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PRE 2010 DOCSCity of Fridley, Minn. EUELDING PEST N® 3594 Date:.�! • . �. ..:�..................... . Owner ....................................... Builder '. �.::; .. .... �..... . Address ................................. `.... Address ............................................. LOCATION OF BUILDING r . No. . (0?P- .® ... Street . . Oia��.� aiit of Lot .. ... . ,tee Lot ..... Block ....., 3.......... Addition or Sub -Division Corner Lot ............ Inside Lot A ......... Setback Z�1.Sideyard /.. —. a ................... DESCRIPTION OF EUILDING To be Used as: , M. Front Depth Height .� :A). Sq. Ft. l4 A CuFt.-74./?4 . �? ... Front .� , ; y Depth Height a;t °. . Sq. Ft. Cu. Ft.,Y�.Yo. Type of Construction ................... Mst. Cost. N...1............... To be Completed ................... � Al t In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. .:.. ........ ..:-: ........... In consideration of the payment of a fee of $. .:M- , permit is hereby granted to ................... ......................... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions : of said ordinances. r -- .. r� � . : . �.......... , Building Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. City of Fridley Application far Plumbing, and Gas Ming Permit DESCRIPTION OF WORK Number, Kind and Location of Fixtures 8 Z Z n �[ � z Z Z O= w Z * WATER M. Ci G Q U� 6� Q a U� O F N GAS ELEC Basle 1st - 2nd 3rd 4th Future Connection Openings Connected with New Fixture, Old Openings Sewer El Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 O Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ - New Ground Run Old Bldg . ............ GAS FITTING FEES: 1st 3 Fixtures .......................... Additional Fixtures .................... Gas Range to 200,000 BTU .............. REPAIRS & ALTERATIONS—Refer to Code x 3.25 $ NO. RATE TOTAL X $1.50 $ x .50 $ x 2.00 $ vepr. o: niags. rnone ou s-isiu Location - 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- 7,— 19LO Owner Cel19 Kind of Building' `� , 19— Used as To be completed about' Estimated Cost, $ Old a wilding Permit No �S SignedBys f;. Business Phone No# Connection Permit No . ....................................................... Water 0 Sewer Description............................................... TOTAL YM $ s 11 1 M-8-58 g� Meter Deposit ;2S City of Fridley, Minn. X® 8983 BUILDING PERMIT Date: AUGUST 29, 1966 Owner: DEAN M. WILEY Builder SAME Address 280 $,ICE CREEK JERRACE N.E. Address FRTDT.VV, M IMSnTA 95432 LOCATION OF BUILDING No. 280 Street RICE CREEK TERRACE N.E. Part of Lot Lot 9 ._ Block Addition or Sub -Division RICE CREEK 'PT.A7A, SOUTH ADDITION Corner.Lot _ Inside Lot _ _ X Setback __ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: ADDN . TO GARAGE Front 5 Depth 26 Height 10 Sq, FL 13 0 Cu. F•t. _1%3 00 Front Depth Height Sq. Ft. - Cu. Ft. Type of Construction FRAME Est, Cost .,....._.�5 00„. 2.Q To be Completed In consideration of the issuance to me of a permit to construct the building described above I agree to do the Proposed work in accordance with the description above set forth in compliance with 21 provisions of ordinances of the city of Fridley. a„ *- /' In consideration of the payment of a fee of $ 4.00 , permit is hereby granted to DEAN - WILEY to construct the building or addition as described above. This Permit is granted ups 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 location, conatructton, alteration, maintenance, repair and moving of buildings within the city limits � permit may be revoked at any time upon violation of any of the provisions of said ordinances. ENOTIChdt don not amr the eondmoilon, batallation for wbIng, plumbing, gn boding, ewer or water. Be sure to aeiter for separate pwnft for thea Neva. N CITY OF FRIDLEY r APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND The undersigned hereby makes application for a permit for the work herein AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE specified agreeing to do all work in strict accordance with the City Codes each add. 50,000 BTU 4.00 GRAVITY WARM AIR: RATE TOTAL Job Address .��✓ Furnace Shell & Duct Work * facts and representations stated in this application are true and correct. Repairs & Alterations -up to $500.00 7.00 Replacement of Furnace 7,00 Repairs & Alterations each add. $500,00 4e00 Repairs & Alterations -up to $500.00 7.00 $ Department of 3444nga Repairs & Alterations each add. $5QO.00 4.00 $ City of Fridley $ #-INP OF BUILD G each addn. 50,000 BTU Tel. #x571-3450 MECHANICAL WAIM AIR: The undersigned hereby makes application for a permit for the work herein Furnace Shell & Duct Work to 100,000 BTU $12.00 $ specified agreeing to do all work in strict accordance with the City Codes each add. 50,000 BTU 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the *Replaceaent of Furnace 7.00 $ ,v facts and representations stated in this application are true and correct. Repairs & Alterations -up to $500.00 7.00 $ Repairs & Alterations each add. $500,00 4e00 $ Fridley, Minn. 19� luty STP:( OR HOT TATER SYSTEM: OWNER Boiler & Lines up to 100,000 BTU $12.00 $ #-INP OF BUILD G each addn. 50,000 BTU 4.00 $ Boiler only up to loo,000 BTU 7 -Qq $ USEp As each addn. 50,000 BTU (.Qq $ ',' TR pp QQq���1 RQAT 7—/S_ � 7' OIL BURNER- to 3 gal. per hour pq.gq $ rJJ>l each add. 3 gal. per hour }q. qq CPS GAS BURNER- from 100,000 BTU to w!qq $/®r®® NM $LMPTNG F.F.PM7, NO,. HERMIT NO. (over 199,999 BTU see Fee Sche4i4lej GAS FITTING FEES: 1st 3 Fixtures x Additional Fixtures X $. Itgq $ ;.qq $, gESQRT?TON OF FURNACE/BURNER Gas Range to 199,000 BTU JJEATTNA pr #?QWPR F?AWTN 9r Ateamf ]Tot Yater Warm Ai No. AIR CONDITIOvING $ ` °� FAX HEATING SYSTEMS $ Trade Name Size No. See Fee Schedule VENTILATING SYSTEMS $*41 ALTER� REPAIRS $ Capacity Sq.• Ft. EAR BTALTERATIONS State Surcharge $ .50 Total Connected Load i Kind of Fuel �¢ TOTAL FEE $ BURNER - Trade Name Size No. ROUGH INSP. REINSPECTION FEE Capacity Sq. Ft. EDR BTU HP Date 010.00) FINAL INSP. �n ' /y (kf� �c.G Company ? a Dated Signed By APPROVAL FOR PERMIT �,Q o Tel. No. C MINIMI.":4 FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE *Attached stack verification form CITY OF FRIDLEY APPLICATION FOR HEATING REPLACEMENT CHIMNEY AND STACK VERIFICATION THIS FORM MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM. LOCATI OWNER DATE S —1-7 Z4 f ADDRESS�� The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined `J 2. Is free from rust or deterioration t/ 3. No foreign objects are lodged within 4. That it is securely supported 5. That it meets all current Code requirements for size and total BTU connected 6. Total Heating BTU All Other BTU TOTAL REMARKS HEATING PERMIT # SIGNED. tic see by Address /,�2®-- -� Telephone 44T-63-3; Fridley City License # susdEcr MIT City of Fridley -(151779 AT THE TOP OF THE TWINS BUILDING PERMIT r RECE NO. • COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r PROTECTIVE 1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 5/10/79 JOB ADDRESS 280 Rice Creek Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 3 Rice Creek Plaza South SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Daryl Zimmer 280 Rice Creek Terrace N.E. 571-8020 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. John Hughes 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 Ek ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 18.5 x 12' Addition and a 8.5' x 12'. Porch 9 CHANGE OF USE FROM TO STIPULATIONS Submit energy calculations. Provide combustion air to furnace area. Provide hire alarm. Complete the section through detail. ,SEPERATE PERMITS REQUIRED� RQW�fleiore � call Iwo Utilities GAS ELECTREtc. 11ttM� HEATING, PLUMBING AND SIGNS By LAW RFQUIRED 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 AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION ZONING SQ. 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 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 $6,500 $3.25 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- $39.00 NONE STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $ 9.75 $52.00 SI ATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY WkLIDATED THIS IS YOUR PERMIT SIGNATURE OF OWNER OF OVVNER BUILDER) (DATE) BLDG INSP ATE • CITY OF FRIDLEY APPLICATION FOR RESMENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS,' OR REPAIRS) OWNER: :�'itayL � BXuiyi Address: Ago X; G�E_E.ic_ Address: Tel. No.: 57/-8o2.0 No.: Street: LOT: C/ BLOCK: .f ADDITION: CS® It �► CORNER LOT: INSIDE TAT: SETBACK: SIDEYARDS: 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: ctd_ � Front: ��., � Depth: la-, height: AI- Square Feet: 222-, Cubic Feet: Z(6! ® Front: Depth: )"t® Height: Square Feet: IC"�. Cubic Feet: e%Y Type of Construction: 4a" d- Estimated Cost: $ o To Be Completed: ( eve e'A-_5 Alt. A Alt. B Prdposed Driveway Width If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that.all the facts and representations stated in this application are true and correct. See reverse side for additional information. DATE: /'/(- /�! % 9 SIGNATURE: Stipulations: zm e ZS.'3'1 10.7,< .2.1? ��rgu3 $6S00 0 Aim 1610"c9p Qct►BuST1®a Flo... �'urr�ul9ca�. �Ow1► 'r� 'TN�C �j£cA7�%`+ 'f'1.� �1 � OI`S'T�'t, . 39.00,. . Q. %, Cit ®f Fridley SUBJECT P 718071 AT T E TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. --COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 = i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/18/85 JOB ADDRESS 280 Rice Creek Terrace N.E. 1 LEGAL LOT NO. 9 BLOCK 1 TRACT OR ADDITION SEE ATTACHED Rice Creek Plaza South Addition DESCR. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Daryl/Bonnie Zimmer 280 Rice Creek Terrace N.E. 571-8020 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESI NER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residen ` al 7 CLASS OF WORK ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Construct 0416" x 15` Porch Addition 9 CHANGE OF USE FROIM TO STIPULATIONS di call local GAS Before SEPARATE' d19909 E1" ELECTRIC PERMITS TELEPMflBE - REQUIRED BY L bM WIRING, HEi'q. TING, FOR PLUMBING RE ��1RE� AND SIG NS. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR C NDITIONING. 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 SUSPENDE 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 GOVE IN THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIE) D HEREIN OR NOT. THE GRANTING OF A PERMIT $4,100 $2.05 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $50.50 PAN CHECK FEE TOTALFEE $12.63 $65.18 OF CONTRCTORORAUTHORIZEDAGENT (DATE) WHEN PROPERLY(DATED THIS IS YOU PERMIT IGGNATURE / BLDG INSP L 0AT SIGNATURE OF OWNEFFf F OWNER BUILDER) (DATE) NEW [ ] City of Fridley ADDN. �R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: - Legal Description:' s: T �/Jar�j/ Z1.1" iev Tel. # Owner Name & Contractor Address: Effective 4/1/84 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 AREA: Llength Width Height Sq. Ft. DECK AREA: Length Width � Hgt/Ground c� Sq. Ft. OTHER: � " Yom K lS I� V i � �i R �oi�[ ��� �}/q V 0 SS9 q Side Yard Setback Corner Lot [ ] Inside ] Ft. Yd. Setback Type of Construction: C�oc�°� d�'-ami Estimated Cost: $ (4 100 Approx. Completion Date: x�� Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: - - APPLICANT: Permit Fee Plan Check State Surchare SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS• �Cvn mPe" CITY USE ONLY Tel. # s7/-��au Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $1425 per SAC Unit Fee Determined by Engineering $ s'r' "'�greement Necessary [ ] Not Necessary [ ] 01 SUBJECT P N City of Fridley 2 �. 2 9 9 AT THE TOP OF THE TWINS BUILDING PERMIT r R COMMUNITY DEVELOPMENT DIV. ' •r � 'PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 4/23/92 JOB ADDRESS 28p Rice Creek. Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 3 Rice Creek.. Plaza,: South. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Rodney/Jean Trocke 280. Rice Creek.Terrace ATE 571-6412 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Viking Home I provement Co, 4832 2� St NE, Mpls,, MN 55421 572-1820 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 JJ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwell' ng (28 S:quares.) Teak -,off 9 CHANGEO F USE FROM TO STIPULATIONS Underla,yment must comply with- State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING MOT. 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 ] STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,484 $,74 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 QR LOCAL LAVY REGULATING CON- ftX $35•.00 Fire SC $1.48 STRU T OR THE PERFOR A C F CONSTRU ON. PLAN CHECK FEE TOTAL FEE ;> License SC $5.00 $42,22 SIGNATOR OFCONTRACTO ORA THORIZEDAGENT tDATEI PRO CRL V ID ED THIS IS YOURPERMIT E;g;WHE1 1 DG INSP DATE SIGNATURE OF OWNER OF OWNER BUILDER) [DATE] 01 .... h>nnn:>: ti>�. `JJ2JfH>f•. �.....>�)2).J. ._�.>Z>.>. w>. h>.'v:..J.>..h>.>..>.>f>..f>.>.>. h>. .>.. •Yf>.1fJQ.•.....'>• .. �>. r.>f�Y•.•f\...frfr• ... .... a>...•.... a .... ... ..>.. a. .. .• ... ... _ .i....... ...... ..... . ..... ... ... ... NEW [ l Effective 3/1/92 ADDN [ J CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: -2 Y? � i c 4 C /� -2..0 /C/- ��I/lcz-cJ2_ Legal Description: Owner Name Address: ,ve ,a J c/C t C ��2e/ v�°'`'� Tel. # Contractor: MN LICENSE # Address: /,#,,lr- .1-J"qz Corner Lot [. j inside Lot [ ] Ft. Yd . Setback _ Type of Constriction: q4t TI AV Approx. Completion Date: Driveway, Curb Cut Width Needed: APPLICANT: Tel # j7.Z-/ DATE: Z Z Permit Fee Fire Surcharge State Surcharge SAC Charge Ft. + 6 Ft = Sq. Ft. Sq. Ft. Sq. 'Ft. .Side Yard Setbacks � Estimated Cost: $ 7/j/v T4 (Cost on Back) Ft x $ = $ License Surcharge $ .5-.00 Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: 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 [ ) Attach to this app 'cation, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height GARAGE AREA: Length Width Height DECK AREA: Length Width Hgt/Ground OTHER: U Z u 4 If .SQ V A- A -e c X Corner Lot [. j inside Lot [ ] Ft. Yd . Setback _ Type of Constriction: q4t TI AV Approx. Completion Date: Driveway, Curb Cut Width Needed: APPLICANT: Tel # j7.Z-/ DATE: Z Z Permit Fee Fire Surcharge State Surcharge SAC Charge Ft. + 6 Ft = Sq. Ft. Sq. Ft. Sq. 'Ft. .Side Yard Setbacks � Estimated Cost: $ 7/j/v T4 (Cost on Back) Ft x $ = $ License Surcharge $ .5-.00 Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: 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 [ ) 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 �2 ?'Q g lCe c 1^j;a j:!r "fie ✓'N'. RATE SCHEDULE 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, Bumer - 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. (Side Vent - Fill Out Back) Ili-� m, 1994 Gas Piping (Needed with new furnace) $10.00 $ OWNER_R 001)ey !:-('dc I<& Gas Range $ 10.00 $ BUILDING USED AS _IZ�SS, r�.� <"p Gas Dryer $ 10.00 $ ESTIMATED COST 5 1,2, 21) PERMIT NO.- *Air Conditioning - All Sizes $ 10.00 $ DESCRIPTION OF FURNACE ANp OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) S , ps Tom, Commercial/1'w'trUr Trade Name Size No. BTU HP EDR 1 % of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge $50 Burner Trade Name Size No. BTU HP EDR TOTAL FEE $_ i J�< 50 MINIMUM FEE FOR ANY HEATINGLOOLINGNENTILATION 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. HEATING COMPANY ��(e 5; 0� r�P �7;r�.`e� A✓� Signed By (10Tel No. b 73 -- 25-&l Approved By Rough—In Date Final Date A'� FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE NOTE: #1 through #8 required when using a side vent furnace. IMNEY AND STACK VERIFICAI 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 ( } b Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes ( ) No ( ) 8. Has combustion air been provided for water heater Yes ( ) No ( ) Remarks: HEATING CO: Signed By: Date: CITY OF FRIDLEY INSPECTION DIViSION Effective On, January 1, 2000 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES 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 Rate TOTAL $ 30.00 $ 2u. U $ 10.00 $ $ 10.00 $ $ 10.00 $ $ 25.00 $ ` 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. $ .50 JOB ADDRESS— _ ... OWN BUILDING USED AS ESTIMATED COST PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating nits____L Circle One (Steam) (Hot Water) (W Trade Na e l�LPi°j _ Size No.;5_� L16 BTU_ HP EDR Fuel kt- Total Connected.Load Burner Trade Name Size No. BTU HP EDR Thewndersigned 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. B INE HTG. A/C ELECT° I�I . 62 CENTRAL AV . N.E. HEATI CO 4 Signe TEL # �7 - Approved By Rough -In Date Final Date Q® I'll I nI IT MAnv nlrlr r- n [-TAf%W l/CI'll Irf1nATI/% AI nr!n1 Al%CAA['AIT rI InKIA/ COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and. manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. The existing combustion air is sized and installed to meet the current codes and manufacturers specifications. 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( Yes ( No ( ) Yes dNo ( ) Yes4No(-) Yesjj 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�k- Is No 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 Tvpe and Size/Common Vent and Vent Connector Information Appliance #1 Type 41A DO V BTU Input an Assisted o Nat 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 Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Lengthft Diameter in Type Appliance #3 Vent Connector Height ft Lengthft Diameter in Type ALTERATIONS: (Describe) - INE HTG A/C ELECT., INC. 355?, CAALR55304 N.E. HEATING CO:VN , MN Date: Signed By: