PRE 2010 DOCSDate:
Owner:
City of Fridley, Minn..
BUILDING PERMIT
DECEMBER 30, 1966
Builder
7 a .
1�®
.9-124
CHARLES E. JOHANSON
Address Address 160 HAMM CIRME N. E.
FRIDLEY, MINNESOTA 55432
LOCATION OF BUILDING
No. 2 _ Street RICE CREEK BOULEV --- Part of Lot
Lot Block 2 Addition or Sub -Division _____ HOLIDAY HILLS r 2ND ADDITION
Corner Lot _ Inside Lot — X Setback Sideyard __.. 10
Sewer Mevation ___ 845.00 _239MDMh Mevation 848.00
TOP OF FOOTING
DESCRIPTION OF BUILDING
To be Used as:
DWELLING Front _j2_ Depth 25 Height 20 Sq. Ft. 13,000 cu, Ft, 26, 000
Front Depth Height Sq. Ft. _— Cu. Ft.
Type of Construction FRAME Est. Cost_ $17,000.00 _ To be Completed
In consideration of the issuance to me of a permit to constuet a building escri above, I agree to do
the proposed work in accordance with the description above s/form any co pli ce with all provisions of
ordinances of the city of Fridley. / // //
in consideration of the payment of a fee of $ 26.00 , permit is W96 granted to—CHARLES E.
JOHANSON 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 reg location, construction, alteration, maintenance, repair and moving of buildings
limits within the city and is permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
CLARENCE BELISLE
Building Inspector
NOTICE:
This permit does not cover the construction, instalFation for wiring, plumbing, gas heating, sewer or water. Be sure to we
the Building Inspector for separate permits for these items.
Date:
Nov. 24, 1967
City of Fridley, Minns
BUILDING PERMIT
owner: _Charles Johanson Builder Same
Address 160 Hartman Circle Address Same
-Ye -;� r",/ -
N° 9565
LOCATION OF BUILDING
No. — 436 — Street - Rice reek Blvd. -- Part of Lot
Lot_ 7 _ Block 2 Addition or Sub -Division — Holiday Hills, 2nd
Corner Lot —_ Inside Lot — X Setback _ _ Sideyard ---
Sewer Elevation 845.01 As= 848.01
Top of Footing
DESCRIPTION OF BUILDING
To be Used as:
Dwelling Front —18L Depth 39' Height 20' Sq. Ft 1320 Cu. pt 23680
Garage Front 20 Depth —1-41 -4 Height 10' Sq. Ft 480 Ca. Ft. 4800
Type of Construction Frame Est. Cost ` $18, 000 __ To be Completed
SEWER LOCATION - 78.5' North jbf Manhole
WATER LOCATION- 88.5' North of Manhole
In consideration of the issuance to me of a permit to cons et the building des above I agree to do
the proposed work in accordance with the description above se�orihd /comp � e wi a'll provisions of
ordinances of the city of Fridley. /�
In consideration of the payment of a fee of $ 43.00.= permit is hereby granted to Charles
Johanson to construct the building or addition as described above. This perndt 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 � city limits and this permit may be revoked at any time u violati of y;of thelprovisions of said
dl !�_ z.
GAS
BuildingROMW
Official
NOTICE:
This permit does not cover the construction, installation for whine, plumbing, gas heating, sewer or water. Be sure to an
the Building Inspector for Separate permits for these Items.
P
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME ®�r�}/(f � /l� Bt7 TLDER � � � ° V ®®� !}/Us OA)
ADDRESS ..� D.
'ADDRESS
LOpATION:OF YLDiI
i3C
NO.STREET fCi�;;�[ I�NC�i" E 7� % - i RT -0f' LOT
s
LOTBLOCKADDITION OR SUBPIVIS1ONO�l�A e•
CORNER LOT'�d
SETBACK + ` SIDE-tAtD
SEWER ELEVATION FOUNDATION ELEVATION
��Le't)
Applicant attacl 4 this orm Two Certificatep. oaf Sugvey,..gf; Lot_..and proposed
building, :i.ocetion c�.ravn. cm 'tiies'e , Certtficates ; z _ a :.Sr�
sq;
Imbo I* BUP_D*
To Be Used A os ..
rout Deph
Cu'.
Front'�0 . Depth 7 Re h l
v.Mr........
Sq. Ft. ® Cuk. Ft.�OD
Type of Construction �" �'�}l?��r :: �a imate& .Coat-
�4wll.rir.r+� �IrArl�r����
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 Catty 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 "rrect.
(Schedule of Fee Costs can be found on the Reverse Sid�-
0 (�
lo� ea &C
r . s
Ci Fridley
City of Fre Y
Application for Plumbing and Gas F'itttng Permit
Dept. of Bldgs. Phone 560-3450
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures Location
61
x $3.25
$
Water Heater (Up to 99,000 BTU) ......
x $3.00
12
New Ground Run Old Bldg . ............
x $3.25
$
Electric Water Heater
a $2.00
w
GAS FITTING FEES:
w
Z
z -
•
$ -�
WATER HTR.
x $ .75
$
Base
x $5.00
$
f
1st
2nd
3rd
4th
• Future Connection Openings
e New Fixture, Old Openings I
Connected with
Sewer
Cesspool []
PARTIAL RATE SCHEDULE
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
$ 2 U
New Ground Run Old Bldg . ............
x $3.25
$
Electric Water Heater
a $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..........................
% x $2.00
$ -�
Additional Fixtures ....................
x $ .75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description...................$
.............................
TOTAL FEE $-
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- % /—t" C! , 19 � 3
Owner / G 6 c ) /� U /-z/
Kind of Building
Used as 1
To be completed about
Estimated Cost, $
Old—New. Building Permit No
Permit No.
Signe
By
Bu ' s Phone Nom���
ROUGH
FINAL
C�
Application for Power Plants and Healing, Cooling, Ventilation, Refrigeration and
t Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ........................... $10.00 $
Replacement of Furnace ............................. 6.00 $
Repairs & Alterations—up to $500.00 .................. 6.00 $
Repairs & Alterations each add. $500.00 ............... 3.00 $
MEGH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ Z6 z
each add. 60,000 BTU ....................... 3.00 $
Replacement of Furnace ............................. 6.00 $
Repairs & Alterations—up to $500.00 ................. 6.00 $
Repairs & Alterations each add. $500.00 .............. 3.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ......
$10.00
$
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water
... 10.00
$
Each add. 200 sq. ft. EDR Steam ......................
3.00
$
Each add. 320 sq. ft. EDR Hot Water . ................
3.00
$
OIL BURNER—to 3 gal. per hour ........................
6.00
$
over 3 gal. per hour—See Fee Schedule
o
GAS BURNER (up to 199,000 BTU) .......................
5.00
$
over 199,000 BTU See Fee Schedule
GAS FITTING FEES:
NO RATE TPT3,L
1st 3 Fixtures ......................
x$ 2.00
$-6 -
Additional Fixtures .................
x .75
$
Gas Range to 199,000 ...........
x$ 5.00
$
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
See Fee Schedule
TOTAL FEE $$
Dept. of Bld,,ge. Phone 560-3480
Location �({36
City of Fridley:
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 representations stated in this application are true and correct.
Fridley,
Owner
Kind of Building
Used as
19/0
To be completed about
Estimated Cost, $ �L! z?,
Old New. wilding Permit No. -I� Permit No.
DESCRIPTION OF WORK
HEATING or POWER PLANTS --Steam, Hot Water, Warm Air—No
Trade Name Size No- 7r3
61
Capacity Sq. Ft. E.D.R BTU H.P.
Total Connected Load -11 q Z Rind of Fuel A%,i-7—
BURNER — Trade Nam Size No- Z ® C3
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVER)
Signed
<a Business Phone No.
Compliments of North Central Public Service Co.,
HEAT LOSS CALCULATIONS DEPARTMENT of
Weatherstrips A,SZ.V.E. Construction No.
Guide
Windows
Doors
Reference
Out. Wall
Wall)
Ceiling
( Roof
Floor
Yesr-No
I Yes --No
19........ 11
(Int.
I
] FL 11 Room
I Length ,.!gL O Width /L% Height
g' II
I Fl.
Windows aA Doors—Crackage and Area
Doors—Crackage and Area
No.
Widtthh Height No. of
of pa�ie of pane lights
Lineal ft.
of crack
Area
No. of
lights
9Y �v
Area
sq. ft.
Area
sq. ft.
tz
COO
Btu
Infiltration -
Btu
Infiltration
o
`� 0
Glass
�®
�
�
wall
%
Infiltration �.-
Glass
(� (�
5
Net`eXp. wall
Exp. wall'
TX
6 ®
Wall
%
t (0
i
Int. wall
Ceiling IMC9
Int. wan
/2
23 60
Floor
('
;
Int. wan
'Dotal Btu:
Floor
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
r i FL I k t- Room I Length //_ Width /Height
Windows and
Doors—Crackage and Area
,
No.
Width
of pane
Height
of pane
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
Area
sq. ft.
tz
Coef.
Btu
Infiltration
Coef.
Btu
Infiltration
& Q
Coef.1
Btu
Infiltration �.-
Glass
(� (�
5
.
Exp. wall'
TX
6 ®
Net exp. wan
%
t (0
i
Int. wall
Net exp. wall
Int. wall
Int. wan
ilixig 9
it`iaor
I qq.11Q
0
Total Btu.
Ceiling
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I
/ Fl. I a I-! Room I Length 4/ . Width <;�'" Height
Windows and
Doors—Cra.ckage and Area
_
_
No.
IWidth
of pane
Height
of pane
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
Area
sq. ft.
tz
Coef.
Btu
Infiltration
Coef.
Btu
Infiltration
& Q
Soo
Glass
:.
Infiltration
.
Exp. wall
TX
6 ®
C Q
Net exp. wan
t (0
B
Net exp. wall
Int. wall
Int. wan
V
I qq.11Q
Ceiling
Ceiling
Int. wan
Floor
�]
Ceiling
Floor
Total Btu.
.3
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
artr
VII
VILLAGE
Insulation
Kind How Applied
II 1'
Room I Length /,A Width 1,57 Height
Windows and Doors--Crackage and Area.
Doors--- r ckage and Area
_
_
Width Height
No. of pane of pane
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
Ll s- 11�): q
Lineal ft.
of crack
Area
sq. ft.
tz
Coef.
Btu
Infiltration
Glass
Coef.
Btu
Infiltration
Exp. wall
6 ®
C Q
Glass
Exp. wall
Net exp. wall
Int. wall
V
I qq.11Q
1 3
Ceiling
Int. wan
Net exp. wall
Ceiling
Floor
/ /
.3
t ��
Total Btu.
Total Btu.
ceiling°
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I
I Fl. IA-/ Roam I Length 1 3 Width I V/ 1AAght
Windows and
Doors--- r ckage and Area
_
_
No.
No.
Width
of ane
Height
of pane
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
tz
Coef.
Coef.
Btu
Infiltration
6 ®
C Q
Glass
Exp. wall
06
V
Exp. wan
Int. wan
Net exp. wall
Ceiling
7
/ /
.3
Int. wan
Total Btu.
ceiling°
Floor
8F. aZ4
U
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I
FL I Room I Length Width , Height
Windows and
Doors--Crackage and Area
_
_
No.
Width,
of pane`
Height
of pane
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
Coef.
Btu
Infiltration
Glass
Exp. wall
Net exp. wan
Int. wan
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I
Compliments of North Central Public Service Co.,
HEAT LOSS CALCULATIONS DEPARTMENT OF
Weatherstrips A.SJLV.E. Construction No.
Guide
WindowsDoors Reference Out. Wall IInt. Wall Ceiling
Yes_NO I Yes—No 19........ l I I
Fl. I Room I Length 17 Width V Height $Z ° .'r
Windows Ed
Doors—Crackage and
_
Width
of pane
No.
Width
of pane
Height
of pane
No. of
I lights
Lineal ft.
of crack
Area
sq. ft.
ly
I
e -s 5-
,
7
i
Coef.
Btu
Infiltration
Btu
Infiltration
66
fro
Glass
®r
a
Coef.1
Btu
Coef.1
Btu
Infiltration
4,01
36 0
Glass
y
02 0
Glass
Exp. wall
�6
j
Exp. wall
AM
0/
14-4
Int. wall
Net exp. wall
Total Btu.
C
/
Floor
Int. wall
Floor
Total Btu.
Ct
a 6�
Ceiling
Total Btu.
Floor
®!b
031/
7 1(®
Total Btu. 1 Y-5 04
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
JZ Fl. I Ra 7-A Room I Length ? Width , F Height
Windows and
Doors—Crackage and Arm
No.
Width
of pane
Height
of pane
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
�--
36
;Z
-�
e -s 5-
,
7
i
Coef.
Btu
Infiltration
Btu
Infiltration
66
fro
Glass
®r
a
Coef.1
Btu
Infiltration
4,01
36 0
Glass
y
�
�0-
Exp. wall
�6
Ceiling
Net exp. wall
AM
0/
14-4
Int. wall
j
Total Btu.
C
Ceiling
Floor
Ceiling
Floor
Total Btu.
Ct
a 6�
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I
n Fl. 1 /2 z --:.l Room I Length / "idth /I/ Height )'
Windows and
Doors—Cra.ckage and Area
No,
Width
of pane
Height
of pane
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
9 Y
5�� 6
e -s 5-
,
7
i
Coef.
Btu
Infiltration
Btu
Infiltration
66
fro
Glass
®r
a
Coef.
Btu
Infiltration
LO
S Q
Glass
y
�
113 OIL
Exp. wall
Ceiling
Net exp. wall
AM
Floor
11-
9J .11-
Int
Int. wall
j
Total Btu.
C
Ceiling'
Floor
Ceiling
Floor
(�
JL1 S
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Roof I Floor
CITY
-TOWN
VILLAGE
Insulation
Kind I How Applied
FL I lV,,� Room I Length /';.Width /*- Height
Windows and
Doors--Crackage and Area
Widtheight
No. of pane
No. of
of pane lights
Lineal ft.
of crack
Area
sq. ft.
Area
ft.
J('
/
�sq.
e -s 5-
,
7
i
Coef.
Btu
Infiltration
Btu
Infiltration
66
fro
Glass
®r
a
C
Exp. wall
(�
Net exp. wall
/476,
/
f
Int. wall
113 OIL
Net exp. wall
Ceiling
/
Int. wall
Floor
i b
Int. wall
j
Total Btu.
C
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I
FL I .a m jb%wRoom I Length .27 Width ) -2_ Height
Windows an&
Doors—Crackage and Area
No.
No. Width He
Of pane ofpane
No. of
lights
Lineal ft.
of crack
Area
ft.
r
�sq.
e -s 5-
,
7
i
Coef.
Btu
Infiltration
o
66
a7-00
Glass
Infiltration
,'-�
Exp, wall
113 OIL
Net exp. wall
Net exp. wall
Int. wall
i b
Int. wall
Ceiling
Floor
Ceiling
Total Btu.
JL1 S
Floor
7
®!b
Total Btu. I/ / 7' /
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FL I Room I Length Width Height
Windows and
Doors—Crackage and Area
No.
Width
of pane
Height
of pane
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
i
e
o
Coef.
Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
11
SUBJECT
P 0.
City of Fridley®
19073
AT THE TOP OF THE TWINS
BUILDING
PERMIT
(�{I
Ir?
`v ______ COMMUNITY DEVELOPMENT DIV.
r � PROTECTIVE INSPECTION SEC.
�
1 . i
CITY HALL FRIDLEY 55432
�•j
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
7/20/87
i
JOB ADDRESS 436 Rice Creek Blvd.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
7
2
Holiday Hills 2nd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Dean Eberhard 436 Rice Creek Blvd.
571-8307
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Jim Konold Construction 88.2998 North.Victoria, Roseville 484-7521
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION Q. REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Rproof Dwellin
9 CHANGEOFUSEFROM TO
STIPULATIONS
Roof can be the 2nd layfer but not the 3rd.
Install ridged galvanized
Valleys.
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 80 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
ISTALLS 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
$1,350
$.68
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-
$23.50
STRUCTION OR THE PER ORMAN OF ONSTRUCTION.
CHECK FEE
TOTALFEE
2`� a ^�%
$24.18
SIGNATURE OF CONTRACTOR ORAUTH RIZEDAGENT (DATE) y.
LfLAN
WHEN PROPERLY
V ATED THIS IS YOUR PERMIT
BLDG iNSP
DATE ��
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
11
NEW
ADDN.
[ ]
[ ]
City of Fridley Effective 4/1/86
R-1 AND R-2
ALTER.
[ ]
Building Permit Application
Construction Address: e_t4 / e' �� VV
Legal Description: �� � '� �'� , /-F�Gisa.6�+ �� �
,� /� �.J � Tel. # J'P�
Owner Name & Address: �_
Conttactor• '7-�! �v� G /� C vim? `Q 7'e Tel. #
Address:
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: IV,(2H 0 cr-F 0 ;2 P
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback
Type of Construction: `F ® �'�� ��°Estimated Cost: $-
'e��� • O G
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
DATE: S-2 APPLICANT: Tel.'' ?��/
CITY USE ONLY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ ,23 .so
•
Fee Schedule on Reverse Side
25% of Building Permit Fee
$.50/$1,000 Valuation
$525 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
CITY OF FRIDLEY INSPECTIOU DIV.
6431 University Ave NE
Effective On January 1, 1991
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING. SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
Gas Piping (Needed with now furnace)
Gas Range
Gas Dryer
Rate TOTAL
$ 20.00 $ _
$10.00 $
$10.00 $
$10.00 $ _
*Air Conditioning - All Sires $10.00 $
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $
Commercial/industrial
1 % of Value of Appliance or Work $
State Surcharge $ .50__
TOTAL FEE $_26. oz
MINIMUM FEE FOR AHY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
*Air Conditioners can not be placed In a side yard without
written permission from adjoining property owner.
JOB ADDRESS��' ��10� 643EK- 12LV2
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 ruling of the Building Division, and hereby declares
that all the facts and representations stated in this application are
true and correct.,1991
OWNER j�j�� GfKK! �
BUILDING USED ASS
ESTIMATED COST 6W- 02 PERMIT NO. �13
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water(Warm Air)
Trade Name UEN OA Size No.,
BTU HP 3 ---EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
Richmond & Sons Elec., Inc. dba:
Golden Valley Iltg. & Air Cd.
HEATING C PAY M 6 es RrnarlwAU
Crystal, MN 55429
�..CJ��-/ Phone 5v5'
Signed By %f No.
Approved By Rough -In Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHIMNEY. AND STACK VERIFICATION
Al
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully 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 ( )
5. Meets all current Code requirements for
size and total BTU's connected Yes No ( )
6. Has. total heating BTU's of t%d GVy
All other BTU's
TOTAL BTU's 675D
Remarks
List Alterations Being Done:
HEATING COMPANY ( h r Sons Her- Inch +.
Golden Valley Htg. & Air Cd
Signed By - 5i82 west Broadway
Date
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1993
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 4'9_X117 C� BLVD -
RATE 9CHEQUILE
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 $ representations stated in this application are true and correct.
:1,1993 '
Gas Piping (Needed with new furnace) $10.00 $
OWNER D,1j
Gas Range $ 10.00 $
BUILDING USED AS "
Gas Dryer $ 10,00 $
ESTIMATED COST i v PERMIT NO. 11,32
*Air Conditioning — AQ Sizes $10.00 $
DESCRIPTION OF FURNAgE ALIO OIBURNER
All Others/Repairs & Alterations (LIST ON BACK)
1% Value Applian or W k ' $ No, of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
Commercial/In ustrial ®Q/\ BTU HP
a R Bance or Work $ Fuel Total Connected Load
fVIJ10D S e Surcharge Burner Trade Name Size No.
140
BTU HP EDR
TOTAL FEE $
HEATING COMP Y " !idhm®nd Sons Eire. dba
MINIMUM FEE FOR ANY HEATING/COOLINGNENTIL.ATIONAir Gd.
X5182 West Br®edwey
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 Signed By Crystal. e
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00 Approved I�� Hough—In pate Final Date
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
Remarks
List Alterations Being Done:
HEATING COMPANY
Signed By
Date
1
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing
chimney
or stack:
1.
Has been carefully 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
5.
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
Remarks
List Alterations Being Done:
HEATING COMPANY
Signed By
Date
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
RAIiSCHEDULE
Effective On January 1, 1993
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential Rate TOTAL.
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace $ 20.00 $
(Side Vent - Fill Out Back)
Gas Pipin (Needed with n furn ce} $1Q.Q0 $
as Range $ 10.00, $
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work
Commercial/industrial
1 % of Value of Appliance or Work
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
PLUS THE X50 STATE SURCHARGE
REINSPECTION FEE $30.00
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
50
5 5�
JOB ADDRESS..'3'� 7C�t-�-� -I
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes and
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
OWNER
4
BUILDING USED AS
ESTIMATED COST PERMIT NO.
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
Fuel Total Connected Load
Burner Trade Name Size No. -
BTU HP EDR
HEATING COMPANY
Signed By Tel No.
Approved By Rough -In Date final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE SUPERIOR CONTRACTORS INC
6121 42nd Avenue No.
Crystal, Mn 55422
NOTE: #1 through X68 required when using a side vent furnace.
CHIMNEY AND STACK )OMFICATION
The undersigned hereby verifies that the existing chimney or stack:
I . Has been carefully examined
Yes {
} No
( )
2. Is free from rust or deterioration
Yes ()
No
( )
3. Has no foreign objects lodged within
Yes (}
No
( )
4. Is securely supported
Yes ()
No
( )
5. Meets all current Cale requirements for size
and total BTU's connected
Yes ()
No
( )
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater
8. Has combustion air been provided for water heater
Remarks:
HEATING CO:
Signed By:
Date:
Yes No
Yes () No ( )
a, City of Fridley
572T360$THE TWINS
SUBJECP
BUILDING
PERMIT
PER�4,-._�
28502
e `
A
v -e -e—, COMMUNITY DEVELOPMENT DIV.
I ; V
r e PROTECTIVE INSPECTION SEC
e = �
,-'I CITY HALL FRIDLEY 55432
,'' 612-571-3450
RECEIPT NO.
NUMBER
910-F15
REV
DATE
11/3/98
PAGE OF
APPROVED BY
JOB ADDRESS
436 Rice Creek Blird NE
1 LEGAL
DESCR.
LOT NO.
7
BLOCK
2
TRACT OR ADDITION
Holiday
SEE ATTACHED
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Philip D. Eberhard
-
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Sela Roofing & Rem, Inc.
-
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 O ADDITION ❑ ALTERATION jjk REPAIR ❑ MOVE - ❑ REMOVE
B DESCRIBE WORK
Reroof house and garage (28 Sq) Tear -off; Repair chimney
& new cap, roof line u
9 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
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
ZONING
SO. FT
CU FT
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
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
VALUATION
SURTAX
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
4199
$2.10
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS gF ANY OTHER STATE OR LOCAL LAW REGULATING CON.
STRUCTION THE FORMANCE OF CONSTRUCTION
$99.75
Fie SC $4.20
PLAN CHECK FEEZ�i
FEE
_3_
en
0
sirahruRE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
E PROP
VALI T THIS IS YOUR PERMIT
S.GNATURE OF OWNEROF OWNER BUILDERI IDATEI
G 'NSP
FAATE
IJ
z
NEW Effective 1/1/98
ADON [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION $5®
ConstructionAddress:2—
Legal Description:
Owner Name & Address: e k / / I a i) , a e r / 4V r,.e'e'- Tel. #
Contractor: SELA ROOFING & fSM®DIFLINC, INC. MN LICENSE # 3 -3/-�q
Address: ST. LOUIS PARK, MN 55416 Tel. # ,?2—Y®ZK
ID #0001050
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: 2 13fI - _
P
Construction Type• "cAtimated Cost: $ 4-)6 f ee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: APPLICANT: Tel. #2
C�
TOTAL $ /'
STIPULATIONS:
CITY USE ONLY
Permit Fee
$�_
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ 2, A)
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$
'$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 j ] Not Necessary [ J
TOTAL $ /'
STIPULATIONS:
CITY OF FRIDLEY INSPEC"I iUN DIV.
6431 University Ave NE
Fridley, MN 55432
763-572-3604
Urinal
Floor 1
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES:
Effective On Jan 1, 2001
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
$ 7.00
Old Opening, New Fixture
$ 4.00
»:7,;; v ;
.Wash
.. ::>::::>
:. Floor
::::.:: Auto.
Gas
.: ater Heater
•. cr,.,.,,or
Travt
: Drain
Bt$Itt f <: Washer
;; : Ran a
t='.: 'Gas
NO. RATE TOTAL
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
60
JOB ADD
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.
" ,20jw
Owner
Building Used As l 2,5
Estimated Cost PERMIT NO. 3
PLUMBING COMPANY
Reinspection Fee $47.00/Hr SIGNED BY
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
Approved B.
State Surcharge S .50
MINIMUM
TOTAL FEE $ �� In PLUSH
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
TEL N0. 7
Rough -In Date Final Date
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 existing combustion air is sized and installed to meet the current codes
and manufacturers 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 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 CO:
Signed By: Date:
TY OF-FRIDLEY INSPECTION DIV.
•31 University Ave NE
idley, MN 65432
� 63) 5i2�fi^d
n.
to
s
v
e r�c O22S
EffectivB On Jan 1. 2002
APPLICATION FOR PLUMBING AMD GAS FITTING PERMIT
_UMBING FIXTURE RATES.
NO. RATE TOTAL JOB ADDRESS U o �i 1 n Q l '� b � ),)F—.
ew Fb tures
Id Opening, New Fixture
eer Dispenser
bw off Basin
etch Basin
w ain Water Leader
J
A urnplReceiving Tarak
LL later Treating Appl'wvce
o tater Heater -Electric
later Heater -Gas**
CJ ias Range. -
6 ias Dryer"
ff ack Flow Preventer Required { )Yes ( )NO
Type
reinspection Fee $47.001Hr
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ -00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
.LL OTHERS ANDIOR REPAIRS AND ALTERATIONS
m 1.5% of Vabe of Fixture or Applience
N
°1 State Surcharge
j
TOTAL FEE
The undersigned hereby makes appkation for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and ruiinp of the Building DiVision, and hereby declares that all the facts
and representations stated In this application are true and correct
Buiklft Used As ea y^ 0
Eatlnneted Cost PERMT PDO.
SiGNED BY�/ FAX
Approved By Rough -In Date Final Date
fANI..UM FEE FOR ANY PLUMMMA PERMIT 13 M,00
PLUS THE SAS STATE SURCHARGE
r,
'COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6,A.
COMMON VENT INFO ON SACK SIDE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
�%WAM1112 ! V 1%:Wr1L11U3 rj0 F- :ri
ADDRESS
436 RICE CREEK BLVD NE
PIN
143024210042
LEGAL DESC
HOLIDAY HILLS 2ND
LOT 7 BLOCK 2
PERMIT TYPE
HEATING
PROPERTY TYPE
: RESIDENTIAL
CONSTRUCTION TYPE
: ADDITION/ALTERATION
PERMI yNO.: 2004-00432
DATE ISSUED: 04/05/2004 lU
VALUATION
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER.
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A
INSTALL ONE RUUD AIR CONDITIONER, 2 1/2 TONS, UAML030JAZ
# A/C UNITS I # FURNACES
# GAS DRYERS
APPLICANT
CENTERPOINT ENERGY/MINNEGASCO
13562 CENTRAL AVE NE
ANOKA, MN 55304-
(763)757-6202
OWNER
EBERHARD PHILIP DEAN
436 RICE CREEK BLVD NE
FRIDLEY, MN 55432
0 # GAS RANGES
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wort
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 5477
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRWED ABOVE.
0
0
0.00
0.00
0.00
0.00
25.00
0.50
25.50
C�-SC4 rrl
CITY OF FPIDLEY INSPECTION DIVISION
643IfJniversity 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
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning . All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Effective January 1, 2003
/e I & g 7
JOB ADDRESS '13(-
OWNER
Rate TOTAL
BUILDING USED AS
$ 30.00 $ 6)
ESTIMATED COST �� OU oU PERMIT N0. AZ).1/- 7 `�
$ 10.00 $
DESCRIPTION OF FURNACE AND OR BURNER
$ 10.00 $
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
$ 10.00 $ Trade Name Size No.
BTU HP EDR
$ 25.00 $ Fuel Total Connected Load
Burner Trade Name Size No.
$ BTU HP EDR
L(33®�Kz- l� - ®ns
State Surcharge
TOTAL FEE
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.
$ 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
$ .50 rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE 3 _,3I' 0
CenterPoint Energy Minnegasco
HEATING C013562 Central Ave NE, Anoka, MN 55304
Signed �'� e 763-757=6202
FAX # 763-757-6701
ApprovedZ LA -
Rough In Date' Final Date/
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
rnivimom yrN1 Vr=NT r-nNNFr'T'nR AND MMBl1STI�N Alo vFRIFI(:ATIDN
When^3,nr e -in "^ a na furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions, Yes (x) No ( )
and is securely supported and firestopped where required.
The venting system is plastic/PVC and meets all current codes and manufacturer Yes x) No ( )
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 nil Furnace Venting Tables s s. fo' fan Yes
include AGA-GAMA Category Yes (x) No ( )
assisted and natural draft appliances.
The ngce b ,etinn air is sized and installed to meet the current codes Yes No ( )
and manufacturer's specifications.
When required to Ira+alr now cnmhiistinn air_ it will be sized and installed Yes No ( )
to meet the current codes and manufacturer's specifications.
When installing a vintimi `=y' the undersigned hereby verifies that
sis c lisicted assembly nes meets ude AGA-GAMA Category I Central Furnace
specifications. This do Yes f) No( )
Venting Tables for fan assisted and natural draft appliances.
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented Yes (x) No ( )
separately as per current codes.
AppH =P- Tyne and Size/Commnn Vent and Van Cnnnec er Infermatinll
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 Lengthft Diameter in Type
Appliance #2 Vent Connector Height ft Length . Diameter in Type
ft
Appliance #3 Vent Connector Height ft Length -ft Diameter in Type
HEATING CO: CenterPoint Ent-ruv M4 -n" 13562 Central Ave NE, Anoka, MN 55304
e.�.as e a
Date
Signed By:
CITY OF FRIDLEY PERMIT NO.: 2004-00433
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 04/05/2004
572-36U4 VAX: (763) 571-1257
ADDRESS : 436 RICE CREEK BLVD NE
PIN 143024210042
LEGAL DESC HOLIDAY HILLS 2ND
LOT 7 BLOCK 2
PERMIT TYPE ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE.
INSTALL AIR CONDITIONER
# INSPECTIONS
APPLICANT
CENTERPOINT ENERGYMIlNNEGASCO
13562 CENTRAL AVE NE
ANOKA, MN 55304-
(763)757-6202
OWNER
EBERHARD PHILIP DEAN
436 RICE CREEK BLVD NE
FRIDLEY, MN 55432
1
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wort
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating constru�4on or the performance of construction.
Annlicant �� 8 Date ,
Bldg Insp
STATE SURCHARGE, ELEC FLAT 0.50
ELEC PERMIT FEE - MIN (RESI) 20.00
TOTAL 20.50
PAID WITH CHECK # 5477
ARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
IEW [ ] CITY OF FRIDLEY
,DDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name [& Address: !° ��� Tel. #
Contractor. Lj°C= C0 -j%+ MN LICENSE#
Address: y �:�` vr-v� lire , j� �S Tel. # 6 0 -38 -YS27
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:
GARAGE AREA:
DECK AREA:
OTHER:
Length width Height Sq. Ft.
Length width Height Sq. Ft
Length width Hgt/Ground Sq. Ft
Construction Type: W ro e�-O rePEstimated Cost: $
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x
DATE: C. -� �` APPLICANT: 46�i�vd'� Tet. #
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 U using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$
$ 40j, ag
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS: