PRE 2010 DOCSCity of Fridley, Minna
BUILDING PERMIT
Date: April 20, 1970
Owner: Warren S. Wilmo Builder r SgMe___
Address 6164 Star Lane N E Address Same.
LOCATION OF BUILDING
No. 6160-64 Street StaK Lane W.E. Part of Lot
Lot 16 Block 1 Addition or Sub -Division Sylvan Hills
Corner Lot _ Inside Lot _ Setback -- Sideyard
Sewer Elevation ____ Foundation Elevation
x
To be Used as:
/3YG
N° 0 6 ® 9
Alterations Front Depth Height Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Aluminum Trim Est. Cost_1, 00_0, _ 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 t forth and in co ce with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $.§- -00 , permit is hereby granted t, Warren S . Wilmo
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.
F
CE BELISLE s
NOTICE:
This permit does not cover the construetioa, installation for wiring, plumbing, gas heating, sawer or water. Be sure to as
the Building inspector for separate permits for these Bei.
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
15JA La=zOUILDER:
OWNER'S. NAM :
ADDRESS:10ADDRESS:
NO:. n,(pq s TREET • A re 1- j / Y 4 -
LOT: BLOCK: ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
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:
�If N S Front: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: Estimated Cost:
� m4
To Be Completed:
Toe undersigned hereby makes application for a permit for the work herein .
specified, agreeing to do all work in sttict accordance with the City of
Fridley Ordinances and rulings f the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE:. 2 G G SIGNATURE: +
(See Reverse Side For Additional Information.)
P
CITY OF FRIDLEY
APPLICATION FOR PUIMBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
V
PLUMBING FIXTURE RATES: NO.
m
N
Number Fixtures
IIIo.
$3.00
$
Future Fixture Opening
X
a�
$
Water
x
$2.00
$
Catch Basin
x
$5.00
N
E
9 „11
}U)
q
.4
`p
$10.00
$
Water Softener
Heater
$7.00
N
New Ground Run Old Building
x
r
m
Electric Water Heater
X�
a)
P
4 0
9 0
4
1st 3 fixtures
41
$3.00
$ -3--oo
Additional Fixtures
•�
LI
fa
N N
c'(d
.0
••i
$10.00
.0
C,
3
57
V N
4J N
N04
ro
a
P4
o w
M
w
ai'cd
� 3
•
v
o
as
lec
U)
U
3
-
i
1st
2nd
11
Ile
—A
3rd
F�'
a -
-
4th
(R) = Future Connection Opening
Connected with Sewer
(*) = New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
Number Fixtures
x
$3.00
$
Future Fixture Opening
x
$2.00
$
New Fixture, Old Opening
x
$2.00
$
Catch Basin
x
$5.00
$ �®
Water Heater - to 99,000 BTU
x
$5.00
100,000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7.00
$
New Ground Run Old Building
x
$5.00
$
Electric Water Heater
x
$5.00
$
GAS FITTING FEES:
1st 3 fixtures
r.
$3.00
$ -3--oo
Additional Fixtures
x
$1.00
$
Gas Range to 199,000 BTU
x
$10.00
$
Job Address ,60 J&�
!N✓t� �r
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.�, 19-zz
KIND OF
USED AS
TO BE COMPLETED ABOUT
EST TED COST
LD / NEW BUILDING PERMIT NO. PERMIT NO. &09
Company
Signed By ��s�
Tel. No. O /�
ROUGH INSP.
Date
FINAL INSP.
Date
APPROVAL FOR PERMIT ,—
REPAIRS 4 ALTERATIONS
First $100.00 $5.00 $ r
each add. $100.00 or fraction $2.00 $ MINIMUM FEE FOR ANY PL MBING PERMIT IS $7..50
State Surcharge $ .50 •SZ
TOTAL FEE -
REINSPECTION FEE
($10.00)
'
SUBJECT
City of Fridley
0
Cil -
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIPT NO.
• _ COMMUNITY DEVELOPMENT DIV.
SEC.
7-5-7-3
r PROTECTIVE INSPECTION
1 �
i ` CITY HALL FRIDLEY 55432
NUMBER
REV,
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910-F15
9/24/82
JOB ADDRESS 6164 Star Lane N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
] 6
1
Sylvan Hills Addition SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Robert Anderson 6164 Star Lane N.E. 574-1241.
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
X
6 DESCRIBE WORK
Reroof Duplex
9 CHANGE OF USE FROM TO
STIPULATIONS
Roof can be 2nd but not 3rd layer. Install ridged galvanized valleys.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Fiberglass
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO.FT.
CU. FT.
AUTHORIZED 1S 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
2
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
$900
$•50
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-
$16.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$16.50
I REOFCONTRACT OR AUTHORIZED AGENT. (DATE)
WHEN PROP LY VALIDATED THIS IS YOUR PERMIT
p
2 _14)22
�
IG A U OF O1 F OW ER BUILDERI (DATE)
BLDG INS T
01
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATION! FOR RESIDENTIAL BUILDING PEMITS
(New. Alterations, Additions, or Repairs)
0MIER: 9,7,d BUILDER: 2
ADDRESS: ADDRESS:
TEL NO: _ � `/— / Ste/ TEL NO:
Construction Location
- STRICT NO: / STREET: % J� 1-7
IAT: & BLOCK: ��� ADDITION: T 1711
Corner Lot: Inside Lot: Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
Front: Depth: Height:
Square.Feet: Cubic Feet:
Front: Depth: Height:
Square -Feet: Cubic Feet:
17
i II (_AS -
Rype of Construction: 0 A& Estimated Cost: $ D O. ® o
Rb Be Cbrpleted:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired:
SEE REVERIE SIDE OF SHEET
Mie 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 Delwirtment of Buildings, and hereby declares that all the facts and
representations stated in this applicatigzh are true and correct.
DATE: SIGNATURE:
Stipulations:
City of Fridley
SUBJECT
PEF72i54
®
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
_ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
"1 CITY HALL FRIDLEY 55432
612-571-3450
REC T NO.
-
NUMBER
910-F15
REV.
DATE
9/19/83
PAGE OF
APPROVED BY
JOB ADDRESS 6164 Star Lane
1 LEGAL
DESCR.
LOT NO.
16
BLOCK
1
TRACTOR ADDITION
-Sylvan Hills
SEE ATTACHED
SHEET
2 PROPERTY OWNER MAILADDRESS
ZIP
PHONE
Robert J. Anderson 6164 Star Lane
574-1241
3 CONTRACTOR MAILADDRESS
ZIP
PHONE LICENSE NO.
same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
5 ENGINEER MAILADDRESS
ZIP
PHONE LICENSE NO.
6 USE OF BUILDING
residettial
7 CLASS OF WORK
❑ NEW ❑X ADDITION ❑ ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
12 x 14 addition
9 CHANGE QF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
TYPE OF CONST.
wood 'Frame
OCCUPANCY
GROUP
OCCUPANCY LOAD
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
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
3,400
1.70
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.
44.50
PLAN CHECK FEE
OTA E
6 20
SIGN of CO RA(CTORORAUT ORIZEDAGENT (DATE)
W�ROP�E
HI OUR PERMIT
Si URE OF OWNER OF O ER BUI ERI fDATEI
DATE
:-%
CITY OF FRiDLEY - Effective Aug. 1, 1981
APPLICATIM F014 RESIDE14TIAL BUILDING PER14ITS
(Nevi, Alterations, Additions, or Repairs)
0WIIER: ll ii
ADDRESS: �1��/ S t �. 6/?,/c
TEL NO: � 7 6/ -
'BUILDER:
ADDRESS:
TEL 110:
Construction Location
STREET NO: STREET:
BIA)CK: ADDITION:
Corner Lot: Inside Lot: Setback.: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed
building location drawn
on certificates
to scale.
DESCRIPTION OF
CONSTRUCTION
Front: �� ` ff ; ' �' `
Depth:
Height:
Square Feet:
Cubic Feet:
Front:
Depth:
Height:
Square Feet:
Cubic feet:
Type Construction:
Estimated
Cost: $ 7
of
To Be (bripleted:
Alt. A Alt. B
Proposed Driveway
Width If New Opening Is
Desired:
$ $
SEE F.EVF.RSE SIDE OF S}IEET .
2be undersigned hereby makes application for a permit for the %:+ork herein specified,
agreeing to do,all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department. of Duildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
Acy/s SIGNATUIE -
Stipulations:
OP -010i V 1. %)
1.7 �
CITY OF FRIDLEY
1.L Luc:Llve Huy. i, i )Nl �-
APPLICATION FOR POWER PLANTS
AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTE14S AND DEVICES
RATE SCHEDULE
RESIDENTIAL RATE
TOTAL
Job Address 6164 NE Star Lane
Furnace Shell and Duct Work,
Burner (Also replacement furnace) $ 20.00
$
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
City of Fridley
Gas Piping $ 10.00
$
Tel. #571-3450
(piping needed with new furnace)
Gas Range $ 10.00
$
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
Gas Dryer $ 10.00
$
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
* Air Conditioning (all sizes) $ 10.00
$
xMx 22 Feb..$9
Fridley, Minn. lg_
All Others/Repairs and Alterations
OWNER .Teff Harris #572,2505
1% of Value of Appliance or Work
$ 15,00
Replace Class• B Stack F Tee
KIND OF BUILDING Frame
COMMERCIAL/INDUSTRIAL
USED AS Res
1% of Value of Appliance or Work
$
TO BE COMPLETED ABOUT 22 FP'h R4
ESTIMATED COST 400.
State Surcharge
$ .50
OLD - i BUILDING PERMIT NO. PERMIT NO. i
TOTAL FEE
$ 15.50
Reinspection Fee ($15.00)
$
DESCRIPTION OF FURNACE/BURNER
Rough Insp.
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Date
Trade Name Size No.
Final Insp.
Date
Capacity Sq. Ft. EDR BTU HP
Approval for Permit ,nom
Total Connected Load Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU _ --HP''
MINIMUM FEE FOR ANY HEATING PERMIT IS 4.00om
��`�� �
P. y�:,�.
�'
PLUS $.50 STATE SURCHARGES
v
Signed By f'rurTrr f.rr
Attach stack verification form with replacement furnace
permits
Tel. No.X342-5337
,.,.nnden
*Air Conditioners can not be placed in side yard without
J11nn Avenue
700
written permission from adjoining neighbor.
0. ®X 1165
P.
MN 550.1165
minneaPOVsv
CITY OF FRIDLEY
APPLICATION FOR HEATING REPLACEMENT
CHIMNEY AND STACK VERIFICATION
THIS FORM MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM.
LOCATION ,j�] (2� A/ DATE
OWNER ,Ak1L/5 0 ADDRESS
The undersigned hereby verifies that the +e* sting -chimney or stack:
1. Has been carefully examined ✓�_
2. Is free from rust or deterioration
3. No foreign objects are lodged within
4. That it is securely supported v '�
5. That it meets all current Code requirements
for size and total BTU connected
6. Total Heating BTU
s All Other BTU a p2
TOTAL oZ d OD
REMARKS A ( U.)
Is C�Ft Z-9� r `-/2 A n/S mcl--
HEATING PERMIT 0
SIGNED
Licensee
by )�) i rlpl/' 25cb )115 Y, d L> 1—
Address
Telephone 5 33' S 3 1
Fridley City License
CITY OF FRIDLEY
Effective Date May 1. 1988
APPLICATION FOR POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
/ (�
Job Address
RESIDENTIAL
RATE TOTAL
Furnace Shell and Duct Work,
09
Burner (Also replacement furnace) $
20.00 $ 'LO
Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432
City of Fridley
Gas Piping $
10.00 $
Tel. /571-3450
(piping needed with new furnace)
Gas Range $
10.00 $
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
Gas Dryer $
10.00 $
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application re true and correct.
• Air Conditioning (all sizes) $
10.00 $
ridley,Minn. 2— ( 3 19 qD
Fridley, Minn.
A,
All Others/Repairs and Alterations
OWNER -6)
1% of Value of Appliance or Work
U vus
KIND OF BUILDING
COMMERCIAL/INDUSTRIAL
USED AS
It of Value of Appliance or Work
$
TO BE COMPLETED ABOUT l Z Z ` 0
ESTIMATED COST
State Surcharge $ .50
OLD - NEW BUILDING PERMIT N0. PERMIT NO. b �j
—
TOTAL FEE
Reinspection Fee ($15.00)
S
DESCRIPTION OF FURNACE/BURNER
Rough Insp.
POWER PLANTS, Ste, Bot Water, Warm Air- No.
TING o am
Date
/
`2— —�
Trade Name iS size No. -sem
Final Insp.
Date
Approval for Permit
Capacity Sq. Ft., EDR BTU U P7 HP
/U C
Total Connected Load Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
MINIMUM FEE FOR ANY HEATING PERMIT IS
$15.00,
Company
PLUS $.50 STATE SURCHARGE
V
RO e i ON HEATING & COOLING
Y�/
Signed By eL
z;-I:2u-r8i Aven«e M.
Tel. No. ggggifiyn Park, MN 535442
• Air Conditioners can not be placed in side yard without
424-8333
written permission frcm adjoining neighbor.
Fill out back side for stack verification on replacement furnaces
CHIMNEY AND STACK VERIFICATION
The
undersigned hereby verifies that the existing chimney
or stack;
I.
Has been carefully examined
Yes
("f,,"'No ( )
2.
Is free from rust or deterioration
Yes
(41 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
�No
total BTU connected
Yes
( )
6.
Has Total heating BTU's of <-o�/",
All other BTU's
TOTAL
Remarks
Company _
Signed By
Da to
021
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 . (612) 571-3450 • FAX (612) 571-1287
August 20, 1992
Jeffrey Harris
6164 Star Lane N.E.
Fridley, MN 55432
RE: First Notice of Noncompliance at 6164 Star Lane N.E.
Dear Mr. Harris:
The City of Fridley has established a City Code for the purpose of
promoting a pleasant and attractive suburban environment. A recent
inspection of the property at 6164 Star Lane N.E. revealed that not
all Code requirements are presently being met. Listed below is an
item which does not comply with the City Code:
1. Fridley City Code requires that all solid waste must be stored
in secured containers. I observed unsecured solid waste
containers with garbage bags and other materials adjacent to
these containers at the northeast corner of your property .
Your prompt attention in correcting this situation would greatly
assist us in helping make Fridley a better place to live. An
inspection will be 'conducted on or about August 28, 1992 to
determine compliance.
If you have questions or would like to discuss this, please contact
me at 572-3595. Thank you for your cooperation!
Sincerely,
Steven Barg,
Code Enforcement Officer
SB:sb
CE -92-405
CIIYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
September 1, 1992
Jeffrey Harris
6164 Star Lane N.E.
Fridley, MN 55432
RE: Final Notice of Noncompliance of the Fridley City Code at
6164 Star Lane N.E.
Dear Mr. Harris:
On August 31, 1992, a second inspection of the property at 6164
Star Lane N.E. confirmed that the following item still does not
comply with City Code:
1. Fridley City Code requires that all solid waste must be stored
in secured containers. I observed unsecured solid waste
containers with garbage bags and other materials adjacent to
these containers at the northeast corner of your property.
A final inspection to determine compliance will be conducted on or
about September 8, 1992. You should arrange to complete an
approved plan for compliance before that date. Should this
inspection confirm that this deficiency still exists, legal action
will be approved. If corrective action cannot be completed by this
time, contact me to coordinate a schedule to complete this
requirement.
If you have any questions regarding this matter, please contact me
at the Fridley Municipal Center, 572-3595.
Sincerely,
Steven Barg
Code Enforcement Officer
SB:ls
CE -92-423
Community Development Department
PLANNING DIVISION
City of Fridley
DATE: October.5, 1992
TO: Carl Newquist, City.Prosecutor
FROM: Steven Barg, Code Enforcement Officer
SUBJECT: Jeffrey Harris / Citation 048-398
On September 16, 1992, I issued the above referenced citation to
Mr. Harris for improper storage of solid waste at 6L64 Star Lam
N.E. On October 15, 1992, Mr. Harris called me indicating that he
had taken care of the problem. A subsequent inspection revealed
that the violation had been corrected. Please dismiss the charge
against Mr. Harris in this matter.
Feel free to contact me at 572-3595 if you have questions or wish
to discuss this further. Thanks for your assistance.
SB:ls
CEM -92-93
p
sue,EtT
PERMIT NO.
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
PERMIT
918 4
r
-RECEIPT N0.
COMMUNITY DEVELOPMENT DIV.
_
r PROTECTIVE INSPECTION SEC.
/ 9 0?4
NUMOEP
REV
DATE
PAGE OF
APPROVED 8Y
CITY HALL FRIDLEY 55432
L 612-571-3450
910-F15
4/12/99
JOB ADDRESS 6164 Star Lane NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
16
1
Sylvan Hills
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jeff Harris 6164 Star Lane NE
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
New Haven Construction 4208 83 Ave N Brooklyn Park, MN 55443 566-5225
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
20077950
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
Q
0 NEW p ADDITION 0 ALTERATION X REPAIR O MOVE 0 REMOVE
8 DESCRIBE WORK
Soffit/Fascia
9 CHANGE OF USE FROM TO
STIPULATIONS
Install soffit ventilation to meet the State
Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday
thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
SEPARATE PERMITS ARE REOUIREO 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
1
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
$2,000
$1.00
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS QF ANY OTHER STATE OR LOCAL LAW REGULATING CON -
TR N THE PER RMANCE OF CONSTRUCTION
$62.25
Fire SC $2.00
PLAN CHECK FEE
TOTAL F
License
$5.00
f7b.25
NA TU RE OF CON• ®R A0RIZE0 AGENT iDATEt
EN P OPER DATED T IS IS YOU PERMIT
, SLO fNSP
a
gAtE
S,GNATURE OF OWNER,IF OWNER BUILDEAt DATE.
p
NEW [ ] Effective 1/1/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION P�
q
ConstructionAddress:
Legal Description: 521A& -L- § cow-� , �--
Owner Name & Address: !� _ _ _ ' = Tel. #
Contractor: tk)--e-� V c� e0 -1A - MN LICENSE #- ? v ®-7 5-0
Address: o5 — $� ~� e . ��.� � Tel. # J (,G -
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 E\IPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: 4 Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: 4-- ( � - R -t APPLICANT: e _ � CA, -b< Tel. # S`3 9 — q '3) (
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ ���
Fee Schedule on Reverse Side
Fire Surcharge
$ 00
.001 of Permit Valuation (1 / 10th %)
State Surcharge
$ /,-00
$.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
$ o
STIPULATIONS:
SUBJECT
P
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
PERMIT (29909
16
CEIP
COMMUNITY DEVELOPMENT DIV.
r 1 PROTECTIVE INSPECTION SEC.
1 . i
CITY HALL FRIDLEV SS432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
L J\ 612-571-3450
910-F15
7/20/99
JOB ADDRESS 6164 Star Lane NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
16
1
ISylvan Hills
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jeff Harris
586-2632
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
NEW Haven Construction 4208 83rd Ave N Brooklyn Pk. 55443 566-5225 0 9
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW XX ADDITION ❑ ALTERATION
❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 171 x 161 Deck
9. CHANGE OF USE FROM
TO
STIPULATIONS
See stipulations on plan
�QIts
�efae digging call for
a!1 Utility boos
z
R-r-vU1RE1) - BY LAIC
LQ
NG, #fEA TINq, D FD#
pL j AND
SIG
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
MFT
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
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
�h
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2700
$1.35
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
OVISIONS OF ANY LOCAL LAW REGULATING CON-
ST UCTION OR P AN CONST CTION
$.37. SO
Fire SC $2.70
PLAN CHEC
e
•
C46.55
TOTAL FEE
SIGN E OF C • R TOP Op Au ORiZE AGENT iOATEi
WH N Y VA ATE IS1 UR EMIT
S,GNATURE OF OWNERoF OWNER BUILOERi iDATE,
LOG �N r�AtE
Jul 16 99 11:40a Kerri 566-7183 P.1
APP -14-1999 11-34 FROM CITY OF FRIDLEY TO 5667183 P.01/02NEW
(�
ADD l 1 CITY OF FRIDLEY v1
ADDt ] �b
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R•Z r,
BUILDING PERMIT APPLICATION 2�l
ConstructionAddress: �0/!G' L.-
Legal Description:
A e
Owner Name & Address�.'-/�'L-Y / �-- Tel. #
Contractor://V�riv G—GZ'e,?ryG`�`7S' Y%f'(�/ 2t�/1 MNLICENSE#
Address;, . 3 I:s:-y E I2 ae lV�'ry ZV; Tell. # 1712
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:
DECK AREA;
Length
Length�[_
Width
Width
Height
HgdGround 2
Sq. Ft.
Sq. Ft.
OTHER:
X
Construction Type: yEstimated Cost: $
(Fee Schedule an Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = _ Ft x $ _ $
DATE: '7 /Ca > APPLICANT`Tei. ll—
Permit Fee
Fire Surcharge
$ �f •`�y
$j l>
State Surcharge
$ .�
SAC' Charge
$
License Surcharge
$-15 j ll
Driveway Escrow
$
Erosion Control.
$
Park Fee
$
Sewer Main Charge $
TOTAL $
STIPULATIONS:
CITY USE -ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 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 I
CITY OF FRIDLEY INSPECTION DIViSION �® 9
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Effective On May tD, 1999
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
$ 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 an
$ .50 rulings of the Building Division, and hereby declares that all the facts'and
representations stated in this application are'true and correct.
HEATING CO Ac 4ic. Z"ke- /_.S 4,uo 4 /�__
Signed DATE %1Z6 /1�711?
Approved By Rough -In Date Final Date L/Z2%
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
101'6
JOB ADDRESS
--
4�T
OWNER
Rate
TOTAL,
BUILDING USED AS
$ 30.00
$
ESTIMATED COST
7 �` G� PERMIT NO. 2 I - Al
$ 10.00
$
DESCRIPTION OF FURNACE AND OR BURNER
$ 10.00
$
No. of Heating Units
Circle One (Steam) (Hot Water) (Warm Air)
$ 10.00
$
Trade Name
Size No.
BTU
HP EDR
$ 25.00
$
Fuel
Total Connected Load
Burner Trade Name
Size No.
$
BTU
HP EDR
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
$ 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 an
$ .50 rulings of the Building Division, and hereby declares that all the facts'and
representations stated in this application are'true and correct.
HEATING CO Ac 4ic. Z"ke- /_.S 4,uo 4 /�__
Signed DATE %1Z6 /1�711?
Approved By Rough -In Date Final Date L/Z2%
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes (} No ( )
8. Has combustion air been provided for water heater Yes () No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CHIMNEY AND STACK VERIFICATION
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
7. Has a liner been provided for water heater Yes (} No ( )
8. Has combustion air been provided for water heater Yes () No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
W
.0
CITY
/
CITY OF FRiDLEY INSPECTION DIV. �D � 9
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
572-3604
MARK NUMBER OF FIXTURES TO RR INSTAI I Fn ON EACH Fi nno
Effective On January 1, 1998
PLUMBING FIXTURE RATES: NO.
RATE TOTAL
New Fixtures
$ 7.00
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** I
$10.00
Gas Range**
$10.00
Gas Dryer**
$10.00
Back Flow Preventer Required ( )Yes {) No
Type
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge $ .50
TOTAL FEE $
JOB ADDRESS S�,V_ La'Ae- U'. - Jo6 # 47EB Rb
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.
OwnerVYIS
Building Used As TtS(&P-I& _
Estimated Cosh-bu'w PERMIT NO. / o
PLUMBING COMPANY McGUIRE & SOBS
s 12th Amealle South
Hopkins. MN 5534
SIGNED BY TEL N0.
Approved By Rough -In Date 2("M Final Date 211-4i'Z°t
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00
PLUS THE $.50 STATE SURCHARGE
"COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE. 6-A. MINIMUM SIZE 9 SQ INCHES.
CI7YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
June 22, 2001
Mr. Jeff Harris
6164 Star Lane NE
Fridley, MN 55432
Re: Final Inspection at 6164 Star Lane NE
Contractor: Action Heating & Air Cond & McGuire & Sons
Dear Mr. Harris:
A mechanical permit was issued on July 26, 1999 to install an air conditioner, and a plumbing
permit was issued on March 15, 1999 to install a water heater at your address. According to
section 305 (a) of the 1991 Uniform Mechanical Code, and section 4715.2800 of the State
Plumbing Code, a final inspection shall be conducted on the work authorized by these permits.
As of this date, no inspections have been called for.
The permit fees that were paid cover the inspections to make sure the work was completed
according to Code. We will keep your permits open for another 30 days and if we do not hear
from you within this time to set up the inspection, we will expire the permits 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.
DJ/mh
10/9/01
I O e� /� i� , a / Owner of �T �D' �6 agreeto allow
Jeff Harris owner ogroperty 6160 / 6164 star lane to install blacktop driveway adjacent to my lot line. Jeff
Harris agrees to install 4 -foot chain link fence adjacent to my lot line along the length of his garage on the
West Side of his property. Driveway is not to exceed 9 feet in width along garage area.
r/,/ NO, Sol
r
i;t i ect.ive Jalluary 1, 2UU3
i'OF FRIDLEY INSPECTION DIVISION
,431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATI0N,
(763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
FAX (763) 571-1287 JOB ADDRESS Uft04r('�
RATE SCHE®ULE
Residential
Rate
TOTAL
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace .$30.00
$
(Side Vent - Fill Out Back)
Gad Piping (Needed with new furnace,
$ 10.00
but not replacement)
Gas Range
$ 10.00
Gas Dryer
$ 10.00
$�
25.00
*Air Conditioning - All Sizes
$
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
$
Commercial /industrial
1.251y, of Value of Appliance or Work $
State Surcharge $ 50
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/CO0LING/1t'ENTILATION
REFRFGERAiION/AIR CONDITIONING PERMIT IS $2%0
ALU TS HE $ 5�STATIr SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
BUILDING USED
ESTIMATED COST
PERMIT NO.
No. of Heating Units— Circle One (Stearn) (Hat Water) (Warm Air)
Trade Name - _ --_- _ _ Size No-------
HP
_.___HP EDR__
Fuel --Total Connected Load—
Burner Trade Name Size No.
BTU HP __ EDR_
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 an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE H Z
i
r i 8
THE BELOW MUST BE F111 I E IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE �y
APPLICATION WILL BE RETURNED �
M MON MEWL MENI C�9���["r�3F2 t1RiA C[9 �� i� QI1i! �F� �89�1C4YB�r�9
Whennig an no ham= the undersigned hereby verifies that the
venting Inas been examined and is free from rust, deterioration, obstructions, i
and is securely supported and firestopped where requited. Yes (► No ()
The denting system,= plastic/PVC and meets ail current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes(
No( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes(
No ( )
The exis ing comm s kW lk is sized and installed to meet the current codes
and manufacturers specifications. Yes(
No ( )
When required to' °W husbypaaiirjt will be sized and installed
Yes(
No( )
to meet the current codes and manufacturers specifications.
When fttaft®� W V, sem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Yes( )
No( )
Venting "fables for fan assisted and natural draft appliances.
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes (}
No ( )
pfiafl-ce-- and
Appliance #1 Type -t �L BTU Input, Fan Assisted or Nat _
Appliance #2 Type BTU Input.. Fan Assisted or Nat
BTU Input Fan Assisted or Nat
Appliance #3 Type
Total Appliances Total Btu Input .�.
Common Vent Type Vent Height ®.. Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
ft Lengthft Diameter in Type
Appliance #2 Vent Connector Height
Appliance #3 Vent Connector Height ft Length �ft Diameter in Type
HEATING CO'
\ 1 M
rIAM 9
® 10
CITYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
June 29, 2004
Mr. Jeff Harris
6164 Star Lane NE
Fridley, MN 55432
Re: Final Inspection at 6164 Star Lane NE
Contractor: Daves Heating & Air Inc
Dear Mr. Harris:
A mechanical permit was issued on April 30, 2003 to install an air conditioner at your
address. According to the 1991 Uniform Mechanical Code a final inspection shall be
conducted on the work authorized by this permit. As of this date the inspection has not
been requested.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. 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 mark the permit "no
inspection called for by homeowner after notification" and the permit will be expired.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
DJ/mh
AW
CI'IYOE
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
July 7, 2004
Mr. Jeff Harris
19175 Azur Rd
Deephaven, MN 55391
Re: Final Inspection at 6164 Star Lane NE
Contractor: Daves Heating & Air Inc
Dear Mr. Harris:
A mechanical permit was issued on April 30, 2003 to install an air conditioner at your
address. According to the 1991 Uniform Mechanical Code a final inspection shall be
conducted on the work authorized by this permit. As of this date the inspection has not
been requested.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. 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 mark the permit "no
inspection called for by homeowner after notification" and the permit will be expired.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
DJ/mh
Building
PLUMBING.
Permit No.:
Inspections
RESIDENT AT, APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
D'
DATE " 1 lJ YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY
NAME: REELS
ADDRESS: �� CITY L STA IP W
OWNER/
TENANT
f
PHONE: 9
CONTRACTOR
NAME:
SUBMIT A COPY OF
STATE LICENSFDATE
YOUR STATE
ADDRESS: 3670 Dodd Rd. #100 CITY STATE ZIP
LICENSE WITH
PHONE Eagan, ISN 55123-1339 FAX
APPLICATION
PERNUT TYPE
INGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW #:VREPLACEMENT
DETAILED DESCRIPTION OF WORK k&D I
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)
BATH SINK/LAV FLOOR DRAINS —SHOWER _ WATER PIPING
_
GAS PIPING (nEsD cn7ijcEiao _ SWARMING POOL —WATER SOFTNER ($35)
—BATHTUB _
CLOTHES WASHER KITCHEN SINK_ WATER CLOSET _BACKFLOW PREV. ($15)
_ _
DISHWASHER LAUNDRY TRAY ,WATER HEATER ($35) FOR IRRIGATION
_
— _ WATER METER _OTHER
Permit Fee $ 35 . 00
Number of fixtures @ $10.00 x $10.00 = $
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $
TOTAL DUE $ so
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 work w . re u' s review d roy of plans.
SIGNATURE OF APPLICANT AME __ a / TE
y. . ngrjvg
1010 ..... v .
'W"HIM, ._..
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432 9
763-572-3604 g15
FAX: 763-502-4977 \�o
L