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AF - 47961a 560-3450 �strs s�ad[e � � ANOKA COUNTY 6431 UNIVERSITY AVENUE NE September 7, 1971 FRIDLEY, MINNESOTA 55421 Minneapolis Post Office Department � Superintendent of Delivery lst & Marquette Avenue Minneapolis, Minnesota 55402 RE; Change of Address City of Fridley Gentlemen: We are listing the following change of address in the City of Fridley: � � N� He1en L. Tn�odall FROM 1448 Rice Creek Road N.E., Fridley, Minnesota 55432 TO 6283 Kerry Lane N.E., Fridley, Minnesota 55432 LEGAL DESCRIP7l'ION Lot 2, Block 3, Heatl�er Hills Addition � - We have notified the occupant of this change and we would appreciate it very much if you would change your records accordingly. Yours very truly, ,_ 4� ' HENRY F. MUHICH Chfef.Building.Iaa.pector City of Fridley �/�mh . _. cc: City Water Billing Dept. _ __ _ - City Asseaaing Dept. , _ Minneapolis Gas Co.- Brooklyn Park"Office Northern States Power Co-, Northwestern Bell Telephone � �� , Cif�r of Fr�dley - , � yw i• 'y� �►PP�calion �a' Pl�bi�9 and Gi�s Ri�i�g P�enrrrt Dept. of Bldys, Phoae 580-3450 DESCRIPTION OF WORK Number, Kiad aad Loealioa of Fixfures ��I� Is�I�izI��I��l�lg�l��l�3l��l��f�o Bas� lst 2nd 3rd WATER HTR. • • I N G�5 EIEC. 4tri _1__� _L__�._1_L__L_� L i�I_ L.I-1-� _Z- • Fulur� Coan�ction Op�nings Coaa�ct�d with * N�w Fixture, Old Op�niags I �°r ❑ Gsspool � PARTIAL RATE SCHEDULE PLIIMBING FI%TURE RATES: NO. R1lTE TOTAL Number FYxtures � x $2.00 $�� Piiture F�xture Opening _� x$2.50 $�� 3 New Fixture Old Opening X a1,5p � Catch Basin X �,�r $ dd Water Heater (Up ta 99,000 BTU) .... � X$3,pp a 3 r New Ground Rua Old Bldg. . x a3,26 $ Electric Water iI�at�r : a2.00 =? j�� O GAS FITTIMG FEES: NO. RATE TOTAL lst 3 Fixtures . . . . . . . . . . x $200 '� - � � Additional Flxtures . . . . . . . . . . . . , . . . . . . x � .75 � Gas Rsnge to 199.000 BTU . . . . . . . . . . . . . . z �5.00 � AEPAIAS � ALTER11TI011'�R�f�s !o Cod� Deacription .................................. . ........... TO'PNI, FEE • �/ �� D ��5 (�� ; � `� / City of Fridley: The undersigned hereby makes application for a permit for the work here:i specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department o! Buildings, and hereby declares that all the faei and representations stated in this application are true and coneM Fridley, Minn / /`� � � - , 29! Q' . Owner �_� 6ifaV'/✓��f(� Kind of Building ��4ii't� Used as D GU �`C l, To be completed about ✓ C f/�/� / Estimated Cost, � �•�b Q d Old—N�ew. Building Permit No.—_ _______Permit No. �� / , Signed. ��L s� %(" /�f. C/vs�3/3r'�6'. By-��iC'.�.�SL �l � r-�. Business Phune No� �G ` S� � ROUOii rzxlw 9— �y- 7/ � Permit for UMBING AND GAS F 1NG N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for inspection sh�ll be phoned in to the plumbing Inapector, 560-345Q giving number of this permit., .�'tOP1e8 Basement lst 2nd 3rd 4th F j _ _ - C y� a W a O Z } m N � U 7 m ��-. m � Connected with Number, gind and Location of Fixturea N Y �" Y � Q Z ] 2 Q l0 3 t O � � / � Z V Z Z M U q x a o u m rc° E k � � � I WATER HTR. � � GAS IELEG. Gas Piping for Openings Permission is hereby grante ' -J to do the plumbing and gas fitting in tlae building described in the s tement hereto attached upon the express condition that the person to whom th.is permit is granted, and his agents, employees and workmen, in the plumbing or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and this permit may be revoked at any time upon the violation of any of the provisions of said ordinances. By Order Of The Inspector Ot Buildings Roughing in Inspection Date nspector. Finallnspection Date � N° 5241 s� ��i 3 �Permit Fee $ �_QC� c�cy of FT�t�y �� 7 , 19% C� Owner �tJ �z 83 � Location � Kind of Buildin� �%��Zp � Used as To be Completed , 19._ Estimated Cost �ew. Building Permit .... , Inspector. Inspector of Buildings. 4z �M_�,�q.V _ �,.,�,� �CC� ,C } �-yv �.c�-�.�.e� City of Fridley .C�,��2�� ; App�ica�ion for Pl�ng and Gv� F� p�nrd�t 4�� -„ . .��, Dept. of B2dys. PIione 580-3450 DESCRIPTION OF WORB �� ,�__�i.,� `��:�,,. �L/ /,� , Nu�r. Kiad aad Locatioa of Fixtures I.aeali� ��s"-'�` �` � o�� Y�?�% �a � i x � € �3( � � Z� � �_ �= o5� �i �z Z � 3 7 S� i N �� C� � LL O U�<; U� <.0 K C'! � Base lst 2nd , 8rd 4th ' Putur� Coua�clba Op�aiaps I Cou�cld with * N�w Fixtnr�. Old Oy�niaqs WATER HTR. • t I N GAS ELEC. S�w�r ❑ �sP� fl PARTIAL RATE SCHEDULE PLOMBING FI%TURE RATES: NO. RATE T T� a Number Flxtures _�., x $2.00 $--Q! �ture Fixture Openin8 _ x $1.50 5 New Fixture Old Opening x a1.50 a Catch Basin x �.� � Water Heater (Up ta 99,000 BTU) .... x$3,00 $ New Ground Run Old Bldg. . _ x�.� $ IIectric Watu� H�at�r z a2.00 = GAS FITTING FEEB: NO. RATE TOTAL c;t� or rhai�.: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department o! Buildings, and hereby declares that all the fact and represeatations stated in this application are true and eorreM. Fridley, Minn �s3-c� %b � 19� Owner // ii��/Y GCJe3N>idfiriCi Kind of Building �i�S� Used as i�GC/G� �C LdYG To be completed about Estimated Cost, � O�1 —Dlew Building Permit No.`_ _. _ Permit No. �� Signed � ' ' By_��,. ' Business Phune No.- �� ' ��-S� ROUGH � Z —/�'' � O �ru. I— �— 7( lst 3 Fixtures . . . . . . . . . . . x $2.00 = Additional P'i�ctures . . . . . . . . . . . . . . . . . . a a .75 ; Gas Range , to 199,000 BTU . . . . . . . . . . . . . . x a6.00 e �3 �� AEPAIAS t ALTEAIITIONB.—R�fu to Cod� �( b De�cription .................................. ............._� V 1"O'PAL FEE ; �.�,�� ,'r�� -� �.��,�,o,�r ��-;� r�<��r.�-�.��-,�� Louis St. Marie of � St.Marie Sheet Metal called to say he had made a service call to 6283 Kerry Lane N.E. on January 17, 1973. He advised them they had a bad relay on the furnace. The � boyfriend called him a cheat and liar and wouldn't let him install the relay. If the relay sticks it could cause a fire. He wants it on record that he made a recommendation, which they wouldn't follow so in the event of a fire he will not take any blame. sua�ECT City of Fridley AT THE TOP OF THE TWINS g U I L D I N G P E R M i T f � 1 � � � �ti; - - --� COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEG 1 i i.___� ��""'1�,� CITY HALL FRIDLE� 55432 NUMBER REV. DATE i 612-571-3450 910-F� 5 3/20/80 JOB ADDRESS 6283 Kerry Lane N.E. 1 IEGAL LOT NO. BLOCK TRACT OR ADDITION �escR. 2 3 Heather Hills 2 PROPERTY OWNER MAIL ADDRESS Z�P Helen Woodall 6283 Kerry Lane N.E. Fridley 55432 3 CONTRACTOR MAIL ADDRESS Z�P R. K. Cons truction 4482 Churchill St. Shoreview 55112 4 ARCHITECT OR DESIGNER MAIL ADDRESS Z�P 5 ENGINEER MAIL ADDRESS PAGE OF � � P IT NO�' 156 RE NQ. 9d'qs � APGROVED BV SEEATTACHED SHEET PFION E 571-7319 PHONE LICENSE NO. 483-1150 PHONE LICENSE NO. ZIP pHONE UCENSE NO. 6 USE OF BUILDING Res i denti.,a1 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATION �'�] REPAIR 8 DESCRIBE WORK Interior Remodelina o� the Ki.tchen and the Bathroom. 9 CHANGE QF USE FqOM STIPULATIONS TO ❑ M4VE ❑ REMOVE TYPE OFCONST. OCCUPANCY GROUP IOCCUPAN�YLOAD SEPARATE PERMI7S ARE REQUIRED FOR ELECTRICA�, PIUMBING, HEATING, VENTILATING OR AIR CONDITIONING. WOOCI FY'dIqe THIS PERMIT BECOMES NtJLL AND VOID IF WORK OR CONSTRUCTION ZpNING SO. FT. AUTHORIZEO IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT R�. ANY 71ME AFTER WORK IS COMMENCED. NO. DWLG. UNITS I NEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS AND KNQW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITk WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1, 460.00 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE PROVISIO S OF ANY OTHER STA E OF LOCAL LAW REGULATING CON- STRUC N OR THE PERFORMA E OF CONSTRUCTION. �9�Q� /% � � / �� PLAN CHECK FEE �/ T! � � � IG TUfiEOFCONiRACTORORAUTHOFIZEDAGENT (DA7E1� WHEN PERLY VA * � --CiGNATURE OF nWNERfif OWNER BUILDERI IDATEI I I)f. INSP CU. FT. OFFSTREET PARKING GARAGES SURTAX $.73 �TAL FEE $9.73 THIS IS YOUR PERMIT 3--��0 ^ qATE � CITY OF FRIDLEY • - � APPLICATION FOR RESIDENTIAL QUILDIPJG PERMTTS � (New, Alterations, Additions, or Repai'rs) . , '� OWPJER: 7"-LGQ� W d � BUILDER: �� o� S T ADDRESS : �' � � 3 �e �� Y �^� * �� ADDRESS: YY �Z- G�•�2�� LC S% TEL �t0: � 7�— 7� l% TEL N0: �5�.� —i/ S—U � Construction Location . • STREET NO: (J � �� STREET: ��(� � / ^� � "' . . � . . LOT: � BLOCK: � ADDITION: �%ig T�� C�c LLS � Corner Lot: Inside Lot: �w Setback: Sideyards: . Applicant attach to this form ttivo Certificates of Survey of lot and proposed building location drawn on certificates to scale. - - DESCRIPTIOf� OF CONSTRUCTION � `�� 1(��--2.�� Front: Depth: Height: Squane. Feet: Gtiibic Feet: ' Front: Depth: Height: Square• Feet: G�bic Feet:. �3 ` p� _i Type of Construction: �/`f G 4� /- �69-i''�- e Estimated Cost: �$ �, ��`! . � 7b Be tbmpleted: ��^.,-.c 2 / �J � ° � . Alt. A Alt. B • Proposed Driveway Wid�h If New Opening Is Desised: $� $ � SEE REVERSE SIDE OF SHEET R�ie undexsiqned hereby makes application for a permit for the w�ork herein specified, agreeing to � all work in strict accordance with the City of Fridley Ordinances and rulinqs of the Department of Buildings, and hereby declares that all the facts and � representations stated in this application are true and correct. DATE: � �% %1'f �j � g� SIGNATURE : � , , Stipulations: - � . ' �"'�rv*, r 9.0� . • . . ' f4c.2T+4a = .7�. . � '. � �--, • . ._ ,��P� 9:7� . . , ._ . . ._ , . ..� � � , m ��v�;;,t�r7t' $ , 1'�7� ?<.r�. f:�±i�r! �:vodall � ��s �:�x�zy �,:�n� ;�. �:. _ • FrJ.�l�y , '-�inn�sota , > 2. Li��ttsa p�r��its,f.��pectians �nRi 3.nitia2 casts i. �i � � 1�0.1?0 2. Flu�tai�^; r�;}afrs - 'furx '��c)��nica2 '�' a. i,;�cn �'1'c�;SG'%'•"crs� ¢Ic�ar cirafn . �tY. r�E:��r i��kin�: s?zut-�ff vRlvcr � . . c. Irst '.'. }a1'' �. 1.7�` vanfty :�nd �toul �+� �Y�p#�RAI' i1.��in a�d s�v�r�Ia�r �r� �at3ttn� • ��. }t�X�3.t�c� =:�itc;�en sir�k s�itn st�inless sLee1 sink _ . �.r�k� r:��r £�.��ets I, g, � S1,�QD.�fl f, Tnst�ll tcs�l.et i�� b��nt X 3. �.2e:�tri�:�i (�':ies �'1�cLrS.c'j L � !�t �1,?f�S.A� - % A. t�tat�ll unc:¢rl�.��t a��' SnAta Cxu� stvl� if�Iay - fla:�ri»;H �n l�itch�n �'loc�r L � �� X,�1(D.n� �, i:�st�li �nd�rla��nt :�nd ."=�rta Crut �tp1e inlay L � r.a $ 150.t?� . �� .tfi �'Sa�ar . {� . '� ��R�s� r. e�:�r d�er �:oz��I , c��a�r j �r�t� , �o�r �nd t�f r�. " InsL�11 na�r r►rc,hun; �? '� �Q X 1 3/�d sQ2id cara �inc►r. ��gl��r. �ttf�=�i�a,Y, thxes:�anl� and alc�in�n �io�a� a�cnin�.� $}� � 6�Q.�0 ��-tri�: 3�zor '��.�2x c�ld tri�s L � '� � 90. �t2 7. Instv.I2 2 �r�ak.� cie��.�cLQxs {ICui1) . �. C:lc,�c �:ell �i.t o��sain;; �.n ha�rx�csnt �it�� c�:�;�ni �l�cks L� M 3 �(f.p0 ��<.�. I�,si�xl ne� kitc°�en Gcrut:ter Lh�a I. %*� ��5.40 Zi). Install tub 2ira�r in ii;q$t:±irs t�sb. L$r � 185.t!4 �I, ;«g��ii n�w �]c�c�rs :��zc� re}z.�ir dra�rers fn kitc}zen ��:� �` � �5.�� _ �.�s� cu;Ri�o.�rds � �2. t�s�:Cal� �:j�ot� an t��se:�a�nt �,�or I. &�1 $ no ch�rs�� . (' � � ;� . � cor,t�rnFC�� C du-WS�'t/t a ,;�, i � / SUBJECT P . c�ty of Fridley 26 90 9 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r ; ` RECEIPT NO. � `y �� COMMUNITY 13EVELOPMENT DIV. � � r � � PROTECTIVE INSPECTION SEC. � . � � � /'�'1 � CITY HA�I FRIOLE� 55�32 NUMBEN REV. DATE PAGE OF APPROVED B� �'"'"� � ,'� 612-571-3450 910-F15 7/30/98 � � �oe no�aess 6283 Kerr LN NE 1 LEGAL LOT NO. BLOCK TRACT OR ADOITtON SEE ATTACHEO DESCR. 2 3 Heather Hills SHEET 2 PROPERTV OWNER Andy Gl1Zlk MAIL ADDRESS 21P PNONE 6283 Kerr Ln 02-0 8 3 CONTRACTOR MAIL AODRESS ZIP PFIONE IICENSE NO. Owner 4 AiiCMITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAII ADDiiESS ZIP PMONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION O ALTERATION � REPAIR � MOVE O REMOVE 8 DESCRIBE WORK Reroof house 12 S Tear—off 9 CHANGE Of USE FROM TO STIPULATIONS Underlayment must comply with State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, NEATING, VENTILATING OF AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION IONING SO. FT. CU. FT. AUTHORIZED tS NOT COMMENCED WITHIN 80 DAYS, OR �f CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT ANY TIME AFTER WORK IS COMMENCED. N0. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIfV THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX AND ORDINANCES GOVERNING TNIS TVPE OF WORK WILL BE COMPLIED WITN WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �IOOO �.SO DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHAFGE PROVISIONS OF ANY OTHER STATE Ofi IOCAI LAW REGULATING CON- STRU.CTION OR THE PERFORMANCE OF CONSTRUCTION. �3�F.%S Fire SC �L.00 PIAN CNECK FEE TOTAL F E $ 5 S�GNATUAE OF CONTRACTOA OA AUTMQRIZEO AGENT IOA1Ei N ROPE V LIDATEO IS YOUR PERMIT � S�GN4 UAE OW A��FOWNENBURDERi iD�TEi . g .�.a�sp q`iE NEW ADDN ALTER �] [l �] ConstructionAddress: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION � Effective 1/1/98 vf �/�'� � � �� U Legal Description: Owner Name & Address: ,,��, i (�,�,`1� '�,. _ Tel. # �i b� - (� gp8 Contractor: � MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. �� LIVING AREA: GARAGE �AREA: DECB AREA: ,�' OTI�R: DESCRIP'I'ION OF IlVIPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. K� �c�� ur.�c �G frArC /%�ar cc�Q Construction T /�.� ��' Estimated Cost: $ �(�� - YPe�_ ' (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ � DATE: ?- 30 � 9g APPLICANT: Tel. # y'o 2� 090 g Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ � , S� $ .�U $ �—Z� $ � $ $ $ $ $ CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th�) $.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 [ ] $ � �- �.�_` r y � � ► � SuB�ECT c�ty of Fridley AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r � � � • COMMUNITV DEVELOPMENT DIV. � ; V'�'�� , r � � PROTECTIVE INSPECTION SEC. � � �"'1 • CITY HALI fRIOLE� 55�32 NUMBEp pEv �""�� ,�' 763-571-3450 9t0-Ft5 108 AO�RESS 62g3 Kerry Lane NE 1 LEGAL ��T NO. BLOCK TRACT Oii ADDITION oesca. 2 3 Heather Hills 2 PFOPERTY OWNER MAIL ADDRESS Dave Ryan/Carrie Leish 6283 Kerry Lane NE 3 CON7RACTOR MAILADDRESS Trip�e R Construction 3708 Tonkawood Rd, Minne ! AFCHITECT OR DESIGNER MAIL ADDRESS 5 ENGINEER 6 USE OF BUILDING Residential 7 CLASS OF WOHK MAII AD�RESS � NEW � ADDITION 8 DESCRIBE WORK Construct a 22' x 23` 9 CHANGE OF USE FROM STIPULATIONS � OATE PAGE O� 11/4/02 / / ZIP ZIP '3�3235 R CEIPT NO. �l'� ACPROVEO BY� SEE ATTACHED SNEET PMONE 763-502-9351 PHONE UCENSENO PMONE LICENSE NO PMONE IICENSE NO O ALiERATVON O REPAIR O MOVE O REMOVE TO See notat�o:�s on p�an. Prov�de a har@ surface driveway. SEPARATE PERINI�� REQUIRED �OR: PLUwMBING ANO 3NG�IS WARNING Before digging call for all utility locations 4540002 REQUIRED Blf LA1A� , TVPE OF CONST SEPARA7E PERMITS ARE REOUIqED FOR ELECTRICAL, PLUMBING, MEATING, VENTI�ATING OR AIR CONOITIONING TMIS PERMIT BECOMES NUII AND VOIO If WORK OR CONS7RUCTION ZONING AUTHORIZED IS NOT COMMENCEO WITHIN 60 DAYS. OR IF CONSTRUCTION OR WORi( IS SUSPENDED OR ABANOONEO FOR A PER100 OF 120 OAYS AT ANV TIME AFTER WORK IS COMMENCED. NO DWLG. UN I MEREBY CEFlTtFV THAT I HAVE READ AND EXAMINEO 7MIS APPLICATION 1 AND KNOW TME SAME TO BE TRUE AND CORi;ECT ALL PROVISIONS Of LAWS VA�UATION ANO ORDINANCES GOVERNING TMIS TVPE Of WORK WILL BE COMPLIED WITM WMETHER SPECIfIED MEFEIN OA NOT TME GRANTING Of A PERMIT �11 f 1H7 DOES NOT PRESUME TO GtVE AUTMOAITV TO VIOIATE OR CANCEL THE pEqMIT FEE PROVISIONS OF ANY OTHER STATE OR LOCAI LAW AEGULAT�NG CON- TRUCTION OR THE PERfORMANCE Of CONSTRUCTION �ZO9.ZS PLAN CHECK fF � %� �l Licer. S�G AfUQEOFCON'Pa(;TOQOQ�UTwOQQEO4GENi 10A E� HEN S�GNn�UAE O� OwtiEQ��F OwtiEpBU��DEQi �O�tEi OCCUPANCVGROUP OCCUPANCvIOAD SO.FT CU FT. OfiSTREET PARKING STALLS IGARAGES $ iURTA% $5.50 �AC CHARGE Fire SC $11.19 OiA EE 231.04 � TMIS IS YpUii P� Gr � nai� a ""� . FROM : JULIO G FAX N0. : 651 455 8395 Oct. 24 2002 03:26PM P1 OCT-22-200� 13�49 FROM CITY � FRIDLEY 74 651�5558395 P.02iO3 NE1N �6Ctivd 1/tl.�D02 � � � C1TY OF RRIOI.EY E At.TER � � SINOL� R/1NN�ANp �� 1 A� R-,� �� a� �8 �P 6UItOlNQ P�R�AtT ApP1.IC�1TiON con�ion Ada+� Lepa1 D�saeription: _ �a � 3 � �,�,� Y � �ti � n��, ��e ��o z �.� �N oMn»r Nams a Adc�: AA�� Y�N� �"�rR,�� L� I�� -- s �- Ts�. *-7 �3 - z-`�.� S j Contracxor. TR , g L� (� �,��►s�-r+�� c�t, � " Addr�s• .3 70 $'taNK�4 wo�0 � MN UCENSE ��%3� 7 1'V�T�+1 (YL J�� T�AI. �M S�-�1�-p7�� Aliaah to d�ie �pplic�tlon, a Ce�k�M of Survey of du tOt� W�11 th�t propo�sid c�strtx�ion dtawn on �� sCele. . �. - . . - . � � � � � �� , _ .� � �. �►t� � Z y�dn, � �� 9q, r� � 11AiA= L�h yyFd�h °�..3 ��d _� 84• Ft. SD % OTNRR; . r / � CS� LG Ca�tn�aion Typ.:__ �p Es�rnama co�� s 1 Co 3 3(�� Lt 7 ��l C+1� �"rl� �'l %iiYdYd: ,r,�FL � � Ff = ��„Fi X � m f _. � � �.. i��i� 3�� cu►r�:1� -.2 �f �✓� r►a'��r.�tNr: __ T•�. r��7r� �(�) 6T�-�OA � P�nnK F� H mWi�p in apppca�on or P�c to TAS-lt7t-1�T !l � on�dk c�ad �nd vr� wiG diR you t�r eord nun�r. POfi'� F�11 . �ins SU�qs . - � S� � S�AC Char�r L� 6�p+� �s�r Esa�ow E��n C:orrMol Park Fee 9�w�' Nl�ln Cha�� Tarnc. � �� (� S �,,,.. _�I�• .. . �Z: �v : 3 . '� ctYr use o�Y. Fee Sche�d� on Reverse �ide � . .001 of Porm� V�luati0ti (1110th9�6) �.sor��,000 vewa�on �12� p�r saC un� 3�.00 {b'� Liaenssd Resldeniial Contr�tore) Alt. "A" c�r Ak. 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L ;r:, �,�+r � N� U ,�': .i . �. a � d' � _ .. � .. . 7 r� ^ � � �4 � � . • I �: % � �r��- a /� � .'g ., r . , .. , .3 � ;; F: ,� ; . i�� wr T . �- -�d a . .--- ✓— AOUSH LOCATION LOT I, BLOC�C 1 SUxVBY F08 � �� i . 1 i .C' �` I � ! � �� .v a �a, .� ,i N I. - '�y '' . ,._ .. ' � J 1 � ..�t ^ _ �. \'T •`� / ' �� `. � z'`1 -- ,. _ -- . "_ � � ,.;ca`e :.I - ..O CITY OP FRIDLSY Ii�ATHBB HILLS 1�. HIiCB 0' SANNODt / �� l�i � eE� �!,' ��. � I � � � � T Aeseby e�rtii� lhat this hons� locatioo wa �ads ttndar art aupervi�ioRt and t�ut � i as a dnl� anthosis�d laad surv�yor nad�r tba�laqw oi th� 8ut• oi Ninn��ota.,` ' . . . . . � - . . . ' 4 . _ _ ._" . . .. .... . . . . . _ . _ . . ', . � •_...�_ .. .� �.'_ ' �.�� : � � .....�f� . '�� . . ,i i�l�iaias S.; Loya, 8.L:8. - h . . ` :�o.� ;x�a.. �ao: :6�e� r ,�. ��. !:.. .. : � �. � . � � _ � ..A s��; a''� � a �f #,", `� `�t'v � Dsts: Masch 10,� i4�0 _ `� , ��;�� y�,�� , - `��{ .E, r �' : u � tI J M T � x� A .-,� ` St ..' .e� { � � r * 4 4 �. � � � % t f �'� -1, �> �' � � 3'� ��^, ,,,� �� ' � �,� � .= ... t+�, a i < J v' l,g�€.'l f��y "�14'�'� �.� S`�, Sc �y^: ..� � " � '�xa i xy �.7y�» k � �.�, �y� } y,��. , , . z �^ � ._ ,.,k -. ..� . L.. �:k � ' ' .. � � � � } �' ! L T�`` + . �Ii ' .. ' � ' - . � . . � � ' .. � � � . . . � . . . � .. . . . . . .. . . __ . .. ' � . .. . � . . • . " � : .. ' i� � � � � -. . � . �� # Y'� . . � � ' . . . . _ . ' A �'� . • . ' ' . . � . � ~� � � � r .� . � - ... - ;_1 ,— �'` � CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2002 V6431 University Ave NE Fridley; MN 55432- � APPUCATION FOR POWER PLANTS AND HEATING, COOLING,:VENTILATION, , .:� 763 5 ' � � � � . REFRiGERAT{ON AND AIR CONDIT{ONING SYSTEMS AND DEVICES �' ' � ° � � ( ), 72-3604 ._ , , _ _ . , . , . . :.` .. � : � ,:�. � .�: _ ..: S �.,R .. rt . / , ._ � - , . . .. • . JOB ADDRE S COv��`J� � lC � `l� �-� " RATE SCHEDULE � ~ - .. ,:: .. � . ; t._ . ' � ' . _ : ; OWNER �A"U�� ..�``�A'� � ` Residential �: � : '' _ . : �=: :�. Rate ' TOTAL : � .-, ; _ Furnace°She1C and Duct Work, Burner - , � ' �� BUILDING USED AS �l.J�'�L--L/".�=/C ` .: � Also Repiacernent Furnace � � - $ 30.OQ $ �A=�O; _ . . � - , . l_, �` f (Side Vent'- Fill Out Back) � ; ESTIMATED`COST _ `_��`� � ' PERMIT N0.'' �� <�c- /� Gas Piping (Needed with new furnace, $ 10.00 $ - -�- � - _ � ' - but not replacement) ; • �� DESCRlPTION OF FURNACE AND OR BURNER Gas Range . : . • . :_ $ 10.00 : $ _ � ie " ' � � � :� ; . � ; No: of Heating Units�, Cirde One (Steam) (Hot Water) arm ' Gas Dryer ;: , � ..:: . . , $ 10.00 .• $ . ; �. Trade Name�U�r� : � Size Na t� 6 �La? ' ; : � - ;. � .. , . .. s BTU_?S,O� HP " , EDR ` � *Air Conditioning - All Sizes " ` $ 25.00 ; $� c�' Fuel_ /U /�"i ' '- Total Connected Load � � � � ' All Others/Repairs & Alterations (LIST ON BACK) f. . Burner Trade Name � _ Size No. � 1% of Value'of'Appliance or Work ' , $ . BTU Hp EDR' ,. Commercial/Industrial 1.25� of Value of Appliance or Work ,. State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONfNG PERMIT IS $25 00 PWS 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. $ 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 $ .50 rulings of the Building,Division, and hereby declares:thaf alf the facts and '- representations stated in this application are true and correct. �_ -`� _�° : � � _ � �� d121�AVENt�NQ DATE /_ / �'"� "'- f CAY�TAl;�166fzit HEATING1�61,� ., __ ` . Signed FAX # G�°° Approved By �� Rou h-In Date g TEL # �L�3�"�?u,`/Lb''S�`�/ �a /l-�rl-O� Final Date FILL OUT SACK SlDE FOR STACK VERlFlCATION ON REPLACEMENT FlJRNACE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED C:(�MMC�N VFNT�(FNT C(�NNFCTnR AND COMgl1STInN AIR VERIFICATI(�N VVhen _r��iacing an existin8 f�rance, the undersigned hereby venfies 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 plastic/PVC 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 manufacturer's specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. The Pxist�npzmb��ti�n a�r is sized and installed to meet the current codes and manufacturers specifications. When required to install a new comb ,st�on air,�it will be sized and installed to meet the current codes and manufacturers specifications. When ins alling a new ventin� cystPm, the undersigned hereby venfies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category 1 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 cades. Yes ( ) No � Yes� No ( ) Yes ( ) No ( ) Yes �'' No ( ) �� Yes�'iNo( ) Yes �No ( ) L�• .�ii�i-�- •- . �• �l •uu.� -• . �• -� •��- • � •u�. .� Appliance #1 Type BTU Input Appliance #2 Type BTU Input Appliance #3 Type BTU Input Totai Appliances Total Btu input Fan Assisted or Nat Fan Assisted or Nat Fan Assisted or Nat 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 C9 c.� N � � � 0��-t �� HEATING CO: �U`��` %� � a � �-1' Signed By: Date : �� v24—fl z