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PRE 2010 DOCS0 City of Fridley, Minn. BUILDING PERMIT N® 3428 Date: ...' .'.—.5. m'.. ��...... Owner....................................... Builder B ............. 4*84-10-m ............. Address...................................... Address ................................... LO)CATAON43, OF BUILDING No. (p J / .�.. Street .............. tel.. Part of Lot ........ Lot ..... .... Block ................ Addition or Sub -Division (�j., . ..li'1. .''x...4 ..�'..�^-'�' Corner Lot ............ Inside Lot ..!�y ` .� / i ,........ Setback .".� .. Sideyard ....1..� ::. to 11.......... . DESCRIPTION OF BUILDING To be Used as:`/ �� .... Front ...: Depth :�:' Height �l. .—�� -Sq. >• t /.4 c�. >± t. Front ........ Depth Hei ht .. Sq. Ft .. Cu. Ft. ........ Type of Construction ................... Bst. Cost �,�y �. ..x.47. 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 fo plian with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $'V� ., ....................... 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. / 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, Minn. BUILDING PERMIT Date: _ June 15, 1965 Gloy Nelson 6871 N.E. 7th St. J y N? '7881 Bundex Dailey Horses, Inc. Address 8510 Central Ave. N.E. LOCATION OF BUILDING No. 6871 Street 7th St' Part of Lot Lot 4_ Block 5 Addition or Sub.Division . Rics Grehk Te ee Plat 7 Corner Lot — Inside Lot Setback _ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Fast. Cost —l7s 0 To be Completed • Rebuild. Storm Damage. • 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 ZI provisions of ordinances of the city of Fridley. P In consideration of the payment of a fee of $ 10.00 permit is hereby granted tov Dailey Homes 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 wiorthi nthe city limits and t� permit may be revoked at any time upon violation of any of the provisions of said Allen Jensen Building Inspector NOTICE: Ub permh den net eery the eonstmetion, hm t gWon for vArEM pimd&g. gas 6a8ng, sewer or water. Be sun to we the funding hr for separate permhs for thea hems. APPLICATION FOR BU41ING PERMIT CITY OF FRIDLEY, IiNESOTA OWNER'S NAME_ Gloy Nelson BUILDER Dailey Homes, Inc . ADDRESS 6871 N. E_ 7th Street ADD9#.SS 8510 Ce tra.l Avenue N. 190 LOCATION OF BDING No. Street Part of Lot, LotL L Block Addit.ioar or Subdlvisiwn -� � T'�'� ` VV� Corner Lot Inside Lot s., etWatk Side Yard, SEWER ELEVATION FOUNDATION EUVATION Applicant attach to this form, Two Certificates of. Survey of Lot and proposed build, ing; location drAwn on these CA-rtificates. To be used as: DESCRIPTION OF BOILDING 'ronC Depth Height Sq. Ft. Cu. Ft. ___.Front Depth Height Std. Ft. Cu. Ft. Type of ConstructionRebuild tornado damage Estimated Cost 17,000.00 The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work ift 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 anSLcorrect. jftbedala.of Fee Coats can be found on the Reverse Side). 0 V I "W. - 0 0 City of Fridley, Minn. N° 8187 BUILDING PERMIT i Date: &ky V., 1965 Owner: GLOP NELSON Builder DAILEY HOMES, INC. Address 6871 - 7th ST. N.E. Address 8510 GENMU AVE,_ NN. Fridley 219 Minnesota Fridley 21.-Ninnesota LOCATION OF BUILDING No 6871 Street 7th ST. N.E. Part of Lot Lot __4____ _ Block 5- Addition or Sub -Division WG. Terrace Plat 7 Corner Lot _ Inside Lot -- Setback — Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth Height Sq. Ft. Cu. Ft Front Depth freight- Sq. Ft Cu. Ft Type of Construction Fat Cost I1M-00--s:9 _ To be Completed • REPAIRS DUE TO STORK DAMAGE • 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'A provisions of ordinances of the city of Fridley. A t) In consideration of the payment of a fee of $ 10.00 , permit is hereby granted to GLOP NELSON 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=thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildffigs within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. .ALLEN G. JEN.SEN Building Inspector NOTICE: ibis paneB deft W* emu the ceastr dim, h stattsttee far r hhM plu Alae, an hatieg, sewer or wafer. Be sun to fte the Buthttoe nae edw for sspa pwadta for thfte Bun. APPLICATION FOR.i .ING PERMIT CITY OF FRnuY� INNESOTA OWNER'S NAME Gloy Nelson�o BUILDER Dailey Homes, Inc.. ADDRESS 6871 N. E. 7th Strert ADDRESS 8510 Central 'Avenue N. E.. LOCATION OF BIDING No, Sttaet Part of Lot. n Lot T Block Addit.ioar or Subd1vision--6" x o Corner Lot Inside Lot_ __.:Set k Side Yard . SEWER ELEVATION FOUNDATION ELRV'PMON Applicant.attach to thi3 form, Two Certificates of. Survey of Lot and proposed`huild— ing lyc�ition deAwn on these Wtificates. Tia be used to: DESCRIPTION OF BMUING —treat Depth Height g Sq. Ft. Cu. Ft. FrontDepth Height Sq. Ft. Cu. Ft. Type of Construction ebuild-storm damage Estimated .Cost $18,000.00 The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work iii strict accordance with the City of Fridley Ordinances and rulings ®f the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. jle.of Fee Costs can be found on the Reverse Side). • 0 t � �� m � �� ,� ys��p�� -42 r -A, Larldn" 6875-110my #C5 #Z. La d"iiy milmwP& V. Soils ramy ENGINEERING, INC. Afom-vl,7 Mwzidp/ I Enyineers C Sur vectors certificate of qjtVVe7f03p CiLDY- �A;'LSOl 7— 'I kA LF e: , LOT 4, CPEUP11—N-T '7 //iv* cedry ftt Ad iso hW and carred MPTSMA0167 0f,9.%WWey e& hwndo o 40& ehow Axmiwd lmd, ad Of& &4478 4rO amidl visike ffvvodwwls, il'my, fm or on sid /toad. As surveyed by me/lvi--lLPdQy julq AQP. Q1161. SUBURBM ENGINEER/NG, INC. 5 So eprq la LIP C SUBJECT PE City of Fridley 27957 AT THE TOP OF THE TWINS BUILDING PERMIT r O. ` COMMUNITY DEVELOPMENT O - _ -__ PROTECTIVE INSPECTION SEC.. r � � 1 . � CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F/5 9/24/98 JOB ADDRESS 6871 7th St NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 5 Rice Creek Terrace Plat 7 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gloy Nelson 571-8385 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Midwest Restroration & Construction 6319 Hwy 65 Fridley 55432 502-1082 5267 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 C REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house & garage (18SQ) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS 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 OWLG. 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 $1,542.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $.77 DOES NOT PRESUME TO GIVE AUTH RITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF OTHER LAREGULATING CON- STRUCTLON CTION WW @51.25 Fi SC $1.54 OR PE ANCE F CONST PLAN CHECK FEE TOTA E Li a SC 5 0 $58.56 .GNAT OF CO RAC OR AUTMORiZEO AGENT Ai HEN RO VA T HIS IS E S.GNATURE OF OWNER..F OWNER BUILDER. .DATE. 8L .NSA iAtE NEW [ ]� Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: 7 `� Legal Description: Owner Name & Address: Tel. #°�f Contractor: MN LICENSE # Address: �� (� ;- r�� l��) p� S �Z Tel. # 50,4 -1®b 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 gt/Ground Sq. Ft. OTHER: Construction Type: Estimated Cost: $ (Fee Schedule on Back) Driveway. Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # CITY USE ONLY Permit Fee $ S Fee Schedule on Reverse Side Fire Surcharge $ /. _41 .001 of Permit Valuation (1/10th%) State Surcharge $ r7 % $.50/$1,00 Valuation SAC Charge $ $950 per SAC Unit License Surcharge $ _ ' 4 D $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 $ STIPULATIONS: SUBJECT PERMIT -- City of Fridley 28552 ?-,571=�TF THE TWINS BUILDING PERMIT r CEIPT NO. COMMUNITY DEVELOPMENT DIV. r F PROTECTIVE INSPECTION SEC. 763 1 ; NUMBER REV DATE PAGE OF APPROVED BY I 1 ----1 CITY HALL FRIDLEY 55432 612-571-3450 910-F15 11/10/98 JOB ADDRESS 6871 7th Street M 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 5 Rice Creek Terrace Plat 7 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Rag G. & Betty Nelson - 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO PhiliR Olson Construction - 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 O ADDITION O ALTERATION 9c REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof house and garage (31 Sq) Tear -off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOVIRED FOR ELECTRICAL, PLUMBING. HEATING, 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT 2656 $1.33 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER S ATE OR LOCAL LAW REGULATING CON- STRUCTIO THE PERFOR 4NCE OF CONSTRUCTION $74.75 Fire SC $2.66 PLAN CHECK FEE TOTAL FEE /may !/G 111 -If License NATURE OF CONTRACTOR OR AUTHORIZED AGENT 1rDATV WHEN PROP Y VALIDATED THIS IS YOUR PERMIT _ V BL G INSP — J ® ')AYE S,GNATUREOfOWNERoFOWNERBUILOERI (DATE, NEW ADDN ALTER �) Effective 1/1/98 [ ] CITY OF FRIDLEY [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 i "J BUILDING PERMIT APPLICATION �� ConstructionAddress: Legal Description: Owner Name & Address:; Contractor:r� Address: �– ON Tel. # _5771 '3 S MN LICENSE # Zt?2G�5q,1 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 GARAGE AREA: Length Width Height DECK AREA: Length Width Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. OTHER: Construction Type: n Estimated Cost: $ e�o (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ APPLICANT: Tel. # CITY USE ONLY DATE: Permit Fee $ , �5 Fee Schedule on Reverse Side Fire Surcharge $— 62 .001 of Permit Valuation (1/10th%) State Surcharge $ 5 $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ ' �S $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 STIPULATIONS: Building O NEW D REPLACEMENT�� PLUMBING Permit No.Ab -7V1 Inspections RESIDENTIAL APPLICATION Rec' y� 763-572-3604 _ BATH SINK/LAV _FLOOR DRAINS —SHOWER _ BATHTUB —GAS PIPING (NEED CITY LIC) _ SWIMMING POOL _ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ DISHWASHER _ LAUNDRY TRAY W ER HEATER ($35) _ WATER PIPING —WATER SOFTNER (M _ BACKFLOW PREY. FOR IRRIGATION �ATER METER —OTHER CITY OF FRIDLEY Date�N: 763-502-4977 FAX EFFECTIVE 2-19-09 DATE 6 30/001 YOUR E-MAIL ADDRESS SITE ADDRESS –f ICJ, e �S Z THIS APPLICANT IS: ❑ OWNER ACONTRACTOR PROPERTY NAME: TENANT ADDRESS: k -� CITY "r ,e c.1 STATEJ%, SsN�Z PHONE: r/ Q 3 3:71 '93�g CONTRACTOR NAME: —T—ee A r e r AC f. -- SUBMIT A COPY OF �J --� YOUR STATE STATE LICENSE # EXP DATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF INSURANCE ADDRESS: CITY STATE ZIP PHONE FAX PERMIT TYPE kl'S'INGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK•I O NEW D REPLACEMENT�� 1 V� r �1 y � 1 , � i,n T c1't � DETAILED DESCRIPTION OF WORK FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $35.50. _ BATH SINK/LAV _FLOOR DRAINS —SHOWER _ BATHTUB —GAS PIPING (NEED CITY LIC) _ SWIMMING POOL _ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ DISHWASHER _ LAUNDRY TRAY W ER HEATER ($35) _ WATER PIPING —WATER SOFTNER (M _ BACKFLOW PREY. FOR IRRIGATION �ATER METER —OTHER THIS 1S AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a plum g permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordi ces and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an a pl ca ' n for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in t c se all work which requires review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME &VC Y e " 4,Ct A/ DATE 1630- O `I City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY PERM NO.: 2004-01087 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 07/12/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 68717 ST NE PIN : 143024120107 LEGAL DESC : RICE CREEK TERRACE PLAT 7 : LOT 4 BLOCK 5 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL A FURNACE (WARM AIR, CARRIER, 90,000 BTUS) AND AN AIR CONDITIONER. # A/C UNITS 1 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 300 APPLICANT HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK 0.00 35.00 NELSON GLOY J & BETTY L 6871 7TH ST NE GAS RANGE FEE 0.00 FRIDLEY, MN 55432 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 25.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT TOTAL 0.50 60.50 OWNER NELSON GLOY J & BETTY L 6871 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 regulatin orthe performance of construction. aconsc* Applic tDate Bldg Insp Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF1,FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SY STEMS AND DEVICES �(� JOB ADDRESS � % � -7 1 7 .:5--T—,' " RATE SCHEDULE Fee Total Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace $35.00 $ Gas Piping (New Fumace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning - All Sizes $10.00 $ $10.00 $ $10.00 $ $25.00 $ e1 All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 3% of cost of Improvement whichever is greater on work less than $300.00 Commercial/Industria I/I nstitutiona I 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for CVrr+mercial/Industrial/Institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR Owner Building Used As ` 1 ,g1w L� g ESTIMATED COST PERMIT NO DESCRIPTION OF FURNACE AND BURNER # of Heating Units. Cir1e (Steam) (HotWater)Wmir) Trade Name ,Rge Size No. BTU k l- /Z 1—(% HP EDR Fuel A- �C 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 $ and rulings of the Building Division, and hereby declares that all the facts - and representations stated in this application are true and correct. HEATING $ Signed_ *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 FAX #, Tel # ' ®� r� Approved by Rough -in Date Final DateL—P 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, Yes X No( ) and is securely supported and firestopped where required. The venting system is plastic/PVC and meets all current codes and manufacturer No specifications including sizing, length, number of elbows and termination. Yes M 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 Ani 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,( 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. Yesm No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented I� separately as per current codes. Yes *P \ No ( ) - - ------ - ---- ---------------- - ---- ---- - ---- ----------- -- �Ui� L 114Appliance #1 Type BTU Input � Fan Assisted or Nat Appliance #2 Type BTU Input an Assisted or Nat ;<'A—,i Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances (� Total Btu Input / , r Common Ven Vent Height Diame er es Appliance #1 Vent Connector Height ft Length G ft Diameter n Type Appliance #2 Vent Connector Height - in Type AppNaac,#3 Vent Connector Height ft Length ft Diameter in ype rs 'W laic HEATING CO: / Signed By: e : — / �