PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT jV0 285
Date:
owner: Builder 't
I
Address Address
LOCATI F UILDING
No. _k Street' ;, /_ _ — Part t 06
Lot _ Block Addition or Sub -Division
Corner Lot;, Inside Lot Act Setback _�� Sidegard'� ,
Sewer Elevation -Foundation- Elevation
DESCRIPTION OF. BUILDING
Front Depth Height 4= Sq. Ft. Cu. Ft It&
nt ' Depth Height Sq. Ft Cu. Ft
sof . � on Es - To be Com leted
TyTypeco! -
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 4amapliance, with ail provisions of
ordinances of the city of Fridley. -
In consideration of the payment of a fee of S , permit is hereby granted to
the
to construct the building or addition as described above. This permit is granted upon
express condition that the person to whom it is gamed and hfs agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conforclr in ali respects to the ordinances of 7Fridley, Minnesota regarding Vocation, construction, alteration, maintenancx, repair �d moving of buildings
whin the dty limits and this permit may be revoked at any time upon violati f aay of the Provisions of said
inaacea. .�' e`
Building Inspector
NOTICE:
Sk psnett does not cover the construction, hwWWon for wW[ng, phmrbino, on heatieo,, awsnr or water. Be ams to no
tho Buthihre InspKtor for separate perm(tc for them Neva.
,40-2,rte a-4 �d /
OWNER ° S PIAIM
ADDRESS
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
LOCATION OF BUILDING
1
No. �� (�� Street Part of Lot
Lot C�Z Block` Addition or Subdivision},,,_
� P
Corner Lot Inside Lot�_Setback Side Yard Z�
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.
DATE ,v` . % �Vg,__STGNATURE
(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 SII 4-74700 i
DESCRIPTION OF WORE
Number, Kind and Location of Fixtures Location
41
C
f5f5RR
,�i< <
Y 7
v�
8c Z
Z
<�
O rp`C�ie
w
Z
�p
•
•
N
WATER HTR.
GAS
ELEC.
Base
E
1
1st
2nd
3rd
4th
• Future Connection Openings
* New Fixture, Old Openings
Connected with
Sewer E]
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ....... (C x $1.50 $ C� U
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) ...... Z x 2.00 $Cj d
New Ground Run Old Bldg . ............ x 3.25 $
City of Fridley:
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 facl
and representations stated in this app
/catio are true and correct.
Frill ay, Minn. " 19
Owner A--' L -T -1 t -'V.-
Kind
'Kind of Building
Used as t`
To be completed about
Estimated Cost, $
OldNew uilding Permit No Permit N
Signe
By
Business Phone No "
ROUGH
FINAL
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 ................................................$ 2�3f6
TOTAL FEE $
42 2tA
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
-RESIDENTIAL
Furnace Shell and Duct Work,
Burner (Also replacement furnace)
Gas Piping
(piping needed with new furnace)
Gas Range
Gas Dryer
RATE TOTAL
$ 20.00
$
$ 10.00
$
$ 10.00
$
$ 10.00
$
• Air Conditioning (all sizes) $ 10.00
All Others/Repairs and Alterations
l% of Value of Appliance or Work
COMMERCIAL/INDUSTRIAL
l% of Value of Appliance or Work
State Surcharge
TOTAL FEE
Reinspection Fee ($15.00)
Rough Insp.
Date /
Final Insp. 6 — �/ _ "
Date /
Approval for Permit
s -06
Job Address
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.
OWNER
KIND O
USED A
TO BE
ESTIMATED COSTLOLD NEW BUILDING PERMIT NO. PERMIT NO.
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Trade Name
Capacity
Total Connected Load
BURNER - Trade Name
Sq. Ft. EDR
Size No.
BTU HP
Kind of Fuel
Size No.
Capacity Sq. Ft. EDR BTU HP
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00 Company
PLUS $.50 STATE SURCHARGE
%% ,, n Signed By C `/
C,��-�..Lw C������!'r� Tel. No.
*Air Conditioners can not be placed in side yard without _` ��Z�✓
written permission from adjoining neighbor. 46
Fill out back side for stack verification on replacement furnaces
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
I.
Has been carefully examined
Yes (,)
No ( )
2.
Is free from rust or deterioration
Yes ( )
No ( )
3.
Has no foreign objects lodged within
Yes ( )
No ( )
4.
Is securely supported
Yes ( )
No ( )
5. Meets all current Code requirements for size and
total BTU connected Yes ( ) No ( )
6. Has Total heating BTU's of
All other BTU's
TOTAL
Rema rk s
Company
Signed By
Date
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures $ 5.00 $
Future Fixtures $ 3.50 $
Old Opening, New Fixture $ 1.50 $
Bear Dispenser S 4.00 S
Blow off Basin $ 5.00 $
Catch Basin $ 5.00 $
Rain Water Leader $ 5.00 $
Hydraulic Valve S 5.00 $
Sump or Receiving Tank S 5.00 S
Mater Treating Appliance $ 7.00 $
Not water Heater $ 5.00 $
Gas Range $ 10.00 $
Gas Dryer $ 10.00 $
Back Flow Prevpn r iType t
$ 5.00 $
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
Is of Value of Fixture or Appliance $
State Surcharge $ .50
Reinspection Fee $
($15.00) TOTAL FEE $ z 6-0
Effective May 1, 1990.
Job Address
Department of Buildings
City of Fridley
Tel. 4571-3450
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 oorract
Fridley, Mn. 19 1,5,e
OWNER1J.ee
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT Ay / , / ' / e
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO. / 6 S.7 �
company
Sign By G
�
Tel. No. y)7�
ROUGH INSP.
Date
FINAL INSP.
Date
APPROVAL FOR PERMIT
!1IN1HU4 FEE FOR ANY PLUMBING PERMIT IS 115.00
PLUS THE $.50 STATE SURCHARGE
a
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lot
2nd
3rd
4th
(R) Future Connection Opening
Connected with Sewer
M New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures $ 5.00 $
Future Fixtures $ 3.50 $
Old Opening, New Fixture $ 1.50 $
Bear Dispenser S 4.00 S
Blow off Basin $ 5.00 $
Catch Basin $ 5.00 $
Rain Water Leader $ 5.00 $
Hydraulic Valve S 5.00 $
Sump or Receiving Tank S 5.00 S
Mater Treating Appliance $ 7.00 $
Not water Heater $ 5.00 $
Gas Range $ 10.00 $
Gas Dryer $ 10.00 $
Back Flow Prevpn r iType t
$ 5.00 $
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
Is of Value of Fixture or Appliance $
State Surcharge $ .50
Reinspection Fee $
($15.00) TOTAL FEE $ z 6-0
Effective May 1, 1990.
Job Address
Department of Buildings
City of Fridley
Tel. 4571-3450
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 oorract
Fridley, Mn. 19 1,5,e
OWNER1J.ee
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT Ay / , / ' / e
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO. / 6 S.7 �
company
Sign By G
�
Tel. No. y)7�
ROUGH INSP.
Date
FINAL INSP.
Date
APPROVAL FOR PERMIT
!1IN1HU4 FEE FOR ANY PLUMBING PERMIT IS 115.00
PLUS THE $.50 STATE SURCHARGE
City of Fridley
AT THE TOP OF THE TWINS
SUBJECT
BUILDING
PERMIT
92
CR
• _____ COMMUNITY DEVELOPMENT DIV.
i LV
r PROTECTIVE INSPECTION SEC.
1 ` �
j CITY HALL FRIDLEY 55432
L J\ 612-571-3450
3,59 ®.
NUMBER
910-F15
REV,
DATE
4/10/90
PAGE OF
APPROVED BY
JOB ADDRESS 6580 Pierce Street N. E,
1 LEGAL
DESCR.
LOT NO.
2
BLOCK
2
TRACT OR ADDITION
Door e s 2nd Addition
SEE ATTACHED
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Bob Skyhawk. 6580, Pierce Street N,E,
571-8396
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Eden Construction 150 East 107th Street Cir,, Bloomington, MN 55420 888-3015
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 l ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside Dwelling and Replace windows
9 CHANGE OF USE FROM TO
STIPULATIONS
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
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
ZONING
SO. FT.
CU. FT.
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
l
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
VALUATION
$9.,000
SURTAX
$4.50
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.
$108.00
PLAN CHECK FEE
TOTAL FEE
A/tel � )
-—,,,$112.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERLY V DATED THI IS YOUR PERMIT
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
BLDG INSP
qaT
0 IN
NEW [ ]
ADEN [ ]
ALTS [ ]
CITY OF FRIDLEY
R-1 AND R-2
Building Permit Application
Construction Address: % 5e () P 1e f -C e S + - ^k
Effective 1/l/g0
Legal Description: Lo t 2 (31 oc- k a D o LS A c� X, i e0 po
Owner Name & Address: 6 u to S h k � Tel. # 5 i / - W3g b
Contractor: eon S+r uc 4- Tel.
Address: 150 (- 10-24-h ,S � _ Cir'_
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DE'SCR=CN OF ncPROVEMM
LIM G AREA: Length Width Height Sq. Ft.
GUUM AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
07MM:
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: SxxZ,V,!, k,�ivxX.c L.: S Estimated Cost:
Approx. Completion Date:
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
Width + 6' See Back Page
DATE: �% - �(' ' y APPLICANT: \ � �, Tel. # V a? - -2 ;) 7
Permit Fee $ , DD
State Surcharge $
SAC Marge $
Driveway Escrow $
Park Fee $
Sewer Main Marge $
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
CITY OF FRIDLEY PERMITO.:
20�01343
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 08/16/2004
(763) 572-3604 FAX: (763) 571-1287
ADDRESS 6580 PIERCE ST NE
PIN 133024240055
LEGAL DESC DONS 2ND ADD
LOT 2 BLOCK 2
PERMIT TYPE PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION : $ 400.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER
HEATER.
# ELEC WATER HEATERS 0
VALUE OF FIXTURE/APPLIANCE
0
# NEW FIXTURES (EXIST OPENINGS) 0
# GAS WATER HEATERS
1
# GAS DRYERS 0
# GAS RANGES
0
# OF NEW FIXTURES 0
VALUE (FOR MINIMUM CALC)
400
# WATER TRMT APPLIANCES 0
APPLICANT
PLBG PERMIT MINIMUM FEE
PLBG FIXTURES (NEW OPENINGS)
0.00
0.00
NORBLOM PLUMBING CO
2905 GARFIELD AVE S
PLBG FIXTURES (EXIST OPENINGS)
0.00
MINNEAPOLIS, MN 55408-2173
WATER TREATMENT APPLIANCE
0.00
(612) 827-4033
WATER HEATER - ELEC
0.00
WATER HEATER - GAS
35.00
GAS RANGE FEE
GAS DRYER FEE
PLBG REPAIR/ALTERATIONS
0.00
0.00
0.00
OWNER
ROBERT SKYHAWK
6580 PIERCE ST NE
STATE SURCHARGE, PLBG FLAT
0.50
FRIDLEY, MN 55432
TOTAL
35.50
PAID WITH CHECK # 28875
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 work
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
regulating construction or the perfor nce o construction.
Applicant Date
Bldg Ins �(,-Date�Z��
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
:ITY OF FRIDLEY INSPECTION DIV.
;431 University Ave NE
=ridiey, MN 55432
763) 572-3604, FAX (763) 571-1287
Effective April 1, 2004
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
3LUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESSnnn,e ' e -j 010 AjLW_
4ew Fixtures
$10.00
MAKK NUMULK UI- FIXTURES To 13E INSTALLED
ON EACH FLOOR
3eer Dispenser
$10.00
. Urinal
Shower
:Sho
Wash € ::::::::: Floor:....
Tray Drain
-»:::. Auto.
Washer
>L<<
-`
Gas
Range
Water Heater
Gas Elec
Basem
Nater Heater -Electric
$35.00
Nater Heater - Gas**
$35.00
jas Range**
$10.00
Sas Dryer**
t
Floor 1
Type
$15.00
Floor 2
Floor 3
Floor 4
3LUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESSnnn,e ' e -j 010 AjLW_
4ew Fixtures
$10.00
)Id Opening, New Fixture
$10.00
3eer Dispenser
$10.00
3low Off Basin
$10.00
.',atch Basin
$10.00
lain Water Leader
$10.00
Jump/Receiving Tank
$10.00
Nater Treating Appliance
$35.00
Nater Heater -Electric
$35.00
Nater Heater - Gas**
$35.00
jas Range**
$10.00
Sas Dryer**
$10.00
3ack Flow Preventer Required ( )Yes () No
Type
$15.00
Reinspection Fee $50.00/Hr
kLL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Appliance
State Surcharge
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 aDDlication are true and correct.
S , ROBERT 8 /� , 20�_
658080 PIERCE STREET" NORTHEAST rr
FRIDLEY, MN 55432
OWNER (763) 571-8396
SCM BUILDING USED AS
ESTIMATED COST q6 0 o_o PERMIT NO. Qo 4l e)J , �
TOTAL FEE $ 3s. SD
PLUMBING COMPANY D (' \%0 ` 0VA c br
SIGNED BY TEL NOAW) $2%-clo33
Approved By
COMBUSTION 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 Fumace 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 Two 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
MECHANICAL
Permit Nae_229
Inspections
RESIDENTIAL APPLICATION
Received By�
763-572-3604
CITY OF FRIDLEY
D I . 1 9 onnfl
763-502-4977 FAX
EFFECTIVE 1-1-08
DATE 2- YOUR E-MAIL ADDRESS
SITE ADDRESS ` e—% G AAv 3 �---
THIS APPLICANT IS: ❑ OWNER' ❑CONTRACTOR
PROPERTY
NAME: U
ADDRESS: 6 -5 -KO l -k-c-+e S� CITY ! & e -Y STATE 21P SS
OWNER/
TENANT
/
PHONE: 6 (a C1 l I $ ^Z—
CONTRACTOR
COMPANY NAME:
CONTACT PERSON:
NOTE:
SEPARATE CITY
LICENSES ARE
STATE LICENSE # EXP DATE
REQUIRED FOR GAS
ADDRESS: CITY STATE ZIP
AND HVAC.
SUBMIT COPY OF BOND
PHONE FAX
ANDINSURANCE
/�
QSINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
PERMIT TYPE
❑ NEW ❑ REPLACEMENT O ALTERATION/REMODEL
TYPE OF WORK:
DETAILED DESCRIPTION OF WORK C I/LL��-
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 )
OR
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)
Equipment Installed MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
$25.00 (GAS) $15.00 _GAS RANGE/OVEN $10.00
_A/C _FIREPLACE
_AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
UNIT HTR $10.00
_BOILER $35.00 _FyyRNACE $35.00 —GAS
CHIMNEY LINER $10.00 GAS DRYER $10.00 _POOL HEATER $35.00
—DUCT WORK $10 00 GAS PIPING $10 00 VENTILATOR $15.00
Permit Fee $ Number of fixtures @ $10.00 x $10.00 =$
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ OR Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ D .50
MINIMUM $15.50 MINIMUM $15.50 Total =
THIS IS AN APPLICA,,ION FOR A PERMIT -NOT VALID UNTIL PROCESSED
formation above is complete and accurate; that the work will be in conformance with the ordinances
I hereby apply for a mechanical permit and I acknowledge that thei-p
City Fridley with the Minnesota Constru Codes; that I understand this is not a permit but only an application for a permit and work is not t
and codes of the of and
e ved plan in the case of all work which requires review and approval of plans.
start without a permit; workE-7
SIGNATURE OF APPLI PRINT NAME DATE
DA O
APPROVED BY
U
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977