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AF - 45576� Date: Owaer; Adaress �'� n ��y of F�a�ey, M�.. BUILDING PERMIT ����� N° 72'73 I�T�� LOCATI � OF BUILDING No. ���StrEet . �� Part o t .� Lot _ Block ddition or Sub-Division �� .2��r�-�S1� r ___� � B / Coraer Lot __ Inaide Lot ._._. Setback ���— Sideyard � Sewer IIevation ���- � � �lon IIevation ���' � �' fd� � �'�� ��c,-�' , �3u��� s t�o i �J��LR�[� DESCRIPTIOW OP BUILDING ,� or /a/� b/��, Cc.�v. `�.�,�,�./ o�� � � t�-�s , Front _'��.�._. Depth �y�� Height �r S4• FL �� Cu. F't. �� P'ront � Depth � iTeight Sq. F't. ��� Cu. P't. � � F�t, Cost � ��To be Completed Ea conatderal3on of the �tsauance to me of a germft to construct the building described above I agree to do the proposed work in accardance with the d�script3on above aet forth aad in compliance with a'Ll proviaions of ordinances aP the city of FrYdley. � � ���.OA�-°�-� � —aa � A — - ar In coasfderatfon of the payment of a fee of $.����� , permit 3s hereby granted to to construct the building or addition as descrlbed above. This �ermit is granted upon the ea�press condit3on that the person to whom it is granted and his agent�, employees and worlmien, fn all work done in, around and upon said huilding, or anypart thereof, shall conform 9n all respects to the oralinanc� oP Fridley, Minaesota g laatton, construction, altera.tion, maintenance, repair and mevin� of bufltlings ordivan�ces. dty limits��aa�thia permit may be revoked at any� u�pon violaj� of an,y of the P�visiona of said / Y Bt�ild9ag Ins�ector NOTIC� 'Ihis peemh dea aef cover t6s conslineH�, tmtall�lee fo� �rWeO. P���B. Oa 6aNeg, snr�r er watsr. B� sura to ss� t6a &►ildiva lesp�tae tor aparaM p�rmMs foe lhus ihaq. �'.�- � � `a `� � ,�— � I ,��I .:..........._. ..._�. ;_. _.� .,.��r-..._____ ,;� ,. �. • � APPLICATION FOR BUILDING PEa1+?IT CITY.OF FRIDLEY, MINNESOTA � OWNER' S NAML��y���_��C,�����,,� BUILDEit �:���� AUDRESS a���.s^ �� � ADDRESS � �-� �-- ° � �,OGATIpP1 OF ,BUILDING No. /tr'��~.� Street ��y�'� _____ __ Part of Loe Lot � Block Y Addition or Subdivision s������. �� ,s�,����� Corner Lot Inside Lot Setback Side Yaxd .. -r- SEWLR ELEVATION FOUNDATION EE,EDATION Applicant atCach to,this form Two Certificates of Survey of Lot and proposed build-• ing location drawa on these Certificates. DESCRIFTION OF BUILDING To be used as; � � � � G� p Froat ���•�:h Height Sq. Ft. Cu. Ft. Front Pepth Height Sq. Ft. Cu. Ft. Type of Construction Eati�ated Cost To be Completed The undersigned hereby°makes application for a permit for the work herein spec�fied, agre�ing to do aZl work in strict accosdance with the City of Fridley Ordinances and ruli�gs of the Department of Buildings, and hereby declares that all the facta and represeatat3ons stated in this applicatiou are true and correct. . DA�E_ �'' ��/� �� � SIGIdATURE _ � �Schedule of Fee Coste can be found on the Reverse Side). _ " • �5 �! _ WF'.�� / \ � R i ' ' ! % � il'.�i� f '�� c BUILDING PE�T FEE SC�EDULE 5ection 2. The Inapector of Bu3.idia�s ,�i�ll., before isauing any pe�it for tbe erection of e.ay building or structure, br for any addition to aay e:�ist- iag building or etructure, or for any a.lterations or repzira to any existlag building or structure, upon application ther�for, require�the pay�neat by the applicant for auch permit of feea to the amount hereia below aet forth and in the manner hereia provided to-wit; 2.1. For any such permit for the erection o,f aaq fire-proof building, other than a garage�, warehouse, factorq or grain elevat�r, or for the erectio� of any fire-proof addition, for aimilar occupaacy, to any zxieting buildir_g shall be at the rate of $1.40 for.each oae thousand cubic feet, or fract��n thereof, in such cubical contents. 2.2. For any.such permit for the erecCion of aay fire-proof garage, warehause,� factory or graia elevator, or for the erection of any tire-proof edditio�, for similar occupaacg, Co eay existing buildimm,g sttell be at the rate o�-$1.25 for each one thousand cubic feet, clasaified as °1fireproof" by Section SC2 of the Minneapolie Building Cade.. . , HOUSES . ,._ i 2.3. For any such permiti for the erection af any non-fi,reproof builcl�Lr.�_ o�:t�et thaa a garage, warehousc:, factory or grain eleva�ar, or auq non-fireg:a�y� addition, for s�tmilar occup�ncy, to any exieting building - permit $�.�J-�ar each one ehousand cubic feet. GARAGES _..—._ 2_ .4._ For any such permit for the erer,r.�.,� � r�r�, ,,�,�_�� ��„��� ga�g�e, .warehouse, factory or graia elevatos, n�- r;,�� ,.'3g; �.F:;:�ien a= ��;� non��?regra�#' additioa, ��or -aimilar occupancy, to r�;,� ��<_:t:�r•�r_Y., �.�s�r�.,�;;.�o or for each auch „.. - bu�.ldiag or add3Cion - ninety r_a�a± � �,�F i,1 ��!(: � $�a er�o,;i one Chousand cuUi� feet or fraction thereof, ia the cu?>:�c��:�. ra}�;:�r.��� ��;ez°�a� with a minimum of $4.04.- For the purpose of compuC�Lag fees fcr 'at,' �.ra.in� per�i��, the cubical contents of aay buildiag or �ddifiioa to a unifc�.a re���i:t throLahaut by m�ultipiying the grouad are� covered frem a point siu (6) inLhAs be?.�w: the floox line of _;�.he basemeat or cellar to the average height o€ ��a � z;��:�er -suL �ace or to tbe average height of the roof surface of the�maiu �a�le of a p9,tched roof. 2.5. For repaira or alterationa to �n exiatiag etruceure, the fee shall be at the rate of $3.00 per each Five Huadred Dollars ($500.00) or fractio�n Chereof in ehe cost of all �roposed work. � 2.6. In no case shall the fea._charged.for;aay permit:as eQt forth ia .Sectioa 2 be less. titan $4.00. a , - . _ � � D i'"� �. ,, � . z � , ,.,s,�, .,,�,>. .., — � �. �{ 4 y v'� Lqnd Plonnin9 68TS-f/igMv�r fGS NE. Loru/Suiweyin9 � Mi�rnea�o/s➢2, .�;,s�st;�9 ENG I NEER1 NG, I NC. ��'° ct�;i � �r�w�� _ sr��ta-6o6s En rtteeri — Fn ineers � Surveyors� 9� y certa,.�zcafe o� ��t�e ��: �. ��. ��:�� ���z ��.,���-� � �: __. _ � _ � ►� ! � . � f� �„1 � � �� � � °�' •' _ _� � ,� ,' �' n �:. `ar`` i c�? �'- c�'d � ! � ���1 � .� \ -- {4�.� -� ---i__. _. _ �; �t�,, ._ S �fa I . � .. 4I , ; f�Pj �'� ! � � L r f , f% � �' ,� � � � ��' , 'G rr, �t-�� �J � ��§ f �' � , 4:1 � � �^ `' P !'/ N �'i � � ��b � � - \.�a i.,^-. a . 6� � �,.�, ` � � � - � � � � . � ` r � ' s I 7 .� - � /L �,� '.`��" >.� �.-� , 1 �- � _ _ ��`� -- r !� ?�'i � �,� .. • � r� ;yr� "'� � � � `�i --.. � �- $j �r� ` "C` °- _ { ! / � , .�` �' _ .�,t�,c� I __-� - _ �,,,,'��� �s- '�.�� : � `.� �.'� . `� � � ��` ���:...�; ���' � ����`�4 ��� , � ` /h�� �i�y �lhis rs o irus ond cor�cf rep��nfoficn o�'o sce^rey �'�bt �dories �'�e o6a►r descr�6�sd /ov�d,ond c�1fx /oavlian a�'o// bwl4rn9s ,1�nieon , m�d ad/ vsrb/e arr�limenis ,��'w�. �nvn � ar� said /and. As surver,ed 6� me t/a�s - dot, °� ��'� A"�"�' SUBURBAN EN6/NEE21NG, INC. ERqmeu�s Fr Surreyors � � �� � '�'�y �� � � f ��`� �' _ . , ` „� _� :���i � „ ,J. s e. s? . - . - � — - -' � � � —'t„ --_ ; I c r . � 7 7 e�, n � 0 w � w � m � o ti � g o m^ a � o� 3 ►�' � m '� a •"_. � a . � m a [ � c n �0 3 M (/J M %n 3 o� N t*f HO � � Cz A� �` _ n� �� '0 � � r3 N a � O 0 � «� o a < � � O � rt b m W � n � \.� ( � � � 0 G �o � a m 'O • O M R � • � �� W C � Or �i L=7 '" � e �S d � a a � n� `- ° m M c • s (� �- z c r, � � � ; `�C Q Q � .] 7 M � i � � � $ n � �� � z °' o � � .0 a � s O y Z "y .G .a .,� _ _ _ - - � � d � n � ` A w �p o � ►� �C 8 A � � Z O. 7 O G �r. 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M � p �* �i � � ag �� M R R � � O n ~ V p 7C �' , N N N iA p O O o � H 0 0 0 o m 0 0 0 0 N N N N N Vl � � o r 0 �r � O N w C O M � � � A z H � '�O �i o v c 5 � � � z n � ���v � � , -� - � � �I � �� 1 � $ [�0 � � �� � � , •,� d �mo a n n O.ro ►�-n � n n � �c d m ►C- � c v+ •�w � �' � � � i+ w n ►1 N 0� R W 1+ r1 nr IC �C O 1p T m A r• m K G ���a � � � ° � °o - -----�-1'61 O �C � �e �--- _ ----a W fD ►- W W n 7 r 7C � �1 R ^ t m � o% o'•w�b < � 7 C �• �r+ ^ � � ~� N 2 7�' a m d �" F ►� ► R R � .° m m n � � �C - n � r O d O r-o o � Z m ° o o � w � Q. 'O 1 � � 7 0 . � �s��«- • � s ac ° a ► A P" G d � � � °m�rs �y g� m m o 6 S w � N 8 a ' N A � 7�C W N � � ��m � R � � � V � s 4 °v a a R A N N . I� � m N c'� S m v c �i � � r n > � O z � 0 � O � m � a�� z f'1 1 O N 2 G D -1 O O S ? a GZ'1 � 2 Cn G'1 < � H m�1 n 3 O N y G � v m L � � m � N � 0 z � m ----�+- � � m .� D � O 2 � z O C'� -� -� O T T .'a O m -� th M M N n f'f C � � 1'-� � � '� � � CHIMr�EY AN� STACK VERIFICATiON The undersigned hereby verifies that the existing chimney or stack; 1. Has been carefully examined Yes (,) No () 2. Is free from rust or deterioration Yes () No () 3. Has no foreign objects lodged within Yes () No ( � 4. Is securely supported 5. Meets all�current Code requirements for size and total BTU connected 6. Ha s To ta 1 hea ti ng BTU � s of All other BTU's TOTAL Rema rk s Ye s ( ) No ( ) Yes ( ) No ( ) x' L�r 1`+AI - - `,� w!�:+ ;f, � , � :; � ` �,�� �; m `<•° � ' �� Com pa ny y � 4� � 5iyned �y __ - _--- - --,�--- _, ��� Da te L�f] a � D � "� N � � o m � 3 � . o u m' � � A o � � 7 Q o O N � � tQ � 'O fl. 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A Q � � ?* 3- � �°—. � � � � C � `� A 7 • � � O O • � n � m su � �► , j � A fD ' Q' ^ `° � � 3 � �� Q«�' « ��w�o o �„ s r. � s � � � n � � � o y O 7C � Q � � I � � � � � 3 Q 0 W b v v � rn � � v � � n N Q � � J W _G C 0 m � „ °.n�<� z � �o �� o Ny m N � z rn � � n -� � Z Q < 37 y � � � � r m n a � _ � Z O Z '11 Z � v� D Ca � � nm � z -o o � _� Z O � Z � Z n �z �v tn = m D � � �� �.. � c� C O m � �� C m z � D � � Z m � A m 0 � D c ca c � 1 � � � � � �N � � �� ( ) vN ( ) sa� i :2�EQ :�Cg Pau�is �O� Jl�it.Ld�H �" : u Q u�ag SI�IOI.LN2I�.L'I�' z :sx�wa� .I2�E2ij 32�L'M .IO� jYdpTAO.Id IIa8(i .IIE IIOT1Sriqiii0� SL'�-j 'g sa�Eaq sa�Enn so� papinoid uaaq iavtl � s�H 'L S � fl.Lg "Id,LO,L S�n�g ia�o nd �� 5.11.L8 �uppa�i i��� �H 9 �) oI�I () SaA pa��awo� s�fl�g i�o� pue azis io3 s�uau►asmbai apo� �ua,un� i� s�aay� 'S � ) oN � ) Sa� pa�oddns �Ciam�as si �� () oN () sa� uTy�rh► pa�poJ s��afyo u�ia.ro� ou s�H '£ () oN () sa� uoq�ouaaap io �sn.i wo.0 aaa� si 'Z i) oN �) Sa� pauiwExa �tJin3a.rr� uaaq sEH � i :x�t�s io �auiuiq� �ur�s►xa a� �ECp sayrsan �CqaJaq pau�issapun aqZ ' � I.LH�I�I2I�A �I d.L Q d]�� WIH� , sue�ecr P City of Fridley � � 8 2' AT THE TOP OF TFIE TWINS g � I L D I N G P E R M I T r � � y� � • COMMUNITY DEVELOPMENT DIV. R / !l , //,/ r � v � PROTECTIVE INSPECTION SEC. ��U�-�'"1 � i � � /"'1 � CITY HALL FRIDLEv $S43Y NUMBER REV DATE PAGE Oi APPROVED BV �°°� � �'� 612-571-3450 9t0-Ft5 9/15/98 � � JOB A�DRESS 7455 Ha es ST NE 1 LEGAL �OT NO. BLOCK TqACT OR ADOITION SEE ATTACFIED DESCR. /,�, 2 Gunderson Terrace SHEET 2 PROPERTY OWNER MAIL ADDRES$ ZIP PHONE Scott Peterson Same 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Home Pride Builder 177 Smoketree Ln Lino Lakes 55014 786-0662 20072528 4 ARGHITECT OR DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION O ALTERATION �] REPAIR ❑ MOVE ❑ REMOVE 8 ,DESCRIBEWORK Reroof house & garage (22SQ) Tear-off 9 CHANOE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GFiOUP OCCUPANCV LOAD SEPARATE PERMITS ARE RE�UIFEO FOR ELECTRICAL, PLUMBING, FIEATINCi, VENTILATING OR AIR CONOITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. fT CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF /20 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING I NEREBY CERTIFV THAT I NAVE READ AND EXAMINED THIS APPLICATION STALLS CaARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VALUATION SURTAX ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED 1 � HSS . OO �p . 94 WITFI WHETHER SPECIFIED HEREIN T. T E GFiANTING OF A PERMIT � DOES NOT PRESUME TO GIVE HORITV T VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE PqOVISIONS OF ANY OTHER TE OR C AW REGULATING coN- $59 . SO F e SC � 1. HH ST CTION FO ANCE OF RUCTION. PLAN CHECK FEE TOTA EE Lice C $5. $67.32 SIGN RE Oi ONTRACTOR OR AUTMORIZEO AGENT , IDATEI EN OPE V A ID THIS IS R PER IT � � r SiGNATURE OF pWNER iIF OWNER BUILDERI IDATEI BL �NSP ryFTE d ,� � NEw ADDN ALTER [] [l [l ConstructionAddress: CITY OF FRIDLEY SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ��`�� , ��_ /��, Effective 1/1/98 ����� �� �o Legal Description: Owner Name & Address: �� S' Tel. # � � � - ���' 9 Contractor: ���� ���c�e �c.c ���..s MN LICENSE �t z607 �S�'z� � Address: /'� �i�o� ��-�2 �/'w ��� `��'� el. # �86 z�� Z. Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECB AREA: OTHER: Length Length Length DESCRIPTION OF IlVIPROVEMENT Width Height Width Height Width Hgt/G� � i � �gr Sq. Ft. Sq. Ft. Sq. Ft. (� " C /t��, Construction Type: �� 9-�� Estimated Cost: $ (Fee Schedule on Back) Driveway Curb C�t Width Needed: DATE: `-�.S -��APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL . STIPULATIONS: $ �9 �O $ l, S� $ 9 $ $ � �4 $ $ $ $ $ -� Ft. + 6 Ft = Ft� ` CITY USE ONLY $ Tel. # /C� �Z�� � Fee Schedule on Reverse Side .001 of Permit Valuation (1 / l Oth %) $.50/$1,000 Valuation $1000 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 [ ] BUII�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 repair to any existing 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 to-wit: TOTAL VALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $21 (Minimum Fee is $21 plus surcharge) $21 for first $SQO plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $2887.25 for the first $SOO,OQO plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000,000 � $5012.25 for the first $1,000,000 plus $2.75 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. VERIFICATION OF FOUNllATION Permits 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 Survey of the lot, showing the location of the foundation on�e it has it has been constructed will be required before proceeding with the framing. .. _ !a.. f� 1�+ I l ,DDN j ] �LTER [ ] al,� u�her reocci C � CITY OF FRIDLEY 6431 University Ave NE, Fridiey, MN 55432 (763) 572-3604 Bidg Insp S�NGLE FAMILY AND DUPLIXES R-1 AND R-Z (763) 571-1287 Fax BUILDING PERMIT P,PPLICATION ///� � O S !O� v� Construction Address: '/ ���.� ��� �`�� -s� ti • � � Legal Description: Owner Name & Address: �/l�l/r�%� ��� ��r����ti Tet. # � " � Contractor. �%�f�Se^� /�.��J'�� � ���'G�����°'`� �N LIGENSE # �D �/�f5 �! i Address: �/,3o S �l�'L� C�''�' .•� f ��L %d�iL�S{ .� ����s TeL # %�3 -��� _ �o��' . ��t . �IZ - �2 ��/6 Attach to this application, a Certficate of Survey of the lot, with the proposed construction drawm on it to'scale. DESCRIPTION OF IMPROVEMENT � y LMNG AREA: Length .��_ Width �O `�� Height � Sq. Ft .Z % GARAGE AREA: Length Width Height Sq. Ft DECK AREA: Length • Width OTHER: Sq. /�T�'D/'� �� Construction Type: ��f���✓ ��Ov � � Estimated Cost: $ /� �'4�0 � � � Drnreway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _ _� �L ��� �� _ 3��� DATE: � � � � � APPLICANT: `f 4 r� �� C� -� Tel. # '% �' i8S— �10� �6 Call (763) 572-3604 for Permit Fees if maiting in application. Fax to 763-571-1287 if using credit card and wre 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 CITY USE ONLY - � ��5.�5 $ � �o°Z .L-1 ( � �s, �I o � � ► �%L7 $ $ 5 �c�0 $ $ � $ $ � � «Q� a�� 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 [ J STIPULATIONS: ���� �:3���i� ►[ei� ; ���r ��l�Yy:i���r1��+ ,� The Chief Buildi.ng Official shall, before issuing permits for the erection of any building or structure, or for any addition to any elcisting buildi.ng or structure, or for any alteration or repair to any existing 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 to-wit: TOTAL VALUE $1 to $500 $501 to $2,000 $2,�1 to $25,000 $25,�1 to $50,000 $50,001 to $100,� $1�,001 to $500,000 �. ��� ��� � �, ����� ����� FEES $23.50 $23 :50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to a.nd 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,�0 plus $10.10 for each additional $1,000 or firaction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each a.dditional $1,�0 or fraction thereof, to and including $5�,0� $3,233.75 for the first $500,000 plus $4.75 for each additional $1,�0 or fra.ction thereof, to and including $1,000,000 $1,000,�1 and up $5,608.75 for the first $1,0(10,000 plus $3.15 for each additional $1,OQ0 or fraction thereof DRIVEWAY DEPRESSION ESCROW � (Concrete C:urb Streets Only) � r,j R�moval and replacement of curb and gutter only - driveway width plus 6 feet times $20.00. 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N 'S < 'Tl w Z rn 0 C77 N �1 {�. ,�p � � -n N � 0 � `D m � m "� � Z � V� � m � � �' O z v _ < � � < m � � N 0 � dtF:�n �n �� ��r � � d � , a , O � � Building Inspections 7. 63-572-3604 DAT'E � �'I � yl' SITE ADDRESS � � THIS APPLICANT I5: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WTTH APPLICATION PERMIT TYPE TYPE OF WORK: 1�C�NICAI.� �S�EN'r� APPLICA��N �ITY OF � LEY YOUR E-MAIL ADDRESS � OWNER COIvIPANY NAIv1E:_ CONTACf PERSON: rCtuu� lvu.. Received By: ATE�{'ZIP, STATE LICENSE # EXP DATE �D�S:� �� � s�- r�� �ti � Q STATE.�� ss � PHONE �° ?7'� �s�' �i I r'l � FAX � �" �S ' Z D �,SINGLE FAMILY ❑ TWO FAMILY ❑ NEw �REPLACEMENT DETAII.ED DESCRIPTION OF WORK � TOVJNHOUSE ❑ ALTERATION/REMODII, PER MS I6B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to S5Q0.U0, whichever is greater, for the unprovement, installation or replacement of a residential fixture, excluding the fDCtures. ('Ihis 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 PROJEGTS Wf�RE LABOR EXCEEDS $500, FEES ARE BASID ON $10.00 PIIt FIXTCJRE, EXCfiP'T WHERE NOTED. Fl3CTURES: (IIVDICATE TOTAL MJMBER OF EACH BII.OV+� Equipmeat Installed . MFG: ,� MODEL: �E11� Q.'� Z 5� SIZFJBN � MFG: MODII.: SIZF/BTU MFG: - MODEL: SIZFJBTU ,�/C g�5,pp FIREPLACE (GAS) $15.00 . _GAS RANGE/O,VEN $10.00 AIR TO AIIt EXCHANGEER $13 FIREPLACE (V+'OOD) $35.00 NEW GAS GRII,L $10.00 BOILER $35.00 =FIJRNACE S35.OU GAS UNIT HT'R $10.00 CWMNEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER $35.00 DUCT WORK $10.00 _GAS PIPING $10.00 VEI�iTlI�ATOR $15.00 Surcharge TOTAL DUE $ �. �fl Number of fixtures @ $10.00 x $10.00 = �- $ .50 Number of fixtures @ $15.00 x $15.00 = $ $ �,�U Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .SO Total = $ � THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSID 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 requires review and approt�al of plans. SIGNATURE OF APPLICANf lA��''` � 1��' PRINT NAME L1'V►6 5 ^ d DATE d� � � �1i3' O� �1'3C��e�' �uilciing �nspec�ions �epartanent 6431 University �venue NE, Fridley, MN 55432 763-572-3604 FAX: 763-�02-4977