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PRE 2010 DOCS01 SUBJECT ,® PER NO. City of Fridley 18794 AT THE TOP OF THE TWINS BUILDING PERMIT � RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 I CITY HALL FRIDLEY 55432 ti____A.� �'J NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 2/11/87 JOB ADDRESS 1487 Onondaga Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt. 6 T-_ Aud. Sub. #129 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Brandon Construction 311 Sunrise Lane, Champlin 867-1845 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 a 42' x 26' Dwelling and a 221 x 22' Garage 9 CHANGE OF USE FROM TO STIPULATIONS provide a hard surface driveway. Provide sod in the front and side yards. Provide City with copy of verifying survey before capping. WATER & SEWER LOCATION: Must be tapped. DRIVEWAY ESCROW: 16'+6'=22' x $13.50 = $297.00 WARM(; SEPARATE PERMITS REQUIRED FOR Refm dig8►lig call local WIRING, HEATING, PLUMBING AND SIC1��S. uff;rti s .ELECTRIC _ Etc. REQUIRED By LAVGA�n v' 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 ] 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 $72,800 $36.40 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- $352.00 $525.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE 'Xz'.'� S& 00 $1,001.40 + DW SIGNATURE OF CONTRACTOR OR AUT ED T IDATEI WHEN PROPERLY I ATED THIS IS YOUR PERMIT i l� BLDG )NSP BATE SiGNATUREOF OWNER IIF OWNER BUILDER) (DATE) 01 t• , NEW City of 'Fridley Effective 4/1/86 ADDN. [ ] R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: J Q � ") (�) � UAB D 4 C Pj- Legal Description: Wr.0 8o f4ZC S )S® fi Lo � 15 Audi i olzs s�6aO1 veJ#aN /Ao4a ]a 9 Owner Name & Address: 11-3 C a te s) rz vc 1 10,./ Tel. # 86? - 1(9 4.5 Contractor: Rge A —a r vA-,,s 4 K Lac i )cti Tel. # Address: 3 11 ,51✓A- 1?I s -E L.+i c L An a 11"' LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Corner Lot [ ] Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length y a Width a-6 Height Sq. Ft. Length a a- Width a a- Height Sq. Ft. Length I 0 Width )a, Hgt/Ground Sq. Ft. Inside Lot [(V Ft. Yd. Setback Side Yard Setback Type of Construction: Woad F Aen F Approx. Completion Date: Estimated Cost: $ `5fn- 8 r? 4z' rba Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ 2 $ See Back Page for Explanation DATE: a - <, - R % APPLICANT: i1 ^lam Tel . ?GL CITYUSE ONLY Permit Fee $ 00 Fee Schedule on Reverse Side Plan Check $ lei; 00 25% of Building Permit Fee State Surcharge $ 'BG.WJ- $.50/$1,000 Valuation SAC Charge $ .626o V $ 525 per SAC Unit Park Fee $ .� Fee Determined by Engineering Sewer Main Charge $ V Agreement Necessary [ ] Not Necessary TOTAL $ • [ ] STIPULATIONS: 298t6o ,j " ti *1 ,1.L. u.lb jib M -Alit IU.u.� �.. ,....� AI.rL"` .���' �t`v::. .i11►L.� J. a ihf A,: In' A. •' -ON x009 *ON qor aiva 'ON •8a)i C:- �s' -= fPol , •��osauu�y� 2IMS 243 ,p sq 243 JQpun J043AMS PUVI P=103)j *P c weI IP43 Puc uoIsiAJadns mlp Aw iapun Jo au Aq pairdaW stA% uodai x> 3tld AjmiwgaW •irld urid *Aaruns si43 3943 Apim Aq2.;4 ! . p o,/,►� _ /Pa �.✓o,ri moo/ ,�a�r.�rrs � o!y . • f o/Y • ' �,� o�� �.�,� �,�,� 4�0� �� oma Ploy eo. oisJ/i. ijo9 rss r_eol ��or'd / 4 j% o�•�lro f�� vv•ps� �.fnos• �yfs�so f�a�Po'o8 f r�r'J �Y1 t/ aoif��ot�Q 4 0 400'o%17r74Y r `ve.7 4otA.;,4, .of ve yoi,A &10,:;7 "- as ay �►a�00�0-��f mos.r hep 7q-r4o - /b W, e /-- r 6 A i tTAM, A, XP4 IX to N M Dao�o�aAq S Deis / 7-4e l<Jes � 80 od �et � o�1% Sou/`i /SD. op *7 7-4 ,o1 Zo / /G! 68 C) 17 17 f '�/ ? No le •' Afo �%e/1--Sw Y Doer i�•�e� -- /rla/ro o--7 ��e I hereby certify that this survey. pian plat. preliminary plat or report was prepared �nder my direct supervision and that I am a duly Registered Land Surveyor under the laws of the State Minnesota. /odf z a`1. got IT06 f/6 G r --VA Reg. No. Date Job No. Book No. i CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RBSIDENTIAL Furnace Shell and Duct stork, Burner (Also replacement furnace) Gas Piping (piping needed with now furnace) Gas Range Gas Dryer a Air Conditioning (all sizes) RATE $ 20.00 All Others/Repairs and Alterations It of Value of Appliance or Work COMMLRCIAL/INDUSTRIAL It of Value of Appliance or Work $ 10.00 $ 10.00 $ 10.00 $ 10.00 State Surcharge TOTAL *EE Reinspection Fee ($15.00) Rough Insp. Date Final Insp. Date Approval for Permit T� MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00 PLUS $.50 STATE SURCHARGE ..a aew t,�a• wa.y. I. ►'.B► TOTAL Job AddressAO $ d Department of Buildings, 6111 University Atte. N.E., Fridley. MN SS112 City of Fridley $ 0� Tel. 0571-11SO $ The undersigned hereby mites application for a permit for the work herein specified agreeinq to do all work in strict accordance with the City Oadea $ 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. Minn. 3/3 i OWNER S RIND OF BUILDING d USED AS $ S .50 S Attach stack verification form with replacnment furnace permits *Air Conditioners can tint tr• placed in •:ide• yard without written permission from adlo►n►iq nr1411door. TO BE COMPLETED ABOUT IL �® ESTIMATED COST Z - ��666 .1 OLD - NEM BUILDING PERMIT NO. PERMIT 80. DESCRIPTION OF'FURNACE/BURNEtt HEATING orPLANTS. Steam. Not Mater, Wats Air- No. Trade Name {isite No. Capacity Sq. Ft. CDR DIM HP Total Connected load Kind of Rte( Al r- BURNER - Trade Name Size No. Capacity Sq. Ft. EOR BTU HP Company Siqned By CITY OF FRIDLEY Effective Date May 1. 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE QESIDENTIAL ` Furnace Shell and Duct Work, Burner (Also replacement furnace) Gas Piping (piping needed with new furnace) Gas Range Gas Dryer RATE TOTAL $ 20.00 $ S 10.00 $ $ 10.00 $ $ 10.00 $ • Air Conditioning (all sizes) $ 10.00 All Others/Repairs and Alterations It of Value of Appliance or Work COMMERCIAL/INDUSTRIAL It of Value of Appliance or Work State Surcharge 8016-148 Herb TOM MM iee3inspection Fee ($15.00) Rough Insp. $ 10.00 P� $ $ .50 $ 15.50 S Date Final Insp. v Date Q Approval for Permit MINIMUM FEE FOR ANY HEATING PERMIT IS :15.00 PLUS $.50 STATE SURCHARGE •Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. Job Address 1487 Onondaga St. N.E. Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 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, Minn. 5/12 , 1989 OWNER KIND OF BUILDING 4inate kmita USED AS hesddence TO BE -COMPLETED ABOUT 5131189 - ESTIMATED /31/89 - ESTIMATED COST $1,568.00 OLD - NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Name Size No. Capacity Sq. Ft. EOR BTU HP Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. CDR BTU HP company C evtAa i xe . Inc. Signed By Tel. No. 941-1044 Fill out back side for stack verification on replacement furna--s ENTERED MAY 15 199 CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; I. Has been carefully examined Yes (,) 2. Is free from rust or deterioration Yes ( ) 3. Has no foreign objects lodged within Yes ( ) 4. Is securely supported Yes ( ) 5. Meets all current Code requirements for size and total BTU connected 6. Has Total heating BTU's of All other BTU's TOTAL Remarks Company Signed B Date No ( ) No No ( ) No Yes ( ) No ( ) rJAM W G7YOF FRIDLEY CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450 June 12, 1987 Brandon Construction 311 Sunrise Lane Champlin, NN 55316 Re: Final Inspection at 1487 Onondaga Street N.E..., Fridley Dear Sirs: The final inspection was made on June 12, 1987 of the above address and the following items were noted which must be completed before the -structure can be finaled: 1. Provide sod in the front and side yards. 2. Grade rear lot to drain patio. 3. Install lights or cover electrical boxes on front of gar$ge. 4. Provide lateral bracing in floor truss as. per design. 5. Do NOT use deck until properly supported. We will expect the above items to be completed by July 1, 1987 when a reinspection will be conducted to determine compliance. If you have any questions on these items, please feel free to contact me at 571-3450.. Sincerely, DG. CLARK Chief Building Official DGC/mh SUBJECT NO. City of Fridley ( ORIWIT 30344 AT THE TOP OF THE TWINS BUILDING PERMIT � RECEIPT NO. `- -__ _ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. f � � PROTECTIVE I NUMBER REV DATE PAGE OF APPROVED BY = I I CITY HALL FRIDLEY 55432 ' 612-571-3450 910415 10/4/99 JOB ADDRESS 1487 Onondaga Street NE 1 LEGAL . BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. ILOTNO pt. of 6 Auditor's Subdivision #129 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ron Nelson 786-2236 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Midwest Cedar Timberoof 1001 E Cliff Rd Burnsville 55337 808-1149 20147336 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATION -Y121 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (22 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Permit Inspection Cards Will Be Mailed T®11=00 Ener To Post 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 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 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 $1923 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $.96 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- $69.25 FireAC STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $1.92 PLAN CHECK FE TOTA F E Lice S $5. 0 $7 3 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IOATEI EN ROM AOA D I$ IS YOUR ;E/T?y INSp Daik SSGNATURE OF OVVNERi1F OWNER BWLDERI IDATEI "WI -1 Effective 5/10/99 ADI)i- s - ] CITY OF FRIDLEY M q vZ9,\' ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Cd n n (i101®a " Legal Description: Owner Name & Address: ft)n Nt�A,5t-jam (O n ®nolo Q Tel. # U 19 -7 (n- �(p Contractor: Plftfft caw � IfY1 �[7�� MN LICENSE # Z 41 &J Lo Address:( rj Tel. # 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: I t) 1-) 41- 9 Construction Type:7Mr Q�� �- Y�X�D� Estimated Cost: $ LHFpO , a� Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: q 2 qq APPLICANT: AUL� cvx-� Tel. # W � - 109 9 Permit Fee $ (O q , Fire Surcharge $ 1'q o� State Surcharge $ o q b SAC Charge $ License Surcharge $ t5,00 Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1050 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 [ ] 3uilding $ BUILDING Plan Review Permit No.: ' Inspections Surcharge RESIDENTIAL APPLICATION Received By: 763-572-3604CITY $ ,;Z 70 OF FRIDLEY Date Rec'd: >ATE YOUR E-MAIL ADDRESS SAC Charge ITE ADDRESS $1450 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ Erosion Control 'HIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR Park Fee PROPERTY OWNER/ NAME: A UiV Z�j e fLOi✓ Sewer Main Charge ADDRESS: CITY �� Pte/ _STAT TENANT $ e � PHONE:��� ��fStS a'6 CONTRACTOR NAME:C4i[oIy-{�� STATE LICENSE # EXP DATE % SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: —WI kt�— CITY STATE ZIP WITH APPLICATION PHO 6 C 1- 4C7 -2dr-7 — FAX EnINGLE FANMY/NEW CONSTRUCTION SIZE PROPERTY TYPE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION❑ �E/SHED ❑ WINDOWS ❑ BASEMENT FINISH RD OOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ SWIMMING POOL ❑ OTHER�— .<o F h' 1'f TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING </ DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. kOOFING ❑ HOUSE ONLY ,4UMBER OF SQU ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 3ARAGES ❑ ATTACHED GARAGE 2. Proposed Boor plan ? DETAILED DESCRIPTION OF WORK rSernDu� of old -U�t 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: (INiDICATE TOTAL NUMBER OF EACH BELOW) MODEL: 395 AAV 042.060 SIZFIBTU 6!PL, 000 Equipment Installed MFG: SIZEIBTU MFG: MODEL: MFG: MODEL: SIZEIBTU A/C $25.00 —FIREPLACE (GAS) $15.00 —GAS RANGEIOVEN $10.00 AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 BOILER $35.00 XFURNACE $35.00 GAS UNIT HTR R $10.00 _ _CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00 WORK $10.00 X GAS PIPING $10.00 VENTILATOR $15 .00 DUCT ��'��iL'���+'1,.�'.J�Z;VS\,S:J.L\7✓di1ti:WJYVaY?... Permit Fee $ 45-00 MECHANICAL Permit No.: 1� �'� � � �C)'--)BuildingReceived Surcharge $ .50 By: x $15.00 = $ Inspections RESIDENTIAL APPLICATION Number of fixtures @ $25.00 Number of fixtures @ $35.00 x $25.00 = $ x $35.00 = $ 763-572-3604 CITY OF FRIDLEY DateRec'd: DATE 1- YOUR E-MAIL ADDRESS IR r1nd ✓4 ��ulotar t>w.air - Oil i he corn Total = $ SITE ADDRESS 0 THIS APPLICANT IS: ❑ OWNER`CONTRACTOR PROPERTY __ Np,�g; OWNER/ ADDRESS: CITY STATE ZIP TENANT PHONE: CONTRACTOR COMPANYNAME: �t�l�tlxbar+ SUBMIT A COPY OF CONTACT PERSON: JCV1 'wi" YOUR STATE STATE LICENSE # EXP DATE I STATEMk ZIP 32' LICENSE WTM ADDRESS: 1210-$ OD✓►�.RA Ne CITYy�`r4Ci �I APPLICATION PHONE 7m3 784-10100 FAX -7& TYPE XSINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE PERYffT ❑ NEW )<REPLACEMENT ❑ ALTERATIONIREMODEL TYPE OF WORK: DETAILED DESCRIPTION OF WORK rSernDu� of old -U�t 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: (INiDICATE TOTAL NUMBER OF EACH BELOW) MODEL: 395 AAV 042.060 SIZFIBTU 6!PL, 000 Equipment Installed MFG: SIZEIBTU MFG: MODEL: MFG: MODEL: SIZEIBTU A/C $25.00 —FIREPLACE (GAS) $15.00 —GAS RANGEIOVEN $10.00 AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 BOILER $35.00 XFURNACE $35.00 GAS UNIT HTR R $10.00 _ _CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00 WORK $10.00 X GAS PIPING $10.00 VENTILATOR $15 .00 DUCT ��'��iL'���+'1,.�'.J�Z;VS\,S:J.L\7✓di1ti:WJYVaY?... Permit Fee $ 45-00 n ins-..- :✓e:., ...... ....:.. .. .. w........ ,...-.M_._. _ _. _... Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ 145-50 Number of fixtures @ $25.00 Number of fixtures @ $35.00 x $25.00 = $ 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 all work which requires review and approval of �_' plaans.��__�-- JJyy�^�SIGNATURE OF APPLICANT'>LWK.%y PSA T NAME h S FyTY'"IC�k DATE I-II:2C City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building PLUMBING Permit No.: Inspections RESIDENTIAL APPLICATION Received B : PQ 763-572-3604 CITY OF FRIDLEY DATE 3"), I O YOUR E-MAIL ADDRESS SITE ADDRESS010h64IQ THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME:4,0606TY STATIi� (� ZIP � 5� 3Z - TENANT ADDRESS: G(. CI PHONE -10- fa- 7�3So CONTRACTOR NAME: Champion Plumbing STATE LICENSE # # 61770 -PAA EXP DATE SUBMIT A COPY OF YOUR STATE ADDRESS: CITY STATE 771P LICENSE WiIH PHONE Fagan MA! ti5� APPLICATION PERMIT TYPE 1SINGL E FAMILY O TWO FAMILY O TOWNHOUSE TYPE OF WORK: 0NEW gREPIACEMENT DETAILED DESCRIPTION OF WORK r b e J 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 labor) improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of 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: (INDIC TE TOTAL NUMBER OF EACH BELOW) BATH SINK/IAV FLOOR DRAINS _ SHOWER _WATER PIPING SO ($35) _ _ BATHTUB _ GAS PIPING (xuD cn ) — SWIlI9�TG POOL —WATER WATER CLOSET BACKFLOW . ($15) _ CLOTHES WASHER _KITCHEN SINK _ _ DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATIO OTHER WATER METER _ _ PERMIT FEE PROJECTS FOR UNDER $500 PERMLT FEE FOR PROJEC`T'S OVER $500 Permit Fee $ 35 -cc Number of fixtures @ $10.00 x $10.00 = S 50 Number of fixtures @ $15.00 x $15.00 = TOTAL DUE $ fir- ._ � Number of fixtures @ $35.00 x $35.00 = 50 State Surcharge = 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 wor i will be in is conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I undeMand this the 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 accOrdm ice with approved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME �CtM'�S G .� er DATE Z _ S Umm FOR BUILDING ELECTRICAL AND MECHANICAL ORK PLEA E NOTE: SEPARATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, NN 55432 763-572-3604 V AN'. 1741) cnP) en M