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City of Fridley, Minn. BUILDING PERMIT x® 4354 Date: /- - Owner: .............................. Builder .eXleC _. ^✓_ ..... Address.............. -......... _.......... - - _ --._._..._ _.- ..._...._.... Address ................. ................... ..... -................ ......... L CATION OF BUILDING No.... .�.0........ Street'-..... - of Lot .... ...._......_....-...._...._............._..... .._� ...._....................... Addition or Sub -Division ....................._....-....---- Lot .............. ............ Block ....._-- - -----.....--•--.........--•--.... Corner Lot ... X ...................... Inside Lot ......................_.-............. Setback '__` ?_ .......... Sideyard ........... -............ - - - Sewer Elevation ..... _....... _................... _............. _......... .... _....... _............................. Foundation Elevation DESCRIPTION OF BUILDING To be Used as: a r� Front ��_ b Depth _"_ .. Height . .." Sq. Ft. Cu. Ft. 4 �Pcr _............._...._.......... .. Front --..................._ . Depth ... ................ _.. Height ................. Sq. Ft. ..... -................. Cu. Ft. ..... ................. Type of Construe ion ....................... -................................. Est. Cost. 57d-®_................_..- To be Completed ............................................ - In consideration of the issuance to me of a permit to constru t tki building desc ' ��v��'agree to do the proposed work in accordance with the description above set)rth and in�ompli cerovisions of ordinances of the city of Fridley. 4i (1 In consideration of the payment of a fee of $ .. ,"permit is hereby granted to....._......_....._......................................... .... _._._...... _...... ................ ....................... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Building Inspector NOTICE: This permit does not cover the constructlon, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building inspector for separate permits for these items. City of Fridley Appliaation for Plumbing and Gas Pitting Permit Dept. of Bldgs. Phone S -7 DESCRIPTION OF WORK©� G Number, Kind and Location of Fixtures Location- O 6g Q� Z �� ZFz .g "a� Z Z_ O U' Z Z �a0 F N WATER HTR. GAS ELEC. sp S dna Base d �' 1st T1 T 2nd _ 3rd 4th • Future Connection Openings Connected withI Sewer New .Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ Future Fixture Opening ................ x New Fixture Old Opening .............. x Catch Basin ............................ x Water Heater (Up to 200,000 BTU) ...... x New Ground Run Old Bldg . ............ x 1.20 $ 1.00 $ 3.25 $ 2.00 $ d 0 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ /150. Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description..................................... ..........$ TOTAL FEE $ "s 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, Minn. — �/ la o� G . , 19_ Owner Kind of Buil Used as To be completed about a Estimated Cost, $ Old Ne . uildmg Permit No .3 Permit No. 16 Signe By Business Phone No ROUGH FINAL 42 2M 7-59 APPlication for Power Plants and Heating, Coaling, Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... 8.00 Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECI;. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 c u each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BUR (up to 400,000 BTU) . ............... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $� Additional Fixtures x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN BEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS REMARKS: $ See Fee Schedule $ TOTAL FEE $ Dept. of Bldgs. Phone SU 4-7470 s LacaIlion _ 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, Minn- Owner inn Owner 195— Kind of Building _ Used as � ,-,-L--1 %=<>ca� To be completed about Estimated Cost, $ .AId--New. Building Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water,(Warm Air No Trade Name- ��/ �Gt�%'i� Size No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Kind of Fuel — BURNER — Trade Name'�'�y� Size No Capacity Sq. Ft. E.D.R BTU H.P. signed 00� 11 POST 1M-12-58411- Business Phone Noi� D•56 a 2'- HEAT AHEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS FRIDLEY, MINN. Weatherstrips A.S.H.V.E. Construction No. Insulation Guide Windowses I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied No a No 19.x. /-V t Zff I I C., I I— H irl o 6kA 2 ,WAS - 9 70Mn4 F1.1 R) T m J01MRoom I Length /'/3 Width eight jo ® F1.1 _ (doom Length' Width Height )' Windows and Doors—Crackage and Area Width Height No. of Lineal f 'Area No. of pane ofpan lights of crack eq. ft. Net exp. wall Coef.1 Btu Infiltration ®® 673 (e 3; 19 1 41/8 V. Floor f �2 l� Btu - - ----- - -- Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I F1.18W j Room I Length r®e Width ® Height Windows and Doors--Crackage and Area 1 17 31VG �G Width Height No. of Lineal ft. Area No. of pane of pane lights of crack a/q. ft. L► �� / 2-2- Windows and Doors—Crackage and Area Exp. wall -b Width Height No. of Lineal ft. Area No. of pane of pane lights of cr ek sq. ft. Net exp. wall Coef.1 Btu Infiltration ®® 673 (e 3; 19 1 41/8 Glass Floor f rr %"n) Exp. wall Net exp. wall / t� Int. wall Net exp. wall 70 /6* _ a Int. wall 0 71 Floor % Ceiling G E 1 Floor '3 D Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1. 113 P, V 2, Room I Length ,2 D Wid /4' Windows and Doors—Crackage and Area Width Helght No. of Lineal ft. Area No. of pane of, llghte of crack eq. ft. Btu Infiltration 1 17 31VG �G Glass J_ / Windows and Doors—Crackage and Area Exp. wall -b Width Height No. of Lineal ft. Area No. of pane of pane lights of cr ek sq. ft. Net exp. wall /a 'to 119 Int. wall 7 6 673 (e Ceiling Btu 3 Floor Iq.2. O'y /q Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area Room I Length eoo Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of Dane lights I of crack sq. ft. Height 05 Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of cr ek sq. ft. Coef. Btu Infiltration 122- 7 6 673 (e Glass Btu 3 Exp. wall Exp. wall �b Net exp. wall Net exp. wall / t� Int. wall Int. wall Ceiling Ceiling Net exp. wall 0 71 Floor % Int. wall G E 1 Total Btu. _' Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I FU VA ISA" .,1 Room I Length TZ, Width He—ht 0 -1 - Windows and Doors—Crackage and Area Room I Length eoo Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Height 05 Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of cr ek sq. ft. -Coef. Btu Infiltration Glass Coef. Btu 3 Exp. wall Net exp. wall / t� Int. wall Exp. wall Ceiling Net exp. wall Floor f % Int. wall Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 h Room I Length eoo Width Height 05 Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of cr ek sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor / v ` Total Btu. Required sq. h. E.D.R. or sq. ins. WA. Leader area Windows and Doors—Crackage and Area Width No. of pane Height No. of pane lfgbts Width Height No. of Lineal f -. Area No. of pane of pane lights of crack sq. ft. Vo 040 rot ^� _..� HEAT LOSS CALCULATIONS` DEPARTMENT OF BUILDINGS FRIDLEY, MtNN. Weatherstrips °.2 A.S.H.V.E. Guide Construction No. Insulation y Windows oors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied es No a No 19' F XYt - 2'-* 1vAAA— 3"YC-PV Nf, F1.1 p, -C i Room I Length 214, Width /?/`d Height >V F1.1 -V741in I Length %' ' Width O Height% Windows and Doors—Crackage and Area Width No. of pane Height No. of pane lfgbts Width Height No. of Lineal f -. Area No. of pane of pane lights of crack sq. ft. Vo 040 rot ^� _..� wall Net exp. wall, Coef. Btu Infiltration °.2 Ceiling ffSW Glasse Exp. wall �� Zzzo- ,s s 2 D Net exp. wall Glass 9� Int. wall Ceiling Net exp, wall Ceiling - Floor fj *430 Floor ? gS Windows and Doors—Crackage and Area Width No. of pane Height No. of pane lfgbts Lineal it of crack Area stirft. rot ^� _..� wall Net exp. wall, 3 r+® Int. wall a Infiltration Ceiling ffSW Floor Total Btu. �� Zzzo- Coef.1 Btu Infiltration Net exp. wall Glass Int. wall Exp. wall Net exp. wall t - Int. wall Ceiling y a I /j Floor Total Btu. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area SL I .d F1.1 V T11-1 ly Room I Length �� � Width P W Height Fl. 1 Room ( Length 2 2 L °Width! 0,!/,9 'flei Windows and Doors--Crackage and Area Width Helght No. of Lineal ft. Area No. of pane of pane lights of crack eq. tt. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area JM.IL 4 6 V, #-doom I Length/ °' Width Height Windows and Doors—Crackage and Area Width Helght No. of Lineal tt. Area No. f'. or, lights of crack sq. ft. 1' 9'G , a Mane >7 Btu Infiltration Glass Exp. wall Net exp. wall 6rj Int. wall Ceiling Floor Total Btu. / � Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area Coef. Btu Infiltration L1 Sm "v T Glass5— Exp. ^� _..� wall Net exp. wall, 3 r+® Int. wall Btu Infiltration Ceiling ffSW Floor Total Btu. �� Zzzo- Required sq. ft. E.D.R. or sq. ins. W.A. Leader area JM.IL 4 6 V, #-doom I Length/ °' Width Height Windows and Doors—Crackage and Area Width Helght No. of Lineal tt. Area No. f'. or, lights of crack sq. ft. 1' 9'G , a Mane >7 Btu Infiltration Glass Exp. wall Net exp. wall 6rj Int. wall Ceiling Floor Total Btu. / � Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area Width Height No. of Lineal [t. Area No. of pane of pane lig to of crack sq. ft. # 9 �!q— d L1 Sm "v T Coef. Btu Infiltration Coef. Btu Infiltration Glass ffSW ZI 7 D Exp. wall Glass 2Q1. Net exp. wall d Int. wall Ceiling Net exp, wall - Floor fj *430 Int. wall Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 171.1 01'11 hf4 Room I Lenmh 7/� Width/,t!A, Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration 7 2� Glass Exp. wall Net exp, wall fj *430 Int. wall Ceiling �® Floor rotal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area SUBJECT P City of Fridley 24698 AT THE TOP OF THE TWINS BUILDING PERMIT r R ECEIPT NO. • __ COMMUNITY DEVELOPMENT DIV. ><. PROTECTIVE INSPECTION SEC. r � ; CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY �"" �•J 612-571-3450 910-F15 10/16/96 JOB ADDRESS 200 Rice Creek Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 3 1 Rice Creek Plaza South SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Carol Mackie 200 Rice Creek Terrace NE 571-6711 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Midwest Siding & Roofing 3533 Perry Ave N, Crystal, MN 55422 521-3652 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20010277 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 Reroof House & Garage (20 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 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 $.83 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,650 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- Fire SC $1.65 STRUCTION R THE PEfifORMANW OF CONSTRUCTION $54.00 PLAN CHECK FEE TOTAL FEE L014 License SC $5.00 $61.48 (GNAT EOFCONTRACT OR AUTHORIZED AGENT (DATE) WHEN PROPERLY V (DATED THIS IS YOUR PERMIT 9IDG 1jfSP j� DATE SIGNATURE OF OWNEROF OWNER BUILDER( IDATEI _ .: ... .. .... .. ..>:..v ... .......:.n:.:.:......: v: t: v:�:v •. •v. ....v. v. v. v. �. ..v .. ♦ ... ....v v .. ..n{.v �ti`v. v.l �. .. .. .. v .w v. v v. ♦ v v ♦l.. v� v .. v v v v v v . . . NEW [ ] Effective 8/1/95 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: ,) 0 o Legal Description: Owner Name & Address: Cao �, 4 l Tel. # 57r.-6 -711 Contractor: /17 ('j„,�� S ' 2�� �' MN LICENSE # J•o f o d 7 Address: S_3 3 n��r / � ,ti . Cr s ( Tel. # S I -3r, S _� 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 t:GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: : 0r-_ - Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: 7-e.,r , Cf �- rZ F - ff.. Estimated Cost: $�� � /� � � CJv Approx. Completion Date: // //��� (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft $ _ $ DATE: 10//4 F` APPLICANT: Tel. # CITY USE ONLY Permit Fee $ Sq, Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $3 $.50/$1,000 Valuation SAC Charge $ $850 per SAC Unit License Surcharge $ `�� a $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A” or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: N3 CITY OF FRIDLEY PERMIT NC.-.200400778 h 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 05/25/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 200 RICE CREEK TER NE PIN : 143024230028 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 0.00 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. REPLACE A FURNACE (WARM AIR, LENNOX, 70,000 BTUS) #FURNACES 1 #GAS DRYERS 0 # GAS RANGES 0 APPLICANT HEATING PERMIT MINIMUM FEE 0.00 MARSH HEATING & AIR CONDITIONING FURNACE SHELL/DUCT WORK 35.00 6248 LAKELAND AVE N GAS RANGE FEE 0.00 BROOKLYN PARK, MN 55420-2937 GAS DRYER FEE 0.00 (763) 536-0667 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 35.50 PAID WITH CHECK # 70291 OWNER MAKIE CAROLE A 200 RICE CREEK TER NE FRIDLEY, MN 55432 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 work 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. Appy Date Bldg hvsp � Dd SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. y CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATIOW REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fee Total $35.00 $.35.00 $10.00 $ $10.00 $, $10.00 $ *Air Conditioning -AII Sizes $25.00 $ All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Minimum Fee $15.00 for Residential or 5% of cost of JOB ADDRESS ZOO Q k- It Iva Owner C.4AO L6 d-/`iJ 141-akif Building Used As ESTIMATED COST PERMIT NO l DESCRIPTION OF FURNACE AND BURNER # of Heating Units_ Circle One (Steam) (Hot Water) rm ' Trade Name LP.NAW Size No. G6/ MPY-39s-070 BTUi®.ovo HP EDR ®� Fuel AWr Total Connected Load 3)) wo Burner Trade Name BTU HP Size No. EDR Improvement whichever is greater on work less than $300.00 The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/Industrial/Institutional and representations stated in this application are true and correct. State Surcharge $ HEATING CO 144A5# y J h.]® 44X (01V(Q1JWa1-e T TOTAL FEE $� Signed�� Tel # _/ 6.3 -.�.3fo ® 0 467 REINSPECTION FEE $50.00/HOUR FAX # 7b -5-3(0— ®2 ---" % Date *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacina an existing furnace, 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 manufacturer's 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 (t/ No ( ) When installina 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 041 No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type k1JU AA BTU Input o ooa Fan Assisted oat Appliance #2 Type BTU Input Fan Assisted or at Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type (Ass .8 Vent Height /Z 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) �/�f�'I L/ e' MUM A--:- 2 P HEATING CO: SyJ y%"� �a��lP✓i c Signed By: Date : S/I y �a ti ADDRESS: 200 Rice Creek Terr APT: FLOOR: CITY: Fridley DATE: k2S // 0 OCCUPANT: CAROL A. MAKIE OWNER: SAME HEAT LOSS: HEATING INSTALLED BY: ELECTRICAL WORK BY: Spark Electric GASLINEBY: Marsh Heating & Air Cond. Co. TYPE OF HEAT: GA FA X ROOFTOP SPACE HTR UNIT HTR OTHER GAS DESIGN MANUFACTURER: LENNOX MODEL: G61MPV-36B-070-6 SERIAL: INPUT: 70,000 BTU CONTROLS THERMOSTAT: T8600 �c VENT SIZE: VALVE: KIND OF LINER: SIZE NONE LIMIT: �'� DRAFT HOOD: i I REGULATOR: LIMIT SETTING: FILTERS - SIZE: NUMBER: i FAN SETTING: Ti, CHIMNEY. INSIDE X' I OUTSIDE PILOT TYPE: 414a �u CHIMNEY CONSTRUCTION: PILOT MAKE: PILOT MODEL: SMOKE BOMB: WIRING: PILOT TIMING: P de IDRAFT: TEST TAG: L.W. CUT OFF: DOOR PRESSURE: !LIGHTING INST: PRESSURE: �t� % CO2 _ !DATE TESTED: INPUT CFH: 70 %02 COMPANY TESTING: STACK TEMP: 0 % CO IVZ NAME OF TESTER: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: (763) 571-1287 ADDRESS 200 RICE CREEK TER NE PIN 143024230028 LEGAL DESC UNAVAILABLE LOT BLOCK PERMIT TYPE ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-00796 � �qq�- DATE ISSUED: 05/28/2004 VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. WIRE FURNACE. # INSPECTIONS 1 APPLICANT SPARK ELECTRIC 2114 WASHINGTON ST NE MINNEAPOLIS, MN 55418 - OWNER MAKIE CAROLE A 200 RICE CREEK TER NE FRIDLEY, MN 55432 STATE SURCHARGE, ELEC FLAT 0.50 ELEC PERMIT FEE - MIN (REST) 20.00 TOTAL 20.50 PAID WITH CHECK # 39815 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 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.