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AF - 35528�....: _r -� / I � 1�� � �� Village of �ridley, Minn. � ^ . BUILDING PERMIT �° � 18 4'7 � Date: . .. . . . .. .. .. . . � �': .��rr.. ....... .. Qwner . . . . . . . . . . Builder . . ��!�'x!:4'.`.''�-. . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. . . . . Address .�r. .7. . �� --v;`.�. Address...................................... ....�.0..�{.`.�..... ... ....... AT[ON OF BUILDWG No. .. �'�.�':�.. Street ....��'.��vZ�� ....................... Part of Lot ....... ... .. Lot'.���.'. � �1 Block . . . . .�.. . . . . . . . . . Addition or Sub-Division .. i�.��°�'T/.+7?'�'. . c��.'':"r'.. • .. . ,/ ,� / � �. � Corner Lot ........... Inside Lot ...!!...... Setback ..!�.�... Sideyard .. f...� ..... .............. DESCRIPTION OF BUILD[NG To be lise as• � . . . . . . . . Front . .'�.� . Depth . �;1. :'.� Height . . !�.�. .`� Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . . . . . . . . . . . . Front . . �. � . Depth . !2'.'�`: . Height . .�. r. .`S Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . . . ��' . . . . Est. Cost . �. �. S� � . . . . . . . To be Com leted Type of Construction . p ..••••••••••• . •. Tn consideration of the issuance� to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with �11 provisions of ordinances of the village of Fridley. ..................................................... � [� �. In consideration of the payment of a fee of $.� 1..... ., permit is hereby granted to ......... ...... ... . . . . . . . . . . . . . . . . . . . . . . . . . to construct the building or addition as described above. This perniit 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, sha11 conform in all respects to the ordinances of Fridiey, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in tne village limits and this pex�mit may be� revoked at any timz upon violation of any of the provisions of said ordinances. � .� ., .. .......... ......... Building Inspector NOTICE: This permit d'oes 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 #or these items. sue�ecr P E City of Fridley ° 4453 AT THE TOP OF THE TWINS B U I L D I N G P E R M I T; r ' ' RECEIPT NO. � �'-/3�/ � • COMMUNITY DEVELOPMENT DIV. ' j L ' "'-� .. . . r � � PROTECTIVE INSPECTION SEG 1 � i � . � . . � . � � ��"�'; � CITY HALL FRIDLEY 55432 NUMBER � REV. DATE �� PAGE OF APPROVED BY � ` -��'�' �� 612-560-3450 910-F15 llf 1/77 I � JOB ADDRESS 6261 A�le Street N. E. 1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED oescR. 17 2 Moore Lake H1CJY11dIlCZS SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE George Heilman 6261 Able Street N.E. 3 CONTRACTOR MAIL ADDRESS Z�F PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE UCENSE N0. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 6 USEOF BUILDING Residential 7 CLASS OF WORK ClX NEW ❑ ADDITlON ❑ ALTERATION O REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 12' x 12' Shed in Yaack yard 9 CHANGE OF USE FROM TO STIPULATIONS Shed to be kept 8 feet from side lot line per owner. � w��N� SEPERAT� PERMITS REQUIREQ F`OR WIRING Be#ore diggin� �al� �z��:�I �E4���r�z; r TELEPMQ�4E - EE.�'C . Zt�% -�„S �er,. MEATfNG, PLUMBING ANfJ SiGNS. �������� �� �t��► TYPE OF CONS7. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOF ELECTRICAL, PLUMBING, HEATING, WO� 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 OFFSTfiEE7 PARKING 1 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 yS`SOO �.SO WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AWTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON'- •�, 5O STRUCTION OR'THE PERFORMANCE OF CONSTRUCTION. $ PLAN CHECK FEE TOTAL FEE yi8.�� I NATUREOFCONiRACTOR R THORIZEDAGENT IDATEI . . � HEN�PROP RLY� VALIDATE THIS IS YOUR PERMIT � �/y� ` C�-�C (, l ,.��/.�._.l� . � iGNATUREOFOWN 1 fR UIL 1 � IDATEI �� . BLDG.INSP� � DATE�.� CITY Of= f=fZIllLEY ' APPLIC/�TIOIJ FOR RESIDC(�TIf�L BUILDING PERt�IITS �NEW, IILTERATIONS, ADDIT'IONS, OR REPAIRS) OWN�R: � � ��� BUILD�R: � �) �,� �° �� Address: Gi � (o / .�� (��_ �%� /iJ,�, Address: � Te 1. . No . . No.: Street: LOT : � .7 BIACY.: �_ ADDITIOI3 : � p �., � f � ,N„ � � � I� /,� � CORNER LOT: INSIDE IAT: � S;TBACK: SIDEYARDS: Applicant attach 'to this foxm �ao Certiiicates of 5urvey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: r S� � i� Front: ( t-- Depth: �'L Height: �� Square Feet: I u t� Cubic Feet: Front: Depth: Square Feet: Cubic Feet: Height: Type of Construction: � p p� Estimated Cost: $�CJ'p ^ Z+o Be Gompleted: �-- j'n ps � Alt. A A2t. B Proposed Driveway Widt� If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance ��ith the City of Fridley Ordinances and ruli.ngs of the Department oi Buildings, and hereby declares �hat all the facts and represniltations stated in this application are true and correct. See reverse sid for aclditional information. . � DATE: _ I I� t `��� SIGNATURE: Stipulations: � � � `. � � g.CJ� � �. . - 0 �r l BUILDI(�G PER��IIT FEt SCHET)�!_L SECTION 2. The Inspector of Buildings shall, before i.ssuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repairs to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: A, NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet.. PLAN CHECK: 25 percent of building permit fee. DRIVEWAY DEPRESSION: (Concrete Curb Streets Only) , Alternate A: Remov�l and replacement of concrete eurb and ':. gutter only; Driveway width plus 6 feet x$11.75 Alternate B:'Removal and replacement of concrete curb and gutter and install a 3 foot wide approach with 6 inch depth; Driveway width plus 6 feet x$15.40 :11 � ► �' p �� For the purpose o£ computing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the ground area covered from a . point six (6) inches below the floor line of the basement or th� cellar to the average heights of the upper surface'or to the average heigh� of the roof surface of the main gable of a pitched rnof. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 per each five hundred dollars ($500.00) or fxaction thereof in the cost o.f all proposed work. Zn no case shall the fee charged•for any permit as set forth in Section 2 be less than $7.50 plus $.50 state surcharge. ' � • • �_1�' �L NQTE: Permits �or construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has been constructed will be required before proceeding with the framing. CtRTIFICATE OF OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a°buiZding permit has been issued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. 0 m sue�ecT PERMIT City of Fridley AT THE TOP OF THE TWINS B U I L D I N G P E R M I T r ; � RECEIPT NO. � • COMMUNITY DEVELOPMENT DIV. r �~ � PROTECTIVE INSPECTION SEG � � i � � i i.-_. �,�/"'1,,, CITY HALL FAIDLEY SS4$2 NUMBER .� REV. DATE . PAGE OF APPROVED 8V i �'� 612--571-3450 910-F15 4/24/85 � � JOB ADDRESS 6261 A,ble 5txeet N. E. 1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. P't. 17,18 2 MOOY'2 Ld.ke H1C3Y11driC1S SHEET 2 PROPERTYOWNER MAI�ADDRESS ZIP PHONE George Heilma,n 6261 T�ble Stxeet N,E. 571-3037 3 CONrRACTOR MAILADDRESS ZIP PHONE UCENSENO. Lee's Siding & Trim R�pair Service 2461 Bunk.er Lake B1vd N.W., Andover 55304 4 ARCHITECT OR DESIGNER MAIL ADORESS 21P PHONE LICENSE NO. 755-5260 5 ENGtNEER MAILADDRESS ZIP PHONE UCENSENO. 6 USE OF BUI�DING Residential 7 CLASS OF WORK ❑ NEW � ADDITION � ALTERATION � REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Aluminiun t�im (�'acia & So��it & windows: (_ 9 CHANGEOFUSEFROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAO VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OF If CONSTRUCTION OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCEO. NO. DWIG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORiiECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ,ORDINANCES GOVERNING THIS TYPE OF WORK W1LL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT y�`1. HrJ�. S. 92 OES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pEfiM1T FEE SAC CHAFGE OVISIONS OF ANY OTHER STATE OR LOCAI lAW REGULATING CON- S U TION O HE PERFORMANCE OF CONSTRUCTION. tiS`3]-.00 � AN CHECKFEE TOTALFEE ,�-�� $31. 92 . S�GNATUfiEOPCONTRACTORORAUTHO Eon IDAT i WHEN PROPERI � ALIDATE THtS IS YOUR ERMIT �� d. , r � L^� SiGNATUAEOPOWNER11fOWNERBUILDERI � IDATEI BIDG WSP D E N� [] City oP Fridley Effective 4/1/84 ADDN. [ J R-1 A1�D R-2 �I,TEp. [ J Building Permit Application Construction Address � r-- Legal Deacription: `�" � � � l�, � � f �--` =z � v • � u u K � c--r-��c � �co�-r-uy-� ,�� - - Owner l�mme i Address :��1^o R C� ���/� �.� 11� �S',Q M� Tel. � l-30 Contractor: � �,�5 � f� /NC. i'! /Y O .�.l�i�1����/'�' . S�/� I/�ic � Tel . # ��'" - S'�-6 d Addreaa:�l�G 6 / �rJ�(/!�f � _.�� -r �� �/,O /1%�!�%� .�I✓�Dd/l.C=� S�S^3o' / LI9IBG AREA: GARAGE AREA: DECI� AREA : OTHER: Attach to this applieation, a Certificate oP Survey of the lot, with the proposed construction draWn on it to scale. DBSCRIPTI011 OF IISPHOYEMENT Length width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Gr?o�und Sq. Ft. �i4 L//k �-� � a'„F ;�t �'7'� o�..P 71� ��— �i G c. M G d l� L: /� Corner Lot [] Inaide Lot [] Ft. Yd. Setback Side Yard Setback �.. d a Type of Construction: Estimated Cost: �.� �s � Approx. Completion Date: Alt. A Alt B Proposed Drivexay Width If NeW Opening Is Deaired: � � See Back Page for Explanation . DATE: APPLICANT: Tel. �7 S�S � �� � � CITY QSE OIiI.Y Permit Fee Plan Check State Surcharge 3AC Cbarge Park Fee Se�r►ar Nain Charge roT�. STIPULATIONS: _ �/. O d a 3 �� ; _ � a �f 9� Fee Schedule on Reverse Side 25f of Building Permit Fee =.50/a1�000 Valuation =425 per SAC Unit Fee Determined by Engineering Qgreement Necessary [ ] Not Hecessary [ ] Y � s �. BIIILDIIiG PBRMIT FEE SCA$DIILE The Chief Building Official ahall� before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for anq alteration or repair to any existing building or structure� upon application therefore, require the payment Dy the applicant for such permit of fees to the amount herein belo� set forth and in the manner herein provided to-Wit: ?otal Yaluation �1.00 to =500.00 Feea �10.00 (Minimum Fee is =15.00) �501.00 to ;2,000.00 =10.00 for the firet =500 plus �1.50 for each additional a100 or fraction thereof, to and including �2,000. =2�001.00 to �25,000.00 =32•50 for the first �2,000 plus �6.00 for each additional �1�000 or Praction thereof, to and inaluding ;25,000. �25,001.00 to a50,000.00 =170.50 for the first ;25,000 plus �4.50 for eaeh additional a1,000 or Praction thereof, to and including #50,000. :so,00,.00 to a,00,000.00 �100,001.00 and up #283•00 for the firat a50�000 plus �3.00 for each additional �1�000 or f raction thereof, to and including �100�000. �433.00 for the first �100,000 plus �2.50 for each additional �1,000 or fraction thereof. DRIYEiiAY DEPRBSSION ESCROiii (Concrete Curb Streets Only) . Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus b feet times �13•50 Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach t�ith 6 inch depth - DriveWay width plus 6 feet times �15.75 YBRIFICATIOA QF FODNDATION Permits for construction Will be issued a minimum of 24 hours from the time of application to al1oW Por proper revieW of the proposed structure and of the aonstruction siLe. - A Certificate oP Survey of tbe lot, ahowing the location of the foundation once it haa been oonstructed aill be required before proceeding with tbe framing. 0 . . r SuB�ECT c�ty of Fridley AT THE TOP OF THE TWINS B U I L D I N G P E 1� M I T ' �, �72-3f t�4 � `y��____ O MUNITY DEVELOPMENT OIV. r � � PfiOTECTIVE INSPECTION SEC. 1 . � � � i"'1 � CITV MALI FRIOIE� SSIJ2 NUMBEN �""�" ,'' 612-571-3450 910-Ft5 lOB ADORESS 6261 t LEGAL ��T�L'. Of BIOCK TRACTORAOC�TION DESCR. 17 & 1$ 2 PROPERTY OWNER MAIL ADORESS Geor�e Heilman 3 CONTRACTOR MAIL AODiiESS Gates Roofing 4640 XiminPs L�n Pl�ut� ' � ARCNITECT OR OESIGNER MAII AD�FESS 5 ENGINEER MAIL ADORESS 6 USE OF BUILOING Residential 7 CLASS OF WORK REV O�TE PAGE OF 12/1/98 / / 28690 R O. ���s APPROVEO BY SEE ATTACNED SNEET ZIP PHONE IICENSE NO ZIP PHONE LI N0. ZIP PHQNE UCENSE NO O NEW O AODITION O ALTERATION � REPAIR O MOVE O REMOVE 8 OESCRIBE WORK Reroof house and garage (27 Sq) tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. rrre vr c vn�� . SEPARATE PERMITS AqE FEOUIqEO FOR ELECTRiCAL, P�UMBING, HEATING. VENTI�ATING OR AIF CONDITIONING THIS PERMIT BECOMES NULI AND VOIO If WORK OR CONSTRUCTION ZONING AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOF A PERI00 OF 1Z0 DAYS AT ANY TIME AFTER WORK IS COMMENCEO. NO DWLG. UN17� 1 HEREBY CERTIFV THAT I HAVE READ AND EXAMINED 7MIS APPLICATION AND KNOW TME SAME TO BE TRUE AND CORRECT. ALl PROVISIONS Of LAWS VAI,UATION ANO ORDINANCES GOVERNING THIS TYPE Of WORK WI�� BE GOMP�►EO WITH WME7MEFi SPECIFIED HEREIN OFi NOT. TNE GRANTING OF A PERMIT $2313 DOES NOT PRESUME TO GIVE AUTH TV TO VIOLATE OR CANCEL THE pEqMIT FEE PROVISIONS OF ANY HER ST R IOCAL LAW REGUTATING CON- STRUCTION O TH EFiFO N OF CONSTRUCTION �]�F. %S PLAN CNECK f EE License SC S�GNIIUQEO�CON'RACTOpOQ�UTMOA�ZEO�GENT IOATEi WMEN PR I S�GH�iUAE O� OWHEQ ��� OWNEA 8UR0@A� � �O�TE�� e� n �aeo \ Sa. STA�LS OCCUPANCYLOAO CU FT. f PARKING GARAGES $1.16 SAC CHARGE Fire SC $2.31 TOTA�FEE $83.22 D TMIS IS VOUii PERMIT � � f�6IE W r NEW ( ] ADDN [ ] ALTER [ ] CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: ��(d � Legal Description: Owner Name & Address: Contractor: L-`7G1 �� : Address: _ �/� , Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Effective 1 / 1198 �Q� �� �6�� Tel. # 'ENSE # Tel.# �����y� LIVING AREA: Length Width Heighf Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: I.ength Width Hgt/Ground 5q. Ft. OTHER: %grc�� �x��s� o� � �� � rroo� h�s � a � �z . a-- Construction Type ��/^1 � d- I'�'1'��� Estimated Cost: $`'t' o?�� �.. (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: �� / � APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ � .�� � o?. 3� $ $ $ ^� UU $ $ $ $ $ c�3 �� Tel. # S�� O d �� CITY USE ONLY Fee Sehedule on Reverse Side 00 L of Permit Valuation (1 / l Oth %) $.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 [ ] BUILDING PERMIT FEE SCHEDULE K w The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: TOTAL VALUE $1 to $500 $501 to $2,000 $2,001 to $��,f�00 $25,001 to $50,000 FEES $21 (Minimum Fee is $21 plus surcharge) $21 for first $500 plus $2.75 far each additional $100 or fraction thereof, to and including $2,000 $62.25 for first $2,000 plus $12,50 for each additional $1,000 or fraction thereof, to and including $25,000 , $349.75 for iirst $25,000 plus $9.00 for:each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 to $500,000 , $887.25 for �rst $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $500,001 to $1,000,000 $2887.25 for the first $SOQ,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000,000 $1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 for each additional $1,000 or fra�t��� thereof DRIYEWAY DEPRESSION ESCROW (Concrete Gurb Streets Only) Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Altemate "B" : Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. VERIFICATION OF FOUNDATION ; , Permits for construction will be issued a minimum of 24 hours from the time of applic�tiQn to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. ' CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLtCAT10N FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH F� nnR Effective On Jan 1, 2000 PLUMBING FlXTURE RATES NO. RE�TE TOTAL New Fixtures � Oid Opening, NewFixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heate� - Gas'" �_ Gas Range** � Gas Dryer"" Back Flow Preventer Required OYes O No Type $ 7.00 $ 4.00 $ 5.00 $ %.0� $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $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 $�►�/•� P�llS THE 5.50 STATE SURCHARCF COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE JOB ADDRESS �� �'s at����. The undersigned hereby makes apptication for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the f�uilding Division, and hereby declares that all the facts and repr���^*�f�^^^ �•�a-a °- iL0- =—" �� 've and correct. HEILMAN, TIM 6261 ABLE STREET N(:RTHEAST jl ��� ' 20 �� FRIDLEY, MN 55432 � (763)571-3037 Owner _ _ . Building Used As �'ES1��lV Ci� o, % �l,' , _ Estimated Cost � PERMIT NO. ,`� 7( / , PLUMBING COMPANY OIZ��I� ZU/✓I�11/l�� � SIGNED BY ��' TEL NO.�[ Z'S�'�O � 7? `l��-J ,_ _ Approved By . Rough-in Date Final Date � �� ��� COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When reqlacin� an existin�t furance, 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 O No O The venting;,system is plastic/PVC and meets all current codes and manufacturer ' specifications ,including sizing, length, number of elbows and termination. � ' Yes O` No O The undersigned also verifies that the repiacement unit is a listed assembly and meets the current codes and mar�ufacturers specifications. This does include AGA-GAMA Category I Centr�i Furnace Venting Tables for fan assisted and natural draft appliances. The existin� combustion air is sized and installed to meet the current codes and manufacturer's specifications. YesONoO Yes ( ) No ( ) When required to install a new combustion air, it wiH be sized and installed To meet the current codes and manufacturer's specifications. Yes O No O When installin a new ventinst svstem, the undersigned hereby verifies that it is a listed assembly and meets the c:urrent codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and n�tural draft appliances. Yes O No O 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 O No O Appliance Tvpe and Size/Common Vent and Vent Connector Information 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 ALTERATIONS• (Describe) - HEATING Cb: i Signed By: ; Date :