PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N® 3462
Date: ....:...1.. ......................
Owner ..... Builder . .............. ....... �
Address ... ....... .... Address ........................................... .
LOCATION O�I DING
No. ��. .. Street ?.r��...... .. ...�... n.. Part f Lot .. .
Lot .. ..... Block ....l ............. Addition or Sub -Division ... .. ...lbw.'... ...... ...
Comer Lot ............ Inside Lot ............ Setback ............ Side .............. ............
DESCRIPTION OF BUILDING
�obe Used as: a �, ./' e s . ® E,
&? ... Front .°.:. _0 Depth ........
. �....... Height .�� ® Sq. Ft. .0Q. Cu.
................. Front ........ Depth .... Height ........ Sq. Ft. ........ Cu. Ft .
... ........
4
Type of Construction .4 .. .
... ........ llkt. Cost... / 4A07—=V. To be Completed ...................
In consideration of the issuance to me of a permit to construct the building degribed above, I agree to do
the proposed work in accordance with the description above set forth and in c o pliance with all p visions of
ordinances of the city of Fridley.
..... .. .... ........
��
In consideration of the payment of a fee of $11-1 ....: 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 any of the provisions of said
ordinances. ®�
... Building Inspector
NOTICE:
This permit does not cover the oonstruotlon, 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
Application for Plumbing and Comas Fitting Permit
Dept. of Bldgs. Phone 560-3480
DESCRIPTION OF WORK Dation ��–�
Number, Kind and Location of Fixtures
y,
NO.
RATE
TOTAL
Number Fixtures ......................
x
$1.50
$
19
�=
J
0
NU'
i
f
F
•
N
WATER HTR.
GAS
ELEC.
x
3.25
$
Water Heater (Up to 200,000 BTU) ......
x
2.00
$
New Ground Run Old Bldg. ............
x
3.25
$ 3
�oas
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
x
$1.50
$
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
Base
1st
2nd
vtA
3rd
4th
_
Future Connection Openings
Connected withI
Sewer �
* New Fixture, Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures ......................
x
$1.50
$
Future Fixture Opening ................
x
1.20
$
New Fixture Old Opening ..............
x
1.00
$
Catch Basin .... . .....................
x
3.25
$
Water Heater (Up to 200,000 BTU) ......
x
2.00
$
New Ground Run Old Bldg. ............
x
3.25
$ 3
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
x
$1.50
$
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $
City of Fridley:
. S- .
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the facl
and representations stated in this application are true and correct.
Fridley,
Owner r I h L
Kind of Building
Used as
To be completed about
19Gk
Estimated Cost, $
5New. Building Permit No Permit NO..
Signe
By
Business Phone No
ROUGH
FINAL
City of Fridley
SUBJECT
,
® 13686
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
ECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
l CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L---- , 612-560-3450
910-F15
8/6/76
JOB ADDRESS 5228 Pierce Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRA CT OR ADDITION SEE ATTACHED
DESCR.
3
4
Horizon Heights SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Leonard E. Foard 5228 Kai Pierce Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION J7 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install a fireplace
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide required clearances to combustibles as per ICBO report.
Provide 12 inch deep footing and 12 inch block wall construction.
SEPERATE PERMITS REQUIRED FOR WIRING,
HEATING, PLUMBING AND SIGNS„
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
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
$1,327
.66
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-
$9.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$9.66
I
SIGNATURE OF CONT CTOR OR HORIZEDA�ENT DAT17C
WHEN PR ERLY VALIDATED THIS IS YOUR PERMIT
8 6
_ Al 4 -6 -7,6
SIGNATURE OF OWNER 0F OWNER UILDERI I IDA EI
BLDG INSP. DATE
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL ALTERATION,
ADDITION, OR REPAIR BUILDING PERMIT
OWNER'S NAME: Leonard E Foard BUILDER: Halux 52 & 86th Ave No. Osseo
ADDRESS: 5228 Pierce Str. N. E. ADDRESS:
NO:. 5228 Pierce StnERa E.
LOT: 3 BLOCK: . 4 ADDITION: Horizen Heights.
CORNER LOT: INSIDE LOT: SETBACK:' 38' SIDEYARD: no
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: Fireplace in existing home
Front:
Depth• Height:
Square Feet: Cubic Feet:
Front: Depth:
Height:
Square Feet; Cubic Feet:
Heatelator 123 38C 3138
Type of Construction: Estimated Cost: $ 1327.00
To Be Completed: AugvAt 31, 1976
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: 8/6/76 SIGNATURE:
(See Reverse Side For Additional Information.)
3,,
,:5r/At '-A Tip .✓ S
City of Fridley
SUBJECT
PE
�""
AT THE TOP OF THE TWINS
BUILDING
P E R M I T
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 = �
CITY HALL FRIDLEY 55432
NUMBER-
DATE
PAGE OF
APPROVED BY
612-580-3450
910-F15
7/6/78
JOB ADDRESS 5228 Pierce Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3
4
1 Horizon Heights Addition
SHEET
7-PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Leonard Foard 5228 Pierce Street N.E.
571-5941
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.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW CA ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 131-x 6' Addition to House
9 CHANGE QF USE FROM TO
STIPULATIONS Provide preformed valleys. Provide 16" x 8" footings.
S 'RAT PERMITS REQUIRED Epi Wffaw ;s
He>ONrG, PLUMBING AND S1
W"G
Note dWftg CA W ulaatift
TELEPHONE • ELECTRIC - GAS Etc.
REQUIRED OY LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
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
78
936
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
$2 OOO
$1.00
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-
$8.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
.00
$11.00
SIGNATURE OF CONTRACTOR OR AUTHORIZED A ENT (DATE)
HEN OPERLY VALIDATED THIS IS YOUR�PE IT
• e12::" -/
4DATI
BL G. )NSP
�G.././ F
///f GATE
SIGNATURE OF OWN R IIF OW ER BUILDER)
CITY OF FRIDLEY
APPLICATION FOR RESIllENTIAL BUILDING PERMITS
(NEW, ALTERATIONS, %ADDITIONS, OR REPAIRS)
OWNER: ��_��h--- J � BUILDER:
Address: �� � � k k- r - Address:Xd
Tel. No.:.�/ •�� i
No. Street: •��.` .�� ,L :.c" �_`>
LOT: BLOCK: 19 ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: •SIDEYARDS:
Applicant attach to this form Wo Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
Front: 15 Depth: �- � Height:
Square Feet: .__� Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: Estimated Cost: $
Th 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
�y�� Fridley Ordinances and rulings of the Department of Buildings, and hereby
D declares that all the facts and representations stated in this application
1 yMi
e9 are true and correct. See reverse side for additional infgrmation.
DATE:Z- SIGNATURE:
Stipulations:
441- - �KW'44-1
/'6W
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
AIR
CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
GRAVITY
�•�
�� —4ir
WARM AIR:
RAT4
TOTAL
,lob Address
Furnace Shell & Duct Work
$12,00
$
' Replacement of Furnace
7,00
$
Repairs & Alterations -up to $500.00
7.00
$
Department of B4ij4ngs
Repairs & Alterations each add. $500,00
4.00
$
City of Fridley
Tel. #x571-3450
.IECIiANICAL ItiAR.M !AIR:
The undersigned hereby makes application for a permit for the work herein
Furnace Shell & Duct Work to 100,000 BTU
$12.00
$
specified agreeing to do all work in strict accordance with the City Codes
each add. 50,000 BTU
4.00
$
and rulings of the Department of Buildings, and 'hereby declares that all the
*Raplace-.ent of Furnace
7.00
$
facts and representations stated in this application are true and correct.
Re?airs & Alterations -up to $500.00
7,00
�S
q r
P
Repairs & Alterations each add. $500,00
440
$
Fridley, Minn. / T , 197
'
STE-V•1 OR HOT Y:aTER SYSMI:
�J
OWNER s'7
Boiler & Lines up to 100,000 BTU
$12.Q0
$
PND pF BUILPTNG ".
each addn. 50,000 BTU
4.00
$
Boiler only up to 100,000 BTU
7.pp
$
pSEp AS -T.
each addn. 50,000 BTU
A. PP
$
I
TA PP. FoMPLETER RANT 1P— -'O
OIL BUP-\ER- to 3 gal. per hour
$1Q.pQ
$
p e)
each add. 3 gal. per hour
1Q.QQ
$
FSTTtVgFp CAST
GAS BURNER- from 100,000 BTU lA 1Q9,Q�9 STN
$,1Q.pp
$162
ALD - I UJ PqT; TNG PTTgTT NO,. FER TT NO.
(over 199,999 BTU see Fee Scheggu )
GAS FITTING FEES:
1st 3 Fixtures X
S Q.pQ
S
PS ART?'Td�I PF FIIR*?ACE/BURNER
Aiditional Fixtures X
$ �;pQ
$
Gas Range to 199,000 ET(J
!RT�H or ?.AY1E#I P.WT$r 944?Rs #TQ7: P10srfW�� Aix- No. �
AIR CONDITIONING$
Trade Name Size No.f 0 N,0 / /
FAN HEATING SYSTEMS See Fee Schedule
$
VENTILATING SYSTEMS
ALTERATIONS 4 REPAIRS
+�
$
Capacity Sq. Ft. EDEi/ BTU
State Surcharge
$ .50
Total Connected Load si/ ff 1/f_ Kind of Fuel 72ty,
TOTAL FEE
$ S D
Bur.NER - Trade Name Size No.
ROUGH INSP. REINSPECTION FEE
Capacity Sq. Ft. EDR BTU HP
Date ($10.00)
G
FINAL INS?. ",3^O
Company
Date
Signed By
APPROVAL FOR PER41T f T+'
Tel. No.
YSb-M- F=E FOR ANY BEATING PERMIT IS $7.50 pLUS $.50 STATE SURCHARGE
*Attached stack verification fora
City of Fridley
AT THE TOP OF THE TWINS
SUBJECT
BUILDING PERMIT
MI
16 0 8 7
fECEIPT
r
_ COMMUNITY DEVELOPMENT DIV.
t✓ PROTECTIVE INSPECTION SEC.
i
CITY HALL FRIDLEY 55432
1 612-571-3450
NO.
/
NUMBER
910-F15
REV.
DATE
3/31/81
PAGE OF
APPROVED BY
JOB ADDRESS 5228 Pierce Street N.E.
1 LEGAL
DESCR.
LOT NO.
3
BLOCK
4
TRACT OR ADDITION SEE ATTACHED
Horizon Heights SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Leonard Foard 5228 Pierce Street N.E. 571-5941
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Milton L. Johnson Cb. 2513 Central Avenue N.E. 781-9548
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
❑ NEW ❑ ADDITION C ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Alter Flat Roof
9 CHANGE OF USE FROM TO
STIPULATIONS
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
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
$1,500
$1.25
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.
$9.00
PLAN CHECK FEE
TOTAL FEE
$10.25
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
- WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
BLDG INSP DAT
SIGNATURE OF OWNER (IF OWNER BUILDER) )DATE)`
01
To $e Oz)rtpleted:
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 cqFrect.
DATE: 3 - 31' - Y1 SIGNATURE:
Stipulations:
CITY OF FRIDLEY
APPLICATIa FOR RESIDENTIAL BUILDING PER14ITS
'
(New, Alterations, Additions or Repairs)
OWNER:
��� � � a� �[� � 2� BUILDER:
ADDRESS:
S ��( �1'0`�� Vv ADDRESS: �s 13
TEL NO:
-S®�/ '° '� �/ TEL NO: 07f'�
1�sF
Construction Location
STRICT NO: `� �1 STREET: L; e -e Al t5
LOT:
� BLOCK: " _ ADDITION:
Corner Lot: Inside Lot: Setback.: Sideyards:
Applicant attach to this form two Certificates of. Survey
of lot and
proposed'building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION -
Front: Depth:
Height:
Square.Feet: Cubic Feet:
Front: Depth:
Height:
Square - Feet: Cubic Feet:
Type of
Construction: ; ®rg '— Estimated Cost: $
To $e Oz)rtpleted:
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 cqFrect.
DATE: 3 - 31' - Y1 SIGNATURE:
Stipulations:
:ITY OF FRIDLEY INSPECTION DIViSION Effective On May 10, 1999
5431 University Ave NE
=ridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND 0711C�S
JOB ADDRESS����� \-'1
RATE SCHEDULE OWNERS l� • I
Residential .Rate TOTAL ' l
Furnace- Burner- BUILDING USED ASL�
AIsR�-Furnace $ 30.00 $' ,
(Side Vent - Fill Out Back) ESTIMATED COST ` ` � PERMIT NO.
Gas Piping (Needed with new furnace, $ 10.00 $
but not replacement) DESCRIPTION OF FURNACE AND OR BURNER
Gas Range $ 10.00 $
No. of Heating Units Circle One (Steam) (H#) W to arm Air) .�,
Gas Dryer $ 10.00 $ Trade me Size Non ---
BTUHP EDR
� ��
"Air Conditioning - All Sizes $ 25.00 $ Fuel l� �1 °`� Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No.
1% of Value of Appliance or Work $ BTU HP EDR
Commercial/Industrial
1.25% of Value of Appliance or Work $ 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 ar
L State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and
1 representations stated in this application are true and correct.
TOTAL FEES "�- �•
26611�RAPQB 80tXE�
C N RAPIDS. MN �
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION_ _ . HEATING4121757-
REFRIGERATION/AIR
f2 757-
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
Signed,
REINSPECTION FEE $47.00/Hr
'Air Conditioners can not be placed in a side yard without Approved By Rough -In Date Final Date
written permission from adjoining property owner. _ _• •� ^_�„ ��_„•, .•..�.�,„.T,,... ^K2 Mr NI A/Ir\Arki rt IMKI ANr
HEATING CO:
Signed By:
Date:
DEPENDABLE INMARQUALITY, INC.
2619 COON RAPIDS BOULEVARD
COON RAPIDS, IWIN 115133
,1 _,5? Lr, -- o r
CEUMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been
carefullyexamined
��
Yes () No
( )
2.
Is free from rust or deterioration
Yes (�.. No
( )
3.
Has. no foreign objects lodged within
Yes (J) No
O
4.
Is securely supported
Yes (;/). -No
( )
S.
Meets all current Code requirements for size
'
and total BTU's connected
Yes( No
( )
6
Has total heating BTU's of1
All other BTU's = ��
TOTAL BTU's
7.
Has a liner': been provided for water heater
Yes ) No
( )
8.
Has combustion air been provided for water heater
Yes No
Remarks:.
List ALTERS
ONS.Being Done:
"
=,; S0
�
N
.
N
HEATING CO:
Signed By:
Date:
DEPENDABLE INMARQUALITY, INC.
2619 COON RAPIDS BOULEVARD
COON RAPIDS, IWIN 115133
,1 _,5? Lr, -- o r
Effective January 1, 2003
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS
AND HEATING, COOLING, VENTILATION,
(763) 572-3604 REFRIGERATION
AND AIR CONDITIONING SYSTEMS AND DEVICES
FAX (763) 571-1287
JOB ADDRESS R' ef G a
RATE SCHEDULE
-r
OWNER Lo;-s L P h(x-j(` 1= � o�.Y'
Residential Rate
TOTAL
Furnace Shell and Duct Work, Burner -
BUILDING USED AS_0 W r- i� a
Also Replacement Furnace $ 30.00
(Side Vent - Fill Out Back)
$
/
ESTIMATED COST — PERMIT NO. /
Gas Piping (Needed with new furnace, $ 10.00
$
,�S_d/3.
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNER
Gas Range $ 10.00
$
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Gas Dryer $ 10.00
$
Trade Name Size No.
BTU HP EDR
*Air Conditioning - All Sizes $ 25.00
$.OD
Fuel Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK)
Burner Trade Name Size No.
1% of Value of Appliance or Work
$
BTU HP EDR
Commercial/Industrial
1.25% of Value of Appliance or Work
$
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
State Surcharge
$ .50
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
TOTAL FEE
$�S�
RIM CRY Sheet MM, ft. PATE 03
0§28 EHUGbW St N.W.--
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
Signed TEL #
FAX #
REINSPECTION FEE $47.00/Hr
'-Air Conditioners can not be placed in a side yard without
Approved By. Rough-In Date Final Date
written permission from adjoining property owner.
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
CI7YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
June 2, 2004
Mr. Leonard Foard
5228 Pierce Street NE
Fridley, MN 55421
Re: Final Inspection at 5228 Pierce Street NE
Contractor: River City Sheet Metal Inc.
Dear Mr. Foard:
A mechanical permit was issued on September 4, 2003 to install an air conditioner at
your address. According to the 1991 Uniform Mechanical Code a final inspection shall be
conducted on the work authorized by this permit. As of this date the inspection has not
been requested.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. We will keep your permit open for another 30 days and if we do
not hear from you within this time to set up the inspection, we will mark the permit "no
inspection called for by homeowner after notification" and the permit will be expired.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Sincerely,
DA%SEN
Build pector
DJ/mh