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