PRE 2010 DOCSCi of Fridle , Minn. 11 8 2 8 .
� Y
6431 University Ave. N. E., Minneapolis, Minn. 55432
BURDING PERMIT
Date; ___December 7. 1972
OyMer; David Nelson Builder Rodney Billman, Inc.
Address Address 151 Silver Lakm Road, New Brighton
LOCATION OF BUILDING
Noy 1535 Street Windemere Part of Lot
$$ot 18 Block 2 Addition or Sub -Division Innsbruck 5th Addition
Corner Lot inside Lot X Setback . 35' Sideyard 10' & 15'
p*ob zlevation 985.56 988.56 Minimum
WZe Ton of Footing
DESCRIPTION OF BUILDING
To be Used as: 49 & 3112 &
' ngFront 7 9 ' Depth 2 9 ' Height 2 0' Sq. Ft. 146 0 Cu. Ft
raragp- Front 30' Depth 24' Height 10' Sq. Ft. 720' Cu. Ft.
Type of Construction Wood Frame Est, Cost_ $31,139 To be Completed June 1, 1973.
Stipulations: Provide a verifying survey before capping. Provide a hard surface
driveway. Provide retaining wall or walls in rear yard if slopes exceed 3 to 1.
WATER LOCATION: 11.5' North of Sewer Service
SEWER LOCATION: 3' W. of Manhole (Inv. 985.57)
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 §0 forth and in c9ppliance with albprovisions of
Ordinances of the city of Fridley.
.In consideration of the payment of a fee of $-82...4O _, permit is hereby granted to Bony Bi 1 1 man 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
Ii'ridley, Minnesota, regarding location, construction, alteration, maintenance, repair and moving of buildings
��� city limits and this permit may be revoked at any time upon tion of any of the provisioas of said
Building Inspector
DARREL CLARK
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas beating, sewer or water. as sure to no
the Building Inspector for separate permits for these items.
A
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME: ��� �1� BUILDER:
ADDRESS • ADDRESS : /J
F.
NO:. STREET •
LOT: BLOCK: ADDITION:—A--,
CORNER LOT: INSIDE LOT:A %,-- SETBACK: 3 J' SIDEYARD: » ¢ /1
Applicant attach to this form Two Certificates of Survey of Lot and.proposed
building location drawn on these Certificates.
DESCRIPTION OF BUIIILDING
To Be Used As:
Front • Dep r Height -
Square Feet:Cubic Feet:
Front:— _ Depth' Height
i
Square Feet; 7 Cubic Feet:
Type of Construction: -i�, �Estimated Cost:
i
To Be Completed: e-�-L—
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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.
/ Z
P
DATE : ' 7 SIGNATURE:401
�,�-✓ ��
(See Reverse Side For Additional Information.)
1 Mid°
F.
• sv s\ _ _ '
AppRCa�i®n fw Pourer and H nags Vm iiat%n` R r�alion and
a
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: 11ATE 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 $
MECIL WARM AM
Furnace Shell & Duct Work to 120,000 BTU ... ....
..$10.00 '
each add 60,000 BTU ....................
. 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 Shell & Line—to 640 sq. ft. EDR Hot Water
10.00
$_
Each add. 200 sq. ft. EDR Steam
;9.0(D
Each add. 320 sq. ft. EDR Hot Water
3.00
$
OIL RURNER—to 3 gal. per hour
over 3 gal. per hour—See Fee Schedule
GAS B (up to 199,00® BTU)
over 199,000 BTU See Fee Sckwdule
GAS FITTING FEES.
1st 3 Fixtures
Additional Fixtures
Gas Range to 109,000
r a.
6.00 $--
NO—
NO RATE TOTAL
- x$ 2.00 $
- x .9b $
_ zffi 6.00
% >6®hd1010 wee ff/t4
TOTAL
(SURCHARGE $ _,50)
Dept. Of Bldgs. Phone SM-34lID
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 pacts
and representations stated in this application are true and correct.
as1
Fridley inn 7 18�
Owner —1 � � V,0V b Af ®A-JJd
Kind of Building
Used as
To be completed about
Estimated Cost,
Old-t� Building Permit No. Permit No.�
HEATING or PO Hot Water,artalir No
Trade Namez7cb Size N��9�(g
Capacity Iwld6 Sq. Ft. E.D.R �6 6W BTU
H.P.
Total Connected Load 7 e� Xtnd of Fue t ,7
BURNER — Trade Name-- Size
ATo-
Capadty i//�� Sq. Ft. E.D.R-.
qy''��d _ 4dLrlc �ae}— pi yam'
004 eA 4AI AMT4 F i -He Si
r AY N ;-i:_A i i f,IG
+-,-hle�=Yam-f1VC
40j#ti4 5Rweev q74. � MIhIELEAPOLIS, MINNESOTA 654027
Boniness Nd � �� /J
(REMARKS -OVER)
n,'
City of FrWIGy
for Pkmbb2 and Gas
Dart. of fie. Phone
CEIr kEMOK of WOaK
lsualber. KWd and Locates of "
.�t� • s
City of Fridber.
� �;. � � � 3 �; � � � � � ► � Gws Euc. The used hereby makes application, for a penult for the. vrorB[ herei•w--.
specified. agreeing to do an work in strict accordance with the City Ordbwwr7
and ruling of the Department of . and hereby declares that ani the fad--:
and representations stated
e�in this app armee tmw and correct
PARTIAL RATE SCHEDULE
M.RMERG FIXTUM RATM
RCL RATZ TOTAL
Plums Flxwm ................
Zan
O u ti6C•rmtm:: .... Y ......
S $Biro S.
MW Fixture OW oprning..........
Catch Basin ............. :......
z om t
Water i kater "Up to W.I W BM .. • .
--J--K-uw a 3,00
New Ground Run old Bbd,.......
z x$�r
_
�l
neetwk.............
!3
_ ti
GAif FPIT[LfG rEM:
M RAT1C TOTAL
fat 3 Mix .............. ...
�_ z $AO® a ' U Ci
Addidand ...............-x&.75
S
*��s
an Ramie to ia0if�m BTU .........t. BTU
M
�t1.W t .
state ser $®
NWAMS & ALTERA AO Ce"
•►..erne.ee..�......s.a..o....e.......a.t�
TOTAL=
A
Ownw U 4 `. ✓ .
Kind of Building
Used as
To be cued about 0
Estimated Cost. g
sP1 krtw6-
ft. ��s;s = Y-21 -
City ®f Fridley
r AT THE TOP OP THS TINM
tL-------cowwuNlTv oEveLoRl+eNT elv,
1 i PNOTgCTIVR weftCTHim ORPt
CCTV HALL MOLCT `MR
4e3-8so-3460
Address
53-84--879.01
PLUMBING PERMIT APPLICATIO14
1535 N. E. Windmere Circle
Owner Address P one
David Nelson
Contractor Address Phone
MINNEGASCO 733 MARQUETTE AVENUE
Kind of Building lUse MPLS.. MINN.
on Date
10-25-73
ad
SAValI
HSYM
I
BNIBVBI
i
W
BVNISI
K
- _4
I' Future Fixtures
I I
$1.50
New Fixture -Old Open.
x
$1.50
f Catch Basin
3BNraI
I
� i i
x
Br°J{
i! Ground Runld
0 Bldg.
I I I
$3.25
•,dart
x
$2.00
� ) '
f
I
BYO
I
I
I
If
R..ee072
I
•�81W1
I
I
I
I
•saa,
•MNrvaI
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ro—
s.
we
%SNI
Holr7ILZ�
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BNIraQ1
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13 c
�Z o
I saaMONSI
I
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'1N
I
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�W���WWWJJJ3
HNIaa
Ha
�tl
U !;jI
tw
O
23 +
SAValI
HSYM
I
BNIBVBI
�
I
BVNISI
I
I
I' Future Fixtures
I I
$1.50
New Fixture -Old Open.
/0-/0-7,5 �4�
t;sti.matea Lost
BNIBVBI
�
I
ff! Number Fixtures
Ii
$2.00®
I' Future Fixtures
x
$1.50
New Fixture -Old Open.
x
$1.50
f Catch Basin
I
I
Water Heater -99,000 BTU
x
I
i! Ground Runld
0 Bldg.
lure
$3.25
I
x
$2.00
j Gas Fitting Fees:
B,rNlan I
I
I
I
I
R..ee072
aatvnl
I
I
I
/0-/0-7,5 �4�
t;sti.matea Lost
Plumbing Fixture Rates: NO.
RATE TOTAL
ff! Number Fixtures
x
$2.00®
I' Future Fixtures
x
$1.50
New Fixture -Old Open.
x
$1.50
f Catch Basin
x
$3.25
Water Heater -99,000 BTU
x
$3.00
i! Ground Runld
0 Bldg.
x
$3.25
Elec. Water Heater
x
$2.00
j Gas Fitting Fees:
lst 3 Fixtures x $2.00
i
I -
Additional Fixtures x $ .75
I
Gas Range -199,000 BTU x $5.00
Repairs & Alterations
See j
Description: Gas Log Code 5.00
VaZ -A- Surcharge .50 �
State Surcharge .50
TOTAL FEE $ .50
!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 declare that
all'the facts and representations stated in this I
application are true and correct.
-S i
Date
SUBJECT
PEfMrL-
City of Fridley
9 4 61
AT THE TOP OF THE TWINS
BUILDING PERMIT
�
NO.
`� ______ COMMUNITY DEVELOPMENT DIV.
SEC
�J
Y /
r PROTECTIVE INSPECTION
0
1 �
j CITY HALL FRIOLEY 55132
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
5/14/99
J08 ADDRESS
1535 Windemere Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
18
2
1 Innsbruck 5th Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Jim Griebel
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Tabor & Sons Inc. 10547 Terrace Rd Blaine 55343
789-1902 20014248
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 ®x REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (30 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
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
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
$2571
$1.29
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
$83.25
Fire C $2.57
PLAN CHECK FEE
TOTA E
!� i� T
Licens C $5.00
$ .11
RI
SIGNATURE OFNCON'RACTOR OR AUTHOZED A GENT IDATE. r-
N OP ALID
HIS IS YOUR PERMIT
r
SIGNATURE OF OWNER, IF OWNER BUILDER1IDATEi
B G NSP
•Ft
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
a
Construction Address:
Legal Description:
Owner Name & Address:
Contractor:
Address:
Tel. #
MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF BIPROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
a�
Construction Type: ,o Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE: 5APPLICANT: (�ij� yJ Tel. # 7,?5; ; `%� Z
TOTAL $
STIPULATIONS:
I - v
CITY USE ONLY
Permit Fee
$ ��
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ L
$.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC Unit
License Surcharge
$ p,
$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:
I - v
0099
IEW [ ] CITY OF FRIDLEY n °�=
,DDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-360'13100insp, I
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address:i ;l .l� W N&A& E CleUk CAS-(
Legal Description:
Owner Name & Address: 5 VUA Grllt5 Ej Tel. # 7 S-11,019-7
Contractor. ST&f �f 0 cc9k—ry. MN LICENSE # -�OZ^737
Zq
Address: 1 I i-1 c) Ll0J r, N E 'AW F /M 5 '� i Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to'scale.
DESCRIPTION OF IMPROVEMENT
LINING AREA: Length width Height Sq. Ft
GARAGE AREA: Length width Height Sq. Ft
DECK AREA: Length width Hgt/Ground Sq. Ft.
OTHER: 080 f FAIHN®M
Construction Type: sAfkmm a Estimated Cost: $ 616p® j� v0
V
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ =$
DATE:1 ®5 APPLICANT: Tel. # 617
Call (763) 572-3604 for Permit Fees if mailing In application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ Fee Schedule on Reverse Side
$ • 65% of Permit Fee
$ I a .001 of Permit Valuation (1/10th%)
$®, $.50/$1,000 Valuation
$ $1450 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 [ J
$ q4 -9 10co STIPULATIONS:
JimP� t9 �2�SC2
COTES f 2 tvL Fy l 15Szf7,1
cr , 0 rc -4-
�E
G111- �Kj Z-0
CONSTRUCTION
110,1 MFAWW* LANENS'
B
f AAA
2/
r s
a' i •
INTY OF FRIDLEY INSPECTION DIViS10N
Effective On January 1, 2000
5431 University Ave NE
=ridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
763) 572.3604
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS
2�ATE $E
C� C
OWNER LO- �', L e
3esidential
Rate
TOTAL.
5 �` ck� C-0,
Furnace Shelf and Duct Work, Burner
Furnace
$ 30.00
$s
BUILDING USED AS
Also Replacement
(Side Vent . Fill Out Back)
l�� . 6.-� PERMIT NO.
ESTIMATED COST _
Gas Piping; (Needed with neve furnace,
$ 10.00
�
DESCRIPTION OF FURNACE AND 0R BURNER
but not replacement)
Gas Range
$ 10.00
$
No. of Heating Units Circle One (Steam) (Hot Water)arDAir)
Lias Dryer
$ x0.00
$
Trade Name lv_//'rr ��v'"� Size No.' ---
BTU,.— HP __ EDR__
*Air Conditioning - All Sizes
$ 25.00
Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK)
Burner Trade Name_ __ _ Size No.
1% of Value of Appliance or Work
$,
BTU _ HP __ EDR
.ommarcial/IndustrW
1.25% of value of Appliance or Werk
State Surcharge
TOTAL FEE
;EINSPECTION FEE $47,00/Hr
Air Condtioners can not be placed in a side yard without
mitten permission from adjoining property owner.
$
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all worst in. strict accordance with the City Codes an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct
Approved By Rough -fn Date Final
Wi
C5,
Ze • d '1H101
COMMON _ L VENT CONNECTOR AN® C.OMB,UOTION AIR VEl?IFICATION
When mniacinca an existing&f OS& the undersigned hereby verifies that the
venting has been examined and Is free from rust, deterioration, obstnrctions,
and is securely supported and firestopped where required. Yes (J'No ( )
The venting system is plasWPVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes (.,f 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 -LAMA Category 1 Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes WNo ( )
The -existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes (-I--No ( )
When required to Install a neer combustion airy it will be sized and installed
To meet the current codes and manufacturers specifications. Yes (4No
When pnstalting 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 appliance. Yes (4-1�0 ( )
Is the common vent and vent connectors sized and installed correctly atter
an appliance has been' removed from the common vent and vented
separately as per current odes. Yes( ) No ( )
Aeroliance T w and Siz MO—mmon Vent and Vent Connector Ipforereation
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
it 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
ALTERATIONS: Mescribe9
CO:
A)a"Z—k��L
Signed By,i �F.q_."�`Q '� • - . - '
T . W 1
?.i/.A I A�Yf1� Cd'i�' 01 ATM 16:1 JO A110 WONJ $S t'4T OOOZ -TZ-r)ON
f
CiiYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
January 18, 2002
Ms. Paula Griebel
1535 Windemere Drive NE
Fridley, MN 55421
Re: Final Inspection at 1535 Windemere Dr NE
Contractor: Dave's Appliance Heating & Air
Dear Ms. Griebel:
A mechanical permit was issued on December 11, 2000 to install a space heater at
your address. According to the 1991 Uniform Mechanical Code a final inspection
shall be conducted on the work authorized by this permit. As of this date, no
inspection has been called for.
The permit fee that was paid covers the inspection to make sure the work was
completed according to the Codes. We will keep your permit open for another 30
days, and if we do not hear from you within this time to set up the inspection, we
will mark the permit "no inspection called for" and no further action will be taken.
To set up the inspection or to have any questions answered, please contact the
Building Inspection Division at (763) 572-3604.
Sincerely,
CITY OF FRIDLEY INSPECTION DIVISION �C�/�%/®(J
�
Effective On May 10, 1999
6431 University Ave NE
Feidley, KN 55432 APPLICA-nON FOR POWER PLANTS AND
HEATING, COOLING, ELATION,
572-3604 - RURIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
g= SCHEDULE
J®B ADDRESS,
¢- -�.,7 7T
Residential Rate
Furnace Shell Duct Work, Burner -
TOTAL
BUILDING USED AS
and
Also Replacement Furnace $ 30.00
$%�8
LPL "
(Side Vent - Fill Out Back)
ESTIMATED COST ___�_ PERMIT NO.
Gas Piping (Needed with now furnace, $ moo
�
but not replacement)
D IP7°YO�I�Oj' . Fxf RNACE APID OR RURMIrR
Gas Range $ 10o00
_.�..
�
No. of Heating UnitaCircle One (Steam) (Hot Vlate.ONarmAcr-
Gas Spryer $ 1.0.00
Trade NamesSize No®. ... -_
f �p9
*Air Conditioning _ ,AII Sues $ 25.00
Fuel_ Total Connected Load
A l Others/Repairs & Afterations (LIST ON BACK)
Surner Trade Name_ ., -_ Size No.
17o of Value of Appliance or Work
�,�
BTU , _ _ HP
Com me► d a l/Industrial
1.25% of Vzlue of App,iance or Work
��
The undersigned hereby makes application for a pmrin:t for the work hereii
specified agreeing to do all wor% in strict accordance with the City Codes z
State Surcharge
�. � ,��
rulings of he Building Divisicn, and heroby declares that all the facts and
representations stated in this application are -true and correct.
TOTAL FEE�
NiWILISIM FEE F®R ANY i`ING/C®O!,INCj/'/ENTI1LATiON
REP-RIGERA7IQ_Af/AIR CONDIT`IONINC PERMIT IS S2%O®
EUS THE 140 STWE-SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
H EATI N om' /2, !^ CSL
Signed6j 1-1�
®ATE.
Approved BA Rough -In Nate Final Date "
V11 -1 -M -N -E: .AN—P—STACR VBRWICATION
The undersigned hereby Verifies that the existing chimney or stack:
1. Has been carefully examined ye -s h No
2. Is free from rust or deterioration `fifes (A No ( }
3. Has no foreign objects lodged within yeas Q) No ( ,
4. Is securely supported Yes (/) No
5. Meets all current Code requirements for size
and total BTU's connected Yes(/) No � }
b Has total heating BTU's of
All other BTU's
TOTAL BTU's
7, Has a liner been provided for water heater Yes No
S. Has combustion air been provided for water heater Yes No
Remarks:
-71
List ALTERATIONSBeing Doe:
HEATING CO:
Signed By:
Date:
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604, FAX (763) 571-1287
Q _ Dosrctive April 1, 2004
APPLICATION FOR PLUMBING AND GAS FITTING PERMI
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
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 JOB ADDRESS 153
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
Type
$10.00 The undersigned hereby makes application for a permit for the work herein
$10.00 40, specified agreeing to do all work in strict accordance with the city codes
$10.00 and rulings of the Building Division, and hereby declares that all the facts
$10.00 and representations stated in this application are true and correct.
$10.00
$10.00 DATE: '2005
$10.00 1
$35.00 OWNER
$35.00
$35.00 BUILDING USED AS - ' (!
$10.00 4
$10.00 ESTIMATED COST "TSM2 PERMIT NO.
$15.00 PLUMBING COMPANY Ir T&I
1
0
w1
Reinspection Fee $50.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
SIGNED BY
Approved By
Rough -In Date
TEL N0. Z �,3 ==a/—/ 5 -Sb
Final Date
MINIMUM FEE FORIANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST
$ 4_ bo OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE.
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE
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 () 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 existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No( )
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 (} 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 Size/Common Vent and Vent Connector 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
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :