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AF - 36453{� �il� Of �71d�eY /J►PPlicafion Ior Plu�nbieg aed Ga� Fitii�q hn�it - 53-8l��915.51 Dept. of Bldq�. Phoru Se0-34S0 - DESCRIPTION OF WORIC Numb�r, Kind �nd Locatfoa oi Fixlures Le�ti�n 1KK�„�,�•na jtro r� ;� I � I S� I /��; F I p �! � I� O I V � I� � I U' � I l`9 � I C) S I , I N I GASTEN MT�C. � �� . .■.■■■I • ��i ' ■■■�.■' ■■■..■I . . . PARTIAL RAT� SCHEDULE s....: ❑ �� n F�.QMBING FIXTURE RATE3: NO. RATE TOTAL Number Fixtures . . . . . . . . . . . . . . . . x �2.00 E Future Fixture Ol�ening . . . . . . . . . . . x 51.50 ; _. New Fixture Old Opening. . . . . . . . . . . x a1,50 3_._._ Catch Basin . . . . . . . . . . . . . . . . . . . . x a3,25 s Water Heater :Up to 99,000 BTU1. •.. x 33.00 $ New Ground Run Old Bldg. . . . . . . . . x a3.25 $ Electric Wat�s H�a4r . . . . . . . . . . . . . . : s2.00 = GAS FITTING FEES: NO. RATE TOTAL lst 3 Fixtures . . . . . • • • • . . . . . . . . 2 x 32.00 ; 2 , � Additional Flxtures . ... . . . ..... . . . . . x i .7b a Gas Ran�e to 199.000 BTU ..,.. .... ... x E6.00 � install (1) gas grill &(1) lite 6,00 City oi F�idiey: The .undersigned hereby makes application [or a permit for the a��rk herei specified, agreeing to do 8ll work in strict accordance with the Cit� (�tdinance and ruling of the Department oi Buildin�s, and hereby declares that ali the tacl and representations stated in this application are true and rnrrect Fridley, Minn -�c'iy l�� 1972 , �g� Owner _ James Durand x,na or B�iia;� frame Used as residence To be completed about _�,y 19.--1972 Estimated Cost, � 20�� Oldx New. Building Permit No. Ps 't No. ��` Signe ' u arg ��ys� By MINNEGASCO --�- Business Phune No. ROU(3H FINAL !� �''� REPAIRS d� ALTER11TI0lrb—R.i•s fo Cod. �s °A�°' Surcharge .5GQ Descriptlon . . . . . . . . . . .... ... . . ...... . ...... . ...... ..... � ToTwL PEE � 8 .00 Ci of Fridley, Minn. �T° � `��: � � t;Y � BUILDING PERMIT � D�te: _.__.. �� Zi, 19i� p�r: J�ea �Mta�i 8„�r ��N,�„ itli�w i _ �Aaar�ss _..._._ x..��st. �l.��gia A� 331 �fl�e Ls1o� La�! x ,� Nw� �si��wt. �yuMA�u]i� ;� , �� ..._ ..�,��, ��..:�.�...,.^,,. : a, � �553 lOCATION OF BUILDING � No. ...__...:._-�. Six+eet �� d .._._.. ..� Part oi Lot ._ _ ,� , , Lot _.�.._._.�.7 __ Block ___�___..�..._.._._.__._._.. Additton or Sub-Divisiaai .� ��l� 3ttit �.� , .. Corner Lot __.__.._.__ Inside Lot __..._ _......�.._.._. Setback _._._._ Sideyard �- s� � � Sewer Elevatiaai ._._._ _� '��1�i�_ � l�4.0 � �- : '-� �. � T� at t±�o�tr� _ � �� :�.�� 4�„ DESCRIPTION 4F BUILDING � � � �.. -� To be Uaed as: __D�t1ti�..�.�._ Froa�t �''� nepth ._._. 2�� Hetght � 1�lou�, F►t, Cet, PY, _�_ - __.. .._._.._._._._. � Front ______�___ Depth ....._.. I�eight � Sq. ia't. �_.�._.. E�tt. $'� .w.«�.:.:,�.�� Type of Ca�struction _ n� _�_�_... Est. Cost .._.. _�!� __ To be Caan�ed '�* �+� ;� � � i�1ii� LOCAlIGw • 3Y' MNt ot 1Ys�e1� ��,. MA'!it LOC�►lIE'�M - 32' fis,st o� Ma�d�als � � � � � - =� `,� :,; y, In cwndderati�u o! the i�suana to me ot a permit to c�striict the buildiag �e�d abo�w I ��It. 44 t1u p�oyowed wosk ia accordance with the d�crlpttar abwe �t foa�th atW ia c�npdianoe t�►l+t�t �;; ��a�= pt o�dinaac�es o! the dty o! Fric'lley. , �; : ;100.OQ ��atr aCauuNCtiM � �,�k�� : �: In ca�laeration ot f.he payment ot a ree ot $- 30.0�1.� �t is hezeby gi�aat�d �" � _...._ to c�oastntet the building o� additiaar as d�bed a�bove. �9iis i�t ; � the exPreas oonciitipn that thep�on to whom it is graated and his age�t� em a��. '�: ,��. � � dane in, araund and upan said building, or an�► thereof, shall �aontos�m in�ra�teb io 'E�eM' �Di,"-' ,. FridleY� Minaeaota regarding locatioa� aa��itx� alteratloa, main�nanoe, rePeir �Iad � ol' wiw�� diy limits and this permit may be reva�ed at anY tinae upon violat[an o! a�y o! 1� �. `" ; �_ ��. i � Cls�rq�e� �a�i�l� - . , NOTICE: "� 1'Ids p�neit deu not eowr 1h. con�IweHae, 6�tltes �e. wMno. P� N� �Mwlw saww� �r twal�e. M+iM�.i��f�N1 `' fM bYiW1aY �mp�er hr aparah p�nMhs fe� fMs� Nw, ti. z ' ' , � � �;. � � °�_ r _ � ;. � � t z . , . . . ' � - .. c�}-'�,�'� � � . . . � � � � . � ' . * _? �. . . � � � � . . � . � . . . : _ �. .u�t.� :.a,s..�.r..i.��,.i. _ . . . . / i �, AFP.�ICATIOPt FOR BUII.DIATG pERMIT CITY OF FRIDLEY, MINNESQTA .. . . . . .. - . A ota�x �s t�ar� �� z z�'�% Z�.��C B'`,,.j�nER %� (1 ��2�� i� ��CP_'. ADDRES� �— _ , ____ � /'7 �lif l �raL711iV.+a7a�— N / � . 1 ' i-�"y'— / � . . �JVY�Z. �"� Z�1/�� ....._. � . "��'� . .. .� .. �+Q��ll�i'ION OF BiTT�LDING � �� J`�� " — l. l �/ �l ..1�5�g . ; _ . � .:p�� ' ST�EET` .. ��. �� ° . s �� 1+��4;.k � . LOT��_�LO�CR__. � ADDL�IpN OR, SUBD�VISION � ''� �.-n �„� � �. CORNER LOT� �'� ' IhSIDE LOfiT�_SETBACK . SIDEYARD : - SEi�1ER ELEVATION � �� --.._.____,_._..,,_,_„_TOP OF F04TING Applicant attach to this form Two Certificates of Surveq of Lot aad proposed building.iocatioa drawn,,on thes� C.ertificates.. ' ' ' ` DESCRIPTION AF BITILDI� ° . � •To Be Used As: � � - ` � � � . . . , • ��: . "� � c "� L Front1, j -- Depth��r /..r� � fleight�-- ,� ti-��/ .. .. � _ � n .+II/I� . � � .4 L�(�I" ^ rr�r.�� . . . /� {% // . Squar feet_,(.� �' O. �` � -�bi�''F�et . � Froat � Depth Height_, . . . ----_ ` � . ' Square feet_ Cubi;c Peet . . TYP� of Construction �+:�Estimated Cost':` " �-� � � To Be Completed �,r r �.�� / i � / � --�^_ The andersigaed hereby makes appiicatioa for a k specified, agreeing to do ail work in strict accordance withethe Citqrof� Fridley Ordiaances aad rulings of the Department of Buildiags, and hereby declares thaC all the facts attd represe ioas stated in thi are true and correct. pplic tioa ��C� �- ��.-� > /� � DATE ��1'�'� '.1�0 SIGNATURE � � - L!%�! �� _ . � (Schedule of Fee Costs can be fou�$ the Reverse Side). �. �' ti _' ` . " �"� r � .st,� � � c.., ��. � r�, � 0 4�. ,ti� . <<. �� t""` ! � � �UIiDING PERMIT �EE SCHEDULE 'S��GTION 2. �he Inbpectbr of Bui�ciings shall, befor.e ;�uing permits for Che erectinn af �ny building aY ��ructure, or for any ad,�ii�-ion to any e�tisting structure or building, �oi� for anX air_�,�tion dr �e�fairs to �ny existing building or structure; upon ap�,licati.on therefore, require the the pay�ent by the appZicant for such permit of fees to the amount herein below set fosth and in the manner herin provided to-wiC; . $n�forin Building Code: Type 1, 2, fx 4- $1.75 for each one thousand cubie feet, or fractio� thereof, in suc�i cubical contents. Type 3& 5-$1.50 for each one thousand cubic feet. For.the purpose of cumputing £ees fo� building permits, the cubical contents of any building or addit.ion to a uniform height throughout by multiplyin,g the ground area covex�ed fram a point six (6) inches below Che floo� 2ine of Che basement or the celZar to the average height of the upper surface or t� the average height of the roof surface of the �nain gabl.e of a pitched roof. F�r repairs or a1C�rations �o an existi�g struc.ture, the fee shall be at the rate of $3.00 per e��ch fis►e hundred dollars ($500.00) or fractioce thereof in the cost �f a11'proposed work, In no case shall the fee charged for-any permit as set forth in Section 2 be less than $5.00. NS$S�1 t,� n�ction Charges based orL locafii�n- Area 1 or 2. � � . x _ � City of Fridley Application for Plumbing and Gas Fitting Permrt Dept. of Bldqs. Phone 560-3450 DESCRIPTION OF WORK y�hoa ,L�-, �- � �_,._.,,_,,� F/� Number, Kind and Locaiion of Fixtures . y�`;'�` � I H � � F=- m Z 1� = y Z 7 � ; � �� 7 � 3� o° Base lst � 2nd ? � � 3rd 4th _ _ _ • Fu2ure Coaaection Openiags * New Fixture, Old Openi:►gs � .a� � Z u Z Q S W Z � U' Z � gotg7<3U7'°i7U'K7U'O Z PARTIAL RATE SCHEDULE WATER HTR. • s F N GAS EIEC. 3ewer � Cesspool n PLIIMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures . . . . . . . . . . . . . . . . . . . . . � L� x $2.00 $ �� G •`� Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening . . . . . . . . . . . . . . x $1.50 $ Catch Basin ..... .......'... ... x $3.25 $ Water Fieater (Up to 99,000 BT[n . . . . . . x $3.00 $ New Ground Run Old Bldg. . . . . . . . . . x $3.25 $ Electric Water Heater , „L z$2,pp 3�� ' GAS FITTING FEES: NO. RATE TOTAL lst 3 Fixtures .......................... x $2.00 $ Additional Fixtures .................... x $ .75 � Gas Range to 199,000 BTU . . . . . . . . . . . . . . x $5.00 � REPAIRS 8c ALTERATIONS—Rafer !o Code Description ................................................� / LVIAJJI'r•n• � C��r{f V City of Fridley: The undersigned hereby makes application for a permit for the work herei spec i f ie d, agreeing to do a ll wor k in strict accor dance wit h the City Or dinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Minn �'' � ? ` �' 9 , 19— Owner `. 1�,-�^�?�'1.�'✓i'-. Kind of Building . /"�` - `'�"� . � Used as To be completed about � �---�' � � `` � � Estimated Cost, $ Old ew. uilding Permit No �� Permit No. �� Signe i.�r�n=w-� �`_ , �-� B �� -. Y Business Phone No. � �� ROUGH FINAL �42 �1 ��o�� CItY OF FRIDLEY INSPECTION DIV. 64��1 University Ave NE Effective On January 1, 1991 Fridley, MN 55432 APPLICATIaN F��R POWER PLANTS AND HEATING, COOLING, VENTILA"�ION� 572-3604 REFRIGERATIO`� AND AIR CONDITION� S'fSTEMS AND DEVICES RATE SCHEDUL� Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace Gas Piping (N�eded with new furnace) Gas Range Gas Dryer ' Air Conditioning - All Sizes R�ite TOTAL $ 20. �0 � S 10.00 S $ 10.00 S �� 10.00 $ � 10.00 a �� Od All Others/Repairs 8 Alterations (LIST ON BACK) 1% of Value of Appliance or Work Comme�ciaUlndust�ial 19b of Value of Appliance or Work State Surcharge TOTAL FEE J()B ADDRESS�S.3 �� iEDCi� The �ndersigned hereby makes application for a permit for the work h�3rein specified agreeing to do all work in strict accordance with the city c;odes and ruting of the Buildiiig Division, and hereby declares that all the facts and representati�ms stated in this applic tion are tnue and correct. � �199; OWNER �r�� D� �,�d�, BUILDING USED AS G'�G!y.GG ESTIMATED COST d4�d�� PERMIT NO. =�-L� DESCRIPTION OF FURNACE AND OR BURNER a No. of Heating Units Circle One (Steam) (Hot Water) (Warm Ai�) T�ade Name Size No. BTU HP EDR � Fuel Total Connected load � .50— a 16.so MINIMUM FEE FOR ANY HEATING/COOLINGIVENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS 515.00 PLUS THE 5.50 STATE SURCHARGE REINSPECTION FEE a30.00 "Air Conditioners can not be piaced in a side yard without written permission from adjoining property owner. Burner Trade Name Size No. BTU HP EDR HfEATING COMPANY v E D!� V V� C f� ..,.:i� �ir i'.0 . 8910 �Nr'NTb':,:�;iN �'dE. S0. ��igned By MINNEAPt�,ry�y, 55420 881-9000 Approved By ��I Rough-in Date Final Data�? ��J �-� F�ILL OUT BACK SIDE FOR STACK VERIFICATION ON FIEPLACEMENT FURNACE sue�ecr PERMIT NO. c�ty of Fridley �.,._---� AT THE TOP OF THE TWINS g U I L D I N G P E R M I T l i � .�I PT.. • � � COMMUNITY DEVEIOPMENT DIV. r � � � PROTECTIVE INSPECTION SEC. �� 7� � � � . � � � �'�'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY �""�' ,'' 612-571-3450 910-F15 5/26/94 � � JOB ADDRESS 1553 Berne Roa t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 � 1 I SHEET 2 PROPERTY OWNER MAIL AODRESS 2�P PHONE E. Weatherman & T Eich 571-238 3 CONTRACTOR MAIL A�DRESS Z�P PHONE UCENSE NO. Sawhorse Builders 4740 42 Ave 533-0352 2382 4 ARCHITECT Oli DESIGNER MAIL AODRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL AODRESS Z�P PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE X 8 DESCRIBE WORK Construct a 15' x 8' Addition to Dwellin 9 CHANGE QF USE FROM TO STIPULATIONS See notations on plan. WARNI�lG SEPARATE PERMITS REQtJIRED FOR Befare digging call for WIR{I��, H�A1 fiV�, F��iuii�% R�u� 51GNS. all utility locations 454-0002 REQUlRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTR�CAL, PIUMBING, HEATING, VENTI�ATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WOFiK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOF A PERIOD OF 120 OAVS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTFEET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOYERNING 7HIS TYPE OF WORK WILL BE COMPLIED $33,523 �IC). %C WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAI LAW REGULATING CON- ��lO.SO Fire SC $33.52 TRUCTION OR THE P RfOR ANCE OF CONSTRUCTION. PLAN CNECK FEE TOTAL FEE S 2(o q License SC $5.00 $365.78 s� Naruae,oFCO ;a oa AUTMOA�ZEDAGEN? ronre� HE PER�Y VALIDA7E0 THIS IS YOUR PERMIT SiGNATURE OF OWNER iIF OWNER BUILOEPi �DATEI BLDG � qATE NEW [ ] ADDN � ALTER [ ] CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Effective 1/1/93 �g�� Construction Address: � SS3 $�� D � �t21D � t�r� � S .� ��--� Legal Description: ,�Owner Name & Address: �� (,t.��l�'�1�;--�1�.� �T ��c-l��-,�..� Tel. # �I l�-�83 f,*3, ,,;, �' ontractor: �'�� %��R-� . MN LICENSE # Z'3 f32-- �Address: � "1 � c� -- �Z`� � /�O�T� �a88,�s�AtE' ,1'�J �S`��Z Tel. # �`33 'b3 S�2 Attach to this applicadon, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT L[VING AREA: Length f5 �� Width � r Hei ht j' !� S Ft. �Z�`� �.- g ? �' �- GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: �'�i�,�-.�L`� P-�xn--. � ►-�PP-c�li.�n.�.��-r� Corner Lot [) Inside Lot ,� Ft. Yd Setback Type of Gpnstruction: Approx. Completion Date: � 1 A U� `�q°1 � Driveway Curb Cut Width Needed: Ft. + 6 Ft = ` Side Yard Setbacks Estimated Cost: $ ��i� s`I'jd° -T (Cost on Back) Ft x $ _ $ DATE: � j q� APPLICANT: �� •�--cs-a¢�� Tel. 1# �33'��2-- Permit Fee Fire Surcharge State Surcharge SAC Charge �� $ " 3.. � �`�-b-�-� � License Surcharge $_ s', � Driveway Escrow $ CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation ° $750 per SAC Unit $5.00 (State Licenseci Residential Contractors) Alt. "A" or Alt_ "B" Above . Park Fee $ Fee Determineci by Engineering Sewer Main Charge $ Agreement Necessary [] Not Necessary [] �i TOTAL � _ ��.� �� STIPULATIONS: .. �. CITY O� FRIDLEY iNSPEC7EQN DIV, 6431 University Ave NE Fric4ley, MN 55432 572-3604 i� � Effective On January 1, 1993 r� �`�� APPLtCA71QM FQR POWER PLANTS AND H�ATING, COOLING, VENTIl.ATION, REFRlGERATtON AND AIA CONQITIUNING SYSTEMS ANp QEViCES Residential Fumace Shell and Duct Work, Burner — Also Replacement Furnace Ca�1n ( ace) Gas Range � �� Gas Dryer *Air Conditioning — Ail Sizes All Others/Repafrs 8� Afterations (LIST ON BAC}� 1�0 of Value of Appl�ance or Work Commerciall� ndustrial 1% of Value oi Appliance or Work Rate 70TAL $ 20.00 $ $ 10,00 $ i G' �J $ 10.00 $ 10,00 $ 10,0� State Surcharge TOTAt, FEE J�B AQDRESS_,S._S 3 �—��'Q ��" �1 The undersigned hereby makes application for a permit for the work herein specifled agreeing to do all work in strict accordance with the City Codes and rulings of the Building Division, and hereby declares that atl the facts and representations stated in this application are true and correc , � -�lC� _,19��, OWNER /Lc�� ° BUILDING USED AS $ / ESTIMATED C05T F�G� (� � PERMIT NO. //.� e`%`� $ � $ �_.__.._:.� '�v MINIMUM FEE FOR ANY HEATtNG COOIING(VENTILAi'ION REFRtGERATiONlAiR CONDtTtONING PERMf'f tS �15A0 PLUS THE 5.50 STATE SUfiCHARGE � REINSPECTION FEE $30.00 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner, � � L ; � � � � QESCRIP710N OF FURNACE AND �R BURNER Na. of Heating Units Circle One (Steam} (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Burner 1'rade Name Size No. BTU HP EDR MEATING COMPANY � � � Signed 8y Tel No. �-��-3 �—�� g 1 Co l�- /-�j a- -�.✓ Gc.-�,� C�2�h��c./ � S y 2 Z A p proved B 1')�___._^. Rau gh—I n D a t e i n a l D a t e � 1� � � F1LL OUT BACK SIDE FOR STACK VERIFICATION ON ; REPLAC�MENT FURNACE i�� ? f�'��,�' CHIMNEY AND STACR VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes ( j No () 2. Is free from rust or deterioration Yes ( j No () 3. Has no foreign objects lodged within Yes () No () 4. Is securely supported Yes O No O 5. Meets all current Code requirements for size and total BTU's connected Yes () No () 6. Has total heating BTU's of All other BTU's TOTAL BTU's Remarks List Alterations Beinq Done: 0 HEATING COMPANY Signed By Date �,i i Y Vt' rl"11UL�T IIV.7F"Cl. I IVIV UIV. 6431 University Ave NE Fridley, MN 55432 572-3604 �neaive �n �anuary t, i yy3 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Bas+n Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric NO. RATE TOTAL � $ 7,00 �VO $ 4.00 $ 5,00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7,00 Water Heater - Gas. $10.00 Gas Range � $10.00 � Gas Dryer $10.00 Back Flow Preventer Required (}Yes () No Ty pe $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance State Surcharge TOTAL FEE . ,,.� .,� $ .50 $ � �� JOB ADDRESS �i"j_�j��j �,��n� ��, 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. �Gc,/l G' �D , 199,.•7 Owner �� 7`- '1 � ,—� Gc��. Building Used As-s/� S.�� K,� �° r � Estimated Cost _��pO�j .�j�% PERMIT NO. %I � 1S PLUMBfNG COMPANY J /� n�' i�� L,��-►1 b l tic �C1 SIGNED TEL N0. %%3-,� 7�%G � j �� Approved By �� Rough-In Date Final Date f MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE �� CITY OF FRID�EY INSFECTION DIV. 6431 University Ave NE � �� Fridfey, MN 55432 �� 572-3604 �,� � � � C3 � RATE SCHEDULE APPLICATION FOR POWER PIANTS AND HEATING, COOLINC, VENTIiATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AIdO DEVICES Residential Furnace Shell and Duct Work, 8urner - Aiso Replacement Furnace (Side Vent - Fil( Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning - All Sizes All athers/Repairs & Alterations (LIST ON SACK) 1°0 of Value of Appliance or Work Com mercial/I nd ustria l 1% of Value of Appliance or Work � Rate $ 20.00 $ $ 10.00 $ $ 10.00 $ $ 10.00 $ $ 10.00 $ State Surcharge TOTAL FEE Eifective On January 1, 1993 JOB ADDRESS /�� ,v� ,�c� The undersigned hereby makes appiication for a permit for the work herein TOTAL specified agreeing to do all work in strict accordance wfth the City Codes ar�d rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. __,�� G �� ] 9 9 4 • � .� .. � . , .i BUILDING USED AS ,�.2 S �, ESTIMATED COS7 `7�` Uc� d� PERMIT NO. f>�C;, `� [�ESCRIP710N (3F FURNACE /�,ND OR BURNER $/� w No. of Heating Units Circle One (Steam) {Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR $ Fuei Total Connected Load .50 $�� S� MINIMUM FEE FOR_ANY HEATING(COOi:INGNENTILAT{ON REFRIGERAiIO�AIR COND17lONING PERMIT 1S 15.00 PLUS_THE_ .50 STATE SURCHAfiGE . REINSPECTION FEE $30.00 *Air Canditioners can not be placed in a side yard without written permission from adjoining property owner. Burner Trade Name BTU HP Size No EDR HEATING COMPRNY �a �-,r+PS ��°c�G�i'l��a-l� �f�L Signed By �� Tel No. yv'�/-o`�.y/ 9 Appraved Rough-fn Date Final Date G F1LL OUT BACK SIQE FOR STACK VERIFICATION ON REPLACEMENT FURNACE NOTE: ��1 through ��8 required when using a side vent furnace. CH�IVINEY ANI� STACK VERIFICATION The und�rsigned hereby verifes that the existing chimney ur, stacic: l. Has been carefully examined Yes (} No () 2. Is free from rust or deterioratior� Yes O No O 3. Has no foreign objects lodged vvithin Yes (} No () 4. Is securely supported I'es () No () 5. 0 7. : R�eet�s al� current Cade requirements for size and total BTU's connected Has tocal t�eating BTU's �f Ali other BTU's TCiTAL BTU's �Ias a liner been provid� for water heater � Has combustion air heen provided for water heater Remarks: �st ALTBRAT,�QNS B�ir�� Done: �'� r,a v,� �//� ,� UG ��'� G� /'TeL'�T �i'c� N S HEATiNG CQ: Signed By: D�r�: 0 - �!.�;y � Yes { } No ( } Yes()No(} Yes ( ) No ( ) «