AF - 45961/
SUBJECT PERMIT '�
City of Fridley 13155 �
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � RECE .
� 1 L______ COMMUNITY DEVELOPMENT DIV. ��� I�
r � � PROTECTIVE INSPECTION SEC. �,
'` � �"��1 � CITY HALL FRIDLEY SS43Z NUMBER REV. DATE PAGE OF APP OVE V
""'� � ,'� 612-560-3450
910-F15 8-2 —7 � �
JOB ADDRESS
6660 HICKORY
1 LEGAL LOT NO. BLOCK TRACT OR ADDITIOM SEE ATTACHED
DESCR. 1& 2 6 FRIDLEY PARK sH�er
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
WAYNE FRIDAY, 1016 BUNKER LAKE DRIVE N.E. HAM LAKE TOWNSHIP
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
FRIDAY CUSTOM HOMES, 1016 BUNKER LAKE BLVD. N.E., ANOKA
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
HOUSE & GARAGE
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
CONSTRUCT HOUSE 48 x 26 x 20
GARA
9 CHANGE OF USE FROM TO
STIPULATIONS �ARNING
PROVIDE VERIFYING SURVEY 8efore digging cail locai utilities
ROVIDE HARD SURFACED DRIVEWAY TELEPHONE - ELECTRIC - GAS Etc.
5EE SPECS ON ROOFING & FIREPLACE
WATER: STUBBED IN — 21.6' N.W. OF HYDRANT REQUIR�D BY L�kW
$$.9' N.W. OF STOP BOX TO THE SOUTH ON HICKORY w,
EWER: STUBBED IN FROM ALLEY TO WEST D�OR W�R�'v��
25' SOUTIi OF M.H. ALSO RE�UIRE
i$EX sao.a5 utn of M.x RA.�E p�RM� NG ANp SIC�NS'
8a5.69 SEP ��NG, P1.i.1Mg1
EA
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, 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 OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO C'iIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAI LAW REGULATING CON-
STRU I N OR THE PEfiF RMANCE OF CONSTRUCTION. $SZ.S9 325.00
, __� PLAN CHECK FEE TOTAL FEE
'°�� ' 3 5 .19
SIGNATUREO CONiRACTOROR O IZEDAGENT IDn E� HEN PROP� VALIDATE THIS IS YOUR PEFMIT
8-26-75
SIGNATUREOF ONs �'_RIIF OWNER BUILDERI IDATEI BLDG WSP � �► DATE
, • l
� .� � . . . - • ' . . .
� � ' ', � . •APpLICATION FOR R�:SI�DI�NTI/1L., ALTL'RA1'ION, '
OR AllllITION.BUILDItiG PLRI�IIT
• C�TY OF FRIDLL'•Y, h1�NNESOTA •
- ,�. -
OWftER' S NATiE •,�" 1 �, � � Buziv�R: �' . �-, , � � ��'i �-�S:
, /_/`
ADDItESS • i^ .DRES� : �� %� .� ���L�P�1" �"�c � r/
. .
ffjZC �Q- . �Lt��, ���
NO:. C� STREET:
�,pT• BLOCh• Cp ADDITION• � �'
. — ,, � � � /
COItIvTER LOT: INSIDE LOT:__���.—SETBACK: ,� SID�YARD:�
N�� - .S .�.. . � �` � 3� - ij,',� �' . , .
licant a.ttacr. �o this fox�r, �ao Certificates �f Surve .of Lot and.pxoposed
App . —
building �ocation drawn on these Cextificates. .
0
� �HESCRIPTION OF BUILDING
, 2�
To Be Used As : Z�
• � , � � i � i/ �
v. .
� �, , ;', ... ��.� �`,�Fxont • � D De th • Height •
. . - � � �� ,� f . �d�
, . Square Feet : % � � bic . Feet : % %�� �
� • �d`� � Front :_� ;�� Depth • ZZ , � Height • / a
.. � Squaxe Feet; G Cubic Feet• ���l�U
. . . . . �; ;
' Esti.ma.ted Cost: ,� �� 1�_______� :
. ljtpe� ot � Cons truction : �c �/ .
To Be Completed: �i�2�T� �1 . � . � . . � . ' •
• The undcxsigned hereby makes applicativn for a pennit for the �oork herein
speciiied, a�reein�� to do all �oorlc in stiict accordance �aith the Cit}• of
Fridley Ordin�nces and rulinss oi tiie Department of Buildings, and her�by
declares that all tlie facts and representations stnted in this application
axe true and corxect.
� �_ � • � ,� ' . � ' , ,6 / ` � .
� • DiATE : � " �`' � - � ' SIGNATURE • � � � �.�'.�' � - .
� �, .
(See I{evexse Side For Additional Information. )� .,%� .
�g� 6�1� � !• �� = 'Sl. 8q � t�'•$ v ,q� �+� . . '
.��, 30 � i � � •
� . 3 G. t.00 u .5� ` , .
.
• � . ;. 3 �� , Q�u�- °'r- �� �" „ ,, � .
/�
s ' �39.s•�5 ,� , � . � , � � .
. . . �.
.
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� . BU1Lll1Nli 1'.L'1(l�ll1 !�L'L' J1.111:UUt�� �� '�'
• ' ' . ' . • � i
. � �
� S�CTION 2. Tl�c Inspector ot Buildings �i�all, bcf-.ore issuing permits for the
execCion ot a.ny building or structure, ox for any addition to any existin�
buildin� or structure, or for any altcration ox repairs to any existing
� building ox struc.ture, upon application theretore, require the payment by the
applicant Lor such pennit of fees to �he arr.ount herein bclow set forth and i�
the manner herein provided to-wit: . , .
UPiIrORt�i 3iUILDII3G COD�: �pe 1, 2& 4-$2.15 for each one thousand cubic
ieet, or iraction thereof, in such cubical contents. Type 3& S-$1.85 for
each one thousand cubic feet. - �
ADDITIONAL I;VFORI�SATION
For the purpose of computing fees rox building permits, the cubical content•
vf any builcting or addition, is determined by multiplying�the ground area
• covF�xed from a point six (6) inches below the floor line of the basement �
ox the cellar to•the average heights of the upper surface or to the average�
�height of the�roof surface oi the main gable of a pitched roof.
For repairs .or alterations to•an existing structure, the fee shall be at the
' rate of $3.00 per each five hundxed dollars ($500.00) or f�:action thexeof in
the cost of all proposed work. ' .
In no case shall the fee charged for any permit as set forth in Section 2 be
�less than $5.Q0. � .. � '
VERIFICATION OF FOUNDATION
• i
rOTE: Permits for construction will be issued.a minimum of 24 hours fror:: the
time of applicaCion, to allow for proper review of the proposed stxucture and
of the c�nstruction site. • "
A Cextified Suxvey of the lot, showin� the location of the foundation, once it
has been constructed, will be required before proceedin� wi.th the framing.
. ,(:�n1'I r I CaTE OF � OCCUPANCY �
Application for a L�C.'Ztl�].CACC pf Occupzncy shall be made ten (10) days prior
to tlie usc vr occupancy of any structure for wl�ich a buildin�; permit has been
issueu; �nd said structure sliall not be used or occupied until a Cextificate
��i: Occup�ncy lias vicen issued. . . •
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� . - ' � CIVIL ENGINEERS
p H.C: NOlUM. AK� �ASS�GIATES, . I�C.� �.�. . ..: ��o ��R��YORs
.
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� Iq30 CENTRAL AvE. N.E. f Hwy.6a)�-BLA�N�.MINNE30T� 66434 . 8�4 80
. . ❑ TI2 3WTH MAIN 3T. — CAMBRID�E .MINNESOTA �00@ . � � fi89�4T98 •
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'�MORTGACE LOAN CERTII�KATE: �R I DAY -- V U STOM .!"1 O M ES :� � y`� �--. _�-��
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_� _- CONCRETE O : 1 `.'1''�'�� .� �, : ��� ' `-.. -
.. .�6 __. BLOCK.— , Z :. � : � � � � � � .
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LEGAL DESCRIPTION: , . K::..,:�",. _ ,f �,,t -w
�� Lots 1 5 2. Block 6, FRIDLEY PARK, Anoka County,`Minnesota. � - �
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THIS IS A►lAT SMOWMIG TME �OUNDARtES O� TH! LAND A�OV! DESCRI�[D AND O� TNL IOCAtiON O� All tUfIDiNGS, IT ANY,
TFIFREON, MJD ALL VISItIE ENCROACMMENTS, If ANY, iROM OR ON SAID LAN0. NQ UANtRY IS ASSUM�D DfCER Td THf HOtDER
Of A MORTGAGE tO/W HOW �EMKi /IACED ON 7M! ►RO�ERTY OR ANY OTHER WTER[ST ACQUIttp tY TM! REASO►! Of SUCN
MORTGAGE R IS UNDERSTO00 AND AGREED NO MONlJMBiT3 HAV! �EB�1 ►IJ1Cl0 ►OR 111/ lURrp�R 01� SiTAMlSF!!!O LOT LiVEb
OR iOUND/1RY CO�MI�S. . '
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a►r� n+is .__..4th.. a►Y or ....... .....���t.x��X ...._............ �.o. �� 75 ,
� N. G HOIUM AND A QATES, INC.
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PUBLIC WORKS DEPARTMENT
CITX OF �'RIDLEY
October 20, 1975 �
4:00 p.m.
Re: Driveway at 6660 Hickory Street N.E.
Mer1e Longerbone, Water Department Foreman, talked with Builder
of this property (above date and time). He informed the Builder
that the City will not be responsible for replacement of black-
top, if the hydrant needs any type of repair. _ �
Also, the owner will be liable for any damage to the hydrant '
caused by said property owner. �
�, �/
RALP VOLKMAN
Superintendent of Public Works
cc: Building Inspection File �
Public Works File �
Contractor: Friday Custom Homes
1016 Bunker Lake Baulevard
Anoka, Minnesota 55303 -
(Tel: 757-2098) `
Crt o r��tle
� �
ANOKA COUNTY
560-3450
6431 UNIVERSITY AVENUE NE October 31, 1975 FRIDLEY, MINNESOTA 55432
Friday Custoan Homes
1016 Bunker Lake Boulevard
Anoka, Mn. 55303
Re: Final Inspection at 6660 Hickory Street N.E.
Dear Mr. Friday:
A final inspection was made on October 31, 1975 of the above address. The
following items were noted and must be completed before the construction
can be finaled out;
l. Reduce openings in guardrail on deck and back steps to 9 inches.
2. Replace missing nuts on anchor bolts.
3. Install house numbers.
4. Correct bZacktop driveway to comply with Fridley Public Works
specifications.
We will expect the items noted above to be completed by No�ember 17, 1975.
If any problems arise that will prevent you from completing these items by
the appointed date, pZease contact us.
A reinspection will be conducted on or about November 17, 1975 to determine
compliance.
Sincerely,
� � , �� )
;� ;
_ ,,/ j' � I��
�
D � G. CLARK
Community Development Ac�n.
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5 ATE OF MINNESOTA
D�rARTM[NT 0/ NUMAN fERVIC[S
444 LAFAYtTT[ ROAO
I,_ ��_ a7 -� fT. rANL. MINN[fOTA •5101
Date
Citv of Fridley
Zoning Authority '
6431 Universitv AVe. N.E.
Street Address
Fridley, MN 55432
City State Zip Code
RE: ZONING NOTIFICATION OF APPLICATION FOR LICENSURE
Subject: �-���
Name of Day Care Home AppliCant
� � 0 � , rv. �
Street Address
� � i� . S S 3 �-
City State Zip Code
�- � r-�. .�..�,,�,
DBS-2722 (9-85)
PZ-02722-02
i- �-y -��
Type of License:
Family Day Care
Group Family Day Care
Licensed Capacity ,n-,�
Phone No. � 1 1- O 3 I i
This is to inform you that we are in receipt
licensure under Minnesota Rules, parts 9502.0300
Rule 2), Family Day Care and Group Family Day Care
this license is subject to compliance with the
Statutes, Sections 245.781 to 245.812 and 252.28,
the Public Welfare Licensing Act and the rules of
Services.
of an application for
to 9502.0445 (formerly
Standards. Issuance of
provisions of Minnesota
subdivision 2� known as
the Department of Human
You should note that under Minnesota Statutes, Section 245.812, Subvision
3, a licensed day care facility serving 12 or fewer persons shall be
considered a permitted single family residential use of property for the
purpases of zoning. Subdivision 4 of the same section indicates that a
licensed day care facility serving from 13 through 16 persons shall be
considered a permitted multi-family residential use of property for
purposes of zoning.
If we do not hear
will consider the
your local zoning
Sincerely,
from you within
above-mentioned
code.
Kathy Speggen/pf
Licensing Worker
Street Address
30 days after receipt of this letter, we
day care home to be in compliance with
COMMUNITY H�ALTH & SOCIAL
SERVICES DEPARTf�1ENT
COUNTY OF ANOKA
COURTHOUSE, FOURTH FLOOR
Name o A ency Organization
City State Zip Code
AN EDUAL OPPORTUNITY EMPLOYER
sue�ecr P IT Na.�'�..,,.
City of Fridley 2 0 8 7 5
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
i �
� � '
� • COMMUNITY DEVELOPMENT DIV. �
r � y � PROTECTIVE INSPECTION SEC. j( L� `.`' r 3•�
i �
� ' /"'1 � CITV HAL� FRIDLE� SS432 NUMBEp REV DATE VAGE Of AVPROVED 8V
�""'��� ,�� 612-571-3450 910-F15 6/14/91 / /
J08 ADDRESS 6660 Hickory Street NE
1 LEGAL �OT NO. BIOCK TRACT OR ADDITION SEE ATTACHED
oescR. 1,2 6 Fridley Park SHEET
2 PROPERTY OWNER MAIL AOORESS 21P PHONE
Eldon Nelson 6660 HickoYy Street NE 571-0317
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS Z�P PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW �] ADDITION ❑ ALTERATION ❑ REPAIR O MOVE � REMOVE
8 DESCRIBE WORK
Construct a 16' x 10' Deck and a 12'' x 10' Deck
9 CHANGEOFUSEFROM TO
STIPULATIONS
�������
Befure digging call for
all utility locations
a54•0002
SEPARATE pER��rs REQC�IRED BY LAW
WfR1�,�G► H�A i I�,�c� �_ t RF(?IJrRcp F�R
� � �: U .� ivi.)
S1GNS.
TYPE OF CONST. OCCUPANCV GROUP OCCUPANCY IOAD
SEPARATE PERMITS ARE REQUIRED FOF ELECTRICAL, PLUMBING. HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NUIL 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 OR ABANDONED FOF A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ ANO EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK Wlll BE COMPUED $2�650 S�-•33
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 LOCAL LAW REGU�ATING coN- $54.00 Fire SC $2.65
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PIAN CHECK FEE TOTAL FEE
$57.98
/ S�GNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEi WHEN PROPERLY V DATED THIS IS Y� ERMIT
� 1� .�� � �, /c
��� � S� ATUAE OF O NEA iIF OWN BUi�DE� R� iDATEi B�DG �NS� � �� E /
� � � EffeCtive 1,/1/91
ADLN [XJ R-1 AND R-2
ALTIIZ [�Q Buildir�g Pezmit Application
•.:ti . .. -
_.. ��« . .
� 07. ��'� C,,�' w . � /� � �`��� �/ d'�^i^-�2
OW7)ex' Naine & AdciL�es.S: �� O�o r� �N � lSa vl Zpl. # S 7/'-� �� 7
G�tractor: /L// /�' Za1. #
Addr+es.s:
Attach to this application, a Q�rtificate of �vey of the
lat, with the p��os�d oonstnr.tic� drawn an it to scale.
�«
•T•
�1.�i�a� �.�C ��
�
.{.
I.NII�G AREA: Iergt'h Width ;:: Heic�lt SQ. Ft.
t�RAGE AREA: Tp*� h Width "H�.ic�1t Sq. Ft.
D�G[t AR�: ^�[,es�gth ! b Width � C� r�. Hgt/c�+o�u�ci l� sq. Ft. / o
o�: j z. , G .. � � ��' 3� r'1
3S�k �.SGz 2�53.sb .
Gbrner Iat j� Inside Lo�t [] Ft. Yd Setback �.: �.� Side Yard Setbacks
Z'ype of Ooa�.structioaz: , Fsti.mated Oost: $�'�Q � 2.Cn 5 0
P.pprox. oc�letiaai Date: 7��'/�1
Proposed Driveway Width If New Openirg Is Desired:_ Ft. $ $
/ Width + 6' See BacJc page
DATE: ��/-` � APPLIC�INP: � �l�d l�i � ��-21 So n% 'l�el . # �S � � �'(J � / %
CI'PY � �II,Y
. . � � - .. r' .
PeYmit Fee $ ��-i,:i� �-. F�e` Sci�edule an Revezs� Side
Fire S�rd�arge S �� �'a t�, j.; � 1�- ; i x Permit valuatior, ( i/ioth �)
state s�arge S . 1, "3'� � �': �o/S�, o0o valuatiori
SAC � . , ; . .. $ -� :_ ';$650 per SAC Unit
Driveway � ;$� � �� `�Alt. "A" or Alt. "B" Abvve
Park Fee . S � , ,^F'ee Dete�mined bY IIxJineerir�g
sew�er Main Q�ax9e S ,�` Ag�e� Neoessa�Y [] � N�-�Y []
To►r�., s ��7 •" �
_����1 : M .,�.
.
�
2G�J
Z.� oc,-- 4�,0�
��� �
�
SU�?U
:�1 � � � f ' .i'. � - _�: : �:I:r� 11 :
�e Qiief Buildir�q Official shall, befa�e issu.ing �*�; ts far the erecticai of z�ny
buildi� or stn�ure, a� far any addition to any e�tisting building ar stnu:ture, or
for ariy alteratian ar� repair to any � buildir�q or struc.�ture� u�z aPPlicatian
therefore, =+equire the paym�t by the applicant far ar� pezmit of fees to the a¢na�mt
2yerein belvw set fc�th and in the mat�ez� i�erein pYwided to-wit:
'I�,L VAIIJE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
� a.
$15 (Minimmm F�ee is $15 plus aizrhan�e)
$15 for first $500 plus $2 for eac3i additional $100 or
fractia� thez�eof, to ar�d i�cltrlir�g $2, 000
$45 for fir5t $2,000 plus $9 for each additi�al $1,000
ar fraction the.re�f, to and ir�cluciir�g $25, 000
$252 for first $25,000 plus $6.50 for each aciditio�al S1,000
or fracticn thel�eof, to ar�d it�Cludit�g 550, 000
$414.50 for first $50,000 plus $4.50 for earh additional
$1, 000 ar fraction the.r+eof, to ar�ci inCludiix3 $100, 000
$639.50 for first $100,000 plus $3.50 for eac31 additional
$l, 000 or fracticn tt�reof, to ar�d includis�g $500, 000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional
$1, 000 or fraCtion thel�eof, to ar�d is�cluding $1, 000, 000
$1, 000, 001 ar�d ug� $3539. 50 for the first $l, 000, 000 plus $2 for eac� additional
$1, 000 or fractiatz thereof
DRIVEi�IY ffiPi�'BSIaN F�W
(Dancret,e C1irb Streets �lY)
Alternate "A�� : RQnoval at�d replao�ent of cR� and gutter only - DriveWay width plus
6 feet times $13.50.
Alternate "B" : Removal ani replao�nt of a�b arxi gutter ar�d install a 3 foo�t wide
approach with 6 irx3� c3epth - D�iveway width plus 6 feet tia�es 515.75.
\���+; �;� v � � , •r �� n,���; M ! �
Pelmits foz' o0�.stn�CtiC[1 will be is.SU�d 8 mini,nnn of 24 ho1115 fY�om the titne of
application t,o allcw far p�aper review of the proposed stYVC4ire arid of the
aon,structiari site.
A Oertificate of S�uvey of the lat, showirg the location of the fau�ciaticn oa�oe it has
it has i�eeiz vonsttuc.-ted will be required before pr�ooeedinq with the fYaaairg.
s
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THIS IS A►LAT SMOWING TM! �OVNDARIES Of TH! IAND A�OV! DESCRItED AND Of T}it IOGATION Of Atl iU1tD1NCrS, t� ANY,
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THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
C(�MMnN VFNT� V NT _nNN _TnR AND nMBIISTInN AIR VFRIFI ./.1TIC)N
VVhen r� In acin�an Pxisiin,� f�rance, 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 plastiGPVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination.
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The PYi� inp ceme��tien air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to instau a new ceme��t�en air�it will be sized and installed
to meet the current codes and manufacturer's specifications.
Whet1 ins allin� a new ventinQ�v� m, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for 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(�o( )
Yes (�( )
�.. .. .- .�. - .����.. -. ... -� .�.-«. . ..��. .�
Appliance #1 Type BTU Input
Appliance #2 Type BTU Input
Appliance #3 Type BTU Input
Total Appliances Total Btu Input
Common Vent Type Vent Height
Fan Assisted or Nat
Fan Assisted or Nat
Fan Assisted or Nat
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
/1 . .. — .9 _ . n
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HEATING CO: � ��
Signed By: Date : f �' ��" U Z
"�`�:::;:
r, Engineering WATER AND SEWER Pe�t No.: -
� i�63-572-355 i pE��T APPLICATION Received By:
763-571-1287 fax CITY OF FRIDLEY Da� �'a: q-R-pq
EFFEC7TVE 6/9/09
APPLICTATION DATE: �`�� O` YOUR E-MAIL ADDRESS:
THIS APPLICANT IS: O QWNER �.CONTRACTOR
JOB ADDRESS: i�d _ G G G± �� c.� O tic, �/ S� AJ i
NEW CONSTRUCTION PERMIT�! (IF APpLICABLE):
PROPERTY NqME;��,� N�e iso-r
OWNER/ ADDRESS: S .q-,.-�-
TENANT Cl'1'x STATE ZIP
PHONE: �T � 3 $' 7/ b 3�'�7
CONTRACTOR xq�,,,�: ��t� i�� 5 e.� r i%/ � w.l� �.,,.,
SUBMITA COFYOF ADDRESS: I L'�-2S' N'S` hy �:.� .�y�¢� C � u ry ��STATE�.yZIP�Y
YOUR STATE
LICENSE R?TH PHONE �°/` 2- �Yc %�'?9 � CELL PHONE: �'7+'`�''�;
.lPPLICATION STATE WC # b G//,b. STATE BOND: '�. EXP DATE: � 2-7 /•� oq
1. Narrative/written descri�tio • _ „
��+..� .,Q.z,�
2. Ptease attach sketch showing cnrb tiue, utitity line, buiM�ng, etc. with distances.
PERMIT TYpE
0 SEWER CONNECTION PERMIT �50
_ PERMIT a50 � �
p�WATER LZNE REPAIR �40 �O
SEWER LINE REPAIR $40
Q ADD STATE: SURCHARGE S.Sp �� '
❑ SAC CHARGE � �2000 = �
OTHER CHARGES (IF APPLICABLE) PAY TO UTILITY BILLING
" NEW WATER METER CAST — SEE UTILITY BILLING
� SPECIAL ASSESSMENTS — SEE FINANCE
WATER TAP — SBE ENGINEERING
NOTE: WATER METER REPAI TNSP OR SHUT-0FF / wEEKENDS & HOLIDnYS $125/HOUR-BILLED
THIS IS AN APPWCATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a water or sewer (new connection or repair) permit and I acknowledge that the information above is complete and
accurate; that the work will be ia conformance with the ordinances and codes of the City of Fridley. I understand this is not a permit but
only an application for a pernut and wo is not to start without a permit.
SIGNATURE OF APPLICANT PRINT NqME: t/!G DATE: /—�'- �' /
APPROVEll BY: DATE: ��� �Q
COPY GIVEN TO: ❑ sI�.�L�1vG (on�y it n�w meter) 0 PUBLIC WORKS ❑ ENGINEERING
.��� c.�%+il� City of Fridley
�,�0 7(03 Engit�eering Department
6431 Univeisity Avenue NE, Fridley, MN 55432
763-572-3551
FAX: 7�i3-571-1287
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