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PRE 2010 DOCSCity ®f Fridley AT THR TOP OF TME TWIN$ rL-------� COMMUNITY DEVIELO MENT OIV, I 1 PROTECTIVR INSPiCTM 89PT, CITY NALL FRIOLgY 416448 Permit No. PLUMING PERMIT APPLICATIO14 Job address — - - Owner Address Phone P9 sem, Plum ng Contr or Address Phone Kind of �Puilding Use Ste/ AJ S'3 �'S Completion Date Estimate ost II I Ii Plumbing Fixture Rates: NO. RATE TOTAL F I j ! i W — -- Number Fixtures --f== x $2.00 Future Fixtures x $1.50 aoNra Svc to I L f i •r ' New Fixture -Old Open. x $1.50 "lady Catch Bastn x $3.25 1 svel Water Heater -99,000 BTU _ x $3.00 3-1) •°SINI I I I � �C r, I Ground Run Old Bldg. x $3.25 'MNItlaI d I e I � j` Elec. Water Heater x $2.00 sNlsra I II kl tulral i `� I } I w i ; Gas Fitting Fees: �I ��� sNnaa eo I I I !I 3 o aO°„I I I •a ! lst 3 Fixtures x $2.00 00 I sa9Mcagl I` f I I I i !p Additional Fixtures x $ .75 •1Nnoa I �tNlanl I I I I Gas Range -199,000 BTU x $5.00 I 4 saval I ... 'A Repairs &- Alterations See I x >a>,NIS Description: Code j Iml iNlBtlo I I State Surcharge.50 l TOTAL FEE $ I tls I ( I! !The undersigned hereby makes application for a permit S7tlNlafll I I I for the work herein specified, agreeing to .do all work 17807 in strict accordance with the City Ordinances and ruling au�MII I I of the Department of Buildings, and hereby declare that all'the facts and representations stated in this d app tion are true and correct. e7i c Ae'l •--2'a 7 - Signa a IfDate a SUBJECT I , City of Fridley1248'7 AT THE TOP OF THE TWINS BUIL DING P E R M I ' COMMUNITY DEVELOPMENT DIV. `® 16 rr ______ r PROTECTIVE INSPECTION SEC. 1 1 �••'1 CITY HALL FRIDLEY 55432 ,'J NUMBER REV. DATE PAGE OF APPROVED BY L•"• 812-580-3450 910-F15 4/12/74 JOB ADDRESS 5643 North Danube Road N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 T1 Innsbruck North SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Robert Olson 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Springfield Homes Inc. 3713 Foss Road N.E. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. B USE OF BUILDING Residential 7 CLASS OF WORK ,q NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 60' x 31 & 32' Dwelling and a 30' x 24' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Hold walkout at least 4.5 feet above sotrm sewer inlet on Lot 2, Block 1. Provide a hard surface driveway. Provide a verifying survey before capping. SEWER: Stubbed to property line. Located 0 + 29' South of Manhole (Measured along sewer main) WATER: Located 54.0' south of manhole on property line. (Direct measure) Top of Footing: 949.0' Manhole Invert: 944.88' WIIRINGII SEPERATE PERMITS REQUIRED FOR PLUMBING AND SIGNS. HEATING, 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 CONSTRUCTIONtM Frame— 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 R-1 1960 45,060 Tot ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. $40,641 20.32 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION R THE PERFORMANCE OF CONSTRUC ION. PLAN CH CK FEE TOTAL FEE Z"� $404.32 SIG ONTRACTORORAUTHORIZED AGENT (DATE) WHEN VALIDATED THIS IS YOUR PERMIT /PROPERLY BLDG INSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) Land Planning /� /� Highway 6875No. 65 N E. � Land Surveying Minneapolis, Soils Testing %J1 I�IPPI[jlrf r9y1('. Minn. ssas2 Civil Engineering ( Telephone 784-6066 Municipal Engineering Engineers. & Surveyors Area Code 612 Certificate of Survey for SPR/lya'Cl o Alomis NORTH O-eno}es Ufdi}y Eo-.ernp-4 Bear4s shown, are assumed o Denote- tti:�vn m1onume.nr 1 fC :c,+tgtr�Cr�Jri tJT CCrrIV5 I'MI rJ A@ nt), f . BLOCK 1 INNSBRUCKNORIN 1 hereby certify that this is a true and correct representation of a survey of the boundaries of the above described land, and of the location of all buildings, thereon, and all visible encroachments, if any, from or on said land. As surveyed by me this day of MQ A.D. 191. r1 SUBURBAN ENGINEERING, INC. 5 ca i e : 1 inch - /� O �, �Q} Engineers Su� ors TQ �e7`,f-) .0 v co'�-T�,O � </, ®' �'rr�ca`''•.- .�%/CC�-sc ��%�-�C,i APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME: Q'� I01SO per.- BUILDER: e° C, ADDRESS: ADDRESS: -3 113 6 s S 1 Off• • NO :.STREET : 9Z LOT: BLOCK 7� ADDITION : gyp l! S fI R �!' C k Z)Ok �' f'� CORNER LOT: INSIDE LOT: L/ SETBACK: SIDE -YARD: ! , d s 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: 4::Pe2 Depth: Height: - Square Feet: v Cubic Feet:� -Front: Depth ° a Height: 4 , Square Feet; if •Cubic Feet: Type of Construction: 1 41 2., Estimated Cost:_ $ 6®":�®� s To Be Completed: The undersigned hereby makes application for a permit for the work herein 001 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: 6� �G SIGNATURE: .(See Reverse Side For Additional Information.)` up Air ai akcj Spas =d Doyle GTRAtPTTT WARM AM: RATE TOTAL Flurnace Shell & Duct Work ... ... 410.00 � Replacement of Furnace 6.00 $— Repairs & Alterations—up to $500.00 6,00 $ Repairs & Alterations each add. $500.00 300 EECDL WA1 W AM Furnace Shell & Duct Work to 120,000 BTU ... ..$10.00/0 , U each add. 60,000 BTU . ......... 3.00 $ 3. e) C� Replacement of Furnace 6.00 Repairs & Alterations—up to $500.00 6.00 $ Repairs & Alterations each add. $500.00 3.00 $ STEAM ax HOT WATER SYSTEM Furnace Shell do Lines—to 400 sq. ft. FZR Steam $10.00 $ Furnace Shell & Linn- to 640 sq. ft. EDR Hot Water I0.00 $, Each add 200 sq. ft. EDR Steam 3.0(1 $ 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 109,000 BTU) 5.00 $_ MW 199,000 RM Sae Fee Schedule GAS t ITI-ING FEE3: NO RATE TOTAL 1st 3 Fixtures X$ 200 $ 07.. � 0 Additional Fixtures x .76 $_ _ Gas Range W MOW E$ 5.00` 5 ��K s « w • t '2 �i1� ..fir:, r V: e State Surcharge .OJ ice. Fee sebadmie TOTAL lei 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 Ordinance¢ and ruling of the Department of Buildings, and hereby declares that an the fad and representations stated in this application are true a 9 correct. Owner . Kind of Building �'L & o Used as C To be completed about. 6n Estimated Cost, $ Old ew. Building Permit No. _— Permit OA or WORK HEATING or PO team clot Water Warm No Trade Name Sias NO Capacity -92 -Sin- USq. Ft E.D.R BTU Total Connected Load li;ind o$ met Gam' BURNER — Trade Name Sim No Capacity S. Ft EDA- 7 wp eaKS—a 560-3450 Cit�f ® rdle ANOKA COUNTY 6431 UNIVERSITY AVENUE NE November 19, 1974 FRIDLEY, MINNESOTA 55432 0. B. Thompson Electric 12201 Minnetonka Boulevard Minnetonka, Minnesota 55343 Re: Electrical Work at 5643 North Danube Road N.E. Dear Sirs: I noted at the above address that the outside receptacles are without ground fault protection. This situation has to be corrected immediately. Please contact me after this has been corrected. Thank you, LEONARD EICHMILLER Electrical Inspector LE/mh SE HEATING TEST RECORD ADDRESS l--;*, APT. FLOOR— CITY URB OCCUPANT OWNER HEAT LOSS DATE HTG. INST. GAS CO. METER BADG-9 # SOLD BY INSTALLED BY Electrical Work By Gas Line By TYPE OF HEAT G HW STEAM— SPACE HTR. UNIT HTR. OTHER DESIGN CONVERSION ., ///!�L!�" a _\�•T��IA� Serial QV'7JL [JU®O,7 Max. BTU Rating INPUT /_ A3" ' MAKE OF FURNACE Model CONTROLS e v THERMOSTATT � Heat Plug Vent Size Valve KIND OF LINE SIZE NONE Limit Draft Hood Regulator Limit Setting d Filters Size Number 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, Door Pressure lighting Inst. Pressure %3 ° Percent CO2 Date Tested Input CFH /Zc4 Percent 02 Company Testing Stack Temp Percent CO Name of Tester I� SUBJECT RM City of Fridley 41167 AT THE TOP OF THE TWINS BUILDING PERMIT i RECEIPT NO. COMMUNITY DEVELOPMENT DIV. Tr ------ r PROTECTIVE INSPECTION SEC. 1 1 ---'tCITY HALL FRIDLEY 55432 i NUMBER REV DATE PAGE Of APPROVED BY .--- L 612-571-3450 910-F15 12/2/91 / / JOB ADDRESS 5643 North Danube Road NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 Innsbruck North.. Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE X=XRNU1XnX Tim Redfield 5643 North Danube Road NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Old Town Cedar 6518 Walker St, St Louis Park 55426 9253338 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. B USE OF BUILDING Dwelling 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof (42 Squares) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with.State Building Code, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 80 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. 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS 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 $2,200 $1.10 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $54.00 Fire SC $2.20, STRUCT) OR THE PERFORMANCE OF C NSTRUCTION. PLAN CHECK FEE TOTAL FEE b 7.30 SIGNATURE 9PCONTRACTOR OR AUTHORIZED AGENT IDATEI AL=LMA ED IS IS YOUR PERMIT G iNSP FIAT SiGNATURE OF OWNER OF OWNER BUILDER) (DATE) I� NEW ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: TG > No rfi� �a /l Uh -f �, ,i Effective 1/1/91 Legal Description: / o ! 3, - /, A I , IrL� ,q 7 ilk - Owner Name & Address: %`/M /� -e W // -e /W Tel. # Contractor: O/d 7Lo w M C-eWA i Tel. # Address: 63-18 w4/K� P S JL I/- to ti15 App 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: Width` Hgt/Ground Sq. Ft. OTHER: �� � � ' Q sg z S % e, li Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: R60 � 14 -ChM c < Estimated Cost: $ Approx. Completion Date: 12 9/ C;?00 (Cb. a .yet) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 2Al APPLICANT: Tel. # 5 S -Z/ d 6, Permit Fee $ fps Fire Surcharge $ ,--), ) << (p e State Surcharge $ /,/0 SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ Fee Schedule on Reverse Side .001 of Permit Valuation (1/10di%) $:50/$1,000 Valuation $650 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 5-1)-30 TOTAL $ MU J STIPULATIONS: J�-�W Sulliky IT NO--- City of Fridley 6 12 2 4 4 AT THE TOP OF THE TWINS BUILDING PERMIT -1 ` ___ v COMMUNITY DEVELOPMENT DIV. 67 ®3N ME R/E O. r PROTECTIVE INSPECTION SEC, �CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF A0PROVEO By 'j L 612-571-3450 910-FlS 10/12/01 10B ADDRESS 5643 North Danube Road NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 1 Innsbruck North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tim Redfield 5643 North Danube Rd NE 763-571-2916 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Hossnpat Construction 18105 31 Ave N, Plymouth, MN 55447 763-475-1872 20004336 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ADDITION Cl ALTERATION O REPAIR O MOVE O REMOVE B DESCRIBE WORK Construct a 32' x 8' and 16' x 8' Deck; Remove existing deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. SEPARATE PERMITS REQUIRED FOR: G WIRING, HEATING Before digging call for PLUMBING AND SIGNS all utility locations 454-0002 REQUIRED BY LAW 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $5,632 $2.82 DOES NOT PRESUME TO E AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVIOF NY H STATE OR LOCAL L W REGULATING CON- SIOSTR $125.25 Fire SC $5.63 CT N OR T E R RMANCE OF CONST TION ll PLAN CHECK FEE FEE Lice SC $5 00 7Tr4L 138.70 S�GNATURF ICON' A OR AUTHORIZED AGENT IDAT f HE VALIAT D THIS ISSYYOUR PPERMIITS.GNATURE 4PRLY a B G INMATE OF OWNER. -r OWNER BUILDER, I.AM NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name & Address: Contractor: Effective 1/1/2001 (763) 572-3604 Bldg Insp �&Ve Tel. # 7/43 6`71-�c1/� MN LICE=NSE # Z L, - Tel.# Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length GARAGE AREA: Length DESCRIPTION OF IMPROVEMENT Width Height Sq. Ft. Width Height DECK AREA: Length 3 Width_ Hgt/Ground OTHER: N /la 8 Construction Type: 000d Estimated Cost: 9 Sq. Ft. Sq. Ft. CC' 10 6v 6 Driveway Curb Cut Width Needed: Ft. - Ft x $ _ $ DATE:©r 16'3 APPLICA Tel.#R; Stl���� CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $_ Fee Schedule on Reverse Side Fire Surcharge $ .57,c3 .001 of Permit Valuation (1/10th%) State Surcharge $ *.8Z $.50/$1,000 Valuation SAC Charge $ $1150 per SAC Unit License Surcharge $ 6:,o o $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 $ / . 70 STIPULATIONS: S �-A43 AJO . Df-)MLA,6L el), Land Planning s{`�tf l �7? 6875 Highway No. 65 N. E. Land Surveyingt) ' 'y (n Minneapolis, Soils Testing L�tuZPplIi%i>�i(�1 P /Z�e Minn. 55432 Civil Engineering ll Telephone 784-6066 Municipal Engineering Engineers & Surveyors Area Code 612 Mortgage Loan Survey for SPONGRILD BIOMES kp4mbe, igla Uc� North. i Innsbr' hof 3'g�o�k I � lin! or Nor00,1irl1 / 14 049 Souih line o�'[01 -i, Sleek t, lnnsbrwe� MOM South line of the northerly 4. 01eel 00", Block 1, lnnsbrurk 41"ll I O ,L of.?, 8/00% 1 and the norfhQr/ ¢. o1?et, ar measured LS o/aq the front andrear /lnes /hereof; o[Zol �, 81K 1, t?///n Innsbruck NoM, Ano%a Counfy, MiMUoto. UJIel g.� to easements ol'record, If any. This is a true and correct representation of a survey of the boundaries of the land above described and of the location ofall buildings, if any, thereon, and all visible .encroachments, if any, from or on said land. This survey is made only in connection with a mortgage loan now being placed on the property and no liability is assumed except to the holder of such mortgage or any other interest acquired by the reason of such mortgage. It is understood and agreed _nay monumep .tis _�have been lac d for the purpose of establishing lot lines or boundary corners, Dated this2"do; of�A. D. 1957 SUBURBAN ENGINEERING, INC. 8 0 � Ingin s S s S�Oak:ineh=30 a inIs 10 A 11 �� t P Nye G O 11 I 10 14 049 Souih line o�'[01 -i, Sleek t, lnnsbrwe� MOM South line of the northerly 4. 01eel 00", Block 1, lnnsbrurk 41"ll I O ,L of.?, 8/00% 1 and the norfhQr/ ¢. o1?et, ar measured LS o/aq the front andrear /lnes /hereof; o[Zol �, 81K 1, t?///n Innsbruck NoM, Ano%a Counfy, MiMUoto. UJIel g.� to easements ol'record, If any. This is a true and correct representation of a survey of the boundaries of the land above described and of the location ofall buildings, if any, thereon, and all visible .encroachments, if any, from or on said land. This survey is made only in connection with a mortgage loan now being placed on the property and no liability is assumed except to the holder of such mortgage or any other interest acquired by the reason of such mortgage. It is understood and agreed _nay monumep .tis _�have been lac d for the purpose of establishing lot lines or boundary corners, Dated this2"do; of�A. D. 1957 SUBURBAN ENGINEERING, INC. 8 0 � Ingin s S s S�Oak:ineh=30 a inIs CITY OF FRIDLEY INSPECTION DIViSION L:ifective January 1, 2003 64ZI 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 �—/ '1 JOB ADDRESS > ; q 3 �d 197W P13A%Ul-5.0- 6 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 Rate TOTAL $ 30.00 $-3-0-110-0 $ 10.00 $ $ 10.00 $ 10.00 *Air Conditioning - All Sizes $ 25.00 e5A-c t-R.�.� -M�� t-rC. t asdv All Others/Repairs & Alterations (LIST ON B)CK) 1% of Value of Appliance or Work 944ebV 3XXF-v Commercial/Industrial 1.25% of Value of Appliance or Work 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 Witten permission from adjoining property owner. $ .50 OWNER_/ / M I"'yd l ZZ19 BUILDING USED AS ©W"LkYdn ESTIMATED COST PERMIT N0. 15 &o 7 I DESCRIPTION OF FURNACE AND OR BURNER No. of Heating U its l Circle One (Steam) (Hot Water) arm Air Trade Name Size No. A BTU HP EDR Fuel Total Connected Load Burner Trade Name Size No. BTU I HP EDR /2lf�f" 3 `/L 7-��v 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 correct. DATE HEATING CO 41444 r Signed TELft 4/0-�-75�-�l� T FAX # Approved By. Rough In Date Final Date `' �•, FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 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 bystem 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 No( ) C� When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specifications. Yes No ( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes ( No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes ( No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type G 2 BTU Input✓7� ,OOO Fan Assisted or Nat Appliance #2 Type IkeOTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type it Vent Height 20 Diameter '7r/ 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: 4IJZ44 t e Signed By: Date': City of Fridley Building Inspections Dept. 6431 University Ave NE Fridley MN 55432 Ph: 763-572-3604 FAX: 763-571-1287 Mechanical Permit# Residential Application City of Fridley See Back Side For Required Information Date —0Address: 543ybxtf� blgtaeo- The applicant is: (cirice one) Owner mantra S� Property Owner: Address: City: AJUJJA State: zip: 3 L Phone: Cell: Fax: Contractor Information Company Name: et Contact Person: • -0 Address: 829U City: Main St. N.E., SU It 319 IF Fri fie. Zip: Phone: qg3p :19g Fax (763) 754-2909 Fax: Email: MN Bond# & Exp Date Type of Work (circle one): New Replacement <6Nmodel Detailed D cnption of work: 61 Equipment Installed: MFG4ZNes27rModel .Wag ze/BTU: MFG: Model: Size/BTU: MFG: Model: Size/BTU: Please check all that apply: fireplace (gas) $15.00 New Gas Grill $10.00 _A/C $25.00 _Fireplace (wood) $35.00 _Gas Unit HTR $10.00 _Air to Air exchanger $15.00 _Furnace $35.00 _Pool Heater $35.00 _Boiler $35.00 _Gas Dryer $10.00 Ventilator $15.00 _Chimney Liner $10.00 was Piping $10:00 Duct Work $10.00 Gas Range/Oven $10.00 Permit Fee $ (Total from above -Minimum fee $35.00) Surcharge $ 0.50 Total Due $ 3 S0 Make check payable to City of Fridley 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 be in accordance with the approved plan In case of all work which requires review and approval of plans. Signature of Applicant: 66� &a Date: Approval Inspector Signature: Date: Please Note: Separate permits are required for Building, Plumbing, and Electrical work Revised 6/14/2005