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PRE 2010 DOCSCITY OF FRIDLEY " APPLICATION FOR PLIJMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLU%3ING FIXTURE RATES: NO. L TOTAL ..u=!;e-. Fixtures •n l U $ ;29, 0 0 x' Q $2.00 Water ::cam Fixture, Old Opening x $2.00 $ I x �'fl $ 0 � I � r, d' � x Heater $ Water Scf terser r. $7.00 I Nsw G=o -=d Old Building x $5.00 $ •1 x $5.00 $ F� sM, q� -� •O A--ditio nal F✓•.tures x $1.00 $ Gas Rzange to 199,000 BTU x $10.00 $ REPAIRS $ ALTEPaTIONS U � ___st $1C0.GO � y $ Iia w ' v; $$2.00 U �' � C: � .. t7 O TOTAL FEE V);: $ F:..Z .: ($10.00) � i�-•� l I I� I I!' 4th (?) = Fa -:,.re Coanection G?ening Co:nected with Sewer (*) _ New _ inure, 01d Cj,ening Water PARTIAL RATE SCHEDULE PLU%3ING FIXTURE RATES: NO. RATE TOTAL ..u=!;e-. Fixtures , x $3.00 $ ;29, 0 0 suture xture Cpening x $2.00 $ ::cam Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ Water .'.cater - to 99,COO BTJ x $5.00 $ �() 1C^, r,0 BiJ to 199,000 BTU x $10.00 $ Water Scf terser r. $7.00 $ Nsw G=o -=d Old Building x $5.00 $ Electric ::arcs Heater x $5.00 $ GAS FITTING FEES: lst 3 fixtures $3.00 $ A--ditio nal F✓•.tures x $1.00 $ Gas Rzange to 199,000 BTU x $10.00 $ REPAIRS $ ALTEPaTIONS ___st $1C0.GO $5.00 $ each add. $100.00 or fraction $$2.00 S State Surcharge $ .50 TOTAL FEE $ F:..Z ($10.00) Job Address Departmont 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 Buildi:igs, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, OWNER A—�— KIND OF BUILDING :J4(y`A,Q- USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW B ILDING PERXIT NO. ROUGH INSP. Date FINAL INSP. f/ " -5 " % Date PERMIT NO. • —6� I Company C Lj Signed By Tel. No. rl APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUXBING PERMIT IS $7.50 .t) -L3 Ye, f CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Job Address O S-� v ea r i c, �� r✓ Furnace Shell & Duct Work $12.00 $ Replacement of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $ Department of Buildings Repairs & Alterations each add. $500.00 4.00 $ City of Fridley Tel. #571-3450 MECHANICAL WARM AIR: The undersigned hereby makes application for a permit for the work herein Furnace Shell & Duct Work to 100,000 BTU $12.00 $ t' v a specified agreeing to do all work in strict accordance with the City Cedes each add. 50,000 BTU 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the Replacement of Furnace 7.00 $ facts and representations stated in this application true and correct. Repairs & Alterations -up to $500.00 /are G' 7 Repairs & Alterations each add. $500.00 4.00 $ Fridley, Minn. -� / . 19 — l`' STEAM OR HOT WATER SYSTEM: OWNER Boiler & Lines up to 100,000 BTU $12.00 $ KIND OF BUILDING �- ✓ c �, -cam each addn. 50,000 BTU 4.00 $ �i Boiler only up to 100,000 BTU 7.00 $ USED AS wsr C each addn. 50,000 BTU 6.00 $ e � �/ �' TO BE COMPLETED ABOUT ( OIL BURNER- to 3 gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $ ESTIMATED COST 'GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $.00 OLD - E�)BUILDING PERMIT NO. PERMIT NO, (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: 1st 3 Fixtures �_ x $ 3.00 $ 3 DESCRIPTION OF FURNACE/BURNER Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x , $10700- $ BEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. AIR CONDITIONING 4`"' J " v '' -7-0-J $ Trade Name j�,-.� Size No. ��, u , ✓= - FAN HEATING SYSTEMS See Fee Schedule $ VENTILATING SYSTEMS Capacity 5q. Ft. EDR / BTU HP ALTERATIONS $ REPAIRS3 $ State Surcharge $ .50 Total Connected Load ' c Kind of Fuel c TOTAL FEE BURNER - Trade Name Size No. ROUGH INSP. REINSPECTION FEE Capacity Sq. Ft. EDR BTU HP Date ($10.00) FINAL INSP. % - - 7,1' Date APPROVAL FOR PERMIT /moo MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE Company Signed By Tel. No.. �..✓ H-vip's by HEAT LOSS CALCULATIONS gim 5��w&c4 _57// 3 ,' Y ICONDITIONING CO. MINNEAPOLIS, Weatherstrips A.S.H.V.E. Guide Reference 19 Construction No. Insulation Windows Doors Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Yes -No Yes -No FI. e� Room I Length Al Width Height--y—dFl.ZmDb Room Length Jo Width /0 Height 0 `l II Windows and Doors-Crackage and Area Area Jv Windows nd Doors-Crackage and Area Area sq. ft. Width Height No. of No. of pa a of p e lights Lineal ft. of crack Width Height No. of Lineal ft. NO' of parxe of pgne lights of crack C4 41 jCoefj Btu Coefj Btu Infiltration .SA . '70 X -1 1 q 0J? Infiltration s- -2.2 316 L Glass�°-7� yt5Exp. Glass 01'0- wall '3 Exp. wall Net exp. wall ®A Net exp. wall a% 720 - Int. wall Int. wall - Ceiling Ceiling C) /0 --300 - Floor & Floor - Total Btu. Total Btu. 12 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI. (rtne.k5 doom Length /Lj Width Height FI. ®�J Room Length Width �� Height k Windows and Doors-Crackage and Area VJindo s and Doors-Crackage and Area l No Width of ane Height of®®pane No. of Lineal ft. lights of crack Area sq. ft. W,dth He,ght No. of No.of of pane lights Lineal ft. of crack Area sq. ft. pane Coef B to jCoefj Btu Infiltration j/� -7 Infiltration "7 S;z 3` Glass`� Glass -.5 "z 00 Exp. wall 1&a ,0 Exp. wall Net exp. wal l f 2 Net exp. wal I Int. wall - __..Int. wall Ceiling Ceiling Yi) Floor U 0 " ® Floor Total Btu. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI. 8-'n Room Length ®'7 Width •Cj Height FI. r& •-f , Room Length �Co Width j Height Windows and Doors-Crackage and Area Windows aA Doors-Crackage and Area No Width Height No. of Lineal ft. of ane of pane lights of crack Area sq. ft. %'V.0th N°]' °f pane Height No. t of oa lights Lineal of crack k Area sq. ft. 7 Coef Btu jCoef Btu Infiltration Infiltration 4 17 3 G Glass Glass 3 /"0 Exp. wall Exp. wall j Net exp. wall C) x - Net exp. wall im wall Int. wall Ceiling Ceiling4 Floor _ 13 Floor Total Btu. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required s 1. ft. E.D.P. or sq. ins. W.A. Leader area M SUBJECT P NO. City of Fridley ® 139 AT THE TOP OF THE TWINS BUILDING PERMIT CEIPT No. ` COMMUNITY DEVELOPMENT DIV. L PROTECTIVE INSPECTION SEC.`S CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY ---- �`� 612-560-3450 910-F15 3/1/77 JOB ADDRESS 15562 West Bavarian Court 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION -�y SEE ATTACHED DESCR. 19 Z Innsbruck N. T. H. PLA-- ` d SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Darrel Farr Dev. Corp. 7286 72nd Lane N. 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING O 0w4/w&LCS& 7 CLASS OF WORK Ek NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK 9 CHANGE OF USE FROM TO STIPULATIONS Provide Truss design copy to City by March 10, 1977 Provide Easrgy calculations to City by March 10, 1977 TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. frame 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 FORA PERIOD OF 120 DAYS AT R-3 1248 24,960 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. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $ 37, 240.00 18.62 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITFEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CO STRUCTION. $ 118.32 375.00 4VAa-.64*8 PLAN CHECK FEE TOTALfEE $ 541.52 SIGNATURE OFCONTRACTOR OR AUTHORIZED AGENT (D E)W J&LY VALIDATED THIS IS YOU PE IT BLDG INSP DATE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) Alli,uCATJON FO1Z R1-*.S1l)J:NTIA1,, ALTEIZATIONJI OR ADDITION BUILDING 1'1:1ZIMIT CITY OF FRID1.1:Y, 1.11\:\`}.Sr)°IA OC:rNL'Y.' S NAPSE : Aii►r1f�, PeU. IOW BUILDi?Tt : SaA%C - ADDIRTE'SS :� �%. ?� L Lahr Alosefh ADDRESS: /,s . �7�a. •� -� � NO .r , STREET: Adm ioh LOT: BLOCK ADDITION:_ I/,,Tw CORXER LOT: INSIDE LOT : V*100, SETBACK:' SIDEYARD : Applicant attach to this form Tt7o Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESC�R(IIPTION OF BUILDING To .Be Used As: V Q/2.4 W-4- -�-�` o1js4L Front: Depth: Height Square Feet: 002- 1� Cubic Feet: a ® Front: o.2 / Depth: Height Square Feet; Cubic Feet:_ ,to Type of Construction: Wo 0 d Entree, Estimated Cost: $ To Be Completed:044 /. Z!922 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: / 00f% SIGNATURE: (See Reverse Side For `Additional Information.' lu r (711� lu r I I4a-r--Z-L� 0) 2. ic'.72.9- 02 2 0 10 'leg - 6-- 4>2 ic'.72.9- 02 2 0 10 'leg - 6-- SUBJECT "FTE R M I T NO. City of Fridley4 (����� 9 7 6 AT THE TOP OF THE TWINS BUILDING P E R M I T Ir? RECEIPT NO. � • COMMUNITY DEVELOPMENT DIV. ��------. r PROTECTIVE INSPECTION SEC 1� 9 NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 4/17/97 JOB ADDRESS 1562 West Bavarian Court NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 19 1 Innsbruck North Townhouse Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Carol Engler 1562 West Bavarian Court NE 574-0776 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Northland Siding & Insulation 2158 Main St NW, Coon Rapids MN 757-7170 4158 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 Cj REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside, Soffit/Fascia, Basement Window, Patio Door, Living Room Window 9 CHANGE OF USE FROM TO STIPULATIONS Install building wrap and have inspection of same unless manufacturer's specifications state it is not required. Sleeping area replacement windows must meet the State Egress Code. Ventilation in soffits,, must meet 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 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 $12,700 $6.35 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $199.75 Fire SC $12.70 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE m z Licenae SC 5.00 $223.80 SIGNATUTRACTOA OR AUTHORIZED AGENT (DATE) H N P LY VALI ATED THIS IS YO)OR PERMIT n(l 4 i s y/ S,GNATURE OF OWNER aF OWNER BUILDER) (DATEI LDG INSP naTE NEW [ ] Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 jh' f7l 9 BUILDING PERMIT APPLICATION ConstructionAddress: 15-(c) a UJ, 6A V A -k[ fl-k� (IT Legal Description: Owner Name '& Address:m E� Tel. # — ®i7 lm Contractor: Orl i W- 40 0 S i n r O 6 -Z MN LICENSE # y I r Address: ,;� I H A-ty \Sy k)O C o &.) P -PrP t P S Tel. # 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. R. GARAGE AREA: Length Width Height Sq. R. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: 5 16 i o it ppb=FIT °* A Estimated.Cost: $ RCk)L,,3o0:OATV0 Do %J'0L' (CxOM Lo1,3o°`-0 (Fee Schedule on Back) , Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 1411, I q j APPLICANT: ` Tel. # 7 7/ 7 �7 CITY USE ONLY Permit Fee $ r `Z Fee Schedule on Reverse Side Fire Surcharge $ /d. 70 .001 of Permit Valuation (1/10th%) State. Surcharge $ 62, $.50/$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge $ 5, 6 $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 j ] TOTAL $ O; ,� 3, U STIPULATIONS: SUBJECT City of Fridley 30508=,.-8 AT THE TOP OF THE TWINS BUILDING PERMIT r ` . • _____COMMUNITY DEVELOPMENT DIV. � w - r � PROTECTIVE INSPECTION SEC. S Q ' 1 CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910415 11/15/99 JOB ADDRES 15 2 es 670t Bavarian Court NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 19 1 Innsbruck North Townhouse Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Giertsen Co. 860 Decatur Ave N Golden Valley 55427 546-1300 1796 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Townhouse 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION NN REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof townhome and garage (40 S Tear-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 I HEREBY CERTIFY THAT I 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 $3496 $1.75 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $97.25 Fl SC $3.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FE T TAL FEE Lice S $5. 107.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI HE P Y VA ED THIS IS Y U PERaZ_ SIGNATURE OF OWNERoF OWNER BUILOERi (BATE, 8 G INS gAtE NEW ADDN ALTER Effective 5/10/99 J [ ] CITY OF FRIDLEY [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: .,' (,L,/ Z, —6J° 6---. 9 Legal Description: Owner Name & Address: Tel. # Contractor: MN LICENSE # / We Address: S-54" Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EWROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: �`�-civ �� � �'us �. � ��� � v S0, Construction Type: _ �" Estimated Cost: $� 29% Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: //—A--� APPLICANT: �, Tel. # 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 $ $1050 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 $ S STIPULATIONS: CITY OF FRIDLEY BUILDING INSPECTION 3431 University Ave NE -ridley, MN 55432 r63-572-3604 FAX 763-571-:1.287 RATE SCHEDULE lesidential =urnace Shell and Duct Work, Burner & ilso Replacement Fumace I as Piping (New Furnace, Fireplace, Insert) Sas Range I as Dryer "Air Conditioning -All Sizes %II 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 mprovement whichever is greater Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Eat Total JOB ADDRESS 15 a 1'6!• C.t-tLtLA' 21 &0%a--6 Owner. v $35.00 $ ,�q?uilding Used As��I $10.00 $ � � ESTIMATED COST � , `� ` ' PERMIT NO $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating Units % Circle One (Steam) (Hot Wafter)arm AI Trade Name,S,?QL-aj0 fD Size No. $25.00 $ BTU q ��9t�% HP EDR Fuel A1(Liw.r&-P eq -AA. Total Connected Load $ Burner Trade Name Size No. BTU HP EDR 'ommercisI/industrieI/InstftLd onaI 1.25°! of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE 3EINSPECTION FEE $50.00/HOUR 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. kAir Conditioners can not be placed In side yard without written approval °rom adjoining property owner - copy to City /- I iii f� ;"Ti FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Fle Tel # 3 19 Z 15 FAX # LI -7 "7q `q %i'tO Date % I —9q 75 Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITv COMMON VENT. VENT CONNECTOR AN® 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 &} 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 x 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 ()Q No ( ) The existing combustion air is sized and installed to meet the current codes Yes( No and manufacturer's specifications. 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 now 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 -LAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes (,I 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 SizefCommon Vent and Vent Connector Information Appliance #1 Type E .C:9= BTU Input Dodo Fan Assisted or Nates. Appliance #2 Type Wt2 BTU Input o ovo Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Z Total Btu Input l U jg Common dent Type Z- Vim"}' VentHeight_ 2-5r Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type C' Appliance #2 Vent Connector Height ft Length �ft Diameter_-? in Type C Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: r Date: ®'