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PRE 2010 DOCSand Cmdb% Irmysi RaMm, Re h 1go otba ®d Air CendWwb4j Sys wW Devices PARTIAL RATE SCHEDULE ciRAVIF 'Y WARM AIR: SATE TOTAL, Furnace Shell da Duct Work -$10.00 Replacement of Furnace 6.00 Repairs & Alterations—up to 5500.00 6.00Repairs & Alterations each add. 5500.00 3 00 $L- - -- _ >Furnace Shell & Duct Work to 180,000 BTU .$10.0o S ZO each add. 60,000 BTU . 3.W : Replacement of ]Furnace 6.00 5 Repairs & Alterations—up to $500.00 6.00 5_ Repairs & Alterations each add. 5500.00 &W 5— _ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. FZR Steam $10.00. - Furnace Shell & Line --to 640 sq. ft. EDR Hot Water I0.00 Each add. 200 sq. ft. EDR Steam 1.00 Each add. 320 sq. ft. EDR Hot Water 3.00 OIL BURNER—to 3 gaL per hour 6.00 over 3 gal. per hour—See Fee Schedule e� a GAS BURNER (up to 199,0 BTU) 5,00 5 .� over 195,000 BST See Fee Schedule GAS FITTING F =. NO RATE TOTAL 1st 3 Fixtures x$ zoo 5___4 JC' e� Additional Flwtures x .75 S -- Gas Range to 195.000! x$ 500 5 AIR CORMT110111MG FAN IULLTMM STSTM Fee Sdksdulw S ALTERATYOits rt B>tDP'AISS TOTAL FMt FBl►AL f/- .2 �/ - 75! Dept. of Bldow Phone 800-M City of Fridley: v The undersigned hereby makes application for a permit for the work hereW; specified, agreeing to do all work in strict accordance with the City Ordinancev and ruling of the Department of Buildings, and hereby declares that all the facts ' and representations stated in this application are true and erect. Fridley, Minn_ /Z-7 X__y 19 Owner Kind of Building Used as To be completed about _�_ Estimated Cost, $ Old—?(e;) Building Permit No. _— Permit No. DT1O1f OF WORK HEATIN POWER M ANTg—Steam, Not Water, lNo Trade Name_ Capacity--_- — Sq. Ft. E D.R G 5" c) BTU 8F Total Connected Riad of TML BURNER — Trade Na*+ Size Ne_ Capacity Sq. FL EDR BTtT Nw t .a-om► B,y Phar City of Fridley - Applicafion for Plug mid Sm Fbtkg Pam* Dept. of Bldgs. Phone NO -3430 DESCRIPTION OF WORK Number, Kimd and Location of Fixtures C NO. RATE TOTAL Number Fixtures ................ . x $2.00 Qg S F Future Fixture Opening ........... ar vi F = O New Fixture Old Opening .......... N Z $ Catch Basin .................... x $3.26 $� Water Heater :Up to 99,000 BTU) .... e e WATER HTR. GAS ELEC. Base Il $ GAS FITTING FE: NO. RATE TOTAL J :, x $2.00 1 Additional Fixtures .':............... x $ .75 r Gas Range to 199.000 BTU.. . x $5.00 $ REPAIRS & ALTERATIONS—Refer to Coda 1st fr $ f $`2 2nd 3rd 4th • Future Coaaaetioa Openings * New Fixture. Old Openings Connected with Sewer Cesspool a PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ . x $2.00 $� Future Fixture Opening ........... x $1.50 $-- _New New Fixture Old Opening .......... x $1.50 $ Catch Basin .................... x $3.26 $� Water Heater :Up to 99,000 BTU) .... �_ x $3.00 $ New Ground Run Old Bldg......... x $3.25 $ Electric Water Heater .............. x $2.00 $ GAS FITTING FE: NO. RATE TOTAL 1stes :, x $2.00 $ Additional Fixtures .':............... x $ .75 $ Gas Range to 199.000 BTU.. . x $5.00 $ REPAIRS & ALTERATIONS—Refer to Coda Description .............................................. $ TOTAL FEE $`2 City of Fridley: �J 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 of Buildings, and hereby declares that all the fact and representations stated in this applicationareare true and correct Fridley, Minn I / ` -7. „ i9z5X' Owner Kind of Used as To be completed about Estimated Cost, $ 4 Old— a uilding Permit No. Permit No. a Signed ' By Business Phune No ROUGH -7� B. H. BRADLEY CIVIL ENGINEER AND SURVEYOR 3829 - 24TH AVENUE SOUTH! MINNIMPOUG. MUMEWrA OW 724-2169 o Ao 7, - 01 SUBJECT PE TN City of Fridley 12'766 AT THE TOP OF THE TWINS BUILDING PERMIT i � 1 • COMMUNITY DEVELOPMENT DIV. r �.------. PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 110/15/74 JOB ADDRESS 166 Longfellow Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 39,40 4 1 Spring Brook Park Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE North Metro Construction, Inc. 5203 Central Avenue N.E., Mpls 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 KI NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 36' x 24' Dwelling (Split Entry) 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before capping. SEWER LOCATION: 51' West of Manhole (Inv. 850.80) Wye Elevation: 850.61 Top of Footing: 853.61 Minimum WATER LOCATION: 10' East of Sewer Service SEPERATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Wood Frame 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 864 17,280 OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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. $9.03 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $18,057 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.- $32.00 $300.00 TION THE PERFORMANCE OF CONSTRUCTION. / ��� PLAN HECK FEE TOTAL FEE $341.03 S%NATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) H PROPERLY VALIDATED,TYOUR PERMIT Te -y— 1., i SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) BLDG INSP OATS 01 SUBJECT PER City of Fridley 131'7 AT THE TOP OF THE TWINS BUILDING PERMIT r j;Z PT N ; '+ ____�_ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. / r 1 1 � NUMBER REV. DATE PAGE OF APPROVED BY = CITY HALL FRIDLEY 55432 612-580-3450 910-F15 9/2/75 JOB ADDRESS 166 Longfellow Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 39,40 4 Spring Brook Park Addition SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Larry A. Blilie 166 Longfellow Street 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 ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK ?A Construct arae' x 24' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a W= hard surface driveway SEPERATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS. 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 SO. FF GU. F�� AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION y� 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 I STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION f D ✓�, SURTAX. AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED J 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- Aj. ev STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL,�EE„e` IZ +SI NATUREOFCONTRACTORORAUTHOWEDAGENT (DATE) WHEN PROPERLY VALIDATED T I!!S IS YOUR PERMIT oZ / ,— SIGNATURE WNERIIF OWNER BUILDER)/(DATE) BLDG INSP DAT APPLICATION FOR RESIDENTIAL; ALTERATION, OR ADDITION BUILDING PERMITS • CITY OF FRIDLEY, MINNESOTA OWNER'S NAME: V 01 BUILDER: rjf gni'► P� ADDRESS : N CADDRES S ; NO:--.A�_ STREET:— LOT: TREET:IAT: d 'e) BLOCK:—W ADDITION : Sir 9 %rao /C CORNER LOT: INSIDE LOT: %C SETBACK: SIDEYARD:. 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: 0 d¢2 Q ye r Front: 16 Depth: ,e1'Fr Height: /B Square Feet; 4180 Cubic Feet: y Q® Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: G°® ®� Estimated Cost: - ��,SSa?OP1 To Be Completed:�'�'jd/tii,/�S 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 rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE 00 S� %® 17 NEEMMI i'' - B. K BRADLEY �T-%� p j CIVIL ENGINMM AHO SUAVZYOR , u¢'wy 1 C�' (' Z)el) vI�r S t•- s! �/ 3829 -24TH AVENUE SOUTH MINNEAPOLIS. MINN:90TA SSWS,� 724-2160 • l � �' .�. : lam`" �, `vim �' • _ . ��. ' �, � `� � - a bo 41, L �6. ,L' .�. 4 � To • � v -'e �'r o %"mss �:-17�i P..r7't� +GG,+-�l�t- �' '® - � - -- i.. 1 560.3450 (Zitcy Of `f ;Al,y ANOKA COUNTY 6431 UNIVERSITY AVENUE NE October' 6, 1975 FRIDLEY, MINNESOTA 55432 Star Electric Lower 441 - 8th Avenue N.W. New Brighton, Mn. 55112 Re: Electrical Corrections Dear Sirs: It was noted at 166 Longfellow Street that the ground run work has not been completed. Also the corrections asked for at 1561 Rice Creek Road of putting running boards under the romex in the garage has not been done. We request that you complete these corrections immediately and call in for the inspections on each. If you have any questions on the above corrections, please contact me. Thank you, LEONARD EICAMILLER Electrical Inspector LE/mh suedEcr PER City of Fridley o 1383'7 AT THE TOP OF THE TWINS BUILDING PERMIT r 1 ` ECEIPT COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. �� �o� 1 � ` 1 "1 CITY HALL FRIDLEY 55432 � ,'J NUMBER REV. DATE PAGE OF APPROVED BY "•'� 612-560-3450 910-F15 10A9/76 JOB ADDRESS 166 Longfellow Street N.E. 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 39,40 4 Spring Brook Park Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Larry Blilie 166 Longfellow Street N.E. 3 CONTRACTOR MAILADDRESS 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 ❑ NEW ❑ ADDITION CR ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Finish siding garage 9 CHANGE OF USE FROM TO STIPULATIONS h TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood 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 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 $700 $.50 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- $7.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE w �® '06($8.00 SIGNATURE O ONTRACTORORAUTHORIZEDAGENT IDA ) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT -') � /® -11?-`tom.'- ! - r !Z , ,Y � `tom.' BLDG )NSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) CITY OF FRIDLEY APPLICATION FOR. RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER'S NAME: �/���/ �'1 1 iF BUILDER: Se F ADDRESS: (o ), o ml 9 zt�P Z l o w S+ ,"/ f ADDRESS: TEL. NO.: 2,f<,933 NO: ` STREET: G� /�iC� —/" a C --j -' -- 'V LOT: q0 BLOCK: Z� ADDITION: Ser/1V9 CORNER LOT: INSIDE LOT: SETBACK: SIMARD: 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: ! G 44,-7e—Front: Square Feet: Front: Depth: Height: Cubic Feet: Depth: Height: Square Feet; Cubic Feet: Type of Construction: &JO 0 V _S100jC— Estimated Cost: $ 7 o o. .*To Be Completed: / lVIC to � 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 rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: 7 G SIGNATURE: GL (See Reverse Side For Additional Information.) S� 0c) SUBJECT W RMTIT NG. City of Fridley 26084 AT THE TOP OF THE TWINS BUILDING PERMIT r 1 , ______ COMMUNITY DEVELOPMENT DIV. v RECEIPT NO. r � PROTECTIVE INSPECTION SEC. 1 � NUMBER REV GATE PAGE OF APPROVED By i CITY HALL FRIDLEY 55432 �---- �'' 612-571-3450 91aF15 5/22/98 JOB ADDRESS 166 Longfellow Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 39,40 4 Spring Brook Park Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Sue Hazelton 166 Longfellow Street NE 784-6933 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. D R Coleman Construction 15 East Rd, Circle Pines, MN 55014 785-9538 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20039473 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION j@ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (2nd Layer) 21 Squares 8 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd layer but not the 3rd. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 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 1 1 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 $1,315 $.66 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- $45.75 Fire SC $1.31 ST TION OR THE PERFORMANC CONSTRUCTION. PLAN CHECK FEE TOTA EE $ �� �� Lice C $5.00 52.72 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI N 7PRPjP��LIDATZHIS IS VQ� P R 3V.D P PATE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI NEW [ ] Effective l/ 1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Q (0 00 a ConstructionAddress:J �2 (107 to"6; P.ELLG CID Si_(__ ` Legal Description: Owner Name & Address: -L- 64t Z Tel. # Contractor: -0 e a L �a s— e,xC MN LICENSE # -,�oG-39 /Y� 3 Address: L 5 'c,' L"i�cr �t s 5 SG jL( Tel. # _Z85 -?53a Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IMPROVEMENT Length Width Height Length Width Height. Length Width Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: 0_-_�CG P ( OUAE*—Lfr� Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 5 - a 1--�8 APPLICANT: F, GTel. # -Z 6 5-- ct 5 3 c TOTAL $ STIPULATIONS: CITY USE ONLY Permit Fee $ S Fee Schedule on Reverse Side Fire Surcharge $ I- / .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $©a $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 $ STIPULATIONS: Cl I Y Of I RlulLt_) IIv ,l't k- I ION Ij1V 6431 University Ave NE I=ttdley, MN 55432 (763)572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBFR nF FIXTI IRFc Tn Rt= lfIQTAI i cr% rul 17A,"., L- ttectwC Un Jan 1. 2UO2 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS Lair ���)�� j S4 New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct Catch Basin $ 7.00 Rain Water Leader $.7.00 203 Sump/Receiving Tank _ $ 7.00 Water Treating Appliance $10.00 e Owner Water Heater -Electric $ 7.00 -k Water Heater - Gas" $10.00 Building Used As hl Gas Range" $10.00 - Gas Dryer" $10.00 Estimated Cost— PERMIT NO. Back Flow Preventer Required ( )Yes () No =a Type $15.00 PLUMBING COMPANY-T�I.LL.Y���CIA�i C) Reinspection Fee $47.00/Hr 6.g SIGNED BY TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance FAX # &5_ - 9 Y7- { Approved By _ Rough -In Date Final Date State Surcharge .50 y MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT ISI20:00:; TOTAL FEE $�'� PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE - r s THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When mping-inn an gwictinftr�, 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 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 existingrnmhustinn air is sized and installed to meet the current codes and manufacturers specifications. Yes () No ( ) When required to install anew cnmhustlon air it will be sized and installed to meet the current codes and manufacturers specifications. Yes () No ( ) When installing anew vpntin8ws�, 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. Appliance Type and Size/rammon ventand Yes( )No( ) Vant CnnnpctnrVan Inronnation 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 : Eineering WATER AND SEWER Permit No.: i 763-572-3551 PERMIT APPLICATION Received By: 763-571-1287 fax A CITY OF FRIDLEY Date R EFFECTIVE 6/9/09 APPLICTATION DATE: YOUR E-MAIL ADDRESS: _ THIS APPLICANT IS: ❑ OWNER WONTRACTOR JOB ADDRESS: _ _ I to V Zo ^ j N'C NEW CONSTRUCTION PERMIT# (IF APPLICABLE): PROPERTY NAME: 57-e tl4tz 1 4-^ OWNER/ TENANT ADDRESS: L Wte L. -T CITY �%e STATE ZIP PHONE: CONTRACTOR NAME: SUBMITA CO YOUR STATEE ADDRESS: 3`{ Cn t. �v.�.� IVT CITY t - o UJ STATE -*& J ,� ( LICENSE WITH � � ' �, 3„ � PHONE CELLPHONE: JZ'; -Z-7 I -W APPLICATION STATE LIC # STATE BOND: EXP DATE: 1. Narrative/written description: .� -i'� (o � S1G r�{s�0�-!! Q cory�.,ars a. fes, f7t-:l eye^ i-�Oyx !`�?/�•* 2. Please attach sketch showing curb line, utility line, building, etc. with distances. PERMIT TYPE ❑ SEWER CONNECTION PERMIT $50 ❑ WATER CONNECTION PERMIT $50 ;N7WATER LINE REPAIR $40 ❑ SEWER LINE REPAIR $40 ❑ ADD STATE SURCHARGE $.50 ❑ SAC CHARGE @ $2000 = OTHER CHARGES (IF APPLICABLE) PAY TO UTILITY BILLING NEW WATER METER COST — SEE UTILITY BILLING SPECIAL ASSESSMENTS — SEE FINANCE WATER TAP — SEE ENGINEERING NOTE: WATER METER REPAIR, INSP OR SHUT-OFF / WEEKENDS & HOLIDAYS $125/HOUR-BILLED THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a water or sewer (new connection or repair) permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley. I understand this is not a permit but only an application for a permit and work is not to start without a permit. JF-/'3SIGNATURE OF F-/'3 10 LICANT PRINT NAME: C I'✓t-- DATE: r APPROVED BY: DATE: G ,, COPY G ❑ ILITY BILLING (only if ❑ PUBLIC WORKS new meter) ❑ ENGINE RING City of Fridley Engineering Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3551 FAX: 763-571-1287