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PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn. No 2769 Date .�f..� ...... ................. Owner e ....°.. ... Builder (�Lfll........................ Address.. .... ..... A Wddress......................................... LOCATIONOFO� F BUILDING .. No. A/.// ....... Street .. � . �,.. � . fw'�:o..... vv -.f...... Part of Lot ....................... Lot ....... C ....... Block .... IJ ........ Addition or Sub -Division .�•f�-� .. x .. Ste+ . ,/�fc! .. Corner Lot ............ Inside Lot ............ Setback %. Sideyard 10.i41�' ............... DESCRIPTION OF BUILDING To be Used as: Front . r, ..... Front Typ6 of Construction— i;'M . . . Depth . `�..Y .. height .... . Depth �.� {jo... Height 1.$o ... 06 Est. Cost /c'g 496.777 ......... Sq. Ft. JPkIP Cu. Ft. ........ Sq. Ft... ,?.IA Cu. Ft........ . To be Completed In consideration of the issuance to me of a permit to construct the building des'bed ove, I agree to do the proposed work in accordance with the description above set forth and in compli with all provisions of ordinances of the village of Fridley. In consideration of the payment of a fee of $.14 ..., permit is hereby granted to -�.�.�� ...... to construct the building or addition as described above. This permit is anted upon e express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the village limits and this permit may be revoked at any time upon' violation of any of the provisions of said ordinances. f% / n - __— K _— HVW--. Building Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. City of Fridley AT THE TOP OR THE TWIN$ r'b'---^-- GOMIWNITY pEV[LOPMENT DIV, I MIOT[CTIV[ INM[CT*M Op'f CITY HALL FINDLtV 5609 PLUMBING PERMIT APPLICATION s98� Joo Aaares9 - L/ /I •- 6 7 �' ��L V, _ Owner Address Phone 7 4 a �„ r o `. _1//I 6 7 ;a .� Ale Sn -� , Contractor ress Phone DILL To4hro-, 3z/2 - S_s..d tet. So Kind of Building Use A/0��1��a_ Completion Date Ys-t3mated Cost I II 11 Plumbing Fixture Rates: NO. RATE TOTAL rIW i Number Fixtures x $2.00 $ `• a I Future Fixtures x $1.50 aoNral eve I � I i i � ! , New Fixture -Old Open. x $1.50 O "Idav I I ; I Catch Bastn x $3.25 CYOe ! Water Heater -99,000 BTU x $3.00 ! Ground Run Old Bldg. x $3.25 I Stla, •MNtval I I � I IJ j Im I Elec. Water Heater x $2.00 .I sNICY9l i Gas Fitting Fees: O o sNlvaa I I I I bt b 3 c aoo�d a lst 3 Fixtures x $2.00 w= VI ,O �o.$ stl7MON$ I kl I I I I I Additional Fixtures x$ .75 I I I I I b•1Nnod HNlan Gas Range -199,000 BTU x $5.00 IW �CA1/a1 q M M511M) I I I I .r I Repairs & Alterations See Description: Code ISNNIS Move � I State Surcharge .50 I TOTAL FEE $ sant I I Hive I I I slvNlan The undersigned hereby makes application for a permit l I I I for the work herein specified, agreeing to do all work alisoo in strict accordance with the City Ordinances and Tulin YilYM hl I of the Department of Buildings, and hereby declare that all'the facts and representations stated in this • 1 application are true and correct. A t I '" e a,. 0 . 6 --1e--_'? Big an ut re Date p SUBJECT E Nq. City of Fridley 41,J2125 AT THE TOP OF THE TWINS BUILDING PERMIT i RECEIPT i L'__�•__ COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. --1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPR VED BY ••"' ,'� 512-560-3450 910-F15 5/10/73 JOB ADDRESS 411 - 67th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRA CT OR ADDITION SEE ATTACHED DESCR. 8 3 Rice Creek Terrace Plat 3 SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE James Thomson 411 - 67th Avenue N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Hank Duevel 9307 - 5th Street N.E., Blaine 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 ❑ NEW CX ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct 15'8" x 17' Family Room 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan S .7 3J-V"3d 'S.i:I1N83d 03 a3b'na3.H SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frame 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 R-1 272 OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFF BEET PARKING I HEREBY CERTIFY THAT I 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 WITH,WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $6,000.00 3.00 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- $21.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTIO PLAN CHECK FEE TOTALFEE �. $24.50 'SIGF14TUF NTRACT R OR AUTHORIZED AGENT (DATE) E/n�N P7R��O^^PE=ATED IS YOUR PERMIT ��W%%HjJ "x-3 - 9IGNATURE OF OWNER IIF OWNER BUILDER) (DATE) BLDG INSP DATE P APPLICATION FOR RESIDENTIAL, ALTERATION., OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNERS S NAME:,7a,,qe -f-- 712xllr6AI BUILDER: ADDRESS: ADDRESS ?e �/4 'Al -e NO:, – Z LOT: - OC' BLOCK: ADDITION:– xe- - )0/4 � 3 CORNER LOT: INSIDE LOT: _)r SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. — DESCRIPTION OF BUILDING To Be Used As: 10 "e.0,0 4e Yr Front: Depth: Height:W X" A _s 27e4—r Square Feet: Cubic Feet: –Front: —Depth: 'eight: Square Feet; Cubic Feet: Type of Construction: Estimated Cost; _$ To Be Completed: Ad 0. The undersigned hereby makes application for a permit for the work herein specifieds agreeing to do all work in stkict 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: 3 SIGNATURE: (See Reverse Side For Additional Information.) J j )s k k 141 44 Ni Rl4 )s k k 141 SUBJECT MIT NO. City of Fridley 24208 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. I LL ------ COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. :)36'? NUMBER REV —j DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 612-571-3450 910-F15 5/23/96 JOB ADDRESS 411 67 Avenue NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 3 Rice Creek Terrace Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jim Thompson 411 67 Avenue NE 571-3898 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Gutter Ring 2425 4 St NE, Mpls., MN 55418-2424 781-3111 20038822 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 ❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install soffit & fascia; gutters 9 CHANGE OF USE FROM TO STIPULATIONS Ventilation must meet the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, 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 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 $.87 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,745 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LA REGULATING CON- $56.75 Fire SC $1.75 STRUCTION O THE PERFORMANCE OF CONSTRU ION PLAN CHECK FEE TOTALFEE G, AA License SC $5.00 $64.37 iGN TURFO CONTRACTOR OR AUTHORIZED AGENT IDATEi WHEN PRROPE VALIIDATED THIS IS YOUR PERMIT -{' BLj6G INSP ,,_ C , HATE _ SIGNATURE OF OWNER OF OWNER BUILDERi IDATEI NEW C ] Effective 3/1/96 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application 4D �o ConstructionAddress: / % % T �� IV L - Legal Description: Owner Name & Address: 3-t <''^ T �y S Tel. # 7/- �LE 21 Contractor: G f -e✓z �/- i rv� MN LICENSE # Z 03 8T2 -'-- Address: —Z T �5 f2 e eT Al, Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. STIPULATIONS: DESCRIPTION OF E%IPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ % o Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = tic $ _ $ DATE: A3/1 b APPLICANT: Tel. # 7..8- 0 a G CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ /. % S� .001 of Permit Valuation (1/10th%) State Surcharge $ cc�% $.50/$1,000 Valuation SAC Charge $ $900 per SAC Unit License Surcharge $ S L $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 $ .J STIPULATIONS: SUBJECT City of Fridley 2 7 0 51 AT THE TOP OF THE TWINS BUILDING PERMIT r(""*,,,) O COMMUNITY DEVELOPMENT DIV. I r PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/7/98 JOB ADDRESS 411 67 Ave NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 3 Rice Creek Terrace Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE James Thomson 571-3898 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Twin City Exteriors Co 9060 Zachary Ln N #108 Maple Gro 425-4737 2595 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 Storm damage repair WEST SIDE ONLY 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. 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 ISTALLS 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 500 $.50 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $21.00 Fire SC $.50 PLAN CHECK FEE TOTAL FEE License SC $5.00 27.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEi HEN PROPERLY VAL ED THIS IS Y014)R PERMIT _ V BLDG INS s TATE S,GNATURE OF OWNERIIF OWNER BUILDERI IDATEI NEW ADDN (] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION -61 ConstructionAddress: 'll l - -7- Legal Legal Description: Owner b Contract Address: Effective 1/1/97 Tel. MN LICENSE #q� OE�MLTel. # -Yd X47-2— 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 Wid Hgt/Ground Sq. Ft. OTHER: (o-) L Construction Type:ST�,e/y/ s 4,A}, �, Ik Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: g 5 -Cj APPLICANT: - Tel. #�z ' CITY USE ONLY Permit Fee $ C� t 00 Fee Schedule on Reverse Side Fire Surcharge $ -r�-D .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge $ (' $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 [ J Not Necessary [ ] TOTAL COCA $ STIPULATIONS: J a 101 suBJEGTM M City of Fridley 704 AT THE TOP OF THE TWINS BUILDING PERMIT r ` RECEIPT NO. `� -------COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r PROTECTIVE 1 � i 1 "'1 CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-FlS 6/17/99 JOB ADDRESS 411 67th Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 3 1 Rice Creek Terrace Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE James Thomson 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Erick N. Kallerup 1602 Archwood Rd. Minnetonka 55305 545-4921 7591 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. (Kallerup Construction) 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION 9( REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Reroof house and garage (27 S Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. 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 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 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 $2360 $1.18 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FELE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON. $83.25 Fire SC $2.36 STRUCT N OR THE PERFORMANCE OF CONSTRUCTION 00, PLAN CHECK FEE TOTAL FEE License$5.00 $91.7 - SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI PR PERLY LI 9TED T YOUR PERMIT BLDG 4SP TIATE S-GNATURE OF OWNERIIF OWNER BUILDERI IDATEI a 101 .r NEW[ l Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION 'J Construction Address: Legal Description: Owner Name & Address: s F �` ^^� !z7 s ®� Tel. # Contractor: 6ICK /U - 16q L LE U 1— MN LICENSE # Address: 1(p o2 A rt, hwod GQ J c M rl X19., J41t ou- 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: O`� f ^ /,?— v� Construction Type: — © Q P'nnated Cost: $ �6 �t Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: GG I7 APPLICANT: Tel. # 70/— / 0/— �7Z CITY USE ONLY Permit Fee $ 83. -S ^ Fee Schedule on Reverse Side Fire Surcharge $ �- 36 .001 of Permit Valuation (1/10th%) State Surcharge $ 4/3 $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ S D U $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 DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES 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 1.25% of Value of Appliance or Work Effective On January 1, 2002 JOB ADDRESS OWNER /;1,1,y Rate TOTAL D BUILDING USED AS $ 30.00 $ ESTIMATED COST PERMIT N0. $ 10.00 $ DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ 10.00 $ Trade NameXma1, �; �//� /�U� Size No. �-<xJ BTU .33, HP EDR $ 25.00 $ Fuel /0•+ Total Connected Load 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. 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. $ DATE HEATING CO Signed = TEL # FAX # �e C - d / ®3Sed /,Po-) Approved By/`�4 Rough -In Date Final Da THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED rmmm N VFNTVFNT (MNNFCTQR AKin CQMR1 ISTIM AIR VFRIFIC-ATIAN When rr la _in0 an eYi_ctin0 furanca, 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 plastiGPVC 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 axosting nnmhusfinn air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a naw rnmht mfinn air. it will be sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When jpntalfinn a new v _ntina systam, 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 Tyne and Sipa/Cnmmnn Vent and Vent Connecter 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 HEATING CO: Signed By: Date :