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PRE 2010 DOCSCity of Fridley, Mian.. BUEWING PERMIT Date:PM Owner: Builder _ Address Address No. Street Lot _ _ _, Block Corner Lot __ Inside Lot keo'p Setback Sewer Elevation Sideyard Z12 _. Foundation Elevation _.._ DESCRIPTION OF BUILDING T ,x V Front Depth Height Sq. Ft "cu. Ft rrtmt Depth H cit - Sq. Ft Cu. Ft. fAK Lzpr Type of Construction-,.�, Est. Cost ""i"o 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 set forth and in compliance with all 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 ordinances,' 'A limits and this permit may be revoked at any time upon violation, of any of the provisions oP said NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we the Building Inspector for separate permits for these hems. R . cQW4 APPLICATION FOR BUILDING POLMIT CITY OF FRIDLEY, MINNESOTA Owner's Name Builder Address 7 l3,4�0 Address `Ieedo1 LOCATION OF BUILDING No. X6� Street Part of Lot Lot Block p Addition or Subdivision Corner Lot Inside Lot Setback �`�,Dftde-Yard /® SEWER ELEVATION FOUNDATION ENATION Applicant attach to this form Certificate of Survey of Lot'and proposed building location. DESCRIPTION OF BUILDING To be used as: o I Frnrnt Alio Denth HeiLht % Sq. Ft. %% Cu. Ft. 4LOj7 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 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. 1-17 n ^ len U (A Schedule of Fee Costs can be found on the Reverse Side.) Dar City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Location 159 — 63rd Way Number, Kind and Location of Fixtures �j NO. RATE = Number Fixtures ...................... 9 x $1.50 $ 13.50 Future Fixture Opening ................ of 1.20 $ w Z • P • N WATER HTR. GAS ELEC. x 3.25 $ 2.00 Water Heater (Up to 200,000 BTU) ...... x 2.00 $ (`JO x 3.25 $ Base 1 1 2 1 1st IDidposal 2nd 3rd 4th Future Coariectioa Openings Connected withI Sewer New Fixture,- Old Openings Cesspool f-1 PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... 9 x $1.50 $ 13.50 Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ 2.00 Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $ 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 June 24 is 61 Owner Paul Schwartz Const. Co.. Kind of Building Frame Used as Ohre l l i ng t To be completed about Sept. 1591961 Estimated Cost, $ 300.00 / F old— ew. uilding Permit No t5d 7 Permit No. / / 49 Signed STANDARD PLUFARILFA AMD nn, nnm p� By Busin Phone No Ne 8"3589 ROUGH I FINAL GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ 1.50 Additional Fixtures .................... x .50 $- Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description .................................. .............$ I TOTAL FEE $—!L- 0 —0 az 2M 7.89 Application for Power Plants and' Heating. Coding, Ventiilation..Refrigeration tod 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 $ MECEL WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $___8 each add. 80,000 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 RIOT WATER SYSTEM NO RATE 1TQMAL 1st 3 Fixtures ...................... Furnace Shell & Lines-ta 400 sq. ft. EDR 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 $5*00- GAS FITTING FEES: NO RATE 1TQMAL 1st 3 Fixtures ...................... x $1.50 $ TUU 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 s__14• ROUGH FINAL Dept. of Bldgs. Phone SU, 4-7470 Location 139 - 63rd Way 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 6-27-61 19 Owner Paul Sehwartz Genstruotion Go. Kind of Building Fr. Used as Res. To be completed about 7-2761. Estimated Cost, $ Q Old--W=z- Building Permit No. Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS -Steam, Hot Water, Warm Air -No..- Trade Name—Westinghouse size r1oIIE-100 Capacity Sq. Ft. E.D.R 100M BTU H.P. Total Connected Load 459' Kind of Fuelagg BURNER -Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Plan R-1 (On file (REMARKS -OVER) Signed By FRED VOLT 8 rn NEATINt & AIR CONDITIONING a 42 7M 7-59 BusinesV-Vr -o Lake St. a wE. 9-6767 St- Louts Park, Minnesota City of Fridley, Mm. BUILDING PERMIT N° 58 4 4 Date: Owne_�- Builder +� Address — — Address — — — LOC T PJ OF BUILDING No. Street A __ _ Part o Lot _ Lot __ Block Additi or SubPldon y '� Corner Lot _ Inside Lot fttback '' Sideyard Sewer Elevation .._.. FC4dation Elevation __ DESCRIPTION OF BUILDING v Front Depth s7 height Sq. Ft. '0 Cu. Ft. n Depth�i Height __ Sq. Ft. Cu. Ft. Type of Construction Est.. CA - --"OTo 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 set forth and in compliance with all provisions of ordinances of the city of Fridley. .r+ In consideration of the payment of a fee of $ h , 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 within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, phnnhing,, gas heating, sewer or water. Be sure to sen the Building Inspector for separate permits for thea hems. 0 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner'a Name f &'z I/ Wee& Builder Address �po 4�p4 ✓��. Address67 LOCATION OF BUILDING No. / /0 Street (�,eo �/l,�,�`Part of Lot Lot Block Addition or Subdivision 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: Fr nt c7L-e Depth Height / a Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Constructi`b�, 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 representations stated in this application are true and correct. DATE SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). SUBJECT - PERMIT NO. City of Fridley 28745 AT THE TOP OF THE TWINS BUILDING P E R M I T r COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 � � ,3o E ` /'"1 CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-Fl 12/14/98 JOB ADDRESS 159 63rd Wav NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 14 2 Eva Erickson River Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Chet Korzeniowski 21 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Town & Country Roofing 7910 12th Ave S Bloomington 55425 545-4233 20091282 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 Jax REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (25 S Tear-off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 I 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2142 $1.07 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 $74.75 Fire SC $2.14 PLAN CHECK FEE TOTAL FEE License SC $5.00A 1$82.96 SIGNAT FC 'RACTORORAUTMORIZEOAGENT IDATEI WHEN PROPERLY/VALIDA ED THIS IS YOUR PERMIT lc��' -�y SIGNATURE OF OW NERIIF OWNER BUILDER. IDATEI BLO -NSP GATE Dec -14-98 09:29A 'NEW [ ] ADDN [ ] ALTER [ J ConstructionAddress: Legal Description: Owner Name & Address: Contractor: �n qF- CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Address:77C7) D JQ*h ./'I -P . S. r-4 ion P-02 Effective 1/1/98 4 ®vl Tel. # 7 / -',;L MN LICENSE # L1 Tel. 11 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF ]MPROVEMENT LIVING AREA: Length Width Leight Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECD AREA: Length Width Hgt/Ground Sq. Ft. OTHER:��1/L1�, f � Construction 'Type: P f' % *C Estimated Cost: $ 3 r?, --� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: ,(,Z t APPLICANT: Tel. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIMULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 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 [ J Not Necessary [ SuB.,ECT PERMIT NO. City of Fridley 3 9 3 AT THE TOP OF THE TWINS BUILDING PERMIT ` RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. ILIA r 6Q NUMBER REV DATE PAGE OF APPROVED BY I CITY HALL FRIDLEY 55432 763-571-3450 910-F15 7/25/02 JOB ADDRESS 159 63 Way NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14 2 1 Eva Erickson River Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Chet Korzenowski 159 63 Way NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Ricksham Construction 17874 Concord St NW Elk River MN 55330 20233417 A ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 612-940-4253 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ADDITION O ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 14' x 12' Addition with basement; install one bow window 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. WARNING SEPARATEPE Before digging calf for OBITS REQUIRED F ' all utility locations NSII6 4640002 P UMB114 AND R�Q�f�E®�i LAW ai% 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 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 @ $7.19 WITH WHETHER SPECIFIED HEREIN OR NOT THE GRANTING OF A PERMIT $14,381 DOES NOT PREwuTY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OFLOCAL LAW REGULATING CON- $251.25 Fire SC $14.38 STRUCTION OCONSTRUCTION PLAN CHECK FEE TOTAL FEE Licens C $5 0 $2A.82 NA URE OF N'RACTOFIORAUTHORiZEOAUNT iDATEi HENROP VALIDATED T IS IS YOUR- 0�rws4led. PERM T 001, LO -NSR Fix E S,GNATURE OF OWNER .IF OWNER BUILDER, iDATE, NEW (J CITY OF FRIDLEY Effective 1/1/2002 ADDN (J 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 A BUILDING PERMIT APPLICATION -r'�zlll YMINN Construction Address: I_j� 1 (.0 2.1 U sem' 0-J"I Legal Description: CAe--r ej ;affW-S I Owner Name Address: Sri, � Tel. # Contractor. USMN LICENSE # 2 (N2 33 411-7 Address: / 797 V PAA rens s7.. Ak) Tel. # Cal - V�0"J�Z 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 P' Width'2. Height Sq. Ft A la GARAGE AREA; Length Width Height OTHER: Construction Type:_ Sq. Ft Sq. Ft 9 Driveway Curb Cut Width Needed: Ft + 6 Ft = t x $ DATE: :Z- /f, APPLICANT: Tel. # 6,�2 Call (763) 572-3604 for Permit Fees if mailing In application or Fax to 763-571-1287 if using credit card and we will call you for card number. cz-/ O?S— Permit Fee $ J Fire Surcharge $ --i State Surcharge 2, /f$ SAC Charge $ License Surcharge $ t 00 Driveway Escrow Erosion Control Park Fee Sewer Main Charge CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1200 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by'Engineenng Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: a 79, 0 sm- V-044 S"mq gat: P44.0 6Wetop* HARRY .8. JOMNOON RORERT.M. MEREDITH I 01If � LAND SUP V E YO RS +harry S Johjlsv11 ssoi!iales G✓� CO♦ 1 f 10021 FRANC[ AVE. IOUTN MINN2AFOL10 20. MINNESOTA TUXEDO 0.2100 1 �L �i39+6 L ° u1 l, i oe vl- 84ora 46 � p/o�fion i I I 840�� 1 t/ 837+5 75 I . hl �d io_ 840*3 h M� 83 716 9 he4eb y cA ttiy .that ,thea ,i4 a ume ,arid c it4t-ct-tep4"e tta ion o?- a uow" o? the God : of Cot l4. Shock %£ U N C k 9 C K 5 0 N K 9 U F k M H N 0 k, N.wka Co",aj, Mime ao,ta. 9t does, Kot pmpoott .to show imp"veA.e t ta. oz eyc..t oac me tt d, amq. fin 4. -w"ed G y ire this. 22nd day of 1%ql' 1961. /los t y �5 . n, M•irrrt. ley. No. 506 5 07/21/2002 19:42 6125729181 RICKSHAM INTERIORS PAGE 02 1% Wcheck COMPLIANCE MORT Minnesota Energy Code MNcheck Software Version 3.0 CouNry: Anoka STATE: Minnesota ZONE: 2 CONSTRUCTION 'TYPE; Single Family DA'Ig: 7-22-2002 DATE OF PLANS: 7/12/02 TITLE�,RJC�KSHA�MCON�'--' pRo IECT INFORMATION: PLAN S 22-139 COMPLIANCE'. PASSES I I I I I Permit I I � jChecked by/Date 9 I Required UA = 69 Your Home = 66 3.e% Better Than Code Area or Cavity Cont. Glazing/Door Perimeter R -Value R -Value U -Value UA --------------------------------- ------------------ CEILINGS: Raised Truss 168 44.0 0.0 4 WALLS: Wood Frame, 16" O.C. 248 19.0 2.0 14 WALLS: Wood Frames,, 24" O.C. 40 10.5 2.0 3 BSMT: Cone. 8.0' ht/0.0' bg/8.0' insul 310 11.0 0.0 17 GLAZING: windows or Doors, Above Grade 80 0.350 26 HVAC EQUIPMENT: Furnace, 85.0 ARM -- --.-----•-------------------------..-----ter---------------- OO4PLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to most the requirements of the Minnesota Energy Code. Huilder/Designer Data iS.1d TWMti02E94::01 8482 1:92 i%' N8 W11.48aa C:N'3.aaQ1Fi:WrN4 rr%C:AS ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 t AX: ( 763) 571-1287 159 63RD WAY NE 153024420053 EVA ERICKSON RIVER MANOR LOT 14 BLOCK 2 HEATING RESIDENTIAL ADDITION/ALTERATION PERM NO.- 2004-00751 It DATE ISSUED: 05/20/2004 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 COOK TOP AND REPLACE SHUT-OFF VALVE. # A/C UNITS 0 VALUE OF APPL OR WORK # FURNACES 0 # GAS DRYERS # GAS RANGES APPLICANT CENTERPOINT ENERGY/MINNEGASCO 13562 CENTRAL AVE NE ANOKA, MN 55304 - OWNER KORZENIOWSKI CHESTER & S M 159 63RD WAY NE FRIDLEY, MN 55432 0 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 construction or the performance of construction. Bldg HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK GAS PIPING FEE GAS RANGE FEE GAS DRYER FEE AIR CONDITIONING FEE HEATING REPAIRS/ALTERATIONS STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 1009368 SEPARATE PERMITS REOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 293 0 15.00 0.00 0.00 0.00 0.00 0.00 0.00 0.50 15.50 CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer I" *Air Conditioning -All Sizes All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater 4�A ea? Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS L� Fee Total Owner_ zLzil az 6k, $35.00 $ Building Used As S ,C� kmfy $10.00 $ ESTIMATED COST Ei�� GV PERMIT NO CZ,& ( `ccs )J $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. $25.00 $ BTU _ ,aj HP EDR Fuel Total Connected Load Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR $ Burner Trade Name Size No. BTU HP EDR 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. $ 15, 5z *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 Tel # 6L42- J�/ —�f FAX #%a-�a%�d� Date 5 13 Approved by Rough -in Date Final Date �L� 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 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) HEATING CO: Signed By: Date : 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 DE/ VICES JOB ADDRESS I J I C3 wa_ RATE SCHEDULE Residential Furnace Shell n Duct W ,Burner Also Replacemen urnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) I 1% of Value of App/l'ance or Work U d Commercial/Industrial 1.25/ of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL FEE Effective On January 1, 2002 lU � OWNER TOTAL BUILDING USED AS 5 $ / �® ESTIMATED COST /cS $ .50 $ REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units l Circle One (Steam) (Hot Water) ( rm r) Trade NameAam-jVfwy, ► Size No. BTU 0o°O HP EDR Fuel Q Total Connected Load Burner Trade Name Size No. BTU HP EDR 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 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. 60, q -6 DATE Ubk\ � � a SU HEATING CO Signed/_, " _ FAX # Approved By Rough -In Date TEL Final C THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON VFNTVFNT CONNFCTOR AND COMRIISTION AIR VFRIFI .ATION When re I� a ring an existing furanna, 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 AxosHnrj r-nmhi s inn air is sized and installed to meet the current codes and manufacturer's specifications. Yes() No( ) When required to install a new cnmNistinn air�it will be sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When installing a new v -n ing c m, 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 #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 Appliance #1 Vent Connector Height ft Appliance #2 Vent Connector Height ft Appliance #3 Vent Connector Height ft ALTFRATIONS- (n .e _ri 1 AM -10A c*\\k HEATING CO: Signed By: Length ft Diameter in Length ft Diameter in Length ft Diameter in ]� eo� CIA ns to IR N1 e.)k inches Type Type Type S� +Yl