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PRE 2010 DOCSG1 e - 4195 F? City of Fridley, NUnn. N° 10112 BUILDING PERMIT Date: Feb. E2g 21, 1969 Owner; Bill Shaw Builder fax Clemron, Inc, Address Address 4411 Central Ave. N. E. LOCATION OF BUILDING No. 5 251 .___ Street ___. Taylor St. X. E. part of Lot Lot 10 Block 1 Addition or Sub -Division Marion Hills, 2nd Addn, Corner Lot . Inside Lot x Setback 35 t �_ Sideyard 23 ' Sewer Elevation saddle Clem. 960.02 963-02 Top of Footing DESCRIPTION OF BUILDING To be Used as: Dwelling Front 54 Depth 24'12 1 Height 20' Sq. Ft. 1346 Cu. Ft. 261980 Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Frame Est. Cost _ 26 000__ To be Completed SEWER LOCATION - 67' North of Manhole 1. Drainage will be away from East Wall - running West on Lot Line between lots. WATER LOCATION 11.5' North of Sewer 2. Back yard will be either terraced or provided wihh a retaining wall. 3. North wall of garage shall be of 8" concrete block rather than frame structure to assist support of East concrete foundation wall. 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 21 provisions of ordinances of the city of Fridley. $100.00 Sewer Connection Charge. In consideration of the payment of a fee of $ 41.00 , permit is hereby granted to Cl emron, Inc. thto construct the building or addition as described above. This permit rmit is granted upon e express condition that the person to whom it is granted and his agents, employees anworkmen, in all work done in, around and upon said building, or any Bart thereof, shall conform in all respects to the ordinances of 7Fridley, Minnesota reg gg location, construction, alteration, maintenance, repair asci moving of buildings whin the city limits anthis permit may be revoked at any time upon violation of aay of the provisions of said inanora. Official mqwmw NOTICE: This permit does not cover the construction, installation for whing, plumbing, gas heating, sewer or wafer. Be sure to see the Building inspector for separate permits for these hems. APPLICATION. FOR BUILDING PEDIET CITY OF FRIDLEY, MINNESOTA OWNER'S NAME B jJj s BUILDER Clemron, Ine. ADDRESS 5212 jorfi,heast ,Capitol ADDRESS Wall Central Ave. N.Ee, Mpla. LOCATION OF BUILDING No. Street Part of Lot Lot 3`0 Block Addition or: Subdivision Marian Mills -, 2nd Jkdde Corner LotInside Lot X Setback 301 Side -Yard 23. SEWER ELEVATION FOUNDATION ELEVATION Garage Slab 31 Applicant attach to this form Two Certificates of Survey of Lot and proposed,build- ing location drawn on these Certificates.' DESCRIPTION OF BUILDING To be used as: l Re aidence -Front 5L Da- th 2h t - 26 t Height Sq. Ft. / Cu. Ft. Z, 4,% Front Depth Height, Sq. Ft. CU. Ft. Type, of Construction Estimated Cost 26, 000.00 To be Completed ,3Months 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 representations stated`'in this application are true andcorrect. w •.• (Schedule of Fee Costs can be found on the Reverse Side). ! L� %��Y�! i j _ T', c BUILDING PEMT 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 exist- ing building or structure, or for any alterations or repairs to any existing building or structure, upon application therefor, 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: 4 2.1. For any such permit for the erection of any fire -proof building, other -than a garages, warehouse, 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 $1.40 for each one thousand cubic feet, or fraction thereof, in such cubical contents. 2.2. For any such permit for the erection of any fire -proof garage, warehouse,_ 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 erecting c -r a ;; ne'ri-flrppr .,f garage, warehouse, factory or grain elevator,' c,� of any non-ft.rcproof addition, -for--similar occupancy, to y '.z� + a r��, %��� . H,c? :�o or for each such � . • build.ing or addition - ninety CPnt^ en,:'- one thousand cubic feet or fraction thereof, in the cuL cel t'%ia e.of with a minimum of $4.00..• For the purpose of computing fees ica 3�..s ,:a.ir.g perm s, the cubical contents of any building or addition to a unifc by multiplying the ground area covered from a point six (6) iacLes bel*w the floor line of _the basement or cellar to the average height of the Tipper surface or to the average height of the roof surface of the main g;aule of a pitched roof. 2.5. For repairs or alterations to an existing structure, the fee shall be at rate of $3.00 per each Five Hundred. Dollars ($500.00) or fraction thereof in the cost of all proposed work. 2.6. In no case shall the fee._oharged..for.any permit .a$ set forth in ,Section 2 be less.than $4.00. a N %y C I T Y 0 F F R I D L E Y 6431 University Ave. N. E. Fridley, Minnesota 55421 July 31, 969 Williams Electric Co. 2312 Central Ave. N. E. Minneapolis, Minnesota RE: PE7T SHORTAGE 25 I Taylor St N E. Gentlemen: Your permit for the above captioned address was short the following: KW $ 3.00 Dishwasher 3.00 Disposal 1.00 7. 00 We would appreciate it if you would kindly give this matter your preferred attention. When sending in the above amount, kindly place it on a regular Minnesota State Affidavit so that we may properly process this permit. Thank you. Yours very truly, ttONARD EICHMILLER Electrical Inspector City of Fridle y LE :bks. r. 'tq Application for Power Plants and Heating, Cooling. Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... $10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ... .................. 3.00 $ Each add. 320 sq. ft. EDR Hot Water .................. 3.00 $ OIL BURNER—to 3 gal. per hour ..... .................. 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTU) ....................... 6.00 $ ' over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x$ 2.00 $ Additional Fixtures x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL__ See Fee Schedule $ TOTAL FEE $ Dept. of Bldgs. Phone 560-3450 IS City of Fridley: 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 representations stated in this application are true and correct. i Kind of Building Used as To be completed about Estimated Cost, $ . Old Building Permit No. /0i Permit No. DESCRIPTION OF WORK BEATING or PO PLANTS team, Hot Water,Warm Air—) -No Trade Name ��" Size Capacity. Sq. Ft. E.D.R�0 BTU_ H.P. � Total Connected Load Kind Kind of Fuel BURNER — Trade Nam Size No=���� Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) RAY N. WELTER HEATING CO. Signed 3— CHIBAS13 AVE. MINNEAPOLIS 7. MINNESOTA as Business Phone Nof��i Cle I ,T 4 C,�I.0 ,A'f1OY�5 DEPAR iWM OF ID�JIID Weathers rs rips �'.S. Coffistremctiolr IJ®. Cul windows I Doors Reference Out. vanInt. /all es (:ailing l300$ Floor I lid d--1�lo Yes—R10 19— n ...A. ViAth 9 Haimht Vr fv---ll I FI.I GZ _ Rooms l N"lindows and *ore—Crachage and Area / Coef. Btu �_ No. NVIdth- of pane Haight of pane No. of Ilghte S.a cat f . ArQo of Crack gm. ft. 2 a 7 �-G ➢�flltrati®It Y D uses Btu $ O O F—mo. 46 /q� e, Z I •-6v Cif. ON Isn6lCratio� ( O �f. I�tet Infiltration � G 2� GIa03 l % zZ Class Eo _O_O 7 v Ceiling l x ( ` Fxp. wall ',4 ®,re S Ust exp. G Met esp. wau Int. rsrall Ceiling / xS-a- Net exp. wall — a c /o <: Int. wall Int. wall Ceiling e�f ,,Floor Floor Total Btu.. I Lwz Z-0 ; ; Total Btu. D � i Required sq ft F-11 d. or eq. ins. FYJL t4ac!--r eras /®_ I Vindows and Dere– Crichane and Am / Coef. Btu �_ No. wtaelt of pane 1nelaAt No. 0f of Dano I1QAts I mord ft. �� of person[ r3. ft. 190 2 a 7 �-G ➢�flltrati®It Y D uses Btu $ O O F—mo. 46 /q� e, Z I •-6v Cif. ON Isn6lCratio� ( O 1 Int. eJzll c COME to � G 2� GIa03 l % 5 Clans Eo _O_O Imp. wall _ t Ceiling l x ( � Ust exp. .5�_ Met esp. wau Int. rsrall Ceiling / xS-a- — (v s0 <: Int. wall 'Ceiling / e�f 2Z Floor Total Btu.. 3 D � required sq. ft. L.dD. or,sq. meati eaju sets r spam I �• � ° � ��� f�n y L�"' �r�u� r� � �S�:i�1t -` Vindowa and Doors—'bra hage a and Area / Coef. Btu �_ Ivo. w10ith WSe1GAt of pane of posse --00. 02 II. IMA ft.&mfg 1113Mo of erect[ 1" . -ft. 190 2 a 7 �-G ➢�flltrati®It Y D uses Btu $ O O F—mo. 46 /q� e, Z I •-6v Net erp. wt;0' 6 l 0 ( O 1 Int. eJzll c COME to Iz�ltrrsti®nl Ceiling Floor t 7� l % 5 Total Pau. N - s' Reglsircd ti. ft. C.D.7L or sq. ions. VA. IAa6r area viindows AvA Doom, --fir, Width 1Tce , No of parvo oe Ilia .! �D v 1 1�rstn®n GIMSS Erp. will cx. 114 ersp. wan Int. M- 11 Ceiling Floor iTotall. I ' 1 yh (W /I- v Insulation How Applied - figth ' Height v / L 1 3 2 No. fallb of pemoa Csoef. Dees swan eq. M 7 �-G Coef. Btu y5 /q� e, Z I •-6v �–v od Required sq. ft. F,,.D.R. or eq. mss. Vim- fader area l� 1.1 � I Ian Z ��Yi�lttl� � – !�'Ieiglnt 8• X71em&ws and re@h&V and Ames °��fl�tA F3®flaAt Ne. of Dano 0f Dc me No. fallb of pemoa of t of Dq►se vol0f meal ft. I117g9m off crack swan eq. M Coef. Btu Inldltratiofl `� e, Z I Clam �–v od COME to Iz�ltrrsti®nl G t7 3 ZLE Clans Eo _O_O Ems. =H �3 yx Ceiling l x ( E/I Ust exp. .5�_ FloorE Int. rsrall Ceiling / xS-a- d _ Flosar P3 :q, EL F. PL or eq. imps. WJL Ue Per area •� IDe?�CJs a Irr�rashasge and Area E °��fl�tA F3®flaAt Ne. of Dano 0f Dc me Flo. of reflmaal Yt. 115MS of erects Arita cel. ft. �o g 4 L( Coef. Btu Inldltratiofl `� e, Z I Clam �–v od 1`Jet emp. wan Ient. mall Ceiling l x ( E/I .5�_ FloorE d _ TOW Btu. F{equired eq. ft. LD.R. or sq. ins. VY.A. Lmeir area I Y r _77 .goal AEN,11i® 48'71 OriginalPermitr SFIfYING Kc Cf Cp y/ N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for Permit � t � T-• 0--d inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit., DESCRIPTION OF WORK Number, Sand and Location of Fixtures City of Fridley"'` �'� ,19 `� Stories C W F 0 Q .1 $ o � Z K � H m F Q O m r- � m Q m � Y Z m m W d r ¢ 2 3 r Y r Z O a 0 ❑ W w O S N � m O Z -1 LL❑ y� t0 W ¢¢ u m Z C Q q a m X E 'a a y ¢ a. o Q W W Z ¢ Q o M WATER HTR. GAS ELEC. Basement ist 2nd 3rd 4th Connected with Sewer -Cesspool Gas Piping for L Openings Permission is hereby granted to do the plumbing and gas fitting in the building described in the statement hJeto attaAed, upon the express condition that the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and this permit may be revoked at any time upon the violation of any of the provisions of said ordinances. By Order Of The Inspector Of Buildings Roughing in Inspection Inspector. Final Inspection Daie Inspector. `W 4 2-6 -65-V Owner &19-� V ri-e� Vocation �a✓ ' . Bind of Building_? Used as— To To be Completed- ,19 �q Estimated Cost $ 16," ' '." Old -New. Building Permit No.,/01, i I Z Inspector of Buildings. Original• 0 PERMIT for Power Plants and Heating, Cool - in , Ventilation, Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of l Heating Plants to b install-altered—repaired Make , Ue Oil fired—,— Coal fired , Cas fired f!!:� ; Gas Authorization Remarks IA Approved Final Inspection Date '19— c Inspector Permit N° 4421 Fee $ /Z Office of the Inspector of Buildings City of Fridley City of Fridley, Minn.21-,h g o , 19--o Owner Location Kind of Buildi How Occupied Work to be Commenced c 19&.-j' To be Completed Estimated Cost, Old -New, Building Permit No. 104 1 12 - Permission is hereby granted to 40d,4 V - Vf P'v- S L -e to install—erect—use the material and devices described in the above statement. This permit is granted upon Me express condition that de person to whom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the spe 'fications set forth in the approved application for this permit on file in the office of the Inspector of Buildings. Inspector of Buildings 4z 2M 11-87 V City of Fridley Application for Plumbing and Comas Fitting Permit Dept. of Bldgs. Phone 560-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures pp v2 NO. RATE TOTAL Number Fixtures ...................... x $2.00 $ 0 ®<00 12 x 3� i": o� 'e2. p % g s 3 O < 3 -j �U' K WU' S I UN' z � 0 R t N WATER HTR. GAS ELEC. Base x $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ...... ................... x $2.00 $ Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ 1st 2nd 3rd 4th ' Future Connection Openings New Fixture, Old Openings Connected with Sewer El Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $2.00 $ 0 ®<00 Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. x $1.50 $ Catch Basin ............................ x $3.25 $ Water Heater (Up to 99,000 BTU) ...... x $3.00 $ O,CrD New Ground Run Old Bldg. ............ x $3.25 $ Electric Water Heater x $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ...... ................... x $2.00 $ Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ..............................$ TOTAL FEE $ 00 City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Owner Kind of Building Used as To be completed about Estimated Cost, $ Old–(IG. Building Permit No 10 1 0!1' Permit No. -/ F 71 ROUGH FINAL—( ° .4111P.42 Signed Business Phone No _ 19_ 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 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 AII'Others/Repairs & Alterations (LIST ON BACK) 11y. of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 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 Effective On January 1, 2000 JOB ADDRESS_ OWNER-7±�����t�r,�ei TOTAL BUILDING USED AS ESTIMATED COST ' PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ Trade Name �e^o� a b ��'� Size No. g�c BTU HP EDR $ FuelTotal 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 an $ .50 rulings of the Building Division, and hereby declares that all the facts and $ representations stated in this application are true and correct. DATE HEATING CO Signed *Air Conditioners can not be placed in a side yard without Approved written permission from adjoining property owner. f ' ������� z'- "ne✓r- FILL OUT BACI< TEL#��� Rough -In Date Final Date ��- 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 manufacturers 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: -- �••+�.�. a owl aw a 1%.,1v "IV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective On May 10, 1999 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB 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 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE 5 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 SYPNIESKI, JEROME Z3 'd_0 5251 TAYLOR STREET NORTHEAST FRIDLEY, MN 55421 Owner (763) 571-8101 Building Used As Estimated Costf 11A To PERMIT NO. � d� PLUMBING COMPANY SIGNED BY Approved BY Rough -In Date Final Date $ _50 $ 0.50IlIfT IS S20_()0 PLUS THE S STA SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. mMKIN NUIVIt3tK OF FIXTURES TO BE INSTALLED ON EACH FLOOR • e Stons ::Ii�.::.;::.Y.I.�.;,Q::•:..:_.:.:ii...:.f,.::...:�Un � Floor 0 . Gas rWash Water r Heate ..ti..:-.,...na S Tray Drain •.ry.:•r:;: sh Range Gas Basement .:.:.•i.. .•:-.i:'.;:st.;:= .�:•:-.::��-.•i-.:::-.:i::-.i>i-. .:.:.:.:. lc Floor y..5.:�....:.F:..:,:... i.:::?::.::i.•.:-.:...:•»:v,i.t•: Floor Floor ti:JF:v.,;;F FI or4 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB 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 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE 5 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 SYPNIESKI, JEROME Z3 'd_0 5251 TAYLOR STREET NORTHEAST FRIDLEY, MN 55421 Owner (763) 571-8101 Building Used As Estimated Costf 11A To PERMIT NO. � d� PLUMBING COMPANY SIGNED BY Approved BY Rough -In Date Final Date $ _50 $ 0.50IlIfT IS S20_()0 PLUS THE S STA SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Effective On January 1, 200( Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS ��S-1 TA*69 CINO O RATE SCHEDULE Residential Rate TOTAL OWNER_ Furnace Shell and Duct Work, Burner - BUILDING USED AS LL t 0 c, Also Replacement Furnace $ 30.00 $ 3D.Oz -JYWz (Side Vent - Fill Out Back) ESTIMATED COST q,300 PERMIT NO. Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) Gas Range DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ Gas Dryer $ 10.00 $ No. of Heating Units 1 Circle One (Steam) (Hot Water) 0arm ir) *Air Trade Named =YZ Size No.s&-,i2,&ApAo_% BTU &ttw HP o EDR Conditioning - All Sizes $ 25.00 $ Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial 1.25% of Value of Appliance or Work $ The undersigned hereby makes application for a permit for the work herein State Surcharge $ .50 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 TOTAL FEE $ �„SU representations stated in this application are true and correct. P -?-3-6 / DATE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO liOZA S*0_T` Ma- . REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE Signed L � TEL #?10 �Y'2-1 19 REINSPECTION FEE $47.00/Hr �yv *Air Conditioners can not be placed in a side yard withoutApproved By Rough -In Date Final Dat e��� 5� written permission from adjoining property owner. .� HOUSE HEATING TEST RECORD ADDRESS�ZZS;/"' !2AV-2&9-S APT. OR C SUB.UR:B a OCCUPANT OWNER T•� HEAT LOSS DATE HTG. INST. GAS CO. METER BA E# SOLD BY INSTALLED BY jp Electrical Work By,�Gas Line By. TYPE OF HEAT GA ' I FA -et �� W STEAM SPACE HTR. UNIT HTR. OTHER G DE G CONVERSION MAKE —• MAKE OF BURNER Model Model SerialMax. BTU Rating INPUT r®L MAKE OF FURNACE Model CONTROLS THERMOST T at Plug Vent Size Valve KIND OF LINER SIZ NONE Limit Draft Hood Regularor Limit Setting, Filters Size Numb Fan Setting — Chimney Location Inside Outside Pilot Type Chimney Construction 0. Pilot Make Pilot Model Smoke Bomb Wiring, Pilot Timing Draft �� Test Tag L� L.W. Cut Off Door Pressure— Lighting Inst. jam, e Pressures P Date cent C 92 Tested ^� Input CFH /I rL n (�2 ^ Company Testing Stack Temp. 45MV Percent COName of Tester Form 235 Building BUILDING Permit No.: An ( Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: `B DATE YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: -TC M 4" c�a C :e S 'jw "5y�� TENANT ADDRESS: CITY 1 / STATE. ZIP PHONE: `763 ' S�? ` NO CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE STATE LICENSE # EXP DATE 7 ADDRESS: —3,3 CITY / G`' STATA±trZIPS�! punw ; ;5 763 FAX SINGLE FAMILY/NEW CONSTI TWO FAMILY/NEW CONSTRU PERMIT TYPE ❑ ADDITION u UAKAU ❑ BASEMENT FINISH ❑ ROOF ❑ DECK 1QSIDING ❑ SWIMM TYPE OF WORK: DESCRIBE WORK ST7E OF IMPROVEMENT ROOFING NUMBER OF SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other ❑ MAINTENANCE/REPAIR r.T)nNF.•'" i a ❑ ADDITION ❑ REMODELINC �-- 5E ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LJ wn LX)WS ❑ DRAIN TILE ❑ OTHER A.C-'��9�- WIDTH HEIGHT Ft. BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 34' ®®p OCCUPANCY TYPE Permit Fee $ -115 See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ -99 001 times the total job valuation Surcharge $ 1 - "(9 .0005 x Permit Valuation Minimum $.50 License Surcharge $ -cc:) $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ 10 Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for pe t and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work whicequ I s review and approval of plans. SIGNATURE OF IN DATE Page 2 - Building Residential Application BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any 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 $23.50 (Minimum Fee is $23.50 plus surcharge) $501 to $2,000 $23,50 for 1g $500 plus $3.05 for each additional $100 or fraction, to and including $2,000 $2,001 to $25,000 $69.25 for 10 $2,000 plus $14 for each additional $1,000 or fraction, to and including $$25,000 $25,001 to $50,000 $391.25 for 1' $25,000 plus $10.10 for each additional $1,000 or fraction, to and including $50,000 $50,001 to $100,000 $643.75 for 1- $50,000 plus $7 for each additional $1,000 or fraction to and including $100,000 $100,001 to $500,000 $993.75 for I" $100,000 plus $5.60 for each additional $1,000 or fraction to and including $500,000 $500,001 to $1,000,000 $3,233.75 for the l' $500,000 plus $4.75 for each additional $1,000 or fraction to and including $1,000,000 $1,000,001 and up $5,608.75 for the 1" $1,000,000 plus $3.15 for each additional $1,000 or fraction 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 proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Only City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 Building $ BUILDING See Back Page for Fee Schedule Permit No.: C;'� Inspections RESIDENTIAL APPLICATION Fire Surcharge Received By: 763-572-3604 .001 times the total job valuation CITY OF FRIDLEY $ Date Rec'd: DATE -5-0 - 06 YOUR E-MAIL ADDRESS $ SITE ADDRESS 'E�,5� r Ory /0 `- f�[ . - $5.00 (State Licensed Residential Contractors) THIS APPLICANT IS: �t�c ❑ 6WNER CONTRACTOR PROPERTY OWNER/ NAME: 9 c K% e S t/,Ou i& 5Kt $ TENANT ADDRESS: Sa l 74, /or Nom= CITY STATEV-LIP Erosion Control PHONE: -7 63 - S 71 CONTRACTOR NAME: $ STATE LICENSE # '\C�G 102 7-7 J EXP DATE Fee Determined by Engineering SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: 3 13 1-5 c f f w CITY �l `A% STATi+VZIP 5-C WITH APPLICATION PHONE -7G3 - 4.17 -96 9 FAX $ PROPERTY TYPE 1ASINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK 1, SIDING ❑ OTHER ❑SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION AMAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: 7---A r o;"r `r- 'ie ; 1 Q, Lot�e 9 t ,2 SIZE OF IMPROVEMENT ¢ S LENGTH WIDTH HEIGHT Sq. Ft. ROOFING r❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE I. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2. Proposed floor plan PROPOSED HEIGHT: 3. List of structural members to be used SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim l . Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 4200 . CK) OCCUPANCY TYPE Permit Fee $ / /. See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ �9-® .001 times the total job valuation Surcharge $ �L,1 0 .0005 x Permit Valuation Minimum $.50 License Surcharge $ 'V_ CX) $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 R = ft x $21 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work whic quire eview and approval of plans. SIGNATURE OF APPLICANT PRINT NAME )z r r� C DATE �2 G aJ Page 2 - Building Residential Application BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any 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 $23.50 (Minimum Fee is $23.50 plus surcharge) $501 to $2,000 $23,50 for 1' $500 plus $3.05 for each additional $100 or fraction, to and including $2,000 $2,001 to $25,000 $69.25 for 1' $2,000 plus $14 for each additional $1,000 or fraction, to and including $$25,000 $25,001 to $50,000 $391.25 for 1" $25,000 plus $10.10 for each additional $1,000 or fraction, to and including $50,000 $50,001 to $100,000 $643.75 for 1' $50,000 plus $7 for each additional $1,000 or fraction to and including $100,000 $100,001 to $500,000 $993.75 for 1 $100,000 plus $5.60 for each additional $1,000 or fraction to and including $500,000 $500,001 to $1,000,000 $3,233.75 for the 1- $500,000 plus $4.75 for each additional $1,000 or fraction to and including $1,000,000 $1,000,001 and up $5,608.75 for the 1' $1,000,000 plus $3.15 for each additional $1,000 or fraction 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 proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Only City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 PURCHASE ORDER IDATE5-31,06 I DEPARTMENT THIS DOCUMENT GOOD FOR PURCHASES UNDER $1,000.00 ONLY / F 66346 TMMMWR MUST A /M/MCOENCE NOUS SUPPLIERri y'F J✓ ..i ADDRESS' CINOF s; 1 / FRIyA�l PHONE6431 UNIV. AVE. N.E 1 MN CONTACT XI ,•il 9 I.. 71•. .01. PAYMENTVOUCHER BY SIGIUNGI DOCLUN BELOW H' 7h1 AMORIN PAYMENTI THAr THE Cbl h. AND SMCES BEEN FECEIM OR RENIOERED AND ALL DE f IC, HAVE BEN FOLLOWED I PRWIFEYM OF THE RaOW STAFED f I 71 - 17AUTHORErff- 1 �® PLEASEOUR ORDER FOR THE FOLLOVANG --�� /lam'. .' �• -j-: � � 1 r I / L THIS AGENCY HAS AGREED NOT TO DISCRIMINATE IN HIRING PRACTICES ON THE BASIS OF RACE, SEX, COLOR, CREED, MARITAL STATUS, RELIGION, OR NATIONAL ORIGIN AND HAS AGREED TO TAKE AFFIRMATIVE ACTION TO RECRUIT MINORITIES AND WOMEN INTO EMPLOYMENT_ IT ENCOURAGES FIRMS AND OTHER AGENCIES WITH WHOM R PURCHASES PRODUCTS OR SERVICES TO DO LIKEWISE. WHITE, VENDOR - YELLOW, PURCHASING - PINK, ACCOUNTING - GOLDEN ROD, DEPT. HD. CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 t MTT NO.: 2006-00871 D: 05/22/2 (763)572-36U4 YAX: (763)571-1287 REPRINTED ON 5/30/2006 ADDRESS 5251 TAYLOR ST NE PIN 253024220029 LEGAL DESC MARIAN HILLS 2ND ADD : LOT 10 BLOCK 1 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL / 70 CONSTRUCTION TYPE SIDING VALUATION : $ 4;200.00 NOTE: PER R703,2000 INTERNATIONAL RESIDENTIAL CODE REQUIRES THAT A WEATHER RESISTIVE BARRIER BE PLACED OVER EXTERIOR SHEATHING TO PROTECT THE INTERIOR WALL COVERING EXCEPTIONS FOR THIS PROVISION WOULD BE IF SHEATHING IS AN APPROVED WEATHERPROOF PANEL OR WHEN THE SIDING IS AN APPROVED WEATHER BARRIER VINYL SIDING IS NOT A WEATHERPROOF COVERING UNLESS THE MANUFACTURER STATES THIS IN THEIR APPLICATION GUIDELINES CALL FOR INSPECTION OF WRAP BEFORE COVERING OR TAKE PICTURES. CONSTRUCTION IN THE CITY IS UNLAWFUL EXCEPT BETWEEN THE HOURS OF7:00 AM AND 9:00 PM, MONDAY THROUGH FRIDAY AND BETWEEN THE HOURS OF 9:00 AM AND 9:00 PM ON SATURDAYS. NO WORK IS ALLOWED ON SUNDAYS OR ANY STATE LICENSED CONTRACTOR? 1 APPLICANT MIDWEST ROOFING SIDING WINDOWS INC 313 JEFFERSON HWY CHAMPLIN, MN 55316- (763) 427-9696 BC20010277 OWNER SYPNIESKI JEROME R & JACQUELYN 5251 TAYLOR ST 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 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 BUILDING PERMIT FEE 111.25 FIRE SURCHARGE 4.20 STATE SURCHARGE, BLDG VALUE 2.10 LICENSE SURCHARGE 5.00 TOTAL 122.55 PAID WITH CHECK # 21385 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY PERAM NO.: 2006-00816 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 05/15/2006 572-3604 FAX: (763)571-1287 REPRINTED ON 5/30/2006 ADDRESS : 5251 TAYLOR ST NE PIN : 253024220029 LEGAL DESC : MARIAN HILLS 2ND ADD LOT 10 BLOCK I PERAUT TYPE BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : SIDING VALUATION $ 3,990.00 NOTE: PER R703,2000 INTERNATIONAL RESIDENTIAL CODF, REQUIRES THAT A WEATHER RESISTIVE BARRIER BE PLACED OVER EXTERIOR SHEATHING TO PROTECT THE INTERIOR WALL COVERING EXCEPTIONS FOR THIS PROVISION WOULD BE IF SHEATHING IS AN APPROVED WEATHERPROOF PANEL OR WHEN THE SIDING IS AN APPROVED WEATHER BARRIER VINYL SIDING IS NOT A WEATHERPROOF COVERING UNLESS THE MANUFACTURER STATES THIS IN THEIR APPLICATION GUIDELINES CALL FOR INSPECTION OF WRAP BEFORE COVERING OR TAKE PICTURES. CONSTRUCTION IN THE CITY IS UNLAWFUL EXCEPT BETWEEN THE HOURS OF 7:00 AM AND 9:00 PM, MONDAY THROUGH FRIDAY AND BETWEEN THE HOURS OF 9:00 AM AND 9:00 PM ON SATURDAYS. NO WORK IS ALLOWED ON SUNDAYS OR ANY STATE LICENSED CONTRACTOR? I APPLICANT MIDWEST ROOFING SIDING WINDOWS INC 313 JEFFERSON HWY CHAMPLIN, MN 55316- (763) 427-9696 BC20010277 OWNER SYPNIESKI JEROME R & JACQUELYN 5251 TAYLOR ST NE FRIDLEY, MN 55421 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin60 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 BUILDING PERMIT FEE FIRE SURCHARGE STATE SURCHARGE, BLDG VALUE LICENSE SURCHARGE TOTAL PAID WITH CHECK # 21357 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 97.25 3.99 1.99 5.00 108.23 Building MECHANICAL Permit No.: ' �►�1',-) InspectionsS RESIDENTIAL APPLICATI®N Recei �ed By: 763-572-3604 CITY F FRIDLEY 763-502-4977 FAX EFFECTIVE 7-1-2010 DATE 7- 1 - f J YOUR E-MAIL ADDRESS SITE ADDRESS Sod S % 141/ ©de l 7t N 1= THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY NAME: ),CrL n"4, u pv, t e.1 Ic- i OWNER/ l 1 xlyt oc� � . fo" C cITY i� a- 16 f STATE o'1 �1 ZIP ADDRESS: SaSS TENANT-21 PHONE: -7 Q -- S% 1- 1 0 i CONTRACTOR COMPANY NAME: d2 ; v v CL!� CONTACT PERSON: C 11z L\ , fQ SUBMIT A COPY OF YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH ADDRESS: �& q b H&(4 S4 N.G` . CITY _STATE M ZIP S i APPLICATION PHONE ' 7 C3 -717 Y �) m FAX PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: 0 NEW ALEPLACEMENT 0 ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK L!/l S% (( f2 t n i o c c, a iAl2 FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE .HANDBOOK I /a Equipment Installed a a MFG: u u MODEL: U A fltl 0 ,I -A — SI TU -y MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU $25.00 FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 _J_:A/C AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 BOILER $35.00 FURNACE $35.00 _GAS UNIT HTR $10.00 CHIMNEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00 _DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00 _z'- � A ?+ .-:S3 z ,8 ���°%4 § •�f4 Sd �ti�.;;cu � �'..° ,M��i � 3"�5•; dr,Yi�t' ; �� � 4� �� ��� Yti"Y£+.AF .. 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In • ( �; �{ jd �. £, '�'i � Thi �k •;r'. ia� ��d,: 3,`+'�t' F�k� k��z ��•��4`'�+�?`�.. �S..Sy.. 1�s �i 1�: �Vr'}t{,� �kL y, hn'i' 4 � �rp`��G�^ �h �u, .i'"7.. �y� � s x s.•� �, ,y��r a .Y 8 '� +$3 x � � £75 � .tib � 8 r s��d: zgd Y g 1 `�+� f E '��: 4 t .�' $�;. ,, ,... :� i'z� t z1 ,Y'y;$"' �.�. �k�;�� �'� �. h• fE ���'.L�. %P.�e,f ������'s'���'yN1 .Y✓� 3 k" �.' K'i. 3�f �� i.{ �S� ���� i 'ilk k&X4z THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work -which requires review and approval of plans. SIGNATURE OF APPLICANT (2 00 PRINT NAME (2 DATE APPROVAL INSPECTORS F^ SIGNATURE DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977