PRE 2010 DOCS0 0
City of Fridley, Minn.
BUILDING PERMIT N® 3709
Date: ... P ... �.... ._. .......
Owner....................................... Builder"/ ..... .... ........
Address ...................................... Address .............................................
LaCA I OF BUILDING
,�`�/�
No. % ./. A../®. Street ..... ....� ....... s.... t . .! ...... Part pOf Lot ..........n ..................... .
Lot ......7 ... Block ......0......... Addition or Sub -Division �e� yC' . ...........
Corner Lot ............ Inside Lot A( ........ Setback ,.53...�.. Sideyard ®P � �
DESCRIPTION OF BUILDING
T Used
.N�� U ..... Front Depth G?:fv Height�T.: �y Sq. Ft/.Y.�f.. Cu.. Ft. .40 f
.................... Front ......... •.. .
Depth .. ... Height .. .. Sq. Ft. ........ Cu. Ft. ... . .
Type of Construction ................ Nat. � � ....... To be Completed
In consideration of the issuance to me of a permit to constTuctbufld,"desribed abo Ia to do
the proposed work in accordance with the description above s' mp wi visions of
ordinances of the city of Fridley.
.... ......................
In consideration of the payment of a fee of $.� ...., permit is here ted to ..........4-,- ......................... to construct the building or addition as described above. This permit is upon
the express condition that the person to whom it is granted and leis agents, employees and workmen, in I awork
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, m ' tenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at any time on violation of any of the provisions of said
ordinances.
"�.. f. .. 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 Insp9dor for separate permits for these Items.
00
13 Pro
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name
Builder`-
Address �i 7��? �_ -4 Address..,,..
LOCATION OF BUILDING
No. MO T Street Part of.. Lot
Lots Block . Addition or Sub. Div..`'
Corner Lot Inside Lot ._..%. Set Back
Applicant attach to -this form Certificate of Survey of Lot and proposed
building location, _
DESCRIPTION OF BUILDING
To be used as
Front ® Depth �2 Height
Sq8(
. Ft. � Cu. Ft.
Front Depth Keight
Sq. Ft. Cu. • Ft.
Type of Construction�'�°� '
To be completed
Estimated Cost
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 qor Qct.
Date Signature
(A Schedule of Fee Costs can be found on the Reverse Side)
f
City of Fridley, Minn..
BUILDING PERMIT N°5 9 2 5
Date: .
Owner: BuilderOE
---
Address _ Address
LOCATION OF BUILDING
No. Street OF ie )Artof Lot
Lot _ Block Addition or Sub -Di �1--
Corner Lot Inside Lot — aback ideyard _---
Sewer Elevation — Fo tion Elevation
DESCRIPTION OF BUILDING
To as: '
Front om-- Depth Height Sq. Ft. Cu. Ft.'
Fro Depth , eight Sq. Ft. Zoe Cu. Ft.
Type of Construction Fit. �, 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 adl 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
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. ,& /I-%
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be suns to see
the Building Inspector for separate permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Name Builder 2�
Address llaAddress �5`
LOCA OF BUILDING
7
NoStreet Part of Lot
Lot Block�_6_Addition or Subdivision
Corner Lot Inside Lot h Setback :140 Side -Yard :
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as:
Front ozo Depth-�Za Height JO
Sq. Ft. Cu. Ft. <�010
Front Depth Height 1
Sq, Ft. Cu. Ft. 1 Z/a
Type of Construction �t D_ Estimated Cost 1115
To be Completed
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 SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
•
0
Date: June 7, 1965
J. D. Lentis
City of Fridley, Minn.
BUILDING PERMIT
Builder
Modern Garage
Address 583 6U Streett N_a E• Address 9240 Landale So•
No. 5810 Street
Lot _ _7�_ Block
N° 7767
LOCATION OF BUILDING
6th Street N. E. -- Part of Lot
6 Addition or Sub -Division Bemett Palmer Add.
Corner Lot _ Inside Lot — Setback
Sewer Elevation --
To be Used as:
Sideyard
Foundation Elevation
DESCRIPTION OF BUILDING
Front Depth Height Sq. Ft Cu. Ft
Gar• Dett• Front Depth Height Sq. Ft Cu. Ft
Type of Construction Fast Cost 1 x•00 To be Completed
Storm damage repair
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 complian with a'll provisions of
ordinances of the city of Fridley. // �l
In consideration of the payment of a fee of $,53..(iQ , permit is hereby granted to M CIOM SAKAWe
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
da a in, around and upon said building, or any part thereof, shall conform is all respects to the ordinaac� of
Fridley, Minnesota gg location, conatructCon, alteration, maintenance, repair and moving of buildings
within the dty ]imitathis permit may be revoked at any time upon violation of any of the Provisions of said
w2nanoas.
Allen Jensen
Building Inspector
NOTICE:
Ub pwn* don not cower the cewdmdlens InIaMen for vdrin& plumbing, on heating, sewer or water. Be wn to me
the Building h>W=Wr for apwata pmft for these Hems.
- I lj--� I Af e �6
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAM1E j
y
ADDRESSo /4
�ADDRESS�%�
�
LOCATION OF BUILDING
No �rae_� ��1� + . Street Part of Lots
LOT BLOCK ADDITION OR SUBDI S.ION
Corner Lot Inside LOT Setback Side•Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDIG
To be use as:
Ja I
a� Front ,fie Depth 2- Z. Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type. of Construction Estimated Cost /zp f)
n j
To beJ completed_ 0
The undersigned hereby makes application for a permit for the work herein specified,
agreeing•to do all work in.otrict 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.
P
DATE --kJ — Z S' SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
SUBJECT
PER
City of Fridley
161.81
AT THE TOP OF THE TWINS
g U I L D I N G P E R M I T
COMMUNITY DEVELOPMENT DIV.
r - PROTECTIVE INSPECTION SEC.
0
i ��'--',•� CITY HALL FRIDLEY 55432
L
NUMBER
REV.
DATEPAGE
OF
APPROVED BY
----�
612-571-3450
910-F15
5/13/81
JOB ADDRESS 5810 - 6th Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
7
6
Bennett-Palmer SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
James D. Lewis 5810 - 6th Street N.E. 571-2171
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Day's Remodeling 2701 Oo. Rd. H, Mpls (CONTRACTOR NOT LICENSED IN FRIDLEY)
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 ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Construct a 25' x 16.' Addition with-fireplace
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide outside combustion air. Provide fire alarm.
W 0 11ING
Before digging call local u�iii�il's
PERMITS
SEPERATIRED FOR
ELECTRIC -WEA REQUSIGNS. WIRING,
TCLEPHOHE-
HEATING, U
BY LA ' BING AND
REQUIRED
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
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
1
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
$16,000
$8.00
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
P 7ER M WIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$96.00
NONE
PLAN CHECK FEE
TOTALFEE
24.00
$128.00
NATURE OF CONTRTORORA HORIZED AGENT IDATEt
N, WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
,f�13-�0
BLDG INSP D E
GNATURE OF OWNER IIF OWNER BUILDERI IDATEI
40,
qft.-
ar
ll`zz'l
CA,
to
vo,
L4
Q
�� i
to
vo,
-ENERGY CONSERVATION SUPPLEMENT TO BUILDING PERMIT APPLICATION
PLANNING AND INSPECTION DEPARTMENT
CITY OF FRIDLEY, MINNESOTA
This supplement is provided to assist the applicant in computing EXTERIOR ENVELOPE
AVERAGE "U" FACTOR INFORMATION. This information is required so the BUILDING.
OFFICIAL can determine that submitted plans comply with the ENERGY CONSERVATION
DESIGN CRITERIA of the STATE BUILDING CODE (Section 6000). It is the APPLICANT'S
responsibility to accurately compute the data; reflect the proper DESIGN CRITERIA
in the plans; submit product specifications, if needed to support the "R" and "U"
factors used; and to assure construction P.
per appr�oeved plans.
JOB LOCAT ION : 5-f- V 1� -51 & r - F . ® L a 4
OWNER/CONTRACTOR:
T�a�F� �•
���hsJrs
V,
A-V ff��/�dl
ADDRESS: ��
���� D
b?"',
PHONE:
3.
Total
A. Determine the
Total Exposed Wall
Area as follows:
Total
1.
Total
wall window area
;3k Sf Fr
`
2.
Total
door area
0
3.
Total
sliding glass door area
4.
Total
fireplace wall area
5.
Total
wall framing area (average'.10 s)
0 SU r�
6.
Total
net wall area above floor(average 90%)
7.
Total
rim joist area
Subtotal: Tctal exposed wall area above rloor
8.
Total
foundation window area
9.
Total
net foundation area above grade
Subtotal: Total exposed foundation area
GRAND
TOTAL EXPOSED WALL AREA
B. Multiply the GRAND TOTAL EXPOSED WALL AREA X .17 =
C. Determine the Total Exposed Roof/Ceiling Area as follows:
10. Total skylight area
11. Total roof/ceiling framing area (10%)
12. Total net insulated roof/ceiling area
GRAND TOTAL EXPOSED ROOF/CEILING AREA
Item I
D. Multiply the GRAND TOTAL EXPOSED ROOF/CEILING AREA X .05 = Item II
E. Determine the "U" value of each segment (1-9) and multiply by the area as
follows:
1. x fluff _
2-X "U" _
r
3. X "U" _
4. x "u" _
5. X "U" _
6. X "U" _
7. X "U" _
8. X "U" _
9. X "U" _
ADD 1-9 FOR TOTAL WALL SEGMENTS = ITEM III
F. Determine the "U" value of each segment (10-12) and multiply by the area as
follows:
10. X "U" _
11. X "U" _
12. X "U"
ADD 10-12 FOR TOTAL ROOF/CEILING SEGMENTS = ITEM IV
G. If Item III is the same as, or less than Item I, you have met the intent
of State Building Code 6006 (c) 2.
H. If Item IV is the same as, or less than Item II, you have met the intent
of State Building Code 6006 (c) 1.
I. Add Item I + Item II =
J. Add Item III + Item IV =
K. If the sum of Items III and IV are less than Items I and II, you have met the
intent of the Code for total envelope system.
The undersigned, as applicant for a building permit, hereby affirms the above
information has been prepared and submitted by himself or under his direction,
hereby acknowledges the information to be correct and accurate; and hereby
presents the information with required plans in support of the building permit
application.
By: DATE:
CITY OF FRIDLEY
APPLICATION FOR P.m[)17fITIAL BUILDING PERMITS
(New, Alterations, Additions, or Repairs)
OW14ER: L BUILDER: �q�( �s ��MO ))&• yes
ADDRESS: _5�`IU l� �� 1�.� ADDRESS: ')76I C ably R0
----.–
TEL NO: — � 7 J — � I � � TEL 140: '
431 ,P -IN 7 err O Rk ,
Construction Location '
STRICT NO: STREET:
LOT: BLOCK: ADDITION:
Corner Lot: Inside Lot: � Setback.: Sideyards:
Ap,51icant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
(�PC� front: Depth: _ Height: P6
�RSo� Square. Feet: Cubic Feet:
f IQC� Front:
Depth: Height:
-/ Square- Feet: Cubic Feet:
�v� f)I� 1�. ,� �o�
Type of Construction: W o o l)
Rb Be Completed: VI M -U
Proposed.Driveway Width If New Opening Is Desired:
1 ` $coo
Estimated Cost: $
Alt. A Alt. B
SEE PEVERSE SIDE OF SHEET
Mie 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
represen tltions stated in this applicatiW are true and correct.
DATE: '� �® � SIGNATURE:
Stipulations:
I L)( 9L oa(D
141 01)
Ty 'Q
r
SUBJECT
NO•
City of Fridley
21742
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
0
_ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r � �
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
2/16/93
JOB ADDRESS 5810 6th. Street NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
7
6
Bennett Palmer
SHEET
2 PROPERTYOWNER MAILADDRESS
ZIP
PHONE
James/Lucille Lewis 5810 6th Street NE
571-2171
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
'Rain City Storm Sash Inc 10825 Greenbrier Rd, Mtka MN 55345
546-8160 3090
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 Ci REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace Bay Window
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.
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
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
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$2,472
$1.23
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$54.00
Fire SC $2.47
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
License SC
$5.00
$62.70
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
HE P
ERY AL
ATE THIS IS YOUR PERMIT
C2
LOG INSP
Z _16 -473
V4
4 MATE
_
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
, wet��/,
NEW Effective 3/1/92
ADDN CITY OF FRIDLEY
ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2
I Building Permit Application
Construction Address:
Legal Description:
Owner Name & Address:
Tel.
Contractor:LICENSE #IIAFIN GITY STORM 6
Address: 10825 GREENBRIER ROAD Tel. # 5166
MINNE-IONKN MM 55345
L 6t 1f this application, a Certificate of Survey of the
K with the proposed construction drawn on it to scale.
DESCRIPTION OF R"ROVEMENT
LIVING AREA: Length Width Height Sq. FIL,
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/G=W Sq. Ft.
OTHER: 46
Corner Lot 1 V
Inside Lot Ft. Yd Setback Side Yard Setbacks
Type of Construction: F-stimated Cost: $ e7-0
Approx. Completion Date:
(Cost on Back)
Driveway. Curb Cut Width Needed: Ft. + 6 Ft = Ft x
DATE: qj APPLICANT: Tel. I
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Park Fee
Sewer Main Charge $
TOTAL
STIPULATIONS:
TY USE ONL
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 "Bw Above
Fee Determined by Engineering
Agreement Necessary I I Not Necessary
CITY OF FRIDLEY PERMIT N 2004-00863 •
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 06/08/2004
Y/Z-36U4 FAX: (703) 571-IL57
ADDRESS 5810 6TH ST NE
PIN 233024240046
LEGAL DESC BENNETT-PALMER ADD
LOT 7 BLOCK 6
PERMIT TYPE HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION : $ 6,700.00
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, CARRIER, 80,000 BTUS) AND AN AIR CONDITIONER.
# A/C UNITS 1 # FURNACES
# GAS DRYERS
APPLICANT
CENTERPOINT ENERGYMIINNEGASCO
13562 CENTRAL AVE NE
ANOKA, MN 55304 -
OWNER
LEWIS JAMES D & LUCILLE M
5810 6TH ST NE
FRIDLEY, MN 55432
0 # GAS RANGES
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 5674
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 wort
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 cons ction or the performance of construction.
ADoHcant /I Date l I
.0 —
SEPARATE PERMITS REHIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
H
0
0.00
35.00
0.00
0.00
25.00
0.50
60.50
Mf TY OF FRIDLEY BUILDING INSPECTION Effective 4/1/2004
9 3431 University Ave NE
9=ridley. MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
L 763-572.3604 FAX 763-571-1287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
9 JOB ADDRESS 'St 10
D
RATE SCHEDULE Fee Tota
Residential Owners
Furnace Shell and Duct Work, Burner &
also Replacement Furnace $35.00 $ Sf �'® Building Used As R�d'c►�+�
Gas Piping (New Furnace, Fireplace, Insert) $10.00 $ ESTIMATED COST 6--200,�� PERMIT NO ��6() % L, o8 69
Gas Range $10.00
$
DESCRIPTION OF FURNACE AND BURNER
�
Gas Dryer $10.00
$
# of Heating Units___L_ Circle One (Steam) (Hot Water)Warm A'
V PQ
Trade Name 0 - � r- Size No.
*Air Conditioning -All Sizes $25.00
3 g' 7 � D 30 %
$
BTU 6,000 oc!)n HP EDR
Fuel Total Connected Load
All Other Repairs or Alterations (List on Back)
Size No.
r 1% of Value of Appliance or Work
$
Burner Trade Name
EDR
a Minimum Fee $15.00 for Residential or 5% of cast of
BTU HP
Y improvement whichever is greater on work less than $300.00
The undersigned hereby makes application for a permit for the work herein
ComrnerciaUfndustrialJlnstitutional
specified agreeing to do all work in strict aocordence with the City Codes
r 1.25% of Value of Appliance or Work (List on Back)
$
and rulings of the Building Division, and hereby declares that all the facts
Minimum Fee $35.00 for Commercial/industriaViristitutional
and representations stated iap li r and correct.
CenterPon�l-.
State Surcharge
$ s®
HEATING CA � 3562 Center Ave
Y
1
763-757-6292
TOTAL FEE
$('
Signed Tel #
v
REINSPECTION FEE $50.00/HOUR
FAXft Date
M *Air Conditioners can not be placed in side yard without written approval
N from adjoining property owner - copy to City
CLi
N
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
IL
Approved by Rough -in Date Final Date
eo'd 1d101
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing fumace, 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 No ( )
The venting system is plastic/PV � nd meets all current codes and manufacturer
specifications including sizir th, number of elbows and termination. Yes No( )
The undersigned also veri4erg�f"tZ he replacement unit is a listed assembly
and meets the current codes aftd�nanufacturer's specifications. This does
include AGA-GAMA Categoy t- ntral Furnace Venting Tables for fan
assisted and natural draft appl res. Yes � No ( )
The existing combustion air is Pized and installed to meet the current codes
°
and manufacturer's specificationt.
Yes ( No( )
When required to install a new combustion air, it will be sized and installed
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 -LAMA Category I Central Furnace
Yes k No( )
Venting Tables for fan assisted and natural draft appliances.
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 ( No ( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type Cur BTU Input '7o,oc� an A
ssistNat
Appliance #2 Type �r BTU Input '�� r�bd 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 Lft Length ft Diameter 4 n Type -)"�-
Appliance #2 Vent Connector Height _°,eft Length �_ft Diameter 3 n Type_ -AL! -
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO: �, ��e Poi h o j i „� -%e-� rh tj
Signed By: nate, oy
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FA/FR I A TPVICW.SL Ol , 7MG 1 dd An hl r 0 W0g-I qP : T T OOOF-LZ-Ndd
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-3604 FAX: (763) 571-1287
ADDRESS 5810 6TH ST NE
PIN 233024240046
LEGAL DESC BENNETT-PALMER ADD
LOT 7 BLOCK 6
PERMIT TYPE ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
PERMIT NO.: 2004-00864 3 J�
DATE ISSUED: 06/08/2004
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. WIRE FURNACE AND AIR
CONDITIONER.
# INSPECTIONS 1
APPLICANT
CENTERPOINT ENERGY/MINNEGASCO
13562 CENTRAL AVE NE
ANOKA, MN 55304 -
OWNER
LEWIS JAMES D & LUCILLE M
5810 6TH ST NE
FRIDLEY, MN 55432
ELEC PERMIT FEE - MIN (RESI) 20.00
STATE SURCHARGE, ELEC FLAT 0.50
TOTAL 20.50
PAID WITH CHECK # 5674
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 atter 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 wort
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.