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AF - 43497CITY 0� FRIDLEY A?PLICAZIO�t FOR Pt.l.i�3ING AKn u/�S �ITTING QEc'�1IT i m � N ro o • k d water i e� � m m R s�+ c� �n q � C, k, � Heater ( � t� .� � c� H-.� �s fa tn ro la o. �tl , -� ,:-t U G ^ �.-�i � ^ C C CJ � }+ .0 � 8 C� � LG f.i C ltJ1 p +t :J N �� N'� 7 O O �'11 N N 41 N N ,C � . �: .� � � •.+ ro s+ o ,c ., ro ro a �c ro -� � " as lec v: U D rr, � m 3 o t+. cn k� U q K 3 t7 �; C7 O 1- f j 1� j � _ �5= � 1 � � ( 2 :d ' 'r, ( � �,�'i( � t�-' (�; _�ture Coruiec�ion Oper.ing Connected with Sewer ;*) = New Fixture, Old Opening Water PAR?IAL RATE SCHEDULE ?L'J:;BI�tG FIXTURi RATES "`,z:.ber Fixtttres ra*ure F:xture Opening =:e•a Fixture, Old Opening Catch Basin riater xeater - to 9�9,000 BTU 100,000 B'SU to 199,000 BTU *aater Softener 27e•,, Ground 13in 01d Buildinq �iectric Water Heater G:S FITTI\G FEES: ist 3 fixtuzes additional Fix tures Gss Rar:ge to 199, Q00 BTU �PAIRS �, ALTERATIONS Fizst 5100.00 each add. 5100.00 or fraction N0. � x 3 X x x �_ x x x x x RATE S3.Q0 $2•00 $2.00 $5.00 $5.00 $10.00 $7.00 $5.00 S5.00 � x $3,00 x 51.00 x $�:0. 00 $S.OQ 52.00 State Surcharge TOT71L FEE REZNSPECTION FEE ($10.Q0) TOTAL $ �1, D �� s 6. oc� S $ S .dC� S $ $ $ $ �6 S S $ S $ .50 S �- � Job Address �`�1? � � ��19+� � �anl' � �y�-C � Department of Buildings City oP rridley Tel. #�71-3450 The underszgned hereby makes apnlication for a permit for the Work hesein speci..fied aqreeing to do all work in strict accordance with the City Codes and rulings of the Department of Bui2dinqs, and hereby dec2az=s that a13 t}ie facts atid representations stated in this upplication are true and correct ��` , /'?A �, Fridley. Mn. � ul ��_, � , I9 n / OWN�R ` � KIND OF BUILDING �� /rr� r USED AS j G � S TO BE COMPLETED A$ODT l] ��'� �� ESTIMATED COST t,� �' e' �'� , OLD - ATEW BUILDING PERMIT NO. PERMIT N0. �ip(�') CompanY r S y` � i� � �/f Signed By ` cb...� Tel . No � 0 � �- � � �f Q ROUGA INSP. Date FINAL INSP. I� "! �-�� Date APPROVAL FOR PERMIT ��—+�-- N.INIMUM FEE FOR A.,IY PLUMBZNG PERMIT IS S7.50 pyUS $.50 STATE SURCHARGE SUBJECT PER . c�ty of Fridley 16 213 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � r � � , � R O. � �L __�__ COMMUNITY DEVELOPMENT DIV. � �3 (� r � � PROTECTIVE INSPECTION SEC. O � � � , ��1 � CITY HALL FRIDIEY 55432 NUMBER REV. OATE PAGE OF APPROVED BV �"""'� � ,�� 612-571-3450 910-F15 6/1/81 / / JOB ADDRESS '7560 Bxigadaon Place N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. �j 2 B�.OICIU2Y'�J ES.'tcl'teS: SHEET 2 PROPERTY OWNER MAIL ADORESS ZIP PHONE Garjac Inc. 481 - 2Q.6th. Avenue N.E. , Cedar, NIl�T 55011 434-7096 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 AFCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ��Rq�� p�R��S�'PR��UikED FORICENSENO. 6 USE OF BUIIDING � A�Q SI�� Res iden ti_al 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE � REMOVE X 8 DESCRIBE WORK Construct a 36` x 44' Dwelling and a 24' x 24' Garage Befae di j TELEPHONE - ELECtRIC - � ��, 9 CHANGE OF USE FROM TO �iA�' rr STIPULATIONS provide a ha.rd surface driveway. Provide Ci.ty with copy of verifying survey before capping. Provide sod in the fxont and side yards. SEWER LOCATION: 102' N. of M.H:. (_Inv. 8�5.39) Wye elev: 895.35 TOP OF FOOTING: �xpose Hzye prior to establishing top of footing elevation. WATER IACATTON: Approx. 1Q' �outh o� Sewer Service DRIVEWAY DEPRESSIDN: Existing curb cut on north side of lot. stiE CltY OF FRIDlEIf DOfS NOT Gt1ARANiB� t��i. �� F� A� < 1N5PECT10N$„ �ICCURAC� 0� UTtI►TY 1AC�►npNS Al�C ELEVAriC��:. �� ( tions ot �tt tradea �i1fS tI�AATA IS tG� INFC>RMA1tON Pt?RPmSiS QWIY AN:7 �� '�Cif.`if l�Ri�Oli6 � E 6NOU1� YE[R!Y iH6 ��IK�MiAiW�i �. +��li TfR �ItK TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDlTIONING. TATOOCI Fr�ltR2 THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SO. 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 ! 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 ORD�NANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED 59,580 $29.HO WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIO OF ANY OTHER STATE OR IOCAL LAW REGULATING CON- 11H. %H $425.00 STRUCTIO OR THE PERFORMANCE F CONSTRUCTION. $ P�AN CHECKFEE TOTAIFEE � $29.70 $603.28 SiG uaEOF NTRACTORORA 7N ¢EDnGENi IDATEI ��WHEN PFOPERLY VALIDATED THIS IS YOUR PERMIT � � .�.� s � Q-�,fC./ `�� 1 Y� SiGNATUREOFOWNERUFOWNERBUILDER� �DATEI BLDG iNSP riA E f y . � dtdf�E(Z: _ /IDDRfSS: Tcl. r;o: 0 CITY 0� FiZIDI_CY � � • �{rr�.IC:n-rl�.� r-�orz r;f:SIUEi�dTIlO�_ f3UILDIilG f'�f��iI'(5 ((Jet�r, A1l:eraLi�ns, /tdditi�ns, or Rc�airs) 0 �I . >+�/" , �UILDEi'.: ��C llv� ' _ /1UURCSS: �/� I oZc�(� � f�✓�e NI�, 7EL I�O: Y3 �� '% �� Consi:ruction Location ' sxz�L�,rlo: �� s2��i�}:T: �%� i�/I4� OG N Q�/iL-P ♦ Lo��: ,S� �LOC:�c : � �nz�rza� : %�' �. o o rl h �,� q i sT�r^{�' �7 , Corner Lot: � Insicle LoL: v SetbacY: 3.� Sideyards: /O -f- � Ap�licant ati:ach to i.his form f_cti�o Certificates of: Suxvey of lot and prop�sed building location clrawn on ceztificates to scale. DESCRIPTIOi� or- co�•1STRUCI"IOPd - ---- � _�t�(YS � I'ront: �� ____ Depth: �"I Y Iieight: 8 Squa�e. l eet: a� �v Cl�Uic Feet: . �A2AC� �' k roi�t: --- � �f � �pth: � � � Heiglit: / � ' Squai:e- I'eet: Cubic I'eet: Ty�e of Co_�struction : �^�C�� '� xU $e �r,�pleted: �� Proposed Drivc�aay �vidth Tf New Opening Is Des:ired: Esi.imai.ed Cost: $ � �� . �j- Alt. A Alt. B $ ` S�� Rc^�VERS�' SID� OF SHEET 7:ile undei: signed liei°eby :n�};e� appli.c��ticn ior a perntit £cr the �:nrk he.rein specified, A.C�YC�1,i7� to c?o ,all wor}; in sZrict accor<lunce ��rith the City of I'ridley Ordinances �nd xulings of L-lie DeZ�artntent. of 73t1il.clit7gs, and hereby c�eclares tiiat all tl�e �'act-s and x'cpresc� t;iticns statecl wii this application are t ue anc3 corzect. n.�mr: S�- �. g— g � sxcNn�r�z:�,: � St:i��ulations : �"� � � 8.i�i P•t. Zq,�d � �c• �5.� � �, �� So�- u �s' a d . � `..---.�-- . s�/ ^� � C�-a - `r � ��•sc.s'�s � �nn's •� ,c J,'b x ZJ'c�r9,y =�. h '� E x m � 2� �� _..__.-� �o • (, � �-°'�� ` Z Z ' �a �o'�zh �S o� 'b� �' � �ay '4� • �� a� � �� ;�.� � �d x�•s�� = �, �� 5��5 � -��LS � ��x so1 '� I '��S = �� x�� = � � � �,g�.l oF�' � T� � a( �h�� y �� Z ' �,�� y�a � � �h'Q98{,, =�' � x 8Z �G = 8 x � 1 y y�2, = h � �c r�l �. �7 = sz x �Z � vc� �1 �y�1 ��SG �� . . . � �urv��ors Certificr�t� � � COMSTOCI� & DAVIS, INC. � Consulting Engiueers and Laud Surveyors 1446 County Road J, Minneapolis, NiN 55432, (612) 784-9346 . SURi7EY FO?Z: B & G Investments 961 Hill�aind Road Fridley, Minnesota 55432 ' ` � � . - c.'� I . . � � N BS° 59'S3"� W 137.lO' i � Zs _ a O�� '.�'' p cWi , � � a x � ~ � Q . � � la d I � � �„ � 10' I . � T ' ♦ /�� r � '�-� ; ;� LD �� = � ►o�:w z - N �� ,a, ;, i � o • . o �� - ;; o q . � �tl i a `�� ° . � � � o � a i � r�v 2 Q� � I � . 588° 59'S3'" W /37,08� � � J `�' , 1 �t . `� 7 . �DESCRTpTION Lot 5, B1ock 2, Blomberg Estates, City of Fridley, Anoka County, Minnesota. SCALE: 1�� _ 40 : / O Denotes 1/2" diameter iron pipe monument set and canped No. 10832. I hereby certify that this survey, plan or report was prepared by me or under my direct supervision and that I am a duly Registered Land Surveyor under the laws of the State of Minnesota. ,. � � ; Y � 10832 I3ov. 17. 1980 4278 9 Reg. No. � Date° Job No. Book Na � � �c? � (� � ____._. ._-------- � � I� � �/ . �' � �_ � �/� ��:� /� � G� /�'( , �, � �� , �_ ��, 35 C,L, �-� �� , �U �`� �� f ��c_ . // ; , � � �G. - ��- � �=- x� -�� s �r��-� s�+ �ti�- �z�� %��- r ��,� :r�� J � � �C t,��a� ,�G-' L;;�.- �� , � �%' i O ,� �� ,� , 1 `/� r �> �,� , �G=� � � �� _ � ��i c: i iK� �r- L�. �� f.� ��' i.,�l � �2 �g � l�l C � � �l�L� .�� 1��ss;�>�,/ �ti �,e�-r� C�r� � f SUBJECT • \ City of Fridley 2 0 7 8 2 AT THE TOP OF THE TWINS g � I L D I N G P E R M I T r � � • � �• COMMUNITY DEVELOPMENT DIV. � �+ �-, � ; .: ----- � � I E � r � � PFiOTECTIVE INSPECTION SEC. ' � �'�'1 � GTY HALL FfiIDLE� 55432 NUMBEH REV. OATE PAGE OF APPROVED BY �""�� J 612-571-3450 910-F15 4/24/91 / / JOB ADDRESS �560 Brigadoon Place NE t LEGAL �OT NO. BLOCK TRACT OF ADDITION SEE ATTACHEO DESCR. �J 2 BIOTCtF?6Y�J EStd't@S SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gary/Gail Brisbin 756Q Brigadoon P1ace NE 784-4469 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO. Same 4 ARCHITECT OR DESiGNER MAIL ADDiiESS ZIP PHONE LICENSE NO. 5 ENGtNEER MAI� ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Res.idential 7 CLASS OF WORK ❑ NEW � ADDITION ❑ ALTERATION O REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Remove existing 132 s� deck and construct a 410 s� deck 9 CHANGE OF USE FROM TO STIPUTATIONS See notations on plan SEPARATE PF^��iT� Rr,+�!,�iRED F�R WIR�f�G, N�,�1i�E�`�;:, ��.�-�i:;v�N� AND SlC3�1�,, WAR�ING � � Before digging caN fot ��EPARATE PF��,4�TS REQUIRED FOR ail utility iocations WfR�NG, NE�-1Tt�su, i�'�.lJ;1�BING AND SIGNS. 454•0002 REQUIRED BY LA� TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHOfiIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED Ofi ABANDONED FOR A PERIOD OF 120 OAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CER7IFV THAT I HAVE REAO AND EXAMINED THIS APPLICAT�ON 1 STALIS GARAGES AND KNOW THE SAME TO BE TqUE AND CORRECT. ALL PROVISIONS OF LAWS VAIUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLtED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S3 ►�-OO. $�., SS DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE Of; CANCEI THE pERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCA� LAW REGULATING coN- 63.OQ Fire SC $3.ZO S7RUC710N OR 7HE PERFORMANCE OF CONS?RUC710N. $ PLAN CHECK FEE TOTAL FEE 7,65 SI ATU CON'AACT� ORAUTHOA�ZEDAGENT IDATEI yyH � pROPERLY V D I IS YO�RMIT � ��— �� M r - NA7UFlE OF OWNEA i�F OWNER BU�LDEA� DATEI INSP �aT � � ] ADI�T [�(] ALTIIt [�(] 1�1 AND 1�2 Buildirg Perimit Applicati� Effective 1/1/91 COTIS�S11Ctladl AdClY'�2S.S: � �j �� i'� `4�>�Ol� /�/ �ic� l F' � � j'i`GG�lc°% �ECj'dl D2SCr'1�04'1 S �� ` / 3 �iz r.l' Z ��/ /!'/ � 1'rda �.�` ��.! �CS Owt�er Name & A�ddzess: ��r,� � ��,� / ,C/ris6, e, Z�e1. #��'`/- ��/�2 e � aoritractor: d�� rf � -- � • # Acldress: /z�� I�tVIIaG AR�: C�ARAGE AR�: DELRC ARF�►: O�R: Attach to this applicati�, a Oertificate of SuYVey of the lat, with the pro�oEed ooaLStn�ctioaz drawn oaz it to scale. � I�et�gth Lex�th T�i2e��/F' ��r,"5%��, Width Width Width �� .�- � �• •.. � � �:� Iieight Sq. Ft. iieic�lt Sq. Ft. �/� �. F't. , �-. . . �1-z n �, � 3 z�� yio �( 7, �G =1 Q4�i.t.� tbrner L�t [] Inside Iat ['] Ft. Yd Setback Side Yard SetbacJcs Z�p2 Of ConStivCtl�1: �rP��r°e� �/"��n�, ��r �rr��F�'t]li��d Oost: $ �� i! V Ap�rox. Caat�letion Date: 3m � , Proposed Driveway Width If New Openir�g Is Desired: Ft. $ $ � Width + 6' See BacJc Page I]ATE: � 7�/` % APP`LICANr: ��- oz�-'�--�. Tel. •#%�`� -�/ L�� 9 % . �;S��i-SS 3�/ Permit Fee Fire Surcharge State Surcharge SAC C�arge Driveway ��tiw Park Fee sewer r�ain cxlarge . �• $ � s tu $ ' ��A�1►� CIR'Y DSE �Y Fee Sc�edule oaz Reverse Side .00l x Pexmit valuation (1/lotn �) S.5o/Sl,OOO valuation $650 per SAC Unit Alt. "A" or Alt. "B" �1Uove Fee Determined by E�gir�eerir�g �� N�Y [ J xot x�ssazY [ J "��b4 '3-� �-- y�10t� �� ,c, � .. ' � _ �. . . � . j �', . . .. . . . '__..' .. .... ... ... . . ..._ .. .__ ...__ _.: . .... . �. � . . . ._. ' . _.._. .. . . . . . . _.. . '. 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" ' I��.1. p i � 6 . ! l� K !I , _i �� .� '''' r . � w. b..�.� t�-t T� 3oi --�"r+"'� � ~� �� ..�.....�.��.Y... ,►> . _ , � �—�., G � � �v� � N �� l2 L a � rv.s;a� / ._r �a ;_y; sue�ecr P • City of Fridley 2 6 6 5 5 AT THE TOP OF THE TWINS g � I L D I N G P E R M I T r � � . � �` ____ COMMUNITY DEVELOPMENT OIV. )�f� r � ti � PROTECTNE INSPECTION SEC. !� � � � /"'1 � CITY HA�� FRIDLEV 55132 NUMBEp REV DATE PAGE OF APPPOVEO BV �""�"� ��' 612-571-3450 9t 0-Ft 5 7/ 16 / 98 � � J08 ADDRESS �560 Brigadoon Place 1 LEGAL ��T NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 2 Blomberg Estates SHEEt 2 PROPERTY OWNER MAIL ADDfiESS 21P PHONE Gail Brisbin 784-4469 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Midwest Sidin -- Roofin 18979 Gladestone Blvd Ma le Grove MN 55311 20010277 4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PMONE LICENSE NO. 5 ENGtNEER MA{L ADDRESS 21P PMONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION �I REPAIR O MOVE O REMOVE 8 bESCRIBE WORK Reroof house and ara e(32 S) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPAfiATE PERMITS ARE REOUIRED FOR EIECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. fT. CU. FT. 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 AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING t HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUfiTAX WI H WRHE'THER SPECOIF EDNHEREIN'Of: NOTOTHE GRANTING OF AO ERMIOT $2668 �1 .33 DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T fEE SAC CMARGE P ONS OF ANY OTHER STATE OR LOCAL LAW FEGUTATING CON- $74.75 Fire SC �2.66 S UCT N OR THE PERFORMANCE OF C NSTRUCTION / PLAN CHECK FEE T L FEE � 7/ l6 � License $5. 83.74 S�GNATUAEOFCON'RACTOAOAAUTHOR�ZEDAGENT IDA EI N ROP Y VAL D THIS IS UR PERMIT �� SiGN/+TUREOfOWNER�iFOWNERBUIIDER� IDAtE� � g� INSP �1P1E NEW ADDN ALTER [l [l Ll CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: �S � � %�e�', r b � �Oa� � �" �Q' � e Effective 1 / 1 /98 Legal Description: n Tel. # 7�f� t`�� Owner Name & Address: (� � � f �j � � ' S �J r /v Contractor: �7� �j,u� S �'. � � ��yi � � (�ao �, yi � _ _ MN LICENSE # a 4G�0�'� Address: /�l7 1 � 14�� s� ��1��. �� c�, d�� Tel. # y/� -�l��J � Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IMPROVEMENT Length Width Length Width Length Width � � Height Height Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: �� s � j- - o�� Estimated Cost: $�� G U��' �' �^ ' (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: 7_% -I c� APPLICANT: V--� � Tel. #�ll� ^��f` Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ �`-�.'7� $ � �� $ %-.�� CITY USE ONLY 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) $ $ $ $ $ C��-`)` Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE Residential APPUCATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Furnace Shel! and Duct Work, Burner – Also Replacement Furnace (Side Vent – Fill Out Back) Gas Piping (Needed with new furnace) � ��S �� Gas Range Gas Dryer *Air Conditioning – All Sizes All Others/Repairs & Afterations (LIST ON BAC� 1% of Value of Appliance or Work Commercial/I ndustrial 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $ $10.00 $ $10.00 $ $10.00 $ $ 25.00 $ $ $ State Surcharge TOTAL FEE $ .50 � ` �� MINIMUM FEE FOR ANY HEATlNG/COOLING/VENTlLATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. ..—_ _ Effective On January 1� t sse JOB ADDRESS �S � � � `� � �' ��U � � ��` The undersigned hereby makes application for a pe�rnit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Building Divisior�, and hereby declares that all the facts and representations sta#ed in this application are true and correct. ��' �-� ,1998 OWNER lp /�'"iZ �/° �/� l S i� I/�/ BUILDING USED AS ESTIMATED COST %✓ � ll PERMIT N0. �� 3 DESCRIPTION OF FURNACE AND OR BURNER No. of Heating U its ( Circle One (Steam) (Hot Water) arm Air Trade Name /�� Lv� Size No. �- BTU=j d d(�p HP EDR Fuel Total Connected Load Burner Trade Name Size No. BTU HP EDR �l f'�11 te�r� �fJ��'ic� HEATING COMPANY /'"C � �J /l� �r°'�7�" �?�fL. Signed By � � � Tel No. Approved By J��2� Rough–In Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Final Date � � � � : ��a� CITY UF FRIDLEY INSPECTlON DIViSlON 6431 University Ave NE � Fridley, MN 55432 APPLICATION FOR POWER PLANT5 AND HEATING, COOLING, VENTILATION� (763} 572•3604 REFRIGERATiON AND AIR CONDITIONING SYSTEMS AND DEVtCE5 RATE�SCWEDULE Residential Furnace Shel) and Duct Wnrk, Burner - Also Replacement Furnace � (Side Vent = Fill Out Back) Gas Piping (Needed with new furnace, but not repl�cement) Gas Range Gas Dryer *Air Conditioning - All Sizes All ��thers/Repairs & Alterations (LIST ON BACK) 1% of Value of AppJiance or Work Commercial/Industrial 1.25%ti of Value of Appliance or Work � Rate TOTAC $ 30.00 $�� $ 10.00 $ $ 10.00 $ $ 10.00 $ $25.00 $c�.5l�d $ $ State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION �tEFRIGEFiATION/AIR CONDtTIONING PERMIT IS $25 00 PLUS THE $.50 STATE SURCHARGE. REINSPECTlON FEE $47,00/Hr I*Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. $ .50 � ��_�r� JOB AI Effective On January 1, 2002 O W N E R_�'�_�.1.�.��lLlZ � BUILDING USED AS��II.O� I�a, (;H, ESTIMATED COST �ID� PERMIT NO.�� DESCRIPTION O�" FURNACE AND OR BURNER No, of Heatin U' � Circ►e One (Steam) (Ho >Water) Warm A'tr Trade Name_ .e%�2�1'��'� Size No� l� JI D BTU_ 9�ODU HI' EDR Fuel �i� Total Connected Load Burn�f Trade Name Size No. � BTU_ HP EDR Tlie 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 aU the facts and representations stated in this application are true and correct. DATE �i��`-�I..� Hcnrinin nn ; . S F, � Approved By � Rough•In Date Final Date �"� �� D� FII.L OUT BACK S(DE FOR STACK VERIFICATION ON REPLACEMENT FURNACE �— �L%d�� - }�� /��ia:�� ' ��d ��'�z/� �.�!�� , THE BELOW MUST BE FiLLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED C(�MM(3N VFNT�VFNT GONNECTnR AND COMBUSTIC)N AIR VERIFlCATInN When r� I�. acing an p�ris ino #�rancP, the undersigned hereby verifies that the . venting has been exarriined and is free from rust, deterioration; obstructions, and is securely supported and firestopped where required. - Yes No (') The venting system is plastiGPVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and te�rnination. 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 Fumace Venting Tables for fan assisted and natural draft appliances. The pY,�rfin8 comhu�t�en air is sized and installed to meet the current codes and manufacturers specifications. Whetl �equired to insiall a new comhuc_tion air�it will be sized and installed to meet the current codes and manufacturer's specifications. Whetl installin� a npw vPntin,4o�ey��, 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 fof 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 { No ) Yes ( No ) Yes ( No ( ) Yes No ( ) Yes ( No ( ) �.. .. .- ... - .��., -� ... -. ...- . . ..��, .. Appliance #1 Type �'� a� BTU Input �!� Fan Assisted or Nat fj' /:j y Appliance #2 Type BTU Input � Fan Assisted or Nat NZ �"' Appliance #3 Type BTU Input Fan Assisted or Nat Tota! App{iances i�, Total Btu Input 1/G O� Common Vent T e • C!�� ,C� yp Vent Height,�-�- Diameter� inches �i Appliance #1 Vent Connector Height a-Y ft Length �ft Diameter �in Type _,�� g Appliance #2 Vent Connectar Height �" ft Length ft Diameter rn Type _�� Appliance #3 Vent Connector Height ft Length ft Diameter �in Type � : � �► �- ■.- HEATING CO: . Signed By: t Date : %d � � Building Inspections 763-572-3604 DATE � - � � " SITE ADDRESS THIS A.PPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR PLUMBING RESIDENTIAL APPLICATION CITY OF FR�DLEY �o � � O OWNER YOUR E-MAIL ADDRESS � , no � Permit No.: Received Date��: ADDRESS: �� a c�ao� P� CITY �i'l C� 1 L° ta STATEM ZIP 554� 3�. PHONE: SUBMIT A COPY OF I STATE LICENSE � VW� EXP DATE \ n� � V 1 ...,rTM �,•....,.r • nr�naoe. ��w =--- D.1 �i1[1ii l�ITV SEDGWICK HEATING & AIR CONDITIONING CO. HEATING 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD .,./a ` C J ' �, ! (! �� ADDRESS OCCUPANT � �! . �� h' � t � �'�6 �—� � _ CITY �� OWNER �—`/,d� �J/Of c�%� SOLD BY �' INSTALLED BY MAKE �G' SERIAL NO. � �g�3 THERMOSTAT � -��,� VALVE �/��y�J"�� LIMIT � XP� � LIMIT SETTING FAN SETTING � >� M p PILOT TYPE ��t� ��'� � C tGNtTION MODEL `-' �� PILOTTIMING /.�tS 4v� � PRESSURE � -� '��C- PERCENT COZ INPUT CFH � � PERCENT OZ _ _ � STACK TEMP. �� PERCENT CO FOfiM 235 (REV. 11/89) SJGNATURE OF APPLICANT_ F.•(/�JN ��'�a� PRINP MODEL 4� � � INPUT v �i VENT SIZE NPE OF LINER / /� LINER SIZE ( � FILTERS: SIZE �/ 4� NUMBER WIRING L )S,��i�SC9/ //e TEST TAG LIGHTlNG INST. DATE TESTED ��,L " � COMPANY TESTING �� NAME OF TEST� FORM DISTRIBUTION: WHITE COPY - JOB FILE YELLOW COPY - CITY � City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 TE -� � I- �� 565 y L