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PRE 2010 DOCSSubscribed and sworn to before me at Minnesota, I vliuzge'i! ®f FAdneyq MUM�DIIKG P N? 617 office Of II1 gp=019 OF BEINGS II. OGVnePG ar Architeat Fridley, Minn., BuildePIL 4q,011 LOI ii i F BUILDING I. No. Street PartLot Lot Bloch - Ad di on or Sub -Division II p DMS,03, TION OF BUILDING Front DePth l3ei ht tortes manner` of Construe l ion s To be used as 4 To be completed do I. Estimated Cost's pro' A - i Permit 1i hereby granted to —! y4r ., the building- II described in the above statement. This, permit is granted m it is granted, and his agents, (nployees and workmen, in all upon the express condition that the person to w the work done in, around and upon said building, or any part thereof, shalleonfin all respects to the ordi- nances of Fridley, Minn.,' regarding the ;construction, alteration, maintenance, ain 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. ! iry1'IC" '_Tnspector of Buildings. AGREMA=1, AND SWORN STATEP:MNtjT In consideration of the issue and deivery to me by the T=pector of Buildings of Fridley of the above permit, I hereby agree to do l he proposer work in occordonce with the 'descriptionabove set forth 9.nd according to the pro, sworn, I hereby state and say that the f' sions of the crclinaneer of. n4 cts stated by me and contained .q ley, and, being first duly, in the above permit are true as therein stated. ! .r Subscribed and sworn to before me at Minnesota, I City of Fridley, Minn. BUILDING PERMY]r N®, 3081 Date: .. j (0 7 S� ..... . Owner a ... a Builder .....,.w':d ttYL...................... . Address .. Address + ............................... LOCATION OF BUILDING No.. !.. Street ........................... Part of Lot ............................... Lot .. LO...... Block ... a;L ........ Addition or Sub -Division .. �cd ,�..... �C�.rr.� ........... . ..... Inside Lot ... ..... Setback .�:...... Sideyard %- Corner Lot ....... .. ... .................. DESCRIPTION OF BUILDING To be Used as: vca e.... Front i.4, ... Depth PA . _ Height /Q;ttw Sq. Ft. aO!W.. Cu. Ft. ........ .................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........ Type of Construction ..FRO M M ..... Est. Cost.. q00 ............ To be Completed ..B ....... In consideration of the issuance to me of a permit to construct the building desribed 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. .:V . ........................ s I��noxisideration of the payment of a fee of permit is hereby granted to A14... . t?.%..r ..! . ........... 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 with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ° ordinances. l�' .... Building Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. i Date: • 0 Owner: I City of Fridley, Minn. BUILDING PERMIT May 19, 1967 Richard D. Bodin Builder Same Address — 5824 3rd St. N.E. _ Address LOCATION OF BUILDING No. 5 824 Street _ _ 3rd S t . N.E. part of Lot Lot 10 & 11 Block 22 Addition or Sub -Division . Hide Park Corner Lot _ — Inside Lot x Setback -- Sideyard Sewer Elevation To be Used as: Move Garage & Foundation Type of Construction Foundation Elevation DESCRIPTION OF BUILDING N9 9265 Front _ Depth Height Sq. Ft. Cu. Ft. _ Front Depth Height Sq. Ft. _ _ Cu. Ft. _ Est. Cost 75.00 _ _.... 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 ordinanoEs of the city of Fridley. e In consideration of the payment of a fee of $___ 5 .00 , permit is hereby granted to Richard D. Bodin 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 tune upon violation of any of the provisions of said ordinances. CLARENCE BELISLE Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heaHne, sewer or water. Be sun to am the Building inspector for separate permits for thea hems. r I APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME � � /64 if D D, D BUILDER 7,s, To Be Completed %%6XF514 ADDRESS ��/—/� 7� ��o ADDRESS LOCATION OF BUILDING NO . 5e STREET ,� f. &Z , PART OF LOT LOT 1® BLOCK Z ADDITION OR SUBDIVISION CORNER LOT INSIDE LOT SETBACK SEWER ELEVATION TOP OF FOOTING SIDE -YARD Applicant attach to this form two certificates of survey of lot and proposed building location drawn on these two certificates. To be Used as: DESCRIPTION OF BUILDING Front Sq. Ft. Front Sq. Ft. Depth Height Cu. Ft. Depth Height Cu. Ft. Type of Construction Estimated Cost 7,s, To Be Completed %%6XF514 D T Z0 7� 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 ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE SIGNATURE (Schedule f Fee Costs can be found on the Reverse Side). • • . Ar YL7 SUBJECT PERMI City of Fridley ®13215 AT THE TOP OF THE TWINS BUILDING PERMIT r ` RECEIP • COMMUNITY DEVELOPMENT DIV. �y-------� PROTECTIVE INSPECTION ^�C� r � � SEC. 1 � ' CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910415 9/19/75 JOB ADDRESS 5824 - 3rd Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 22 Hyde Park Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Richard D. Bodin 5824 - 3rd Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW jI ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 12' x 20' Addition to dwelling 9 CHANGE OF USE FROM TO STIPULATIONS Owner realizes he is zoned C-2 Commercial and that is is a non-conformi xx use. SEPERATE PERMITS REQUIRED FOR WIN& HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Wood Frame 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 C_2 14O 2800 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. $3,800 1.90 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- $13.99 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $15.89 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT r o IV BLDG INSP D rE GNATURE OF OWNER IIF OWNER BUILDER I (DATE) •APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION.BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME'u �,�3:�®BUILDER: �� ADDRESS: " c e - � 9 -�� �. ` ADDRESS :��AL L ALYZ'XA1-X- Z,4 &,I-:' NO:. STREET: LAT: _! D BLOCK: 2 2- ADDITION: Z/00 d IF CORNER LOT: INSIDE LOT: _SETBACK: SIDEYARD:— Applicant attach to this 'f orm Two Certificates.. -If Survey .of Lot and _proposed building location drawn on these Certificates. 0 To Be Used As: DESCRIPTION OF BUILDING 20D Front: -L,')-- r Depth: a D Height: Square Feet: Cubic.Feet: 2- Front: Front: Depth: Height: i Square Feet; Cubic Feet: — Type of* Construction: ,141 e�?O, Estimated Co TO -Be Completed: 1�r��. 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:' l SIGNATURE: ' d (See Aeve�s Side For Additional Inf ti n.)* 13� IH 1 . - SUBJECT City of Fridley 27746 AT THE TOP OF THE TWINS BUILDING PERMIT f COMMUNITY DEVELOPMENT DIV. ^ C`eJ r PROTECTIVE INSPECTION SEC. �� 1 � NUMBER REV DATE 9/14/98 PAGE OF APPROVED BY = CITY HALL FRIDLEY 55432 IL �'' .... 11.� 612-571-3450 910-F15 JOB ADDRESS 5824 3rd St NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 10 22 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lucile Bodin Same 571-1273 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. J D Construction Inc 926 Blackoaks In Anoka 55303 421-0164 5157 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 [1 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house & garage (18SQ) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the 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 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 $1,S42.00 $.77 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- $51.25 Fire SC $1.54 STRUCTION OR THE PERFO NNCE�CONST TION. QQ PLAN CHECK FEE TOTAL FEE `�� -f® Licen SC $5 0 $58.56 NA E CONTRACTOR OR AUTHORIZED AGENT IDATEI N ROPE ALIDAT HIS IS R P RM BLD IN DATE SiG NATURE OF OWNER 11F OWNER BUILDERI IDATEI NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: 5 Legal Description: P Effective 1/1/98 Owner Name & Address: A u C �-� ��L i Tel. # 5-7/ —Z2 % 3 _._ � Vic , {q �,.a l` MN LICENSE Contractor: �f � j� o � '�� Address: �j �_T %rp�� Da m fa !n e , 4snbk:a-//h0, Tel. # d/c3 (o �} Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EVIPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Len Width Hgt/Ground Sq. Ft. OTHER: —k- r6 %� � Ot—/ -- U e� Construction Type: -e v Q �'� Estimated Cost: $� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ r DATE: — e 3 APPLICANT: Tel. # La i^';x (' o 10 Permit Fee $ Fire Surcharge $ State Surcharge $ /% SAC Charge $ License Surcharge $ 66 Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ ��3's� STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] SUBJECT PERMIT NO. City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT 2 9 0 4 0 r C I 16 `v _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. /90�� r 1 � = CITY HALL FRIDLEY 55432 NUMBER REV DATEPAGE OF APPROVED BY 612-571-3450 910415 3/22/99 10B ADDRESS 5824 3 Street NE 1 LEGAL LOT N0.BLOCK TRACTOR ADDITION SEE ATTACHED OESCR. 10 22 I Hyde Park SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Lucy Bodin 5824 3 Street NE 571-1273 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO J D Construction Inc of Anoka 926 Black Oaks Lane, Anoka, MN 55303 421-0164 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5157 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION 1j REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reside House 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 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 1 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $8,000 $4.00 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHAR E PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $137.25 Fire Ci $8.00 STRUCTION OR THE PERFORM E OF CONSTRU TION PLAN CHECK FEE TOTAL OV LX. Licen C $5.// - 54.25 OG M E F CON TRACTOR OR AUTHORIZED AGENT IOMTEI N P LID T S IS AqUR PERMIT _PR S,GNATUAE OF OVYNER,IF OWNER BUILDERi IDATEi BOG I a TIMit NEW [ ] Effective 1/1/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �b BUILDING PERMIT APPLICATION ConstructionAdiress: S $ a V ;? S_4 �/ ,o Legal Description: Owner Name & Address: Contractor: Tel. # -57:2 / -- /a 7 !, MN LICENSE # Address: Tel. # 4(-2 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EWPROVEMENT 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:k-'%,- Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: - APPLICANT: d Tel. # CITY USE ONLY Permit Fee Fee Schedule on Reverse Side Fire Surcharge $ R - oro .001 of Permit Valuation (1 / 10th %) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge $ ::E,: 00 $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above or TOTAL $ t STIPULATIONS: $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY INSPECTION DIV. 3431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTI IRFS TO RF INRTAI I Fn nN r-ArM Fi nno Effective On Jan 1, 2000 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas" Gas Range'" NO. RATE Gas Dryer" Back Flow Preventer Required ( )Yes () No $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 Type $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL JOB ADDRESS -5400 te- dt, &3•E?-- 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 P,uilding Division, and hereby declares that all the facts and representations stated in this application are true and correct BODIN, LUCILLE `0/' 2001 5824 3RD STREET NORTHEAST FRIDLEY, MN 55432 Owner (763) 571-1273 Building Used As �;SS 1 DPJ C R Estimated Cost PERMIT NO. PLUMBING COMPANY &S&ZPZj)1V7j;1Aj(4 SIGNED BY L NO Z` D Approved By Rough -In Date Final Date 11-1 TOTAL FEE $2—D. 550 PLUS THE $.50 STATE SI IRr.HeR�F COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A COMMON VENT INFO ON BACK SIDE J c • 7 . T ISR ® o ' ® e M rcm® PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas" Gas Range'" NO. RATE Gas Dryer" Back Flow Preventer Required ( )Yes () No $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 Type $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL JOB ADDRESS -5400 te- dt, &3•E?-- 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 P,uilding Division, and hereby declares that all the facts and representations stated in this application are true and correct BODIN, LUCILLE `0/' 2001 5824 3RD STREET NORTHEAST FRIDLEY, MN 55432 Owner (763) 571-1273 Building Used As �;SS 1 DPJ C R Estimated Cost PERMIT NO. PLUMBING COMPANY &S&ZPZj)1V7j;1Aj(4 SIGNED BY L NO Z` D Approved By Rough -In Date Final Date 11-1 TOTAL FEE $2—D. 550 PLUS THE $.50 STATE SI IRr.HeR�F COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A COMMON VENT INFO ON BACK SIDE COMMON VENT_ VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the BTU Input venting has been examined and is free from rust, deterioration, obstructions, Appliance #2 Type and is securely supported and firestopped where required. Yes () No ( ) The venting:. system is plastic/PVC and meets all current codes and manufacturer BTU Input 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 Vent Height include AGA-GAMA Category I Central Furnace Venting Tables for fan Appliance #1 Vent Connector Height assisted and natural draft appliances. Yes ( ) No ( ) The existing combustion air is sized and installed to meet the current codes ft Length and manufacturer's specifications. Yes ( ) No ( ) When required to Install a new combustion air, it will be sized and installed ft Diameter in Type 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 asper 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 : ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE R5673 CITY OF FRMLEY PE NO.: 2004-02000 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 10/26/2004 572-36U4 FAX: (763) 571-1287 : 5824 3 ST NE : 233024230058 : HYDE PARK : LOT 10 BLOCK 22 : HEATING : RESIDENTIAL : 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. INSTALL A FURNACE (WARM AIR, RUUD, 920%). # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 1800 APPLICANT RIVER CITY SHEET METAL INC 9929 BLUEBIRD ST NW COON RAPIDS, MN 55433 (763) 754-2199 OWNER BODIN LUCILLE A 5824 3RD ST NE FRIDLEY, MN 55432 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 regula ' , construction or the performance of construction. Applicant " Dated Bldg Insp. HEATING PERMIT MINIMUM FEE 0.00 FURNACE SHELL/DUCT WORK 35.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 35.50 PAID WITH CHECK # 13871 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. P U. CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Resfden ial Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace. Fireplace, insert) Gas Range Gas Dryer *Air Conditiordng -All Sizes Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS -5-9 4X - 341W S� A% C—' Fee 19im Owner Z' Cr LL..e_ gD®1 rV $35.00 $ •po Building Used As $10.00 $ ESTIMATED cow—14k) Odd -d U PERMIT NO $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating Units—/ One (Steam) (Hot Water) (Warm Ai Trade Name 9 -AA l wa 1. �(U °/v Size No. -6?e q-1 t_ $25.00 $ BTU '20„ 6-0 HP MR Fuel Total Connected toad 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 InWovement whichever is greater on work less than $500.00 Co m merc la Vl n dustria l/i ns-Ututlonal 1.25' of Value of Appliance or Work (Liston Back) .. Mlnimurn Fee $35.00 forCo-imercial/industrial/Institutional Burner Trade Name Size No. BTU HP EDR The undersigned hereby makes application for a permit for the work herein specified agreeingto 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, State Surcharge $ - TOTAL FEE $19-- SD 14 M REINSPECTION FEE $50.00/HOUR N .r *Air Conditioners can not be placed In side yard without written approval from adjoining property owner -copy to City i' FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE S' p�gcco_rti 46t4n It) d4 lah2 HEATING CO A A S V11A5W !!__ r Signed_� Ad::2 oa&AQ Tel # .3- FAX #7W -29%o1r!D i Date ,lP -2/--45/ Approved by Rough -in Date Final Date CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 VAX: (763) 571-1287 ADDRESS : 5824 3 ST NE PIN : 233024230058 LEGAL DESC : HYDE PARK : LOT 10 BLOCK 22 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-02002 DATE ISSUED: 10/27/2004 VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. WIRE FURNACE. # INSPECTIONS 1 APPLICANT DEPENDABLE ELECTRIC INC 2619 COON RAPIDS BLVD NW COON RAPIDS, MN 55433 71 AIZ ' BODIN LUCILLE A 5824 3RD ST NE FRIDLEY, MN 55432 ELEC PERMIT FEE - MIN (RESI) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 28866 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 worts 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 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.