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PRE 2010 DOCSi City of Fridley, Minn. BUILDING PERMIT Date: ..� . / .... !............. . Owner ....................................... Address ...................................... �J N® 3789 Builder ..��� .............�........ Address ............................................. L ATION OF BUILDING No. ..� 1 :.J . Street ... �. o %. s .... Part of Lot .. . .......... . .................. ............ ... Block ... �.... ...... Addition or Sub -Division ..... ..�C. Lot ....l.... ... . Corner Lot ............ Inside Lot .. X ....... Setback 3 �..�. Sideyard . % Q-... ............... . DESCRIPTION OF BUILDING To,be Used as: / q .. .... Front J..`�'. D Depth °�: .� Height .!.. '*Sq. Ft. . (. .. ... .................... Front � :. 6 Depth 94R—!q ^ He Sq. Ft. ?/. // .. Type of Construction ................... Est. Cost. IR, &.!,/.......... To be Completed . In consideration of the issuance to me of a permit to co the uildh the proposed work In accordance with the description ah set forth id in ordinances of the city of Fridley. A Cu. Ft. Cu. Ft.-?6.VO agree to do provisions of In consideration of the payment of a fee of $, !Wi?"( .�.. permit Iso6ereby 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. • �::�/�'�(.,,,o ....`Building Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items APPLICATION FOR BUILDING PERMIT CITY DF FRIDLEY, MINNESOTA CLEM JOHNSON & SM Owners Name Builder 25% .VE N E Address _ Address _ yvMPLS.18, -MINN.~ LOCATION OF BUILDING No. Street Part of Lot Lot Block . Addition or Sub. Div. Corner Lots Inside Lot Set Back.._ Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used :as Front .,; DepthHeight It Sq. Ft. Cu. I Ft. Front .. Depth _Height :.,At-.,.____ Sq. Ft. 'Cu. Ft. Type of Construction .` �. � —. Estimated Cost . or To be completed< The undersigned hereby makes application for a permit for the work herein specifieds 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 c rect Date Signatur (A Schedule of Fee Costs can be found on the Re se Side) 61 Ic Application for Power Plants and Heating. Cooling, Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept of Bldgs. Phone SII 4-7470 GRAVITY WARM AIR- RATE TOTAL Location 7 - 067 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 $ MECIL 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. IDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. IDR 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 $ GAS PIPING (Up to 3 Fixtures) .......................... 1.50 $ (Add 50c each over 3) AIR CONDITIONING FAN DATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS REMARKS: �0 See Fee Schedule TOTAL FEE 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—_6-0- a �' ,195-4 Owner lx 711 - / l E -l", " 195..,-. Rind of Buildings--e-'j 195— Used as To be completed about ® c� Estimated Cost, Old��Building Permit No. DESCRIPTION OF WORK SEATING or PO PLANTS -Ste Hot Water, arm Air o i Trade Name maize No- /- G % J Caps, Sq. Ft. EM.R tdO o BTU H.P. Total Connected Load �do Find of Fue " BURNER - Trade Na—_ Size No— Cap cdi o Capadty Sq. Ft. E.D.R, BTU H.P. RAY Na WELTER HEATING CCI Signed 4631 CH I C.AQ,A-AV E By MINNEAPOLIS 7. MINN-ESO7TA ag�ll POST IM -8-58 Business Phone No J� o, City of Fridley Application for Plumbing and Gas Fisting Perndt Dept of 8� Phone SII 4-7470 � �� DESCRIPTION OF WORE /3 '7/. Number, Kind and Location of Fixtures Location PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: 3 TOTAL �� _ a; Future Fixture Opening ................ c° n .3 u c _ � Z t�3 O U°d WG (� U' Z �a (70 . F ® N WATER HTR. GAS ELEC. Base 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 $ 1st 2nd 3rd 4th • Future Connection Openings I New Fixture, Old Openings Connected with Sewer Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... 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 BTU) ...... x 2.00 $ 1100 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 $ oZ 5-0 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 applicationa true and correct. Fridley, Minn / / /r; 1 Owner A� CP, -IC. - 19_ y Kind of Building Used as _- "4E27 To be completed about .' Estimated Cost, $ / f'L:"'vr v" Building Permit No 13 2607 DEC 11 1959 .QW11 POST 1M-12-58 Business Phone n —/&5 19— SUBJECT PER City of Fridley 213981 AT THE TOP OF THE TWINS BUILDING PERMIT i � RECEIP 1 �• COMMUNITY DEVELOPMENT DIV.j� a. PROTECTIVE INSPECTION SEC. r _ K I CITY HALL FRIDLEY 55432 LOJER REV DATE PAGE OF APPROVED BY 612-571-3450 0-F15 6/12/92 JOB ADDRESS 913 68th Ave NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 1 E rookview Terrace SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lyle Groth 913 68th Avenue NE 571-5257 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Rockow Exterior Remodelers 18015 Ute St NW, Anoka 753-3179 4967 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 Reside House 9 CHANGEOFUSEFROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $4,069 $2.03 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHE ATE OR LOCAL LAW REGULATING CON- $72.00 Fire SC $4.07 U�NORTHE PER R NC F CONSTRUCTION. PLAN CHECK FEE TOTAL FEE XT License SC $5.00 $83.10 SIG A R OF NTRACTOR OR AUTHORIZED AGENT IDATEI Vy EN P OP V LI TE THIS IS YOUR PERMIT INSP L - �Z, 5� v DATE SiGNATURE OF OWNER OF OWNER BUILDERI IDATEI NEW [ ] ADDN [ ] ALTER [ ] Construction Address: Legal Description: Effective 3/1192 CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Owner Name ddress: L6 d Tel. # 5 %/—.5-25-7 Contractor: CJ 1:5- MN LICENSE # 000 "19(o'? Address:��71/ %, Tel. # 7Q - 3/ `% q 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 GARAGE AREA: Length DECK AREA: Leng �,_ OTHER: 5> Width Width Width 1�(ts�� Height Height Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [ ] Inside Lot [ ] Ft. Yd . Setback Side Yard Setbacks Type of Construction: f L _ Estimated Cost: $ Approx. Completion Date, 2 2 k Driveway Curb Cut Width Needed: Ft. + b Ft = DATE: 2 APPLICAN (Cost on Bac Ft x $ _ $ CITY USE ONLY Tel. # 2-53-21% F Permit Fee $ 72,0,0 Fee Schedule on Reverse Side Fire Surcharge $ '/,O `] .001 of Permit Valuation (1/10th%) State Surcharge $ .,�1-3 $.50/$1,000 Valuation SAC Charge $ $700 per SAC Unit License Surcharge $ .5-,00- $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: $ .,1 n SUBJECT P City of Fridley ('16349 AT THE TOP OF THE TWINS r BUILDING PERMIT i _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 1 NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 �`' 612-571-3450 910-FlS 6/25/98 JOB ADDRESS 913 68 Avenue NE 1 LEGAL LOT NO, BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 1 Brookview Terrace SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lyle Groth 913 68 Avenue NE 571-5257 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. All American Roofing & Remodeling 4112 97 Ln NE, Blaine MN 55014 786-6676 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5160 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION ❑ ALTERATION j] REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof House & Garage (20 S) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIRED 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 1 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 $1,669 $.83 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE License SC $5.00 $61.50 SI TUREOFCONTRAC OR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY BLD )NSP LIDATED THIS IS YOUR PERMIT r�ATE SIGNATURE OF OWNER)IF OWNER BUILDER) (DATE) NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION( �� f ConstructionAddress: qj 3 Ayt O t Legal Description: Owner Name & Address: CYo-rH Tel. # 5-71 SZ57 Contractor: IAS jwcie%cik J (_oi>f Ly%C% MN LICENSE# Sl 4�0 Address:., 4( c a 9-7t- " Lnj N E- . S 7 Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: �90 .5 Construction Type: Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 6-;L5 ' 9 ce APPLICANT: (—"**rA UL W c.e r o Tel. #��-(-6-74 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL . STIPULATIONS: $ 6/.5-0 CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 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 [ ] CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763)572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On Jan 1, 20u2 PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater -Electric $ 7.00 Water Heater - Gas** $10.00 Gas Range'" $10.00 Gas Dryer`" $10.00 Back Flow Prev��e-nter Required (AYes () No Type �d—' 765 _J_ $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS ®� 1.5% of Value of Fixture or Appliance ' State Surcharge .50 TOTAL FEE syt7l r")O'sz COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TAB JOB ADDRESS ( 13 og '—p"" 69r,�• A� e. 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. I 20 0;�_ Owner Building Used As h6"4 - Do Estimated Cost _300 PLUMBING SIGNED BY PERMIT NO. FAX# % -670-5 c Approved By Rough -In Date Final Date BACK SIDE 4� 6/1 THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When renl� acinn an ipxestann furanna, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes( ) No( ) The venting system is plasticlPVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes( ) No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. — `fes () No ( ) The axion ina cnmh istinn air is sized and installed to meet the current codes and manufacturer's specifications. When required to install a now _nmb "stinn airy it will be sized and installed to meet the current codes and manufacturer's specifications. When installing a now venting _-.ySWm, the undersigned hereby verifies that it is'a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA -LAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( ) No( ) Yes( ) No( ) Yes( ) No( ) Yes( )No( ) Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance ;'#3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type HEATING CO: Signed By: Date: .-.' Building PLUMBING Permit NO.: '- 3 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 DatAM U L CITY OF FRIDLEY DATE_ ,I/ /0 9 YOUR E-MAIL ADDRESS SITE ADDRESS (J' 13 6, A' - 6_.Le t, 1 1= THIS APPLICANT IS: ❑ OWNER ONTRACTOR PROPERTY NAME: '/6,eL" 6A. TENEN/ ADDRESS: 9 13 & CITY r °- ' i! ZIP e, ANT _STA PHONE: 3 NAME: Terry Overacker Plumbing Inc CONTRACTOR SUBMIT A COPY OF STATE LICENSE #_ 502 E Main St YOUR STATE ADDRESS: Anoka, MN 55303 STATE—ZIP- TATEZIPLICENSE LICENSEWITH PHONE (763) 572-8880 APPLICATION - .SINGLE FAMILY 0 TWO FAMILY ❑ TOWNHOUSE PERMIT TYPE TYPE OF WORK: 17 NEW REPLACEMENT DETAILED DESCRIPTION OF WORK 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 f&-tures. (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 FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) —BATH SINK/LAV ' _FLOOR DRAINS SHOWER WATER PIPING _ _ —BATHTUB _ GAS PIPING (mrm cn7ucEwo _ SWIMMING POOL _ WATER SOFTNER ($35) _ CLOTHES WASHER _ KITCHEN SINK_ WATER CLOSET BACKFLOW' PREV. ($15) _ —DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ WATER METER —OTHER PE�11!�TF,EE.PR03��'T� FOR:T7Nl'3ER $500, ," �., � � .,. �. a, , �'" ��'�4�', � 4''�'FR1VlI.T•'Ft,�lt`�irO�C'T�����ER'$500 `. Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surch a .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ Number of fixtures @ $3$.00 x $35.00 = $ i State Surcharge = $ .50 Total = $ 3,5' i1 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 review and approval of plans. ,which "requires SIGNATURE OF APPLICANT. IffibUx�G(� fiiLti,� PRINT NAME,TAC k-, E k- 4 ,J f- DATE _'Ili 17 lo I r�PLEAS :1V.O.TL- ;S£P .'�E)?;E,... •S AR.Ei�E.I�I�U�(7R:BL�ID.. Gsp�..'G.;��tICA1�iD.:C�iA,NIC,�.L..�4;�;;:,::. City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building MECHANICAL Permit No;:a Inspections RESIDENTIAL APPLICATION Received 763-572-3604 CITY OF FRIDLEY D Ng' 763-502-4977 FAX EFFECTIVE 1.1-08 DATE=, YOUR E-MAIL ADDRESS _ SITE ADDRESS —�1< h�------"------ --- ^.- THIS APPLICANT IS ❑ OWNER XICONIRACfOR PROPERTY NAME. OWNER/ ADDRESS f��^ C'I11' !fit �Z�f IRS' -Sq 13 TENANT --S'`" — PHONE: Jam% r ' Sai CONTRACTOR COMPANY NAME: e--�� CONTACT PERSON:►'�.�/ NOTE: SEPARATE CITY _ FXP DA IT: STATE LICENSE #nCX LICENSES ARE REQUI RED FOR GAS AND HVAC /— Q _ 'IL��' I.LL� b ADDRESS ,�/91� P20®j--- Ct-te'-CITY � �(�( S'A"� - J�—- SUBMIT COPY OF BOND PHONE _to�=-[�-=F FAX AND INSURANCE c� D;SINGLE FAMILY ❑ TWO FAMILY ❑ l(MA'NHOt ISE PERMIT TYPE TYPE OF WORK: ❑ NEW ??REPLACEMENT ❑ ALTEiRAT'IOMRI-MODEI. DETAILED DESCRIPTION OF WORK✓ 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 ) OR 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) Equipment Installed MFG: MODEL MODEL SIZE./BTU MFG MODEL SIZE/BTU MFG MODEL S17_E/BTU _-----_ A/C $25.00 FIREPLACE (GAS)%l 5 00 _GAS RANGE/OVEN $10 00 TO AIR EXCHANGF.ER $15 FIREPLACE ( WOOD) $35 00 _NEW GAS GRILL $10 00 _AIR $35.00 FURNACE $3500 GAS IJNIT HTR $1000 _BOILER LINER $10 00 DRYLR S1000 _POOL HEATER $35.00 _CHIMNEY _GAS WORK $10.00 _GAS PIPING $10 00 _VLNTTLATOR $15.00 _DUCT PERMIT FEE PROJECTS FOR UNDER $500 PERMIT FEE FOR PROJECTS OVER $500 _ Permit Fee $ Number of fixtures $10.00 x $10.00 = $ Surcharge $ 50 Number of fixtures r $15.00 — x $15.00 = $ TO'(AL DUE $ OR Nwttber or fixtures a $25.00 x $25.00 = $ _ _ Number of fixtures a, $ 35.00 _�_ x $35.00 = $. State Surcharge = $ .50 MINIMUM $15.50 MINIMUM $15,50 Total = $� THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED 1 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 tdley and with tl nnesota Construction Co : that I understand this is not a permit but 0111) an application for a permit and work is not to start without a permit, that t work w in a cordance wth the appro ed Ian m the case ufall \\urk \nhich r It fres review and approval ofplans SIGNATURE OF APPL PRINT NAME i AT APPROVED BY __ __ — DA % PLEASE NOTE: PARATE 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