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PRE 2010 DOCSG `^ I� Number Fixtures x $200 $ z� x $1.50 i 8Z �j x $1.50 $ 0 i • • WATER HTR. x $8.00 $ New Ground Run Old Bldg. x $3,25 $ Electric Water Heater s $200 $. GAS FITTING FEES: NO. RATE TOTAL <Z x $200 0 a4 0 p I N GAS ELEC. Base -- lst- 2nd 40 3rd ° Future Connection Openings Connected— * New Fixture, Old OpeningsI ❑ Ceer Poo ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $200 $ Future Fixture Opening x $1.50 $ New Fixture Old Opening x $1.50 $ Catch Basin x $3,26 $ Water Heater (Up to 99,000 BTU) x $8.00 $ New Ground Run Old Bldg. x $3,25 $ Electric Water Heater s $200 $. GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .... x $200 $ Additional Fixtures ..... .............. x $ .?b $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS B ALTERATIONS -Refer to Code Description .... ........... $ TOTAL FZE $ V I LEI 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, MJnn- 19 Owner Kind of Building Used as To be completed about Estimated Cost, $ Old—New. Building Permit No._ __ e it No. a Signed ROUGH FINAL By- — - Business Phone No IdealN? 4950 Origin Permit for PLUMBING AND GAS PITTING 4/73V5- N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for Permit 0-15inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit., T+ee DESCRIPTION OF WORK Number, Kind and Location of Fixtures City of Fridley StoTles W F O Q J 3 U Z 4' 0 tz. m Q 7 m h Z Gl Q m U Y Z M = N m¢ Q C F Z 7 E 0 O U. O T N Z O Q J a 4. 0 S Z t0- of Q 4 U f0 3 Z C Q O K J ai X e a d 6 W m Z Q Q WATER HTR. GAS ELEC. Basement ist 2nd 3rd 4th Connected with Sewer -Cesspool Gas Piping for Openings Permission is hereby . granted 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. Location J -5 ZOO -- & (o A CLxl— Kind of Building � Used as—a::��—� To be Completed '19— Estimated 19_ .Estimated Cost Old -New. Building Permit Date Inspector of Buildings. QMVT-TT WARK AIR: RATE TOTAL - Furnace Shen & Duet Work ... .... .. $10.00 Replacement of Furnace 6.00 5 Repairs & Alterations—up to &W.00 6.00 i- -- -- — Repairs & Alterations each add. 3500.00 300 Furnace Shell & Duct Work to 180,000 BTU STEAM .$10.00 =_ each add. 60,000 BTU . .. ...... 3.00 Replacement of Furnace 6.00 ® Repairs & Alterations—up to $W.00 6.00 $L— Repairs & Alterations each add. 5500.00 3.00 — _ $--,— STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq- ft. KDR Steam $10.00 $--- Furnace ___Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $_ Each add. 200 sq. ft. EDR Steam Xon $ Each add. 320 sq. ft. EDR Hot Water 3.00 $_ OIL SURNER—to 3 gaL per hour 6,00 over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 189.000 BTW over 199,000 BTU Be* Fee Schedule GAS FrMNG FEES. NO RATE TOTAL 1st 3 Fixtures x5 200 Additional Fixtures x .75 $ Gas Range to 199.000 X$ 5.00, i A R COMMIONMG PAN INCA711M STSTZK FN Schodolle NTSTW5 r�' AL & REFAM TOTAL Fitly /ASO FHS m 1-13- 2s -- city of Fridley: The undersigned hereby makes application for a permit for the work dereis specified, agreeing to do all work in strict accordance with the City Ordinancev and ruling of the Department of Buildings, and hereby declares that all the fads and representations stated in this application are true and correct. Fridley, Minn- Kind inn Kind of Building Used as To be completed about Estimated Cost, $ 45 New. Building Permit No. _— permit No. ON OF WORK �HKA7n7Nor POWER PLANTS—Steam, Hot Water, Trade Name gj= No- Capacity------ o- Capacity---- — Sq. Ft. E.D.R Brij— Total TU Total Connected Ltaad _ Rad of Ftm t BURNER — Trade Name size Nie COia&dty Sq. !t ZD -R -BTO =I,- City of Fridley AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT PERA - . 12486 ' r ', L'•_____ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. ECEIPT NO. NUMBER 910-F15 REV, DATE 4/12/74 PAGE OF APPROVED BY /•'•1 CITY HALL FRIDLEY 55432 �•••' �'J 612-580-3450 JOB ADDRESS 1328 - 66th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 1 Aud. S SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE David Coppernoll 1328 66th Avenue N -R- 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. 6 USE OF BUILDING Residential i CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 14' x 14' Storage Shed 9 CHANGE QF USE FROM TO ..STIPULATIONS Approved by Council on April 1, 1974. Stipulations; The building be attached to a permanent foundation. The use of this building be limited to storage. This building is not to be used for any commercial enterprise. Waiver of Survey signed by property owner at 1340 - 66th Avenue N.E. SEPERATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGN SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Meta I THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION ZONING SQ. FT. CU. FT. 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 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED, VALUATION SURTAX WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 300.00 . 50 DNO PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE VISION OF ANY STATE OR LOCAL LAW REGULATING CON- TRUCTION OR T E RFO MANCE OF CON TR CTION. $5.00 -lL-7 PLAN CHECK FEE TOTALFEE $5.50 , SIGNAT RE OF CONTRICThRORAUTHORIZ DAGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT BLDG. )NSP. DA E SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) I, RR-1 C P-,A-C /'I-- Z A"'oP , owner of the property located at 1540 (A -Arc, have no objection to the City allowing the construction of a Stal6A&g. ��a�►i� to be located at 1122 (6— A41L without the required certificate of survey that the City ordinarily requires for all new construction. Signed 13 y6 d 1 AVE N• �. Address Date Witness APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME:_�/q v /J C07j EP� ,UOLL BUILDER: ADDRESS : I3 N. ADDRESS: / 14V NO:-.- 3 Z STREET: 6 -je- /v - E LOT: 6 BLOCK: SLS 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. To Be Used As: DESCRIPTION OF BUILDING Front: Depth • Height Square Feet: Cubic Feet: Front: Depth; —Height: Square Feet; Cubic Feet: Type of Construction:� Estimated Cost: $.3 To Be Completed: The undersigned hereby makes applicativn for a permit for the work herein specified, agreeing to do all work in stxict 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. 1 12�� �' / '__j DATE: / Z — 71 SIGNATURE: (See Reverse Side For Additional Information.) City of Fridley SUBJECT P ®133 AT THE TOP OF THE TWINS BUILDING PERMIT NO. COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. !EIPT 7: 1 1 i NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 �••--� �•� 612-560-3450 910-F15 2-20-76 JOB ADDRESS 1328 66th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 Parcel 156 A.S. #10 SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE David Coppernoll 1328 66th Avenue 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. 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW �I ADDITION ❑ ALTERATION C)( REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK construct a masonry chimney and reroof o 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING & VENTILATING OR AIR CONDITIONING. fel sonry shingle 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 1 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 $6OO MIX WI WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .5O DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 5.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE 5.50 ��SIGATUREOF RACTO ORAUTHORIZEDA EN IDATEI HEENPR RLY ATED TIIS IS YOUR PERRMIT � 4.rr rig="G✓� � ~/ci' /;...+�=g~� BLDG INSP Al DATE SIGNATOR OF OWNERIIFFJWNER BUILDER) (DATE) �� APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY$ MINNESOTA OWNER'S NAME :D1,f� ADDRES S : 13 7-9 � � � / ► "� / ` ADDRESS: NO:. / STREET: LOT: (� -- 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: C/ k ° Front: Square Feet: Cubic Feet: z Depth: Height: Front: Depth: Height: Square � Feet; Cubic Feet: Type of Construction: l�/-I,/Lff Estimated Cost: /. Ai To Be Completed: %Z The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stzict 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: SIGNATURE- (See Reverse Side For Additional Information.) 4�r: :�' (_ . (&*197-8 -87900; CITY OF FRIDLEY • APPLICATION FOR PWMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE e PLUMBING FIXTURE RATES: NO. RATE e Number Fixtures R $3.00 u Future Fixture Opening 4• a $ water A $2.00 e • x $5.00 b ep � m g $ +� a w $ Water Softener Heater $7.00 _ $ New Ground Run Old Building x $5.00 qq Electric Water Heater ,y $5.00 $ GAS FITTING FEES: 1st 3 fixtures x '$3.00 $ Additional Fixtures 0 7 0 � L x $10.00 $ -..4 c First $100.00 $5.00 $ o vii u $ ani a� 0 3 w vii w ucbo r i� as lec is*_ irange 2nd 3rd •4th IE - (R) a Future Connection Opening Connected with Sewer (•) - New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures R $3.00 $ Future Fixture Opening x $2.00 $ New Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU x $5.00 $ 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 _ $ New Ground Run Old Building x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: 1st 3 fixtures x '$3.00 $ Additional Fixtures x $1.00 $ Gas Range to 199,000 BTO x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ 8.00 REINSPECTION FEE ($10.00) Job Address 1328 NE 66 Ave. Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. 9-1-78 , 19 OWNER HORN KIND OF BUILDING frame USED AS res. TO BE COMPLETED ABOUT 9-8-78 ESTIMATED COST 20.00 OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company Signed By Tel. No. ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT�•/p 10 MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLUS $.50 STATE SURCBARGE CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Residential Furnace Shell and Duct Work, Burner — Also Replacement Furnace (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer Effective 0 1 anuary 1, 195 �19 JOB ADDRESS l 3,g Gl 60 I0,Ute The undersigned hereby makes application for a permit for the work herein Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes arid rulings of the Building Division, and hereby declares that all the facts and $ 20.00 $ representations stated in this application are true and cct. _1q -1994 $10.00 $ OWNER_L,A 1 )4 lA I $ 10.00 $ BUILDING USED AS $ 10.00 *Air Conditioning — All Sites $ 10.00 ttS).G'-- a U 1— a7-0-1 i avlv\OiC All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial I% of Value of Appliance or Work State Surcharge TOTAL FEE $ /L7 SZ MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REF—BRIMAMNJAIIR CONDITIONING PERMIT IS $1500 ,® c, PLUS THE .50 STATE SURCHARGE REINSPECTION. FEE $30.00 b *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. ESTIMATED COST 20:)6 a e-90 PERMIT NO._Ll� DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units, Trade Name BTU _ Circle One (Steam) (Hot Water) (Warm Air) Size No. HP EDR Fuel Total Connected Load Burner Trade Name Size No. BTU HP EDR HEATING COMPANY 1 t;-F=y`.S prA " Q',y► VL-ey Signed By Pdi_ f". Tel No. Y Rough—In Approved B h—In Date Final Date p 9 \� FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE NOTE: #1 through #8 required when using a side vent furnace. 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 3. Has no foreign objects lodged within 4. 5. 6 7. 8. Is securely supported Meets all current Code requirements for size and total.BTU'S connected Has total heating BTU's of All other BTU's TOTAL BTU's Has a liner been provided for water heater Has combustion air been provided for water heater Remarks: Ust ALTERATIONS Beim Done: HEATING CO: Signed By: Date: Yes () No ( ) Yes ()No{) Yes ( ) No ( ) Yes ( ) No ( ) Yes () No ( } Yes () No ( ) 0 CITY OF FRIDLEY BUILDING INSPECTION 8431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer '; �o0&-tea`% Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS 152-a 6 Fee Total Owner Lexi i ► e $35.00 $ '-1 152 -°`0 Building Used AsBesidence - $10.00 $ ESTIMATED COST y3 9 S _ PERMIT NO !_ $10.00 $ $10.00 $ *Air Conditioning - All Sizes $25.00 $ All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $. Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater,on work less than $500.00 .Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) $ Minimum Fee $35.00 for Com mercial/Irid ustria1/Institutional State Surcharge $ .50 TOTAL FEE $ REINSPECTION FEE $50.00/HOUR *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE DESCRIPTION OF FURNACE AND BURNER,.-, # of Heating Units_ Circle One (Steam) (Hot Water) Trade Name ick" tyo1 (.- Trade Size No. BTU *10, OOO HP EDR Fuel Natural Gas Total Connected Load Burner Trade Name BTU T Size No. 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. HEATING CO FAX # 763-476-1143 Tel 0763-476-1990 Date 1 a 3.6 b \ Rough -in Date Final Date Approved by I`� FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMQN 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 existina 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-GAIVIA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Ye () 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 %-ry'L-c-)r— BTU Input '�D 000 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) MOME ENERGY CM I LR HEATING CO: 15200 25TH AVE. N #128 Signed By: Date 431 University Ave NE ridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BF INSTAI I Fn nN FArN Fi nnP ILUMBING FIXTURE RATES: Jew Fixtures Nd Opening, New Fixture Seer Dispenser Now Off Basin match Basin lain Water Leader lump/Receiving Tank Nater Treating Appliance Nater Heater -Electric NO. RATE TOTAL JOB ADDRESS 5?Nm e � 5 ©W0 Qv" Nater Heater - Gas** 3as Range" 3as Dryer** Sack Flow Preventer Required ( )Yes () No $10.00 $10.00 $10.00 $10.00 $10.00. $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 Type $15.00 Reinspection Fee $50.00/Hr 4LL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE 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. �.T.. 20 HUIE CHOCK OWNER 1328 66TH AVENUE NORTHEAST FRIDLEY, NIN 55432 (763)572-0644 BUILDING I rJmce_ L4 00ESTIMATED COST f"I 00 PERMIT NO. NORBLOM PLUMBING CO. PLUMBING COMPANY 6- 121 A2�7-403 SIGNED BY 2945 GARFIELD AVE. SO.. d $ o Approved By Rough -In Date Final Date $ 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 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 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. R; Yes O No( ) When installing a new`yenting 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 :