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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT o,4 s s 4 Date:" ........ ... _.__........... ....... �r+ _..._.._._........... _..._.. Owner: Builder .................. ...... ................ 4_...__._.._..._---.._ _._.....__ _ ....._.._.._.._.__._... Address.t .... Address ............. ...... ..._....0 .. .... _....................... _....... �p LO Ti. N OF BUILDING No. _.__ .�!=........ Street .....:y ..... _,r...._ .............. Part of Lot .......................... _.._... ----------- Lot ....... ............. Block ..... ........ ..... -...... -................. Addition or Sub -Division 'A .... .................:...4....: - �........._:.... Corner Lot .......---- .------- Inside Lot ....................................... Setback .......... Sideyard .. ..... ../V ........ _................. ....... SewerElevation ..... .............. _............_............._............................_............._........ Foundation Elevation .. ........................................................................... DESCRIPTION OF BUILDING To bm Used as rr 3 Front _.. Depth ... .. Height Sq. Ft. Cu. Ft, ........... Front Depth.. ",�.:.!1jdAe Height ...._.. Sq. Ft. ..� Cu. Ft...... *d r Tyle of Construction ......:.:. :.:........... .:..._. Est. Cos ...4- ........ _........ To be Completed ..... _............. .......... ............. 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 . the payment . of a fee of $ ...:............... permit is hereby granted to ....................... _._:_..:..__............. ... ........ ..:.. tb 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 violation"o any of the provisions of said ordinances. � Rlilding Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, r,pr , .0 r_ re to see the Building Inspector for separate permits for these items. ((.,R TW' c. - LAT - 0N 4 ON OF ' PRIVATE LAND COVENANTS AND BUILDINu RESTRICTIONS, - APPLICATION kOR,BUILDiNG PERMIT dITY OF FRIDLEY$ MIkMOTA Owners Name d' 44. i Builder Address _ 1// 7 - w&� Ste- b'-1 Address„✓„".,. 7?// Gfo LOCATION OF BUILDING J No. Street—el c L i - r r' 4 e o-- Part of Lot Lot f Block ®-VF Addition or Sub -Div. leawrrase� f Corner Lot,__Inside Lot Set Back ,Side -Yard SEWER ELEVATION : FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DtSdRtPTION OF B U ILDING r To be sed as 3 4S %� ®cam fYgn-��. �A Ff e. ' �'�` ,Cm- Front�Depth_ Sq& Ft. 11-7 Cu. Ft. Front 22- Depth : g— 11.ight Sq. Ft. Cu. Ft. Type of Construction ar m e- Estimated Cost9 s To be 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 co a t. DATE. /�! � � - _--_--__ - SIGNATURE /�— (A Schedule of Fee costs can be found on theAeverse Side.) City of Fridley Application for Plumbing and Gas Fitting Permit DESCRIPTION OF WORK Number, Kind and Location of Fixtures C NO. RATE TOTA� Number Fixtures ...................... x $1.50 Zz R��Z �a QpZ iTjZ O x 1.00 (9 Z. Z �a F ` N WATER HTR. GAS ELEC. New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL oLL Z x $1.50 �'o cpm <3 t�°d C�4a coo $ Base 1st 2nd _ 3rd _ 4th • Future Connection Openings Connected with Sewer New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTA� Number Fixtures ...................... x $1.50 $--*,O _6 Q Future Fixture Opening ........ x 1.20 $ -"k)' *c New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ......o x 2.00 $ ` New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL lst 3 Fixtures .......................... Z x $1.50 Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $ Z DepL of Bldgs. Pho" 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. Owni Kind Used To b, Estimated Cost, $ / . Old—New. Building Permit ROUGH FINAL j L ti m oo .QJW42 2M 7-59 Business Phone �I I APPLICATION FOR HEATING OR POWER PLANT AND SPECIAL DEVICE PERMIT PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ......................... 8.00 $ Replacement of Furnace ............................. 4.00 $ Repairs & Alterations—up to $500.00 ................. 4.00 $ Repairs & Alterations each add. $500.00 ............... 2.00 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ........... 8.00 $ ✓ each add. 60,000 BTU ........................ 1.00 $ Replacement of Furnace ............................ 4.00 $ Repairs & Alterations—up to $500.00 ................. 4.00 $ Repairs & Alterations each add. $500.00 2.00 $ 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. IDR Steam ...................... 2.00 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.00 $ OIL BURNER to 3 gal. per hour ........................ 4.00 $ over 3 gal. per hours—See Fee Schedule GAS BURNER. ................................ 4.00 $ GAS PIPING (Up to 5 Fixtures) .......................... 1.25 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM REMARKS: See Fee Schedule $ J`a TOTAL FEE $. Z g2rfl le- tt�� " Dept. of Bldgs. Phone JU. 8-4614 0/— Village / Village ofe The undersigned here y makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the Village 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. Brno Center, Minn �!'� /� 191 Owner V195— Kind of B ' ding�195- 61 ® . Used as To be completed about" Estimated Cost,®� a Old New. uilding Permit No. z DESCRIPTION OF WORK HEATING or P WER PLANTS—Steam, Hot Water, Warm Air—No Trade Nam Size No Capacity Sq. Ft. E.D R �� BTU H. P. Total Connected Load �Y , . (0 J Zo Kind of Fu • G o BURNER — Trade Name Size No Capacity Sq. Ft. EM.R BTU H. P. FfAY N. WELTER HEATING CC: Sign A 627 GI 1IGAGG AMS. By MINNEAPOLIS 7. MINNESOTA 1 1 3M-3-59 Business Phone NO - s S— City of Fridley, NHnn. BURDING PERMIT N® 7463 Owner: Fred Sherr Builder 0• Ro Anderber Cg�C. Address 701 Rice Creek Terrace Address 2 2 Odd Avenue LOCATION OF BUILDING No. 701 Street Rice Creek Terrace Part of Lot Lot —1___ Block l Addition or Sub -Division . Brook�e�r Terrace 3rd.-CWT'M — Corner Lot Inside Lot __ _ Setback --- Sideyard _. Sewer Elevation To be Used as: Foundation Elevation DESCRIPTION OF BUILDING Front — Depth Height Sq. Ft Cu. Ft Front Depth Height Sq. Ft. Cu. Ft Type of Construction Fast Cost _ L.O?0__ To be Completed Replace storm damage In consideration of the issuance to me of a permit to e the proposed work in accordance with the description above ordinances of the city of Fridley. �- ng described above, I agree to do compliance with all provisions of In consideration of the payment of a fee of $ M Q ? ., permit is hereby tom AA!IZR@Pg 920 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, construclaton, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances Building Inspector NOTICE: We penot does not cover the construcHoe, instaMon for wirke, pluwbinp, em heating, sewer or gator. Be wre to me the SWUh a inspector for separate permits for them item. r .. APPLICATION FOR B ING PERMIT CITY OF FRIDLE,Ib NNESQTA OWNER'S NAME _ BUILDER ADDRESS , /� ,del iAexi/zl "- ADD SS LOCATION OF BUMDING No. Street $art of -Lot>, Lot Block _ Addit.ioze or SubdIvistion Corner Lot Inside Lot . _Setback Side -Yard - SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to.this form, Two Certificates of Survey of Lot and proposed build-* ing location drivn ort these.(:ertificates. DESCRIPTION OF BtMDING To be used as: `roxtC Depth Leight Sq. Ft. Cu,,. Ft. Front Depth Height Sze. Ft. Cu. Ft. Type of Construction Estimated Cos_��, . _ o -.be, _completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to coo all work iri strict accordance with the City of Fridley Ordinances and rulings Of the Department' of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. . DATE _Ochedule.of Fee Costs can be found on the Reverse Side). Oemera! G'wractar$ 2923 OAKLAND AVE., MINNEAPOLIS, MINN. 55407 TAYLOR 4-2605 May 11, 1965 PERMIT APPLICATION Job Address: 701 Rice Creek Terrace Property Ower: Fred Shaw Description: Replace damaged roof structure, garage and any other damaged structural material. Estimated Cost: $7,000.00 Original PERMIT for Power lasts and Heating, Cool= ing, Ventilation, Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of Heating Plants to be installed--altered—repaired Make , Size a--14 4-0-6 ; Oil fired—, Coal fired ; Gas fired_; Gas Authorization No. Remarks Approved Final Inspection 19_ Inspector Y-7? Permit N° - 4538 Fee $ %0' Office of the Inspector of Buildings City of Fridley City of Fridley, Minn. , 19 Owner Location Kind of Buildi How Occupied Work to be Commenced—, 19— To be Completed 29'- / 6 ,19 � ? Estimated Cost, $ 66-C • tW Old -New, Building Permit No. Permission is hereby granted to 'c v to install—erect—use the material and devices described in the above statement. This permit is granted upon the express condition thatAe person to whom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein na d, and to the specific ns set forth in the approved application for this permit on file in the office, of the Inspector of Buildings. Inspector of Buildings 34 Crff OF FRICLEs 1. APPLICANT: RECEIPT # Name 7 e /'. � ®� �� °r,�� HATE Address Telephone Number 2. PROPERTY OWNER(S): Street Address City, State Office Phone Zip Code Bane Phone FEE $ Street Address City, State Zip Code Office Phone 3. LEGAL DESCRIPTP7N OF PROPERTY TO BE ALTERED: Lot Block Tract Home Phone City State -- Zip Code 4. DESCRIPTION OF LAND ALTERATION OPERATION Cy -� S. PURPOSE OF LAND ALTERATION: 6. VALUE OF WORK TO BE PERFORM: S )10 d , 00 7. SOURCE AND OOKFOSITION OF FILL: Xy/%2 ...��•�. �� Y •� r 9. ATTACHMENTS (Information Needed to Properly Evaluate Application): 7he following plans, drawings, calculations, bonds and/or statements will be required by the Public Works Department. _ Half section map or sketch of property showing all adjacent property indicating the exisiting buildings and/or structures. —Grading plan showing exisiting and proposed finished contours and evaluations. Drainage plan showing exisiting and proposed drainage structures, stabilization walls, retaining walls, cribbing, dams, or other protective items. _ Calculations for and approximate quantities of excavation and/or fill required. _ Signed statement from the property owner accepting responsibilty for the operation and granting permission for land alteration/mining operation. _ Statement to be attached to deed advising of potential need for soil tests prior to any construction on lots where additional fill material has been placed. _ Rice Creek Watershed District Approval (If Applicable) _ Soil Borings (if required) _ Other 10. UT MATIONS - READ BEFORE SIGNIIN3 APPLICATIM: a. A surety bond or oeritified check in the amount of $ (5% of value of work to be completed) must be submitted after approval of application and prior to any work commencing. This bond or check is to ensure satisfactory performance and compliance with the below stated stipulations. 7he surety bond or check shall be kept active until the completion of work and/or expiration of permit and can only be released by written notification of the City after a satisfactory final inspection has been performed by City forces. b. A11 access and street frontage of the land alteration site must be controlled by a fence, a minimum of four (4) feet in height. All entrances must have gates that are capable of being locked. c. Only rock, sand, gravel, dirt, or similar natural earth fill is permitted. No concrete, asphalt, or demolition wastes will be permitted as fill unl= a demolition landf ill permit is f irst obtained from Areola Cmznty. d. Operations shall be limited to daylight hours and shall not interfere with the health and safety of surrounding residents and the premises shall be maintained at all times so as not to create a nuisance. e. Any explosives used must be done so in accordance with Chapter 212.3, paragraphs d, e, f, g, of the Fridley City Code and any other applicable standard e.g. Federal, State, Industrial, etc. f. At the end of each season's operations and no later than the last clay of December each year, the site is to be left in a neat and orderly condition, with maximum slopes of 2:1 with no overhang or vertical banks and with a level bottom. g. On the Friday of each work week, or when required by the City, material from this operation that is found to exist on City streets shall be cleaned to the City's satisfaction by the applicant. h. Upon oonpletion of land alteration operations, the land must be left according to the plans and contours submitted with this application and planted with suitable vegetation to prevent erosion. i. Upon completion of land alteration operations or expiration of this permit, an inspection by the City will be made of the premises and adjoining streets. Any damage found to have been caused by these operations will be corrected by the applicant upon notification by the City. Applicant's Signature Property Owner's Sign Recommended For Approval By: Date: APPROVED By: Date: PERMIT EXPIRATION DATE: CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT '* u H RATE SCHEDULE PLUMBING FIXTURE RATES: NO. New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer RATE $ 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 TOTAL Back Flow Preventer Required. . . Yes ( ) No ( ) Type $ 5.00 S ALL OT11V,3S AND/OR REPAIRS AND ALTERATIONS 1e of Value of Fixture or Appliance $ State Surcharge $ .50 Reinspection Fie $ ($15.00) TOTAL FEE $ ttfective Udte May I, 1988 Job Address 701 NE Rice Creek Terr 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 representations stated in this application are true and correct Fridley, Mn. 4 Dec 89 , 19 OWNER Debra L Kahmann #571-9307 KIND OF BUILDING Frame USED AS RPS TO BE COMPLETED ABOUT 4 Dec 89 ESTIMATED COST 300, OLD BUILDING PERMIT PERMIT No. l Q�� Signed By Tel. No. Minnegesco #342-5337 ROUGH INSP. 700 W. Linden avenue Date p. 0. BOX 1155 Minneapolis, MN 55440-1165 FINAL INSP. � -13; _F® Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE Waterm 14 q Q .14 � Heatery p r0 iJ NN 0 D o B o Wv o� W 3 w° W w u oa ag 3 as lec RaSp 1st 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (*) - New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer RATE $ 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 TOTAL Back Flow Preventer Required. . . Yes ( ) No ( ) Type $ 5.00 S ALL OT11V,3S AND/OR REPAIRS AND ALTERATIONS 1e of Value of Fixture or Appliance $ State Surcharge $ .50 Reinspection Fie $ ($15.00) TOTAL FEE $ ttfective Udte May I, 1988 Job Address 701 NE Rice Creek Terr 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 representations stated in this application are true and correct Fridley, Mn. 4 Dec 89 , 19 OWNER Debra L Kahmann #571-9307 KIND OF BUILDING Frame USED AS RPS TO BE COMPLETED ABOUT 4 Dec 89 ESTIMATED COST 300, OLD BUILDING PERMIT PERMIT No. l Q�� Signed By Tel. No. Minnegesco #342-5337 ROUGH INSP. 700 W. Linden avenue Date p. 0. BOX 1155 Minneapolis, MN 55440-1165 FINAL INSP. � -13; _F® Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures- $ 5.00 m Future Fixtures $ 3.50 $ old opening, New Fixture $ 1.50 � Beer Dispenser $ a S Water $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ 41 p, w S Sump or Receiving Tank Heater 5.00 $ Water Treating Appliance $ 7.00 $ c $ 3 $ Gas Range c 10.00 o{ Gas Dryer 14 a 10.00 $ 10•00 Back Flow Preventer Required. . o ) roro� $ 5.00 $ g �u vdv11 M O lec vl U 5 P�0 00 W 3 G w y W Un 3 tW7/ £ C�7 s Q 1st 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (*) - 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 $ Beer Dispenser $ 4.00 S Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic'Valve $ 5.00 S Sump or Receiving Tank S 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer �_ $ 10.00 $ 10•00 Back Flow Preventer Required. . . Yes ( ) No ( ) Type $ 5.00 $ ALL OTHT:�?S AND/OR REPAIRS AND ALTERATIONS le of Value of Fixture or Appliance Reinspection Fee $ State Surcharge TOTAL FEE Eftective Date May I, 1986 Job Address ItC-i Q1� -C 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 representations stated in this application are true and correct Fridley, Mn. I �L , 19� OWNER {---'.'A Sh'iANN DEBRA KIND OF BUILDING_ 701 RICE CREEK TERRACE N.E. FR I DLE e' 9 NN 554.E USED AS H 571-9307 W TO BE COMPLETED ABOUT '� Lo 0 5P:4 ESTIMATED COST �J®. C t 1— OLD - NEW BUILDING PERMIT NO. PERMIT NO. 'E company 5 Signed By n or. Tel. No. 6&4,0133 827-4311 ROUGH INSP. Date FINAL INSP. -` Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 $ PLUS THE $.50 STATE SURCHARGE $ .50 r "11 SUBJECT PERMIT NO. City of Fridley 1 23730 AT THE TOP OF THE TWINS BUILDING PERMIT r R E Ck��. • COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 � � NUMBER REv DATE PAGE of APPROVED 8� CITY HALL FRIDLEY 55432 612-571-3450 910-F15 JOB ADDRESSi E, I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 15 1 BROOKVIEW TERRACE 3RD ADDITION SHEET 2 PROPER OWNER MAIL ADD ZIP PHONE 15 11mQVI - 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. �c 701 RICE CREEK TERRACE FRIDLEY MN 55432 574-1784 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 WX ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK ADDING THREE SEASON PORCH TO EXISTING DECK 9 CHANGE OF USE FROM TO STIPULATIONS SEE NOTATIONS ON PLANS 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 I 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 4,249.00 2.12 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- 99.75 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. FLIIRF- SC 4-21-5 PLAN CHECK FEE TOTALFEE 106.12 SIGTU14fOFCONTRACTOR0 AUTHORIZEDAGENT IDATEI WHEN PROPE YYALIDATED THIS IS YOUR P RMIT SIGNATURE OF OWNER,iF WNER BUILDER) IDATEI DG INSP BATE ...: .: :.. ..:. . ..... ..., .. ,.. _, ... ..... .... ........ .., ....., ..... .. ...v ........ ,.......c . v�iT:.i v>Q<)i)i)i>.•i.i•i)i.i•:!:):`i`i.QiTiTi)iWi?i•i•i.i?.?i.i>C•i.i?i?i!i?i)i?i+i`, i•i•i?.Tv:C?i`i?i?:.i?iTi).).!:ri:i.i!i!i?i?i2i: i?iijt)...... i..i. v .....?i. r NEW [ ] Effective 8/1/95 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2�Z Building Permit Application Construction Address: 701 LL -e- Legal Description: Owner Name & Address: ®. Tel. #� Contractor: "� eir L -W MN L CENSE # Address. / / ` 9 Tel. # � I4I ` � S'7 Attach to this lication, a Certificate of Survey f the ?Z(-'- 12. 7 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�r „ Width: Hgt/Ground 2"(-" Sq. Ft. OTHER: Comer Lot [ ] Inside Lot (] Ft. Yd Setback Side Yard Setbacks _ Type of Construction: Estimated Cost: $� _ Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 t= F x $ _ $ DATE; 5 APPLICANT: Tel. # 7 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $850 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] Land Planning Land Strveyi y Soils Testmy OW Fr Mrmicipal £n9ineerir.q (4a&T6ulliL 6875-1liyhway Acs A(E., Minrn )mll/ 21, ENGINEERING, INC. "n1xs°' SUnset4-6066: Engineers E Sur vectors certificate of survey f°` JUS Il cIlmet- r! — ,T,w H 1 7 A 11 T-- Olot ibis is o %vie Md Wrftd,re see ti fof ian "0sw very Ox Lavndaries 'Vf 460re 06r'4AW ,kv d,aid yldm9s fhcieaen, ondaJ/ rti6/e ara»adima�fs,gr'a►�, or aysoid /and As sw-veyedme fhCs' d =;SUBLlRBANfNG1NEERlNG; /NC —CMM rpf afi Ef1(�l!!@Cl'Saf .sN'!"Ql'3 $7r�7 .r• Af—x, a /.e .�� _a. naa�,d h 1 � 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 t ide 41111 C:: ping (Needed with new furnac , but of replacement) Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Effective On January 1, 2000 r f JOB ADDRESS �C� 1 r C -e- C / P►'� 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. $ 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 HEATIN�CO �`�c ife 45 Signed Approved Rough -In Date TEL # (� -��-�d Final Date OWNER Rate TOTAL BUILDING USED AS $ 30.00 $ ESTIMATED COST PERMIT NO. - O.$10.00 $10.00 $' DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ 10.00 $ Trade Name Size No. BTU HP EDR $ 25.00 $ Fuel Total Connected Load Burner Trade Name Size No. $,52&., BTU HP EDR 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. $ 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 HEATIN�CO �`�c ife 45 Signed Approved Rough -In Date TEL # (� -��-�d Final Date 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 anal 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 to HEATING CO: ra 4- I cJ <L, '"— Signed By: Date: —32 ^ ��—� susiEdT IT NO. City of Fridley 30921 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. � r.y ___�__ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. �� r PROTECTIVE 1 = ®---1 CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 5/8/00 JOB ADDRESS 701 Rice Creek Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 15 1 Brookview Terrace 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kevin Kahmann 701 Rice Creek Terrace NE 574-1784 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 0 ADDITION 0 ALTERATION Ox REPAIR 0 MOVE 0 REMOVE 8 DESCRIBE WORK Replace patio door 9 CHANGE OF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE REOUIRED 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 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 $500 $ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON. 23.50 Fire SC $ STRUCTION OR THE PERFORMANCE OF CONSTRUCTION .50 PLAN CHECK FEE TOTAL FEE $ 4.50 NAT RE OF CON'aACT uiH iZED AGENT iDATE, E PROP VALID,4T§6 THIS IS Y UR P RM IT e) c J�GNATURE BL G iNSo a r s gAtE OF O dF OWNER BU4 DE Ri iDATEo NEW [ ] Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: 7o C P- ► G F G ",j- K TC-°-AA6 F - Legal Description: f - f -Pete V- PA -r(0 c(?o® �, Owner Name & Address: ir— Eyt Ni eA- 0RA oN °j Tel. # [p 57 1 Z J� 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 Width Height Sq. Ft DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: e- E P Z -A/- F— P X47 10 PCS O t-- ® m Construction Type: Estimated Cost: $ J/ too • r Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ --=$ DATE: 1`'� �' t ( APPLICANT: -K£ V f AJ Tel. # CITY USE ONLY - Call (76�3y) 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 $ $.50/$1,000 Valuation SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee $1100 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: - . � W SUBJECT RMI City of Fridley 31581 AT THE TOP OF THE TWINS P•'790N B U I L D I N G P E R M I T RECEIPT NO. COMMUNITY DEVELOPMENT DIV. fr __�_�_ r PROTECTIVE INSPECTION SEC. I , = CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 11/30/00 JOB ADDRESS 701 Rice Creek Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 1 Brookview Terrace 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kevin Kahmann 701 Rice Creek Terrace NE 574-1784 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] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace 7 windows within existing openings 9 CHANGE OF USE FROM TO STIPULATIONS 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 ARE REOUIRED 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 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 $2,840 $1.42 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 E TOT FEE 87.51 Si CONTR ORAUTH DAGENT IDATEt H PRO VALID 5a TE THIS IS Yy PERT a gAtE S-GNATURE OF OWNER OF OWNER BU4DERi iDATEi NEW I l Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION , Construction Address:0 / ✓`�ic'� �'r� p j`Ls�l2 y Legal Description: J� Owner Name & Address: /� ei ze ,k/zz � Tel. # S' 7 Contractor. S�/✓/� MN LICENSE # Address: Tel. # LIVING AREA: GARAGE AREA: DECK AREA: 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 Hgt/Ground Sq. Ft. OTHER: Construction Type: �,i^AoW 5 fiitiIe l S/stimated Cost: $ 9Ble cly Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: APPLICANT: Tel. # CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ s Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ < <�a $.50/$1,000 Valuation SAC Charge $ $1100 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 $ a ! 15- STIPULATIONS: Building Inspections 7.63-572-3604 DATE _ Imo! SITE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK: MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS C,eLu \ePceiCe_ E3 OWNER ACONTRACTOR PHONE:—"I lP3 ` �—✓' `� o I v NY NAME: NORTHERN HEATING & AIR CONTACT PERSON: STATE PHONE INGLE FAMILY O TWO FAMILY O NEW PREPLACEMENT DETAILED DESCRIPTION OF WORK EXP DATE Permit No.. Received By: FAX 0 TOWNHOUSE ❑ ALTERATION/REMODEL Date Rec'd: -7 ATk:f _3ZIPL�3_v? 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) MODEL: PE&L<kW SIZEBTU Equipment Installed MFG: MODEL: SIZEBTU MFG: SIZEBTU MFG. MODEL: GAS RANGEIOVEN $10.00 A/C $25.00 _FIREPLACE (GAS) $15.00 NEW GAS GRILL $10.00 _AIR TOILER EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 GAS UNIT HTR $10.00 BOILER $35.00 _FURNACE $35.00 POOL HEATER $35.00 _CHIMNEY LINER $10.00 _,GAS DRYER $10.00 VENTILATOR $15.00 DUCT WORK $10.00 GAS PIPING $10.00 se M -- - �, C•:� ° " ��tFiv�3*�Lte aur:.: :Auras .� . _ Number of fixtures @ $10.00 x $10.00 = Permit Fee $ Number of fixtures @ $15.00 x $15.00 = $ Surcharge $ .50 TOTAL DUE $ Number of fixtures @ $25.00 0 x $25.00 = $ 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 and with the Minnesota Construction Codes; that I understand this is conformance with the ordinances and codes of the City of Fridley 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 wor . ich ares review and approval of p DATE 1� 14 SIGNATURE OF APPLICANT — - PRINT NAME City of Fridley Building Inspections Department . 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building Inspections 7.63-572-3604 DATE l_z_J �, SITE ADDRESS _ THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION MECHANICAL RESIDENTIAL APPLICATION 4, CITY OF FRIDLEY 0 OWNER COMPANY NAME:_ CONTACT PERSON: STATE LICENSE #_ PHONE YOUR E- L ADDRESS V T, , r eel PCONTRACTOR z PERNIIT TYPE ANGLE FAMILY ❑ TWO FAMILY TYPE OF WORK: b NEW 19LACEMENT DETAILED DESCRIPTION OF WORK EXP DATE Permit No.. Received By: Date Recd: o�-6* 13 TOWNHOUSE 0 ALTERATION/REMODEL A4A)—zT PERMS 16B.665 the permit feels replacement of r inimum sidential fixture xclluding the fixturee total cost up s $(This should reflect only thegreater, cost of labor ) improvement, installation or rep 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. (I DICATE TOTAL NUMBER OF EACH BELOW) MODEL: ' SIZEBTU — Equipment Installed MFG SIZEBTU MFG: MODEL: ZEIBTU MFG: MODEL: SIEIOVE _FIREPLACE (GAS) $15.00 GAS RANG RILL $ 0.0.00 —AIC $25.00 FIREPLACE (WOOD) $35.00 NEW GAS GRILL 0.0 00 AIR TO AIR EXCHANGEER $15 FURNACE $35.00 GAS UNIT HTR $10.00 BOILER $35.00 GAS DRYER 5.0.00 POOL HEATER $35.00 _CHIMNEY LINER $10.00 VENTII,ATOR $15.00 DUCT WORK $10.00 _GAS PIPING $10.00 w x a L� ll�SliJ!�XYi�,k a, in•Wil.Arts"eUM*.ys.�v�s.3?.arza:.w xi _ offixtiires $10 op x 10. 0 Surcharge $ .50 Number of fixtures SSa $13:00 --_ x _ TOTAL DUE $ Number of fixtures @ $25.00 x $25.00 = $ 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 applica '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 a Por w 7 r uires review and approval of pl s. 11 1ild' SIGNATURE OF APPLIC PRINT NAME DATE J�� City of Fridley Building Inspections Department . 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building PLUMBING Permit No.. Inspections RESIDENTIAL APPLICATION Received .B ' 763-572-3604 CITY OF FRIDLEY 2010 DATE i J 0 YOUR &MAIL. ADDRESS SITE ADDRESS ?fa L Rick-, CM C 7ro .t'_ C e-. iQ � THIS APPLICANT IS: 0 OWNER MCINTRACTOR PROPERTY NAME: e,p- a' Gtr 2e- ADDRESS: 70l 11rCJZ C� 0921ZI� I CITY 2 STATI3 ` `ZIP Ss�a OWNMTENANT PHONE: 1(03-151(0-1�O( �� 7(��_�(�-? 9-9 9"A&e( CONTRACTOR NAME: " I C . C STATE LICENSE # -L2 (,2 AgA�-r EXP DATE / 3i /0 5,23 i� Avg �(� AA SS� SUBMIT A COPY OF YOUR STATE ADDRESS: ;{7 CITY,^y Li,� � STATE LICENSE WITH PHONE .'(P-3- 511- ®t{Sq FAX -74p3^ APPLICATION PERMIT TYPE •SINGLE FAMILY O TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 0 NEW kREPLACEMENT DETAILED DESCRIPTION OF WORK lai C.e _ 4 Q&(101 St&.ti k LJ &- 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 14U'0° -.05= `zq - td 0 FOR PR03ECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) _ BATH SIN)C/LAV FLOOR DRAINS —SHOWER _ WATER PIPING —BATHTUB _ GAS PIPING owED crrrtrcmm) _ SWIM IING POOL _ WATER SOFTNER ($35) — CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ BACKFLOW PREY. ($15) _DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION — WATER METER _ OTHER PERART FEE. PROJECTS FOR TINDER $500 PERMIfi FM VORPPRUJECT'S filly, $500 ` 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 $ .2 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 Iwork which requires review and approval of plans. 4 V' 10 SIGNATURE OF APPLICANT PRINT NAME i L b DATE PLEASE Nt)TE: SEPARATIa P1aR1liTS AIKE MQ tJIREIi FOR BULDiTCr= ELECT RICAI~ ANDIANICAL WTJRK, City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977