Loading...
PRE 2010 DOCS"=r l SUBJECT E RMWRO. City of Fridley14354 TF-' AT THE TOP OF THE TWINS PERMIT BUILDING ECEIPT N0. � COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 9 ! "1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 9/12/77 JOB ADDRESS 6416 Riverview Terrace 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 331 Auditor's Subdivision #23 SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Elaine Heitman 6416 Riverview Terrace Fridley, MN 55432 566-2579 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING 7 CLASS OF WORK i ElNEW ElADDITION ❑ ALTERATION] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Re-foofin 9 CHANGE OF USE FROM TO STIPULATIONS 1. Install ridged galvanized valleys. 2. New roof can be 2nd but not '3rd. 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, 09 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 HERESY CERTIFY THAT I HAVE READ AND EXAMINED, THIS APPLICATION 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. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 600.00 .50 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. $7.50 CHECK FEE TOTALFEE VPLAN ®V— 8.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DAT 1 WHEN PRO ERLY VALIDATED S IS YOURPERMIT 9A BLDG IN F 2A 4 DATEr SIGNATURE OF OWN (I OWNER WILDER) (DAT "=r l I CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: CZ/9/1VE 7-7- BUILDER: Address: 64//6 I//LTJ /h sP. Address: Tel. No.:_ 6-4, 6 a`7 No.: Street: LOT: ;� BLOCK: ADDITION: CORNER LOT: INSIDE LOT: SETBACK: . SIDEYARDS: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To Be Used As: DESCRIPTION OF BUILDING Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: S�5 _0 Estimated Cost: $ To Be Completed: -e �D f'. -"� -7 Alt. A Alt. B Proposed 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: A 5- �7 - _ SIGNATURE: Stipulations: SUBJECT PERMIT city of Fridley C - 1531 AT THE TOP OF THE TWINS BUILDING PERMIT P RECEIPT N COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 7/6/79 JOB ADDRESS 6416 Riverview Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 31 1 1 Auditor's Subdivi-Si-on #23 SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Hal Loge 6416 Riverview Terrace N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Crestview Builders, Inc. 10856 Crooked Lake Blvd., Coon Rapids 421-2140 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 11 REMOVE X X B DESCRIBE WORK Construct a 16' x 24' Addition to Dwelling 9 CHANGE QF USE FROM TO STIPULATIONS AA,#— �pr#4.r WARHINC, F A�I '°FR 80fal d19 ft W1 Joest utilities TEUPRONE • ELECT +c. Eta a Qt�►i REQUIRED BY LAWt� �'# SSG TYPE OF CONST. OCCUPANCY GROUP OCCUPAN"Y LOAD 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 384 7680 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 $12,200 $6.10 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- $75.00 NONE STRUCTION OR THE PERFORMANCE 0 CONSTRUCTION. PLAN CHECK FEE TOTAL FEE -7 1 $18.75 $99.85 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT 'l 8 0J_ 94a- BLDG INSP DA7 SIGNATURE OF OWNER IIF OWNER BUILDER! (DATE) CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) OWNER: JANL . C,4' TEL NO: BUILDER: 6-5Jl ADDRESS: 1055- C—&WD TEL NO: Construction Location STREET NO: �� I STREET: LOT: IS1 BLOCK: ADDITION: TO( -5 50SIAU I sp-) 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 -tJ Front: Depth: Height: k0bim�1D°r Square. Feet: Cubic Feet: g6to Front: Depth: Height: Square - Feet: Cubic Feet: Type of Construction: Estimated Cost: $ To Be Completed: Gf.'T � 4 1,3-) Alt. A Alt. B Proposed 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. F _ n d a "I DATE: 2 ;,2^ SIGNATURE: Stipulations: (. v ti `%S"()a g9,yI5 ' �� 7 THE JOHN J. RYAN CO. SCALE: I INCH FEET 1602 SELBY AVENUE. ST. PAUL 55104 ELEPHONE- 646-6833 PLAT OF SURVEY OF PROPERTY OF LOCATION DESCRIBED AS FOLLOWS "eV Cc' CERTIFICATE OF LOCATION OF BUILDING I hereby certify that on- / _.._19.Y X I made a survey of the location of the bui!din;:i.,,) on the above described property and that the location, of said buildi g(s) is correctly shown an the above plat.rl 19475 CERTIFICATE OF SURVEY I hereby certify that on. — I surveyed the property desqribed above and that the above plat is a correct representation of said survey. ii 3 CITY OF FRIDLEY R APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WAP.,ii 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 jtiARd AIR: Furnace Shell & Duct Work to 100,000 BTU each add. 50,000 BTU *Replacenient of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 STELM OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU each addn. 50,000 BTU Boiler only up to 100,000 BTU each addn. 50,000 BTU OIL BURNER- to 3 gal. per hour each add. 3 gal. per hour GAS BURNER- from 100,000 BTU to 199,999 BTU (over 199,999 BTU see Fee Schedule) GAS FITTING FEES: 1st 3 Fixtures Additional Fixtures Gas Range to 199,000 BTU AIR CONDITIONING FAN HEATING SYSTEMS See Fee Schedule VENTILATING SYSTEMS ALTERATIONS $ REPAIRS TOTAL S $12.00 $L6 - rD 4.00 $ 7.00 $ 7.00 $ 4.00 $ Job Address 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. 1 Fridley, Minn. 0 % , 19C OWNER F/Lrl $12.00 $ KIND OF BUILDING 4.00 $ . 7,00 $ USED 'AS 6.00 $ �rZZ TO BE COMPLETED ABOUT $10.00 $ 10.00 $ ESTIMATED COST $10.00 $ ®6.-?) LD NEW BUILDING PERMIT NO. PERMIT NO. X $ 3.00 $ �• P_V X $ 1.00 $ x $10.00 $ State Surcharge TOTAL FEE ROUGH INSP. REINSPECTION FEE Date ($10.00) FI:1;L I:ISP. / r5% • Date APPROVAL FOR PEFMIT DESCRIPTION OF FURNACE/BUr%N-ER HEATING or POWE LANTS, Steam, Hot Water, warm Ai No. I Trade Name LLA� Size No. �� X-45 Capacity Sq. Ft. EDR BTU HP Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company ,,.Q�� •m Signed By Tel. No. , MINIMUM 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. LOCATION -XLDATE OWNER ADDRESS The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined 2. Is free from rust or deterioration 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 MA Q «Tn;I Address /® — Telephone 11 r— ( Fridley City License # i CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE m PLUA)BING FIXTURE RATES: NO. > 0 rd 0 Number Fixtures x 0 $3.00 Water 01 m m New Fixture, Old Opening x so, c a m A $5.00 N ro u o, w 0 100,000 BTU to 199,000 BTU Heater o .v rt e $7.00 E •'+ 0 x $5.00 o w $5.00 00 11 - N 0 4 •N N 0 m 0 It u a q C 3 _i 0 Q e w U M 4j 3 N U N r� .0 o as lec r� v'ii roti W L 1st tad 3rd 4 t_h (R) = Future Connection Opening Connected with Sewer () = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUA)BING FIXTURE RATES: NO. RATE Number Fixtures O� x $3.00 Future Fixture Opening x $2.00 New Fixture, Old Opening x $2.00 Catch Basin x $5.00 Water Heater - to 99,000 BTU �_ z $5.00 100,000 BTU to 199,000 BTU x $10.00 Water Softener x $7.00 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 $10.00 REPAIRS & ALTERATIONS TOTAL $�() 0 Job Address 6`i- L k < ( 0C l V L_(�) l e r r 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/�,re true and correct Fridley, Mn. �� I -?, 19Z OWNER LL©q!R e RIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST 2 5po. ®®/ OLD - NEW BUILDING PERMIT NO. PERMIT NO. 810 ® I Company l le r Signed By 1 `� Tel. No. ROUGH INSP. Date FINAL INSP. -9 - ). 'k $ 0Date S $ APPROVAL FOR PERMIT First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ • �� REINSPECTION FEE ($10.00) MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE w SUBJECT City of Fridley l6579�6 e AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. 3 1 � � CITY HALL FRIDLEY 55432 NUMBER REV DATEPAGE OF APPROVED BY 612-571-3450 910-F15 10/16/96 JOB ADDRESS 6416 Riverview Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 31 1 1 Auditor's Subdivision #23 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Hal Loge 6416 Riverview Terrace NE 574-9789 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Minnesota Exteriors Inc 8600 Jefferson Hwy, Osseo MN 391-5514 2877 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 17 REMOVE 0 8 DESCRIBE WORK Reside House; soffit & fascia 9 CHANGE OF USE FROM TO STIPULATIONS Install ventilation to meet State Building Code. 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $8,320 $4.16 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 $8.32 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $149.75 PLAN CHECK FEVC AL FEE License $5 00 1/7$167.23 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI E ROP VAij0jKD M'Dif INSP THIS IS YOUR ,P/EEftMIT GATE SIGNATURE OF OWNER t IF OWNER BUILDER) IDATEI w NEW [ ] ADDN [ ] ALTER �f ConstructionAddress: 6-W- 9)4m Effective 3/1/96 CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Legal Description: Owner Name & Address: Contractor: Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Tel. # MN LICENSE # Tel. #,3 Sc�� A*ach to this applicatiod, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: ,1 estimated Cost: $ -6 Approx. Completion Date: �' / (Cost on Back) Driveway Curb Cut Width Needed: _ DATE: APPLICANT: Ft. + 6 Ft = Ft x $ STIPULATIONS: CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ F, ,3-�)— .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $900 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: :,ITY OF FRIDLEY INSPECTION DIV. 3431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTAL I Fn ON FAr.H PI MR Effective On Jan 1, 2000 ,£ _ p4 • NO. RATE TOTAL New Fixtures R• � - ',ung • Beer Dispenser �� M $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater -Electric $ 7.00 Water Heater - Gas** �_ $10.00 Gas Range** $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater -Electric $ 7.00 Water Heater - Gas** �_ $10.00 Gas Range** $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes () No Type $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge $ .50 TOTAL FEE $Z7.5-0 JOB ADDRESS_ fMRIF F S dta O1E e— 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 P,uilding Division, and hereby declares that all the facts .and representations stated in this application are true and correct LOGE, HAROLD/ELAINE 6416 RIVERVIEW TERRACE N.E. 21 FRIDLEY, MN 55432 200 (763)574-9789 Owner _ Building Used As___ `f=�tV4�ji Cz Estimated Cost PERMIT NO. PLUMBING COMPANY Q��LoQI� ZtJN11_'a�A (4 SIGNED BY TEL NO.� O Approved By Rough -In DateFnal Date l `� COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT�VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes O 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 existina 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 ( ) No ( ) When installinsa a new ventinsa system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as,per current codes. Yes( )No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nate Appliance#2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat �. Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO. Signed By: Date : 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 JOB ADDRESS RATE SCHEDULE , Residential Rate TOTAL Furnace Shell and Duct Work, Burner - Also Replacement Furnace $ 30.00 $ (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ *Air Conditioning - All Sizes $ 25.00 $ All Others/Repairs & Alterations (LIST ON BACK) 117o of Value of Appliance or Work $ Commercial/Industrial 1.2570 of Value of Appliance or Work $ State Surcharge 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 OWNER Cd - BUILDING USED AS_ ESTIMATED COST PERMIT N0. )1 91 DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Burner Trade Name Size No. BTU HP EDR 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. DATE HEATING CO K -'(r COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes and 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 () No ( ). When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( )No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) �I� 4�_cn �., qw W ? ^ Q a t.a..). (4 " Signed By:LeaDate : YD- '�-1 tot Building $ BUILDING Plan Review $ Permit NO.:tJ�/ Inspections $ RESIDENTIAL APPLICATION Surcharge Received B 763-572-3604 License Surcharge CITY OF FRIDLEY $5.00 (State Licensed Residential Contractors) SAC Charge Datetoe 4 200! 763-502-4977 FAX Curb Cut Escrow $ ft + 6 ft = ft x $21 =$ Erosion Control $ $450 Conservation Plan Review EFFECTIVE 1-1-09 $ Fee Determined by Engineering Sewer Main Charge DATE -5 — — ®� YOOUUR, E-MAIL ADDRESS 6kAq34&& M k / SITE ADDRESS !® 1,� (Y iml, THIS APPLICANT IS: ❑ OWNER ONTRACTOR PROPERTY OWNER/ NAME: TENANTADDRESS: ` TY STATE ZIP PHONE:—763 CONTRACTOR NAME: SUBMIT A COPY OFff d �® YOUR STATE LICENSE STATE LICENSE # EXP DATE y� f e ZIP AND CERTIFICATE OF ADDRESS: CITY STAT INSURANCE PHONE 7 FAX PROPERTY TYPE AA SINGLE FAMILY/I,TEW CONSTRUCTION SIZE_ ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ROOF 52 �` S ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: 'UaA SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY ��v�° BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES KHOUSE & GARAGE 1. Existing Floor Plan GARAGES C[��'J� ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: Jq DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ADDITIONS. & PORCHES SUBMIT: ❑ Vinyl ❑Soffit 1. Site Plan/Survey showing the existing structures ❑ Aluminum ❑Trim and proposed project. ❑ Other ❑Fascia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: SING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ P� � OCCUPANCYJ rt .e.- TYPE ke_�) Permit Fee $ L1 —4 See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2000 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinan es and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applic on r a permi and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all ork whic eq r iew and approval of plan r r SIGNATURE OF APPLIC PRINT NAME %� 1 O� I DATE PLEASE NOTE: SEPARATIAkEUMRS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK