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PRE 2010 DOCSSUBJECT City of Fridley MOVING ® 12956 AT THE TOP OF THE TWINS BUILDING P E R M I T r � ECEIPT N COMMUNITY DEVELOPMENT DIV. 1 PROTECTIVE INSPECTION SEC. NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 L•"' ,�J 612-560-3450 910-F15 I 5/21/75 I JOB ADDRESS 134 Longfellow Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 31,32 4 Spring Brook Park Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Hank Muhich 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Badger Movers Inc. 3550 Grimes Avenue North, Mpls. 529-1331 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Dwelling 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR j] MOVE ❑ REMOVE 8 DESCRIBE WORK Move koxx house into Fridley to be set on foundation constructed on #12,931 9 CHANGE QF USE FROM TO STIPULATIONS Route: East frontage road of 47 to 49th Main to 57th to Univ. to Osborne to East River road to Longfellow TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. wood Frame 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 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 GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTIQjV OR HE PERFORMANCE O� F CON® RUCTN $65.00 PLAN CHECK FEE TOTAL FEE A `�" �`y�✓+"' "tv-'�� ,i =,7% "-17j $65.00 SIGNAT RE OF Co RORAUTHORIZEDAGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT BLDG INSP DAVE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) City of Fridley Permit No. r 4T THE TOP OF TME TWINY MOVING PERMIT APPLICATION ` ---'--DEV[LOPNENT DIV. Receipt No. i r t.GOMMVNITY PROTECTIV! W9ftCTf" 99W, ---� CITY "LL IRIOLtr Omit 03-000-3400 N(111Ypt DATE PAOL, OF, v ev 1910-F21 0 2/15/73 l 1 800 Property Owner Address Phone --1 / resent Lot No Block 'No Tract or Addition Legal To Be Moved To 3/O 32 S ✓ = /3 /� Mover �//Addresg Phone W, cense�o .� e,i-- L 3.ss-v G'�: e,s /z/ / -i lExpectddTime in or Thru Fridta Estimate Cost X� U r Routing A/7 l� Approved By: Utilities Notified; State whether notified and date Minneapolis Gas Company Engineering Department 372-4850 Northern States Power Company Customer Business Office 330-5540 Northwestern Bell Telephone Co. Business Office y ;332-4112 Approved By Water & Sewer Department: j All Bills Are Paid Services Are Disconnected �! The undersigned hereby makes application for a permit to move the building described above, agreeing to do all work in strict accordance with the City Ordinances and rulings of the DepArtment of Buildings, and hereby declares that all facts and representations stated in this application are true and correct. Contractor ly U" rv,w le Ink'u a!)•�rtr�...,w.i+w .... .3/^:.^^. r..,n. P.�rww� Q�p M1e���e �} �_� „e : > I 'a2ar Ga vs -1 i 6 frGa': bau.ds W v.L'iabCiva.ti. r m •P ,b .:�Y J tom: S.i��i b Yv'`swr PARTIAL RATE SCHEDULE GiRAVrrT WARM ATR: i'Jr^a:J.. T0VALL Furnace Shell do Duet Work $10.00 $ Re, 'ace-n:►rt of Furnas a 6.00 $ P.rpa:-c & AltrraLons--up to $500.00 6;k3 S Repairs do s:teraticros each add. $500.0 3 O $ mzm WARM ASR 7l:rnaee Shell Lc' Duct Work to 130,000 BTU 51000 $ es -ch add. CO,000 BTU 3.WJ S Replacer. -Ant of il.:rnace 6.00 3 Repairs & A'trrations.--vp to $500.00 6.00 # Repairs do Alterations each add. $50.00 3.00 $ STEAM ex HOT WATER SYSTEM P.. -race Shell Sc Lines-- to 4010 sq. ft ?.DR Steam . V0.00 $ Furnace Shell & Line --to 640 sq ft. EDR Hot Water 1000 S. Each add :0O sq. ft. EDR Steam S 00 $ Each add. 320 sq. ft EDR Hot Water 3.0 S OIL BUENEP.—to 3 gal. per hour 6.00 $ over 3 gal. per hour—See Tree Schedule GAS BURHYR Cup to MOW BTU) 5.00 $� corer i23,OCd BTU sae Fee schoduie GAS FITTING FLT -3: NO RATE TOTAL 1st 3 fixtures z$ 200 $ Additional Fixtures x .76 Gas Range to 199=0 xS 5.00 $ AIR CODMI IONW.Gr FAN EZ-- ° TING S T Zi'�. A ALTa'RATTONS & REPAIRS ROUGH Y=;m/, s141- i i State Surcharge .50 TOTAL 's= S D -rpt. of Dl-ir . all?BLD SZD-14:0 �G 2✓>� a ,�-P�G o City of Fridley: The irndcrsigned hereby maces application for a permit for L>e work herd specified age,.-ving to de all work in strict accordance with the City Ord!= -.v »nd rut'r.F of the Depa: unont pf Buildir.�s, and her tby declares that all the fie and reprecPntativas stated in this application are true and correct. F}:dley. ?&nn 1C, 71 e" Z I07s own" //r J.'/ ), �57 /' % G' Kind of Building a 0 S / (76-2,Pl C t" K ,, el V P (f Used as . Pea , .r/r 7-r c To he complexed about Estimated Cast:. S -� 00 /' Old—New. Building Permit No Permit No. e-3 1r4iU="13017 OF WOi°ui HEATING or POWER PLANfiS—utxam, Sot Water, Wsxm AAr—No Trade Name — Size NO-(&jr CapacitylS—a/-0':7L Sq. Ft. E.D.R BTU I3: Total Connected Lard—_— Kind of ?fleeter S BURNER — Trade Namt. Size Tdo Capacity E.D.R BTU terseasza-oasai slv E3 City of Fridley ApplicestIcn for Plumbling and Gos RHbrtg P`►mit Dept. of Bldas. Phone M-3450 DESCRIPTION OF VlOIZi Lota:ti3 41nrs / Num}xr, Kind and LoerIlon of Fixturei 'CI O s i `< < N x N O o� . V K < 3 7 U l <S U 4 N Z 7 IU S ► N WAT(% "TR. GAS tt[G Base / l Ist 2rd _ 3rd -f-i—F-17 4th I I I I wu�w�w wla • Futuro Conao.:!'.cn Opoainrps Soesar e New Flxture, Old Openings Ccsspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL l� aG Number Fixtures ................ I x $2.00 $�= Future Fixture Opening ........... x $1.50 $—_. New Fixture Old Opening.......... x $1.50 $ - Catch Basin .................... x $3.25 $ o f� Water Heater :Up to 99.000 BTU) ... • x $3.00 $ New Ground Run Old Bldg......... x $.3.25 $� Electric Water Haator, .......... a $2.00 3 3" FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..... ...... • • • • • • x $2.00 $ � � 0 Additional Fixtures .............. x $ .75 $ Gas Range to 199.000 BTU ........... x $5.04 P.EPAMS & ALTERATIONS—Refer to Code Description .........................................$ TOTAL FEE City of Fridley: it The undersigned hereby makes application for a permit for the work here! specified, a:;reeing to do aI1 w•erk in strict accordance with the City Ch -d nan ce and ruling of the Department of BuiId;ngs, and hereby declares that all the fact and representations stated in this appL'ca: clvtL 41k. k / A/ �� { I. ®n,-iel/ow � ;" /W, fl44 w !Www Y ruro etOOP"J nFate5 1'0-c. Per*'y cc"-nek-3' .Itic►�� y c crTs` v �hd r r"Hss �s c vert I-epr�se��Ta ���• p d .S v t vcy c., -;r`7_"p f /®c 4" 44, Spri �►�r �' �o us yr b m �e9S a „i OH v e w /1/c►r f;�ir Put-& 4c/d. CI,'fy o -y" re, c�lsc�j I S5- fceY- ole Lor peyg Sutveyod o lcler M If 167 Ail, se-evevoo ti H t ; k A t I : ! w N�wnu�•v �• • v.e�.. : wn 7:. O ERW T l lt4 04 "" vt tr /'�' IXYN It Giy.s77,71 tyr'y AIV A / ' � on VarlfiCa-l'-1all ,S'v`v'ea� t reg a #n Y j't)j' j4 c'Or O O-41 ,afe5 pt.c perry i`ha,S s p�' c3 Survey c,.� 7s J? ep= Cdr` ��Z, l�: �'/dc4' 44', P8rk' �tld. G'J` y` y J � /e��-a c�/�c,1 ego rb«r rr t�i9s mon th Over 7%e/ /1/ortyf►► a La r" ®� t'w /U cjrP as e�, �S w�v rve if n+ v rr/Y hi y SuPrr vi s i �s7 ter /7' "' 0r�q�St . ey, Sued'(fo� /VO. ��� i 2.5.3 THE MINUTES OF THE REGULAR MEETING OF THE FRIDLEY CITY COUNCIL OF JANUARY 20, 1975 The Regular Meeting of the Fridley City Council of January 20, 1975 was called to order at 7:31 P.M. by Mayor Nee. PLEDGE OF ALLEGIANCE: Mayor Nee invited all who were present to join the Council in saying the Pledge of Allegiance to the Flag. ROLL CALL: MEMBERS PRESENT: Councilwoman Kukowski, Councilman Breider, Councilman Starwalt, and Mayor Nee. MEMBERS ABSENT: None. ADOPTION OF AGENDA: Mayor Nee indicated he had an item to add under Old Business, the consideration of an ordinance to amend Chapter 603, Intoxicating Liquor, of the City Code of the City of Fridley. MOTION by Councilman Starwalt to adopt the agenda as amended with the addition of the consideration of the amendment to Chapter 603, Intoxicating Liquor. Seconded by Councilman Breider. Upon a voice vote, all voting aye, Mayor Nee declared the motion carried unanimously. OPEN FORUM: VISITORS: Mayor Nee asked if anyone was present who wished to address the Council during the Open Forum Section and there was no response. PUBLIC HEARINGS: HERWAL RICE CREEK Mayor Nee explained that this item had been tabled last week with the request that some representative of the plat be present at this time to discuss the various conditions. Councilman Starwalt suggested that this item be taken care of later in the meeting, allowing for the possibility that the representative will attend. Mayor Nee said the Council would come back to this item later in the meeting. -OLD BUSINESS: IIII ' ORDINANCE NO. 578 - FOR REZONING REQUEST ZOA #74-04, BY HENRY F. MUHICH LOTS 11-21, AND LOTS 28-35, BLOCK 4, SPRING BROOK PARK ADDITION, FROM M v GENERALLY LOCATED BETWEEN 79TH AND LONGFELLOW STREET AND ASHTON AVENUE 4 AND CONSIDERATION OF APPROVAL OF REQUEST FOR HOUSE RELOCATION ON LOTS 31 AND 32, BLOCK 4, SPRING BROOK PARK ADDITION TABLED DECEMBER 16, 1974): Mayor Nee explained this item to be a request for rezoning and pointed out the general location of the area. He explained that the rezoning had been initiated by Mr. Henry Muhich and the proposed action has the support of all the property owners involved. Mayor Nee continued to explain that the property is currently being used as residential and the people residing in the area are having some problems with financing and maintenance of the homes because of the M-1 zoning. Mayor Nee stated the people of the area petitioned for the rezoning and it was recommended by the Planning Commission that this area be rezoned. He pointed out to the members of the Council that the proposed rezoning would take four Council votes. Mayor Nee asked if there were any questions by any members of the Council. i 254 REGULAR COUNCIL MEETING OF JANUARY 20, 1975 PAGE 2 MOTION by Councilman Starwalt to adopt Ordinance No. 578, an ordinance for rezoning request ZOA #74-04, by Henry F. Muhich, to rezone Lots 11-21 and Lots 28-35, Block 4, Spring Brook Park'Addition, from M-1 to R-1, generally located between 79th Way and Longfellow Street and Ashton Avenue and the Railroad tracks. Seconded by Council- woman Kukowski. Upon a roll call vote, Mayor Nee voting aye, Councilwoman Kukowski voting aye, Councilman Breider voting aye, and Councilman Starwalt voting aye, Mayor Nee declared the motion carried and the ordinance adopted. MOTION by Councilman Breider to issue the permit for the relocation of the house on Lots 31 and 32, Block 4, Spring Brook Park Addition with the stipulations that a two car garage be constructed by the end of 1975 and that a landscaping bond for $5,000 be posted. Seconded by Councilwoman Kukowski. Upon a voice vote, all voting aye, Mayor Nee declared the motion carried unanimously. CONSIDERATION OF -A REQUEST FOR THE CITY TO AUTHORIZE AN EMPLOYEE TO ACT AS A VOLUNTEER REGISTRAR FOR THE SELECTIVE SERVICE SYSTEM TABLED JANUARY 6, 1975): The City Manager pointed out that the representative from the Selective Service System was present and if the members of the Council had any questions concerning the proposal, he could answer them. Mr. Junior K. Anderson, Executive Secretary, Selective Service -System area office #19, addressed the Council and introduced himself. Mr. Anderson said they are presently concerned about the distance that the Fridley young men have to travel to register. He pointed out that there is a registrar in Grace High School and also in Robbinsdale. Councilman Starwalt questioned why the registrar had been eliminated at Fridley High School. Hr. Anderson explained that an attorney had questioned if there may be a conflict being this was being done during the school employees compensation time. He said the question had not been resolved, but the school had discontinued the practice because of the question. He said this is currently being resolved, and there is the possibility if this is resolved with the opinion that it is not a conflict, the school would again designate the registrar. He explained this to be the best condition for such registrations because the young people are at the school and would not have to travel. Mayor Nee asked Mr. Anderson how much time would be spent on the average for each individual registration. Mr. Anderson said this is estimated at about five minutes. Mr. Anderson further mentioned that the Selective Service System furnishes the necessary paper, materials, etc. The registrations are mailed to the Selective Service office once per week. Ar. Anderson explained that they would not want to take any more time than necessary from the employee s normal duties. Mayor Nee said he felt this would be a reasonable thing to do for the convenience of the young men in the community. Councilman Breider said he agreed and stated this would be some help to the young men in the City rather than them going to Robbinsdale. MOTION by Councilman Starwalt to provide and authorize a member of the City Staff to act as volunteer registrar.under the jurisdiction of the State Selective Service System. Seconded by Councilwoman Kukowski. Upon a voice vote, all voting aye, Mayor Nee declared the motion carried unanimously. CONSIDERATION OF APPOINTMENTS TO CITIZEN BIKEWAY COMMITTEE, AREAS #1 AND #3, TABLED DECEMBER 9 AND JANUARY 6, 1975 Mayor Nee named two recommendation for appointments if no other members of the Council had suggestibns., These persons were Mrs. John E. Gardiner, 371 Ironton, Area #1, and Mrs. Verner E. Johnson, 5832 University Avenue N. E., Area #3. MOTION by Councilman Starwalt to appoint Mrs. John E. Gardiner as the representative from Area #1 and Mrs. Verner Johnson representative from Area #3. Seconded by Council- woman Kukowski. Upon a voice vote, all voting aye, Mayor Nee declared the motion carried unanimously. i . v\ 97-84-416051 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 49 m v a 0 t°a a o m Hb 3 W ca w 0 m S$ A w (d N� 51a3 ri - 4 V 11e ri R, w m 0 m e Water Heater s lec x $7.00 New Ground Run Old Building x $5.00 Electric Water Heater x $5.00 GAS FITTING FEES: 1st 3 fixtures x '$3.00 Additional Fixtures x $1.00 Gas Range to 199,000 BTU 1st $10.00 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $3.00 Future Fixture Opening x $2.00 New Fixture, Old Opening x $2.00 Catch Basin x $5.00 Water Heater - to 99,000 BTU x $5.00 100,000 BTU to 199,000 BTU x $10.00 Water Softener x $7.00 New Ground Run Old Building x $5.00 Electric Water Heater x $5.00 GAS FITTING FEES: 1st 3 fixtures x '$3.00 Additional Fixtures x $1.00 Gas Range to 199,000 BTU x $10.00 REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction State Surcharge TOTAL FEE REINSPECTION FEE ($10.00) P Job Address 134 Longfellow St. NE Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. 5-26-77 , 19 OWNERMargal'et K. Bradley KIND OF BUILDING Frame USED AS TO BE COMPLETED ABOUT 6-2-77 ESTIMATED COST 1Q�� OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company Signed By Tel. No. ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT $5.00 $ / $2.00 $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7..50 PLUS $.50 STATE SURCHARGE $ .50 „ Class • ", Ay Surcharge, .50¢ $ R nn SUBJECT PERMI City of Fridley FOUNDATION PERMIT X. 12931 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. w COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. �77/ 1 /'•'1 CITY HALL FRIDLEY 55432 �'•" ,�� NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-1715 5/8/75 JOB ADDRESS 134 Longfellow Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 31, 32 4 Spring Brook Park Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Henry Muhich 200 Logan Parkway N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 F�1,>�](]ati811 ❑ REMOVE CVV ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE 8 DESCRIBE WORK Construct foundation for 30' x 30' Dwelling and a 18' x 20' Garage that are to be moved into the City 9 CHANGE OF USE FROM TO STIPULATIONS Performance Bond of $500.00 submitted. Provide a hard surface driveway. (Receipt #75993) SEWER LOCATION: (Approx. 9' Deep) 168' East of Manhole (Inv. 850.80) Wye Elev: 851.49 Top of Footing: 855.49 Minimum Before digging call local utilities WATER LOCATION: Approx. 10' E. of Sewer Serv4MEPHONE • ELECTRIC - GAS Etc. REQUIRED BY LAW SEPERATE PERMITS REQUIRED FOR WIRING, HEATING, PLUM13ING ANI) SIGNS. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPf4&!S 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 R-1 876 7,008 +3,6 OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS 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 $5,500 2.75 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $20.28 $325.00 / PLAN CHECK FEE TOTAL FEE tel/ 348.03 SIGNATURE F 6ONTRACTORORAUTHORIZEDAGENT (DATE) OPERLYY� V®�ALIIDA�TE/D� THIS IS YOUR PERMIT 20L,"1. C-cL�z.s'C/ /G �%a� .• BLDG INSP DATE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) I APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME : ��P �'/ % 111441 -BUILDER: Ja -d? e --r ADDRESS :Z-00- ADDRESS: NO • . STREET • /0 7? f LOT„4— 3 / 9- 32 BLOCK: '� ADDITION: :i;2 L_ n :2 13z-oa e P*, CORNER LOT: INSIDE LOT: SETBACK: S2 SIDEYARD : 3 ,— GQ �•a� e Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: zP5; y C F' —Front: 3 e Depth: j 0 / Height: Square Feet: _R5Cubic Feet: Gam$ a_ 7 Front: Depth: 20 Height: �67 Square Feet; e Cubic Feet: 3 ' Type of Construction: 64-ro 5 P Fro—N Estimated Cost: $ :2�0-0-67 To Be Completed: 21��, / The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stiict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. 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Y .,Y�.pF.• k �y�, v ! f• f p f' • e ,1. 4 S • a R s 3 .sl.�.sa # 'P.. a f: ,,, s �, •4'�? � -L- • • A ~ a Ft.. `( . yn •� %ir�4i A.i f C,49ff)eoDe ET-) 3 Ca-- a % w � r r v,c M • 4 0• • • Y 97-81 —879001 n CITY OF FRIDLEY APPLICATION FOR PWMBING AND GAS FITTING PERMIT L7' PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction X $3.00 x $2.00 x $2.00 x $5.00 X $5.00 x $10.00 x $7.00 o $5.00 Water $5.00 +� .et m E ro m `� m ro ►a pa, k' Heater � m �e .0 w .c a � w a ►� .� U D 3 A w O 3as 3lec (a C 9Q fA i» to 1st connect r .nff 2nd 3rd 4th = Future Connection Opening Connected with Sewer = New Fixture, Old Opening E Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction X $3.00 x $2.00 x $2.00 x $5.00 X $5.00 x $10.00 x $7.00 x $5.00 x $5.00 x '$3.00 x $1.00 x $10.00 $5.00 $2.00 State Surcharge TOTAL FEE REINSPECTION FEE ($10.00) S $ .50 $ 0.00 Job Address Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct 4 Fridley, Mn. 5-16-77 , 19 KIND OF BUILDING frame USED AS res. TO BE COMPLETED ABOUT 5-23-77 ESTIMATED COST 10.00 j OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company T aaA, Y c Signed By MINNEGASCA Tel. No. ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE 01, -,Ss "A" Surcharge .500 G7YOF FRIDLEY AFug stY lk1UNIC�PL CENTER •6431 UNIVERSITY AVE. NOTICE EY, MN 55432 • (612) 571-3450 •FAX (612) 571-1287 Levi Wilcox 134 Longfellow Street N.E. Fridley, MN 55432 RE: Noncompliance of Fridley City Code 105 (Weeds) at the Following Property: Location: 134 Longfellow Street N.E. Legal Description: Lots 31-32, Block 4, Spring Brook Park Property I.D. No.: 03-30-24-42-0030 Dear Mr. Wilcox: Fridley City Code 105 (copy enclosed) states that it is unlawful to maintain land in the City upon which weeds, grass, or rank vegetation exceeds ten (10) inches in height; or other noxious growth exists as outlined in the ordinance. This was enacted to protect the health and safety of the community and its residents. A recent inspection of the above referenced property revealed conditions which are not in compliance with this ordinance. It is important that you take appropriate steps to correct this situation immediately. I will conduct a reinspection on or shortly after August 28, 1991, at which time full compliance is expected. Should this deficiency still exist, I will instruct the City's Public Works Department to abate the condition. In the event the City abates the condition, you will be served a notice in writing indicating the work performed and the costs and expenses involved. The total amount must be paid to the City within 30 days after this notice or before the following October 1, whichever is later. If this is not done, the costs and expenses shall become a lien in favor of the City; and a 15% penalty will be added to the amount due as of the date, with the total costs, expenses, and penalty thereupon to be certified to the County Auditor for entry on the tax books as tax against the land. Please call me at 572-3595 if you have questions or wish to discuss this further. Thank you for your cooperation! Sincerely, cc: Shearson -Lehman Stevenr 1201 East Highland Avenue Weed Inspector San Bernadino, CA 92404 CE -91-337 CITY OF FRIDLEY INSPECTION DIV. Effective On January 1. 1991 6431 University Ave NE Fridley. MN 55432 APPLICATION FOR POWER PLANTS AND HEATING. COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work. Burner - Also Replacement Furnace Gas Piping ' N'beded with new furnace Gas Range Gas Dryer JOB ADDRESS f' The undersigned hereby maker application for a permit for the work Rate TOTAL herein ePecifled agreeing to do all work in strict accordance with the 66 city codes and ruling of the Buiiding Division, and hereby declares $ 20.70 S that all the facts and representations stated in s applipation are true and correct. .19 $ 10.00 3 OWNER Uhl $ t o.o03 BUILDFyG USED AS (ale Gi 10,1 0.00 $ ESTIMATED COST PERMIT NO.__ *Air Conditioning - All Sizes $10.00 $ All Others/Repairs & Alterations (LIST ON BACK) I % of Value cf Appliance or Work S CommerciaVlndustrial I % of Value of Appliance or Work a State Surcharge S .50 TOTAL FEE $�®.0 MINIMUM FEF FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hct Water)Va"rm A� Trade Name JAN ft -oft L Size No. <;;VAW m7r-- BTL-__W 0 r--BTL'_DOO HP. EDR Fuei��% Ttaal Connected Load Burner Trade Name Size No. BTU HP EDR HEATING Signed By Approved By Rough -In Date Final Date 4�p *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 0 0 Remarks List Alterations Being Done: HEATING COMPANY Signed By Date 4-i 1 4--b CHIMNEY AND BTACR VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes No ( ) 2. Is free from rust or deterioraticn Yes No ( ) 3. Has no foreign objects lodged within Yes (Vj No ( ) 4. Is securely supported Yes (yQ No 5. Meets all current Code requirements for size and total BTU's connected Yes No�( 6. Has total heating BTU's of 400 All other BTU's TOTAL BTU's Remarks List Alterations Being Done: HEATING COMPANY Signed By Date 4-i 1 4--b CITY OF F E'Y� TION DIViSION 6 — PW73LJ 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, 2002 JOB ADDRESS JO` L��V ii Of lI 1 \k–" OWNER S VIii xr)n Rate TOTAL BUILDING USED AS PA S, $ 30.00 $ ii ESTIMATED COST �I ���� PERMIT 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. � j BTU HP EDR $ 25.00 $ ��.(� 0 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. $ 50 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 Qr)--" Final Date' FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE I THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When ren acinagan existing furanrp, 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 plasticlPVC 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 manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The exic i g comb ictinn air is sized and installed to meet the current codes and manufacturers specifications. Yes () No ( ) When required to install a new cnmhtistinn a04 it will be sized and installed to meet the current codes and manufacturers specifications. Yes () No ( ) When Installing a new yenting system, 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 Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) 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( ) 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 PERMITo.: 2004-01301 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 08/11/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 134 LONGFELLOW ST NE PIN : 033024420030 LEGAL DESC : UNAVAILABLE : LOT 0 BLOCK 0 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WINDOW/DOOR REPL VALUATION : $ 800.00 NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS. INSTALL BASEMENT EGRESS WINDOW. APPLICANT BUILDING PERMIT FEE 32.65 KASI ATEN PLAN CHECK FEE 21.22 134 LONGFELLOW ST NE FIRE SURCHARGE 0.80 FRIDLEY, MN 55432 STATE SURCHARGE, VALUE 0.50 TOTAL 55.17 OWNER KASI ATEN 134 LONGFELLOW ST NE FRIDLEY, MN 55432 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 work 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 local law regulatin co ction or the performance of cons cti on. Appligant Date e �I Bldg hasp D SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. NEW [ ] CITY OF FRIDLEY e4'� EireAP 04 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: l3C� �`' �� /fa W 57-r Al 5 Legal Description: Owner Name & Address: ICcl S A7-,E,;jJ STel. # 79 3– Contractor –Contractor. ® Nc MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: ;jV 5°Z// & �g of £ er ��I 62 5 S w ' g1 b a tj Construction Type: � 4 R E 55 W i A/ 6 0 LIJ Estimated Cost: $ 5� 0 6 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: 7 o1S/L?APPLICANT: fiC'r G �GC' � � �� m—=��e1. # Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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 [ ] TOTAL $ STIPULATIONS: NEW [ ] CITY OF FRIDLEY ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION 0-S Construction Address: Legal Description: Owner Name & Address: IC GI �, i Gi 7r- N F 2 z PPI E� Tel. # -?C3-- 16 —05 SS Contractor: MN LICENSE # Address: Tel. # LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. -f Dov tv, 7 ' k /® ; Construction Type: Estimated Cost: $ 5 O 0 0. 0 O Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$ DATE: 3 /J O S APPLICANT: adz,G rk25- 1�-S,5 Tel.# 7�3, 7�S-o5 SS Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY - Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1450 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 [ ] STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004 6431 University Ave NE 1� -DV Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT ©� " (763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 137 LoA)67 F-9//0 (,,j 5T PE New Fixtures $10.00 DU The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $10.00 and representations stated in this application are true and correct. Catch Basin Rain Water Leader $10.00 $10.00 DATE: ��L, 20 Sump/Receiving Tank $10.00 11 Xf) S h� N s Water Treating Appliance $35.00 OWNER Water Heater -Electric $35.00 O 1N1 Water Heater - Gas** �_ $35.00 ` BUILDING USED AS !7 Gas Range* $10.00 Gas Dryer** $10.00 ESTIMATED COST PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMPANY %C 3 7S Reinspection Fee $50.00/Hr SIGNED BY TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Gb Approved By Rough -In Date Final Date State Surcharge $ .50 MINIMUM FEE FORA PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST TOTAL FEE OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE f FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing 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 venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and terminatidn. 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 Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No 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 Fumice Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) 19 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 ( ) Appliance Type and Size/Common Vent and Vent Connector Information 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: (Describe) HEATING CO: Signed By: Date: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 FAX: (763) 571-1287 REPRINTED ON 1/12/2006 ADDRESS 134 LONGFELLOW ST NE PIN 033024420030 LEGAL DESC UNAVAILABLE LOT 0 BLOCK 0 PERMIT TYPE HEATING PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE X ALTERATION NOTE: INSTALL AMANA NATURAL GAS FURNACE #FURNACES 1 i I APPLICANT NORTHERN HEATING & A/C INC 9431 ALPINE DR NW RAMSEY, MN 55303- (763) 323-7597 OWNER KASI ATEN 134 LONGFELLOW ST NE FRIDLEY, MN 55432 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 wort 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 construction. Applicant Date Insp Date PERMIT NO.: 2006-00085 DATE ISSUED: 01/11/2006 FURNACE SHELL/DUCT WORK STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 11516 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 35.00 0.50 35.50 CITY OF FRIDLEY, BUILDING INSPECTION Effective 4/1/2004 6431 University Ave NE Fridley, MN 554x2 APPLICATION FOR, PLANTS AND HEATING, COOLING; VENTILATION ` 763-572-3604 FAX 763-571-1287 ' REFRIGERATION AND AIR CONDITIONING` SYSTEMS AND DEVICES " JOB ADDRESS RATE SCHEDULE EIS jgt�l Residential Owner, &fa\ e Furnace Shell and Duct Work, Burner & also Replacement Furnace ='. $35.00 $3 Building Used As [€`.nfi6.1 Gas Piping (New Furnace, Fireplace, Insert) $10:00 $ ESTIMATED COST `"I PERMIT NO Gas Range $10.00 $ DESCRIPTION OF R]RNACE N R Gas Dryer $10.00. $ # of Heating Units—L— Circle One (Steam) (Hot Water) Trade Name Size No. *Air Conditioning -All Sizes $25.00 $ BTU HP EDR Fuel W_.�-r Total -Connected Load All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work. $ ` Burner Trade Name Size No. Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EDR Improvement whichever is greater r The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional --T specified agreeing to do all work in.str"ct accordance with the,City Codes 1.250/o of Value of Appliance or Work (Ust on Back) $ > and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 forCommercial/Industrial/Institutional and representations,stated in this application are true nd correct. State Surcharge $ Sti HEATING CO TOTAL FEE- $�0 gigned Tel #323 --1Sit -7 T. REINSPECTION FEE $50.00/HOUR FAX # -1\Q�- 323 I��L1 -Date ° ( h D *Air Conditioners 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 Approved by Rough -in Date Final Date - FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS - COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION _;Wien replacing an existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely s0pported'find firestopped where, required. Yes N No ( ) =The venting system is plastic/PVC and meets all current -codes and -manufacturer ;=specifications including sizing, length, number of elbows and termination.. Yes (yt) 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 Furnace Venting Tables for fan assisted and natural draft appliances. Yes (�) No.{: ) - The existing c:otnbustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes No( ) When required to Install anew combustion air. it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No (` ) When Installina 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 _ Venting Tables for fan assisted and natural draft appliances. Yes Q) No 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 odes. Yes (}O No Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type la -a fyL(,e 111% BTU Input��L)W Fan Assisted or Nat �n 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 t inches J Appliance #1 Vent Connector Height ft Length 1® ft Diameter �'' in Type _d Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe HEATING CO: NORTHERN HEATING & AIP CONDITIONING, INC. Signed By: — Date: