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PRE 2010 DOCSCity of Fridley, Minn.. BUILDING PERMIT N° qTL3•) Builder Address Address UILDING Na 34eet • � • Part Lot Block No. -Fart o t Lot Block � Bd�tlm or Su6.Dlvld� edition or Sub -Division -A Corner Lot _ �.__._ Inside Lot Setback__ _ Sideyard __ k Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING TobeUsed, ,f r Depth % _ Height _ Sq. Ft.I=Cu. Ft. 'tont _ Depth eight SO. Ft. Cu. Ft. Type of Construction Est. Co� 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 in compliance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any 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 violationypf any of the provisions of said ordinances. 1 '-1" —,^ d+ Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA • - 7 u o ,errPRILI M -a S.. ..� t S • e .►rIY ■por - r ■ , • . ■ONEW Address 3200 France Avenue South Address 3200 France Avenue South LOCATION OF BUILDING No. 5261 Street,3rd Street N. E. at Part of Lot 2 13Zing,So-,the No. 70' thereof as measured along the West line thereof, Lot 3 & the No. 27' of lot 4 as measured along IMH the West lineh reo£ egee-nt t At part thereof lying within the right of way of State Trunk Highway No. 56, in Block 1, Corner Lot Inside Lot 2g Setback '1 Side -Yard 47'-4"& 47' SEWER ELEVATION 8' below basement floor FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: Apartment Dwelling -- - Front 77 Depth 3fi height L Sq. Ft. 29772 Cu. Ft. 76.000 Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Frame & Brick Veneer Estimated Cost $60,000.00 To be Completed August 1961 The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. November 16. 1 (A Schedule of Fee Costs can be found on the Reverse Side.) Carlson's Summit Manor Annex, Anoka County, Minnesota Uildin Inspector f Application icor Power Plants and. Heating, Cooling, Ventilation..Reh igeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ........................ 2.00 $ _ Replacement of Furnace .§.00 $ Repairs & Alterations—up to $500.00 .... ............ 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. IDR Steam ...... 8.00 $ %` Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ...' 8:00 Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 • r Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $$T` ALTERATIONS & REPAIRS TOTAL ROUGH FINAL Dept. of Bldgs. Phone SU. 4-7470 Location . �%•• 3 'r'/��dd 4* • G City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinance. and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this applicationaretrue and correct. Fridley, Minn. �-�� o 18 Owner 4!v""v Kind of Building am .rs!s -e Used as A&,y To be completed about _7�` "bowed yr, Estimated Cost, $ #-3 F0 0• a 0 Old New Building Permit No. \,:!5-y2 permit No. % d� DESCRIPTION OF WORK HEATING or POWER PLANTS—Steamd of Water Warm Air—No Trade Na '0!;&da. U'*a -M Size No Capacity Sq. Ft. E.D.R- 9/1-6,06 BTU H.P. Total Connected Load /� f', / L Kind of Fue "Jr BURNER — Trade Name sG,�. Size No Capacity Sq. Ft. E.D.R. ,2 /1 i D O4 BTU H P. (REMARKS -OVER) Signed s 20-- 46g�g�— Bye- �4z 2M 7_59 Business Phone No7A2EA i SUBJECT PFie City of Fridley 623 AT THE TOP OF THE TWINS I' I L D I� 1 i� BUILDING P E R M I T r DV 'vv L I CEIPT ' ' L'__---_ COMMUNITY DEVELOPMENT DIV INSPECTION SEC. C� r PROTECTIVE i A '��'� CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By ••-• 612-571-3450 910-F15 9/2/86 JOB ADDRESS 5200 - 5291 3rd Street N.E. 1 LEGAL LOT NO. OCK TRACT OR ADDITION SEE ATTACHED DESCR. various 1- �,`-Bl. 2 & -6, Bl. 1, Carlson's Summit Manor Annex SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bigos Properties 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Twin City SThrm Sash Co. 2641 Louisiana Avenue South, Mpls. 55426 927-6534 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Apartments (8 Buildings) 7 CLASS OF WORK C NEW ❑ ADDITION CIA ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace windows 9 CHANGEOFUSEFROM TO STIPULATIONS TYPE OF CONST_ OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING. HEATING. VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU FT AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUC7<M OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED NO OWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT t 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 TYPE WORK WILL BE O IOR $100,000 $50.00 WITH WHETHER SPECIFIED HEREIN NOTS . THE GRANTING OF AF 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 - $433.00 TR CTION OR THE PERFORMANCE OF NSTRUCTION PLAN CHECK FEE TOTALFEE $483.00 SIGNATURE OFCONTQAC OR AUTHOQiZED AGENT iDATE. WHEN PROPERLY ALIDATED THIS IS VOURIPE MIT B.DG '.5� - ,ATE S,GNA%uQE Cr Cr.%ER,-c OI,tiNEP Bw.DEQ DATE SUBJECT City of Fridley 2239 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 1 &� r 1 I CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/4/94 JOB ADDRESS . 3rd Street NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 5, 6, 7 1 Carls n1 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bi os Pro erties 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Four Seasons Builders & Rpmndplprg 1410 Quant Ave N, lae en 4 ARCHITECT OR DESIGNER MAIL ADDRESS I N L SE NO. 55047 433-4846 6334 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Apartment 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Building 9 CHANGEOFUSEFROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 11 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $10,500 $5.25 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 PERFORMANCE OF CONSTRUCTION. $126.00 Fire SIC $10-50 PLAN CHECK FEE TOTAL FEE $141.75 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN OPER Y VALIDATED THIS IS YOUR PERMIT C� _ -S - 1'6 BLDG DATE SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI NEW ADDN [ .] ° . CITY OF FRIDLEY ALTER [ SINGLE FAMILY AND DUPLEXES R -•1 - i Build* I'emut" pplication ConstructionAddress: �1C-1 Legal Description: Effective 1/1/94 4�i l475- Owner Name & Address: p r Tel. # Contractor:yy) MN LICENSE # Address: �`l l 6 �W.r.� ►� ►N �Nf jT� ey\ W Cro,�a �iNN ._Tel. # Attach to this application, a Certificate7of 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: Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction:751--r a Y e-� ro �� Estimated Cost: $ X0-50 D - o 0 Approx. Completion Date: lei r-\\-) (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT:- Tel. # �� 1��din Permit Fee $ Fee Schedule on Reverse Side ,Am Stege $ .001 of Permit Valuation (1/10th%) State Surcharge $ ��SP $.50/$1,000 Valuation SAC eharge rtA $ / l' ST $800 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: ____-- Fridley Municipal Center — 6431 University Ave NE, Fridley MN 55432 Building Inspection Department (763) 572-3604 FAX (763) 571-1287 Open Permit Letter March 15, 2005 Boiler Services 10327 Flanders St. N.E. Blaine, Mn. 55449 Re:5761P St N.E. Fridley, Mn. 55421 Dear sirs: The city building inspection records indicate you have an open permit, correction, and/or inspection that have not been addressed in accordance with Minnesota Rules, Chapter 1300. Within (14) working days after the receipt of this letter, you must contact the Building Inspection Division of the City of Fridley to schedule an inspection. Should you not schedule an inspection within that time period, your permit will be considered expired per Minnesota Rule, Chapter 1300, and all non-compliance issues for which you will remain liable, will be put in the property address file for permanent record at the City Hall. In order to obtain a final approval for the work allowed under your permit at the above address, which would then allow the city to issue a certificate of occupancy, the following issues must be addressed: 1. There was no final inspection called in. Please call the phone number below to schedule an inspection. Please complete the above corrections and call to schedule an inspection with the permit technician at (763) 572-3604. Sincerely, Kevin Hanson Mechanical Inspector CITY OF FRIDLEY PERMITO.: 2004-00715 • 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 05/18/2004 572-3bU4 r'AX: (763) 571-1287 ADDRESS : 5261 3RD ST NE PIN : 263024220002 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : HEATING PROPERTY TYPE : MULTI DWELL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 4,000.00 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. INSTALL RPZ VALVE WHERE NECESSARY. REMOVE EXISTING 390,000 BTU HOT WATER BOILER. INSTALL 1 150,000 BTU AND 1250,000 BTU HOT WATER BOILER. APPLICANT BOILER SERVICES INC 10327 FLANDERS ST NE BLAINE, MN 55449 - OWNER BIGOS HELENA 11641 CEDAR PASS MINNETONKA, MN 55305 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 construction or the performance of construction. Applicant Date Bldg InsgO w Dat `E-12 HEATING PERMIT FEE, COMM 50.00 STATE SURCHARGE, VALUE 0.50 TOTAL 50.50 PAID WITH CHECK # 23918 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Cond Itioning - All Sizes Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS Fee Lold � t� Owner �--g �0 1" f D aox 2.6 74c a ,u ec he-f.j l A t 0 S7 1- 3gCit. - $35.00 $ Building Used As fa d i ld � tf4 $10.00 $ ESTIMATED COST,�O PERMIT NO r�l $10.00 $ DESCRIPTION OF "WE AND BURNER $10.00 $25.00 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 on work less then $300.00 Commercial/ladustrial/Institutional 125% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/IndustriaVinstitutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR $ # of Heating Units Circle One {Steam) of Wats (Warm Ail) Trade Name �— Size No.®Sm $ BTU ),10 /So / SJ aso aeO HP FDR Fuel oc-,> Total Connected Load a 8 0 0 00 $ Bumer 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 acoordanoe with the City Codes $ S°' ?9 and rulings of the Building Division. and hereby declares that all the facts and representations stated in this application are true and correct. $ ` so HEATING CO ko ila S er uv --e s wL —ZPS$ Sfa Signed ( e6 FAX # 76 �k '?941 83 0'> gate 51161 41 *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City �/ �•t/ FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE/ Approved Rough -in Date Final Date✓<U' � Aodl m 1'1H1-1W-dWVt4 1"-47 t'KUI'I 1.l 1 T Ur rKlLq-tI lu 1 OYOJC7 1 1 . v✓. v✓ FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON ,WENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When judlacina mn oxlsdn-q fUMM, 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 ri/ No( ) The venting system is plasticlPVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No 06 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-OAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes AA, ' No( ) The SWOU11a combustion air is sized and installed to meet the current codes and manufacturers 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 (j(j No ( ) When fin stalling a new venting sysiaer�t , the undersigned hereby verifies that It Is a fisted assembly and meets the current codes and manufacturer's specifications. This does include AGA-OAMA 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 Q(S No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type C&A J. W" Le."TU Input /q j ®ao Fan Assisted or Nat et - Appliance #2 Type w Ana( -f BTU Input /do ve o Fan Assisted or Nat Id 44 Appliance #3 Type Com. s .r A.id _ BTU Input -So ono Fan Assisted or Nat jj,,f Total Appliances 3 _ Total Btu InputS 9 g o04 Common Vent Type C l - &_ Vent Height 3 O / Diameter —/0 � ° inches Appliance 01 Vent Connector Height 3' ft Length r ft Diameter 6 A/ in Type s: -As l,.q- tw t l fl J Appliance #2 Vent Connector Height it Length ° ft Diameter 7 °° in TypeS. � we c,�_ On t( 4;, J Appliance fila Vent Connector Height _ 3 ' ft Lengthr ft CJiameter $ °' in Type W a to," '4A.L) A_VERATIONS:1Describel RQ Woo bV--9 --R 3 &L. ) st ®vac IA4-0 f HEATING CO: Signed By: Date: o TOTAL P.05 Apr 27 05 01:45p BSI 763-784-8307 p.2 Date: 04/21/2005 Revision Date: 04/2112005 Site Information Address 1: 5261 3RD ST NE Address 2: City: FRIDLEY County: ANOKA Application Information Business Name: BOILER SERVICES, INC. Contact Person: GARY EMERY Office Ph: 763-784-8178 Fax: 763-784-8307 Address 1: 10327 FLANDERS STREET NE City: BLAINE State: MN Zip Code: 55449 Existing Construction: Pre 1994. Project #: Lot: Block: Subdivision: MN Contractor License #:037665 -CL Cell Ph: 612-328-1640 Combustion Appliance Water Heater: Natural Draft Input BTUs: 199,000 Common Vent Fumace/Boiler 1: Natural Draft Input BTUs: 150,000 Common Vent FumaceBoiler 2: Natural Draft Input BTUs: 250,000 Common Vent Make -Up Air No Make -Up Air Required by Code Combustion Air Round Rigid Required: 16 inches or Insulated Flex: 17 inches Applicant Name (print), 44ylez.Y � e �' SignaturelDate: Code Official (print): Signature/Date: ��v'i•N- �1•S .Gvas P��'�T � �r�m %,�� Cae�ier �>.".vi s l�' ct -F Te r i Pu JA/ .41/ //re �-- , , • 7F� l ,,off s �� 5,r. �-� R2 a e) /a/ u�lPlc uia u !c1' Vo u /�Y� � r .L use. rg,'n� G 7 3) 7ez(- � / 7 9 C J , 0 2004 CenterPoint Energy Minnegasco' 2004 Mechanical Code Guidelines. Page i Date: 4/28/05 Revision Date: 4/28/05 Site Information Address 1: 5261 3rd st ne Address 2: City: fridley County: anoka Application Information Business Name: boiler services Contact Person: gary emery Office Ph: Fax: Cell Ph: Address 1: City: State: Zip Code: Existing Construction: Pre 1994. Project #: Lot: Block: Subdivision: MN Contractor License #:037665-cl Combustion Appliance Water Heater: Natural Draft Input BTUs: 199,000 Common Vent Furnace/Boiler 1: Natural Draft Input BTUs: 150,000 Common Vent Furnace/Boiler 2: Natural Draft Input BTUs: 250,000 Common Vent Other Combustion Appliances Gas Fired Direct Vent Fireplace(s): No Gas Fired Power Vent Fireplace(s): No Gas Fired Natural Draft Fireplace(s): No Solid Fuel Appliance(s): No Exhaust Equipment Continuous Exhaust Ventilation Capacity (cfm): NA Clothes Dryer (cfm): 135 Exhaust Fan Rating (cfm): 0 Make -Up Air No Make -Up Air Required by Code Combustion Air Round Rigid Required: 16 inches or Insulated Flex: 17 inches Applicant Name (print): Code Official (print): Signature/Date: Signature/Date: C 2004 CenterPoint Energy Minnegasco. 2004 Mechanical Code Guidelines. Page I Permit Fee Plan Review Surcharge Total Due I hereby apply for a pkMMV V*rMt and I I crdinanom and codes of fha City of Fdit permit and work is rug to sari wWmW a poi approval of plans. NAME OF APPUCANT SIGMTIAiE OF Minimum: $38.00 $.50 on pwmldi I*Aq than $9,000 -S-6 Make Checks Payable to: City of Fridley iI APPLICATWN FUR w rVAWI• ---• •• •�••• ------ o�uadsP ttu)t tlw bjb=tion e;Wg a oW"M and aocurato; that the vaork vM be in oonformenca VNI IAO' Wm ft tVtenoaot Carat C*M Coded that i Wwareland tkts is cot a permit but only an appitcaum ter athat the work wit be in a000rda nm vA h are approved p1m in the ossa of of work rrbloh requires review end DATE Q d l B-® C41 ® 9 5434 UNWMTff AV8=.N r4 RUDLEY, MN UM (183)-VZ'3W4