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PRE 2010 DOCSCity of Fridley, 1Vlim. " 113-90 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERNUT 'Date: _ April 25, 1972 Owner: Rrcoe Inc. Builder _ Same Address _ 3231 Central Avenue Address Same No - 7153 Street Riverview Terrace N.E. Part of Lot Lot 3 Block 1 Addition or Sub -Division R;verwood Manor Corner Lot Inside Lot - X Setback -35' — Sideyard 10' & 15.52 `t A*k Elevation -_ 839.42 *A"& W"tjdo(- 842.42 (ApDrox . ) O.WNP To of Footing To be Used as: Dwelling Front 49.5' Depth 46' Height 20' Sq. Ft. 1250' Cu. Ft. Qn—r,ngp Front 20' Depth - 235 Height _ ___10Sq. Ft. _ _4ML Cu. Ft. 4,700' Type of Construction Frame F.st, Cost -_. $21,736 To be Completed _.._ August 1.1-1972 Stipulations: Provide verifying survey and hard surface driveway. WATER LOCATION: 10' N. of Sewer Service, g 34.0' E. of Manhole SEWER LOCATION: 23.6' S. of Manhole In consideration of the issuance to me of a permit to construct the described above, I agree to do the proposed work in accordance with the description above se compliance with all provisions of Ordinances of the city of Fridley. I in consideration of the payment of a fee of $_J5. 00 . permit is hereby granted to Erco, Inc. 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 V'ridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings Within� city limits and this permit may be revoked at any time upon violation of any of the provisions of said r Tncprsntpp LARENCE BELISLE NOTICE: This permit does not cower the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to sae the Building Inspector for separate permits for these items. FTTrw pry Alum 11 APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAM • BUILDER:- ADDRESS: ADDRESS :��/ P eg NO:. 7/,6- 3 S TREET : < 6, --e e /C b i c : -e 't' a C —'tom LOT : -:3 _ BLOCK: ADDITION: osr_-rp <, i,o.> � M,47J c, CORNER LOT: INSIDE LOT: _SETBACK: �� SIDEYARD: b �/�- 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: �- C Front: Depth: Height Square Feet: 115� co Cubic Feet: Depth :'D r �l Height l� Front: -)-0 Square Feet • r, < Cubic Feet: =' ' Type of Construction: Estimated Cost: $ To Be Completed: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sti-ict 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. DATE: at'1 �1 y SIGNATURE. (See Reverse Side For Additional Information.) �7l y� rj BUILDING PERMIT FEt SCHEDULE SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structures or for any alteration or repairs to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: UNIFORM BUILDING CODE: Type 1, 2 & 4 - $2.15 for each one thousand cubic feet, or fraction thereof, in such cubical contents. Type 3 & 5 - $1.85 for each one thousand cubic feet. ADDITIONAL INFORMATION For the purpose of computing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or the cellar to the average heights of the upper surface or to the average height of the roof surface of the main gable of a pitched roof. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost of all proposed work. In no case shall the fee charged for any permit as set forth in Section 2 be less than $5.00. VERIFICATION OF FOUNDATION NOTE: Permits for construction will be issued a minimum of 24 hours from the time of application, to allow for proper review of the proposed.structure and of the construction site. A Certified Survey of the lot, showing the location of the foundation, once it has been constructed, will be required before proceedIR& with the framing. CERTIFICATE OF OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. f U AF 7- rg L-7 V3 610T-) (4) G Al, _ 1 P. 1E' PARTIAL RATE SCHEDULE City of Fimey: 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 riling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and orrect Fridley, Mnn i8 owner r 77!j (21 Kind of p used as PLUMBING FIXTURE RATES- RATE TOTAL Number Fixtures ................ �NO. x 52.E i Future Fixttwe Opening .... a ..... • x $1.60 New Fixture Old Opening .......... x $1.50 5 Catch Basin .................... x $3.26 g Water Heater 'Up to 99,000 BTU) .... x $3.00 $ New Ground Run Old Bldg......... x $3.25 $ Elegy Water Heater .............. s 52.00 8 - GAS FITTING I'EE8 . NO. BATE TOTAL lot 3Fixtures ............... —x$2.00 $ ,UJ Additional Ybdurea ................ z 5 .76 $ Gari Range to 199,000 BTU ............ x $6.00 $ State Surcharge $ .50 F"AMS &r AL TI® ea Is Cc&_! Description . . . O . . . . O . .. p P . 0 O. O A..• . . ®.... O A . O.O. ... ..� TOTALru T� .J To be completed about Estimated Cost, $ OI —New. uilding Permit No. / Permit No. Signed ROUGH Business kune No 52-84-5915.51 City of Fridley Applicaffm for Nombbq and Gat F "bg hndt Dept. of Bldgs. Phone NOLM o - DESCRIPTION OF WORK Number, Kind and Location of Fixtures TAM On 7153 Riverview Terr® PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL p <y ` x $2.00 $ y¢( 5 7 �j �j�g7 � • • wArea �. N GAS ELEG $.__ Catch Ba� �ite................ S2 S► OO oto t V < U' (3 e� New Ground Run Old Bldg. ........ -/ $ Base Electric Water heater .............. a $200 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures . • .......... • ... 1 x $2.00 ¢ 2.00 Additional Fixtures .................. Is< $ Gas Range to 190.000 BTU ... ,............ x $5.00 $ 1J to 2nd ....ns4all 3rd I 44th I 1 1 114 741 1, • Future Connection Openings Connected with } Now Fixture, Old Openings sower ❑ Cesspool 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 Ba� �ite................ x $3.25 $ Water Heater :Up to 89,000 BTU) . • .. 1 x $3 00 $-3.00 New Ground Run Old Bldg. ........ x $3.25 $ Electric Water heater .............. a $200 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures . • .......... • ... 1 x $2.00 ¢ 2.00 Additional Fixtures .................. x $ .75 $ Gas Range to 190.000 BTU ... ,............ x $5.00 $ City of Fridley: The .undersigned hereby makes application for a permit for the vmwk 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 AIL the fact and representations stated in this application are true and correct. Fridley, Minn Aug. 2s 1972 „ 18, owner Erso Inc. 3231 NE Central Kind of Building fr. Used as res. To be completed about g. 7 Estimated Cost, $ 10.00 Old—New. Building Permit oq.'gp:K�:: Permit No. —j(� Business Phone No ROUGH FINAL G6� REPAIRS & ALTERATIONS—Refer to Codd 61as& "A"' Description .............................................. ; Surcharge .50¢ TOTAL FEE $ 55.00 (SURCHARGE $_.50) City of Fridley 53-84-s-915,51 Appkafioe for PMmbbg and " I ftmk Dept. of Mdg& Phone 980-3450 DESCRIPTION OF WORN 7153 N. E. Riverview Terrace Number. Kind and Location of Fixtures �� PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ x $2.00 $ IDA x $1.50 $ New Fixture Old Opening .......... x $1.50 $ Catch Basin .................... N WATER HM. GAS ELM Base $ New Ground Run Old Bldg......... x $3.25 $ Eleat do Water Heater .............. : $2.00 $ GAS FITTING FRES: NO. RATE TOTAL 1st 1 2nd 3rd 4th • Fuge Connection Openings Coaaec bad wish + NOW Fixture. Old Openings Sewer ❑ 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 $ Eleat do Water Heater .............. : $2.00 $ GAS FITTING FRES: NO. RATE TOTAL 1st 3 ]Fixtures .......... • • • • • . x $2.00 $ Additional Fixtures .................. x $ .76 $ Gas Range to 190,000 BTU.. . 1x $5.00 $ 5.00 REPAIRS & ALTERATIONS—Refer to Code Description ........................................« ..,...$ TOTAL FEE $ 5.00 (SURGHARGE $}_.50) City of Fridley: The .undersigned hereby makes application for a permit for tine work herei specified, agreeing to do all work in strict accordance with the 0117 Ordinance and ruling of the Depart of Buildings, and hereby declares that all: the fact and representations stated in this application are true and correct Fridley, 1Rinn 8-11-72 19_.. Owner Erco Inc. - Kind of Building Frame Used as Res. To be completed about Estimated Cost, $ 10.G0 8-11-72 XMRPLNew. Building Permit No. P 7 ot No. �CD Signe By flflINNEGASCO Business Phone No ROUGH FINAL /- �) IWN%.Vass $v1i+Ci�g a t) 53-%-s-915-51 City vF idly Appkaftm for PWmbbq and Gm Mao Pwmk Dept. of Eldim Phone :Zit'- ."MMM-�=1MMMJ PARTIAL RATE SCHEDULE FL.WMING TM IRATE : N06 RATE TOTAL mumbef NZWMZ ........... x alas S Future FWure Open .... ® ... ©®. Is $1.60 �®.. New Nxture ®Dei Opening .......... x $LSD 8 CWN BmAn ........... x 33.ffi Water beater (up t® 99.00 BM.... x 33.00 3 New Ground Rear Old Bldg......... a 33.5Ekcbk f Watm E6stw .............. s $100 : GAS WTMMG FEED: 1M. RATE TOTAL lot 3NUtum ......•...®••••:•• _X8100 i .4idaitlonml ...... o ... a ....-x$.75 1 OW RaW .t8 1W.000 BTU.. e.. s . s • ... x W09 • Mate .Surcharge m .. o .. o o ....... s o.. a s.®.. m. •a... e. e. e e•e . S TWAL F. 6 5 50 7153 RT �. Riverview Terrace _ •icr oaf �!' , �- ru .i°. ,gr; ..S Ix a<:1} ,uLde. rk �. :) -.{ F . w`".- F;�' ,� a n mi spedfled, &Vedas to do an wortz to 7,aif` accordanm wfth the 0fo _ X1;4ranng .l'.the iD :fW ?:1'. .. of u ;!:i n -lit ."kl the fact u and }'€'. t.'ut:% 5ta1 .A1 '_51 thAs aPPlicaftS W2 11>e Bad Wfl."_.a tS %,%'�$•urchgrge $Z0 LJ CITY OF FRIDLEY 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 $12.00 $ 7.00 * Replacement of Furnace 7.00 $ 4.00 Repairs & Alterations -up to $500.00 7.00 $ Department of Buildings Repairs & Alterations each add. $500.00 4.00 $ City of Fridley OWNER b-1 i l—D ® l c Boiler & Lines up to 100,000 BTU Tel. #571-3450 MECHANICAL WARM AIR: MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE *Attached stack verification form 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 *Replacement of Furnace 7.00 $ 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 4.00 $ Fridley, Minn. , 19 M STEAM _4&4- OR HOT WATER SYSTEM: OWNER b-1 i l—D ® l c Boiler & Lines up to 100,000 BTU $12.00 $ KIND OF BUILDING 0-0001) each addn. 50,000 BTU 4.00 $ Boiler only up to 100,000 BTU 7.00 $ USED AS �� L each addn. 50,000 BTU 6.00 $ TO BE COMPLETED ABOUT OIL BURNER- to 3 gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $ ESTIMATED COST GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $ OLD - NEW BUILDING PERMIT NO. PERMIT NO. �� 9G (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: 1st 3 Fixtures x $ 3.00 $ DESCRIPTION OF FURNACE/BURNER Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00 $ HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. AIR CONDITIONING $00 FAN HEATING SYSTEMS $ Trade Name Size No. See Fee Schedule VENTILATING SYSTEMS $ ALTERATIONS $ REPAIRS $ Capacity Sq. Ft. EDR BTU HP State Surcharge $ .50 Tonal Connected Land Kind of Fuel TOTAL FEE $ 10,156 BURNEP. - Trade Name Size No. ROUGH INSP. REINSPECTION FEE Capacity Sq. Ft. EDR BTU HP Date (.$10.00) FINAL INSP. Company t X7 Y Data Signed 8 APPROVAL FOR PERMIT "�, - L, Tel. No. MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE *Attached stack verification form SUBJECT IT NO. ' City of Fridley f ; , . 25581 AT THE TOP OF THE TWINS BUILDING PER IT,' ' r RECEIPT"N"O. �• COMMUNITY DEVELOPMENT DIV. __e__PROTECTIVE INSPECTION SEC. r L ------ PROTECTIVE 1 � I NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 •� L 612-571-3450 910-F15 10/10/97 JOB ADDRESS 7153 Riverview Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 Riverwood Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Donald Weeding 7153 Riverview Terrace NE 574-1581 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 [3k REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof House & Garage (29 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING. HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD 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 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 $2,418 $1.21 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 $2.42 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK F OTAL FEE _$78.38 I A U OFC NTRACT RAUTHORIZED AGENT IDATEI EN PR Y V ID TED THIS IS YOUR PERMIT UROF OWNE90F OWEBDERI tDATEI Bl INSP BATE NEW [ ] Effective l/1/97 ADDN ( ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2Al� BUILDING PERMIT APPLICATION ConstructionAddress: `��� �IP1/PYf/)�C� Legal Description: Owner. Name & Address: Tel. # 5-,;? Contractor: MN LICENSE # Address: Tel. # 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: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER:o -/ ,' . I, -1-e Z V ® Construction Type: �t", Estimated Cost: (Fee Schedule on Back) Driveway Curb Cut Width Needed Ft:` 6 Ft Ft x DATE:- — APPLICANT: Tel. # '-T 7 S'1113ULATIONS: R 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 $ $950 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 j) Not Necessary [ ] TOTAL $ r 1 -30 S'1113ULATIONS: R BUILDING PERMIT FEE SCHEDLI.F I7rc Chief Building Official shall, before issuing. permits for the erection of any building or structure, or for - any addition to any existing building or structure, or for any alteration or repair to any or building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -Wit: TOTAL VALUE FEES $1 to $500 $21 (Minimum Fee is $21 plus surcharge) $501 to $2,000 $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25;000 $25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to- and including $50,000 $50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $1()0,000 $100,001 to $500,000 $887.25 for fust $100,000 plus $5.00 for each additional $1,000 or fraction thereof,.to and including $5001,000. $500,001 to $1,000,000 . F `' . $2887.25 for the fust $500,000 plus $4.25- for each additional $1,000 or fraction thereof, to and including $1,000;000 $1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only. - Driveway width plus 6 feet times $13.50.. Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper- iew of the proposed structure and of the construction site. %i <::u.titicatc o1 Survey of the lot, showing the location of the foundation once it has it has Been constr-uctk:�! .. ', reyuilud before hroceedin-1, with tic framrn<ll CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 763) 572-3604 FAX: (763) 571-1287 ADDRESS : 7153 RIVERVIEW TERRACE NE PIN : 103024420043 LEGAL DESC : RIVERWOOD MANOR : LOT 3 BLOCK 1 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT O.: 2004-01575 DATE ISSUED: 09/13/2004 .� VALUATION : $ 0.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL IRRIGATION BACK FLOW PREVENTER. # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS # GAS DRYERS 0 # GAS RANGES # OF NEW FIXTURES 0 VALUE (FOR MINIMUM CALC) # WATER TRMT APPLIANCES 0 APPLICANT WEEDING DONALD J & MARILYN 7153 RIVERVIEW TER NE FRIDLEY, MN 55432 OWNER WEEDING DONALD J & MARILYN 7153 RIVERVIEW 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 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 other state or local law regulating construc ' r the perf ance of construction. Applicant Date Bldg PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) PLBG FIXTURES (EXIST OPENINGS) WATER TREATMENT APPLIANCE WATER HEATER - ELEC WATER HEATER - GAS GAS RANGE FEE GAS DRYER FEE PLBG REPAIR/ALTERATIONS STATE SURCHARGE, PLBG FLAT TOTAL PAID WITH CHECK # 16193 SEPARATE PERMITStEOUMED FOR WORK OTHER THAN DESCRIBED ABOVE. 0 0 100 15.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.50 15.50 CITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004 6431 University Ave NE L�8 / 2 Fridley, MRN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT a � (� (763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $10.00 Old Opening, New Fixture $10.00 Beer Dispenser $10.00 Blow Off Basin $10.00 Catch Basin $10.00 Rain Water Leader $10.00 Sump/Receiving Tank $10.00 Water Treating Appliance $35.00 Water Heater -Electric $35.00 Water Heater - Gas** $35.00 Gas Range** $10.00 Gas Dryer** $10.00 Back Flow Preventer Required (-,)?es () No Type $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE $ .50 JOB ADDRESS Z/. 1�Vifry �� "7 1'� 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 Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: ® , 20 BUILDING USED AS -e ,$ - ESTIMATED COST 2 S7o4 PERMIT NO. �0041 PLUMBING COMPANY SIGNED BY Approved 01 ^� TEL N0. Rough -In Date Final Date COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE i FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT; VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing 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 terminatidn. 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 Fumace V6nting 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( ) Aaaliance Tvpe 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) HEATING CO: Signed By: Date : i°