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PRE 2010 DOCSO Village of Fridley, Minn. BUILDING PSI' N° '756 Office of INSPECTOR OF BUILDINGS own Archite6ti-12-1r - .. r<° � r w.,; ,£ ate- Fridley Minn.,- Builder LOCATI N OF BUILDING .7 Street 0-t42-) JZ 1 1 � Part of Lot s yr, g Lot Block Addition or Sub -Division DESCRIPTION OF BUILDING Front-as—IL, DepthL-" Height _-, Stories -'' ��-° Manner of Construction -------- r, To be used as `�' r _ To be completed 4- ; Estimated Coat,f " F Permit is hereby granted the building ' described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, Minn., regarding the construction, alteration, maintenance, repair and moving of buildings within the city limits, and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permit, I hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein stated. Subscribed and sworn to before me at Fridley, day o��'l jei k, "_, A.D. 19 . 1 Minnesota, this SUBJECT PERMI City of Fridley®13158 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. `y -----_ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. /'--1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 8-26-75 JOB ADDRESS 4675 MAIN STREET N.E. FRIDLEY 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 28 & 29 12 1 PLYMOUTH SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE ' VIRGIL LUNDBERG, 4675 MAIN STREET N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. INTER CITY BUILDERS, 2500 MURRAY AVENUE N.E., MINNEAPOLIS 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING RESIDENCE 7 CLASS OF WORK ❑ NEW XXI ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK CONSTRUCT DETACHED GARAGE 20x 22x8 9 CHANGE QF USE FROM TO STIPULATIONS PROVIDE HARD SURFACED DRIVEWAY SEPEME PERWItTS REQUIRED FOR WIRIN 14tATIM pLuMBNG AND SIGNS. WARNING Before digging call local utilities TELEPHONE - ELECTRIC - GAS Etc. REQUIRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. 1' RAKE 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 R-1 440 3,520 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 $3,256 $1.63 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. $8.50 STRUCTION OR THE PE FORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE 1 $10.13 GNATUREOFC TRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY ALIDATED HIS IS YOUR PERMIT 8-26-75 BLDG INSP DATE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) • ' APPLICATION FOR R)SI'DL'NTIAL., •ALTL'ItATION, OR ADDITION.BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME : l A a/ l, 1 Ud;? 6 zj? 2 BUILDER: e l- e Tis - ADDRESS: y d7 S_ A,�A/ ADDRESS : ';?SC�� STREET: LOT l BLOCK • ADDITION: llzy v ill CORNER'LOT: INSIDE LOT: // SETBACK: SIDEYARD: Applicant attach to this form n,7o Certificates -)f Survey -of Lot and.pxoposed building location c.,:awn on these Certificates. DESCRIPTION OF.BUILDING To Be Used As: Front: `aD Depth: Height: • Square Feet: Zly0 Cubic.Feet: Front: Depth: Height• ' Square Feet; Cubic Feet: Type of Construction: � Estimated Cost: $;fid®• To Be Completed: 3o - 1%5 - The undersigned hereby makes application fox a permit for the work herein specif ied,.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: �.s— SIGNATURE- : .(See cverse Side For Additional Information.)* AGREEMENT I, , owner of the property located at 22 a,;,r have no objection to the City allowing the construction of a to be located at V6 7 without the required certificate of survey that the City ordinarily requires for all new construction. witnes C:.. . ✓�r Signature L Address Date SUBJECT PER City of Fridley o 18013 AT THE TOP OF THE TWINS BUILDING PERMIT _ r RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. INSPECTION / ��� (p r PROTECTIVE SEC. CITY HALL FRIDLEY 55432 , NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 �g os- / / JOB ADDRESS 4675 Main Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 28, 29 12 1 Plymouth Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Virgil Lundberg 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. s ame 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 R ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof 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 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $15. SO CONTRACTORO UTHOR12 A NT IDATEI WHE PROP L V D ED IS IS YOURPERMIT "SIGATUREOF F OWN IIF O NER BUILDER) IDATEI G _NSP SATE NEW [ ] City of Fridley Effective 4/1/84 ADDN. I R-1 AND R-2 ALTER. [ ] Building Permit Application M � Construction Address: i 77/ t.','��. Legal Description: Owner Nasse i Address- Tel. Contractor: Tel. d Address: 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 Vidth Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DEC[ AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Type of Construction: Estimated Cost: $ Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: S- a' cI ' kS—APPLICANT: vv w Tel. # CITY USE ONLY r Permit Fee $ c a Fee Schedule on Reverse Side Plan Check $ 25% of Building Permit Fee State Surcharge $ 9 =.50/$1,000 Valuation SAC Charge $ $425 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ _ � J v Agreement Necessary [ ] Not NecessaryTOTAL [ ] STIPULATIONS• r SUBJECT PERMIT NO. City of Fridley 6 0151 AT THE TOP OF THE TWINS BUILDING PERMIT 1 ? RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r_-__ I L PROTECTIVE INSPECTION SEC. QQ 1 I NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 5/4/98 JOB ADDRESS 4675 Main Street NE 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 28, 29 12 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Virgil Lundberg 4675 Main Street NE 572-8978 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 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION j] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Garage (6 Sq) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd but not the 3rd layer. 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 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 $.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $375 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- $21.00 Firjkl SC $050 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOT L EE 22.00 SIGNATURE OF CONTRALTO OR AUTMO IZED AGENT IDATEI c Af!t,V'EN R P BL INS- VALID TE HI$ ro I$ OUR P RMI _ i 70 MATE SIGNA UR OW NEA OF pWNER BUILDERI IDATE, NEW [ ] ADDN [ J CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: 4 � "� S` Effective 1/1/98 Legal Description: p- Owner Name & Ad,4ress: Tel. # Contractor: Address: MN LICENSE # 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: LengthWidth Height DECK AREA:Lfn-M /Width Hgt/Ground OTHER: Construction Type: Driveway Curb Cut Width Needed: Ft. + 6 Ft = Tel. # Sq. Ft. Sq. Ft. Sq. Ft. Estimated Cost: $ ('o )C �'q VS. - (Fee Schedule on Back) / _Ft x $ _ $C- a \ DATE: 5�` '� - APPLICANT: Tel. # CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ .001 of Pe ion (1/10th%) State Surcharge $ . l� $.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 51kt C L� Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ 2Z 4-0 STIPULATIONS: l'� sue.iECT RMIT NO. , City of Fridley 2940 AT THE TOP OF THE TWINS BUILDING PERMIT -RECfr IPT NO. `COMMUNITY DEVELOPMENT DIV. v------ INSPECTION SEC. r PROTECTIVE O?W7 1 r = CITY HALL FRIDLEY 55432NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 5/6/99 JOB ADDRESS 4675 Main Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 28,29 12 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Virgil Lundberg 4675 Main Street NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Four Season Roofing & Remodeling 7930 University Ave NE, Fridley, MN 55432 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 795-9410 20138780 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION IR REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof House (12 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. SEPARATE PERMITS ARE REOUIRED 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 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 $1,028 $ .51 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- AC $1.03 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $37.50 Fire PLAN CHECK F TOTE e C $5.0 4.04 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI NEN PR A ID HI$ IS R RM _ 9l �i5bNowpAtE �// �" /�� SIGNATURE OF OWNER,IF OWNER SUILDERI IDATEI l'� NEW[ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 1 BUILDING PERMIT APPLICATION Gt�� Construction Address: Yg 7� lzf#( aV Legal Description: Owner Name & Address: Vk Rte) L L Aj f) A E- A(z Z(G-x- Contractor: c c S o i) Ro y -P , iJ U ck-- A C Q A)& MN LICENSE # Address: 7 4'3o L.L0 k o F.RS j',j-j( A 0 C-, 1,J, F:. Tel. # l 0 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: WKF— C-E O �s 119, Cz �- D Construction Type: Estimated Cost: $ 3� License Surcharge Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: S' APPLICANT: a Tel. #,S /a ??;--'T 4( / D STIPULATIONS: mra CITY USE ONLY r� Permit Fee $ 32. 0 Fee Schedule on Reverse Side Fire Surcharge $ I D 3 .001 of Permit Valuation (1/10th%) State Surcharge $ S/ $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ S . CSG $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 $ D 91 STIPULATIONS: mra CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: (763) 571-1287 ADDRESS : 4675 MAIN ST NE PIN : 263024330062 LEGAL DESC : UNAVAILABLE # GAS RANGES 0 : LOT BLOCK PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 2,800.00 PERM O.: 2004-00503 DATE ISSUED: 04/14/2004 # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 APPLICANT HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK 0.00 35.00 SUPERIOR CONTRACTORS INC 612142 AVE N GAS RANGE FEE 0.00 CRYSTAL, MN 55422-1601 GAS DRYER FEE 0.00 (763) 537-8491 AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 16473 0.50 35.50 OWNER LUNDBERG VIRGIL J & B E 4675 MAIN ST NE FRIDLEY, MN 55421 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 permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulatingi ction or the performance of construction. Bldg Insp J • 1 T1ATf ♦TT T1TTlW/TTL1 T1 T/IT TTATT\TJ/1T TT1/I"TJ /'1TTTT`T] TTTALT TlTOlTD TDL'Tl AD�1T 7L� ULl <>l�[-11L 1 L1�1T111U 1W�V11WL 1 Vim ♦. Vain v aa1a..�a� +iu uT aia...v vav✓rry a auv . a...• rr .•CITY OF FRIDLEY BUILDING INSPECTION Effec�/ 2004 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION 763-572-3604 FAX 763-571-1287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICESO()C/ JOBADDRESS /�A'//✓ �T �- �' RATE SCHEDULE Fee Total Residential owner V l RAJL Furnace Shell and Duct Work, Burner & 0 e4l—I also Replacement Furnace $35.00 $ Building Used As ' d L') "ic Fireplace, Insert) $10.00 $ Jv� ESTIMATED COST 2y®d PERMIT NO '0 S62 Gas Piping (New Furnace, Gas Range $10.00 $ DESCRIPTION OF FURNACE AND BURNER Gas Dryer $10.00 $ # of Heating Units_ Circle One (Steam) (Hot Water) Warm Air Trade Name C AK R t cg< Size No. (d 0 70 *Air Conditioning -All Sizes $25.00 $ BTU &6,,0(9Z) HP EDR Fuel A; *7- 6 A-1 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 The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/Industrial/Institutional and representations stated in this application are true and correct. State Surcharge $ HEATING C a (fo AJ TV A-e-mcs I A✓ � TOTAL FEE $, Signed Tel # REINSPECTION FEE $50.00/HOUR FAX # Date%��'®q *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 i::� Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existina 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 Length 3 specifications including sizing, length, number of elbows and termination. 11 Yes () No The undersigned also verifies that the replacement unit is a listed assembly Length -5 and meets the current codes and manufacturer's specifications. This does Type Cis e include AGA-GAMA Category I Central Furnace Venting Tables for fan Length assisted and natural draft appliances. Yes Ix 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 manufacturers 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 Furnace No- Venting Tables for fan assisted and natural draft appliances. Yes () 99 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 60 k& At'if- BTU Input ob Fan Assisted or Nat �AAJ Appliance #2 Type 0114 BTU Input ® cco Fan Assisted or Nat wA-� Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Zi Total Btu Input Common Vent Type dl -A -6s ni Vent Height l 8� I Diameter �� inches Appliance #1 Vent Connector Height '� ft Length 3 ft Diameter in Type C/ -A---5 6 Appliance #2 Vent Connector Height =ft Length -5 ft Diameter 4-f in Type Cis e Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) A) C /HA) i5Y 0A* Y- El P-Cr-57TEV HEATING CO: RS ZN Signed By: Date 0