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If c� City of Fridley Applicatim for Plowing sed cap Fh1bq Pemb - Dept. of Ridge. Phone 560-3490 DESCRIPTION OF WORE Number, Kind and Location of Fixtures --,T • Future Connection OpeningsI c;onaersea IF= Sewer * New Fixture, Old Openings Cesspool F1 PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL _ -_- $ ' Number Fixtures ................ x 200 $ z® Future Fixture Opening ........... x $1.60 $ _ New Fixture Old Opening .......... . x $1.50 $ Catch Basin .................... x $3.25 $ Water Heater :Up to 89,000 BTU) .... �_ x $3.00 $ New Ground Run Old Bldg. ........ x $3.26 $ Electric Water Heater ............. x $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures • • .. �►- 'x $2.00 $ Additional) ::... .. x $ .75 $ Gas Range to 198, BTU . x $6.00 $ REPAIRS R ALTERATIONS—Refer to Code Description ............................................. TOTAL FEE C3 City of Fridley: The .undersigned hereby makes application for a permit for the- work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are tr a and correct blian2 Owner Kind of Build7v-,e- �/��'�''� Used as6i �Z To be completed about i Z s ` S csC' Estimated Cost, $ Old—New. Building Permit ROUGH Business Phune Permit N 7 g I N WATER W". GAS ELEC. Base t f 1st / 2nd 3rd 4th • Future Connection OpeningsI c;onaersea IF= Sewer * New Fixture, Old Openings Cesspool F1 PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL _ -_- $ ' Number Fixtures ................ x 200 $ z® Future Fixture Opening ........... x $1.60 $ _ New Fixture Old Opening .......... . x $1.50 $ Catch Basin .................... x $3.25 $ Water Heater :Up to 89,000 BTU) .... �_ x $3.00 $ New Ground Run Old Bldg. ........ x $3.26 $ Electric Water Heater ............. x $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures • • .. �►- 'x $2.00 $ Additional) ::... .. x $ .75 $ Gas Range to 198, BTU . x $6.00 $ REPAIRS R ALTERATIONS—Refer to Code Description ............................................. TOTAL FEE C3 City of Fridley: The .undersigned hereby makes application for a permit for the- work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are tr a and correct blian2 Owner Kind of Build7v-,e- �/��'�''� Used as6i �Z To be completed about i Z s ` S csC' Estimated Cost, $ Old—New. Building Permit ROUGH Business Phune Permit N -111114-wall Ceillt g Moor '. Total Btu. or sq. ins. W.A. Leader arca Infiltration [ �j Gh" a Fsp. wall Net exp. wall Int. waU Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FLI Room I LengthWidth Windows and Doors—Craeluge and Area Infiltration Glaze Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. ED.R. or sq. itis. W.A. Leader area FLI Roam I Length Width Windows and Doors—Craekage and Area Widlh •I<Sht Na at Lineal lt. Area Na _ot ptba of pan• Ilrhta of crack ea. ft - Gla" W. wall Net exp. wall Int. wall ICeiling FIoor® Total Btu. Rtq .,red sq. ft. E.D.R. or sq. ins. WA. Leader area ta. Btu ■ �c, 66 illd LOSS CALCULATIONS DEPARTMENT OF BUILDINGS VILLAGE OF Weatherstrips A .V VZ Gui Construction No. Insulation Windows Doors Reference Out. Waq Int. Wall I Ceding Roof Floor Kind How Applied Yea— o a 19_ YevW / FI•1 Room Length 12 dth HeightFl.) - m Length Width Q Heisht S Win owa and Doors—Crachage a a Windows and Doors—Craeltage and Area Width Height No. o[ LI Pal t . Ana No. of pane of pane Vigo! of crack , IL 1 Width- Na of pa • tv� He1tht No. of Lineal k q i of vane Ilabu of crack p. V I , .1A -111114-wall Ceillt g Moor '. Total Btu. or sq. ins. W.A. Leader arca Infiltration [ �j Gh" a Fsp. wall Net exp. wall Int. waU Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FLI Room I LengthWidth Windows and Doors—Craeluge and Area Infiltration Glaze Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. ED.R. or sq. itis. W.A. Leader area FLI Roam I Length Width Windows and Doors—Craekage and Area Widlh •I<Sht Na at Lineal lt. Area Na _ot ptba of pan• Ilrhta of crack ea. ft - Gla" W. wall Net exp. wall Int. wall ICeiling FIoor® Total Btu. Rtq .,red sq. ft. E.D.R. or sq. ins. WA. Leader area ta. Btu ■ / es4ieA hr Ceaw& Ventgolion. Retdge ofto ®d Air Caotkknkg Symm mW Devices PARTIAL RATE SCHEDULE C MV -r Y WARM AIR: RATE TOTAL Furnace shell & Duct Work ... .... .$10.00 S} Replacement of Furnace 6.00 $ Repairs & Alterations—up to $W.00 &00 Repairs & Alterations each add. $500.00 3 00_ MECIIL WARN AM e j Furnace Shell & Duct Work to 120,000 BTU $10.00 each add 60.000 ETU .. ...... 3. W i RepluemeW of Furnace 6.00 Repairs & Alterations—up to SM.00 6.00— Repairs & Alterations each add. :500.00 3.00 _ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. F.DR Steam $10.00 $ Furnace Shell & Line --to 640 sq. ft. EDR Hot Water 10.00 $_ Each add. 20+) sq. ft. EDR Steam xon $ Each add. 320 sq. ft. EDR Hot Water 3.00 $_ OIL BURNER—to 3 gaL per hour 6.00 over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199JU BTU) 600 = S over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 3 st 3 Fixtures �_ xE Zoo E —_ b Additional Fixtures x .76 f -- Gas Range too IMAM Ns 6.00, i F1Fllii. /i -s- 7 � Foe schedule TOTAL Fm I I� Dept. of Bldva. Phosm 560.3490 Leceues � v� — S-7 Oi9e e 9 City of Fridley: The undersigned hereby makes application for a permit for the work hereW specified, agreeing to do all work in strict accordance with the City Ordbiancev and ruling of the Department of Buildings, and hereby declares that all the fact€ and representations stated in this application are true a7ect Fridl y, Minn—__27y,19 5e Chvner _Aj Ida S Kind of Building Used as— To be completed about ___ � Z — IS-- 79 Estimated Cost, E Old Ne Building Permit No. _— Permit No. /S DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Not Water. arm Atr— o Trade Name i size Capacity---_ — Sq. Ft. E.D.R e'oe) BTU g, ✓1� R,_ Total Connected Load wlo "� �LJ Rind of ftal ,p `1'x` 6 e -f BURNER — Trade Name Size 1tTo Capacity Sq. FL ED R BTV IS_ 1 560-3450 �..e�t o ��icl�ec t ANOKA COUNTY 6431 UNIVERSITY AVENUE NE October 25, 1974 FRIDLEY, MINNESOTA 55421 North Metro Construction, Inc. 5203 Central Avenue N.E. Minneapolis, Minnesota 55421 Re: Change of House Numbers Dear It has been necessary for this office to change the address of your house •FROM 452 - 57th Place N.E. TO 450 - 57th Place N.E. LEGAL DESCRIPTION Lots 9 & 10, Block 5, City View Addition Ile 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, a��M-Q DARREL G. CLARK Community Development Adm. DGC/mh 560-3450 ci�y ® grictlecy . ANOKA COUNTY 6431 UNIVERSITY AVENUE NE October 25, 1974 FRIDLEY. MINNESOTA ti 432 Minneapolis Post Office Department -Superintendent of Delivery lst & Marquette Avenue Minneapolis, Minnesota 55402 Re: Change of Address City of Fridley Gentlemen: We are listing the following change of address in the City of Fridley; • NAME: North Metro Construction, Inc. FROM: 452 - 57th Place N.E., Fridley., Minn. TO: 450 - 57th Place N.E., Fridley, Minn. LEGAL DESCRIPTION: Lots 9, 10, Block 5,.city View Addition We have notified the occupant of this change and we would appreciate it very much if you would change your records accordingly. Sincerely, C�Lz DARREL G. CLARK Community Development Adm. DGC/mh CC: City Water Billing Dept. City Assessing Department Minneapolis Gas Company - Brooklyn Park Office Northern States Power Company Northwestern Bell Telephone City Voters Registration Homeowner City of Fridley SUBJECT rEO. 1269 AT THE TOP OF THE TWINS PERMIT r ` BUILDING CEIPT N COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. -� 1 /---< CITY HALL FRIDLEY 55432 IL ik" ,`J NUMBER REV. DATE PAGE OF APPROVED BY .... 612-560-3450 910-F15 8/23/74 / JOB ADDRESSD 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 City View Addition SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE North Metro Construction, Inc. 5203 Central Avenue N.E, 3 CONTRACTOR MAILADDRESS 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 X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 36' x 24' Dwelling and a 20' x 22' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before caPPang• SEWER LOCATION: "Y" 7' West of Manhole "Y" Elev: 838.20 - Manhole Inv. Elev: 838.48 WATER LOCATION: 8' West of Manhole SEPERATE PERMITS- REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS. 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 864 21,680 TO ta 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 COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT e� 00 $20,962 10.48 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. $41.00 $300.00 PLAN CHECK FEE TOTALFEE 1.48 IGNATURE OF CONTRACTOR OR AUT IZEDA T (DATE) WH PROPERLY VALIDATE T IS YOU6 P61RMIT 71 �7✓�.��, 7 y FSI NATURE OF OWNER IIF OWNER BUILDER) IDATEI BLDG INSP BATE APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA 43 OWNER'S NAME . -Wo r kj-//f1C1?z1 e^5 i LER : 511 ADDRESS ADDRESS: NO:. STREET: LOT: BLOCK: ADDITION• C� i CORNER LOT: INSIDE LOT: ETBACK : Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used An: �. �Front: Depth: ol Height: 5A44 6; Square Feet: d Cubic Feet: + )L u r L r t f- Front: o� d Depth: cP— Height: Square Feet; Cubic Feet:. Type of Construction: !000 to r q'Pklti-Estimated Cost: , $ To Be Completed: Z2 —�✓�'"7 The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stf ict accordance with. the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representatio1►sstated ap is o are true and correct. ./�j DATE : 7 *4 SIGNATURE : � ` a (See Reverse Side For Additional Info eo _t � -` k/ NJ -- A CODE B. H. BRADLEY CIVIL ENGWKSR AND SURVEVOR 3829 -24TH AVENUE SOUTH MINNKAPM16. MINNESOTA 5UN 724-2,09 1 �vr�rty �or ,�en�e`s ,��'rrrer Ce J1 57 f" Ple-►e e �. t©` 57Mo4ue. X.E. Sc a pro' • Oehoto pro perry coNorers n ro v .4 � m � V � � lb -s 1 40 1 r 10 ,a. r N N Q � s Q � s Q r e t (T r SUBJECT City of Fridley 26548 THE TOP OF THE TWINS BUILDING PERMIT Ir?AT ` RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. /141 r 1 N�BERREV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 7-10-98 JOB ADDRESS 450 57th Place 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9,10 5 City View Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Sandy Joswiak 572-1979 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Scott Construction, 5545 Knoll Dr, Shoreview, 55126 780-4800 20131822 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 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Re-Roof (20 Sq) shingles 6 feet Ice & Water 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with 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 BO 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 $13668 $.83 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- $54.00 Fire SC $1.66 STRUCT N OR THE PERFORMANfiE OF CONSTRUCTION. 1 PIAN CHECK FEE TOTA FEE License $5. $ 1.49 SIGNATURE OF CONTRAC AUTHORIZED AGENT IDATEI WH OP RLY A DATED NIS IS YOUR PE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI BC,IG IN ',A T16 NEW [ ADDN [ ]/ ALTER [✓j ConstructionAddress: CITY.OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1/1/98 Legal Description: Owner Name & Address: S �� u0 5 is Tel. #j c1 ci Contractor. MN LICENSE # oZ © 13 Address:E_�S`+S 4L�e c� �%c�fe �W i� .� 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: cR + �J - e�-�. TV1 Construction Type: 6 o Estimated Cost: $ r (Fee Schedule. on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: o Tel. #790 -'-f 6 d CITY USE ONLY Permit Fee $ SV, 61D Fee Schedule on Reverse Side Fire Surcharge $ 6 .001 of Permit Valuation (1/10th%) State Surcharge $ A3 $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ g 00 $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 [ J Not Necessary [ J TOTAL $ 6. �0 l STIPULATIONS: SuBjECT PER City of Fridley 2 8 94 0 AT THE TOP OF THE TWINS BUILDING PERMIT r R . � `v ______ COMMUNITY DEVELOPMENT DIV. SEC. r PROTECTIVE INSPECTION (J�/ 1 � = I 1 CITY HALL FRIDLEY 35432 '•j NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 2/25/99 JOB ADDRESS 450 57 Place NE / LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 9,10 5 City View Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Sandy Joswik 450 57 Place NE 572-1979 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO D M TRANBY SIDING 9131 178 Ave NW, Ramsey, MN 55303 441-6399 3889 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 J3 REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reside House 9 CHANGE OF USE FROM TO STIPULATIONS Call for building wrap inspection before covering. 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 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 COMPLIED $2.25 WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT $4,500 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIO OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- Fire SC 4.50 STRUCTI N R THE PERF STRUCTION $99.75 PLAN CHECK FEE TOTAL FE �AlRE Licens C $5.00 $ .50 OF CO 'RAC R OR AUTHORIZED AGENT IDATEI N P OP LIDATE T IS YOUR PERMIT BLD INSP -�s ZZ �IAtE S-GNATURE OF OWNER,IF OWNER BUILDERI (DATE, NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress:�— Effective 1/1/99 Legal Description: Tel. # -5�a _ Owner Name k Address: 'SLA -L-4 Contractor: P /'1/t 7`"%q /V -o' x 5, d r "V MN LICENSE Address: 3% - /-�7 f `a'"".o 1��'� a 3 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: Construction Type:�T 1_') J � L Estimated Cost: $ ��y (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: r APPLICANT: Tel. # STIPULATIONS: /)/ S-15 CITY USE ONLY Permit Fee $ , %� Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1 / 10th %) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ OU $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 $ (Z) STIPULATIONS: /)/ S-15 CITY OF FRIDLEY INSPECTION DIV, 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT '2 '5 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB New Fixtures 3 $10.00 _30.,o6 Old Opening, New Fixture $10.00 Beer Dispenser $10.00 Blow Off Basin $10.00 Catch Basin $10.00 Rain Water Leader $10.00 Sump/Receiving Tank $10.00 Water Treating Appliance $35.00 Water Heater -Electric $35.00 Water Heater - Gas** $35.00 Gas Range" $10.00 Gas Dryer*" $10.00 Back Flow Preventer Required ( )Yes () No Type $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance - z State Surcharge $ .50 TOTAL FEE $13 /� ,�v . JAL 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. DATE: --mor, Cor, I OWNER S n 4� JC'S C) C� BUILDING USED AS 1 irl <Y1 ESTIMATED COST PLUMBING SIGNED Approved By 20 G • TEL N0. bS ,- (9 -) 5 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 i FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existina 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 in6talled 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 Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) 15 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( ) ADDliance TVDe 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 :