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PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn. N? 2 Q 2 3 Date . ' ..`'�.% .................... Owner........ Builder .............................. Address !-y �j.�.. Address ......................................... LOCAy�TIION OF BUILDING No. .141.1 ....... Street .-✓f ........................... Part of Lot ....................... r Lot ......1f........ Block ....'`% ........ Addition or Sub -Division �.lit'�.. e�./. ! . .. . r 0 Corner Lot ............ Inside Lot ...� ..... Setback 3a�. . Sideyard 1jP/&s................ . DESCRIPTION OF BUILDING To be Used as: ��^//////�.... I '1 (T� Front Depth 'OL`.�... Height ......... Sq. Ft. Cu. Ft. ..... . . A!I ? ...... Front .1. .. Depth r ... Height ......... Sq. Ft..174.499 Cu. Ft........ . Type of Construction .a!Z ? Est. Cost ....... To be Completed V. 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 village of Fridley. )(,.D.1 ... Q. - .............. .......... In consideration of the payment of a fee of $. /*... I permit is hereby granted to* � . ......... ......... to construct the building or addition as described above. This permit isgr ted 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 village limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. — / ... 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 Inspector for separate permits for these Items. City of Fridley SUBJECT PER Tw'9 7 5 0 0 AT THE TOP OF THE TWINS BUILDING PERMIT � NO. `L ______ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 99 "1,,� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 5/22/84 JOB ADDRESS 6821 - 7th. Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 9 2 Rice Creek Terrace Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Zembal 6821 - 7th Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Russ. & Bob Johnston Construction 12815 - 30th Avenue North, Plymouth 55441 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 559-9596 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW JJ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 22' x 20"' Living Area Addition and a 16' x 121 Garage Addition 9 CHANGE QF USE FROM TO STIPULATIONS Provide a hard suri:ace driveway. WARAf, SEPERATE PERMITS REQUIRED FOR WIRING (�P . di % HEATING. PLUMBING r call AND SIGNS, �44LECTR,� REQggiftg a� , lll�� p 8 Y L Erc. A IN SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frame 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 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 $9, 900 $4.95 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONSANY OTHER STATE LOCAL LAW EGULATING CON- $80.50 None ORFTHE PERFORMANCE OFRCONSTRUCTION. PLAN CHECK FEE TOTALFEE Al $20.13 $105.58 SIGNATURE OF CONTRACfi5R OR AUTHORIZED AGENT Y (DATEf I WHEN PROPERL ALI DATED THIS IS YOURP RMIT S BLDG INS r)ATE SIGNATURE OF OWNER 0F OWNER BUILDERI IDATEI NEW [ ] ADDN. [ ] ALTER. [ ] AREA: Length _ City of Fridley FR -1 AND R-2 Building Permit Application Effective 4/1/84 Construction Address: Legal Description: Property Owner/Address: Contractor: G 4 (0 7` Width /� �� �la k ;L Rice C u � % rlvice /�fi 7oDDhh Zemket 6521 '4 �'°� Tel. # Tel. # Dad If, Address: 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 20 Height `a Sq. Ft. GARAGE AREA: Length— Width /� Height T �yG�vv Sq. Ft. DECK AREA: Length ____r Width Hgt/Ground Sq. Ft. OTHER: 0 Corner Lot [ ] Inside Lot] Ft. Yd. Setback _ Side Yard Setback Type of Construction: wocj Estimated Cost: $ ���� ��•�V Approx. Completion Date:��5 Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation DATE: �1 `!� /6 APPLICANT: �` Tel. Q �CITY USE ONLY `� Permit Fee $ g �') Fee Schedule on Reverse Side Plan Check $ LD • 'v 25$ of Building Permit Fee State Surcharge $ 441 $.50/$1,000 Valuation SAC Charge $ $1425 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ l TOTAL $ � , " UL-', O��Z4 ff l' ► '-4-A I r !o cc ilk 0, C, ZX(, ai Ivori.41 ;�Fill wolil (9-13), I'ASPI:'3--14-7 2 � Z/ M#,- 16 'o. C. 5/8 fors -civ Id wmderlqy"c,+,- Lj A - 7y5ecql,.o.4 110 SUBJECT City of Fridley Z0,4 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. (� NUMBERATE REV D PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/20/92 JOB ADDRESS 6821 7th Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 2 Rice Creek Terrace Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jack Zembal 6821 - 7th Street NE 57.4-1966 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Russ & Bob Johnson Construction 5433 Vernon Ave, Mpls., MN 55436 927-5298 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 1152 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION Cj ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install egress window in basement; bay window in living room, new front door; new garage cLoor 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT 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$5,400'$2 , 70 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- $81.00 Fire SC $5.40 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE License SC $5.00 $94.10 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI EN OP Y kTE THIS IS YOUR PERMIT VALI SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI DG INSP OATS 110 NEW [ ] Effective 3/1/92 ADDN [ ] CITY OF FRIDLEY ALTER[ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: , �x ! %"-- 67 Legal Description: Owner Name & Address: TAG% 'Z epn bot 1 Tel. # 6-7z7,— 1966 Contractor: j (y 55 4- K6 b �o h s o � S / - MN LICENSE # Address: J33__ AVS, ��� is 5-5 -3k_ Tel. # 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: New F1' n* clno w ivtdw 4 i h ®®-t. /Vo -vi °/ 'k-7 41r q j -e cicoy' (44va"i�i dM� g K% < Oor Corner Lot [ ] Inside Lot [`j Ft. Yd Setback Side Yard Setbacks Type of Construction: — Approx. Completion Date: Driveway Curb Cut Width Needed: Ft. + b Ft = DATE: APPLICANT: Estimated Cost: $ 5��a0• oa Ft x $ (Cost on Back) Tel. # TOTAL $ ` STIPULATIONS: CITY USE ONLY elPermit Fee $ (J 00 Fee Schedule on Reverse Side Fire Surcharge $ 4S -,e 40 .001 of Permit Valuation (1/10th%) State Surcharge $ 2 7 $.50/$1,000 Valuation SAC Charge $ $700 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ — Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ ` STIPULATIONS: SUBJECT PERMIT NO. City of Fridley 3 AT THE TOP OF THE TWINS P, BUILDING PERMIT(0-59- r ' COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 . � CITY HALL FRIDLEY 55432 NUMBER REV DATE 92 PAGE OF APPROVED BY 612-571-3450 910415 JOB ADDRESS 6821 - 7th Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 2 1 Rice Creek Terrace Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Zembal 6821 7th Street NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Beissel Window & Siding Co 153 E Thompson Ave W.St Paul 55118 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 6451 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION j1 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Siding & Aluminum Trim 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. 1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION l ISTALLS I 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $6000 $3.00 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- $81.00 Fire SC $6.00 STRUCTION OR THE PERFOR ANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE Li se SC $5.00 $95.00 SIG NATU OF CO i RACTOR OR AUTHORIZED A IDA7EI N PROPE LID T D T IS IS YOUR PERMIT BLDG )NSP DATE SIGNATURE OF OWNER OF OWNER BUILDER) )DATE) NEW [ ] Effective 3/1/92 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Legal Description: Owner Name & Address: ,1,7a— 41-7 'Z / 'Oov Tel. # Contractor: ��/�$� l Gam/ ���� ���G� ��� C� MN LICENSE Address: / 5 s Sll Tel. # A151-411�S 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: 9�lGe-�1��%lG�l/r�' Comer Lot [ ] Inside Lot [ ] Type of Construction: Approx. Completion Date: Ft. Yd Setback Side Yard .Setbacks o Estimated Cost: $ 4 �/ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ (Cost on Back) = S DATE: �l �dZ APPLICANT: �� Tel. #�� S CITY USE ONLY Permit Fee $ l - Fee Schedule on Reverse Side Fire Surcharge $ f .001 of Permit Valuation (1 / 10th %) State Surcharge $- �� $.50/$1,000 Valuation SAC Charge $ $700 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: $ ,V 9,5-- oD MINIMUM FEE FOR ANY HEATING[COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr "Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. 91� r0l� z�HEATING COMPANY �/l�%l ®moo Signed By Tel No. L? �3 Approved ByRough—In Date Final Date FILL OUT BACK SID OR STACK VERIFICATION ON REPLACEMENT FURNACE `v CITY OF FRIDLEY INSPECTION DIV. 1 3�. Effective On March 1, 1996 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS 60', -7 RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner — rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 30.00 $ representations stated in this appiication are true and correct, (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) $ 10.00 $ ,1996 OWNER Gas Range $ 10.00 $ BUILDING USED AS P Gas Dryer $10.00 $ *Air ESTIMATED COST _ -:�7 PERMIT NO, Conditioning — All Sizes $ 25.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs &Alterations (LIST ON BACK) I% of Value of Appliance or Work $ No. of Heating U its Circle One (Steam) (Hot Water) (Warm Airj Trade Name Al( o"'O Size No. %ire A7— Av-w f Commercial/Industrial BTU toto-c�> HP' EDR 1.25% of Value of Appliance or Work $ Fuel Total Connected Load State Surcharges, .50 Burner Trade Name Size No. �t--�,�77 BTU HP EDR TOTAL FEE MINIMUM FEE FOR ANY HEATING[COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr "Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. 91� r0l� z�HEATING COMPANY �/l�%l ®moo Signed By Tel No. L? �3 Approved ByRough—In Date Final Date FILL OUT BACK SID OR STACK VERIFICATION ON REPLACEMENT FURNACE CHEMEY 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'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 () No ( ) Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: •/ SUBJECT City of Fridley 2 5 516 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. LV COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r � � 1 . � NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 �"""' •'� 612-571-3450 910-F15 9/17/97 JOB ADDRESS 6821 7 Street NE 0 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 9 2 Rice Creek Terrace Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jack Zembal 6821 7 Street NE 574-1966 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Russ & Bob Johnson Const 5433 Vernon Ave, Edina, MN 55436 927-5298 1152 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 O NEW Cj ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 38' x 7' Garage Addition 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. 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 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 $4,918 $2.46 WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A 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• $99.75 Fire SC $4.92 TRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOT FEE Li n SC $5 0 $112.13 SIGNATURE OF CONTRACTOR O UTHORIZED AGENT IDATEI _VVEN ALIDAT THIS IS R PERMIT BLD IN WOPEY �2-1111SIGNATURE f OTA TE OF OWNER, IF OWNER BUILDERI IDATEI •/ NEW [ ] Effective 1/1/97 ADDN [ ] CTrY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 4 BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: Owner Name & Address: 'J-qc4 b of / Tel. # Contractor: EG(SS *&j- �C�I�sed,017'54. MN LICENSE# Address: fir33 V-P-rnoi, /'Iv /5. /'[N 55t3(o Tel. # �a7 "Sagg 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 38 ( Width -71Height Sq. Ft. .j.Z6 )( /&f W DECK AREA: Length Width Hgt/Ground Sq. Ft. = IF OTHER: Construction Type: bV00ct e . Estimated Cost: $ 3,o, -, 3 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: APPLICANT: 44'ala-&46�- Tel. # CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ Z .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $950 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 $ • /3 STIPULATIONS: f �z TZ 11 W 00 �9 \ LI/ '9 Sho P• t3coo \ ' �� � \ J s �. v I \ v V e CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604' • REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace 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 *Air 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 $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 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. Effective On May 10, 1999 JOB ADDRESS o a l S- kk - OWNER TOTAL BUILDING USED AS ESTIMATED COST U' 0-0 PERMIT NO. 43 93 1/ DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units_ �rcle One (Steam) (Hot Water) ( rm $ Trade Name 111 Gt�Vl Size No. 3�36P VO 0 �0 BTU ab -0 HP EDR $ �� Fuel KS • Total Connected Load 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 with the City Codes an $ .50 rulings of the Building Division, and hereby declares that all the facts and $ representations stated in this application are'true and correct. BLAINE HTG. A,C ELECT-, "MO- 13562 CENTR [� AN01 HEATING CEaMNEY 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's connected. Yes K) No9 ( } 6 Has total heating BTU's of V All other BTU's 40 TOTAL BTU's 12-01 7. Has a liner been provided for water heater Yes () No ()�j 8. Has combustion air been provided for water heater Yes ()6 No ( ) Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: �31.AI1� HT(). A: C EL`L: � . --s--.,r®AI &v1, _ d' HEATING AIR CONDITIONING AND ELECTRIC, INC. ADDRESS _ S� Ale - OCCUPANT C- ! HEAT LOSS DATE HTG. INST. �� l SOLD BY lv�� Electrical Work TYPE OF HEAT GA_ FA HW STEAM SPACE HTR. GAS DESIGN MAKE lqrWi Model ?734:�h fk8"4 $0. Serial -7 INPUT THERMOSTAT Value CONTROLS 9-4 C+o Heat Plug C Limit Limit Settin Fan Settin .o FLOOR Pilot Type l Su r Pilot Make 12, V; Pilot Model M-7 td Pilot Timing UNIT HTR. OTHER L.W. Cut Off CONVERSION Pressure �r Percent CO2 Input CFH Percent 02 7 �' Stack Temp. %� Percent CO?yl— HOUSE HEATING TEST ECORD APT. FLOOR C SUBURB OWNER INSTALLED BY Gas Line By td UNIT HTR. OTHER CONVERSION �r Vent Size KIND OF LINER %� SIZE r` NONE Draft Hood .. A e a Regulator Filters Size Number Chimney Location Inside Outside Chimney Construction Smoke Bomb wring Draft Test Tag Door Pressure Lighting Inst. f Date Tested f Company Testing Name of Tester Pressure Percent CO2 Input CFH Percent 02 Stack Temp. Percent