PRE 2010 DOCS52-84-5915.51
City of Fridley
APPECONQU nor Numbing and Gas vlimn g Peum a$
Dept. of Bldgs. Phone 560-3450
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures Location 655 N E 59th Ave
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Base
1st
1
2nd
3rd
4th
_
• Future Connection Openings
Connected with
* New Fixture, Old Openings
Bower
Cesspool El
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures .....................
Future Fixture Opening ................
New Fixture Old Opening ..............
Catch Basin ... .....................
Water Heater (Up to BTU) ......
New Ground Run Old Bldg. ........... .
Electric Water Heater
GAS FITTING FEES:
x SIO $ 82'900
x. $ $1.50
x $ $1.50
x 3.25 $
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 true and correct
6 5
Fridley, Minn -67 19_
Owner Jas Stande
Kind of Building frame
Used as
res
To be completed about A-12-67
Estimated Cost, $ 10.00
Old—New. Building Permit No Permit No.
- .
By
Business Phone No
— x 220 $ #3.00
— x 3.25 $ ROUGH
$2.00 FINAL,
NO. RATE TOTAL
1st 3 Fixtures .......................... x $ bd&$ $2.00
Additional Fixtures ...n.(n� ................ x C $ .75
$'Pi.T
Gas Range to .............. 1 x
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $� ° as
`7-8),41051 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Job Address 655 .59 Ave. NE
Department of Buildings
City of Fridley i
Tel. 0571-3450
The undersigned hereby makes application lora permit for the work hei
specified agreeing -to do all work in strict accordance with the City Coy
and rulings of the Department of Buildings, and hereby declares that al
the facts and representations stated in this application are true anal a
Fridley, mi. 7-1 ?-77 , 19_
OWNER CL! R.ENCE, TNUNBERG
KIND OF BUILDING frame
USED AS res.
6 .
TO BE COMPLETED ABOUT
PARTIAL RATE
SCHEDULE
a
i
PLUMBING FIXTURE RATES:
u
.
-1i
e
°h
water
Nu:-.ber Fixtures
x
$3.00
$
Future Fixture Opening •
3i
$2.00
$
Company
w
Heater
w
J
C
$2.00S
5lgned By'
Catch Basin,
x
$5.00
8
..,
t Water Heater - to 990000 BTU,
x
$5.00
$
Tel. No. ,
100;000 BTU to 199,000 BTU
^�
x
$10.00
$ __
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K $
ROUGH INSP.
"
o
as
• lea
Electric Water Heater
�_ x
$5.00
$
GAS FITTING FEES: ,'
FINAL INSP.
�J
Date
1st 3 fixtures
x
$3.00
$
Additional Fixtures
�- x
$1.00
$ _-
.Gas Range to 199,000 BTU
x
$10.00
$
APPROVAL FOR PERMIT
1st
�
tad
3rd
4th
(R) - Future Connection Opening
Connected with Sewer
(•) - 11ow Fixture, Old Opening
Water
Job Address 655 .59 Ave. NE
Department of Buildings
City of Fridley i
Tel. 0571-3450
The undersigned hereby makes application lora permit for the work hei
specified agreeing -to do all work in strict accordance with the City Coy
and rulings of the Department of Buildings, and hereby declares that al
the facts and representations stated in this application are true anal a
Fridley, mi. 7-1 ?-77 , 19_
OWNER CL! R.ENCE, TNUNBERG
KIND OF BUILDING frame
USED AS res.
6 .
REPAIRS $ ALTERATIONS
First $100.00
each add. $100.00 or fraction
State Surcharge
TOTAL FEE
REINSPECTION FEE
$5.00 $
$1.00 $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50
$ _50
$ 8.00CIass "A" Surcharge .500. .
TO BE COMPLETED ABOUT
PARTIAL RATE
SCHEDULE
ESTIMATED COST 10,00
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
y
OLD - NEW BUILDING PERMIT N0. PEMIT N0. csb
Nu:-.ber Fixtures
x
$3.00
$
Future Fixture Opening •
3i
$2.00
$
Company
_-
� SCO
Now Fixture, Old Opening
x
$2.00S
5lgned By'
Catch Basin,
x
$5.00
$
t Water Heater - to 990000 BTU,
x
$5.00
$
Tel. No. ,
100;000 BTU to 199,000 BTU
^�
x
$10.00
$ __
Water Softener
x
$7.90
$
New Ground Run Old Building
x
$5.00
$
ROUGH INSP.
.
.
Data .
Electric Water Heater
�_ x
$5.00
$
GAS FITTING FEES: ,'
FINAL INSP.
Date
1st 3 fixtures
x
$3.00
$
Additional Fixtures
�- x
$1.00
$ _-
.Gas Range to 199,000 BTU
x
$10.00
$
APPROVAL FOR PERMIT
REPAIRS $ ALTERATIONS
First $100.00
each add. $100.00 or fraction
State Surcharge
TOTAL FEE
REINSPECTION FEE
$5.00 $
$1.00 $ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50
$ _50
$ 8.00CIass "A" Surcharge .500. .
CITY 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 CONDITIONING SYSTEMS AND DEVICES
FAX (763) 571-1287
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
rcp/--4�
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
10/. of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Effective January 1, 2003
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
$ 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
$ .50 rulings of the Building Division, and hereby declares that all the facts and
$ SL representations stated in this application are true and correct.
DATE -.;I. -
HEATING CO
Signed
FAX #
*Air Conditioners can not be placed in a side yard without Approved By,
written permission from adjoining property owner 0J., �'
AFILL OUT BACK SII
Ae
�. Aw F/
�a
O3_5c v AW
%d -
TEL #
Rough -in Date Final Date /
JOB ADDRESS
OWNER S ✓ :2 e_/"5
Rate
TOTAL
�c
BUILDING USED AS -5.
$ 30.00
$
ESTIMATED COST PERMIT NO. �� 7
$ 10.00
$
DESCRIPTION OF FURNACE AND OR BURNER
$ 10.00
$
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
$ 10.00
$
Trade Name ezl : Z?(,- Size No.
BTU c► HP EDR
$ 25.00
$
Fuel Total Connected Load
Burner Trade Name Size No.
$
BTU HP EDR
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
$ 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
$ .50 rulings of the Building Division, and hereby declares that all the facts and
$ SL representations stated in this application are true and correct.
DATE -.;I. -
HEATING CO
Signed
FAX #
*Air Conditioners can not be placed in a side yard without Approved By,
written permission from adjoining property owner 0J., �'
AFILL OUT BACK SII
Ae
�. Aw F/
�a
O3_5c v AW
%d -
TEL #
Rough -in Date Final Date /
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
RIECAIM
mmmnN .,T Vr=uT nnl►IAIC^T/1R AN COMB ISTIO
WhennqgaWnga axicting, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions, Yes (i No ( )
and is securely supported and firestopped where required.
The venting system is plastiGPVC and meets all current codes and manufacturer Yes 1 No( )
specifications including sizing, length, number of elbows and termination.
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's Furnace Vent nspecifications.
Tables for fan
include AGA -LAMA Category I CentralYes () No ( )
assisted and natural draft appliances.
The mWiM rnmha antinn air is sized and installed to meet the current codes Yes( No( )
and manufacturer's specifications.
When required to inetau a j3 w emb adpn air_ it will be sized and installed
Yes( No ( )
to meet the current codes and manufacturer's specifications.
)
When installiD , 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 Yes( ) No( )
Venting Tables for fan assisted and natural draft appliances.
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented Yes( )No(
)
separately as per current codes.
Aenl-, ca ne a
.,,; ci�p/r�nmmn^ ���^t and Vena r'^^necter Infntmatl�ll
Appliance #1 Type BTU Input Fan Assisted or Nat
BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type Total Btu Input
Total Appliances
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height
_ft Length..
Diameter
ft Diameter
in Type
in Type
Appliance #2 Vent Connector Height
= Length
ft Length
ft Diameter
in Type
Appliance #3 Vent Connector Height
_
HEATING CO:
Date
Signed By: