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PRE 2010 DOCSCity of Fridley, Minn.. BUILDING PERMIT N® 4299 Date:.-._00tober -13, .1959 Owner: ...-��r.._TAG.... ..I AB$�. Builder .................. iiB6it'..........._............._. ..................................-- Address 4036- Street . No Be ................. Address Hda �8 21, Nimeepta LOCATION OF BUILDING No................Sfreet . -_ B...._ 89� .1��_..�� ...-......................... _.............. Part of Lot ..... ..... .................... -... .............................. _..... Lot ...................................... Block .... .......... ..................... ................. Addition or Sub -Division .....,t-W.f a..._�'�1.... 3, _K4:_..9 CornerLot .............. Y................ Inside Lot ............ ........................... Setback ...... .............. ....................... Sideyard ..... _.............. ......................... ........................... SewerElevation........................................................................................................ Foundation Elevation .................... _............. -.............. ...... ....................... .... - DESCRIPTION OF BUILDING To be Used as: WtB.t had ........ ....... _.............. Front Depth ._.....��__.. Height Sq. Ft . .................... ... Cu. Ft. ............................................... Front ................... Depth _ ................._.. Height Sq. Ft......................... Cu. Ft. Type of Construction .......... .......................... Est. Cost.......................................... 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 city of Fridley. � _ 7 ;� �% Ply- 6 /2/A ct U-'A't In consideration of the payment of a fee of $.....4* ........... permit is hereby granted to.......... ........... I.................................... ........ ......... .......................... ._............._........ 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 any of the provisions of said ordinances. Building Inspector NOTICE: This permit does not cover the construction, installation ¢or wiring, plumbing, gas heating, sewer or water. Be sure to as* the Building Inspector for separate permits for these items. 4 LOCATION OF BUILDI No. 1-3 Street- � - �� ' Part of 'Lot Lot Block - - -- - Addition or Sub.Div. Corner Lot Inside Lot Set Back Side -Yard SEWER. ELEVATION FOUNDATION ELEVATION Applicant attach to this form'Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUIMING To be.0 edema �J aL Ca Front l - Depth Height Sq. Ft. . Cu. Ft. Front Depth Height Cu. Ft. Type:. of Construction Estimated Cost To be completed The undersigned h6reby makesapplica.tion for a permit for the work herein specifiedp 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 repreaenta- tions"stated in this application are true and correct. DATE G / 3 SIGNATURE 6AL (A Schedule of Fe costs can be found on the Reverse Side.) .W.. P. City of Fridley, Minn. 11-195 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT Date: September 24, 1971, Owner: Anthony Pikas Builder Bruce Nedegaard Address _ _ 4036 Main S t . N.B. Address 111 - 45th Ave N. E. LOCATION OF BUILDING 4036 Main St. N.E. No. _ _ _.___� _ Street .—. Part of Lot Lot _._... -5 _ Block ____.__..A _____..._.___ Addition or Sub -Division __ Berlin Comer Lot ___ X Inside Lot _ Setback Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Garage _ Front 6' Depth 24' Height 10' Sq, FL 624 Ca. Ft. 6240 2 Type of Construction Front .— Depth Height Sq. Ft. - Ca. Ft. Frame Est. Cost 2,100.00 To be Completed June 30, 1972 State 2,�3�.�� Stipulations: 1. Direct drainage from garage & drive to 41st Ave. 2. Existing elevauions of remained of property N Not be be altered. 3. Provide Hard Surface Drive In consideration of the issuance to me of a permit to construct the building described above, I agree tp 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. 10-3 _ '-� t . In coderation of the a 11.00 Anthony Pikers 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 ,Mthin the city limits and this permit may be revoked at any time upon violation of any of t#eprovisions of said ordinances. G C Lil'linff Inspector Hank u c NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to sae the Building Inspector for separate permits for these hems. 7 APLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S BUILDER: G ADDRESS: Wre ADDRESS NO:. STREET: i LOT : ` — S BLOCK : ADDITION: . �tJ CORNER LOT:— INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: _ Front: Depth: Z Height: 24 /o Y Square Feet: Cubic Feet: t/6 I. Front: Depth: Height: / b- Y,— Square Square Feet; Cubic Feet: 3!L a o Type of Construction: �Estimated Cost: 4 Z y 0 To Be Completed: Vv -A ,P 3 Q — / t %� "� ' `vJ The undersigned.hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE SIGNATURE: (See Reverse Side For Additional Information.) 7 2, _ ��'i`3✓t° i It '' p cr ��` a ? a : SUBJECT Pj77979 City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT r R 1, • COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 = � CITY HALL FRIDLEY 55432 j NUMBER REV. DATEPAGE OF APPROVED BY 612-571-3450 910-F15 5/14/85 JOB ADDRESS 4036 Main Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4, 5 1 Berlin Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Anthony Pikus STAN 4036 Main Street N.E. 788-7955 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct an 18' x 12' Deck 9 CHANGE OF USE FROM TO STIPULATIONS If deck is over 30 inches off the ground, a railing has to be provided with spacing of not more than 6 inches. ARiNly SEPARATE PERMITS Before d%gl�g call RF WIRING, HE,gTING' Q�iRED FOR PLU�I'g1�� lt�cal utilities TFLEP+H+�iVE. s .' �� SIGNS.REQUIRED�L�crRIC. GAS Etc. 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 ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION 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 1 1 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 $.68 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,350 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $23.50 PLAN CHECK FEE TOTALFEE $ 5.88 $30.06 SIGN AUTHRIZE AGENT (DATE) WHEN PROPERLY VALI TED THIS IS YOUR PER T =0FCOTOR SIGNATURE 0F OWNER IIF OWNER -BUILDER) IDID T-- Ei BLDG INSP q TE NEW [ ] City of Fridley Effective 4/1/84 ADDN._ [ ] F R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: �� _� 2�Z�,l a a4 Legal Description: Owner Name & Address: f'1�h eh �� ^ u S �6 3 Ce t Tel. Contractor: '�-5 c_ry. -e -Tel. i 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. i DE% AREA: Length - 1 �- Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [L4X Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Type of Construction: Estimated Cost: $ 1 Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation . DATE: - / 3 S P ICANT . J Tel. .� ' � AP L Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Hain Charge TOTAL CITY USE ONLY STIPULATIONS• 342 Fee Schedule on Reverse Side 25% of Building Permit Fee $•50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] S. SUBJECT P City of Fridley 18065 AT THE TOP OF THE TWINS BUILDING PERMIT _ ', � CEIPT NO Y_ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 7 d D 1 I 1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/13/85 JOB ADDRESS 4036 Main Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4,5 . 1 Se lin Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Anthony Pikus. 4036 Main Street N.E. 788-7955 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW C1 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 121.x 18' 7hree-Season Porch Addition 9 CHANGE OF USE FROM TO STIPULATIONS SEPARATE PERMITS REQUIRED WIRING, HEATING, FOR PLUMBING AND SIG I TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION 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 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX $.68 AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,350 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 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- $23.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $5.88 $30.06 •i UREOFC ACTo OR AUTH RIZ AGENT (DATE) NAL WHEN PROPERLY V LIDATED THIS IS YOUR PERMIT C. — BLDG )NSP DAT SiG ATURE OF N Riff OWNER BUILDER) IDATEI S. NEW [ ] City of Fridley Effective 4/1/84 ADDN. [ ] �R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: Legal Description: )- ^� S Owner Name & Address: �L�v/ L r Tel. � % � Contractor • !�5 q 1-k\ 'z -Tel. # 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 DECK AREA: Length OTHER: FC 6 Go, Corner Lot Inside Lot [ ] Width Height Sq. Ft. Width Hgt/Ground Sq. Ft. /9 '8xa)� i�� Ft. Yd. Setback Side Yard Setback Type of Construction: Estimated Cost: $ �� Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: �3 APPLICAN 0tQe Tel. # Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] Is . . 0 SUBJECT PE City of Fridley 02 0 9 4i� AT THE TOP OF THE TWINS BUILDING PERMIT � EIPT • COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. I I i CITY HALL FRIDLEY 55432 NUMBER REV GATE PAGE OF APPROVED BY 612-571-3450 910-F15 9/8/93 JOB ADDRESS 4036 Main Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4,5 1 Berlin Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Anthony Pikus 4036 Main Street NE 788--7955 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION L1 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (.Tear -off) 14 Squares 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the. State Building Code. Provide adequate attic ventilation, Provide smoke detectors as per UBC 1210 adjacent to all sleeping areas and in basement. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $800 $.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $21.. G0 $-80 Fire SC. STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $22,30 SIGNAT RE OFC N'RAQT6RORAUTHO IZE AGENT IDATEI WHEN ROPE Y VALIDATED THIS IS YOUR PERMIT OG 0ATE ---SIGN URE OF OWNER OF OWNER BUILDERI IDATEI NEW [ ] Effective 5/26/93 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 431 Z Building Permit Application Construction Address: �,'d , (ra LQ Legal Description: L of 5 -�—� (v Owner Name & Address:div:fL) �� „ �� ! S Tel. ��'� ?�S S~ Contractor: (D U ) h P kL- MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF B"ROVEMENT LIVING AREA: Length Width Height GARAGE AREA: Length Width Height DECK AREA:Width HgWround OTHER: L77 c `-5-e_ - I e9 � Sq. FL Sq. FL Sq. Ft. Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: 6. Estimated Cost: $ 0 Approx. Completion Date: Driveway Curb Cut Width Needed: DATE: -_I F Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL Ft. + 6 Ft = (Cost on Back) Ft x $ _ $ $ U u Fee Schedule on Reverse Side $ (fj 6 .001 of Permit Valuation (1/10th%) $ -L�7� $.50/$1,000 Valuation $ $750 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ Conservation Plan Review $450.0 $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary t ] STIPULATIONS: Tel. # CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Residential Furnace Shell and Duct Work, Burner — Also Replacement Furnace (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning — All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $ $10.00 $1 $10.00 $ $10.00 $ $ 25.00 $ State Surcharge TOTAL FEE �I MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Effective On August 1, 1995 JOBADDRESS ®3 Cn M[: 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 representations stated In this application are true and correct. v _,1995 BUILDING USED AS , ESTIMATED COST 0 5-00 PERMIT NO. J®?Ce2 No. of Heating Units�--Circle One (Steam) (Hot Water) arm Air Trade Name �e n � ��: Size No. � � Q BTU j!S g�9 i,O047 HP EDR Fuel &e 4Qv Total Connected Load Burner Trade Name Size No. BTU HP EDR HEATING COMP NY a^ 156 07 4 n a Signed ByTei No. l Approved By _ Rough—In Date Final Date FILL OUT BACK SID 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 2. Is free from rust or deterioration 3. Has no foreign objects lodged within 4. Is securely supported 5. Meets all current Code requirements for size and total BTU's connected 6 Has total heating BTU's of , All other BTU's TOTAL BTU's�6 0 C 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: c,/ HEATING CO: Signed By: Date: Yes � No ( ) Yes r `' AA No ( ) Yes �j No O. Yes -) No ( ) Yes No71 ( ) Yes( ) No ( ) Yes () No 0 CCNOF FRIDLEY FRIDL$1 'l 'N UAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 - (6121) 571-3450 • FAX (612) 571-1287 Anthony Pikus 4036 Main Street N.E. Fridley, MN 55421 RE: First Notice of Noncompliance of Fridley City Code at 4036 Main Street N.E. Dear Mr. Pikus: The City of Fridley has established a City Code for the purpose of promoting a pleasant and attractive suburban environment. A recent inspection of your property revealed that not all Code requirements are presently being met. The following items do not comply with the City Code: • Please discontinue the improper outside storage of items including, but limited to, boxes of material, lawn tools, shovels, tires, pallets, a snowmobile, awnings, ladders, and fluorescent bulbs. The Fridley City Code requires all materials to be screened from the public right-of-way, with the exception of boats, trailers, and stacked firewood which are permitted in the side or rear yard. We understand that you may have been unaware of this requirement. Correcting this situation will greatly assist us in helping make Fridley a better place to live. An inspection will be conducted on or shortly after May 21, 1997. Please have your property in compliance at that time. If you have questions or would like to discuss your particular situation, please contact me at 572-3595. Thank you for your cooperation! Sincerely, C17,OF FRIDLEY urt sen -Schneider Code nforcement Officer KJSJs CE -97-140 Building Labor cost between $300 to $500 = cost of labor x.05 = MECHANICAL permit No Inspections SIZF/BTU _0 RESIDENTIAL APPLICATION Received By 763-572-3604 C $25.00 MFG: MODEL: PLACE (GAS) $15.00 CITY OF FRIDLEY DM's too DATE NEW GAS GRILL $10.00 —GAS UNIT HTR $10.00 E-MAIL RESS GAS DRYER $10.00 POOL HEATER $35.00 VENTILATOR $15.00 DUCT WORK $10.00 _ GAS PIPING $10.00 SITE ADDRESS THIS APPLICANT IS: ❑ OWNER CONTRA OR PROPERTY NAME: 2) l u f/ ST ZI d OWNER/ ADDRESS: %{1 I TENANT PHONE- � S CONTRACTOR COMPANY NAME; CONTACT PERSC ;� T L,SC 410 WEST LAKE STRE SUBMIT A COPY OF $ % , MN 55408 YOUR STATE STATE LICENSE 2 Ni STATE ZIP LICENSE WITH ADDRESS: APPLICATION PHONE FAX PERIVIIT ,TYPE `,SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE ❑ NEW PEPLACEMENT ❑ ALTERATION/REMODEL TYPE OF WORK: ` DETAILED DESCRIPTION OF WORK CF/ f �� 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, tor 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 ARE BAS $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FUMJRES: (INDICATE TOTAL NUMBER OF EACH BELOW) MODEL: SIZF/BTU _0 Equipment Installed MFG: MFG: MODEL: STZWBTU C $25.00 MFG: MODEL: PLACE (GAS) $15.00 SIZFJBTU _GAS RANGE/OVEN $10.00 _AIR TO AIR EXCHANGEER $15 $35.00 _ FIREPLACE (WOOD) $35.00 FURNACE $35.00 NEW GAS GRILL $10.00 —GAS UNIT HTR $10.00 BOILER CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00 VENTILATOR $15.00 DUCT WORK $10.00 _ GAS PIPING $10.00 Permit Fee $ Number of fixtures x Surcharge $ .50 Number of fixtures @ $15.00 x $15.00= $ TOTAL DUE $ Number of fixtures @ $25.00 x $25.00 = $ :1S •eO Number of fixtures @ $35.00 x $35.00 = $_ State Surcharge = $50 Total = $ THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I ledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and of a ity of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only f a ermit work is not to start without a permit; that the work will be in accordance with the approved plan in th case o hi h r review and approval of plans. ATE � SIGNATURE OF APP City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-5024977