PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT 'N? /iiij2:)
Date: ..... ...... .... "'`....I�t✓_.. ...__._._ ._ ..._..._......_..__..
Owner: ........ !. .......: ... Builder Y
Address... •/-•• e••a -..;._ H .... _L.- Address........_............._............._.._........._......._..._.._.._......._.._..._......._......._......._.._....
Y LO TION BUILDING
No..... Street.._....4............................ Part'of t ..._-..... .......... ....
...._........_.
...... Block ....._...... .. Addition or Sub- i ' ion
Lot ....._......._.. ........._........ ---• .: .:. ..._.....
ComerLot .................................... Inside Lot ..................._.............. ... Otback . ...... . ..... ......... deyard ..... ... ---- ........ .............. ......
......
SewerElevation ..... .............. -............. _.............................................................. Fo dation Elevation ...................._ ........ ..... .......................... ........ ............. ....
_..
DESCRIPTION OF BUILDING .
To be Used as:
'm' X040
'.;; _ ............ Front ..... ._ .. Depth .. d _.. Height .... Sq. Ft. 1 .._ ''Cu Ft.,� ....._..
... Depth ...!....: Height ............. Sq. Ft. -- rw
F on o be Completed Cu. Ft. ..
Type of Construction .. Est. Co t
.. P ...................._. ._.................
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 compliance with all provisions of
ordinances of the city of Fridley.
.............---.....-....__ ------ _....... ........ _._._._.._.._.._.__......_._...___------._..._..............
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
within the city limits and this permit may be revoked at any time upon violate f 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.
cigejo,4
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name
Address Address
LOCATION OF BUILDING
r
t
No. a
Street Part of Lot
Lot C� 07
Block . Addition or Sub
J `• 4
Corner Lot -Inside Mot et Back Side -Yard
SEWER ELEVATION FOUNDATION UVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
on Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of
r.
trT�r�
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 Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representa-
tions stated in this ap ication are true an 1,
correct.
DATE ® SIGNATURE C
(A Schedule of Fee costs can -be found on the Reverse Side.)
4
City of Fridley, Mim.
BUH DING PERMIT
Date: Aug. 21, 1969
pymer; Tiiilliam D. B. Hanson Builder
Address 6171 Rainbow Drive N. E. Address
No. 6171 Street
Lot _ _ 10 — Block
Same
Same
LOCATION OF BUILDING
Rainbow Drive part0 f Lot
? Addition or Sub-Divisior
Corner Lot ._ Inside Lot
Sewer Elevation
Sylvan Hills
Setback -- Sideyard
Foundation Elevation
N° 10377
DESCRIPTION OF BUILDING
To be Used as:
Ra -Roof Front Depth Height Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Est. Cost 40Q . 00 __ 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 in compliance with all proyisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $-5..00 ., permit is hereby granted to William D. B.
HAAs ofd_ to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and. moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
A
Clarence Belisle °
NOTICE:
This permit does not corer the construction, Installation for whine, plumbing, gn heating, sewer or water. Be sure to we
the Building Inspector for separate permlh for then hems.
APPLICATION FOR BUILDING PERMIT
CITY OF MMLEY, MINNESOTA
OWNER'S NAME �l%�LGI/1�J �, /'. /��i�%�D� BUILDER/f✓��
ADDRESS 6,/7/ 1zA11v130w DR, ADDRESS Ss4/WLir
LOCATION OF BUILDING
No. �/ 7/ STREET 12,4i00%3®a-) P'?
LOT BLOCK
ADDITION OR SUBDIVISION
CORNER LOT /0 INSIDE LOT Z SETBACK SIDEYARD
SEWER ELEVATION TOP OF FOOTING
Applicant attach to this form Two Certificates of Survey of Lot and
proposed building location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Front Depth Height
Square feet Cubic Feet
Front
Depth Height
Square feet Cubic Feet
Type of Construction ,ESS//N6F Estimated Cost �OD°
To Be Completed /p - Z S-- 1,"
The undersigned hereby makes application for a permit for the work
herein specified, agreeing to do all work in strict accordance with the
City of Fridley Ordinances and rulings of the Department of Buildings,
and hereby declares that all the facts and representations stated in
this application are true and correct.
DATE 2!'- Z/— e7 SIGNATURE
r
(Schedule of Fee Costs can be found on the Reverse Side.)
d"
0
• 53 -8h -s-915.51
City of Fridley su"EGT
AT TW TOP OP THE TWIN$
tu-------; COMMUNITY DEVELOPMENT DIV, PLUMBING PERMIT APPLICATION
i t t PROTECTIVE WSftCTN}N WT.
i --- CITY HALL sR10L9Y $642
DATE P"E OF APPROVED by
Job Address 2115/73 1 1 800
Contractor
Kind of Bu
Compion
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6171 N. E. Rainbow Drive
William Hanson
mll'vw,Er�
Frame
5-30-7L
I i II i 1
I �
I
t
I
I
,•
�
10. Go
s
s 7,33 MARQUE u TF A
se
Gas Fitting Fees:
lst 3 Fixtures x $2.00
I -
Additional Fixtures x $ .75
f
Gas Range -199,000 BTU x $5.00
Repairs & Alterations I
See IDescription: Install Gas Grill Code 5.00
Class -Am Surcharge , a0
State Surcharge .50
TOTAL FEE $ 5.50
,The undersigned hereby makes application for a permit
for the work herein specified, agreeing to do all work
in strict accordance with, the City Ordinances and Tulin
of the Department of Buildings, and hereby declare that
all'the facts and representations stated in this
appycs4gg_4re true and�ect.
Zi C;e :rye
-S ignat-urTe V Date
Res.
Estimated Cost
10. Go
Plumbing Fixture Rates: NO.
RATE TOTAL
Number Fixtures
x
$2.00
Future Fixtures
x
$1..50
New Fixture -Old Open.
x
$1.50
Catch Basin
x
$3.25
Water Heater -99,000 BTU
x
$3.00
Ground Run Old Bldg.
x
$3.25
Elec. Water Heater
x
$2.00
Gas Fitting Fees:
lst 3 Fixtures x $2.00
I -
Additional Fixtures x $ .75
f
Gas Range -199,000 BTU x $5.00
Repairs & Alterations I
See IDescription: Install Gas Grill Code 5.00
Class -Am Surcharge , a0
State Surcharge .50
TOTAL FEE $ 5.50
,The undersigned hereby makes application for a permit
for the work herein specified, agreeing to do all work
in strict accordance with, the City Ordinances and Tulin
of the Department of Buildings, and hereby declare that
all'the facts and representations stated in this
appycs4gg_4re true and�ect.
Zi C;e :rye
-S ignat-urTe V Date
Air ConMenhig Synems cmd Davicu
PARTIAL RATE SCHEDULE
GRAVITY WARM AM-
KATZ
TOTAL
Furnace Shell & Duet Worts
410.00
�
Replacement of rurnace
6.00
Repairs & Alterations ---up to $500.00
600
R
Repairs & Alterations each add. 2500.00
300
$
MEML WADI AM
Furnace Shell & Duct Work to 1x0,000 BTU
each add. 60,000 BTU . .. ......
3.0U
;
Replacement of Furnace
6.00
$
Repairs & Alterations—up to $500.00
6.00
$
Repairs & Alterations each add. $500.00
3.W
$
STEAM or HOT WATER SYGTEM
Furnace Shell & Lines—to 400 sq. ft. F,DR Steam ?10.00 $
Furnace Shell & Line --to 640 sq. ft. EAR Hot Water 10.00 $.
Each add 200 sq. ft. EDR Stearn -.1. on $
Each add. 320 sq. ft. EDR Hot Water 3.00 $
OIL BURNER—to 3 gal. per hour
over 3 gal. per hour—Sae Fee Schedule _
GAS BUZZ (up to M,0W BTU) 6 QtD $
Deasy 199,000 RM Se Fri, Schedule
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures $g 200 $
Additional Firtures ,76 $_! -
Gas Range to MAW Wo $
-State Surcharge .50
1;TT0H
rAN HMTMG SYSTEM Goo Too 1k /6-0 0
=mLaTma
ALTS i 47TONS &REPAIRS 'DOTAL Pm $ 1® -
-LVAIYf l
DaPt. of Bldg& Phosam i
City of Mdley:
The undersigned hereby makes application for a permit for the work hereir-'
specified, agreeing to do all work in strict accordance with the .City Ordinance*
and ruling of the Department of Buildings, and hereby declares that an the fad
and representations stated in this application are true and correct.
Fridley, Adan lip
Owner Uj t L L i Ai'`i H At-) S a
Kind of Building 3 73L—DP—Oa— (�At I t3LElZ
Used as Rt! &1t7Et,,�,CC
To be completed about, Aute • 3o'11 Pl 74-
Estimated
4Estimated Cost:, $
Old --New. Building Permit No. Permit No.
HFAT1NG or POWER PIANTS--Steam, Hot Water, Warm Air—No
Trade Name �F_N 0 Y_ Size No
Capacity 7-6600 TSTv SqPM. E D.R B'I'[T H.ya
Total Connected Load Kim of Fuel
BURNER — Trade Name Size Yeo
Capacity _ Sq. FL Z.D.R
BM—
S ud
to aM—odea)
SUBJECT
PERMIT NO.
City ®f Fridley
2 0 4 9 2\,
AT THE TOP OF THE TWINS
BUILDING PERMIT
t
EIPT
� COMMUNITY DEVELOPMENT DIV.
6 _
v PROTECTIVE INSPECTION SEC.
3 /
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED By
612-571-3450
910-F15
3090
7//
JOB ADDRESS 6171 Rainbow Drive N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
10
2
Sylvan Hills SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Bill Hanson 6171 Rainbow Drive N.E. 571-2789
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
D & D Home Improvement 7401 Central Avenue N.E. 784-7543
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 ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
Reroof Dwelling (22 Squares)
9 CHANGEOFUSEFROM TO
STIPULATIONS
On all new roofs or tear -offs and replacement roofs,
State Code requires that 2 layers of 15 lb, felt,
mopped together, be installed to a point 24 inches
up from exterior wall line, or the use of other
approved underiayment membrane.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SQ. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
VALUATION SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$1,100 $.55
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$27.00.
STRUC OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
ki�)/AAA, A //
/I $27,55
GN TU E OF CON i RACTOR OR AUTHORIZED AGENT (DATE)
W N PROPER D TE IS MERMIT
Q
E& INSP DATE
SIGNATURE OF OWNER OF OWNER BUILDER) (DATE)
NEW [ ] Effective 1/1/90
ADEN [ ] R-1 AND R-2
ALTER [ ] Building Permit Application
Construction Address: 1�e/�l AVAU) 0//&
Legal Description:
D.
Owner Name &Address: 11
� Q0 7Jel. #
Contractor: LZ �� Tel.
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
m
LIVIM AREA: Length Width
Height
Sq.
Ft.
GARAGE AREA: Length Width
Height
Sq.
Ft.
DECK AREA: Length Width
OTHER:
Hgt/Ground
Sq.
Ft.
Corner Lot [ ] Inside Lot [ Ft. Yd Setback Side Yard Setbacks
Type of Construction: - - Estimated Cost: $ //0 d
Approx. CmTpletion Date:OF
,
Proposed Driveway Width If New openip& Is Desired: Ft. $ $
Permit Fee
$ %, o o
State Surcharge
$ 1 Y
SAC Charge
$
Driveway Escrow
$
Park Fee
$
Sewer Main (urge
$
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
SUBJECT
PERMIT NO.
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
PERMIT
3�32
r
PT NO.
`
COMMUNITY DEVELOPMENT DIV.
f PROTECTIVE INSPECTION SEC.
1 . �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
i ��"' �'� CITY HALL FRIDLEY 55432
.--•�
1 612-571-3450
910-Fi5
10/1/99
JOB ADDRESS
6171 Rainbow Drive
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
12
2
ISylvan Hills - 1
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Bill & Kathleen Hanson571-2789
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Country Craft Homes LLC 21236 Cleary Rd NW Anoka 55.303 753-9709
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
O NEW O ADDITION O ALTERATION AM REPAIR 0 MOVE 0 REMOVE
B DESCRIBE WORK
Reroof house and garage (25 S) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED 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
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
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
$2185
$1.09
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
83.25
Firm SC $2.19
PLAN CHECK FEE
TOT EE
�11.NAT�.IIFCON�T.AITO.�O.AQT.�.ZIENT
Licens $5.20
.53
OAYE
HEN R
BLD NSF' '
VALIDA IS IS YOUR PERMIT
MATE
S-GNATURE OF OWNER OF OWNER BU4DER. iDATE7
do
NEW[ l ~ Effective 5/10/99 ,
ADDN [ ] CITY OF FRIDLEY �Av 3
ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 69
BUILDING PERMIT APPLICATION
Construction Address: o/'71 ,'Pr!!I & rrl cl /.,,. � /" K 5��� -72-
v
Legal Description:
Owner Name & Address: all r L, o*h L e*e ,�- H4 #t _ r , x Q'71 � «s bry ' Tel. # ir' i -3-7/-
Contractor:
S%/ -Contractor: ����� ,�, ,�� MN LICENSE #
Address.ZI,Q-?,(
�✓ 4h6k- At v 5 ���i Tel. #,04 fid"
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
161111111111 N 1 79
LIVING AREA:
Length
Width Height
Sq. Ft.
GARAGE AREA:
Length
Width Height
Sq. Ft.
DECK AREA:
Length
Width Hgt/Ground
Sq. Ft.
OTHER:
T& tr &rp
-, Ad-®'%' a S
License Surcharge
Construction Type: 7",e; P
er=?
Estimated Cost: $-
$
Driveway Curb Cut Width
Needed:
Ft. + 6 Ft = Ft x $ _
$
DATE: % - APPLICANT: Eoft it�I'`� 7' tfY �� Tel. #OX - 2S`7 -
TOTAL
STIPULATIONS:
J' p-0
CITY USE ONLY
Permit Fee
$ 83,o�g
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ /, (
$.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC Unit
License Surcharge
$ ® 0
$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
STIPULATIONS:
J' p-0
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.
TEL # 41.�g - -7& �T
CITY OF FRIDLEY INSPECTION DIViSION l
Effective On January 1, 2000
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS j� r��,
RATE SCHEDULE
OWNER S ck�
Residential Rate
TOTAL
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace $ 30.00
$
BUILDING USED AS r
(Side Vent - Fill Out Back)
ESTIMATED COST -41 �37-0 , 00 PERMIT NO. 12
Gas Piping (Needed with new furnace, $ 10.00
$
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNER
Gas Range $ 10.00
$
No. of HeatinUnits Circle One (Steam) (Hot Water) ar Air)
Gas Dryer $ 10.00
$
Trade NameLtofti et' Size No,
*Air Conditioning - All Sizes $ 25.00
01D
BTU HP EDR
Fuel -;-_ Total bonnected Load _fj' m
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
TOTAL FEE
, "D
representations stated in this application are true and correct.
$
DATE '� a
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.
TEL # 41.�g - -7& �T
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.
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination.
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.
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications.
Ye:No ( )
YeSANo( )
Yes No( )
Yes () No ( )
Yes O 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 •
JAN -05-2000 14:59 FROM CITY OF FRIDLEY TO 5712547 P.03/03
COMMON VENT, VENT CONNECTOR AND COINBU4TI0N 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 KNo ( )
The venting system is plastic(PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes o ( )
rsi� ���'®
The undegned also verifies that the replacement unit Is a listed assembly // ``
and meets the current codes and manufacturer's specifications. This does
include AGA (SAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. YesXNo ( )
The @xistina combustion air is sized and installed to meet the current codes
and manufacturer'ri specifications. YeskNo ( )
When required to install a new combustion &,:d will be sized and installed
To most the current codes and manufacturer's specifications. Ye9A No( )
When IIgkilling a new ventinc system, the undersigned hereby verities that --
a Is a listed assembly and meets the current codes and manufacturers
specil'Ications. This does include AGA-GAMA Category.I Central Furnace,., --
Venting Tables for fan assisted and natural draft appliances. Yes No O
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 RNo ()
ARptiance Type and Size/Common Vent and Vent Connec�b�ha 0 i�
Appliance #1 Type „-✓r^��c-`�- BTU Input EdiaJI) Fan Assisted or Nat �,�
pl
A iance#2 Type c., _ T l4k.� BTU input - cJ Fan Assisted or Nat y
Apppliance #3 Type BTU Input Fan Assisted or Not
Total Appliances Total btu Inputr'l i9 l
Common Vent Type ` 414A- Vent Height ice— Diameter inches
Appliance #1 Vent Connector Helght �`ft Length ft Diameter in Type _, ,�►��
Appliance 02 Vent Connector Height Z ft Length _),,,�ft Diameter �_in Type . Cool� t s�
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By:
ow
r�.
Date: I -'ct)
TOTAL P.03
0000 00-00-00
Arid
GiYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
May 25, 2001
Ms. Kathy Hanson
6171 Rainbow Drive NE
Fridley, MN 55432
Re: Final Inspection at 6171 Rainbow Drive NE
Contractor: Action Heating & Air Cond Inc
Dear Ms. Hanson:
A mechanical permit was issued on January 14, 2000 to install a furnace and air conditioner at
your address. According to section 305 (a) of the 1991 Uniform Mechanical Code, a final
inspection shall be conducted on the mechanical work authorized by this permit. As of this date,
no inspection has been called for.
The permit fee that was paid covers the inspections to make sure the work was completed
according to the Mechanical Code. 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 expire the permit and no
further action will be taken.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
DJ/mh
Building
Inspections
7.63-572-3604
I�LI:f�L
SITE ADDRESSLkL
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERWM TYPE
TYPE OF WORK:
:)ETAILED DESgP�
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
ADDRESS
0 OWNER
ADDRESS: / CITY,
PHONE:���1
n
COMPANY NAME: l
CONTACT PERSON:
STATE LICENSE #_
PHONE
INGLE FAMILY 0 TWO FAMILY
0 NEW 0 REPLACEMENT
WORK
DATE
C
FAX
0 TOWNHOUSE
>(ALTERATION/REMODEL
Permit No.,
Received By:
EVEN
ATE ZIP,
PER MS 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)
d0..._.._..
Labor cost under $300 = $15..00..: Labor cost between $300 to $500 = cost of labor X.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES' (INDICATE TOTAL
NUMBER OF EACH BELOW) MODEL: SIZEBTU
Equipment Installed MFG: SIZE/BTU
MFG: MODEL:
MFG: MODEL: SIZEBTU
A/C $25.00 _FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00
—AIR TO AIR EXCHANGEER $15
_ _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_BOILER $35.00 _FURNACE $35.00 _GAS UNIT HTR $10.00
_CHIMNEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $1500
THIS IS AN APPLICATION FOR A PERMIT 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
ic tion for a permit and work is not to start without a permit; that the work will be in accordance with the
not a permit but only an appl
approved plan in the case. of a work w�iich requ�ir�s review and approval of plan
SIGNATURE OF APPLICANT
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
i
$ 1,'� "
M"vR'Akd . nmvava+Han:� ;a....,�.rv,: :. .. .. __.
Number of fixtures @ $10.00
x $10.00 = $
Fee
Permit
•
$ 50
Number of fixtures @ $15.00
x $15.00 = $
Surcharge
DUE
$
Number of fixtures @ $25.00
x $25.00 = $
TOTAL
•50
Number of fixtures @ $35.00
x $35.00 = $
State Surcharge = $ .50
Total = $
THIS IS AN APPLICATION FOR A PERMIT 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
ic tion for a permit and work is not to start without a permit; that the work will be in accordance with the
not a permit but only an appl
approved plan in the case. of a work w�iich requ�ir�s review and approval of plan
SIGNATURE OF APPLICANT
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
i