PRE 2010 DOCSCITY OF FRIDLEY
APPLICATION FOR HEATING REPLACEMENT
CHIMNEY AND STACK VERIFICATION
THIS FORM MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM.
LOCATION 6542 Oakley St. N.E. DATE June 14, 1979
OWNER Ron Bloom ADDRESS 6542 Oakley St. N.E.
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined
2. Is free from rust or deterioration
3. No foreign objects are lodoed within
4. That it is securely supported
5. That it meets all current Code requirements
for size and total BTU connected
6. Total Heating BTU 100,000
All Other BTU
TOTAL
REMARKS
HEATING PERMIT #
X
X
X
SIGNED
ce
Licensee
by-N-ortheast Sheet Metal
Address _4347 Central Ave. N.E.
Telephone zgi-9776
Fridley City License 14834
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
Furnace Shell & Duct Work
* Replacement of Furnace
Repairs &. Alterations -up to $500.00
Repairs & Alterations each add. X5500.00
MECHANICAL WARM AIR:
Furnace Shell & Duct Work to 100,000 BTU
each add. 50,000 BTU
*Replace=ent of Furnace
Repairs & Alterations -up to $500.00
Repairs & Alterations each add. $500,00
STFAM OR HOT P AaTER SYSTEM:
Boiler & Lines up to 100,000 BTU
each addn. 50,000 BTU
Boiler only up to 100,000 BTU
each addn. 50,000 BTU
OII. BURNER- to 3 gal. per hour
each add. 3 gal. per hour
RATE
$12,00
7,00
7.00
4.00
$12.00
4.00
7.00
7,00
4.00
$12.00
4.00
7! PQ
A•qp
TOTAL
$7,00"
SlQ.pp S
}p:qq S
GAS BURNER- from 100,000 BTU 1,0 199,jjq STN S}O:qq $
(over 199,999 BTU see Fee Sc}egj4le� S
GAS FITTING FEES:
1st 3 Fixtures _j_ x $ I:qq LL.
A4ditional Fixtures X $ l:Pp $
Gas Range to 199,QQQ BTU q
AIR CONDITIO.NING ao .00
FAX HEATING SYSTEMS See Fee Schedule $
VENTILATING SYSTEMS S
ALTERATIONS $ REPAIRS $
State Surcharge $ .50
TOTAL FEE $20.50
,lob .Address 6542 Og4ley St. N.E.
Department of BRlldfngs
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. June 14 , 19 7 9
OWNER Ron Bloom
KIND PF BUTLDTNG Frame
pSNp AS Residential
Tp pp. cpMp?,ETpR #.ppHT June 14, 1917
FmTTwpip, cpsT 2475.00 /
PR - NM PN}RTNP PTMTT N. FERMTT NO.
RESCRTgTTON AF FURNACE/BURNER
UEATTNP or j?QWPP,F? ]TS1 A#P_Z le #)RI: timer{ Warm A}r- No.
Trade Name Friidrich-Greenbriar Uze No.
capacity
Sq. Ft. RER BTU 1 00 y0()0 UP
Total Connected Load Kind of Fuel na tiiral gas
BURNER - Trade Name
Size No.
ROUGH INSP. REINSPECTION FEE '.Capacity Sq. Ft. EDR BTU HP
Date 010.00)
We are installing furnace to existing ductwork.
FINAL INSP. Company Northpast�Sheet Metal
• Date We are also installing a Freidrich Tempo 24,000 BTU air
/
Signed By
to system.
APPROVAL FOR PERMIT �� Tel. No. 781-9776
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
*Attached stack verification form
SUBJECT
PERMIT NO.
of Fridley
1��-2 2 9 ®1
AT THE TOP OF THE TWINS
BUILDING
PERM1f--�------
Ir?City
RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
1 � PROTECTIVE INSPECTION SEC.
��
r
Y✓
1
NUMBER
REV
GATE
PAGE Of
APPROVED BY
iCITY HALL FRIDLEY 55432
612-571-3450 1910-F15
9/13/94
JOB ADDRESS 6542 Oakley Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
8F
I Second Revised Auditor's Sub. #21 SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Ronald Bloom 6542 Oakley Drive NE
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
MIlton Johnson Co. 525 Lowry Ave NE M ls. MN
781-9548 2083
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
R❑
8 DESCRIBE WORK
Reroof House (13 Squares) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State BUilding Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. FT
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
975
.50
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-
$25.00
Fire SC $.98
TRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
License SC $5.00
$31.48
S IGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI
WHI PR
NSP
%LID A D THI IS YOUR ERMIT 9
DATE
S.GNATURE OF OWNERIIF OWNER BUILDER) IDATEI
NEW [ ] Effective 1/ 1/94
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: 49,6 tea. y 41!2 .
Legal Description:
Owner Name & Address: A,u,4 4A /JLo eq 1.71 Tel. #
Contractor: iyj/L 7a �" �'®,t/ Cfl . MN LICENSE # le �3
Address: :�:,-2 o4o!K- Tel. #
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: �F.19c- - it a,,;=7 Estimated Cost: $ �� 1
Approx. Completion Date: 9 - -2y- 9 y� /
(Cost on Back)
Driveway Curb, Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: 9 -/3 - y c l� APPLICANT: - a.� ` Tel. # '% F / -
CITY USE ONLY
Permit Fee
$ DD
Fee Schedule on Reverse Side
Fire Surcharge
$ 96
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$800 per SAC Unit
License Surcharge
$ 00
$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
STIPULATIONS:
$ 3/. A
CITY OF FRIDLEY INSPECTION DIV. Effective On August 1, 1995
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION_AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS
RATE SCHEDULE
: The undersigned hereby makes application for a permit for the work herein
Residential Rate TOTAL specfied agreeing to do all work in strict accordance with the City Codes and
Furnace Shell and Duct Work, Burner - 00 rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace $ 30.00.• $ ya representations stated in this application are true and correct.
(Side Vent - Fill Out Back) - ,1995
Gas Piping (Needed with new furnace) $10.00
OWNER®� ��Q� �!®6 �' - o
Gas Range $10.00
' •
BUILDING USED AS�,�@��
Gas Dryer $10.00 $
ESTIMATED COST ? Q(0 ®® PERMIT NOJ 3 G
*Air Conditioning - All Sizes $ 25.00 $
DESCRIPTION OF FURNACE AND OR BURbIER
All Others/Repairs & Alterations (UST ON BACK)
I% of Value of Appliance or Work $ No. of l-ieatin Units_ Circle One (Steam) (Hot Water)arm Air)
Trade Name Size No. Gi aA �
Commercial/Industrial BTU HP EDR
1.25% of Value of Appliance or Work $� Fuel —Total Connected Load
State Surcharge X50 Burner'Trade Namecxa'-s f' P.,- Size No. &A\ 0a
BTU ,�C'�C'��t'�p�` HP EDR
TOTAL FEE
HEATING COMPANY C Gc-"'A
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION%-
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Sig No.
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr Approved ByRough-In Date Final Date
*Air Conditioners can not be placed in a side yard without FILL OUT BACK SID OR STACK VERIFICATION ON
written permission from adjoining property owner. REPLACEMENT FUR CE
Remarks:
HEATING CO:
Signed By:
Date:
CHIMNEY AND STACK VEWFI
ATION
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)
No ( )
3.
Has no foreign objects lodged within
Yes
No ( )
4.
Is securely supported
Yes '( A.No
( )
S.
Meets all current Code requirements for size
and total BTU's connected
Yes y)
No ( )
.6
Has total heating BTU's of
All other BTU's (C)
TOTAL BTU's \ LI ® , 00
i.
Has a liner been provided for water heater
Yes ()
No
S.
Has combustion air been provided for water heater
Yes
No ( )
Remarks:
HEATING CO:
Signed By:
Date:
S��
NEW [ ] CITY OF FRIDLEY
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: (�1
Legal Description:
Owner Name & Address: �"� ��� e U ��vUt,� C- , Tel. # -76P 3
Contractor:
MN LICENSE #
Address: Tel. #
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 ® 2— Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: (k o`P 6 a,, r 'C" s -roti
Construction Type: w Estimated Cost: $� grin,
Driveway Curb Cut Width Needed: Ft. X6 Ft = Ft x $ _ $
DATE. 2 - 2 APPLICANT: v- ® Tel. # LS f
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
CITY USE ONLY -
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ �i� A STIPULATIONS: