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AF - 46408�r., i � City of Fridley, Minn. BUII.DING PERMIT N° 3� 15 �te: . .y' . �.3 .: ...� �. .. .... . ow�r ....................................... suuaer .Li:Y�iSG+/..��-!�!�!GQ'°L..�.oX+t.�—� Addrees...................................... Address ............................................. p� LOCA,7/'I�ON OF BUILDING �.oc f.o�0. a .. s�x t. .. ..C� . .!V/.4f�4, . .. . ... P�c c.vt.e�,v.*�.!: .�a.T.`�i..G� naainon or subn;visiy" q r y a�r �t . .. ...... .. . � r.� i!C . ..... ... ser�x.�s�:. P. ... siaer�a ..1. Q --Q .... ...... .. .. .. .. DESCRiPT10N OF BUILDING Tb j�q Uaed : !� !� G !� �..� . : .. . FY'aM �i4�.:� �� °.4.��. .j.����t � 7 -� 59. Ft�Q R� �. �✓yyz�- . . . . r�,c %5.�.'D. n� �?.1.1 � `x�n' t �Q.-:a 'sa. r�?. 9..5.!'. cu. r�. a�'S.!fl � or co � ................... �c. c�c../.9�89.. =. .. . To � c«���a ................... In constderatlon of t.he Iseuance W me ot a permit W construct the building desribed above, I agree W do the propoaed work in accordance with the d�crtption a6ove set forth q�ad in compllance with all proviaiona M m�dinancea of the city of F7id1eY. /1 // _ � A A ��/,�1� !r�/L'/,�-'�`�j,iM�n%��.'�� �/ ao V In conaideration of the PaYment of a fee of S•.��. .��. Permit is hernbY �ted to ................... ........ .................. to construct the buffding or addit3an as described above. This peimit is Sranted upon the e�resa oomdttton ihat the person ko whmn St Ss gianted and Lis aBenffi, emploYees and worl�ea. in all ww'k done in, around and upon said bullding, or atq part thereof, shall owiform in all respects to the ordinancea of F�idley, ffiinceaota regarding location, cata94actian, alteration, maintemnce, repair and moving of build'mga wiffi- 5n the city limlts and this permit may be revoked at any time upon violatlon of sny of the provisions of safd ordinances. ��"��i�.i�'ii NOTICE: This permit does not cover !Me oonstructlon, InRallation or altention tor wl�lny, plumbinp, gas sewa� or wate�. Be wre tu aea tl�a 9u11dinp I�npeotor tor qparate pormlb for theae {tema. � A�"�`r;" �� � N tL � � O C � �U � � � � � 0 a� i � Q � oa H � � U� Ra � z �� � � Y�� � F � � a�,� �������o M U �� ro r3 v a a g� �, ,"„ m i3 �p, �' o � S w 0 A � M �' C m �y :� G �p'� a��� ���9m xw��+ �3°� Y ❑ �� �Ca d � q � � b � � ,o�a�, ���w� � ��o� � ��m� � �. �� � �s� � � 3 � • z • a sv� 3�JNVa �� ,<ad r� M3HSVM SIJISVfi iOlYJ SNIVtlO aome 'StlMHS '1NOOi MNina SAVal HSVM S�NIS SNISVB seni S�vN�an S1.iOlJ a31vM �"�r � rl �y e�l � ✓ � � � � � o � '" q U Gi � 3 � o � „ m z � � � E ["� O �I N � W � � 0p0 A � � �M �z .� W J a 0 W N W 4 � J a � a O� � � � w � g � � � y Q � z � .� � o a � � o � . m � � �. Cy � � �� � F eN N �Hi LV O N O LV � ri .-i ai M ei! w ae x oa x x �� ' : � O . . p� . O ',,,�0 . pp � q . p i�i � �� � o � E d g� .. "o °� � � o � a w � � s Q � � �i �C � xi Q m �*i � C7 ������a � z � z ci � z � �� � Ie b 1[i O a ; � IC X k � I I Qp� � Oo O � � wW '�3 � sroro W �q � � o F � � � � � . F� : F U .�i O � z 0 a � � � � a a � City of Fridley, Minn. BUILDING PERMIT Date: ....._....._�-...-... -_._/...r...�.......,...:...._!'...�......._.._—.. owner: ._, .r..'�.� ::_-._',C�.CJ..:....��._`.�, �G--fi�� Address �.�i._.�.,���j�({F_..-_'_C'�iY3t, t�� �' N fr�f �94 �� Builder ..... ..._.__. ._. _•1�a!'_�'_. _�-�' ����-'�L=L�!. _� �_.. l�ddress _....... ..--..__.---_ ___. /q�/ /��,� j�j,QCATtION � BUILDING No. _I.�..i..:....-� Street . �'7z�,1?�'�_J �... .. /„�(...,...�t'�„�....___...�art of Lot ._- Lot ....._ . .....__........ Block ...._.. _ _.......______..._.... Addition or Sub-Division .._ _.........-- Corner Lot ..__..._..._.___........_. Inside Lot ..._.___..._.......___._... Setback ...__ .................._..._........ SideYard Sewer Elevation To be Used as: Foundation Elevation DESCRIPTION OF BUILDING Front _......__.. Depth __._ _._._.. Height ___. _. Sq. Ft. __...._- Cu. Ft. ---- ___.. Front �. �r' :�'Depth . ._. � Heig-�ht �7 ` Sq. Ft. .__ Cu. Ft. __... _. Type of Constructaon v_- �.-r,� :° �__....__ .. Est. C�` ! r.(,r "�" f' To be Compieted ._ . t .�-:f _.... .... In consideration uf the issuance to me of a permit to construct the building desccibed above, I agree to do � the pmposed wa¢�k in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of F'ridley. �� x r �' In.rnnsideration of the payment of�a fee of $_�.._.t'..."""=.....' .�permit is hereb Y �ted to.....,..._..---..........._......_.--......._.. --___...__.....__.._._.__._.___.... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof,� shall conform in all respeots to the ordinances of Fridley, Minaesoffi regazding lxation, construMion, alteration, maiatenance, mpair and moving of buildings within the city limits and this pernvt may be revoked at aqv time�,}� � olation of any of the provisions of said ordinances. / � / . . . - �_'r_;�..:,..:t.�,c. `� i� ° _ •,j Building Inspector NOTICE: ihie p�emh dces sp} tpvar ffia westruMien, inqallalion for wiring, plumbinp, pao Aealinp, sawar or wdar. Ba suro to fes the Building Insp�cbr for ppanls psrmih for 16ssa iNms. . n w � e+w. �'' �4 �p�a ���tV1�fi f���$-NQT �lUTHORiZE VIOLAT- fQ� �', ���;Y �'FIv.11"E LA�.0 cU;�=_r;aNrs arv� �u�i��iivG f����'tr;�nc�ra�. O:7x1@I' � B .�C�T888 � APPL2CATION F�t BIIIi;DING PFS?Mi4 CITY OF FRIDLE7f, ZIINI�I'SOTA ' � i I'i�%��--i ��' IACATION OF BIIIT�UING , of Lot Lot Block Addit3on or Subdinision Corner Lot Inside Lot Setback Side-Yard SF�R. ELEVATION FOIINDATION ELE1rATI�i 6�pplicant attach to thia form Certificate of Survey oP Lot and proposed building location. .�'`� /��� � ESCRIPT�F BU IDING To be used as: � Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft T�,/pe of Conatruction Estimated Cos _/�i� To be Completed The undersigned hereby makea application for a permit for the work herein apecified, agi'eeing to do all work in strict accordance vith the City Ordinances and ruling oY the Department of Buildings, and hereby declarea that all the facta and repreaentationa stated in applicatio�} az'e true and correct. / � / �fJ I �/ --7� �j_��c � C� l �--(J . ,,..� � � � l . �S� _� / // crr�a�mrrov .�E� � (A Schedule of Fee Costs can be found on the Reverse Side.) -�.,>,a�✓6. s` ' � � � � 1 ° � . sm � I �o�� t U n � u c m- yo IJ d G 'y i L V u ? �' : s- o t L J L Y L b y i� L � p V (J V y V j ^J C Y O � m a y e � � rn „ _ d V 6 M y i � M L �+ i.(� d o _ � v v _ � � s. a c a � � L � � ti � �,,,� O O� u S � Y C �i y L M C N m H V � J� .� � fl U ��.� m .+ � a ,� � a, m CY y y a �. 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V O n ' N 'D � a N I N � ri - . � �. m o p� c a = 6 V � 8 ° � � � wW O F U N 4 � � � - R� � G n �q o i � 4 � [� - a � C ` ;.� E .� � � u O � � .] V C � � � O Ll 4+ 2 en U E � C � 4 V g 1 c] p p m T N N O U1 � O Y � F Ll O L 11 J U 2 +� w e vl 3 � 2 y c� V � I I � � c � � o c ( � � I I I ti 9 I � O U ( I I O L U X" u -� Y (u � J 4 � 'j Y ( ' I r,. z T � .N.I 9� ^I �e I s � c � � u .a a o a � 0. _ _ O G 0. �" N � a �f C H � O cJ a � ` y � f.�, 4 t -���(II(I1I( ������ � iG G � � y O N G � M � N Z a U � � a � O 3 r � Z E l ! �(� � o 0 0 0 0 0 0 0 0 0 0 o a o p-. o 0 0 0 0 0 0 0 o a o 0 0 0 C �a u�i v� w�� .��s .n vs m� us .n � N h x x x x N x x z H x x x �° IIl.11llll III U) � H ¢ � C C " H a � � � � ma g ¢. _ a y o � - m o a � . � - a F— � y� o� � F N L �.� F- . m . o m - . m 2 `+ � c -m � u O u O_. � O T..1 m �• m O O m O � O O 4 O f . L"1 d O,J -� � u a+ � � � p v u O — 4t . � � � N y � � O o a O .� � 4 c ti F.., � 4 Y _ ¢1 0 � � '� N J � � � J u Y C 4 4. a O C m O � 4 v � J ¢ ' O � �. -%+ � u a O �� c Z L Y a a ,� o. v �. W n u- O J a F. .� O C us +�'J � 4 y y m �� N y � � � �1 V] a L [r L Y� f Y U J .� u C. 'Y +� [L1 � J V J U {� � � �. n L ] J J j'U J^'.t � • U �. � t c3 x s ':.i C .... � a u a. u 6 U � c Q t U Y t] N � � 3 t s o N H 4 O F U :.� G � � r� � g'� • i 1� Aest d f QURES� AGEB'S OFFICE SUB,IECT: Dangerous Situation on Street 1032 Hackman Circle. Request . by Councilman Barnette MEMORANDUM dF-161 The property owner southwest of 1032 Hackman Circle is pumping his basement sump water onto the street, and this water freezes on the street creating a hazardous situation. All other neighbors are pumping into their back yards. Look into this situation and work with minimizing this problem. Thank you for your assistance NMQ/la CC: City Council 12(1/82 To: City Manager We inspected the properties at 1024 and 1048 Hackman Circle and found they both were pumping sump water onto the street. While the Address file does not have any correspondence on this issue, the City has apparently authorized this action as the drain pipe from lot 1024 is built into the asphalt curb. This must have been allowed because the proper- ties are sloped to the street and there is no other area to put this water. We do not allow connection into our sanitary sewer system as this increases the City's cost fran MWCC. Because of the recent wet, warm weather the basement pumps have been working. Once it drys up or freezes the system will not place any water on the streets. Suggest we allow the existing system to remain as there is no good solution and we have a number of the same problems throughout tfie City. JGF/mc ��� �� CITY OF FRIDLEY E�31 UNIVERSITY AVENUE N.E., FpIDLEY, MINNESOTA 55��2 �r 3, 1982 ;riens ickman Circle �. Minnesota Dear Mr. Kriens: N.E. 55432 Re': Sump Pump Discharge TELEVNONE (612�5I1•�ISO It has been brought Co the City's attention that you are dischargin9 your sump pump water onto the street resulting in an unsafe condition and a violation of City codes. Since it is not permissible to pump sump water into the sanitary sewer system and your property does not allow drainage into the rear yard, I am sub- mitting to you a possible method for eliminating or at least reducing the amount of water discharged onto the public street. The attached plan is designed so you can accomplish the work by yourself with minimal cost or effort. Approximately 10 feet from the curb you can dig a hole and install a drum of sufficient capacity to hold the water pumped. This drum should have holes puncfied in tfie sides and may have holes punched in the bottom to allow the water to percutate into the ground. Loose hydrant rock should be placed around the outside of the drum to insure the water can easily enter the soil. A baffle at the top and between the inlet pipe and outlet pipe is required to prevent direct flow through the system. To insure the top of the drum does not collapse, a concrete lid, larger than the drum , should be placed on the top and can be covered with sod. Request you complete this change in your current sump pump discharge system by Ju1y of 1983, as a means of correcting the existing problem. If you have any questions on this matter please feel free to contact me at the Civic Center, telephone 571-3450, ext. 159. .____ Thank you for your consideration and assistance on this matter. Si ncerel .f�C� � :l Kn 6. 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N �+ y � j Z � � N G/ CO N �a a -o c m c c�i d ��' m a� m � d � � � N N N � li Q C7 C7 � � N A C7 N N � ¢ � C O � c U Q W O I Z N � m U � � N C 3 m d 2 49 Y Q m Z Q � v O H3 C o � Y Q 1`O � � C ¢ !o 03 �. � Q •� O a � 3 � i � a> ,� t O O � Q � C � R � y C L � N O in � V U ; � w U � L N +L+ V �-' L ` � � N `� � �+ O ++ •- l6 U � r � .N V d N N G. � m � W'O U..`- w U � d C � � l6 R V � � U y L A �. � -G U n C C Q R Y � a Y � O � � N 3 VI L E'°'-c T O O • - �---'�-�. toz. � p c �; m « � '6 � 7 y � y m C m.,a�o • pQ L :. daoc C w y N da�ima Ft- w � � Q '.\l w Q � \`' V! fi9 Y O � O U C lp W n «a N p 7 � N c � \ > m ` o m 6 u� � N V � � `m L w U '3 tWi_ � « � R � O O U c7 Z Q W S # J w F S \ O n � w W W LL Z 0 U w a � Z W � � N � C t OO 7 0 � m v a� O a a Q 3 0 t 3 vti l d T3 � o � � N � R n � o V n U � R C n� L V y m c o c � A U C y. 0 i �1A m C � O y L 'v a C U� L Y .` ¢ 3 763-572-3604 763-502-4977 FAX SITEADDRESS fl: THIS APPLICANT IS: PROPERTY OWIVER TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DESCRSBE WORK BE[NG C ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: S IN inyl A{uminum ❑ Other __ ❑ OWNER BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY ADDRESS: YOUR E-MAII. ADDRESS fJ PHONE STATE I.ICENSE # J,�SMGLE FAMILYMEW CONSTRUCTION ❑ TWO PAMILY/NEW CONSTRUCTION ❑�D DITION ❑ GAAAG �PIBASEMENT FMISH ❑ ROOF � DECK SIDING ❑ NEW HOME CONSTRUCTION ❑ MAINTENANCEJREPAIR WINDOWS �/ IN EXISTTNG OPETJINGS �BYes ONo OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & l TYPE OF WINDOW TO BE INSTALLED [ P� ALL FEES ARE BASED OD TOTAL JOB VALU Permit Fee Plan Review Fire Surchazge Surchazge License Surcharge SAC Charge Curb Cut Escrow Erosio� Control Pazk Fee Sewer Main Chazge $ $ $ ❑ ADDITION j�LEMODELING ❑ HOUSE ONLY ❑ HOUSE & GARAGH ❑ ATTACHED GARAGE ❑ DETACHED GARAGE Permic Received ��,:�•: ;. � ii: . 1 a� � i � � t� u �- STATE M ZIP S ' STATE ZIP JATE — a Alio FD� WS TILE raa �4aa a►a rebu�ld � BASEMENT REMODELING SUBMIT: L Existing Floor Plan 2. Pmposcd floor plan 3. Lis[ of swcwral members to be used, FOR NE W CONS7RUCTION INCLUDING DECKS, ��,� ADDITIONS & PORCHES SUBMIT: ❑Trim �. Si[eP1an/Surveyshowingtheexis[ingSW��rcs and proposed project. �'Fascia - 2. Two sets of conswc[ion pla�s 3. Energy Calculations LOCATION OF WINDOWS ' �y NUMBEROFWINDOWS 1 lALUATION, INCLUDING THE COST Of (USINC THE 1997 UBC FEE SCHEDULE) '�' �— n('('1 AND See Back Page for Fee Schedule 65% of Building Permit Fee .00I times the total job valuation .0005 x Permit Valuation Minimum 5.50 $5.00 (State Licensed Residential Conuactors) 51825 per SAC Unit (Plans to MWCC for determination) ft+bft= Rx$21=$ $450 Conservation Plan Review Fee Determirnd by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks oavable to: City of Fridley Atta� THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building pertni[ and i acknowledge thffi the informalion above is complete and accura[e; Ihat the work will be in conformance wi�h the ordinances end codes of the CiTy of Fridley and with the Minnesota ConsWC[ion ; ffia[ I understand [his is no[ a permi[ but only an applica[ion for a permit and work is no[ to s[ar[ without a permit on site; thatthe work will be in accorQ�u wiN� e vcd pl ' the case of all work which requ review d approval of pyla�C..�� � SIGNATURE OF APPLICj�Aa3�7 ( PRINT NAME ��� SM� +� DATE:�� APPROVED BY � > - � ------ , —f ! t� � .� �� �; ��--�__�� o � ..�� ,�`,, s - .� � �--- } ' O�; ``` a � �---�.. �` � — , �, � �t � , � � ,P _ �; P . � . — '� '� . . r , �,,_-�- ,; , `� ;�;, ----- �� _ -� � _ ; i_ , i � o � ;fi_ . s � � I i ;_ _ - � � V► ► ,' ..---__ .. � � ! 1 , � � � �,*, �. � ' . �� U S�i �J � _: i � u7 � -'. � 1 . � ' i l �" �✓ � v,���; . r f� 6F, u �; � I_ a//' --- ^ r � � � L ..� a ' /� _�' �'� �f' '' .,\ �k' � � 11'.�3 � . �di 'i I 4j � _.,'... � i �T i � �'' .. _ ___..���,�-�-r, ! � `s'_�i ���� #— � - — � Z� .� . �o � -+ ^- - — — ...... •V_�.�� , r s ' �� �! _, `�-=�.\ _ „ � �v � -�� � � �. . ��. � �� � ,; ,' � � ,� �� V � � � � �� —� �� W'� 3 �,n�,�� n N YJV� �� A � .� � � w � �?� W _ � - �. .� � � � 3 � 1 s � � �, �----=� � --� , � ,_ . �n E� i �--_�.:... W 2 :� �� � �-�' !� � � ,� � _- --� "�f ; t _ t; S� _._ --T � � � �� `3•? i :`` � � z � � Q \� �; ti ? --� � �� � � � ��� � �� u � --.�. < r ��// ''� ___'.___(f� (n 1 . ;�� ._f�-� G � ,C � �v �')i . s.- ,_ � �. _4 ; �d � . �} � �; � �I at""-_:. � � �L ____._ �-� _. --_ �� �,F'! -- -; ��� s�C�... . ,� ; ��I �Y � I \�.' f �I i ` _' �+� . � , V _� --=a-_ � . > c� - � n�- '�.�= 3 U�, tT �'� 1 1 , � : ��, � ' � � �� , j�� � :i �'. N' h� r I ; ,; ��q —�/" pJ� � __ : } �s ��y � , � �J � � ,� --- -i � � �,..- � � �:,� � �; � I � 1' " � �; _ L_�-- � _-� i: � � , r� i : ��,t� .,�,n� � S 1 � - �-I� � �u-.- . ,��-� .i :�:_ _ - ---- _ � l _ _ ,�- Building PI,jJM$ING Permit Q� � �nspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY ���: � 763-502-4977 FAX EFFECINE t-1-08 nnr� 3. 20. 0 8 vou�c E-n+nu. anDxess r i �{� mp m o� ri, s n C e m s�TenooxFSS Ia�lB h1aclCrnan CirrlP THIS APPLICANT IS: ❑ ONRJER �CONTRAC7'OR PROPERTY NAt,¢�ICIC Sm�th owlvERl .�na�ss: to�l8 Hackman Circle crrr �ridle� srnreMNz�r�� �xnN�r rHO�e: ?b3. �9�. 9obfi —� CONTRACTOR pAME: � M r i �P I L L SUBMITACOPYOF STATELICENSE# nb�RO3-PM �D TE �Z�3�.Q8 YOUR STATE LICENSE, BOND AND STATE BOND #%� ZOQ � b i� EXP DATE I 2.3 I. 08 CERTIFICATEOF pDDRE55: i%v h*" St. N�E� CITY M�n�eaPol�S STA7EMN Zrn�iSylS INSURANCE pHOP1E L!J 12 � i88. b I B{ Fw7c b I 2. 7$f3. b 1� � PERMIT TYPE � SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPEOFWORK: ❑�` iG�P�.nCFt�i DETAILED DESCRIPTION OF WORK � S �er�n � h W r ; � FER MS 16B.665 the permit fee is a minimam of S15.00 or 5•/. ot the total coat ap to 5500.00, whichever is gea[er, for the improvement, installa[ion or replacemeM of a resideotial fix[ure, e�ccluding the fi�ctures. (This should reflect only the cos[ of labor ) Labor cost under 5300 =$ t 5.00. Labor cost between 5300 to 5500 = cos[ of labor x.OS = plus .50 surchazge OR FOR PROJECTS W}�RE LABOR EXCEEDS 5500, FEES ARE BASED ON 510.00 PER F'IX'1'URE, IXCEPT WFfr.RE NOTED. FIX'1'URES: (INDICATE TOTAL NUMBER OF EACH BELOW). I�UNIM[1M FEE SI5.50. � BATH SINK/I.AV ZFLOOR DRAINS I SHOWER X WATER PIPING LBAI'HNB GASPIPING(NEEDCI7YLIC) SWIA�ffNINGPOOL WATERSOFfNER(S35) CLO'I'f�S WASE�R I K�7'CHEN SQJIC Z WATER CIASET BACKFLOW PREV. (S15) DISHWASI-IER �LALINDRYTRAY j_WATERHEATER(f35) FOROtRIGATION WATERI�TFR OTHFR Permi[ Fee S Nwnber of fixtures Qa S 10.00 �J_ x S 10.00 = S Surchaz e .50 Number of fixtures (a3 S 15.00 _ x S 15.00 = S TOTAL DUE S OR Number of fixtures @ 535.00 x 535.00 = S State Surcharge = S .5 IMUM 515.50 MINIMCJM 515.50 Total = S , S THIS IS AN APPLICAT[ON FOR A PFRMI7'-N07 VALID IINTtL PROCESSED I hereby apply for a plumbing pennit and I acimowledge thffi the informafion above is complete and accurate; that ffie work will be in confonnance with the ordinances and codes of the City of Fridley and with the Minnesota ConsW etion Codes; ihaT I undershend this is not a pem�it but an application for ermit and work is not to start without a petmit on site; that the work wiil be in accordance with the approved p in ihe all k which req ' r�iew and approval of plaos. SIGNATURE OF APPLIC PRINT NAME 57Nt :,af1 aR'�-�T DATE 3` 2 O�{ APPROVED BY DATE � City of Fridley Building Inspections Department 6431 Universiry Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building Inspections 763-572-3604 763-502-4977 FAX - U SITE ADDRESS _ THIS APPLICANT [S: PROPERTY OWNER! TENANT NOTE: SEPARATE CITY LICENSES ARE REQIDRED FOR GAS AND HVAC. SUBMIT COPY OF BOND MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR ❑ OWNER COMPANY NAME:_ CONTACIPERSON: STATE LICENSE R_ ADDRESS EXP Permit Received By: Date Rec'd: v---�--' I ' � . PHONECp,�-7�j�i� �iSZ� FAX Lo.S7-� �1��- c- PERMTf TYPE I� SMCiLE FAMILY ❑ TWO FAMILY TYPE OF WORK: DETAILED DESCRIPTION OF ❑ REPLACEMENT ❑ TOWNHOUSE ❑ ALTERATION/REMODEL PER MS 168.665 [he permit fee is a minimum of $15.00 or 5% of the total cost up to 5500.00, whichever is greater, for the improvement, installation or replacement of a reside�tial fixture, excluding the fixtures. (This should reflect only the wst of labor ) OR Labor cost under 5300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = FOR PROJECCS WHERE LABOR EXCEEDS SSOQ FEES ARE BASED ON 310.00 PER FIXTURE. EXCEPT WHERE NOTED. FIXTURES ([NDICATE TOTAL NUMBER OF EACH BELO� Equipmen[lnstalled MFG: MODEL: SuF1BTU p,�G; � MODEL: SIZE/BTU �G: MODEL: SIZFIBTU A/C 525.00 FIREPLACE (GAS) SI5.00 . _GAS RANGE/OVEN 510.00 AIRTOAIREXCHANGEERfIS FfREPI.ACE(WOOD)535.00 =NE GASGRILLSI0.00 _BOILER 535.00 _PURNACE E35.00 G S UNIT HTR SI0.00 CHIMNEY LINER 510.00 _GAS DRYER EI0.00 L HEATER 535.00 T�%nr rrr wnu r a n nn GAS PIPING S I0.00 V ENT[LATOR S I5.00 Pennit Fee S Number of fixtures Q 510.001_ x$10.00 =$��. �J Surcharge $ .50 Number of fixtures @ T>15.00 _ x$15.00 =$ TOTAL DUE $ OR Number of fixtures @ 525.00 `x $25.00 =$ Number of fixtures @ 535.00 _ x$35.00 =$ S[a[e Surcharge = $ 50 MINIMUM $15.50 MINIMUM $15.50 Total = $ ' � THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply foc a mechanical permit a�M I acktwwledge that Ihe infortnation a6ove is wmple[e and accurate; Nffi tt�e wofk will be in conformance with the ordinances and codes of the City of Pridley and with Minnesota ConsWCti Codes; [hat I unders�and this is no[ a pertni[ but onty an application for a pertNt and work is no[ [o s[ar[ withoul a permit; ttia[ tlre work will i acwrdance th the ap roved p�an �n the cau of all work which tequires review ar�d approval of plans. SIGT3ATURE OF APPLI PRINT 1�iAMFsa MQ iit�uc� If�� DATE /� V g APPROVED BY City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502�977 DA