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PRE 2010 DOCSCity ®f Fridley, Minn. BUILDING PERMIT Date: March 5, 1971 owner: Arthur J'ePsen Bider Rodney Billman Inc. Address 154.2.Trollhagen Address 151 Silver Lak.@ Road LOCATION OF BUILDING _$--5-o ;2() 1096 No. 1942 — Street _ Trol1 hagen _ Part of Lot Lot _..8, _ _ Block _. _ _4 _ Addition or Sub -Division . IZMSSbr.UCk 5 th Addn . Corner Lot _ ____ Inside Lot _._. X Setback 35Sideyard OW 80 2 fAnvrox.) Elevation _..._..�� • 9 2 ._... Elevation ..,,�...� WYE TOP OF FOOTING To be Used as: Dwelling, Front 546' Depth 25' 6"Sgdeighp 1p it EntSq. F, 1426 CtL F, Front Depth 271 Height Sq. Ft. Cu. Ft. Type of Construction Frame Est, Cost ` 32 000_ _ To be Completed 6/1171 Verification Survey. MM Hard Survace Drive. Maintain Minimum 18" and maximum 48" elevation above center line of street. Sewer Location - 87' E. of Manhole Water Location - 97.2' E. of Manhole 10.2' E. of Sewer Service In consideration of the issuance to me of a permit to constru the building described above, I agree to do the proposed work in accordance with the description above se o and incomplian th, all provisions of ordinances of the city of Fridley. '?z' Gt/ 9�Pi�rY' 9>n In consideration of the payment of a fee of $_.L2. 00 , pmt is herby granted to RodneyBBillman Inc. 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 andmoving 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. �! 7�r ��Building Inspector HANK. MUHICH NOTICE: This permit dose not cover the construction, installation for wiring, plumbing, gas heding, sewer or water. Be sure to we the Building Inspeetar for separate permits for these Items. r APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNEE 2S NAME BUILDER 'a;i� ADDRESSZa- ADDRESS V -7- &ev LOCATION OF BUILDING NO.JA STREET , / / x !��2 �- -— Y -= LOT BLOCK ADDITION OR SUBDIVISIO.%,,-,,�)," COR -NMI LOT INSIDE LOT e. SETBACK-SIDEYAP SEWER FLYTATION TOP OF FOOTING Applicant attach to this form Two Certificates of Survey of Lot and proposed buildirZ location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: ao -.n -t Sd Depth&C' Heigh ;4� t4LL-L-7--� Square feet Cubic Feet Front Depth Height, Square feet Cubic Feet Type of Construction Estimated Cos+-'&y,c� , To Be Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. 4-�:-'e< - - - ' DATE --Z /v 7 1 SIGNATURE j -3 -, - (Schedule of Fee Costs can be found on the Rever se Side.) Ile, 0 1' v --------------- SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any existing structure or building, 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 c.ontentsa 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 multiplying the ground area covered from a point six (6) inches below the floor line of the basement or the 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 ($500000) 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 $5e00e NSSSD Connection Charges based on location - Area 1 or 2e Application for Power Plants and Heating, Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone 560-3450 GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ..........................$10.00 $ � Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ a Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 $ Each add. 320 sq. ft. EDR Hot Water .................. 3.00 $ OIL BURNER—to 3 gal. per hour ........................ 6.00 $ over 3 gal. per hour --See Fee Schedule GAS BURNER (up to 199,000 BTU) ....................... 5.00 $ ae-42, over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x$ 2.00 $ Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ 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 hereir. 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'�i� To be completed about Estimated Cost, $ , �= Old New Building Permit No. Permit No. '7` 7 7` DESCRIPTION OF WORK HEATING or PO team, Hot Water,<No Trade Name -0 Size No ,.o Capacity Sq. Ft. E.D.R� �6 BTU- Total TU H P. Total Connected Loa ® Find nd of Fue BURNER — Trade Nam A—�' r i i Size No Capacity Sq. Ft. EDR �IC� BTU H.P. S ign'y lel . Vii E L.TE R H EAT I N lar CO 4637 CHICAGO AVE. By®arMtwEBOTo as Business Phone No (REMARKS—OVER) City of Fridley Application /or PhwdAn9 and Gas Fbtbg Form* Dept. of Ridge. Phone 360-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures �9 f � �kR^ IIQTT QQ FF Y d G X71 _.__ x $200 tJ fig{ z e I e WATER MTR. N 7GASELEC. Base New Fixture Old Opening .......... x $1.50 $ Catch Basin .................... x $3.25 $ 1st �' U Water Heater :Up to 99,000 BTU) .... x $3.00 $ 2nd x $3.25 $ Electric Water heater ............. z $2.00 $ e 3rd TOTAL 1st 3 Fixtures ............... __ x $200 $ o2 O a Additional Fixtures ..................—x$.76 $ 4th x $5.00 $ • iuiture Connection Openinpa nnected with s Now fixture, Old Openings Sewer Cesspool � PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ _.__ x $200 $ 0 0 Future Fixture Opening ............ x $1.50 $ New Fixture Old Opening .......... x $1.50 $ Catch Basin .................... x $3.25 $ �' U Water Heater :Up to 99,000 BTU) .... x $3.00 $ New Ground Run Old Bldg......... x $3.25 $ Electric Water heater ............. z $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ............... __ x $200 $ o2 O a Additional Fixtures ..................—x$.76 $ Gas Range to 199.000 BTU.. . x $5.00 $ REPAIRS k ALTERATIONS—Refer to Code Description .................. .............:....... .... — . .1 TOTAL FEE $ 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 ah the fact and representations stated in this application are true and correct Fridley, Minn / / Owner Kind of Building Used as To be completed about Estimated Cost, $ % OldNew. uilding Permit No. Permit No.,� Signed. Business Phone No 'j® —� ROUGH HOUSE HEATING TEST RECORD ADDRESS ��' ��Q�a+i APT. F 0� CITY S�JBU OCCUPANT OWNER ; - �� - HEAT LOSS DATE HTG. INET. GAS CO. METER BADG SOLD BY INSTALLED BY Electrical Work By Gas Line By TYPE OF HEAT GA FA "��HW STEAM SPACE TR OTHER —i,- H UNIT HTR. =�� GAS DE�1GN j� � � CONVERSION MAKE �/ .� /c MAKE OF BURNER Model % / d 172-W Model Serial�- "� kd- Max. BTU Rating INPUT fes, MAKE OF FURNACE Model _ CONTROLS THERMOSTAT x eat Plug Vent Size Valve KIND OF LINER IZE NONE LimitDraft Hood Regularor Limit Setting Filters Size Number Fan Setting Chimney Location Inside Outside Pilot Type Chimney Construction Pilot Make Pilot Model Smoke Bomb Wiring e Pilot Timing-� Draft f le, Test Tag L.W. Cut Off Door Pressure —R Lighting Inst. Pressures Perce C ' ate Tested 00 Input CFH P'02 P-02 Wmpany Testing Stack Temp. 5 Percent CO 0 Name of Tester Form 235 r c �✓° � 3 i s s r � J » a 1 CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 5f72-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning - All Sizes Rate TOTAL $ 20.00 $ ZO- 00 $10.00 $_L® R _00 $10.00 $ $ 10.00 $ $ 10.00 $ All Others/Repairs & Alterations (LIST ON BACK 1 % of Value of Appliance g Pq' Commercial/industrial 5� 1 % of Value of Appliance or Work $ State Surcharge $ .50 TOTAL FEE $,5Z MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. JOB ADDRESS 15510 Z -7A 4- A ff6- E,^l Ag- Thundersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and ruling of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. q-17 ,1m- OWNER %_ VL D/ d 4/. BUILDING USED AS ESTIMATED COST02-000 , o PERMIT NO. / / 41- 0.2 DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name I-e-wox ®'. /SE Size No. OY - 8'0 BTU S®i 000 HP EDR Fuel iy4T Total Connected Load Burner Trade Name Size No. BTU HP: EDR HEATING COMPANY �Q'��'1"0� �'d� �7 C® �11 Signed By Approved B Rough -In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION O REPLACEMENT FURNACE I CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 6. Has total heating BTU's of All other BTU's TOTAL BTU's Remarks List Alterations Bein Done: HEATING COMPANY S®1 e�h )t a%61 Signed By Date 1. Has been carefully examined Yes ( No ( ) 2. Is free from rust or deterioration Yes (+r No ( ) 3. Has no foreign objects lodged within Yes (✓� No ( ) 4. Is securely supported Yes (Lill' No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes ( ) No ( ) 6. Has total heating BTU's of All other BTU's TOTAL BTU's Remarks List Alterations Bein Done: HEATING COMPANY S®1 e�h )t a%61 Signed By Date HOUSE 11ZATINC TL•'CT RECORD ADDR=S�;��a i•o h� c�.� r APT. FLOOR _ MY SUBURB_ ' OCCUPANT of oil(7s— OWNER MT LOSS DATE riTC. INST. %% %_ G INSTALLED IIY SOLD 3TY- work By g Gi Cas Linc IIy ciacc:ical. ,///rr TYPE Or tIL'AT: CA FA11W STFJ%M S�'ACE ItTR.UNIT 11TR.� aTIiLIz _.. - • CAS DESiCK , CONVERSION ' I•;i.i:I: I vim..-�r M KZ OF. BURNER ---.. Model Scrial�CJgyC.��O Max. BTU Ratint; . INPUT 9® 00 tut:z: OI FURt1ACE 140acl CONTROLS TttERttO:+i•� $t "�ac� Heat Plug Vent Si:.c, 2 LY MIND OF LX ItER d=s� SIZL _HONIs _,� ValveG� ' L:.utit 67 Draft hood Rcrulator ______ jor2 Limit Setting BOO ® Filtere Size �l�C . Kumiacr Fan Setting' % /� ®� Chimney Location: 'Insidc_Outside ilot Type tu ' Po Chimney Construction . Pilot Make ' a Pilot Model Smoke Bomb Wiring_ i'ila t iiminR .Se cry. S Draft Tea t TaI; L.N. Cut Off Door Preaaurc Lighting I,rtst.__ Data Tan Tea ted C Prcasure9'� wc- Percent COz 0. Input CFiI Percent O`CT ?O Company Tcatinr'%�L p , . �-`- Name, of Taste �� ✓1�� ark �,r--_ Stack Tamp. Percent COC0A/00 •�_ I SUBJECT PERMIT NO. City of Fridley 4 0=9 8 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. ______ COMMUNITY DEVELOPMENT DIV. L Re r PROTECTIVE INSPECTION SEC ®®®® CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 4/23/9 JOB ADDRESS 1542 Trollhagen Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. g 4 1 Innsbruck 5 Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Carl Ohliger 1542 Trollhagen Dr NE 572-3892 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. D & D Home Improvement Inc 7401 Central Ave NE, Fridley, MN 55432 784-7543 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 4840 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Reroof House (19 Sq) 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 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 $1,520 $.76 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 PROVISION F ANY OTHER STATE OR LOCAL LAW REGULATING CON. $51.25 Fire SC $1.52 STRUCTIO OR THE PERFO ANCE OF CONSTRUCTIO��11570 PLAN CHECK FEE T L FEE Lice se SCA$5.00YI$58.53 S GNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI N PR P LY VA ID D THIS I�SOARjjERMI'� i 41LOG )NS DATE SIGNATURE OF OWNER of OWNER BUILDER) IDATEt NEW [ ] $ Effective 3/1/96 ADDN [ ] ALTER [ ] CITY OF FRIDLEY ,I. SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �f 9z -_:z Building Permit Application $ ConstructionAddress:_ /�_�%®�� Legal Description: $ oo Owner Name & Address: Tel. # 5.3� Contractor: D & D Home Improvement, Inc MN LICENSE# 4840 Address: 7401 Central Avenue NE, Fridley, MN 55432 Tel. # 784-7543 $ 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: :orner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks _ Cype of Construction: �Pi9 ,'Pr Estimated Cost: $ Ate— 1pprox. Completion Date: /— If (Cost on Back) )riveway Curb Cut Width Needed: Ft. t = Ft x $ _ $ )ATE: 4j�7 APPLICANT: Ot, 4a&9Tel. # 784-7543 'ermit Fee $ �l ire Surcharge ;tate Surcharge $ ;AC Charge $ Icense Surcharge $ oo )riveway Escrow $ ?rosion Control $ 'ark Fee $ ;ewer Main Charge $ TOTAL ;TIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $900 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 [ ] ' City of Fridley 3 0 2sue.iEtr ePR10 AT THE TOP OF THE TWINS BUILDING PERMIT r NO. COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. / � NU M0Eit REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 9/13/99 JOB ADDRESS 1542 Trollhagen Drive NE 1 LEGAL LOT NO. BLOCKTRACT 11 OR ADDITION SEE ATTACHED DESCR. 8 4 Innsbruck 5th Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Carl Ohlinger 572-3892 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO New Haven Constr. 4208 83rd Ave N Brooklyn Park 55443 566-5225 20077950 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW 0 ADDITION O ALTERATION MR REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage 2Tear-off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the 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 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 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2098 $1.05 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER ST TE OR OCAL LAW REGULATING CON- CON - STRUCTION OR THE PERF RM CE OF 0, $83.25 Fire SC $2.10 -- - �� PLAN CHECK FEE Lic S 5 0 // TOTA F E .40 SIGNATUR OF CONTRACTOR OIA AUTHO IZED AGENT .DATE. MEN PRO VALIDAT HIS IS Y Bt G .NSP ZF < <E S.GNATURE OF OWNEROF OWNER BUILDER. IDATEI MAY -10-1999 10:06 NEW[ ] ADDN [ ] ALTER � 1 70 6125667103 P.01/02 FRS'! CITY aF Fl2I I3I EY wective 51109 CM 4F nMLBY . 0 SINGLF FAMII,Y AND DUPLA � R-2 c) BUiLj►'�"a► PERIaII'T APPLt Co m: pdtjess. dJ � � Attach to this appy a Cestifwaw of Survey of the lot, with the proms coffitrtction drawn on it co scale. DESCRwnON OF UAFROVENt M Hew Sit. Fx. G AREA: W FL GARAGE AREA . I ------ "'.Width�"_ _ 5q. Ft. DFM ARTA. ----- Width 73gt/�d o'er» !!'' Consnuation Type: �C' EV/� Coat: + Fc Driveway Cwrb Gut Ft. Width Needed' 6 ! t x $ � $ T.J. Ll DATEAPPLICANT: STIPUt1ATl0NS: Fee Schedule on Reverie Side .001 of Perrah valuation (1/10th%) $.501$1.000 Vahm*m $1050 per SAC Unit $5.00 (ate Lmosed Reside" yrs) Ah. -A° or Alt. "B" Above $450170 Conservation Plan Review Fee Deterwi ned by B*iueer Agreemmmt NecesM [ j Ncn Necessuy [ ] Perandt Fee f Fire Scut"$ $ State SumbsTge SAC Charge Lkmm Sur<:harge $ Driveway Escrow $ Erten Comd $ park Fee $ Sewer Main (e $ 2L�.D TOTAL .. STIPUt1ATl0NS: Fee Schedule on Reverie Side .001 of Perrah valuation (1/10th%) $.501$1.000 Vahm*m $1050 per SAC Unit $5.00 (ate Lmosed Reside" yrs) Ah. -A° or Alt. "B" Above $450170 Conservation Plan Review Fee Deterwi ned by B*iueer Agreemmmt NecesM [ j Ncn Necessuy [ ] CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-5711287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning -AII Sizes All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater y Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fee Total $35.00 $ 35,00 $10.00 $ JOB ADDRESS I tz® -91&A/ D it AL Oki iv Building Used As ESTIMATED COST A 2-�bo "' PERMIT NO $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) arm Air Trade Name (a r+�-Vx Size No. 6 S/ M?'180fo $25.00 $ BTU 24. 00Z HP EDR Fuel Total Connected Load S-7 boo 6T14 $ Burner Trade Name BTU HP Size No. _ EDR The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/IndustriaVInstitutional and representations t. ions stated in this application are true and correct State Surcharge $ HEATING COti _ I ° � AR M #64" IVP AA ego/ Jn t'^o` TOTAL FEE $ `� Signed 94 'P Tel # -763-.�3k-t*&) REINSPECTION FEE $50.00/HOUR FAX # '763 -53b -Q7-6_ Date IZ310� *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When 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 V 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 (41 No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No (Vf 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 (VK 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 (L/ No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type & BTU Input :a; ,x:oo Fan Assisted or at Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances �_ Total Btu Input '7o,®aa�o Common Vent Type41 L' Vent Height /� Diameter inches Appliance #1 Vent Connector Height ft Length __�t_ft Diameter n Type �f N Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) /4 614.t j S V P J' e t4/ P �% HEATING CO: A A&M & W0l+48 (-J-1 Signed By: !�''� Date: 23 Z®57-