PRE 2010 DOCS---7
City of Fridley, Minn..
BUILDING PERMIT
Date:
Owner:�-
Address':�.":....._�
IZWEN
Builder -----------
—
-----
_ .....
_._.._.
Address..
LOCATION OFfjJl DING
No. fa.. .r Street- r ..`°.�,.._ Part o t e
_...
Block addition or Sub-Divisio J W . J a
Lot ......
•- . - :.
Corner Lot ..:...:....................._.. Inside Lot ........ J "................. Setback ............... Sideyard ..l . _...... _.. .€.........._......._..
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To bo Used as
��:.�•� ...._,��°4.iy.... Front Depth ..:......._.. Height --------... Sq. Ft. Cu. Cu. Ft.
...._ .......... .... _......... ...._....... ........ Front ... Depth ........ _...Height .. Sq. Ft. .............. .... ... Cu. Ft. ..... _.................
{
Type of Construction".'* Est. ost.. ......_ .....,.. To be Completed ............... .... ...............................
5
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 compliance with all provisions of
ordinances of the city of Fridley.
In consideration of theayment of a fee of
p $ --•--...--------- ............._...
;.=: 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 conform 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 any tim up; violation f any of the provisions of said
ordinances. V,Building Inspector
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.
4
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name C ff 94 La ., / f/�5 � Builder ..._.�.G A .
Address _„-tj41 1,4 St A14-7 Address AA
LOCATION OF BUILDING
No. 3 %® Street 4292AiC„LSZ� Part of Lot
Lot Block Addition or Sub.Div.C22fib,
Corner Lot Inside Lot L-- Set Back Side -Yard -/d
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
Front Depth s Height ---=E-,0
.� --
Sq. Ft. „91.2 Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction/'&i�/'� Estimated Cost
To becompleted�
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 representa-
tions stated in this application are true and correct.
DATE Z��G SIGNATURE _ �L:�A�.� Q(,
(A Schedule of Fee costs can be found on the Reverse Side.)
fC/0
City of Fridley, Minn.. N° 10,364
BUIIDING PERMIT
Date: Aug. 11, 1969
Owner: Mrs. Florence Builder Sussel Co.
Address 6370 Quincy St. N. E. Address 1850 Como Ave.
LOCATION OF BUILDING
No. 6370` Street Quincy St, N. E. . Part of Lot
Lot — 2 Block 7 Addition or Sub -Division — Christie Addn.
Corner Lot , Inside Lot X Setback _____ Sideyard
Sewer Elevation __ _ r — Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Garage Front 22.4' Depth 24' Leight _ 10' Sq. Ft 535 ca. Ft 5,350
AlterationsFront Depth freight Sq. Ft. Cu. Ft.
Type of Construction _ _ Frame Est Cost — $3900.00 _ To be Completed
Survey located with permit No. 4805 ,
In consideration of the issuance to me of a permit to c tract the buildi des ed above, I agree to da
the proposed work in accordance with the description abo a
sq
forth d in p with all provisions of
,==
of the city of Fridley. /� ➢�
In consideration of the payment of a fee of $ 8.00 , permit is hereby granted to /Sussel Co.
the express condition that
to construct
person the building or addition as described above. This permitisgranted upon
done in, around and upon said building, or anwhom y is granted � conform
onf agents, in all
re and to the workmen, in all work
Fridley, Minnesota regarding wlocation,gconstructio�n, alteration, maintenance, repair amend moving ordinances
buiildings
within the city limits and this permit may be revoked at any time upon viola of any of the provisions of said
ordinances. %
uVector
Clarence Belisle
NOTICE.
We permit dos not cover the construction, Installation for wiring, plumbing, gas henthm sewer or water. Be sire to we
the Building Inspector for separate permhs for these items.
APPLICATION FOR.BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER Is NAME>L�1 _ � i� 1 _ , BUILDER
i
ADDRESS je, ADDRESS Zr
LOCATI
F%
r
• / BUILDING
NO e ? 20 STREET
LOT I- BLOCK
CORNER LOT INSIDE LOT SETBACK SIDEYARD�
SEWER ELEVATION TOP OF FOOTING
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:
a -._Front Depth Height �®
Square feet �� 5� Cubic Feet
Front Depth
Height
Square feet Cubic Feet
Type of Construction
o!�le�jsvt.� Estimated Cost
—T
To Be Completed ( U
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 factsanepresentations stated in
r
this application are true and correct. , '___7
DATE / SIGNATURE ,-
(Schedule of Fee Costs can be found on the Reverse Side.)
2" Id--e-
/V
� 7
f
City ®f Widley
AppriaMas
Dept. of Rldg& prone _%0-3W
DESCRIPTION OF WORK
Number. Kind and Location of Fixtures
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures
x $2.00
$
Fixture Fixture Opening
31
Y
New Fixture Old Opening
x $1,50
$
Catch Basin
x $3.25
W
Z
•
t
N
WATER MTR.
GAS
ELM
Bax
a $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..... ........ 2
x $200
$_2_00
Additional Fixtures ..... ..............
x $ .75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
install (1) gas grill & (1) lite
6.00
lst
—
—
2nd
3rd
4th _
® iraatura Connection openings Connected with —
e N®w Fixture, Old openingsSewer
I El El
Cesspool
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures
x $2.00
$
Fixture Fixture Opening
x $1.50
$
New Fixture Old Opening
x $1,50
$
Catch Basin
x $3.25
$
Water Heater (Up to 99,000 BTU)
x $3.00
$
New Ground Run Old Bldg.
x $3.25
$
Electric Water Heater
a $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..... ........ 2
x $200
$_2_00
Additional Fixtures ..... ..............
x $ .75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
install (1) gas grill & (1) lite
6.00
REPAIRS & ALTERATIONS—Refer to Code
Description .................................. ..........$
TOTAL FEE $_8 00
53-84__915.51
6370 NE. Quincey St.
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 Wiling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct.
Fridley, Minn. June 259 1970 i9—
Owner _Florence Gordy
Kind of Building frame
Used as residence
To be completed about _ June 292 1970
Estimated Cost, $ 20.00
Old-XNew. Building Permit No. _ _. __Permit No.
S e
By -
Business Phon P®LIS GAS
ROUGH
FINAL__L ) I- ` �O
e
SUBJECT
P
City of Fridley
19022
AT THE TOP OF THE TWINS
BUILDING
PERMIT
P
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
�S 3I
1 ; I
"1 CITY HALL FRIDLEY 55432
�•j
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
6/23/87
JOB ADDRESS 6370 Quincy Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
7
Christie Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Florence Goudy 6370 Quincy Street N.E.
571-2092
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
AMRE 3700 Annapolis Lane, Plymouth., MN
553--b020
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 �1 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Construct a 16' x 16' Deck Addition
9 CHANGE OF USE FROM TO
STIPULATIONS
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
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
1
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
$1,750
$•88.
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
PROVISIONj_ZF., ANY OTH TATE OR LOCAL LA GULATING CON-
$29.50
N/A
STRUCTI OR PE R ANCE OF CONST
PLAN CHECK FEE
TOTALFEE
`�
$ 7.38
$37.76
SI NATURE OFCONTRACTOR O THO ED AGENT (DATE)
WHEN PROPER-LY VALIDATED THIS IS YOUR PERMIT
a
BLDG INSP
n E
SiGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
e
NEW [ City of Fridley Effective 14/1/86
ADDN. [ ] R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Addri
Legal Description: c..U< a --
ell, Tel. ## 6 2/
Owner Name & Address:
Contractor:14Ia-1 Tel. #s
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width _ Height Sq. Ft.
Length __ Width Height Sq. Ft. _ -
Length Width gj!-�2 Hgt/Ground a� Sq. Ft.
Corner Lot [ ] Insi
Type of Construction:
04
Lot [ ] Ft. Yd. Setback
Approx. Completion Date: eg -'3 en, —� 9 --
Side Yard Setback
Estimated Cost: $
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
DATE: L APPLICANT: �" > Tel.
CITY USE ONLY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ '[�j®� Fee Schedule on Reverse Side
$ ° 25% of Building Permit Fee
$ $.50/$1,000 Valuation
$ $525 per SAC Unit
$ Fee Determined by Engineering
$ Agreement Necessary ( ] Not Necessary [ ]
$
• �' Of9e�
CITY OF FRIDLEY PERMIT NO.: 2004-01482
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 09/01/2004
NYM-11iL s �I ;ar[Xi��►�� ��t;�i
ADDRESS : 6370 QUINCY ST NE
PIN : 143024410013
LEGAL DESC : CHRISTIE ADDITION
: LOT 2 BLOCK 7
PERMIT TYPE ELECTRICAL
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE ADDITION/ALTERATION
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL SAVERS SWITCH.
# INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
ST PAUL, MN 55114 -
OWNER
GOUDY FLORENCE B
6370 QUINCY ST NE
FRIDLEY, MN 55432
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
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date
ELEC PERMIT FEE -MIN (RESI) 20.00
STATE SURCHARGE, ELEC FLAT 0.50
TOTAL 20.50
PAID WITH CHECK # 117431
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
February 21, 2003
Ms. Florence Goudy
6370 Quincy Street NE
Fridley, MN 55432
Re: Final Inspection at 6370 Quincy Street NE
Contractor: Shiloah Water Co.
Dear Ms. Goudy:
A plumbing permit was issued on October 24, 2001 to install a water softener at your
address. According to Section 4715.2800 of the State Plumbing Code, a final inspection
shall be conducted on the work authorized by this permit. As of this date the inspection has
not been requested.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. We will keep your permit open for another 30 days and if we do
not hear from you within this time to set up the inspection, we will mark the permit "no
inspection called for by homeowner after notification" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
DJJmh
CITY OF FRIDLEY INSPEC'I ION DIV
~6431 University Ave NE
Fridley, MN 55432
763-572-3604
1 X4101
do APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Effective On Jan 1, 2001
uj*y
/- tp o
MARK NUMBER
OF
FIXTURES TO
BE INSTALLED ON EACH FLUOR
<. :.: :I.:
:•i�:}r
'.in '?..
•.Y.v.7l.•.
••�•'•�•'••-•'••.�•'.•:-•:�-•;�••:•-.�;:
Beer Dispenser
:r. `- ::.{.
< ✓
?'il n
Blow Off Basin
Floor Via "`: <- Auto.
-- `�Sivry; �•d •.. Ati
;^R;.;.t:t•-:�••.TSv: :..::4 '=:v ^}.•e:%;^: h..
: •: ;Water Heater
+Gas<•:•.... Gas
%j: �ti::.::::�/� ~•
'••f.•:_ r.-a,.:aY ••, v`•a•:i
. . :.
cry?
T
$ 7.00
Sump/Receiving Tank
Tra
.
'>' Drain B�il;< Washer
..
Range >:: Gas Elec
Stories>e... Urinal
:? :
.>.....
Shower`==
$10.00
Gas Range"
til
. ..{
;..,•+i:`e:S:;fc>7i
Basement
...n:.
..:::::.
:::LW :
$15.00
::ai%::;•'':::ti.:: .....r<:..:::
•::�•:hOR
v: e:r-:a:<.•:ri:. ••��..
>...::�.
:..s:: ,::,��::::
:::::.<:::e.;:::>
y
..,.:
1 r1
Foo :::ter:..:.?-:::::
.vy......4.• ::•
Floor 2
�•`•
-
:.
il...
Foo
..:.v::.:•.r:::n:..
Floor 4 ::::.....
::: is i:: h?•.
..........
�;:i+•.
:.::>
PLUMBING FIXTURE RATES: NO.
RATE
New Factures
$ 7.00
Old Opening, New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater -Electric
$ 7.00
Water Heater - Gas"
$10.00
Gas Range"
$10.00
Gas Dryer"
$10.00
Back Flow Preventer Required ( )Yes () No
Type
$15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
TOTAL JOB ADDRESS QCL>,/y r( �e CK C13C�- �__)I
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 facts
and representations stated in this application are true and correct.
Owner
Building Used
Estimated Cost PERMIT NO.
r
PLUMBING COMPANY 4C�>1Ti�
SIGNED BY
Approved By Rough -In Date
Final Date 0'�
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
0.
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, 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 manufacturers 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
BUILDING
Permit. No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date 'd:
DATE �[/— A ' C�
/
YOUR E-MAII. ADDRESS J` �V I N r� W
SITE ADDRESS 633n
kk ST Zi
THIS APPLICANT IS:
❑ OWNER 19CONTRACTOR
PROPERTY OWNER/
NAME: �-
ADDRESS:() Ov% ^A. jS l� CITY t4 STA
TENANT
PHONE:
CONTRACTOR
NAME:
STATE LICENSE # CaIg EXP DATE d9la rc.� a,
SUBMIT A COPY OF
S 5" ?-1 t STATI IP�.
YOUR STATE LICENSE
ADDRESS: I 4, CITY 11%
WITH APPLICATION
PHONE (a ' -7 " FAX
X SINGLE FAMILY/NEW CONSTRUCTION SIZE
PROPERTY TYPE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WNDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING JI OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION , r
&S
❑ MAINTENANCE/REPAIR StREMODELING
DESCRIBE WORK BEING DONE: LO 3o " i0� eW V% v� �►'` '
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
1 • Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1. Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project
2. Two sets of construction plans
WINDOWS
IN EXISTING OPENINGS X'es ❑No LOCATION OF �'}�OWS
3. Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE
SIZE OF T
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED ER OF WINDOWS 10
ALL FEES ARE BASED ON VALVATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ JtN1Mn6Qb OCCUPANCY TYPE
Permit Fee
Plan Review
Surcharge
Fire Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ o 0 (.0005) times the total job valuation — Minimum $.50
$ .001 x Permit Valuation (1/10%)
$ $5.00 (State Licensed Residential Contractors)
$ $1450 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$20=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ /,* Make checks vavable to: City of Fridley Attach
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 re * and approval of plans. f� P
SIGNATURE OF APPLICANT PRINT NAME V �W6C1J iFa— DATE
r, 'x
Building
PLUMBING
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd: 1,01A17
DATE M fUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS: 0 OWJPR UC15NTRACTOR
PROPERTY
NAME: fill ` -
CITY e` STATE qU
OWNER/
R/ ADDRESS:
s
PHONE:
CONTRACTOR
NAME:
STATE LICENSE EXP DATE
SUBMIT A COPY OF
YOUR STATE
ADDRESS: to CITY STATEZIP_O`c�
LICENSE WITH
PHONE FAX
APPLICATION
PERIVIIT TYPE
,�,
n SINGLE FAMILY ❑ TWO FAMILY 0 TOWNHOUSE
0 NEW REPLACEMENT
TYPE OF WORK:
DETAILED DESCRIPTION OF WORK Q1. d I
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 SINK/LAV FLOOR DRAINS SHOWER _ WATER PIPING
_ _
GAS PIPING w" cnyLrcEAw) _ SWIMMING POOL _ WATER SOFTNER ($35)
—BATHTUB
CLOTHES WASHER KITCHEN SINK _ WATER CLOSET _ BACKFLOW PREV. ($15)
_
TLDISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) & FOR IRRIGATION
METER /4WOTHER
WATER
Permit Fee $
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 $
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 codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an appli on f a permit aptVwork is not to start without a permit; that the work will be in accordance with the
approved plan in the case of rk is eqd rev d approval of p1
SIGNATURE OF APPLICANT / PRINT NAME'r�c�V VV • DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977