PRE 2010 DOCSVj
BUILDING PERMIT
IOT° 2347
Valla a of Fridley.) Minn.l.
Date40�71
}A ABuilder
.............................
Owner t`.
7
.......... ..............................
Address ..........
.............. ..,.......... Address ...........
J—OCA371QN JQ9.. BUILDING
A
No. ..........
Street ....... ... ............ Pqrt of ...... ......
Lot :� ....
Block ............. Addition or Sub -Division .. .. .
.
�
y...
Corner Lot ............
Inside Lot ............ . de
Setback Sideyard ....................
....
DESCRIPTION OF BUILDING
T be Us , as:
Front ,... DepthHeight ......... Sq. !Ft......... Cu. Ft. ........
.....
� ..
e.'
Front
......
Dept. .. Height y„�. Sq. Ft. Cu. Ft.
........ ........
Type of Constructio
............ Est. Cost .. .'............. To be Completed ...................
In consideration
f 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 aboveset forth and in compliance with all provisions of
ordinances of the vill
ge of Fridley.
i
n
f the payment of a fee of $........ , permit is hereby granted to ..... .... ......... .
... ................
.. to construct the building or addition as described above 'This permit is granted upon
the express condition
t the person to whom it is granted and. his agents, employees and workmen, in all work
done in, around and
pop said building, or any part thereof, shall conform.. in Fall ,respects to the ordinances of
Fridley, Minnesota r
arding location, construction, alteration, maintenance, repair 'and moving of buildings with-
in the village limits
d this permit may be revoked at any time n vio t any of the provisions of said
ordinances.
. .. .. ... Building Inspector
NOTICE:
This permit d
not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water.
B sure to see the Building Inspector for separate permits for these Items.
J
P1.•r, .+��r.Ir.V... sal �.r+c.•.. «. �.: ,7 �._•.!'.... r... is �i.'�.+.-_� �rr� HC'•�l�.n ;%.. p� S!°�. ...1•'?—t °r��. t'i�r-: C.'.......^:.•. --ssitt vi
L`v it»w:. :: �`.. a wCa •.:..d a ...ti:e .i. ,. ,,..,...�.... ri w:a. (. -. .. :a .+r :...� ';}...c �..: <v%..d C'.�y
;1C.00 m
czrh add. izoo.^J 3 V0 3
S:.e?I 4: ^,:; : Work to I: nOo BiV
r-C�% add. COS= 'B71"
..��.:. .. tit ...:P'a .......r'—L: �^• to 1,5r. -O.00
g. ... J.r A.tr tics each add. $SOO.CO
4-N 57. ft Fz? S'..:w^.1
..me- ze 64; :,G :t. Z R f?ot Water
£at^ and :t•; s. 't Ln:: S•r:�m(
F-ach add. 32^ r;.:t EDR Hot Wtatet
CIL z NZ-F—:o 3 gal. W. hour
ovr. 3 Lal. per hour—Sec Fee Sch:ule
GAS :=X -Mt (t:y to L"5, w BTU)
o,•t•:
Is. 3 F.x:ures
Add.*Xnal
G:.s FL-ne.
Sa.... l.r.•r i.�. �.i J�J.LrY":Y
^0D
a
..SIC
5
3.L"1
v
5. MJ
s bp
$.t�3,
3.00
S10.rn
a
20 co
S.
3.00
S
,"..C~? 3
ro ?/%iz TOTAL
7, .75
z., 5M S
Sta"a Surcharu, ,50
e
City of rz dIC-f:
Tht i:ndr- fr^c� hcrebti r ta'.{r. appltca :en :o- a ; ;r-: it for L,e aor� *.e--
spccui�d a,, �:-5 ;o do all •aCr:, in :ict ac;o-dance with ..:e C:: C.d: _ r.
and ri31irg.of *he ••° yn3 he:cby decl ::s 'Sat a:l thr :.c
and r.'Ur':�Pntatiu:�; s;a:rd in oris app-caucn arr tr,:c a:,d cc::-.^•::.
Own"
Kind of
Used as
d
To 1>e com ieted about
z � y
Es:ima'c Cosmo 5&
a..G�i..11yri O: �es::[�. �L,..raj•'..:'.'.)'--C7�^;.:.ti',iCt i.1�.:'•,�F"w..:.a �:�--•'i0--��_.
Trade Name SL Ho
Capacity___.._.—__._. � S-,. Pt- z', 7.R �•
Total Ccrm: --ted f✓.�^_d `C: -L---' cf r'1.-'
ss'v:ti.:r? -- T errs iia fie_ S:c^. rSrkt2
'No
C„I+ c:fy So. J -,-L E.:)?2 a v w
Subur
8419 Center Drive
-'
0 Mi'1066M 554372
Inspections RESIDES PLICATIOiN C\���Lt
763-572-3604 d
.
E
DATE 2-h9Ioq
YOUR E-MAIL ADDRESS
° U
SITE ADDRESS
THIS APPLICANT IS:
OWNER
CONTRACTOR
PROPERTY
OWNER/ADDRESS:
NAME: DKAA—
��I
- 'I j
STATE�ZIP j 'Z
TENANT
PHONE:-iu- - s-�"I
-
COMPANY NAME: IL
I Vet- Ciel She-&
CONTRACTOR
SUBMIT A COPY OF
CONTACT PERSON:
YOUR. STATE
STATE LICENSE #
EXP DATE
STATFIW ZIP
LICENSE WITH
ADDRESS: iqr
&i/l 5 /u� �� CITY d` �l�
APPLICATION
PHONE ��� _ �a�l
' f FAX
PERMIT ,TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: o NEW XP-EPLACEMENT ❑ ALTERATIONIREMODEL
DETAMED DESCRIPTION OF WORK
G
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 fxture, 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 TABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW) / ovl
Equipment Installed �!G MFG: MODEL Gl Lff A�_ SIZE/B
MFG:A6MODEL: �C 4o" S�BTIJ ora
MFG: MODEL
-
FIREPLACE M.00_FIREPLACE (GAS) $15.00. _GAS RANGE/OVEN $10.00
_AIR TO AIR EXCHANGEER S15 —FIREPLACE (WOOD) $35.00 NEW GAS HTRGRI$100.0.00
BOILER 535.00 _L,FURNACE $35.00 ,_GAO UNIT HTR $00
—_CHMgEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING 510.00 —VENTILATORS15.00
_ x_.s.., tele'.,.., r.•.....� iUittr'hrn
'..L+�LT. Fii+!i:.1±+e,Wi�...." :.ynren+.pw—'w*.: .e -D-
D Number of fixtures $10.00 x $10.00 = S
Permit Fee $ �D . � @ .
Surcharge $ 50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE S �.4 Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x 535.00 = S
State Surcharge = S 50
Total = '
THE IS AN APPLICATION FOR .-k PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acl0zowledge that ne
Iinformation above is complete and accurate; that the work will be in
-is is
conformance with the ordinances and codes of the City of " -idley and with the Minnesota -Construction Codes; that I understand th
not a permit but only an application for a permit and •.vork s not t0 start •vithout a permit; that the workwill be in accordance with the
approved pian in the case of ail work -.vhich requires review and approval of pians.
]IGNATUnE OF;PPLiC.'�14T 1,�{ i(i1 ��'+y�iB ?PINT : iAIv1E ��'�l'7 ,/✓'' TATE G'
,.:,'.�?: 9� NCS .: E:'?'' 9TE-PER3vI3TS', :RECL7II D,:_"OR Uii ulLiCr IEC' C Y,: iVlE c3i' I.0 iL: ?C.Ifli
aI11G4 fi1�
-ions.—
��IIl�'eIS1TY �.�e:lue _ j - ridle�' _','l�'t