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AF - 43961�° 356 ��a`��C �� .�'' �Ti��C�'9 �i"�HIIIY. �� ' ��' ��e� �� r��.�a��s �> . . . Own2r =>`r-'yc,s'' � .��'z,��.--�C-�° ! M .{ Architect Bu3lder �.�.�' . '`��t �� ;�� :,_:� <,1 .s; � °" I'ri�'_ey, Minn., , 19 "=� L�c TIC�I'� GF' B�TILDING �~-,f f � � ��:�� ""' h �"�� Part of� � r No. �� treet '�"'" , Eiock -��or Sub-Division :� � �'o be used as_ _.�'. _. >� , _ Permit is hereby granted ��i `� �e,�� i a�� .I�s'� ��T�a To be x k �� F ,��.'�� ... f. �� .r �. F ... ll3ar_r�e•r of Con�tr��ction '"'� "�'' — ✓ � ?'" �,~`'` � t` �°� `�Estimate3 Cost� �:" � , d �' —, W . _, , . �� . ,_ ,r �. �,. ; �;: the bt�ilding.�,�t`�-'�A.r �� t''��_s'�''� �;�,,� - Y described in the above statement. This permit is granted upon the e�press condition that the person to whom it is �ranted, and his a.gents, employees and workmen, in all the work done in, around and upon said building, or an;� pa,rt thereof, eha,ll conform in all respects to the ordi- nances of Fridley, ' Minn., regarding the construction;' alter�.tien, maintenanee, repair and movin� of buildfngs within the city limits, and this permit may be revol:ed at a�y time upon violat�on of any of the provisians of said ordinances. , }` �� r , �� /` ' �� pector of Euildin�s. ��R,�EMENT 1-11`3D SVt7Q�,I>i 5�1�3`EI��ENT In consider�,tion of t�ie issue and delivery to me }�y t�e In::�ect�r a.f �uiPdin�s of �'ridley of the above permit, I hereby agree �Q; do the pro�osec� �Wor�� zn ?ce.^r�a.nc� �,ri.�� tY�� description above set fort�a ancl aeeording to the provisions a� t�e ord?.�stinces c�f �°rzc?aey, �,nd, being first duly sworn, I hereby ��ate and say that the facts stated'ay me and co�iained �� tb.e above pe�.°mit 2,re true as therein stated. Subscribed and sworn to Y�efore me at F`i idley, 1! day of--�� .D. 19,� � CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING $YSTEMS AND DEVICES RATE SCHEDULE �ESIDSNiTIAL RATE TOTAL Furnace Shell and Duct Work, Burner S 2�•�� Gas Pipinq $ 10.00 (pipinq needed with new furnace) Gas Range $ 10.U0 Gas Dryer $ 10.00 Air Conditioning (all sizesl $ 10.00 All Others/Repairs and Alterations 18 of Value of Appliance or Work COMMERCIAL/INDUSTRTAT• 18 of Value of Appliance or Work State Surcharge ti��_� � � Reinspection Fee ($15.00) Rough Insp. Date Final Insp. d - �y- � Date � Approval for Permit � MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00 PLUS $.50 STATE SURCHARGE S U C; � $ IC. �U $ $ $ S $ $ .50 $ S �j, � � Attach stack verificati.on fozm with replacement furnace pexmits Effective Aug. 1� 1981 Job Address �� %OCa �� /; �G� ��i� �� Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified aqreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. �/ � , 19� «,,�R S�rr ur /-'� �-�rrv � KIND OF BUILDING S/NGG i3 %��i.�✓i,'�. � USED AS TO BE COMPLETED ABOUT (� ��-yLi"�+S ESTIMATED COST �Q� ��"' OLD - NEW BUILDING PERMIT NO. PERMIT NO. C�l�� DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. � Trade Name (� Size No. Capacity Total Connected Load BURNER - Trade Name Capacity Sq. Ft. EDR BTq HP Kind of Fuel Size No. Sq. Ft. EDR BT[) HP Company �� „ t' L/-� % / (�( / {` I Siqned By (�J to � ��Y��l�l �2�t.7 S�U.l�. Tel. No. � �� ' �"/ /7 � _ U1Y OF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287 March 22, 1990 Steven Flattum 6566 Brookview Drive N.E. Fridley, MN 55432 RE: First Notice of Noncompliance at 6566 Brookview Drive N.E. Dear Flattum: The City of Fridley has established a City Code for the purpose of promoting a pleasant and attractive suburban environment. A recent inspe�tion of the property at 6566 Brookview Drive N.E. revealed that not all Code requirements are presently being met. Listed below is an item which does not comply with the City Code: 1. Observed yellow car without license plates parked on property. Fridley City Code 123 requires that all vehicles must be currently licensed/street operable and kept on a hard surface parking area, or they must be stored in an enclosed strueture. Your prompt attention in correcting this situation would greatly assist us in helping make Fridley a better place to live. An inspection will be conducted on or about April 9, 1990, to determine compliance. If you have questions or would like to discuss this, please contact me at 572-3595. Thank you for your cooperationd Sincerely, Steven Barg Code Enforcement Offieer SB:ls C-90-144 � � W i� �, `t� � �` �,q-0i\ l. LOG1T{ON Of YECL� County Mame A�JOKA Township Nama Township � §TATE OF MINNESOTA DEPARTMENT OF HEALTH �� ABANDONED NELL RECORD � � MINNESOTA UNIQUE WELL N0. �� (leave blenk if n known) Range �� I 3 0 s" I 2: Numerical Street Address and City af Well intersection 566 BROOKVIEW VE W Show exa (in s �-- 1 +i L --� E y .:. 1 Sectfon No. Fraction k k of 4 13 ESWNW or Distance from Road N Sketch map of well locattoe � (F�oa' �, S / � ` � ` W��4 _!-�j � M � 0 2. PROPERTY OWNER'S NAME Mailing Address if different Lhan STLVE � v*oxrty address lndicated above 6566 HROOKVIEW DRIVE �LATTUM RIDLEY, MN. 55432 HARDNESS OF 3. FORMATION lOG tOIOR FORM0.TION FROM TO if not known, iadteate formatton log troa'new well or nearby well. TE� I /SANDST. R � 2� 20 60 60 190 215 I 235 6. REMARKS, ELEVATION. SOURCE Of DATA - CASIN65 RENOVED, CASINGS PERFQRATED. ETC. �BOLOGY WAS TAKEN FROM THE WELL AT: :ENTRAG AVS. � MI33ISSIPPI ST.,FRIDLEY IATER LEVEL IN THS ABOVE WELL: 45' �A�E WATER LEVEL WA� TAKLN: 3-22-64 JUN � 6 1991 According to MN State Reguta�ons U'� FFICIAL ABANDONED WELL RECOitD (May be used for Prpperty Transfer) IlfPQRTANts PILS MITB DBSD 4. WELL DEPTH (completed) � Date sea 43 ft' �7UN _ 16� 199] 5. DRILLING METHOD (if knawn) 1� Cable tool 4� Reverse 7[] Driven 1� Dug 2�( Hollaw Rod 5� Air 8[] Bored 11[] !� 30 Roiary 60 Jetted 9� Power Auger 6. OBSTRUCTIONS , Nell obstrueLed Q Yes � No Obstructlons reaaved � Yes ❑ No It obstructions tannot be removed. Contact MOH beforc zealing. 7. USE 1� Domesitt 40 Monitoring 80 Heat Loap 2� Irrigation 50 Publie 9� Industry 3� Test Mell 60 Municipal 1� tomnereial 7Q Air Conditianing 11[] 8. CASING(5) 1[] Blaek �Threaded 7Q � cai�. �] w.ta.a 3]] Plastic 6[] Stainless Steei 2 tn. to 40 tt. 1n. to ft. 9. SCREEN �Screened we11 tro� 4O tt. w 43 fs. — — (It knovm) ❑ op�n Hol� fron _ ft. to _ ft. . 0. STATIC HNTER LEYEL.�,I �J ft.�belor ❑ above i�le��l land ur aee Date Measured 11. VIEILHEAO COMPLETION 1� 7ltless Adapter � Found Buried �Basement offset � Well Ptt 12. GROUTIN6 INFORiWTION I�Neat Cenent � Bentonite � $ $ �--� d Groui mater�a�RT �� frQf� _ R fi. cu. yds_ NEAT GROUT 13. NEAREST SOURCES OF CONTAMINATIOM 310 reec E directton e=== el11fR NaI• eype Neil dtsinfected before sealingl � Yes 14. PUMP �Removed � Not Present Type: 1[I Submersible � L.S. Turbine � Reciprocating �Jet � Centrlfugal 6� 15. EX7STING IiELLS (Pleaze sketeh loe�ttons of abandoned and att/w we11s in rema�ks zeetlon or on back.) Other unused w�lt(s) on propertyt � Yes Ho Abandoned: [] Permanent � Temporary � N t seeled 17. WATER WEIL CONTRACTORS CERi1FICATION This well was sealed under my jurisdletton and thls report is true to the best ot my knowledge and beitef. E.H. RENNSR & SONS.INC. 71015 I.rJ�oo�e�AKYl�� ST. N.M11:ense No. Addr�� KlYlSK� .7�33U 9L /—d1U s,9�ee e� 6-18-9 Naae 6f Drtll�r MATT/KEVIN HOPPE SuBJECT Clty O! FCldley 4?�RECKING AT THE TOP OF THE TWINS �� P E R M I T f 1 1 � �` .___ COMMUNITY DEVELOPMENT DIV. r � L � PROTECTIVE INSPECTtON SEC. � � � � �""1 � CITV HALL FRIDLE� 55432 NUMBER r+Ev �""�� 612-571-3450 910-F15 JOB ADDRESS 6566 $.rookview Drive NE t �EGAL LOT NO. BLOCK TRACT OFi AODITION DESCR. S 2 Brookview 2nd Additi�n 2 PROPERTY OWNEF MAI� ADORESS ' Steve Flattum 6566 B:rookview Drive NE 3 CONTRACTOR MAILADORESS same 4 ARCHITECT OR DESIGNER MAIL AD�RESS 5 ENGINEER MAILADORESS 6 USE OF BUILDING Residential 7 CLASS OF WORK 0 NEW ❑ ADDITION ❑ ALTERATION 8 DESCRIBE WORK Remove 20� x 14` Garage 9 CHANGE OF USE FROM TO STIPULATIONS DA7E 7/3/91 ZIP 21P PAGE OF � � 20912 �o �3 3 APPROVED BV SEE ATTACHED SHEET PHONE 572-0974 PHONE LICENSE NO. PHONE LICENSE NO. PHONE LICENSE NO. O FiEPAIR ❑ MOVE �7 REMOVE �ite must be cleaned/cleared o� all debris. New garage to be erected mus,t be a double garage� f,,yith.in 90 days garage must be started. TYPE OF CONST. SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING AUTHORIZED IS NOT COMMENCED WiTHIN 60 DAVS, 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 I HEREBY CERTIFY THAT I HAVE FiEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT $SOO DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE Ofi CANCEL THE PERMIT FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $�-5 * QO RE OF CON iIFOWNERBUILDE� ' I lUnrtl OCCUPANCYGROUP OCCUPANCYLOAD SQ. FT. CU. FT. OFFSTREET PARKING STALLS GARAGES SURTAX N/A SAC CHARGE TOTAL EE 15,QQ :RL V LI T TH S S YOUR PERMIT � pa7E [ l M�� ( � wrecking crrst o� ��c l�NII�IG odt WRECI�IG !►P�Z.IC�TI�t JobAadress: (^��66 G_�v��o% � ��rr.�.,� �/v' %t-�1�. ICN�ot,rt� , r�.) Legal Description: �-,,�T' ,� //�C�,�. k ;� �U�,c��C�„'nti.� n��o /�►��o Owner & Address: �77rv1� ��A-�`'tt�� .�.�.,r�� Z�el. # �7a-o%�N � - Contractor • Ziel . # Addr�es� : State LioerLSe # �� n �+• �M �:, •t- :+�)� � �,_ , Living Area: Ie.ngth width Height Sq. Ft. C�i. Ft. Garage Area : Leng�th � c� Width � Heic�t / C� Sq . Ft . CZi . Ft . Other: Length Width Heic,�t Sq. Ft. G1i. Ft. Estimated Cost of Wreckir�g/Moving �(��G� Approx. Oonq�letion Date g .k . :� . . ��,. City Water/Sewer N�ls. Gas Cc�any Northern States Pbwer Northwestern Bell 'Pel Co. 571-3450 [ ] 372-4720 [ ] 566-9120 [ ] Water Bill Paid: Yes [] Amount To Be Collected [$ Maving Route: FEE.S Maving: Principle Building into FYidley . Aooessory Buildir�g into �idley . Zl�x�, within or out of City . . . . 293-0665/293-1319 ( ] j Initials $ 80.00 $ 20.00 1rL*+»++'�*^ Fee: $15.00 $ 15.00 Wreck.ing: For each 1,000 cubic feet or fraction .$ 1.25 For structures whieh would be i�ractical to cuUe, the fee shall be based on the total oost of wrecking at the rate of $6.00 for each $500.00 or fraction. The ur�dersigr�ed hereby makes application for a permit to wreck/move the building described ak�ove, agreeir�g to do all w�rk in strict a000rdanoe with the City Ordinanoes ar�d rulings of the Buildir�g Depar�nent, ar�d the State Oode which rec�uires ar�y Water well on the property to be sealed by a State lioen.sed water we11 driller, ar�d herei7y declares that all facts and representations stated in this application are true ar�d . Signa � �: ; .��-, �n ��: .. _. SUBJECT City of Fridley 2 � 9 g 8' AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r � � . � � � � COMMUNITY DEVEIOPMENT DIV. J / r � v � PROTECTIVE INSPECTION SEC. '�f �� '-'1 � 1 CITY HALI FRIOLE� 55432 NUMBER REV. DATE PAGE OF nPPROVEO Bv �"'"�� ,�� 612-571-3450 910-F15 8/2/�1 � � JOB ADORESS 6566 B�rpokview Drive NE t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. S 2 arookview 2nd Addition s►+eer 2 PROPERTY OWNER MAIL ADDRESS 21P PHONE Steve Flattum 6566 B.rook�iew Drive NE 572-0974 3 CONTRACTOR MAIL AODRESS Z�P PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGiNEER MAIL AODRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK C� NEW O ADDITION ❑ ALTERATION O REPAIR O MOVE O REMOVE 8 OESCRIBE WORK Construct a 40` x 24� Detached Garage 9 CHANGEOFUSEfROM TO STIPULATIONS �zflv�de a hax'�1 s.n��'ace driyew�y, See nota,tions �� 8efore digging cal( for aN utility locations 454-0002 REQUIRED BY LAW SEPAR�iTL� ��^E1��TS REQUIRED FOR WIR(NG, HEQTING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PEFiMIJS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NUIL AND VOID IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED fOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1. STALLS GARAGES AND KNOW THE SAME TO BE TRUE AN� COAREC7. ALL PROVISIONS OF LAWS ypLUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL 6E COMPUED $14 850 $7�.� WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT � DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR �OCA� LAW REGULATING CON- STRUCTION OR THE PERfORMANCE OF CONSTRUCTION. ��-�2 e QO k'l.x'@ SC y�`1.4 e 8�J PLAN CHECKFEE TOTALFEE 4.28 / si" n FlEOFCON'RACTOAO uT R12EDAGENT IDATEi WHEN ROPERLY V LI T TH S YOUR PERM17 x u ;"� `%/ � r � '" L � SiGNATUREOFOWNERUF WNERBULLDERI i0ATE1 DFTE � [ � A�t1 � � �� [ � R-1 Pit�ID R-2 A, i t dir�g Petmit l�pplic�tian .�1C[I �iio.�: _ �56� /� �!'c�0 /` U !'l�'cJ IC.J V" . � n�ri�i�: C��-r- s �Lk a ��k�,►��.� �•� Effectiv+e ],/1,/91 • aaner rr�e i Aa�aress: S7-�v� �'G �9-�'rvw► .� �r� �el. # s �;� - o°d � y OarYtrac.�ta�r: v��ir �• # 1�c3dr+ess: . L1VII�1G l�tt'E�,: � 7�: D�GR 7�: �: attadi to thi,s applicatian, a Oertificate of SZiYVey of the lat, with the p�o�ed oocstxuc.�tian drawn an it to scale. ffiBC�tIPPIQ�1 C� II�AUVH+��T L�gth Width Height Sq. Ft. ior�hh �/o width � y Heic�t _ 11,' sq. F't. 9Go Iesx3th Width Hgt,/�'c7tu�d Sq. F't. Cbrn�er Iat [] Inside Iot [] Ft. Yd Setb�3ck Side Yard SetbaGts Zj�pe of oonstru�.-tion: �� 'v�,�,,,�, Estimatea oost: s��cavc� �� ApQrox. �letian Date: '� �,.,�,,,t�S �- Prvposed D�iveGray Width If New Openit�g Is Desired: Ft. S $ Width + 6' See ffick Page DATE: _��%� APPLICAPF!': � 'Del. � �'"7;�-c�9'�� F�e,rmit Fee Fire S��zge State Suz�c�l�a�cge SAC Q�ait�e D�riveway Fscrow Park Fee Se�a+�r Main �e � �•� �_ M�+1 �_M _i� 0 < S 1 c�a�0a S 1y�8� � �2 � 4,3 S S $ .. , � �M � � ��_.' 1';� L� �r � c�,��te rn Aevets�e Side .001 x Plexmit Valuatian (1/lOth $) $.50�$l,00o valuatian $650 per SAiC Unit Alt. ~A„ Gr Alt. ~B� AboV@ F�ee Determined by �*; r�r; r� �gre� NeoessarY [ ) � �-�� I ] � c� 0 ��i,gS� a ooa— C3X� �s.oc� 1 1'� ,va t4a�� CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE � �� . �_� �� Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION� 763•572•3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent • Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning • All Sizes All Others/Repairs & Alterations (LIST ON BACK) lq, of Value of Appliance or Work Commercial/industrial ` 1.25°Jo of Value of Appliance or Work Rate TOTAL $ 30.00 $ �� , �� $ 10.00 $ $ 10.00 $ $ 10.00 $ $ 25.00 $ ��U� $ $ State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. $ .50 g ��,5� Effective On January 1, 2001 JOB ADDRESS � S�� C�J +� �0 �-V 1�.� A) G�k' OW N ER _ S�"-�. Y`{ �l Q-� 1�'� - BUILDING USED AS_ �E.IT�f�i_.� ,l Y'la► ' ESTIMATED COST � �e v�• lT(� PERMIT.NO. /� S� DESCRIPTIQN OF FURNACE AND OR BURNER ' No. of Heating U its � Circle One (Steam) (Hot Water) ( arm ') Trade Name � l.� 0..1'�� Size No. �� I'Yl �F�lc3�-I a(Xa0 BTU �0 � 17Q�0 Hp EDR Fuel �. � - Total Connected Load Burner firade Name Size No. BTU HP EDR The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes an rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE � —� � --� 1 BLAIN� HTti. A/C ELECT.� INC. NEATING CO i356e nEke RiAuN �S�nQ��E� Signed ��' � � ��\ \ TEL # t ll1��J�� l� � Approved By Rough-In Date Final Date °� BACK S1DE MU57 E FILLED IN ON VENT SIZE, VENT CONNECTORS �iAND COMBUSTION IR VERIFICATION COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATtON When re�lacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes� No () The venting system is plasticlPVC and meets all cunent 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 manufacturers specifications. This does incfude AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. The existing combustion air is sized and installed to meet the current codes and manufacturers specifications. When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturers specifications. Yes'(� No { ) i� Yes No ( ) Yes� No ( ) When installin� a new ventina svstem, the undersigned hereby verifies that it is a listed as�embly 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`�) No () 1° 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 cuRent codes. Yes ( No () Appliance Tvpe and SizelCommon Vent and Vent Connector Informatinn Appliance #1 Type �la,�YlGI-(°� _ BTU Input l.e� �� Fan Assisted or Nat �(� . Appliance #2 Type BTU Input _. Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliartces _ Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type "'- :�. ALTERATIONS• (Describe) - $LAIN� HTG. A/C �LECT., INC. 'i3562 vENTRAL AJ�. N.E. HEATING CO: N 55304 - Signed By: � Date : S'I S`"U � Building Inspections 763-572-3604 DATE� i � SITE ADDRESS � THIS APPLICANT IS: PROPERTY owrrExi TENANT CONTRACTOR PLUMBING RESIDENTIAL APPLICATION { CITY OF FRIDLEY y YOUR E-MAIL ADDRESS _ a�. �wv�.cr ❑ OWNER ONTRACTOR N�: Steve Briggs twn�ss: 6566 BROOKVIEW DRIVE PxoxE: NORTH EAST Fridley, MN 55432 Permit No. Received By: Date Rec'd: �� STATE ZIP. SUBMIT A COPY OF STATE LICENSE # SDG � � EXP DATE / Z�o 7 YOUR STATE �D s: 29oS �tnrfi' [�O� ii✓C s CITY /NdIJ STATE�ZIP �fNop' LICENSE WITH pHON�� IZi SZrI-N�33 FAX APPLICATION ' PERMTT TYPE TYPE OF WORK: �SINGLE FAMILY ❑ NEW DETAILED DESCRIPTION OF WORK O TWO FAMILY - O TOWNHOUSE �REPLACEMENT HEATING AIR CONDITIONING AND ELECTRIC, INC. ADDRESS lD�� lfx l{� �� C> c".` �C Vel �� { OCCUPANT UE_? }'_G , _ �r �v► HEAT LOSS DAiTE HTG. INST. -�i '�Z`"�"''�' / SOLD BY u i vf ` ({ Electrical Work By � � � 'l � � � G � TYPE OF HEAT GA FA_� HW STEAM SPACE HTR. GAS DESIGN MAKE �� n�dei 335� �/� L� b d Serial i Z� � t� / I 0��t INPUT IaO.Oc-'(% CONTROLS Heat Piup Limit Fan ; Pilot Pilot L.W. Cut Off Pressure 7r � � Percent COZ � `<L� Input CFH Percent OZ lri e/d � �. Stack Temp. ��d� Percent CO_ f7 ln � HOUSE HEATING TEST RECORD APT. FLOOR�--- CITY �� SUBURB OWNER '�'�"�P►' � �� 7�/�iG*"► INSTALLED BY �( rf i k-� . � r� f P�- Gas Line By jf � 4 `!•'�< � � %c, . �- t' � . UNIT HTR. OTHER CUNVERSION Vent Size �% � KIND OF LIN 9 iLt SIZE `f NONE Draft Hood �'� r Regularor Filters Size 1�' � Gi Number Chimney Location Inside � Outside Chimney Construction __ i � lf •� > �"11iS'e✓�`� Smoke Bomb Wiring 1� Draft Test Tag � SC" Door Pressure Lighting Inst. 7� Dale Tested r'C'J Company Testing tt 1G Name of Tester Pressure Percent COZ Input CFH Percent OZ Stack Temp. Percent CO SI'iA: / V.7-.�vc-�� i � 7 Building BUILDING Permit rto.: --� l Inspections RESIDENTIAL APPLICATION Received By: 7631572-3604 CITY OF FRIDLEY vat�' 'c�UG 20�9 763-502-4977 FAX EFFECTNE 1-1-09 DATE Gd YOUR E-MAIL ADDRESS PNl��Jo�f� b� f�K� S- S1TE ADDRESS ��- GJ /'i:� THIS APPL[CANT IS: ❑ OWNER ONTRACTOR PROPERTY OWNER/ N,�vtE: : �'"" �� ' TENANT �i�S�'ti�� /�/C-'►� � ADDRESS:��l��t//C-� c/s!/C� CITY �'��/�'�/ STAT�ZIP .�x� �i�/ l �✓[C t � �G `-//� � ONE: %�P-3 — �J /�� iZY �.iG CONTRACTOR NAME: J p �� .�• r`p . ��-- � SUBMIT A COPY OF STATE LtCENSE # d� � I EXP DATE �� / 3// .�Zii G�/ YOUR STATE LICENSE � AND CERTIFICATE OF ADDRESS: �d _..L/i /1 G �� CITY I�PLS STAT�ZIP �'/2/ INSURANCE PHO l Z� Z. `— ��l FAX C� — JF?�'— �r 7�03 PROPERTY TYPE INGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ��DITION ❑ GARAGE/SHED C►3'�VINDOWS �'�ASEMENT FINISH D ROOF ❑ DRAIN T[LE ❑ DECK ❑ SIDiNG ❑ OTHER ❑ SW[MMING POOL - TYPE OF WORK: ❑ NEW HOME CONSTRUCTION �IT[ON ❑ MAINTENANCE/REPAIR EMODELING DESCRIBE WORK BEING DONE: F"� K�� +SC�st �.-- (� _ - r � u,,:,��9a✓s' � � SIZE OF IMPROVEMENT LENGTH WIDTH EIGHT S FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: i. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS es ONo LOCATION O� W[NDO S '/ OR FOR NEW OPENINGS,DESCRIBE SIZE OF .�/� S�UL. 5 � Hi�tC-- OPENING CHANGES & TYPE OF.WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL NLES AKE BASED ON VALUATION, INCLUDING THE CUST UF LABOR ANU MA7'N;K1AL5: ' (USING THE 1997 U.B.0 FEE SCHEDULE) �2 TOTAL JOB VALUATION $ �%�!.'�• "' OCCUPANCY //[kGr��TYPE r�t �.�ol� Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due i.53, $ 3? S $ �'j Od $ $ $ $ $ $ rnQ . ( ( See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $2000 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$22=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( Make checks pavable to: City of Fridley THIS [S AN APPL[CATION FOR A PERMIT-NOT VAL[D UNT[L PROCESSED Attach Stipulations 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 Cades; that 1 understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all r t whi review and approval of plans. 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