The URL can be used to link to this page

AF - 44482• � � City of Fridley, Minn. BUILDING PERMIT Date: ___.�__ SEPTEMBER 16z_ 1965�_____.____ Owner: ___..__. RICHARD �NII,i.LER _.._.__� Builder 8256 Monroe St. N. E. Address ._.._._._..__._.__._..___._.._._...�__._.._._.__.._.._.____.._.__.._..._.._ Address SPRING LAKE PARK. MINN. SANlE LOCAT{ON OF BUILDING No. ..___5480._..__ Street ..._.._ Altura Road N. E.__.---------.--.- -- - Part of Lot _. Lot _..._....__...---..__..._ Block _._.__--•----------......---- Addition or Sub-Division .--•-•------�...— Corner Lot ...___.__..._.._.._ Inside Lot -----••-------..._...r...---- Setback ._--•------•--._..._._._._.._ Sideyard Sewer Elevation Foundation Elevation xo .3o S� y 8462 To be Used as: ____.�___ _..._..__ Front _._.._.__._..___._,._..__..._..__ Front Type of Construction _.._......__ DESCRIPTION OF BUILDING DePth _..___._.._ Height .._._._..._..._ Sq. F� Depth ____._.___ Height _.._.._.___� Sq. F� _..__._._. _.�.. Es� Cost _...,�.2�.Q.Q�..._..--••--------•--•--- To be Completed Cu. Ft Gu. E't. REPAIRS DUE TO STORM DAMAGE In consideration of the issuance to me of a permit to construct the building described above, I agree to do th� proposed work in accordance with the description above set forth and in complianoe with all provisions of vrdinances of the city of Fridley. � In caa�sideration of the paymex►t of a fee of �._ 2 ��_.._.__._.., permit is hereby granted to_._.. �� LER to construct the building or addition as described above. This permit is granted up� the �express condition that the person to whom it is granted and his agents, employees and workmen, in all wark done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regardfng location, construction, alteration, maintenance, repair and maving of buildings within the city limits and this permit may be revoked at ar�y time upon violation of any of the proviaiana of said ordinancea ALLEN G. JEl�SEN B�� NOTICE: 'IMs pkmtt dou not eowr fh� eonshveNoe. i�uhilalton fo� wirino, plumbino. Yu huftn�, snw�r er wat�r. B� wn to sw th� duiWiaa In�ebo� fe� »puat� pw+nits fer f6�a iNms. + , ., .. APP'LICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME ///�L��, ,� BUILDER �,�;�i ADDRESS �°� '��' !`��,.��,,,� _ ADDRESS LOCATION OF BUILDING N0 , � � `J� � (� S TREET �� , �� PART OF LbT LOT BLOCK ADDITION OR SUBDIVISION CORNER LOT INSInE LQT SETBACK SZDE-YARD SEWER ELEVATION FOUNDATION ELEVATIQN Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DE3CRIP1ZOft OF BUILDIftG To be used as; °t i _� Front w` ! Depth Height — �_ Sq. Ft . ' Cu. Ft .`� i' �? ,. , �-, � Front � � ' Depth � � Height� Sq. Ft. � � ' ; Cu. Ft. ' ' , `` ' � ..��JL� � 6'��`�� v�l� Ci Ca Type of Constructio �, e_ Cost To be completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance wiC.h the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations atated in this application are true and correct. DATE_��/ ( /G' j SIGNATURE �,�.�,L,,,�a .�_��L�� , (Schedule of Fee Costs can be found on the Reverse Side), . ` � , '� , � �� .� . . - ti . . ,�., . c � - �� CITY OF FRIDLEY 8,31 UNIVERSITY AVENUE N.E., FRtDLEY, MINNESOTA 55432 TELEPHONE ( 612)571-3450 Narch 16, 1984 Mr. H. M. Granroth 5�80 Altura road Fridley, I�A1 55421 Ae: Tree Overhanging Garage Roof Dear Mr. Granroth: It Was called to our attention that a tree in your rear yard has branches that are growing over the garage roof at 5u68 Altura Road. Would you please contact your neighbor to try and work out a solution to the problem. Your cooperation in solving the problem Would be appreciated. Sincerely, DARREL G. CLARK � Chief Building Official DGC/mh sua�ecT PERMIT City of Fridley g 5$ 2 � AT THE TOP OP THE TWINS g U I L D I N G P E R M I T � , iP � � � � ; y _.____ COMMUN�TY DEVELOPMENT DIV. T� / r � � PROTECTIVE INSPECTION SEC. c,�� I�( — � � � `.C.� ' � /'��1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BV �'"""'�� ,�� 612-571-3450 910-F15 7/6/88 / / JOB ADORESS 5480 Altura Road N. E. t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1% 6 Carlson�s Summit Manor North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP pHONE Mildred Granroth 5480 Altura Road N.E. 572-9574 3 CONTRACTOR MAIL ADDRESS Z�P PHONE UCENSE NO. American Remodeling 3700 Annapolis Lane, �lymouth, ,l�T 55447 553-0020 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 O ADDITION ❑ ALTERATION C�} REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Soffit & Fascia 9 CHANGE QF USE FROM TO STIPULATIONS SEPAFATE PERMITS ARE REQUIRED FOR ELECTR�CAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENT{LATING OR A1R CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1. STALLS GAqAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALI. PROVISIONS OF LAWS VALUATION SURTAX AND ,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED ITH WHETHER SPECIFIED HEREIN OR NOT. THE GFANTING OF A PERMIT S2 �OOO $�-. QQ ES NOT ME TO GIVE AUTHOFITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE P QVISI S OF NY OTHEFi STATE OR LOCAL LAW REGULATING CON- S ION OR E RFOR CE OF CONSTRU TIO $45.00 � PLAN CHECKFEE TOTALFEE . $46,00 �{NATUREO corv�ancroaoa RIZEDAGENT �onTEi r. . � WHEN PROPERLY V LI ATED THIS IS YOUR PERMIT � SiGNaTUREOFOWNER�IfOWNERBUiLDER� IDATEI BLDG WSP �7E �1 �� City of Fridley EEfective 5/L88 �fDDN [ ] R-1 AND R-2 ALZ£R [ ] �,; � ding Permit Ap�al ication Constr uction Address : `s ��a �L7�i.P� ,��„� �'/c� Legal Descripticn• Owrer NaQne & Address : /� �l�Q ��(i GTf/ T�. �, f"�- fJ%S/ Contractor : _.��1��(./ � .�.Q L°. �-�� Tel. # �� G�� o . �dress : � � a ° ��s ,�iti �l��, o•r�� s'"s'�7 Attach to this appl ication, a Certif icate of Sl�rvey of the lot, with the proposoed construction drawn on it to scale. L1ES(RIPrION OF IM�RWII�NP LIVII� ARFA: Length Width Height St�. Ft. C�RAGE ARFA: Length Width Height S�. Ft. D�(3c AItFA: Length Width Hgt/Gro�d S�. Ft. ��y.la�; Gbrner Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks Type of Construction: �,S'°�i'��/��'��1r' ��%'� �imated Cost: S�, a�'o °°- Approx. Completion Date: % �.�a'�%' � Alt. A Alt. B Prop�sed Driveway Width If New Opening Is sired: S S idth + 6' See Back Page % `%' �� r �� . ,S-,S�,�-o°� o IaATE : APPL ICANP : Tel. # CLTY USE Q�S�Y �,/ 0 Permit �ee S /`r� F�e Schedule on Reverse Side State Surcharge S /-°--°-- 5.50/51,000 Valuation SAC Qzarge � 5550 per SAC Unit Driveway Escrow S Alt. '�," or Alt. "B" Above 1�k � $ �e Determiryed by Engir�eeri.ng Sewer Mai.n c�arge $ Agreener�t Neoessary [) No�t Neoessary I] TOTAL S . �'�- STIPUI�I�TS: � � e J ' / / �`I.`.' f C.! / .-GiN QF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 , RATE SCHEDUIrE APPLICRTIOH FOR POWER PLANTS AND HEATING, C�JOLING, VENTILATION� REFRIGE�ATION AND A!R CONDITIONING SYSTEMS AND �EVICE5 Residential Furnace Sheil and Duct Work, Burner - Also Replacement Furnace (S(de Vent - Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Ait Conditionfng - All Sizes Ail Others/Repairs & Alterations (LIST ON BAC:f� 1% of Value of Appliance ar Work Commercial/I ndustria l 1.25% of Value of Appliance or Work Rate T07AL $ 30.00 $ �11� �60 $ 10.00 $ $ 10.00 $ $ 10.00 $ $ 25.00 $ 02 ,S �G � $ $ State Surcharge TOTAL FEE �� $ �S.SD MINIMUM FEE FOR ANY HEATING/COOLIhICNENTILATION REFRIGERATION/AIR CONDITIONING PEFtMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr �*A1r Conditioners can not be placed in a side ;rard without nvritten permission from adjoining property owner. Effective On August i, 1995 N o F �, � JOB ADDRESS •S�'��'�i ��.�,s.� �� d � The undersignecf hereby makes application for a permit for the work herein specified agreQing to do all work in strict accordance with the City Codes arrd rulings of the Building Division, and hereby deciares that all �he facts and representations =3tated in this application are true and correct. /f - 'I ��,1995 OWNER �/,��✓/,m �i��.n-�.h��i S 7eZ"' I�S�7 BUILDING USEL7 AS �/�.l�,G ESTIMATED COST �'�i�,�3 � PERMIT N0. ;'��7�/ �E�CRIPTION OF FURNACE AND OR BURNER No. of Heating nits � Circie One (Steam) (Hot Wat�:r) arm Air) Trade Nam�.,G��at Size No.� - S' BTU %SODI� HP EDR Fuel y Total Connected Load Burner rade Nr�me Size No. BTU HP EDR HEATING COM?ANY �„J Signed By � . � � � -�; : - '�el No. � ,;� . � ��;.r Approved By %C, Rough-In Date Final Date FILL OUT BACK SIDE R STACK VERIFICATION ON REPLACEMENT FURNAGE . `� e,c-��L� ��p�re.r� � � �r�s � Q � y� �� NOTE: 4�1 through 4�8 required when using a side vent furnace. �;�r�-r� 2� �-� � �� 1��- �d S'H� MNF� �ND STACK VERiFICATION The undersigned hereby verifes that the existing chimney or stack: 1. Has been carefully examined Yes (')() No () 2. 3. 4. 5. Is free from nist or deterioration Has no foreign objec�t.s lodged within Is securely supparted I�I�*� a� c�**!�nt �c}d� *�iirsment� for size and total BTU's connecbed 6 Has total heating BTU's of �%-�, v c� All other BTU's 3 s'� �, d� TOTAL BTU's I%�� o J 7. Has a liner been provided for water heater $. Has combustion air been provided for water heater Remarks: Yes (� No ( ) Yes (�i) No ( } Yes{X}No() Yes t%� No ( ) Yes (�) IVa ( ) Yes �r) No ( ) ! _ ,_"!' . , � _ � � ,j�L HEATING CO: Signed By: Date: ��i�r�r� . . 5ve�eGT MIT N . City of Fridley 32081 , , AT TME TOP OF THE 7W�NS � U� L D I�� P E R M I T REC I T NO. r � �; y �_�� COMMUMITY OEVELOP�MENT OIV. �% -��0/' " r � � PROTECTIVE INSPECTION SEC. �( � it �� , /'�'1 � CITY MAII FRIOLEY SS�3Z NUMBER pEV OATE PAGE OF AViROVEO 8Y �"""'�" �'' 612-571-3450 9t0-Ft5 8/13/O1 � � �oe AooRess 5480 Altura Road � t LEGAL �OT NO. BLOCK TRACT OR AODITION SEE ATTACMED DESCR. 1] 6 Carlson's Summit Manor North SHEET 2 PROPERTY OWNER MAIL AOpRESS 21P PHONE Steve Johnson, 5480 Altura Road, Fridley, MN 55421 763-781-6339 3 CONTRACTOR MAIL ADORESS Z�P PHONE LICENSE NO Tom Walek Construction, 3621 Roosevelt St NE, Minneapolis 55418 763-789-9388 � ARCMITECT OR DESIGNER MAIL ADDRESS ZIP PHONE UCENSE NO BC-20226198 5 ENGINEER MAII ADDRESS ZIP PMONE LICENSE NO 6 USE OF BUIIDING Residential 7 CLASS OF WOHK O NEW O ADDITION ❑ ALTERATION C� REPAIR O MOVE O REMOVE 8 DESCRIBE WOFiK Re-roof (tear-off) 17 sq. (H & G) 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with State Building Code. TYPEOfCONST OCCUPANCVGROUP OCCUPANCVLOAO SEPARA7E PERMITS ARE REOUIRED FOR ELECTFiICAI. PLUMBING. HEATING, VENTI�ATING OR AIR CONOITIONING. � THIS PERMIT BECOMES NULL AND VOID �f WORK OR CONSTRUCTION 20NING SO. fT CU FT. AUTHORIZED IS NOT COMMENCED WITMIN 60 OAYS. OR IF CONStRUCTION OR WORK IS SUSPENDED OR ABANDONEO fOR A PERIOD Of 120 OAYS A7 " ANV TIME AfTER WORK IS COMMENCED. '� NO DWLG. UNITS OFfSTREET PARKING I HEREBY CERTIFV THAT I HAVE REAO AND EXAMINEQ TNIS APPIICATION STA��S GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISlONS Of LAWS VALUATION SURTAX ANO OROINANCES GOVERNING TMIS TYPE Of WORK WILL 8E COMPLIEO � 1� 822 , OO �• 91 WITH WHETMER SPECIfIED HEREIN Oii NOt. TME GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL ?HE PEqMIT fEE SAC CHARGE PAOVt510NS Of ANY OTHER STATE OR LOCAL LAW REGULATING coN- �66. ZO Fire SC � 1. HZ STfi CTION OA TME GERFORMANCE O CONSTRUCTION ��`/y� PIAN CHECK FEE TOTAI FEE �� ense SC $5. 0 $73.93 �� $�GNATUQE OF CON'AA(;TOpOp AUTHOA�2ED �GErvt iO�TE� WMEN PRO VAUDATED THIS IS VOU PERMI - � 7 � � S�GNaTUaE OF OwtiEQ��F OwrvEQ BU��DEQ� �D�tE� . B�OG� iaSo � � � r� TE NE1N [ ] ADDN [] ALTER [ ) Construction Address: Lega1 Description: _ Owner Name & Addre Contractor: �C�l�t � Effective 1/1/2001 CITY OF FRIDLEY (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ,,_�� E'v, ��lt �/f �� '� Tel.# �� MN LICENSE # ��d� o� �`C%� Tel. # 7g� � -�13 � � Attach to this application, a Certificate of Survey ofi the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. F� GARAGE A-REA: Length Width Height Sq. Ft. DECK AREA: Length idth HgUGround Sq. Ft. OTHER: /� �4� L� (' /�'r-�iL' - O �7 In� � Construction Type: �� r'� e�"` D Q� Estimated Cost: $ v2 �% � S j�°2°2 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: � / �M�� APPLICANT: � �''" `� Tel. # ,7 �� " CtTY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in appfication Permit Fee $ ..�ZG Fee Schedule on Reverse Side Fire Surcharge $ 1. ��;L .001 of Permit Valuation (1/10th%) State Surcharge $ ' / $.50/$1,000 Valuation SAC Charge $ $1150 per SAC Unit License Surcharge $ � C'f G $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ J Not Necessary [] TOTAL STIPULATIONS: $ �� , Building BUILDING Permit No.: � �� Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY ° 763-502-4977 FAX EFFECTTVE 1-1-2010 �� DATE �' Z(o " � O YOUR E-MAIL ADDRESS / I.0 � N G t T�Y �✓n � Lt7�J �. l OIN� � SITE ADDRESS .S � j� {� I7 V/' ct THIS APPLICANT IS: ❑ OWNER �ONTRACTOR PROPERTY OWNER/ NAME: "�' ,�I_� �'T'E2.Sa TENANT ADDRESS: � � a ��v✓'� C�TY � O L tT �' ST ZIP PHONE: S D Z^ g S 6 rp CONTRACTOR NAME:'� W(,v �,T�r �-w Q.2 k_S SUBMIT A COPY OF STATE LICENSE # Z- O'� S 2--� �— EXP DATE 3 � l I � YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS: I I Z,4�� CITY C�U 1M D ov� STA'f IP � INSURANCE pHONE � d O FAX - — O PROPERTY TYPE SINGLE FAMILY/NEW CONSIRUCTION SIZE ❑ O FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGElS}{ED ❑ WINDOWS ❑ BASEMENT FINISH �ROOF ❑ DRAIN TTLE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION AINTEI�IANCElREPAIR ❑ REMODELING DESCRIBE WORK BBING DONE: O SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES J i� �OUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2 Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTtOid INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS_ & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures and proposed project. � Other ❑ Fascia 2. Two seu of construction plans WINDOWS 3. Energy Calculations IN EXtS1TNG OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE S7'ICKER ON WINDOW. OPEAIING �HANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: TOTAL JOB VALUATION Permit Fee Plan Review Fire Surchazge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Pazk Fee Sewer Main Charge Total Due (USING THE 1997 U.B.0 FEE SCHEDULE) OCCUPANCY TYPE $ See Back Page for Fee Schedule $ 65% of Building Permit Fee $ � .001 times the total job valuation $ .0005 x Permit Valuation Minimum $.50 $ $5.00 (State Licensed Residential Contractors) $ $2100 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$24=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( $ �,�- Make checks payable to: City of Fridley THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED ch I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in confornnance 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 on site; that the work will be in accordance with the approved plan in the case of all wo which requires review and approval of plans. SIGNATURE OF APPLICANT �''e� c PRINT NAME�i j!�-� L V!l%'�/Y�NO�ATE S ZL ' IO Building Inspections 763-572-3604 763-502-4977 FAX DATE � "' % °� � U SITE ADDRESS ` THIS APPLICANT IS: MECHANICAL RESIDENTIAL APPLICATIUN � • ./► : CITY OF FRIDLEY EFFECTIVE 7-1-2010 PROPERTY NAME: � �'z. J OWNER/ p,DDRESS: Sy8 /'T �= TENANT CONTRACTOR SUBMIT A COPY OF YOURSTATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK: PHONE: COMPANY NAME: CONTACT PERSON: ADDRESS Q �' 2 i �T� 2 Permit No.•��6�6�� Received By: ��c�r 5 CITY ��L f O 1- l.- �-�I STA' C� STATE LICENSE # EXP DATE ADDRESS: �O o�% (� �� I�% E 2 /( �CITY J` )/�d K/+ STAT .�aIP S✓� � PHONE�1� J� —�aa � O 76� FAX {�SINGLE FAMILY � TWO FAMILY ❑ NEW �,tEPLACEMENT DETAILED DESCRIPTION OF WORK �. ❑ TOWNHOUSE O ALTERATION/REMODEL FEES ARE BA5ED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK. �/ � Equipment Installed MFG: �. ��'1/J1� � it MODEL,� � 3%} C�C. 'D� d- a3oS��TU a,Z p _A/C $25.00 _AIIt TO AIR EXCHANGEER $15 _BOILER $35.00 _CHIMNEY LINER $10.00 DUCT WORK $10.00 MFG: MODEL: MFG: MODEL: FIREPLACE (GAS) $I5.00 FIREPLACE (WOOD) $35.00 FURNACE $35.00 GAS DRYER $10.00 GAS PIPING $10.00 SIZE/BTU SIZE/BTL1 GAS RANGE/OVEN $10.00 NEW GAS GRILL $10.00 GAS LTNIT HTR $10.00 POOL HEATER $35.00 VENTILATOR $15.00 THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in confortnance 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 o 1 work which re9 ires review and approval of plans. SIGNATURE OF APPLICANT � RINT NAMEP �' Yk� DATE �/� f� APPROVAL INSPECTORS SIGNATURE DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-36Q4 FAX: 763-502-4977. HEATING �� J �� SEDGWICK HEATING & AIR CONDITIONING CO. TEST RECORD JOB NO. 8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(612) 881-9000 ADDRESS ✓ ��D �� r � �� (� � /t,�., t OCCUPANT � �✓ V-� ' Uw � � SOLD BY � �3' t MAKE _`-�'!!'! � SERIAL NO. �� ,�� THERMOSTAT � �-' `�'�' VALVE � �-'�-° LIMITI� "" �Yi UMIT SETT FAN SETTIP PILOT TYPE IGNITION M PILOT TIMIP PRESSURE INPUT CFH STACK TEN CITY r / OWNER INSTALLED BY �' ��"� I MODEL � ��,� �=' ��J '� ,p INPUT � �� /%-1 " � �,( �/ VENT SIZE _.,/ TYPE OF LINER �'`` �� -`�'�i' � �'� LINER SIZE � � J' FILTERS: SIZE ��_ NUMBER ^�. WIRING TEST TAG �_' LIGHTING INST. DATE TESTED �` � - COMPANY TESTING �'� � �''�'� NAME OF TESTER 1 FORM 235 (REV. 11(89) FORM DISTF10UTION: WHITE COPY - JOB FILE YELLOW COPV - CIN