PRE 2010 DOCSCity ®f Fridley, Minn. � 19
6431 University Ave. N. E., Minneapolis, Minn. 55432
BU"LNG PERMIT'
Date: December 29, 1972
Owner: Richard Miller Homes Builder SAME
Adder 16"—Rice Creek Road Address SAME
LOCATION OF BUILDING
No. 160..5—street Woodside Court Part of Lot
Lot—__.5--- Block Addition or Sub -Division Briardal e
Corner Lot ___ X _ Inside Lot _ Setback 35' Sideyard 61 and 18'
)&W* Elevation ___ 906.02 K§�jX ,K 909, 2._Minimum
Wye Top of Foo i n t
To be Used as:
..
Dwelling---- Front 31 '_. _ Depth 26 ' � 2 8 ' Height _2D!_ sq. Ft. 62 , Cu. Ft. 19,24
G ar aize int 21' Depth 2 2 ' Height. 10 Sq, Ft 2 8 0 cu, Ft 2 .80
0
Type of construction Frame Est cost$_2 9 , n.7_.3 _ To be completed June 1973
STIPULATIONS: Provide a hard surface driveway.. Provide a verifying survey before
framing. Storm sewer escrow due of $280.80 when water meter is taken out.
5 .a -k// 0 fe to r y s oe ff X d o y S v f v -e/
WATER LOCATION: Stopbox 12' East of Sewer. SEWER LOCATION: "Y" 59' East of Manhole
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.
$14.54 State Surcharge
In consideration of the payment of a fee of $4 9 , Q_ 9 , permit is hereby granted to v 1 h a r- a Mi; 1 o r Homes
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
W. ithin the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
o7rdiiiances. &—Ajj
�sJC-E.Q.� Building Inspector
DARREL CLARK
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we
the Building Inspector for separate permits for these items.
560-3450
U
Cite"o �Ni d Ce
ANOKA COUNTY
6431 UNIVERSITY AVENUE NE December, 1972 FRIDLEY, MINNESOTA 55421
TO WHOM IT MAY CONCERN:
Whereas the City of Fridley has issued a building permit to construct a
structure at //6-5- WO-6c&ZI-� Ct
Whereas the permit is dated prior to January 1, 1973 and the City of
Fridley did not collect or receive any "Service Availability Charge".
Therefore if for any reason the Metropolitan Council and or the Metropolitan
Sewer Board assess or bill the City of Fridley a Service Availability Charge for
this structure or sewer hook up, we the undersigned agree to and will. pay the
City of Fridley for said charges.
Witness
Signa
H
��! /%.�,- - -
Abl-
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME: BUILDER: P_KMAjZQ Mj1=L= :4oRo_=S
ADDRESS: ADDRESS: BPO® J?jcg CeW-X POND, DL16Y
NO:. .&0 5- STREET: WOODS [DE CoUrL-r
LOT: —BLOCK:— ADDITION: Rem? idyl --C
CORNER LOT: 9eV INSIDE LOT: SETBACK:- _3S SIDEYARD:L �1't
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Front:
—Depth: ?-L"Height: 20'
Square Feet:. -Z- Cubic Feet: W, R
Front: S( Depth :--Z.Z Height: lot I
Square Feet; 46�i, —Cubic Feet: "Zo
Type of Construction: _r0&14S -Estimated Cost:�
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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:' V-- e. Z& SIGNATURE:
(See Reverse Side For Additional Information.)
7I5�
12
167
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thereon,aez: b� rJ Icgnri end �+ er,.� loco r,on of all buildin s, thern, and all visible encroachments, if any, from or Get
sdl� Isind A% sv'.k yed by me rh,s_ _— doy of �_� .+: t__ .. _ A. 0. 19
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SUBURBAN ENGINEERING, INC.
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Minneapolis,
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hSir+n. S5437
un,r i,�,I Cnv�ncarin
Engineers
Surveyors
Telephone 784-6066
Area Cade 612
Certificate
of Survey for
�
s
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thereon,aez: b� rJ Icgnri end �+ er,.� loco r,on of all buildin s, thern, and all visible encroachments, if any, from or Get
sdl� Isind A% sv'.k yed by me rh,s_ _— doy of �_� .+: t__ .. _ A. 0. 19
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SUBURBAN ENGINEERING, INC.
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5 14 I ,
RICHARD MILLER INC.
11MAGINEERS
June 20, 1973 =
Fridley City Council
City of Fridley
6431 University Avenue N.E.
Fridley, Minnesota
Gentlemen:
I would like to request a 90 day extension on 17 building permits for the
following addresses. These houses are all located in Briardale Subdivision.
1616 Rice Creek Road 1650 Briardale Road
1620 Rice Creek Road 6151 Benjamin Street
1605 Woodside Court 6141 Benjamin Street
619 Woodside Court 6131 BenJamin Street
629 Woodside Court 1601 61st Avenue N.E.
1603-Bri'ardale Road 1611 61st Avenue N.E.
1613-Briardale,Road 1621 61st Avenue NNJN.E.
gist N
1623 Briardale Road Nil 61sA..
Iam requesting this extension as there was a lengthly delay in originally
processing these permits and at the time I felt this would not create a
problem. However, there is now a shortage of ready mix concrete and concrete
blocks and many of the builders have been put on certain rations of these
materials. Therefore, it appears that an extension will be necessary.
I hope that you have had an opportunity to drive through Briardale. I am
personally very proud of the houses we have built here and I hope that you
feel they are a credit to the community.
Thank you for your consideration.
Si re y,
hard N. Miller
:cs
786-1600
1600 RICE CREEK ROAD, MINNEAPOLIS, MINNESOTA 55432, AREA CODE 612-n=464
Silty of Fridley
Application for and Gas Fhtkg Penn*
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
Base
• Future Connection Openings I "�'�""� ram
131swsr �
* New Fixture, Old Openings d---9
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ................ 0 x $2.00 $ c;d' (-) U
Future Fixture Opening ........... x $1.50 $
New Fixture Old Opening .......... x $1.50 $
Catch Basin .................... x $3.25 $
Water Heater Mp to 98,000 BTU) .... r x $3.00 s,3- C1 o
New Ground Run Old Bldg. ........ x $3.25 $
Electric Water Heater ............. z $2.00 $
SAS FITTING FEES: NO. RATE TOTAL
Ist 3 Fixtures 1 x $2.00 $ !!K-
Additional Fixtures .................. x $ .75 $
Gas Range to 199,000 BTU ................ x $5.00 $
REPAIRS & ALTERATIONS --Refer to Code
Description ................................................$
TOTAL FEIN $ a�•
Dept. of Bldgs. Phone SO0-3430 0
City of Ridley:
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 &W the fact
and representations stated in this application are true and correct
,Ridley, Mnn
/' 18
Owner
Kind of Building/
Used as
To be completed about
Estimated Cost, It / /1
W& —New. Building Permit No. Permit No. .)/o
m
Signed.
By 'SL
Business Phone No u Y
ROUGH
.
City ®f Fridley
r 4T TNQ TOP OV TNI TWINS
6
tL'-'--'^- COIrMVNITY DHYIL.OrMENT OIY,
PR0TICT1VR WIftCTNIN OIK,
°._ I CITY "LL FPAM49Y 0648
53 -8h -S-917.71
PLUMBING PERMIT APPLICATION
6,:2
Job Address - u 1 44 IDI 1.3 1 1 J. I uuc
1605 N. E. Woodside Court
Owner Address Phone
Richard Miller Inc.
Contractor
MINNEGASCO Address A32 hLtARQUETTE AVENUE one
of Building
tion
6-27-7b
e
Repairs & Alterations
See
Description: Code
State Surcharge Class "A'OSurchsrge .50o .50
TOTAL FEE 5.50
!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 declare that
all°the facts and representations stated in this
application are true and correct.
'Signature Date
10.00
Plumbing Fixture Rates:
NO.
RATE TOTAL
Number Fixtures
x
$2.00®
Future Fixtures
x
$1.50
New Fixture -Old Open.
x
$1.50
Catch Bastn
x
$3.25
Water Heater -99,000 BTU
x
$3.00
Ground Run Old Bldg.
x
$3.25
Elec. Water Heater
x
$2.00
Gas Fitting Fees:
1st 3 Fixtures
x
$2.00
Additional Fixtures
x
$ .75
Gas Range -199,000 BTU
1 x
$5.00 5,00
Repairs & Alterations
See
Description: Code
State Surcharge Class "A'OSurchsrge .50o .50
TOTAL FEE 5.50
!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 declare that
all°the facts and representations stated in this
application are true and correct.
'Signature Date
3oz ds � i
AppIlecaba Poem P�� end
Air candfloam, synow md Devi
• yi Ti: t � ,..
GRAV= WAZX IAM
RATE TOTAL
Furnace Shell & Duet Work
-$10.00 $
Replacement of Furnace
6.00 �---
Repairs & Alterations—up to $300.00
B4Oa $
Repairs & Alterations each add. $500.00
300 $
J3iIEC& VIAM 1
Furnace Shell & Duct Work to 120,000 BTU
ewh add. 60,000 BTU ......
Replacement of Ft rriace
Repairs & Alterations --up to $500.00
Repairs & Alterations each add. $500.00
..$10.00 * 10.00
3.av ;
6.00
6.0() $
3.00 $
Furnace Shell & Lines—to 400 sq. ft. FMR Steam $10.00 $
Furnace Shell & Line ---to 640 sq. ft. EDR Hot Water I0.00 $.
Each add 204 sq. ft. EDR Steam
Each add. 320 sq. ft. EDR Hot Water 3.00 $
OIL BURNIM—to 3 gal. per hour 6.00
over 3 gal. per hour --See Fee Schedule
GAS ZUR (up to MOM BTU) &00 3 * 5. 00
a"a 199,00 VW Soo Few Schedule
GAS FITTING Fes: NO }RATS TOTAL
1st 3 Fixtures x$ ZOO S 2.00
Additional Mrtures x .76 3_— _
Gas mange t D I.0,6W 6.00` $
1605 Woodside Ct.
City of Mdley:
The undersigned hereby makes application for a permit for the work herd
specified. agreeing to .do all work in strict accordance with the City Ordisiancee
and ruling of the Department of Buildings, and hereby declares that arl the fad
and representations stated in this application are true and correct.
Fridley. Minn 5-14-74 1�
Owner Richard Miller Homes
Kind of Building frame
Used as residential
To be completed about, 6-15-74
Estimated Cost;, S 1400.00
Old --New. Building Permit No. _ Permit No.
a, VCWIV(01�1�11
FMA77NG or POWM PLAMS--Steam, Not Watwa Waren Air—No
Trade Name West •Size No FGUB-110P
110M
Capacity—_—. .— Sq. Ft E.D.R BrEj XP
Total Connected Load 5 4' 7 5 3 IrfmA of F�sl
BURNER — Trm& No same as above Size
AIM CONDoN G State Surcharge 10 . A0 Capacity , ED -IL
FAR NZA S F" mcbsimb
West. SL036C 3 tons
VEMMIRE
TWO SYSTM
ALTi 7°S s l r AL3 Tom . lam' $ 27.5 0
FRS \/OGT & CO.
}IfAnNg & A1R COND1ITIONIN6G G �Pirrr� el
929-67
ROUG X_ lag% Py Luwwwta 59426
SALESMAN: John Borry #4649B. haat loss atta
SUBJECT
City of Fridley
2 8149
AT THE TOP OF THE TWINS
BUILDING
PERMIT
f
o
0
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
�%
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
JOB ADDRESS
1605 Woodside Court NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
1
Briardale Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Yasser Adouaish
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Karl Ki huth Const. 1122Z Garnet
-
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
D NEW Q ADDITION D ALTERATION REPAIR D MOVE D REMOVE
8 DESCRIBE WORK
Reroof house and garage 26 S 2nd Layer
9 CHANGEOFUSEFROM TO
STIPULATIONS
Roofing can be 2nd layer but not 3rd.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING. HEATING.
—TYPEOOFCONST.
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 OWLG. 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
$1673
.84
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 PERF RMANCf OF CONSTRUCTION
54.00
Fire SC $1.67
PLAN CHECK FEE
TOTAL FEE
License SC
5.00
61.51
SIGN UAE OF CON' TOR OR AV NORIZED AGENT (DATE,
_a
WHEN PROPERLY
BLD .INSP
IDATED THIS IS YOUR PERMIT
^ � ,
r'A If
S-GNATURE OF OWNEROF OWNER BUILDER, iDATE�
NEW ' [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 16 e�7 W p OQ S jd e Cd/ oY'- cr
Legal Description:
Owner Name & Address: —Y4 S5 ef'- 6 Pe N A ('flTel. #
Contractor: 1 < 11 tom' ( K �r 14 q T' H MN LICENSE # 2�o p
Address: I Z 2.. 7 �—q Y -n { -r C67" /-7- G 1-14 et- Tel. # Y f
Attach to this application, a Certificate of Survey of the22--j
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: Len Wid Hgt/Ground Sq. F/�
OTHER:
a
Construction Type: R �' roo, Estimated Cost: 1073
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE: (0 (� APPLICANT: (/� Tel. # q q q
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge
$
TOTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 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 [ ]
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMRFR C)F FIXTURES TO RF INRTAI I Fn r1N FArW M nnR
Effective On Jan 1, 2000
F CR
•
7
PLUMBING FIXTURE RATES:
R•
�
New Fixtures
' %F •
The undersigned hereby makes application for a permit for the work herein
�®
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser
$ 5.00
and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin
$ 7.00
and repro—n+-2+it%na entad in this nnntiratinn are true and correct.
Catch Basin
$ 7.00
ABOU-AISH, YASSER
Rain Water Leader
$ 7.00
1605 WOODSIDE COURT NORTHEAST 12,`� n
(�7
20
FRIDLEY, NIN 55432 _
Sump/Receiving Tank
$ 7.00
(763) 571-3162
Water Treating Appliance
$10.00
Owner _
Water Heater -Electric
$ 7.00
Water Heater - Gas**
$10.00
Building Used As
Gas Range*`
Gas Dryer**
$10.00
$10.00
®o
Estimated Cost PERMIT NO.__�
Back Flow Preventer Required ( )Yes () No
Type
$15.00
PLUMBING COMPANY ®1��1�J� C
PLUnblAj
Reinspection Fee $47.00/Hr
SIGNED BY / TEL N0. LZ -8Z7 Tj
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
)6 � it
. Approved By Rough -In Date Final Date 1, (�-�-
-Z
State Surcharge
$ .50
NO.
RATE
-s
PLUMBING FIXTURE RATES:
TOTAL
JOB ADDRESS 54MF i
New Fixtures
$ 7.00
The undersigned hereby makes application for a permit for the work herein
Old Opening, New Fixture
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser
$ 5.00
and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin
$ 7.00
and repro—n+-2+it%na entad in this nnntiratinn are true and correct.
Catch Basin
$ 7.00
ABOU-AISH, YASSER
Rain Water Leader
$ 7.00
1605 WOODSIDE COURT NORTHEAST 12,`� n
(�7
20
FRIDLEY, NIN 55432 _
Sump/Receiving Tank
$ 7.00
(763) 571-3162
Water Treating Appliance
$10.00
Owner _
Water Heater -Electric
$ 7.00
Water Heater - Gas**
$10.00
Building Used As
Gas Range*`
Gas Dryer**
$10.00
$10.00
®o
Estimated Cost PERMIT NO.__�
Back Flow Preventer Required ( )Yes () No
Type
$15.00
PLUMBING COMPANY ®1��1�J� C
PLUnblAj
Reinspection Fee $47.00/Hr
SIGNED BY / TEL N0. LZ -8Z7 Tj
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
)6 � it
. Approved By Rough -In Date Final Date 1, (�-�-
-Z
State Surcharge
$ .50
TOTAL FEE
$Ma _50
PLUS THE 7601TATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-k COMMON VENT INFO ON BACK SIDE
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacina an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required.
Yes( )!No( )
The venting system is. plastic/PVC and meets al[current codes and manufacturer
specifications ]ncluding sizing, length, number of elbows and termination.
Yes( ).No(.-)
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
Yes ( ) No ( )
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
Yes ( ) No ( )
When required to install a new combustion air, it will be sized and installed
To meet the current codes and. manufacturer's specifications.
Yes ( ) No ( )
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes () No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance -.;has been -removed from the common vent and vented
separately aspen current codes. Yes( )No.(
)
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat'®
Appliance -#2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING Co:
Signed By: Date :
�f
Building
Inspections
763-572-3604
DATE I— r��P
SITE ADDRESS f6
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
E-MAIL ADDRESS
0 OWNER )(CONTRACTOR
b, i.
Permit No.:
Received By:
Date Rec'd:
A
CONTRACTOR COMPANY NAME: Anderson Heating and Air -Conditioning
SUBMIT A COPY OF CONTACT PERSON:
YOUR STATE STATE LICENSE H a 4341 Central Ave N.E.
, _STATE ZIP
LICENSE WITH ADDRESS: r� Col. Hts Mn 55421 Im
APPLICATION PHONE ZZ9-29/_ 4p.Sf/
PERNIIT TYPE
INGLE FAMILY D TWO FAMILY D TOWNHOUSE
D NEWREPLACEMENT 0 ALTERATION/REMODEL
TYPE OF WORK:
DETAILED DESCRIPTION OF WORK G
the
PER MS 16B.665 the permit fee is a minimum
of fixture excluding the flxtue s� (Ths OShouldwhichever
reflect only the costoflabor )
improvement, installation or replacement of a residential
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 BELONG MODEL: SIZE/BTU
Equipment Installed MFG: MODEL: SIZE(BTU
MFG: _ SIZE/BTU
MFG: MODEL: ______ __— GAS RANGE/OVEN $10.00
TO AI FIREPLACE (GAS) $15.00 _NEW GAS GRILL $10.00
A/C —FIREPLACE (WOOD) $35.00 GAS UNIT HTR $10.00
_AIR R EXCHANGEER $15 —FURNACE $35.00 —
BOILER
AR $35.00 GAS DRYER $1D00 POOL HEATER $35.00
CHIMNEY LINER $10.00 . —VENTILATOR $15 00
GAS PIPING $10 00 —
—DUCT WORK $10.00 FOFflCTS QR$50
Permit Fee $ �• Number of fixtures @ $10.00 x $10.00 = $
Surcharge $�1.50 Number of fixtures @ $15.00 x $15.00 = $
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
it and I acknowledge that the information above is complete and accurate;
that the work will be in
I hereby apply for a building perm
conformance with the ordinances and codes of the Cityit and of Fs not o start ley and lwithou a permth the it that the work.Cwidll be in accordance withthe
not a permit but only an application for a p rm
approved plan in the case of all work which requires review and approval of plan/s•. y� l
%{„j,/1 E • /�•��! � �7 � � �q � DATE
SIGNATURE OF APPLICANT C .. PRINT NAM
City of Fri4ley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAQ'.: 763-502-4977
�If-7b
ARE
Building BUILDING
Permit No.: tiq �3�4
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604
Permit Fee
763-502-4977 FAX CITY OF FRIDLEY
Da
REMfEA
EFFECTIVE 1-1-08
$
DATE • a - D g
Fire Surcharge
YOUR E- ADDRESS
.001 times the total job valuation
SITE ADDRESS / D S D
, `11 r)
THIS APPLICANT IS: ❑ OWNER ONTRACTOR
IJ
PROPERTY OWNER/
Nom: ez-ti
SAC Charge
TENANT
ADDRESS L!%';T:�.a -P CrrY
t
STATEJ�zII' .7 0�
$
G4
PHONE, `� 5-%/—a
Erosion Control
$
NAME:
Park Fee
CONTRACTOR .
ADDRESS: 7
,,
CITY STATRM ZIPS OI
SUBMIT A COPY OF
PHONE /
Total Due
STATE LICENSE
FAXYOUR
STATE LICENSE l � �
#
�
EXP DATE l D
PROPERTY TYPE
INGLE FAMILYINONE= Sim
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED
WS
❑ BASEMENT FINISH 0 ROOF ❑ DRAIN TILE
❑ DECK Cl SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
;nIAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: -.Pu_d
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT S FT
IROORN 0 HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES1.
❑ ATTACHED GARAGE
PROPOSED SIZE:
Existing Floor Plan
2. Proposed floor plan
❑ DETACHED GARAGE
PROPOSED HEIGHT:
3. List of structural members to be used
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,'
❑ Vinyl ❑Soffit
ADDITIONS & PORCHES SUBMIT:
❑ Aluminum ® Trim
I. Site Plan/Sw vey showing the existing structures
❑Other 13 Fascia �' —
1�.
and proposed project.
'WINDOWS
2. Two sets of construction plans
IN EXISTING OPENINGS lkYes []NoLQf TI NOF WINDOWS /�
3. Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE SIZE OF `^f L p , �,y, 'b.-
OPENING CHANGES & 14
c7
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS a
ALL FEES
BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATEMAr c:
ING THE 1997 UB FEE SCHEDULE)
TOTAL JOB VALUATIONS
""Q
OCCUPANCY TYPE
Permit Fee
$2�_
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6; ft = ft x $21= $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
—J
Agreement necessary ( ) Non Necessary( )
Total Due
$ '15
Make checks a abl to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the info on 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 Minns nstruction Codes; that understand this is not a permit but only an application f r a permit and work is not to start without a
permit on site; that the work will be in
th the ved in the case of all work which requ. aw d appro of lana.
SIGNATURE PL ANT PRINT NAME DA
TB� y
APPROVED B DA