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l 1VMage of Frldleyq Mffm n. BUIIMEM PERMIT N� 902 Ofce of INSPECTOR OF RT "PIGS Owner'_ Fridley, Minn., '` 19 ;r LOCATION OF BUILDING No. f Street " g Part of Lot Lot 4,1 , Block k `" Addition or Sub -Division~ T J r DESCRIPTION OF BUILDING Depth-' Height Constru��oa " ann� STo To be used as k1 " To � r� �f p Estimated Cost— be com leted the building ii " =g` ' described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, Minn, regarding the 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. �° �spector of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permit, 1 hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein staffed. Subscribed and sworn to before me at Fridley, Minnesota,. this 2 r day P„ !", A.D. 19-L' of ,�, �_. Permit is hereby gralited r the building ii " =g` ' described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, Minn, regarding the 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. �° �spector of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permit, 1 hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein staffed. Subscribed and sworn to before me at Fridley, Minnesota,. this 2 r day P„ !", A.D. 19-L' of ,�, �_. 3o 6 4 � City • • 1, a Fridley, Blinn. Date: September 23, 1965 Owner: Richard T. Giles Builder J & J Asso teS Address 4204 - 2� Street X.E. Address 9309 Lyndale Avenue South LOCATION OF BUILDING No. 4704 Street 2r. ��reet N.E. Part of Lot S.W. Lot -__ Block _____6 _ Addition or Sub -Division Plygmth ,addition Corner Lot — X Inside Lot -- Setback 22' Sideyard 20' Sewer Elevation _ Foundation Elevation 2' DESCRIPTION OF BUILDING To be Used as: Det. Garage Front 22' Depth 24' Helght8 ost Sq. Ft 528 Cu, Ft 22 Front Depth Freight Sq. Ft. Cu. Ft. Type of Construction - "PraTne Est. Cost-$2.GOAD— To be Completed 10-25-65 In consideration of the issuance to me of a permit to const thole �� � � city of��yce with the description above set In consideration of the payment of a fee of I above I agree to do with 21 provisions of permit is hereby granted to Sok J A c a nr-i a t es , jue 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 buil" within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. NOTICE: IMM pem* don not cover the eondmcfiee, halaWan for unclog, phrnohing, gn heaft, swnr or wafer. Be sure to see the se uhm hupeetor for aparate pwndit for there itenm APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME —i� � d BUILDER ADDRESS _ IV r 6 ADDRESS G x ®we LOCATION OF BUILDING z1 7PStreet � LA2, Part of Lot LOTS i Y4 /3„ x �� ADDITION OR SUBDIVISION G /00 4)7,4 dig SPI `T®e� Corner Lot )C Inside LOT y,,.dtback� �'SideYard40 SEWER ELEVATION k06M)ATfON ELEVATXbN, .. r� Applicant attach to this forth Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as: 6h` Front Depth, I Height ®,.-76!57 Sq. Ft. Cu. Ft. ` 2 Z e Front Depth height Sq. Ft. Cu. Ft. Type of Construction � �� � Avi-r„ ,Sr,A®,;6 Estimated Cost a 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 the Department of Buildings, and hereby declares that all the facts and representations stated*in this application are true and correct. � W/tiji WE'n" (Schedule of Fee Costs can be found on the evyWe Side). W<_- City of Fridley, Yffim BUILDING PERMIT Dates Jan. 14, 1969 Owners Richard Giles Builder Address 4704 211, S t 1 N. E. Address Same Same LOCATION OF BUILDING No. 47 04 _Street 2,1,- S t . N. E. Part of Lot Lot 14 &15 _Block 6 Addition or Sub -Division Plymouth Addn . Corner Lot _ Inside Lot Sewer Elevation Setback _ - Sideyard Foundation Elevation Rec. #45598 N° 10,081 DESCRIPTION OF BUILDING To be Used as: Finish Basemenpront _ _ Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Rramp Est. Cost — $1, 000 _ To be Completed 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 inn 6mmpliance with 21 provisions of ordinances of the city of Fridley. 1 In consideration of the payment of a fee of $ 6.00, permit is hereby granted to Richard Giles 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 ordinancem Clarence Belisle NOTICE: 'This permit does not cover the construction, installation for wiring, plumbing, gas hosting, sewer or water. Be sura to we the Building inspector for separate permits for these Dorm. APPLICATION FOR BUILDING PE MIT CITY OF FRIDLEY, MINNESOTA OUM 'S NAME BIIILDER. Z- AflnRTi�S.R -� /rJ �'- � � ���' ADDRESS LOCATION OF BUILDING NO. 14STREFSI LOT /6� BLOCK ADDITION OR SUBDIVISION CORM LOT � INSIDE LOT SETBACK SIMARD SEWER ELEVATION i�kTi��1�Woohl� g 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: �/Jse-Me�T� Front Depth Height Square feet Cubic Feet Front Depth Height_ Square feet Cubic Feet Type of Construction Estimated Cost 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 the Department of Buildings, and hereby declares that all the facts and i,::dresentations stated in this application are true and correct. DATE� �� SIGNATURE �/� : �-�---�/ (Schedule of Fee Costs can be found on the Reverse Side.) N? 4845 Original Permitr PLUMBING AND GAS FITTING4 1` N.B. When work covered by this permit is ready, the PlumbingOrdinance r Permit equines that request for Fee � f ®. �0 inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit., DESCRIPTION OF WORK Number, Sind and Location of Fixtures City of Fridley --E-� ,19� .�tOT3e8 E w tW- O Q-1 3 U Q Z K U ... ,,.,� r m 6 7 m F 2 M Q m m Y z N = N m¢ Q C 3 F Y 1" Z 0 O O LL w 0 S (ry E z O Q A K LL O 2 2 ttl- N Q Q U m ; Z z Q O K -1 X rc 4. m q Q 6 tl Q W a z Q Q tl z WATER HTR. 6A8 ELEC. Basement ist / �G 2nd 3rd 4th Connected with Sewer -Cesspool Gas Piping for Openings Permission is hereby grante CJ=AA=2n2 avo v to do the plumbing and gas fitting in the building descri ed in the statement ereto 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 wz� Inspector. Owner Location q-7 0 q r: Kind of Building Used as To be Completed 7 A V_ —,19--6-9 .Estimated Cost $ (0-� , e --j Old -New. Building Permit No. Date Inspector of Buildings. SUBJECT PERMIT City ®f Fridley 5 3 4 8' AT THE TOP OF THE TWINS BUILDING PERMIT P RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. i �rI t NUMBER REV. DATE 17/19/79 PAGE OF APPROVED BY i "1 CITY HALL FRIDLEY 55432 1'1 It'"-' 612-571-3450 910-F15 10B ADDRESS 4704 - 21� Street N.E. 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14,15 6 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard Giles. 4704 - 2-2 Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Virg Luken's Professional Pools P.O. Box 1099, Minnetonka 933-6362 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 ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE x 8 DESCRIBE WORK Construct an round swimming pool (191-x 381) 9 CHANGEQFUSEFROM TO STIPULATIONS See stipulations on letter dated July 16, 1979 from Envirormsental Officer. SEPERATE PERMtTs REQUIRED FOR. WIMNG. WARNING HEATING, PLUMBING AND SIGNS® Before-done call Iml utilities iEI..OW60-EEECtRIC • CAS IES REQUIRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Masonry THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 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 $6,200 $3.� 0 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT RITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE R LOCAL LAW REGULATING CON- $39.00 It CONSTRUCTION. PLAN CHECK FEE TOTAL FEE iSIGNU4=AUTHORIZED ? $42.10 RIZEDAGENT (DATE) WHEN PROPERLY�ALIDATED THIS IS YOUR PERMIT BLDG INSP f NA VE SIGNATURE OF OWNER 0F OWNER BUILDERI (DATE) CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New, Alterati'ons, Additions, or Repairs) OWNER: BUILDER: ��i�`� ADDRESS: �� ��� ADDRESS: 49'a/<- 9,9 TEL NO: � '�® % �� TEL NO: 3 -6 3 �` Construction Location STREET NO: I� 0��STREET: LOT:BLOCK: ADDITION: Corner Lot: Inside Lot: Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. f ` G eO � DESCRIPTION OF CONSTRUCTION P co L— Front: /C? < Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: Estimated Cost: $_ 9.b 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, 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 ares roue and correct. DATE: C:7e-SIGNATURE: Stipulations: 3,10 k)1-4(-'H'4(eC"L , c rt a� ' L SP1_. July 16, 1979 Al Virg Luken's Professional Pools Inc. lnsY P.O. Box 1099 14508 Excelsior Blvd. Minnetonka, M 55343 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 TELEPHONE ( 612)571-3450 Re: Swimming Pool Construction at 4704 - 2'i Street N.E. Dear Sirs: This letter is to make clear this department's requirements for the swimming pool construction at the above address. 1. As indicated, one (1) skimmer approved by the National Sanitation Foundation will be provided. 2. As indicated, three (3) inlets of approved design for fresh and/or repurified water will be provided. 3. As indicated, a main drain of approved construction will be provided. 4. The filter and pump shall be approved by the N.S.F. and be of sufficient capacity to provide a minimum turnover of at least two (2) times in 24 hours. This department recommends a turnover rate of 6-8 hours. 5. A deck of at least three (3) feet wide, measured from the pool waters edge, shall be provided which extends completely around all private residential pools. Above ground private residential pools may be provided with decking of a minimum size of 4 feet by 4 feet at pool entry points and provided that such decking has the approval of the City. 6. The diving area will be acceptable provided there is no overhead obstruction. 7. Fencing or other effective means including but not limited to walls or buildings, acceptable to the City, shall be provided to positively control all access to public and private residential swimming pools. Fencing shall meet the following criteria: (a) The fencing shall prevent the entrance of children and be without hand or foot holds that would enable a person to climb over it. (b) The fencing shall be at least 6 feet high and entrances shall be equipped with self-closing and self -latching gates capable of being locked. (c) Self-closing and self -latching devices shall be placed at the top of the gate or otherwise inaccessible to small children. (d) The opening between the bottom of the fence and the ground or other surface shall be not more than four inches. 8. An automatic chlorinator should be provided with a suitable test kit. Virg Luken's Professional Pools Inc. July 16, 1979 Re: 4704 - 2' Street N.E. Page ,2 9. All electrical and plumbing installations shall be.inspected and approved by the City Inspection Department. 10. All electrical lines must be greater than 15 feet away from the pool surface. An alternative is to bury said lines. 11. The pool fill spout must be air gapped or protected by a vacuum breaker. 12. Suitable safety equipment to include but not limited to a ring -buoy and rope that is A times the pool diamter, and shepherds crook pole must be provided and maintained with the pool at all times. Furthermore, these and any other requirements must meet the provisions of the Fridley City Code, Section 115, Swimming Pools. The building permit is approved contingent on final inspections and approval by the City. If any -questions or problems arise from this letter, please feel free to contact me at 571-3450. . Sincerely, STEVEW J. OLSON Environmental 0 SJO/mh CC: Mr. Richard Giles 4704 - 2'� Street N.E. r e Virg Luken's Professional Pools Inc. P.O. Box 1099, 14508 Excelsior Blvd., Minnetonka, Minnesota 55343 Telephone: 612/933-6362 July 13, 1979 City of Fridley Inspection Department 6431 University Ave. N.E. Fridley, MN Re: Concrete Swimming Pool Specifications Attached hereto, for your review and consideration, is a plot plan depicting the location of a concrete swimming pool pro- posed to constructed at 4704 2% St. N.E. Further, I have outlined, herein, construction specifications, mechanical components and the deck equipment we:will be installing. POOL DATA Size: 19' x 42' Surface Area: 592 sq. ft. Perimeter: 104 linear ft. Depth: V-6" to 8"-6" Capacity: 24,000 gal. FILTER DATA Filter Area: 165 sq. ft. Flow Rate: 65 gpm Turn -over capacity: 6.2hrs. CONCRETE SHELL Excavation as necessary, under normal soil conditions, with soil hauled from site. Forming as necessary to buyer approved grade. Re -enforcement of 3/8" rebar tied in place 12" on center. (Typical wall section attached). Concrete shell of pneumatically placed concrete using 4,000 psi or greater cement with 8" walls and 6" bottom. Coping of paver brick mortared in place. Tile accent using 6"frost proof tile mortared in place at the water line. White plaster finish using white portland and silica sand brought to,a sponge float finish. Concrete steps as shown with tile accent. Concrete swim -out ledge with tile accent. MECHANICAL EQUIPMENT M 165 Modular, no backwash, filter with 1 hp bronze pump. Member: WET INSTITUTE Water Environments Technology We care enough to build it better. City of Fridley July 13, 1979 261,000 BTU gas Raypak direct fire heater. U-3 automatic surface skimmer . Main drain with hydrostatic relief 'valve. 3 directional flow inlet fittings. Schedule.40 pvc piping with bronze gate valves. DECK EQUIPMENT 6' fiberglass diving board. i meter fiberglass diving stand. Concrete swim -out ledge. 500 watt underwater light with wet niche, 8' brass extention, deck box and 2.0' cord. Maintenance kit containing a pole, vacuum head, wall brush, hand skimmer, hose, test kit and thermometer. Leaf -Master cleaning tool. Initial start-up and balancing. FENCE The property owner, Richard Giles, will install a swimming pool fence in accordance with the rules and regulations of the City of Fridley, Minnesota. Lu J 0 �O v3 . ,o LLJ CL Lu J 0 SUBJECT City of Fridley 19730 AT THE TOP OF THE TWINS BUILDING PERMIT _ r RECEIPT NO ______ COMMUNITY DEVELOPMENT DIV. L / 0 r PROTECTIVE INSPECTION SEC. 1 i i CITY HALL FRIDLEY 55432 �.j NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 10/25/88 JOB ADDRESS 4704 -• 212 Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14,15 6 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dick/Jeanette Giles 4704 - 22 Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Merchant's Maintenance 12020 Radisson Road N.E., Blaine, MN 755-0904 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 6 DESCRIBE WORK Window & Soffit Replacement; new front steps 9 CHANGE OF USE FROM TO STIPULATIONS 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 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 I 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 $6,500 $3 ZS 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- $90.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $93,25 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI WHEN PROPER Y VALIDAT D THIS IS YOUR PERMIT BLDG I DA SIGNATURE OF OWNER IIF OWNER BUILDER) (DATEI NEW [ ] City of Fridley EEfective 5/1/88 AMN [ I R-1 AND R-2 ALTER [%" Building Permit Application rhnatrnr+-i nn AMresr,! % % � h-� _ J 1 i>e z 1 Y -j Til Description: �J Owner Name & Address: Tel. # Contractor : Tel. # S 07 Address: Attach to this application, a Certif icate of Survey of the lot, with the proposoed construction dram on it to scale. DESCRIPTION OF INPROVIIMENT LIVING AREA: Length Width Height sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. _ DECK AREA: Length Width Hgt/Ground Sq. Ft. _. arm: ► �..c� ilk L>,����� 1it� ODrner Lot [ l Inside Lot [ I Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: S Approx. Completion Date: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ Width + 6' See Back Page MM: 1�' / - v"� APPLIC2M: otic Tel. # M-3( SE Y Permit Fee State Surcharge SAC Charge Driveway Escrow Park Fee Sewer Main Charge TOTAL IPOLATICINS: � Q,) MIU ,�i►4 Fee Schedule on Reverse Side $.50/$1,000 Valuation $550 per SAC unit Alt. "A' or Alt. 'a" Above Flee Determined by Engineering Agreement Necessary [ I Not Necessary [ ] SUBJECT UIQ._17 City of Fridley 2 5 3 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPTNO. �• _ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED BY -"1 CITY HALL FRIDLEY 55432 612-571-3450 910-F15 7/25/97 JOB ADDRESS 4704 2 1/2 Street NE 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 14,15 6 Plymouth Addition I SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard Giles 4704 2 1/2 Street NE 572-8905 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. B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 14' x 16' Porch Addition 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. 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 80 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 1 1STALLS 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 $13,560 $6.78 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- $212.25 Fire SC $13.56 STRUCTION OR THE PE ORMANCE OF CONS UNION. -- PLAN CHECK FEE TO L FEE 232.59 r.IGNA_'T']URf OF CO TRACTO a - IDATE1 HE PROP VALID T THIS IS YOUR PERMIT BL G iNSP GATE NATU EO RSI W ER BUILDERS IOATE1 NEW [ ] Effective 1/1/97 ADDN ( ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: Owner Name & Address: Contractor: Address: Tel.# S•72- SGOS- MN LICENSE # N Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # LIVING AREA: Length J �(Width 1(n' Height I Z' Sq. Ft. Z Z y X C 0, T GARAGE AREA: Length Width Height Sq. Ft.���® DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: w®<J- Estimated Cost: $ 0 (p C, CO3- A ," (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Rix $ _ $ DATE:..). APPLICANT• Tel. # \i2 d-C10S5' STIPULA"PIONS: CITY USE ONLY Permit Fee Fee Schedule on Reverse Side Fire Surcharge $ 3.5� .001 of Permit Valuation (1/10th%) State Surcharge $ �, %Q $.501$1,00 Valuation SAC Charge $ $950 .per SAC Unit License Surcharge $ $5.00 (State Licensed Residential. Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULA"PIONS: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On January 1, 1998 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS ZI New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 _'1998 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner Water Heater —Electric $ 7.00 Water Heater — Gas** $10.00 Building Used As�� Gas Range** $10.00 _� 75 Gas Dryer** $10.00 Estimated Cost PERMIT NO. Back Flow Preventer Required CAYes () No Typef $15.00 _ PLUMBING COMP NY Reinspection Fee $42.00/Hr SIGNED BY ��`> TEL N0. �✓� ���7` ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved By Rough—In Date Final Date a State Surcharge $ .50 4169 MINIMUM FEE OR ANY PLUMBING/GAS PERMIT IS $20.00 TOTAL FEE $ '`,d PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. SUBJET:Y A�11 City of Fridley 370 2 AT THE TOP OF THE TWINS � U I L D I � C PERMIT i NO. �(f `- _ _ COMMUNITY DEVELOPMENT DIV. _7-73 r � � PROTECTIVE INSPECTION SEC. 1 . � NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 L 612-571-3450 910415 9/13/99 JOB ADDRESS 4704 2 1/2 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14,15 6 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard Giles 572-8905 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 Residential 7 CLASS OF WORK O NEW 0 ADDITION XX ALTERATION 0 REPAIR 0 MOVE 0 REMOVE 8 DESCRIBE WORK Install insulation, sheet rock, ceiling and siding in porch addition 9 CHANGE OF USE FROM TO STIPULATIONS R-15 Insulation Wall R-44 Ceiling with ITT air space SEPARATE PERMITS ARE REOUIRED 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 20Q0 ' WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1.00 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE T T L FEE 72.25 SIG IATURE OF CONTRACTOR OR AVIMORIZED AGENT IDATEI HE P V I D THIS I$ UR PE M B OG -NST" z Z)ATE fl NATURE OF OWNER.IF OWNER BUILDER. IDATEI r „ NEW[ ] Effective 5/10/99 \ ADDN [ ] CITY OF FRIDLEY \ ALTER [ ] SINGLE FANMY AND DUPLEXES R-1 AND R-2 ?4b BUILDING PERMIT APPLICATION 6 Construction Address: %® /z_ cS t Legal Description: Owner Name & Address: _ �0 a / LStTel. # Contractor: �u _ MN LICENSE # Address: Tel. # 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/G nd Sq. Ft. OTHER: Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6R = Rx $ _ $ DATE: ? r 13-1 % Tel. #\(o /i S %a - g f 0 ,x° STIPULATIONS: �,../���LA�/�/J ALG CITY USE ONLY Permit Fee $ / (� �, �� Fee Schedule on Reverse Side Fire Surcharge $ 6e.2 .001 of Permit Valuation (1/10th%) State Surcharge $ l $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: �,../���LA�/�/J ALG v v SUBJECT - - NO. City ®f Fridley 30789 AT THE TOP OF THE TWINS BUILDING PERMIT ' F � 1 L COMMUNITY DEVELOPMENT DIV. b______ E PROTECTIVE INSPECTION SEC. c7 ' e 1 � � NUMBER REv DATE vAGE OF Af~PROVED By CITY HALL FRIDLEY 55432 IL I'' ---" 612-571-3450 910-F15 4/5/00 JOB ADDRESS 4704 2 1/2 Street NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14,15 6 1 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard/Jeanette Giles 4704 2 1/2 Street NE 572-8905 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 O NEW O ADDITION O ALTERATION j] REPAIR O MOVE O REMOVE B DESCRIBE WORK Reside House & Garage 9 CHANGE OF USE FROM TO STIPULATIONS Call for building wrap inspection before covering. 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 1 ISTALLS 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 $3,375 $1.69 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 $102.31 S. RE OF CON175ACLGRORA MORIAEDAGENT tDATE. NWHV PROPERLY VALIDATED THIS IS YOUR PERMIT NATURE OF ow NER,IF OVYF4ER BUILDERS ,DATE, ,B G yv5o DATE v v NEW ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Z/-? Q / Effective 1/1/2000 (763) 572-3604 Bldg Insp e Legal Description: Owner Name & Address: V -e a � Tel. # �� _5- Contractor: 5Contractor: MN LICENSE # Address: Tel. # 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 DECK AREA: Len th OTHER: _ Width Height Sq. Ft Hgt/Ground Sq. Ft Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ DATE: d APPLICANT: a- , 9uTel. # 2� 72- cfFas CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ 9�2, tZ— Fee Schedule on Reverse Side Fire Surcharge $ .>% .001 of Permit Valuation (1/10th%) State Surcharge $.50/$1,000 Valuation SAC Charge $_$1 100 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: $ /009 - - SUBJEt774 City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT 315 96- r � RE • -------COMMUNITY DEVELOPMENT DIV. fr INSPECTION SEC. ���� r � � PROTECTIVE NUMBER REV DATE PAGE OF APPROVED BV CITY HALL FRIDLEY 55432 j L 612-571-3450 910-F15 12/14/00 10B ADDRESS 4704 2 1/2 Street NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 14,15 6 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard Giles 4704 2 1/2 Street NE 572-8905 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Sierra Homes Inc 1125 216 Ave NE, Cedar, MN 55011 763-434-5888 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO- 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION Q ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Interior finish of porch (sheetrock, taping, insulation, trim) 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. SEPARATE PERMITS REQUIRED FOR: WIRING, HEATING,- PLUMBING AND SIGN 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 80 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 1 ISTALLS 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 $5,500 $2.75 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 RFORM F CONSTRUCTION PLAN CHECK FEE TOT FEE L/ Licens C $5.00 $ 38.50 SIGNATURE OF CONTRACTOR OR AUT ORI EO AGENT IDATEI HEN ROP Y ALIDATEO His Is Y UR PPE IT , BLO -NSF' f1AIE<S�A/ SIGNATURE OF OWNEAOF OWNER BUILDER[ [DATE- NEW [ ] Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (7_63_) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: 4L O z/ Legal Description: s'L Owner Name & Address: u _ Tel. # .rO';� Contractor: `r MN LICENSE # Address: Tel. # 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: Construction Typ<i2oc'1L Estimated Cost: $ �, f PD Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ DATE: APPLICANT: aaal Tel. # CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ � Fee Schedule on Reverse Side Fire Surcharge .001 of Permit Valuation (1/10th%) State Surcharge $ `%5 $.50/$1,000 Valuation SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge I "S I F -11I STIPULATIONS: $__$l 100 per SAC Unit $ S- d D $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review Ell $ Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] J. 'CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2000 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 51L" �?67 JOB ADDRESS RATE SCHEDULE OWNER Residential Rate TOTAL 1 Furnace Shell and Duct Work, Burner . BUILDING USED AS Also Replacement Furnace $ 30.00 $ �•g �v (Side Vent - Fill Out Back) ESTIMATED COS T�� vv PERMIT NO. Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range �e✓� �Q��c9�� $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Gas Dryer $ 10.00 $ Trade Name Size No. BTU HP EDR *Air Conditioning - All Sizes $ 25.00 $ Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial 1.25% of Value of Appliance or Work $ 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 State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the fa is and TOTAL FEE $ � representations stated in this application are true andcor ect. /� ' DATE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING C14 REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 9 PLUS THE $.50 STATE SURCHARGE Signed TEL # REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without Approved By! Vim/ Rough -In Date Final Date written permission from adjoining property owner. COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes( No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specifications. Yes( ) No( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes( ) No( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( )No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date : CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1997 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOUNG, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work Commercial/I ndustrial 1.25% of Value of Appliance or Work JOB ADDRESS LI -7 o � -*-' 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 rulings of the Building Division, and hereby declares that all the facts and $ 30.00 $ representations stated in this application are true and correct. $ 10.00 $ 1997 $10:00 $ OWNER, • c- L vi,` BUILDING USED AS $10.00 $ $ 25.00 $ ESTIMATED COST PERMIT N0. DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating U its-/ " Circle One (Steam) (Hot Water) (Warm Air) Trade Name r7/6to Size No. BTU HP EDR $ Fuel �� Total Connected Load State Surcharge TOTAL FEE $ .50 MINIMUM FEE FOR ANY HEATING/C OOLING['ENTILATIO_N_ 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. ym Burner Trade Name BTU HEATIN_ =MPANY HP Size No. EDR Signed BY \' U ����Tel No. 0-9 ©sem Approved By Rough -In Date Final Date 73' FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Remarks: . List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CUMKNEY 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 () No ( ) 8. Has combustion air been provided for water heater Yes( ) -No ( ) Remarks: . List ALTERATIONS Being Done: HEATING CO: Signed By: Date: LUNIMUM FEE FOR ANY HE- TING/COOLING/VE-NTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS 125 04 P1_US THE $.563 STAT. SIIRCHARCE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard mithout written permission from adjoining property owner. Approved By Rough -In Date Final Date ,_ a FILL OUT BACK SIQE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 111 1eC Li.V� Jall{laI y 6 , LUU.) CITY OF FRIDLEY INSPECTION D:ViSION -643 UniyeF4j Ave JAI= Fridley,'MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, , (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES FAX (763) 571-1287 JOB ADDRES RATE SCHEDULE OWNER Residential Rate Furnace Shell and Duct Work, Burner TOTAL BUILDING USED AS Also Replacement Furnace $ 30.00 $ ESTIMATED COST PERMIT NO. (Side Vent, Fill Out Back) Gas Piping (Needed with new furnace, $ 10.00 $ DESCRI TION OF FURNACE AND OR -BURNER but not replacement) Gas Range $10.00 $ No. of Heating Units__L_— Circle One (Steam) (Not Water) ,¢ rm Air Gas Dryer $ 10.00 $ 1 Trade Name Size No. BTU C HP EDR *Air Conditioning - All Sizes $ 25.00 $ Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No.—_- o._1Jo EDR` 1%of Value of Appliance or Work $ _ a_ BTU ____ HP Commercial/industrial $ The undersigned hereby makes application for a permit for the work herein 1.25% of Value of Appliance yr Work specified agreeing to do all work in strict accordance with the City Codes an State Surcharge $ .50.: rulings of the Building Division, and hereby declares that all the facts and _ representations stated in this application are true and correct. TOTAL FEE $55_10D DATE _=-71 LUNIMUM FEE FOR ANY HE- TING/COOLING/VE-NTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS 125 04 P1_US THE $.563 STAT. SIIRCHARCE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard mithout written permission from adjoining property owner. Approved By Rough -In Date Final Date ,_ a FILL OUT BACK SIQE FOR STACK VERIFICATION ON REPLACEMENT FURNACE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON MENI. MENS A-81 ISTilIS MERIS AMICN When the undersigned hereby verifies that the venting has been examined and Is free from rust, deterioration, obstructions, and is securely supported and frestopped where required. Yes { No { ) The venting system is plastic/PVC and meets all current codes and manufacturer Yes (ss�NO { ) specifications including sizing, length, dumber of elbows and termination. The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturees specifications. This does include AGA -LAMA Category I Central Furnace Venting Tables for fan Yes (� No { ) assisted and natural draft appliances. The a=xkfin .Pmb►icslan air is sized and installed to meet the current codes Yes (,.f 'No( ) and manufacturer's specifications. When required to cpwbusfia a'j�it will be sized and installed Yes ¢�No ( ) to meet the current codes and manufacturer's specifications. When katifog a afflu 92�,t�® ��+, 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 Yes No {� { ) 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 (o ( ) separately as per current codes. --A than, C canrt�r Appliance #1 Type BTU Input LCI)Fan Assisted or Nat _ Fan Assisted or Nat Appliance #f2 Type BTU Input Appliance #3 Type ETU Input _ Fan Assisted or Nat Total Appliances Total Etas Input Common !lent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter, in Type in Type Appliance ##2 Vent Connector Height ft Length _ft Diameter Appliance #3 Vent Connector Height ft Length ft Diameter . In Type HEATING CO. ®ate 'moi' ) � —�