PRE 2010 DOCSBuilding
Inspections
763-572-3644
PLUM RING
RESIDENTI.A.L APPLICATION
CITY OF FRIDLEY
Permit No.:
Received By:
ilziwr
DATE____ uly 20,2007 YOURE-MAIL ADDRESS wmelson(a)-larsonplumbing.com
SITE ADDRESS 7610 Stinson Blvd.
THIS APPLICANT IS: IJ OWNER 69CONTRACTOR
PROPERTY
Nom; PatGicia Itzmaurice
ADDRESS: 7610 Stinson Blvd CITY Fridley sTATEMNZIP 55432
OWNER!
TENANT
PHONE: _ Z()3/717-7094
CONTRACTOR
NAME: Larson Plumbing, Inc
STATE LICENSEN. 3341 PM EXP DATE 12/31/2006
SUBMIT A COPY of
YOUR STATE
ADDRESS: 3095 -162nd Lane NW CITY Andover sTATEMN zip 55304
LICENSE WITH
PHom 763/427-7680 FAX 763/427-9448
APPLICATION
PERMIT TYPE
M SINGLE FAMILY 0 TWO FAMILY Q TOWNHOUSE
TYPE OF WORK:
0 NEW H REPLACEMENT
DETAILED DESCRIPTION OF WORK Water Heater Replacement
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 1AWRE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW}
BATE SINKILAV FLOOR DRAINS _SHOWER WATER PIPING
_
GAS PIPING Rszo cm'ucz=4 _ SWIMMING POOLWATER SOFTNER ($35)
J
—BATHTUB
__BACKFLOW PREV. ($15)
CLOTHES WASHER KITCHEN SINK WATER CLOSET
_ FOR IRRIGATION
DISHWASHER LAUNDRY TRAY X WATER HEATER ($35)
_ WATER METER —OTHER
- _
'L' '�G+ ..YYyyra{{,T�CCf�;;++ �,!vv {{.•.. ,��icnry"�
. T'
:�L :.�H=+:.L.�ll$F3C%, �`;r,.�`.;1C.:�!:DJ.'i�1Y r...
;Fyyi=n!}'L?'..'r"Yi."^`i:•S".'.`;.ui�a:�y:: 'Cu:.C.'E':v�,.�'$.'-Sb•�:," i''�-•i T•`.
,f, :.�z., ..�. ,. r, t.:a.,3 � w._. �.: �.. .3 , .>. F . ;�. •,:fit, • � ;�.. �a`�?.t�3�t:Po-�7��F�,O�'EI2:,$�f?0�•
.gym . rv�:.,:<5?...v/. �" � k. to �•�7��..s-�L? ,�. .
ia•y .>'r "�'"
Permit Fee. $ 35
Number of fixtures @ $10.00 x $10.00 = $
_.00
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $
TOTAL DUE $ 5 .50
_
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 cas of all work w ' requires review and approval of pians. � tc Y�X.t %vo-
SIGNATUREOFAPPLICA ►_PRINTNAME Wendy Nelson DATE7/20/07
_:. ... ,. .,�•
::... ';
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building
$
BUILDING
Permit No.:,207-0 aQz
Inspections
65% of Building Permit Fee
RESIDENTIAL APPLICATION
Received By:
763-572=3604
Surcharge
CITY OF FRIDLEY
e�
DATE a —14d "4% 7-
YOUR E-MAILADDRESS
$5.00 (State Licensed Residential Contractors)
SITE ADDRESS 61 5R dy) 6�
$
THIS APPLICANT IS:
0 OWNER ONTRACTOR
$
PROPERTY OWNER/
NAME:o'C—
$
TENANT
ADDRESS: ® �41 A,'
CITY il,,'�1 STATRV
Fee Determined by Engineering
PHONE:
$
CONTRACTOR
NAS: TMN M.
$
SUBMIT A COPY OF
STATE LICENS� EXP DATE'
Low
YOUR STATE LICENSE
ADDRESS: '
CITY STATE ZIP
WITH APPLICATION
PHONE giggig FAX,
�`P �' �• S'7
PROPERTY TYPE
MINGLEFAMILYN
SIZE
0 TWO FAMILY/NEW CONSTRUCTION
STORIES
PERMIT TYPE
0 ADDITION 0 GARAGEISHED
0 WINDOWS
0 BASEMENT FINISH GOOF
0 DRAIN TILE
O DECK 0 SIDING
0 OTHER
0 SWIMMING POOL
TYPE OF WORK:
0 NEW 0 ADDITION
0MAINTENANCE/REPAIR 0 REMODELING
If
DESCRIBE WORK BEING DONE: � �Pit-N. glA P
SIZE OF IMPROVEMENT LENGTH
WIDTH HEIGHT Sq. Ft.
ROOFING O HOUSE ONLY
2
NUMBER OF SQUARES =�
0 HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
0 ATTACHED GARAGE
1. Existing Floor Plan
2. Proposed floor plan
PROPOSED SIZE:
0 DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DF,CKS,
0 Vinyl
OSoffit
ADDITIONS. & PORCHES SUBMIT:
0 Aluminum
0 Trim
I. Site Plan/Survey showing the existing structures
0 Other .
0 Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations ,
IN EXISTING OPENINGS DYes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
�C (USING THE U.B.0 FEE SCHEDULE)
OTAL� B ALUATION $ OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1675 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21 =$
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$
Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMITNOT VALID UNTIL PROCESSED
I hereby apply for a building permit and acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and cod of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application r e t 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
P�v�fplans.� ZSIGNATURE OF APPLICANT RINT NAME AAA�/�i�%,��'`� DATE �d � 0 T
Page 2 - Building Residential Application
BUILDING PERNUT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or structure, or for any alteration or repair
to any existing building or structure, upon application therefore, require the payment- by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
provided to -wit:
TOTAL VALUE
FEES
$1 to $500
$23.50 (Minimum Fee is $23:50 plus surcharge)
k
$501 to $2,000
$23,50 for 1' $500 plus $3.05 le each additional $100 or fraction, to and
including $2,000
$2,001 to $25,000
$69.25 for I' $2,000 plus $l4 for`each additional $1,000 or fraction, to and
including $$25,000 .
$25,001 to $50,000
$39125 for 1' $25,000 plus $10.10 for each additional $1,000 or fraction,
to and including $50,000
$50,001 to $100,000
$643.75 for 1- $50,000 plus $7 for each additional $1,000 or fraction to and
including $100,000
$100,001 to $500,000
$993.75 for l- $100,000 plus $5.60 for each additional $1,000 or fraction to
and including $500,000
$500,001 to $1,000,"000 `
$3,233.75 for the 1- $500,000 plus $4.75 for each additional $1,000 or
fraction to and including $1,000,000
$1,000,001 and up
$5,608.75 for the 1' $1,000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Only
City of Fridley _ . . _ ` , • •
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977