AF - 46779BUILDING PERMIT
Village of �ric�fley, 1Vlinn. �� 2 O l 1
Date . � . �.1 � • . . �. .�.'"'�.� . . . . .
Owner Builder . l � .
�'K.:.�r3.t„' . X. . . . . . . . "\�J�- """ "'�'"r`�.It`'°�"""`..�`�-....+.,,
r i
Address... ....................... ........... Address .........................................
LOCAT[ON OF BUfLDWC
No. . � .�.+�. �:�` . . . . . Street �. �. � t . . . . . . . . . . . . . . . . . . . . . . . . .
;;,�• ���k��. Part of Lot
�, �
Lot . ..�. .. ..... Block . .. .. ..� . . .. . Addition or Sub-Division . . .��'.��. .. �,�.��, . .. .y�'�����
�t,,.�„�_' �
Corner Lot ............ Inside Lot ............ Setback�.��...... Sideyard ..........................
DES�CR[PTION �F BUILD{NG
To be Used as:
,
, ��' � ?�� . . Front . . . . . . . . Depth . . . . . . . . _T�eight . . . . . . . . . Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . .
e�..-""°�..� ... .
.................... Front ........ Depth ........ Height ......... Sq. Ft. ........ Cu. Ft. ........
Type of Construction .............. Est. Cost .............,.......... To be Completed ...................
In considerafion of the issuance to me af a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the village of Fridley. � -
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♦ f.!� f i� _. j� If
�'�;��'�r.��!����.�!�.31�►9P��S4�
In consideration of the payment of a fee of $./��.permit is hereby granted to r c.,,
.. to construct the build'ufg r addition as described above. Th' ,�is` granted upon
the express condition that the person to whom it is gran ted and lus agents, employees and wo " n, in all work
done in, axound and upon said building, or any part thereof, shall conform in all respects to the ordinances of
F'ridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any tir.ie upon violation of any of the provisions of said
ordinances.
�~�g..�,,.p,;,s,L;, . . . . . Building Inspector
�
IVOTICE: rJ "
This permit does not cover the construction, installation or alteration for wiping, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
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MEMORANDUM
/
/�1 %
TO: John G. Flora, Director of Public Works PW89-165
FROM: Mark A. Winson, Assistant Public Works Director/!�J�
DATEs July 5, 1989
SDBJECT: Water Quality
at 53 Hartman
On June 27, I met with Walter and Susan Miskowic of 153 Hartman
Circle. The meeting was requested by Mr. & Mrs. Miskowic to discuss
the quality of the water received in their home.
Their major complaints are as follows:
1) Theyare continuously getting sand in their water. Mrs. Miskowic
stated that on numerous occasions they are getting sand coming
through their faucets and on at least one occasion she found
approximately two teaspoons of sand in the bathtub.
2) Discoloration of dishes and the interior of the dishwasher.
Most, if not all, of their dishes are covered with a brown scale.
They repeatedly have to clean the interior of their dishwasher with
muriatic acid.
3)They have been informed by a septic line cleaning company that
they will need to replace their toilet due to the excessive buildup
of deposits at the discharge. The Miskowic's are concerned over the
cost of replacing the toilet (especially if the problem is going
to be recurring) and if the toilet drain is plugged, what other
portions of their plumbing and/or fixtures will need replacing for
the same reasons.
The Miskowic's stated that they have suffered this situation for
30 years and they now want some action.
I inquired if any of their neighbors had indicated that they had
similar problems. Their response was that most, if not all, of
their neighbors had water softeners and were not experiencing
problems of this severity. Mr. � Miskowic expressed the
feeling that since they were on city water they shouldn't need to
install a water softener, as it's the City's responsibility to
provide them with good water. I advised them that the City is
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charged with providing potable water, meeting all State and Federal
guidelines, which the City's water did. I also informed them that
the City water in his area was considered "mediwn hard" and that
a water softener would eliminate most, if not all, of their
concerns.
I had told the Miskowic's that I would see what could be done, but
that I felt there was nothing the City could do beyond what is now
being done, i.e. periodically flushing the water mains.
I realize that there is little that can be done regarding the
calcium content of the water, short of doing mineral reduction of
the City's entire water supply, but I am mystified by the continual
recurrences of sand in their water system. The Water Dept. tells
me that they flush those lines on a regular basis.
Please advise on how to proceed.
MAW/ rs
SuBJECT
c�ty of Fridley
AT THE TOP OF THE TWtNS g U I L D I N G P E R M I T
i�
� �
� • COMMUNITY DEVEIOPMENT OIV.
� `�: -----
r � � PROTECTIVE INSPECTION SEC.
i �
i_---� ��"' �,� CITY HALL FRIDLE� 55432 NUMBER pEv
i 612-571-3450 9� 0-Ft 5
JOB ADDFESS 153 Hartman Circle NE
1 LEGAL LOT NO. BLOCK TRACT OFi ADDITION
DESCR. 1({ 2 Sandhurst Addition
2 PROPERTY OWNER MAIL ADDRESS
gue Miskowic 153 Hartman Circle NE
4
DATE P�GE OF
8/22/96 / /
4CTOR MAIL ADDRESS Z�P
Paulson Construction Inc PO Box 247, Anoka MN 55303
ECT OR DESIGNER MAIL ADDRESS Z�P
5 ENGINEER
MAIL ADDRESS
�����
RECEIPT NO.
3g��
APPROVED B�
SEEATTACHED
SHEET
571-3493
PHONE LICENSE NO
427-0033 6329
PHONE LICENSE NO
P PHONE IICENSE NO
6 USE OF BUILDING
Residential
7 CIASS OF WORK
O NEW X ADDITION � ALTERATION D REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Construct a 14' x 14' Porch Addition and a 34' x 18'&14' Deck
9 CHANGE OF USE FROM
STIPULATIONS
See notations on plan.
SEPARATE PERMITS REQU)Rfi� �pR
� �lNtRtNG, HEATlNG, #'LUM8ING AfV� SlGNS�,
TO
V�ARH��6 .
Before ��iIB�� � �
all uti���
REQt�IR�fl SY �..i�►w :
SEPARATE PERMITS ARE REOUIRED FOfi ELECTRICAL, PLUMBING, HEATING,
VENTIIATING OR AIF CONOITIONING.
THIS PERMIT BECOMES NULI AND VOID IF WORK OR CONSTRUCTION 20tJING
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCfION
OR WORK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS APPL�CATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF IAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL 8E COMPLIED @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �P6,414
OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEI THE pEqMIT FEE
PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGUTATING CON-
STRUCTIaN Ofi,7HE PEF3F�RMAN�E OF CONSTRUCTION �i2�F.7S
TURE OF CON7FAG70f3 OFl AU�MORIZED AGENi !OA
�
S�GNwiURf OF OwNEA uf OWNEP BU�LDER+ iD►TE�
OCCUPANCY
SO. FT.
STALLS
$�
OCCUPANCVLOAD
CU FT
OFFSTREET PARKING
IGAFiAGES
$3.21
SAC CHARGE
Fire SC $6.41
TAL FEE
$139.37
TED THIS IS VOUR PERMIT
� �-��-�6
NEW
ADDN
ALTER
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ConstructionAddress:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R 1 AND R-2
Building Permit Application
. _ ��D
�.3 �9�1�i�rQ�,� �r,ec�� �, �
� b� /y
Owner Name & Address:
�£ontractor: I�'C(,U �SU,
Address: r
LIVING AREA:
a
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Effective 3/1/96
/� �
; �
�
�
Tel. # S7/ 3�f 4 3
MN LICENSE # �o
Tel. # �� ��j O � -�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
_ DESCRIPTION OF Il4IPROVEMENT
1 �
Length �_ Width _�_ Height Sq. Ft. ��17. / � � � ,3� � �
GARAGE AREA: Length Width Height Sq. Ft.
U,
DECK AREA: Length �3 ��' Width I i�- J y� Hgt/Ground 7� Sq. Ft. ��.� �y� Z-�
01'HER: ' S 3, X,ci Z 71. ;
y � /fvy_ �o
i �
Comer Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks �
Tyge of Construction: IIV,�i,v- Gvpa c� Estimated Cost: $ /a OD!' `�� �.j ��`
Approx. Completion Date: � Q P� �,S � R' 4'(p � �
(Cost on Back)
Driveway C�rb Cirt Width Needed: Ft. + 6 Ft = t x =$
DATE: -` � APPLICANT: � Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
l�i�►i:� �l
� l�y �5
$ ii
� 3, -2
$
$ ��
$
$
$
$
$ �
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Vatuation (1/lOth%)
$.50/$1,000 Valuation
$9()0 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.Q0 Conservation Plan Review
Fee Detemuned by Engineering
Agreement Necessary [] Not Necessary [ �
�
STIPULA�TIONS: �
s _
I ADDRESS
IP�
� LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENLTE NE
FRIDLEY, MN 55432
572-36U4 1+'AX:
: 153 HARTMAN CIR NE
: 153024120051
: SANDHURST ADD
: LOT 14 BLOCK 2
: ELECTRICAL
: RESIDENTIAL
: ADDITION/ALTERATION
571-1Z87
PERMIT NO.: 200401775 �a n �
DATE ISSUED: 10/05/2004
VALUATION .
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT I5SUE DATE. INSTALL A SAVERS SWITCH.
# INSPECTIONS 1
APPLICANT
I HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
j ST PAUL, MN 55114-
OWNER
MISKOWIC SUZANNE
153 HARTMAN CIR NE
FRIDLEY, MN 55432
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 wori
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
vicrlate or cancel the provisions of any other state or local law
regulating conshuction or the performance of construction.
Applicant Date
Bldg Insp Date
ELEC PERMIT FEE - MIN (RESI)
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 118132
S�;YAKA"1'�; Y�KMI"1'S KE(1UllZED FOR WORK OTHER THAN DESCRIBED ABOVE.
20.00
0.50
20.50
sue�ecl PERMI .
City of Fridley L ,, �.: �9
AT THE TOP OF THE TWINS g U I L D I N G P E R M i
r
; � RECEIPT N .
COMMUNITY DEVEIOPMENT DIV.
r � y � PRQTEC7IVE INSPECTION SEC.
� �
� �
� � I���� . CITY HALL FRIDLE� 55432 NUMBER REV OATE PAGE O� 4PPROvED BV
�""� � �'' 612-571-3450 910-F15 4/23/96 / /
JOB ADRRESS 153 Hartman Circle NE
t LEGAL LOT NO. BLOCK TRACT OR AOOITION SEE AT7ACHED
DESCR. 1/{ 2 Sandhurst Addition SHEET
2 PROPERTY OWNEH MAIL ADORESS ZIP PHONE
Suzanne Miskowic 153 Hartman Circle NE 571-3493
3 CON7RACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
D& D Home Im rovement 7401 CenCral Ave N -
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDfiESS Z�P PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR O MOVE O REMOVE
X
8 DESCRIBE WORK
Reroof House (25 S ) Tear-off
9 CHANGE OF USE FROM TO
SiIPULATIONS
Underlayment must comply with the State Building Code.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAI, PLUMBING, HEATING.
VENTI�ATING OR Alp CONDITIONING.
THIS PERMIT BECOMES NUIL AND VOID IF WORK OR CONSTRUCTION ZONiNG SO. FT. CU FT
AUTHORIZED IS NOT COMMENGED WITNIN 60 DAYS. OR If CONSTRUCTION
OR WOfiK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINEO THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VALUATION SURTAX
AND OROIIVANCES GOYERNING THIS TYPE OF WORK WILL BE COMPLIED @
WITH WHETHER SPECIFIED HEREIN OF NOT. THE GRANTING OF A PERMIT 'P2 s OOO � 1.00
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL 7HE pERMl7 FEE SAC CHARGE
PROVISION ANY OTHER STATE OR LOCAL LAW REGULATING CON- $62. 2S Fire SC �.00
STRUCTfO OR TNE PERFO NCE OF CONSTqUCTION.
PLAN CHECK FEE TOTAL FEE
�j Licen SC 5.00 $70.25
SI NATUNE OF CON� RACTOFi OR AUTHORIZED AGENT . IDATE� EN fiLY V I ATED THIS IS YOU PERMIT
G- �3 -��
SiGNATUFE OF OWNEA UF OWNEA 8U40ER� �D�7Ei BIDG �NSP �)kTE
NEW
ADDN
ALTER
[)
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXFS R-1 AND R-2
Building Permit Application
ConstructionAddress: ��,j i��'���%�i� �it?G'��
i.egal Description:
Effective 3!1/96
A � -
�
Owner Name & Address: ��7,(�if/l/'.(/e ��%%%SF p uJ/G Tel. # ��l��y�3
Contractor: D& D Home Improvement, Inc MNLICENSE� 4840
Address: 7401 Central Avenue NE, Fridley, P9N 55432 Tel. # 784-7543
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK AREA: Length Width HgtJGround
OTHER:
Sq. Ft.
Sq. Ft.
Sq. Ft.
;omer Lot [) Inside Lot ] Ft. Yd Setback Side Yard Setbacks
.�ype of Construction: 08 -- �-d� Estimated Cost: $ o��D
�pprox. Completion Date: .$- 7 �� �j s�r.[�2�s
(Cost on Back)
)riveway b Cu Width Needed: Ft. + Ft = Ft x$ _$
)ATE: Z APPLICANT: Tel. # 7 8 4- 7 5 4 3
'ermit Fee
�ire Surcharge
�tate Surcharge
;AC Charge
.icense Surcharge
)riveway Escrow
:rasion Contro!
'ark Fee
;ewer Main Charge
TOTAL
;TIPULATIONS:
$ � �� �s�
$ �.��o
$ � D C�
$
$ i - �L�
$
$
$
$
$ '%Q. ��
CITY USE ONLY
Fee Schedule an Reverse Side
.001 of Permit Valuation (1/lOth�)
$.50/$1,000 Valuation
$900 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Ptan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
sus�ECt P
City of Fridley 2 8 6 8 6
AT TNE TOP aF TME TWINS g � I L D I N G P E R M I T
� �.572-3604 Na.
� ; y__��_ C O M M U N I T Y O E V E L O P M E N T D t V. n_� Q
r � � PAOTECTIVE INSPECTION SEC. �n
i.-_• � �"' �,� CITY HA�L FRIOLEY 55�32 NUMBfA �EV O�TE P�GE Oi �vnaOvED 9r
L '� 612-571-3450 910-F15 12/1/98 � �
J08 AODRESS
153 Hartman Circle
1 LEGAL LOT NO. BLOCK TiiACT OA AODITION SEE ATTACHED
oesca. 14 2 Sand SHEET
2 PROPEFiTY OWNER MAi� AODRE55 11P PHONE
Mrs. Miskowic
3 CON7qACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Home Owners Im rov. o -
s AqCH11ECT OR OESIGNER MAIL AODRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDiiESS ZIP PMONE LICENSE NO
6 USE OF BU�LDING
Residential
7 CLASS OF WORK � REPAIR ❑ MOVE O REMOVE
❑ NEW O ADDITION ❑ ALTERATION
8 DESCRIBE WORK
Reroof house and garage (30 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPUlAT10NS
Jnderlayment must � comply with the State Building Code.
TVPE OF CONST. OCCUPANCV GROUP OCCUPANCV �OAD
SEPARATE PERM�TS ARE REOUIRED FOp ELECTAICAL, PIUMBING. HEATING.
VEN7ILATING OR AIR CONOITIONING
TMIS PERMIT BECOMES NUIL AND VOI� IF WORK OA CONSTflUCT10N 2QNING SO. fT CU FT
AUTHORIZEO IS NOT COMMENCEO WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOEO OR ABANDONED FOp A PERI00 OF 120 pAYS AT
ANY TIME AFTER WORK IS COMMENCEO. NO OWIG. UNITS OffSTREET PARKING
1 MEREBY CERTIFY 7MAT I HAVE READ ANO EXAMINEO THIS APPLICA710N STA�LS GAFiAGES
ANO KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
ANO ORpINANCES GOYERNING THIS TYPE Of woaK w«� BE COMPL�ED
WITH WMETHEii SPECIFIED HEREIN OR NOT. TME GRANTING Of A PERMIT 2571
OOES NOj PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL 7HE pERMIT fEE SAC CHARGE
PROV�SIONS OF ANY OTHER STATE OR LOCA� LAW REGUlA71NG CON-
STRUCTION OA TME PERf RM CE OF CON57RUC710N ](F�
PLAN CNECK FEE TOiA� FEE
, 5� t pc N' t Op�uTMOA�2ED�GEtit iD�iE� WNEN PROpERIY IOATE TMIS IS VOUp PEpMiT
� ! J
5 N tiE NEp BU�ID iD�iE� Bl0 �hSP �� ���tE
•
NEW � [�
ADDN
ALTER [ ]
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1 / l /98
������
ConstructionAddress: / J 3 ��c�,v+�ati �.ti1�`K� __
Legal Description:
Owner Name & Address: ,_ 1L/��r i /� !S �d w�C. Tel. �
Contractor: �� (� w K,� v s �re� �� MN LICENSE #� i�f' 6 t( ,�'�
Address: °��6 %� rt �(n'i� _�t ��c„�► P�'a i r i�, IU� NI 1� 3�� Tel. # G� 2�5' 0 3 S� 0�r
�
LNING AREA:
GARAGE AREA:
DECI� AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
DESCRIPTION OF IMPROVEMENT
W idth
Width
Width
Height Sq. Ft.
Height Sq. Ft.
Hgt/Ground Sq. Ft. _
f� � �D -� . � �_�.�-
Construction Type:_� ud �t k q Estimated Cost: $, — ���1
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _�
DATE: � �- � I�� APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ .S�
$ -��
$ 1�9
$
$ • C1d
$
$
$
$
$ ��- � �
CITY USE ONLY
Tel.# g�3s�a�
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1q00 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 [ ]
� - ..,.��.:� _.._
��-o �- �-Z� � b0 -�%
Quiiding
Inspections
763-572-3b04
i�n�'i-._ T , :� 1
������:,��7»�z��ss �±
l'fIIS APPLIC�\NT 1S
PROPERTY
ow�vEw
TEIVANT
C'ONTRACTOR
SUBMIT n Cf)PY OF
YpUR STATG
LI('F.NSG WITIi
,�i�i�i,�cnTrc�tv
PERMIT TYPE
TYPE OF WORK:
MECHANICAL Permit No.:'
RESIDENTIAL APPLICATION Receivect By:
CITY OF FRIDLEY � � —
YOU E-MAfL ADD - �
it� � � ;
�T ;; �,�
❑OWNER QNTRACTOR ' - � __���!
NAME _ � lA� \ �/ (u
ADDRE3S: CI"tY S7'ATF. 7[PjC7 I 3 a'
�H�NE: a�8 -
�4�+�iP.4NY NAME:ti
CONTACT PERSON:
S"iATE LiCENSE #
PHONE
C�CSiNGLE FAMii,Y ❑ TWO FAMILY
❑ NEW C�REPLACEMENT
f�ETAILrD DESCRIPTION OF WORK
� -
EX DATE
✓'Pi � CITY �
FAX � �
C] TOWNHOUSE
❑ ALTERATION/KEMODEL
'ATT' //(/'71P ssra
PGR NIS 168.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
i mprovement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
'.�05= ----__
I'<)R PRO.IEC7:S WH�RE LABOR EXCEEDS $500, FEES ARB BASF.D QN $lO,OQ PER FIXTURE, rXCEPT WNERE NOTED. FtXTURF.S: (IND{CATE TOTAL
NUMRI?.R t)F I;nCH Ai:LOW) � c �D� � 00
I;yuipmcnt Installed MFC: ��Yt PX MODEI_: 7 � 1� SIZFJBTU
MFG: Y t U�_ MODEL: p�4��G� SIZE/BTU .�.. .
� MFG: MODEL: SIZE/BT[I �
�/,1/C"�25.0t1 FIREPLACE (GAS) $I>.00 _GAS RANGFIQVEN $10.00
_,�IIL 1'O AIR LXCHANGEF.R $15 �jiREPLACG (WOOD)$35.00 NEW GAS GRILL$l0.(xl
ROII.rR �3�.00 ✓�URNACE $35.00 _GAS UN[T HTR $10.00
�('I IIMNF,Y L1NER $10.00 GAS DRYER SI0.00 POOL HEATER $35.0(l
1)UCT WORK 510.00 GAS PIPING Si0.00 VENTILATOR$I�.00
PERMIT PEE Fit�JE�i'��FCiR F;II�tI�� ;�S�Q ' PERK��'i"°�E FEiIt i"II��JEGT� E���R;,:�SU�'
Permit Fee $ . Number of fixtures @$10.00 x$10.Q0 =$
Stircharge $ .50 Number of fixtures @$15.00 x$ i 5.00 =$
TOTA L DUE $ Number of fixtures @$25.00 �— x$25.00 =$=r�Z=_
Number of fixtures @$35.00 T x$35.00 =$ -�
State Surcharge = $ 50
Tota1= $��
THIS IS AN APPUCATION FQR A PERMIT-NOT VALfD UNT1L PROCESSED
I hereby apply for a buifding permit and 1 acknowledge that the informatia� Tbove is complete and accurate; that the work will be in
confonnance with the ordinances and cocfes of the City of Fridley and with the N1innesota Construction Codes; that 1 understand this is
not a permit but oniy an application for a permit an rk is not to start without a�er�nit; that the work wiil be in accordance wid� the
approved plan in the case o all ork which re uire re ew and approval of plai .
SIGN.ATURG �>(' APPLICANT NT NAME ,. �,�:/���ATE � � � ` ^ � �
PL:EASE NOTE: SEPARA`�'�'�S�vlt`i�'t1;R:� �QUI��E�';�OR $t1iLDING, EL���'1`�tIC�kL ��U?�t!I��1`iANI��G Vt!{�R"�.. ,;
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977