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PRE 2010 DOCSV"lage Of Fridley. i BUILDING PERMIT ° 1257 r Date, _ Owner saw i� Address ...... Builder _......... Address NO. LOCATION .. . Street OF CIILbDG . -e IN . Lot... Block .. Part of IPt Corner Lot " " Addition or Sub -Division .. ........ Inside Lot Z ,. ,y :+ ., Setback? •.. -` Sideyard ......... o be Used as: DeSORiP1`[Ol�i r ®F SL.IIL.DI�IO „ Front ,� _Q,a. Depth . � Height a `" ' Sq. Ft. Type of Co Construction 4�Frant Depth ....... , Height Cu. Ft. .. .... _ - . , Est. Cost Sq. Ft. ....... f.':.... . Cu. Ft. ........ s ... To be Completed .................. In consideration of the proposed the issuance to me of a ordinanceswork in accordance with permit to construct the building of the village of Fridle the description above g described above , I agree to do Y. set forth and in compliance with all provisions of In consideration of the Payment of a fee ° .... ....... of $s •e ' permit is hereby the express condition that to construct the building granted to ... '. -t _ done in, around and u the person to who g °r addition as m it is described above. This pent . an Fridley, Minnesota re pan said building, or an granted and his agents in the village Y l�az'i thereof, shy , employeeS and workme meted upon g limits ding location, construction, alteration conform• in all work ordinances. permit ,maintenanm respe� to the may be revoked at any time u ' repair and'movin ordinances of ii upon violation of g of buildings With - any of the provisions of said NOTICE:c`l; J • . .. Bunftg Inspector This per does notcover a sewer or water, the construction, installation or �e sure o see t,' alteration for t"�utlding Inspector for se wiring, p[umbin parate permits for gy gas heating, items. sewer or wager. ee su SUBJECT PER JT'1 City of Fridley 14090 AT THE TOP OF THE TWINS BUILDING PERMI RECEIPT NO. COMMUNITY DEVELOPMENT DIV. t✓ PROTECTIVE INSPECTION SEC. 1 . , CITY HALL FRIDLEY 55432 NUMBERREV. -T- DATE PAGE OF APPROVED BY 612-560-3450. 910-F15 5/18/77 JOB ADDRESS 6337 Van Buren Street 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DescR. 21-22 6 Florence Park Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Richard F. Gervais 6337 Van Buren Street, Fridley, H1 55432 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION [ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Re-siding 9 CHANGE OF 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 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, WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $429.00 .50 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. $7.50 PLAN CHECK FEE TOTALFEE 8.00 SIG ATUREOFCONTRACTTORORAUTHO 1 EDAGENT (DATE) - EN PR ERLY VALIDATED THIS IS YOUR PERMIT �WW SIGNATURE OF OWNER (IF OWN E UILDER) (DATI BLDG. INSP DATE CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: BUILDER: Address: �'p�� % r�t�' Address: Tel. No.. No.: Street: LOT: —off BLOCK: ADDITION: CORNER LOT: INSIDE LOT: 2C 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: AT Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Type of Construction: To Be Completed: Cubic Feet: Estimated Cost: $ 00 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: —19-7Z 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 _ADDITIONAL INFORMATION 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. SUBJECT PERMIT NO. City of Fridley 142 18159 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. �o NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/13/85 JOB ADDRESS 6337 Van Buren Street N.E. 1 LEGAL LOT NO. 21,22 BLOCK 6 TRACTOR ADDITION Florence Addition SEE ATTACHED SHEET DESCR. 2 PROPERTYOWNER MAIL ADDRESS ZIP O PHE Richard Gervais same 571-x/654 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 REsidenti.al 7 CLASS OF WORK ❑ NEW ❑ ADDITION Cid ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof structure 9 CHANGE QF USE FROM TO STIPULATIONS Roof can be the 2nd layer but not the 3rd. Install ridged galvanized valleys.. 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 1F 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 $250.00 .50 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 1�+' STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $15.50 SIGNATURE OF CONTRACTOR R AUTHORIZED' AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT BLDG INSP DATE SIGNATURE OF O NE F OWNER BUILDER) (DATE) r NEW [ ] City of Fridley Effective 4/1/$4 ADDN. ( ] �R-1 AND R-2 I ALTER. [ ] Building Permit Application Construction Address:��?� Legal Description: LoT-s� 1 �� f� �� r e - Owner Name s Address: 1�� fps v� Corz-r�- 14 1' Is Tel. # Contractor: S A uQ 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 Width Hgt/Ground Sq. Ft. OTHER: Qnnn I A) Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side YardWetback Type of Construction: Estimated Cost: $ Z' 06 Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: Q $ See Back Page for $ Explanation DATE: "' 86' Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: APPLICANT. ® '. ® Tel. # CITY USE ONLY $ 10C1 Fee Schedule on Reverse Side $ 25% of Building Permit Fee $ $.50/$1,000 Valuation $ $425 per SAC Unit $ Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 10 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 $1.00 to $500.00 $501.00 to $2,000.00 $2,001.00 to $25,000.00 $25,001.00 to $50,000.00 $50,001.00 to $100,000.00 $100,001.00 and up Fees $10.00 (Minimum Fee is $15.00) $10.00 for the first $500 plus $1.50 for each additional $100 or fraction thereof, to and including $2,000. $32.50 for the first $2,000 plus $6.00 for each additional $1,000 or fraction thereof, to and including $25,000. $170.50 for the first additional $1,000 or including $50,000. $283.00 for the first additional $1,000 or including $100,000. $25,000 plus $4.50 for,each fraction thereof, to and $50,000 plus $3.00 for each fraction thereof, to and $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. CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL RATE TOTAL Job Address Furnace Shell'and Duct Work, Burner (Also replacement furnace) $ 20.00 $ Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Gas Piping $ 10.00 $ Tei. #571-3450 (piping needed with new furnace) Gas Range $ 10.00 $ The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes Gas Dryer $ 10.00 $ and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. * Air Conditioning (all sizes) $ 10.00 Fri ey, Minn. 19_ r All Others/Repairs and Alterations OWNER li of Value of Appliance or Work S KIND OF BUILDING COMMERCIALIINDUSTRIAL USED AS It of Value of Appliance or Work S To BE COMPLETED ABOUT ESTIMATED COST c / �I /� "")Q P� • State Surcharge $ .50 OLD - NEW BUILDING PERMIT NO. PERMIT NO. TOTAL FEE $ Reinspection Fee ($15.00) S / DESCRIPTION OF FURNACE/BURNER Rough Insp. Date HEATING or POWEE PLANTS, Steam, Hot Water, Warm Air- No. Final Insp. �� f°9 X94 Trade Name Size No. �' �lJ 1 Date Capacity Sq. Ft. EDR BTU HP Approval for Permit Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00, Company PLUS $.50 STATE SUI2CHARGE Signed By � Tel. No. *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. Fill out back side for stack verification on replacement furnaces CHIMNEY AND STACK VERIFICATION The undersigned hereby'veri.fies that the existing chimney or stack; 1. 'Has .been. careful ly. _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 connected Yes ( ) No 6. Has Total heating BTU's of All other BTU's TOTAL Rema rk s Company _ Signed By Da to SUBJECT MIT NO. City of Fridley 26517 AT THE TOP OF THE TWINS BUILDING PERMIT i COMMUNITY DEVELOPMENT DIV. V _ PROTECTIVE INSPECTION SEC. r ; C1®l NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 ti.__.11.' �•e 612-571-3450 910-F15 7/9/98 JOB ADDRESS 6337 Van Buren Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 21,22 6 Florence Park Addn . to Fridley SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard 09909= Gervais 6337 Van Buren Street NE 571-7654 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Four Season Roofing & Remodeling, 7930 University Ave, Fridley, 55432 795-9410 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20138780 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Remove & Replace Roof- (17 Sq) -tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State building Code. 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 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 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 $1,417 $.71 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 PRIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $48,50 Fire SC $1.42 ST U ION ORERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTA EE �% � Lice C $5 00 5.63 SIGNATURE OF FACTOR OR AUTHORIZED AGENT IDATEIN OP L VALIDAT - 6L IN P IS HIS S Y PERM?D. DATE - SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY -OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 DI ERMIT APPLICATION BUIL NG P ConstructionAddress: 03-7 Vg,^ Ru e v Legal Description: Owner Name & Address: Q%di ar (Pr ug Is t®331 Una 11c r -ea Tel. # 57L W!®5� Contractor: Fo" ,- S eq j ®K k , r3 d kem ado f ®H � L L C MN LICENSE # Address:,7R3® U % o oer t Jif A cs c Tel. # WE c?glo 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 Hgt/Ground Sq. Ft. OTHER: Remove't- k'e'06ce o C4 Sk," I's Construction Type: Remoue ge Oce KOO Estimated Cost: $ /0 17 (Fee Schedule, on Back). - Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE:. 1- APPLICANT: LWO&Z Tel. # % IS- STIPULATIONS: CITY USE ONLY Permit Fee $ Z Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ `7f $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge _ $ CJL $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL 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 $21 (Minimum Fee is $21 plus surcharge) $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000. $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $574.75 for"first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $887.25 for first $100,00 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5012:25 for the first $1,000,000 plus $2.75 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 it has been constructed will be required before proceeding with the framing. Building MECHANICAL Inspections RESIDENTIAL APPLICATION 763-572-3604 CITY OF FRIDLEY Permit No.: Received By: Date Rec'd: CG,( DATE�YOOUR E-MAIL ADDRESS SITEADDRESS `)&AS A &4 THIS APPLICANT IS: OWNER CONTRACTOR a PROPERTY NAME: F OWNER/ ADDRESS: �—I CITY TENANT PHONE:��� ���---- CONTRACTOR COMPANY NAME: Anderson Heating and Air -Conditioning SUBMIT A COPY OF CONTACT PERSON: _ F�Yt YOUR STATE STATE LICENSE # N�A 4347 Central Ave N.E. LICENSE WITH ADDRESS: 0 -ft APPLICATION PHONE7& Col. Hts, Mn 55421 PERNIIT TYPE !! 'q SINGLE FAMILY O TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 0 NEW XREPLACEMENT ❑ ALTERATION/REMODEL DETILED DESCRIPTION QF W RK C ATEAWIP —STATE—ZIP— _V STATEZIP _V 0 or 5% of the total cost up chever is PER MS 16B.665 the permit fee is a minimum arses denof s a0] fixture excluding the fixtures (�O.Ohouldireflect only the cosotrthe of labor ) improvement, installation or replacement 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 BEL0�0If a MODEL:Ih �7 ✓JA� SIZE/BTU /�/ V Equipment Installed MFG: SIZEBTU MFG: MODEL SIZEIBTU MPG: MODEL: GAS RANGE/OVEN $10.00 A/C $25.00 _FIREPLACE (GAS) $15.00 _NEW GAS GRILL $10.00 AlR TO AIR EXCHANGEER $]5 FIREPLACE (WOOD) $35.00 GAS UNIT HTR $10.00 BOILER $35.00 YFURNACE $35.00 —POOL }EATER $35.00 _ CHIMNEY LINER $10.00 —GAS DRYER $1000 —VENTILATOR S15-00 _GAS PIPING $10 00 — —DUCT WORK $10.00 �. ..� �,n �.�; r i IN!: ;t�� �Rfl ECTS O R:S50 iIf''F',EE pR4CI$;F,OR Number of fixtures @ $10.00 x $10.00 = $ Permit Fee $ Number of fixtures @ $15.00 x $15.00 = $ Surcharge $ .50 TOTAL DUE $ Number of fixtures @ $25.00 x•$25.00 = $ 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 work will be in is conformance with the ordinances and codes of thandity of workFsrnot to startley and iwithouthe Ma permit; that theConstruction work woll berlintaccordance understand with ishe not a permit but only an application for a permit approved plan in the case of all work which _requires review and approval of plans. �7 IC!�G{P� DATE SIGNATURE OF APPLICANT e. ��/ Z ✓�&MSc� .. PRINTNAMEC. City of FritIley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAQ'.: 763-502-4977 From: City of Fridley To: 612-822-5408 Page: 414 Date: 1002006 2:47:28 PM ,Burt ng TLt IJ A I71TN l.T Pei iiill�.: Inspections _ R 763572-3604 ACITY,�� Yate Rev'd__ - DATE- tO C4 (Ck" YOUR E-MAIL ADDRESS �1/�_ �Gs ( �Q&i G (� • � 4'"� STTEpDRFss W33-1 aAkin '5t THIS APPLICANT IS: DOWNER `i )(CONTRACTOR , iPERTY NAME: " -iS -A)W-NEAR/ ADDRESS: CITY STATE ZiP TENANT PHONE:_ -T of - S",� — I1®5_ CQNTRACTOR NAME- A 6 �4btq V1 V b a l STATE -LICENSE -0 AJA 931� 0 EJG' DAii Z-4 26l 10L, SUBMIT A COPY OF YOUR STATE /� e�'1t ADDRESS- bg4-1 0 Id iLJA y Y e S. CPPV T � STATE ziP�� 6 LIrEENSE WITH PHONE (01Z- 51A FAX V17 - 7 -PLICATION APPLICATION P�RMIT TYPE **SINGLE FAMILY. 0 TWO FAMILY Q TOWNHOUSE TYPE._0F W0RK- 0 NEW *REPLACEMENT DETAILED DESCRIPTION OF WORK f f Qt OL °U__ PER IytS I6R 665 the permit fee. is a minimum of SI&SO �" 5"!e-oftwaatal tea up 4e SSwf18 whidtever•is greater, farms impx}vement, 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 oflabor X.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEELS ARE BASED ON 10:0 FIXTURE, EXCEPT WHERE NOTED: FIXTURES: 4ND1CAT$TOTAL NUMBEROF EACH BELOW) BATH SINKILAV DRAINS _ WATER PIP NG _FLOOR —SHOWER — BATHTUB _ GAS PIPING NzsD.cn7uc&2m) _ SWIMMING POOL _ WATER SOF TIMER{$35) CLOTHES WASHER KITCHEN SINK _ WATER CLOSET _ BACKFLOW PREV. (S-15} —DISHWASHER_'LAUNDRY. TRAY WATER HEATER $35) FOR IRRIGATION _ _ WATER METER _ OTHER :..:AAAA: -.> ••:::._..::,-. ..,.: -:AAAA: -' : :-:.,,_:.:..:::.:.....,> :...:::.......-.........:: AAAA >::::•;::: _>:>:_,..>::-=---- -------->---------- <>:>:.:::::: :.._.:.,...:..:....:.,-, ,.:.:..:...:., :..:-.;:..:-::...,::;�`5 : ,AAAA ::1�s:::•: ' <:: Permit Fee $ f ' Number of fixtures � $10.00 _ x $10.00 - $_� — Surehar a .50 Number of.fixtures $15.00 x $1500= 5- - fixtures $35.00 =-S TOTAL DUE $ Number of (a3 x-$35.00 .� State Surcharge = .50' Total _ $ THIS IS AN APPLICATION FOR A PERMIT -NOT. VAIN 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 under-star&--ois is not a permit but only an application for and work is not to start without a permit; that the work will be in accordance with the approved pian in.the To of work w equiresxe. w and aplsroval of plans: SIGNATUREOAPPLICA PRINT NAME T C p 4A q CGATE ...:... ..., AAAA... .. .,. ... .. AAAA... . - C4ty-of-Fridley Building Inspections Departmept 6431 University .Avenue NF, Fridley, MN 55432 763 -572 -3604 - FAX: 763-502-4977 /0 rl