PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
•
Date: OCTOBER 18, 1966
Owner: _ Builder
Address Address
•
•
No. 160 Street
DREW SCHERER
3se/7,
N° 9059
6525 - 2nd. St. N. E.
Fridley, Minnesota 55432
LOCATION OF BUILDING
62nd Way N. E. ___ Part of Lot
Lot _ 5 —_– Block 1 Addition or Sub -Division ___.._ POTASEK' S ADDITION
Corner Lot _ Inside Lot . _ X Setback Sideyard --
Sewer Elevation ___ 821.80 _—�MUM& Elevation 824.80
TOP OF FOOTING
To be Used as:
DWELLING Front 42
ATT. GARAGE r,,,,,,i. 20
Type of Construction
DESCRIPTION OF BUILDING
Depth .._?4 Height
Depth ____22 Height
—Est. Cost $20,000
SEWER LOCATION - 48' East of Manhole
WATER - NEEDS TAPPING
20 Sq. Ft. 1,008 Cu. Ft 20,160
10 Sq Ft. ____ 440 cu. Ft. 4,40
__ To be Completed
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\t\ fa
ordinances of the city of Fridley. \ v I,h andn compliance with all provisions of
REEKED= —
In consideration of the payment of a fee of $ 25.00 , permit is hereby granted to—
DREW L. SCHERER 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 anypart thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota reg location, construction, alteration, maintenance, repair and moving of
limits buildings
within the city mits ands permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
CLARENCE BELISLE Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, sae heating, sewer or water. Be sen to see
the Building Inspector for separate permits for those hems.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME BUILDER
ADDRESS ADDRESS
LOCATION OF BUILDING
N0STREET-�� 6tJ LOT
LOT BLOCK / ADDITION OR SUB SION
CORNER LOT INSIDE LOT ,� SETBACK SIDE -YARD
SEWER ELEVATION FOUNDATION ELEVATION
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; a
To be completed
(Height
Cu. Ft. 1_1�� 6
Depth Height.,---,'�
Cu. Ft. 0
Cost a e 0
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.
DATE ��' SIGNATURE Cid
(Schedule of Fee Costs can be found on the Reverse Side).
,3 V,-1 �7.3
City of Fridley, Minn. ° 9207
BUILDING PERMIT
• Date: April 28, 1967
Owner, —xRft Drew Scherer Builder A.B.C. Blacktop Co.
Address 6525 2nd S t . N. E. _ Address 1308 Main S t . N. E
No. 160
Lot 5
Corner Lot ---
Sewer Elevation
To be Used as:
LOCATION OF BUILDING
Street — 6 2nd Way _ Part of Lot —
Block 1 Addition or Sub -Division ._ Potasek
Inside Lot — Setback --_ Sideyard _
_-- Foundation Elevation
DESCRIPTION OF BUILDING
Front _ Depth _ _ _ _ Height _ _ Sq. Ft. Cu. Ft --
Front Depth __ _ Height Sq. Ft _— Cu. Ft
Type of Construction Asphalt Drivewaxst Cost_.$166.00 To be Completed May 1, 1967
3" Class 5 Stabilizer Minimum
• 2" Mat
•
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 let forte and compliance with all provisions of
ordinances of the city of Fridley.
Inconsideration of the payment of a fee of $--L-0" _._..__., permit is hereby granted to....._..A .B . C.
Blacktop Co. 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, constructaton, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
CLARENCE BELISLE
Building Inspector
NOTICE:
This perni t does not cover the construction, insuft"on for wlring, plumbino, gas hosting, sower or water. Be sun to No
the Building Inspector for separate permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME P k E(,) S G H , 1� t l� BUILDER A, A ; C • &AC A7LI p C, o
ADDRESS S - �) -Azj3 S%-� fU + f • ADDRESS /30,Y- /))fiend STI N .6 .
LOCATION OF BUILDING
NO. STREET PART OF LOT
LOT BLOCK i ADDITION OR SUBDIVISIONG'�z
CORNER LOT INSIDE LOT SETBACK SIDE -YARD
SEWER ELEVATION TOP OF FOOTING
Applicant attach to this form two certificates of survey of lot and proposed
building location drawn on these two certificates.
To be Used as:
DESCIPTION OF BUILDING
Front Depth
Sq. Ft.
Front
Depth
Height
Cu. Ft.
Height_
Sq. Ft. Cu. Ft.
Type of Construction Asp-, az7- !� //,),ec7 yVA-VEstimated Cost // /.1
To Be Completed K eS 0A,4-1
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 ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
DATE ,%, �,��! ) 2, 1q4,2 _SIGNATURE /
(Schedule of Fee Costs can be foundthe Reverse Side).
xf
i'l A 't"i
Application for Power Plants and Healing. Cooling, Ventilation. Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ........................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ v
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. IDR Steam ..
.. 8.00
$
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water
.. 8.00
$
Each add. 200 sq. ft. EDR Steam ......................
2.50
$
Each add. 320 sq. ft. EDR Hot Water ..................
2.50
$
OIL BURNER—to 3 gal, per hour . .....................
5.00
$
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU)
5.00
�✓' �"�
.......................
1
$
GAS FITTING FEES:
NO RATE TOTAL
1st 3 Fixtures ......................
x $1.50
$—Z—I=
Additional Fixtures . .............
x .50
$
Gas Range to 200,000 BTU ...........
x 2.00
$
AIR CONDITIONING
$
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS TOTAL FEE
ROUGH
FINAL
Dept. of Bldgs. Phone SU 4-7470
Location 0 eclAng/// • � a
City of Fridley:
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.
Fridley, Minn_ 19
P
Owner a e,,,
Kind of Building v�
s
Used as
To be completed about
Estimated Cost,
Old �uilding Permit No. Permit No. -3
DESCRIPTION OF WORK
HEATING or POWER PLANTS -Steam, Hot Wa Warm Air No -
Trade Name e" -7 cs X Size No G M-//0
Capacity ` � qq. Ft. E.D.R BTU //++H.P.
Total Connected Load �?�•� Kind of Fuel &d`�Ca�S'
BURNER — Trade Name 1- A'% /2 o_x Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVER)
Aon
-,® -
Signed- -=
HEATING AND AIR CONDITIONING ImG.
By
920-3800
X42 2M Business Phone No
I / r
Total Btu.
Required sq. ft. E.D.R. or sq. ins.' W.A. Leader area
Infiltration
Glass'
Exp. wall
Net exp. wall'
Int. wall
Ceiling jr
Total Btu.
Required sq. ft. ED.R. or sq. iris. WA. Leader area
I
FljqPRRoom I Lengt . Wild
Windows and Door*--•Crackage and Area
Width I Height No. o[ Wnaal [t. Area
No. of Dane of Wane Ila
hts of crack aq. [t
G
6
Y
Coef. Bta
Infiltration s
Glassor -
Exp. wan
Net exp. wall . F
Int. wall
Ceiling ��q 7
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader arra d �A
f.
$tu
Coe
Infiltration
...
Glass A
Exp. wall
;"LLS.
T LOSS CALCULATIONS
DEPARTMENT OF BUILDINGS
r, t `d /e MINK.
W atherstrt
Int. wall `
Ceiling
Floor
Construction No.
Ceiling P�
Floor N .�
Total Btu.
Total Btu.
Insulation
Guide
Fl liR� Room Length .-&, Width/0 14sighr,
FI.b Room I LenjA 0 Width
Windows and Doors—Cracka0 and Area
Wldlh Helght No. of ILlnaal ft. Arca
No. of Dane of Dane Ilghu of cr ok p. ft.
Ceiling
indows oors
Reference
Out. Wan
Int. Wall Ceiling
Roof
Kind How Applied
Y — o s—No
19_r:._Fl.
FFoor
WA, Leader area
Room. Length Wid
-� sigh �"
Fl.Ir
Room Len With Haig
Windows and Doors —Cracka'� and Area]
Windows a
Doon—Crackage and Area
Wlath Helgnt No. of Lineal ft. ren
No. of Dane .o(p;ne lights '', of Crack _aq. ft.
na"Got
Width
_NO. of DatU
Hslgbt No. o[ LlnaI tt. Area
aLMna Ilfbb of Meek aQ. tt.
I / r
Total Btu.
Required sq. ft. E.D.R. or sq. ins.' W.A. Leader area
Infiltration
Glass'
Exp. wall
Net exp. wall'
Int. wall
Ceiling jr
Total Btu.
Required sq. ft. ED.R. or sq. iris. WA. Leader area
I
FljqPRRoom I Lengt . Wild
Windows and Door*--•Crackage and Area
Width I Height No. o[ Wnaal [t. Area
No. of Dane of Wane Ila
hts of crack aq. [t
G
6
Y
Coef. Bta
Infiltration s
Glassor -
Exp. wan
Net exp. wall . F
Int. wall
Ceiling ��q 7
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader arra d �A
f.
$tu
Coe
Infiltration
Infiltration
Glaze
Glass A
Exp. wall
Net exp. wall
Net exp. wall
Int. wall
Int. wall `
Ceiling
Floor
3773
Ceiling P�
Floor N .�
Total Btu.
Total Btu.
1 Required sq. ft. E.D.R. or sq. ins; W.A. Leader area
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl liR� Room Length .-&, Width/0 14sighr,
FI.b Room I LenjA 0 Width
Windows and Doors—Cracka0 and Area
Wldlh Helght No. of ILlnaal ft. Arca
No. of Dane of Dane Ilghu of cr ok p. ft.
Ceiling
Windows and Doors-Cfackage and Area
Width Height No. of Lineal ft. Aea
No. of pace o[ p1M lights of crack Stir ft.
c
I / r
Total Btu.
Required sq. ft. E.D.R. or sq. ins.' W.A. Leader area
Infiltration
Glass'
Exp. wall
Net exp. wall'
Int. wall
Ceiling jr
Total Btu.
Required sq. ft. ED.R. or sq. iris. WA. Leader area
I
FljqPRRoom I Lengt . Wild
Windows and Door*--•Crackage and Area
Width I Height No. o[ Wnaal [t. Area
No. of Dane of Wane Ila
hts of crack aq. [t
G
6
Y
Coef. Bta
Infiltration s
Glassor -
Exp. wan
Net exp. wall . F
Int. wall
Ceiling ��q 7
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader arra d �A
i i i
Coef.
Btu
infiltrations
Glace
Exp. wall
Net exp. wall
°
Int. wall
Ceiling
V
�.
Floor --
Total Btu.
Requir d sq. ft. E.D.R. or sq. ins.,l
WA, Leader area
Fl r- „A , Room I Len
3 Widig
Heigh
indows and Doors--Cracksop
and Area
ht No. of
No. ne lights
heal ft. Area
sofcrack sq. ft.
na"Got
Ia
�}d
p
Coef.
Btu
Infiltration
Glace
Net exp. wall
Int, wall
Ceiling
Floor
I / r
Total Btu.
Required sq. ft. E.D.R. or sq. ins.' W.A. Leader area
Infiltration
Glass'
Exp. wall
Net exp. wall'
Int. wall
Ceiling jr
Total Btu.
Required sq. ft. ED.R. or sq. iris. WA. Leader area
I
FljqPRRoom I Lengt . Wild
Windows and Door*--•Crackage and Area
Width I Height No. o[ Wnaal [t. Area
No. of Dane of Wane Ila
hts of crack aq. [t
G
6
Y
Coef. Bta
Infiltration s
Glassor -
Exp. wan
Net exp. wall . F
Int. wall
Ceiling ��q 7
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader arra d �A
VOCONSTROMS HTG.. '& AIR O1�D.r INC. Job Nartt. -� 4. Tc A er e *—
tr-u;; alto Excela w Boulevard, MhMeir w4 ta, ttuen, //
" oz II�AT ims CALL{ILAt10YR Job Addre /%,0 — 4� 2nd W LU A/ G .
- a llw t a i rps A.S.I A 'E. Construction No. laudationGuido
Reference Out. Wall 11ut.WaU Ceiling I Roof Floor Kind Host, Applied
Windows and Doors—Crackage and
%Vldth_ He1.9hl No. of Ineal ft.. Area
- No. ,of pane ut Dane _ lights of crack 1 .e. et_ t
elf
Infiltration
Glass
" Exp. wall r,
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E D.R. or sq. ins. W.A. Leader area
m Length, tdtlt
Windows and Doors—Crackagd; and Area
LNo. I of pane I of pans I Ilrkta I Wf e;an6 I r. a -t
Infiltration
Glass
Exp. wall
Net exp. wau
Int. waU
Ceiling
Floor -
Total Btu.
Required sq. ft. E.D.R. or sq. ins. WA Leader`area
R.1 Room I Length Width
Windows and Doors—Crackage and Area
Width Hel�bt 11,
o. of peal ft. Area
No. of pan• of Datta Ilgbb of crack w. R
p. waU _
et exp, wd
nt. wall
"'oiling
loor
otal Btu.
e uired so. ft. E.D.R. ors . ins, WA, I-AaAer
It _ FI.) Room Length Width
Windows and Doom—Cracl cep and Area
No. I Of Dan
tUh. I
alteofDana lahN111.111.4 f r.lnaal [t ANa
of rr.nk .n rt -
RM
Btu
Infiltration
Etp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FI.I Room I Lenath Width
Btu
w6hi
Windows and Doors--Craekage and Area
A
W10111111 HeIght Na. or raneal ft_ Ants
No. of sww of patty utsts of crack sq. ft
-IF
Infiltration
-Coef
"Glass -
Exp. wall
Net exp. wall
Int. wall
`Cei ine - - -
-
}
Floor
M1 o"u zKW
Required sq. ft. EDA or sq. itis. WA. Leader area
,Al Room I Length Width Might
Windows and Dooekage and Area
Width Haight Nix of uncal tt Area
No. of pane of pass Iititte of crack p. rt.
Coef: Bou
Infiltration
Glace
Exp. wall
Net exp. waU
Int. wall
Ceiling
Floor
• vw otw
Rwtttuswl ... �. r n D
GRAY!TY WARM AIR:
RATE
.TOTAL
Furnace Shell & Duct Work
... $10.00
=�
Replacement of Furnace
6.00
$
Repairs & Alterations—up to $50o.00
600
$--_
Repairs & Alterations each add. $500.00
300
$
MECH. WARN AER
Furnace Shell & Duct Work to 190,000 BTU
..$10.00
$--
each add. 60.000 VM .......
3.00
Replacement of Furnace
6.00
$
Repairs & Alterations --up to $500.00
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. 200 sq. ft. EPR Steam a.0(1 $
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 (tip to 199,0W BTU) 600 $
over 199,000 VM Be* Fee Schedule
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures -- _ — x$ 200_—
Additional Fixtures — x .78
Gas Range to 199,000 X$ 5.00 $
AIR CONDITIONWO
FAN HEATING ST37CM
YEN LATIXG SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FWAE. -7- 3a 76
State Surcharge .50
�9019 Fee Schedule
TOTAL FEE 1/0,5
6 4�?A
City of Fridley:
The undersigned hereby makes application for a permit for the wont herein
`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 facts
and representations stated in this application are true and correct.
Fri ey. Minn- Z / .� 18
i)�
owner—a
Kind of Building
Used as
To be completed about --77 " -,—/
Estimated rrwt, S.
Uld New. Bwlding Permit No. Permit No..
DESCREPTION OF WORN
ER
PLARr3—Stea/m, Hot Water, Warm Air—Ido
Trade Name-----�! Size No
CapacitY— - ------ — — -- Sq. Ft. E.D.R BTU � / ` H Pg
Total Connected Load—__ _—__ Kind of Fuel
BURNER — Trade Name Size No
Capacity— -- Sq. !t E.D-N BTU Hp
(RINARRf—OVER)
Business Pb=& No. 7ifoZl ( L/
SUBJECT
PERMIT
City of Fridley
19418
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
r
RECEIPT NO.
`y ___-_•COMMUNITY DEVELOPMENT DIV.
r � PROTECTIVE INSPECTION SEC.
'
/'--1 CITY HALL FRIDLEY 55432
ti.__.11.� �•�
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
4/27/88
JOB ADDRESS 160 - 62nd Way N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
5
1
Potasek' s Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Stan Jackson 160 - 62nd Way N.E. 571-4180
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
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Dwelling (22 Squares)
9 CHANGE QF USE FROM TO
STIPULATIONS goof can be 2nd layer but not 3rd. Install ridged galvanized valleys.
On all new roofs or tear-offs and replacement roofs,
State Code requires that 2 layers of 15 lb. felt,
mopped together, be installed to a point 24 inches
Up front exterior wall line, or the use of other
approved uhderlayment (nembrafle.
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
I 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
� $1
A& lOO
$.55
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 PERFO NCE OF CONSTRUCTION.
$19.00
kPLAN CHECK FEE
TOTAL FEE
$19.55
SIGNATURE OF CONT CT R OR AUTHORIZED AGENT (DATE) .,
WHEN PROPERLY V�DATED THIS IS YOUR E MIT
/
b
BLDG INSP MATE
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
NEW [ ] City of Fridley Effective 4/1/86
ADDN. [ ] R-1 AND R-2
ALTER. Building Permit Application
Construction Address:
Legal Description:
Owner Name
Contractor
Ir
Address:
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:
OTHER:
Length
R� ny
Width
ral C� &)!7!
Hgt/Ground
'-
`Sq. Ft.
! 0 Q
Corner Lot [ ]
Inside Lot [V]
Ft. Yd. Setback
Side Yard Setback
Type of Construction:
Estimated
Cost: $ it ® V
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: `f 'n_ & O
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
APPLICANT:
- // 6®
Tel. J�7s
CITY USE ONLY
$ (CJS o a Fee Schedule on Reverse Side
$ 25% of Building Permit Fee
$ . SS $.50/$1,000 Valuation
$ $ 5,5Q per SAC Unit
$ Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $
STIPULATIONS:
1100
101 dd
/19,0 d
CITY OF FRIDLEY INSPECTION DIV, dq 1
6431 Univerary Ave NE 6 Y'
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
572-3604
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective On March 1, 1996
PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS_
New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein
Old Opening, New Fixture $ 4.00 specitied agreeing to do all work in strict accordance with the city codes
Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts
.3low Off Basin $ 7.00 and representations stated In this application are true and correct.
Catch Basin $ 7.00
Rain Water Leader $ 7.00 1996
Sump/Receiving Tank $ 7.00 -IAKL IS STANLEY
Water Treating Appliance $10.00 Owner 15CI 522ND WAY ttORTHERC.-TFR I CiLEY_��_-;-�
Water Heater –Electric $ 7.00 H 57 t®� ISS' t�' ` j %/– S/ ,/ YD
Water Heater – Gas** —1 $10.00 10•00 Building Used As
Gas Range** $10.00
17
Gas Dryer** $10.00 Estimated Cost � PERMIT NO. f l
Back Flow Preventer Required ( )Yes () No //11
Type $15.00 PLUMBINGrA
Y �Qr1 /l�
Reinspection Fee $42.00/Hr SIGNED BY TEL N0.
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS nA
1.5% of Value of Fixture or Appliance VV' �
Approved By Rough–In Date Final Date
State Surcharge .50 l�/��
MINIMUM FEE OR ANY PLUMBING/GAS PERMIT 1914M14M PLUMBING CO.
TOTAL FEE $X -9D PLUS THE $.50 STATE SURCHARGE ®BA VENTGO//AP274033 8 NSTALLEW
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6–A. MINIMUM SIZE 9 SO INCHES. MIA5 QARF1 LD H
NNI:APOU ►MN 8
;ITY OF FRIDLEY INSPECTION DIV.
431 University Ave NE
Adley, MN 55432
763) 572-3604, FAX (763) 571-1287
Effective April 1, 2004
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT '�Z)
MARK NUMBER OF FIXTURES TO BE INSTALLED ON FArH FI! nnR
ILUMBING FIXTURE RATES:
NO.
RATE TOTAL
JOB ADDRESS 'dse n r2 .!g -
.I o'W dlty4i
Sew Fixtures
$10.00
The undersigned hereby makes application for a permit for the work herein
)Id Opening, New Fixture
$10.00
specified agreeing to do all work in strict accordance with the city codes
leer Dispenser
$10.00
and rulings of the Building Division, and hereby declares that all the fads
Ilow Off Basin
$10.00
and representations stated in this application are true and correct.
:atch Basin
$10.00
081505 5
Iain Water Leader
$10.00
DATE: .2D _
;ump/Receiving Tank
$10.00
Vater Treating Appliance
$35.00
OWNER 160 62ND WAY NORTHEAST _
Vater Heater -Electric
$35.00
FRIDLEY, MN 55432
Vater Heater - Gas"
$35.00
BUILDING USED AS(763) 571-4180
las Range'
$10.00
)as Dryer"
$10.00
ESTIMATED COST w opo PERMIT NO.
lack Flow Preventer Required (
)Yes () No
Type
$15.00
PLUMBING COMPANY IVQ �i �?` �'11a� t► L(�,Vv1 IpiJ�o„�
teinspection Fee $50.00/Hr
kLL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
SIGNED BY
TEL N0. ('l012) $2%—clo33
Approved By Rough -In Date Final Date
$ -0
MINIMUM FEE FO ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST
$ �S OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE.
.OMBUSTION 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 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. 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 Installinsa 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 1 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)
HEATING CO:
Signed By: Date :