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PRE 2010 DOCSELI MEMORANDUM TO: Michele McPherson, Planning Assistant PW94-189 FROM: Scott Erickson, Assistant Public Works DirectorA DATE: June 9, 1994 SUBJECT: Drainage, Grading and Utility Review for the Harstad Development on Hillwind Road 1. A Storm Pond Maintenance Agreement will need to be recorded with the property. 2. A hold harmless agreement will be necessary for any improvements on sewer easements. 3. Provide a plan and profile for the City maintained portion of the sanitary sewer main. The utility lines shall be designed according to City of Fridley standards. 4. Open trenching in Hillwind Road will not be allowed. 5. How is water service to be provided to the buildings located on Hillwind Road? 6. A shared driveway, operation, maintenance and repair agreement will be required if the property to the southwest is to use the driveway. 7. Install silt fence at the toe of all exposed slopes. 8. A rocked entry point will need to be installed to access onto and off of the site during construction. Provide a detail on the plan. 9. The City of Fridley requires detention ponds to be used for storm ponding. The proposed design includes dead storage. Please discuss this with the Rice Creek Watershed District as this is in conflict with our design requirements. 10. Address all comments previously noted. 11. Modify the 15 -in. RCP pond inlet so it directs the flow of water toward the pond outlet. Install rip - rap at the end of the 15 -in. RCP. 12. Provide two complete sets of calculations and drawings. 13. The sanitary services should be installed to provide only one main connection to the City system. SE:cz PaIks streets Maintenance MEMORANDUM TO: Scott Hickok, Planning Coordinator PW94-258 Michele McPherson, Planning Assistant s FROM: Scott Erickson, Assistant Public Works Director DATE: July 27, 1994 SUBJECT: Drainage, Grading and Utility Review for the Harstad Development on Hillwind Road (No. 3) 1. Clearly show the water and sewer service locations on Polk Street and Hillwind Road. Clearly note size and location of existing mains. 2. Install concrete cross gutters and aprons at all driveway and street entrances. 3. Provide documentation for the roadway easement off of Polk Street. 4. Clearly address all previous comments. 5. Address storm water flow from units on Hillwind and Polk. 6. Provide a cul-de-sac at end of Polk Street. 7. Correct the easement line - utility easement near Fillmore. Clearly note the boundaries of the easement. Please provide a written narrative on how each item has been addressed. SE:cz cc: Todd Mattke, Mattke Engineering, Inc. 7671 Central Avenue NE, Fridley Community Development Department PLANNING DIVISION City of Fridley k TO: Files of Harstad Townhomes FROM: Michele McPherson, Planning Assistant DATE: August 19, 1994 SUBJECT: Building Permit Issuance The Fridley City Council approved the attached site plan at its August 15, 1994 meeting. In order for the development to proceed, a rezoning was approved for the east half of the project site. At the writing of this memo, the second reading of - the rezoning. ordinance has not been conducted. The second reading. and subsequent publication -will not occur until building permits have been issued for the building adjacent to Fillmore Street: Building permits•a�re to be issued forbuilding. plans as .ndicated on the enclosed'site plan. An increase in the number of units will require review and approval by� the Fridley. City.' Council. Any, decrease in density will be permitted, without review, by the City Council. Stipulated as a condition of the plat is that the petitioner is to petition for construction of a cul-de-sac at the end o.f--Polk Street when building permits are applied for for 5531 and 5533 Polk Street. MM: ch M-94-484 f MGM ANT UMUT= smm ON AUS PLM � M'�t X111.1 YW .y, pwlleq�y w e rr w.., hr.wr..,l ARe a LY APPRMAX N WMH AND a s ...+a.1 r «. LOCAADN AND um or %WMED B1 Rawer P..1.A..A 60-- 1. M • IY11 ..1 t..w ..c.r. D.w Art CONTRACWR. 01M UYUM V4 0 YAw.M. -A. - S a 30M 1 nN by by AMT MW. AND R STALL BE 1NE b iYO.M • a ri w �r. �� M Y1.a1q Caw.lwb RESPW9®nY fle-w r.ww�v.iwne 7.�1.t:1.� nib.7 ww Bn..AIN b n.outY6 Planning Division Official Copy Y� / 6( (. rYWU.V.GiL, tA.r A. A•..r R.nl - n 1A1-.ou TTKE ENGINEERING, INC. 7671 Caird Av . NE . Hillwind Townhomes `lW"Y MN &%32 pbre. Utilit Plan (612) 783-0300 `"0° A1°°p m T+ a ".• r-yD «4 6 .1 4 SUBJECT City of Fridley 77,� 0 8 AT THE TOP OF THE TWINS BUILDING PERMIT 'r' REC COMMUNITY DEVELOPMENT DIV v r ; PROTECTIVE INSPECTION SEC NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 612-571-3450 910415 11/18/94 JOB ADDRESS 5545 West Fillmore Circle NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 Hillwind Townhomes SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Twin City Townhomes 1250 East Moore Lake Dr NE Fridley 55432 572-8872 826 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 Townhouse 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE A 8 DESCRIBE WORK Construct a 27' x 32' Townhouse and a 17'6" x 18' Garage 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Paid Park Fee of $750.00 Variances approved on 8/15/94 to reduce the front yard setback from 35' to 30'; reduce setback from 25' to 18.9' for front patios; and to increase the width of the driveways from 32' to 361. SEPARATE PERMITS REQUIRED FOR WIRING, HEATING, PLUIMBING AND SIGNSN 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 $91,001.03 $45.50 WITH W HER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES O PRESUME TO IVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE Fire SC PROVI I SOF ANY O ER ATE OR LOCAL LAW REGULATING oN- $599.00 $800.00 STR ION OR THE P FO ANC CONST CTION PLAN CHECK FEE TOTAL FEE License SC $5.00 $1,540.50 + PF SIGNATURE OF ONT ACTOR OR AUTHORIZED AGE NT (D TEI WHEN PROPER VALIDATED THIS IS YOUR PERMIT BL G INSP BATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI .1 4 100 ADDN [ J CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Applicatign ConstructionAddressl Legal Description: Effective 1/1/94 -*,1-7A Owner Name & Address: 1(c)1A) T7/ Tel. # Contractor: S (i-Gn /1J MN LICENSE # ��lo Address: L / Ak i 216Lb,,> 61Z1,362 Tel. #. �/� -966 a Attach to this application, a Certificate of Survey, of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT �,jlrl .,jASe 613 /s LIVING AREA: Length Width Height X99 S -%.1 Ft. GARAGE AREA: Length / T L Width /0 Height Sq. Ft. 31 S DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Lid 0 f) r� q -a) �, Estimated Cost: $ _ Approx. Completion Date: (Cost 'on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: JU 4 P� APPLICANT: Tel. # 59 - 632 Permit Fee $ �'%�. �0 Fee Scheduleon Reverse Side Fire Surcharge $ ql • 00 :.601 of Permit Valuation (1/10th%) State Surcharge $ S^. SCS. .,$.50/$1,000 Valuation SAC Charge 15CC $ $800 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 $ f7, 0 - DO Fee Determined by Engineering Sewer Main Charge $ - 0 - Agreement Necessary [ ] Not Necessary NT TOTAL ` $ . m L JD L ' STIPULATIONS: I BUILDING INSPECTION DIVISION BUILING PERMIT REVIEW CHECKLIST AND ROUTE SHEET , 4. FILE DATE f° ��' �Aj / /— DUE , ,# -ae--DUE DATE LA,1,J® /60j,�J4 ' ADDRESS�� COMPANY NAME ' ,a.1h&L*L (,Ie, ' e (f Frey" { }PLANNING � :0Barbara Davy Scott Hicko Michele McPhers ( ] Performance Bond Amount: .� ( vj Park Fee Amount: Ao, 0TV` [ ] Setbacks i [ ] Parking [ ] Landscaping [ ] Wetlands [ ] Compliance w/ Council Stipulations :NGINEERIN fohn FloraScott Erickson ] Grading'/Drainage Plan ] Conservation/Erosion Control Plan ] Sewer Laterals Required ] Water Laterals Required vj"Land Alteration Permit Issued ✓] Pond Maintenance Agreement ] Rice Creek WSD Permit Required ] Easments Required ] Inspections {LEON MADSEN oil { v4 BILL CHAMPA 'JOHN PALACIO DICK LARSON { } MARY HINTZ STWVLATIONS: P1 1 u�Fil �• �� Clyde Moravetz Fee: zIS® Fee: // Fee: )) / [ ] Obtained Al jearly oft 0010 alt � (If it �v7 KJ. Lvf- Uo-e- i NEW ADDN ] CITY OF FRIDLEY ' ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application 6�5'.s -3, 55-ys, s z 7, s'Sz3 W, F; 11,woac �. Construction Address: SI -N6,5 -S 2572 571 Legal Description: Owner Name & Address: �Gzl U� ` �c e-5 7 Contractor:—,,;v z MN LIC] Address: I LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Corner Lot [ ] Inside Lot Type of Construction: �k Approx. Completion Date: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Length Length 17 ° t® Length Driveway Curb Ct Wdth Needed: �Ft. DATE: /0 /� �'qc//APPLICANT: -2 Permit Fee $molt Fire Surcharge $ 7M, 0 t State Surcharge $ 77 SAC Charge 6 $° License Surcharge $ Driveway Escrow $ Erosion Control $ (2 0 Park Fee 00 Sewer Main Charge $ / TOTAL STIPULATIONS: Effective 1/ 1/94 . 15772- iM7Z HeigltA Sq. Ft. l �3°7r5 e Height Sq. Ft.9� d a -S316.9® 'Igt/Ground Sq. Ft. �' .� 6 �'!• � � X653 � Side Yard Setbacks Estimated Cost: $ - o� d•q —Tel. # CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1 / 10th %) $.50/$1,000 Valuation $800 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering vu Agreement Necessary ( ] Not Necessary Pj 6 6431 University Ave NE Fridley, MN 55432 572-3604 Stories Basement Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR F Wash I r uto. .&..... Ga s ... . RangeeTraY Washer a NO. RATE TOTAL $7.0010(3() $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.0.0 $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance State Surcharge TOTAL FEE $ .50 $-` 6 Water Heater Gas Elec JOB ADDRESS15T�I�rr) VV .41 C 9yi 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. )vl , 19915 Owner U\! ),A C , j 1 Lot,'VA) Building Used Asl Vy "e1/v)-pu Estimated Cost PERMIT NO. PLUMBING COMPANY SIGNED BY N1��`�" FJ� TEL NO. \J Approved y Rough—In Date Final Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE 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 Gas Dryer Back Flow Preventer Required ( )Yes () No Type $7.0010(3() $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.0.0 $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance State Surcharge TOTAL FEE $ .50 $-` 6 Water Heater Gas Elec JOB ADDRESS15T�I�rr) VV .41 C 9yi 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. )vl , 19915 Owner U\! ),A C , j 1 Lot,'VA) Building Used Asl Vy "e1/v)-pu Estimated Cost PERMIT NO. PLUMBING COMPANY SIGNED BY N1��`�" FJ� TEL NO. \J Approved y Rough—In Date Final Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE CITY OF FRIDLEY INSPECTION DIV, Effective On January 1, 1993 0431 UniversV Ave NE Fridley, MN 55432 APPUCATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS RATE SCHEDIJLE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner – rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $20. 00 $ 1^� moo_ representations stated in this application are true and correct. _ ,199 Gas Piping (Needed with new furnace) $10.00 $ tO✓ /y ~�- OWNER 1 kAJ sv�', Gas Range $ 10'00 $ BUILDING USED AS , 2 `'uw-tel �r 1 �ccc,Vt-e Gas Dryer $10.00 $ ESTIMATED COST 2-7 O Cit PERMIT NO. ;�e > � *Air Conditioning – AD Sizes $10,00 $ /V ` o` DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work $ No, of Heating Units Circle One (Steam) (Hot fate arm Trade Name —F- vt& -s v- Size No. Commercial/Industrial BTU cxf> v HP EDA I% of Value of Appliance or Work $ Fuel a Total Connected Load State Surcharge $ .50 Burner Trade Name Size No. BTU HP EDR- TOTAL FEE HEATING COMPA MINIMUM FEE FOR ANY HEATING/COOUNG/VENTILATION�^.� REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 Signed By I No. PLUS THE $ 50 STATE SURCHARGE E° Rou h in Date Final Date ' REINSPECTION FEE $30.00 Approved By g . – *AJr 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 FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 • FAX (612) 571-1287 April 3, 1995 Twin City Townhouses Inc 1250 E Moore Lake Dr NE Fridley, MN 55432 Re: Final Inspections at 5524, 5528, 5546 and 5554 East Fillmore Circle NE, and 5523, 5527, 5545 and 5553 West Fillmore Circle NE, Fridley Dear Sirs: Final inspections were conducted on March 30 and March 31, 1995 for the above noted addresses. We found that the construction of the building complies to the best of our knowledge and belief, with all the requirements of the building codes of the City and the State of Minnesota relating thereto, and permission is hereby given for the occupancy of said building. If you have any questions on this matter, please feel free to contact me at 571-3450. Sincerely, rpraliwkgv--A� F9 F 76-; � mm_ 0 Building Official JPlmh SUBJECT TN, City of Fridley 33414 AT THE TOP OF THE TWINS BUILDING PERMIT( r `T NO. � • _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. �f r � � 1 . , NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 763-571-3450 910.F15 4/8/03 JOB ADDRESS 5545 West Fillmore Circle NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 1 Hillwind Townhomes SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Amy Sylvester 5545 West Fillmore Circle NE 763-502-9309 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 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Finish Basement add bathroom 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. SEPARATE PERMS REQUIRED FOR: WIRING HEATING PLUINDINd AND SIGNS 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $7,500 $3.75 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 $153.25 Fire SC $7.50 PLAN CHECK FEE TOTAL F E $16 .50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT h IDATEI /03 EN ROPE ALIDATED TH IS YOU P IT SIGN i RE OF O R,IF OWNER BUILDERI IDATEI B-LOVINSP TIATE NEW [ ] �4, CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] L�6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ]0� �� SINGLE FAMILY AND DUPLEXES R4 AND R-2 (763) 5714287 Fax BUILDING PERMIT APPLICATION 515 Construction Address:`' �� �t9—Q rn o-� � �Q N f 1 � S S�k-3 a Legal Description: Owner Name & Address: S ti 1yi e Tel. # _+b3 -S0-c)--9 _E109 Contractor: MN LICENSE # Address: Tel. # LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. �t x-500 - Construction Type: u7--eCy-k =L� Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$ DATE: 44 / o 3 APPLICANT: r -v ­NS, Tel. # } b3- Sea - 9 30 1 Call (763) 572-3604 for Permit Fees if mailing in applica n. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY $ C $ 31-1,15 Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 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 [ ] GI I Y 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: NO. RATE TOTAL JOB ADDRESS S,"�3AS �aJ`'� -�\�._C�R C_AM.QE; New Fixtures 3 $ 7.00 c_:�\ • ®� The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00�� Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner Water Heater -Electric $ 7.00 Water Heater - Gas"` $10.00 Building Used As Gas Range** Gas Dryer** $10.00 $10.00 k X7� Estimated Cost • PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMPANYT�,3Qh- `�� Reinspection Fee $47.00/Hr SIGNED BY TEL NO.(VQk—S%F5—�_I�� ALL OTHERS AND/OR REPAIRS AND ALTERATIONS FAX # (pts 1.5% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge .50 f MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 TOTAL FEE $�\ • `gam 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 s`OMMQN VENT- VEWT CONNECTOR AND COMR114TION AIR VFRIFICATION When raplarinaan jaxietingyranne, 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 (1 No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer BTU Input specifications including sizing, length, number of elbows and termination. Yes( ) No( } The undersigned also verifies that the replacement unit is a listed assembly Fan Assisted or Nat and meets the current codes and manufacturer's specifications. This does BTU Input include AGA-GAMA Category I Central Furnace Venting Tables for fan Total Appliances assisted and natural draft appliances. Yes( ) No( ) The eYistir% rcambtastion air is sized and installed to meet the current codes Vent Height and manufacturer's specifications. Yes( ) No( ) When required to inetall a new _nmb uetinn air; it will be sized and installed ft Diameter in Type to meet the current codes and manufacturer's specifications. Yes( ) No( ) When installing a now venting syetam, 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 #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: CITY OF FRIDLEY INSPECTION 6431 University Ave NE Fridley, MN 55432 (763) 572.3604 FAX (763) 571-1287 RATE SCHEDULE DIViSION APPLICATION FOR POWER PLANTS AND HEATING, COOLING,'VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Effective January 1, 2003 JOB ADDRESS 55 L�S W J� MG -)J State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. $ 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 $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE /9 103 HEATING CO Signed TEL #3 " 50-)�- fr30--1 FAX # U Approved By Rough -In Date' Final Date OWNER Rate TOTAL BUILDING USED AS c5— $ 30.00 $ ��® ®� ESTIMATED COST PERMIT NO.– O.$10.00 $10.00 $ DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ 10.00 $ Trade Name Size No. BTU HP EDR $ 25.00 $ Fuel Total Connected Load Burner Trade Name Size No. $ BTU HP EDR State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. $ 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 $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE /9 103 HEATING CO Signed TEL #3 " 50-)�- fr30--1 FAX # U Approved By Rough -In Date' Final Date THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When raplive-Ann an exictin0 Iran _e, 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 (i No ( ) The venting system is plastictPVC 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 manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes( ) No( ) The a,c-�0 _nmb ,Minn air is sized and installed to meet the current codes and manufacturers specifications. Yes( ) No( ) When required to install a new _nmb jcfino ai ;,it will be sized and installed to most the current codes and manufacturer's specifications. Yes( ) No( ) yy�en jpatallin: 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 -LAMA 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 #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: