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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT AddressDate: 9-.- / Z-6 Z2 Owner: P)p 010,06 Address N® 6751 J.00ATIONUILDING No. 1 Street ____ -- I� P o Lot lie 13 _ Addition or Sub-Divij04 ' Corner Lot Inside Lot Setback t Sideyard �+ Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING Te iT8@d` s Front Depth Height _i� Sq. Ft./"—I Cu. Ft. Front ��3 Depth Height. Ft. ? Cu. FLV:Z: Type of$nstruction Est. _"7R o be Completed In consideration of the issuance to me of a permit to co the b ding escribed above I agree to do the proposed work in accordance with the description above set f fiance th a'tl provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of E C ;E ., 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 coffiorm 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 aay 1ti viola of any of the provisions of said NOTICE: M permit dose not emu the eomtwetion, hatallation for wiring, plumbing, gas hosting, sower or wrier. Be sun to sse the Building lespeeter for separate pwm% for these Mena. OWNER'S ITAME APPLICATION FOR BUILDING.PERMIT CITY OF FRIDLEY, MINNESOTA ADDRESS®(� / %�¢, �1i� ADDRESS LOCATION OF BUILDING No. Street Part of Lot Lot Block _Addition or Subdivision Corner Lot Inside Lot X' Setback 3 Side Yard / g ° SEWER ELEVATION. FOUNDATION ELEVAtION Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. To be used as: DESCRIPTION OF BUILDING Front Depth Height, Sq. Ft. Cu. Ft. Front Depth Height 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 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. 7 DATE SZGNATVRE (Schedule of Fee Costs can be found on the Reverse Side). City of Fridley Application for Plumbing and Gas Fitting Permit Dept, of Bldgs. Phone SU 4-7470 DESCRIPTION OF WORK �% ��� Number, Kind and Location of Fixtures Locatio l� • Future Connection OpeningsI uonnecrea wua Sewer New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: C RATE TOTAL Number Fixtures ...................... Z $1.50 ; N 1C Z 1/1 K C Z G Z O W x W Z 0p F • N WATER HTR. GAS ELEC. Base 2.00 $ Q–E 0 d New Ground Run Old Bldg . ............ x 3.25 $ 1st 2nd 3rd 4th • Future Connection OpeningsI uonnecrea wua Sewer New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ e - Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin .... .................. .. x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ Q–E 0 d New Ground Run Old Bldg . ............ x 3.25 $ City of Fridley: f 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. Owner A-4 do Kind of Building Used as To be completed about Estimate Cost, $ Old New. ding Permit ROUGH 6_ C FINAL GAS FITTING FEES: N RATE TOTAL. _ 1st 3 Fixtures .......................... 7x $1.50 Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE c` 42 t Business Phone r = Application for Power Plants and Heating. Cooling. Ventilation..Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU. 4.7470 GRAVITY WARM AIR: RATE TOTAL, Locafio " � Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ City of Fridley: Repairs & Alterations—up to $500.00 .................. 5.00 $ 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 Repairs & Alterations each add. $500.00 ................ 2.50 $ and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. MECH. WARM AIR 0 Fridley, n 'nn 'J , l"c Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 y p $� � !Y each add. 60,000 BTU ..... . .................. 2.00 $ Owner -L4 Replacement of Furnace ............................. x.00 $ Kind of Building Repairs & Alterations—up to $500.00 ................. 5.00 $ . Repairs & Alterations each add. $500.00 .............. 2.50 $ Used as°�-� ms's STEAM or HOT WATER SYSTEM - To be completed about Furnace Shell & Lines—to 400 sq. ft. IDR Steam, ...... 8.00 $ Estimated Cost, $ Furnace Shell & Line—to 640 sq, ft. EDR Hot Water ... 8.00$ Old-(!ew. wilding Permit No. Permit No. Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ + ; DESCRIPTION, OF WORK OIL BURNER—to 3 gal. per hour ........................ 5.00 hour—See Fee $ HEATING or POWER PLANTS—Steam, Hot Water, No over 3 gal. per Schedule GAS BURNER (up to 400,000 BTL) 5.00 t� $ „ , ��� 14T5-90 Trade Name � Size No - ....................... Capacity Sq. Ft. E.D.R �� BTU H.P. GAS FITTING FEES: NO RATE :r AL 1st 3 Fixtures ...................... x $1.50 $— �a Total Connected Load J� 7. 3 3 Kind of Fue eLj- Additional Fixtures ................. x .50 $ BURNER — Trade Name Size No Gas Range to 200,000 BTU ........... x 2.00 $ Capacity Sq. FL E.D.R BTU H.P. AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule FRANKS HEATING VENTILATING SYSTEM $ AND SHEET METAL She CCU A 11 Sj- ALTERATIONS & REPAIRS TOTAL FEE $--� By ROUGH 1,14 o eu?.Pv 42 2M 7-59 Bus ess Phone No— F (REMARKS—OVER) HEAT LOSS CALCUTATIONS Weatherstrips Guide llindo ( Doom"' oo Reference Out. Wall Ia Y No Y " 0 14 / F1_I 1 hl Renin Beeth / Width // X7!5- (VI f S S 1EPARTNENT OF BUILDM Construction No. all I Ceiling I Roof I Floor IAM Windows and Doors--Oaekage and Area Height Width Height No. of#-Ldn�ealftAreallo. or pane of pane lights q. ft.At q4z- /s a Width Height No. of- Lineal ft Area No. or pane of pane lights of crack ell. tL Coal. to COCEI Btu Infiltration 3 , Glass $ y; Glass -" , 6 6-0 Jr 6 Exp, wall of f int. wall lag? / () 3 G Net exp. wall 9 0 10 ) 0 0 Int. wall (Q Vti - /� / Ceiling ) X %I 11 0'?w (d A l _ O' '.. Floor %%, 1k ) S33 Total Btu. I f 0 o . S II Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.1 Room I Length ( 1 1 -,Width Height Windows and Doors-•Crackage and Area ® 1 3 ct �3 Width Height No. of- Lineal ft Area No. or pane of pane lights of crack ell. tL Coal. to Coef. Btu Infiltration 3 , Glass '5-0 1'6 Exp. wall Py lou -" Net exp. wall 1b Jr 6 Int. wall of f int. wall Ceiling / () 3 G Floor rotal Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area I F1.1 - , Room I Length I I i Width h- Heizht Windows and rs-Crackage and Area Width Height No. of Lineal tt. Area Jo. of pane of pane lights of crack q. ft. ® 1 3 ct �3 Coal. to Coef. 'Btu Infiltration 3 , �• IV oLd G Maga -" 6 Net exp. wall Q W. wan of f int. wall / () 3 G Net exp. wau Int. wall Zj e Zeiling (Q Vti - /� / Floor v1 11 12 11 9 foW Btu. � Required sq. ft. E.D.R. or. sq. -ins: WA. Loader area. Insulation Kind How Applied Room I LengRh �©yts Vflidth f I vHeig6t � No. 1 of vane 1 of pane I lights II! of crack 1 q. M J Infiltration Glass Fxp. wall Net exp. wall Int. wan rCeiling o ®y, X Floor ' 1 Total Btu. Required sq. ft. E.D.R. or C Btu 2-7—O 490 360 01 9 .J^� W.A. Leader area s% Width 9- Hit Windows and Doors—Cracka °e and Area Width_ Height No. of anal ft. Area No. of panof pane lights of crack q. ft. Coal. to Infiltration Btu Infiltration Claw . 3 Class �• ��, oLd G Exp, wall -" 6 Net exp. wall © of f int. wall 41cl / () 3 G Ceiling Floor l i 'ST Ceiling Total Btu. Required sq. ft. E.D.R. or sqi ins. W.A. Leader area - i t:1_I R.. I beech G ; Width 16 eight 7 Windows and Doors-Crac '' and Area Width Height No.of Ineal et. Area No. of pane of pane lights of crack q. ft. G Coef. Btu Infiltration Claw . 'J - -X3. • C) im E:p. wan 6 Net exp. wall 41cl / () 3 G Int. wall' Ceiling (Q Vti - /� / Floor 11 12 11 9 Total Btu. of J Required g4 h. E.D.R. ot aq. inn. IWA. Leader arra RICHARD DELONG ATTORNEY AT LAW Mc COLL BUILDING 866 JACKSON ST. SAINT PAUL, MN. 55101 PHONE 224-2655 August 2, 1975 Mr. Clyde Moravetz City df Fridley Clerks Office 6431 University Avenue N.E. Fridley, Minnesota 55 432 RE: Retzer Real estate, 1675 Mississippi St. +1/1-1 Yr, Mor,avetz, I have reviewd the abstract of the Retzer real estate on which you allege that the City of Fridley has a drainage and utility easement and find that there was no such easement of record as of the date that the Retzers purchased the property and,therefore, there is no such easement valid as against them. I have accordingly advised them notto sign the Quitclaim deed which you prepared and which would grant to %e City of Fridley an easement ofer certain described portions of' the perimeter of the .property, In the event that you desire to proceed with obtaining such an easemnet, I suggest that you contact me regarding financial consideration to be paid to the Retzer's for such purpose. Sincerely, "Ri h rd De Long Attorney for Duane zer cc Duane Retzer SUBJECT PE City of Fridley 29148 THE TOP OF THE. TWINS BUILDING PERMIT f`AT NO. ►V __-__ COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 4/7/99 10B ADDRESS 1675 Mississi i St NE I LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 8 I 3 I Moore Lake Park 1st Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Monika Ha en 1675 Mississippi Street NE 571-6910 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO R Miller Construction Inc 953 Mississippi St NE, Fridley, MN 55432 571-3514 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO, 6354 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (20 S) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. 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 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWL,G. 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 AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,714 $•86 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- $56.75 Fire S $1.71 S�T�iUCTION OR THE PERFORMAVCE OF CONSTRUCTION \ PLAN CHECK FEE TOTAL F License %tq5.0 $6 2 S�GN4 u R R MORi2ED AGENT iDATE� NPR LIDATE I��UPEPMIT I S,GNATUAE Of OWNER,IF OWNER BWLDERI iDATE-7--r. NSP pAtE NEW [ ] Effective 1/1/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION 94 ConstructionAddress: r.� Legal Description: Owner Name & Address: kA n AJ , %Zo /,n 671Y Tel. #,L2 %- �P T`O Contractor: /v 5 L c i p/'� MN LICENSE # f� Address: Oita 15 s , S /, r �� < �/ Tel. # `/- f LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVEMENT Length Width Height Length - Width Height Length Width Hgt/Ground C'�e Cid /7'6JJ_C Driveway Curb Cut Width Needed: Ft. + 6 Ft = Sq. Ft. Sq. Ft. Sq. Ft. M Estimated Cost: $ —'�f�� ��� _ (Fee Schedule on Back) Ft x $ _ $ DATE: 9 ` '� APPLICANT: e �o Tel. #3-'2Z _32-Y �, CITY USE ONLY Permit Fee $ Fee Schedule. on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ -- $.50/$1,000 Valuation SAC,Charge $ $1050 per SAC Unit License Surcharge $�Oy $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 ;p $ ��- • STIPULATIONS: �, AGREEMENT GRANTING ]PERMISSION TO INSTALL DRIVEWAY AT PROPERTY LINE 1, Monika Hagen, owner of the property located at 1675 Mississippi St. N.E., Fridley, Minnesota, give my permission to Earl Burke, 1695 Mississippi St. N.E. Lot 7, to install a concrete driveway, up to the property line, at the east side of my property line. I reserve the right to revoke this permission at any time if the concrete driveway is removed. This permission does not allow any other code violations to be permitted on this property line. �V-3� Monika Hagen ate I, Earl Burke, acknowledge that my use of this land, up to the property line, is by permission only. 1 Burke Dat P R CIPi OF FRIDLEY BUILDING INSPECTION Effective W1 22,00044` 6431 University Ave NE iii) Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION 763-572-3604 FAX 763-571-1287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS /675— /`t/.S-S/SSI "f_ S -f- AJ6-4 RATE SCHEDULE Fed Total Residential Owner Ab,01/le, Furnace Shell and Duct Work, Burner &L` also Replacement Furnace $35.00 $ 5:;"00 Building Used As Gas Piping (New Furnace, Fireplace, Insert) $10.00 $ ESTIMATED COST 6000 PERMIT NO� Gas Range $10.00 $ DESCRIPTION OF FURNACE AND BURNER �'� Gas Dryer $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) Wal�pa Air _ Trade Name kuJD Size No. 06 PA. 0? *Air Conditioning - AllSizes $25.00 $ BTU 7�i�0 HP EDR Fuel t A-4-- Total Connected Load All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Burner Trade Name Size No. Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EDR Improvement whichever is greater The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/Industrial/Institutional and representations stated in this application are true and correct. State Surcharge $ HEATING CO�G� TOTAL FEE $ REINSPECTION FEE $50.00/HOUR *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE am Tel # FAX # Date SUPERIOR CONTRACTORS INC 612142ND AVENUE NO. CRYSTAL, MN 55422 OApproved by Rough -in Date Final Date -v,44`� J FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. YesY No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes ( No( ) The existing combustion air is sized and installed to meet the current codes (( and manufacturer's specifications. Yes () No( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes) No ( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 TypeBTU Input 2Z-0§1::' an Assi�ed r Na Appliance #2 Type tai BTU Input ; Fan ssiof Appliance #3 Type VP t� BTU Input � c)c) Fan Assisted o gt Total Appliances , -1 - Total Btu Input Common Vent Type e/ -A-55__,9 Vent Height Diameter inches Appliance #1 Vent Connector Height 3 ft Length ft Diameterin Type 6- Appliance #2 Vent Connector Height _Sft Length _eft Diameter t` in Type C Appliance #3 Vent Connector Height _,j_ft Length __ ft Diameter -in Type C� ALTERATIONS: (Describe) HEATING CO: Signed By: Date : CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 571-36U4 FAA: 1 7631 571-1237 ADDRESS 1675 MISSISSIPPI ST NE PIN 133024140031 LEGAL DESC MOORE LAKE PARK 1 ST ADD LOT 8 BLOCK 3 PERMIT TYPE HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT O.: 2004-01950 DATE ISSUED: 10/22/2004 VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL A FURNACE (WARM AIR, RUUD, 75,000 BTUS) AND AN AIR CONDITIONER. # A/C UNITS I # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) APPLICANT SUPERIOR CONTRACTORS INC 612142 AVE N CRYSTAL, MN 55422 OWNER HAGEN MONIKA 1675 MISSISSIPPI ST NE FRIDLEY, MN 55432 6000 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 regulatiug construction or the performance of construction. Bldg Insp_ Date HEATING PERMIT MINIMUM FEE 0.00 FURNACE SHELL/DUCT WORK 35.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 25.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 60.50 PAID WITH CHECK # 16898 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 1rQoi 'i�n-) !U94 Building PLUMBING Permit No.:., -�``>G Inspections RESIDENTIAL APPLICATION Received By:2?q� j 763-572-3604CITY OF FRIDLEY Date Rec'd:_ I' DATE ` �0 _0 6 YOUR E-MAIL ADDRESS 1 SITE ADDRESS NA 1 l j THIS APPLICANT IS: ❑ OWNE IWCONTRACTOR PROPERTY NAME: M611 KG A OWNER/ ADDRESS: ) CITY- Fr- STATENLIPSS�a TENANT I _�yL�- pHONE: `7103 -S 71 - X61 v CONTRACTOR N 0 SUBA2IT A COPT' OF STA L SIS # DATE U L® b YOUR STATE AD> CITY STATE ZIP LICENSE WITH P$e _FSC V51-311051340 APPLICATION _ � I PERMIT TYPE INGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW "1f1tEPLACEMENT DETAILED DESCRIPTION OF WORK A"(ACf LAI Iua I 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, 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 SINKILAV DRAINS —SHOWER _WATER PIPING _ _FLOOR BATHTUB GAS PIPING (NEED crn zjcEwsE) _ SWIMMING POOL —WATER SOFTNER ($35) _ _ CLOTHES WASHER KITCHEN SINK _ WATER CLOSET _BACKFLOW PREY. ($15) _ _ DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION — WATER METER —OTHER PERNIIT FEE "PROJECTS FOIA _', w, s,'ITIM5r1 , .",Ti; Permit Fee $ fie. 60 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 $ .150 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 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 not a permit approved plan in the case of all work which requires review and approval of plans. D(X/I 2 11 ek1 DATE L ® -3 0 - () 6 SIGNATURE OF APPLICANT� �� ,j PRINT NAME .j 001, � `.OWNT .3 PLEASE NOTE ,'P IRA I E'EItTS,Ft ..em City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 M