PRE 2010 DOCS•
City of Fridley, Minn.
BUILDING . PERMYT
Date: .. ............. ..................
Ownero..,.'(4,
.�,,�.� .... ...
Address .. 1... .... ..
r-]
� f
11 Jill
�CATION OF BUILDING
No. .. ... Street. ....... (� .................. Part of Lo ... ....... / :....... .
. y...
Lot ..� . ?.... Bl .. � .......... Addition or Sub -Division .. ....... .... ,�
Corner Lot ............ Inside Lot ............ Setback /... Sideyard
DESCRIPTION OF BUILDING
To e U ed as 1 a p - , �� yr,�✓
'1 . /�DfA... 4�r Front ./.. v... Depth . o�. .. Height ?? S� Sq.l� Y. Cu.
................... Front
t Depth ..... I eight ... Sq. Ft. ........ Cu. Ft.
Type of Constructio �.Cost. . Fj0 �..... To be Completed ...
%1R 4u. ..c
In consideration of the issuance to me of a permit to construct the
the proposed work in accordance with the description above set forD.
ordinances of the city of Fridley. /J�
�' ..
�m
building desribed above, I agree to do
Xjid in
c 'ance with provisions of
In consideration of 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 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 with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
�A.O 460:. Building Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, bing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
53-8L-879001 CITY OF FRIDLEY
APPLICATION FOR PUMBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
PLUNSING FIXTURE RATES: NO.
RATE TOTAL
N=bear Fixtures
x
$3.00
n
x
$2.00
>1
¢
$2.00
Catch Basin
x
$5.00
Water Heater - to 99,000 BTU
x
d
'03,000 B:J to 199,000 BTU
Water
$10.00
a
n
$7.00
Xew Ground n:n Old Building
x
H
c M
rs
m
a
G.,S FITTING FEES:
4
b 11
�
w
�
$3.00
Heater
O
$1.00
Gas Range to 199,003 BTU
x
$10.00
n ?Ai RS & ALTERATIONS '
E
••�
x �,
L1
o
u
N
.0 C
6 0
W
iC
$2.00
11
TOTAL FEE
O
!a O
+`1
.0
a
C
m
•.1 y
O
O
ai a
as W
N
w
Np
4
t7
'ri
O
.0
b ''J
7 1110
C9
�
C7
O
a5
leC
ranige
�St
'ad
3rd
4 :•1
I
I
(B) = Fu:ture Connection Opening
Connected with Sewer
(*3 = New Fixture, Old Openir7
Water
PARTIAL RATE SCHEDULE
PLUNSING FIXTURE RATES: NO.
RATE TOTAL
N=bear Fixtures
x
$3.00
at•_re Fixture Opening
x
$2.00
New =fixture, Old Opening
x
$2.00
Catch Basin
x
$5.00
Water Heater - to 99,000 BTU
x
$5.00
'03,000 B:J to 199,000 BTU
x
$10.00
Water Softener
x
$7.00
Xew Ground n:n Old Building
x
$5.00
Electric water Heater
x
$5.00
G.,S FITTING FEES:
1st 3 fixtures
x
$3.00
Ad3itional Fixtures
x
$1.00
Gas Range to 199,003 BTU
x
$10.00
n ?Ai RS & ALTERATIONS '
First $100.00
$5.00
each add. $100.00 or fraction
$2.00
State Surcharge
TOTAL FEE
REINSPECTION FEE
($10.011)
Job Address h901 3 Street NE
Department of Buildings
City of Fridley
Tel. #571-3450
The undersigned hereby flakes 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 t -at all
the facts and representations stated in this application are true and correct
Fridley, Mn. 3-9-81 , 19
C41NER Redder
KIND OF BUILDING frame
USED AS res.
TO BE COMPLETED ABOUT 3-15-81
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. �PERMIT NO.
Company
Signed By ��NNEpKSCpf
Tel. No.
ROUGH INSP.
Date
FINAL INSP.
$ Date
$� $ APPROVAL FOR PER'9IT
$
$ MINIMUM FEE FOR ANY PLUMBING PERM= IS $7.50 PLUS $.50 STATE SURCHARGE
$ .50
s 10•50
j
10 �50
Building
BUILDING
Permit No.: ZOO I Yci'
Inspections
COMMERCIAL/INDUSTRIAL
Re�®
763-572-3604
CITY OF FRIDLEY
nate ee
763-502-4977 FAX
EFFECTIVE 1-1-2010
L
DATE / 0 — S- /D YOUR E-MAIL ADDRESS /1 e I e-1-4 7 Lam' n M fm,
SITE ADDRESS
TENANT Suite No.
PROPERTY OWNER
NAME: lVe /1 u, s
ADDRESS: 3 ?60 CITY 6 ��% �-�c STATIy OVZIP U l c
PHONE: -71,7 - 31 3 -7
ARCHITECT
NAME:
ADDRESS: CITY STATE ZIP
CONTRACTOR
NAME: Se I
* NOTE: CITY
LICENSE REQUIRED
ADDRESS: CITY STATE ZIP
COMMERCIAL,
PHONE: FAX
INDUSTRIAL AND
MULTI FAMILY
PROPERTY TYPE
❑ TOWNHOUSE ❑ COMMERCIALANDUSTRIAL ❑ INSTITUTIONAL
0MULTI-FAMILY
PERMIT TYPE
❑ ADDITION ❑ NEW CONSTRUCTION ❑ OTHER
❑ REMODEL WROOF ❑ SWIMMING POOL
PLEASE SUBMIT:
1.4 SET SETS OF DRAWINGS 5. CONTRACTORS OR LICENSE 8. 1 SET -DIGITAL OR ELECTRONIC
2. SURVEY/SITE PLAN LICENSE APPLICATION PLAN
3. LANDSCAPE PLANS 6. SPECIAL INSPECTION SCHEDULE
4. ENERGY CALCS 7. PERFORMANCE BOND AMOUNT $
BUILDING TO BE USED AS: OFFICE sF WHS sF OTHER se
TOTAL SIZE: -7 - , ' 33 s9 w g P STORIES / .tea FIRE PROTECTION (Y/N) AC(Y/l�
DETAILED DESCRIPTION OF WORK r o
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 on site; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
/ L
l- I /vH 7
�/ �` S DATE:
SIGNATURE OF APPLICANT : PRINT NAME: //
APPROVAL INSPECTOR SIGNATURE: DATE:
ALL FEES ARE BASED ON VALUATION
Sq. ft. x $
Sq. ft. x $.
Sq. ft. x $
TOTAL JOB VALUATION: $ -37��
Permit Fee
Plan Review
Fire Surcharge
Surcharge
SAC Charge
Erosion Control
Park Fee
Special Assessments
Total Due
Cost/sq. ft. = Valuation $
Cost/sq. ft. = Valuation $
Cost/sq. ft. = Valuation $
.It USE _ OCCUPANCY TYPE
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$2100 per SAC Unit (Plans to MWCC for determination)
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach