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PRE 2010 DOCS59917 City of Fridley, inn -11412 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT Date: _ May 4, 1972 Owner: Viewcon, Inc. Builder Same Address 5901 Brooklyn Blvd. Address Same LOCATION OF BUILDING No 1551 Street North Oberlin Circle part of Lot T.ot 1 Block 3 Addition or Sub -Division Innsbruck North Corner Lot Inside Lot x Setback Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: 1240 TwnhGarageous a Front O Depth 2331. � Height 2 8 � Sq. Ft. X4-6 620 Cu. Ft. 1_ 36 0 Cu. Ft Depth Height __ Sq. Ft ____ _ — 446 Type of Construction Wood Frame Est Cost21,417.80 _ To be Completed 10/1172 Stipulations: 1. Developer agrees he will supply all the materials noted in the letter written by the City'LOagineer dated 2/22172. BY May 30, 1972. 2. Same as indicated on foundation permit. In consideration of the issuance to me of a permit to construct the uiI ' g s above, I agree to do the proposed work in accordance with the description abovt forth d ' co 'th all provisions of Ordinances of the city of Fridley. -- �.0..�1 S�atc $irr•hargo In consideration of the payment of a fee of $ 41.00 permit is hereby granted to_ Vk&wcon, Inc. 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 E 3dley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings ancm city limits and this permit may be revoked at any time upon violation of any of the provisions of said -'�-- LQ --` - % Building Inspector NASIM QURESRI 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. APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME : " (�� BUILDER :_ a ADDRESS : Q b y ADDRES S: �� 0 NO:. STREET: 62 YCkM) n • LOT: BLOCK: ADDITION:_,,t o 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: ,�[ x sg.-'U A,4�Front: c U ' Depth:_ Height:-- 1.24C) eight:/o24C) Square Feet: 1ea20 Cubic Feet: Front: Depth: Height: /0 Square Feet; 4^10 Cubic Feet: Type of Construction: &.'1A 0 estimated Cost:_$ To Be Completed: 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. n n DATE: i�(j..� . LIZ_ SIGNATURE: (See Reverse Side For Additional Information.) �0 oma Poo (��c� yy4 i��/)ala �� ti�3 1993x0 117901)-20 /,g/ ,740 /99jao 101 ficate of Survey for VIEWCON A INU. - -20.0- � -Z000- -25.00- f f I 0.0 20.0 I �\ I 1 \Z� b 240 tly O ' 200 ` C i''t 1 C1 i 2p.0 200 ` 0 n ' O 'II � O q N � �• ,`' � 1 , i Y., �., � � � I � 20.0 N c� I �O.p rn 2 G.0 U fL L- No,eT14 : nofe5 iron monumen i - —24 O�Erz� iN -ZI.UO- j C)PCLF Application for Power Plants and Haa b% Cooling. Vendkdon. Refdgention 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 Furnace Shell & Duct Work to 120,000 BTU .. _ .. . .. $10.00 $_ each add. 60,000 BTU .................... .. 3.00 i Replacement of Furnace . .. .... 6.00 $ Repairs & Alterations—up to $500.00 .. 6.00 $ Repairs & Alterations each add. $500.00 &00 $ STEAM or HOT WATER SYSTEM -010 $ `d 010 over 199,000 BTU See Fee Schedule Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $. Furnace Shell & Line,—to 640 sq. ft. EDR Hot Water 10.00 $_ Each add. 200 sq. ft. EDR Steam 3.00 x$ 6.00 $ Each add. 320 sq. ft. EDR Hot Water 3,00 $ OIL BURNER—to 3 gal. per hour GAD $ — over 3 gal. per hour—See Fee Schedule GAS BURNER cup to 188,000 BTU) -010 $ `d 010 over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x$ 7.00 $ Z - 1.40 Additional Fixtures x .76 $ Gas Range to 199,000 x$ 6.00 $ AIR CONDITIONING FAN HEATING SYSTEM Sao FN Schedulle ) ) - &W VENTILATING SYSTEM c, $ ALTERATIONS & REPAIRS TOTAL FEE $ ROUGH _ � _ —� -.,7FINAL � / (SURCNARUE $_.50) Dept. of Hldos. Phorm 660-3= •,.,• /mac 'i .� City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordbumei and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. e Fridley, Owner Kind of Building Used as --- - - - — - To be completed about aa Estimated Cost, $__—_1� fid_ '70- Old—New. Building Permit No. Permit No. J 4/ DESCREP77ON OF WORK HEATING or POWER PLANTS—Stearn, Hot Water, Warm Air—No Trade Name_ ��-�1.� Sin Capacity Sq. Ft. E.DR BTU H.P Total Connected Load Kind of Fue 4 67 BURNER — Trade Name Size No Capadty Sq. Ft. ED R- BTV BD! (REMARKS—OVER) SUBJECT PERMIT NO. City of Fridley 2 8 5 AT THE TOP OF THE TWINS BUILDING PERMIT r RECE NO. COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. r NUMBER REV DATE PAGE OF APPROVED BY -' % CITY HALL FRIDLEY 55432 � ,�� 612-571-3450 910-F15 9/1/94 JOB ADDRESS 1551 North Oberlin Circle NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 1 3 Innsbruck North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Tabor & SOns Inc. 3716 St Francis Blvd, Anoka, MN 55303 789-1902 20014248 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential Townhouse 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION RI7 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroofing & Gutters 9 CHANGE OF USE FROM TO STIPULATIONS UNDERLAYMENT must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMING, 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 I 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 $2,089.00 $1.05 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- $54.00 Fire SC. $2.09 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTALFEE ,Oelx �� 'F-� License SC $5.00 $62.14 SIGNATURE OF dONTRACTOA OR AUTHORIZED AGENT IDATEI WHEN PROPERLY LIDATED THIS IS YOUR PERMIT LA .1W -NSP q— ?=q C 999f q SIGNATURE OF OWNER I IF OWNER BUILDERI IDATEI NEW (] Effective 1/1/94 ADDN { CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R -I AND R-2 Building Permit Application �7 Construction Address:. 1551 - North Oberlin Circle, Fridley. Legal Description: Owner Name & Address: Tel. # - Contractor: Tabor* and Sons, Inc.' MNLICENSE# Pending Address:, '.3716, St. _ Francis -B1vd. Anoka' -5*530.3 -Tet. #- 78.9-1902. cry 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 [ I Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: roofing /gutters Estimated Cost: $ 2 0 8 9.0 0 Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: 911,194 APPLICANT: Tabor and Sons, Inc. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ 6"yo $ $ Tel. # 789-1902 Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) =r $.501$1,000 Valuation <. i $$00 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 [ l 0, r` Alk I SUBJECT IT NO. City of Fridley 3103-7 I AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. rCOMMUNITY DEVELOPMENT DIV. ^ n `�/J % PROTECTIVE INSPECTION SEC. I/V 360 � 1 ± r CITY HALL-FRIDLEY 55432 / NUMBER REV OATS PAGE Of APPROVED By 612-571-3450 910-FI5 6/8/00 /a / JOB ADORESS 1539, 43, i, 51 North Oberlin Circle NE 1LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. .1-4 3 1 Innsbruck North Addition SHEET .2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Innsbruck Townhome Association - 651-224-5482 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Garlock -French Roofing Corp 2301 E 25 St, Minneapolis, MN 55406 612-722-7129 a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 1423 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING `Res'idential Townhomes 7, CLASS,OF WORK O NEW O ADDITION D ALTERATION R REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof Building -:9',CHIANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. .. Permif IospeC . tion Cards Woos B Permil Inspection Cards To Homeow balled Will 8e wiled nor TO post To Homeoviner To Post TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. TNIS: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. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 4 ^ 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 $7 801.96 $3.90 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 TOTA FEE License $5.00 169.95 SIGNATURE OFCON'RACTORORAUTHORIZE DAGENT IOATEI N ROPE Y ALIDATE EYTHIS IS YQpR PEM IT -w INSo UA It S.GNATURE 001 OWNER.Io OWNER BUILDER, MATEI 01 SUBJECT 4VERMIT NO. City of Fridley 31564 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. _ _ COMMUNITY DEVELOPMENT DIV. ........ V .. r PROTECTIVE INSPECTION SEC. 1 ` i -"I CITY HALL FRIDLEY 55432 NUMBEa REV DATE 11/14/00 PAGE OF APPROVED BY 612-571-3450 910-Ft5 JOB ADDRESS 1539, 1543, 1547, 1551 North Oberlin Circle NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1-4 I 3 Innsbruck North Addition SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Innsbruck North Townhomes 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Columbus Exteriors Inc 2131 111 Lane NW, Coon Rapids, MN 55433 763-757-7530 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 3509 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO B USE OF BUILDING 4 Unit Townhouse Building 7 CLASS OF WORK ❑ NEW O ADDITION ❑ ALTERATION] REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reside Building; replace trim 9 CHANGE OF USE FROM TO STIPULATIONS Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive barrier be placed over exterior sheathing to protect the interior wall covering. Exceptions for this provision would be if sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in their application guidelines. Call for inspection of wrap before covering. 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 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 DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 4 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $30,220 $15.11 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 $451.85 Fre SC $30.22 PLAN CHECK FEE TO AL FEE r �� Lice C $5. $502.18 uRE OF CONTRACTOR OR AUTMORiZEO AGENT IDATE1 PRO Y VALI T THIS IS YO PERMIT ��',. 8 INSD gAtE SIGNATURE OF OWNER..F OWNER SUILOERI IOATEI 01 :ITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004 431 University Ave NE ridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO RF INSTAI I Fn nN FAr.N FI n('jR 7E=: 'LUMBING FIXTURE RATES: Jew Fixtures )Id Opening, New Fixture leer Dispenser Ilow Off Basin :atch Basin Iain Water Leader 3ump/Receiving Tank Vater Treating Appliance Vater Heater -Electric Vater Heater - Gas** Sas Range** NO. RATE TOTAL JOB ADDRESS Sry y a.S OW AAw- gas Dryer** lack Flow Preventer Required ( )Yes () No $10.00 $10.00 $10.00 $1.0.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 Type $15.00 teinspection Fee $50.00/Hr kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE 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 fads and representations stated in this application are true and correct. NGUYEN, CHI 1551 OBERLIN CIRCLE NORTH FRIDLEY, MN 55432 OWNER (763) 574-1329 BUILDING USED AS kj!C/51 Je4/1C-CL 711.E 20 ®S ESTIMATED COST q6 Jj oo PERMIT NO. PLUMBING COMPANY NO (-YO ` O'M Cai1M r SIGNED BY E TEL N0. Av 12) 92 %- 5/033 Approved By Rough -In Date Final Date $ -0 OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. ,OMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE 'LUMBING FIXTURE RATES: Jew Fixtures )Id Opening, New Fixture leer Dispenser Ilow Off Basin :atch Basin Iain Water Leader 3ump/Receiving Tank Vater Treating Appliance Vater Heater -Electric Vater Heater - Gas** Sas Range** NO. RATE TOTAL JOB ADDRESS Sry y a.S OW AAw- gas Dryer** lack Flow Preventer Required ( )Yes () No $10.00 $10.00 $10.00 $1.0.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 Type $15.00 teinspection Fee $50.00/Hr kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE 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 fads and representations stated in this application are true and correct. NGUYEN, CHI 1551 OBERLIN CIRCLE NORTH FRIDLEY, MN 55432 OWNER (763) 574-1329 BUILDING USED AS kj!C/51 Je4/1C-CL 711.E 20 ®S ESTIMATED COST q6 Jj oo PERMIT NO. PLUMBING COMPANY NO (-YO ` O'M Cai1M r SIGNED BY E TEL N0. Av 12) 92 %- 5/033 Approved By Rough -In Date Final Date $ -0 OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. ,OMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE 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. Yes () 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 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date: Building PLUMBING Permit No.: c9 p Inspections RESIDENTIAL APPLICATION Received By: 763-572-360 CITY OF FRIDLEY Date Recd: DATE YOUR E- ADDRESS SITE ADDRESS THIS APPLICANT IS: 0 OWNER OCONTRACTOR PROPERTY NAME: A!.� OWNER/ ADDRESS: CITY STATE TENANT ------ PHONE: CONTRACTOR NAME: e SUBMIT A COPY OF G, ` STATE LICENSS # ! Com% C._ EXP DATE YOUR STATE ADDRESS: / CITY ATEn� LICENSE WITH PHONE n Ga �� Q/ FAX APPLICATION PERMT TYPE ®ZKOLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: 0 NEWPLACEMENT 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 SINKILAV _FLOOR DRAINS _ SHOWER _ WATER PIPING —BATHTUB —GAS PIPING (Azeo =Limw4 _ SWIMMING POOL _ WATER SOFTIIER ($35) _ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15) —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 = $ TOTAL DUE $ 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 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 allwork which requires review and approval of plans. SIGNATURE OF APPLICANT '7 PRINT NAME DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977