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PRE 2010 DOCSSUBJECT MIT NO. City of Fridley ®13387 T THE TOP OF THE INS BUILDING PERMIT r' ECEIPT NO • COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION ,I������r� 1 SEC. NUMBER REV. DATE 2/25/76 PAGE OF APPROVED BY I /--n % CITY HALL FRIDLEY 55432 ---•� '.J 612-560-3450 910-F15 JOB ADDRESS 1531 Woodside Court 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 1 Rice Creek Estates 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Pine Tree Builders, Inc. 8535 Central Avenue N.E. Mpls 55434 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. SAME 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING residential 7 CLASS OF WORK © X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 1� 8 DESCRIBE WORK 26 x 22 NUM garage and 40 x 26 house OILas- � ��ng A1C 9 CHANGE OF USE FROM TO STIPULATIONS SEWER (approx. 1. Provide a new survey of the lot. 41' E. of M.H. (Inv. 909.90) Z. Provide a verification survey. Wye Elev. 910.06 3. Provide a hard surface drive. :top of footing 913.56 (minimum) WATER 10' East of sewer service Note: The City does not guarantee accuracy on utility locations. --IMPORTANT--, �s- SEP£RATE PERMITS REQUIRED FOR WIRING, {VOTIFY THE FRIDLEY ENGR. HEATING, PLUMBING AND SIGNS. ©IVISION REGARDING CURB REMOVAL AND REPLACEMENT TYPE OF CONST. OCCUPI Y®RONEINA POREMMWD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, wood frame VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.5720 AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION 572 811,040 21,376 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 33 5OO $16.75 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOESPRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PR OVI ION OF ANY OTHER ST OR OCAL LAW REGULATING CON- 50.13 350.00 STRU .ION OR HE PERFOR NCE F C NSTRUCTION. PLAN CHECK FEE TOTALFEE 1 _ $416.88 , SIG TU EOFCONTRACTORORAUTHORIZEDAG (DATE) HEN PROPERLY VA A ED THIS Is YOUR PERMIT ✓i G2: ec BLDG. INSP DATE SIGNATURE OF OWNER (IF OWNER BUILDERI (DATE) APPLICATION FOR RESIDENTIAL, AL'T'ERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME: BUILDER: 4".-Tkra 6udd_F", ADDRESS: ADDRESS : -c-; _'- C FA/4 41 4 ufz--: J0 F— NO • STREET • W00-0 S ! 10 E,. UC e 7 - LOT:- LOT: s— BLOCK: ADDITION: e 't wic "kA., `y CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach `.o this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: (4'L Front: 26, Depth: z Z_ Height: 12— At_LLS9z Square Feet: 4—!:�7 2-- Cubic Feet: ,522.-0 Front:, Depth: 2-C-1 Height: Ik Square Feet; 10 iii Cubic Feet: "91 5?16 Type of Construction:�p���Q Estimated Cost: $ To Be Completed: &.4 '3 S��'• The undersigned hereby makes applicatinn 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 represent ions stated in this application are true and correct. DATE: SIGNATURE: (See Reverse Side For Additional Information.) e -9i v" Illy mig SM l000r ik ago. 3 ,� v FOR a 7' t11if�M[� t hereby certify that this isa truelnd coiract ieplese,jitatrc�tt'ut•a "cri vt5y c� le> eco. the boundaries of the above dQ`scilbed lanai and of thelocation of all bt*It01flt ®�l�It i. ® �6d1°vBL O/'l if any, thereon, and all visitdo encroachmonts, "if any; frarrr. �r ©i vai$ lanai. Lanai Surveying a Site Piann,riy A5 sttrveyt:d by me this : . z3.3iL -'day of Civil Engineering 8816 TOth 4v. N. (i 94 at Boone Av N.) 9Brookiyn Park, MN 55428 Phone 533.7340 Minn. Rag.. No.'T_.1—_ ,mz- ;: 'a� Ci of Fridlay Appliceflan for pl rri-bnng end = FaffIS llt • �.---•.. Nyt. of Bidas. Phone SSO.3450 n DESCRIPTION or \ii OI1RLocation` � -3 / � W - Num. b4r. Kind and Loerssen of Fixtures City of Fridley:. The undersigned hereby makes application for a permit for the @sorts herei specified, agreeing to do all work in strict accordance with the Cit1 Ordinance and ruling of the Department of Buildings; and hereby declares that all the fact and representations stated in this application are true/" correct' If 1 iFYid1eY. �Vpn � . • Futuzo Cca.nactica C-r4nir; s t New 11ttur9. Old 0;4n ngs Sevar Ccupool Owner ... 1::: kjv— .' Kind of Building �- Used as �o --, / To be completed about / PARTIAL RATE SvH`DULc Estimated Cost. $ Old Ne ullding Permit No. LUMBING FIXTU11E RATES: RATE TOTAL 00, $ . Number fixtures . • .. s • ....... • .. �� X $2• Sig Future Fixture Opening ........... .. x 51.50 $ d By ", v Business Phone ;tiew Fixture Old Opening..... • • • • • x 51.50 Catch Basin .................... x $3.25 $ ooN �` '-U ' *ATI" HTA. � ww O fres+ Ground Run Old Bldg.... • .... u g a GAS «<c. FlNn 4L` � L ` j � TOTAL O V� < 3 U< U a U V x $2.00 $ Additicnal Fixtures ............... N • ;. d F �n � f ► O r •A a State Surcharge P.T,'?AI:iS fife ALTERATIOYS—Rafer to Cod* .50 M=ri;tJon ...............:........ ,.• .. < .... o <... 4 / / Ind 3rd. 4th • Futuzo Cca.nactica C-r4nir; s t New 11ttur9. Old 0;4n ngs Sevar Ccupool Owner ... 1::: kjv— .' Kind of Building �- Used as �o --, / To be completed about / PARTIAL RATE SvH`DULc Estimated Cost. $ Old Ne ullding Permit No. LUMBING FIXTU11E RATES: RATE TOTAL 00, $ . Number fixtures . • .. s • ....... • .. �� X $2• Sig Future Fixture Opening ........... .. x 51.50 $ d By ", v Business Phone ;tiew Fixture Old Opening..... • • • • • x 51.50 Catch Basin .................... x $3.25 $ �` '-U ' Water Beater fUp to 99.000 BTU) • • • • x $3.00 $ ROUGH fres+ Ground Run Old Bldg.... • .... x $3.25 3 V ctr'ic Water Heatar.....:........ a $2.00 $ FlNn 4L` � L ` SAS FITTING FEES: NO. RITE TOTAL a. ev Ist 3 Fixtures ........ . ........ x $2.00 $ Additicnal Fixtures ............... x S .75 $ Gas Range to 194.000 BTU ........... x $5•00 $ State Surcharge P.T,'?AI:iS fife ALTERATIOYS—Rafer to Cod* .50 M=ri;tJon ...............:........ ,.• .. < .... o <... 4 TOTAL M Pormit j .CITY OF FRIDLEY 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 TELEPHONE ( 612)571-3450 Mr. Ed •Dropps .Pine Tree Builders, Inc. 8535 Central Avenue N.E. Minneapolis, Mn..55434• Re: 1531 Woodside Court N.E. Dear Mr. Dropps: A final inspection was made on April 30, 1976 of the above address. The following items were noted and must be.completed before the construction can be finaled out; 1. Extend firewall sheetrock to roof sheathing next to garage by June 1, 1976. 2. Provide sod in the front and side yards by June 1,, 1976. 3. Provide a hard surface driveway by June 1, 1976. If any problems arise that will prevent you from completing these items by the appointed dated, please contact -us. A'reinspection will be conducted on or about June 1, 1976 to determine compliance. Sin ely, DARREL G. CLARK Community Development Adm. DGC/mh 1OX.UTIDN 40; 400 Q U m V1 �blT,e �87�^a CIVIC CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 - PHONE (612) 571-3450 April 29, 1987 Mr. Larry Bloomberg 1531 Woodside Court N.E. Fridley, MN 55432 Re: Construction of Residential Addition Without Obtaining a Building Permit Dear Mr. Bloomberg: It was noted during a field inspection conducted to investigate a variance request at 1520 Rice Creek Road, that you have added onto the rear of your dwelling. This addition was constructed without first obtaining a building permit and it is possible that the addition is encroaching into the required rear yard setback. Since you or a contractor working for you constructed this improvement without a permit, we have no way of knowing if it is built in accordance with the Building Code requirements. This matter is a serious violation of City ordinances and requires your immediate attention. Would you please contact me as soon as possible by telephone or in person. We need to have you bring in a complete set of building plans, together with a plot plan showing the location of the addition. I am enclosing a building permit application with this letter for you to submit with your plans. Upon receipt of your application and plans, we will want to make an inspection of the construction to verify its compliance to the Building and Zoning Codes. If we have.not heard from you by May 8, 1987, we will turn this matter over to the City Attorney for his legal consideration. Your cooperation in this matter will be appreciated. Sincerely, DARREL G. CLARK Chief Building Official DGC/mh ENC: 1 SUBJECT PER .. City of Fridley a '19 827 AT THE TOP OF THE TWINS BUILDING PERMIT - -= ` RECEIPT NO. � • _____ COMMUNITY DEVELOPMENT DIV. - r PROTECTIVE INSPECTION SEC. 1 . � -'1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/12/89 / / JOB ADDRESS 1531 Woodside Court Na E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 2 1 Rice Creek Estates 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Michael/Patricia Serie 1531 Woodside Court N.E. 571-7719 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION Ek ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Change upper screen porch to glassed in porch 9 CHANGE OF USE FROM TO STIPULATIONS Rear yeard setback variance approved by City Council on 6/15/87. 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 $2 000 $1.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $45.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $46.00 HEN PRP R AL ATED THIS IS YOUR PERMIT M SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) b BLDG INSP f�ATE SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI NEW [ ) Effective 5/1/88 ADDN [ ] R-1 AND R-2 ALTER [ ] Building Permit Application Construction Address: 5 i (�% o dC S GHQ i -I c 4L �i f ► !���43Z �"" 1 Legal Description: k Z 1 106du [e owner Name & Address: PST 2 t ,'—' k 4 S!5e (E- Tel. # 6-71 - % �l Contractor: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVIM AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. 07HEt: Corner Lot [ ] Inside Lot [ J Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ Approx. Completion Date: ;� 00a. ®® Proposed Driveway Width If New opening Is Desired: Ft. $ $ Width + 6' See Back Page ,r DATE: l "f APPLIC W: :�Le kC- t S Z t !G Tel. # -1,6 T- t la,- `1' W C= USE ONLY S� (- -7-71 Permit Fee $® State Surcharge $ �' SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ ;CMN. 1 C-14 M CC��. Fee Schedule on Reverse Side $.50/$1,000 valuation $575 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CERTIFICATE OF SURVEY 40.82 WOODSIDE COURT C Denotes iron monument Description: Lot 2, Block 1, RICE CREEK ESTATES 2ND ADDITION. Anoka County, Minn. Is 3� WDEIG sr�� , �� 27- . • F)Ot[11t +�' COtI/Ztrt� t hett:l,y certify that this rsa true and correct ieptesCntwiun of a su,vvy of Aoii 4" the boundaries of the above described land and of th•2 location of all btrrfaujq�h' if any, th,:teon, and all visible encroachments, if any. from. or on -md 14A L and &,rveytny • Site Planning As surveyed by me this _ day of C.guJ Enqu,eennq • s;$16 lett, A,j N 11 94 at B<wrx Av N.! 'yronk,yn Park. MN 55428 Phone 533 7340 Minn. Reg. No. SUBJECT PE N City of Fridley'! 1 AT THE TOP OF THE TWINS B U I L D I PERMIT i LJ 1 V RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. d j .tee_ L ------ PROTECTIVE INSPECTION SEC. , NUMBER REV DATE PAGE OF APPROVED BY _ 1 "1 CITY HALL FRIDLEY 55432 612-571-3450 910-F15 4/30/93 JOB ADDRESS1531WOODSIDE CT 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 RICE CREEK ESTATES, 2ND ADD SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE MIKE & PAT SERIE 1531 TnTOODSIDE CT FRIDLEY M 55432 -5,71-7719 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. D & D HOME IMPROVEMENT 7401 CEN 784^7543 4840 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 REPLACING EXISTING DECK. 9 CHANGE OF USE FROM TO STIPULATIONS S -EE NOTATIONS ON PLAN Before digging call for all utility locations 454-0002 REQUIRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 ,. _ STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 745, QD , 50 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., 21 QQ, FTPE SC e 75 PLAN CHECK FEE TOTALFEE L; - ENSR aC 5 Q.Q. 273,25 SIGNATURE OF CO ACTOR OR AUTHORIZED AGENT IDATEi V�fHE VALI ATED THIS IS YOUR PERMIT /jPpgfO��PERLY F2 BLDG INSP MATE SIGNATURE OF OWNER OF 0WNER BUILDERI IDATEt NEW [ l ADDN [ ] ALTER Construction Addrw. Legal Description: Effective 1/1/93 CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 1tb Building Permit Application �. Owner Name & Address: �S e, h i f- Tel. #_nE%l - � `?d Contractor: ° en`s -rm�"y flh-en`t' MN LICENSE # q yO Address: 4 W n±[g � ayt Y6 Tel. # '751Y-7!541-3 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:' ( $e G� o o n Corner Lot [ ] Inside Lot Ft. Yd Setback _ Type of Construction: -tPjev, yip(90 Approx. Completion Date: 5—h5---13 Driveway Curb Cut Width Needed: Ft. + b Ft = Side Yard Setbacks Estimated Cost: $ (Cost on Back) Ft x - $ = $ 'I)ATE: APPLICANT: Tel. # 9V -75V ---P CITY USE ONLY Permit Fee $ 2 to 0 ® Fee Schedule on Reverse Side Fire Surcharge $ ,7r.00i of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $750 per SAC Unit License Surcharge $ ®® $5.00 (State Licensed Residential Contractors) Driveway Escrow $ �_—_ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ TOTAL $ STIPULATIONS: ; CONST'. WAgM DAILY, STOVE IN AN APP20VED MANNER kFMOVE ALL REFUSE WFEKLY 2,31 j,QJI DECK RAILING 36" MIN. HEIGHT 6" MAX. SPACING 6 FLASH OVER ALL EXPO ED EXTERIOR JQPENINGS /llv" Thisl Plan Must Be aintained And Accessible On The Construction Site CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Water Bath Stories Closet Urinal Tub Shower Wash I Drink. Floor Catch Auto. Gas Gas Misc. Water Heater Sink Tray iFount. Drain Basin Washer Appl. Range Fixt. Gas Elec Basemen $ 4.00 Floor 1 $ 5.00 Floor 2 $ 7.00 Floor 3 $ 7.00 Floor 4 $ 7.00 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS I531 WOOD5196 COugr New Fixtures $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater -Electric $ 7.00 Water Heater - Gas I $10.00 Gas Range $10.00 Gas Dryer $10.00 Back Flow Preventer Required ( )Yes () No Type __ $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance _ State Surcharge .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 codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. 14' 1,i , 199 . Owner PAT- SG-kIE Building Used As REs ' c16*I P1t- Estimated Cost Aeego�- 3W—" . PERMIT NO. 26`f,2z PLUMBING COMPANY -TIM'S ®EXALlr`t SIGNED BY TEL N0. Approved By Rough- n Date Final Date M1141MUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 TOTAL FEE $ to.50 PLUS THE $.50 STATE SURCHARGE J 6 I Effective January 1, 2003 CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES FAX (763) 571-1287 JOB ADDRESS 51 v4 RATE SCHEDULE Z OWNER f 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 Applia ce or Work nn�� Commercial/Industrial 1.25% of Value of Appliance or Work Rate TOTAL 3o oo BUILDING USED AS c�Cs $ 30.00 $ ESTIMATED COST PERMIT NO.'S/cam $ 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 Pn� tic Size No. 0 BTU__A0 %o HP EDR $ 25.00 $ Fuel it, a Toto Conngcted Load Burner Trade Name Size No. $ BTU HP EDR U.0 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 7 Z Q i 4 HEATING CO Q ilk 14 C r} Signed J ` r �-" \ TEL # LC Y 3�� / %f FAX # Approved By/ice Rough -In Date Final Date THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED ANN r.QMR1 ISTIM AIR VFRIFICATICM r,nmIL nmyr=NT VENN CCNi`FCTOR When rapine -Ann an axietin0 ff Fran _ _, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, Yes No ( ) and is securely supported and firestopped where required. The venting system is piasticIPVC and meets all current codes and manufacturer and termination. Yes! No ( ) specifications including sizing, length, number of elbows 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 existinn rnmhi stinn air is sized and installed to meet the current codes and manufacturer's specifications. Yes( No( ) When required to install " new cemhusgan airs it will be sized and installed to meet the current codes and manufacturer's specifications. Yes (,' No( ) When inStallin„ naw 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 No Yes (� ( ) Venting Tables for fan assisted and natural draft appliances. Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented Yes No separately as per current codes. . Appliance #1 Type f jj / e � BTU Input Fa Assisted or Nat Appliance #2 Type Jicb4cq_ - BTU Inputter= Fans`is sted or f Appliance #3 Type BTU Input Fan Assisted or at Total Appliances ® Total Btu InputII �= Common Vent Type Vent Height ® Diameter inches Appliance #1 Vent Connector Height ft Length, Diaeter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type S HEATING CO: Date Signed By: ,o J