AF - 36451•
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City of Friclley, Mi.nn..
BUILDING PERMIT
APRIL 25, 1967
Date: _.._.._..._.....__---_.._..__.._...._.__
�����
N� �200
Owner: ��'D ZAPPA . JIM ZAPP�.
_..._........_..----..__._.___.._._._._.....__..._..._..---._..._._...____� Bmlder _..___..._..._.._.�--•----...-- ............._._..----------......--�•----....._.._..._.__...-••--
Address 2305_.__E .... 24th Street_.South __ __ Address _.__...__._.__._..._3559 _HALIFAX AVENUE NORTH
-��-- -.. . - �-------��-�----.......____...._.__.._-____
MINNEAPOLIS, MINNESOTA MINNEAPOLIS, MINNESOTA
LOCATION OF BUILDING
No. ..---1549..._......... Street ....._ .............BERNE _ROAD..__..........._._._.--�---�--.....---�-�----�--...... Part of Lot ..------�------.....___..._..._______..._._._......�
Lot .._..18.-------._.._........_ Block .---_.._..---....._1--.........._.. .. INNSBRUCK, 5TH ADDITIOft
• -- .------- Addition or Sub-Division ....._......._.___....._.._____....._._._...._...._.__.___._._____...__
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CornerLot ----�- ............._........ Inside Lot --------�-�---..........._..----------- Setback -----35-•--------�-•-•�------�--- Sideyard ......_.....1:.� --••-•---........�-----_...__.__..�..
974-56 , , 977.56
SewerElevation .---•---•....---._..-----•-----..._._-----•------..._...._.__.._..--�-----------...._ ����ion --------•-----.__._.._--•----...__..._.__._._.___.—_
TOP OF FOOTING
DESCRIPTION OF BUILDING
To be Used as:
DWELLING 71 36 20 2,518 50,360
._._ .............__._..___._.._....._...__ Front _..._........_----•• DeP� ...-.__.---......_ Height ..-------•--••-•-----. Sci. F� _.__.._.._._._ Cu. Ft _.._..___._..
GARAGE 22 32 10 704 7,040
.._._.._..._..-•------•••-•, .............._...._ Front ---___........._.. Depth _...--•-----------._ Height ._.--•.------....._.. Sq. Ft. .-----_.........__. Cu. F� _._._..__�
Type of Construction _-•----F�M� ------••--._......_....._.. Es� Cost -----•-$35 ,_000_..._.---------- To be Completed _..._..._._.._.._..__._......_...�._.
SEWER LOCATION - 123' West of Manhole on St. Moritz
WATER LOCATION - 10' West of Sewer
Tn consideration of the issuance to me of a permit to construct the building described above, I agree to do
th� proposed work in accordance with the description above t forth and in compliance with all provisions o!
ordinanc�s of the city of Fridley.
�
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In consfderation of the payment of a fee of �._.86.�..� ... __....._.., permit is hereby granted to_.._.. JIM �PPA
._.._._...._....._..__._.._...----•-�--_•---•-•....---_. to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances o�
Fridley, Minnesota regarding lceation, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit ma,y be revoked a t any time upon violation of an,y of the provisions of said
ordinances.
CLARENCE BELISLE � B�� ���
�
NOTICE: '
?his p�rmh dou nof eowr tlu eon�ruetioe, installatlon for wirin9, plumbing, oas h�atino, snw�r er wabr. B� wn h tN
th� Buildin8 Intp�cto� for s�parat� p�rmNs for 1hu� if�ms.
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OWNER'S NAME
Annx�ss :,. _ < <:; ; _
APFLICATiO� TOR BUILDING °ERMIT
CiiY OF �'Ri�LEY, MIN�TESaTA
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LOCATION OF BUILDING
N0. � S �� � STREET '��,� r h e �� a PART OF LOT
LOT ' ` BLOCK � ADDITIQN OR•,SUBDIVISION� ��, �, � ��`" �'cc
� � : � .�
CORNER LOT INSIDE L4T SETBACK �.� SIDE-YARD /i,,,,
�-
SEWER ELEVATION % .� � 1 � �i�8� ELEVATION � � � _
. � , .S �
Appiicant attach to this form Two Certi£icates of Survey of Lot and propo�ed'
building location drawn on these Certificates. I`
.5 -- i-� 3 �
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To Be Use� As :`� w�
� '7
DLSCRIPTION OF BUILDING %� �
•��, ,w . 4.`_ .�z-, !-h .-�-�
�6�-�.ti-�.�
�� ` � � , � � Frout �� �� Depth � �-� Height '�- �
Sq. Ft . � '� 1 � Cu. Ft . � � ) 3 � �
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�
� c � :� � -� _ ` ,Front '�� _ DepCh � � Height���„_
, . G
Sq. Ft. .` � o�- Cu. Ft.� ��
(i(/�� __� Estimated Cost _ '��',,,, (� O � �,
Type of Construction o ���
To Be Completed �_=�a r� ,' `y - ,' � �,�
�
. . � � : ' . � . . . � ' . . .
The undersigaed hereby makes application far a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances
and rulings of,-the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
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DATE � � „ r��,� ....r,..l'.: .. _ SIGNATURE �_��,.y.�- 1., . _ _��,L,-,.:..��.
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(Schedule of Fee Costs can be found on th��R�verse Side). ; �
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BUILDING PERI'�CT FEE SCNEDULE
SECTION 2. The In�pector of Buildings shall, before issuing permits for the
erection of any buiiding or structure, or for any addition to any existing
building or structure, or for any alterations or re�sirs to any existing building
or �tructure, upon appl�.cation therefore, require the payment by the applicant
for such percnit of fees to the amount herein below set forth and in the manner
here3a, provided:..to-wit:......
2.1. For any such permit for the erection of any fire-proof building,
other than a garage, warehouse, factory or grain elevatoz, or for the erection
of any fire-p�oof addition, for similar occupancy, to any existing building,
shall be at the rate of $1.40 for each.one thoc�sand cubic feet, or fraction
thereof, in such cubical conteats.
2�„2� For any such permit for the erection of any fire-proof garage,
warehouse,�factory or grain elevator, or for the erection of any fire-praof
addition, for similar occupancy, to any existing buildin� shall be et the rate
of $1.25 for each one thousand�cubic feet, classified as '!firepxapf" by Section
502 of the Minneapolis Building Code.
HOUSBS
2•3• For anq such permi�t
other thaa a garage, warehouse,
addition, for similar occupancq,
each one thousand cubi¢ feet.
GARAGES
M
for tlie erection of any non•fireproof building,
factory or grain elevator, or anq noa-fireproof
to any existing building permiC fee $1.00 ior
. .. . . . .. . . . .... . ..
2,4. For any such permit for the erection of any non•fireproof garage,
warehouae,�factory. or grain elevator, or for the erection_of anp non-fireproof
addition, for similar occupancy, to any existing building or�for�each such
building or additiout - niaet�y..cea;ta ($0.90) for each one thousand cubic feet
or fraction thereof, in the cubical conteats thereof with the minimum of $4.00.
For the purpose of computing fees for building permits, the cutrical contents of
any building or..addition tQ_a uniform height throughaut by multiplying the ground
area covered from a point six (6) inches below the floor line of the basement or
cellar to the average height of the upper eurface or to the average height of the
roof surface of'the main gable of a pitched�roof.
2.5. For repairs or alterations to an`existing st�ructure, the fee shall
be at the rate of $3.00 per each Five Hundred DoZlars ($5Q0.00) or fraction
thereof in the cost of all proposed work.
2.6. in no case shall the fee charged for �ny permit as set foxth in
Section 2 be less than $4.00.
. ... . . ..
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±: Application �or Power Plants and Heafing. Cooling, Ventilation� Refrigerertion and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work . . . . . . . . . . . . . . . . . . . . . . . . . . $10.00 $
Replacement of Furnace ............................. 6.00 �
Repairs & Alterations—up to $500.00 . . . . . . . . . . . . . . . . . . 6.00 $
Repairs & Alterations each add. $500.00 . . . . . . . . . . . . . . . 3.00 $
MECH. WARM AIR
Furnace Shell & Duct Work to 124,Q00 BT[T . . . . . . . . . . . . $10.00 $ 10 . 00
each add. 60,000 BTU . . ........ . .. .. . . . . . . . . 3.00 ;
Replacement of Furnace . . . . . . . . . . . .. . .. . .. . . .. . . . . . . 6.00 $
Repairs & Alterations—up to $500.Q0 . . . . . . .. . . . . . . . . . 6.00 $
Repairs & Alterations each add. $500.00 .. . . . . . . . . . . . . 3.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDft Steam .... .$10.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $
Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . . 3.00 $
Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 3.00 $
OIL BURIvER—to 3 gal. per hour . . . . . .. . . . . .. . . . . . . . . . 6.00 $
over 3 gal. per hour—See Fee Schedule
5.00
` GAS BURNER (up to 199,000 BTU) . . . . . . . . . . . . . . . . . . . . . : 5.00 $ 5. 00
over 199,000 BTU See Fee Schedule
_ GAS FITTING FEES: NO RATE TOTAL
� lst 3 Fixtures . . . . . . . . . . . . . . . . .. . . . x$ 2.00 $ 2.00
� Additional Fixtures . ............... x .75 $
Gas Range to 199,000 .. .... x$ 5.00 $
'� Westin house MO-36 3 Ton � 18.00
:" ''�' IR CONDITIONING g
a ",
�, FAN HEATING SYSTEM See Fee Schedule
� VENTILATING SYSTEM �
,` ALTERATIONS & REPAIRS TOTAL FEE � 4(� .�0
ROUGH
j�" t
. FINAL
Heat Loss attached -
Dept. of Bldgs. Phone 560-3450
1549 Berne Rd.
,
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City of Fridley:
The undersigned hereby makes application for a permit for the work hereir.
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley, 1Vlinn. �' 1 � 6 � , 19 _
Owner �ei�� ���appa
Kind of Building Frame
Used as _ � 1 Q •
To be completed about
8-17-67
Estimated Cost, $ 500.00
� ���
Old—New. Building Permit No. ��-� Permit No.
DE$CRIPTION OF WORK
HEATING or POWER PL.ANTS—Steam, Hot Water, Warm Air—No. 1
Trade 1Vame Westinghouse Size No. FGU/-175iGB-45
Capacity Sq. Ft. E.D.ft. 17 SM; 4$M g� g p
Total Connected Load 112 , 429 I�ind of Fue� � S
BURNER — Trade Name Size No.
Capacity Sq. E't. E.D.R BT[J g,p,
(REMARKS—OVER)
.:
FRED VOGT & C0.
Signe ,. � ;
gy 3260 Gorham Ave • 929-6767
St. Louis Park, Minnesota 55426
Business Phone No
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F�► T LOSS CALCU[.A'f l0 / A�=�`M E �ti' T O F►�' s Y�: (�: �t � l O'�� M! NIVEAPOLIS, M1NN. -
Weathentrips A•S• • Construction No. Insulation '
Guide _____ -_
Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind -T— How Applied
Yes— o I Ye— s�10 19_ -- ----i --
f Fl ,„, �, Room � Length Width (� Height � ; FI. - ' Room L.en th ' Width %. H
�ff�...�_-�L. � 8 .. !
Windo � and Doori—Crackage and Area � Windows an Doors--Crackage and Aroa
Width HelgAt No. ot Llneal [t. Area WIAth Helght No. 01 � Llneal ft. Ares
No. ot Daae of pane Ilshta o[ creck eQ. fL ^� Nc. o( pane o[ pane Ifglits ot crack �p. ft.
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Coef. Bcu Coef.
lnfiltration ,j �' '� 'f�o 6 Infiltration -7 � �
Glasa j —.____ ;
` o / -� �'��" Glasa tt �,
Exp. wall ; i �.S ' Exp. wall � `, � • - - — „J� ,
Net e:p. wall , z. o '> / b I N t II ---- ,
Int. wall
Ceiling
Floor
Total Btu.
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� sq. ft. E.D.R. or :q. ina. W.A. Leader area
L Fl.� �/�; �' Room' Length ,,� � Width
Windows and Doors—Crackage and Area
Wldth Hel�ht No. o[ Llneal tt. Arew
No. ot pane o[ D�ne Ilsht• o crack �p. tt.
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_ � .� f / �`t ;- � / l � .s /
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lnfiltration
i,�a:s
Ezp. wall ,� � '
Net exp. wall
Int. wall
C.eiling
Floor
Coef. Btu
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lotal Btu. ' � �:� e,,7
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Requited sq. ft. E.D.R. or sq. ins. W.A. l.eaaer area
1 Fl. �ti,,, Room � Length � Width ".� Height `�
Windows and Doors--Cracicage and Area
Wfdth Helght No. ot Llneal (t. Area
No. o[ pan� o[ pane Il�ht• ot crack �y. ft.
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infiltration
�tp. wall/,� •
IVet txp. wall
tnt. wall
Ceiling
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t
Coef. Btu
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ITota) Btu.
IRequired aq. ft. E.D.R. or aq. ins. W.A. l.eader ares
e exp. wa �{✓
---- -- --._ —
Int. wall
.—.___. _ _---
Cei�ing
Floor
Total Btu. -- ------ —
Requirtd sq. ft. E.D.R. ot sq. ins. W.A. Lsader area
i/ Fl.l � �' Room I Length o5 � Width /
�, Windows and Doors—Crackage and Arca
! �titdth He'gnt No. oC Llnral fL Area
I h�. of pane ot pane Itghts ot crack ea [t.
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" 1n61tration ''
j — --- _------ j-- � ' --
II Glass --- — � ,_
� Exp. wall,i ° `
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�� Net exp. wail i: ,
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Height : '
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C ei�ing , • Y_ j.
---F loor �. .�—.. ..-----
------ — � ___ _ .. --- --
Tota! Btu. '_ i ? '
Required sq. ft. E.D.R. or sq. ins. V4'.A. Leader area
_L Ft.j �', ,, 4. . Roomi_Length "' " Width ��
W'indows and Doors- -Crackage and Area
!�� i R'tdth Hel—ght r��� !:�,,, ,% Llnebl it. wrea
No pane of pane �, Ifa!;te of r¢ck �p. !t.
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iIn:. wall,_._.___._---_�_ ._._.. _
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K+�T LA6S GI�CIJIATIONS DEPARTMENT OF 1NSPECTION M(NNEAPOLIS. MIMV.
�►ed6entrips G��� • Coastruction No. Inaulation
�u�aowt Doon Referenu Out. Wal! Int. Wail, CeJiag Roof Floor Kind How Applied
�a�i`o��� 19_...
FI. Room Len�tb Widtk� / Height Fl,� Room Length Width Hei
Mli�dows and Door�---Cracka�e and Area Windowa and Doors---Crackage aad Area
(dth Hef�At No. ot In�al t. Ar�a WIdtA Hel�ht No. ot Ltneal tt. Ar�a
No, of pa�t of Dan� Il�hb of crack p. [t. No. ot pan� o[ pans IlrAt■ of crtet p. tR.
'� l � .3 �% Q /
�h� �
Coef. Btu Coef. Btu
infiltration +
Ini�ltration ja / .
Glaa / v � O. Glas� ,3 / Sv c�-
Ezp. wal) � lJ� Ezp. wall i �
Net e:p. wall Net e:p. watl p i Y oy
lnt. wa11 Int. well
Ceiling , Cciling • ,2 �
Floor •
Floor
Toal Btu. S S Tocal Btu. �
R�u�red .q. h. E.O.R. or sq. ins. W.A. Leadcr area Required :q. ft. E.D.R. or �q. in�. W.A. Leadet area
Fl. Room L.enEth Width // Height Fl�, �m I�ngth /� Width // Height �'�
Wiadows aa Door�—CrackaQe and Area Windows and Doorr—Crackage and Area
Idth HN� t No. ot Llneal [t, Are� Wldth Helsht No. ot Llneal I[. Area
Noa o! pns ot p�ne Il�hu ot crack p. tt. No. ot nane of nane llrhu ot crac!c �a. tt.
[n6ltr.tica / S •
Glaa / o / $' ta �
Ezp. wa11 . �
Net esp. w�U / S' �-
Int. wal!
Ceiiing / � • �
�loor "
� Tatal &u. ,¢
,Required �• k• E.D.R. or �q. ins. W.A. Leader area /
�i� Fl. Room �Length Width // Height '
Windorw aad Doon—CrackaQe and Area
�Vldth HNSht No. ot Ine�l it. Area
!o. ot yan� ot Dans Il�dt• ot crRCk �a. tt.
�- ��_ ��' / Z7 1 /
Btu
;nfiltratioa i � / �1- '.
�lau .2. S � ! .�
�p. � f � .
, Vet e:p. waU % s
� nt. wal!
:eiling �, y � .�
'loor ,,.,.
fota! &u. � r
ieqwred �q. ft. E.D.R. or sq. in�. W.A. l.eader area ,/
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-- ------ ___ __
i
Infiltration '.;� �-� ,
Glasa
Exp. wa]! /I �
Net exp. wall
lnt. wall
Ceiling
Floor
Total $tu.
Required sq. ft. E.D.R. or sq. ina. W.A. L.eader area
/ Fi.���.,.�--- Room I Length / l Width
Windowa and Doors--Crackage and Area
Wfdlh Heltht No. ot L1ne�1 tt. Araa
No. o! paee ot pane lichte ot crack �a. tt.
In6ltration '" '
Glaas
Exp. wal!
Net exp. wal[
Int. wall
Ceiling, f , .�/' �-
Floor
/; ,
7 9 .i—
Coef. Btu
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tcequ d aq. tt. t.U.K. or sq, ins. WA. Leader area J/ -
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�EA� L,Q�►s CAL�iJI,AnON$ DEPARTMENT OF INSPECTION MjNNEqpp[j$� MINN,'
wa����P+ C��� Con:tructan No. Insulation
Via�ow� Doon Refereace Out. Wall Iat. Wall C,eiling Roof Floor Kind How Applied
�� �0 19_
Room Len=th Widtl� y, Heiaht � Fl.� _ Room Lengt6 Wideh Height
�i�o�w and Doors—Cr�ckap aad Ana Windows and Doors�racka�e and Area
NtA el�ht Ne. o Lte�al tt. Ans Wldth Hst��t No. ot l.lo�al ft. Ara�
No. K Nne o! p�ne Itsht• oI crack q. tt. No. ot pan• of Dan• 11�6t� � ot erack p. tt.
� � ti � . a- .s-�.� i .
� U o •P�
__ Coef. &u (`...� Q...
C.ws
� N'+�/�t •
IV�t t�. w�1
bK. waN ,
1
?otd 8tti. _
�M� �q. k. E.D.R. ot p. ia�. WA. Leader :rea
R,00�u l.eagcl, Width`
�u
�►'�io�rr� ud Doon-�-�racka�e aed Area
t �1� t N�. ot Lin��l tt. Ana
N1. K MN �t pan• II�YU ot anck p. tt.
S�F �-� J �l >i.
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ar �q. ir. �►.A. Leader area
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....�.::�...r..�
....r.�,....�
Infiltration
� �'3Z' Glau /
Fap. wall /
?� 3 4• Nec e:p. wau ,3 (o ,
d 7 - Int. wall �
Ceiling
C�1. Floor
� �v Total &u.
Required sq. ft. E.D.R. or sq. ias. �.A. Leader area
ight ,�.I Room I l.ensth Width
R/indows a d Doon--Cracluge and Atea
Wldth Hel�dt No. oL Llnt�l tt. Ar�a
No. ot pane ot Dan� 11�4b o[ craek �a. [t.
� �
� In6ltratan
, s „� C,�ass
� F.�cp. waU ' ,
t b • Net ezp. wall ,
L _ D Int. w�ll
�eiling
�� . Floor �
� S % Tota! &u.
ReQuued �q. k. E.D.R. � sq. ies. WA. L.eader area
'�,� Fl. R�oom I I.,en�cl� �Videh
�l'mda�w and Doort--Craekase and Area
th 1[dsAt Na st n�at tt. A�a
i10. st Dln� e! O�u tlrAe. w/ e..w�. r n
�
r.� q . 1a61tratioo
� � . GI...
�
��
�_ N�t eso. wall
�_ tet. w�q
Ceilin�
7 ,Q C F{oor
� - _
. . �,
City of Fridley '�
Application for Plumbing cmd Gas Fitting Pernut �'/
/
Dept. of Bldgs. Phone 560-3450
DESCRIPTION OF WORK
Number, Kind and Loca3ion of Fixiures Locatioa % c� ��'� ��/�N %
Ci l ec ,�, � N =� Y Z
Z <
K ~ m � K C Q
�iZ Z
� 3 � � � � � � 3 � o LL
Base � 1 �� --
ist .� o� c�
2nd
,� �i c�
c Z~ z O= N a Z W
n
� so s7 <3 �< �� �o
/ J f �'
WATER HTR.
• •
R N GAS EIEC.
4th _ i ���� I I �_�— --
• Futuss Coaaection Openiags Connected with
* Nev► Fixlure, Old Opanings I Sewer �
Cesspool �
PARTIAL RATE SCHEDULE
PLIIMBING FIXTURE RATES: NO. RATE
Number Fixtures ....... ..............�� x $2.00
Future Fixture Opening . . . . . . . . . . . . . . . . x $1.50
New Fixture Old Opening . . . . . . . . . . . . . . x $1.50
Catch Basin . . . . . . . . . . . . x $325
� T�
$
$
$
o O
Water Heater (Up to 99,000 BTLT) . . . . . . --y� x $3.00 $ � �
New Ground Run Old Bldg. . . . . . . . . . . . . x $3.25 $
Electric Water Heater z $2,pp $
GAS FITTING FEEB: NO. RATE TOTAL
a GO
lst 3 Fixtures .......................... x �2.00 $
,
Additional Fixtures . . ... . . . . . . . . . . . . . . . . x $ .75 $
Gas Range to 199,000 BTCT . ..... ........ x$5.00 �
REPAIR3 8c ALTERATIONS--Refer !o Code
Description ................................................$
TOTAL F'EE $-��
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
specifie d, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the facl
and representations stated in this application are true and correct.
Fridley, Minn. , 19_
Owner �--� ` �
Kind of Building __-�
Used as ��-Z—
To be completed about � / �� , �O � �
Estimated Cost, $ � � l G �G
Old—nTew. Building Perniit No. /`�� � Permit No. ��� `�
Signe !.= i� �L �.
G
By
Business Phone No % ,���— � � l�
ROUGH �o ' S'� 7 ��`f 33
FINAL
az
- —
HOUSE NEATING TEST RECORD
ADDRESS 'x APT. FLOO - CITY Sl1BlJR8 *
d_
OCCUPANT OWNER
• HEAT LOSS AT H INST. ^-AS CO. ME7ER BADGE #
SOLD BY � ' tNSTALLED BY �
Eleetrieol Wwk By Gas Lin� By �� ' �
tYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. � OTHER
AS SIGN CONVERSION
MAKE � � ' �-� MAKE OF BURNER
Model C.s �.lirii%� Mod�l
Seriol Mox. BTU Ratiny
INPUT d� MAKE OF FURNACE '
;
Mod.l
CONTROLS y _
THERMOSTAT �� � Heat Plug V�nt Size � `�
- Yalw �� KIND OF LINER � SIZE� ~ NOFiE._,.:..�� �
Limit D►oh Hood � Rspulawr —� �'" '
.,. � -�:
Limit S�ttin9 Filt�rs Sizs Nu ber
Fan Settieg � �� Chimw�y Loeation Insids Outsida .
Pilot Typs �� Cl�imn�y Conshuetion � � '� - s
Pilot Make ' � x
Pilot Model �' 'S Smob Bomb ~ Wirinp � + ��_ :
`�_"'
Pilot Timiny Draft � Te:i Tay� .�.� ��� .
L.W. Cut Off Door Pnsswe Liyhtin9 In:t. ��
Prossure 3' �'"' P�retnt COZ Date Tested " ""`� �
Inp�t CFH�.d� Peresnt 02 Compony Testing
Staek Temp. y Psreent CO Nana of T�st�r ��
Porm 235 r
�_ � .
: � HOUSE HEATtNG 7EST REGORD:. . �
:= ADDRESS ,% � ,�� �.s?IG� �/t-T APT. FLOOR___l�CiTY � .
OCCU i�ANT OWNE R
z NEAT LOSS E H 6. 1 S. AS C0. METER BADGE #
� S�.D 8Y ' � INSTALLED BY
Etectriea! Work By Caos Lin� By �
TYPE OF NEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER � "a
� AS.DESI COItYER$#FJ�f '' ^_
E . , . �;�
� ,. i�AAK � MAKE OF BURNER _
Mod�l /�' 1s �/ �Q % i Modsl
Ssrial Max. BTU Ratiny �
_ INPUT ,� ?+� MAKE OF FURNACE
I�odel
-�-r
,:--�:
...�._.....:._�
�-
� �., �
CONTROLS �, >� 4
THERMOSTAT�.�� Heat Plug Vent Sizs 1
Yalve KIND OF LINER SIZ lt��$, �
Limit y-�� �„ ��� Drah Hood + R�yula�or
' Limit S�tting Filtsrs Size Nu r �
. Fan Settin9 " d Chimney Loeation Inside QufsilM „ `� -�. -
Pilot Type Chimn�y Construdion ,
Pilot Make ��� , � ' ': r. .
Pilot Model "��'�'��"� Smob Bomb Wiriny � ,.4......._,M....
Pilot Timing ��!� ;. D►aft T�st Ta� w:
L.W. Cut Off Door Prossure Li�tin� Irut.- �:..._......`^T..:':.�-'�
Pr�ssure �'J , P�reent CO �" g Date Tested s~ �
I�ut CFH r 7 7 Pere�nt 02- �%�► Company T�sting � _ . s
Staek Temp. ,�.� Percent CO2 �-0 Num� of Twster ' "^� �+ `' -�"
-' Form 235 : F �:
�
�;�� �; � _ �
, _
� � � � � . ,..a:7».� _ _
CITY OF FRIDLEY INSPECTION DIV.
643i University Ave NE
Fridley, MN 55432
572-3604
�ffedive On January �, 19�3
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
nnaRK NUMRER OF FIXTURES TO gE INSTALLED ON EACH FLOOR
;
� .
? PLUMBING FIXTURE RATES: NO.
.; .
; � - New Fixtures --
Old Opening, New Fixture
Bee� Dispenser �,_
B(ow 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 OYes (} No
, .
,
Type
RATE TOTAL
$ 7.00
$ 4:00
$ 5.00
$ 7.00
� 7.��
$ �.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$5.00
Reinspectioh Fee $30.00
ALC OTHERS AND/OR REPAIAS AND ALTL=RATlONS
: 19'0 of Value of Fixture or Appliance
�:
�'
State Surcharge
TOTnL FEE
$ .50
n �
JOB ADDRESS��� _ ��., �l-`.�
t
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do ali work in strict accordance With the city codes
and rulings of the Building Division, and hereby declares that ail the facts
' tion are true and correct.
� � `���� ��-� � �� ^.�'� �
°' �� % • , 1993
1� y�
^..
0
8uiiding Used As
Estimated Cost �i • � PERMIT NO. ��� ��
PLUMBING CO ANY
SIGNED BY . G� TEL N0. 7.55� U
Approved B � Rough-In I�ate Finai Date
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS 15.00
$�_�D PLU 3 TH=�_50 3T/1TE SU RCNARGE
L wasv��4�.�
Inspections
�63-�72-3604
DATE �-ll'.�1 �
S.IT'c ADDRESS ,
THIS APPLICANT I5;
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WPI'f3
APPLTCATION
PERNIIT TYPE
TYPE OF WORK:
���������� �����������
ni
CI'��.' �� �'�����
YOUR E-MAIL ADDRESS
� • ./�1�t7
CiTY
PxorrE: ��� , �.� - �j���jv
COMPANY NAIvtE:_
CONTACT PERSON:
Received By: '
i ,:
� ..
Dat��dF E B
AT'E,i�ZIP `_J,
STATE LICENSE � ExP DATE
ADDRESS; �52�ia lM.[�.�� St I�� ��✓� CITY,�� STATE�N ZIP �✓S Z
PHONE ��� - �y�{ - 2� � � F� �� � - �s�- Z�
�SINGLEFAMILY ❑ TWO FAMILY
❑ NEW �REPI.ACEMENT
DETAILED DESCRIPTION OF WORK
� TOWNHOUSE
p ,4LTERATION/REMODEL
PER MS 16B.665 the permit fee is a minimum of 515.00 or 5% of the total cost up to �540.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJEGTS WI�RE LABOR EXCEEDS 5500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT Wi�iERE NOTED. FLYTURES: (INDICATE TOTAL
NUMBER OF EACH BELOV� f' n 3,D SiZ�BTU 3 Tnn
Equipment Instalicd , MFG: (.I� uri � MODEL:
MFG: MODEL: SIZEBTt7
�G; . MODEL: SIZElBN
�A/C 525.00 _FIREPLACE (GAS) S15.D0 . _GAS RAN�GFJO,VEN $10.00
AIR TO AIR EXCHANGEER S15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL 510.00
^BOILER 535.00 _FURNACE 535.00 _GAS UN1T HTR $10.00
�CHIMNEY L1NER 510.00 „GAS DRYER $10.00 ,_POOL HEATER 535.00
DUCT WORK $10.00 ,_GAS PIPING $10.00 _VENiTLP.TOR S15.00
— �,. _ .,..,,,�,w,�
Permit Fee
Surcharge
TOTAL DUE
.,,,-- -:_:. T„ .,.�_ ...:... .
$ Z,S , � Number of fixtures @ $10.00 x $10.00 = $
$ .50 Number of fixtures @ $15.00 x $15.00 = $
$ � .� Number of fixtures @ $25.00 x $25A0 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .SO
Total = $ �
THI5 1S AN APPLICATION FOR A PERMIT-NOT VALID UN7'IL PROCESSED
� I hereby apply for a o�iilding permit and I acknowledge that �he information a�ove is complete and accurate; that the work will be in I
'; r.onformance with the ordinances and codes uf the C:ty or rridley and with the tilumesota�Construciion Codes; that I under�tand thi5 is �
� not a permit but oniy an application ior a permit and �.vork '.� not to start -Nithout a permit; that the worK ��iil be in accordance wiih the i
; approved �ian in the case oT all •,voric �:vhich reauires review <_nd a�nrovai oi pians. ;
' � (;�U� i''��' _� CG�vis ��=,� �ATE 2/r� D�_-- '
� �IGNATURE OF ;;PPLIC.�NT RiNT VAME
'". ., PL�ASL':I�T(�TE:':�Ez'',_�1RA�'E::P.ERMITS`,ARE:REGiTIRLD,;r:OR,Bi7IIjDING,�EIs�:CS'RIC:�i;.?..?��;iv1E�i3AT�I.G�.�i?C.RK , ... ::�:
' ,:l`'? 'JI i �'.Q�e�I
:��iir��ng y�s�e��=ions .�e�a�-�ne:��
�4� . ':niver,:iii� .�veaue `�E. ^�idle��, _,�12�T � �4�.-
�5�-; � _-��604
,, -, ^6�- `--°� .
- :� :. _ OL-
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE •�� ��� %i
SITE ADDRESS �_
THIS APPLICANT IS:
PROPERTY Np
OWNER/ ai
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2010
❑ OWNER
COMPANY NAME:�
CONTACT PERSON:
YOUR E-MAIL ADDRESS
��
� �`
Permit No.:
Received By:
Dat�la+d'�d:N
ATE
1 ; 1''��1
STATE LICENSE # EXP DATE j� � p/
ADDRESS: �-' ^ r��''iW "" �' ' � CITY ' 'lX�/,I �[.�i"( STATE� �IP�e�
PHONE � FAX
FAMILY ❑ TWO FAMILY
�W ❑ REPLACEMENT
DETAILED DESCRIPTION OF WORK V�
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
�J ������ :�wJ��.-
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANUA J 200 A$ RAE HANDBOOK.
Equipment Installed MFG: �� �° MODEL:�J"�O'�'��� SIZEBTU �_
r T ��
MFG: MODEt,: SIZE/B7U
MFG: MODEL: SIZFJBIU
A/C $25.00 FIREPLACE (GAS) $15.00 �GAS RANGFJOVEN �10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GA5 GRILL $10.00
BOILER $35.00 FURNACE $35.00 GAS LJNIT HTR $10.00
CHIMNEY LINER $]0.00 GAS DRYER $l0.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $]0.00 �VENTILATOR $15.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VAL1D UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an app '' n for a permit and rk is not to start w' out a permit; that the work will be in accordance with the
approved pian in the case o equ�res review and approval o plans. �—��
SIGNA►'[IRE OF APPLICA PRIN7 NAME � DATE
APPROVAL INSPECTORS SIGNANRE _ DATE
City of Fridley
Buitding Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
� NEW HOMES/ADDITIONS 0 EXISTING HOME � MAKE-UP AIR
REOUIRED FOR NEW/EXISTING HOMES
l. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments MN Rule 1346 Sec. 501
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
4. Heat loss & cooling load per room
a. MN Rule 1322, Sec. N 1104.4.13
5. Ventilation
a. Per MN Rule Chapter 1322. Sec. 1104
6. Duct Design Per IMC 134b.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.