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PRE 2010 DOCS0 0 Vfflage of Md1eyq'X1ztu BUMMING PERM" 6 5:4 Office of INSPECT019 OF BUIMINGS Fridley, Minn., LOCATION OF BUILDING No,. of Lot 131ock—. Addition or Sub -Division DESCRIPTION OF BUILDING Front- Depth- Height- Stories Manner of Construction To be used as To be completed tSti mated Cost 4 Permit is hereby granted to the building-----,_ described In the above statement. This permit Is granted upon the express condition that the person to whom It is granted, and his agents, employees and workmen, In all the work done In, around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, Minn., regarding the 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 ordluances. —Inspector of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of the above Permit, I hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit I are true as therein stated. Subscribed and sworn to before me at Fridley, day of_Lz�� - A.D. Minnesota, this A Date: June 2, 1965 • e - t eTt n. • E ;w . - a. fr. LOCATION OF BUILDING No. 6161 Street Sunrise Drive N. E. Part of Lot Lot 5 Block 1 Addition or Sub.Division gy'lyan HiU.s Corner Lot Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation To be Used as: Front Front Type of Construction Storm Damage Repair DESCRIPTION OF BUILDING N® '7656 Depth Height Sq. Ft Cu. Ft. Depth Height Sq. Ft Cu. Ft — Est Cost 41400-00 _ To be Completed 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 and in ce with a'll provisions of ordinaaoEs of the city of Fridley. In consideration of the payment of a fee of 10•QS _ _ _ t is hereby granted to-Antk gay A za,3i21sId to construct the building or addition 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 ordinance& Allen Jensen Building Inqmtor NOTICE Ub permit dot not sorer the condruetien, Installation for wiring, plumbing, gn heating, wwor w water. Be sure to we the Building leepeatar for oparate permha for d wa <tem% APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Ar OWNER' S NAME h 7 IG BUILDER.. ADDRESSL 1z L 4.e,, �i �� f-- ADDRESS LOCATION OF ILDING No �� % ! `Street Part of Lot�_� LOT __� BLOCK ADDITION OR SUBDIVISION,; Corner, Lot �Inside, LOT Setback Side: Yard SEWER ELEVATION FOUNDATION ELEVATION 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 Front Depth .� Height Sq. Ft. Cu. Ft.• Front Depth Height Sq., Ft. Cu. Ft. Type DfOoaetruction Estimated Cost To be -completed The' -undersigned hereby makes application for a permit for the work herein specified, agreeing'to do -all work in.strict accordance with the City of, Fridley.ordinances and rulings of the Department of Buildings, and hereby declares that 'all -the facts and rept-esentations stated 1h this-applicarion are.true and correct. DATE ( ' O �� SIGNATURE (Schedule of Fee Costs can be found on the s + r /J, BUILDING PERMIT FEE SCHEDULE SECTION 2. The Inspector of Buildings shall, before issuing any permit for the erection of any building or structure, or for any addition to any existing build- ing or structure, or for any alterations 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; 2.1. For any such permit for the erection of any fire -proof building, other than a garage, warehouse, factory or grain elevator, or for the erection of any fire -proof eddiiion, for similar occupancy, to any existing building, shall be at the rate of $1.40 for each one thousand cubic feet, or fraction thereof, in such cubical contents. 1.2: For any such permit for the erection of any fire -proof garage, Wsreho se, factory or grain elevator, or for the erection of any fire -proof addition, for similar occupancy, to any existing building shall be at the rate of $1.25 for each one thousand cubic feet, classified as "fireproof" by Section 502 of the Minneapolis Building Code. HOUSES 2.3. For any such permit for the erection of any non -fireproof building, other than a garage, warehouse, factory or grain elevator, or any non -fireproof addition, for similar occupancy, to any existing building - permit $1.00 for each one thousand cubic feet. GARAGES 2.4. For any such permit for the erection of any non -fireproof garage, warehouse,_factory or grain elevator, or for the erection of any non -fireproof addition, for similar occupancy, to any existing building or for each such building or addition - ninety cents ($0.90) for each one thousand cubic feet or fraction thereof, in the cubical contents thereof with the minimum of $4.00. For the purpose of computing fees for building permits, the cubical contents of any building or addition to a uniform height throughout by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or cellar to the average height of the upper surface or to the average height of the roof surface of the main gable of a pitched roof. 2.5. 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. 2.6. In no case shall the fee.charged for any permit as set forth in Section 2.be less than '$4.00. WARN AM. RATE TOTAL Furnew Shell & Duct Work ... ... .$10.00 $— Replacement of Furnace 6.00 $ Repairs & Alterations --up to SW.00 6.00 Repairs & Alterations each add. SM.00 300 $10,00 $. 30) Furnace 6.00 ! 6.00 $-- 3.00 — — $---- furnace Shell & Lines—to 400 sq- ft. XDR Steam $10.00 Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 Each add. 200 sq. ft. ZDR Steam 2.00 Each add. 320 sq. ft. EAR Hot Water 3.00 $--_--- City of Tddley: The undersigned hereby makes application for a permit for the work specified, agreeing to do all work in strict accordance with the City Ordimancerz. and ruling of the Department of Buildings, and hereby declam that all tho facts and representations stated in this application are true and correct Fridley, Mon f (� Kind of Building Used as - _ To be completed about _ _ Estimated tact, $ - 6100. =7� .----- --- Id New. Building Permit No. __ permit No. DZSCMEMON or WORK HEA77NG or POWER PIANTS—atem% Hot Water� N;A A Trade Na r _ Sq. J Total Connected Load—I� Mod of BURNER — Trade Sin (MMAN as—OM) Make,reports,!�w/4ackground material as complete as poss- ible. Make interim report if necessary. ; COMMENTS. Rusty has been out to talk with Mr. Zabinski at above address. He is well aware of this problem. The only way:to,eliminate the problem is to dig up the service. We wild put it on the list, nd hope to take 'care of it before he has another problem. II See attach REMARKS: Apparently Rusty discussed the problem with the property.owner it appears there may be a problem in bur sanitary sewer line. ;Please comment on Review & take appro- what action is necessary to eliminate the problem. priate action I understand the sewer line is on some back property lines. [] Review & comment Thanks. I-" I Aima 2 Acrimc with ma Make,reports,!�w/4ackground material as complete as poss- ible. Make interim report if necessary. ; COMMENTS. Rusty has been out to talk with Mr. Zabinski at above address. He is well aware of this problem. The only way:to,eliminate the problem is to dig up the service. We wild put it on the list, nd hope to take 'care of it before he has another problem. II SUBJECT PERMIT NO.. City of Fridley ---- =-=6} AT THE TOP OF THE TWINS BUILDING PERMIT'el r iEIPT _NOS • COMMUNITY DEVELOPMENT DIV. �.:------, PROTECTIVE INSPECTION SEC. q� y ---1 CITY HALL FRIDLEY 55432 �l..__.Jl.' �•� NUMBERREV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 5/23/83 JOB ADDRESS 6161 Sunrise Dr. N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 5 1Syzan SHEET HilIg 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Anthonv Zabinski 55432572-1698 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. L. R. Tabor and Sons 1800 Central Ave. N.E. - 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 r ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Fut on Gable roof and reroof partiai 9 CHANGE OF USE FROM TO STIPULATIONS 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 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 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 $5,400.00 $2.70 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DaES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE ROV NS OF ANY HER STATE OR LOCAL LAW REGULATING CON- $56.50 STRUCTIO OR THE P R ORMANCE OF CONSTRUCTION. PLULQLLECK FEE OTAL FEE 17 $59.20 SIGNATURE OF C047 R OR AUTHORIZED AGENT (DATE) PS D ED IS IS Y �IR PERMIT DATE �-'DG SIGNATURE OF OWN ER IIF OWN ER BUILDER) IDATEI CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATION FOR RESIDENTIAL BUILDIJJG PERMITS (Acv. Alterations. Additions. or Repairs) OWNER: t1N P-& P'--' y z 43 8 i aJ sit ADDRESS: TEL MO: -21���i� BUILDER: Z- .e. 7-lWO,;—" V- ADDRESS: TEL 110: 4 Construction location • STR= NO: l Ga / STREET: S cj J R- f S E LOT: Bloats ^� ADDIT=ON: 12a 102— kJ -7- lj Corner Lot: Inside Lot: Setback: Sideyards: Ap?.licant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. COMt-- P DESCRIPTIOR F •h 1 0 CO JSTPUCTJO � Front: Depths Height: square Feet: Cubic Feet: Front: Depths Height: Square Feet: Cubic Peet: Type of Construction struction s 12 � ®® f Estimated Cost: Tb Be Completed: G Alt. A Alt. 8 Proposed Driveway Width If New Opening Is Desired: SEE REVERSE SIDE OF SHEET Mie undersigned hereby raf;es application for a permit for the work herein specified, Agreeing to sb ,all work is, strict accordance with the City of Fridley Ordinances And rulings of the Delyirtsnent of Build'and hereby declares that all the facts and represrntatiens stated in this applicatio are trued correct. ZL1TEa 2� % &-"a SIMATDIE: Stipulations: SL -sem ar. BUILDING PERMIT FEE SCHEDULE 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 structure, 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 berein below set forth and in the manner herein provided to -wit: TMAL VALUATION li3rS $1.00 to $5DD.00 $10.00 Minimum Fee $15.00 plus surcharge $501 to $2,000 $10.00 for the first $500 plus $1.50 for each additional $100 or fraction thexeof,.to And Including $2,000 $2,001 to $25,000 $32.S0 for the first $2,000 plus $6.0D for each additional $1,000 or fraction thereof, to and Including $25,000 $25,001 to $50,000 $170.50 for the first $25,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $1DO,000 $283.00 for the first $5D,000 plus $3.00 for each additional $1,000 or fraction thereof, to and including $1DD,000 $100,001 and up $443.00 for the first $100,000 plus $2.50 for each additional $2,000 or fraction thereof PLAN CHECK: 25 percent of building permit fee DRIVIRA] DEPRESSION ES(RCW: Concrete M rb Streets Only Alternate "A": Renov&l and replacement of curb and gutter only Driveway width plus 6 feet x $13.50 Alternate "B": Removal and replacement of curb and gutter and install a 3 foot vide approach with 6 inch depth Driveway width plus 6 feet x $1S.75 VERIFICATION OF FOUNDATION 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 Certificate of Surrey of the lot, showing the location of the foundation once it has been constructed will be required before proceed with the framing. SUBJECT P City of Fridley 2 6 8 5 AT THE TOP OF THE TWINS P, BUILDINGt PERMIT RECEIPT RE[CNO. �• COMMUNITY DEVELOPMENT DIV. •ti.------- PROTECTIVE INSPECTION SEC. r � � NUMBER REV DATE PAGE OF APPROVED BY 1--�\ CITY HALL FRIDLEY 55432 IL .... � 612-571-3450 910415 7/29/98 JOB ADDRESS 6161 Sunrise Dr 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 1 1 $ lvan Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tony Zabinski 571-1.698 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Four Seasons 7930 University Ave Fridley 795-9410 201387.80 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO, 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION O ALTERATION [ REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK geroof house and garage (23 Sg) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with 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 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 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 6 DOES NOT P SUME TO GIVE AUTHORITY TO. VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISION F ANYSTATE OR LOCAL LAW REGULATING CON- STRUCTIO R TH ERF MANCE OF CONSTRUCTION. Fire SC $1.92 PLAN CHECK FEE TOTAL FEE SIGNATOR OF EONT/ACTOR OR AUTHORIZED AGENT IDATEI N OPER B G (NSP Y (DATED T ISYOUR PERMIT • DATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] �,.. , :.,CI'i�Y,OF,FRIDLEY .. ,. ALTER [ ] + SINGLE FAMILY, AND DUPLEXES R- AND R-2 BUILDING PERMIT ,APPLICATIQN �� ConstructionAddress: Legal Description: Owner Name & Address: 7 -Vl Si Z—e--b L n S t 1. i Tel: t_59/— Contractor: :_5%/-,Contractor: ,f5U U r j eCcs CiYI 5 o dl na Rem �sl� a tt? . MN LICENSE # Address: r%Gl 3 d CJ vt [ u e.4r Y -u A u F Al 1 Fri cl 1 � Tel. # rJR S--' 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. DECD AREA: Length Width Hgt/Ground Sq. Ft. OTHER: R94r4L,-L d-lade-, n 3 e r sA a41e s Y Construction Type:fRtr4uVel-&42la.ce_?oo-r Estimated Cost: $ 1916 (Fee Schedule, on Back): Driveway Curb Cut Width Needed: Ft. - +'6 F� = Ft x $ _ $ DATE:. /� �' APPLICANTS. f ,CITY USE ONLY Tel. # 'W5 5" Permit Fee $S Fee Schedule on Reverse Side Fire Surcharge $ �• �/ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1;000' Valuation SAC Charge- $ $1000, per. SAC Unit License Surcharge $ $5..00'(State Licensed Residential ContracPrs) Driveway Escrow,' $ 'Alt. `"A" or'Alt. "B". Abovea� Erosion Control $ Conservation P14n,.Review, x$450.00 Park Fee $ Fee Determined by Engineering Sewer Main Charge ° '$ -41 . Agreement Necessary [: ] . Not. Necessary a TOTAL.: Q_ gyp. STIPULATIONS: . , BUILDING PERMIT ,FEE SCH, EDULE The Chief Building Official shall.,befbrq' 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 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: 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 $100,600 $100,001 to $500,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000. $500,001 to $1,000,000 $2887.25 for the first $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 widthplus 6 .feet times $15.75. VERiFI((CATION OF FOUNDATIONJ. - V 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 Certificate of Survey of the lot, showing the location of the foundation once. it.has .it. has been constructed will be required before proceeding with the framing. CITY OF FRIDLEY PERMIT NO.: 2004-02121 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 11/18/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS 6161 SUNRISE DR NE R6077 PIN 143024330005 LEGAL DESC SYLVAN HILLS LOT 5 BLOCK 1 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 0 # GAS WATER HEATERS 1 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 300 APPLICANT HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK 0.00 0.00 NORBLOM PLUMBING CO 2905 GARFIELD AVE S GAS RANGE FEE 0.00 MINNEAPOLIS, MN 55408-2173 GAS DRYER FEE 0.00 (612) 8274033 AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT WATER HEATER - GAS TOTAL 0.50 35.00 35.50 OWNER ZABINSKI ANTHONY A & CLEONE 6161 SUNRISE DR NE PAID WITH CHECK # 29428 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 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 of any other state or local law regulating construction or the erform ce of construction. Applicant Date Bldg Insp 1, Dae SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MAKK NUMtitK OF FIXTURES TO BE INSTALLED ON EACH FLOOR JOB ADDRESS 'Sa~.2 • a.S 0'w Axw- Urinal .......... ..Shower ... Wash Tray Floor Dram ............:........ Auto. Gas Washer ...���:��".•:.::.:.. Range e :................ Water Heater S tones Gas Elec a Basement and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $10.00 and representations stated in this application are true and correct. Catch Basin Flo r 01 - ZABINSKI, ANTHONY Rain Water Leader $10.00 6161 SUNRISE DRIVE NORTHEAST _ /D/Z9 .20 O� Sump/Receiving Tank Floor FRIDLEY, MN 55432 Water Treating Appliance $35.00 OWNER (763) 221-9307 Water Heater -Electric Floor 3 I r ............. ......... $35.00 5• UD p 11 BUILDING USED AS SI a e. C_P_ Gas Range** Floor 00 4M Gas Dryer** $10.00 111111,11,11 Back Flow Preventer Required ( )Yes () No PLUMBING FIXTURE RATES: NO. RATE - TOTAL JOB ADDRESS 'Sa~.2 • a.S 0'w Axw- New Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $10.00 and representations stated in this application are true and correct. Catch Basin $10.00 ZABINSKI, ANTHONY Rain Water Leader $10.00 6161 SUNRISE DRIVE NORTHEAST _ /D/Z9 .20 O� Sump/Receiving Tank $10.00 FRIDLEY, MN 55432 Water Treating Appliance $35.00 OWNER (763) 221-9307 Water Heater -Electric $35.00 Water Heater - Gas** $35.00 5• UD p 11 BUILDING USED AS SI a e. C_P_ Gas Range** $10.00 Gas Dryer** $10.00 ESTIMATED COST q6 O ov PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMPANY No r \t ONA LXA/VL �D Reinspection Fee $50.00/Hr SIGNED BY TEL N0. ('lo1Z) 1327- 5/033 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge TOTAL FEE 3S MINIMUM FEE F R ANY PLUMBING/GAS PERMIT IS $15.00 or 50/6 OF COST $ OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. 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 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 ( ) 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 verges 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 :