PRE 2010 DOCS•
•
City of Fridley, Minn..
BUILDING PERMIT N° .694'0
Date:
Owner: Builder;?-•—
Address'
Address
LOCATIONOOjjF BUILDING
No. Street f� e� _!_L•`.. Part f t
Lot �_ Block 7— ALtion or Sub -Division
Corner Lot — "' Inside Lot _ Setback _ Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To Used
Front d Depth Height _L Sq. Ft.eCu. Ft. Z4#lZe)
Front Depth Height Sq. Ft. ._ _ Cu. Ft.
Type of Construction�j�.� Est. __ 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 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 aad 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 dty limits and this permit may be revoked at any t upon vi n of any of the provisions of said
ordinances
Building Inspector
NOTICE:
Uls permit does not cover the construction, inshllarien for wiring, phnebing, gas heating, sewer or water. Be sure to as
the Building hapeCtor for apmft permits for these hems.
City of Fridley
Application for Plumbing and Gas Fitting Pennit
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
- Number Fixtures .......................
NO.
RATE
x $1.50
TOTAL
$ j op
Future Fixture Opening ................
x
F
Z
0
$
Z
c
Z
x
�U' °d
w
(7
Z
Z
•
R
•
N
WATER HTR.
GAS
ELEG
New Ground Run Old Bldg . ............
x
o`d
$
�n
NO.
0
RATE
LL
t�
<
x
(�Y
p
Additional Fixtures ....................
x
.50
$-
Gas Range to 200,00 BTU ..............
x
2.00
$
Base
1st
2nd
_
3rd
4th
' Future Connection Openings
Connected with
Sewer
New Fixture, Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
- Number Fixtures .......................
NO.
RATE
x $1.50
TOTAL
$ j op
Future Fixture Opening ................
x
1.20
$
New Fixture Old Opening ..............
x
1.00
$
Catch Basin ............................
Water Heater (Up to 200,000 BTU) ......
—
x
x
3.25
2.00
$
$ y P
New Ground Run Old Bldg . ............
x
3.25
$
GAS FITTING FEES:
NO.
RATE
TOTAL
1st 3 Fixtures ..........................
x
$1.50
$
Additional Fixtures ....................
x
.50
$-
Gas Range to 200,00 BTU ..............
x
2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ...........$ 00,
TOTAL FEE °
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, Ms..:nA
Owner
Kind of Building
Used as
- %0/i %/C -!9z
r Iz
To be completed about s
6 f-/
Estimated Cost, $
Old—New. Building Permit No v Permit No.
Signe
By,�-
Business Phone No.�
ROUGH 3-11- (o 'f
FINAL
d2 2M 7-89
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 $ 0
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. 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 $�_
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x $1.50 $
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 $ Z4 �__8
ROUGH
FINAL
Dept. of Bldgs. Phone SU 4-7470
W.C.
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 '4f AP_C'# f 'Z- y 19ly
Owner ! 1�G 0 Z Pic, -
Kind of Building A"k- 4 r9 6'
Used as D w sL.1_ 11116
To be completed about
Estimated Cost, $L7 ®-
Old New. wilding Permit No. `® Permit No.
DESCRIPTION OF WORK
HEATING or POWER (PLANTS—Steam, Hot Water, arm Air No._�_
Trade Name 1h���1>%"/ S a Size No s//% - 0-7
Capacity.
Sq. Ft. E.D.R 7L_ BTU H.P.
Total Connected Load Z 4T � D A. "'` Kind of Fuel G W K
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R I BTU H.P.
(REMARKS—OVER)
Signe
By GEO. SEDGWICK HM & A -CON®. CO,
1001 Xenia Av. S.
A 2 2M Business Phone Nn
Minneapo is 16,
U. 54611
PCICS /;VG,—E P 0
7
0
HEAT LOSS CALCULATIONS DEPARTMENT Olt° BUILDINGS
Weatherstrips A.S.H. .E. Construction No.
Guide
Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor
Yes—No .Yes—No 19_.
Fl Y Room I Length Width e a Height II a FI_I A'rb
Win ows an Doors—Crackage and Area
Width Height No. of Lineal f . Area
No. of pane of pane lights of crack sq. ft.
8 e / 2 /
13
o 6 b 19
Coef. Btu
Infiltration 4
y
Glass -7
:'®
Exp. wall
Glass
Net exp. wall
Int. wall
- o 0
Ceiling /
Floor
,
Total Btu. 2 Z
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
/ FIA frrcrosVRoomI Length r :t Width 17- Height Jr
Windows and Doors—Crackage and Area
Wldth Height No. of Lineal ft. Area
No. of pane of pane lights af crack . ft.
8 e / 2 /
13
Coef.1 Btu
Infiltration
® 0
Glass
S°eq
Exp. wall Y. 0 0
Glass
Net exp. wall
- o 0
Int. wall
Ceiling
,
Floor
1 Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
13
Coef.1 Btu
Coef.
Btu
Infiltration J
9,0 2 0 0
Exp. wall 2—o K
Glass
S"0
- o 0
Exp. wall S- K o
Ceiling®®
Net exp. wall 3 2—
Floor
Int. wall
Int.
Net exp. wall
Ceiling
2—
0
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
MINNEAPOLIS. MINN.
Insulation
Kind How. Applied
Room I Lenath /0 Width /0 Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
/ 32-,
Coef.1 Btu
Infiltration
,? 0 (o
Glass l
9,0 2 0 0
Exp. wall 2—o K
Net exp. wall
9 z 2
Int. wall
Ceiling®®
/ /goo
Floor
Total Btu. 2
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
t^t 1 D__ 11 ....L i' cam+ W:.t.L " V% U.: -Lf- op !
Windows and Doors—Crackage and Area
--
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
/ 32-,
Coef. Btu
Infiltration
Coef.
Btu
Infiltration
Z3L
//0 2 -
Glass
Int. wall
2so
Exp. wall
Floor
Net exp. wall
2—
Int. wall
Ceiling r
/
0 0
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F9_I Rnnm I Length Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane llghte of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Reouired so. ft. E.D.R. or so. ins. W.A. Leader area
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-3604 FAX: (763) 571-1287
ADDRESS : 15 63 1/2 WAY NE
PIN : 153024410033
LEGAL DESC : UNAVAILABLE
: LOT BLOCK
PERMIT TYPE : HEATING
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE ADDITION/ALTERATION
PERMIT JV 2004-01862
DATE ISSUED: 10/18/2004 .
VALUATION : $ 3,900.00
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.
CONSTRUCT A FURNACE (WARM AIR, RUUD, 80%) AND AN AIR CONDITIONER.
# A/C UNITS I # FURNACES 1
# GAS DRYERS 0 # GAS RANGES 0
VALUE (FOR MINIMUM CALC)
APPLICANT
RIVER CITY SHEET METAL INC
9929 BLUEBIRD ST NW
COON RAPIDS, MN 55433
(763) 754-2199
OWNER
15 63 1/2 WAY NE
FRIDLEY, MN 55432
3900
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 wort
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.
Au xc /I Date
Bldg
HEATING PERMIT MINIMUM FEE 0.00
FURNACE SHELL/DUCT WORK 35.00
GAS RANGE FEE 0.00
GAS DRYER FEE 0.00
AIR CONDITIONING FEE 25.00
STATE SURCHARGE, MECH FLAT 0.50
TOTAL 60.50
PAID WITH CHECK # 13809
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
-
R5506
CITY OF FRIDLEY BUILDING INSPECTION
Effective4/1/2004
g
6431 UniversityAve NE
m
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
o_
763-572-3804 FAX 763-571-1287 REFRIGERATION AND
AIR CONDITIONING SYSTEMS DEVICES
R
//AND
10BADDRESS Ir— tl 3 /L (�/Q�J.•
N
RATE SCHEDULE Em
1QW
n/�
Residential
Owner_ A x O 2,014 04&yRo-C&I
Furnace Shell and Duct Work, Burner &
also Replacement Furnace $35.00
$ 3r.0
Building Used As
Gas Piping (New Furnace, Fireplace, Insert) $10.00
$
r-�
ESTIMATED COST .22, f es -00 PERMIT NO SCG
Gas Range $10.00
$
DESCRIPTION OF FURNACE AND BURNER
0
F -
Gas Dryer $10.00
$
# of Heating Units ! Circle One (Steam) (Hot Water) Warm Air
Trade Name Size No.
*Air Conditioning- All Sizes $25.00
$
BTU HP EDR
Fuel Total Connected Load
AU Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work
$
Burner Trade Name Size No.
u}i
Minimum Fee $15.00 for Residential or 5% of cost of
hhprovement whichever is greater on work fess than $500.00
BTU HPDR
1�1G &AAtA U Wm me. —O i fr "z I /Z. 'Ibv
LL
The undersigned hereby makes application for a permit for the work herein
o
CommerciaVIndustrial/institutional
specified agreeing to do all work in strict accordance with the City Codes
}
1.25% of Value of Appliance or Work (List on Back)
$
and rulings of the Building Division, and hereby declares that al the facts
Minimum Fee $35.00 for Commercial industriaVInstitutiorial
and representations stated in this application are true and correct.
State Surcharge
$�,�,.
HEATING CO 1 ��
TOTAL FEE
$
Signed Tel #7-o —7S
N
REINSPECTION FEE $50.00/HOUR
FAX #: /,p 3 — oDd Date `D
*Air Conditioners can not be placed In side yard without written approval
from adjoining property owner - copy to City
FILL OUT
i�
BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT
FURNACE
ti
yV'1C4&t[� ' / —tm aw _ /
Approved by Rough -in Date Final Data
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 1 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 specfcadons.
Yes () No ( )
When installing a now venting systemthe undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-0AMA 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 odes.
Yes (j No ( )
.Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Not
Appliance #2 Type BTU Input Fan Assisted or Not
Appliance #3 Type STU Input Fan Assisted or Not
Total Appliances Tatal 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—
n Type
Appllance #3 Vent Connector Height ft Length ft Diameter
in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By:
Date :
TOTAL P.03
Is"—.(.3 `lz Gu°
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an exMng furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
`
o
k
• and is securely supported and firestopped where
. required.
YesG:,t) No( )
The venting system is plasbctPVC and meets all current nodes 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 manufacturers specifications. This does
include AGA-GAMA Category 1 Central Furnace Venting Tables for fan
assisted and natural draft appliances.
Yes , .", No
The exisdrin combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
Yes i%j . 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 installina 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.
g�
Yes t\ -i No ( )
Is the common vent and vent connectors sized and Installed confectly after
an appliance has been removed from the common vent and vented
separately as per current codes.°
Yea j Not )
Appliance Type and SlzefCommon Vent and Vent Connector in-- - - �Jl—on
Appliance #1 Type����c BTU Input �� g )kssisted or N �
Appliance #2 Type �° �� BTU Input ��� ���� Fan Assisted oKIW
Appliance #3 Type BTU Input Fan Assisted or Not
Total Appliances Trial Btu Input �®
Common Vent Type , -" ' Vent Height Diameter inches
Appliance #1 Vent Connector Heightft Length r ft Diameter in Type
Appliance #2 Vent Connector Height %° ft Length �ft Diameter min Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
Gti �s�GF (C` -74
HEATING CO: ' ���'� ° �y 111'-V1W4 (!r
Signed By:/ 0�,
Date :
11101ftIM- S -P
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-3604 r'AX: (763) 571-1287
PERMIT N.: 2004-01863 )
DATE ISSUED: .10/18/2004
ADDRESS :
15 63 1/2 WAY NE
0.00
PIN :
153024410033
0.00
LEGAL DESC :
UNAVAILABLE
0.00
:
LOT BLOCK
0.00
PERMIT TYPE :
PLUMBING
0.00
PROPERTY TYPE :
RESIDENTIAL
35.00
CONSTRUCTION TYPE :
ADDITION/ALTERATION
0.00
VALUATION :
$ 700.00
0.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER
HEATER.
0.50
15 63 1/2 WAY NE
# ELEC WATER HEATERS
0
# NEW FIXTURES (EXIST OPENINGS) 0
# GAS WATER HEATERS
1
# GAS DRYERS 0
# GAS RANGES
0
# OF NEW FIXTURES 0
VALUE (FOR MINIMUM CALC) 700
# WATER TRMT APPLIANCES 0
APPLICANT
PLBG PERMIT MINIMUM FEE
0.00
RIVER CITY SHEET METAL
PLBG FIXTURES (NEW OPENINGS)
0.00
9928 BLUEBIRD ST NW
PLBG FIXTURES (EXIST OPENINGS)
0.00
COON RAPIDS, MN 55433-
WATER TREATMENT APPLIANCE
0.00
(763) 754-2199
WATER HEATER - ELEC
0.00
WATER HEATER - GAS
35.00
GAS RANGE FEE
0.00
OWNER
GAS DRYER FEE
0.00
��'��� ��®
STATE SURCHARGE, PLBG FLAT
0.50
15 63 1/2 WAY NE
TOTAL
35.50
FRIDLEY, MN 55432
PAID WITH CHECK # 13809
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 wort
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
re construction or the performance of construction.
Applicant y Date 9 9
Bldg Insp
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004
64 ;1 Urnversity Ave NE
Fridley; MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 6
(763) 572-3604, FAX (763) 571-1287 , � e"1 e1
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
JOB ADDRESS S-' �3 �L &.)A -k4
New Fixtures
$10.00
The undersigned hereby makes application for a permit for the work herein
Old Opening, New Fixture
$10.00
specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser
$10.00
and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin
$10.00
and representations stated in this application are true and correct.
Catch Basin
$10.00
Rain Water Leader
$10.00
DATE:f D t —a V .20
Sump/Receiving Tank
$10.00
�'kl b U
Water Treating Appliance
$35.00
OWNER RA
Water Heater -Electric
$35.00
Water Heater - Gas** _Z_
$35.00
3S�U
T
BUILDING USED AS t►�W�..
Gas Range**
$10.00
ESTIMATED COST �:00. PERMITNO.
Gas Dryer**
$10.00
Back Flow Preventer Required( )Yes () No
Type
$15.00
PLUMBING COMPANYYIS�,A_,D(�
Reinspection Fee $50.00/Hr
SIGNED BY ����� TEL
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Appliance
Approved By J4 Rough -In Date Final Date
State Surcharge
�.
MINIMUM FEE FJ ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST
TOTAL FEE
OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE.
3-S-,
COMBUSTION 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 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:
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSiON AIR VERIFICATION
When replacing an existing fumacethe 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 -LAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
Yes
` No
(�
'The exisdria combustion air is sized and installed to meet the current codes
l
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 K) No( )
When installing a new denting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA -LAMA 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 odes.
Yes ( No 1 )
Appliance Type and Siza(Common Vent and Vent Connector infonnatilon
Appliance #1 Type u BTU Input LY0 Fan Assisted or Net
Appliance #2 Type BTU Input Fan Assisted or Not
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances _ U Tdal Btu Input114',00
Adra
Common Vent Type W LZ Vent Height ` _ s 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
AL.TERA71ONS: (Describe) �-F' M AAAA' J 43 ✓Pem f- st!:
HEATING CO:
Signed By:
Date : /do
L/ 71 S 0) a,�► s7- N t
TOTAL P.03
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 V'AX: (763) 571-1257
ADDRESS
: 15 63 1/2 WAY NE
PIN
: 153024410033
LEGAL DESC
: UNAVAILABLE
: LOT 0 BLOCK 0
PERMIT TYPE
: ELECTRICAL
PROPERTY TYPE
: RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
11
PERMIT NO.: 2004-01926 SSS
DATE ISSUED: 10/19/2004
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. WIRE FURNACE AND AIR
CONDITIONER.
# 0-100 AMP CIRCUITS 1
APPLICANT
DEPENDABLE ELECTRIC INC
2619 COON RAPIDS BLVD NW
COON RAPIDS, MN 55433
AMANDA KUBACKI
15 63 1/2 WAY NE
FRIDLEY, MN 55432
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.
Applicant Date
Bldg Insp Date
ELEC CIRCUIT FEE (0-100 AMPS) 20.00
STATE SURCHARGE, ELEC FLAT 0.50
TOTAL 20.50
PAID WITH CHECK # 28852
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
Building
BUILDING
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd: 1'
DATE Z -k o ';o
YOUR E-MAIL ADDRESS c n /SIDS 7�"/`lC�v G1 ct vl Oc),COOK
SITE ADDRESS t5—G1I17 w
THIS APPLICANT IS:
❑ OWNER ❑CONTRACTOR
PROPERTY OWNER/
NAME: iIm nd'a S kvhZ7 Posy-,wa -b C-h-o's
Pest -"-q
ADDRESS: I 6 3; e W,4 V CITY 6 I n b,CY
STATEP X -1V 3 Z
TENANT
PHONE: q10 - 2.i17
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE—ZIP
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
INGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION"' 'YARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ OOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
XNEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: B v, J ✓' Ura s pct lJ
SIZE OF IMPROVEMENT ZZ' LENGTH 27Z' WIDTH t}-
HEIGHT `1`'to6 " sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES .
PROPOSED SIZE: ��—x Z.Z
ATTACHED GARAGE ry� p
�7P� �❑DETACHEDGARAGE � 'X �Q(/
1.
2'
Existing Floor Plan
Liopo�uctfloor plan
IHT y
3.
List of strucpual members to be used
PROPOSED HEIGHT-
/
� �
SIDING
O�C0 7(,
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
off
ADDITIONS
& PORCHES SUBMIT:
Alumni
I.
Site Plan/Survey showing the existing structures
er Ioau� 9A
asc,a
and proposed project.
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS ❑Yes ❑No LOCATIOX OF WINDOWS
3.
Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE
TOTAL JOB VALUATION $ - $/J, (P7151-96 OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$15:.01
$
$ S/(o /-_7n
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work tc u es re d approval of plans. (�
SIGNATURE OF APPLICANT �'�I� PRINT NAME�� P 5 rEJS�'/L�rC DATE I Z L—
�
------------------------------
UTILITY
---UTILITY EASEMENT
I ---------------- --------------
I
I
I
I
I
EXISTING
�6'-9I PATIO CONCRETE
EXISTING HOME
3'
PROPOSED GARAGE
3'r-
CURB LINE
t ?'
EXISTING CURB60 I
-11
SITE PLAN
SCALE 1/16"=l' -O"
ANCE.
u
24" O.C.
ENGINEERED
TRUSSES
lh" GYPSUM
BOARD FOR 36x24 (2)2x6
SEPARATION WINDOW HEADER
"t c..4�C
16'x7' DOOR B I wtC=� (
(2)14" LVL HEADER
FLOOR PLAN
SCALE 1/8"=1'-0"
-A4t:f-�V4
I NJ
1. 14' ELEVATION TO PEAK OF ROOF.
(2)2x6
HEADER
(2)2x6
HEADER
(%
========c--
36x24
36x80
WINDOW
DOOR
24" O.C.
ENGINEERED
TRUSSES
lh" GYPSUM
BOARD FOR 36x24 (2)2x6
SEPARATION WINDOW HEADER
"t c..4�C
16'x7' DOOR B I wtC=� (
(2)14" LVL HEADER
FLOOR PLAN
SCALE 1/8"=1'-0"
-A4t:f-�V4
I NJ
1. 14' ELEVATION TO PEAK OF ROOF.
2. 42" FOOTING DEPTH, 5 COURSE OF 8" BLOCK,
16"Wx8"D FOOTING.
3. 3.5" CONCRETE SLAB FLOOR
4. 2x4 WOOD STUD, WITH WOOD PANEL SIDING.
N
ELEVATION
SCALE 1/8"=1'-0"
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DATE OS112103
..............................................
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FROM BAF
.................................. ............
G7YOE
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
BUILDING PERMIT APPLICANT: PROPERTY OWNER
I, CLQ �, IS SOS Mft understand that the State of Minnesota
requires that all residential building contractors, remodelers and roofers obtain a state
license unless they qualify for a specific exemption from the licensing requirements. As
the owner of the property at IS & 3'/2 wiqy Ali , Fridley, I
am exempt from the state licensing requirement only if I am not building or improving
this property for purposes of resale. By signing this document, I attest to the fact that I
am improving this house for my own use and do not intend to sell it. I hereby claim to
be exempt from the state licensing requirements because I am not in the business of
building or remodeling on speculation or for resale and that the house for which I am
applying for this permit, isl the first residential structure I have built or improved in the
past 24 months. I also acknowledge that because I do not have a state license, I forfeit
any mechanic's lien rights to which I may otherwise have been entitled under Minn.
Stat. 514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to perform
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is
a misdemeanor under Minnesota law, and that I would forfeit my rights to
reimbursement from the Contractor's Recovery Fund in the event that any contractors I
hire are unlicensed.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to the City of Fridley for compliance with all
applicable building codes and city ordinances in connection with the work being
performed on this property.
Name Cts V,(5 ?0 sT'��,J
Date__ 1D,2l®rg