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PRE 2010 DOCSp F, Date -4,7 •I, 1 Owner 07;,iti'+F: � Address BUILDING PE 'IT Village of Fridley, �inn. N° 2 `5 76 ..� .�.f`...... ,....�� ...... . . ... ! !!.. ... fes.......... . Builder.......................................... AddressF ....................................... LOCATION OF BUILDING No. L ?i�'. Street ...ar" `��1.......................... Part Lot of ...... ........... . Lot ". I . Block ..... ...... ..Additi n or Sub -Division: ..................... Corner Lot ..... p• .... Inside Lot ....V ..... Setback , W, .+%�4 Sideyard............ . DESCRIPTION_ OF BUIL ING To be Used as: e • AJAL .. Front. q M. Depth 14... Height d! etf'!.'� .. Sq. Ft. 1000 Cu. Ft. ........ .................. Type of Constructi . Front ........ Depth......... Height ......Il .. Sq. Ft......... Cu. yFt. . n * .. Est. CosI•�].vtop J. To be Completed- .,rd...... I, In consideration of the issuance to me of a .permit to construct the building described above, I agree to do the proposed work accordance with the dedcription. above set for a d m co fiance with pro ' i s of ordinances of the village of Fridley. b 1 b ... ...... ..... ......... In c ns deratio' ... of the payment of a fee of $.. j►permit is er y' granted to717W..... . to building 'addition the express conditic ... , construct the as descri ed above. This permit Is anted upon p t;z' P that the person to whom it is granted and his agents, employees and workmen, in all work done In, around anc upon said building, or any part thereof, shall confo' in all respects,; to the ordinances of Fridley, Minnesota in the village limits egarding location, construction, alteration, mainten a,n, e,' 'repair and moving of buildings with- and this permit may be revoked at any time upon., a of any of the provisions of said ordinances. . , . Building Inspector NOTICE: i This permitoer, not cover the construction, installation or aitera on for wiring, plumbing, gas heating, sewer or wzter. te sure to see the Building Inspector for separate pe ,Its for these Items. City of Fridley, Minn.. BUILDING PERMIT N° 31A Date: ..�. ........... Owner 7 �� ee /Builder �!?� ..,1...... ......... S ..... . Address....'L.1...�........./.. .. Address .... ............................... LP ,9ATION OF BUILDING No. .......... Street ....... .......................... Part of Lot ............................... Lot ............ Block .................. Adelition or Sub -Division. ........... ........ ........ Corner Lot ............ Inside Lot ............ Setback /Liu! ....Sideyard ..� ................... . DESCRIPTION OF BUILDING To Used as: . Front 1 / Depth 07-19/ Height /.eI.. q. Ft. P CFV. Cu. Ft. ........ .................... Fr nt ........ Depth .... Hei ht .. Sq. Ft. ........ Cu. Ft. . Type of Construction .......... Est. Cost...© ........ To be Completed ...�? 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 $. ...� t 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. ..... .. g TaSUector NOTICE: This permit does not cover the construction, Installation or alteration for wiring, pI!!pqWg, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these s. SUBJECT PEri City of Fridley oV�� AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT O. COMMUNITY DEVELOPMENT DIV. 9 r PROTECTIVE INSPECTION SEC. 1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY ..... �•j 612-571-3450 910-F15 8/27/84 JOB ADDRESS 6240 - 7th Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 5 1 Upland 1st Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Frank Falesnik 6240 - 7th. Street N.E. 571-1841 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Reroof House/Garage 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be the 2nd layer but not the 3rd. Install ridged galvanized valleys TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Asphalt 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 I 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 $400 $'50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $15.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. P AN CHECK FEE TOTALFEE $15.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) j NPHEN PROPS Y V ED THI IS YOUR PERMIT SIGNATURE OF OWNERIIF OWNER BUILDERI (DATE) BLDG INSP r)ATE NEW [ ] City of Fridley Effective 4/1/84 ADDN. [ ] �R-1 AND R-2 ALTER. [ Building Permit Application Construction Address Legal Description Owner Name & Address: 6 - 17 ?W re—, 4:' F'4 I -L S (j r lC Tel. #, Contractor: ' S E�' �• jel. # Address: EA -21 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: Lengt -Width Hgt/Ground Sq. Ft. OTHER: �- Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback ____ Side Yard Setback Type of Construction: Estimated Cost: E v®- U !� Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation DATE: APPLICANT: &�5 � % Tel. CITY USE ONLY Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Dain Charge TOTAL STIPULATIONS: Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit ' Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 011 SUBJECT City of Fridley �PERMI 20045 AT THE TOP OF THE TWINS BUILDING PERMIT T N0. 1 `y COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 ; � NUMBER DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 718/8/89 / / JOB ADDRESS 6240 - 7th Street N.E. 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 1 Upland lst Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Vincent Griffith. 6240 - 7th Street N.E. 571-7854 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 1 REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reside GaraGe 9 CHANGE OF USE FROM TO STIPULATIONS 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 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 BE $400 $.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF AO PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $15.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $15.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLY LIDATED THIS IS YOUR PERMIT BLDG INSP AT SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI 011 NEW [ ] Effective 5/1/88 ADDN [ ] R-1 AND R-2 ALTER [ ] Building Permit Application Construction Address: Legal Description: Owner Name & Address: Y/j X./e7- 6/e' 7-1 Tel. # Ski 7�,5SL Contractor: Tel. # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. lXvnr- AREA: length Width Height Sq. Ft. GUAM AREA: length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. Corner lot [ ] Inside Lot [ Ft. Yd Setback Side Yard Se Type of Construction: ��. �/J ,a Estimated Cost: $ mac, Approx. Completion Date: Qeva J-9 Proposed Driveway Width If New Opening Is Desired: Ft. Width + 6' DATE: APPLICANT: Permit Fee $ J.' O C) State Surcharge SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main amrge $ srlxrr_ATICKS: C,I'1'Y USE ONLY See Back Page Tel. # Fee -Schedule aai Reverse Side $.50/$1,000 Valuation $575 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by flxji neer *7 Amt Necessary [ ] Not Necessary [ ] SUBJECT PE City of Fridley 20069 AT THE TOP OF THE TWINS BUILDING PERMIT _ Ir • COMMUNITY DEVELOPMENT DIV. 1 r PROTECTIVE INSPECTION SEC. ��/ 1 � i CITY HALL FRIDLEY 55432 ' '•� NUMBER REV. DATE PAGE OF APPROVED BY L.__. 612-571-3450 910-F15 8/18/89 JOB ADDRESS 6240. - 7th Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 5 1 Upland lst Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Vincent Griffith. 6240 - 7th Street N.E. 571-7854 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 Ck NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE CA REMOVE 8 DESCRIBE WORK Remove 141 x 2W Garage and Construct a 22t x 20..t Garage 9 CHANGE OF USE FROM TO STIPULATIONS New garage to be on existing garage location. 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 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 Z 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 $6,450 $3.23 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $9-0100 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $93.23 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT ,rQ Np r� BLDG INSP q/p2 SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) NEW [ ] ADCN [ ] A= [ ] R-1 AND R-2 Building Permit Application Construction Address:z Legal Descripticn: Effective 5/1/88 Owner Name &Address: V Tel. Contractor: / A-)es2,--� Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESQUIF!'IC K OF IIMPSOVIICQA' LIVING AMM: nth Width Height Sq. Ft. GRRAGE AMM: length 2`2- Width Zo Height Sq. Ft. EECR AREA: Length Width Hgt/Gro u d Sq. Ft. 07HER: Corner Lot Type of Construction: Approx. Completion Date: . - Ft. Yd Setback Side Yard Setbacks Estimated Cost: $__ 11 lso, N Proposed Driveway Width If New Opening Is Desired: Ft. $ $ Width + 6' See Back Page DATE: APPLICANT: Tel. # Permit Fee $ 6,66 State Surcharge $ �, SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOTAL $ 2 -Ss srzPUTATZCKS: CITY TSE COY Fee Schedule cn Reverse Side $.50/$1,000 Valuation $575 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL RATE TOTAL Job Address Furnace Shell and Duct Work, Burner (Also replacement furnace) $ 20.00 .. $ ®U, p0 Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Gas Piping $ 10.00 $ Tel. #571-3450 (piping needed with new furnace) Gas Range $ 10.00 $ 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 Gas Dryer $ 10.00 $ and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. • Air Conditioning (all sizes) $ 10.00P. SAO �O Fridley, Minn. 52-4VIa 194 All Others/Repairs and Alterations OWNER 1�� ti T 11 of Value of Appliance or Work S 1 KIND OF BUILDING COMMERCIAL/INDUSTRIAL USED AS 1 4;,—ne 11 of Value of Appliance or Work S +� TO BE COMPLETED ABOUT) ESTIMATED COST State Surcharge ,^ $ .50 OLD - NEW BUILDING PERMIT NO. PERMIT NO. TOTAL M Reinspection Fee ($15.00) S DESCRIPTION OF FURNACE/BURNER Rough Insp. Date HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Final Insp. Trade Name Size No. ' Date Capacity Sq. Ft. EDR BTU HP Approval for Permit Total Connected Load Kind of Fuel BURNER -Trade Name Size No. Capacity Sq. Ft. EDR BTU HP MINIMUM FEE FOR ANY PERMIT HEATING IS $15.00 PLUS $.50 STATE SU9CHARGE —� Signed Tel. No. *Air Conditioners can not be placed in side yard without written permission from adjoining neiqhbor. Fill out back side for stack verification on replacement furnaces CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; 1. 'Has .been. carefully examined Yes (, ) No ( ) 2. Is free from rust or deterioration Yes ( ) No ( ) 3. Has no foreign objects lodged within Yes ( ) No ( ) 4. Is securely supported Yes ( ) No ( ) 5. Meets all current Code requirements for size and total BTU connected Yes ( ) No ( ) 6. Has Total heating BTU's of All other BTU's TOTAL Rema rk s Company _ Signed By Date J suBjEGT PERM City of Fridley 5 604 TWINS BUILDING PERMIT REC;20. v_ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 6A09 E NUMBER REV DATE PAGE OF APPROVED BY I { I CITY HALL FRIDLEY 55432 ' 612-571-3450 910415 10/13/98 JOB ADDRESS 6240 7th Street NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 1 1 Upland - 1st SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE W. Pederson 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Rainguard Const. 12008 Pennsylvania Ave li421-0897 6061 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 REPAIR D O NEW D ADDITION ❑ ALTERATION ! MOVE D REMOVE 8 DESCRIBE WORK Reroof house and garage (22 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS i Underlayment must comply with the 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 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 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES G NG THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SP ) E EREIN OR NOT. THE GRANTING OF A PERMIT 1885 $.94 DOES NOT PRES TO GI E AUTHORITY TO VIOLATE OR CANCEL TME PERMIT FEE SAC CHARGE PROVISIONS Y HE STATE OR LOCAL LAW REGULATING CON- STRUCTION ji HE FO MANCE OF CONSTRUCTION $59.50 Fire SC 11.88 PLAN CHECK FEE TOTAL FEE I c $67.32 SIG ATURE CON• TOR OR AUTHORIZED AGENT ATEA WHEN PROPERLY LIDATED THIS IS YOUR PERMIT BL NSP r Q FATE S.GN41U EOF OW NEA iiF OWNER BUILDM IOATEi J NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ J SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 d� BUILDING PERMIT APPLICATION ��6qo b 1 ConstructionAddress: Legal Description: Owner Name & Address: Tel. # Contractor. MN LICENSE # BOG Address: 110 0 nn r r Tel. # Z/? 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: % c' -Of— f,, -.,-.Estimated Cost: $ _ o S ( ee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft , F x $ _ $ DATE: /p s APPLICANT: Tel. # Zf STIPULATIONS: CITY USE ONLY Permit Fee $ q /. S O Fee Schedule on Reverse Side Fire Surcharge $ /, 9,q .001 of Permit Valuation (1/10th%) State Surcharge $ 9-/ $.50/$1,000 Valuation SAC Charge $ $1000 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 $ (o-23,� STIPULATIONS: �. r FRIDLEY INSPECTION DIViSION Effective On January 1, 2001 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 2�: JOB ADDRESS-WqC) RATE SCHEDULE ��p� OWNER_�)[I "��y��.�� Residential Rate TOTAL Furnace Shell and Duct Work, Burner . Also Replacement Furnace 30.00 )BUILDING USED AS (Side Vent - Fill Out Back) $ $_�J • ,, ESTIMATED COST _ 0. 00 PERMIT NO. Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range -.$10.00 $ its No. of Heating UCircle One (Steam) (Hot Water) (Warm Air Cas Dryer $ 10.00 $ Trade Name r Size No. dIn BTU HP EDR "J.ir Conditioning - All Sizes $ 25.00 $ Fuel /LcC Total Connected Load Ali Others/Repairs & Alterations (LIST ON BACK) Burner trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial 1.25%, of Value of Appliance or Work State Surcharge $ .50 TOTAL FEE $ 30 • � ,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 rulings of the Building Division, and hereby declares that all facts and representations stated in this application are true ar/d corr t. H EATI N DATE TEL # Approved Z�-InRough Date Final Date BACK SIDE MUST BE FILLED IN ON VENT SIZE, VENT CONNECTORS AND COMBUSTION AIR VERIFICATION COMMON VENT, VENT CONNECTOR AND CLQ? MU STI®i I AIN VERIFICA : i®N Vviien rri laciv. as exl.;Iing fur°ance, the undersigned he-eby vren ►es that the 1. Height venting r 3s bei: a•t a tamin.:d and is free from rust, deieriora �,n, rh,4r9, Gtiwsn:', inches�,f= ;?n1 is seg rarely -u1. port&J and firestopped where required. yesx)No ( ) T : verb j sys e. - a is pl .°3ticiPVC and meets all dwrent cc Appli zee 1 Vc; at Co., .;tor Height�. s° tcificaU ;Is inti ding s ging, length, number of elbows and tare.:` chn. Yes O No ) T- ., und' . igned Iso ve. iiies that the replacE.ment unit is a liste.A :::.scriik�ly �—Ty c, I meet the cu ant cc ,los and manufactu, 2r's specifications. This do^s Length it in `ude !`., A -GA ,a Category I Central Furm ce Venting Tables f^tl v isted i ; id natu. tl draf' appliances. Yes ( No( ) !� TI- i erllk_ an coniousti+� r air is sized and ;tailed to meet the current cosies of man...aeturer , spec fications. ' es K N+.. ; ) / VV ,en req tired to istalt _d new combustor( air, it will be sized tea feet tiv) currer. code : and manufacture ; specifications. a"es R" k ) V" an in!-. ailing i 'iew N• rating system, ti undersigned hereLy venTf ).:. th'it it i . a listed asses :)ly and meets the currer codes and manufac°+rrnr's s, cificali ins. Ti° does rrclude AGA-GAi Category I Centra` F mcce �� V ;-sting TS-. tiles fci ',ori aG: isted and natural .-aft appliances. {es XO Ni ; ) / �` I:: 2ha c� .onion v, . and lent connectors-,. ;d and installed coir � :?.?} :Z:`i.rT ar ppli?^ce has .-a re novel from the c limon vent and venae:! :IPatc` , as per :rrent codes. Yes Kj No( ) e Type and Size ..)mmon Vent and'Jon -afomiation fi.pOianc 1�1 T L-A E U Input 7c�, D6 ® ;-� Assisted u Nat r4 P_ yp; -� r- Ap? `tang.:: -2 Ty, .. �.. - - -- E J Input Fan Assisted c:: Nat App".incC " 3 Typ ! E tJ Input Fan Assisted or Nat • rital f opliar ,: s _._- Total u Input _ Com, <yn ` 'int T;': e C 4.5Ve 1. Height Diarntnr s.� inches�,f= _ Appli zee 1 Vc; at Co., .;tor Height�. Length � ft Di�iii � �i; ° Ty 92 Vnr:f t��.1�r-Plnht Length �tQPPP: �—Ty ,- _.I -----� Applis •lco ';'3 Vert Coi; :tor Height Length it Dinmef^r_ Tyl:,,r; ALT' "ZA a `".SNS: (Deb-, o.je Signed By: � ` _��. _ Date: O;