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PRE 2010 DOCS• n U City of Fridley, Minn. BUILDING PERMIT Date; — April 4. 1968 Xo owner; Harley A. Parker Builder Clemron'Iucc. Address — Address _ 701 Columbia Blud LOCATION OF BUILDING No. 399____ Street 73rd Ave. N. E. part of Lot Lot _ ll Block 4 � Addition or Sub -Division _._.__ Melody -Manor Corner Lot ?; Inside Lot --- Setback � 29 � _�_ Sideyard -- Sewer Elevation _ 857.38 _ _ _ 860.3B- Top 60.3$Top of Footing DESCRIPTION OF BUILDING g101 9651 To be Used as: Welling Front_4.4' Depth 25' Height —20' Sq. Ft. 1100 Cu. Ft. —2"00 Garage Front 21' Depth 24' Height 10' Sq. Ft 5 04 CLL r -t, 5 040 Type of Construction Frame Fst. Cost _ 27 5 00 __ To be Completed 6 Months SEWER LOCATION -- 58.5' North of Manhole on 73rd Ave. WATER LOCATION -- 68.5' -North of Manhole on 73rd Ave. In consideration of the issuance to me of a permit to c the proposed work in accordance with the description above ordinances of the city of Fridley. 00.00 Sewer b building and in cc agree to do provisions of In consideration of the payment of a fee of $ 41 .00 , permit is hereby granted to— Clemron, Inc. 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 ordinanc. Inspector Clarence Belisle NOTICE: Tbis permit does not cover the construction, Installation for whing, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these hems. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME`,�/�� �� /_s' �' : BUILDER ADDRESS ADDRESS LOCATION OF BUILDING N0. \' 99 STREET PART OF LOT LOT BLOCK ADDITION OR SUBDIVISION CORNER LOT INSIDB LOT —SETBACK SIDE -YARD .� •.a• SEWER ELEVATION Jam% 3� FOUNDATION ELEVATIOft ��.�� `moi •`�d - �-�1 %3� Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn o these ertificates. 15?"' . /✓. dam &-w '%31LO4-"' DESCRIPTION OF BUILDING To be u d as: Front �Depth Height Sq. Ft. z/z e Cu. Ft. ® a Front_ �2 �� Depths —� Height 16 Sq. Ft. a Cu. Ft." d Type of Construction ��..�o _Estimated Cost. To be completed The undersigned hereby makes application for a permit for the worerein 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 application are true and correct. DATE (Schedule of Fee Costs can be found on the Reverse Side). 16-6 .S C C' E Application for Power Plants and Healing. Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... $10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR % Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ ✓ each add. 60,000 BTU 3.00 $ 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 Furnace Shell & Lines—to 400 sq. ft. IDR 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 ........................ 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTU) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TO L 1st 3 Fixtures x$ 2.00 $ Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH See Fee Schedule TOTAL FEE $ Dept. of Bldgs. Phone 560-3480 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 �a/n►d correct. Fridley, Minn- Owner Kind of Building Used as To be completed about EstimatedCost,ost, $ Old(- eve' auilding Permit No. 016S] Permit No. 141151 DESCRIPTION OF WORK HEATING or POWER O!L / team, Hot Water, arm Air No Trade Name e:�ne;w Size No- Capacity Sq. Ft. E.D.R6 A�-:) BTU H.P. Total Connected Load Kind of Fue BURNER — Trade Na--- Size Size No- A Capacity Sq. Ft. E.D.R k BTU H.P. FINAL (REMARK RS V- WELTED HEATING Co. 4637 CHICAGO AVE. <z Business Phone No.�—� City of Fridley Application for Plumbing and G= Rating Permit DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ........ i x $2.00 $ 2- 2, 9 - Future Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. x $1.50 $ Catch Basin ............................ x $3.25 $ Water Heater (Up to 99,000 BTU) ...... x $3.00 $ 3'.13 New Ground Run Old Bldg. ............ x $3.25 $ Electric Water Heater s $2,00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $2.00 $ Additional Fixtures .................... —x$.75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE 2 71 015 Dept. of Bldgs. Phone SM -3450 Location . q % — 7 3 A c4f-, A J , C� City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are tru and correct. Fridley, Minn- 19— Owner -L C_ /"1 -2 Kind of Building — T? c -S Used as / To be completed about �u Y Estimated Cost, $ Z (d Old—New. Building Permit No Permit No. Signe h ff� s Business Phone No ROUGH FINAL QD 42 u�aS Y Z 8 NWWi W ? 0O F N WATER HTR. GAS ELEC Base Ist 2nd 9� 3rd 4th • Future Connection Openings New Fixture, ON Openings I Connected with Sewer Cesspool � PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ........ i x $2.00 $ 2- 2, 9 - Future Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. x $1.50 $ Catch Basin ............................ x $3.25 $ Water Heater (Up to 99,000 BTU) ...... x $3.00 $ 3'.13 New Ground Run Old Bldg. ............ x $3.25 $ Electric Water Heater s $2,00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $2.00 $ Additional Fixtures .................... —x$.75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE 2 71 015 Dept. of Bldgs. Phone SM -3450 Location . q % — 7 3 A c4f-, A J , C� City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are tru and correct. Fridley, Minn- 19— Owner -L C_ /"1 -2 Kind of Building — T? c -S Used as / To be completed about �u Y Estimated Cost, $ Z (d Old—New. Building Permit No Permit No. Signe h ff� s Business Phone No ROUGH FINAL QD 42 SUBJECT City of Fridley ('12 9 1 7 AT THE TOP OF THE TWINS BUILDING PERMIT I RECEIPT NO. �• COMMUNITY DEVELOPMENT DIV I _ ~ PROTECTIVE INSPECTION SEC [ 0 NUMBER REV DATEP AGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 9/16/94 JOB ADDRESS 399 73 Avenue NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 11 1 4 Melody Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Judy/Al Quam 399 73 Avenue NE 786-2652 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 X ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (24 Squares) Tear -off 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1 800.0 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERF MANCX,OF CONSTRUCTION. $41.00 Fire SC $1.80 PLAN CHECK FEE TOTALFEE jj $43.70 $IGNA R � IDATEI WHEN PROPERLZVIDAT D THIS IS YOUR PERMIT r"IR �6UTHORIZEDAGENT vV s BLDG ' GATE NERTIF b-WNER BUILDERI IDATEI NEW j ] Effective 1/1/94 ADDN (J CITY OF FRIDLEY ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R -Z Building Permit Application Construction Address: 9 Legal Description: Owner Name & Address: ✓—a ` u � Nt Tel. # -7 �2, Contractor: _ ' MN LICENSE # Address: Tel. # 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: ��e {' oo v�C S � OjIF V x Q — a `l 5C �' . / c.4 v c Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Type of Construction: ' r t� /Ass Approx. Completion Date: Side Yard Setbacks Estimated Cost: cc (Cost on Back) Driveway Curb Cut Width Needed: Ft. V+��' t;Et x $DATE: � 4 APPLICANT: Tel. # r._ L._ CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ % , 00 .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $800 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "II" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary ( ] TOTAL $_ L !TA STIPULATIONS: _ _ r CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Effective On May 10, 1999 JOB ADDRESS %3 OWNER Rate TOTAL BUILDING USED $ 30.00 $ ESTIMATED COST PERMIT NO. 3 $ 10.00 $ DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ 10.00 $ Trade Name 4 CLo Size No.AT- BTU —1 HP EDR $ 25.00 $ Fuel CG -i.., Total Connected Load Burner Trade Name Size No. BTU HP EDR State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. $ 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 an $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are'true and correct. $ �SS17 �AMed Fimside dba Fireside Comer License 420090911 HEATING CO 2700 N. FairviewAvs. hospV1111rd, MN 551101 651,%633-2561 Signed DATE Approved ByA Rough -In Date Final Datdo�qq FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE CHUdMY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes () No ( ) 2. Is free from rust or deterioration Yes () No ( ) 3. Has no foreign objects lodged within Yes () No ( ) 4. Is securely supported Yes () No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes () No ( } 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes () No ( ) 8. Has combustion air been provided for water heater Yes ( ) No ( ) Remarks: List ALTERATIONS~ Being_ Done: e b G 9 V HEATING CO: �1 �Q (�DJULY-7 Signed By: 0 LaLL== Date: p�c o "ITY OF FRIDLEY INSPECTION DIVISION Effective On January 1, 2000 5431 University Ave NE Ytdley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, CODLING, VENTILATM, 763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEWCES 7 y'04 ` J08 ADDRESS; ' l: A Vl RATE SCHEDULE 01Af14ER U sidential Rate_ TOTAL Furnace Shelf and Duct Work, Bumex • BUILDING USED A$ Also Replacement Furnace $ 30.00 l (Side Vent - gill Out Back) ESTIMATED COST _ PERMIT NO. % � j Gas Piping (Needed urlth new furnace, $ 10.00 $ but not replacement) DI:SCRIPTIDNQE FURNACE„ AND OR BURNER Cas Range $ 1G.00 No. of Heatin Units Circle One (Steam) (Hot Water) d rn Ai Gas Dryer $10.00 $ Trade Name _ ^ Size No. �- BTU_ 14P EUI2_ *Air Conditioning - All Sizes $ 25.00 Cap Fuel ._ Total Connected Load_ All Others/Repairs & Alterations (LIST ON BACK) I /o of Value of Appliance or Work :ommerciial/lndua trial 1.25% of Value of Appliance or Work State Surcharge TOTAL FEE GENT UM FELE FOR ANY HEA1IiidG,/C00i,1NfiiYEN-1 RAT -10H IE RIGCNIITIOIll4AlRCO1 IT1QfollfllGRI�I_ I IS $25,Q0 'WE THC -UQSTAN SURCHARGE 1II4SPECTION FEE $47.00/Hr Air Cordttioners can not be placed in a side yard without rotten permission from adjoining property owner. 3 Burner Trade Name Size Flo. BTU ---HP EDD 6 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all wont in strict accordance with the City Codes an ratings of the Building Division, and hereby declares that all the facts and representations stated in this application are two and correct. o DATE HkATiNi A'f Signe TEL !f 7 L–� `/ Gj J Approved By ..,. Rough -En Date — Final Date ob3 Fill_ OUT BACK SIDE FOR STACK ZIERIFICAI[QN ONREPLACEMENT FU N CE N THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED 'ranca, the undersigned hereby verifies that the When ®einnin an axietinn venting has been examined and is free from rust, deterioration, obstructions, Yes and is securely supported and firestopped where required. The venting system is plastictpVC and meets all current codes and manufacturer Yes (No specifications including sizing, length, number of elbows and termination. The undersigned also verifies that the replacement unit is a listed assembly specifications. This does and meets the current codes and manufacturer's include AGA -LAMA Category I Central Furnace Venting Tables for fan Yes (4,�'No ( ) assisted and natural draft appliances. The �,zia4inn mmhi m+i air is Sized and installed to meet the current codes Yes (°-�f No { ) and manufacturer's spedfications. When required to install-" naw rnmht uWa a€r_ it will be sized and installed Yes (o ( ) to meet the current codes and manufacturer's specifications. Inatallinn a naw warding n0jam, the undersigned hereby verifies that When it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Yes No (( } Venting Tables',for fan assisted and natural draft appliances. Is the common vent and vent connectors sized and installed conrectly after has been removed from the common vent and vented an appliance separately as per current codes. gent and V nt Co Yes ( o ( ) AnnlianmTyng and gi7giCnmmnn lt9gAppllance #1 Type BTU Input Fan Assisted or Nat $ Fan Assisted or Nat Appliance #Z T BTU Input Appliance #3 Type BTU Input 52 Fan Assisted or Nat ►_ Total Appliances Total Btu Input o! Common Vent Type? Vent Height i Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter Appliance #2 Vent Connector Height ft Length ____ft Diameter in Type in Type Appliance #3 Vent Connector Height ft Length ft Diameterin Type p- . � _ 1''���� Building PLUMBING Permit NO.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date DATE i f YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: ❑ OWNER RCONTRACTOR PROPERTY NAME: ADDRESS: CITY STATE ZIP OWNER/ TENANT Zffte PHONE: 42�5_7– CONTRACTOR ,- NAME - SUBMIT A COPY OF STATE LICENSE,/ # EXP DATE �lor STATI&/ ZIP,P--3'3 YOUR STATE ADDRESS: Y / S l CITY L@— LICENSE WITH PHONE FAX APPLICATION PERMIT TYPE 'I�"SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW ❑ REPLACEMENT DETAILED DESCRIPTION OF WORK L v 11�L 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 $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) BATH SINK/LAV DRAINS SHOWER _WATER PIPING _ _FLOOR _ —BATHTUB _ GAS PIPING (vEm cmucEvsE) _ SWIMMING POOL _ WATER SOFTNER ($35) CLOTHES WASHER KITCHEN SINK WATER CLOSET �KFLOW PREV. ($15) _ _ _ DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ WATER METER —OTHER ti 1st_ 1 E - � Permit Fee $ J S Number of fixtures @ $10.00 x $1000 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 z $35.00 = $ L� TOTAL DUE $ /_ J1 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 al work which requires review and approval of plans. JJ, -,-�� SIGNATURE OF APPLICANT PRINT NAME �? ATE �` /s�l��!/� G e City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 17 Building PLUMBING PemiitN0.*a0$j:,-Qa30p Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIEDLEY DateM: DATE-- IT 10-01-1 0-o YOUR E- ADDRESS SITE ADDRESS 1 l� F THIS APPLICANT IS: O OWNER 'CONTRACTOR PROPERTY NAME: OWNER/ TENANT ADDRESS:_CITY— PHONE: rI - i6 -7%6- D 6- CONTRACTOR NAME: AIRO ROFIR (i022111g PM SUBMIT A COPY OF STATE LTCENS _ EXP DATE (�-' 'k YOUR STATE ADDRESS: 3670 L A�: dd CITY STATE ZIP LICENSE WITH PHONE 11, MN $6193--1336 FAX APPLICATION PERmrr TYPE PSINGLE FAMILY ❑ TWO FAMILY O TOWNHOUSE TYPE OF WORK: O NES''' �LREPLACEMENT DETAILED DESCRIPTION OF WORK �_p pl &C"o Ot ak r VtezLk" 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 $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 P4=Cln7LlcENA _ SWIN&IING POOL WATER SOFTNER ($35) _ _ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15) _ _ DISHWASHER _ LAUNDRY TRAY =WATER HEATER ($35) FOR IRRIGATION _ WATER METER OTHER PEI 1?EE P tO I S,FOI lJi+7 X50 .. �f IR Permit Fee $ -00 Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ 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 Worw require review and approval of plans. )ich r� SIGNATURE OF APPLICANT PRINT NAME ® S7 V DATE I l - I q' �r _ A.�, 73! ` ,c•.L1',�iCl, ,�. , '4:'.` City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 17