PRE 2010 DOCSin
City of Fridley, Minn.
BUILDING PERMIT N® 3 8 61
Date: ...�...;../.... ..........
Owner ............. Builder ....1�6V°'�OJ'. 8 ..... ... ......
Address ...................................... Address .............................................
LOCATION OF BUILDING
No. Street . .. ...... r.....1....... PartZoft ............. ....... ......
Lot ...3 ...... Block ..9...... .. Addition or Sub -Division.
.. )K ... Setback,3677'��... Sideyard & .:'rte .............. .
Corner Lot ............ Inside Lot ..... .....
DESCRIPTION OF BUILDING
Togr
.s .ed .. .. Front /..�.Depth�. c Height %�' �. Sq. Ft.I:.�', Cu. Ftp 9 /
Front ........ Depth .......,.�Heiggh�t .... Sq. Ft. ........ Cu. Ft. ........
Type of Construction .......:..........Fast. Cost....... To be Completed .............. ; ... .
In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley. y
!�.................................................
In consideration of the payment of a fee of $. ............. permit is hereby granted to ...................
......................... to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at any time upon violation of any, of the provisions of said
ordinances.
Building Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
APPLICATION FOR.BUILDiNG PERMIT
CITY`OF FRIDLEY, MINNESOTA
Owners, Name Builder
Address _ _.._ Address _.
LOCATION,OF BUILDING
Part of Lot
No. Street _._...�s�. �_ - _ ____.._.._....
Lot,. .�.1. Block Addition or Sub. Div.
Corner Lot Inside Lot Set Back
Appli.,cant attach'to this form Certificate of Survey of Lot and proposed
bullding.location.
DESCRIPTION OF BUILDING
To be used as
Front __.�: Depth -Height
1 t4.®
Front .66-9 Depth -2e---;' Height
Sq. ... �'� ' -Cu' ' Ft.
Type of Construction Estimated Cost.��€'.
To be completed
The undersigned hereby -makes application fora permit for the work
herein specified, agreeing to do all work in strict accordance with the
City Ordinances and ruling of the Department of Buildings' and hereby
declares that all the facts and representations stated in this application
are true and correct.
Date .� Signature
(A Schedule of Fee Costs can be found on the Reverse Side)
' ,e
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
572-3604
MARK NI IMRFR OF FIXTURES TO RE INSTALLED ON EACH FLOOR
Water
Stories Closet
Urinal
Bath
Tub
Shower
Wash
Sink Tray
Drink. Floor Catch
Fount. Drain Basin
Auto. Gas Gas Misc.
Washer Appl. Range Fixt.
Water Heater
Gas Elec
Basemen
Floor 1
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES:
NO. RATE TOTAL JOB ADD
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
Gas Dryer
Back Flow Preventer Required ( )Yes () No
Type
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$5.00
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
I % of Value of Fixture or Appliance _
r
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.
l' -®d 1991
Owner
Building Used As_(2 e 5�
Estimated Cost _1®6 . &-e PERMIT NO. / C�
PLUMBING COMPANY vA rL _-�, C_-
BQYTEL N0.
G
MINNEGASCO
Approved By Rough n Date Final Date -.L- - `- `
State Surcharge .50
MINIMUM FEE FOR ANY PLUPABING/GAS PERMIT IS $15.00
TOTAL FEE $ PLUS THE $.50 STATE SURCHARGE
�--i ,n------ --- -'-- -^--- - _ � __'_-
'��r-- ------� --- --' -
`''
CITY OF FRIDLEY INSPECTION DIV.
Effective On March 1, 1996
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 I �� S Ly[wouc Lzn"e�
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work herein
Residential Rate
TOTAL
specified agreeing to do all work in strict accordance with the City Codes and
Furnace Shell and Duct Work, Burner -
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace $ 30.00
$ J®. OO
representations stated in this application are true and correct.
(Side Vent -Fill Out Back)
`--� ,
1 199
Gas Piping (Needed with new furnace) $ 10.00
$
OWNER P h l I FJah �e �l C CC 13
Gas Range $ 10.00
$
^f
BUILDING USED AS 1.k1
Gas Dryer $ 10.00
$
J �� � D�
ESTIMATED COST l f rf
PERMIT NO, ®a
*Air Conditioning - All Sizes $ 25.00
$
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water) ( arm Air
Trade Name Size No. Af 6
Commercial/Industrial
BTU 75_c®0 0 HP EDR
1.25% of Value of Appliance or Work
$
Fuel1 - 4 S Total Connected Load
State Surcharge
150
Burner Trade Name Size No.
TOTAL FEE
S
BTU HP EDR
HEATING COMPANY C � Q.�'
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
-21-1
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
Signed By� Tel No. 75_V -q000
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr Approved By Rough -In Date Final Date
*Air Conditioners can not be placed in a side yard without FILL OUT BACK. SIDE F R STACK VERIFICATION ON
written permission from adjoining property owner. REPLACEMENT FURN E RICCAR HEATING & AIR COND.
2387.136th AVE. N.W.
ANDOVER, MN 55304
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CHIMNEY AND STACK VERIFICATION
The
undersigned hereby verifies that the existing chimney or
stack:
1.
Has been carefully examined
Yes ( )
No ( )
2.
Is free from rust or deterioration
Yes ( )
No ( )
3.
Has no foreign objects lodged within
Yes ( )
No ( )
4.
Is securely supported
Yes ()
No ( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes ()
No ( )
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7.
Has a liner been provided for water heater
Yes O
No ( )
8.
Has combustion air been provided for water heater
Yes ()
No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
City of Fridley
Application for Plumbing and Gas Fitting Permit
DepL of Bldgs. Phone SU 4-7470
DESCRIPTION OF WORK
Number. Kind and Location of Fixtures T_nwa+?nn
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO RATE TOTAL.
Number Fixtures ......................
x $1.50
$P
Future Fixture Opening ................
x 1.20
$
New Fixture Old Opening ...........:..
x 1.00
$
Catch Basin .............................
x 3.25
$
Water Heater (Up to 200,000 BTU)
...... e� x
New Ground Run Old Bldg . ............
x 3.25
gqrr
GAS FITTING FEES:
NO. RATE TOTAL
12
Z
1st 3 Fixtures ..........................
S� a
Z
o
x .50
�U'
z
�U'
s
R
N
WATER Kra.
GAS
ELEC.
a�
t!29d
4c
O
Base
1st
2nd
3rd
_
4th
• Future Connection Openings
Connected with
New Fixture, Old Openings
I
Sewer ,®
Cesspool p
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO RATE TOTAL.
Number Fixtures ......................
x $1.50
$P
Future Fixture Opening ................
x 1.20
$
New Fixture Old Opening ...........:..
x 1.00
$
Catch Basin .............................
x 3.25
$
Water Heater (Up to 200,000 BTU)
...... e� x
New Ground Run Old Bldg . ............
x 3.25
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..........................
x $1.50
$
Additional Fixtures ....................
x .50
$
Gas Range to 200,000 BTU ..............
x 2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $ /1115"
City of Fridley: y,
The undersigned hereby makes cation for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correot.
Fridley, Minn_ y,T �� 19_
Owner 19
Kindof Building
Usedas
To be completed about �'z j'� 4/
Estimated Cost, $-�'�
®
Old '2
w. euilding Permit No.
Sign
By
Business Phone No
JUL 21 1959 Rough
,Qpoall POST iM-14-58
19
City of Fridley, Minn.
BUILDING PERMITN® 4 5 20
Date: .. .. ".. ::.:. .:: ^.........................:_._.._..�_..__...._............_
0
Owner: - l +6� 4...... Builder - - __..... ''�e _ ...x'.. ........ _......
s
Address _. �'.:...__..__'"_•__ Address ,...:_. ........................
n A
LOCATION OF BUILDING
,&..... ... ................. ........ _..... Part of Lot -----_ ---------- _...__..__............ -............... .._
Lot ............ Block ---- ............ ............... -........ Addition or Sub -Division ..... ..... ............. :; ... ......... ._.._.............. ....
-- - - -
CornerLot .... ............. Inside Lot ........... ................. Setback ..... .............. _....................... Sideyard........ _...... ..-............................. ......... ...... ............
SewerElevation ................ ..................... _........ .................... -....................... Foundation Elevation ............. ....... -............................ ................ ......
DESCRIPTION OF BUILDING
UTb Used as. ....... .. Front
...:::.. Depth r. Height°°:...... Sq: F t. Cu. Ft ,,
................... _. ..................... . r..nt Depth ......... --. Heigh ..... Sq. Ft...........--•---....... Cu. Ft. ..... __..........---
Type of Construction t °1,,, .::. Est. CosU/4101 ... To be Completed ...__ ............._............._.......-........
Al�
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $. ............ permit is hereby granted to. .......... ...... .................................
...._..
.... ...... ... ..... ........ ................. r............_....... to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall ,conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. r /7 A ^, c
.:..Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
I
APPLICATION FOR'BUILDING PERMIT
CITY OF FRIDLEY$ MINNESOTA
LOCATION OF BUILDING
z Street / �2�e a -e_ )j . o Part of Lot
No. �-
Lot
Block
Addition
or Sub -Div,
Corner Lot
Inside Lot,_.Set
Back
Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
nt f clz Depth_ � 6- , Height __Z ®,_;__
Sq. Ft. 1.Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft,
Type of Construction Estimated CostB� G1
To be completed a,
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representa-
tions stated in this application are true and co ct.2/ �e
DATE„ d SIGNATURE p
(A Schedule of Fee costs can be found on the Reverse Side.)
BLOCK IDDRMS/3 VALUATION!/&v
ADD.
If
P=perty Line
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-
SUBJECT -
PER
City of Fridley
12297
AT THE TOP OF T_HE TWINS
BUILDING D[RvIT
r
�
ECEIPT NO
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
8/27/73
JOB ADDRESS 1378 Skywood Lane N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
3
2
S'wanstroms Court SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Phillip Dahlen 1378 Skywood Lane N.E.
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO.
Sussel Company 1850 Como Avenue
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION HCl ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBEWORK Alterations to basement for family room
9 CHANGEQFUSEFROM TO
STIPULATIONS
FOR "RING,
P ERMITS REQUIRED
SEPERATE
AND SIGNS.
HE &-rING, PLUMBING
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
Wood Frame
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 JS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
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
$4,422
2.25
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVIS NS DF ;ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRU ON OR THE PERFORMANCE OF CONSTRUCTION.
26.53
PLAN CHECK FEE
TOTALFEE
$28.78
3
SIGN URE OFONTRAC ORAUTHORIZEDAGENT ID TE)
I �
WXFN PROP RLY, A AT THIS IS YOUR PERMIT
&A -MATURE OF OWNER (trOVrNER BUILDER) (DATE)
BLDG. )NSP DATE. e,
APPLIC'ATION FOR RLiSIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
C fTY OF I -RI DLI Y, MINNESOTA
SOTA
OWNER IS NAME: $UILDER •
ADDRESS: U ADDRESS:
STREET:
LOT: � BLOCK; 1r_-" ADDITION:
CORNER LOT; INSIDE LOT: SETBACK; SIDEYAFD;
Applicant attach to this form Two Certificates of Survey of Lot and proposed
buildiiig Location drawn on these Certificates,
DESCRIPTION OF BUILDING
To Be Used As:
1 Front: Depth: Height:
Square Feet: Cubic Feet:
Front:
Pepth: Height:
Square Feet; 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 stfict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that ,ill the facts and representations stated in this application
are true and correct.
(� %
DATE: / 3 S IGNATURE: r
(See. Reverse Side For Additional Information.)
If96.:s7a
--
V
0
suajEcr
NO.
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
PERMIT
f
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC_J
r
vim•
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED By
612-571-3450
910-F15
8/6/96
/
JOB ADDRESS 1378 Skywood Lane NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3
2
1 Swanstrom Court
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Phil Dahlen 1378 Skywood EXKXM Lane NE
574-0920
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Sela Roofing & Remodeling Inc 4100 Excelsior Blvd,
St Louis Park 55416
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
823-8046 1050
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Reroof House & Garage (30 Sq) Tear-off
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the 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
1 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
$2415
$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
SACCHARGE $2.42
ROVI IONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$74.75
Fire SC
S R CTI T PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
License SC $5.00
$83.38
SIGNA URE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY V" DATED THIS IS YOUR PERMIT
BLDG I SP
HATE
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI "'
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: 1,3 7
Legal Description:
Effective 1/ 1/95
Owner Name & Address: Pff1L 60#Lrol) Tel. # _S--7Y-6q2-0
Contractor: BELA ROOFING & REMODELING, INC. MN LICENSE #
Address: �° i nt nS AAIB. MINNESOTA 55416 _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:
Comer Lot [ ] inside Lot [ ] Ft. Yd Setback Side Yard Setbacks ,
Type®f�Construction: elmm 4 t /-=Aw'f- 41C -f- C- Estimated Cost: $ _/ 1601� T
Approx. Completion Date: l -. �✓`� ��
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: 9-4:K APPLICANT: Tel. # 8-23 FQ Y�
CITY USE ONLY
Permit Fee
f
!`
$ %
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1 / 10th %)
State Surcharge
$ /. ,2/
$.50/$1,000 Valuation
SAC Charge
$
$$50 per SAC Unit
License Surcharge
$ _S_.00
$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:
-
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
5 7L -36U4 YAX: 1 7631 571-1257
ADDRESS 1378 SKYWOOD LN NE
PIN 243024340045
LEGAL DESC SWANSTROMS COURT ADD
LOT 3 BLOCK 2
PERMIT TYPE HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
PERMITO=2004-01222
DATE ISSUED: 07/30/2004
VALUATION $ 0.00
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 AN AIR CONDITIONER
# A/C UNITS 1 VALUE OF APPL OR WORK 0
# FURNACES 0 # GAS DRYERS 0
# GAS RANGES 0 VALUE (FOR MINIMUM CALC) 0
APPLICANT
DAVES APPLIANCE HEATING & AIR INC
160137 AVE NE
COLUMBIA HEIGHTS, MN 55421
(763) 781-6901
1111,9e131:7
DAHLEN PHILLIP A & LADONNA
1378 SKYWOOD IN NE
FRIDLEY, MN 55421
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
regulgfing.4onstWction or the performance of construction.
Bldg Insp.
HEATING PERMIT MINIMUM FEE
0.00
FURNACE SHELL/DUCT WORK
0.00
GAS RANGE FEE
0.00
GAS DRYER FEE
0.00
AIR CONDITIONING FEE
25.00
HEATING REPAIRS/ALTERATIONS
0.00
STATE SURCHARGE, MECH FLAT
0.50
TOTAL
25.50
PAID WITH CHECK # 34898
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY BUILDING INSPECTION
6431 University Ave NE
763-572-3604 FAX 763-5711287
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
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
f�J� 4111 Effective 4/1/2004
i. M G POWERPLANTS AND.REATING, COOUNG, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
41
JOB ADDRESS
Fee Total
Owner l ZLI DO
$35.00 $ Building Used As
.Mn VV. L �.✓'1���
$10.00 $
$10.00 $_, — -
$25.00
Commercial/Industrial/Institutional
1.25% of Value of Appliance or Work (List on Back)
Minimum Fee $35.00 for Commerctai/industrial/institutional
DESCRIPP170N OF FURNACE AND BURNER
# 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
$ and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
State Surcharge $_
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
Tel #��
�krfil�1�Ci�1Cih� • . -
Approved by Rough4n Date Final Date
FILL IN COMPLETEL FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
n•.n7+ ffl'�\T r.n\IIIL•fTAd Akin 1%nMQ1 ICTInN AIR VFRIFICATION
Wheni realacina an existing fI pace, the undersigned hereby verifies that the
venting has been examined ari is free from rust, deterioration, obstructions,
and is securely supported and restopped where required. Yes( )
The venting system is plastic/I
specifications including sizing,
The undersigned also verifies 1
and meets the current codes a
includle AGA -LAMA Category
assistied and natural draft apps
The ekistina combustion air
andan- anufacturees specificatii
Wheri required to install a nes
to meet the current codes and
When Instail)nna a new v®nth
it is alisted assembly and me(
specifications. This does inch
Venti6g Tables for fan assists
Is tho common vent and vent
an appliance has been remove
sepaifately as per current cod(
i
Appliance #1 Type _
Appliance #2 Type _
Appliance #3 Type _
Total Appliances
M,
Common Vent Type
Appliance #1 Vent Connector
Appliance #2 Vent Connector
Appliance #3 Vent Connector
HEATING
Signed By:
and meets all current codes and manufacturer
gth, number of elbows and termination. Yes
the replacement unit is a listed assembly
manufacturer's specifications. This does
antral Furnace Venting Tables for fan
ms_ Yes ( )
No( )
No( )
No( )
sized and installed to meet the current codes
5.
Yes { } No( )
mit will be sized and installed
specifications. Yes O No ( )
,s� vstem, the undersigned hereby verifies that
i the current codes and manufacturer's
e AGA-GAMA Category i Central Furnace
and natural draft appliances. Yes ( )
nnectors sized and installed correctly after
from the common vent and vented
BTU Input
BTU Input
_ BTU Input
Total Btu Input
Yes ( )
Fan Assisted or Nat
Fan Assisted or Nat
Fan Assisted or Nat
Vent Height Diameter inches
ft Length ft Diameter in Type
ft Length ft Diameter in Type
ft Length ft Diameter in Type
No ( )
No ( )