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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N0 715 5 Date: Owner: / '1"ZA ���� Bauder Address Address �OCAT PJM,qF jUILDING N0..1 /�J Street 40f/ //tA acyl • 4z,& � — PartOf t_ Lot Block L Addition or Siih-MAgimn.���---((( oI a Corner Lot Inside Lot Setback cAe Sideyard Sewer Elevation ___ _ _ Fo dation Elevation DESCRIPTION OF BUILDING T ))er Front Depth Height 11*9 Sq. Ft.,IJ Cu. Ft�,S�� t Depth�Height Sq. Ft. Cu. Ft. gyp Type of Construction �.�.._.... Es - t. �.. To be Completed ._.._ In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance wi all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $,__. , permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall coffiorm in all respects to the ordinances oP Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the dty limits and this permit may be revoked at any time upon vision of any of the Preens of said ordinances. ®� 1 Building Inspector NOTICE. ihb pendt does not corer the construction, hatallation for wiring, phrmhhfg, gas Mating, Bawer or water. Be sun to we the Buildhig hnpeetor for separate permits for thaw Hems. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME'/ i / �G//�/ BUILDER ADDRESS 7.f f^. ,41 IS-" SSIP?l S77 N,6 ADDRESS LOCATION OF BUILDING No.. �f .f- i� iss rss /�/'/ ` /NL o Street .. Part .of Lot 96_,49 Lot^ Block % Addition or Subdi�is.ion Corner % otInside Lot - Setback iC Side Yard . SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to.this. form -Two Certificates oB Survey of Lot -and proposed build- ing,location drawn -on these,Certificates.r DESCRIPTION OF BUILDING To be used as; 04 h'.4 4 Front L "�. Depth Height. sq. Ft.: .2 ' Cu.. Ft. 70''z'.2 Front Depth Height Sq. Ft..- Cu. ,Ft . Type of Construction &.000�W%gF-S%,)ec?c X7- Estimated Cost .7?,r. To be Completed_ _ N y.s `Po ss r Btc' 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 o#:the Department.of Buildings, and.hereb,y declares that.all the facts and representations stated in this application are true_and correct.. DATE _ f Z - SIGNATURE�G/� �L (Schedule of Fee Costs can be found on the Reverse Side). m" SUBJECT PER City of Fridley 16 AT THE TOP OF THE TWINS B U I L D I N G P E R M I T _ r RECEIPT NO. `y _____ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. , CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/13/82 JOB ADDRESS 715 Mississippi Street N.E. 1 LEGAL LOT NO. 6 BLOCK TRA OR ADDIT ON SEE ATTACHED ��lover f Addition DESCR. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Michael L. Rohr 715 Mississippi 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION C)( REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK re -roof house & garage 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. fibreglass THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. 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 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 725. OO WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .5O 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 25=W /15- S® SIGNA]URE OF CONTRACTOR RAU THORIZED AGENT (DATEI EN PRO ERLY VALIDATED THIS IS YOUR PERMIT 13 BLDG INSP DATE SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE) m" CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICAT194 FOR RESIDENTIAL BUILDING PER?41TS (NEw, Alterations, Additions, or Repairs) OWNER: %� � c% e � �- �c� � � BUILDER: ADDRESS: `� /� e" -1ra- ,'-r, ,',/JCA,' S`f 0,t4_:_ADDRESS: TEL N0: _ei,' 71 S'7 `- ® TEL NO: Construction Location • STRITT NO: ! STREET: /"I • "(r " _r"' ' p" i S "e- "l -/Z- LOT: BLOCK: ADDITION: /o ver Corner Lot: Inside Lot:_ Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Pc 0- — 4 _ Front: Depth: Height: Square.Feet: Cubic Feet: Front: Depth: Height: Square -Feet: Cubic Feet: Type of Construction: '!b Be Cbmpleted: Estimated Cost: $ Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET The undersigned hereby makes application for a permit for the tnrk-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: �— / 3 — � L- SIGNATUM : Stipulations: 11 �0 � SUBJECT - of Fridley jPE ;1`9669 AT THE TOP OF THE TWINS BUILDING PERMIT _ rpCity RE • _____ COMMUNITY DEVELOPMENT DIV. � LV r PROTECTIVE INSPECTION SEC. 1"'1 CITY HALL FRIDLEY 55432 IL NUMBER REV. DATE PAGE OF APPROVED BY ----A, j 612-571-3450 910-F15 9/12/88 JOB ADDRESS 715 Mississippi Street N. E. 1 LEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 1 Clover Leaf Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Mike/LuAnne Rohr 715 Mississippi Street N.E. 571-5740 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. John Murphy Builders 1337 Gardena Avenue, Fridley 55432 571-9629 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 12 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Replace and add cabinets - fi.restop soffits 9 CHANGE OF USE FROM TO STIPULATIONS 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 $250 $.50 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- $15.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE 11 1 $15.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY V LIDATED THIS IS YOUR PERMIT BLDG INSP `� _n —A Tr SiGNATURE OF OWNER OF OWNER BUILDER) (DATE) NEW [ ] City of Fridley AMN I ] R-1 AND R-2 ALTER [ ] Building Permit Application ODnstruction Address Legal Description:_ Ower Name & Address ODntractor: Address: Effective 5/1/88 Tel. # 571- Tel. Attach to this application, a Certif icate of Survey of the lot, with the proposoed construction drawn on it to scale. Width Height sq. Ft. Width Height Sq. Ft. Ft. abrner Lot I ] Inside Lot I ] Ft. Yd Setback Side Yard !Mks Tipe of Construction: rd�wr- - Estimated Cost: 5 oZ� Approx. Completion Date: Ll -,L Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $_ Width + 6' See Back Page DATE: APPLICUU: QL Tel. # MY USE ONLY Permit Flee $ IS. OC) Flee Schedule on Reverse Side State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $550 per SAC Unit. Driveway Escrow $ Alt. °A" or Alt. "BA Above Park Flee $ Flee Determined by Engineering Sewer Main Charge $ Agreement Necessary I ] Not Necessary [ ] TOTAL $ o SUBJECT PE NO City of Fridley 075 AT THE TOP OF THE TWINS BUILDING PERMIT TNO. � • COMMUNITY DEVELOPMENT DIV. _____ r � � PROTECTIVE INSPECTION SEC. 1 � � 1 = .."'1 CITY HALL FRIDLEY 55432 NUMBER REVDATE PAGE OF APPROVED By 612-571-3450 910415 8/18/99 JOB ADDRESS 715 Mississippi Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 1 Clover Leaf Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Hill. 586-9514 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Suburban Exteriors 9701 Penn Ave S Ste 107 Bloomington 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 X29 REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage 28 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 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 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 $244% WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1.22 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE ROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $83.25 Fire TRUCTION OR THE PERFOR ANCE OF ONSTRUCTION SC $2.45 PLAN CHECK FEE TOTAL FE License 5.00 $91. NATURE OF CON 'RA TO A AUTHORIZED AGENT IDATE. JJK ENP OP R LIDATE TH IS YOUR PE .,. SIGNATURE OF OWNERi6 OWNER BUILDERi iDATE, BLDG NSP GATE NEW[ ] Effective 5/10/99 q" y " F 6 ADDN [ ] CITY OF FRIDLEY ALTER [ SINGLE FAMILY AND DUPLEXES R-1 AND R-2 b®7 BUILDING PERMIT APPLICATION Construction Address: "7 S Legal Description: -` _Q,O,A__ al L 6 1U. • Aly , Owner Name & Address:, U Tel. #�6 Contractor: MN LICENSE # L-/ o� Address: D I T -QA� ,•Q -.3. */ o j Tel. # Attach to. this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMFROVEMENr LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: R Estimated Cost: $ Z4 Driveway Curb Cut Width Needed: Ft. + G Ft = Ft x $ = $ DATE: S ` / '*2 •' i 9 APPLICANT: � A Ct/r, Tel. # 'RS/ -9'a 8Q Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit `valuation (1/10th7o) $.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 [ ] suejEtr P City of Fridley 3 0 3 3 0 AT THE TOP OF THE TWINS BUILDING PERMIT r R IPT NO. • COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. , PROTECTIVE NUMBER REV DATE PAGE OF APPROVED BY l CITY HALL FRIDLEY 55432 --_- '� L J` 612-571-3450 910-F15 10/1/99 JOB ADDRESS 715 Mississippi Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 6 1 Clover Leaf Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 586-9514 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Custom Remodelers Inc. 474 Apollo Dr Lino Lakes 55014 651-784-2646 1748 a 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 O ADDITION 0 ALTERATION -X6 REPAIR O MOVE O REMOVE B DESCRIBE WORK Soffit and fascia 9 CHANGE OF USE FROM TO STIPULATIONS Provide soffit ventilation to meet the 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 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 5600 $2.80 WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACC ARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $125..25 F' SC $5.60 TRUCTION 0 HE PERFORMANCE OF CO RUCTION PLAN CHECK FEE License C $5 0 T FEE 38.65 'GNATURE OF CONTRACTOR AUTHORIZED AGENT (DATE, HE P Y VALI THIS IS YOUR PER SAG ,NSR ATE S,GNATURE OF OWNER„F OWNER BUILDER, (DATE, NEW [ ] Effective 1/1/99 -ADD?4 [ ] CITY OF FRIDLEY ALTER [ ri]� SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION P y 3 3�9 ConstructionAddress: !% c /Vit -CS 1 Legal Description: -57" s `e— Owner Name & Address: 17 t S7- 4 / s c .' s f i'PA -r s T N C , Tel. Contractor: MN LICENSE # Address:;t-"2, IV _APd1le 49& 4 fhx#- ke!,r , Z210, s -so< 9 Tel. # / 0 ` h 92 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: Construction Type: -5,,g67-9P-7Aae- 4 Estimated Cost: $ ,M (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft Ft x $ _ $ DATE: to - / - 9yq APPLICANT: �Q-'� 6K �G� . Tel. #� s -a Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control $ Z60 Park Fee $ Sewer Main Charge $ 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 [ ] TOTAL :. $ , .. STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 ,�005-0/ Qk Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK All 1MRt=R (1G PIYTI IRFC Tn RF INRTAI I i=n r)N FACH FI r)r)R PLUMBING FIXTURE RATES: NO. Urinal �` Shower ............ :.f:':::` Wash T II:I:::: Floor Drain ::>::>:::: �....... >��...... Auto. .�<....... Washer �� . Gas R ane _ r.::::. Water Heater Stories ���#�:; ��<.. . > Gas Elec Basemen t r"*r=�> and representations stated in this application are true and correct. Catch Basin Rain Water Leader $10.00 $10.00 DATE: ����� , 2047C_ Sump/Receiving Tank $10.00 Water Treating Appliance $35.00 Floor 1 >> Water Heater -Electric $35.00 Water Heater - Gas"" $35.00 BUILDING USED AS Gas Range" $10.00 � Floor 2 $10.00 ESTIMATED COST PERMIT NO. Back Flow Preventer Required ( )Yes () No r'&%rVj r Type $15.00 PLUMBING COMPANY Reinspection Fee $50.00/Hr Floor 3 SIGNED BY _1_TEL N0. >> 1.25% of Value of Fixture or Appliance Approved By Rough -In Date Final Date Floor 4 $ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 6% OF COST TOTAL FEE $ )0, OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS New Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $10.00 and representations stated in this application are true and correct. Catch Basin Rain Water Leader $10.00 $10.00 DATE: ����� , 2047C_ Sump/Receiving Tank $10.00 Water Treating Appliance $35.00 OWNER Water Heater -Electric $35.00 Water Heater - Gas"" $35.00 BUILDING USED AS Gas Range" $10.00 � Gas Dryer"" $10.00 ESTIMATED COST PERMIT NO. Back Flow Preventer Required ( )Yes () No r'&%rVj r Type $15.00 PLUMBING COMPANY Reinspection Fee $50.00/Hr SIGNED BY _1_TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge $ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 6% OF COST TOTAL FEE $ )0, 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 k FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT; VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacina an existing furnace, the undersigned hereby verifies that the BTU Input Fan Assisted or Nat venting has been examined and is free from rust, deterioration, obstructions, BTU Input Fan Assisted or Nat and is securely supported and firestopped where required. Yes () No( ) The venting system is plastic/PVC and meets all current codes and manufacturer Tctal Btu Input 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 inttalled 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 Fumice Venting Tables for fan assisted and natural draft appliances. Yes () No( ) N 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 Tctal 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: Jul I-- - -, 01� - . D j l ! l 1: 1 r'r Ur- I` k I DLEY 6) V ll IN Il ER i J instruction Address: gal Description: _ P. 0j."02 CITY OF FRIDLEY 6431 University Ave NE, Fridiey, MN 55432 (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) S71-1287 Fax BUILDING PERMIT APPLICATION &mer Name & Address: V H N HX LL_ Tel. #7&. mtractor.815e_ Atid �m�Y� -�1"U't c.c• r.�T' r� MN LICENSE # L� Idress:� C�/� fes' L �n � . �. [3['A ""'t /)?It -554(7 Tel. Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to'scale. DESCRIPTION OF IMPROVEMENT DING AREA: Length Width Height Sq. FL RAGE AREA: Length Width Height Sq. Ft. :CK APX-A: Length Width Hgt/Ground Sq. Ft rHER: QQ__ ���� instruction Type: A't TM Rev ,Y\ {" I A r S i4 Estimated Cost: $ ikY60 ctf 11"— iveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ �o}rh av�,� k� �►. p ►TE: APPLICANT it Tel. # %', v 1(763) 572.3604 for Permit Fees if mailing in application. Fax 763-571-1287 if using credit card and we will call i for carts number. :rmit Fee an Review re Surcharge :ate Surcharge 4C Charge cense Surcharge .jrb Cut Escrow •osion Control ark Fee awer Main Charge TOTAL CITY USE ONLY - $ Fee Schedule on Reverse Side $ 65% of Permit Fee $ SD .001 of Permit Valuation (1/10th%) $ a� o25r $.50/$1,000 Valuation $. $1450 per SAC Unit $ S . 00 $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ _ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary j 1 Not Necessary j ] $ L I'5' �'� STIPULA'T'IONS: -1-144 4-ee.tr 7-ae,3 ev A-rri /�E % r�e_, i j•d daj:20 go j,a unr Add 4o PPV-m'l� r:Yb i F3 S •e ? 1 � m Is 5 t s s;�� ` -S7-- � '7i,k D ll�k:2 130" 4y(W eft rIDOY, K ck") { H 15 O"C U e9fr : 60 SO LZ unC