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SUBJECT MIT NO. City of Fridley ® 989 AT THE TOP OF THE TWINS BUILDING PERMIT COMMUNITY DEVELOPMENT DIV. ------. INSPECTION R r � � PROTECTIVE SEC. 3 1 CITY HALL FRIDLEY 55432 ,'J NUMBER REV. DATE PAGE OF APPROVED BY `---- 612-560-3450 910-F15 10/26/78 JOB ADDRESS 1474 - 76th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 Meadowmoor Terrace 2nd SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Garjac Construction Inc. 675 Highway #10, Blaine 784-6850 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS DNE SE NO. EIPERATE f'ERMIi5 REQUIRED FORVVIRI as 6 USE OF BUILDING HEATING, PLUMBING AND SIGNS. Residential 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR. ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 24' x 44' Dwelling and a 22' x 26.5' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side yards. Provide a verifying survey before capping. Soil tests may be required if footings are placed on compacted fill. SEWER LOCATION: 8' E. of Manhole (Inv. 888.83) WYE ELEV: 888.84 TOP OF FOOTING: 891.84 Minimum WATER LOCATION: 13.5' E. of Sewer Service DRIVEWAY DEPRESSION COST: N/A Recommended but not required THE CITY OF FrIDL-;Y DOES PJOT GUARANTE- THE ARMING ACCURACY OF UTILITY LOCATIONS AM) ELLVATIC,1,6. Before call utilities THIS DATA IS FOR INFORMATION PU THE �NFpyRMATION TELEPHONE AND Ing ELECTRICaIGRSEtc. PERSONS USING R SHOULD VERHY ON THE SITE. REQUIRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame 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 + 497 27,124 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION I 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 $38,148 U22. $19.08 DOES NOT PRESUME TO GIVE AUTHORITY T VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIO OF ANY OTHER STATE OR L AL LAW REGULATING CON.- STRUC7I0NVR THE PERF9RMANCE OF CCPSTRUCTION. $108.50 $400.00 PLAN CHECK FEE TOTAL FEE p 2s6 I� 12 N-,-$554.70 W EN PR EALI THISIS YOUR PERMIT SIGNATURE OFC NTRACTORORAUTH RIZEDAGENT )DAT G INSP DATE SIGNATU E OF OWNER IIF OWNER BUILDER) (DATE) CITY OF FRIDLLY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NL" -W, ALTERATIONS, ADDITIONS, OR REPAIRS) 01111ER: / '- 12 - BUILDER: / I Address: �%S" Address: �7S-�� /Q . Tel. No.:G No.: / `7 Street: LOT: BLOCK: I ADDITION CORNER LOT: INSIDE IAT: SETBACK: SIDEYARDS: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: NEE tj - 1�0<00'- Front: 9q Depth: q 1. Height: go / . Square Feet: Cubic Feet: �J •Front: � �1 _ Depth: 96,3 Height: US$ sP Square Feet: Cubic Feet: 4ryr)® Type of Construction: PL Estimated Cost: $ To Be Completed: 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 -or additional information. DATE: SIGNATURE: Stipulations: pzi,LVn P.C- . Wy S19_� tR, 69 L-100100 "70 '53, -�1- MA -Y IF L' u," p 4<-G K-0 F7( k -,L . '' �'Y eVri:�l.�cvArxor� �U LU tju Pu MI ATrPi f'i1T3{3iV �� f Fr'JINN�N'. r ►'r; .'s'.'�ri n} t'r �PPM1 %NT M' CI 14144,01W Zirl (.mcnt In, f,iwvfc3Cd t c, s��,'-aeaTrt xiJ ?'E�rput;n� k:XTk; 1QR Ffl�llst,rp f'N1' • 119'Ic)f. ` nit $nn i::g lbqu.,yir SO 6; t Jthe" �t, .:�iIJ���1�4 +�. C-ztll L�l, �tt,v Y � 1, t lry �.�Tv.lt Ij1'r , iiJP ('�'�r o�.w'ifj;i !-t'Ki�. s.1ri rs �I �Ofj.'!'�.'.��y%f ,'�'�,I 01w •. ?,, .; DESI 7 CkZTLIUr uf.. the fS.L TE,131 r;, . iSectie"n 0000}.. It is the i1PPLIiANX'`5; iresp ''ns�bi:]iryr„ to: aL Uia,t.ly r�f7;e :•t the prop&,r 'DES1 t ''G"RTEPAAi: f irrG'dt :to suPtrart the "K" 'at>d factors used;' aridt¢' assure ca,taf ;', i, Fier aFrproved 'plans it0E TOCATION. ��NEE/�O�ITRACTOR � ;' ADDRESS !PHONE A Determine the, Total, Exposed ya' Area. as follows m, r' 1. Total wall w ndo;i area 2, Total door area s 3: Totalsliding glans door •, Ztital . fireplace wall edea 5. T tal gall framing area (average 10$) 6..Tbtal 00t wall area aboite .floor average 9zlgv 8 z+o to fi .rim joist _area Subtotals 1`otai .wcpoadd +fa11 abcive flpot ,area JK;.: 8;. Total I oundatio'h 'window area �^ Zb'tal net foundation area above grade Subtotal: Total exposed foundation area Y GRAND TO= EXPOSED WALL AREA 8. kuliiply the GRAND TOTAL EXPOSED WALL AREA R .17 . _ Item I ; Determinethe Total Exposed Roof/CeiliWgi Area as fol2os r 10. Total skylight area ' ll� Total roof/ceiling framing area: (10%) Z 12. Zbtal. net insulated roof /ceiliryq area 4039 GRAND .TOTAL EXPOSED ROOF/CEILING AREA D, .Multiply, the GRAND TOTAL. 'EXPOSED ROOF/CEILING AREA X .05 a i-teR4 r t r r; YI 4 b v, C, t,ply; rb ";'.' I a -'A 40 4 x A aiL tout$ .... . .... .9 'xp 11ITS ,kbD1-9 VOR T L.,WALL SE04ENTS nt� the each segment DO t*xn i 'u" Valu6 0 f . (10-7l2 ,and' multirl V B the mea 'as Y, 0"'U 0 'x "!gulf 7." 4 F -SEGMiMTS f- 4 t1w .same as, or. less .have met ;the t' -thaw Item I. yoq�, 8ta-te_Ouildi jig; 6006 (c) -2 E If XV is, e same as, 6r less than Item II you. have met theL intent'' ,Dein bb Iding ;Co4e, 6006 (c) 1 D + Item 11 ;!4 J 'did Item III2ytZ:s. + Item IV t1i eand j m of Tt s III and IV are less than Items II, .you have rixet the a the,.C6de':for total envelops system. 'Jim The rsigned, as applicant for a building permito � -u*,'de:i +jjL„'.ha, been r0oared and submjt,te& byhimsq nfoft6tioh. t6`be correct '40 ksetObV, acknqwXedg�ts 'the f_64nn4-4t%n-- WI: reauirdd vlans,',, nt'sur + `BY _ DATE: h.preby affir the;: above On f o r.� u 44,6�t., .,h 4, ccuratet anti hereby ., 5' 031 $ec, '`�h A A h d $ M; III z 4% -gss t, :. h1 oz x ll I LA x Qb = Lb %43 Q_ -j SSy7 � h , a ie Or x �Sol xfie -.9 f Ax • CITY OF FRIDLEY .9-317'19 APPLICATION FOR RESIDENTIAL BUILDING PEMITS (THEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: BUILDER: GjI 0c JV Address: Address: Tel. No . No. Street: % -t7# i% G C /1� LOT: BLOCK: ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS: Applicant attach 'to this form T<oo Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: Front: Depth: Height: Square Feet: Cubic Feet: 'Front: Depth: Height: Square Feet: Cubic Feet: Type of.Construction: Estimated Cost: $ To Be Completed: 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 wort: 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 &lditional informati4. DATE: SIGNATURE: Y-' Stipulations: , 'S" Lj I CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS & ALTERATIONS First $100.00 each add. $100.00 or fraction NO. RATE m x $3.00 >. 3 x $2.00 $ x $2.00 0 Water W $ ,-ei 9 m $ H-1 ro m a" q+"ggEtl'i x a w 5 x Heater $ x $5.00 $ d x $3.00 $ x $1.00 $ ie$ X $10.00 $ O O O V of N-1 p O O tlf N m EQ v raa vi 3 n w to w U oa .�% c� o as lec RA— t l 1st tt f 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS & ALTERATIONS First $100.00 each add. $100.00 or fraction NO. RATE TOTAL x $3.00 $ 3 x $2.00 $ x $2.00 $ x $5.00 $ x $5.00 $ Sic x $10.00 $ x $7.00 $ x $5.00 $ x $5.00 $ x $3.00 $ x $1.00 $ X $10.00 $ $5.00 $ $2.00 $ State Surcharge $ .50 TOTAL FEE $ 6-19 REINSPECTION FEE ($10.00) Job Address ! Y17 Y°— d'/ im d . Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley. Mn. 5 , 1919 :AMY$ KIND OF BUILDINyG USED AS & [� S TO BE COMPLETED ABOUTP Y a ESTIMATED COST O AO OLD - NEW BUILDING PERMIT NO. PERMIT NO. CompanpByt� R n( -� Signed C--u_�Tel. N ROUGH INSP. Date FINAL INSP. F -3t- Date 3/ Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND Furnace Shell & Duct Work to 100,000 BTU AIR CONDITIONING SYSTEMS AND DEVICES each add. 50,000 BTU PARTIAL RATE SCHEDULE $ *Replacement of Furnace /_Z� % Z71 $ GRAVITY WARM AIR: RATE $ TOTAL Job Address — 7°O O Furnace Shell & Duct Work $12.00 $ Boiler & Lines up to 100,000 BTU *Replacement of Furnace 7.0u $ 4.00 $ Repairs & Alterations -up to $500.00 7.00 $ Department of Buildings 6.00 Repairs & Alterations each add. $500.00 4.00 $ City of Fridley each add. 3 gal. per hour 10.00 $ GAS BURNER- from 100,000 BTU to 199,999 BTU Tel. #571-3450 $� MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU $12.00 $� each add. 50,000 BTU 4.00 $ *Replacement of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $ Repairs & Alterations each add. $500.00 4.00 $ STEAM OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU $12.00 $ each adds. 50,000 BTU 4.00 $ Boiler only up to 100,000 BTU 7.00 $ each addn: 50,000 BTU 6.00 $ OIL BURNER- to 3 gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $ GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $� (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: 1st 3 Fixtures x $ 3.00 $ Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00 $ AIR CONDITIONING $ FAN HEATING SYSTEMS See Fee Schedule $ VENTILATING SYSTEMS $ ALTERATIONS $ REPAIRS $ State Surcharge $ 50 TOTAL FEE $rt7 ROUGH INSP. uaLea G FINAL INSP. c�- ✓ / O Date APPROVAL FOR PERMIT 114S REINSPECTION FEE ($10.00) MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE *Attached stack verification form 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, Minn. OWNER 4J1/ ez/g KIND OF BUILDING USED AS TO BE COMPLETED ABOUT G OLD / S98 NEW BUILDIN ERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER / HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Name Size No.Vor Capacity Ft. EDR BTU 5� HP Total Goruiected load Kind of Fuel BURNER - Trade Name Size No. Capaaity Bq. Ft. EAR BTU HP Company '.�Cac'l�ltjGlClYliL4 Co.Signed By o e tZ Minnepr_O!iota 55432 Tel. No. CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE �7�D GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work $1*,00 $ ' Replacement of Furnace 7.00 $ Repairs & alterations -4p to $500.00 7.00 $ Repairs & Alterations each add. $5QOz00 4.00 MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU $12.00 each add. 50,000 BTU 4.00 *Replacement of Furnace 7.00 Re:airs & Alterations -up to $500.00 7.00 Repairs a Alterations each add. $500,00 4,00 STEAM OR HOT WATER SYSMI: Boiler & Lines up to 100,000 BAIT $}2.OQ each addn. 50,000 BTU 4.00 Boiler oray up to 100,000 BTU 7.Pq each addh. 50,000 BTU P. PP OIL EU -NER- to 3 gal. per hour s•�q.gQ each add. 3 gal. per hour GAS BURNER- from 100,000 BTU to Igj,gjq ?TR S}Q•Rq (over 199,999 BTU see Fee Sche ulej GAS FITTING FEES: a 1st 3 Fixtures c 9 7 4/� x S,qq A33i:ional Fixtures x S }:Pp Gas Range to 199,000 $TU x g1G;OA AIR CONDITIONING FAX HEATING SYSTEMS See Fee Schedule VENTILATING SYSTEMS ALTERATIONS 4 REPAIRS State Surcharge TOTAL FEE ROUGH INSP. Date rmin Date , APPROVAL FOR PERMIT REINSPECTION FEE ($10.00) S YS1'Il:::M FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE *Attached stack verification fora Job Address Department of B14jj43.nBs C*ty 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, Minn. 19,7 45� OWNERat-ya'a, - r,IND PF BUILPMG usFP AS TP FF FORLFTFA 'PUT F-STTWI P.P PPST PFR:}T NO. /) �' PESr_RTPTTgN pF FPMACE/BURNER U:mwi r' R#' Imm :?. W.TI.5f Sxe ?i!r #IRS Flgxert Waw} AIr- No. Tr4de Name Stze No. Capacity Sq. Ft. FDR BTU HP Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company C0NF)1T[ BAN AIR Signed By ®NINM CO■ ..._ . 7 9 ENTER DR, Tel. No. MIRIPdEAPp CITY Or FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL. RATE SCHEDULE G.i2AVITY WARM AIR: RATE Furnace Shell & Duct {Fork $12'00 * P.eplacerent of Furnace 7,00 Repairs & alterations -up to $500.00 7.00 Repairs & Alterations each add. $500,00 4.00 XECHANICAL StiAIM AIR: Furnace Shell & Duct Work to 100,000 BTU $12.00 each add. 50,000 BTU 4.00 *Replace=e:t of Furnace 7.00 Re?airs & Alterations -up to $500.00 7,00 Repairs & Alterations each add. $500,00 440 STE4:•1 OR HOT I%ATER SYSIZI: Boiler & Lines up to 100,000 BTU $}2.pQ each addn. 50,000 BTU 4.00 Boiler only up to 100,000 BTU ?•pp each ade-i. 50,000 BTU A.Qp OIL EUR.\ER- to 3 gal. per hour S�q.gp each add. 3 gal. per hour GAS BURNER- from 100,000 BTU �o 1gq,gqq STA SIp:qq (over 199,999 BTU see FeaSS hequlle) GAS FITTING FEES:- Q'�"' A`� a��' 1st 3 Fixtures x S A:pq A!ditional Fixtures x $ I:pq Gas Range to 199,Q0Q BTU % �U:QQ AIR CONDITIONING PAN HEATING SYSTEMS See Fee schedule VENTILATING SYSTEMS ALTERATIONS 4 REPAIR5 State Surcharge TOTAL FEE ROUGH I:'SP. Date FI2iAL Iz;sp. 3'y' Date APPROVAL FOR PEMIT REINSPECTION FEE ($10.00) TOTAL $ $ Y.IA'MUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS'$.50 STATE SURCHARGE *Attached stack verification fora Job Address Department of B1#jdUngS C*ty of Fridley Tel. #x571-3450 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 Jtrue and correct. ZFridley, Min / , 1901 MMER f—W pF or�rr rarer us11:P AS FSTTNAPP pP.ST `�/ // • v P� A - PA��P• . F .F'��T NQ. FPR+ITT 3i0. PPSORT:PTTpN OF FPrUjACE/$URNER BAI^JBIi BITS, S1 e�?r!r #(Qj: Pl4Zert T qM AI;- No. Trade Name Size No. Capacity Sq. Ft. FDR STU HP Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company SLI RJDIT99]N'NG COs, INC, ' Signed By 84 L9 -C MINNEAPIXIs, MN Tel. No. 55432 • C Iii, oil b.� .. -N.E., F'RIDL:EY, `PdINNIESOTA 1643.2 T-EL'E€ H 0 N E ( 612)671,34-50 February 29, 1980 Mr. Gary D'Ai.gle Garjac Construction Inc 675 Highway #10 Blaine, MN 55434 Re: Final.Irispection at 1474 - 76th Avenue N.E. Dear Mr. D'Aigle: A final inspection was made on February 27, 1980 of the above address and the following.items were noted which must be completed before the structure can be`finaled out; 1. Provide sod .in the front and side yards by June 15, 1980. 2. Provide a hard surface driveway by June 15, 1980.. 3. Complete the fire wall by March 14, 1980. 4. Install ball checks in the floor .drains by March 14; 1980. We will expect the above items to be completed by the scheduled dates when reinspection will be made to determine compliance. If you have any question on these items, please feel free to contact me at 571-3450. Sincerely, DARREL G. CLARK Chief Building Official DGC/mh 9.7-811 Zt16051 APPLICATION FOR PUJMB114G AICD 6AS FITTING PI:K'1l r n 3J474 V1.2 1• Hater Job Address 11474 76 Ave. NE r4 t 7 .. •+ I J J. W Ilea tar I,• �" yVj U DeparL(IthnC se ti.: !j c �� i�c 3� J s� i� ac Clly Gt Prldlcy a Tel. !1571-3.150 —I_ _I Thu undoral.3n�a Il_teC ca 1 grill i epaClfled a7rcc11;� LZ Jyo ilk work r. SLr: •_r a ;.`r^'lt tar the Cit Lezclr • I I I _t_ and rulings cr the Ge::e.rurcnt -u `t `c=crasc,n wltt. tL1 City Coke, of B�::a1nJs, _ •ezttr .Jn.larel. tl.at all • l t 1 �,`. tho facto a,1d rc1�r,,surtaLtona etatua .icatic nto truo and x.t I F In thtti 4-29-80 MINER MCCLAY ._ . ti M I..t„Ic :..nnccttcn GL�n:r j :;•Vatca withSt:wt:r KIND OF DUILLIN4 fr Ae '1—I/Cr t l•(4td, Gla Ol:tntr] Hater USED AS res. 1 f T I J TO DE COMPLCTEO 1,1”; j r 5-6-80 -- L) ill l ! L l: 11L :Srl V :i!._,.0 ► ESTINIATL•D COS, 50.00 Atli h:. L� liu. RATE TOTAL. OLD - NLt1 x $3.00 ; — INl.1ta FiACJIt G(.cr::r.3 $2.00 •- I x $:.00 5 Gtt.fi 1a•stn �--- MIPdNEGA x $5.00 ; StJnua By "Ate, "Ia:Attr - to $7,000 61V _ x �j.DD lu,►,dJO 61V to 1S OLD ®Su x $10.00 $ x 57.00 5 Ilcw l.tt.una Ilan Ola b,alla11r.7 x 55.00 $ ROUGH IIISP, Llecttl„ Hater Ileeter Y 65.00Data S _ FItU,L IIISP. _�. Z���•(} D►t 1 fl•tucas Datu x ;3.00 ; Al.11tlan•1 MLLuces �-- x $1.00 i �" ha••/+ to 159,00u 61U x S10.00 ; AI•(•pUVAL lGlt FEau•IIP 41 � - 6 ALitHnTiuNS yIOu.ou sa.l•3.1. $5.00 5 i1��.u0 or lcactian ;2,00 S MIIIIMut, I'LL Ii.p 1:1'1 I,LUI:ulfiu Pok;;ir IS s7.5a PLUS i,:D :Ii.TL 6UkoLs SC SLatt7 5�rcr,arg6 $ SG T:.rr.L t 1.c 5 8.00 SUBJECT P City of Fridley o 118941 AT THE TOP OF THE TWINS BUILDING PERMIT r REC COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. L/ P// CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 5/11/87 JOB ADDRESS 1474 - 76th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE AI TACHED DESCR. 2 1 Meadowmoor Terrace 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Stephen R. Hayden 1474 - 76th. Avenue N.E. 784-862a M'I 3 CONTRACTOR MAIL ADDRESS ZIP PHONE I 'CENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE 11 LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 12' x 12' Deck and a 12' x 12' Three Season Porch 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. PERMITS REQUIREDJmmJF[p�o��ggi$Idea! i`cei*a FOR DN diELEtIft HEATING, PLUMBING ft AND SIGNS. REC�1rLOY 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 SQ. 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 $4/ ()QQ $2,00 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 OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $57.63 SIGNAT EOF NTRAC O AUTM QED AGENT (DATEI •-- - 'i WHEN ROPE L D THIS IS �YYSUR PERMIT ( Z 8 )NSP GATE SiGNA RE OF OWN-,IFJ5W BUILDER) IDATEI AM Mamie Mod NEW [ ] ADDN. ALTER. [ ] Construction Address: Legal Description: 11 Owner Name & Address: Contractor :_______ Address: `� 6_z)n if LIVING AREA: GARAGE AREA: DECK AREA: OTHER: City of Fridley R-1 AND R-2 Building Permit lApplication AV e Effective 4/1/86 >y 7-erTrc.GC Tel. # % ^ V" Tel. #-- 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 Length Width Length Z Width Height Height Hgt/Ground y iG `4t3 �ge17.�Z r 1,44)0 low ac0. 2' Side Yard Setback Corner Lot [ ] InsideLot [I ] Ft. d Type of Construction: afte Estimated Cost: $ 49ii� Approx. Completion Date: 1� � v5 I g 7 Sq. Ft. _ Sq. Ft. Sq. Ft. Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation DATE: 16 �— � Z APPLICANT: &I JeK Tel. ,e CITY USE ONLY 4 Permit Fee $ .8b Fee Schedule on Reverse Side Plan Check $ 11.13 25% of Building Permit Fee State Surcharge $ a�.yl� $•50/$1,000 Valuation SAC Charge $ $ 525 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: 4060 ;0 (1 e., 3�.�� ,11741- 1� Main Office 571 6066 UOUROAN 6875 Hiqhway No 65 N.E r,--jE]NOINEERINO Minneapolis, Minnesota 55432 South Office 8906510 Ca ,d & Municipal Engineering • Sod Testing • Land Surveying • Land Planning 1101 Cldf Ruad ®�© Burnsville, Minnesota 55337 a Mortgage Loan Survey for AAraAe. ,— u�' ruW ZVI I `1%.I VkV N 15.E P ts UIk'%TY !KPO-Or'7er't �.oAT�orAT ILy= V1`l 10 lo �2Ile 1t, L L'a�rlrrj o.t5� -16ax- V— d� 1 Z )e eL 3 Sal qis- ti% A02e a- 5--8$ 7 ham: 1".40, 1 rad 4, 1, M9%%VOWM <Offo�-Z*J2ro (AroVLA. 4a -r -'TY) This is a true and correct representation of a survey of the boundaries of the land above described and of the location of all buildings, if any, thereon, and all visible encroachments, if ny, from or on said land. This survey Is made only in connection with a mortgage loan now being placed on th property and no liability is assumed except to the holder of such m . t age er any other interest acquired the reason of such mortgage. It is understood and agreed n� nionu is h ve been ced for the p;�IPICINE'540- a of establishing lot lines or boundary corners. Dated this Le day of A. D. 144.. SUSUI G, INC. 11" L lot Published: All Rights Reserved CITY OF FRIDLEY INSPECTION DIV. �- l 1 V Effective On March 1, 1996 6431 University Ave NE Fridley, MN 61 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, /" 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVI6ES JOB ADDRESS /�/ 7 e RATE E SCHEDULE Residential The undersigned hereby makes application for a permit for the work herein Rate Furnace Shell and Duct Work, Burner – TOTAL specified agreeing to do all work In strict accordance with the City Codes and Also Replacement Furnace $ 30.00 $ rulings of the Building Division, and hereby declares that all the facts and (Side Vent – Fill Out Back) representations stated in this application are true and correct. �� .p Gas Piping (Needed with new furnace) $ 10.00 $ /119 OWNERIq Gas Range $ 10.00 $� BUILDING USED AS Gas Dryer $ 10.00 $ *Air Conditioning –All Sizes 1% �5 900 � ESTIMATED COST PERMIT N0. $ 25.00 $ All Others/Repairs & Alterations (LIST ON BACK) MCRIPTION OF FUR A A Mr, 08 B_URNER 1 % of Value of Appliance or Work$ No. of" madng Units Circle One ( � (Hot Wa er) (Warm Air) Commercial/Industrial Trade Name Size No. ° � BTU �' HP 1.25% of Value of Appliance or Work $ EDR Ft* 4 Total Connected Load YS'L'104; 6L.' /4 &,1 /0/774 LW 'I State Surcharge 50 Burner Trade NameSize No. TOTAL FEE r � STU HP EDR ��� 9 HEATING COMPANY PVIiNIMUM FEE FOR ANY HEATIN�C[COOLIIVGvNTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed sy ! - PLUS THE $ 50 STATE SURCHARGE - Tel No.—Un REINSPECTION FEE $42.00/Hr Approved By Rough–in Date Final Date I4_ l *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE9R STACK VERIFICATION ON written permission from adjoining property owner. REPLACEMENT FURNACE CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the. existing chimney or stack: 1. Has been carefully examined Yes () No 2. Is free from rust or deterioration 3. Has no foreign objects lodged within 4. Is securely supported 5. Meets all current Code requirements for size and total BTU's connected 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: Yes No Yes No ( ) Yes O No ( ) Yes ()No() Yes No Yes () No ( ) su6JEtT P City of Fridley 28213 AT THE TOP OF THE TWINS BUILDING PERMIT r � ITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. ® r NUMBER REV GATE PAGE OF APPROVED BY � /"'1 CITY MALL FRIOLEV 55132 %J 612-571-3450 910-F15 10/13/98 JOB ADDRESS 1474 76th Avenue NE 1 LEGAL -I BLOCK TRACT OR ADDITION SEE ATTACHED OESCR. ILOTNO 2 1 1 Meadowmoorj Terrace 2nd SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Steve Hayden 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO American Roofing & Const. 23624 St Francis Blvd S753-7451 20109195 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 5jx REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (22 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 OCCUPANCYLOAD 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 GOV THIS TYPE OF , RK WILL BE COMPLIED WITH WHETHER SP IED REIN OR NO H GRANTING OF A PERMIT 1885 $.94 DOES NOT PRE ME TO PfVE AUTHO Y TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS,O ANY O ER STAT OR LAW REGULATING CON- ,LOCAL STR 10 R THE P RFORMA E O TRUCTION $59.50 Fire SC $1.88 PLAN CHECK FEE TOTAL FEE License SC $5.00 $67.32 SiGN4 AE OFC N'RACTORORAUTHORIZEDAGENT IDATE- WHENPROPS VALIDATED THIS IS YOUR PERMIT (pl/ o BAG INSP 10-15—`5R T1ATE S,GNATURE OF OWNEROF OWNER BUILDER, IDATEI NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: Owner Name & Address: 757; 1" Contractor: Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Effective 1/1/98 .t Tel. # _ MN LICENSE Tel. # ?e 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. Length Width Hgt/Ground Sq. Ft. Ptj LA-7� Construction Type: & 1-(oo Z Estimated Cost: $ _4/_('; m )Us-- (F Sche ule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = __z!�Ft x $. DATE: APPLICANT: Tel.#��,J% TOTAL $ 62, . STIPULATIONS: CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ /, ��' .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 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 [ ] Not Necessary [ ] TOTAL $ 62, . STIPULATIONS: SUBJECT PERMIT NO. City of Fridley " AT THE TOP OF THE TWINS BUILDING PERMIT r 572-3§ 4 RECEIPT NO. w______ OMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. / `3eA r moi ' ' NUMBER REVD ATE PAGE OF APPROVED BY f CITY HALL FRIDLEY 55432 ti.__.11.' '•� 612-571-3450 910415 111/10/98 JOB ADDRESS 1474 76th Avenue NE 1 LEGAL BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. ILOTNO. 2 1 Meadowmoor Terrace 2nd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Hayden 753-1451 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Am.Roofing & Const.Inc. 23624 St Francis Blvd St Francis 55070 753-7451 20109395 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 O NEW ❑ ADDITION O ALTERATION tMx REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reside house and garage 9 CHANGEOFUSEFROM TO STIPULATIONS Call for building wrap inspection 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 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 COR 1_11L PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS OF WORK WILL BE COMPLIED VALUATION SURTAX WITH WHETHER SPECIFIED HEROR NOT. THE,.dRANTING OF A PERMIT $5000 2.50 DOES NOT PRESUME TO GI AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY 01PIR STATE OR LOCAL LAW REGULATING CON. STRUCYPN OR THE P FORMANCE OF CONST ION $99.75 Fire SC $5.00 PLAN CHECK FEE TOTAL FEE Lice se SC $5.00A 1$112.25 "SICKATWE FCON'RACTORO I+O NT IOATEI WHEN PROPERLY , LIIDAATTED THIS IS OUR PERMIT LD INSp' rIAtE S-GNATURE OF OWNEROF OWNER BUILDERa IOATEI NEVA' [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY �y, ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 , n'l BUILDING PERMIT APPLICATION �,�ry ConstructionAddress: �( (� Legal Description: / V—) �( :7 Owner Name & Address: , AA /j, Tel. # -73�1-- 7q2_1 Contractor:fivu-e-A' Com► i a t�� �- L<� 7— _77,,y ` MN LICENSE # 2_ 001 3 -Li Address: - - Z �-�d J Ij 4[ (-J 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: Construction Type: t _ P Estimated Cost: 0 d (Fee dule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = t x $ _ $ DATE: (LU �) l ( TV APPLICANT: Tel. # -3 L(d-Z TOTAL $ 11 2_� STIPULATIONS: CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ G3 .001 of Permit Valuation (1 / 10th %) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ OG $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 $ 11 2_� STIPULATIONS: CITY Or FRIDLEY INSPECTION DIViSION Effective On January 1, 2000 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 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 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. JOB ADDRESS - / V -7'1" °76 A) A%h� OWNER d TOTAL �00 BUILDING USED AS "DU-) e_� ��tq $_� ESTIMATED COST ;0�2'-?'60- 00 PERMIT N0. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units _ Circle One (Steam) (Hot Wate (Warm Air) $ Trade NameSize No. o C� BTU ( ,.,D 0CDC') HP EDR $ 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 $ 't representations stated in this application are true and correct. DATE _3 0- ®C� BLAIW HM. A/C & ELEC7: INC. HEATING CENTRAL AVE. .I`. Signed L # 1� -?. - V. Approved By Rough -In Date Final Date v0 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 (YNo The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes (vj"No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current cgoes, and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes (a)'No ( ) ^0"a The existing combustion -air is sized and installed to meet the current codes and manufacturer's spedif,ditions. Yes (v�No ( ) When required to lnstall a niiw combustion air, it +gill 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 (y"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 (,s'No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type r a c BTU Input (o CIO 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) BL ME HTG. A/C & ELECT. INC. 1 62' CEN AL AVE. N.E. HEATING CO: I AN MN 55304 Signed By: Date : -S- Q0 - CSC? HEATING AIR CONDITIONING AND ELECTRIC, INC. fav HOUSE HEATING TEST RECORD ADDRESS NN — 71Ave, . C. __ P% -161-a OCCUPANT 0a HEAT LOSS DATE HTG. INST. SOLD BY,�'- ElecVical Work TYPE OF HEAT GA— FA HW STEAM SPACE HTR. y��y GAS DESIGN MAKEd�r 0.rrf Model ® r% serial -30517A-11J INPUT ba, otp APT. FLOOR CITY SUBURB OWNER INSTALLED BY 16 A Gas Line By / UNIT HTR. OTHER T-ff 7 F CONTROLS THERMOSTAT Vent Size Heat Plug Value Vhf SIZE NPNE Draft Hood unit Filters Size Number Limit Setting Outside Chimney Construction Fan Setti Pilot Type r✓' kr Pilot Make Y etl�L Pilot Model Pilox Tim c�YCG L.W. Cut OR Pressure u/- Percent c0 _ t Input CFH Percent 02 % ` # Stack Temp. .3 7-:!;'-F-Percent CO_ 0gQjE1t APT. FLOOR CITY SUBURB OWNER INSTALLED BY 16 A Gas Line By / UNIT HTR. OTHER Smoke Bomb Draft Door Pressure Wiring V Test Tac / lighting Inst Data Tested Company Testing Name of Tester PressurePercent CO2 Input CFH Percent % Stack Temp. Percent CO CONVERSION j!t `y Vent Size KIND OF LINER SIZE NPNE Draft Hood Regulator Filters Size Number Chimney Location Inside Outside Chimney Construction Smoke Bomb Draft Door Pressure Wiring V Test Tac / lighting Inst Data Tested Company Testing Name of Tester PressurePercent CO2 Input CFH Percent % Stack Temp. Percent CO 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 Rate Furnace Shell and Duct Work, Burner - Also Replacement Furnace $ 30.00 (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, $ 10.00 but not replacement) Gas Range P�j ( 10.00 Dryer Gas D er A -5o $ 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 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 7q 7 6 P7A.,P_ %) OWNER S -7-e ve— TOTAL BUILDING USED AS ESTIMATED COSY' ZPERMIT NO. 6 C� DESCRIPTION OF FURNACE AND OR BURNER No. of Heatingits _ Circle One (Steam) (Hot ater)�W�'�Air) $ Trade Name J �.f17e_ Size No. BTU HP EDR $ Fuel Total Connected Load $ .50 $S" 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 fy G HEATING CO 1711, /?LSD Signed 04& ow= TEL# Approved By Rough -In Date Final Date ®°� i7 01 BACK SIDE MUS ,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 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 :