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PRE 2010 DOCSCITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 FAX: (763) 571-1287 ADDRESS : 381 66TH AVE NE PIN : 143024240012 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-00541A A i ?3 DATE ISSUED: 04/21/2004 VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. WIRE FURNACE AND AIR CONDITIONER # INSPECTIONS 1 APPLICANT CENTERPOINT ENERGY/MINNEGASCO 13562 CENTRAL AVE NE ANOKA, MN 55304- (763)757-6202 OWNER RASMUSSEN GREG 381 66TH AVE 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 worl 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 STATE SURCHARGE, ELEC FLAT 0.50 ELEC PERMIT FEE - MIN (RESI) 20.00 TOTAL 20.50 PAID WITH CHECK # 5510 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY PERM o.: 2004-00540 � 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 04/21/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 381 66TH AVE NE PIN : 143024240012 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 6,000.00 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 INSTALL A FURNACE (WARM AIR, CARRIER, 60,000 BTUS) AND AN AIR CONDITIONER # A/C UNITS 1 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 APPLICANT HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK 0.00 -599- CENTERPOINT ENERGY/MINNEGASCO 13562 CENTRAL AVE NE GAS RANGE FEE 0.00 ANOKA, MN 55304- GAS DRYER FEE 0.00 (763) 757-6202 AIR CONDITIONING FEE 25.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 5510 0.50 . -60-5&- OWNER RASMUSSEN GREG 381 66TH AVE 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 notpres a to give authority to violate or cancel the provisions o y other state or local law regulating construction or the p orm a of constru 'on. Applicant Date Bldg Insp &�L SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. {/Af&Nfit. &ergy Minnegasco V ADDRESS 4 •'i�- OCCUPANT HEAT LOSS Yes DATE HTG. INST. SOLD BY CenterPoint Energy Minnegasco Electrical Work By to TYPE OF HEAT FA X SPACE HTR. DESIGN MAKE rf,P Model 10—/ Serial!_Z �3 3_ �. 7 � NPUT 4-070000- CONTROLS THERMOSTAT Heat Plug Value W A i Limit Limit Settin Fan Settin Pilot Type C Pilot Make C./ r- r I r �+ Pilot Model Pilot Timing i4-5-!�W- Pressure_Percent CO2 nput CFH 47,0 ®®o Percent 02. Stack Temp. /® e/ Percent CO l APT. FLOO CITY OWNER �o :S XeV�S ioA INSTALLED BY CenterPoint Gas Line By t UNIT HTR. OTHER CONVERSION Chimney Construction Wiring r Test Tag e"' Lighting Inst. Date Tested d Company Testing Qent intr n asco Name of Tester Vent Size KIND OF LINER SIZE NONE Draft Hood dr7ed Regulator Filters Size Number l Chimney Location Inside Outside Chimney Construction Wiring r Test Tag e"' Lighting Inst. Date Tested d Company Testing Qent intr n asco Name of Tester 0 K 55 (0 CITY OF PRIDLEY INSPECTION DIViSION ti 643kUniversity Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES FAX .(763) 571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.251yo of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. P�a,93 Effective nuary 1, 2003 JOB ADDRESS ZI (-0� div �t OWNER &_6ck TOTAL BUILDING USED AS c� PY1 ESTIMATED COST UQCQ- 00 PERMIT N0. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water (Warm Air) $ Trade Name �rtfie,r Size No. _ r" BTU OCA Q HP EDR $ '� �� Fuel aws Total Connected Load Burner Trade Name Size No. $ BTU HP EDR r- I gern&lq o524onS $ 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 $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. $ S�O DATE CenterPoint Energy Minnegasco HEATING C013562 Central Ave NE, Anoka, MN 55304 Signed 763-757=6202 FAX # 763-757-6701 Approved By Rough -In Date' Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED r= w,.* w�T nr1A1nIG^Tr1R AND GOM ISTInN No �iFRIFIGATION �n MnN When pisininganexistin fliranne, the undersigned hereby verifies that the venting has been examined d i sfr a from where, required.teortin, obstructions, Yes (R) No ( ) and is securely supported and PP The venting system is plastic/PVC and meets all current codes and manufacturer Yes x► No ( ) specifications including sizing, length, number of elbows and termination. The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufactCentral Furnacerees VentingVent ngcTabl s fohlf noes include AGA-GAMA Category Yes (x) No ( ) assisted and natural draft appliances. The is sized and installed to meet the current codes Yes No( ) and manufacturer's specifications. When required to °-"`"" " c n busfinn air_ it will be sized and installed to meet the current codes and manufacturer's specifications. Yes �) No ( ) When Installon- " "�" fine system, the undersigned hereby verifies that itis a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace yes f) No( ) Venting Tables for fan assisted and natural draft appliances. inst led Is the common as been removed from the common vent and vent connectors sized vent and vented after an appliance ( ) separately as per current codes. Yes (x) No ynp and Sbp/Cnmmen Vent and Vent C Appliance #1 Type BTU Input_. Fan Assisted or Nat ,/ BTU Input 335 z Fan Assisted or Nat s Appliance #2 Type � � ��-y � --�--- Appliance #3 Type BTU Input Fan Assisted or Nat cu Total Appliances _.� Total Btu Input 3 5,1- Common Vent Type �/�� Vent Height % Diameter inches ft Diameter "I in Type � Appliance #1 Vent Connector Height ft Length �. �'in Type Appliance #2 Vent Connector Height _ ft Length _ft Diameter_. Appliance #3 Vent Connector Height= Length_, ft Diameter in Type N s HEATING CO: Cent xPoint E Ee 13562 Central Ave NE, Anoka, MN 55304 Date: Signed By: