Loading...
AF - 42722City of FridleX, Minn. BUILDING PERMIT lv� 6 2 5 9� Date: ��. "`�' .'�� -� Gi �` _ Owner: � �-�'�" ��.°�-�t�'2"{'�-�'�''i Builder �.. Address � Addr�se — � L� TION F BUILDING No. Street - ^� _..t .��. P Lot Lot __ Block Additfon or Sub-Diviaion -�-:�"'���� Coraer Lot _ Inside Lot �� Setback ' �� Sideyard ' �� Sewer IIevatian ____ � Foimdation Elevation DESCRIPTION OF BUILDING To U �,,�� Front _�� Depth _.���� Height -.�-'*� S�l• F''� �'-+r�.:�-s'� C�u. Ft .�� Front �. Depth ITeight _� Sq• Ft, -�i��" Cu. Ft �� .,, �y Type of nstruct3on Fs� Co ���c�---�-"i° T be Completed _._. Ea conaideral3on oE the isauance to me of a perm4t to construct the building described above, I agree to do the proposed work in accordance wlth the description above set forth and in compliance with e11 Provisions oP ordinances oE the dty oP Fridley. �� r� In consfderation of the paqment of a fee of ��p,[� , permit fs hereby granted to to conatruct the building or addition as deseribed above. Thia permit is granted uPon the express condition that the person to whom it is granted amd his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding lacation, construction, alteration, maintenance� repair and moving of buildfngs within the dty limits and thia permft may be revoked at any time upon violation of aay of the provisions of eaid ordinanoea � Buildin8 Inspector !� Nonc�: 11ds p�m�h dea eof eow� ths eoestrueNoe, IeshOaHae fo� vrieley. 'lumbtno, �as 6�at6iy, sww� or �raf�n 8� sun to s� fh� Bnildteg lesp�etor foe ap�raM p�neih Poe f6�a itsms. � _ — tr � _ ,,;� _ _ � i"^. � �c,�,.. . , �. Lund Plonnin9. Lond Surreyin� Suils Testr'ny CJvil fr Mun�ai�l En9meermy ,,�. .. 6B7S-Ni�hwoy �GS ,V.E. . MimaeoPo/s 2/, ENGINEERING, INC. �n��'° i SUnset4-&066 — En9ineers � Su�vecJors certs�ica#e o� s�ss�e fot � T � z� � 9 RI ,� � `. � �A°! �VVE�;l�0�1 - - -_-� ,:__ - - ____ _� _ _----- - _ - � z , ��- - - , 33 ri i ti�'e ,�. � � � � � � � � � 0 � � � ,� � V _ N at�-r H IZ I H i 2 0 N � , _ / e � — —� �F_��• — — � � Q � 0 N • o �a�: /' - �o' m Io — � H L,�O / � V� J , L/�lJ�/\ (D ,qL,��' Cv' lr�n�°'�Er AGtry" , LYING.. I/L9 M f D aA l,f L F° ,9 L�",� L,E".V T 7�iF fc'� C F . Q/-1 !\ l�f�� i/�� eQ �Le`'l �IVJ Y A N U �f A C�i'. , f�7 /.� e.�'. J/�zhy �i{� ffhoi �hh�s is a�'ue arrd mrr�cf �ep�tesenfof�cn o�'o surrey �'fl� 6nvndor�es �'�e � afr�cri6�d /m�0, ond o�'!f� laEafion o�'aU brri!ldu�9s ,�ecv�, and d/ ris'�b/e arrn�arhmenfs ,��'om,. �n or ansaid /arro! As surveyed 6� moe flys 2 3`� cbt, `� t�'�±�'�'er A•��• SUBURBAN ENG/NEE2/NG, INC. , ineers/� fr� Sur'gveyors, ,. i . � � � « � E- � � � �'Lr ��' ����- _=� a� yS � 2��45 I"'1 f°`� � APPLICATION FOR BUILDING PERMIT CI�Y OF_FRIDLEY, MINNESOTA y- ow�R ° s r�� BUILDER ADDRESS ADDRESS LOCATIOPT OF BUILDING No. Street Part.of Lot Loe Block Additioa or Subdiv3sion Corner Loe Znside Lot Setback Side-Yard SEWER ELEVATION FOUNDATION ELEi1ATION Applicant attach to this form Two Certif�.cates of Survey of Lot and proposed build- ing location dra`an on these Certificate�;. DESCRIFTION OF BUILDING To be used as: Front � Depth �n � Height ���` __ Sq. Ft.. Cu. Ft. Front `-�; � � Depth �� r _ Height / �� _ Sq. Ft. Cu. Ft. Type of Construction Estimated Coat To be Completed The underaigned hereby makes application for a permit for the work herein.specified, agreeing to do all work in strict accordance with the Citq of Frfd].ey Ordinances aad rulings of the Department of Buildiags, and hereby declarea that all the facte and representations stated in this appl3cation ar�e and corr�-. D ATE SIGAlATI1RTz �' (schedule of Fee Costs can be found on the y� • h ( ` Side). 1 ` f: ,�. 1''.r_-�; =R A ' 4 BUII,DZNG PEItMTT T8E SCAEDULE Section 2. The Inspector of Buildings shall, before issuing any pertait far the erPct3on of aay buildiag os structure, or for any additioa to any exis�- iau bi��lding or structure, or for any alterations or repaira Co any e�i�t�.ng building or structure, upon application therefor, require the paymen� by the applicant for such pernutt of feee te the amount herein below set forth and in the manner herein provided to-wit: 2.1. For any such permit for the erection o.f any fire-proof building, othes thrn a garage� warehouse, factory or grain elevator, or for the erection of any fire-proof addition, for simiiar mccupancy, to any exi.ating build�x�� shall be at the rate of $j,.40 for each oae thousand cubic feet, os frac��.e�a thereof, in such cubical contents. 2.2. For any such permit for Che erection of any fise-proof garage, wmrehouse, factory or grain elevator, or for the erection of any fire-proof additioa�, for similar occupancy, 'to any existing building shall be at the ra�te of �1.25 for each oae thousand cubic feet, classified as °1fireproof" by Sectioa 502 of tae Minneapolia Building Code. �`€}USES 2.3. For anq such permft for the erection of any non-firepsoof building other than a garage, w�rehouse, factorq or ffixain elevator, or anq non-fireproof additioa, for similar occupancy, to any existing tauilding - permit $1.00 for each one thousend cubic feet. �AitA�ES 2.L�. For any such permit for the erection of any non-fireproo� garage, �.��rehouse, factory or graia elevator, or for the erection of any non-fi.�epro�f a�dit�on, £or similar occupancy, to any existin� building or for each such building or �ddition - niae�y centa ($0.90) for each one �housand cubic fe�t oz fr.action thereof, in the cubical caatents thereof with a minim�mn of $4.0�. �'or the purpose of compu�ing fees for building permits, the cub3cal coatents of any building o�^ additioa to a uniform height throughout by �ltiplyin� the gsnund area covered from a poiat six (6) inches beio�r the floor liae of the b�sement or cellar to the average height of the uppes aurface or to the ave�age height of the roof surface of the ma3n gable of a p3.tched roof. 2.5. For repa3rs or altesations to an existing structure, the fee siiall be at the rate of $3.U0 per each Five Hundred Dollars ($500.00j or frsction thereof in the cost of all proposed work. 2.6. In. no case shall tYie feQ char�Ad �or anp perm,tt as set forth in Section 2 be less than $4.00. • �ti � �. �1 � � p � � � G � �, � 'd � o �p : °x : � . � • M : O : �' �9 : t' : � � {/� � 0 N � � "� � y � � w � � p � � � 5* m � � � � � . o • o � o . o . o . � : : � . . � � �\0 N � �O °o q o � a 0 V' � � a t� � ba t�e � � cZa � � 7• 8 � � 8 �' R] �'1 � � � � � � � � � � � a � �o � � : O � �y � � 'ad � a � � � � �.N: � �: � W _°o : � : 00 � � � . . ' � . . . . . � '. . . . : � : : : : \ � �a oa �a k iC ia w N w ►� ►� ~ � C�71 p C�i� O O O � ffl {A tA fA {f! H! � �H Q �I � c ° � � r � m � ♦ / 2 m C r m '� � � i�, p ~ � � � � �' � StorYes 8 � w�r� � m ciosers c � � URiNALS � � e�rH O � � p - e,.si�s � tT I SINKS � � W�►, � °� rantrs � � b e i r M �� I I � o ° � 4 � � � � Q R' cr R. cz a x z � � � � � � a � hd Cd � ' � � o C�. Vc'F � �� � � iU � g „� � `� � � z � � � � 0 � � R � p �. . � � � � `) I � � DRINK. FOUNT. SHNfRS. � ROOR o��� GTUi B/�SINS /1UTC WASIiER GAS APPL GAS RANGE GAS OPENINGS 9 � Z • c� — � i A m � � p w a. � � � �� � � �a� � m �oH,°�� � W 1� �• F• � y � O W � �' � ��o � ���� � � ��.� � m � 'd � �'�d � hy mk��� `�° � w � � � o � � o p �' `d, O � � � p w � � �� .. � � ���� ���� �� � � � M i'�1 � � A � � � � � w � �' � �Ce A W � � � a S� & �°n i� =i M � �� � � �. �i � � � • � �. � � �i � � � � � o » � � M b0 � � . �` � w �� � � �,. � V � L 1� � 3 a � � I �i 0 � � M � � � � � r t� Y � Y [ � x x �/� y M�'�' �• � � r- H x "w� � y "� a�i R�. �-y. ryi . ox�`" � �wx � � � O p� d ,,�'. 4� �' � � � m � � `� rp rp � o �1 � y b a � y � "� a : � o � : �o : : � . ��'' . . . � : : : � H � � m � � � 0 � � � °o 0 0 � �y tA t3� fA '� O � y r � N � � � w � p cD � o � � 0�y I � � � � a � �' � � °. � � � � W z x � ro 0 0 0 0 0 O � � 0 0 {i! w � � � � 0 O r � a � 7i °c � �' o w on �`' d � ..� '� � � M o p• y O U� y � fD � • � . �: & �. ; � en 0 0 � � � 0 e� � �' �' a a 0 0 � � �� � � x� � ��y P � M ' � � � ��,�� � ��x�S � ���'y7 �Q�y�'� �' � � b � � � � ~ Id• % � Vl N � n � 0 �'° R° lD Pf � � R° R' � � � �� ���'�'� �9��� R° y ° Q, R' � � w� R' y �� � � � .. � o o� Q� o o��:� � g S � � p � � '� � ,� ° � � �, � � o � I o � a � � � o � � : � � p, 4A . F+ .. G� ' . O . � � O : . � O p . . � o � . . Q � � ° : : ' � $ : : � � : : : : : : : : : � : � : : : : : : : N � � � en en o 0 0 0 0 0 fiJ {A ifl i� � � .� x° M � � t� en en w o0 o °o °o °o °o � � 0 � '� O t�. �: z � `° � n bd � m � y � � � � g� b � � O ' ` m � � I� � � � �'9 V�1 y � �• s ¢ �C m �� � w ea en oo � cn o 0 0 0 0 0 0 {� O r � � � K a.a� � ���� a � �a�r � y � c � 0 � � � •-' �+ "� (p (D N � H �E o��"' y d°� � �b{y � W y p y � p p ,""'-'�C �*� y.�y p�7 7'. �' ���b � �mii� o- �� a��,cr. �p•Cp ►e ���y �! ��� � b � a� �h ���� �� � f� �� � ��M ��� tp p. rb � SPi 5' a � i � � ir� tn 2 m C T • 1 � � � I �* � � � � a � � � a a �.� � � - V O � ° J � �• � � � O '� = Q O � � 0 � � O = D � � �; D � � � �h Q � 0.� A A �� � � � �. 0 � � :�. � � � ' � . � � F+ r O 3 � � � � � � Cr p f0 � � r��"� � � � � � � � � w R1 � ~ � n t" '� O y y � fA M y'b � w a� H 'y O ''' � "' �' �`: � � 6�I p � �' Cd � � 0 a� � � a � � � e� � � Vl W � �* � � � o �� o ro � � y o 0 0 O � � : O O y � 0 � : : � --„-- . . . . N . . . . � : : : : � : H � . � �' m C4 >C DQ o : � � " `� v o 9 � o ti! fI! tti tF3 �H °� � � V � � V � � � �� � ���o :� �O -r �� ;.� w �s �v �� � ;�� ± a ,c�i � � I � � � � 0 o w � � � � � m � � R� � � � � � � �i' m 0 o � � r � �'�'��p �� �' �� � Q7 °' � � " � � `� � a. sz c� � � � c j � N�� y t� t� ��� � °' b'� o o° G G� ��� G� ma �`' � a R' R° b' ��° '� a' R° w ;r oa � � ���'�� � o �� y � V � � � � �+ cro ero � � :�Q w � � Q � � � �' . � � � � � o �I v� °' ��, °. �o p g w 5' :'� 5� N : � � � � � o : : ~ � � � � � : � : � � g g : : $ � . . . . . o � : : : � � ° : � : � � : ' : � � : : � � ' . . . � � . . . : : : : : �y : : : : : : �N��� N��N� 00000 00000 Cii fA i'fl {fl {iT Hi iA H► ( � i 0 � � � �i M 0 � 0 w z � c � � p � �N' � � � � O 0 � N n P � �. � �. i�. ¢ � � � H � � � � � � � b H �' � �G � � � � R° R° � � � � � � � � o G � � "'�°� E]' � 7�J �° � �'r '� fD °� � � o : R, tss . . � . . e�r� ,°o : : 0 0 . . o . . $ : : : ����� �000 q O O p � O � a. a � �' � � y � � F��A � �¢� � � �� � � ��O4p � d � �b � ��°� � , � �• � �� I � ��'M �. � � �� `�, �����, C� �' � 1 ' O y �� � � �. p��°o h �°,op �a � �°` ° f'f � ►f � � � ���� � �� � ���o ,� � ���y � �.�� I ��� � �: m I .. �• � � � m H, � co I I� ��� > � i � � m H n m C m d b � M � � � � a A A 0 �� \ ��� � � � � a� � �� �w �� if� � � •'w �w �� � � �� � � e• � � Q• 3. � � � � � ,. .� � a ��'+ nr c : � ;i M N M �o X � < �, � � M H � � H 'J L� ory � 9 � H N N � N 0 tro+ N �n N O N � � � � E�i � 0 e n� � � � � ro ro � � � �� � V m � r V' o bn H O O H x° � H m f) ~ a ro o . °' � . m AC�9 � � o t'"t:fY�-+• H % � ,'+o N � �-+ �Hxn � o 0o tu o g �l 'F 7+ � H N C C_ Y !r- ��-1 �-1 b � v e y n� � p �S tp +i '1�, i% 1 uai i� i'r " �� n� n� o c�i m (/I L� L7 H Y• (,7 l� 1 ,7' I .7 7.7 � � K''� ] � � �T� o O pa. � p' � pp,' �. M H�-3 cz') � ra-� K cMi� w� w � R7 7 a 9�M ° wm .. �o w ra-� o�o� �N� �x a � ° fa,,' o000 tn �o`c� co o ro o00 �/�(v o m �� ° �� bo °o w o �D fD W �H -�' H O H` � C :�'� G � [�'G°o W co b* n � -p� y � W� � o N � I I ( � � c�i � . � , � m :x :x :x �`a m �Wl�4!•N/1 _N •.N -.N +• -r -�-�-r -r D-F� � O SJ .D '01 � J�d� N a��o � n_n n�-o 0 0 DD17 -0 .DD D:O O O � � m � � O M ro �U N � W ta-�• W W � u o � w � M (,M N «1' � Mr~t� r~r O W!-' ;v ��ro• � G a M �n R Ct G O CJ � W W rS [. 0 0 � o � ��aorr N 'N A O .. �ro�u�� �, c� x a� r� • O O o°o °o Q O D H a i/� �AJ�1AN 0 0 0 0 0 O O O O O M �n . z brob� .. n M•~•N a � n n � � � N N �D (D y 7 R� ,R+ ] � �7 A ���� � � m ro `' r�+ � a a �' ::� -p � O O � � A N N n � � I N $ � . a ro � r" �, a x � pai N � m N O � o a = °o � �, � a��N y a000 iz1 D D D O f/! i�C/4Ai/f-YA -N�NifA iin:N -.i?�:Vf '.N��V/N:�VI -0�*N-0�Vl�ll -Miq-A�Dl � N C� c: J a �, ° c • C� � � ' r N C O � *i � � � � n � � � � p� H � W � � rt � 7. a (� �1 _ � �d W a � � �q � 'l�0 M � •� �n :Y .�'n � m -��°d' �� -,., z rt � �, ° � � W N � ��1{ �f/ J\' � q1 N � N I =a �'� � � � �u a .ta o � � o t°n � � � � �- r � o � � . � 0 � � � � 'l7 � n A� (rou �{ � � � -t7 ro .� 70 N M M.� � � tbn � m N w � r• m �a � � C � W w � -� 'n � :7 *m0 O k W (° +t rn �u w � � .� 'y�j Z y w m � ;� � � ,o a � � N t7 m �..� � � � � � ry O +C � -.�o � �,� �� � � � G � -� I� � -H :z -o ��, Gv r � rt � • rr � m ''i Y ��X�U �'� �c�.ro � ►�- � w � � �y �t w . � m m o � v � ` rt M � �-+ M N O 6'tl n P+ n � c� � o w � wm aro �am�ryfgD pt 't W W � K M � � o n o i � a x n ��x� � N � m ��w'� �8 n�iX ' �a�x �tO n ~ � �. � � � fyD -Aw �ldD ~ �C w � o �r ln M i K r�r w h+• N N +�i, o� � +� i-' � tn D v � *i � ta m !� �'3 � � � `I = � v � -o r n —1 O z 'T1 O � O f m :S1 n� � n � O y Z r� a � d o x Z v z --� �, .. � � � � N --I n I�7 O � O � Z z c� a � d C < � f� �-+ m � � � 0 2 v � m � � � m .'U a � 0 z a z ei 0 c-� � -c � 0 -r� T .'U C m -�G CITY OF FRIDLEY APPLICATION FOR HEATING REPLACEMENT CHIMNEY AND�STACK VERIFICATION THIS FORM MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM. LOCATION � ,�S" `� ° � i �� � S /` DATE .� �l � � � , OWNE � � d; � � � � , � � ADDRESS _�°�,� � The undersigned hereby verifies that the existing chimney or stack: 1. Nas been carefully examined 2. Is free from rust or deterioration 3. No foreign objects are 1adQed within 4. That it is securely supported 5. That it meets all current Code requirements for size and total BTU connected 6. Total Heating BTU All Other BTU ToTa� REMARKS ' � �� S f �' c� 5��,��� �:� ��� �� I � � � ��� v� ,.� � a..t.� �._.�..�..�.e� � HEATING PERMIT # ' SIGNE�� censee ' Y � �` � by , Address • Telephone � �'=�- U(�'?� � Fridley.City License � --- Buildir�g ���s �� MECHANICAL Permit No.: �- � : Tnspections RESIDENTIAL APPLICATION Received By: 7. 63-572-3604 CITY OF FRIDLEY Date Rec'd: �'� ��'�� DATE � � � ����� YOUR E-MAIL ADDRESS S1TE ADDRESS Lc`-� �-� � �r : c� l�- �� �� ��. THIS APPLICANT IS: ❑ OWNER �CONTRACTOR PROPERTY NpME: �a,� z Cc� �-� �=�� OWNER/ ADDRESS: �'�� �l �r �� �-� i-� S� � E CITY �'r � �- �-1 STATEV�1 I�ZIP SS��31� TENANT PHONE: � k' � - `� —I � ' ; ��-S c� CONTRACTOR CoMP,��NY NAI�: �OII� L�'i1TERGY SUBMIT A COPY OF CONTACT PERSON: JOAN�i ZI�T YOUR STATE STATE LICENSE # E3� DATE LICENSE WTTH pDDRESS: 13562 C�TBAI. AVE iBZE CITY ANORA STATE MNZIP 55304 APPLICATION PHO� �63�7§�-62p� Fp�; 763°757=6701 9 PERNIIT TYPE ��GLE FANIILY O TWO FAMILY O TOWNHOUSE TYPE OF WORK: � �W ��PLACEMENT ❑ ALTERA'fIOTI/REMODEL DETAILED DESCRIPTION OF WORK �� E �� � C � ��-° `� '� °`� � �-� � � �` `� �-�'�' � � �' E''� PER MS t6B.665:the germit fee is a miaimum of $15.00 or 5% of t6e total cost up to $500.00, whichever is greater, far the improvement, installation or replacement of a residential fixture, excluding the fixtwes. (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 PROIECCS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT R'I�RE NOTED. FIXTURES: (IIdDICATE TOTAL NUMBER OF EACH BELOV� �, pc0 Equipment Installed , A�ffG: C cA r r.-c r MODEL: S��� C3 b�' � SIZEBTU � � i IvffG: a� r c e� MODEL: ;3f' TL'�c .� � SIZE/BTU ��•-� ✓ MFG: _FIREPLACE (GAS) $15.00 ODII.: _GAS RANGFJOVEAI$10.00 _A/C $25.00 AIR.TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW OAS QRILL $10.00 BOII.ER $35.00 _�`URNACE $35.00 _GAS IJNTf HTR $10.� CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL I�ATER $35.00 DUCT WORK $10.00 GAS PIPING $10.00 VEATfII.ATOR $15.00 — ,:. , , . -' . � �.: ' � , � � .i�,:� , , .� J ' '. �.: . � s � Permit Fee � $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ Number of fixtures @$25.00 � x$25.00 =$ o� S�� Number of fixtures @$35.00 l x$35.00 =$ 35 , c.G State Surcharge = $ .50 Tota1= $ �c,�G. 5 O TI-IIS IS AN APPLICA'I70N FOR A PERMIT NOT VALm UNTII. 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 applicarion 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 which requires review and approval of plans. SICrNATURE 0F APPL1 ��. � ` PRINT NAME ROGLR �idFI�HEII+T DATE L� � � �i � r . . . . ..: .. . � . . - .., .. ., _. ` - '�� r (:ity of !+'ridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 r� � v. ni� cn� nn•f'f �.- REQUIRED INFORMATION NEEDED TO PROCESS PERMIT ' RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS �EXISTIAIG HOME ❑ M,AKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) . - -� Ui.� or solid fuel lMC Chapter 7 with MN Amendments b. Naivral Gas or PropanellFGC Chapter 3 with MN Amendments � 2. Make-up Air (See note below) � a. IMC Chapter 5 with MN Amendments 3. Venting a, Gas appliances IFGC Cha.pter 5 with MN Amendm.ents b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load pe7 room � , a. Required on new co�struction IMC 1346.0312 5. Ventilation . � P_er MN Ener�y God:e.7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for , � � combtistion and make up air calculations Building pI,UMBING Permit rio.� Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY nate Rec'd: :' ���� DATE �� 7� YOUR E-MAIL ADDRESS SITE ADDRESS �� �dI �P y �� THIS APPLICANT IS: � OWNER ,�CONTRACTOR PROPERTY NqME; , �(�-,�SPi� OWNER/ qDDRESS: ��� �vIGY/� `/ �� I" CITY F�i�i��P � 1 STATE IP�� TENANT pHONE:,�/. r�--� 7/ �.5�'l CONTRACTOR N,y�: SUBMIT A COPY OF STATE LICENSE #�L/ EXP DATE I� ���f� YOUR STATE ADDRESS:� 7/� li �L�/rl `S� CITY��%h/.Yi STATF�IP�,/� ZI�EI�SE�VTI1�_-- PHONB���-�7 ���� - gAX f�� �.S?��/,�i�l--= -- ---- --- - - APPLICATION PERMIT TYPE �GLE FAMILY � TWO FAMILY � TOWNHOUSE TYPE OF WORK: � ��'`' � �p�CEMEN'P DETAILED DESCRIPTION OF WORK ��/i/'��;���9� PER MS 16B.665 the permit fee is a minimum of 515.00 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 $30Q =$15.00. Labor cost between $300 to $SOD = cost of labor x.OS = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOV� BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING BATH'TUB GAS PIPING R+� cmuc� SWIMNIlNG POOL WATER SOFTNER ($35) CLOTHES WASHER KITCHEN SINK WATER CLOSET _BACKFLOW PREV. ($IS) DISHWASHER _ LAUNDRY TRAY �WATER I�ATER ($35) FOR IRRIGATION WATER METER OTF�R PfiRbIIT:�EE�R�3��`�'���0.,�,{�; _ .. ��� . ���`�" � �`���•�k��� ���,�„^���`-�'�����F"�,'�,�'' ������`�r�r�����"±`�� `' ..: �;�rQ: �3.�7�..��T��3;�ER-$500: Permit Fee $ Number of fixtu.res @$10.00 x$10.00 =$ 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= $ 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 which re uires review �nd approval of plans. SIGNATURE OF APPLICANT 9 PRTNf NAME ��� L���,�f DATE �� ��� �PL£A���C���`.���'�1.,��. s' ..,�.. �, �� ..i��Q�='�'$,. '��..�?`�:� p.� � �, ��� `',���°.��,`�Q�i�.�,�., City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 �