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City of Fridley, T ihm. BUILDING PERMIT Date:' Owner: ' Address Builder ! __— Address L CAATION OF _jLDING No. ! 9 Street � , Part of t Lot Addition or Sub-]ivisia>,g--- Corner Lot . Inside Lot Setback_ _ _ Sideyard . Sewer Elevation ____ _ Foundation Elevation DESCRIPTION OF BUILDING To , Used Front - Depth 4* Height Sq. Ft. Cu. ]± t Depth 'Hplght Sq. Ft. Cu. Ft. _ Type of Construction _ Est. cost.. 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 $..0 , _. permitis 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, maietenance; repair and moving of buildings within the city limits and this permit may be revoked at any time upon violatio f any of the provisions of said ordinances. 'e -N .of A 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 Nems. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY* MINNESOTA owner Is Address Address�w'� LOCATION OF BUILDING No. Street. Part of Lot Lot .. Block Addition or Subdivision �( Corner Lot Inside Lot Setback Side -Yard 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: &-4- * 57f 110 FrontDepth Height Sq. Ft, cue Ft Front._ ---Depth Height 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 /I- (, - Co 9 SIGNATURE IM OA-'� (Schedule of Fee Costs can be found on the Reverse Side). Application for Power Plants and Heating, Cooling, Ventilation, .Refrigeration and Air Conditioning Systems and Devices , PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL. Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations -up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ each add. 60,000 BTU ....................... Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 .... ............. . Repairs & Alterations each add. $500.00 .............. STEAM or HOT WATER SYSTEM Furnace Shell & Lines -to 400 sq. ft. EDR Steam...... . Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... Each add. 200 sq. ft. EDR Steam ...................... Each add. 320 sq. ft. EDR Hot Water .................. 8.00 $ 8.00 $ 2.00 $ €x,.00 $ 5.00 $ 2.50 $ 8.00 $ 8.00 $ 2.50 $ 2.50 $ OIL BURNER—to 3 gal, per hour 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...:..................Z x $1.50 $—/' Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fes Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ o ROUGH- OUGH FINAL- FINAL Dept. Dept. of Bldgs. Phone SU 4-7470 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. Fridley, Minn_ /�/� , 19 % Owner Kind of Building./ Used as G . To be completed about Estimated Cost, $ IT -em Old—New. Building Permit No. 's'5—e 174 Permit N DESCRIPTION OF WORK HEATING or POWER PLANTS -Steam, Hot Water, Warm Air—No Trade Name " Size No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load 2 ,JP' Kind of Fuel BURNER — Trade Name Size Capacity. (REMARKS -OVER) Sq. Ft. E.D.R BTU H.P. Signe By 4 z 2M 7-59 Business Phone No- © d a a -'JD4pe r JCoef.j Btu Infiltration No. of Lineal ft. Area No. of pane of pane tights of crack eq. ft. D•56 79 . / ,v / HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS, MINN. Weatherstrips A.S.H.V.E, Btu Construction No. Insulation' Guide Reference 19— ,%? --31AZ Glass In ows o rs I Yes No Out. Wall JInt.WaIl I Ceiling I Roof Floo Kind How. Applied Yes No Q? - ' Exp. wall Room I Length Width Height Fl. •Room I Length ✓ Width/`? a HeighV" Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area Width Height No. of Lineal ff. Area No. of pane of pane light. of crack eq. ft. Width Height Total Btu." Required f E.D.R. or sq. ins. W.A. Leader area / Fl. t . Room I I math Width /-V Height Windows and Doors--Crackage Ad Area JCoef.j Btu Infiltration No. of Lineal ft. Area No. of pane of pane tights of crack eq. ft. / ® ,0 A10 . / ,v / Net exp. wall lG Btu Zf Coef. Btu Infiltration Glass 167 ,%? --31AZ Glass Net exp. wall 119 Int. wall Exp. wall A,-15 Ceiling Floor // Net exp. wall/0 /� / Int. wall Ceiling �® /Q®7Q Q Floor 'f / Total Btu." Required f E.D.R. or sq. ins. W.A. Leader area / Fl. t . Room I I math Width /-V Height Windows and Doors--Crackage Ad Area JCoef.j Btu Infiltration Width Height No. of Lineal ft. Area No, of pane of Rang lights of crack sq. ft... r ® / / o't . / ,v Net exp. wall Coef. Btu Infiltration Coef. /r /®1 29 Infiltration Glass 167 ,%? Glass Net exp. wall 119 Int. wall Exp. wall XT Ceiling Floor // Net exp. wall AMP Int. wall Ceiling / Q Floor 'f Total Btu. Required s . E. .R. or sq. ins. W.A. Leader area F1.1W. e Room I Lengthc/'— Width Height ' Win ows a d Doors—Crackage, and Area JCoef.j Btu Infiltration Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Glass Exp. wall Net exp. wall Coef. Btu Infiltration Ceiling /r /®1 29 Floor Glass 167 Exp. wall Net exp. wall 119 Int. wall Ceiling Floor // Total Btu. / Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Kequired schM. t:. .K. or sq. ms. W.H. L.eaaer area Fl . Room ( Length / ` Width Windows End Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. 16" 075& Required sq. ft. E.D.R. or sq. iris. W.A. Leader area 49 49 Fl.) Room I Length 7 Width Windows and Doors—Crackag and Area Width Helsht No. of Lineal ft. Area No. of pane of.pane lights of crack sq. ft. Coef.1 Btu Infiltration Glass Exp. wall Net exp. wall y I ■Nfr�- g/I 9WORM Total Btu. sq. ft. E.D.R. or sq. ins. W.A. Leader area JCoef.j Btu Infiltration / - / Glass Exp. wall Net exp. wall Int. wall Ceiling /r /®1 29 Floor Kequired schM. t:. .K. or sq. ms. W.H. L.eaaer area Fl . Room ( Length / ` Width Windows End Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. 16" 075& Required sq. ft. E.D.R. or sq. iris. W.A. Leader area 49 49 Fl.) Room I Length 7 Width Windows and Doors—Crackag and Area Width Helsht No. of Lineal ft. Area No. of pane of.pane lights of crack sq. ft. Coef.1 Btu Infiltration Glass Exp. wall Net exp. wall y I ■Nfr�- g/I 9WORM Total Btu. sq. ft. E.D.R. or sq. ins. W.A. Leader area City of Fridley App cation for Plumbing and C= Pitting Permit DESCRIPTION OF WORK Number. Kind and Location of Fixtures 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) ...... Z x 2.00 $ S�Ry New Ground Run Old Bldg. x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ /• Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Dept. of Bldgs. Phone SU 4-7470 Location �' City of Fridley: The undersigned hereby makes application for a permit for the work here! 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, Owner Kind of Building 19— Used as To be completed about Estimated Cost, $ ew uilding Permit No Permit No. d Signe Business Phone No ROUGH FINAL Description ................................................$ TOTAL FEE $L' ' v az 2M 312 .. �� ? VI 3� Y o BanZ Q S� p� W <3 4 C�9G W �4a UN' Z O • F • N WATER HTR. GAS ELEC. Base 1st 2nd 3rd 4th Future Connection Openings New .Fixture, Old Openings Connected with Sewer � Cesspool El 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) ...... Z x 2.00 $ S�Ry New Ground Run Old Bldg. x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ /• Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Dept. of Bldgs. Phone SU 4-7470 Location �' City of Fridley: The undersigned hereby makes application for a permit for the work here! 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, Owner Kind of Building 19— Used as To be completed about Estimated Cost, $ ew uilding Permit No Permit No. d Signe Business Phone No ROUGH FINAL Description ................................................$ TOTAL FEE $L' ' v az 2M City of Fridley, Mnm BUH DING PERIMT Date:APRIL 253 1966 Owners WILLIAM J. PODROTZ Builder SAME Address 5884 WASHINGTON ST. N,E. Address FRIDLEY, MINNESOTA 55421 N° 8788 LOCATION OF BUILDING No. 5884 Street WASHINGTON ST. N.E. Part of Lot Lot 2 Block 2 Addition or Sub -Division LYNDALE BUILDERS, 7TH ADDITION Corner Lot Inside Lot % Setback 10, Sideyard 31 - Sewer c - Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Dei:. Garage Front 16 Depth 22 Height 10 Sq. Ft. 352 Cu.. Ft 3,520 Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Frame Est, Cost _ $1, 000 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 pli c with aft provisions of ordinances of the city of Fridley. 'Q. f) r f,, r In consideration of the payment of a fee of $-±-- 00 , permit is hereby granted to V LLL' J. EQDRUZ - 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 �gg location, construction, alteration, maintenance, repair and moving of buildings within the city limit vans permit may be revoked at any time upon violation of any of the provisions of said ordinances. ALLEN G. JENSEN Building Inspector NOTIch 'Ible psnell don not eewr the aendmedoe, IndWhoon for wMb& piumbing, gas hoong, awer or wafer. Be sure to an the Buingag hmpo far for apmft permMe for Nes Mems. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME BUILDER ADDRESS ADDRESS. LOCATION OF BUILDING NO.STREET FART OF LOT LOT BLOCK / ADDITION OR SUBDIVISION CORNER LOT INSIDE LOT SIDE -YARD SEWER ELEVATION UNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF.BUILDING To be used as; Front �� Depth Height f Sq. Ft. Cu. Ft. Front Dept � Height Sq. Ft. Cu. Ftp 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 rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE r� SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). /I- 0-11k r i APp9_0 for Power PhDts and Heath % Cooling. Veahlatio�DB D cmd Air Condltloelwg Systems and Devices, PARTIAL RATE SCHEDULE GRAV_VrY 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 $-- – - DREC*L WARM AIB Furnace Shell & Duct Work to 120,000 BTU ...... r . .. $10.00 $ each add. 60,000 BTU ............... I .... .. 3.00 = Replacement of Furnace .. .. .. .... 6.00 $ 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 FurnaceShell & 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 Riot Water 3.00 $ OIL BURNER—to 3 gal, per hour 6,00 $ _ over 3 gal. per hour—See Fee Schedule GASB (up to 199,000 BTU) over 199,000 BTU See Fee Schedule GAS PITTING FEES. 1st 3 Fixtures Additional Fixtures Gas Range to 199.000 &00 $ NO RATE 'T'OT'AL — x$ 200 $ — x .96 $ _ X$ 6.00 $ S CO h;TIOh3tIt � FAN HEATING SYSTEM See Fee Schedub TING SYSTEM ALTERATIONS & REPAIRS TOTAL. FEE ROUGH r SSU Rlr "11 i19 G L7E $ -o50, FINAL _6� - o? Dept. of Bldge. Phonic M -MM City of Fridley: The undersigned ereby makes application for a permit for the work bereir specified, agreeing to do all work in strict accordance with the City Ordinance: and ruling of the De artment of Buildings, and hereby declares that all the facts and representations s ated in this application are true and correct. Fridley. Minn_ . iS 2Z Kind of Building Used as To be completed about Estimated Cost, i Old—New. Building F ermit No. Permit No.. DESCRIPTION OF WORK EMAT1NG or POWER PIA team, Bot Water, Warm Air—No Trade Name Size No Capacity—___ _ Sq. Ft. E.D.R BTU E p Total Connected Load- bind of Fuel BURNER — Trade Na►e Size No Capacity , Sq. Ft. EM.R BTU UP. (R[MARK5-0YER) 7,7771 591 "MM -4 i e o 9 SuBjECr RMIT NO. City ®f Fridley 29512 AT THE TOP OF THE TWINS I III DIA fG DEDA BUILDING AIT COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r E PROTECTIVE E i I CITY HALL FRIDLEY 55432 "'j NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 5/20/99 10B ADDRESS 5884 Washi n ton Street .NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 2 L ndal a Builders 7th Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Geraldine Glinian 574-0689 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO .R. Miller Construction 953 Mississippi St. Fridley 55432 571-3514 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 ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (21 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with theState 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 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 $1799 $.90 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $63.15 STRUCTION OR THE PERFORMAN' OF CONSTRUCTION Fire SC $1.80 PLAN CHECK FEE TOTAL FEE rA License SC $5.Oa $70.85 SIGNATURE OFC •RACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLY,*ALIDATED THIS IS YOUR PERMIT _ 4 '� BL G INSp �%fA/ V OAtE S-GNATURE OF OWNER, iF OWNER BUILDERI IDATEI NEW[ J Effective 5/10/99 ADDN [ J CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION J� Construction Address: Legal Description: Owner Name & Address: t' na / L4. (� l , lot ! CA4 s Tel. # _S 7 �^ c 2 (2 Contractor: LI;Ll(3'(-) It _S/ 6 1L�;e`7os MN LICENSE # S— 4 Address: %<?��yl r S So SSS �� S�` ��.� Le V Tel. # .5 -3, S l� 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: '. Or Le - S'e9 d� f � a JJ -e- eConstruction ConstructionType: Estimated Cost: $ 11799 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _. $ DATE: _ 2 APPLICANT: F Tel. # CITY USE ONLY Permit Fee $ �. / S Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ _dC, $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 STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763)572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On Jan 1, 2002 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range" NO. RATE TOTAL Gas Dryer** - Back Flow Preventer Required ( )Yes () No Type Reinspection Fee $47.00/Hr $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTALFEE JOB ADDRESS S13 S y Ojl4-SVIE- 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. L Owner "7 ii c^ e L T �4_e_k '_j (ol'Z� ACL ^stn' Building Used As t>Qj- -_L \% &J '1= Estimated Cost q®G o a 0 PERMIT NO. 1306 6 PLUMBING SIGNED BY TEL N0. FAX # Approved B Rough -In Date Final Date 50 a s -b MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 $ PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON V]ENT-- VENT CONNFMOR AND _OMB ISTION AIR VERIFICATION When Mnla ing au existing ,ran _ _, 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 exinfinrl comb+ ,stinn air is sized and installed to meet the current codes and manufacturers specifications. Yes( No( ) When required to install a new comb istinn air. it will be sized and installed to meet the current codes and manufacturer's specifications. Yes( No( ) When jpntalleng a now v antina 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 ( ) Annliar nae Typ g and Sozp/Cnmmnn Vent and Vent mens mater 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 HEATING CO: Signed By. Date: Building $35.50. PLUMBING Permit No.:M Q q(—)l Inspections _ BATH SINK/LAV RESIDENTIAL APPLICATION Received By: 763-572-3604 BATHTUB CITY OF FRIDLEY c 763-502-4977 FAX _ CLOTHES WASHER _ KITCHEN SINK _ _ WATER CLOSET _ BACKFLOW PREV. ($15) EFFECTIVE 1-1-2010 _ LAUNDRY TRAY r _ FOR IRRIGATION DATE I S YOUR E-MAIL ADDRESS OTHER SITE ADDRESS IF1 t V16 -WV 1 THIS APPLICANT IS: ❑ OWNER ONTRAC OR PROPERTY NAME: OWNER/ ADDRESS- CITY STA IP TENANT PHONE: CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE STATE LICENSE EXP DATE LICENSE, BOND AND STATE BOND EXP DATE CERTIFICATE OF ADDRESS: CITY STATF�&&ZIP6r 557W INSURANCE PHONE ,710 °- FAX ,.•%iAe, PERMIT TYPE IISINGLE FAMILY 0 TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 0 NEW Er DETAILED DESCRIPTION OF WORK FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $35.50. _ BATH SINK/LAV DRAINS SHOWER WATER PIPING BATHTUB _FLOOR GAS PIPING (NEED CITY LIC) _ SWIMMING POOL _ WATER SOFTNER ($35) _ CLOTHES WASHER _ KITCHEN SINK _ _ WATER CLOSET _ BACKFLOW PREV. ($15) DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) _ FOR IRRIGATION WATER METER OTHER THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the ase o work i h req^ review and approypi of plans. SIGNATURE OF APPLICANT PRINT NAME AfielV City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977