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PRE 2010 DOCSVM4ge of FAMey, Minm j PIP UtTHMING .011111M N° 370 ice ; of INWFMOR OF BU"MGS �I Owne ar.r `o"'. Architect 19 F'rid'_e Minn. y Builder, 6 i jLOCATION OF BUILDING No- Street Part,of Lot Lot ! Block i Addition or Sub-DivisionP DESCRnMON OF BUMDING i g� r �►11 Front. 40±` De th I Height /- Stories Manner of Co nsi nactio*+ To be used as To be complet '�"' ! Estimated Cost Permit is hereby ted to, .. the bull ` described in the above statement. This permit is granted upon the express c Dndition 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, shalt conform in all respects to the ordi- naaces of Fridley Minn., regarding the construction, alteration, maintenance, repair and moving of buildings within the city ts, and this, permit may be revoked at any time upon violatign of III any of the provisions. of said ordinances. 7sispeetor of Buildings. AGGREP= Alm SWORN STATE1d7T In co ode tion of the issue and delivery to me by the Iuspectgr of Buildings of Fridley of the above pern it, I hereby agree' to do the proposed work in accgrdance with the description above set forth and according to the provisions of the ordinances;, of�IFridley, and, being first duly sworn, I'llereb3i state and say theft the facts stated, by me atld contained in the above permit are true as therein stated. tie Subscribed d sworn to before me at Fridley, M nnesota, dw —JA*—o day o J). 18 r r - .. _ ii 52-84.5915.51 City of Fridley APP9eeti®n for Plimbing cmd Gas Firing Fendt Dept. of Ridge. Phone 360.3480 DESCRIPTION OF WORK 5610 N E 4th St Number, Kind and Location of Fixtures LeeaRon PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures .. ...... Future Fixture Opening .... ... ..... New Fixture Old Opening .. Catch Basin . . Water Heater (Up to 99,000 BTU) ... New Ground Run Old Bldg. Electric Water Heater CAS FITTING FEES: x $2.00 $ x $1.60 $ x $1.60 $ o0 $ x $3.00 5 3 $ e e e e N WATER HTR. GAS ELEC. Base lea - 2nd 3rd — — 4th ° Future Connection Openings e Now Fixture, Old Openings I Connected with Cesspool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures .. ...... Future Fixture Opening .... ... ..... New Fixture Old Opening .. Catch Basin . . Water Heater (Up to 99,000 BTU) ... New Ground Run Old Bldg. Electric Water Heater CAS FITTING FEES: x $2.00 $ x $1.60 $ x $1.60 $ x $3.26 $ x $3.00 $ x $3.26 $ _ $2.00 $ NO. RATE TOTAL 1st 3 Fixtures ..... x $2.00 $ Additional Fixtures . .......... , ....... x $ .76 $ Gas Range to 199,000 BTU .............. 1 x $6.00 $ 3.00 REPAIRS & ALTERATIONS—Refer to Code Description ...............................................$ TOTAL. FEE s ----Lo 00 City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct Fridley, Minn 10-13-69 19— Owner d Stons Kind of Building frame Used as To be completed about _ 10-17-69 Estimated Cost, It 10.00 Old—New. Building Permit ®emit 4 Cz B hWE60US GAS CO. Business Phone No ROUGH FINAL—j � V 53_e4_891�-51 City ®f Fridley Appy ®o for Permit Dept. of Bldgs. Phone 980-3490 DESCRIPTION OF WORK Locstina 5610 N E lith St Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: s Number Fixtures ...... ... ...... aF Future Fixture Opening ... .... ...... uZi 3 O �C 3 p� o i3 0 Z o� N 00 • • N WATER HTR. GAS EIEC. Base Additional Fixtures . .......... , ....... —x$.75 $ Gas Range to 199,000 BTU .............. x $5.00 $ Ii ist Ga d REPAIRS & ALTERATIONS—Refer to Code Description ...............................................$ TOTAL FEE $ 5.00 — 2nd 3rd --- 4thl 1_1 -- ° Pat=* Connection Openings • Now Fixture, Old Openings Connected w94h Cesspool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...... ... ...... x $2.00 $ Future Fixture Opening ... .... ...... x $1.50 $ New Fixture Old Opening ....... . .. x $1.50 $ Catch Basin ... ................. x $3.25 $ Water Treater (Up to 99,000 BTU) ...... x $3.00 $ New Ground Run Old Bldg. x $8,25 $ Electric Water Heater : $200 $ GAS FITTING FEES: NO. RATE TOTAL lot 3 Fixtures .......................... x $2.00 $ Additional Fixtures . .......... , ....... —x$.75 $ Gas Range to 199,000 BTU .............. x $5.00 $ Gas Dryer 1 5.00 d REPAIRS & ALTERATIONS—Refer to Code Description ...............................................$ TOTAL FEE $ 5.00 City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct Fridley, Minn U-8-70 19_ Owner J Stone Kind of Building frame Used as rag To be completed about -_ 4-13-70 Estimated Cost, $ Old—New. Building Permit No to x Signer] _WNEAPOM-C"t P9 By ROUGH FINAL /f- � - %a Business Phone No tlon fOr Power Pla0Ms and N6016% COORngs Ventil0kne Refrivmflon and AppRca Air Conditioning Sptems mid Devices PARTIAL RATE SCHEDULE GRAVITT WARM AIR: MTN TOTAL Furnace Shell & Duct Work ................ .. $10.00 $ Replacement of Furnace .. . ..... .. ..... .. 6.00 $ Repairs & Alterations—up to $500.00 600 $14 _ Repairs & Alterations each add. $600.00 3.00 $--- Sae Fee Se6ednls VENTILATING SYSTEM MECH. WARM AIR ALTERATIONS & REPAIRS Furnace Shell & Duct Work to 190,000 BTU ...... . ..$10.00 $L_ each aid. 60,000 STU .................... .. 3.00 = Replacement of Furnace 6.00 $ Repairs & Alterations—up to $500.00 6.00 $ Repairs & Alterations each add. $500.00 300 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $. _ Furnace Shell & Line --to 640 sq. ft. EDR Hot Water 10.00 $_ Each add. 200 sq. ft. EDR Steam 3.00 Each add. 320 sq. ft. EDR Hot Water 3.00 $ OIL BURNER—to 3 gal. per hour 6.00 $ _ over 3 gal, per hour --See Fee Schedule GAS BURNER (up to 198,000 BTU) ...... 5.00 $� over 199,000 BTU See Fee Sche"o GAS FITTING FEF.B: NO RATE TOTAL 1st 3 Fixtures x$ 7.00 J4i Additional Fixtures a .75 $ Gas Range to 199,000 a$ 600 $ AIR CONDITIONING 4 - FAN HEATING SYSTEM Sae Fee Se6ednls VENTILATING SYSTEM ALTERATIONS & REPAIRS TOTAL FEE � ROUGH FINAL f/` d Dept. of Mos. Phone SM -MM we 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 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. 4 idler, Minn 1672.. Owner _ Kind of Used as .. To be completed about Estimated Cost, Building Permit No Permit No. DATION OF WORK BEA77NG or POWER PI -ANTS ---Steam, Hot Water, Warm Air—No Trade Name Size No Capacity— Sq. Ft. F-D.R BTU H,P Total Connected Load Hind of Fuu �44-f BURNER — Trade Size :NO N,2�- A17 -r3 Capacity cis_ BTU (REMARKS -OVER) CITY OF FRIDLEY Effective Date May 1. 1988- . APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL RATE Furnace Shell and Duct Work, Burner (Also replacement furnace) $ 20.00 Gas Piping $ 10.00 (piping needed with new furnace) Gas Range a $ 10.00 Gas Dryer $ 10.00 • Air Conditioning (all sizes) S 10.00 All Others/Repairs and Alterations It of Value of Appliance or Work COMMERCIAL/INDUSTRIAL 10 of Value of Appliance or Work State Surcharge T$ . 1 s Reinspection Fee ($15.00) TOTAL $ ZO.da Rough Insp. Date Final Insp. Date���` Approval for Permit L� V old Job Address �+ 6/0 ! 4 � �v� Department of Buildings, 6431 University Ave. N.E.. Fridley, NN 55432 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 applic ion aretrfus and correct G Fridley, Minn. r OWNER KIND OF BUILDING 1C y& s a i.+ ( f er �- qua 719,fO 7%f --f USED AS 1Ze.&/ t. -'C4— G TO BE COMPLETED ABOUT b-af, 71G ESTIMATED COST I. O oo. _ OLD - NEW BUILDING PERMIT NO. PERMIT NO. /0 A DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Nana Size No.A( U_ Irne!T Capacity �� Sq. Ft. EDR BTU HP Total Connected Load .SZ/Kind of Puel /iIA17 1/,> BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00 �I/ Company PLUS $.50 STATE SURCHARGE �L- Signed ey Tel. No. 7/73 b *Air Conditioners can not be placed in side yard without written permission from adjoining rx.gl.bur. Fill mut back side for stack verification on replaceaent furnaces CHIMNEY 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 (i.' No ( ) 4. Is securely supported Yes No ( ) 5. Meets all current Code requirements for size and total BTU connected Yes (L' No ( ) 6. Has Total heating BTU's of All other BTU's TOTAL/0, 000 Rema rk s^-°-"''`'�"'� Company (i�'`���� Gilc Signed By ✓�—� nate /�f�� CITY OF FRIDLEY Effective Date May 1. 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESInENTTAL IRATE TOTAL Furnace Shell and Duct Work, Burner (Also replacement furnace) $ 20.00 Gas Piping $ 10.00 (piping needed with new furnace) Gas Range $ 10.00 Gas Dryer $ 14.00 • Air Conditioning (all sizes) S 10.00 All Others/Repairs and Alterations li of Value of Appliance or Work COMMERCIAL/INDUSTRIAL li of Value of Appliance or Work Reinspection Fee Job Address �l� ! O $ Department of Buildings, 6431 Universit ve. N.E., Fridley, MN 55432 City of Fridley $ Tel. #571-3450 $ The undersigned hereby m es application for a permit for the work herein specified agreeing to all work in strict accordance with the City Codes $ and rulings of the partment of Buildings, and hereby declares that all the facts and repres tations stated in this application are true and correct. $ Fridley, Minn. OWNE P� hl� ^e 5 '-f-b N b' $ IND OF BUILDING L) #1r-kP USED AS ode $ State Surcharge. 50 TOTAL FEE $ ® . �- I ($15.00) $ TO BE COMPLETED ABOUT -Df-t- 7 -- ESTIMATED ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER Rough Insp. Date HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Final Insp. /* Trade Name ( Size No. Date Capacity Sq. Ft. EDR BTU HP J�Approval for Permit Z' ' ;- �%. ,� Total Connected Wad Kind of Fuel IRNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP MINIMUM FEE,. -'/OR ANY HEATING PERMIT IS $15'& PLUS $.50 PTATE SURCHARGE f *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. Company _ Signed By Tel. No. Fill out back side for stack verification on replacement furnaces 5. Meets all current Code requirements total BTU connected 6. Has Total heating BTU S s of All other BTU's TOTAL Rema rk s for size and Com pa ny Signed By Da t Yes ( ) No ( ) CHIMNEY 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 deterioratior Yes ( ) No ( ) 3. Has no foreign objects lodged wit in Yes ( ) No ( ) 4. Is securely supported Yes ( ) No ( ) 5. Meets all current Code requirements total BTU connected 6. Has Total heating BTU S s of All other BTU's TOTAL Rema rk s for size and Com pa ny Signed By Da t Yes ( ) No ( ) SUBJECT P� City of Fridley �, � � AT THE TOP OF THE TWINS BUILDING PERMIT f RECEIPT NO. • _______ COMMUNITY DEVELOPMENT DIV. I L PROTECTIVE INSPECTION SEC. _ r 1 CITY HALL FRIDLEY 55432 �"" •'' NUMBER REVDATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/6/96 JOB ADDRESS 5610 4 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR, 9,10 4 Hamilton's Addn to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Omar Nelson 5610 4 Street NE 571-9232 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 ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Reroof House 12 S 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd layer but not the 3rd. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REOUIRED 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 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 $744.00 $.50 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- $ $.74 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECKFE TALFEE _/ $30.49 S ATUREOFCONTRACT O AUTHORIZED AGENT IDATEI PR LY VALI D THIS ISIS YOU T P DATE ATURE OF OWNER tIF OWNER ILDERi IDATEI NEW C l Effective 3/1/96 ADDN [ l CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: �� %Q Legal Description: Owner Name & Address: zkes-o '-411 Tel. # Contractor: �.e ` e MN LICENSE # Address: 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 GARAGE AREA: Length Width Height DECK AREA: Length Width Hgt/Ground OTHER: p / /) u 5,e l ";7– Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Type of Construction: Approx. Completion Date: Tel. # Sq. Ft. Sq. Ft. Sq. Ft. Side Yard Setbacks Estimated Cost: $ )7 TOTAL STIPULATIONS: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + Ft = Ft x $ _ $ DATE:�� ` /�� APPLICANT: Tel.�— CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ 17`1 .001 of Permit Valuation (1/10th%) State Surcharge $ SZ) $.50/$1,000 Valuation SAC Charge $ $900 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: GiYOE FRIDLEY FRIDLEY MUNICIPAL CENTER •6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 September 25, 2000 Karen Soete 5610 4 Street NE Fridley, MN 55432 Re: Final Inspection at 5610 4 Street NE Contractor: A.R.E. Plumbing Dear Ms. Soete: A plumbing permit was issued on April 21, 1998, for the above noted address, to install a gas water heater. According to section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the plumbing authorized by this permit. As of this date no inspection has been called for. You will be given thirty (30) days from receipt of this notice to respond. If we do not hear from you, we will expire the permit and any inspections on this installation will require a new permit. Any questions can be addressed to myself at (763) 572-3603. Sincerely, r E-Wiws • - • CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On August 1, 1995 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 7fv r 60 � PLUMBING FIXTURE RATES: NO.. RATE TOTAL JOB ADDRESS S ICS `irk S� C 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** F• Gas Dryer** Back Flow Preventer Required ( )Yes {) No Type $ 7.00 The undersigned hereby makes application for a permit for the work herein MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR and rulings of the Building Division, and hereby declares that all the facts $ 7.00 and representations stated in this application are true and correct. i� _1:./--70 p , 1995 $10.00 Wash Floor Auto. ;� x Gas} =Water Heaterr Stories Urinai,, $10.00 Shower :. E�� Tra Drain )rf >, Washer Ran_ Gas Eiec Basements °4� ��: Floor 1 -AIN us . „r Floor 2 I . - F oor 3M-011 l L -' ' ui [ @T. .� .i b d : } itib r'� ii 5 �.� Floor 4 ._21��.1 .:v� : .i. �Fi tea, , C.!hi'�il�'i'�i1..,_..:. Sri - PLUMBING FIXTURE RATES: NO.. RATE TOTAL JOB ADDRESS S ICS `irk S� C 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** F• Gas Dryer** Back Flow Preventer Required ( )Yes {) No Type $ 7.00 The undersigned hereby makes application for a permit for the work herein -$4.00 specified agreeing to do all work in strict accordance with the city codes $ 5.00 and rulings of the Building Division, and hereby declares that all the facts $ 7.00 and representations stated in this application are true and correct. $ 7.00 $ 7.00 _1:./--70 p , 1995 $10.00 Owner ,kava w 5S5'c,e-4- 5;-70 2 —10 Y i $ 7.00 $10:00 1 U Building Used As $10.00 $10.00 Estimated Cost Sa 0 PERMIT NO. $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appilance State Surcharge .50 TOTAL FEE $ 4915*6 SIGNED Approved By Rough- In Date Final Date 10 /5 -0 0 PLUS THE $ 50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SO INCHES. CIiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287 May 17, 1999 Karen Soete 5610 40' St. NE Fridley, MN 55432 Re: Final inspection at 5610 4' St. NE Contractor: Lakeland North Heating Dear Ms. Soete: A mechanical permit was.issued on April 20, 1998 for the property located at 5610 4h St.. NE for a new air conditioner. According to Section 305(a) of the 1991 Uniform Mechanical Code a final inspection shall be performed on the mechanical permit. As of this date no inspection has been called for. You will be given thirty (30) days from receipt of this notice to respond. If we do not hear from you, we will expire the permit and any inspections on this installation will require a new permit. Any questions can be addressed to myself at (612) 572-3603. Sincerely, ze Z4 /' /c/a, r Bary Riesch Building Inspector CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1, 1998 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES le, JOB ADDRESS ,v- Sle y � f _ RATE SCHEDULE Residential Rate_ TOTAL Furnace Shell and Duct Work, Burner — Also Replacement Furnace $ 30.00 $ (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) $10.00 $ Gas Range $10.00 $ Gas Dryer $10.00 $ *Air Conditioning — All Sizes $ 25.00 $� All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work $ Commercial/Industrial 1.250 of Value of Appliance or Work State Surcharge X50 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. a- L ) ,1998 OWNER BUILDING USED AS ESTIMATED COST / Y •�� u� PERMIT NO. • / 3 Z DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One Trade Name BTU Fuel Burner Trade Name BTU TOTAL FEE � MINIMUM FEE FOR ANY HEATING/COOUNGNENTILATION 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. HP (Steam) (Hot Water) (Warm Air) _ Size No. EDR Total Connected Load HP Size No. EDR HEATING COMPANY Z_1.14�-4v -J A-) fl�t Signed By U , Tel No. Approved By Rough—In Date Final Datef— 2, 4t FILL OUT BACK SIDE FOR STACK VERIFICATION ON 44 REPLACEMENT FURNACE M Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CHEWNEY 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: I give my permission to Karen Soete to locate her Air Conditioning Unit on the south side of the house. Print Name i� Signature = - � ��- ' 1.�'� �' :2-V 1-