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PRE 2010 DOCSM 9� [� Community Development Department PLANNING DIVISION City of Fridley TO: Files of Harstad Townhomes FROM: -Michele McPherson, Planning Assistant DATE: August 19, 1994 SUBJECT: Building`Permit Issuance The Fridley City Council approved the attached site plan at its August 15, 1994 meeting. In order for the development to proceed, a rezoning was approved for the east half of the project site. At the writing of this memo, "the second reading of the rezoning. ordinance has not been conducted. The second reading and subsequent publication -will notoccur until building permits have.. been issued for the building adjacent to Fillmore Street. Building permits ale to.be issued for building.plans as indicated on the enclosed'site plan. An increase in the number of units will require review and approval by. the Fridley City'Council. Any decrease in density will be permitted, without review, by the. City Council. Stipulated as a condition of .the plat is that the petitioner is to petition for construction of a cul-de-sac at the end of Polk Street when building permits are applied for for 5531 and 5533 Polk Street. MM: ch M-94-484 tl 4 ab Prom a Prhab Owl Wt -7 — One WICI b —d" Planning Division ,�O(ffCopy ///op ���� (ye o+-tAwl dvy- �� 119 4Aw A a e�7n3l 7a 3 ITTKE ENGINEERING, INC. 7.671 Central A%"Ue NE, me Hiliwind Townhomes Fridley, MN 3W2 aa4 Utility Plan (612) 783-0300 a m.FveP m Yr arAtO I,�� '4 a __ o.v amAM 4 S my ANT V14:1R5 EMOM/ ON 1105 PUN AM QlY APP407W/ATE N 0EFA1 AND oil 10CA7NN1 Arra um WE %Vw= By l/W CONIRAtTOq, OTHER U14JTIES w nM�ir yr,r. ev >tm M r`++,M ie,aA.A i.cew Ism "T rll IfY P.y. twA 0 77r nr 71N e,Au : a ur b MAY OW. AND IT WALL K i¢ b .vasa . 3 lMl IMI HII rN+.. w. Aw e..l 4ESPDNSWJW OF .ie. WNTRAMR %r —ft.— a IMI Iw Y a.w TO OBTAIN UM LWAMN OF swl. TiY M rrPti P - p .. MOe Iµ IY.,. A+t rt /era a 4 ab Prom a Prhab Owl Wt -7 — One WICI b —d" Planning Division ,�O(ffCopy ///op ���� (ye o+-tAwl dvy- �� 119 4Aw A a e�7n3l 7a 3 ITTKE ENGINEERING, INC. 7.671 Central A%"Ue NE, me Hiliwind Townhomes Fridley, MN 3W2 aa4 Utility Plan (612) 783-0300 a m.FveP m Yr arAtO I,�� '4 a __ o.v amAM 4 S SUBJECT City of Fridley:� AT THE TOP OF THE TWINS BUILDING P E R M I T If? � REC-E T NO. COMMUNITY DEVELOPMENT DIV L r 1 i PROTECTIVE INSPECTION SEC6/ 1 CITY HALL FRIDLEY 55432 I vv NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 11/30/94 JOB ADDRESS 1045 South Fillmore 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 1 Hill SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Twin City Townhomes Inc572-8872 8269 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 Foundation for Townhouse 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Paid Park Fee of $750.00. Variances approved on 8/15/94 to reduce the front yard setback from 35' to 30'; reduce setback from 25' to 18.9' for front patios; and to increase the width of the driveways from 32' to 36'. 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 DI UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT ESUME TO GIVE THORITY TO VIOLATE OR CANCEL THE P RMI F SAC A PROVISIO F ANY OTHER AT -OR LOC LAW REGULATI G CON- Fire SC STRUCTIO OR THE PERFOR E OF CO RUCTION P C E FEE L Li e WHEN PROP Y VALIDATED THIS IS YOUR PERMIT SIGNATOR FCONTRACTORORAUTMORIZEpAGENT (DATE SIGNATURE OF OWNER OF OWNER BUILDERI (DATE I �. BL G INSP MATE NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R -Z Building Permit Application Construction Address: __Z Owner Name & Address: Contractor: 'rwi SV Address:lZS� �. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Effective l/i/94 Tel. # S7 Z -g 8 7 t % MN LICENSE # o 01` Tel. #*. 5'7 Z -$$ 7 Attach to this application, a Ce cath 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. v Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Type of Construction: Approx. Completion Date: rJ Z i , 1 f 8&I eew ?15-' 7 & I Side Yard Sacks S3 l b l o Estimated Cost: $ / '� je> i (Cost on. Back) Driveway CWP Cut Yidp Needed: Ft. +J& Ft = F r $ DATE: 11120 19zl APPLICANT: Tel. # ZZ 40 F -- CITY USE ONLY Permit Fee $ 1�? Fee .Schedule on Reverse Side Fire Surcharge $ ..001 of Permit Valuation (1110th%) State Surcharge $ l $.50/$1,000 Valuation SAC Charge $ $800 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 $ % 5 cV . oC Fee Determined by Engineering 3v Sewer Main Charge $ :t=Agreement Necessary [ ] Not Necessary K TOTAL $ `� STIPULATIONS: SUBJECT City of Fridley 2 3 , o 0 AT THE TOP OF THE TWINS BUILDING PERMIT Ir RECEIPT NO. COMMUNITY DEVELOPMENT DIV. j r 1 PROTECTIVE INSPECTION SEC. NUMBER REV DATEGE OF APPROVED By CITY HALL FRIDLEY 55432 I.J 612-571-3450 910-F15 3/2/95 Ll! JOB ADDRESS 1045 South Fillmore Circle NE T LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 1 Hillwind Townhomes SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Twin City Townhomes Inc. 1250 East Moore Lake Dr, Fridley MN 55432 572-8872 8269 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 Townhouse & Garage FULL Permit 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Full permit for 27' x 32' Townhouse and a 17'6" x 18' Garage. Foundation permit issued 11/30/94. 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Paid Park Fee of $750.00. Variances approved on 8/15/94 to reduce the front yard setback from 35' to 30' and to reduce setback from 25' to 18.9' for front patios and to increase the width of the driveways from 32' to 36'. 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 1 STALLS I 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 $72799 2 $36.40 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES N PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE Fire SC PROVIS S OF ANY OTHER STATE OR LOCAL LAW REGIILATING CON- $401.00 PAID @@ 72.80 STRUN OR THE PER ANCE CONSTR CTION. C W PLAN CHECK FEE TOTALFEE Z� License SC $5.00 $515.20 IGN T R OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PPROPERL VALIDATED THIS IS YOUR PERMIT 5`� BL INSP r) AIT E - SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI NEW { ] Effective 1/1/94 ADDN { ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-222���' - Building Permit Application �--- Construction Address: �r�--�2� `Legal Description:" /J Owner Nam & Address: Tel. # 5 7 Z-93-72- Contractor: a.4� MN LICENSE # Address: S d ` Tel. # 57z---� -7 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT �Y7 Z.Mq 6 3 s° J-1-1 LIVING AREA: Length 7, Width 32,' Height Sq. Ft. 5"'2A - GARAGE AREA: Length Width % Height Sq. Ft. pis DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Comer Lot [ ] inside Lot [ ] Type of Construction: Approx. Completion Dat Driveway Curb Cut DATE: Ft. Yd Setback Side Yard Setbacks Needed: Estimated Cost: $ q/1610 , 73 (Cost on Back) 72, 7 y, Z i Ft. Ft — x $ Tel. # CITE Permit Fee $ yU /, u'' Fee Schedule on Reverse Side Fire Surcharge $ :72, ..001 of Permit Valuation (1/10th%) State Surcharge $ 36,0 $.501$1,00 Valuation SAC Charge $ �IJa ., $800 per SAC Unit License Surcharge $ 1, $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review y Park Fee $ Fee Determined by Engineering a . )" i� Sewer Main Charge $ Agreement Necessary [ ] Not Necessary TOTAL STIPULATIONS: 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Stories >Ba h Urinal : ower ...:......�.�......Y<. WFloor h . .. Drain �•` : Auto. Washer Range ••,,: Old Opening, New Fixture ate eater Gas ElecS sem n $ 5.00 Blow Off Basin ;.;:. Catch Basin .$7.00 Floor 1 Rain Water Leader $.7.00 V - Water Treating Appliance $10.00 Floor or 2 Water Heater —Electric .$7.00 Water Heater — Gas $10.00 /Q.OGj Gas Range Floor.3 Gas Dryer $10.00 Back Flow Preventer Required ( )Yes () No l0 4 F or -$5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS PLUMBING FIXTURE RATES: NO. RATE. TOTAL New Fixtures $ 7.00 r% 61 U Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin .$7.00 Rain Water Leader $.7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater —Electric .$7.00 Water Heater — Gas $10.00 /Q.OGj Gas Range $10.00 Gas Dryer $10.00 Back Flow Preventer Required ( )Yes () No Type -$5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance State Surcharge $ .50 TOTAL FEE $ %.5C-, JOB ADDRESS I b V1 5 S 6 ,�,• VL'm 6-4 -9 C 1 The undersigned hereby makesapplication 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. OwnerLy JV C y + Building Used As Estimated Cost PERMIT NO. PLUMBING COMPANY J ly SIGNED BY l TEL N`0. Approved By Rough—In Date Final Date MINIMUM FEE 'FOR ANY PLUMBING/GAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE 01 SUBJECT PER O. City of Fridley DEMOLITION ,j AT THE TOP OF THE TWINS PERMIT �� o f RECEIPT NO. • _____ COMMUNITY DEVELOPMENT DIV. z: - PROTECTIVE INSPECTION SEC. r 1 � NUMBER REV DATE PAGE OF APPROVED By 1 CITY HALL FRIDLEY 55432 612-571-3450 910-Ft5 4/13/95 JOB ADDRESS 1045 & 1051 South Fillmore Circle NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 14,15 1 Hillwind Townhomes SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Twin City Townhomes 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Shade Tree Construction Inc 2420 216 Ave NE East Bethel - 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 B DESCRIBE WORK DEmolition of two fire damaged townhomes 9 CHANGE OF USE FROM TO STIPULATIONS Site to be cleared of all demolition debris 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 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 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 FEE TOTALFEE $15.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI H PERL VALIDAT D THIS IS Y0AUFy PERMIT BLDG SP BATE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI 01 CITY OF FRIDLEY� MOVING [ ] OR WRECKING N APPLICATION Job Address: h�' i� /oir% -S' , �L41,,WDoge— li- xo l,�16 Legal Description: Owner & Address: � 1,-/?' 7 Tel. # Contractor: S Z ,� (:f0,0,Ww, Tel. # �lZP-4:223; ® Address: 2y2- - 4G ri,�tate License # &Z DESCRIPTION OF BUILDING Living Area: Length Width Garage Area: Length Width Other: Length Width Estimated Cost $ Height Sq. Ft. Cu. Ft. Height Sq. Ft. - Cu. Ft. Height Sq. Ft. Cu. Ft. Approx. Completion Date UTILITIES TO BE NOTIFIED City Water/Sewer Mpls. Gas Company Northern States Power U S West 571-3450 [ ] 372-4720 [j,,] 566-9120 663-6000 [ ] Water Bill Paid: Moving Route: Yes [ ] or Collect [$ ] Initials The undersigned hereby makes application for a permit to wreck/move the building described above, agreeing to do all work in strict accordance with the City Ordinances and rulings of the Building Division, and the State Code which requires any water well on the property to be sealed by a State licensed water well and hereby declares that all facts and representations stated in this application are true and correct. if ,13 -�� ��'�� Date Signature Moving: Principle Building into Fridley . . . $ 80.00 Accessory Building into Fridley . . $ 20.00 Minimm Fee: $15.00 Through, within or out of City . . . $ 15.00 Wrecking: For each 1,000 cubic feet or fraction . .$ 1.25 3 '--- o '0 For structures which would be impractical to cube, the fee shall be based on the total cost of wrecking at the rate of $6.00 for each $500.00 or fraction. PEi�IIT FEE: 1, , 00 CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1993 6431 Universily Ave NE Frklleya MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS /00,� �_, _ RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner — - rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $20. 00 $ representations stated in this application are true and correct. . � ,19.93 Gas Piping (Needed with new furnace) $10.00 $_.L�— OWNER Gas Range $10.00 $ BUILDING USED AS Gas Dryer - $10.00 $ *Air Conditioning —Alt Sizes $10.00 $ v v_ ESTIMATED COST Z-7 PERMIT NO. A5�, � DESCRIPTION OF FURNACEAND OR BURNER All Others/Repairs & Alterations (UST ON BACK) 1% of Value of Appliance or Work $ No. of Heating Units ) Circle One (Steam) (Hot Water)arm Trade Name 'Te Size No. Commercial/industrial BTU���� v� HP EDR 1% of Value of Appliance or Work $ Fuel 77--' Total Connected Load State Surcharge $ .50 Burner Trade Name Size No. BTU HP EDR. TOTAL FEE HEATING COMPANY MINIMUM FEE FOR ANY HEATING/COOUNGNENTILATION —� � REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 Signed By Tel o. ✓� PLUS THE S.50 STATE SURCHARGE *rj REINSPECTION FEE $30.00 "'Approved By Rough—.In Date Final Date *Air Conditioners can not be placed in a side yard without written permission from ad)olning property owner. FILL OUT SID FOR STACK VERIF N ON REPLACEMENT FURNACE CRrXNRv AM OTACK VERWICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes ( No ( ) 2. .Is free from rust or deterioration Yes ( ) No ( ) 3. Has no foreign objects lodged within Yes ( ) No ( ) 4. Is securely supported Yes ( ) No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes ( ) No ( ) 6. Has total heating BTU's of All other BTU's TOTAL BTU's Remarks List Alterations Beina Done: HEATING COMPANY Signed By Date FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 - FAX (612) 571-1287 September 1, 1995 Twin City Townhouses Inc 1250 E Moore Lake Dr NE Fridley, MN 55432 Re: Final Inspections at 1045 South Fillmore Circle NE and 1052 Fillmore Circle NE, Fridley Dear Sirs: Final inspections were conducted on August 31, 1995 of the above noted addresses. We found that the construction of the building units comply to the best of our knowledge and belief, with all the requirements of the building codes of the City and the State of Minnesota relating thereto, and permission is hereby given for the occupancy of said units. If you have any questions on this matter, please feel free to contact me at 571-3450. Sincerely, BARRY' W. RIESCH Building Inspector BWR/mh Building MECHANICAL Permit 1\o.: InspectionsRESIDENTIAL APPLICATION Received By 763-572-3604 91MAVE C CITY OF FRIDLEY 7673-5024977 FAX EFFECTIVE 2-19-09 DATE _(�'Oq E-MAIL ADD RFSS_ h ` C I3 I%i1f Y ")�t° IrS.• TYOUR SITE ADDRESS I0 ri �J S-� F( �j 4^riGYf, THIS APPLICANT IS: -:. @ t OCONTRACTOR PROPERTY NAME: I(t G r- UWNERI TENANT yyYl lhL ADDRESS: 1 D"i fir, F1 I(YI�Y� Crry Fr 'l t"i STATEAtLZIP ssti 2- PHONE: CONTRACTOR COMPANY NAME: CONTACT PERSON: �_Q, {t I1 C SUBMIT A COPY OF YOUR STATE STATE LICENSE # F_XP DATE LICENSE WITH ADDRESS: CITY STATE ZIP APPLICATION'; PHONE FAX PERMIT TYPE 16(SINGLE FAMILY ❑ TWO FAMILY ❑ TOWN14OUSE TYPE OF WORK: ❑ NEW �L.REPL'ACEMENT ❑ ALTERATION,'REMODEL DETAILED DESCRIPTION OF WORK i Alf vNd c FEES ARE BASED ON S10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (WDICATETOTAL NUMBER OF EACH BELOIY) Equipment [stalled MFG: ,�un.a_& MODEL: _AM'1W%' SIZE18TU >C>Je MF%3: MODEL: SIZEAM MFG: MODEL: SIZE13TU _A/C $23.00 _FIREPLACE (GAS) S15.00 GAS RANGE/OVEN $10.00 _ AIR TO AIR EXC14ANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 _BOILER $35.00 ,_FURNACE $35.00 UNIT HTR $10.00 `GAS _CHIMNEY LINER $10.00 GAS DRYER $10.00 HEATER $35.00 _POOL _DUCT WORK $10.60 GAS PIPING $[0.00 VENTILATOR515.00 Number of fixtures @ $1.0.00 x $10.00 = S Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures@ $-2.5.00 x $25.00 = $ Number of fixtures 0$35.00 x $35.00 = $ State Surcharge = $ .50 (MINIMUM FEE $35.50 Total = $"�' . THIS 1S AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and 1 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 Minnesom 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 requires review and approval of plans, �work �,jwhich �, 1 ►� �C� SIGNATURE OF APPLICANT [-'j_4)( +J%'J I]P2Y1 PRINT NAME d6dj L • 7-kiks,c in DATE PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX, 763-502-4977 Ad W:OC: L 600Z/6/Z 1 :a;ea £/ l, :abed 9 WL 961? £9L :uaw=l ►N'1