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PRE 2010 DOCSVillage of Fridley, Minn. N° % S Q Office of INSPECTOR OF BUILDINGS i' i' owne] 46!'.t •'-," 71 Architect Fridley, Minn., Builder II LOCATION OF BUILDING v No. Streeter v`` '� �_ Part of Lot I Lot Bloc k Addition or Sub -Division DESCRIPTION OF BUILDING Front Depth �. Height_2_ s...... Manner of Construction a � r To be used as �To be completEstimated Cost Permit is hereby grantedto'� `a��" � � � � �'",�_ = � �, to the building described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, Minn., regarding the construction, alteration, maintenance, repair and moving of buildings within the city limits,'; and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Inspector of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permit, 'I hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein stated. Subscribed and sworn to before me at Fridley, Minnesota,,, this - day of k__f...F� :r A.D. I' CITY OF FRIDLEY. APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. New Fixtures• Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer RATE $ 5.00 $ 3.50 S 1.50 S 4.00 $ 5.00 $ 5.00 S 5.00 S 5.00 S 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 Back Flow Preventer Required. . . Yes r ) ( ) Type $ 5.00 TOTAL S S ALL OTHAS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance 0o' Reinspection Foe $ 16 00 State Surcharge S . 50 ($15.00) TOTAL FEE Slj&_�� ve Date May 1, 1988 /y Job Address / h/ � �/ Department of Buildings City of Fridley Tel. 9571-3450 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 J/ Fridley, /Mn. a/ 49"&!52_. 199,17 OWNER ` U �%% --Z[% • �1. int 4e, KIND OF BUILDING r USED AS /rQP .' q�� e g G TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. ROUGH INSP. Date (��FINAL INSP. Date APPROVAL FOR PERMIT !s, MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE W m U X' 0 Water ul m m w H e .c+ RC u 1m� �'i Wu 4 w0% Heater .ei b C Ol ppM C G 6 aMi 4y 0� N Nu 5 "W4 O W O Yl fa 3 U) [&M U CI 3 C7 F. s leC lsi 2nd 3rd 4th (R) m Future Connection Opening Connected with Sewer (') . New Fixture, Old Opening ester RATE SCHEDULE PLUMBING FIXTURE RATES: NO. New Fixtures• Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer RATE $ 5.00 $ 3.50 S 1.50 S 4.00 $ 5.00 $ 5.00 S 5.00 S 5.00 S 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 Back Flow Preventer Required. . . Yes r ) ( ) Type $ 5.00 TOTAL S S ALL OTHAS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance 0o' Reinspection Foe $ 16 00 State Surcharge S . 50 ($15.00) TOTAL FEE Slj&_�� ve Date May 1, 1988 /y Job Address / h/ � �/ Department of Buildings City of Fridley Tel. 9571-3450 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 J/ Fridley, /Mn. a/ 49"&!52_. 199,17 OWNER ` U �%% --Z[% • �1. int 4e, KIND OF BUILDING r USED AS /rQP .' q�� e g G TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. ROUGH INSP. Date (��FINAL INSP. Date APPROVAL FOR PERMIT !s, MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE l SUBJECT P City of Fridley 29683 AT THE TOP OF THE TWINS BUILDING PERMIT i ` E COMMUNITY DEVELOPMENT DIV. ►V ^ /� ....... r PROTECTIVE INSPECTION SEC 1 . � CITY HALL FRIDLEY 55432 NUMBER RE7 DATE ;GE OF APPROVED BY 612-571-3450 910-F15 6/14/99 / JOB ADDRESS 1611 66th Avenup NF 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Luhman 571-8787 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO New Haven Construction 4208 83571-5844 MOM() 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 ❑ ADDITION O ALTERATION REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof house (18 S) Tear -off 9 CHANGE OF USE FROM 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 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 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL P VISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE O WOR WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT HE ANTING OF A PERMIT $1573 $-79 DOES NOT ESUME TO GIVE AU RIT TO V LATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISION OF ANY OTHER ST O OCA LAW REGULATING CON- STRUCTI R THE PO FOR N ONS RUCTION $57.05 Fir SC $1.57 SCJ PLAN CHECK FE TOT F E �-i Li cen SC $5 , p $ .41 S1&ft4zyRF CON ACTOR OR AUTHORIZED AGENT tOATE, N PR 4110 Aj�!/ VALIDA HIS IS JOUR Py1 r BLD -NSP r� E S,GNATURE OF OWNER ,IF OWNER BUILDERi ,DATE. l Jasn..l$ 99 01:18p Kerri 566-7183 P.1 APR -14-1999 11:34 FROM CITY OF FRIDLEY TO 5667183 P.01/02 NEW I J CITY OF FRIDLEY ADDN [ 1 SINGLE FAMILY AND DUPLEXES R a AND R-7, ALTER[ ] S>av BUILDING PERMIT APPLICATION a✓ ConstmetionAddress: A:�L�L- LegaiDmription: -7 0�1tA ��/f Tel. Owner Name'8t Add Contractor: aG7 MN LICENSE # ,( Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale• DESCRIMON OF IMPROVEMENT LIVING AREA: GARAGE AREA: DECD AREA: • Length Width Height _ Sq. Ft. Length Width � Height � Sq. Ft. �- Length Width Hgt/Ground Sq. Ft. _ ®THER. . � �� - S n.� QY�'�� mated Cost: $ / Construction Type' f� 6 Esti (Fee Schedule on Back) =S Driveway Curb Cut Width Needed: Ft. + Ft = t x $ j �iJ t `Tj Te1• ff DATE: 1 S (�APpLICANTe Permit Fee Fire Surcharge State Surcharge SAC' Charge License Surcharge Driveway Escrow Erosion Control Park Fee . Sewer Main Charge TOTAL. STIPULATIONS: qTY USE NLY $ I.OY Fee Schedule on Reverse Side $ ;,s% .001 of Permit Valuation (1/10th%) $ 1 9 $.50/$1,000 Valuation g $1050 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 [ 1 Not Necessary Q $ 6�(' C/i ,N) SUBJECT City of Fridley 3 1781 AT THE TOP OF THE TWINS BUILDING PERMIT RE NO. ` i tr i VV � _____ COMMUNITY DEVELOPMENT DIV. T 572-36►04 r � � PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV OATS PAGE OF APPROVED BY ' L J` 612-571-3450 910-F15 4/30/01 JOB ADDRESS 1611 66 Avenue NE I LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 2 1 Moore Lake Park 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Luhman 1611 66 Avenue NE 763-571-8787 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Ashland Enterprises 6440 Baker Ave NE, Fridley, MN 55432 763-571-6725 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 ❑ NEW ❑ ADDITION ❑ ALTERATION) REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace front steps 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. SEPARATE PERMITS ARE REOUIREO 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 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 $1,000 $.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 THER STATE OR LOCAL LAW REGULATING CON. @ $38.75 Fire SC $1.00 TRUCTION R TH P R RMANCE OF CONSTRUCTION PLAN CHECK FEE OTAL F E --�— City L se $ 0.25 SIGN TU E OWRAtTOA OR AUTHORIZED AGENT (DATE, N P PEWYATE I$ IS � S,GNATURE OF OWNER OF OWNER BWLOERI IDATEI BLOC SP zr,At ,N) NEW [ J Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION l Construction Address: Co A u C' N Legal Description: Owner Name & Address: Tell. # 76 � S 7 / 7� 7 Contractor. rl�ec �t2' MN LlCSE# Address: &ULtO Golec Aje Tel. # -� � 3 15-7/ 6 7c� S 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: Construction Type: 1�- Sfi1&"k-mEstimated Cost: $ $ l no® . n 7 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$ DATE: /Y' 30 — U APPLICANT. Tel. # 763,5- 7/ 60 7,�1-5— CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application $ Fee Schedule on Reverse Side $ 00 .001 of Permit Valuation (1/10th%) $ F,�Cj $.50/$1,000 Valuation $ $1150 per SAC Unit $5.00 (State Licensed Residential Contractors) "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] $ 1-15, '? 0 l', De- \ e � - Co�c,c'e�e, Con c.r� \ e A , rl �,, m C, 11Q � 1 , I -V\� � c V� )10k,' SJ��,ecua y � klsF<s o,� ino,2F ,�fa v,�� dN ;UPBJ CT To p -\ INQnr.,FIELD CITY OF FRIDLEY INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572.3604 RATE SCHEDULE DIViSION 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, but not replacement) Gas Range Gas Dr *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% 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. Effective On January 1, 2001 JOB ADDRESS 1 �l �o A'-C/e OWNER �y��. /� ��L e r, TOTAL BUILDING USED AS $`�J�G ESTIMATED COST PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ Trade Name Size No. BTU HP EDR $ Ac Fuel 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 $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. $ 2 $7. L&'oDATE HEATING CO e Signed—TEL # ✓�!� �% �i Approved ByA Rough -In Date Final Date BACK SIDE MUST BE FILLED IN ON VENT SIZE, VENT CONNECTORS AND COMBUSTION AIR VERIFICATION 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 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 manufacturers 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 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 ( ) 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 Tvpe 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 : SUBJECT MIT NO. City of Fridley 31902 AT THE TOP OF THE TWINS BUILDING PERMIT r ' COMMUNITY DEVELOPMENT DIV. ' • ��----.-. �` •t^ 572 � RECEIPT NO. 1 I r � � PROTECTIVE INSPECTION SEC. �N � 1 CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910415 6/14/01 JOB ADDRESS 1611 66 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 2 1 Moore Lake Park 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE John Luhman 1611 66 Avenue NE 763-571-8787 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 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW 0 ADDITION ❑ ALTERATION J] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside House & Garage; Replace soffit 9 CHANGE OF USE FROM TO STIPULATIONS Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive barrier be placed over exterior sheathing to protect the interior wall covering. Exceptions for this provision would be if sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in their application guidelines. Call for inspection of wrap before covering. 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 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 ANO 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 @ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,400 $.70 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- Fire SC $1.40 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $50.95 PLAN CHECK FEE FEE T�3. 05 SIG R F CON O R AUTHORIZED AGENT iDATEi E PROPS ALIDATE THIS IS Y UR PERMIT J SGNAT WNER,IF OWNER BWLDERI IOATEI Bl INSP qA E NEW [ ] Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: .4v �o Legal Description: Owner Name & A=/f �� %r2� ? Z±e= el. # 7� Contractor. e, MN LICENSE # Address: 5 Tel. #7/%�� LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Construction Type: Estimated Cost: $ ��Od Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application $ � .� Fee Schedule on Reverse Side $ 1d .001 of Permit Valuation (1/10th%) $ %CS $.50/$1,000 Valuation $ $1150 per SAC Unit $ $5.00 (State Licensed Residential Contractors) "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ J $ 01 k--7 3,3 CITY OF PRIDLEY BUILDING INSPECTION M ,9 3431 University Ave NE 9=ridley, MN 55432 L r A J a Y 763-5723604 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 �0I p' Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS \ to l 1 6lQ� �"v'e- WE Fey Total Ownerh $35.00 $ 35, CC) Building Used As $10.00 $ $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 $300.00 ESTIMATED COST i 3_U0.00 PERMIT NO DESCRIPTION OF FURNACE AND BURNER # of Heating Units Circle One (Steam) (Hot Water) 0 arm Air Trade Name Q cA- r r- i -- f SB rh 1 A U k -o U Size No. BTU G Q 1000 HP EDR Fuel N a ., c-cJ ao-s Total Connected Load Sumer Trade Name BTU HP Size No. EDR The undersigned hereby makes application for a permit for the work herein Commerciallindust(al/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/industriaVicisiitutional and representations stated in this application are true and correct. CENTERPOINT ENERGY State Surcharge $ .50 HEATING Co 13562 CENTRAL AVE NE BLAINE, HN 55304 tie TOTAL FEE $ 3 -,.Sc) Signed — Tel # 763-757-6202 REINSPECTION FEE $50.00/HOUR FAX f! 763-757-6701 Date rU 0�- *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 Approved by Rough -in Date Final Date C0' d IClul 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 R No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer Yes No( ) specifications including sizing, length, number of elbows and termination. (y) 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 spec cations. 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-GAMA Category I Central Furnace Yes ( No( ) Venting Tables for fan assisted and natural draft appliances. 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 F QAQU-e., BTU Input ICUICOO Fan Assisted or Nat f-cw- 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 W Q-1 Vent Height (in i _ Diameter � inches Appliance #1 Vent Connector Height �Lft Length �� ft Diameter min Type P�c-j Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) CENTERPOINT ENERGY HEATING CO: 13562 CENTRAL AVE NE BLAINE, MN 55304 Signed By: Date l� FRIPP ' A T PV ICV SL 01 A37Q l N� �D AM WON -I SF : t T t'00?-LZ-NC4H