PRE 2010 DOCSI,!
I �
Village of Fridley,, 311nn.
�p o
BUILDING PElli1�IF
l� O 8 0
Office of INSPECTOR OF INGS
I
Architect Fridley, Minn.,
Builder
LOCATION OF BUILDING
_.
No. Street ' e Part' of Lot
Lot
' �^ it Block Addition or Sub -Division, 7, �` 9
�-
DESCRIPTION OF BUILDING
Front==� Dep�h Height Stories/ Y-- Manner of Construction -.11A
To be used as C'e- , `il--tea "° To be completed `® �` °` Estimated Coat ti
I
Permit is hereby wanted to
I
Ft
the building 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, round 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 lits, and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Inspector of Buildings.
In consider;
the above perm
above set forth
sworn, I hereby
true as therein i
Subscribed
day
ti
AGREEMENT AND SWORN STATEMENT
to of the issue and delivery to me by the Inspector of Buildings of Fridley of
I hereby agree to do the proposed work in accordance with the description
I according to the provisions of the ordinances of Fridley, and, being first duly
ite and say that the facts stated by me and contained in the above permit are
sworn to before me at Fridley, Minnesota, this
Q.D. 1 LSM._
City of Fridley, Minn. 11N9 10396
BUILDING PERMIT
Date: September 8. 1969
Owner: David. Walker Builder Sus sel Company
Address 4868-2g Street N.E. Address 1850 Como AV-Qnue,
LOCATION OF BUILDING
No. 4$ 6 8 _street2a Street N . E, part of Lot
Lot __ Block Addition or Sub -Division
Corner Lot Inside Lot _ _ Setback
Sewer Elevation
Sideyard
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Base, Alters, Front Depth Height Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction — Frame Est. Cost ..._.$.BOO 0_,–Q -Q __ To be Completed Nov- - 1-5,__196-9
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 setforthand=mipltanceth null visions of
ordinances of the dty of Fridley.'�
In consideration of the payment of a fee of $18-Q_Q_.._, permit is hereby granted tOS-U S e� I r ammo Y
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
n
CLARENCE BEL LE
NOTICE:
'fids pem* don not cover the eonstroction, iestaMon for whing, phomhing, gas heating, sower or water. Be core to as
the Building Inspector for separate permits for these items.
APPLICATION FOR.BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWATEft'S ® V.4 2 BUILDER
ADDRESS 4£SG e 2 ST Xl� ,,!f- ADDRESS
LOCATION OF BUILDING
NO�6-'R STREET
LOT BLOCK ADDITION OR SUBDIVISION
CORNER LOT INSIDE LOT SETBACK SIDEYARD
SEWER ELWATION TOP OF FOOTING
Applicant attach to this form Two Certificates of Survey of Lot and
proposed buildinglocation drawn on these Certificates..
DESCRIPTION OF BUILDING
To Be Used As:
,,Us�rT• .q�T��,��iv�ri
,_Front Depth Height
Square feet Cubic Feet
Front Depth Height
Square feet Cubio Feet
Type of Construction Estimated Cost r
To Be Completeda
The undersigned hereby makes application for a permit for the work
herein specified, agreeing to do all work in strict accordance with the
City of Fridley Ordinances and rulings of the Department of Buildings,
and hereby declares that all the facts and representations stated in
this application are true and correct.
DATE �S�G SIGNATURE
(Schedule of Foe Costs can be found on the everse-Side,)
P.M.
`7 1
-(A
m
-i
r
M
LO
L9
°$��� q.tt � � QJ � • � wA� �.rs.
!
USE=- t �l.-No
2nd
3rd
4th
' Fn![es® Co rainga
�eills
ee..es �
• now .018cesepow
PARTIAL RATE SCHEDULE
ALVMBINt,I FIXTURE RATES-
NO. RATE
TOTAL
Number Fixtures ................
--x52.06 $
Future Fixture Opening .... a ......
x $1.50 i
New Fixture Old Opening ..........
x $1.50 i
Catch Basin ....................
x $3.25 _
Water Beater 'Up to 89,000 BTU) ....
x $3.00 $
New Ground Bun Old Bldg.........
x $3.225 S
Electric WaterHeater. . . . . . . . o o . o • •
a $too $
GAS FITTING FEES.
NO. RATE
TOTAL
1st3Fixtures ..•.••••.••••.•.••
x$100 $
Additlonal Fixtures..t -.
x $ ..75� $
Mt... �...........
Gas a to 180.000 BLV o . •. e o . . • ...
x $5.00 $
State Surcharge
$
.50
REPAIRS A AL 'TI® ter ft Cc&_
Install Gas mh:........................$
5.50
Description ®1®.L
TOTAL rZE 8 5.50
City of Ridley:
The undersigned hereby makes application for a permit for the work herei<
specified, agreeing to do 0 work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the favi
and representations stated in this application are true and correct
Fridley. Wnn 10/11172
David 14alker
Kind of Building Frame
Used as Res.
To be completed about 10/16/72
Estimated Cost, S 10.00
Old $New. Building Permit No. permit N .
Signed L::Ii�
By MINNEGASCO
Business Phune No
ROUGH �
FINAL r/��
97-84-h16051 CITY 6F FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
at
PLU.\3ING FIXTURE RATES: NO.
N
m
TOTAL
.V ..: er Fixtures
x
u
$
n
0
$2.00
Water
e
m
m
o
Catch Basin
m
w
rn c
ee
0
$
u
A
W
•+
++
0 U
r+
a.
c'
+
w
to
$10.00
Heater
O
Y
.a
R
$
C:
H
C7
X 4j
$4
U
fa
4 C
a O
.4
GAS FITTING FEES:
N
1st ? fixtures
x
-,
$
Additional Fixtures
x
$1.00
$
Cas Range to 199,000 BTU
x
$10.00
$.
REPAIRS & ALTERATIONS
First $100.00
O
$5.OQ
$
$2.00
O
State Surcharge
vj
TOTAL FSE
rC
N
N
+�
h .C+
u
I4
a
r.
c
..i ,s
y a
s.i
o a.
.00
CA
.O -I
a
rd
u w
p �0
a o
a
�
u`�
o
as
lee
L
1'_s�TT
1
�.
tad
4
1
3rd
;
I
HEI
(R) - rFlavare Connection Opening
Connected with Sewer
(;} - Now Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLU.\3ING FIXTURE RATES: NO.
RATE
TOTAL
.V ..: er Fixtures
x
$3.00
$
Fat.:re Fixture Opening
x
$2.00
$
New mixture, Old Opening
x
$2.00
$
Catch Basin
x
$5.00
$
:Cater Heater - to 99,000 BTU
x
$5.00
$
100,000 B_J to 199,000 BTU
x
$10.00
$
Water Softener
x
$7.00
$
New G=round Fin Old Building
x
$5.00
$
Electric Water Heater
x
$5.00
$
GAS FITTING FEES:
1st ? fixtures
x
$3.00
$
Additional Fixtures
x
$1.00
$
Cas Range to 199,000 BTU
x
$10.00
$.
REPAIRS & ALTERATIONS
First $100.00
$5.OQ
$
each add. $100.00 or fraction
$2.00
$
State Surcharge
$ .50
TOTAL FSE
s8.00
REINSPECTION FEE
($10.00)
Job Address
AAjxq --,2 ,_
Department of Buildings
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. 10-20-80 , 19
OWNER
KIND OF BUILDING fr
USED AS res.
TO BE COMPLETED ABOUT 10-27-80
ESTIMATED COST 50•00
OLD -NEW BUILDING PERMIT N0. PERMIT N0.k / '-
; / / /)-
- ,O
Signed By MINNOGASCO
Tel. No.
ROUGH INSP.
Date
FINAL INSP. 7 Z
Date
APPROVAL FOR PERMIT ��V
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.SO STI+TE SURCHARGE
ra
sueaEcr
MIT NO.
City ®f Fridley27410
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
�COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
'.
/ 330
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
�..__ !l.' �•� 612-571-3450
910415
8/26/98
JOB ADDRESS
4868 2 1/2 Streqt
t LEGAL
. LOT NOBLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
3, 4 3
-1 011th
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Dario & Gloria Tion son
-
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Milton Johnson Co. 525 Lowry A e7RI-954R
9083
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof garage (6 Sq) Tear -off; Soffit & fascia
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State BBuilding Code.
Install soffit ventilation to meet State Building Code.
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
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
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2500,
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORM CE OF CONSTRUCTION.
PLAN CHECK FEE
TOT L FEE
Ar,-()/
3-50 J
SIGNATURE OF CON ' RACTOR OR AUTHORIZED AGENT IDATEI
N P QP
BL )NSP
VALID THIS IS U ERMIT
�l E
SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI
ra
NEW [ I Effective l/l/97
ADDN " [• f • CITY OF FRIDLEY
ALTER [Xl SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 4868 2�,- St. N. E.
Legal Description:
Owner Name & Address: Dario & Gloria Tiongson ( same) Tel. # 571-6087
Contractor: Milton Johnson Co. MN LICENSE# 2083
Address: 525 Lowry Ave. N.E., Mpls. 55418 Tel.# 781-9548
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:
gar.-oo , **
Construction Type: , sof.
` .
,
& fas. Estimated Cost: $ 4 C1Q
Driveway Curb Cut .Width .Needed: Ft.
(Fee
+ 6 Ft = Ft x
Schedule on
$
Backj'—��006)
DATE: r APPLICANT:
.
J
� �
_
Tel781-9548
. #
CITY USE ONLY
Permit Fee $/ Fee Schedule on Reverse Side
sire Surcharge c?, �Z� $ `- ,001 of Permit Valuation (1/10th%)
State Surcharge $ 1S $.50/$1,000 Valuation
SAC Charge $ $950 per SAC Unit
License Surcharge- $ . (i $5.00 (State Licensed Residential Contractors)
'3riveway 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
�'rtt'ULATIO,NS:
SuBjECT
City ®f Fridley
1
AT THE TOP OF THE TWINS
BUILDING
(W560
PERMIT
r
O.
COMMUNITY DEVELOPMENT DIV.
f PROTECTIVE INSPECTION SEC.
I
= I CITY HALL FRIDLEY 55432
,"�
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910.F15
5/20/99
JOB ADDRESS 4868 2 1/2 Street NE
1 LEGAL
LOT NO.
I
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3, 4
3
I Plymouth
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Gloria Tiongson
296-5231
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Milton Johnson Co. 525 Lowry Ave NE M is 55418
781-9548 2083
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 ❑ ALTERATION IP( REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house (15 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1285
$.64
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE 0 LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE F C NSTRUCTION
$47.90
Fire Ci 1.28
PLAN CHECK FEE
TOTAItFEE
'
?SIGNATURE
Licens2ISI
5.00
$54.82
OF CONTRACYOR OR AuiHORiZED AGENT 16AfEt
N eIROPE
BL0 �NSo
ALIDAT IS IRgERyIIT/,7/7
.:WIT
gAtE
SIGNATURE OF OWNER. -F OWNER BUILDER, IDATEi
N EW [XT Effective 1 / 1 /97
ADDN [ ] 'CITY OF FRIDLEY
ALTER 1. J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION �1
ConstructionAddress: 4868 2 1/2 Street N. E.
Legal Description:
Owner Name & Address: Gloria Tiongson (SAME AS ABOVE) Tel. #296-5231
Contractor: Milton Johnson Company MN LICENSE# 2083
Ad.dress: 525 Lowry Avenue N.E., Mpls. Tel. # 781-9548
_
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 Type: Tear off and _r . e-roJouse
Estimated Cost: $ a P®
(Fee Schedule on Back)
Driveway Curb Cut Width.Needed: Ft. + 6 Ft = Ft x
DATE: APPLICANT: Tel # 781'-9548
.
CITY USE ONLY
Permit Fee Fee Schedule on Reverse Side
"ire Surcharge $ 2 .001 of Permit Valuation (1/10th%)
State Surcharge $ o i -f $.50/$1,000 Valuation
SAC Charge $ $950 per SAC ' Unit
License Surcharge' $. 00 $5.00 (State Licensed Residential Contractors)
driveway Escrow $ Alt. "A" or Alt. "B" Above
:rosion Control $ x$450.00 Conservation Plan Review
'ark Fee $ Fee Determined by Engineering
;ewer Main Chargc $ Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ 5I1 -5—Z
nPUI.ATIONS:
. . .r
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 VAN: (7631
ADDRESS : 4868 2 1/2 ST NE
PIN : 263024320030
LEGAL DESC : UNAVAILABLE
LOT BLOCK
PERMIT TYPE HEATING
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE ADDITION/ALTERATION
PERMIT N 4 .: 2004-00469)�)
DATE ISSUED: 04/09/2004
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, LENNOX, 70,000 BTU'S) AND AIR CONDITIONER
# A/C UNITS 1 VALUE OF APPL OR WORK
# FURNACES
# GAS RANGES
APPLICANT
DAVES APPLIANCE HEATING & AIR INC
160137 AVE NE
COLUMBIA HEIGHTS, MN 55421
(763) 781-6901
OWNER
TIONGSON GLORIA & DARIO
4868 2 1/2 ST NE
FRIDLEY, MN 55421
1 # GAS DRYERS
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 construction or the performance of construction.
Bldg
HEATING PERMIT M 41MUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
AIR CONDITIONING FEE
TOTAL
PAID WITH CHECK # 34183
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0
0
0.00
30.00
0.00
0.00
0.00
0.50
25.00
55.50
W
RID�NE
BUILDING INSPECTION
ty Av
Fridley, MN 55432
763-572-3604 FAX 763-5711287
RATE SCHEDULE
Residentlal
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
Gas Dryer
*Air Conditioning -All Sizes
All Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work
Minimum Fee $15.00 for Residential or 5% of cost of
Improvement whichever is greater
Commercial/Industrial/Instft to
Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS � i � D -A
Fee Total
$35.00_-- Building Used
$10.00 $
ESTIMATED COST
PERMIT NO
$10.00 $ DESCRIPTION OF FURNACE AND BURNER
$10.00 $ # of Heating Units _ Circle One (Steam) (Hot Water) rm A'
Trade Name L Size No.
$25.00 BTU HP EDR
Fuel Total Connected Load
$ Burner Trade Name Size No.
BTU HP EDR
1.25% of Value of Appliance or Work (List on Back)
$
Minimum Fee $35.00 for Commercial/Industriai/Institutional
State Surcharge
$
TOTAL FEE
$
REINSPECTION FEE $50.00/HOUR
*Air Conditioners can not be placed in side yard without written approval
from adjoining property owner - copy to City
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
FAX# I10�_
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
Approved b Rough -in Date Final Date
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
('*'rl6"mnR VFNI, EVENT GQNNF=R Am rQMRt1SjIn1Y QR VFRIFICATInN
When raglInnn;:..,,�w haranna, 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 plasticJPVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes { _ No.,K
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 Yes Vi No( )
assisted and natural draft appliances.
The is sized and installed to meet the current .codes
and manufacturer's specifications. Yes( ) ,No
When required to ' will be sized and Installed
to meet the current odes and manufacturer's specifications. Yes No( }
When installing a g= venting sg 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 YesNo ( )
separately as per current codes. YN
,ACISIl nr_r -e and i7sanmmnn Veit and Vant Cnnnactnr Information
Appliance #1 Type, A_ .�. BT:U Input Dd10 Fan Assisted or Nat aha
Appliance #2 Type I 67 U Input-� Fan Assisted or Nat
Appliance #3 Type
BTU Input Fan Assisted or Nat
Total Appliances ��___ Total Btu Input
ll
Common Vent Type 1b " 4s0l wA L`tVent Height –iSl Diameter_ ___ inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type •,.,
' ht ft Length .ft Diameter in Type
Appliance #2 Vent Connector Height _,___ g ft Diameter rn Tyles
Appliance #3 Vent Connector Height ft Length
M]
•Signed BY' elt*—
'
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 tAX: (763)571-1287
ADDRESS : 4868 2 1/2 ST NE
PIN : 263024320030
LEGAL DESC : PLYMOUTH
: LOT 3 BLOCK 3
PERMIT TYPE : ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
PERMIT NO.: 2004-00553 n I
DATE ISSUED: 04/21/2004 �l-
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE.
# INSPECTIONS 1
APPLICANT
HARO ELECTRIC SOLUTIONS
415 DECATUR AVE N
GOLDEN VALLEY, MN 55427
OWNER
TIONGSON GLORIA & DARIO
4868 2 1/2 ST NE
FRIDLEY, MN 55421
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 construction or the performance of construction.
Applicant Date
Bldg Insp Date
STATE SURCHARGE, ELEC FLAT 0.50
ELEC PERMIT FEE - MIN (RESI) 20.00
TOTAL 20.50
PAID WITH CHECK # 1311
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.