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PRE 2010 DOCS. 1P C1/i ° City of Fridley, Minn.. BUILDING PERMIT No 7022 Date: Owner: _ Builder Address Address LOCATIO F TU'LD'NG No. Sheet _.A`.- Part of Lot Lot 2, -- Block ____. Addition or Sub -Division Ixt Corner Lot _ Inside Lot �_ Setback Sideyard Sewer Elevation —_ Elevation tep F° C7/ Nr, DESCRIPTION OF BUILDING T I q0ttruction / �J/ Front Depth Height Sq. Ft�� Cu. Ft&4w t Depth Height � Sq. Ft. Cu. Ft. 040 Type Est. a _ — To be Completed In consideration of the issuance to me of a permit to construct building descri abo agree to do the proposed work in accordance with the description above sere in com. ' provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $a permit is hereby granted to thtion thto construct the building or addition as described above. This permit is granted upon e express condiat 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 regardtnug location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon vis�laon of any of the provisions of said ordinances. w _ P 1 Building Inspector NOTICE: Ah permit does not Carer the Contend ion, bata"on for Wiring, phm ialne, on boding, sewer or water. Be are to we the Bnibliog laspedor for separate pormhs for tboso Nona. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA ,ell e�CLEMWH, Owner's Name dz Builder_ -- 4Q. ,4619 Benjamin St. N, Address Address aile�rn r�na'I; In Anin,- ___-- LOCATION AF BUILDING No. Street Part of Lot_ �,4 Lot Block a:? -Addition or Subdivision Corner Lot Inside Lot Setback Side -Yard d 4' _ SEWER. ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING Type of To be Completed Sq. Ft. A2713 & Cu. Ft. Front DepthJe Iieight Sq. Ft. Cu. Ft. The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application e tnde and correct. DA7Is 4 �� SIGNATURE' (A Schedule of Fee Costs can be found on the Reverse Side.) City of Fridley Application for Plumbing and Gas Fitthing Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Locatio®� e m Q 18 a�� v 12 inF ��n Zfz a�j 8cZ <�� O J 0 �U' �u U' Z �s O • F • N WATER HTR. GAS ELEC. Base A 1 1st 2nd 3rd 4th • Future Connection Openings e New Fixture, Old Openings I Connected with Sewer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE T ynTAL Number Fixtures ...................... x $1.50 $ &6-® 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 $ 1200 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 to Code Description ................................................$ TOTAL FEE $ City of Fridley: Pl The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Minns 19�� Owner Kind of Building Used as To be completed aZt Estimated Cost, $ ' i� im Old ew. uilding Permit ROUGH��' FINAL d2 le City of Fridley, Minn. N° 8172 BUR DING PERMIT Date: JULY 10, 1965 Owner: EDWARD SEARS Builder STUART PENGALLY Address 118 Craig Way N. E. Address 7836 Alden Way N. E. Fridley 32, Minnesota Fridley 32, Minnesota LOCATION OF BUILDING No. 7360 Street Memory Lane N. E. Part of Lot Lot --- Block Addition or Sub -Division Corner Lot _ Inside Lot _ _ Setback Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Est Cost $16,000.00 _ To be Completed REBUILD HOUSE In consideration of the issuance to me econstruct se1 a permit to cotrc tip wilding d I agree to do the proposed work in accordance with the description above set o In con with provisions of grdinances of the city of Fridley. In consideration of the payment of a fee of $ 10.Oo , permit is hereby granted to STUART PENGALLY 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 regardinlocation, construction, alteration, maintenance, repair and moving of ordinances. buildings within the city limits as permit may be revoked at any time upon violation of any of the provisions of said ALLEN G. JENSEN Building Inspector NOTICE: Y6b peemif don not sown go candruaHm, hatagMan for rrir m piumbtne, on hn8oe, sewer or wNer. Be son is sso the soildias hapestor for sopmft permits for thea iters. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME I— 8)a. a jj S FAAe S BUILDER -40- ►U C U u j ADDRESS P ujA,.i ADDAESS `%e(.36, A we, -T LOCATION OF BUILDING N0. STREET '1 up M f IVll l L4-sk r PART _AF LOT: LOT BLOCKDITION OR SUBDIVISION CORNER LOT INSIDVLOSETBACK SIDE-YARDSEWER ELEVATIONFOUNDATION 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). � s w •' w SUBJECT PE - '72 -7 City of Fridley 2 AT THE TOP OF THE TWINS BUILDING PERMIT i RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r ~ PROTECTIVE INSPECTION SEC. 1 . � CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By I.J 612-571-3450 910-F15 7/19/94 JOB ADDRESS 7360 Memory Lane NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 2 Melod Manor 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Edward Sears 7360 Memory Lane NE 786-1432 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4ARCHITECT 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 Q. REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside House & Garage; Install beam in garage roof 9 CHANGEOFUSEFROM TO STIPULATIONS Provide solid blocking from beam to foundation and additional ceiling joists. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,900 $.80 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SACCHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $43.00 Fire SC $1.90 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE 45.70 SIGNATURE OF CONT FACTOR OR AUTHORIZED AGENT IDATEI ROPERL VAL TED THIS IS YOUR PERMIT BLDG IN SP QATE SiGNA OF IF OWNER BUIL IDATEI NEW (J Effective 1/1/94 ADDN [ 1 CITY OF FRIDLEY ALTER [ SINGLE FAMILY AND DUPLEXES R-1 AND R-2 -�7S-V Building Permit Application Construction Address: Legal Description: Owner Name & Adess: .�.�"�t>.N'o7 �' Sc�� Tel. # Contractor: MN LICENSE # Address:. 'fel. # 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: DESCRIPTION OF IMPROVEMENT Length Width Height Length Width Height Length Width Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. '2 670h •Ze,qV kp Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks ��.*`�� 1,6 /j n, Type of Construction: Estimated Cost: $ Ce 0 D Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: ! % y y APPLICANT: �`�`�� f ��-lr—,-c Tel. # CITY USE ONLY Permit Fee $ J j , U U Fee Schedule on Reverse Side Fire Surcharge $ /, 9L) .001 of Permit Valuation (1/10th%) State Surcharge $ .60 $.50/$1,000 Valuation SAC Charge $ $800 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 [ J Not Necessary ( ] TOTAL $ G �% STIPULATIONS: City of Fridley AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT WR 2 12 9 r I L _____ COMMUNITY DEVELOPMENT DIV. V r PROTECTIVE INSPECTION SEC. i ----/'�',•� CITY HALL FRIDLEY 55432 L J\ 612-571-3450 - ECEIP NUMBER 910-F15 REV DATE 8/12/98 PAGE OF APPROVED BY JOB ADDRESS 7360 ory Ln 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 2 1 Melody Manor, 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ed Sears 786-143 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Midwest Siding & Roofing 18979 GladstoneBlvd Ma le Grove 55311 416-4804 2001207 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 O ADDITION ❑ ALTERATION X2 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage 29 S Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION ZONING SO, FT. CU. FT. 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 SA TO SE R CORRE .ALL PROVISIONS OF LAWS AND OROINANC OVE THIS TYPE F WORK WILL BE COMPLIED VALUATION SURTAX WITH WHETHE,Fr CIF EREIN R THE GRANTING OF A PERMIT $2418 $1.21 DOES NOT P M IVE TH TY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIO A O STA OR LOCAL LAW REGULATING CON- STRUCTI N OR T F M TRUCTION. $74.75 Fire SI, $2.42 J!� PLAN CHECK FEE TO L FEE 83.38 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI ENP OP LID THIS IS ;R JPMIT ar SIGNATURE OF OWNER OF OWNER BUILDER), IDATEI ,BLD INSP DATE NEW [ ] Effective 1 / 1 /98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: , Owner Name & Address: Contractor: Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER• Construction Type: lot, Length Length Length Tel. # :4% ^ MN LICENSE #2 o c, / Z this Ypplicldon, a Certificate of Survey of the the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Width Height Sq. Ft. Width Height Sq. Ft. Width Hgt/Ground Sq. Ft. z y' Driveway Curb Cut Width Needed: Ft. + 6 J 12 DATE: / APPLICANT: Estimated Cost: $ 6-2 Y% b (F a Schedule on Back) 'OTt x A /j = $ Tel. # ��7 �v' dll Permit Fee $ S Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ / / $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ 5.0(-) $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 [ J TOTAL $ (53-30 STIPULATIONS: 1., CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 ' APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective On May 10, 1999 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR New Fixtures Urinal .1..�..................... Shower ..........:.....:.Was h Tray ..::..:.:.:.:.:Floor Drain specified agreeing to do all work in strict accordance with the city codes Auto. ...........:::::::::�:.as . Washer Range .� rHea r Gas Elec Stories Basement $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 Floor 1 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner g b S6,4jeS Water Heater -Electric Floor 2 Water Heater - Gas** 1 $10.00 10 -do Building Used As A /n'4_ Gas Range** $10.00 P Floor 3 $10.00 Estimated Cost PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 Floor 4 Reinspection Fee $47.00/Hr SIGNED BY TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS C 1.5% of Value of Fixture or Appliance PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS -7 310 ° 1714,n o ,e% L-4,,JZ- 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 Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 /10/20 ,1999 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner g b S6,4jeS Water Heater -Electric $ 7.00 Water Heater - Gas** 1 $10.00 10 -do Building Used As A /n'4_ Gas Range** $10.00 P Gas Dryer** $10.00 Estimated Cost PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMPANY Reinspection Fee $47.00/Hr SIGNED BY TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS C 1.5% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge $ .50 TOTAL FEE $ Lb.50 **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. Building GV, Inspections 763-572-3604 DATE `°l — ta— C SITE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS ❑ OWNER PHONE: —16 3 — L%- I LI 3-2, CONTRACTOR I COMPANY SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERNIIT TYPE TYPE OF WORK: DETAILED CONTACT PERSON: STATE LICENSE # Tf%AWM 7TR1 WWM i7 Permit No.•W01A Received BDateRecd: ATEbY_)ZIP ADDRESS: 13562 CENTRAL AVE NE cITY AT\TORA STATE ffi�TZIP 55304 PHONE 763757-6202 FAX 763-757-6701 SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE ❑ NEW REPLACEMENT KALTERATION/REMODEL —'In PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x .05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)MODEL:I�SO l �b�I SIZE/BTU Equipment Installed MFG: San" S u r" SIZE/B 1 U MFG: J MODEL: SIZE/BTU MFG: MODEL: L -A -'/'C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 AIR TO AIR EXCHANGEER $15 —FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 BOILER $35.00 _FURNACE $35.00 GAS UNIT HTR $10.00 CHIMNEY LINER $10,00 —GAS DRYER $10.00 POOL HEATER $35.00 —GAS PIPING $10.00 VENTILATOR $15.00 DUCT WORK $10.00 •- MI-AAR, Permit Fee $ Number of fixtures @ $10.00 x 10.0 = Surcharge $ 50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ Number of fixtures @ $25.001_ x $25.00 = $ 075 Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ gq. S. SCS THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLIC. PRINT NAME ROGER HOF�IN DATE � ' �a -6 f City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 1631572-3604 FAX: (763) 571-1287 ADDRESS : 7360 MEMORY LN NE PIN : 113024130009 LEGAL DESC : MELODY MANOR 2ND ADD : LOT 2 BLOCK 2 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-00256 po DATE ISSUED: 02/23/2004 VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A GAS PIPING FOR FIREPLACE VALUE OF APPL OR WORK # GAS DRYERS ENTER VALUATION APPLICANT FIRESIDE HEARTH & HOME/ALLIED FIRES 2700 N FAIRVIEW AVE ROSEVILLE, MN 55113 (651) 633-2561 OWNER SEARS EDWARD R & JUDITH G 7360 MEMORY LN NE FRIDLEY, MN 55432 0 # FURNACES 0 0 # GAS RANGES 0 2300 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 regulating petlstruction or the performance of construction. Bldg HEATING PERMIT MINIMUM FEE 25.00 FURNACE SHELL/DUCT WORK 0.00 GAS PIPING FEE 0.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 25.50 PAID WITH CHECK # 1784 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY INSPECTION DIVISION Effective January 1, 2004 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES FAX (763) 571-1287 JOB ADDRESS IhOMOYY �h RATE SCHEDULE OWNER Residential Rate TOTAL �� Furnace Shell and Duct Work, Burner - BUILDING USED AS A5�n Also Replacement Furnace $ 30.00 $ (Side Vent - Fill Out Back P003" ESTIMATED COST � PERMIT Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) r ot*�,L DESCRIPTION OF FURNACE AND OR BURNER Gas Range r 112'. $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water (Warm Air) Gas Dryer $ 10.00 $ Trade Named�b�re Size No. D✓1`30 *Air Conditioning - All Sizes $ 25.00 BTU 002 HP EDR $ Fuel IV61Total 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 $ �� representations stated in this application are true and correct. TOTAL FEE DATE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS S25-.00 PLUS THE $.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. HEATING CO Signed FAX # TEL # Approved Bye Rough -In Date' Final Date THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When , 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 (:i No ( ) The venting system is plastiGPVC 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( ) No( ) The ovintinn cnmhustinn air is sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When required to inctall a n - _emh ncfinn ai ;.it will be sized and installed to meet the current codes and manufacturer's specifications. Yes() No ( ) When jpaMilina a new yanting--.=tam, 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 #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 M HEATING CO: Signed By. Date : Building Inspections 7.63-572-3604 DATE STCB ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS 1r'1 P IQ r - Permit No.; Received By: Date Rec'd: q , alb;' NAME: ADDRESS: CITY STATE ZIP COMPANY NAME:_ CONTACT PERSON: STATE LICENSE #_ PHONE TYPE OF WORK: 1 o NEW EXP DATE '4 CITY S STATE ij1�ZT FAX FAMILY p TWO FAMILY 0 TOWNHOUSE I� REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to 5500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor i�16�x .05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) MODEL: SIZE/BTU Equipment Installed MFG: SIZE/BTU MFG: MODEL: MFG: MODEL: SIZE/BTU _A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00 AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 �ILER 535.00 _FURNACE $35.00 _GAS HE HTR $10.00 CHIMNEY LINER $10.00 _,GAS DRYER $10.00 POOL HEATER $35.00 _GAS PIPING $10.00 VENTILATOR $15.00 DUCT WORK $10.00 - _. _ ..__ _ M_ .. .�: �.;.t3 �n rauagwll—.wiz— _r Permit Fee $ &1 Number of fixtures @ $10.00 x $10.00 = Surcharge $ 50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $. 5® Number of fixtures @ $25.00 x$25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the cas ll wor wh` uires eview and approval of plans. SIGNATURE OF APPLIC PRINT NAME �=1{�1 1► �� tJ� DATE 11 R ��-t�, City of Fridley Building Inspections Department . 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977