PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N® 4151
Date: ....._._.®�._.,.._-.----......._...._..
Owner: -------------------------- -..........._....----------------- .............._---- —-------------- ---------------- Builder 1 .._-------
f..___..
Address
Address
OCATI N OF B�JILDING
No........ .:N Street .... .-' � - - -------.._....!2. ......................................... Part of Lot .......... ......... ........
_..._.._........ .... .................
�._
Lot ..................... Block .----....P < ................ Addition or Sub -Division ..._._.
Corner Lot .................................... Inside Lot..X............................. Setback .-.._...................................... Sid -............._............._....... - --------------------
Sewer Elevation ..... . ............. _..................... ....... _........ ....._................. ..................... Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
A- ._......:.... FrontR Depth 99.4- Height Id Sq. Ft. . Cu. Ft. _.. I..._�
..... .................................................... Front ..... _................. Depth ...................._.. Height ..... ............. ._.. Sq. Ft. ...................... Cu. Ft. ..... _.................
Type of Construction ........................... ............... --............. Est. Cost ....1 ... ... ..... To be Completed . ................... .............. _... :............
In consideration of the issuance to me of a permit to construct the building de 'bed above, I agree to do
the proposed work in accordance with the description above set forth in com ce with all provisions of
ordinances of the city of Fridley. /I
/l
In consideration of the payment of a fee of $42a.... ......, 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 part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. ,/'
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
4
CITY OF FRIDLEY
APPLICATION FOR HEATING REPLACEMENT
CHIMNEY AND STACK VERIFICATION
THIS FORM MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM.
LOCATION gaz��al �I �� _ DATE
OWNER ADDRESS
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined
2. Is free from rust or deterioration
3. No foreign objects are lodged within
4. That it is securely supported
S. That it greets all current Code requirements
for size and total BTU connected
6. Total Heating BTU
All Other BTU
REMARKS
TOTAL
4 —1 ®J '& �%l Z'* `
HEATING PERMIT #
i
SIGNED
Licensdd
FRANK'S HTG- & AIR CONDITIONING INC.
by a i nZ r%21dnrni2 Sor92 b U
MINNEAPOLIS, MINNESOTA 55418
Address Phone 781-8636
Telephone
Fridley City License #�
SUBJECT
PERMIT NO.
City of Fridley
.14'710
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
;.
ECEIPT NO .
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.j
/6
1
/ (�
;
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
,'j 612-560-3450
910-F15
5/17/78
JOB ADDRESS 4531 - 2nd Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
11
2
Rearrange. of Blks. 13,14,15, Plymouth SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Edwin H.. Hoglund 4531 - 2nd Street N.E.
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 Ek ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
Asphalt
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT 1 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.
$900
$� 50
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$8.00
SI" ATURE OF CONTRACTO ORAU HORIZED AGE T (DATE)
WHEN PROPERLY VA ATED THIS IS YOUR PERMIT
I Y&�URE
IIF OW ER DER) IDATEI
BLDG INSP DATE
CITY 01" f=RIDLEY
APPLICATION FOR RES1llENTIAL BUIL-DING PERMITS
MEW, ALTERATIns, ADDITIONS, OR REPAIRS)
01111ER• MILDER:
Address: Address:
Tel. 11o.
110. Street :
LOT: BLOCK: _ q,TrfiU �
COMER LOT: IUSIDE LOT: SET13ACK: `SIDEYIIRDS:
Applicant attach 'to this form IiVo Certificate_ of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUI LDI !IG
Be Used As:
Front:
Square Feet:
Depth: Height:
Cubic Feet:
Front: Depth: Height:
Square Feet: -r-' Cubic Feet:
Uype of Construction: q� � 1 Estimated Cost: $
To Be Completed: Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the work herein
specified, agrocing.to do all work in strict accordance with the City of
Fridley Ordinz.nccs and rulings of the Dct�artment of 13uildings, and hereby
declares that all the facts and representations stated in this application
are true and correct. See reverse side for additional information.
llAT)r: � ! SxGI�i1TUR1::
Stipulations:
P
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
RESIDENTIAL
Furnace Shell and Duct Mork,
Burner (Also replacement furnace)
Gas Piping
(piping needed with now furnacs)
Gas Range
Gem Dryer
a Air Conditioning (all aizeo)
RATE TOTAL
$ 20.00 S
$ 10.00 $ �
$ 10.00 $
$ 10.00 S
All Others/Repairs and Alterations
It of Value of Appliance or Work
COIMERCIAL/INDUSTRIAL
1s of Value of Appliance or Work
$ 10.00 $
State Surcharge
Reinspection Fee (SIS.00)
Rough Insp.
ate
Final Insp.
Date
Approval for Permit IV4-,y
MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00
PLUS $.50 STATE SURCI(ARGE
S
S
Attach stack verification forte with replacement furnace I.ermits
*Air Conditioner9 can tint to placed in %ids- yard without
written permission from adtotninq nrttgtd+or.
a
Effective Aug. 1. 19"1
Job Address ? 4�
Department of Buildings, 6171 University Ave. N.E., Fridley, lel SS472
City of Fridley
Tel. 1571-3450
The undersiqned hereby naked application for a permit for the work heroin
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.
Fridley, Minn. , 19491e-'�
�) 4
OWNER
RIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT //—
ESTIMATED COST GCJ(� e-
-
olj) - NEM BUILDING PERMIT ND. PERMIT NO.
DESCRIPTION OF FURNACE/sUIXER
HEATING or POWER PLANTS, Steam, Not Nater, 4tm Air- Na
Trade Now
Capacity Sq. Ft. EDR fjnj2&V9TU
' s NP
Total Connected load Rind of Fuel
BURNER - Trade Name Size No. czz' Lou
Capacity Sq. Ft. Eon BTU IIP
Company FRANK'S HTG. & AIR CONDITIONING INC.
Signed By MINNEAPOLIS. MINNESOTA 55418
CITY OF FRIDLEY INSPECTION DIV.
Effective On January 1, 1997
6431 University Ave NE
Fridley, MN 55432
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENT1LATlON,
572-3604
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES 2��ti, q
JOB ADDRESS '4511 Z n Of'Eik n `� .
RATE SCHEDULE
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
Fumace Shell and Duct Work, Burner —
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace
Vent — Fill Out Back)P(1-
$30.00
$.�
representations stated in this application are true and correct.
(Side
Gas Piping (Needed with new furnace) $10.00
$
1 9
� KOJ
OWNER V aL o�� i m _Z &a2!,--
a2!,.Gas
GasRange
$10•00
$
ha)
BUILDING USED AS r n M
Gas Dryer
$10.00
$
ESTIMATED COST QO l� PERMIT NO.
*Air Conditioning —All Sizes
$ 25.00
. $
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (UST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
State Surcharge
TOTAL FEE
$ .50
s30 -Sb
MINIMUM FEE FOR ANY HEATING/COOUNGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
No. of Heating Units Circle One (St
Trade Name Ruud
BTU -1!5 A HP
Fuel Total Connected Load
am) (Hot Water) arm Air)
Size No. (A PI}O7E.l4Qq-,(Z,
EDR
Burner Trade Name
BTU
Size No.
EDR
HEATING COMPANY 11e� C�` �� [I'1Pa�e 7;�ZC
Signed By �� Tel No.
Approved By Rough—In Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
Remarks: .
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
- 11`fe
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 (-f No ( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes (,No ( )
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7.
Has a liner been provided for water heater
Yes ( ) No ( )
8.
Has combustion air been provided for water heater
Yes ( ) No ( )
Remarks: .
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
- 11`fe
SUBJECT
P
City of Fridley
3 3 210
AT THE TOP OF THE TWINS
BUILDING PERMIT
r '
1
-------COMMUNITY DEVELOPMENT DIV.
i
RECEIPT NO.
ri
v
r PROTECTIVE INSPECTION SEC.
� �
NUMBERDATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55032
763-571-3450
910415
Ll
10/24/02
j
JOB ADDRESS 4531 2 Street NE
1 LEGAL
LOT NO,
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DIE
11
2
Plymouth Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Zina & Vladimir Rolosov 4531 2 Street NE
763-502-0476
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
)FJ ADDITION ❑ ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 15' x
�2' Deck
9 CHANGE OF USE FROM
TO
STIPULATIONS
See nota
ions on plan.
WAI?lf pjw�'
SefOre digging
call top
all "ty 0c tions
Rt:QUIFIED fly LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIREO F R 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 WI HIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMEN ED.
D.
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE REA AND EXAMINED THIS APPLICATION
1
STALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AN CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS OF WORK WILL BE COMPLIED
$1.12
WITH WHETHER SPECIFIED HEREIN 0 NOT. THE GRANTING OF A PERMIT
$2,235
DOES NOT PRESUME TO GIVE AUTH RITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE R LOCAL LAW REGULATING CON-
$83.25
Fire SC $2.24
STRUCTION OR THE PERFORMANCE F CONSTRUCTION
PLAN CHEC
TOTAL FEE
$86.61
SIGNATURE OF CON'RACTOR OR AUTH RIZEO AGENT iOATEE'
E PR LY VALJOATED
THIS IS YOUR 5rAMIT
X_
$.GN U OF WNERiF QVUNER BUIL ERi IDATEi
LOG INS
f�AT
NEW [) CITY OF FRIDLEY
ADON (j 6.431 University Ave NE, Fridley. MN 55432
ALTER (J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: -'l 1,, Fadi A
Legal Description:
Owner Name & Address:
/NOL Q Tel. #
Contractor. MN LICENSE #
Address: -1eV Tel. #
Effective 1/12002
(763) 572.3604 Bldg Insp
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 a Sq. Ft
DECK AREA: Length A< Width / H t/Ground Ft
OTHER:
o �
Construction Type:/�I Estimated Cost: $ C;e� 3 ��
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ ---=$
0u
DATE: �� "" 1Z �� APPLICANT: �, �� Tel. #76 f
Call (763) 572-3604 for Permit Fees if mailing in application or 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
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 per SAC Unit
$5.00 (State Licensed Residerital Contractors)
Alt. "A or Alt. 'B" Above
$450.00 Conservation Plan Review
Fee Determined by•Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ a(� STIPULATIONS:
Is
sueJEcr
ERMIT NO.
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
PERMIT
337
RECEIPT NO.
______ COMMUNITY DEVELOPMENT DIV.
I -
�r `®�
L
r PROTECTIVE INSPECTION SEC.
,
NUMBER
REV
DATE
PAGE OF
APPROVED By
_
CITY HALL FRIDLEY 55432
A ".j 763-571-3450
910415
8/1/03
JOB ADDRESS 4531 2nd St NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
11
2
Plymouth Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Vladimer Kolosov, 4531 2nd St NE, Fridley, MN 55421
763-
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Ilyas Construction Co, 17020 9th Ave N, Plymouth, MN 55447 612-282-9644
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
20159642
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
IMMMKIilKIE4 Residential
7 CLASS OF WORK
1 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Re-roof (tear-off) - 12 sq.
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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
$.69
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,389.00
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMITTEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
Fi9p SC $1.39
STRUCTION OR THE PER CDIISTRUCTION
X $50.95
PLAN CHECK FEE
AL FEE
$5.0 c e n
;$r5 8.03
SIGNATURE OF CON 'R TOR OR AUTHORi2E0 AGENT [DATE,
E PR
VALIDAIED THIS IS Y UR PERMIT
r
S,GNATURE OF OWNER..F OWNER BUILDER, [DATE,
B G [NSR .
f)AYE
Is
NEW [ ] CITY OF FRIDLEY Effective 1/1/2003
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 5714287 Fax
BUILDING PERMIT APPLICATION
Construction Address:
a
Legal Description:
Owner Name & Address: (f I a Lo Cn e -o y Tel. #
Contractor. �-� C&' `STQ �� MN LICENSE # 6/�� `�-01S �l2
Address: /'�D U � � e. . raXAA (9LAL Tel. # (tel l 1?6 C/ °
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction
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.
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: �" 1 ®�% APPLICANT:_ Tel. # 6 3 3
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
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$
$ a
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 [ ]
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-3604 VAX: (763) 571-1287
ADDRESS 4531 2ND ST NE
PIN 263024330111
LEGAL DESC REAR BL 13,14 & 15 PLYMOUTH
LOT 11 BLOCK 2
PERMIT TYPE HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
Ta
PERMIT NO 2004-0038
DATE IS3Uji,-D: 30 /25/2004 F
VALUATION
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER.
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A
INSTALLED DRYER WITH 1/2 INCH COPPER
# A/C UNITS
#FURNACES
# GAS RANGES
APPLICANT
CENTERPOINT ENERGY/NIINNEGASCO
13562 CENTRAL AVE NE
ANOKA, MN 55304-
(763)757-6202
OWNER
KOLOSOV VLADIMIR F & ZINA P
4531 2ND ST NE
FRIDLEY, MN 55421
0 VALUE OF APPL OR WORK 218
0 # GAS DRYERS 1
0
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wort
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construc#,on or the performance of construction.
Bldg Insp
HEATING PERMIT MINIMUM FEE
25.00
FURNACE SHELL/DUCT WORK
0.00
GAS PIPING FEE
0.00
GAS RANGE FEE
0.00
GAS DRYER FEE
0.00
AIR CONDITIONING FEE
0.00
HEATING REPAIRS/ALTERATIONS
0.00
STATE SURCHARGE, MECH FLAT
0.50
TOTAL
25.50
PAID WITH CHECK # 1004748
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CIN OF FRIDLEY INSPECTION DIV.
muecuve vn MUgUbL 1, IJJO
X431 University Ave NE
Fridley, MN 554.32 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND
AIR CONDITIONING SYSYEMS AND DEVICES
v I V
JOB ADDRESS
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work herein
Rate
TOTAL
specified agreeing to do all work in strict accordance with the City Codes and
Residential
rulings of the Building Division, and hereby declares that all the facts and
Furnace Shell and Duct Work, Burner —
$ 30.00
$
representations stated in this application are true and correct.
Also Replacement Furnace
1 dt� 95
(Side Vent —Fill Out Back)
Gas Piping (Needed with new furnace) $ 10.00
$
OWNER
—,--Gas Range $10.00
$
S
.BUILDING USED AS-'
Gas Dryer $1040
$
� �(�®�/ '�L�
ESTIMATED COST l � PERMIT NO.
*Air Conditioning — All Sizes $ 25.00
$
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
$
No. of Heating Units One (Steam) (Hat Water) (Warm Air)
1'/0 of Value of Appliance or Work
_Circle
Trade Name Size No.
Commercial/Industrial
$
BTU HP EDR
Fuel Total Connected Load
1.25% of Value of Appliance or Work
State Surcharge
X50
Burner Trade Name Size No.
FEE
r
BTU HP EDR
TOTAL
HEATING COMP NY
MINIMUM FEE FOR' ANY HEATING/COOLINGNENTILATION
Tel No.
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
Signed 8y
PLUS THE $ 50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
Approve Rough—In Date Final Date
*Air Conditioners can not be placed in a side yard without
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
written permission from adjoining property owner.
REPLACEMENT FURNACE
Remarks:
List ALTERATIONS Being Done
HEATING CO: r
Signed By:
Date:
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's connected
Yes ( )
No ( )
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7.
Has a liner been provided for water heater
Yes O
No O ,
8.
Has combustion air been provided for water heater
Yes ()
No ( )
Remarks:
List ALTERATIONS Being Done
HEATING CO: r
Signed By:
Date: