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PRE 2010 DOCSCity of Fridley, inn BUILDING PERMIT N° Address Address L05 TIO F BUILDING No. Street+=` ` !� '� _ P of Lot 44 Lot Block __ _ Addition or Sub -Divisions Corner Lot —_ Inside Lot___ Setback _� Sideyard _ -- — Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To he Used r : j� ' FrontP181 Depths Height Sq. Ft. Cu. Ft. � 40i) OOF Front DepthHeights Sq. Ft. Cu. Ft. Type of Construction�'r'�_ Est. Cost?-51.4' ost -,c � fir" 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 compliance with all provisions of ordinances of the city 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 workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings Within the city limits andthis permit may be revoked at any time upon violation of any of the provisions of said prdinanoLs. sem, ".0t /` i Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas beating, sewer or water. Be sure to we the Building Inspector for separate permits for these Items 1 a s APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA owner's NameBuilder Address Address LOCATION OF No. J % Street ,�- Z...,Part of Lot Lot Block J _ Addition or Subdivisio Corner Lot inside Lot f✓ Setback side -Yard SEVIER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING Tob used as, Front J Depth Height o Sq. Ft. -//-, 3 Cu. Ft.r FrontDepth Height Sq. Ft. Cu. Ft. U� Type of Construction r Q4aje_Estimated Cost To be Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and ruling of the Department of Build- ings, and hereby declares that all the facts and representations stated in this application are true and correct. r (Schedule of Fee Costs can be found on the Reverse Side). d 0 City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location Gl U I CQry1= o ;; u�i 88a '� u. C w U et �j `u�i < 3 'd w �U' �n Z O • R • N WATER HTR. GAS ELEC. Base / / 1st / 2nd 3rd 4th • Future Connection Openings New Fixture, Old Openings Connected with Sewer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES:RATE TOTAL Number Fixtures •x $1.50 $ Future Fixture Opening ................ x .1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ...... x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ "'00 New Ground Run Old Bldg. ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ �� Additional Fixtures x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................ '.. TOTAL FEE $ -2 C--' City of Ridley: The undersigned hereby .makes application for a permit for the work here! specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Ridley, Owner Kind of Building Used as To be completed about 0 1s- Estimated Cost, $ G 01&—New. Building Permit No it No. 1' '3 0z ROUGH FINAL d2 2M Signe By 'RI mess Phone No �—L �� Original PERMIT for Power Plants and Heating, Cool. ing, Ventilation, Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of Heating Plants to be installed--altered—repaired Make Oil fired—, Coal fired ; Gas fired—; Gas Authorization 06c -Remarks Approved Final Inspection Date , 19_ Inspector Permit N9 4392 Fee $ f o Office of the Inspector of Buildings City of Fridley City of Fridley, Minn. 9 , 19—&7 Owner ' Location _-5'-q0!2 �> Kind of Building 0 How Occupied Work to be Commenced—, 19— To be Completed Estimated Cost, • 0-d Old -New, Building Permit No. Permission is hereby granted to • to install—erect—use the material and devices described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the specific ns set forth in the approved application for this permit on file in the office of the Inspector of Buildings. Inspector of Buildings 4 z 2M t t.a7 v U° Application for Power Plants and.Heating. Cooling, Ventilation, -Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR over 3 gal. per hour—See Fee Schedule Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ 5.00 $ each add. 60,000 BTU ... — .................. 2.00 $ _ Replacement of Furnace ............................. .§.00 $ Repairs & Alterations—up to $500.00 .... ............ 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam....... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM ALTERATIONS & REPAIRS TOTAL FEE C®y-70f. ROUGH FINAL s 4 Dept. of Bldgs. Phone SU. 4-7470 (� City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn 19 Owner Kind of Building Used as To be completed about Es timated Cost, $ p Building Permit No. Permit No. ` DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load Rind of Fuel BURNER —Trade Name Size No - Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) By. 4 Z 2M 7.59 Business Ph( W/ o cv 2 -if 5_6 Sif ® a y r a *r 'y. 9TH 1. �6I•: JE � Z � - _ A s ,� '••.3Tr. - ' ..,fir... � � � - ... �.. m � '4n, S et has a , n. ' PARTIAL RATE SCHEDULE L�f8111C I I:CTJRE RATES: • aiv S Nurr.ber Flxlure:...... • • • • • • • • • • •..-..--.---- 53-84-879001 ' , Ail c:jyi'an fc? Plu►r = : � �u v �fi,�� er':�i� Future ><lzture Opening . • • • • ••• • • • • •----- X $1.50 $.r—.. , .•few .%,gw Fixture Old Oyrning • •.. • • •' • • • •--------- Dopt. of illdoz, Phone M. 3W i--:--- DESCRIPTIO11 OF V701111; x $3.25 LA.�.-& LOU' 5202 w� Catch I3a11n .................... ------ iru=5sr. Kind and Lecrlloa of Fixtures .r Rater lfeater'L'p to 99.000 BTU) • • • • ------ x S.3 S - ' Nes+ Ground Run Old Bldg.:..:.. •• • e - x i:.ette Y.a:er Y.eat+r..... City of Md -ley'. • Z= i 7 �• r I g rX _ C x S2.G0 ' 7 i j 7 =� O e WATfe Mrs. r H r.,,s rue. The undersigned hereby makes app'lcatlon for a permit !or the work work is strict acco.Ca^ce with the Cit? O: d+ N if i1 3 M : o I 3 r ° ° • �° G:s R:.:ae to 199.000 BTU x $5.00 specified, a� eeing to do all of the Department of >;utly.'a�. a:►3 hereby declares t.. a:i L � I and ruling • and lreprest-Mations stated is Lhis xppllcaL'oa are true ar.d eo:rc%W Es:r FIT , 8-5-76 "Fridley, b:inn Owner 3:d f r �.me Kind of Building _„ • Fur; -:0, Ca-.aa:tI:a C-:):clr.;. Cca M__ c.0 d With so•aer [] • Used as res. s New Flxtun. Old 0;�%:.ings ❑ 8-21-76 To be completed about PARTIAL RATE SCHEDULE L�f8111C I I:CTJRE RATES: NO. • RATE , TOTAL x 52.40, S Nurr.ber Flxlure:...... • • • • • • • • • • •..-..--.---- Future ><lzture Opening . • • • • ••• • • • • •----- X $1.50 $.r—.. , .•few .%,gw Fixture Old Oyrning • •.. • • •' • • • •--------- x 51.50 i--:--- x $3.25 $ - Catch I3a11n .................... ------ .r Rater lfeater'L'p to 99.000 BTU) • • • • ------ x S.3 S - ' Nes+ Ground Run Old Bldg.:..:.. •• • e - x i:.ette Y.a:er Y.eat+r..... a $2.00 S _ i!S :'1: _ •ING TEES: NO. RA TOTAL ' x S2.G0 5------ • 1st 3 Fixtures • • • • • • • • • • • • • • • • ' ------^-'- x + Ad:ltlanal Fixtures ..:............ ...... G:s R:.:ae to 199.000 BTU x $5.00 5-.---- 10. Estimated Cost, S Pesmit :�a.,r y ' old—No= i3uilding Permit No. s Si— By- MINNEG SCO - Busin= Phone INN ROUGH riN & ALTLRATIONS--P.sfer !o Code .50 State Surchaxge . • � z .rk;crlp.Jon.'..............:......................y 5.50 . 53-81,-9915051 City of r jdloy 4plic:aLton for Plu�r) z:�:� �.�� Cs�� v �4;7� �er:�is Dopt. of Bldgs. phone SM -34W DESCPIPTIOII 0: V1011l: I,o:s:lo,L 5209 Lincoln Street NE - -- NumSsr. 1:i:�d sad Lccr:lc'a of Fixtures . -• - - �� — �iG:SGt::ra rw ►sem • FL• 0 Cc::Z:'.'.i:n C-.)4 C-1 =:• Jruar s Naw Flurun. Old Cr -,%=b C% Cc *rel PARTIAL RATE SCHEDULE LL^d8ING FIXTURE RATES: N0. RATE TOTAL Nulr.ber Fixtures ................5...—.-.-- ' 2 $ _..----- 1ew Fixture Old Opening.... • • • • • •*•----•--• W�Tfa wTw. c � = 3 M �?.g� C]Ich Basin .................... � 80'3 s 3r u� �:�� . few Ground Run Old Bldg. :..:.... _._.-- C ► e W CA: ««. i<� 3 - 1AS FITTING FEES: NO. Rn TOTAL • 1st3Fixtures x32.03 S• - . Addf anal Fixtures ............... ----- x + .75 $ . Gas R.::a^e to 1W.000 BTU ...........--------- x 85.00 6. --.-- B s:e 2 ry -3:—d �.� • 1-4 -1 -• - - �� — �iG:SGt::ra rw ►sem • FL• 0 Cc::Z:'.'.i:n C-.)4 C-1 =:• Jruar s Naw Flurun. Old Cr -,%=b C% Cc *rel PARTIAL RATE SCHEDULE LL^d8ING FIXTURE RATES: N0. RATE TOTAL Nulr.ber Fixtures ................5...—.-.-- F utur a Fixture Opening .. • • • • • • • • • ---- x $1.50 $ _..----- 1ew Fixture Old Opening.... • • • • • •*•----•--• x 51.50 i....�:»--- C]Ich Basin .................... �.--•x33. 25 S ---- water heater 'L'p to 99.000 BTU) • • • • ---- x . few Ground Run Old Bldg. :..:.... _._.-- x ;1.25 S._..----- El.etric Yla:es Haat.es• .. • .:.............�..-_ s S?.CO 3 - 1AS FITTING FEES: NO. Rn TOTAL • 1st3Fixtures x32.03 S• - . Addf anal Fixtures ............... ----- x + .75 $ . Gas R.::a^e to 1W.000 BTU ...........--------- x 85.00 6. --.-- City of Fridley: The undersigned hereby sakes appllcat:on for a permit for the, cork h specified, agreeing to do all work is strict acco:darce with tl a Cit? O: --'Lr and ruling of the Departrnent of Buil UmP, and hereby declares that 2A the • , and represent -,tions stated 1a this appacat:on are true and eo.rect' , • Fridley, 8-11-76 I Minn Owner James Uarper, Kind of Building frame Used as fres. 8-18-16 To be cornpleted about Estft3t.ed Cost. S 10,00 Old--NVW. Building Permit Ivo. Pasoit 'Na. Sizrcd By CASCO Busin= Phone No ROUGH PS?i:°3 k AL?D.'.ATIONS—P.afes !o Cods . ' .50 State Surchar5e •.• • • • .0.6.00.60 .3 ti .Iit:.crl'yiion .'....... • • • • • • .: • • •.• • • • 5.5® - TOTAL rM S . LT `0 CRY • fit" r1i4dicy Application for Plumbing Ond Gas fri;ng Pe it - ... . — 1?spt. o� BGf�• ?ho:,a �` x.3/450 ' 'DFgCWT1014 QV V/Of% •Loczt: :5"-L®"Inn tt%inUe•e, Kind and 1.eenliosr Of k'irc4t i City of Fridley: _ The undersigned hereby rralces application for a perrnft for L'he vo:>` ?:e. specified, a,;rec:ng to da as work in st ct accc ce with the C:� and ruling of the Department of Bu :d,.'nZs, and hereby decl2res L*►et s:l L':e.f:�l • and representations statc-d- Ln ' is aprlicat:on are ttrue:trd co.:ect Fridley, Owner Kind of Building�� • Gp14n6'=44 Vt= • i::r�-a Ccs a: •:ca O�c :.:;s �rae.YJ' Used as = �� v ~ ?lev ii:ch:rs• Old 0 -3::r-,rs Ccgsy�ooQ WATtR � �x O U S N GM ecaG �3 C �� .- a V. �3 o� l a �•� o �v a -C v a U V ` No. Ol A'ew. Building Permit No.— �LL2MSIMC iFi�'ital$C i�1►'igS� RATE NO. RATE TOTAL - r Signed Nw:.ber F:xtures .... x AGO $ • , ' FLture Fixture Opening ............ B Y Businc= P: Application for Power Plants and Heating, Cooling, Ventilation, ReMgeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ........................... 8.00 $ Replacement of Furnace ............................. 5.00 Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECIL WARM AIR (% v Furnace Shell & Duct Work to 170,000 BTU ............ 8.00 $ ® each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add, $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ..... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. 8.00 $ Each add. 200 sq. ft. EDR Steam ............ . ......... 2.50 $ Each add. 320 sq. ft. IDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule CP -V - GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ v GAS FITTING FEES: NO RATE TOTAL 1st 3, Fixtures ...................... x $1.50 $ Additional Fixtures x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING g FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM ALTERATIONS &REPAIRS TOTAL FEE ROUGH— OUGH FINAL— FINAL Dept. Dept. of Bldgs. Phone SU 4-7470 Location— 4 City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Owner n Fridley, Minn— 63 19� Kind of Used as To be completed about Estimated Cost, $ �/ Old—New. Building Permit No. +� �^-�Yermit No. DESCRIPTION OF WORK HEATING or POWZR PLANTS—Steam, Hot Water, Warm Air—No-ZZ Trade Nam Size No Z®® a-o� Capacity �Sq. Ft. E.D.R BTU H.P. Total Connected Load Kind of Fuel BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) 42 ZM Business Phone 01 SUBJECT City of Fridley 4 1 AT THE TOP OF THE TWINS BUILDING PERMIT f RECEIPT NO. i v______ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC/ r ' CITY HALL FRIDLEY 55432 1'j NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910415 8/5/96 JOB ADDRESS 5209 Lincoln Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 3 Marion Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Nikki Haak 5209 Lincoln Street NE 572-1693 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Kodiak Construction 2607 Brighton NE, Minneapolis MN 55418 781-0286 8608 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (15 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, 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 ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING 1 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 $1,237 $ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .62 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $43.00 Fire SC $1.24 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTALFEE License SC $5.00 $49.86 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLA VALIDATED THIS IS YOUR PERMIT 7e 7 " � BL G INSP �� I)ATE SIGNATURE OF OWNERIIF OWNER BUILDERI (DATEI 01 ZMATA ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress:`� �' 0 Z- ; Gd 4-, s r �u � Legal Description: Effective 3/1/96 to) Owner Name & Address: A)i K � ° lrAAez- 3-2-69 Tel. # 7 2 - / R --p Contractor: X% 0,4- L MN LICENSE Address: 2-407 A'n (Jo . f ou 'o Tel. # 7 ?-,P6 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF E%IPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: J r A. f- t FF- ?-r oCye F S g t 1•9 -rt f s Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: S-- 1-7gC APPLICANT: �1rL�Tel. #, % /-o Ze"L CITY USE ONLY Permit Fee $ 0 Fee Schedule on Reverse Side Fire Surcharge $ %,o? .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $900 per SAC Unit License Surcharge $ J j)® $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ 9. STIPULATIONS: ' 01 .1 ' CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 763.572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25%, of Value of Appliance or Work Effective On January 1, 2001 JOB ADDRESS 52-40'3 4i'ma /! QST / l -t OWNER Rate TOTAL ,' `n ,� / BUILDING USED AS_ .UJZAth9 _1 $ 30.00 $ 41. ESTIMATED COST PERMIT-NO.- $10.00 ERMIT.NO.$10.00 $ DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ 10.00 $ Trade Name Size No. BTU HP EDR $ 25.00 $ 1 Fuel Total Connected Load 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. 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 7-1 GI _D l BLAINE HTG. AIC ELECT, t�INC. 13562 CENTRAL AVE. N.E. HEATING CO Amn.KA__Mm B&q" Signed Approved By TEL # I LP`� Rough -In Date Final BACK SIDE MUST BE FILLED IN ON VENT SIZE, VENT CONNECTORS AND COMBUSTION AIR VERIFICATION COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, Yes No( ) and is securely supported and firestopped where required. The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes ( No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA -LAMA Category I Central Furnace Venting Tables for fan Yes No ( ) assisted and natural draft appliances. The existing combustion air is sized and installed to meet the current codes Yes ?No ( ) and manufacturer's specifications. When required to install a new combustion air. it will be sized and installed Yes No ( , to meet the current codes and manufacturer's specifications. When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Yes No ( ) 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 Yes ( No ( ) separately as per current codes. Appliance Type and Size/Common Vent and Vent Connector Infonnation 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 ALTERATIONS:. (Describei BLAINE 14TG. A/C ELECT., INC. 13552 CENTRAL VF— N.E. HEATING CO: Date Signed By: ems. GiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 February 14, 2003 Ms. Geralyn Peel 5209 Lincoln St NE Fridley, MN 55421 Re: Final Inspection at 5209 Lincoln St NE Contractor: Blaine Heating Air Cond Electric Inc Dear Ms. Peel: A mechanical permit was issued on July 16, 2001 to install an air conditioner at your address. According to the 1991 Uniform Mechanical Code a final inspection shall be conducted on the work authorized by this permit. As of this date the inspection has not been requested. The permit fee that was paid covers the inspection to make sure the work was completed according to the Codes. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will mark the permit "no inspection called for by homeowner after notification" and take no further action. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. DJ/mh CITY OF FRIDLEY COMMUNITY DEVELOPMENT DEPARTMENT TOTAL P.01 PLUMBING Permitil � RESIDENTIAL APPLICATION -1weraww ey- City of Fridley CD 1 2008 NOTE: IF PROPERTY IS NOT OWNER(OCCUPIED- A UCENSED CONTRACTOR MUST O13TAIN THE PERMIT. G DATE 6 `)L( - "r YOUR E-MAIL ADDRESS STrE ADDRESS S,�, 0 R L i C is l dy 3 E 10 F, THE APPLICANT IS. (CIRCLE ONE) OWNER NAME GG> -011,0+ Ptt_( PROPERTY OWNERI ADDRESS 5 ZI-0 t? L- e't e t (e.a SS< A l E TENANT CITY FP- i A (i*, STATE H 0 23P PHONE 6A 5 l X q- -I� q NAME l r C", (a t I-• k LICENSE # CONTRACTOR ADDRESS P-9 0 0,- crry ts. t C ` STATE t` 1 ZIP 4� PHONE # b i ,S LI t:)I q FAX# PERMTTYPE SINGLE FAMILY TWO FAMILY TOWNHOUSE TYPE OF WORK p. NEW REPLACEMENT- DErA1LED DESmPT[ON OP woRK�n.�r/.a ISS ARE BASTED ON $10.00 PER FIXIM B, EXCEPTWHERE NOTED M(TURES: (INDICATE TOTAL NUMBER OF EACH) 13AT1i SINKILAV FLOOR DRAMS SH0INER WATER PIPING BATHTUB GAS PIPING (Need City Uc anse) POOL WATER SOFTENER ($30 Cf.OTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREY. (SIS) DISHWASHER LAUNDRY TRAY WATER HTR ISM FOR IRRIGATION WATER METER OTHER Permit Fees $ 3 ay 0 MINNNUM: $93.00 or 5% of cost of the Improvement -whichever is Plan Review $ greater on work less than $300 Surcharge $ .50 TOTAL DUE $ 3 S' J Make checks payable to: City of Fridley THIS IS AN APPLICATION FOR A PERMIT- NOT VALID UNTIL PROCESSED I hereby apply for a plumbing penrot and I acknowledge that the intimation above Is complete and awt ate: that the, work win be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Code% that I understand this is not a permit but only an application for a permit and work. is not to start without a permit; that the work viii be in accordance with the approved plan in the case of all work which requires review and approval of plana. (� ,,NAME r i 4 /,J(,c OFAPPUCANT A " DATE l� I ` Please or SIGNATURE OF APPUCANT %A ` , . n , CITY OF FRIDLEY COMMUNITY DEVELOPMENT DEPARTMENT TOTAL P.01