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PRE 2010 DOCSSUBJECT PERMIT NO. City of Fridley ® 1 AT THE TOP OF THE TWINS P E R r BUILDING RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. ` "1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 6/13/77 JOB ADDRESS 5682 West Bavarian Pass N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACH ED DESCR. 4 1 Innsbruck Villages SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Darrel A. Farr Development Corp 7286 - 72nd Lane North 560-8110 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 DA NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 27' x 28' Townhouse and a 21' x 22' Garage (Hapsburg Model) 9 CHANGE OF USE FROM TO STIPULATIONS PERMITS RFOUIRED r.w WIRING, WIRNIN6 SEP�� AND SIGNS- Before digging tail W utilities tiEgIN� P<- t11i�R1NG TOMNE. aECTMC - GAS Etc. RFOUIRED By LAW SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES N.ULL 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 796+462 20,002 Total ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 1 STALLS ° GARAGES AND KNOW THE SAME TOBETRUE 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 $25,795 *2 $12.90 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. $80.80 $375.00 PLAN CHECK FEE TOTAL FEE $20 20 $488.90 SIGNATUREOF CONTRACTOROR AUTHORIZEDAGENT (DATE).HE PROPERLY VALIDATED THIS IS Y�yOU PERMIT - BLDG INSP DATE SIGNATURE OF OWNER (IF OWNER BUILDER) - (DATE) AP1' 1,1 C' TI ON I:Ol: PIES I Dl;N' MI,, AL•1-1:1"ATION ) Olt ADD1'1'10.\ BUILDING 1'1:11141T i CITY OF FRI:DLE) , '.1fj\-X1;S0TA 0:�I:I:' S .�AI•.L•' : �i��,�_ �d•���t�. y BUILllI:I.:_ �,�Dg°b�. ._ :�.SS :7 LaKe iii sib° ADDIZESS : :C) : STREET: •_ C 5�4.2 lii�Grtf 2.Ld el�'�1Lf /- e LOT BLOCK: ADDITION: nsh -m 1r,tlt-llatntes CORN -ER. LOT: INSIDE LOT:-. V-00 SETBACK: SIDE"'1aD ; Applicant attach to this form n -7o Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESC4IPTION OF BUILDING To -Be Used As: ��'�' 1 75&zj tej te- Front: Depth: eZQ Height: Square Feet: Cubic Feet: e— Front: 621 Depth: Height: 140 Square Feet; Cubic Feet; 0 , Type of Construction: W004 Feawel Estimated, Cost: To Be Completed: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all cork 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: SIGNATURE: (See Reverse Side For Additional Information.) w * r • .. CITY OF FRIDLEY APPLICATION FOR PWMBING AND GAS FI'T'TING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: let 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction x $3.QO x $2.00 x $2.00 >, m x itu�a x o x x 0 $5.00 Water N W m u H,i id d! C� m 1$4 W w Heater w� m 0 4j $4 'rt 4� x $4 A U � I N C -1 I 4M a�� ci to ra rd O 01 M pq 3 A W i U 9 3 c7 lec C l a f 1st I [ 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: let 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction x $3.QO x $2.00 x $2.00 x $5.00 x $5.OQ x $10.00 x $7.00 x $5.00 x $5.00 x '$3.00 x $1.00 x $10.00 $5.00 $2.00 State Surcharge TOTAL FEE REINSPECTION FEE ($10.00) Job Address 66- CJS 'b aw OL. -'(q q- 5�} Department of Buildings City of Fridley Tel. #571-3450 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 rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this//application are true and correct Fridley, Mn. lam; ` �� , 19_= OWNER /D(1c--Ck- _� KIND OF BUILDING ICJG� U 0 `� SSE l USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. 90 Company LLe b, Signed By Tel. �£ 0 ROUGH INSP. Date FINAL INSP. f ® Date LL// APPROVAL FOR PERMITH� MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE o CM OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE VITY WARM :SIR: F•.irnace Shell & Duct Work R•2 :aca-.er of Furnace Re_ _rs & Alterations -up to $500.03 e airs & Alterations each add. $500.00 HANICAL KAR?S AIR: Furnace Shell & Duct Work to 100,000 BTU each add. 50,003 BTU Be^lace=en- of : urnace Re -t -airs & Alterations -up to $50J.00 Re: airs & Alterations each add. $500.00 TEAM OR IST WATER SYSTDI: Boiler & bines up to.100,000 BTU each add:.. 50,000 B'ZU Boiler only up to 100,000 BTU Each adder. 50,003 BTU RATE $12.00 7.00 7.00 4.00 $12.00 4.00 7.00 7.00 4.00 $12.00 4.00 7.00 G.00 )IL BURNER- to 3 gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $ :-%S BURNER- frcZ 100,000 BTU to 199,999 BTU $10.00 $ (over 199,999 BTU see Fee Schedule) $ ;AS FITTING FEES: 1st 3 Fixtures x $ 3.00 $ 3. Q Additional Fixtures X $ 1.00 $ Gas Rang to 199,000 BTU x $10.00 $ IIP. C.ONDITION:NU s�/rh ,-,� �- �•� $ =iN HE:�TZNu' SYSTEMS See Fee Schedule $ '=NT IL�TING SYSTEMS $ 'ITERATIONS $ REP aI RS 1 $ _ State Surcharge $ .50 TOTAL FEE $ 3 � :--Ti INSP. REINSPECTION FEE Date (.$10.00) ?Z1AL INSP. - Date +PPsZOVAL FOR PER?:IT MI.\IMMM FEE FOR ANY HEATING PER.'KIT IS $7.50 Job Address � � � '®6� � ." � � 'ev`"' Department of Buildings City of Fridley Tel. 571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Cages and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. - .a . 19 � -) OWNER KIND OF BUILDING USED AS TO BE COMPLETED ABOUT 3 ESTIMATED COST OLD - BUILDING PERMIT NO. PER4IT NO. DESCRIPTION OF FU?VACE/BUR!TER HEATING or POWER PLANTS, Steam, Hot Water, Warm ir- No. Trade Name �d "�� �� Size :Io. �� J V 4 cs .e Capacity Sq. Ft. EDR ` BTL' EP Total Connected Load —B, / (, — Kind of Fuel BUR.'QER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Wmpany D iA 9aI Signed By ' r C a Tel. No. e;C,:r� x;17 • c' o _ �✓ sem° HEAT LOSS CALCULATIONS ME-TI]PR CORI DETOWN4 11 Mr. (CO_ MINNEAPOLIS, MINN.. Weatherstrips A.S.H.V.E. Guide Reference 9 Construction No. Insulation Windows Doors Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Yes—No Yes—No Length d Width �"� Height FI.Q� �e� om Length `�.`� Width Height Windows and Doors—Crackage and Area Windows andboors—Crackage No, Width Height of pane of pane 13 6 ® :— and Area No. of Lineal ft. Area lights of crack sq. ft. 2 p1 1-0q No. Width of pane Height No. of Lineal ft. Area of pane lightsof crack sq. ft. � Coef Btu Coef Btu Infiltration Infiltration Glass � � ® Glass Exp. wall Exp. wall Net exp. wall ® Net exp. wal I L Int. wall Int. wall Ceiling Floor ® Ceiling Floor Total Btu. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area AFI. Room Length Width ® Height F1. f Room Length Width . Height Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area No. Width Height No. of Lineal ft. Area of pane of pane lights of crack sq. ft. W,drri Height No. of Lineal ft. Area No. Of pane of pane Lits of crack sq, ft. Z 9 Coef Btu jCoef Btu Infiltration Infiltration Glass ® ®� Glass Exp. wall Exp. wall Net exp. wall 8 Net exp. wall Int. wall Int. wall Ceiling Ceiling ®2— � Q Floor le® Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI ffi4 1 P�.y�, Room Length �i Width %1 Height FI. o Room Length® Width �� HeightZ Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area No Vt,dih He ght TNo. of L Heal ft. Area of pane of pane lights of Arack sq. ft. � d� No.Width Height No. of Lineal fl. Area of pane of pane flights of crack sq. ft. Coef Btu Coef Btu Infiltration Infiltration Igot IY? Glass Glass Ar 4 Exp. wall Exp. wail B ®P Net exp. wall Net exp. wall L Int. wall Int. wall Ceiling Floor Ceiling Floor Tota I Btu. Total Btu. 0 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area PARTIAL RATE SCHEDULE PLUM NG FIXTURE RATES: NO, RATE lA► ,3er Fixtures - ....._-._.x $3,00 Future flicure Opaning $3,00 New Fixture, Old Opening x $2,00 Catch 9iein +x $5,00 %.water Heater - to 99,000 BTU, x $5.100 100; C00 'BTU to 199,000 BTU x 510.00 Hater Softener x $7,QO ' New Ground tin Old Building x $5,00 Elact.rlc Hater Naater - x 55,00 .CAS FITTING FEES; ' x 53.00 - x 51,00 x $10,00 1st 3 fixtures Mditional tixturas :Gas lunge to 199,000 BTU REPAIRS d ALTERATIONS rirst 5100.00 each add. $100.00 or fraction State Surcharge TOTAL FEE TOTAL. S $5.00 5 $2.00 $ $ 8.00 97-8 —879001 ' Job Address � g oWgt Ravvainn Department of Buildings City of Fridley I Tot. M571-3450 , I Tho undersigned hereby makes application fora permit for the wo specified agruaing•to do all work in strict accordance with the Cl and rulings of the Department of Buildings, and hereby declares tl the faotu and reprquuntations stated in this APPlicntlon Are true Fridley, M,'1, 3-6-78 , OWNER DONALD TONN KIND OF DUILOINO frame - USED AS res. . TO BE C014PLETED MOUT 1-13—`18' ESTIMATED COST .20.00 OLD - NEW UUILDIIIG PERMIT N0. ...... -PE IT 110, ---p—Compn MINK CASCO Signed By' ' Tol. No. ROUGIL INSP, Data PI144L INSP, Data ' APPROVAL FOR PERMIT , MINIMUM PEE FOR ANY PLUMBING PERMIT 19 $7.50 I'll a Hato r f O ■■ •t~' h o► c •c+ a w n u N ' w o. liaata r , r Y Aj D .aDi (A A U C .D 0 N ic ..1 a h 8 M 1A 1A 1A 0 a A uci w ti w K x ae Lac '1st • .a ' 2 i.d. .. -a 701 3rd' A 14 th - (R) - rutura Connection Opening Connected with Sugar 1.1 - Nev Fi9m ra, Old Opening Hater PARTIAL RATE SCHEDULE PLUM NG FIXTURE RATES: NO, RATE lA► ,3er Fixtures - ....._-._.x $3,00 Future flicure Opaning $3,00 New Fixture, Old Opening x $2,00 Catch 9iein +x $5,00 %.water Heater - to 99,000 BTU, x $5.100 100; C00 'BTU to 199,000 BTU x 510.00 Hater Softener x $7,QO ' New Ground tin Old Building x $5,00 Elact.rlc Hater Naater - x 55,00 .CAS FITTING FEES; ' x 53.00 - x 51,00 x $10,00 1st 3 fixtures Mditional tixturas :Gas lunge to 199,000 BTU REPAIRS d ALTERATIONS rirst 5100.00 each add. $100.00 or fraction State Surcharge TOTAL FEE TOTAL. S $5.00 5 $2.00 $ $ 8.00 97-8 —879001 ' Job Address � g oWgt Ravvainn Department of Buildings City of Fridley I Tot. M571-3450 , I Tho undersigned hereby makes application fora permit for the wo specified agruaing•to do all work in strict accordance with the Cl and rulings of the Department of Buildings, and hereby declares tl the faotu and reprquuntations stated in this APPlicntlon Are true Fridley, M,'1, 3-6-78 , OWNER DONALD TONN KIND OF DUILOINO frame - USED AS res. . TO BE C014PLETED MOUT 1-13—`18' ESTIMATED COST .20.00 OLD - NEW UUILDIIIG PERMIT N0. ...... -PE IT 110, ---p—Compn MINK CASCO Signed By' ' Tol. No. ROUGIL INSP, Data PI144L INSP, Data ' APPROVAL FOR PERMIT , MINIMUM PEE FOR ANY PLUMBING PERMIT 19 $7.50 City of Fridley SUBJECTIT 71t vt NO. n g AT THE TOP OF THE TWINS f BUILDING PER l - IPT N 1 1 ' ' COMMUNITY DEVELOPMENT DIV r PROTECTIVE INSPECTION SEC. 1 � i -T CITY HALL FRIDLEY 55432 NUMBER DATE PAGE OF APPROVED BY 612-571-3450 910-F15 3/28/97 JOB ADDRESS See Below - Multiple Buildings 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Columbus Exteriors Inc 2131 111 In, Coon Rapids MN 55433 868-9195 3509 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Townhouse Buildings 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reside 11 Buildings 9 CHANGE OF USE FROM TO STIPULATIONS Install building wrap and have inspection of same unless manufacturer" specifications state it is not required. 5600,5602,5604,5606 North Innsbruck Ct; 1511,1513,1515,1517 North Innsbruck Dr; 1510,1512,1514,1516 Trapp Ct; 1531,1533,1535,1537 Trapp Ct; 1511,1513,1515,1517 Trapp Ct; 5610,5612,5614,5616 W Bavarian Pass; 5621,5623,5625,5627 W Bavarian Pass; 5631 5633,5635,5637 W Bavarian Pass; 5651,5653,5655,5657 W Bavarian Pass; 5680, 5682 5684,5686 West Bavarian Pass; 5691,5693,5695,5697 West Bavarian Pass SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING. HEATING, TYPE OF CONST OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING 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 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 $232,000 $116.00 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 $1,547.25 Fire SC $232.00 'C7�r PLAN CHECK FEE TOTAL FEE Lie SC 5.00 $1, 900.25 S,GNA EOF CONTRACTOR OR AU HORIZED AGENT iDATE6 H N P ERLYV (DATED THIS IS YOUR PERMIT S,GNATURE OF OWNEROF OWNER BU,L DER, ,DATE, fiLDG ASP F/ATE CITY OF FRIDLEY INSPECTION DIVISION W1 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILA 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Rate TOTAL Furnace Shell and Duct Work, Burner - Also Replacement Furnace $ 30.00 $ (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace) $10,06 $ Gas Range $10.00 $ Gas Dryer $10.00 $ Tern eat -&A ;kTo L i *Air Conditioning -All Sizes C A 9 c a 4 V kp $ 25.00 $c)5-00 Ail Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work 62a 0� Effective On January 1, 1998 9' 1.` lAgikss �e,'%,DLe 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 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. D) a e.a A-- -,19mi BUILDING USED A 109. ESTIMATED COST NOD. O D PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air► Trade Name Size No, Commercial/industrial BTU HP EDR 1.25% of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge $ 50 Burner Trade Name Size No. BTU HP EDR TOTAL FEE N111MMUM FEE FOR ANY HEATING/COOLINGNENTILATION REF .AIGERATION/ IR CONDITIONING PERMIT 118 425-09 PLUS THE $.60 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjolning property owner. River City Sheet Metal, Inc. HEATING COMPANY 9920e C®On Rapids, 85433 Signed By Approved ByA Rough -in Date Final Date FILL OUT BACKSIDE FOR STAC VERIFICATION ON REPLACEMENT FURNACE I GiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287 August 9, 2000 Kathy Benson 5682 West Bavarian Pass NE Fridley, MN 55432 Re: Final Inspection at 5682 West Bavarian Pass NE Contractor: River City Sheet Metal, Inc. Dear Ms. Benson: A mechanical permit was issued on May 3, 1999 for the property located at 5682 West Bavarian Pass NE for an air conditioning unit. According to Section 305(a) of the 1991 Uniform Mechanical Code a final inspection shall be performed on the mechanical system. As of this date no inspection has been called for. You will be given thirty (30) days from receipt of this notice to respond. If we do not hear from you, we will expire the permit and any inspections on this installation will require a new permit. Any questions can be addressed to myself at (763) 572-3603. Sincerely, DAT/E/JUNSEN Build(4inspector Building PLUMBING Permit No.:�7 InspectionsRESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Recd DATE Ah' YOUR E-MAIL ADDRESS SITE ADD SS KATHLEEN OLSON THIS APPLICANT IS: 0 OWNER CONTRACTOR 5682 WEST BAVARIAN PASS PROPERTY NAME: FRIDLEY, MN 55432 OWNER/ ADDRESS: 7635717191 ZIP TENANT - PHONE: CONTRACTOR NAME: NO LOM PLUMBING CO. STATE LICENSE # .'r6 &!r- l ®�Y 18274D33-- 7'4D 33YOUR SUBMIT A COPY OF YOURSTATE ADDRESS: c o n a- aEmI�Y t r a e� ae a rem c+ ESTATE ZIP LICENSE WITH PHONE F ' APPLICATION PERMIT TYPE SINGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: 0 NEW X.REPLACEMENT DETAILED DESCRIPTION OF WORKcT�act LtJaft✓ y�Q C✓ PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This.should_reflect only.the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 = fo",ROJECTS WHERE LABOR EXCEEDS5500,TEES ARE BASED ON $10.00 PER FIXTURE,'EXCEPT-YaMRE'NO:TED :FIXT-UM:.(INDIGATE TOTAL NUMBER OF EACH BELOW) BATH SINK/IAV _FLOOR DRAINS _ SHOWER _ WATER PIPING _ _ GAS PIPING (vFzDcrrrumm) _ SWIMMING POOL _ WATER SOFTNER ($35) —BATHTUB CLOTHES WASHER KITCHEN SINK _ WATER CLOSET _ BACKFLOW PREY. ($15) _ _ _ LAUNDRY TRAY ,WATER HEATER ($35) FOR IRRIGATION —DISHWASHER WATER METER OTHER `✓ y . b i Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surchar a .50 Number of fix-mras @ $15.00 x $15,00 = $ Number of fixtures @ $35.00 /_ x $35.00 = $ 35.00 TOTAL DUE $ State Surcharge = $ .50 Total = $ 3S. ro 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 ordinTces and codes of the City of Fridley and with the Minnesota Constniction Codes, that I understand this is not a permit but only an ap 'cation for a p rmit and work is not to start witlouf a permit; that the work will be in accordance with the approved plan in the case o 11 work wh' requires review and approval of plans. SIGNATURE OF APPLICANT PRINT NAMEPi��//!!� DATE AbO X67 City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977