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AF - 47953
Application �or Power Plants and Heating. Cooling, Ventilation. Refrigerarion and Air Conditioning Systems and Devices � a��..�. PARTIAL RATE SCHEDULE nept. of Bldqs. Phone 560-3450 GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work . . . . . . . . . . . . . . . .. . . . . . . . . . . $10.00 � Replacement of Furnace ............................. g,pp � Repairs & Alterations—up to $500.00 . . . . . . . . . . . . . . . . . . g.pp $ Repairs & Alterations each add. $50U.00 . . . . . . . . . . . . . . . 3.00 $ MECH. WARM AIR Furnace Shell & Duct Work to 12U,000 BTU . . . . . . . . . . . . $10.00 each add. 60,000 BT[J .. ............. ..... .. . 3.00 Replacement of F�zrnace ............................. 6.00 Repairs & Alterations—up to $500.00 . . . . . . . . . . . . . . . . . 6.00 Repairs & Alterations each add. $500.00 . . . . . . .. . . . . . . 3.00 1D o° � $ � $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. FDR. Steam ......$10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . . . 3.00 $ Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 3.00 $ OIL BURNER—to 3 gal. per hour . . . . . . . . . . . . . . . . . . . . . . . 6.00 $ over 3 gal. per hour—See F�e Schedule a GAS BURNEit (up to 199,000 BTU) . . . . . . . . . . . . . . . . . . . . . . 5.00 $ ✓�'� over 199,000 BTLT See Fee Schedule GAS FITTING FEES: NO RATE TOTAL lst 3 Fixtures B O . . . . . . . . . . . x$ 200 $�— Additional Fixtures ................. x ,75 $ Gas Range to 199,000 . . . . . . . . , x$ 5.00 $ AIR CONDITIONIMG FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL %– ls " 7 7" � See Fee Scheduls TOTAL FEE �— � � n;`�! ' ��. �) u � �G�c,� �.�/z . City of Fridley: The undersigned hereby makes application for a permit for the work hereir. specified, agreeing to do all work in strict accordance with the City Ordinance: and ruling of the Department of Buildings, and hereby declares that all the fact: and representations stated in this application are true and correct. Fridley, Minn. � � 1 � , 19c� Owner �1�JGf_.I`Z2 �, Kind of Building _ T `�-'YY��_ � n . � Used as To be completed about �y a Estimated Cost, $ D �� � �E—New. Building Permit No. Permit No. �C.aln� DESCRIPTION OF WORK HEA,TING or POWER PLANTS�.Steam, Hot Water, Warm Air—No. Trade Name 1 Size No. ��' � 1���d Capacity Sq. F't. E.D.R, BTU H,p, Total Connected Loac� `7� �Q a Kind of Fuel- �-�' �"�-�.� BURNER — Trade Name.�Q�- size No.._.,,%d �� � Capacity Sq. Ft. E.D.R BTU H,p, (REMARKS—OVER) �E Signed � �tic0 ��� ii'LG�� �� By n`D-t,�.�o �� i:�2/�,r.�i� Business Phone No �� y s a�/ Ci1ty of Fridley, Minn. 6431 University Ave. N. E., M�nneapolis, Minn. 55432 BUILDING PERMIT ��. _ June 22� 1972 �; ('.�nmc�rc�ial F.r ors Builder ..Sr�i11��..._ ...� ,Address �2R.$...F.ilmQra:�S t'r'P �.. rL.�.,. ._._. Address .��ue._.... . M LOCATION OF BUtLDING Na 6275 S�t � Kerr�.Lane N.E. _.. Part of Lot �_ Lot 3 Block ._._...� 3._._...____:�. Additian or Sub-Divisian . Heather Hills Addition Corner Lot ._X_._.._.__ Inside Lot _..___. _ Setback _._..___._...._.__.._._ Sic3eyard ._._.__� �eb%�/Elevatian _�� I�F���i/�1�•/aiti�o(i/_909.40__A,pnrox. Wye Top of Footigg DESCRIPTION OF BUILDING To be Used as: . ilia�lli n�.._.._ Front ._..._�_. DePth � Height _._2�.�__ Sq. Ft. __.. C�. Ft Garage __ Front ..�.22 � Depth 23 � Height _ 10' �. �. ` 506' � � 5060' Ty�e of Construction .�._ ood Fr�mP ES� Cost .,.q�Z�.�.l.�.�_�_____.._� To be Completed _.._.. �S�'jLC' 972 Stipulations: Provide a hard H surface driveway and a verifying sur�ey before capping. WATER LOCATION: 10' S. of Sewer SEWER LOCATION: 170' S. of Manhole In consideration oi the issuance to me of a permit to construct the p%poserl work in xccordance with the description above set O�dinances of the city of Fridley. � ilding described � ���� C I agree to �u provisions at In consideration� of the payment of a fee of $..��,_00 _�, permit is hereby granted to Co�nercial ErQCtors to construct the building or addition as described above. This permit is granted upcai ' the express condition that the person to whom it is granted and his agents, employees and workmen, in all work �one in, around and upon said building, or any part thereof, shall conform in all respects •to the ordinan� of �'ridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildiIIg�t ��ce& c�tY lunits and this pernut may be revoked at any tirne upon violation of any of the provisions o! Said ! � CLARENCE BELISLE NOTICE: This psrmi! doss not eover fhe construction, installation for wiring, plumbing� gas heating, sswer or wafer. B� sur� to aN �h� 6uilding Inspecto� for separata permits for thase items. P' � � � APPLICATION FOR RESIDENTIAL, AI•TERAT�ON, OR AllDITION BUILD�NG p��IT CITY OF FRIDLEY, MINN�SOTA OWNER' S NAME t,��� C��� BUILDffit • �t r e , e � . ...��.� w A,nDRESS : .�.7 �'�' �*��Ylv2Pi.�/ � �s : .��h2�� _ �. . � �iQ : � .,� _ �' S TREET • �/?ir- LOT ;�� BLOCK • � ADDITION i �iit..� - ,., �.,.,. �.. � CO�tNER LOT: r/ INSIDE LOT: SETBACK: SIDEXARpt ...�..�....�- App].icant attach to this form T�ao Certificatea of Survey of Lot aad pzopo8ed building location drawn on these Certificates. HESCRIPTION OF BUILDING To Be Used As: , � • /� �/ �GL Front : Depth : �lo Height : � Square Feet: Cubic Feet: ,.� ' � �D � ' Front: � � Depth: v��j Height: Square Feet ; � � �o Cubic Feet : �` C1 � t�,_ , ,�,�„�, �„ ,�. '�►pe of Construction: ��� _ Estimsted Cost: $ 1 1 � A�w�AII�R To �e Completed: _T������ • ��� �.-, -� � � ) �"� y ��)1��`�,�t`,, The undersigsied hereby makes applicativn for a pes7nit fos tl�e .wpx1� '����,p specified, a�greeing to do all work in attict accordance with the City 0� F��,d1ey 0=dinaacea and rulinga of the Department of Buildings, and 1�e���b�' d��la�es that all the facts aad representations stated in this appliaAt�oA a�re tsve aand correct. � �►��; ;ZTj -�`%� ��� • � . (See Revera ide For Additional Information. ) � � �' �� �" �r� '� '""`` '�`'� � `� �^"' ... _ ,� ,� 'r�` 4.� ��- ;�. � ,i � r � � u .� .. ` �� "� � ) � � �� --_�_.a...-......." - - _. �`�r�.� � t..,�.�- -- -�-` �.� �`j �"`' ': , /—>' ! /%!� �j � t� . � w� � t+. . t.� !�� l � I� ti r�'� G� r� . F` r � ----�--- � (1 " Ci4y aE Fridtey Applicalion for P� �ad Cas �ig �t a�. � Bwv. pho.r. sea�so DESC1lIP1'ION OF WOR1[ , Im� �O o� �s —/�'' iiumb�r, Kind u�d Locatioa si flxtur�s ' � N i �i - i2 � �I�� i� � �a 3� �� �v� �� v� ; � S I . I Basc l�t 2nd 3rd {th • Fat�w Co�wedoa Op�daqs • N�w Fisfur�. Old O�ainqs PARTIAL RATE SCHEDULE w�rr� �.rn. • . / N GAS [IEC. � S�w�r ❑ �P� ❑ PLV1tSING FiXTURE AATES: •• xa X=2A� _��� O 0 Number FYxtures . . . . . . . . . . . . . . �. PLture Flxture Opening . . . . . . . . . . . � a i1.b0 t `�j � 0 O New Fixture Old Opening . . . . . . . . . . . x i1.50 i__ Catch Basln . . , . . . . . . . . . . . . . . . x s3.25 i � Od Water Heater !Up to 99,000 BTU) •••• � x t3.00 s -�, New �round Run Old Hldg. . . . . . . . . x i3.25 S II�ctric Wat�s iiybr . . . . . . . . . . . . . . s S'2.00 = Gl1s FITTIliG FEEB: NO. RJ1Tt ?OTAL O� Ist 3 Fixtures • . • • • • • • • . • . • • l x �.00 i�s— Additbnal l�turea . . . . . . .... . . . . . x = .T6 i Ga� Ru�e to 19a.000 BTU ..... ....... a=5.00 i State Surcharge $ .50 REPJ1IRS � ALTEAA?IOlfd�—R�bs to Cod� _ Dyeripff� . . . . . . . . . . ... . . . ... . ... . . . ..... . .. . . .. . ... . � � 1�O�PAI. �'6E Cid oi l�idtey: The undersigned hereby makes appllcation tor a permit for the wosk Txrei� speci�icd, agreeing to do aII wark in sttict accordance with the fat, Ordinance and ruling of the Department of Buildings. and hereby declares that a2I the fact and representatlons stated in this appHcation are true and correct Pt'idltY. 1�IinA � .19ZL Owner . Kind of $uildin� Used as To be completed about Estimated Cost� S Old ew. Building Permit No. P•smit No. ��(G�•� Signed , By ,.�„� , Business Phune No xouox i'IPI1li. /'� V _ Applic�ation I�or'ow�r l�Ia�Ns and H�aN�g. Cooliag. Yenh'lotion. R�tEie�ra�ion �d Air Con�niAg S� �d D�ric�s PARTIAL RATE SCHEDULE GEAY!TY WAIW A1A: 1t11?6 TO?AL ll�rnace Shell d� Duct Work . . . . . . . . . . . . . . . . . .:10.00 i Replacement of P�rnace . . . . . . . . . .. . . . . . . 6.00 � Repairs & Alterations—up to =500.00 6.00 i -_-- Repaira dz AlteraUona each add. s500.00 . 3.W �_-- IiLC!!. WJ11u[ J1U Ptiunace Shell dc Duct Wori� to 1�0,000 BTtJ . . . . . . . . .a10.00 �� ekh add. Ad.000 B'!'�T ............. ... .... .. 3.W i RePlacement of Ftirnace . . . . . . . . . . . . . &00 � RePair� do AZtcrationa--up b ;5�0.00 . . . . . 6.00 � ReP�'s d� Alterations each add. :500.00 . . . . . . . . . . 3.00 ; STF.J11�t or HOT W1►TER gysi'E�[ Furnace Shell d� Lines--to 400 aq. ft. IDR Steam �10.00 �. Furnace Shell & Linc►-to 640 sq. ft. EDR Hot Watrr 10.00 �. Each add. 200 aq. ft. EDR 3Eeem S,lKt �_- _— Each add. 320 sq. ft. EDR Hot Water $.pp :__ OIL HORNER—to 3 gal. per hour g,pp = _ over 3 Qa1. per hour�ee Fee 5chedule GA8 BIIRlIER (up to 199.000 BT[T> . . . . . . . . . . . . 6.00 � id C7 arot 199,000 BTf1 8�. F�. seMdul� G11a FITTING FSi�: 110 R]►TE TOTAL lat 3 ltixtures . . . . .. . xi Z00 =� Additional llxtw�ea .. : .76 = Gas Raa�ie to 1l9A00 .. si �_ un co�trio�nsa 111If ilE�TI� STf?EN v�rrna►Tnta aYSrmr ALTEM7'i0lfs ! 1ltP111A8 -•��. i'OU1L % ` � � - %S (SURCHARGE $_,50j��b s« r« se�.ad. ToT�:. �'R � 'R art. � s�a�.. rj►�. seo-�so City a? l�ldley: The undersip►ed hereby makes applicatioa ior a permit for the work hereir specified, agreeing to da all work in strict accordance with t6e City Ordinaace: and ruling of the Department ot Buildin�s, and hereby declares that sIl t�c Iacts and representations stated in this application are true and correct. FridleY. Minn_ �'° ( !� � 1��� Owner -�����C.�1.dc_ -C'�� s�2L.� �'�� Kind oi Building _�_ �'Z-<<�'�'1� � t/�% n . ► Use(� as _ _ _ �c�G-�..tt•t'_-��` f/ , �y �7 To be rnmpleted about _�._ �. -! `' O�-Q" �� �ry �om Estimated Cost, a____ �✓�� �- Oid New Building Permit No. P•rmit No. ��� �TIOIt OF WOA1[ AEATING or POWLB PI.ANIB--Steam, Hot Water. �No Q � Trade Name g� ata...�� .S' �� l!� C� CaD�tY Sq.1R. E.D.it BTIJ AB. Total Connec�ed Iead �.�� �� 1[iad o� !1u �----- BURNER — Trade Nun� ' k Size No._�� D r L°1 �x' @ aD'�b Sq. !4. E.D R- g�) g,p (�!M/111Rf—OVER� 1 � � � �� f, � � I ����_ � �/ � / 9?-8�-879�01 0 CITY OF FRIDLEY APPLICATION FOR PWNBING AND GAS FITTING PEF�IIT • A ro rn c u ..�i ri .,�� b, Wdter al m m S+ c•a N 4 � a, G. � Aeater .°.+ u m � a an E, e� a� wQ .c c e a�i a' w O � O `� V �1 � N�.d a O O �•N J� N N ` N UI .0 ++ -+ w A ro •-� �a �+ o.c .ti ro ro � ro ro ro +' as 'lec v� U a W R7 N 3 O k+ v1 t+� U/G Q 3 (9 � l7 O lst 2 Ke I, Q 2nd �r er 3rd 4 `h (R) a fliture Connection Opening Connected with Sewer (t) a New Fixture, Old Opening Water PARTIAL RATE SCHEDULE � PLU:�iBING FIXTUR� RATES: N0. RATE TOTAL Nu.�er Fixtures Fliture F:xture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 STU 100,000 BTU to 199,000 STU Water Softener New Ground iain Old euilding Electric Water Heater GAS FITTIA'G FEES: lst 3 fixtuzes Additional Fix turea Gas Range to 199,000 HTI1 REPAIRS $ ALTERATIONS First $100.00 each add. g100.00 or fraction x S3.Q0 x $2.00 x $2.00 x $5.00 x 55.00 x $10.00 x $7. o0 x $5.00 x $5.00 x $3.00 x S1.00 � S�0.00 $5.0� $2.00 State Surcharge TOTI�L FCE REINSPECTION FEE . ($10.00) S S —_, $ $ S S S $ S $ S S S $ $ .50 S A _ t� Job Address b�%5 Kerry Lane Department of Suildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein speeified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all tho facl•3 niid repYO�ontations st�ted in thia nYplication nrc truc and correct Fridley, Mn. 6-�1-79 , 19 OWNER FAGFiN KIND OF BUILDING ' frame USED AS 2'gg. TO BE COMPLETED ABOUT 6��$-T9 ESTIMATED COST J�O_�O OLD - NEW HUZLDING PERMIT N0. PERtdIT N0. C`���D Com an--�� a� • P Y � � MlNNEGASCp Signed By AOUGF2 INSP . Date FINAL INSP. Tel. No. Date APPROVAL FOR PERMIT ���/�!=� DlINZMUbI FEE FOR RNY PLUV.BING YERMIT ZS $7.50 pLUS �.50 STi�TE SURCFiARGE 0 CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572— 3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On January 1, 1999 PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water l.eader Sump/Receiving Tank Water Treating Appliance Water Heater —Electric Water Heater — Gas** 1 Gas Range** Gas Dryer** Back Flow Preventer Required ()Yes ( j No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $�o.00 /o.vo $10.00 $10.00 $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.596 of Value of Fixture or Appliance State Surcharge TOTAL FEE $ .50 JOB ADDRESS G� 75 �£�22y L,4- The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and represerrtations stated in this application are true and correct. �s 2oa U , 19�J9 Owner -, o m '`" ��42 oC 6 fc�LG�, Building Used As /�D�n � Estimated Cost y`�� �G PERMIT NO. ��� �j� PLUMBING COMPANY ���2,� D(/E�2,4CKC.�2.• '��ly SIGNED BY , TEL N0. `s��' ���D Approved By Rough—In Date Final Date � f �O $ ZD.SO PLUS THE $.50 STATE SURCHARGE **COMBUS110N AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM S)ZE 9 SQ INCHES. NEW I� AUDN ; [ ] ALTER [ ] Construction Address; Legal Description: Owner Name & Address: Contractor: � ����`=� c�-=c�% CITY OF FRIDLEY 6431 University Ave NE, Fridley, MN 55432 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION :� e2 7�S /�� �T� �l �� /�Gvr� � � � ( _—�� -f--� � �`�:t I � (763) 572-3604 Bldg i (763) 571-1287 Fax� J � / � � ��l �'Cf��� Te�. # 7�3' �s'-7– �� 5�/ MN LICENSE # Address: ' Tel. # LMNG AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Cert�cate 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 � 0 � � Construction Type:./l�e.� /�""' �L°�""� _ Estimated Cost: $ c�B�'O Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _� . � �/ v � PPLICANT:�' °ti`"-P-� � Tel. #�G 3 -'7 s� —7G �l �ATE. A Call (763) 572�604 for Permit 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 C�3�i'i���3��7►]A'� $ /�. �`� Fee Schedule on Reverse Side $ � , 65% of Permit Fee $ r .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 Consenration Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ � � STIPULATIONS: C�.. ___.. ; _ � _ ' ; _ i _ _ . . ._ _ _ � - __ ; . � .� . . . . � 1 ' . � �. . . . . � . . ' j ' .... ..... ........... .. ..�_ .. . ..... . ,.. . . . . . . ... ... - � . � �� . . � . . . : : r ' .�__ __ .." � � � . '.. ._... . �..�.._..__L.�_� . .. �._� .. . . ... ........_ , ., . 1 . . ...._ . . . . . . ; , i . . ; � �, .... ,-. . .... . '. •. , ........ . . . . . .. . . . ........ .. .._.... ........ . . . .. ... . .. . .... ... �......... .. ._. . .. 4 . _ ... � + . .. .. . .;. . . . . _ . . � � I i ( ) i � _ . .... ; .._._ . .. _.: ......__.. _.... �._.. .... . ... . i �; ' . . . ... ._". .. . . __ _ _.. .. . ...... � I � 1 I , t _ ... ... .. . .. .._ . . . _. �. . 1 �' ; ...: t . L. �,� , , �. :. -: : ' . , �. : �. . . •,, � _� : , . . � ; : � .... ...... _ .... ' . 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' -- -- --._ _- �---- - ---- --- -- -- - - _: I s � � ! } , , ; , "'� ._., . ,_... , , ; . , � -- . . _. i �. -F I ' � ! { .�. + j i ± 1 � Y I��" JJY Gi ' il d,C 3� , � �� , ! %. � _$��.�:3 PLUMBING RESIDENTIAL APPLICATION City of Fridley :�Zo�� - C� �� e u ber eceiv By Date Received NOTE: IF PROPERTY IS NOT OWNER/OCCUPIED- A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT. DATE /��' �� YOUR E-MAIL ADDRESS .�,.� �c- r II 7% �/ �(� fy/ 5/V� L� orj SITE ADDRESS lv � 1 S%�.� ti f'l L/ Lni �h'r c� P s�� THE APPLICANT IS: (CIRCLE ONE) NAMEi �-vwrr / � �'`� fa`i t PROPERTY OWNER/ ppDRESS � 2- � f X� �� Li ��l TENANT CITY �%' � cl �� �i STA�E if" �Y ZIP S S'y.��'- PHONE #'G � - 75�7 "7�' �/I I NAME _ CONTRACTOR ADDRESS PERMIT TYPE LICENSE # CITY STATE ZIP PHONE # FAX# TYPE OF WORK � ❑ NEyy FAMILY TWO FAMILY � REPLACEMENT TOWNHOUSE DETAILED DESCRIPTION OF WORK ���r�tr�� z�`i+-�— ��v'l.trc�� `+� I �� �.� �L.a�.a - FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED FIXTURES: (INDICATE TOTAL NUMBER OF EACH) � BATH SINKlLAV FLOOR DRAINS � BATHTUB GAS PIPING (Need City License) CLOTHES WASHER KITCHEN SINK DISHWASHER LAUNDRY TRAY Permit Fee Plan Review Surcharge TOTAL DUE � �. o� $ $ .50 $ �b. 5° rHis is ari aP �SHOWER SWIMMING POOL �WATER CLOSET WATER HTR ($35) WATER METER WA1'ER PIPING WATER SOFTENER (;35) BACKFLOW PREV. (;15) FOR IRRIGATION OTHER MINIMUM: $15.00 or 5% of cost of the improvement-whichever is greater on work less than $300 Make checks payable to: City of Fridley I hereby apply for a piumbing 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 1 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. NAME OF APPLICANT SIGNATURE OF DLVU l � %�F '�'�f • f DATE � ~�' '� �' r )F FRIDLEY COMMUNITY DEVELOPMENT DEPARTMENT 6431 UNIVESITY AVENUE NE, FRIDLEY, MN 55432 (763)572-3604 Building Inspections 763-572-3604 1V�iECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY DATE � �<-� — � � YOUR E-MAIL ADDRESS _ &ITE ADDRESS � � � � � 1� � � �� � � THIS APPLICANT IS: O OCONTRACTOR PROPERTY Nq�: cv �. � � �� OWNER/ � � r ��: ,�'���; ADDRES� �" TENANT PHONE:�G .3' �Sr� ` �<o � /' w�r/fi y�' Permit No.: Received By: Date Rec'd: /nS� . �G/+✓1 /�%z c ct I��STATE ���'1LIP ss y.� CONTRACTOR CoMpaNY N�: � SUBMIT A COPY OF CONTACT PERSON: w�t !� � `` YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH ,r�DRESS: CITY STATE ZIP APPLICATION PH�� F� PERNIIT TYPE Y"��GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ��W D REPLACEN�NT �ALTERATION/REMODEL DETA_ ILED DESCRIPTION OF WORK � ��+- 'Z�'�?n ,`� �� v y.yv[ .-vy� �-�ti PER MS 16B.665 the permit fee is a minimum of $15.00 or 5°/a of the total cost up to SSOO.Oq whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This 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 PROJECTS WI�RE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (1NDiCATE TOTAL NUMBER OF EACH BELOV� 5��.� Equipment Installed MFG: MODEL: MFG: MODEL: SIZFJBTU MFG: MODEL: SIZE/BTU A/C $25.00 _FIREPLACE (GAS) $IS.00 _GAS RANGFJOVEN 510.00 AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 BOILER 535.00 _FURNACE $35.00 _GAS UMT H'fR S 10.00 CHIMNEY LINER $10.00 _GAS DRYER 510.00 POOL HEATER 535.00 DUCT WORK $10.00 GAS PIPTNG $10.00 _ VENTILATOR �15.00 _ — .,�..r��,� - � .�. ... • _ .. _ . Permit Fee $ .CiC7 Number of fixtures @$10.00 x$10.00 = Surcharge .50 Number of fixtures @$15.00 x$15.00 =$ TOTAL DUE $ � .� Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Tota1= $ THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclrnowledge that the information above is complete and accwa.te; 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 w ires review and approval of plans. SIGNATURE OF APPLIC PRINT NAME � u' �.1( ����.i.E y' �'° — a S City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 �1