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PRE 2010 DOCS97-84-879001 CITY OF FRIDLEY I • APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUDIBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Cas Range to 199,000 BTU REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction x $3.00 x y Q x $2.00 a U) x $5.00 x U ; $7.00 d $5.00 Water A 0 e0 01 yro� E a •ci {y� +� roeO w MINNEGASCO Heater +oi V b Tel. No. X E O! Np A G W 14 Date 0 u 0 .4 V •i G N •.Ci 7 0 O L� •N j Ill! N '•N UI a a p d �' o c ro ro o ro to'as 'lec rLnu PO V1 3 q W to W U PO 3 t7 1st 2nd 3rd 4th 77 1 (R) o Future Connection Opening Connected with Sewer 1') o New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUDIBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Cas Range to 199,000 BTU REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction x $3.00 x $2.00 x $2.00 x $5.00 x $5.00 x $10.00 x $7.00 x $5.00 x $5.00 x $3.00 x $1.00 x $x:0.00 State Surcharge TOTAL FCE REINSPECTION FEE $5.00 $2.00 S Job Address 224 Panorama Department of Buildings City of Fridley Tel. 0571-3450 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 facLu and reprosontations statod in this application aro true and corroct Fridley, Mn. 7-23-79 , 19 OWNER KIM KIND OF BUILDING frame USED AS res. TO BE COMPLETED ABOUT 7730-79 J< ESTIMATED COST }0,00 OLD - NEW BUILDING PERMIT NO. PEP14IT NO. 4 Company MINNEGASCO Signed By Tel. No. ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT S .00 $ . MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE $ ,50 $ 8.40 city minimum L� A SUBJECT 0. City of Fridley 17 481 AT THE TOP OF THE TWINS BUILDING PERMIT Ir I R EIPT NO. • COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. 1 ' O- � 1 ---� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 5/4/84 JOB ADDRESS 224 Panorama Avenue N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 3 Carlson's Summit Manor South SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE James Kim 224 Panorama Avenue N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Western Construction Company 5353 Wayzata Blvd., Mpls. 546-3385 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK f NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 241.x 28' Detached Garage 9 CHANGE QF USE FROM TO STI ULATIONS Provide a hard surface driveway. WARNEIV,5% Before digging cull! lacal Utilities SEPERATE PERMITS REQUIRED FOR WIRING, TELEF1I; �11E - ELERiG - GAS Etc. HEATING, PLUMBING AND SIGNS, REQUIRED BY LAW 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 $7,533 $3.77 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES Wz SUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISI NS OF Y OTHER STATE OR OCAL LAW REGULATING CON- $68.50 TRU CTI TH ERF RMA OF ONSTRUCTION. PLAN CHECK FEE TOTALFEE -W-IWL� m/o 1 $72.27 SIGNATURE OF CONT ACTOR OR AUTHO AGENT (DATE)WHEN PROPERL ALI DATE THIS IS YOUR PERMIT BLDG INSP aTE SIGNATURE OF OWNER(IF OWNER BUILDER) (DATE) NEW [_4� ADDN. [ ] ALTER. [ ] Construction Address Legal Description:_ Property Owner/Addre Contractor:�L Address: LIVING AREA: GARAGE AREA: DECK AREA: City of Fridley R-1 AND R-2 Building Permit Application Attach to thiVb(pplication, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width �/ Length Width 0a Length Width Height Height Hgt/Ground Effective 4/1/84 Tel. # 5_7" lv?ry Tel. # NYp Sq. Ft. Sq. Ft. Sq. Ft. OTHER: �A Corner Lot [ ] Inside Lot .P-] Ft. Yd. Setback Side Yard Setback n Type of Construction: Estimated Cost: $ f®y� �6 YP Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation � # DATE: 6/'J1 1��g/[,/APPLICANT • Tel. ` CITY USE ONL Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Hain Charge STIPULATIONS: —peo L), 0 �_ $ (0,8.Cb $ $ •'7'7 $ $ 4 4e0&0 Z., kc�E Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 3200 FRANCE AVE. S0. 3rd. STREET N.E. vi Z ROMAN ROAD t Os IW 1 hereby sonTwenty ify that the above Is s survey of Lots One (1) through (20)+ Block Three (�)I.CAFISONIS.=*UT MANOR SOUTH ADDITION. Anoka County. Minnesota. shoving the location of the houses on said late. + v As surveyed by we this 18th day of April 1955 A. D. Signed„ Hituwacta Reirintration No. 2 84 1 ja I W m Z w 0 Z CL 3rd. 8S w 14 40.2 3�4 4988 /10 4� F4—' v 13 N 26.2 lio 75 ov mv 32.2 /4,9 7 6 /N 10.2 - 3200 FRANCE AVE. SO,. - STREET 75 co 7s 4o.2 fol 32 2 4964 F`4 9 5 2 ,aiN N4 102O 15 16 17 It 26.2 14 3 oraina e UhNigi Fj5er. 7.4 7.4 !Y—e—1 —'— —75— 10 9 W.9 4o.2 9 40.2 4 Ao-Zl 40.2 N i, N N a .2 ra 4965 "o 4977 N =14 -j QD 6: q se N. RA 75 7S 69 68 ROMAN CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer Back Flow Preventer Required. . Type TOTAL $ 5.00 $ W 3.50 $ >4 W $ ro 4.00 u $ % 0 $ Water $ $ 5.00 A $ 5.00 $ C 5.00 $ $ 7,00 $ 'Td) $ 5.00 $ $ of W of $ Yes ( ) No ( ) ►roi •-ci W A V 0, w C Heater 47 41 -4 m F .x+ rd W m $4 0, e� a •N 4Wi N C r: V) ?� C c 3 g o •-Ci ero o X o 0 0o 0 •1 .0 y En .0 ro •.a 0 o .0 W L 47 W U1 En U) A ro�4 W to rd • 4 ro W 0 .4 .-i ro rd o ro to .i ro N as lec In r u o w M rn 3 In r� m w U m a 3 0 E 0 0 1st 2nd 3rd 4th , (R) - Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening - Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer Back Flow Preventer Required. . Type TOTAL $ 5.00 $ $ 3.50 $ $ 1.50 $ $ 4.00 $ $ 5.00 $ $ 5.00 $ $ 5.00 $ $ 5.00 $ $ 5.00 $ $ 7,00 $ 'Td) $ 5.00 $ $ 10.00 $ $ 10.00 $ Yes ( ) No ( ) _ $ 5.00 $ ALL OTH1''S AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ State Surcharge $ .50 Reinspection F -e $ 1 ($15.00) TOTAL FEE $� Effective Date May 1, 1988 Job Address 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 applicaltion are true and correct 6,11f-7 ''�j Fridley, Mn. / / 19OWNER atl I RIND OF BUILDING r USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. / OS --'2 ROUGH INSP. Date FINAL INSP. Company X IA t t)tgi '--r ` / V -C 6/V 7 - Signed By�/� Tel. No. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERM I IS $15.00 PLUS THE $,50 STATE SURCHARGE CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Stories Basement Floor 1 Floor 2 Floor 3 Floor 4 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Bath Wash lrinit Floor Catch Auto. Urinal Tuts Shower Sink Tray Fount Drain Basln Washer PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater —Electric $ 7.00 Water Heater — Gas** $10.00 Gas Range** $10.00 Gas Dryer** $10.00 Back Flow Preventer Required (}Yes () No Type_ �e.�LO -7 6q �I —4— $15.00 Reinspection Fee $4.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge $ .50 Effective On January 1, 1997 Gas Mise:.; : Water Heater Range .)=ixt..; Gas Elec ................. b JOB ADDRESS 2 q 'Pc&n O r Pn MC-- 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 1" and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. Z .1998 Owner{�— Building Used As /fie „rr Estimated Cost ®® '—PERMIT NO. PLUMBING COMPANY SIGNED Approved By e0412 Rough—In Date TOTAL FEE $ 0 PLUS, THE $ 50 STATE' SURCHARGE -,7o. FIEC& t No. 753-311611 Final Date IAIT IS loo on **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES. SUBJECT r ,P City of Fridley`2 d s 1 26 AT THE- ®U4 BUILDING PERMIT -ReeerrTND=. • _ COMMUNITY DEVELOPMENT DIV. ` INSPECTION SEC. 86 ell l PROTECTIVE NUMBER REV DATE PAGE OF APPROVED By 'o—.11 1 o --.1 I CITY HALL FRIDLEY 55432 "'j 612-571-3450 910-F15 10/6/98 JOB ADDRESS 224 Panorama Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 1 CArlson's Summit Manor South Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Douglas Krant 571-0484 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 55421 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 O ADDITION ❑ ALTERATION 5ax REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace basement windows 9 CHANGEOFUSEFROM TO STIPULATIONS Install smoke detectors to meet the State Building Code - in each sleeping room and on each level of house. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAO 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 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 250 .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. STRUC N OR THE PERFORMANCE OF CONSTRUCTION $21.00 Fir SC .50 / 900 PLAN CHECK FEE TOrT0E E `04 SIGN E OF CON 7 PACTOf OR AUTHORIZED AGENT IDATEI N RO WALIDA THIS IS OUR PERMIT SrGNATURE OF OWNER,IF OWNER SUILDERI IDATEI BL INSR IA1E NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION CP r ConstructionAddress: 2— Z o rlgvac AV_Q1 4 ctx_ Legal Description: Owner Name & Address: /,—. -5 J_ Tel. # Contractor: 5 9_-/C // MN LICENSE # Address: 21, 2 4 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: 0 Construction Type: 16 CtS_e_%M Estimated Cost: (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: /0 APPLICANT: ` r Tel. x'12, -.-W- 0 2�-y STIPULATIONS: CITY USE ONLY 01 Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ . <'O .001 of Permit Valuation (1/10th%) State Surcharge $ S'O $.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 Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] O_ Q TOTAL $ igt STIPULATIONS: SUBJECT NO. City of Fridley 28398 572-31964 THE TWINS BUILDING PERMIT RECEIPT NO. • _ COMMUNITY DEVELOPMENT DIV. �� ----- . PROTECTIVE INSPECTION SEC. -71 R I III i �r--- ".j CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY ----� L 612-571-3450 [91aF�5 10/23/98 � 10B ADDRESS 224 Panorama Avenue NE 1 LEGALLOT NO, BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 3 lCarlson's Summit Manor South Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Douglas Krant 571-0484 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Builders & Remodelers Inc. 3517 Henne in Ave S Mpls 55408-3830 827-5481 1100 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 O QK REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house and garage (24 S) Tear -off; Reside house and garage; Fascia 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. Call for building wrap inspection before covering. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTIO,� ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTIO . OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS A7 ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATIO STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAW VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIE WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMI 9739 4.87 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TH PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON. STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $162.25 Fire SC $9.74 PLAN CHECK FEE TOTAL FEE SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT iDATE. WHEN PROPERLY YAYDATED THIS IS YOUR PERMIT )A Tj S-GNATURE OF OWNEROF OWNER BUILDER, iDATE, BLDG NSRP NEW- ADDN ( ] ALTER Construction Address: Effective 8/1/95 CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 'Jor' Building Permit Application ad t4 1 Legal Description: Owner Name & Address: Tel. # '5-71-0 — Contractor: BUILDERS & pEMODELERS, INC. — MN LICENSE # 3517 Address: MW &Q30 IS. MN 5540&3= Tel 2-827-5481 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. �3 DECK AREA: Len Width Hgt/Ground Sq. Ft. �� OTHER: - ✓�� --- Z ��E,, Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost- $ /3� Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Int x $ _ $ DATE: /0/?V98 APPLICANT: Tel. # Permit Fee $ -)- 5� Fee Schedule on Reverse Side Fire Surcharge $ % _ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $850 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 $ &l -1 STIPULATIONS: Building PLUMBING Permit No..eXo Inspections RESIDENTIAL APPLICATION Received By; 763-572-3604 CITY OF FRIDLEY Da' DATE YOUR E-MAIL ADDRESS SITE ADDRESS Sd„sd� s �wre �✓ THIS APPLICANT IS: ❑ OWNER *NTRA1 Douglas Krant 224 Panorama Avenue PROPERTY NAME:Fridle MN 55421 TENANTS ADDRESS: 7635 10484--'ST`�TE ZIP PHONE: CONTRACTOR NAME: SUBMIT A COPY OF STATE LICENSE # C% EXP DATE YOUR STATE ADDRESS' f, / CITY ' t �Y STATE 41 tSNlr LICENSE WITH . PHONE 7— MO,3 FAX — APPLICATION PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW )(REPLACEMENT DETAILED DESCRIPTION OF WORK % PER NLS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $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 $300 = $15.00. Labor cost between $300 to $500 =cost of labor X.05 = -FD"ROJECTS WHERE LABOR EXCEMS-UN.TEES ARE BASED ON $10.00 PER FM I W, EXCEFr,, JHERE NDIEEI..: FISC S:.. INDICATE TOTAL NUMBER OF EACH BELOW) _ BATH SINKII AV FLOOR DRAINS _ SHOWER WATER PIPING �_ _ —BATHTUB GAS PIPING �nEWMYIJCWSE) _ SWIMMING POOL WATER SOFTNER ($35) _ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15) _DISHWASHER _-LAUNDRY TRAY LWATER HEATER ($35) FOR IRRIGATION _ WATER METER _ OTHER 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 @ $35.00 x $35.00 = $ 36 oc State Surcharge = $ .50 Total = $ THIS IS AN APPLICATION FOR A PERMrr 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 accor ce with the approved plan in the case of w r res review and approval of plans. / SIGNATURE OF APPLICANT a// PRINT NAME Je. Ildellors-i DATE a City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 I . CO'OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND nFvICFs 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 All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25/0 of Value of Appliance or Work Rate TOTAL $ 30.00 $d-� $ 10.00 $ $ 10.00 $ $ 10.00 $ $ 25.00 $ :�� ° 00 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. •:, OWN Effective On January 1, 2000 BUILDING USED AS US f �"f-� ESTIMATED COST SC9� ,. ®0 PERMIT N0. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating U�pits Circle One (Steam) (Hot Water) r ir) Trade Size No. S BTU ? 6&U "J HP EDR Fuel 0 Notal Connected Load 13 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 an .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true andect. DATE co r ( Z� 410 WEST LA, ,E1'-'HEATING CO,� F, < - Signed qq TEL # Approved By Rough -In Date Final Date COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, 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) [WO W_%II►leyelel Signed By: Date :