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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N? s o 5 5 Date: ww►. e�,. Owner: t Builder —.-- Address9�_Address ---- LO I ING No. Stree P of t y Lot _ r _Block Addition or Sub -Division Corner Lot _ Inside Lot Setback __ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING T be V Front Depth i%eight Sq. Fk Cu. F'trze !L,N"" Fron Depth eight " Sq. Ft. Cu. 1♦`t. .. 7 OVA Type Of ttcYei Fst. C� _ _ •lie 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 set forth and in compliance with a'll provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $.67 f0i'!'*''" permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the exprefs 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, bu11d1-- within the city limits and this permit may be revoked at anytime upon violin of any of the Previsions of said ordinances. - - NOTICE: 'Ibis permh deft not Cover the ConstwCtion, InthlWan for whAi,, p"hig, on hating, sewer or water. Be wre to ses the SUN[ig Inspector for esparate permits for thea hems. tf APPLICATION FOR BUILDING PERM CITY OF FRIDLEY, MINNESOTA Owner is Name Builder ��� �i Address LOCATION OF BUILDING ZW-1 MR No. ',- Street 161,,YnnFart of Lot Lot Block. Addition or Subdivision Corner Lot Inside Lot Setback, Side -Yard r SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be d as: Z S Front Denth 2Heitht -- Type of To be Completed Sq. Ft. Cu. Ft. Front Depth Height Z2 Sq. Ft. C 9 Cu. Ft. Estimated Cost Z A-2, fl r2, 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 an presentations stated in this application are true and correct. a , (A Schedule of Fee Cvsts can be found on the Revere Side.) iliF il I i ��iui HIlDo 1 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 build- ing or structure, or for any alterations or repairs t6 hby existing building or structure, upon application therefor, require the p4.iyfiie4t by the applicant for such permit of fees to the amount herein below set forth and in the manner herein p-rovided to -wit: 2.1. 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 $1.4.0.for each one thousand cubic feet, or fraction thereof, in such cubical contents. 2.2. For any such permit for the erection of any fireproof garage, warehouse, factory or grain elevator, or for the erection of any fireproof addition, for similar occupancy, to any existing building shall be at the.rate of $1..25 for each one thousand cubic feet, classified as "fireproof" by Section 502 of the 14 nneapolis Building Code. HOUSES 2.3.e For any such permit for the erection of any non -fireproof building other than a garage, warehouse, factory or grain elevator, or any non -fireproof addition, for similar occupancy, to any existing building. Permit $1.00 for each one thousand cubic feet. GARAGES 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. Iinety Cents for each one thousand cubic feet or fraction thereof, in the cubical contents thereof with a minimum of $1+.00. For the purpo�n of computing fees for building permits the cubical contents of any building or addition. to a unj.-.orm height throughout by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or cellar to the average 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 existing structure, the fee shall be at the rate of $3.00 for each Five Hundred Dollars ($500.00), or fraction 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. 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 v 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 FINAL Dept. of Bldgs. Phone SU 4-7470 1.5 G/ 14 -- 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 cornett. Y, Owner ly �v[ ,/ Kind of ylilding f/ Used as ° __C To be completed about s �' Estimated Cost, $ Old ew. Building Permit No. Permit No. DESCRIPTION OF WORK BEATING or PO PLANTS—Steam, Hamot Watl,Warm Ain—N o � Trade Name 1p- t.�'% Size `—' Capacity Sq. Ft. E.D.R i 8 "�'I BTU H.P. Total Connected Load Lkl G ol�v Kind of Fuel, BURNER — Trade Name Size No Capacity Sq. Ft. E.D.ft I BTU H.P. (REMARKS -OVER) RAY N. WELTER HEATING CO. Signed 4637 CHICAGO AVE. MINNLAP®Lis 7, MINNESOTA By Ct�- <Z 4M Business Phone No d 0 City of Fridley Application for Plumbing and Gas Fitting Permit DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE Number Fixtures ......................� x $1.50 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 VOTAL $ , $ Q $ GAS FITTING FEES:� RATE TOTAL. � 1st 3 Fixtures .......................... x $1.50 $ e Additional Fixtures x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ...........$ TOTAL FEE $ Dept. of Bldgs. Phone SII 4-7470 Location 17i 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 are true and correct. Owner Kind of nuuamg Used as – - - To be completed about Estimated Cost, $ ®� 01 — ew uilding Permit No Permit No. J ROUGH X _ 13 – 6 ?-- FINAL 42 2M Business Phone No g ; U � � ? 3 � Y� o � 8Z uJ. °�c �i t� o 6 3 �U' °1 W �U' o� UN' ? 0 p • F N WATER HTR. GAS ELEC. Base 1st 2nd 3rd 4th • Future Connection Openings New Fixture, Old Openings Connected with Sewer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE Number Fixtures ......................� x $1.50 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 VOTAL $ , $ Q $ GAS FITTING FEES:� RATE TOTAL. � 1st 3 Fixtures .......................... x $1.50 $ e Additional Fixtures x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ...........$ TOTAL FEE $ Dept. of Bldgs. Phone SII 4-7470 Location 17i 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 are true and correct. Owner Kind of nuuamg Used as – - - To be completed about Estimated Cost, $ ®� 01 — ew uilding Permit No Permit No. J ROUGH X _ 13 – 6 ?-- FINAL 42 2M Business Phone No City of Fridley, Minn. N° 7814 BURDING PERIMT5 Date: June 9, 1965 owner: Beggenstoss miu,= Builder iioyer Constr., Ca. Address 7399 Tempo T ma -g E. Address 5213 W. 61st Street LOCATION OF BUILDING No. X99. street _Tempo Terrace N• E. Part of Lot Lot 16 _ Block 4 Addition or Sub -Division Melody Manor, 2nd Add. Corner Lot _ Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation To be Used as: Type of Construction Front DESCRIPTION OF BUILDING Depth Height Sq. Ft Front Depth Height Sq. Ft. Est. Cost $7 00.00 To be Completed Storm damage repair Cu. Ft Cu. Ft In consideration of the issuance to me of a permit to construct the building described above I agree to do the proposed work in accordance with the description above se forth and in compliance with provisio of ordinances of the city of Fridley. �C "�lla In consideration of the payment of a fee of 1$ 0,00 ,permit is hereby granted to Hoyer Coilstr! -Coo 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. AUen Jensen Building Inspector NOTICE: TW peemb don Mt ewer the coedrudim, huh n fon for vA&& plumblap, Bn hee8n& sewer or wster. Be sure to see the Budding inspector for s wmft pwff&s for these [toms. LOCATION ' OF' BUILDING No. Street Part` ouLot` LOT BLOCK�ADDITION OR SUBDIVISION Corner Lot _Inside L Setback ' Side+Yard SMk': XLEVAT'i©N . ,IsF 2 5 ` OELEVATION Applicant attach to this form Two Certi0cates o€ Survey of Lot - and proposed :`—building location drawa on these Certificates.` DESCRIPTT014 OF >3VILDING ` ' 7 "to be used ast Front Depth Height Sq. Ft. Cu. Ft, Front tie, pthHeight Sq. 'Ft.u. Ft: Type of Construction ��ixa- tit. Estimated Cost. .To b4 completed The undersigned herebyinake's application'-fora*,permii for the wbrk here i'ipecifled, agreeing to do all work in strict accordance with the City of Fridley;prdinances presentations `stat`ed-in this`Applicati`on are true and correct;'. a facts and rules 'of the De artinent of � Build'in s acid 'here declares ihat••all th and re DATE?ule � SIGNATURE(Sche o€ Fee Costs can be found on the Reverse Side), wovw cvksc-vir�(-�W- RrioA11Qd irrt4 our Zioati.ck i+P ����� �W�e \ �VC�, C`L►�C iICY I����� ��a V-�K�S BUILDING PM=T 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 build- ing or structure, or for any alterations or repairs 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; 2,.1. 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 thousand cubic feet, classified as "fireproof" by Section 502 -of the Minneapolis Building Code. ROUSES 2.3. For any.such permit.for the erection of any non -fireproof building, other than a garage, warehouse, factory or grain elevator, or any non -fireproof addition, for similar occupancy, to any existing building - permit $1.00 for each one thousand cubic feet. GARAGES -.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 - ninety cents ($0.90) -for each one thousand cubic feet or fraction thereof, in the cubical contents thereof with the minimum of $4.00. For the purpose of computing fees for building'. permits, the cubical contents of any building or addition to a uniform height throughout by multiplying.the ground area covered from a point six (6) inches below the floor line of the basement or cellar to the average height of the upper surface or to the average ..height of the roof surface of .the main gable of a pitched roof.. .5.For repairs or alterations to an existing structure, the fee ¢hail be at the; rate of $3.00 per.each Five Hundred Dollars ($500.00) dor fractiod a 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. SUBJECT E �, City of Fridley ® 14039 AT THE TOP OF THE TWINS BUILDING PERMIT" r NO. COMMUNITY DEVELOPMENT DIV. UECIPT PROTECTIVE INSPECTION SEC.� ' . ' 1 . � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 5j2/77 JOB ADDRESS 7399 Tempo Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 16 4 Melody Manor 2nd Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Carrol Rahn 7399 Tempo Terrace N.E. 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 ElALTERATION ❑ REPAIR ❑ MOVE ElREMOVE X 8 DESCRIBE WORK Construct a patio deck (12'.x 16') 9 CHANGE OF USE FROM TO StIPULATIONS Before digging call local utilitie TELEPHONE - ELECTRIC - GAS Etc REQUIRED BY Ltd SEPERATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS. 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. $300 $.5O 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- $7.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $8.0,0 SIGNA7 RE OFCONTRACTOR O HORIZEDAGENT (DATE) WHEN PRO ERLY VALIDAT D THIS IS YOUR PERMIT BLDG INSP DAT SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: >°�� ' P a', BUILDER: Address: %3 a.r�°�.Address: Tel. No.: ' No. LOT: 1(_0 Street: BLOCK: ADDITION: p y yy���.. 4 � CORNER LOT: INSIDE LOT: a SETBACK: SIDEYARDS: 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: Front: Square Feet: Front: Square Feet: Type of Construction: To Be Completed: Depth: Cubic Feet: Depth: Cubic Feet: Height: Height: Estimated Cost: $ Ae) Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) 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 representations stated in this application are true and correct. See reverse side for additional information. DATE: .11 7 SIGNATURE: Stipulations: BUILDING PERMIT FEE SCHEDULE SECTION 2. The Inspector of Buildings 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 repairs 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: NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet. PLAN CHECK: 25 percent of building permit fee. DRIVEWAY DEPRESSION: (Concrete Curb Streets Only) Alternate A: Removal and replacement of concrete curb and gutter only; Driveway width plus 6 feet x $11.75 Alternate B: Removal and replacement of concrete curb and gutter and install a 3 foot wide approach with 6 inch depth; Driveway width plus 6 feet x $15.40 A.13lo ww �llim► � . 'I.jOMM For the purpose of computing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or the cellar to the average heights of the upper surface or to the average height of the roof surface of the main gable of a pitched roof. 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 fraction thereof in the cost of all proposed work. In -no case shall the fee charged for any permit as set forth in Section 2 be less than $7.50 plus $.50 state surcharge. VERIFICATION OF FOUNDATION NOTE: 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. CERTIFICATE OF OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. e News Printing Co., Walk. Nebr. Form 216 \-� i®x I l Nil oc....._ -�.......>, mm d .... ff ..... i ....>....,. ,., m _.,. 40 ...>,,,...,?„.......»..,..(..........�,-.n .......«,,,._.......»�:..... _..-._`�'_.,'._""'".".' .....w...« i :....,, a....., ..v---._. ._...... ...«......,. ........ ._._... .„<...a. ,>... tf ... , 3........,...� ....,a .. .:..n.....::..:.. ........-., : : C C _ I ••Y a L a s i....I j � _ P . f P E t j i p S a� qqq I oore S • _Y P a Y t f < f!7 41-01 a 1 s _ News Printing Co., Walk. Nebr. Form 216 \-� i®x I l Nil 01, SUBJECT RMIT NO. City of Fridley o 16 5 9 6. AT THE TOP OF THE TWINS BUILDING PERMIT r R NO • COMMUNITY DEVELOPMENT DIV. j PROTECTIVE INSPECTION SEC. ® CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 5/25/82 JOB ADDRESS 7399 Tempo Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 16 4 Melody Manor 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Carrol Rahn 7399 Tempo Terrace N.E: 786-0265 3 CONTRACTOR MAIL ADDRESS 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 Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 2414" x 12' Addition to Dwelling 9 CHANGE QF USE FROM TO STIPULATIONS mv i Ag 0010 W SEPARATE PERMITF, ftQpitEjD Folt1WRI '033 sve - 3WID313 " t31 HEATING, P"JIMBING AND . S N&. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 12,750 $6.38 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- $98.50 NONE STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $24.63 $129.51 SSIIGGN/N//AT////Ujj�iiiE OF CONTRACTOR OR AUTHO ED/A/✓GENT (DATE) WHEN PROPERLY VALIDA�TLED THIS IS YOUR PERMIT /1 e � fo � � • / 6! BLDG INSP DATE tidT��1 SIG URE OF OWNER IIF OWN E R°BUILDERI IOATEI 01, CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATIM FOR RESIDENTIAL BUILDING PER4ITS (Nest, Alterations, Additions, or Repairs) O1114ER:C40"04. MAJ ADDRESS: 739? r4600 o TEL NO: W6 — to /- 9z BUILDER: ADDRESS: TEL NO: Construction Location STREET NO: STREET:j�It- LOT: BLOCK: ADDITION: ��6�,�® �� p 1-) 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 _h, -1®s Front: `� Depth: Height: �® Square. Feet: ?C{% Cubic Feet: Front: Depth: Height: Square -Feet: Cubic Feet: 292 �!3•S t'Z%moi Type of Construction: LA -o-Q 8 FeAf 1. L Estimated Cost: $ To Be Cbrnpleted: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET Tile undersigned hereby makes application for a permit for the %aork-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 representations stated in this application are true and correct. DATE: 'S SIGNATUM: Stipulations. - 9M(I VA qf'to tipulations:Pis(IVAi,P 9. ,� BUILDING PERMIT FEE SCHEDULE The Inspector of buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any bxisting building or structure, or for any alteration or"repairs 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 $15.00 plus surcharge $501 to $2,000 $10.00 for the first $500 plus $1.50 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $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 to $50,000 $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 to $100,000 $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 and up $443.00 for the first $100,000 plus $2.50 for each additional $1,000 or fraction thereof PLAN CHECK: 25 percent of building permit fee DRIVEWAY DEPRESSION ESCROW: Concrete Curb Streets Only Alternate "A": Removeal and replacement of curb and gutter only Driveway width plus 6 feet x $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 x $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. AGREEMENT . I, owner of the property located at 7.3R 1 I / -e m Pa P-P-RC'e, have no objection to the City allowing the construction of a to be located at "7-3 V % 7�mn® %� ✓-1 e without the required certificate of survey that the City ordinarily requires for all new construction. S g ature x-39 tl Addres's Date Al fitness u 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 A REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace Gas Piping (Needed with new furnace) Gas Range Gas Dryer Rate TOTAL $ 20.00 $10.00 $ 10.00 $ 10.00 $ "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 MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 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. JOB AD 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 ruling of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. �/_Z_'�p- ,199if OWNER C� f/ � n BUILDING USED AS &w -s -e ESTIMATED COST7_5'�. V • PERMIT NO. ✓�� C' a DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units— _ Circle One (Steam) (Hot Water) arm Air A' Trade Name ee, ®� Size No. � BTU . 4z4; HP EDR Fuel Total Connected Load _ v Burner Trade Name Size No. BTU • HP EDR HEATING COMPANY Signed By xf Approved lei Rough -In Date _ Tel No. Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 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 RESIDENTIAL LOAD CALCULATION Purchaser (�-V�rrrc, , � �� 414 Sales Rep 0/1111kit-'e Date Address 2191-LE1,11al —1.IOL-L- e ' Sq Ft gross wall Running walls below grade: x_(Ft wall Ht)= below grade _ Sq Ft windows and doors below grade Net wall below /r); % rafiea '-�� Sq Ft gross wall Running walls above grade: � x(Ft wall Ht)= 102 )above arade(1st floor) (1st Floor) Running walls above grade: (2nd Floor) x (Ft wall Ht)= Ft gross.wall Ft gross wall tal gross Sq Ft Sq Ft windows and doors above grade Net wall above 7 c trade Windows & Doors Sq Ft x HTM = TUH Inf.(w&d x 1.3) Z7 Sq Ft x HTM = ®BTUH Net wall below grade t0 Sq Ft x HTM =� BTUH- T Net all above gradel�j� Sq Ft x © HTM = =? BTUH Exposed Ceiling Sq Ft x HTM = BTUH Exposed Floor Ij Sq Ft x HTM = U�ZBTUH _ BTU TOTAL Windows & Doors G Ceilings & Floors 5 � 2 410 W. LAKE ST. 1072 PAYNE AVE. MINNEAPOLIS, M N 55408-2998 ST. PAUL, MN 55101-3892 612/824-2656 CC:TINGANDAIRCONDMONINGCOD 612/772-2449 'Serving 7we 7ivin Cities Since 1930' 4 ORSAT TEST RECORD ADDRESS 2, CITY OCCUPANT OWNER / l(' A(' DATE HTG. INST.���/ INSTALLED BY GAS LINEw BY ,5 (/4A4 TYPE OF HEAT: GA FA 4---t STEAM SPACE HTR. :a UNIT HTR. OTHER GAS DE51GN CONVERSION MAKE MAKE OF BURNER MODEL 6V40 Po 1 40,1,,-)-0 /✓v MODEL SERIAL �y ��� MAX. ---; INPUT e� �\�✓`S MAKE CONTROLS MODEL BTU RATING OF FURNACE THERMOSTAT�,> HEAT PLUG VENT SIZE ;? t ` 146160 VALVE zl% k KIND OF LINER c'14SS J�' LIMIT / DRAFT HOOD O� SIZE 5�'t NONE REGULATOR �` LIMIT SETTING / 0 CHIMNEY CONSTRUCTION FAN SETTING / %®® DRAFT TEST TAG(!S4 j' G 4A1! PILOT TYPE LIGHTING INST. PILOT MAKE PILOT MODEL � r� PILOT TIMING ,% S PRESSURE _) PERCENT CO2 ` --) DATE INPUT CFH PERCENT 02 STACK TEMP ^PERCENT CO NAME SUBJECT PE NO. City of Fridley 30166 AT THE TOP OF THE TWINS BUILDING PERMIT r O. COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. 1 . � i A CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY ��"',.� -.•- L J` 612-571-3450 910415 9/3/99 JOB ADDRESS 7399 Tempo Terrace 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 16 4 1 Melody Manor, 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Carroll Rahn 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Ea leview Const. Inc. 2937 174th Ln NW Andover 55304 753-5469 20067043 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 ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (28 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 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 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 $2447 $1.22 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CH GE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $83.25 f FirC $2.45 PLAN CHECK F TOT EE Lice S 5 .92 'NATURE OF CON'RACTOR OR AUTHORIZED AGENT IOA E, EN RO e M A I THI$ U E M S,GNATURE OF OWNER„F OWNER BUILDER, IDATEI 1 0 BLD I S� - gATt NEW [ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY �0 ALTER [ ] SINGLE FAMELY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: 0/U, -73W /para Legal Description: Owner Name & Address: ( 4"X /C+Ai i Tel. # Contractor: C two=� -�' . �,r. c - MN LICENSE # Address: wat 3 7 ! -7y LA,,k 9Jj J , A4-4� ,; S 3 o (lTel. # '7 S3 - s q &7 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: LenT Width Hgt/Ground Sq. Ft. OTHER: 0 � Construction Type: baac a " ` -R 6"�timated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =S DATE: APPLICANT:W - Tel. # CITY USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee $ Sewer Main Charge TOTAL STIPULATIONS: 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 [ ] 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 VALUE FEES $1 to $500 $23.50 $501 to $2,000 $23.50 for first $500 plus '$3:05 for each additional $100 or fraction thereof,. to and including $2,000 $2,001 to $25,000 $69.25 for first $2;000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 to $500,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $500,001 to $1,000,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $1,000,001 and up $5,608.75 for the first $1,000,000 plus $3.15 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 $15.50. 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 $23.25. 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 it has been constructed will be required before proceeding with the framing. CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 763) 572-3604 FAX: (763) 571-1287 ADDRESS 7399 TEMPO TER NE PIN 113024130056 LEGAL DESC MELODY MANOR 2ND ADD LOT 16 BLOCK 4 PERMIT TYPE BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WINDOW/DOOR REPL PERMITO.: 2004-01866 DATE ISSUED: 10/13/2004 VALUATION : $ 2,300.00 NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS. INSTALL BASEMENT EGRESS WINDOW TO MEET THE STATE BUILDING CODE WITHIN THE EXISTING OPENING.. STATE LICENSED CONTRACTOR 1 APPLICANT NORTHERN CREST INC. 7401 CENTRAL AVE NE FRIDLEY, MN 55432 OWNER CYNTHIA STRONCEK 7399 TEMPO TER NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating co It 'o or erfor ance of construction.Annlicant / � // Date lam(, Bldg BUILDING PERMIT FEE 83.25 FIRE SURCHARGE 2.30 STATE SURCHARGE, VALUE 1.15 LICENSE SURCHARGE 5.00 TOTAL 91.70 PAID WITH CHECK # 5651 SEPARATE PERMITS iEQ&RED FOR WORK OTHER THAN DESCRIBED ABOVE. NEW [ j CITY OF FRIDLEY Effective 4/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION q -dg l� �- C) Construction Address: "913 7"Ll190 T-W'"Ie-- Legal Description: Owner Name & Address: C v tla �` Ince.,' Tel. # �` � zn Contractor. Iva V\_frt-P- J -1-1a MN LICENSE # ejo !2 E Address: jai. I A V4e - IVJ Tel. # 763— '7,7)- gT-d 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 Width 1 _ Hgt/Ground Sq. Ft. OTHER:��� bmt!51�611� �1�cPSI���5 �SiCd�� �ih1 �" 'I Construction Type: Estimated Cost: ®� Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: -0 q APPLICANT: a6az Tel. # Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee $ 'per- Fee Schedule on Reverse Side Plan Review $ 65% of Permit Fee Fire Surcharge $ 3 0 .001 of Permit Valuation (1/10th%) State Surcharge $ / /4 $.50/$1,000 Valuation SAC Charge $ $1350 per SAC Unit License Surcharge $5.00 (State Licensed Residential Contractors) Curb Cut 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 $ I. STIPULATIONS: 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 VALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof CURB CUT ESCROW (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined rate 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. VERIFICATION OF FOUNDATION A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Onto Building PLUMBING Permit No.: - By: e(( Inspections RESIDENTIAL APPLICATION ved � IJ`"1�ec'd� 763-572-3604 CITY OF FRIDLEY DATE M y 25 2047 YOUR E-MAIL ADDRESS wnelson ,larson[3lumbin%com SITE ADDRESS 7399 Terrace Tern_ THIS APPLICANT IS: 0 OWNER ®CONTRACTOR PROPERTY NAME: Cindy Stonceck ADDRESS: 7399 Terrace Tempo CITY Fridlgy STATE ZIP OWNER/ TENANT PHONE: 763/273-6402 CONTRACTOR NAME: Larson Plumbing Inc STATE LICENSE # 3341 PM EXP DATE 12/31/2006 3095 -162nd Lane NW CITY Andover STATEMN ZIP 55304 SUBMIT A COPY OF YOUR STATE ADDRESS: LICENSE WITH PHONE 763/427-7680 FAX 763/427-9446 APPLICATION PERMTT TYPE 11 SINGLE FAMILY O TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 5P NEW 0 REPLACEMENT DETAILED DESCRIPTION OF WORK Back Flow Valve PER MS 168.665 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 AV FLOOR DRAINS —SHOWER _ WATER PIPING _ _ BATHTUB GAS PIPING OEM Cm uczw4 _ SWIMMING POOL —WATER SOFTN•ER ($35) CLOTHES WASHER KITCHEN SINK _ WATER CLOSET J,,,,• BACKFLOW PREY. ($15) _ DISHWASHER LAUNDRY TRAY —WATER HEATER ($35) FOR IRRIGATION _ WATER METER —OTHER .......... ......_..._._.. ... .....................,P.�r:�:3,°;o>aX:r;.,,mx3;T.'rT1 •-ry�.•.;,j-�'�tt�j,,.. Lam. ��r{{O,�/R-+ r• . ,s..,, ��..;VaLC. '`.� ��+-.?� �:�:r,. a.. vs; ;w.: .�-...fi.� ,;:•�,�• .t:;„,r..<,. .�:: -.u:�. :�<- .::. t:n�: 110,R. - Hl� r��•`•:e;...e`s.,:�'r:'`.=.G....'Al..<�;.�nY'�tr.,n.Y ,-7:�. . Permit Permit Fee $ 15 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 $ X5 .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 theA694f all wo;h w,knjequires review and approval of plans. SIGNATURE OF City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, NIN 55432 763-572-3604 FAX: 763-502-4977 5/2