AF - 34891Ca.ty of Fridlep, Minn.
6431 University Ave. l�i. E., Mnnneapolis, Minn. 55432
BIT.Q�DIl�TG PERMIT
��; Aug�st 9y 1971
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p��; Victor Seiler g�� Richard Mi11er Homes Inc.
Address - -__.._ �� _ 1700 Silver L�e Road N_E�,,,,
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LOCATION OF BUILDING
rr� - �s42 s�t aiaen wa� N.E. P� ��t
Lot —'S�_._. B1ock _. 5 Aaait3on or sub�iv4sian .��+�x�son's Crai�w�,y Estates 2nd .
Coraer Lot Iuside Lot -- X Setback 35' g;�y�d
Sewer IIevation
Founciation IIevation ..__
DESCRIPTIOW OP BUILbING
To�v�a�:
.,��1 1 i n$ Front .__��.!_ Depth_ ��, Height 20 � 5�1. Ft. 1806' Co. Ft 27. 546
--���ge Front _3.�`_ �pth _ �27-6�}��ht 10 Sq, �, 605 �, �, 6050
Type of Construction �---.._F7Cam�. F.st. Cost .._.- 4.0_ OR(i., �� To be Complete�i �/� /71
tZ��� .
Stipultions: Prov�de Verification Survey Before Framing. Provide Hard Suxface Drive.
WATER LOCATION: 21' N.W. of Maahole SEWER 0 14' Wese of M�hole
Wye Elevation: 845.33' Top of Footing: 848.33 Approx.
In consideratton of the issuance to me of a perxnii to construci the building descrybed above,�� I sgree fi� do.
'�He PraP�d work in accordance wlth the deseriptioa above set forth and in comgliaac� with a]1 provlaat�ss oi
ord�ances oP the dty of FrYdiey.
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1Ly�/�9 Ctni-o C��rr'hargp
Ia consideration of the payment of a fee of $ 5.OQ_._, permit is herebY graated to R—_. � s�A�d 'M� i�er Homes
to construct the buflding or additian as dascrlbed abov� Th3s �ermit 9s granted uppn
$ n expre� condition that the person to whom it is granted and his agents, empipyees and worlmnen, 9n aII Wpo�k
in, around and upon said building, or any part thereoi, shall conform in all respeCts .to the or89n�tCes oP
I+iidley, Minnesota regarding location, construction, alteration� maintenance, re�r aad movYag of
�th�e dty limits aad this permit may be revoked at any time upon violation oE anq of the providone og
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IdOTICE:
This penntt doas not eove� fI16 C0113�1YdI0A� iustallaNaa ier wMas, P��+�B. 8� �8. �wer � watar. Be son is sas
Ws Buildine IasPeeto� for aeparate permits for t6ese he�.
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� -� RIGFIAqD. MILLER INC.
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SUYER: ;1r. and rirs. Victor Seiler a r
LOT: Lot 5� Eilk. 5� Pearson's Craiyway Estates ���
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,��d0 SILVER LAKE ROAD, NEW BRIGHTON, MINN. 55112, AREA CODE 612-633-7464 � y
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APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME : v i c..-rp2 S E� ►.�� BUILDER: �.«N (•�RD (%� ��1'(_ �.�'n�� .��.
ADDR13a�S : _ ADDRE,SS ; ('-7� � i IaU�J'(- 1�04tC� �J,
NO:. �� STRi�ET:_ At�EtU WA�.I Yl�.�.
LOT: 5� BLOCK: .5 ADDITION:_�EAr�l�t� �I�W�,y �S7'1�$
CORNEA LOT: INSIDE LOT:�_gE�CK: 3S% $IDEYA,RD;r_
;`�Applicaat attach to this farm �,io Certificates of Survey of Lot and proposed
building location drawa on theae Certificates.
HESCRIPTION OF BUILDING
To Be Uaed As;
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.__, � � F7ront : th : � �
�E� � D NC � A�� °� � � ` � �P Zt� Height : �`,- Q
Square Feet: � _ Cubic Feet: ,� `� � �' �
� s_� n<��-�-�'�:�,� �-.- „-�-.—Fr°nts � `�= DePth: ';� :f = � Height ��' �'
.
• Square Feet; � � ��` Cubic Feet: � � � �
� . 1�►pe of Construction: ��5�p��-�,q��Ed�;atimated Cost:_$����08fl.oa
To Be Completed: _ !��/ / 7J ' � 'Z- � � � �'`
The uadersigaed hereby makes applicativn for a permit for the work herein
specified, agreeing to do all work im sttict accordance with the City of
Fridley Ordinaaces and rulings of the Department of Buildiags, aad herebq
declarea that all the facta and representations stated in this application
are true aad correct.
DATE : � _ $'�S/7 i ' � SIGNATUItE : ��� �%2
(See gev�rse Side For Additional Infoxmati� . ) � � � � �.� � � �' /�
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BUILDING PERA�IT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure, or for any additioa to any exiating
buildiag or structure, or for any alteration or repairs to any exi8tiag
building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in
the manner herein provided to-wit:
UNIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3� 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical conteats
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average.�
height of the roof surface of the ma.in gable of a pitched roof.
For repaira or alterations to an existing s�ructure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
Ia no case shall the fee charged for any pexmit as set forth in Section 2 be
lesa than $5.00.
VERZFICATION OF FOUNDATION
NOTE; Pe7rmits for coastruction will be issued a minimum of 24 hours fram the
time of application, to allow for proper review of the proposed structure and
of the caastruction site.
A Certified Survey af the lot,.showf.ng the l�cation of the fouadation, oace it
hae beea constructed, will be required before proceedin� with the frami�g.
CERTIFICATE.OF OCCUPANCY
Application for a Certificate of Occupaacy ahall be made ten (10) days priox
to the use or occupaxicy of aay structure for which a building perinit has been
iasued; and said strueture shall not be used or occup3ed until a Certificate
of Occupancy hae been issued. •
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. �Rar���ge L�am Surve� �or ��f.'�At�D }�►11r��1� �N+►E.�
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�di�do�s . � . Doors - Referense Oue. lgdall IaG �dall �es�ia� ; , l�oof Flooi ` �d '' � h := �%�+ �.pgl'a�d '
Yes— b Ye— s"—�`ido ' 19 `` .
' kl.� r -�r�i'.,i,: Rooar. I.en�t�� /Z '�Iideh / s T�eighe d'—°_ � Fl.j ;r�.1 ; �� I�n'� :-.� . -Wi�h� /�:: . $�zi��ie �s =-'
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�t':d�h Hetght .: Z:o: oQ. Ltaeal ft Area !3�'•�' Widtt� Het6bt Na o%' ,Ltaeai t4. ,�.rea
No. of �aoe st yaas 'ilght� oTcrac:t ay. t4 ° Pto. o@ pana of pape 13ffiLCs • o8eescla� 8�. Yt,
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Int. tvall',
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: �'otal Btu. ' ` �, -
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�tequired sq. f� E.D.R. os sq. ins. W.A. Leader area `. Required sq. $e. £.I).E�: aa sq. ins. �d.A. I.iae$�.ar� •' .
.,�-F7 � ._ ;, ^,wf;�x; �om�.l.esagth ;i�� �Iidch /� !-leight n-•° _ ; Fl.l /^�>c:��{-sg"r�' 13ao�►l I.engett � �J:�� c,/ �$�'s�. v f .'
' ��Juidnws and .L3aors-iratk�e and Area Windama+s �and Lloaxs—Crackage �� ��a � � '
'Y�'itch • Hei�mt Na of- Llneal tt Asem � a,
�Na . ot ysne �pt;pahe ligh s ot erack ap. Y4 Tr tdth Helght 2]0. ot Ltnesl ft,. ATeA, , ~�
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_ . : 4•ybT �'otal @tu _ :. fd �� ".�.
� Eiequired sq fe. E,D.�. o: sq tns.,�lA, i.exd�r area Requie.d sq. fi. E.D.E�. �r �q.r ans. �d.A: I;�der agr� V �
� : �• � �';�; ::�:Y'I��xm �lJen� � �•7 �idch ? -. Y�eight k'= � — ' _
� 1�lincows aad �9aots�-Cracka� aad Area ��..- ,. • � �.� �..:�•'T: � �as I I,�n�th ,:�� �lideia. /',✓ ��i�hi � �
�;':daA . ..HalgLt Na o! I.lnoai tt. Azea' ..•s�,-,i;� �ilindows aad i�sars�—�racL-a�ee��d �re� �_ � �
ATO: of tan� a( yaee ilg8ts of crack aQ. Yt. j'; � Wldth &�el�hi . Na oY I.ia¢ei St� . Aeaaa %+£ .
. � _ ,. .. � - �,,,:_.- ' A1o. o! D�ne e4 Daae lt�hts o8 cee.ch: < �1. �S. � t
�: _- :5 .7. J ..,.' .rn .,
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Coef. �4u �.
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yp�� ` � ,'`.',s �s Infil4eation �< j�'"' a.,
. � V.WSJS � � . � . . ,r-� - }� . . . 3 � '���:. ����: f.l� Y
� ' '"�`4 � � 4 � � L�G�S, � W�a$$ . :
� ,. _ , - . L' . . � , . : � �.y , +� i . r
�r�. �:•aIi � . - ..J7�� � .�;'r�..4,'�
Exp. wall � �
T�ei ���..well` � ... � �c.� -. , ;
.�• �'✓ � � •' ! � . Idet exp. wall
lne. �reti;• ; ��.�' -� /L.�� �;
, .
i Ceiling jttt. �vate .
' Ce�iing, =; .
� loor - � %S'S�° r.'�t ;.� ., ,.
% ' � � �' Fioor �
Tofad �tu. " p � ' � .�-- ' �
' � �� T�o2a! Etu. .
_Reu�r. • :: - �:�.
c� � � sG tt. � !2. ��'aq. ias. �.A. l,eadee �rea. . ' ,� .
' � �"Z. , _ - . / : ,;a fi�ca� I.e � . - �eqnlrfd S ' fe. E.�.#� o�seg�:ins.' �l.a�. �i��-��a_= : : �
� � � . �id►h :�� I�eighe y-: . _ - - .
� �dIIL'�a;=:s a��i $�eor�.r--Caackaga atqd Asea - � �`I � ,".?��°i'�r✓�> �rn { Ioerig�n .' �!� �i�tla `-/� a�°�;;ir� �t ,.�;
a lduidaws and Br�ors--�rac��e ��td ��8x� . :
FL ��tG p1ziSA�. •.;c. ot Lloesi tt_ Area � '
.%a. of yane ot �ea Hshta of creei. ap. t4 . «IdtA Hcighc Ata aY Y r'
Lln�sl.te.� .Ares
� -, _. �: _�� �, :.. : �, Nw oY Dana o4 Pane '!1�!►ts of cvaok° 'aa. t8.
'° 4 �' ? L- �'aZ"3'' •' .. I 1�i< • ;%-�J _�. �1� . �a ,s�
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Infiltr::ticss . _ � Caef� . S%LiS pi
� `�' ' ''�` / .-�. � C.:: Inhltaation �
�l�s� �,' ..,r� • �, .�� � �
Fscp. 4va#i �� . {'' . ,;• � , �: Class _ � «�' __.� �. �, ,� x
� ._ :C , �
p� �p. waU .r�' a :�
7'il°� �w�.• ti'a8� ♦ . . � . . 4%. . . L .a
Ica4. 4�a!! �'�': `� � C% Net e�p. wall _ .
gnt. dvali .��`� ? e,f� � .
��iling ,,,.,.; . �
Floor �. • " Ceilin� � ya
ToeaI �. ���'° ` �e �;.., . Floor , . %�"'�"' �;'' ,�°.%� ,,.�;
I$equire� sq. fe. E:D.R.. or sq. ins. 9J.�4.1� �� t?_• Total.�3eu. _. - �, ,, �, �
, ader �res � f3equued sq. �t. E.D.R.'�r - f��'`..��;
�q..ans.:�.,�: l.eadee ar�� .
- _ ____ � _ N — � r - �� �"_ _ —.*�"--_ _"y' _ ._'
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~ Wcatl�eratn�s A.S.i�[.1/.E. + Constr .:� } .
y Guide uctioa No. : . :_' iast�att�sssa ; : :' ` ,'
d/indows � Doflzs ` Reference Qut. Wall Int. �lall Cciling " Roof Floor ' Kiud . How Ap�1;�d ... '
�es--No � Yea=�lo 19� �
,- , ,
_ _
FL� � �:. ;ry- /� Raaca Length ��� l�Jidth �! Height �; `'-- �: Fl.j .��t`? ' Eaoam L�rngeh ��'.
. �.. . . fo i����b� GY-=:�
�`•din�c�+s a:d i�looes-Crac�a�e and Area �6lincows and Docrs-Crac�� aad Area !-_
«'fd:*. he[gh; i;o.pf Ltaealtt_ wrea WIGC6 He�atie No.ot Ltnaalge. :are: = 1
No. ot ;.sne r. zene `ifghia of crsck ap. Lt. 1 No: ot Dane ot Dana '` tiBAte of ciac�a �q. St -
�� � � �� s. �.!_ � � .. . �� s
Y �
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.
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Cocf. Btu ���� ` �oef. �!� " ti
Inftltratice -�
-��` �`� ��? In6ltration 6, •
. ' 3�' � � x ��
G�ass f.-� � �i7 -;�,i�i1 �
� C"ase � ,�� �`�✓ �?'r� Q
Fzp. ttai 1 � ` �r.:4' ' Exp. wal� �. <. • ",
)�7 r i I�i^A . ,.. . i a
Net e; p. wai!' `�'"''s '� ?% fi., -
I n t. w a!! Net e�p. Wd1�I �tl�.^ .q ��{:�-
Ceilin� Int. •.all (� "
- r, ' '
Floor _ `� ,���_ Caiing 'f'��� � `t�di�3 _`;�
' Floor �
Tota1 Btu a'..`.�i'�Z� � _ ,
` Total Btu. ; : �'�..�1� �
Rcqui:cd sG. ft. E,L'_R. or sq: ins. W.A. Leadrr area Ftequired sq. ft. E.D.R. or aq. ins. W.A. Lea1Pr arZa
7 �1.� ;, � _; , �m j l.rn�tl� `�'? .: lsJ►dth I :S Hcight �=- � Fj ( � r?, �;:�� '�2.oam 1 Len�tli ,j� : �li�t:3 jo . fre�'s��:�t e� ;�
.�,.,,
' lqJiedow.s and I}oflrs—�:ackage and Area �� 2�,p \AJindov�s and Boar3--�rae�a�e aac3'Arz� :.-
�1";dtfl � jie?sht :tio_ at .<Lfoeat it. � Area . � . . � � -
No. ot tzne o' , aae USIIti ot crack sQ. tt. N�:� W �dth Hetght No. ot Lineai !t Ares
` � .-� No: ot pano ot Pana ` >ilghU af cracic e4. tt -
.� . � ' • y-; , . � ) r y � I C i` � �� � . � - . � .
c? / 2„'' �1;; i f �? 4;r :� ry� •
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:.� . , .' . ; , �. : __ .. .!�- -:S.
i : Coef. B�u ' : ge�. ' �:s� .4 :
In,Sttraeion - ? r.t , _=��,3 ;;,� In5ltration , � �' :. �� �m � :.,
Glass ->' - ,-:.,.-ti a.
r�� � Cilass �r,�' •-;r2 �r;,-'J' �
�GSC,Y�. Ft'2�� — - f � .� .- . . . � . - a.a_�
� -_.,,� Ezp. waii .,�;f' ;�t,fc:.� ,
Net e�p. wali ` �r7 . ,, i';;S ;�,; : Net exp. wa11 ' ��•� � �,`�;�� _`.
In[. �vall : : Int. arall
Ceiling I5�'r: ' , 9 �'�;''r.� Ceiling .1 �'•.� � '' • � :'C� ��'.5 y�
� ' ` �- ' P..�� .
Floor , _ ,
�' Floor -�
Total btu. � • : . ,' : , y ?r ToEa! Btu .: . _ _ - = �:� ; � :
� .. ;. -
� „ .. ;, _
Required sq. ft. E.D.R. os sq. ins, �J.A. I,eader area Required aq. ft. E.�.R. oz.aq. tas. LVA. I:eader ar�a ,:;
� Ff. �, - ' R��n � L.engt}� : ` �'Jidth � �
. . : - _. ._ % :Neight �= � zFl ( r�','_��.� ` 'IwamlLength � '- "�'did�- j� �i6��St Fr'a �
Wiador�s and l�ccrr,-�rackage a�d Area t�liadows aad Doora-Cracka�e aad Area �'
F::ech iie!gtt . ��.<to, 01 �Lfneal t[.� Area � W{dtn tielght - . � No..o1 ..Li:t=_31 ft. Atea. .. . .�-,,.. �:
No. �� �� ot L_r.o � ot ^ra��t ]l6Dts ot eraek� �ep. tt: � , No. �� o! yn��a . ot pan��� � Ilah:s �of craek�' . c¢. [L - � � - -
' :, �. � � . :. • .
� � `� � i � � � `-� i . t� . . . � . .
. . . . . .. . _ , -. -. .
� � : .. , ., , . . �. .
. . . . � . . .. �... . . _ :; , . .k
•
.. :.�� .��.' , '.�,� �:. .... . ... - � _- '._. : -��
Coef. Btu _ Coef. . `:< �tia • ;:
lnhltratian = ZEi : ' -.�:=; i'�: e� ' Infil:ration . ° ' . ' .: _ .;:
.
-� =
Glasa , .: t/ .c � -� �� Glass _ . _
f.asp. w�f3 � n
` � r�p. wall _
i�et ex�. �.ali ..� E( �; S- i..7 Net exp. waii _ ��
,, x
,lnt. wa?i Int. wall . .��,
Ceiling -� _�- ,� . c{�, : Ceiling - . _ ���;. . � � ��,,�,. ;,
�loor :.. �, �_�,� `%�
-- _" Floot -
iota! �tu. . ,e; �i � •/ Total $iu. _ ���
�3ec�uired sq. £t. E.�.i:. or zq. ir.s. �.A. Ltadzr area P.tquired sq:#t, E.U.R..or. �$.,:_. _
2 Fl.( .. .- _. � �> �oa� j's..=ngth Cc; 'r�lidth � H-igh2 � � I �1.) R.o�m I Exn�Eh � �Tic�G� ..: � �g��,� ,'
�:lin�'oti�s a::� I1a: : �--�raskage aad Area : �-----" —°�
Windows and Doors=Cr�cSsage z�� Area :. r
: �r .
� . Flod:h . � Y.ci��c \e.�ot .Llasal tt.- Area � � �� Wtdth . Fief�ht i1'c: ot Lineal�fk� �qres � ' ��
"No. o( Dsne � cf Dsr.e lighta ot eraek ea. [t. No. ot psne of Dane IlShia o[ cracic
. - .�. _r.�_ _ �. . . '
- . _ .. ._ � _, , aII. t4� . ...
:,
. . .._:.._�_._. . ..._ . �.,. T -
��.�� . .- ' ... � -• . .-... . .,� -..,._.,.._._... .._ . � . .. ' .,...�'�
` Ccef. Btu . _ . �ce►�. . �t�x r
Ir�ltration ,r�`->,-� ���- IafilttaEion
,��'?� : .
�
Cs1a�3 Glass "_ ., •
� `�Exp. wall �- - - �
'-- Exp. wall 7
�;
IVet ear�. �3•et! 1 �" ��,;�� Net exp. wall _ �
_'•. J -�'' - :�
int. waIl Iat. waU "
Ceiling ,�G r.; _
, 4, '.',�4'" Ceiling ` ;:. x
I�loar _,,._�_ � ' ->,.
:..-f° Floor _ ,_ ,. '.
Total 8iu. !�� �'i - �Total Btu. `
R.guired sq. it: £.1i.R. or sq. ins. L°J.r1. l.eader area : : . :_.� .>
_ Required sq. ft. E.D.R. o� sq. in"s. G�.A. I.ea�sr.:a�a
_ _ , �� ,��, �
_ _ �
.-� _..�'J
:�-n-;"�-. . - ___.._.-.._--------- ---
SUBJECT ER NO.
City of Fridley 18021
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � R .
COMMUNITY DEVELOPMENT DIV. /� ` � _ I
i ��, ___'__, Y
r � � PROTECTIVE INSPECTION SEC. �`
� ` ;
i----� ����;,� CITY HALL FRIDLEY 58432 NUMBER REV. DATE � PAGE OF APPROYEO BY
L 6� �-s�,-3460 910-F15 5/31/85 � �
JOB ADDRESS 7842 A1 den Way N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 5 5 Pearson's Craigway Estates 2nd Additon SHEET
2 PROPERTY OWNER MAIL ADDRES$ 21P PHONE
Victor P. Seiler 7842 Alden Way N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same �
4 ARCNITECT OR DESIGNER MAIL ADDRESS 21P PHONE LI�ENSE NO.
5 ENdINEER MAILADDRE83 ZIP PHONE LICENSENO.
B USE OF BUILDIN(i �
7 CLASS OF WORK
� NEW O�( ADDITION ❑ ALTERATION O REPAIR � MOVE ❑ REMOVE
8 DESCRIBE WOHK
Deck - Treated Wood
9 CHANOE OF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBIN(3, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONINO SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION R_1
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOO OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLO. 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 SUHTAX
AND ORDINANCES (30VERNING TH13 TYPE OF WORK WILL BE COMPLIED �750.00 $, 5O
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PEHMtT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THB pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR CAL LAW REGULATING CON-
STqUCTION OR E PERFOHMANC F NSTRUCTION. �.rJ.00
� e PLAN CHECKfEE TOTALFEE
3�7� $19.25
SIGNAT EOfCONTRACTOR UTHORI2EDA6ENT �oarE WHEN PROPERLY VALIDATEO THIS IS YOUR PERMIT -
C� ����- 5
SiGNATUREOFOWNERIIFOWNERBUILDERI IDAT BIDG �NSP nATE
4 _ !
� �
t� [ 7
IIDDN. [ j
et,T�. I J
Construatioa Addr�
Legal Description
City of Fridley
a-1 �/D 8-2
Buildiag Permit Applicatioa
Effective 0/1/84
1 . �
owner lla�e i l►ddress: ._!l••�rp+' � S�.# B �' ?el. • "
Contraotor t SQ 1�' Zel , i �
,'
Address: �`�
�':�. � ,��,, _ ' - ,-v
Attach to this applioation, a Certificate of Survey of tbe �-- ��.� `�". �� -� �
lot� vith the proposed eonstrucLion draWn on it Lo acale. E�� '� �°�f
� � �` r�' h�:�� �-�°` .
�,
LIYING AREA:
QARAQE AHEA:
DECa 11REA:
0?AF.Jt:
Corner Lot [ �
DESCRIPTIOII OF �lPBOYBI�NT
Length Yidtb Bei�t 3q. Ft.
Length Yidth Height Sq. Ft.
Length � Yidtb Agt/Cround Sq. Ft. �
� �� JO ` � i ��- . �%
Inside Lot� Ft. Yd. Setback Side Yard Setback
Type of Construction: ��f�ae�a��
Approx. Completian DaLe:
Estimated Cost: a �`-�
`�] �� , c�U
Alt. A Alt 8
Propoaed Drive�+ay Yidth If Nex Opening Is �sired: a a
See Back Page for Explanation
� r �
DA'TE: � ! APPLICANT: Tel . �� ����
Permit Fee
Plan Check
State Surcharge
�AC Charge
Park Fea
3e�+er !lain CLarge
lOZ�I.
STIPULJtTIONS :
CITY OSE O�.Y
� � Fee Sctiedule on Reverse Side
_ ��� 25f of Building Permit Fee
_ �'� 1•50/�1,000 Valuation
_ =425 per SAC Uait
= Fee Determined by Engineering
�
nt Necessary [ ] Boy Becessary [ ]
��
. _>
�
-
�
�
BDII.DIIIG PBRI+lIT FEE 3CABDDLB
?he Chief Building Official ehall� before tasuing permita !or tbe erection.of any
Duilding or atructure� or for asy addition to any exiating Duilding or atructure, or
for any alteration or.repair to any existirig building or atructure� upon applicatio n
therefore,�require tbe payment Dy tke applicant tor aueh permft of leea to the a�ount
berein belo�+ aet Porth and in the manner berein provided to-vit:
Zotal Oaluation
�1.00 to �500.00
:so,.00 to a2,000.00
Feea
=10.00 (!�linimum Fee ia =15.00) �
=10.00 for tbe Pirat =500 plue �1.50 for each
additional �100 or fraction thereof, to and including
=2,000.
=2,001.00 to a25,000.00 =32•50 for tbe first =2.0��00 plus �6.00 for each
additional �1,000 or fraction thereof, to and
ineluding �25,000.,
�25�001.00 to =50�000.00
=50,001.00 to a100�000.00
�100�001.00 aad up
=170.50 for the firat a25.000 plue �q.50 for eaeh
additioaal a1�000 or fractioA tbereof, to and
including =50�000.
=283.00 for the firaL �50,000 plus �3.00 for eaeh
additional �1,OA0 or fraction thereof, to and
including �100,000.
��33.00 for the first E100, 000 .�lvs �2. 50 for each
additional �1,000 or fraction thereof.
DRIYEYAY DEPRESSION ESCROiI
(Conerete Curb Streets Oaly)
Alternate "A": Removal and replacemeat of curb and gutter only - DriveWay �aidth plus
6 feet times �13.50
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot xide
approach �ith 6 inch depLh - DriveWay width plua 6 feet times a15.75
YBRIFICATIOA OF FOONDATION
Permita tor construction Will be issued a miaimum of 2� bours from tbe tiIDe of
application to a11oW Por proper reviev of the propoaed structure and ot the
construction site.
A Certifieate oP Survey of tbe lot� ahoving the location of the foundation onQe it
has peen ooastructed xill be required before proceeding rith tbe�traming.
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FRIDLEY MUNICIPAL CENTER • 643 ! UNNERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (61 Z) 571-1287
June 1, 1999
John Bass
7842 Alden Way NE
Fridley, MN 55432
Re: Final inspection at 7842 Alden Way NE
Contractor. Vogt Heating & AC
Dear Mr. Bass:
A mechanical permit was issued on June 25, 1998 for the property located at 7842
Aiden Way NE for a new air conditioner. According to Section 305(a) of the 1991
Uniform Mechanical Code a final inspection shall be perFormed on the mechanical
permit. As of this date no inspection has been called for.
You will be given thirty (30) days from receipt of this notice to respond. If we do not
hear from you, we will expire the permit and any inspections on this installation will
require a new permit.
Any questions can be addressed to myself at (612) 572-3603.
Sincerely,
Barry Riesch
Buiiding Inspeator
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City of Fcidley 2 9 6 9 9
AT TNE TOP Of TFIE TWINS � � I L D I N� P E R M I T
;�
� ; L � COMMUNITY O�VELOPMENT OIY. �
r � � PROTECTIVE INSPECTION SEC. ��a�
� . �
`--_.� ��"' �'� CITY NALL f RIQLEY SS�Si NuMqEq REV DATE PAGE Or AvvaOVED Br
L bt2—s��-34b0 9/Q-F1S 6/16/99 / /
JOB ADpRESS 7842 A1 den Wa
t LEGAL ��T N0. BLOCK TRACT OR Ab01TION SEE ATTACMEO
DESCR. 5 5 Pear ' C SMEET
2 PFiOPEflTY OWNER MAtL AODAF$$ ZIP PMONE
John Bass
3 CONTRACTOR MAIL AODRESS ZIP PFIONE LICENSE NO
S lvestre Construction _
a ARCMITECT OR OESItiNER MAI ADORESS ZIP PMONE LICENSE NO.
S ENQiNEER MAII ADQR83S , tIP PMONE LICENSE NO
8 USE OF BUILDINCi
Residential
7 CLASS OF WORK �
❑ NEW � ADDITION O ALTERATIQN O REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Remove existin deck and c nstr t
9 CHAN(3E OF USE FROM TO
STIPULATIONS
II�AR�III��
See sti pulati ons on plan Bet�e dfggipg pi1 f� �
e� nutfty �ti�•
4�4�2 � .
R�Q�IREQ �Y L�IW
�I�1TE PERMtTS �EQUIRE� � �
�RiNG, HF.Aiif�G, PL.UMSI�IG qNp S►G��. � .
SEPARATE PERMITS ARE REGUIREO FOR ELECTRICAL. PLUMBIN(i. MEATING. �P� �F CONST. pCCUPANCY dqOUP OCCUPANCY LOAO
VENTILATING OR AIIi CONDITIONING.
TMIS PERMIT BECOMES NULL AND VOID IF WORK Qq CpN3TRUCTION jONINd SQ. FT CU. FT.
AUTHORIZED IS NOT COMMENCEO Y�(ITHIM 80 OAYB, OF IF CONSTqUCTION
OA WORK IS SUSPENOED OR ABANOONEO FOR A PERIOD Of 120 OAYS AT
ANV TIME AFTEii WORK IS COMMENCED. NO. OWI,G. UNITS OfFSTREET PARKING
I MEREBY CEiiTIFY TNAT 1 HAVE REAO ANO FXAMIN�O THIS APPLICATION STAL�S GAAAGES
AND KNOW TME SAME TO BE TRUE ANO CORRHCT. ALL PROVISIONS Of LAW$ A�UATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE Of WpRK WIt,L �E COMP�IEp �
WITM WMETHER SPECIFIED HEREIN Ofl NOT. THE GRANTINt3 Of A pERMIT $3427,Q7 1. %1
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TNE pE MIT FEE SAC CMARGE
PROVISIONS ANY OTNER STATE OR LOCAL LAW REGULATING CON-
STR CTI Op E PERf NCE OF CONST TION �7, �5 Fi r 43
PLAN CMECK f EE TOTAL E
Si N4 AE Oi ON'PaCTOp N AU�MONIZED eGEhT IOAT[� 1 C EN O ALIDAT MIS IS Up P IT
�� �
S�GN4TUqE O� OWNEp��� OWNEpBURO@R� � � ATHi �q5p ' qpiE
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ADDN [ ]
�'�'� [ l
� �,
Construction Address • � (
Legal Description:
Owner Name & Address:
Contractor:�� L v�s�
Address: � B c� S � �
LIVING AREA:
GARAGE AREA:
DECS AREA:
01'HER:
Effective 5/10/99 )
CITY OF FRIDLEY �}�./
SINGLE FAMII.Y AND DUPL�EXES R 1 AND R 2�� ` ��
BUII,DING PERMIT APPLICATION Ql`O �'�-
� � �.
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� so. ��15
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.5.�5�� 3
s y,,� Tel. #
Nnv r.�c�vsE # /��
Tel. �vi� ��/ - rJ�a' 8'
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Le� _ Width , Hgt/Ground Sq. Ft.
�,
����`� ���'� �`'%/%J Z� = 3, yZ7 g'/ ,
Construction T c�c It � G' D�� /� Estimated Cost: $�S, O O o, ��
Yl��—
J
Driveway C�rb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ .
DATE: � ��� % APPLICANT: Tel. # �/�c� ��� �/ P �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULAiTONS:
$ ,Z
$ 3v y3
$ /t
$
$ S ��
$
$
$
$
$ v ,�
CITY USE ONLY .
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
�ee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
E.B
�
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or siructure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or structure,
upon application therefore, require the payment by the applicant for such �rmit of fees to the amount herein
below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $5(�
$501 to $2,0�
$2,001 to $25,�0
$25,001 to $50,000
$50,001 to $100,�
$100,001 to $500,000
$500,001 to $1,�,000
$1,000,001 and up
FEFS
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,OW
$69.25 for first $2,000 plus $14.00 for each additional$1,OOQ
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.(� for each additional
$1,000 or fracrion thereof, to and including $100,0(�
$993.75 for first $1W,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $SQ0,000
$3,233.75 for the first $5�,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete G�irb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of applica�aon to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the l�ation of the foundation once it has it iia.s b�n constc�acteci �rill
be required before proceeding with the framing.
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June 7, 1999
PERMIT FOR:
OS+dAtER: John Bass
7842 Alden Way
Fridley, Mn 55432
CONTRACTOR: Sylvestre Construction Inc
7708 5th Ave. 3.
Mpls, �i 55423
861-0188
PROJECT �GSR : Katie Post
Estimated Value : $15,000.00
Start Date :6/15/99
Completion :9/30/99
City of Mpls Contractor �: 562
State License # . 1428
Descrlption :15'6"x12' screen porch over the existing deck. Add 2 skyl3ghts in the bedroom.
A
�. -
� �
sue�etr _ _ .
City of Fridley -
AT TME TOP OF TME TWINS � u I L Q 1 N� P E R M I T 3 0 3 2 3
;,
� �`L �����_� COIiAMUNITY OEVELOPlNENT DIY. �� O�
r � � PROTECTIVE INSPECTION SEC. ��
i = .
� �"'1 � CITY MALI FRIDLEV j�3i NUM�EN 11EV OATB PAGE Of APPAOVHO BY
�----� • •,, 612-57�-3a50 9�aF�5 1.0/1/99 / /
�oe nooRess 7g42 Alden Way 1VE
t LEGAL �OT NO. BLOCK TRACT OR AOOITION SEE ATTACHED
oescR. 5 5 Pearson's Craigway Estates 2nd Addn. SNEET
2 PROPERTY OWNER MA1L AOORF$$ ZIP PMONE
John Bass 571-5300
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
PTL Contracting 2526 N Ferry St Anoka MN 55303 323-7400 y� 5294
d ARCMITECT OR DESICiNER MAIL AODRE88 LIP PMONE LICENSE NO.
5 ENGINEER MAII AODRE$S � IIP PMONE LICENSE NO
8 USE OF BUILDING
Residential
� c�ass oF woRK
O NEW O ADDITION � ALTERATIpN x�g REPAIR O MOVE O fiEMOVE
8 DESCRIBE WOqK
Reroof house and ara e 32 S Tear-off• Gutters
9 CHANGE OF USE FROM Tp
STIPULATIONS
Underlayment must comply wi�h the State Building Code.
SEPAqATE PERMITS ARE RECUIREp FOR ELECTRICAL, PLUMBING, HEATING. �P� OF CONST. OCCUPANCY GqOUP OCCUPANCY LOAD
VENTILATING OR Alp CONDITIONING.
TMIS PEFMIT BECOMES NULL AND VOID IF WOtiK QR CpNSTRUCTION 20NING SC. FT CU. FT.
AUTHORIZED IS NOT COMMENCEO V1fITHIN 80 OAYS, Oq If CONSTpUCTION
OR WORK IS SUSPENOEO OR ABANDONEO FOR A PERI00 OF 1T0 OAYS AT
ANY TIME AFTEfl WORK IS COMMENCED. NO. OW�G. UNITS OFFSTiiEET PARKING
I MEREBY CERTIfY TNAT I MAVE REAO AND EXAM�NEO TMIS APPLICATION STA�L$ GARAGES
ANO KNOW TME SAME TO BE TRUE AND CORRECi. ALL PROVISIONS OF LAWS ALUATION SURTAx
ANO ORDiNANCES GOYERNING THIS TYPE OF WppK WILL �E COMPI,IEO
WITH WMETH SPECIfIED MEREIN Oii NOT. TME GRANTING OF A PEflM1T .�2%9% ,�'],.Q.O
DOES NOT RE UME TO GIVE AUTN ITY TO VIOLATE OR CANCEL THE pE MIT FEE SAC CMApGE
PROVISIO S OF ANY OTHER STAT R LOCAL LAW REOULATINO CON-
STRU N O TME PERF N Of CONSTRUCTION $3. 2�S Fire SC Z. HO
PLAN CNECK fEE TOTAL FEE
License SC 5.00 92.45
SiGNATU�iE �p Ci Op4uT ai2EDaGENi �0� E� WMEN PROPEiiIY VAUOATEO THIS IS VOUR PERMIT
S�GN4TUAEO�OWNEp���OWNEA8U�l0Ep� � A E� BLOG �N$P' �IGTE
� " ` [ ]
ADDN [ ]
ALTER [ ]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: �
Legal Description:
Owner Name & ess:
Contractor:
Address: o�—� ^
LIVING AREA:
GARAGE AREA:
DECK AREA:
Effective 1/1/98
�� �
o� ('i�
� �
'�.�il...� Tel. # �` '—.��
r MN LICENSE # .�—`�
o�l-f� Tel. # 3 �--� �4��
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlIZPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
OTHER: �
Construction Type: timated Cost: $ a� /�%
(Fee Schedu.�e on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ —$
DATE: � .-- � l APPLICANT: � . Tel. �# � �—� � ��
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �.� �s
$ ��o
$ l. �C�
$
$_�. � DO
$
$
$
$
$ 9� �"
CITY USE ONLY
Fee Schedule on Reverse Side
.�1 of Permit Valuation (1/lOth%)
$.50/$1, 000 Valuation
$10� per SAC Unit �
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.� Conservarion Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
a�
�---"
3�
�,, . � �.,
BUILDING PERNIIT FEE SCHEDULE
The Cluef Building Official shall, before issuing permits for the erection of any building or structure, o� for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon applicarion therefore, require the payment by the applicant for such pe�mit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,0�
$25,(�1 to $50,000
$50,001 to $1�,�0
$100,�1 to $5(�,000
$5�,�1 to $1,�0,000
$1,QW,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75� for each additional $100 or
fraction thereof, to and including $2,�
$62.25 for first $2,000 plus $12.50 for each additional $1, (�0
or fraction thereof, to and including $25,000
$349.75 for first $25,(�0 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,�0
$574.75 for first $50,(�0 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $1�,000
$887.25 for first $1�,000 plus $5.� for each additional
$1,� or fraction thereof, to and. including $500,(1�0
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or� fraction thereof, to and including $1,�,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "A": Removal and replacement of curb and gutter only - Driveway width plus b feet times $13.50.
Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minunum of 24 hours from the time of applicarion to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required l�fore proceeding with the framing.
Building ��
Inspections -
763-572-3604
0
� t/�' C BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
SITE ADDRESS %YY'� 6�4in
THIS APPLICANT IS: ❑ OWNER
YOUR E-MAIL ADDRESS
PROPERTY OWNER/ Np�: �„r, /�,�„�
TEN.�NT annxESS: 7 S� �! � Q.�c.,. cc�s.H crrsr
PHONE: f0��� '�LaS o1[�l ,� .
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
�� � �,. �1n � r� �.r, , . . r ��, r
% 1��1`�;A:�. .,� ..l � :' i1
PROPERTY TYPE ��� F�'
❑ TWO FAMILY/�
PERNIIT TYPE
TYPE OF WORK:
� BASEMENT FIATISH 0 ROOF
O DECK .B�DING
❑ SWA�➢VJ
0
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
� NUMBER OF SQUARES
� GARAGES
' PROPOSED SIZE:
� PROPOSED i�IGHT:
O REMODELII�TG
� ., •
❑ HOUSE & (3ARAGE
O ATTACHED GARAGE
❑ DETACI�D GARAGE
ID �001060
❑ DRAIN TILE
❑ OTHER
Permit
�� - - - � : � ��
�
_ . :r, t�1 1 • � •
I� . �i4.ia� ��� �
Li.l���*M�1
BASEA�NT REMODELWG SUBNIIT•
1. Existing Floor Plan
2. Proposed floor plan
3. List of strucwcal members to be used
Ft
� FOR NEW CONSTRUCTION INCLUDING DECKS,
��1AY��, � ���t ADDITIONS 8c PORCHES SUBMIT•
❑�►� ❑ Fascia 1. Site P1adSurvey showing We existing structures
and ProPo� P%1�
�ppqrS 2. Two sets of construdion plans
IN EXISTIIdG OPENINGS OYes �No LACATION OF WINDOWS 3. Energy Calculations
OR FOR NEW OPENINGS-DESCRIBE STZE OF
OPENRVG CHANGES &
TYPE OF WIl�iDOW TO BE IIVSTALLED NUNBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1 7 U .0 FEE SCHEDULE)
TOTAL JOB VALUATION $ _� S��% � pCC'�JpANCy TypE
Permit Fee
Plan Review
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Dne
See Back Page for Fee Schedule
65% of Building Permit Fee
� 1�(,�j .0005 x Permit Valuation Minimum $.50
$ � t�[� $5.00 (State Licensed Residential Contractors)
S $1675 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservaxion Plan Review
$ Fec Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ L.� Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMTf NOT VALID UNTIL PROCESSED
I hereby apply for a building pernut and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work w'ch requires revie and approval of plans.
SIGNATURE OF APPLICANT �/� PR1NT NAME �'iC�7/!�'��j I/G�G DATE Y/��/ v
P�ge 2- Building Residential Application
BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or structure, or for any alteration or repair
to any existing building or slructure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
provided to-wit: � � �
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
a11ow for proper review.of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing founda.tion will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Deparlment
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
HOUSE HEATING TEST RECORD
ADDRESS � � Y `` �' ��`"{ �; "- �''�'' � �' APT. FLOOR F CITY Ski�11RB
OCCUPANT 1�i,.• , ;., . ,, -'-�� .i i• ' OWNER ��. - t
�`
HEAT LO55 D E�„�i�G. �NS �
—�—r--, �� AS C0. METER BADGE #
SOLD BY f'� ` .�� ' ,�'" �,",J'� j� � ' � INSTALLED BY _� �'�:, ; d'� � , � ���'' ' „ ,r;
Electrical Work By Gas Line By �� `�`y f '
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
,.; ""9AS DESIGN CONVERSION
�'� ./�'b � ars4 . �:,f'J'!r�'1,.;,_.
MAKE MAKE OF BURNER
Model /�" -" :i''�. ,� �'�. 4j � �
Model �'
S��a� Max. BTU Rating x�
INPUT ,� '�' 1"" ''f MAKE OF FURNACE
Model ____ _
THERMOSTA
Valve �
Limit �
Limit Setting
Fcn Setting _
Pilot Type _
Pilot Make �
�/�/CONTROLS
T V u--' °�-
�
Pilot Model 'r�,—�1
Pilot Timing -,` �� -�"��''�°"
i.. W. Cut Off
Vent Size �
KIND OF LINER `�`�"=--' �'�~ SIZE y'�NONE
Draft Hood Regulcror T�- r`'
Fi Iters Size Num i
Chimney Loeation In�si'�° ` Outside
Ghimney Construetion ! '�� '��'"`' �''�'`
Smoke Bomb ,L Wiring =��� 4 �,
Draft `''�� Test Tag �»
�; : ,�
Door Pressure Lighting Inst. "y ' '+
.� � �� a i '
Prossure � Percent CO � ' Date Tested � � ` "'' f � -
Input CFH � -j � Pereent 02 �' r✓ Company Testing � � ! K � � � ' � -�'
Z r-
Stack Temp. �=+ �� Pereent CO �� �-�'' Name of Tester •�•
Form 235
n�_�
CITY of FRIDLEY
6431 Vaive=sity Ave. N. E., M�nneapolis 21, Mi�n�.
PHONE: �iTas�t 4-T#T�
REMARKS:
, = ..�,
� 9 - `� �. _ . . ,a�, - -u _
ADDRESS
INSPECTOR
DATE -
SCHAFER'S SPECIALTIES MPL�.