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PRE 2010 DOCSCity of Fridley, Mian.. N9.10 8 71, BUILDING PERMIT Date: October 23 1970 Owner. Eugene E. Emerson Builder Same Address 50 N.E. 6_ 3:3g Way Address S ame LOCATION OF BUILDING No. .9_�Street 64th Way N.E. _____ Part of Lot Lot t 18 ,19 _ Block 12 Addition or Sub -Division .__ _Fridley Park Corner Lot — Inside Lot _.._ % Setback --_ Sideyard Sewer Elevation To be Used as: Foundation Elevation DESCRIPTION OF BUILDING Residence Front _ �' Depth 28'4" Height 20' Sq. Ft. 1260 CLL Ft'. 25,200 Garage _ Front 24' Depth 28.4 Height 10 Sq. Ft. 672 Cu. Ft. 22 6720 Type of Construction Frame —Estcost $20,000---- To be Completed 10/15/71 Elevation 18" above center line of street Bard surfaced driveway Verification survey required 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 aft provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $_6O. 00 , permit is hereby granted to Eugene E. EMCKSQU to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any past thereof, shall conform in all respects to the ordinaaoEs of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings orwithin the dty limits and this permit may be revoked at any time upon violation of say of the provisions of said dinances. Building Inspector HANK MUHICH NOTICE: This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be euro to son the Building Inspector for separate permits for these Nona. 0 APLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA .�� OWNER'S NAME: ADDRESS: 5-0 /U E= 16,3 1 ADDRESS: L x NO: _ STREET: & LOT :1-G, / 7-1,F-//7 BLOCK: ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: Front: Depth: _i�-� Height• Square Feet: Cubic Feet: Front : Depth : ? V Height • (� Square Feet; le 7 Cubic Feet:_ Type of Construction: sc e�ls�7C— Estimated Cost:_$ eZ 0, c;ej 0 To Be Completed: �� C- 1,T / 577 . F„ ,d The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stfict 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 : _ �% �� SIGNATURE: - 1 (See Reverse Side For Additional Information.) �`°� Land Planning su�i�%L'C�a 6875 Highway No. 65 N. E. Land Surveying I •I'nnhh • � //++ Minneapolis, Soils Testing �'� /eel� ) E'/ L• Minn. 55432 Civil Engineering Telephone 784-6066 Municipal Engineering Engineers & Surveyors Area Code 612 Certificate of Survey for I 11k- 4' V �J� p , � n W ►lZ/n VVA Y _T11C..iC.l.i �� -�E3r_ _'9 ,v. C,.+!.`j ! 0�� "�._4' .7 ,.tea r� ✓�� .'.,., J f 1 hereby certify that this is a true and correct representation of a survey of the boundaries of the above described land, and of the location of all buildings, tfiereon, and all visible encroachments, if any, from or an said land. As surveyed by me this /3 f'�day of 0 o ft: ,a m• A. D. 191; SUBURBAN ENGINEERING, INC. Engineers - Surveyors L `� by C CJ ra 1 0 , ry W 0 t 4- 5-VJ /� b /. 'I Land Planning %2 6875 Highway neap N.E. Land Surveying • ��j Minneapolis , &Will Ql . Vii• Minn..SS432 Soils Testing Ctelephone 784-6066' Civil Engineering i Area Code 612 Municipal Engineering Engineers & Surveyors Certificate of Survey for Ell-t----17e'��'� i 11'A(.0 Of L4 19 e.,,�, 05+/ 5 � x x u r q j Le - �'-� a fat " a �- , O v .6 *- C : I "co id . ff + 3` sOVA line of I01 11-/ WA Y e, r t -T 7, 4y, /17 Wiz,.Oc I hereby certify that this is a true and correct representation of a survey of the boundaries of the above described land, and of, the location of P) buildings t ereon, and all visible encroachments, if any, from or an sold land. As surveyed by me this Jay obe,� A. 0. 19 .f4 I I SUBURBAN ENGINEERING, INC., �b Engineers Surveyors by + �- �'DYK s N? 5231 Permit for PLUMBING AND GAS F1 ING N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for Permit inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of thispermit., Fee $ 4406 DESCRIPTION OF WORK Number, Kind and Location of Fixtures city of Fridley U � �1° , Is Q Stories m � C W a tW o z a J n �. U 7 m m a O m I.. m z m a m Y z m m m r a .; t Y F' z C O O LL w 3 o x M C m 0= o a J a LL p S m U z f 'm a s U m Z m x a 0 LL' J v m x f 4 m y a s O a tW7 m z a s L9 K WATER HTR. GAS ELEC. Basement 1st 2nd 3rd 4th Connected with(Zer-A6spool Gas Piping for Openings Permission is hereby granted �?"°.L-A2 P_ I %J1. to do the plumbing and gas fitting in the building described in the statement hereto attached, upon the express condition that the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and this permit may be revoked at any time upon the violation of any of the provisions of said ordinances. By Order Of The Inspector Of Buildings Roughing in Inspection Date Inspector. Final Inspection Date Inspector. 42 JM -."9-v Owner - coA),g iettG/d) Location (99-6117- " W O/ r[ Kind of Building f 1e #4 M 6_,_ Used as Atm [ L, Ai To be Completed �� , 19,E Estimated Cost ew Building Permit No. Date Inspector of Buildings. City of Widle i Application for Plug and Gas Fbtkg Feuer Dept. of Bldos. Phone 960-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures I.erat}e� • New Fixture. Old Openings PARTIAL RATE SCHEDULE PLZIMMBING FIXTURE RATES: • ... • � x $RATE$ TOTAL Number Fixtures ........... 15f. Q Future Fixture Opening ............ x $1.50 $ _ New Fixture Old Opening .......... x $1.50 $ Catch Basin .................... x $3.25 $ Water Heater (Up to 99,000 BTU) .... x $3.00 $ New Ground Run Old Bldg. ........ x $3.25 $ Electric Water heater .............. z $2.00 $ 3AB FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .................. x $2.00 $ '2. y Additional Fixtures .................. x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS S ALTERATIONS—Refer to Code Description ............................................. f TOTAL FEES :43• 0 ri City of Fridley: The .undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct Fridley, nn 19 _z0 Owner sof �' 1�r'+ C O h S 2 t1 G7',- 6h 24 Kind of Building S Used as SI h 4 L �P I D To be completed about S % Estimated Cost, $ Old—New. Building Permit No. Permit No. Signed � By. Business Phune No 5' 3 3 Y V ROUGH • I • N WATER NTR. GAS ELEC. 1st % 2nd 3rd 4th • suture connection Ooeninas connected with • New Fixture. Old Openings PARTIAL RATE SCHEDULE PLZIMMBING FIXTURE RATES: • ... • � x $RATE$ TOTAL Number Fixtures ........... 15f. Q Future Fixture Opening ............ x $1.50 $ _ New Fixture Old Opening .......... x $1.50 $ Catch Basin .................... x $3.25 $ Water Heater (Up to 99,000 BTU) .... x $3.00 $ New Ground Run Old Bldg. ........ x $3.25 $ Electric Water heater .............. z $2.00 $ 3AB FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .................. x $2.00 $ '2. y Additional Fixtures .................. x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS S ALTERATIONS—Refer to Code Description ............................................. f TOTAL FEES :43• 0 ri City of Fridley: The .undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct Fridley, nn 19 _z0 Owner sof �' 1�r'+ C O h S 2 t1 G7',- 6h 24 Kind of Building S Used as SI h 4 L �P I D To be completed about S % Estimated Cost, $ Old—New. Building Permit No. Permit No. Signed � By. Business Phune No 5' 3 3 Y V ROUGH APPReatfon for Power Plants and Heating, Coofim Ventilation® Refrigeration and Air Conditioning Systems -and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: BATE TOTAL Furnace Shell & Duct Work ........................... $10.00 $ Replacement of Furnace 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR �t Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 �P$Joe each add. 60,000 -'BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations. _each add. $50040 ............. 9.00 $ STEAM or HOT WAFER SYSTEM Furnace Shell & lines—to 400 sq. ft. EDR Steam .. .$10.00 $ Furnace Shell & Line_o 640 sq. ft. IDR Hot Water .. 10.00 $ Each add. 200 sq. ft. EDR- Steam ...................... 3.00 $ Each add. 320 sq. ft. IDR Hot Water ... .. 3.00 $ OIL BURNER—to 3 gal. per hour ... . ' ... ... .. ..... 6.00 $ over 3 -gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTU) ....... ....... .......... 855 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL city 1st 3 Fixtures ...:. ................ x$ 200 $ Additional Fixtures ................. x .75 $ Gas Range to 199,000 .......... z$ &W $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM ALTERATIONS & REPAII03 TOTAL FEE ROUGH Dept. of Bldaa. Phone 8O-3485 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 Ordinanm 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 12- — J // 1&70 Owner /()' �o �L' 1'0 C& 4 /t Kind of Building Used as J�c,�loh To be completed about 3-15--76 Estimated Cost, $� 00 Old—New. Building Permit No. Permit Pio. ' 7` Iz DESCRIPTION OF WORK HEATING or PQW= PLANTS -Steam, Hot Water, arm Air No� Trade Nam MK 00 W Size No 46 Capacity 0 000 0(4sgq. Ft. E.D.R BTU H.P. Total Connected Load 1 ®® Hind of e4s BURNER — Trade Name_ Size No Capacity Sq. Ft ED R- BTU HY0 FINAL (REMARKS -OVER) °nom 0 • PERMIT for Power Plants and Heating. Cool- ing. Ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of Heating Plants 0A&X / Lto be nstalled tered—repaired Make ,Size 3d- /a d Oil fired ; Coal fired--!,- Gas fired ; Gas Authorization No. Remarks Approved by. Final Inspection Date , 19_ Inspector Pest N° 4861 Fee $ A7 CO Office of the Inspector of Buildings City of Fridley City of Fridley, Minn. � • , 19-20 Owner /c'e F" 66IM Location —U Kind of Building FAA -r f How Occupied Work to be Commenced—, 19— To be Completed&Apad ,19--0$ Estimated Cost, $ %000or) ONew, Building Permit Permission is hereby granted to to install—erect—use the material and devices described in the above statement. This permit is granted upon t express condition that the person to whom itis granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the specifications t fin the approved application for this permit on file in the office j°ice o f the Inspector of Buildings. Inspector of Buildings 42 2M11 -67v SUBJECT PERMIT NO. City of Fridley, 0 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEI � COMMUNITY DEVELOPMENT DIV r 1 L PROTECTIVE INSPECTION SEC 3� CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 970-F15 10/6/95 JOB ADDRESS 99 64 Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 17-19 12 Fridley Park Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gene Emerson 99 64 Way NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Richard Hastings Contr 6331 Riverview Ter NE, Fridley 55432 574-9966 4051 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 O NEW O ADDITION 0 ALTERATION REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof Dwelling (25 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 I 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 $2,000 $1.00 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- $62.25 Fire SC $2.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE License SC $5.00 TOTAL FEE $70.25 SIGNATURE OF CONTRACTOR O UTHORIZED AGENT IDATEI WHEN PROPER VALIDATED THIS IS YOUR PERMIT 4 ® )NSP w )ATE - SIGNATURE OF OWNER )IF OWNER BUILDER) (DATEI 1 NEW [ ] Effective 8/1/95 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application�� Construction Address: 6 y7/,' Legal Description: Owner Name & Address: C >eWE- MFz So L�/ Tel. # Contractor: < C, �' k 'tZ 0 A 5 ,' g S _ MN LICENSE # Li o 5 I Address: �_3 I viFe 0 1'1F'j -ric 12 Tel. # 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: _ Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: -oFF , - i2 c Estimated Cost: $ S -e' - Approx. Completion Date: /�1 /� s -p S (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: �0 6 APPLICANT: �.. Tel. # 5';? CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ ' 0 0 .001 of Permit Valuation (1/10th%) State Surcharge $ G) $.50/$1,000 Valuation SAC Charge $ $850 per SAC Unit License Surcharge $ 0 6) $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $� STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On March 1, 1 fib, APPLICATION FOR PLUMBING AND GAS FITTING PERMIT P r MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FI OOR PLUMBING FIXTURE RATES: NO, RATE TOTAL JOB ADDRESS_�� New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 a �2� .1996 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner_X? ,k Water Heater -Electric $ 7.00 Water Heater - Gas** �_ $10.00 gip, pa Building Used As Gas Range** $10.00 Gas Dryer** $10.00 Estimated Cost Lpoo . cycS PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 T— PLUMBING COMPANY --j-_z�jl7e_Ktfl,4=+L. r, - /,rt, e_0, i Reinspection Fee $42.00/Hr SIGN E r TEL N0.` 7% 9 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance 4,0. va Approved By Rough -In Date Final Date State Surcharge $ .50 ,-,-)0,5 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $2000 TOTAL FEE $2zacv PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. Q CITY OF FRIDLEY INSPECTION DIViSION Effective On May 10, 1999 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS 9 9 AM' 6qA %C/Cc.V RATE SCHEDULE OWNER Gen e— Om ev',;5oa Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED AS @2 iVenLR Also Replacement Furnace $ 30.00 (Side Vent - Fill Out Back) $-3010D 0-' PERMIT NO. �•� �- �� ESTIMATED COST239's- Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range :s 10.00 $ No. of Heatin Units I Circle One (Steam) (Hot Waterarm Air) Gas Dryer $ 10.00 $ Trade Nam w,saaoA3b Size No.-G,4115 BTU aQ, 00 C> HP EDR *Air Conditioning - All Sizes $ 25.00 $ Fuel A),Q �- 6--as Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $_ BTU HP EDR Commercial/Industrial 1.25% of Value of Appliance or Work $ 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 State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are*true and correct. TOTAL FEE $%[� MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO � J n ai'(- REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE Signed DATE T(�ITCjT REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without Approved By J4 Rough-In Date Final Date written permission from adjoining property owner. ,J 0 h ,4=;'- C 9 ej 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes ( ) No ( ) 8. Has combustion air been provided for water heater Yes ( ) No O - Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CHIMNEY -AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes () No ( ) 2. Is free from rust or deterioration Yes () No ( ) 3. Has no foreign objects lodged within Yes () No ( ) 4. Is securely supported Yes () No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes () No ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes ( ) No ( ) 8. Has combustion air been provided for water heater Yes ( ) No O - Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CITY& FRIDLEY INSPECTION DIViSION Effective On January 1, 2000 6$31 University Ave NE Fridley, MN 55432 APPLICATICI FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572.3604 REFRIIERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS RATE SCHEDULE OWNER .lire6_27,94-or�.2 Residential Rate TOTAL Furnace Shell and Duct Work, Burner • Also Replacement Furnace 30.00 BUILDING USED AS (Side Vent - Fill Out Back) $P0 ESTIMATED COST U X .00 PERMIT NO. 1W9J Gas Piping (Needed with new furnace, 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range 10.00 $ No. of Heating Units_ Circle One (Steam) (Hot Water)War�Air Gas Dryer 10.00 $ Trade Name a Size No. 333 P C� BTU For 61�HP EDR *Air Conditioning - All Sizes 25.00 $ Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial . 1.25% of Value of Appliance or Work $ 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 State Surcha e $ .50 rulings of the Building Division, and hereby declares that all the facts and 30,50 representations stated in this application are true and correct. TOTAL FEE $ DATE 9-1-3 _6t BLAINE HTG. AfC a ELECT. INC. CENTRAL AVE. N.E. MINIMUM FEE F ANY H ATING COOL NG/VEN 0 HEATING �: ANOKA. MIN 6iik PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in -a side yard written permission from adjoining property owner. Signed Approved Byjf!x�_ Rough -in Date TEL # '?( �2�� /lq - Final Date, kt3lbo COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and fire -stopped whe.[e required. Yes() No(,)— The o(,) 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 installedN'__ / % Ll - When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's j 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 Tv6e 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 inv Type Appliance #2 Vent Connector Height ft Length ft Diameter ;,inti Type Appliance #3 Vent Connector Height ft Length ft Diameter. jif Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date MAK U12 HEATING 8..LA%11vrM AIRCONDITIONING AND ELECTRIC, INC. ADDRESS -79— GIN tj A1C l6% e. Frill (eY m rj . WY. ' OCCUPANT C 'Qr, r1 r HEAT LOSS DATE HTG. INST.' 22 —00 SOLD BY.9IXARo Electrical Work By --&L" 2 E6, i A i - TYPE OF HEAT GA FA_>—e, HW STEAM SPACE HTR. GAS DESIGN MAKE Moder tl19 YvO-go Serial 320nAS 110 3 INPUT THERMOSTAT ®® CONTROLS F`� Heat Plug Value Test Tag �K Door Pressure Lighting Inst >e Date Tested 9' '00 Limit A Name of Tester J3 /&, d i 11 Limit Setdn f Fan Setting Iorned Pilot Type ALL�* Pilot Make h/ Ao+/�" Pilot Madel Pilot Timing 14 5 $ Lac L.W. Cut Oft Pressure 3.6- IJG Percent CO2 % 70 Input CFH K0. 000 Percent 02 910fle Stack Temp. 3-2;- Percent CO J 3 AP^ ROUSE HEATING TEST RECORD APT. FLOOR CITY °' UBURB OWNER INSTALLED BY 1X' #-t&, Air Gas Line By g %,i. N f. 4ir UNIT HTR. OTHER CONVERSION Vent size sit KIND OF LINER IwM iA., erl SIZE _ it NONE Draft Hood Regulator lad Filters Size Number Chimney Location Inside Outside Chimney Construction Smoke Bomb Wiring X Draft Test Tag �K Door Pressure Lighting Inst >e Date Tested 9' '00 Company Testing N C Name of Tester J3 /&, d i 11 & 0 4. f— Pressure 3-5'-zn1 y L Input CFH_ *V. ®M Stack Temp. Percent CO2 %/® Percent 02 9190 Percent CO dPAOM Building PLUMBING Permit No.�ZG c% Inspections RESIDENTUL APPLICATION Received By-Pa4f U_ 763-572-3604 CITY OF FRMLEY Datd: 763-502-4977 FAX " EFFECTIVE 2-19-09 DATE o YOUR E-MAIL ADDRESS SITE ADDRESS 1% THIS APPLICANT IS: 0 OWNER ONTRACTOR PROPERTY NAME: C� ADDRESS: W ,4 W C CITY Ft,i STATE M ZIP Z'E 2 � TENANT y _7u PHONE: 3-J514 - 194 CONTRACTOR NAME: L V4- V 1 '&M vel` /U! STATE LICENSE# EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND STATE BOND # EXP DATE _ CERTIFICATE OF ADDRESS: S 2O AU1/L SfL�CITY STATE` ZIP � INSURANCE PHONE '-105- �S�- 2M4 FAX PERMIT TYPE #NGLEFAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW 9REPLACEMENT DETAILED DESCRIPTION OF WORKWki�� FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $35.50. _WATERPIPING _BATHSINK/LAV _FLOORDRAINS _SHOWER GAS PIPING (NEED CITY LIC) _ SWD&.0 NG POOL —WATER SOFTNER ($35) —BATHTUB _ CLOTHES WASHER KITCHEN SINK _ WATERCLOSET _ BACKFLOW PREV. ($I5) _ _ LAUNDRY TRAY ,+WATER HEATER ($35) FOR IRRIGATION —DISHWASHER _ WATER METER _ OTHER yy WE � I WS �'� �¢ m 2��, h � ��5i ��. $ _�' � t rZ.'� �� v�.3''A1 .�.$h{. i., �r � H��1bih �'C', i^`^t ,"4. . { � � �. •L �� I� �t � � � t. F R i.j E 7� �1�uP��`C+�'��, •`?3{�"''�I �u a. �Y �'i'�,y�?u' M'3 }; 3��:1. i F-.3'��'rF4, �t'ei' �' l.s�`I "F �i ;d .i�&!�: � �,� .sx `�µ, ��+r 2�'nh �[. r r.,? s �..„.. rhr. �.q. �L'��bwyi.�4.eF�pIS 4.t;t. t.,7�{1.sd..y^1� ....(9.M�,j".h:,� ')�1.��14� {1 "�a3;45�...!. F��,',:}t.,r.•rr {1 �.r ,t. _i . t� ti � Al'r��(.' S ��:r t.. u�;F�. ...'�.��9�t�.ai..;. i�1��#� .,..,.r.1, t'. `�..':d.. 1 i 5...vn,,.... .:�tr1Gi.�+ ��, :.!i,.;:,:,,d,.,h.16:::,��u1f� :. 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"rr ,i .�::.. r +h• THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a plumbing 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 on site; that the work will be in accordance with the approved plan in the case a�lll which requires review and approval of plans. �of work SIGNATURE OF APPLICANT G'U�'V ��'V�U✓� PRINTNAME )Q;/ - DATE PLEASENOTEB SEPARA`L'EP.ERMIT SARE:REQUIREDFOR BLIILDING,.ELECTRICAL.ANDMECFtANICALWORK: City of Fridley Building Inspections Department 6431 University Avenue NE. Fridley, MN 55432 763-572-3604 FAX: 763-502-4977