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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N® (:4:6:71) Date:_ . w.. .:° _ _.._.... _ Owner: _.. ._R?`_.....::.. Builder -----...--- Address., ........ ._....... _..... Address ........ ........ _... _............. LO ATIO I OF BUILDING No....:: Street ..... :...:, :. _:.. .._.............. Part o Lo _......._...._.._..._. _.....__...._.._ Lot ....._/901..:- .............. Block ... _........ Addition or Sub -D 'si�on. '... �... ........_.� Corner Lot ........... :.:....:................ Inside Lot ..... ......... ...................... Setback ...__ .,:.... ........ ....... Sideyaxd...----...............�'�... ......._........... SewerElevation....._......._...._............._............._...................._......_...................... Foundation Elevation * ................ ........... ........ _............. ............................. _............. ... DESCRIPTION OF BUILDING Te Used as: Front. Sq. Ft.,.. Cu. Ft. Depth .:...:_.. Height ... a Fron Depth ... ...; eight Q...... Sq. Ft.. :.� .. Cu. Ft. _ Type Construction o ..:........ Est. Cost..:...:. ,:.,,,�.... .. .......... To be Completed :........... ........ _ ............. _................. CAUTION THIS PERMIT D( `:j fd()T AUTHORIZE VIOLAT- ION OF ANY PRI'vA-[E LAND COVENANTS AND BUILDING RESTRICTIONS. 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 and in compliance with all provisions of ordinances of the city of Fridley. :......._.......----------- _...... _.._ ___._.___.__._...._....._..._..._.._..._........_.... 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. 0 Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gasheating, sewer or wafer. Be sure to see the Building Inspector for separate permits for these items. 4 APPLICATION FOR BUILDING -PERMIT CITY OF FRIDLEY, MINNESO dLEMRON, INC. GENERAL CONTRACTORS Owners- Nane _Ri chard Heffter Builder 2500 22nd. Ave, N. E.. inneapo, -fid;-- . Address; _ Address LOCATION OF BUILDING No.-, Street Ri c. a Cie d'k_Me=Ac &art of Lot Rine Creek Terrace. Lot 10 :Block 3 Addition or Sub. Div. Plat 7 Corner Lot Inside Lot X Set Back ..:351 Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION.:OF BUILDING To be used as Wigle Dwelling Front 431_ DepthHeight 8I Sq. Ft. Cu.. Ft.. Att.� arag- Front - 241 Depth .221 .._Height At Sq. Ft. 528 Cu. Ft. Type of Construction FreMa-- — Estimated.Cost _1.8,510 -- To be completed jex�,- 6 Months 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 app1j9ation. are true and correct. eX Date 6/8/60 Signat Le - (A Schedule of Fee Costs can be found on the Reverse r�de)-, SUBJECT P City of Fridley 1788 AT THE TOP OF THE TWINS BUILDING PERMIT i ? RECEIPT NO. COMMUNITY DEVELOPMENT DIV. i PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/12/93 JOB ADDRESS 580 Rice Creek Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 3 Rice Creek Terrace Plat 7 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ernest Black 580 Rice Creek Terrace NE 574-7422 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 Q. REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage C25 Squaresj, 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd'layer but not the 3rd. 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 SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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� 350 $.68 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- $33.00 Fire SC $1.35 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $35,03 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) HEN PROP LY V LI AT )3,'THIS IS YOUR PERMIT �! DG I SP GATE SIGNATURE OF OWNER,IF OWNER BUILDERI IDATEI NEW [) Effective 1/1/93 ADDN [) CITY OF FRIDLEY ' } ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: ��, 1 C ! 7 - LR Legal Description: - Owner Name & Address: S P Lwe Tel. #7 Contractor: MN LICENSE # Address: Tel. # LIVING AREA: GARAGE AREA: DECK. AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Length Width Len Width 0o�1 Comer Lot [ ] Inside Lot [ ) Type of Construction: Approx. Completion Date: Ft. Yd Setback Height Sq. Ft. Height Sq. Ft. Hgt/Ground Sq. Ft. Side Yard Setbacks Estimated Cost: $ (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: /yt/t.��i2/ i n Tel. # CITY USE ONLY Permit Fee $- Fee Schedule on Reverse Side Fire Surcharge $ .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 Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ) Not Necessary [ ] TOTAL $ J. -,o3 STIPULATIONS: , 01 SUBJECT P IT NO. City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT(��27842 r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. P EW4 SEC. 1 = r---1 CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F159/17/98 JOB ADDRESS 580 Rice Creek Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 3 1 Rice Creek Terrace, Plat 7 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Paul Urback 572-9041 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Dave Wiger Construction 901 Rice Creek Terrace NE Fridley 55432 572-8403 8392 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 O REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house & garage (26SQ) Tear -off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST, OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 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 1 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 $2,228,00 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• @74.75 Fire SC $2.23 STR ON OR THE PERFORMANCE OF CONSTRUCTION W PLAN CHECK FEE TOTA EE Li ss $5.00 $83.09 k_AIGNATURE OF CO • RACTOp OR AUTHORIZED AGENT IDAT 9 IT MEN OPE A IDAT HIS I UR01 OF QyyNER pF OWNEA BU40ERI IDATE� BL �NS� :?S�GN4TUAE DATE 01 NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION 'D ConstructionAddress: , Legal Description: Owner Name & Address: Contractor: V') A U Address: C/6 / A'ze-e Oj?eg-, MN Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # 5- 7 - ld .ENSE # Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA:// Length Width Hgt/Ground Sq. Ft. OTHER: �C 5 ejob r#kt r/� tfo teSe (t-- CIM#6e Construction Type: Estimated Cost: $ y (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 7/qFAPPLiCANT: j//Tf!�Tel. # J�^' CITY USE ONLY Permit Fee $ S� Fee Schedule on Reverse Side Fire Surcharge $ -<'7--23 .001 of Permit Valuation (1/10th%) State Surcharge $ l l $.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 [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: AppUcation for Rawer Punts and. Heating, Cooling. Ventilation, Sea rigeraiion and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone 11 SU. 4- Po GRAVITY WARM AIR:RATE TOTAL, Locaffo Furnace Shell & Duct Work .......................... 8.00 $ City of Fridley: Replacement of Furnace 5.00 $ The undersigned hereby makes application for a permit for the work herein Repairs & Alterations—up to $500.00 .................. 5.00 $ specified, agreeing to do all work in strict accordance with the City Ordinances Repairs &Alterations each add. $500.00 • • . • • ' 2.50 $ and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 each add. 60,000 BTU ........................ 2.00 $ Replacement of Furnace .............................. P.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 BURNER (up to 400,000 BTU) ....................... 5.00 $� GAS FITTING FEES: NO RATE TOT1yL 1st 3 Fixtures ...................... x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VEiNTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL F$E $ a ROUGH FINAL Owner Kind o. Used a: To be Estimated Cost, $ e, w wilding Permit No. I Permit No. DESCRIPTION OF WORK HEATING @' + Warm Air—No Trade Nam �� Size n-. Capacity. Total Connected BURNER — Tra H.P. Capacity Sq. Ft E D. ° iE ' '� BTU H.P. EO. SEDGWIC HTG. & AIR-COND. CO 1001 Xenia Av. S. Minneapolis 16, Minn. Signe By � 42 7M 7.59 Business Phone o (REMARKS -OVER) fi Width Height No. o1 Lineal ft. Area No, of,pane of pane lights _ of crack sq. ft. Coef.. Btu ' HEAT LOS$ CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS, MINN. 'Weatherstrips A.S.H,V.E, Construction No. Exp. wall,: Insulation Guide Net exp. wall Int. wall Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Yes -No I Yes—No 19— ,t' F1.1 � :r' �% Room Length ; Width./A, Height ' Fl.� °' j Room Length '0 ` Width �� Heiglit' Windows and Doors—Crackage and Area Windows an ,.Doo;s—Crackage and Area Width Height No. of No. of 'pane of pane lights Lineal ft. Area of crack sq. ft. Width No. of pane Height No. of Ltneal ft. Area of pane lights ' of crack sq. ft. ' € Coef. Btu .Coef. Btu. Infiltration , ' Infiltration Ri I A Glassy rs n -Exp. wall Net exp. wall'' Int. wall Ceilings j Floor Total ' u. F1.1 Room I Length I Y Width. Height Windows and Doors—Crackage and Area Width Height No. of Lineal -ft. Area, No. of pane of pane lights of crack sq. ft: p Coef. Btu Infiltration `7�` .zr Glass Exp. wall°, Net exp. wall Int. wall Ceiling •, 1. �- Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area C� F1.1 Room I Length 3 Width Height Windows ania Doors—Crackage and Area Width Height No. of Lineal ft. Area No* of pane of pane llghts,', of crack sq. ft. Coef. Btu Infiltration ^` Glass Exp. wall ? Net exp. wall 4C. 1P Int. wall Ceiling 17 Floor Total Bt . 12 C7 6:1 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Exp. wall Net exp. wall' Int. wall Ceiling "f V ^ 2 Floor 11-11, Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area ;� FI_I 7 c - Room 1 Len,rth / . "° Width J,1 HeiAht Windows and Doors—Crackage and -Ar a Width Height No. o1 Lineal ft. Area No, of,pane of pane lights _ of crack sq. ft. Coef.. Btu Infiltration 1 3 "7 ILL Glass Exp. wall,: Net exp. wall Int. wall 'Ce ding , . I Floor Total ME . Windc W Z. of. 'Net exp. Int. wall Ceiling r-, .f.,, Btu Application for Power Plants and. Heating, Cooling, Ventilation, .RefrigerW 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 $ NECK. WARM AIR / Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ...... .................. 2.00 $ Replacement of Furnace ............................. P.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 BURNER (up to 400,000 BTU) ....................... 5.00 $ ' L ---- 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 HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ ROUG„H Dept. of Bldgs. Phone SU. 4-7470 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. Owner Kind of Building Used as Fridley, 10& To be completed about Estimated Cost, $ e4 QJ Ol —New. wilding Permit J. / Permit No.� DESCRIPTION OF WORK WORK HEATING or P WER PLANTS -Ste Hot Wa Warm Air— Trade Name Size No 9 Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load e Kind of Fuel BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R . _B. H.P. (REMARKS -OVER) signeR AY N .WELTER HEATING CO 4637 CHICAGO AVE. By MINN�laMmINESOTA Qj'03 _ 42 7M 7-59 Business Phone No I '«� ppp/pp� City of Fridley Application for Plumbing and Cas Fitting Permit Dept. of Bldgs. Phone 560-3450( DESCRIPTION OF WORK ` Number. Kind and Location of Fixtures Locationo PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $2.00 $ . y x $1.50 ae Zvi 6Z O J ! w O �U' ? z • F • N WATER HTR. GAS ELEG x $3.00 $ New Ground Run Old Bldg . ............ x $3.25 $ Electric Water Heater s $2.00 $ < °d a � O 1st 3 Fixtures .......................... x $2.00 $' Additional Fixtures .................... —x$.75 $ Gas Range to 199,000 BTU .............. x $5.00 $ Base 1st gg 1 2nd 3rd 4th • Future Connection Openings Connected with New Fixture, Old Openings I Sewer El Cesspool El 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 $ New Ground Run Old Bldg . ............ x $3.25 $ Electric Water Heater s $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 X / , 19 Owner L V - Kind of Building Used as To be completed about Estimated Cost, $ 01 —New 'ding Permit No Pe it No.- ^9 Signe By Business Phone No ROUGH FINAL CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Effective On January 1. 1991 Fridley, MN 55432 APPLICATION P:)R POWER PLANTS AND HEATING, COOLING. VENTILATION. 572-3604 REFRIGERATIOA AND AIR CONDITIONING T(STEMS AND DEVICES JOB ADDRESS LYC &Ce.e' RATE SCHEDULE The undersigned hereby makes application for a permit for the work Residential Rate TOTAL herein specified agreeing to do all work in strict accordance with the Furnace Shell and Duct Work. Burner - city odes and ruling of the Building Division, and hereby declares Also Replacement Furnace S 20.00 $ that all the facts and representations•stated In this application are true and sorra* Gas Piping (Needed with new furnace) $10-00 $ Gas Range $10.00 - Gas Dryer 10.00 "Air Conditioning - All Sizes - .;•10.00 S All Others/Repairs A Alterations (LIST ON BACK) 146 of Value of Appliance or Work S CommerciaVlndustrial I % of Value of Appliance or Work S State Surcharge $ .50— TOTAL FEE $ ZL. -60 L) MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION U' REFRIGERATIONIAIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.0C "Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. OWNER BUILDING USED AS ESTIMATED COST ' PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of HeatingV-1 ts. Circle One (Steam) (Hot Water) (Wenn Ai Trade Name 1 Size No. BTU HP EDR Fuel Q Toga) Connected Load Burner Trade Name Size No. BTU HP EDR HEATIN M Signed eyqbV96Tel No. LIAl— Z// 0 V � Approved BJ�L, Rough -In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE (/?C, C, 0 5. Meets all current Code requirements for size and total BTU's connected Yes (per No ( ) 6. Has total heating BTU's of All other BTU's 5Z A 0c) 0 TOTAL BTU's M-7 g 00 Remarks List Alterations HEATING COMPANY Signed By Date NEW 20 V TA The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes (VQ No ( ) 2. Is free -from rust or deterioration Yes (6 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 (per No ( ) 6. Has total heating BTU's of All other BTU's 5Z A 0c) 0 TOTAL BTU's M-7 g 00 Remarks List Alterations HEATING COMPANY Signed By Date NEW 20 V TA .,o 4Y Or FRIDLEY INSPECTION DIViSION Effective On January 1, 2002 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS ,fTx() R 6 a— RATE SCHEDULELA OWNER f'0__A_Q f`�� Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED AS Also Replacement Furnace $ 30.00 $ (Side Vent - Fill Out Back) ESTIMATED COST PERMIT NO. Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Gas Dryer $ 10.00 $ Trade Name Size No. * it Conditioning AA11 Si $ 25.00 $ BTU HP EDR Fuel Total Connected Load All Others/Repairs && Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial 1.25% of Value of Appliance or Work $ 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 State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and —50 representations stated in this application are true and correct. TOTAL FEE $� `—� DATE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE Signed ATEL # ^ O L{ FAX # -0 I ® REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without Approved BA_ Rough -In Date Final Dat &M4�_ written permission from adjoining property owner. a. THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON VENT_ V NT CONNECTOR AND COMBtISTION AIR VFRIFI ATION When re In acing an eAS inq furan . _, 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 Pxicting rnmfuc ion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new r_nmeustion amt will be sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When installing a now v _n ing sy_9 m, 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 #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat - Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in' Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type HEATING CO: Signed By: Date CITY OF FRIDLEY PERMIT NO.: 2004-00659 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 05/07/2004 572-36U4 YAX: (763)571-1287 ADDRESS 589 RICE CREEK TER NE PIN 143024120064 LEGAL DESC RICE CREEK TERRACE PLAT 7 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. CONNECT ATTIC AIR CONDITIONER. # INSPECTIONS 1 APPLICANT DEPENDABLE ELECTRIC INC 2619 COON RAPIDS BLVD NW COON RAPIDS, MN 55433 OWNER BLASKA CAROLE B 599 RICE CREEK TER NE FRIDLEY, MN 55432 ELEC PERMIT FEE - MIN (RESI) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 28416 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 worl 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.