AF - 35241._,- ..:....._., ..�......, r .. ..... . .. ....... .R'+-.,w: . ...,�.:w, . ._......... .....,.;...�_...:. ... . . .
. . . . . . . -�4���urm• e� ee., :e � ..�r, _. . . a�- ,. .. .
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Date
Owner
BUILDING PERMIT
Village of Fridley, Minn. N� 2 2 � S
������.... ....................
�,�, ,,,..,,'�"�."..,�
..�'� ...... ......... .. ..... Builder ...........................................
Address .� �� �!'� .......... . .............. Address .............
' LOCATION OF BUtLDING
No. . . :!. !' �. .��. . . . . Street . ��"� C��+�
.................................. Part of Lot ' ..
Lot . . . . � . . . . . . . . Block . . . �. . . . . . . . Addition or Sub-Division . . . . .�'", ; ; , , ; - , . . . . . . . . . . . . �
Corner I.ot . .. . . . . . . . . . Inside Lot . . . . . . . . ♦ �
� . . . . Setback . ���, Sideyard �`.�. , ���, , , , , , . . ,
� DESCR[PT[ON OF BUILDING
To be Used as:
•
. . . . . . . . . � . . . Front . !�'� . Depth . L�. . Height . . . . . . . . . Sq. Ft. . . . . . . . . Cu. Ft.
`�l �� ........
y;���G�. . . . . . . Front . Depth ��. . Height . . . . . . . . . Sq. Ft. . . . . . . . . Cu: Ft, . . . , . . . .
Type of Construction ��'"'��, , Est. Cost . `. �., � �� � �
............... To be Completed��..... ......
In eonsideration nf the issuance to me of a perrnit to construct the bailding described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinanees of the village of Fridley.
•�. . . . . . .�. . . . . . . . �'/��'"'i1J/N+��j��
����ideration of the payment of a fee of $. .... , permit is hereby granted to .
. . . . . . . . . . . . to construct the building or ad dition as described above. This . . . . . �t •is . . a . . . . . . . . .
the e Permi gr nted upon
7cpress condition that the person to whom it is granted and his agents, employees an& wprlunen, in all work
done in, around and upon said building, or any part thereof, , shall conform in all respects to the ardinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in tlfe village limits and this permit may be revoked at any time upo viol n of any of ihe provisions of said
ordinances. ��
. t%. �!�. . .�i .�. . ���"�' �,�. . Buiiding InsPector
NOTICE: `
This permit does not cover the construction, instaliation or alteeation:for wir7ng, plumbing, gas hea#irey,
sewer or water. Be sure to see the Building Inspector for separate pertnits for these `itarr�,
:�
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HARVEY A. CAR7WRIGIiT C��R=Gg� & Oi�iO�
ANOKA COUNTY SURVEYS � �
MENNEPIN GOU[�iTV SURVEYS LAND SUR VEYORS
MINNEAPOLI5 SURVEYS
6410 PALM STREET REGISTERED UNDER LAWB OF STATi OF MINN[SOTA
SUNSET 6-007D L�CiNBHD BY ORDINANC[ OF CITY OF MINNRJ►POLIS
owNCn
345 PLYMOUTH BUILDtNG FEDERAL 8-8721
INDUSTRIAL — JUDiC1AL
SUSINESS — TOPOORAPHICAL
CITY LOTS - ALATTING
�Ot.t,�72.ICit, B
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�urbepor'g �ectii�cate
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COMBINING THE RECORDS OF
J. E. HtLL, CIVIL ENGINEER
[fTABL18M[D teY6
C. F. SANDHOFF
CIYIL ENdINEER
EBTAlLISHED f00s.
JAMES NELSON
SURVEYOR
ESTABiIfHED 1022
METROPOLITAN LAND
SURVEYORS. ESTABLISM6D 1851
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I hereb,y c�rtir'y t<�at tnis is a true and correct �lat of a su.rvey of �`y
all of La� l�, Block 2, 1yin� ;�o,zth� o�' th� I�lorth li��� �'eet thereo�' and
the :torti� 7 � °�ct o� �at 1; B� ock � an::i the I�ortn J�.°���t of tne
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�;ast 1<- a_ �_�ot 1� '� �' �_ ' � '
�� :�1��.:.. � :�.���'L ..;' i11��1�L�%T7.�..:.:� `i Oi.e�. i_����.L'Zti`��r :,Z�117.1�0.7�_'!
as su, v�yed by me th:�s �L;tti ua;- of . ay, 19; ,:., .;. u*,
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�ART1N GHT. AND OL90N
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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' ' COMMUNITY DEVELOPMENT DIV.
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r � ' � PROTECTIVE INSPECTION SEC.
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` --�'��""1`,� CITY HALL FRIDLEY 55432 NUMBER REV.
`�� 612-571-3450
910-F15
JOB ADDRESS 6250 Baker Avenue N. E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION
DESCR. 1,3 2 Moore Lake High.lands
2 PROPERTY OWNER MAIL ADDRESS
Ti.mothy Ecklund 6250 Saker Avenue N.E.
3 CONTRACTOR MAIL ADDRESS
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAII ADDRESS
6 USE OF BUILDING
R2 S1 C�E
7 CLASS OF WORK
8 DESCRIBE WORK
9 CHANGE QF USE FROM
Ld �.
C NEW ❑ ADDITION ❑ ALTERATION
X
TO
OATE PAGE OF
6/5/80 � /
° 15762
ECEIPT NO.
9
APPFOVED BV ��
SEEATTACHED
SHEET
ZIP PHONE
571-0948
ZfP
ZIP
PHONE LICENSE NO
PHONE LICENSE NO.
PHONE LICENSE NO,
❑ REPAIR ❑ MOVE ❑ REMOVE
STIPULATIONS
Be sure adequate ventilation is provided; Code is 1:300 ratio, half in
soffi.t and half near top of roof.
Roof can be 2nd but not 3rd roof. Install ridged galvanized valleys.
TVPE OF CONST.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAI, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED Ofi ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTEFi WORK IS COMMENCED. N0. DWLG. UNITS
I HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVEANING THIS TYPE OF WORK WILL BE COMPLIED $]_�QOO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW FEGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $7 • SO
PLAN CHECK FEE
�
SiGNA7URE OF CONTfiACTOF OR AUTHORIZED AGEN7 IDATEI
�� > �/ /�i �r' �i%1 _ i
�
OCCUPANCYGROUP OCCUPANCYLOAD
SQ. FT. CU. FT.
OFFSTREET PARKING
STALLS GARAGES
SURTAX
$.50
SACCHARGE
HEN PROPERLY V
INSP
TOTrALFEE
y8.��
D THIS IS YOUR PERMIT
CITY OF FRIDLEY •
, ARPLICAI'ION FOR RESIDENTI111_ CiUILDTPJG PEftMITS
(f�ew, Alterations, Additions, or Repairs)
ab�PdER: __ 7--,., �; ��,�, A; , ,� ; �- A _: _ ��,,:�,�.��. BUI LDER : '
— , • -
ADDRESS: ��j a;:� ,r, �=�.'`f_r-;�, ,:=�r�' �,,, ADDRESS: -�!"��'?_
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TEL N0. __ -, �,� :����E TEL N0:
Construction Location
STI2F�T NO : �,�', .�;. l STI2EET: f _; �,� r �� �� ��� _ ,/;l1:.
LOT: / ,� BLOCK: � ; ADDIT�ON: ,!���. � � � � �'
� � _ s=- ��' _ �/,/_-�" T�i'�t` i
Corner Lot: Inside Lot: Se�.back: �� Sideyards:
Applicant attach to this form two Certiiicates o� Surv�y of lot and
proposed building location drawn on certificates to scale.
aESCRIPTIO« OF CONSTRUCTION
r�,
=� i�c %i��'i;, - I'ront: • Depth:
�' Squar.e F�et: Cub�..c Feet:
H eight :
_ Front: Depth: Height:
Square Feet: Cixbic Feet:
7`ype af Construction: ._�sf>���/'�!- Estimated Cost: $'�/.t-. ��'""
� � � � � � / �v `� �
Zb Be Cbmpleted: '
, Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desixed: $ $
, . SEE REVERSS SIDE CF SHEET
�'he undersigned hereby makes application for a permit for the wor3: herein specified,
agreeing to dc� all work i.n strict accordance with the City of �'ridley Ordiiiances and
rulings of the Departmen t oi Builclings, and hereby declares that all the facts a�d
representations stated in this applica�ion are true an d correct. �
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; ._ ,,
. • .: ; _. �.! ��, / "�_T /-' f O
r
DATE: ��� r' ' � _ SIGNATUF2E : ��_��, ..- —..�� < r �: -�� .,./` '„�,J,!F. - r ,,
Stipulations : � �•.j
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�_�p,! ,''� . � / �y .-i�+�-� �..,�- /`��. ,(� 1 , r°t
,
^C✓".�s5�� �+4 .t�-. � f'!� +��..n� 7.,�A. rf.�Jd,!..1�i.�C,. �/'+/ "1� . W . jd �� �,.,�..;
. .!^�.,.. ; ,,./. T � � , r
. � � �, �
�.+ � ,�� �i /�,..e.l��. �` �..' i l s �'� /�,�� � .. � •�--`--' _ ;+° /YLp-OL°'"° � " �
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I,T�i,�L�'Y� � �� . , ..
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BU)LDI(�G PE�RI�IIT �C� SCf1CDUl_E .
SJ;C'a"ION ?.. 7'}ie 7ns��ector of 13ui1Qiri��� .:ha]_1, }aefo�:e i::::.uing l�ennii:s for the erecLion
ot any y�ui_.ld�.n� or :.:Lruct:uY'c, or. for any add�.La.c>n ;:o any CY.l;Li_ng building oz strucLure,
ar. for any �Z:.L�lat�i�11 or r_c��air.s to •any, c>:a_�ting )�ua.l.ai.ng or sL�:uctur_c, uZ�on application
LiZCr.efor.c, rcquirc the i�aymenL }�y tlie aJ�Z�].i_cariL L-or. sttcli per.mi.L- of fees to tlie amount
hcrein Uclova seL' for.t.h ancl in L-he i�ianner her.ein prc>viclecl Lo-wiL-:
1�isW C011STP.UCTInN: Single 1'a�nil.y lIomes anci Gar.ages: $�.00/1,000 cubic Leet.
i'T�1�t� CIiI;CY.: 25 l�ercent of }�u�.lcling permi.t f.-ee. ,
U1t1VE1�JAY ll�PI2I:SSI0i1: (Concrete, Cur.b StreeL's Only)
• Alternai�e A: Remova]. and replacement o£ concrete curb and
yuL-i�er only; Driveway widi:li plus 6 feet x Y�,.�',.75
tilternate }3: Removal. and replacement of concret� curb and
� gutter and instal.l a 3 fooi� �vide approach with
• 6 i.nch depth; Dri.ve4�ay width plus 6 feet x$17.85
. � _Lp�?IS�o�n�. 1r�ro����LI_o_�__
For the puri�se of computing fees for building permits, the cubical'contents of any
buil_da.ng or addition, is deter_mined by rnultiplyany the ground ar.ea covered fr_om a
poznt six (6} inches below ihe floor line of the basement or th� cellar to the
average heights o� t.�ie upper surface oa� to the average height of the roof surface
oi tlie �ain gable of a pitch.ed rooi'.
kor zepairs or alterations to an existing structure, the fee shall be at the rate
of $3.00 ner each five hundred dollars ($500.00) or fraction thereof in tlie cost
oi all proposed wor_k. •
In �no case slial.l t.he fee charged for any per.mit as set fort}i in Section 2 be less
than $7.50 plus $.50 state surcharge.
LERIFICATIO� OF FOUNn�TIOP�
hdTE: Per_mits �or construci�ion t�ill be issued a minimtun of 24 hours fr.om the time
of appli.cation to allow for proper review of tlie proposed structure and of th�
constnlction si te.
i1 Certificate ot Survey of thc lot, showing the location of the foundation once it
has l�een constnicted ti�ill be xequired before pr.ocecdinc� with the framing.
Cr=RT I F I CdTE OF OC�IPANCY
1lpplication for a Certificate oi' Occupancy shall be mzde L-en (10) days prior to the
use or occupancy of any sL-ructure for which a building pexmit has been issued; and
sai.d structure shall not be used or occupied until. a CerL-ificate of Occupancy has
been issue.d.
0
_ ..� _
�
c�ty of Fridley
AT THE TOP OF THE TWINS
r
� .
� �
' ' COMMUNI7Y OEVELOPMENT DtV.
� �V'_
r � ' PROTECTIVE INSPECTION SEC
� ,
� ,
i
� �"'1 � CITY HALL FfiIOLE� SS�J2
�������� ,�� 612-571-3450
�U ILD11�1G PERMIT
NUMBEA AEV D�TE PAGE OF
9�o-Fis 3/29/00 / /
J08 ADDRESS 6250 Baker Avenue NE
1 LEGAL ��T NO. BLOCK TRACT OR ADDITION
DESCR. Pt 13 2 Moore Lake Highlands
2 PROPERTY OWNEfi MAIL AODRES$ 21P
Tim Baklund b250 Baker Avenue NE
3 CONTiiACTOR MAIL ADDRESS Z�p
Steven Lee Contractor 9465 Irving Ave, Brooklyn Park, MN
d ARCHITECT OR DESiGNER MAIL ADDRESS ZIP
5 ENGINEER
6 USE OF BUILDING
Residential
7 C�ASS OF WORK
MAII ADDRESS
0 NEW ❑ ADDITION p ALTERATION
8 DESCRIBE WORK
Reroof House & Garage (23 Sq) Tear-off
9 CHANGE OF USE FFOM
STIPULATIONS
TO
ZIP
30770
RE� IPT�
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�
APPROVEO 8Y
SEEATTACHEO
SHEET
PMONE
571-0948
PHONE LICENSE NO
55444 424-1198 5758
PHONE UCENSENO
PMONE IICENSE NO
� REPAIR ❑ MOVE O REMOVE
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIREO FOF ELECTRICAL, PIUMBING, MEA7ING, 7YPE OF CONST.
VENTILATING OR AIR CONDITIONING. �
THIS PERMIT BECOMES NULL AND VOID IF WORK OF CONSTRUCTION ZONING
AUTHORiZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONEO POfi A PERIOO OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCEO N0 DWIG. UNI
I HEFiEBY CERTIFV THAT I HAVE READ AND E%AMINEO THI$ APPLICATION 1
ANO KNOW THE SAME TO BE TRUE AND CORRECi. ALl PROVISIONS Of LAWS yq�UATION
ANO ORDINANCES GOVERNING TMIS TVPE OF WOiiK WILL BE COMP�IED
WITH WHETMER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �2�OIO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pEqMIT fEE
PROVISIONS Of ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTIO fi THE PERFOfiMANCE Of CONSTRUCTION �83. ZS
�, ��.��� PLAN CMECK FEI
,�'"-�" �� � �, ,��°2 �►. � V Licens
S�GNaiUREOFCON'AACTOAOpAU��OQ�2EDeGENT IDATEi . ,�.. .
S�Gtin7UaE O� OwrvEQ i�F OWNEQ BU�LDEA� iD�iEi I �-• �� �tisp
SO.FT
STA�LS
$5.0
L ALI
VGROUP OCCUPANCVLOAD
CU FT
OfFSTREET PARKING
IGARAGES
�1.�1
SAC CMARGE
Fir SC $2.01
TOT � FEE
$91.27
TM��L/6M�,
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r�cif
NEW [ ]
ADDN []
ALTER [ )
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address l�,oZ.S'�
Legal Description:
v
Effective 1/1/2000
(763) 572-3604 Bidg Insp
�it'�� ; �
Owner Name & Address: _ rr w, ,� c, JC %,�,,,� � Tel. #.�7/— �O !' y,l�
Contractor: S/ -{v+Q.,� 1� L MN LICENSE #-�1rp
Address: .l'- ,� 1� v�^ k �� Tel. #�%v2 y� /% S 0'
�
�. �,,�/�„ 1va.�k /y-�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCii1PTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Lengfh Width HgbGround Sq. Ft.
OTHER:
��G�'� ��s/o
Construction Type: �to�- y}�-- � v<... �'� �7s,� ' —
� Estimated Cost: $ c.+�/ O o.
Driveway Curb Cut Wdth Needed: Ft. + 6 Ft = Ft x� _$
DATE: � � �l —��APPLICANT: _ '�/ '�'�. L t Tel. # 7'vZ y— JI �p
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Call (763) 572-3604 for Permit Fees if mailing in application
��� �S Fee Schedule on Reverse Side
$_ �.6 / .001 of Permit Valuation (1J10th%)
$ /� d� $.50/$1,000 Valuation
$ � $1100 per SAC Unit
$ v�dU $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
E�
$450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary [ j
TOTAL
STIPULATIONS:
$ .
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing pernuts 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 VAL,UE
$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
$23.50
$23.50 for first $SOO plus $3.05 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 iust $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 first $500,000 plus $4.75 for each additional
$1, 000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Ciirb 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.
VERIFICATION OF FOUNDATION
Pernuts 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. New Houses Onlv
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APPLICATION WILL BE RETURNED
rn���en�i t�RT� �+��T CC]NN CTOR AND CDII�� ISTinI� AIR V RIFI . TI�N
�en � �� i an aYic in0 f ir�anae, the undersigned hereby venfies 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 plastiGPVC and meets ail current codes and manufacturer
specifications including sizing, length, number of elbows and termination.
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The pYi� � cemh ��t�en a�r is sized and installed to meet the current codes
and manufacturers specifications.
When required to'��a^== " ne��� remh �st� ion ai�; it will be sized and installed
to meet the current codes and manufacturer's specifications.
�en jp�lljp� np�s� ��QntinQyystem, the undersigned hereby verifies that
it is�a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances.
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes.
Yes �o (
�
Yes ( No ( )
Yes ( • ) No ( ) � �-
,
Yes( ) No( ) f��i�
Yes (r�No ( )
Yes ( No ( )
—,-r---- . ✓
Appliance #1 Type �� BTU Input (G'� �� Fan Assisted or Nat ��--
Appliance #2 Type „� ��'t"YL (� BTU Input 5?, �� Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Tota! Appliances Total Btu Input �ti� ���
r + /-"", '� /
Common Vent Type � i Vent Height Diameter .�___� inches
/ �
Appliance #1 Vent Connector Height ��� Length ���ft Diameter �� G in Type� �—'
Appliance #2 Vent Connector Height '7ift Length _�ft Diameter " in Type �
Appliance #3 Vent Connector Height ft Length ft Diameter in Type __
HEATING CO: ' � �J � ���� �.��
Signed By: Date : ,�� �.3 " �' �
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FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacinq an existinq furnace, 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 replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
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 ( )
r'es ( } No � j
Yes ( ) No ( )
WMen installit�t a new ventin� sv�tem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. 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 ( )
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
Total Appliances Tdal 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 CO:
Signed By: Date :
CITY OF FRIDLEY PERMIT 1�0.: 2004-o122i �
6431 UNIVERSITY AVENUE NE ,
FRIDLEY, MN 55432 DATE ISSUED: 07/30/2004
�63) 572-3604 FAX: (763) 571-1287
ADDRESS : 6250 BAKER AVE NE
PIN : 133024330013
LEGAL DESC : MOORE LAKE HIGHLANDS
: LOT 13 BLOCK 2
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION : $ 2,990.00
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL AN AIR
CONDITIONER.
# A/C UNITS 1 VALUE OF APPL OR WORK
#FURNACES
VALUE (FOR MINIMUM CALC)
APPLICANT
STANDARD HEATING & AIR COND CO
410 WEST LAKE ST
MINNEAPOLIS, MN 55408-2998
(612) 824-2656
OWNER
JOAN BOULEY
6250 BAKER AVE NE
FRIDLEY, MN 55432
0
2990
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wor}
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate ar cancel the provisions of any other state or local law
regulating con�truction or the performance of construction.
Applicant `' � � _ Date , ;
Bldg In�.� � �,i: ��_. Date
# GAS DRYERS
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS DRYER FEE
AIR CONDITIONING FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 11107
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0
0
0.00
0.00
0.00
25.00
0.00
0.50
25.50
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FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERM(TS
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacinq an existinq furnace, 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 replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
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 ( )
When installinq a new ventinq svstem, the undersigned hereby verifies that t
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. 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 ( )
Yes ( ) No ( )
Appliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #Z Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances 7otai Btu Input
Common Vent Type
Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Leng$h 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 CO:
Signed By: Date :