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MINNESO A DEPARTMENT OF HEALTH Minnesota Well and Boring � ����� �
WELLORBORINGLOCATION E AND BORING SEALING RECORD ��ngNo. H
Counry wame Minnesota Unique Well No. : �
����� Minnesota Statutes, Chapter 1031 or�W� ��Nno.
, �
Township Name Township Na. Range No. Seclion No. Fractfon (sm. -s Ig.) Date Seated Date Well or Bonng Constructetl . .
€' � � iL� ! �. �7�i�' 6�' tT � � ;� ��fi���
Numerical Sheet Address or Fire Number and Ciry of Well or Bonng Location ��
Show exact la�tion of x�etl or boring
in sectlon grid with °X'.
N
�
�
W E
� � � �
� �
� � � �
"f' _ i ' _�'_ '_'�'_
Y1Mle
--�- -i-- -�-- --1-- �
e(� f mne �
�'� � Depth Before Sealing ' !
Sketch map of weil or bonng ApU1FER(S)
loca�on, showing properry 1� Single Aquifer ❑ Multiaquiter
lines, road ildings.
� WELL/BORING
����q�� � � Water Suppty Well ❑ Monit. Well
��.i� ❑ Env. Bore Hole ❑ Other
CASING TYPE(S)
J'�Steel ❑ Plastic ❑ Tle ❑ Olhei
CASING(S)
Diameter Depth
�' � in. trom � to
in. from to
'� ��
�eAy owners mailing address if diHerent than weil location eddress irMicated above. in. from to
R� ��� SCREEWOPEN HOLE
Screen trom � to � �
Original Depth it
STATIC WATER LEVEL
,�Measured ❑ Estimated
� ft �low ❑ above land surtace
Set in oversize hole?
� ry. ❑ Yes �No
fl. ❑ Yes ❑ No
ft. ❑ Yes ❑ No
ft. Open Hole from to
Annuiar epace initlally grouted?
❑ Ves ❑ No ❑ Unknown
❑ Yes ❑ No ❑ Unknown
❑ Yes ❑ No ❑ Unknown
ft.
WELL OVYNER'S NAME ❑ RodslDrop Pipe ❑ Check Valve(s} ❑ Oebris ❑ FlO �j No Obstruction
Wen mmets meNrqy a�resa 8 Sdterant than PropeAY ownets aaaress indicated above. . Type of Obstructions (Dascribe)
ObsWCtlons removed7 ❑ Yes ❑ No Descrfbe _'"
Type
HARDNESS OF ❑ Removed •�Not PreseM ❑ Other
OEOLOOICAL YATERIAL . COLOR ` �R�nON FH06A TO
If not Imown, tndimte esdmeted lomiation log trom nearby well oi buring. �THOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINaS, OR CASING
� No Annuler Spece Exists
O Annular space grouted with tremle pipe
❑ Ce�ng ParfaretloNRemovel
in. from to k.
in. from to ft.
REYARKS, SOUNCE OF DATA,
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p other
GiROUTINO b1ATERIAL(5) (O
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❑ Perforeted ❑ Removed
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— trom � ro � �" e. � y� �'�4 �gy
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— from to It_ Yards bagy
_ hom to ft. yards pags
OTHER WELLS AND BORINGS
Other unsealed end unused well or boring on prapeAy? ❑ Yes � Nq How meny?
�CENSEO OR REfi1STERED CONTRACTOR CERTIFICATION
'ihis well or boring wes sealed in exor�nce wfth Minnesota Rules, Chapter 4725. The informatlon eantained in Mis report ia
true to the best ot my knowledge.
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.C�MMON VENT. VENi CONNECTOR AND COMBUSTION AIR VERlFICATION '
When reolacinn an existin� furanc�, the undersigned hereby verifies that the
venting has baen examined and ia free from rust, deteriora�on, obstructions,
and is securety supported and �restopped where requlred. Yes �No ()
The venting system is plastiGPVC and meets alf current codes and manufacturer
specifications (ncluding siZing, length, number of elbows and termination. Yes () No (y�
The undersigned also verifies that the replacement unit is a listed assembly
and meets the cumerit codes and manufacturer's specificattons. This does
include AGr4-GAM�► Category I Central Fumace Venting Tables for fan
assisted and natural draft appliancss.
The existing combustion air is siied and installed to meet the currerrt codes
and manufacturer's spacifications.
1Nher� rr�quired to Install a n�w combustion air it will be sized and installed
to meet the cuRent codes and manc�facturers specifications.
Yes (L,YNo ( )
Yes ( ) No (J�'
Yes (,�No ( )
When installina a raew ventina svstem� the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers .
spe�cifications. This does include AGA-GAMA Category I Cerrtral Fumace
, Venting Tables for fan assisted and natural draft appliances. Yes (�No (
[s the common vent and vent connectors sized and inst�lled correct(y after
an appliance has been removed frorrt the common vent and verrted
separately as pe� current codes. Yes (�No ()
Appll�nce Tvpe and� SizelCommon Vent and Vent Connector Information
Appliance #1 Type _��''0�"' BTU Input 7o,G'r� an�ssiste �or Nat
Appliance #2 7ype Wnft�rt l.c�, BTU (nput �S'� Fan Assisted or ���
Appliance #3 Type BTU Input Fan Assisted or Nat
. Total Appli�nces ____ Total Bfiu Input � .
w
Common Vent Type �SC Vent Height �� � Diameter � inches
Appliance #1 Vent Connector Height ft Length �ft Diameter,,,_in Type �
Appliance #2 l/ent Connector Height ft Length „ft Diameter in Type �
Appliance �03 V�nt Connector Heighf ft Lc�ngth ft Diamet�r ____._in Type r„�
ALTERATIONS: (Describe) �
FiEATI{VG CO: %��SN �(� i�,�✓�p l�iS't �o,^s ��� i(�c
Signed By; _ ��w� �� %��°"` � Date : %� / 3 �O I
�
��0 3�Jtid �IIb '8 �JNIlb3H HS�IdW 9ZZ09E9E9L 0T �80 �00ZlE0/0i
10/03/2001 08:10
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PAGE 01� •
� � ��•.��:,.�:..�tr;+�ra'r•'.:;:'., . .. �. .
HEA.TiNG & QIR CONDIT[C7L�I�1�C C�-.,� [1'�IC.
,�48 lakalanQ Avmuss Nac�t - Suite t10
�saokryR P�arlc, MN 5��428 '
� ', � . Pliasse (T6.i� 5.86-06c'e
� Fa:c (763) i36-0�6
0
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TO : �N �'( FROM' l ✓`' ��I�!
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Instali3uort
PACE�OF�
S air
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EI�clr'lC31
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1 __ �- , \ -- � j � � \ � -
ADDRESS: � � � .� �� � �� APT: FLOOR: CITY: � � ,�,1 � DATE: 8 � / � / o �
OCCUPANT• OWNER• s�� ��aa P� a
HEAT LOSS: HEATING INSTALLED BY: ���§
ELECTRICAL WORK BY: � P�� D� GAS LINE BY: ���..5 �
TYPE OF HEAT: GA FA � ROOFTOP SPACE HTR UNIT HTR OTHER
.GAS DESIGN
MANUFACTURER: � � ��� �
MODEL: � 5ou � � ��� • o °To
SERIAL: � °�� � � ��
INPUT: � � ,
CONTROLS
THERMOSTAT: "� ° �'� VENT SIZE: � I �
VALVE: �, KIND OF LINER: s�zE NONE �''
LIMIT: DRAFT HOOD: REGULATOR:
LIMIT SETTING: FILTERS - SIZE: �� x ZS 5 NUMBER: d
FAN SETTING: °�° ����� CHIMNEY -� INSIDE OUTSIDE
PILOT TYPE: � � °� � � � ��� CHIMNEY CONSTRUCTION: � �' , ,�¢ �s
PILOT MAKE:
PILOT MODEL: SMOKE BOMB: WIRING:� K,
PILOT TIMING: � ���, DRAFT: TEST TAG: N�l����1
L.W. CUT OFF: DOOR PRESSURE: LIGHTING INST:
PRESSURE: `� � S �� % COZ a : � DATE TESTED: � � �' �� D
INPUT CFH: °T � % 02 � e� COMPANY TESTING: � Qe� �.
STACK TEMP: ��� % CO �' NAME OF TESTER�� �� � �RC e 6�. ;�o
�
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CIlYOF
FRtDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
February 14, 2003
Matt & Jan Smigleski
319 Ironton Street NE
Fridley, MN 55432
Re: Final Inspection at 319 Ironton Street NE
Contractor: Marsh Heating & Air Conditioning Iac
Dear Matt & Jan Smigleski:
A mechanical permit was issued on October 4, 2001 to install a furnace 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 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 C�es. We will keep your pernnit open for another 30 days and if we do
not hear from you within this tune to set up the inspection, we will mark the permit "no
inspectaon 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.
Y�
DA
Inspector
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FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When realacin�a an existina furnace, the undersigned hereby verifies that the
venting has been examined and is free from n�st, deterioration, obstnactions,
and is securely supported and firestopped where required. Yes (} No ()
The venting system is plasticlPVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifles 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 natural draft appliances.
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combustion air, it wrill 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 ()
Is the common vent and vent connectors sized and installed coRectly after
an appliance has been removed from the common vent and vented
separately as per current codes.
No ( )
Yes ( ) No ( )
Appliance Tvae and SizelCommon 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 Tatal 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 CO:
Signed By: Date :
ADDRESS
PIN
LEGAL DESC
PERNIIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 ITNIVERSITY AVENUE NE
FRIDLEY, MN 55432
s�z-36u4 r�Ax:
: 319 IRONTON ST NE
: 033024240013
: AUD SUB NO 103 (REV)
: LOT 23 BLOCK 0
: HEATING
: RESIDENTIAL
: ADDITION/ALTERATION
��r� � �►�t;�r�
PERNIIT NO.: 0.�� 0676"�
�,
DATE LSSUED: OS/11/2004
VALUATION : $ 0.00
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERNIISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
INSTALL AN AIR CONDITIONER
# A/C UI�TITS
#FURNACES
# GAS RANGES
APPLICANT
MARSH HEATING & AIR CONDITIONII�TG
6248 LAKELAND AVE N
BROOKLYN PARK, MN 55420-2937
(763)536-0667
OWNER
SMIGLESKI, MATT & JANAE
319 IRONTON ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
applicarion and lmow the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant ,,� Date , ,
1 VALUE OF APPL OR WORK
0 # GAS DRYERS
0
Bldg Insp � ��d��- Dat� � l�Z��
HEATING PERMIT NIINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONII�TG FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 70236
SEPARATE PERNIITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE.
�
0
0.00
0.00
0.00
0.00
25.00
0.00
0.50
25.50
�
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 l+'AX:
: 319 IRONTON ST NE
: 033024240013
: AUD SUB NO 103 (RE�
: LOT 23 BLOCK 0
d
PROPERTY TYPE .
CONSTRUCTION TYPE .
ELECTRICAL
RESIDENTIAL
ADDITION/ALTERATION
571-1Zif7
�+
PERMIT NO.: 200400748 `�
�
DATE ISSUED: OS/20/2004
VALUATION .
I NOTE: ELECTRICAL PERNIIT BECOMES VOID 12 MONTHS AFTER PERNIIT ISSUE DATE. WIRE AIR CONDITIONER
' # INSPECTIONS 1
APPLICANT
SPARK ELECTRIC
2114 WASHINGTON ST NE
MINNEAPOLIS, MN 55418-
� .0 I`-`/�I��
SMIGLESKI, MATT & JANAE
319 IRONTON ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances goveming this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construcrion or the performance of construction.
Applicant Date
Bldg Insp Date
ELEC PERNIIT FEE - MIl�T (RESn
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 39767
SEPARATE PERNIITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
20.00
0.50
20.50
I ADDRESS
IPIN
LEGAL DESC
CITY OF FRIDLEY
6431 iTNIVERSITY AVENUE NE
FRIDLEY, MN 55432
57Z-36U4 FAX:
: 319 IRONTON ST NE
: 033024240013
: AUD SUB NO 103 (RE�
: LOT 23 BLOCK 0
571-1287
PERNIIT NO.: 2004-01468
DATE ISSUED: 09/Ol/2004
PERMIT TYPE : ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: ELECTRICAL PERNIIT BECOMES VOID 12 MONTHS AFTER PERNIIT ISSUE DATE. INSTALL SAVERS SWITCH.
# INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
ST PAUL, MN 55114-
OWNER
SMIGLESKI, MATT & JANAE
319 IRONTON ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and lmow the same to be true and correct. All
provisions of laws and ordinances governing this type of worls
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date
ELEC PERNIIT FEE - MIN (RESn
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 117431
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVL�.
20.00
0.50
20.50
Building PLUMBING Permit 1vo.: ���.�,� I� �
Inspections RESIDENTIAL APPLICATION Received By: , �
763-572-3604 CITY OF FRIDLEY Date Rec'd: ��.11 p�.`� �%
DATE %�//� O 6 YOUR E-MAIL ADDRESS
Sr[� nnDttESS °3 f 9 Ti��» �- 111 L-
7'FIIS APPLICANT IS: �WNER OCONTRACTOR
PROPERTY Np�; J o � %h. ��
OWNER/ ADDRESS: 3 1 9 i.sm � v� �/�%� CITY �r� cJ C4. �r STATE�ZIP sSy3.Z
TENANT pHONE: `7� 3 3 70 S��,13
CONTRACTOR NpME:
SUBMIT A COPY OF STATE LICENSE # EXP DATE
YOUR STATE ADDRESS: CITY STATE ZIP
LICENSE WITH PHONE F,47�
APPLICATION
PERMIT TYPE b'DU�GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: �w 0 REPLACEMENT
DETAILED DESCRIPTION OF WORK .f�, S�/l�,�F�°pG., a.�' L.�; ( i h,�, 6,•,o�.e t��p/� ,��,es�,,,�
V'e+ C,�ti/� �„�� k�r
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures:. (This_shnuidreflect only the cost of labor )
Iabor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS WI�RE LABOR EXCEEDS $500; FEES ARE BASED ON $10.00 PER FIX3'[JRB• €�X�T_�� l�If3r'FED.: FIXTUIt�S: �IGATE TOTAL -. -•+_
NUMBER OF EACH BELOVI�
BATH SD�iK/LAV _FLOOR DRAINS SHOWER WATER PIPING
BATHTUB GAS PIPING f��o c�rr�c�) SWA�NIII�G POOL WATER SOFINER ($35)
_ CLOTI-IES WASHER _ KITCHEN SINK WATER CLOSET � BACKFLOW PREV. ($15)
DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
_ WATER METER _ OTHER
� � , . ..
�
` '� � � � � �,� � , � ������ � � �s , � � � �
_. '�.� �� ,y.-x .. � < , . „ ,.� .„��. M � �,,. �_.��: ;, , �.�,. � . ._. .>�-.� . �,M�� � � , r�` �'' t� � �� ;�
�'' ` � � ,�,£ .
Permit Fee $�t s. pCD Number of fixtures @$�10.00 � x$10.00 =$
Surchar e .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $�. S� Number of fixtures @$35.00 x$35.00 =$
State Surcharge = $ .50
Tota1= $
THIS IS AN APPLICATION FOR A PERNIIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of a11 work which requires review and approval of plans.
SIGNATURE OF APPLICANT i��s•-.- �� PRINT NAME "�T "e �� T: °�.9 DATE_ %�/ 1�� C�
`�c -� �`r ' � _ � Q. � £ > �N , �� ��
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City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, NIN 55432
763-572-3604
FAX: 763-502-4977