AF - 47119�
�
. �""'' Village of Fridley, Minn. _
��` BUILDING PERMIT �°• 18 6 0
�
Date: . . . . . . . . . . . , .%. � ` . .'�'C . . . . . .
Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Builder . � . . . . .i!��.I�'?`'. .�. . . �!�?'�"": ��-: . . .
Address...................................... Address .............................................
CAT[ON OF BU[LDWG
I�TO. . .�? �/. . . . . Street . . . . . . . . . . . . . . . . . . . �--ti�. . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . .
.... ..
s '
Lot . . . . .% d. . . . . Block . . . . .� . . . . . . . . . . Addition or Sub-Division �.r/1ts�.�� . . . . : � • • • • • !iy°
I .
Corner Lot . . . . . . . . . . . Inside Lot . !�. . . . . Setback . . 3. .�. . . Sideyard . . . . .,,l.O . . . . . . . . . . . . . . . . . . . .
DESCRIPT(ON OF BUtLDING
To be tised as:
- i �-
� . . .. ... . . ... .. . . Front .��. . Depth !� 3•.:� Height j.-. �. Sq. Ft. ... .. .. . Cu. Ft. . .. .. .. .
..................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........
Type of Construction �!"��l..t . . . Est. Cost . �. 3..�.�.0 . . . . . . To be Completed
In consideration of the issuance to me of 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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In consideration of the payment of a fee of $. .� ......., permit is hereby granted to f�/. �... .
. . . . . .. .. .. .. . . . . . . . . . . . . to construct the building or addition as described above. This permit is granted upon
the e�cpress 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 respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
��
, � . . . . . . .0 ; �,�. ? . . . . . . . . . . . . . . . . . . Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
City of Fridley, Minn. -
BUILDING PERMIT �� . s 1 s 2
Date: ___./�""� .F.�"J' �'CO � � __._
t
� Builder �
Owner: . _..___.. , _.._..__._
Address . Address ..._..._._ �
CATI L NG
No.f Street ('r���--���/�-L- Part Lot
b�e�� .
Lot ._._.�.___ Block ._..._�� Addition or Sub-Divisian .._.
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Corner Lot ____._� Inside Lot _Y�■_"'� S.etback "�� j.` Sidryard ! �
Sewer Elevatian .�� � Foundatian IIevatian
DESCi��PTlC�E� �?E �UILDIIVE3
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To � � . �.� f �, � . � �' �'' �� f�f' ��`,�� %m
.�::;,w.��� ' =-�. F`rc��.ti �` !..,...�...._.. Agi;.�. �..� �._� : xi.Figixi �..:_`.__ ��. �to �-.�s-__ �.c. ��, �_ : ;
�: a,°� . De�i:ig. z:,�� Tzei�� : ._.._. _ �. �°t. �et. ��.
_..__.._..___............_..____.._. ... _. �. ---..._...._.. ...._.._._.__
�..� -'{ i�;�`�:_ gr �.c �%�, ..
� of Constructiioa�' : °_..� �.� :_ _�...�; .�_. Es�. Co�t�r_;•,��.--�#-- f,.r -._._.._._........ 'Fo k� �ompleted ......_..._._.._._..�____�
In consideration of the issuance to me of a permit to construct the buiiding described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinanoes of the city oP Fridley.
�
In caosfderation of the payment of a fee of ;.�. - , permit is hereby granted to,
to construct the buildiag or additiaai as described above. This permit is granted upon
the express c�ndition 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 thereo� shall oonform in all respects to the ordinances of
Fridley, Minnesota regarrling location, construction, alteration, maiatenance, repair and moving of buildings
within the city limits and this peraut may be revoked at aqy time upon violatioa of any of the provisions of said
ordinances. � .�I �1
Building Insnectac
NOTICE:
Thb panit doa no� eowr tiw eoeshve�ios, i�aa8nien for wi�, �Iu�t�a �u h..�y, swwr or w�Nr. 6� wn fo sM
Nu Building letp�etor for s�puat� p�nuifs for 1Ma� hMns.
�
.
City of Fridley, Minn.
BUILDING PERMIT
��: � AIIGUST 20, 1965
�o���
No 8391
�r: MR. S� MRS. C. RIYq'GHOFFER Builder BLANSKE_ CONTRAGTORS, IftC.
� 641 Helene Place N. E. Aa� � 108 Patton Read
Fridley 21, Minnesota Pew Brighton, Minnesota
LOCATION OF BUILDING
No. 641 3treet _._....�.._....HELEPE PLACE _...__ Psrt ot Lot
Iat _
Corner I.ot _�
Sevver Fde�+atlan
Block
Inside Lot
Addition or Sub-Divia[an
Setback r Sideysrd
� Fwmdatian Elevation
To be Used as:
FY�oat
F�o�t
Zj►pe of Co�structi�
DESCRIPTION OF BUILDING
Depth Height ....._..._._.._.. Sq. F"t.
Depth Height Sq. Ft.
� ��, � S7.40..Q,��_ To be Completed
Cu. Ft
Cu. Fk
REBUII.D AFTER STORM
In ca�sideratton of the issuanoe to me of a permit to construct the building described above, I agree to do
the propo�ed work in acaordance with the d�scrlptioa abo�ve set farth aad in ooanpliance with all pro�v3sfons o!
aadinances M the dty oi Fridiey.
Ea cm�[deration ot tbe paymeat o! a fee oi i 10.00 , p�t is herebY Sranted to^ BLANSKE
COflTRACTORS � INC . to c�oristruct the building or addition as described above. This perniit is granted upon
the express oonditioa tirat the person to whom it is �anted and his agents, employees and workmen, in all wark
do�e in, around aad uP� said building, � aru► part thereo� shall conform in all respects to the ordinances o�
��'Y, Minneaota re8ar�iin8 locatian. co�structim. alteratioq maintenauce, repair aad ix►ovin8 of buil�in�s
wi�� dty Ifaaib sad this permit may be revu�ked at any tizne upo� violation of aqy of the provisioas o[ said
ALLEft G. JENSEft Buildins InsPectae
WORIC6
1W �Mrif doM �ef eswr fIN ooMle�elio�. Ia�aN� hr �r�iy. P�W !� �Y. swv�e or waNr. M an fe sM
iw MYdiy M�sNr ier s�rah Ne�Ys �er 1i� tlwrs.
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APP�.ICATION FOR BUILDING PERMIT
CITY OF FRIDiLEY, �JSSOTA
OWNLR' S NAI��� _ % �h`s`��/ 1 / %t �j' /� o �t H BUILDER �� _C' /i � � � �L- �_1 G G
annxsss � 5`/ /`7�� /Pha /�/ac � ann�ss lU� ,f7i9 %�� �,�Q.i
LQCATION OF BOILDING / �K �cu %J V � ! �i �'° h
N0. STREET PART OF LOT
LOT BLOCR ADDITION OR SIIBDIVISION
CORNER LOT INSIDE LOT SBTBACK" � SIDE-YARD
SEWER ELEVATION FOONDATION ELEVATIOP
Applicant attach to this form Two Gerti�icates of Surarey of Lot and proposed
building location drawn on these Certificates. ,
f
To be used �s;`
�
DBSCRIPTION
�
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BUILDIN�
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,
i �- Height
Sq. Ft. Cu. Ft.
.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction _�i�,�i,ju Estimated Cost � 1��0 °--°----
To be completed
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Bui�dings, and hereby
declares that alZ the facts and representations stated in this application
are true and correct,
DATE � � S� _SIGNAT[TRE ��
J����
(Schedule of Fee Costs can be found on the,Reverse Side). 1�
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��a���e Construction Co.
Generul Contra,ctor
lU ����0�d� IT i;�Y :;� V����v :
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108 PATTON ROAD • NEW BRIGHTON 12, MINN. • ME. &2548
l'uis is -co certi�y tina�c 1 save �io objection tio _.:r. :z �rs. �narl�s
xiir�gcioizer addi�l� a za�ily ro�:� aire��cly �eai.zd �c�zeir �ara;�e a�t
----Ei�l-��-�e�ie rlace, r�,dley, �:in�.
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irio �a.�.ri
P
:�. �ie' �lo �aari
651-aele�ze place
rridley, i�iixlnesota
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��LZ���¢ Construction Co.
General Contractor
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108 PATTON ROAD • NEW BRIGHTON 12, MINN. � ME. 3-2548
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SUBJECT PER .
City of Fridley 18015
AT THE TOP OF THE TWINS 6 U I L D I�� P E R M I T
! � ECEIPT
� ' L _ COMMUNI7Y DEVELOPMENT pIV. �
r � ♦ � PHOTECTIVE INSPECTION SEC. �
� . �
� � �
� /'��1 CITY HALL FRIDLEY 55a32 NUMBER REV. DATE PAGE Of APPROVED B�
�""� � ,'� 612-571-3450 910-Ft5 5/29/85 / /
J08 ADDHESS 641 Helene Place
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ],Q 7 Donnay's SHEET
2 PROPERTY OWNER MA4l. ADORESS ZIP PHONE
Charl�s G. Ringhoffer same
3 CONTRACTOR MAIL AODRESS ZIP PHONE IICENSE NO.
same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE �ICENSE NO.
5 ENGftJEEA MAILADORESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
7 CLASS OF WORK
❑ NEW L7X ADDITION ❑ ALTERATION O REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Wood Frame Deck
9 CHANGE QF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONOITIONING. INOOC{ Fi�711e
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON3TRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZE� IS NOT COMMENCED WITHIh1 60 DAYS, OR IF CONSTRUCTION �_1
OR WORK IS'SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
� 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 VAI.UATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE GOMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �g�0• �� �. SO
DOES N07 PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL. THE pERM4TFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING corv- �16.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECKFEE 70TA�FEE
. 0 $20.50
SiG nt�N-RACT UTMOF AGE IDATEI WHE PROPE Y D THIS IS YOUF PERMIT �
- .� � �
S�GNATURE OF OWNER �IF OWNER 8 lOERI IDATE� WSG qATE
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ADDN. [
�t,T�. [ J
Construction
Legal Desari�
wnez 11aee �
Contracto�:_
Addresa
Citr ot FridleT
a-1 �D R-2
Building Permit �ppliaation
Effective 4/1/8�
G tsr fi�GE✓� � t,. <�,T'/!�� t.�c 7
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; y�' ��iGC� t G- IQ/�vL /��.� I� _?el . i
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Attach to thia application, a Certificate of Survey of the
lot, vith the proposed eonstructioa draxn on it to scale.
DSSCRIPTIO� � DlP1tOTB1�IiT
. i
LI1fLiG AREA: Length Midth Height Sq. Ft.
GARAGE �REA: Lengtb Yidth Heigt�t Sq. Ft.
DECL UtEA: Length � Yidth � Hgt/Ground _� SQ. FL. 1 f� Y
OTHER:
l�� �c�,a� = �o�-
Corner Lot (] Inside Lot [] Ft. 7d. Setback Side Yard Setback
Type of Coastructioa: �{jod � �'�A�+E
Approx. Completion Date : ��/ �� t �
1
Propo�ed Driveway Yidth If New Opening Ia Desired:
0
DATE:
Permit Fee
Plan Chack
State Surcharge
3�C Charge
Park Fee
Sewer Main
?0?�ll.
STIPULATIONS•
Estimated Cost: _ �
� Q 1/
Alt. A Alt B
_ �
See Back Page for Explanation
APPLICANT C�" � Tel. #
CIT? OSE 011l,
= Gl4 �U Fee Schedule on Reverse Side
= cC) v 25i of Building Permit Fee
_ �� =.50/=1,000 Valuation
� � 5425 per SAC Unit
Pee Determined Dy Engineeriag
•greement Necesaary [] No� l�ecessary C 1
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Gene%i Cant+�actor
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City of Frid�ey
AT THE TOP Of THE TWINS
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� ; y _�___ COMMUNITV OEVELOPMENT OIV.
r � � PROTECTIVE INS�ECTIpN SEC.
1 •
� _ �"'1 % CITY MAII fR10lE� SS�32
�'"""�� �'' 612-571-3450
Sul�ECT
BU ILDiN� PERMIT
NUMSEN pEV DATE �AGE OF
910-F15 9/18/00 / /
S08 ADpRESS 641 Helene Place NE
t LEGAL LO7 NO. BLOCK TfiACT Oii AOOITION
DESCR. lO 7 Donnay' s Lakeview Manor
2 PFiOPERTY OWNEfi MAIL AODRESS
Charles Ringhofer 641 Helene Place NE
3 CONTRACTOR MAIL ADDRESS
P J Siding 19420 Tri Oak Circle, East Bethel MN 55092
� ARCMITECT OR DESIGNER MAIL AODRESS
5 ENGINEER
6 USE OF BUIIOING
Residential
7 CLASS OF WORK
MAIL ADDRESS
� NEW O A�DITION O ALTERATION
9 DESCRIBE WORK
Reside House & Garage
9 CHANGE OF USE FNOM
TO
ZIP
IIp
� REPAIR
i 400
RECEIPT NO.
�� ��
�►vnOvEO !v
SEE ATTACHED
SHEET
PHONE
571-7433
PHONE LICENSE NO
763-434-0730
PMONE IICENSE NO
PHONE IICENSE NO
O MOVE O REMOVE
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather
�' resistive barrier be placed over exterior sheathing to protect the interior
wall covering. Exceptions for this provision would be if sheathing is an
approved weatherproof panel or when the siding is an approved weather
bsrrier. Vinyl siding is not a weatherproof covering unless the manufacturer
states �his in their app�ication guidelines. Call for inspectioz of wrap
before covering.
TYPE Of CONST
SEPARATE PERMITS ARE NEOUIREO FOR EIECTiiICAL, PLUMBING. MEATING.
VENTIIATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL ANO VOID If WORK OR CONSTRUCTION 20NING
AUTHORIZEO IS NOT COMMENCEO VyITHIN 60 OAYS. OR IF CONSTpUCTION
OR WORK IS SUSPENOEO OR ABANOONEO fOR � PER100 OF 120 DAVS AT
ANY TIME AfTER WORK IS COMMENCED. NO DWLG. UN
1 HEREBY CERTIFY TMAT I MAVE READ ANO EXAMINED TMI$ APPLICATION 1
ANO KNOW THE SAME TO BE TiiUE ANO CORRECT. ALl PROVISIONS Of �AWS VALUATION
AND OpDINANCES GOVERNING TMIS TYPE OF WORK WI�L BE COMP�IED
WITH WMETMER SP IFIEO MEREIN OR NOT. THE GRANIING OF A PERMIT �4'9000
DOES NOT PRE M IVE AU7MOfiITY TO VIOLATE OR CANCEL TME pEqMITfEE
PROVISIONS AN OT ER STA7E OR LOCAL LAW REGUTATING CON- $97.25
TRUCTION R 7H ER RMANCE Of CONSTRUCTION
pLAN CNECK F
C,lty
I N4TUq Ot 'NACT R�U�MOp�ZED �GENT AT � NE
$�GN4TUAE 0� OWNEQ��i OWNEpBUROEAi �D�TE� 11� im�
SO.
e
STA�LS
NCY GFOUP OCCUPANCV�OAD
CU FT
OffSTFEET PARKING
GnRAGES
SURTAX
�2.��
SAC CHA GE
Fire C $4.00
TOTA FEE
03.25
.IOAT HIS I F P IT
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N�y � � Effecfive 1/12000
ADDN [ j CITY OF FRIDLEY (763) 572-3604 Bidg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUlLDING PERMIT APPLICATION
Construction Address:
�
Legal Description:
Owner Name & dress: �,lri ar�rs �►•,G h� Tel. # 7�7 ��3
Contractor: /� � MN UCENSE #
, /,�.,- � � a �
Address: ► �c � � /�� Tei. # %6�3 � b%��/
LlVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
.s,
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height �
Length Width HgUGround
Sq. Ft.
Sq. Ft
Construction T e � �� Estimated Cost: $��� �'�
YPe�
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: �U APPLICANT: Tel. # � ��
CITY USE ONLY - Call (763) 572-3604 for Pertnit Fees if mailing in application
Permit Fee $ -�S� Fee Schedule on Reverse Side
Fire Surcharge $ 'j� aZ� .001 of Permit Valuation (1/10th%)
State Surcharge $ ��dC� $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
$ $1100 per SAC Unit
` $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
Park Fee $
Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
TOTAL
STIPULATIONS:
� 1 c��3 . ��.-"
3uilding BTJILDING Pe�it No.: ot uva �
:nspections RESIDENTIAL APPLICATION R�ived By:
163-572-3604 CITY OF FRIDLEY Daxe Re�'d:
�ATE�ITE ADDRESS �
'HIS APPLICANT IS:
❑ OWNER
PROPERTY OWNER/ I Npl„�;�
TENANT .9nnxESS:
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
YOUR E-MAII_ ADDRESS
STATE LICENSE #� � ^ v�O3� 0
AnI�RFSS� I�I�O !i C�'r Sf
❑ SINGLE FAMII.Y/NEW CONSTRUCI'ION
❑ TWO FAMII.Y/NEW CONSTRUCTION
❑ ADDITION O GAR.AG
❑ BASEMENT FWISH �tOOF
❑ DECK ❑ SIDING
�ESCRIBE WORK BEING DONE:
;IZE OF IlvIPROVEMENT
3UMBER OF SQL3ARES l I
sARAGE&
'ROPOSED SIZE:
?ROPOSED HEICsHT:
3IDIN
7 Vinyl
� Aluminum
� Other
i�'IIVDOWS
7�1 EXISTING OPENINGS DYes DIJo
JR FOR NEW OPENINGS-DESCRIBE SIZE OF
�PENWG CHANGES &
TYPE OF WINDOW TO BE INSTALLED
� / . C3TY � d 1 e�
� e ����� �
� DATE� 3I' �o
� '�� �-,� �/ 3'� Q
SIZE
STORIES
�Si�D � WIIQDOWS
O DRAIN TII.E
0 OTf�R
O SWA�IIvID1G PC
❑ ADDTITON
�FJREPAIR O REMODELING
� �-- ��
LENGTH
OUSE ONLY
� HOUSE & GARAGE
❑ ATTACII�UU GARAGE
� DETACHED GAR.AGE
❑Soffit
❑ Ttim
� Fascia
LOCATION OF WINDOWS
NUMBER OF WD�iDOa
WIDTH HEIGHT
A"l��I�IP���
A��3
F�
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of shvcwral members to bc used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMTT:
1. Site Plan/Survey showing thc cxisting structures
and propvsed project.
2. Two sets of construction plans
3. Energy Calculations
ALL REES ARE BASED ON VALUATION, INCLUDING THE COST OF LABUR AND MATERIALS:
(LTSING � 19�7 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION S�� ��� OCCUPANCY TYPE
Permit Fee
Plan Review
Surcharge
Fire Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ -
$
$
$
$
$
$
$
$
�
$
See Back Page for Fee Schedule
65% of Building Permit Fee
(.0005) times the total job valuation — Minimum $.50
.001 x Permit Valuation (1J10%)
55.00 (State Licensed Residential Contractors)
$1450 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks oavable to: City of Fridley Attach
THIS IS AN APPLICA'flON FOR A PERMIT NOT VALID L3NTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge 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 Construcrion 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 w whic ec ' s r view d approval of plans. �_
`_%� �� O Or M� DATE " v
SIGNATURE OF APPLICANT PRINT NAME.�o tft fn v' • �- �� �^ �
Building
Inspections
763-572-3604
DATE
`� Z'
SITE ADDRESS �
THIS APPL[CANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
�
❑ OWNER
ADDRESS: (��-i / —
PHONE: _�-� %�`��
NAME: �71r'
STATE LICENSE #
•v � ��x I�7`i�tC-Z�►7�i«+��G�
' • .G�
O,SiNGLE FAIvIILY
❑ NEW
DETAILED DESCRIPTION OF WORK
❑ TWO FAMILY
L�.l�PLACEMENT
Permit No.:
Received By:
Date Rec'd!
A
v�3Z
�� . � y�,��� '`� ,
�i
❑ TOWNHOUSE
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 residenrial fixture, excluding the fi�ctures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between �300 to $500 = cost of labo� x.0$ =`�.J "�
FOR PR0IECTS WHERE LABOR EXCEEDS 5500, FEES ARE BASED ON 510.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXT[JRES: (INDICAT£ TOTAL
NUMBER OF EACH BELOV�
BATH SINK/LAV _FLOOR DRAINS SHOWER WATER PIPING
� BATHTUB GAS PIPING (n�oCmuCFxsE) SWRvIMING POOL � WATER SOFCNER (S35)
�CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. (S15)
DISHWASHER LAUNDRY TRAY WATER HEATER (S35) J FOR IRRIGATION
— WATER METER _ OTHER
Permit Fee
TOTAL DUE
. o-a
.50
Number of fixtures @ $10.00
Number of fixtures @$ I 5.00
Number of fixtures @ $35.00
THIS IS AN APPLICATION FOR A PERMIT-N�T VALID UNTIL PROCESSED
x$10.00=$
x $15.00 = $
x$35.00=$
State Surcharge = $ .50
Tota1= $
I hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work will be in
conformance with ihe 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 wo � hiC�review and approval of p���
SIGNATURE OF APPLICANT �Y/! /. PRINT NAME_ y DATE �
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
?63-572-3604
FAX: 763-502-4977