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PRE 2010 DOCS(�N!i W", � ALTE �4S � v� ® Construction Address: Legal Description: _ L� Owner Name & Address: A Contractor: Address_ LIVING AREA: GARAGE AREA: DECK AREA: OTHER: CITY OF FRIDLEY Effective 1/1/2003 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Tel. # 41a) 3at� -357.3 Y �(� MN LICENSE # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Aj a� Length Width � Height®Sq. Ft. Length ' Width C Height_ Sq. Ft. Length J Width Hgt/Ground Sq. Ft. Construction Type: kew #,Kse, Estimated Cost: $ CZ 0, Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x DATE: -3 APPLICANT: /y/� 1 ��.J�l '�Tel. —13A 3V'/ Call (763) 572-3604'for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee $ Fire Surcharge $ State Surcharge $ SAC Charge $ License Surcharge $ Curb Cut Escrow $ soI Park Fee $ 1.6w.00 Sewer Main Charge $ TOTAL $ Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above 5� Fee Determined by Engineering! Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY PERMf�. - 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 03/16/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS 1308 SKYWOOD LN NE PIN T000036 LEGAL DESC SKYWOOD MANOR LOT 2 BLOCK 1 PERMIT TYPE BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : NEW CONSTRUCTION VALUATION : $ 197,034.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. PROVIDE SOD IN FRONT AND SIDE YARDS. PROVIDE HARD SURFACE DRIVEWAY. PROVIDE CITY WITH VERIFYING SURVEY BEFORE CAPPING. SEWER AND WATER LOCATIONS AVAILABLE FROM CITY ENGINEERING DEPARTMENT. CONSTRUCT A NEW HOUSE & GARAGE (61.67 X 35.67) PARK FEE 1500 SAC UNITS 1 APPLICANT BUILDING PERMIT FEE FIRE SURCHARGE 1,542.55 197.03 BISMARK, MICHAEL STATE SURCHARGE, VALUE 98.52 SAC CHARGE 1,350.00 PARK FEE 1,500.00 TOTAL 4,688.10 PAID WITH CHECK # 13162 OWNER BISMARK, MICHAEL 231126 AVE NW APT NEW BRIGHTON, MN 55112 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 work will be complied with whether specified herein or not. The granting of a permit does not pre; to give authority to violate or cancel the provisions of other state or local law regulating construc ' o the pe an of construction. Applicant Date Bldg Insp SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 3 5?/�' o c) & V, , /a& �)' NEW [ ]"d �� CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 F a BUILDING PERMIT APPLICATION (� Construction Address: 136�; -5kYOM ZMy 6�0C)' Legal Description: 1-07- Q, AlQd< -1 5kVL,,LPQJka17rr Owner Name & Address: /��C �G i -� t� Tel. # Contractor: (ilk MN LICENSEO# A d d r sse: �� a If) W �1�f• �1,�"/� ��J�f+t�l�"-%I Wl Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. l DESCRIPTION OF IMPROVEMENT JA LIVING A Length Width Height ' Sq. Ft. GARAG AREA: Length ® Width ;•, S Height a, Sq. Ft. DECK REA: Length _ Width J Hgt/Ground Sq. Ft. OTHER: _ - l`7 5 3.q', Y Construction Type: bew / 1 se, Estimated Cost: $ s Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: /G �%� J�� Tel. # (4- 003 - Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee $ ' �! �. S5 Fee Schedule on Reverse Side Fire Surcharge $ 19 7,03 .001 of Permit Valuation (1/10th%) State Surcharge $ 9 8 . S a $.50/$1,000 Valuation SAC Charge $ $1275 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Curb Cut Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ w - - Park Fee $/ S ®®�00 Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 tAX: (763) 571-1287 ADDRESS : 1308 SKYWOOD LN NE PIN : 243024340064 LEGAL DESC : SKYWOOD MANOR : LOT 2 BLOCK 1 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : NEW CONSTRUCTION PERMIT NO.: 2004-00592 DATE ISSUED: 04/27/2004 VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. WIRE NEW HOUSE & GARAGE # INSPECTIONS 2 # 0-100 AMP CIRCUITS 25 # 101+ AMP CIRCUITS 0 APPLICANT ELEC PERMIT FEE - MIN (RESI) 0.00 ADVANTAGE ELECTRIC ELEC AMP SERVICE FEE 0.00 917 142 AVE NW ELEC CIRCUIT FEE (0-100 AMPS) 0.00 ANDOVER, MN 55304-7726 ELEC CIRCUIT FEE (101+ AMPS) 0.00 (763) 413-1843 STATE SURCHARGE, ELEC FLAT 0.50 ELEC PERMIT FEE - MAX (RESI) 85.00 TOTAL 85.50 OWNER PAID WITH CHECK # 11157 BISMARK, MICHAEL 231126 AVE NW APT NEW BRIGHTON, MN 55112 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. CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 YAX: (763) 571-1L5"/ PERMITO.: 2004-00875 DATE ISSUED: 06/09/2004 ADDRESS : 1308 SKYWOOD LN NE , PIN : 243024340064 LEGAL DESC : SKYWOOD MANOR LOT 2 BLOCK I PERMIT TYPE SEWER & WATER PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE SEWER/WATER CONNECTION VALUATION NOTE: CONNECT NEW HOUSE TO CITY SEWER & WATER. R APPLICANT SEWER PERMIT FEE SEWER PERMIT SURCHARGE 25.00 0.50 OAK GROVE SEWER & WATER CO INC PO BOX 459 WATER PERMIT FEE 25.00 ST FRANCIS, MN 55070 WATER PERMIT SURCHARGE 0.50 TOTAL 51.00 PAID WITH CHECK # 5580 OWNER DISMARK, MICHAEL 231126 AVE NW APT NEW BRIGHTON, MN 55112 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 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 UE5GR113hU A13Uvn. s CITY OF FRMLEY PERMIT NO.: 2004-01238 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 08/02/2004 ►63) 572-3604 FAX: (763) 571-1287 ADDRESS : 1308 SKYWOOD LN NE PIN : 243024340064 LEGAL DESC : SKYWOOD MANOR : LOT 2 BLOCK 1 PERMIT TYPE : DRIVEWAY CURB CUT PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DRIVEWAY CURB CUT VALUATION LINEAR FOOT 32 APPLICANT BISMARK, MICHAEL 231126 AVE NW APT NEW BRIGHTON, MN 55112 OWNER BISMARK, MICHAEL 231126 AVE NW APT NEW BRIGHTON, MN 55112 Sl`? 4e 42 - DRI 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 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. I� GIYOF� FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 July 29, 2004 Mr. Michael Bismark 1308 Skywood Lane NE Fridley, MN 55421 Re: Final Inspection at 1308 Skywood Lane NE, Fridley, MN 55421 Dear Mr. Bismark: A final inspection was conducted on July 29, 2004 for the construction of the house & garage located at the above noted address. It was determined that the construction complies with the approved plans and the structure is approved for occupancy. The following items were noted which must be completed before the building permit can be finaled; 1. Provide the City with a copy of the verifying survey. 2. Provide a hard surface driveway. 3. Provide sod in the front and side yards. 4. Seal all air duct returns. 5. Remove landscaping rock and large rock from City boulevard. We will expect the above items to be completed on or before September 15, 2004 and a reinspection called for. If you have any questions on this matter, please feel free to contact me at 763-572-3604. Sincerely, DAVE #NSEN Building I spector DJ/mh CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 763) 572-3604 FAX: (763) 571-1287 ADDRESS 1308 SKYWOOD LN NE PIN 243024340064 LEGAL DESC SKYWOOD MANOR LOT 2 BLOCK 1 PERMIT TYPE HEATING PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE NEW CONSTRUCTION PERMIT 0.::27 .: 2004-00585 DATE ISSUED: 04/26/2004 , VALUATION : $ 5,200.00 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. INSTALL FURNACE (WARM AIR, YORK, 100,000 BTUS) GAS PIPING AND AN AIR CONDITIONER # A/C UNITS 1 # FURNACES # GAS DRYERS APPLICANT WESTAIR INC 11184 RIVER RD NE HANOVER, MN 55341- (763)498-8071 OWNER BISMARK, MICHAEL 231126 AVE NW APT NEW BRIGHTON, MN 55112 0 # GAS RANGES 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 or cancel the provisions of any other state or local law regulating construction or the performance of construction. AvD can A Date Bldg FURNACE SHELL/DUCT WORK GAS PIPING FEE GAS RANGE FEE GAS DRYER FEE AIR CONDITIONING FEE STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 7870 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 1 0 35.00 10.00 0.00 0.00 25.00 0.50 70.50 CITY OF FRI > INSPECTION 6+'31 University Ave NE Fridley, MN 55432 (763) 572.3604 RATE SCHEDULE DIViSION APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/ Industrial 1.25% of Value of Appliance or Work Al -:250r Effective Oi ivary 1, 2002 JOB ADDRESS 338 &lc`( UkYND Uy OWNER CSW Rate TOTAL w ' BUILDING USED ASST $30.00 —_ ESTIMATED COST PERMIT NO. 6041- $ 10.00 $= DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ 10.00 $ Trade Name CS r_ Size No � _ 6� BTU HP EDR i A $ 25.00 $76 _ Fuel Total Connected Load Burner Trade Name `I Size No. $ BTU HP EDR 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. 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 cor rect. DATE f:I Si F1 Approved Byi Rough -In Da y Roug to Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE F ' THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When re la .ing an existing ff ur�anrA, 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 Fumace 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 manufacturers specifications. When required to install a new norrihi us ion air. it will be sized and installed to meet the current codes and manufacturer's specifications. When installing a new van ina 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. 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 ( ) Yes( ) No( ) Yes( ) No( ) 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 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 57L -36U4 YAx: ("/63)'71-125-/ ADDRESS : 1308 SKYWOOD IN NE PIN : 243024340064 LEGAL DESC : SKYWOOD MANOR : LOT 2 BLOCK 1 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : NEW CONSTRUCTION PERMIT O.: 2004-00623 DATE ISSUED: 05/04/2004 VALUATION NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL 17 FIXTURES AND A GAS WATER HEATER # ELEC WATER HEATERS 0 # GAS WATER HEATERS 1 # GAS DRYERS 0 # GAS RANGES 0 # OF NEW FIXTURES 17 APPLICANT NORTH ANOKA PLUMBING INC 22590 RUM RIVER BLVD ST FRANCIS, MN 55070 (763)753-3373 OWNER BISMARK, MICHAEL 231126 AVE NW APT NEW BRIGHTON, MN 55112 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. Bldg Insp�4�_ Da` PLBG PERMIT MINIMUM FEE 0.00 PLBG FIXTURES (NEW OPENINGS) 170.00 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 35.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 STATE SURCHARGE, PLBG FLAT 0.50 TOTAL 205.50 PAID WITH CHECK # 10943 QTZDAD ATR DRRTRTTQ T?RfITTTRRTI 1PC1R QTCIRTI nTT-TPI? TT-TANI T1FQ(`RTT2RT) ARCIVR University Ave NE 'r Univr r Fri I ryMN 55432 (763) 572-3604, FAX (763) 571-1287 Stories ton es Basement Floor 1 9 Floor 2 Floor � 1 7 Floor 3 Floor loor 4 PLUMBING FIXTURE RATES New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range" Urinal At NO. RATE OTA - Gas Dryer** Back Flow Preventer Required ( )Yes No 1170-00 $4.00 $5.00 $7.00 $7.00 $7.00 $7.00 $10.00 oo $10.00 $10.00 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 BE INSTALLED ON EACH FLOOR iFik—*-�,,�,--.'.,.'-'.".,..'..-'*-.----.'1 Floor i Ca Auto. I Gas Heater Range Gas jElec JOB ADDRESS 309 5&yoo®o Ll-', 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. S/,3 / 2061/ Owner Building Used As A1,6&; i or -j 77 + L Estimated Cost PERMIT NO. 0Q mCIO PLUMBING COMPANY --- 16�6�// SIGNED BY TEL NO. 76 5-3-337-3 Approved By!� Rough -in Date Final Date MINIMUM FEE FOR ANY PLUMBINGIGAS PERMIT IS $20.00 TOTAL FEE PLUS THE $.50 STA SURC!jARG NoYtk Avuolen 1>LitVV-btv-0, IK,,,. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(1) 4ANSD TABLE 6-A. COMMON VENT IIS 90 RJAVIA, RiVeY Wo(. 10 St. FY01VVLS, W-4 55070 S,�c..Du— IV SEPARATE PERMITS IMQUAED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY PE NO.: 2004-01578+� 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 09/13/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 1308 SKYWOOD IN NE PIN : 243024340064 LEGAL DESC : SKYWOOD MANOR : LOT 2 BLOCK 1 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 0.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL AN IRRIGATION BACK FLOW PREVENTER (WILKINS 720A). # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 0 # GAS DRYERS 0 # GAS RANGES 0 # OF NEW FIXTURES 0 VALUE (FOR MINIMUM CALC) 0 # WATER TRMT APPLIANCES 0 APPLICANT PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) 15.00 0.00 BISMARK, MICHAEL 231126 AVE NW APT PLBG FIXTURES (EXIST OPENINGS) 0.00 NEW BRIGHTON, MN 55112 WATER TREATMENT APPLIANCE 0.00 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 0.00 GAS RANGE FEE GAS DRYER FEE PLBG REPAIR/ALTERATIONS 0.00 0.00 0.00 OWNER BISMARK, MICHAEL 231126 AVE NW APT STATE SURCHARGE, PLBG FLAT 0.50 NEW BRIGHTON, MN 55112 TOTAL 15.50 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 work 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 o y other state or local law regulating construction or the p ormance f construction. Applicant Date Bldg Ins p A117Da �Z'W� SEPARATE PERMITS IMQUAED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY INSPECTION DIV. 6431 Univaersity Ave NE Fridlsy, MN 55432 (763)'572-3604, FAX (763) 571-1287 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR NO. RATE TOTAL JOB ADDRESS ,� `%� �`>� �L rr ►�� Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range** Gas Dryer** Back Flow Pr venter Required( )Yes () No Type�a1/�J 1 `9 7�iO-A $10.00 The undersigned hereby makes application for a permit for the work herein $10.00 specified agreeing to do all work in strict accordance with the city codes $10.00 and rulings of the Building Division, and hereby declares that all the facts $10.00 and representations stated in this application are true and correct. $10.00 /L� $10.00 7 DATE: 2 lam, 0y $10.00 $35.00 OWNER $35.00 l $35.00 /� BUILDING USED AS $10.00 $10.00 ESTIMATED COST PERMIT NO. �t4' + $15.00 X!5�6b PLUMBING COMPANY,,f Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE SIGNED BY Approved By $ .50 Rough -In Date TEL N0. Final Date $ /S D OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE { FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT; VENT CONNECTOR AND COMBUSTION AIR VERIFICATI.O_N 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 Fumice 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 ( ) 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) HEATING CO: Signed By: Date: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 kAX: (763) 571-1287 ADDRESS : 1308 SKYWOOD IN NE PIN : 243024340064 LEGAL DESC : SKYWOOD MANOR : LOT 2 BLOCK 1 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : FIREPLACE VALUATION NOTE: INSTALL TWO GAS FIREPLACES. CALL FOR GAS LINE AIR TEST. APPLICANT WESTAIR INC 11184 RIVER RD NE HANOVER, MN 55341- (763)498-8071 BISMARK, MICHAEL 231126 AVE NW APT NEW BRIGHTON, MN 55112 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 construc ijon or the performance of construction. ADD1iC�^q. / T Date Bldg PERMIT •2004-0063_ DATE ISSUED: 05/04/2004 HEATING PERMIT MINIMUM FEE 20.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 7890 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. r CIT;; OF , .DLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnac Fireplace Insert) Gas Range Gas Dryer *Air Conditioning -All Sizes 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 Effec. +/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES _Fee Total JOB Al Owner $35.00 $ Building Used As $10.00 $ ESTIMATED COST+��l1 PERMITNO $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. $25.00 $ BTU HP EDR Fuel Total Connected Load Commercial/Industrial/institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR 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. *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 l.ff-1111! —.111��11�►f1 a I FAX 0 I Approved by4 Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacina 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 () 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) HEATING CO: Signed By: Date: