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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N® 3777 Date: ... .. .. !.... ............ owner ....................................... Builder............................ P Address ...................................... Address ............................................. -J.00ATION OF BUILDING No. 1S /.F`/... Street .. .. Part of Jot ...... .... ..... ... . Lot Block ... /............ Addition or Sub -Division WIA.... .... .... . Corner Lot ............. Inside Lot ..)(........ Setback ............ Sideyard ................... DESCRIPTION OF BUILDING To b.� Used .... ...Wont . J�e 'Depth ........ Height ! �� t Sq. Ft. .�.f� � Cu. Fk/�Q."<.. . ........... ...... Front ........ Depth ........eight ... Sq. Ft......... Cu. Ft......... Type of Construction ................ Est. Cost. A04F.07 To be Completed In consideration of the issuance to me of a permit to construct the buildin esribed above, I agree to do the proposed work in accordance with the description above set forth and pliance with all provisions of ordinances of the city of Fridley. . .. .......... ..... ..... In consideration of the payment of a fee of $..I 7--- 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�of. the provisions of said ordinances. w / / r� •� .'� •,eY . , 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 Ihspector for separate permits for these Items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owners Name—::2�� — Builder Address LOC TION.OF BUILDING No. 1 l Street _. Part of Lot Lot Block Addition or Sub. Div. Corner Lot , ,. Inside Lot __ Set Back Applicant attach to this form.Lertificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as _. Front .. Depth Height Sq. Ft.�z Cu. Ft. Front Depth. __..Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost To be completed The undersigned hereby makes.applidation 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 an cor eet. Date Signature (A.Schedule of Fee Costs can be found on the Reverse Side) r City of Fridley Appiicatioe for Plumbing and Gas F'* ing Permit Dept. of Bldgs. Phone SU 4-7470 DESCRIPTION WORE L on Z- -2 ./ ®� Number, ]diad and Location of Fixtures O x ? Z S ZO yy K K Z �� xx l,, Z o 2 W G ? : WATER HTR. 60 Q� '� ui �4c ii OLL N E!o H� �m 5� a3 a V' °d �Z Uc4 a C90 F N GAS ELEG Base 1st 2nd 3rd 4th • Future Connection Openings Conned with New Fixture, Old Openings Sewer Cesspool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ e� Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BM ...... x 2.00 $ � New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE /TOTAL y 1st 3 Fixtures .......................... Z x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description................................................$ TOTAL FEE 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 declines that all the facts and representations stated in this application are true true and correct. Fridley, Minn- , 2�_ Owner.�4J� , 19— Kind 19Kind of Building �„�.� , 18— Used as To be completed about Estimated Cost, $— :old. -New. Building Permit No.---/-- 2 / 7 F Sign L' �" B" Blx'siness one No -t6-9- 2 / ;2 Connection Permit No . ....................................................... 11 IM -8-58 Water Sewer Meter Deposit City of Fridley,. Minn. BUILDING PERMIT N 4748 Date: Owner: ... +' r:._.. _..... Builder ..-.._._..__.. _.._..._.._._..._._._.-. - .._.._.._ _ _..__.... Address_..- ` _..__ ,� . �.�- �° ..,,� Address ..-.-_�:°` _.....��,.',.__......_._...__..___..._.._._.._.... LOUILDING No..,/...[...._ Street _._.._� .. . £ __. � ......;r'_..._.._.._._ Part of Lot Lot to ................ Block .-.-. ........................ -.._ ddition or Sub-=.4�'" _' ._ f.7..__.... Corner Lot .............................-.-... Inside Lot ..-...-.:-.-.-..._...-.--...---.... Wback ...::� .:.....Sideyard ....._..._. . Sewer Elevation ................. _............. ..................................... --------..._........ Fo dation Elevation DESCRIPTION OF BUILDING To Used _ i _... i!:' Front. -. Depth ... ..... .......: Heighr_ ft -Sq. Ft. -1011-a..Cu. Ft...... ........._. ..............._.:........_....-.._.............. on .................. Depth ............... 40517 -� V� Sq. Ft. .......... .........- Cu. Ft. ...................... Type of Construction ......... ....�• rpC.kl . Est. Cost....-. To be Completed .......... ............................... CAUITION THIS PERIP01T DO. - h); Owners N Address APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA LOCATION OF BUILDING No. / Street C P/! 9j - jf T- Part of Lot Lot Block Addition/�r Sub.Div. Corner Lot Inside LotA�L Back, SEWER ELEVATION TION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: Front yr Depth Z: L height O Sq. Ft. � yr Cu. Ft. 41. sr o-' Front Depth Height Sq. Ft. Cu. Ft. A;,CIO 69 Type of ConstructionEstimated Cost 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 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 L'tc /� C�� 6� SIGNATURE (A Schedule of Fee costs can be found on the Reverse Side.) City of Fridley e . Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone 360-3 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location. qy I F F Y F C Z N 11f W 00 z 0 O f F N WATER HTR. GAS ELEG Base 1st 2nd _ 3rd 4th • Future Connection Openings e New Fixture, Old Openings Coanected with Sewer ❑ Cesspool. ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ Future Fixture Opening ........... .... x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin .... x 3.25 $ Water Heater (Up to 200,000 BTU) x 2.00 $ 2 e� New Ground Run Old Bldg. x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $&2-,0-0- 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 app o are t e and correct. 1.17 Fridley Munn- Owner inn Owner Kind of Building AOT--,Oy Used as To be completed about Estimated Cost, $ Old—New. Building Permit ROUGH FINAL 42 sueJEcr City of Fridley172709062?, AT THE TOP OF THE TWINS BUILDING PERMIT COMMUNITY DEVELOPMENT DIV. L PROTECTIVE INSPECTION SEC. —� r i CITY HALL FRIDLEY 55432 NUMBER REV GATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/28/91 JOB ADDRESS 6191 - 6th Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 1 Upland 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kenneth.Palmer 6191 - 6th. Street NE 571-7676 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. American Remodeling 3700 Annapolis LN, Plymouth 55447 553-0020 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 0 ALTERATION �7 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK RENNNIf soffit & fascia 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 80 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 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 $4,200 $2.10 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- $ Fire STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE 78.30 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI WH N PROP LY D D HIS IS YOUR PERMIT SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI + G INSP BATE 'Ieo�agi�4�E ��'z Effective 1/1/91 NEW [ ] ADEN [ ] I-1 AND R-2 ALTER [ ] Building Permit Application construction Address: 0/ S� X-�L legal Description: / owner Name & �'.�.r GC �//��% Tel. Cil-nv 2 �G.� Tel. Contractor: Address: 0,0 Attach to this application, a Certificate of survey of the lot, with the prgmsed owwtruction drawn on it to scale. rpF mlw of IleliWF = ISS% M AREA: length Width Height Sq. Ft. GARAGE AREA: length Width Height Sq. Ft. DECK AREA: length Width Hgt/Gro and Sq• Ft. .n_ • vc. . r�M a Corner lot [ ] Inside lot [ ] Ft. Yd Setback Side Yard4�® Type of Construction: Estimated Cost: $ Apprax. Cwipletion Date: �� Praposed Driveway i f New/jVeninq Is Desired: Ft. $ $ .,Wlath + 6' See Back Page 4/ / 9i APPLIafNT: C�21 ' Tel. # C �y Permit Fee $ / I ® Fire Surcharge $ - zo--O�- State Surcharge $ /® SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ T= $ 466 C=T USE cry Fee Schedule on Revel -Sc Side .001 x Permit Valuation (1/loth $) $.50/$1,000 Valuation $650 per SAC Unit ;L Alt. "A" or Alt. "B" Above Fee Determined by.Exgineering Agreement Necessary [ ] Not Necessary [ ] C� sueJEtr PER R City of Fridley 919 6 AT THE TOP OF THE TWINS ? BUILDING PERMIT i: q `v COMMUNITY DEVELOPMENT DIV. I /� -7 r PROTECTIVE INSPECTION SEC. 1 � NUMBER REV DATE PAGE OF APPROVED By � CITY HALL FRIDLEY 55432 612-571-3450 910-F15 4/13/99 10B ADDRESS 6191 6 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 1 Upland 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Ken Palmer 6191 6 Street NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Jayson Lindsay Roofing Inc 2638 Clearview Ave, Mounds View, MN 55112 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 792-1857 20172717 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION 0 ALTERATION] REPAIR 0 MOVE O REMOVE B DESCRIBE WORK Reroof House & Garage (20 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. SEPARATE PERMITS ARE REOUIRED 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 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 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 ISE COMPLIED $.86 OT. THE GRANTING OF A PERMIT WITH WHETHER SPECIFIEjA $1,714 DOES NOT PRESUME TO TY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHLOCAL LAW REGULATING CON•nS, $56.75 Fire SC XX $1.71 THE PERFCONSTRUCTION PLAN CHECK FEE TOTAL FEE License SC $5.00 $64.32 FCON'RA TORORAUTMOR E AGENT iDATEi WHEN PROPER VALIDATED THIS IS YOUR PERMI � � S-GNATURE OF OWNER of OWNERBUILDEA1 �DATE, BL iNSD f�A 11 NEW [ ] Effective 1/1/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: k Legal Description: Owner Name & Address: Contractor: Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: MN LICENSE # 9017 .97 j Tel. # -7 92 ' 101 % Attach to this application, a Certificate of Survef6T tht lot, with the proposed construction drawn on it to scale. DESCRIPTION OF Il"ROVEMENT Length Width Height Length Width Height Length Width Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: Estimated Cost: (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. +�6 Ft = Ft = $ "'�L�, DATE: APPLIC Permit Fee $ co - 17, Fire Surcharge $ State Surcharge $ 8 SAC Charge $ License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: Tel. # 7 %' -� —/2 CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1050 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 Effective On May 10, 1999 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DE/0"I VICES/ J c �J .JOB ADDRESSdT� gl RATE SCHEDULE OWNER Aej &/—,& L� Residential ...,�Urnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer ,f'r Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate TOTAL ,� 30.00 BUILDING USED AS t// 1��=– $ $�� ESTIMATED COST PERMIT NO. $ 10.00 $ DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heating U its Circle One (Steam) (Hot Water) (Warm Air) $ 10.00 $ Trade Namervr" Size No. BTU HP EDR $ 25.00 $� Fuel Total Connected Load Burner Trade Name Size No. $ BTU HP EDR 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. $ 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 $ .50 rulings of the Building Division, and hereby declares that all the facts and $ ,.� 50 representations stated in this application are'true and correct. Sharp HEATIqBy I i and A' Conditioning en r ve. IN t Signedis Hei ts. MN 55A2ATE gtk ApprovRough-In Date Final Date 2 CEWWgEY 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 O No ( ) 3. Has no foreign objects lodged within Yes () No ( ) 4. Is securely supported - Yes O 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 O No ( ) Remarks: List ALTERATIONS Beine Done: HEATING CO: Signed By: Date: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 YAx: (763) 571-1257 ADDRESS : 61916 ST NE PIN : 143024340043 LEGAL DESC : UPLAND 2ND ADD : LOT 10 BLOCK 1 PERMIT TYPE : HEATING PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION PERMIT O.: 2004-01 65 3) • DATE ISSUED: 09/09/2004 VALUATION 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 DRYER FLEX CONNECTOR, 1/2 INCH COPPER, SEDIMENT TEE AND SHUT-OFF VALVE. # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 0 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 181 APPLICANT CENTERPOINT ENERGY/MINNEGASCO 13562 CENTRAL AVE NE ANOKA, MN 55304 - OWNER PALMER KENNETH E & NANCY D 6191 6TH ST NE FRIDLEY, MN 55432 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 worl 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 constraction or the performance of construction. AniFI Date HEATING PERMIT MINIMUM FEE 15.00 FURNACE SHELL/DUCT WORK 0.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 15.50 PAID WITH CHECK # 1017409 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. ,CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer i 11 *Air Conditioning - All Sizes All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater n��yg Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fee Total JOB ADDRESS �l 7 / j!�Q J7_ tJ // ../ $35.00 $ Building Used As �G; ��0�/Gij� WAI $10.00 $ ESTIMATED COST II PERMIT NO �� $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. $25.00 $ BTU HP EDR Fuel Total Connected Load $ Burner Trade Name Size No. BTU HP EDR Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR 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. *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE HEATING Tel #,-, / FAX # ��L ,�� Date r "✓� Af Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, 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/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () 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. f Yes ( ) No( ) The existing combustion air is sized and installed to meet the current codes 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 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-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes ( ) 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 ( ) No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type _ Appliance #2 Type _ Appliance #3 Type _ Total Appliances BTU Input _ BTU Input _ BTU Input Total Btu Input Common Vent Type Vent Height Fan Assisted or Nat Fan Assisted or Nat Fan Assisted or Nat Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type 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 : n.._ G 1 11 . n ^") Building BUILDING Permit No.: Inspections RESIDENTIAL APPLICATION $ Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: J DATE L-1-cd G YOUR E-MAIL ADDRESS i'Zi S + Q A CQiyj� SITE ADDRESS PP; -7e --e,4- THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: K -f- M44tw PAU"'LCiY TENANT ADDRESS: C t Y310CITY STATE—ZIP PHONE:?i0 3 S. �D CONTRACTOR NAME:_ RENEWAL BY ANDERSEN SUBMIT A COPY OF STATE LICE 1920 COUNTY RD. "C" WEST YOUR STATE LICENSE ADDRESS:_ ROSEVILLE, MN 55113 CITY STATE ZIP WITH APPLICATION PHONE 651_2644777 SINN LICENSE #20130983 PROPERTY TYPE ❑ FAN- ARIES PERMIT TYPE QADDITION ❑ GARAGE/SHED J9WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWAd1v1INGPOOL TYPE OF WORK: ❑ NEW ❑ ADDITION 1 91 MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: IO U) s - SIZE OF IMPROVEMENT LEN TH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE O NUMBER OF SQUARES O HOUSE ARAGE BASEMENT REMODELING SUBMIT: GARAGES 11 ATTAC D GARAGE 1. Existing Floor Plan PROPOSED SIZE: ❑ DET HED GARAGE 2. Proposed floor plan PROPOSED HEIGHT: PROPOSED HEIG 'T.?�— 3. List of structural members to be used SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS VYes ❑No3. LOCAT ON OF WIND WS Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION$ !J &QS• OCCUPANCY �� TYPE Permit Fee Plan Review Surcharge Fire Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due See Back Page for Fee Schedule 65% of Building Permit Fee (.0005) times the total job valuation — Minimum $.50 .001 x Permit Valuation (1/10%) $5.00 (State Licensed Residential Contractors) $1450 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building 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 wjana �po f to start without a permit; that the work will be in accordance with the approved plan in the case of all work which requires vijval of plans. SIGNATURE OF APPLICANT i /�—� J PRINT NAM 71'JAA �� ` �/1/ DATE � D $ •(o $ 5-0o See Back Page for Fee Schedule 65% of Building Permit Fee (.0005) times the total job valuation — Minimum $.50 .001 x Permit Valuation (1/10%) $5.00 (State Licensed Residential Contractors) $1450 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building 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 wjana �po f to start without a permit; that the work will be in accordance with the approved plan in the case of all work which requires vijval of plans. SIGNATURE OF APPLICANT i /�—� J PRINT NAM 71'JAA �� ` �/1/ DATE � D