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PRE 2010 DOCSDate: C ty "of Fridley, BUILDING PERMIT April 5, 1967 Builder Homedale Builders Address Address 7000 Humboldt No. 7544 Street LOCATION OF BUILDING Tempo Terrace Part of Lot Lot 38 Block 3 ,;73 15- City 5o N9 91'7¢7 Addition or Sub -Division . Melody Manor 4th Addn. Corner Lot _ — Inside Lot x Setback 35 � � Sideyard W 13 - 27 Sewer Elevation 883.80 _9%RWAq@PZ@W0n 888.80 Top of Footing To be Used as: Dwelling Garage Type of Construction DESCRIPTION OF BUILDING Front 32 Depth 24 Height 20 Front 20 Depth 22 Height 10 Frame Est. Cost $21,000.00 Sewer- 256' W. of Manhole - 1 Lot W. of Jackson Water- 11' E. of Sewer Sq. Ft. 768 Cu. Ft. 440 To be Completed 7%1%67 In consideration of the issuance to me of a permit to c ct the building described above, I agree to do the proposed work in accordance with the description abo rth and in compliance with all pro ons of ordinances of the city of Fridley. 00 10 In consideration of the payment of a fee of $ 20.00 permit is hereby granted to Homedale Builders to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Clarence Belisle Building Inspector NOTICE: This permit does not corer the construction, instalfation for wiring, plumbing, gas heating, sewer or water. Be sure to no the Building inspector for separate permits for these teems. y APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY,,MINNESOTA OWNER'S NAME BUILDER�� ADDRESS ADDRESS LOCATION OF.BUILDING N0. T -S'TREET ' ;".<' PART .OF LOT LOT BLOCK. ADDITION OR SUBDIVISION - / CORNER LO!ONSIDE LOT SETBACK 5 SIDE -YARD e:S i SEWER ELEVATION 107� Applicant attach to this form Two Certificat s f Surve of and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as; DepthI Height1101, Sq.., Ft 1071-1 Cu. Ft. n Front, Depth Height Sq. Ft.Cu. Ft. Type of Construction Estimated CostZY To be completed .� The undersigned hereby maakes"application for a permit for thd'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. 01 - (Schedule (Schedule of Fee Costs can be found on the Reverse Side). ° d °� o 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'alteratipns 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 -wits 22..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 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. 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. 2.55. 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. STORM REPAIR DAMAGE FEES: Residential: Estimated Cost of work up to S:00.00 - $5.00 Estimated Cost of worts. e : ry o Commercial; Estimate,- `os t of u- A Estimate. .oat of work over $ 5j:;+�. vU - y« _ .0 - • Application for Power Plants and Heating. Cooling. Ventilation. Refrigendion 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 1660 Furnace Shell & Duct Work to 120,000 BTU ............ $ 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) ....................... .rrW $ GAS FITTING FEES: NO TOTAL 1st 3 Fixtures ...................... 9'E x $tit -0 $ 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 560-3480 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 co Estimate Fridley, r, 19 q w— ding Permit No. _ / �� ✓ Permit No. U77 DESCRIPTION OF WORK HEATING or PO)FER PLANTS -Ste Hot Wa Warm Air / J o� Trade Name_4 � n A -� -P_ �� Size No �° /® Capacity Sq. Ft. E.D.R.Z0V—BTU-1:1.P. Total Connected Load I/ 7 `7 Kind of Fuel BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) PAY N.WELTER HFZATNG 00 4637 CHICAE30 AVE. By r 42 Business Phone No- City of Fridley, Minn. BURDING PERMIT Date: June 23, 1967 Owner: Homedale Blders. Builder Address 5 217 Wayzata Blvd. Address No 9331 A. B. C. Blacktop Co. 1308 Main St. N. E. LOCATION OF BUILDING No. 7544 Street Tempo Terrace part of Lot Lot 38 _ Block 3 Addition or Sub -Division _.._Melody Manor 4th Corner Lot --- Inside Lot Setback -- Sideyard. Sewer Elevation To be Used as: Foundation Elevation DESCRIPTION OF BUILDING Front ___ Depth Height _ Sq. Ft. Cu. Ft. Front Depth Height _ Sq. Ft. Cu. Ft. Type of Construction, Asphalt Drivegst. Cost 144.30 To be Completed July 7, 1967 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 met forth compliance with aft provisions of ordinanms of the city of Fridley. IT � In consideration of the payment of a fee of $500 permit is hereby granted to - to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work. done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regardin4 location, construction, alteration, maintenance, repair and moving of build�gs within the city limits and this permit may be revoked at any time upon violation of any of the provisions of cad ordinances. CLAUNCE BELISLE Building Inspector NOTICE: Uls pentt does not cover the construction, installation for whing, phanhing, gas heating, sewer or water. Be sure to ass the Building Inspector for separate permits for there Nems. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME o 6'h e, ,4 L `(_ b C= /dam BUILDER A. , Q. 8_ �b ADDRESS 6'06 I.I r P� � L-0 T ® ADDRESS /30a- An) 57' A), Z . LOCATION OF BUILDING NO. % / STREET '%M p c _EkR, j C+ PART OF LOT LOT a< BLOCK = ADDITION OR SUBDIVISION J' el od,, 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: DESCIPTION OF BUILDING `Front Depth Sq. Ft. Front Depth Cu. Ft. Height Height Sq. Ft. Cu. Ft. ' Type of Construction ,94:) U &LVJ Estimated Cost IL/ Ye, 3 To Be Completed Tct 7 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 2 SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). Q J' Q 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 building --or structure, or for any alteration or repairs to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount 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 $5.00. NSSSD Connegtion Charges based on location- Area 1 or 2. a r` CD LA N r. W Cn CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Stories Basement Floor 1 Floor 2 Floor 3 Floor 4 Effective On March 1, 1996 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR garb ' Wash C)frttk Floor i;aich > Auto. Cas Das Mic Water Heater Urinal Trite Shower :5irlk Tra Y soup( Drain 1$asirt Washer A I"'I Range i~ixt, ,y, Gas Elec PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 7.00 Old Opening, Now Fixture $ 4.00 Bear Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Recelving 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 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.6% of Value of Fixture or Appliance State Surcharge TOTAL FEE JOB ADDRESS- Z�3® 72; e oe s 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. D�� , 1 egs �--- Owner Aele 7' Building Used As Estimated Cost-��ePERMIT NO.. M3& PLUMBING COMP SIGNED BY TEL N0. Approved By Rough— Rough—In Date Final Date $ .50 PLUS THEA 54 STATE SURCHARGE . ,()V� **COMBUSTION AIR SHALL BE PROVIDED PIER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 80 INCHES. ,oa —4 m 0 HOUSE HEATING TEST RECORD ADDRESSAPT. OOR TY SUBUR ��- OCCUPANT OWNER HEAT LOSS DATE HTG. INST. GAS CO. METER BAD # SOLD BY INSTALLED BY = Electrical Work By Gas Line By TYPEOF HEAT GA - FA HW STEAM SPACE HTR. UNIT HTR. OTHER GA ESI N MAKE �� MAKE Model Model Seria I Max. INPUT ej MAK CONTROLS THERMOSTAT 0 ?�: Heat Plug Volvo Limit Limit Setting Fan Setting =%L Model OF BURNER BTU Rating E OF FURNACE CONVERSION Vent Size KIND OF LINER - SIZE f` NONE Draft Hood p_ Regularor Filters Size Number Chimney Location Inside �-®� Outside Pilot Type Chimney Construction Pilot Make Pilot Model Z 2'�� Smoke Bomb Wiring Pilot Timing lello k2 Draft *— Test Tag L.W. Cut Off Door Pressure Lighting Inst." �— •.� 2 - Pressure 'I C'� Percent C 2 Date Tested Input CFH 21 P t '2 4 P"''P' J mpany Testing 71, L' Stack Temp. �� Percent COQ Name of Tester Form 235 M SUBJECT City of Fridley 24549' ' AT THE TOP OF THE TWINS BUILDING PERMIT Ir RECEIPT NO. • COMMUNITY DEVELOPMENT DIV r � PROTECTIVE INSPECTION SEC 21- 1 ' i NUMBER REV DATE OF APPROVED BY 1 1 /"'1 CITY HALL FRIDLEY 55432 A, 1'' 612-571-3450 910-F15 1:;GE 9/10/96 / JOB ADDRESS 7544 Tempo Terrace NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 38 3 Melody Manor 4 Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Cory Arlt 7544 Tempo Terrace NE 784-6050 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. George B Johnson Contr. 5410 Girard Ave N Brooklyn Center 55430 566-2351 1016 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 ❑ El NEW 11 ADDITION ❑ ALTERATION % REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Reroof House & Gare (19 Sq) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd layer but not the 3rd. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 $.59 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,170 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- Fire SC $1.17 STRUCTI O THE PERFORMANCE OF CONSTRUCTION. $40.25 PLAN CHECK FEE T L FEE Li s SC $5 0 $47.01 SIGN RE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI 4PROP L INSP VALI AT THIS IS UR j R DATE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI M NEW j ] Effective 3/1/96 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 6 Building Permit Application ConstructionAddress : Legal Description: Owner Name & Address: G y Tel. # Contractor: �Q MN LICENSE # V Address: 7 U Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIMON OF EMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length --7T—, Width Hgt/Ground Sq. Ft. OTHER: meq, - 101) cj _ Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Site Yard Setbacks Type of Construction: OvO 4A3='ted Cost: $ Approx. Completion Date: r (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft 7, $ _ $ DATE: ^ U" o APPLICANT: -111 Tel. # _ �I TOTAL $ L 210/ STIPULATIONS: CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $900 per SAC Unit License Surcharge $, f $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ L 210/ STIPULATIONS: 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 4t has been constructed will be required before proceeding with the framing. Q-k-a0i 0 �Effective January 1, 2003 CITY OF FRIDLEY INSPECTION DIViSION 6431 -University Ave NE ,.Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES FAX (763) 571-1287 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 All Others/Repairs &Alterations (LIST ON BACK) 1% 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 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. JOB ADDRESS 5 C-1 OWNER TOTAL BUILDING USED AS $__20 - _0 11 ESTIMATED COST `t� OCA OC) PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Wat (Warm Air) $ Trade Name �? Size No. BTU l&00HP EDR $ Fuel Total Connected Load Burner Trade Name Size No. $ BTU HP EDR $ The undersigned hereby makes application for a permit for.the work herein specified agreeing to do all work in strict accordance with the City Codes 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 q q CenterPoint Energy Minnegasco HEATING C013562 Central Ave NE, Anoka, MN 55304 Signed ero. �s - T'accef FAX # 763-757-6701 Ii�LApproved By Rough In Date Final Date Ivld w FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED Wheni� i an exie in0 furance, the undersigned hereby verities that the venting has been examined and is free from rust, deterioration, obstructions, supported and firestopped where required. xl No Yes ( ( ) and is securely The venting system is plastic/PVC and meets all current codes and manufacturer Yes (x) No ( ) specifications including sizing, length, number of elbows and termination. The undersigned also verifies that the replacement unit is a listed assembly and meets the currentds and include AGA-GAMA Category entral Pomace VentingcTables for fan Yes Yes 6) No ( ) assisted and natural draft appliances. The gxietflng r-amhi-infinn air is sized and installed to meet the current codes YesNo ) ( ) and manufacturer's specifications. When required to inatalr a new cemhvi�tien air_ it will be sized and 'installed Yes) No( ) to most the current codes and manufacturer's specifications. When 11nsta11'ng a new ventingsystemm, 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 Yes (x) No ( ) separately as per current codes. Annl� nre Tjde and Sim /common Vent and Vent Connprter Information Appliance #1 Types BTU Input -'f` Ass' or Nat Appliance #2 Type ,e-,Ww,e BTU Input I/ Fan Assisted o[ Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input b, Common Vent Type C Vent Height Diameter S inches Appliance #1 Vent Connector Height 3ft Length ft Diameter in Type 0-,/ Appliance #2 Vent Connector Height —LLft Length _;L:_ft Diameter min Type c_ Appliance #3 Vent Connector Height ft Length ft Diameter in Type HEATING CO: CenterPoint Energy Mi^^�^saes 13562 Central Ave NE, Anoka, MN 55304 Signed By: Date: I- (3�Q ^ C,3 Minnegasco/� ADDRESS 7S u � -krho Dr, lj e, OCCUPANT��t� HEAT LOSS Yes DATE HTG. INST. SOLD BY Electrical Work By _ M TYPE OF HEAT FA SPACE HTR. GAS DESIGN MAKE rre Model r 20 Serial NPUT Pressure Percent CO2 nput CFH v wo Percent 02 Stack Temp. Percent CO, � APT. FLOOR CITY OWNER h A0 iv Af-i INSTALLED BY i Gas Line By f UNIT HTR. OTHER Vent Size q Y KIND OF LINER A7k _n', hi, SIZE ��" 4 NONE p � Draft Hood ��aC d Filters Size Chimney Location Inside Chimney Construction Wiring Regulator L.) Number Outside Test Tag v Lighting Inst. Date Tested®� Company Testing CenterPoint r ne asco Name of Tester Ilij COS - l -Q9 NkW a [ 1 CITY OF FRIDLEY ADDIS! [) 6431 University Ave NE, Fridley, MN 55432 (763) 5723604 Bldg Insp ALTER [ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: <i d �' �a V;a Legal Descdption: Owner Name & Address: C.�,P,u 7S'cr ce Contractor.MN LICENSE # Address: S10 s4,;/e a oa, -r ®g f -Tel. # ,� mil 4 6- io Qj a 71, Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ DATE: moi' APPLICANT: PO -1Q-7 Tel. # re i -, 2.a Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using cmd1t card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ %3C1, -'�5 $ 90 $ 3140 $�eb� Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1450 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] STIPULATIONS: CGI /PP1 ',4 4 A aia T ?1A An A 1 T 1 RT. ! T. T. CGIGI7-4G1->4AH