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PRE 2010 DOCSSUBJECT PE NO. City of Fridley 14524 AT THE TOP OF THE TWINS BUILDING PERMIT/' r ECEIPT NO. • COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-560-3450 910-F15 12/16/77 JOB ADDRESS 1425 North Innsbruck Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 2 Innsbruck North SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE DaVerne Corporation 2200 Silver Lake Road 631-1213 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 CX NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 68' x 28' Dwelling and a 19'2" x 264" Garage 9 CHANGE OF USE FROM TO STIPULATIONS Side yard setback must be exactly 11' and 25' to fit house on lot. Provide combustion air to the furnace area or 1i diameter flue vent into cold air return. Provide truss design before capping. Expose and mark all lot irons before calling for a footing inspection. Provide sod in the front and side yards. Provide a verifying] survey before capping. Provide a hard surface driveway. SERVICES OFF NORTH INNSBRUCK DRIVE. SEWER (Approx. 12.5' Deep In Street) 92' E. of Manhole (Inv. 952.65) WYE ELEV: 953.28 TOP OF FOOTING: 956.78 Minimum WATER: Approx. 10' E. of Sewer Service DRIVEWAY DEPRESSION COST: N/A Existing Surmountable Curbing TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame 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 R-1 1904 + 572 32,800+4576 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, $60,980 $30.49 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 R LOCAL LAW REGULATING CON- $ 149.50 $375.00 STRUCTI R THE PE ORM CE CONSTRUCTION. PLAN CHECK FEE TOTALFEE A ��i �7 7.38 $592.37 SIGNATURE OF CONT ACTOR RAUTHORIZEDAGENT / ATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT /A, "QWLMG3b�`</ 4-2 eZ 12 BLDG INSP DAr E SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI ...4 CITY OF FRIDLFY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) IIWO l OWNER: BUILDER: Q CJS%�1n�9-- Address: Address: as b U Tel. No. No.. /yrs LOT: ' 9 Street: / % a7A)A,5 ,4"Ar, 214, BLOCK: ADDITION: l�yK 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: �-�-� Front: 6 g Depth: ,=* 9 Height: � Z7 Square Feet: Q Cubic Feet: JZZ 9d6 e Front: Z9 Depth: Height: Square Feet: Cubic Feet: je_T Type of Construction: lJ-i Estimated Cost: $ !� To Be Completed: ' l Alt. A ® Alt. Cb Proposed Driveway Width If New Opening Is Desired o? o $ $ (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: 77 SIGNATURE: Stipulations: 7o . /.WU&4r 1e. A-�;''d" �l► �! a/ , �— sig .r •�,zy = z� its, fed, .3®y 9 CITY OF FRIDLEY APPLICATION FOR PWMBING AND GAS FITTING PERMIT el 14 aOp�J 49 v1 p) s+ .ci U IA .¢1 M 0 m M of �p W YG d W >. N H ro m q -4►apt o In W Ip rG N L7 M g '3 W .0 ro m U M vx � g d a 3 W 4 U W • m � c7 ►� O Water Heater as lec Catch Basin x $5.00 $ Water Heater - to 99,000 BTU _� x $5.00 $ 'S --U Q 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ New Ground Run Old Building x 1st $ Electric Water Heater x a $ GAS FITTING FEES: 1st 3 fixtures (_x '$3.00 $ _00 Additional Fixtures x $1.00 $ 2nd x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 S State Surcharge 3rd $ .50 TOTAL FEE $ -1±l.5-b 4th (R) = Future Connection OpeningConnected (*) = New Fixture, Old'Opening with Sewer Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $3.00 $ �� Future Fixture Opening x $2.00 $ New Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU _� x $5.00 $ 'S --U Q 100,000 BTU to 199,000 BTU 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 $ _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 S State Surcharge $ .50 TOTAL FEE $ -1±l.5-b REINSPECTION FEE ($10.00) a � Job Address I q01- �)b'V��JU���� 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 applicat&M are true and cor rPot Fridley, Mn. c;2 , 19 OWNER KIND OF BUILDING USED A TO BE COMPLETED ABOUT I ESTIMATED COST /y OL -NEW BU LDING PERMIT NO. PERMIT NO. Company U I D Signed By c Tel. No. /� ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT i MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.SO STATE SSE 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 66432 TELEPHONE ( 612)671-345() J & E Electric 8881 Syndicate New Brighton, MN 55112 Re: Electrical Wiring Correction at 1425 North Innsbruck Drive N.E. Dear Sirs: An inspection on April 18, 1978 noted the banding jumper around the water meter was visible but the ground clamp was not. Would you please call me about this so a final inspection can be made. Thank you, LEONARD EICHMILLER Electrical Inspector .LE/mh CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE er L,4 / R GRAVITY WARM, AIR: RATE TOTAL Job Address / /`'`p -7, Furnace Shell & Duct Work $12.00 $ Replacement of Furnace 7.00 7.00 $ $ Department of Buildings Repairs & Alterations -up to $500.00 4.00 $ City of Fridley Repairs & Alterations each add. $500.00 Tel. #571-3450 MECHANICAL WAR.I4 AIR: The undersigned hereby makes application for a permit for the work herein Furnace Shell & Duct Work to 100,000 BTU $12.00 $ �,� U specified agreeing to do all work in strict accordance with the City Codes each add. 50,000 BTU 4.00 $ G and rulings of the Department of Buildings, and hereby declares that all the Replacement of Furnace 7.00 $ facts and representations stated in this application are true and correct. Repairs & Alterations -up to $500.00 7.00 $ Repairs & Alterations each add. $500.00 4.00 $ Fridley, Minn. ,,JJ 124 V A /7 lin`- STEAM OR HOT WATER SYSTEM : OWNER Boiler & Lines up to 100,000 BTU $12.00 $ KIND OF BUILDING each addn. 50,000 BTU 4.00 $ Boiler only up to 100,000 BTU 7.00 $ USED AS each addn. 50,000 BTU 6.00 $ TO BE COMPLETED ABOUT OIL BURNER- to 3 gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $ ESTIMATED COST GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $ ,, OLD - NEW BUILDING PERMIT NO. PERMIT NO. (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: 51 G � 1st 3 Fixtures x $ 3.00 $ DESCRIPTION OF FURNACE/BURNER Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00 $ HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. AIR CONDITIONINGy% ^� � $ Size No. a� �, p 17 Trade Name �/� ! FART HEATING SYSTEMS See Fee Schedule VENTILATING SYSTEMS ( $ Capacity � � � �' Sq. Ft. EDR BTU HP ALTERATIONS $ REPAIRS_ State Surcharge $ .50 Jr Total Connected Load �% ` �% Kind of Fuel G� /4 TOTAL FEE BURNER - Trade Name Size No. ROUGIi INSP. REINSPECTION FEE Capacity Sq. Ft. EDR BTU HP DateC$10.00) /� Company 6 L °�� �/� C 0/ [�y T>d�z�� �� �/ FINAL INSP. 'mss -795 Date a Signed By APPROVAL FOR PERMIT Tel. No. MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 rug, y) 7 4( NEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS VILLAGE OF CHAMPLIN Weatherstrips Guide Construction No. Insulation Windows Door Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied eY a=l o�est— a 19— C7 I 1—#k . =Ath ''7 u -:®fit C% n 0 1 Rnnm I Lanolth Width Height Windows and Doors—�Crackage and Ana width Helgbt No. of Lineal ft* ifs. of pane of pane lights of crack Width Height No. of Lineal t . Area No. of pane of pane lights of track q. ft. Z f%G < C -:4© 3 3 s :a a -7 ` 1 •'? . 0 'Y- 3 C Coef. of Coef. Btu Infiltration Coef. Btu Idbration Int. wall 0 Class Exp. wall Net exp. wall Glass a 1 `' () L 0 15 4-1 3 (, Int. wall Int. wall Net up. wall Ceiling S a G Ws wall Floor 2,V60- ZS$ /0 Total Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area FU / / Room I Lmnetll � Width Q' Height Windows and Doors--- rackage and Area width Helgbt No. of Lineal ft* ifs. of pane of pane lights of crack No. of Lineal ft. Area wld l Height a No. of pans of pane lights of track E4.9%. 3 ` 2 G G �CJ Coef.1 Btu Infiltration Coef. of Coef. Btu Infiltration Coef. Btu Idbration Int. wall C Glass Glass 11 6 ®C:/ Exp. wall Int. wall Net up. wall Net ew wall S a G Ws wall lat. wall 2,V60- Ceiling Ceding Floor Floor Told Btu. I � L L) Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Ream I L--nath Width Height Windows and Doors—Craekage and Area width Helgbt No. of Lineal ft* ifs. of pane of pane lights of crack Area q. Its 3 ` G �CJ Coef.1 Btu Infiltration Coef. of Infiltration 'L *5 Coef. Btu Idbration Int. wall 1,50 to L060 Glass 11 6 ®C:/ �p. wall Int. wall Net up. wall Ceiling S a G Ws wall 2,V60- Ceiling Floor TOW Btu. 1114 -1 C% U Required sq. ft. E.D.R. or sq. ins. WA. Leader area Windows and Doors--Crackage and Area Width Height No. of Lineal ft. Ara No. of tune of pone Ilgkte of crack q. N. Width height No. et Lineal tt. Area NO. of pane of pane lights of crack q. ft. I i I Coef.1 Btu Infiltration Coef. Btu Infiltration Exp. wall Net exp. wall Glau Int. wall Ceiling Exp- wag Floor Net exp. wall 3ZL Int. wall Ceiling S a G Floor 2,V60- Total Btu. Required sq. h. E.D.R. or sq. ins. WA. Leader area Fl.l Room I Length Width Height Windows and Doors—rCraekage and Area Width Height No. of Lineal ft. Ara No. of tune of pone Ilgkte of crack q. N. I i I Coef.1 Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. itis. WA. Leader area FLI Ream I Unath Width Height Windows and Doors—Crackage and Area Width Haight No. of Lineal ft. Area No. of psno of pane lights of crack q. ft. I i I Coef.1 Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ias. WA. Leader area BROOKLYN PRINTING a ADV. Co. 8431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 56432 October 23, 1978 Mr. David Ficek DaVerne Corporation 2200 Silver Lake Road New Brighton, MN 55112 TELEPHONE ( 812)571.3450 Re: Final Inspection at 1425 North Innsbruck Drive N.E. Dear Mr. Ficek: A final inspection was made on October 20, 1978 of the above address and the following items were noted which must be completed before the structure can be finaled out; 1. Install ball checks in floor drains by November 10, 1978. 2. Sheetrock all walls in garage by November 10, 1978. 3. Double header over north service door by November 10,•1978. 4. Provide house numbers on structure by November 10, 1978. 5. Owner complains of musty smell in laundry room - provide cover on sump basket by November 10, 1978. We will expect the above items to be completed by November 10, 1978 when a reinspection will be made to determine compliance. If you have any questions on these items, please contact me at 571-3450. Sincerely, G. Community Development Adm. DGC/mh CC: Mr. Rod Johnson 1425 North Innsbruck Drive N.E. SUBJECT PE City of Fridley 2 3 1 1 AT THE TOP OF THE TWINS BUILDING PERMIT f RECEIPT NO. � • ______ COMMUNITY DEVELOPMENT DIV INSPECTION SEC 7 rPROTECTIVE i 6 dJ v i NUMBER REV DATE PAGE OF APPROVED By 1 : CITY HALL FRIDLEY 55432 I'' 612-571-3450 910-F15 11/22/94 JOB ADDRESS 1425 North Innsbruck Dr NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 2 Innsbruck North SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tsuchya 1425 North Innsbruck Drive NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. D & D Home Improvement Inc 7401 Central Ave NE, Fridley 55432 784-7543 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 4840 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Reroof House (24 Sq) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd layer but not the 3rd. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, 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 $1,320 .66 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- STRUCTIO OR THE PERFORMANCE OF CONSTRUCTION $33.00 Fire SC $1.32 PLAN CHECK FEE TOTAL FEE ��� License SC $5.00 39.98 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI WHEN PROPER VALIDATED THIS IS YOURPERMIT P B G INSP )Y",,�� 11-2-2 DATE SIGNATURE OF OWNERoF OWNER BUILDER) IDATEI y' NEW [ ] Effective 1/ 1 /94 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 -�*Lf- Building Permit Application �o Construction Address: �� ���/��C/� b /Z Legal Description: Owner Name & Address: 7 drh U& Tel. 1/ Contractor: D c D Home Improve nt , Inc. MN LICENSE # 4 8 4 0 Address: 7401 Central Avenue NE, Fridley, MN 55432 ,Tel # 784-7543 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: Corner Lot [ ] inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: :�� Estimated Cost: $ /30 Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + Ft = Ft x $ = $ DATE:- I ZZAPPLICANT: Permit Fee $ 33, 66 Fee Schedule on Reverse Side Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control $ / 3-? $ �o $ .001 of Permit Valuation (1 / 10th %) $.50/$1,000 Valuation Tel. # $800 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary ( ] TOTAL STIPULATIONS: :ITY OF FRIDLEY INSPECTION DIV. 431 University Ave NE 'ridley, MN 55432 763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT�� MAKK NUMtShK UI- FIATUKES TO BE INSTALLED ON EACH FLOOR TOTAL JOB ADDRESS 6&A -A& - 0.5, &W tnA.IV- fabt?>< Urinal Shower Tray � Floor Auto. Washer :.-..•>:.... Gas Ran Water Heater Gas Elec Basement : flow Off Basin $1.0.00 and repre!-6-14— -f-hit in thic nnnliration are true and correct. ;atch Basin $10.00 TERZICH, DAN Floor $10.00 1425 INNSBRUCK DRIVE NORTH 7/) 5 20 ;ump/Receiving Tank $10.00 FRIDLEY, MN 55432 Floor (763) 574-0878 Vater Treating Appliance $35.00 OWNER _ Vater Heater -Electric $35.00 FIoor 3 $35.00 1 BUILDING USED AS SI o)evtc-e_ gas Range** $10.00 las Dryer** $10.00 Floor ESTIMATED COST �� PERMIT NO. lack Flow Preventer Required ( )Yes () No 1 'LUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 6&A -A& - 0.5, &W tnA.IV- Jew Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein )Id Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes leer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the fads flow Off Basin $1.0.00 and repre!-6-14— -f-hit in thic nnnliration are true and correct. ;atch Basin $10.00 TERZICH, DAN Iain Water Leader $10.00 1425 INNSBRUCK DRIVE NORTH 7/) 5 20 ;ump/Receiving Tank $10.00 FRIDLEY, MN 55432 (763) 574-0878 Vater Treating Appliance $35.00 OWNER _ Vater Heater -Electric $35.00 Vater Heater - Gas** �_ $35.00 1 BUILDING USED AS SI o)evtc-e_ gas Range** $10.00 las Dryer** $10.00 ESTIMATED COST �� PERMIT NO. lack Flow Preventer Required ( )Yes () No 1 Type $15.00 PLUMBING COMPANY O (_\0k OVA ," t teinspection Fee $50.00/Hr SIGNED BY' TEL N0. (6,12) $27- 033 kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge $ - MINIMUM FEE F R ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST TOTAL FEE $_jE, $_j OF THE IMPROV MENT 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 () 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 ( ) 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 ( ) Apollance 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 Iin Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date: 5 Building Inspections 763-572-3604 DATE t0' SITE ADDRESS J_ THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY E-MAIL ADDRESS ❑ OWNER 1$ON7RACTOR PHONE:—M— - — • ,[&Qf[#Jl ini Received BY: COMPANY NAME: Anderson Heating and Air -Conditioning SUBMIT A COPY OF CONTACT PERSON: 1934AU ` YOUR STATE STATE LICENSE A/ Central Ave N.E. — LICENSE WTTH ADDS: u STATE ZIP W - APPLICATION PHONE 7&--9-/- &L/L/ � Col. Hts, Mn 55421 A PERNUT TYPE 'I SINGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: O NEW XREPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up 6 $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 S300= $15.00. Labor cost between $300 to $500 =cost of labor X.05 = FOR PROJECTS WHERE LABOR EXCEEDS S5CO, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATETOTAL NUMBER OF EACH BELOW) MODEL: SIZEIBTU SIS, CiJ�% Equipment Installed MFG: SIZEIBTU MFG: MODEL: SIZEBTU MFG: MODEL: _ A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 _AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILLAS UNIT HTR $10.00 $10.00 _BOILER $35.00URI�ACE $35.00 _G _CHIMNEY LINER $10.00 _GAS DRYER $10.00 _VEPOOL HEATER $35.00 DUCT WORK $10.00 _GAS PIPING $10.00 _NTILATOR $1500 . �9'i!,'Z4'*;'jCIJ�1,Q".V1vT.r'.i't191\:ayllui::l.;inV,avwwtm xnnuMr ,cscn,,.,.,..rur .-vim,-. --- Permit ___. _ .. 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 z $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surgb.4rge = $ .50 Total = $ THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plah in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT C- Sc!/� PRINT NAME LNI T�e�L7tGrq Lf� DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977