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PRE 2010 DOCSVillage of Fridley, N[Inn. N° 244 BUILDING PERMW Office of INSPECTOR OF BUILDINGS Owner Architect Fridley, Minn i�� ,. � 18 ,r Builder �ht LOCATION OF BUILDING No. 7T Street �� r d Part of Lot Lot Block Addition or Sub -Division DESCRIPTION OF BUILDING Front � Depth Height Stories Manner of Construction I/ To be used as^ ` To be completed +"" `� $ Estimated Cost Permit is hereby granted to 'a' �" � ` �� " ' :mar, - f to the building : 'a",>' °°-• described in the above statement. This permit is granted upon the exprescondition Nat 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. n x Inspector 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. ,'° /� r Subscribed and sworn to before me at Fridley, Minnesot this day o `'t>., �,!n .D. 19 ' ; d . iJ 1 SUBJECT PET City of Fridley o11 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. I ��------, r � I PROTECTIVE INSPECTION SEC. 1 ` � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 10/12/88 JOB ADDRESS 4757 Main Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 23,24 5 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Peter Zirkle 4757 Main Street N.E. 574-9201 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Western Construction Co. 4301 Highway #7, Mpls., MN 9208888 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 Ck NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 261 x 281 Detached Garage 8 CHANGEQFUSEFROM TO STIPULATIONS Sideyard setback.must be increai;ed to 4 feet unless the lot stakes can be found. Provide a hard surface driveway. SEPARATC WON` 41F1 WIRINGh' , `"' ° F �f� y Defore Og call local utilities aUM d8�i1�� " evhGilvfCV�9®j �tl�® AND ��G14y�, �N��1 ELE Nt-Eif�i�RIC > SAS Etc. REQUIRED� BY LA%Ai 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 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 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 $lO 450 $5.23 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 TOTALFEE $104.23 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI WHEN PROPERLY VALIDATED THIS IS YOURPERMIT BLDG INSP �� InAT SIGNATURE OF OWNER (IF OWNER BUILDER)- (DATEI Prepaid Plan Check $ Estimated Cost $ Receipt # City Of Fridley R-3, comm aAL & imusIRIAL Building Permit Application EEfective 5/1/88 Construction Address: 4757 -MAIN STREET N.E. Zomig: Legal Description: Property Owner & Address: 4757 -MAIN STREET N.E. PETER ZIRKLE Tel. # 574-9201 OONTRACPOR & Address: WESTERN CONST COMPANY 4301 -HIGHWAY #7 KP LS T1.#, 920-8888 Architect & Address: Reg. # Engineer & Address: Reg.# Type of Work 11-lNew I ] Addition [ ] Alteration USE OF BUILDING: 26X28 -DETACHED RESIDENTIAL GARAGI APPLICANT SIGNA'URE: G� a Tel. # 920-8888Date: 10/05/88 BUILDING DIMENSIONS Size of Structure Length 28 Width 26 Height 10 Sq. Ft. 728 # of Stories 1 OFC. AREA: Length Width Height Sq. Ft. RM. AREA: Length Width Height Sq. Ft. OTHER AREA: Length Width Height Sq. Ft. VALUATION Sq. Ft. X $ Cost/Sq. Ft. - Valuation $ Sq. Ft. X $ Cost/Sq. Ft. = Valuation $ Sq. Ft. X $ Cost/Sq. Ft. = Valuation $ ) Total Type of Cont: FRAME O=Up, Group; A/C I ] Yes I ] No Fire Prot. [ ]Yes [ ]No Performance Bond Amount $ See Reverse for Scheele Received I ]Yes I ]No. Permit Fee $CV,00 See Fee Schedule on Reverse Side excess of Prepaid Plan Check -See Back Pg. State Surcharge $.50/$1,000 Valuation (See Sched. for > $1 mil) SAC Charge $ $550 per SAC Unit Park Flee $ Flee Determined by Engineering Sped Assessments $ Agreement Necessary I ] Not Necessary I ] Driveway Escrow $ feet at $13.50/foot STIPULATIONS: kA,/ -' 13 1 rrr to A qv a 6 () 1 ,<b �1� FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 • FAX (612) 571-1287 July 19, 1994 Resident 4757 Main Street N.E. Fridley, MN 55421 RE: First Notice of Noncompliance at 4757 Main Street N.E. Dear Resident: The City of Fridley has established a City Code for the purpose of promoting a pleasant and attractive suburban environment. A recent inspection of the property at 4757 Main Street N.E. revealed that not all Code requirements are presently being met. Listed below is an item which does not comply with the City Code: 1. Remove area of brush located along the rear of the garage. Your prompt attention in correcting this situation would greatly assist us in helping make Fridley a better place to live. An inspection will be conducted on or about August 8, 1994, to determine compliance. If you have questions or would like to discuss this, please contact me at 572-3595. Thank you for your cooperation! Sincerely, Steven Barg Code Enforcement Officer SB: sb CE -94-353 CINOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 August 15, 1994 Angela Bielawski 4757 Main Street N.E. Fridley, MN 55421 RE: Final Notice of Noncompliance of the Fridley City Code at 4757 Main Street N.E. Dear Ms. Bielawski: On August 15, 1994, a second inspection of the property at 4757 Main Street N.E. confirmed that the following item still does not comply with City Code: 1. Discontinue outside storage of brush located along the fence in your rear yard. A final inspection to determine compliance will be conducted on or shortly after August 29, 1994. You should arrange to complete an approved plan for compliance before that date. Should this inspection confirm that this deficiency still exists, legal action will be approved. If corrective action cannot be completed by this time, contact me to coordinate a schedule to complete this requirement. If you have any questions regarding this matter, please contact me at the Fridley Municipal Center, 572-3595. Sincerely, Steven Barg Code Enforcement Officer SB: sb CE -94-413 SUBJECT P ERMIT NO. City of Fridley 321 � 9 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. _ _ COMMUNITY DEVELOPMENT DIV. ------ r - � PROTECTIVE INSPECTION SEC. 57®S L�7 �'7 � 1 CITY HALL FRIDLEY $5432 "'' 7 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 9/21/01 JOB ADDRESS 4757 Main Street NE 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 23,24 5 Plymouth Addition SHEET I 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Angie Bielawski 4757 Main Street NE 763-571-1672 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Renewal By Andersen 350 73 Ave NE, Fridley, MN 55432 763-502-4777 20130983 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 O NEW O ADDITION O ALTERATION REPAIR O MOVE O REMOVE B DESCRIBE WORK Replace 10 windows within existing openings 9 CHANGEOFUSEFROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all exterior openings. Permit Inspection Karr,; Will Be Mailed To Homeowner To Post 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 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 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 $6,410 $3.21 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- $139.25 Fire SC $6.41 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE License 5.00 $157V87 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEt N POPERL DATE T IS�tMP/V� NSP f)AtE S-GNATURE OF OWNEROF OWNER BUILDER, iDATE, NEW[ ] Effective 5/10/99 ALTER [ l CITY OF LEY [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: ' Ll "j- 5+ M®.i cv S� . Uv A Legal Description: Owner Name & Address: 60, t . T�,; 4-)iC► W-tL Tel. # 47 Contractor:, Renewal By Andersen MN LICENSE # Address: LIVING AREA:.- GARAGE REA:GARAGE AREA: DECK AREA: OTHER: Construction Type: 350 -73rd Ave. NE Fridley, MN 55432 Tel. # 763-5024777 ' 44Survey of the 1 on it to scale. DESCRHITION OF UWPROVEMIENT. Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Driveway Curb Cut Width Needed: Ft. + 6 Ft = Estimated Cost: $ La, Lj, I (jam% Ft x DATE: •S • C) I APPLICANT: 1.aXrA .. Tel. # R�o"1.3� 5• �G y Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control $ �,-LtL- Park Fee S Sewer Main Charge TOTAL $ S V CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1050 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 [ ] STIPULATIONS: �y�� /- '�' 7' • l• ! �/ ��5�' �-°' d v r < o 0 v SUBJECT PER City of Fridley 36� 9 AT THE TOP OF THE TWINS BUILDING PERMIT .114 r I , REC COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r 1 . � NU.IIER REV DATE PAGE OF APPROVED BY i A CITY HALL FRIDLEY 55432 ,��"-,'� --_• L „ 763-571-3450 910-F15 6/27/03 JOB ADDRESS 4757 Main Street NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 23,24 5 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bielawski/Weckwerth 4757 Mair Street NE 763-571-1672 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same e 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 o ❑ NEW X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE A 6 DESCRIBE WORK Construct a 30' x 13' Addition to Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS See rotations on plan. WARNING Before digging call for SEPARATE PERMITS all utility locations REQUIRED FOR: 4540002 REQUIRE® BY LAVA PLUMRBINGANTSIGNS 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 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 $62,407.80 $31.20 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- $734.75 Fire STRUCTION OR THE PERFORMANCE OF CONSTRUCTION SC $62.41 PLAN CHECK FEE TOTALFEE $828.36 S1 4TURE OF CON'RACTOR AIITMORI AGENT i ATE. WHEN PROPERLY VALIDATED THIS IS YO' R PERMI A It R NEA�I IO BU40ERi .,ATE, —4 BL NSP r�AtE v r < o 0 v NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 763) 5711- 7 Fax " BUILDING PERMIT APPLICATION Construction Address: ) 7 S& Legal Description: IL Owner Name &Address: y1)� ETeI. #-1la �� l�- 1101 Contractor: ? W ' MN LICENSE # o Address: C Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. e LL� Cl 4S� Sq. Ft. Sq. Ft. -140 DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width _ Height GARAGE ARLength_ Width Height DECK AREA: LengthWidth Hgt/Ground OTHER: _ f�:1 �.�� I � - - - '� wCQpl LtO7. 830 10 t� t�9l is ►� Construction Type: W00, Od f� Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. #{Sl�--`I 160-3 l i Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will — call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 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 [ ] SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY PERMIT N4.- 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 07/06/2004 ' (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 4757 MAIN ST NE PIN : 263024320072 LEGAL DESC : PLYMOUTH : LOT 23 BLOCK 5 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 0.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL 4 FIXTURES ON FIRST FLOOR AND 3 FIXTURES ON SECOND FLOOR # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 0 # GAS DRYERS 0 # GAS RANGES 0 # OF NEW FIXTURES 7 VALUE (FOR MINIMUM CALC) 0 # WATER TRMT APPLIANCES 0 APPLICANT PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) 0.00 70.00 BIELANSKI ANGELA G 4757 MAIN ST NE PLBG FIXTURES (EXIST OPENINGS) 0.00 FRIDLEY, MN 55421 WATER TREATMENT APPLIANCE 0.00 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 0.00 GAS RANGE FEE GAS DRYER FEE PLBG REPAIR/ALTERATIONS 0.00 0.00 0.00 OWNER BIELANSKI ANGELA G 4757 MAIN ST NE STATE SURCHARGE, PLBG FLAT 0.50 FRIDLEY, MN 55421 TOTAL 70.50 PAID WITH CHECK # 2518 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 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 provisions of any other state or local law regulatin cons ction or the performance of cons cti Applicant Date 7, 7� kjA Bldg Insp Datel SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004 6431 University Ave NES Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 44 (763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader NO. RATE TOTAL Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas`* Gas Range'" Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE 76-00 $ .50 JOB AD 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 DATE: 2/�_A� , 20 BUILDING USED AS ESTIMATED COST PLUMBING COMPANY SIGNED BY Approved By PERMIT NO. � � 0 / 0`39 TEL N0. Rough -In Date Final Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST $_2Q,_S© OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT; VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing 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 specifications including sizing, length, number of elbows and terminatidn. 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-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () 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 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-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 ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date : EW [ ] Effective 1/1/99 ITN [ ] CITY OF FRIDLEY LTP,R [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION '��'� " 0 ConstructionAddress• 61 w) — v Legal Description: Owner 1` Contract Address: Tel. # 7b 9 - MN LICENSE # P7 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 AREA: Length Width. Hgt/Ground Sq. Ft. OTHER: j y (�*dhstnac on Type: ��►f+.l In J/ Estimated Cost: $ ��) 1 -1 �� D (Fee Schedul a on Back) 1 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft'x $ _ $ DATE: r '� APPLICANT: Tel. # CITY USE ONLY °.- Permit Fee $_ _ Fee Schedule on Reverse Side Fire Surcharge $ joO. 1-4 .001 of Permit Valuation (1/10th%) State Surcharge $ ,S $.501$1,.000 'Valuation SAC Charge $ $1050 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 $ STIPULATIONS. J CITY OF FRIDLEY INSPECTION DIVISION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDI'T'IONING cvcTrMc AMIN nrUlr•rc FAX (763) 571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON [SACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25 Jo of Value of Appliance or Work Rate TOTAL $ 30.00 $ $ 10.00 $ $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE 5.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. JOB Al OWNE i:Ili I i7 Effective January 1, 2003 ESTIMATED COST- � '' PERMIT NO DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air, $ o Trade Name _Atc abyA Size No. BTU4d' ogoo HP EDR $ � Fuel WA Total Connected Load cd, aoo ,.- Burner Trade Name Size No. $ BTU HP _ —EDR $ 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 $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. $ I � X5-010 DATE HEATING CO'�• Signed - TEL # �✓ �� G (L� G FAX # FIL Approved By 0_ Rough -In Date' Final Date THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When ra in _in0 an AY➢CtinO hiranna, 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 plastictPVC 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 manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes a No The aviggU_n cnmhiiatinn air is sized and installed to meet the current codes and manufacturers specifications. Yes (v) No ( ) When required to install a naw rnmhuntinn air. it will be sized and installed to meet the current codes and manufacturer's specifications. Yes (l� No( ) When Insftilina 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 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 dNo ( ) Appliance Upfa- and RLe_/Common Vent and Vent Connecter Information e at 44 ° a J 0► Appliance #1 Type N RK) BTU Input _� Fan Assisted d o r N Appliance #2 Type Q AV ` f i . Y tk BTU Input qp,,, w?.) Fan Assisted or a a IJAY Y1 �l Appliance #3 Type BTU Input Fan Assisted or Total A Iia - ces-� _ � __.. _Total Btu Input Common 'Vent Type ��" ? R Vent Heights Diameter �inches \\� Appliance #1 Vent Connector Heightft Length ft Diameter_in Type C Appliance #2 Vent Connector Height L ft Length__V ft Diameter min Type C Appliance #3 Vent Connector Height ft Length ft Diameter in Type w 1( v 01 T ROTInKIR- 1 /a, y, �� HEATING CO: °v Signed By: Date: