PRE 2010 DOCSCity of Fridley, Minn..
BUILDING PERMIT N° 4159
Date:
Owner:
..............---------.._.......---..._............._...................._.....__..........._.........---------- Builder �,:......................._...._...---•---•-•----•---_..._......._...._.._---......__---�__
Address............. .............. ............. ... _...._....._.._....—..— --------------------- _. Address.............---•.......................................................................
�i LOCAT OF BUILDING
No.......-- �( �'J...... Street .......... - ........... . Part of Lo
Lot ............ /-3 ......... Block ............. .... 1 ........... ....... ......... Addition or Sub -Division ..._ � ayrn.s.:..._ - 07 •
CornerLot .................................... Inside Lot;e .......................... Setback ..... _............. _.............. ........ Sideyard..... .............. _............. .............. .............. -
SewerElevation ................................... ............... ..................................................... Foundation Elevation...................._..-----......_............._............---............_......._. .......
DESCRIPTION OF BUILDING
o be Uwfi as:
f rs
...... Front ...� Depth `. Height /......:_ Sq. Ft. .. Cu. F't..s.._
............................................................
...................................... Front ..............................Depth ...................._.. Height .........v Sq. Ft. ........................ Cu. Ft......_.................
//
Type of Construction .............................................. Est. Cost..../0..�� ....fC6...... 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 epinpli e�with all provisions of
ordinances of the city of Fridley. �/ ®� �� /0
acIn consideration of the
payment of a fee of $........................ permit is hereby granted to ....................................................... ...
... ._.............. ......... -................ .............. ......... to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. / — —
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
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CITY OF FRIDLEY INSPEC1 iUN DIV.
6431 University Ave NE
Fridley, MN 55432
763-572-3604
Floor 1
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES:
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
,$ z*.-- % :ry. Auto.
fr; Wash )` Floor I�I/i��r' ::
,<. .. Washer
Trav �`�iil�`� Dram
NO. RATE
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 () Nc
Type
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
Effective On Jan 1, 2001
Heater
TOTAL JOB ADDRESS 'bec � y y
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.
KELLNER, CLEMENS I t� e/ ( , 20
148 PILOT AVENUE
FRIDLEY, MN 55421
Owner _ (763) 572-8813
Building Used Aa
Estimated Cos `'C —
''rrl�l��� � 01 PERMIT NO.
State Surcharge $ .50
TOTAL FEE $ �" �_
PLUMBING COMPANY NDI Dl`s 00, XO -5 eld
SIGNED BYTEL Nvl�
Approved By Rough -In Date Final Date
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
i
COMMON VENT INFO ON BACK SIDE
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 existina 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 ventina 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: