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PRE 2010 DOCSA Date:8/sal � .. City of Fridley, Minn. WELDING PERMIT owner ....................................... Address ...................................... N® 329. Llder ......... Address ............................................. �„ LOCATION OF BUILDING No. r.y! Street ... 4. .......... Part A Lot ........... ................. a Lot ...... f... Block ......v......... Addition or Sub-Di;Won .. .... . .. .... . o .. Corner Lot ............ Inside Lot ......... Setback ... ..ai.... Sideyard ./a ...... ........ DESCRIPTION OF BUILDING o bp Used as: W- L�.... Front 1.. Depth . . Height ........ Sq. Ft. ®. rCu. Ft. .r , r ont ........ Depth ..... t .. td, v .. Sq. Ft......... Ft. .................... ........ Type of Construction !i.:�t-rte . liigt. dost. �. �....... To be Completed :. .. o .... . F 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 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 with- in the city limits and' this permit may be revoked at any time upon violation of any of the provisions of said ordinances. N, 44,.A(�Ouildlng Inspector 1 NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbin gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Item City of Fridley, Minn.. BUILDING PERMIT ;2 4 9 61 / tr` Date: Owner: Build Address.....___._.._ _ ___ _ ____._. _ _ _ Address ____._....__......... __._...._ ..__.._ ._..____. _._.._.__._._........ 1001 F BUILDING No....?.,.... Street _... '.. ---j----........_ .............. Pqk of Lot ........... _..... > . _ . .......... f ................ Addition or Sub -Division �.�a.....�:��...:t` .y21✓A_..._.. _. ___ Lot ....._........----.....---...... Block ....._..----------••---...------. �. ... .... Corner Lot .......................... _--.- ---.Inside Lot ......._.......... aback t�.•--. . Sideyard • - -._...._.........----.............................. Sewer Elevation ............... _.............._...._............._.....__..._............._........ Foi dation Elevation DESCRIPTION OF BUILDING V ��,!�+ .4- Front ..-.__.. Depth .:.. Height j .._. Sq. Ft....?/��. Cu. Ft. .... _.............._..... .: _......._.............. ...................... Depth ....._......... Heigh ....._.... Sq. Ft......_................. Cu. Ft......................... Type of Construction .. .� _........ Est. Cos .......�....!...._........ 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. y 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 tim n lation of y of the provisions of said ordinances. .*� . i�J 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 PEWT CITY OF FRIDLEY, XMNESOTA • •_ - iic i fir/al- �/...::.�.�ii..i_."..r-_�..1..� / LOCATION OF BUILDING No..S 5/� Streeit 1-1 Part of Lot Lot Block. Addition or Sub.Div. Corner Lot; side Lot` t Back Side -Yard SEWER ELEVATION FOUNDATION ELE"YATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: d���, - Front , 16 Depth o2 �. Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. 0, ma Type of Construction Estimated Cost %6 d To be completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in striet accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representa- tions stated in this application are true and correct. DATE.,, _� SIGNATURE (A Schedule of Fee costs can be found on the Reverse Side.) .. - 1* 0 + - -'sex. T/9, -,?- JF6 Y-7 SUBJECT City of Fridley - 15652. AT THE TOP OF THE TWINS BUILDING PERMIf _ r RECEIPT NO. • _ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 � � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/10/80 JOB ADDRESS 5916 - 5th Street N.E. ° 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 2 Bennett Palmer SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bernard Solyntjes 5916 - 5th Street N.E. 571-2830 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 Install stove and masonry chimney 9 CHANGE OF USE FROM TO STIPULATIONS SEPERATE PERMITS REQUIRED FOR WIRING, HEATINGs PLUMBING AND SIGNS, 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 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 VALtATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $500 .50 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 TOTALFEE $8.00 SIGNATURE OF CONTRACTOR ORAUTHORI ED AGENT (DATE) WHEN PROPERLY (DATED T IS IS YOUR PERMIT �y ZINREAWNE1101NERBUILDERI _hczu_p_j_ ID EI BLDG WSP DATE CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL_ BUILDING PERMITS (New, Alterations, Additions, or Repairs) OWNER:&244 ADDRESS: S- 7 - Ste • TEL NO: _� 2/ & 3 d BUILDER: ADDRESS: TEL NO: Construction Location �/ STRT T NO: 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. .5sT,4I �"° �" N''''� STv DESCRIPTIO14 OF CONSTRUCTION Front: Depth: Height: F, Square Feet: Cubic Feet: ce_n uQ PAS Front: Depth: height: Square Feet: Cubic Feet: Type of Construction: Estimated Cost: $ 5704:' ®6 Ub Be Cbmpleted: Alt. A Alt. B Proposed.Diiveway 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 are true and correct. DATE: 16 SIGNATURE: Stipulations: � A? SUBJECT PE IT NO. City of Fridley 17889 AT THE TOP OF THE TWINS BUILDING PERMIT REC • _____ COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. � `..-.� �/-"1,•� CITY HALL FRIDLEY 55432 NUMBER REV, DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 4/3/85 JOB ADDRESS 5916 - 5th Street N.E. 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 2 1 Bennett Palmer Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bernie Solyntjes 5916 - 5th Street N.E. 571-2830 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Larry Gudmunsen Remodeling 2651 Rice Creek Road, New Brighton 636-1841 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 Construct a 14' x 12' Addition 9 CHANGE OF USE FROM TO STIPULATIONS NA A Bente diNhIg coil la^Ul utiliiie TE�EpIIOPdE- ELECTRIC - GAS EtC. SEPARATE PERMITS REQUIRED FOR BY LAW WRING, HEATING, PLUMBING AND SIGNS. EC,0RED SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. Wood Frame 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 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 $3,150 $1.58 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- ON- $44.50 STRUCTI OR THE PEMANCE OF CONSTRUCTION. STRUCTRF PLAN CHECK FEE TOTALFEE la"' $11. $57.21 SIG NAT - F CONT ACTOR OR AUTHORIZED AGENT (DATE) WI�E PROPE LY DA ED IS IS YOUR PERMIT r r BLDG IN SP GATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI NEW [ ] City of Fridley Effective 4/1/84 ADDN. [id R-1 AND R-2 ALTER. [ ] Building Permit Application Const ruction Address: S} / G — S 4 4 S 4 ' /'U • —9— • Legal Description: L a 4- 8 -43- 1 k. 7 - Owner owner Name & Address : B �' N i t So �,+ �J 4- ► e S Tel. # Z $ 3 C Contractor: `" �w s e �Q-e �r d d �� d Tel. # 434 — 11.9 1 Address: LG S/ 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 / Y r Width / Z Height !! Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER -- Corner Lot [ ] Inside Lot N Ft. Yd. Setback Side Yard Setback Type of Construction: W Oy -ML Estimated Cost: $ i Approx. Completion Date: .5-X.?0 ( SS 0 �X I o% Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: i � APPLICA Tel . # 3 C "' / CITY USE ONLY Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer !lain Charge TOTAL STIPULATIONS: $ 'V Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ sueaEcr PER City of Fridley '1243.9 AT THE TOP OF THE TWINS BUILDING PERMIT 1 , E r COMMUNITY DEVELOPMENT DIV. ______ r 1 L r PROTECTIVE INSPECTION SEC. �3 1 r 1 r NUMBER REV. DATE PAGE OF APPROVED BY ; CITY HALL FRIDLEY 55432 612-571-3450 910-F15 3/30/92 JOB ADDRESS 5916 5th . Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 2 Bennett Palmer. Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bernard Solyntjes 5916 5th.Street NE 571--2830 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Gudmunsen Design/Builders 1405 SilverLa,ke Rd, New Brighton 55112 6368464 2632 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 XQ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Replace windows_ (Same size as. existing) Egress- windows. in .bedrooms 9 CHANGEOFUSEFROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. 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 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 BECOMPLIED $4 2�0 $2 a 10 WI H WHETHER SPECIFIED EREINOR NOT. THE GRANTING OF AERM ^ PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISI OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $ 72' �� k'lre SC $4.20 TRUC O OR THE P FORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE 3 i3o ZZ T c/eyny�se SC$ 5.00 $83.30 SIGN URE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) PROPERLY VALID TEED .HIS IS YOUR ERMIT r 3 30 9z ---=�-!�N BLO )NSP MATE SIGNATURE OF OWNER) IF OWNER BUILDER) IDATEI NEW [ j Effective 3/1/92 ADDN [ j CITY OF FRIDLEY ALTER[ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: &, y �y 2�- 2% Legal Description: Owner Name & Address:- & S �-r----ter— Tel. # S??/-- 7.830 Contractor: Idv g MN LICENSE # 119 7 .� 7 Address: J y o -s-- u,-. L, Ir r- 1Z j VV � 6.4) � � L+ 4-c 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/ ound Sq. Ft. OTHER: Lo jvj c( 1-SAzh r 2�` - �& k e S /,'J Q ebo"'rs Corner Lot [ ] Inside Lot [ J Ft. Yd Setback Side Yard Setbacks Type of Construction: W I J= - Estimated Cost: $ ! , z co n 00 Approx. Completion Date:�i ,�— Driveway Curb Cut Width Needed: Ft. + b Ft = (Cost on Back) Ft x $ = $ DATE: 3 c) APPLICANT: Tel. # 636 -9V6(/ Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Park Fee $. Sewer Main Charge $ TOTAL STIPULATIONS: $-2j--'3D CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.501$1,000 Valuation $700 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary ( I Not Necessary RR3 SUBJECT . RMIT N City of Fridley 4 AT THE TOP OF THE TWINS BUILDING PERMIT r ` -RECEIPT'N COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 1 � 1 . � NUMBER REV DATE 18/31/98 PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 L „ 612-571-3450 910-F15 JOB ADDRESS 5916 5th Street I 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 2 Bennett Palmer Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE '> ak jmx Bernie Sol nt'es 571-2830 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO MCR Roofing 829 20th Ave NE M is MN 55418 788-5749 20063096 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 kk REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage 20 S Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Unlderlayment 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 ANYTIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 1668 .83 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- TRUCTION OR PE RMANCE F CO RUCTION. $54.00 Fire SC $1.66 PLAN CHECK FEE L FEE T21. ` icens 5.00 49 NA U E F NTRACTOR OR AU HORI EDA IDA _ Uv U EN P OPE BLD INSP ALIDA E T'I$X OUR MATE SIGNATURE OF OWNER i IF OWNER BUILDERI IDATEI NEW [] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION 0 ConstructionAddress:�j Legal Description: Owner Name & Address: 5FTel. # 57/-7—s 30 Contractor: �� MN LICENSE # Address: 2 ptg 4t! g Tel. # 79F -r �5 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: ores (I(E ¢6 1� Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 8 —31 —c(5' Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side Tel. # 7�k" -5-775 .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 [ ] CITY OF FRIDLEY INSPECTION DIViSION R 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 RATE SCHEDULE Residential Rate TOTAL Furnace Shell and Duct Work,: Burner - Also Replacement Furnace $ 30.00 $d (Side Vent Fill Out Back) Gas Piping (Needed with new;furnace, $ 10.00 $ but not replacement) 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 1.25% of Value of Appliance or Work State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. JOB ADDR OWN Effective On January 1, 2002 V BUILDING USED AS ESTIMATED COST 'I C PERMIT NQ.:. �i No. of Heating Units_ Circle One (Steam) (Hot -Water) arm r) Trade'Namek fLA G.,.r Size No. ,.'3 r5= BTU G( O®c HP EDR Fuel otal Connected Load Burner 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 accordance_' ith the. City Codes an rulings of the Building Division, and hereby declares that °all"the facts and representations stated in this application are true and corse' t. STANDARD HEATING & AIR CMDIT14ldlNG M TREET MINNE;OUS,MMN 5540&2898 DATE 612-8242656 HEATING CO Rough -In Date # Final Date THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON VFNT, V NT .ONN TOR AND COMM ISTION AIR VERIFInATION ' When re In acing aranee, the undersigned hereby verifies that the ` venting has Peen exomned and. is free from r6st, deterioratiort;-obstructions, and is securely supported and 1 estopped where required. Yes (Lro (.) The venting system is plastic/PVC and meets all current codes and manufacturer" specifications including sizing; length, number of elbows and termination. Yes O 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 ( "( ) The axistina combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes( No( ) When required to install a new pombuction air, itwill be sized and installed to meet the current codes and manufacturer's specifications. Yes() No( ) When ins aliinrl a new venting gqystam, the undersigned hereby verifies that itis 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 (v�'No ( ) lithe 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 (�o ( ) Appliance #1 Type BTU Input U -0a Fan Assisted or Nat Appliance #2 Type W tel, BTU Input Fan Assisted or Nates Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu 'Input o 0 0 Common Vent Typey, Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter min Typej�G' Appliance #3 Vent Connector Height ft Length ft Diameter in Type n Tr;