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PRE 2010 DOCSCity of Fridley, Minn. °1T° 9610 BUILDING PERMIT Date: Feb. 6, 1968 Owner: Homedale Blders Builder Homedale Blders . Address 5217 Wayzata Blvd. Address LOCATION OF BUILDING Same No. 7539 Street Lyric Lane _ .,__ Part of Lot Lot ---L3--- Block 3 Addition or Sub.Division ___.._ Melody Manor 4th Addn . Corner Lot — Inside Lot __._ x Setback 35' . Sideyard _ 10'- 9' Sewer Elevation -- 877 ..47.___ . _ 880.47 Top of Footing DESCRIPTION OF BUILDING To be Used as: Dwelling Front 40' Depth 24/30 Height 20 Sq, Ft. 1032 Ca. Ft. 20640 Garage Front 20 Depth 24' Height 10 ` Sq. Ft. 480 Cu. Ft 4800 Type of Construction Frame Est, Cost -... 20 000 __,. To be Completed 4/15168 SEWER LOCATTON - 119' East of Manhole WATER LOCATION - 129 ' E. of Manhole 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 ;h provisions of ordinances of the city of Fridley. / In consideration of the payment of a fee of $ 38.00 , permit is hereby granted to Homedale Blders . 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, >yiinnesota regarding location, construction, alt ti maintenan and m g of buildings within the city limits and this permit may be revoked at any ' ie upon do 0 of th provisions of said ordinances. ! I !! Official Building NOTICE: This permit does not cover the construction, Installation for wiring, Plumbing, gas heating, $swer or water. Be sues to see the Building Inspector for $operate permits for these hems. OWNER'S NAME ADDRESS APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA LOCATION OF BUILDING NO._7�2 STREET, IVA -1 PART OF LOT LOT /3 BLOCK ADDITION OR SUBDIVISION e%L/�; CORNER LOT INSIDE LOT !/ SETBACK SIDE -YARD /C - SEWER ELEVATION 9 7 7 • --,z 7 TOP OF FOOTING S 101:9 • -_1�7 Applicant attach to this form two certificates of survey of lot and proposed building location drawn on these two certificates. DESCRIPTION OF BUILDING To be Used as: Front l Depth Height Sq. Ft. �� / Cu. Ft.- ;z Front,�%� Depth_- Height 17 Sq. Ft. �� Cu. Ft. 000 Type of Construction4:IZ��i�i- Estimated Cost To Be Completed The undersigned hereby makes application fora 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 Buildings, and hereby declares that all the facts and representations stated in this apcation are tr and correct. DATE (� SIGNATURE;; (Schedule of Fee Costs can be found on the Reverse Side). - � ------- 00 8v 1 Jy c s City of Fridley 52-84-s-915.51 Application for Plumbing and &n fitting Permit Dept. of Bldgs. Phone 560-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ..................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin ............................ Water Heater (Up to 99,000 BTU) ...... New Ground Run Old Bldg . ............ Electric Water Heater GAS FITTING FEES: — x $2.00 ae — x $1.50 , — x $1.50 $ — x $3.25 �i Z hn c z 8 Z � _ sO J t9 0 (a i Z 0 0 P N WATER HTR. GAS ELEC. Base 1st 2nd 3rd 4th • Future Connection Openings * New Fixture, Old Openings I Connected with Sewer E] Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ..................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin ............................ Water Heater (Up to 99,000 BTU) ...... New Ground Run Old Bldg . ............ Electric Water Heater GAS FITTING FEES: — x $2.00 $ — x $1.50 $ — x $1.50 $ — x $3.25 $ — x $3.00 $ — x $3.25 $ _ a $2.00 $ NO. RATE TOTAL let 3 Fixtures ...... ................... x $2.00 $ Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ 5.00 REPAIRS & ALTERATIONS—Refer to Code Ligon 7539 Uric Dane City of Fridley: 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 application are true and correct. Fridley, Minn 10-11-68 19— Owner Homedale $iilders Kind of Building Frame Used as Res. To be completed about 10-17-68 Estimated Cost, $ 10.00 n� WXC-New. Building Permit 'No Permi o. f �� 4I .SAS a 00�- - - - By X1 Business Phone No. - ROUGH FINAL 3' Description ................................................$ TOTAL FEE $ 5-00 %J190.42 Application for Power Plants and Healing, Cooling, Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone 560-3450 GRAVITY WARM AIR: RATE TOTAL Location Furnace Shell & Duct Work ...........................$10.00 T Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH, WARM AIR o Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 $ 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 I GAS BURNER (up to 199,000 BTU) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ..... ................ x$ 2.00 $ ' Additional Fixtures ................ x .75 $ Gas Range to 199,000 ......... x$ 6.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE ROUGH FINAL 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- Owner 0 Kind of Building 4 Used as To be completed about TT_ Estimated Cost, Old-, -- Building Permit No. '-7 �� Permit No. ®85� DESCRIPTION OF WORK HEATING or PO WF PLANTS—,Steam, Hot Water, W. -1—No A Trade Name—�' �� Size Nod Capacity Sq. Ft. E.D.R ' BTU H.P. Total Connected Load �� Kind of Fuel ' r BURNER — Trade Name 1�' <. Size No. Capacity Sq. Ft. EDR- �1 �'� BTU A.P. (REMARKS—'�' Sig►Y N. WEL-TFP HEATING CO. 463f i.� AVE. ByWN t41*P0h;F5-7- M I bi w EN OTA ae Business Phone No- ' r a City of Fridley Application for Plumbing and Gas F'itttng Permit Dept. of Bldge. Phone 560-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location - (5 ocation � 3 � )TOTAL Number Fixtures ...................... x $2.00 $ Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. x $1.50 $ ZP 0O • • N WATER HTR. GAS ELEC. Base x $3.25 $ Electric Water Heater z $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..........................�— x $2.00 $ Additional Fixtures ..... .............. x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ 1st 2nd 3rd 4th • Future Connection Openings * New Fixture, Old Openings I Connected with sews: ❑ Cesspool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE )TOTAL Number Fixtures ...................... x $2.00 $ Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. x $1.50 $ Catch Basin ...... ..................... x $3.25 $ Water Heater (Up to 99,000 BTU) ......� x $3.00 $�� New Ground Run Old Bldg . ............ x $3.25 $ Electric Water Heater z $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..........................�— x $2.00 $ Additional Fixtures ..... .............. x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $ 1124 City of Fridley: r 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 deF'- Owner that all the fact and representations stated in this application are t • e andect. Fridley,9 19 I3—CTG Kind of Building Used as To be completed about Estimated Cost, Old—New. Build ROUGH FINAL 42 fOr ftwer Fknh cad N Cooling,e R I+OI�O® aid Air kg S mid Demos PARTIAL RATE SCHEDULE Dent. of BMdgw Phone 911"M GRAVr- rY WARM AIR: RATE TOTAL <.3 Furnace Shell & Duct Work $10.00 IL- Replacement of Furnace 600 $L— city of Fridley: Repairs & Alterations—up to $500.00'The undersigned hereby makes application for a permit for the work herein 6.00 $-- --- -specified, agreeing to do all work in strict accordance with the City Ordinance. Repairs & Alterations each add. $500.00 300 $--_ and ruling of the Department of Buildings, and hereby declares that all the facts FiECA. WARD[ AIR and representations stated in this application are true aid correct, Furnace Shell &Duct Work to 130,000 BTU .$10.00 g—Fridley,, Minn 6 �— each add. 60,000 BTU . 3.OU ; - Owner Replacement of Furnace 6.00 $ K)nd of Building Repairs & Alterations---up to $500.00 6.00 Repairs & Alterations each add, i500.00 8.00 $ _- Used as W� STEAM or HOT WATER SYSTEM To be completed about Furnace Shell & Lines-to 400 sq. ft. FZR Steam @10.00 5 _-_ _. _ Estimated root, $. H S td Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $_ ._ _ __--. _ _ T Each add. 200sq. ft. EDR Steam A,on $ — U(d ew. Bwlding Permit No. Permit No. Each add. 320 sq. ft. EDR Hot Water 3.00 - - - -- -- �� OIL BURNER-to3 gal. per hour 6.00 $_ �- DESCAIPTYON OF WORK, over 3 gal. per hour-See Fee Schedule HM17NG or POWER PLANTS-Steam, Not Water, Warm Air-Ido GAS BURNER (up to 198,000 BTU) &00 $ Trade Name -- Size No over 199,000 BW See Fee Schedule Capacity-_ - - Sq. Ft. E.D.R BTU �, GAS FITTING FEES: NO RATE TOTAL -- - - ist 3 Fixtures _—. _ — x$ 200 $ —.. — -- - -_ Total Connected Load— — , Kind of Fuel Additional Fixtures — x .78 $---.. _ .__ _ _ _ BURNER — Trade Na.ne Size Na Gas Range to 199,005 :S 5" AYR CORiDITIONIIIG State Surcharge .50 capacity_ Sq. Ft E.D BTU Np FAN HEATING SYSIM Sea Fee Schedule vEI1TI1ATING SYSTEM $ ALTERATIONS & REPAID TOTAL FEE RGUGR— Budnew Pboae ..- (REMARIIf—OVER) MVNNEGAscO 53-84—S —915.51 CH -1 of a ridhy Dopa. of Bldga. Phone 5W-3450 DESCRIPTION 07 W011I, 7539 N: E. Lyric Lane Hua►lror, Kind and LocrSfca of Fimtures Loraii�- I NO. RATE TOTAL Number Fixtures ................ x $2.00 zr't 'o - 1 2 o ;v New Fixture Old Opening.....:.... I I x $3.25 WATfR MTR. x S3.00 $ Bate x $,3.25 S E'.*ctrie Watar Hsator• ........... s $2.00 $ TrA.S FITTI`iG FEES: NO. R.;. TE TOTAL Ist3Fixtures ......••••.• x$2.00 $ Additional Fixtures........:...... x $ .75 $ Gas Ranze to 19.9.000 BTU ..:........ x $5.00 6 1stIn sta 11 r 2rd _ 3:d Ath • Fuwlzo Cop.: oc• -a Opocl: ,s Xaw T :-turo. Old O;�eairm, PARTIAL RATE SCHEDULE Bovis Q Cczzpuol C] PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ x $2.00 $ Future Fixture Opening ............ x $1.50 $ _. New Fixture Old Opening.....:.... x $1.50 Catch Basin .................... x $3.25 $ Water Heater 'Up to 99.000 BTU). • • • x S3.00 $ New Ground Run Old Bldg. x $,3.25 S E'.*ctrie Watar Hsator• ........... s $2.00 $ TrA.S FITTI`iG FEES: NO. R.;. TE TOTAL Ist3Fixtures ......••••.• x$2.00 $ Additional Fixtures........:...... x $ .75 $ Gas Ranze to 19.9.000 BTU ..:........ x $5.00 6 City of Fridley: The undersigned hereby suites application for a permit for the work herel specified, agreeing to do all work in strict accordance with the C. -t7 C:-d.rancc and ruling of the Departmeat of Buildings, and hereby declares that all the fad and representations stated in this app cation are true and correct Fridley, &'.inn • 5 —, I9_.. Owner William Schcinski Kind of Building Frame Used as Res To be completed about 8`11-75 — Estimated Cost, $ 10.00 Old—fit Building Permit No. Par Signed By MINNEGASCQ • -- Business Phone ' io ROUGH . P.E'PAIRS if ALTERATIONS—Refer to Code .50 State Surcharge .Description 5- 00 - mr tz. >z s 5.50 Gass `"A" Surcharge CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Susp or Receiving Tank Water Treating Appliance Hot Watqr Heater Gas Range Gas Dryer RATE $ 5.00 $ 3.50 S 1.50 S 4.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 Back Flow Preventer Required. . . Yes ( ) No ( ) Type $ 5.00 TOTAL S ALL OTHCRS AND/OR REPAIRS AND ALTERATIONS /,� It of Value of Fixture or Appliance S/ J't Reinspection Poe State Surcharge $ .50 S • (515.00) TOTAL FEE $Z -�'-5-6 Effective Date May 1, 1988 Job Address /�,`Lin Department of Buildings City of Fridley Tel. 8571-3450 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 appl Yt tion are true and correct Fridley, M.4 y 19 Mee— OWNER KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. L, / oo Company f 14 / h Signed By Tel. No. �b aka V -- ROUGH ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT 4 2W MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE e >.m d u N N Water F .Gid 0 `3� �' A ro w pa, w b+ Heater .. ° ea t pmt m +� pN .t9 c 9 014 'c u w p S aqq+ g�ayy R W p O a+ pmp U u m qq m �Ny v�! U D 0! 01 N 3 N W OD 3 �7 7 t7 O a8 leC at 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (') a New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Susp or Receiving Tank Water Treating Appliance Hot Watqr Heater Gas Range Gas Dryer RATE $ 5.00 $ 3.50 S 1.50 S 4.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 Back Flow Preventer Required. . . Yes ( ) No ( ) Type $ 5.00 TOTAL S ALL OTHCRS AND/OR REPAIRS AND ALTERATIONS /,� It of Value of Fixture or Appliance S/ J't Reinspection Poe State Surcharge $ .50 S • (515.00) TOTAL FEE $Z -�'-5-6 Effective Date May 1, 1988 Job Address /�,`Lin Department of Buildings City of Fridley Tel. 8571-3450 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 appl Yt tion are true and correct Fridley, M.4 y 19 Mee— OWNER KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. L, / oo Company f 14 / h Signed By Tel. No. �b aka V -- ROUGH ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT 4 2W MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE CITY OF FRIDLEY ` H t � APPLICATION FOR POKER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATIDN AND ti AIR CONDITIONING SYSTEMS AND DEVICES m RATE SCHEDULE ' � �� H RESIDENTIAL ` RESIDE - RATE TDTAL Job Address I m Furnace Shell and Duct Work, $ l !!11 \�' 20.00 $�ya Department of BaildingS, 6431 university Ave. H.B.. Fridley, NN 5543I Burner (Also raplaoeaent fuznaoef City of Fridley Gas Piping $ 10.00 $ Tel_ 1571-7450 (piping needed with mew furnace) $ 10.00 $ The undersigned hereby makes application for a penis !or the irk Gag Range cbd W specified agreeing to do all work in strict accordance Wlth the Clty Ebdea $ 10.00 $ and rulings of the Departs—t of Buildings, and hereby declarer that all the Gas Dryer facts and representations atatsd in this application are true and correct. 7 e Air Conditioning (all sizes) $ 10.00 $ Fridley, Minn. _ _f m r - All others/Repairs and Alterations OWHER 11 of Value of Appliance or Mork KIND OF BUILDING i • �.� �:_� C0MMERCIAL/INDUSTRIAL USED AS � }-�-�I�J%mac _ 11 of Value of Appliance or Bork $ To BE ooHPIJ+zEx1 ABOUT $ SO ESTIMATED COSTS � � � -A State Surcharge ' oI4D - Hsu HUILDIyG PERMIT No. PERMIT 160. C / _ T02AL !EL $ Reinspection pee ($15.00) $ IIESCRIP?ION OP rUyAACr'/WjftWR Rough Insp. • HEATING or R PIJ1WM Stena, 1Wc )tater, riacn A1�No. �A Date //11 Size No. / Trade Naas _ FLaal Znap. - ( Date (�I) Sq. Pt. EDR BTU I. Capacity -- „ �.=�U— .. Y.1 ApprOval for Permit Total Connected Toad Kind of Fuel v BUFAER - Trade Hams Size No. r • Capacity S4. Ft. EDR BTU NP � k.0 MINIMUM PEE FOR ANY HEATING PEFOLIT ZS $ S.Do • Company a PLUS $.So STATE SURCHARGE Signed By _ C> Tel. No. •Air Conditioners can not be placed in side yard without Mcitten permission from edjolning neighbor. Fill out back 'side for stack verification on replacement Furnaces c=, P.: C> �✓J 06 CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; 1. Has been carefully examined Yes (-A No ( ) 2. Is free from rust or deterioration Yes ( No ( ) 3. Has no foreign objects lodged within Yes W No ( ) 4, Is securely supported Yes No ( ) 5. Meets all current Code total BTU connected requirements for size and Yes (x) No ( ) 6. Has Total heating BTU's C of , o All other BTU's ��b -- TOTAL bQL Company Signed E Da to CITY OF FRIDLEY INSPECTION DIV. 643,11 University Ave NE Fridley. MN 55432 572-3604 Effective On August 1, 19% APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Water t3ptth Wash � UT* : t Flour Catch : Auto. Ga4 '. `� Gas �F�ix rStories ,Closet . Urinal Tub Shower Sink* :: Tra ? Fount. Drain Basin ' Washer 1. : Ran j Gas Eiec .Basement.. ,, . 1; Floor 1 t Floor 2 { Floor 3 Floor 4 i PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures Old Opening, New Fixture Beer Dispenser Slow Oif Basin Catch Basin Rain Water Leader SumplReceiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range** Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $`10.00 $ 7,00 $10:00 $10.00 $10,00 $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance �� ®� JOB ADDRESS 1- L Z -M I L LAAAIFa _ The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. Owner Building Used Estkrialled Cost PERMIT PLUMBING COMPANY SIGNED SY h -m5 / z,,J TEL N16�3 Z!� Approved By - .— Rough -In Date Final Date State Surcharge $ .50 MINIMUM FEE OR ANY PLU9uIWNG/ TOTAL FEE Ce—at PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SO INCHES. m r rn I - NO I V1 ti r N co V1 r UJ 00 i G 0 0 co 0 N N CiTYOF FFVDLEY IWECTION ONION 60 Unrv" Ave NE Effective On January 1, 1997 Fridley, MN 554.32 APPUCAIION FOR POWER PLANT& MD HEATING, 0001LING, VENTILATION, 672-38D4 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOBADDRESS S RATS S H UL iReSulentid The undersigned hereby makes appUcatiion lbr a perrnit for the work herein Rate TOTAL specified agreeing to do off work in strtot accordance With the Pomace Sim and Duct Wok Burner - ridirros of the l D1Y1sl and he �Y Codes and Alyea Replacement F mce hereby dsclares that all the facts and �+ $ (Side Vent - Fill Out Bwkj representations stated in this appicatfon are true and correct. Gas Piping (Needed With new funace) $11100 $ / 1998 . r1 io n Gas Range $10.00 ....I.-1. r d�%LG>��.�� S �� Cas Dryer $10,00 $ BUILDING USED A ESTIMA7E0 COST PERIWTNO. % (13 9f *Aft Conditioning -All Sixes $2.5.00 $ OZ All OthsMAtefu frrr &Ateratioris WON BAGg 1% of Value of Appriancee or t CarunercWndUStrtai 1.2of Value of Appliance or Work ^� State Svrchwge (� kkt--70TAL FEF 1� DESCRIPTION OF FUITNACE AND 0R 0UgNER No. of Heating Units Circle One (Steam) (fioi Wateij (Mn TradeNeme �., �Z„ P q'- -No. BTU _ FF EDR $ Fuel Total Connected Load l� UNI UM FEE FOR ANY hIE4T@VC C00UNGAOWILATION / REM 110 GERA Nl AIR CONDITIONING PERNiT IS $2v�Op PLUS THE W STATE SURCHARGE REINSPECTION FEE $42IXiAir 'Air Omd0oners cannot be placed dna side yard wIttout written peimad n from adjoining Wipertyowner. Bumex Trade Name She No, BTU HP EDR HEATING COMP i62 Signed By ATel No. 577,- ZIP Approved 13yt4-Rough-In bate Final Date FILL OUT BACK SIDE FJR STACK VERIFICATION ON REPO CEMByT FURNACE v i` m co 3 Cl z 0 Clr- C 11, r` m