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PRE 2010 DOCSs •• , A- I 1101M ' I KRUT 1 Village of Fridley, Minn. No 2 R 8 8 Date . , W64 .. J.)I.... 5% .V........... Owner Address .... R. Builder .........4()L1rLz ................... Address...... .................... LOCATION O BUILDING r No. .. �� ....... Street ....�� ................... Part of .� Lot ...................... . Lot ..... ......... Block ..... ( .......... Addition o r Sub -Division , d Corner Lot ............ Inside Lot ....L„✓... Setback ...... Sideyard...................... DESCRIPTION OF BUILDING TqAe Used as: � . Front . q as... Depth Q. 6.... Height -Sq. Ft.109.),. Cu. Ft. ........ .................... Front ........ Depth ........ Height ......... Sq. Ft.........Cu. Ft. ..... Type of Construction .FR-0AA.r_ . Est. Cost .. f 5r�V. 0........... To be Completed .'4 / '.s? %A ........... 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 village of Fridley. V, . . Ir! consi ation of the payment of a fee of $. .. �'��? permit is hereby granted to ei�... 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 th, s conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, enationdz..Vj intenance, repair and moving of buildings with- in the village limits and this permit may be revoked a any tu fn vaotion of an of the provisions of said ordinances. ( lv �L e . L,--7 y ing Inspector NOTICE: !/ This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. City of Fridley Application for Plumbing and Gas Fitting Permit Dep:. of Bldgs, Phone SU 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ Z • GAS FITTING FEES: WATER HTR. GAS ELEC. Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer :o Code Description ................................................$ TOTAL FEE c�0 Base lot 2nd _ 3rd _ — 4th • Future Connection Openings Connected with Sewer El New Fixture. Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $�-,�- GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer :o Code Description ................................................$ TOTAL FEE lk 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 applicatigxj are true and correct. 196- '4 Owner Kind of Building Used as To be completed about Esllmakd Cost, $ Old—N . Building Permit No Permit No 9 Signe ROUGH FINAL da 2M 7-59 Business Phone City of Fridley, Mian.. BUILDING PERMIT N® 6696 Date: 1 Owner: Builder Address Address ION BUILDIN559G No. ,� f Sheet r-id"T,�- P of Lot Lot Block Addition or Sub -Di on J Corner Lot W ____ Inside Lot t. aback 446m,4e Sideyard Sewer Elevation ____ _. FouTadation Elevation DESCRIPTION OF BUILDING TWUU Front Depth Height Sq. Ft. cu. Ft. Front Depth // Heights _ Sq. Ft. cu. Ft. Type of Construction4�4L Cgl Est. —f To be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ ,permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time uponvioltign of any of the provisions of said ordinances. ---,%- .; /` 1 NOTICE: Ub permit doss not cover the construction, Iastallallon for whing, phmbing, gas hooting, sower or water. Be sure is see the Building Inspector for separate psrmNs for thea Nona. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME 9 BUILDER ADDRESS ADDRESS LOCATION OF BUILDIN No. ` Street jtrt of Lot Lot Block Addition or Subdi ion Corner Lot Inside SEWER ELEVATION Lot -fttback Side -Yard F14NDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. DESCRIPTION OF BUILDING To use as: 2a A FrostDepth Height_ Sq. Ft. Vcr�)_ Cu. Ft. Front Depth Height Cu. Ft. Type of Cons tructio Estimated Cos '/, 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. DATESTGNATURE (Schedule of Fee Costs can be found on the Reverse Side). y// n ,5'% • n $3.00 Future P,xtura >1u q $7,00 n Opening x $7.00 11 u x Wator water Haater - to 99,000 BTU, x $5..00 100;000 'BM to 199,000 BTU i_ r W1 Water S•of toner Data A $7.90 ' New Grour.d' Run ' x Ilontorp U Heater - x $5,00 $7.50 Aj L Jt C' 1� Y V D li U D A IAN O !in .100 i r o k lit 'i s r re laF 'r rrge . 7�d 3 rd �. (R) - Future Cc McCtion Opening Connected with Sowor j(0) - Now Fix tura, Old Opening Water PARTIAL RATE SCHEDULE PLUNLRING FIXTURE RATES; N0, RATE TOTAL ).u, tier FLxtuxes -X $3.00 Future P,xtura 6psning • >2 $7,00 New Fixture, Old Opening x $7.00 Catch Basin• . Company x $5.00 water Haater - to 99,000 BTU, x $5..00 100;000 'BM to 199,000 BTU i_ x $10,00 Water S•of toner Data x $7.90 ' New Grour.d' Run Old Building x $5,00 Elacctic Water Heater - x $5,00 GAS FITTING FEES; ' x $3,00 x $1,00 x $10,00 13t 3 fixture■ M ditto nal rix tures Cas Range to 3.99,000 BTU REPAIRS 6 ALTERATIONS rirst 5100.00 each add. $100.00 or traction i State Surcharge TOTAL. FEE S $5.00 $ $7,00 $ S .50 8.00 Job Address 16631 NE McKinley Street Department of Buildings City of Fridley I Tol. M571-3450 The undersigned hereby makes application for -a permit for the wor' epeeified agruoing'to do all work in strict accordance with the Cit and rulings of the Departmont o! Buildings, and hereby deelareo the the ta0t9 and repraeentations stated in this application ars true c Fridley, Ma, 1,1-8x-77 OWNER R0Y MCCUE KIND OF BUILDING frame, USED AS res. TO BE COMPLETED ABOUT 11-15'77 ESTIMATED COST 20_00 OLD - 1IL14 BUILDING PERMIT NO, pE(PIT 110. L�n�`� 6raw� . Company MINI EOftQp\SC0 , ' Signed By' Tal. No. ROUGH INSP, Data FIt4hL INSP. q -,2(a -2K Dato APPROVAL FOR PERMIT MINIMUM PEE FOR ANY PLUMBING PERMIT 19 $7.50 AWN. A. ,•,W, CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL RATE TOTAL Job Address Furnace Shell and Duct Work, Burner (Also replacement furnace) $ 20.00 d S� De ►' Ye. N.C., Fridley, M55412 Department of Buildings, 6411 University Ave.l City of Fridley Gas Piping $ 10.00 $ Tel. 0571-3450 (piping needed with new furnace) Gas Range $ 10.00 $ 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 Gas Dryer $ 10.00 $ and rulings of the Department of Buildinqs, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. • Air Conditioning tall sizes) $ 10.00 $12), All Others/Repairs and Alterations OWNER It of Value of Appliance or Work KIND OF BUILDING COMPIERCIAL/INDUSTRIAL USED AS It of Value of Appliance or Work $ 70 BE COMPLETED ABOUT �--�y�,� ^,o ESTIMATED COST ®,I CJ c..ic1. State Surcharge S .50 OLD - NEti tlUItDING PERMIT No. PERMIT NO. TOTAL !EE $ Reinspection Fee ($15.00) $ -- DESCRIPTION OF FURNACE/BURNER Rough Inep. HEATING or POWER PLANTS, Steam, not Mater, Man Air- No. Date Trade Name_yum�ee .� site No. Final Insp. Date capacity vm-o�� � sq. Ft. CDR BTU RP Approval for Permit lfy� Total Connected toad 1 `24 Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU RP a/ MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00 Company / PLUS $.50 STATE SURCIUIRGE Siqned By Attach stack verification form with replacement furnace permits Te 1. No. _ *Air Conditioners can nest In- placed in %id*- yard without written 1H•rmission from adjoining nrigldmr. CINOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 • FAX (612) 571-1287 August 6, 1993 PW93-168 Mrs. Roy McCue 6631 MclGnley Street Fridley, MN 55432 Subject: Storm Water Utility Fee Dear Mrs. McCue: I received a note that you submitted asking about our storm water utility fee. The storm water utility fee was adopted in 1985 as a dedicated fund to operate, maintain and repair the City's storm water system. The storm water system consists of surface water drainage along the streets, catch basins, pipe, lift stations, detention ponds and retention ponds. With the establishment of the storm water utility, we are able to ensure that the surface water drainage system is maintained and operated. u+r%2F There are locations in the City were some of the streets have worn and deteriorated or have not been built to todays standards. These problems will be corrected as the streets are rebuilt. There are sections of the City which do not have a totally designed storm water system. Those areas, it is envisioned, will be upgraded as major projects are identified and the neighborhoods participate in funding these improvements. There is always the question by the upstream person about storm water since they don't have a problem. The problems are on the downstream end. With the establishment of the storm water utility, every resident in the City contributes equally to the overall storm water maintenance. I hope that this response answers your question. If you desire additional information, please contact me at 572-3550. - Sincerely yours, John G. Flora Director of Public Works JGF:cz SUBJECT PE City of Fridley (?) 8 TOP THE TWINS 3 3 7 AT THE OF BUILDING PERMIT ' r I RECEIPT fJO. COMMUNITY DEVELOPMENT DIV. I v PROTECTIVE INSPECTION SEC. j�/ r I 1 i / ((7 (® CITY HALL FRIDLEY 55432 NUMBER REV DATEPAGE OF APPROVED BY 612-571-3450 910-F15 5/18/95 JOB ADDRESS 6631 McKinley Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 1 Moore Lake Park 2 Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Roy McCue 6631 McKinley Street NE 571-9791 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Gary Nordstrom HC3, Box 158H, Remer MN 56672 (218)566-3276 8832 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 Reroof Dwelling (24 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 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 Fire AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,800 .71i $.90 $1.80 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE 5.00 PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR E PERFORMANCE OF CONSTRUCTION $41.00 License SC UM PLAN CHECK FEE TOTAL FEE 48.70 SIG A RE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPER VALIDATED THIS IS YOUR PERMIT �e BLD INSP -�M1f pAT SiG NA TURF OF OW NER IiF OWNER BUILDERI (DATEI NEW [ ] Effective 1/ 1/95 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2�$�� Building Permit Application Construction Address: �`Q3 M�uV �: _ N58 Legal Description: Owner Name & Address: Contract. Address: Tel. # —9c( MN LICENSE Tel. C2ig� 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 GARAGE AREA: Length Width Height DECK AREA: Length Width Hgt/Ground OTHER: Sq. Ft. Sq. Ft. Sq. Ft. Comer Lot [ ] Inside Lot (j Ft. Yd Setback Side Yard Setbacks Type of Construction:Estimated Cost: $ -5) Approx. Completion Date: 3O� �;71 CIO (cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: q S APPLICANT: Tel. # I k1\1 CITY USE ONLY Permit Fee $ 1, Fee Schedule on Reverse Side Fire Surcharge .001 of Permit Valuation (1 / 10th %) State Surcharge $ , GJU $.50/$1,000 Valuation SAC Charge $ $850 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 Necessary ( ] TOTAL $ o STIPULATIONS: fi SUBJECT P City of Fridley 2 4 1 5 7 AT THE TOP OF THE TWINS BUILDING PERMIT 6- Ir COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 15/8/96 JOB ADDRESS 6631 McKinlev Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 Moore Lake -Park n Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Barbra McCue 6631 McKinley Street NE 1 3 CONTRACTOR MAIL ADDRESS Pmnp1rrpfr of MN 31111 RnL-11ing Ave 9 ZIP PHONE LICENSE NO. 721-662R 9179 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside House* Saffit/Fagria 9 CHANGE OF USE FROM TO STIPULATIONS 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 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 1 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 $1,630 $.82 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE License SC $5.00 $61.45 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) HEN PROPERLY Y4LIDATED THIS IS YOUR PERMIT -- BLD C111 TE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI fi NEW ( I Effective 1 / 1 /94 ADDN CITY OF FRIDLEY ALTER SINGLE FAMILY AND DUPLEXES R -I AND R-2 Building Permit Application Construction Address: CQ 3 I I _ `C 1� I n eg SS r��T ' y Legal Description: Owner Name & Address: �Bojbra no u Q, Tel. # 57/- C %q Contractor:F1�xf OF N MN LICENSE # Address: ox, __aug_ '_S JpLu_/7a Ao& V 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 t.DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Corner Lot ( ] Inside Lot (] Ft. Yd Setback Side Yard Setbacks Type of Construction:1�j A j %^ . SOFFi �� -�QSGI Q Estimated Cost: $ Approx. Completion Date: % — (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT:xt, �b 'L_ A tza'A) Tel. # — 2 IF Uf Permit Fee $` Fire Surcharge $ State Surcharge $ ,Z _ SAC Charge $ License Surcharge $ d ce) Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ / • 5� STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side O� 1 .001 of Permit Valuation10th% 1 / 1 ( ) 0 $.50/$1,000 Valuation Yyr $800 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 ( ] CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Effective On January 1, 200( Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE JOB ADDRESS ��-�?V A �/� OWNER � Ae4p(/-L Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED AS PWe al Aq:- Also Replacement Furnace $ 30.00 $301 (Side Vent - Fill Out Back) ESTIMATED COSTS oa PERMIT N0. >'��� Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) arm r) Gas Dryer $ 10.00 $ Trade Name fie) Size No.A4.6G BTU HP EDR *Air Conditioning . All Sizes $ 25.00 $ Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial 1.25% of Value of Appliance or Work $ 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 State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and TOTAL FEE $ .�_O representations stated in this application are true and correct. 21 River City Sheet NPe a 1,02- MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO 9925 Bluebird St. N.W. REFRIGERATION/AIR CONDITIONING PERMIT 1S $25.00 Coon Rapids, MN 55433 PLUS THE $ 50 STATE SURCHARGE Signed �p -2199 TEL # REINSPECTION FEE $47.00/Hr 4N�;_ Ov *Air Conditioners can not be placed in a side yard without Approved By Rough In Date Final Date written permission from adjoining property owner. :ITY OF FRIDLEY INSPECTION DIV. 431 University Ave NE ridley, MN 55432 763) 572-3604. FAX (763) 571-1287 I _ -2—S Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR tUMBING FIXTURE RATES: low Fixtures 3d Opening. Now Fixture neer Olspenser gow Off Basin :atch Basin :ain Water leader aiumplReceiving Tank s ftw Treater Appliance iVater Heater 43ectr1c � ,Vater Heater - Ge.s— NO. RATE TOTAL JOB ADDRESS�ipSI YDW( ,fin lc�'Ei� $10.00 The undersigned hereby makes application far a permit for the work herein $10.00 spec ifred agreeing to do an work in strid accordance wAh the city codes $10.00 and rulings of the Building Division, and hereby declares that ad the facts $10.00 and representations slated in this application are true and correct. 'as Range' Dryer— lack Flaw Preventer Required ( )Yes () No Type — $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 $15.00 ,� teinspec6on Fee $60.001Hr ^%i iLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE $ .50 DATE: a- a- . 24 evILDING USED AS re -A d D m D ESTIMATED COST W:21 PERWr NO. I Approved By Rough -in Date Final Date 111/ WIN FEE FOR ANY PLUMBINGtGAS PERMIT IS $15.00 or 5°/o OF COST OF THE IMPROVEMENT V*WHEVER IS GREATER ON WORK LESS THAN 5306 .'OMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 5"A) AND TABLE 6-A. "'PROVIDE COMMON VENT INFO ON BACK SDE SE_ -21-2044 13:59 CITY OF FRIDLEY P.03/03 a FILL IN COMPLETELY FOR REPLACEMENT FUEL BUIkNING APPLIANCE PERMITS COMMON VENT: VENT CONNI=ACTOR AND COMBUSTION R VERI02agN When roAlacinsr anexistint furnace, the undersigned hereby verifies that the v6nting has been examined and is free from rust, deterioration, obstructions, and is securely supported and flrestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and mdnufacturer specifications Including sizing, length, number of elbows and termination. Yes () No( ) The undersigned also verifies that the replacement unit Is a listed assembly and meets the current codes and manufacturer's specifications. This does Include AGA -LAMA Category I Central Furnace Venting Tablas for fan assisted and natural draft appliances. Yes { } No( The existing combustion air Is sized and Installed to meet the currant codes and manufacturer's specifications_ Yes { } No ( ) When required to Install a new comm! stlon aLK-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 -LAMA Category I Central Fumice 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( ) Aaaliance Tobe 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 �in Type Appliance #2 Vent Connector Height ft Length ft Diameter Type Appliance #i3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date TOTA,- P.0