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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Date: .....10 ...... _ ._..._.__............._ Owner: .---- -.B -..--- --- _ .. ..... Builder Address ----�• ti . _ tF.Iffa.7._ Address N? 4460 • LOCA N OF BUILDING No. .... Street -. x..-_ ................... -.................... Part o t ----------------••--- --- ......... ..... _._ Lot ..................._........ Block............�..... .........._..._ Addition or Sub -Division -._. _.... ..... .- ...... - .� CornerLot .................................... Inside Lot .. -..... ....... Setback ....._......... .......................... Sideyard.................... _............. ..... .................................. Sewer Elevation .............. _................... -............. .............. -............. _............... .--.-.. Foundation Elevation DESCRIPTION OF BUILDING Kofction a aa '' ....... -- ..._ Front . -.. Depth ..--�._® Height .��...... Sq. Ft. B()-.- Cu. Ft. 4_17A � a ...._............ Front .................-- ..._Depth ...... Height .. ... Sq. Ft. .................. -_.. Cu. Ft..--------.............. ruction ....... .. Est. Cost... //40_ ..x�-- To be Completed .................... ............... ................. CAU..� IPEL , E 2s.n1T kt i:^?T AUTHOPIZE V1C�� � COVENANTS �s Fri d'uV�d B�d UIiOINC RESTR�'�,1,_;,i�. 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 complian th all provisions of ordinances of the city of Fridley. Ro !� /� wij In consideration of the payment of a fee of $ 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 regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any timeupon viol o of any of the provisions of said ordinances. /_� 4 7 Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. 4 a I 0 111 r � 1 II I 1 I I I I , 1 I ; I I , i I , —1 i I I I I 'LL ul 4 ' 1 I t r I I � I a I I i , r I 1 I _ I I I r ' � y I T �` I a fi i I , I I i CITY OF FRIDLEY • 5-3- L-9915051 APPLICATION, FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: N0, RATE TOTAL h1L:.ser Fixtures x $3.00 $ Future Fixture Opening x $2.00 $ waterA v y $ Catch Basin x $5.00 u e .4 w a $ y x w r°', Water Softener Heater • `�vp 'C x $5.00 $ 0S x $5.00 $ N N 1 Ntlo o lech am a w aOi w cw a rMp -lst C rill Ct r ri 2ad 3rd r(R)- Future Connection Opening Connected with Sewer - New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: N0, RATE TOTAL h1L:.ser Fixtures x $3.00 $ Future Fixture Opening x $2.00 $ New Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU, x $5.00 $ 100;000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.90 $ New Ground Run Old Building x $5.00 $ Electric Water Heater - x $5.00 $ GAS FITTING FEES: 1st 3 fixtures x $3.00 $ Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $10.00 $ REPAIRS 4 ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ $.00 REINSPECTION FEE ($30.00) Job Address 6130 TRINITY DRIVE Department of Buildings City of Fridley Tel. #571-3450 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 cord Fridley, Mn. 1.2-23-76 , 19 OWNER LEROY HALVERSON KIND OF BUILDING fr ame USED AS res. TO BE COMPLETED ABOUT 12-30-76 ESTIMATED COST 10.00 OLD - NEW BUILDING PERMIT N0. PERMIT NO. Company Signed By MINNEGASCO 1 Tel. NO. ROUGH INSP. Date FINAL INSP. C l3 Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 SUBJECT MIT NO. City of Fridley 42 7916 AT THE TOP OF THE TWINS BUILDING P E R M I T ' R ' • ______ COMMUNITY DEVELOPMENT DIV. 1 ~ ' Q r 1 � PROTECTIVE INSPECTION SEC. V 1 � ` 1"•1 CITY HALL FRIDLEY 55432 1'j NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/19/85 JOB ADDRESS 6130 Trinity Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt. 7,8 2 Sylvan Hills Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Milton L. Johnson Co. 2513 Central Avenue N•E., Mpls. 781-9548 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. 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 Install aluminum trim & Overhang 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $11700. $•85 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 ATE OR LOCAL LAW REGULATING CON- $28, 0� STRUCTION OR THE PERFORfy�IINCE O CONSTRUCTION. PLAN CHECK FEE TOTAL FEE \\ /k S,4 $28.85 SGNATU EOFCONTRACT R RU ORIZED AGENT TEI WHEN PROPERL ALIDATED THIS IS YOUR PERMIT BLDG IN P f1ATE SIGNATURE OF OWNERIIF OWNER BUILDERI IDATEt NEW [ ] City of Fridley Effective 4/1/84 ADDN. [ ] R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: Legal Description: Owner Name &Address. S E$Ill Tel. # S7/ `/*9 �s Contractor: ® t - '-)"q /'f '-j S ® .'j Tel. # -7 Address: 4 S / M 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: Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Cx3, Type of Construction: Arlo 44 � t'j � 00 9 7 Estimated Cost: $ �®� � • Approx. Completion Date: 0- Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: 45- APPLICANT: Tel. # JJ CITY USE ONLY Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer !lain Charge TOTAL STIPULATIONS: W01 Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 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 Valuation Fees $1.00 to $500.00 $10.00 (Minimum Fee is $15.00) $501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each additional $100 or fraction thereof, to and including $2,000. $2,001.00 to $25,000.00 $32.50 for the first $2,000 plus $6.00 for each additional $1,000 or fraction thereof, to and including $25,000. $25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $50,000. $50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each .additional $1,000 or fraction thereof, to and including $100,000. $100,001.00 and up $433.00 for the first $100,000 plus $2.50 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 214 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 been constructed will be required before proceeding with the framing. SUBJECT PERM City of Fridley 1,(7i993§ AT THE TOP OF THE TWINS BUILDING PERMIT rp RECEIPT NO. ' • COMMUNITY DEVELOPMENT DIV. r 1 � PROTECTIVE INSPECTION SEC. �o 1 i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY j 612-571-3450 910-F15 6/6/89 JOB ADDRESS 6130 Trinity Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE TACHED DESCR. Pt.7, 8 I 2 Sylvan Hills Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE LeRoy Halverson 6130 Trinity Drive N.E. 571-1985 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Milton L. Johnson Co. 2513 Central Avenue N.E., Mpls 55418 781-9548 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 Reside Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS 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 SO. 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 Z ISTALLS 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 $2,500 $1.25 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- $54.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $55.25 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY BLDG WSP VA4.IDATED THIS IS YOUR PERMIT DA E. SIGNATURE OF OWNER(IF OWNER BUILDER) (DATE) NEW [ ] ADDN [ ] ALTER t ] R-1 AND R-2 Wilding Permit Application Effective 5/1/88 Construction Address: 6130 Trinity Dr. N.E. - Legal Description: Residential owner Name & Address: LeRoy Halverson Tel. #571-1985 Contractor: Milton L. Johnson Company Tel.#781-9548 Address: 2513 Central Ave N E Mpls 55418 LIVIM AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed oonstruction drawn on it to scale. EESCRIPTIGN OF IMPROVEKERr Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. 14 Corner Lot [ ] Inside lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Alum. Siding Estimated Cost: $ 2,500.00 Approx. Completion Date: 7/7/89 Proposed Driveway Width If News Desired: Ft. $ $ /Width + 6' See Back Page DATE: 6/7/89 APPLICANT: 7 - l��ey,e = Tel. # 781-9548 _e Permit Fee $ 6--%, Q 0 State Surcharge $ / . O s- SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main (Barge $ STIPUTATICKS: CITY USE D�II,Y Fee Schedule on Reverse Side $.50/$1,000 Valuation $575 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Neoessary [ ] � i1ii1 s" . 1.+01 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: $1 to $500 $15 Minim= Fee is $15 plus surrharge) $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 *14 $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 ERIVEWhY DEPRESSION ESCKW (Concrete Oirb Streets Only) Alternate "All: Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Alternate "B": Removal arra 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 iscnied a mininm 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. s SUBJECT PERMIT NO. City of Fridley 26931 AT THE TOP OF THE TWINS BUILDING PERMIT f RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. � � PROTECTIVE INSPECTION SEC. r 1 � NUMBER REV DATE PAGE OF APPROVED BY i CITY HALL FRIDLEY 55432 , 612-571-3450 910415 7/31/98 JOB ADDRESS 6130 Trinitv Dr 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt. 7, Pt18 2 1 Sylvan Hills Plat2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Leroy Halverson 6130 Trinity Dr 571-1985 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Owner 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 l] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK house and garage (20 Sq.) Tear—off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with State Building Code. 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 1 HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 166 .83 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $54.00 FJ—re SC $1.66 PLAN CHECK FEE TO FEE 56.49 SIGNATUREOF CONTRACTOR OR AUTHORIZED AGENT IDATEI ml�N EN ROP VALID THIS I U PE IT SIGNATURE 'k IDA EI BLAG INSP O E s NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 1 BUILDING PERMIT APPLICATION ConstructionAddress: l _� o 7- Legal Description: " Owner Name & Address: Z_e s Tel. # Contractor: MN LICENSE # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Len Width Hgt/Ground _meq. Ft. OTHER: 400 77r C `� - f�2C`- `0 �/r�00/668 Construction Type: Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: �)� APPLICANT: Tel. # 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 $ $1000 per SAC Unit License Surcharge $ $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 $�p 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 thetim�te:'T' l tion to&kgyv for proper review of the proposed structure and of the construction site. 31l� 00 Receipts OW755 CHEJf+.49 A Certificate of Survey of the lot, showing the location of the foundation onehha �t }� S hen constructed R" EPS-�5i 0 N L Y will be required before proceeding with the framing. PAY TO THE MER OF NORWEST RM ACMWO 100479 CITY OF FRIMM . . - CITY OF FRIDLEY INSPECTION DIViSION ' Effective On May 10, 1999 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS ANDD DEVICES &/ 1® ��" JOB ADDRESS r'7 RATE SCHEDULE /� OWNER Residential Rate TOTAL Furnace Shell and Duct Work, Burner - Also Replacement Furnace $ 30.00 'OD BUILDING USED AS _�57% 6 L� (Side Vent - Fill Out Back) $ 010 ESTIMATED COST /_?1 PERMIT NO. 43CS1 7 Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 $ Gas Dryer No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ 10.00 $ Trade Name Size No. BTU 7)r HP EDR *Air Conditioning - All Sizes $ 25.00 $ Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $__ BTU HP_ EDR Commercial/Industrial 1.25% of Value of Appliance or Work $ The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes an State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are*true and correct. TOTAL FEE $ � cihorp Heaf n and ,lir Conditioning ��=4 Central Ave. NE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING - Col m is Heights MN 55421 REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE Signed DATE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without Approved By Rough-In Date Final Date 7� written permission from adjoining property owner. 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 O 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 O 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: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2000 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 30 hr. RATE SCHEDULE Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED AS 'OWAgAnCA Also Replacement Furnace $ 30.00 $ (Side Vent - Fill Out Back) ESTIMATED COST i b PERMIT NO. Gas Piping (Needed with new furnace, $ 10.00 $ Gas Range but not replacement) $ 10.00 $ DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Gas Dryer $ 10.00 $ Trade Name Size No. BTU HP EDR *Air Conditioning - All Sizes $ 25.00 $oZS, &rb Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial 1.25% of Value of Appliance or Work $ The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes an "y State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and 6109q representations stat in this, ap lication are true and correct. TOTAL FEE $ a"�S- S O 'River Uity �heet Metal, Inc 9925 Bluebirds W MN 55433 , MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO Coon Repid75x_s REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE Signed Weir� TEL # REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without Approved By Rough -In Date Final Date o� written permission from adjoining property owner. COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new combustion air, it will be sized and installed To meet the current codes and 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 :