AF - 47390Date:
Owner
Addres
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Village of Fridley, Minn.
BUILDING PERMIT
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Builder ..' ................ .... .................
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Address . . �j. � . � . ��G¢-�; .'��!l!r . . .
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OCAT�f�!�G,,, F BUILDING
N�. (� � .� . � . . Street . . . . . . . . . �r%!� . . . . . . . . . Part of Lo . . . . . . . . . . . . . .
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Lot . . . . . �. . . . . Block . . . . . . y. . . . . . . . . . . Addition or Sub-Division . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Corner Lot ........... Inside Lot ...���. Setback ���... Sideyard .�.�.�� ��!'���
DESCR[PTION OF BU(LDING
To be tised as
. . . . . . . . . . . . . . . . Front .4!. . `.'. . Depth . � . �. Height !�� �• � ' - Sq. Ft. . /. / •'• • c:u. Ft. . . . . . . . .
...............�.... Front ....... Depth ...... Height ...... Sq. Ft. ........ Cu. Ft. ......
Type of Construction . . . . . . . . . . . . . Est. Cost . � �ll: . � �. . . . To be Completed . . v . . . . . . . . . .
����� a �� �
Yn consideration of the issuance to 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 nd in compliance with all provisions of
ordinances of the village of Fridley.
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Tn consideration of the payment of a fee of $. .,l�. .�rmit is hereby granted to(��.6����`: :'",� ... .
. . . . . . . . . . . . . . . . . . . . . . . . . to construct the building or addition as described above. This pernut is granted upon
the express condition that the person to whom it is granted and his agents, employees and worinnen, in all work
done in, around and upon said building, or any part thereof, sha11 conform in all respects to the ordinances of
Fridley, Minnesota regarding location, 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
ordinances.
. . .. . ... . g InsPector
NOTICE:
This permit does not cover the construction, installaiion or alteration for wiring, piumbing, gas heating,
sewer or water. Be sure to see ihe Building Inspect�rrfor separate permits for these items.
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City of Friclley, Minn.
BUILDING PERMIT
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N° 5822.
nat�: ..__..�.�. `"� "_'_..� ...�_____.._._._.______
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Owner: _. . : �r.1,L.•-.��,�'.�. �_.G.�_'�!�_ Buiider ...._.��.:1�'�:�._- � -- --... _ _..�...._�.:.�.__
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Address..-----•---- ............._.._...__.._._..___.__..._.._..__.-----•---._...._._._._....----. Address _.__._.___.�......--•---_.._T---___._..___..._.___.._._...._..._._..__.._.
��CATIO���!��,I,�DING
No. .{�!_i� � �.... Street ... • _._. _.. . .��--::1�'�._f.. .__..�t.. .s �t........ Part *._.:-----.. __. _--- _ __�
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Lot ....--.�- . Bloc .�`�� .............---------.. Addition or Sub-Divisi�pn ..- ---- ------ - - � • ._.._.W._
...___--•-------..._ ------•--•---•-
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Corner Lot _..._ .............-........ Inside Lot -----........._.---.•-----.......-•----- Setback •-•--l�---�.�._.._ Sideyard _....... ---._........_..___-•-•----._.._.�_.—...
Sewer Elevation ....___.._...__.---.___.._.._..--•------••---_.._..._......._.__..._.:_ Foundation Elevation
DESCRIPTtON OF BUlLDI[VG
To U as: ._
r:._... '..� Front � .._.. Depth ��-...!'t-_ Height ��...�_ Sq. F�. � Cu. F .
'_..� .... . ._._...._.. Front _. ......�_ Depth �.�..:.. Height .�� Sq. F� .L Cu. F't/-..�
� ; � t�__.'
Type of Construction ._�.�rr±_"!!��..�':�L�--.. Est. Cost �.L%�;�!"!!!"'_"..��.. To be Completed --------...__._.._.__._._._.�.
In consideration of the issuance to 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 compHance with all provisions of
ordinances of the city of Fridley.
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In consideration of the payment of a fee of $�,,,�:.__.._._..__._...._._.., permit is hereby granted to.._.._..:._..
.,.._..._....._._...____.._...._._....._..__..___ to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
dane in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance and moving of buildings
within the city limits and this permit ma be revoked at any time upo�} vi9� on of any of the rovisions of said
ordinances. y /^� ., A / � p
Buildin8 Inspecto�
NOTICE:
This permit doss not eowr the eonstrudion, imtallallon for widng, pivmbing, gas hsating, sew�r or wstsr. B� svr� to sN
fhs Building la�peetor for ssparate p�rmNs for th�s� ihms.
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Owner's
Addresa
APPLICATION FOR BUILDI� PERMLT
CITY OF FRIDLSY, MINNESOTA
No . � L!i 2�
Lot_�Block�
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tion or Subdivis
/
Lot
� _ � / // , �
Corner Lot Tneide Lot �Setback �J - l� Side-Yard �
�EWER BLEVATION FOUNDATION BLBVATION -
Applicant attach to this form Two Certificatea of Survey ot Lot aad pr�posed
building location drawn on these Certificates.
D�SCRIPTIQN OF BUILDING
To b used as:
�'ront � Depth���Height /�%
Sq. Ft, ��YI ,,,_Cu. Ft. ���.
� ,
Front Depth �"� Height �� � �
Sq, Ft. 1���. Cu. Pt. /,���
Type of Canatruction ,�,_i ._ � 8stimated Coat •�I���
__'±-� g. �
To be Canpleted �. �` � � � �
The uadersigned hereby makes gpplication for a permit �or the work herein
specif�ed, agreeing to do all work in strict accordance with the Ci�y of .
Fridley Ordinances and rulings of the Departmeat of Buildings, and herebq -
declares that all the f�cts.and repre�entatio ated �.n t s applic n
are true and Eorrect.
,
DATS �„�_�� � �� SIGNATtiRB
(Sche@ule of Fee Coats can b�'fouad on the R v se 3ide).
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City of Fridley, Minn.
BUILDING PERMIT
nat�: ._.._._� �7� 19b5
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�1Ta '7585
Ovvner: _ D. 0188oII Builder _IttteT Cit�_ Gaz'a,ge $�1.rc�.e�.
Aa� _6� 3b0 J�ckson �. N. E. __.._ aaa� ..�.�.�._l� __.. �1�,_�.`�:51�33
LOCATION OF BUILDING
No. �3�� Street rT8C�C80II �tT'8@t N. E• �_..._.._.._...._.._..__ Part o! Lot
Lot ._._ 2 _.�__ Block _ � ._. Additio� or Sub-Divisiaai __._�i Lri st; e,�dfL��j.�xi
Corner Lot �___..._.... Inside Lot .._._._..,. Setback � �r._ Sideyard
Sewer Ele�vati� ____._..r ..._..�_. Foundatioa Elevation
To be vsed as:
____ ..._ Fro�nt _
__..w..._._._._..._ �t _
Type of Construction ��
DESCRIPTION OF BUILDING
Depth Height ...�...._._.. Sq. Ft. Cu. FL
Depth Height ._._.. Sq. Fk Cu. 1�'t.
..._.. Es� Cost �.+�y��?.�?.,a�....._...__ To be C�►pleted
Sto�n �amage xepair
In consideration of the issuance to me of a permit to c�struct the building described above I agree to do
th� ProPoeed work in accordance wlth the d�scriPtion above se�t forth anc� � coinpliance with a�l pravisions o!
ordinanoes oi the city o! FridleY• . A
In eans[deratiari o! the payment of a fee of �-1f�.4Q , P�t is hereby granted toT`�°��' �i�v B7 d�1'S.
to c�struct the building or addition as described above. This permit ia granted upofi
the express conditiart that theperson to whom it is granted and his agents, employees and arorl�nen, itt sll work
da�e in, around and upon said building, or any part thereof, shall oonform in all respects to the ordinances o�
Frfdley, Mfnnesota regarding location, constructian, alteration, maintenance, repair and mavin8 af buildia�
within the dty limiLs and this permit may be revoked at any time upon violation of aqy of the pi^ovisians o� said
ordinaaces.
�S �
NOTICE:
ihk p�emil dea net eowr tla eoe�kueNos, Iu�tallNies fer wt�iY. P�W Y� �0. �w�r er wNa. !� mn to aN
N�s luildMy Imp�for foe s�p�rN� p�emits for 1ha� i1�ns.
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APPLICATION FOR BL��'�iNG PERMIT
CITY OF FR.IDLFY, ,�iN1�SOTA
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owr�� � s r� � D aunnEx
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��S 3 � a ,� �D�ss � 3
: , LOG4Z'ION OF �DZNG "
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No. Sti�eet � c. �,_,Part, of Lot ...
K �`�
Lot � Block �� Additi, or Subd�.vision ni �,� ( . ;.., _ ,.
Corner Lot Inside Lot� _:.:$e�ir�k Side�Yard _
SBWF.R E�.E�ATIQN FOi3NDATIUN EL$V'AfiION
Applic:ant ateach to tt�iA form �'wo Certificates .of, Survey of Lot .and� propose.d build- �
ing location d��wn o�i these ���tificates.
To be used �.s ;
DESCRIPTION OF B�JILDING
�ronC Depth Hei,ght
9q. Ft. Cu. Ft. .
Front Depth Height
St�. Ft. C�. Ft,, - - —
. 00
Type af Constructfon � .%�,ry,l Estimated _Cost , � �,1, �
_ . �;a be ...Compl eted
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The undersigned hereby.makes appl.i¢ation for a permit for the work herein specified,
agreeia�g �o �o a3:1 work iri str3ct accordaace with the City of Pridley Ordinances and
rulings �� tk�e Departmeat" of Buildings, and hereby declares that aIl the f�cts and
representations stated in this application are true and correcC.
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�Se2�edule of Fee Costs can be found on the Reverse Sidej.
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F 3G-112
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City of Fridley, Mi.nn.
BUILDING PERMIT
Date: _.._A.-�ril 23a..._.1�...68 .,..____.�
Ovcner: Walde.mar Olaen
Builder _.� Same
��� � �� y s �
�vo �ss�
Address _6,�60.._Jacks,Qn. N�.,�.._......_...__..._____._..____..... Address �___Same....__....______._.._.._..._..___. _..._..._.
LOCATION OF BUILDING
xo. ._._6�60__._. street ._��.��x�..___.____.__.._._---------..._._------.---.. part ot t..ot
Lot ....:_.._....�_._._.__ Block ._._._.._.-8._..___.._..___._. Addition or Sub-Division ._.---.__._��.�.-��.._....._..
Corner Lot _.__...___.._._.._ Inside I,ot •---._.... ?�_..._.._...__ Setback __..____._�..._._ Sideyard ___
Sewer Elevatfar► ..._.__..._.._.._._.._ ___.__ ._..._..__.___ Foundation IIevation ._.._....
DESCRIPTION OF BUILDING
To be Used as: -
Poxch Enclosure __ �t _,____._ �p� _,,.___....— Height ._.___.__._._ Sq. F't. .�._._.
Scxeen^a..nd Walls �nt _�______ Depth _...__.�__ Hei�ht ....._.._..�..__ Sq. F'� ._._..._..
Type of Construction ___._.__._.._�.�._.._..._...___ Es� Cost __._.�-.'1lJII...i2Q._.._.__....... To be Completed
�
Cu. FL __._
Cu. F�
In consideration of the issuance to me of a permit to construct the building described above, I a�+ee to do
the proposed work in accordance with the description above set forth and in compliance with all pro�vlsions of
ordinances o! the city of F�ldley.
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In consfderation of the payment of a fee of a��.QQ...._......_., permit is hereby granted to...._.
Olsen to cons�ruct the building or addition as described above. This permit is 8ranted upoa
the �express condition that the person to whom it is granted and his agenta, employees and workmen, fn all work
done in, around and upon said buiiding, or any part thereof, shall conform in all respects to the ordinances o�
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buil
within the city ]imits and this permit may be revoked at any�time up�o�ie�e�,d�.o� any of th�e provisions ot�
ordinances. � I ' // / �T. /
.�:1:�.A;i: .1.1.�:�:�.�.
�t"5`{�:i���t �;���,� t.;,.K
NOTICE:
• lbis p�nnif dws not eowr th� eeearuelion, hufallallon fee wirino. Plumblay, yu h�tliey. swne ee wahr. !� wn to �
fh� euildfoo latp�e�o� for »p�raN p�nnih for fha� I1Nm.
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APPLICATION FOR BiT�I.DING PERMIT
CZTY OF 1�I�I.EY, MiN1�R:SOTA . � ..
, .
..OWNER � S NA� ��A � s I��I �U�LDER� /�� �
ADDRES"5 ` (_//�� �.V / l. �'�� � �J �/�D$�55,_ 1 :. ;.
.. �i �' � ` � L.a. - .r.► ...+.� . ' � . . . . ., t . .� � -r.� - .. ��.��
' �' . .. : •. LOG�TtOfl1 OF` �Bi�ILDI1�iG .. � � .
Na...�..`�S�'RBEi�_f�C�S�` �..�...� _
L, .
LOT ;.. �____B�.00R _,_,�, : ADDITI�iT OR . SiJB�DIVi$.�.(��11 R:iS����,.'►
� . : : _ - . �
; . COR27ER LOT INSIDE LOT_�SETS��K �S�A�YARD� ,�..�.,..
t • - •
SEWER ELEVATION TOP OF FOdTING �
Appli�.ant attach ta this €orm Taro C�rtffi�:at�e$; of..3y},�rey .Q£:L�� aod'proposed
. �r, ,
buildiag location drawa a�n these �e"f�ifi.cates�. � ` ; ; � � •. � .
. . : DESCxIPTiOAi ' OF BUTI.DII� � • � � .. � . :
, . - . � . ... � .
To Be . Us a As � � . . - . "; - . . . .
�R� G(1 N�+ � v�,� Froat De th .Hef t.
��-. G S � ._ � p �� � w�
v��,��•.� � "� ���i��..SSquare feet � � Cubic FeeC � . .
�, � , . .� t . � - �
_ , , Froat De�th �,, ;R��ght �
, , : . �� : _ _
� Square feet Cubic F C
. �,-�.. �1 c� d
Type of Constructiaa 8etiaiated Cast
To Be C�npleted
�.
The uadersigaed hereby makes appiication fur a permit for the work herein
specified, agreeiag to do al�. wark ia strict accordance witb the Citq of
Fridley 4rdinaaces aad rulings of the Departmeat pf Bulldings, and hereby
declares thae all the tacts and representatioas stated in thia application
are tru and correct.
DATE,,,� _.:,.,���� ,SZGNATURE� _ �,_,_,_ _
.._...�.�
�Schedule of Fee Costs can be fouad an the Reverse Side).
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Application for Power Plants and Heating. Cooling, Yentilc�ion. Refrigeration and
Air Conditioning Systems ond Devices
PARTIAL RATE SCHEDULE
GRAVITY WAAM AIR: RATE TOTAL
Furnace Shell & Duct Work . . . . . . . . . . . . . . . .. . . . . . . . . . . $10.00 E
Replacement of Furnace ............................. 6.pp �
Repairs & Alterations—up to $500.60 . . . . . . . . . . . . . . . . . . 6.00 $
Repairs & Alterations each add. �500.00 . . . . . . . . . . . . . . . 3.00 a
MECH. WARM AIR
Furnace Shell & Duct Work to 12U,Q00 BTIT . . . . . . . . . . . . $10.00 $
each add. 60,000 BTLJ . . .. .... .. .......... .. . 3.00 ;
Replacement of Fixrnace ............................. 6.00 $
Repairs & Alterations—up to $50Q.00 . . . . . . . . . . . . . . . . . 6.00 $
Repairs & Alterations each add. $500.00 . . . . . . . . . . . . . . 3.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR. Steam ......$10.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $
Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . . . 3.00 $
Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 3.00 $
OIL BURNER—to 3 gal. per hour . . . . . . . . . . . . . . . . . . . . . . . 6.00 $
over 3 gal, per hour—See Fee Schedule
p0
GAS BURNER (up to 199,000 BTU) . . . . . . . . . . . . . . . . . . . . . . 5.00 $ L�
over 199,000 BTIJ See Fee Schedule
GAS FITTING FEES: NO RATE TOTAL
lst 3 Fixtures ....... �
, . . . . . . . . . . x$ 2.00 $ ��
Additional Fixtures ................. x .76 $
Gas Range to 199,000 . . . . . . . . . x$ 5.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
YENTILATING SYSTEM
ALTERATION3 8t REPAIRS
i�OUGH
i
FIi�iAL
Y
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See Fee Schedule
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TOTAL FEE � � �
Dept. of Bldqs. Phone 560-3450
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City of Fridley:
The uttdersigned hereby makes application for a permit for the work hereir.
specified, agreeing to do all work in strict accordance with the City Ordinance:
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application �are true and correct.
Fridley,
Owner
Kind of Building � /I C�/1'n �
Used as ,� _ �,
To be completed about
��,
Estimated Cost, $ U � �/
Old—New. Building Permit No. Permit No. G
DESCRIPTION OF WORK
19 CdJ
HEATING or PO � R PLANTS-�Steam, Hot Water, Warm Air—No.
Trade l�am Size No �
Capacity � Sq. F't. E.D.ft. BTiJ °�� H.P
Total Connected Loa �� . Kind oi Fue �
BUR.NER — Trade Name Size No.
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS-OVER)
�42
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Signe
sy
Business Phone No- �o" � �b ��
� : MINNEAPOLIS GAS COMPANY S-1931
' " ' Auth. No.
To the Suilding Inspector Fridley
City or Village of
For your information, the Minneapolis Gas Company has received a survey from the Installer
indicated below and has this date authorized the use of natural gas for this residentia) space
heating instollation. If survey is for new construction, we will have the capacity and facili-
ties to serve the installation when we have installed the gas service pipe and/or meter,
City or
Customer address 63b0 NE Jackson St NE Village Fridley
Customer W Olsen
Installer Sieg;ler Minnesota City or Mpls
{nstaller address 106 E Lk St Village
Equipment____Fire�lace Hect Loss
Construction: Ntew � Old � Input 2�M BTU
MIN POL15 GAS COMPANY
.. _ � ,. . „ -- - - lll t,c _- �.--
SUBJECT
City of Fridley 13424
AT THE TOP OF THE TWINS g U I L D I N G P E R M! T
r
� � CEIPT N
� ; L _����_ COMMUNITY DEVELOPMENT DIV. ���
� � � PROTECTIVE INSPECTION SEC.
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l---_ � �����;,� CITY HALL FRIDLE� 5S4$2 NUMBER REV. DATE PAGE OF APPROVED BV
� � � 612-560-3450
910-Ft5 3/30/76 / /
JOB ADDRESS 6360 3ackson Street N.E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 g Christy Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Robert Borth 6360 Jackson Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO.
$�F.
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
residential
7 CLASS OF WORK
❑ NEW � ADDITION O ALTERATiON ❑ REPAIR ❑ MOVE ❑ REMOVE
8 OESCRIBE WORK
16' x 16' kitchen addition
9 CHANGE QF USE FROM TO
STIPULATIONS
1. Insulate wa11s with 3 1/2" Batt insulation
2. Insulate rim joint with 3 1/2" or better
3. Maximum block exposure 8"
4.Provide vapor barrior on walls & ceiling �
��.���A � � �a�K�d�� � � K�t�utR�O �rOR �1Rt�i�,
}�T�i�� PLU�A$ING AND SIG�'i. -
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 3 O'%2
ANY TIME AFTER WORK IS COMMENCED. NO. DW�G. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED 2� 75
WITH WHETHER SPECIFIED HEREIN OR NOT. TFiE GRANTING OF A PERMIT SS�SOO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY QTHER STATE OR LOCAI. LAW REGU�ATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � �S`19.34
PLAN CHECK FEE TOTAL FEE
$22.09
N UREOF NTRACTORORA�THORI2EDAGE T IDATE) HEN PR Y I TED THIS IS YOUR PEFMIT t
,_ . , _ � ss 7� �
� _. _ __
SIGNATURE OF OWNER IIF OWNER BUILDEFI � IDATEI
BLDG.WSP `°� DATE
' � ' '. � •APF'LICATION rOR RLSI'DI:IVTI/IL., ALTL'It�l1'IOIV, � � �
. OR AllllITTON. BUILDI�G P�RI�IIT _
• ` CITY OF FRIDLEY, �tINN�SOTA . �
Oj+�dER' S N11�1E t ���T Q BUZLU�F.. CS�.� � . �.
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� , � ADDIt�5S : �O � � O '—�a � ��'o k S �/�v�DDR�SS • � s�� .
v�'�'? l�-7 f � `�• � . �
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, COIiIv�R i0T : ZNS IDE. LOT : � SETEACK : SID�X�I:D : : .
....,,._._..�. .
� Applieant a.*_tacF°. to this for:� �.t�o Certificates .�f SurveY . of � Lnt an� .pxaposed . . �
buildino ?ocatkon dx:cwn on these Cextificates. ^ • �.
. � - • • : . �.
� - BESCRIPTION' OF BUILDING � . -
. o , • .
. � . .
� _ . To Be Used As : � � _ : . - _
- ,,�te�lEa ,4c�ol�r��,� . �. � � , � ; �� � f �
• Front: lG Depth• l6 Height: �
_ • . • �o �-Z �
. • . . Square Feet: ���° � Cubic.Feet: ���,
� • - .
. . � Fronfi : � Deptii : • Height :
�, . . � � .Square Feet; Cubi,c Feet: � . - �. . '
. .
� �.jiPe o£'Construction: �l2� �.��-, . Estimated Cost: � � .�0 0
., ..�
�. �o� Be Completed: • ` 94 � � . . .
- • ' . c G` . • . •
. . . . �
• • . - _ ;. _ .
�� The undersigned hereby malces applicativn• for a permi�. for the wark herein �
specifiec�, aoreeing to do aIl worlc in strict accordance taith the City af -
' Fxidley Ordin�nces and rulings oi the DepartmcnG of Buildin�;s, and her�by �
decl�rSs �thaC all the iacts and representaCions stated in this application -
e�e true and corrcct. . - . .
... ' � . � �
_. � •- i .� . -
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7r�$� 3a� 7o.s y Fi+s�t,v �r : S;CTION
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�UNLlNEO CN/MNEY SEGTiOM L/NED CN/MNEY S�cC7/ON � .
DE'r�+iL .t DETq/L 2
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NOTES=
1. LV'ti'�nE DLATE5 A2� CUY AF:CNdR TO C�tiM?��Y 6Y 3%'xi� STE�C •
Si P•APS �!00KED iNTO CHIMNEY AiJU A7T�C!!cD 7o a�,ar�S p,Y
2.- 3��"x�' �.AG SC�ZE�VS� 2-%2'60t-75 0�2 6-16d NA:LS.
2. REiNF�2CCh1EfiT A►v� AtlCN�RAa� SHOWN AC�v� IS aEQUi2E0
1Td SE:SM!C ZauE ho.?,. -
�. VJN°_2� D�MP�RS AR� USED iH°_i SHAL! h�T 8E l.=55 1`)!DJ�
• NJ•t2 GAUGE McTa! A�'9 4;H�N f�.lY c?��; 7KE Or,�nP�c. OPci::,ti'S
�:�3.:.1. �i✓`t E'C L��S i'ria.V �'J�J :JY �:'":.�C�'�,,tll'1F-✓ rli/:- A%�:a.
0
�
1
PAG� 1�6 A 7rairting Manua! in FieFd lnspection
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SPARK ARRESTER
' U2 GA. GALV'D., I/2• MESH )
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NOTE =
CARRY ANCNORS TO 3RD
J015T, FASTEN 1NITH 2 �/2'
BOLTS OR 6 16/D NA1 LS.
SPARK ARRESTER
_ (!2 GA. GALV'�, 1/2"MESH)
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SUPPbRT LINING
Oh MASOTIRY—
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UNLJNED Cf,UMNEY SECT/ON VERT/CAL FGASHING C/NED CK/MNEY SECTION
DEiA/L / _ DETA./L Z
FIG. 1
KEY TO SYMBOLS ON CHIMNEY AND FIREPLACE DETAIL: �
FIRBPLACE: G* Horizontal reiniorcing One-fourt6-irtch rouad bon at 24
' A Heacth slab ihickeess Eour incfies • Fttchts
1 B Hearth slab width H Bond beams, five-inch Two on+s-foarth-Inch round fies a�
f(each side of openiRg} Twelve inches mi»imum height the onehorage atrd at iho top
i J EtFective flue area Raund lininq--one-twelfifi; ree-
C Face oi [ambs Eight inches ibased on areo of targutar litfing—wne-tenih; un- .
� D 7kickness of welts of Ten inches common brick, or eight fireplace opentng) lined—one-eigl�th
firebvx inches inciuding firebrick lining
K Ciearance from wood On� inch when outside o€ woil:
E Disfiance from fop of framing two incfies when en4irely wilhin
apening io '}hroat Six inches strucfure •
� L Unliaed brick flues No plosterrn�
CHIMt1EY: M ftues with lininq Brick wifH grout around iining:
f'� Yertical reinforcing Four one-half-inch fali length bars. fonr�inch minimuen from outsidt
40-diameter lap if spticed to 04 flue Iining to outside foca
footirtg dowels. . of ehimaey _ ,
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� ��sc:::�-ro:r c� c: oi;�. ' • 3 � �i -
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N=� �, �S � 1 � I• ! . specifi^d, a� ee;nE to do �!2 «�crk :n s::ict acco:var.ce wit?� the C:� C-�::.:::=<
�3:r r �� •� / I • ar.d ruling of the Depu::me�t of Bui1r.'��s, a.^.3 he:eby �ecl2:es L':at srI �`.e f:d
_� � I , and r2presenLations siated ia L�is a�,^.:.�caio� are ir�.:o snd c�:rect�
:'; ' — r idley. b�aa �' ���' , 29,t�
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❑ Used as
s,�(�v rir�sra. O:d Uys^_r.L'� Cc :spcol � . .
-- To be co:npleted about 3� ���
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P.�RiIAt RATE S�H�DUL� . E-.=��1�a c�st, s'��''�°. —
• • Oid--h'ew. FIu'.'.ditlg Pert�it 2�0. _�.�- p�=ait :�o. .��
; L�'ti1$S2t� FI:CTU:?E RATES: . H�. RATE TOTAL %
. . � x�a� g /G.CU • . '. Si�::cd � :ct,.
�'LjjT�beT �X�Ui�S • • • • • • • � • • � • • • . • �,�.�.� %C v-. -- . . • ��� �J+l ��.�
. B �� • y�-� G��� : i�
Fl�ture FZxture Ot,cning . . . . . . . . . . . . x 51.:0 S , ... ' Y
x S1.5o 3____:._ . Euainrss Pi:vr.e No ��1,� �3—
::ew Fix:u:e O;ci O��erung.......... . . . • .
C�tc!� F3asin . . . . . . . . . . . . . . . . . . . • x 53.25 3 . . • ' ' • . '
��'alcr iieater 'L'D to 99.000 BTU�• ••• x e3 G0 S , •. . .
. • ROUGH •
�e:+ G:o��3 Rua Old B:dg. ... r..•.. x:3.25 S '- .. .
�ectt'.^_ .Yla:er f:as;,ar . . . . . : . . . . . . . .� Z :?.C� �------ • FINAL . ' ' �
iiS F:i :FtiG FE£S: ' HO. R3+i:,` TO7AL • • ' ' • � �
• Ist 3 Fix:cres • •• • • • • • • • • • • • •• • • ' x 52.Cn� S • ' • ' ' .
t.d�lti�nal FKxtures ............... _-.—_. x S .75 S . ' . • . • .
G:s R:�ae to la3.OG0 BTV . . ... . . . . .. .,.----.- x SS.Ca L . . . . .
• � - .
°....�'?�:.°.S k ALTF°Jl7SOHS--P.•:er !o Code - • . '.50 StBte $1]rCl:�g@ . , - •
.hc:c:i�'.:on ...............: ....�......5 . , . .
........,..... . .
. Tp'i AL FT'.�r. S � �' '�- � • . . , •
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SUBJECT PER
City of Fridley 18148
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i �
, � ECEIPT NO
� • COMMUNITY DEVELOPMENT DIV.
� <<: ----- �
r � � PROTECTIVE INSPECTION SEC. / �'/I
i � ,
� � /'��1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�""��� ��� 612-571-3450 910-F15 8/5/85 / /
JOB ADDRESS 6360 Jackson 5treet N. E.
1 LEGAI �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 8 Christie Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHON
Robert Borth. 6360 Jackson S:treet N.E. 571-717�!
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL AODRESS ZIP PHONE LICENSE NO.
6 USE OF BUI�DING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION �7 ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside Dwelling and add insulation
8 CHANGE QF USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCt1PANCY GROUP OCCUPANCY LOAD
"SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PEFMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION zONING SO. FT. CU. FT.
AUTHORIZEO IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OF WORK IS SUSPENDED OR ABANDONED FOR A PERIOO OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OfFSTREET PARKING
I HEREBY CEFiTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION S7ALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT +�800 $. SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEfiMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $15•QO
LAN CHECKFEE TpTALFEE
$15.50
UREO ONTR TOROAAUTHORIZEDAGENT IDATEI WHEN PROPERIY V IDATED T IS IS YOUR PERMIT
. £�. • 8 s
SiG TUREOFOWNERiiFOWN RBUILDER� IDA EI � BLDG �NSP � E
NEW [] City of Fridley Effective �/1/84
ADDN. [ ] � R-1 AI�D R-2 �
pLTER. [ � Building Permit Application
Construction Address: `��
�
, o /� "
Legal Description: �oi a. �L, o� (_�tSi7� D�.J• -
Owner Name & Address : L'�� �`e R-� 1�-� �� /��� Tel .� v� f 7���
Contractor•
� ��-f.L �2 Tel . # �, c�
. �
Address: ���0 �'_�.1�C �1'oL• �'�� �i� i�YLc a� ���/
Attach to this application� a Certificate of Survey of the
lot, With the proposed construction dra�n on it to scale.
DESCRIPTIOA OF IMPROQF.l�NT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA:
DECR AREA:
OTHER:
Length Width Height Sq. Ft.
Length �lidth Hgt/Ground Sq. Ft.
Corner Lot [] Inside Lot [�] Ft. Yd. Setback Side Yard Setback
��
Type of Construction: Estima e Cost: �
� Q� / �.�'i� �
Approx. Completion Date: Y
Alt. A Alt B
Proposed DriveWay Width If NeW Opening Is Desired: � �
See Back Page for Explanation
DATE: Ti� ����' APPLICANT: � Tel. #��71 �7I77
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Nain Charge
TOTAL
STIPULATIONS:
CITY �SE ONLY
y /,� vo
�
a sv
�
a
#
a is s�
Fee Schedule on Reverse Side
25x of Building Permit Fee
E.50/�1,000 Yaluation
�425 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
� , ,
�
SUBJECT
City of Fridley ��� t� .� J
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
f
; � RECEIPT NO.
� • COMMUNITY OEVELOPMENT DIV.
� a��
r � L � PROTECTIVE INSPECTION SEC.
i �
i �
' ' �'��1 ' CITV HALL FRIDLE� 55432 NUMBERI REV DATE PAGE OF APPROVED BV
�----�; �., 612-571-3450 9i -F�5 6/27/9 / /
JOB ADDRESS (3FjO .T3CICSOLI Street NE'
1 LEGAL LOT NO. BLOCK TRACT OR ADDI ION SEE ATTACHED
DESCR. 2 8 Ch istie Addition SHEET
2 PROPERTV OWNER MAIL ADDRESS ZIP PHONE
Robert Borth 6360 Jackson St eet NE 571-7177
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Steven Lee Co 9465 Irving Ave, rooklyn Park MN 55444 424-1198 5758
4 ARCHITECT�OR DESIGNER MAIL ADDRESS ZIP PHONE I.ICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PNONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
CJ NEW ❑ ADDITION ❑ ALTERATION � FiEPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Garage (28 Sq) Tea -off
9 CHANGE OF USE FROM !I TO
STIPULATIONS
Underlayment must com ly with the State Building Code.
i
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV IOAD
SEPARATE PERMiTS ARE FiEOUIRED FOR ELECTRICAL, PLUMBING, HEA ING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRU TION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCEP W�THIN 60 DAYS. OR IF CONSTRU TION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DA S AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ ANO EXAMINED THIS APPUC�TION 1 STALLS GARAGES
ANO KNOW THE SAME TO 8E TRUE AND CORiiECT. ALL PROVISIONS OF AWS VALUATION SURTAX
AND OADINANCES GOVERNING THIS TYPE OF WORK WILL BE COM�UED !�
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A P RMIT �2�310 T1.16
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING �ON- $74.75 Fire SC �Z.31
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION I
PLAN CHECK FE TOTA� FEE
�
���� � vZ7'-i f' { Lice e S 5.0 $83. 22
�. S�GNATU�:E OF CON��7ACTOA OA AUTH0�7�2ED AGENT IDATEI Pq P ly V TED THIS I�OUR PERMI
�
I 'v
S�GNATURE OF pWNEP i1F OWNER BUILDEAI iDATEi G iN5 04TE
NEW
ADDN
ALTER
Il
[l
Ll
ConstructionAddress:
Legal Description:
Owner Name & Address: _
Contractor: �%e.� �
Address: i i b S
LNING AREA:
GARAGE AREA:
DECK AREA:
OTI�R:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
3 60
�
'� w %��
J
oV.- c �Cs � h
��i
r� . L ��
�.r,^� � .
Attach to this application,
lot, with the proposed cor
Effective 3/1/96
� s
d � .
6 a .����,1c1 ��, Tel. # s'7J —�/ 7 7
MN LICENSE # � 7 -��
� . . �� �/%,-� �o-�>e Tel. # �oZ i- i% `% f'
Certificate of Survey of the ��yy
uction drawn on it to scale.
DESCRIPTION Q?F IMPROVEMENT
Length Wi
Length Wi
Length Wi
/ e_�-� �f�
Height Sq. Ft.
Height Sq. Ft.
Hgt/Ground Sq. Ft.
1/-� Ya� YI �o w �. °�- �'tY'1► �unR
02� �'�.
Comer Lot [] Inside Lot [] Ft. Yd Setback _'t Side Yard Setbacks
Tyge of Construction: �—Estimated Cost: $ 3� a°, ��/�
Approx. Completion Date: 6-� 9- 9� i
(Cost n Back)
Driveway Curb C�it Width Needed: Ft. + 6 Ft = Ft x$
DATE: � - � 7- � �APPLICANT: - _ -�„
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Gharge
TOTAL
STIPULATIONS:
$ % . S'� Fee Schedule
$ • � / .001 of Perm
$ �. /(o $.50/$1,000'
$ $900 per SA(
$ � � $5.00 (State l
$ Alt. "A" or �
$ $450.00 Con:
$ Fee Determin
$ Agreement N�
� c�3�a-
n Reverse Side
Valuation (1/lOth%)
Unit
_$
_ Tel. # f�Z y�- �,/ p�
�nsed Residential Contractors)
"B" Above
►ation Plan Review
by Engineering
ssary [ ] Not Necessary [ ]
sue�ecT ERMIT NO. `.
City of Fridley 26 59 3
AT THE TOP OF THE TWINS g U I L D i N G P E R M I T
r
� ` IPT NO.
� • COMMUNITY DEVELOPMENT OIV.
� 1 L �•'�� � �/ /
f � � PROTECTIVE INSPECTION SEC.
� _ �
� �"'1 � CITY HALL FRIDLE� 55�32 NUMBER REV OATE PAGE OF APPNOVEO 8Y
�"°�� ,'' 612-571-3450 9t0- �5 7/13/98 � �
J08 ADDRESS 6360 Jackson St. TTE �
t LEGAL LOT NO. BLOCK TRACT OR ADDITI N SEE ATTACHED
DESCR. 2 g Christie ddition SHEET
2 PROPEHTY OWNER MAIL ADDRESS 2iP PMONE
David & Staci Lundeen 6360 Jackson St. NE Fridle MN 55432 572-2123
3 CONTRACTOR MAIL ADDRESS ZIP PMONE UCENSE NO.
Owner
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION � REPAIR O MOVE O REMOVE
X
8 DESCRIBE WORK
Chan e ara e door from9� to 16'• reroof G 2
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with S ate Building Code. See notations on plan.
I
TYPE OF CONST. OCCUPANCY GFiOUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEAT NG,
VENTI�ATING OR AIF CONDITIONING.
TNIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUC�ION ZONING S�. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUC ION
OR WORK IS SUSPENDED OR ABANDONED FOR A PER100 OF 120 OAY AT
ANV TIME AfTER WORK IS COMMENCE0. ' NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE REAO AND EXAMINEO THIS APPLICA ION 1 STAILS GAfiAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF L WS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMP IED
WITH WHETHER SPECIFIEO HEFEIN OA NOT. TME GRANTING OF A PE MIT 3066 1.53
DOES NOT PRESUME TO GIVE AUTHOR�TV TO VIOLATE OR CANCEL "fHE pEfiMl7 FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CbN-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 8],2,rj Fire SC 3.07
'� PLAN CHECKfEE TOTAL EE
91 85
SIGNAiURE OF CON7RACTOR OR AUTNORIZEO AGENT IDATEI � N P PE ALIDAT HIS I�R PE i
7 _� '
SiGNATUAE OF OWNEA UF OWNER BUILDEA� �DATE� BIOG SP f�6TE
NEW [] � 3 Effective 1 f��
ADDN [ ] CITY OF FRIDLEY ��' �
ALTER [) SINGLE FAMILY �AND DUPLEXES R-1 AND R-2 . �
BUILDING PERMIT APPLICATION ��'�l�'%� y
� /
ConstructionAddress:
� � 3�U :
c.k �o✓� �{-. N �
����/
Legal Description:
Owner Name & Address: (�a v� G� & S'�ccc r�- � c�2 2�-� Tel. # 5� 2- _ I Z 3
Contractor: I ___ MN LICENSE #
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
`� i � �
Construction Type:
Attach to this application,
lot, with the proposed cor
DESCRIPTION
Length
Length
Length
Sl� i �� � I-�w� `+-
Driveway Curb Cut Width Needed:
DATE: � 13 g APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ 7�
$
�___.��.�-
$
$
$
$
$
$
$ �
Ft. + 6 Ft =
Tel. �
Ccrt'�ficate of Survey of the
vction drawn on it to scale. �
,
�F IMPROVEMENT ��L ,
, '�
3 ����
h Height Sq. Ft. � �(� �
h Height Sq. Ft. � '�
,e � �-
h � Hgt/Ground Sq. Ft _�1
��,X�Y' 7YU �'Yl '! � '�U � � � �`t , Soo)
Gc�� _ Zs, S�u��es �.�1��
_ Estimated Cost: $ �"� �O � � ,
(Fee Schedule on Back)
Ft x $ _ $„ -�
Fee Schedule bn Reverse Side
.001 of Pern
$.50/$1,000
$1000 per S
$5.00 (State
Alt. "A" or
$450.00 Co�
Fee Determi
Agreement Ne
Te1. # 572-21Z3
Valuation (1/lOth%)
.luation
Unit �
;ensed Residential Contractors)
. "B" Above
vation Plan Review
l by Engineering �
essary ( ] Not Necessary [ ]
a
a� �
�
�
U ' OF
FRl LEY
FRIDLEY MUMCIPAL CENTER • 6431 UNNERSITY AVE.
June 1, 1999
Staci Lundeen
6360 Jackson Street NE
Fridley, MN 55432
Re: Final inspection at 6360 Jackson
.,,
Contractor: Quality Air, Inc.
Dear Ms. Lundeen:
FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
NE
/ ( (� 1
��
�C
��
A mechanical permit was issued on June 3, 1998 for the property located at 6360
Jackson Street NE for a new air conditione . According to Section 305(a) of the 1991
Uniform Mechanical Code a final inspectio shall be perFormed on the mechanica!
permit. As of this date no inspection has b en called for.
You will be given thirty (30) days from ri
hear from you, we will expire the permit
require a new permit.
Any questions can be addressed to myself
Sincerely,
Barry Riesch
Building Inspector
�t of this notice to respond. If we do not
any inspections on this installation will
(612) 572-3603.
CIN OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
ResideMial
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
All Others/Repairs & Arterations (LIST ON BACK)
196 of Value of Appliance or Work
Commercial/I ndustrial
1.2596 of Value of Appiiance or Work
Rate TOTAL
$ 30.00 $
$10.00 $
$10.00 $
$10.00 $
State Surcharge
TOTAL FEE
Effective On January 1, 1998
U"' J
C'l-�7 y
JOB ADDRESS Co?JCo� � Y�,K50 � � , � ��- �
The undersigned hereby makes appiication for a permit for the work herein
specified agreeing to do ail wo�C in strict accordance with the City Codes and
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
�— �� ,1998
OWNER � � �PC,\ �l� ���,� 1�
BUILDING USED AS� W�,�, �►� �
ESTIMATED COST ,� QC7 PERMIT NO. 13��5'
�—
DESCRIPTION OF FURNACE AND OR BURNER
�
$ N. Circle One (Steam) (Hot Water) (Warm Air)
Trade Name�v v7 Size No. U�il� A 02t-1�S ��
BTU 2, �� HP �} EDR
$ Fuel ��C"�2.i Total Connected Load �; o� s
��
�
MINIMUM FEE FOR ANY HEATING/COOLINGNENTIIATION
REFRIGERAT{ON/AIR CONDIi'IONING PERMiT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
' *Air Conditioners can not be placed in a side yard without
; written permission from adjoining property owner.
Bumer Trade Name Size No.
BTU HP EDR
QuauTV �, mc.
10830 MAGNOLIA ST• 1HVN
COON RAPIDS, MN 55448
HEATING COMP Y (612 54-3357
Signed By � Tel Na
Approved By Rough—In Date Final Date �'�� ��
FiLL OUT BACK SIDE FOR STA VERIFlCATION ON /�
REPLACEMENT FUF�VACE