PRE 2010 DOCSDate: June 23_, 1970
Joe Powers
City of Fridley, Minn..
BUR DING PERMIT
Builder
Same
Address 4544 -2nd Street N.E. Address Same
No. 4544 , Street
LOCATION OF BUILDING
2nd Street N.E. _ Part of I.ot
Lot 4 Block 13 Addition or Sub -Division Plymouth Addi tj nn
Corner Lot Inside Lot —.. K Setback __ Sideyard 3'
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Garage Front 24' Depth 22Height 10' Sq. Ft. 528' CtL n 5280'
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Frame Est. Cost _12.p ( 00 __ To be Completed Oct. 1, 1970
Provide Hardsurfaced Driveway
In consideration of the issuance to me of a permit construct the buil ' cribed above, I agree to do
the proposed work in accordance with the description ab set forth and in m ance with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $--1 —0- 0 0 , permit is hereby granted to._._. -Toe Pnsaerc
th
to construct the building or addition as described above. This permit is granted upon
e express condition that the person to whom it is granted and his agents, employees anworkmen, in all work
done in, around and upon said building, or any apart Thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regardinng location, construction, alteration, maintenance, repair and. moving of buil
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of d
ordinances.
ig�44
Building Inspector
HANK MUHICH
NOTICE:
This perndt does not cover the construction, InstaWan for wiring, plumbing, gas heating, sewer or water. Be sure to we
the Building Inspector for separate permits for these items,
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAM:
0`�' 0 P S BUILDER:
:� .6_`i 7 �/I� ��
ADDRESS ADDRESS:
NO:. .� � STREET•
LOT: BLOCK:ADDITION:
CORNER LOT: INSIDE LOT: ETBACK: SIDEYARD:�_
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As:
P Y'
DESCRIPTION OF BUILDING
Front: 2— Depth: Height: l
Square Feet: "5 —Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: '�q'7*1 -9 Estimated Cost: $ ® O O
To Be Completed: 67,C-1
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 1 SIGNATURE
(See Reverse Side For Additional Inform4ion.)
STATE OF MINNESOTA
COUNTY OF ANOKA
MUTUAL AGREEMENT
THIS AGREEMENT made and entered into this �Sr" day of
1969, by and 'between Joseph Powers, hereinafter
referred to as the "Owner"; and the City of Fridley, a Municipal
Corporation, hereinafter referred to as the "City"
WHEREAS, the owner desires to have the City grade and
gravel an alley between Main Street Northeast and Second Street
Northeast to and including 4544 Second Street Northeast, Fridley,
Minnesota; and
WHEREAS, the City has agreed to grade and gravel said
alley if Joseph Powers.signs an agreement to the effect that he
will be responsible for all snow removal on said alley.
NOW THEREFORE, it is agreed by and between the parties
that the City will grade and gravel said alley as above described
and will provide periodic maintenance in order to keep said alley.
passable for automobile traffic.
IT IS.FURTHER AGREED, that Joseph Powers will be
responsible for all snow removal on said alley and that the City
shall be absolved of any responsibility of failure of said Joseph
Powers to remove said snow.
The consideration for this Agreement is the mutual promises
of the party's hereto and each party's reliance upon the others
agreement.
IN TESTIMONY WHEREOF, the parties hereto have hereunto set
their hands this day of ...% .' z_'-� 1969.
. i
Josh Powers
In Presence Of
STATE OF MINNESOTA )
ss.
COUNTY OF ANOKA )
71
On this ! `v *day of 1969, before me, a
Notary Public within and for said County, personally appeared
Joseph Powers, to me known to be the person described in, and who
executed the foregoing instrument and acknowledged that he executed
the same as his free act and deed.
MERVIN J. HERRMANN
Notary Public, Anoka County, Minn.
My Commission Expires Sept. 19, 1969.
f
The consideration for this Agreement is the mutual promises
of the party's hereto and each party's reliance upon the others
agreement.
IN TESTIMONY WHEREOF, the parties hereto have hereunto set
their hands this day of ...% .' z_'-� 1969.
. i
Josh Powers
In Presence Of
STATE OF MINNESOTA )
ss.
COUNTY OF ANOKA )
71
On this ! `v *day of 1969, before me, a
Notary Public within and for said County, personally appeared
Joseph Powers, to me known to be the person described in, and who
executed the foregoing instrument and acknowledged that he executed
the same as his free act and deed.
MERVIN J. HERRMANN
Notary Public, Anoka County, Minn.
My Commission Expires Sept. 19, 1969.
IN TESTIMONY WHEREOF, the parties hereto have hereunto set
their hands this i 1 day of -; 71 !',, .��. ��- 1969.
v
Jack 0. Kirkham
CITY MANAGER - Homer R. Ankrum
In Presence Of
r rTi1.
STATE OF MINNESOTA )
COUNTY OF ANOKA )
On this day of 1969, before me,
J
a Notary Public within and for said County, personally appeared
Jack 0. Kirkham and Homer R. Ankrum to me personally known, who,
being each by me duly sworn did say that they are respectively the
Mayor and the City Manager of the corporation named in the foregoing
instrument, and that the seal affixed to said instrument is the
corporate seal of said corporation, and that the instrument was
signed and sealed in behalf of said corporation by authority of its
City Council and said Jack 0. Kirkham and Homer -R. Ankrum acknowledged
said instrument to be the free act and deed of said corporation.
ERVIN J. HERRMANN
Notary Public, Anoka County, Minn.
My Commission Expires Sept 19,1969.
e �
�
IN TESTIMONY WHEREOF, the parties hereto have hereunto set
their hands this i 1 day of -; 71 !',, .��. ��- 1969.
v
Jack 0. Kirkham
CITY MANAGER - Homer R. Ankrum
In Presence Of
r rTi1.
STATE OF MINNESOTA )
COUNTY OF ANOKA )
On this day of 1969, before me,
J
a Notary Public within and for said County, personally appeared
Jack 0. Kirkham and Homer R. Ankrum to me personally known, who,
being each by me duly sworn did say that they are respectively the
Mayor and the City Manager of the corporation named in the foregoing
instrument, and that the seal affixed to said instrument is the
corporate seal of said corporation, and that the instrument was
signed and sealed in behalf of said corporation by authority of its
City Council and said Jack 0. Kirkham and Homer -R. Ankrum acknowledged
said instrument to be the free act and deed of said corporation.
ERVIN J. HERRMANN
Notary Public, Anoka County, Minn.
My Commission Expires Sept 19,1969.
I
f
sueaEcr
P MIT NO.
City of Fridley
F?" 12559
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
EIPT NO.
• COMMUNITY DEVELOPMENT DIV.
INSPECTION
114141-7
r PROTECTIVE SEC.
1 Ii
1
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
"1 CITY WALL FRIDLEY 55432
".J 612-560-3450
910-F15
5/28/74
JOB ADDRESS 4544 2nd Street N.E.
1 LEGAL
LOT NO.
BLOCK
ACT OR ADDITION SEE ATTACHED
TRPlymouth
DESCR.
4
13
Addn. SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Joe Powers 4544 2nd Street N.E.
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
8 DESCRIBE WORK
28 x 30 addition to 2nd floor
9 CHANGE QF USE FROM TO
STIPULATIONS
1. Install P.C•a arm
SEPERATE PERMITS REQUIRED FOR WIRING,
HEATING, PLUMBING ANO SIGNS _
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
SQ. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
840
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 1 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,
13524
6.76
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-
$10.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
16.76
SIGNATURE OF CONTRA TOR OAAUTHORIZED AGENT (DATE)
WHEN PROPERLY VALIDA IS YOUR PERMIT
B
SIGqATURE OF OWNER( IF W RBUILDER) ID 1
BLDG INSP. - ATE
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME: j�� �(��) BUILDER:
ADDRESS: y`( Bim/ ADDRESS:
NO:. STREET:
LOT:,. BLOCK: / ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDE -YARD:
•
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:
A�a 1, r'1 D &� Front: -2 ZA 3 C Depth :
Square Feet':-,ej ss`;f. Cubic Feet:_
Height:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: tboc l) FVj.MEEstimated Cost: $ e Cj
. l
To Be Completed:}
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.
DATE: SIGNATURE:
.(See Reverse Side For Additional Information.)
,b
r
City of Fridley
P9i �. n for P=Nag td Cv= Rgnbg
Dept. of Bldgs. Phono SM -3930
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures 1'ocaflau
O I3
NO. RATE
TOTAL
S
iO�►
$
Future Fixture Opening ...........
x $1.50
$
_
New Fixture Old Opening .....:....
x $1.50
f�7
V p
O
•
M
WATER NTR.
7'ASFIEC.
Base
Water Heater :Up to 99,000 BTU) . • . •
x $3.00
$
New Ground Run Old Bldg......
x $3.25
$
Electric Water Heater ..............
: $2.00
$
SAS FITTING FEES:
NO. RATE
TOTAL
bt
a
r
t
2nd
3rd
4th
-Future Connection Openings
+ Now Fixture. Old Openings
Connectud vdth
Saver ❑
Ccaapaol ❑
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE
TOTAL
Number Fixtures .................
x $2.00
$
Future Fixture Opening ...........
x $1.50
$
_
New Fixture Old Opening .....:....
x $1.50
3
Catch Basin .....................
x $3.25
$
Water Heater :Up to 99,000 BTU) . • . •
x $3.00
$
New Ground Run Old Bldg......
x $3.25
$
Electric Water Heater ..............
: $2.00
$
SAS FITTING FEES:
NO. RATE
TOTAL
1st 3 Fixtures ................ x $2.00
Additional Fixtures .................. x $ .75
Gas Range to 199,000 BTU .............. x $5.00
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 Cita Ordinance
and ruling of the Department of Buildings. and * hereby declares that all the fact
and representations stated in this application are true anck correct
Fridley,
Owner 'J
Kind of Building E,
Used as 1-4 e YL E_
To be completed about ).2—
Estimated Cost,
Old—New. Building Permit No. it No.
7QSigned .
ROUGH
FINAL
REPAIRS & ALTERATIONS --Rotor to Code .50 State Surcharge
Description ........................................... i
TOTAL 1~ EE $
By -..
Business Phune No --t
192Y
CITY OF FRIDLEY INSPECTION DIVISION
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential Rate TOTAL
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace $ 30.00 $ f -:,-
(Side
-
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace) $10.00 $
Gas Range $10.00 $
Gas Dryer $10.00 $
*Air Conditioning - All Sizes $ 25.00 $
All Others/Repairs & Alterations (LIST ON BACK)
I% of Value of Appliance or Work $
Commercial/Industrial
1.25% of Value of Appliance or Work $
State Surcharge $ .50
Effective On January 1, 1998
JOB ADDRESS Y,5 -L/ Yi ,��� St /-� F
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.
/ - 1998
OWNER �� �� �✓��/�'e
BUILDING USED AS �2 e- L Ci
ESTIMATED COST PERMITNO. 13 3 f
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (St
Trade Name I�n2z-r'*^-
BTU X70& vz, HP
am) (Hot Wat (Warm Air)
Size No. A..)
EDR
Fuel ov_ 4, Total Connected Load
Burner Trade Name
BTU
TOTALFEE
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Size No.
HP
EDR
HEATING COMPANY LA14 6, .� /t% /-//Z
Signed By
Approved ByRough-In Date _
FILL OUT BACK SIDE FORJSTKERIFICATION ON
REPLACEMENT FURNACE
Tel No.
Final Date I % _0
CHE%MY 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 `� C)C) LJ
All other BTU's
TOTAL BTU's /0 .S , Of
7. Has a liner been provided for water heater Yes () No ( )
8. Has combustion air been provided for water heater Yes (--'I-'No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
t Alk
1-17z-�
r
f
CIiYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
January 18, 2001
Roger Frankie
4544 2 Street NE
Fridley, MN 55421
Re: Final Inspection at 4544 2 Street NE
Contractor: Lakeland North Heating
Dear Mr. Frankie:
A mechanical permit was issued on October 7, 1998 for the above noted address to
install a replacement furnace and an air conditioner. According to Section 305(a) of the
1991 Uniform Mechanical Code a final inspection shall be performed on the mechanical
permit. As of this date no inspection has been called for.
The permit fee that was paid covers the inspector's time to check to make sure the
furnace was installed correctly, that the State Mechanical Code has been complied with
for installation of combustion air for fuel burning appliances and that the vent has been
sized correctly with the correct vent connectors.
You will be given thirty (30) days from receipt of this notice to respond. If we do not
hear from you, your permit will expire and any inspections on this installation will require
a new permit.
Any questions can be addressed to myself at (763) 572-3603.
Sincerely,
DAVE -J EN
Building I peci
DJ/mh
Are
CIlYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
April 13, 2004
Mr. Joe Ayers
43442 nd Street NE
Fridley MN 55432
Subject: Driveway Paving Requirement
Dear Mr. Ayers:
Enclosed find the requested City Code Chapter 110 and in particular, Section 110.02 which declares
unpaved- driveways as a public nuisance.
Please contact me at 763-572-3550 if you have any questions.
Sincerely,
Jon H. Haukaas
Director of Public Works
JM.cz
Enclosure
FRIDLEY CITY CODE
CHAPTER 110. PUBLIC NUISANCE
(Ref. 374, 714)
110.01. MINNESOTA STATUTES BY REFERENCE
Minnesota Statutes Sections 609.74 and 609.745 are hereby adopted by reference and be in full
force and effect in the City of Fridley as if set out here in full.
110.02. PUBLIC NUISANCE DEFINED
Whoever, by an act or failure to perform a legal duty, intentionally does any of the following is
guilty of maintaining a public nuisance, which is a misdemeanor:
1. Maintains or permits a condition that unreasonably annoys, injures or endangers the
safety health, comfort, or repose of any considerable number of members of the public.
2. Interferes with, obstructs, or renders dangerous for passage any public highway or
right-of-way, or waters used by the public.
3. Causes obstruction or excavation affecting the ordinary use by the public of streets,
alleys, sidewalks, or public grounds except under such conditions as are permitted by this Code
or other applicable law.
4. Causes any well hole or similar excavation to be left uncovered or in such other condition
as to constitute a hazard to any child or other person coming on the premises where it is located.
5. Accumulates in the open discarded or disused machinery, household appliances and
furnishings, or other materials; or stores in the open machinery, equipment, cars, or materials not
in normal use on the premises where stored, in a manner conducive to the harboring of rats,
mice, snakes, or vermin, or to fire, health or safety hazards from such accumulations, or from the
rank growth of vegetation among the items so accumulated.
6. Is guilty of any other act or omission declared by law to be a public nuisance and for
which no sentence is specifically provided.
110.02. DRIVEWAY NUISANCE
Any driveway located within the city and not paved is a public nuisance.
Any nuisance under this provision must be abated by construction of an approved surface on the
driveway in a manner prescribed by the City. The City expressly reserves and declares its
statutory authority to abate any such nuisances under the assessment and levying powers granted
by Minnesota Statutes chapters 429 and 463. All assessments levied for the repayment of a
hardsurface driveway installation shall be reimbursed in accordance with the terms and
conditions established in each instance by the City Council.
Fridley City Code Section 110.05
"Driveway", for the purpose of this Chapter, shall not include any public owned or dedicated
unpaved road or alleyway used for purpose of access to any property; nor any roadway, path or
other access to a parcel of unsubdivided property that can, without variance, be subdivided in the
City. A roadway or path to subdividable property in the City shall be a "driveway" subject to
this Chapter at such time as the property on which it is located is subdivided and the roadway or
path continues to be used for the purpose of access to the property. Any roadway or path to
subdividable property must be paved to a distance of at least twenty feet from the edge of any
connecting curb or roadway surface in order to qualify for this exception. (Ref. Ord. 1098)
110.03. POWER OF OFFICERS
Whenever in the judgment of a City official, designated by the City Manager, it is found by
investigation that a public nuisance is being maintained or exists on property within the City, the
following procedures shall be followed to abate the nuisance:
1. Written notice shall be issued to the owner or occupant requiring the termination or
abatement of said nuisance or to remove such conditions or remedy such defects;
2. Service of said notice shall be in person or by mail;
3. If the premises are not occupied and the address of the owner is unknown, service on the
owner may be made by posting a copy of the notice on said premises;
4. If the nuisance is not abated within ten (10) days of the date of said notice, the City
official shall issue a code violation citation to the notified owner or occupant.
110.04. ABATEMENT OF NUISANCE
If after such service of notice, the parry or parties fail to abate the nuisance or make the
necessary repairs, alterations, or changes as directed by the City official, said official may bring
the matter to the City Council, which may direct the City staff to abate the nuisance and recover
such expenditure plus an additional twenty-five percent (25%) thereof to cover administrative
costs. The above may be accomplished by civil action against the person or persons served; or if
such service has been had upon the owner or occupant, by ordering the City Clerk to extend such
sum, plus twenty-five percent (25%) thereof as a special tax against the County Auditor for
collection in the manner as taxes and special assessments are certified and collected.
110.05. PERMITTING PUBLIC NUISANCE
Whoever permits real property under his or her control to be used to maintain a public nuisance,
or lets the same knowing it will be so used, is guilty of a misdemeanor.
Fridley City Code
110.06 ABATEMENT ASSISTANCE
Section 110.08
For the purpose of protecting the health, safety, and welfare of its citizens and insuring prompt
compliance with the provisions of this section, the City may, in its complete and unreserved
discretion, offer such financial and other assistance as it may find appropriate and necessary to
mitigate financial or other hardship that may be caused by the enforcement of this chapter in any
particular case, including, but not limited to, the extension of time ordinarily required for the
abatement of any nuisance or hazard, as well as the provision of programs providing for financial
assistance for the purpose of abating any particular type of nuisance or hazard in the City. The
refusal or failure of the City to provide any such assistance in any particular case shall not be a
defense for a violation of this chapter. (Ref. Ord. 1098)
110.07. PENALTIES
Any violation of this Chapter is a misdemeanor and subject to all penalties provided for such
violations under the provisions of Chapter 901 of this Code. (Ref. Ord. 1098)
110.08. SEVERABILITY
Every section, provision or part of this Chapter is declared separable from every other section,
provision or part to the extent that if any section, provision or part of this Chapter shall be held
invalid, such holding shall not invalidate any other section, provision or part thereof.
±suilding
- PLUMB
Permit No. ®lI
rispectlons
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEYD
763-502-49 77 FAX
EFFECTIVE 1-1-08
DATE 2'fl oq YOUR E-MAIL ADDRESS
SITEADDRESS Ll�q I
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY
NAME: LbS
OWNER/
TENANT
ADDRESS: CITY �►'Z���+1 STATE�ZT sJ
PHONE:��:25�� D3otl
CONTRACTOR
NAME: 2-141- Ll+u P�1 i�12f, Cd•
SUBMIT A COPY OF
YOUR STATE
STATE LICENSE # - . EXP DATE
LICENSE, BOND AND
STATE BOND # EXP DATE
CERTIFICATE OF
y
ADDRESS: CITY En STATE /�'Nu ZIP
INSURANCE
_I��!`/l
PRONE �4�1' ' �✓�' 2ig % F A X
PERAM TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW �REPLACEMENT
DETAILED DESCRIPTION OF WORK 14:Lt l�1
PER MS 1613.665 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 = plus SO surcharge
OR
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW). MINIMUM FEE $15.50.
BATH SINKILAV FLOORDRAINS _SHOWER WATERPIPING
—BATHTUB _ GAS PIPING (NEED CITY LIC) _ SWIMMING POOL —WATER SOFTNER ($35)
CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
_ _ _
DISHWASHER _ LAUNDRY TRAY ]:WATER HEATER ($35) FOR.IRRIGATION
_
WATER METER OTHER
i7+`tEM MEdl$7 YCLJaYL�iR't/=�'.
Permit Fee $
Number of fixtures @ $10.00 x $10.00 = $
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
OR Number of fixtures @ $35.00 -T- x $35.00 = $ 35,E
TOTAL DUE $
State Surcharge = $ .50
(MINIMUM $15.50)
(MINIMUM $15.50) Total
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing 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 on site; that the work will be in accordance
with the approved pian in the case of all work which requires review and approval of plans.
SIGNATURE OFA C: T PRINT NAME /V/� LC1lDY%lf� DATE I 0 /
II APPROVED BY ?ATE
r
PLEASE�O` Z: PARATE'i'ERNIITS,ARE'R-OUIRED FOR 3UTLDING:ELE*.--'RiCAL._AiND'ititECHANIC.�L.,,VORK.
-1—
'Ay o 7 ridlev
:wilding Insvections hepar-ne at
1 ''niversin• Avenue '�IE. =ridlev.:iih! "-,L,-
_-_,60d
,L,= -=h0d