PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Builder FA -401-4s
Addrm
N4 60 1 7
PLOCATIQUEOF BUILDING.
NO. -,f ;rr -— Part ok4at
Lot _ Block Addition or, Sub -Di
Corner Lot _ Inside Loi _ Setback Sideyard
Sewer Elevation r Foundation Elevation
DESCRIPTION OF BUILDING
To Used as:
Front _ DepthHeight �� Sq. FL, CU -
Fronto Depth_ Height _, Sq. Ft. Cu. Ft..
Type of Constructioni Est. Cost '"'W_ bee be Completed
lie
In consideration of the issuance to we 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.
i
In consideration of the 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 pari thereof; shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, nbe ctiokedalteration,
at � time upon viollationof any of the provisd moving ions b of�said
within the city ]units and this permit
OPdinanCeB.
p "ATAW_ er`: P p m i
NOTICE:
Uls permit doss net emu the eonstruetlen, hu aWan for v hb& plumbing, gas heating, sewer or water. Be sure to we
the Building inspector for separate permhs for these ftem
Application for Power Plants and Heating, Cooling, Ventilation, Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
Furnace Shell & Duct Work .........................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 .................
Repairs & Alterations each add. $500.00 ...............
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............
each add. 60,000 BTU ......................
R�*lacement of Furnace .............................
Repairs & Alterations—up to $500.00 ................
Repairs & Alterations each add. $500.00 .............
I&
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam .....
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water . .
Each add. 200 sq. ft. EDR Steam ......................
Each add. 320 sq. ft. EDR Hot Water .................
RATE TOTAL
8.00 $
5.00 $
5.00 $
2.50 $
8.00
$
2.00
$
5.00
$
5.00
$
2.50
$
8.00
$
8.00
$
2.50
$
2.50
$
OIL BURNER—to 3 gal. per hour 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x $1.50 $
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU .. ........ x 2.00 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $
ALTERATIONS & REPAIRS TOTAL FEE $
ROUGH
FINAL
Dept. of Bldgs. Phone SU 4-7470
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 Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner
Kind of
Used as
19L,2 -
0
To be completed about
Estimated Cost, $
Old Ne . uilding Permit -No. 60/7 Permit N
DESCRIPTION ,OF WORK
HEATING or M
,=-Ste Hot Water, Warm Air -No
Trade Nam Size No
Capacity 7-Z e)e Sq. Ft. E.D.R 3ob;90 BTU H.P.
Total Connected Load_�' 7 6 ;a- Kind of FuelP
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVER)
W
.AJ.42 2M
Business Phone
D -M v
HEAT LOSS CA
Weatherstrips
Windows Doors
Yes—No I Yes—N,
LATIONS DEPARTMENT` OF BIS
k.S.H.V.. Construction No.
Guide
Reference Out. Wall Int. Wall Ceiling Root
19—
4GS MINNEAPOLIS. MINN.
Insulation
Floor I Kind How Applied
Le th Width He' ht L II mvr R-1 7 r n.,0i Room I Length f n Width i.I • Height
F v
doom ng �a
Width Height No. o Lineal ft. Area
No. of pane of pane light of crack eq. ft.
/
d
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
:1
Infiltration
'r
Coef.
Btu
Infiltration
Coef.
Btu
Infiltration
Int. wall
Exp. wall
/A 1,
.a
Glass
Net, exp. wall
A;, �.
f.,
,Y �"A
Exp. wall
"-x
?._
_LL
i �,
Ceiling
Net exp. wall
i, 6
� 7
Nei exp. wall
Int. wall
/ 4 M
Ceiling
®A
4x j
Floor
Ceiling
b'
Total Btu. a
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area _�^+
/.,-r F1.1 j , � Room I Length /n Width / / Height
Windows and Doors—Crackage and Area
Width Height No. o Lineal ft. Area
No. of pane of pane light of crack eq. ft.
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
14 !-
Windows and boors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of?pane of pane lights of crack sq. ft.
:1
Infiltration
'r
Coef.
Btu
Infiltration
Coef.
Btu
Infiltration
Int. wall
Exp. wall
/A 1,
Glass
Glass
Net, exp. wall
P
1,34
Exp. wall
?._
_LL
i �,
Ceiling
Net exp. wall
i, 6
� 7
Nei exp. wall
s
/ 4 M
Int. wall
®A
4x j
Floor
Ceiling
b'
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 3
o, r M 0-11-1- c�3 A VY/: -].L Lr_:_L. go
Total Btu.
Required sa. ft. E.D.R. or sa. ins. W.A. Leader area .f.4._ n_ .,;§i— .
Windows and Doors—Cracliage and Area
Width Height No. o Lineal ft. Area
No. of pane of pane light of crack eq. ft.
2
It 24
Windows and boors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of?pane of pane lights of crack sq. ft.
:1
Infiltration
'r
Glass
,
Exp. wall
Coef.
Btu
Infiltration
Int. wall
Exp. wall
Ceiling
w - �.
Glass
Net, exp. wall
Ztl
Exp. wall
��
?._
_LL
i �,
Ceiling
Net exp. wall
i, 6
� 7
Floor
Inc. wall
/ 4 M
Ceiling
®A
4x j
Floor
�' e
b'
Total Btu.
Required sa. ft. E.D.R. or sa. ins. W.A. Leader area .f.4._ n_ .,;§i— .
Windows and Doors—Cracliage and Area
Width Height No. o Lineal ft. Area
No. of pane of pane light of crack eq. ft.
2
It 24
Coef. Btu
Infiltration
'r
Glass
,
Exp. wall
•" �,
Net exp. wall
Glass
Int. wall
Exp. wall
Ceiling
Floor
Net, exp. wall
Windows and Door s—Cra * e and Area
Width HeightNo. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
It 24
Coef.1
Coef.
Btu
Infiltration
,
•" �,
J,,
Glass
Exp. wall
.11 /'
Exp. wall'
Net, exp. wall
Net exp. wall
Ceiling
Int. wall
Floor
Ceiling
/ 4 M
Floor
®A
4x j
Total Btu.
Required sq. ft. E.D.R. or sgJi iis. W.A. Leader area I N , , ;
i ` F1.1 ;2 ^ f..• Room I Length p!-' Width - 4 Height
Windowa and Doors—Cra'' kage and Area
Width Height No. L Lineal ft. Area
No. of pane of pane lig s of crack sq. ft.
Coef.1
Btu
Infiltration
Glass
Exp. wall
.11 /'
Net, exp. wall
Int. wall
Ceiling
Floor
/ 4 M
Total Btu.
Required sq. ft. E.D.R. or sq'. ins. W.A. Leader area y P
D56
HEAT LOSS CALCULATIONS DEPARTMENT OF 'BOILDINGS
Weatherstrips A.S.H.V.. Construction No.
Guide
Windows DoorsReference Out. Wall Int. Wall Ceiling Roof Floor
Yes—No I Yes—No 19-
2 `iL Fl.1 A A, 7 4 Room I Lenath _T' Width 2 ° Height " II Fl.l
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No* of pane of pane lights of crack eq. ft.
Width Height No. of Lineal f . Area
No. of Dane of pane lights of crack sq. ft.
hl
lCoef.1 Btu
Infiltration
Coef.
Btu
Infiltration/
►j'
II
V 7C
Glass
Int. wall
Ceiling
Exp. wall
Floor
Net exp. wall
a
Int. wall
Ceiling
10
rn
3
Floor
Total Btu. I /' 361
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area+
4.
Windows and D=ors—Crackage and Area
Width Height No. of Lineal ft. Area
No* of pane of pane lights of crack eq. ft.
Width Height No. of Lineal ft. Area
No. of pane of p ne lights of crack sq. ft.
J B a4
lCoef.1 Btu
Infiltration
Coef.
Btu
Infiltration
Exp. wall
/ Z q 7.
Glass
Int. wall
Ceiling
Exp. wall
Floor
Net exp. wall
/
Int. wall
Ceiling
Floor
Total Btu. 1y,
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area "
F1.1 Room I Lenath Width 14eiaht
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No* of pane of pane lights of crack eq. ft.
lCoef.1 Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
MJNNEAPOLIS. MINN.
Insulation
Kind How. Applied
Roo— m L ath Width Height
Windows and Doors—Cray age and Area
Width Height No. o Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sql ins. W.A. Leader area
FI -1 Room I Length Width Height
Windows and Doors—Crackage and Area
Width Height No.Iof Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall,' . a.$: b ;172,
Int. wall
Ceiling
Floor
Total Btu. `,?f _ 1, 7- ev
Required sq. ft. E.O.R. or sq. ins. W.A. Leader area
Fl.l Room I Eenath Width Height
Windows and Doors—COIckage and Area
Width Height NC. of Lineal ft. Area
No. of pane of pane It hts of crack eq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
"Total Btu.
Required sq. ft. E.D.R. or'q. ins. W.A. Leader area
r
D46 s l
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS � MINNEAPOLIS. MINN.
Weatherstrips A.S.H.V.E. Construction No. Insulation
Guide
Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How. Applied
Yes—No I Yes—No 19_
'I, de- L'I 1 a 1?,..... I r ---&L Pe B V11-hL :..1.► A 11 L'1 I A-12— 11 -&L W;rlth t4piaht d
. r°Y � 1 a a.1 � d vt.r
a.wau t a.c..tyu. gty, ®
n wa.a
�
• acaau.
Windows and Doors—Crackage and Area
t.s 2 4D 2
A�
Width Height No. of Lineal f . Area
No. of pane of pane lights of crack sq. ft.
Z 2C, A!j
Glass i
Coef. Btu
Infiltration
Coef. , Btu
n
Coef.
Btu
Infiltration
Exp. wall
Exp. wall
Floor
yC
Glass,`
d
Int. wall
Ceiling
Net exp. wall
Exp. wall
1093
16
Floor
Net exp. wall
Ceiling
�
d ,I cn
Int. wall
Floor
d •-�
Ceiling;
Floor
I ......L9 I .G . _ L►___ I f ___L wrJ.L u_:_L. .0
-11_1111"# r
Rv -I ------ rka�
....a... 0
Windows and Doors—Crackage and Area
Windows and D' rs—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
t.s 2 4D 2
A�
Infiltration J
45' .�
Glass i
Coef. Btu
Infiltration
Coef. , Btu
n
Glass'
1.4,2
1 721.
Exp. wall
Exp. wall
Floor
Net exp. wall
"�
d
Int. wall
Ceiling
Net exp. wall
Ceiling
1093
16
Floor
Total Btu.
Kequired sq. tt. L.U.K. or sq. ms. W.A. Leader area
FI R If- WH
ath '
ooIn ength c, 1 elgh
Total Btu.
Required sq. ft. E.D.R. or sq. ins. WA. Leader area I & j 3
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
t A .
Windows and D' rs—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of Dane lights of crack sq. ft.
Coef. Btu
Infiltration J
45' .�
Glass i
*�
Exp. wall
Coef. , Btu
Infiltration
&
1.4,2
1 721.
Glass
Exp. wall
Floor
Exp. wall
a
Ceiling
Net exp. wall
4-C,
Int. wall
Ceiling
7Y
jai I 72,t)
Floor
d •-�
Total Btu.
Required sq. ft. E.D.R. or sq. ins. WA. Leader area I & j 3
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane ligh of crack sq. ft.
Coef. Btu
Infiltration J
45' .�
Glass i
*�
Exp. wall
Infiltration
Net exp. wall
r'
Int. wall
"
Ceiling
Exp. wall
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area .
dL F1.1 F-' +a :r" K%OOm 1 L-MUSUI 12 n.uua
a acatyua
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane ligh of crack sq. ft.
Coef. Btu
Infiltration i,q
45' .�
Glass
Exp. wall
Coef.
Btu
Infiltration
'
Glass
"
.0
Exp. wall
Net exp. wall
Int. wall
a
Ceiling
Floor
Total Btu. 1 1 5„3.37
Required sq. ft. E.D.R. or sq, ins. WA. Leader areaI A—
W
FI.1 Z? $ft m Rnnm I Lenath 4 4_ Width v; 4 Heistht .;
Windows and Doors—Craekage and Area
Width Height No. of Lineal ft. Area
No. of pane of.panelights of crack sq. ft.
h 1
Coef. Btu
Infiltration i,q
45' .�
Glass
Exp. wall
d
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or s 'F ins. W.A. Leader area est:
I,i
City of Fridley
Application for Plumbing mid Cn Fitting Perndt
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK a
Number. Kind and Location of Fixtures mho
y
N
112
NO. RATE
TOTAL
Number Fixtures ......................
x $1.50
$ S o p
Future Fixture Opening ................
x 1.20
$
New Fixture Old Opening ..............
= z
$
n
o
0
d
coo
R
N
WATER HTR.
GAS
ELEC.
Base
GAS FITTING FEES:
NO. RATE TOTAL
J
1st 3 Fixtures .........................._—�
x $1.50
$ ,
1
x .50
$
Gas Range to 200,000 BTU ..............
x 2.00
$
1st
2nd
3rd
4th
• Future Connection Openings I
e New fIxtare, Old Openings
Connected with
Sewer
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE
TOTAL
Number Fixtures ......................
x $1.50
$ S o p
Future Fixture Opening ................
x 1.20
$
New Fixture Old Opening ..............
x 1.00
$
Catch Basin ............................
x 3.25
$
Water Heater (Up to 200,000 BTI) ......
x 2.00
$ U
New Ground Run Old Bldg. ............
x 3.25
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures .........................._—�
x $1.50
$ ,
Additional Fixtures ....................
x .50
$
Gas Range to 200,000 BTU ..............
x 2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ...........$ r, d
TOTAL FEE $� a -
City of Fridley:
C
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 applicationl are true and correct.
Owner
Kind of
Used as
To be completed about
Estimated Cost, $
Ol Ne . ding Permit No U
ROUGH
FINAL
d2 %M
Business Phone
t
F1
In
MEMO FROM:
RICHARD N. SOBIECH• DC 53 7-15-75
Public Works Director MEMO NO. REPORT BY.
DATE 7-8-75
1
SUBJECT: Water in Basement at 6325 Pierce Street; Apartment Bldg.
❑ See attached REMARKS.:
6
Mike Oman - 574-0059 reported a problem with water
in his apartment bldg. basement at this address.
Apparently the landlord has been contacted. Could
❑ Review & take appro- you check into the complaint the determine if
priate action the City can take any action to help him. It
seems the water problem didn't develop in recent
XC Review & comment weeks as the result of the heavy precipitation, but
has existed for some time.
°' ❑ Note & discuss with me -
0
❑ Work with
=:)
❑ Rush, immediate action
desired
oW&.0
,y`'1 M►�/Uec Nro�s
Make reports, w/background
material as complete as poss- COMMENTS:
ible. Make interim report if n — _A
necessary. p L
� AhtiN
0
w ❑] Action completed, no
z
further review needed
❑ Further action necessary (� •�
❑ See attached letter
❑ Interim report
v�
3
l
ss
? s
'� ~
tki 41,
S
re
71r—
L r
November 1, 1995
City of Fridley
Permit Department
6431 University Ave NE
Fridley, MN 55432
To whom it may concern:
The owner of 63J5 Pierce St
authorizing the building of
certificate of survey. The
the new garage is at least 3
Marita K. Larson
_ ----------
Wayne A. Larson
NE has no objection to the city
a garage on 6325 Pierce St without a
owner of each property also agrees
feet from the common lot line.
Robert D. Shimanski
--------------------------
Mary Lou Shimanski
SuBjECT
PER
City of Fridley
2
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
Ir? ' '
� • COMMUNITY DEVELOPMENT DIV.
_
r i PROTECTIVE INSPECTION SEC
"1 CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED Y
612-571-3450
910-F15
10/27/95
JOB ADDRESS 6325 Pierce Street NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
4
1
Don's 3rd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Richard Shea 6325 Pierce Street NE
571-0534
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
EX NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
Construct a 22' x 22' Garage
9 CHANGE OF USE FROM TO
STIPULATIONS'
Provide a hard surface driveway. See notations on plan.
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
$8,576
$4.29
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-
$149.75
Fire SC $8.58
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$162.62
SIGNATURE OF CON-RACTOR OR AUTHORIZED AGENT (DATEI
'WHEN PROPERLY LIDATED THIS IS YOUR PERMIT
IDIJ�JJE
Dav,4'1141)
BLDG I SP
)ATE
SIGNATURE OF OWNER FIFO N RBUILDERI (DATE
NEW (J Effective 8/l/95
ADDN (] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: 3 'S P6 e ✓r -e S I ti C
Legal Description: l v / y &,4 -
Owner Name & Address: Ai',"Zj -V -"- Tel. #
Contractor:
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 IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length 2 - Width 2- z �� Height Sq. Ft. Y_/'I, %Z
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot Qc] Ft. Yd Setback Side Yard Setbacks z/.
Type of Construction: 1-10V.Irle Estimated Cost: $ /-/CIO 0 06
Approx. Completion Date: 114
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE: APPLICANT:
Tel. #
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 $ $850 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 $ 162,6Z
STIPULATIONS:
Building
PLUMBING
Permit No.: � -6(�
Inspections
RESIDENTIAL APPLICATION
Received By:
/
763-572-3604
CITE OF FRIDLEY
Date Rec'd: !
14
DATE—I I I D YOUR E-MAIL ADDRESS
PierceZ�%t Fr LGA
SITE ADDRESS
THIS APPLICANT IS: OWNER ❑CONTRACTOR
PROPERTY
NAME:01 K IM W�.
ADDRESS: 6P 32.G l n ('ecce S CITY STATEN IP Z
OWNER/
TENANT
PHONE: 71P3 oja q�%Qo
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE
ADDRESS:�AXCITY STATE ZIP
LICENSE WITH
PHONE_ FAX
APPLICATION
PERMIT TYPE
[3SINGLE FAMILY TWO FAMILY ❑ TOWNHOUSE
❑ NEW /REPLACEMENT
TYPE OF WORK:
DETAILED DESCRIPTION OF WORK Al 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 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 FIN TURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SINK/LAV DRAINS _ SHOWER _WATER PIPING
_ _FLOOR
GAS PIPING axzD cm'uC&YA _ SWIMMING POOL —WATER SOFTNER ($35)
—BATHTUB _
CLOTHES WASHER KITCHEN SINK _ WATER CLOSET _ BACKFLOW PREY. ($15)
_ _
DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
_
WATER METER _ OTHER
CF y ��g�,�)
FP45✓\ .. , �,"�w.�i. 'I�J wv �+'.
!.
Permit Fee $_15 60 Number of fixtures @ $10.00 x $10.00 = $
Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ /z� . SO 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 all work which re uires review arapproval of plans. l
I
PRINT NAME M am I `a � Ck DATE
SIGNATURE OF APPLICA T
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977