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AF - 44821SUBJECT City of Fridley AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r � � � � � • COMMUNITY DEVELOPMENT DIV. � �y------ � r � � PROTECTIVE INSPECTION SEC. 1 � � � �"'1 � CITY HALL FRIDLE� 55432 NUMBER iiEV DATE PAGE oF �----�•� ,•' 612-571-3450 9� 0-F� 5 6/2 5/86 � � JOB ADDRESS 6576 Anoka Street N. E. 1 LEGAL LOT N0. BLOCK TRACT OR ADDITION oescR. Parcel A, Lot 4, Pt. 5, Block 4, Oak Grove Addition 2 PROPERTY OWNER MA�L ADORESS Z�P Terry Ba.rrett 3 CONTRACTOR MAIL ADDRESS Z�P Vista Construction 961 Hillwirid Road N.E., Fridley 55432 4 ARCHITECT OR DESIGNER MAIL ADDRESS SEPARAiE PERM�TS Z�C�EJ� 5 ENGINEER 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW 0 ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ,❑ REMOVE X MAIL ADDRESS PHONE PERM O. � 18514 - REGE �? //.3 0 APPROVED BV SEE ATTACHEO SHEET PHONE LICENSE NO. 571-920d PHONE LICENSE NO. C ��� NO. i7 8 DESCRIBE WORK Construct 30' x 30' Foundation for House t�o be Moved in fram New BrightAn. Construct a 20' x 20' Garage 9 CHANGE QF USE FROM TO STIPU�ATIONS � not move house until bond is submitted to the City or bond is waived by the City Planning Department. Park Fee of $750.00 paid previously. ��-?b�86 All electrical wiring to meet the present Electrical Code. Provide new roof jack on all plumbing & heating. All base�nent plumbing to meet present Plumbing Code. Pxnvide new stack (heating vent). Provide new furnace. Provide egress windows. Reroof dwelling. Provide soffit vents. House to meet the State energy code. Provide fire/smoke alarms in dwelling. Repaint outside of dwelling. Provide sill plate. Provide header for basement stairs. SEWER LOCATION: 133' North of Manhole "Y" ELEV: 884.15 WATER LOCATION: 15' North of Sewer. TO P OF FOOTING: 887.15 Minimum� _ �,. ,,,.. , w������ SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK, OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 DAYS AT FT R TYPE OF CONST. I OCCU ING ANY TIME A E WORK IS COMMENCED. NO. DWLG. UNITS I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STAL�S AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF �AWS VALUATION AND,ORDINANCES CaOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OF NOT. THE GRANTING OF A PERMIT $43, 900 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERMIT FEE PROVIS�ONS OF ANY OTHER STATE OFi L CAL LAW REGULATING CON- STRUCTION O �� AN E STRUCTION. yS`ZS6.00 PLAN CHECK FEE % on SIGNATUFEOFCONTRACTOFlORAUTHORIZEDAGENT IDATEI WHEN ROPE Y * . , �, SiGNATUREOF OWNERIIF OWNER BUI�OERI IDATEI , w5P � FICi f PARKING GARAGES $21.95 SAC CHARGE $475.00 TOTALFEE $752.95 D THIS IS YOUR PERMIT � _� � tC. N�,' [ J ADD27. [ ] ALTER. [ ] Construction Addre Le�al Description:, City of Fridley jY R-1 AND R-2 � Building Permit Application �C I�.,, r .�.a _ (��. Effective 4/1/8G Owner Name & Address : � �'�� y ���� E �� Tel . � 5 y `� Contractor: l�>� �/� �o,�vs�,2u��.ds�c� Tel. #� S 9vto 0 Address: i� /- /�eLLcvi�✓� �� `'.�i,�L£,�,Y, ,SS%31 LIVING AREA: GARAGE AREA: DECR AREA: OTHER: Attach to this application� a Certificate of Survey of the 2ot, With the proposed consLruction draxn on it to scale. DESCRIPTION OF IMPROVEMENT Length ,�! Width �O _ Height � Sq. Ft. 4O Length �Q � Width �?0 � Height _�_ Sq. Ft. �l'�d� Ler,gth � Width _1j[�_ Hgt/Ground ��- Sq. Ft. �.4 Corner Lot [] Inside Lot [� Ft. Yd. Setback �� � �_ Side Yard Setback /Jr Type of Construction: Estimated Cost• $ C o d Approx. Completion Date: �/3����0 Alt. A Alt R ProposeC Driveway k'idth If New Opening Is Desired: $ $ � See Back Page for Explanation Q DATE: G� � a� APPLICAI;T: �--- - N G/i.-���G�c�..I�..L�e.. Tel. ����� Perciit Fee Plan Check State Surcharge SAC Charge Park Fee Sexer Main Charge TOTAL STZPULATIONS: CITY IISE ONLY �—�,��,�� Fee Schedule on Reverse Side � ��w 25� of Building Per�it Fee $ 1 �� ' $.50/�1,000 Valuation ���� z �:..� � . % .S 3 ��i S4 5 per AC Unit � Fee Determined by Engineering � v-�—� ��$, Agreement Necessary [ J Not' Necessary [] �i 1�0 �vet ;,,_ Sva �, �i� O�l. �� ���s�D (�` ��u�� � �- Mowt lyo� G►,�.�►it �'b i t � w� � c�c,«� � 0�.,��� Q�P'r. . 3y �4�i� �e2�t��bus . � . . �/ BU II.DING PERMIT FEE SCHEDIILE 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 structure, upon applicatio n therefore, require the pa}►ment by the applicant for such permit of fees to the amount herein belox se.t forth and in the manner herein provided to-Wit: Total Valuation a1.00 to 5500.00 Fees �10.00 (Minimum Fee is �15.00) �501.00 to $2,000.00 $10.00 for the first a500 plus �1.50 for each additional :100 or fraction thereof, to and including �2,000. �2,001.00 to $25,000.00 �25,001.00 to 550,000.00 �50�001.00 to $100,000.00 �100,001.00 and up �v32•50 for the first �2,000 plus $6.00 for each additianal �1,000 or fraction thereof, to and including �25�000. $170.50 for the first �25,000 plus $4.50 for each additional �1�000 or fraction thereof, to and including �50,000. 3283•00 for the first �50,000 plus $3.00 for each additional �1,000 or fraction thereof, to and including $100,000. �433•00 for the first �100,000 plus $2.50 for each additional �1,000 or fraction thereof. DRIVEWAY DEPRESSION ESCROH {Concrete Curb Streets Qnly) Alternate "A": Removal 2nd replacement of curb and gutter only - Drivexay width plus 6 feet times $13•50 Alternate "B": Renoval and replace�ent of curb and gutter and install a 3 foot wide approach r:ith 6 inch depth - Driveuay Width plus 6 feet times $15.75 VERIFICATION OF FOUNDATION Per�its for construction r;ill be issued a mir,imum of 24 hours from the time of application 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 onee it has been constructed will be required before proceeding �rfth the framing. ��j �jC�� o� ,�'� oar.--- (�i C���t� � � � � �� ��", �� -- ��;�,,�r.� ^ ��,�� � i ��� �} t.�tt. �i �t,r� .� . ...� •► � 1.1V Ir� � � v0uf t1t� �y �►� � j �c� '_ ��,�� � SUBJECT PER . City of Fridley Mo�ING 18 515 r ' AT THE TOP OF THE TWINS X���� p E R M I T , � RE . � ; y _ COMMUNITY DEVEIOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. ,����D I � � � � /"'1 � CITY HALL FRIDLE� 55432 NUMBER REV. OATE PAGE Of APPROVEO BV �""'� � ��� 612-571-3450 9to-F�5 6/25/86 / / JOB ADDRESS 6576 Anoka Street N. E. t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ,4, Pt. 5 4 Oak Grove ACIC�ltlOri SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ter Barrett 3 CONTRACTOR MAIL ADORESS 21P PHONE UCENSE NO. Dale Movers Inc. 7816 Central Avenue N.E. Fridle 784-4269 29 STA 4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 6 USE OF BUiIDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATION O REPAIR � MOVE ❑ REMOVE 8 DESCRIBE WORK Move house frcm �iew BrightAn into Fridley tA above legal description. 9 CHANGE OF USE FROM TO STIPULATIONS Route: 29th Avenue (New Brighton) to Mississippi Street to Anoka Street tx� site. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIF CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OFi CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORI2ED IS NOT COMMENCEO 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. OWLG. UNITS OFFSTiiEET PARKING I HEFEBY CERTIFY THAT I HAVE FEAD AND EXAMINED THIS APPLICATION ]_ 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 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAI LAW REGULATING CON- STRU� OR THE PERFOFMANCE OF CONSTRUCTION. $HO. OO PLAN CHECK FEE TOTAL FEE �Li�Z%�J�°v" ���J �`$�. �� slGn�niva CONiRACTO� �� � GENT �DnTEi WHEN PROPER�Y VALIDATED THIS IS YOUR PERMIT /J'"� � � %� � d � ��,�.� �—l����� SiGNATUAE OF OWNER�IF OWNER BUILDERI IDATEI ^ G�NSP qATE Effective Aug. 1, 1981 p��[CT c�ty of F��a�ey Pe��t No. •T *�T�°'TM�TM'"" MOVI�VG PERMIT APPLICATIOi� i�� Receipt To. � rL-------� cowruN�r. a��oi..EMT av. , ; M�«� �..��.� .�. a � � � a � � �. . ; arr �c.� r�ou� Mw� �....�.I �.� Ni'NO�iNO M�WO� . O�TE E' OR A►�110v Dir 910-F21 0 2/15/73 1 �1 800 property Owner Address one - ,� 5��2� � � 33� -� � �� re�ent Lot No B oc No Tract or tion �� - gal . /(v ;�c � 5 `" � �„� nJ, �✓/G'Fw/,�.�', ��'� To Be � wed To -;; %lj C,G�l�`� �er, ress one icense o. � . • ' �t� <�t� =-� � j.� - �a:� =.�z� r: = ���! 1 � � � .,� ° � , � �-��° �" z_ Expecte une n oz ru r ey Eet mate Cost Ty of Building $ 11L%C� � ,���t���--c Rvuting �� , / 4� ,� l �xc , - �%�/�,,��/✓�� .� ��i�!i�'..�- ,�,1;. %- _ Approved By: • IItilities � be l�otified and aate Servfces �isconnected llpls. Gaa Oo. ti.S.P. Northwestern Hell Tel. Co. Snqr. Dep� C1�st. 8us. Ofc. Bus. Ofc. 372-4850 330 554Q 332-4112 Date Date Date l�iavinq Fees: Movinq PYinciple Suilding Into Fridley $ 80.00 Mcvinq 14ccessory Suildi�g Into Pridley $ 20.00 1�toyinq tiiznuqh, vith.in or cut o� City S 15.0.0 No State surcI�arqe on lla�vinq PeYmits Apprwed By Water � Sewer Department: •All Bills Are Paid Services Are Disconnected The•undersigned hereby makes applicaticn for a permit to move the building descsibed abave, agreeing to do all work in strict accordance with the City Ordit1ances and xv lings of the Department of Buildings, and hereby declares that all facts and representations stated in this application are txue and correct. `��? ��L� - ,��!����t � � t= - U � � � � Con tractor i .._---..�.-----`-_._.--- �, I y � -- �-�: ��. � � e \ s • ` C1TY OF FRIDLEY APPLICATION FOR PWMBIN6 AND �AS FITTING PEf�1IT ay. � a u • x y Water �A an � w c a m � u p, �a�, °� Heater N m° �.�+ " �c'�a i �M'��gs � u� a�i v�i u � oo a� v�i a O w v�i t�.o, u m 4 3 � � c� O as lec � ,� lst � � 2nd 3rd 4 th (R) � FuWra Connaction Opening Connected with Sewer (�) � New Fixtura, Old Openinq Miates RATE SCHEDULE PLUMBING FIXTURE RATES: N0. Mew !1=tur�� lutur• rixtura� Old Op�ninq, N�v li:tur� e�er Di�p�na�r 81or Off ea�in C�tch Basin R�in Ylatar Lsad�r Nydraulic Valv� Su�p or R�ceiving Tank Mat�r Tse�tinq Appli�nce Hot ilater tleater Ga� Renqe Gas Dryer � � RATE S 5.00 S 3.50 S l. 50 S 4.00 S 5. 00 $ 5.00 S S.OU S 5.00 S 5.00 $ 7.00 $ 5.00 $ 10.00 S 10. 00 ALL OTHERS AND/OR REPIIIRS AND ALTERATIONS ls ot Valus o! ti:tur� or llppliance � State Surcharge Asinapection !ee $ (515.00) . TOTAL PEE TOTAL S ,�� S S S S S S S S S S ��� S S S "5 Q, � V Etfective Aug. 1, lyal Job Address �/., �(/ /y+,rf-��y. S�° �_�j.._�_.:. Department of Buildings City of Fridley Tel. M571-3450 The undersigned hereby makes application for a paroit !oz the work herein specified agreeinq to do all work in atrict accordanc� with the City Codes and rulings of the Departaient of Buildinga, and hsreby declarea that all the facts and representatio�s etated in thia application ara true and correct Fridley, Mn. � lg OWNER �'�� � S� � �- �'C�.r s� I KIND OP BUILDING �— /Z /9,M 1. ,` / USED AS % � `- S TO BE COI�LETED 11BOUT I � - � �j °- � � ESTIMATED OOST /� m d _� OLD - NEW BUILDING PERMIT NO. PERMIT NO. `7 ��� OowPanY `) W �. � I� I•-R.nn /��' `f'� Siqned By c�-- Tel . No ��'/ �% Tj RO(1Gt1 I NSP . nate FINAL INSP. ec `�"�� nate 11PPR0'VAL FOR PERMIT --�� HININUM FEE FOR ANY PLUMBING PERMIT IS 510.00 PLUS THE S.50 STATE SURCHARGE � _ UTYOF FRIDLEY CI�'IC CF:tiTf-:K • 6-131 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE(612) 571-3-�SO February 9, 1987 Vista Construction 961 Hillwind Road N.E. Fridley, MN 55432 Re: Final Inspection at 6576 Anoka Street N.E., Fridley, MN De ar S i rs : A final inspection was conducted on February 9, 1987 of the above address and the following ite�ns were noted which must be completed before the structure can be finaled: 1. Provide house number on structure by February 19, 1987. 2. Provide a handrail on the basement stair by Februaxy 19, 1987. 3. Insulate rim jois t by February 19, 1987. 4. Head off floor joist by February 19, 1987. 5. Pay Double Fee on iieatirig Permit by February 19, 1987. 6. Provide sod in tne front and side yards by June 15, 1987. 7. Provide a hard surf ace driveway by June 15, 1987. 8. Paint the exterior of structure by June 15, 1987. We will expect the above items to be completed by the scheduled dates when reinspections will be made to determine compliance. If you have any ques tions on these items, please feel free to contact me at 571-3450. Sincerely, DARREL G. CLARK Chief Building Official DGC/mh CC: Mr. Terry Barrett C11Y OF FRIDLEY APPLICATION fOR P011ER PlANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SVSTEMS ANO DEVICES RATE SCHEDULE �csto��r u►� /urn�ce Shell •nd �uct Mork, 6u[net IAI�o tpl�cwnt Iurn�n) C�� Plptnq (P�p��9 M�� vltll Mr turNC�) C�• II�n9e G�• Drr�r • Air CondLtioniny (�ll �ls��) MTE S 20. 00 S 10.00 S 10.00 s io.00 S 10.00 Al1 OtAer�/Ilep�/r• •nd Aiter�tion• l� o[ V�lue ot Appli�nce or Mork C01�1 LRC I A L/ INDUSTR I AL l� ot V�lu• ol Appll�nc• os Mosk St�t• Surcharqe rarur. ne R�ln�p�cttoe It� Ii1S.001 Rouqh Ie�p. ' D�te PLaal Insp. �te Approval toc P�rw1t � d'� MINTMUM PEE FOR ANY HfJ►TINC PERN[T IS 510.00 PLUS S.SO STATE SURCIIARG� .......���• w�ry. � �'Yn{ TO'fAL J�b Ackfre.s � ✓ /�/�� O.C!'� �� �o,�/y a` s C�� t►r�.artment of 6ulldlnqs b111 Unlverslty Av�. N.L., �r/dl�r, MM SS�)2 ,�7 O� Clty o( F(/dley s �l/ � tel. �S71-]�SO s s S Tf�� unders/qned h�reby w�k�� �ppllc�tlon to� � perwlt (O[ tM wrk A�[�ln ��clfled �qre�lnq to d� �11 wrk t� �trlct �ccordanc� �ItA th� Cltr Ood�• �nd rul�nq� of th� Dep��t�e�t of su/ldlnq�, �nd htceby d�cl�r�• th�t •ll th� f�cta •nd ceprt�ent�tlon� • uted ln thl� �ppl/c�tlon �r• ttu� �ed eo�r�ct. • ►r/dl�r. Mlon. _,_ ��„/�3 _. l�� Q/NF.R s RINO OF �UILDlNG S S .50 S s � �o-.�� �-0'- Att�eA �t�et ver/tiaat�oe [oes v� N r�ptec.wene (urnace pocwles . •A�r t:�wdlt�onesx c�n �u�� lw• {�Isccd io •:�.1.• yard �ttlwut rr�u�n p�rw�ivwn fr�w ndin�n��q rr��1���x. USEO AS �o �e eawtiteo �sour % 6 0 PSTIIY►TEO C06T G!� � �_ OW - Mtll W1l�IMG /EIMiT q0. ���IIT NO. / � oescurria� os ruaN�ce/�uw�c� eu►rtuc o� vare� ruKrs, se..., Noc wc.r, wr+� �i�- i+o. n�e� ww� ��i�/✓o jC sis� No. �� ��'� ��_ c.p.��cy sy. rc. co� nv _,,,,.�....,.. er ---- lbtai Connected Io�d It1nd ol IWl 5- R� su101ER - Tr�de N� s�s� �• Ca���clty Sq. Ft. EOR 01v N� r Cow{+�ny ��'��6 � � Slqn�d !y T� 1 . IN� . � 4�/ � �� � ��'" •'s CITYOF FRIDLEY CIVIC CENTER • 6431 UNIVERS[TY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-34$0 April 28, 1987 Ztierry G. Barrett 1463 Wi.ndc�ere Drive N.E. Fridley, A�I 55421 RE; Non-CaY�liance of the Fridley City Code at 6576 Anaka Street N.E. Dear r;r. Barrett: On April 22, 1987 it was confirn�d by an on-site inspection that the PropertY at 6576 Anoka Street N.E. dces not meet the mini�u.aY► standards necessary to maintain a pleasant and prosperous subu�.'�an environment. While major code requirements are satistied, the follawing items do not co�nply with the perf ozn�ance standards of the City Cod.e: 1. It was stipulated when you were granted a lot split in 19ti6 that a paved driveway be installed to the n�a 9ara3e• This stipulatian has yet to be ccx�letg3. In addition, the Yard has rwt y�et been sa3aed and tree txunks and branches have not been ranwed trccn the site. I understand that there may have been same extenuating circi.unstances for this to have occurred, havever, yaur quick action to correct this situation would be a great itrq�rov�r�ent for your proPertY arui the entire cac�nu�ity as well. An inspection will be conducted on or about May 14, 1987 to determine ca�l iance. If you have any questians or concerns, please feel free to contact me at the Fridley Civic Center, 5'/1-3450. S ' erely, �� Daryl Mc� ptanning Assistant I�`�/lu� C-87 -191 _ _ � _ 5�12� �� -- _ Te�� G���,r��" d.e.-�.,,,(-�eel ��� ,�� �- _ Dry � v�,� � 5 a -� �ac�.� ow v� i �� �` � � . �; � �� � v'e h _ _ _. _. Y� tAv� �' 1 � % S(o 2�it� jLa�. 5 � �� w¢.- � . _ _ _ _ - - _ • st' b�-v-E-i�.,►- �, s�-� w; l l b�. (�u�; �� �; �� I�,��, a�- � N�..e. 1- t�w.-�� �� 1� U�e. � v` , � � �� �,L, r vc� e v��'�5 -_ _ �. �o,� c� dr► �� � CJ .�, . _ . _ � . �� ��� 3. +r�,,,�.�.�e -��. s�u�. � l h����s r �_ �Ai t/�� � U-Se f � �o�j,� (/ � R ' %". , �_ .� CI�iYOF FR( DLEY � CIUIC CENTER • 6�331 UNIVERSITY AVE. N.E. FRIDLEY, I�1INNESOTA 55.�32 • PHONE (612) 571-��t50 June 18, 1987 Glen and Gail Ahlgren 6562 Anolca Street Fridley, rf� 55432 F,E: Seoond t:otice of Non-�c,mpliance af the Fridley City Code at 6576 Anoka Street N.E. Dear r.r. and M.rs. Ahlgren: On J�e 17, 1987 s seoond inspection of your property at 6576 Anoka Street 1�. E. rev�led that it still does not c�omply with the perf ormance stanciards established within the Gity CAde. �he following items still do not comply k i rh ttie Ci ty Gode : 1. Tne rear yarci needs to be sodded and the driveway to the garage neeas to be paved. iZegardless of extenuating circu��stances, this situaticn must be corrected pronptly to naintain a gleasant and healthy environment. A thirc inspection will be conducted on or about J�e 29, 1987 at w�hich time it is expected that this iter� wi11 be in wmgliance. If corrective action cannot be �mplEteci b� this tin�e, please sutrait a schedule indicating when this deficiency will be oorrectea If you nave not oontacted me before the inspection date or abatea L'ne problc-si� then I�ill st�mit all reoords regarding this m�atter to the City Council ht►o can apprave legal action. If you tiave any questi�ns �ncerning this matter please contact me at the Frinley Civic Center, 571-3450. �ank you for your prampt attention to this n�atter. �. � ...�c.�.......,_.....,,..� Sincerely, Datyl rArey Planning Assistant Lri/lmn C-S7-261 (C-87-191) Inspection: October 6, 1988 by Darrel Clark, Chief Building Official, noted that the sod, driveway, and garage were completed and ap ro d. ,00 bo d should be rel�.eased. c`���� . . : �. "' • �, �"'' C�TY OF FR[ DLEY .. Cl�'IC CENTER •(�3?t UNIVERSITY AVE. N.E. FRIDLEY. A1INNESOTA 55�3;2 • PHONE (61?) i7�_3.�$p, Apri1 28, 1987 �� Terry G. Barnett 1463 4�'indc�ere Drive N. E. Fridley, I��1 55421 RE: NorrCa�liance of the Fridley City dode at 6576 Andca Street N.E. Dear Dir. Barrett: On April 22, 1987 it was confi�nc.�d by zn on-site inspection that the property at 6576 Anoka Street N.E. does not meet the mini�.an standards necessary to �intain a pleasant and prosperous suburban environment. While major code requirements are satistied, the follawing items do not co¢nply with the perf o�nance standards of the City Oode: 1. It was stipulated when you were granted a lot split in 19�6 that a paved driveway be installed to the new 9ara9e• This stipulation has yet to be camplete�3. In addition, the yard has not yet been saiaed and tree trunks and branches have not been rar�oved trcm the site. I understand that there m�y have been sane extenuating ci�ianstances for this to have occurred, haaever, your quick action to correct this situation would be a great imprwement for yaur propertY and the entire carnauiity as well. An inspection will be conducted on or about Ma.y 14, 1987 to determine ca�liance. If you have any questians or concerns, please feel free to contact me at the Fridley Civic Center, 5'/1-3450. S' erely, 1 ��1, Daxyl P2anning Assistant � , i. C 8%-�1. _ _' �.pl �I �I i�NF FIV LJLGI CIVIC CENTER • 6431 UNIVERSITY AVE. IV.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450 October 14, 1988 Terry Barret 1463 Windemere Circle West N.E. � Fridley, 1�T 55432 RE: Performance Bond for 6576 Anoka Street N.E. Dear Mr. Barret: Chief Building Official, Darrel Clark, inspected the above referenced property for compliance to the City Code. Apparently, a personal check was issued for comgleting outside improvements at the site. The improvements have been completed, therefore, the check is being released. Thank you for your cooperation. Sincererly, Kathlyn Castle Planning Assistant KC/dn C-88-513 � .� _. SUBJECI City of Fridley AT TNE TOP OF THE TWINS g � I L D I N G P E R M I T r � . � � � ; y__.��_ COMMUNITY DEVEIOPMENT DIV. r � � PAOTECTIVE INSPECTION SEC. � � � � �"'1 � CIFY NALL fRIOLE� SS�J2 NUMBEfi AEv �""�� �'� 612--571-3450 9t0-F15 JOB ADORESS 6576 Anoka Street NE t LEGA� LOT NO. BLOCK TRACT Op ADDITION oesca. 4, Pt. 5 4 Oak Grove Addition 2 PROPERTV OWNER MAIL ADDRESS Dale Meyer 3 CONTRACTOR MAII ADORESS Owner 4 AiiCHITECT OR OESIGNER MAIL AODRESS 5 ENGINEER MAtI AOORESS 6 USE OF BUILDING Residential 7 CLASS OF WORK O�TE 9/15/99 ZIP ZIP ZIP v�GE Of / / PERM17 NO. 3022 RECEIPT NO. ��/7� ►PPROVEO 0� SEE ATTACHEO SMEET PNONE 586-6911 PHONE LICENSE NO PHONE LICENSE NO. PHONE IfCENSE NO O NEW ❑ ADDITION O ALTERATION � REPAIR p MOVE O REMOVE 8 DESCRIBE WORK Revlace 6 windows 9 CHANGE OF USE FFiOM STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling. TYPE OF CONST. SEPARATE PERMITS ARE RE�UIREO fOR EIECTRICAL, PLUMBING, MEATING. VENTILATING OR AIR CONOITIONING THIS PERMIT BECOMES NULL AND VOIO IF WORK OFi CONSTRUCTION 20NING AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. Oii If CONSTpUCTION OR WORK IS SUSPENOED OR ABANDONEO FOR A PERIOD OF 120 �AVS AT ANY TIME AfTER WORK IS COMMENCED. NO OWLG. UNI I HEREBY CEFiTIFV TMAT I MAVE READ AND EXAMINEO THIS APPLICA710N ANO KNOW THE SAME TO BE TRUE ANO COfii;ECi. ALL PROVISIONS Of �AWS yq�UAT10N AND ORDINANCES GOVERNING THIS TVPE OF WORK WILI BE COMPLIED WITM WHETMER SPECIFIED MEREIN OFi NOT. TME GRANTING OF A PERMIT ].ZOO OOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEI THE pERMITfEE PROVISIONS OF ANV OTHER STATE OR LOCAI LAW REGUTATING CON- $TRUCTION OR TME PERFORMANCE OF CONSTRUCTION 44.HS PIAN CMECK FE SiGNyupE OF CON'p�f,i0a Op �UiNORrZED �GENT iOAiEr � � �� �o•rE� SO. fT STALLS �ROUP OCCUPANCVLOAp CU FT. OFFSTREET PARKING IGARAGES SUfiTAI( $.60 SAC CMAAGE Fire 8'C $1,20 �►+rS i O R E M� ' �' r �cTE �l NEW`r ] ` ADDN ALTER Effective 5/10/99 [ ] CITY OF FRIDLEY [] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 BUII.DING PERMIT APPLICATION Construction Address: Legal Description: _ a ,�� `�a � �� � � ��,�� � � Owner Name & Address: ? !� Tel. # ��� �� 7 � � Contractor: _ MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: QTHER: Construction Type: Length Length Length Driveway Curb Cut Width Needed: DESCRIPTION OF IMPROVEMENT Width Width Width Height Height H�Ground Sq. Ft. Sq. Ft. Sq. Ft. Estimated Cost: $ I b'' � v Ft. + 6 Ft = Ft x$ _$ DATE: 6� 6� f�- 7 I APPLICANT: Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge I.icense Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY $ �� �~ Fee Schedule on Reverse Side $ f, a C� •001 of Pemut Valuation (1/lOth%) $ . �(� $.50/$1,000 Valuation $ $1050 per SAC Unit $ �5.00 (State Licensed Residential Cor�tractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $_ _ Agreement Necessary [ ] Not Necessary [ ] $ J CITY OF FRIDLEY INSPECT{ON DiV. 6431 University Ave NE Fridiey, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On Jan 1, 2000 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heate� -Electric Water Heater - Gas" Gas Range"'" NO. RATE �_ Gas Dryer"" _ Back Flow Preventer Required ()Yes () No Type _ $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 �V %.�0 $10.00 $10.00 $10.00 TOTAL � JOB ADDRESS Co �? Lo �/� z f� r'� �T lU � The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. �-- /�-/ / c � , 20_ Owner �� /t% J a � � v ° .1� t. /-i J T Building Used As ��' � Estimated Cost J G o� PERMIT NO. ��f��/�� $15.00 PLUMBING Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE SIGNED`B�; � �c . Approved By $ .50 MINIMUM I $ :�2-c .5 � PLUS THE �i . A . �o Fl �i s c: � a. � � �' a�n�ayL/ TEL N0. �� 3"�� 3� Rough-Iri Date Final Date l-� "�-� % COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When re�lacinq 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. The existinq combustion air is sized and installed to meet the cuRent codes and manufacturer's specifications. 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() Yes ( ) No ( ) Yes ( ) No ( ) When installina a new venting svstem, 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 Fumace 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 Tvae 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 : � m rCITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2002 6431 University Ave NE 'hridley, MN 55432 APPUCATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572•3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES ' Co5%'!� f1�VD,e.4 57 NC ; JOB ADDRESS RATESCHEDULE 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% ofValue of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $ �• °O $ 10.00 $ $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTALFEE MINIMUM FEE FOR ANY HEATlNG/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT I� 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. OWNER ���D ���0 BUILDING USED AS 1���//��/�� ESTIMATED COST I1 �7� PERMIT N0. /���� DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units__j__ Circle One (Steam) (Hot Water) ( arm Ai $ Trade Name <�P - 9�l P VSa Size No. �D� f,� BTU HP EDR $ 2S � Fuel N!-}T. �AS Total Connected Load $ $ $ .50 $ SS-� Burner Trade Name Size No. BTU HP ED 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 �tion are true and correct. Home Energy Center 15200 25`h Ave N #128 Plymouth MN 55447 763-476-1990 fax 763-476-1143 DATE � ' �' �� Signed �'�'�� TEL # FAX # ; Approved By_ Rough-In Date 1 � Final Date -/� y�`f � FILL OUT BACK SIDE FOR STACK VERIFICATICN ON REPLACEMENT FURNACE �.,�s, �a I ,' / ' THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED •uu•► ► ► •►► •: �►� •�i: •► ! : : ! �► When r�- I(La -ing an Pxic in� furanrP, the undersigned hereby venfies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. The venting system is plastiGPVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. The PYi� �ng comh�st�on air is sized and installed to meet the current codes and manufacturer's specifications. When required to install a new cemb �� ien air�it will be sized and installed to meet the current codes and manufacturer's specifications. When inc alling a new ventinq cy_etPm, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. 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 ( ) Yes (,�j No ( ) Yes � No ( ) Yes (,� No ( ) Yes (�/j No ( ) Yes (✓j No ( ) Yes (✓j No ( ) •.. .. - .- .�. - .����.. -� .�. -. .��- . . ..��. .. Appliance #1 Type �uR�/AG� BTU Input �,ovv an Assiste r 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 App(iance #3 Vent Connector Height ft Length ft Diameter in Type ' 1 :' •► �- r.- Home Energy Center 15200 25th Ave N #128 Plymouth MN 55447 763-476-1990 fax 763-476-1143 HEATING CO: Signed By: Date : � • � - D-� . �a � I�i �� ���4� RIGHT-J LOAD AND EQUIPMENT SUMMARY Entire House Home Energy Center 15200 25th Avenue North, Plymouth, MN 55447 Phone: 763.476.1990 Fax: 763.476.1143 � • ' • • For: Rondo 6576 Anoka St. NE, Fridley, MN Notes: Desi n Information Weather: Minneapolis-St. Paul, MN, US Winter Design Conditions Summer Design Conditions Outside db fnside db Design TD Heating Summary Building heat loss Ventilafion air Ventilation air I�ss Design heat load Infiltration -22 °F Outside db 70 °F Inside db 92 °F Design TD Daily range Relative humidity Moisture difference 91 75 16 M 50 29 �F �F �F % gr/Ib Sensible Cooling Equipment Load Sizing 41120 Btuh Structure 18331 Btuh 0 cfm Ventilation 0 Btuh 0 Btuh Design temperature swing 3.0 °F 41120 Btuh Use mfg. data n Rate/swing multiplier 0.96 Total sens. equip. load 17598 Btuh Method Simplified Construction quality Average Fireplaces 0 Heating Cooling Area (ftZ) 1224 122�i Volume (ft3) 9792 9792 Air changes/hour 1.0 0.5 Equiv. AVF (cfm) 164 82 Heating Equipment Summary Make Trade Efficiency Heating inpu; Heating output. Heating temp rise Actual heating fan Heating air flow factor Space thermostat 80.0 AFUE 0 Btuh 0 Btuh 0 °F 980 cfm 0.024 cfm/Btuh Latent Cooling Equipment Load Sizing Internal gains Ventilation Infiltration Total latent equip. load Total equipment load 1380 Btuh 0 Btuh 1595 Btuh 2975 Btuh 20572 Btuh Cooling Equipment Summary Make Trade Efficiency 0.0 EER Sensible cc�o[ing 0 Btuh Latent cooling 0 Btuh Total cooling 0 Btuh Actual cooling fan 980 cfm Cooling air flow factor 0.053 cfm/Btuh Load sensible heat ratio 86 % Printout certified by ACCA to meet all requirements of Manual J 7th Ed. ,�, wr�ghtsoft Right-Suite ResidentialT"" 5.0.28 RSR20001 2003-Aug-06 1428:17 AC� C:\WrightsoR HVAC12003�AABasicLoad.rsr Page 1 RIGHT-J WORKSHEET Entire House Home Energy Center 75200 25th Avenue North, Plymouth, MN 55447 Phone: 763.476.1990 Fax: 763.476.1143 �MANUAL J: 7th Ed. Name of room Entire House Rondo � 2 � Length of exposed wall � 140.0 ft � 140.0 ft � � � 3 Room dimensions 36.0 x 34.0 ft 4 Ceiings Condit.Option 8.0 ft heat/cool d 8.0 ft heaUcool TYPE OF CS HTM Area Load (Btuh) Area Load (Btuh) Area Area EXPOSURE NO. Htg Clg (ft� Htg Clg (ft� Htg Clg Htg Clg Htg Clg 5 Gross a 12C 8.3 1.8 1120 "" "" 1120 Ex osed b 0.0 0.0 0 ***' '*** 0 ( I walPlsand Icl O.OI O.OI pl .... I.... I �I .... I.... I I.... I,... I I ... I.... I � � partitions � d � � 0.0 � 0.0 � 0 � "" �"" � 0 � *"` �"" � I"'." �.." � � � � e 0.0 0.0 0 ..., .... � ,... .... .... ,�., .... .... f 0.0 0.0 0 ...< .... p .... .... .... .,,,. .,., ,... 6 Windows and a 2A 43.7 "* 162 7079 **** 162 7079 *"' ""�` ""� glass doors b 0.0 ** 0 0 "" 0 0 I I Heating I c I I 0.0 I" I o I o �.~. I o I o �,". I I I"" I I I�" I I I I dl I o.ol �• I ol ol •_•% I ol ol ""� I I I"" I I I•"' I e o.o •• o o~" o o`•" "" "" f 0.0 .. � �.... 0 0.... ,x.. .... 7 Windows and North 0.0 0 ""' 0 0'*" 0 "" �"" glass doors NE/NW 0.0 0 "" 0 0 "*' 0 � � Cooling � E/W � 52.8 � 120 �""" � 6336 � 120 �"" � 6336 � � '** � � �'"'�� � � SE/SW 0.0 0I "" 0 0 "" 0 I I I South I 44.8 I 42 J'*" 1882I 42 I"" 1882I I�"" I I I'"`�� I Horz 0.0 0 "** 0 0 "" 0 '_" `�"� 8 Other doors a 10F 29.4 6.3 42 1236 263 42 1236 263 b 0.0 0.0 0 0 0 0 0 0 c 0.0 0.0 0 0 0 0 0 0 9 Net a 12C 8.3 1.8 916 7584 1616 916 7584 1616 I I exposed I b I I o.o I o.o I o I o I o I o I o I o I I I I I I I walls and c 0.0 0.0 0I 0 0 0 0 0 I I partitions I d I I G.0 I O.O I 0! O I p I o 0 I 0 I I I I I I I I I el I o.ol o.ol ol ol ol ol ol ol I I I I I I f o.o o.o 0 0 0 0 0 0 10 Ceili�gs a 16D 4.9 2.1 1224 5968 2595 1224 5968 2595 I I I bl I o.ol o.ol ol ol ol ol ol ol I I I I I I I I Icl I o.ol o.o oI ol ol ol ol ol I I I I I I d 0.0 0.0 0 0 0 0 0 0 I I I el I o.ol o.ol ol ol ol ol ol ol I I I I I I f 0.0 0.0 0 0 0 0 0 0 11 Floors a 21A 2.2 0.0 1224 2703 0 1224 2703 0 I I(Note: room I bl I o.ol o.ol ol ol ol ol ol ol I I I I I I I I isedi P�ter I c I I O.O I O.O I 0 O I O I O I O I O I I I I I I I d 0.0 0.0 0 0 0 0 0 0 � � forslab �e� � 0.0� 0.0� 0� 0� 0� 0� 0� 0� � � � � � � floors) f 0.0 0.0 0 0 0 0 0 0 12 Infiltration a 81.1 7.1 204 16549 1439 204 16549 1439 13 Subtotal loss=6+g +11+12 '*'* 41120 ***` *'*' 41120 *'*` ""`* m�` I I Less extemal heating �;;;; I o I•*'• I•"` I o I"'*• I"" I I*`"' I"*' I I*'� I � � Less transfer ���� ,,,, 14 DuCt loss po� � .... �o� Q .... o� . .... �� .... 15 Total loss = 13+14 '**' 41120 **** **" 41120 "'* *"' '�"' i6l int. gains: People cLD 300 6 ""* 1800 6 "" 1800 "" �� Appl. � 1200 2 "'"* 2400 2 "" 2400 "'« � � 17 � Subtot RSH gain=7+g„+�Z+16 �"`*' �"'" � 18331 �"" �*"' � 18331 �*'"`* �"" � �`�" ��"" � � Less extemal coolin "" ""` 0="' `*"* p I I Less transfer 9 I..,. I,.,. I D I .,,,. I.... I � I ,.. I.... I I.... I.... I I� a I Duct gain I o�id "" I o I o°id •*•' I o I °id •"' I I °id "" I I � 19 � Total RSH gain=(17+18)'PLF � 1.00 �*"' � 18331 � 1.00 �""' � 1 8 3 3 1 � �`*"" � � ��"` � � I 20I Air required (cfm) I""' I 98� I 980I `"`• I 98� I 98� I`••• I I �"'• � � � Printout certified by ACCA to meet all requirements of Manual J 7th Ed. ,� wr�ghtso%t Right-Suite ResidentialT" 5.0.28 RSR20001 2003Aug-06 14:28:17 ACCR C:\WrighlsoR HVAC�20031AABasicLoad.rsr Page 1 - _ C! l l Ol FR[DLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 March 23, 2004 Mr_ David Rnndn HOUSE HEATING TEST RECORD /�s� �� ADDRESS ���G `'Na�A ST �� APT. FLOOR CITY ���� L�� OCCUPANT OWNER ���0 HEAT LOSS DATE HTG. INST. SOLD BY HOME ENERGY CENTER INSTALLED BY HOME ENERGY CENTER Electrical Work By HARRISON ELECTRIC Gas Line By TYPE OF HEAT GA FA X HW STEAM SPACE HTR. UNIT HTR. bTHER MAKE � � � Model � �'1 Serial �-- � INPUT THERMOSTAT � He t ug _ Valve __T Limit Limit Setting Fan Setting Pilot Type Pilot Make Pilot Model Pilot Timing L.W. Cut Off Pressure 3• 9 Percent CO2 Input CFH S� Percent 02_ Stack Temp. Percent CO . Form 235 Builc� Inspector DJ/mh MAKE OF BURNER _ Model Max. BTU Rating _ MAKE OF FURNACE Model Vent Size KIND OF LINER SIZE NONE Draft Hood Regulator Filters Size Number Chimney Location Inside Outside Chimney Construction Smoke Bomb Wiring Draft Test Tag Door Pressure Lighting Inst. Date Tested Company Testing HO GY CENTER Name of Tester 0