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PRE 2010 DOCSCity of Fridley, Minn. BUELDING PERMIT Date: ... e�.—z.�/- �................ Owner ....................................... Address...................................... N® 3999 Builder...... ........................ .......... Address ............................................. LOCATION OF BUILDING No. R.. (9. Q ... Street . . .......�..... Part of Lot ................. ....... . , Lot .... (0...... Block .......rte.......... Addition or Sub -Division ..... .. ....... . Corner Lot ............ Inside Lot ............ Setback `!.... .. Sideyard /O...................... DESCRIPTION OF BUILDING To be Used as: fo/ ........... .. Front ' Z/ . ?. �/ Depth Z '. /Height �% 0 Sq. Ft.1 T Cu. Ft. .................... Front ........Depth ..... Height ..... Sq. Ft. ........ Cu. Ft. ........ Type of Construction ................... Est Cosf. � ,�.� Y:.o.9 To be Completed ... ...... . In consideration of the issuance to me of a permit to co ct the )gilding desribed above, I agree to do the proposed work in accordance with the description aboSte sly forth/ nd in �pmpliance with all provisions of ordinances of the city of Fridley. i��, e ...W ........................................... In consideration of the payment of a fee of $. !?! �.� 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 bis 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 with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. �- .. .. Building Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. City of Fridley, Minn. YUHDING1 .156 MK� , Ar .�. I�.rr....,.. � .JI►I�I _ .. .:r ., rf,11 ,I _ s . - ...w' . /...di.,..,.�' .:# LLQ2CA,TION B1 NG No. Street Part Lot Lot _ Block - dditionor Sub- . Corner Lot — Inside Lot IMback Sideyard Sewer Elevation Fo tion Elevation DESCRIPTION OF BUILDING m Front Depth ot Height Sq. Ful—f- cu. F. Frog , •---....._...._.. Depth Helgh Sq. Ft. cu. Ft. Type of Constructs Est. Cwt To be Completed 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 21 provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $"` , 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 regardia_g location, conatructson, alteration, tenants, repair and mov7ng of buildings within the city limits and this permit may be revoked at aqy u violation of any of the provisions of said ordinances. A►. �'"'t NOTICE fhb permb don not eover the co ntroction, hnta[latlon for wMh& phmbing, gn hennas, sw w w water. Be sone to see the Building bqm for for separaM permits for thea Bann. s APPLICATION FOR BUILDING PERMIT CITY OF FRIDL9Y; MINNESOTA Owner's Name dAltl,r 42/a -v : n/W . j2 Builder (:o Rc® co Ns Corner Address D6 0 y egA-D 4 P fl ✓e" Address J,7 9 ,fr )Ied wAI-16 ftd 4J-' LOCATION OF BUILDING No. Street `s-��� 4� , Part of Lot Lot G Block G Addition or Subdivision Af," ,loyo w Yory 'goo Corner Lot Inside Lot — Setback 971f Side -Yard SEWER' -ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates'of Survey of Lot and proposed building location drawn on these Certificates. To be used as: DESCRIPTION OF BUILDING "leef-ig Front /4 Depth a Y Height Sq. Ft. _360y Cu* Ft. Vp iP C 1*4 Front Depth /a Height Sq. Ft.eig_ Cu. Ft Type of Construction Estimated Cost /5-". c✓& To be Completed O C -It- D v/t 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. DATE % /e G z (Schedule of Fee Costs can be found on the Reverse Side). 3i/3v City of Fridley, Mian.. N° 8566 BUILDING PERMIT Mpls. LOCATION OF BUILDING No. 800 Street ntrar+nn nr•i xe NoMa Part of Lot Lot .1;_ _ Block h Addition or Sub -Division PrOOlcuJ aw 3rd Addl M cm corner Lot _ Inside Lot K Setback — Sideyard Sewer Elevation -- Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Forth & Front _ Depth ._ IJ ___ height _ 13.. _ Sq. Ft. Cu. Ft. RR= ai r4 Front Depth — Leight Sq. Ft, ______ Cu. Ft. Type of construction ._EI'ame Est. Cost _ To be completed 19,-1m65 Storm damage and addition In consideration of the issuance to me of a permit to the buildtflg des above I agree to do the proposed work ffi accordance with the description above o and is comp ce with ail provisions of crdinaaces of the city of Fridley. n In consideration of the payment of a fee of $ , permit is hereby granted to SimaT-t raus±amc- Iiti17 SSL 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 acrd his agents, employees sad workonen, ffi aII work done 14 around and upon said building► or any pert thereof, shall conform is all respects to the ordinances o4 Fridley► Minnesota regardlag location, construction, alteratton, anaiateaaace► repair and movhig of buildings within the dty limits and tb3a permit may be revoked at any bane upon violation of any of the provisions of said ordinsaosa. NOTICh M pumN dot not emu tho aonttruWa, knalNMon for wbb& plumbieo► oa ho ht& ower or water. Bo am to ao do BuNhis hnpoalor for aparato paenNt for thea None. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA wn'kt . 0 OWNER'S NAM BVIL ADDRESS 4rr; 'I LOCATION OF BUILDING Street Part of Lot.. L(Yf ADDITION OR SUBDIVISION,�Q' Corner Lot Inside LOT Setback, side -Yard ..SEWER ELEVATWX FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPT NOF Iw ING To be used as; Front "r -� Depth,_ Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction �� Estimated Cos �� To be completed �,' 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 Building's, and hereby declares that all the.facts and representations stated in this application are true and correct.lii r (Schedule of Fee Costs can be found on the Reverse Side). C SUBJECT City of Fridley o 19563 AT THE TOP OF THE TWINS BUILDING PERMIT COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r PROTECTIVE ®®�� 1 � i 1 "1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY ' 612-571-3450 910415 6/27/88 JOB ADDRESS 800 Overton Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 6 Brookview Terrace 3rd SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Jerome Hanson 800 Overton Drive N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Future Pride Aluminum 6156 Star Lane N.E., Fridley 571-1481 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 8 DESCRIBE WORK Reroof,Dwelling and Soffit & Fascia 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be 2nd layer but not 3rd. Install ridged galvanized valleys. On all new roofs or tear -offs and replacement roofs, State Code requires that 2 layers of 15 lb. felt, mopPed together, be installed to a point 24 inches ap fr9m exterior cull line, or the ase of other apprand underkayment membrane. 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 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 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 $3,000 $1.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $54.00 STRUCTION OR THE P FORMANCE OF CONSTRUCTION. :: LAN FEE TOTAL FEE XCHECK caw fs a7�%"g' 1 $55.50 SiGtrATUREOFCONTRACTORORAUTHORIZEDAGENT IDATEI WHEN PROPERLY V ATED THIS IS YOUR PERMIT ' -� SiGNATURE OF OWNER IIF OWNER BUILDERI (DATE) BLDG INSP - D TE NEW I I AODN I I ALTER I I Obnstructian Address City of Fridley R-1 AMID R-2 Builth PermitAmna, ication Effective 5/1/88 legal Description: � _— e�',n 9 ' � _ i �, P `� � �' � ° 1-9f- /47 S %.s Owner Nene & Address: J lfeol,07 z�'? Sova Tel. # ODntractor: z ZZsp %-2�4/Y Address: Attach to this application, a Certif irate cf Survey of the lot, with the proposoed construction drawn on it to scale. LTWNG ARFA • Length Width Height --- ---- gh Sts. Ft. MAIM • Length Wict t: Height Sts. Ft. ' W Y& . � Width Hgt /Ground Sts. Ft. Cbrner Lot I I Inside Lot I I Ft. Yd Setback :side Yard se ks =.ty= Type of ODnstructicn: C- 09- ,:'.-. :1 ;estimated Cost: Approx. Completion Date: Alt. A Alt. B Proposed Driveway Width If New Open#`g, Is ljesjied`s $ 5 �; Width + 6' See Back Page DATE: �/� ��'� APPLICANT 4 Tel.` aTY USE OILY Permit Flee S_ ��/ 0 U Flee Schedule on Reverse Side State Surcharge $.50/51,000 Valuation SAC Charge 5 $550 per SAC Unit Driveway Escrow S Alt. "A" or Alt. "B" Above Park Plee S Flee Determined by Engineering Sewer Hain Charge $ Agreement Necessary [ l Not Necessary [ I TOTAL S SmULMIOIS.S: 9a.sv _..4 a su6jEtT PE of Fridley 2 7 984 ?City AT THE TOP OF THE TWINS BUILDING PERMIT r NO. 1 COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. 63" r PROTECTIVE I CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY j 612-571-3450 910415 9/28198 1013 ADDRESS 800 Overton Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 6 lBrookview Terrace 3rd SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Carol Hanson 571-5632 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Premium Roofing 6680 Lucia Lane NE Fridley MN 55432 571-3973 20097688 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 0 ADDITION 0 ALTERATION REPAIR 0 MOVE 0 REMOVE 8 DESCRIBE WORK Reroof house and garage 24 S Tear -off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIRED 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 MOT 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 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 13E COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 2056 $1.03 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $74.75 Fire SC $2.06 PLAN CHECK FEE 7TTALFEE Lice S 5.0 $82.84 SIGNATURE OCCONTRACTOR ORAUTHORIZE DAGENT IOATEI HEN R P VAL Dg THIS - SIGNATURE OF OWNERIIF OWNER BWLDERi [DATE, BL _-N9P GATE a NEW [ ] Effective 1/1/98 ADDN [ J CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION All �� ConstructionAddress: 't-00 OX-ifVV D'0045 - Legal Description: %%p-oxlC �—IfFAWF Owner Name &Address:/��� f f �/J/�O/1/ �Q� C7U�rE►,�•y ,p,(�/y�' Tel. #/-s'C, Contractor: &2 /(J/Y/ /Qpp� j4�� MN LICENSE # Address: 44Wd Tel. # 51-21-377 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: /J00iC b661e'wer— oZ 5.y�-- $1000 per SAC Unit Construction Type: e00Fl4'r.0 $ ®d Estimated Cost: $ —�4 ' o2o" $ Alt. "A" or Alt. "B" Above (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: APPLICANT: Tel. TOTAL STIPULATIONS: CITY USE ONLY Permit Fee $ 174-199 Fee Schedule on Reverse Side Fire Surcharge $ -2-049 .001 of Permit Valuation (1/10th%) State Surcharge $ l,®3 $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ ®d $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: . SUBJEtT PE City of Fridley 28921 AT THE TOP OF THE TWINS BUILDING PERMIT 1 � • _ _ COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. 1 ; i NUMBER REV DATE PAGE OF APPROVED BY 1 / /"'I CITY HALL FRIDLEY 55432 " 612-571-3450 910-F15 2/17/99 JOB ADDRESS 800 Overton Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 6 1 Brookview Terrace 3rd SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Carol Hanson 800 Overton Drive NE 571-5632 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Siding Plus Window 301 E 2 St Fairmont MN 56031 502-238-1773 8275 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK p O NEW O ADDITION X ALTERATION ❑ REPAIR O MOVE O REMOVE X 8 DESCRIBE WORK Install 6' x 7' Patio Door in Porch; Construct a 6' x 3' unattached landing 9 CHANGEOFUSEFROM TO STIPULATIONS Install smoke detectors to meet the State Building Code - in each sleeping room and on each level of the house. Separate permit required if the landing is attached to the house. SEPARATE PERMITS ARE REOUIREO 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 80 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 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 @ $3,000 $1.50 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 OR Ti#OERFO ANCE OF CONSTRUCTION $74.75 F e SC $3.00 PLAN CHECK FEE TT FEE Lic e C $ $84.25 SIGNATURE OF CON'RACTOp OR AUTHORIZED AGENT iDATEo HE P BLZG -NSP VALI 0 THIS IS YOUR P MIT F . r�AiE S,GNATURE OF OWNERoF OWNER BUILDER, JDATE P, NEW [ J Effective 1/1/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 G\� BUILDING PERMIT APPLICATION ConstructionAddress: &4 a Legal Description: 1—o i Owner Name & Address: Tel. # , -71—S6 3 z. Contractor: s MN LICENSE # 08 2 75— Address: 30 / �' � 57- , �i �i ;1T &w • 5' o 3 i Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EVIPROVEMENT LIVING AREA: Length Width Height r Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Len Width Hgt/Groun Sq Ft. OTHER: $ —/D � Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review n $ CG.1 _terra Leo �5,.7�s $ Agreement Necessary [ ] Not Necessary [ ] Construction Type: n ©oo (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: ,7-k/q T APPLICANT: ,2 Tel. # S 7� ; 6 3 2— STIPULATIONS: CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ D .001 of Permit Valuation (1 / 10th %) State Surcharge $ /, SD $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ $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: f f' Lund Plarn�in9 370Mini m ppil Aff. laud Suw�m� .. Mimm)w s V. Sols7ating ENGINEERING, 1 N C. Milo Civil fimaidp i Amt 4-0" y — Ey,► Beers Survecyon5 — Cest "ate of owrve7 - 6YRNE �Oo � 0,�'E270N Z.p/tiF 6utpog L. .= FRIDLEY INSPECTION DIViSION 6431 University Ave NE Effective On January 1, 2001 Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 76_ -572 -?504 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICE .03 ADD R P 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 Ali Others/Repairs & Alterations (LIST ON BACK) 17o of Value of Appliance or Work Commercial/Industrial 1.2570 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 written permission from adjoining property owner. $ 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 $ .50 rulings of the Building Division, and hereby declares that all the facts and $32-50 representations stated in this application are true and correct. DF TE I qI SICO HEATING CO TEL # Approved By Rough -in Date Final Date l BACK SIDE MUST BE FILLED IN ON VENT SIZE, VENT CONNECTORS AND COMBUSTION AIR VERIFICATION OWNER_ �__ al «L _TT_ UA1 Rate TOTAL 30.00 $_x.M BUILDING USED AS . 115 � ESTIMATED COST PERMIT NO.— 0.$10.00 $10.00 $ DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heating Units I Circle One (Steam) (Hot Water Warm A' $ 10.00 $ Trade Name f'IY1S Size No. BTU HP EDR $ 25.00 $ Fuel 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. $ 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 $ .50 rulings of the Building Division, and hereby declares that all the facts and $32-50 representations stated in this application are true and correct. DF TE I qI SICO HEATING CO TEL # Approved By Rough -in Date Final Date l BACK SIDE MUST BE FILLED IN ON VENT SIZE, VENT CONNECTORS AND COMBUSTION AIR VERIFICATION VENT, `JEEI . ®NNEC p$ AND C' MBLIS`o a'�­r: AIR VEkiFiCATIUN ' Vhen re ?acinp an existi� since, the idersigned I ereby verifies that the •enting h is been examirind and is free fron rust, deterioi ation, obstructions, -,nd is se urely cupportec and estopped ,ere required. Yes til No ( ) 'he venti ig sys'. m is plc,,tic1F . 0' and met ; all current codes c nd manuiracturcr -- pecificat ins in- !uding si::ing, 1r igth, numl. r of elbows and termination. _ Yes (4 No ( ) The uncle igned also ver=pies tit .t the reple Inent unit is a listed azz;cie-.bly and meei the current codes an, manufact ces specificz°tions. This does include F 7A -GF IIA Category I i entral Fur! ice Venting Tables for fan assisted, wid natural draft applia ces. Yes (VfNo The exis nn ce.nbustlo. i air is sized and :.stalled to me A the ;urrent codca and man, +racturer's specif icatior Yes f4 No O . When re, aired `. a install - nevi ombustic , air, it will be sized and installed to meet V° a curs int codes and n .inufacture , specificatic;,s. Yes No ( ) When in: lallin, , a new v 9ntln°-sy tem, tr under signec' ;ierc: y verifies that it is a Iistf c.1 asst � � ibly and meet,: the curren :odes and m; nufau:turer's specifica� ons. * -his does include AGA-GAi '\ Category 1 entral Furnace Venting'i able: :Jr fan asFisted � nd natural `raft appliance Yes (WrNo Is the cc tumor rent and vent ct inectors sued and install °d correctly after an applic rice has been removed rom the co:.. ,mon vent at d vested separate'; as • �r current codes. Yes( Q/O'No ( ) ,pplian., Type -- and Sizei _'immon Ver and Vent Connector Information Appliance p,' ry )e 4' E ' 'J Input ?S K _Fan Assist�:u Nat Appliance #'' Type ASA.& L E J Input 3 Fan Assisted ort Appliance #13. Ty; Je Ei J Input Fan Assisted or Nat Total Appliances Total -,..j Input ­ Common °,J .;nt "` �,�pe G- L( S V. � �d i Oeig it SIAL Giaou�c 6,;r _ � inches Applianc,.- P'll Wit Connc Height Lent;°;i