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PRE 2010 DOCSCITY OF , FRII)LEY APPLICATION FOR RE-SH)ENTIAL BUILDING PEttKIT9' NEW ALTERATIONS, ADDITIONS, OR REPAIRS) 0111MR. / - 13UILDEII: Address: Address: Tel. No.: No.: &00 Street: LOT: 15 alb {U 6�-sLocr,;_ ADDITIOr1: L-� Gec`�i COP34UR LOT: ✓ INSIDE IAT: SETBACK.: SIDEYARDS: k Applicant attach to this form T`oo Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: '®• Front: 4 Depth: W Height: a - Square Feet: %30-0 Cubic Feet: 2 Z 4�0 6 VL, -1� Front: i6 Depth: Height: Square Feet: q6 O Cubic Feet: 4W 3� 6a Type of Construction: ��® \ Estimated Cost: $ S d To Be Completed: — Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) 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. See reverse side for additional .information. DATE: SIGNATURE: Stipulations: _ L' pn� ,,kL ,1} i C t,�i}cc.s i� T�% q�y,Y,Et.�wa` • v2 , 60 O �'/�'rw-obi 3/�/ �, , Si�•c. - 4�Q�. �oQ CrA. 2 Y IX 0 City of Fridley suedEcr PER � 14663 AT THE TOP OF THE TWINS BUILDING PERMIT ,V r E.1PT -NO.'° _ • COMMUNITY DEVELOPMENT DIV. w ------ y r � � PROTECTIVE INSPECTION SEC. 9 ` --',,, CITY HALL FRIDLEY 55432 L NUMBER REV. DATE PAGE OF AP VE ---- ,\ 612-560-3450 910-F15 5/2/78 JOB ADDRESS 4600 - 2nd Street N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt. 14,'15 12 1 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Harvey Rolstad 4608 - 2nd Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Emmerick Construction` 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADMEM PERMITS REQUIRED FOiP REQUIRED W114INQCENSENO. R��ii// 6 USE OF BUILDING , 91 � -Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X. 8 DESCRIBE WORK Construct a 50' x 25'4" Dwelling and a 16' x 25' Garage TELEPHONE - ELECTRIC - GAS Etc. 9 CHANGEOFUSEFROM TO REQUIRED BY LA"VV STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side yards. Provide a verifying survey before capping. Provide Type -X sheetrock on all frame walls in the garage (Fire Code) . Provide 3/4" subflooring or approved alternate on 24" truss floor joists. )?XVIl Provide combustion air to furnace. SEWER MCATION: 8" VCP in center of street. Approx. 9' Deep In Street. No existing Wye. WATER IDCATION: 6" CIP watermain 10' W. of Sewer Main. 20' E. of W. line of 2nd Street. DRIVEWAY DEPRESSION COST: 12' + 6' x $14.50 = $261.00 THE CITY Of, fRIDLEY DOES .NOT GUARANTEC THE ACCURACY OF U 1LITY LOCATIONS AND ELEYATION(,. THIS DATA IS FOR INFORMATION PURPOSES ONLY ANO PERSONS USING R SHOULD VERIFY THE MRMATION 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 R-1 1300+ 400 25,600 Total 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, WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $41,710 $20.85 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- $400.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $102.40 PLAN CHECK FEE TOTALFEE $25. $548.85 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) W N PROPERLY V iqtD THIS IS YOUR PERMIT BLDGINSP DATE SIGNATURE OFOWNER 0F OWNER BUILDER) (DATE) ���� ��z..� �� �� 560-3450. Mr.:Harvey-Rolstad 4608 - 2nd Street N.E. Fridley, MN 55421 Re: Change of House Numbers Dear Mr. Rolstad: It has been necessary.for this.office to change the address p{ of your house FROM 4600 -2nd Street N.E. TO 141 -46th Avenue N.E. LEGAL DESCRIPTION Lot '15, So. 16' of 14. Block 12, Plymouth ddn. We have notified the Post Office Department, Minneapolis Gas Company, Northern States Power Company, Northwestern Bell Telephone Company and various departments in, City hall of this change. Sincerely, DARREL G. CLARK Community Development Adm. DGC/mh c1le y ANOKA COUNTY 6431 UNIVERSITY AVENUE NE May 10, 1978 FRIDLEY, MINNESOTA 55421 Mr.:Harvey-Rolstad 4608 - 2nd Street N.E. Fridley, MN 55421 Re: Change of House Numbers Dear Mr. Rolstad: It has been necessary.for this.office to change the address p{ of your house FROM 4600 -2nd Street N.E. TO 141 -46th Avenue N.E. LEGAL DESCRIPTION Lot '15, So. 16' of 14. Block 12, Plymouth ddn. We have notified the Post Office Department, Minneapolis Gas Company, Northern States Power Company, Northwestern Bell Telephone Company and various departments in, City hall of this change. Sincerely, DARREL G. CLARK Community Development Adm. DGC/mh CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work $12.00 $ Replacement of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $ Repairs & Alterations each add. $500.00 4.00 $ MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU $12.00 / $ each add. 50,000 BTU 4.00 $ Replacement of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $ Repairs & Alterations each add. $5010.00 4.00 $ 7 STEAM OR HOT WATER SYSTEM: 0 d )cc, r 1 %. 00 Boiler & Lines up to 100,000 BTU ,_WP � each addn. 50,000 BTU -If $12.00 4.00 $ $ Boiler only up to 100,000 BTU 7.00 $ each addn. 50,000 BTU 6.00 $ OIL BURNER- to 3 gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $T GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $ ' �o (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: 1st 3 Fixtures x $ 3.00 $ •�Q Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00• $ AIR CONDITIONING $ /0.00 FAN HEATING SYSTEMSSee Fee schedule $ VENTILATING SYSTEMS $ ALTERATIONS & REPAIRS $ State Surcharge $ 50 TOTAL FEE $°y ROUGH INSP. REINSPECTION FEE Date ($10.00) FINAL INSP. LlaLe APPROVAL FOR PERMIT 411 MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE i 1A Job Address L [J a- av-t 4 p o Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. / L �/ , 1971 OWNER e KIND OF BUILDING dN nor USED AS TO BE COMPLETED ABOUT ESTIMATED COST 17 i t eA '}' / OLD - NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER e BEATING or POWER PLANTS, Steam, Hot Wat , arm AiY- No. r � €� , r Trade Name , rf Size No. Capacity Total Connected Load Sq. Ft. EDR BTU HP Kind of Fuel I BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company r) Signed By •a Tel. No.- �T J: A A• /=btNA.L.m • ' v a �• • w L EnLd un J: A �a C A• - �a C Ll D. f: C• Coit C D. t. C. 8t W. �. D�• ewAa-f ; e� Ax ivy ti Amp •� �i, 0;l�.tiY CU A At e/.ow Pw�P Pa CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMING FIXTURE RATES: NO. RATE TOTAL Number Fixtures 11— x $3.00 $,-33-00 Future Fixture Opening x $2.00 $ New Fixture, Old Opening x Water . $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU x $5.00 S V ►+ 100,000 BTU to 199,000 BTU w to, g $ Heater Water Softener x $7.00 $ New Ground Run Old Building x $5.00 $ pw �(j •.Wp1 x $5.00 $ O x 'S3.00 W R M I O O +� W .0 x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ 1st 2nd 3rd 4th (R) Future Connection Opening Connected with Sewer (*),= New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMING FIXTURE RATES: NO. RATE TOTAL Number Fixtures 11— x $3.00 $,-33-00 Future Fixture Opening x $2.00 $ New Fixture, Old Opening x $2.00 . $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU x $5.00 S U 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ New Ground Run Old Building x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: 1st 3 fixtures x 'S3.00 $ 3 Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ REINSPECTION FEE ($10.00) Job Address / �! r �CQ en Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in thisa lare < ication a -r -e7 true and correct Fridley, Mn. , 19� OWNER �C's3�lr$s�. 67 KIND OF BUILDING e in/% USED AS TO BE COMPLETED ABOUT ESTIMATED COST /� / OLD �B ILDING PERMIT NO. PERMIT NO. - J(�,r9,L company �m Signed Byt9- �/ Tel. No. ��4 7/ ROUGH INSP. Date FINAL INSP. Date f APPROVAL FOR PERMIT r C® MINIMUM FEE FOR ANY PLUMBING PERMIT 10 $7.50 PLUS $.SO STATS SURCHARGE r July 31, 1978 !V1111111 lik=VA 0431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 66432 TELEPHONE ( 812)571-3450 Mr. Harvey Rolstad 4608 - 2nd Street N.E. Fridley, MN 55421 Re: Final Inspection at 141 - 46th.Avenue N.E. Dear Mr. Rolstad: A final inspection was made on July 28, 1978 of the above address and the following items were noted which must be completed before the structure can be finaled out; 1. Provide sod in the front and side yards by October 31, 1978. 2. Call for a plumbing final by August 3, 1978. 3. Complete stucco work by October 31, 1978. 4. Install rear step by August 3, 1978. S. Add step in the garage by August 3, 1978. 6. Install house numbers on the house by August 3, 1978. 7. Be sure to apply for all permits and inspections involving the solar heating system. We will expect the above work to be completed by the scheduled dates when reinspections will be made to determine compliance. If you have any questions on these items, please contact me at 571-3450. Sincere , RON HOLDEN Building Inspector RH/mh I /)o sue.iEtr NO7 MIT82 City of Fridley 2 7 � AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PR SEC. 6111 E /---I CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910415 9/16/98 JOB ADDRESS 141 46th Ave NE I LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DEscR. Pt 14,15 12 I Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE IMBELt Harvey Rolstad 572-1705 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Town & Country Roofing 7910 12th Ave S Bloomington 55425 545-4233 20091282 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 REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Rxf Reroof house & garage (21SQ) 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. 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 $1,799.00 $.90 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOT FEE ��� d7 g . �f�/(- �j �/ Lice SC $ .00 $64.45 SIGNATURE OF CON'RACTOR OR AUTHOR IEO AGENT IDATEIEN O VALIDA E HIS IS R P I 190511 Ipgp J gAiE S,GNATURE OF OWNEROF OWNER BUILOERI IDATEI /)o NEW (] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 \ BUILDING PERMIT APPLICATION TV�I ConstructionAddress: / L/(m 1 J� I V C Legal Description: Owner Name & Address: z *k Tel. # Contractor - 77-0- -0 urn -4- i/iv1 01 MN LICENSE #- k a - Address: I Q � O/ 'E>I � ��42 Tel. # aj '" �iJ_33 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, o / �,� - D r --,r ( d Construction Type: Estimated Cost: $ f �9 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ � C DATE: ' (APPLICANT: Tel. #,SC/S - q� 3 STIPULATIONS: r. 4 CITY USE ONLY Permit Fee $ 5~l0 • S Fee Schedule on Reverse Side Fire Surcharge $ /90 .001 of Permit Valuation (1/10th%) State Surcharge $ 620 $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ 60 $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 [ ] �S TOTAL $ STIPULATIONS: r. 4 CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 �(O 4 . MARK NUMBER OF FIXTURtS TO BE INSTALLED ON EACH FLOOR :4 ...:.: ...... ...:: .. ... ....:....:.....:........::...:.:... :e...t..c..(: ►:.<::::::::::.::.:::; Au to Gas Water HeaterWash Floor Stones ..:.> : Range Gas ElecShowUrinaI Tra sherDrain Basement nt Floor 1 a:. Floor 2 Floor 3 Floor 4 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective On Jan 1, 2000 PLUMBING FIXTURE RATES; New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range** NO. RATE I Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $7.00- $7.00 7.00- $7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance TOTAL JOB ADDRESS Z—*� 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�a�20 Owner 20ftle 1/beZS®A Building Used As Estimated Cost PERMIT NO. State Surcharge $ .50 TOTAL FEE $ PLUMBING COMPANY ". �40;0W SIGNED BY TEL N0. Approved By COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE GNOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 February 11, 2002 Dave Carlson 141 46 h Avenue NE Fridley, MN 55421 Re: Final Inspection at 14146" Avenue NE Contractor: Mr. Rooter Dear Mr. Carlson: A plumbing permit was issued on December 6, 2000, to install a water heater at your address. According to Section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the plumbing authorized by this permit. As of this date, no inspection has been called for. The permit fee that was paid covers the inspections to make sure the work was completed according to the Code. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will mark the permit "no permit called for" and take no further action. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. DAVjENSEN Bu Inspector DJ/ls �;i TY OF FRIDLEY INSPECTION DIVISION 6431 University Ave NE Fridley, MN 55432-- APPLICATION FOR POWER PLANTS. -AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONpITIONING SYSTEMS AND DEVICES JOB ADDRESS 141 L4(o OWNER BUILDING USED AS ESTIMATED COST PERMIT NO. Effective On January 1, 2002 RATE SCHEDULE Residential Rate Furnace Shell and Duct Work, Burner - Also Replacement f=urnace $ 30.00 (Side Vent-. FI -P Out•Back) Gas Piping (Need ed;wiff new furnace, $ 10.00 but not. -replacement) Gas Range _ $ 10.00 Gas Dryer $ 10.00 *Air Conditioning -All Sizes $ 25.00 All Others/Repairs.-& Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial. 1.25% of Value of Appliance or Work State Surcharge 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. $ :50. DESCRIPTION OF FURNACE AND OR Br OR No. of Heating Units ( Circle One (Steam) (Hot Water) arm Air Trade Name K Pi Size No. BTU -HP EDR Fuel Total Connected Load Burner Trade Name Size No. BTU HP EDR The.undersigned hereby makes application for apermit 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: the facts and representations stated in this application are true and correct. DATE HEATING CO Signed,. '7� / Z TEL #tel FAX # Approved PP d BY Rough -In Date - '0-� I Final Date 3 FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED CnMMQN VENT VFNT CnNNFCTQR ANn COMR1 IST nN AIR V RIFICATJQN When a -inp an exts tiny jranrp, .the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes( ) No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes�No ( ) The aviating.me„stien air is sized and installed to meet the current codes and manufacturers specifications. Yes I, -No( ) When required to Install n new fl-nmeuctinn airr,it will be sized and installed to meet the current codes and manufacturers specifications. Yes ZX No( ) When in�_ct`a0fnn a new varifing SUSWW, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA -LAMA 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( )No( ) Applianr-e Tyne and Si7e/Cemmnn Vent and Vent Connecter Infemlatien Appliance #1 Type -P -(-Lr r\ BTU Input 00 Fan Assisted or Nat Appliance #2 Type l.J'�' �. , 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 _� f inches Appliance #1 Vent Connector Height ft Length ft Diameter �in Type Appliance #2 Vent Connector Height!I--ft Length ft Diameter _AL_in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type L.1 MI "RM -1 - Building BUILDING C;k 'g!� ermit No.: Inspections COMMERCIAL/INDUSTRIAL Received By: rN 763-572-3604 CITY OF FRIDLEY Date Rec'd;(,-/,& DATE Z� /G� YO E- L ADDRESS SITE ADDRESS %� L n TENANT Suite No. PROPERTY OWNER NAME: ' ADDRESS: CITYZ STATF.,i'%1,�.F' PHONE -._,&3 ti: —7 — 0% Z v ARCHITECT NAME: ADDRESS: CITY STATE ZIP CONTRACTOR NAME: 4' ADDRESS:�- Gi fd� CITY�STATFO s7 PHONE: 6, 5� q,!; -I- C��� FAX `NOTE: CITY LICENSE REQUIRED FOR MULTI FAMILY/COM MRCLUANDUSTRIAL JOBS PROPERTY TYPE ❑ TOWNHOUSE ❑ COMMERCIAL/INDUSTRIAL ❑ INSTITUTIONAL ❑ MULTI -FAMILY PERMIT TYPE ❑ ADDITION ❑ NEW CONSTRUCTION OTHER ❑ REMODEL ❑ ROOF ❑ SWIMMING POOL PLEASE SUBMIT: 1.4 SETS OF DRAWINGS 5. CONTRACTORS LICENSE OR 6. SPECIAL INSPECTION 2. SURVEY/SITE PLAN LICENSE APPLICATION SCHEDULE 3. LANDSCAPE PLANS 7. PERFORMANCE BOND 4. ENERGY CALCS AMOUNT $ BUILDING TO BE USED AS: OFFICE sF WHS SF OTHER SF TOTAL SIZE: STORIES 4 FIRE PRO C ION (Y/N) Y/1� DET IL DVNCRIPTIOI�[ OF W <I �F X0,0 () THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a buildingpermit 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 w w ' requires rev' w and approval of plans. SIGNATURE OF APPLICAN &� _ ` �' PRINT NAME Ica DATE ALL,KES ARE BASED ON VALUATION Sq. ft. x $ Cost/sq. ft. = Valuation $ Sq. ft. x $ Cost/sq. ft. = Valuation $ Sq. ft. x $ Cost/sq. ft. = Valuation $ TOTAL JOB VALUATION: $ .7/ 0 i� USE OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge SAC Charge Erosion Control Special Assessments Curb Cut Escrow Total Due g Si $ a v $ /O _ S6 See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $1675 per SAC Unit (Plans to MWCC for determination) $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) ft+6ft= ftx$21=$ Make checks payable to: City of Fridley Attach