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PRE 2010 DOCSSUBJECT P City of Fridley 1800 AT THE TOP OF THE TWINS BUILDING P E R M I T r COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. > �dD® 1 � L1 i �r"'i,,� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY •--.� L 612-571-3450 910-F15 5/23/85 10B ADDRESS 1568 South Bavarian Pass NE.. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 44 1 Innsbruck North Townhouse Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Darrel A. Farr Development 4600 Lake Road, Mpls., MN 55422 536-9936. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO, 6 USE OF BUILDING Residential 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 421 x 35' Townhouse w%th a Tuckunder Gaxage and a 151 x 10' Deck 9 CHANGE OF USE FROM TO STIPULATIONS Separate- waster & sewer serui.ces are necessary. permit .;!.sued contingent upon letter dated May 22, 1985 for completion of concrete curbing and asphalt driveways. 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 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 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND.ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $62,400 $3� •2� 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- $ 322.00 $425.00 STR CTI N O THE ERFORMANCE OF CONSTRUCTION. c PLN CHECK FEE TOTALFEE z7A,-hs $ 80.50 .$858.70 SIGNAT E F tONTRACTORORAUTHORIZED AGENT IDA EI WHEN PROPE RLXVALIDATED THIS IS YOUR P11RMIT BLDG INSP. DATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI Mom 04" 764 6064 URUNBAN s j�s4/S MPan b 65 M 1 NOINStRINO �— r4 + ` Mvvaepil . M+aarou 6%37 6906510 I'uuf 4 Yunr•ypd Enparetw.t • 1wi 7•n+wr •Lad SWWVO4 • lma/ ph-%" �I Bwn•..W MOW."s 36337 Pertificate of Survey for OAkV[--L A, Fm..V Owc--L. Cdr Le C o. ��,��► a= /C + v2 pe-0Pos(: ►) T6LAIL Jlti61 4. � e . t 0 ^ Derl046 iron MOINMed ,L O?"5 43 X44 19LOCK 1A11V58--4q11Ck MOWN TOWN11-015CS PAT .AT_ 1 hereby codify that this is a true and te►rott representation of a survey of the boundaries of the above Anoka described Iced, and of the 104911on of all buildings thVoon, and all visible encroachments, if any, from tx at Anoka sold land. As surveyed by ase this day of s A.O. 19_U" S RURB" ',fiNGIfjJEKjt1NG, INC. by�1., jjj f 1 1 "X P NEW [ ADDN. [ ] ALTER. [ ] Construction Addr4 City of Fridley �R-1 AND R-2 Building Permit Application Effective 4/1/84 Legal Description: - �r Owner Name & Address: . Arr ` r& -Cr No mc-n:Tel. # -53(.nT 3� Contractor: e) - r Tel. # Address: y ��''a• /!fie s kitI 7F 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: Lgngth Width '� Height �6 ° Sq. Ft. .+OC �c Length � GARAGE AREA:L DECK AREA:C0. Length /� Width Width /D/ Height Hgt/Ground Sq. Sq. Ft. _ Ft.. �� OTHER: Corner Lot [ ] Inside Lot [x] Setback Ft. Yd. Setback z2Q _ Side Yard Type of Construction: A060 ce -pmmlm� Estimated Cost: $ Approx. Completion Date: +j6 Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation DATE: APPLICANT: Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sever Main Charge TOTAL a Tel. # CITY USE ONLY Fee Schedule on Reverse Side $ e ® 25$ of Building Permit Fee $ 1+ Z $.50/$1,000 Valuation $ 4 VC# 00 $425 per SAC Unit ' $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] $ Effective Aug. 1. 1981 CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL RATE TOTAL Furnace Shell and Duct Mork, S 20.00 $20.00 Burner (Also replacement furnace) Gas Piping $ 10.00 $10.00 (piping needed with new furnace) Gas Range $ 10.00 S Gas Dryer $ 10.00 $ a Air Conditioning (all Dismal All Other•/Repairs and Alterations It of Value of Appliance or Mork COM!lERCIAL/INDUSTRIAL Is of Value of Appliance or Mork 8 10.00 $te_ State Surcharge . eg / Rminspeetion Fee (815.00) Rough Insp. Date Final Insp. 3-17 -'� Date Approval for Permit MINIMUM FEE POR ANY HEATING PERMIT IS $10.00 PLUS S.SO STATE SURCHARGE 8 s s_ $30.50 8 Attach stack verification fors with replacement furnace permits •Air Conditioners can not b.+ placed in m ide yard without written prmission from adjoining neighbor. Job Address 1568 South Bavarian Pass Department of Buildings, 6111 University Ave. N.E.. Fridley. MN 55412 City of Fridley Tel. /571-1450 The undersigned hereby naked application for a permit for the work herein specified agreeinq 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. rridley. Minn. -8-2n . Is ai OWNER Farr Development KIND of BUILDING frame USED AS residence TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. 1)1? DESCRIPTION of rurmACE/BumER NCATING or POWER PLANTS. Stems, Not Nater, NaMe• One Trade NemeCarrier site No. 58GS075 Capacity Sq. Pt. LDR M 7575 000 NP Total Connected load Rind of Rtes gas BURNER - Trade Name Size No. Capacity Sq. Ft. CDR BTU NP -.- Eq P�anDe en ole Tel. No. 757-5040 CITY OF FRIDLEY APPLICATION FOR PWMBING AND GAS FITTING PE114IT RATE SCHEDULE PLUNBING-FIXTURE RATES: NO. :4 TOTAL New Fixtures $ 5.00 $ v°e $ Water $ 1.50 $ Beer Dispenser $ 4.00 $ e $ 5.00 $ Catch Basin ag wxua Heater $ 5.00 $ Hydraulic Valve $ 5.00 $. Sump or Receiving Tank $ 5.00 $ cuu cm $ 7.00 $ �_ $ 5.00 $ 5-00 Gas Range O $ Gas Dryer $ 10.00 a yw awo ALTERATIONS 8t »aac+ uMu to State Surcharge u D ($IS.DO) TOTAL H $ �n um lot I 2nd 3rd 4th (R) - Future Connection opening Connected with Sewer l�) w New Fixture, Old Opening Water RATE SCHEDULE PLUNBING-FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser $ 4.00 $ slow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve $ 5.00 $. Sump or Receiving Tank $ 5.00 $ Mater Treating Appliance $ 7.00 $ Hot Water Heater �_ $ 5.00 $ 5-00 Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1s of Value of Fixture or Appliance $ Reinspection Fee $ State Surcharge $ .50 ($IS.DO) TOTAL FEE $ Ettectave Aug. 1, lysl Job Address /5 W �yo • �Jy? r i2 , S 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. OWNER 0,�,Y -re L � r r KIND OF BUILDING ra^a USED AS TO BE COMPLETED ABOUT J 2 — J'/ kl- - ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. -- 9561 Company Signed sl► Tel. No. ROUGH INSP. Date FINAL INSP. js > Date APPROVAL FOR PERMIT HINIHUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE Effective Date May 1, 1988 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE N PLUMBING FIXTURE RATES: NO. >1 m New Fixtures rd $ 5.00 o Future Fixtures z 0 $ Water u7 rn m Beer Dispenser $ 4.00 u Z -ci N Cn $ .0 a w r. Rain Water Leader Heater 0 41 -1N $ 5.00 $ H_4 Ids, $ 5.00 $ m' m u a $ Hot Water Heater $ 5.00 $ N G $ 10.00 cN x I C 3 O o a a Q u vv $ ALL OTHI'•'S AND/OR REPAIRS AND ALTERATIONS O -a V N N 4 :3 O 0 V fn 11 U) v, N m .0 fn ro 14 U $4 U ro CJ ro W -.- to ro W O O .44 X to 14 W rd ro U W 0 �Q 3 ro U ri ro4JaS 0 O lec lst 2nd 3rd 4th , (R) = Future Connection Opening Connected with (*) = New Fixture, Old Opening - War RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $'4�' V Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser $ 4.00 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ Water Treating Appliance f / $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Required. Yes ( ) No ( ) Type $ 5.00 $ ALL OTHI'•'S AND/OR REPAIRS AND ALTERATIONS l% of Value of Fixture or Appliance $� State Surcharge $ .50 Reinspection Fee $ TOTAL 1 ($15.00) FEE $�0 Job Address 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. � , lg OWNER '/11 ci It7F 1 J KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company�hta �&toad , Signed By Tel. No. qz�—'a1 ROUGH INSP. Date FINAL INSP. uace APPROVAL FOR PERMIT G MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE SUBJECT City of Fridley 3119 AT THE TOP OF THE TWINS BUILDING PERMIT r FiiRWT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC 443,3 1 . � NUMBER DATE FFAGE OF APPROVEO By i CITY HALL FRIDLEY 55432 •_-.��"'>;.� 612-571-3450 910415 7/14/00 JOB ADDRESS 1566 - 68 S. Bavarian Pass - I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 43$44 1 Innsbruck North Townhouse Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Innsbruck Townhome Association 651-224-5482 - 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Garlock-French Roofing Co2301 E. 25th St, lso' MN 55406 651-224-5482 a., 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 00001423. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION J7 REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Tear Off and Reroof Townhome Building 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. _ hermit inspection Cards III Be Mailed To HomeownerTo Post 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 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 2 ISTALLS GARAGES ' AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS ypLUAT10N SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $8,639.83 $4.32 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- .167.25 F're SC STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $8.64' PLAN CHECK FEE.4/ TOT L FEE 1 p $180.21 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IOATEI EN ROP VALI AT THIS IS Y�PERIMSIGNATURE OF OWNERpF OWNER BUILDERI "" IDATEI BL INSFI CITY OFFRIDLEY INSPECTION &'01p �,,J&IS1111) � v� D _ 6� v�ctive On Jan 1, 2000 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 MARK NUMBER OF FIXTURtS TO BE INSTALLED ON EACH FLOOR Water Heater Gas I Elec PLUMBING FIXTURE RATES;_ New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range** Gas Dryer** Back Flow Preventer Required ( )Yes () Nc Type NQ. RATE TOTAL JOB ADDRESS '✓�lJ�!S $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 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 Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. / .20 Owner C_X' Building Used As Estimated Cos 6,PERMIT NO. PLUMBING COM Reinspection Fee $47.00/Hr SIGNED BY ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved By State Surcharge $ .50 MINIMUM I TOTAL FEE PLUS THE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. TEL N0.;17,1 �S Rough -In Date Final Date COMMON VENT INFO ON BACK SIDE rLAN CIlYOE FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 June 22, 2001 Ms. Joyce Lehrke 1568 South Bavarian Pass NE Fridley, MN 55432 Re: Final Reinspection at 1568 South Bavarian Pass NE Contractor: Mr Rooter Dear Ms. Lehrke: - A plumbing permit was issued on March 10, 2000 to install a water heater at your address. According to section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the plumbing authorized by this permit. There were corrections noted on the inspection on January 30, 2001 and we have not been called to approve the corrections. The permit fee that was paid covers the inspections to make sure the work was completed according to the Plumbing Code. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will expired the permit and no further action will be taken. To set up the inspection, or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. Inspector DJ/mh Building $ BUILDING See Back Page for Fee Schedule Plan Review Permit No.: Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION $ Received By: 763-572-3604 Fire Surcharge CITY OF FRIDLEY .001 x Permit Valuation (1/10%) Date Rec'd: DATE YOUR E-MAIL ADDRESS $5.00 (State Licensed Residential Contractors) SAC Charge SITE ADDRESS &4w,—ftej-a& A—sl $1450 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow THIS APPLICANT IS: ❑ OWNER PICONTRACTOR ft + 6 ft = ft x $20 = $ Erosion Control PROPERTY OWNER/ NAME:c-e-- �/� $450 Conservation Plan Review Park Fee ADDRESS:z ,68' 5.,. i*" l�.`r� /.'OsSCITY �rY r ��ei STATlJIP TENANT $ �- _—Agreement necessary ( ) Non Necessary ( ) $ '7S Make checks payable to: City of Fridley Attach Stipulations PHONE: CONTRACTOR NAME: STATE LICENSE W 6C— ®;,B 3 3 .Eta EXP DATE 3/3/70C SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY 46 6 / STATIP dS WITH APPLICATION PHONE FAX PROPERTY TYPE SINGLE FAMILYlNEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN THE ❑ DECK `SIDING ❑ OTHER ❑ SWARMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR WREMODELING DESCRIBE WORK BEING DONE: z14'�- SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2. 3. Proposed floor plan List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, Vinyl 990ffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum L6Trim 1. Site Plan/Survey showing the existing structures ❑ Other WFascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes DNo LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1"7 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 9,44=-7— OCCUPANCY TYPE Permit Fee $ 2ti534,2S See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Surcharge $ (j (.0005) times the total job valuation — Minimum $.50 Fire Surcharge $ .001 x Permit Valuation (1/10%) License Surcharge $ '00 $5.00 (State Licensed Residential Contractors) SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge Total Due $ �- _—Agreement necessary ( ) Non Necessary ( ) $ '7S Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which requires review gpd. approval of plans. /� SIGNATURE OF APPLICANT—�� PRINTNAME7 72 Gf � — DATE /-W,O &P� 11 — -4 a Building MECHANICAL Permit No. Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date R��. DATE sbq YOUR E- II ADDRESS y SrrE ADDRESS 1 S THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY Nom; ADDRESS:li�f�► C STATE ZIP OWNER/ TENANT PHONE: CONTRACTOR COMPANY NAME: q CONTACT PERSON: 1 SUBMIT A COPY OF YOUR STATE LICENSE WITH STATE LICENSE^ T EXP DATE C� STATF&Zll&�L ADDRESS: ``�''��II 61 -l'll l_.. WAM APPLICATION PHONE ??:)0 I 6 U dO FAX PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW/ REPLACEMENT 13ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK U_ TIX'C\ -", A IC 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 T / MFG: MODEL: Q SIZE/BTU MFG: 16 MODEL: 1 CJ<i SIZE/BTUCVQ MFG: MODEL: SIZE/BTU _A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 _AIR TO AIR EXCHANGEER $15 --FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 BOILER $35.00 URNACE $35.00 _GAS UNrr HTR $10.00 _SOHIMNEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00 _DUCT WORK $10.00 _GAS PIPING $10.00 VENTILATOR $15.00 I'RiV1T'1EE,PRU3EGT$QR$fl(I, 3.,Et :.1 w fict"sd; x ' ai` „ tea{.'`.u,r<R1I Fly€Ii+I�;PQTE&T#� It=00x, Permit Fee $ Number of fixtures @ $10.00 X$10.00=$ 10 Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ Number of fixtures @'$25.00 x $25.00 = $_ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ 50 Total = $ Sa 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 ana ' tion for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in all �ch requires review and approval of plans. cS)m SIGNATURE OF AP PRINT NAME DATE ` Z,C�ANTof . , . City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 F5- '007