PRE 2010 DOCSCity of Fridley
Application for Plumbing and Cas Fitting Permit 53-84-s915.S1
Dept. of Bldgs. Phone 560-3450
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
pa
$
X $1.50
s
x $1.50
$
x $3.25
$
x $3.00
$
x $3.25
$
$2.00
Sz
Z
OI;
,
t
WATER HTR.
GAS
ELEC.11
Base
3®00
1st
2nd
3rd
4th
• Future Connection Openings
e New Fixture, Old Openings
I
Connected with
Sewer �
Cesspool
PARTIAL RATE SCHEDULE
PLUUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ......................
Future Fixture Opening ...............
New Fixture Old Opening .............
Catch Basin ............................
Water Heater (Up to 99,000 BTU) ......
New Ground Run Old Bldg. ............
Electric Water Heater
GAS FITTING FEES: NO.
1st 3 Fixtures .......................... 1
Additional Fixtures ...................
Gas Range to 199,000 BTU ..............
install (1) gas grill
REPAIRS & ALTERATIONS—Refer to Code
x $2.00
a
$
X $1.50
$
x $1.50
$
x $3.25
$
x $3.00
$
x $3.25
$
$2.00
$
RATE TOTAL
x $2.00
$ 2.00
x$.75
$
x $5.00
$
3®00
City of Fridley:
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 fact
and representations stated in this application are true and correct.
Fridley, Minn. Jul- 24, 1970 19_
Owner Paul Olson
Kind of Building frame
Used as residence
To be completed about July 29, 1970
Estimated Cost, $ 10-00
Old-XNew. Building Permit N Pe it No.
BY
Business Phone b ®LIQ SAS o
ROUGH
FINAL I
Description ................................................$
TOTAL FEF $--1---00 4 a
CITY OF FRIDLEY INSPECTION DIV.
Effective On January 1,199y'
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER
PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
JOB ADDRESS t® �0 e6L Rid C—'—
The undersigned hereby makes application for a permit for the work herein
Residential Rate
TOTAL
specified agreeing to do all work In strict accordance with the City Codes and
Furnace Shell and Duct Work, Burner —rulings
of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace $ 20.00
$ 0 • C)C
representations stated In this application are true and correct.
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace) $10.00
$
/
Al -
OWNER L9 �� �`Ze- / 2
Gas Range $10.00
$
�dH
BUILDING USED AS L
Gas Dryer $10.00
$
ESTIMATED COST_,,) PERMIT NO. 11900
*Air Conditioning —Ali Sizes $10.00
DES'TION OF FURNACE AN 0 OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water) ��Ar
Trade Name ate ems- Size No.6
Commerclal/industrial
BTU 600&Q HI' EDR
1% of Value of Appliance or Work
$
Fuel Total Connected Load
State Surcharge
x.50
Burner Trade Name Size No.
BTU HP EDR
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $1500 of
PLUS THE $.50 STATE SURCHARGE g 1A
REINSPECTION FEE $30.00
*Air Conditioners can not be placed in a side yard without'
written permission from adjoining property owner.
HEATING COM f�Axl
Signed /Be
Tel No. SAo2
Approved By/ Rough—In Date Final Date)
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
NOTE: #1 through #8 required when using a side vent furnace.
DIRMY .i.M SI -&CK V►�.i._ ..iTI`,
The undersiped hereby e+ ++.thattheexistingchimneyor stack:
1.
Has been care y examined
Yes ()
No
( )
2.
Is free from rust or deterioration
Yes ()
No
( )
3.
Has no foreign objects lodged within
Yes ()
No
( }
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 of
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:
HEATING CO:
Signed By:
Date:
City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
Mechanical Permit#
Residential Application
City of Fridley
See Back Side For Required Information
Date v Site Address: lvv
Theapplicant is: (cirlce one)
Owner Contractor
Property Owner.
e"
Address:
City;
State: Zip:
Phone: -S" �".L
Cell: Fax:
Contractor Information
-
Company Name:
4 M FkMhatlA •
Contact Person:
t,io 11-1 90512000
Address:
p' Pahview Ave'
. N155113
City;
State: Zip:1/d1
Phone:
Cell: Fax:
Email:
MN Bond# & Exp Date
Type of Work (circle one):
New Replacement Alteration/Remodel
Detailed Description of work:
Equipment Installed: MFG: W
VgdqLo Model: -,37r o -r Size/BTU: e�
MFG:
Model: Size/BTU:
MFG:
Model: Size/BTU:
Please check all that apply:
_Fireplace (gas) $15.00 New Gas Grill $10.00
A/C $25.00
Fireplace (wood) $35.00 _Gas Unit HTR $10.00
to Air exchanger $15.00
_Furnace $35.00 _Pool Heater $35.00
_Air
$35.00
_Gas Dryer $10.00 _Ventilator $15.00
_Boiler
_Chimney Liner $10.00
_Gas Piping $10.00
Duct Work $10.00
Gas Range/Oven $10.00
Permit Fee $
(Total from above -Minimum fee $35.00)
Surcharge ro 0.50
Total Due Make check payable to City of Fridley
This is an application for a permit- not valid unto processed
I hereby apply for a mechanical 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 accordance with the
approved plan in case of all work which requires review and approval of plans.
Signature of Applicant: Date:
Approval Inspector Signature: Date:
Please Note: Separate permits are required for Building, Plumbing, and Electrical work
no
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