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PRE 2010 DOCSFli, BITIMP-ING PEB3ff N? 2066 Village of Fr dley, Minn. Date. ........... ............... �!Buflder ............................................ Address •' ss iAddre......................................... LOCATION OF BUILDING No. Street ............ Part of Lot ....................... Lot .................. Block .................. Addition or'!Sub-Division ................ ...... 1. ................. Corner Lot ......... Inside Lot ............ Setback ............. Sideyard .... e..40W*f ...... DESCRIPTION OF BUILDING To be Used as: Front ,:pW.. Depth- %..4..Leight /..4r,00t.. Sq. Ft. ........ Cu. Ft........ . .................. Front ........ Depth ........ Ilelght ......... Sq. Ft......... Cu. Ft, ........ Type Of Constructio Fat Cost .............. To be Completed In Wd 'M6 '30' :or� of the issuance to me of a permit to construct the building described above, I agree to do ed the proposed work ordinances: of the, f accordance with the description above setoJorth and In cram 211ance with. all provisions of age of Fridley. consideratt ... ..... A of the payment of a fee of,$ ... permit Is hereby granted to to construct the buildift 6r addition as described above. IM permit is granted upon c ' c 'that the person to whom It is granted and his agents, employees and workmen, In all work done In, around =01 upon said building, or any part thereof, i shall conform in all respects to the ordinances of r4 'r'the eYv'M=age construction, n, alteration, maintenance, repair and moving of buildings with- in and this permit may, be revoked at any- time upon violation.0 any of the provisions of said ordinances. �e ding Inspector NOTICE: This perms does, not cover the construction, I nst4 I lation or alteration for wiring, plumbing, gas heating, sewer or water • Be-aura to see the Building Inspector for separate permits for these items. Fli, • City of Fridley, Minn. BUILDING PERMIT Date: - September 24, 1965 3e Ko 7 i N° 8484 Owner: Dorothy Larson Builder Kenneth J. Platt Address 41 - 58th Avenue N.H. Address 7001 West old Shakopee Road Mpls. 31 LOCATION OF BUILDING No. 641 Street 58th Avenue N.E. Part of Lot Lot - 5 _ Block 8 Addition or Sub -Division —Donnays Corner Lot _ Inside Lot Setback _ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: House Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. cu. Ft. Type of Construction Fast, Cost $2,000.00 To be Completed Repairs due to 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 cOmpliauc t with Zi ons Of ordinances Of the city of Fridley. 1/ i/ /% r ) �% In consideration of the payment of a fee of $ $1 ()- 00 , permit is hereby granted to K1:nnPth .1 Platt 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, Mitmceota regarding location, construction, alteration, maintenance, repair and moving of buildings city limits and this permit may be revoked at aqy time upon violation of any of the provisions of said • NOTICE: ihb pump don not emw the condnwflon, InshilkMan for wiring, pkmd&g, ga heating, ower or water. Be wn to an the Building hner for nparato permW for thea ft"M APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA LOCATION OF BUILDING -�� Street Part of Lot,, LOT K ADDITION OR SUBDIVISION Corner Lot Inside LOT Setback Side -yard . .SEWER ELEV'ATUM FOONDATI011 ELEVATio w 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 as; Front Det _Height Sq. Ft. Cu. Ft. Front Depth _Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost'//��'' To be completed 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 reprpsen-tations stated in this application are true and correct. �p..NGYYlC UL ruu Uoszs can De round on the Reverse Side). 0 -r .. - 0 JJ SUBJECT - City of Fridley 31730__ AT THE TOP OF THE TWINS BUILDING PERMIT r COMMUNITY DEVELOPMENT DIV. f PROTECTIVE INSPECTION SEC. 572-3604 1 � NUAABEA RE DATE PAGE O: APFROvED r = CITY HALL FRIDLEY 55132 612-571-3450 910-F15 4/6/01 JOB ADDRESS 641 58 Avenue NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 5 8 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Darlene Dowling 641 58 Avenue NE 763-572-1387 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 1 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install egress window in basement 9 CHANGE OF USE FROM TO STIPULATIONS Install to meet the State Egress 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 1 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 $700 $.50 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- $29.60 Firf SC $.70 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK E TO FEE 0.80 SURE/OFF CON .RAJCCT�OR OR ATNOR'ZED AGENT (DATES HE P VALI T THIS IS R RMI BAG -NSP 'r / t SIGNATURE OF OWNER OF OWNER BUILDER) iDATI NEW [ ] Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: _ [o �- �� Qin, Pr i'LI e.Z4 1>-) Legal Description: Owner Name & Address: b a r1g e. T>Lu Ij` ti ` Tel. # 76 3 - 5-7z 13 1 Contractor: MN LICENSE # Address: 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: C A Construction Type: Estimated Cost: $ -7 0 0 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$ DATE: L+ I lP I Q 1 APPLICANT: /,t l� Tel. # 2� 3 - % Z - 13 g CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee Fee Schedule on Reverse Side Fire Surcharge $ . 70 .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1150 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 [ ] 30.60 TOTAL $ STIPULATIONS: :ITY OF PRIDLEY INSPECT iON DIV. 431 University Ave NE 'ridley, MN 55432 163-572-3604 AouoP'­ K Urinal Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: NO. New F'nftures 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" Gas Dryer** Back Flow Preventer Required ( )Yes () Nc Type APPLICATION FOR PLUMBING AND GAS FITTING PERMIT FIXTURES TO BE INSTALLED ON EACH FLOOR wach Ec r�I * x Floor }' Auto. RATE TOTAL JOB ADD $7.00 $ 4.00 $ 5.00 $ 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 State Surcharge $ -50 TOTAL FEE 1*^ Effective On Jan 1. 2001 Gas rI Elec 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. t+-- LI - . 20_0 Owner Building Used As 2 l Estimated Cost PERMIT NO. PLUMBING COMPANY e 57 Z _ 3 n A - I - - COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, 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 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 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 ( ) 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 HEKI-ING CO: Signed By: Date: t� LZ I CIIYOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 March 29, 2002 Ms. Darlene Dowling 64158 Avenue NE Fridley, MN 55432 Re: Final Inspection at 64158 Avenue NE Contractor: Homeowner Dear Ms. Dowling: A plumbing permit was issued on April 6, 2001 to install three rough -in fixtures at your address. According to Section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the work authorized by this permit. As of this date the inspection has not been requested. The permit fee that was paid covers the inspection to make sure the work was completed according to the Codes. 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 inspection called for by homeowner after notification" 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. DJ/mh CITY OF FRIDLEY PERMIT NO.: 2004-0050612 ate? 6431 UNIVERSITY AVENUE NE I k'RWLEY, MN 55432 Lrii� iaavr.L: v+ii+«.vv� 572-3604 FAX: (763) 571-1287 ADDRESS : 641 58TH AVE NE PIN : 233024130062 LEGAL DESC DONNAYS LAKEVIEW MANOR ADD LOT 5 BLOCK 8 PERMIT TYPE ELECTRICAL PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. WIRE AIR CONDITIONER # INSPECTIONS 1 APPLICANT ASPEN AIR INC 308 15 ST SW STE 25 FOREST LAKE, MN 55025 OWNER DOWLING DARLENE M 11504 HEATHER ST NW COON RAPIDS, MN 55433 STATE SURCHARGE, ELEC FLAT 0.50 ELEC PERMIT FEE - MIN (RESI) 20.00 TOTAL 20.50 PAID WITH CHECK # 9673 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 regulating construction or the performance of construction. Applicant Date Bldg Insp Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. FA SUBJECT P City of Fridley 31796 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. `v ------COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 672-360/S (� � 3 40 NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 5/4/01 JOB ADDRESS 641 58 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ,5 8 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Darlene Dowling 641 58 Avenue NE 763-421-0907 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 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 ❑ ADDITION RZ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Finish two basement rooms 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED 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 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 @ $1.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,000 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $69.25, Fire SC $2.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE T ALFEE $72. SG RE OF CONTRACTOR OR AUTmoRiZEO AGENT (DATE, EN PR PERLY I TED THIS S YOUR PERMIT " SIGNATURE OF OWNER .-F OWNER Bw E , tOATE, SLOG o ATE FA NEW [ ] Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: �o ec 9 Legal Description: Owner Name & Address: r'1 e Tel. # '763 -- Ll LI 4 —67 Contractor: 0 w r- MN LICENSE # Address: 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: -� V0 p, K 2- ` 3c: 1' e vn -t roe .,,, s Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ 2 1 C-0 DATE: ! `ky , APPLICANT: DCa-2 e--, & l)' U L�- Tel. # 169 -q-2—( 9 7 CITY USE ONLY - Call (76/3) 572-3604 for Permit Fees If mailing in application O Permit Fee $ -ZS Fee Schedule on Reverse Side Fire Surcharge $ OD .001 of Permit Valuation (1/10th%) State Surcharge $ /,00 $.50/$1,000 Valuation SAC Charge $ $1150 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 $ ,?• c�� STIPULATIONS: r CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 763) 572-3604 FAX: (763) 571-1287 ADDRESS 641 58TH AVE NE PIN 233024130062 LEGAL DESC DONNAYS LAKEVIEW MANOR ADD LOT 5 BLOCK 8 PERMIT TYPE HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-00486 DATE ISSUED: 04/13/2004 VALUATION : $ 7,495.00 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 FURNACE (WARM AIR, CARRIER, 60,000) AIR CONDITIONER AND UNIT HEATER. INVESTIGATION FEE PAID. # A/C UNITS 1 ENTER FEE AMOUNT 95 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 APPLICANT ASPEN AIR INC 308 15 ST SW STE 25 FOREST LAKE, MN 55025 OWNER DOWLING DARLENE M 11504 HEATHER ST NW COON RAPIDS, MN 55433 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 constru tion or the performance of construction. Anuli i fig N Date Bldg Insp HEATING PERMIT MINIMUM FEE 0.00 FURNACE SHELL/DUCT WORK 60.00 GAS PIPING FEE 10.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 25.00 STATE SURCHARGE, MECH FLAT 0.50 FEE SHORTAGE AMOUNT 95.00 TOTAL 190.50 PAID WITH CHECK # 9596 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CIiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 TO: COVER SHEET FROM: Inspection Division, City of Fridley, 763-572-3604 Ron Julkowski, Building Official Dave Jensen, Building Inspector Mary Hintz, Permit Technician CONTRACT INSPECTORS: Bob Clauson, Electrical Inspector Kevin Hanson, Mechanical Inspector Terry Overacker, Plumbing Inspector DATE: Page 1 of NOTE: Please call if all pages have not been properly received. _,N Y`OF FRIDLEY INSPECTION DIVISION Il University Ave NE m ley, MN 55432 APPLICATION FOR DOWER PLANTS AND HEATING, COOLING, VENTILATION, 3) 572.3604 REFRIGERATION AND AIR CONDITIONING -SYSTEMS AND DEVICES m a : (763) 571-1287 DATE SCHEDULE M ' inv sidential Rate TOTAL nnace Sheil and Duct Work, Burnell LA Furnace «" $ 30.00 so Replacement �/� Out Back)ll�'wr— (Side Vent - Fill as Piping (Needed with new furnace, $ 10.00 $I,LL but not replacement) as Range $ 10.00 $ O as Dryer $ 10.00 $ tir Conditioning . All Sizes $ 25.00 .11 Others/Repairs & Alterations (LIST ON BACK) 1%, of Value of Appliance or Work $ } immercial/Industrial Effective January. 1, 2004 JOB ADDRESS t"g/ �� A29 s4l3-a BUILDING USED AS Q eS i`A&a c 9 ESTIMATED COS Tr -r--tom PERMIT N0. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units q- Circle One (Steam) (Not Water) arm Air) Trade Name Size No. D3oA-1or34 BTU Cam/yoo / -D{oo�1P EDR Fuel T Total Connected Load Burner Trade Name Size No. BTU HP EDR A.25% of Value of Appliance or Work $ 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 uU- State Surcharge .50 rulings of the Building Division, and hereby declares that all the facts and U- 0 �, e� representations stated in this application are true and correct. TOTAL FEE $ LNIMUM FEE FOR ANY HEATING/COOLING/VENTILATIONHEATING CO U EFRIGERATION/AIR CONDITIONING PERMIT IS S25 QO J LUS THE 2,50 STATE SURCHARGE it,i z�� Signed DATE 3— — /2 -- D4- -.. . TEL tf "-7 -q --, - 4(ad , FAX # (0 5 s7 8 - ! ) ElNSPECTION FEE $47.00/Hr v kir Conditioners can not be placed in a side yard without Approved By Rough -In Date' Final Date - ritten permission from adjoining property owner. �, ELL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE MAR -15-2004 09:43 FROM CITY OF FRIDLEY TO 6519825911 P.02i02 THE BELOW MUST Be FILLED IN WHLN KW-LAtdNts 1-uLL nurcivilva ftrrrUtur-r_a mart r no APPLICATION WILL BE RETURNED When 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-V/.iNo The venting system is plastidPVC and meets all current codes and manufacturer specal`imtions including sizing, length, number of elbows and termination. Yes t/No ( ) The'undemigned aWo verifies that the replacement unit is a listed assembly and meets the cunw t codes and manufacturer's specifications, This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. YesWfNo ( ) The is sized and installed to meet the current codes and manufacturer's specifications. Yes () No (' y✓ V*m required to Inalnlllnn+hu.flan a,� it will be sized and installed to meet the current codes and manufacturers specifications. Yes Wto ( ) VWM n now Wopn aSsipmP the undersigned hereby verifies that I is a listed assembly and meets the Current codes and manufaMnes spa6orls. This does Include AGA -LAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances, Yes "-*0 ( ) 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 amend odes. Yes f- 0 (: ) ApWi2nGg Igga and _ i m-M-nmmnn Vant and V -nt Ce na tnr Inf rmatian ApRtrance 01 Type?`����� A�, BTU Inpu' _ Fan Assisted or Net Appb= #2 Type,,, BTU input _ Fan Assisted or Nat AppPratice #3 Type _ BTU Inpt _ _ Fan Assisted or Nat Teal Appliances _ Total Btu Input_ Common Vent Type' Vent Height Diameter inches ApplTatrce #1 Vent Connector Height ft Length ft Diameter in Type Applfarm #l2 Vat Corrector Height ft Length ft Diameter in Type Applies #3 Vent Connector Height ft Length ft Diameter in Type HEATING CO: Signed Bir. / ,Q— Date: 7 "_ 3/ - D V TOTAL P.02 Llt-l SYS Building $ e S BUILDING Permit No.:.) Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By: 763-572-3604 Surcharge CITY OF FRIDLEY Date Rec' 763-502-4977 FAX $ $5.00 (State Licensed Residential Contractors) SAC Charge $ EFFECTIVE 1-1-08 Curb Cut Escrow —1 cL— ft + 6 ft = ft x $21 = $ Erosion Control DATE — YOUR E-MAIL ADDRESS Park Fee SITE ADDRESS CONI Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) THIS APPLICANT IS: ❑ OWNER JUCONTRACTOR $ 'R !01 PROPERTY OWNER/ NAME: OIC- �l ADDRESS: CITY C-, 1 STATE M-1. ZIP— TENANT ' 1 PHONE: PHONE: o - L,a `— d10-1 NAME: r �= ADDRESS: 04-711 1`oI51� A\)c-� CITY J C.i