PRE 2010 DOCSCity of Fridley, Minn..
BUILDING PERMIT N° x',,5066
,..�
Date:
Owner: 4 IC7t.`"�- -'� Builder
Address Address
CAT10OF WBING
No. Q Street P of Lot
�. .
Lot —__ Block Addition or Sub-Divisia
Corner Lot ____ Inside Lot ____'" Setback f g _ __ Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To sed as•
4' Front Depth , height Sq. Ft.' ['` Cu. Ft. y
r
Depth eight Sq. Ft. `� Cu. Ft
is
Type of etion Est. CostTo 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 city of Fridley, - - -
In consideration of the payment of a fee of $ ` a' , 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, aroundand 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 usolation f any of the provisions of said
ordinances.
_ Building Inspector
NOTICE:
This permit does not corer the construction, Insteflation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for there tta m
APPLICATION FOR BUILDING MaT
CITY OF FRIDLEY, MINNESOTA
0 -.mer I s Nam® i
��t l �� 17' ..Builder
/�"Sc a Ns ��,
Address dress
&OGATION OF H ILDiNG
No.� Street I Part of Lot
Lot Block Addition or Subdivision-�-�
Corner Lot Inside Lot_ Setback �! Side -Yard . r / o
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
'X�L4 49� Frontc & Depth
Tj JI Sq. Ft. � Cu. Ft.
V 6M J
Fron
---- z )
Sq. Ft. ® Cu. Ft.
Type of Construction__ Estimated Cost
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 Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representations
stated in this application are true and correct,. _
DATE.. s `—., / : `i SI
GNATM
(A Sch d e..4 c tt�,rpan be found on the RQv�rse. _gSide.)
j% y.f i c'.i .
Bum= PERMIT FEE samm E
Section 2. The Inspector of Buildings shall, before issuing any pandt for the
erection of any building or structure, or for any addition to any existdag build-
ing 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 herein
provided to -wit:
2.1. For aqy 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 fire-
proof addition, for similar occupancy, to any existing building shallbe 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, 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 $1.25 for
each one thousand cubic feet, classified as "fireproof" by Section 502 of the
Minneapolis Building Code.
2.3. For any such permit for the
than a garage, warehouse, factory
addition, for similar occupancy,
each one thousand cubic feet.
erection of any non -fireproof building other
or grain elevator, or any non -fireproof
to any existing building. Permit $1.00 for
2.4. For any such permit for the erection of any non -fireproof garage, warehount
factory or grain elevator, or for the erection of azr non -fireproof addition, for
similar occupancy, to any existing building or for each such building or addlt
Ninety Cents for each one thousand cubic feet or fraction thereof, in the oubiml
contents thereof with a minimum of $4.00,
For the purpose of computing fees for building permits the cubical contents of
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 0911W
to the average height of the upper surface or to the average height of the root
surface of the main giabie of a pitched roof.
2.5. For repairs or alterations to an existing structure., the fee shall be at '
rate of $3.00 for each Five Hundred Dollars ($500.00), or fraotiom thereat In WO
cost of all propaeed work.
2.6. In no ease shall the fee charged for any permit as sot faith iu Sectiep 2 be
less than $4.00.
Appl eaflon for Power Pmts and. Heating. Cooling. Yentilation..Refrigeration and
Air Conditioning Systans and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
Furnace Shell & Duct Work ..........................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 ..................
Repairs & Alterations each add. $500.00 ...............
MECEL WARM AIR
Furnace Shell & Duct Work to 12.0,000 BTU ............
each add. 80,000 BTU .......................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 ......... .
Repairs & Alterations each add. $500.00 ..............
RATE TOTAL,
8.00 $
5.00 $
5.00 $
2.50 $
8.00 $ 8.00
2.00
$ _
5.00
$
5.00
$
2.50
$
STEAM or HOT WATER SYSTEM
NO RATE TOTAL
1st 3 Fixtures ......................
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ......
8.00
$
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ...
8.00
$
Each add. 200 sq. ft. EDR Steam ......................
2.50
$
Each add. 320 sq. ft. EDR Hot Water ..................
2.50
$
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ 5.00
GAS FITTING FEES:
NO RATE TOTAL
1st 3 Fixtures ......................
x $1.50
$ 1•—
Additional Fixtures .................
x .50
$
Gas Range to 200,000 BTU ...........
x 2.00
$ °
AIR CONDITIONING
$
FAN HEATING SYSTEM
See Fee Schedule
VENTILATING SYSTEM
$
ALTERATIONS & REPAIRS
TOTAL FF,E
$ 14.30
. ROUGH
FINAL
Dept. of Bldgs. Phone fiW. 4-7470
Location §MTfneoln St. N. 8. --
City of Fridley:
UT"
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 representations stated in this application are true and correct.
Fridley, Mit 2-23_61 , 19 _
Owner Philip Aire ab Constriction Co-, _
Kind of Building — t
Used as RSS•
To be completed about 3-23_61
Estimated Cost, $
Old—New. Building Permit No. Permit No.
DESCRIPTION OF WOR7
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No 1
Trade Name Wetinabo 38e Size No. 100
Capacity. 1001tI BTU H.P.
Total Connected Load 61,390 Kind of FueL Gas
BURNER — Trade Name Size No
Capacity.
(REMARKS—OVER)
Sq. Ft. E.D.R BTU H.P.
Signed
By NNW VOGT & Co
42 amu► 7.89 Business VA_ & AIR CONDITIONIS;
8530 West Lake St. , WE. 9-biai
St. Louis Park, Minnesota
/Y IN
®ods-fP.�� c?
WAT LOSS CAL.CUt.ATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS, MINN.
Weat1wratrips Construction No. Insulation
Guide
Windows I Doors Reference I Out. Wall Int. Wall I Ceiling I Roof Floor Kind How Applied
Yea, --Ne- —e ---4q0— 19_
/ F7_ , ; i - Rmm I t nath -7 / Width /dO-- Heistht Ste' II / F1 I
Windows and Doors—Crackage and Area
1
t
Width Height No. of Lines; ft. Area
No. of pane of pane lights of crack sq. ft.
x
a
i 34 27
Coef.1 Btu
Coef.
Btu
Infiltration as
Glace
-2q
70
Exp. wall p
Net up. wag
Int. wag
Net exp. wall
1z z l
/ 1
Ceiling
Int. wag
Elooi
Ce its
Floor
Total Btu. 0 zzf,
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
/ Fl1rF& -,0 -:- Room I L.ensth-n n Width 9 Height �
Windows and Doors--Crackage aced Area
Total
WidthHeigih,No. o apl tt. Area
No. of pace of pane lights of ok p ft.
�Y.
x
t7
Coef.1 Btu
Infiltration
y `�
Class
Exp. wall
Exp. wag i
.Z
Net up. wag
Int. wag
Ceilingf ��' iif
Floor1711/s,/2—
1z z l
/ 1
Total Btu. "0 Vic
Required sq. ft. E.D.R. or sq. ins. WA. leader area
/ .. Renes I L enath Off, width t P".
Window and Doom—Crackage and Area
Width Haight No.of Lineal ft. Area
No. of pane of pane llghts of crack I sq. ft.
�Y.
0
Coef. Bta
Infiltration
y `�
Glass
Exp. wall
Exp. wall 4fy
.Z
Net exp. wag
Int. wall
Ceiling
Elooi
Total Btu.
Required sq. ft. E.D.R. or sq. ins. WA. Leader area r�
Rmm I Lunch Width Height A*>.
Windows and Doors—Crackage and Area
Width HelahtNo. et Lineal ft. Area
No. or pane of pane llahts or crack sq. ft.
�Y.
0
Coef. BW
Infiltration /-10
C�
Glass
Exp. wall
Net exp. wall
.Z
Int. wall
Ceiling b
Floor
Total Btu. 1,23.5 O
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
. FI I a I Rmm I Length / eJ Width 4- Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane Ilghts of crack sq. ft.
y.
0
Coef. Btu
Infiltration
JL 573 2,
Glass
Up. wag i
YO
Net ezp. wall
.Z
Int. wag
Ceiling
J
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. itis. W.A. Leader area
/ R7 L.Z _ / Rnntn I lrnath /-? Width / 7 _ Height .G
Windows and Doom—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pans lights of grack eq. tt.
0
Coef. Btu
I�filtratiail
Z
Glass
Exp. wag
Net exp. wag
Int. wall
Ceiling ,t- j v
Floor 7dp
Total Btu.
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
i
D•!� �r. r v
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MOMAPOUS. MIMI.
Weatlwrstrips AAN.L. Construction No. Insulation
WindowsDoors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied
Ye&_No 19—
Fl. Room Length Width Height Fl Room Length Width Height
Windows and Doors—Crackage and Area
width HeightNo. of Lineal ft. Area
No. of pane of pane IlghLeof crack p. ft.
2-f-
Coef.1 Btu
InOtratian
Glass O
Esp. waU 0 z
Net exp. wall /773
Int. wall
Ceding
Floor
Total Btu. 7
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F7. Roam Lenge Width 0 Height
Windows and Doors--Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
ICAMEJ Btu
Infiltration
Glace
FAp. wall • V
Net exp. wag 1�
Int. wag
Ceiling ':-
Floor
Total Btu. 4 b
Required sq. ft. E.D.R. or sq. mss. WA. Leader area
Ak Fl. Room i L-emew e Width lvlfeaght
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pans of pane tights oWeek 416A.
i y
Coef.1 Btu
Imetration Zrud
Glass
Exp. wall
Net exp. wag
Int. wall
Ceiling 67 Q 0
Floor
Total Btu.
Reauired sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and Doors—Crackage sad Area
Width Helgbt No. of Lineal ft. Area
No. of pans of pane llgbte of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wan
Int. wan
Ceding
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
M i R,.,•w. I I math Width Height
Windows and Doors—Crackage and Area
width Height No. of Lineal ft. Area
No. of pane of pans lights of crack cep- ft.
Icaef. Btu
luffitration
Glass
Exp. wall
Net exp. wall
Int. wan
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. iris. WA. Leader area
n 1 u......, 11 Vi&h Heiuht
Windows and Dion--Crackage and Area
Width Height No, of Lineal ft. Area
No. of paw at pass lights of crack q. tt.
Coef. Btu
Infiltration
Glass
Exp. wag
Net exp. wag
lat. wag
Ceiling
Floor
11 Total Btu.
11 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
City of Fridley
placafto fW r1� end em m T'"12 n, -I?
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
W
Yl
'�f
�
N
t
S
Z
(N%
�gYu•
e
e
WATER MIR.
Base
1st
2nd
3rd
4th__
• Future Coaaecffioa Openings
Connociod With
+ Now Fixture, Old Openings
Bower Q
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ................. x $2.00 $_�_
Future Fixture Opening ........... x $1.50 $ _.
New Fixture Old Opening .....:.... . x $1.50 $ -
Catch Basin .. x $3.25 $
Water Heater ;Up to 99,000 BTU) . • • • x $3.00 $
New Ground Run Old Bldg...... x $3.25 $
Electric Water Heater........... �.� s $2,00 $
:.AS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures x $2.00 $
Additional Fixtures ................. x $ .75 $
Gas Range to 199.000 BTU .............. x $5.00 $
Dept. of Bldgs. Phone 50-3450
Location �"/ �� •�� c C �`� <
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 Cit, 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, Minim
Owner
Kind of Buildingf� Gs -
Used as :S.
To be completed about /2 — F'�-75-"
Estimated Cost, $ �✓ ` ��
Old ew. Building Permit No. Permit No.
Signed
By
Business Phune No 6
ROUGH
REPAIRS it ALTERATIONS—Rotor to Cod* .50 State Surcharge
Description ..............................................._ 3b
TOTAL FEE 2 ��
PARTIAL RATE SCHEDULE
LLM-6111G FIXTU'E RATES:
• •
l✓HY 04
F:7iGl--Y
x 82•QO•
'3-11-9915051
Ap.plic;5 ion
ucr plurab _ ,� � U i�!`1: i:�
Future Fixture Opening . • • • • • • • • • • ----
Dopa. ofBldps. Phono S:�•3;50
•
DESCmPTIO11 O: Woos.
s�� 5185 'Lincoln ATF' -
I;uzzS::, i:i,+d a --id LecrS3c%a of Fixtures
s
.
Water I{eater 'Up to 93.000 BTU2 • . • • ____._
x $1,3 00
S
• tiew Ground Run Old Bldg....: • • •• •
City of FridlcY:
T4:
i I �.
t
7
•� i i u i
8 - i,.
p
l
u
7 <
Y
z-
7 _
o
r
A.+rs.
w
ras arc,
The undersigned hereby makes application for a permit for t`te aorY her,
Cit,7 O:dir.:
'}
g _
x $ .75
: o �w
3 s
u
o .
to $
x 85.00
s----
specified, aV eefng to do all work is strict acco:da^c@ with tl:e
L+tat 41 LZe f.
`o
11
and ruling of the DaPa--- of Buily.'av, and hereby declares
Bs:r
and represertations stated in this app:.ic"0C are true and correct'
I
'ns'
qi1C,r
5-2-76 19_
l::
r' ridley. Mian
ohn Sauk
-
Owner
3:d
'
Kind of Building 7
ity
• -
c�::._::,a
with
FL:.::O CG..-.L:•.iC, Cij�.G�.^.��
vCQO:❑
E� Used as
i ?tav F::2urr. Old Cr-,smir.Cs
Ccwpool []
5-27-76
To be completed about
PARTIAL RATE SCHEDULE
LLM-6111G FIXTU'E RATES:
KO. RATE
TOTAL
x 82•QO•
S
Nurr.ber Fixtures ................ _---
Future Fixture Opening . • • • • • • • • • • ----
x $1.50
S ,
New Fixture Old Oprring.....:....
x $3.25
s
Catch Basin ....................
Water I{eater 'Up to 93.000 BTU2 • . • • ____._
x $1,3 00
S
• tiew Ground Run Old Bldg....: • • •• •
- x ;=3.25
S.-------
il.ctek Wa:.r H.atar... • .:.... • • • ..._._._.----
z :2.00
S
NO. RAIMS TOTAL
Z .S :ZTTING TEES.
x$2.03
E
1st3Fixtures ••••••••••••••••'•
.
x $ .75
S -
M41ticnal Fixtures ...... • ........ ----
G:s p :aa to 193.000 BTU ........... ------
x 85.00
s----
Estirr10.00ated Cost. $ / �`
pa:a:2 'No.
—L Iluilding Permit NO.—
Signe ,
By—
Busincss Ph.,re No
F:CUGH -7
FINAL
p�A;q$ k ALTFAJITIOXS—P.afor
to Codi
.50 State Surcharge
.ik;.cri;.tlon . • .. • • ... • .....:. • ..................... urchai'E _�0�
5'.
• 50
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
Rate TOTAL
$ 20.00 $ 9®
$ 10.00 $
$ 10.00 $
$ 10.00 $
$ 10.00 $ l�
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $
Commercial/Industrial
1 % of Value of Appliance or Work $
State Surcharge $ .50_
TOTAL FEE $ 10 �
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
JOB ADDRESS !!rZ8 5' / 1-,&2 Co 4 --e-) � « 6
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 ruling of the Building Division, and hereby declares
that all the facts and representations stated in this a plication are
true and correct. < 19 ,1991
01
OWNERA2eg6df Ab C!f® € �.
BUILDING USED AS -,4� E el G 45:'
ESTIMATED COST PERMIT NO. l�l�
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units00,
Circle One (Steam) (Hot Water) arm Air
Trade Name 4C"o15�14oe Size No.
BTU ®_®c -n' c� HP EDR
Ful -- Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
HEATING COMPANY
Signed By,/lam 144 =Tel No. _40";7Z —®
Approved By Rough -in Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHIMNEY AND 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 (e" -f No ( )
3. Has no foreign objects lodged within Yes No ( )
4. Is securely supported Yes, No ( )
5. Meets all current Code requirements for
size and total BTU's connected Yes k- No ( )
6. Has total heating BTU's of 90, o®esl�
All other BTU's
TOTAL BTU's
Remarks
List Alterations Being Done:
HEATING COMPANY
Signed By
Date
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES:
New Fixtures
Future Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Hydraulic Valve
Sump or Receiving Tank
Water Treating Appliance
Hot Water Heater
Gas Range
Gas Dryer
NO. RATE TOTAL
$ 5.00
$ 3.50
$ 1.50
$ 4.00
$ 5.00
$ 5.00
$ 5.00
$ 5.00
$ 5.00
$ 7.00
$ 5.00
$ 10.00
$ 10.00
Back Flow Preventer Required. Yes ( ) No ( )
Type $ 5.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1% of Value of Fixture or Appliance
Reinspection Fee $ State Surcharge
($15.00) TOTAL FEE
Effective Date May 1, 1988
Job Address O �\ f\� A r,
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. �.� , 19�
OWNER(if 4n (� -4'
KIND OF BUILDING
USED AS C'e S
TO BE COMPLETED ABOUT , oL Q 9 O
ESTIMATED COST A C3 O /}
OLD - NEW BUILDING PERMIT NO. PERMIT NO. ✓�®�
$
$c:�:2 Company A%;R; Judy
$ �o Si ed 700 W, I (ndAn Avenilp
$ No. P. 0• Box 1165
MN 5544,3-1165
t e®
S
S
$ ROUGH INSP.
S Date
S
$ FINAL INSP.
$ Date
S
$ APPROVAL FOR PERMIT
S
$ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
$ .50
s ,S�
W
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N
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K
w
Water
W
S.
�
�
0,
w
b,Heater
m
9
ur
�
•c+
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$4
8
�y
u
v
yl
°
N
ro
a
•.,
pH
.W O
.°c
.a
b roe
a ro
10
m
m
y
(n
U
a
o7
W
3
o u.
to
w
U to
•t 3
0
o
as
lec
1st
2nd
3rd
4th
(R) = Future Connection Opening
Connected with Sewer
(*) = New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES:
New Fixtures
Future Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Hydraulic Valve
Sump or Receiving Tank
Water Treating Appliance
Hot Water Heater
Gas Range
Gas Dryer
NO. RATE TOTAL
$ 5.00
$ 3.50
$ 1.50
$ 4.00
$ 5.00
$ 5.00
$ 5.00
$ 5.00
$ 5.00
$ 7.00
$ 5.00
$ 10.00
$ 10.00
Back Flow Preventer Required. Yes ( ) No ( )
Type $ 5.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1% of Value of Fixture or Appliance
Reinspection Fee $ State Surcharge
($15.00) TOTAL FEE
Effective Date May 1, 1988
Job Address O �\ f\� A r,
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. �.� , 19�
OWNER(if 4n (� -4'
KIND OF BUILDING
USED AS C'e S
TO BE COMPLETED ABOUT , oL Q 9 O
ESTIMATED COST A C3 O /}
OLD - NEW BUILDING PERMIT NO. PERMIT NO. ✓�®�
$
$c:�:2 Company A%;R; Judy
$ �o Si ed 700 W, I (ndAn Avenilp
$ No. P. 0• Box 1165
MN 5544,3-1165
t e®
S
S
$ ROUGH INSP.
S Date
S
$ FINAL INSP.
$ Date
S
$ APPROVAL FOR PERMIT
S
$ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
$ .50
s ,S�
Jam(.-Co9 �3 ( - a -- �=
NEW [ ] CITY OF FRIDLEY Effective 4/1/2004
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 F
BUILDING PERMIT APPLICATION
Construction Address: SiSS r! o I VIE
Legal Description:
Owner Name & Address: rno q D -4- OaineOe7j cv/J Tel. # O 9
Contractor. /14J Co✓�c t 00 MN LICENSE # a Oa33cl Za
Address: S)0-7/ KrcAch evs i Lyyr' Sc/,3 Z Tel. #263 - 7,F5-,fES/
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
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 Sq. Ft
Length Width Hgt/Ground Sq. Ft
Construction Type: W Irof7Estimated Cost: $ b
r.�'r1
Driveway Curb Cut Width Needed: Ft + 6 Ft Ft x $_ _ $
DATE: OV APPLICANT: Tel. # 703 - VS nS
Call (763) 572-3604 for Permit Fees ifding in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ 3.93
$ _ I .`? kP
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 $ 0 A 1 L STIPULATIONS: