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PRE 2010 DOCSCity of Fridley, Minn. N9 9620 BUILDING PERMIT Date: Feb. 27, 1968 Owner: Romedale Bl ers Builder Same Address 5217 Wayzata Blvd. Address Same LOCATION OF BUILDING No. 7 45 2 T Street Melody Drive --- part of Lot Lot 26 Block 4 — Addition or Sub_Division -Melody Manor 4th Addn . Corner Lot —_ Inside Lot — x Setback 35' _ _ _ _ Sideyard 10' -13' Sewer Elevation _ _ _ _880.37 _ 883.37 Top of Footing DESCRIPTION OF BUILDING To be Used as: Dwelling Front 36Depth 40%20 Height 20' Sq. FIL 1200 Cu. Ft. 24,000 Garage Front 19' 6" Depth _U.' ' Height _10' Sq. Ft. 468 Gt1. Ft. 4680 Type of Construction Frame Est. Cost 22 000 To be Completed SEWER LOCATION - 98' West of Manhole WATER LOCATION 88' West of Manhole 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 complian with ail provisions of ordinances of the city of Fridley. //' r9 � 17 /7 In consideration of the payment of a fee of $ 43.00 , permit is hereby granted to Somedale Blders 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, alterati9a, makten re and moving of buil within the city limits and this permit may be revoked a t a�Yy tine upon o ti of theAl%rovision 1 of d ordinances. I Official Building NOTICE: This permit does not cover the construction, hntalielon for whing, plumbing, gas heating, sewer or water. Be sane to we tho Building Inspector for separate pwndb for these Nene. v A:; JM.c.cl3 leOR '1 111 -KLD NZG l�' I':MIT C17 Oar MYNNESOTA OIJi�ER `S I1AiP �. _. _.. F,`� ?,. i11 µ ADDRESS ADDRESS_s� LOCATION OF BUILDINZG rI00 STtF,T T ,;:�6 . _PART 0_4' LOT Y� LO`f__�� 4� $LOCf:«�M1�V +% ADDITION OR SU`VIS30 COMER LOT INSIDE LOT SETBACK ► ' K SxDE-•I...� ----—ART)..e2. SE41ER ELEVA' YON FOUNDATi0;1 ELEVA TION 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 Ag: _Front Depth f® Height Sit_ . _tib �. Sq. Ft Cu t /06 . Front��, Depth Height % 49 Sq. Ft. Cu. Ft. Y,690 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 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 G SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). ,6d -� 1. . A Application for Power Plants and Healing, Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ..........................$10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR r Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR 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 Fee Schedule GAS BURNER (up to 199,000 BTU) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x$ 2.00 $ Additional Fixtures x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL $ See Fee Schedule TOTAL FEE_ Dept. of Bldgs. Phone 560-3450 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 Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application true and correct. Fridley, Minn- f .moi;°�'✓ 19%n Owner Kind of Building'' Used as To be completed about Estimated Cost, $ Old -(New, uilding Permit No. 1 Permit No. -V/ U / DESCRIPTION OF WORK HEATING or PO PLANTS -Steam, Hot Water, Air—No Trade Name- Size ?� Size No Capacity Sq. Ft. E.D.R-o %�—_� BTU H.P. Total Connected Load4T Kind of Fuel- BURNER— ue BURNER— Trade NameLZ-Z° = ` Size No Capacity Sq. Ft. E.D.R r . BTU H.P. R"dN.WELTER HEATING; CO. 4637 CHICAGO AVE. Bp�9l. EM"MA ae Business Phone No (REMARKS-6OVEl LWA q 4 C I T Y O F F R I D L E Y 6431 University Ave. N. E. Fridley, Minnesota 55421 August 5, 1968 Spencer Electric 3017 Lyndale Ave. South Minneapolis, Minnesota Gentlemen: RE: PERMIT SHORTAGE 7452 Melody -Drive Your permit for the above captioned address was short the following: Disposal $3.00 Dishwasher -3.00 Dryer 1.00_ $ 7.00 We would appreciate it if you would kindly give this matter your preferred attention. When sending in the above amount, kindly place it on a regular Minnesota State Affidavit so that we may properly process this permit. Thank you. Yours very truly, LEONARD EICHMILLER Electrical Inspector City of Fridley LE :bks City of Fridley Application for Plumbing and Cas fitting Permit Dept. of Bldgs. Phone 560-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location./ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures .............. ....... x $2.00 y1 iii �x<n ,� z �z �aZ Z c vi a86 z U< w O xy< 3 N ,qJ Ua' ` w z c+ Z z O F N WATER HTR. GAS ELEC. Base x $3.25 $ Electric Water Heater a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ...... ................... x $2.00 $-21- &40 Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ 1st 1 2nd 3rd 4th _ • Future Connection Openiags e New Fixture, Old Openings I Connected with Sewer ❑ Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures .............. ....... x $2.00 $ 12 *!!P 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 a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ...... ................... x $2.00 $-21- &40 Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ......... TOTAL FEE $ City of Fridley: M 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 tate and correct. Fridley Kind of B ' ding Used as To be completed about jj''� � Estimated Cost, $� Old—New. Building Permit ROUGH /-/- � l& FINAL 4z Cii' 2 n Business Phone 191 PERMIT for Power Plants and Heating, Cool. ing, Ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of Heating Plants CSC l(� toe installe —altered—repaired Make 1s X1,4/ , Sixe GAG' G' Oil fired ; Coal fired ; Gas fired ; Gas Authorization Remarks Approved Final Inspection Date , 19_ Inspector Permit 4'784 Fes $ POO Office of the Inspector of Buildings City of Fridley City of Fridley, Minn. /d Owner Location -ZY � Y2- E! dP_ti 19---p-6- AL. Kind of Building 9��Z How Occupied `1� Work to be Commenced—, 19 To be Completed 19-10- Estimated Cost, $ qST, tl o hew, Building Permit No. Permission is hereby granted tom dam`'yl 7i'( QsL' to install—erect—use the material and devices described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the specifications s t forth in the approved application for this Lpermit on file in the office of the Inspector of Buildings. /y' 'f�•'��'���✓�Y� ��'� oi�,✓ ,Inspector of Buildings az 2M11 -67V PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATig TOTAL Furnace Shell & Duct Work ........................... $10.00 $ Replacement of Furnas ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................ 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ KOCH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Eines—to 400 sq. ft. EDR 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 .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 Fee Schedule GAS BURNER (up to 199,000 BTU) .......:...... '......... 6.00 $ over 199,000 BTU See, Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x$ 100 $ Additional Fixtures x .75 $ Gas Range to 199,000 ........... x$ 5j* $ AIR CONDITIONIIIG ' FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS is REPAIRS ROUGH See Fee Schedule $ TOTAL FEE $� Dept. of Bldgs. Phone 880-3480 City of Fridley: The undersigned hereby makes application for a permit for the work hereic specified, agreeing to do all work in strict accordance with the City Ordinancee 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, Minn. �"" `ry ?� is Owner a` j . Kind of Building Used as — To be completed about 4 Estimated Cost, $' / , `/► Old—New. Building Permit No. Permit No. 7 /� /®' D ON OF WORN HFATING or POWER team, Hot Water, Warm Air—No Trade Name Size No F/ Capacity Sq. FL E.D.R. BT L124 0-r� H.P. Total Connected Load Kind of Fuer BURNER — Trade Name Size No Capacity Sq. Ft. ILD -R- BTU H.F. (REMARKS—OVER) siva �%�-�✓y �� Business Phone No. 7 om 'iWvae 3-i0-99 �,m. E. H. Bonner I sons INCORPORATED MARCH 9, 1994 WELL DRILLING FOR FOUR GENERATIONS 15688 JARVIS STREET N.W. / ELK RIVER, MN 55330 PHQNE: (612) 427-6100 / FAX: (612) 427-0533 MINNESOTA DEPARTMENT OF HEALTH 925 DELAWARE STREET HINNEAPOLIS,MN. 55414 ATTN: GROUND WATER CONTROL UNIT DOUG EDSON, 627-5141 SUBJECT: UNUSED OR INOPERABLE WELL THIS LETTER IS TO NOTIFY YOU OF A WATER WELL THAT IS NOT FUNCTIONAL ACCORDING TO THE MINNESOTA WATER WELL CONSTRUCTION CODE. E.H. RENNER & SONS INC. WAS CONTACTED BY THE OWNER OF THIS PROPERTY OR AN INTERESTED PARTY AND WE HAVE SUBMITTED TO THEM AN ESTIMATE FOR THE SEALING OF THIS WELL. THE OWNER MAY HAVE ALSO RECEIVED ADDITIONAL ESTIMATES AND HIRED ANY NUMBER OF MINNESOTA LICENSED WATER WELL CONTRACTORS IN THE AREA TO SEAL THIS WELL. HOWEVER, THERE IS A POSSIBILITY THAT THIS WELL MAY NOT BE PROPERLY SEALED AND THUS JEOPARDIZING THE GROUND WATER AND PUBLIC HEALTH. SITE ADDRESS: 7452 MELODY DRIVE HE CITY: FRIDLEY WELL DIAHETER:1 1/4" ESTIMATED DEPTH: 15' LOCATION:IN YARD OWNER/CONTRACTOR: BARB VAN HAVERMAEX PHONE: 780-6291 ADDRESS: SAME WORK: DATE SEEN: CONTACT PERSON: PHONE: _ AUG. '93 IF E.H. RENNER & SONS INC. CAN BE OF ANY FURTHER ASSISTANCE ON THIS SITE PLEASE FEEL FREE TO CONTACT ME. SINCERELY SUBMITTED, KEVIN D HOPPE WELL ABANDONMENT DIRECTOR CC: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN. 55432 ATTN: DARREL CLARK F49 An Egpral Opportynity Employer SITE DIAGRAM - Of MC1 ado I/ SuBjECT PERMIT NO. City of Fridley1 AT THE TOP OF THE TWINS BUILDING P E R M I T (' Ir? RECEIPT NO. � • COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r PROTECTIVE 1 � � CITY HALL FRIDLEY 55432 NUMBER REV DATEPAGE OF APPROVED BY �'j 612-571-3450 910-F15 4/15/96 JOB ADDRESS 7452 Melody Drive NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 26 I 4 I Melody Manor 4 Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Rick Riesing 7452 Melody Drive NE 786-5015 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 Reroof House (22 Sq) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd layer but not the 3rd. 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 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 $1,299 $.75 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- $ STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TO EE $45.05 NTRAC R RAIJTHORIZEOAGENT IDATEEi i ROPER VALIDATE IS IS YO PpMIT QUIRE 'g IVSD 6A7E SIGNATURE OOWNER IIF OWNER BUI E I IDATEI I/ NEW { ] Effective 3/1/96 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 -tk7 Building Permit Application ConstructionAddress: 245-Z n'1twy Dr. Legal Description: - Owner Name & Address: �i e� j QS, 1 Tel. # -716 - S© I,— Contractor: Address: MN LICENSE # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EAPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: C -e- MCI la vD Ute!' Z 2. Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Type of Construction: _ Approx. Completion Date: Driveway Curb Cut Width Needed: DATE: APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge STIPULATIONS: Side Yard Setbacks Estimated Cost: $ OS6 X 51 (Cost on Back) Ft. + 6 Ft = Ft x $ CITY USE ONLY Fee Schedule on Reverse Side Tel. # �s 7S .001 of Permit Valuation (1/10th%) A-1 /I '% 3 $.50/$1,000 Valuation $900 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 [ ] SUBJECT of Fridley 249507 AT THE TOP OF THE TWINS BUILDING P E R M I T Ir?City RECEIPT CEIPT NO. •______ COMMUNITY DEVELOPMENT DIV v r ' PROTECTIVE INSPECTION SEC. �� 2 � . I 1 CITY HALL FRIDLEY 55432 NUMBER REV DATE P AGE OF APPROVED BY 1.j 612-571-3450 910-F15 4/8/97 JOB ADDRESS 7452 MElody Drive NE I LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 26 4 Melody Manor 4 Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Rick Riesing 7452 Melody Drive NE 786-5015 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 a ❑ NEW X ADDITION ❑ ALTERATION 0 REPAIR 0 MOVE 0 REMOVE 8 DESCRIBE WORK Construct a 24' x 12' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. WARNING SEPARATE PERMITS digging call for REQUIRED FOR WIRING, HEATING, a all all utility locations PLUMBING NG AND SIGNS.454-0002 REQUIRED BY LAW 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 SO. 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 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 $2,554 $1.28 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- $74.75 Fire SC $2.55 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TAL FEE 7$78.58 SI TUREOF .9 TRACIOR OR AUTHORIZEO AGENT IDATTESI% PA Y VALD ED THIS IS YOU5 PERMIT r SIGNATURE FOWNERUFO N RBUILDER) IDATEI DG INSFO BATE NEVA [ ] Effective 1/1/97 ,ADDN [ ] CITY OF FRIDLEY ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: '745Z A t l ojy D p- Fir 4 t`e-Y M X Legal Description: Owner Name &Address:�'�c.� Tel. # I %�6O FS Contractor: Slclk� 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 If"ROVEM NT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length R4 Width ! Z- Hgt/Ground X to Sq. Ft. Z , e 7 OTHER: =. SSBI 1-6 Construction Type: Estimated Cost: $ .2,5-5 y (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x;-$ _ $ DATE: -1 ' . 7 .APPLICANT: Tel: # 7—S r� CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ , Z $.50/$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt: "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: Building PLUMBING Permit No.:. Inspections RESIDENTIAL APPLICATION Received By: 763-572-3 04 CITY OF FRIDLEY Date: PR 2 I DATE v YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: ❑ OWNER 19CONTRACTOR PROPERTY OWNER/ NAME: U_S ZI0 ADDRESS: — CITY STATE TENANT PHONE: CONTRACTOR c NAME: C5 _ STATE LICENSE J# 2 ' EXP DATE SUBMIT A COPY OF YOUR STATE ADDRESS: `13 CITY STA ZIP LICENSE WITH PHONE,3 CZ2H L FAX APPLICATION PERMIT TYPE INGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE ❑ NEW M46PLACEMENT TYPE OF WORK: DETAILED DESCRIPTION OF WORK 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 WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) _ BATH SINK/LAV _FLOOR DRAINS _ SHOWER WATER PIPING SWIMMING POOL WATER SOFTNER ($35) —BATHTUB —GAS PIPING mm cnrrrcFw) _ CLOTHES WASHER SINK _ WATER CLOSET _ BACKFLOW PREV. ($15) _ —KITCHEN DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ WATER METER —OTHER <= Permit Fee $ Number of fixtures @ $10 00 x $10.00 $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ State Surcharge = $ .50 Total = $ 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 applicati r 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 0f work which re ices review and approval of plane SIGNATURE OF APPLICANT PRINT NAME DATE Q ,....r .� Liv:==``�.r�I��k.. .. _ a W__ -< - .- 3•' .NI .'..` City of Fridley Building Inspections .Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977