The URL can be used to link to this page

PRE 2010 DOCSCity ®f Fridley, BUILDING PERMIT No* 6544 r Date: Owner: _L46taL4 B d " e � Address Address LOCATION Of BUILDING No. Street _ PAut of Lot Lot Block Addition or Sub -Division . B J Corner Lot Inside Lot �`� Setback Sideyard Sewer Elevation ____ Foundation Elevation DESCRIPTION OF BUILDING In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. , In consideration of the payment of a fee of permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any pari thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings vnthin the city limits and this permit may be revoked at any time upon viola]aon of any of the provisions of said ordinan NOTICE: ., " permit does not corer the construction, Installation for Wi& plumbing, gn beating, sewer or water. Be sore to we His Building Inspemr for separate permita for these itomm., APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER ° S PIAME BUILDER ADDRESS ADDRESS LOCATION OF BUILDING No. Street Lot Block Addition or Subdivision Part of Lot Corner Lot Inside Lot Setback Side-Yard— SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. DESCRIPTION OF BUILDING To -be used as: Front Depth Height, Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft., Type of Construction To be Completed Cu. Ft. Estimated Cost 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 – __ SSGNATT. (Schedule of Fee Costs can be found on the Reverse Side). Application for Power Plants and Heating. Cooling. Ventilation, Reh iget on and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SII. 4-7470 GRAVITY WARM AIR: RATE TOTAL, 1. Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECIL WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ each add. 80,000 BTU ....................... Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 .... ............ Repairs & Alterations each add. $500.00 .............. STEAM or HOT WATER SYSTEM r Furnace Shell & Lines—to 400 sq. ft. EDR Steam...... . Furnace Shell & Line—to 640 sq, ft. EDR Hot Water .. . Each add. 200 sq. ft. EDR Steam ...................... Each add. 320 sq. ft. EDR Hot Water .................. 8.00 $ 2.00 $ §.00 $ 5.00 $ 2.50 $ 8.00 $ 8.00 $ 2.50 $ 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule p� GAS BURNER (up to 400,000 BTU) ....................... 5.00 $� GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures(/ ...................... x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM ALTERATIONS & REPAIRS TOTAL FFE $ ROUGH- OUGH FINAL- FINAL City City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Owner _ ^ r-� Kind of Used as To be completed about Fridley, Minn (.Afk–<, , 19462 Estimated Cos $ Old—New. Building Permit No. to ( Permit No. `)` DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No Trade Name L Size No �j Capacity Sq. Ft. E.D..R BTU H.P. Total Connected Load•' fes' Kind of Fuel BURNER — Trade Name Size No Capacity. (REMARKS—OVER) a z 2M 7.59 Sq. Ft. E.D.R BTU H.P. HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS Weatherstrips A.S.H.V.E. Guide Reference 19._ Windows and Doors---Crackage and Area Construction No. Width Height No. of Lineal ft. Area No. of pane of pane lights, of crack sq. ft. Windows Doors I 11 Out. Wall Int. Wall Ceiling I Roof I Floor Yes—No Yes—No 4-td Glass` Exp. wall 2 FI.I Room I Length y Width Height F1.1 Windows and Doors—Crackage ,Vidth Helght No. or Dane of pane and Area No. of Lineal ft. Area lights of crack sq. ft. .S Windows al Width No. of pane .Coef. Btu Infiltration Glass Exp. wall Net exp. wall & Int. wall Ceiling X Floor '2 - Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.1 Xle.Z Room ILength 12, Width f Height p Windows and Doors—Crackage and Area Room I Length—k WidthHeight No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. e a l 8 Windows and Doors---Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights, of crack sq. ft. Coef. Btu Infiltration ^ Coef. Btu Infiltration ' Net exp. wall 4-td Glass` Exp. wall 2 C 1 X t 26 C� Net exp. wall Int, wall .S Ceiling v ( AA Floor Total Btu. 12 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI.I ZTr 14 Room I Lenath -7 Width / >_ Heiuht Windows and Doors—Crackage and Area Room I Length—k Width Height No. of Lineal ft. Area No. of pane of Dane lights of crack sq. ft. e a l 8 Windows and Doors---Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights, of crack sq. ft. Coef. Btu Infiltration ^ 6 Glass Exp. wall ' Net exp. wall ef. Btu Int. wall Ceiling C� Floor 4 Kind Room ROSEVILLE, MINN. Insulation How Applied 1 Width Heigh z and Area dneal ft. Area of crack aq. ft. Btu Infiltration 244-11 Glass /IV, Exp. wall 10 ko Net exp. wall (448 Int. wall Ceiling 1 120 Floor 2 Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length—k Width Height Windows and Doors---Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights, of crack sq. ft. (0 A Infiltration 6 Class ' _ Exp. wall �( ef. Btu Infiltration Ceiling Floor Glass .S Exp. wall Net exp. wall Int. wall Ceiling f Floor 1962 --fl Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area n I t I. -r-- R.xtrrt I Length I r- Width 0 '�--Heistht Windows and Doors--Crackage and Area Width Height No. ofLineal ft. Area No. of pane of pane lights of crack sq. ft. A/ C� Coef. Btu Infiltration 6 Class ' _ Exp. wall �( Net exp. wall MIX Int. wall I i Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS ROSEVILLE, MINN. Weatherstrips A.S.H.V.E. Construction No. Insulation Guide Windows Is—No Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Yes—No Ye19_ F1.1 Room I Length Width Height FI.1 Room I Length Width Height Windows and Doors—Crackage and Area Windows -and Doors—Crackage and Area trV dth Helght No. of Lineal ft. Area No. of vane of pane llshta of crack aq. ft. Width Height No. of Lineal ft. Area �.Coef. Btu Infiltration (y -2-40-0 Glass Exp. wall fps t I 7. Net exp. wall Int. wall 0 Ceiling 1® Floor 'T' '/CD Total Btu. 14.1-160 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area f F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane llghta of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I FI. Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef: Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 1 Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI.I Room ( Length Width Height Windows and Doors—Crackage and Area Wldth Helght No. of Llneal ft. Area No. of Dane of Dane lights Lof crack sq. ft. Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area p°I.I Rnnm I Length Width Height Windows and Doors-Crackage and Area No. of Dane of pane lights of crack eq. ft. Coef. Btu Infiltration Glass Exp, wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI.I Room ( Length Width Height Windows and Doors—Crackage and Area Wldth Helght No. of Llneal ft. Area No. of Dane of Dane lights Lof crack sq. ft. Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area p°I.I Rnnm I Length Width Height Windows and Doors-Crackage and Area Width Height No. ofLineal ft. Area No. of pane of pane lights of crack aq. ft. Coef. Btu Infiltration Glass _ Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area City of Fridley Application for Plumbing and Gas Fitting Perndt Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Location � V&" 0000/v Number, Kind and Location of Fixtures y sZ z5 a�Z �j��i < 3 0U' •� 0U' Sn U' 0 O R N WATER HTR. GAS FIEC- Base Ist 2nd 3rd 4th • Future ConnectionOpel New Fixture, Old Opepinga 0innscted with Sewer w+ Cesspobl 14 PARTIAL RATE SCHEDULE _ PLUMBING FIXTURE RATES: NO. RATE TOTAL x Number Fixtures ....... x $1.50 $_ Future Fixture Opening x 1.20 $ -� New Fixture Old Ope,"hing .............. x 1.00 $ Catch Basin ...... ..................... x 3.25 $ Water Heater (Up to 200,000 BTU) ...... _ x 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: 1st 3 Fixtures .......................... Additional Fixtures .................... Gas Range to 200,000 BTU .............. REPAIRS & ALTERATIONS—Refer to Code NO. RATE TOTAL — x $1.50 $—�� — x .50 $ — x 2.00 $ City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Minn.AU C4 Z-- 19 Owner 80 16 Q 52—'e Kind of Building 1-7,,e /e A m L Used as u'JF'1—zr, To be completed about Estimated Cost, $ Old—New. Building Permit No -5 Permit No. / Signe -6iQ I IU IV �T A' C By �- Business Phone ROUGH cJ _ % a?' (0-3 FINAL Description ............................. $ ................... TOTAL FEE -9so-4 z 2M J SUBJECT PE NO. City of Fridley 13151 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT -NO. COMMUNITY DEVELOPMENT DIV.�� PROTECTIVE INSPECTION SEC. 1 ; � NUMBER REV. DATEPAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-560-3450 910-F15 8-22-75 JOB ADDRESS 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 5 1 iJIMOLA'ATT) T.AKF V= SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE EDWARD MaM 5948 WOODY ZANE N 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. OWNER 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 . USE OF BUILDING RESIDENCE 7 CLASS OF WORK ❑ NEW XX ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK CONSTRUCT DECK 9 CHANGEOFUSEFROM TO STIPULATIONS SEPERATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS, WA DnHING Before digging Call local utilities TELEPHONE - ELECTRIC - GAS Ete. REQUIRED BY LAIN 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 FRAME 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 $600 .50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERM IT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $5.00 PLAN CHECK FEE TOTAL FEE 5.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPE VALIDATE THIS IS. YOUR PERMIT 8-22-75 BLDG INSP a DATE SIGNATUAWNER(IF OWN BUILPENsr J :APPLICATION FOR. RkiSI"pL'NTIAL.,-ALTEIZATION, • OR ADDITION•BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA • OWNER'S NAt1E : C> BUILDER : ADDRESS: ADDRESS: STREET: � / o LOT _BLOCK: ADDITION.: %L G I—a•, e I frlr�a CORNER'LOT: INSIDE LOT:. ✓ SETBACK: SIMARD: Applicant attach to this fora ficvo Certificates -i£ Survey. -of Lot and.proposed building location czawn on these Certificates. r DESCRIPTION OF.BUILDING To Be Used As: Front: Depth Height: Square Feet:�O SO O Cubic . Feet : Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost:_� 4 To Be Completed: 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. DATE: �7 SIGNATURE: � .(See Reverse Side For Additional Information.)' 02, I . . CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL RATE TO'T'AL Furnace Shell and Duct Work, Burner (Also replacement furnace) $ 20.00 $ Gas Piping $ 10.00 $ (piping needed with new furnace) Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ * Air Conditioning (all sizes) $ 10.00 $ /0-00 All Others/Repairs and Alterations 1% of Value of Appliance or Work $ COMMERCIAL/INDUSTRIAL 1% of Value of Appliance or Work $ State Surcharge 1001 TOTAL FEE Reinspection Fee ($15.00) Rough Insp. Date Final Insp. Date Approval for Permit MINIMUM FEE FOR ANY HEATING PERMIT IS $15 -00 - PLUS $.50 STATE SURCHARGE *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. $ .50 s/5"50 Job Address Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 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 Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. OWNER KIND O Fridley, Minn. 11_� 0 , 19 eg-;e a USED AS TO BE COMPLETED ABOUT. ESTIMATED COST f Lo OLD - NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. (% Trade Name �t-j��t� Size No.7L,1(�� Capacity �� Sq. Ft. EDR BTU HP Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP a, 4 W_ * fii�,L I I 1 11 _ _:�" W_ i Companye Signed By 0_7 .-WWW& Tel. No. Fill out back side for stack verification on replacement furnaces Jr a CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; 1. Has been carefully examined Yes ( ) No ( ) 2. Is free from rust or deterioration Yes ( ) No ( ) 3. Has no foreign objects lodged within Yes ( ) No ( ) 4. Is securely supported Yes ( ) No ( ) 5. Meets all current Code requirements for size and total BTU connected Yes ( ) No ( ) 6. Has Total heating BTU's of All other BTU's TOTAL Rema rk s Company _ Signed By Date Engineering Sewer: Water Parks Streets Maintenance MEMORANDUM TO: William W. Burns, City Manager PW92-092 FROM: John G.- Flora, Public Works Director DATE:. April 3,.1992 SUBJECT:. Water Break On March 30, 1992, we became aware of a water break between the homes at 5948 and 5988 Woody Lane. The break was just beyond the cul-de-sac where the line runs between the properties and connects to Central Avenue. Our drawings showed the water line to be 5 -feet inside the easement and approximately 15 feet deep. This was of some concern because the home at 5948, owned by Mr. Zylka, was constructed apparently on the easement line and his. driveway access extended into the easement. The home had been constructed on 21 concrete blocks because of the filling in of the cul-de-sac, and the driveway was supported with a limestone retaining wall. The leak appeared to be at the closest, point to the home. On March 31 we started excavating in the area that we were able to determine as the approximate location of the break, and found that the soil was so saturated -it was collapsing, and the soil adjacent -to the Zylka home was settling. Accordingly, we stopped and contacted a contractor to install piling to protect the home and driveway structures, as an emergency action to restore water for the neighborhood. On April 1, Park Construction's large backhoe was retained to install the sheathing and dig the hole. We spent that entire day driving in 13 piles along the driveway and home. On Thursday, April 2, we drove some additional piling and excavated down. to the approximate location of the pipe. At that time we found the pipe was closer to the easement line then expected and running behind the sheathing that was installed. It also appeared that some of the sheathing could have been driven through the pipe. The sheath piles were relatively short because of the difficulty in driving them in the clay, the home was a major concern, the driveway retaining wall was cracking and moving, the break was not defined, and the hole was collapsing, so we abandoned the hole. We then moved up to. the cul-de-sac to dig down to the pipe and install a valve so that we could restore water service to eight of the nine homes on the street which have been without water since Monday. This was accomplished Thursday night. April 3, 1992 Page 2 As a temporary measure, we installed a surface line from the fire hydrant to 5988, the Peterson home. This they accepted until we could install a new line and reconnect it to the existing linea This should be accomplished next week. As an emergency action to restore full service, we propose to retain a jacking contractor to jack a new water line from the valve that was installed, through the hill, to a location where we can connect to the existing water line downstream of the homes. We will attempt to place the pipe in the center of the 30 -foot easement and locate it 8 -feet below the surface to eliminate the exceptional depth we have in that area. It is hoped that the total project can be completed by Wednesday. In regards to restoration, we propose to mud jack Mr. Zylka's driveway and replace the two sections of concrete sidewalk that were removed. Since there was considerable settlement and movement of the retaining wall, which may be on the easement, I will review whether or not he should replace the retaining wall for the driveway or if we should participate in that cost. Regarding the yard work and disruption of the Peterson property, we will restore the soil and seed it, and possibly provide them some landscaping timbers to replace those which were removed and damaged during the initial exploration. We would propose to complete the soil restoration as soon as possible and delay the driveway and sidewalk work until later this summer when all the soil has settled and recompacted. Of all the water breaks we have had in recent years, this is by far the most difficult because of the improper designation of the water location, the proximity to buildings, and the extensive depth of the line. As a result of these actions and our attempts to restore water service. to the residents on Woody Lane cul-de-sac, we request council to pass a motion for emergency expenditures from the Water Capital Improvement Utility Fund for these costs. JGF:cz CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1993 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 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 NO. RATE TOTAL Sump/Receiving Tank Water Treating Appliance Water Heater —Electric Water Heater — Gas Ga �//tel e v Gas Dryer Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4:00 $ 5.00 . $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.0011, e= $10.00 $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance •: ADDRESS ien, 41f 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 fads and representations stated in this application are true and correct. '1993 Owner Building Used Ash Estimated CosYeCP eelt �� PERMIT NO. �� PLUMBING COMPANY SIGNED BY gj� TEL N0. Approved By ,� r='--- 'aRough—In Date Final Date State Surcharge $ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 TOTAL FEE $-�PLUS THE $.50 STATE SURCHARGE -ITY OF FRIDLEY INSPECTION DIV. 1431 University Ave NE 'ridley, MN 55432 763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 �r APPLICATION FOR PLUMBING AND GAS FITTING PERMIT�01 1 MAKK NUM13E1K OF t-IXi UKES TO BE INSTALLED ON EACH FLOOR TOTAL ' s .... Urinal ...... Shower Wash Tra �::�:......... Floor Drain�Washe ....:Auto. G8s .: Ran e $10.00 Water.Hea Heater and rulings of the Building Division, and hereby declares that all the facts lecSto Gas Basemen and representations stated in this application are true and correct. :atch Basin $10.00 fain Water Leader $10.00 HUYNH, TRIEU 205948 WOODY LANE NORTHEAST % D J� >ump/Receiving Tank Floor 1 FRIDLEY, MN 55432 Vater Treating Appliance $35.00 OWNER (763) 574-2331 Vater Heater -Electric $35.00 Vater Heater - Gas** Floor 2 11 BUILDING USED ASS l o► e,�, tc Sas Range** $10.00 aas Dryer** $10.00 ESTIMATED COST q6 orD PERMIT NO. lack Flow Preventer Required ( )Yes () No Floor 3 NO \0 Type $15.00 PLUMBING COMPANY C 1N� U,w, br teinspection Fee $50.00/Hr Floor 4 kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By Rough -In Date Final Date ILUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS�nnn¢ aS o'I.JV�ni dew Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein )Id Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes leer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the facts flow Off Basin $10.00 and representations stated in this application are true and correct. :atch Basin $10.00 fain Water Leader $10.00 HUYNH, TRIEU 205948 WOODY LANE NORTHEAST % D J� >ump/Receiving Tank $10.00 FRIDLEY, MN 55432 Vater Treating Appliance $35.00 OWNER (763) 574-2331 Vater Heater -Electric $35.00 Vater Heater - Gas** $35.00 11 BUILDING USED ASS l o► e,�, tc Sas Range** $10.00 aas Dryer** $10.00 ESTIMATED COST q6 orD PERMIT NO. lack Flow Preventer Required ( )Yes () No NO \0 Type $15.00 PLUMBING COMPANY C 1N� U,w, br teinspection Fee $50.00/Hr SIGNED BY TEL N0. Aa 12) 827—clo 3 kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge $ MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST TOTAL FEE $ OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. ;OMBUSTION 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 replacina 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 O 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 existina 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 :