PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT -�
4'798
Date:*�'"
_.._. _. ...,,"'
Owner:'�,°.. `.� ••---�+° '. � Builder .... .......... .... _ - ... ............. _.._........... _..._.................. ...........
Address , �' L•Y .. a= - Address• .�c.._.._.................. ........
OFAT
l-.. 0.. 0...'UIL
No. - 2. .... Street . _ .. Pari o Lot
Block ....._.... .... Addition or Sub -Division ...
Lot ...._... .. ........_
Corner Lot ..----....... :.......... _........ Inside Lot ... ......... Setback „ ?..:: ....................... Sideyard ..41 ._.......................----------------
SewerElevation ...........------- _....... _................... -....... _................... _....... _.............. Foundation Elevation ........... ........................ _............. .............. _............. _............. ...
DESCRIPTION OF BUILDING
To Used as:
r Front ..°. Depth .� . Height ... Sq. Ft.yrrCu. Ft„._.._ t+G
�'Depth ei ....... Sq. Ft.
� ..�:_�............ Front ..............._...._. Est. Cos��!s`��.. g�-��.. _... To be Completed ...._Cu....Fi...._. L..._�.__........ '.
Type a14� Construction ...............................
J
Q
THIS PERP:71 T DO 41JTHORl7_E VIOLAT'
ION OF ANY
;� f E LA:vD CO°j�NANTS AND
BUILDING RESTR'C`'ONS.
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. �r
..,d�.....--••----....... .._... __. ..._._..._ .__._......._ _.._ _... ._.._ _ ._.._...._......._....
0
In consideration of the payment of a fee of $..... ' .................., permit is hereby granted to....._ ...... ................................ ..... .... .
... _........... _........ .......... ........................... to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, ,shall conform in all respects to the ,ordinances of
Fridley, Minnesota regarding location, construction, alteration,' maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violatiany of the provisions of said
ordinances. a
Building Inspector '!
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or. water. Be sure to see
the Building Inspector for separate permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name PMMt,=—Bu-ilder,%J a h 1i �k -c t
Address ` I �- 1a.� �.�,' � �c �R:. Address
LOCATION OF BUILDING
No. 2 :2 3. Street CLL— d % Part of Lot
Lot "� Block .. Addition or Sub.Div. -z e r. ��-`�- �1 A �- d
Corner Lot—Inside Lot__7-,„Set Back jC � Side -Yard , � o„
SEWER. ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as: Cv am
L�. Front Depth / Height
Sq. Ft... ` 1 Cu. Ft.
AA dr . G_Front psi Depth 12, Height
Sq. Ft.
Cu. Ft.
Type of Construction L -d Estimated
To be completed
Cost
The undersigned hereby makes application for a permit for the work herein specified$
agreeing to do all work in strict accordance with the City Ordinances and ruling of
the Department of Buildings, and hereby declares t t all the facts and representa-
tions stated in this application are true and cor ct.
DATE �l ._ -��---SIGNATURE
(A Schedule of Fee costs can be found on theJReverse Side.)
Application for Power Plants and. Heating. Coolleg. Ventdation..Refrigerand
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL,
Furnace Shell & Duct Work .......................... 8.00 $
Replacement of Furnace 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU ... — .................. 2.00 $
Replacement of Furnace ............................. §.00 $
Repairs & Alterations—up to $500.00 5.00 $
Repairs & Alterations each add. $500.00 ....... :...... 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam.......
8.00
$
Furnace Shell & Line—to 640 sq, ft. EDR Hot Water ...
8.00
$
Each add. 200 sq. ft. EDR Steam ......................
2.50
$
Each add. 320 sq. ft. EDR Hot Water ..................
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
�7A
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. JJ __
,Frif X, Minn �- • `dam 19 C04
Owner _
Kind of
Used as
To be co
.Utfitding
Estimated Cost, $
Old �ew.Building Permit No.
f Permit No.
DESCRIPTION OF WORK
BEATING or P9WER PLANTS--Steam-, Hot W ter, Warm Air—N
Trade Name Size No
Capacity •/Sq. Ft. E.D.R- BTU H.P,
Total Connected Load `� l y '�p Kind of Fuel
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
RAY N WELTER HEATING C
Signed 4637 CHICAGO AVE.
MINNEAPOLIS 7, MINNESOTA
By
4Z 7M 7-59 Business Phone No �� ��� d6,
(REMARKS—OVER)
City of Fridley
Application for Plaenbing and Gas Fitting Pennitt
Dept, of Bldgs. Phone 4A4-7470
DESCRIPTION OF WORK
Number, Sind and Location of Fixtures Locafio
PLUMBING FIXTURE RATES:_
NO. RATE
TOTAL
Number Fixtures ......................
x $1.50
$ 2-00
Future Fixture Opening ................
x 1.20
$�
New Fixture Old Opening ..............
�3z
$
Catch Basin ............................
Z
z
a
•
•
WATER -HTR.
New Ground Run Old Bldg . ............
ELEC.
$
GAS FITTING FEES:
NO. RATE TOTAL
x $1.50
$
1st 3 Fixtures .......................
..
Additional Fixtures ....................
x .50
$
Gas Range to 200,000 BTU ..............
iio
F
N
GAS
Base(2)
1st
2nd
_
3rd
_
4th
• Future Connection Openings
Connected with
�
Sewer
New Fixture, Old Openings
Cesspool El
PLUMBING FIXTURE RATES:_
NO. RATE
TOTAL
Number Fixtures ......................
x $1.50
$ 2-00
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) ......
oe x 2.00
$ ' C)
New Ground Run Old Bldg . ............
x 3.25
$
GAS FITTING FEES:
NO. RATE TOTAL
x $1.50
$
1st 3 Fixtures .......................
..
Additional Fixtures ....................
x .50
$
Gas Range to 200,000 BTU ..............
x 2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description .............................................. $
��
TOTAL FEE °
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 truhand,orrect.
19
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old—New. Building Permit No Permit
Signe e
By
Business Phone No —1" !9 ® AIZZ
ROUGH ? T /?— & C
FINAL
A z 2M 7-59
F PN
cation for Power Piaets and Heath % Cooling, Ventlkdens ReftiweraM®® and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE Dept. of Mdse. Phone W -UM
GRAPr'ff WARM AIR:
RATB TOTAL
Furnace Shell & Duct Work ................
.. $10.00 $
Replacement of Furnace ... . ..... .....
.. 6.00 ;
Repairs & Alterations—up to $500.00
B.00 $
Repairs & Alterations each add. $500.00
3.00 $___
MECIL WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ........ ..$10.00 $
each add. 60,000 BTU .................... .. 3.00 i
Replacement of Furnace .... 6.00
Repairs & Alterations --up to $500.00 6.00 $
Repairs & Alterations each add. $500.00 3.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $_
Each add. 200 sq. ft. EDR Steam +3.on
Each add. 320 sq. ft. EDR Hot Water 3.00 $
OIL BURNER—to 3 gal. per hour 6.00 $
over 3 gal. per hour --See Fee Schedule
GASB (up to 188,000 BTU) &00 $
over 199,00013 M See Fee Schedule
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures .. .... x$ 100 $
Additional Fixtures x .76 $
Gas Range to 199,000 a$ 5.00 $
i
ROUGH
FINAL a -
See Fee Schedule
TOTAL rim $
;SURGE ARGC $_.50)
p
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 Ordinance:
and ruling of the Department of Buildings, and hereby declares that an the facts
and representations stated in this application are true and correct.
Fridley,, Minn- QX)j4A o o`?dff
Owner _��/ C
v
Kind of Building -_—_
Used as
To be completed about _—__ ��✓ /S
Estimated Cost,
Old—New. Building Permit No. Permit No. c J
/ ` `d""vL DEB TION OF WORK
(d�imam, %t Water, Warm Air—No
Trade Name A.4 4e",j�" Ne ,45'6 -74: .2—
(/
Capacity Sq. Ft E.D.R ®O ® BTU M.P.
Total Connected Load Kind of Fuel
BURNER — Trade Name Size No
Capacity Sq. Ft E.D.R BTU Hip.
1 �, S U (REMARKS—OVER)
SUBJECT
PERMIT NO.
City of Fridley
Xf 12286
AT THE TOP OF THE TWINS
I� 1 i� P C D A A I T
D f I IL DING
i
Dv 'vv C'\'vt I
�
COMMUNITY DEVELOPMENT DIV.
INSPECTION
PROTECTIVE SEC.
I . �
Ii "1 CITY HALL FRIDLEY 55432
�'�"�
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
8191 /'7Q
JOB ADDRESS
273 Rice Creek Blvd.
1 LEGAL
LOT N0.'
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
17
3
SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
James Cass 273 Rice Creek Boulevard
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Milton L. Johnson Company 2513 Central Avenue N.E.
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 [-'K ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBEWORK Alterations to closet dorm.
9 CHANGE OF USE FROM TO
STIPULATIONS
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
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
$�F7O.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
.5O
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-
5.00
STRUCTION OR THE PR ORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
,e v a 1-'V
5.50
WHEN PROPERL VA (DATED-THIS IS YOUR PERMIT
SIGNATURE OF CO TR CTOR OR AUTHORIZED AGENT (DATE)
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
BLDG. INSP DAT
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
-00'' S �-2-ZL012�'r �� BUILDER . ��% /�/ e)z d 'j
ADDRESS �-C te KI V O ADDRESS • ,� / ��� .4
STREET:
LOT: / BLOCK: 3_ ADDITION:i
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
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: e 1" ;
Front: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: Estimated Cost: $ 76 -
To Be Completed: 16. Z �'
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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. I—,
i E t' '1.e PA
(See Reverse Side For Additional Information.)
0-6 Perot I.4 -C
SvleG
63-8D-416051 CITY OF FRIDLEY
APPLICATION FOR PWNBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: ATO.
RATE
TOTAL
Fixt:ares
x $3.00
$
c^1ture Fixture Opening
x $2.00
$
New Fixture, Old Opening
x $2.00
W
Catch Basin
Water
e
m
m
$
300,000 B.J to 199,000 BTU
x $10.00
10
54
to c
c -.1
11
W
u
New Ground aun Old Building
-oi
4J
,.�
i.
.4
w
x $5.00
$
Heater
G
..4
V4
C
c
x 4j
U
$4
4 C
E0
C
M
1.1
5 G
-a
y
G
C
N
. y
O
pUO
4j M
U!
N
N
.0
(A
W
U W
R. s
0
0
O
ds
leC
1 lst
2nd
ars
�
(R) = Future Connection Opening
Connected with Sewer
(*) = New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: ATO.
RATE
TOTAL
Fixt:ares
x $3.00
$
c^1ture Fixture Opening
x $2.00
$
New Fixture, Old Opening
x $2.00
$
Catch Basin
x $5.00
$
"later :eater - to 99,000 BTU
x $5.00
$
300,000 B.J to 199,000 BTU
x $10.00
$
Hater Softener
x $7.00
$
New Ground aun Old Building
x $5.00
$
Electric water Heater
x $5.00
$
GAS FITTING FEES:
1st 3 fixtures x $3.00 $
Additional Fixtures x $1.00 $
Cas Range to 199,000 BTU x $10.00 $
REPAIRS & ALTERATIONS
First $100.00 $5.00 $
each add. $100.00 or fraction $2.00 S
State Surcharge S .50
TOTAL FEE $ 8.00
REINSPECTION FEE
(510.00)
Job Address 273 Rice Creek Blvd..
Department of Buildings
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 roprosentations stated in this application arc true and ccrrect
Fridley, Mn._)� _� 19
OWNER CASS
KIND OF BUILDING frame
USED AS res.
TO BE COMPLETED ABOUT r 5-11-81
ESTIMATED COST 50.00
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
Company _ ��
AO
a�
Signed By 11AINI i:EGASC4
Tel. No.
ROUGH INSP.
Date
FINAL INSP. Jt - �� p
Date
APPROVAL FOR PEIUIIT
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SUR0MpGE
SUBJECT
P
City of Fridley
25574
AT THE TOP OF THE TWINS
BUILDING PE
MIT
r
`
RECEIPT NO.
_ COMMUNITY DEVELOPMENT DIV.
~ PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
10/7/97
JOB ADDRESS 273 Rice Creek Blvd NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
17
3
Rice Creek Plaza North Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Richard Gill 273 Rice Creek Blvd NE
571-5706
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.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION j3 REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside House & Garage (Vinyl)
9 CHANGE OF USE FROM TO
STIPULATIONS
Install building wrap and have inspection of same unless
manufacturers specifications state it is not required.
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 80 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 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
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
$2,000
$1.00
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-
$62.25
File SC $2.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FE
T AL FEE
If
$65.25
SIGNATURE OF CON TRACTOR OR AUTHO ZEDAGENT
HE
THIS IS YOUR PERMIT
`` ^(DATEI
1�' !'g7
�PROVALIYAJFD
•
BL INSP
' /®"r
MATE
SIGNATURE OF OWNER OF OWNER BUILDERI (DATEI
NEW [ J
Effective 1/1/97 ,
ADDN ( )
CITY OF FRIDLEY
1J
ALTER [ ]
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
50
Permit Fee
$
5
ConstructionAddress:
�2 ,_e d- ,e -e
$
Legal Description: 17,
Rl o -- .471 6_a4 bio kt7 Add
, tr O �„
Owner Name & Address: /f /� e- d G- ," Tel. # S 7/- S-2
a ro
Contractor:
MN LICENSE #
$
Address:
Tel. #
License Surcharge
$
Attach to this application, a Certificate of Survey of the
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
lot, with the proposed construction drawn on it to scale.
Alt. "A" or Alt. "B" Above
DESCRIPTION OF IMPROVEMENT
$
LIVING AREA:
Length Width Height Sq. Ft.
Park Fee
GARAGE AREA:
Length Width Height Sq. Ft.
Fee Determined by Engineering
DECK AREA:
Length Width Hgt/Ground Sq. Ft_
OTHER:
R $ t /l v U s L, -
Construction Type: t/ A r ^, ! Estimated Cost: $ 2,0o a
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft: + 6 Ft Ft it
DATE: ®- 7_?'2 APPLICANT: a Tel. # S" 7l - S' .7aWl
STIPULATIONS:
CITY USE ONLY
_
Permit Fee
$
5
Fee Schedule on Reverse Side
Fire Surcharge
$
616
.001 of Permit Valuation (1/10th%)
State Surcharge
$
�, G��'
$.50/$1,000 Valuation
SAC Charge
$
$950 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
$�
STIPULATIONS:
SUBJECT
..
City ®f Fridley
761776
AT THE TOP OF THE TWINS
BUILDING
PERMIT
i �
RECEIPT NO.
e a.
COMMUNITY DEVELOPMENT DIV.
l
PROTECTIVE INSPECTION SEC.
J
1 �
1
NUMBER
REV
DATE
PAGE OF
APPROVED BY
IL "'1 � CITY HALL FRIDLEY 55432
-""'A 612-571-3450
910-F15
6/9/98
JOB ADDRESS 273 Rice Creek Boulevard NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
17
3
Rice Creek Plaza North Addition SHEET
2 PROPERTYOWNER MAIL ADDRESS
ZIP PHONE
Richard Gill 273 Rice Creek Blvd NE
571-5706
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
B DESCRIBE WORK
Construct a 10' x 12' Shed in Rear Yard
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
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
$500
$.50
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALE
$ .00
, �SIGNATURE OF CONTRACTOR OOJjpi-��AUTHORIZED AGENT WATEI
ENS RO
SP
VALIDAT D I$ IS Y R
DATE
SIGN ATURE OF OWNER IIF OWNER BUILDERI IDA EI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 2Z 7 -q _ PNAL �, hj,,L ,
Legal Description:
Owner Name & Address:. Sc Tel. # J- 7
.tor: a-ve�l�vrn_ P/� MN LICENSE #
Address: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
GARAGE AREA: Length
DECK AREA: Length
OTHER: / ti %�
DESCRIPTION OF IMPROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Width Hgt/Ground Sq. Ft.
Construction Type:D, ,P,.,ru Estimated Cost: $ J'
Driveway Curb Cut Width Needed:
t ceueon ac
Ft. + 6 Ft = Ft x $ = $
DATE: �'J' - l APPLICANT:�,S W_ Tel. # 5 7�-574�6
CITY USE ONLY
Permit Fee $91,60 Fee Schedule on Reverse Side
Fire Surcharge $ 'ID .001 of Permit Valuation (1/10th%)
State Surcharge $ . w $.50/$1,000 Valuation
SAC Charge $ $1000 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 $ Z 2
STIPULATIONS:
< <�1 , \ •• ^,+~�� _..~ter,
a . . .
J �
G
l� • 1�
1y
•1
< <�1 , \ •• ^,+~�� _..~ter,
a . . .
01
SUBJECT
PE
City of Fridley
2 7073'
AT THE TOP OF THE TWINS
BUILDING
P MIT
f
RECEIPT NO.
_ COMMUNITY DEVELOPMENT DIV.
v
PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
8/10/98
JOB ADDRESS
273 Rice Creek Blvd
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
17
3
1 Rice Creek Plaza North Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Rich Gill
571-5706
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Tabor & Sons Inc 3716 St Francis-
20014248
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
❑ NEW ❑ ADDITION ❑ ALTERATION XX REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage 24 S Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
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
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2001.60
1.00
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.
$74.75
Fire SC $2.00
PLAN CHECK FEE
TOTAL EE
5
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
ALI ATE I$ IS V PE T
BLD SP
MP
GATE
S,GNATURE OF OWNER OF OWNER BUILDERI IDATEI r•
01
Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION d� O
;10
� DL
ConstructionAddress: -2-73 /�( C L s' % �3 I V ID
Legal Description:�-
Owner Name & Address:9!6A 6�7" d / o? 23 k cc C -ler' Tel. # 5 71 `-�ZP �
Contractor: S o ej S C MN LICENSE #
Address: E LC pt C" f'Y lS/cls 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:
����
2
`"l S4.
Park Fee
$
Fee Determined by Engineering
Construction Type:_
e
Agreement Necessary [ ] Not Necessary [ ]
Estimated Cost: $
. 0 d 6
(Fee Schedule. on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft =
Ft x $
_ $
DATE: �� �� `'
APPLICANT:
� �-�-
-
Tel. # 2 5C)
CITY USE ONLY
Permit Fee
$ '75 '-, Fee Schedule on Reverse Side
Fire Surcharge
$ C-) J
.001 of Permit Valuation (1/10th%) _
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$ S�, oto
$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 $
STIPULATIONS:
sueJEtr
PERMIT N.
City of Fridley
1279
AT THE TOP OF THE TWINS
BUILDING
PERMIT
i
COMMUNITY DEVELOPMENT DIV.
f PROTECTIVE INSPECTION SEC.
1 . ,
NUMBER
REV
DATE
PAGE OF
AvvR vE0 BY
I CITY HALL FRIDLEY 55432
L 612-571-3450
910-F/5
8/3/00
JOB ADDRESS 273 Rice Creek Blvd NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
0EscR.
17
3
Rice Creek Plaza North Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Richard/Mildred Gill 273 Rice Creek
Blvd NE 763-571-5706
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
0 NEW ADDITION O ALTERATION 0 REPAIR 0 MOVE O REMOVE
B DESCRIBE WORK
Construct a 20' x 161 Addition to Dwelling
9 CHANGE OF USE FROM .-._
TO
STIPULATIONS
See notations on plan. Provide smoke detectors in all sleeping rooms and on all
levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code.
SEPARATE PERMITS
rutilliity
all ll® atiolns®r
REQUIRED FOR:
454-0002
�LUM�ING� D�SIG�S
REQUIRE® LAW
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
S0. 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$20,326
$10.17
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHAR
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$335.25
Fire $20.34
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FTOTAL
F
I /$3
.76
SIGN4 TUR OF CONTRAC ROR AUT ijd'A NT IDATEI
/®
EN R�P7�E/YS r
GNATu RE
.��
OF OWNER,- OWNER BUILOERI [DAT i
pA1E
NEW [ J Effective 1/1/2000
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R- p
BUILDING PERMIT APPLICATIONsi�
Construction Address: (�
Legal Description:
Owner Name & Address:
Tel. # —16.3-- S 2/, -5 7 Did
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 0 Width /� Height Sq. Ft. ®
GARAGE AREA: Length Width Height Sq. Ft
DECK AREA: Length Width Hgt/Ground Sq. Ft
OTHER:
/'' — ZC (O
Construction Type: OOb r�y4M L Estimated Cost: $ / S-'=>6
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ Fee Schedule on Reverse Side
Fire Surcharge .001 of Permit Valuation (1/10th%)
State Surcharge $ 17 $.50/$1,000 Valuation
SAC Charge $_$1 100 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
�eC'
STIPULATIONS:�,,S
LandPlonnin9 a7S-Hr &Vy 1945 N.E.
Minneopo/s 2/,
la:d .Scv'�tCyrr>y:., Minhesofo
.�,isrstuy EN G I NEERI NG INC.
C7vil fi Mruircipal SUnset46066
En�tneer�nf
"ineers Surveyor,
e'ts�icate su,tYe-.�
1e�
2
q
,x
s
x`Clie ?o 1
r -
//rereby' ctrfi�y, flraf *6is a bw and carred repre;enfofwn ,rl sa^rey d1l�ft bow domes ell& 46air a(e aVkd /arrdl and
o�i% Iowtmn gl'a// brriklrn9s , lheieon , and ar/ risible mu�ochnrenfs , rF�,y, fvn. or w said land. As survegJ hy me flus �=' cbtf
9�
SUBURBAN ENGINEERING, INC.
En�rnears & Surveyors
\. 1 i
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work.
r7 Ate p (`P -C V l_ ._ ` U`.� [ t� e 4–
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Effective On January 1, 2000
JOB ADDRESS 3 RL e:!e d. l'e-e\rT 1311/9
OWNER
TOTAL
BUILDING USED AS yo r��•e—
$ l
ESTIMATED COST 3 S1 ' PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
$ Trade Name Size No.
BTU HP EDR
$ Fuel Total Connected Load
Burner Trade Name Size No.
$ BTU HP EDR
$ 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 an
$ .50 rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE /
HEATING CO
Signed TEL # –21 S 76C
ZVI
Approved By Rough -In Date Final Date //"&"eC'
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 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 Type and Size/Common Vent and Vent Connector Infonnation
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
; ' `
Back Page for Fee Schedule
BUILDING
$ 6 3, ,
Permit No.: X21
Inspections
RESIDENTIAL APPLICATION
(.0005) times the total job valuation — Minimum $-50
Received By:
763-572-36 ,>
;
License Surcharge
CITY OF FRIDLEY
$5.00 (State Licensed Residential Contractors)
Date Rec'd:
DATE �s— N—
$1450 per SAC Unit (Plans to MWCC for determination)
YOUR E-MAIL ADDRESS
$
SITE ADDRESS A
J_-0_ CE
afiE Fi< VP
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
THIS APPLICANT IS:
XOWNER
❑CONTRACTOR
$
PROPERTY OWNER/
NAME:
ADDRESS .2-
- CITY
TATEJ%ZIP.KCV3A
TENANT
PHONE:
CONTRACTO
—-
STATE LICENSE #
EXPIATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS:
CITY
STATE ZIP
WITH APPLICATION
PHONE
FAX
PROPERTY TYPE
D SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION
❑ GARAGE/SHED D WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
'DECK
❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW
❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
142')<
SIZE OF IMPROVEMENT
LENGTH WIDTH ®r�
HEIGHT _L9 2 V Sq. FtZ Jo
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
2•
Existing Floor Plan
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
WINDOWS
2.
Two sets of construction plans
rN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
3.
Energy -Calculations
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ O cno OCCUPANCY TYPE
Permit Fee
$ q % dqf5See
Back Page for Fee Schedule
Plan Review
$ 6 3, ,
65% of Building Permit Fee
Surcharge
$
(.0005) times the total job valuation — Minimum $-50
Fire Surcharge
$ 1
.001 x Permit Valuation (1/10%)
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $20 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$ �—
Agreement necessary ( ) Non Necessary ( )
Total Due
$
Make checks payable to: City of Fridley Attach Stipulations
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 d- of plans.
�j
SIGNATURE OF APPLICANT ;Z �/�/f`% PRINT NAME DATE
q-.� &mA i A&w �—
Building MECHANICAL Permit No.; 7
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY D&ACtJO U20
DATE_
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
YOUR E-MAIL ADDRESS
t"
COMPANY NAME:\ 8l H -C'1y ati Li
CONTACT PERSON: K9 4 w I L L. IAAASi
STATE LICENSE #♦♦'.p EXP DATE / �r�±
ADDRESS: .3;74&IJCE ST. CITY w1T N TATFi�/� EP7�II
PHONE
FAX
PERK UT TYPE ® JINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: ❑ NEW wfmPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK
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: (INDICATE TOTAL
NUMBER OF EACH BELOW)
Equipment Installed
MEG: GIr MODEL:
990 y=am—
SIZE/BTU —6OPoe
,
MFG: MODEL:
SSIZE/BTU-
MFG: MODEL:
SIZE/BTU
A A C $25.00
(GAS) $15.00
GAS RANGE/OVEN $10.00
AIR TO AIR EXCHANGEER $15
_FIREPLACE
FIREPLACE (WOOD) $35.00
NEW GAS GRILL $10.00
BOILER $35.00
,FURNACE $35.00
_GAS UNIT HTR $10.00
CH[MNEY LINER $10.00
DRYER $10.00
_POOL HEATER $35.00
DUCT WORK $10.00
_GAS
_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 $ Number of fixtures @ $25.00 / x $25.00 = $— OKA
Number of fixtures @ $35.00 j— 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 appli 'on 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 ork w res review and approval of plans. JA ��jw��..�4
SIGNATURE OF APPLICANT PRINT NAME u.L F, `' 1 , DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977