The URL can be used to link to this page

PRE 2010 DOCSCity of Fridley, Mi BUIIDING PERMIT N° C5-5-28 Date:"" t Owner: Builder _ —._---_-.--- Address Address O F BUILDING NO.. Street - Part of Act Lot�_ Block _..— Addition or Sub-DivisioF Corner Lot — Inside Lot �""� Setback j ° ideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To ,ry •� Front _ Depth Height Sq. Ft . Cu. FLAW O Fr Depth �__ __.0HVgh Sq. Ft. Cu. Ft''.��''_''��_ Type of Construction`_ Est CoX -Ait .�_ be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work m accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. 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, pair and moving of buildings within the city limits and this permit may be revoked at any �n vio�o of any of the provisions of said ordinances. A Building Inspector NOTICE This permit does not cover the construction, Installation ter wiring, plumbing, gas heating, sewer or wafer. Be sure to see the Building Inspector for separate permits for these items. APPLICATION FOR BUILDING PERMIT CITY OF FR.IDLEY, MINNESOTA Owners Name Builder L a Address Address `��"� ► vi �N� ��^�°"�l - LOCATION OF BUILDING '� .fir. we - No. �` i Street Part of Lot Lot Block. ti Addition or Sub.Div. Corner Lot_____ Inside Lot "t Back 3 9 Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost 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 Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representa- tions stated in this application are true and correct. ff , DATE? / - ; �` SIGNATURE �w „_......_ (A Schedule of Fee costs can be found on the Reverse Side.) Application for Power Plants and Heating, Coding, Ventilation, .Refrigeration and Air Conditioning Systems and Devices ' PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, F 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 ............................. §.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. EDR Steam....... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ 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 e® GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ � GAS FITTING FEES: NO RATE TOTI. 1st 3 Fixtures ...................... x $1.50 $ �iOa Additional Fixtures x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE ROUGH FINAL Dept. of Bldgs. Phone SII. 4-7470 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. Owner Kind o: w Used as To be completed about Estimated Cost, $ r �New.Building Permit No. V �-A;/ permit No.�� DESCRIPTION OF WORK F HEATING or POWER PLANTS Steam, Hot Water, Warm Air—No Trade Namci- �tt� Size No.•Z 26�A®B (5-0 Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load Kind of FueI JLIO,:� BURNER —Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) Siffn By u0 az 2M 7-59 Business Phone No eA�'— n•T8 .a2 HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS FRIDLEY, MINN. Weatherstrips A.S.H.V.E'Construction No. Insulation Guide n ws I rs Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Ye No Yes No 19_ Fl. 5 Room I Lensah Width Height II Fl.l / Room 1 Lena Width/,W/ Heigh WIN oors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. jiar¢rud �� IFAMIAPA WR W5, r AN�rJArIM UJMMF/jTA Heigh / It—MIMMEMP, WPM y 1•.T MW- APiMW Vi' R AAP—W RMF, 4 M, V Infiltration 137 A .3 115M Net exp. wall ice-r.�rl Net exp. wall Int. wall Coef. Ceiling / r�� -. Net exp. wall XX Glass / isz Exp. wall WK AM &M F-7 MA1111 ic�s��: Room I Length a Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. jiar¢rud �� IFAMIAPA WR W5, r AN�rJArIM UJMMF/jTA Heigh / Windows and Doors—Crackage and Area ' Coef. Btu Infiltration 137 A .3 115M Net exp. wall ice-r.�rl Net exp. wall Int. wall Coef. Ceiling / r�� -. 1 otal Btu. :.D. . or sq. ins. W.A. Leader area oom I Length Width Doors—Crackage and Area i No. I of Btu Infiltration Glass12 50 1 6 Exp. wall Net exp. wall Int. wall Ceiling Floor Tbtal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area Room I Length a Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. .00 Heigh / Windows and Doors—Crackage and Area ' Coef. Btu Infiltration 137 A .3 Glass Exp. wall Net exp. wall Int. wall Coef. Ceiling / Floor 1115-1 '-' Total Btu. Requiro !%t. E.D.R. or sq. ins. W.A. Leader area I / FIY-ITV° ep Room I Lenath 00-' Width % ' Height or Windows and Doors—Crackage and Area Room I Length a Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. it .00 Heigh / Windows and Doors—Crackage and Area ' Coef. Btu Infiltration A .3 Glass Exp. wall Net exp. wall Coef. Int. wall Ceiling Infiltration Floor Total Btu. Reauired sq. ft. E.D.R. or ea. ins. W.A. Leader area 41.1 Room I Length a Width.,,,r/ Heigh / Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of Dane lights of crack sq. ft. A .3 Coef. Btu Infiltration / ff Glass / isz Exp. wall Net exp. wall VQV Int. wall Ceiling (J Floor 1 otal Htu. sq. h. E.D.R. or sq. ins. W.A. Leader area A" City of Fridley Application for Plumbing and Gas Fitting Pemdt Dept. of Bldgs. Phone SU 4-7470 DESCRIPTION OF WORKLocation ,G�' 0�! - 71 � Number, Kind and Location of Fixtures y p Z 3� C� Q V w Z W fjZ g° W �Z Z gn P N WATER HTR. GAS ELEC. Base ( r 1st 2nd 3rd 4th • Future Connection Openings New Fixture, Old Openings Connected with Sewer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $Qcc�,�,,C) Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 New Ground Run Old Bldg. ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $,r City of Fridley: The undersigned hereby .makes application for a permit for the work here! 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 trueApd corVect. Owne Kind of Building Used as To be completed about Estimated Cost, $ Old—New. Building Permit No - ROUGH FINAL d2 2M Business Phone 19-Z / 52-84-5915.51 City of Fridley Application for Plumbing and Gas F'itti'ng Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK5861 N E 7th St Number, Kind and Location of Fixtures Location ai I i2 = F zZ c z v z W W NU' Z F N WATER HTR. GAS ELEC. 3 vi�O Base as DrWrl 1st 2nd 3rd 4th _ Future Connection Openings Connected withI Sewer � New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures ...................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin ..... ..................... Water Heater (Up to 200,000 BTU) ...... New Ground Run Old Bldg. ............ NO. RATE TOTAL x $1.50 $ — x 1.20 $ — x 1.00 $ — x 3.25 $ — x 2.00 $ — x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL let 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ Gas Dryer 1 2.00 REPAIRS & ALTERATIONS—Refer to Code Description................................................$ TOTAL FEE $ 2 • !?0 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 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, Minn.— 10-6-66 - 19— Owner Frank Keeley Kind of Building frame Used as To be completed about 1 ON •s Estimated Cost, $ 10.00 Old—New. Building Permit No Permit No. e • By Business Pho a No ROUGH FINAL City of Fridley SUBJECT P IT NO. ® 12950 AT THE TOP OF THE TWINS BUILDING PERMIT 1 � COMMUNITY DEVELOPMENT DIV. INSPECTION r PROTECTIVE SEC. 1 � ] CITY HALL FRIDLEY 55432 �•--- %.J NUMBERR EV. DATE PAGE OF APPROVED BY 612-560-3450 910-F1S 5/19/75 JOB ADDRESS Frank Keeley 5861 N.E. 7th Street 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 2 1 V. dale Builders 7th Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Frank Keeley 5861 7th Street N. 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 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK construct 24 x 24 ft. Gar agg 9 CHANGE OF USE FROM TO STIPULATIONS I. Provide a hard surface driveway. SEPERATE PERMITS REQUIRED FOR WIRINA ��o�`S<c�c• ��a��°�'�-G� HEATING, PLUMBING AND SIGNS. 10 SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GRONhr OCCUPANCY LOAD 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 OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT 576 5,760 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 $4,626.40 2.13 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- $11.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE 10 $13.13 SIGNATURE OF ONTRACTOR OR AUTHVqKED AGENT (DATE)/ENn'PRROOPERLY V IRA�T�E/�j/%/THIS IS YOU - MIT o � � BLDG INSP DATE SIGNATURE F OWNER(IF OWNER BUILDER] (DATE) APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNERS NAME • 4 / BUILDER a. ADDRESS: / /� S f , 6�AE5S : NO:. Cv / STREET: -7 LOT: / BLOCK: ADDITION: Z 1114116a Ile �G,i � � 7� CORNER LOT: INSIDE LOT: -��`=SETBACK: /SIDEYARD: 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: /0 �r,►- �a Front: epth : Height: Square Feet: % Cubic Feet: y� Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost:_ To Be Completed:e ��-2-lO-U 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: 4 (See Reverse Side For Additional Information.) l :50a Cort ti c, 13.13 -78V —cad AFL Y r 4' Land Plwvnn9 6875-HOwoy 0457 ALE. Lagd"i� Mimwpo/s ti .50;l5TstiV ENGINEERING, INC. °t° r Civil fr M�rncipial SUntetQ-6066 En9►ineers Surveyors — 1 Mortgage Loan Survey for w i` /3-,.97 Z 7.6 , to r 1 � i� w 1 Q 4Z �1A/ Cb �, This rs o true aid correcf req,esentafian oj'o surrey el'fhe barnrdaries e�I'fhe /ond o%a►e of w ibed o�d n�'/lp' lorofian c�"a1/ dviild�gs iPay, Amw, mrd o// alible gwwchxed5, imy, frab or an said laid. Thi sarratJ mode ady n eff0why, , h a morf /ate _ 6n�y pbeed an the prnvgrty and no Gobi/it �s aJwmed sxcepf d'o tkelrolderwdi moro9e or o1h�' merest oc�rrd �y�i�nsm rye szarh mar yaye. Nis andasfiad and a� nnm cvirents fare 6r�n�ared Nie?WPM �' /a�/rncs m-6arr�di�ry, amus. Av>9 SUBURBAN EN&NEERiNG INC. &W this day — / &yweers and SurreW n i+PLICATION FOR PUjMD11JG AND GAs FIT ING t �. p qq •• d .• �i .. ;.0 1;;195.-• ! Ilf::hL ft -,TES titf. RATE TOTAL L.,CG! x $3.00 $ I'+L•,ta .:w tare G).cr:r.I x $2.00 c ;it. .1,c --- -- Gtt.ltaaln x $5.00 $ Na Let luaaier - LO $;,000 bTtl x i $ Dri�- er _�- x $10.00 $ wALur s flenec —� � 1 $ h --__ X $5,00 $ 11C�LIL- Hate[ IlttltC Y $5.00 i 4__ k) 1,•a"re CJrnccllon Gl.cnir3 C:. a.e.CeJ with Scorer ') - uc- t I tturo. Gld DIJcn:r.) Nater t'r,iTirl::L"!,,�C ;.0 1;;195.-• ! Ilf::hL ft -,TES titf. RATE TOTAL L.,CG! x $3.00 $ I'+L•,ta .:w tare G).cr:r.I x $2.00 —�— $ L.,Le Old x $2.00 $ Gtt.ltaaln x $5.00 $ Na Let luaaier - LO $;,000 bTtl x $5.00' $ IU—JJO bW La 1S 0;0 b:U _�- x $10.00 $ wALur s flenec —� x ;1.00 $ Ilesf L.Lb.,f„1 Lin Old bJ►lsll (If --__ X $5,00 $ 11C�LIL- Hate[ IlttltC Y $5.00 i 15 III TING FEES: 1st 1 taelutts • x $3.00 $ x $1.00 $ +~`. ht �• t� 199,COJ bIU x $10.00 $ ------ LPA K -.j 4 A1.TtKATICM5 -- rl:.t )u. ()u . $500 $ t',1' •�j• $IJ,..UJ oc fracucn $5.00 $ SLSLa 5urct,ergr $ Su TdrJ.L LI.L• S 8.00 97-84-0416051 Job hddres5 5861 N.E. 7th St. DtparL:ar:nL of b�L:1:r�J1 CI.Ly ct 1'r:dI.y Tela 11571-3.150 Thd'undaralgn,:d hareLy rakt:a appllcet:ar f r e ;.errlli f.:r Ltl. work Lerf lr, ep11"f'ed egrtuI11-j LJ d:' «11 work in Str:ct r;_cr1_r.to b.ltt. C1.1 City and rulings of Lhu G@I:arLWcnt of Bdi:ding;, a-1 �eretr .:c lacer tt.et alt tI10 fact.il nad rcI,r r.I•L.1LIOf19 9CJLOd 1^ Lhlo 1. •�:C�LIG,i 3rq C,afl and J:,.1 t•n i 01•INCR Frank Keeley KIND OF IIUILZuTu:i Frame USED AS Res. TO BE COMPLCTLG iL"r 5-2-80 ► BSTIMATL'D COS -2 Kn 00 OLD - NEW UCILGI:13 PLIu•f11 UJ, Oznip_Iry 'Ld11e 1 By MINNEGASCO ':al, NO. ROUGH IIISP. Da to ' FINAL IIISP, tV - ?/_ y0 Data hPNIUVAL t'GIL PLlulir MIIIIMUII I'L'L• 11.11 11IY PLWI uill:, Pciu.iP IS 67.950 FLUS ;.950 ►.TC 6Uk0l►.h&t I 01 SUBJECT P O. City of Fridley 3863 AT THE TOP OF THE TWINS BUILDING PERMIT � COMMUNITY DEVELOPMENT DIV. rR7c/ ; � ______ f PROTECTIVE INSPECTION SEC. �9 , E E � � NUMBER REV DATE PAGE OF APPROVED BY E = 1 CITY HALL FRIDLEY 55432 763-571-3450 91 0-F15 918/03 JOB ADDRESS 5861 7 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 2 Lyndale Builders 7th Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Frank Keily 5861 7 Street NE 763-571-2811 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Tabor & Sons Inc 10547 Terrace Rd, Blaine, MN 55434 612-789-1902 20014248 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 WORN ❑ NEW ❑ ADDITION ❑ ALTERATION 1j REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (15 Sq) Tear -off; Soffit/Fascia 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Install soffit ventilation to meet the State Building Code. TYPE OF CONST OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 80 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 1 ISTALLS 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 $2, 737 $1.37 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 - ION OR THE PERFORMANCE OF CONSTRUCTION $83.25 Fire SC $2.74 �AJO3 PLAN CHECK FEE TOTAL FEE se PC $5.00 $92.36 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDA EI H PROPERLY VALIDATED THIS IS YOLIR PE MIT Aft SIGNATURE OF OWNER,IF OWNER BUILOERI IDATEI Lp 5O DATE I 01 NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: X58 i"n S 7 Legal Description:' � Owner Name & Address: Ff i°fi�% � �Y _ Tel. # )6 3 157/ o' Contractor. F Qti �' �� 11 ` MN LICENSE # ®Q e�t,a�e��• ��/`% /f r�rj.�%L?� %i , (i/U� �J�� Tel. #oz - LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height _ Sq. Ft. Length Width Height _ Sq. Ft. Length Width Hgt/Ground Construction Type: �'"� °0 �f°v Estimated Cost: $ Q V),v Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x Sq. Ft. 36 DATE: 9'8 -03 APPLICANT: 6Zn—� cZ>er, Tel. Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. TOTAL $ l/ • 3 _ W Y CITY USE ONLY - Permit Fee $�� Fee Schedule on Reverse Side Fire Surcharge $ . % .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1275 per SAC Unit License Surcharge $ ® $5.00 (State Licensed Residential Contractors) Curb Cut 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 [ ] TOTAL $ l/ • 3 _ W Y Building PLUMBING Permit No.. Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: 763-502-4977 FAX EFFECTIVE 1-1-08 DATE YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR PROPERTY NAME: F_ C c OWNER/ ADDRES -Y CITY 4I WC_e STA 4ZIPSS� TENANT PHONE.7G✓ 3•- __7/ - �� 1 CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF ADDS: CITY STATE ZIP INSURANCE . PHONE FAX PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW REPLACEMENT DETAILED DESCRIPTION OF WORK PER MS 16$.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 .50 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 FEL $15.50. _BATH SINK/LAV _FLOOR DRAINS _SHOWER d WATER PIPING GAS PIPING (NEED CITY LIC) SWIMMING POOL _ WATER SOFTNER ($35) _BATHTUB _ _ WASHER KITCHEN SINK _ WATER CLOSET _ BACKFLOW PREY. ($15) _CLOTHES _ DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ WATER METER —OTHER W 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 x $35.00 = $ 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 butORan 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 p�l in the case of alwork jhich requires review and approval of plans. SIGNATURE OF APP LIC / PRINT NAME Zf Al Z f344-4 % 1 Pe le I DATE O APPROVED BY ' DATE City of Fridley )Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977