PRE 2010 DOCSCity of Fridley, Alinn.
BUILDING PERMIT N° �z 1 4
Date:
Owner: BuilderOr
--
J'
x
Address _
...... .._. ._ ____�__..___... Address ...._._ ._._.._..._ ..�_...__._..._ ._._.._�....._..
f_1 LOCAYIF, N OF BUILDING
No. _ Street . L,.:,:. Partes Loi
Block Lition or Su -Division
Corner Lot ___ __ __ Inside Lot _'"_ Setback �_� _ Sideyard
Sewer Elevation _ _ _ _ _ _ __ _: _ __ Foundation Elevation
DESCRIPTION OF BUILDING
_ Front Depth a Height Sq. Ft. Cu. Ft./—'
Front JYL Depth IX
: Height Sq. Ft. .s6 Cu. Ft.let
J
Type of nsiruction " t Est. Cost - `-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.
t
r u°
In consideration of the payment of a fee of $ s _ __, 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 violation of any of the provisions of said
ordinances. 1117
" ,�� building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Besure to see
the Building Inspector for separate permits for these items.
4
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's
Name 'P -t,\ `lt Builder
A +?,�%ok t ,� Z ,r �
b'*,- e
Address
Address
%S-1 ' wtllSels'a
LOCATION OF BUILDING
No. t d �Street i�,� �-"�� �,� ,_Part of Trot
Lot Block Addition or Subdivision v W`
Corner Lot I V 1 inside Lot yerSetback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION.
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
To be used as:
4
DESCRIPTION OF BUILDING
6 nAnth CA
Sq. Ft. Cu. Ft.
aq. Ft.
Type of
To be Completed
ight
Gu. Ft.
ted Cost s 1j 0 —
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. - n
Q
(A Schedule of Fee Costs can be found on the Reverse Side.)
City of Fridley
Application for Plumbing and Gas Fitting Pern►itt
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
y
$
-
�
3.25
Z
=QQQ
�y
zp
3.25
jm�
�V"
rj6
�°
�z
z
�a
•
R
f, WATER FtTR.
N GAS ELEG
3Ci
Is��
;t
cu
LLo
a3
C7'd
G�
(70
Base
1st
2nd
_
3rd
4th
• Future Connection Openings
I
Connected with
Sewer �
* New Fixture, Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:RATE TOTAL
Number Fixtures ...................... 20,x $1.50 $ 9. �O'
Future Fixture Opening ................ x
New Fixture Old Opening .............. x
Catch Basin ...... .....................
x
Water Heater (Up to 200,000 BTU) ...... x
New Ground Run Old Bldg . ............ x
1.20
$
1.00
$
3.25
$
2.00
$
3.25
$
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... / x $1.50 $ 1,5'0
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code .
Description................................................$
TOTAL FEE $
Dept. of Bldgs. Phone �SyU 4-7470
. __ .:__ 0� Yl - 171�a
City of Fridley:
6U2"
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.
Fridley, cc���n2dinn
�
Owner / 'eelt %
Kind of Building
Used as
To be completed about
Estimated Cost, $ !f �j
016— ew Building Permit No cJ�` �` _ —Permit No.
J
ROUGH
FINAL
4 2 2M 7-59
I
Refrigeration and
Application for rawer Plants and HeaRti�tg. Caoling. Ventilation, er
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SII 4-7470
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 $ 8.00
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace 5.00 $
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 $ 5 • 00
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x $1.50 $_ ]_o 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 $ 14,50
REMARKS:
Locaialoa 108 Rivers Edge Way
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.
Fridley, Minn June 20, 1961 195—
Owner Mark Z Jones 195_
Kind of Building
ffie
Used as Dwelling
To be completed about August 1961
Estimated Cost,
195—
Building Permit No. Mew -192VI IWRI "
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water4Warm Air--No1 ,
Trade Name Delco size No DGH100B2
Capacity Sq. Ft. E.D.R loll BTU H.P.
Total Connected Load379370 Kind of Fuel Ga S
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
Sign
By
PERFECTION HEATING CO
11 POST 1M-12-58 Business f ;" AYLrSM 9 SA, 3252871
MINNEAPOLIS. 8 MjtjNESOTA
D,56 7 v / ® / I. -,5zl—
HEAT LOSS TIONS DEPARTMENT OF BUILDINGS
Weatherstrips A.S.H.V.E. Construction No.
Guide
Windows I Doors Reference Out. Wall IfJ
X-14—hir
Ceiling Roof Floor
Yes—No Yes—No 19_
FI 1 [.. t R....,.. I i e,.., , _ ul- t 1 11 9 FI I
Windows an
Doors—Crackage and Area
Height
No. of
Lineal ft. Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
pane
.J Z a
l0
1Q
G
2 r9
Z
2— 2_i v
Coef.
Btu
Glass
Infiltration
x'
f _
Net exp. vfall
/ 6
Z to
Int. wall
Glass
Coef. Btu
Ceiling
G
Int. wall
25 o
Exp. wall
Ceiling
2_ `,'4
Floor
U_?
Net exp. wall
4 0
o 6
g *
D
Int. wall
Ceiling
Floor
Z,.3
is
3
Total Btu. u '67-)
Required sq. ft. E.D.R. or sq. ins. W.A. jAader area
F1.1 F 1 P Room I Len � i Width / Height
Windows and Doors—Crackage and Area
Width
Height
No. of
Lineal ft. Area
No. ofpane_of
pane
lights
of crack sq. ft..
G
2 r9
Z
2— 2_i v
Glass
"a
Glass
/
x'
/003
Net exp. vfall
/ 6
Int. wall
Net exp. wall
Coef. Btu
Infiltration qz� Z l b
Glass T --Z, o v
Exp. wall
Net exp. wall i)
Int. wall
Ceiling
Floor
Total Btu. _
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
% F1 l / Rnnm 11-rnoth 4r W;,Ith J12146ht Cl
Windows and Doors—Crackage irnd Area
Coef.
-
Width HeightNo. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
z
Glass
Coef.
Btu
Infiltration
��
Z
Glass
"a
Glass
Exp. wall
x'
/003
Net exp. vfall
/ 6
Int. wall
Net exp. wall
Total Btu.
Ceiling
"ID
Int. wall
Floor !ir
7J
Total
sq. it. in.u.m. or sq. ins. w.A. t.eacer area l
k"
0
—II Kind
MINNEAPOLIS. MINN.
Insulation
How. Applied
W;at // f_014;.ht
..l r - - ---o--- -
Winel and Doors—Crackage and Area
Coef.
-
Width Height No. of Lineal ft. Area
N of pane of pane lights of crack sq. ft.
G 2 Z Z�
Glass
Coef.
Btu
Infiltration
Z
j o
l�
Glass
L�
x'
/003
Exp. wall
/ 6
Floor
`
Net exp. wall
Total Btu.
0
"ID
Int. wall
Ceiling
Floor
U_?
l
4 0
Total Btu. 0
Required sq. ft. E.D.R. or sq. ins. W.A. Lea er area
--7—M—I'l R O I Rnnm I L.enath Cr Width Heistht
Windows and Doors—Crackage a d Area
Coef.
Btu
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
2 Z�
Glass
Coef.
Btu
Infiltration
Net exp. wall
j o
N Z$
Glass
/0 00
Exp. wall
/ 6
Floor
`
Net exp. wall
Total Btu.
1® I
"ID
Int. wall
Ceiling
Floor
U_?
/S-,
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Length Width
Windows and Doors—Crackage d Area
Width Height No. of Lineal ft. Area
No. of pane of.pane lights of crack eq. ft.
Height
Coef.
Btu
Infiltration
el D
Glass
Exp. wall
Net exp. wall
j o
c�, v
Int, wall
Ceiling
Floor
`
o
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
R
SUBJECT
PER
'�7
City of Fridley
®12962
AT THE TOP OF THE TWINS
T I I D I N i� PERMIT
BUILDING
r
4.
D V L v
RECEIP NO.
• COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION
r SEC.
1 �
= CITY HALL FRIDLEY 55432
�•'�' ,'�
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
5/27/75
JOB ADDRESS
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
26
River Edge Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Fred C. Harvey 108 River Ede Way N.E.
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
7 CLASS OF WORK
❑ NEW EX ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
11 x 22 addition to a garage
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REQUIRED FOR WIRING,
HEATING, PLp,.MBING AND-.§I1GhtSm
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
frame
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
242
2,420
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.
$19800
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
.90
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 PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE/-ATOTAL
FEE
14
1 $5.90
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
HEN OP DATED THIS IS YOUR PERMIT
SIGNATURE OF.OWNER (IF OWNV BUILDER) (DATE)
ALDG. INSPk DATE
R
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S BUILDER: 2
ADDRESS :-ICI 0 e® Vers e cye, Ala i4 ADDRES S
NO:. IVO STREET: R i y e.-,�Vd Q e c9
LOT: BLOCK: I ADDITION:-ayex— AV,& e.
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and propose•.'.
building location drawn on -these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
eC. ront: Depth: *)'a Height: 9
A q -t'
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: A-rw-ow e- Estimated Cost: v
To Be Completed: E3 ®7 A
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE: _-�j -7 - 7� 7 SIGNATU2ion
•(See Reverse Side For Additional Info.)
Vx3
® o ou
/n j
�`it
SUBJECT
P.
City of Fridley
pp 3298_,
AT THE TOP OF THE TWINS
BUILDING
P E R M I
r
R NO.
� • _ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED By
612-571-3450
910-F15
4/20/95
JOB ADDRESS 108 River Edge Way NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
26
1
Rivers Edge Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Fred Harvey 108 River Edge Way NE
571-3961
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
B & B Roofing Inc 6760 Madison Street NE, Fridley
MN 55432 571-0248 9046
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 jJ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (20 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED 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 W ER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$.75
DO NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
P VISIO S OF ANY OTHE ATE OR LO AL LAW REGULATING CON-
S R CTI N OR THE PERFO NCE OF STRU TION
$35.00
Fire SC $1.50
PLAN CHECK FEE
TOTALFEE
License SC $5.00
$42.25
SIGNATURE OF 0 ACTOR ORAUTHORIZ AGENT DA )
WHEN PROPERL VALIDATED THIS IS YOUR PERMIT
BL G INSP
02%%IN, �e
b DATE
S,GNATURE OF OWNER OF OWNER BUILDER) IDATEI
NEW ( ] Effective 1/ 1/95
ADDN (] CITY OF FRIDLEY
ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress:
Legal Description:
Owner Name & Address: Tel. # —57/--&
Contractor: kpai`/4 C S MN LICENSE # a te
Address: &74.--o ,Z 0 1. yol S i Tel. # 5 7/ Q Z ��
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: Len Width Hgt/G"ro7 Sq. Ft.
OTHER: ✓L L40� /�/O U S� G
oZO 41� —Tl�w C ® /4':/ --
Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: .�? 1%0 y/15 -F --9L" ss' Estimated Cost: $
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: F + 6 Ft = Ft J $ _ $
DATE: APPLICANT: Tel. # —z) e�
TOTAL $ �°
STIPULATIONS:
CITY USE ONLY
Permit Fee
$
-
Fee Schedule on Reverse Side
Fire Surcharge
$
1 . S -e)
.001 of Permit Valuation (1/10th%)
State Surcharge
$
- ?S_
$.50/$1,000 Valuation
SAC Charge
$
$850 per SAC Unit
License Surcharge
$
5-06
$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:
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-3604 VAX: (763) 571-IZ57
ADDRESS
: 108 RIVERS EDGE WAY NE
PIN
: 153024430067
LEGAL DESC
: RIVER EDGE ADD
: LOT 26 BLOCK 1
PERMIT TYPE
: ELECTRICAL
PROPERTY TYPE
: RESIDENTIAL
CONSTRUCTION TYPE
: ADDITION/ALTERATION
PERMIT NO.: 2004-02221
DATE ISSUED: 12/01/2004
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE.
2;2 # 0-100 AMP CIRCUITS
APPLICANT
SCHOO ELECTRIC
4065 LANCASTER LN #2
PLYMOUTH, MN 55441 -
OWNER
HARVEY FRED C & BARBARA K
9156 ORIOLE LN SW
ALEXANDRIA, MN 56308
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg ]nsp Date
STATE SURCHARGE, ELEC FLAT
ELEC AMP SERVICE FEE
ELEC CIRCUIT FEE (0-100 AMPS)
TOTAL
PAID WITH CHECK # 12276
SEPARATE FERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
8
0.50
30.00
42.00
72.50
Building PLUMBING Permit No.:
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY
DATE /O Z S 7 YOUR E-MAIL ADDRESS
SITE ADDRESS aeg
THIS APPLICANT IS: 17 OWNER CONTRACTOR Brett Harvey
PROPERTY NAME: 108 River Edge Way Northeast
OWNER/ Fridley, MN 55432
ADDRESS: ATE ZIP
TENANT 7635713961
PHONE:
CONTRACTOR NAME:
SUBMIT A COPY OF STATE LICENSE # C% EXP DATE
ADDREss kr14crrY /s
YOUR STATE ,- m_STAT'EAs'J_Nlr
LICENSE WITH • PHONE — 6`0 FAX —
APPLICATION
PERMIT TYPE
SINGLE FAMILY 0 TWO FAMILY IS TOWNHOUSE
TYPE OF WORK:
0 NEW REPLACEMENT
DETAILED DESCRIPTION OF WORK &Ilftf
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. CMis.should_reflect only.the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 =
FOMROIECTS WHERE LABOR EXCEEIISiS00;7EES ARE BASED ON310.00 PER FIXTURE; EXCEPT VIRE NQTEiIH:FIICTiI1 Ss_ jiND1GATE TOTAL
NUMBER OF EACH BELOW)
BATH SINK/LAV DRAINS _ SHOWER _ WATER PIPING
_ _FLOOR
_ GAS PIPING (sm crjy ucrost) SWIMMING POOL _ WATER SOFTNER ($35)
—BATHTUB
CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ BACKFLOW PREY. ($15)
_
DISHWASHER =LAUNDRY TRAY •LWATER DATER ($35) FOR IRRIGATION
WATER METER OTHER
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 @ $35.00 --�- x $35.00 = $ 3S.0o
State Surcharge = $ 50
Total = $
THIS IS AN APPLICATION FOR A PERMrr 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 ann app ' ation 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 oLowhicquires review and approval of plans.
/SIGNATURE OF APPLIC "� PRINT NAME J /r/O/b /DYYi DATE 1,01-7f 147
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977