PRE 2010 DOCSpity ®f Fridley, Minn.
BURDING PERMIT NO.
_-W*MWft.
Zia,, to
Date:
Owner: Builder
W
Address Address
L
OIPATI IF I N
NO. Stre G
I I
"JOINA
Parrof Lot
10
74A
Lot Addition or Sub -Division
Comer Lot Inside Lot J1 Setback S1
Sewer Elevation Foundation Elevation
DESCRIPTION'` OF BUILDING
Used 'Wee
Front Depth Height�%� Sq. Ft. Ft. 'g.
Height Sq. Ft.
Ak Depth - 40 Front Heigt Ft _"_04
A -W
Type of Co traction Est. CO�fftz, zm %aOro be Completed
In consideration of the payment of a fee permit:i's hereby granted to
to construct the building or addition as degeribedabove. Thisge t"4.s, granted upon
the express condition that the person to whom it granted ,and his agents, employees an workmen, In all work
done In, around and upon said building, or any part 'thereof, shall calgruix in all, 'respects to the 6ftUnanow of
Fridley, Minnesota regarding location, construction, alterAtiOX4 maintenance,repair and ri:Lo", of buildings
within the city limits and this permit may be revoked at any time ixpon vio tion of any of the Orikisions,--pf said
ordinances.
444SM=', -,,Building Inspector
NOTICE
'Ibis pemdt don not cover the candruefien, InUftdon for wl" plufthing, _9at heating, , sewer: or water.' -Be sun to see
the Building hapecter for separate permits for Own Ihmm
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Name Builder jo
Address Address �l 1.� 1—U'
LOCATION OF BUILDING
�
No. e �� Street a/::e; b"z � Part of Lot
Lot Block Addition or Subdivision
Corner Lot Inside LotSetback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and.proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To.bsed as:
73 9y
71e%�
� - Front Depth 12V Height
Sq. Ft.
/2 2- 0
Cu. Ft.
p
Front Depth o Height
Sq. Ft. o Cu. Ft.
cam;'
Type of Construction �a Estimated Cost
To be Completed
The 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 Department of Buildings, and hereby
declares that all the facts and representation tated in this app tion
are true and correct.
DATE /4z SIGNATURE
(Schedule of Fee Costs can be found on theoeeverse Side).
F
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 exist-
ing 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 -wit;
2.-s.12 For any such permit for the erection of an fire -
than a garages warehouses. facto g y proof building, other
for the
any fire -proof addition, for similar occupancy, atoranyorexisting buildinn of
shall be at the rate of $1,40 for each one thousand cubic feet
thereof, in such cubical contents. , or fraction
22.2_ For any such permit for the erection of any fire -proof garage, warehouse
factory or grain elevator, or for the erection of any fire
for similar occupancy, to any existing -proof addition,
building shall be at the rate of $1.25 '
for each one thousand cubic feet, classified as B1fireprooft° by Section 502 of
the Minneapolis Building Code,
HOUSES
1.3. For any such permit for the erection of any nom -fireproof building other
than a garage, warehouse, facto
addition, for similar occupancy,�to�anyaexistingin tbuildinor, or any non -fireproof
each one thousand cubic feet. g permit $1.00 for
GARAGES
2.49 For any such permit for the erection of any non -fireproof garage,
warehouse, factory or grain elevator, or for the
addition, for similar occupancy, erection of any non -fireproof
building or addition to any existing building or for each such
- ninety cents 00 .90) each one
or fraction thereof, in the cubical contentsfor thereof with a mined cubic feet
ilII� Of $4.00..
.For the purpose of computing fees for building
pets,
of any building or addition to a uniform heightthhroughoutebycubical multiplyingcontents the
ground area covered from a point six (6) inches below t
basement or cellar to the average height of the u
average height of the roof surface of the main gableroge floor line of the
uby
or to the
Pitched roof.
2.5. For repairs or alterations to an existing structure, the fee shall be
at the rate of $3.00 per each Five Hundred Dollars ($500.00) or Erection
thereof in the cost of all proposed work.
2.6• In no case shall the fee charged for any permit as set forth in
Section 2 be less than $4.00.
City of Fridley
Application for Plumbing and Gas Fitting Permit
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK 7
Number, Kind and Location of Fixtures Location
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ......................
x $1.50
$ s e U
Future Fixture Opening ................
- x 1.20
$ 0
New Fixture Old Opening ..............
x 1.00
$
Catch Basin .... .......................
x 3.25
$
a
p
Z x 2.00
N
WATER HTR.
GAS
ELEC.
Base
NO. RATE TOTAL
1st 3 Fixtures ..........................
x $1.50
$
Additional Fixtures ....................
x .50
$
Gas Range to 200,000 BTU ..............
x 2.00
$
1st
f
2nd
3rd
4th
• Future Conaectioa Openings
e New Fixture, Old Openings
Connected with
Sewer
Cesspool El
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures ......................
x $1.50
$ s e U
Future Fixture Opening ................
- x 1.20
$ 0
New Fixture Old Opening ..............
x 1.00
$
Catch Basin .... .......................
x 3.25
$
Water Heater (Up to 200,000 BTU) ......
Z x 2.00
$ —i it
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 herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application re true and correct.
Fridley, Minn t-?— 196r
61
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $
Biding Permit NoOl �-"— cl'- Permit No. ?
-
ROUGH
FINAL
By
Business Phone No.
Application for Power Plants and Heating, Cooling, Ventilation, Refrigeration and
Air Conditioning Systems and Devices
or B
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
$
MECK. 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 $
Dept. of Bldgs. Phone SU
3 3e
City of Fridley:
is
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 Ae true and correct.
Owner
Kind of lding
Used as
To be completed about V e C "✓ �'
Estimated Cost,
19
DESCRIPTION OF WORK
HEATING or POWER PLANTS--Stean3, Hot Wa r, Warm Air—No
Trade Name �' '�-�-- E 1 C�Size No 6--vCapacity Sq. Ft. E.D.R. �' BTU A.P.
Total Connected Load �, G J_")
Kind of Fuel"
- rA
BURNER — Trade Name
Size No
Capacity Sq. Ft. E.D.R BTU H.P.
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $ RAY N .WELTER HEATING C13.
ALTERATIONS & REPAIRS TOTAL FEE $ 46Signed 4637 r. } is C A r n AVE.
By MINNEAPOLIS 7, MINNESOTA
ROUGH z P z 7
4z 2M Business Phone No �j'
FINAL
(REMARKS—OVER)
SUBJECT,
IT N
City of Fridley
199 5
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
r
RE
' '
• COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
(� /
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED By
L 612-571-3450
910-F15
6/6/89
JOB ADDRESS 7330 Tempo Terrace N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Clifford Fabianke 7330 Tempo Terrace N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Richard Hastings Contr. 6331 Riverview Terrace 574-9966
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION
Q REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof (26 Squares)
8 CHANGE QF USE FROM TO
STIPULATIONS
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
ISTALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND.ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$l 300
$. 65
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
TOTAL FEE
$31.65
SIGNATURE OF CONTRACTOR OR ALVHORIZEDAGENT (DATE)
WHEN PROPERLY XPLIDATED THIS IS YOUR PERMIT
BLDG INSP nAT
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATEI
NEw [ ]
ADDN [ ]
ALTS [ ]
R-1 AND R-2
Building Permit Application
Construction Address: 73 So 7"E vL P c, ?� it,
Legal Description:
Effective 5/1/88
Owner Name & Address: C. L; FFo R n .F (5 (,q,-/ k JA m r Tel. #
Contractor: K% c k A e n A q '11 -,` Tel .#
Address: 63,31 k' & o I'&- � -rE R,
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
CRRIPTION OF Il+PRWE MBU
UMM AREA: length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: length Width Hgt/Ground Sq. Ft.
07MM:
Corner Lot [ ] Inside lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: REZoo F Estimated Cost: $ / -& o 2
Approx. Completion Date: 7/r S%i L4 S8,
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
Width + 6' See Back Page
e
DATE: rfl 8 APPLICANT: / Tel. # 5"?
Permit Fee $ 6 b
State Surcharge
SAC Charge . $
Driveway Escrow $
Park Fee � $
Sewer Main Charge $
$ aI. b1�-
�yVst 0 F.04 M to,,k'
CITY USE CONLY
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$575 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
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:
$1 to $500 $15 (MbAmu n Fee is $15 plus surcharge)
$501 to $2,000 $15 for first $500 plus $2 for each additional $100 or
fraction thereof, to and including $2,000
$2,001 to $25,000 $45 for first $2,000 plus $9 for each additional $1,000
or fraction thereof, to and including $25,000
$25,001 to $50,000 $252 for first $25,000 plus $6.50 for each additional $1,000
or fraction thereof, to and including $50,000
$50,001 to $100,000 $414.50 for first $50,000 plus $4.50 for each additional
$1,000 or fraction thereof, to and including $100,000
$100,001 to $500,000 $639.50 for first $100,000 plus $3.50 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for each additional
$1,000 or fraction thereof
EPZVEMIlsiY ISSICH 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.
Permits for construction will be issued a mi_ninum 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
it has been constructed will be required before proceeding with the flaming.
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
*Air Conditioning - All Sizes $ 10.00 $
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $
Commercial/Industrial
1 % of Value of Appliance or Work $
State Surcharge $ .50
TOTAL FEE $_aC � i
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS .115.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units 0 Circle One (Steam) (Hot Water) arm Air
Trade Name � ��` Size No. - /,'J�
BTU R,�t� _HP_ EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
STANDARD HEAT 1 AND AIA COMI) iONEJG M
110 WEST LJ`.KC Gi P.EET
HEATING COMPANY MINNEAPOLIS, Iter W4001-29913
Signed By 1 Tel No.
Approved B � Rough -In Date Final Date lZ
a
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
JOB ADDRESS 2373 L
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work
Residential
Rate
TOTAL
herein specified agreeing to do all work in strict accordance with the
Furnace Shell and Duct Work, Burner -
city codes and ruling of the Building Division, and hereby declares
Also Replacement Furnace
$ 20.00
$ a o 00
that all the facts and representations stated in this al plication are
true and correct. ,19
Gas Piping (Needed with new furnace)
$ 10.00
$ e c�) • 0( )
/
OWNER
Gas Range
$ 10.00
$
BUILDING USED AS
Gas Dryer
$ 10.00
$
ESTIMATED COST 7VIVe� PERMIT NO.
*Air Conditioning - All Sizes $ 10.00 $
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $
Commercial/Industrial
1 % of Value of Appliance or Work $
State Surcharge $ .50
TOTAL FEE $_aC � i
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS .115.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units 0 Circle One (Steam) (Hot Water) arm Air
Trade Name � ��` Size No. - /,'J�
BTU R,�t� _HP_ EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
STANDARD HEAT 1 AND AIA COMI) iONEJG M
110 WEST LJ`.KC Gi P.EET
HEATING COMPANY MINNEAPOLIS, Iter W4001-29913
Signed By 1 Tel No.
Approved B � Rough -In Date Final Date lZ
a
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
13
•
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
Remarks
List Alterations Being Done:
HEATING COMPANY
Signed By
Date
` STANDARD HEATING & AIR CONDITIONING CO.
SERVING THE TWIN CITIES SINCE 1930
HEAT LOSS CALCULATION FOR IRWIN
----------------------------------------------------------------------
92592 CDS
FIRST FLOOR
----------------------------------------------------------------------
LENGTH 44 WIDTH
30
HEIGHT 8
WINDOWS
& DOORS - CRACKAGE AND
AREA
WIDTH
HEIGHT NO. LIN FT
AREA
NO. PANE
PANE LIGHTS CRACK
SQ FT
2 36
48 1 31
29.4
4 36
24 1 46
32.2
3 32
32 1 36.5
27.7
2 32
80 D 37.3
35.6
COEFF
BTU 148 R.FT
INFILTRATION
................. 150.8
20
3016
GLASS ..............................
124.9
50
6245
EXP WALL ...........................
148
NET EXP WALL
........................
1059.1
13
13768.3
BELOW GRADE......
8 ................
1184
5
5920
CEILING .............................
1320
15
19800
FLOOR ...............................
1320
3
3960
VENTILATION......
0 ................
0
0
0
TOTAL BTU .................................................
52709.3
TOTAL BTU OF ALL ROOMS/FLOORS....................................... 52709.3
A
i
410 W. LAKE ST. 1072 PAYN E AVE.
MINNEAPOLIS, MN 55408-2998 ST. PAUL, MN 55101-3892
612/824-2656 EATINGANDMRCONI) NINGC 612/772-2449
Serving The Twin Cities Since 1930'
ORSAT TEST RECORD
ADDRESS CITYt'�
OCCUPANT/ - :OWNER S -
DATE HTG. INST.'= - INSTALLED BY �
GAS LINE BY
TYPE OF HEAT: GA FA X HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN �
MAKE MAKE OF NER
MODEL Z -eQA I-0 3 CosD r ---A MODEL
SERIAL )7�rZth2 -743 MAX. BTU RATING
INPUT b �oe pwcD _ MAKE OFF CE
CONTROLS
CONVERSION
THERMOSTAT W HEAT PLUG VENT SIZE Vie" F j/
VALVE A KIND OF LINER - SIZE NONE
LIMIT ,V.'A 0,4 DRAFT HOOD REGULATOR
LIMIT SETTING /'7b9 CHIMNEY CONSTRUCTION
FAN SETTING p,� 4- m-��`' r DRAFT IpJbv-e, - TEST TAG (" st-tm-
PILOT TYPE 1-1�'TS''i'14?,.:pA P -'5_ LIGHTING INST. A°rt�✓Sid�-" �eO-�`
PILOT MAKE_
PILOT MODEL
PILOT TIMING
YRESSURE PERCENT CO2 DATE TESTED
INPUT CFH PERCENT 02.
STACK TEMP. �J � PERCENT CO NAME OF TESTER
Building
PLUMBING
Permit No.:a607 -0114.3
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd: v
DATE 7 YOUR E-MAIL ADDRESS
SITE ADDRESS ' D
THIS APPLICANT IS: dOWNER PfCONTRACTOR
PROPERTY
NAME: � —"y
OWNER/
TENANT
ADDRESS: 14.o.'- - CITY STATE ZIP
PHONE: D
CONTRACTOR
NAME:
STATE LICENSE # l]6a_7 U EXP DATE
ADDRESS: CITY o4VeZ4 STATI?0r0°UZIP,j 6&
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
PHA c2,f J- :i If%
APPLICATION
PERMIT TYPE
PSINGLE.FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
IXIEW ❑ REPLACEMENT
DETAILED DESCRIPTION OF WORK A,1 l r/( 7Jd4 el" 46,,,n,
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
—BATHTUB _ GAS PIPING —SWIMMING POOL _ WATER SOFTNER ($35)
—CLOTHES WASHER _ KITCHEN SINK CLOSET BACKFLOW PREY. ($15)
—WATER
_ DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
WATER METER OTHER
. ...$ .
..._ _Numbe T.. a 0
Permit Fee
r 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 $
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 aA work which requires review and approval of plans.
��
SIGNATURE OF APPLICANT 2�� PRINT NAME �"��/�� KL,��y'�� DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977