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PRE 2010 DOCSCity of Fridley, Minn.. BUILDING PERMIT N°5791 Address Address LOTION OF BUILDING No.,74eg. Street _— _ _ Pari o t Lot_ Block Addition or Sub -Division Corner Lot ._�.�'� Inside Lot Setback -c0-4w'— Sideyard .�._.—.. Sewer Elevation Foundation Elevation DESCRIPTION .OF BUILDING Z11"0 4' o ` s Front Depth Height Sq. F't. � Cu. FtS4L t DepthHeight Sq. Ft. Cu. Ft. Type of Construction Est. Cost . To be Completed _ i 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 all provisions of ordinances of the city of Fridley. y �D In consideration of the payment of a fee of $s�� , permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is grunted 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 within the city limits and this permit may be revoked at any time upon violof any of the provisions of said ordinances. 'on � A Y' Building Inspector NOTICE: This permit does not cover the construction, Installation for wiring, plumbing, gas hBatine, sewer or water. Be sure to NO the Building Inspector for separate permits for these items. 4 A 1P • ! .6 f PPROVED SUIDJEC'T TO TO +YPPJaIIs, C:-tS �ON FOR BUILDING PERMIT &UILDING iId i;�y OF FRIDLEY, MINNESOTATY OF FRI ICY, L�TLSOTA Owner's Name YV4iiJj�e Gam_ LA)Co Builder Address -C/ ; ®- o�� AZ� Address %'54 ®% LOCATION OF BUILDING No. � 7 �� Street of ,%%�S%art of Lot Lot ,� Block %® Addition or Subdivision/_ 14k "04 Corner Lot _Inside Lot Setback side -Yard SEVIER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: 197Y wont \ -.*>4,1 , nenth �4 Heiaht j2n / Sq. Ft. Cu. Ft. s_?/,!Zf_® FrontDepth H eight Sq. Ft. Cu. Ft. Type of Construction C&Al a Estimated Cost,® To be 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 ruling of the Department of Build- ings, and hereby declares that all the facts and representations stated in this application are true and correct. (Schedule of Fee Costs can be found on the evera side) /- `mac. r Application for Power Plants and Heating. Cooling, Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ........................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH.. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. IDR Steam ..... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 8.00 $__9_', v Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ 5—, C' GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ......................� x $1.50 $ /' J O Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL See Fee Schedule $ TOTAL FEE $ Z � 0 Dept. of Bldgs. Phone SII 4-7470 15-9116 S7® t City of Fridley: 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 declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. Owner Kind of Building ®` D Used as Y_ To be completed about 49kz�..-s 0-d— Estimated Cost, $ ep OW—New. Building Permit No. - �� Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS --Steam, Hot Water, Warm Air—No Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load Kind of Fuel BURNER — Trade Size No Capacity Sq. Ft. E.D.R I BTU H.P. �� '?t/&I f ` Glib ,az 2M (REMARKS—OVER) 'TUERWWRIMP,I i By Business 'hon i City of Fridley Application for Plumbing and Gas Fining Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK _.�® � � ��y` Number, Kind and Location of Fixtures Location NY6 [[/�1 G% ern 10 10 > �1 3 1 3F YZ zz yi p -O w a- a�gz udl O?1 <3 ,� (�9� W C9 �Sa 0 Z Z- �O F r N WATER HTR. GAS ELEG Base NO. RATE TOTAL 1st 3 Fixtures ..........................Z x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ 1st 2nd 3rd _ 4th • Future Connection Openings New Fixture, Old Openings Connected with Sewer El Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... 'r'/ x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTL) ...... Z x 2.00 $ O New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..........................Z x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FSE $-:O .tea City of Fridley: The undersigned hereby makes application for a permit for the work beret specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, lV =' - `7 o 19 Owner Zh4� i Kind of Building Used as To be completed about Estimated Cost, $ Old ew. uilding Permit No V / Permit No. ROUGH FINAL 42 ft Signe By Bus' ess Phone No City of Fridley, Minn. BUILDING PERMIT Date: JUNE 18, 1965 Owner: ROBERT L. FRANK Builder Address 5980 - 24 S t . N. E. Address Fridley 21,Minnesota SAME, Owner LOCATION OF BUILDING No. 5980 Street 22 Street N. E. Part of Lot Ir 1.4. 1 & 2 _ Block 10 Avisi Hyde Park Corner Lot _ Inside Lot ddition or Sub -Di on Setback Sideyard Sewer Elevation _ Foundation Elevation DESCRIPTION OF BUILDING N° '7946 To be Used as: D. Garage Front 42 Depth 26 Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Est. Cost —1,.500 To be Completed • DETACHED GARAGE (New) 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 ail provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 11.00 , permit is hereby granted to Robert L. Frank 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 within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. ALLEN G. JENSEN Building Inspector NOTICE: Sk peredt den not carer the can rudion, toatalladen for whing, plumbing, gn beatiog, sower or crater. Be an to sn the Building hupeatar for separate pen ft for thea Nemm APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA a z4XOWNER'S NAME G-L�$UILDER y` .....rte ADDRESS_ 2- S %� /fk!!�! ADDRESS LOCATION OF BUILDING Street S� H� Part of Lot LOTTJ%� Z gLOCK/c") ADDITION OR SVBDIVISION r�,? � (a te Corner Lot_,4_Inside LOT Setback Side -Yard NEWER ELEVATION FOUNDATION ELEVATION 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: Front �2 ` Depth,_a C Height Sq. Ft. Cu. Ft. Front Depth T_Height Sq, Ft. Cu. Ft. Type of ConstructionEstimated Cost f, S a 0, C, C" 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 (Schedule of Fee Costs can be found on the Reverse Side). CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL e e $ Future Fixtures U $ Old Opening, New Fixture _ m $ Water $ 4.00 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Nater Leader $ 5.00 .moi " Hydraulic Valve w $ Sump or Receiving Tank Neater ND Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance Rana - $ State Surcharge $ .50 W Q W (a ti V 14 3 C9 E U O 9 leC lot 2nd 3rd 4th (R) a Future Connection Opening Connected with Sewer (*) . New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture _ $ 1.50 $ Beer Dispenser $ 4.00 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Nater Leader $ 5.00 $ Hydraulic Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance $ State Surcharge $ .50 Reinspection Fee $ ($15.00) TOTAL FEE $ Job Address ; ' qF 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. '/ ® "' Ct® / '195./ OWNER RIND OF BUILDING USED AS TO BE COMPLETED ABOUT / b m '-4- / r I ESTIMATED COST © � OLD - NEW BUILDING PERMIT NO. PERMIT NO. C� / [I,7 Date FINAL INSP. /® ` y " S' 3 Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas Gas Range Gas Dryer Back Flow Preventer Required (4Yes () No Type 0 0 `i Q T $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance _ State Surcharge $ .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 codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. Owner I (. "�."� ,1991 Building Used As �1=9�1 Estimated Cost 15 ° PERMIT NO. PLUMBING COMPANY aQ" SIGNED BY - Approved By Rough- n Date Final Date /2 �G F/ MINIMUM FEE FOR ANY PLUFABING/GAS PERMIT IS $15.00 TOTAL FEE $ L S> PLUS THE $.50 STATE SURCHARGE Water Closet Urinal Bath Tub Shower Wash Drink. Sink Tray I Fount. Floor Catch Drain Basin Auto. Washer Gas Gas Appl. Range Misc. Fixt. Water Heater Stories Gas Elec Basemen Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas Gas Range Gas Dryer Back Flow Preventer Required (4Yes () No Type 0 0 `i Q T $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance _ State Surcharge $ .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 codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. Owner I (. "�."� ,1991 Building Used As �1=9�1 Estimated Cost 15 ° PERMIT NO. PLUMBING COMPANY aQ" SIGNED BY - Approved By Rough- n Date Final Date /2 �G F/ MINIMUM FEE FOR ANY PLUFABING/GAS PERMIT IS $15.00 TOTAL FEE $ L S> PLUS THE $.50 STATE SURCHARGE P SUBJECT City of Fridley 2 9 AT THE TOP OF THE TWINS BUILDING PERMIT ` RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC 1 . � NUMBER REV GATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 9/25/98 JOB ADDRESS 5980 2 1/2 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1, 2 10 1Hvde ark SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Paul Schulz 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof garage (18 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING. HEATING. VENTILATING OR AIR CONDITIONING THISpPERMIT 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 $1542 $.77 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 $51.25 Fire SC $1.54 PLAN CHECK FEE TOTAL FEE 53.56 ECO TOR OR AUTHORIZED AGENT WHEN PROPERL VA.LkD TED THIS IS YOUR PERMIT cID)ATE,]/1jj S-GNATUA�pi f !OATEi Bl NSP PATE P j��'�J (w NE L ] ADDN [ ] ALTER [ ] CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1/1/98 6 f�jgeI ConstructionAddress: �-%s'e " ZlZ oL17 a A) '47'0&, Legal Description: Owner Name & Address: 06 %sem)/L -- S?me /'is 15�& ve Tel. # bI Z • 5&- • `1z 73 Contractor: deVAW-2 MN LICENSE # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF E%IPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Wt'1ooF #4e' 195.004663 fr� Construction Type: Driveway Curb Cut Width Needed: DATE: JWeS' 1/8 Ft. + 6 Ft = Estimated Cost: $ /I °I w (Fee Schedule on Back) Ft x $ = $ APPLICANT: Tel. # CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $d .� L% .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ $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 [ J TOTAL STIPULATIONS: G1t ss4'.%13 ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 763) 572-3604 FAX: (763) 571-1287 : 5980 2 1/2 ST NE : 233024220085 : UNAVAILABLE : LOT BLOCK : BUILDING : RESIDENTIAL : WINDOW/DOOR REPL PERMIT NO.. 2004-01100 DATE ISSUED: 07/13/2004 VALUATION : $ 4,600.00 NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS. REPLACE 4 WINDOWS WITHIN EXISTING OPENINGS. STATE LICENSED CONTRACTOR 1 APPLICANT RMA HOME SERVICES INC 3200 COBB GALLERIA PKWY #200 ATLANTA, GA 30339 - OWNER SCHULZ PAUL 5980 2 1/2 ST NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Bldg Insp J c ; Date BUILDING PERMIT FEE 111.25 FIRE SURCHARGE 4.60 STATE SURCHARGE, VALUE 2.30 LICENSE SURCHARGE 5.00 TOTAL 123.15 PAID WITH CHECK # 36061 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 04/02/2004 FRI 13:21 FAX ELDER JONES ✓o o� X1001/001 NEW [) CIN OF FRIDLEY Effective 4/1/2004 ADDN [ J -6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ 1 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name & Address Qy� sGh� TeL # (o3 -4a4 X33 Contractor. _ RMA HOME SERVICES, INC. MN LICENSE # Address: Home Deopt Installed Sales 3200 Cobb Galleria Pkwy.Ste. #200 Tel. Atlanta, GA 30339 1 Certificate of Survey of the 763-542-8826 BC -20268257 traction 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 r Hgt/Ground Sq. Ft OTHER: Construction Type: Estimated Cost: s_. (DO C) — Driveway Curb Cut Width Needed: ,_,Ft: + 6 Ft = __Ft x DATE- S V APPLICAf11T: M n ��� Tet. s 9's a -3_ �$i(Oogl Call (763) 672-3604 for Permit Fees if mailing in application. Fax to 763-571.1287 N using credit card and we will call you for card number. �' 6 CITY USE ONLY - Permit Fee $_ 11�. a1S Fee Schedule on Reverse Side Plan Review $ 65% of Permit Fee Fire Surcharge $ �t.lac� .001 of Permit Valuation (1/10th%) State Surcharge $ 0"1.30 $.50/$1,000 Valuation SAC Charge $ $1350 per SAC Unit License Surcharge $ S,O0 $5.00 (State Licensed Residential Contractors) Curb Cut Escrow $ Alt. "Mor Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ �'.,.. STIPULATIQNS: 1 l� J �' 6 \0 Building PLUM ING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date REM J U i 22-21 YOUR E-MAIL ADDRESS DATE �0_ M v; i �7 SITE ADDRESS THIS APPLICANT IS: ❑ OWNER 45CONTRACTOR PROPERTY NAME: S OWNER/ ADDRESS: ' CITY lea V STATE.,M � 54 3 TENANT PHONE: (0�\A0 Lj CONTRACTOR NAME: H8 PAA STATE LICENSCMAMPION WATER SEQV1Cj,% EXP DATE 13 -b A SUBMIT A COPY OF YOUR STATE ADDRESS: 212 N. River Ridge Cir CITY STATE ZIPS_ LICENSE wnH PHONE urnsv e, 7 FAX APPLICATION PERMIT TYPE FJINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE ys TYPE OF WORK: ❑ NEW REPLACEMENT DETAILED DESCRIPTION OF WORK6 A ik r -ecI,: e 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 oflabor ) 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 BELOW) BATH SINK/LAV DRAINS _ SHOWER _ WATER PIPING _ _FLOOR GAS PIPING (naso ammm) _ SWIMMING POOL _ WATER SOFTNER ($35) —BATHTUB _ CLOTHES WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15) _ _ _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION —DISHWASHER WATER METER OTHER 77777,77 { , n 77 Ql > ova $say, Permit Fee $ � a co Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ C50 . 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 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; that the work will be in accordance with the approved plan in the case of all rk which requires review and approval of plans. 1 SIGNATURE OF APPLICANT PRINTNAME� �// [/ -DATE-_-L 7q ` City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 07 V A V. ^r(.? Cn01 An'717 3e,:5_0