PRE 2010 DOCSDate:
MAY 24, 1966
,-� 3 7-�V
City of Fridley, 1VHnn.. N° 8851
BURDING PERMIT
Owner: MR. & MIS. DONALD DELICH Builder WEIRLEENGET CONSTRUCTION COMPANY
Address4556 MADISON STREET N.E. Address 1,601 - 127th�v_P a N.W.
MINNEAPOLIS, MINNESOTA COON RAPIDS, YMMSOTA
LOCATION OF BUILDING
No. 5284 Street TAYLOR STREET N.H. part of Lot
Lot — 15 Block 1 Addition or Sub -Division MARIAN HILLS, 2ND ADDITION
Corner Lot . Inside Lot ._ _ X Setback 35' Sideyard 4'
Sewer Mevation 9 Foundation Elevation z0/
DESCRIPTION OF BUILDING
To be Used as:
DWELLING Front 48 Depth 26 Height 22 Sq. Ft. 11248 Ca. Ft 27,45
ATT, GARAGE Front 20 Depth 22 Height 10 Sq. Ft. 440 Cu. Ft. 4,400
Type of Cinstruction FRAME Est. Cost _ 27 000______ 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 forth and in compliance with a& provisions of
ordinances of the city of Fridley. / d�
In consideration of the payment of a fee of3, 2 * 00 , permit ismhereby granted to MELEENGET-
CONSTRUCTIM CO 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 satd building, or any pat thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota reg location, construction, alteration, maintenance, repair and moving of buildings
within the city limits andnthis permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
WILLIAM H. SANDIN
NOTICE:
Iib pwmk dos not cover the conakuedw, loshMe ion for 'wkb& phn"g. on hodfim' ewer or water. Be ars to no
the Building lespeator for separate permhe for tins keno.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLLY, MINNESOTA
OWNER S
ADDRESS�/� �'� �%/�®v%, ��„�� %�- ADDRESS�c�/
LOCATION OF BUILDING.
NO. S--2 STREET ART OF LOT /
LOT %5 BLOCK / ADDITION OR SUBDIVISION
CORNER LOT INSIDE LOT__�('SETBACK �� / SIDE Y
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; 4 �/
Ala— —Fr aq*.� Depth, � (' Height
Sq. Ft. Cu. Ft.
r ' Front 0 Depth --? ,—�Height �'' d
Sq. Ft. Cu. Ft.
E r
Type of Cons tructi a ,/k. 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 representations stated in.this application
are true and correct.
DATE �a SIGNATURE
OF
(Schedule of Fee Costs can be found on the Reverse Side).
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
building 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; -
.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 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 shah be at the
rate of $1.25 for each one thousand cubic feeti.classified as "fireproof"
by Section 502 of the Minneapolis. Building Code.
SOUSES
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 -fire -proof
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.frc:CLiPn
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.
STORM REPAIR DAMAGE FEES;
Residential; Estimated Cost of work up to 8500.00 » $5.n0
Estimated Cost of wor" c- e_ z ":�
Commercial; Estimated Cost of cwn5•K, u-�:- to e;ai�` 00 - AJC 1
I & - -, Estimate<' )st of work ova. y50W..00 - $2L J
Application for Pourer Plants and Heating. Cooling, Ventilation. Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ........................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ...... ... ........ 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 1 8.00 $
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam .... .
8.00
$
Furnace Shell & Line—to 840 sq. ft. EDR Hot Water ..
8.00
$
Each add. 200 sq. ft. EDR Steam ......................
2.50
$
Each add. 320 sq. ft. EDR Hot Water ..................
2.50
$
OIL BURNER—to 3 gal. per hour .......................
5.00
$
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) .......................
5.00
$
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 $
AIR CONDITIONING �'-
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $
ALTERATIONS & REPAIRS TOTAL FEE $
ROUGH
Dept. of Bldgs. Phone SU 4-7470
r ....eaa...�
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.
Owner
Kind of Building,
Used as
To be completed about
Estimated Cost, $
Building Permit No.
Permit No. (
DESCRIPTION OF WORK
HEATING or PO PLANTS—Steam, Hot Water, W Air—No
Trade Name- Size No 2 z
Capacity Sq. Ft. E.D.R BTU H.P
Total Connected Load /4 Kind of Fuel
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P
FINAL
(REMARKS—OVER)
Signer]
By SUBURBAN HEATING & SHEET METAL
4Z Busines 39
ASTER DRIVE1K1NF
.ZICBATA
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS
Weatherstrips A.S.H.V.E, Construction No.
Guide
WindowsI Doors Reference Out. Wall Int. Wall Ceiling Roof Floor
Yes—No Yes—No 19—
I Flan ,-1., '—, Room I Length Width
Windows and Doors—Crackage and Area
y,
Y
Width Height No. of Lineal ft. Area
No. of Dane of pane lights of crack sq. ft.
r11-
.6
P � B
e
Coef. Btu
Infiltration
:�o
Glass
-2 0
Exp. wall
Glass
Net exp. wall
Int. wall
Glass
Ceiling
Net exp. wall 1/2
Floor
71-7
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
I M I ... 1 i—.....L I --Y M-11.1- 3 A LJ—:—L.
Windows and Doors—Crackage and Area
e"o
lv
Width Height No. of Lineal ft. Area
No. of pane of pane Ilghts of crack sq. ft.
Width HeightNo. Of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
.6
1
e
Coef.
Btu
Infiltration d
-2 0
206
Glass
Gl}ss
Exp. wall
Net exp. wall
Exp. wall
Glass
Int. wall
Net exp. wall 1/2
j
71-7
Int. wall
Floor
Ceiling
Int. wall
Q
Floor
Ceiling
/ F1.1 Room I Lenath -5,< Width /,0 Height o
Windows and Doors—Crackage and Area
e"o
lv
Width Height No. of Lineal ft. Area
No. of pane of pane Ilghts of crack sq. ft.
ur . G
.6
1
e
Coef.1 Btu
Infiltration
Infiltration
Btu
Glass
Gl}ss
Exp. wall
Net exp. wall
®,
Glass
Int. wall
lr
AD
Ceiling
Net exp. wall
Floor
Int. wall
Tbtal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
No. of pane I of pa
t �
FRIDLEY, MINIM.
Insulation
Kind How Applied
om I Length Width / Height
--Crackage and Area
No. oL Lineal ft. Area
No,
of crack sq. ft
I` I I- I I 1 Coef.l Btu
Infiltration ' 1 ,3'
Glass o
Exp. wall
Net exp. wall a
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
1 >r'1 I R....... 1 i �..e�1. 9 � �4/;.7►i, ♦ � i-Ie:sl,t �
Windows and Doors-Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
ur . G
.6
1
e
Coef. Btu
Infiltration
Btu
Infiltration
Gl}ss
-17
Glass
Exp. wall
lr
AD
,z
Net exp. wall
Int. wall
Net exp. wall
Inc. wall
Ceiling
Ceiling
Floor
Floor
Total Btu. 7 17
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
RI I .a _ se R.......1 i -.e.th'.fes W;dth 14.6hi
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft
.6
1
e
Coef.
Btu
Infiltration
-17
Glass
lr
.
,z
Exp. wall
Net exp. wall
Inc. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
fatty ° of Fridley, N9 9292
BUILDING PERMIT
Date: MX June 6, 1967
Owner: Donald Delich Builder Chucks Const. Co.
Address 5284 Taylor St. N. E. Address __ 3800 Hayes St. N. E.
LOCATION OF BUILDING
5284 Taylor St. N. E.
No. .___... Street ._._. Part of Lot
Lot _ 15 _ Block 1 Addition or Sub -Division . Marion Hills 2nd Addn
Corner Lot — Inside Lot . _ Setback Sideyard —
Sewer Elevation — Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front __ Depth Height _ Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Paneling & ElooEst Cost ` $600.00 _ To be Completed — June 16, 1967
Tile -
In consideration of the issuance to me of a permit to constru the building described above, I agree to do
the proposed work in accordance with the description above met f and colian� tit x,11 provisions of
ordinanoEs of the city of Fridley. ,� 9 �i /�
Chucks Const. Co.
In consideration of the payment of a fee of $ 6.00 ., 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 anypart 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.
_CLARENCE BELISLE Building Inspector
NOTICE:
71110 permit does not cover the construction, installation for wiring, plumbing, gas heating, sewar or water. Be sun to sae
the Building Inspector for separate permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
s
/n,OWNE 'S NAME BUILDER
_
(� T
ADDRESS"t1 ( ��`� �J`�ADDRESS
LOCATION OF BUILDING
NO. (j STREET l 'rA' / '(--- PART OF LOT
LOT BLOCK J ADDITION OR SUBDIVISION/ .2,7�%
CORNER LOT INSIDE LOT SETBACK SIDE -YARD
SEWER ELEVATION TOP OF FOOTING
Applicant attach to this form two certificates of survey of lot and proposed
building location drawn on these two certificates.
To be Used as:
DESCRIPTION OF BUILDING
Front
Sq. Ft.
Depth
Front Depth
Cu. Ft.
Height
Height
Sq. Ft. Cu. Ft
Type of Construction- 1X",a 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 ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
DATE 1i) -t-7 e SIGNATURE
(Sche ule of Fee Costs can be found on the Reverse Side).
i
I
BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building of structure, or for any addition to any existing
buildi.ng;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 herein below set forth and in the manner
herein provided to -wit;
Uniform Building Code: Type 1,2, & 4- $1.75 for each one thousand cubic feet, or
fraction thereof, in such cubical contents. Type 3 & 5 - $1.50 for each
one thousand cubic feet.
For the purpose of computing fees ,for building permits, the cubical contents of
any building or addition to a uniform height throughout by multipluing 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.
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.
In no case shall the fee charged for any -permit as set forth in Section 2 be
less than $5.00.
NSSSD Connection Charges based on location- Area I or 2.
53-84—s-915.51
b E'
„ I
1 .
'���■s.�■�_ '■._■.�.. �`c^ gym.
FLUMMING FIETMO RATES:
N®. RATE TOTAL
Numbd Fixtuires ............... .
Future Mature Opening .. m . m ......
New Fixture ®1d Maung ..........
SIM 0
Cal(r }1 Bazin .. a .. .... m m .....
Water Hester fup to 99'm 3M• m ..
x 93.00 3
New Ground Run ®ad Bldg. . . . . m . . .
x i�.q�A �
Elactrk Water Heater .... a ........ m
a .00
GAB XG FEED:
NO. RATE TOTAL
ast3fixtures •.••••.•••••••••••
23100 $
AAattton.a FIxtures ...............
z :.76 $
Gal Rama to 119.E FM. m ,.........
x $500 $
. State Surcharge
MCFAMB fr ALTERATE® to
Dee t .... .-Itaabj%. qa s � ................
®... 5.00
TOTAL FM 5.50
Kind
of Building
Used as Res.
To be completed about
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PEF41T
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures $ 5.00 $
Future Fixtures $ 3.50 S
Old Opening, New Fixture $ 1.50 $
Beer Dispenser $ 4.00 S
Blow Off Basin $ 5.00 $
Catch Basin $ 5.00 $
Rain Water Leader $ 5.00 $
Hydraulic Valve $ 5.00 $
Sump or Receiving Tank $ 5.00 S
Water Treating Appliance $ 7.00 $
Not Water Neater $ 5.00 $
Gas Range $ 10.00 $
Gas Dryer $ 10.00 $
Back Flow Preventer Required. yes 0q No ( )
Type Pt�SS° G lfrac. $ 5.00 $
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
It of Value of Fixture or Appliance $ el1D
State Surcharge S .50
Reinspection Fee $
(515.00) TOTAL FEE 5 6.6
Effective May 1, 1990.
Job Address 5484 5�-. �j-C,
Department of Buildings
City of Fridley
Tel. 1571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
OWNER
KIND O
Fridley, Mn. , 199.0
USED AS
TO BE COMPLETED ABOUT 7
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
ROUGH INSP.
Date
Company AG C'.' Q -c �1 -
Signed By
Tel. No. 6931-9� 71
FINAL INSP. C/
Date
APPROVAL FOR PERMIT
!1ININUM FEE FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
a
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ro
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1st
leg
2nd
e
3rd
4th
(R) - Future Connection Opening
Connected with Sewer
V) - New Fixture, Old opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures $ 5.00 $
Future Fixtures $ 3.50 S
Old Opening, New Fixture $ 1.50 $
Beer Dispenser $ 4.00 S
Blow Off Basin $ 5.00 $
Catch Basin $ 5.00 $
Rain Water Leader $ 5.00 $
Hydraulic Valve $ 5.00 $
Sump or Receiving Tank $ 5.00 S
Water Treating Appliance $ 7.00 $
Not Water Neater $ 5.00 $
Gas Range $ 10.00 $
Gas Dryer $ 10.00 $
Back Flow Preventer Required. yes 0q No ( )
Type Pt�SS° G lfrac. $ 5.00 $
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
It of Value of Fixture or Appliance $ el1D
State Surcharge S .50
Reinspection Fee $
(515.00) TOTAL FEE 5 6.6
Effective May 1, 1990.
Job Address 5484 5�-. �j-C,
Department of Buildings
City of Fridley
Tel. 1571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
OWNER
KIND O
Fridley, Mn. , 199.0
USED AS
TO BE COMPLETED ABOUT 7
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
ROUGH INSP.
Date
Company AG C'.' Q -c �1 -
Signed By
Tel. No. 6931-9� 71
FINAL INSP. C/
Date
APPROVAL FOR PERMIT
!1ININUM FEE FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
CITY OF FRIDLEY INSPECTION DIV. Effective ,On January 1, 4V'993
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 t5�-4S" I i
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 $ 20.00
$ Zc� 'ccs
representations stated in this application are true and correct.
(Side Vent -- Fill Out Back)
— m 1 -1994
Gas Piping (Needed with new furnace) $10.00
$ i, C"' 0 01
OWNER.
Gas Range $ 10.00
$
BUILDING USED AS
Gas Dryer $ 10.00
$
ESTIMATED COST 1. t -3-� ; s� PERMIT NO.
*Air Conditioning - All Sizes $ 10.00
$
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)ar�Ai-6)N,
Trade Name -i,o Size No. -_� ,3
Commercial/industrial
BTU q V100 I HP EDR
1 % of Value of Appliance or Work
$
Fuel 4 1_1114� Total Connected Load
State Surcharge
.50
Burner Trade Name Size No.
BTU HP EDR
TOTAL, FEE
VIN1010 INWING AND AIR CONDITIONING CO.
410 WEST LAKE STREET
MIHNEAPouS, MN 5506-2998
HEATING COMPANY-)., O I
MINIMUM FEE FOR ANY HEATINWCOOLINGJVENTILATION
REFRIGERATION AIR CONDITIONING PERMIT IS $1500
Signed By Tel No.
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
Approved Rough -In Date Final Date
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
NOTE: #1 through #8 required when using a side vent furnace.
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 ( ) No
8. Has combustion air been provided for water heater Yes ( ) No
Remarks:
HEATING CO:
Signed By:
Date:
f
' RESIDENTIAL LOAD CALCULATION
II I,, - per,
Purchaser - RQI� P'` e � ti Q," /^ ` Sales Rep w UQ// - Date G
Address l 2�U l t q 1157' !�Ej 1-4E G-4/01
Running walls below grade: x (Ft wall Ht)=
Running walls above grade. x (Ft wall Ht)=
(1st Floor)
Running walls above grade: x (Ft wall Ht)=
(2nd Floor)
f
Sq Ft gross wall
below grade
3q Ft windows and
ioors below grade
Jet wall below
Sq Ft gross wall
Sq Ft gross wall
above grade(2nd f
Sq Ft gross wall
ahnvP Trarip (1 st f
Total gross Sq Ft
above, grade
Sq Ft windows and
doors above grade
Net wall above
Windows & Doors Sq Ft x ® HTM = /�i�TUH
Inf.(w&d x 1.3) ® Sq Ft x ® HTM = ��BTUH
Net wall below
grade Sq Ft x 'HTM = [�BTUH
Net wall above
grade ® Sq Ft
Exposed Ceiling ® Sq Ft
Exposed Floor I Sq Ft
x HTM = 9� Z�j BTUH
x HTM = lib TUH
X HTM = /J/1/ BTUH
= EiFjPNTF TOTAL
Windows & Doors iD ID Ceilings & Floors
uD 1 o l�
6 '� to
�o
�J
410 W. LAKE ST.
MINNEAPOLIS, MN 55408-2998
612/824-2656
(rcLkrcvG=mpbm.7w r"AW, khro, r "0." IN ST.
LN I
HEATIIVGAND AIR CONDITIONING c--#...,))
8ecvipg ne TVvin Gilles Since 1930`
ORSAT TEST RECORD
ADDRESS-° CITY
.,OCCUPANT 2a'nAld OWNER S .
DATE HTG. INST. 5- -!' INSTALLED BY
GAS LINE BY -7A (f
1072 PAYN E AVE.
PAUL, MN 55101-3892
612/772-2449
TYPE OF HEAT: GA FAHW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
MODEL ,�'r5"��,y-,�,�T,9 MODEL
SERIAL 5���/ MAX . BTU RATING
INPUT Sz-CSC MAKE OF FURNACE
CONTROLS MODEL_
THERMOSTAT HEAT PLUG VENT`SIZE &/ "
VALVE T KIND OF LINER , SIZE ;7" NONE
LIMIT _; DRAFT HOOD --s REGULATOR
LIMIT SETTING CHIMNEY CONSTRUCTION
FAN SETTING / ?,c _DRAFT P -,l TEST TAG &�_ l f /ti^,
PILOT TYPE zr-�, Cep, S LIGHTING INST. _T', t jPvr ,,e_e-�
PILOT MAKE
PILOT MODEL.
PILOT TIMING
PRESSURE 5 r® d c -PERCENT CO2 _ DATE TESTED 9
INPUT CFH " PERCENT 02
STACK TEMP. PERCENT CO _���' NAME OF TESTEP, ,p7l,-,./if ✓��2 se/
TY OF FRIDLEY INSPECTION DIViSION �' ✓
ru 131 University Ave WE
VSoC/6
Effective On January 1, 2001
® idley. MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
i9 i3.572-3601 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
a
-i RATE SCI�ULE
asidential
-urnace Shell and Duct Work, Burner
%Iso Replacement Furnace
(Side Vent - Fill Out Back)
Sas Piping (Needed with new furnace,
but not replacement)
aas Range
Sas Dryer
U
E
1�
Air Conditioning - All Sizes
Rate
$ 30.00
$10.00
$ 10.00
$ 10.00
$ 25.00
;II Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
3mmnerclal/Industrial
1.25% of Value of Appliance or Work
State Surcharge
TOTAL
TOTAL FEE $39. :5D
INIMM FEE FOR ANY HEATING/COOLING/VENTILATION
EFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
LUS THE $.50 STATE SURCHARGE
�a EINSPECTION FEE $47.00/Hr
i' qir Conditioners can not be placed in a side yard without
ritten permission from adjoining property owner.
CD
JOB ADDRESS 5-22 � kr
OWNER pow ()--1 "6k
BUILDING USED AS____�_��`✓«+ _
ESTIMATED COST 22100' � PERMIT NO.
Df:SCRIPTION OF FURNACE AND OR'BURNER
No. of Heating Units__1___ Circle One (Steam) (Hot Water)arm Air)
Trade Name C Cer Size Size No. s G�e4V o - 19
BTU _ G&I 0.0 HP EDR
Fuel l 6f6S Total Connected Load _.
Burner Trade Nam_ a 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
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE LIJI'Ol
[:I0.111UTTE91
1366? CENTRAL AV N.E )�� . 757-6,2�,
Signed ANOI
Approved By Rough -In Date Final Date
BACKSIDE MUST BE FILLED IN ON VENT SIZE, VENT CONNECTORS
AND COMBUSTION AIR VERIFICATION
SEP -20-2001 14:53 FROM CITY OF FRIDLEY TO
7576701 P.02i02
COMMON YAW, VENT CONNECTOR AND COMBUSTION AIR MIRIFICATION
When replacing M11 existio furmce, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and f restopped where required.
Yes. No( )
The venting system is piasdc/PVC and meets all current codes and manufacturer
specifications including stzing, length, number of elbows and termination.
YeM No ( )
The undersigned also vermes that the replacement unit Is a listed assembly.
and meets the current codes and manufacturer's specifications. This does
Include AGA -LAMA Category I Central Furnace Venting Tablas for fan
assisted and natural draft appliances.
YesyqNo(
?
The existing combustion air is sized and Installed to most the current codes
and manufacturer's specifications.
Yes;No( )
When required to Install a new cArrikot3on air. k will be sized and Installed
to meet the current codes and manufacturers specifications.
Yes () No(
When installing a new ventlnsi system, the undersigned hereby verifies that
it is a listed assembly and meats 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.
Yesy} No( )
Is the common vent and vend connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as current codes.
Yes No ( )
per
Aaoliancse Tape and liizelCommon Vent and Vent Connector Information
Appliance #1 Type Puk'm cc- STU Input Fan Assisted or Nat tA-k
Appliance #2 Type STU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fen 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 R Length ft Diameter
in Type
Appliance M Vent Connector Height ft Length ft Diameter
in Type
.ALTERATIONS: f0mribe)
1356?. CENTRAL AVE. N.E.
ANOKA, MN 55304
HEATING CO:
Signed By:Date : A/
TOTAL P.02
rBL41ME
ADDRESS���
AIR CONDITIONING
AND ELECTRIC, INC.
OCCUPANT .[✓ oa a/ AL
14-ig 04
HEAT LOSS te-- DATE HJG. INST. ®&/?J.& L
SOLD BY
Electrical Work By
TYPE OF HEAT GA FA_,�F— HW STEAV SPACE HTR.
GAS DESIGN
MAKE _ CsA1`%,°Cie
Model daisAt k1d70^moi�
Serial
INPUT
THERMOSTAT
Value 4.,1
d,
CONTROLS
_ Heat Plug
Limit i���v
e -d
Limit Setting
-9 d, e
Fan Setting
Tr°
Pilot Type
711-9v
�1 P 1
Pilot Make _�y-r
•
Pilot Model__,
�7
PIIotTlming
v--
— -L.W.
L.W.Cut Off
Pressure •
f
Percent CO2
Input CFH
7& :�A-
Percent 02
Stack Temp.
,%e—
Percent
APT. FLOOR CITY SUBURB
OWNER 4aa
INSTALLED BY
Gas Line By _
UNIT HTR.
.Ar ® r 1.01T
OTHER
CONVERSION
Vent Size 19"
KIND OF LINER %e- SIZE -'T- NONE
Draft Hood
Regulator
Filters Size &!:� �gQ Ito / Number r
Chimney Location inside V Outside
Chimney Construction 49 4--�
Smoke Bomb
Wiring
Draft -;e� Test Tag
Door Pressure
Lighting Inst. of -
Date Tested i, Z, ✓°
Company Testing ° 0v,0,/,r
Name of Tester
Pressure Percent CO2
Input CFH Percent 02
Stack Temp. Percent CO
GiYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
February 28, 2003
Mr. Don Delich
5284 Taylor Street NE
Fridley, MN 55421
Re: Final Inspection at 5284 Taylor Street NE
Contractor: Blaine Heating AC Electric Inc
Dear Mr. Delich:
A mechanical permit was issued on November 2, 2001 to install a furnace at your address.
According to the 1991 Uniform Mechanical Code a final inspection shall be conducted on
the work authorized by this permit. A final reinspection on December 21, 2001 noted that
the following corrections had not been completed:
1. Downsize common flue per NFRA and GAMA tables.
2. Provide a listed chimney cap.
3. Provide firestopping in joist area.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. Please contact us within 30 days to reinspection the above noted
items.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Sincerely
Inspector
QVII
INSPECTION REPORT
CITY OF FRIDLEY MINNESOTA
(763) 572-3604
ADDRESS
DATE % fes/ & PERMIT NO. '
DESCRIPTION'
ESCRIPTION
INSPECTION REPORT
DATE lChdll D / REPORT
lrZO"t/ E 16 UfJc./i t "'As ft Jt/Vj�rt2
corrections as called for.
u
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 tAX: (763) 571-1287
ADDRESS : 5284 TAYLOR ST NE
PIN : 253024220034
LEGAL DESC : MARIAN HILLS 2ND ADD
: LOT 15 BLOCK I
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
PERMIT(NO.: 2004-00859.;
DATE ISSUED: 06/08/2004
VALUATION : $ 3,600.00
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 GAS PIPING FOR TWO FIREPLACES.
# A/C UNITS 0
# GAS DRYERS 0
APPLICANT
RIVER CITY SHEET METAL INC
9928 BLUEBIRD ST NW
COON RAPIDS, MN 55433-
IVA570 OF'11
DELICH DONALD C & BERNICE A
5284 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 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
regulatconstru tion or the performance of construction.
Am) icant
an` t \ Date . N
Bldg Insp
# FURNACES
# GAS RANGES
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS PIPING FEE
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 13253
SEPARATE PERMITS REOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0
0
20.00
0.00
0.00
0.00
0.00
0.00
0.50
20.50
CITY OF FRIDLEY BUILDING INSPECTION
6431 University Ave NE
Fridley, MN 55432
763-572-3604 FAX 763-571-1287
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work
Minimum Fee $15.00 for Residential or 5% of cost of
Improvement whichever is greater
vqq Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS �a1 D r
Fee Total
Owner Z e— r n C g— _De. U!C
$35.00 $ Building Used As ems o p,i
$10.00 $ ESTIMATED COST 34v4f . PERMIT NO - �� 'C N
$10.00 $
DESCRIPTION
OF FURNACE AND BURNER
$10.00 $
# of Heating Units
Circle One (Steam) (Hot Water) (Warm Air)
Trade Name
Size No.
$25.00 $
BTU
HP EDR
Fuel
Total Connected Load
1-14EC.DV 3o_R
$
�
Burner Trade Name/'Aj
s L, C, Size No.
BTU 30,00,*
HP EDR
Commercial/Industrial/Institutional
1.25% of Value of Appliance or Work (List on Back)
Minimum Fee $35.00 for Commercial/Industrial/Institutional
State Surcharge
TOTAL FEE
REINSPECTION FEE $50.00/HOUR
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
$ and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
$ ,�� HEATING CORiver City Sheet Metal, Inc.
*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
925 Bluebird St. N.W.
igned Coon Rapids, MN 55433 Tel #
? L,3 -754-2199
FAX # Date DIr"
Approved by Rough -in Date Final Date
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacina an existing furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes ( ) No( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes ( ) No( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No ( )
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes () No ( )
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes () No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes () No( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type
BTU Input
Fan Assisted or Nat
Appliance #2 Type
BTU Input
Fan Assisted or Nat
Appliance #3 Type
BTU Input
Fan Assisted or Nat
Total Appliances
Total Btu Input
Common Vent Type
Vent Height
Diameter inches
Appliance #1 Vent Connector Height
ft Length
ft Diameter in Type
Appliance #2 Vent Connector Height
ft Length
ft Diameter in Type
Appliance #3 Vent Connector Height
ft Length
ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date
CITY OF FRIDLEY PERMIT .:2004-01557
6431 UNIVERSITY AVENUE NE
FRMLEY, MN 55432 DATE ISSUED:
09/08/2004
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 5284 TAYLOR ST NE
PIN : 253024220034
LEGAL DESC : MARIAN HILLS 2ND ADD
: LOT 15 BLOCK 1
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION : $ 200.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL AN ELECTRIC
WATER HEATER
# ELEC WATER HEATERS 1
VALUE OF FIXTURE/APPLIANCE
0
# NEW FIXTURES (EXIST OPENINGS) 0
# GAS WATER HEATERS
0
# GAS DRYERS 0
# GAS RANGES
0
# OF NEW FIXTURES 0
VALUE (FOR MINIMUM CALC)
200
# WATER TRMT APPLIANCES 0
APPLICANT
PLBG PERMIT MINIMUM FEE
PLBG FIXTURES (NEW OPENINGS)
0.00
0.00
H P PIPEWORKS
3670 DODD RD STE 100
PLBG FIXTURES (EXIST OPENINGS)
0.00
EAGAN, MN 55123-
WATER TREATMENT APPLIANCE
0.00
(651) 365-1340
WATER HEATER - ELEC
35.00
WATER HEATER - GAS
0.00
GAS RANGE FEE
GAS DRYER FEE
PLBG REPAIR/ALTERATIONS
0.00
0.00
0.00
OWNER
HARVEY MILD
5284 TAYLOR ST NE
STATE SURCHARGE, PLBG FLAT
0.50
FRIDLEY, MN 55421
TOTAL
35.50
PAID WITH CHECK # 9675
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
regul . nstruc ' n or the performance of constructi n.
Applicant Date
Bldg In p Date
A��
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
F
CITY OF FRIDLEY INSPECTION DIV.
431 University Ave NE
Adley, M N 55432
733) 572-3604, FAX (763) 571-1267
d
1�4148410_1
E.ifeciive April 1, 2004
APPLICATION FOR PLUMBING AND GAS EJTTING PERMIT
P.m Aov nn IRAm ro r%r: MVTI It?GQ Tri r2[= INgTAI I Fr)nN FAi-P F•1 CV)P
:(o
c?{:(c
�•�:n-.<C
+
,:o_
y-. -
.:_,{{cz xi,r_::a
-�.
Wash
n F X!.:
>:r,.%_
ita�:>
Floor
:.!nes
r.'(a �..rj ri_.:
, Auto.;;;._; Gas 'y, wafer He
• .Ju>F i=dcy
Stories $s ' >
:.:i.-:'
:. •_,SFti'aaja:
:. ri:(�: Shower
Urinal t+ri,:a
;. <J:Y �l(>�{:
v ,aa...
-�
`",
Tra
C_J•.NS:C....J ..
-Xt T
'. " .<:::
Drain
{Citi>vF.?gin
. •" ._v " > r'<'%,;..
,. ,N;x Washer NmGas Elec.
]SiC:":v.•�(N•CYv
:•� l*WNN':'-'N. ';
JQ'j{>jYC._i.:',C'�'CCOa0S .XC!49D -:)CC'
A lump/Receiving Tank
$10.00
..j�S+oJ:J---XXi!P!7=bCG::.i[C:X<3-_�'tiCJJ�'\\>'iv^fC:jj
tiYCh?.�:•?P<Yi/.l�XiiOQOC}�:�vnXW!(SJ?0?:>�-'�SX�.
`./:{.•
Basementralla.l.h1
$35.00
OVVNER _W__aAj,��
$35.00 3 .SFJ
w?�,ti.:a•ii,•.V:Y..Y...aTNC-�!'•%
X.YV -_ . . h•... _. ...
r.>r%xF:
?C4JSj:{i:_..
:[ " 'rCv l.>'`Y'
$10,00
X .,>.A_. � :?o':iiu2.
Sas Dryer"`
,a,.x: X,>}X^?o ;jc..aW..__':fdic5a 5:<u ;r,."w?;a�;4•'.'diat
ATF.-X:}kNOs'St
j:. >b
Floor 1{ ars :.;
Y, :?>Y,.::->::
..u-_
:.�>
<aaca-.:
�CNi:L1-j?.L:'S.�Y.0
n.
^-taro:^__:-.:•.�.
n
.'S:�PX1%J(J:-:
; ;; > z�_ _
.{._ ._.....
$15.00
:)a.:?•O>�Oy.0\_.U•.'. OS..?->. :W%iW:
r
._ ......._.
'j��?.:w((�(�S%O6%.r:..^-(
R teinspection Fee $50.0011 -Ir
--:•[��.;>_
m ,LL OTHERS AND/OR REPAIRS AND ALTERATIONS
_Jh>
aNi::-4:ld ,/Wb.O�!.C.•>l?>}o)>>Nia:Y�RC0.Y(yyi>�
F2a/_C.NC�.
�jn.\ti.:.`%<CoY
Floor 2•"X4�Y-j[�.n1:.
..PaJ_:
�a�'�.Jj^.K-_-:.P.
-^'/'_:YjYvJ[j>>':.:>�>i?:
(y(fVYY,.x>�G.
(wJY:= • ^!t;,
�:0r_�->,
P.J:.
AGCo<I>CQ
Floor 3
i.�y. .X.t.
n WrA�.IX
ldiY<':>>IX-=?
_��ya Yh. h{Y•
Y:??).3iXJXOJ.<
�'W-: 'N�JY:_.li
SYOO^}a
ii1(O:Y.= NIJDvv.
:h r?�YC<GT%Yi.0 •jX,.i.V>���YT:X `!4>.CK<p:Y•1.. �!
Floor4
ILUMBING FIXTURE RATES: NO, RATE TOTAL JOB AD
u1.. X102
low Fixtures
$10.00
The undersigned hereby makes application for a permit for the work herein
)Id Opening, New Fixture
$10.00
specified agreeing to do all work in strict accordance with the city codes
leer Dispenser
$10.00
and rulings of the Building Division, and hereby declares that all the facts
flow Off Basin
$10.00
and representations stated in this application are true and correct.
:atch Basin
$10.00
} :ain Water Leader
$10.00
DATE: 9L Ile, 20
A lump/Receiving Tank
$10.00
Vater Treating Appliance
$35.00
OVVNER _W__aAj,��
Vater Heater-Eiectric L
$35.00 3 .SFJ
O Vater Heater -Gas"
$35.00
BUILDING USED AS
!_ aas Range*"
$10,00
-U PERMIT NO. ��
Sas Dryer"`
$10.00
ESTIMATED COST � . t9
(lack Flow Preventer Required ( )Yes No
n
Type
$15.00
PLUMBING COMPANY �� T'f�� �3�7 �IM n
J5d.263
R teinspection Fee $50.0011 -Ir
SIGNED BY TEL NOZ-5/ ,315 -j,3 1-16
m ,LL OTHERS AND/OR REPAIRS AND ALTERATIONS
` 1 125% of Value of Fixture or Appliance
v Approved By
mState Surcharge $ .50
MINIMUM FEE FO
TOTAL FEE $35. S V OF THE IMPROVEM
J
10MBUSTION AIR SHALL BE PROVIDED PER UMG SECTION 504(A) AND TABLE 5-A
Rough -In Bate Final Date
"PROVIDE COMMON VENT INFO ON BACK SIDE
R
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 exIAtIM,g2m:bust11on air is sized and installed_ to, meet the current codes
and manufacturer's specifications. Yes No ( )
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes () No { )
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA -LAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes O 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-(kNo ( )
Appliance Type and Size/Common Vent and Vent Connector Inform9tion
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 incites
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: Dae:���
wilding
MECHANICAL
Permit No.
Inspections
SIDE T � PLICATIO
Received By:
763-572-3604
Q�
CITY OF FRIDLEY
e
763-502-4977`` FAX
I
EFFECTIVE 2-19-09
etOT to
DATE i o"2_O YOUR E-MAIL ADDRESS
A \ _
SITE ADDRESS a. S� dV-
THIS APPLICANT IS: ❑ OWNER KICONTRACTOR
PROPERTY
NAME: -1)C °E- ic°"
OWNER/
ADDRESS:S-.�-%L{ AJCO( S N� CITY �>r d ��� STATEmNZIP 5S4a)
TENANT
PHONE: l®3 - C'n ` - 6 3
CONTRACTOR
COMPANYNAME: --- CENTERPOINT-ENERGY-----_ ----. ___ --- ---- -- --
CONTACT PERSON: JOANN ZINKEN
SUBMIT A COPY OF
BOND 22013346 08/19/2009
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE WITH
ADDRESS:9320 EVERGREEN BLVD NW SUITE B cITYC00N RAPIDS STATE MN ZIP 55433
APPLICATION
PHONE 763-757-6202 FAX 763-757-6701
PERMIT TYPE
eMINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW �MEPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK
FEES ARE BASED ON $10.00 PER FIXTURE, AXCEPT WHERE NOTED. FIXTURES: (INDICATE TO AL NUMBER OF EACH BELOW)
C"_- (m
Equipment Installed MFG: o MODEL: a C� QoSIZEBTU 3 yj
MFG: MODEL: SIZEIBTU
MFG: MODEL: SIZEIBTU
'.A/C $25.00 _FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00
_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 HEATER $35.00
_POOL
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
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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
approval of plans.
approved plan in the case all work which r��.PRINTNAME
�• ROGER HOFFHEIN 01 -1 -IC)
SIGNATURE OF APPLIC DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
0 NEW HOMES/ADDITIONS ZEXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2: Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other .than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.