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PRE 2010 DOCS11 f 1 L J 0 of Fridley, Y, Minn. BUILDING PERMIT N° 6-550 Date: Owner: Builder =� Address Address 10 O� B I ING No. street Part t 04_ Block Additi or Sub -Division / Corner Lot _ Inside Lot _ Setback - — ideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To Front AIS711 j . i D- . . %-Height =-=-o be Completed Type of Construction In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley2 MAne -,6—� 6f, ,-AAAA� .�- '' CW In consideration of the payment of a fee of $ permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work doL n,Fry,withe dty limits anted t�bis permit may be revoked at any t�q� upon violal3ea of any of the provisions of said ordinances. NOTICE~ Ob peraift does not corer tho construction, hafallaMon for whing, phnnbhrg, gn hoadng, sewer or waNr. Be sore to see the BWMing Ingm for for soparata peruas for these Bans. V. Application for Power Plants and Healing, Cooling, Ventilation. Ref'rigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ........................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ........ 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 2.50 $ STEAM or HOT WATER SYSTEM t Furnace Shell & Lines—to 400 sq. ft. IDR Steam .... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 8.00 $ g • a Each add. 200 sq. ft. EDR Steam . .................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... i x $1.50 $�t� Additional Fixtures x .50 $ Gas Range to 200,000 BTU .......... , x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $�� ROUGH- OUGH FINAL- FINAL Dept. of Bldgs. Phone SU 4-7470 City City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn19 40 Owner/ � ZZ.29 Z Kind of Building - Used as To be completed about Estimated Cost, $ Old—New. Building Permit No. Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No Trade Nam a_— Size No- I /Q �0®® Capacity ° ® Sq. Ft. K.D.R.BTU. Total Connected Load 73 �1� Rind of Fuel �`'o � / / BURNER — Trade Name-'�-�"" Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) Signed 04 IV 4 - By r el - x. 42 2M Business Phone No-- A/I —� i J O1 13Z � <Ot e r �\ A 1=B=R CALCULATION SHEET 1502,Copyright 1960 by the Institute of Boiler and Radiator Man acturers, Fifth Ave., New York 20, IS. Y• OWNER r SS ��� _ DATE TYPE OF BUILDING RES1®�=�i�� ONSTRUCTION �o� — DESIGN TEMPERATURE DIFFERENCE SOo F. C�ZO `%®I C)� WNF' A— 3/4%1 C® r.— FkRST Fmo 4 _ nxl INCREASE BATHROOM TOTAL 20% on i aa: <O � r COL, A COL. B C COL. D E COL. F 1I Room �a p� LJ�SF-l;%`:fvr Y"A @��CnOnL.. aI t c- ZA- T ), UkKlb'RQDV) Ek-IMCE SCOL. �+, 1 t t s� 170 Ai era _ W H L I W H I L I W H I L I W H I L I W H L W 2 ROOM DIMENSIONS, FT.q 15 -q� Ie1,� ,44 � �Z 16, 6 �3 9 '8 3 3 LENGTH EXPOSED WALLS, FT. BTU/HR -5/ REQUIRED % BTU/HR �. JCO.REQUIRED O 4I BTU/HR REQUIRED I BTU/HR 7 REQUIRED 618 5 BTU/HR REQUIRED 4I GROSS WALL AREA. SQ. FT. 30 11 2� 5 GLASS AREA. SQ. FT. I (0 1 2Zc s 00 C)3700 �l :0C. 800 � CO 6 NET WALL AREA. SQ. FT. 01® A 5i 1 � `_ P 14 M 20 lQ9L®8 I q co 6.1 b 122CO CEILING AREA. SQ. FT. [ FLOOR AREA, SQ. FT. I1000 -------r------ - ------ 018___._ --------- 1 dil _ .. rJ '� I ^00 11 {Cly/ 5(0 19010 8 FLOOR AREA, SQ. FT. I (p a 21 ao b BE? ,700 ® --------------- --------------- :. ______________ ______________ 19 -900 —h 10 TOTAL BTU/HR AT 70F TEMP. DIFFERENCES 9 ROOM VOLUME FOR INFILTRATION CU. FT. .____A_ _ �______ ? __. -_ _ _ ________ �___-----__-- 52'90 10000 ______________________________ 510 9`F 6 _______________ ;�7 ++ _______________ —y _________--__--- - --- �-- ______L_o® _ _______________- 10 TOTAL BTU/HR AT 70F TEMP. DIFFERENCE' 12 11, 2DO 1 1 I TOTAL BTU/HR AT DESIGN TEMP. DIFFERENCE 2 O I -q. ' �� 2 G W 12 HEAT DISTRIBUTING UNITS �y .}+fit 3�3Z, 331 FA COL. A COL G COL. H COL. 1 COL. J COL. K 1 Room ifF-DRO A ?– BEDRWIM wa KI1V1c1-tim:, R1✓tk Ek-IMCE L W L W H L HH L W H L W 2 ROOM DIMENSIONS, FT. pH p 1 1 pH 0 1-5 1B.5 ®W ' IS (l ® � a5, 3 LENGTH EXPOSED WALLS, FT. 210 BTU/HR �® REQUIRED. I I1. En BTU/HR REQUIRED 20, b73 BTU/HR REQUIRED R.5 BTU/HR REQUIRED BTU/HR REQUIRED 4I GROSS WALL AREA, SQ. FT. .�Q 5 GLASS AREA, SQ. FT. I '�y 1 lt5'I , 1�Zy OOO R{ 00 6I NET WALL AREA. SQ. FT. �N e 1 ® �l :0C. k(CM -76 OO 2 ,� 1'9 fid@ 7 1O® 71 CEILING AREA. SQ. FT. j �, S CS 00 Z 1 g 100 21 100 8 [ FLOOR AREA, SQ. FT. I1000 -------r------ - ------ 018___._ --------- 1 dil 9 ROOM VOLUME FOR INFILTRATION CU. FT. - -------- ---------------- _ _�._ _ ! c _ �! R __ --� �`--•—�--- ---1- O 0®-- ______________ _______________ --------------- QQ aa _�7__I___1__ --------------- 2100 --_--_ ___- --------------- --------------- :. ______________ ______________ 19 -900 -------------- ---------------- -________ _________-______ ___---------------------------- 10 TOTAL BTU/HR AT 70F TEMP. DIFFERENCES 5100 2900 1 aw 11 TOTAL BTU/HR AT DESIGN TEMP. DIFFERENCE (05bo -75'ctO 1 SAq 12 HEAT DISTRIBUTING UNITS WOR CONCRETE FLOOR ON GROUND OR FILL AT GRADE LEVEL, USE LINEAR FEET OF EXPOSED EDGE ROOM TOTALS FROM LINE 11 B-2-21 490 M q 86_- D 1'51720 E 2.5-70 F bib® 3730 159 r, J M -1- K TOTAL BTU/HR OF BUILDING AT DESIGN TEMP, DIFFERENCE FORM 1f:pg City of Fridley G� Application for P'lunmbing and Gas nqf ermit i Dept. of Bldgs. PKono SII 4-7470 DESCRIPTION OF WORK] / !'tom / n f� Number, Kind and Location of Fixtures Location � `-yp 7� C1 I �n Q z 0 z WATER HTR. GAS ELEG 3 FFF N 3 1- C LL LL C V 3 C� '1 (� K t� O Base 1st 2nd 3rd 4th • Future Openings Connected with New Fixture, Old Openings I Sewer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... $1.50 $® Future Fixture Opening ................ fL x 1.20 $— a New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ '�' 00 New Ground Run Old Bldg. ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ / 'S E 0 Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. ,{ Fridley, Minn 19 Owner l!/ -.�-a- �. �4, Kind of Building i ca�w�ea Used as To be completed about Estimated Cost, $ pQ rj� /-C-0 Olde)Building Permit No— iQ Permit No Signed Business Phone ROUGH FINAL az 2M 0 • City of Fridley, Minn. BUILDING PERMIT Date: —.d / J— Owner: Builder Address Address O TIO OF UILDING No- tluStreet Part of Lot Lot __ Block Additi or Sub -Di on Corner Lot _ Inside Lot _ _ s� tbac Sideyard Sewer Elevation — F dation Elevation DESCRIPTION OF BUILDING N° 7122 To as: YD—Front Depth Height Sq. Ft. Cu. W Front Depth H t Sq. Ft. Cu. Ft. Type of Construction Est. __ �To be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $- , permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the 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 reg location, construction, alteration, maintenance, repair and moving of buildings within the city limits anadthis permit may be revoked at any time upon violation of any of the provisions of said ordinances. -.A Building Inspector NOTICE: Ibb psrmh does not corer the condrucHon, hutallation for whus, plumbing, on heatbo, sower or water. Be sure to we dto Building Inspector for separde permits for these hens. APPLICATION FOR,BUILDING PERMIT CITY OF , FRIDLEY,' MINNESOTA OWNER'S NAME �,SrC' %� G e s e. BUILDER e S Te- R Fie c s2 4 .D o Al fiS',4 ADDRESS .3 °l -'7 0h W,4Y ly _ ADDRESS _ l 9' - %?'rh trvky „ LOCATION OF BUILDING No.%�'_ Street 1/}(y Part .of Lot Lot Block Addition or Subdivision Corner Lot Inside Lot Setback Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to'this form Two Certificates of Survey of.Lot and proposed builds ing location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as : . .6A R 9 P_ Front D r Depth 2 t�7- Height Sq. Ft. 11LO Cu. Ft; .Front Depth Height. Sq. Ft... -Cu. Ft Type of Constructions Dyl .5�"/� CC © Estimated Cost 5�> /,O To be Completed ,/( /�'P /,� D s2 1/�CJ e- 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. DATE SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). t • M - . . M SUBJECT City of Fridley 5 4 g 2 AT THE TOP OF THE TWINS BUILDING PERMIT - - RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r 724 1 NUMBER REV DATE PAGE OF APPROVED BY 1ICITY HALL FRIDLEY 55432 ,�1 612-571-3450 9t0 -F15 9/9/97 JOB ADDRESS 369 79 Way NE 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 91 10911 2 Spring Brook Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Shirley Erickson 369 79 Way NE 784-1296 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Walker Roofing 2701 36 Avenue S, Mpls., MN 55406 729-2325 4229 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 X7 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (23 Sq) Tear -off 8 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 9 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 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, 918 $.96 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT W 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- $ 62.25 Fire SC $1.92 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE License SC $5.00 $70.13 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLY Xaewl &/, BLD INS LIDATED , - THIS IS YOUR PERMIT L_ L_ 4ATE SIGNATURE OF OWNER OF OWNER SUILDERI IDATEI - NEW (] Effective 1/1/94 ADDN [ ] CITY OF FRIDLEY LTER () SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: 3&q 79 fijE Legal Description: Owner Name & Address: Tel. # W' i''4-2- 9& Contractor: UJa"zr w4o l � MN LICENSE # Address: 310Ma&P -• Tel. # 7,.2 9- 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: .r Lot f ] Inside Lot [ ] Ft. Yd Setback of Construction. .� )x. Completion Date: iveway Curb Cut Width Needed: _ ATE: APPLICANT: Side Yard Setbacks Estimated Cost: $ (Cost on .Back) Ft. + 6 Ft = Ft x $ Tel. # CITY USE ONLY dt Fee $ Fee Schedule on Reverse Side Surcharge f � ( $ r .001 of Permit Valuation (1 / 10th %) Surcharge �� $ $.50/$1,000 Valuation Charge $ $800 per SAC Unit ise Surcharge' $ $5.00 (State Licensed Residential Contractors) ,way Escrow $ Alt. "A" or Alt. "B" Above Sion Control $ $450.00 Conservation Plan Review k Fee $ Fee Determined by Engineering rer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL TIONS: I� SUBJECT City of Fridley 25544 AT THE TOP OF THE TWINS ? BUILDING PERMIT r : i RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r 1 . i NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910_F15 9/26/97 JOB ADDRESS 369 79 Way NE I LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 9,10,11 2 Spring Brook Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Shirley Erickson 369 79 Way NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Norling Exteriors 341 79 Way NE, Fridley, MN 55432 784-8936 20098700 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 j] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Soffit/Fascia; Window Trim 9 CHANGE OF USE FROM TO STIPULATIONS Install soffit ventilation to meet 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 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 $1,500 $.75 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- $48.SO Fire SC $1.50 STRUCTION OR HE ERFOR E�ONSTRUCTION.PLAN CHECK FEE TOTALFEE License SC $5.00 $55.75 SIGNA REO NTRACTORORAUTHORIZED ADEN IDATEI WHEN PROPERLY L''00 INSP LI DATED THIS IS YOUR PERMIT GATE S.GNATURE OF OWNER,,F OWNER BUILDERI IDATEI I� EW [ I Eff--ctivc 1/ 1/97 iADDN [ I CITY OF FRIDLEY LTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ionAddress: 3 �D q -? q 4-� W -+q Description: l 0 ( (0 1-,K / 1 --ODk yy / j r Name &Address: - 739 % 79� k1ir ontractor: mS / MN LICENSE # C200-16-200 Address: 3 yj 7 Q 4 A w'2 y 1%' F/'c dle,y MAJ . �;S V 3,? 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 S . Ft. g q ARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: p : 4- Fc� `cam t4ILItlolou,, Construction Type: Estimated Cost: $ (Fee Schedule on Back). D "veway Curb Cut Width Needed. Ft.- + 6 Ft = Ft x . $ $ �' :5-�qC), o0 # 79V- gq c36 DTE:2 APPLICANT- -is_ CITY USE ONLY Permit Fee $ o . O Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ 2S$.50/$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge $ : 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 Sevier Main Charge $ Agreement Necessary [ ] Not Necessary [ OTAL S'fIpul-K'1ONS: :5-�qC), o0 # 79V- gq c36 CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE SI;� Fridley, MN 55432 APPLICATI N FOR P WER LAWTS AND HEATING, COOLING, VENTILATION, 763.572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner -66,10,E 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 TOTAL $ 30.00 $3060 $ 10.00 $ $ 10.00 $ $ 10.00 $ $ 25.00 $ 01,5 0 State Surcharge TOTAL FEE $ .50 $ 16,0's-0 MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION ' REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Effective On January 1, 2001 JOB ADDRESS 387- 77 ?h WAY OWNER C/c/E' by BUILDING USED AS d402,451 ESTIMATED COST PERMIT NO. 1 f DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units_% Circle One (Steam) of Wat (Warm Air) Trade Name c5'ld wl Pt �4 P1 Size No. 10,00 BTU 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 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. C, EATING CO , /—(2- /d-/" Signed DATE � �_ 0/ TEL # 'I Approved By/L/.Y Rough -In Date Final Date IAND COMB STISO� AIR VERIDFICA�IONENT SIZE, VENT CONNECTORS I 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 : CIIYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 1 March 14, 2003 Mr. Jack Kulseth 369 79 Way NE Fridley, MN 55432 Re: Final Inspection at 369 79 Way NE Contractor: Peterson -Pinney Dear Mr. Kulseth: A mechanical permit was issued on June 11, 2001 to install a boiler and an air conditioner at your address. According to the 1991 Uniform Mechanical Code a final inspection shall be conducted on the work authorized by this permit. As of this date the inspection has not been requested. The permit fee that was paid covers the inspection to make sure the work was completed according to the Codes. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will mark the permit "no inspection called for by homeowner after notification" and take no further action. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. DJ/mh