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AF - 45634n � n City of Fridley, Minn. BUILDING PERMIT ��; � March 7, �fa 1969 N° 10126 ����o� � 3 p�: Lawrence Prichett g��r _Clemron, Inc.._.��.___.._�_� _, pdd�ss _______. � .� Address �+�+11 Centra�Ave •$, E. LOCATION OF BUILDING No, 7517� S�t ._._„ He�e s S t. N. E. _____,_.._..__ Part oi Lot Lot ? __ Biock 2 Additioai or Sub-Divisiaa► ___Don's Sth Addition i � i Corner I.at —_�..__._ Inside Lot � x —._.._ Setback 35 �_ Sideyard _ 10 5 Sewer IIe�,atta�, ,.� 885 .97 _. _� 888.97 Top of Footing DESCRIPTION OF BUILDING To be vsed as: Dwelling, �t 40' �p� 25' Height ?�� Sq. �'k 1000 �, r-t, 20•000 GaraF e.._._...__.� Fr�t ?��..�.. Depth 23 �.__ Keight 10' ___ Sq. F� _46 0_ Cu. F't _ 46 00 Type of Constructi� _.._.Frame�.��.._.__. Est Cost _.. $21,.000_._...__._._. To be Completed _..._...._._.r...:._..� SBWER LOCATION - 94` South of Manhole WATBR LOCATION - 10.2' North of Sewer In condderation oP the issuance to me of a permit to co�struct the building d�cribed abave, I agree to do the propo�ed work in acxordance with the descriPtioa above set farth and in c�anpliance wlth all p�avidons of aadinances oi the city o! Fridley. /��—'\ A �100.00 Sewer Conne�fiotL6iiarge In ooasideTation oi the payment of a fee o! �_.._ 3�T.00 _.._.., peTmit is hereby gi�anted to Clemron�Inc . to c�atruct the building or addition as described above. Thiap�ni t ia granted upon tt�e express conaiac� rhat theperaon to whom it is granrsa ana his asenta emplorees and .nrl�, in su work do�e in. around eud upon said buildix►8� or any part thereof, shall cwnfa�m in sll reapecta to the ordinaaces o� FSridley, Minneaota locatfo�, constructioe�, alteratiou, maintenance, repair aad. maving oi bu�lclin�s withiu the dty limits�� permit may be revo�Ced at aqy time upon violatiar► of at�► a[ the P��� o� said ordinancea � �� n .,�A / � i� Official �� NOTICE ihk p�esh doa not eewr Nw w�ulndie�. hafaqMion fw MrteiM. P�W f+� �. aw�e er wN�r. M wn N s» �� M�qoe for s�p� PN+�ib Ior fl� il«lu. � S ��.-����-� Y APPLICgTION FOR BIIII.�INC PII�MIT C?TY OF F&IDLEY, MINNESOTA ot�i's NAME I�aawr�ncs Priai��t BIIII�DSt Clomron, Iac. an�R�ss e�sl�.li.11 c�atral Ave. N.E. IACATION OF EtTTLDING N0. 'jS1T STREL� Hi� 3tre�t IAT 2 BLOCK 2 A'�DITION OR SIIHDI1iISI0N CQRI�F� I,OT INSIDE LOT X SETBACI��_SIDEXARD 10� S� EI�fATION TOP OF FOCTING Kinw 5' Applicaat attach to thie form Two �ertificates of Survcy of Lot and propoaed building locatio� drawn on thc�e� Certificates. DESCR.IPTION OF BIIILDING - To Be IIeed Ae : Saale as 7500 H8r i R�sideIIae Front �I.� Depth �5 Height '$' � �' �quare feet 1000 Cubic Feet �. � ¢'""*`°"`� Qaraa� Front 24 Depth 23 Height •+��' / Q Square � eet 1160 Cubic Feet ��1 0 G Type of Conatruction Fr�a Eetiu►ated Coet 21, �OU.00 To Be Completed 7-15-69 The undereigned he�eby makes application for a permit for the work herein apecifie�'agreeing to do all work in atrict accordance with the City of Frid Ordi.nances and rulings of thc Depsrtment of Building+a, and hereb eclaxes that all the facts and i�;�ree ' ns etatEd in this apgiication are true and correcto _ DATE �-6•-69 � (Schedule of Fee Coets can be fourid on the � 137,��' � ��- � � �, �� .� ide.) j,--�,, , � SC.. ,G � , r� � . -. ;,.,�., _ � - _ ,� • „ ,e B[JILDING PII�NlIT FEE SCAE�III,E S��TIO�N 2. The Inspector of Buildings shall, before iaBUix�g perciita for the erection of any building or atructure, or for �.ny addition to any existing etructure or building, or for an� alteration or repsire to way exiati�g building or etructure, upon application therefore, require the payment by the applice,nt for auch pernnit of fees to the amount herein .. bolo�r aet farth and in the manner herein provided to-wit: IIniform Buildix� Code_ Type 1, 2, � 4. -�1.75 for each one thoueaad cubie feet, or fraction thereof, in euch cubical cpntents. Type 3� 5_ �1.50 for each one thousand cubic feet. For the puxpoae of computing fees for build' coxltent'e of ar�y build' �8' Permits, the cubical multi 1 �6' or addition to a uniform height throughout hy p ying the ground area covered from a point six (6) inchee below the floor line of the ba,sement or the cellar to the aversge height of �he upper eurface or to the average height of the roof surface of the mai� gable of a pitched roof. For xepairs or alteratione to an existing etxucture, the fee ehall be at the xate of �3.00 per each iive hundred dollare (=500.00) or frac��on thereof in the coat of abl proposed work. Ix� no case sha,ll the fee charged for any permit_a8 eet forth in Section 2 be lese thexi �S.00o NSSSD Coxinection Charges ba,�ed on location - Area 1 or 2. . � 8" . ` � � � L L �'l .9+r �. . t.:.,. . , . �, . . ._ f . ,.e +�: , � ,��� �ar-�=::� . . . "`.�'�:���',' , � :� " . ;.�,, , }, : . r��y an��j�cr � r�s�y,� , �u. `,: �s�� ENGINE�R�l�tfl�►, tNG. . ,�°� cxN�.b,►�.�;�� sa��aori ., �� — En ineers � Surve�rars -- . 9 C��"�1f�olt/ /N�: �; * � ��r�rt��cste o� s�as�►e �•: �-::f , --�--�. F�,�. .� . _ � ,.:� r. .. . . � � . . . 1 . . y � - � . Y � l� QRT N � � :� �, t-- �J ll� L.L:. : . � -.m, . �. . �� �--- "! -" .P .,� r � � � r � M p ' . ... , � �O i � r .. � _- � r t � . I . - - . . ��:5 v ! 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' � . � � �;�`�<4'lxr�. . .. _-..T„ .. ; �_��,. ,��. _. . . ... .. .. ._ . .. _ z ._ _ _ . . SUBJECT P City of Fridley " � .� � � 5 � AT THE TOP OF THE TWINS B U I L D I N G P E R M I T ` t r � � RECEIPT NO • COMMUNITY DEVELOPMENT OIV. � �y------- � �PO r � � PROTECTIVE INSPECTION SEC. 1 � , � �'��1 ' CITY HALL FRIDIE� 55432 NUMBER NEV DATE PAGE UF APPROVED B� �""'�" ,'' 612-571-3450 910-F15 / / 4/10/95 J08 ADDRESS 7517 Hayes Street NE t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED oesca. 2 2 Don's 5 Addition SHEE7 2 PROPEFTY OWNER MAII ADDRESS ZIP PHONE Jon/Lynda Neumann 7517 Hayes Street NE 785-2587 3 CONTRACTOR MAIL ADORESS ZIP PHONE LICENSE NO Same d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION O__ REPAIR ❑ MOVE O REMOVE X 8 DESCRIBE WORK Reside House 9 CHANGE OF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION ZONING SQ. fT. CU. iT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANOONED FOfi 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 EXAMINEO THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION SURTAX AND OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT � 1� SOO �. 7S DOES N PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEI THE pERM1T PEE SAC CHARGE PROVIS S OF Y HER STATE OR LOCAL LAW REGULATING CON- STRUC 10 OR T P FOFMANCE OF CONSTRUCTION. �35.0� Fire SC �1.5� � � �� PLAN CNECKFEE TOTALFEE $37.25 ATU�7E OF C �AACTOA OR AUTHOAIZED AGENT IDATEI HEN PHOPERIY IIDATED THIS IS YO R PERMIT � � U � - , SiGNaTUREOFpWNERUiOWNERBURDER� iDATEi BLOG S� Di7E i � �� 'v NEW ADDN AL'('ER 11 II l� Construction Address: Legal Description: C[TY OF FR[DLEY S(NGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Ap�lication ' � I�l N�v� s ��f.��- Owner Name 8r. Address: ��J �, �.\//�1Q,A �V rLU1'Y�l1V Tel. #� Contractor: Q� (�1 �.� �(��J��. MN LICENSE # Address: '�-M e. � �b i��J � Tel. # Attach to this application, a Certificate of Suivey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Length Leagth Length DESCRIPTION OF IMPROVEMENT Width Width Width Height Height Hgt/Ground Effective 1 / 1 /95 Sq. Ft. Sq. Ft. Sq. Ft. �Z�� Corner Lot [] Inside Lot [] Ft. Yd Setback . Side Yard Setbacks Type of Construction: �; �� n o ��� ��; $ ��p p � o O Approx. Completion Date: � � �� � (Cost on Back) Driveway Curb Cut Width Needed: Ft. + b Ft = Ft x$ DATE: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: APPLICANT: $ �- o c� $ �, �v $ $ $ $ $ $ $ , _"'= -�=�� CITY USE ONLY _$ Tel. # Fee Schedule on Reverse Side .001 of Pernut Valuation (1/lOth9b) S.SO/$1,000 Valuation $850 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determ�ed by Engineering Agreement Necessary [ ] Not Necessary [ ] _ � _.... _v ItUlt.l)(NG 1'l:KMt"1' I�EI? SCtIE[)ULI: I�h�� Cl�i;:t i3uilcliii}; Ul�ticial tihall, (wlorc issuing �x;rinits for tfic erc;cticm of any huilcling or �tnicturc, ��� t��r any a�lciitiuri tu any cxisting buildinl; or struciure, or lor arry allCration or rci�air to any cxistint, (>uiliiing ur structurc, u�n d�i��lication thcrcfc��e, rcyuirc tfic paymcnt by thc ap�licant for tuch Pcrmit �>1 tc:c� tc� ttu: amount hcrcin bcli�w sci 1<��th and in tl�c ntaancn c�rcin ��roviclul tc�-wil: �ro���n�_ vnr_ut: � 1 co $500 $501 to $2,000 �2,001 to �25,000 $25;001 to �50,000 � $50,001 to � 100,000 �i00,001 to $500,000 $500,001 to �1,000,000� � $i,000,001 artd up rr�;s $15 (Minimum Fcc is S15 plus surciiarge) $15 for first $S00 plus S2 for each additional $100 or fraction thereof, to and including 52,000 - $45 for fust �2,000 ptus $9 for each additioaal $1;000 or fraction d�exeof, to and including $25,000 � - $252 for fust� $25,000 plus $6.SQ for each additional $1;000 or fraction thereof, to. and including �50,000 .- $414_SO for first $50,000 plus $4.50 for each a�iditional .$1,000 or fractiou thereof, to and including $100,000 $639.50 for f�rst 'a 100,000 plas ��i.50 for each additional � $1,000 or fiac6on �ereof, to and including -$500,000 $2039.50 for tt� first $500,000 pins $3 for each additional $1,000 or fraction thereof, to and including $1,000,000 $3539.50 for the first $1,000,000 plus $2 for each additional $1,000 or fraction thereof - DRIVEWAY DEPRESSION ESCROW (Concrete C�u�b Streets Only) Alternate "A": Removal and re{�(acemait of curfi and gubter only - Dci�eway width plus 6 feet times S13_S0. Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width pius G feet times � 15.75. V L• Rl F[CA"CION Or FOUN DAT[0[Y Permits for cor�suuction will be issued a minimum of 24 hours from the time of ap�(ication to allow for proper rcvicw of tt�c� proposcxi str�ucturc and of thc construction site_ A Certiiic:atc oC Jurvcy of tlie lot, showing the location of dic founciation once it has it has t�ccn constructe�i will bc rcyuire�cl i�efore procoedi�g with the framing. " _ s� � y* m � � Z � 0 � � � � � m � � n � �• � O vyi, � Z N O '71 � c, __m -.. � m � � � O v � O O � � . �� � _ �� n � oq �p '� Q' o �. m °' � a o `D � d � � ,Q. - � S a c � n �-' O `�o � p� � � o �, � � � m a C o � � oi �. � �. �. 0 � O � � � � o � d a e r � m � . r^ ..� n� m � � i� �, � y � L7 G� D�� � O � N N t�/1 0'Z N n. � Q � � = v � � � � � A � � m � � o � c�n . � m � tn °1 � � � � � Z � ip cu o �. �' '"' � � � � > > � ^ , o � �? Q -p � � � �. _ '�1 � — c n�' D � -fDp � p � � ? � cD � � � � � � p o .� �• m �` o m. i c°'i � . O v' ��v � � � 7 � �c r � � � � . � o . z � D c� � `-' � � t� � c� N � ►-� f-+ W . cn o 0 0 0 °o °o °o °o °o �' � ^�7d�f� W Q W � 1--� �� � � � W z m � � ptn�� '� � �' `� � rn w � (/1 . . _ N cD Z S rnm v � c � m ° Z � C � a � -o z 4fi b9 <J9 {�A b9 69 b9 O _ � D _.... ....:. ..:.. ... ':._.._.._ . .: � .,r �.._.._. , a_. � cn = ro� v, -a oo W ..� o� -i z rn W � � v x .� �^ . c!� � �• m m C � m .0 � :° . � .. .0 D � � Q ={ � `v°, � = � m m ° � H � .� 3 v 2 D a � z a � ,.���. � .n- m � � m -i z W � n g= � ..« � . � n� rn G� � rn�rr�� o m°� 04� o' �= p C �j `D o� p (� c1� do �� c�i y W�' Q aZi • C I'*t O m N- ��� � � S � � N � 0 '�'� � „�,f a .� fp �p .-r D � Z �p � O � tn (n �J1 � �-j � Q � G. '� � `-� p o .c -1 � ����y y � T. ,Z CJV � �p �� � O y = p � C7 � � ( �� �, � �, � � �� ; �7 Q " �p �- �. � � � � � \ y "�'D � ? � n � � / � � �. � fi � � � m -°: `< °' � � c�n �' � �• a � Q� O N fl' (nN Z 'U � �"� N O� � r N� I'r'1 , C.�..fl-� .Z �. � � _ %A „. - _ . , � � .� ... .. T m-� �.o o. Q�Z,. _ .. .. � . . � v' cD'� �' � O � �... � � � . � . �. . . : Q � ..> . ,..' ._ ...•..�� - . .. � �.,�=r er:, . .. � . . 1. : . . n :A1 � . _ �. r TJ �. � O., "' � .'�+� � , . _ _ . � . � � • ._O - . i.., Q ^ . ,� _ 'rr � m ' �.. ; , .,. . . . . � .� — ,-r '-r , y� -. . .., � , � �� .� 3 : �. , . �.. . � . .'�. . "� fD Ci_ � �`i � . d � �' � �� o '� j� N � � � � � �'�� � � G. v' � D N �. v � �o r � � �O �Z RI .n. � a o ..., � �L O O 3 Z�* Z � > v aD � Z .. Z Z �v o= Z�-�� .. . N � -y.l C� mp N Z Z � �m vZ C � �a N O Z rn m n .� < r �CD �'� ,7 ` - :� -_ � � � N O O N THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED -- -.�. G�MMnN VFNT, VENT CONNEGT(�R AND GnMBI IST1C)N �41R VFRIFIGATIC)N =� V1/h2t1 rp��inq an QYistin��rance, the undersignEd heref�y verifies that the ; ' ` �:. �° venting has_tieen eX�mine� and=is free from ,ri;ist, deteHoratior�;-obstructions, i� :_ and is secur.eiy supporEed-�ria firestopped wfi:ere req�iired -� Yes O No (.) : ' The Venting system is plasticJPVC and meets all current codes and manufacturer'" ��� : specifications including sizing; length, number of elbows and termination. ` Yes (�o O 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 natur�t draft �ppliance�, ;� Yes (�lo O The existinq ceme��on a�r is sized and installed to meet the current codes •�,,�,and manufacturers speaflcations. Yes ( ) No ( ) � r� �. Whe11 t`equll'ed to inc�ll a new remb �ctien air�it wi11 be sized and installed � to meet the current codes and manufacturer's specifications. When inc allinA a n_w v_n in03�, the undersigned hereby verifies that it is a listed assembly and meets the current codes and marwfacturers sp�ecifications. This does indude AGA-GAMA Category I Central F�imace V+snting 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 (�o ( ) `.'-. Yes (�� o ( ) �.. .� ..- .�. - .���e.. -� .�. -.� .�.-.,. . ..��. .. Applianae #1 Type � �� BTU Input CQ � o o� Fan Assisted or Nat V� Appliance #2 Type �YL Nr(rl � BTU Input-��a Fan Assisted or Nat Appliance #3 T�pe -- BTU lnput Fan Assisted or Nat _ Total Appliances � Total Btu'Input � o U ° . �� Common Vent Type -e C �.(�,2� 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 v� Appliance #3 Vent Connector Height ft Length ft Diameter in Type � 1 _ 1 • ► �.- � .,- HEATING CO: ���f �0 �,� ��7�- . � . Signed By: Date : l o-��- � Z_ �"��� � l ...a' „. �:. ..�.;�z�---,,F..:,,..: _�.:.e,,,�M..-,«�..>.��r..-�r.�HS,.��.:raw�•. �.�rs+wu��»r:��.�;�;� ; .- ..., ,.._..- ..x_ . .. ....... .... . . .. . .. . � '.5 GAS WO�C..ORDE.R . _ . _ . . ,:; 1082 Payne Ave. STANDARD 4�o W. Lake St. St. Paul, MN 55101 Minneapolis, MN 55408 651 /772-2449 b HEAT 1 NG � 612/824-2656 & AtR CONDITIONING A Blue Do�: Service Co. EQUIPMENT INFORMATION LAST Z/�cLi o�,'a c�_ FIRST --�r��c TYPE �� AUDKt55 ��--i � �jfc�-.� s s t- �r_— cinr F�. �r-�� ziP �� HM PH "7G ?c!8 3 �G y WK PH , TECH ���e �r �- ✓t DATE /U --�' -c CO2 S' - 9' �6 02 j'.9 % CO (� °�6 NET STACK TEMP rU � MAKE ' �'3 MODEL ; �g-�,o G G ` ��tIAL Q 't_ 2 \ INPUT ORSAT TEST RECORD METERED INPUT L� U Cfh CHIMNEY TYPE LIMIT SETTING �vCJ ° FLUE SIZE v PILOT OUTAGE � sec CONNECTOR SIZE � TOTAL CHIMNEY INPUT � �Y. .� ✓ � ” in. �� � r III. G//J �'J!'1C� btuh C� � N � Z D � � � r W m � � S v m v � m � c � � m ___�__ _ O z cn � ,-. D Z v D � r m rn � n � O Z � z � Z 1'1 0 0 Z � n � � O m 0 D r � m m � � D :U ���. � � N o = N � 7 c � � o z m -^ v � �� `D m i �..°�� D C � � . cn � °� D c �v � D � r m � 0 z � D cn � Z � v � � � . O c � � � v °.' m 1� �� d Z � o rt � N � 0 � fq � n W GO Q Z � ��% � L11 :11 Cl C�. rt �� G. � r �i C1 N V/ rt.+ •� 3 7 C1 �� � C �` �v�`�° � �v �D�o-,� � c� � � � _ � � �p � � � � W �p Z � fD .��. .�. N �p � N' pWj � � � �i 9 � cD o x c�u c� � z• r �n. �, t° �n — � � � c� � � � c� Z m cn m N `� � � � � � * c�i' � � T . .� _ . m � 1 . � .. _ .... .... . . . ... �. . . . � � '� � .:.. .. ..... ,.. - m � v z 0 I I I�I I I I I I I( I � � cr o° '� r c 3 W z � ci � � D .'C � � ba ��n �� t�r+ t�► t�► t� tr+ tfl O O O V p V V�I �1 (l� A�I o c o-� o-c a-rs o-o -a a_ 0 0 0 0 0 0 0 0 0 0 0 0 m 3 �' � O w �0 � m � � -�1 � 'a � C cyD a � � a� � � a � m � � n� N D rn � � D ^�+ �v�� � � m = D � W � � :iJ N • � m D y N � � (/> � � y � a -� � � m � < rwv�m 5' Z �. O N � o� , i v D � O 7 N . m � --- -- � d � � � a , i � � I � �. � � � � i � i 0 � � � � n�' a w O� C � � �' Z N �� .a. `� N D m Z m y COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existin� 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 O No O The venting:, system is plastic/PVC and meets all current codes and manufacturer specifications .inciuding sizing, length, number of elbows and termination. Yes O No (` ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturers specifications. This does inciude AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appiiances. The existing combustion air is sized and installed to meet the current 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 installins� 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 Furnace 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( ) Aapliance Tvpe and Size/Common Vent and Vent Connector Infonnation 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 --� � 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 : . C[TYOF FR[DLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 Apri120, 2004 Mr. Steve Zacharias 7517 Hayes Street NE Fridley, MN 55432 Re: Final Inspection at 7517 Hayes Street NE Contractor: Norblom Plumbing Co Dear Mr. Zacharias: A plumbing permit was issued on June 30, 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 Codes. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will mark the pemut "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. 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VENT CONNECTOR AND COMBUSTiON AIR VERIFICATION When replacins� an existin� fumace, 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 Fumace Venting Tables for fan assisted and natural draft appliances. The existin�t combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes ( ) No ( ) Yes ( ) Na ( ) When required to install a new combustion air, it will be sized and installed to meet fhe current codes and manufacturers specifications. Yes O _ _ U�Ihen insta�fihs� a new ventins� svstem, th� undersigned hereby verifies that it is a listed assembly and meets the cuRent codes and manufacturer's spe�cations. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () 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 () Appliance Tvpe 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 Tdal 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: (Describel _ No ( ) No ( ) No ( ) HEATING CO: Signed By: Date :