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PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn. Date :: �.'�, .. •(� ... ....is—&..... Owner : ,". .. " J A;4,. . 00 Address ../,r.,� L :i� . a'`Pra. Vii? +1s......... . 2020 Builder . �,,� ar.-4-�'' .j ..................... Address ................. LOCATION OF BUILDING .� No. .. q„ �•34..... Street .... Part of Lot . ......... ...... . Lot .....7......... Block ... p. .... Addition or Sub -Division 101�...... Corner Lot ............ Inside Lot .... Setback 1:1 Side and .� � .......... DESCRIPTION OF BUILDING To be Used as: • ,4v Af .. Front #jDepth , ... Height /$ . Sq. Ft..... . Cu. Ft. ........ .................... Front ........ Depth ........ Height ......... Sq. Ft..... Cu. Ft......... Type of Construction ..,.z4. Est. Cost . 5,��1}' ..... To be Complete ................... e In consideration of the issuance to me of a permit to construct the building described the proposed work in accordance with the description above set forth and in compliance ordinances of the village of Fridley. above, I agree to do vith all provisions of csonsideration of the payment of a fee of $. ,��or:. , permit is hereby granted to r r.:,.... ik�'j.. 4ft to construct the building or addition as described above. •p$rmit 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 o the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the village limits and this permit may be revoked at any time upon violation of any of a provisions of said ordinances. ice-�cr:+'r . i . Building Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring, piui Bing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Ite s. City of Fridley, Minn.. BUILDING PERMIT N° 5 8 2 3 Date: Owner: " Builder r-- Address Address f� LOCATION �_ ALI ING No. Street. _ Part t Lot _ _ _.._ Block — , Addition or Sub -Division Corner Lot --- Inside Lot SetbackSideyard ._ Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To :p AA , Front Depth y � �' 'Height Sq. ' _ Cu. Ft., ff/ ` Front._ Depth � eight Sq. Ft Cu. Ft. ., -,:. .,, x `�� ;` '�" Completed Type of Gutrucden , Q Est. Cest� �! .._s_. _ - i be p ted 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 with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ ' eft , 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 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. _ ", ,r, " - ' Building Inspector NOTICE This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner's Name Builder Address ® - Address LOCATION OF BUILDING 2) Street J# Part of Lot Lot _Block___lO ___Ad ition or Subdivision Corner Lot Inside Lot Setback 119 Side -Yard 3 SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as; Front Depth,Height Sq, Ft. Z4 Cu. Ft. J�z 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 specified, agreeing to do all work in strict accordance with Fridley Ordinances and rulings of the Department of Buildings declares that all the facts and representati s stated in are true and correct. ,�,®,� / DATE &— /� — � GNATURE (Schedule of Fee Costs can be found on the .. Side). work herein the City of and hereby s applicAio Application for Fearer Plants and Heating, Cooling, Ventilation, Reftigerrrtlo0 and Air Condi Oning SYstem and Devices PARTIAL RATE SCHEDULE GRAV3TY WARM AIR: Mn TOTAL Furnace Shell & Duct Work ................ .. $10.00 Replacement of Furnace ..... ..... 6.00 : Repairs & Alterations—up to $500.00 6.00 Repairs & Alterations each add. $500.00 3.00 $-- - - MECIL WARM AIR Furnace Shell & Duct Work to 120,000 BTU` ...... . $10.00 $L_ each add. 60,000 BTU .................... .. 3.00 i Replacement of Furnace 6.00 $ Repairs & Alterations—up to $500.00 6.00 $ Repairs & Alterations each add. $500.00 3.W $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $. Furnace Shell & Line --to 640 sq. ft. EDR Hot Water 10.00 $_ Each add. 200 sq. ft. EDR Steam 3,00 Each add. 320 sq. ft. EDR Hot Water 3.00 $_ OIL BURNER—to 3 gal. per hour 6.00 $ _ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199.000 BTU) 6.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x$ Zoo $ Additional Fixtures x .75 $ Gas Range to 199,000 a$ 5.00 $ AIR CONDITIONING � L� P FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM ALTERATIONS & REPAIRS TOTAL FEE ROUGH FINAL (SURCHARGE $ _.5j) Dept. of Bldgs. Phone Seo�--3480 City of Fridley: 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 are true and correct. Owner Kind of Used as To be completed about / d � Estimated Cost, $_.�_._..__... C: 0 o = - Old New. Building Permit No. Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No Trade Name Size Na - Capacity Sq. Ft. E.D.R BTU HP Total Connected Load Kind Of Fuet BURNER — Trade Name Size No Capaci Sq. Ft E.D R_ Bim) up (REMARKS-OV[R) Z/1(3W- ®gr DESCRIPTION OF WORKF Number, Kind and Location of Fixtures Lem (� � PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: $ Number Fixtures SF d �n� x $1.50 $ . New Fixture Old Opening x $1.50 $ Catch Basin x $3,26 $ Water Heater (Up to 99,000 BTU) . • WATER MTR. GAS ELEG Base = $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..... ........ x $2.00 $ Additional Fixtures .... .............. x $ .76 $ Gas Range to 199,000 BTU .............. x $5.00 $ 1st -- — 2nd - 3rd 4th _ - -- • Future, Connection Openings Connected with * New Fixture, Old OpeningsSower I Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $2.00 $ Future Fixture Opening x $1.50 $ . New Fixture Old Opening x $1.50 $ Catch Basin x $3,26 $ Water Heater (Up to 99,000 BTU) x $3.00 $ New Ground Run Old Bldg. x $3,26 $ Electric water Heater = $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..... ........ x $2.00 $ Additional Fixtures .... .............. x $ .76 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS B ALTERATIONS—Refer to Code Description ......... ........................ ...........$ TOTAL FM City of Fridley: 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 appUeption ime true and correct. IZZ Owner Kind of ading Used as To be completed about Est' ated Cost, $ d New. Building Permit No— _ Permit No. �T cQ 89Signed ROUGH FINAL—, ot L By- - Business Phone HOUSE HEATING TEST RECORD ADDRESS J6)30- X 213"'e S f-` r K " 'E ' APT. FLOOR CITY SUBURB OCCUPANT ® , h i -c= & _X i el ke s OWNER HEAT LOSS —DATE HTG. INST. SOLD BY INSTALLED BY Electrical Work By Gas Line By — TYPE OF HEAT GA FA —'L—HW STEAM SPACE HTR. �GAS DESIGN �?,4 MAKE ej S MAKE OF BURNER _ Model C4 wcy `0ru 3 p Model Serial A /1 / 69 7 (10 11 Max. BTU Rating — INPUT 109-0 ®�' �" MAKE OF FURNACE Model UNIT HTR. OTHER CONVERSION CONTROLS � THERMOSTAT Heat Plug V Vent Size Valve ® KIND OF LINER `� SIZE s NONE Limit. f �' ' y Draft Hood rs —" Regularor J9 Limit Setting 200 Filters SizeNumber Fan Setting Chimney Location Inside Outside Pilot Type Chimney Construction Pilot Make Pilot Model Smoke Bomb Wiring Pilot Timing _-'- " Draft Test Tag L.W. Cut Off Door Pressure Lighting Inst. o 6 Pressure Z Percent CO2r Date Tested Input CFH LOS ® Percent 02 7 _ Company Testing Stack Temp. O Percent CO O Name of Tester Form 235 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE m PLUMBING FIXTURE RATES: NO. >,m{ TOTAL Cd x o $ k m r. Water $ a�pp J+ .phi 3 x 0 $ E-1 -r44 �tl x $5.00 m b H a w $5.00 $ Heater 100,000 BTU to 199,000 13TU x $10.00 $ Water Softener x $7.00 $ p � a $ Electric Water Heater x $5.00 $ O +i - 0 C: N of O O 19 tq N x N W Gas Range to 199,000 BTU x TA ro U D ro PO y 3 8 Q w to w U we 3 U each add. $100.00 or fraction U b as lec State Surcharge $ .50 TOTAL FEE $ lst 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $3.00 $ Future Fixture Opening r. $2.00 $ New Fixture, Old Opening 3 x $2.00 $ t;,o 0 Catch Basin x $5.00 $ Water Heater - to 99,000 BTU x $5.00 $ 100,000 BTU to 199,000 13TU x $10.00 $ Water Softener x $7.00 $ New Ground Run Old Building x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: - 1st 3 fixtures x '$3.00 $ Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ REINSPECTION FEE ($10.00) Job Address /-,331) 1-" A -a -p Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. / - , 19? % OWNER KIND OF B ILDING%�..� USED AS TO BE COMPLETED ABOUT 5 '3 % ESTIMATED COST Sa d %Q OLD - NEW BUILDING PERMIT NO. PERMIT NO. / V 7 01 Company Signed By Tel. No. ROUGH INSP. Date FINAL INSP. �? Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SE :SItiZ+:: FEE FOR ANY HEATING PERMIT IS $7.50 J CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE}} &33-C) n4om ry� s v'�,� GRAVITY WARM AIR: RAT I. TOTAL Job Address — :`-,r :ace' S --.ell & Duct Work $12.00 $ Replacement of Furnace -up 7'00 7.00 $ $ Department of Buildings Repairs & Alterations to $500.00 4.00 $ City of Fridley Repairs & Alterations each add. $500.00 Tel. #571-3450 MECHANICAL WARM AIR: The undersigned hereby makes application for a permit for the work herein $12.00 $ specified agreeing to do all work, in strict accordance with the City Codes Furnace Snell & Duct Work to 100,000 BTL' 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the each add. 5;,,600 BTU 7.00 $ �00 facts and representations stated in this application are true and correct. Replace.:.ent of Futnace Repairs & Alzerstions-up to $500.00 4.00 Fridley, Minn. � 9 Y 1 3 N/ a 0 1� Reairs &Alterations each add. $500.00 $ Sita:•: OR HOT 1•ATi R SYS 2,1: OWNER- =� Boiler a Lines up to 100,000 BTU $12.00 $ KIND OF BUILDING each ad'-dn. 50,000 BTU 4.00 $ 1 r1 Boiler only up to 100,000 BTU 7.00 $ USED AS each adds. 50,000 BTL' 6.00 $ TO BE COMPLETED ABOUT IJ a46 OIL BURNER- to 3 gal. per hour $10.00$ %� � � �,. each add. 3 gal. per hour 10.00 $ ESTIMATED COST GAS 5u 1 N K- :rca 100,000 BTU to 199,999 BTU $10.00 $� OLD - NEW BUILDING PERMIT NO. PERD:IT N0. (Over e eu FeL! sclledalu) $ GAS FITTING FEES: 1st. 3 fixtures x $ 3.00 $ DESCRIPTIO14 OF FURNACE/BURLIER Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00 $ HEATING or POWER PLANTS, Steam, Hot Water Warm Air- No. ' t AIR CONDI IJNING $ {-� Size No. Trade Name ��- �� ' ..._ FAX HEATING SYSTE IS See Fee Schedule $ VENTILATING SYSTEMS $ Capacity sq. Ft. ED Fjr BTU ALTERATIONS $ REPAIRS-� $ State Surcharge $ .50 �s Total Connected Load 7, s VV Kind of Fuel TOTAL FEE $J 7T_� BURNER -Trade Name Size No. RJUC•H INSP. REINSPI:CT10N FEE Capacity Sq. Ft. EDR BTU HP Date ($10.00) / Company FINAL INSP. Date Signed By 2� (�� APPfi.;VAL FOR PER?IIT /� Tel. No. :SItiZ+:: FEE FOR ANY HEATING PERMIT IS $7.50 A-) 1 0 e' LP HEAT LOSS CALCULATIONS DEPARTMENT OF INSPECTION MEMEAPOULS. MSI. Weatherstrips iA.S.H.V.E. Guide Construction No. Insulation Windows I Doors Reference. Out. Wall jInt. Wall Ceiling Roof Floor Kind How Applied Yes—No 19— 1 1 k;;m— Length �_)_*idt 2—S77—Height Room Length Width Height Windows and Doors—Crackage and Area Width H016h9 No. of pane of pane No. 1 Width Hel ht No. of Ll ft Area of pane of pane ligInerack ' so. ft. lights o 11 _ & d?_ I q � 3 z Coef. to Infiltration Glass Coef. Btu Coef. Btu Infiltration Glass Ceiling Coef. Btu Infiltration Floor Int. wall Ceiling Exp. wall Floor 0 1� Glass Exp. wall 1-; Ceiling Net e. -.p. wall Int, wall Floor Ceiling Floor Total Btu Windows and Doors—Crackage and Area Width H016h9 No. of pane of pane Na. of Area IISts et crack sq. ft* -7 Coef. to Infiltration Glass Coef. Btu Coef. Btu Infiltration Glass Ceiling Exp. wall t Glass Net exp. wall Floor Int. wall Ceiling Exp. wall Floor Net exp. wall Int. wall Ceiling Floor Required . sq. ft. E.D.R_ or sq. ins. W.A. Leader area _!L_U_" Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Room I Length Width s Height F1.1 Room I Length Width Windows and Door*--Crackage and Area Width No, otpane Height No.of Lineal ft. Area or pane lights of track eq. It. Coef. to Infiltration Glass Coef. Btu Infiltration Int. wall Glass Ceiling Exp. wall t Floor Net exp. wall Floor Int. wall Ceiling Floor I otal Utu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FIA Room I Length Width IUrht Windows and Doors—Crackage an—d Area No. Width Height No. at*a' '. Area of pane of pane lights tC*.,..k sq. ft. Coef. to Infiltration Glass Btu Infiltration Int. wall Glass Ceiling Exp. wall Floor [Net exp. wau Int. wall Ceiling Floor Total Btu. Required sq. (L or sq. ins. WA Leader area HeWit Windows and Doom—Crackage and Area Width Height. Na.Area of Lineal ft. No. or pans of pane lights of crack sq. ft. Coef. to Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor I otal Itstu. I Required sq. ft. E.D.R. or sq. ins. W.A. Leader area _I F1.1 Room I LenKth Width Heistht Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area NO. of vine of Dan*_ lights 01 crack sq. M Coef. Btu Infiltration Glass Exp. wall Not exp. wall Jut. wall Ceiling Floor I otal ISM I Required mi. ft. ED.R. or sq. ins. WA. Leader area I City of Fridley SUBJECT THE TOP OF TME TWINS PERMIT D39! rAT gUILDING •COMMUNITY DEVELOPMENT DIV. ��------. r � � PROTECTIVE INSPECTION SEC. NUMBER REV. DATE PAGE OF APPROVED BY --1 CITY HALL FRIDLEY 55432 IL ---- A 612-560-3450 910-F15 3/l/77 JOB ADDRESS 6330 Monroe NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 6 Cristie Addition SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE John Drobnick same 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. T. M. Campion Company 2139 Lowry Avenue N M ls. NN 529-9216 -4-ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION 9 REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Fire damage repair 9 CHANGE OF USE FROM TO STIPULATIONS Call for inspection after clean up. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Fire. Reit Ra 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 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 $18,000.00 $9.00 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 ERFORMANCE OF CONSTRUCTION. AEONFEE PLAN TOTALFEE 117.00 SIGNATUR OFC NTRACTOR OR AUTHORIZED AGENT (DATE)EN PR PEWVALIATY THIS IS YOUR PERMIT DG INSP DATE -JGNATUREO OWNER(IF OWNER BUILDERIIDATEI CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: BUILDER: / N / Address : Address Tel. No . No.: Street: MOM BLOCK: ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: F Square Feet: Front: Depth: Cubic Feet: Depth: Square Feet: Cubic Feet: Type of Construction: To Be Completed: Height: Height: Estimated Cost: $ Z) J /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 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. See reverse side for additional information. DATE: SIGNATURE: % i'I LL Stipulations: / S �- JAJ. � q 'J ftEffective 1. 1991�� On January -ITY OF F► -LEY INSPECTION DIV. 1_ 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION. Trade Name REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES 572-3604 STU JOB ADDRESS, ''' RATE SCHEDULE r The undersigned hereby makes application for a permit for the work . r. Rate TOTAL herein specified agreeing to do all work in strict accordance with the Residential city codes and ruling of the Building Division. and hereby declares Furnace Shell and Duct Work, Burner - $ that all the facts and representations stated in this application are Also Replacement Furnace S 20.00 true and correct. c 1 3 .1991 Gas Piping - $ 10.00 $ �. OWNER , 1 o�r1 r o\u \, e k Gas Range $ 10.00 $ BUILDING USED AS Gas Dryer $ 10.00 $ � b a ESTIMATED CO" � _ Q r ® o PERMIT NO. I I "Air Conditioning - All Sizes t,,\) , -0 $ 10.00 j All OthersIRepairs & Alterations (LIST ON BACK) of Value of Appliance or Work Commercial/industrial I% of Value of Appliance or Work State Surcharge TOTAL FEE $ DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units Circle One (Stearn) (Hot Water) (Warm Air) Trade Name Size No. STU HP EDR $ Fuel Total Connected Load S ,50 Burner Trade Name Size No. BTU HP _ EDR $ HEATING COMPANY_ !t r 5C 5 'e- C',® T `n A 2 - MINIMUM FEE FOR ANY HEATINGICOOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $ 50 STATE SURCHARGE REINSPECTION FEE $30.00 ,Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. 11 Signed By Tel No.L 3- AppriVIA BY Rough -In Date Final Date FILL OUT BACKSIDE FOR STACK VERIRC ATION ON REPLACEMENT FURNACE I � Y P 4 .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 CONDITIONING SYSTEMS AND DEVICES 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 & A.Iterations (LIST ON BACK) 1% of Value of Appliance, or Work Commercial/Industrial 1.25% of Value of Appliance or Work JOB AD Effective On January 1, 2001 State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 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. $ .50 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 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and corre t. �z DATE HEATING CO Signe TEL # L4- -c--)--c� Approved Bf� Rough -In Date Final BACK SIDE MUS f BE FILLED IN ON VENT SIZE, VENT CONNECTORS AND COMBUSTIM AIR VERIFICATION � � � I c OWNER /' (c Rate TOTAL 30.00 C�) BUILDING USED AS $ $o , ESTIMATED COST PERMIT.NO. / $ 10.00 $ _ DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (�arm u) $ 10.00 $ Trade Name n Size No. BT HP EDR $ 25.00 $ Fuel A -t Total Connected Load Burner Trade Name Size No. $ BTU HP EDR State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 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. $ .50 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 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and corre t. �z DATE HEATING CO Signe TEL # L4- -c--)--c� Approved Bf� Rough -In Date Final BACK SIDE MUS f BE FILLED IN ON VENT SIZE, VENT CONNECTORS AND COMBUSTIM AIR VERIFICATION COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, 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 O : No ( ) The, undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturers 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 ( ) I's 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 4- A ' . 1082 -Payne Ave. St. Paul, MN 55101 651/772-2449 ,GAS WORK ORDER. STANDARD dHEATING 410 W. Lake St. Minneapolis, MN 55408 612/824-2656 & AIR CONDITIONING A Blue Doi: Service Co. EQUIPMENT INFORMATION LAST Nf) FIRST TYPE MAKE ADDRESS �� '`, �"f�S� �� CITY ZIP -/ 3 �- HM PH TECHDATE FRI ORSAT TEST RECORD CO2 % METERED INPUT cfh CHIMNEY TYPE MODEL 02 % LIMIT SETTING 0C) ° FLUE SIZE SERIAL 55Z::) 55''03'6 INPUT � 6 FRI ORSAT TEST RECORD CO2 % METERED INPUT cfh CHIMNEY TYPE 02 % LIMIT SETTING 0C) ° FLUE SIZE in. CO % PILOT OUTAGE sec CONNECTOR SIZE in. NET STACK TEMP 0 TOTAL CHIMNEY INPUT' i .btuh FRI 1082 Payne Ave. St. Paul, MN 55101 651/772-2449 GAS WORK ORDER STANDARD 6HEATING09 410 W. Lake St. Minneapolis, MN 55408 612/824-2656 & AIR CONDITIONING A Blue DoE. Service Co. EQUIPMENT INFORMATION LAST FIRST ADDRESS lw-��3 Y/�„-j fZQ E �-,\ C CITY , c�� ZIP U.-fia HM PH 7 4,-.�; � � F` WK PH TECH DATE � W w TYPE MAKE -92L SERIAL S �+ INPUT ORSAT TEST RECORD CO2 t®' % METERED INPUT & (V Cfh CHIMNEY TYPE - 1% 02 a, ' % LIMIT SETTING O�D° FLUE SIZE in. CO % PILOT OUTAGEZ., , sec CONNECTOR SIZE in. NET STACK TEMP 3 ! c TOTAL CHIMNEY INPUT btuh UiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 November 26, 2001 Mr. John Drobnick 6330 Monroe St NE Fridley, MN 55432 Re: Final Inspection at 6330 Monroe Street NE Contractor: Standard Heating & Air Conditioning Dear Mr. Drobnick: A mechanical permit was issued on September 28, 2001 to install a furnace at your address. According to the 1991 Uniform Mechanical Code a final inspection shall be conducted on the work authorized by this permit. As of this date, no inspection has been called for. The permit fee that was paid covers the inspection to make sure the work was completed according to the Codes. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will expire the permit and no further action will be taken. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. DJ/mh 3uilding BUILDING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: )ATE YOUR E-MAIL ADDRESS ITE ADDRESS 'HIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: � k TENANT ADDRESS: 6 4i'd %s rut r �l CITY STATEZ PHONE: CONTRACTOR NAME: C/ /' ��r STATE LICENSE # ��_7J F EXP DATE Ut&"aG SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: �cA roc.-� -e —CITY G STATE WITH APPLICATION PHONE 4 �� FAX SINGLE FAMILY/NEW CONSTRUCTION SIZE PROPERTY TYPE el TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITIONGARAGE/SHED [I WINDOWS AROOF E3BASEMENT FINISH ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR JA.REmoDELiNG L DESCRIBE WORK BEING DONE: �% �tr✓'S-� �` �`� f �' 3IZE OF IMPROVEMENT LENGTH WIDTH HEIGHT /Sq. Ft. ?,OOFINGN'" ❑ HOUSE ONLY NUMBER OF SQUARES � / HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 3ARAGES 11 ATTACHED GARAGE 2. Proposed floor plan 'ROPOSED SIZE: DETACHED GARAGE 3. List of structural members to be used 'ROPOSED HEIGHT: 1 ING FOR NEW CONSTRUCTION INCLUDING DECKS, Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures :3 Other ❑ Fascia and proposed project 2. Two sets of construction plans WINDOWS 3. Energy Calculations N EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS DR FOR NEW OPENINGS -DESCRIBE SIZE OF DPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 99, 7 �Q OCCUPANCY TYPE Permit Fee Plan Review Surcharge Fire Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due off®/. $ See Back Page for Fee Schedule 65% of Building Permit Fee (.0005) times the total job valuation — Minimum $.50 .001 x Permit Valuation (1/10%) $5.00 (State Licensed Residential Contractors) $1450 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks navable to: City of Fridley Attach 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 wor=��PRINTNAME eview and approval of plans. SIGNATURE OF APPLIC C // �Qc1✓ .`(� G� Building Inspections 763-572-36 DATE I ( t SITE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK: MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL �r 0 OWNER CONTRACTOR NAME: ADDRESS: PHONE: COMPANY NAMES� STANI CONTACT PERSOIO^^ �� STATE LICENSE 4 ADDRESS: PHONE `SINGLE FAMILY 0 TWO FAMILY D NEW >kPLACEMENT DETAILED DESCRIPTION OF WORK 410 WEST LA W, MN 5540 2-24 — FAX 0 TOWNHOUSE 0 ALTERATION/REMODEL Permit No.: Received By: Date Recd: 7, ATE ZIP PER MS 1613.665 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 $;P, FEES ARE BAISED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) SIZE/BTU0� Equipment installed MF MODEL: MFG: MODEL: SIZE/BTU MFG: MODEL. SIZEBTU _FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00 4/C $25.00 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 $ Number of fixtures @ $10.00 x $10.00 = Surcharge $ .50 Number of fixtures @ $15.00 x $15.00= $ TOTAL DUE $ Number of fixtures @ $25.00 1 x $25.00 = $�.� Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $___d0_ Total = $ _S_Ss 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 cod e f Fridley and with the Minnesota -Construction Codes; that i understand this is not a permit but only an r perm and . is not to start without a permit; that the work will be in accordance with the approved plan in the a of w hich r ires r vi and approval of ATE SIGNATURE OF APPLI I`J City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley,. MN 55432 763-572-3604 FAX: 763-502-4977