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AF - 45367,�--� �� City of Fridley, Mi.n.n. N° 819 5 BUILDING PERMIT nat�: J'� 1�.� i965 Owner: �ED COMP�IY, INC. suilaer T&� TRED CE�PANY � ].�27 I,c»wrg �ivenue �orth Ad� 11�27 T,owry Avenne North Minneapolis 11, Miraaesota Miruiea,�olis ]1, Nlinnesota LOCATION OF BUILDING No 30 S'iceet GI��NC� ST. Part of Lot � 1& 52__ glock I Addition or Sub-Division Riverview Heights Caraer Lot Inside Lot g Setback 35� Sideyard 10� Sewer IIevation � Foundat3on IIevation DESCRIPTION OF BUILDING To be vsed as: one-Famil� Res. �t ��. nepth38� x��,t sq. r-t.1��8.08 a,, F.t, 17�DOO� Ftont Depth I�eight Sq. Fk Ctl. Ft. Zj►pe of Camstruction Dwellitlg Fst. Cost _�lOs Q00.00 To be Compleied OUTSIDc AFPEAR�;fVCE OF TH�c � �+ Ne�a House APPROVED VA(iIANCE WITH OTFPE{�B�ILQINGS N THI�S �LGCK. In consideratlon oP the f�uanae to me of a permit to construct the building descrlbed abave I agree to do tha p�opo�d work in acc�rdance with the drescription above set f compliance with a�l pro�visions of �dinanc�s oP the dty oP Fridley. �� Q (_,1 „ o In co�sideraiion of the payment of a fee oP 3�-1-�� , Permft ia hereby granted to TgtID CO.s I1VC. to construct the builciing or addition as descrYbed above. Thia t� granted u�n the express c�ndition that theperson to whom it is granted and his agente, employees an worl�nen, fn all work. done in, arouad and upon safd building, or anyp� thereof, shall conform in all respects to the ordinanc� oE Fridley� Minnesota locat[on, cwnslsuctfon, alteratian, maiatenance. repair and moving of buildinge wlthin the dty ]iadts� a�� pernoft may be r�voked at ar�y time upou vYolation of aay of the P�vistana oP esid ordineac�s. �TT^h.N G. J�;niiSEN B�� NOTIC� 'llds � doa � eewe t6s comleoeHo�e, Ies�aWtiee fer �In6� P��9. 6a 6udne, awu er wNer. B� an to a� 1M euildi� lo�ar to� pp�rw �mNs Por t6� N�ms. � � � � � A �� .1io�g� �.A�so�i�#�� r�� Office �� -� ., .- .�312-42nd AMe.No. ��<� R�GISi�R�D t�Al�t� �UI�V�1f4F�S ��,�p,oi�s 27, M��. Phone� Ks.3-�2�6 Minnesotc Regisfrcfion No. 552� Phon�es Ke. T-6047 F�l?5 !'ratt-.vsl�i�r� •?`o. � __ - �l � �r Book Page Fila � �� f�r._ . T�T� co. � � � �1 � -� � � „'�,� � �, �� d�� 1 � � .•' � �,S�o' O, . � S ` \ L ;� `� �, ,. /d � Q � \ b ea �� ,� a 1. ' i I �1 ; ,y � ('►� � � 1� o , �j O � l�/r�� tii.C/ �� i � ..� �'�' , .� � �� a� � a°.g � 3 � � 3 . �; p *� V � � � �. �� .� �� ` 6 wj a � �j,. a . e fi. ��: T her��y cer�ify that t}�is is a true and correc� x°epresenta�ion of a s�urv�3r of the bounc�aries �ai' Lc�ts 51 �. 5� , Black I, FtIV ;:;VIF::VJ H�,IGHTS and of' the locdtion ��f dll Luildin�s, if any, thereon, and all visi�le en�roachment�, if any, ir��m or on saici larc�. It �lso s?��w� th� location �.f the st�kes as set f'or � propased �?uildin},. As surveyed �Sr me tizis 9t.h . day of June , 19b5. ; • °' ✓ y, ; r � ` , , �� s + -.m a. �:'m. L. Voi�t - :�t�rv�yor _� �. � �Yb � �1 �: � �� y` , �- � � d � � � 'd �-�i EL y p M : � : `1. :Y . m : M : o . a . � O • � : � ' t!! • N � � � r y � � W � � p � � �' o � � � N • o • o • o $� : o . o . � � : F� � i4 k 5C N N � O Q O � �9 � N o '� � O t' z � � � � � m � � z x 8 � � � � n � � � � � � �u m y ry ay �� d : O � � � o' ,d � y � p � � �' : � N . W _o° : � : O4 � � � . . O ' bd : : : : : � : : : : I I I I I I � iG yC k >! >C id W N W f+ F+ t�+ �J C�71 Q � O O O � {fl {/3 {� .g9 {y H H C�" 0 a x � � r � m � n 2 m C r m � � �z � a � o � � Q. .�, . � w p � p� �7 � R. p, � e�e m � � �° � � �� I � � �� 8 $ M � ❑ o � � � °0� � � tn Orf, � o � m a � � �• � � 7+ g � � a . � � m � � 0 WATER a� URINALS e�rH � e�s�►� SINKS wast+ �� DRINK. FOUNT. s►+wris. FLOOR DRAINS CATCH B/1$INS �uro WASHER GAS APPL cws RANGE GAS OPENINGS � • 2 � � � > A f+ � aa� ."��' � � � �. � ~ �a`D � y � � � o � � � � � �C y � � fD i7� Ir. y � � � � � �� a � �°�y� �� b �� o�� p � �' o g p. n p O` id � .°y o � � M � ~ � � � w � ¢� ��: �� ° �. � � w ~ � M M "'�.� �: i�i' ►� � � � I b � 3 `� � � � ti d �A � ro a� R � & �°n p � M � � i� � � m -p � ' � � � � � l0 � � � � � � � � � � � O M bs � � �• O � w � � � � a m '" �,• � V no 0 � � -�1 � • � F� � , � � � � � � �� ' � � . � � � � � � � . ,. � ' � � �� , • � �{ .� � : � a ; : � y s • r � o � • • • � a s� � e � o � � � • q W • * ' � � 0 v ► s e Y • • s � � e a � e � o �7 � • s • • • a a � e �(p } } � � • �. � r • • � t • � e � • r • o � • • � � • • � • v .ry • s , e . e r � . �N. • • • • • e • • � • u • � • i • a � • s o �I,,,rj i • • f • � f • • R � � • • � • � P � M M N p M M � M M 1/ AA �;, �� » � :� � r � �. � � � � I� � � � � � , . cs . � v a �,, � . � . � � �� ' , � � i � . �. .q i� �, , , � � , � \ . � N � , A� • � , � , � P � � � ' � �'1 �i � � e � �o 3 � w � � �1° r � a , n 0 � 4 � , ► � • • �� . o. �i .� � � � x � � � � � � �� i O , � 1 �� .� ~� . �� . � �� .� �� ,.� � ;. � � � is � E � � �� RO � � � � G� � . � �� w ., � �� , � � �� sue�ecT E T N O. c�ty of Fridley 17921 ' ` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ECEIPT NO r � ; y _ COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. � � 9 1 i � ' /�"1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BV �"'"� � �� 612-571-3450 910-F15 4/22/85 / / JOB ADDRESS 530 Glencoe S'tTP.G''t N. F;. 1 LEGAL �OT NO. BLOCK TRACT OR AODITION SEE ATTACHED oesca. 51, 52 I Ri.verview Heights SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PNONE Herbert/Donna Bi.xler 530 Glencoe Street N,E. 784-�0099 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO. Sama 4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PFIONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 8 USE OF BUILDING Residential 7 CLASS OF WORK X NEW O ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Cons truct a 20 F z 22 ` Ga,ra,ge 9 CHANGEOFUSEPROM ' TO S71 PU LATION S Provide a hard sur�ace clrivewa.y�.. SEPAHATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OH CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANV TIME AFTER WOHK 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 TYPE OF WORK WILL BE COMPUED �5�363 . C?O �S`2, GB WITH WHETHER SPECIFIED HEHEIN 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $SGa SO PLAN CHECK FEE TOTAL FEE $59,18 SIGNATUREOFCONTFACTORORAUTHORIZEDAGENT �DaTE� � WHEN PROPERLY VA ATED THIS IS YOUR PE IT �—�"��----�.�'.---�-�A .a _ � � �� 'iGNATURE OF OWNER iIFCOWNER BUI DERi IDATEI BLOG iNSP ipTE � NE1d (� ADDN. [ j el,T�t. I J Construotion Address Legal Deso; Owner Name Contraotor City of Fridley R-1 AHD R-2 Buildir�g Permit Appliaation Effective 4/1/8�1 � ) �� U (,� � Addreea: •ttech to this applieation, a Certificate of Survey of the lot� with the proposed construction draWn on it to scale. DESCRIPTIOH OF II�lPBOYE�iT LI971�G AREA: Length Yidth Height Sq. Ft. �ARAGE ABEA:� Length � Width �� Height � Sq. Ft. � DECB AREA: Length Width Hgt/Grouad Sq. Ft. OTHER: Corner Lot [ 7 Inside Lot L� Ft. Yd. Setbaek Side Yard Setback Type of Construction:��ra �. � Q— Estimated Cost: SX � � UU. Oc,� Approx. Completion Date: � ' ��%- ��' `�'��'�'� Alt. A Alt B Proposed DriveWay Width If NeW Opening Is Desired: � � See Back Page for Explanation /� �. � � k DATE: � " r ��. �' APPLICANT: TVi%�,�,��'�-f`�e.vc. � • �:�c,�0�_ Tel . # ��% - O U %�' Permit Fee Plan Check State Surcharge 3AC Charge Park Fee Ser►er Nain Charge roraL STIPULATIONS: CITY QSE ONI.Y � � % � S� � � � • � C� � a � a '� �'. �,� Fee Schedule on Reverse Side 25� of Building Permit Fee �.5o�a�,000 vaivation a425 per SAC Uait Fee Determined by Engineeriag Agreement Necessarq [ ] Hot Necessary [ ] .,� , . � BIIII.DING PBRMIT FEE SCHSDIILE The Chief Building Official ahall, before issuing permits for the erection of any building or atructure� or Por any addition to any euisting building or structure, or for any alteration or repair to any euisting building or structure� upon application therePore, require the payment bq the applicant for such permit of Pees Lo the amount herein belo� set forth aad in t�he manner herein provided to-wit: Total Yaluation Feea =1.00 to ;500.00 �10.00 (Minimum Fee is �15.00) �501.00 to a2,000.00 �10.00 Por tbe first a500 plus �1.50 for each additional �100 or fraction thereof� to and including �2�000. �2�001.00 to a25�000.00 a32•50 for tbe first a2�000 plus �6.00 for eaeh additional �1,000 or fraction thereof, to and including �25,000. �25,001.00 to �50,000.00 �170.50 for the first �25,000 plus a4.50 for each additional �1�000 or fraction thereof, to and iacluding �50,000. a50,001.00 to �100,000.00 �283.00 for the firet �50�000 plus �3.00 for each additional �1,000 or fraction thereof, to and including �100,000. �100.001.00 and up 5�33.00 for the first �100,000 plus �2.50 for each additional �1,000 or fraction thereof. DRIYEiTAY DEPRESSION ESCROiT (Concrete Curb Streets Only) . Alternate "A": Removal and replaeement of curb and gutter only - Driveaay width plua 6 feet times �13.50 Alternate "B": Removal and replaeement of curb and gutter and install a 3 foot wide approaeh with 6 inch depth - Driveway �idth plus 6 feet times �15.75 VERIFICATIOp OF FODNDATIOA Permits for construction Will be issued a minimum of 24 hours from the time of application to a11oW for proper review of the proposed structure and of the construction site. A CertiPicate oP Survey of the lot� showing the location of the foundation onee it has heen eonstructed r�ill be required before proceeding with the framing. � -. ; Wm. L.Voigt 8� AssociQtes Inc. Office �� REGISTERED LAND SURVEYORS ��po isd� M'u�iR eq�poN� �2, M��' Phote� Ke. 7-604T phon�� K�.3-8246 Minnssoto Rayist►ation Alo. 5522 61�5 ''et`vs�ur�* �I o. � - � \ � , �' � � fQ� .. . T�T� c�. -- � � .,. � � /% e rr ay � f' � ` � : • �.. �.. C t Li � a +..t 5� ;�r . � t�,� � Z�.O i i � 1. •� . � `� , � � �� 1 R t � � , � � . � �e .�` � � � ' .� `� ;e 1 1� fl � ♦ � A � � No , ► � � 1lr�o i. � �; . � � �� ,_ �a'� , ! '%�S ' �f� r 'v . . 1 � ,� �a � ` @ � ��4`* r `� ,� � n : here�� rLify that this is a true ar.d correct re�reser.tatian o,f a surve�r of the bour.carie� of Lots 5I � S� , bloc�: I, FtIV ;.�:VIt:Vd H�;IGHTS and of �,ne locatior of ail 'tuildings, if any, � thereon, ar.d all vi sirle en�roaChr�ents, i� ar.y, fr�r-i or or. sd�c - lar.d. It also shows t'�e locatior: �'' tre stakes as set for a pro;�osed buildin<:. As surveyed by r�e this 9th. day of June, 1965. ,, - r' °' . . ..s.� � "_ r� '. �f' r-. , .- '/ ' • ' °��L�°�''� 800k ':;m. L. VoiFt - �urveyar -- P�oqe � = Y - . . . .. � �S .-. * rt D � C� � o � � m a: 3. ? � � y. � O N � n -., n� o � � � 0 d '"" d � 0 �•-Q � fl' a� � fD � �.' 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"' z 3 0 � a r. _ 0 `2 � CC ��-. � � � a v rn [n � � � rn v C�i 0 � -� � Q !� � m � � z O �� v ` � C r v z � c � rn v O Z � ,� � � J�, � � � � � m N c� 2 m v C r r� cn -n � n �J =. .p, NaW--I �� rn� C O o � -n � � -• '�t z�� W � � N � z z� m� m C7 � O z 0 < � � � � Z � r r�n > a � � Q mZ � O �� o� z° z� v n� �Z O � vZ . -i v � o= �-- Z m � Z -�i D +n z o �� c�"n m � 0 �, N o �R aZ �1 � Z � v� O � Z C � n r � n rn� �o � Z � � � � rn � � . � � < m � O � . c_ v � c v K F-+ N O O NEW [] ADDN [] ALTER [ ] . I� � _ Iy; �� CITY OF FRIDLEY 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDfNG PERMIT APPLICATION Construction Address: �� s�v1 �C7Zl� �� ll�� Legal Description: Owner Name & Address: �i ►� � °� � a'��o � Tel. � " °� Contractor: A/ a Q MN LICENSE # Address: Tel. # _ LMNG AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Cert�cate of Survey of the lot, with the proposed consttuction drawn on it to �scale. DESCRIPTION OF IMPROI/EMENT Length �dth Height Sq. Ft Length Width Height Sq. Ft Length � �dth Hgt/Ground Sq. Ft t^ l'-�•r �e�S C� � �c�(.�� 0 Construction Type: ('t�� o ��;�� c�c�c�oc� Estimated Cost: $ �C� Driveway Curb Cut Wdth Needed: Ft + 6 Ft = Ft x$ _$ (, -- --_. _ _ DATE: Co � C� `C�� APPLICANT:� --- Tel. #C 7�� )��G�°Sa� Call (763) 572-3604 for Permit Fees if mai(ing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge � � � � S� � $ �� $ $ $ $ $ $ CITY USE ONLY - Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1450 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 $ �� •�� STIPULATIOfdS: BIT�DING 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 repa.ir to any e�sting building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided tawit: TOTAL VALUE $1 to $500 $501 to $2,�30 $2,(�1 to $25,000 $25,�1 to $50,000 $50,001 to $100,000 $100,(K)1 to $5(10,0� $500,001 to $1,�0,0()0 $1,0�,001 and up FEES $23;50 $23.50 for first $5(� plus $3.05 for each ad.ditional $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 $50,0� $643.75 for first $SO,OOQ plus $7.(� for ea.ch additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,� plus $5.60 for ea.ch additional $1,� or fraction thereof, to and including $5�,000 $3,233.75 for the first $500,(�0 plus $4.75 for each additional $1,0� ar fraction thereof, to and including $1, 000, 000 $5,608.75 for the first $1,�0,0� plus $3.15 for each ad.ditional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - driveway width plus 6 feet times $20.�. VERIFICATION OF FOUNDATION Pemnits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Sbrvey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Only NEW ADDN ALTER Il [l Il CITY OF FRIDLEY 6431 University Ave NE, Fridley, MN 55432 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: .�� ' Legal Description: Effective 4/1/2004 (763) 572-3604 Bldg Insp (763) 571-1287 Fax �aoS�- 6��93 Owner Name 8� Address: �/��r°"� �iXl ��'► Tel. # Contractor. � �� HOYE REMODELINa MN LICENSE #�a S/S'9S � LMNG AREA: GARAGE AREA: DECK AREA: Tel. # Ph. 763572 2577 Attach to this application, a Certificate of Survey of the bt, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft Length Width Height Sq. Ft Length Width Hgt/Ground Sq. Ft OTHER: �xts.�.� �c� � / � Construction Type: /�e�i�� G�.�►'�� Estimated Cost: � 1� B�. �°t1 Driveway Curb Cut Width Needed: Ft + 6 = x$ _$ % 3 DATE: �� A5° � S�" APPLICANT: Te1. # S'7 2"�� Call (763) 572-3604 for PeRnit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ � 2 �� $ $ � . B� $ /. �� $ .$ � � � $ $ $ $ $ �'/�•�S° CITY USE ONLY - Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation ' $1350 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 [ ] STIPULATIONS: � � ♦ BUII.DING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing pemuts 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 sttvcture, upon application therefore, require the payment by the,.applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: TOTAL VALUE $1 to $500 $501 to $2,000 FEES r , :�� ;;;� a .� s �rr� �� , . s -, r� s�� a�:.i �° �,��;� $23.50 '��4' � �W �;� ;�� ,�<�^�,�� .,�a `.... .. !�:*�« �.ry 3 I� -_ �! $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $69.25 for first $2,Q00 plus $14.00 for each addidonal $1,000 or fraction thereof, to and including $25,0� $25,001 to $50,000 $391.25 for first $25,0� plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,�0 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up $643.75 for first $SU,000 plus $7.00 for each additional $1,000 or fraction thereof, � to and including $100,000 $993.75 for fust $100,000 plus $5.60 for each additional $1,Q00 or fraction thereof, to and including $500,�0 $3,233.75 for the fust $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,Q00,�0 plus $3.15 for each additional $1,Q00 or fraction thereof CURB CUT ESCROW - - (ronr�t� C�rb Street1s �n�y) - Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined rate 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 construcdon site. VERIFICATION OF FOUNDATION A Certificate of Survey of the lot, showing the location of the existing foundadon will be required before proceeding with the framing. New Houses Onlv Building lY�CI-�ANIC�-L In.spections �S�ErTT'� APPLICAZ'ION 7.63-572-3604 �I�y ��, g,��,��j,� DATE � � - ''� ' � � YOUR E-MAIL ADDRESS STI'E ADDRESS _ THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITT3 APPLICATION PERNIIT TI'PE TYPE OF WORK: � OWNER �ONTR.ACTOR �� C1�� iGllllil 1VU.. r Received By: n��aN 0 V(� 6 20 ADDRESS: �� c' � g ✓l � � �-- i� fV � CITY ��I � ( � _STATE�i a" ZIP $�g � � � PHONE: 'A �•� °' 7 S�' � S e� 0� COIvg'ANY NA.ME: ,�.�. dr a/ �v� s� I�a �... � �' m- �� 9 CONTACT PERSON: G�^ ✓ d � �-� STATE LICENSE # E7�' DATE ADDRESS: �� °`-' "� �� t� � CITY �d� i O �� v�_STATE M �' ZIP vS 4 3 i PHONE "D 6 � � S �� FAX '�INGLE FAMILY ❑ TWO FAMILY p 1•rEw Za°x�La,cE�rrr 0 TOWNiiOUSE ❑ ALTERATIOAI/REMODII. DETAII.ED DESCRIPTION OF VJORK'�sE �l l I�. �l G;- �� '°`� �w rra- � a� �-'�' — PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the totai cost up to 5500.00, whichever is greater, for the improvement, iastallation or repiacement of a residential fixtzu'e, excluding the fnctures. (This should reflect only the cos# of labor ) Labor cost under $300 =$15.00. Labor cost between $300 to $SOD = cost of labor x.OS = FOR PRO.IEGTS Wi�RE LABOR EXCEEDS $500, FEES ARE BASID ON $10.00 PIIt FIXTURE, EXCHPT WHERE NOTED. FD�TURES: (II�iDICATE TOTAL NUMBER OF EACH BII.OV� � V� � Equipment Installed . MFG: i� .v v Y� MODEL: l J�P4a ° A� � tS �°f ��- SIZE/BTU ,��,_ MFG: MODII.: SIZE/BTU MFG: • MODII.: SIZFJBTU A/C 525.00 FIREPLACE (GAS) 515.00 . GAS RANGFlO,VEN $10.00 AIR TO AIR EXCHANGEEA $IS FfREPLACE (WOOD) $35.00 =� iJNIT � 0100 � BOII.ER $35.00 �FURNACE $35.00 _CHIDRVEY LINER $10.00 _GAS DRYER $t0.00 POOL HFATER $35.00 DUCT WORK �10.00 GAS PIPING $10.00 VENTTLATOR $15.00 — , �� Permit Fee Sw�� TOTAL DUE _.-_, __�__... _ __�...__. _ _. $�� u Number of fixtures @$10.00 x$10.00 = _ � _ _gQ_ _ __ __ Number of fixtures @ $15.00 x $15.00 = $ $ ;`�r� Number of fixtures @ $ZS.00 x $25�U = $ — Number of fixtures @$35.00 �_ x$35.00 =$ �S. � � State Surcharge = $ -SU Tota1= $ 3 S• � u THIS IS AN APPLICATION FOR A PERM�T 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 Pridley 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 requires review and approval of plans. SIGNATURE OF APPLICANT l_ �- n� i �o I � �-rD PRINT NAME C � r t .l � �. �p � DATE l � " � ' � � Cnty of �+'r�dle� �uilding �nspections �epartment 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAJ�: 763-502-4977