PRE 2010 DOCSCity of Fridley, Mian..
BUILDING PERMIT
Date: /7— 1 """ 6z
r
Owner: Builder
Address _._ _ Address
N° 5'701
1 OCAT ON OF BUILDING
No. ,#140 Street ,-/0.„-- —Part of Lot
Lot _ Block lee ition or Sub -Div oq—�”
Corner Lot ___ Inside Lot �� Setback, _ _ — Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
T be Use 1#1
Front Depthfight Sq. Ft. Cu. Ft
Srrant Depth Height Sq. Ft Cu. Ft
01
Type of Constructio t,e A? _ Est yl� "''r 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.
if
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 grantedupon
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, re _ and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of of the provisions of said
ordinances. o».. %A
Building Inspector
NOTICE
This permit does not cover the construction, installation for wiring, plumbing, gas heating, Dewar or water. Be sure to see
the Building Inspector for separate permits for these Items.
APPLICATION FOR BUILDING PEST
CITY OF FRIDLEY, KDMOTA
Owner's Name Builder
Address ��� — !KAddress
LOCATION OF BUILDING
go. �.Street �����Gi Part of Lot
Lot-% Block Addition or Subdivision,��`
Corner Lot _____Inside Lot Setback 3-5" --., Side -Yard /cam —
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
To be used as:
DESCRIPTION OF BUILDING
?d—. G/
Sq. Ft. Cu. Ft.
Front Depth Aeight
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. ,>
(A Schedule of Fee Costs can be found on the Reverse Side.)
A
City of Fridley
Application for Plumbing and Gas Fitting Pernat
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures .......
x
_>
ZI
•
y
g
o
_
FZ7
�i3
s� m
w
Z
Z
w
•
R
•
N
WATER HTR.
GAS
ELEG
m
Water Heater (Up to 200,000 BTU) ......
x
2.00
$ 2.00
New Ground Run Old Bldg . ............
x
�
$
u�.
c ad
< f�9 d
(ge
(�9 O
$1.50
$ 1.50
Additional Fixtures ....................
x
Base
$
Gas Range to 200,000 BTU ..............
x
2.00
$
1
1
1
1
1
1
1
Di po
al
ist
2nd
_
3rd
4th
• Future Connection Openings
I
Connected with
Sewer [79
New Fixture, Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
Number Fixtures .......
x
$1.50
$ 10.50
Future Fixture Opening ................
x
1.20
$
New Fixture Old Opening ..............
x
1.00
$
Catch Basin ............................
x
3.25
$
Water Heater (Up to 200,000 BTU) ......
x
2.00
$ 2.00
New Ground Run Old Bldg . ............
x
3.25
$
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................................................$
TOTAL FEE $ 14.00
Dept. of Bldgs. Phone SII 4-7470
Location 146 - 632 Way M E.
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 December 4 is61
Owner Paul Schwartz Const. Co.
Find of Building
Used as
Frame
Dwelling -
To be completed about April 1962
Estimated Cost, $ 800.00��
Old—New. Building Permit No Permit No.
Signed ST DUm " mn a opukr m C
By
Business Phone No We 8 3589
ROUGH 12 -19 -& f
FINAL
4a 2M 7-59
Application for Power Plants and Heating, Cooling, Ventilation, .Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
Furnace Shell & Duct Work ..........................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 ..................
Repairs & Alterations each add. $500.00 ...............
j
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............
each add. 60,000 BTU ...................... .
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 .... ............ .
Repairs & Alterations each add. $500.00 .............
RATE TOTAL,
8.00 $
5.00 $
5.00 $
2.50
8.00 $---8 LO -0
2.00
;
5.00
$
5.00
$
2.50
$
STEAM or HOT WATER SYSTEM
NO RATE TOTAL
1st 3 Fixtures ......................
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 $ 5,00 --
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
$
AIR CONDITIONING
$
FAN HEATING SYSTEM
See Fee Schedule
VENTILATING SYSTEM
$
ALTERATIONS & REPAIRS
TOTAL FEE
14.50
$
ROUGH
Plan R-1 0n file
.
FINAL
Dept. of Bldgs. Phone SII 4-7470
Location 146 – 65 -12 -Way N. E.
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, .n 12-12 '1961
Owner Paul Schwartz Construction Co..
Kind of Building Fr'
Used as Rees
To be completed about 1-12-62
Estimated Cost, $
Old—New. Building Permit No. o Permit No.
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No
Trade Name Westinghouse Size No GIIE-100
Capacity Sq. Ft. E.D.R BTU 100-K H.P.
Total Connected Load 459 631 Kind of Fuel GsA
BURNER — Trade Name Size
Capacity Sq. Ft. E.D.R BTU H.P.
r
(REMARKS—OVER)
Signed FRED VD -0T & CO.
By HEATIN & AIR CONDITIONIN5
6530 West Lake St, * WE. 9-6767
4Z 2M 7.59 Business Phofkb yiS Par1f. Minnesete
C�
40
City of Fridley, Minn.
BUILDING PERMIT
Date: June 9, 1969
Owner: Donald Meyers Builder
Address _ 6633- Way N. E. Address
Same
Same
N° 10270
LOCATION OF BUILDING
No. 146 Street _ _ 633.- Way X. E. Part of Lot
Lot _ __4 --- Block 2 — Addition or Sub -Division . Eva Erickson River Manor
Corner Lot --- Inside Lot --- ` Setback — Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Garage Front 16' Depth 28 Height 101
Sq. Ft. 448 Cu. Ft. 4480
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Frame Fst. Cost 1800.00 _ To be Completed Sept. 1. 1969
Surfaced Driveway by Sept. 1, 1969
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 setrth and in compliance with 21 provisions of
ordinances of the city of Fridley. , /7 , /7 , fl
In consideration of the payment of a fee of - 7.00 , permit is hereby granted to Donald Meyers
to construct the building or addition as described above. This permit is granted upon
the express condition that theperson 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, Mhmesota regarding location, construction, alteration, maintenance, repair andmoving 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.
I / '—.zj2�4/&1&V- 2 Building Inspector
F. Muhich
NOTICE:
Wo pormh does not cover the construefion, installation for whing, phnnhing, gas headne, sewer or water. Be sun to we
the Building Inspector for separate permhs for these Ilona.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER Is NAME a 1 A , ers BUILDER own e
ADDRESS I C� � V ADDRESS11
LOCATION OF BUILDING
NO.ZZ ( STREET'
LOT BLOCK�s ADDITION OR SUBDIVISIONfa,= ( �
CORNER LOT INSIDE LOT — SETBACK SIDEYARD
SEWER ELEVATION TOP OF FOOTING
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:
y
Front /6 / Depth Height
Square feet '44 9 Cubic Feet 4/41 9
Front Depth Height
Square feet Cubic Feet
Type of Construction �it.e.�, 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. A
DATE �,�, q. % SIGNATURE ,iC�.&�c
(Schedule of Fee Costs can be found on the Reverse Side.)
LAND SURVEYORS _
ssdciales,
10[21 FRANCE AVE. 6OUTK
,Sww� go -t: Pato bQv�p 7C
Co. MINN[APOLIS 20. MINNESOTA
J TU[DO !f•2f00
HARRY S. JOHNSON
ROBERTS. MEREDITH
'
C 75'
�s2 a0 1
U4 Prem
' � 6 1 � • r� V
� .0 �.
. j.�
aGa�a�� ii.
ANNA
PRA IM AS�MF:
�Tr�.lTyLjl
_ --
57,32 c,'S
th%d ptcrL i.� a eoaiter ze��se+c't't,c'n of a o� the Go/1,u!cv�-te. c
f E; 7 C K S 0 N 9 9 U F R M H N 0 R, Rrtoka CoWI_'f f N4�''',.•,c��.
of 1961.
•00•'1'$ uiaq� 990T
' d. T 5i'%:9:�Ci..:. trr ..n �..., ..^,.. _— -- _- _ " - - - ---� --- .."� ..�•,....n nmvn OU LIT *g'Z
City of Fridley
sue�Ecr
PE
®i36
AT THE TOP OF THE TWINS
PERMIT
`
BUILDING
REC TNOy
� `COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION
�?/�
1 SEC.
C/X
1 � �
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 56432
�---- �'J
512-580-3450
910415
6/28/76
JOB ADDRESS 146 63 1/2 W N. E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
4
3
Eva Erickson River Manor SHEET
2 PROPERTY OWNER MAILADDR ESS
ZIP PHONE
Donald A. Meyers 146 63 1/2 Way N.E.
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.
5 USE OF BUILDING
7 CLASS OF WORK
❑ NEW ❑ ADDITION CX ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
flnidh basement
9 CHANGE OF USE FROM TO
STIPULATIONS
1. No finished bedroom in the basement unless windows meet code for bedroom.
sr!--*'ERATE PERMITS REQUIRED • FOa WIRING,
HEATING, PLUVOING AND SIGNS,
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
SQ. 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
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'L
OOO
1.00
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-
12.00
STR TION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
13.00
SIGNATURE OF CONTRACTOR OR AUTHORIZED 4JENT (DATE)
N PROPE
BLDG INSP
LY V D THIS IS YOUR PE MIT j
DA7
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME : a UILDER :
ADDRESS:/" — 4p 3 �Iz L� ADDRESS
NO:. STREET:
LOT: BLOCK: ADDITION: a P.a.a-,p,-`�
CORNER LOT: INSIDE LOT: K SETBACK: SIDEYARD:
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:
am r'ront :
Square Feet: Cubic Feet:
Front:
Height:
Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: Estimated Cost: $ � G v 0. °y
To Be Completed: / if 1577
7 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: _-�) S- 19' (, SIGNATURE 1
(See Reverse Side For Additional Information.)
SUBJEtT
NO.
City of Fridley
3045 7
AT THE TOP OF THE TWINS
BUILDING
PERMIT
EIPT NO.
r- _ COMMUNITY DEVELOPMENT DIV.
_____
.5x
69-
r � � PROTECTIVE INSPECTION SEC.
1 . �
CITY HALL FRIDLEY 55132
NUMBEi1
DATE
GE OF
A0PROVEO BY
L 612-571-3450
910-F15
T71
10/29/99F7;
/
JOB ADDRESS 146 63 1/2 Way NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
2
Eva Erickson
River Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Don Meyers
3 CONTRACTOR MAIL ADDRESS Riverview
ZIP PHONE LICENSE NO
Richard Hastings Contr. 6331 Ter. NF, Fridley
574-9966 5
/ 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 XN REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
Reroof house and garage (22 Sq) Tear-off
9 CHANGE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with the State Building 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 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
ISTALLS
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
$1923
$.96
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
$69.25
Fire C $1.92
PLAN CHECK FEE
Lice C
$5.00
TOTAL F E
$7 .13
SIGNATURE OF CONTRACTOR ORA THORiZEO AGENT (D Ei
EN P P
8,DG SP
ALIDAT IS IS V U RMI
q
OAtE '
S-GNATUREOFOWNERi6OVVNERBUILDERi MATES
NEW[ ] f Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMULY AND DUPLEXES R-1 AND R-2 �J
BUILDING PERMIT APPLICATION
Construction Address: % V6 63 tz ick
Legal Description:
Owner Name & Address: Do1v IjAi �ZC 4S Tel. #
Contractor: ;c_ S.�'Ck(VC
s MN LICENSE # 6 S I
Address: Tel. # 5 -7Y -F941;.6
Attach to this application, a Certificate of Survey of the
lot, with the, proposed construction drawn on it to scale.
DESCRIPTION OF EMPROVEMENT
LIVING AREA:
Length Width
Height
Sq. Ft.
GARAGE AREA:
Length Width
Height
Sq. Ft.
DECK AREA:
Length Width
Hgt/Ground
Sq. Ft.
OTHER:
Z S
Construction Type: %£,4-?-
z) rd- tZ 6 k L, v t'
Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Ft x $ _ $
DATE: 1041—a 7A CANT: Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
R
Park Fee $
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 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 [ ] Not Necessary [ ]
CITY OF FRIDLE`P INSPECTION DIV
6431 University Ave NL
Fridley', WJ )5=32
_72 '36c
I�',b,gq
f 16001'
Effective On March 3 . 1996
„q �U
De
o
",.:So
'-"COMBL.IS70W A0 SHALL lJC 6' -<AIDED PER ,Jtvt�. i�I_C i ANL, t At:1 r
C;TY OP FRIDLEY INSPECTION DIV. Effective April 1, 2004
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
(763) 572-3604, FAX (763) 571-1287
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
asr`:
IT
I:::>::::> Wash:::>::::»::::>::>::>::>Auto. Gas >::>: water Heater
Stories >: UrinahooverS Tra��.>:<.>: �>> Drain...��... (#..... .I�(#`I� �:��:;:<:::��I>: �> Washer :::
.................... ................. .................. i��[#�!I+ Range ' :' .-::::>::` Gas Elec
Floor 1
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
l '— �2
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
Rain Water Leader
$10.00
$10.00
DATE: '20
Sump/Receiving Tank
$10.00
Water Treating Appliance_
$35.00
OWNER
Water Heater -Electric
$35.00
Water Heater - Gas**
$35.00
n—
BUILDING USED AS
Gas Range**
Gas Dryer**
$10.00
$10.00
�
ESTIMATED COST PERMIT NO._
Back Flow Preventer Required ( )Yes
() No
�
�
Type
$15.00
PLUMBING COMPANY � ceL5K
r
Reinspection Fee $50.00/Hr SIGNED BY V TEL N0.
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS �, __D y
1.25% of Value of Fixture or Appliance
Approved ByL Rough -In Date Final Date 2 b d �
State Surcharge $
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST
TOTAL FEE OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE.
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 asse%nbly
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
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 FAX: (763)571-1287
ADDRESS : 146 63 1/2 WAY NE
PIN : 153024420043
LEGAL DESC : EVA ERICKSON RIVER MANOR
: LOT 4 BLOCK 2
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
PERMIT O.: 200400729
DATE ISSUED: 05/19/2004
VALUATION : $ 300.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A WATER
SOFTENER.
# ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0
# NEW FIXTURES (EXIST OPENINGS)
# GAS DRYERS
# OF NEW FIXTURES
APPLICANT
SHILOAH WATER CO
7319 166 AVE NW
RAMSEY, MN 55303-
(763) 753-9244
[$I`:/ilI p1 :7
LEONARD RADDOHL
146 63 1/2 WAY NE
FRIDLEY, MN 55432
0 # GAS WATER HEATERS 0
0 # GAS RANGES 0
0 # WATER TRMT APPLIANCES 1
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.
Bldg
PLBG PERMIT MINIMUM FEE
0.00
PLBG FIXTURES (NEW OPENINGS)
0.00
PLBG FIXTURES (EXIST OPENINGS)
0.00
WATER TREATMENT APPLIANCE
35.00
WATER HEATER - ELEC
0.00
WATER HEATER - GAS
0.00
GAS RANGE FEE
0.00
GAS DRYER FEE
0.00
PLBG REPAIR/ALTERATIONS
0.00
STATE SURCHARGE, PLBG FLAT
0.50
TOTAL
35.50
PAID WITH CHECK # 9860
AR ATR PF.RMTTS RROTTTRED FOR WORK OTHER THAN DRSCRURRD ABOVE