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PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn. N? 2569 Date 7V -V./ M`:*iw...... ................. Owner ilrr Builder ................. Address .x,3.0..... ;'r... Address ......................................... LOCATION OF BUILDING No. .. ....... Street ,............. Part of Lot ....................... Lot ................ Block ................ Addition or Sub-Division.-�• Corner Lot ............ Inside Lot ............ Setback ............ Sideyard .......................... DESCRIPTION OF BUILDING To be Used as: 1 Front . jp� � Depth Height ai Sq. Ft..�<�.. Cu. Ft........ . .................... Front ......... Depth ........ Height ......... Sq. Ft......... Cu. Ft . ........ Type of Construction Est. C0S ........... ,• • , �• 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. , ,,...,, .. :.....F:.R. ............. In consideration of the payment of a fee of $. i� r. , permit is ereby granted t tAj, #..... to construct the buildingo'bt•.addition as described above. t•is granted upon re ' s condition that the person to whom it is granted and his agents, employees and workmen, in all work e i . 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. i 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 Date: Owner: ,,.. '.. . ...... Builder Address_ - _ Address _...._° -w.. _ W,�ATION F BUILDING No...._._,,,rf.. .. Street ____ ....-_......_..._._...._.... Part_ Lot Block ...____ :::--••-----..... ...... _ Addition or Su1�-Di on. f..' r. Corner Lot ...... _.._ ........ Inside Lot .....-............._....-.._- --... Setback, _ .�. ideyard .....___... _. c _....---_............ --_.._.._. Sewer Elevation ...................... ........ _....... ___..__._.._..._.._.__......_...._....__ Foundation Z levation.... _................... _.._._._..-.._..___.._._.__......._......._...._. DESCRIPTION OF BUILDING Tojx Used as: _...._" _.. ..E..,. Front __...._.. Depth ..@EHeight .... •- Sq. Ft. ,'57' Cu. Ft. ----_.............................. _..._......._..... Front ..................... Depth Height ......__� Sq. Ft ....................... Cu. Ft.._..---•----••------ Type of Construction :.... =% -0-0.4X........------ Est. COV77 ...... �� ....._..-... To be Completed ....._._...___. _........................ CAUTION THIS PERMIT D�-)ES NOT AUTHO.RiZE VIOLAT- ION OF AINY PRI'd; ;"! E LAND COVENANTS AND EUELDii : i=?�Sl-rai;T;ONS. 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 city of Fridley. In consideration of the payment of a fee of $. _...._...._, permit is hereby granted 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 respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of�ny of the provisions of said ordinances.. uilding Inspector NOTICE: This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. 4 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owners Name a �, �� �ti cI1! Builder ��< 0,9- C, C . �_, �� r L� Address 3 0 L F_I LL .I -LS Address LOCATION OF BUILDING No. Street Part of Lot Lot t -A 3 6- Block Addition or Sub.Div. Corner Lot Inside Lot Set Back Side•Yard SEWER ELEVATION _ _ a� FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To beused as: , 1�I��•--+�'��''�— a I' ... t= Front �? ? Depths - r",HeS ght Sq. Ft. 'S Ft. Front Depth Height Sq. Ft. Cu. Ftp Type, of Constructio �l e`�" ,i. ' " ' �� Estimated Cost =-40 r • 0 0 To be completed X14 F e® r N L f� 61- :ti s The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representa- tions stated in this application are true and correct. DATESIGNATIktE ( ?� (A Schedule of Fee costs can be found on the Reverse Side.) BUILDING PERMIT FEE SCHEDULE Section 2., The Inspector of Buildings shall, before issuing wW permit for the erection of any building or structure, or for, any addition to any existing building or structure, or for any alterations or repairs to any existing building or structure, upon°application therefor, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner hersWpro-%�ided.to-wit: ., 2.1. For any such,permit for the erection of.any fire -proof building, other than a garage, warehouse, factory or ;,grain elevator, or for the erection of any fireproof addition, for similar occupancy, to any existing building shall be at the rate of $1.40 for each one thousand cubic feet, or fraction thereof, in such cubical. contents. 2.2. For any such permit for the erection of any fireproof garage, ware- house; factory or grain elevator, or for the erection of any fireproof addition, for similar occupancy, to any existing building shall be at the rate of $1.25 for`each one thousand cubic feet, classified as "fireproof" by Section 502 of the Minneapolis Building Code. HOUSES 2.3. For any such permit for the erection of any non -fireproof building other than a garage, warehouse, factory or grain elevator, or any non - fireproof addition, for similar occupancy, to any existing building. Permit $1.00 for each one thousand cubic feet. GARAGES 2.4. For any such permit for the erection of any non -fireproof garage, warehouse, factory or grain elevator, or for the erection of any non - fireproof addition, for similar occupancy, to any existing building or for each such building or addition. Ninety Cents for each one thousand cubic feet or fraction thereof, in the cubical contents thereof with a minimum of $4.00. For the purpose of computing fees for building permits the cubical contents of any building or addition to a uniform height throughout by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or cellar to the average height of the upper surface or to the average height of the roof surface of the main gable of a pitched roof. 2.5. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 for each Five Hundred Dollars ($500.00), or fraction thereof in the cost of 41 proposed work. 2.6, In no case shall the fee charged for any permit as set forth in Section 2 be less than $4.00. Village of Fridley, Minn. BUILDING PERMIT Date: ................. Owner........ .... . . Address ....63.0 �C+ No 1832 Builder . .. ........................... Address............................................. OCA N OF BUILDING No. . rA.. .... Street .. .................... Part of t ............... . s Lot 3 . S7.4;. Block ........ �....... Addition or Sub -Division ...6% " 'V�?O.i -- . .. . Corner Lot .....� Inside Lot ........... Setback ........... Sideyard ............................. DESCRIPTION OF BUILDING To be Used�,as: �O .......... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........ ..................... Front ........ Depth... Height ........ Sq. Ft. ........ Cu. Ft. ........ Kve Type of Construction �ivto e ...... Est. Co / �' .......... To be Completed .................. /C IX /ell alll�j lam" / cosi eratio o e issuanc o me of a permi o 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. In consideration of the payment of a fee of permit is hereby granted 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 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. . ...... g Buildin for ..... �.. NOTICE: \--P1 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. 52-84-s915.51 City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK 6 o N E wa; Number, Kind and Location of Fixtures Location d7I TOTAL �_�er2�Z $ x 1.20 $ x 1.00 $ 8� N $ x 2.00 $ — x 3.25 2 • • WATER HTR. +'3 3 lii i ; F o �i LL G G� U < 3 �U'd �O' �a 0U' O F N GAS ELEC. r Base In t a ye 1st 2nd 3rd 4th _ • Future Connection Openings Connected with I Sewer e New Fixture, Old Openings Cesspool [] PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures ...................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin ............................ Water Heater (Up to 200,000 BTU) ...... New Ground Run Old Bldg . ............ NO. RATE TOTAL x $1.50 $ x 1.20 $ x 1.00 $ — x 3.25 $ x 2.00 $ — x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ Gas Dryer 1 2.00 REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $-1- 02 City of Fridley: The undersigned hereby makes application for a permit for the work herei 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 8-2 9-66 - 19_ Owner Geo Myren Kind of Building frame Used as res To be completed about 9-4-66 Estimated Cost, Old—New. Build ROUGH FINAL 42 Business Phone Air Zr61 5a CL -A ®073= PARTIAL RATE SCH E GRAVITY WARM ATR: A.A:'E TOTAL. Plzrnace Shen & Duct Work $10.00 $ Replacement of i urnare 6.00 $ Repairs & Alterations— up to SS00.00 600 x .76 Repairs & A!teratlons each add. 9500.00 3 O S $ eo�ITlt®tea State Surclarge 110E 1. WARM A R IFAX h-ZA—j SG >STSTM Furnace Shell & Duct Work to 120,000 BTU ..$1000 $ each add. 60,090 BTU 3.W i Replacement of Furnace 6.00 9 - Rep -airs & Alterations—up to $500.00 6.00 $ Repairs & Alterations each add. 5500.00 3.00 $ STEAM as HOT WATER SYSTEM Ftnrace Shell do Lines --to 400 sq. ft KDR Steam 33000 S Furnace Shell & Line --to 640 sq ft. EDR Not Watei 20.00 S, Each add 200 sq. ft. EPR Steam 300 g Each add. 320 sq. ft EDR Hot Water 3.00 $ OIL BUI§NER—to 3 gal. per hour 6.00 =. over 3 gal. per hour—See Fee Schedule GAS BURNER Cup to W9,000 BTU) 6.00 $ over 159,000 RM See Fee Schedule GAS FITTING FLTZ: Ifo RATE TOTAL 1st 3 Fixtures x$ 200 $ Additional Fixtures x .76 S_._. Gas Range to M.000 :$ 5.00 $ eo�ITlt®tea State Surclarge IFAX h-ZA—j SG >STSTM S" roe >3c2" YzzrrnL'iTYLMG MMT=w ALTffiATrOPM ria REP AM rte' FEE DvPt. of Bld9a. Phone 5W -3-M r 3 0 1,,P �� y'_e If-eN, City of g`ridley: The undersigned hereby makes application for a permit for the work h�erda� specified agreeing to de all work to strict accordance with the City Ordinances- and riding of the Depat tmrnt of Buildings, and hereby declares that all the facts and represontatiuns stated in this application are true and correct. Owner - Kind of Fridley, Minn rjz4 e— /<? j ;�L Used as 4 � To be completed about a Estimated Costti $ Old --New. Building Permit No. _ , _ _ Permit No. HEATING or POWER PLANTS --.St> M Hot Water, Warm Alr—No- A )✓ eO " l Trade Name C pN ��w Sine No- 4 f 010 CapacityLe4?C—vj-T'- Sq. Ft. F-D.R BTU Np Total Connected Lead._j Kind of FtixL,Pf,& G _ BURNER — Trade NaSize 2Ho Capadty Sq. Let. E.D R Irm _ (1413AM911—OVID) City of Fridley AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT r2. NO. 8359 COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 1 i � "1 CITY HALL FRIDLEY 55432 612-571-3450 0 NUMBER 910415 REV. DATE 3/31/86 PAGE OF APPROVED BY JOB ADDRESS 630 Lafayette Street N. E. 1 LEGAL DESCR. LOT NO. 35-37 BLOCK D TRACT OR ADDITION Riverview Heights SEE ATTACHED SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE George Doday 630 Lafayette Street N.E. 784-6565 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Panelcraft 3118 Snelling South., Mpls. 721-6628 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.' 6 USE OF BUILDING HKIN Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside with. aluminum & aluminum trim 9 CHANGEOFUSEFROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION ZONING SQ. FT. CU. FT. OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I 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 VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $5,Q00 $2.50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON - SUCTION OR THE PE O OF NSTRUCTION. yr, $50.50 LAN CHECK FEE TALEE / 0 9go * 0, - $53.00 OF CORTF6ICCTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLY VKPDATED THIS IS YOUR PERMIT w SIGNATURE OF OW NER I IF OWNER BUILDERI IDATEI BLDG INSP ATE / Ilk NEW [ ] City of Fridley Effective 4/1/84 ACDN. [ ] 1 R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: Legal Description: Owner Name & Ad esss : �C- y :�- Tel. # Contractor: / ® Tot. # Address: 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 Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground - Sq. Ft. OTHER: _ Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback _ Type of Construction: A�cent�i�►i,_, ��it� ;jgEstimated Cost: $ Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: _ $ _ $ See Back Page for Explanation DATE: APPLICANT: el. #��� C7�I,` USE ONLY Permit Fee $ Fee Schedule on Reverse Side Plan Check $ 25% of Building Permit Fee State Surcharge $c 4SO $.50/$1,000 Valuation SAC Charge $ $425 per SAC Unit Park Fee $ Fee Determined by Engineering Sever Main Charge $ DOTAL eS o�, (�Li Agreement Necessary [ ] Not Necessary $ STIPULATIONS: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: (763) 571-1287 PERM NO.:2004-00889 DATE ISSUED: 06/10/2004 ADDRESS : 630 LAFAYETTE ST NE PIN : 033024220093 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING VALUATION : $ 1,968.00 NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE. REROOF HOUSE & GARAGE (17 SQ) TEAR -OFF. STATE LICENSED CONTRACTOR 1 APPLICANT TABOR & SONS INC (20014248) 10547 TERRACE RD BLAINE, MN 55434 OWNER DODAY HELEN E 630 LAFEYETTE 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 worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating g cstruct�n o e performance of construction. ADnlig an ��,r : Date Bldg Insp. BUILDING PERMIT FEE 69.25 FIRE SURCHARGE 1.97 STATE SURCHARGE, VALUE 0.98 LICENSE SURCHARGE 5.00 TOTAL 77.20 PAID WITH CHECK # 8487 QRUAR ATF IMPKATTQ 11?PnTTM7PTl Vr)17 W(11?V rITURR TTJAV T11P?4Zr1? RRrl ARrIXM NEW [ J CITY OF FRIDLEY Effective 4/1/2004 ADDN [ J 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: Legal Description: 94 Owner Name & Address: l��v � ��� -,-z --5'l��<✓ Tel. 74' 7 6 It'al o 1,ger s7 MN LICENSE # Contractor. �t� f -V vs z Address: /© X9/7 c -r a-7-1 ssyfy Tel. # Z/Z 2R —1 ie - Attach to this application, a Certificate of Surrey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length _ Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: / 2 � T_� t / o � l�j' ���q��'r�'� Estimated Cost: $ Construction Type: u �6�d Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ = $ DATE: �—,16 -d 5;�- APPLICANT: 6T'S-z1V Tel.# 6-f 7�5'��°Z Call (763) 572-3604 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 CITY USE ONLY - $ / 0 '�� Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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 [ ] TOTAL $ (71)2L L STIPULATIONS: PLUMBING RESIDENTIAL APPLICATION City ®f Fridley Date Reosivii NOTE: IF PROPERTY 13 NOT OWNER/OCCUPIED- A UCENSED CONTRACTOR MUST OBTAIN THE PERMIT. DATE 3 - 17 - @ $ YOUR E-MAIL ADDRESS SITE ADDRESS Iva® THE APPLICANT IS: (CIRCLE ONE) OWNER CONTRACTOR NAME IKI4a,A FIQ- Oa, ^ !_- PROPERTY OWNER! ADDRESS _ (A o L a- W TENANT CITY I STATE 1-10 ZPP 31.3 � PHONE # i6 -A -711',4 4S L S NAME fit ViX Gi.17 NU11'�t'�I LICENSE # CONTRACTOR ADDRESS �i�- � D 11✓� d1 i w �'� ti � S vl I ij � 3 `� CIl'Y �' STATE M ZIP �7 y PHONES �'-{ �-� FOYe l� - �i - ? lam( PERMITTYPE %l SINGLE FAMILY TWO FAMILY TYPE OF WORK p NEIN '0REPLACEMENT DETAILED DESCRIPTION OF WORK W A 4 > k c a- � 0 FEES ARE BASED ON $10.00 PER RXTURE, EXCEPT WHERE NOTED FIXTURES: (INDICATE TOTAL NUMBER OF EACH) BATH Sll>tIKlLAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING (!deed Cliy Ucenw) SWIMMING POOL WATER SOFTENER (am CLOTHE$ WASHER KITCHEN SINK WATER CLOSET BACKR_GW PREY. (SIS) DISHWASHER LAUNDRY TRAY WATER HTR ($W FOR IRRIGATION WATER METER OTHER Permit Fee $ _3457. o o MINIMUM: $15.00 or 5% of cost of the improvement -whichever is Plan Review S greater on work less than $300 Surcharge $ ,Sp TOTAL DUE. S S J 43 Make chucks payable to: City of Fridley I ens is AN APPUCATION FOR A PERMIT- NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I admowtedge that the information above Is complete and aocurate: that the work will be In conformance with the ardinerwes and codes of the City of Fridley and with the N6nnesots 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 accvrdanoe with the approved plan in the case of all work which requires review and approval of plana. NAMEOFAPPUCANT Cb,r t,s 0.412 DAA �� _ I8- ay' Please type dr print SIGNATURE OF APPUCANT TOTAL P.01 Building Inspections 763-572-3604 DA' SITE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT NEP CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERYJIT TYPE MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS ❑ p XCONITRACTOR ti - - Cn ® cat k- ADDRESS:�-�, r t Cr PHONE: �6 `77 Ll 6 S COMPANY NAME: Y- t V ti Cc � k t c die CONTACT PERSON: CENSE # EXP DATE Permit N Received B, Datfkgdj s0 ZIP SSY3:i- STATE LI ADDRESS: 1-190 1��t 2 Sf Y-CrrY Li 1 0! `°� STATE ZIPss `/� �- PHONE -7 C.3 - -1 5 '-f - c> 19 FAX TYPE OF WORK: I ❑ NEW FAMILY ❑ TWO FAMILY REPLACEMENT ❑ TOWNHOUSE ❑ ALTERATIONMRAODEL )ETAELED DESCRIPTION OF WORK �✓u s� 11 �'-�-� enc ``� `�� �t" �' 'o `-`' PER MS 1613.665 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 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.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERENOTED:' FDC!%JRESt (INDICATE TOTAL NUMBER OF EACH BELOW)SIZEIBTU Equipment Installed MFG: U V � MODEL: � � F' N 07 _ SIZFJBTU�— G,: MODEL: • MFG: MODEL: SIZEIBTU A/C 525.00 _FIREPLACE (GAS) $15.00. GAS,-RANGE/OVEN 510.00 AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 FURNACE $35.00 _GAS UNIT HTR s10.00 BAY 5 00 $10.00 GAS DRYER $10.00 POOL HEATER $35.00 DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR S15.00 Permit Fee $ 3 J` .00 Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ ?, S . 5 o Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ 3,S- 01' State Surcharge = $ .50 Total = $ 35.Z o THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED 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 approval of plans. I SIGNATURE OF APPLICANT r. C) A- c 4 `+ _PRINT NAME lam, r t s DATE / a d City of Fridley Building Inspections department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977