AF - 42180�_�
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�TE6T HOLE NO. 1
LOCATION Lotc lA-1R1S�c Site Plan
HOIE AOYANCED BY -7"o_rl_ hnl 1 n�.� �t�m �i��nr
.QGGED BY_ H.H. - J.W. pqTE_ Mar.23, 19R5
NO. BLOWS PER fOOT DESCRIPTION
0 �0 20 30' 40
�t't
;�� I
r r T
t} 1:."` ..'+ Black orqanic clayey sanc�,roots
SC-OL) Wet. Loose.
TEST HC
o �ocar�oN I
E
P H�JIF ADVAF
T �
H tOGGEO Br
ELEV NO BLO W 5
FT. 0 �U �
_�.-�..-.
. E . . . '•'� ''
� ', ,- + � � • rrj; ;ay�v sand (SC) Wet. Loose . .� --
�!°r . . . . . . � _ . : . . � � Rrown � r ~` --� ' - _-
.'.; . ' � � - -
�• sand clay, trace qravel.
; :y� : : . i � . . .-� . _ � , . (CL) Slightly plastic. , . . . . .., :-_--
;,� • • • - - � • • • - • Stiff to touqh. �.;.;�. _-__
��' - . . , . . . . . . . . . _ � _ _ . . �.
:%`..:�: _ . . . .. - - - . . . . . . Red-brown clayev fi-med.sanc�, 5�5 �'� ._..+ �, .
�'�;. . ._ . . , . _ . _ . . . - - little qrl (SC) Moist.Mec3 dense �.5 ; x� -+- ` �-
.4 Red-brn cla e silt (�IL-CL) � '� -t- •�-
. . . , . . .� . . . . . . . . �� __ ,
_ _ _ , _ , , Saturated.Sl plastic. Tough. a
. .: . . _�. ._
� � \ , , .
. .
. .. .. . ,
. .-� . . _
. -_ : . : a.. -r't- r - - -s -r r-s- ,' . 0
. . : r� a _ _ ___._ ._ ____ ___._ - - . ' . - .
`: . _. . _ . . . . ' . . . � • - ;- Red-brown 'o .'' _ . . 1 . . . �
• _ . . . ..�- - .. / . . . clayev fine to medit�m sand, '-�•` : � . . _�
.�f- j
;� . . . , ... . .�. : . . . trace aravel �°• _ . . �. . . - 1
• . . . . . . . _ . .�, . . � . ; �SC� 1� c. . l . . . � . . �
,�e. , Wet. ^^c�dium dense. ` "�
;. �° . . _ � � . ! . . . .. . � � . � �°. �•t — - i -� : ' _ �
' ._. .... ... �� _..i . .�
'°, .� - . .. • . . . . _ . . . . : ' ; • � .- : • � ' • -
. . _. . _ . . . . Q . . . - . . , �_� . .-. . .
, . . . . � . .. . .� . . t �. . _ . . . . , �
'r .
'��"': . . .. . . . . . . . . . . . Grey to recl-qrey sandy clav, 6 � - � � zS-�
.;. .
�• • � - • • - � - � • • � • --} tracc� rg avel (CL) S1 . plastic.
•'�• ' . ' ' " ' " ' " " Vcry touqh.
'�:
:�::�:::i�::::}': "� HOLF TERMINATRD
j I�'o Refusa 1 .
- - . . . . .. _ , � . . , - • ^dnTF: �^,'ater lc�v�l at 18' depth
� � ' � ' ' " " ' ' ' ' ' ' ' ut�on cor�p letion ; at Q . 1' c3c��th
._ . . . . ... . . ;_., � , . ; 3'� hrs. later.
_._�. ,.. ..., �_�. .
... �+._ .... ....
.... .... .... .... � .
,.., :,. .1.. .... .
...� �.� �. , . ,
-»-... i� �i-} t? • } + , _r .a t!
NO BlOWS oER fUOT
� .
. .:
_,..1....
_. .� ,,.
o lo io
r.c; RIO�ti
•- ���T HOl E NO. 2
IOCATION LOt 2
HOIf ADVnNCEO BY !��o.d, ilollow stem auqer
IOGGEO gY H.H. - J.�ti�, pATE �iar.2q, 19F3;
NO BLOWS PER FOOT DESCRIPTION �
� tU i0 3� 40 T__�L_L.__ ,�,_ ,� a_.. rl_ �
r
.�.T..+.Y ♦ t �'".� .-�--t�+ ♦�t,i--�
♦...- . . • . 1 . . . , •
- • • � � � r- t ; *�� -� Plack orQan ic �andy cla�, roots
"" '' �' '' d.�� OL) Sliqhtly plastir. Soft.
�ti;. � . - • � : . � • • • - � Fil l Brown claYev fi-med.
,.tip� �. •-�-- *-•� sanc�� (SC) �aet. Loose.
.' .
"�•'•' - - -� - - • Fi•1� Dk.brn fi-med.sand (SPl & brn-blk
�;?'�' .$�' "'" organi.c sand silt (OL) Moist
"�`� � `� ��` �"� Loose to medium dense. '
•� ,
' ' " ' -,--�-•� . -•--.- --�----
.;,ri� "; +�: � ... Brown sand c lay, trace qrave 1
.•? t� ��` 'r � ZCLI S 1 i�itl —� as ic• ou �.
• ;
� ,� •� i-. � /�..� .-r-}--i- - . - i
�� o . . . � . . . . , , ._ : . Red-brown
��•�• +1 '��' clavev fine to medium sand,
� _ 1 � -. . . ' ' ._ _.._
.--
•��, � trace ravel. �
.;�'•"° • -' �' '*-'-' (SC) Wet to saturated �
.L, . . .- �. . . . _ . . •_ . . Medium dense •I
. . � . �. ..-• �-- - --
♦''�.� _ . . � . . . . . _.- . . . . ;
` � `' _-. _�.- - .. . :_� --_ . i
.�� . -.� �� . . _ . . . ��-. B r ow n �
., : _ . .� . . . . . . . . . . �
sand clay, trace rg avel �
, �-� _�- .�_ .�._.. . iCL) �
-- . -
':: �� • ~; • • • � - • � ; Sliqhtly plas�ic. Tough. �
' -1�-. - -�-. �-?. �..r.�...�. i. -.-�--r
, . . . . . . , I
., : . . . �, . . . . , i
��.;. � • • • • • � 1 • � � - • - Red-brown f inP to medit�m sand, ,
' -�' � ' ' ' � ' trace��gravc�l�(SPl Moist. �^ i
. .'' ._... . . . . . � . Medium dense. i
' o, � :
_��_ �L-L. .S"'�.�.:_ ...1. 2-:1- 7 2..x..F"t _ .'" _'.. __"'__'.�_--...__"'_ -___""'_'_'
� �-.`... . . . . . . . . . � .
• � • • • • , f;OLE TFRMINATF,D I
nlo Refusal. f
, . . . . , . . . NOTF: tiolc dry upon completion. ;
-.. �.. .�. .��" Open to 19' depth and dry 2 j
. ' ' " " " • " ` hrs. later �
� �
- --_.. . . _... . . . �
.._. ..t� .... � •
_... _.. ..., ..., i
,
... ...._ .,_.. ., . �
.._ ... ... .:;.
-i t't 1 t t t f t i 1 ti i f F� � �
0 10 ?0 30 aU
NO AIOw�, ��ER � ..���T
TEST HOLE NO._
D IOCATION LOt ', S
E , ��
P HOIE ADVANCED BY
T
H IOGGEO gY Fi.N. - J
ELEV. NO BlOWS PER FOOT
FT. 0 10 20 30 •
. �_• ._� � ��* ����I� t � � � � ��
,,, _ ..__ ... .__-
:1=•'�: t--. -._._ _.. . _ . . ._ _
� 'i'r.j. _ . . . , . . . . . _
: I ;_.1=
S-.y.� • _ �. . . . .-..-. �--- . . . . .
.' • y rt � ..._-.._ ._.._
. _ _.. . . .�. . . . . . � ___
I � �' _. . �-.-� _ ._l.. . . . .
� �'. � �' _ . . . .__ � �; � . . --
� ��: - _ . . , . • -�. . - ----- -
� .. ..� ... . .. ..--
� ::: �. ._._.. . . : . I : ; . . _ .
.__�, � ; . . _ l �_�- . . . _
��• .. .. ... �.... ...
�° ;�; . . _ . . � . . . . . ' -
' . -. _ . . . . . . . . . .
, ___._._ _ . _ : .j . . . . . .
. , . . . . . � . �. � . . . _
J•�,.i _ _ . . . . . . . . . . .
'c:;; _Y._ : : ; : : :t:: :�
� _ ... . . . . . :�s . �.�
�.. .... .� .. ..
�,-._.- .... . . . . . ..
, . . . . . :.. . _.-, .
1-+� _ .�. ... .,..
. : :'.., ... . ..
�... ..: ,.. ....
0 '� .:. �v •
NO BIOWS PER FOOT
�
i" ? ' PROJECT 3 SINGLF FAMILY D�t�ELLINGS
� N O. _ � Lots lA-1B, 2,3, B1k.l,Iwen Terrace
,f. _ ,,c� nwg. No.1
SITE �'illm�rc� �t-_ l�T_F._
:o Br %"� �3. f��llow stem auaer
,
Fridley, Minnesota
__ -�7 T' DATE Mar.29, 19R5 FOR Mr uAnt R�os�lr�r
; .
�ER FOOT DESCRIPTlON ��-�—�� G—�n��' P����s
30 40 OUR JOB NO. -_ X-R�,Q54
ri1-:.�r��-�r>>.c s:�nav ciav roots <<�
: � �- -�- --- •
•-• - Fi � �.F�rn clave sand (SC1 h1oist ,
� " •�`" �-'-�°1oi�t. Very loose
----1----
-- - --� ^ix�d Fill
.: :::; F�lack �r anic sand silt (OLlanc�
. _ _ . .._ qrc�y-bro�an, �ilty �in�,�and (51�11 �
�i�t to moi�t. Loose.
• - -. _- _ -___... . ._. ._..._._....
. . . . __ Red-b ro�an
=-�ndy cl�,v, tracc �ravel. �
_. � . _ __ - c cL �
� " -.:: �l iqrtly nlastic� to ,
... ._._ �lon-plasti�.
. . . . . . _ `.'cry touqh .
�.. ._.._ �
i
- - - . . . . Rec3-bro�an
.. .._� c-1 ayc�� finc to me�3iur, sanci, �
• •'� 1 ittic crravc�l. up to 2" size.
. ..._ (SC)
_. .... �,���t t� W�t. �
. � . . . '�ledi��m c3en��.
.... Q '
_'�;- }� �� �� ��' __ ° -
. . �,:'1:. � � a�,���
,
IinLE TRR^IINATED
_ , , , � ` � r]o Refusal .
� � � • • • ^'OTF: Hole dry upon completion.
.. ...- C<����c� at �. F' depth and c3ry
' l�r. l�ter.
:.1:'T:
. , ..
.. .��__ _
�J 40
ER FOOT
� INDEX
(jf ORGANIC
�LJJ CIAY MOISTURE
� CIAY CONTENT %
ORGANIC
SIIT �
�� SIIT � NO. BIOWS
� STANDARD
C PEAT /r pENETRATION
[�� � TEST
�J SAND �� NO. BIOWS PER
��� � � FT. - CONE
'�'�'� GRAVEI y
1 PENETRATION
� BED ROCK � TEST ��
� WATER LEVEI � �
�PIASTIC IIMIT
�l rE---- -�r l l� 2-0'�
LIQUID UMIT--� �DIA�
SYMBOLS
C - COHESION, L8 / SO FT.
� - tNTERNAI FRICTtQN, DEGREES
S - SATURATION, %
�m - WET DENSITY, lB �:.U. FT
O� -' UNCONFINED COMPRESSION
STREfVGTH .
�
O
� .
E
H
a
L
E
L
�_J
W - NATURAI MOISTURE CCINTEN7 °,�o �
I - UNDISTURBED SAMPIE
SUBTERRANEAN
ENGINEERING CORP.
MINNEAf'(.)I,l�, MINNESOTA
CONSULTING SOIL ENGINEERS
d.awn date
� Apr.2,1985
checked drawing no -
•� . * s
R.H.I. * 2 ,
SUBJECT PER�
City of Fridley _ 18 312
AT TNE TOP OF THE TWINS g�J I L D I N G P E R M I T
r
; � RE .
� `y _ COMMUNITY DEVELOPMENT DIV. � ����
r � � � PROTECTIVE INSPECTION SEC.
1 � i
' r"�1 � CITY HALL FRIDLE`1 SS4$Z NUMBER REV. DATE PAGE OF APPHOYEO BY
�'----� • •`� 612-571-3450 9t0-F15 1/10/86 � �
JOB ADDRESS 5586 Fill�re Street N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oesca. Parcel B, Lot lA, Bl ck l, Iwen Terraae SHEET
2 PROPERTYOWNER MAIIADDRES$ 21P PHONE
Kenco Constructi.on, Inc. 10666 University Avenue N.W., Qoon Ra.pids 757-4052
3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO.
Same 55433
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS E E NO.
�
8 USE OF BUILDING
Residential
7 CLASS OF WORK
�1 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 22' x 46' Dwelli.ng and a 22'� x 22' Garage
9 CHANOE QF USE FROM TO
S7IPULATIONS p�vide separate sewer & water service. Provide sod in the �ront and
side yards. Provide a hard surface driveway. Provide the City with a copy of a
verifying survey befoxe capping. Pai.d Park Fee of $750.00.
SEWER SERVIGE: No Service - S�er main on Centerline of Fillmore Street.
WATER SERVICE: MU5T BE TAPPED - 6" CIP �rtIest of Sewer Main.
DRIVEWAY DEPRES5ION:16' x 6' = 22' x$13.50 =$297•00
�IA������
THE CITY OF FRIDLEY DOES NOi GUARANTEE TH� ��pr� digging call local utilitie�
ACCURACY OF UTILITY LOCATICNS AND ELEVA i EC�hlS. �����}�ONE - ELECTRIC - GAS Etc.
THIS DATA IS FGR INFC�°IlA i;ON PURPOSES ONLY,
AND PERSONS USING THIS INFORMATION SHC3ULD ����J�REp �Y L�.�v
, VERIFY IT ON THE SITE,
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATINCi, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOCI Fidl[L2
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONIIdG SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT �
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VAIUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $48,050 $24.03
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- �278� 50 $475. OO
STRU TI OR THE P RFORMANCE OF CONSTRUCTION.
C� PLAN CHECKFEE TOTAIFEE
'-/�s 69. 63 $ 847 .16+ PF &DW
SIGNATUREOFCONTRACTORORAUTHOR12EDAGENT �Da7E� WHEN PROPERLY V IDATED THIS IS YOUR PERMIT
/ —�� ���
S�GNATUREOFOWNERUFOWNERBU�LDER� �DATEI a+ .� t -"'BLDG �NSP DFTE
NEW ]
ADDN. [ ]
pLTER. [ ]
Construction Address•
Legal Description:�
Owner Name & Address:
Contractor:�
Address: 101e (c
LIVING AREA:
GARAGE AREA:
DECg AREA:
OTHER:
City of Fridley
� R-1 AND R-2 (
Build �ng Permit Applieation
� � .
� ��
Effeetive 4/1/84
�
� 1. � IwOA�
Tel. �
� u�S
. � 75'�--� S�
Attach to this application, a Certificate of Survey of the
lot, With the proposed construction draWn on it to seale.
DESCRIPTION OF IMPROVEMENT
Length � � Width '`�� � Height Sq. Ft.
Length a� Width �� Height Sq. Ft.
Length
Width Hgt/Ground Sq. Ft.
Corner Lot [] Inside Lot [] Ft. Yd. Setback Side Yard Setbaek
Type of Construetion: /�Estimated Cost: $ � o
Approx. Completion Date: ��°���
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: T'0 ��� $�� ____ �
See Back Page for Explanation
�' DATE: /1-/.�-8'S APPLICAN • . . Tel. � %✓�%�O✓�oZ
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Setaer Main Charge
�OTAI.
f�S�. w �
STIPULATIONS:
P(�,f� (� u �J�LO
CITY IISE ONLY .
$ � Fee Schedule on Reverse Side
$ ��.3 25� of Building Permit Fee
$ .o� $.50/$1,000 Valuation
$ J. C1U' $425 per SAC Unit
$ '%�D.O C� Fee Determined by Engineering
�
Agreement Necessary [ ] Not Necessary [ ]
$ `�
��lic �� al`C�k1S OJC�� /� ''��"
�� �.
� � ��'�• � ia'
S� p R-r��-�vt— ��i� � d- c�.1�1?�'6� SG 2c� �
BIIII.DING PERMIT FEE SCHEDIILE
The Chief Building Official shall, before issuing permits for the ereetion 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 strueture, upon applicatio n
therefore, require the payment by the applicant for sueh permit of fees to the amount
herein below set forth�and in the manner herein provided to-wit:
Total Valuation
�1.00 to $500.00
�501.00 to $2,0OO.OQ
$2,001.00 to $25,000.00
$25,001.00 to $50,000.00
$50,001.00 to $100,000.00
$100,001.00 and up
Fees
$10.00 (Minimum Fee is $15.00)
$10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof� to and including
$2,000.
$32.50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraction thereof, to and
inelud3ng $25,000.
$170.50 f°or the first $25,000 plus $�.50 for eaeh
additional $1,000 or fraction thereof, to and
ineluding $50�000.
�283.00 for the first $50,000 plus $3.00 for each
additional $1,000 or fraetion thereof, to and
including $100,000.
$�33.00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof.
DRIVEfiAY DEPRESSION ESCRO�i
(Conerete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus
6 feet times $13•50
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approaeh With 6 inch depth - DriveWay �aidth 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 strueture and of the
construction site.
A Certifieate of Survey of the lot, showing the loeation of the foundation once it
has been eonstructed will be required before proceeding With the framing.
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FRIDLEY
�
PLANNING DIVISION
1�1EMOR.ANDUM
MEMO T0:
MEMO FROM:
Nasim Qureshi, City Manager
James Robinson, Planning Coordinator�
MEMO DATE: March 6. 1986
REGARDING: Declaration of Covenants for Fillmore Street
(��(.d�`t�
����a � �
Attached is a declaration of covenants for the zero lot line duplexes on
Fillmore Street N.E, and the Action Taken Notice which stipulates this action.
On October 7, 1985 the City Council officially approved a lot split request,
L.S. #85-07, to allow duplexes with zero lot lines on Lots lA and 16, Block 1,
Iwen Terrace, to be split in half and also Lot 2, Block 1, Iwen Terrace, to be
split in half and Lot 3 to be split in half to allow duplexes to be sold
individually.
As a condition of the subdivision the City required a declaration of covenants
which covers such items as building uses, insurance and maintenance. Execution
and recording of this document is standard policy with zero lot line affairs.
On October 23, 198� thE Mayor and City Manager executed a declaration of coventants
for this project. Due to a problem with some white-out on the signature page,
it will be necessary to re-execute this document. Once signed, the City Clerk
will need to affix the Fridley Seal.to the signature page,
JLR/dm
M-86-46
cc: John Flora, Public Works Directorv"
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CITYOF
FR[DLEY
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
June 18, 1986
Kenco Construction, Inc.
10666 University Avereaie N.W.
Coon Rapids, MN 55433
Re: Final Inspections at 5586 & 5588 Fil]snore Street N.E., Fridley
Dear Sirs:
The above units were inspected on June 16, 1986 and the following items
were noted which must be completed before the structure can be finaled:
1. Provide sod in the front and side yards by July 31, 1986.
2. Provide house numbers on structure by July 31, 1986.
3. Paint beam in garage to provide fire protection by July 31, 19E6.
4. Provide verifyinq surveys on both sites by July 31, 1986.
We will expect the items to be completed by the scheduled date when a
reinspection will be conducted to determ.ine complianoe. If you have any
questions on these it�s, please feel free to contact me at 571-3450.
Sincerely,
DA G. CLARK
Chief Building Official
DGC/mh
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CITYO�
FRtDLEY
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
June 30, 1986
Kenco Construction, Inc.
10666 University Avenue N.W.
Coon Ra.pids, MN 55433
Re: Final Reinspections at 5586-88 FilLnore Street N.E., Fridley
Dear Sirs:
Reinspections were made on the above two units on June 30, 1986 to determine
compliance with our letter of June 18, 1986. The following items were noted
which must be completed b.efore the units can be finaled:
1. Provide the City with copies of the verifying surveys by July 31, 1986.
2. Pai.nt the �am in garage tA provide fire protection by July 31, 1986.
We will expect the above it�ns t,� be completed by the scheduled date when a
reinspection will agai.n be conducted to determine compliance. 'I'he units are
approved for occupancy.
If you have any questi.ons on these items, please feel free to contact me at
571-3450.
Sin ely,
DARREL G . CIoARK
Chief Building Official
DGC/mh
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Clllf OF
FIZIDL�.Y
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
August 4, 1986
Mr. Kent Roessler
Kenco �ns truction Inc.
10666 University Avenue N.W.
Cbon Rapids, rMI 55433
Re: Final Ins�ction at 5586-88 Fillmoze Street N.E., Fridley
Dear Mr. Roessler:
A reinspection was conducted on July 31, 1986 t,o dete�ine comp7.iance with
our letters of June 18, 1986 and June 30, 1986. The inspection noted that
the �ollowing itens are still incomplete:
1. Provide the City with. aopies of the verifying surveys.
2. Paint the beam in garage to provide fire protection.
We will expect the above items t� be completed by August 15, 1986 when a
reinspection will aqain be conducted to detertnina compliancae. Failure to
c�plete these items by the scheduled date may result in this matter being
turned over to the City Prosecutor for his legal consideration.
Please feel free to contact me at 571-3450 if you have any questions on these
items.
Sincerely,
L G. CLARK
Chief Building Official
DGC/mh
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CHIlVINEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1.
2.
3.
4.
5.
s
7.
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Has been carefully examined
Is free from nist or deterioration
Has no foreign objects lodged within
Is securely supported
Meets all current Code requirements for size
and total BTiJ's connected
- H�ss totai �a�ing B'FU's o€
au or�er BTU°S
TOTAL BTLT's
Has a liner been provided for water heater
Has combustion air been provided for water heater
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
Yes ( �) No ( )
Yes()No()
Yes ( ) No ( )
YesONoO
Yes ( ) No ( )
Yes()No()
Yes()No()
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FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
Apri120, 2004
Mr. Dan Janson
5586 Fillmore St NE
Fridley, MN 55421
Re: Final Inspection at 5586 Fillmore St NE
Contractor: H P Pipeworks
Dear Mr. Janson:
A plumbing permit was issued on February 5, 2003 to install a water heater at your
address. According to Section 4715.2800 of the State Plumbing Code, a final inspection
shall be conducted on the work authorized by this permit. As of this date the inspection
has not been requested.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Code. We will keep your permit open for another 30 da�s and if we do
not hear from you within this time to set up the inspection, we will mark the permit "no
inspection called for by homeowner after notification" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
DJ/mh