AF - 47210•
u
•
City of Fridley, Mi.nn.
BUILDING PERMIT
Date: _.._..._.___ ftov. 8a.. 1967 ._.__._._._.�_..�..
� �� � ��
�1T� 9546
Owner: _. D�x....H._.... T. Aeziman...__.._..__ ..� Builder _.__._Same ...._._._._..._.---_...___.._...._._...._..._._..._.._..__.—
Address _6814._.Hickox� Driv_e�_.__.._...._._.___...._.._ Address .._.__Same .__......._.�_._..._......._......__._
LOCATION OF BUILDING
No. _. 6814..._.__.. Street .�_. Hickory..._..________._..._....__..._._._.._.._._. Part of Lot ._._..
3 Bl 1 ddi S b D'vi ' Ostma�s lst Addn.
Lot _.._....__._.__._...._ ock _.____.__.._........_.._..._._.._. A tion or u- i s�on ._.._..._.._.�_�
Corner Lot _.__.....----..�._ Inside Lot _._.._.._.._...._..---._.._ Setback ._.._..__._._..._._._._.._ Sideyard
Sewer Elevatio� _._._.._..._.._._.._.._�._......_.._...._.___...._----__.._ Foundation Elevation _...__...._.
To be Used as:
Gara e
___.._._. _.S._..__..._ Fro�nt _._
_._._..__.._....__.._........_._...� Front _...__
Frame
Type of Construction _..._......._..._..__.
DESCRIPTION OF BUILDING
2 0� Depth _.._..?? � Height .__1 ��..._ Sq. F't. 440
..._.� Depth _._---.__._.. Height _.._..._____ Sq. F't. _.��_
$2000. To be Completed
__._.____.. Est Cost _..••---._.._............_........._. _.
� � 4400
Cu. Fk _._
In consideration of the issuance to me of a permit to construct the building described abave, I agree to do
th� proposed work in accordance with the description above set forth aud/ in compliance�tyith all provisiiona of
ordinances oY the city of FrfdleY• '�. � /� '
In ca�sideration of the payment of a fee of ��_._.Z...QS��_._.., pexmit is hereby granted to Dr. fl. T.
Aeziman to construct the building or addition as described above. This pernut is granted upo�►
the express condition that the person to whom it fs granted and his agents, employees and workmen, in all wark
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinaaces o�
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and mavin8 of bufldings
within the city limits and this permit may be revoked a t aqy time upon violation of any of the provisiana of said
ordinancea
CLAREftCE BELISLE B�� �
NOTICE:
Yhis p�rmit doa ne� eowr th� eonsMneHoe, tn�allMten fer wir6�9. Plumbino, ya h�aNn�, s�wK or wat�r. d� wn to tN
th� Buildieo In�p�efor for ap�ral� p�emits for Hna N�ms.
�_ -.
APPLYCATION FOR BUXLUTAIG PBRMIT
C2TY OF FRL�LE7t, MINNESOTA
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OiiNEB'S IOAI� U�.. �..�L�.�.11��..�.....,.-. �... . ��UILDEx,...... �� �£.,._...._�.�....._.._�..
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p� � '�.C� � '� �� BTitEB'l� • � � ' >.. , y ' � a�ttT' OP � ' +� t"----_..
�, BZOCK ADDITION OR SUSD S�Q1� t ' j'" s f"' Ha�� �', �o
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SBWBit BLEYATION F�►Txo� �,gva�tc�t
Applicant attach to thi� fosm Toro .Cestiiicates o€ Swcv�eY of I.�� and ,pro�osed
buildii�g-:rd�at�ot�:c�safii�':~��a-:�tili�s��.�e=C�f3.cafei,,.,:�., . - ��x �`•
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Tqpe oi Constructiod •� n:�» P � �stid�t`ed CoaE ..�- �� ,.>
�+���w ��rY�r�r��
TO B@ GC6�l1@t8d
The uadarsi�ed hereby makes spplicaticn for a psrmit �or t1�R v�rh l�siu sp�eiti�d,
agresing to do ail work in stti�t accordanc� vith the City of Fridley Otdluae�ss
aad rulings of ttee Departaient of Buildiugs, and berebq daclare� Cbat all t6e �acts
and representatians stated in this applfcation are truQ aad aos�rsct.
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(Schadula of Fas Costs can bQ fou�nd oa the Aevefcs• Si�1e).
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CITY OF FRIDLEY
aPPLICATION FOR POWER PLANTS AND HEATIN�, COOLIN6, VENTILATION, REFRIGERATION AND
AIR CONDITIONI�G $YSTEMS AND DEVICES
PARTIr'�L RATE SCNEDULE
GRa�'ITY l�aR:�l AIR: RAiE TOT�1L Job Address
fsrr.ace S :ell & Dnct Work $12.00 $ --
F.e�laca::er.t of �rr.aca �' �� $
32j73irs a. Alteraticns-up to $500.00 � �-�0 S . Dcpartment of IIuildings
Repairs 6 Alterations each add. $500.00 4.00 S City of Fridley
Tel. #571-3450
�fECH.a\ICaL iVaR�1 :\IR.:
Flirnace Shell & Duct Work to 100,000 BTU
each ad3. 50,i.00 STJ
Re�lace:r.e�t o-". Fur^ace
Rerairs S nl�erstions-up to S50C.00
nepairs s Alterations each add. $500.00
STE�.�I OR HOT �ti:aTi:R SYSTL?I:
Boiler & iines Lp to 100,0��0 BTU
eac� ac::n. SO,OGO s:�
Boiler o.^.ly up to 100, 000 BTD
eacn addn. 50,000 STU
OIL BURXER- to 3 gal. per hour
each aCd. 3 gal. pe� hour
GaS 3UR\ER- fro:a 100,000 3TU to 199,999 STU
(over 199,999 BTU see ree Schedule)
$12.00 S
4.00 S
7.00 $�
�.00 v
4.00 $ -
$12.00 $ �
4.00 y �
7.00 $
6.00 $
$�o.00
10.00
slo.00
GaS FITTIAG FEES:
lst 3 Fixtures x$ 3.00
Additiozal r^ixtures x $ 1.00
Gas Rar.ge to 199,000 BTU • x$1C.00
.�IR CO\DITIQ�:\G �
F?�:: HEaTI\G S1'STc?1S �
_ � See Fee Schedule
�'E\TILaTI\G SYSTE�IS
ALTER�TIO\S �, REPaIRS
' State Surcharge
RAUGH ID1SP.
Date
FIIdAL INSP.
D3te
.1PPR:JV.aI. FOR PER*1IT I TfFA
TOTAL FEE
REINSPECTION FEE
(.$10. 001
MI23Z.KUM FEE FOR ANY HEATING PER+IYT IS $7.50
s
;
$ �D.lr�
S
$ 3.�
S
S
$ io, o0
S
S
S
$ 50
;�fV•�JU
�
The undersiqned hereby makes application for a permit for the wark hezein
specified agreeing to do all w�rk in strict accordance with the City :.ozes
and rulings of the Depart�nent of Buildings, ar.d 'nere'�y declares c�at ail the
facts and representations stated in t:�is application are true and correc�.
OW.7ER
FriAl�v_ Mi
1—� �97�
, � i
KIND OF BUILDI:JG
USED AS
TO SE COMPLETED ABOUT %�,'� 3/�' / G
/,�oo �
ESTIMATED COST
OLD NEW BUILDING PERMIT NO. PERMIT I30. ��
DESCRIPTION OF FURNACE/BJRNER
HE}1TING or POWER PLANTS, Steam, Hot Wate , Wazm Air- o.
Trade Name ������j Size No. ��1,�% �
Capacity �� �BTU HP
Total Connected Load �i Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR $� Hp
%��C/�.X�-��' "'� � ,C.(/�'� � Company —
A '� Signed By f
�� � � �� .
.�_XJ����{�/� . Tel. No. ✓ 3 �
�� � '
�%
sus�ecT PE NO.
City of Fridley 18759
�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
; � REC .
� • COMMUNITY DEVEIOPMENT DIV.
� j V �"�� ,
r � � PROTECTIVE INSPECTION SEC. �? U�yCJ
1 . , J l 1
�
' � �'��1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�""'� � �'' 612-571-3450 9�0-F15 12/8/86 / /
108 ADDRESS 6814 Hickory ��� Street N.E.
1 LEGAL �OT NO. BLOCK TRACT OR ADOITION SEE ATTACHED
DESCR. 3 1 Ostman's lst Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Ellsworth Mystrom 6814 Hickoxy Street N.E.
3 CONTRACTOR MA1L ADDRESS 21P PHONE LICENSE NO.
Builders & Remodelers 3517 Hennepin Avenue, Mpls. 55420 827-5481
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE UCENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Res idential
7 CLASS OF WORK
❑ NEW ❑ ADDITION l� ALTERATION ❑ REPAIR ❑ MOYE ❑ REMOVE
8 DESCRIBE WORK
Reside Dwelling
9 CHANGE QF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKfNG
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION �" STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORfiECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $6,425
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3.21
OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PRO ISIONS OF ANY OTHER STATE OR IOCAL LAW REGULATING CON-
STR CTION R THE PERFORMANCE OF CONSTRUCTION. 62. SQ
/ PLAN CHECK FEE TOTAL FEE
a -�'-�(O $65��1
. SIGNATUREOFCONTRACTORORAUTMORIZEDAGENT IDATEi WHEN PROPER�Y UDATED THIS IS�YOUR PERMIT
., /
�
S�GNATU�7E OF OWNE�711F OWNER BU�LDERI IDATEI BLOG �NS� TE
N�' [ l
ADDN. [ ]
pLTER. � J
Constructi�
Legal Desc�
Owner Name
Contractor
Address
City of Fridley
�R-1 AIiD R-2
Building Permit Application
Effective 4/1/86
Attach to this application, a Certificate of Survey of the
lot, With the proposed construction drawn on it to scale.
DESCRIPTIOp OF IMPROYEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECR AREA: Length Width Hgt/Ground Sq. Ft. __
OTHER: � ' �
Corner Lot [] Inside Lot [] Ft. Yd. Setback _ Side Yard Setback
Type of Construction: Estimated Cost: � n`��-
Approx. Completion Date:
Alt. A Alt B
Proposed Drivexay Width If New Opening Is Desired: See Back Page for Explanation
[�
DATE: /� � � APPLICANT: Tel. � � '� `51��r
�
CITY QSE ONLY
Permit Fee � ��� Fee Schedule on Reverse Side
Plan Check $ 25� of Building Permit Fee
State Surcharge � �•�i $.50/$1,000 Valuation
SAC Charge $ ��d75 per SAC Unit
Park Fee $ Fee l'ietermined by Engineering
SeWer Main Charge $
Agreement Necessary [ ] Not Necessary [ ]
TOTAL � � S � %�
STIPULATIONS:
SUBJECT •
City of Fridley 2 � 7 g 9�
AT THE TOP OF TME TWINS g U I L D I N G P E R M I T
� ` RECEIPT NO.
� ` __��_ COMMUNITY DEVELOPMENT OIV. J
r � V � PROTECTIVE INSPECTION SEC. •O/„
� �� � VJ
� � ��"1 � CITV NALL FRIDLE� SS0.32 NUMBER REV DATE PAGE OF AViqOVEO BY
�""�' ,'' 612-571-3450 9�0-F�5 9/15/98 / /
J08 ADDRESS 6814 Hickory St NE
t LEGAI �OT NO. BLOCK TRACT OR ADDITION SEE ATTACMED
DESCR. 3 1 Ostman's LSt SHEET
2 PROPERTV OWNER MAIL AODRESS 21P PMONE
�sxa Ellsworth Nystrom 571-9052
3 CONTRACTOfi MAIL ADDRESS ZIP PMONE UCENSE NO.
Maverick Construction 11227 River Rd NE Hanover -
d ARCHITECT OR DESIGNER MAIL ADDFESS Z�P PHONE IICENSE NO.
5 ENGINEER MAIL ADORESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION �7 REPAIR O MOVE O REMOVE.
8 DESCRIBE WORK
Reroof house & garage (23SQ) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST. OCCUPANCV GROUP OCCUPANCY �OAD
SEPAFiATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, MEATING,
VENTILATING Ofi AIR CONDITIONING.
TMIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTqUCT10N
OR WORK IS SUSPENDED Ofi ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME 9�TER WOAK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIfV THAT I HAVE READ AND EXAMINED THIS APPLICATION STALIS GAFAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VAIUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOiiK WILL BE COMPLIED ���971.00 �.IB
WITH WHETHER SPECIfIED HEREIN OR NOT. THE GRANTING OF A PERMIT
OOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVIStONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- �62.25 Fire SC �1.9I
STRUCTION OR THE PEAFORMANCE OF CONSTRUCTION.
PLAN CNECK FEE TOTAL F E
9 Licen C $5.0 $70.20
si 4TUREOFCON�AACTOAOAAUTHOAIZEDAGENT ♦rEi N P PERL V IDATE T IS IS Y R PER tT
)
� �
SiGNATUFlE OF OWNER �IF QWNE�7 BU�LDEA1 iDATE� BLDG ��FTE
� �
NEW
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: �j�'lL���/G',�//��1� lT'�/ �
Effective 1/1/98
OV , �
�� ��
� �
Legal Description:
Owner Name & Address: �GG�S'y1�Q,e�'� /V�/�"T/2('f�? Tel. # �7/— °,�OS�-
Contractor: ,�1������'����/,ST MN LICENSE # ����2.
Address: �/�.�'7 ,(ij�� �l1� �� f-�,��/, �� Tel. # �q�'—���1
LIVING AREA:
GARAGE AREA:
DECK AREA:
Attach to this application, a Certi�cate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width Height
Width Height
Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft. -
OTHER:
��-,� o���,�� = , 9� -
Construction Type: � , � Estimated Cost: $ � �D'1,
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: .S� �APPLICANT: Tel. � ����?�O/
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ Zs
$ �,�'�
$
$
$ ;S °'�
$
$
$
$
$ �, �
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)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
� �
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� N� Minneso�a unfq�e No.
�a� � . �I./lnnesof8 5faluies.�CnqplBr �0�i . : _ . • ' . or W-series No. �
. . . . Iuaw euM a ngl woovnl
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Nwnshtil Suw� Adorey6 a Fin Nurntlor ana Ctly el Wdi er Bonng locelbn
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snow owa bwtlon a.tin or earina Skv�d+ mvn oi wq� or oerim� AOUKER(6� 9TAnC WATEA �ErEI
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6$ a a H�CBA�Y rS3�' '.� ' 9CNlEWOiEN MOLE
FB�DI.�Y Y� 5 5� 3 2 sa.e� h,,,, �� � 8�i� oaan Nom iron, a �.
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anw«a e,.n p�ep.ny sr�.ia eoerea u+aiaree eeev., lype of Ooevualone (0eecrme)
Oeeuueuone remowe4 ❑ Ves ❑ No OeeerOe
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rot wewe. a�afnm �o e
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FOMIATION
i bptron nesipy �oa aoodn?, r�� � TQ'� �NNUULR9►ACE 9E1W�N 2 CAWN06, OR CN911Ni Itllp Opt� NOLE:
� MO A11f1W�f $paCO EltiilB
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Acco�ding to MN State Regulations
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P.�lT�' SC'�I�Eit1,�1/ KEV T N i K?NIPB
_ ---
.�,,.� � � � -�---
CITY OF FRIULEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective Un Jan 1, 2002
, .
� ,fi j .s„i i
PLUMBING FIXTURE RATES:
NO. RATE
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance �_
Water Heater -Electric
Water Heater - Gas`*
Gas Range"'"
Gas Dryer**
Back Ftow Preventer Required OYes O No
Type
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
TOTAL
�
i �
$15.00 ��.
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
�
$ .50
$ �d•�
JOB ADD
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.
� � , 20C� Z
r
Owner ���✓�'1r� %CS�lP�,3��
Building Used As ��(�E�
Estimated Cost PERMIT NO. / � `7 / /
PLUMBING COMPANY��c l�� (X/!� ��
SIGNED BY � TEL N0. 2� ��'(���lz;/
FAX #
-`�Approved By Rough-In Date y�� at
MINIMUM FEE F R ANY PLUMBING/GAS PERMIT IS �20.00
PLUS THE 5.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
THE BELOW MUST BE FILLED IN WHEN REPL_ACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
COMMnN VFNT� VFNT CnNN _TnR AND C�MRI IRTI(�I� AIR V RIFI ATI(�I`
When r�- la _inq an pYictin0 f�� ranr_P, the undersigned hereby verifies that the
venting has been examined and is free from n.ist, deterioration, obstructions,
and is secure(y supported and firestopped where required. Yes () No ()
The venting system is plastidPVC and meets all current codes and manufacturer
specifications inGuding sizing, length, number of elbows and ter►nination. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The pxie in0 cemb ,� ien air is sized and installed to meet the current codes
and manufacturers specifications.
When required to in�tau a new ceme ��en air�it will be sized and installed
to meet the current codes and manufacturers specifications.
When inc a1Gnq a n_w v_ntin0y�� m, ttie undersigned hereby verifies that
it is a listed assembly and meets the cuRent 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 ( )
YesO NoO
Yes( ) No( )
Yes ( ) No ( )
Yes( )No( )
;.. .� - .- ... - .����.� -� .�. -� ...-.,. ��..��. ..
Appliance #1 Type • BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances 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
� - � •► .- �.-
HEATING CO:
Signed By: Date :
CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2002
6431 University Ave NE
Fridley, MN 55432 APPLICATION EOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS � �� � `-,'� ` � �
RATE SCHEDULE w '
OWNER '�/..rwu, ���-�1--,0-�--
Residentiai
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent • Fill Out Back)
Gas Piping (Needed with new furnace,
but no replacement)
Gas Range ��5���{
Gas Dryer
*Air Conditioning - All Sizes
Alt Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25°jo of Value of Appliance or Work
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
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.
TOTAL y -
BUILDING USED AS ` `� �a'�---�
� !^ J
ESTIMATED COST ���� PERMIT N0. /�..7.�.%��
$
DESCRIP710N OF FURNACE AND OR BURNER
$
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
$ Trade Name Size No.
BTU HP EDR
$
$
$
$ .50
� ��.�
Fuel Total Connected Load
Burner Trade 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 I D f �j (��
HEATING CO � �
Signed �/ �"'� a�u-�—
FAX # So-.�.�..�
Approved By�_ Rough•In Date
TEL # `�T�� �1�� " �o �
��
Final Date f� �a' �
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNiNG APPLIANCES OR THE
APPUCATION WILL BE RETURNED
C`pll�M(�I� ��I`T' ����T (�I�I� CTnR AND .nMBl1STInN AIR VERIFICATI�N
When � ��p an _Yist�r,o �ran , the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped whe�e required. Yes (► No O
The venting system is plasticlPVC and meets all cuRent codes and manufacturer
speafications including sizing, length, number of elbows and termination. Yes ( i No ()
The undersigned also ve '�ies that the replacement unit is a listed assembly
and meets the current codes and manufacture�'s specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The pY�� � S�mb ��t�en a�r is sized and installed to meet the current codes
and manufacturers specifications.
Whet1 requ'tred to ���+all a n_w _emb �e+ien airi it will be si�ed and installed
to meet the current codes and manufacturer's specfications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
�gn jp�,jjjpa a new v�ntin� cue�m, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
speaflcations. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors si�ed and installed correctly after
an appliance has been removed from the common vent and vented
separately as pe� current codes. Yes () No ()
! • • . � - ��' . � • ' • 11 11 • � ' � . 1 • ' � • � /' M • � • �11 . • �
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances 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 �
^ 6 -,
• �� �� � �� � �
r�_
� / � • -
. -. � � •� - �- � � �
/
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
(7631572-3604 FAX: (763) 571-1287
6814 HICKORY ST NE
153024120008
OSTMANS 1ST ADD
LOT 3 BLOCK 1
HEATING
RESIDENTIAL
ADDITION/ALTERATION
PERMIT NO.: 2004-02142
DATE 1SSUED: 12/Ol/2004
R6275
VALUATION '
NOTE: AIR CONDITIONERS ERNCOMBUSTION AIR SHALD BE P OVID DOPER UMC SECTION 504(A) AND ABLE 6-A.
ADJOINING PROPERTY OWN 1
# 0-100 AMP CIRCUITS 0 # A/C UNITS
VALUE OF APPL OR WORK
# GAS DRYERS
VALUE (FOR MINIMUM CALC)
ASPEN AIR INC
(651) 982-2626
APPLICANT
OWNER
THOMPSON GERARD G& WOOD BETH
6814 HICKORY ST NE
FRIDLEY, MN 55432
0 #FURNACES
0 # GAS RANGES
4000
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of constxuc,tion.
e,,,, ;�a�„� ., Date � .
.
/.►�./ � \ �i � . ' �
: � � � _ _ ---
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
ATHLETIC FIELD 0-100 AMP CIRCUITS
TOTAL
PAID WITH CHECK # MASTER
cFpau aTF pFRMiTS RE(SUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
1
0
0.00
35.00
0.00
0.00
25.00
0.00
0.50
0.00
60.50
CtTY OF FRIDLEY BUILDING INSPECTION
6431 University Ave NE
Fridley, MN 55432
763-572-3604 FAX 763-571-22$7
:.: r_ . �
Residential
Furnace Shetl and Duct Work, Bumer &
also Replacement Furnace
Gas Piping (New Fumace� Fireplace, Insert)
Gas Range
(3as Drysr
*Air Conditioning - All Sizes
All Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work
Minlmum Fee $15.00 for Residential or 5% of cost of
Improvement whichever (s greater
Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR COND1T14NING SYSTEMS AND DEVICES
Es� I�1
$35.00 $ �:S 1�
$10.00 $
$10.00 $
$10.04 $
$25.00 $ o� � �
.�
Co m m ercia �( I n d ustria l/ I nstitutio na i
�.2596 of Vaiue of Appliance or Work (Ust on Back)
Mfnimum Fee $35.00 for Commercfal/Industriai/Institutional
State Surcharge
TOTAL FEE
REINSPECTION FEE $50.00/HOUR
$
�-.S'U
, (�
$ � �'v
�,, sv
*Air Corxlitioners can not be placed in side yard without written approval
from adjoining property owner - copy to City
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
✓�
�
JOB ADDRESS C� 1 l l - l� c
Owner � ) f' ���('� L� 11�:►�1L�ifl��'1-n �
Building Used As �\ I �11 f f.�A v o ,
ESTIMATED COST�� o� PERMIT NO
� : J •► � 7 :►.' :.►� :► :
# of Heating Units�_ Circie One (Steam) (Hot Water) arm Air
7rade Name �e��tr"in, Qk' Size No.
BTU rIO rdb� HP EDR
Fuel 1� a"�'�'�a S Total Connected Load
Burner Trade Name Size No.
BTU ' WP EDR
The undersigned hereby makes application for a permit for the work herein
specified �greeingto do ali work in strict accordance with the City Codes
and ruUngs of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
HEATING
�^
. . _"''�'����.�ITI , � :
— � �
/� ✓ � �• �
/' , • � � . -
Approved by Rough-in �ate Final Date
� FILL IN C4MPLETELY FOR REPLACEMENT FUEI. BURNING APPLIANCE PERMiTS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATI.ON
When realacina an existinq furnace, 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 verrting system is plastic/PVC and meets all current �des and manufacturer
spec�fications including s'¢ing, length, number of etbaws and termination. Yes ()� f� No ()
The urtdersigned also verifies tFrat the replacement unit is a I'�sted assembly
and meets the current c�des and manufacturers speciftcations. This doe.s
indude AGA-GAMA Category ! Central Fumace Venting Ta�es for fan �
assisted and natural draft appliances. Y�sc�'� �()
The existlnca combustlon atr is s¢ed and instalted to meet the wrrer�t oocles
and manufacturer's speafications. Yes� No ()
When required to instal! a new combustion air, i# witl be sized and instaNed
to meet the current codes and manufacture�'s speafications. Yes () N� No ()
When installin� a new verrtin� svstem, the undersigned hereby verfies that
� is a listed assembiy and meets tt� current oodes amd m�ufacturers
spe�cations. This does include AGA-GAMA Category I Cerrtral Fumace n
Venting Tables for fan assisted and natural draft �pliance.s. Yes () N/-t No ()
ts the commai vent and vent oon�ctors sized and installed correctly a#t�
an appliance has been removed from the c�ommon verrt and verrted
separately as per cx�rrent codes.
Yes�., No ( )
Aupliance Time and SizeJCommon Vent and Ve�rt Connect�r Information
Appliance #1 Type BTU Input o� Fan Assisted or Nat��
Appliance #2 Type 1�t � BTU Input � Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Apptiances�� Tdal Btu lnput ff�,Dtf1�, i
Common Vent Type Verrt t-��ht - Diameier inches
A�iance #1 Ve�t Conrie�t� Fleight
Appliance #2 Vent Connector He�gh
Appliance #3 Vent Connec�or HI '�it
��ft Diame#er in Type
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MECHANICAL
RESIDEN'�'NAL ApPL��CATIQN
CITY O�' FRtDLE''Y
Permit No.: �
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City uf �'ridl�y
BuildiriT l�ean�etit�ns Dep�t-tment
6�i;; !.'ni��ertiit} <����nu� \l:. l�ri:3ie��, h9N ;�4:��
7ft �-572 •.if,ll��
F�1X: ?Gi-`�q���+�?7
Wd 9£�9£�Z 900Z/£/6!. :a�ea � :a6ed 8£L9tiSti6S9 :wa�
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Date: 1Q/1312006 Revision Date: 10/13/2p06
Site Information
l�lddress 1: 681� Hickory St NE Project #:
Address 2: Lot: Black:
Gity: Fridley County: Anoka Subdivision:
Aoelication Infonnation
6usiness Name: Aurora AAechani�l MN Contractor �icens� #:
Cantact Persnn: Brayden
O�ce Ph: 651-455-6324 ��x: 651�454-8138 Cell Ph:
Address 1: 4�1 ANarble Lane
City: Eagan State: MN Zip Code: 55122
Existing ConstruCtion: P�e 1994.
Sauare Feet
Square Feet: 2�50 sq. ft,
Cambustion Analiance �
WBter Heater: Natu�al Draft Input 6TUs: 3fi,000 Common Vent
�um�ce/Boiler: N�tural Draft Input BTUs: 80,000 Cammon Vent
Othsr Combustion Aooliances
Gas Fired Direct Vent Fireplace(s}: Yes Gas Fired Power Vent Fireplace(s): No
Gas Fir�d Natural Draft Fireplace(s): No Solid Fuel Appliance(s): One
Exhaust Enulnment
Cflntinuous Exhaust Ventiiation Capacity {afm): NA Clothes Drye� (cfin): 135
Exhaust Fan Rating (cfm): 0
Maks-Uc Air
Total Make-Up Air Required {cfm): 32
Passive Make-Up, Round Rigicf� 6 inch�s �r Insulated Flex: 7 inChes
Appficant Name
Cade Off'icial {pri
Signature/Date:
3ignaturelDate: lG �c ��v
f�i �OU4 CenterPaint Energy Minnegascu. 20U4 Mechanical Ccade Guidelines.
Wd S£�9£�Z 900Z/£1L l�a3�0 UE :a6�d 8£68bSb�S9 :�o��
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