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PRE 2010 DOCSSUBJECT PERM) City of Fridley ® 1898 8 AT THE TOP OF THE TWINS BUILDING PERMIT REC `L _ ____ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. �� r i PROTECTIVE ,"'1 CITY HALL FRIDLEY 55432 A NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/2/87 JOB ADDRESS 7106 Riverwrood Drive N.E. 1 LEGAL BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ILOTNO. 12 2 'verwood Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mr. Richard & Carol.Jansen 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. McMullen/Moselle & Associates Inc. 430: Industrial Blvd., Mpls. 55413 378-3981 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 ❑ REMOVE _ 8 DESCRIBE WORK Construct 4 36t' x 30" Dwelling and a 25'11 x 3W Garage 9 CHANGE of USE FROM TO _STIPULATIONS Provide a hard surface driveway, Provide s:od in the front and side yards. Provide City with_ copy of verifyingo survey before capping. See notations on plan. Paid Park Fee of $1,500.00 and a IN Escrow of $297.00 SEWER LOCATION.; "Wywr." 21' South, of Manhole INV; 846.08 TOP OF FOOTING; Minimum elevation 849,08 WATER LOCATION: In same trench. as severer WARNING Before digging ca F'iities SEPARATE "PER ITS REQU� EL) F6f� TELEPHONE - ELECTRIC - GAS Ei`. q WIRING,i-I�kTl�lG, PLUM�d�� Alp SIGNS. REQUIRED 6Y LAW 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 1 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 GOVERNING THIS TYPE OF WORK WILL BE COMPLIED NOT. THE GRANTING $117,450 $58.73 WITH WHETHER SPECIFIED HEREIN OR OF A PERMIT DOESN r PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROV NS OF AN OTHER STATE OR O L LAW REGULATING CON- $478.00 $Ciredit from SchO ST U TT OR THE'PERFO E OF ONS RUCTION. PLAN CHECK FEE TOTALFEE �% ) $ 119.50 $656.23 + PF & DW SIGN RE OF CONTRACTOR AUTHORI2EDAGE T (DATE) WHEN PROPERLY 8 _LD16)NSP VALIDATED THIS IS YOUR PERMIT Po ATE SIGNATURE OF OWNER OF OWNER BUILDER) (DATE) NEW City of Fridley Effective 4/1186 ADDN, [ ] R-1 AND R-2 �� t ALTER. ;.[,, j Sul, ding, Permit Application Conatruct.an Adr.s:"7 06IVERWOOD DRIVE = FRIDLEY MN Legal Description: LOT 12 - BLOCK 2 CAROL WK.'781-5588 Owner Name &Address: RICHARD & CAROL JANSEN-700 MARIGOLD TERRACE Tel, #T,iM, 571 6534 McMULLEVMOSELLE & ASSOCIATES INC. Tel. # 378-3981 Contractor: Address: 430 INDUSTRIAL BLVD. - MINNEAPOLIS, MN. 55413 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;,- Width Height Sq. Ft.._.,_ ;Length _,r..--.—r— DECK AREA;,- Length- Width. -- Hgt/Ground Sq. Ft. OTHER: Corner Lot (' J . Insides. Lot, ( ] Ft, Yd,. Setback, _ Side Yard Setback Type of Construction: NEW HOME CONSTRUCTION' Estimated Cost: $ 10 .y So' C AUGUST 1,; 1987`' Approx. Completion Date._,,-., Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $' See Back Pa6e $ for Explanation DATE: APPLICANT: Tel. # CITY USE ONLY Permit Fee $ 00 Fee Schedule on Reverse Side Plan Check $ t kso 25% of Building Permit Fee State Surcharge. $.50/$1,000 Valuation SAC Charge $ $475 per SAC Unit Park Fee 0 UUd Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ TOTAL $ �, t STIPULATIONS: MVJLI QL00, 0(1 ,c�o� V33.9u Wx 64 f q i 4' n+ $ Mein Office 671 SM i 6676 Highway No. 68 N E " '+ USURNAN • Mhnreapolis. Minnewis 66432 NOINISISRINO (. -- '�'• INC. rftnhOfRce 8la4661QCliftRoadCivil & Municipal Engineering • Sail Tasting a land Surveying • Lnnd Planaing sville. Minnesota 66337 ` Certificate of Survey hoar s N. ,,''•• N 1 m proQOSed :: 00 •Os Iy•. A :7ti..t / 1 Y\011 ,oj� ® n .O N `( N o 11 Q -x..5.5 20.0 6G tj ' • 35.50 \n.' 30 ®. Q0_ T Sub act to alasi ama�n$s 1 Sc rEngs s1,ovvn are- awuri%ad O �t¢notrZs non rlu-%u mo-,r.k- , R1. =_e_ p�n4tes�c�rainaq¢ am utildc 0-a►saMOr t . PA.RY\ `: 1 hereby certify that this Is a true. and correct representation of a survey of the boundarles mf the above. described land, and of the location of alJ bcfllditi 4 • •o y and all nig le encroachments, If any, from or at sold land. As surveyed by me this i1!40Y of S�ii�URl�, IV 6 IiERI ti, INC. t Engineer urwyovs '1 :O'Scola 1. It' cv 1i Fa.at by 9 1 Not Pubidslseti: All p1013 Rid w I AV, T'o � d F �= 6 r� T ✓ �/ G €fit r i1 r p�t�*� v l'v1 _ aat:ect.e lwq, 1. t'txt _ CITY OF FRIDLEY ArfLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION_, REFRIGERATION AND AIR CONDITIONING SYSTEMS AMO DEVICES-- - RATE StHEIN RISIDENTIAL RATE TOTAL Job Address Burner Also and Duct Mork, Burner (Also aeplaceiunt furnace) S 10.00 $ 2 0 - Department of Buildings, 6431 university Bra. N.L.. Fridley. MN SSt72 r - City of Fridley Cas Piping $ 10.00 _ S/,V Tet. x571-3150 )piping needed with new furtMee). -Gas Range $ 10.00 $ The undersigned hereby waked • lication for emit for the work bersin PP � specified agreeinq to do all work in strict accordance with the City Codes Gas Dryer $ 10.00 $ and rulings of the Department of Buildings. and hereby declares that all the facts and representations stated in this application are true and correct. • Air Conditioning (all sizes) $ 10.00 8/ Fridley. Minn. All Others/Repairs and Alterations ` amok 1�� il�� 1'�er� r)"ILx- I Q 1t of Value of Appliance or Mork $ RIND OF BUILDING ERCIAyINDUSTRIAL USED AS It of Value of Appliance or Work S To BE C010PLZTED Asan s ESTIWZD COST -�C� •5 state Surcharge $ .50 ® OLD - NEW BUILDING FEIMIT MD. MORI? 010. TOTAL MS . Reinspection Pee (S1S.00) S DESCRIPPION OF FURNACL/BUIM Rough Insp. ater. . ,� ,,4,r"&A-L or VOMER PLANTS, Stems. Not Mrm Alr 0b !DateHEATING Final Insp. �� _ Trade Name �� . / size No. 41kl /Ue7az- to' .Capacity Sq. Ft. unt S7U d&& Jc/v HF Approval for Paralt Total Connected load hind of Feel BURNER - Trade Name size Ro. Capacity Sq. Ft. EDP BTU MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00 Compa y PLUS S. SO STATE SURCHARGE sinned By Attach stack verification fors with replacanent furnace permits Tel tin *Air Conditionerq can not ta- placed in +id.• yard without written 1"•Mis%ion frca adtocninq nrigtdxx. tttective Aug. 1, 19HI CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: New Fixtures Future Fixtures Old Opening, Nev Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer NO. /b ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance RATE S 5.00 $ 3.50 S 1.50 S 4.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 Reinspection Pae $ State Surcharge ($15.00) TOTAL FEE TOTAL s ,o•bo s Cb.�v S Job Address '6 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 thisapplicationare true and correct Fridley, Mn.y 19 A. KIND OF BUILDING d � G { 4 N USED AS a UL d) IU 1, TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. _tau ROUGH INSP. Date Company � T V J • ! WV -71 Signed By*�e� l! Tel. No. `, � t v] 5-t� FINAL INSP. "„i Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE > a U u 01 water E" 16 11, U. 5a Heater .psi d b c 0) u u� W c c8 d d w 0 N l UI e7 -00 W -1 �0 W O i.' '4ra �0 7 �0 pN �Np N U :2a a N a t..0 w U t0 a 3 C! C7 O aS leC let 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (®) - New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: New Fixtures Future Fixtures Old Opening, Nev Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer NO. /b ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance RATE S 5.00 $ 3.50 S 1.50 S 4.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 Reinspection Pae $ State Surcharge ($15.00) TOTAL FEE TOTAL s ,o•bo s Cb.�v S Job Address '6 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 thisapplicationare true and correct Fridley, Mn.y 19 A. KIND OF BUILDING d � G { 4 N USED AS a UL d) IU 1, TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. _tau ROUGH INSP. Date Company � T V J • ! WV -71 Signed By*�e� l! Tel. No. `, � t v] 5-t� FINAL INSP. "„i Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE y ,..� f; G CITYOF FRIDLEY CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MINNESOTA 55432 • PHONE (612) 571-3450 August 4, 1987 McMullen/Moselle & Associates Inc. 430 Industrial Blvd Minneapolis, MN 55413 Re: Final Inspection at 7106 Rverwood Drive N.E., Fridley Dear Sirs: A final inspection was conducted on August 4, 1987 of the above address and there were no items that were found to be incomplete. The building permit is now finaled out and the structure is approved for occupancy. This final is subject to the electrical, plumbing & heating inspections being completed and approved. If you have any questions on this matter, please feel free to contact me at 571-3450. Sincerely, D CLARK Chief Building Official DGC/mh SUBJE& EAMIT NO. City Of Fridley 2973 AT THE TOP OF THE TWINS BUILDING PERMIT 1 1 RECEIPT NO. COMMUNITY DEVELOPMENT DIV. INSPECTION SEC- �� r � � PROTECTIVE NUMBER REv DATE PAGE OF APPROVED BY T ��"' �•� CITY HALL FRIDLEY 55432 ---•� 1 612-571-3450 910-F15 6/21/99 JOB ADDRESS 7106 Ri verwood Dri e NE I LEGAL LOT NO. BLOCK 11 TRACT OR ADDITION SEE ATTACHED DESCR. 12 2 1RiveRiverwood Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard Jensen971-6914 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Lloyds Home Improv. Inc. 1078R -56n2 1798 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO B USE OF BUILDING Residential 7 CLASS OF WORK D NEW 0 ADDITION D ALTERATION XX REPAIR 0 MOVE O REMOVE 8 DESCRIBE WORK Reroof house and garage 27 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 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 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 $2360 $1.18 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE �-- License SC $5.W $91.79 SiGNATUREOFCON'RACTOQ CWAUTHORIZVEN �OATE, WHEN PROPER ALIDATED THIS IS YO R PERMIT " F �� - SLOG ,NSP ' it Q L� OATE _ S,GNATURE OF OWNERJF OWNER BUILDER, (DATE, NEW I l CITY OF FRIDLEY ADDN [ ] ALT [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress : 7106 RIVERWOOD DR& Effective -1/1/99 Legal Description: Owner Name & Address: RICHARD JENSEN Tel. # 612-571-6534 Contractor: LLOYDS HOME IMPROVEMENTS, INC.. MN LICENSE # 0001798 Address: 1012-421-2 AVE... NE Tel. # 612-788-5602 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 Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. 27 SQU ARES Construction Type: TEAR OFF & REROOF HOUSE & GARAGE Estimated Cost: $ / (/i0 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ 159 STIPULATIONS: .. 9 ' ' Tel. # DATE: Le PLICANT:. .�� CITY USE ONLY Permit Fee $ 03-o? Fee Schedule on Reverse Side Fire Surcharge $ 3 ( .001 of Permit Valuation (1/10th%) State Surcharge $ % i/; $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ 5.0() $5.00 (State Licensed Residential Contractors) t . 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 $ 91"2:2 STIPULATIONS: .. 9 CITY OF FRIDLEY INSPECTION DIVISION 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 Rate 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) 1°J of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work 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. TOTAL Effective On January 1, 2000 JOB ADDRESS /0(o �_i�U�W��Q IV�� BUIL $ / ESTIMATED COST PERMIT N0. / 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 �vaC Burner'Ra`d�eNjtr 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 $ .50 rulings of the Building Division, and hereby declares that all the facts and $ ';�Y representations s_ tated in this application are true and correct. DATE Zn/®/ umm #=90911 HEATING Q& M 55111 Signed 4Q&jdgL TEL # Approved B Rough -In Date Final Date 0 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 As s@�`c f a t .� Appliance #3 Type BTU Input Fan Asda Total Appliances Total Btu Input c Common Vent Type Vent Height s Appliance #1 Vent Connector Height ft Length ft Appliance #2 Vent Connector Height ft Length ft Appliance #3 Vent Connector Height ft Length ft ALTERATIONS: (Describe) HEATING CQ ;! �;y3 -..., ems Diamete , � 4 inches Diameter in Type Diameter in Type Diameter in Type Signed By: Date : CITY OF FRIDLEY PERMIT NO.: 2004-02094 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUER: 417/04 571-36U4 VAX: ("/63) 5-/I-IZ57 a®-- ' %" ADDRESS : 7106 RIVERWOOD DR NE PIN : 103024420069 LEGAL DESC : RIVERWOOD PARK : LOT 12 BLOCK 2 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 300 APPLICANT CENTERPOINT ENERGY/MINNEGASCO 13562 CENTRAL AVE NE ANOKA, MN 55304 - OWNER JANSEN RICHARD G & CAROL M 7106 RIVERWOOD DR 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 wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate cel the provisions of any other state or local law regulating crio or the performance of construction. Applican,fj� Date HEATING PERMIT MINIMUM FEE 0.00 FURNACE SHELL/DUCT WORK 35.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 35.50 PAID WITH CHECK # 6202 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. ;ITY OF FRIDLEY BUILDING INSPECTION M a 3431 University Ave NE 9=ridley, MN 55432 L 763-5723604 FAX 763-5711287 9 D )LATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) 0 Gas Range Gas Dryer *Air Conditioning -All Sizes Effective 4/1,!2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES ee 10-tAl $35.00 $ 3 , M $10.00 $ $10.00 $ $25.00 $ All Other Repairs or Alterations (List on Back) >- 1% of Value of Appliance or Work $ A Minimum Fee $15.00 for Residential or 5% of cost of Y improvement whichever is greater on work less than $300.00 j Commercialf industrial/Institutional > 1.25% of Value of Appliance or Work (List on Back) $ Minimum Fee $35.00 for Commercial/•industriaVinstitutionai YState Surcharge $ .50 i TOTAL FEE $ Iq 1, REINSPECTION FEE $50.00/HOUR M *Air Conditioners can not be placed in side yard without written approval N from adjoining property owner - copy to City J_ FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Q JOB ADDRESS Owner T� Y15eY7 - Building Used As �I I'1L �- ESTIMATED COST �' 33Q2 QC) PERMIT NO DESCRIPTION OF FURNACE AND BURNER # of Heating Units__`_ Circle One (Steam) (Hot Water (Warm Air Trade Name ,)G1 lit V5 Size No. BTU "�� C HP EDR Fuel NaS _ (220_S Total Connected Load Burner Trade Name BTU HP Size No. 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 and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. CENTERPOINT ENERGY MINNEGASCO HEATING C;0 13562 CENTRAL AVE NE BLAINE, MN 55304 Tel # 763-757-6202 Signed_ / (� FAX # 763-757-6701 Approved by Rough4n Date Final Date 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 termination. Yes (y) No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturers 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 ()o 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 -LAMA 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 Infonmation Appliance #1 Type -P BTU Input'25.-,Fan Assisted or NatEA Appliance #2 Type isA " A-,a.l� BTU Input 3-T Fan Assisted or Nat . Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type c'X 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 CENTERPOINT ENERGY MINNEGASCO HEATING CO: 13562 CENTRAL AVE NE BLAINE, MN 55304 Signed By: R Date 1-T �Gtl�Gt'rl tt�J.91.SL 01 Jo3"IQ i old �n )ll i o WoN-I C,?: T t bH®Z-LZ-�1dH CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 554,32 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Effective 411/2004 APPLICATION FOR POWER PLANTS AND HEATING, CODLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOBADDRESS -1166 r�4VeVVV06d PV. NE $35.00 $ $10.00 $ `610,00 $ Gas Dryer $10.00 $ *Air Conditioning- All Sizes $25.00 $ ' All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Minimum Fee $15.00 for Residential or 5% of cost of improvement whichever is greater on work less than $500.00 CommercialilnduMrial/Institutional 1.25% of Value of Appliance or Work (List on Back) $ Minimum -.Fee $35.00 for CommerelaVindustrieVinstitutionai State Surcharge $ .59 TOTAL TOTAL FEE $ REINSPECTION FEE $50.00/HOUR *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Owner Building Used As ESTIMATED COST I s Sbu ' ®® PERMIT NO # of Heating Units Circle One (Steam) (Hot Water) ('Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load I 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 and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. HEATING 00 Slgned gAtk Tei # River City Sheet Meta , Inc. Fn wA..; a+, nr.e., Date - Fridley, MN 55432 (763) 754-2199 Fax (763) 754-2906 Approved by Rough -in Date Final Date