PRE 2010 DOCSPermit Fee paid on Permit #11,315 for 1560-1570 69th Avenue N.E.
City of Fridley, Nzn. -11-330
e
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
Date: - EehTnin3 ; 29. 1979
Owner: __Rice Creek Development Company Builder Approved Contractors, Inc..
,Address 85 West Road, Circle Pines, Minn. Address 1052 Osborne Road N.E., Fridley
786-3680
167331675216772 LOCATION OF BUILDING
no. 167921681,h 68th Avenue N.E. Part of Lot
Parcels 10 & 200, Section 13
Lot Block Addition or Sub -Division
Corner Lot inside Lot Setback _____ Side -yard
Bower Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as: Each Unit
6 Townhouse Units Front 20' Depth 32' Height _ 21' Sq, Ft, 1213'
Front Depth Height Sq. Ft.
Cu. Ft.
Cu. Ft.
Type of Construction Woo d -R -r mp I Fust. Cost See_ #11,1_ To be Completed 1 year
In consideration of the issuance to me of a permit to constrVqt the building described abimp, I agree to do
ft proposed work in accordance with the description above 7S= and in cOM3231ance provisions of
Ordinances of the city of Fridley.
In consideration of the payment of a fee of $ See #11 31permit is hereby granted to Rice Creek Dev. Co.
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
vithin
anceae. city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinn
S
CE BELISLE
NOTICE:
This permit does not corer the construction, installation for wiring, plumbing, gas heating, sewer or water, go sure to see
the Building Inspector for separate permits for these hems.
Application for Power Plants and HeathM Cooling. Veeti O&R. Re1jigerrotion and
Air Conditioning Sydem and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ................ .. $10.00 i
Replacement of Furnace ... . 6.00 i
Repairs & Alterations—up to $500.00 600 $ _
Repairs & Alterations each add. $500.00 3.00 $—__ _.
MECH. WARM AIR //��
Furnace Shell & Duct Work to 130,000 BTU ......CO. .110.00 $��� 0 C)
each add. 60,000 BTU .................... . 3.W i
Replacement of Furnace 6.00 $
Repairs & Alterations—up to $500.00 6.00 $
Repairs & Alterations each add. $500.00 .... .. 3.00 $
STEAM or HOT WATER SYSTEM
NO RATE TOTAL
Furnace Shell & Lines to 400 sq. ft. EDR Steam
$10.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water
10.00 $_
Each add. 200 sq. ft. EDR Steam
3,00
Each add. 320 sq. ft. EDR Hot Water
3.00 $—
OIL BURNER—to 3 gal. per hour
over 3 gal. per hour --See Fee Schedule
GAS BURNER (up to 186,000 BTU) `p
over 199,000 BTU See Fee Schedule
Dept. of Bldgs. Phone 680-3480
— -,,/ C-- —,&./—lV/—.i- 4
City of Fridley:
if
The undersigned hereby makes application for a permit for the work :hereir
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 RWiW/7�r1�/.Y'lS�r/J111
Kind of Building
4ZZ&
Used as
jro be completed about
Estimated Cost,
Building Permit No.
1t- 2
Permit No. S��
DESCRIPTION OF WORN
6.00 $
HEATING or
d PLAN1Stem, Hot Water,
5.00 $3D.oo Trade Name- �Size ANo-
ir�N-o S��
r.-;4 C1 ®OO off'QD_�7i
GAS FITTING FEES:
NO RATE TOTAL
y --- --"4• miE.D.R
BTU H.P.
1st 3 Fixtures
x$ Zoo
$ /2 • 0 O
Total Connected Load
Hind of Fuel
Additional Fixtures
x .76
$
Gas Range to 199.000
.. s$ 600
$
Q�Capadty
BURNER — Trade Name
Size No
AIR COIfDTRONI1fa
(49b
Sq. Ft. EDR
BTU l3P
p
FAN HEATING SYSTEM
See Feo schedule
1.�
VEIrMATING SYSTEM ® V fJ
ALTERATIONS & REPAIRS TOTAL FEE U V
Pq
ROUGH
FINAI.
4� e
l (REMARKS -OVER)
City of Fridley
Appiicalioe for Pkmbiftg and G= luting Pwn*
DESCRIPTION OF WORK
Number. Kind and Location of Fixtures
MuMBIMMUMMMMMM1140"
MEMEMEMOMMEMOMMEMM
MOMMOMMEMEMEMEMEMN
MEMMMEMMEMMEMEMEM
MM
MMMMMM
..................
PARTIAL RATE SCHEDULE
PLOMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ................ C/ x52.00 t
Future Fixture Opening .... :...... x $1.50
New Fixture Old Opening .......... x $1.50 i
Catch Basin .................... —x$3.25 S
Water Heater !Up to 99,000 BTU) .... — 16 woo i
New Ground Run Old Bldg......... x $3.25 S
Electric Water Heater .............. a $2.00 $
GAS FITTING FEES: NO. RATE TOTAL
lot 3 Fixtures :5200 i )
Additional Fixtures ............... x 41.75
$
Gas Range to 199.000 BTU ............ x $5.00 S
State Surcharge $ .50
REPAIRS A ALTERATIONS— Refer to Code
Description • . . . . . . . . . .. • • . . • . . A.. . . . ..... . ... . .-. 1.. �
TOTAL FFA
Dept. of Hldaa. Phone 560-3490
Leca�/�'/gym Il,®7S-i6,17-11, V—ILS'l -/&,S--
City of ilridley:
The undersigned hereby makes application for a permit for thee work herei:
specified, agreeing to do all work in strict accordance with the Citar Oretin m a
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. Ml— ;y l9.
Owner `- r lAr Cr K lJ '(2 ('
Kind of Building
Used as
To be completed about`
e.
Estimated Cost, $
Old—New. Building Permit No. Permit No.
Sign
By
Business Phune No'
ROUGH
SUBJECT
P
City of Fridley('31459
AT THE TOP OF THE TWINS
BUILDING PERMIT
.
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
7O
1 . �
NUMBER
REV
DATE
PAGE OF
AVPROVEO BY
---I CITY HALL FRIDLEY 55432
L J` 612-571-3450
910-F15
10/10/00
JOB ADDRESS 1673, 1675, 1677, 1679, 1681, 1683 68 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
Parcels 101&
200
Section 13
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Jim Bern Co 8162 Bloomington Ave S, Bloomington, MN
952-854-7788
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
BEL Exterior Maintenance Corp 405 W 60 St, Mpls., MN 55419
612-861-6243
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
6 USE OF BUILDING
Townhouse Building
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION] REPAIR
❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof 6 Unit Townhouse Building (53 Sq) 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 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
6 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
$5,419
$2.71
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY O ER TATE OR LOCAL LAW REGULATING CON-
Fire SC $5.42
STRUCTION OR T F CONSTRUCTION
$.125.25
PLAN CHECK FEE
TOTAL F E
1
$ 3.38
TUR CON'RACTORORAUTHOR,2EDAGENT ,DATE,
EN ROPE LI )AT PHIsIS YOtj_q PERMIT
OL OGI.NSP
,
DATE
S,GNATURE OF OWNERai OWNER BUILDER, ,DATE,
Prepaid Plan Check $
Estimated Cost $
Receipt #
Construction Address
Legal
Owner & Address
CITY OF FRIDLEY
R-3, COMMERCIAL & INDUSTRIAL
BUILDING PERMIT APPLICATION
Effective 1/1/2000
(612)572-3604
Zoning
Tel# (��✓�) �� / ��/cN
CONTRACTOR & ADDRESS', fiY%dY1i✓ dV/ct.,Y�}n ��'!!-'`" ••`"'� Tel*
® S frlS✓(0
Architect
TYPE OF WORK [] New
Reg.# Engineer.
BUILDING CONSTRUCTION
U Addition [] Alteration -Describe
Reg.#
Building Use
Air Conditioning [] Yes [] No
Performance Bond Amount $
Permit Fee $
Construction Type Occupancy Group
Fire Protection Provided []Yes []NO
See Reverse for Schedule Received []Yes
Plan Check $
Fire Surcharge $ 6-, �62
State Surcharge $ r .�
SAC Charge $
Erosion Control $
Park Fee $
Spec. Assessments $
Driveway Escrow $
TOTAL $
PERMIT FEES
See Fee Schedule on Reverse Side
In Excess of Prepaid Amount - See Reverse Side
.001 x Permit Valuation (1/10th t)
$.50/$1,000 Valuation (See Sched. for > $1 Million)
$1100 per SAC Unit (Plans to MWCC for determination)
$450.00 Conservation Plan Review
Fee Determined By Engineering
Agreement Necessary [] Not Necessary []
feet x $15.50/foot
ATTACH STIPULATIONS
�et
— v
OFC. AREA:
Length
Width
Height
Sq. Ft.
WHSE AREA:
Length
Width
Height
Sq. Ft.
OTHER AREA:
Length
Width
Height
Sq. Ft.
APPLICANT
�.
Tel # (laIa r I / ��
DSte v ' ��
VALUATION
Sq. Ft.
x $
Cost/Sq.
Ft. = Valuation $
Sq. Ft.
x $
Cost/Sq.
Ft. = Valuation $
) _ $
Sq. Ft.
x $
Cost/Sq.
Ft. = Valuation $
) TOTAL VALUE
Building Use
Air Conditioning [] Yes [] No
Performance Bond Amount $
Permit Fee $
Construction Type Occupancy Group
Fire Protection Provided []Yes []NO
See Reverse for Schedule Received []Yes
Plan Check $
Fire Surcharge $ 6-, �62
State Surcharge $ r .�
SAC Charge $
Erosion Control $
Park Fee $
Spec. Assessments $
Driveway Escrow $
TOTAL $
PERMIT FEES
See Fee Schedule on Reverse Side
In Excess of Prepaid Amount - See Reverse Side
.001 x Permit Valuation (1/10th t)
$.50/$1,000 Valuation (See Sched. for > $1 Million)
$1100 per SAC Unit (Plans to MWCC for determination)
$450.00 Conservation Plan Review
Fee Determined By Engineering
Agreement Necessary [] Not Necessary []
feet x $15.50/foot
ATTACH STIPULATIONS
Ettective Date May 1, 1988
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Job Address l 1a 6l (�' 9 - W< E—
RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
New Fixtures
�.
m
Future Fixtures
ro
$ 3.50
o
Old Opening, New Fixture
X
0
$
Water
Cd
mo
q�
$
qm
$ 5.00
Cd
"
HA
0 -A
M
q
$
it
�
p0.a'
wR�
$
Hydraulic Valve
Heater
+i
m
Sump or Receiving Tank
R
N
Water Treating Appliance
Al N
t
N
.0
m
$
Gas Range
$ 10.00
$
o
$ 10.00
$
Back Flow Preventer Required.
. . Yes ( ) No
Type
$
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1% of Value of Fixture or
Appliance
13 0
"qq
State Surcharge
N
$ .50
($15.00)
TOTAL
FEE
O
N
N34
Y
Wro
v
Mani
cin
3
n� w
cn
w
v w
a' 3
o
as
lec
Base -
1st
2nd
3rd
4th
(R) = Future Connection Opening
Connected with Sewer
(*) New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
New Fixtures
$ 5.00
$
Future Fixtures
$ 3.50
$
Old Opening, New Fixture
-$
1.50
$
Beer Dispenser
$ 4.00
$
Blow Off Basin
$ 5.00
$
Catch Basin
$ 5.00
$
Rain Water Leader
$ 5.00
$
Hydraulic Valve
$ 5.00
$
Sump or Receiving Tank
$ 5.00
$
Water Treating Appliance
$ 7.00
$_
Hot Water Heater
$ 5.00
$
Gas Range
$ 10.00
$
Gas Dryer
$ 10.00
$
Back Flow Preventer Required.
. . Yes ( ) No
( )
Type
$ 5.00
$
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1% of Value of Fixture or
Appliance
$
Reinspection Fee $
State Surcharge
$ .50
($15.00)
TOTAL
FEE
$
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn.
OWNER ✓ ��D-G�
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT
5Zl-.;So
ESTIMATED COST �j bra
OLD - NEW BUILDING PERMIT NO. PERMIT NO. -
Company
Signed By
Tel. No. a
ROUGH INSP.
Date
FINAL INSP.
Date
APPROVAL FOR PERMIT 'ems
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1281
6431 University Ave NE
Fridley MN 55432
Mechanical Permit # O?d®�- 0IRq
Residential Application
City of Fridley
See Back Side For Required Information
Date Site Address: O `6
The applicant is: (cirl a one)
Owner Contractor
Property Owner:
Address:/6.5-7- 49/07 VKe7cca1
City: jrrAA
State: AA/ Zip::e�2
Phone:
Cell: Fax:
Contractor Informati n
-
Company Name:
Contact Person:
r
Address:
City:
State: /d?A/ Zip:,�S
Phone: 6-177 4,%%���
Cell: S/�® �e�9 Fax: lo.°S! 0%V ��
Email: e
a MN Bond# & Exp Date
Type of Work (circle one):
New Replacement Alteration/Remodel
Detailed Description of work: fi-"6am'64,2L e-49 calk,
Equipment Installed: MFG:
Model: Size/BTU:
MFG:
Model: Size/BTU:
MFG:
Model: Size/BTU:
Please check all that apply:
_Fireplace (gas) $15.00 New Gas Grill $10.00
_A/C $25.00
_Fireplace (wood) $35.00 _Gas Unit HTR $10.00
to Air exchanger $15.00 _Furnace $35.00 _Pool Heater.$35.00
_Air
_Boiler $35.00
_Gas Dryer $10.00 _Ventilator $15.00
_Chimney Liner $10.00.
_Gas Piping $10.00 T ,_F
ft
1
Duct Work $10.00
Gas Range/Oven $10.00
Permit Fee $
(Total from above -Minimum fee $35.00
Surcharge $
0.50 e— a
Total Due $
Make check payable to City of Fridley
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 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 case of all work which requires review and approval of plans.
a
Signature of Applicant: // Date:
Approval Inspector Signature: Dater-Z.�d,:�-
Please Note: Separate permits are required for Building, Plumbing, and Electrical work
r
AUG -09-2005
13:34 CITY OF FRIDLEY
PLUMBING
RESIDENTIAL APPLICATION
City of Fridley
Permit Number
Received By
Date Received
NOTE: IF PROPERTY IS NOT OWNERIOCCUPIED. A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT.
DATE / Z_ YOUR L ADDRESS IfA� � �/ uA h
SITE ADDRESS
THE APPLICANT Ia: (CIRCLE- ONE) OWNER CONTRACTOR f_.—
NAME
PROPERTY OWNER/ ADDRESS
TENANT
CITY STATE: ZIP
PHONE #
NAME ® \rlJ �ICENSE # 2
CONTRACTOR ADDRESSZ 4, Z
CITY STATE /k ZIP
PHONE # FAX# _ _ 41L -�r iyz P
PERMIT TYPE SINGLE FAMILY TWO FAMILY
TYPE OF WORK ❑ NEW Ee REPLACEMENT
DETAILED DESCRIPTION OF WORK
es _
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED
FDCTURES: (INDICATE TOTAL NUMBER OF EACH)
BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING
BATHTUB GAS PIPING (Need Co License) SWIMMING POOL WATER SOFTENER ($35)
CLOTHES WASHER KITCHEN SINKVyATER CLOSET BACKFLOW PREV. ($15)
DISHWASHER LAUNDRY TRAY "WATER HTR ($35) FOR IRRIGATION
WATER METER OTHER
00
PermitFee$ , 3► MINIMUM: --$15.00 or 5% of cost of the improvernent-whichever-is-
Plan Revi®w $ greater on work less than $300
Surcharge $ ,SO
TOTAL DUE $ _-, Make checks payable to: City of Fridley
• • • w ray ti- r -4-r I w'% ryR /K rr-AIVI11 - 1Yv 1 VAULO UNTIL PROCESSED
1 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 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 p s.
NAME OF APPUCANT
SIGNATURE OF APPLICANT
type or print
OF FRIDLEY COMMUNITY —DEVELOPMENT DEPARI
$01 UNIVESITY AVENUE NE, FRIDLEY. MN 55432
AUG -09-2005 13:34 CITY OF FRIDLEY P.03iO4
City of Fridley Building Inspections Dept. Ph: 763-572.3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
Mechanical Permit# '�po�- 06
Residential Application
City of (Fridley
// See Back Side For Rpnidrad Infnrmn inn
Date Site Address:
The applicant is: (cirice one)
Owner Contractor
Property Owner.
Address:
City:
State: Zip.
Phone:
Cell: Fax:
Contractor Inforrnatj r, % ® ,
Company Name: ((��
Contact Person:
Address:
City:
State: Zip:
Phone:_ WIZA lid
Cell: B17 i0p Fax: 0P® 4/LU24'
Email: CA a 4 ~b- MN Bond# & Exp pate .T6 66S`
Type of Work (circle one):
New Replacement Alteration/Remodel
Detailed Description of work
Equipment installed: MFG:
Model: Size/BTU:
MFG:
Model: Size/BTU:
MFG:
Model: Size/BTU:
Please check all that apply:
_Fireplace (gas) $15.00 New Gas. Grill $10.00
_AIC $25.00
Fireplace (wood) $35.00 _Gas Unit HTR $10.00
Vir to Air exchanger $15.00
_Fumace $35.00 _Pool Heater $35.00
_Boiler $35.00
_Gas Dryer $10.00 Ventilator $15.00
_Chimney Liner $10.00
_✓Gas Piping $10.00
Duct Work $10.00
Gas Range/Oven $10.00
Pemvt Fee $
&6-00
(Total from above -Minimum fee $35,00)
Surcharge _ $-.—_.. --
._ ...... 0.50'-- - - _ - .. .
Total Due $
Make check payable to City of Fridley
u ms rs do dppnvauon Tor a pennti- not vara un -w 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 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 actordance with the
approved plan in case of all work which requires review and approval of plans.
Signature of Appli
Approval Inspect
Building
MECHANICAL
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
Dated Ql:MAY 20
CITY OF FRIDLEY
DATE S^ % YOUR E-MAIL ADDRESS
SITE ADDRESS 14 5'� O !,!!"CL t/[—
THIS APPLICANT IS: ❑ OWNER [-ONTRACTOR
PROPERTY
NAME: jT" µ �Cistc� P� U l% C—s2 F/ FJ
ADDRESS: CITY STATE ZIP
OWNER/
TENANT
PHONE:
CONTRACTOR
COMPANY NAME4::_�.i e_(ej:j1,
CONTACT PERSON: �- &/1 t U w
SUBMIT A COPY OF
��Gn
YOUR STATE
LICENSE WITH
STATE LICENSE # EXP DATE / /
ADDRESSZ66/7 S ��'b/L WA� efi F CITY d /Z- STATW /ZIP
APPLICATION
PHONE FAX
PERMIT TYPE
❑ SINGLE FAMILY 13TWO FAMILY TOWNHOUSE
TYPE OF WORK:
❑ NEW *EPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK6�s
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 FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
Equipment Installed MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZEBTU
$25.00 _FIREPLACE (GAS) $15.00 GAS RANGEIOVEN $10.00
_A/C
TO AIR EXCHANGEER $15 (WOOD) $35.00 _ EW GAS GRILL $10.00
_AIR _FIREPLACE
$35.00 _FURNACE $35.00 _GAS UNIT HTR $10.00
_BOILER
LINER $10.00 DRYER $10.00 _POOL HEATER $35.00
_CHIMNEY _GAS
DUCT WORK $10.00 _GAS PIPING $10.00 VENTILATOR $15.00
Permit Fee $_ + Number of fixtures @ $10.00 x $10.00 = $ Ifi• On
Surcharge .50 I 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 ap i ion f r permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case o 1 w ich re ires review and approval of plans.
/�/
W f0kSO( 7
SIGNATURE OF APPLICANT PRINT NAME c; —DATE-
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977