PRE 2010 DOCSDate: _ AUGUST 24, 1965
RODNEY BILLMAN
3 0.;L 7 2-
N® 8400
A.t
Builder RODNEY BILLMAN, INC.
Address Address 3 000 - 36th Avenue N. R.
Minneapolis 18, Minnesota
LOCATION OF BUILDING
No. 5174 Street ST. IMIER DRIVE Part of Lot
Lot 1 _ Block 4 Addition or Sub.Division _ INNSBRUCK, 5TH ADDITION
Corner Lot Inside Lot X setback 35 __._ Sideyard 25 & 31
Sewer Elevation ____970.8 V92MM Elevation 973.8
TOP OF FOOTING
To be Used as:
DWELLING
2 Stories
Front 41 Depth 26 Height Sq. FL 1,48
GARAGE Front 24 Depth 24 Height 10 Sq. Ft. 576
Type of Construction Frame Est, Cost _ 33 2 000.00 _ To be Completed
In consideration of the issuance to me of a permit to construct the building
the proposed work In accordance with the description above set,t*rth and in co
ordinances of the city of Fridley. (
Cu. Ft29.640
Cu. Ft. 5,760
described above I agree to do
mylian with a'11 ons of
prX
In consideration of the payment of a fee of $ 36.00 permit is hereby granted to RODNEY BILLMAN, INC.
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.
ALLEN G. JENSEN Building Inspedw
NOTICE:
This permh does not twor the construction, hataRation for Ydring, phombing, gas headne, sewer or water. Be sure to we
the Bntldbig inspector for separate peraft for these Dom
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME � is p 6 �_ BUILDER T `
4
ADDRESS ADDRESS
LOCATION OF BUILDING
NO, ySTREET_ � � �� ;� PART OF LOT
LOT
----L—BLOCK ADDITION -OR :SUBDIVISION
CORNER LOT INSIDE .LOT SETBACK 3.�SIDE YARD
SEWER ELEVATION_ �� ®� FWUNDAT ON ELA. '7
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;
c Front Depth Height Siall, �
Sq. Ft. %?�-tu. Ft. 0�'6
Front Depth `' Height -4-4
IF
Sq. Ft.Cu. Ft 00
Type of Construction -/Z rL Estimated Co 3 4 6
To be completed r As -
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.
.,
Ale—
DATE SIGNATURE
(Schedule of Fee.Costs can be found on Reverse Side),.
`:
�► t iU 1VA U vvx 'ns 1.5'
9
't . r J
Air ComMim1mg Syvema and.Davkss
GRATY'1'9' WARM AIR:
RATE ' oTiL ..
Furnace Shell & Duct Work ... ...
..... .. $10.00 $
Replacement of Furnace
6.00 $
Repairs & Alterations—up to $500.00
600 $
Repairs & Alterations each add. $500.00
300
HZCD . WA21 AM
Furnace Shell & Duct Work to 130,000 BTU
each add. 60,000 VM .. ......
RepLwement of Furnace
Repairs & Alterations—up to $500.00
Repairs & Alterations each add. $500.00
STEAM! or HOT WATER SYSTEM
ll t. of Bldva. Phom l -
City of Irridley:
The undersigned hereby makes application for a permit for the work Aero:
specified. agreeing to do all work in strict accordance with the City Ordi>nanee¢
and ruling of the Department of Buildings, and hereby declares that'all the fad
and representations stated in this application are true and correct.
Furnace Shell & Lines—to 400 sq. ft. FDR Steam $10.00 $.
Furnace Shell & lane --to 640 sq. ft. EDR Not Water 10.00 $.
Each add 200 sq. ft. EDR Steam
Each add. 320 sq. ft. EDR Hot Water 3.00 $
OIL BURNER—td 3 gaL per hour 6.001 $
over 3 gal. per hour—,See twee Schedule
GAS BURNER (up to M,000 BTU) 5.00 $
oar 199,000 See F@* 3ch odule
GAS FITTING FEES: NO RATE TOOTAL
1st 3 Fixtures xs 200 $
Additional Fixtures B .75
Gas Range Range to 1N,M 23 5.M S
State Surcharge®® .50
1309 Fee
TOTAL no 04
UFridley. Aggro ,"10f .
r a Furl / e— c 4��
To be completed about.
Estimated Cost; $
Old—)dew. Building Permit No. --- p®rmit No. d
MA:e�.v /
G or PO llSte1$ot Water, Warm Air—No
Trade Name 4__ Sfae No- -� ✓
Capacity--__ .— Sq. Ft. E.D.R BTU XP_
Total Connected Lmd Mind of Flua1
BURNER — Trade Name No
Capacity.
IAM—OVER)
®�
..$10.00
S/gyp�
3.W
$ Owner .
&00
8 Kind of
0.00
$
Used as
3.00
S
Furnace Shell & Lines—to 400 sq. ft. FDR Steam $10.00 $.
Furnace Shell & lane --to 640 sq. ft. EDR Not Water 10.00 $.
Each add 200 sq. ft. EDR Steam
Each add. 320 sq. ft. EDR Hot Water 3.00 $
OIL BURNER—td 3 gaL per hour 6.001 $
over 3 gal. per hour—,See twee Schedule
GAS BURNER (up to M,000 BTU) 5.00 $
oar 199,000 See F@* 3ch odule
GAS FITTING FEES: NO RATE TOOTAL
1st 3 Fixtures xs 200 $
Additional Fixtures B .75
Gas Range Range to 1N,M 23 5.M S
State Surcharge®® .50
1309 Fee
TOTAL no 04
UFridley. Aggro ,"10f .
r a Furl / e— c 4��
To be completed about.
Estimated Cost; $
Old—)dew. Building Permit No. --- p®rmit No. d
MA:e�.v /
G or PO llSte1$ot Water, Warm Air—No
Trade Name 4__ Sfae No- -� ✓
Capacity--__ .— Sq. Ft. E.D.R BTU XP_
Total Connected Lmd Mind of Flua1
BURNER — Trade Name No
Capacity.
IAM—OVER)
City of Fridley
SUBJECT
�y 140'7
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
' ,
t_
C�IPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE. INSPECTION SEC.
1 . ,
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-560-3450
910-F15
5/10/77
JOB ADDRESS 5174 St. Imier Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
4
Innsbruck 5th Addition
SHEET
2 PROPERTY OWNER MAILADDRESS
ZIP PHONE
Dr. Verne Fuglestad 5174 St. Imier Drive N.E.
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
L. Gudmunsen Construction Inc. 1054 - 93rd Avenue N.W. 786-1881
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
8 DESCRIBE WORK
Construct porch addition 16' x 16'
9 CHANGE QF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REQUIRED. FOR WIRINGs
� WARIONG
HEATING, PLUMBING AND SIGNS.
Before d199109 call local utilities
iELEP"E . ELECTRIC - W Etc.
REC_UIRED 'By LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Wood Frim
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
R-1
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 SAMETO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED.
$4, 700
$2.35
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-
$30.00
STRUCTIOtj OR THEYFRFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
/o
$32.35
SIGONTRACTORORAUTHORIZ GENT (DATE)
VALIDATED, THIS IS YOUR PERMIT
�PROPERLY
�WHEN
�-BLDG. INSP
- DATE
SI NATURE OF OWNER IIF OWNER BUILDER) 41D�TE� j
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER: D, BUILDER: ( ., e�l� e vtJSPvi✓
Address: . ,74 (u'r ��• Y�Jm �v Cir Address : lG,s y _ j' � �i� v e
Tel. No.: -
No. :
o.
No..
LOT:
Street:
BLOCK: ADDITION:
CORNER LOT: INSIDE LOT: V SETBACK: SIDEYARDS:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Front: %/ i d 11 Depth: I G '- 0 t' Height:
Square Feet:�( '� Cubic Feet:
Front:
Depth:
Height:
V
Square Feet: Cubic Feet:
® c3
Type of Construction: Coco Cj ri2eet-71 Estimated Cost: $
To Be Completed: Q p L Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
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 representati LL stated is application
are true and correct. See reverse side f ad.Aitional', formation.
DATE: �� /G % SIGNAj
Stipulations:
X30.®()
O
SUBJECT
City of Fridley
/
0 2 0
AT THE TOP OF THE TWINS
BUILDING PERMIT
(r�3
r
-RECVPT NO.
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
r E PROTECTIVE
CITY HALL FRIDLEY 55432NUMBER
NEV
GATE
PAGE OF
APPROVED 8Y
L f\ 612-571-3450
9t0-Ft5
9/13/99
JOB ADDRESS 5174 St. Imier Drive
1 LEGAL
LOT NO.
BLOCKTRACT
11
OR ADDITION
SEE ATTACHED
DESCR.
1
4
Innsbruck Sth Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Edson Fuglestad
571-5751
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
New Haven Constr. 4208 83rd'Ave N Brooklyn Park 55443
566-5225 20077950
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
O NEW ❑ ADDITION ❑ ALTERATION Nx REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage 35 S Tear-off
8 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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 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
$3059
$ 1.53
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 LO AL LAW REGULATING CON•
$97.25
Fire SC $3.06
STRUCTIDN R THE PERFORMAN OF CO STRUCTION
PLAN CHECK FEE
License $5.00//06.84
TOT FEE .
S1uAE O A OAAUTHOAiEDAGENT IOATE�
E pq p VALID D THIS UR ER T
S,GNATUAE OFOW NEA.6 OWNER BU4DEAi IDATEi
8 GNSP
GATE
a 7D 56125667183 P.01/02
1�tYe-10-199`3 10: 06 Fly C Y TY OF FR Y DLEY Em 5/1099
NMI 1 CnY OF FRYi'lM
ADDN t 1 SM" FAMILY AND DUp.EM R-1 AND R-2
ALTMBI&DRper ARLICA110N P9-0
• I; .
,,
Legal De ., /
Tej-
owner
LICENSE
• Iso • �
aI
Amb 1 • a&appucaftn,
Caffmate
I Survey
Of
rl
f
, wo the propoW conmuction drawn On it to SCWIC.
U&SCWnON OF VAROVLMSNT
Sq. Ft...�.---
JJVYNG AREA: ---�------ W� Heigh - Sq. Ft.
GARAGE AREA:. ...--- --Agt/C�roumd Width Sq. Ft.
DECD AREA: ___------
� Com:
_�.
(i17dER:
Coon TYPe-, _
$
Driveway Curb Cut Nom' Ft. + 6 Ft
Tel. 0 ` L'_
DATE: AprUCANT: Kir
'permit Fee
Fie SWeharge
State Smmbarge
$_
$
% S-3
SAC Charge
Utme Suk
$
s
v®
D*ftway Escrow
$
Erosion CoMol
$
Pack Fee
$
Sewer Main Charge$
TOTAL
$ /
SrVvLaTtoNs:
'.'i.. 1 �I
Fee SchedWe on ReveM Side
.001 of Permit Valuation (1110th')
$._W$1,000 Vahiadon
$1050 l" SAC Unit
$5.00 (State Lmensed Reddealial Cobra 1)
Alt. "A" or Ak. "B" Above
SMAD Canservation Phu Review
Fee Determimd by Fq*
Agrema NCMLWY [ ] Not Ncces=YL l
Building
PLITMBING
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd: �®
DATE V O "'YOUR E-MAIL ADDRESS
j p�
SITE ADD S l f -
THIS APPLICANT IS: 0 OWNER 060NTRACTOR
PROPERTY
OWNER/
NAME:
'1-' S—A-1 c � l✓ c STATE IF `
TENANT
ADDRESS: orf
Jai
PHONE: �(—
CONTRACTOR
NAME: 4�=
,r
STATE LICENSE #_! �' 1C E DATE G' �L41> ,
STAT7ZIP_ �i�
9 —.ZQQ
SUBMIT A COPY OF
YOUR STATE
ADDRESS: t-3C OV CITY __-
LICENSE WITH
PH p FAX
APPLICATION
PERMIT TYPE
as,44GLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE
TYPE OF WORK:
a NEW PLACEMENT
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 $540, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SINKILAV FLOOR DRAINS —SHOWER WATER PIPING
—_ BATHTUB _ GAS PIPING PEEDCn7,LrCE� _ SWIMMING POOL WATER SOFTNER (S35)
CLOTHES WASHER KITCHEN SINK _ WATER CLOSET _BACKFLOW PREV. ($15)
_ _
DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
_
_ WATER METER _ OTHER
SODOM., '
FIRM 1.' OF,
Permit Fee $
Number of fixtures @ $10-0.0 x $10.00 = $
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $
TOTAL DUE $
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 all rk whic r ires review and approval of plans. "
DATE
SIGNATURE OF APPLICANT
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
SUBJE61
PERMIT NO.
City of Fridloy
3 01
AT THE TOP OF THE TWINS
BUILDING
PERA'r1IT
r
CEIPT NO
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
/ / 0
e
NUMBER
REV
DATE
PAGE
APPROVED BY
� CITY HALL FRIDLEY 55432
L 612-571-3450
910415
9/28/99
JOB ADDRESS 5174 St. Imier Drive
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
4
Innsbruck, 5th Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
P PHONE
Edson Fugelstad
z A 571-M5751
3 CONTRACTOR MAIL: ADDRESS
ZIP ONE LICENSE NO
New Haven Constr. Co. 4208 83rd Ave N Brooklyn Par 55443 6 =5225 20077950
4 ARCHITECT OR DESIGNER MAIL ADDRESS
Z PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS
PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITI N O A T RATION
EPAIR 0 MOVE 0 REMOVE
8 DESCRIBE WORK
Reroof house and garage f.4- So
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply wit the State Building Code.
SEPARATE PERMITS ARE EOUIRED FOR ELECTRICAL. PLUMBING. HEATING.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR NDITIONING.
THIS PERMIT BECOM S 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 SUSP DED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER ORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERT FY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
AND KNOW TH SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINA CES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHET ER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
3408
1.70
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIO S OF ANY OTHER STATE OR L CAL LAW REGULATING CON-
STRUCTIO I OR THE PERFORMAN OF C NS RUCTION
$97.25
Fire SC $3.41
� j�
�V �
PLAN CHECK FEE
TOTAL FEE
° �
•
Li ens
SJGNATUR OF CON TRAC ORO AUTr10 QEO AGENT IOAiti
WHEN PROPERLY
:2G JgySP
VALIDATED THIS IS YOUR PERMIT
BATE
S-GNATURE OF OWNEROF OWNER BUILOER. IDATE. I.L
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �C)
BUILDING PERMIT APPLICATION J�
Construction Address: / 7
Legal Description:
Owner Name & Address: w6c)le I'S%1-Tel. # :5 :Z/-- S -�S-J
Contractor: 1',?!17 ��YZ. MN LICENSE # 2-00 -) -)%,Vb
Address: ��(1 ��' A121' Tel. # S&
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EM PROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: / -/W dFF - // C Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: 17,-?Ie�eiAPPLICANT: 12 Tel. #
TOTAL
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ 91
Fee Schedule on Reverse Side
Fire Surcharge
$_
.001 of Permit Valuation (1/10th%)
State Surcharge
$ �, �°] (3
$.50/$1,000 Valuation
SAC Charge
$
$1050 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:
Building WAS-
MECHANICAL
Permit No.: 6
Inspections ew
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date 1[e n r
vs k ®Q YOUR E-MAIL ADDRESS
DATE 161
SrrEADDRESS S icy a1b2Cv"�
THIS APPLICANT IS: ❑ OWNER JJCONTRACTOR
PROPERTY
NAME: S® v% zzC.
OWNER/
ADDRESS: S 1 i V1 Jit' i ba. CITY e d -a ti STATIM NZIP'S S Ll 21
TENANT
PHONE: low • 5-1 1 S I
CONTRACTOR
COMPANY NAME: CENTERPOINT ENERGY
CONTACT PERSON: JOANN & INKEN
SUBMIT A COPY OF
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE WITH
ADDRESS: 9320 EVERGREEN BLVD STE BITY "COON'"°RAP.IDS sTATEMN zIP55433
APPLICATION
PHONE 763 - 757 -- 6202 FAX 763-757--6701
PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW 19 REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK �v�5 t c` �` �e �Ae� ��r r�qe CCS CA 06 r
0e�yxd;�«V-1 ear -
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 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 MFG: 0— &Lr r � -e r- MODEL: S hn V t3lOA O SIZE/BTU '60,000
MFG: C, r r-, t f MODEL:e1 �i S (� SIZE/BTU ®yt
MFG: MODEL: SIZEIBTU
,--A/C $25.00 FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
TO AIR EXCHANGEER $15 (WOOD) $35.00 NEW GAS GRILL $10.00
_AIR _FIREPLACE
BOILER $35.00 ✓FURNACE $35.00 _GAS UNIT HTR $10.00
LINER $10.00 DRYER $10.00 _POOL HEATER $35.00
_CHIMNEY _GAS
WORK $10.00 _GAS PIPING $10.00 _VENTILATOR $15.00
_DUCT
PERMIT FEE PROJECTS FOR UNDER $500
PERMIT FEE FOR PROJECTS OVER $509
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 j x $25.00 = $ '2Z5.C5
Number of fixtures @ $35.00 t x $35.00 = $ AS.00
State Surcharge = $ 50
Total = $ UO -56
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 and approval of plans.
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SIGNATURE APPLICANT °J L. NAME ROGER HOFFHEIN DATE I O 1 l S l O$
PLEASE NOTE:= SEPARATE PERMITS ARE REQUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK
City of Fridley
Building Inspections -Department
6431 University Avenue NE, Fridley, NN 55432
763-572-3604
FAX: 763-502-4977