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PRE 2010 DOCS3v & 3. - City ®f Fridley, Mian. 11T° 8 413 BUILDING PERMIT Date: AUGUST 272 1965 Owner: JAY ANDERSON Builder CLEMRON, INC. Address Address 701 Columbia Blvd. N. E. Minneapolis, Minnesota LOCATION OF BUILDING No. 7394 Street Memory Lane N. E. part of Lot Lot 22 _ Block 3 Addition or Sub -Division _ Melody Manor, 3rd Addition Corner Lot _ Inside Lot — $ Setback 35' Sideyard 10' Sewer Elevation — Foundation Elevation DESCRIPTION OF BUILDING To be Used as: HOUSE Front 40 Depth _____24 Height — 20 Sq. Ft. —120D Cu. Ft. -4.00 ATTR GARAGE Front 20 Depth 21 Height --AL Sq. Ft. 420 Cu. Ft. 4,200 Type of Construction RRAm Est. Cost $22,500.00 – To be Completed In consideration of the issuance to me of a permit to cons building describd a I agree to do the proposed work in accordance with the description above t fo and in ce wi a'll provisions of ordinanoes of the city of Fridley. In consideration of the payment of a fee of $ 29.00 permit is hereby granted to MEMRONa INC 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 upon violation of any of the provisions of said ordinances. ALLEN G. JENSEN Building Inspector NOTICE M permb dos not emu the constmetion, hntakdon for wiring, plwnbing, on hooting, smar or water. Bo an to sw the BuNing Mqm for for separab pormhe for thew items. . APPLICATION FOR BUILDING PEM41T CITY OF FRIMEY, MINNESOTA OWNER'S NAME BUILDER ADDRESS ADDRESSL LOCATION OF BUILDING No. %.�"�J,�[ Street, Part of Lot.�� Lot Block Addition or Subdivision 01 `. Corner Lot Inside Lot setback Side -16C SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. DESCRIPTION OF BUILDING Sq. Type of Construction To be Completed Dapth_ Height CU. Ft. ool Depth Height Cu. Ft. timated Cost, 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 SIGNATURE ,Schedule of Fee Costs can be found on the Reverse Side). SUBJECT PEO. City of Fridley o 20166 AT THE TOP OF THE TWINS BUILDING PERMIT _ RE O. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L J\� 612-571-3450 910-F15 10/19/89 JOB ADDRESS 7394 Memory Lane N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 22 3 Melody Manor 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dave Brockob 739.4 Memory Lane N.E. 784-0162 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. D & D Rome Improvement Inc. 740.1 Central Avenue N.E., Fridley 784-7543 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 B DESCRIBE WORK Reroof Dwelling (24 Squares) 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be 2nd layer but not 3rd. Install ridged galvanized valleys. On all new roofs or tear-offs and replacement roofs. State Code requires that 2 layers of 15 9b. felt, mopped toge,hc;; be installed to a point 24 inches up from exterior iyall line, or the use of other approved underlayment membrane. 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 $1200 $a60 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- $29.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $29.60 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY VA ATED THIS IS YOUR PERMIT SIGNATURE OF OWNER 0F OWNER BUILDERI (DATEI BLDG INSP TE NEW [ ] City of Fridley Effective 5/1/88 ADDN [ l R-1 AND R-2 ALTER [ ] Building Permit Application Construction Address: �/�� AL Legal Description: Owner Name & Address: �%������f C°%®� Tel. # 79ei Contractor:Tel. ... - �W�IiI lei' Attach to this application, a Certificate of Survey of the lot, with the proposoed construction drawn on it to scale. LIVING AREAL: Length Width Height Sg. Ft. MRAGE AREA: Length Width Height Sg. Ft. DECK AREA: Length Width Hgt/Ground Sg. Ft. Corner Lot [ ] Inside Loot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: /°fie -A Ort�WK- 1�y� Estimated Cost: $_ �0;) 6.6 Approx. Completion Date: � �S �% ` Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: 5 $ Width + 6' See Back Page DATE: ADPLICANT:f �lJ '��Ii�, /"wlTel. # CITY USE ONLY Permit Flee Fee Schedule on Reverse Side State Surcharge S IL $.50/51,000 Valuation SAC Charge 5 $550 per SAC Unit Driveway Escrow 5 Alt. RAn or Alt. "B" Above Park Fee 5 Fee Determined by Engineering Sewer Main (Barge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL 5 %. 6) STIPOLATIONS: SUBJECT �. City of FridleyC/2 6 9 2 4 AT THE TOP OF THE TWINS BUILDING PERMIT r O COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. r NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 7/30/98 JOB ADDRESS 7394 Memory Lane I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 22 3 1 Melody Manor, 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Larry Johnson 786-2496 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Midwest Siding & Roofing 18979 Gladstone 416-4204 20010277 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 O NEW O ADDITION O ALTERATION I$ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage 30 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 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 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 T AT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE S TOB TR E AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANC OV G HIS PE OF WORK WILL BE COMPLIED WITH WHETHE C HER NOT. THE GRANTING OF A PERMIT $2502 1.25 DOES NOT P E VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISION O R A OR LOCAL LAW REGULATING CON- STRUCTIO OR RF AN E OF CONSTRUCTION. $74.75 FAxe SC $2.50 PLAN CHECK FEET7.,/8 EE Licens 5.00.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATE I N ROPE ALID �. - 'BL G INSO THIS IS YOUR PERMI r GATE SIGNATURE OF OWNER of OWNER BUILDERI IDATEI NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: -73961 Legal Description: Effective 1/1/98 Owner Name & Address: LQ V"r w S o Tel. # '7 9� �i c(6 Contractor: A i,� 6oe 9 4- dt MN LICENSE # Z© ® (0 2 ? 7 - Address: ! 7 -7 9 (g a+ -e— Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction T✓ -'c �� Estimated Cost: Type: / a $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE:.'7 -5 d -70 d L ArrLICANT. Tel. # STIPULATIONS: CITY USE ONLY Permit Fee $ 6%L�- 9.5 Fee Schedule on Reverse Side Fire Surcharge $ c, C' .001 of Permit Valuation (1/10th%) State Surcharge $ /- ��� $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ -S—,00 $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: ' SUBJECT , City of Fridley 32493 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. � • COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. do I r PROTECTIVE 1 . � NUMBEA PAGE OF APPROVED BY CITY HALL FRIDLEY 53432 L 612-571-3450 910-FlS JW7��DATE 4/4/02 JOB ADDRESS 7394 Memory Lane NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 22 3 Melody Manor 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE L & L Johnson 7394 Memory Lane NE 763-786-8496 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Quarve Contracting Inc 8427 Center Dr NE, Spring Lake Park, MN 55432 6016 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 763-785-1472 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION Cj REPAIR ❑ MOVE - ❑ REMOVE 8 DESCRIBE WORK Install windows in existing openings 9 CHANGE OF USE FROM 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. 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 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 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 $10,016 $5.50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- PERMIT FEE SAC CHARGE 2 STRU I OR THE PERF R CE CONSTRUCTION $195.25 �O. Fire SC OF PLAN CHECK E TAL FEE Lice e C 5.00 rl$215.77 SIGNATURE OF CONTRACTOR OR AUTMORIZEO AGENT IOATEI HE FOR RLY V LI ATED THIS IS YO I PER IT BIAG IN$F' IMATE v S-GNATURE OF OWNER IIF OWNER BUILOERI IOATEI NEW [ J Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: 13v1 M !�a Legal Description: Owner Name & Address: d/ U'su llnspn U'sTel. # ��� ' �� Contractor: i l MN LICENSE # Address:1`V b N� �11 553 Tel. # ``13- q9-_S-f�d,,, 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: P(001ckafiA In ,ll rP.rJa(.e_ ne, oa)]nrJna; in P -x]4] riQ ®Pe n, n�3 I -_j Construction Type:Home' Estimated Cost: $ 1©01 Q Driveway CurbCut Wid Needed: Ft. + 6 Ft = Ft x $ —=$ // r7 /1 � r� DATE:_�j APPLICANT: 64� G Tel. #_70 185-17 / 9 CITY USE ONLY - Call (7763) 572-3604 for Permit Fees if mailing in application Permit Fee $ l7 Fee Schedule on Reverse Side Fire Surcharge $ In O .001 of Permit Valuation (1/10th%) State Surcharge $_, 50 $.50/$1,000 Valuation SAC Charge $ $1150 per SAC Unit License Surcharge $ 5,00 $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 k STIPULATIONS: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 ►63) 572-3604 FAX: (763) 571-1287 ADDRESS : 7394 MEMORY IN NE PIN : 113024140033 LEGAL DESC : MELODY MANOR 3RD ADD : LOT 22 BLOCK 3 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT N .=2004-00881�,, DATE ISSUED: 06/10/2004 ' VALUATION : $ 400.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL GAS WATER HEATER. # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) # GAS DRYERS # OF NEW FIXTURES APPLICANT NORBLOM PLUMBING CO 2905 GARFIELD AVE S MINNEAPOLIS, MN 55408-2173 (612)827-4033 OWNER JOHNSON LISA M & LARRY D JR 7394 MEMORY LN NE FRIDLEY, MN 55432 0 # GAS WATER HEATERS 1 0 # GAS RANGES 0 0 # WATER TRMT APPLIANCES 0 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 wort 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 construction or the performance of construction. Arml c�an—t-, { Date I 1 Bldg Insp PLBG PERMIT MINIMUM FEE 0.00 PLBG FIXTURES (NEW OPENINGS) 0.00 PLBG FIXTURES (EXIST OPENINGS) 0.00 WATER TREATMENT APPLIANCE 0.00 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 35.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 PLBG REPAIR/ALTERATIONS 0.00 STATE SURCHARGE, PLBG FLAT 0.50 TOTAL 35.50 PAID WITH CHECK # 28437 SEPARATE PERMITS REOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. :ITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004 431 UniVrsity Ave NE ridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 763),672-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR ILUMBING FIXTURE RATES: dew Fixtures )Id Opening, New Fixture Seer Dispenser Ilow Off Basin ',atch Basin Iain Water Leader iump/Receiving Tank Nater Treating Appliance Nater Heater -Electric Nater Heater - Gas** Sas Range** NO. RATE TOTAL Sas Dryer** Sack 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 5-. cv $10.00 $10.00 $15.00 Reinspection Fee $50.00/Hr kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE $ 3S SD JOB ADDRESS 6nnn.¢. u.5 &W Kid - 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. JOHNSOK LARRY 7394 MEMORY LANE NORTHEAST FRIDLEY, MN 55432 O� (763) 786-8496 1078 ,20 0/ BUILDING USED AS kf/SI d e./tG� ESTIMATED COST `I Li Lj oo PERMIT NO. 0010� PLUMBING COMPANY NO f YO ` OVA CaM�1 IOr SIGNED BY TEL N0.t- R2� 0 Approved By Rough -In Date Final Date lov MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE W. I Shower Wash Tray Floor rain Auto. Washer . Gas Range Water Heater s Gas ElecSton' Basement Floor 1 Floor 2 Floor 3 Floor 4 ILUMBING FIXTURE RATES: dew Fixtures )Id Opening, New Fixture Seer Dispenser Ilow Off Basin ',atch Basin Iain Water Leader iump/Receiving Tank Nater Treating Appliance Nater Heater -Electric Nater Heater - Gas** Sas Range** NO. RATE TOTAL Sas Dryer** Sack 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 5-. cv $10.00 $10.00 $15.00 Reinspection Fee $50.00/Hr kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE $ 3S SD JOB ADDRESS 6nnn.¢. u.5 &W Kid - 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. JOHNSOK LARRY 7394 MEMORY LANE NORTHEAST FRIDLEY, MN 55432 O� (763) 786-8496 1078 ,20 0/ BUILDING USED AS kf/SI d e./tG� ESTIMATED COST `I Li Lj oo PERMIT NO. 0010� PLUMBING COMPANY NO f YO ` OVA CaM�1 IOr SIGNED BY TEL N0.t- R2� 0 Approved By Rough -In Date Final Date lov MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. 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 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 existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes O 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 installina a new venting system, the undersigned hereby verifies that it 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 Building MECHANICAL Permit No.: ' Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY C' f . 763-502-4977 FAX EFFECTIVE 1-1-08 DATE '� -4 — ey YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: ❑ OWNER *ONTRACT R PROPERTY NAME: ADDRESS: CITY STATIWZIPJ�.� OWNER/ TENANT PHONE: CONTRACTOR COMPANY NAME: r a NOTE: SEPARATE CITY a/ CONTACT PERSON: Gt STATE LICENSE #_ p EXP DATE °"GAS ADDRESS:/: SI lO� �1 CITY 1A ! � { STAT ZIP. �sS�3q LICENSES ARE SUIRED FOR AND HVAC. �,_[� e SUBMIT COPY OF BOND PHONE -6 3� FAX n:3 " 7-51' —�a AND INSURANCE PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK' 11 NEW REPLACEMENT ❑ ALTERATION/REMODEL ` DETAILED DESCRIPTION OF WORK s d 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) OR 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 FDCTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: MODEL: SIZF./BTU 0 MFG: I P N MODEL: [- (b( SIZE/BTU MFG: MODEL: SIZE/BTU .XA/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 _DUCT WORK $10.00 _GAS PIPING $10.00 _VENTILATOR $15.00 PERMIT FEE PROJECTS FOR UNDER $500 PERMIT FEE FOR PROJECTS OVER $500 Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ OR Number of fixtures @ $25.00 —4— x $25.00 = $ ! !!U Number of fixtures @ $35.00 1_ x$35.00=$-35-.00 State Surcharge = $ 50 MINIMUM $15.50 MINIMUM $15.50 Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a mechanical 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 acordance with the approved plan in the case of all work which requires review and approval of plans. jin SIGNATURE OIPPLICANT PRINT NAME O&V L° 6LA DATE DA's hk APPROVED BY PLEASE NOTE: SEPARATE PEPAWS ARE REQUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK M City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977