AF - 35735BUILDING PERMIT
�
Village of
Date ����� ��• ...................... .....
��� L��:�G�
Owner............................. �
Address �,�� . . . �.,w. . .��. . . . . . . . . . . .
Fridley, Minn. N� 2 3 4 2
Builder . . . .��: :�� :"':!!/!."�.� . . . . . . . . . . . . . . . . . . . . . . . .
Address.........................................
L CATION OF BUILDING
No. . � � �. . . . . . Street . . . . . . . . . . . . °."'."��.� . . � �'. .!�'. . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . .
Loi ....'�.�....... Block ...�... .... .. . Addition or Sub-Division ��.r.�.��'.`"`. ��wa� V
.r r►/I_ .
Corner Lot . . . . . . . . . . . . Inside Lot . . . . . . . . . . . . Setback . �. . ."�? Sideyard !��. . "'�! . . . . . . . . . . . . . . . . .
DESCR[PTION OF BUILDWG
To be Used as:
t
.. . . . . . �. . . . Front �L.A . . Depth � �. . . Height . . . . . . . . .
!' �� ' ' • ' 'i/' . . . . . . . . . . ! ��. . . . . . . . . . . . . .
Front �� Depth .�"�� . Height
,% Q�� �
Type of Constructio����".�"�. . Est. Cos �/. .� !+! . . . . . . . . . . . . . . . . .
Sq. Ft. �:�.�. . . Cu. Ft. . . . . . . . .
Sq. Ft.'�1. �... Cu. Ft. . .. . ....
To be Completed �.� .........
In consideratiaa of the issuance to me of a perrnit 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 all provisions of
ordinances of the village of Fridley.
�f I���4 csf the payment oi a fee of $. ..�.. . permit is hereby granted to ...... ."��. ...........
�� ` '�`. . to construct the building or ad dition as described above. This permit i5 granted upon
the express condition th�t 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, shali conform in all respects to the ordinances of
�"ridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this perrnit may be revnked at any time up� vi,olation�of�any of the provisions of said
ordinances, �'! i� ,�
. . . Q' �. . : j.r: �I..AFr^'�.":":*."�'. . . . Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. �e sure to see the Building Inspector for separate permits for these items.
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A�Cal�011 �Oi' � MOIMi � � COOIi!l�j. rlRh�OljO� �� �
Ai� Condkioei�q S�� ond Devk�s
PARTIAL RATE SCHEDULE
GlU1V*TY WARM AIA: MTE TO?AL
lLrnace Shell dc Duct �Io�rk ... i10.00 �
Replacement of PLraace . 6.00 �
Repairs & Alterations--up to =500.00 gpp ��_�_
Repairs d� AlteraUons each add. =500.00 . 3 W f
t[LCI�. WJ11tIrE AtR
iLrnsce Stiell dt Duct Work to 190.000 BTV .
each add. 60.000 BTU . . . . . . . .
Replacrment of P1�rnace
Repain dc Alterations---up to t500.00
Repairs & Alteratiooa each add. :500.00
aio.00 s—
3.W ; '
6.00 =—.�q -�r''V
6.00 �
3.00 i _ --
STE11M or HOT WA'1'ER sYSTEM -
Furr:ace Shetl 3t Lines--to 400 sq. !t. F.DR Steam �20.00 S___ _. __
Flirnace Shel? & Line--to 640 �q. ft. EDR Kot Water 20.00 $_ ._ _______ __
Each add. 200 aq. tt, EDR Steem �.(Nl ;. ___.
Each add. 320 sq. ft. EDR Hot Water 3.Cjp ;_ _____
OIL SIIRNiER—LO 3 gal. per hour . 6.00 s-__ ___ _.__
over 3 gal. per hour-�ee Fee Schedule _, _
GAS BiTRIfEA !up to 199,000 BTU) b.pQ ;�
wer 199,000 BT[J See F.� Schdul�
GJ1S FI'I'I'ING FEES: It0 AATE TOTAL
Ist 3 i5xtures ___. __ xE 200 E—�'%�v
Additionai FYatures _ x .76 S_.----.--_-_.
Gas Range to 199.00p x= s,p�p ;
AIA CO!!DI?IOlillf0
F1lN HEATIItG sTS'�!t
vExnia►rzxa sYSrsa�
11LTERA'tIORS t REPAIR3
0
xovvH
�ru. 3-a/- 7 S�
State Surcharge �Q ..50
Sw PN SeLL�dds "'
d
:
ros�. rae s 1-T
a.�c. � a�.. n,�.�,. seo-�eo
L�.. fe S�� / ��C S�L- ��
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ctey oi Frldley:
.The undersigned hereby makes application for a permit 1� !he worl� Aereis
�specified, agreeir►� to do all work in strict aceordance with the City Ordinaac�
and ruli�g of the Department of Buildin�. and hereby declares that aIl We factt
and reyrvsentatiot�s stated in this applicat,iptl are true and eon�ct, .
fl id1eY. Minn 7 v' 3� 1� 7�
,
oW � _�` � , /bLa-�.�,��
�.
V
K�nd �f Buildirtg �
�A e
Used as �..� -�1��
To 1ye completed about ���" �- '� 7�
Estimate.9 C'�ct, a_ ,L�J
UId New. Bwlding Permit No. P�rmit No. I �7�''
�'ll..��_- .. -.. - : --
f¢ti..i-�.A.f �v � . �"n�
s/ 2 S' z � or wo�ec
iTEATiNG or P'OWF.ii PLAN'1"3�Steam. Hot Water, 6�arm�Ai�-No
,A- �/
Trade Name__v�''(�(�_ � �_ ,��l,TL,�_p �
Capacily �0�-(4� � Sq. lp't. E.D.R gT�J g,p�
Tota? Cennected Load___ ____ l�ind ot 11�e
BURNER — 'lYade Nae+e g� �
Capacity_ ,— 39. !'E. E.D-R- g�� �r
�_��.�-e. �l� �1�,�
. � � � Q ,-�'��' .. - _
ausinw pboa� � '7 �'o �/ / 6 �/
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� (REMI�RIft—OVER)
sua�ecT PERM T NO.
City of Fridley � 15 7
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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; � RE N
� • COMMUiJITY DEVEIOPMENT DIV.
, �� -- - -. 9 � y7�
r � � PROTECTIVE INSPECTION SEC.
� �
1 � �
1 � ��'��1 � CITY HALL � PRIDLEY BS4$Z �NUMBER REV. DATE � PAGE OF APPqOVED BV
� ----� � ,•� 612-571-3450 910-F15
5/2�gp � �
JOB ADDRESS
6421 Able Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTAGHED
oescR. 24 2 .t�ore Lake Hi hl nds SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
vin Ha 642 -
3 CONTRACTOF MAII ADDRESS Z�P PHONE LICENSE NO.
Srothers Oonstruction 162Q - 3rd Avenue South 427-6877
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZFP PHONE LICENSE NO.
6 USE OF BUILDING
R2S 1C3Eri t131
7 CLASS OF WORK
� NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
S DESCRIBE WOFK
REYOOf HOII52
9 CHANGE QF USE FROM TO
STIPULATIONS �O� can be. 2nd but not 3rd roof. Install ridged galvanized valleys.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
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 1N�RK IS SU5PENDED OR ABANDONED FOR`A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFY THA7 I HAVE READ AND EXAMINED THIS APPLICATION �- STALIS 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 $8OQ y�`. rJO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T fEE SAC CHARGE
PROVISIONS OF ANY OTHER S TE ii LOCAL LAW REGULATING CON-
TRUCTI THE PERFOR A E F CONSTRUCTION. $7• 5Q
PLAN CHECK FEE TOTAL FEE �
yS`8.00
� SIGNATUREOFCON'RAC ORORAUTHO DAGENT - IDAT�,i .. ..a WHEN PROPEfiL ALIDATED THIS IS VOUR PER�MIT
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SiGNATUREOFOWNERIIPOWNERBUILDERI � IDATEI BIDG WSP nATE �
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CITY OF FRIDI_GY •
AFPLICIITION FOR RCSIDLNTIIIL E3UIl_DIhdG PERMI7S
(fdew, Ali:era�;ions, Acldii:ions, or Repairs)
OWfdEK: � � � Y� A �' ,✓
ADDRESS : � �'I � � ��I4 5 i . , Z �
TEL �VO: �%I ' %5`t�
,�
BUILQER: � v/ `�� S � r 5'T.
�c1
�DDRESS: ,��� �c'—�, ��i. S
TEL NO• � �i � � g77
Construction Location
STR3�T NO : � �?`_1___ STREET: ��CI U / � �"l 1�/� � •
I,pT: �� BLOQC: —�_ ADDITION: / ' [ UO�C . l�� �–�c. �=�f ` � /�- � �/�/,(%
Corner Lot: Inside Lot: Setback: Sideyards;
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIO�d OF CONSTRUCTION •
Front: Depth: Height:
Squar.e. Feet� Clibic I'cet:
Front : Depth : H eight :
Square� F'eet: Cubic Feet:
� �,
Type of Construction : � � /< �p � Estimated Cost: $ � � �b
Zb Be Cbmpleted: � %� '� �/ ��% '
Alt. A Alt. B
Proposed Driveway Width 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 iri strict accordance with the City of Fridley Ordinances and
rulings of the Departme.�it of Buil.dings, and hereby declares that aIl the facts and
representations stated in this application are true and correct.
DATE: �� q V! gV SIGNATIJRE :
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Stipulations:
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. r3UJt_i)IiJG nrw,r���ti1T c��_i� sc���nut_�
SI.C�1.'IOI.� ?.. 'ilie 7nr.;pector r�f' L��i�_1c1�.r�rJ�, ;c}za]_1, bc�far.c� a:; ,ui.nq �>ca�niL-s for trie erecL°�.on
of 111j� )�ll:L�.�J.1'1�J or :�t.ruct:ux.�c, oa: foz any <zcicli.t.�..c�n L-o any e�.a.�tinc� uuildi_ng or. st.ructux�e,
ar for. ar2y altcr<:itiori or r�c���Airs t.a •a�7y cr,a.:;L.ing }�ua.7.d,i.nc� or sLruct:urc, uZ�on i.21�j>I.1Ci11:1.UI1
L1►cT:efor_c, rcquirc L-hc p<iymcriL by tlie aa��,�li.cant: for. such perm�t of fees to. tl�e arnounL
hcrei,n bel.c�w seL iorLh and i�i L-he �nanner hezein �;�rovicTecl L-o-wiL: �
I�li4� CONSTP.UC'TION: Single I'amiJ.y iIomes and Garac�es : $� . 00/1, 000 cubic iee�.
Z'LnN CHl�,'CY.: ?.5 percenL- of bu�.lding permii� fee.
DRIVL�dAX D�P12L•'SSIO2�: (Concx:eLe, Curb SLrcets Onl.y} �"
' 111ternate A: Itemoval and replacemcnt of concrete curb and
i gutL-ez oniy; Driveway width plus 6 feet x Y�.�.75
1�l.tern�te Bs Removal and replacement of cancrete curb and
• � gutter and install a 3 fooi. wi.de approach with �'
' . 6 a.nch depth; Driveway width plus b feet x$17.85
ADDITI��AL INFOR��1�,TION
I'or the purpose of computing £ees far building permits, the cubical content-s of any :
bui.lding or addition, is determined by multiplying ihe ground area covered from a
-, point six (6) inches below tiie iloox line of the basement or the cellar ta the
averag� heights of the upper surface ar L-o the average height of the roof surf:ace
of t1�e riain gable of a pitched roof.
For repairs or alterations to an exzsti.ng struci.ure, the fee shall be at the rate
of $3.00 Pex each five hundred dollars-�($500.00) or fxaction L-hereof in the cost
oi-' a11 proposed work.
Tn •no c�se shal.l the fee charqed foz any pexmit as set farth in Section 2 be less
than $7.50 plus $.5Q state surcharge. '
' : ! � � ►� �
NOTE: Permits for construci:ion will be issued a minim�n of 24 hours from the time
df application to a�.low for �roper review of the proposed structure and of the
construction site.
A Gertificate of Suxvey of the 1ot. showing the locati.on of the foundation once it
has been constructed will be required before proceedinc� with the fzaming.
CtRT I F� C.Q,TE OF OCGS�PA.�l..�Y �
� Application �or a Certificate o� Occupancy shall be made ten (1Q) days pr�:or to the
use or occupancy of any stx�xcture £or whiclY a builcling permit has been issued; and
said stxucture shall not be used or occupied uni:il a Certificate of Occupancy has
been a.ssued.
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CITY OF FRIDLEY INSPECTION DIV.
6431 Universfty Ave NE
Fridley, MN 55432
572— 3604
t
Effedive On January 1, 1993
APPLICAT10NfOR PLUMBING AND GAS FITfiNG PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES: NO.
New Fixtures �
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater —Electric
Water Heater — Gas
Gas Range
Gas Dryer
Back Flow Preventer Required ()Yes () No
Type
RATE TOTAL
�ao
$ 7.00 � •
$ 4:00
$ S.OQ
$ 7.00
$ 7.00
$ �.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.b0
$5.00
Reinspection Fee $30.00
ALC OTHERS AND/OR REPAIRS AND ALTERATIONS aa
1% of Value of Fixture or Appliance ��`
State Surcharge
, TOTAL FEE
$ .50
��g •�
JOB ADDRESS � T�-1 � � `�- � '1� � � I � �
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 ail the facts
and representations stated in this application are true and correct.
0
Owner
\\V � V
C`� � y aa� , , 993
Building Used As `,
Estimated Cost PERMIT NO. // Q��
PLUMBING COMPANY
SIGNED BY EL N0. (�o ( a- -S� I'�a`�7�
Approved By Rough—In Date Final Date ��� 7� /�
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00
PLUS 7HE $.50 STATE SURCHARGE
sue�ecr P IT N .
c�ty of Fridley 219 9 6
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i � I .
� �• COMMUNITY DEVELOPMENT DIV. �� ` �
i VV ����� �
r � � PROTECTIVE INSPECTION SEC.
� � /'��1 � CITY HALI FRIOLE� SS43Z NUMBER REV. DATE �AGE Of APPROVED BV
�""��� �'� 612-571-3450 910-F15 7/26/93 / /
J08 ADDRESS 6421 Able Street NE
1 LEGAL LOT N0. BLOCK TRACT OR A�DITION SEE ATTACHED
oescR. Pt. 24 2 Moore Lake Highlands sHeer
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Holly Swartz 6421 Able Street NE 571-32�8
3 CONTRACTOR MAIL ADDRESS Z�P PHONE UCENSE NO.
Same
4 AFCHITECT OR DESIGNER MAIL AODFiESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE IICENSENO.
G USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Interior walls fox new bathrocam; egres:s. �,�tindow
9 CHANGE OF USE FROM TO
STIPULATIONS See notations pn plan,
TYPE OP CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PIUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO 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 OFFSTREET PARKING
I HEREBY CERTIFY THA7 I HAVE READ AND EXAMINED THVS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL PROVISIONS OF LAWS VALUATION SUF;TAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPUED $1 � OQO $. 5O
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEqMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $2S.00 F1Y'0 SC y5`I..00
STRUCTION OR THE PERFORMANCE Of CONSTRUCTION.
PLAN CHECKFEE TOTALFEE
$26.50
S�GNATUi7EOFCONiRACTORO A THORIZEDAGE T IDATEi WHE PER ALIDATED THIS IS YOUR PERMIT
� �, � ? z ��
SiGNATURE OWNER�if OV7NE B DER� iDATE� � G ��FTE
NEW �]
ADDN [ ]
ALTER [ j
,- : a�±+�-� ;;° - r ;-.'
- _ - :-Effective 111/93
• :��� :CITY OF -FRIDLEY : .
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Applic�tion .
Construction Address: �n �} 2 � �-� 1.,. �- S`C' 1Z ��: 1, i= ��-� �.-� �i N� ��
Legal Description: "T 1� �. Sa ��r l� � RLF �, � L.aT �-� , 3�icK �� lYloo� � �. R-K � N�.�,�5
Owner Name & Address: ��� Cc � A�-r � — S A m E Tel.,e# �1 I- 3a4 ��,,,,C
Contractor: � �� � � �3(0-- 3�S lt,c�,-(�
Address: � / A Tel. �
Attach to this application, a Certific�t,e of Survey of the
lot, with the proposed construction drawn on it to scale.
� DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length -� Width Height
DECK AREA= Length - Width . Hgt/Ground �
OTHER: 1��� �Ic � �- N p< <��� ►-��,,,,,;. - �w.esc,Q vtc �. 1-'�
Sq. Ft
Scl-. Ft T
Sq. Ft. � �
�S a ��i �c�oc.� .
Comer Lot [] Inside Lot � Ft. Yd Setback �_ Side Yard Setbacks � -��
r
Type of Construction: �`A�� � 1 S 4� l� ��.�.� a� Estimated Cost: $\, OCO .
Approx. Completion Date: � — � - � '� � � � '
� (Cost on Bacl� j ..
Driveway Carb Cut Width Needed: Ft +.6 Ft = Ft x$ _$_
DATE: APPLICANT: -- Tei. #
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
� � �
$ /�
$ . S�
SAC Charge $
I.icease Surcharge $
Driveway Escrow $
Park Fee $
Sewer Main Charge $_
TOTAL
STIPULATIONS:
i
$ Z�,S
Fee Schedule on Reverse Side
.001 of Permit Valuation {1/lOth%)
$.SO/$1,000 Valuation .
$750 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt "A" or Att. "B" Above .
Fee Determineci by Engineering
Agreement Necessary ( ] Not Necessary [ ]
� •
�, •� - : .
� l.� , , _� ��',k''[,�i�.. . . •
BUII.DING PERMTr FF.E SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any buiiding or structure,
or for any addition to any eusting building or stzucdrre, or for any alteration or repair to any e�cisting
building or stiucture, upon applicadon therefore, require the paymeut by the applicant for such permit
of fees to the amount herein below set forth and in the manner herein pravided to-wi�
TOTAI. VALUE
$1 to .$S00 -
$SOl to �$2,000
$2,001 to $25,000
� . $25;001 to $50,000 '
0
FEFS
$15 (Minimum Fee is $15 plus surcharge) -
�.$15 for first $500 plus $2 for each additional $100 or �
� fiaction thereof, �to and including $2,000 -
. $45 for fust $2,000 plus $9 for �each additional $1;000 �
or fraction thereof, to a�� including �25,000 -
� . _ $252 �for �fust� $25,000 plus $6.50 for each additional $1;000
- or fraction thereof, - to. and including $50,000 .�
$50,001 to $100,000 . � : �$414.50 for - fust $50,000 plus $4.50 for. each additional
.$1,000 or fraction t�ereof; tA .and including $100,000
$100,001� to $500,000
$500,001 to $1,000,000� -
$639.50 for � first �$100,000 plus: �i.50 for each additional� �.
��$�1,000 or fiaction thereof, to aad including �$500,000 � �
$2p3q.Sp for die first $500,000 pius $3 � for each additional
$1,000 or fra.ction tf�ereof, to and including $1,000,000
$1,OOU,001 and up - $3539.50 for the first $1,000,000 plus $2 for each additional
� $1,000 or fraction �thereof -
. DRIVEWAY DEPRESSION ESCROVf/
. {Concrete � Curb Stree�s Only) .
� Alternate "A": Removal and replacement of curb and gut�' only - Driveway width plus �6 feet times
$13_50. . . '
Alternate "B" : Removal and reptacement 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 const�uction will be issued a minimum of 24 hours from the time of application to allow
for proper review of the proposed s�tructure and of the coastruction site.
A Certificate of Survey of the tot, showing the location of the foundation once it has it has been
constcuct�d will be required before proc�eding with the framing. .
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sue�ecr P
City of Fridley 2 3 2�9
AT THE TOP Of TNE TWINS g U I L D I N G P E R M I T
r
� � R
� � •
� • COMMUNITY DEVELOPMENT DIV.
� � �: ------� ��5�'
r � � PROTECTIVE INSPECTION SEC.
� �
i_-_-�; �'��,•� CITV HALL FRIDIE� 55<32 NUMBER REV. OATE PAGE Oi APPROVED BV
i 612-571-3450 9�0-F15 6/23/98 � �
JOB ADDRESS 6421 Able Street NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2Lf 2 Moore Lake Highlands SHEET
2 PROPERTY OWNER MAII ADDRESS 21P PNONE
Holly Swartz 6421 Able Street NE 571-3298
3 CONTRACTOR MAIL ADDRESS Z�P PHONE UCENSE NO.
Same
♦ ARCNITECT OR OESIGNER MAIL AODRESS ZIP PHONE LICENSE NO.
5 EIJGINEER MAiI ADDRESS 21P PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 C�ASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION �7 REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Garage (21 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE RE�UIRED FOR EI.ECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIF CONDITIONING.
THIS PERMIT BECOMES NUIL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHOf;IZED IS NOT COMMENCED WITHIN 60 DAYS, OFi IF CONSTRUCTION
OR WOHK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCE,D. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CENTIFV THAT I MAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VAlUAT10N SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PEFIMIT �1 s 7S2 �• 88
DOES NOT PRESUME TO GIVE AUTHORI7Y TO VIOLATE OR CANCEL TNE pEFM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- �56. 75 Fire SC �1. %S
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOT t FEE
ip- -`� 59.38
Si NaTUFE 0 NTRACTOfi OR AUTHORIZED NT iDATE� EN R P VALIO T THIS IS V UR R 1
�
i
SiGNATUREOFOWNEFUFOWNERBUILDERI IDATEI - G iNSp qGTE
NEW
ADDN
ALTER
[l
�]
[l
ConstructionAddress:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXE5 R-1 AND R-2
BUILDING PERMIT APPLICATION
�1�- � P_.�� � r- � ci �
Effective 1 / 1 /98
�� �
��'� �� �
3d
Owner Name & Address: �� , f= �, ., Q c--{ z. - � a+�.. � h di �.� : P s s Tel. # 51 �� 3��
Contractor: (� �w� s ow,� t R MN LICENSE #
Address: . Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
DESCRIPTION OF IMPROVEMENT
Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width � Hgt/Ground Sq. Ft.
OTHER: ��, a �
��'�� `O�
Construction Type: � �, Estimated Cost: $ � 7 SrZ. . b(
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ �, �� oZ .�o l�
DATE: �a �_ APPLICANT: �.. _ Tel. # ��I � " 3 �( �'
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$—��
$ I • 7 s'
$ . ��b
$
$
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.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 [ ]
Q �r
.�
�x-'
BUILDING PERMIT FEE SCHEDULE
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,OOl to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for 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 first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for vfirst $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $S.� for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012:25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "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 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 it has been constructed
will be required before proceeding with the framing.
� r �, ,y
_
_
CIiY OF
FRiDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNNERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
December 30, 1998
Holly Swartz
6421 Able St NE
Fridley, NIlV 55432
Re: Construction Without Obtaining a Building Permit
(Windows at 6421 Able Street NE)
Dear Ms. Swartz:
According to Section 106.1 of the 1994 Uniform Building Code as
adopted by the City of Fridley, no building or structure regulated
by this Code shall be erected, constructed, enlarged, altered,
repaired, moved, improved, removed, converted, or demolished unless
a separate permit for each building or structure has first been
obtained from the Building Official.
You have been notified of your need to obtain a building permit and
have failed to comply as of today's date. As a result, a special
investigation fee will now be added to the permit, equal to the
permit fee. The City of Fridley will give you 30 days in which to
comply before turning this matter over to the City Attorney for his
legal consideration.
Please contact me at 572-3603 if you have any questions on this
matter.
Sincerely,
� .
B RY IESC
Bui].ding Inspector
BR/bk
' � � SuB�ECT . � � PE . � �
City of Fridley �2 8 8 � 8
AT THE TOP OF TME TWINS g �� L D I N G P E R M I T
;,
, � o.
� ' COMMUNITY OEVEIOPMENT DIV. /'
r � � � PROTECTIVE INSPECTION SEC. �
� ,
� � �"'1 • CITY MALL FRIOLE� SS�3i NUMBEA REV OATE P�GE O� •bPpOvED 8�
�""��� �'� 612-571-3450 910-F15 1/29/99 � �
JOB ADDRESS 6421 Able Street NE
t LEGAL LOT NO. 9LOCK THACT OR ADDITION SEE ATTACHED
�escR. 24 2 Moore Lake Highlands s►+eer
2 PROPERTY OWNER MAlL A,OpIiF$$ 1�P PHONE
Holly Swartz 6421 Able Street NE
3 CON7RACTOR MAIL ADDRESS ZIP PHONE UCENSE NO
Showcase Builders Inc 16026 Lakeshore Dr', Eden Prairie, MN 934-1490
� ARCMiTECT OR DESIGNER MAIL AODRESS IIP PMONE LICENSE NO.
20078380
5 ENGINEER MAIL ADORE$S 21V PHONE IICENSE NO
6 USE OF BUILDING
Residential
7 CLASS Of WORK , ,
O NEW p AODITION � ALTERATIpN �7 REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Window Replacement
9 CHANGE OF USE FROM TO
STIPUTATIONS
Smoke detectors must be installed to meet the State Building Code -in
each sleeping room and on each level of the house.
TVP� OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE FEOUIRED FOR ELECTRICAI, PLUMBING. MEATING,
VENTILATING OR AIR CONOITIONING
TMIS PERMIT BECOMES NULI AND VQID IF WORK Ofi CONSTRUGTION 20NING SO. FT CU iT.
AUTHORIZED IS NOT COMMENCED NfITHIN 60 OAYS. OR If CONSTRUCTION
OR WORK IS SUSPENOED OR ABAMOONEO fOR A PERIOD OP 120 DAYS A7
ANY TIME AFTER WORK IS COMMENCED. NO DW4G. UNITS OFFSTREET PARKING
I HEREBV CEi;TIFY THAT 1 HAYE pEAD ANO EXAMINED TMIS APP�ICA710N 1 STA��S GARAGES
AND KNOW TME SAME TO 8E TRUE AND CORREGT. A�L PRQVISIONS Of LAW$ VALUATION SURTA%
ANO ORDINANCES GOVERNING TMIS TVPE OF WpRK WILI 9E COMPUED �[F�dOO �Z.00
WITM WHETMER SPECIFIEO MEREIN Op NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL 7NE pEqM17 FEE SAC CMARGE
PROVISIONS OF ANV OTHER STATE OF LOCAL LAW REGUTAT�NG CON- d87 � 25 F� Y2 SC . OO
STRUCTION OR E PE ORMANCE OF CONSTFUCTION '�
PLAN CHECK fEE iA� PEE
� Z ��- � f-+4 Licens 5.00 $98.2
S�GN�iUQEO� N'RA(;TQAOQAUTHOA�ZEDAGENT iD�7E� N PR PE L AT OU RMIT
/ �
/
S�GNeTUAE O� OWaEQ��� OWNEABU0.DEA� � �OATQi �� B gp : � r��tE
1
NEW
ADDN
ALTER
[]
[l
I]
ConstructionAddress:
Legal Description: _
Owner Name & ddr
Contractor: �
Address: l (o D 2.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
� � Z / �� - �..�
Effective 1 / 1 /99
��
�� \�
��
MN LICENSE # ZD O%� 3�n'%
'� r�� � Tel. # ��2-- �'3f%f��0.
--�
Attach to this application, a Certificate. �f Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width H�ight
Length Width Height
Length Width HgdGround
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction T�: �!i/��� s ated Cost: �
YP � � $ •
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �.z. - APPLICANT:
Permit Fee
Fire Surcharge
State� Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STTPULATIONS:
Tel. � �2 -- !� �
� ��
�
$ /• � Fee Schedule on Reverse Side
$ , �� .001 of Permit Valuation (1/lOth%)
$ ..�a $.50/$1,000 Valuation
$ $1050 per SAC Unit
$ �S �� $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 [ ]
��
/ �
�
BUII.,DING PERMIT FEE SCHEDULE
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 $25,000
$25,001 to $50,000
$50, 001 to $100, 000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for 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 first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each° additional
$1, 000 or fraction thereof, to and including $1, 000, 000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb 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 application to allow for proper
review of the proposed structure and , Qf the construction site.
A Certificate of Survey of the lot, showing the iocation of the foundation once it has it has been constructed
will be required before proceeding with the framing.
�
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CM?Y OF FRIDLEY INSPECTION DIViSION
6431 University Ave N�
Fridley, MN 55432
572-3604
RATE SCHEDULE
APPLJCATtON FOR POWER PLANTS AND HEATING� COOLING, VENTIlAT10N�
REFPoGERATION AND AIR CONDITIONING SYS'�EMS AND DEMCES
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Fumace
(Side Vent - Fiil Out Back�
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Ai� Conditioning - All Sizes
AII Others/Repairs & Aherations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/I ndustriel
1.25�0 of Value of Appiia�ce or Work
Rate TOTAL
$ �o.00 ���
$10,00 $
$10.00
$ tO.OQ
$ 25.00
State Surcharge
TOTAL FEE
�Ilec#ive On January 1, 1998
.�B ADDRESS (o yoZ I �'��P S�- n�• '
,
The undetsigned hereby makes applic�on for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes and
ruli�gs of the Building Division, and hereby dec�ere�s that all the iacts and
representations stated in this application are kue and correct,
�.� � l_9 _;r„�
. i . � �. ✓
$ �
BUILDING USED AS ��U �I �n -
$ ESfIMATED COST �%JD � PERMIT N0, ���
$
$
$
� ,50
���
MINJMUM FEE F4R ANY HEJ4TiNGICOOLiNC,NENTILATION
REFRIGERATION AIR CONDITIONING PERMIT IS 25.00
•-PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.001Hr
*air Conditione�s can not be placed in a si� yard without
written permission trom adjoining property owner.
DESCRiPTION OF FURNACE AND OR BURNER
No. of tieating Units Circle One (Steam) (Hat Wate arm Air
Trade Name T�°rn n.41s� Size Na
BTU 7,�. �1`tl0____ HP EDR
Fuel �('� S Tatal Connected Load
Burner Trac� Name Size No.
g� HP EDR
HE4TING COMPANY ��/]p� �ii�c� ,��N.� i%lP�a'`�,
Signed By Tel No. �
�
Approved By ��""" Rough-in Date � Final Date ��� � l
FILL OUT @ACK SIDE FOR STACK VERIFICATION ON
REPLACEA�IT FUF�VACE
� ,
. �
CHIMNEY AND STACK VERIFICATION
The undersigned hereby veri�'ies that the existing chimney or stack:
1. Has been carefully examined Yes (/f No ()
2. Is free from rust or deterioration
3. Has no foreign objects lodged within
4. Is securely supported
Yes t �No ( )
I'es � � Na ( )
Y�s (� Na ( )
5. Nieets aIl curreni Code requirements for size
and total BTU's connect�d Yes (�No (}
6 Has toral heating BTU's of
All other BT[J's
TOTAL BTU's
7. Has a liner been providad for water heater
8. Has combustion air been provided for water heater
Remarks:
Y�s (�No ( )
Yes (/�No { )
List ALTERATIONS Being Do�:
9
HEATING CO:
Signed By:
Date:
.� �� ' ��
_
_
CIIYOF
FR[DLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
March 12, 2001
Holly Swartz
6421 Able Street NE
Fridley, MN 55432
Re: Finai inspection at 6421 Able Street NE
Contractor: River City Sheet Metal
Dear Ms. Swartz:
A mechanical permit was issued on March 17, 1999 for the installation of a furnace at
your address. According to Section 305(a� of the 1991 Uniform Mechanical Code, a
final inspection shall be performed on the mechanical permit. As of this date no
inspection has been called for.
The permit fee that was paid covers the inspector's time to check to make sure the
appliance was installed correctly. We also need to check for the installation of
combustion air, vent and connector sizing.
You will be given thirty (30) days from receipt of this notice to respond. If we do not
hear from you, your permit will expire and any inspections on this installation will require
a new permit.
Any questions can be addressed to myself at_(763) 572-3603
Sincerely,
D SEN
Build' Inspector
...
DJ/mh
.t
sue�ect P 0....
c�cy of Fr�a�ey 32016
' , AT THE TOP OF TME TWINS � U� L D I 1 \ G P E R M I� qECEI .
r
� � COMMUNITY DEVELOP�ENT DIV. �
' ' ��T2-3604� �%
� tV������ . . .
r � � PROTECTIVE INSPECTION SEC.
� . ,
( � �'��� � CITY MALL FRIOLE� SS�JZ NUMBER NEV OATE PAGE Of AVVROVEO BY
�----�•' �•' 612-571-3450 910-F15 7/20/O1 / /
J08 ADDRESS 6421 Able Street NE �
1 LEGAL �07 NO. BLOCK TRACT Op ADDITION SEE ATTACHEO
oesca. 24 2 Moore Lake Hi hlands s"EET
2 PAOPERTY OWNER MAIL AOqRES$ 2►P PHONE
Holly Swartz 6421 Ab1e Street NE 763-571-3298
3 CONTRACTOR MAIL ADORESS ZIP PHONE IICENSE NO
Same
1 AfiCNITECT OR DESIGNER MAI� ADOfiESS ZIP PHONE UCENSE N0.
5 ENGINEER MAII. ADDRESS ZIP PHONE IICENSE NO
6 USE OF BUILOING
Resider�tial �
7 CIASS OF WORK _
O NEW � ADDITION O ALTERATI�N O REPAIR O MOVE • O REMOVE
8 DESCRIBE WORK
Construct a 36' x 12' Addition; dn 8' x 12' & 4' x 26' Deck
9 CHANGEOFUSEFROM TO
STIPULATIONS
See notations on plan.
Provide smoke detectors in all sleeping rooms and on all levels of the
dwe�ling per Sectioa 310.9.1.2 of the 1997 Uniform Building Code. Caulk
and fl�sh all exterior openings.
VVARNING
SEPARATE PERMITS Before di�ging call for
REQUiRED FOR: a�� ����tY locations
WIRING HEATING 4�002
P�uMBiM� aNn sisl�s REQUIRED BY LpW
° TYP O CO ST. OCCUPANCVGROUP OCCUPANCVLOAO
SEPARA7E PERMITS AFiE REOUIREO FOFi EIECTRICAL, PLUMBING. MEATING.
VENTILATING OR Alii CONOITIONING
THIS PERMIT BECOMES NULL ANQ VOID If WQFK OR CONS7RUCTIOM ZONING SO. fT CU FT.
AUTHORIZED IS NOT COMMENCED Y\IITHIN 60 DAYS, OR IF CONSTRUCTION �
OR WORK IS SUSPENDEO OR ABANQONQD fOA A PERIQO OF 120 DAY$ Ai
ANV TIME AfTEF WORK IS COMMENCEO. ' NO DWLG. UNITS Of�STREET PARKING
I HEREBY CERTIfV THAT I HAYE READ ANO EXAMIN�O THIS APPLICA710N 1 STALIS GARAGES
ANO KNOW THE SAME TO 8E TRUE AND COQ�ECT. ALl PROVISfONS Of �AWS VA�UATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WpRK WILL 8� CpMP�lEO s. 26� �1�.13
WITH WHETHEA SPECIFIED MEREIN OR NOT. THE GRANTING Of A PEFiM1T 'Y�34' �
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OFi CANCEL THE pEqMIT FEE SAC C ARGE
PROVISIONS OF ANY OTMER $TATE OR LOCAI lAW REGULATING CON• �SO2 . 35 E� SC �3�F . ZG
STRUCTION OR THE PERfORMANCE OF CONSTRUCTION
P�AN CMEC FEE TO A FEE
5 3.74
S�GN uA O�CON'p ,70 OQ�UT�OqiZEO>GENi iO�iE� H N Pq0 R VALID E MI ��ERMI�
�
SiGN q NEF� OwHEaBui�D.Ea�. � � � iO�TEi.!� ..'_. . . G"�rvSr � � � � � ��cTE
. � �y.
sEP, �3, 2ooi 12:o�P�
� r�
umber
Co n�ctors^�
A G� RALTAR COMPANY
Kip Porath
9113/01
Jobsite: 6421 Able St.
Fridley Mn.
Fastener Schedule
USP I,IVERMORE N0, 4848 P, 1
West Coast Office
2150 Kitty Hawk Road, Livermore, CA 94550-9611
800-2Z7-0470 " 925-449�100 ' Fauc 925-373-9213
www.USPconnectors.com'e-mail: rspurgeon�USPconnectors.com
"��� /6
�/ �� V�
���
��� , /��
�
Dear Mr. Po�ath.
You have i�quired as the load value regarding USP 7HD410.
You stated, during our conversation yesterday, that you had installed USP THD410 to the face of a
2x8 of Southem Yellow Pine using (12) tweNe 10 x 1 1/2" wire nails, The described nails were
installed in the top 6 holes of each flange,
In the conditions as stated above, the THD410 will have an allowable load of 1104 Ibs.
The above assumes that the wood members are property sized and that the remainder of the installation was in
accordance with the manufacturer's published literature and all applicable building codes.
If you have any questions, please contact me at 1-800/227-U470 Ext. 229
Respectfully,
Rick Spurgeon
�
�
�� ° >
��
USP Technical Support Representative
Weste�n Region
NEW [ ]
ADDN [ ]
ALTER [ ]
J l�
,o�
b
Effective 1/1/2001
CITY OF FRIDLEY (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMITAPPLICATION
Construction Address: ( j, �} -�-1 �.� 1 � ���`1�� � � � . �- �; �, � 1 �= �; , �' 4� 1 ��1�� � � ��5 �- ��
�
Legal Description: S�.: � � Z_-. c� �.�. ���� i�� � c �c -� � 1� c� Q c� �,�tikF y� ��.�-L�:
J
Owner Name & Address: E���� (-. �_���:;� �-� 2-- Tel. #`���„� -% I 7`I �
Contractor: � � r� �" MN LICENSE #
Address: � Z 1 , ' � � � ^— i �. � '�;� ��i Z Tel. # �1 � ?� `S 7 � � � Z y �
Attach to this appiication, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIV(NG AREA: Length ��� Width ��- r Height � I Sq. Ft. � 3 z�
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA:
OTHER:
Length Width � HgUGround Sq. Ft.
��( �G
dE
��L7"t-!•'s � �% ..%.i- = oG�. �
Construction Type: � � � �� � '� � � Estimated Cost: $ . drO.r%i '=�+�Da• �
.c�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ 3/��°'3• �
DATE: � � � tr. "� U T APPLICANT: � Tel. # �Crr � `� � I " 3,a�. !�
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$��,35 Fee Schedule on Reverse Side
$ .�� .001 of Permi# Valuation (1/10th%)
$ / 7� /.3 $.50/$1,000 Valuation
$ /� $1150 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 [ J
$ ���
BUII,DING PERMIT FEE SCHEDULE
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 $25,000
$25,001 to $50,000
$50,001 to $100,000
� �
$100,001 to $304;000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23 .50 for first $500 plus $3 .OS for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25, 000 plus $10.10 for each additional $1, 000
or fraction thereof, to and including $50�000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the %rst $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,OOQ,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "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 $23.25.
VERIFtCATION OF FOUNDATION
Pernuts for construction will be issued a minimum of 24 hours from the time of application to a11ow 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. New Houses Onlv
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CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
.,��--c�l %2-�' �D� -a�� �,
�
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
763-572-3604 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 Ra ge
t>� C. l�� -� �, C� -t � 1<--c� �� ��-
Gas Dryer ��/`���Y
*Air Conditioning - All Sizes
-All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25°�0 of Value of Appliance or Work
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
70TAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATtON/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.
•: �.
OWNE
Z
�.
Effective On January 1, 2001
Z
TOTAL � (
BUILDING USED AS PC' ; uc�-� e 1�'�ovv��
$
ESTIMATED COST �� PERMIT N0. /
$
DESCRIPTION OF FURNACE AND OR BURNER
$
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
$ Trade Name Size No.
BTU HP EDR
$ Fuel Total Connected Load
$
$
$ .50
� ��' �
Burner Trade Name Size No.
BTU HP EDR
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
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE �"�I�O �
HEATING CO � 1.��-v�!� �
Signed �_ TEL # � � 3 '�5� � ° 3 2- � d
� �
�
Approved By Rough-In Date Final Date '°��"�l
D COMBUSTI(�N AIR VERIFICATION
NT SIZE, VENT
COMMON VENT VENT CONNECTOR AND COMBUST__ION AIR VERIFICATION
When replacin� an existing 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 () No ()
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the �eplacement unit is a listed assembly
and meets the cuRent codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for far�
assisted and natural draft appliances.
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combustion air, it will be sized and installed
to meet the cunent codes and manufacturers specifications.
Yes ( ) No ( )
Yes � ') No i )
Yes ( ) No ( )
When installin� a new ventina_svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
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 Appfiances 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
L'
��.� �� --
HEATING CO: � "
Signed By: - Date :
. . � . SuB�ECT . .. . . � � � .. � �
c�ty of Fridley 32607 '
AT TME TOP OF TME TWINS g �� L D I N G P E R M i T
r
; � RECEIPT NO.
� • COMMUNITV DEVELOP��NT OIV. � �
� •v "'»
r � � PROTECTIVE INSPECTION SEC.
� � �"'1 � CITY HALI FRIDLE� 55132 NUMBER pEV O�TE PAGE oi •PVROVEO r
�.---�•� �'' 612-571-3450 9t0-F15 5/17/02 / /
JOB ADDRESS 6421 Able Street NE
t LEGA� �OT NO. BLOCK ' TRACT OR ADOITION SEE ATTACHED
DESCR. 2!} 2 Moore Lake Highlands sHeEr
2 PROPERTY OWNER MAIL AOORESS ZIP PMONE
Hol.3,r Swartz 6421 Able Street NE 763-571-3298
3 CONTRACTOR MML ADORESS ZIO PMONE UCENSE NO
Same
� ARCMITECT OR DESIGNER MAIL ADDRESS iIP PMONE LICENSE NO.
5 ENGINEER MAII ApORE$S ZIP PHONE UCENSE NO
6 USE OF BUILOING
Residential .
7 CLASS OF WORK _ . _ ,
❑ NEW O ADDITION ❑ ALTERATtON C� REPAIR O MOVE • O REMOVE
B OESCRIBE WOfiK
Reside existing house & garage
9 CNANGE Of USE FRpM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive
barrier be placed over exterior sheathing to protect the interior wall covering.
Exceptions for this provision would be if sheath�ng is an approved weatherproof
p�.nel or when the siding is an approved weather barrier. Vinyl siding is not a
weatherproof covering unless the manufacturer states this in their application
guide�ines. Cail for inspectio�. of wrap before covering. Cau7Lk and flash a11
exterior openings.
SEPARATE PERMITS ARE REOUIRED FO tVP OP CONST. OCCUPANCV GROUP OCCUPANCY lOAO
R ELECTRICAL, PLUMBING. HEATING.
VENTII.ATING OR AIF CONDITIONING
TNIS PERMIT BECOMES NULL AN� VOID If WQRK OFi CONS7RUCTIOM jpNING SO. FT CU fT.
AUTMOR12ED IS NOT COMMENCED WITHIN 60 OAYS. OR IF CONSTRUCTION �
019 WORK IS SUSPENDED OR ABANQONEO FOFi A PER100 Of 120 OAY$ Ai
ANY TIME AFTER WORK IS COMMENCED. ' NO DWLG. UNITS OFFSTREET PARKING
I HEfiEBV CERTifV THAT I MAYE REAO ANO ExAfy�IN�O THIS APPUCA710N 1 STA�LS GARAGES
AND KNOW THE SAME TO BE TAUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTA%
AND ORDINANCES GOVERNING TMIS TVPE Of WORK WILL BE COMPLIED
WiTH WHETME%i SPECIFIED HEREIN OF NOT. TME GRANTING OF A PERMIT �2�600 �1.30
DOES NOT PRESUME TO GIVE AU7HOFt17Y 70 VIOLATE OR CANCEL THt PEFPMfT FEE SAC CMARGE
PpOVISIONS OF ANY OTHER STATE OR LOCAI LAW REGULATING CON-
STRUCTION OR THE PEFfORMANCE Of CONSTRUCTION �83.25 Fire .SCi �2.6�
PIAN CNECK FE TOiA FEE
$ .15
5�G tupEOF oN'a�C�auT �ZED�GENi i0�t�i ME PROP VALIO T THIS IS VQUp PERMIT
./� � -(�'0z-- ��� _�_..�"•�� -��-'
S�GN�7UAE O� OWN �� OWNEA BU�IDEp� � � IpATE� � ' ' � � " B G� �NSo ' �i��E
NEV1l ( J CITY OF FR�DLEY Effective 1/1R002
ADDN (] 6431 Univers'rty Ave NE, Fridley, MN 55432 (763) 572�604 Bldg insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: �.o�'�i Z- ( t-�'�o � e, �'�t' � e�
Legal Description:
Owner Name & Address:
Contractor.
_ S a �til e
Tel.# `1��-571-��2-`�g
MN LICENSE #
Address: Tel. #
Attach to this app(ication, a Certificate of Survey of the
lot, with the propased construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
� / � q
LMNG AREA: Length � � Width �� Height � Sq. Fi (��
GARAGE AREA: Length Width Height Sq. Ft
DECK AREA: Length
orHeR:
Width HgUGround Sq. Ft _
� X�,S �`� v�u ��u CP W 1' c�
� 1' �i q, z°
U
0
`�y � o�
Construction Type: ��� t�� Estimated Cost: � � io O O.
Driveway Curb Cut Width Needed: F� + 6 Ft = Ft x$ _$
DATE: � � I � - 6 Z APPLICANT: Tel. #� � � � Si � ���`� g
Call (763) 5T2-3604 for Permit Fees if maili�g in application or x to 763-571-1287 if u ing c�edit card and we will
call you for card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
$ �� -�� Fee Schedule on Reverse Side �
$ G .001 of Permit Valuation (1/10th%)
$ /- .3 0 $.50/$1 �000 Valuation
$ $1200 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 [ ]
�
$ S7- � s
STIPULATIONS:
BUII..DING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any ex'tsting building or structure, or for any alteration or repair to any e�sting 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 $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,OOQ plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,OOQ
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 pius $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION_ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $17.00.
Permits for 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. �
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Onlv
CITY OF FRIDLEY INSPECT.ION DIV.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604, FAX (763) 571-1287
nanR►t N� innRFR nF FixTi IRFS Tn RF INSTALLED �N EACH FLOOR
Effective Aprii 1, 2004
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT ����7 �3
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB
New Fixtures $10.00
Old Opening, New Fixture $10.00
Beer Dispenser $10.00
Blow Off Basin $10.00
Catch Basin $10.00
Rain Water Leader $10.00
Sump/Receiving Tank $10.00
Water Treating Appliance $35.00
Water Heater -Electric $35.00
Water Heater - Gas"'' $35.00
Gas Range'"" $10.00
Gas D er'`* $10.00
ack Flow Preventer Re uire Yes () No
TypeS ' ►'� 2 r � ._�___ $15.00
�.� C..o `� ZO
Reinspection Fee $50.00/Nr
ALl OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
I�,O�
( � �6�D
$ .50
$ � te'=.2_ �'
The undersigned hereby makes application for a permit for the work herein �-'
specified agreeing to do all work irr strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this apptication are true and correct.
DATE: � � , 20 � ��
. l r ( ,� � � �.-_
OWNER
r�
1
BUILDING USED AS � 1N�ca� C �� C� �� C'�
ESTIMATED COST �� O�Z� PERMlT NO.
PLUMBING COMPANY,
SIGNED BY
Approved By
Rough-In Date
�
TEL N0. ( �� I r � � �
Final Date
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE
[
FILL IN COMPLETELY FOR REPLACEMENT FUEL BUF�NING APPLIANCE PERMITS
COMMON VENT; VENT CONNECTOR AND COMBUSTION AIR VERIFICATION :
V1/hen replacinq an existinq furnace, the undersigned hei�eby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required.
The venting system is plastic/PVC and meets all current codes and m�nufacturer
specifications including sizing, length, number of elbows and terminatidn.
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This dbes
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existinq combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) -
Vljhen installinq a new ventinq svstem, the undersigned hereby verif�es that
it is a listed assembly and meets the current codes and manufacturer's�
specifications. This does include AGA-GAMA Category I Central Furn�ce
Venting Tables for fan assisted and natural draft appliances. : Yes ()
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.
No ( )
No ( )
Yes( ) No( )
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
Totaf Appiiances 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
ALTERATtONS: (Describe) __
HEATING CO:
Signed By: Date :
;ITY OF FRIDLEY INSPEC"1 �UN DIV.
i431 University Ave NE
=ridley, MN 55432
763-572-36a-
�� � J` � Effective On Jan 1, 2001
9-o�t>
APPLICATION FOR PLUMBING AND GAS FITTING PERM17
PLUMBING FIXTURE RATES:
New Fixtu�es
Oid Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas"
Gas Range"
NO. RATE
�
_Z
�_
Gas Dryer•'
Back Flow Preventer Required ()Yes () No
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.��
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
Type $15.00
Reinspection Fee $47AO/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAI
..�
$ •°o
��%•d�
�
JOB AODRESS ts� � 2- , l�'� 1 e- ��`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.
Owner
1=
.A i � �.'� � �
�
Z
�
Building Used As �T�" r� ���1 e �"l e-- —
Estimated Cost PERMIT NO. ��� ��
PLUMBING COMPANY��'-ri ��
SIGNED BY
Approved 8y,
�.?� �..�.....,
TOTAL FEE � pLUS
9��
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A AND TABLE 6-A.
) TEL NO.� �s� 3 2 t°
Rough-In Date Final Date � °�`� �
COMMON VENT INFO ON BACK SIDE
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the unde�signed hereby ve�ifies that the
venting has been examined and is free from n.ist, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plastic/PVC 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 cuRent codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combustion air, it will be sized and installed
to meet the curcent codes and manufacturers specifications.
Yes()No()
Yes ( ) No ( )
Yes� No ( )
When installin a new venting svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes � No ()
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 (u) No O
ApQliance Tvae and Size/Common Vent and Vent Connector Irifortnation
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• (Describel -
HEATING CO:
Signed By: Date :