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PRE 2010 DOCSVillage of Fridley, Minn. BUILDING PERMIT Date: ....,�Q .................... Owner....................................... Builder ... ..... .. .. N° 1843 Address...................................... Address ............................................. A �t OF BUILDING No. 7s5 .. Street ... 7` f ................. Part of Lot ....................... Lot ...... ...... Block ..... f ........ ddition or Sub -Division .. � ........ Corner Lot ........... Inside Lot ........... Setback S? ... Sideyard ................... DESCRIPTION OF BUILDING To be Used as: q 40.. A. igl-•y ..... Front .61. ... Depth ..a.47. Height n .�: Sq. Ft. ........ Cu. Ft. ........ ..................... Front ........ Depth ........ Heigh.t ....... Sq. Ft. ........ Cu. Ft. ........ , a Type of Construction �7-_u ....... Est. Cost / Z. —. . . . . . 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 village of Fridley. ..................................................... In consideration of the payment of a fee of $.1A ..... I 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 village limits and this permit may be revoked a�t_y time upon violation of any of the provisions of said ordinances. �. .............. 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. BUILDING PERMIT Village of Fridley, Minn. N? 2477 Date�..?'.Z:.r . �e ..................... AA ..0 Owner ............. Builder Address 7A 7f : n. 4 ...... Address ......................................... LOCATION OF BUILDING ,�r No. . ... Street !� +!''� .. .......................... Part of Lot .............. ..... . Lot ...... ......... Block ...... .I ....... Addition or Sub -Division . f�'`� �'" `... �!� ......... . Corner Lot ............ Inside Lot ............ Setback ............ Sideyard .......................... DESCRIPTION OF BUILDING To be Used as: .. ...... Front . I.. Depth . AA... Height I.S!..... Sq. Ft.Cu. Ft........ . " "+O' ........ .... Front ../1 ... Depth /r ./..... Height ......... Sq. Ft... �.� 4.. Cu. Ft........ . �! OD ..� Type of Construction !0:+. '.. Est. Cost .. �wvp............. 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 village of Fridley. OR(In co •ideration of the payment of a fee of $.: R+ ... , permit is hereby granted to &'4 ........... .. 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 village limits and this permit may be revoked_ at any time upon violatio of any of the provisions of said ordinances. A& Y pr.. LV .. 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. 0 � 0 01 SUBJECTPERM14'790 IT City of Fridley AT THE TOP OF THE TWINS PERMIT ' BUILDING RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. �------� y- r� � PROTECTIVE INSPECTION SEC. ' CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L 812-580-3450 910-F15 6/29/78 10B ADDRESS 7518 - 5th Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 1 Osborne Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Irean Gabrielson 7518 - 5th Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Gus Golden Jr. 952 -89th Avenue N.W. 786-7487 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW Ij ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a deck and sliding glass door. 9 CHANGE OF USE FROM TO STIPULATIONS wpimm; SEPERATE PERMITS REQUIRES Ft)R WM'+ WON owns call local utilities TaEPRONE - ELECTRIC - GAS Etc. NEAT1(+t PLUIrI M AND �G�. REQUIRED BY LAW. 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 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 l 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 $2,000 $1.00 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 QR LOCAL LAW REGULATING CON- $12.00 STRUCTION E PER AN FCO CTION. PLAN CHECK FEE TOTALFEE $13.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)WHEN PROPERLY V I ATED THIS IS YO R PERMIT BLDG INSP DATE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) 01 • ask :a CITY OF FRIDLEY APPLICATIOt1 FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWI4DR: c�r eq 4j �'1 G'/SO �% BUILDER: �lj5 Address: Z57ff S-�. �T %1%,L Address: q5— d 'f � 1� V'�- Tel. No.:.�e� No.Street: LOT:_ BLOCK: �_ ADDITION: CORNER LOT: INSIDE I/JT: SETBACK.: SIDEYARDS: Applicant attach to this form Taro Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: Front: Depth: r' Height: Square Feet: Cubic Feet: ' Front: Depth: Height: SquareFeet: Cubic Feet: Type of Construction: � Estimated Cost: $ (90, ® v To Be Completed: 0)66 Alt. A Alt. B Proposed Driveway 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. See reverse side fop diti., i at'on. DATE: I)t)1 ,e f SIGNATURE: Stipulations: ��C SUBJECT City of Fridley 15.8 0_ AT THE TOP OF THE TWINS _ BUILDING PERMIT r RECEIPT NO • I LL��«� COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r � � PROTECTIVE 1 � � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY �""" ,•� 612-571-3450 910-F15 6/26/80 JOB ADDRESS 7518 - 5th Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 8 1 Osborne Manor SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Irene Barber 7518 - 5th Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Don R. Benson Construction Co. 2006 - 55th Avenue No. 560-0808 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 �l ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install aluminon comb. windows, soffits, facia, window & door trim insulate & ventilate attic area. 9 CHANGE OF USE FROM 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 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 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 $3,000 $1.50 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- TRUCTI OR THE P OR E OF CONSTRUCTION. / -90 $18.00 PLAN CHECK FEE TOTAL FEE ftL `�' ^ $19.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) _ � WHEN PROPERLY ALIDAATED IS YOUR PERMITrT gTHIS BLDG INSP FIAT SIGNATUREOF OWNER IIF OWNER BUILDER) (DATE) CITY OF FRIDLEY APPLICATIO14 FOR RESIDENTIAL BUILDING PERMITS (flow, Alterations, Additions, or Repairs) OWNER:BUILDER: ADDRESS: �� , �. s ADDRESS:�o •S�C�e- ` _ TEL NO: TEL NO: 0 _.0 X16) Construction Location STRM, T NO: __ zS_/ I STREET: LOT: BLOCK: �_ ADDITION: r � , 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. 4RtITIOtI101 C1 JJTRUCTI11 1 /4/yrontjj: pth ;?eight: _._. Square. Fee t_ Cubic Feet: Front: Depth: Height: Square - Feet: Cubic Feet: 60 Cl Type of Construction: _..(�yat-�i� Estimated Cost: $ �e)'o 7.b Be Completed: GL 4 P.77 � Alt. A Alt. B Proposed Driveway Width I£ 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 atrue an t. DATE: L� SIGNATUF3 : D•�- Stipulations: 1� 63-8h-879001 CITY OF FRIDLEY APPLICATION FOR PWNBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures- $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 m Beer Dispenser Water $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 m C $ 5.00 $ Hydraulic Valve a'{+ w w $ 5.00 $ Heater 64 $ Hot water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ State Surcharge $ .50 Reinspection Fee $ ($15.00) TOTAL FEE $10.50 u ur 3 o w m w ue obi 3 o lec lst 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures- $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser $ 4.00 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ Hot water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ State Surcharge $ .50 Reinspection Fee $ ($15.00) TOTAL FEE $10.50 c eccive Aug. L, 1701 Job Address 7518 NE 5 Street 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. 10-26-81 , 19 OWNER DHLWJP�LL RIND OF BUILDING frame USED AS res. TO BE COMPLETED ABOUT 11-2-81 ESTIMATED COST 50.00 OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company f T Signed By Tel. No. ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMITrsa MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE t RESIDENTIAL 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 ` RATE Furnace Shell and Duct Work, Burner (Also replacement furnace) Gas Piping (piping needed with new furnace) Gas Range Gas Dryer * Air Conditioning (all sizes) All Others/Repairs and Alterations 1% of Value of Appliance or Work COMMERCIAL/INDUSTRIAL 18 of Value of Appliance or Work TOTAL $ 20.00 $ $ 10.00 $ $ 10.00 $ $ 10.00 $ $ 10.00 $ C u State Surcharge $ .50 TOTAL FEE $ ko�e-' Reinspection Fee ($15.00) $ Rough Insp. Date Final Insp. Date Approval for Permit c MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00- PLUS 15.00PLUS $.50 STATE SURCHARGE *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. Job Address 7,fZ --3--" �r� �� Department of Buildings, 6431 University Ave. N.E., Fridley, MN 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 application are true and correct. Fridley, [[Mi--nn__.�191-;� OWNER A a -i �c KIND OF BUILDING ern lrJ�t USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Name Size No. Capacity Total Connected Load BURNER - Trade Name Sq. Ft. EDR BTU HP Kind of Fuel Size No. Capacity Sq. Ft. EDR BTU HP Company Signed By Tel. No. -2 Fill out back sidE for stack verification on replacement furnaces CHIM14EY 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 fnr size and total BTU connected Yes ( ) No ( ) 6. Has Total heating BTU's of All other BTU's TOTAL Rema rk s Company Signed By Date C 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 TOTAL Job Address L Furnace Shell and Duct Work, yy Burner (Also replacement furnace) $ 20.00 $40od Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Gas Piping a $ 10.00 $ /p.yJ Tel. #571-3450 (piping needed with new furnace) Gas Range $.10.00 $ The undersigned hereby makes application for a permit for the work herein Gas Dryer $ 10.00 $ 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. * Air Conditioning (all sizes) $ 10.00 $ g Fridley, Minn. / 4�/ 19�/ All Others/Repairs and Alterations OAR Ui 18 of Value of Appliance or Work $ -<rg KIND OF BUILDING COMMERCIAL/INDUSTRIAL USED AS 1% of Value of Appliance or Work $ TO BE COMPLETED ABOUT ESTIMATED COST �6 U State Surcharge $ .50 OLD - NEW BUILDING PERMIT NO. PERMIT NO. lC� TOTAL FEE $ 30.5® Reinspection Fee ($15.00) $ DESCRIPTION OF FURNACE/BURNER Rough Insp. Date Final Insp. Z ^l.7 — ?!1 Date Approval for Permit MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00, PLUS $.50 STATE SURCHARGE Attach stack verification form with replacement furnace permits *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. 'HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Name 4-11— Size No. Capacity Sq. Ft. EDR BTU &1 6 p 0 HP Total Connected Load L(3 I Kind of Fuel lxe-l-4�� BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company Signed By ( / Tel. No. 824-2656 / x STANDARD HEATING & SERVING AIR CONDITIONING CO /HE TWIN CITIES SINCE 1930 ^ ' . HEAT LOSS CALCULATION FOR BARBER -7518 STH -------------------_____ --------------------------------------------------------------- ST. N.E. MAIN ------------------------- LENGTH 37 10989 LS WIDTH 25 __________ ��zo�T o _ AND ---------------------- � WINDOWS & 000na - o��rx�o� -------- wzoT* -------- HEIGHT NO. LI'TAREA � NO^ PANE PANE LIGHTS CRACK SQ FT ^ 54 48 2 20 �^u.o 21.3 z2.4z 2 18 5 3216 23v 1 32 24 ��^7 �r.� . 2 � 1 20 20 2 tg 13.5 z 3678 �D 36175.7 -7.7 2 . 3� g0 � az^� 39 � 3r'3 35.6 � INFILTRATION,,,,,,,,,.,^.,^, COEFF BTU .^^^^^^^^~^^^��^7 20 124 R .FToLASg ^.^~^^^^^^^^ WALL ^^^^`^^^^^^^ �B2.� 50 4514 ,,..^.,,,,,,^^^^^^~^^^^^^^^ 124 NET EXP wALL, 9130EXP BELOW GRADE,,,,,, 0 '^^^^^^^ 309^4 13 10522' 2 CEzLzme..............'^^^^'^^^^^^^^^ » � ^ FLOOR 025 925 13 » VENTILATlON...... O 0 z� V .^^^^^^^^^^^^^^^ TOTAL BTD...~........^^^^^^^^^^^^^^^ » u O~"25 0 36191.2 — WINDOWS & DOORS WIDTH —''~'`~~= =»u *«�* �-- HEIGHT NO. LIN FT AREA O^ pAwE PANE LIGHTS CRACK SQ FT INFILTRATION..^..,^,,, COEFF BTU GLASS o z�� n,�T s«p WALL '^^^^^^^^^^^^^ o " O 0 ,.. NET EXP WALL 124 ' O ,,,,^^^^^^ BELOW GRADE..~.,, 9 0 0 CEILING. �92 5 0 ^^^^^^`^^^~'^ FLOOR..,^,,,,,,^,,,, ^^^^^^^^^^^^^^~ o » 4960 ^^^^^^^^^^^^^~^^ 925 VENTILATION 3 0 ...,,, o TOTAL 8TU..,,,,,,,,,^^^^^^^^^^^^^^^^ » » 2775 V ^~^^^^ ,,,,,,,,,,,,,. ' 7735 TOTAL BTU OF ALL ROOMS/FLOORS ... ...................... , ' ..........^... 43926.2 � \ ' 410 W. LAKE ST. -1 1072 PAYNE AVE. c((�C0'1,MINNEAPOLIS, MN 55408-2998 ST. PAUL, MN 55101-3892 612/824-2656 HEATING AND AIR CONDITIONING CO 612/772-2449 Serving The Twin Cities Since 1930- ORSAT TEST RECORD ADDRESS- r7 !S C _8 bt-- sfu 0 .(-,_ CITY tV- & OCCUPANT OWNER. , 4ISo C4 DATE HTG. INST. INSTALLED BY o— GAS LINE BY SAVE TYPE OF HEAT: GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN CONVERSION MAKE.P, �`o'A MAKE OF BURNER MODEL ®Lc ^rk MODEL SERIAL _ �- $c(, � � ®`� � j � MAX. BTU RATING INPUT %®, MAKE OF FURN CONTROLS MODEL THERMOSTAT W PLUG 'L- VENT SIZE 3L. VALVE jNL(`n KIND OF LINER A SIZE_5� NONE LIMIT AV C0 DRAFT HOOD 00 REGULATOR J,f LIMIT SETTING 1.tO CHIMNEY CONSTRUCTION Qu --GC, tDJ-k Q`� FAN SETTING Qt©- 0010 DRAFT ® CiCX- TEST TAG 6Ll CC(Ag PILOT TYPE Q��OUD �(,C;c LIGHTING INST. M_ PILOT MAKE (/\ CC) PILOT MODEL 0,VCC) PILOT TIMING PRESSURE_2 _ PERCENT CO2 DATE TESTED INPUT CFH -� ®� PERCENT 02 STACK TEMP.pERCENT CO ��1.6 NAME OF TESTER (� �S� 8 3t` � r✓E CHIM14EY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; 1. Has been carefully examined Yes (;4 No ( ) 2. Is free from rust or deterioration Yes (Lf No ( ) 3. Has no foreign objects lodged within Yes (vf No ( ) 4. Is securely supported Yes (v� No ( ) 5. Meets all current Code requirements for size and total BTU connected Yes (vf No ( ) 6. Has Total heating BTU's of X69® O All other BTU's y ® C/ TOTAL ( ®�> � fW Rema rk s Company Signed By Date A. City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287 6431 University Ave NE Fridley MN 55432 Mechanical Permit # ' Residential Application City of Fridley See Back Side For Reauired Information DateSite Address: The applicant is: (cirice one Owner Contrac Property Owner: Address: City: State: Zip: Phone: 7,4, ell: Fax: Contractor Information /IT Company Name: Contact Person: / Address: > City: ga14 , State: /W zip: , dY Phone: Cell: Fax: Email: MN Bond# & Exp Date Type of Work (circle one): New Replacement Alteration/Remodel Detailed Description of work: Zrf�k v.,/ /�/��o 64 lx- ,� � �rC6�W/Qa , Equipment Installed: MFG: Model: Size/BTU: MFG: Model: Size/BTU: MFG: Model: Size/BTU: Please check all that apply: _Fireplace (gas) $15.00 New Gas Grill $10.00 A/C $25.00 _Fireplace (wood) $35.00 _Gas Unit HTR $10.00 _Air to Air exchanger $15.00 _Furnace $35.00 _Pool Heater $35.00 _Boiler $35.00 _Gas Dryer $10.00 _Ventilator $15.00 _Chimney Liner $10.00 _Gas Piping $10.00 Duct Work $10.00 Gas Range/Oven $10.00 Permit Fee $ 3 c'. (Total from above -Minimum fee $35.00) Surcharge 1 Total Due j__25" 0.50 , 5'U Make check payable to City of Fridley This is an application for a permit- not valid until processed I hereby apply for a mechanical permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in case of all work which requires review and approval of plans. Signature of Applicant: r Date: o Approval Inspector Signature Date:/o L)- -7 e> Please Note: Separate permits are required for Building, Plumbing, and Electrical work Revised 6/14/2005 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new construction IMC 1346.0312 S. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make up air calculations "a City of Fridley Building Inspections Dept. 6431 University Ave NE Fridley MN 55432 Mechanical Ph: 763-572-3604 FAX: 763-571-1287 Residential Application City of Fridley See Back Side For Required Information Permit # V Date a•) -,65 Site Address: 751 Theapplicant is: (cirice one) Owner Co trac r Property Owner: Address: City: State: Zip: S Phone: t;" Cell: Fax: Contractor Information Company Name: Contact Person: 60 i!�_ Address: 1,352e A L City: W4,Z& . State: Zip: Phone: Cell: Fax: Email: MN Bond# & Exp Date Type of Work (circle one): New Replacement Alteration/Remodel Detailed Description of work: Equipment Installed: MFG: Model: Size/BTU: MFG: Model: Size/BTU: MFG: Model: Size/BTU: Please check all that apply: _Fireplace (gas) $15.00 New Gas Grill $10.00 _A/C $25.00 _Fireplace (wood) $35.00 _Gas Unit HTR $10.00 _Air to Air exchanger $15.00 _Furnace $35.00 _Pool Heater $35.00 _Boiler $35.00 _Gas Dryer $10.00 _Ventilator $15.00 _Chimney Liner $10.00 _Gas Piping $10.00 Duct Work $10.00 Gas Range/Oven $10.00 Permit Fee $ (Total from above -Minimum fee $35.00) Surcharge $ 0.50 Total Due $v •`off Make check payable to City of Fridley This is an application for a permit- not valid until processed I hereby apply for a mechanical permit and I acknowledge that the information above is complete and accurate; that the work will be In conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in case of all work which requires review and approval of plans. ZSignature of Applicant: Date: a'Jq" 6� Approval Inspector Signature: Date: Please Note: Separate permits are required for Building, Plumbing, and Electrical work Revised 6/14/2005 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new construction IMC 1346.0312 5. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make up air calculations