AF - 37956�����
City of Fridley, Minn.
�
BUILDING PERMIT NA . s 8� 5
Date: ��� �� �
Owaer: Buflder_ !�'� ._.._...._..
Addrea$ Adclress
/ 1
LOCAT,�ON F BUILDING
No. Stseet ..[��"� ���T � P f Lot
� r _ Slock � Addition or Sub-Divisian ����
Cor�ter Lot � Inside Lot � � Setback �._ � __._ Sideyard _ f� � � �
Sewer IIevation �� � • `�' L — I��en IIevation � � � ' � /
'� P ta F�e� ea � t.vc� �
DESCRIPTION OF BUILDING
�e \ � ���- �5 - , � " yJ
;H 1' � _ � Lrr�� . , , i �
y;r�
�,,/��� ' � - i _ _ � - l 1 - :7� ��/�
. � . .f � �. �-'
.�.%- �if . � � � i� ��
1•�i c � � _ -.�i.�
In cons3deration of the issuance 'to me of a Permit to co the bwtlding des d�d above I agree to do
th� proposed work fn acc�ordance with the d+escrlption above fo , and ffi�pj�an�e wlth a'll provisions of
ordinances of the dty oP FricIley. _� /�/i
!�'�
In camsfderatioa of the payment of a fee of $.� , Fe�t is hereb3' granted t°
to construct the building or addition as described above. Thiape rmit is graz►'ted uPon
the exPress c�ndition that the n to whom ft is granted aad his agen'ta, emPloyees and workmen� in all work
doae in, around and upon sai building, or anYpart thereof, si�all conform in all respecta to the orrlinances of
Frldley, Minnesota regar�, g l�ton�naco � cti��al t�� � vio a,tio�n o�f any�of th�e pioviaio s�oE�aeid
within the dty limits and th38 �
ordinana�. � ��
BuildinS Inspector
� NOTIC�
TI� pseedt dea �rot sevsr t6s eee�weHoe, Ie�taUdion !oe �rtriee, plumbtee� 6� b*�e. aw�r er vrdar. B� wre !o a�
tla Boildleg lesp�to� tee aparat� P�rmhs fer fh�» ihms.
"F � .
Qr�Tiu's�s.' S
APPLICATION FOR BU:�.�nTNG PEBMIT
C�'1'Y OF FF.IDLEY, tfi.�IlQES07'A
�
�
ADDP,��S ADDRESS _ �l��' -- C���'�� /��
L�CATION OF B!'�ZDING
No.
� ' � � Street �.� Part of Lot
Lot Block � Addition or Subdivision °Z �'
�_
.�� .� � B
Cnr*r.er Lo�:�Inside Lot 7� Setback �� Side-Yard �' I �l- �,
SBWLR ELEVATIOIQ F�JDATION II,EVATIO'!V
Applicant attach to this foxm Two Certificates of Survey c+f i,ot and proposed build-
ing location dra�aa on thesa, Certi.ficatea .
To be �ged as;
DESCRIPTION OF $VtLDING
� � Depth � � / Hei�h*_ � /
Sq. Ft . ,"„�.s / � Cu . Ft .
�
e.�+��' Front �� � I?epth � � Height `� /
Sq. Ft. �i �"� Cu. Ft.
�jpe of ConsCruct�on � . , ������� EstimaCed Coat � �, .3 �
To be Completed
f
The unders3gned hereby makea application for a permit for the work herein apecified,
agreeing to do all wo�lc ia stsict accordance with the C3ty of Fridley Otdinancea end
s�lfags of the De�axtmPnt of:}}uildinga, and heseby declares that all the facts and
sepresentatioas s�Pted in this application ar�erue and correct.
>,(
�- • " . ���
(�chedule of Fes Costs caa be found on the Reverse Side).
_ � �
�
�..� — _ , . �--,, . ., ,. �
0
c
BUILD7NG PERMIT FEE SCREDULE
Section 2. 'i'he InspecCor of Buildin�e shall, before issuiag any permit ��r
the erection of any building or structure, or for any addition Co any exiet-
ing building or sCructure, or for any alterations or repairs Co any exiating
building or s�ructure, u�on application therefor, require the gayment by the
applicant for such permit of fees te the amount herein below aet forth and
in the manner hereia prov�ided to-wit:
Z.1. For any auch permit for the erection oi any fire-proof building, othe�
than a garage� warehouse, factory or grain elevator, or for the esection of
anq fire-proof add�.ticln, fot� sim�.lar occupancy� to anq existiag building
shall be at the rate of $i.40 for each one thousand cubic feet, or fract�ton
ghereof, ia such cubica]. contente.
2.2. �or aaq such permit for �he erection of anq fire-proof g�arage, warehadse,
factory or grain elevatort or for the erection of aay fire-proof edditiea,
tor similar occupancy,'to a�ny exiating bu�ilding shall be at Che rate of $1.25
for each one thoueand cubic feet, �lgssified as °1fireproof" by Sectfea 502 of
the Minneapolie Buildidg Code.
HOUSES
2.3, For aay sueh permit for the erection of e,ny non-fireproof build3ag ot�es
thaa e garage, warehouae, factorq or gsain elevator, or any aon-fireproof
additioa, for s3milar occupancq, to aay exiatiag buildin� - permit $1.00 for
each one thouae.nd cubic feat. .
GARAGES
2.4�. For aay such permit for the erectioa of any non-f3reproof gara e
w�rehouse, factory or grain elevator, or for the erectioa of aay non-fire�ouf
additi�s, �or s3m�.lgr occupancy, to any esistSng buildiag or for each such
build3ng or addition - niaety ceata ($0.90) for each oae thousand cubic feet
or fraction thereof, in the cubical coateata thereof with a mfnim�tm of $4.OQ.-
For the purpose of computing fees for building permits, the cubical caatents
of aay buildiag or addit9.oa Co a uniform height throughout by multiplyia� the
ground area covered fram a point ais (6) iaches below the floor line of the
baseanent or cellar to the average he3ghC of the upper surface or.to the
average height of the roof sur€ace,_of the maia gable of a p�.tched roof.
2.5. For repairs or alterationa to aa exiating structure, the fee amall be
at �he rate of $3.00 per each Five fluadred Do].lars ($500.00) or frectfoa
thereof in the cost of all progosed work.
2.6. In rio CBSe 8ha11 the fep,.chargwd for anp pes�u�i� as set forth in
Sectian 2 be less than $4_(T0.
a' �: :K-�� /� S � r "�' ^\
� / 1
�'a---i- _•--_-cz.
/
�
lvnd F'lonnmq
Can�i su�vPy;,x�
So�lS Tesirn9
Gwl fr tilunu�pal
En�►rrePrvn�
6875 N�hwoy �GS kE.
�1��ni�ev�w/s 2/,
ENGINEERING, INC. ����nx��a
-- En9ineers
su„�f 4-svr�
� Su� vec�ors —
cesti��cate o� s�t,t�►e �o.t - E�. r� DEYELOPMF�iT C0.
�
d
� � ��� �
��
�d8�`. �
�'
a
O DENOTES IRON
\
� t��l
\ � ..� �.
� �� �
A�
� UENOTE 5
NoTE :-
1. Elt�o'�ions 56own ar¢ Propos¢d
Cirs+ tleor sl. 2.5 $�. e6.v� grwnd
e heus¢ co�n¢rs .
O�ei�� c�t f.�/"'�ff.se!':e�` `L�' /,�oefs2
c�r.r��r"f _B&/.S
� l e7�0
� � �,� 8��7
pr�
�r`
�
�0 � �
` nfij °.
4���
r `��
�v
��
t
��/ ��� �
DRAINAGE � UTILITy EASEMENT
�
�
LO T � BLO CK � MELODY MANOR 2'''� �DD I T IO�t
��nokaGCoun}� — Mintte�o-irw�
/ hr�by �arfr�iJ �i'eof lhrs fs a Ii-ue anrd c�rrtc� rrPresenfafian o�'a su�wetf {'fl y diov�rdor�es �('�ie aba�e dsu�►6�d /�, ered
�'lle /c�ca�n o�'aU br�ildin9s , ilrrear� , a�id d/ nsib/t axrnvrbmenls , i�'ar�, �ir,rn ar n Js,d /ax/. As surveyed 6t, nt� ffrrs - d�
y(' Ao r r I A.0 /9 62.
SUBURBAN ENG/NEE2/NG, INC.
Lir neers E Surr� rs
r� � , � �° .� s;� �.
5 C A L_ E 1"= 3 O' � t- .� ..+�� �•;� `_
� _ , � ,,--� s ,, �-
�', '
�^�-^ r ��� ----
�
�
�
�����
City of Fridley, irn �.1T° 8'726
BUILDING PERMIT
Date: Maz'ch 22, 1�66
p�r; Chester Terkerw3.ez $„�� J�aa��„�p Rrn$� ��,��.���A�
Address �70 Concerto Curve N. E. Ad� Rte. 2, �n„�; Take� M3nn�sota
1�73-l�579
LOCATION OF BUILDING
No. 7370 g�t Concerto Curve N. E._ Part oP Lot
Lot ��__ Slock 3 Additton or 9ub-Div�efon Me]_O.dg N►a�,�r_ 9nd
Coraer Lot _ Iaside Lot � 3etback Sideyard
8ewer IIevatloa — Foimdation IIevation
�
�� �� DESCRIPTION OF BUILDING � 6� �
To be Used as: one
637� 13 "3�
House �t 40' ��, 34�4" He��t on� sq. Fe. ��272 cu, � 12,720
Att. Gara�e �t 22 � �� 22 � Height �- sn. F'� !� Cu. gt. �s�-0
Type of Constniction F?'�tt�e F•st. Coat �.2Qs��-?- To be Completed 8,�� �.+.� ---
In c�deratlon oP the issuance to me oP a permit to c b crl above I agree to do
th� ProPosed work in accrordance with the descriptton above fo ia piien wlth �pro�vlsions of
ordinances oY the dLy of Frldley °
c �
Ia ca�deratlon of the PaYa►ent of a fee of $ 1$•� � P�t 7e hereby graated to Sea9Y►_o?'e �?°9�.
ConstTUCtion to conatruct the buildfng or additton es deacribed abave. Thispe rmit is granted up�
the exPr�ss condition that thepe�o n to whom it is granted and hfs agents� emPloy�e and worl�aen, 9n all work
done fn, around and upon seid builain8� or enYpart thereof, shall conform fn all respecte to the ordinst►ces oP
Fridley� Minaesota g lacatlon, conatruction, alteration, maintenance, repair and moving oP buildin�e
�� dty► ]imita�3a�thia Permit may be revoked at aTMy tlaae upon vlolat4on oP aay oY the provleions oE eaid
ALIEN G. JEN�IIIT BuilBtag Iaspector
n NOTICB:
'llds p�nnlf doa uot aovu t6� aomtnrad�, ImtaWNon Io� wirle�, plmrtb�o, oa 6aNno, a� er waf�r. d� an to a�
�In duimie0 leqnalse fer a�r�M p�rmh� Ior 1ha� �
•� .. , _
APP`LICATION FOR BUTLDING PERI+'QT
CITY �F FRIDLEY, MINNESOTA -.
OWNER' S NAME �/Y P� i° �,���r •.;; ' "'`C-� �' BUiLD$�� S � - a�le' :.- �- G/ /r
� ic' lT ��
� ,/� . �
ADDRESS ��� �� ( F�,��'��T� �/'!� �- ADDRESS�?�TE �� � . �' e �(d��
L�ATION QF BUIL�ING , -
NO.� ,��� STREET l f��cef�/�T Cb / o��'�J� . PART OF L4T :- '
LOT BLOCK � ADD�TION SUBDI9ISION �L � �,� .�r���'c . ��/�Avrr�c� �
��� � .
C�RNE� LOT�_INSYD� LO'��SBTBAC� � i' �` �s�SID�?�
.
SEWER ELEVATION , . . ; FOUNDAT'lOft ELBDATIQI4 . . .
Applicant atCach to this form Two Certificates of Suiwey of��,ot and propoaed
building location drawn on these Certificates. ' ..
�
. � DESCRIPTIOR OF BOILDiNG _ �
To be use s;��' �... ' 1 .
� / �`> � .� �
�C � i �� � � � Front-���Depth==7`�Aeight � TUr�c' �
Sq. Ft. � Cu. Ft. � .� .
1 ��
C�°�%�I�, � rl�TT�tCr�� F�ont ��- Depth` � Height' /�>� k
Sq. Ft. � � . Cu. Ft. �
� . � �� �
Type of Construction�,��/,��,� Estimated Cost���� Q��
To be completed � �— / — � ,�
— , �.
The unders3�ned herebq`makes application for a permit for the work he�rein
apecified, agreeing to do all work in atrict accordance with the Cit� of
Fridley Ordinances and xulinge'of �he Department of Bui�.dings,, and,hereby
declares that all the facta and representations stated in th�,s application
are true and correct.
. �•
DATE � � �� — (,� � SiGNATITRE e .
(Schedule of Fee Costs can be found on the Reverse Side).
� ��
�
�� _ , �.
�1
- ��
, . . � �
� �
�-��
BIIILDING PERMIT FEE SCHEDULE
SE{.TZON 2. The Inagactor of $uild3ngs shall, before isauiag any permit for
the erection of any building or structure, or for any addition �o aay existing
building or structure, or for any alterationa or repairs to any existing.
building or structure, upon applicatian therefore, require the p�yment by the
applicant for such permit -of feee to the amount herein below set forth and in
the manner herein provided to-wit;
2�1_ For any auch permit for the erection of any fire•proof building,
othei than a garage, warehouse, factory or grain elevator, or for the erection
of any fire-proof addition, for similar occupancy, to any esiating building,
shall be at the.rate of $1.40 for each one thousand cubic feet, or fraction
thereof, in such cubical contents.
2.2 Eor any such permit for the erection of any fire-proof garage,
warehouse, factory or graia elevator, or for the erection of any fire�probf
addition, for similar occupancy, to any existing building sha11 be at the
rate of $1.25 €or each one thousand cubic feet, classified as 10ffreproof"
by Section 502.of the Minneapolis Building Code.
HOIISES
2.3. For any auch permit for the erectioa of any noa-fireproof
building, other than a garage, warehouse, factorq or graia etevator, or
anq non-fireproof addition, for similar occupaacy, to any esisting building -
permit $1.00 for each one thousand cubic feet.
GARAGES
i
�4 `
2.4. For any such permiC for the erection of any non•ffreproof garage,
warehouse, factory or grain elevator, or for the erection of any non-fire•proof
addition, for simflar occupancy, to any egiating buiidiag or for each such
building or.addition - ninety cents ($0.90) for ea.ch one thousand cubic feet
or fraction ttiereof', in the cubical contenta thereof with the miaimum of $4.00.
For the purpose of computing fees for building permita, the cubical contenta
of any building or addition to a uaiform height throughout by multiplying the
ground area covered from a point six (6� inches below the floor line of the
basement or cellar to the average h��ght of the upper aurface or to the average
height of the roof surface of the main gable of a pitched roaf.
2.5. For repair8 or alterations to an existing structure, the fee shPgl
be at Che rate of $3.00 per each Five Aundred Dollars ($500.00) or fractivn
thereof in the cost of all proposed work.
2.6. . In no case 8ha11 the fee charged for any permit as set forth in
Section 2 be less than $4.00.
STORM REPAIR DAMAGE FEES;
Residential: Estimated Coat of work up to $50f1.!?� - h.5.!?�
Estimated Coat of work over ���:;.:..^:"� -"�•
� �..., , �0
Commercia7.; Estim�.teci�'�at of work, t�� ,. r� ;,;t� ,. ,�' r�
Estimated _�sr of Wd�i�: �i'�1::�� f.,�1iL'�•Uii .�' �IGt!�-J
�� ��! .
� ��
560-3450
�`� o i�'�d��
c� c�
ANOKA COUNTY
6431 UNIVERSITY AVENUE fVE July 12, 1976 FRIDLEY, MINNESOTA 55432
Mr. Chester Perkerwicz
73?0 Concerto Curve N.E.
Fridley, Mn. 55432
Re: Location of Storage Shed
Dear Mr. Perkerwicz:
This letter is to confirm our telephone conversation of July 8, 1976.
On July 7, 1976 we were called to investigate whether your storage shed
was in violation of the City Zoning Code as it relates to setback from
lot lines.
On the 7th we made an inspection to try and determine if the required
side yards were being maintained. As near as we can deterniine, the
bua.lding is far enough off the rear lot line however the northwest
corner is 2'8" from the north property line which does constitute a
zoning code violation as the required distance from the side lot line
is 3 f eet. �
During our July 8, 1976 telephone conversation you were told of the
apparent violation and that you would either have to relocate the building
br help us in determining the lot line more accurately so that a definite
dimension could be made.
In either case you must comply with the side yard clearance by September
15, 1976.
If you have any further questions on this matter, please feel free to
contact me.
5i.ncerely,
DARREi, G. CLARK
Caqnmunity Development Adm.
DGC/mh
��
SuBJECT
City of Fridley
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
� �
� • COMMUNITY DEVELOPMENT DIV.
� ��: ------�
r � � PROTECTIVE INSPECTION SEC.
� �
i..-.� �"' �.� CITY HALL FRIDLE� 55432 NunnBER
Z 612-571-3450 910-F15
JOB ADDRESS '7370 Concerto Curve NE
1 LEGAL LOT NO. BLOCK TRACT OFi ADDITION
DESCR.
REV
2 PROPERTY OWNER MAIL ADDRESS
C�ester Perkerwicz 7370 Concerto Curve NE
3 CONTRACTOR MAILADDRESS
5ame
4 ARCHITECT OR DESIGNER MAIL ADORESS
5 ENGINEER
MAIL ADDRESS
DATE ( PAGE OF
6/2�/93 � �
PERMIT _N_Q�
9
RE�EIP,T 1�40:
����
APPROVED BV
SEE ATTACHED
SHEET
'784-1317
ZIP PHONE LICENSE NO.
ZIP PMONE LICENSE NO.
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Res i�dent%a 1
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroo.f House (22 Squares� Tear,off
9 CHANCiE OF USE FROM
TO
STIPULATIONS Underlayment must comply Fzith the State BUilding Code. Ice and water
protection at eaves and valleys, Provide adequate attic ventilation.
TYPE OF CON57
SEPARATE PERMITS ARE RE�UIqED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, Ofi IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. U�
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1� 18S
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pERM1T FEE
PROVtSIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $29. QO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIGNATURE OF CONiFj(1CTOR OR AUTNORIZEO qGENT IDATEI
�DA Ei
OCCUPANCY GROUP IOCCUPANCYLOAD
SO. fT. CU. FT.
OFFSTREET PARKING
STALLS GAFAGES
SURTAX s 59
$1.19�Fire SC
SAC CHARGE
�i�cliIIY���
TOTALFEE
$30. 78
, LY IDATED THIS IS YOUR PERMIT
� z� �
�
�u+�tz�tt� +x,�,�.,ti
NEW [ ] EffectiVe S/26/93
ADDN [ ] CITY 4F FRIDLEY �� �
ALTER j] SIN(�LE FAMILY AND DUPLEI�ES R-1 AND R-2
Bailding Pennit Application
Constivction Address: ����� �J (' �T D (' c,c, �2 U �_ f',2 / � � M ,c�
I��r_
Lega! i�scription:
�arner Name & Address: � r TF _��� ,� �j= �2. �/ i c°Z ° s a,� �� s �� p �/ t_ Tel. #�' � f 3 � 7
Coutractor: � u} N i= rZ - MN LICENSE #
Addr�s: Tel. #
Attach to this application, a Certificate of Survey of the
lut, witbt the praposed construction draw�t on it to sca%.
DESCRII'TION OF IMPROV�
LiVING AREA: Ix,ngth �Vidth Heighi
(i�ARAGE AREA: Length �V'�h Heig�t
DECK AREA: irength Width Hgt/C�rc�ad
OTHER: /v��J i� � m���- S' o�' F � T o�� �--SP' �
Sq. F�
�. Ft
�. Ft.
�
Cornea.' Lot [ J I�nside Lot � Ft. Yd S�ck ` Sic�e Y�rd Se�acks �'�
1�rpe of Constivction:��,,,..✓ 6,� � o� Esdma%d C�t: $ -�O, °�
Approx. Co�lerion Date: // ��
. - (Cost � Back)
Driveway Cucb Cut Width N��: T�t. + 6 Ft = Ft x$ _$
nA�: �� 2 9� 9 3 ArP�cArr�r: ��� 7E 2��. ,e�r- ,� U/ , e. � Te�. �
� � ;��� ���
CITY�jSE ONLY
Permit F�
Fire Surcharge
State Si�rcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Conirol
Park Fee
Sevve�' Main C6arge
ToT�.
� � , ao
� / ��
� , �,.�
$
$
$
$
$
�
��.�b•�
Fee Sct�lule on Reverse Side
.001 of Permit Yaluation (1/lt��)
$.50/$1,000 valuatioa
$750 pex SAC Unit
$5.00 (State Licensed Reside�ial Contractors}
Alt. °A" or Alt. "B" Abo�►e
Conservatian Plan Revie�v $450.�
Fee l�ermined by Engiaeering
Agreement N�ry [ 1 Not Necessary [ l
- -- �
s�ru�►�oNS: �
�� � -
BUII,DING PERNIIT FEE SCHEDULE
'The Chief Building Official shall, before issuing pe�mit� for the erection of any building or structure,
or for any addition to any existing building or structare, or for auy alte�raarion or repair to any existing
building or sttucture, upon application theiefore, require the pay�nent by the applicant for such permit
of fees to the amount herein t�low set forth and in the manner herein provided to-wit
TOTAL VALUE
$1 to $S00
$501 to �$Z,000
$2,001 to $25,000
$25;001 to $50,�0 '
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,�0 .
$1,OQ(1,001 and up
��y
$15 (Minimum Fee is $15 plus surcharge)
$15 for first $500 plus $2 for each additional $100 or
fraction thereof, to and including $2,OOU
$45 for first $2,000 plus $9 for each additional $1;000
or fraction thereof, to and including $25,000
$252 �for first $25,(Xl0 p��as $6.50 far each additional $1,000
or fraction thereof, to. and iacluding $50,000 -
$414.50 for first $SO,OOU plus $4.50 for each additional
$1,000 or fract�on thereof, to and including $100,OQ0
$639.50 for fi�rst $100,00U plus $3.50 for each additional
$1,000 or fiaction thereof, to and including �$500,000
$2039.50 for the first $500,000 pins $3 for each additional
$1,000 or fraclYOn thereof, to and including $1,OQ0,0(�
$3539.50 for the first $1,�,000 plus $2 for e�ach additional
$1,000 or fraction �thereof -
DRIVEWAY DEPRESSION ESCROW
{Concrete G�rb Sireets Only)
Alternate "A" : Removal and replacemert of c�n�b and gutter only - Driveway width plus 6 feet times
$13.50.
Alternate "B": Removal and replaceme� of c�rb 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 minimum 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 once it has it has been
constcucted will be required l�fore proc.eeding with the framing.
- _ ��
�
� D^`' m'^ C'^
� 1
� V/ v'
o � ,�
�
rn
� � � m
. � O �
N � z �
O� t�n O
3
A
o � m --��
3 � � �
a� ° iv rn
o m °o �
� -a = �
c� � � n
v n. �
O j'
� N m
O m •
� �
m �'
� Q
�
�
0
�
� �
v �
m o �
� ci �
(D
� � Q
�� �
°m�
� T
�
� �
�
� �
� �
rri �
37 !
�
Ci o
-D_-i m
O
z
�
Z
il
�
a�
v
a:
�
�'
. �
Z
�
� L
-<
Z �2
v
� �
zZ
Z n --� Cn
� � D �
r �
Z �
r
�
� � m �-
� �
� z �
� � .
� �
�n =
m
Q �
� Z
� �
�
�
O� `
(V
�
�
,�
�
0
�� �
I� �
�
m
�
m
z
3
_m
v.
�
O �
�
z � �
�.� � Z
���m�
v
���
� n
0
N 3
\ �
o �
� �
�
� Q
o �
� 1
� �
c�
�
0
0
�
�•D
�
O O 1
� (D �
w � °-
� �� ��,,�0
v �
O � (Q
D N
� ¢° D
� � _
o � •�
m �+
o ~'. vfD,
� o
� �
o �'
��
-�-�1
0
Z
D
n
�
�
. �
�
t� <�
C � 1 . Z
� �, o
— m 0
zz
� � � �
�� � �
c�
� c
7
�
�
_
o � n
m n
O �
� �
� �
m
� �
Q �
(n p1
� m 3
C� � O = .
�o - �,
J. .
� � ;: :
m
�
D
�
� .
�
�
�
O
�
i►%
N
v
W
�
�
w
N
�
N
�
(�
<D
G� D � �
¢i p � fn
� � � n fD
Q. � � � �
S �
Z��`—°
� � A�
Q I 7 �
n. ?� � v
� � d ~
� �
m � �D �
� �
c � o0
�
� �.
v '
r� cfl rfl cfl
o .o o � �
� � °o o° �'
m
� � � �
� O
Q D
G r
�
�
�
v
c�
0
'--�
�
•
�
�
�
m
�
�
�
z
o.
;�
�.
�
�
6
Z
�
c
�
m
v
�
5
0
�
� � � �
��p � A �
N N � C
� � �
� O � �
��
� � � �
fA C• � Q.
m fl; � S
m � o �
a: o a- a
� � o�
� � � �
N o
� � o �
v � � N
� � �
o, � .� �.
n
� m � �
�' � c�i �
� A
C A � O
� � � �
' � � � �
�-
o.n�, � �
�a� �o
s m �r
m n �
n '� O
•�►j (7 7'�'
� � �
� � � m
� � N �
> >
a
n
m
�
c�
2
m
�
C
m
�
�
�
�
m
�
�
�
J
�
�
�
�
�
�
�
V � � �
N Q � ��
w� ? O
� Z � �
�
�� v
N < �
� Z
rn �
m
C)
�
Z
v
<
��
'm77 �
� �.
� n -
� �.
-� O �
O Z
z
D �
Z �
v. �
D
��
Z �
� �
_t ..�L
z ��n
z�
�
cn v
��
�.z �
��
v�
�o
n C
z
� �
m .
Z
D
Z
�
�
O
�
�
C
N
`�
�
�
�
` CHIlVIlYEY AND STACS VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. . I3as 1�een carefully examined
2o Is free from n�st or deterior�ion
�3.
4e
Has no foreign object� lqdged within
Is securely supported
5. 1Vleets all current Code requirements for size �
and total BTU's connect�d _
6 �Ias total heating B1'U's of �Q (� ,��
All other BTU's � o �� �
TOTAL BTU's (� d� B� v
7. �Ias a liner been provided _ for water heater �.
8e Has combustion air becn provided for water heater
Remarkse .
Yes (� No ( )
Yes (X) � No ( �
Yes �) No ( )
Yes ( � No ( )
Y�s (� I�Io ( )
Yes (� No ( ).
Yes .(� No ( )
. r�.,
List ALTERATIONS Being Done: � � �° �.. �
. `. .
- � ;,;
� �r: .
��..� ; ;
B4P►INE HTG. A�'C ELECT., INC. ,��..`
� % 13562 CENTRAL AVE. N.E. ,
HEEITING CO: I/ �� ANOItA, M�� .
Signed By: r"""` v!' °'�%`r„v"�
Date: I 0 ''��j '�l �
--�
�
HEATING
AIR CONDITIONING
AND ELECTRIC. INC.
�2L�
� HOUSE HEATING TEST RECORD
ne�r�ss �3�� �poc�l�� C �rvi,
OCCUPANT l° 1� L� 4� o t% Z
HEAT LOSS DATE HTG. pVST. �`2 3'�'i �'i
SOLD BY R ��A S.
Elecvfcal Work By i3 ;n e
TYPE OF HEAT GA FA�O HW STEAM SPACE HTR.
('� GAS QESIt?N
AAAKE 1J�P @�7'�
,i�e�e, �3� t9�►�► g�b � _
se�a� �o � o �'GS�' -
��
INPUT - GQ.D00
CONTROLS
THERMOSTAT � Heat Plua
Value 1� �i M Q sp
Umit ' � °�
Limit Settlr�a � � 9
Fan Settlna °�' � h e
PitotType �o i S�� .
P�ot Malce r y,w r
Pilot AAodel � �y
Pilot TfmUm �'� e `'
L.W. Cut Off
Preaswe �s • Percent COa
Input CFH Percent OZ b
Steck TemP• 3 7� Peraent CO �
APT. FLOOR CITY �'J�� SUBURB
OWfVER
INSTALLED BY ,�7 � 4 � � �
Gas Lfrre By 's t
UNR HTR. OTHER
CONVERSION
�/ � ` ,
ven� stze -- - — - — —
KMD OF LINER � Q SIZE � NONE
� � -� Reguleror
Fllters Size I �X]8'�e) Number
Chimney Locadon Inside °� Outside
Chimney Construction .i�
Smoke Bomb Wiring �
� Test Tag
Door P��+►e Lightirre Inat
o� T��d 6-% 3-°s fr
Company Testlna _ /e:4 �
Neme of T�ter �
Pressure Percent CO2
Input CFH � Percent Oa
Stacic Temp. Percent CO