PRE 2010 DOCSCITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
x $3.00
$
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
Number Fixtures
x $3.00
$
Future Fixture Opening
x $2.00
$
New Fixture, Old Opening f
x $2.00
0
Catch Basin
Water
7Q
0
m
V
e
.4
$
m
x $10.00
M
H
c a
.a Rf
0
34
o
m
u
m S4
G7
W
W
rte,
$
Heater
N
•C
"'7
O
0
w
1
41
ta
C
N
,1
O
O
JV1 N
4.07 N
N
W
U
a
q
N
3
W
vi
w
fz
U
pN
U
as
lec
N
CC
M3
C�7
1st
2nd
3rd
4th
(R) = Future Connection Opening
Connected with Sewer
M = New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
x $3.00
$
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
Number Fixtures
x $3.00
$
Future Fixture Opening
x $2.00
$
New Fixture, Old Opening f
x $2.00
Catch Basin
x $5.00
$
Water Heater - to 99,000 BTU
x $5.00
$
100,000 BTU to 199,000 BTU
x $10.00
$
Water Softener
x $7.00
$
New Ground Run Old Building
x $5.00
$
Electric Water Heater
x $5.00
$
GAS FITTING FEES:
1st 3 fixtures
x $3.00
$
Additional Fixtures
x $1.00
$
Gas Range to 199,000 BTU
x $10.00
$
REPAIRS $ ALTERATIONS
First $100.00
$5.00
$
each add. $100.00 or fraction
$2.00
$
State Surcharge
$
.50
TOTAL FEE
$13--0
REINSPECTION FEE
($10.00)
Job Address 1!99 — Z-'? /1' .
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.��
OWNER
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT
ESTIMATED COST =,�� ✓
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
9 P
1 •
Company
Signed By
Tel. No.� 7
ROUGH INSP.
Date
FINAL INSP. & -I-,
—Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
SUBJECT
I
City of Fridley
981
AT THE TOP OF THE TWINS
BUILDING
PERMIT
(78�
NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC,
j
' r--9 CITY HALL FRIDLEY 55432
�j
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
3/5/99
JOB ADDRESS 5628 6 Street NE
1 LEGAL
LOT NO.
I
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5,6
2
Hamilton's
Addition to Mechanicsville SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Dorothy Seip 5628 6 Street NEf
574-9519
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
Town & Country Roofing 7910 12 Ave S Bloomington, MN 55426
858-9365 20091282
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
O NEW ❑ ADDITION ❑ ALTERATION REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House (13 Sq) Tear -off
9 CHANGE OF USE FROM
TO
STIPULATIONS Underlayment must comply with
the State Building
Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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 1 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
$1, 114
$.56
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
,,te e A di)_
License SC $5.00
$46.92
SIGNATU OF CONTRACTOR OR AUTHORIZED AGENT DATE
WHEN PROPERL ALIDATED THIS IS YOUR PERMIT
BLO iNSP
r
PATE
S-GNAruRE OF OwNER,�F OWNER BwLDERI ATEA
Mar -04-99 05:46P P.02
A0DN ( ] CITY OF r'RIDLEY
ALTER ( ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Q�
BUILDING PERMIT APPLICATION q D O
ConstructionAddress: �4 a� (n— :. L=
Legal Description: ] e ad o f14 It ? _
Owner Name & Address: Tel. # 'V —9411
Contractor:� v� MN LICENSE #1 1 l _
Address • ~, Tel. # SS 1S 2 J (o
Attach to this application, a rtificate 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.
DUCK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: -� Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: J C APPLICANT: ' Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
$ x/G,,7
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
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS:
$ C 9Z
CITY OF FRIDLEY INSPECTION DIViSION
Effective On January 1, 2001
6431 University Ave NE
® Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
m 763-572.3604 REFRIGERATION AND AIR CONDITIONING
SYSTEMS AND DEVICES
a
JOB ADDRESS rid ,5593.
RATE SCHEDULE
m
OWNER
o Residential Rate
TOTAL
In Furnace Shelf and Duct Work, Burner -BUILDING
1O
USED AS
Also Replacement Furnace $ 30.00
$-3-0 �
(Side Vent - Fill Out Back)
ESTIMATED COST PERMIT N0. �(6Y
Gas Piping (Needed with new furnace, $ 10.00
$
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNER
Gas Range $ 10.00
$
0
Gas
No. of Heating Units Circle One (Steam) (Hot Water) arm A'
Dryer $ 10.00
$
Trade Name kewvoy Size No.
BTU 65- o0o HP EDR
Air Conditioning All Sizes $ 25.00
$
Fuel_ 4i / Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK)
Burner Trade Name SerRej'T Size No.
1% of Value of Appliance or Work
$
BTU HP EDR
ACommercial/Industrial
1.25% of Value of Appliance or Work
$
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 an
0
0 State Surcharge
$ .50
rulings of the Building Division, and hereby declares that all the facts and
50
representations stated in this application are true and correct.
U TOTAL FEE
$ 30
s
0
M
9
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
4EFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
FLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
m
cmiv `Air Conditioners can not be placed in a side yard without
N written permission from adjoining property owner.
0
Z
DATE //-,7,?-0/
HEATING CO #22,00, a A) Rur Iger Sery cc 1 AJC
Signed 2'e' )5
Approved By/C '--'I Rough -In Date
ACK SIDE MUSVBE FILLED IN ON V
ND COMBUSTION AIR VERIFICATION
TEL # - - 99
Final Date
IT SIZE, VENT CONNECTORS
6�9� ("„
pal if 1r NaT I N5%9lleQi fly ir tA�� NeedFd
C�OWi
open kASe mev1 iF '1 L)5rt l�►tl iA�st�ll �/►ier
COMMON PENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes bU No( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes() No (X .
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 1 Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes W No ( )
The existing combustion air is sized and installed to meet the current codes Z4
and manufacturer's specifications. Yes () No
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturers specifications. Yes w 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 1 Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes UO No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes PO ' No ( )
Appliance Type and Size/Common Vent and Vent Connector Information
oVE-)
Appliance #1 Type 4aut - BTU Input Fan Assisted or Nat-_2-U-r.,___�
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 J,_in Type C,,
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
b0/20'd E800L16TS9 01 A31QIad .A0 AM WO&I TS:60 T00Z-LZ-nON