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PRE 2010 DOCSCity of Fridley, Minn.. BUILDING PERMIT N9 C587 8 Owner: Buildez AddressAddress ION Oc DUI DING No. Street ' Part t Lot _ _ Block , _ Addition or Sub -Division Corner Lot _ _ ____ Inside Lot Setback -�� Sideyard Sewer Elevation ___ _ Foundation Elevation DESCRIPTION OF BUILDING be Front A- Depth Height ,{ Sq. Ft & Cu. Ft M 90 F won Depth eight Sq. Ft -- Cu. Ft Type of Construction _-_ ___ — Est Coati __ 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 withianthee. city limits and this permit may be revoked at any time upon-vioatti� of any of the provisions of said �.. Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we the Building Inspector for separate permits for these Rema APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner's Name Builder Address Address LOCATION OF BUILDING No. Street Lot Block Addition or Subdivision Part of Lot Corner Lot Inside Lot Setback Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To be `used as; DESCRIPTION OF BUILDING Front Depth Height Sq. Ft, Cu. Ft. Front Depth Height Sq, Ft, Cu. Ft. Type of Construction 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 rulings of the Department of Buildings, and hereby declares that all the facts, and representations stated in this application are true and correct. DATE (Schedule of Fee Costs can be found on the Reverse Side). City of Fridley Application for Plumbing and Gas Fitting Perndt Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures r ....sus.... City of Fridley: 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 applic on are true and correc . Fridley, A11nn 2 .19 -4 -,,— Owner 19 ,,— Owner Kind of Building"'"Q° Used as��" To be completed about PARTIAL RATE SCHEDULE Estimated Cost, $ Old—New. Building Permit No Permit No. PLIIMBING FIXTURE RATES: NO. RATE TOTAL L Number Fixtures ....... .......:— x $1.50 �d t90 F N WATER HTR. GAS ELEC Base x 1.00 $ Business Phone No Catch Basin ...... ..................... x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ -, _ U c7 ROUGH (o New Ground Run Old Bldg . ............ 4 $ 1st { 1 FINAL 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 $ 2nd 3rd 4th • Future Connection Openings New Fixture, Old Openings J New Connected with Sewer � Cesspool City of Fridley: 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 applic on are true and correc . Fridley, A11nn 2 .19 -4 -,,— Owner 19 ,,— Owner Kind of Building"'"Q° Used as��" To be completed about PARTIAL RATE SCHEDULE Estimated Cost, $ Old—New. Building Permit No Permit No. PLIIMBING FIXTURE RATES: NO. RATE TOTAL L Number Fixtures ....... .......:— x $1.50 $—q- C) U Signe Future Fixture Opening ................ x 1.20 $ By ' New Fixture Old Opening .............. x 1.00 $ Business Phone No Catch Basin ...... ..................... x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ -, _ U c7 ROUGH (o New Ground Run Old Bldg . ............ x 3.25 $ FINAL 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 $ 42 2M A APPLICATION FOR HEATING OR POWER PLANT AND SPECIAL DEVICE PERMIT PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ......................... 8.00 $ Replacement of Furnace ............................. 4.00 $ Repairs & Alterations—up to $500.00 ... 4.00 $ __ Repairs & Alterations each add. $500.00 ............... 2.00 $ _ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ........... 8.00 $ each add. 60,000 BTU ........................ 1.00 $ Replacement of Furnace ..... ;...................... 4.00 $ Repairs & Alterations—up to $500.00 ................. 4.00 $ Repairs & Alterations each add. $500.00 .............. 2.00 $ _ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 a Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ _ Each add. 200 sq. ft. EDR Steam ...................... 2.00 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.00 $ OIL BURNER—to 3 gal. per hour ........................ 4.00 $ w over 3 gal er hours—See F S hedul Dept. of Bldgs. Phon(/e/,JyJU. 6-44614 T -0 -'fes �/ ®, _ r Village o er: � v , The undersigned hereby makes applicati or a permit for the work herein specified, agreeing to do all work in strict acc ance with the Village 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. Kind of Building Used as To be completed about Estimated Cost, $_ Permit No. 195 195- 5_ DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water Warm Air—No Trade Name Size No_.44M4%o-0 Capacity Sq. Ft. E.D.R BTU H. P. Total Connected LoadKind of Fue BURNER — Trade Name Size No . _ Capacity Sq. Ft. ED. R BTU H. P. D7^ t___j 2M-5-58 � � 6-1 Business 'ho.e Noi i �� GAS BURNER ........................................... $ GAS PIPING (Up to 5 Fixtures) .......................... 1.25 $�.�— AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule _ ' VENTILATING SYSTEM $ TOTAL FEE $ - REMARKS: Dept. of Bldgs. Phon(/e/,JyJU. 6-44614 T -0 -'fes �/ ®, _ r Village o er: � v , The undersigned hereby makes applicati or a permit for the work herein specified, agreeing to do all work in strict acc ance with the Village 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. Kind of Building Used as To be completed about Estimated Cost, $_ Permit No. 195 195- 5_ DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water Warm Air—No Trade Name Size No_.44M4%o-0 Capacity Sq. Ft. E.D.R BTU H. P. Total Connected LoadKind of Fue BURNER — Trade Name Size No . _ Capacity Sq. Ft. ED. R BTU H. P. D7^ t___j 2M-5-58 � � 6-1 Business 'ho.e Noi i ter• � m e ng / COMPLIMENTS Windows and Doors=Crackage and Area _ Width Height No. of Lineal f . Area No. of pane of Dane lights of crack eq. Lt. D. C. SALES C O . 4 "HEAT LOSS CALCULATIONS;,- . 1113 E. FRANKLIN AVE. MINNEAPOLIS, MINNESOTA FEderal 2-8321 W"erstrips' _ &S.Kv-r- Guide Construction No. ^ Insulation Windows I Boors ' Reference Out. Wall Int:all -Ceiling Roof Floor Kind How Applied Yes. -No Yep—No 19- F7 " Room ILen` ih Width ®H ' ht F7g R L° th Width �i Hel' ht g elg Windows and Doors=Crackage and Area Winagws and Doors--Crackage'an Area Width Height No. of Lineal f . Area No. of pane of Dane lights of crack eq. Lt. Width Height No. of Line ft. Area No. of pane of pane lights:". of cr k sq. ft. 77- ' r 4 S Pet. Z tt- Infiltration ?; - Coed lU Glass 64L '1060 -2,CL Exp. wall x Exp. wall Net exp. wall Int. wall Ceiling (v Floor 0j .� oo Windows and Doors—Crackage and Area Width Height No. ofLineal ft. Area No. of peas of pane IfBoh�tq of crank eq. Lt. �1 33 i Coef' to Infiltration Glass Exp. wall Net exp. wall 0 ® f70 Int. wall Ceiling 3 7 i� Floor Total Btu. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or ins. W.A. Leader area 124 9 I F1.1 Room I Length'7,6, Width Height Winagws and Doors--Crackage'an Area r Width Height No. of Line ft. Area No. of pane of pane lights:". of cr k sq. ft. 77- ' r 4 S 1 n7 1 4rob Net'exp. wall Int. wall Coed lU Infiltration Glass =' 0 t Exp. wall 7& Net exp. wall (v Inc. wall Ceiling r} Floor Total Btu. FS.� Required sq. ft. E.D.R. or. .A sq. ins. W. Leader area I7,"'- I-1 Ya /"_ _ f_KM/n I f .anO}h 7 ^ W;A}h li Mafn�! Y Windows and Doors--Crackage and Area __j Width Height No. of Lineal ft. Area No. of pane of pane lights at crack eq. ft. 9,1W 3- K�Z 76 r Windo an a—Crackage and Area Coef. Infiltration Glass el Z Exp. wall ' 1 n7 1 4rob Net'exp. wall Int. wall o 7 Ceiling Floor 19 4 Total Btu. sq. ft. E.D.R. or sq. ins. W.A. Leader area e� F1.1 Room I Length Width Height Win ows and Doors—Crackage and Area Width Height . No. of Llaeattt. Area No. ofyypane of�panOe ilghte of crack eq. [t Infiltration Glass Exp.'wall Net exp. ;all Int. wall Ceiling _ Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Rohm I Length Width 0 He''ht Windo an a—Crackage and Area Width No. of pane ght No. oL Lineal ft Area o ane IfBhte royf crack eq. ft. � iv0 -71 o 7 � V �d !r /� (�gCoef. CA tU' Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor/ AU – Total Btu. , Required sq. ft. E.D.R. or sq. ins. W.A. Leader area City of Fridley, Minn.. BUILDING PERMIT n LO 'SIO OF LG No. Stt'eet - _ I Pamf-m Lot _ _ Sub- vision ._ i Corner Lot Inside Lot _ —Setback Sideyard Sewer Elevation ____ _ _ _ F dation Elevation DESCRIPTION OF BUILDING N? 6672 T U Front Depth ; Height 10 Sq. Ft Cu. Ft (�ra n - Depth iC'os� Height Sq. Ft Cu. Ft. Type of Construction —. t��1_ Est %���r 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. o zpl 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 and this permit may be revoked at any t Met op v3o on any of the provisions of said ordinances. '1 flf 1 NOTICE: This permit doss not cover the construction, hufallation for wWng, phunhing, gas heating, sewer or water. Be sore to we the Building inspector for separate permits for these Nems. MEMO FROM: RICHARD N. SOBIECH Public Works Director MEMO N0. TC 230 DATE 5/19/76 REPORT BY: 5/28/76 SUBJECT: Possible Drainage Problem at 6526 McKinley; Don Friedlind ❑ See attached ❑ Review & take appro- priate action Ld "' [?q[ Review & comment J °- ❑ Note & discuss with me 0 '" ❑ Work with 0 ❑ Rush, immediate action desired ,.� ► ll.. ► Don Friedlind 571-1630 6526 McKinley Councilman Starwalt at the meeting of May 17th indicated this property owner had complained about drainage problems. I explained that grading of a swale had taken place to prevent any problem in storm water runoff. Could you please review the site and ensure there are no potential problems to this property? Make reports, w/background material as complete as poss- COMMENTS: ible. Make interim report if necessary. �/ '�.c�.4 0c3 CL LU Action completed, no further review needed 0 ❑ Further action necessary L -4"A ��� [] See attached letter ❑ Interim report47 0 �L . Tw 7Z 4 4 x4 II/A t" DATE: 7 SIGNATURE % SUBJECT PE , City of Fridley I td. 190 5 AT THE TOP OF THE TWINS BUILDING PERMIT r ECEIPT NO `y _ ___ COMMUNITY DEVELOPMENT DIV. INSPECTION 74 r PROTECTIVE SEC. Asa 1 i � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 7/7/87 JOB ADDRESS 6526 McKinley Street N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 2 Clark's Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jean Baker 6526 Mckinley Street N.E. 571-1630 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. John Jarvi Construction 240 Longfellow Street, Fridley 784-7142 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. B USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION O ALTERATION? REPAIR 0 MOVE O REMOVE B DESCRIBE WORK Reroof, Dwelling & Garage C26 squares) 9 CHANGE OF USE FROM TO STIPULATIONS hof can be 2nd layer but not 3rd. install ridged galvanized valleys. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. 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 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 ] 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 $1,.300 $.65 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- UCTION HE ERFOR OF CONSTRUCTION. $22.00 PLAN CHECK FEE TOTAL FEE % 7 $22.65 SI ATURE 01 CONTRACTcrOR AUTHORIZED AGENT ( ATE) WHEN PROPERLY VA TED THIS IS YOUR PER IT - a SIGNATURE OF OWNER 0F OWNER BUILDER) (DATE) BLDG INSP D TE NEW [ ] City of Fridley Effective 4/1/86 ADDN. [ ] R-1 AND R-2 ALTER. Building Permit Application Construction Address: Legal Description: Owner Name Contractor: & Address: �J \1-0 HIU 0 fU e a K,�X Tel . # J`-- %% & -3� Tel. # — �- k' rI` R VZ 0-64L5 %- Address: '--) tVa © /?!i 2!!�L Lo c eJ 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 Length Width Height Length Width_ Hgt/Ground ..2(P Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [ ] Inside Lot [QJ/ Ft. Yd. Setback Side Yard Setback Type of Construction: ! Q �®© l Estimated Cost: $ L -CO Approx. Completion Date: �CJ! 7— Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: % APPLICANT: - "'/ r1y c? rd1 Tel. # CITY USE ONLY Permit Fee $ Dy Fee Schedule on Reverse Side Plan Check $ 25% of Building Permit Fee State Surcharge $ $•50/$1,000 Valuation SAC Charge $ $ 525 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ TOTAL $ Agreement Necessary [ ] Not Necessary [ ] �- �S-� STIPULATIONS: �'� SUBJECT IT NO. City of Fridley 2 6 5 37 AT THE TOP OF THE TWINS BUILDING PERMIT � � RECEIPT NO. ______ COMMUNITY DEVELOPMENT DIV. - PROTECTIVE INSPECTION SEC. n� 4/a r i/y 1 NUMBER REV GATE PAGE OF APPROVED BY 1 �"'1 CITY HALL FRIDLEY 55432 I.J 612-571-3450 910-F15 7-10-98 JOB ADDRESS 6526 McKinley 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 6 2 Clark's Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 571-1630 Jean Baker 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Renewal by Andersen, 350 73rd Ave NE, Fridley MN 55432, 502-4777, 20040630 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 [j REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace 14 windows in home within existing opening. 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $9,000 $4.50 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. $ 149.75 ire SC $9.00 PLAN CHECK FEE7$168.25 AL FEE Lic SC .00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI MENR A VALI B G INSP ED THIS IS YOUR PE R r O LATE SIGNATURE OF OWNER OF OWNER BUILOERI IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ SINGLE FAMILY AND DUPLEXES R-1 AND R-2 A BUILDING PERMIT APPLICATION V ConstructionAddress: Legal Description: Owner Name & Address: � J � �� � � ° ,� � �, 1 Yif 1 � � o Tel. # 521- IL- 31-) r Contractor: V u\'ln MN LICENSE# c -Q . C)(QA�,C Address: Tel. # _ Q 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: Construction Type: DESCRIPTION OF iIVVIPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. 1�'? ✓lf /� /' f, � � JI 1 < ' E Yr�� d � l \� , i c I r n �� C .1r7.� i r ��,� e I ,1 Ei ..- , i � �„ <—, ref Driveway Curb Cut Width Needed: Ft. + 6 Ft = Estimated Cost: $ J.s (Fee Schedule on Back) Ft x $ _ $ DATE: APPLICANT i '�a�' ? CITY USE ONLY Tel. # st/_ g Permit Fee $ %� Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ )y $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ $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 Necessazy ] TOTAL $ STIPULATIONS: - CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURFS TO RF INSTAI I Fn nN FArH FI nnR Effective On Jan 1, 2000 In El �� I'll-, PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS._ 54NI - OtS 4SWL)16�12— 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 S,uilding Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representatinns stated in this annlicatinn are true and correct. Catch Basin $ 7.00 BAKER, JEAN Rain Water Leader $ 7.00 6526 MCKINLEY STREET NORTHEAST/`S- 20dL FRIDLEY, MN 55432 — Sump/Receiving Tank $ 7.00 (763) 571-1630 Water Treating Appliance $10.00 Owner_ Water Heater -Electric $ 7.0D Water Heater- Gas" �_ $10.00 Building Used As _ e6 kD4vj C. C. Gas Range*" $10.00 p0 Gas Dryer'" $10.00 Estimated Cost PERMIT NO. [_ Back Flow Preventer Required ( )Yes O No Type $15.00 PLUMBING COMPANY RV AJ C, Reinspection Fee $47.00/Hr SIGNED BY TEL N0. &'8C'%' 0 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved By Rough -In Date Final Dat State Surcharge $ .50 Z-'� c 7 � �r MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS S20.00 TOTAL FEE $20<-50 PLUS THE S.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacina an existing furance, 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 O ) 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 existina 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 ventina 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 () 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 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 T 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 57L -36U4 VAX: ( 763) 571-1257 ADDRESS : 6526 MCKINLEY ST NE PIN : 133024140013 LEGAL DESC : CLARKS ADD : LOT 6 BLOCK 2 PERMIT TYPE : SEWER/WATER REPAIR PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : SEWER LINE REPAIR PERMIT NO.: 2004-00148 is DATE ISSUED: 02/04/2004 VALUATION NOTE: CALL FOR INSPECTION AFTER UNCOVERING THE LINE, BEFORE ANY REPAIRS ARE MADE, AND AGAIN WHEN THE REPAIR IS MADE BUT BEFORE RECOVERING THE LINE. APPLICANT ROTO ROOTER 99 5 AVE NE NEW BRIGHTON, MN 55112- (651)755-1263 OWNER BAKER JEAN B 6526 MCKINLEY 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 worl will be complied with whether specified herein or not. The granting of a permi does not presume to give authority to violate or �anc el, a pro 's'ons of any other state or local law regulating io r performance of construction . Applicant Dat Bldg Insp Date. SEWER LINE REPAIR/RELOCATION 40.00 TOTAL 40.00 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.