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PRE 2010 DOCSvly Ad00f.i ti ' ... Ad00 • _; Ad00 �- - �� gOtl3X Ad00 ' Otl3X _ OL13X s 0213X City of Fridley, Minn. BUILDING PERMIT Date: ....dune .24..t..1935, ....... Owner....................................... Address ...................................... N® 3970 Builder ...e, Benom ......................... Address ............................................. LOCATION OF BUILDING No... M... .. Street ... �►44r4 . P431:4 .................. Part of Lot ............................... Lot . A0....... Block .......A ......... Addition or Sub -Division .. BTOQTeac7;aCe=, Mrd 44 - Corner Lot ............ Inside Lot ............ Setback .�519U .... Sideyard . 100". ........ . DESCRIPTION OF BUILDING To be Used as: .AwoUlm ........ Front .41!4!. Depth ;V§!. Height 19.!9" . Sq. Ft. x:05.4.. cu. Ft. ?PM. .................... Front ........ Depth ........ Height ........ Sq. Ft......... Cu. Ft. ........ Type of Construction ................... F.st. Cost.. !?r2.:99..... To be Completed ................... In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do the proposed work in accordance with the description above t forth an In rmpliance with all provisions of ordinances of the cityc of Fridley. /,/ • ..T.b! �• .!/.Y� .NY .�i..^r\/.. .. .. .. .......... ........... 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 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 anions of said ordinances. T'..:... 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. J City of Fridley, Minn.. N9 9082 BUILDING PERMIT Date: — NOVEMBER 7, 1966 owner. _ VERLIS B. CARSTENS Builder SUSSEL COMPANY Address _701 PANDORA DRIVE N. E. Address 1850 COMO AVENUE FRIDLEY, MINNESOTA 55432 ST. PAUL, MINNESOTA LOCATION OF BUILDING No. 701 Street _.. PANDORA DRIVE N. E __ Part of Lot I,ot __,_ 16 --- Block 4 Addition or Sub -Division . B-OR_V_U—w TERRACE, 3RD -ADDITION Corner Lot — X Inside Lot w Setback _.__ Sideyard __ 241 Sewer Elevation To be Used as: DET. GARAGE Foundation Elevation DESCRIPTION OF BUILDING Front 24 Depth 22 Height 10 Sq. Ft. 528 Cu. F,t. 5,280 —.—. Front Depth . _ Height Sq. Ft. — Cu. Ft. Type of Construction _ FRAME Est. Cost _,$1 J700. 00 __ To be Completed SURVEY ATTACHED In consideration of the issuance to me of a permit to construct the buildin escribed apeye, I agree to do the proposed work in accordance with the description above t forth and pli all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $_:5 00 , permit is hereby granted to— SUSSEL COMPANY 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 regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. CLARENCE BELISLE Building Inspector NOTICE: This permit doss not cover the cowtrucdon, hntalkilon for whine, Plumbing, gas heating, sewer or water. Be sure to No the Building Inspector for separate permhs for them bean. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME G -C I t s D' C.�� S ice` BUILDER :S�j � 5 ej ADDRESS _�®� �. � �Q � _ ADDRESS 19SO ` C O �n& CD R Q e,, LOCATION OF BUILDING N0. ®.1 STREET®, (!� o �. PART OF LOT LOT BLOCK ADDITION OR SUBDIVISION ,,c,nk i t e,4j CORNER LOTINSIDE LOT SETBACK y 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. DESCRIPTION OF BUILDING To be used as; a V -C. Front— 2-4 Depth__?,—L Height —% Sq. Ft. S`Z<b�' Cu. Front Depth Height Sq. Ft. Cu..Ft. Type of Construction�.�,, ;� Estimated Cost 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 Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE_j I --1 —(® (0 SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). 4 SUBJECT PERK City of Fridley '-2 6 44 9 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. _ r ~ PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 ,j 612-571-3450 910-F15 7/6/98 ___l JOB ADDRESS 701 Pandora Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 16 4 Brookview Terrace 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE ]Brian Nelson 701 Pandora Drive NE 574-2578 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. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION J7 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (23 Sq) Tear -off; Reside House 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Call for a inspection of building wrap before covering. 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 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 1, EREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS GARAGES A KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1.96 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3,918 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- Fire SC $3.92 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $87.25 PLAN CHECK FEE TOTALFEE $93.13 SIGNATURE OF CONTRACTOR OR THORIZED AGENT (DATE) WHEN PROPE VALI ATED THIS IS YOUR PERMIT / , SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI 8 yNSP GATE 4 NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEYG� ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ,� � a ConstructionAddress: r° ®� /'"Cy� ,I'f r� �� � ✓'� rd?� � lwj Legal Description: Owner Name & Address: �' e N� Tel. # 5 "� -,25 7 Contractor: Ow Az y-- °T 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 -Z;2, Width Height Sq. Ft. DECK AREA: Le Width Sq. Ft. OTHER:�,�,�Gr�ound ✓G . �i�Jfi!/G , Construction Type: Driveway Curb Cut Width Needed: Ft. + 6 Ft = DATE: APPLICANT: Permit Fee $ Fire Surcharge $ - State Surcharge $ • q SAC Charge $ License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ q3,'13 STIPULATIONS: zU _ Estimated Cost: $ / c%q, 2U 7 2 (Fee Schedule on Back) Ft x $ = $ Tel. # 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 [ ] SUBJECT ND• City of Fridley 26696 AT THE TOP OF THE TWINS BUILDING PERM f RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r 1 � REV DATE PAGE OF APPROVED BY = CITY HALL FRIDLEY 55432NUMBER 612-571-3460 910-F15f' 17/20/98 JOB ADDRESS 701 Pandora Dr. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 16 4 lBrookview Terrace 3rd Addn. SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Brian Nelson 574-2578 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO The Cities Home Improvement Co. 6148 Olson Memorial Hwy, Golden Valley MN 55422 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 591-0332 20076414 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION I] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Window Replacement 8 CHANGE OF USE FROM TO STIPULATIONS Install smoke detectors tcbeet the State Building Code - irhach sleeping room and on each level of house. 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 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 1 HAVE READ AND EXAMINED THIS APPLICATION I 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 WHETH RSPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3,000 $1.50 DOES NOT P ESUME TO GIME AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS F ANY THE ST TE OR LOCAL LAW REGULATING CON- STRUCTION THE OF CONSTRUCTION.74.75 Fire SC $3.00 7RFOCE PLAN CHECK FEE TOTALFEE Ll License SC $5.00 1$84.25 SIG T REO O TRA OR WAUTHORIZEDAGENT )DAT WHEN PROPERLY V,#LPATED THIS IS YOUR HERMIT LO INS- MATE StGNWYURE OF OWNER OF OWNER BUILDER) IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 a (� BUILDING PERMIT APPLICATION d rpo�� ConstructionAilress: � 0 r - c, Legal Description: Owner Name & Address: Contract Address: LIVING AREA: GARAGE -AREA: DECK AREA: OTHER: Tel. # e� 7 MN LICENSE # P 0-0' -7& V1 r Tel.# s9/ -0 r 6f the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Construction Type: L2, — e0V `-0 & 91 ke If-OAJ' ' Estimated Cost: $ 3 © 0o/ o -s 1 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: -7 APPLICANT: e LA (�et Tel. # STIPULATIONS: CITY USE ONLY Permit Fee $ l , Fee Schedule on Reverse Side Fire Surcharge $ 3, c)C) .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation PIan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ 21 STIPULATIONS: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 PERMIT NO. 2004-01215 DATE ISSUED: 07/30/2004 ADDRESS : 701 PANDORA DR NE PIN : 143024110078 LEGAL DESC : BROOKVIEW TERRACE 3RD ADD : LOT 16 BLOCK 4 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 500.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER HEATER. # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) # GAS DRYERS # OF NEW FIXTURES # WATER TRMT APPLIANCES APPLICANT CASPER MECHANICAL INC 4948 357 AVE DALBO, MN 55017 - OWNER DAVID BARRETT 701 PANDORA DR NE FRIDLEY, MN 55432 0 # GAS WATER HEATERS 1 0 # GAS RANGES 0 0 VALUE (FOR MINIMUM CALC) 500 0 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regy nstruction or the performance of construct}'�°n. Annlicant A Date , 11 Bldg PLBG PERMIT MINIMUM FEE 0.00 PLBG FIXTURES (NEW OPENINGS) 0.00 PLBG FIXTURES (EXIST OPENINGS) 0.00 WATER TREATMENT APPLIANCE 0.00 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 35.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 PLBG REPAIR/ALTERATIONS 0.00 STATE SURCHARGE, PLBG FLAT 0.50 TOTAL 35.50 PAID WITH CHECK # 13499 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY INSPECTION DIV. 6.431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT V-4�?r MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range** Gas Dryer** Back Flow Preventer Required ( )Yes (�No Type $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 $15.00 JOB ADDRESS 901 f7onjo-fa, 121& Q F - 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. DATE: 7—/-s7— .2 BUILDING USED AS _/l eg— 7 ESTIMATED COST PLUMBING COMP Reinspection Fee $50.00/Hr SIGNED BY:;GO2 TEL N0,17(o -7 / ALL 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 FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST TOTAL FEE $ S.SO OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. It COtABUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE M. 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( ) Appliance 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 in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date : CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: (763) 571-1287 ADDRESS : 701 PANDORA DR NE PIN : 143024110078 LEGAL DESC : BROOKVIEW TERRACE 3RD ADD : LOT 16 BLOCK 4 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT N .=2004-01216 r DATE ISSUED: 07/30/2004 VALUATION : $ 1,300.00 NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL A FURNACE (WARM AIR, RUUD, 50,000 BTUS) # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 1300 APPLICANT RIVER CITY SHEET METAL 9928 BLUEBIRD ST NW COON RAPIDS, MN 55433- (763) 754-2199 OWNER DAVID BARRETT 701 PANDORA DR NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give. authority to violate or cancel the provisions of any other state or local law regulating cons tion or the performance of construction. ADDllcant'.s Date 1 1 Bldg Insp. HEATING PERMIT MINIMUM FEE 0.00 FURNACE SHELL/DUCT WORK 35.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 35.50 PAID WITH CHECK # 13499 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 'FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning - All Sizes All Other Repairs or Alterations (List on Back) 1% of value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater 'flP—_ Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESSFee Total T�.yi Owner Iic�A Z0..Y Y'e'r $35.00 $ 3S.00 Building Used As 4�Y"-X $10.00 $ f ESTIMATED COST ) 3,00 PERMIT NO •OD $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) Warm Air) Trade Name )RR �,�.GPK osF ue Size No. $25.00 $ BTU SD,goe, HP EDR Fuel V 6' Total Connected Load dt � rum 5ro 0 $ Burner Trade Name&m �ci Size No. BTU HP EDR Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR 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. $ .-5O $ 3 _sty *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE FAX # Date Tel 3�75�f=�/ 4 9 Approved by Rough -in Date Final Date �o I fmc? R-011 IDA 0 15. FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION Wher..replacing an existing furnace, the undersigned hereby verifies that the verJting 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,K No( ) The existing combustlon air is sized and installed to meet the current codes and manufacturer's specifications. Yes K"' No( ) When required to install a new combustion air, it will be sized anl installed to meet the current codes and manufacturer's specifications. qll& Yes () No ( ) / J4 �4 1 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. Yesk/) 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 ��� BTU Input ��°'� 6�4sisted or N Appliance #2 Type BTU Input Fan Assisted or at Appliance #3 Type BTU Input Fan Assisted or at Total Appliances Total Btu Input Common Vent Type Sjvt'VIL Vent Height Diameter inches Appliance #1 Vent Connector Height 3 ft Length Z ft Diameter in Type /3 Appliance #2 Vent Connector Height —/ft Length Z—ft Diameter in Type C Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: vr� Date: CITY OF FRIDLEY PERMIT NO.: 2004-01203 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 07/28/2004 610491Z1Ls7r,W,qffrDMI&V aV-f:yA ADDRESS 701 PANDORA DR NE PIN 143024110078 LEGAL DESC BROOKVIEW TERRACE 3RD ADD LOT 16 BLOCK 4 PERMIT TYPE ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. CONNECT FURNACE. # INSPECTIONS 1 APPLICANT DEPENDABLE ELECTRIC INC 2619 COON RAPIDS BLVD NW COON RAPIDS, MN 55433 1 �d ' DAVID BARRETT 701 PANDORA DR NE FRIDLEY, MN 55432 ELEC PERMIT FEE - MIN (REST) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 28649 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp. Date SEPARATE PERMITS REQU1REll FOR WORK OTHER THAN DESCRWED ABOVE.