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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N? Eis� Date: Owner: Builder Address Address BUILDING No. No. Part of Lot Lot ,ZV__ Block Addition or Sub- on 4AZi=--- Corner Lot _ Inside Lot _'►"'° S�lback Side d , " Sewer Elevation ______._ F dation Elevation DESCRIPTION OF BUILDING ToJJ��ee U ' 740 r - Front � . Depth :;�� Height, {g1 Sq. Ft. Cu. Ft. Front DepthHeights� Sq. FL - Cu. FL Type of Construction Est.. 'ro be Completed In consideration of the issuance to me of a permit to construct the building described above I agree to do v the proposed work in accordance with the description above set forth and in compliance with afl provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $_ '"", 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, repair and moving of buildings withianordin� city limits and this permit may be revoked at a upon vi�lon of any of the provisions of said NOTICE: iib porn* does not aorar the sondructlon, IestaWae for wkb% pkmbk& gas heating, sower or waMr. Be sure to see the Building hopeetor for soparaM pw dM for these *ems. APPLICATION FOR BUILDING PERMIT CITY OF FRIDIEY, KMIESOTA Owner' a Name s.lee-n Addres a LOCATION OF BUILDING No. Street Part of Lot Lot Block Addition or Subdivision Corner Lot Inside Lot Setback Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. To be used as: DESCRIPTION OF BUILDING i Death �'� Height__ Sq. Ft. �� . �( Cu. Ft. FrontDepth Height Sq. Ft. Cu. Ft. Type of Construction �/'�i��' Estimated Cost/.S-ja To be Completed /�C-� The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. �( DATE l , 6 SIGNATURE Via' "�- (A Schedule of Fee Costs can be found on the Reverse Side.) CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE Aj a H PLUMBING FIXTURE RATES: NO. N roV m I a -Hc�' 4J New Fixtures 0 OO wvu • n� u 41 V 3M p, % W r" w hi 14 .oC Water Heater as lec $ Beer Dispenser S 4.00 S Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve 1st S 5.00 $ Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range $ 10.00 2nd Gas Dryer _�_ $ 10.00 $ Back Flow Preventer Required. . . Yes ( ) NO ( ) Type $ 5.00 S ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance 3rd $ 00 State Surcharge $ .50 Reinspection Fee $ ($15.00) TOTAL FEE $ /550 4th (R) - Future Connection Opening Connected with Sewer (") a New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser S 4.00 S Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve S 5.00 $ Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer _�_ $ 10.00 $ Back Flow Preventer Required. . . Yes ( ) NO ( ) Type $ 5.00 S ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance $ 00 State Surcharge $ .50 Reinspection Fee $ ($15.00) TOTAL FEE $ /550 Effective Date May 1, 1988 Job Address oc / ? 67-7 -t4- PL , AjE , 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, Mn. �- , 19 7 OWNER /e�� e�K EtJ//J KIND OF BUILDING USED AS TO BE COMPLETED ABOUT 6--7-90 ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. Minnegasco #342-5337 Company 700 W. Linden Avenue Signed By P. 0. BOX 1165 � + IP-11-Pll 55440 11 Tel. No^� v ROUGH INSP. AUNMGA= Date FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE 4% / SUBJECT ADERMIT N City of Fridley 27799 AT THE TOP OF THE TWINS rp BUILDING PERMIT y ,� 11. Lu COMMUNITY DEVELOPMENT DIV. I PROTECTIVE INSPECTION SEC. r NUMBER DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 �""'� 612-571-3450 91041577-1 9/11/98 f' JOB ADDRESS 217-219 57th Place NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7,8 1 1 Citv View SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Robert Russell 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Panelcraft 3118 Snelling Ave S MInneapolfs 55406 721-6628 2179 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Rx Residential 7 CLASS OF WORK ci NEW ❑ ADDITION ❑ ALTERATION Ck REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof & Reside Building 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED 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 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 $17,355.00 $8.67 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- $262.25 Fire SC $17.35 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FE Licens $5.0 $293.27 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) N P P ID TED S, V PER bA BLDG NSP � v r�ATE SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI 4% / N k W Lllectrve 1/1194 ADDN I I CITY OF FRIDLEY Auru.iz I I SINGLI, FAMILY AND DUPLEXES R -I AND R-2 Building Permit Application ConstructionAddress: d/ PZdee, Legal Description: Owner Name & Address: Contract Address: Tel. // MN LICENSE #_dl07P _ Tel. // 074W_4�4pif — - of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING ARCA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft.- DECK t.DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Corner Lot Inside Lot Ft. �Ydd Setback Side Yard Setbacks _ Type of Construction: Kentr� 2�5�� Estimated Cost: $ d Yp Approx. Completion Date: /Z,36s,_ (Cost on Back) Driveway Curb Cut Width Needed: Ft. -I- G Fl — �Ft x $ _ _ $ DATE: APPLICANT: Tel. // % _010 Permit Fee Fire Surcharge Stale Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL .STIPULATIONS: CI'T'Y USE ONLY $ �;,S7-17,ee Schedule on Reverse Side olm fl, $ _ .001 of Permit Valuation (1/10111%) $.50/$1,000 Valuation $ _ $800 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 I I Not Necessary $ 0107 ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 571-36U4 JFAX: (763)571-1287 : 217 57 PL NE : 233024230005 : CITY VIEW : LOT 7 BLOCK 1 HEATING DUPLEXES CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT �0.: 2004-0194"j DATE ISSUED: 10/18/2004 ' r 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, RUUD, 50000 BTUS) # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 0 APPLICANT SHARP HEATING & AC INC 7221 UNIVERSITY AVE FRIDLEY, MN 55432- (763)572-0459 OWNER RUSSELL ROBERT M 3025 JERSEY AVE N MINNEAPOLIS, MN 55427 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 worl 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 regula ' construction or the performance of construction. ADDli t A Date 1 Bldg HEATING PERMIT MINIMUM FEE 0.00 FURNACE SHELL/DUCT WORK 35.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 35.50 PAID WITH CHECK # 14882 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. *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 Approved by Rough -in Date Final Date CITY -OF FRIDLEY BUILDING INSPECTION Effective 4/1/2004 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION 763-572-3604 FAX 763-571-1287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES a k- —1 5 - 0--la-Le a L JOB ADDRESS 1 ,_ RATE SCHEDULE Fee Total Residential Owner a -Q A Furnace Shell and Duct Work, Burner & ( ��. - also Replacement Furnace $35.00 $ Building Used As Gas Piping (New Furnace, Fireplace, Insert) $10.00 $ ESTIMATED COST PERMIT NOL6"( 7 �� l Gas Range $10.00 $ DESCRIPTION OF FURNACE AND BURNER Gas Dryer $10.00 $ # of Heating Units Circle One (Steam) (Hot Water)Warm Air) Trade Name C100 Size No. *Air Conditioning - All Sizes $25.00 $ BTU HP EDR Fuel Total Connected Load All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Burner Trade Name Size No. Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EDR Improvement whichever is greater The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/Industrial/Institutional and representations stated in this application are true and correct. State Surcharge $ ' 'M HEATING CO Sharp Heating '& AC Inc TOTAL FEE $ Signed Tel # 763-572-0459 REINSPECTION FEE $50.00/HOUR FAX# 763-572-0164 Date *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 Approved by Rough -in Date Final Date City of Fridley MN 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. y7 ( 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 �4 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. YesN No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type 4 .klf V\A-ksl BTU Input 5�0 0 Fan Assisted or Nat Appliance #2 Type W- BTU Input Fan Assisted or Nat Appliance #3 Type 44 BTU Input Fan Assisted or Nat Total ppliances Total Btu Input i [ \ // Com n2Vent Type S C, 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 Type Appliance #�t Connector Height ft Length _,eft S Diameter in c HEATING CO: Sharp Heating & AC Inc 1 Signed By: Date : ' 1\2- J®,j • (Tot, 11 04 06234p 612-722-0415 0.5 PIGHT4 WORKSHEET mire ouse Centerf"cint Energy►Mennegasco Your CoMoany Addn as Your City, St 99996.M?hoM: WjD -$55.1213F W%fiW2121 7a -- b! GL( MANUAL J'. 7t17 Ed. 1 llama of r% -t m. 1 AGry Hour whole hour 2 Length of exposed V a l 75.0 h 76 O ft 3 Rwwrr, dimenrpone; 20.0 x 18.0 tt 4 Ceiinga Condit. Option 120 ft d 12.0 ft heaticool TYPE OF EXPOSURE CE 111"m 18 Htg G!g Arbil (n�f Luau (Btul11 Hig Gig Area (ftp Woo fEf[W)) Ht9 CNg Area Htg c!g Aw rltg Clg 51 Gross a 12C R1 2.1 912 ••" "'• 992 • " «"• •»• .», .... .... I E> b 14A 45.9 8.3 132 "•P• "" 152 "'• ""° '"" •••° •••• •�• wallet miJ C IOq '11.3 Qu Jtfg „" "" 3[10 '•'• +••• •••• •»• .+.■ +«. ei9ions d 0 .... ..« 0 «... .... ..,. «... .... »« e 0.0 0.0 0 •a• «.. 0 ..« .... .... ..« .... .... I 0.0 0.0 0 Wind"sOng a �A 428 ^ 100 4276 •M• 100 4275 »•• •°^^ •-- gins doors bD.O •` 0 0 ^+•� 0 0 » .«. .. , heating a 0.0 0 g �•• 0 0 ..» ,». 7 Windowpand North 51.0 25 - 775 28 - 775 •••• •»• Jim doors NE1Nw O.a 0 - 0 0 -� 0 =wino CPAI Pt49.o 75 "O• 8876 71; Q075 3EISW QOSouth 0 ""' 0 0 "" 0 •••- Hoa 0.0 0 0 0 '"" 0 »•• »+• ti Othordoo.s s 1OF �.9 7.8 42 9210 317 42 1210 3'17 b I'D O.0 0 0 0 0 0 0 t 0.0 0.0 0 0 0 0 0 0 9 Net a 12C 8.1 2,1 770 6237 1638 770 9237 1836 bxpoaed b 14A 45.9 0.3 102 6977 12" 1142 0977 1:64 W81Ie and c 15A 11.3 O.0 380 4275 0 380 4275 0 paAitlons a o.D 0.0 D 0 0 o D o 00.0 0.0 0 0 0 0 0 0 f 0.0 0.0 0 a 0 0 0 0 10 Ceilings a 18G 7.g 3,7 360 2851 1315 360 2851 1315 b Ise 7.0 3,7 0 0 0 0 0 4 c 0.0 0,a 0 0 0 0 0 0 d e Db .O 0 o �' a° 0 0 0 f D.0 00 0 0 0 0 D D 11 Flows a 21A 2.2 00 300 776 0 360 778 0 (Note: room b 0.0 0.0 0 0 a 0 0 0 perimeter 0 D.0 0A 0 0 0 0 0 0 16 displ. d D.0 cc 0 0 0 0 0 0 for slab a 0.0 0.0 0 0 0 0 0 0 flown) f 0.0 0.0 0 0 0 Q 0 0 12 Infiltratlon a 44.4 _4 1 142 6$03 584 142 8303 W 13 s4motal 8s=8+8..+11+12 "•' 32005 •••• ,«• 32905 •«• ,+•• ••.. »» .,M Lm ademel hosting •••' 0 ..tl/ /i.1 ® Wm$ transfer »» w .•.. Q Heating redistribution °+» 0 ••» »» 0 »» .... .„. .,.. ,.,. 14 Ductlosa O° 0 »» 0+ 0 ••« •••• •••• 15 Total loss =13+14 '°^' 32905 "°" "°° 32405 ^•'° •••• ^ •• � •^•• •••• 1w Ins. gains: acro 4 .".' 1200 4 - 1200 "°"• App. 4 11201) "" 1200 1 »" 11200 "'+ "'• 17 $ubtot (k9h galr>a7*6..+12413 »°• 14286 »<• »°• 14055 •••• •••° •••• •+■+ Less external dooling •^-• •«• 0 •• - »» 0 »» «.. .... . �. •.• Cuv165g iedlmlrilmon ..^• .••• 0 •••• I 0 +... .». ..., «.. 18 Dud gain 0° 1°"' 0 OIAp w »» ••» 194 ;edRSH galrl=(17+18)•PLF 1.00 - 149555 1.00 *•"• 14966 ••» °••• Air required (0m) "" BOa 80D "" 8D0 800 -^» '0R• Printout c0ddi8d bj ACCA to meet all Muirements of Manual J 7th Ed. w•'•1�1�7t f9e Rl01A4 sReskia"-5.&.12RSRSQ586 21106Ori-1116'08;30 C: VQ piKtinml11s1Wr1gtaswrt NVAL"019 Vihplw-A no w Pap I 157518 If no corrections are listed above, appr violation of the ordinance if you do not corrections as called for. is hereby given to proceeds. You will be in for the proper inspections and make 158045 INSPECTION REPORT CITY OF FRIDLEY MINNESOTA (763) 572-3604 ADDRESS OWNER BUILDER DATE L� TIME DESCRIPT N INSPI=TION REPORT DATE ��//p9 / REPORT If no corrections are listed above, approvefjis hereby given to proceeds. You will be in violation of the ordinance if you do not cq1 for the proper inspections and make corrections as called for. CITY OF FRIDLEY PERMIT Nq:: 2004-0197 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 10/25/2004 (763) 572-3604 FAX: 763) 571-1287 ADDRESS : 219 57 PL NE PIN : 233024230005 LEGAL DESC : CITY VIEW : LOT 7 BLOCK 1 PERMIT TYPE : PLUMBING PROPERTY TYPE : DUPLEXES CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 0.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL A GAS WATER HEATER. # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS I # GAS DRYERS 0 # GAS RANGES 0 # OF NEW FIXTURES 0 VALUE (FOR MINIMUM CALC) 0 # WATER TRMT APPLIANCES 0 APPLICANT PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) 0.00 0.00 SCHADEGG MECHANICAL INC 225 BRIDGEPOINT DRIV PLBG FIXTURES (EXIST OPENINGS) 0.00 S ST PAUL, MN 55075- WATER TREATMENT APPLIANCE 0.00 (651) 292-9933 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 35.00 GAS RANGE FEE GAS DRYER FEE PLBG REPAIR/ALTERATIONS 0.00 0.00 0.00 OWNER RUSSELL ROBERT M 3025 JERSEY AVE N STATE SURCHARGE, PLBG FLAT 0.50 MINNEAPOLIS, MN 55427 TOTAL 35.50 PAID WITH CHECK # 1237 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 constructio or the pe orm a of construction. Applicant Date Bldg Insp D SEPARATE PERMITS FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY INSPECTION DIV. Effective April 1, 20 6431 University Ave NE f 646 "Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT (763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE t /� S CfW_ � 1. PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS ( New Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $10.00 and representations stated in this application are true and correct. Catch Basin $10.00 �� 'Z2� �Y Rain Water Leader $10.00 DATE: 20 Sump/Receiving Tank $10.00 Water Treating Appliance $35.00 OWNER ater Heater -Electric $35.00 � ater Heater - Gas** $35.00 BUILDING USED AS Gas Range** $10.00 `� s ESTIMATED COST PERMIT NO. Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes () No / SC Type $15.00. PLUMBING COMPANY ZZ 61Z,ld 'Oy,�77 Reinspection Fee $50.00/Hr SIGNED BY TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge $ .50 3 r C, MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST TOTAL FEE $ OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacina 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 () No The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and terminatidn. 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 ( ) 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 Fumice V6nting Tables for fan assisted and natural draft appliances. Yes () No( ) 19 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 ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input 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: Signed By: Date : City of Fridley Building Inspections Department 6431 Universitt- Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-5024977