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r f1, nsun Deed- redea �Z.dduel 10 carpo Millcr-Davi, Co.. Mmncepu6, Form No. 2&M. y_ Minnc,uu Vnilunn "Cnn%eyancing Blank, (Rc%.i,cd 197.tL x'big inbenture, Made this ......2 o .............day of ...QCtober...... ._. ...... ..... ... I .... , 18..84...., between .Robert_Howard- -and ... Mari.on... v..Howar..d... (H sband. 1 . Wi fe )fe wners ano ..Ri chard...T.....Bri ckner (a singe person) Contract urchaser of the. County of ................ An.oka.................................................... and State of ...... Minnesota ... ........... ............................................. , part ..les o f the first part, and--...lr.ity...of...Fr. idl.ey...................................................... ...................................................................... ......................................................................................................... . .................................................................................. a /munlr�Ya1................ e..... f f Mi nnesota...................... corpora n under the laws o the State o ............................. ......................., party of the second part, Witne0elb, That the said part i.es of the first part, in consideration of the sum of ..One.do.l.l.ar.... ($1....00.) ... and ... other ... valuable ... considerations-------------------- ___.D0LL.4RS, to .............................. ...................in hand paid by the said party of the second part, the receipt whereof is hereby acknowledged, do .es..." hereby Grant, Bargain, Quitclaim, and Conve- unto the said party of the second part, its successors and assigns, Forever, all the tract ... or parcel .... of land lying and being in the County of ....Anoka .......................and State of .Minnesota, described as follows, to -Tit: A 15 foot Bikeway/Walkway easement lying over and across the East 15 feet of that part of the Southwest Quarter of the Northeast Quarter of Section 13, Township 30, Range 24, described as follows: Beginning at a point on the north line of the plat of Gena -Rae Addition distant 249.00 feet West of the northeast corner of said plat; thence West, along said north line and its westerly extension, a distance of 163.50 feet; thence North a distance of 247.50 feet, more or less, to a point on the South line of Outlot A, Dennis Addition distant 417.50 feet East of the southwest corner of said Outlot A; thence East, along the south line of said Outlot A, a distance of 163.50 feet; thence south a distance of 247.50 feet, more or less, to the point of beginning. hJ -re j. The City of Fridley hereby accepts this easement for Bikeway/Walkway purposes. SIDNEY C. INMAN - CITY CLERK NO STATE DEED TAX REQUIRED Gie' 1142, No /_3r7e5 To lbabe anb to J$olb the *3111C. To,;, th, r iri.,7i .,;1 the hereditalnrnts nrtd nppurtr>'jay,r, . luuto bclon6in_s or in any risr appertainin ', t(, th, .cci'i t,'rl•ty of the scc.ond Part. its a7id Forc ver. 3n Tro itnonr 12bercof, The said part ies n,-' thf first part '1a ve hercun! s- t thei r hands til!• !Intl anti pcnr prst nbor!• 71'7'it1r?i. SUBJECT PERMIT City of Fridley 18737 AT THE TOP OF THE TWINS BUILDING _ PERMIT r ECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. � � ---I CITY HALL FRIDLEY 55432 f NUMBER REV. DATE PAGE OF APPROVED BY ----A L 612-571-3450 1910415 110/31/86 JOB ADDRESS 1362 - 66th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. Tract B Registered Land Survey No. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bernie Kriens 1362 - 66th Avenue N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Brickner Builders Inc. 6199 Heather Place N.E. 574-9871 4 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 2 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct 561 x 36f Dwelling and a 22F.x 241 Garage. - PERK73 REQU RED FOR WIRING. HEA-IING, 9 CHANGE OF USE FROM TO PLUMBING AND 816pj STIPULATIONS provide a hard surface driveway. Provide sod in the front and side yards. Provide City with copy of verifyinq6urvey, SEWER LOCATION; "y`' is 31' West of M,H, "y" ELEVATION: 875.73 MINIMUM TOP OF FOOTING: 878,73 water location: In same trench., DRIVEWAY ESCROW: 181 ♦ 61 = 24' x $13,50 = $324,00 /j THE CITY OF FRIDLEY DOES. NOT GUARANTEE THE `�.A ACCURACY OF UTILITY LOCATIONS AND ELEVATIONS. ; t+gcall local utilities THIP DATA IS FOR INFORMATION PURPOSES ONLY, ELECTRIC ND INFORMATION SNOUI,D - CAA S'irIC, V�ERIFYE �' IDN 'THE. SITE. REQUIRE® BY LAW 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 BO 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 1 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 $ g4 950 $42.48 WITH WHETHER SPEC ED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESU, 1. _ GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS O AN THER STATE OR L A LAW REGULATING CON- $388.00 $475.00 S ION T ERFORMANCE O NS RUCT N. 31) - PLAN CHECK FEE TOTALFEE $97.00 $1r002.48 + DW ji5A REO TRA 6TOR OR AU AGENT (DATE) t WHEN OPP ERLY A�LJIDATEDT—HIIS IS YOUR PERMIT NSYPR n :CP_9ATEBLG SIGNATURE OF OWNER IF OWNER BUILDER) XA NEW [ ADDN. [ ] ALTER. [ ] Construction Address: City of Fridley R-1 AND R-2 Building Permit Application 2, At,? ;!Z, c Effective 4/1/86 Legal Description: A Tel. # Owner Name & Addss: oe _ r Contractor: Tel. # Address: �1 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT CITY USE ONLY Permit Fee $ MI. ®o Fee Schedule on Reverse Side Plan Check $ g%'0 a 25$ of Building Permit Fee State Surcharge $ $.50/$1,000 Valuation SAC Charge $ y e%:s.0 $475 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer !Rain Charge $ •An a ent Necessary [ ] Not Necessary TOTAL $ 100Z STIPULATIONS: DQ'r X6.48 8 t3'i2' LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. �,_ 3 SO,. Q� 0 OTHER: Yd. Setback Side Yard Setback Corner Lot [ ] Inside Lot] Ft. ., Cost: $ Sq. qSp Type of Construction: Estimated Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ 32 • oV $ See Back Page for Explanation �® Z A Tel. # DATE: APPLICANT: CITY USE ONLY Permit Fee $ MI. ®o Fee Schedule on Reverse Side Plan Check $ g%'0 a 25$ of Building Permit Fee State Surcharge $ $.50/$1,000 Valuation SAC Charge $ y e%:s.0 $475 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer !Rain Charge $ •An a ent Necessary [ ] Not Necessary TOTAL $ 100Z STIPULATIONS: DQ'r X6.48 8 1t�NALD F. M LAND SURVEYOR ..ANO suNVl1/1Nc sunDIVIs1ON oaelcN Tal.apmeNC 771.4888 chs Jessie ST. ST. PAUL. M114N. 93101 I hereby certify that this survey was prepared by me and that I am a duly Registered Land Surveyor under the laws of the State of Minnesota. 04 ._.. Reg. No. 9051 Date: October 12, 1936 m.CES V. E EC bl "•C1 ry 2"OW w Gamoad LE IIVO Ovf/o f' A, Deh� is A�� Scale i 1"=40' J� l o Indicates iron monument placed I I ` t i • Outlot A, Dennis Addition, Anoka County. Minnesota, excepting therefrom the East 249 feet and excepting therefrom the West 492.5 feet. also Lot ae)urteen, Revised Auditor's Subdivision No. 10, except the East 249 feet and except tho west 75 feet. also That part of Lot Six, Revised Auditor's Subdivision No. 10, described as folloTrJs co=enOizjr,P at a point 467.5 feet East of,/the Southwest corner of said Lot S:ai thence North parallel with the West boundary line of said Lot Six, 140.25 feats thence Fist parallel with the South boundary line of said Lot Size 75 feet to the poia: of beginnings thence continuing East on last said course to the West line of the East 249 feet of said Lot Sixi thence South parallel to the East boundary line of said Lot Six, 15.75 feet; thence West parallel to the South bounda.9 line Of said Lot Six to intersect with a line produced South from the point of beginning parallel to the .Wast boundary line of said Lot Six; thence forth parallel to the West boundary line of :.aid Lot Six to the point of beginning. Also known as Proposed .Tract Be Registered Land Survey NO. .___,_,_• 11 M 3 I - 54 a�P- AA.. hl 73 4� P -T Nr _ rel, �� ► h(G t=���v �?�' `�'. l f i trts.;-�r ,OF1 V; 1%� • j I j 1 I � j 1 i IIIA I, It 44 � rrp � • r r r I ; , i I . ,aP ♦/ oiiM ® i� � CO � 0 I :—� 1 AVop, 'h �771 y 1 I� �•''• ail o�ros fy/r I I Of, 00 0 670 t srAm � I i � III o �.� u RAM AI ILLiI Ij • I t2.X2$ 4 3'3� d- t8vZvz 30 c/ IC y ,� /0.0/ m swt Ni. 1c )e 3C fo8y x 1cf,.e Z G % 390 �- 2 3x I %- z ;OL 4- 1 x 3 9 13 42, N q. 3 r7 l K)C IV I qo 'aAaAds- ZIX Zi �' u (2.2 7 34, 950 S'6.. 60 co — a93 35X3 = 10'T isk ou 9, U9.72 S7, fit. 54, •a EXTERIOR ENVELOPE AVr^,RAGE "U" COYIPL7r�n^IO.N OwNza (6, SITE ADDRESS CONTRACTO;14tY-S X3,C DATE_ /0-0/-eA PHONE 631 -14F - Determine working square footage of each. 1. Total exposed wall area . a0O 1 sq. ft. x 2. Total roof/ceiling area. j S 3, S sq. ft. Total exposed wall area above floor = a. Total wall window area ..............:...•,.,...,• 190.E b. Tctal .. door area...... co Total sliding glass door area................... d. Total fireplace wall area..... ................... e. Total,wa11 framing., area . (average; 10%) f.''Total" net wall area above floor...L/3a,— .g. Total rim - joist. area...... ................... 16 y Total exposed foundation area = • h.� Total`,;foundation winnow- area........ , . ; ,-..... �.:.�..; _ i. Total net foundation area above grade..`......... I,4 v Determine. "U" - value of each wall segment: -b. SS, X_ Ilu3a, 13 is _. X, „U„ d�. . . X U e. IIU 11 IOU II �IU 11 -- h. X 3IU 11 3. ...........' ...................Total , -2- . S I; itezi #3 on pr as - you evlous page is the 'same-- Y ..ave rae - ; he intent o; SBC :ze as, or less than -item #1 5006 (c) 2. Total exposed roof/ceiling area- = - 3 • 'Total Sc. Total roo?/ceiliniggafram ......`.......... l• Total net ing area (ave insulated roof/ceilrage 1096) ing area a Determine "U" value for eachj. flu 51 roof/ceiling segmen�. • V IIU l• "3 ♦ X •11Un ..Total ...:i° •, ' totalo ' g r ., above is the the-intent"of'SBC same as,'Or "less than #77(c) 6006 (c) I.#2.:you hvemet 'Alternate Be[ilain TaT- _ Envelo a `Desi n .. utiiize the tots by''the 'sum 'Of ' it l envelope s ; �5...,#3 and , hall , method, the "values -established 02,11tems #1 and.P#2: _ #4: shall ; not °be -greater`-t �- ` han � the sum ♦ .. . -. • . ., a v v w .y o 6 u x w) ®rte'_`-."'" �y1-r.. m,w 3. • t I • . Q 7' _ .. w ,. _ o a• , . , a . .;.•..w--.a:...a..dm.•„,i.,,,,,,,.-m,,.rro�.,.,... 4 w z;PK A444W5 VZl V 7 JO z;PK A444W5 CIVIC CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 - PHONE (612) 571-3450 February 11, 1987 Mr. Tom Brickner Brickner Builders, Inc. 6199 Heather Place N.E. Fridley, MN 55432 Re: Final Inspection at 1362 - 66th Avenue N.E., Fridley Dear Mr. Brickner: A final inspection was conducted on February 11, 1987 of the above address and the following items were noted which must be completed before the structure can be finaled: 1. Provide sod in the front and side yards by June 15, 1987. 2. Provide a hard surface driveway by June 15, 1987. 3. Post house number on structure by February 20, 1987. We will expect the above items to be completed by the scheduled dates when reinspections will be made to determine compliance. If you have any questions on these items, please feel free to contact me at 571-3450. Sincerely, D G. CLARK Chief Building Official DGC/mh Ettective Aug. 1, 19n1 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Yater Leader Hydraulic Valve Sunp Or Receiving Tank Yater Treating Appliance Hot Yater Heater Gas Range Gas Dryer NO. C ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance RATE $ 5.00 $ 3.50 $ 1.50 S 4.00 $ 5.00 8 5.00 S 5.00 S 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 TOTAL $_Alo. oU S Job Address Department of Buildings City of Fridley Tel. 0571-3450 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. OWNER KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST � OLD - NEW BUILDING PERMIT NO. PERMIT NO. 4 /V(S Company �-- Signed By ROUGH INSP. Date FINAL INSP. P- - q S, Date APPROVAL FOR PERMIT Tel. No. • Reinepectioa Fee State Surcharge S .50 $_� (815.00) TOTAL FEE $ C� MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE b W a 9 v Mater 9 .e+ m ["• a '14 m m a w wo w 5 Heater I U u lec 3C 1� t� s G �p Ind 3rd 4th (R) - Future Connection Opening Connected with Sever (a) • New Fixture, Old Opening Yater RATE SCHEDULE PLUMBING FIXTURE RATES: New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Yater Leader Hydraulic Valve Sunp Or Receiving Tank Yater Treating Appliance Hot Yater Heater Gas Range Gas Dryer NO. C ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance RATE $ 5.00 $ 3.50 $ 1.50 S 4.00 $ 5.00 8 5.00 S 5.00 S 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 TOTAL $_Alo. oU S Job Address Department of Buildings City of Fridley Tel. 0571-3450 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. OWNER KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST � OLD - NEW BUILDING PERMIT NO. PERMIT NO. 4 /V(S Company �-- Signed By ROUGH INSP. Date FINAL INSP. P- - q S, Date APPROVAL FOR PERMIT Tel. No. • Reinepectioa Fee State Surcharge S .50 $_� (815.00) TOTAL FEE $ C� MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE \ESIDEATIIIL RATE TOTAL Furnace Shell and Duct Mork, Burner (Also replacetsent furnace) $ 20.00 $,2,2,00 Gas Piping $ 10.00 S v 1piping neeM d with RON furnace) Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ s Air Conditioning (all sizes) All Others/Repairs and Alterations It of Value of Appliance or Mork COMM ERCIAL/INDUSTRIAL 1• of Value of ApplLance or Ibrk S 10.00 $ State Surcharge TMAL FEE Reinspection Fee (S1S.00) Rough Insp. Date Final Inap. Date Approval for Permit MINIMUM FEE FOR ANY NFATING PERMIT IS $10.00 PLUS $.SO STATE SURCHARGE S Attach stack verification form with rrlslacnarnt furnacr Inuits •Air Crtndittonery can nnl (w• placed in •adr yard without written inrmisxton fr.ss adutu►ttiq nrigldm,r. ........r ...4. .. .'Yni Job Address 1,3&L9 W 1� ';O'� Department of Buildings 6411 University Ave. N.[.. Fridley, HN SS412 City of Fridley Tel. IS71-3450 The undersigned hereby &"ad application for a permit for the work herein specified agresinq to do all work in strict accordance with the City Codes and rulings of the Department of Buildings. and here declares that all the facts and representations stated in this application • true and correct..G Fridley, nn. z OWNER USED AS 7O BE COKPLCTZD ABOUT ESTTUOU T O G OLDDING PERMITNO. DESCRIPTION OF FURHACR/aUWZR HEATING or PONE, PLANTS. Stem. Not water. Warm Air- No. Trade Naos Oise No. � oozy y� Capacity ^ © eesq. Ft. EDR BTU � HP 7bta1 Connected load jor /,- e- Kind of Fuel BURNER - Trade Now Size No. Capacity Sq. Ft. LDA Company Signrd B Trl. Nn. CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Rate TOTAL Furnace Shell and Duct Work, Burner - Also Replacement Furnace $ 30.00 $ 3 U. r7D (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ *Air Conditioning - All Sizes $ 25.00 $ All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work $ Commercial/Industrial 1.25% of Value of Appliance or Work $ State Surcharge $ .50 TOTAL FEE $2—L-5-0 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. Effective On January 1, 200( JOB ADDRESS_ V; 6 c�, — �& LJVN,J OWNR2CL1N�� 1�szI eryS ' BUILDING USED AC ESTIMATED COST x$00 . 0 ® PERMIT NO._ DESCRIPTION OF FURNACE AND OR BURNER No. of Heating nits � Circle One (Steam) (Hot Water) Warm Air Trade Namey.,u_ Size No.�(�4!!o h Ea , � le BTU r'lS o 0 HP EDR Fuel _ w w -V. C Total Connected Load Burner Trade Name Size No. BTU HP 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 an rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE HEATING CO River City Sheet Metal, Inc. Bluebird9928 N. . Signed Coon Rapids, MggL5433 -754-2199 Approved By%� Rough -In Date Final Date S'. `yl .. 13&,a-Io&Th Ave,PU� COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR I j 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 firestopped where required. Yes'tXNo ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes() No L y The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes KNo ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes by"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( )A(14 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'(jNo ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type l W BTU Input Fan Assisted or Nat Appliance #2 Type VjQ&hjjrj4TrBTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances -2— Total Btu Input Common Vent Type �/ Vent Height �� Diameter .0-// inches Appliance #1 Vent Connector Height .3 ft Length ft Diameter 4 in Type G Appliance #2 Vent Connector Height _L_ft Length ft Diameterin Type C Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) River City Sheet Metal, Inc. HEATING CO: 9928 Bluebird St. N.W. Coon Rapids, IVIN SM33 Signed By: Date CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 F63) 572-3604 FAX: (763) 571-1287 ADDRESS : 1362 66TH AVE NE PIN : 133024130097 LEGAL DESC : REG LAND SURVEY NO 094 : LOT BLOCK B PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT N .: 20040 DATE ISSUED: 05/27/2004 VALUATION : $ 500.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER HEATER. # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) # GAS DRYERS # OF NEW FIXTURES APPLICANT NORTHWOODS MECHANICAL BOX 1085 FOREST LAKE, MN 55025- (651) 257-4951 OWNER KRIENS BERNARD J & LORALEE 1362 66TH AVE NE FRIDLEY, MN 55432 0 # GAS WATER HEATERS 1 0 # GAS RANGES 0 0 # WATER TRMT APPLIANCES 0 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. ADDlicaat 4 Date Bldg PLBG PERMIT MINIMUM FEE 0.00 PLBG FIXTURES (NEW OPENINGS) 0.00 PLBG FIXTURES (EXIST OPENINGS) 0.00 WATER TREATMENT APPLIANCE 0.00 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 35.00 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 # 54576 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIee9,LJ3� MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range** Gas Dryer** NO. RATE TOTAL JOB ADDRESS_/a(a /�j=d A )V= $10.00 The undersigned hereby makes application for a permit for the work herein $10.00 specified agreeing to do all work in strict accordance with the city codes $10.00 and rulings of the Building Division, and hereby declares that all the facts $10.00 and representations stated in this application are true and correct. Back Flow Preventer Required ( )Yes ( ) No Type $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance !a - U0 State Surcharge $ TOTAL FEE $ DATE: 20= BUILDING USED AS h. D)a 'y — ESTIMATED COST ST52D-- PERMIT NO. &&Ll <CQ'(C C' PLUMBING COMPANY A o A SIGNED BY TEL N0. Approved By A Rough -In Date Final Date / 1 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-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 installina 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 :