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PRE 2010 DOCSCity of Fridley, Mian.. PUIILDING PERMIT N? 5 7 9 6 Date: - . Builder Address Address �,.LOCATIOIN OF BUILDING No. Street . Part, of t �� Lot Block ddition or Sub -Division _='� •-�' ��`� Corner Lot _ _ Inside Lot Setback ` 7—L Sideyard — ' W . Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To yfe Used Pr, ' �'th+ t Front Depth Height Sq. Fro Depth _ igh�t _ Sq. Ft Cu. 2.0Type of Construction-,,4-a-�•s 5' � Esta Cost, 4'" _r To be Completed Ft Ft _ 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 ordt9nnan= city limits and this permit may be revoked at any'tune upon violation of any of the provisions of said �r:.,,,.•�:.,.�. Building Inspector NOTICE: This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sura to we the Building Inspector for separate permits for these items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner's Name Builder Address LOCATION OF BUILDING No. 9�Street Part of Lot,_ Lot Block ____4dation or Subdivision�A� Corner Lot `Inside Lot Setback a S Side -Yard SZM ELEVATION FOUNDATION ELEVATION 903 Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: Sq. Ft. C -A _Y) Cu. Ft. gl,,� Front epth Height r Sq. Ft. Cu. Ft. Type of Construction Estimated Cost To be Completed _4712-l"', 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 )J application are true and correct. DATE / u /Gy _ SIGNATTAiE-C (A Schedule of Fee Costs can be found on the Reverse Side.) Application for Power Plants and Heating. 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 $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 $ �. GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $—A — 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 $ 30 • ROUGH FINAL Dept. of Bldgs. Phone SU. 4-7470 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 B �-' 2 1944.Z_- Owner 944vOwnerL-a-- Kind of Building _-_,; 0 1 _/Z/ Used as X� To be completed about' Estimated Cost, $ y" Q Old=P Building Permit No. `��Permit No. C DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, Jrm Ai —No Trade Name GtJ �a�'i4 Size No - Capacity Sq. Ft. E.D.R BTU 6--u M H.P. Total Connected Load 46;�: �o ��_ Kind of Fuel BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) Signed FILED V®GT & CO, By HEATING & AIR CONDITIONING 6530 West Lake St. * WE. 9-6767 ZM 7-59 ,Business Pho.iuis Park,Minnesnfp City of Fridley, Minn. BUILDING PERMIT Date: Owner: !' Address Builder Address N4 qjs: �. � TION OFBUILDING No. Street -- Part f Lot ' Lot _ ._x_ Block _— �L _ Ad tion or Sub - Comer Lot _ Inside Lot — Setback Aa. [,W -W, Sideyard _. Sewer Elevation Foadation Elevation DESCRIPTION OF BUILDING To U ;, ,,,�� 1R��r Front { Depth Height ._ Sq. Ft. -rr�!'� Cu. Ft. J. FroDepth ITei t Sq. Ft. Cu. Ft. Type of Construction Fast. Cost _ 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 ail 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 _w_h�it==h__inw__tth/.h�ep city limits and this permit may be revoked at any time upon. violation of any of the provisions of said ordinances. �1 I t f' 1 NOTICE: 'fhb permit don not .cowr the constracdoe, Installation for wkbgb pbmrbino, gas ham, serer w water. 11s, sun to see the Sulbliue Inspector for separats permits for those Namm iP APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner's Name Ro 6-, + FC' `� dap sKr' _Builder .,VSse Address 3 i CU /UL-. Address /ff'sd Cotvtc� - S+ pe,� No. Street LOCATION OF BUILDING Lot Block Addition or Subdivision Corner Lot Inside Lot Part of 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. To be used as: DESCRIPTION OF BUILDING Front z Depth -2-y Height Sq, Ft. SQe Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction F 4 -&4,-t.. 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. we�L, , r _�-��WA (Schedule of Fee Costs can be found on the Reverse Side). X40 -/S/,z LOT— � M^-M�,'' e`f � � C f � N� , a r E� / k/ � ./fl' / Sm��� BLOCK ADDRESS / 9,6 4 3 VALUATION ADD. TYPE JA/��f� O " h ®Iain n P of CcF /6 D to c r J70 r"o/9 Con cevo �u. e� p �w..r. JA/��f� O " h ®Iain n P of CcF /6 D to c r J70 r"o/9 01 SUBJECT P RMIT NO. City of Fridley ®14595 AT THE TOP OF THE TWINS BUILDING PERMT r RE N • COMMUNITY DEVELOPMENT DIV. © r � � PROTECTIVE INSPECTION SEC. /� �` /'-•1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY `•--- ,•J 612-560-3450 910-F15 13/17/78 JOB ADDRESS 195 63-1/2 Way 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 1 EV SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Richard F. Olchefski 195 63-112 Way N_ 561-5421; 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Richard Olrhpfqki, nenny Wilson Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION fel REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK re -roofing, siding, patio door - 3 front windows & casings, 2 new doors rough cedar siding 9 CHANGE OF USE FROM TO STIPULATIONS 1. Owner agrees that original roof will be removed (3rd roof not permitted) 2. Builder agrees to call for rough -in inspection on window framing. 3. Provide pre -formed valleys. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. 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 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 $5'00000 $2.50 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- $30.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE, 7Z $32.50 Or SIGNATUREOFC ACTOR ORAUTHO ED AGENT (DA I VVAfEN PROPERLY VALI TED THIS IS YOUR PERMIT BLDG. iNSP ATE SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE) 01 • CITY OF FRIDLEY , APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: .1_�slld��.� k� he •K� MILDER: •_harChe-Esxl. C)mr-NnLi wi l..sor1 Address: I q S- (03 a 00-&-A '&c` Address : A rv� e Tel. No. No.Street: (�,,3r/4� GO a�a� ,L1 F': _ LOT: S BLOCK: _ _ ADDITION: E" e r i C KS®n i UCS r m a n o r CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS: Applicant attach 'to this form A-io Certificates of Survey of Lot and proposed • building location drawn on these Certificates. To Be Up ed As: DESCRIPTION OF BUILDING 3 Front: Depth: Height: Square Feet: Front: Square Feet: Type of Construction: To Be Completed: Cubic Feet: Depth: Height: Cubic Feet: • � Dd�IJ'-(J Estimated Cost: $ , Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEE MXTERSE SIDE OF SHEET) Vare dersigned hereby makes application for a permit for the work herein ied, agreeing to do all work in strict accordance with the City of y Ordinances and rulings of the Department of Buildings, and hereby es that all the facts and representations stated in this application ue and correct. See reverse side for additional information. DATE: 'I SIGNATURE: Stipulations: or J/2 �e*L s � w- Job- ' • PARTIAL, RATE SCHEDULE PLUMBING. FIXTURE RITES: NO, RAT i-xmbe�.t Fix, tutee '• x 13,06 Nture PLccura Opening 12,06 Acv Flxcuce, Old Opening _;,•• x $2,00 Cscch 91eLn • �_-x 15600 �• x 55,100 100300 'BTU to 199, 000 BTU __..r u M � x a� ' 11aw Ground, FOan Old Building x 15.00 � IIOaCOr .+ .. N lst 3 fixtures �-x f. .�i JJdlcic:%.l rLxtures •r,_• x w uc x 510.00 .� a 0 di A 4 1A g -as a to '.�� Q I� w t� t o nea Ac • ��I tA ,T-77 ,, — (Ri - n cure COnnectiOn Oponing Conneccad with suuor (•J w 11ow Figtucoo Old Opening 11aCar ' • PARTIAL, RATE SCHEDULE PLUMBING. FIXTURE RITES: NO, RAT i-xmbe�.t Fix, tutee '• x 13,06 Nture PLccura Opening 12,06 Acv Flxcuce, Old Opening _;,•• x $2,00 Cscch 91eLn • �_-x 15600 I w3cor Moaner - to 99,000 BTU.'`' x 55,100 100300 'BTU to 199, 000 BTU __..r x 310,00 tdatet sal Caner x 11,90 ' 11aw Ground, FOan Old Building x 15.00 Lleccrlc Hster Heaton - ._ �_ x $5,00 CAP FITTING FEES: lst 3 fixtures �-x 13,00 JJdlcic:%.l rLxtures •r,_• x 51100 .-r-11 Ring a to 199s000 BTU -,_ x 510.00 RF'PAi RS 4 ALTERATI ONS ' rlrat i100.0o ' each ac3. $100.00 or traction S.tAto Surcharge TOTAL. F E E TOTAL s 15.00 1 Job Addreeeb5 ,,,� tiT• 97 -84:8-79001 1 Department of 0uildinge ' City of Fridley I Tal. N571-�a50 � i Tho undareignod hereby makes application lora permit for the i apacifled agruolgg•to do all work in strict accordance with Cho I and rulings at the Oopartnoni of Buildinge, and hereby daclaral the taacu and raprgeuntatione Mated in Chir applLcatlon are tri Fridley, K.%, '5-2-78 o<r�IFR OLCHEGSKY KIND OF BUILDING - frame A USED A9 res, TO BE C014PLETED "OUT 5-9-78 ESTIMATED COST 20.00! OLD 111:11 UUILDING PERMIT N0, PERMIT 110. Company WASCO Signed Dy' xol, No. �OUGII INSP. ' Dnto i FIN1?L INSP, /® �/� •-Zj Dato ' APPROVAL FOR PERMIT ' 52,00 1 MIIIIHUH rEt FOR N1Y PLUMDING PEMIT 13 11, 50 1 .so , 8.00 , 11 6_� SUBJECT City of Fridley =a�� AT THE TOP OF THE TWINS ?'•5 BUILDING PERMiT `I ■ RECEIPT NO. _2_-34NITY DEVELOPMENT DIV. - r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 53432 NUMBERREv I DATE F;GE OF APPROVED BY 612-571-3450 910-F15 116 98 / JOB ADDRESS 195 63 1/2 Way NE 1 LEGAL LOT N0, BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. g 1 Eva Erickson River Manor SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Sandra Walch 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Richard Hastings Contr. 6331 Riverview574-9966 4051 a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION ❑ ALTERATION 7a REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (23 Sq) Tear -off 9 CHANGEOFUSEFROM 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 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 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 1971 .98 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 $62.25 Fire SC $1.97 PLAN CHECK FEE TOTAL FEE �� l/ ` se 70.20 S'GNAT..1 D� 1:.I ACTOR OR THORIIEO AGENT 40ATEiWHEN�PROOPERLY LIDATED THIS IS YOUR PERMIT Bl iNSv TATE S.GNATUAE OF OWNEA,IF OWNER BWLDER� iOATEi 11 6_� NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 -A BUILDING PERMIT APPLICATION ConstructionAddress: ' ✓� - Legal Description: Owner Name & Address: PA1V,-1kt4 4 Tel. # Contractor: ,y Z 0 4A5 r` N65 MN LICENSE # Address: j j iZ ; v ,. z o i' c � (t t2 Tel. # . -7 74 6 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: Length Width Hgt/Ground Sq. Ft. OTHER: --->3 S4 --7 %, 9 -// ' Construction Type--1;i-A?. c R�7 Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: �6Z,- Zfe APPLICANT: �s� Tel. # 5 j —`f %'6� Permit Fee $ Z, Z' Fire Surcharge $ q State Surcharge $_ , SAC Charge $ License Surcharge $ 0-d Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ 10, Z® STIPULATIONS: 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 [ ] Not Necessary [ J CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 YAX: (763)571-1287 ADDRESS 195 63 1/2 WAY NE PIN 153024420038 LEGAL DESC EVA ERICKSON RIVER MANOR LOT 8 BLOCK 1 PERMIT TYPE HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERM �0.-O!tO118�—"-' DATE ISSUED: 07/28/2004 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 AN AIR CONDITIONER. # A/C UNITS 1 # FURNACES 0 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) APPLICANT KNIGHT HEATING & AIR COND INC 13535 89 ST NE OTSEGO, MN 55330 - OWNER LAUREL CLAIR 195 63 1/2 WAY NE FRIDLEY, MN 55432 2924 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 constTction or the performance of construction. ADDli&k Date / f Bldg Insp. HEATING PERMIT MINIMUM FEE 0.00 FURNACE SHELL/DUCT WORK 0.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 25.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 25.50 PAID WITH CHECK # 5497 SEPARATE PERMITS REOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY BUILDING INSPECTION 3431 University Ave NE =ridley, MN 55432 763-572-3604 FAX 763-5711287 lesidentlal =umace Shell and Duct Work, Burner & also Replacement Furnace aas Piping (New Furnace, Fireplace, Insert) aas Range ft as Dryer 'Air Conditioning -All Sizes kil Other Repairs or Alterations (List on Back) 176 of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of mprovement whichever is greater le4049 � Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS / qS- " k3l')6 �• 2g=� F� y � Owner L� $35.00 $ Building Used As.S/Q R L7 $10.00 $ ESTIMATED COST �e ®� PERMIT NO 40041' ' ®� $10.00 $ $10.00 $ $25.00 $-2f, 2 , D commercial/Industrial/Institutional L25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE 3EINSPECTION FEE $50.00/HOUR $ • 11• • :l` • :. # of Heating Units�Circle One (Steam) (Hot Water) (Warm Air) Trade Name /C-N/y?I72 fYt 2J &4�2-a q* Size No. BTU HP EDR Fuel Total Connected Load Burner Trade Name BTU Size No. HP I 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. $ '50 HEATING $ aS, Signed_ kAir Conditioners can not be placed in side yard without written approval °rom adjoining property owner - copy to City FILL OUT BACKSIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Tel # Z/k3-A 7'1-99X5 FAX # 027q-9 9X� Date Approved by Rough -in Date Final Date 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 odes 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 odes 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 manufacture's specifications. Yes ( ) No( ) When Installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current odes 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 Lengthft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date: Building PLUMBING Permit No � Inspections RESIDENTIAL APPLICATION Received B 763-572-3`604 CITY OF FRIDLEY Date Recd: DATE -3 YOUR E-MAIL ADDRESS SITE ADDRESS l %S - G13 `% W THIS APPLICANT IS: 0 OWNER 526ONTRACTOR PROPERTY NAME: C°L4� OWNER/ /� ADDRESS' 1KS7` 3 2 CITY C2 STATE�ZIP TENANT =(-SI 28in PHONE: CONTRACTOR NAME: STATE LICENSE GeJ (�- EXP DATE ^ O G �3�G1 PcA, STATERs ZIP��tJ SUBMIT A COPY OF YOUR STATE ADDRESS: / ,P i�+'�%f CITY 9,,,e_ LICENSE WITH PHONE FAX APPLICATION PERMIT TYPE UZfNGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE 0 NEW LACEMENT TYPE OF WORK: DETAILED DESCRIPTION OF WORK PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. is s � reflect only the cost of labor) Labor cos(unde:$300 = 5.00. Labor cost between $300 to $500 = cost of laborFOR PROJECTSLABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) BATH SINK/LAV FLOOR DRAINS —SHOWER _ WATER PIPING _ GAS PIPING aam) cm LjcEirA _ SWIMMING POOL WATER SOFTNER ($35) —BATHTUB _ WASHER KITCHEN SINK —WATER CLOSET _ BACKFLOW PREV. ($15) _CLOTHES _ DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ WATER METER —OTHER Permit Fee. $ Number of fixtures @ $10.00 x $10.00 = $ Surch a .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ State Surcharge 0 Total (= $ 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 which requires review and approval of plans. SIGNATURE OF APPLIC PRINT NAME - DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977