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PRE 2010 DOCS
• • City of Fridley, Minn. BUILDING PERMIT N° 6746 Date: Owner: - Address Address OC OF , ILDING No. I� Street - - -Soe____ P tAft Lot �__ Block Addition or Sub - n Corner Lot _ Inside Lot .._--Setback Sideyard Sewer Elevation Fouiddation Elevation DESCRIPTION OF BUILDING T Front Depth ,Ceight Sq. Ft-�Cu. Ft. _ _ Front Depth freight Sq. Ft. Cu. Ft. Type of Construction Est. o 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 a'll provisions of ordinances of the city of Fridley. _ s„ _ A I � In consideration of the payment of a fee of $ �s ��, 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, mpair and moving of buildings within the city limits and this permit may be revoked at any t3m�upon vio n of any of the provisions of said ordinances. / `� � Building Inspector . NOTICE Ibis permit doss not cover the construction, haftWon for wirht& plumbing, gas heating, sown or water. Be ams to we the Building hkgm tar for separate permits for these Hems. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER' S NJUVi ,4 L�_ f ��/ /K, &os A BUILDER ADDRESS � 0,3 O - 7*9 6T_ A, 15, ADDRESS LOCATION OF BUILDING No. Street I f. Part of Lot Lot Block Addition or Subdivision -B /% /y /V 2' AD I T I ® %1/ Corner Lot Inside Lot Setback Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form.Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as: 0319R'Q& F- Front 1 Depth 2 Height %l Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated 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 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 : " / IONATtME / -T_ T (Schedule of Fee Costs can be found on the UvArse Side). City of Fridley, Minn.. N° 7749 • BUIEDING PERMIT Date: June 7, 1965 owner: Al. Goshy Builder Carlson Winep Inc. Address 6030 7th Street N. E. Address 2854 Columbia Ave. So„ LOCATION OF BUILDING No 6030 Street 7th Street N. E. Part of Lot Lot 5 _ Block �' Addition or Sub -Division gonna Add • Corner Lot , Inside Lot Setback Sideyard Sewer Elevation To be Used as: Front Front Type of Construction • Storm damage repair • Foundation Elevation DESCRIPTION OF BUILDING Depth Height Sq. Ft Cu. Ft Depth Height Sq. Ft Cu. Ft — Fast Cost 500-00 -- 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 a'll provisions of ordinances of the city of Fridley. J o In consideration of the payment of a fee of . 1� , permit is hereby granted to Carl eOn T BS to construct the building or addition as described above. This permit is granted upon the express condition that the personto 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, Minnesotalocation, construction, alteration, maintenance, repair and moving of buildings owitherdinances.city limits permit may be revoked at any time upon violation of any of the provisions of said Allen Jensen Building Inspector NOTICE 'lids permh den not emer the eoestrucH m, bmft ton for wbb& plimbing, ga heating, sewer m water. Be sun to sn the Building hapeetor for separate permits for then he ns. &, y APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA r OWNER'S NAME A L o/ V ea C /-7 4 BUILDER' t a ADDRESS 7t 6 A ADDRESS�t LOCATION OF BUILDING No.. Street Part of Lot LOT \16 BLOCK ADDITION OR SUBDIVISION 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. To be used as; - DESCRIPTION OF BUILDING Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction ® d =2 stimated 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 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 a (Schedule .f ,Fee. Costs can be found on the Reverse Side). L/ City of Fridley, Minn. 1099 BUILDING PERMIT Date: May 3. 197 owner: T. C. Haik Bider Same Address 6030 -7th Straet N.F- Address Sammi_ LOCATION OF BUILDING No. - 6030 Street . _ 7tb S r -P N -P. --- Part of Lot Lot 5 __ Block - L Addition or Sub -Division __-Bonny Additi^n Corner Lot _ Inside Lot —. X Setback --- Sideyard Sewer Elevation To be Used as: Foundation Elevation DESCRIPTION OF BUILDING SwimmIng -Pool Front r Depth Height — Sq. Ft. Cu. Ft. Front Depth _ _ Height . _ Sq. Ft. Cu. Ft. Type of Construction Above Ground Est. Cost 1TOOQ,_ - To be Completed May _fie 1971 Stipulations: 1. Recommend a skimmer and a main drain. 2. Recommend 2 inlets. 3. Provide a vacuum breaker on hose bibb if hose used to fill. However height of pool may dictate other means. See Plumbing Inspector. 4. Electrical Inspector must check all wiring. 5. Provide letter on fence if none at this time. 6. Pool should have at least a 6 hour turnover. H. J. McPhee 4.28.71 In consideration of the issuance to me of a permit to constru the building described ab ve I agree to do the proposed work in accordance with the description above set orth and in ce wi a'll visions of ordinances of the city of Fridley. c .f �� � 4 in consideration of the payment of a fee of $ ___ , permit is hereby granted to , T, C. Haik 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. S\ AL NOTICE: This permit does not cover the construction, hntaMon for wiring, plumbing, gas heating, *war or weter. Be sure to no the Building Inspector for separtla permits for thew heave APLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S HAM: fC %? J �� BUILDER : � 119 ADDRESS:. /Y- _ ADDRESS NO:. STREET: LOT: �� BLOCK: / ADDITION: CORNER LOT: INSIDE LOT:SETBACK: SIDEYARD: 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: Depth: Height: 1 Square Feet: Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: 196c)G4 � rCoc-,7 _ Type of Construction: r'uc ° Estimated Cost: —$ To Be Completed: _"/f % o? 5�, / )C2 1 The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict 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 : ' -j 7 SIGNATURE: (See Reverse Side For Additional Information.) 7 'Iris i -V IL MCC113 1,7 /I• 15 Q tN" 0,1 id cc, e c repi set! n ol"� Strlfj 11 kt7hoa,,?Pot' rf*5ib,e ox,-o7(J,.7?eq1s �'f' furl rrvn or fne lk5 g, 7 sa; d kwd. A5 5-60 -5-9-619 11PSMI J, INC. -M6 /I• 15 Q tN" 0,1 id cc, e c repi set! n ol"� Strlfj 11 kt7hoa,,?Pot' rf*5ib,e ox,-o7(J,.7?eq1s �'f' furl rrvn or fne lk5 g, 7 sa; d kwd. A5 11PSMI J, INC. -M6 0ftp I 8 16 �� m 1 Minnesota Well and Boring WELL OR BORING LOCATION MINNESOTA DEPARTMENT F HEALTH Sealing No. H County Name WELL AND BORING SEALING RECORD Minnesota Unique No. Minnesota Statutes. Chapter 1031 or W -series No. Amok ®k (Leave Wank a ,rot known) Township Name v Township No I Range No. I Section No. I Fraction (sm.. Ig.) Date Sealed Approximate Date Well e� m S or Boring Constructed / 9,60® s )10 )14 )I4 6J Numerical Street Address or Fire Number and City of Well or Boring Locations° ��/yAl 42 ® '7-+" +, A)�, r telr , Depth Before Sealing ° ft. Original Depth n• Show exact location of well or boring d Sketch map of well or boring Static Water Level ❑ Accurate in section grid with'X-. location. showing property lines. roads. and buildings. Approximate N W 20 t n le Aquifer ❑ Multiaquifer ft. —r= below above land surface E SAA 1-- 1mile -N PROPERTY OWNER'S NAME -r.13n t S, Dec-ke Mailing Address If different than property address indicated above. f ( �/� t 1wp j� E1 j'�� ` � 1 9 CASING TYPE )LI FASteel ❑ Plastic ❑ Tile ❑ Other p Screen from to fl. Open Hole from to ft. OBSTRUCTIONMEBRISIFI LL ❑ Obstruction ❑ Debris El Fill f Type of debrislobstruction /V0 0 Obstruction/Debris/Fill removed? ❑ Yes ❑ No PUMP ❑ Not Present ❑ Other GEOLOGICAL MATERIAL COLOR ', HARDNESS OF I FORMATION FROM TO Diameter Depth Set in oversize hots? Annular space initially grouted? fIf � ,, �r Z in. from to 424 ft. ❑ Yes VNo ❑ Yes ❑ No ;9Unknown in. from to It. ❑ Yes ❑ No ❑ Yes 11No 11Unknown in. from to ft. ❑ Yes 11No ❑ Yes ❑ No ❑ Unknown not known. Indicate estimated formation log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: No Annular Space Exists ❑ Annular space grouted with tremie pipe [3Casing Perforation/Removal REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING H in. from to ft. ❑ Perforated ❑ Removed in. from to ft. 11Perforated 13Removed Type of perforator ❑ Other GROUTING MATERIAL -{ OL,4GL (1 -1Priser_(. �+ Grouting material,P L i) '?'Ts In r � (�^ from 0-/ to 42ft. yards ��ey from to ft. yards from to ft. yards from to ft. yards bags UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? ❑ Yes klo LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report is true to the best of my knowledge. Contractor Susiil Name License or Registration No. Au*o zdd Repress I ti a ppSignature Date neParwerson seating wen or donng 91 SUBJECT P O. City of Fridley 2 7 0 61 AT THE TOP OF THE TWINS BUILDING PERMIT i RECEIPT ______ COMMUNITY DEVELOPMENT DIV. 1 L PROTECTIVE INSPECTION SEC. r 1 1 � I NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-515 8/7/98 JOB ADDRESS 6030 7 St NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 1 Bonny SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Mark Stebbens 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Bob & Son's Roofing 920-1251 20012 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 XX REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house and garage 27 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State Building Code. 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 I HAVE READ AND EXAMINED THIS APPLICATION 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 22552 $1.12 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 PERFORMANCECONSTRUCTION. 74.7,5 Fie SC 2.25 1 q �9' 7" I PLAN CHECK FEE TO FEE Lice$5-(/3.12 SIGNATURE OF CONTRACTORAUTHORIZEDAGENT IDATEI N ROP VALI T THIS IS P M L! VVV SIGNATURE OF OWNER OF OWNER BUILDERi IDATEI - BL INSP FIAT 91 NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress : Legal Description: Owner Name & Address: MFkRk SrERRIDS& Tel. # Contractor: Ba 3 S ig �ar tN�o 5 ,_� MN LICENSE #X0 Address: 60 31IO Si IVrt. Tel. `r a0 .1 SSI 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: S9. f (zxJM 3 60*2A61Z Construction Type: 0 ef%tZ OF177R�Et= Estimated Cost: $ 3s� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: V-1 —M% % APPLICANT: Permit Fee $ Fire Surcharge $ State Surcharge $ „ l SAC Charge $ License Surcharge $ 11>D Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ �• ��� STIPULATIONS: Tel. # 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 Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY INSPECTION DIVISION Effective On Jammy 1, 1998 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND DATING, COOL[NG, VENTILATION, 572-36D4 REFRIGERATION AND AIR COMTIONNG SYSTEMS AND DEVICES JOB ADDRESS ®rJ RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residerdial Rate TOTAL specified agreeing to do all work in strict accordance with the City Cotler; and Furnace Shell and Duct Work, Burner — rulings of the Building DivWon, and hereby declares that all the facts and Also Replacement Furnace $ 30.00 $ representations, stated in this anion are true and correct. (Side Vent - Fill Out Sack) & ,1998 Gas Piping (Needed with new furnace) $10.00 $ r Gas Rage $10.00 $ BUILDING USED AS �� ,p�GQe��.e_ Gas Dryer $ 10.00 $ ESTIMATED COST ��' �; a PERMIT N0. 133 �- *Air Conditioning — All Sizes $ 25.00 DESCRIPTION OF FURNACE AND OR ICER All Others/Repairs & Alterations (UST ON BACK) 1 % of Value of Appliance or Work $ No. of Ideating Units Circle One (Sivern) (Hot Water) (Warm Air) Trade Name Size No. Cornmiercialfindustriel BTU HP EDR 1.25% of Value of Appliance or Nfork $ Fuel Total Connected Load State Surcharge $ T50 Burner Trade Name Size No. BTU 4P EDR TOTAL FEE. IIIINIMUM FEE FOR ANY HEATiNGJCOOLINGNENTILATION REFRIGERATIONXR CONDITIONING PEANUT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $4200/Hr *Air Conditioners can not be placed in a skle yard without written permissiort from adjoining property owner. DATING C0N Signed 4 - Approved By� FILL OUT BACK SIDE FOR REPLACEMENT FURNACE VERIFICATION ON 1. 2. 3. 4. S. 5- 7. 8. HEA Date: +CHIMNEY AND STACK TRJCATYnN u,ndersigned hereby verifies that the existing chimney or stack: f Has been carefully examined Yes () No ( ) i Is free from rust or deterioration Yes ( ) No ( ) Has no foreign objects lodged within Yes {) No { } Is securely supported Yes ( } No ( } Meets all current Code requirements for size acid total BTU's connected Yes () No ( ) Has total heating BTU's of _ All other BTU's TOTAL BTU's Hasa liner been provided for water heater Yes () No ( ) Has combustion air been provided for water heater Yes ( ) No ( ) NG CO: By: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: (763)571-1287 ADDRESS : 6030 7 ST NE PIN : 233024210019 LEGAL DESC : BONNY ADD : LOT 5 BLOCK 1 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-01431 4q� DATE ISSUED: 08/27/2004 VALUATION NOTE: INSTALL PER MANUFACTURERS SPECIFICATIONS. REMOVE AND REPLACE SHINGLE ROOFING. # INSPECTIONS 1 APPLICANT DEPENDABLE ELECTRIC INC 2619 COON RAPIDS BLVD NW COON RAPIDS, MN 55433 OWNER STEBBINS MARK E & THEO R 6030 7TH 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 work 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 ELEC PERMIT FEE - MIN (RESI) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 28718 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRLBED 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 *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 Commercial/Industrial/Institutional ,-�061.5-000 &gEffective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fee Total $35.00 $ 35' 00 $10.00 $ JOB ADDRESS 6050 `7 -rt-+ _S -r liz_&jrm-T 6- • C Y� Owner IZ3 rt) .AaS Building Used As H O M F ESTIMATED COST 3 5 ©O ©J PERMIT NO $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating UnitsL_ Circle One (Steam) (Hot Water (Warm Air Trade NameSize No. e. i t^FV 0.70 $25.00 $ BTU 6 6, o oo HP EDR Fuel t Je - Total Connected Load $ Burner Trade Name Size No. BTU HP EDR 1.25% of Value of Appliance or Work (List on Back) $ Minimum Fee $35.00 for Commercial/Industrial/Institutional b State Surcharge �s $ TOTAL FEE REINSPECTION FEE $50.00/HOUR J *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 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. HEATING CO IESIDE01 AL HEATING & AIR' jai 5 6 Signed Minneapolis, MN 55407-3425 Tel # (612) 724-1399 FAX # lL- 7 2-9 - Lo 1 g Date 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 (W-� 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. 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 (1),," 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 ( (j/ No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type -C , r— c BTU Input 6 6 o o c7 Fan Assisted or Nat \J i 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 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 : 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( W"-� 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. 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 (1 / 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 ( ty/ 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 ( y No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type c C -BTU Input b 6, o oy 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 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 ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Date Signed By:� _ 3uilding BUILDING Permit No. nspections RESIDENTIAL APPLICATION Received By: 763-572-3604CITY OF FRIDLEY Date Recd: D 6 )ATE / — D YOUR E-MAIL ADDRESS ;ITE ADDRESS (e O 3 U — 7�-- i M APPLICANT IS: ❑ OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: M14-9 k S Mx" 5 - ADDRESS: G® ? U ` 7#-- 5T • CiTYt7-7,-; F-Z� STATES IP��� TENANT TENANT PHONE: 76 3 - �5- 3/-25� CONTRACTOR NAME; STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE—ZIP— TATEZIPWITH WITHAPPLICATION PHONE FAX PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE O y- �- ❑ TWO FAMILY/NEW CONSTRUCTION STORIES / PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK RSIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR .,0 REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, avinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project 2. Two sets of construction plans V"NDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF w OPENING CHANGES & P'o TYPE OF WINDOW TO BE INSTALLED 12nQ 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 $ OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge 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 .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $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 work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which require evie and approval of plans. SIGNATURE OF APPLICANT - PRINT NAME