AF - 45410. City of Fridley, Min.n.. _ �
6431. University Ave. N. E., Minneapolis, Minn. 5543
BUILDING PERMIT
�}�; February 2�,, 1972
p�; Da�.berr� Builders, Inc. Builder _..�Same _,_..,___,. ��,Y
Add�ss .._L121-- Rnt-r ai=pn�,e,.l�l E... Address ..._Same _....___._...._..__._.�_._.._..._..._..._
LOCATION OF BUILDING
Na - 1499 S�t Gardena� Avenue N.E. ��____.._.__ p� of Lot ........._
j,pt 19 g;ock _ _.._.� Addition or Sub-Division ._���.�la,�.�.._�'.�____.Y._.._
Corner Lot � In�side Lot .._.._ X Setback ___._..�� �___�.._ Sideyard __....�� �1� � __.._�
$eWe� Etevatian ____.�.._....._ Foiuidation Elevation
• „
DESCRiPT10N OF BUILDING
'1b be Uaed as:
j,�p 11; n o Firont ._..3�$� Depth __2�$ t__ Height 2.Q_..�c_.,�.8 Sq. Ft. .....�.�52.� � Cu. Ft �.J_�.$$� �
.('�i�.g�.. _._.. Front ._2� � Depth � Height 1Q.�,_...... Sq. Ft. ..._._ 440' Cu. Ft .�400 �
Type of Cm�struction _.bio.�S1...E�C�tu€� Es�. Cost ...��4.�-00 ....._ To be Completed _._.._._,�u iX.:. l,� s 1972
Stipulations: Provide verifying survey before capping foundation and provide a
hard surface driveway.
In consideration of the issuance to me o# a permit to construct the building described above, Y agree to do
fhe proposed work in aceordance with the deBCrlption above set f d in complian vv�th all provisions oP
O�dinaaces o! the city of FridleY• /i � �. „
In coa�sideration of the payment of a fee of $.�� , permit is hereby granted
to construct the building or addition as descxibed above. This permit is granted upon
tbe express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, �our,a �a upon said building, or any part thereof, shall conform in all respects •to the ordinanCea of
1�'ridley, Minnesata regarding location, construction, alteration, maintenance, repair and moving of buildiri�c
�� city ]imits and this pernut may be revoked at any time upon violation of any�of the provisions of Said
__......._.. Inspector
CLARENCE BELISLE )
�
NOTiCE: '
'ihis p�rmit does aot eover the eonsfruetion, installation for �/`iring, pl�mbing, Qas heatin9, sewar or water. Bs wn to sM
tb� BuiWinp lntpecto� fo� saparafe psrmifs fo� fhess ifems. - '�
, Inc.
. _ . . � n� avrn� a. � � h�� �.v.
SCALE: f INCH �'=�' FEET 1602 SELBY AYENUE, ST. PAUL SS104 TELEPHONEi 646-6888 i
�y� ��.��T�.�,.��, � PLAT C�F SURVE�
,�"�� ��.-�-,�-.._._
OF PROPERTY OF ����"'�'�'-�� `
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LOCATION ��f �.�'�-:�``,����� ���.-���' � �yi���
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{ CERTIFICATE OF 'LOCATION OF BUILDING CEBTI.FICATE OF SURVEY
,! I hereby certify that or 1g-.�... I hereby certify Lhat an .��" �''� 19 =--�_
I made a survey of the location of the building(s) on the I surveyed the propertv aescribc:d abuve and that the �bove ,
above described property and that the location of said
building(s) is correctly shawn on the above plat. ' plat is a correct representation of said survey'. �
� � � � �. �� �� � -°"�:� ,.�� � � � ��
� JOHN J. RYAN. REGISTERED SYIRVEYOR. No.4�'�89 ;
�� PAUL J. CRANE. RBGISTEREq;SURVEYOR, No;;l�L449 5,l ',
��
`Forw No. 183 2M McClsin Hedman Schnldt Co. ¢-^' /. �
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APpLICATION FOR RESIDENTIAL, ALTERATION,
OR AllDITION BUILDING P��RMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME : -� BUILDER : ,�,�/;7"� �� � ���'�B�S
�, �
ADDRESS : ADDRESS : ���--� � �0 �°r"^'P �� y �
NO:., STREET•
LOT: BLOCK: � ADDITION: � ""� ��-
---�,
CORNER LOT: INSIDE LOT:_�_SETBACK: l SIDEYARD:�S� �/
Applicant attach to this form �ao Certificates of Su_ rvey of Lqt and proposQd
building location drawn on these Certificates.
�ESCRIPTION UF BUILDING
To Be Used As:
Front: � p Depth: �� Height: o'�- 0 ���
j �t �
Square Feet: Cubic Feet: � ° � , '� '�
�, � � . ^-�
� �: -� Front : ��9 Depth : 3 �. Height : �` c:>> , _ ,,,.�
Square Feet; Cubic Feet;_ �l, /../ �1 � ` � �. � � �
�
Z�pe of Construction: � Estimated Cost: $ o`� �S�a `�
To Be Completed; /l " �9% 2-- � �i l � ���
The undersigned hereby makes applicativn fox a permit for the work herein
specif ied, agreeing to do all work in stiict accordance with the City of
Fridley Ordinanees and rulings of the Department of Buildings, and hexeby
declares that all the facts and representations stated in this application
are true and corxect.
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. 1� AGREEMEN'f i � -,
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�� the owner of th
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foliowing described roperfiy - �
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,� Hereby agree to pay in cash $ �� �-� o� � ;
, to the city of Fridley to cover � propor ion e '► �
,a , � � ; �
� share of the utility system, or i,n lieu thereo f agree .� '
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'_� to have the C+ty levy an assessment against the � i 4
;d {
� ' property described above to cover the cost of my �� �,�
� �.� � � � �� � �
, proportionate share of the utility system as pro- _ �
� vided in Secfiion 2 of Ordinance No. 113, passed '
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� �. by the Counci{ of the City of Fridley on December "
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,� . 11, 1458. �
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' fi`� � OWNER'S SIGNATURE '
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'! Tapping Permit No. �
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� OF FRIDLEY � 3 9 5
Application for Inst�lation of Water and Sewer Bervice
This form to be completed before a ta.p is made to any existing water
or sewer line. �% ��
Lot --�---� :...-------. Block ._.._..--- ................ Addition . �..�.._..�._��!��:'�' � ....°�-
?� _ n /L �
Address
Owner
Plumber......�_. .. . __ ..._....S...l _-- ----- ._�.. ......----__..
(this rtion of orm to be compl by person requestang tap)
CHARGES TO BE PAID BEFORE TAP IS MADE — WHERE
ASSFSSMENT HAS NOT BEEN LEVIED AGAaIlVST �'ROPER,TY
Sewer Connection fee ........................................
'Street patch •-----•---__...._......._.:._.........::.
Water Connection fee
Meier deposit
Materials used
'Street patch __
' Where applicable
The above applies for all regular residentiai size
�
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SD,00
g' I,ATERAL ASSESSMENTS HAVE BEEN LEVIED AGAINST
THE PROPERTY, TI�fiE WILL BE NO CHAR�ES OTHER THAN
GONNECTION PERMITS AND 14tETER DEPOSIT
The City will furnish materials for water service and the plumber
will bill the City for sewer, not to exceed $3.� a foot or a maximum
of $60.00.
ASSF..SSM�V'PS �O H'� LEVIED
Water Lateral $ . ................._...-----�'.-._
Cre�lit for material -- - -.-----........,..
Tata1 assessmen ..:... ................................._ ,
Sewer Laterai $.......-----•----........---� --.........
Credit for rrtaterial 60.00
...............Total assess3nent $........._.--�----_...........---........
,.
Glerk's signature .... .. .. ... ... �. .. ....._..-- - .._...._. ....................._
I hereby authorize the a ove tap
lst copy—Publie Works Director of Public Works
� �r ��� , ���-a--
HEAT LOSS CALCULATIONS DEPARTaV1ENT OF BUILDIN
� � �i� --
Weatherstrips A Guide �nstruction No. Iawlation
Windows Doora Reference Out. Wall Int. Wall CeJing Roof Floor Kind How Applied
. Yes—No � Yes�—�o 19_
FL� Room L.eagth Width Height Fl,� ' Room Lengtl� Width Height
Win o" and Doorr—Crackage and Ares Wincbwa and Doors---Crackage �nd Area
�Vid. h Hel�ht No. ot Lln�al t. An� Wldth H�1tht No. ot Lla�al tt. Ana
No. ot p:ne ot Dan• Iliht� o! erack p. 1t. No. ot paa� o( pan� ll�ht� o! eracl[ W. tt.
� `� f l ( �
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� I�������t�
� Infiltratioa �
Glasa
Exp. wall
Net exp. wall
Int. wall
Ceiling _
Floor
Total Btu.
Required aq. h. E.D.R. or tq. ias. W.A. L.eader area
� F1.� Room 1.ength °` Width �
Win ws and Doon--Crackage �nd Area
Wid h el�ht No. o! Lin�ai tt. Ar�a
No. ot pan� ot pan� II�At� ot ersok �p. !t.
. .� st �v / � ��: a 3�, �
C«f.l Btu
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Eup. wall
Net exp. wap
Int. wall
Ceiling ,
Floor
Total Btu.
Required aq. ft. E.D.R. or aq. ina. W.A. Leader ana
FI. , m � Length Width ,
Win and rackage and Area
Wldth HNfht No. ot Lineai tt. Area
No. ot pan• o[ p�n� II�At� ot crack p. ft.
� /
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c
Infiltration <
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Exp. wall . Q
Net esp. wsp ;
Int. wall
Ceiling
Floor
ToCal Btu.
Required�.aq. fG E.D.R. or sq. ias. �W.A. Leader arca
In6ltration
C,lasc
Fsp. wall
� e�p. wa11 -
InG waA
Ceiling
Floor
Total &u.
Required eq. k. E.D.R. or sq. ini. Q/.A. Leader area �
Fl.I Room � Length Width ?� Height
WindoMn and Door�—Crsckage and Area
Wldeh HHSbt No. of Lln�al tt. Ana
Ne. ot yRn� o[ pan� il�ht� ot ce�ck M. t�
D �� �
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Net ezp. wall
Int. wall
Ceiling
F Ioor
?ota! Btu.
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Wiadows :� Doors--Crackage and Area
Wldth He1�At Na o! Lin�al tt. Ana �
� Na ot pao� ot pane If�ht� ot c�ack p. tt.
�r
E. etu co�f. S�u
Glaa
�p. w.0
Net exp. wall
Int. wall
Ceiling
Floor
'fotal &u.
Required p. k. E.D.R. or sq. in:. WA. l.eadu aeea
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SUBJECi . P NO.
City of Fridley � 218 5 9
AT THE TOP OF THE TWINS g U i L D I N G P E R M I T
�
� � .
� �
� • COMMUNtTY OEVELOPMENT DIV.
r � L � PROTECTIVE INSPECTION SEC. l�D �
� �
� � �
� � /"'1 � CITY HALL FRIDLE� SS4$2 NUMBEN REV DATE PAGE OF APPROVED BV
�""� � ,�' 612-571-3450 910-Ft5 5J19/93 / /
J08 ADDRESS 1499 Gardena �,�enue NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ].� Al1CI. S17�J, #92 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
David Shafran 14g9 Gardena Avenue 5�2-3834
3 CONTRACTOR MAIL AODRESS ZIP PHONE LICENSE NO.
D& D Hane I�nprovement 7401 Central Avenue NE k'ri.dle 55432 784-7543 4840
d ARCHITECT �R OESIGNER MAI�AOORfSS ZIP PHONE UCENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CIASS OF WORK
❑ NEW O ADDITION O ALTERATtON L� REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCR19E WOFK
Rexoof House C18 Squa�res� 2nd La, er
9 CHANGE OF USE FROM TO
STIPULATIONS
i�oo�ing can b�e the 2nd layer but not the 3rd.
TYPE OF CONST. OCCUPANCY GfiOUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OF AIF CONDITIONING.
THIS PERMIT BECOMES NUIL AND VOID IF WOFK OR CONSTRUCTION 20NING SQ. FT. Cll. FT.
AUTHORIZEO IS NOT COMMENCED WiTHIN 60 OAYS, OF IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCEO. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF �AWS VALUATION SUFTAX
AND OflDINANCES GOVERNING THIS TYPE OF WOHK W1lL 8E COMPUED $g72 �. SO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PRQVISIO S OF ANY OTHER STA7E OR LOCAL LAW REGULATING CON- $2S.00 Flxe SC ��%
STRUCT OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECKFEE TOTALFEE
License SC $5.0,0 $31.47
S Narua Of O"RACTOAOAAUTHOA�ZEDAGENT i0n7Ei WH N OP R Y V IOATED THIS IS YOUR PERM17
�s -/� -�'�
.SiGNATUREOFOWNEP�!FOWNERBUILDEA� �DATE� BIOG �NSP r�piE
NEW [ ]
ADDN [ ]
ALTER [ ]
Constcuction Address:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit AppliCation
Effective 3/1/92
�Cb°`�
Owner Name & Address: �_��I,Q ��J� Tel. #_ `�i�.�3�
Contractor: D& D Home Improvement, Inc. MN LICENSE # 4840
p��: 7401 Central Avenue N.E., Fridley, MN 55432 Tel. # 784-7543
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DBCK AREA:
OT�IFR:
DESCRIPTION OF IMPROYEMENT
Length Width Height
i,ength Width Height
Lengtb, Width Hgt/Grwmd
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [ J Inside Lot [] Ft. Yd Setback Side Yard �acks
Type of Construction: Rp,-�/�O BliL°�G ,�"L� Estimated Cost: $ ��
Approx. Completion Date: D'IA�r/�e /.5.�%9'�_ � `��eS
{Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ = S
DATE: APPLICANT: G��� TeI. #
Permit Fee $ �� ��U
Fire Surcharge $ r �f `%
State Surcharge S - �D
SAC Charge $
License Surcharge $ �, Dd
Driveway Escrow $
Park Fee $
Sewer Main Charge $
TOTAL
STIPULATIONS:
$ �� • �
��-
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth�)
$.50/$1,000 Valuation
$700 per SAC Unit
$5.00 (State Licensed Itesidential Contra.ctors)
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary ( )
�
sue�ecT PERM _
City of Fridley 219 8 4�
AT THE TOP OF THE TWINS g � I L D{ N G P E R M I T
i � RECEIPT .
� �
COMMUNITY DEVELOPMENT DIV. ���
r � �' � PROTECTIYE INSPECTION SEC.
i �
� � /"'{ � CITY HALL FRIDLEV 55432 NUMBER REV.� DATE P+�GE Of APPROVED BY
�""� � ,'� 612-571-3450 910-F�5 7/19/93 / /
�oe no�aess 1499 Gardena Avenue NE
1 IEGAL LOT NO. BL�CK TRACT OR ADDITION SEE ATTACHED
DESCR. Pt. 19 Audit�r's SUb. #92 SHEET
2 PRaPERTY OWNER MAII AODRESS ZIP PHONE
David Sha£ran/Diane Snow 1499 Gardena Avenue NE 572--3834
3 CONTFiACTOR MAII ADDRESS Z�P PHONE LICENSE NO.
Same
e ARCHfTECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
l�esidential
7 CLASS OF WORK
❑ NEW C� ADDITION ❑ ALtERAT10N ❑ REPAIR ❑ MOVE ❑ AEMOVE
e oESCAieewoaK
Construct a 12' x 12� Deck; RemAYe 12' x 10.t Deck
9 CHANGEOFUSEFROM TO
STIPULATIONS See nptations, an plan. Provide smoke detectors as, per tJBC 1210 adjacent
to all sleeping areas and i.n basement.
M
WARH�N�
gefore digging cait for
all uiility loca#ions
q54-0002
(�EQUtRED BY LAW
TVPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAD
SEPARATE PERMI�S ARE RE4UIRED FOR ELECTRICAI, PLUMBING, HEATING.
VENTI�ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID If WORK Ofl CONSTRUCTION ZONING SQ. fT. CU. FT.
AUTHORIZED IS NpT COMMENCED W�THIN 60 DAYS, OR If CONSTRUCTION
OR WORK tS SUSPENDED OA ABANDONED fOH A PERIOD OF 120 DAYS AT
ANY TIME AFTER WOiiK IS COMMENCED. NO. DW�G. UNITS OFFSTREET PARKING
1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPIICATION 1 STALLS GARAGES
ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
ANO ORDINANCES GOVERIJING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPEC�FIED HEREIN O OT. THE GRANTING OF A PERMIT $�'� 117 $.S6`
DOES NOT PRESUME TO GIYE AU ORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF Y THER S TE OR LOCAL LAW REGULATING CON- 29� OO Fire SC $l.: �-2
STRUCTION O T NCE OF CONSTRUCTION. $
/�� /� PLAN CNECK FEE TOTAI FEE
� � $30.68
SiGNA CON�R TORORAUTHOAIZEDAGENT IDA7E1 w QP VALIDATED THIS IS YOUR PERMIT
. . �-/�--r�
SiGNATUREOFpWNERUfOWNER8U1lDE(�� tDATE� BLD SP nFTE
rtEW
ADDN
ALTER
tl
[l
Il
Consauction Address: �
Legal Description:
Owner Name & Address:
Co�ractc�r:
Ad�'ess:
CTfY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
�
Effective 5/26/93
�2 z�1
2
Tel. # s�Z-3�.3y�
MN LICENSE #
Atiach to this application, a Certificate of Survey of the
lot, with the propased construction drawn aa it to scale.
DESCRIPTION OF II1�IPROVEMENT
LIVII�IG AREA: Length
GAItAGE AREA: Leng�th
DECK ARBA: 2/ '
o�R: �m � ��
Width Height
Wic�h H�ight
Width /2 � �igtlGr�nd / `
�a- ` ,r �o' f� � ��,�
TeI. #
Sq. Ft.
Sq. Ft.
Sq. Ft. /�S�' �
Co�mea' Lot [ I Iaside Lot [� Ft. Yd Setback Si� Yat�d Setbacks
Type of Covstructia�: e r Esdmat�ad C�: $���'����--`-�
Ap�xox. Co�letion I3�te
(Cost � Back}
Driv�way �urb Cut Width Ne�d: Ft. + 6 Ft = Ft x$ =$
DATE: ��� APPLICANT: � Tel. # S�Z-�'.3,�
Permit Fee
Fire Surcharge
Spte Surcl�azge
SAC Chairge
License Surcharge
�r;veway Escrow
Erosion Control
Park Fee
Sewer Maia Charge
TOTAL
s � �a°
S - ��
S • S�
�
S
S
S
S
s
� �d� ��
' � .4_
Fee Schedule on Reverse Side
.001 of Permit Valuation (1llOth96)
$.SO/$1,000 Valuation
$750 per SAC Unit
�5.00 (State Licensed Residential Contractors)
lut. �Aw Or L1�t. �BM L'lUllYei
Conse�vation Plan R+evi,ew $450.00
Fee Determined by EagineerinS
Agreement NecessarY I l Not Necessary [)
STIPULATIONS:
i
. �
C. E. COULTER 8� ASSOCIATES, lNC.
JOHN A. PETERSON FRANK R. LENZ JR.
PROFESSIONAL REGISTERED SURVEYORS
REOISTERED IN MINNESOTA S W�SCONSIN LICENSED IN CITY OF MpiNEAP0�18
3300 LYNOAI.E AVE. S0. MINNEAPOLIS� M1NN. 55408
TEI.EPHONE � 612 - 824 - 03?0
i_. • --- '15.oZ MEAS. -- - .
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•,�J p Denotes iron monument - set
, • Denotes iron monument - found
N��
This d'rawing does not purport to show
fences.
13.45 .�• ��AG�
13.45 � EAK N
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17.41 5.98 � �
-- — - N � LEGAL DESCRIPTION:
N p4. •
Z The South 120 feet, front and rear, of
. au ';'
" Lot 19, except tha� part thereof lying
e�- 23.a3 East of the West 75 feet; and the
� West 75 feet of Lot 27, except that
� part given for highway; Auditor's
� Subdivision No. 92, Anoka County,
� Minnesota)
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Subject to essements and restrictions
of record, if any.
I H[REiY CERTIFY TMAT THis sUl1VEY, 1'LAN, 0!1 REPOf1T WAS 1'REMRED �Y
ME OR UND�lt MY Dtl16CT SU�ElIVISION AND THAT I AM A OULY 11E.OISTERED
LAND SUR� OR UND[ 7N� AW OF THE tTATE OF 1A{HNESOTA.
�
DAT[ IlEO. N0. �Ob�
CL�ENT COLDWELL BANKER
JOO N0. 11, 131 , ECALE 1" = 30'
SK./P0. 745/66+ � SNEET 1 OF 1-
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Building
Inspections
763-572-3604
DATE 1( U1 � U
SITE ADDRESS �
TH[S APPL(CANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
❑ OWNER
NAME: �� nn
ADDRESS:��,
PHONE:� Ul�- t
COMPANY NAME: �
YO(JR F-MAIL AI)DRESS
Permit No.:
Received By:
Date Rec'd: % � �
A
SUBMIT A COPY OF CONTAC7' P[RSON. _�,� l, {��ll �� _�
YOUR STATF STATE L[CEyNSE # EXP DATE
LICENSE WiTN ADDRESS: t�� I ��..���Y��^__C(TY � S7'A
APPL[CATION pHONE �����'�� ��)�-,, � FAX � '� O '
PERMIT i`YPE �SiNGLE FAMILI' O 7'WO FAMtLX O TOWNHOUSE
TYPE OF Wo)RK: �;' �'EW CXREPLACEMENT � ALTERATION/REMODEL
/�
DETAILED DESCRIPTIUN OF WORK ._�_���,L�__��_ 't
PER MS 16B.C65 die pem�it fee is a iru;�;m�n� oi 515.00 or 5% of :�ae total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a i�esidential tixture, exc�uding the fixtures. (This should reflect only the cost of labor )
Labor cost under $3�0 =- $1 �.00. Labar cost n;.hveen $�OQ to �50� = cost of labor x.OS -
FUR PROJECTS l�'HERE t,A�30R EXCEEDS $=00. FF'r_'S ARE 6ASED ON S'.Q00 PER F(�"NRE, E`CCEPT WHERE ?�,'OTI:iD. FIX'fURLS i?.'�l)��:.'A.TE COTAI.
�vUME3ER OF EACH QELOW} h
Fquipmentlnstalled �lFi�: ���iL R�nD[L: �IM��Vi� Sl"LEl13T1_�
I�iFG: ���� �±ODEL� !��"��� SI"L}::3TU _,�'L1�12.
MFG: MODEL: SI"LL,73Tr i
�A�'C $25.00 -----_ FII�PLACE (�?: �,S) $ t S.UO GAS ��:.\NGF/0V E �; 5 i V 0 ,_... _.— �
A(R TO .0.1R EXCHANGErR Sl5 FtREPLACE (WOOD) $3>.00 �NL•�V GA5 GR[LL S? 0.00
JBO(LER 535.00 �FURNACE $35.00 GAS UNIT HT[: $10.00
ACHIMNEY LINER �10.00 GAS DRYER $10.00 f'OOL HEATER 535.U6
lDUCT WORK $10.00 GAS PIPING 510.00 VENTILATOR �I� UO
PERMIT FEE PRCIJEGTS FOR UNDER $500
�ernut �ee $
Surcharge $ _ .50
TOTAL DUE $
PER1vIIT FEE FOR PRnJEC1'S OVER �500
Number of �xtures �� $ i OvU _, x� 10.0t� -- �
Number of fixtures (c� $15.00 x $1.i.OG = `�
Nuinber of fixtures aL> 5?�.UJ � x S�� �;0 =_ $_��
�'i.�l�€f-„c C.,vz--ri„i '��`c'.� '�cCn_',-��.;..�%C�n,..� : .�:.,. �{�.._.=����
StdlC JIITC:iaT%C - �_ ` 5�
TOial == $�
THIS IS AN APPLICATION FOR A PERMIT-yOT VALID UNT1L PROCESSED
I hereby apply for a buiidinD permit and I aclaiowledge that the information above is complete and accurate; that the ���ork will be in
conformance with the ordinances and eodes of the City of Fridley and with the Minnesota Construction Codes; that I�.iziderstand this is
not a pernut but only an a ' n for a vt and �vork is not to start without a pernut; that the work will h� in acccrciance with the
approved plan in die case r�c �.vh equire review and approval of Qlans.
SIGNATUREOFAPNLICAN� '�ME li� �� _�t"C[._I'����--
PLEASE NOTE: SEPARATF _�21�1IT'S ARE KEQUIRED E�OR BUILDING, ELECTRICAL AND M.ECHANICAL WORK
.___...____ � City of Fridley ~~�i ^�—_�.�
Building Inspections Department
6�31. University Avenue NE, Fridley•, MN 55432
'763-572-3604
FAX� 763-50?-4977
Building PLUMBING Permit r�o.: -�Co� �j
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Dat�'�:�3� a$
763-502-4977 FAX E�crivE i-i-oa
DATE 8� 13�08 YOURE-MAII,ADDRESS serickson@ericksonphc.com
srrE ann�ss 14 9 9 Gardena Ave NE
THIS APPLICANT IS: ❑ OWNER C'�ONTRACTOR
PROPERTY N�: John Bina
��E� nvnxESS�499 Gardena Ave crrY Fridlev sTn�� zir
TENANT
Pxor�: 763-572-2418
CONTRACTOR N,�; Erickson PHC
SUBMTT A COPY OF STATE LICENSE # 0 61419 - PM EXP DATE 12 / 31 / O 8
YOUR5TATE
LICENSE, BOND AND STATE BOND # 5 5 17 5 0 54 E�cr DA� 12 / 31 / 0 8
CERTIFICATE OF ,�Dx�ss: 14 71 9 2 nd Ln NE �� B 1 a i ne sTnTE MN z�r5 5 4 4 9
INSUxANCE Pxorr�763-783-4545 F� 763-783-4566
PERMIT TYPE � SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � �W � REPLACEMENT
DETAILED DESCRIPTION OF WORK Replace water heater & install water softner
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. Iabor cost between $300 to $500 = cost of labor x.OS = plus .50 surchazge
OR
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW). MINIMUM FEE $15.50.
BATH SINK(LAV FIAOR DRAINS SHOWER WATER PIPING
BATHTUB GAS PIPING (NEED CITY LIC) SWIlvtMING POOL � WATER SOFTNER ($35)
CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
DISHWASHER _ LAUNDRY TRAY �WATER HEATER ($35) FOR IRRIGATION
WATER METER OTHER
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Permit Fee $ Number of fixriues @$10.00 x$10.00 =$
Surchar e .50 Number of fixtures @$15.00 1 x$15.00 =$��-
TOTAL DUE $ OR Number of fixtures @$35.00 � x$35.00 =$�
State Surcharge = $ .50
MINTMUM $15.50 MINIMLTM $15.50 Tota1= $ •
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID IJNTIL PROCESSED
I hereby apply for a plumbing pemut 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 c ion for a 't and work is not to start without a permit on site; that the work will be in accordance
with the approved plan e of all w' h equires review and approval of plans.
SIGNATUREOFAPPLIC � Stacy Erickson DATE 8%13�08
APPROVED BY DATE
_ _
�.
`� � , s%'.
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977