PRE 2010 DOCS0. 0
City of Fridley, Minn.
WELDING PERMIT N° 3152
Date: ....��� ......................
Owner . d ........ . ..... ... Builder t
Address ! :.......... ��.�.�d. : ...1:�1... .... �.� F. � ...���?.I t 'et:�? ....
Address .
LOCATION OF BUILDING
No. 4�6 . .. Street.. .. .fir ..................... Part of Lot . �? ' ..................
Lot ....�............ Addition or Sub -Division G' i .. ....... ..y �e
Corner Lot ............ Inside Lot ............ Setback .�.:....... Sideyard I .
..
DESCRIPTION
To Used as
'Front ..,: Depth ..
OF BUILDING
rri
Height ... Sq. Ft. Cu. Ft. ........
.................... Fr,,ont ........ Depth ....... el t ........
Sq. Ft......... Cu. Ft.........
to 0 ��//r 66 r 7
Type of Construction .. ?. .... Est. Cost..®. , .. .... To be Completed .......
_ r �p
el
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 compliance with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $..
� � .�f ''�., 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.
.s
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 Rema
A/a Ci of Fridley, Minn.
t3' Y9
7 9.3 >( 149.9 BUILDING PERMIT N° (5::6 3 5 )
Date:
A �
Owner: Builder�t-
or
Address _ _ _ __ _ Address --
LO ON OF BUILDING
No. Street _� �_ Part of Lot
Lot _ _ - .__ Block z Addition or Sull-ni
Comer Lot Inside Lot _ #ibackSideyard
Sewer Elevation Foundation Elevation —
DESCRIPTION OF BUILDING
To
FrontDepths .; Height ZAQ_ Sq. Ft. Cu. Ft.
Frp t Depth eigh Sq. Ft. Cu. Ft.
..,r'�
Type of Construction_ Fist. Cost - L! '" _- 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.
In consideration of the payment of a fee of $- %+y'_' , 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. In A- '
Building Inspector
NOTICE:
This permit door not cover the construction, installation for wiring, plumbing, gas heating, sower or water. Be sure to we
the Building Inspector for separate permits for these hems.
APPLICATION FOR BUDDING PERMIT
CITY OF FRIDIEY, MINNESOTA
Owner's Name BuilderG�<�
Address �°� Y Address
LOCATION OF BUILDING
No. : e Street _ "� att'lll � F. Past of Lot
Lot Block Addition or Subdivision
Corner Lot 4-- Inside Lot Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
To be used as:
Sq. Ft.
DESCRIPTION OF BUILDING
Cu. Ft.
Front Depth Height
0
Sq. Ft. Cu. Ft.
Type of Constructions ® Estimated Cost 7�
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 representations
stated in this application are true and correct. n
W
(A Schedule of Fee Costs can be found on the Reverse .9:fde.)
X7 E
PARTIAL RATE SCHEDULE
GRAVITY WARM AI1Fi:
RATE TOTAL
Furnace Shell & Duct Work ... ...
..... .. $10.00 $
Replacement of llrrnace
6.00 $
Repairs & Alterations—up to $500.00
6.00 $
Repairs & Alteratlons each add. (500.00
300 $
Furnace Shell & Duct Work to 120,000 BTU .. ..
..$10.00
each add. 60.000 BTU . .........
3.W i
Replacement of Furnace
6.00
Repairs & Alterations --up to $500.00
6.00 $
Repairs & Alterations each add. $500.00
3.00 $
STEAM ox HOT WATER 3Y6TEN
Furnace Shell & Lines—to 400 sq. ft. XDR Steam
$10.00
$
Furnace Shell. & Line—to 640 sq. ft. EDR Hot Water
10.00
$.
Each add 200 sq. ft. EDR Steam
xrA
$
Each add. 320 sq. ft. EDR Hot Water
3.00
$
OIL BURNER—to 3 gal. per hour
6.00
$.
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 186.= BTU)
6.00
$_
over 199.000 BW Ss Foe Schedule
GAS FITTING FEW:
NO RATE TOTAL
1st 3 Fixtures
x$ Z00
$
Additional Inxttures
x .76
Gas Range to 10,0W
a$ 6.00
$
State Surcharge.50
6: 0!6
tM Fee BcbodWe
TOTAL Fm 0, SL
Dept. of Bld9L Ph"M M
City of Mdley:
The undersigned hereby makes application for a permit- for the work herei
specified. agreeing to do all work in strict accordance with the City Ordiniuxt
and ruling of the Department of Buildings, and hereby declares that all the fat
and representations stated in this application are true and correct.
Fridley, 11(<inn
Owner t l - /7 A.-' 0 it e
Kind of Building Fes) I / I0-1
Used as /® %�`� 0 % 9 a i
To be completed about, �� d� �`� Ff- i 17
Estimated Cost~ $ 60it.
01 -New. Building Permit No. Permit No.
HEATING or POWER PLANTS_- , �i - '
//�► Hearn, Hot Water, Worm Air—No-
Trade
� NFloo-
Trade NameC le 4YC_ Sia¢ NO.
.7 /x
Capacity!Sq. Ft. E.D.R BTU
Total Connected Loud l of ptret �"•
BURNER — Trcde Nome Size Ido
Capacity ft Ft ED -IL BM I®
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97-81--979001
. APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
•
x
$10.00
a
PARTIAL RATE SCHEDULE
$7.90
�,
a
PLUMBING FIXTURE RATES; N0.
'�
TOTAL
U
h%=bar Fixtures x
$3.00
e
zoe
Water
$2.00
S
Company
Now Fixture, Old Opening x
$2.00
S
�M(1INNEGASC
Signed By MINNEGASCO
Catch Basin • x
$5.00
$ ,
t Water Heater - to 99,000 BTU, x
$5.00
p,
�
Heater
,
H
�
a�
w.21
u
0
0
N
C
as'.lee
u'a
x
a w
bGi
w
c�
R
0
is t
C
to
c't•
r4j
r
tad
3rd
4 th
(R) - Future Connection Opening
Connected with Sewer
(•) - 110v Fixture, Old Opening
Water
Job Address �-q67owhTF -7 iiypP E
Department of Buildings
City of Fridley 1
Tel. #571-3450
The undersigned hereby makes application lora permit for the work ht
specified agreeing -to do all work in strict accordance with the City C,
and rulings of the Department of Buildings, and hereby declares that a
the facts and representations stated in this application are true and t
Fridley, Mn. -3 fit -77 , 19_
OWNER RIC14ARD ERZCkSON
KIND OF BUILDING fume
USED AS res.
t
100;000TTU to 199,000 BTU
x
$10.00
TO BE COMPLETED ABOUT 3-11-77
PARTIAL RATE SCHEDULE
$7.90
Nev Ground Run old Building
ESTIMATED COST ��•��
PLUMBING FIXTURE RATES; N0.
RATE
TOTAL
OLD NEW BUILDING PERMIT N0. PElVIIT N0. ! Q3
h%=bar Fixtures x
$3.00
S
zoe
Future Fi-xture Opening X
$2.00
S
Company
Now Fixture, Old Opening x
$2.00
S
�M(1INNEGASC
Signed By MINNEGASCO
Catch Basin • x
$5.00
$ ,
t Water Heater - to 99,000 BTU, x
$5.00
$
Tel. No. ,
100;000TTU to 199,000 BTU
x
$10.00
Water Softener
x
$7.90
Nev Ground Run old Building
. x
$5.00
Electric Water Heater -
x
$5.00
GAS FITTING FEES; ,
1st 3 fixtures
x
$3.00
I.dditional Fixtures
x
$1.00
.Gas Range to 199,000 BTU
x
$10.00
REPAIRS 6 ALTERATIONS
First $100.00 $5.00
each add. $100.00 or traction $2.00
State Surcharge
TOTAL FEE
REINSPECTION FRF,
S
S
$ ROUGH INSP.
Data
S '
FINhL INSP. 7 - / - -7
Date
$
$ APPROVAL FOR PERMIT _
$
$ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50
$ .50
$ 8.00
SUBJECT
PERMIT NO.
City of Fridley
(--3j-270
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
�
RECEIPT NO.
_____ COMMUNITY DEVELOPMENT DIV.
Z/17/
r � � PROTECTIVE INSPECTION SEC
7
1 CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910415
8/1/00
JOB ADDRESS 5670 7th St NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1,2
1
Hamilton's
Addition to Mechanicsville SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Leila Farah 5670 7th St NE
574-7334
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Dave Berry 20625 Co Rd 30, Rogers, MN
55374 612-685-5662 9204
a 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] REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof (Tear Off) House and Garage 23
sq
9 CHANGEOFUSEFROM
TO
STIPULATIONS
Underlayment must comply with the State
Building Code.
SEPARATE PERMITS ARE REOUIREO 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 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
$1.01
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2,010.00
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 PE
ORMANCE OF CONSTRUCTION
PLAN CHECK FTOT
FEE
5
Lice IC$5./
$91.27
7ATURE CONTRACT& ORAUTMORIZEOAGENT ADATE,
EN PROPE VALID T THIS IS Y P�
�
,NSF' BATE
S-GNATURE OF OWNER„F OWNER BUILDER, ,DATE,
NEW [ J Effective 1/1/2000
ADDN [ J CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: ,57(, %0 7 ST AJ C
Legal Description:
Owner Name & Address: /,61 L-A F:fA-1ZA 4 Tel. # 5254-73
Contractor: D'kJ E B le�zk=m MN LICENSE # 9 7 � j
Address: I►J°
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
Hgt/Ground
Sq. Ft.
OTHER: Eko6F-
Me'0—
. -)3 Sq
1-7%� `U_d
(�
2 0 )=r— d— v
Construction Type: ke:— (e0 0 F Estimated Cost:
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $
DATE: O APPLICANT: -14fTel. #
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ 3-�S- Fee Schedule on Reverse Side
Fire Surcharge $ D / .001 of Permit Valuation (1/10th%)
State Surcharge $ ®/ $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ $1100 per SAC Unit
$60 $5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
/-a
Agreement Necessary [ ] Not Necessary [ ]
e
SUBJECTP
City of Fridley
3 3 0 9
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
�
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
/�
r PROTECTIVE INSPECTION SEC.
Com®
i1 ` �
A CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
��'��,•�
---.
L J` 612-571-3450
910.F15
8/15/00
JOB ADDRESS 5670 7th Ave. NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DescR.
1,2
1
1 Hamilton's Addn. to Mechanicsville SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Leila Farah 5670 7th Ave NE 574-7334
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Owner
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 CX REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Replace siding
9 CHANGE OF USE FROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather
resistive barrier be placed over exterior sheathing to protect the interior
wall covering. Exceptions for this provision would be if sheathing is an
approved weatherproof panel or when the siding is an approved weather
barrier. Vinyl siding is not a weatherproof covering unless the manufacture
states this in their application guidelines. Call for inspection of wrap
before covering.
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
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 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$3,000.00
$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-
Fir SC $3.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$83.25
PLAN CHECK FTOT
dUFEE
87.75
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT � � IOATE�
�7/OA
ME P P ALIDATE I$ I� PE,WuT
's
SGNATURE OF OWNER --F OWNER BUILDER- iE-
BL -NS-
e
NEW [ ] Effective 1/1/2000
ADDN [ ] CITY OF FRIDLEY (763) 572-3.604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: -7o % -7 0 -- -7�— d''C"V'�
Legal Description:
Owner Name & Address Tel. # q —1-53,
,
Contractor: t MN LICENSE #
Address: d ��. Tel. # "r
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: 6i Estimated Cost: $ -3 0 o
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $
DATE: 01M APPLICANT: — �" Tel. # 7&-S— 57 l 73LSK
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee
STIPULATIONS:
$
83, '�S�
Fee Schedule on Reverse Side
Fire Surcharge
$-
Uo
.001 of Permit Valuation (1/10th%)
State Surcharge
$
Sy
$.50/$1,000 Valuation
SAC Charge
$
$1100 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [
TOTAL
$
S'
8?1 ?S--
STIPULATIONS:
CITY OF FRIDLEY INSPECTION DIVISION
Effective On January 1, 2002
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
n:
JOB ADDRESS
RATE SCHEDULE
A
OWNER__ L91 Petr,
r Residential Rate
TOTAL
I �.
ip Furnace Shell and Duct Work, Burner •
N
BUILDING USED AS f`� 1 � i
`` Also Replacement Furnace $ 30.00
(Side Vent • Fill Out Back)
$
S
ESTIMATED COSPERMIT NO. /S
T
Gas Piping (Needed with new furnace, $ 10.00
$
but not replacement)
REIGRIPT, 01 OF FURNACE AND OR BURNER
Gas Range $ 10.Q0
$
0
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
~ Gas Dryer $ 10.00
$
Trade Name Size No.
BTU HP EDR
"Air Conditioning • All Sizes $ 25.00
$
Fuel Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK)
Burner Trade Name Size No.
I% of Value of Appliance or Work
$_ ice
BTU HP EDR
W
:ommerciaVlndustrial
LL 1.25% of Value of Appliance or Work
$
The undersigned hereby makes application for a permit for the work herein
US
specified agreeing to do all work in strict accordance with the City Codes an
State Surcharge
1------Q0-
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
TOTAL FEE
$.S• 5
DATE of-)LJ- D_
0
IL MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
HEATING CO
1EFRIGERATIDN/AIR CONDITIONING PERMIT IS $25.0
FLUS THE S.SO STATE SURCHARGE
Signed"�� I't
FAX # J - - 4566
ry EINSPECTION FEE $47.00/Hr
i 4ir Conditioners can not be placed in a side yard without
'Rough-In Date Final Date `��-
Approvers By v�
�v Titter) permission from adjoining property owner.
SID F 0
LLFALLOUT
FEB -26-2002 14:40 FROM CITY OF FRIDLEY TO 7637834566 P.06/06
THE BELOW MUST BE FILLED 1N WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE.RETURNED
When , 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 plast dPVC and meets all cunV t codes and manufacturer
specficattons including sung, length, number of ebows and termination. Yes( ) No( )
The undersigned also verifies that the replacement unit is a fisted assembly
and meets the current codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No ( )
The . is sized and installed to meet the current odes
and manufacturer's specifications. Yes( ) No( )
When required to it will be sized and installed
to meet the current codes and manufacturers specifications. Yes() No ( )
When ' the undersigned hereby veriftes that
it is a listed assembly and meets the current codes and manufacturers
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 moors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes( ) No( )
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fain Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type
Vent Height Diameter inches
App #1 Vent Connector Height ft Length ft D►ameter n Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter n Type
HEATING CO.
Signed By:
TOTAL P.06
CITY OF FRIDLEY INSPECTION DIViSION
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 $
(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 $ .50 .
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/CO-OLING/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 ADDRESS '�) Eo'7 y
BUILDING USED AS �S[ aCQ.dtC�
ESTIMATED COST � PERMIT NO.
DESCRIPTION OF FURNACE.AND OR BURNER
No. of Heating Units---L—Circle One (Steam)'_ (Hot -Water) (Warm Air)
Trade Name Size No.
BTU _ HP EDR
Fuel Total Connected Load
z'
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 iniith the City Codes an
rulings of the Building Division, and hereby declares that Iall;the facts and
representations stated in this application are true and correct.
STANDARD HEA11NG & AIR O1DD1ONM CO.
410 WEST LAKE .;TREET
MINNEAPOUS, MN 55408-5 DATE �':•��
612-8242656
HEATING CO d
Signed - AM44-,,��TEL #
FAX #
Approved By Rough -In Date Final Date, �f"0-3
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
COMMnN VFNT�VFNT CnNNFCT0R AND cnMBl ISTInN AIR VFRIFICATIM
When i� ming an eYicing f gran _ the undersigned hereby verifies that the `M
== venting has-been eKgm1nef! and; is free from post, deteiiorat onf obstructions,
r: and is secutify supported end firestopped where required. Yes O 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 manufacturers specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes O No ( )
The existing cnmhustien .air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No ( )
When required to install a now rnmhi ,Minn air it will be sized and installed
to meet the current codes and manufacturers specifications. Yes () No ( )
When installing a new venting sem, the undersigned hereby verifies that
it.9s a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA -LAMA Category I Central Fiiimace
Venting Tables for fan assisted and natural draft appliances. Yes( No( )
Is the common vent and vent connectors sized and linstalled correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes ( )No(
)
Appliance #1 Type
BTU Input
Fan Assisted or Nat
Appliance #2 Type
BTU Input
Fan Assisted or Nat.
Appliance #3 Type
BTU Input
Fan Assisted or Nat
Total Appliances
Total Btu'Input
d
Common Vent Type
Vent Height
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
ALTFRATInNS- (tel
ft Length
ft Diameter in Type
HEATING CO:
Signed By:
Date: