The URL can be used to link to this page

PRE 2010 DOCSCity of Fridley, Minn.. UILDING PERMIT Date: -` P Address _._._ N4 5717' Builder. Address r �,: CATION ®� DING No. a Street Part Lot _ Lot _._._.__ Block _ _ ______ addition or Sub -Division Corner Lot __ _ Inside Lot Setback _ Sideyard Sewer Elevation _ __ r _ _ Foundation Elevation DESCRIPTION OF BUILDING �. Front Nf Depth Height 194 Sq. Ft. /19' d Cu. FGA- t Front . _ Depthh Sq. FL ._ Cu. Ft. Type of Construction �'� . _ Est,Cos:r g To be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. 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 time upon violation of any of the provisions of said ordinances. .— Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sower or water. Be sure to see the Building Inspector for separate permits for these items. b, .,, . . , OJW4 .. Owner's APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MIANESOTA Address —�.�c� J�2,� re,� .i_ Address _„_g.&g.1 LOCATION OF BUILDING Noe1 Street re J Part of Lot Block 2. Addition or SuhdivisioiU� _ -0 4_!!' Corner Lot Inside Lot �Setback..-91_1" Side -Yard � ,; f SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as Front _ Depth Height Sq. Ft. Cu. Ft. Front,.Depth Heigh Sq. Ft. Cu. Ft. Type of Construction. Estimated Cost To be Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and ruling of the Department of Build- ings, and hereby declares that all the facts and representations stated in this application are true and correct, DATE SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side. BUILDING PERMIT FEE SCHEDULE section 2. The Inspector of Buildings shall,'before issuing any permit for the erection of any building or structure, or for any addition to any existing building or structure, or for any alterations or''repairs to any existing building or structure, upon application 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 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. 2.3. For any such permit for the erection of any non -fireproof build- ing 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. E 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 -fireproof addition, for similar occupancy, to any existing, building or for each such building or addition. Ninety Cents 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 con- tents 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 root surface of the main gable of a pitched roof. 2.5. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 per each Five Hundred. Dollars ($500.00) or 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 �ess t" 1 $4.00. n City of Fridley vo . fi Application for Plumbing and Gas Fitting Perndt Dept. of Bldgs.. Phone SII 4-7470 DESCRIPTION OF WORK// •:_ — Number, Kind and Location of Fixtures Location 1 pp C.' M NO. yyz Number Fixtures ....... .....:. _ $1.50 r z X24 �z QZ y ox 1 - U' 4a UN' z �U' O • R • N WATER HTR. GA5 ELEG Base 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $ % 1st 2nd 3rd 4th • Future Connection Openings New Fixture. Old Openings Connected with Sewer � Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL 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 $ New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: 1st 3 Fixtures .......................... Additional Fixtures .................... Gas Range to 200,000 BTU .............. REPAIRS & ALTERATIONS—Refer to Code NO. RATE TOTAL X $1.50 $ x .50 $ x 2.00 $ City of Fridley: The undersigned hereby makes application for a permit for the work here! specified, agreeing to do an work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, W n. ! ' 19— Owner Kind of Building Used as To be completed about Estimated Cost, $ Old—New. Building Permit 717Permit No. Signed ds ROUGH FINAL, Description ............................................ .... $— TOTAL FEE $ -48N.42 2M By Business Phone Application for Power Mints and Heating. CoollIng, Ventilation, i%j Of and Air Conditioning Systans and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. P .SII 4-7470 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 $ MECIL 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 TO AL 1st 3 Fixtures ...................... x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ , ROUGH FINAL 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 applicationare true and and correct. i4lley, MJ inn AN 6 1962 19 — Owner _Z:�- Kind of Building e Used as To be completed about MAR 2 6 6962 Estimated Cost, $ ej` sI wa 1IMPT-WOTY-41in Q . .. .. HEATING , Warm Air --No Trade Name ✓ `„y 9 Size No-;,- Capacity s Sq. Ft. E.D.R ��r �='. r' BTU H.P. Total Connected Loa r .° ' a f Kind of Fuel BURNER — Trade Named ` F d * Size No.� - A Capacity. Sq. Ft. E.D.RZ22-2�'' BTU H.P. �r GE0. SEDCWICK c ATG. 8 AIR -CONN. co ®jfv 9tr03 Xenia Av. S. Minnaapolis 16, Mfin. Si ed f -Buis -m� „ 42 2M 7-59 Business PhGo No (REMARKS -OVER) D•SB v 9 HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS 11 Weatherstrips A.S.H. Guide a Construction No. Windows Doors ReferenceOut. Wall Int. Wall Ceiling Roof FFloor Kind Yes—No I Yes—No 19— Room I Length Width Height Room Windows and Doors —Crackage. and Area Windows and Doors—( Wldth ] of Dane of Dan1 Width Height No. of Lineal ft. Area No. of pane oP pane lights of crack aq. ft. Height No. e Total Btu. 1S Required sq. ft. E.D.R. or sq. ins. W.A. Leader area / F1.1 7)1A//!l-- Room I Lenath I Width I t9 Heixht Sl Windows and Doors—Crackage and Area Width Width Height No. of Lineal ft. Area No. of Dane of pane lights of crack sq. ft. a t3® 0 . / 1;20 36 3 1 3Cv jj �� U Coef.1 Btu Infiltration lCoef.1 Btu Infiltration Glass 1 6315- 39 -341 Glass sni66 Net exp. wall y, Int. wall Exp. wall 3 X Ceiling a.$n 9 Ceiling Net exp. wall 236 9� f Int. wall Floor ILI YC s Ceiling Floor S X / im Total Btu. 1S Required sq. ft. E.D.R. or sq. ins. W.A. Leader area / F1.1 7)1A//!l-- Room I Lenath I Width I t9 Heixht Sl Windows and Doors—Crackage and Area Width Width Height No. of Lineal ft. Area No. of Dane of pane lights of crack sq. ft. a W1. 9 DR. i I I T orb 4()Q U Coef.1 Btu Infiltration Coef. Btu Infiltration 3 Glass Glass 391 1-7 Exp. wall X sni66 Net exp. wall y, Int. wall 1-26 0 Int. wall Ceiling loo 9 Ceiling Floor )t /V f Total Btu. Required sq. ft. E.D.R. or sq. ins.W.A. Leader area Windows and Doors—Crackage and Area Width Width Height No. of pane of pane No. of Lineal ft. Area lights of crack sq. ft. W1. 9 DR. i I I T orb 4()Q U / ! Coef. Btu Infiltration Coef.1 Btu Infiltration Glass 391 1-7 Glass sni66 Exp. wall f y, Int. wall Net exp. wall Ceiling loo 9 Int. wall Ceiling Floor ILI YC s Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area ❑c MINNEAPOLIS. MINN. Insulation How Applied ength r I Width `% Height 9 ckage and Area of Lineal ft. Area is of crack eq. ft. Coef.1 Btu Infiltration 145-6 Glass Exp. wall 76 X Net exp. wall S` Int. wall Ceiling Floor X 132. Total Btu. 3 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.jT, Be Room[ Length v Width I Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights _of crack sq. ft. .� .rC O a3 Coef. Btu Infiltration 3 $ 1 Glass $� Exp. wall Net exp. wall 113 Int. wall Ceiling Floor 3 Y, Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area P F1.1 #a Bep Room I Length 13 Width / i Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of papne of.panje tights of crack sq. ft. r z0 4D ( IAI /�2 Height Btu Infiltration139 mx Glass- Exp. wall 23 Net exp. wall Int. wall Ceiling S. Floor Z 13 X /0 f.30 `'t W 0 Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 1 ♦ V � J D•S6 colaW 7 s _ HEAT LOSS CALCULATIONS DEPARTMENT OFBUILDINGS Weatherstrips A.S.H.V.E, Construction No. Guide Windows DoorsReference Out. Wall Int. Wall Ceiling Roof Floor Yes—No I Yes—No 19T F1.1 .3 RM Room I Length ►! Width A Height lJ II FU Windows and Doors—Crackage and Area Width Height No. of Lineal f . Area No. of pane of pane lights of crack sq. ft. 36 -34 f JI l 24 36 1 12 8 JCoef.j Btu Infiltration Coef. Btu Infiltration Exp. wall ,3 $ Glass Int. wall 550 S1— Exp- wall Floor Net exp. wall Int. wall Ceiling Floor lilt Total 13tu. 1 13 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lisrhts of crack Coef.I Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 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. JCoef.j Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and 1 Width H of Wane of MINNEAPOLIS, MINN. Insulation Kind How Applied Room I Length Width Height ors—Crackage and Area ht No. oY Lineal ft. Area ne llahts of crack sq. ft. Coef.l Btu Infiltration Glass 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.l Room I Length Width Windows and Doors—Crackage and Area Width Height No. o! Lineal ft. Area No. of pane of pane lights of crack eq. ft. Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length Width Windows and Doors—Crackage and Area No. opane of pane lights of crack ar ft. Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Height Btu MINNEGASZO 53-84-S-915.51 City of Fridley Dept. of Bldam. Phone 560-3430 DESCRIPTION OF WORK 1485 N. E. Trollhagen Ave. Numbar, Kind and Location of Fixtures Lorain pp v7 x $2.00 $ FFF x $1.50 $ _. New Fixture Old Opening.....:.... . x $1.50 $ yzSQAS o0 x $3.25 Oct N 0ELEC. x $3.00 $ New Ground Run Old Bldg. ........ H*ATIQii $ Base a $2.00 $ 3AS FITTING FEES: NO. RATE TOTAL 1st 2nd Insiall Gas Grill 3rd 4th • Futuro Coag=tlom Openings %1OZ&AUGAVA Trim � t New Fixture. Old Openings �� pn PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................. x $2.00 $ Future Fixture Opening ............ x $1.50 $ _. New Fixture Old Opening.....:.... . x $1.50 $ Catch Basin ...................... x $3.25 $ Water Heater :Up to 99,000 BTU) • • • • x $3.00 $ New Ground Run Old Bldg. ........ x $3.25 $ Electric Water Heater............ . a $2.00 $ 3AS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures x $2.00 $ Additional Fixtures .................. x $ .75 $ Gas Range to 109,000 BTU ... ,.......... x $5.00 $ City of Fridley: The .undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct Fridley, 8-2-714 lV[inn „ 19� Owner Donald Larson - Kind of Building Frame Used as Res. To be completed about 8-9-74 Estimated Cost, $ 10.00 Old— Building Permit No. ermi o. Signed. By ]VIR EGASCQ -- - - Business Phune No ROUGH REPAIRS ALTERATIONS --Refer to Code .50 State Surcharge Install Gas Grill 5,00 Description .......................... • ............... .. 3 TOTAL rzE $ 5.50 Mass `A7 Surcharge, -50¢ N sueJEcr PEF5�_, City of Fridley 94 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. ' S r t PROTECTIVE INSPECTION SEC. t ) i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 7/1/85 JOB ADDRESS 1485 Trollhagen Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 2 lInnsbruck.2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Peter Dupay 1485 Trollhagen Drive N.E. 574-0027 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO, Same 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 Ek ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 6 DESCRIBE WORK Reroof Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be the 2nd layer but not the 3rd.. Install ridgE:dif galvaxizied valleys. 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 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 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 $65.50 $.550 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- $15.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL$1g.50 TUR CONT AC OR AUTHORIZED AGENT (DATE) WHEN PROPERLY V DATED THIS IS YOUR PERMIT T RE OF OW O BUILD 1 IDATEi BLDG INSP - AT N NEW [ ] ADDN. [ ] ALTER. [ ] Construction Address: Legal Description: City of Fridley fR-1 AND R-2 Building Permit Application Effective 4/1/84 Owner Name & Address: C "'I-'- Tel. 27 Contractor: 15k� Tel. # Address: 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: / )e Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Cost: $ Type of Construction: Estimated Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: " �L ( PLICANT: Tel CITY USE7 ONLY Permit Fee $ 0 J Fee Schedule on Reverse Side Plan Check $ 25% of Building Permit Fee State Surcharge $ �U $.50/$1,000 Valuation SAC Charge $ $425 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ J TOTAL $ ��y 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 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 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 been constructed will be required before proceeding with the framing. 2 9", OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Effective On January 1, 1991 Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE JOB ADDRESS RATE SCHEDULE The undersigned hereby makes application for a permit for the work Residential Rate TOTAL herein specified agreeing to do all work in strict accordance with the Furnace Shell and Duct Work, Burner - city codes and ruling of the Building Division, and hereby declares Also Replacement Furnace $ 20.00 that all the facts and representations stated in this application are true and correct. Z2 Gas Piping (Needed with new furnace) $ 10.00 $ ,1991 OWNER Gas Range $10.00 $ BUILDING USED A$ ��r (<�•�L Gas Dryer $ 10.00 $ "Air ESTIMATED COST 2, L C''%Ca — PERMIT NO.�� Conditioning - All Sizes $ 10.00 DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs $Alterations (LIST ON BACK 1 % of Value of Appliance or Work $ No. of Heating gnits >' Circle One (Steam) (Hot Water) arm Al c Trade Name 2 Size No. 1ldf�'�(l??� CommerciaUlndusirial BTU 2�z o HP EDR 1 % of Value of Appliance or Work $ Fuel 1,44 X- Total Connected Load 5a.,, o State Surcharge $ .50 Bumer, Trade Name Size No. TOTAL FEE $ 30, S—c) BTU HP EDR HEATING COMPANY, �(JsTn vvk ��P.Qolrasa� �c�L��c MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $16.00 Signed By Tel No. PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 Approved By Rough -In Date Final Date Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes ( No ( ) 2. Is free from rust or deterioration Yes ( No ( ) 3. Has no foreign objects lodged within Yes No ( ) 4. Is securely supported Yes (L4 No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes ( No ( ) 6. -Has total heating BTU's of- 175 - All other BTU's (� — TOTAL BTU's If ovo Remarks List Alterations Being Done: HEATING COMPANY JU G,��L�� C✓C , Signed By Date