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AF - 40229City of Fridley, Minn.. 6431 University Ave. 1�. E., Minneapolis, Minn. 55432 BUILDING PERMIT aate: A�� * 2s,�] sz� p��; __ Ha.rland Berry g�� Same Address —�29 H� kC o� Drive N_E. Ad� S mP 784-2879 � • ��r : � � LOCATIOiV OF BUILDING No. 6931_� g.�t East River Road N.E. p� �g �� Lot ._._.._ 4._.._.__ Block 4' __.__.__ Addition or Sub-Division Ostmants 3rd Addit�Lon Corner Lot ___.�____ Inside Lot _..._ X Setback Sideyard $��b�/ne�a�o� __s3.Q.93._.. .� �bvbd�/�:tbb��d� ����-��s�X. �Tve H Top of Footing , DESCRIPTION OF BUILDING To be Used as: Dwelling __ Front 41 � Depth 25 � Height 20' gq, �, 1025' �,yi, �, 7680' �=a7C8ge Froni �_ Depth � Hei�ht ��. Sq. F'� ..525 � Cu. Ft ] R 7 5 Ty►pe of Constructfion Wnnd gram - �, Cost .` �.� 2�.�,f35 To be Completed 1��v Stipulation: Pxovide a hard surface driveway. Provide a verifying survey before capping. WATER L(1CATION: 10� South of Sewer Service SEW$R LOCATION: 43' South of Manhole In consideration of the issuance to me of a permit ta c � proposed work in accordarice with the description above Ordinancea of the dty of Fridley. t �� } e building descn'bed above I agree tp do and in co�plian�vlth a'11 prov3sions oE In con�ideration of the payment of a fee of $�e� , permit is hereby granted to construct the building or addition as described above. This permit 3s granted upon the express condition that the person to whom it is granted and his agents, employees and worl�nen, in sII Work done in, around and upon said building, or any part thereof, shall conform in all respects •to the orclinanC� oP ls'ridley, Minnesota. regarding location, construction, alteration, maintenance, repaiT and moving of btlildiIIge Withiu the city limits and this permit may be revoked at any time upon violation oE any of the provisions of �id ordinances. a CLARENCE BELIS • NOTICE: This permif does not eove� the eonstruetion, installafton for wtring, plum6ing, gas 6eating, sewer or water. Be sure io tas ths Building InspeeFar for aeparate permits for theae hems. s �� '�—___ AP.PLICA�ION �OR RESIDENTIAL, A�T�RATION, OR Allll�TION BUILD�NG P�RMIT CITY OF FR�D�EY, MINN�SOTA � �p�� ��'�� O � �,• � � r� �s. " ��' .i ii. �- , � � . . . � '% � f � ' , ` • 1 1 . . � • • r i i ' 1 / c / / �Q : • l I ►S �'� .� : L�Q.$ T �/ � �°� ,(�^ A /'l /Y s.�.� I� ; � BLOCK ° � ADDITION t� //� �'[��7 �» � h :s � �` � . . � � � � �• �1 A�R�R �1 CORNER LOT : INS IDE LOT : /\ SETBACR: SIDEXA�tp g,� -�--- ppp�.i.caat attach to thia form Z�o Certificates of Survey of Lot aad pxop��e+d building location drawa on these Certificates. HESCRIPTION OF BUILDING To Be Used As: . ��lRd����h g Front: � Depth: ��i�tl� Height: `=�T :.' _ , �� , Square Feet: �6�=- Cubic Feet: `7,68'c� � � a �. �� ��g�� ' Front:_ �a ` Depth: a� � Height: ' �,. " ��s �wa m Square Feet; �,r�'- �-� Cubic Feet: �-�-� �T' T� '�, ` .� m:.�.. � '�rpe of Construction: ��`y, � Eatimsted Coet: $ .�,���oo To Be Comnpleted: /973 '� r� � ..� . The undersigned hereby makes applicati�n for a perpdt for tt+,e .w�7c1� ��7���p $pec�f�,ed, agreeing to do all work in sttict accordaaca with the G��r�p� F��d�ej► Osdinaacee and sulis�ge of the Department of Buildiags, aad '�e��bT d�+cla�es that all the facte aad representationa stated ia thie ap���,e���,� s�re t�cue and correct. � �1TF : � oz 3 (See �tever�e Side For AdditionaY Information.) I' •I�..,, p, ( i . , � � ' � ' ' � i� �(,.% G I; � � U Qa /• ; `! � (,J I � �,< . � �_ , * $UILDI�G PERMIT FEE SCHEDULE S�CTION 2. The Inspector of Buildings ehall, before issuiag penait� for the exectioa of aay building or structure, or for any addition �o any exist�n$ buildin� or structure, or for any alteration or repairs to aay exiating bui,lding or structure, upon application therefore, require the payme�t by �h� applicant for such permit of fees to the amouat herein below set fo7rt13 and i.r► the manner herein prwided to-wit: UIVIFORM BUILDING CODE: �pe 1, 2& 4-$2.15 for each one thousand cubi.c �e,�t, ox fraction thereof, in such cubical contents. 1jTpe 3� 5-$�.$5 f4r each one thousand cubic feet. ADDITIONAL INFORMATION Far the purpoae of computing fees for building permits, the cubical contents of any building or additioa, ie determined by multiplying the ground area covered from a point aix (6) inches below the floor line of the baseaeent � o= the cellar to the average heights of the upper aurface or to the average� � height of the roof aurface of the mein gable of a pitched roof. For repairs or alterations to an existing structure, the fee ahall be at the rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost of all propoeed work. T.r► ao case ahall the fee charged for aay permit as set forth in Sec�iQ� � b4� lese than $5.00. VFRIFICATION OF FOUNDATION 1�pT�; Permits for eonstruction will be issued a mini�um of 24 hours fYOwR Ghs �ime of applicatioa, to allow for proper review of the proposed structu�e aad of the construction eite. �1 Ce7ctified Survey of the lot, ehawiag the location of the foundat�,pt�A q�t�� �,� hga been constructed, will be required befo�e proceeding with the f;am�ng• CERTIFICATE OF OCCUPANCY Applicatioa for a Certificate.of Occupaacy ahall be made ten (10) days px�,AL �� the use or occupancy of any atructure for which a buildi�g pesmit �as b�sA iseued; and said atructure ahall not be used or occup3ed until a Certific$t� o� Occupancy has beea isaued. . . t . - � . • . _ _ E�LCP��6" � , CU`��'�f1��3�.� ���� '; � ! ��t� �;r ��� � � _ f, . � � e � • � � :.d � ! � tl 6 �d3 � a.A a.A � � � � i Cm �.d q � � � o' •,.'�� �' ..1 '�•� fi� , ��, F 44 INDUSTRIAL JOHN A. PETERSON FRANK R. LENZ, .JR. �� �;�_ .'Q�?Tr�"'��. �` ''' . s.: eusiwess LANG SURVEYORS ` 1pqaM 5uctvEVS 't � CITY �oiS . REGISTERED UNDER LAWS OF STATE OF MINNESOTA '���AK�sttoRE��' TOPOGqAPHIC MAPPING LICENSED BY ORDINANGES OF CITY OF MINNEAPOUS �? � ��7UDICtAL ��. 3300 LYNDALE AVE. SO, MINNEAPOLIS, MINN. 55408 � t>; ` 824-0370 - �- _"+ � �utbcpor'� f�ertiftc�ic _ . � ,� ' �� \ '.� �� � � �� : J ` - , 1 . ` �� � , �� ,� �"1�' s' 6� �` z6s`� � f; s : d ., . � 6 � � - � �/ �k� a`\ ��` eo�� 'rJG�.�..� �`� _.3t9s } 3 �.� i 3'� fe.. �` � ry . `� , �'�i' �S o \, �� , , _ � � � q s � �� � � p d` � �y'� �• . � � �`a°o ' - , - � �c � '� � N � � j ' � `_ �.,/�� � °�.. �k,8 �� �. ,r - f i: 6� 1 C!s �� �+, i � �� � � �, � h �a , ���,..�° � s - J, JO�'��_p) � . . . � � � I ' ,� , � ��' �.f � � �` ��' - '; � \ � �O � . ' /' fe�� ' F;R 1 � 10� , 18 (i/ ti , ,/ d � Jt , '�. ° . � 1►-� / "" � i' /�� E` . .,;; � � � `�, , �, �, ,��r��'. - , N �S : ��o�. .� `/ j� S�;' . � f2� Q � e '�G,`�� _ i • +-° �- �g . �'�' . m ° � _ � n . �,., ti . � �, � ° �,�`,����4� �� �s ,a s3� > �� , ��( . - �o Cy ,�� `O f ..�' J `v - ` r n � o � s ' . �':r,-- _ _' S u � ' � � � � � ��. � �i _ ` � /�' � - � �P . . � �\�' �� .. . - ' � r� Y �'�a � ' � ,�ti / - . f�` /0�� - . � . ��i � I hereby certify that this is a true and correct plat of a�urvey bf: ' �` �r Lot 4, Block 4, OSTMAN'S THIRD ADDITION, Anoka County, Minra�sota, subjeCt to '� � easements and restrictions o£ record, i£ any; that the buil�ing is enti�ely wi,thin� - said'property and there are no visible encxoachments onto o� from adjoining properties - other than as shown. . - � �:A ', .. - . ' ` �+ - ' ' . � .,�' . 4; � g hereby certify that this surve�9 Plaa, �� ' �� - � ' : . a. •'� ; report was prepared b� me or u3ider rn� ;� �, . direct aupervision �.nd th�t I am a dul� - � �" Re�istered Land Surve�ror under tli� Ia�c�->�� ?�� '` �, tr ,; - ' a , °' � the �ate f B� e�o . � , - . .. • � .�f� o .. . "i-� . .. �� } , j � F ���:6 � l r.� r @g . �O o � ?;� - 889 � --L� UD ����'Y 5.3//l � -- _ _- - -- -- -- --- — - --- _. __ _ ---- , _ a,.. - ,.,: -a-=- .�-,�, --- — —:�., ' • INDU87RUL • 4 � C O U L T E R • BUSiNE58 + C • 1� • v '�� CITYLOTS. LAhD SURVEYOR � TOPOORwrr�c wwppina REGISTERED UhDER LAWS CF STATE OF MIhtVE50TA w ' LiCEKSED BY OR�iNANOE OF CtTY OF M(NNEAPOLIS 3300 L.YNOALE AVE. 50. MINNEAPOLIS 8, tv11N(V. � ' TAYLOR 4-0370 � . . �, !v / /. � �urnr�nr�Y C�Fi1lfltcTlF ' J\ � ' � � / . � r� Y. `_ ��' . �� . .� , J� •..l s� / �R -y - . - . .V �r ��., , ., , ,�� . � � •� �., �. "��� '�� ,. ., .,.. A L E : "= 3;:.' ` h � h� : � "° � � � � ~ ` PLATTING FARM SURVEYS LAKESHORg JUDICIAI � �--, ` � / � �" ��J ° X, �. / � . �, . . ' T,- // � ,�°� a -L :� , .� � � � , y�,� � � /�'CN �� � \ � / � � ` / l . ' � / �� / � lY / � / .. — �y � �'t/ . i Qp '�1� l'� `` r � / A// a� � �''R �` 3/ .', � �S j � `'-', �o'� ��� �� ,� ��, _ ..., , , u. � ':: _. ` 5 � -� ��A� �Z � / YG/V � � ���,, � r/ ' . � � � � � -�- , . L J / _7' �.P / �� � , ,�, �� �J � ' , ' �. . , �. .� . _ ,�v�'�fi , 1�'nr` /% I� . ,/ � �a/ / r/ I hereuy certi;y that t:�e ai�ove is a true ana correct pla� ci a surv�y cf; Lot Four (4) , 31ock Four (4} , OS^I�,AN'S T';IRD �':DDI'�IO2], A;,oYa Caur.ty, ;•I?_�:i:; .;�,; . As surveyed by m� tnis 30th. dai� af :•iarc:i 1�55 �. D, � . ..° � , !,-o Signed _ , _' ' I - NIlIlI�°SGt•: .':i,<;i:;tr���ion .•"-- . _. � .,, �����, . J . ° e ^a P . 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"�`,">k' 9A:. 9f+ ..� K, �,, : � � � � � � �► � � � ����'`� � � �' � � . s �� � � a . �� .. � � � � ���� �� •H � � � � : •!� � • � � * � �(p N r e r • � �CF • e • � e �jU � s 1 r �i � t • �h-� � � � � � � � a , � ��--� �i r • . o v . • • • • s • • r � r �s • . . . . . . . . •p,� � . . . , � ., o a• . �fA � � • • • � • .r • s • • • • � • � o • � ��-i • r e e • • • . � � � � • .� • � e • e • • • � • f • • � • 0 • •� � � � f • • • • • • � •�- • f • � . � � M � M � M a M M � M a eo M �; ; ��i���������� �, � « � �� �r � s • {•� � � O O O �i � rr , � � � � : � ' � �a � �• y r � � , • e � � , �. �� � r 0 � � r ' � � � T � � � o • n � a � ��� � � � Q � � � � � � ��� � � �, , � � �� a �' % o � � ��g� o� � � � � � , �. .. � � . � ��� � - ���� � � � � �� ��� � , ; �� � W � � E �� � �� ��� �� � � a � � ; �� � M1, �� A � � � � � � � � � � � � � . ' .� � � � � � s �� � � O� � W � � � � � � 0 � �. � � � w i � �n � � V \J-1 � � HOUSE HEATING TEST RECORD 6931 E. River Road NE. Fridle�r )RESS APT. FLOOR CITY SUBURB ,:tJPANT �e Hammerstrom ONMER :AT LOSS DATE HTG. INST. s�LD BY �-�egasCO INSTALLED BY � � � � � � � � �. � Electrical Work By Gas Line By � / � � � � � `�� TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER fire�alace GAS DESIGPt CONVERSION MAKE Temco MAKE OF BURNER Modet FP-2035-2 FPBlt-1 blower Model Serial 7� �� �% 1- J Max. BTU Rating INPUT �,� �'� � � �-�'� MAKE OF FURNACE Model CONTROLS THERAAOSTAT� Heat Plug Valve � �• �'� � �� � Limit — Limit Sstting Fan Setting — Pilot Type �° � � � P `' a � �� P�ilot Make —� � Pilot Model y � � Pilot Timing � ✓� s �' � La.W. Cut Off Prassure �" � PereentCO� Input CFH %�l'� Percent OZ Staek Temp. Percent CO Form 235 Vsnt Size � `' KIND OF LINER / SIZF NONE G%� Draft Hood ���/ � /� Regularor Fi Iters Size Number Chimney Loeation Inside�_Outside � �, Chimnsy Constwdion e' � . � ' � �_� 4� � Smoke Bomb Draft Wiring _ Test Tag Door Pressure Lighting Inst. Date Tested �� ° a � ° � �' Company Testing "� d' �� ° R' � �- Name of Taster � � �' �� , � �� ro :_� —. - � ,: _: . _ : �, : . __ + ..__. __ _.: � . : - ° _ ..,_ � � • N � ,. � 0." � � � `� M mr' � w x � F �' �� x R E � n � c. �._f.� b Y 'aw0 ' o .,,� G) �= n ^ � M � � ' � ' � � � y ft "1 ti p ie ��i,. � �..i'.. � C � M �D �. �.Mj r . ? °' � ,�,� t! • y p .� a �. M p' -AS A .ti. x � ' � � . � � . : p � � M � ��o � ; : � y b : � � N y � ID -.. - . � :� � - �.. e: . . S- � p . $ j � Gt • VI � 'z! : �' � � : : : : W � .. : �• : F'� � _ . � hd .. . . .� . , • . •Q . oct • �- a 1 .ryj N . . . p1 a� . . . . o;�o : ...: _ . . � : •: : - �.•� n , � -; • . �] � . . ..� . . . �'? . �� s v • • • N .� � • o . . i � • • �� • • . • • • • �� • i � • � . . . . . . . . . .�+ •�q� •rr . . .�+ :c� • ' .� ��. 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TfixAS DAVTOhA BEACH F..A DENVfiR. CJLO DETRO�T. M��N 6A57,)N. PA GRAN^ AAV�DS M�CN GAEE�VSBORU. h �_ HOME INSPECTION C4NSULTANTS 55 NO. LEXINGTON PKWY. ST. PAUL. MINN. 55104 224-8300 Au�ust 8, 19?6 N'r. Dale iiamm,erstrom � ti431 E. River Road Fridley, Minn. Dear Mr. I?.aamerst�om; OiMER UFi10E5 MARRISBURG PA MOUSLON.TE%A$ ►+uNrsviu e. wu KANSAS Cfi� MO l_AS VEGAS_ NEV UY�•aGSTIiN h J. MEMPM/y. TEPIN MUM�. F�h MUNTp�At LUEBEC NEW YOR't N 1 ORLANDO �LA PIiTSBUFCS.�. PA PHI�EIELPr11A PA R�LNt�WNO YA A�rCKV�LLE CENTER. N� • FiUHN11MEDE N 1 `i7 LUU�S. Mv 5AN FRAIVC�`iCd. GAi.1F SEA�*� E. WA>H 1AiLAHAStEF_' Fl,h WASMiNCi.'^.N. C C At yotu° request I inspected the home �ou now own at the above address ori August 5, 19'l6. T:ao t�t�se oi the inspection was �o observe certain surface s�ructural imperfentior�s that are occurMng or have occurred Lo the basic structural system of the house. I�st of the problams were noted bJ you in the house and pointed out to me at the inspection. � ' '1. �. ; PiaDHI.�IS _� A beilge or ra3s3ng of Lhe roof ab��re the partition bet�een the housg and the garage. A rather large crack (1f4 to 3/8 " wide) in the front foundation Wall near the intersection of the house and �arage. The entira fovndation rear xa11 of the house 3s tilting ou�ward at the top. TME FOREGOtNG REVORT IS FURNISMEG AT YOUR REOUEST IN STRICT CONPIDENCE !Y US AS YOUR AGENT AND EMPL01fEE FOR YOUR EXCLUSNE USE AS AN AID IN DETER- M{NING TkE PM'ISKAI CONDITION Of THE SUdJEC7 VREMISES. THIS REYORT IS INTENDED TO COVER OtrlV SUCH PORTIQNS Of THE PREMlSES AND TIiE EQUIPMENT THEREIN AS MAY SE EXAMIHED vISUAIIY; AND WE WARN YOU TNAT AITMOUGM SUCN PREMISES AND/OR EOUIPMENT MAY BE IN GOOD GONDITION WMEN lXAMINEO, THE CONDlTION MAY CMANGE TNEREARER. FURTMERMORE, THIS REPORT IS NOT i0 8E USED AS A BASIS FOW DETERMINING TME VAIUE Of SUCM PREMISES O8 WHETWfR SAME IS OR IS NOT TO 6E PURCHASED TMIS REPORT i4 NOT TO 6E CONSTRUfD AS A GUARANiY OR WARIUMY OF TNE PREMISES OA EOUIPMENT THERIN OR OF TMEtR FITNESS fOlt USE_ HOME AND BLlILDING INSPECTION FOR THE HOME OWNER AND 9UYER . . •,i , L 4. The concrete floor slab at the bettom of the stairs has moved sach that tbe floor ti�.e has opened up considerabls. 5. It appeare tt�hat t,he wal� in the agra�e is motr3ng out�rard sucrr, that the ceiling joists haye pul],ed ayaey from the wal.].. 6. �'he w3ndoxs and doors are out of pinmb and ali.grmnent� such tbat ihe storm �r3,adoxs and doors da not fit proper],�P resul'�ing 3,n per3.od3,c pla�tng do�n to- make thetm fit� _ .� - IXLSWSSI�Bi In �r jucl��SAi all of the above pr�bl.e�rs are c�u�ed b3r nn�nta� dif�er- . entia� settlement abou� xhich we do �t have� at►y m�thad ta deir.ernnit�� whsisI���r it has stopped. The sattling iass occurred bsoause ths eaiire hous� has been glaced npon poor soil. Due to t,h� fact that t,he gar$�e has greater dead load caused i�r t]ie� conarete fl,00r slab most of t,he problems ara loca,ted ia the garage°ars�� A].thongb mar�,y houses and small b�dings are placed upon poor soil, the foot� and foundatior� are d�sigried accordi�g],Sr, REC4i�i�+DAT� Since� in my judgAent, t�►ese problems may c�ntiru� 3,ridefi.nite�y� I wauld rec�e�d repa�.ng a7,1 of the ma�or defects and consider selling t,he house. On the ot,her harid if it is your decision to keep the house you should be prepared to have contintial, maintenance prcblems until all of the ssttlemnent cesses. ���,s � ' ��' � , . . • .c.�..�*�^"' � Chester ' i�an3�g�.E. Clvil tructru g3nser xes. xo. 4532 � � � � � �INHF OiFICES � . \., a . ` ,! i1 .��e�r,v a r AN�,^OA�GE A�ASKA ATLANTA.. GA BAI,TiMORE. MO BLOOM�IEID. f.C�NN B01SE.�DA eosxur+. M�ss CMARtESTCN. W VA C►�E►ENNE. wv� CM�CA!�J ��LL CIHVELANC C`�+Il: CL�NTpfv N. Y COWMBUS. OMIO ' DALLAS.TEYAS OAYtONA BEACt�. F�A DHNVEN CJLO DETRO�T MICM EASTCN. PA GRAN-O RAPIDS. MiGM GREEN58�RO.N C. HOME INSPECTION CONSULTANTS �:arch 26, 1977 55 NO. LEXINGTON PKWY. ST. PAUL. MINN. 55104 224-9300 ;ar. Dale Hammerstro� d931 East River Road Fri�].ey, bliruzesota 55432 Dear I�ir°. Hammerstrom; OTMER OiFiCES MARpISBURQ. PA MOUSTON.TEXAS MUNTSVILIE. Ai.A KANSAS CiT/. h7p LAS VEGA3. NEV LIYINGS70P� N J MEMPMi3. TENh. M�14M1. iLA MONTREAL OUEBEC NF_W �Oi1K N r ORLANDO FLA. PIffSBUR�3N. PA PM�LAOELPN/A. PA. RICNNIfsND. 1fA RuGMV1LLE CEN7ER, N Y RUNN�MflDB. N. J. 5T LOU�S, MO. SAN RRANCISCO. CAl.li. SEATT:.E. WwSN TAtLAMAS$EE. iL/! WASM/WGTGN. O G This lettsr is in answer to your letter dated February 4� 197?. First of aIl let me apologize for the long delay i,n answering yeur letter. I have been qui,te busy lately in addition to now being a Review Ewaluator Consultant of houses �or the Truth-in-Sale-oi-Housing Baard in the Clty of Minneapolis. � Basically you ask me to answer two 9UE5TIONS 1. What is the estinated cost to repair thesa defects? �. Naw �izch 3o you feel these defects �.=ould a.ower the value cf L�e house based upon today!s marketsB OPII�'ION . 1. I aould judge that to repair all of the defects properly would cost in �ze nei�hborhood of �5,000.00 to �10,000.00. Insofar as your concern re�ardir,o tt:e horizontal sidin�, my estimate is based agon the removal of a11 the aif �cted horizontal siding and windows and repZacing thc� THE FOREG0ING REYORT IS FURNISNED AT YOUR REQUEST IN STRICT CONFIDfNCE 6Y US AS YOUR AGENi AND EMPLOYEE FOR YOUR EItCLUSIVE USE AS AN AtD IN DETER MINING TNE PN�SICAI CONDITION OF THE SUSJECT PREMISES. THIS REPORT IS INTENDED TO COVER ONIY SUCM PORTIONS OF THE PREMISES AND THE EOUIPMENT THEREtN AS MAY BE EXAMINE[l VISUAItY; AND WE WARN YOU THA7 ALTHOUGN $UCH PREMISES AND/OR EOUIPMENT MAY BE IN GOOD CONDITIOlM WHEN EXAIWt�IfD, THE CONDITION MAY CHANGE TMEREAFTER. FURTNERMORE, THIS REPORT IS NOT TO BE USED AS A pA515 FOR DETERMINING TME VAIUE OF SUtM PREMISES OR WHETHER SAMf IS OR IS NOT TO BE PURCHASED TMIS REPORT IS NOT TO SE CONSTRUEb AS A GUARANTY Oft WARMNTY OF TNE PREMISES OR EQUIPMENT TkERIN OR OF THEIR flLiVE55 FOR USE. MOME AND BUII,DING 1N5PECTION FOR TNE HOME OWNER ANO BUYER .., . P '• including a new paint job on the entire houss. I do not now if I told you or not, but the footings, foundations and S].gDS could be raised by a method known as "mud jacking." This would take care of the problem for the prasent. There is no way to be sure tha,t settle_ ment hss ceased. 2. I aould judge tha� the pxresent problems r�ould lower the valve of the haus� by �'Ipoppp�00 if the house was bought by a scrc�.pul,aus b,u�er.� �' �ourse, sc�e bqy�rs would be infatuated i+►ith the hous�, t3a� t�igia� borhood, the loca�Gion aud complete�r overl.eok any irregular9,ties iaa the structu,re of the haus�o T�iey may even affer you more than y��n think you cavld ge� in a normal, mm�°ket. If you have at�rfnrther questions, �lease do not hesitate to oontact me. C�4j tOL 0 Yours very iruly, � � ��f �� � �-• G'?"'rtoSGC.Y-�G4� . Chester,.J;,�3efricz �' ,,E. Reg. �w�832 / � b: �� 6 � l�oo•� .le.cdin� fo �undec�r .- /%4 .inch �ap 6e#ween dooa a,u! P�ame. ^�If.f lcand iui�dora ove�.loo�<�e� aundech -//� inch gap be�e�t Lvuaelc �i;ql►t co�en�. and mi,i,da.� r,fi�anee. �'�e�ck in uxe.L,L 6� doo�c .Leoding �inio 9a�cag�ee �'�ack in �Cowmle,t,ion �. .Ge�. •si.d�. o� ga�ag,e doo�. - �L !/4 �rch. �ou�da.tion be.#�ee�c 6eue�n� and �oam cu�de� � ti,lt,ing ou#u�d. S#,a.ra,� p�.Lle.d arua� �aom r�,�a.LL //4 incly parn�liny, bvrhe.L�d 0% .incfi. auxe� �m �.. Soa.tleecvst co��e�. ol h�cl�R and .L�vtng �coo�+ee -�oau //2 inc% ocef o� .Leve.! B�se,�ent �.[oo�, u#, �oot o� •�irun� �ett.Ge�ol !//2 i.nch. Lcue�,e, clrack, �oin.f be�een b4xh �vund.a�,i.on �»,d maen hvu��. in �teo.�e., !�v ///2 inch c�ac.h. BaAe�e�uE m<ndaca, ove�loo�hing .oeax �poad oat o�C LeveL' ��8 � raitli.i►c u.idt� o,l each u,irrdo�. �'�ac1�a �n ba�n.t .Gaund�.� �.00� �.loon. a,rd w�a,LL //4 ,i�cche.�. C�ach�, in 6�e�en.t ba#lue�o� �.LaoR and +r�.lo . �'wacJrs a,e hu.�e�et be.d�wwx �.Low� I/4 �ch. l�o.se�„e�e.t 11ooK. 4et�.led cv►►�i�Lenab.l,e. in lec.Llu�ct�g a�a .Le.arf�c�. i.i+t.o .La�n,d�� noo►�. Law�,z 6riLy,e in �ool abov+e pvic.ti�,ioR be#iuee�c #l�e l+octi.e and gnnccg,�, . l?ea�c wa,l,L �o�rda�.i.nR v� hvu.le �il#,ing o�t�rrxucl a,t #lre fop. Sa�a.�,e �tu�ivn se.tf.ce..c�. dvu�rur�ed �ieom �,aie��e �P,cooR I.�av.inQ �a�e 9�P. n e SUBJECT • City of Fridley 2 2 6 2 5 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T f ; � RECEIPT NO. � • COMMUNITY DEVELOPMENT DIV. ' `� - aa� � 1 � � PROTECTIVE INSPECTION SEC. 1 = � � �"'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE GAGE OF APPROVED BV ����"� � �'' 612-571-3450 s�aF�S 6/20/9 � � J08 ADDRESS 6931 East River Rd NE t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. (} 4 Ostman�s 3 Addition SHEET 2 PROPERTY OWNEfi MAIL ADORES$ ZIP PHONE Dale Hammerstrom 6931 East River Rd NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE IICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAII ADDRESS ZIP PMONE LICENSE NO. 8 USE OF BUILDIN(i Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE X B DESCRIBE WORK Construct a 248 SF Deck 9 CHANOEOFUSEFROM TO STIPULATIONS See notations on plan. WARHIH6 Before digging call for all atility locations REQUIRED BY LAW TYPEOFCONST. OCCUPANCY(iROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REDUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERAAIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONINO SO. FT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WOFiK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. � NO. OWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEHEIN OR NOT. THE GRANTING OF A PERMIT �ZsO21 �I.OI DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEfiMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- ' @ STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �pS�F.00 Fire SC �L.OL P�AN CHECK FEE TOTAL FEE $57.03 SIGNATUREOFCONTRACTORORAUTMORIZEDAGENT IDATEI yy EHLY IDATED THIS IS YOUR PERMInT �_ Y� SiGNATUREOFOWNERiIFOWNERBU1LDEfi� IDATEi BLOG INS IATE NEW ADDN ALTER il II fl Construction Address: [.egal Descriptic�n: Owner Name & Address: ContraCtor: CITY OF FRIDLEY SIAIGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Applicadon 3/,N�' Effective 1 / 1 /94 �+��i7 Tel. 1# 2 SS ��'/.� MN LICENSE # Adciress: S'� �I �;' Tel. # Attach to this appiication, a Certificate of Survey of the lot, with the proposed conshtiction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length R/idth Height Sq. Ft. Length Width HgtlGround � Sq. Ft. � 4x/ Comer Lot j] Inside Lot [] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ � � � I , � � _ Approx. Completion Date: (Cost on BackJ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: APPLICANT: Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY $��, o o Fee Schedule on Reverse Side $ � ��� .�1 of Permit Valuation (1/lOth%) $ � , � $.SO/$i,000 Valua.tion $ $800 per SAC Unit $ $5.00 (State Liceased Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Coaservation Plan Review $ Fee Determined by Engineering $ Agreemem Necessary ( ) Not Necessary [ ) � ����� r BUILDING PERMIT FEE SCHEDUI.E 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 stntcture, or for any alteration or repair to any existing building or sttucture, upon application therefore, require the payment by the applicant for such permit of fces to the amount herein below seX forth and in the manner herein provided to-wit: TOTAL VALUE $1 to $500 $SOi to $2,000 $2,001 to $25,000 $7_5;001 to $50,000 � $SO,t?Ql to $100,000 $100,001 to $500,000 $500,001 t,o $1,000,000 $1,00(3,001 and up FEES $15 (Minimum Fee is $15 plus surcharge) $15 for first $500 plus $2 for eaci� additional $100 or fraction thereof, to and including $2,000 � $45 for fust $2,000 plus $9 for each additional $1;000 or fraction thereof, to and including $25,000 $252 for fust� $25,000 pl�s $(_50 for each addifional $1;OOQ or fraction thereof, tn. and including $50,000 $414.50 for first .$50,000 plus $4.50 for each additional $1,Q00 or fraction thereof, to aad including $100,000 $639.50 for first �$i00,000 plus $3.50 for each additional� - $1,Oa0 or fraction thereof, to and including -$500,000 . $2039.50 for the first $500,000 plus $3 for each additian,al $1,000 or fractio3n thereof, to and including $1,000,000 $3539.50 for the fust $1,000,000 plus $2 for each additional $1,000 or fraction �thereof • DRIVEWAY DEPRESSION ESCR011V (Concrete G�u�b Sireets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13_50. Alternate "B": Removal and repiacement of curb and gutter aad install a 3 foot wide. approach with 6 inch depth - Driveway width plus 6 feet times $15_75. VERIFICATION OF FOUNDATION Permits for conslruction 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 const�uction site. A Certificate of Survey of the lot, showing the loca6on of the foundation once it has it has been constructed wil! be required before proceeding with the firaming_ � �� iU �� '� �_��. � ,: � : � _� ,�__ �--� � _ � . , ; , ------=�, � - . . _. �� _ ____� �_ __ - -- : �. .� • � � -- °=_ ---_ -� . - — -:-�:.; �; 't �-<a. __ _�.. _' i+. . , >. , ... _._. _ �+��... __. � i -_. • . -- ',�t � , `.; ..-.--", }�� � .. . � f � . _ �'�, ' �: ��- 1. — � —,�_�--� c:-� �` � ; _ � M _ � ` � � � �. - f ''�� �, h, . �� l:Y . 1 r� � . �h � • • �` 7 ..� _� r � r ,, C_ . '�-- j . n-., ��- �;:.�` , � '� , � I . 'r�J �. -.L' !'ii , � �' y � `L-, �' . ,-� —� ;v . : � � ��` _ 1 � , �'�i � ._.,. - - - - - - - . . .__.. _, c�� � - % , . ___._ •} , . _ . �-. � . � � r �� U„ —1 .� -- � _ I � � " �. ) . . ! t _:.�? I i. � . ...�..a_— " ---�-- -- �'. i� i. �—_ _���.�.�.J: i _ :, �i •—•------- - . _ �•� . : i /_�-- ' — ; . ;�'. _ �! Z - t �° �. � \'° . �' � . . � �� � ; � a� �� � � — --- — - ---- --•----- - —� � J �� • ----- - -L z 4 -, � � - ., -+' r°°4-,-. _ ^ �w� ��._ � ^+ �.� � � �' ✓'J � t. � , � ,�, � i Ji ; �� ,�-. , •�� . � .\ •_%- - � , ;� `� , � ; ' r:, —r u � _ y-' � � ' , � ' . TR) . I . '°�.,. �- r_= __ __ __ -- — � - ;•a--— - � ;. ,� � � A� . 5 � - aa ' _'�' � � , , '��I � r` l^ I b ° -� �.;� . � c�., � _; = �,,, ,, � . a �, � e � : `� . ,��c�, � . __ (,� °� �' �`��,�' f � � � d ` - " ���� "�; �.-�. - RIGHT OF ENTRY AGREEMENT r r; o�%y C`'o � T�IIS AGREEMENT, is made and entered this (� day of �� �� , 1995 by and between Dale A Hammerstrom and Janice A. Hammerstrom, hereinafter refened to as the "Grantor", and the County of Anoka, a palitical subdivision of the State of Minnesota, hereinafter refened to as the "County". WITNESSETH: WHEREAS, The County is in the process of constructing Anoka County Highway Project No.S.P. 02-b01-36, which includes improvements to East River Road in the city of Fridiey; and WHEREAS, the Grantor(s) is the owner of property which adjoins the construction limits of said County project; and WHEREAS, the County desires to enter upon the Grantor's property for the purpose of conducting certain work therean, which work is identified and describ�? in Exhibit A,, which is attache� hereto and incorporated herein; and WHEREAS, the Grantor(s) agrees to grant permission to the County to enter ugon t�iie property io perform said work. NOW, THEREFORE, it is mutually agreed between the parties as follows: 1. The Grantor(s) hereby grants to the County the right to enter upon hisfher property for the purpose of performing the work identified and described in Exhibit A. 2. The County shall perform said work in a timely manner and return the Grantor's property to its original condition, except for the changes described in Exhibit A. s t � IN WITNESS WHEREOF the parties hereto have set their hands on the dates so indicated. COUNTY OF ANOKA By: � Name: .� � �' l�� v; � Title: �roJ��.� ��i'�u ; Sa ✓ Dated: �/ ��-�'� GRANTOR � �_.,� �.� ��t�►�� .,._ ��.1 _� � ` - ;. ,. I�. -� ' ��� � �/., By: `.. �- ,s.� 9 ; %� � � � N ��,�dda� Dated: ��/ �j �� � 0 EXHIBIT A � I. Address: • ��. .u�'.1►.■ ��L/ Project No: ��' �D �— 3 (p Description of Required Work Area: II. Work Statement i. ,A,�I� cow�.fiy .a�.0 ►�e,w�ou� -�u�o cc�u�aed -%ne�s, � 5+�c�.ups, 2. 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BLOCK TRACT OR ADDITION DESCR. (F 4 Ostman' 2 PROPERTYOWNER MAILADDRESS � Dale Hammerstrom 3 CONTRACTOR MAIL AODRESS Richard Hastin�s 6331 Riverview Ter NE � d ARCHITECT OR DESIGNER MAIL ADDRESS 5 ENGINEER MAILADDRESS 8 USE OF BUILDING Residential 7 CLASS OF WORK REV OATE PAGE OF R/��/aR / / 27432 _./ RECEIPT NO. ���� AVPROVED BV SEE ATTACHED SHEET ZIP PHONE ZIP PNONE LICENSE NO. 574-9966 4051 21P PHONE' LICENSE NO. ZIP PHONE LICENSE NO. O NEW ❑ ADDtTION O ALTERATION � REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK 8 CHAN(iE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, � irc vr wna�. VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NUIL AND VOID IF WORK OR CONSTRUCTION ZONING AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS ypLUAT10N AND ORDINANCES CaOVEFNING THIS TYPE OF WORK WI�L BE COMPLIED WITFI WHETHEH SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OH CANCEL THE pERMIT FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFOHMANCE OF CONSTRUCTION $5h _ 7S � '� � � �? � � SIGNAiURE Oi CONiPACTOR O UTMOpIZED AGENT IDATEI i � STALLS OCCUPANCYLOA CU. FT. ET PARKING IGARAGES 1C CHARGE 'i SC 1.75 ) A FEE THIS IS �RM 7 1 � DATE N� " [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ��3� `� E� . a �� ConstructionAddress: � �3/ .�,�s� �� ���� Z d Legal Description: Owner Name & Address: �,� �.� ,z-�,�,c,�� � � .� � � 4 �'t Tel. �# Contractor: � � �,I�, �. �p - ,�,�.� �'� > ti � � MN LICENSE � � � � / Address: � 3 3/ ►� �,� � b�z i� t 1= � '%s�= Z Tel. �# S' 7�f - t��'G Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IlVIPROVEMENT LIVING AREA: Length Width Height GARAGE �AREA: � Length Width Height DECB AREA: Length Width Hgt/Ground 'i : v � • �I �J / Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: /�� � � �� �-- i� s�� c� � Estimated Cost: $ � `% � � � � (Fee Schedul e on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: � �-� � . �' � � g � APPLICANT. �,�� �.� Tel. � 5 ' � - l' ��� Permit Fee Fire Surcharge State Surcharge $ .� �- 7S°� $ /, � $ � ��7 CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation SAC Charge $ .$1000 per SAC Unit License Surcharge �$ � D C, $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above � Erosion Control $ $450.� Conservadon Plan Review Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ Fee Determined by Engineering � $ Agreement Necessary [ ] Not Necessary [ ] $�� � BUII.DING PERMIT FEE SCHEDULE . �. The Chief Building O�cial shall, before issuing germits for the erection of any building or structure, or for any addirion 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 permit of fees to the amount herein below set forth and in the manner herein provided to-wit: TOTAL VALUE $1 to $S00 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 . $50,(}O1 to $100,000 $100,001 to $500,000 $SOO,W1 to $1,000,0{?0 $1,000,401 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 $2,000 �� $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $2�,�0 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $1�,U00 $887.25 for first $100,000 plus $5.00 for each addirional $1,000 or fraction thereof, to and including $500,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1, 000 or fraction thereof, to and including $1, 000, 000 $5012.25 for the first $1,000,000 plus $2.75 for each additional $1, �0 or fraction thereof DRNEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Altemate "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 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 constructed will be required before proceeding with the framing. 0 * � � n m � � Z 7 O � � � 'D � a n � = � 3• � o N, � Z O H 'rl �� m -., c� m O j � 3 0 � QQ o 0 �p O � � 2 • d -t � A QO �p 'p Q. O � W � N � � o `D � � 1 � Q . . � rt � 0 C .� -a D v x < � m n W l �! o � 'r° c 1 00 � � o � � -i m r � �i � 01 ` � � c"D � �� �- I 2 a � z � n O _ �w �G�1 N Z� �� � D? �m m Z� m � 0 '� �1 n � r � m � A m � IIt QQ cD �O D c,Nn3 �O O !'1 "� � c� � < a� fl' � d � � � c�uc, o� � � �D y a _. . _ .o Q„ � � ci D d � �D d cu o M 0 o � N O � r 7� N -� � Z � n � v b9 E�9 4f1 0 � � y � ��.�� c� A �D y (D � a �. °. °- m a� .., e� � N O �D � � N W � � C � p, _ � Q oa �- � � � Q �D d T � vo� m ,., < °9 � ? v_+ y � �. � y � o �' =a ' -�a °:?� y � c�e �rt � O m �,.��� ma�o � � °.'' c�,�� .�� w 1 � _ � � art`° 3 �n 'p1 � '" O'� �-w , � pt rt O c - �- .. .. '.��S�D � m c� �D � c � o 4�! Q � . _ _� Q � � � p. � � 7 � C � � � � a� C. � z � � S � N � Z 0 v � n -. n O � 0 � �' OG r � N � N cr 0 O �. mo�i o�i Dc u�i ul vi N O� Q. 0 � � � � N � � � �p. (n �D W .��. W � � � � Nm C Z � � W '.. � �, � c� � a • > > o � �r.a � �-��0 c � 3 � A � c �, co � a� � o � � A 7C � '� � v � � 3 � at � � � � � �'% � a . O � O O O � O O O O � � �6A i�A EA 69 . Q a + r � _°-�°�o c�'n � � C W o -_i J� � a 3 �,': . v a �D = � � � O C � n � � N _ (� � � A O � d � � . � � � o p > > � � rt � � �D a �� o � � z a o�" � �-� _ =-i � Z NO � - ._._ � � v _ . �. . d . . :.. �- - 3 .._ � �- y . ��ti� � , � c � v_ z � C � m v _ .. I O z 3 � N ei _ v C r v� d�(�'; w� c''� ►r � � C O a V � wZc`u � o��° � �� m W < -C N cfl Z Z � - m � m � � Z � � a � � z � r � -�i �AO . L/ Z m �, �O -�i � O � Z� Z� � .� a� �z n 1 ON vz �v o= zm a°o z -Di a �Z °v � � � m� N O �N Z D (� � m � mZ �� f� � y O � ? m � A < (D � � ` d � � � � � � N � O O N , THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION W1LL BE RETURNED ' • �i �� • ► / ► / ► • ► ► • : � ► � • ii � 1 • ► ! : � 1 � ► Wh@n ela _in9 an eYistinA f�rance, the undersigned hereby verifies that the ��°�nting has been examined and is free from rust, deterioration, obstructions, • �d is securely supported and firestopped where required. Yes (� No ()- ��e venting system is piastic/PVC and meets all current codes and manufacturer �eafications including sizing, length, number of elbows and termination. Yes (`k No () The undersigned aiso verifies that the replacement unit is a Gsted 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 p� ' ��� ��-�+�+�si�ed-and irtstalted fio meet i�t� currerrtcodes and manufacturer's speafications. When �2quired to ine+all a new cemh�e±ien air�,it wi11 be sized and installed to meet the current codes and manufaeturers speafications. When in�Q a n w v_r,t�r,o� Pr,,, the undersigned hereby verifies that it is a Gsted assembly and meets the current codes and manufacturers speafications. 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 appiiance has been removed from the common vent and vented separately as per cuRent codes. Yes � No ( ) .. Yes � No ( Yes (� No ( ) Yes (� No ( ) Yes�No ( ) �nliance Tv�n�and S' a/ _emmen V_n and V _enn _cter Ir�fermafien Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appfiance #3 Type BTU Input Fan Assisted or Nat Total AppGances Total Btu Input _ � _ _ Common Vent Type Vent Height Diameter inches AppGance #1 Vent Connector Neight ft ��hgth 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 � - 1�► �:- ..- -- � - - - - Center Potnt Energy MGCO 13562 Central Ave NE HEATING CO: �ot�a, MN 553�4 � � Signed By: � Date : � �' a� � e Cerr�erPoint� Energy Minnegasco ADDRESS UC�?7� �l�aST Z���'� �B� OCCUPANT�L�� lqti1a61rtL° HEAT LOSS Yes � DATE HTG. INST. —1 21�03 SOLD BY s o Electrical Work Bv__ C�� w dt� � 14�41QWUS Cp TYPE OF HEAT FA �. SPACE HTR. GAS DESIGN MAKE � �� Model � �5-01� 4� �. Serial �� D ��Z �00 �O 1 � NPUT ��� f30� IlA 1.. ea�^�� CONTROLS Pressure ?� � Percent CO2 � nput CFH Percent OZ �� � Stack Temp. � Percent CO � 1'° ' r'�" HOUSE HEA�TING iEST RECORD APT. FLOOR CITY T" rl(!l OWNER � rr INSTALLED BY ent int E er Mi ne sco Gas Line By �,v� � 0�� " w� y d�nwy,a5 ( p UNIT HTR. OTHER CONVERSION Vent Size � KIND OF LINER SIZE NONE � Draft Hood �u+ V L ti'� Regulator Filters Size I `IGZ � Number Chimney Location Insid Outside Chimney Construction G ���5 wirin9 k Test Tag _ k Lighting Inst. Date Tested � " �- — Company Te ' ter o' t Ener Minne asco Name of Tester --C �"