PRE 2010 DOCSCITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
57L -36U4 YAX: ( 763) 5 71-125 7
ADDRESS : 6260 RAINBOW DR NE
PIN : 143024330054
LEGAL DESC : SYLVAN HILLS
: LOT 1 BLOCK 4
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING
k.4:3rF
PERMIT N .: 2004-00871
DATE ISSUED: 06/09/2004
VALUATION : $ 2,084.00
NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE. REROOF HOUSE & GARAGE (18 SQ) TEAR -OFF
STATE LICENSED CONTRACTOR 1
APPLICANT BUILDING PERMIT FEE 83.25
FAULKNER GREG REMODELINGUO1 35l 08 FIRE SURCHARGE 2.08
1005 HUBBARD ST STATE SURCHARGE, VALUE 1.04
ST PAUL, MN 55104- LICENSE SURCHARGE 5.00
TOTAL 91.37
PAID WITH CHECK # 8679
OWNER
AUSTIN DARCY L & KOONTZ B J
6260 RAINBOW DR 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.
Bldg
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
NEW [ ] CITY OF FRIDLEY
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
N.
Construction Address: b 9
Effective 4/1/2004
(763) 572-3604 Bldg Insp
(763) 571-1287 Fax
�00 �-0065 2 r
Legal Description:
owner Name & Ad r ss: Tel. #
Contractor. MN LICENSE # o? ®l 3 &E-/ ® 2�—
Address: l �� Tel. # S/- V f,, 21 - yi ®-3r
LMNG.AREA:
GARAGE AREA:
DECK AREA:
Attach to this application, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height _ Sq. Ft -
Length a Width Height _ Sq. Ft
Length Width Hgt/Ground Sq. Ft
a
I
Construction '�yyp�e:�> >_
le Estimated Cost: $
11
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x
6Si--3o� -a�3
DATE:, Meng _ APPLICANT: Tel. #
Call (763) 572-3604 for Permit Fees if mailing in appl cation. Fax to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "Nor Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ � STIPULATIONS:
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to -wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
CURB CUT ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Only
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
INSURANCE
PERMIT TYPE
TYPE OF WORK:
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
_ EFFECTIVE 2-19-09
YOUR E-MAIL ADDRESS (__J 0
❑CONTRACTOR
Permit No.:
Received By:
�a
Date : J U 2e
ADDRESS: G COCY{ `g f L L OV CITY Qf!).'jj,0 STATE4fjiZIP S2Z�.Za
PHONE: L4 q
NAME:
STATE LICENSE # EXP DATE
STATE BOND # EXP DATE
ADDRESS: CITY STATE ZIP
PHONE FAX
SINGLE FAMILY ❑ TWO FAMILY O TOWNHOUSE
O NEW
DETAILED DESCRIPTION OF WORK
PREPLACEMENT
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED.
FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
_ BATH SINK/LAV
_FLOOR DRAINS
SHOWER
WATER PIPING
_ BATHTUB
_ GAS PIPING (NEED CITY LIC)
_
_ SWIMMING POOL
_
WATER SOFTNER ($
— CLOTHES WASHER
_ KITCHEN SINK
_ WATER CLOSET
_
BACKFLOW PREY. $1 )
_ DISHWASHER
` LAUNDRY TRAY
JYWATER HEATER ($35)
_
FOR IRRIGATION
WATER METER
OTHER
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I ac ow dge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of he C' of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application fo a pe it a work is not to start without a permit on site; that the work will be in accordance
with the approved plan in th case of all ork ch re uires review and appro al of
fplans.
SIGNATURE OF APPLICANT PRINT NAM tl`LJI 1 alms -DATE `lJ
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977