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PRE 2010 DOCSCity of Fridley, NUnn. No 10042 BUILDING PERMIT Date: Nov. 27, 1668 Owner: Robert DeGardner Builder Same Address 7950 East River Road Address Sam_ LOCATION OF BUILDING No. 5940-42 Street 2nd S t . N. E. part of Lot Lot . 3 & 4 Block 9 Addition or Sub -Division _T4ydp Park Adan Corner Lot — Inside Lot __._ x Setback 35 Sideyard ._ 91811 Sewer Elevation 846.57 850.A7 Top of Footing To be Used as: Dwelling (Doublet 3218" Dept 28' Height 20' Sq. F.t. 997 Cu. Ft, _38,840 Garage ^ Front 14' Depth 22 ' Leight 10' Sq. Ft. 616 Cu. Ft. 516.0 Type of Construction Frame Fist. Cost 22 000 __ To be Completed Sewer Location - 175' N. of Manhole Water Location - 165' N. of Manhole 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 sein compliance with all provisions of ordinances of the city of Fridley. ' � J $ /57 150.00 Sewer Connection Charge In consideration of the payment of a fee of $ 69.00 ,permit is hereby granted to_.. Robert DeGardner 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 Clarence Belisle NOTICE: Tlds permit does not cover the consfrndion, installation for wiring, Plumbing, gas beating, sewer or wafer. Be mre to nes the Building inspector for separate permits for thews items. r APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA LOCATION OF BUILDING N0. , V#y' a. i/—STREET 2 LOT_j n tl BLOCK ADDITION OR SUBDIVISION CORDS LOT INSIDE LOT_ff_SETBACK JS SIDEYARD a P of SEWER ELEVATION TOP OF FOOTING Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: .- Front fig$% Depth�� Height 20 Square feet 7 �12 Cubic Feet 17911® Front isle Depth 271.1 Height 10 Square feet Cubic Feet A/4 6 Type of Construction Estimated Cost 2- Z4 a-&4 To Be Completed 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 than Department of Buildings, and hereby declares that all the facts and iwiresentations stated in this application are true and correct. _ DATE Z/&L- -2.G,/q a S/ SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side.) PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...... ...... /f/ x $2.00 $ Future Fixture Opening .. .... ...... x $1.50 $ New fixture Old Opening ..... x $1.50 $ Catch Basin ... ........ .. x $3.25 $ Water Heater (Up to 99,000 BTU) .... �" x $3.00 ■MOEN ' New Ground Run Old Bldg. ... .... x $3.25 $ Electric Water Heater a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL lot 3 Fixtures ...... .................. x $2.00 $-- Additional Fixtures .................. x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ IN0 MEN OEM N ■M PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...... ...... /f/ x $2.00 $ Future Fixture Opening .. .... ...... x $1.50 $ New fixture Old Opening ..... x $1.50 $ Catch Basin ... ........ .. x $3.25 $ Water Heater (Up to 99,000 BTU) .... �" x $3.00 $ ' New Ground Run Old Bldg. ... .... x $3.25 $ Electric Water Heater a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL lot 3 Fixtures ...... .................. x $2.00 $-- Additional Fixtures .................. x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ IMPAIRS & ALTERATIONS—Refer to Code Description...............................................$ TOTAL FEE $ 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 a OwnerRa���z per 2 Kind of Building ---' Used as 411 To be completed about 1�c-- Estimated Cost, $d �! Old—New. Building Permit No. « U ®mit a40.�� Signed�9�. l By Business Phone Z Ax er ROUGH rINAL :i'` 7 111 0 X Application for Power Plants and Heating. Cooling. Ventilation. Refrigeration and Air Conditioning Systems and Devices R PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone 560-3450 GRAVITY WARM AIR: RATE 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 $ MECH. WARM AIR 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 ...................... 3.00 $ Each add. 320 sq. ft. EDR Hot Water .................. 3.00 $ OIL BURNER—to 3 gal. per hour ........................ 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTU) ....................... 5.00 $_ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures / x$ 2.00 $� Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL See Fee Schedule $ TOTAL FEE $ RV- 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 facts and representations stated in this application are true and correct. Owner Kind of Building ,mss- m Used as To be completed about Estimated Cost, $� Old Ne . Building Permit No. Permit No.—!!a-O' e M10-* 4043rMt� • I HEATING or PONnM PLANTS -Steam, Hot Water, ' NO_ Trade Name `��"'tj� Size No- Capacity o Capacity Sq. Ft. E.D.R d BTU H.P. Total Connected Load ��� f 60r') Kind of Fuel BURNER — Trade Name �'✓ Size Capacity. (REMARKS—OVER) Sq. Ft. E.D.R BTU H.P. Si"Y M WELTER HEATING -CO. 4637 CHICA120 AVE. By Business Phone No. Windows and oors—Crackage and Area _ Width No. of pane Height of pane HEAT LOSS CALCULATIONS DEPAR m T OF BUILDINGS t Area sq. ft. Weatherstrips A.S.H.V.E. Guide Construction No. C W' dows Doors Reference (gut. Wall Int. Wall Ceiling Floor— Glass e —No � _ es :No Btu Infiltration Glass 7; Z — --- --- _ ----______--- G Fl.! L ; ,� ," _19._ _, Room 0 Length / 7 Width /1 ` Height X `- II '--)- FI.I 1-:3,-A Room i Length Windows and oors—Crackage and Area _ Width No. of pane Height of pane No. of Lineal ft. light:+ of crack Area sq. ft. Area sq. ft. d /[_ Infiltration Glass Coef. Btu Infiltration Glass 7; Z f —67--K FAp. wall ��( G 3 C. _Int. wall _ _ Net exp. wall / Ceiling Floor Int. wall _ — _CJass Exp. wall 3 x b CJ Ceiling 2 --- Net exp. wall Int. wall _-- l6 Floor i i 6 30 T C;- 7 Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Ceiling - / FI.If it Y * Room I Length Al, -L- Width Y' Height ;S" ._ I Windows and Doors--Crackage and Area q _ Width No. of pane Height of pane No. of Lineal ft. lights. of crack Area sq. ft. Area sq. ft. d /[_ Infiltration Glass Coef. Btu _ Infiltration Glass 7; Z Coef. Exp. wall' y ©0 3 C. _Int. wall Net exp. wall Infiltration _ -- Ceiling Floor Int. wall _ — _CJass Exp. wall 3 x b CJ Ceiling --- Net exp. wall Int. wall _-- l6 Floor 6 30 Ceiling X Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Ceiling - r 'V Fl.l l'SZt-O'. Room I LenRth Width >J Heifzht 2%- -/ I Windows and Doors—Crackage and Area q _ No. Width of pane Height No. of of pane lights Lineal ft. of crack Area sq. ft. Area sq. ft. Infiltration Glass Coef. Btu _ 7; Z Coef. Btu Infiltration 3 C. _Int. wall 3 6 Infiltration _ -- Ceiling Floor 5-70 _ — _CJass Exp. wall 3 x b CJ ' 0 _ _Glas:s_y Exp. wall;j�� Net exp. %vall v_ _ Net exp. wall Int. wall _-- l6 ((/ 6 30 Ceiling X _ dotal L3tu. Ceiling - Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area ( L/ �_--f- IL Insulation How Appli 7`= Width 0 Heistht Windows and Doors—_-Crackage and Area .Bidth of pane No_. Width of pane Height of pane No. of lights Lineal ft. of crack Area sq. ft. Infiltration Glass Coef. Btu _ 7; Z Net exp. wall /` --C� _Int. wall Coef. Btu Infiltration _ -- Ceiling Floor 5-70 _ — CJ ' 0 _ _Glas:s_y Exp. wall;j�� Net exp. %vall v_ _ . } L (/ l6 Lf Za Int. Wall i _ dotal L3tu. Ceiling - _Floor Total Btu. iRey.tired sq. ft. E.D.R. or seg. ins. W.A. I.Aaaler area Windows and Doors—Crarkage_a_n_d Area .Bidth of pane -pT No. - Width Height ( of Dnne— of p�.ne I Flits I of crack �I oq. tt. Infiltration Glass Coef. Btu Infiltration 7; Z Net exp. wall _Int. wall _ E.xpwail Net exp. Wali Ceiling Floor Int. wall_ Total Btu. yRequired sq. ft. E.D.R. or sq. ins. W.A. Leader area 1" loor _ dotal L3tu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area l.� Room l Length _ Width Windows and and Area No. .Bidth of pane HaFt, h0. of palke Ro. of lights Llneel ft. of crack Area sq. It. Coef. Btu Infiltration Glass Exp. Wall Net exp. wall _Int. wall Ceiling Floor Et Total Btu. yRequired sq. ft. E.D.R. or sq. ins. W.A. Leader area Original PERMIT for Power ants and Heating. Cool- ing, Ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of__ Heating Plants to be 4 tape ltered—repaired Make^� ®� ��,s , Size— Oil ize Oil fared—, Coal fired ; Gas fired ; Gas Authorization No. Remarks Z, Approved Final Inspection 19_ Inspector Pest N° 4359 Fee$ad Office of the Inspector of Buildings City of Fridley City of Fridley, Minn.. , 19.0 Owner 6 ., Location N�;E9'/ Kind of Building How Occupied Work to be Commenced s - —4u-, 19-L-, To be Completed �-� ,19-4--Z Estimated Cost, $ /Q 90 ° 4--.0 Old -New, Building Permit No. / ®. Permission is hereby granted to 4 • & to install—erect—use the material and devices described in the above statement. This permit is granted upo t express condition that the pefson to whom�it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the speca . ns set forth in the approved application for this permit on file in the office of the Inspector of Buildings. z2. , Inspector of Buildings 4P ZM 11-67 V N? 4808 Original Permit forPLUMBINGM 1��d�-- N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for Pen e $ inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit., Fee DESCRIPTION OF WOR} II Number, Kind and Location of Fixtures ) ,�tOT1P,H F O a J 3 0 Z ❑ t=- m Q O m r m m d m Y Z m m¢ d 3 r I- Z O O ❑ a of O Z N I O J a❑ = N y Q d u m Z a d❑ a s X E O a d a W m Z d d WATER HTR. GAS ELEC. Basement 1st 2nd �. 3rd 4th Connected with Sewer Cesspool Cas Piping for � Openings Permission is hereby granted to do the plumbing and gas fitting in the building described in the stateme9t hereto attached, upon the express condition that the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and this permit may be revoked at any time upon the violation of any of the provisions of said ordinances. By Order Of The Inspector Of Buildings .Roughing in Inspection Inspector. Final Inspection Date Inspector. -09E- a z t M -6.65-V City of Fridley .-� Owner 'a' Location 5948 --?7 j Kind of Build ing_2 ft�� Used asp " To be Comple 010j , i9 -k-9 Estimated Cost $ /Roy • '-_4 Old -New. Building Permit No. / 57 0�� Date Inspector of Buildings. 879.01 City of Fridley ApplcMiz@ Dept. of Bldge. Phone 560-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures L 591!0 NE. 2 Street 5912 BE. 2 Street PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...... x $2.00 $ Future Fixture Opening ......... ...... x $1.50 $ New Fixture Old Opening ...... . .. x $1.50 $ Catch Basin ... I ... I ........ .. x $3.25 $ Water Beater (Up to 99,000 BTU) .... x $3.00 $ New Ground Run Old Bldg. . ... .... x $3,25 $ Electric Water Heater z $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $2.00 t—L 00 Additional Fixtures . .................. —x$.75 $ Gas Range to 199,000 BTU .............. 2 x $5.00 $ 6.00 OEM M N NONE M NONE 10 M! W PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...... x $2.00 $ Future Fixture Opening ......... ...... x $1.50 $ New Fixture Old Opening ...... . .. x $1.50 $ Catch Basin ... I ... I ........ .. x $3.25 $ Water Beater (Up to 99,000 BTU) .... x $3.00 $ New Ground Run Old Bldg. . ... .... x $3,25 $ Electric Water Heater z $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $2.00 t—L 00 Additional Fixtures . .................. —x$.75 $ Gas Range to 199,000 BTU .............. 2 x $5.00 $ 6.00 ALTERATIONS—Refer to Code Description ................................................$ TOTAL mm 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, 11liinn MAY 2 2 1969 ls_ Owner D. E. Gardner % D. E. Gardner Kind of Building Frame Used as Residence To be completed about --MAY 2 7 1969 Estimated Cost, $ 5.00 Each Old—New7Building Permit No. Permit No.— sign MINNEAPOLIS S CO, Q - BusinessPhone ROUGH FINAL (o IC ' ?G 52-84--s915.51 PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...... x $2.00 $ Future Fixture Opening ......... .... x $1.50 $ New Fixture Old Opening ....... x $1.50 $ Catch Basin .. ...... .... .. x $3.25 $ Water Heater (Up to 99,000 BTU) ...... x $3.00 $ New Ground Run Old Bldg. ... ... x $3.25 $ Electric Water Heater x $2.00 $ OAS FITTING NO. RATE TOTAL 1st 3 Fixtures ................... I...... x $2.00 $ Additional Fixtures . .......... :....... —x$.75 $ Gas Range to 199,000 BTU .............. x $5.00 $ Gas Dryer 1 5.00 NOME PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...... x $2.00 $ Future Fixture Opening ......... .... x $1.50 $ New Fixture Old Opening ....... x $1.50 $ Catch Basin .. ...... .... .. x $3.25 $ Water Heater (Up to 99,000 BTU) ...... x $3.00 $ New Ground Run Old Bldg. ... ... x $3.25 $ Electric Water Heater x $2.00 $ OAS FITTING NO. RATE TOTAL 1st 3 Fixtures ................... I...... x $2.00 $ Additional Fixtures . .......... :....... —x$.75 $ Gas Range to 199,000 BTU .............. x $5.00 $ Gas Dryer 1 5.00 REPAIRS Fa ALTERATION --Refer to Code Description ...............................................$ TOTAL. FEE $--:5:,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 7-1849 .19 Owner R HOsman Kind of Building frame res Used as To be completed about 7-23-69 Estimated Cost, $ 10.00 Ll J Old—New. Building Permit No. Peami c._ `�t q a By m&POLIS GAS CO. Business Phone No ROUGH FINAL U - 1 ' 1 L' s 53.48h-8915.51 City of Fridley AppllicaAm for Moddag and Dept. of Bldgs. Picone 980-3M DESCRIPTION OF WORK Number. Kind and Location of Fixtures Q I TER M 1,11111 Is IC ®! I4 ®It� I< �t�9 I(79 I P I N I GAS STR. Base 1st Bawer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RITES: NO. RATE TOTAL Number Fixtures ................ x $2.00 $ Future Fixture Opening ............ x $1.50 $-- _New New Fixture Old Opening .......... x $1.50 $ Catch Basin .................... x $3.25 $ Water Heater ;Up to 99,000 BTU)... • x $3.00 $ New Ground Run Old Bldg. ........ x $3.25 $ Electric Water Heater .............. x $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures . • .............. x $200 $ Additional Fixtures .................. x $ .75 $ Gas Range to 199,000 BTU.. •....... x $5.00 $ Gas Dryer 1 5.00 REPAIRS & ALTERATIONS—Reser 20 Code Description .........................> .................... # 5.00 TOTAL FEE $ Location.- 5940 N E 2nd St 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 an the fact and representations stated in this application are true and correct Fridley, Minn 10-9-70 19, Owner Nobt hosmen Kind of Building f rame Used as res To be completed about 10-14-70 Estimated Cost, $ 10.00 Old—New. Building Permit No. Permit'42 o '01 Sign Sign G% n MINN By FA ti Business Phone No ROUGH GIT`! OF FRIDLEN i r�. SPECTION DIV. F_Yi�c:rd s On January 1, 1 96 6431 University Alve NE t Fridley, SAN 5W�.' �P������ �l_t�t,6�F�Br_ E- ,�.r GAS FITTING PERMIT 572-3604 Gas Llec a <a/"Y `Cc ��r�,1 Yfo5m AAJ 1c)3co) 9 CIiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 January 18, 2001 Robert Hosman 281 Sylvan. Lane NE Fridley, MN 55432 Re: Final Inspection at 5942 2nd Street NE Contractor: R A Johnson & Son Dear Mr. Hosman: A plumbing permit was issued on October 19, 1998 to install a gas water heater at the above noted address. According to Section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the plumbing authorized by this permit. As of this date no inspection has been called for. The permit fee that was paid covers the inspector's time to check to make sure the water heater was installed correctly, that the State Plumbing Code has been complied with for installation of combustion air for fuel burning appliance, and that the vent has been sized correctly with the correct vent connectors. You will be given thirty (30) days from receipt of this notice to respond. If we do not hear from you, we will expire the permit and any inspections on this installation will require a new permit. Please contact me at (763) 572-3603 if you have any questions concerning this matter. Sincerely, y L-Iftr— DAVE SEN Build' Inspector DJ/mh CITY OF FRIDLEY PERMIT NO.: 2004-00246�� 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 02/20/2004 572-3604 FAX: (763)571-1287 ADDRESS 5942 2ND ST NE PIN 233024220071 LEGAL DESC HYDE PARK LOT 3 BLOCK 9 PERMIT TYPE HEATING PROPERTY TYPE : DUPLEXES CONSTRUCTION TYPE : ADDITION/ALTERATION 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 REPLACE FURNACE (WARM AIR, TRANS, 60,000 BTU'S) # A/C UNITS 0 VALUE OF APPL OR WORK # FURNACES 1 # GAS DRYERS # GAS RANGES APPLICANT TOTAL COMFORT 12800 HWY 55 PLYMOUTH, MN 55441- (763) 383-8383 OWNER HOSMAN ROBERT A & JANE I 281 SYLVAN LN FRIDLEY, MN 55432 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 worl 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 constr#ction or the performance of construction. Bldg HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK GAS RANGE FEE GAS DRYER FEE AIR CONDITIONING FEE HEATING REPAIRS/ALTERATIONS STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 37111 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0 0 0.00 30.00 0.00 0.00 0.00 0.00 0.50 30.50 CITY OF FRIDLEY INSPECTION DIViSION ,,b431 University Ave NE Fridley, MN 55432 APPLICATIOPOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIMATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRES�.� RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner . Also Replacement Furnace (Side Vent • Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work i Rate i $0.00 0.00 $10.00 State Surchai TOTAL FEE M M MINIMUM FEE FOR ANY HEATING/COOLING/VE DILATION REFRIGERATION/AIR CONDITIONING PERMIT IS X5.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard written permission from adjoining property owner TOTAL $_M OWNE BUILDING USED ff Effective On January 1, 2002 e ESTIMATED COST ��C PERMIT NO.';;�,'J = E DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) ( of Water (Warm Air $ Trade Name �zA'4 Size No.W__ _BTU -I Hp EDR $ Fuel Total Connected Load Burner Trade Name Size No. $ BTU _HP EDR $ 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 l HEATING CO C Signe __ TEL FAX # (� Approved By Rough -In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED i When rQ la .ina an existing furan .,, 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. i. Yes 14o The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. 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. anE manufacturer's specifications. When required to install a npw nnmhuction air it will be sized and installed to meet the current codes and manufacturer's specifications. Yes() No Yes No ) Yes (r-� No ( ) Yes (No( When installing a npw yantinagystam, 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 (ts 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. N Yes No Appliance Tyne and RileLQommon Vent and Vent C`onnectnr lnform-atinn Appliance #1 Type _ -�-�, n c� BTU Input _' ,�c> Fan Assisted ee-N-s �y C Appliance #2 Type X9 aja�c BTU Input =�, F Nat Appliance #3 Type BTU Input -� Fan Assisted m -Nat �� � Total Appliances Total Btu Input %ktI Common Vent Type , k eN t Vent Height l 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- (n _cr_rihP1 HEATING CO Signed By: Building PLUMBING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: r 763-572-3604 CITY OF FRIDLEY Date Rec'd:4—I�-�� 763-502-4977 FAX EFFECTIVE 2-19-09 DATE _� YOUR E-MAIL ADDRESS SITE ADDRESS n _FLOOR DRAINS SHOWER WATER PIPING THIS APPLICANT IS: ❑ OWNER CONTRACTOR _ WATER SOFTNER (bl.) CLOTHES WASHER PROPERTY NAME: BACKFLOW PREY. DISHWASHER _ LAUNDRY TRAY OWNER/II _ FOR IRRIGATION WATER METER TENANT ADDRESS: CITY STATE ZIP PHONE: CONTRACTOR NAME: q SUBMIT A COPY OF STATE LICENSE # d ^ �% YOUR STATE EXP DATE LICENSE, BOND AND STATE BOND #XP DATE % — CERTIFICATE OF ADDRESS: Lf Itsm i CITY STATE&AIZIP�q INSURANCE PHONE 7/' / �j� p �3 FAX !�/1 PERMIT TYPE I SJNGLE FAMILY IWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 113 NEW A REPLACEMENT W FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER -OF EACH BELOW). MINIMUM FEE $35.50. —BATH SINKILAV - _FLOOR DRAINS SHOWER WATER PIPING BATHTUB _ GAS PIPING (NEED CITY LIC) _ _ SWIMMING POOL _ WATER SOFTNER (bl.) CLOTHES WASHER _ KITCHEN SINK WATER CLOSET BACKFLOW PREY. DISHWASHER _ LAUNDRY TRAY _ _WATER HEATER ($35) _ FOR IRRIGATION WATER METER OTHER THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit ork is not to start without a permit on site; that the work will be in accordance with the approved plan in the cagfo whi uires review and approval of plans L c SIGNATURE OF APPLICPRINT NAME S DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977