Loading...
AF - 46629Date: Owner: Addres City of �'ridley, Mi.nn.. BUILDING PEI�I�IIT Builder Address __._..._. N° 51�0 } — ` ! l C' L CAT{ON F�BUILDtNG y f r °�� No. � Slaeet � P a rt o f t �t ___ ___�__ Bl� _,_ _.�_.._.�_ Ad ' ' n or Sub-Division '" '� 4C � � / Corner Lot �_—.._— Inside Lot --.. Setback -�-- Sideyard ----- Sewer Elevation ..�_..�__....__.. ----.—.._.. — Foundation IIevation _._—.___-•-----._.._.�..._.._._W�._...�� DESCRIPTIO�V OF BUlLDIIVG To `e Used : � � , ,�,� �^ /.t ...k �� � .��'%.�... Front � �"'`-=--- Depth � �"` Height __.�.. Sq. Ft.f�� Cu. Ft. � f��' �,r ---- _ .�.f - ..��! . f -��1-: �--- Front .� --- � Depth � H�ight ---�-G-!=_ Sq. P`t. ��� Cu. Ft. . ;�---���=-� -- ,�w � �t:__. � �f !„ �, ��,,,• Type o� Construction ...!�'����'�.._.. Est. Co .�.����-�--�--- --...._.. To be Completed --------------�-----------_..... In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in comPhance with all Provisions of ordinances of the eity of Fridley. � In consideration of the payment of a fee of ��--. Permit is hereby granted to_..._. � 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 worlmnen, in all work done in, around and upon said builduig, or any part thereof, shall conform in all resPects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, reP� �d moving of buildings withiu the city limits and this pertnrt may be revoked at any time upon violat-^io�n of aAy of the provisions of said ordinaaces. ,r�''� .� n �� ) Building Inspector NOTICE: 7j�is peemif does not cover fhs conafrue�ion, installation for wiring, piumbing, gas 6eating, sewer or water. Bs wn fo sa� fhe BuiWiag In�eetor for, separate pe�mits for lhase iMms. �4 Owner's Addresa /O�vo — APPL�C�TION F0� BIIILDING PSRMIT CITY 0�' FRIDIEY, �0`PA � �, LOCATION OF BIIILDINiG No. /��-�_,Street /�t_�-� z<<� �� L!� Part of Lot Lot Z Block �� Addition or Subdivision--�l�.i` Corner Lot ____,�___Inside Lot Setback Sid�-Yard SE�, ELEyATlplii FOIINDATION EL�VATIQN Applicant attach to this fo�m Certificate of Survey of Lot and proposed building location. DESCRIPTION 0�' BIIII,aING To bs used as: I%�� �- P`ront�Depth 3 � Height Sq. Ft. l 2 GJ � Cu. Ft. � �-�/ L I�pnt--,��—�,---Depth �Height /` � Sq. Ft. �X,�_ Cu. Ft. ��__,��� -'�%` " o � Z`gpe of Construot3on ✓u�---�,.-,,� _ Eatimated Cost � D O O ` To be Completed � � � � The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance �►ith the City Ordinances and ruling of the Department of Buildings, and hereby deciares that all the facts and esentations statsd in this a pli tion are true and correct. ! DATE SIGNATik� C, {A Schedule of Fee Coste can be found on the Reverse Side.} � � � � � �� _ . ,� �" �� � b � . � oC � .� � � •— � � C�. � . h H � C _ � ��Q • ,V• V a � � � • �i � � � \` � r a� � .� � � a 0� � a Q � � .��r � � o � a ' m A . W J 0 W _ U H W 1�— � J 1-- � a a N �� o „�« x �, x y �. o .-. 3�a a� +' � ���� o,�yaU{yi W �1-� {y iQl L^ Y � V N3�A «1 co�yd �°o�� O v � � �� U U Vi •� c�+-'.� c> �y"�� ����, %.'"a� � pq ��o;� ���� .�� �� '�°�� Ay .��do � ���� � � � Q � �� �� y d.� c. o ���v M F U m c�e c�a h � w vs e�r efr �o 0 0 0 0 0 o ua � 00 �[i �e'i N : : : g : : $ c 0 ' . °o w ..�b .� � � � � x � � I y 'ii �t N �' � � � a A w ° � � °� o � � �r1 +.a y � � � � 3 a� � �J �J � � � � � .., w w ; a a a � a w a i9 � � � � � � ., .. ,� I � I � � . � ,a � � o � � a � O � 5 � i t � � � � o° °o 0 0 �°c� OC N �[i �fi N � : : : o o : : o g • o �°- : : oo � � :�� s�:�� � $ � � °�' m � o 0 i"'3- T1 � ,� � q., c`°. r°tl, w o � °y,' d � q � � a � �, � � � 4 u ti � M M V � � a � � � � � v d � 0 U � Ey �I z � � a � � � �U Q� y � z � � W �ss va � c� 0 0 0 0 0 o ua �r., GO 00 N N � w 0 0 a V A �r 0 0 � z � � g .� � O x � °�,' � � � a° V z � � d : : : . �, � � � � � � � � �i � x : : Pp', : : : � W A : : : � W . d � . a� +� a�i W w � • � � g � g �go d o �� N � o m x � � � '�' � W W a a�'i � a ra �.�j '� w `o 00 � 3 ,� � � � M m M F � � N M y � � � � ,� .� a o '� '� z o � � � � u t� � 4 � � W W °q � �,,�,_.. m z � � � � E� 0 �� v} 0 0 � � 0 0 0 a 0 W 0 �, a oG w z � m � � x �` \ � A W � � � � � � Y U A � U U � U E� z d N � � � � � a � 04 � E� N � �u� � � u� a � � o r+ � N � O k � k z � � � H : � o � � � o � k N W � � y � N bA w o � F '" d C7 w � 4 t9 � U � m U �*� � � � � • � F � � � w N ��� a E W I� z�,�w z�'N� O �ry � tn M � x o ���"H N � a � a � W � 4 w > 4 a � .J �,� A .�i R� � � .� co � � a � � 0 � � � e form �D5 4 !� NEAT LOSS CALCULATiONS +�BUILDIN6 DEPARfiMENT 60LDEN VALLEY, MINN. Weatherstrips A.S.H.V.E. Construction No. Insalation - Guide Windows Doors eference Out. Wall Int. Wall Ceiling Roof Floor Kind How Apptied Yes--No Yes—No 19 ' FI. (�j�j •� Room � Length �� Width � Height $' � FI. � D o o K Room � Length /,S ` Width/,� b�' Height � L' Windows and Doors—Cracka e and Area Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area Width Height No, of Lineal ft., Aren No. of pene of pane lights of crack sq. ff. No! of pane ot pane lights of crack sq. ft. / 20 5� � �S9' �7 / 38 fA 2/ 7 .�1�� I I � I Coef. Btu � Infiltration ,'� p 33 �pp Infiltration � Glass 1 f " � Glass Exp. wall Z. Exp. wall Net exp. wall �/ /p / t7 Net exp. wall Int. wall Int. wall Floor f�7 7',3 Floor Ceil. yJ // Ceil. " Total Btu. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leade area � FL ��(�,�'f� Room � Length :7 o Width d" � Ne+ght8' a � Fl. � y Room � Length 8' 6 Width �; Wi�dows and Doors—Cracka e and Area Windows and Doors—Crackage and Area ' Width Height No. of Lineal ft. Area Width Height No. of Lineal ff. Area No. of pane o{ pane lights of crack sq. ft. No. of pane of pane lights , of crack sq. ft. / � .� � 7.. / // 7 / 7 / 5� / —� � Coef. Btu 3e S 70 Infiltration Glass Exp. wall Net exp. wall Int. rvelt Floor Ceil. Total Btu. ` Ccef. Btu 0 � Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FL � KC Room � Length,2% f Width /,3 Windows and Uoors—Crackage and Area Width Height No. of Lineal ft. Area No. of ptSne of pene lights of crack sq. ft. 3 3 � ,6� 9 / 2� 2� r Infiltration Glass Exp. wall Net exp. wall Int. wall Floor � CeiL To#al Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area \ �ia Coef. Btu �_ Infiltration � 5 ',,3$ c�� �iz'� Glass ,S O Exp. waf1-- - -__ .. _ _ _ �j?7 Net exp. wall Int. wall /cJ �' S�t' �� Floor � / j 4 Ceil. i�%d i � 6 D �2 Total Btu. � Required sq. ft. E.D.R. or sq. ins. W.A. Leader area ight 7� FI. � Room � Length Width Height Windows and Doors—Crackage aRd Area No. IWidih Heigh} No, of�—Lineal ft. Area of pane I of pane liqhts I of crack sa. ft. �7 � �'' ' ��JI�=Z ci,���r— L����3�" ■�s���.r� � m � r�s;rr c -a�.�-z- � , � Infiltration j I Glass � Exp. wall Net exp. wall Int. wall j Floor ! CsII. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Coef.l Btu .� ; �� � � r - y E` . � O. C � � � m � �t� d � �` �� U � � � 0 � � �w 00 30 � � .����ppFpFpppyyjyj � d � N � �'r N O � � � � � d H y Nd��' �° � � o � � ,�: v ���� �� ��, .� � � H y ����, % U � � O �p ai A O �°�O� a � a ;� � � a .� s� m �x� � ° a � ���� d � 0 �'d a� � � N VJ .�0 .�a °' .�°. �; N ��y � � � 0 � W � � pp m N b a � o ��� � � ; b •a � ��� � 1 � w � W 3 � � • z • u S�JNIN3d0 �� �va � ,� �� a�svM oim SNIS1/9 FU1V� � � f .� � � �J � \ \ � � � � � � . c � PO � W 0 � x � a� � • 4 B p, � � � � � a" � � � � � Y y � � O � a U O � � � � � � o ; � E-+ w o r' W J � � 2 U N W �0 � I x � °a �� � F �►' E� ' vs vs er� e9� er� v} 4 � N O N O N pG rr ri .� ri �i ai � x �e x x x �e °z z w �O F O E p �a aa � � � o° � .+ N tf) k x k O z O. . . . . . . � . SNIV114 �' : � .�+ b aooid Q : : : : : : . : � � � � « �san�u+s a : : : � o eo : : � " � II�G bq �1Nno� J . ' � : o � : : � m � �4 '�Ntaa Q ; � � ; N � : : a1 � : W� � sxvai �� � p,� : � g o 0 � o Z ►�SVM F � O ! Q � y O b : � � � °o ON � S71N�5 O � a . : o '� a� O " P� � N 4 z �� � o � � � � � � � m c � ° W � w seru o � '��, k � " ° w x a � F� � .� x �. .� ►uw � � � d w � N L7 � r"' � � � � s'rvirian I•� �G � 3..�. � 3 w"� m dd o° si�sa� ,,,, z�v' z U 3 z H� 4(7 ao A a�vM � � � �"' 4 SaF�o3S � .�,, 'd '� � k" x a �,,U' � � .-�i N M d� b h ♦ � � � : G� : � : � � � . � � � aC � � � € .� �� C 0 � V � �� Cr• tI�Y _� � � �° V V � a � � � � � 0 ti .r � � � �� ac a � �, � � � 0 � « � : A � J � W _ N W H � � H � a G �," �� x � � \� � � F�w 0 3�a °��m ���� ti�d"y� ��" H � .�+�� O � V U �, �3 b a t`l �O�yd �. c.'�y� ( ""o'q� �UbN � � c�i u v; � p� � L; u f: a�'�� � `���� � �� v �3°� � �� ���C � xb �� aJ y � � �O °OA � M � � O � � "��o � ��oo� � � �� .�,y' F G1 � 0 [H � i�r i�i � a�i'd'a U v�'i c�"o c�a � � � vs w �'; °o o°, °o, �°a, � OD b � N . . . 6 : ; $ c 0 • o � '�' 'Cl . �" zs � o ' a u � � � d � � N � � A o � M a' .?3 w s�+ � � °�a � 4 C,C/1 � � �'�� � u � � � � � � ,,, � �, a a ��ar�a v N � O � � � � i O � � a�i .'Y�. J � .� a � 0'• ,� � � v\ � � ( � � O � � � 0 ; ! efr ' vr �r vs °o °o °o °o �°ra CO N �[i LL� N � � � °�' a 0 U � .a Ey I � o z � � a � � � � � 0 U � � � � I i-� � W O � W � O a v A ��, �: � 0 z�. � �. ��� � a1 � � � Fss �rs ar} Fsr crr °o °o �°n �°n °o CO CO � N N �[i � : : : : � : : : : � . . �i � . . . p g : ' S $ w ' °o � $ : . ,�, ,� � ' � o o � � y : ,S w ° 0 0 �; � � � � � $ � � � � � b � � � � a PG � b w F' y '� �?3 � ,� � o � .� � : y � � Q � E d � � d � � � � � 3 � � '� .., ° `° �� a�aa� W� � m : v � d o � x w w W W m � O o N M � '� w w : °; : � U � �, W d �� �, o � � o � � a � a � bD � M m M O � OG o W z x � cv a 0 a x 0 'd � � � � �'; � '� ` � ' t� � � m � C � y O � .� U Ey U E+ N N � a� � � H � �i � G0 ,� � I H H �sr EW,, v> I Fss °o a �°n �°n o IC� .ti � N � : � DS k >C x i i i E 0 0 0 0 O d� 0 C� v a W z x � oa � � � E�-� 0 � o � o +., O v� k N N s�. w ° W � � n� � y � x .. F ~ d C7 u. � � c� -.�"'. U c� a � U � � � � W � w a • � F � H u N � G4 m m � ��� a� a E" F W t± � � pG z��°� O � v v� F x z z M F E O p F '`�p W a 4 v x H w 4 w > 4 � � a°�, W O m � d a � a� � z w > 0 N Y t � � � City of Fridley, Minn. 6431 University Ave. N. E., Mmneapolis, Minn. 55432 BUILDING PERMIT D8t@I MA,; � ?.�. 19 72 _.. � � � - -- --� � � p�; _ Wavn - F.. Samoson g�� _,_, �� • a� 1 10 �„tlilall. . i ri',.a,.P.. N- E- Address '�id 0- /l � . LOCATION OF BUILDING Na 110 S�t � Hartman Circle ___, p� og �t � �,p� �,� 1.2 �� _„_ 1__ Addition or Sub-Division _ Sandhurst Addition Co2�er Iat xnside Lot __. X_ Setback ....____ Sid�eyard 8ewer Elevatiom _. ......_ Foundatioa IIevation DESCRIPTION OF BUILDfNG � � v� �' Alterations J?eck Addn. & �ont _ Depth Height _._.._......._ Sq. F't. _-----:___._._.. Cu. Ft Front ....._..__...._..... Depth Height �_�._.. Sq. FL -------•---- Cu. Ft � og �� Wood�. Cedar �� 2 500.00 ._._ To be Completed June 1, 1972 Plans prepared by Patch & Erickson Architects In c�nsIderation oi the issuance to me of a permit to c�struct tbe building described above, I agree to do '�he proposed work in accordance with the desCrlption abave set forth and in compliance with all provisions o! Os+dinances a2 the cit,y of Fiidley. �. —_ 1.50 Sta�e SurcharQ�� f ; In cat�sideration of the payment of a fee of � 15. 00 � perrnit is hereby granted to �'s . Sampson to construct the building or addition as described above. This permit is granted upo� #he express conclition that the person to whom it is granted and his agents, employees and workmen, in all wo�k d�e in, around and upon said building, or any part thereof, shall conform in all respects •to the ordinances �` Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildia�t Wi�� city ]imits and this permit may be revoked at any time upon violation of any of the provisions of said .� j��. L���' s�a� � , NASIM M. QURESHI NOTICE: This permit dos not eover ths construcfion, instailation fo� wiring, plumbing, gas hsafing, sewer or wat�r. Bs sur� to sN t4� BuiWiny Inspaetor for separats p�rmits for thes� itsms. -� _ - �'� APPLICATION FOR RESIDENTI�L, ALTERATION, OR AllDITION BUILDING P.ERMIT CITY OF FRIDLEY, MINNESOTA OWNER' S NAME :�/ � D BUILDER : anDxESS :_ 1/Q �k'�,mQ n C�! r, ii .� anDx�.sS : , ., NO•. �% � STREET: :. LOT : " � BLOCK: � . ADDITION : _ �C� �'l a {7 Cf `'.S"� ���. i /D/� CORNER LOT: INSIDE LOT:�SETBACK: SIDEYARD: -----._... Applicant attach to this form T�ao Certificates of Survey of Lot and proposed building location drawn on these Certificates. �ESCRIPTION OF BUILDING To Be Used As•, , '�c k �i%ion / / � , G�o1 f�IferG'fiortSFront: X�y Depth: %2 Height: J� Square Fee�: Cubic Feet: Front• Depth: Height• . Square Feet; Cubic Feet: Type of Construction: �LV�Q yr Estimated Cost: $�-s� .�, � � . To Be Completed: �(��e. The undersigned hereby makes applicativn for a permit for the work hexein specified, agreeing to do all woxk in stiict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hexeby declares that all the facts and representations stated in this application are true and correct. DATE : II �� 1%a� S IGNATURE • t� , (See Reverse Side For Additional Inforn�ation.) �/�� � � �� � �I ���i�: � C�z. `-e�. /._ � < � �� � ., � a�� � _ � ,�_� r.' �` � � 1.f� 1-f� a o� � � 1 M t� Fa � x 0 � � � .c a � e �. � �. � d � � � .� � • � � � � K M� O� 3g o� o '� a� W .�9� Q M � � � � D � `��A I r ^ 1�. � . � Iy II ��" I s��� �I ���8 i �3�� � � N M � � � a � � a ��t � �� e � �'�� N u �+ � s a� a .x�,°� a � � ��°� � � ���� ^ � ,� � � e $��M w 0� F Y O ��5� o� � � d � � �� � aa� � y � r W ; � u • _ • • S9N1N�0 r�ww� �av ON�YM � �� �� �� sti�ws .a�noa '7NIfW f�wa N�VM �H�: lIK+A �u wav� s�r+xrn sarlorD IiLYM � � $ � � � t�. w .. 8 A � � 3 F oa E o i � � � SC � F � ����� ,■.■■ ' � �.. ,. ■.. • � ,■■■■ , � ,.. �. r ,. ■. ■ I ,■..■ � � oa z � a a � z � � N C � o �, U p � 3 E � � O W J 0 W _ U � � � � J � � a 0 a�, � � O � � H I I �"' � � �� � � gg� N N M N N N N N (? � � O � �f N O� N O� O t��, �Sp 1 � �.0 � N N M N M M N � N M � a i � � 1� It X it � It M M M N K • d f�G Z � g • � . � � o . . . . . . . . . �o . . . . . . . : �. . . : : : . : : : : � � � : '. ' . � . : • ; � w V� g , ' � zs . . � � $ �i : � : � at �s . . en . o �o . . � u .! m � a�i : .5 `�g� : � �o ' : : Q ca �O F o� 5.° 0� .�yy 25 U � 6�i �' 'C � `J� j � , 7 � � . w ; v o . a�M �p « ~ � : �i X � � � 0~i 'O • b Y � � � a r K a � e�0 G� w � � �'+ MM �' h y p � %i "' � �r g �' �`' � x � � � �" i� � � $ t! p� � ` i� : � M � � Z Z F. z U� Z� �,`"'„ �� CJ � A � � � � �a v � sua�Etr RM) c�cy of Fridley 3 2 0 8 AT TME TOP Qf TME TWINS g� i L D I N G P E R M I T i � 0. � �� � ; y �����_ COMMUNITY OEVELOPMENT OIV. �/� � � � � PROTECTIVE INSPECTION SEC . X.f 1 . � � / � ' �'�'� • CITY HAIL FRIDLE� 55132 MuMBER pEV O�TE PAGE OF AvPNpvEO S• �'""�" ��� 763-571-3450 s�aF�s 10/24/02 / / �oe �o�pess I10 Hartman Circle �iE 1 IEGAL ��T NO. BIOCK TRACT OR ADOITION SEE ATTACMED DESCR. 2 1 Sandhurst Add�t�o�: SNEET 2 PiiOPEiiTV OWNEq MAIL ADDRESS 21P PHONE He:en Sampsar: 110 Hartman Circie vE 3 CONTfiACTOR MAIL ADDRESS Z�P PMONE LICENSE NO L J Roof �ng 10151 Foley B? vd N6r', Cooa Ra �ds l�v 55448 767-1587 a ARCMITECT OR OESIGNER MAI� ADORESS ZIP PMONE UCENSE N0 9036 5 ENGINEER MAII ADDiiE55 ZIP PMONE IICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION ❑ ALTERATION � REPAIR O MOVE O REMOVE 8 DESCii1BE WOfiK Reroof House & Gara�e (26 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Ur.derlayment must comply with the State Bui�.d�ng Code. TYPEOFCONST. OCCUPANCVGROUP OCCUPANCVLOAD SEPARA7E PERMITS ARE REQUIRED FOR EIECTRICAL. PLUMBING. MEATING, VENTILATING OR AIR CON�ITIONING TMIS PERMIT 6ECQMES NUII ANO VOIO IF WORK OR CONSTRUC�ION ZONING SO. FT CU iT AUTHOAIZE� IS NOT COMMENCEO WITMIN 60 DAYS. OR If CONSTRUCTION OR WORK IS SUSPENOEO OR ABANDONE� FOii A PER100 OF t20 OAYS AT ANV TIME AFTER WOAK IS COMMENCEO. NO DWLG. UNITS OffSTFEET PARKING I HEREBY CEHTIfY THAT I HAVE READ ANO EXAMINED THIS APPLICATION 1 $TALLS GARAGES AND KNOW TNE SAME TO BE TRUE ANO CORRECT ALL PROVISIONS OF LAWS VALUA710N SUFTAX AND OROINANCES GOVEFNING THIS TYPE Of WORK WILL BE COMPLIED $3 � OIO � 1. S 1 WITH WHETMER SPEC�fIED MEAEIN Oii NOT TME GRANTING OF A DERMIT OOES NOT PRESUME 70 GIVE AUTMORITV TO VIOIATE OF CANCEL TME pERMIT FEE SAC CHARGE PROVISION$ OF ANV OTMER STATE OQ IOCAI LAW REGULATING CON- @ @ TRUCTtON OR TME PERFORMANCE OF CONSTiiUCT10N WJ7.ZS F�re SC y3.O1 PLAN CHECK f TOTA� FEE g 2 By Lice $5.0 $106.77 � S�GNSTUA �CON'AACTOQOp4UTNOAIZEO�GEHi iD�tE� E ROP VAUOAT D THIS IS YpUii PE MIT � -- S�GNSTUAE O� OWNEA��F OWNEpBU�LOEAi �D�TEi - B G�h$o - �1� NEW [ J CITY OF FRIOLEY Eftectnre 1/12002 ADON (] 6431 University Ave NE. Fridley. MN 55432 (763) 572�604 Bldg insp ALTER (] SINGLE FAMlLY AND DUPLEXES R-1 AND R-2 BUILOING PERMIT APPUCATION Construction Address: . /% 4 ��,`7 �"`�^ . Legal Description: Owne� Name & Address: � Contractor. L T 2.00�i O�� I � � � LMNG AREA: GARAGE AREA: OECK AREA: onieR: � Tel. # 76 � - MN LICENSE # �� � I� Tel.# 7�7-tS d % �ttach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. �ESCRIPTiON OF IMPROVEMENT Length Width - Height Sq. Ft Length Width Height Sq. Ft Length Width � ��°� ��5� fi HgYGround Sq. Ft %1/0 - � � s9 Construction Type: Estimated Cost $ • �� f� Driveway Curb Cut Wdth Needed: Ft + 6 Ft = Ft x 3 =� DATE: 0 2,f 9 2 APPUCANT: �2 `�✓ Tel. # 7 b'� -�s P 2 Call (763) 572�604 for Permit Fees if mailing in application or Fax to 763-571-1287 if using c�edit card and we will call you tor card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY - $ ,�� Fee Schedule on Reverse Side $ ��.� t .001 of Permit Valuation (1/10th%) $ /� `�/ $.50/$1,000 Valuation $ $1200 per SAC Unit $ �.C�O $5.00 (State Licensed Residential Contractors) $ Alt. "A" or AIL "B" Above $ $450.00 Conservation Plan Review $ . Fee Determined by �Engineering $ Agreement Necessary [ ) Not Necessary [ ) � ��C�� � / STIPULATIONS: � H d O N � v d > � w r 2 O � � W W � � � W Z d O 4 U N C3 � � W f=d N W N _ � C Z � � a o � �' W � Z D C � V o W � � � d a Z . a °o z r= O � aW � a � ao � O V W a N � V ~ Z N 0 ' J � C� c� r � m � � Q � � � � G � � � c'v � � ti �� � M � M � t�0 ti � � m c O Z � � � a � � U � � � a v � m' w � O � � � � � N m � � � - d N I� � � r � e�� 3 �' � �� � ti m •- � a � �' � � .., 3Nw z°w o �� � � ��� �. o � � # � � � . 9+ m � J a� ° � " G� O� � � R a � � �� � � d � � � � � V . c� .. � _ � m � � LL � a r. o — « � � ; ^ o = a a � � �a a� � m � _ � � o� � i () N � d1 � s;°'E m_o' E �a c °�,,' �'v°" y � o � � °' r � 0° _€> V � c z � m � � mm � �m�� g A Z � � �y � � '��. O � = m d � ~ � � � � * 'd� m �� Lu mC vv a '� a�� �i m� F� IJi � l�0 = tn 4. 8 � a // tf! iA t�► N �A � q O 0 C O G M� � � Q �� o _ o� �n • � � � � K iA d! K► x� � � w � - o O � � �� c N � :i " � S� v .L,^r U � y as � °� t 3 G � y � +' O L j � J Y C N m a � c'� m o, �3wa� 3 � LL m �� ��.� N d '�i � c�6 N m c� Q' � 1� � Q Q oo p� .p ... LL O a ttf o � m % � � Q N i — E v c '�`o m .. � � d N � � °p d � � A � � m � Q � �. � d > > j � a � o c� � o E o c $ � �o � v v � a�� � � G � � y � c � !V6 10 � W � � m � N J O � a�.. � N C � O � � Y � 3 � O � C V �o 0 Q O Q O O !h N v► � y � LL O � � 3 E N C �'1 � � � 0 _ 0 O G tfi as W 1a7 w Z O f- W d � Z W � 7'0 0 � c � d eo 0 c � bo � Q ¢ W Q Z � � � � z W O � W � � � -m- � � � � O Y o 3 � � � U v � a v C S � � a �i u V m " F n � tq a � a o C C � � v o cn y � e0 U ° � 040 :. c r- � � � !6 0 ,,, � J J a � 1J.. i � Q �. � =� �0 ' d �d101 � t o� �a ��' Ma.K C� �.c ( � �e ► ,p 1e�. FiLL IN COMPLETELY FOR REPLACEME�IT FUE�L BURNING APPLIANCE PERMiTS COMMON VENT, VENT�CONNECTOR AND CONBUSTION A1R VERIFlCATION When reolacinq an existin�tumace, the undersigned hereby verifies that the venting has been examined and is free from tvst, deteriorado�, obstnx�fons, and is securely suppoKed and f�restopped where required. Y� � �( The venting system is plasticll'1/C and meets all current oodes and manufacturer specificatans including sizing, kngth, number ofi elbows and termination. Yes () ��tJa i The urxiersigned also verifies that the r�plaoement urtit is a listed �mbly and meets the cur�nt codes and manufacturers specfications. This does include AGA GAMA C�egor}r I Central Fumace Venting Tables for f� assisted and rratural draft appliances. Th� existi�q canbustion air is sized and �stailed to me�t the curtent codes and mattufacture�s specifications. When r+equired to it�st:til a new comtaustion air, i� wiU be sRed and inst�Ned to meet the current ccdes and manufadurer's speafications. Yes� No ( ) Yes Q� No ( ) �� - Yes � No ( ) Whsn instalt�tx� a nsw ventins� svstem, the undersigned hereby vesifies that � is � listed assembly and meets ttk currerrt codes and manuFac�t�ers specificati�s. Tftis does indude AGv4-GAMA Categary ! Cer�ral Fumace `� Venting Tables for fan assisted and natural dr�dft appiianoes. Y� 1�y Is the c�mmon vcM and vent connectors sued and �stalled �► afte�' an appliance has been r�emov+ed from U�e commcn vent and v�ented separatdy as per current codes. No ( } Yes No ( ) �liance 'iWQe u�d S�elComnnon Vet�t and Veot Conne�tor Information Appliance #1 7ype �•e�✓4t-� BTU Input �l� or Nat Apptfance #2 Type ��� BTU Input �O or Appliance �3 Type kr-rrz a► L BTU Ir�ut ,00�O an � ted vr at Total Appliances �_ Tdal Btu Input �yr� � � ,, Common Ver►t Type ��� lc�ve�"� VeM He+ght �� Diameter , L inct++es Appliance #1 Vent Connector Height -3 ft Length �ft Diame�eer in Type �, r Appliance #2 Verrt Connector Height �_ft Length �.b ft Diameter in Type i Appiiance �13 Vent Connector Height .CS'•• ft Length Z ft Diameter �in Type ALTERA7IC?NS• (DesCrib�l HEATIIdG CO: Signed By: / �� �y��- ,: , ,� �0i£0 ' d .131Q I2J� �0 J,l I� LZ : Z t b00Z-Z i-(10N