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PRE 2010 DOCSVillage of Fridley, Minn. BUILDING PERMIT �° 1834 a Date: ��.� ............ Owner ... Builder ...... Address...................................... Address ...%L�f'........ .. LOCATION OF BUILDING No. .�. `' �. Street .... .......... Part of t ... ........ Lot ...... �3...... Block .......�........ Addition or Sub -Division ... ............... D Corner Lot ............ Inside Lot .... Setback ... Sideyard ............. DESCRIPTION OF BUILDING To be Used as- . ... .... Front .. . � Depth .. ��' Height 7. 4. Sq. Ft. ........ Cu. Ft. ........ ........... ....... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........ Type of Construction Z_03�ii ..... Est. Cost �6�®.® ® ....... To be Completed .................. ",In consideration of the issuance to me of a permit to construct the building described above, I agree to do proposed work in accordance with the description above set forth and in compliance with all provisions of nances of the village of Fridley. . sLr:��;�' �- .. In consideration of the payment of a fee of $../ dam` 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 village limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. 4. ..... Building Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. Origins Permit t®r FLUMBING AND GAS FI ® ANG N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit., Number, Sind and Location of Fixtures Stories F U Q J U Z rc O I tp 6 m t Z 4 m x Z W m Q r Q M 3 t Z 2 E O O LL 3 S N p ZZ_ OJ R' LL a u Z a�a a U m Z m 6 0 K J tl K y J 6 d < Q WATER HTR. GAS ELEC. Basement $t 2nd 3rd 4th Connected with Sewer -Cesspool Gas Piping for Openings Permission is hereby granted ` to do the plumbing and gas fitting in the building described in the stfitement hereto attached, upon the express condition that the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and this permit may be revoked at any time upon the violation of any of the provisions of said ordinances. By Order Of The Inspector Of Buildings Roughing in Inspection Date Inspector. Final Inspection Date Inspector. 4z 'M–"9 -v N? 5228 '5' F $* 166 I City of Fridley ---k- ,19–lb Owner &nM��� Kind of Building Used as— Lt� 1.164 To be Completed , 19— Estimated Cost Old -New. Building Permit Date Inspector of Buildings. City . Dept.ey :, DESCRIPTION OF WORK Number, Kind and Location of Fixtures � NO. RATE TOTAL Number Fixtures x $2.00 $ Future Fixture Opening x $1.50 $ New Fixture Old Opening x $1.50 34 Catch Basin .. x $3,25 $ V f N WATER NTR. GAS EIEC- Base z $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..... 3x $200 $ 2.00 Additional Fixtures ..... .............. x $ .75 $ Gas Flange to 195,000 BTU .............. x $5.00 $ install (1) gas grill & (2) lite 9.00 lot 2nd 3rd — — 4th _ °Future Connecam Opel Connected �vfth e Now Fixture, Old OpeningsI Sewer Cess osl p O PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $2.00 $ Future Fixture Opening x $1.50 $ New Fixture Old Opening x $1.50 $ Catch Basin .. x $3,25 $ Water Heater (Up to 99,000 BTU) x $3.00 $ New Ground Run Old Bldg. x $3.25 $ Electric Water Heater z $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..... 3x $200 $ 2.00 Additional Fixtures ..... .............. x $ .75 $ Gas Flange to 195,000 BTU .............. x $5.00 $ install (1) gas grill & (2) lite 9.00 REPAIRS S ALTERATIONS—Rotor to code Description .... ............................. 11.00 TOTAL FEE $ 53-84-s915.51 L« 62L0 NE rainbow Drive 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_ June 5, 1970 19— Owner Lovern Otten Kind of Building frame Used as residence To be completed about June 10 s 1970 Estimated Cost, $ 30vOO Old New. Building Perrin —_ _ ermit Nsr� Business Phone No ROUGH FINAL_// Is suadEcr PERM14'781 City of Fridley • AT THE TOP OF THE TWINS BUILDING PERMIT Ir � RECE O. • COMMUNITY DEVELOPMENT DIV. Ly------- : ! PROTECTIVE INSPECTION o/ c s 49®[®p' r SEC. 1, CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY �•--- �'� 612-560-3450 910-F15 6/26/78 JOB ADDRESS6XAN 6240 Rainbow Drive N.E. 1 LEGAL N::OXX. LOT 3 BL CK TRACT O A DITION SEE ATTACHED Sylvan Hills. DESCR. SHEET 2 PROPERTY O NER M R SSZIP PHONE Lauren Otten Vainbow Drive N.E. 3 CONTRACTOR MAILSS I p ICENSE NO. . Bob & Sons Roofi Inc. `5°93 Xerxes Avenue South , 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. SAME 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION X7 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK re -roof 9 CHANGE OF USE FROM TO STIPULATIONS 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 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, 1200', OO. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT a .60 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. CHECK FEE TOTALFEE 4p&PLAN - 1 9.60. SIGN TUREOFCONT C RORAUTHORIZEDAGENT (DATE) HEN PROP ALIDAT D THIS IS YOUR,P MIT '7 1-4 BLDG.INSP DATE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) Is • CITY OF FRIDLEY APPLICATION FOR RESII)ENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: BUILDER: Address: / ;?2LIe , %9/L, Address: Tel. No.: No.. LOT: Street: BLOCK: q ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS: 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: ° Estimated Cost: $ To Be Completed: da 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 represe -itions stated ii us application are true and correct. See reverse sidr additional ' fo-mation. 9 /9 DATE: !t SIGNATURE: suB�ECT P NO. City of Fridley 16 -787 AT THE TOP OF THE TWINS BUILDING PERMIT _ rp RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. t ( _ CITY HALL FRIDLEY 55432 It NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 9/27/82 JOB ADDRESS 6240 Rainbow Drive N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 3 4 Sylvan Hills Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lovern Otten 6240 Rainbow Drive N.E. 571-1768 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Minn. Exteriors 295 Highway #55, Hamel 478-6001 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 EIX ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Aluminum trim with. doors 9 CHANGE OF USE FROM TO STIPULATIONS 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 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 $4,133 $2.21 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- $50.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $52.71 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT - BLDG WSp PTE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATION FOR RESIDENITIAL BUILDIRG PEMITS (flew, Alterations, Additions, or Repairs) OWNER: BUILDER: ADORES S : h �, , i �, �/ ADDRESS: 0/5- IV 5� N TEL MO: _ — 26 54-- TEL NO: 4-1 Construction Location -STRICT NO: STREET: 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: Square. Feet: Depth: Height: Cubic Feet: Front: Depth: Height: Square - Feet: Cubic Feet: 0 -v - Type of Construction: 'WEstimated Cost: 7b Be Oonpleted: ! 0 Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SID£ OF SHEET . Mie 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 applic ton re true and correc DR;7 � O�� TE: (, SIGNATURE: to --r4- / Stipulations: MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00' PLUS $.50 STATE SURCHARGE Attach stack verification form with replacement furnace permits *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. Capacity Sq. Ft. EDR BTU HP richmond 9Sens Eiec., Inc. cd%,,. Company « Signed Tel. No. CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL RATE TOTAL (��) Job Address Furnace Shell and Duct Work, Burner (Also replacement furnace) $ 20.OG $ '�;6,,66 Department of Bu .ldings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Gas Piping $ 10.00 $ Tel. #571-3450 (piping needed with new furnace) Gas Range $ 10.00 $ 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 Gas Dryer $ 10.00 $ and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. * Air Conditioning (all sues) $ 10.00 $ I Fridley, Minn. IAN 19_ All Others/Repairs and Alterations OWNER ` 1% of Value of Appliance or Work $ KIND OF BUILDING COMMERCIAL/INDUSTRIAL USED AS 1% of Value of Appliance or Work $ TO BE COMPLETED ABOUT���-- TI TED COST State Surcharge $ .50 �q OLD NEW BUILDING PERMIT NO. PERMIT NO. 1V .2 TOTAL FETE $ Reinspection Fee ($15.00) $ Rough Insp. ��f� 0 i DESCRIPTION OF FURNA7eN. Date HEATING or POWER.P , Steam, Bot Wateri No. L Final Insp. Date Trade Name T/` S Capacity�l�✓i v (/ v Sq. Ft. EDR BTU HP Approval for Permit Total Connected Load Kind of Fuel BURNER - Trade Name Size No. MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00' PLUS $.50 STATE SURCHARGE Attach stack verification form with replacement furnace permits *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. Capacity Sq. Ft. EDR BTU HP richmond 9Sens Eiec., Inc. cd%,,. Company « Signed Tel. No. _ CHIM14EY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; 1. Has been carefully examined Yes W) No ( ) 2. Is free from rust or deterioration Yes fr�� No ( ) 3. Has no foreign objects lodged within Yes (✓j�f No ( ) 4. Is securely supported Yes No ( ) 5. Meets all current Code requirements for size and total BTU connected Yes No ( ) 6. Has Total heating BTU's ofJ �D All other BTU's TOTAL Rema rk s Company _ Signed By Date / SUBJECT City of Fridley 2 8479 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. `L COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r � � PROTECTIVE ',•J CITY HALL FRIDLEV 55432 NUMBER REV DATE PAGE OF APPROVED BY L 612-571-3450 910 -Fl 10/30 98 JOB ADDRESS 6240 Rainbow Drive 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 4 1 Sylvan Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kris Paradise 574-9683 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Trendy Roofing 210 Zachary Ln Plymouth 55441 591-9433 20027543 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 jx REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house and garage 18 S Tear -off 8 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 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 1542 $.77 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 $51.25 Fire SC $1.54 PLAN CHECK FEE TOTAL FEE License SC $5.00 1$58.56 SIGNATUREOFC TRACTOROR AUTHORIZED AGENT iDATEi WHEN PROPERL ALIDATEO THIS IS YOUR PERMIT BLD NSP W I OAfE S-GNATURE OF OWNER,1F OWNER SUILDERI IDATE. _1;69 r NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION 0� b` ConstructionAddress: C Legal Description: ((`�� Owner Name & Address: r ` c' S Tel. # Contractor: MN LICENSE Address:` 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: /(5 :�g e '(� . Construction Type: �� ���� es Estimated Cost: $- (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: G - �`''� °�' APPLICANT: Tel. #��\ TOTAL Y(1� STIPULATIONS: CITY USE ONLY Permit Fee $ � Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1 / 10th %) State Surcharge $ °/� $.501$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ S . DO $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 Y(1� STIPULATIONS: •..1I 1 Vr rnWLtT l IUN tAV 6431 UMWWS4 Ave NE l Fridley. MN 55432 l � 572-31604 ' hffftb /e loll Jan 1. Guth � PL ROM: NO. RATE TOTAL NIWFMM $ 7.00 amapuftmewmin $ 4LO ftwompum $ 5.00 amovemb $ 7.00 cd*9mm $ 7.00 Rd" VAw@r $ 7.00 3-1 Twtit $ 7.00 VAM TIa"6ypimice $10.00 vftwmmlw tic $ 7.00 9R1 w mG@w • G"" / $10.00 LO .00 Gaftaw $10.00 on $1000 lbw Ptv@riet { )Yes () No Typs $15.00 ALL OTHERS ANGOR REPAIRS AND ALTERATIONS 1-5% of VWw ®t Fbdure or Appianoe ®P o .00 SWe SumhwpS 50 TOTAL FEE '57) EslNreed®d CSI PEAW1 c= 47 PL COMP Y n�►l<:Nr`�� �,, �6 y � r SIGNED BY. Approved BY Rough -In Deb Fired Oft COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A COMMON VENT INFO ON BACK SIDE C17YOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 May 25, 2001 Mr. Robert Paradise 6240 Rainbow Drive NE Fridley, MN 55432 Re: Final Inspection at 6240 Rainbow Drive NE Contractor: Lee Stull Plumbing Dear Mr. Paradise: A plumbing permit was issued on January 13, 2001 to install a water heater at your address. According to section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the plumbing 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 State Plumbing 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. Sincerely, .�.//�i� %�.SEN • �TInspector DJ/mh �, CITY OF FRIDLEY INSPECTION DIV. 6431 Univero0ity Ave NE Fridley,MN 55432 (763) 572-3604, FAX (763) 571-1287 Urinal Basement 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 Floor " i..... Auto. Wash <'< Shower Tra Drain Washer -. S� T :: <_:: v Incl <. _............. NO. RATE TOTAL JOB ADDRES 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 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge 50 TOTAL FEE Effective On Jan 1, 2003 Water Heater Gas I Elec 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 cor ect. 20AY Owner SIGNED BY PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE THE! BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED _ ,I When reIn acing an ipAr-tong fi irance, 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 plastictPVC 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 exisfing cnmhusfinn air is sized and installed to meet the current codes and manufacturers specifications. Yes () No ( ) When required to onntaii a new .nmh ,c inn air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When Mcfalling.a new v _n ing nyc m, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers 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 #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 HEATING CO: Signed By: Date CINOE FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 June 2, 2004 Ms. Christine Paradise 6240 Rainbow Drive NE Fridley, MN 55432 Re: Final Inspection at 6240 Rainbow Drive NE, Fridley Contractor: Shiloah Water Co. Dear Ms. Paradise: A plumbing permit was issued on July 23, 2003 to install a water softener at your address. According to Section 4715.2800 of the State Plumbing 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 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 mark the permit "no inspection called for by homeowner after notification" and take no further action. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. Sincerely, DJ/mh