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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT(26013�5 Date: _._ °`e% Owner: AW_Builder— Address Address LO9 OF ING No. Slee P . of Let Lot Block Addition or Sub LAW=— Corner Lot _ Inside Lot - Setback E _ _ _ Sideyard 7–z Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To U r Front Depth Height Sq. n/-99Cu. . V4ade Fron Depth freight Sq. Ft.� Cu. P't.1�. C) ction Eat.°Cost!!" o be Completed Tyle -y-, ! In consideration of the issuance to me of a permit to construct the building described above, I agree to do the Proposed work in accordance with the description above set forth_ and in compliance with all provisions of ordinances of the city of Fridley. 9 In consideration of the payment of a fee of $ , permit is hereby granted to to construct the building or addition 'ars 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 reg location, construction, alteration, maintenance, repair and moving of buildings whin the city limits and permit may be 'revoked at• any up violation of any of the provisions of said ordin =� NOTICE: 4>, lots permit don net cover the eonstrLetiam, inddtatton for wiring, ,phnobbep, pasb•+ a sewee or water. Be sere to see the Bntldtae Inspodor for soparata pormhs for these Renu. c -4 111 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA r Owner°s Name Builders 4 A-,) /�'. 6�, Address Address 2 7 LOCATION OF BUILDING No. Street Part of Lot If V Lot Block Addition or Subdivision ��% �%--•; Comer Lot Inside Lot—x—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,: Depth '2,PHeight Sq. Ft. 12-4-0 Cu. Ft. ZQLel� Cmw===* Front 2„2, Depth 7-2- Height Sq. Ft. 4/�6 Cu. Ft. Type of Construction �Estimated To be Completed Cos t_ 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 �°X 2.-- SIGNATURE �. (Schedule of Fee Costs can be found on theverse Side). A . , " C 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 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; 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 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 a 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 on to the average height of the roof surface of the main gable of a pitched roof. 2a5. 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. 9 Application for Power Plants and Heating. Cooling, Ventilation. ReMgeration 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 ............ 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 640 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 lst 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 FINAL Dept. of Bldgs. Phone SU 4-7470 Location ��✓�I e� 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. Fri Minn d -� '? � B , 19 CQ Y Owneryl-� Kind of 1 Used as To be completed about/ Estimated Cost, $ 4 7,J_ _ Ol New. wilding Permit No. Permit No. DESCRIPTION OF WORK HEATING or PAWER PLANTS- Steam, Hot Wa er, Warm. Air—No Trade Name n �� -' � 'u Size No 2_G l a-� Capacity. Sq. Ft. E.D.R BTU H.P. Total Connected Load Kind of Fuel/ u-1 'q-,.1 BURNER — Trade Name Size No Capacity Sq. Ft. EM.R BTU H.P. (REMARKS -OVER) RAY N.WELTER HEATING C17. Signed 63-7 rr H i r. A G O AVE. By MINNEAPOLIS 7. MINNESOTA . .^q 42 2M Business Phone No "f �°�� Windows and Doors—Crackage and Area ng _ Jell-O 10 11049 Width Height No. of Lineal ft. Area No. of pane of pane lights of crack SQ. ft. e �- 0. Width Height No. of Lineal ft. Area Noo..,y ofpane ofpane lights o4cracksq. ft. Coef. Btu Infiltration HEAT LOSS CALCULATIONS DEPARTMENT OF INSPECTIONS r Weatherstrips A.S.H.V E, Guide Glass Construction No. Glass Insulation WindowsDoors I Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied e No eNo Int. wall 19_ Int. wall 4 .E`° .. F1.1 Room I Length /,gP .& Width - O Ieight r z II ./ Fl.l P , d. Room I Length /-'e— Width ,//-' Height I Windows and Doors—Crackage and Area ng _ 1 Width Height No. of Lineal ft. Area No. of pane of pane lights of crack SQ. ft. e �- 0. Width Height No. of Lineal ft. Area Noo..,y ofpane ofpane lights o4cracksq. ft. Coef. Btu Infiltration Coef. Btu Infiltration, Infiltration Infiltration , Glass - ' 1 Glass - '" Exp. wall,►'' v Exp. wall Net exp. wall' Net exp. wall Int. wall Net exp. wall Int. wall 4 .E`° Ceiling,, e Ceiling Floor 211 Floor Total Btu. 16, T -.L -2, Required sq. ft. E.D.R. or sq. ins. W.A. Leader area J FI_I Y/i R.. ( I .moth s'' +4"`_� Width J-10 _? 14nioht V-6 Windows and Doors—Crackage and Area ng _ 1 WidthHeight No. of Lineal ft. Area No. of, pane , of pane lights of crack sq. ft. msq. -'! or .. 6 �- 0. Width Height No. of Lineal ft. Area Noo..,y ofpane ofpane lights o4cracksq. ft. Coef. Btu Infiltration Coef. Btu Infiltration Infiltration Infiltration ,MFR' Glass - ' 1 Glass - '" Exp. wall Net exp. wallJ7�# v Exp. wall Net exp. wall' Int. wall Int. wall Net exp. wall Ceiling 4 .E`° Ceiling,, e Floor.`T Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.l T! °,u %,.Room ( Lenuth° Width � Heiaht Windows and D rs- Crackage and A ng _ 1 Width Height No. of Lineal ft. Area No. of pane of pane lights `. of crack ft. msq. -'! or .. 6 Width Height No. of Lineal ft. Area Noo..,y ofpane ofpane lights o4cracksq. ft. Coef. Btu Infiltration Coef. -Coef.1 Btu Infiltration Infiltration j 4,10 4, Glass. - ' 1 Glass 6 51W v Exp. wall Net exp. wall' Net exp. wall? Int. wall Net exp. wall Int. wall Ceiling,, e Int..wall Floor Floor Ceiling Lo ' Floor '. . Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A.' Leader area Windows and Doors—Crackage and Area ng _ 1 Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft* Windows and Doors-Crackage and Area Width Height No. of Lineal ft. Area Noo..,y ofpane ofpane lights o4cracksq. ft. Coef. Btu Infiltration Coef. Btu Infiltration "� Infiltration j 4,10 4, Glass. Glass 6 51W Exp. wall Net exp. wall' Net exp. wall? Int. wall Int. wall Ceiling,, Ceiling '"'.'►° Floor Floor / Total Btu. 1 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Jel Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.( ._ Room I Length Width Height Windows and Doors—Crackage and Area ng _ 1 etg Windows and Doors-Crackage and Area Width Height No. of Lineal ft. Area Noo..,y ofpane ofpane lights o4cracksq. ft. Coef. Btu Infiltration Glass Exp. wall Coef. Btu Infiltration Int. wall 'v2.,. Glass 6 51W Exp. wall Net exp. wall' Int. wall Ceiling,, Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.( ._ Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor 1 otal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Permit dee $............................ APPLICATION FOR MECHANICAL WARM AIR HEATING PERMIT No. P ........................ Dateof issuance ------------------------------------------------------1196 ...... Location-•----. -----•-•-------------------------------------------------•---- Minneapolis, Minn ........................................ ------ 196.. ---- Inspector of Buildings The undersi_gned hereby -makes application for a permit for the installation, alteration or repair of a heatinf, air eonditionin¢ or ventilatin_9 system, device or equipment, as herein specified, afreein_ to do all such work in strict accordance with the City Ordinances awl rulin_'s of the Departinent of Inspections and the specifications set forth in this application as approved and filed in the Department of Inspections. Owner----•---------------•-----------------........--•-•---•----.....-•---•-------------------4ddress of Owner ................. ...................... ......................... Kindof Building ...................................... ........................... How occupied-------------- ------------ ------------------------ -1- .............. Work to be started --------------------------------------------------- 196...... Work to be completed --- ----..------ -------------------------- 196...... EstimatedCost 0 ------------------------------------------ -------------------Old —: New,, Building Permit Xo---------------------------------------------- DESCRIPTION ----------------- -- --------------------- DESCRIPTION OF WORK Note: Insert the word install, add, alter, or repair, according to which is`;to be done. Under "Remarks," itemize removals, if any, and alterations to equipment. ................................................ Mechanical Warm Air Heating Plants—Furnaces ---------------------- --------------------------------------------- Make------------------------------------------------ •---- ----------------------------------------------------..Size-----------------------•---•---------------------- ----------------------- Connectedload-•------------------------------------------------------------------------------------------Capacity-----=->:......................... ---------- .................. Air Conditioning System: Summer — Winter — .FIZZ Year; ............................................. ....................................... Make------------------------------------------------------------------------------------------ - Capacity ---------------------------------------- Cfm................................ -------------------------------------------------------------------------•-•--------•---••---------------------•--. ----.....-----------............----------------...------------------------------------ VentilatingSystem: Make .............................................. --------------------Capacity -------------=----•--------•--- Cfm>------------------------------ ..-------------------------•...----------------------•-•--.....------------•-------•-------.............-------------•-----•-•--------------------•------------------------•--...-----•.............. Remarks: .................................................................................. ---------•--------•-•-••------------------------•-•-------- -----------------------------•------•--- ... --......... .......................•-----•-----••-----•--....._...---.......-•-------------•------.-------.........------......•-•-------•----------------................... ---------------------- ....................................................•----..............................................--•-•-•-•-•---------••------....------.....•--------•-•----•-•-••••--.........--....----••---•----- ✓1 pproved. ............................ ------------------------------------------------------------ ----------------- ...........•. Si_gned---------------------------------------------------------------------------------------- By------------------------------------------=-------------------•------------------------- ............ 196.----- .4ddress -------------------------------------------------------------------------- ........................... Telephone-------------------------------------------------------------------- Inspector. ----------------------------------------------------------------------------------------------------............ •---------•--------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ D-20 a a Y City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Location--L— a ocation Number, Kind and Location of Fixtures C� 3d 1 SRF ii Z� in 3� Zrz z0 eu yc paZ K ire �Z � t�m O <3 .J c�°d WU'2 2a 0 a' 'aa c90 F 6 N WATER HTR. GAS EIEC Base /f 1st 2nd 3rd 4th • Future Connection Openings ISewer * New Fixture, Old Openings Connected with Cesspool [:] PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TqTAL Number Fixtures ......................� x $1.50 $� Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ C' New Ground Run Old Bldg. ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $� Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. REPAIRS & ALTERATIONS—Refer to Code x 2.00 $ 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 aretrue and correct. Fridley, Minn ei "`` �` 19 14` Owner Kind of Building Used as To be completed about „�. doo Estimated Cost, $ /% Old New. uilding Permit No -6 X-53—^5 Permit No.� i ROUGH Y . �+— to FINAL Description ................................................$ TOTAL FEE $ a a 2tA Business Phone City o: Fridley, YHnn. 1 Date: June 2, 1965. Owner: John Moening Builder P. D. Q. Claim Service Address 7121. Tempo Terrace X. E. Address 6305 Bryant Ave. So. LOCATION OF BUILDING No. 7421 street Tempo Terrace N. E. Part of Lot Lot 19 Block 4 Addition or Sub -Division Melody Manor$ 2nd. Add. Corner Lot _ Inside Lot Setback Sideyard Sewer Elevation Foundation Mevation To be Used as: Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft Cu. Ft Type of Construction Est Cost $6.x$•00 To be Completed Storm Damage Repair In consideration of the issuance to me of a permit to construct the building the proposed work in accordance with the description above set forth and in cc ordinances of the city of Fridley. ®� ' l above, I agree to do with allTrovisions of i condderation of the payment of a fee of 1$__ � , permit is hereby granted to ce P• D• Q. ervi to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work. done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, constructions, alteration, maintenance, repair and moving of buildings wig city limits and this permit may be revoked at any time upon violation of any of the provisions of said Allen Jensen Building Inspector NOTICE: fhb perndt don not aenr the eonstromfoe, bnhdbdon toe wlrhm phmbine, Bn heatb& nww or water. Be sure to see the BuHdiue In*. r for s"watf pwnft for thno Bene. APPLICATION FOR B'• ING PERMIT CITY. OF FRIDLEYO , 11NNESOTA l'S NAME,,je4 BUILDER ADDRESS ADDRESS jg��3 - f - LOCATION OF BLrMDING No. Street Part of Lot Lot Block Addit.iozr or Subdivision L � ✓�-�L �� , Corner Lot Inside Lot _.;.SetWack Side-YardL.�.. SEWER EiEVATIQN FOUNDATION ELEVATION Applicant attach to thin form, Two Certificates of,Survey of Lot and proposed build- inglocation. drAvn on these Cattificates . DESCRIPTION OF BUILDING To be used as: Front Depth Height,. Sq. Ft. Cu. Ft. Front Depth height t Std. Ft. ' Cu . Ft. of Construction Type �� i �.�eEstimated Cost e.;?L:F0'-,r0 p F _._Tz_,be ,CompLeted The undersigned hereby makes application for a permit for the work herein specified, agreeing to ao.all work iii strict accordance with the City of Fridley Ordinances and rulings of the Department'of Buildings, and hereby declares that all the fects ando representations stated in this application are true and correct. , Schedule of Fee Costs can be found on the Reverse Side). ' BTMDING PERMIT FEE SciftM- E t. Section 2. The Inspector of-Buildings'sbal•1, before isegi% any permit for the erection of any building or structure., •or for any add$ti-4a to any exist- ing building or structure, or for.any'alteratfOA,sto,...repaixt to any existing .building or structure, upon application a :eior, require the payoroft by the applicant for such permit of fees •ter -ttie amount 'heroin•below. set forth -and in the manner herein provided to -wit -.- For any ouch permit for the ereq,ttoriKof` any fireiJprqof buil.dipg, other {- ..Zthen a garages warehouse, factory Qr• g in' Q1tqv4j1pW4 W.fir the erextiora of any fire -prof addition, fox. siR.11. r`°oir u ancyp to a*,y oxist,i tg build .,' shall be at the rate orf $1.40 for aach';m co thous4md .pubie feet, or* fra"ion M...:thereof, in such cubical contents; - ;+y Yt `a 2.2. For any such permit-f•:,.e erection of any fire -proof £a tory or grain elevator, or for -the wroction of anyi t ` a for similar occupancy, . to. any 6kist•ing' lldivg shall be att 4e .w fob"each one .thousand cubic .feet,, -,classified ss. p'firepxoraf" by. .81 the, Mittnpl.is...8u33d3a1g Cod.'�Sru',�. , HOUSES 2,3. For any such permit for the erection of any non-firep **f building at thea a garage, warehouse, factory or, grain elevator, dr any stat-fireprVat addition,, for simi,ldr octupAb4y, to any ektatirtg Tierilding - permit $1:100 for each one thoubaoO -cubit, feat. 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•fireprogf- 4add ticii,--£-or-•-s-imilar' occupancy, to any existing building dr for each such ,ding or addition. - ninety cents ($0.90) for each one thousand cubic feet or fiction thereof, in the cubical contents thereof with a minimum of $4.M-• For the purpose of computing fees for building permits, thb cubical content& of any building or addition to - a uniform height throughoot •'b�y multip+lying tip.-�_ ground area covered .from a •point six (6) inche9 b' elaw the door lime. 0f ,..Che:::.. basement or cellar. to the average height of the upper surface or to the average height of the roof surface of the maim gable of a pitched roof. 2.5. For repairs or alterations to an existidS • at the rate of 3 00 $ c�.ctu,� a fee sal . be�.:�' . $ per each Five Hundred, Dollar..s .($g0bs.,,.�� Qir. frsctio�' thereof in the cost 'of e11Tproposed work, .` In no case shall ' the fek e&, for ,ea -2 be..l".tL_than..v yo_P4Ls�3�. set "forth in •sti�.�- � r 4 . Statement"" • A A Q. Contractors AppIcation for PO4;, Pkmft aed �{ eating, Coaling, YenNlatbe, RePger�ion al�d Box 6481 /ur COMM01f11ig Systems and Devices Richfield, Minn. 55423 Telephone: 869-0057 FILE NO. 196 To C9 /Z1 ®�f7 1 /, C/ PARTIAL RATE SCHEDULE R WARM AIA: RATE TOTAL mace Shell & Duct Work ........ ....... $10.00 $ Iacement of Furnace ......... ........ ...... 6.00 $ sirs & Alterations -up to ;.800.00 800 $ firs & Alterations each add. $800.00 3.00 � ^� WARM AIA r ►ace Shell & Duct Work to 120,000 BTU ......... .. $10.00 $ each add. 60,000 BTU .................... .. 3.W ; acement of Furnace .... .. .... 6.00 In & Alterations -up to $500.00 6.00 $ drs & Alterations each add. $500.00 ... .. ... 3.00 $ �Tl O ® u HOT WATER SYSTEM //T-, /:' V/'k o- /' � /0 -P " l - 's 141® U C � e V S ee- o ( C W ',', T a T�.5s over 3 gal. per hour --See Fee Schedule INER cup to 199,000 BTU) 6.00 $ over 199,000 BTU see Fee Schedule e WING FEES: NO RATE TOTAL �• I L°1 f' � 3 Fixtures x$ 2.00 $ dditional Fixtures x .75 $ as Range to 199,000 z$ 500 $ HMO �® s see Fes Schedlulo SYSTEM $ & REPAIRS TOTAL I= o *'® Dept. of Bidge. Phom 560-M 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 an the farts and representations stated in this application are true and correct. Kind of Fridley, Used as To be completed about Estimated Cost, $__-�4- ®� Old -New. Building Permit No. Permit No. DESCRItr'PION OF WORK HEATING or POWER PIJLN78--4team, Hot Water, Warm Air -No Trade Name Sim No -,39 !C Ob cA . Capacity Sq. Ft. E.D.11o2 Dd-o BTU H.P. Total Connected Load Kind of F1ret BURNER - Trade Ne+•+e size N-_ Capacity Sq. Ft. IE.D.R BTU (REMARKS—OVER) ace Shell & Lines -to 400 sq. ft. EDR Steam $10.00 $. -- lice Shell & Line -to 640 sq. ft. EDR Hot Water 10.00 $_ add. 200 sq. ft. EDR Steam 13.00 $-- __add. add.320 sq. ft. EDR Hot Water 3.00 $--- -NER-to IM-to3 gal. per hour 6.00 $ _ over 3 gal. per hour --See Fee Schedule INER cup to 199,000 BTU) 6.00 $ over 199,000 BTU see Fee Schedule e WING FEES: NO RATE TOTAL �• I L°1 f' � 3 Fixtures x$ 2.00 $ dditional Fixtures x .75 $ as Range to 199,000 z$ 500 $ HMO �® s see Fes Schedlulo SYSTEM $ & REPAIRS TOTAL I= o *'® Dept. of Bidge. Phom 560-M 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 an the farts and representations stated in this application are true and correct. Kind of Fridley, Used as To be completed about Estimated Cost, $__-�4- ®� Old -New. Building Permit No. Permit No. DESCRItr'PION OF WORK HEATING or POWER PIJLN78--4team, Hot Water, Warm Air -No Trade Name Sim No -,39 !C Ob cA . Capacity Sq. Ft. E.D.11o2 Dd-o BTU H.P. Total Connected Load Kind of F1ret BURNER - Trade Ne+•+e size N-_ Capacity Sq. Ft. IE.D.R BTU (REMARKS—OVER) SUBJECT 151ERMIT . City of Fridley '` ® 19877 AT THE TOP OF THE TWINS BUILDING PERMIT _ r RIPI NO COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. �o�J jCITY HALL FRIDLEY 55432 L NUMBER JREV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 5/5/89 JOB ADDRESS 7421 Tempo Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 19 4 Melody Manor 2nd Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Gerald Hayen 7421 Tempo Terrace N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Palmford Construction Co. 19063 Baldwin Street N.W., Elk River 441-5747 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW] ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 16' x 16' Addition, Reroof Dwelling, Install bay window & skylight anct rebrick front of house 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan SEPA eLf WIRINGA PERMITS R blQhF'ng FURIC - GAS'Eta. ri�� PivA48"ISE®BY LAW NG ANQ. SIGNS. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD 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 $13 800 $6.90 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $198.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $204.90 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT a BLDG INSP ATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI 13 884.-7 0 DENOTES IRON --- migorES DRAINAGE 4 UTILITY 'EASEMENT LOT 19 BLOCK 4- MELODY MANOR 2.lw- ADDITION,.,,-, CAlnoka Coun}X t hereby cerhrly' fliai &5 is a bw and awyed repremdatinn 0,Pg SLrVey 4'#Jt hWr P45 9'& 404PV ASW40d 109d, *d lczqbo,7 0/100 &41dmr&y f -o" or go �ww load "rye p, #izrew, mdaff risible &"wchm&71.c As surveyed tr fm #16— dwi Apr i I co if. SUBURB" EN61NEERIA16, INC. SCALE 1" 30' NEW [ ) Effective 5/1/88 ADDN R-1 AND R-2 ,jqALTER [ ] Building Permit Application Construction Address: q-21 'j T Legal Description: Owner Name & Address: CSP �r ex& -�§. 3 Mel. # Contractor: \��,5 rv. G � . s s . Teal. 1-5 7 q -] Address: \ ``t 6 T M • ") C It( Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. EESCRIPTION OF II VENIQB' L11MO AREA: Length I Width ! (, Height Sq. Ft. L �� GiRHM AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. 07 HER: Pie -_��u� 2t� So Ra_L-� W; A';,}SkLd 1 aa Re- 8r.cL /26b'10 V 1500,0D e2� 2,166, U� Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Kra I, o �3 Estimated Cost: Approx. Completion Date: ASC' 259 K Afal _ Proposed Driveway Width If New Opening Is Desired: Ft. $ $ Width + See Back Page Ham: APPLICANT: Tel. # q u r- s 7 q7 - V Permit Fee $ lei 9.68 State Surcharge $ G, SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOML $ ,� STIPULATIONS : MY USE CNLY Fee Schedule an Reverse Side $.50/$1,000 Valuation $575 per SAC Unit Alt. "A" or Alt. "B" Above Fee i�termi by Engineering Agreement Necessary [ ] Not Necessary [ ] 13,2P®' 20 0 c.® �1; . 6 6 21�j 2 The Chief Building Official shall, before issuing permits for the erection of any Wilding 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: $1 to $500 $15 Q nimum Fee is $15 plus surcharge) $501 to $2,000 $15 for first $500 plus $2 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $45 for first $2,000 plus $9 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $252 for first $25,000 plus $6.50 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $414.50 for first $50,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 to $500,000 $639.50 for first $100,000 plus $3.50 for each additional $1,000 or fraction thereof, to and including $500,000 $500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional $1,000 or fraction thereof, to and including $1,000,000 $1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for each additional $1,000 or fraction thereof URIVERRY SSICK 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 width plus 6 feet times $15.75. 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 flaming. Palmford 19063 Zane Street N.W, Elk River, Gerald and Jan Ieyen 7421 Tempo Terrace Fridley, Min.. 55432 786-7265 u !I 016/441-0 /4 / April 27, 1989 page 1 of 2. Estimate to build addition as perplan furnished by Mr. & Mrs. Heyen with the following changes. A. Hand framed roof changed to manufactured sissor trusses. Roof pitch to match existing with 2 / 12 vault inside. b. Size of trapizoid windows; 5' 1/2" wide 1 leg 21" other leg 9" square ends instead of coming to point. c.Recess room 6" 1. remove existing patio roof. 2. Remove and haul away concrete slab that is now patio. 3. Excavate addition and haul away excess dirt. Leave center area that will not need excavation. 4. Frost footings and 5 coarse block foundation, with 1 1/2 styraphom insulation around blocks. US a TtPf. e3 ® lad OVMA-4 5. Floor joists: 2 X 10 16" O.C. �R®��'�• 6. Flooring: plywood, 2 layer 7. Wall framing: 2 X 4 16" O.C. 8. Headers over doors and windows 2 X 10. 9. Gable end to be baloon framed. 5r�ri.R I�LOG P'1 �.oL.A'rolti OO OA 10. Steel T wall braces, & 3/4" Tuff R wall sheathing. 11. 3 1/2" F.F. fiberglass wall insulation. fZ' p'3 12. Siding: 1/2" X 12" smooth masonite. 13. Soffits; 3/8" plywood. 14. Facia: 1 X 8& 1 X 3 Construction grade redwood. 15. Ceiling insulation 6" F.F. fiberglass doubled. 16. Interior finish sheetrock, 5/8" on ceiling and 1/2" on walls hung taped sanded and ceiling sprayed with texture. 17. Interior trim: Birch base and casing. 18. Roof Construction: Manufactured trusses with 1/2" L.P. board 15# felt and asphalt shingles, Install ( 2 ) R-61 roof vents. 19063 Zane Street N.W, Elk River, "0 • 30 612/441-5747 April 27, 1989 page 2 of .2 Gerald and Jan Heyen Fridley, Mn. 19. Windows and Patio doors: A. 2 trapizoid windows in gable, with insulated glass, B. 3 Norco primed slide -by no. 5050 with insulated glass & screens. C. 1 Norco primed patio door 90 X 6'8" with insulated glass & scree D. 1 Norco primed patio door 50 X 6'8" with ins. glass and screen. E. 2 Velux V 56 Ventilating skywindows with tempered glass 21 1/2 X 38 1/2" with remote handle 20. Floorcovering allowance of $ 20.00 per yd installed. 21. Paint: exterior: 1 @,oat on siding, soffit and facia. interior: 1 coat each of stain, sealer and varnish on trim and 1 coat of flat latex ( off white ) on walls skylights: 1 coat of ceiling white. 22. Concrete: step as shown on plan included ( no brick23- ) E3ectrrca ;- A. Openings and switches for 3 exterior fixtures B. Opening and switch for ceiling fan. C. 6 electrical outlets., 2 GFI outlets Above does not include fixtures of fan but we will install them if they are available while the electrican is doing his finish work. D. Moving of any wiring in wall that is to be removed from.dining area is included. 24. Removal of wall and installation of micro -lam beam for support and.finishing of opening included. 25. Heat: includes 2 heat runs installed in addition. 26. This estimate includes all material and labor for above work. 27. This estimate includes building and electrical permits. CITY OF FRIDLEY Effective Date May 1, 1g88 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL RATE TOTAL Job Address Furnace Shell and Duct Work, Burner (Also replacement furnace) $ 20.00 $ Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Gas Piping $ 10.00 $ Tei. #571-3450 (piping needed with new furnace) Can Range $ 10.00 $ The undersigned hereby makes application for a permit for the work herein Gas Dryer $ 10.00 $ 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. * Air Conditioning (all sizes) $ 10.00 $ Fridley, Minn. z�J ut OL .22 ig,^ All Others/Repairs and AlterationsR It of Value Appliance Work S,0'0 OWNER of or $ / RIND OF BUILDING COMMERCIAL/INDUSTRIAL USED AS i( (-e V LL, , A3 6, _ It of Value of Appliance or Work $ TO BE COMPLETED ABOUT ESTIMATED COST State Surcharge $ .50 OLD NEW BUILDING PERMIT MD. PERMIT NO. TOTAL !`EE $ Reinspection Fee ($15.00) $ DESCRIPTION OF FURNACE/BURNER Rough insp. Date HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Final Insp. Trade Name Size No. ` Date Capacity Sq. Ft. EDR BTU HP Approval for Permit Total Connected Load Rind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00- Company M(o AAC' PLUS $.50 STATE SUL(CHARGE Signed By *Air Conditioners can not be placed in side yard without Tel. No. written permission from adjoining neighbor. Fill out back side for stack verification on replacement furnaces CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; 1. 'Has .been. carefully.. examined. Yes (, } -No Z. 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 connected Yes () No 6. Has .Tota 1 heating BTU's of All other BTU's TOTAL Rema rk s Company _ Signed By Date CITY OF FRIDLEY INSPECTION DIV 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On January 1, 1997 PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater -Electric $ 7.00 Water Heater - Gas** �$10.00 Gas Range** $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMPANY MR R I-Clf QF7A0VdkA QTY. Fee $42.00/Hr SIGNED BY . -^ TEL N0. AND/OR REPAIRS AND ALTERATIONS ue of Facture or Appliance 0 a 60Approved By Rough -In Date Final Date **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. Reinspection ALL OTHERS JOB ADDRESS 7"i� / 72U� 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. Owner Building Used As Estimated Cost 7"7`® PERMIT NO. ,1998 1.5% of Val State Surcharge $ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 TOTAL FEE $ . �� PLUS THE $.50 STATE SURCHARGE SUBJECT PE NO. City of Fridley 28124 AT TS72HE®yi BUILDING PERMIT RE O. t �: _____ COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. I I � NUMBER REV DATE PAGE OF APPROVED BY e—t CITY HALL FRIDLEY 55432 612-571-3450 910-F15 10/6/98 JOB aooREss 7421 Tempo Terrace " I LEGAL LOT NO. BLOCK TRACT OR ADDITION 1 SEE ATTACHED DESCR. 19 4 Melody Manor. d Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE James Chellis - 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE N0. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage 30 S Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 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 I 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 2571 $1.29 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHAR E PROVISIONS OF ANY OTHER STATEPR LOC6L LAW REGULATING COW STRUCTION OR THE PERFORMANC F RUCTION �• 74. 75 Fire �', 2.57 PLAN CHECK FEE IOTA E �}/( . 61 SIGNATURE OF CONTRACTOR ORAUTHORIZED AGENT IDATE, N 0T HIS Is YO R PE�R„A IT S-GNATURE OF OWNER,,F OWNER BUILDER, (DATE, 'NSF' 0DATE v „ NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION B I� ConstructionAddress: 7 z - / �.��•�,¢� .� !�e^� ��P-/ Legal Description: Owner Name & Address: Tel. # Contractor: MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. A11199 � S?/ Construction Type: LZ 7-77 re��,* ® 4r Estimated Cost: $ 30 (Fee Schedule on ack) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: /® APPLICANT:._.J, i�CS �i�� Tel. # 311? -If 7 0� f.Ja2�G Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee $ 7 5 $ • r7 $ 1.29 $.50/$1,000 Valuation $ $1000 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) Sewer Main Charge $ TOTAL STIPULATIONS: $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] V I P 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 $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 $100,000 $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 width plus 6 feet times $15.75. 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 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. ;ITY OF FRIDLEY BUILDING INSPECTION 9 3431 University Ave NE 16cl t( 1 V 9 ?ridley, MN 55432 i 763-5723604 FAX 763-571-1287 1 S1 D A IWTE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) D Gas Range Gas Dryer *Air Conditioning -All Sizes Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING,'COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fee Tota $35.00 $ $10.00 $ $10.00 $ $10.00 $ $25.00 $-a:5—,6D All Other Repairs or Alterations (List on Back) >- 1% of Value of Appliance or Work $ a Minimum Fee $15.00 for Residential or 6% of cost of Y improvement whichever is greater on work less than $300.00 i 5 Commerciallindustcial/Institutional > 1.25% of Value of Appliance or Work (List on Back) $ M161mum Fee $35.00 for Commercial/industriiai/irisiitutionai YState Surcharge $__.1.50 l TOTAL FEE P 1-1 REINSPECTION FEE $50.00/HOUR 17 *Air Conditioners can not be placed in side yard without written approval y from adjoining property owner - copy to City r N FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE ELQ JOBADDRESS PeMP6 ` f—rrgCQ- Owner ' fiQfrt.2 s Building Used As �c Sfa6e'lC" ESTIMATED COST v2 � C)O• C)C- PERMIT Pio DESCRIPTION OF FURNACE AND BURNER # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Burner Trade Name BTU HP Size No. EOR 411 --Ruvc( -C) - *)"� 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. CENTERPOINT ENERGY HEATING CO 13562 CENTRAL AVE NE BLAINE, MN 55304 Signed Tel #763-757-6202 S e FAX 0'763-757-6701 Date )-j Approved by Rough -in Date Final Date " V// CFS ' d ldlul 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 No( ) specifications including sizing, length, number of elbows and termination. Yes 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 (io 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 Yes ( No( ) Venting Tables for fan assisted and natural draft appliances. Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes) No( ) 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) -CENTERPOINT ENERGY HEATING CO:13562 CENTRAL AVE NE BLAINE, MN 55304 Signed By: Date : --T- C) M/Flit' H TPVAISL Ol JA91G 1 NA �0 A110 WON -1 SF : T T bBOZ-LZ-�Idd