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City of Fridley, Minn.
BUILDING PERMIT NA ss81
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' L CATIO F UILDING
No. �G����� Stteet � , Part o t
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Lot ._._.�..___ Block ddition or Sub-Divisi � �
Corner Lot � Inside Lot � Setback Js�__._ Sideyard �i� `����°�'�' ��
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Sewer IIevation — Founda.tion IIevation
P DESCRIPTION OP BllILDING
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In consideration o4 the issuancae to me of a permit to construct the building describecd above I agree to do
the Proposed work fn acc�rdance with the descriptton above set Porth and in compliance wlth afl provisions of
ordinances oP the dty of Fridley. ,,r �4 �LO .�/�� / �
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In conafderatian of the payment of a fee oP ��, permit is hereby granted to
to construct the buflding or addition as described above. Thia permit is granted upon
the express c�ndition that tbe pereon to whom it fs granted and hia agents, employees and worl�nen, in all work
daae in, around aad u�n said building, or anypart thereo� shall c�nform in all respecta to the ordinaaces of
Fridley, Minnesota regarding location, conatruct�on� alteration, maintenaace, repair and moving of bufldings
ordinan� dty limits and tbis permit may be revoked at ��u� violati� of aay of the Proviaiona oP said
� O/
Ins�ctOr
n NOTIC�
'tids permh do� aet ea�sr �6s constrneHoe. leshllatloe �e� wtria9. P��e. 6a 6�adng, sewee er w�tsr. 8� wro fo ses
t6a &rlWt� le�etoe hr apual� parm6a /or th� h�.
APPLICATION FOR BUILDING PERMiT
CIZ`Y OF FRIDLEY, MINNESQ'TA
OWRTER' S NAME
�/
ADDRESS �✓� � Ca ����e�t-M.r� �-�-!' • � � aV ADnRESS .� � a�- �a �'�( • % �.
%��' /� ;�.�
LOC�iTION OF' BU�LDING
No. Street % � � �it . �� `� _ part of Lot
�'
Lot Block Addition or Subdivision
Coraer Lot Inside LoC Seeback S�Lde Yard
SEWER ELEVATION FOUNDATION ELEOATTON
Applicant attach to thia form Two Certificates of Surveq of Lot and pxopoaed build-
ing locaefon drawn on these Ce�tificatee.
To be used as;
DESCRIPTION OF SUILDING
Front Depth Height
Sq. Ft. Cu. Ft.
Froat Depth Height
Sq. Ft . Cu . Ft .
�
Type of Construction Est�maCed Co '
To be Completed
The undersigned hereby makea application for a pesmit for the work herein specified,
a�reeing to do all work ia strict accordance with the Citq of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in this appl3catioa are true and correct.
DA�'E � l 6 3 S IGNATL11iE (.1/��`'i`'�.�C.. /" v'"^-°-�"-
(schedule of Fee CosCs can be found on the Reverse Side).
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BU�DZNG PEItIaRT F'B� SC�iEDULE
SPGt3on 2. The Inspector of Buildings shall, before iesuing anq pex�it for
�h� erect�.on of anq building or atructure, or for any addition to any ex3st-
ing buil�ing or structure, or for any alterations or repaira to any e�is�ing
buildiag or stcructure, upon agplication therefor, require the paymant bq the
applicant for auch permit of fees to the amount herein below set forth and
in the manner here3n proeided to-wit;
2.1. For any such permit for the erection o.E any fire-proof building, othes
than a gasage� warehouse, factory or grafn elevator, or fos the erection of
any fire-proof addition, for sim�lar occupancy, to any eaciating building
shall be at the rate of $1.40 for each one thousand cubic feet, or fractioea
�lnereof, in such cubical coatents.
2,2. For any such permit for the erection of anq fire-proof garage, warehouse?
faetory or �raia elevatox, or for t&e erection of any fire-proof a�iditiea,
for similar occupancy, to any existing bu3lding shall be at the r�te of $1.25
for each one thousand cubic feet, clasaified as t1fireproof" by Sectiais 502 of
the r:inaeapolis Building Code. �
t'�USES
2.3. For anq such permit for the erection of any non-fireproof buildiag ot�e�
thea a garage, warehouse, factory ar grain elevator, or any non-fireproof
addition, for similar occupancy, to any esiating building - permit $1.00 far
each one thousand cubic feet.
rAL�A�ES
2.L¢. For aaq such permit for the erection of aay non-fireproof gasage,
w4rehouse, factory or grain elevator, or for Che erection of any noa-firepro��`
additioa, €or similar occupaacy, to anq existing building or for each such
bui.iding or addition - ninety cents ($0.90) for each one tl�ousand cubic fee�
or fraction thereof, ia the cubical contents thereof with a miniaQUm of $4.00.
For the purpose of compueiug feea for building permits, the cubical contents
of anp buildiag or additioa to a uniform height throughout by multiplying tTie
ground area covered fram a poimt six (6) inches below the floor �ine of tbe
basement or cellar to the average height of the upper eurface or to the
average height of the roof surface of the main gable of a p9.tched roof.
2.5. For repairs or alterations to an exiating structure, the fee shall be
at the rate of $3.00 per each Five fluadred Dollars ($500_OOj or fraction
thereof in the coat of all propdaed work.
2.6. In no ca�e shall the fee chargad for anp permit as set forth in
Sectian 2 be leas than $4.00.
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3300 LYNDALE /tVE. SO. MINNEAPOLt$ �: HHI�I.
TAYLOR' 4A370
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I hereby eertify that the above f� ee tru� ana correct �let 'af a su,rvey oti �� " �
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Lot Si�etecn �16}. �3�c,�sk Four �,t��. OSTlL,AN�S �iIRD AAI)ITION� An.oka County, A-,gnnesota, ,
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4s surveyed by me thi:�r lOth day of D�sy 19K8 a�n�
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HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS NQNNEAPOLIS, NIINN. �
Weatherstrips A.S.H.V.E, Construction No. Insulation
Guide
Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof F1oor Kind How Applied
Yes—No Yes—No 19_
�
Fl.� � s ��,�,� Room � Length � ,� ` Width � � Height a� � Fl ���,�,�;a����` Room Length �, ;;:.� Width � * ° �:,,, Height � '
Windows an Doors—Crackage and Area � Windows a d Doors—Crackage and Area
�Vldth Height No. of Llneal f. Area Wldth Haight No. ot Llneal ft. Area
No. - of pane of Dana Ilghte ot crack eq. ft. No, of pane of pane ligbte � of creck eq. ft.
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Inhitration
Glass
Exp. wall � � �t; �y
Net exp. wall
Int. wall
Ceiling
Floor ,
7'otal Btu.
Required sq, ft. E.D.R. or sq. ins. W.A. Leader area
F7.� �`� �'�, d�+a�-�`Room � Length �°� �;�: Width :�'
Windows and Doors—Crackage and Area
Wldth Hefght No. of Llneal Lt. Area
No. ot pane of pane Ilghte of crack eq. ft.
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Ceiling
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Total Btu.
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Coef. Btu
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Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
� FI. � _ �� �` s � � Room � Length ''� �' Width ��
Windows and Doora—Crackage and Area
Wldth Height No. ot Llneal ft. Area
No. of pane of ane llBhte ot crack e9• ft.
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Total Btu.
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ired sq. ft. E.D.R. or sq. ins. W.A. Leader are�
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Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FI I�'_.."� �"����;� ' Room � Leagth ;:� Width ��'`M
Windows and Doors—Crackage and Area
Wldth Height No. oL Llneal ft. Area
No. ot pane of pene 1lghte of cre.ck eq, ft.
Infiltration ,��
Glass ,�'' �`� r
Eap. wall '� ;� ::� ';�r
Net esp. wall � �`'
Int. wall
Ceiling
Floor � � �, ' ?� �,
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader aree
Fl ��;�:�`�,� Room � Length ���;. Width �' n
Windows and Doors—Crackage aad Area
Width Hefght No. of L1nea1 ft. Area
No. of pane ot pane Ilghte ot crack ea. tt.
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Net exp. wall gs �
Int. wall
Ceiling
Floor
'fotal Btu.
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HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS. MINN. i
Weatherstrips A.S.H.V.E, Construction No. Insulation �
Guide
Windows I Doors Reference Out. Wall Int. Wall Geiling Roof F1oor Kind How. Applied
Yes—No Yes—No 19_
' Fl.� � - °'�� Room � Length - - Width ,� �'., Height `�' °� Fi � `� _ Room Length g�+ �"-,: Width �',�, Height ,�
,, _ .
Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area
�Vldth Helght No. of Llneal f. Area Wldth HeiBht No. oY Lf¢eal tt. Area
No. of pane of pane llghte oY crack e9• ft. No. of pane ot pane 11gLte of crack eq. fG
�s
� _ �r'� ,' ,✓:.. ,.. ,. . �'�.6: e:, `,�t, .A « :i :� ,Fw ' ll . _ n a?'_
Infiltratioa
Glass
F.sp. wall ',
Net exp. wall
lnt. wall
Ceilin� � y�
Floor
°fotal Btu.
Coef. Btu
�� _,� �
, -� �. .,-� :g I
Required sq. ft. E.D.R. or aq. ins. W.A. Leader area �
� F1.� ,�; Room � Length Width �' Height
Winaows and Doors—Crackage and Area
Width Helght No. of Llneal tt. Area
No. of pane ot pane IfBhte of crack eq. ft.
Infiltration
Glass
Exp. wall , ' ,�;� ;;�
Net exp. wall �
Iat. wall
Ceiling `' :�;� a�. 4
Floor
Total Btu.
.oef. Btu I
;�
, ,. �, .w;,�'
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area __
;r.; F1'�� � n�,�,; �� Room � Length ,�,� Wic
Windows and Doors—Crackage and Area
Wfdth Helght No. oL Lineal ft. Ai
No. of pane of De.ne Ifghte o[ crack eq.
� � %� C� �i
� � � �
_�
'!
In6ltration _ „=' �'
Glass
�p. Wau
Net exp. wa
Int. wall
Ceiling �g;�
—T
Floor
Total Btu. :
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
�
,�
i�hc �
Btu
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,��;�;:i
�
� `�
„ �
� Coef. Btu
In6ltration �' =�` �",,'.� `�
Glass - ,� `�•�� �.�
wall �' "
�P• � � ,� _ � '�' � '
Net esp. wa1D �' _ }" �•
Iat. wall � -
Ceiling �r °,?��,. �� � - �:�
Floor �
Total Btu. _' . ��
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
,�"; Fl � , �: `"� �"� Room ( Length � � . Width rr� ;�.`,, . Height :�
Windows and Doors—Crackage and Area
Wldth HefBht No. o! Lineal ft. Area
No. ot pane o! pane lighte ot crack eQ. ft.
'lr k .. �� «�
� r".. g; `` � ;y
Coef. Btu
Infiltration - � ;`�" �� � -:w�
Glass . � "'�� ,� `*�`�,
Egp. wall �. �.'',�.= �' `��i
Net eap. wall _ � �, „<> �:,
Int. wall
Ceiling �� �, �'��',�. � �� - a�?.
Floor =
Total Btu. '"°�`� �": �`
_- = .�:.:.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
�'t_ F1 ��`,;- � a'�"��' Room l Length �' �e Width ,�A.�r Height �?
Wiadows and Doora—Crackage and Area
Width He1Bht No. af Lineal Pt. Area
No. of pane ot pane IfBhte ot crack ea. tt
,, � ?�., ,� � -
�r �
�?' - �,i! .4':. � r: � ; -
Coef. Btu
In6ltration ; � �.�;;�:�'�
�
Glass �,' H��, J '� �`,
Eap. Wall � r °�,
Net exp. wall ,� � _; �
'���� , r�,
Int. wall �
Ceilin� - x � R : ;:a ,., � ��
Floor
Total Btu. �`'��:�:� �;,� ; _ � -���
Required sq. ft. E.D.R. or sq. ins. WA. l.eader area
sue�ecT pE
c�ty of Fridley 19 4 71
AT THE TOP OF THE TWINS g U I L D I N G P E R M i T
i�
� � .
� • COMMUNITY DEVELOPMENT DIV.
' j y � p
r � � PROTECTIVE INSPECTION SEC. �O ���
l� i �
•--.� ��"�',,j CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE Of APPROVED BY
i 612-571-3450 910-F15 5/13/88 / /
JOB ADDRESS 6912 Hickory Drive N. E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION
DESCR. ]„6 L.� OStII13I1�S Third Addition SHEETTACHED
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Geoxge 6912 Hickory Drive N.E. 571-5789
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
D& D Home Tniprovement Inc. 7401 Central Avenue N.E. 784-7543
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDIN(3
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑g REPAIR � MOVE O REMOVE
8 DESCRIBE WORK
Reroof Dwelling
9 CHAN(iE OF USE FROM TO
STIPULATIONS Roo� can be 2nd layex but not 3rd. Install ridged galvanized valleys.
G:� a!I new roofs or teae-offs and replacemenf roofs,
S�a�e Coc1e requiees ti�at 2 layers oi 15 Ib. felt,
m;,pped together, be insta�led t� a point 2�! in��es
up from e.ilercor wall line, or 4he use of ofiher
approved underlayment membrane..
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY OROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S0. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. � NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND COHRECT. ALL PROVISIONS OF I.AWS VALUATION SURTAX
AND,ORDINANCES GOVERNING THIS TYPE OF WORK WII.L BE COMPLIED $�OO $.SO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $23.00
�/��� � RLAN CHECKFEE TOTALFEE
�.�J G�.'��'� J /�- �'� �s . � $23. 50
� SIGNATUREOFCONTFACTOf70RAUTHORI2EDAGENT �DATEi WHEN PROPER�Y V ATED THIS IS VOUR PERMIT
a_
S�GNATURE OF OWNER i�F OWNEA BUILDEAI IDATEI � � J
BLOG �NSP aTE
I�rl [ ]
ADDN [ ]
ALR�R �
Gbnstructian Address: �' / /
Legal Description
City of �icAey
R-1 Ai�ID R-2
Building Permit Application
�
�
EFfective 5/L88
Owner Namae & Address : ,��� c� �`� � � � � � Tel. � � �! � �"7��
Contractor : � �� �ca�,y� � r,�Pi ����r��,�- .�i1C ° 1 Tel. # � � ° �.�
.
Adaress :��� 1 C�'� f�'w.( ��e • f���
Attac� to this application, a Certif icate af �rvey of the
lat, with the proposoed construction drawn on it to scale.
�'.S(RIPPION OF IN�ROVII�iJP
LIyI11� AREA: Length Width Height St�. Ft.
C�,RAGE ARFA: Length Width Height 9q. Ft.
DE�c �: Length � width Hgt/Groima 9q. Ft.
S�S:.
4�rner Lot [] Insicie Lot [�(i Ft. Yd Setback Side Yard Setbacks
7jipe of Construction: h'�5rie�l�_ ��°�CQ�I /��7 Estimatec] Cost: $ ��
Approx. Completion Date: � � � � � �
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: S $
Width + 6' See Back Page
DATE : � = �� -� � APPL ICANP : �-cP� Q,..i��✓
P�ermit F�ee
State Surcharge
SAC Qzarge
Driveway Escrow
Park Fee
Sewer Main Qzarge
Z"OTAL
STIPCTI.�I�IONS:
S �� - �U
S
� ��
$
$
S
$_ �� ��Z�
C1TY OSE �Y
Tel. � °� � � 7��
I�e Schedule on Reverse Side
5.50/51,000 Valuation
5550 per SAC Unit
A].t. °A" OI A].t. "B" Ab�Ve
F�e Determirecl by F�girieering
Agreeaerit Neoessary [ ] Nat Neaessary [ ]
=`_ ) . �. �, ' �+��v 4 ��1 ��:i��. J
The (�iief Building Official shall, before issuing permits for the erection 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 structure, upon application
therefore, require the payment by the applicant for such permit of fees to the amount
herein belaw set forth and in the manner herein pravided to-wit:
�TAL VALUE
S1 to $500
5501 to 52,000
S2, 001 to $25, 000
525,001 to $50,000
���
S15 (Minimtua Fee is S15 plus surcharge ) `
S15 for first 5500 plus S2 for �ch �lditional $100 or fraction
thereof, to and including 52,000
S45 for f irst S2, 000 plus S9 for each additional $1, 000 or
fraction thereof, to and including $25,000
5252 for f irst 525, 000 plus $6.50 for eac,�i additiona]. $1, 000 or
fraction thereof, to and including $50,000
550,001 to 5100,000 $414.50 for first 550,000 plus 54.50 for each ac�ditio�al $1,000
or fraction thereof, to and incl�]ing 5100,000
5100,001 to 5500,000 5639.50 for first $100,000 plus $3.50 for each additional 51,000
or fraction thereof, to and including 5500,000
5500,001 to 51,000,000 52039.50 for the first 5500,000 plus S3 for each additional
$1,000 or fraction thereof, to and including 51,000,000
$1,000,001 a�d up 53539.50 for the first �1,000,000 plus $2 for each additional
$1,000 or fraction thereof
DRIVEfn�Y DEPRESSION E9Q2�1
(Concrete Curb Streets Only)
Alternate "A": Remwal and replaoement o� curb and gutter anly - Driveway width plus 6
feet times $13.50.
Alternate "B": Renoval and replaoement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times 515.75.
/�; �1 � � • ' ��. l� �,: � �I
Permits for construction will be issued a minimum of 24 hours f rom the time of
applicatian to allow for proper review of the proposed structure and of the wnstruction
site.
A Certif icate of Slirvey of the lat, shawing the location of the foundation once it has
been oonstructed will be required before prooeeding with the fraQning.
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CHIM��EY AND STACK VERIFICATION
The undersi.gned hereby veri.fies that the existing chimney or stack; ��
1. 'Has .been. careful ly exami ned. � : Yes (�� � No O
2. Is .free from�rust or deterioration �� - Yes (�j° No ()
3. Has no foreign objects lodged within � Yes (1%/) No ()
4. Is securely supported Yes (� No ()
5._ Meets all current Code requirements for size and
total B7U connected
6. Has Total heating BTU's of ��U l�'1
All other BTU's
TOTAL
Rema rk s
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Yes (�No ( )
Company _
Signed By _
Da �e- - - _
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HOUSE HEATING TEST RECORD
ADDRESS �" ��� �/'�-���'�� ti/��- ��� APT. FLOOR CITY SUBURB �-'P"°�'��°���
OCCUPANT �°�'�'��t�� � s���?��'-- 01MNER `�
HEAT LOSS DATE HTG. INST.
SOLD BY INSTALLED BY
Elsetrical Work By Gas Line By
TYPE OF HEAT GA FA �HW STEAM SPACE HTR. UNIT HTR. OTHER
„� �— GAS DE51GN CONVERSION
MAKE ��'G�7sa�'� � MAKE OF BURNER
Model —� � � � � � � Model
Serial �� 1 � ��� � Max. BTU Rating
INPUT /��-���-' MAKE OF FURNACE
Model
CONTROLS _.�. :. ___ :: _ _ .,z:_ __.... ---- _ .
..F.1 �----,-- .f
THERMOSTAT _ Heat Plug -
� o � ' "�Vent Size �
Valve ` i¢�'j.-�f`' KIND OF LINER SIZE NONE
Limit �'�• ° Drah Hood Regularor
Limit Ssiting � u.tAn Filters Size `� � - 0 umber
Fan Setting Chimney Loeation Inside Outside
Pilot Type ���� Chimney Const►uction
Pilot Make
Pilot Model Smoke Bomb Wiring
Pilot Timing — Draft ��'6'�'�?�� Test Tag J-�
L.W. Cut Off Door Pressuro Lighting Inst. �P
� �
Prossure �`'� Pereent COZ � � Date Tested '� � � � ���
Input CFH �E% 0 Percent 02 %' � Company Testing �� ��/'�
. �
Stuck 7emp. ���zs � Percent CO �� Name oF Tester `��-�--- �'�
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��'z COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When realacinA an existing furance, the undersigned hereby verifies that the
ven6ng 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 existina combustion air is sized and installed to meet the cuRent codes
and manufacturers 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 installina a new ventina 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 Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors sized and ins4alled coRectly after
an appliance has been removed from the common vent and vented
separately as per cuRent codes. Yes () No ()
Aqaliance Tvae 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 Total 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
HEATING CO:
Signed By: Date :
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CCIYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6�t31 LJIVIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
February 1, 2002
Mr. Terry George
6912 Hickory Drive NE
Fridley, MN 55432
Re: Final Inspection at 6912 Hickory Drive NE
Contractor: Shiloah Water Co Inc
Dear Mr. George:
A mechanical permit was issued on May 4, 2(�0 to install a water softener at your
address. According to the 1991 Uniform Mechanical Code a final inspection shall be
conducted on the work authorized by this permit. As of this date, no inspection has
been called for.
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 permit "no inspecrion called for" and no further action will be ta.ken.
To set up the inspection or to have any questions answered, please conta.ct the
Building Inspection Division at (763) 572-3604.
Sincerely,
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COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When realacins� an existins� furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstru�tions,
and is securely supported and firestopped where required. Yes () No ()
The yenting; system is. plastic/PVC and meets all current codes and manufacturer '
specifications :including 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 manufacturer's specifications. This does
inciude AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existinst 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 instalied
To meet the current codes and manufacturer's specifications.
Yes ( ) No ( )
Yes( ) No( )
Yes ( ) No ( )
When installin� a new ventinsa svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does inciude AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors sized and installed correctly after
an appiiance-;has been-removed f�om the common ven� and vented
separately as`:per current codes. Yes O No O:
Apqliance Tvae and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat�_
Appiiance #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 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• (Describe)
HEATING Cb: '
Signed By: Date :