AF - 46795�
.BUILDING PERMIT
Village of Fridley, Mi.nn.
N° 2394
Date 7����......... ....................
Owner My�Ke� , . . . . . . . . . Builder ,.�,,,�?�!CA . . . . . . . . . . . . . . . . . . . . . . . . . .
Address j�}��, , , ���,�,4p .�
Address
LOCATION OF BUILDING
No. . . ��'d. .. .. . . . Street J�!���s„�r,�,i. .. .� . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . . . . .
Part of Lot
.+�.� . . . . � . . . . . . . . . . . . � . . . . . . .
Loi . . .. .. . . . Biock Addition or Sub-Division�� ��;,�'"". ,
Corner Lot .. ... .... .. . Inside Lot . .. �
• . . . .. . . . Setback �� .�'!i , Sideyard �.l� �.�fif."'-�','. , , , , , , , , , , ,
DES�CRIPTION OF BUILDING
To be Used as:
����, R, }r�:+ F. r" .. Front .. °.�,,�:.. Depth L: .,,.....::ei ht z. ,,
�':: ' g .�. .� <<<. . Sq. Ft. . , G 4: . Cu. Ft. . . . . . . . .
a � ::; .,�,�2� . . . . . Front . . 'u. .. Depth . F � . Heigiit . . . .'. . . . . S
. �: ..� q. Ft. . � _ Cu. Ft. ... . . . . .
Type of Construction � �� .�{�(� r'`�:
f.fi ::�.. Est. Cos� �. To be Completed �,,r�'�,�, {�„
�
.
, In consideration of the issuanee ta me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the village of Fridley.
In onsideration of the payment of a fee of $. yf�,�, .,, permit is hereby granted to • • •..
. to construct the building or addition as described above. This permit is granted upon
the expre�ss co�� �at the person to whom it is granted and his agents, employees and worlunen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
F'ridley, Minnesota regarding loca,tion, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ardinances. _ w
..... Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
` HOUSE �HEATING� TEST RECORD j��7�
r✓ ..,
' ADDRESS ^'� � e APT. FLOOR CITY SUBURB ��1��"�
OCCUPANT '�'�+ � OWNER S �"1'�'it�
HEAT LOSS DATE HTG. INST.
; SOLD BY ���"1� i�CS�rT � INSTALLED BY ��Z �
E)sctrecol Work By Gas Lina By -S�fK �'
iliit{YPE OF HEAT GA FA ' HW STEAM SPACE HTR. UNIT HTR. OTHER
G S DESIGN CONVERSION
MAKE � �-° � a MAKE OF BURNER
Model �aZ � � � AAodel
Serial � Max. BTU Rating
INPUT � � MAKE OF FURNACE
Model
TH E RFt05TAT
Va be
l.imit
Limit Sstting _
Fon Sstting —
Pilot Type _
Pilot Make
CONTROLS
saf Plu9 _
— - --- -�� - - - - _
Venf 5ize
KIND OF LINER /!!AS S SIZE�NONE
Droh Hood �� Reyularor
Fi Iters Size Number
Chimnsy Location Inside Outside
Chimney Construction ��L e
Pilot Model Smoke Bomb Wiring d�
` Pilot Timing �,Z. �t Draft d� Test Tag �
L.W. Cut Off Door Pressure Lighting I�st. U'�
Prossure �� f Percent CO2 � Date Tested ��� "'
Irq�uT CFH � � Peree�t 02 �/ Company Testing ' �� -�
Sloek Temp. Percent CO [�- Name of Tester
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