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PRE 2010 DOCS• CitY oFridley, , inn. 0 BUILDING PERMIT N® 410 5 Date: 99 p � q Owner: ..... . ................... _............. _...................... ................................... ..................... Builder ... .. ....... Address ............. ..... _.......... -............. Address .., ..... 6. LOCATION �OF BUILDING No.......-�1........... Street ....._�.07-- r.. .. ' da. v ..... ;.z ..9. ....... _.............. Part of Lot .......................... Lot 47-A.. t./7. AS Block ..... ........(,.5............-................. Addition or Sub -Division _t _.._. .............._. Corner Lot .................................... Inside Lot .......... e. ---------- ------. Setback .............. Sideyard � Sewer Elevation Foundation Elevation /0 ............... _................................................. ........ DESCRIPTION OF BUILDING To be Used as: F((�.Height/ .®Sq. Ft.,.'rontz.?...ZCu. Ft ................. Front ..............'-..... Depth Height/,0........_A. Sq. Ft........T.C..'..... Cu. F't...�7..�.® Type of Construction. ............. Est. CA/. f g. l O®.To 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 in accordance with the description above seo-, 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 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. _�,_ i _ — - Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. 4 City of Fridley Application for Plumbing and Gas Fitting Perndt DepL of Bldgs. Phone SU 4-7470 DESCRIPTION OF WORK - _ �- � Number, Kind and Location of Fixtures Location e� h� ,sd� yp oQ Z _ 5 W �Ugn Z. . N WATER HTR. GAS ELEG 3�(�9'd oo O �O R U) Base v ✓ 1st ✓ 2nd _ 3rd 4th • Future Connection Openings I Connected with Sewer � New .Fixture, Old Openings Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: /NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ 0 Future Fixture Opening ................ x 1.20 $ 0 New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... � x 2.00 $ G 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 IS ..... 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 ,, 1 Owner //® 0-1-A-1 Kind of Building -a Used as DAV et e_ To be completed about &4' �A® Estimated Cost, �' / Old—NP6v.� Building Permit No � a � Permit No. Signed ea&ntt-- ROUGH MAY 11 1960 FINAL ez 2M 7-59 Business Phone No-� City of Fridley SUBJECT 16063 AT THE TOP OF THE TWINS BUILDING P E R M I T r N • COMMUNITY DEVELOPMENT DIV. 3 0 r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 N MBER REV. DATE PAGE OF APPROVED BY j J\ 612-571-3450 910-F15 3/11/81 JOB ADDRESS 31 - 653� Way N.E. 1 LEGAL LOT NO. BLOCK TRACT O ADDITION SEE ATTACHED DESCR. 17A, 17B 5 1 X Edgewater Gardens SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE J. Kruetzer 31 - 65h la N.E. 574-7429 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Patio Village 3918 W 4.� Street Edina, MN 55424 926-2771 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 ❑. ❑ NEW % ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 1819" x 12' Porch- Addition 9 CHANGE OF USE FROM TO STIPULATIONS s#014146 local UVWml %we diong call t �IECTRIC - GAS Ec. iE1.EPKN . BY LAW i,EC4U1RED SEPERATE PERMITS REQUIRED FOR )FIRING, HEATING, PLUMBING AND SIGNS. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. 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 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 $9,000 $4.50 WITH WH HER SPECIFI HEREIN OR NOT. THE GRANTING OF A PERMIT DOES N T SU T GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVIS ON ANY O HER STATE OR LOCAL LAW REGULATING CON- $54.00 NONE TRUC ONO THE P FOR ANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE ,� 6 -4 $13.50 $72.00 SIGNATURE OF CONTRACTOR ORA THORIZED AGENT (DATEF WHEN PROPERLY VALIDATED IS YOUR PERMIT /n%THIS t�A z// 0 IUA TfE SIGNATURE OF OWNER 0F OWNER BUILDER) (DATE) CITY OF ruDLEY APPLICAnoN FOR 1:1:SIliNTIAL BUILDING PEW41TS (New, Alterations, Additions or Repairs) • 01.114E R : r ADDRESS: l �5 lq-y iVz TEL h0: L'UI LDLR :TE6T® l f' ADDRESS: 3`x(9 b=� �ejA, TEL NO: X2-7 i / Construction Location ' STRICT NO: X STREET: / i10-9 . LOT: BLOCK: ADDITION: Corner Lot: Inside Lot: Setback.: Sideyards: Applicant attach to this form two Certificates of Survey of .lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION �_oC,4 Front: Depth: Height: 1 Z Squane.Feet: Cubic Feet: Front: Square -Feet: Type of Construction: L,.� Depth: Cubic Feet: To Be Completed: , Proposed Driveway Width If New Opening Is Desired: Height: Estimated Cost: $ W 0 Alt. A Alt. B SET REVERSE SIDE OF SHEET . The undersigned hereby makes application for a permit£or the %,nrk' 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 applicatio true and correct I DATE: SIGNATUI%'& : ` Stipulations: Aravw Sq. 0o PC 4x Io CED&RZEAM AAL,OU51E. %A/I"DCVJS z4s ef-otz r- *mii1cj �-2'�fRoST FooTiNGS-� t��4T�D,�CooM��Z 31-G5%2 \.JAY A/9, � -57�F-7424 4x8 86A MIS 2 X6 T/G, V�l G?-K� F *1 -Tr -2 :r- 0240 ASP6 A:7- SWAa4 SS . �C>-41Z 41ot%Se- vv4GL ati .z 3//018 / r� G �J Z_ -. !Z ;G 0 SUBJECT PERMIT NO. City of Fridley 23754 AT THE TOP OF THE TWINS BUILDING PERMIT Ir ' ' E • ______ COMMUNITY DEVELOPMENT DIV. L INSPECTION SEC �;N. 47 r ' - PROTECTIVE 1 � I NUMBER REV DATE PAGE OF APP CITY HALL FRIDLEY 55432 612-571-3450 910-F15 10/2/95 JOB ADDRESS 31 65 1/2 Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. I 17A-17B 5 Edgewater Gardens SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE David Halvorson 31 65 1/2 Way NE 572-9553 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. D & D Home Improvement Inc 7401 Central Avenue NE, Fridley 55432 784-7543 4840 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING R ENZ Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION j REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling (22 Sq) TearOff 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 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. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION I 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 $1,760 .88 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- STRUCT R THE PERFORMANCE OF CONSTRUCTION $56.75 Fire SC $1.76 PLAN CHECK FEE TOTALFEE KIGNA UREO'IeNeART0111059YHORIZED License r tri-00 4.39 AGENT (D EI s WHEN PROPERA VALIDATED THIS IS YOUR PERMIT BL46G INSP rJAT SIGNATURE OF OWNER(IF OWNER BUILDER) (DATE) NEW Effective 8/1/95 ALTER I 1 SINGLE CITY OF FRIDLEY j FAMILY AND DUPLEXES R-1 AND R-2� Building Permit Application Construction Address: Legal Description: Owner Name & Address: Tel. # _L ., 2. Contractor: D & D Home Improvement, Inc _ MN LICENSE # 4840 Address' 7401 Central Ave NE Tel. # 784-7543 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LMNG AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground 5q. Ft. OTHER: Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: - 7e"7� -� Estimated Cost: $ I 1 — i� Approx. Completion Date: /_ 71V��"' �` ` (Cost on,Back) Driveway Curb Cut Width Needed: Ft. rIn"L Ft =_Ft x $ _ $ r . DATE: L' APPLICANT: Tel. # -� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY $ (®, �j Fee Schedule on Reverse Side $ I , .001 of Permit Valuation (1 / 10th%) $ $.50/$1,000 Valuation $ $850 per SAC Unit $ l p $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 [ ] $ �Llo I SUBJECT , City of Fridley 3 0415 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. _ r PROTECTIVE INSPECTION SEC. 1 NUMBER REV DATE PAGE OF APPROVED BY i ��"'T;,; CITY HALL FRIDLEY 55432 --•.� L 612-571-3450 910415 10/18/99 JOB ADDRESS 31 - 65 1/2 Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 17A $ 17B 5 Edgewater Gardens SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE David Halverson 572-9553 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 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION O ALTERATION x® REPAIR O MOVE O REMOVE B DESCRIBE WORK Replace kitchen cabinets and upgrade electrical 9 CHANGE OF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD 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 DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $500 .50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- S UCTION OR THE PERF RMANCE OF CONSTRUCTION $23.50 Fire S $.50 PLAN CHECK FEE TOTALZFVE L-6k2� - �� - // 24 SIGN- TUAEOFCON'RACTORORAUTHORIZEDAGENT IDATEI I EN PPOP ALIOATED TM IS YOUR PERMIT S-GNATURE OF OWNER I IF OWNER BUILDERI IDATEIBLD INSP PATE NEWT I Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: -'� I !V [; 6S 12- 0jo, Legal Description: Jte,y, fhN SSy3Z Owner Name & Address: as () Ld /44 Tel. # 9 %; Contractor: vh 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 EVIPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: {� a f� Y�}''F s �pq Construction Type:_ to �c� c I�e�, Cep r� e 5 Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: /D APPLICANT:QTel. # 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 $1050 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 [ ] NEW [ ] CITY OF FRIDLEY 00 11` —? ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER @'f SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: 31 Cod �-' A -r F -P - i V -� Legal Description: cje 6 �r-106 —5 Owner Name & Address:gA--F ayo ter- v%eLvoof,- Tel. # -7 to 5-5- 7 Z-9SS3 Contractor: MN LICENSE # WC — Z0'f -f 3zso Address: o S_�� ��. ,��, �P�m`€`r. �-^r �sy�Z Tel.* '703-CP-70-gg5q Attach to this application, a Certificate of Survey of the 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: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: Estimated Cost: $ y , d o 0 Driveway Curb Cut Width Needed: o Ft + 6 Ft = G Ft x $ 0 = $ c3 DATE: 3 / 11 (-DS APPLICANT: n D -CF'`^` Tel. # 71u3 --(a -7D'I'A5 t 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. Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge CITY USE ONLY - Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1450 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 [ ] TOTAL $ ���'� STIPULATIONS: Building PLUMBING Permit No.: - Ce Inspections RESIDENTIAL APPLICATION Received By- 763-572-3604CITY OF FRIDLEY Date R AY - DATE os� a % YOUR E-MAIL ADDRESS / SITE ADDRESS �! , THIS APPLICANT IS: ❑OWNERCO TOR PROPERTY NAME: ✓ OWNER/ TENANT ADDRESS: I1 0a w CITYy(`� STATbZIP�5y3 PHONE: Me 3 ^.7-7 CONTRACTOR NAME: STATE LICENSE # b b C, A W `- EXP DATE - (% D ADDRESS: CITY STATP AJ SUBMIT A COPY OF YOUR STATE LICENSE WITH PHONE -7 FAX - - APPLICATION PERMIT TYPE 1 TINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 1!w ❑ REPLACEMENT DETAILED DESCRIPTION OF WORK 1 r� c�Y- /��7 % er` -Sa-�)N'e 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 of labor ) 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 $1 o.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) BATH SINK/LAV DRAINS _ SHOWER _ WATER PIPING _ _FLOOR —BATHTUB _ GAS PIPING pvmn crrymcwm) _ SWIMMING POOL WATER SOFTNER ($35) CLOTHES WASHER KITCHEN SINK —WATER CLOSET _ BACKFLOW PREV. ($15) _ _ DISHWASHER _ LAUNDRY TRAY WATER BEATER ($35) FOR IRRIGATION _ WATER METER OTHER PERMIT FEE PROJECTS FOR UNDER $500 PERMIT FEE FOR PROJECTS OVER $500 Permit Fee $ S_5--.u>b Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ Number of fixtures @ $35.00 mr x $35.00 = $ _��.,5- 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 work which/ requires review and approval of plans. SIGNATURE OF APPLICANT 44./ AA ,la PRINT NAME=A 6L f`l e!S �(�S DATE PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 2007 Building MECHANICAL Permit No. Inspections RESIDENTIAL APPLICATION Received BY: 763-572-3604 0 R 00 CITY OF FRIDLEY DATE 3_1 YOUR E-MAIL ADDRESS SITE ADDRESS T (/ J /�. /,ti llJt THIS APPLICANT IS: ❑ OWNE ONTRACTOR PROPERTY NAME: -12 TENANT cC NN AtA / )C CITY STATE ZIP S ADDRESS: 3 & � /4� I�n PHONE: ' CONTRACTOR COMPANY NAME: SUBMIT A COPY OF CONTACT PERSON: _ cl✓Y I G(t S ( a, 3 06 YOUR STATE STATE LICENSE # L©I "1 EXP DATE ( LICENSE WITH ADDRESS: Off.W J oc, �v►i0, , � /tj CITY STAT9"fl ZIP553/(0 APPLICATION PHONE "1( —c�iSaS FAX V1(�c3 - Sr7U --laa PERMIT TYPE ❑ SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW ❑ REPLACEMENT 7A TERATION/REMODEL DETAILED DESCRIPTION OF WORK 5�4 c j/fid /, AA. - � tel,,cN 6115 LIQ N k r 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 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIX EXCEP WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) � / , ✓`7ft4,W rf- (at-x Equipment Installed MFG: Ile 1 �' tT l G� f�7//`( MODEL: Sob V % CZb SIZEIBTU MFG: V MODEL: SIZE/BTU MFG: MODEL: SIZEIBTU $25.00 FIREPLACE (GAS) $15.00 RANGEIOVEN $10.00 _A/C _GAS _AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 $35.00 FURNACE $35.00 GAS UNIT HTR $10.00 _BOILER LINER $10.00 AAS DRYER $10.00 POOL HEATER $35.00 _CHIMNEY _DUCT WORK $10.00 (/_GAS PIPING $10.00 _VENTILATOR $15.00 Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ 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 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 vhich require s re .ew an approval of plans. �/ SIGNATURE OF APPLICANT 'i PRINT NAME I' DATE 'l7'-d6 r �- M s:? --- AFF-. City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977