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PRE 2010 DOCSCity of Fridley SUBJECT K1 18337 AT THE TOP OF THE TWINS BUILDING PERMI _ r RECEIPT NO. 'COMMUNITY DEVELOPMENT DIV. O f PROTECTIVE INSPECTION SEC. 1 i 1 "1 I CITY HALL FRIDLEY 55432 j NUMBER REV.DATE 13/18/86 PAGE OF APPROVED BY 612-571-3450 910-F15 JOB ADDRESS 1410 - 66th Avenue N. E. 1 LEGAL LOT NO, BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 2 Creekridge SHEET 2 PROPERTY OWNER MAIL ADDRES$ ZIP PHONE Dave Larson 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Brickner Builders 6195 Heather Place N.E., Fridley 574-9871 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. S EP 6 USE OF BUILDING t ; 111"s HEA Residential , TIAIr. 7 CLASS OF WORK B/iNG'�� ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAI REMOVE X v., ,: 8 DESCRIBE WORK A= Construct a 391 x 261 Dwelling and a 23.1 x 23' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hand surface driveway. Provide sod in the front and side yards. Provide City with copy of verifying survey before capping. SEWER LOCATION: Wye 25' East of Manhole WYE ELEV: 883.67 TOP OF FOOTING: 886.67 Minimum WATER LOCATION: Saone trench as sewer Paid plcGJ� 8F FRIDL 0-00 3Iocal DOES NOT ACCURACY NOT 111 OF UTILITY LOGES GUARANI u� T EI F��13 ?c„� THIS DATA IS FOR INFORP�A7,O�, AND { NAND c, u;� ;_Isis n,;l . PERSONS USING THIS R ��'RED IN CRIFY IT ON THE SITE. FORIIATIOrV SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP 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 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 $ 93,150 $46.58 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESU TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS O A OTHER STA R LOCAL AW REGULATING CON- TIO R E PERFORM F ONST CTION. d $ 415.00 Credit from School r PLAN CHECK FEE TOTALFEE $103.75 $565.33 + PF IGNATURE OF CONTRALTO UTMORIZED AGENT IDATEI WHEN PROPS BLDG )NSP Y VALIDATED THIS IS YOUR PERMIT I OA SiGNATURE OF OWNER IIF OWNER BUILDER) (DATE) 1 NEr; [ ] City of Fridley Effective 4/1/84 ADDN. [ ] L R-1 AND R-2 ALTER. [ ] Building Permit Application -.-JI Construction Address: /�� kor �Y6- Legal Description: L 07 % & 2, C'Zmeezpa Owner Name & Address: � �' AIAP f 44, re "Zr 'V Tel. # Contractor:�s�r� �s' Til . # Address: --- 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: Corner Lot [ ] Inside Lot [I Ft. Yd. Setback 3J., Side Yard Setback Type of Construction: Estimated Cost: $ c V Approx. Completion Date: ( 3' Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: — $ $ _ See Back Page for Explanation DATE: 3 �/ - �� APPLICANT: - - Tel. # CITY USE ONLY Permit Fee $ ( oc) Fee Schedule on Reverse Side Plan Check $ ®� -e2D 25$ of Building Permit Fee tate Surcharge $ LA 6 5 8 $.50/$1,000 Valuation OcgSAC Charge $ $425 per SAC Unit Park Fee $ kW/ J Mo(-) Fee Determined by Engineering Sewer Main Charge $ 1FOTAL $ Agreement Necessary [ ] Not Necessary [ ] STIPULATIONS: c2O4S • �� ts VO - a o •+;' � �� ss - t: r, lC � cava i3 g sq. x ' ., s1`� C't°4 � Yo`''re a � •�� ( � /'� .� �e ,• osea area al exp ilirg axed ' • ' " �� 0 low so o£ f ce wall . • . �.0 \ 1• opal exp°sea -•• '•• '-• 'gp� ,. 2• offal' axed, ••.• •,.• ••.• •.•• Tw .•' axed ,.•'y0ofl•'•,.••-.,.•' o 11 IC a • , 5 aoS:iea - . • . total w a°o y04 gl wall � ea La 0- • - - • • • b O ya oe rg a °V e - • • . • • . c6 . S p,°tal e'911-01 w�xart` axed a• - . • axed c • dotal wall all axed - .•- a• °tal yeti °i5t oard -.• e.• , - - iota xyta exposed w axed aye �xaa 1 se°j``�er�� •��// _ - _ __ .g • �° total , °r � aveach a, at10 • of v 1 foai' £ovra r alae ' 1/ •1 a ret tex�ire r i • pe i IV Y � / X / -low: I y��rq� iS • 0 Sit J 0•� 0 0 -- ._ _ - -- --- -- CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures _(_ $ 5.00 Future Fixtures PERMIT NO. S 3.50 u Old Opening, Nov Fisture x 61 $ Mater x S 4.00 S Blow Oft Basin $ 5.00 H C x �i $ x a w $ Heater .� •.� V OO a C M Water Treating Appliance �C( N 11w�� Y MM q L C M I H L < Gas Range 4 S 10.00 $ Gas Dryer p e 0 •.1 t sq� a 4 •M O� C O 4 .upl u w+ m N � a U 0 e0 a� 0 s O w A w U IGI< s ti 9 a 0 .a9 leC 1st 2nd / 3rd 4 th (R) - Future Connection Opening Connected with Sewer (•) a Hew Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures _(_ $ 5.00 Future Fixtures PERMIT NO. S 3.50 S Old Opening, Nov Fisture $ 1.50 $ Boer Dispenser S 4.00 S Blow Oft Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader S 5.00 $ Nydraulic Valve S 5.00 $ Sump or Rsceivinq Tank S 5.00 $ Water Treating Appliance S 7.00 S Hot Water Beater _L $ 5.00 Gas Range S 10.00 $ Gas Dryer S 10.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1s of Value of Fixture or Appliance $ Reinspection lea $ State Surcharge S 50 (515.00) TOTAL FEE $ (O() _o Ettecttve Auq, 1, lynl Job Address 1 --J(410 Department of Buildings City of Fridley Tel. 0571-3450 The undersigned hereby makes application for a permit for the work herein specified aqreeing 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 f� Fridley, Mn. 3 , 19� . w OWNER KIND OF BUILDING :5t4 USED AS /n fes j TO BE COMPLETED ABOUT ESTIMATED COST O- NEM S ILDING PERMIT NO. PERMIT NO. Company Signed By Tel. No. C / ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE f w 4M s 7 � • lip op too -V sp •. a 1D Pii $ w " nW 3por w C r • • ^� 10 FIX sp ? mc. I, O • r w we _ w a Sir • � S w 3� Po go oa • N w a ,. N + w �• 1:0 0 10" 0 w N I'm M M M M M M M M Q o o S s •:3 0 a C2 r City of Fridley SUBJECT ER AT THE TOP OF THE TWINS BUILDING PERMIT r RE v_ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. (9 CITY HALL FRIDLEY 55432 �.__..11•� �•� NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6 � � JOB ADDRESS 1410 - 66th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 2 Cxeekridge SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE David Larson 1410 - 66th Avenue N.E. 571-0852 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 x 6 DESCRIBE WORK Construct a 14' x 16' 'Three Season Porch Addition 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan WARNkv Before digging call local utilities SEPARATE PERMITS REQUIRED .FOR TELEPHONE - ELECTRIC - CAS Etc, WIRING, HEATING, PLUMBJNG REQUIRED BY LAW MD S 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 1 HAVE READ AND EXAMINED THIS APPLICATION 1 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 $4,650 $2.32 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- $72.00 STRUCTION OR THE PERFORMANCE OF CONSTR TION. PLAN CHECK FEE TOTAL FEE \ $74.32 SIGNA E ONTRA ORA iO DA . T iD TEI •WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT V BLDG INSP , ^ . 'SiMMTUME OF OWN IIF OW BUILDERI I TEI NEW I I AMN lxl ALTER [ ] Construction Address: MI Legal Description: LOT 1 City of Fridley R-1 AND R-2 Building Permit Application e \IX 11D16 IL Effective 5/1/88 Owner Name & Address:Tel. # 57I-D�SZ� Contractor: 1CuaL 98r - o�v Tel. # Address: if Attach to this application, a Certificate of Survey of the lot, with the proposoed construction drawn on it to scale. Ini-DILL610 IV io (0Q E02jog D�IDI LIVING AREA: Length Width Height sq. Ft. CURAGE AREA: Length Width Height Sg. Ft. DECK AREA: Length Width Hgt/Ground Sg. Ft. Corner Lot [ I Inside Lot I l Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ q 140 Approx. Completion Date: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ Width + 6' See Back Page DATE: APPLIC U : Tel. # MY USE ONLY Permit Fee Fee Schedule on Reverse Side State Surcharge S Z.32 $.50/$1,000 Valuation SAC Charge $k $550 per SAC Unit Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Flee $ Flee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ l Not Necessary [ ] TOTAL $ r) q, 3 STIPULATIONS: 2 0Gci q W. Mt it ZA t. amp; M qeep zG.,FT, 44 v- Aff �,avla L,ersonG 0" 11111100�� AO 51p, T-4 SUBJECT city of Fridley 730123 AT THE TOP OF THE TWINS BUILDING PERMIT R�ECE�IPT9 COMMUNITY DEVELOPMENT DIV. : -_____� PROTECTIVE INSPECTION SEC. 6O. 1 � NUMBER REV DATE PAGE OF APPROVED BY i CITY HALL FRIDLEY 55432 612-571-3450 910415 8/25/99 JOB ADDRESS 1410 66th Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 2 iCreekrid&e SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE LeAnn Lind 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Ken's Roofing Co. 3600 Minnehaha Ave. Mpls M 55406 721-6705 5035 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 O NEW O ADDITION O ALTERATION -10 REPAIR 0 MOVE O REMOVE 8 DESCRIBE WORK Reroof house and garage 31 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 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 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 $2709 $1.35 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 $83.25 F e SC $2.71 PLAN CHECK FEE AL FEE L' e C 0 92.31 S.GN4TURE OF CONTRACTOR OR AUTHORIZED AGENT IOATEi H P ALV VA TED THIS IS 1 RSC/ S-GNATURE OF OWNEROF OWNER BWLDERi iDATE. B OG INSFV NEW AD -ON f 1 ALTER Construction Address: Legal Description: Owner Name & Address: Contractor: kxWL Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R=1 AND R-2 Building Permit Application Effective 8/l/95 C6 STIPULATIONS: 30 �� Tel. # MN LICpENSE # .SlJ SS 5`Sy Tel. # 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 Sq. Ft. IJ Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: i;4j4'6-0-11 Estimated Cost: $ &iP 7 Q 9, Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: APPLICANT: Tel. # STIPULATIONS: CITY USE ONLY Permit Fee $ 93, ,9 L' Fee Schedule on Reverse Side Fire Surcharge $ a .001 of Permit Valuation (1/10th%) State Surcharge $ J , 7j $.50/$1,000 Valuation SAC Charge $ $850 per SAC Unit License Surcharge $ j L �� $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 [ ] TOTAL $ J? STIPULATIONS: NEW [ ] CITY OF FRIDLEY Effective 4/1/2004 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 %Fa, BUILDING PERMIT APPLICATION Construction Address: JLJIQ �4Autn<. LL Legal Description: Owner Nam & Address: L.CC j -. JqJQ b(P�TeI. #_7(23 571 Ug�� Contractor. V/hdV1br_% MN LICENSE #-�- Address: CC ►a TeI. #'"b3- f((oZ 7320 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: (L n&jcl Ila IUL C 16 am 0 Wr an ti _ I Construction Type: lrcmd /,rQC.Q if-cf'D_ _r Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 1 U� APPLICANT: `'LggA Tel. #-7Z-?3 )_ o 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 $1350 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 $ - y ® STIPULATIONS: Building Inspections 763.572,3604 DATE SiTE ADDRESS A TENANT_ 'ECT From: 95289142500 • Page~3/5 Date: 2/18/2008 8:08:10 AM \ N - BUILDING PermitNo ' DIJSTRIAL Received �y: &YDI CITY OF FRIDLEY D*"' � � /,', Y�O�U,R EMA IL ADDRESS -eV t�/iW1 R Suite No._,_ NAME: 'J'4' 0" k u ADDRESS;.__ CITY STATE ZIP PHONE; NAME: _ ADDRESS:^ CITY STATE XTP NAME; ADDRESS: PHONE: "NOTE: CITY LICENSE RE V TYPE 0 TOWNHOUSE Q MULTT-FAMILY TYPE C1 ADDITION ODEL UBMTT: 1.4 SF..TS OF DRAWINGS 2. SURVEY/STTE PLAN 3. LANDSCAPE PLANS CITY FAX (F -D, FOR. MULTI FAMILY/C NEW 5. CONTRACTORS LICENSE OR LICENSE: APPLICATION BUILDING TO RC USED AS,: `S 10 C-) - OFFTCE CF WHS TOTALSIZE: STORIES FiRE PROTECT] DPTAiLED DESCRIPTION OF WORK a,r`4 %'FfrotIw Q SWIMMING POOL 6. SPECIAL INSPECTION SCHEDULE 7. PERFORMANCE BOND AMOUNT $ THIS IS AN APPLICATION TOR A FERMIT-NUr VALill UNTi1, PROCESsrn 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 t without a permit; that the work will be in accordance with the approved plan in the case of all work whi t r view oval plans. SiGNATIIRE OrAPPLMANt _ 4-e, i�%M,y, ATg ALL FEES ARE BASED ON VALUATION Sq. f1;. x $ Cost/sq. A. = Valuation $ _ Sq. ft. —x $ Cost/sq, ft. = Valuation $ Sq• ft• r Cost/sq. ft. = Valuation $ TOTAL JOB VALUATia: $,V* USP�OCCUPANCY _TYPE Permit Fee $ " -a See Back Page for Fee Schedule Plan Review $ o 65% of Building Permit Fee Fire Surcharge $ .001 times the total job Valuation Surcharge SAC Charge $ :Z, Qj - .0005 x Permit Valuation Minimum $.50 _$ � $1675 per SAC Unit (Pians to MWCC for determination) Erosion Control °'--"� $ $450 Conservation Plat Review Park Fee $ Fee Determined by Engineering Special Assessments $ Agreement necessary ( ? Non Necessary ( ) Curb Cut Escrow $ _p; + 6 ft 1 -_ft x $21 = $„ Total Due $ Make checks navahle to: City of Fridley Attar �o b From: 9528914250 . Page) -5/5 Date: 2/18/2008 8:08:11 AM A d Nc.�1 (OEV*- - k,60SE- 4S awx - T 8110 _ , 1'4 16'3— ,'' `%jL J rr= \ II fl II fl 4 \� Mech room ti LIVING 84 ft 3 �� 2 1/2 Wali System 2 1/2= 49' ! 1" wall system P-1 1#1= 46' Steel Studs Total= 97' U Soffit=37" d ' _ ° Soffit Steel Studs= 20' Not doing 2'5 187 fir►► �� SC��. 2'1 - W4 r 4'8 � REVIE ED LIN��e � �� cofxfAl� G In p co� Building MECHANICAL Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 763-502-4977 FAX CITY OF FRIDLEY vat EFFECTIVE 1-1-08 DATE f G YOUR E-MAIL ADDRESS SITE ADD s— / 4 I U Lo U�� THIS APPLICANT IS: ❑ OWNER ONTRACTOR PROPERTY NAME: LG c1— OWNER/ ADDRESS: le+'�I t - 41 STATE CITY � h� \ e(Q �G �LIP�� TENANT _ PHONE: CONTRACTOR COMPANY NAME: NOTE: SEPARATE CITY CONTACT PERSON: SU STATE LICENSE # EXP DATE LICENSES ARE REQUIRED FOR GAS AND HVAC. ICI C Z (Q %�I U ✓( �tsl r P,41 CITY CSS Lr STATE PnP SUBMIT COPY OF BOND PHONE —44 Lgze) — FAX -7 4Z) ANDINSURANCE PERMIT TYPE 1�6GLE FAMILY ❑ TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: [3 NEW 13 REPLACEMENT C)4LTERATION/REMODEL DETAILED DESCRIPTION OF WORK ,� j �C1a a,� 1�i V CAIXAw" (T_ � I 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 ) OR Labor cost under $300 = $15.00. Labor cost between $300 to $500 =cost of labor x.05=120--25 FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: MODEL: SIZEBTU MFG: MODEL: SIZE/BTU MFG: MODEL: SIZEIBTU _A/C $25.00 _FIREPLACE (GAS) $15.00 RANGE/OVEN $10.00 _GAS _AIR TO A EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 TWO _BOIL $35.00 _FURNACE $35.00 UNIT HTR $10.00 _GAS C Y LINER $10.00 _GAS DRYER $10.00 HEATER $35.00 _POOL $10.00 _GAS PIPING $10.00 VENTILATOR $15.00 PER ME Iw Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ OR Number of fixtures @ $25.00 x $25.00 = $ I t Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 MINIMUM $15.50 MINIMUM $15.50 Total = $O THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a mechanical 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 'dley 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 work will be in acce with the appy ed plan in the case of all work which requires review and approval of plans. SIGNATUREOFAPPL ANT PRINTNANIECI_lC�n S1CQ�� DATE Mf APPROVED BY DATJP/" City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977