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PRE 2010 DOCSCity of Fridley SUBJECT P NO. ®i3'738 AT THE TOP OF THE TWINS 4 PERMIT • r �ftKXIZT BUILDING NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. ?- el �-JI ??-4 1 . � CITY HALL FRIDLEY 55432 j ® moi' NUMBER REV. DATE PAGE OF APPROVED BY 612-660-3450 910-F15 9/3/76 JOB ADDRESS 6180 Rice Creek Drive N.E. 1 LEGAL LOT NO. 10 BLOCK 1 TRACT OR ADDITION SEE ATTACHED Rice Creek Estates 2nd Addn. DESCR. SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE The Rottlund Co., Inc. P.O. Box 32082, Fridley, Mn. 571-2060 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 j7 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 281 x 36' Dwelling and 28' x 241 Garage zrPFOAT PER{ R .Fci W001'"%Ar°NAF '�✓off , 9 CHANGE QF USE FROM HEAT1KWftW AND 8" STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before'yfj��,n capping. Provide sod in the front and side yards. SEWER LOCATION (Approx. 121 Deep) 145' South of Manhole (S. Inv. 908.30) WYE ELEV• 908.88 TOP OF FOOTING: 911.88 Minimum WATER LOCATION: 10' South of Sewer Service NINO wan THE OTY OF Before dialing call Im! Uf itlet ACCURACy Op UT"y �TtAN�g � �� if�F�1'(�IE � �.€C�IC • �+�5 E— DATA IS FOR Y,tFp�� PflivpCtSFS ONlY AIVJ HOUND PERSONS USING IT p PERSONS HOUND V `/Q�+i'� ON THE SITE Y THi. M tMAT ON SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frame 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 1-1 1104 + 624 21,088+6240 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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. $35, 25O �1X $17.62 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON - $�-09.31 $350.00 0 N OR THE PE FOR ANCE OF CONSTRUCTION. `-'Aare, PLAN CHECK FEE TOTAL FEE P �7 to Z7 �,e " 7-3-74 27.33 1 $504.26 s � HEN P O Y� AL THIS ISYOU PE MIT I Jq� SIGNATU OF CONTRACTOR Oft AUTHORIZED AGENT (DATE) maF17// BL G INS DATE SIGNATUREOF OWNER(IF OWNER BUILDER) (DATE) 11 1 CITY -OF FRIDLEY APPLICATION FOR RESIDENTIAL ALTERATION, ADDITION, OR REPAIR BUILDING PERMIT OWNER'S NAME:A)reJ� 9 7a)` /� �1 , -rge . BUILDER:];�� 7-i- Lrra9 el Ci • `ry... ADDRESS: ADDRESS :R° Q 'gew ® Kms. _ NO :. 6 / K' IQ STREET: i�Q Y -e ip Q h . ?--, prr-*'LOT: /® BLOCK: JADDITIONZ&� /Vre°ek° a5_7 -4t' -5-S -7 dJ"" CORNER LOT: INSIDE LOT: X SETBACK: 34r SIMARD: D Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. , DESCRIPTION OF BUILDING To Be Used As: Amiz S e, Front • 7, Depth: Height • f Square Feet: rl 0 L/ Cubic Feet: 6'®r .4 �e_ -Front: % Depth: : Height: Square Feet; �Cdbic Feet: Type of Construction: FYAAd Estimated Cost: $ �To Be Completed: /2 - 3 ®- 7L The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stxict 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. ( �-el �� 7`'i-� fie eJ t� • ���°. TE: - 23 - 7 t SIGNATURE: ` LanaV7 ro, ; (See Reverse Side For Additional Informa.tion.) e" 1' �r® �, 'z 4 1 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT e Job Address"�6 �' Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this applicat• n are true and correct Fridley, Mn. •� , 19 e- k� OWNER ��/ �' LA KIND OF BUILDING USED AS TO BE COMPLETED ABOUT PARTIAL RATE SCHEDULE ESTIMATED COST PLU.MBIN G FIXTURE RATES: NO. RATE TOTAL OLD - NEW BUILDING PERMIT NO. PERMIT NO. Number Fixtures ?_ x $3.00 $ 01,0C _ .� Future Fixture Opening 7 x $2.00 $ `v p a Company X617" New Fixture, Old Opening x $2.00 $ Signed By Catch Basin x $5.00 $ Water Heater - to 99,000 BTU ) x $5.00 $ �J',V 0 Tel. No. 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ New Ground Run Old Building x $5.00 $ ROUGH INSP. Date Electric Water Heater x $5.00 $ GAS FITTING FEES: FINAL INSP. Date 1st 3 fixtures j x $3.00 $ S";o Additional Fixtures x $1.00 $ APPROVAL FOR PERMIT Gas Range to 199,000 BTU x $10.00 $ � REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 State Surcharge $ .50 TOTAL FEE $ 3 REINSPECTIQN FEE ($10.00) W W ,'y X 0 Water A 0 '4 w Heater i.Wi H W E •.Ci rrC X WCa v P W C fd$4 E N W � � H -A C7 ° ro C •.4 N .0 •U C C 3 O U •.i O .0 U W N d 0 0 ..C4 u N i. ..1 N ro •.i O N O O A O .-f 1j W ro to7 4j N ro N ro •'i fd .0 � lec ro v a w y s caw 0 w U 3 0 U 0 as vii 1st 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water Job Address"�6 �' Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this applicat• n are true and correct Fridley, Mn. •� , 19 e- k� OWNER ��/ �' LA KIND OF BUILDING USED AS TO BE COMPLETED ABOUT PARTIAL RATE SCHEDULE ESTIMATED COST PLU.MBIN G FIXTURE RATES: NO. RATE TOTAL OLD - NEW BUILDING PERMIT NO. PERMIT NO. Number Fixtures ?_ x $3.00 $ 01,0C _ .� Future Fixture Opening 7 x $2.00 $ `v p a Company X617" New Fixture, Old Opening x $2.00 $ Signed By Catch Basin x $5.00 $ Water Heater - to 99,000 BTU ) x $5.00 $ �J',V 0 Tel. No. 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ New Ground Run Old Building x $5.00 $ ROUGH INSP. Date Electric Water Heater x $5.00 $ GAS FITTING FEES: FINAL INSP. Date 1st 3 fixtures j x $3.00 $ S";o Additional Fixtures x $1.00 $ APPROVAL FOR PERMIT Gas Range to 199,000 BTU x $10.00 $ � REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 State Surcharge $ .50 TOTAL FEE $ 3 REINSPECTIQN FEE ($10.00) : CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE Furnace Shell & Duct Work $12.00 Replacement of Furnace 7.00 Repairs & Alterations -up to $500.00 7.00 Repairs & Alterations each add. $500.00 4.00 MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU $12.00 each add. 50,000 BTU 4.00 Replacement of Furnace 7.00 Repairs & Alterations -up to $500.00 7.00 Repairs & Alterations each add. $500.00 4.00 STFAM OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU $12.00 each addn. 50,000 BTU 4.00 Boiler only up to 100,000 BTU 7.00 each addn. 50,000 BTU 6.00 +SOIL BURNER- to 3 gal. per hour $10.00 each add. 3 gal. per hour 10.00 TOTAL S $ /'i -."e GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $ (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: 1st 3 Fixtures / x $ 3.00 $ 3 Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00 $ AIR CONDITIONING $ FAN HEATING SYSTEMS See Fee Schedule $ VENTILATING SYSTEMS $ ALTERATIONS $ REPAIRS_ ) $ State Surcharge $ .50 TOTAL FEE $ �-g. S -V Job Address 4� / d" ') �c ' C' e /� -e le Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. / 19 % G OWNER�- KIND OF BUILDING \��/ s/ate -C— USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD -�g BUILDING PERMIT NO. PERMIT NO. B DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Name W p,&, G s✓ Size No. l�Sov> Capacity Sq. Ft. EDR BTU HP Total Connected Load C Kind of Fuel 4 .O BURNER - Trade Name Size No. ROUGH INSP. REINSPECTION FEE Capacity Sq. Ft. EDR BTU HP Date �7 (.$10.00) FINAL INSP. 17'— ;Z2- / � Company Date ;'� Sign®By APPROVAL FOR PERMIT ��� XEMA 6JIIigNEAP0L!S, N1i4- 545-1611 MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 Infi Itretion Glass Exp. wall Net exp. wai I Int. wall Ceiling Floor Total Btu I Coef! Btu l i ! t Infiltration Glass Exp. wall f° Net exp. we!t Int. wallCeiling / x $ ! Floor Required SQ. •:. E.D.R. or sq, irs. W.A. Leader area Room Le t r f g % L 4i idt' 'eight Windows &,,d Doors–Crackage and Area -------------- Cf p ' p.7nr �g^Ts Jf CrdCk i -- Totel Btu. Required so. ft. or sq. ins. W,A. Leader area Btu -` r yJ. /1. . Le -^gm / _.. veldt) Y, "eight Windows a Coors-Crackage and Area 14_c' c Lifneal ft. Are- ... ! ocrack sc. f - ,eA _Btu ( Y - Inft!tratio- •' A ed 1 CC*e` Btu - i-ii=AT LuALCULATfu'ZHEATING&AIR CONINTPONFING CO. MINNEAPI:LS, MINN. +eat to --rips A.S.N.`:f.� Const7uCt+"0--IP.SUia°int^, lass Exp. veal I ----- Wi,•�dows :J0ofS Guide Refere:ce - — ---• --- r� r. Net exp. Wa: r Out. Wali tit�'a?1 Ce 8:,--- Roof yr Ex,2. wa„ Yes-Nc 'fes --No r =QV* Z;� fied Ce i ! r r --x -- -- - F( f _ Room �9eaath d 4h,c�t- t Heigr ® Y �t ' orgy to^qt~ �f`` > loor--.... k s -eight and Doors -Crackage and'Are -- _4dlnac�m; <t J. n ---- r, —_T Y ft moors-Cwkage and Area "_ �f if31 Lj l4 — .r+ �;T, % } - L,neai ft 4. I ?` Biu Inflltratlo a Btu '-flltratlo �' f` I -_ Exp. wail / °'. .;�. ,7r,> Glass r H L Net ex W& exp. Exp. wai 4 d Int. wall C-, Net exp. wa . > r Ceiling Int. wall ; Floor Cei(inf rd'% " �` +� `. I Total Btu. Floor �,� F` —T Required s;,. t. E.D.R. or sq. ms. W.A. Leader area "7 ; Total Btu. doom Length ! Widtn� r Required sq. ;: E.G.R. or sq. ins. W.A. Leader area i Height FI.. Room i Length . d Wldttl :r Height if _ f' Vdindows and Doors-Crackage and Area Windows a:xd Doors-Crackage No• ; WCr- � ! � � Height NC. of Lineal ft. Area of pane Ilghts of crack Sc. '' r and Area j Area � No, ynt tri. of I Lineal ft. of Pc�E U` oa•,�er 'ihts ofccgra'c]k s ft, a = Infi Itretion Glass Exp. wall Net exp. wai I Int. wall Ceiling Floor Total Btu I Coef! Btu l i ! t Infiltration Glass Exp. wall f° Net exp. we!t Int. wallCeiling / x $ ! Floor Required SQ. •:. E.D.R. or sq, irs. W.A. Leader area Room Le t r f g % L 4i idt' 'eight Windows &,,d Doors–Crackage and Area -------------- Cf p ' p.7nr �g^Ts Jf CrdCk i -- Totel Btu. Required so. ft. or sq. ins. W,A. Leader area Btu -` r yJ. /1. . Le -^gm / _.. veldt) Y, "eight Windows a Coors-Crackage and Area 14_c' c Lifneal ft. Are- ... ! ocrack sc. f - ,eA _Btu ( - Inft!tratio- 1 CC*e` Btu - GIass irf; ltr3tlp., - lass Exp. veal I ----- - - — ---• --- r� r. Net exp. Wa: r Ex,2. wa„ Ce i ! r r --x -- -- - loor--.... �°Egttir5t� 62 �.rf� HEA, L S CALCULAT 07,EEATS 8 1 $w • MINNE.AP O s MINN Weat^4175?r; PS A.S.. ,:.E. Ode Reso�se..ce COrtSituCt,a °o _ �.®.a.... Insulatror, Windows Doors - Out. Vra•, '-.t. Wall Ce `; a Roof -. rr ` KtIC How=4^gttfed L_ + Yes -No Yes --No a r7da� ',' '. Roan' Le,•,oth "� IA- xs Y' Her `�t Ft. J g -conn LF' * Wrdt'-. Height Yo-'Ind^v,= and Door;-frac age and Are Winoov%L > : cNorc Crac __ce and Area �� . : 4'l. -- �•., G.•.f . - t i^Fay ♦. - Line e of �•raik -'" No. N - - —_ 'v �e3r fr. - - - r.f rack sC i _,.J= I �f' Btu Tyrie{ Btu Infiltra*' o- - Infiltratro- Glass Glass �j 4, Exp. wai+-- - Exp. wai' — _ Net exp. vv, Net exp. u,•a - r'" 7 Int. wai! I Int. waif ! I Ceiling 1 Ceiling - Floor Fl4.oor 1 Total Btu. -- Total Btu.' Required sc. ft. E.D.R. or sq. +ns. W.A. Leader area ' Required s.. `t E.D.R. or sq. ins. W.A. Leader area FI. Room i Length Wrdt-I Height FI. Room ! Length Width Height Windor,s and Doors-Crackage and Area Windot%s and Doors-Crackage and Area i j No. w 'P` r Height I No. ;f Lrneal ft. =.•__. of pale of pa'e irahts of crack I 5C. ft, I No. ""grit No. of Lrrieal ft. Area : IfI of p='•= ^� pane tights of crack sq. ft. 3 ! Coef! Btu i ICoef! Btu Infiltration j Infiltratio :_' Glass Glass ! Exp. waft Exp. wallI Net exp. wall I Net exp. we;: Int. wa I 1 if 1 Int. we. 11 Ceiling Ceifino _ I Floor Floor + Total Btu. I Total Btu. Required sti: ft. E.D.R. or sq. ,^.s. W.A. Leader a*ea Required s:;. ; E.D.F, ins. W.A. Leader . or so. area FI. Room ' Le-gthN,= � Neiq ht FI. Noon, j Length Width Height Windov,_ and Doors-CracKage and Area Wincowl, -c Colors--Crackage and Area . crack - No.r�'" "- - ^No j LUneal ft. Area 1 p•• : of cracksr q. fr. CreF B r } iCoef Btu Infiltra.io + IrtfIit'a*' C i i - G Lass _ _ G lass Exp. wal' — Exp. \'Vali Net exp. w? Net exr, - -- -- Int. wail - - - --- - ------ ---- 1 I,. Ceil'ng ._.—.._.�T. CeIi;ng Fluor _. - . _ ----- -- i Total Rt,, —' RegUrred SC ...�.F". ,�• _�. :S. `i+. LPAc�P' .f`P-'----_� R�'gUrrP"L S:;. j- _ _ 560.3450 citty o/ 7rdleY ANOKA COUNTY 6431 UNIVERSITY AVENUE NE December 16, 1976 FRIDLEY, MINNESOTA 55432 The Rottlund Company, Inc. P.O. Box 32082 Fridley, Mn. 55432 Re: Final Inspection at 6180 Rice Creek Drive N.E. Dear Sirs: A final inspection was made on December 15, 1976 of 6180 Rice Creek Drive N.E. and the following items were noted which must be completed before the structure can be finaled out; 1. Lower sod to 6 inches from siding on the south, west and north sides by June 25, 1977. 2. Reduce spacing between deck rails to 9 inches maximum by April 25, 1977. 3. Provide self-closing tight fitting door to scuttle from garage firewall by January 3, 1977. 4. Tape corners in garage by January 3, 1977. We will expect the above items to be completed by the appointed dates when reinspections will be made to determine compliance. If you have any questions on these items, please feel free to contact me at 571-3450. Sincerely, RONALD E. HOLDEN Building Inspection Officer REH/mh CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 53-9)-9915051 PARTIAL RATE SCHEDULE t'OMPANi' KIND OF BUILDING frame PLUMBING FIXTURE RATES: NO. RATE TOTAL homer Fixtures x $3.00 $ Future Fixture Opening s $2.00 $* Water x y $ g x $5.00 E oro x w' $ Aj 04' w o+ Water Softener Boater $7.90 $ .oi x N $ Electric Water Heater •i d $ .CCrod a lst 3 fixtures m $3.00 $ Additional Fixtures w J0 .,tj ami w C N �a o 8 4j m e each add. $100.00 or fraction H u $ State Surcharge N TOTAL FEE a w° W w ci ti o 3as kec ? lst I corkectrn 2nd 3rd 4h (R) - Future Connection Opening Connected with Sewer (•) - Now Fixture, old Opening Water PARTIAL RATE SCHEDULE t'OMPANi' KIND OF BUILDING frame PLUMBING FIXTURE RATES: NO. RATE TOTAL homer Fixtures x $3.00 $ Future Fixture Opening s $2.00 $* New Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU, x $5.00 $ 100;000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.90 $ New Ground Run Old Building x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: lst 3 fixtures x $3.00 $ Additional Fixtures x $1.00 $ .Gas Range to 1991000 BTU x $10.00 $ REPAIRS fi ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ 8•oo REINSPECTION FEE ($30.00) • Job Address 6180 RICE CREEK DRIVE Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work hereat specified agreeing -to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and corr, Fridley, Na. 12-23-76 , 19 OWNER ROTTLUNT� t'OMPANi' KIND OF BUILDING frame USED AS res. 12-30-76 TO BE COMPLETED ABOUT ESTIMATED COST PERMIT NO. OLD - NEW BUILDING PERMIT NO. • Ce rt. Company MINNEGASCO Signed By Tel. No. ROUGH INSP. Date FINAL INSP. (, - / '� e i K Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 THE ROTTLUND CO., INC. Post Office Box 32082 Fridley, Minnesota 55432 Phone: 561-4340 February 3, 1977 . and . William Michaelis 6180 Rice reek Drive Minnesota 55432 Dear Mr. & Mrs. Michaelis: MAR 199 Due to recent code enforcement; We have been asked by the Fridley Building Inspection Department to send a letter to those people who have the metal fireplaces with gas logs, informing them not to burn wood products in them. Please sign the following statement and remit two (2) copies to The Rottlund Company, Inc., P. 0. BOX 32082, Fridley, Minnesota 55432. Retain one copy for yourself. Thank you. Sincerely, Ellroy J. Lund President It is our intent to use the fireplace only with the gas log and not for the use of burning wood products. Signed'10116-11:24&lze--I� CITY OF FRIDLEY 97-8t,-879001 APPLICATION FOR PWMBING AND GAS FITTING PERMIT PARTIAL RATE.SCHEDULE y PLUMBING FIXTURE RATES: NO. RATE q Nu--ber Fixtures x $3.00 0 Future Fixture Opening k m $ Water J N W Catch Basin x $5.00 W ro x Q w b H a G+ g Water Softener Heater $7.90 $ New Ground Run Old Building x p $ Electric Water Heater •.Fi S >gI A aW .a° a� x $3.00 $ Additional Fixtures $4m ° $1.00 $ x $7:0.00 $ REPAIRS $ ALTERATIONS u :1 � o�a leox , 4 go. m c� N� sro o►+ wo w iA as uA14C lst c vnn eb d .ye tad 3rd 4th (R) . Future Connection Opening Connected with Sewer (*) m New Fixture, Old Opening Water PARTIAL RATE.SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Nu--ber Fixtures x $3.00 $ Future Fixture Opening ii $2.00 $ Now Fixture, old Opening x $2.00 $ Catch Basin x $5.00 $ water Heater - to 99,000 BTU, x $5.00 $ 100;000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.90 $ New Ground Run Old Building x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: 1st 3 fixtures x $3.00 $ Additional Fixtures x $1.00 $ .Gas Range to 199,000 BTU x $7:0.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 S each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ .8.00 REINSPECTION FEE ($30.00) Job Address 6180 RICE CREEK DRIVE Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work hereir specified agreeing -to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and corri OWNER NICHLIAIS Fridley, Mn. 1-20-77 , 19 KIND OF BUILDING frame -- — USED AS res. TO BE COMPLETED ABOUT 1-27-77 ESTIMATED COST 10.00 OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company Signed By MINNEGASCO 1 Tel. No. ROUGH INSP. Date FINAL INSP. ff -It- - 21y Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 1 01 SUBJECT E NO. City of Fridley41 16 0 91 AT THE TOP OF THE TWINS BUILDING PERMIT r ' ' R >v .......COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC.a 40 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L J` 612-571-3450 910-F15 4/1/81 JOB ADDRESS 6180 Rice Creek Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 1 Rice Creek Estates 2nd SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE TP1. Michaelis; 6180 Rice Creek Drive N.E. 574-1071 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 Ej ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Remodel Basement 9 CHANGE OF USE FROM TO STIPULATIONS Use treated bottom plates. SEPERATE- PERMITS REQUiREO FOR WRING, - HEATING, PLUM 81NO AND SIGN& 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 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. $5, OOO $2.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $32.50 ENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT xx7jk;�� BLDG INSP 41AI E SIGNATUREOFO ' RIIF OWNER BUILDERI IDATEI 1 01 CITY OF FRIDLEY APPLICATIOJ FOR RESIDbITIAL BUILDING PERXITS (New, Alterations, Additions, or Repairs) OWNER: Lo Ll�h/g_ h_jggl ADDRESS:�Pc.����Q,�" TEL NO: • STREE, T NO: BUILDER: ADDRESS: TEL NO: Construction Location STREET: Z c..,z /- SIJ LOT: . /D BLOCK: , z 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 �TrJ� Depth: Height: Square. Feet: Cubic Feet: Front: Depth: Height: Square - Feet: Cubic feet: Type of Construction: Estimated Cost: TO $e Completed: % 6/,,�tp,s1./ Alt. A Alt. B Proposed Driveway Width If New Opening Is -Desired: SEE RSVERSE SIDE OF SHEET The undersigned hereby makes application for a permit for the uork'herein specified, agreeing to do -all work in strict accordance with the City of rridley Ordinances and rulings of tlhe Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: _$_4 /_ PZ SIGNATURE: Stipulations: S x 3o.Oa 015 rt Ta"TC 4 ariwm Qom. I�j SUBJECT IT NO. City of Fridley o 16958 AT THE TOP OF THE TWINS BUILDING PERMIT rp COMMUNITY DEVELOPMENT DIV. �f/ r PROTECTIVE INSPECTION SEC. 1 i � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 3/29/83 JOB ADDRESS 6180 Rice Creek Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 1 Rice Creek Estates 2nd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE W. D. Michaelis 6180 Rice Creek Drive N.E. 574-1071 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a Masonry Fireplace 9 CHANGE OF USE FROM TO STIPULATIONS Install outside combustion air to existing furnace or new fireplace. Install products of combustion fire alarm. 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 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 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 $1,800 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .90 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $29.50 NONE STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE None $30.40 SI I RE OFC NTQACTO RAUTHO ZEDAGENT (DATE) W N PRO RL V ID TE HIS IS YOUR PERMIT A, 4 -13 1- .-83 SIGNATU OF NER (IF OWNER BUILDI (DATEI BLDG INSP DATE I�j CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATIC14 FOR RESIDENTIAL BUILDING PERMITS (Neal, Alterations. Additions. or Repairs) OWNER: C.r v L ADDRESS: TEL 110: • STRITiT NO: STnm Lm:. ZO BUILDER: ADDRESS: TEL NO: 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: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic feet: Zype of Construction: Estimated Cost: 1b Be Ooropleted: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: SEE REVERSE SIDE OF SHEET Mie undersigned hereby by mal;es application for a permit for the work herein specified, agreeing to do ,all work Im strict accordance with the City of Fridley Ordinances and rulings of the Depaxtment of Buildings, and hereby declares that all the facts and represontatiens stated in this application are,.,true and cor"ct.A DATES 3 '�� �~ O � SIGNATUME: Stipulations: 13 a. v- 0 SUBJECT ERMIT N-57 City of Fridley 21596' AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. � • COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. t � CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 10/6/92 JOB ADDRESS 6180 Rice Creek Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 1 Rice Creek Estates 2nd Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bill/Sandra Michaelis 6180 Rice Creek Drive NE 574-1071 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. The Cities. Home Improvement Co. 6148 Olson Memorial Hwy, Gol. Val. 591-0332 1839 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 j7 ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 6 DESCRIBE WORK Reside Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. 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 $5850 r $2.93 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUT RITY TO VIOLATE OR CANCEL THE PROVISIO OF OTHER STAP OR LOCAL LAW REGULATING CON- $81.00 F] l^e SC $5.85, O PERXOARE OF EPLAN CHECK FEE TOTALFEE �ST7CT WCONSTRUCTION. Lk License SC $5.00 $94.78 TNOR"ED AGENT (TEI HE R Y V DA D THIS IS YOUR PERMITyr, l� ! I ` / BLDG INSP GATE SiGNATURE OF OWNER OF OWNER BUILDER) IDATEI 'b NEW [ ] Effective 3/1192 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: (01 3.0 /Q(C � Legal Description: Owner Name &/ Ad` dress: `�►ll +fit Mgf�C Tel. # S-7? e & 7/ Contractor: ��'�--/ `�-e- 0 MN LICENSE # 6,9,o Address: l'S�ALW Tel. # ,-%f ®3 3.2 - Attach to this applicaU , a Certificate o urvey 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: Comer Lot [ ] Inside Lot [ ] Ft. Yd . Setback Type of Construction: e tc& L.s/ sy- 5� Approx. Completion Date: Driveway Curb Cut Width Needed: Ft. + 6 Ft = Side Yard Setbacks Estimated Cost: $ -WW-50 (Cost on Back) Ft x $ _ $ DATE: Q�h APPLICANT: Tei. # S %%0?3 Z Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Park Fee $ 8- 1. 00 Sewer Main Charge $ TOTAL STIPULATIONS: $ z -' 8 CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $700 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ) SUBJECT PERM - . - City of Fraley 21 i 7 AT THE TOP OF THE TWINS P M I T BUILDING i RECEI COMMUNITY DEVELOPMENT DIV. _ PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEV 55432 612-571-3450 910-F15 9/20/93 JOB ADDRESS 6180 Rice Creek Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 1 Rice Creek Estates 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE William Michaelis 6180 Rice Creek Drive NE 574-1071 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 � REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling (23 Squares) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd layer but not the 3rd. Install adequate attic ventilation. Provide smoke detectors as per UBC 1210 adjacent to all sleeping areas and in basement. TYPE OF CONST. pCCUPANCYGROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING S0. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 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 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 $2,300 $1.15 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- $54.00 Fire SC $2.30 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $57.45 TRACTORORAUTHORI AGENT (DATEI - WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT XTC 6 L INS DATE SIGNATURE CK OW IIF OWNER BUILD ERI ICIAI NEW [ j ADDN [ j ALTER [� Construction Address: �( Legal Description: Owner Name & Address: Contractor: Address: Effective 5/26/93 CITY OF FRIDLEY SINGLE FAMILY AND DUPIMMS R-1 AND R-2 Building Permit Application I& LQ -"XL, MN LICENSE # Attach to this application, a Certificate of Survey of the lot, with the proposed construction dawn on it to scale. DESCRIPTION OF IA+IPROVEAMNT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length - Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [ j Inside Lot [ Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ _ _ 2 Approx. Completion Date: ``yj ,� (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: �3APPLICANT: 4 Tel. # 7% CITY USE ONLY M 7/ Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ 0 .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $750 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ Conservation Plan Review $450.00 Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ j Not Necessary [ j TOTAL STIPULATIONS: CITY OF FRIDLEY INSPECTION DIViSION Effective On IViay 10, b�99 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 ADDIZESS 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 gm-riu 6�,oc,) Gas Dryer *Air Conditioning - All Sizes OWNER_ %�//l :tel 1I �" Rate TOTAL BUILDING USED AS $30.00 $ 10.00 $ -�" ESTIMATED COST PERMIT NO. 12,c),$ q DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work 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 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 $—c�/ representations stated in this application are•true and correct. HEATI E — 77L 7�1-vt DATE Rough -In Date Final Date r ITYoOF FRIDLEY INSPECTION DIVISION + 431 University Ave NE ridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, °1 )63) 572-3604 a_ m RATE SCHEDULE r esidential 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 Q F- Gas Dryer 'Air Conditioning • All Sizes REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS / ce (Ytek Effective On January 1, 2002 All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 W A :ommercial/Industrial 1.25% of Value of Appliance or Work U_ 0 State Surcharge U TOTAL FEE o` o: U_ UNIMUM FEE FOR ANY HEATING/COOLING/VENTILATION -, .EFRIGERATION/AIR CONDITIONING PERMIT IS S25.01) r7 'LUS THE $.50 STATE SURCHARGE CD :EINSPECTION FEE $47.00/Hr m Air Conditioners can not be placed in a side yard without mitten permission from adjoining property owner. A OWNER 1,0 1 I 0 GLYY) M ! c -h af-fi S TOTAL BUILDING USED AS ESTIMATED COST PERMIT NO. 911 $ $ K -4-D $ .50 $es,S-D DESCRIPTION OF FURNACE AND OR_BUR!4 No. of Heating Units Circle One (Steam) (Hot Water) ( ir) Trade Name (J�S�t"I �� Size No.S-'y l'�V ®fes® BTU Le 1), U 00 HP EDR Fuel int. C - Total Connected Load Burner Trade Name Size No. BTU HP EDR 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 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. HEATING CO BLAINE HTG. A/C ELECT.P L-1—( D_ 13562 CENTRAL AVE. N.E. ANOKA, MN 55304 .Approved Rough -In Date TEL ## Final Date Sl�� JP,,.; -15-2002 ©e : 32 FROM C I TY OF FR I DLEY I r�D rb roi r. vjciva:� THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED SUMMON VIFNT, VI=OR AND C_OMBLISTION AIR VERIEIC:ATIM1 When mpla -i an ey;:sfij3U finance, 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. 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 existing _omh istinn air is sized and installed to meet the current codes and manufacturer's specifications. When required to install a new combusdion air, it will be sized and installed to meet the current codes and manufacturer's specifications. WhenkisWln a n -w venting ustem, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specircaticns. This does include AGA-GANIA Category I Central Furnace 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 separately as per current codes. Yes.(Ik No ( ) Yes No ( ) Yes (� N o ( ) Yes No( ) Yes No ) Yes No ( ) Appliance #1 Type UfV�aC-f BTU Input14 0 6VD 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 'p -w- Ud r INC. y1le V - 13502 CENTRAL AVE. N.E. HEATING CO: ANOKA, MN 55304 Signed By: e,, �- Date: TOTPL P.O2