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PRE 2010 DOCSCOMMUNITY DEVELOPMENT DIVISION CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NORTHEAST Name Current Occugant Address 1242 Norton Avenue N.E. FRIDLEY, MINNESOTA.55432 . NOTICE OF NON-COMPLIANCE Date July 30, 1979 Date & Time of Inspection July 301 1979 11:00 AM i An inspection by this Department has indicated that you are in non-compliance with the following checked (x) sections of Chapter 113, Refuse Disposal, of the City Code. You are hereby notified to take whatever action is necessary to correct any violations on or before August 13, 1979 Failure to comply with this notice may result in legal action by the City Prosecutor. ( X ) 113.02 Provide sufficient containers for the storage of all refuse (including garbage) accumulated on the premises between collections. ( X ) 113.02 All refuse containers shall be water tight, have a tight fitting lid, be impervious to insects, rodents, vermin, and absorption of moisture, be fireproof, and not exceed 30 gallons in size (unless otherwise specifically authorized). ( X ) 113.02 All refuse shall be stored in approved containers, with the cover in place. ( ) 113.08 Containers shall not be placed or maintained as to interfere with the use of adjoining property. For the purposes of collection only, the containers may be placed a maximum of 3 feet in front - of the dwelling unit. ( X ) 113.07 The contents of storage containers shall be collected at least once every week, or more frequently if necessary. ( ) 113.09 Containers without covers, in poor repair, corroded, or otherwise defective shall be repaired or replaced. ( X ) Other Immediately discontinue the practice of storing garbage in plastic bags. Provide 30 gallon metal containers with covers to store garbage inside between weekly collection. If you have any questions concerning this matter, please feel free to call on -us at 571-3450, extension 164. CC: Donovan Elias 7390 Concerto Curve N.E. By: _ 10. Inspec ion Department STEVEN J. OLSON Environmental Officer N •- CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS; OR REPAIRS) ►r1 M OWtJBR: BUILDER: Address: Address: zw Tel. No. Z �zel i No.: Street: LOT: BLOCK: ADDITION:�CG�G/%�✓� ��c.e- i � 'r 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: �-t� Front: Depth: Height: G Square Feet: 1,3'1 (P Cubic Feet: J6,U �A Front: Depth: � Height: /Q Square Feet: Cubic Feet: L9' � a •S/� /SO Type of Construction: L0036 Estimated Cost: $ To Be Completed: 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 additi nal information. DATE: 4/�,Zz z SIGNATURE: Stipulations: 9CV*%;V c .. P.C. % 5jft!W z 4S z m� III,,)n M. 4q Z31SOR JEC* ®n �8.vb /, 6 83 - ?8 CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR, CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE Furnace Shell & Duct Work $12.00 Replacement of Furnace 7.00 Repairs & Alterations -up to $500.00 7.00 Repairs & Alterations each add. $500.00 4.00 MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU $12.00 each add. 50,000 BTU 4.00 *Replacement of Furnace 7.00 Repairs & Alterations -up to $500.00 7.00 Repairs & Alterations each add. $500.00 4.00 STEAM OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU $12.00 each addn. 50,000 BTU 4.00 Boiler only up to 100,000 BTU 7.00 each addn. 50,000 BTU 6.00 OIL BURNER- to 3 gal. per hour $10.00 each add. 3 gal. per hour 10.00 GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 (over 199,999 BTU see Fee Schedule) GAS FITTING FEES: lst 3 Fixtures x $ 3.00 Additional Fixtures x $ 1.00 Gas Range to 199,000 BTU X $10.00 AIR CONDITIONING FAN HEATING SYSTEMS See Fee Schedule VENTILATING SYSTEMS ALTERATIONS & REPAIRS State Surcharge TOTAL FEE �k Job Address /;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, Minn. � , Jam�" , 19 OWNER 4W 4 KIND OF BUILDING USED ASv� TO BE COMPLETED ABOUT ESTIMATED COST U OLD NEW BUILDING E IT NO. $, A1� ad $ $ $ .50 .':RQ. f® PERMIT NO. r�C92 DESCRI?TION OF FURNACE/BURNER HEATING or POWER , Steam, Hot Water, Warm Air- No. Trade :dame Size No. ���.. � �✓ —r Capacity / Sq. Ft. EDA BTU RI HP Total Connected Load / (j Kind of Fuel _ BURNER - Trade Name Size No. ROUGH INSP. REINSPECTION FEE Capacity Sq. Ft. EDR BTU HP Date ($10.00) FINAL INSP. �� — ® Company 1 Date �� � _ Signed By � APPROVAL FOR PERMIT�'_-�-�— Tel. No. MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE *Attached stack verification for 0- CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Job Address _A �® — � z4 yt 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 OWNER KIND OF BUILDING USED AS Fridley, Mn. / r / , 19 1-1% % TO BE COMPLETED ABOUT PARTIAL RATE to o as Water ESTIMATED COST PLUMBING FIXTURE RATES: NO. RATE TOTAL OLD BUILDING PERMIT NO. PERMIT NO. ` J� Number Fixtures 1p S $3.00 4j 04 Future Fixture Opening x Heater $ ani ro r� $2.00 $ 3 4 o c Signed By Catch Basin x $5.00 $ Sa a) O x N 5°�' C. a N •ri 0 O S .ci $ Water Softener x $7.00 m -4 N ro ry -I ro W o c r+ rd ro g ro ro $ Date "as to U p M Rl m 3 0 W to W U W 3 C7 $/ ' Date O lec $1.00 $ Gas Range to 199,000 BTU x $x:0.00 $ APPROVAL FOR PERMITko�" 1st 02 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water Job Address _A �® — � z4 yt 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 OWNER KIND OF BUILDING USED AS Fridley, Mn. / r / , 19 1-1% % REPAIRS & ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE State Surcharge $ .50 TOTAL FEE $ NFTN Vtr—rTnN rm" _ ($10.00) TO BE COMPLETED ABOUT PARTIAL RATE SCHEDULE ESTIMATED COST PLUMBING FIXTURE RATES: NO. RATE TOTAL OLD BUILDING PERMIT NO. PERMIT NO. ` J� Number Fixtures 1p x $3.00 $ Sq. b Future Fixture Opening x $2.00 $ Company New Fixture, Old Opening x $2.00 $ Signed By Catch Basin x $5.00 $ Water Heater - to 99,000 BTU�- x $5.00 $ /0-00 Tel. No.7 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ New Ground Run Old Building x $5.00 $ ROUGH INSP. Electric Water Heater x $5.00 $ Date GAS FITTING FEES: FINAL INSP. /—/Io- 1st 3 fixtures / x $3,00 $/ ' Date Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $x:0.00 $ APPROVAL FOR PERMITko�" REPAIRS & ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE State Surcharge $ .50 TOTAL FEE $ NFTN Vtr—rTnN rm" _ ($10.00) City of Fridley SUBJECTMIT ®1506 AT THE TOP OF THE TWINS BUILDING PERMIT ` RECEIPT NO. `L------ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. ry Soo 1 % NUMBER REV. DATE PAGE OF APPROVED BY = CITY HALL FRIDLEY 55432 �•�" ,•3 612-560-3450 910-F15 'JOB ADDRESS 1240-42 Norton Avenue N.E. 1 LEGAL LOT NO, BLOCK TR ACT OR ADDITION SEE ATTACHED DESCR. 5 1 SHEET 2 PROPERTY OWNER MAIL ADDRESS Martinson Builders 9131 - 6th St- N-F- Mp1q-, MN ZIP PHONE 7Afi-1599 3 CONTRACTOR MAILADDRESS Samp ZIP PHONE LICENSE NO. 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 �(7 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 46' x 26' duplex ' garagem 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side yards. UTILITIES WERE PUT IN BY PRIVATE CONTRACT. NO AS-BUILTS AVAILABLE AT THIS TIME. CONTACT DEVELOPER FOR LOCATIONS. (Sanitary Sewer Main Charge: $48.00) SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD 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 1346 + 672 32.440 total 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. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $47,145 123-98 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 OPTHE P RMANCE OF CONSTRUCTIO $129.76 ig5f)-nn s`"�¢ _ PLAN CHECK FEE TOTAL FEE SIGNATURE OF CONTRACT&S ORA, THORIZED AGENT (DATEI WHE PROPER LI ED IS IS YOUR PERMIT AJ SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) 6 LOG INSP PATE �. CITY OF FRIDLEY APPLICATION FOR RLSI ENTIAL BUILDING PEW41Ta • (NEW, ALTLRATIns, ADDITIONS, OR REPAIRS) 13UILDEIt: OWNER: >�► Address: Address: Tel. No.: No. Street: LOT: BLOdK: ADDITION: 4 COMER LOT: INSIDE TAT: SETBACK: SIDL'YARDS: . Applicart attach '-to this form Too Certificates of Survey of Lot and proposed '4• building location drwan on these Certificates. DESCRIPTION OF BUILDING To Be Used As: •• Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: Estimated Cost: $ To Be Completed: Alt. A Alt. B Proposed Driveway Width If New Opening is Desired $ (SEE 11EVERSE 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 Dcpartment of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. See reverse side for-joat' informatio DATE: SIGNATURE: 0-1 Stipulations: ' rug ► �� 1 t�. '� 6 pw*,Aj CL -J%.. wy s•u... -,c -L'S.a • SAS.+ 1240 N 04aw ZGx 4c® = 11 tti w x S = 9140 umv. Lso%t' 26x 4 r- 1144 / 3q L d.v i i z 14, ISZo C" -Ar, 2 fX 28 • 4 to 4012o C. 3Z, yqd I I% I(A-s Gam.- x �• w PCS41 r 37.1 4qo PLAO, 5 AO. - 41 1n k �l,�d /ouv = �I let 7L Kse ® UwUwwAM 1- Mill ww wee N. M %L SbOJ? .i6 SIU ® ?1 O r • r r.r i Nn.nr,!►:� !ni,nrr•,n(e i�ri lnhy IawA ti,,••w •n0 lend I9inrYry I!VI( J. i.•� M.o•... , ow u 55!.11 Q. A 11 Certificate of Survey for /79rl� ILDWS 440 NORTON AVENUE 7o nn NORTH gCcl/e40' C tt rA An �yrVV 00enotes Iron monument LOT 5 BLOCK /9 Denotes Drainage t Uti It ty Easement NO J? TO N A V�. HOM FSI TES ANOKA COUNTY • r 7. 1 hereby certify that this is a true and correct representation of a survey of the boundaries of the above ( described food, and of the location .fit a+l) buildiw st thereon, and all visjlbio eacreochnfootst if any, free" ar as said hod. As surveyed by ewe lhis.4 day N A '-F _A. 0. 112. SUBURBAN iNGINKIRING, INC. d h6a4l011-bllfhed. An qtgl.ts_fiswwed M2l suB.lEcr P NO. City of Fridley 2772 2 7 7 2 4 AT THE TOP OF THE TWINS BUILDING PERMIT i RECEIPT NO. ______ COMMUNITY DEVELOPMENT DIV. 1 v - PROTECTIVE INSPECTION SEC. r NUMBER REV DATE 9/11/98 PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 JOB ADDRESS 1240-42 Norton Ave NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 1 Norton AVenue Homesites SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Elias 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. uarve Contracting Inc 8427 Center Dr7R5-1472 6016 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 ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ .REMOVE 8 DESCRIBE WORK gxx�x x C g )Cx I_YM Reroof duplex (28SQ) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 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 $2, 399.60 $1.20 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- $ 74.75 Fire SC $2.40 TRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL F E Licens C $5.0 $83.35 SIGNATURE OFC NTRACTOR R AUTHORIZED AGENT IDATEI N OPE LIDAT IS I 3 Y R PERMIT BL09FINSP �S GATE SIGNATURE OF OWNERIIF OWNER BUILDERI IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: 161 'k) •- 4/1 AJ0421 All'( - Legal Description: Owner Name & Address: 61 / /�5 Tel. # Contractor: n 1l eU &� N UAW D lU6 I AUC MN LICENSE # 6- 0l �9 Address: c �a�`l C.�f1 WL, —(-)� AJ& Tel. # �lS`�`/g7Q- Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EWPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: ZI/ ef, 7Z) Construction Type: IPS Ire - roo( Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: Ql'lI-G% APPLICANT: , Tel. # 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 (1/10th%) $.50/$1,000 Valuation $1000 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 [ ] $ iA63 � ' 3 r M& FANS 91at6 VA '�-ITY OF FRIDLEY INSPECTION DIVISION 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Effective On January 1, 1999 JOB ADDRESS___ 12 r' 0.1Y y RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner — rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 30.00 $�,1� representations stated in this application are true and correct. (Side Vent — Fill Out Back) ,1998 Gas Piping (Needed with new fumace, $10.00 $ J but not replacement) OWNER I Gas Range $10.00 $ BUILDING USED AS Gas Dryer $10.00 $ ESTIMATED COST ��p(®> PERMIT NO. /380 *Air Conditioning — All Sizes $ 25.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (UST ON BACK) 1 % of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water) arm Air) Trade Name F,ASize No.- Commercial/Industrial BTU IS , HP EDR 1.25% of Value of Appliance or Work $ Fuel QA4-6k4 Total Connected Load State Surcharge $ .50 Burner Trade Name Size No. BTU HP TD TOTAL FEE $ HEATING COMPANY �`Yk ` , MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed By PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr Approved By 16 Rough—In Date __ Final Dat e � , *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOR STA VERIFICATION ON REPLACEMENT FURNACE written permission from adjoining property owner. CHEYMY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1: Has been carefully examined Yes (,�No ( ) 2. Is free from rust or deterioration Yes (t�'No ( ) 3. Has no foreign objects lodged within Yes (No ( ) 4. Is securely supported Yes No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes j No ( ) 6 Has total heating BTU's of 0 All other BTU's u G ® o TOTAL BTU's 7. Has a liner been provided for water heater Yes (6f -'No ( ) 8. Has combustion air been provided for water heater YesNo ( ) Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: r- IAOO- FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 March 23, 2001 Don Elias 1242 Norton Avenue NE Fridley, MN 55432 Re: Final Inspection at 1242 Norton Avenue NE Contractor: Dependable Indoor Air Dear Mr. Elias: A mechanical permit was issued on September 3, 1999 for the installation of a furnace at your address. According to Section 305(a) of the 1991 Uniform Mechanical Code, a final inspection shall be performed on the mechanical permit. As of this date no inspection has been called for. The permit fee that was paid covers the inspector's time to check to make sure the appliance was installed correctly. We also check to make sure combustion air has been installed and that the vent and vent connectors have been sized properly. If you would like the installation inspected, please contact us within 30 days to arrange the inspection. If we do not hear from you we will expire the permit and note that no inspection were called for. Any questions can be addressed to myself at (763) 572-3603. Sincerely, DAVE,lNSEN Build Od Inspector DJ/mh TY OF FRIDLEY BUILDING INSPECTION 31 University Ave NE dley, MN 55432 3-572-3604 FAX 763-571-1287 RATE SCHEDULE ,sidential rnace Shell and Duct Work, Burner & ;o Replacement Furnace is Piping (New Furnace, Fireplace, Insert) I_dAv- is Range ;s Dryer tir Conditioning - All Sizes Other Repairs or Alterations (List on Back) 0 of Value of Appliance or Work inimum Fee $15.00 for Residential or 5% of cost of iprovement whichever is greater Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS 1,2"t® / V9.46filA92ge Z7. Fe Total Owner $35.00 $�`nb Building Used As &ryja�_ $10.00 $_1!21_�C>0 ESTIMATED COST 1 � `� PERMIT NO $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating nits —f Circle One (Steam) (Hot Water Warm Trade Name 4L—% - -rO Size No $25.00 $ BTU t3 HP EDR Fuel Total Connected Load Zmmercial/Industrial/institutional 25% of Value of Appliance or Work (List on Back) inimum Fee $35.00 for Commercial/Industrial/institutional $ Burner Trade Name Size No. BTU HP EDR The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes $ and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. State Surcharge $ �D TOTAL FEE $ _INSPECTION FEE $50.00/HOUR 60 air Conditioners can not be placed in side yard without written approval am adjoining property owner - copy to City ILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE HEATING CO 1 Signed Tel 7� Date '% 18t 1 Approved by Rough -in Date Final Date 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 jq No ( ) The existing combustion air is sized and installed to meet the current codes BTU Input Fan Assisted or Nat and manufacturer's specifications. Yes No( } When required to install a new combustion air, it will be sized and installed BTU Input Fan Assisted or Nat to meet the current codes and manufacturer's specifications. Yes No ( ) When installing a new venting system, the undersigned hereby verifies that Vent Height Diameter inches it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. YesjQ) 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 SizelCommon 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 Y�w A I Y1G�L-� II�PLZGC@ ZG� i HEATING CO: Signed Date