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COS (2)r�tS W suedEcr PERMIT14019 City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. ' ______ COMMUNITY DEVELOPMENT DIV. ~ r PROTECTIVE INSPECTION SEC. y CITY HALL FRIDLEY 55432 L J\ NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 4/21/77 JOB ADDRESS 1560-1564 731j Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Lot 31, A.i. #129, exq. the N. thereof & exc. the W. 92.75' SHEET Let 31 - ef said 2 PROPERTY OWNER MAIL ADDRESS -ZIP PHONE Dennis Kugler Const. 8331 Terrace Road N.E. ls. 784-4746 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 (DUPLEX) 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Du 1 NOex Construct a 56' x 24' and two garages 24' x 26' ' SEPERA'M PERMITS REQUIRED TELEPHONE • ELECTRIC - GAS 1 9 CHANGE OF USE FMATING, PLUMBING AND SIGN, REQUIRED BY UI STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side yards. Provide a verifying survey before capping. Provide exhaust fan in laundry area. Provide combustion air to furnace room. Insulate ceiling with R-22 or better. Provide vapor barrier in ceiling. NO SEWER OR WATER AVAILABLE AT THIS TIME DRIVEWAY DEPRESSION: N/A To C" OF HMO DOSS NOT GUAM= M ACC CCT OF VOW MXAMNS MID ELEVATIORS,. THIS DATA IS FOR INFORMATION PURPOSES ONLY AND rE23QN3 USING a SHOUID VERIFY THE WORMAWN pN IRE SITE. 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 OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-2 1392 + 600 33,456 Total ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 2 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 $43,695 $21.85 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. $133.82 $750.00 PLAN CHECK FEE TOTAL FEE P' 3 $939.13 SIGNATURE OF CONTRACTOR OR AUTHO PZEDAGENT (DATE) �77 H ROPE LY VALIDATED THIS IS YOU, PER ° aV BLDG INSP RTE SIGNATURE OF OWNER 0F 01NER BUIL 1 IDATEI w r�tS W CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: Z). r1t n't5 14!o ( e— BUILDER:. �vy� ° Address: W Tel. No.: %84— -1741-- No.: Street: %� /Ze LOT:„-� o -F ,31 BLOCK: ADDITION: �ivdi-lor s j� bd S uiS�oN �Z`l Address: _ &33 / �d ` ®5-7�' r CORNER LOT: INSIDE IAT: SETBACK: SIDEYARDS: 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: ---Gy� Front: s(o Depth: ��t� Height: Square Feet: /— Cubic Feet: �S d. (zf )Le4b Front: Zg Depth: z611 Height: Square Feet: 4P00 Cubic Feet: 6 000 � / �9� Type of Construction: ��-av�n� CiitJooc�> Estimated Cost: $ To Be Completed: 671111-7? '- /Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict 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. See reverse side for additional info atio . DATE: 3/327 A 7 :S'`;GNATURE: L Stipulations: .094A444 4o, 64� � y��wL«+•re. /taoya . .13 3, e .z �3.17fo a/, 8zso� L&O', t-/ 2 ev tW 4;, P"3 ; I, I - - __ _ _ _ _ _- __ _- I i r#v I - I � ----p CNERRIM LINTER & ASSOCIATES INC. REGISTERED PROFESSIONAL a LAND SURVEYORS Cert if icate of Tslephorte 581 SHEET 1 OF 2 SHEETS SUITE 308 VILLAGE NORTH PROFESSIONAL SLOG. 7420 UNITY AVENUE NORTH BROOKLYN PARK, MINNESOTA 55443 Survey PROPERTY OF Dick Gregor - described os fol lows : See sheet 2 of 2 sheets for legal description. H y 46.2 2 N N I J r. Ave /Is 92-0-0 x Ayd sib. N N !✓o. / Z j I , 1 � a s, 110� 0a NNJ t'j \ 0 a �►, �® jq WP`s c, 9Z.7G 0 I hereby certify that this survey, plpn, or report was prepared by me or Scale: I inch etptals,, 6Q••_ fNt under my direct supervision and that I or" a duly Registered Land Surveyor • - Indicates Iron mm"ot Sat under the laws of ouzo State of �Ilhnnesota from. O - Indicates n Manu ttsat FWAldgq / ' AUL 111"M .. pop ........00 Na. "/.f ..... Dote 110-28'-71 Req Nora¢ t TNephorn 561 Sheet 2 of 2 sheets CNERRIER WINTER & ASSOCIATES INC. REGISTERED PROFESSIONAL a LAND SURVEYORS SUITE 306 VILLAGE NORTH PROFESSIONAL BLDG 7420 UNITY AVENUE NORTH BROOKLYN PARK. MINNESOTA 55443 Certificate of Survey PROPERTY OF Dick Gregor described os fol lows • - Legal Description Lot 31, Auditor's Subdivision No. 129, except the North half thereof, also except the west 92.75 feet of the south half of said Lot 311 Anoka County, Minnesota. I hereby certify Mot this surrey, plan, or report was prepared by me or under my direct siopervipion and that I am a duly Reaisteirso Land Surveyor under the lows of the State ofM�nret.oto. res . , .1 / / Date Rog No Scale : 1 incl) etpale., •, , hot W- Indicates Iron Momment Set o - Indicates baa Maawesd Faits/ Mph ..F%P ........JeS Ile .................... EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION AaDATE ,3 %S PHONE: 7e4- 174(o OWNER: a V-� SITE ADDRESS: CONTRACTOR: /�P` Determine working square footage of each 1. Total exposed wall area....... sq. ft. x .17 2. Toal roof/ceiling area • ..... 344 sq. ft. - x .05 Total exposed wall area above floor a. Total wall window area........... �. � a��............. • b. Total door area ....... 40, 6Z� ° c. Total sliding glass door area ......................... d. Total fireplace wall area ............. ......... -- • e. Total,wall_framing area.(average 10%)•. � ...•••.••. .. f. Total rim, joist area .... ,..................... ........ / 07, Z- 9. wall area above floor .......................... h. wall area above floor .......................... i. wall area above floor ........................... j. wall area above floor .......................... Total exposed foundation area = k. Total foundation window area ........................... 1. Total net foundation area above grade ................. s®7aZ- Determine "U" value of each wall segment (e.g. window, door, each separate wall section) a• ZZq X nun d. X "ue' _ g• X h. 1p x X nun = #pun �Z = nun Q = jX "u" _ . lee k X "u" _ 7. x 3. ••.•..........•......•..••... Total es 4one If item #3 is the same as, or less than item #1, you have met the intent of SBC 6006 (c) 2. 32-1 '3?y g 0 Exterior Envelope Average "U" Computation Page 2of4 Total exposed roof/ceiling area m. Total skylight area ............................ n. Total roof/ceiling framing area (average o. Total net insulated roof/ceiling area........... Determine "U" value for each roof/ceiling segment M. X "U" _ n. X faun = 0. X fault 4.......... .................. Total 2 Z = If total of #4 is the same as, or less than #2, you have met the intent of SBC 6006 (c) 1. Alternate Building Envelope Design To utilize the total envelope system method, the values established by the sum of items #3 and #4 shall not be greater than the sum of items #1 and #2. 1. + 2. _ t d� 3. + 4. _ WALL SECTIONS NOTE: Use 10% of opaque wall area for .41 frame construction FRAi4E WALL e • 1 FSG. #3 a 7o4 • - t , 9` rQy.: J VL Y Construction R -Value 1. Interior air film 0.68 0.68 2. vv�, 0.4s 3. 4. °/Z —C; LC 6cai- 5' fir- .lid D e ,� / �o l� �9 r`� r1 G. Q=ior) 6. Exterior air f ilm 0.17 1. Total Interior air film 14.4 3 0.68 2./7Z ".)a If boa v - j- 0. qa® 3. AB -7,78 4. '/� ' Imo'° mer• �,. S �n� - l e 3 Z e ' A 6. Exterior air film 0.17 1. Total' �V 15, Interior air film 14,43 0.68 2 • p T 3. ��Z S® " 1, 5. °%L� X /ZL a P t-,; —� I 6. Exterior air film -0.17 Total 1. Interior air film 0.68 2. vv�, 0.4s 3. / ZCa�c, l3 X, Z,48 4 ,� / �o l� �9 r`� r1 G. Q=ior) / 5. 6. Exterior air film 0.17 Total -7,78 FIG' #4 /ll r � • p � /it <<r Y` • NOTE: Indicate tppc1, "R" 'value, depth and placement of insulation. • aT'M!/iS ROOF/CEILING r. VDIT Vented Heat flow up FIG. n5 " •uiyj.s.�! V�•;�.0�-•�1i_:��r::`�P�•S�:e�`'�.i t'J•'�: <..G �T Cyl u e }feat • . ' £low up . pT.r. #7 . Page •4 of 4 Construction R -Value 1. Interior air film 0.61 2. sibSo ev% 6d- 3. fo, 8�s m e�� . �✓eSv . 4. Exterior air film (still) 0.61 _ Total 1. Interior air film 0.61 2. 3. 4. Exterior air film (still) y 0.61 Total 1. Inside air film 0.61 2. 3. 4. 5. Outside air film 0.17 Total Note: use additional sheets if more space is needed for details and calculations • }:eat flow up .-ventede a _ .FIG. 6'..... " 03 • ' -- � � : �,. ��'�..: ;- :•• _ yam:.:--• T � u e }feat • . ' £low up . pT.r. #7 . Page •4 of 4 Construction R -Value 1. Interior air film 0.61 2. sibSo ev% 6d- 3. fo, 8�s m e�� . �✓eSv . 4. Exterior air film (still) 0.61 _ Total 1. Interior air film 0.61 2. 3. 4. Exterior air film (still) y 0.61 Total 1. Inside air film 0.61 2. 3. 4. 5. Outside air film 0.17 Total Note: use additional sheets if more space is needed for details and calculations • 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 TELEPHONE ( 812)571-3450 Mr. Dennis Kugler 8331 Terrace Road Minneapolis, Mn. 55432 Re: Final Inspection at 1560-64 731i Avenue N.E. Dear Mr. Kugler: A final inspection was made on August 23, 1977 of the above noted property and the following items were noted which must be completed before the construction can be finaled out; 1. Provide nuts on anchor bolts in garage. 2. Provide door closers on doors between garages and dwelling units. 3. Provide sod in the front and side yards. 4. Complete decks. The above items should be completed by October 3, 1977 when a reinspection will be made to determine compliance. If you have any questions on the above items please feel free to contact me at 571-3450. Sincer �71 DARREL G. CLARK Community Development Adm. DGC/mh 8431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 66432 TELEPHONE ( 612)671.3460 ,a August 24, 1977 X Royal Electric 6441 University Avenue N.E. Fridley, Mn. 55432 Re: Corrections on Electrical Work at 1560-64 733i Avenue N.E. Dear Sirs: e A final inspection was made on August 24, 1977 of the above address and the following was noted which must be completed before the structure can be finaled out; Put running boards under Romex cables crossing garage framing. Would be much easier to follow it in feeding light. We will expect the above correction to be completed by September 2, 1977 when a reinspection should be called for to determine compliance. If you have any questions on this item, please feel free to contact me at 571-3450, between 9:00 a.m. and 10:00 a.m. Sincerely, LEONARD EICHMILLER Electrical Inspector LE/mh . L11 Y OF FiUDLEY �• APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE , /s _ & t� CZAVITY WAIM AIR: RATE TOTAL Job Address / Furnace Shell a D.:ct Mork $12.00 $ R=pace= :t of ?:rnaco 7.00 7.00 $ $ Department of Buildings e: airs a Alterations -up to $500.03 4.00 $ City of Fridley Re.airs & Alterations each add. $500.00 Tel. ;#572-34501 ECHANICAL WARM AIR: The undersigned hereby makes application for a permit for the work herein Vurnace Shell & Duct Mork to 100,000 BTU $13.00 $ �- y, u`� specified agreeing to do all wor'r, in strict accordance with the City Codes each add. 50,003 BTU 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the 7.00 $ facts and representations stated in this application are true and correct. Re-lacament of Furnace Re airs & Alterations -up to $500.00 7.00 $ 19 % Ro airs & Alterations each add. $500.00 4.00 $ Fridley, Mian. . J 1"� 1 �� Pr �v ,' .� r IEV.' OR 143T{ti WATER Sl'STLNI: OWNER /; Boiler &Lines up to 103,000 BTU $13.00 $ KIND OF BUILDING i � � �/"� "ems each ad--. 50,03J BTU 4.00 $ � h Boiler only up to 1CO,GvO BTU 7.00 $ USED AS v✓T/� each ad :.•i. 50,000 BTU 6.00 $ / TO BE COMPLETED ABOUT IL BURNER- to 3 gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $ ESTIMATED COST AS BURNER- from 103,000 B:U to 199,999 BTU $10.00 $ 2 v•ca`' OLD - 4�UILDING PERMIT NO. FEWMIT NO. (aver 199,999 BTU see Fee Schedule) $ AS FITTING FEES: lst 3 Fixtures x $ 3.00 $ u °� DESCRIPTION OF FUPVACE/BURNER Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00 $ HEATING or POWER PLANTS, Steam, Hot Water, Wast Air- No. Z. IR COXDiiTO.NI�G �i $ / Trade Name 1-'7 n 0�G Size 1o. Co l �i X HEATING SYSTEMS See Fee Schedule $ E\Tl ASI\C SYS- .V.S :` $ Capacity Sq. Ft. EDR?'-,' BTU ;? LTEti�TIO\S REPAIRS' ) $ State S::rcharge $ .50 Total Connected Load / i Kind of Fuel !' TOTAL FEE $ -so b� BURNER - Trade Name Size No. D_ ( I%S?. REINSPECTION FEE Capacity Sq. Ft. EDP BTU HP Date ($10.00) Company IXAL INS?. Late r -ned By _ PPROVAL FOR PER.:IT I _ i n _ Tel. No. =12=24 FEE FOR ANY HEATING PEP -MIT IS $7.50 HEAT LOSS CALCULATIONSQ u MINNEAPOLIS, MINN.' Weatherstrips A.S.H.V.E. Guide Reference 19 Construction No. Insulation Windows Daars Out. Wall Int. Wall Coiling Roof Floor Kind How Applied Yes -No Yes -No FI. Room Length Width 3 Height FI. Room I Length Width Height Windows and Doors-Crackage and Area Windows and Doors-Crackage and Area No Width Height No. of Lineal ft. Area of pane of pane lights of crack Sq, ft. No. Width Height No. of of pane of pane lights Lineal ft. Area of crack sq. ft. tv3ILIzip Coef Btu 4--1 lCoefl Btu Infiltration Lf`' G Infiltration Glass J� ) ` Glass Exp, wall Exp. wall Net exp. wall Net exp. wall Int. wall Int. wall Ceiling Ceiling Floor IR j 5 '9 Floor Total Btu. - Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl. CG Room Length l I Width " Height Fl.Room Length Width Height Windows and Doors-Crackage and Area Windows and Doors-Crackage and Area No. Width Height No. of of pane of pane lights Lineal ft. Area of crack sq. ft. ?'71,11He ght No. of Lineal ft. Area No, of pane I of pane lights of crack sq. ft. Coef Btu Coef Btu Infiltration,3 1 Infiltration Glass f - `� Glass Exp. wall �2(� K Exp. wall Net exp. wall Net exp. wall Int. wall Int. wall Ceiling - Ceiling Floor 9- Lf -' Floor Total Btu. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl. Room I Length l` -_ Width G Height Fl. Room Length Width Height Windows and Doors-Crackage and Area 1 s-� E Windows and Doors-Crackage and Area Width He,ght No. of L+Heal ft. Area No. of pane of pane lights of crack sq. ft. No Width He.ght of pane of pane No. of Lineal ft. Area lights of crack sq. ft. Coef Btu Coefj Btu Infiltration 4 L7 7 Infiltration Glass Glass Exp. wall �� Exp. wal I Net exp. wall l ( �e L Net exp. wall Int. wall Int. wall Ceiling Ceiling Floor l - -- Floor --— Total Btu. ' j =� {. L� ,J Total Btu. Required sq. ft. E.D.R. or sq. Ins. W.A. Leader area Requtred sq. ft. E.D.R. or sq. !,s. W.A. Leader area HEAT LOSS CALCULATIONSf, I��G�� Q� y�+,l ��®��®• MINNEAPOLIS, MINN. Weatherstrips A.S.H.V.E. Guide Reference 99 Construction No. Insulation Windows Doors Out. Wall Int. Wall Ceiling I Roof Floor Kind How Applied Yes—No Yes—No FI. l Room Length Width Height FI. �Gz'1 Room Length Width Height WinddWs and Doors—Crackage and Area Windowsfand Doors—Crackage and Area i ZD No. Width Height No. of Lineal ft. Area of pane lights of crack sq. ft. No Width Height No. of Lineal ft. Area/ of pane ofpane lights of crack sq. ft.L/ .-�f G� ® Coef Btu Coefj Btu Infiltration Will -F-T- [f �j Infiltration Li /^1 Cf 2 Glass �:�L7 Glass Exp. wall i( Exp. wall Net exp. wal l 73 Net exp. wal I lzlq Int. wall Int. wall Ceiling 3 Ceilinga 11 3a - / Floor 1�2G,) Floor Total Btu. ' �9;2 Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI, r oom Length Width Height FI. f UJAj Room Length ! Width I Height Windows and Doors—Crackage and Area Windows and Doors—Crackage NW dth Height o of pane of pane and Area No. of Lineal ft. Area lights of crack sq. ft. No. Width Height No. of Lineal ft. Area of pane of pane lights of crack sq. ft. Coef Btu jCoef Btu Infiltration Infiltration L- L Glass Glass Exp. wall C+ oma- � Exp. wall 7 X_ Net exp. wall Net exp. wall Int. wall Int. wall Ceiling 12 Sly; �- L L) Ceiling Floor Floor Total Btu.Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl. K, ZcZaP Room Length ` Width j Height FI. �x�t^• L?Qn Length , Width f` Height Windows and Doors—Crackage and Area � I/ Windows and Doors—C ackage and Area p No. Width Height No. of Lineal ft. Area of pane of pane lights of crack sq. ft. No Width Height of pane of pane No. of Lineal ft. lights of crack Area sq. ft. I (:, _51 =ZE: - I 2 1!2 _Iil_3� Coef Btu Coef Btu Infiltration Infiltration Glass s— Glass Exp. wall Exp, wall Net exp. wall ��j �';� n Net exp. wall Int. wall Int, wall Ceiling ;�X131 --�� _Ceiling Floor Floor Total Btu. �Lt13 Total Btu. l <� Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT m I vi m t� m .�rq1 a a� c� m u E+ 3 a .g y a w° ym 01 A W g m :c 8)i •i 0 3 a °a c5 w a, g p�4 FI o Water Heater as lec Catch Basin x $5.00 $ Water Heater - to 99,000 BTU x $5.00 $ f 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ New Ground Run Old Building x lst $ Electric Water Heater x' $5.00 a GAS FITTING FEES: 1st 3 fixtures x '$3.00 $ Additional Fixtures x $1.00 $ 2nd x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge 3rd $ .50 TOTAL FEE $ 4th (R) = Future Connection Opening (*) = New Fixture, old Opening Connected with Sewer Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $3.00 i z $ G(�J • CC' 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 $ f 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 BTU x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ REINSPECTION FEE ($10.00) Job Address /"-6 o- (cy � 3 lj_ _�_� • �K 1 0 L 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 KIND 0 Fridley, Mn. , 19 USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company Signed By Tel. No. ROUGH INSP. G Date FINAL INSP'3' 2 7 I Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR s_ cbr4i-3 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PLUMBING FIXTURE RATES: NO, RATE TOTAL JOB ADDRESS! (/2 AVB N_G New Fixtures $10.00 Old Opening, New Fixture $10.00 Beer Dispenser $10.00 Blow Off Basin $10.00 Catch Basin $10.00 Rain Water Leader $10.00 Sump/Receiving Tank $10.00 Water Treating Appliance $35.00 Water Heater -Electric $35.00 Water Heater - Gas** 1 $35.00 Gas Range** $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes () No Type $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance —3T. NO State Surcharge $ ro 0 TOTAL FEE $ '7f -)-5D 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. DATE: r 20 v 5 OWNER OSS r LJL sD� BUILDING USED AS ESTIMATED COST U.•l� • QV PERMIT NO. PLUMBING COMPAN � SIGNED BY TEL NO. 65 3In5 1 JL40 Approved By 4f 1�-r Rough -In Date Final Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF CO' 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 -35%�)o GP FILL IN COMPLETELY FOR REPLACEMENT FUEL BU14NING APPLIANCE PERMITS COMMON VENT; VENT CONNECTOR AND COMBUSTIONAIR VERIFICATION When replacing an existing f rnace, 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 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 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 :