910-F15 JOB ADDRESS 6266 East River Road t LEGAL LOT NO. BLOCK TRACT OR ADDITION oescR. Par. 4300 Aud. Sub. �i�' 2 PfiOPEfiTY OWNER MAIL ADORESS Peter Diearlo 3 CONTRACTOR MAIL ADDRESS Walker Roofing 2701 36th Ave S Mv G� 4 ARCHITECT OR DESIGNER MAIL ADORESS 5 ENGINEER MAIL ADORESS 8 USE OF BUILDING Residential REV DATE PAGE OF 8/26/98 / / 27426 RE T NO. �%dJ ' ' � AVPROVED B� SEE ATTACHEO SNEET ZIP PHONE IICENSE NO. 422� ZIP PHONE LICENSE NO. 21P PHONE LICENSE NO 7 CLASS OF WORK CI NEW � ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WOfiK Reroof house and l�arage Tear-off 9 CHAN(iE OF USE FROM ro STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF COI SEPARATE PERMITS ARE REOUIREO fOH ELECTRICAL. PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NUIL AND VOID IF WORK OR CONSTRUCTION ZONING AUTHORIZED IS NOT COMMENCED WITHIN 80 DAVS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. I NEREBY CERTIFV TNAT I HAVE READ AND EXAMINEO THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALl PROVISIONS OF LAWS VALUATION ANO ORDINANCES GOVEF;NING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIE� HEFEIN OR NOT. THE GRANTING OF A PERMIT 283 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OFi CANCEL THE pEqM1T FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR TNE PERFORMANCE Of CONSTRUCTION. OCCUPANCY STAILS OCCUPANCrLOAD CU.FT. ET PARKING IGARAGES SIGNATURE OF CONTRACTOR OR AUTMORIZED AGENT IDATEI EN OP L VALID E TMIS I��OU�ERM �� ..r.ueniocnrnwuco�icnwNFiifilllL�ER1 IDATEi 8� �NSP __ OpTE NEW [ ] ADDN ` [ } as ALTER [ ] ConstructionAddress: �G Legal Description: Owner Name & Address: Contractor: � Address:p��j� —'� LIVING AREA: GARAGE AREA: DECK AREA: OTHER: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R=;1 AND R-2 BUILDING PERMIT APPLICATION Effective 1/1/98 Tel. # �� — �� MN LICENSE # �o�c�� C'--_ Tel.'#� � � ' � � Attach to this application, a Certificate of Survey of the lot, with the proposed construction dra�vn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width HgdGround Sq. Ft. Construction Type: ��Q.)+( ��ICL Estimated Cost: $ ��'`� ` � (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x S =$ , . � " APPLICANT: � Tel. # � DATE. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE Oi�TLY $� •� Fee Schedule on Reverse Side $ �g .001 of Permit Valuation (1/lOth%) $ �,� $.50/$1,000 Valuation $ $1000 per SAC Unit $� ,Q $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 [ ] �� Building Inspections 763-572-3604 DATE � SITE ADDRESS _ THIS APPLICANT IS: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLE�_ _ 3 � �� PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION � . YOUR E-MAIL D �dJ�.�- � �ONTRACTOR � 1 �. P� P�.. � � _ � d �.sa, dL tv,�tv�: ' ��SS �. STATE LICENS�E # Z`�� ADDRESS: J 3 � puntvF � �.s"'a �,�., �� PROPERTY TYPE ��GLE FAI� ❑ TWO FAMIIJ Pernut No.: �r �`�,� °� Received By: Date Rec'd: ��EXPDATE 3.�� ( �� 1 /j�- �—°� CITy STA �- Fax �•'1'1 .�� — PERMIT TYPE ��DITION ❑ GARAGF/SHEll u wuv�w� ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER 0 SWIMIVIDVG PC�L TYPE OF WORK: DESCRIBE WORK BEING SIZE OF IlvIPROVEMENT LENGTH HEIGHT � Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES 0 HOUSE 8c GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 2, proX'p Se�.d floor plan PROPOSED STZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, p v�y� ❑Soffit ADDTTIONS & PORCHES SUBMIT: � Aluminum ❑ Trim 1. Site Plan/Survey showing the e�cisting structures ❑ p�� ❑ Fascia and proposed project 2. Two sets of construction plens WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES 8c TYPE OF WINDOW TO BE INSTALLED NUMBER OF WiNDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIAL5: (USIN THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $�� `� OCCUPANCY TYPE Permit Fee Plan Review Surcharge Fire Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Chatge Total Due $ oQ� See Back Page for Fee Schedule $ 65% of Building Permit Fee $ (.0005) times the total job valuation — Minimum $.50 $ „ �� .001 x Permit Valuation (1/10%) $ . $5.00 (State Licensed Residenrial Contractors) $ $1450 per SAC Unit (Plans to MWCC for determination) $ ft+6fi= ftx$20=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering R �� Agreement necessary () Non Necessary () Make checks navable to: City of Fridley Attach S IS AN APPLICATION FOR A PERMIT-NOT VALID UNTII, PROCESSED I hereby apply for a buil ' g pe 't and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ord' ances and codes of the City of Fridley and with the Minnesota Construcrion Codes; that I understand this is not a permit but only an appli 'on 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 w rk hich requires review and approval plans. ��' SIGNATURE OF APPLIC � I�� OP � PRINT NAME �� DATE �� J Page 2- Building Residential Application BUILDING PERMIT FEE SCHEDULE 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 building or structure, upon application therefore, require the payment by the applicant for such pemut of fees to the amount herein below set forth and in the manner herei.n provided to-wit: p ' VERIFICATION OF FOUNDATION Pemuts for constructioa will be issued a minimum of 24 hours from the time of application to allow for proper review of proposed structure and of the conshuction site. A Certificate of Survey of the lot, showing the location of the existing foundation will be required hefore proceeding with the framing. New Houses Onlv City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 FROM :City of Fridley Bvilding Insp�ctio��s 7V�� I //�3604 � � � SITE ADDR�SS THiS MPLIC.qNT tS; �'ROT'ERTY p W1�.ER/ TENANT CO1�ITRACTUR SUE3MIT A CAPY QF YOUR STA.TF LICENSE WITH APPLlCAT10N P�iZMTi 'TI'P� TXPE QF WORK: � �C� FAX N0. :7635711287 Dec. �►rT..un��vi� �ESIDEIV'i`YAIr APPLIC�TION CITY �F FR�DIL�Y ,� � -� Yo« � c,�- 0 OWN�R �CONTftA NAM�: ��- `�_ 1 � AUDRESS: � s7 v� it� �- NHOAIIE:,,, ' 1--�— -•-„� N.p.ME: STAT'E LdCENS6 # AUDRESS:_�� % . �1 PI30NE � � i '° �Gl di FANRLY �� ❑ NEW pETAILED D�S(;RIPTION OF WORK ❑ TWO FANBLY �� 20 2005 12:49PM P2 P �� Permit No.: � Receivec� By: ,_ Date Rec' � Z . ;PI'Y .. � ST1tiTE 1 �1 .-ZTP�� ._..._.__�..- fiXP DA'I� ItEPLACEWIEtdI' a �rUwNr�oUS� A�r� r�� pER MS ] 6$.fi65 the pormit fee is a menfmum of $15.00 or 5% of the tota) cc�t ap to $K00.00, whicbever is greater, for r.he iimprovemcnt, irestallation or reglacement of a residential fixtz�ze, exe}uding the fn�tures. ('Tb.is should reilcset onty the cost of Iabor ) Labor cost under $3aU �$15.00. Labor cwst betweer, $30U to $5� ° cost of labar „^ _ x.US = FQR PROJL�TS Wi�RE l.A}�4R EXCEIDS $540, irEES ARE �ASEU ON � 10.00 PER FIXTURF-, EXC�PT WI�RE NOT�b. MXTLJRFS; (INDiCATE TUTAL NL7M�'N_R QP �ACFi BELOR� Wp-I.'Lft l+IFlNG 33ATfi SDdK/LAV FLOORDRArNS —SHUW}�R � WATER 50FI`NFR ($35� � AATH'1'1113 (iAS P)Y'IN(3 (a�xo cmu�xl�'SE) _ SWIA9vIINd POOL -'. BACKiTAW Plt��. (S15) CLOTFff•S WASHER KTfCFIEA! S1TiiC WATER Q,OS�°C' — ��1SHWASI�R _ I.AUI��URY TRAY ' WA7ER HGAT�R ($35i !'OR IFtR1GAT10'fI — FVATER 3vtE7'EFi _ OTfiFR Pcrmit �'ee TOTAL Number of fixtures @$1 R.00 x$14.00 =$ � Numbes o�fixt�cs a7 $15.00 x �15.OU = $_,_„_,,. Number of f�actures Q�3S.U0 � x$35.00 �� $ State Surcharge = $ .50 'rotal � $ TF{IS IS AN APPLICATION FC3R A PERMIT NOT VALID UN'fiL PROC�SSED i hareby apply f.or a building permit and I ac�owledgc fhat the iztforrnaiaon above is eomplete and accurate; that tbe work will be in conforniance with the ordinances and aodes of the City of �'ddley nnd with the Minnesota Consttvction Codes; that I undersumd this is not a perm�t but only an 'cation for a permit and wor ' not to start without a permit; tlaat the worl: wiil be in aecordance witi� the apPmved plsn in tho cas of wprk which � revi and a proval �f . � l.� ��-- SIGNATLJRE OF AI'FLICA � � J � NANiL��,._f �—a..,_...-... Ciiy of F�ridley Suil�liu.g j.nfipections �epart�m.ent 6431 Univer.sity Avenue N�, l�ridley, MN 55432 763-572-3b04 FAX: 763-5Q2-�4977 � < CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 (763) 572-3604 FAX: (763) 571-1287 ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE NOTE: REPLACE BOILER # FURNACES REPRINTED ON 1/12/2006 : 6266 E RIVER RD NE : 153024430002 : UNAVAILABLE : LOT BLOCK : HEATING : RESIDENTIAL : X ALTERATION APPLICANT ST PAUL PLUMBING & HEATING 640 GRAND AVE ST PAUL, MN 55105- (651) 228-9200 003516PM C�1:'/�I �1:� DICARLO PETER N& THERESA S 6266 E RIVER RD NE FRIDLEY, MN 55432 1 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 know the same to be true and correct. All provisions of laws and ordinances governing this type of worl� 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 any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date. PERMIT NO.: 200Cr00044 DATE ISSUED: 0]/05/2006 �\ �b� ��2 FURNACE SHELL/DUCT WORK STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 043046 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 35.00 0.50 35.50 s / �� FP,OM :City of Fridley �uxldulg �nspectio�s 763-�72-3�04 S1'I'� AUDRLSS �„ Ti3IS APPLICAN'C I5; pitOP�R�"1' OVVNl"L�/ 7'�NANT SUBMIT A C0�'Y 4F YovR srAa� �.�c�rrs� wix�t APPLICATION P�RMIT'T'XPE �/�/..}�� //� � �� `�_� �J � � � . "�� PJ� ! ` � � �� a FAY. N�. :7635711287 Uec. 20 2005 12:5aPM P3 ?M ' i. r :� :, : '* .�- _ :�'. - ; !. . '. :�, : � (,� � XOUR E-MAII � lp l►� (� � t�CC.tv� [� OWN�R �CON'f'RACTOR N.a�• ff�'Yl 1 � (� ADDRESS:��,�s�.`��,�. -�- ,�'�� YHONE: � � � �� -� `!I f � c� I ' ' �'�.� COMPANY NAMG: _e CONTACT PEFLSON: � � � � sra� �cFa•ss a� _ __ , PHONE �� ° ' `�I – � _.___�— SiA1GLfi xAMILY Cl TvdO FAMrL.Y TYPE U�' WORK: � � NEw ��r.ACEt�rr FAX V Q Pet�Ilii Na.: __ ReceYVea �3y:� -- Date Rec' d: �� 3 F,S� DATE _ � a� � � �rnr�l�zse�`a i � ❑ TOWNHOUSB (� �;j�RpTION(FtEMODLI, D�TAII.�D DESCRIPTIUN OF WOR1C ,J'(J �` L�- ' pER MS 16B.665 the perrnit fee is a miaianurn of 515.00 or 5% of the total cost up tu S500A0, whichever is groater, fcrr the impravement, instaUation or replaeement of a residential f'txture, exeludiug the fixtures. ('rhis s�u1d refleck dnly tha cost of labox ) Labor cast under $340 °$15,OQ. Labot cost hetwecn 5300 to $500 = cost of labor T ��,,.^� x.OS °„�,�,.� FOR PROJ&G'I'S VdHERE tABOR EXCEEDS $500, FEES AR� $ASLD ON S10.o0 PER FIX7't3itE. �XCBPT wi'IER� 1�� i �� T�� A�' NUT.�ER OF FJ+CH i3ELOW) y • j��/ry� Ettuipment Instalied , MFG: l� � �'\, MU17EL: ��.L1.. STZ.EJBTl1 tJ�G: MODFL: „_____�_ S�TU A4FG: MOUF.�.: .,�.,�...� ,,,_,�/C �25.00 FTitLYLACE (dAS) 515.00 _GAS;tnNGElOY�N $iQ.40 25 �W GAS GRIL1- SI0.00 AIR TOl.�t EXCHANGE�R $i5 �� ''��D� �S•� _Gpg �►y'p �R $10.04 �BQII.ER $35.OG _FLJFNACE $35.(►D P00T. I�ATEK S3S.00 CHIM}a�Y LINER �lo.oD GAS nxYER �10.00 ��,�q�OR S15.00 DUCT WORK SI0.00 �GAS PiPTNG $f 0.00 . _ `�� . . A , . k�. . . .� . � . i r _ : � ' , . _._ Number of Fixtures (a; �10.00 �,,,, x $10.Q0 = $ Permit Fee $�� Number of iv�twes Q�15.40 _____ x$15.00 = S Surcb�'gc 54 TOTAL DUE $�, `'�� Numbcr of fnch�res Q$Z5.0(� x$25.�0 �� Number of fixtures (r� �35,00 x $35.00 = $ State Surcharge = $ •50 �`ota] _ $�, 'YiiIS TS AN APPL?GATtON FOR A P�RMtT NOT VALID UNTTL pROC�SSm ' I hereby apply for a building permit and I acknowledge that the infozt�letion above is comp��te and ac�urate; that the work will bo in confomiance with the nrdina�c�s end codes af the City of �ridley and with the Minnesot� �Conshvctian Co�e&; that I under5tand this is not a pernzit buc only sn IIcatiori for a permit azxd wwork is not to start withoue a per�nit; ihat the wArk will be in accordance with the approved plan in the cas�e of work v��ich re uire�s revie�.nd appro��al of pl� _^, �. �� f1., .^ � 1�1� I ��._I� 51GNATURF QF City o� Fridley ��aId�� Inspecti�ns T3e��rts�ent 643I Universit�� Avenue N�, Fridley, MN SS432 ��c�_c��_ztind __