PRE 2010 DOCS'p, 099®
City of Fridley, •
BU11DING PERMIT N® 6539
Date:
Ownerder
Address Address
LOCATIO OF "PAG
G
No. Street artfnf Lot
Lot Block Additi or Sub -Division
/i
Corner Lot Inside Lot Setback 2 --� Sideyard
Sewer Elevation ___ _ — Foundation Elevation
DESCRIPTION OF BUILDING
In consideration of the issuance to me of a permit to constructthe building
the proposed work in accordance with the description above and in cc
ordinances of the city of Fridley.
to do
ns of
®V
In consideration of the payment of a fee of It , permit is hereby granted to
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,
ith e , MJnny lota imit and g tion, conatructton, alteration, maintenance, repair moving provisions of said
this permit may be revoked at any time upon violation of
ordinances. _ AA "I—]
Building Inspector
NOTICE:
'Ibis permb dons not cover the construetien, hista0etton for vririag, plumbing, en heating, sewer or water. Be sure to no
the Building Inspector for separate permits for those Hams.
L �.
APPLICATION FOR BUILDING PERKIT
CITY OF FRIDLEY, MINNESOTA
Owner - al rJ/Address- Address
LOCATION OF BUILDING
No, Street' ,fPart of Lot
Lot .Block
,_____,addition or Subdivision
Corner Lot Inside Lot Setbac :-�Side-Yard
SEVER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and
proposed building location.
DESCRIPTION OF BUILDING
To Ioe - used as:
FrontDepth
sq. Ft. /� S —,0 Pu. Ft .
. Front_. i7epth eight E -UCS
Sq : Ft., Cu. Ft.
Type of Construction ��� .� Estimated Cost ---z2 J224 -
To be Completed_
The undersigned,hereby,makes application for a permit,for the work
herein specifisd,,agreeing to do'all work in strict accordance with
the City of Fridley Ordinances and ruling of the Department of Build-
.ngs, and hereby declares that all the facts and representations
stated in this ppli tion.are true and coir.
DATE SIGNATUE2E
(schedtile of Fee Costs can be found on the'Reverse Side).
BUILDING PERMIT FEE SCHEDULE
Section 2. The Inspector of Buildings shall, before issuing any
permit for the erection of any building or structure; or for any
addition to any .,existing building or structure, or for any alterations
or repairs.to:any existing building or structure, upon application
therefor, 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 -wits.
2A. For any such permit .,for the erection of any fire -proof building,
other than.a garage; warehouse, factory or grain elevator, or for the
erection.of any,fire-proof addition, for similar occupancy, to any
existing building shall be at the rate of $1.40 for each one thousand
cubic feet, or fraction thereof, in such cubical contents.
2.2. For any such permit for the erection of any fire -proof garage,
warehouse, factory or grain elevator, or for the erection of any fire-
proof addition, for similar occupancy- to any existing building shall
be at the rate of $1.25 for.each`,one �housand cubic feet, classified
as "fireproof" by Section 502 of the Minneapolis Building Code.
obi„ USES
a For any such permit for the erection- of any non -fireproof build-
ing other than a garage, warehouse, factory or grain elevator, or any
non -fireproof addition, icor similar occupaancy, to any existing building.
Permit $1.00 for each one thousand cubic feet.
2.4. For any such permit for the erection of any non -fireproof
garage, warehouse* factory or grain elevator, or for the erection of
any non -fireproof addition, for similar occupancy, to any existing,
building or for each such building -or addition. Xinety Cents .for each
one thousand cubic feet or fraction thereof, in the,cubical contAnts
thereof with a minimum of $4.00.
For the purpose of computing fees for building permits the cubical ,con-
tents of any building or addition to a uniform height throughout by
multiplying the ground, area covered front a point six (6) inches below
the floor line of the basement or cellar to the aveXage height of the
upper surface or to the.average height of the roof surface of the main
gable of .a pitched roof.
2.5.° For repairs or alterations to an
shall be at the rate of $3.00 per each
or// ;Fraction thereof in the cost of all
2.6. In no case shall the fee charged
Section 2 be less than "4.00.
existing structure, the fee
Five Hundred Dollars ($500.00)
proposed work.
for any permit as set forth in
Ad
City of Fridley 'In LA
Application for Plumbing and .Cas Fitting Permit
De»L of Bldcm. Phone SU 4-7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
.r1
1u
RATE
TOTAL
y�
12Sy
Z
K
Future Fixture Opening ................
x 1.20
$
%
Z
t
$
WATER HTR.
ELEC.
$
Water Heater (Up to 200,000 BTU) ......
�
$
New Ground Run Old Bldg . ............
x 3.25
$
GAS FITTING FEES:
NO.
RATE TOTAL
d
0
R
N
GAS
x .50
$
Gas Range to 200,000 BTU ..............
x 2.00
$
Base
1st
2nd
_
3rd
—
4th
• Future Connection Openings
Connected with
Sewer
New Fixture, Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures ......................7
x $1.50
$,,de
Future Fixture Opening ................
x 1.20
$
New Fixture Old Opening ..............
x 1.00
$
Catch Basin ............................
x 3.25
$
Water Heater (Up to 200,000 BTU) ......
x 2.00
$
New Ground Run Old Bldg . ............
x 3.25
$
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
x $1.50
$
Additional Fixtures ....................
x .50
$
Gas Range to 200,000 BTU ..............
x 2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description............... ............................$
TOTAL FEE $.�'®
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley, Minn 19
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $�
Old ew. uilding Permit N( Permit No. Z
a 4 .4
ROUGH
FINAL
a z 2M 7-59
i
I
By ^I -'A
Business Phone
_—� J_ _L_I_ ► I 11 I I I l l; I I I,.. I ,rel t ._ I L i. I
Application for Power Plants and Heating, Cooling, Ventilation, Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
RATE
TOTAL
Furnace Shell & Duct Work ...........................
8.00
$
Replacement of Furnace .............................
5.00
$
Repairs & Alterations—up to $500.00 ..............
... 5.00
$
Repairs & Alterations each add. $500.00 ...............
2.50
$
MECH. WARM AIR /
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ..... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
& Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ -�
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x $1.50 $
Additional Fixtures ............... x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS TOTAL FEE $
ROUGH-
OUGH
FINAL-
FINAL
Dept. of Bldgs. Phone SU 4-7470
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley, Minn —y 19
Owner (�_" – &� I
Kind of Building
Used as
To be completed about
Estimated
Estimated Cost, $��
Old Ne 'Building Permit No. - 7 Permit No.
DESCRIPTION OF WORK
HEATING or POWER PLANTS --Steam, Hot Wa W —No
Trade Name �� e'£ d���Fj�� Size No
Capacity Sq.. Ft. E.D.R � BTU p H.P.
Total Connected Load Co �- Kind of Fuel/�
BURNER —Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVER)
SigneRAY N. W E Lml E R� 1 EATI 101 G Ca
4637 CHICAGO AVE.
42 sM Business Phone No
SUBJECT
P IT
City of Fridley
18562
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT
_COMMUNITY DEVELOPMENT DIV.
W
PROTECTIVE INSPECTION SEC.
r �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
,�
L J\ 612-571-3450
910-F15
7/25/86
JOB ADDRESS 7381 Symphony Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
20
4
Melody Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Brad Vanasse 7381 Symphony Street N.E.
784-9576
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 11 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
Roof can be 2nd layer but not 3rd. Tnstall
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
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 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
$430
$•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-
$15.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$15,.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT II DAAT�E)
.. �" ems'67
WHEN PROPERL ALIDATED THIS IS YOUR PERMIT
SiONATORE OF OWNER 11F OWNER BUILDERI IDATEI
OG INSP
nATE
NEW [ ] City of Fridley Effective 4/1/86
ADDN. [ ] FR -1 AND R-2
ALTER. [ ] Building Permit Application
9381 Construction Address:
�� St
LX T 20 L.Ci v
Legal Description:
Owner Name & Address :`...40.�/� �S Tel. #
Contractor: �� �� Tel. #
Address:
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: Length Width Height Sq. Ft.
DECK AREA: Length /W,�idth Hgt/Ground Sq. Ft.
OTHER ; ! r�e cc r- � a-5 '_-
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback __ Side Yard Setback
Type of Construction: Aloe rD®� / >�� `��� Estimated Cost: $
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
DATE: ` APPLICANT: �. Tel.
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ Fee Schedule on Reverse Side
$ 25$ of Building Permit Fee
$ d�% $.50/$1,000 Valuation
$ $475 per SAC Unit
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
e
BUILDING PERMIT 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 Valuation
Fees
$1.00 to $500.00
$10.00 (Minimum Fee is $15.00)
$501.00 to $2,000.00
$10.00 for the first $500 plus $1.50 for
each
additional $100 or fraction thereof, to and including
$2,000.
$2,001.00 to $25,000.00
$32.50 for the first $2,000 plus $6.00 for
each
additional $1,000 or fraction thereof, to
and
including $25,000.
$25,001.00 to $50,000.00
$170.50 for the first $25,000 plus $4.50 for
each
additional $1,000 or fraction thereof, to
and
including $50,000.
$50,001.00 to $100,000.00
$283.00 for the first $50,000 plus $3.00 for
each
additional $1,000 or fraction thereof, to
and
including $100,000.
$100,001.00 and up
$433.00 for the first $100,000 plus $2.50 for
each
additional $1,000 or fraction thereof.
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus
6 feet times $13.50
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75
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 the proposed structure and of the
construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
,. .
TY OF I9RII-�Y INSPEC, i lelN ulv
39 U.P?ve3rsi(y Ave W:
'��ey� Inti a6i:SG
631572-3t3t#4. FAX (7/63),5Y =, • :?.;37
1
*01,1CATInN Ff-'R :-€ ti ?:r rg AND GAS r-I-rl IWG PMAAI t
)LUM. BING FIXTURE RATES:
NO. RATE TOTAL JOB
qew Fwiutes
Did OpertLng. 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 Ramie*`
Gas Dryer-**
Bade Flow Pteventer Required ( )Yes (} No
Type-
67.00
ype
$7.40
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00.
$ 7.00
$10.01}
$ 7.40
$10.00
$10.00
$15.00
Reihspection Fee $47.00/Ht
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
4.5% of Value of Fixture or Appfiarice
Stvaie Surchow 50
TOTAL FEE $100
The undersigned hereby roakes afplicatlon for a permit flor the work heMn
spec ied agreeing to do all work in strict accordance wWt the city codes
and rulings of the Burg Division. and hareby declares 0*4 all the facts
and representations stated in this appAcation are true and rorfl..
2Q�
Ower
C9
m
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$sm
pw
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m
Co
m
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Ia)
3
N
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►. v
-c
0
V
M
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Bidd€ng Used As
' � a
fir►
Estimated Cant PERMIT
A -2 46 _ _ .. _ _s Ami
Rough -in Date Final
�U�THE $.5A STATE SURCHARGE
CC ABUSTION' AiR SHAL i (.3 PROV€t3B) PER t. NIC, SECT)ON 504(A).,A.,N0 TABL.k 6 ft
Ct)WM40N VEN*f' s`WF0 ON BACKSIDE
Minnegasco _
ADDREss_ % ii' St�y►r►p�eoyur clji A
OCCUPANT ' /
HEAT LOSS_ Yes DATE HTG. INST.
SOLD BY CenterPoint Enerav Minnecac^,a
Electrical Work ey
TYPE OF HEAT FA SPACE HTR.
MAKE Lr9.�Yti e
Model <-9 PAIA (I
Serial -3Q n-4 & 11--'3 i
NPU' td LEV&
CONTROLS
THERMOSTAT
Value
Limit b x est
Limit Setting
Fan Setting
Pilot Type
Pilot Make
Pilot Model
Pilot Timino
Heat Pluo
Pressure Percent CO2 ___%__,
nput CFH Percent 02 I Z
Stack Temp, Percent CO
� .� r : , �w _�, � :�� �: �, s • i ,; Ery
APT
v�NCITY rJi
OER rte-�er�
INSTALLED BY _ CenterPoint Energy Minnegasco
Gas Line By
UNIT HTR. OTHER
``�� CONVERSION
Vent Size �Vc-
KIND OF LINER
NONE
Draft Hood
Filters Size
Chimney Location Inside
Chimney Construction
Wiring
Test Tag
Lighting Inst.
Date Tested
SIZE
Regulator
Number
Outside
Company Testing _ CenterPoint Energy Minnegasco
Name of Tester
CI"IYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
June 29, 2004
Mr. Asheber Amare
7381 Symphony St NE
Fridley, MN 55432
Re: Final Inspection at 7381 Symphony St NE, Fridley
Contractor: Appliance Installers of MN
Dear Mr. Amare:
A plumbing permit was issued on June 17, 2003 to install a water softener at your
address. According to Section 4715.2800 of the State Plumbing 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 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 mark the permit "no
inspection called for by homeowner after notification" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
DJ/mh
llgq�
CITY 0 FRIDLEY INSPECTION DIVISION
6431 University Ave NE
Effective January 1, 2003
Fridley,.MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
FAX (763) 571-1287
JOB ADDRESS �� ! e
RATE SCHEDULE
OWNER AY► Otf A-Sh-+t•beef
Residential Rate
TOTAL
Furnace Shell and Duct Work, Burner -
BUILDING USED AS (^C 5ic c 4e_
Also Replacement Furnace $ 30.00
$
(Side Vent - Fill Out Back)
ESTIMATED COST f Sup .6D PERMIT N0. _Z)
Gas Piping (Needed with new furnace, $ 10.00
$
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNER
Gas Range $ 10.00
$
No. of Heating Units Circle One (Steam) (Hot Water)Warm Air
Gas Dryer $ 10.00
$
Trade Name Size No:
*Air Conditioning - All Sizes � . $ 25.00
$ J>'�
BTU HP EDR
Fuel AD 4-urcp/ Gars Total Connected Load
All Others/Repairs &Alterations (LIST(BACK)
Burner Trade Name Size No.
1% of Value of Appliance or Work
$
BTU HP EDR
/
6u rn �G er - 3(� 1� l"edy -,� �&h
Commercial/Industrial
1.25% of Value of Appliance or Work
$
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
State Surcharge
$ .50
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
TOTAL FEE
$
DATE _ &/Ji6 4LS
CenterPoint Energy Minnegasco
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
HEATING C013562 Central Ave NE, Anoka, MN 55304
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
0
° M
Signed - . 763-757=6202
FAX # 763-757-6701
REINSPECTION FEE $47.00/Hr
*Air
Conditioners can not be placed in a side yard without
Approved By_t Rough In Date Final Date
written permission from adjoining property owner.
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
When ranlanij3n an exon ing furance, the undersigned .hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions, x� No
and is securely supported and firestopped where required. Yes ( ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes (x) No ( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan Yes (x) No ( )
assisted and natural draft appliances.
The daySzting ceme,atienAir is sized and installed to meet the current codes
and manufacturer's specifications. Yes �) No ( )
When required to YL..gmW.I w new cemh,,stien air_ It will be sized and installed
to meet the currentcodesand manufacturer's specifications. Yes f) No ( )
When in�stallina a naw y nf'ng syqam, 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 f) No( )
Venting Tables 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 Yes (x) No ( )
separately as per current codes.
ne nd Sim ICemmen Vent and Vent Cenn c er Infermatian
�•
PPI
Appliance #1 Type BTU Input 6 FnAss
r d or NatAppliance #2 Type ��Za �� ✓��� BTU Input FssistedVaAppliance #3 TypeBTU Input__Fan Assisted
Total Appliances Total Btu Input
jf
Common Vent Type 1- Vent Height %� Diameter inches
Appliance #1 Vent Connector Height
�,�l-ewftLength ft Diameter in Type V �-
Appliance #2 Vent Connector Height --L—ft
Appliance
Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter _in Type
HEATING CO: CenterPoint Energy egas ee
Minn 13562 Central Ave NE, Anoka, MN 55304
r.....
Signed By:
Date:
Building
PLUMBING
Permit No.: Wo3
Inspections
RESIDENTIAL APPLICATION
Received B .
rf� "
763-572-3604
CITY OF FIZIDLEY
DATE 1-7-'27-7-05 YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY
OWNER/
NAME:
ZIPsc3q3
ADDRESCITY nj ST AT$
TENANT
PHONE:
CONTRACTOR
NAME: Champion
STATE LICENSE # 651-365-1340 EXP DATE y A
SUBMIT A COPY OF
YOUR STATE
ADDRESS: 3670 Dodd Rd. #100 CTTy STATE zIP
LICENSE WITH
PHONE Eagan, MN 56123-R!
APPLICATION
PERMIT TYPE
DINGLE FAMILY ❑ TWO FAMILY 0 TOWNHOUSE
TYPE OF WORK:
0 NEW REPLACEMENT
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 $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SINK/LAV DRAINS _ SHOWER _WATER PIPING
_ _FLOOR
—BATHTUB _ GAS PIPING pkm cn7LjcEhA _ SWIMMING POOL —WATER SOFTNER ($35)
KITCHEN SINK WATER CLOSET PREV. ($15)
_ CLOTHES WASHER _ _BACKFLOW
DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
WATER METER —OTHER
r
�ry
n tr �'r�� �E x €
..., � �
Permit Fee $
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 $ 6 1 . 1:50
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 case of all work whic requi;;es review and approval of plans.
-
SIGNATURE OF APPLICANT " — TPJNT NAME
City of Fridley
]Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 3f Cf �-
FAX: 763-502-4977
� __ ,rte. 44
PLUMBING Permit No.:pections
4 • 8
[Building
RESIDENTIAL APPLICATION Received By:3-572-3604
CITY OF ERIDLEY Date Rec'd:
DATE_' I
YOUR E-MAIL ADDRESS
SITE ADDRESS _ F
THIS APPLICANT IS: O NTRACTOR
PROPERTY
NAME:
OWNER/
TENANT
ADDRESS: mei CITY ryidNe STATF4 Nzw
S 5` 3 Z_
PHONE:
CONTRACTOR
NAME:
STATE LICENSE #---4N-3664340__ EXP DATE
SUBMIT A COPY OF
YOUR STATE
ADDRESS: 3670 [Tadd Rd #100 CITY STATE-ZIP-
TATEZIPLICENSE
LICENSEWITH
PHONE Eagan, MN 55123-133ax
APPLICATION
PERNIIT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
ONEW UREPLACEMENT
DETAILED DESCRIPTION OF WoRK
PER MS 1613.665 the permit fee is a minimum of 515.00 or 5% of the total cost up to $500.00, whichever is greater, for tbD
improvement, installation or replacement of a resideMA fixture, excluding the fixtures. (This should reflect only the cost of
tabor)
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: (INDIC TE TOTAL
NUMBER OF EACH BELOW)
—BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING
_
_ BATHTUB _ GAS PIPING Mw SWIMMING POOL —WATER SOFTNE
($35)
_ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET BACKFLOW PRE V. ($15)
_
—DISHWASHER _LAUNDRY TRAY EWATER HEATER ($35) FOR IRRIGATIO
WATER METER —OTHER
PERMIT FEE PROJECTS FOR UNDER $500
PERAW FEE FOR PROMM OVER
$500
Permit Fee $ .00 Number of fixtures @ $10.00 x $10.00 =
Surcharge .50 Number of fixtures @ $15.00 x $15.00 =
TOTAL DUE $ Number of fixtures @ $35.00 x $35.00 =
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 wo
will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Conshvction Codes; that I underland
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 accordw
ice with the
approved plan in the case of all work and approval of plans.
SIGNATURE OF APPLICANT_;,. -" PITT NAMECU.�i C r DATE �"
7ZZ7
PLEASE NOTE. SEPARATE M.NUTS ARE.-. UDOw FOR BUILDING, ELECTRICAL AND MECHANICALORK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604