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PRE 2010 DOCSCity of Fridley, Minn.. BUILLDING PERMIT /(:4:915 Date:......._.`"`�.._......_._......__.._..... of Owner: ......... _.............__............ Builder Addres.....__..........._............ _...._. _..__._......_..._...._._._ Address LO ATION OF BUILDING No. ........ Street ... --._..L.__..._ ........................._......._.._ Part of Lot............................ _._. i Lot .....Z.'�................. Block .......... ....... Addition or Sub -Division' _.:...-: ...�. ......................... -• -- .. Corner Lot .---..._................._........ Inside Lot ...__. ....._............. Setback ... .._�......... Sideyard _ �...:�.�.--....�....... Sewer Elevation ............... ............ ....................... -....... _.... _............. _.................... ... Foundation Elevation DESCRIPTION OF BUILDING To Used a _... ..... Front 7..'°.._.. Depth :., _.. Heights-:.. Sq. Ft.`'.,. Cu. Ftd-„s.... r s ........ Fron .�'x�.._.. Depth ....��' _-> Height ._.r�"�?........ Sq. Ft.....! Cu. Ft........... Type Construction 7—' -A � $ ........ Est. C. jf� .......... "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 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, re and moving of buildings within the city limits and this permit may be revoked at any time upo violation of y of the provisions of said ordinances. , 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 FRIDIEY, MINNESOTA Omer s Name L i�AJ Builder ��` LOCATION OF BUILDING No. Street Li.e eiz 16 `- 9-0 n—ZL-Part of Lot Lot Block Addition or Subdivision -e— Carn Lot Inside Lot Setback / Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Appli t attach to this form Certificate of Survey of Lot and proposed building loca.t on. DESCRIPTION OF BUILDING To be used 'as : d , FrontDepth Height � Sq. Ft. Cu. Ft. Front ?.�/ Depth Height Sq. Ft. Cu. Ft. Type of Construction,__, r,- c Estimated Cost To b Completed °� The dersigned hereby makes application for a permit for the work herein specified, agre ing to do all work in strict accordance with the City Ordinances and ruling of the epartment of Buildings, and hereby declares that all the facts and representations stat d in this application are true and correct. <f`. J1 DATE � u° ; SIGNATUA� (A 4hedule of Fee Costs can be found on the ReverseSide.) Application for Power Plants Air Cc PARTIAL RATE SCHEDULE 91 Heating, Coding. Ventilation, .Reirigm a ion and ening Systems and Devices 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 $ NECK. WARM AIR / Furnace Shell & Duct Work to 120,000 BTU .......... 8.00 $ ✓ each add. 60,000 BTU ................ I ....... 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 $ W____ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ 'f Additional Fixtures ...... :.......... x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL $ See Fee Schedule TOTAL F$E $ Dept. of Bldgs. Phone SU. 4-7470 Location (/ C 4. t -e., 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. rriSuw' Minn 194,1 Owner Kind of Bu 14� g tl n A Used as K'"t To be completed about Estimated Cost, $ Old ew.�Puilding Permit No. ��a� Permit No. -12 DESCRIPTION OF WORK HEATING or PO R PLANTS -,Steam, Hot Wa •,=WarmAhr-7No Trade Name- Size No Capacity Sq. Ft. E.D.R %`�� BTU / H.P. Total Connected Load �4 6 ' 6 Kind of FuL BURNER — Trade Name Size No Capacity. (REMARKS—OVER) %az 2M 7-59 Sq. Ft. E.D.R BTU H.P. Signed RAY �q,� L T E r. l P. 9 /6 T' 1 ill P� C r'�T sTG7T6"TT-rcr By 4637 CHICAGO AVE. M(NNEAP LIS 7, MiNNESOTA Business Phone No- �_\ C- _/' Aeg f? City of Fridley Appiication for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone SII 4-9 DESCRIPTION OF WORK Number, Kind and Location of Fixtures �" NO. RATE •. Number Fixtures ...................... Li $//Ste,—/ x} Zz ha rcz $� iT3z lg Ox a3 J �U °d WU C�94a 0 z O F p N WATER MIR. GAS ELEG Base GAS FITTING FEES: NO. RATE TOTAL % .. x $1.50 .$ /'fid Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ % 1st 2nd 3rd 4th City of Fridley: The undersigned hereby .makes application for a permit for the work here! specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this applicatio_ are true an correct. Fridley,, Minn. , . 19 f Owner Kind of Building � I wnnnwaa Future Connection Openings wuu Sewer E�-- Used as New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE ��TO,T��A��L � Number Fixtures ...................... 7 x $1.50 $//Ste,—/ 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) ...... x 2.00 $ �2? • d New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ....................... .. x $1.50 .$ /'fid Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATION§ --Refer to Code Description ........................... TOTAL FEE $� To be completed about A Estimated Cost, $ Old—New. Building Permit No _Permit Sign `f By Business Phone No ROUGH FINAL d2 2M. PERMIT for Power Plants 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 Oil fired ; Coal fired ; Gas fired ; Gas Authorization • � m Remarks Approved Final Inspection 19_ Inspector '�_/ -�r'I/V Permit N° 4543 Fee Office of the Inspector of Buildings City of Fridley City of Fridley, Minn., _S Owner Location Kind of Building How Occupied Work to be Commenced—, 19 To be Completed Estimated Cost, $ �� Old -New, Building Permit No. Permission is hereby granted to -�V Ld o L-0 o to install--erect—use the material and devices described in the above statement. This permit is granted upon the express condition that the erson 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 qlJlp 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 named, and to the specifica set forth in the approved application for this permit on file in the office of the Inspector of Buildings. ° Inspector of Buildings 42 2M11 -"V 53-84-5915.51 Cify of Fridley Dept. of Bldge. Phone 380-345D DESCRIPTION OF WORK 710 Rice Creek Terr Number, Kind and Location of Fixtures Location— WATER cats` ® x 12 z� �8� <y` O3 �4J {qjC �gJ l �SY I WATER KM. k GAS ELEC. ny D Base I s t Ga e 1st 2nd 3rd 4th I wazwaa�.r w.a•• - — Future '� ��s � SAO! * New Fixture. Old wings spool ❑ PARTIAL RATE SCHEDULE PLUMMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ x $2.00 $ Future 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 .............. : $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures x $2.00 $ Additional Fixtures .................. x $ .75 $ Gas Range to 199.000 BTU... > ........ x $5.00 S Ges Dryer 1 5.00 REPAIRS & ALTERATIONS—Refer to Cede Description ........................................« ..... TOTAL FEE . 00 City of Fridley: The .undersigned hereby makes application for a permit for the- work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct Fridley, Minn 11-19-70 lg! Owner Russ Holm Kind of Building frame Used as res To be completed about 11-24-70 Estimated Cost, $ 10'00 Old—New. Building Permit No. o• IR By Business Phune No ROUGH 53-84-s-915.51 j My Base PLVM81mG nzTuRz MATES: NO. TOTAL Number Fixtures ................ x $2.00 ATE$ Future Fixture Opening .... o ...... x $1.50 a New Fixture Old ming .......... x $1.50 a Catch Basin .................... x $3.25 � Water Heater (Up to 99,000 BTU) .... x $3.00 S New Ground Run old Bldg......... x $3.25 S Electric Wates Heater .. . ........... a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st3Fixtures ••••• •••• •••• x$2..00 $ Ild4U41ona1 Fixturesx $$ .766 ; to .00 i0 B V • . o. s e . e .... Gas 119 x SS -00 g State Surcharge $ .50 REPAMS A AL TIO ter to Code Install Grill �on . ®, a ®.. .. ®".. , . ,....... .00 TarAL rM tip- 5.50 City of Fridley: The undersigned hereby makes application for a permit for the stork herei, specified, agreeing to do all stork in strict accordance with the Qty Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact' and representations stated in this application are true and correct Fridley, Mnn 4-18-73 IS. owner Herbert L. Egeness Jr. Kind of Building Prattle Used as Res. To be completed about 4-25-73 Estimated Cost, a ]0.00 Older Building P'ermit smittNNo• -5-9,21 Signe ByEGAM Business Phune No ROUGH FINAL SUBJECT MIT NO. City of Fridley 26742 AT THE TOP OF THE TWINS BUILDING PERMIT r ' , O COMMUNITY DEVELOPMENT DIV. ______ r � L PROTECTIVE INSPECTION SEC. NUMBER REV OATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 ' 612-571-3450 910415 7/22/98 JOB ADDRESS 710, Rice Creek Terrace 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED oescR. 14 4 Brookview Terrace 3rd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Irfan Khan Sandozi 571-0566 3 CONTRACTOR MAIL ADDRESS ZIP, PHONE LICENSE NO David Wiger 901 Rice Creek Terrace Fridley MN 55432572-8403 8392 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 M, REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof (20 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 I 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $-a37e% $1,668 .83 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- STRUCTI OR THE PERXORMANCE OF CONSTRUCTION. $54.00 Fire SC $1.67 PLAN CHECK FEE TOTALFEE �� 6.AOROR License SC 5.00 61.50 OFC AUTHORIZED AGENT [DA [ SIG ATUREON WHEN PROPERLY LIDAT D THIS IS YOUR PERMIT LO [NSP MATE SIGNATURE OF OWNER, IF OWNER BUILDER) IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2�` BUILDING PERMIT APPLICATION% ConstructionAddress: eleg Legal Description: Owner Name & Address: �1�/ tV 4%) 'S;k/ -_>l Tel. # Q'�_?/ Contractor: bPA V I D - W /a i,e MN LICENSE # e27,2 Address: d / el CE offirK 7�/?Ie, Tel. # S_7 ^ 9*d_? 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. F OTHER: �jOe F /(� 6' % T cS' G41cle-) Construction Type: Estimated Cost: $ C3,66e (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 7 APPLICANT: o fief %��(o' %� Tel. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control $ 5_0<-) Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: I CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 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 [ ] SUBJECT - 0 City of Fridley C"- 33498 AT THE TOP OF THE TWINS P B U I L D I N G P E R M I T � I � COMMUNITY DEVELOPMENT DIV. CEIO. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 1 NUMBER REV DATE PAGE OF APPROVED BY ----J%l 763-571-3450 910-F15 5/7/03 JOB ADDRESS 710 Rice Creek Terrace NE 1 LEGAL LOT NO. TRACT OR ADDITION SEE ATTACHED DESCR. 14 JBLOCK 4 1 Brookview Terrace 3rd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Chris & Harry Reynolds 710 ffi Rice Creek Terrace NE 763-572-3914 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Custom Home Remodeling Inc 4517 5 St NE, Columbia Heights, M 55421 20317269 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 763-574-9769 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 Reside house & garage; Replace 9 windows within existing openings 9 CHANGEOFUSEFROM TO STIPULATIONS Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive barrier be placed over exterior sheathing to protect the interior wall covering. Exceptions for this provision would be if sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in their application guidelines.. Call for inspection of wrap before covering or take pictures. Caulk and flash all exterior openings. 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. Caulk and flash all exterior openings. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO OWLG. 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 $ 17,500 $8.75 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- TTI $293.25 Fire SC $17.50 RUC NOR THE PERFORM CE OF CONSTRUCTION , PLAN CHECK FEE TOTALFEE v tr Licen SC $5.00 $324.50 $IGL N4TURE OF CON'RACTOR OR AU T MOR IZED AGENTIOATE, W N PROPERLY VALIDATED THIS IS Y UR P MIT 1AAj DG RS11 S-GNATURE OF OWNEROF OWNER BUILDER, (DATE, NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R4 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: l [ Q C.re-e- k Legal Description: _ Owner Name & Address: CJAP; � S 4- �rrt° �aA n ®� S Tel. # b� �2- St I y Contractor: (A S- o in Horn e e�/-nnle U hc, "CSC MN LICENSE # Address: L'4' I �c fUE CC1vryS10La_ s��1-t�' Tel.#Ili 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 Hgt/Ground Sq. Ft. .� 4 Zl Construction Type: J'�c�i ncl f W',A L-0 ceiWP-Lf Estimated Cost: $ o Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: / 7l c APPLICANT: l 1 &IavTel.# (QiZ- 211� Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ c 3 ,7S_ Fee Schedule on Reverse Side $ .001 of Permit Valuation (1/10th%) $ $.50/$1,000 Valuation $ $1275 per SAC Unit $ Q® $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 [ ] $ ,3'? ' o Building MECHANICAL Pernut No.: InspectionsRESIDENTIAL APPLICATION Received By: 763-572-3604nate CITY OF FR IDLEY : nA n DATE .r - YOUR E-MAIL ADDRESS . 7 SITE ADDRESS ( I6 Uggk TePPAcC . ,E, THIS APPLICANT IS: ❑ OWNER *ONTRACTPR PROPERTY NAME: & TOENNANT ADDRESS: SEE �jP N• CITY ° STATE M ZIP S 3 CONTRACTOR COMPANY NAME: Sharp Heating & A.C. SUBMIT A COPY OF CONTACT PERSON: Floyd Josw:Lck YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH ADDRESS: 7221 University Ave'. N. E. CITY Fridley sTATE IyINap 55432 APPLICATION PHONE 763-572-0459 FAX PERMIT TYPE 36INGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW REPLACEMENT ❑ ALTERATIONIREMODEL DETAILED DESCRIPTION OF WORK PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up 10 $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 $10.00 PER FIXTURE, EXCEPT NUMBER OF EACH BELOW) WHi3gB.NOTED. FD{TURES: (11QDICAT$ TOTAL p ,r Equipment Installed MFG: C�QQ��(i' MODEL:�Y CQ�O SIZE/BTU (% MFG: C utox MODEL: SIZEBTU MFG: MODEL; SIZE7BTU A/C $25.00 FIREPLACE (GAS) $15.00 _GAS RANGEJOVEN $10.00 _AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 _BOILER $35.00 ,:FURNACE $35.00 GAS UNIT iiTR$10.00 _CHIMNEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER $35.00 _DUCT WORK 510.00 GAS PTPINQ $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 - $ 0 Number of fixtures @ $35.00 j_ x $35.00 = $ 3s, 00 State Surcharge = $_____m5_0 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 ap lication 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 o all work wh ires review and approval of pl s. SIGNATURE OF APPLICANTPPRINT NAME DATE __j �df z