AF - 47392�
•
-,,�..,�...-.—_ _ _ ._ . ._ _ _ .� . . � r _
City of Fridley, Minn.
BUII.DING PERMIT N° 3 3 6 0
% - ,/� � .� d'`(
Date: ........ .............. ..........
.....::..
.,-'"" \..
Owner ���i�ckG�Ci�... . ..� ........... .. Builder ....................................
Address /..�✓...r.,,,�!K.GLn:t%li(�.�. :?. Address .............................................
' � . � �, _�' ..
OCATION OF BUILDING
No. !� .`�. � . Street . .� �'2� . . . . . . . . . . . . Part of�.ot . . . . . . . . . . . . . . . . . . . . . . .
. . ................ .. . ...
�� 3 d �t� q � X �a :� �� . . .,S . . . . . . . . . . . . Additio • sub-�ivision ./. `��� . . .�s.'�?� . . . . . . . . . . . . .
Corner Lot . .. ..?.'�.. .. . Inside Lot . . . .. .. .. .. . Sidey .. . . .. . .
. ...................
._�o��,� .-33 O �� .�a /�:°.tiv _
DESCRIPTION OF BUILDING
To be Used as:
� . . . . . . �t . :S!�. . nepr.n . a (' x�ght . . . ./. .`�. sQ. �. ./. 0. .`I.a cu. �. ����1��'
Q Tr . . . . . . . . Front . .�7 . . . Depth . . .°?.Y. . Height . . �.Q. . Sq. Ft. ��0: . G�. F't. -���%
Tj�pe of nstruction . . �/%!.�!!9!C�. . . . . �a� Co�tt. . /. .,1. .L .�. � . . . To be Completed . . . . . . . . . . . . . . . . . . .
In consideration of tihe issuance to me of a permit to construct the building desribed above, I agree to do
tkie prnposed work in accordance with the descrlption above set forth and in compHance wfth all provisions of
ordinances of the city of Fridley.
� , � .--.�.
.'.�.�:�.� -:�-.v�.°. . ..� . :�t.: .. . . . . . .
�
In consideration of the payment of a fee o a.. `5:....., 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 gcanted and I�is agents, employees and worlcmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fi�idley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at any time upon violation of�a�i y of the provisions of said
ordinances. /_..•-
....... Bl�ildfn�g InsPecbor
NOTICE:
This permit does not cover the construction, in�tallation or alteration for wiriny, plumbiny, gas heatinp,
sewer or water. Be aure to see the Building Inspeotor fo� separate permits for these itema
_ _ _ __ — _ _
G�f�
. . ���
C�ty of Fridley �°�
Ap�ication fa' �umbing and Gas Pitring Penrr�it �
�
- Dept. of Bldgs. Phone SU 4-74R�
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
� �
,�u � �,. = N Z x y Y Z 'n� � Z V Z O x 3 U' Z
; ��� �? 3� o� urS g� S� �t3 �U' ot" C�'JSc �U' O
Base
lst
2nd
3rd
4th _ _
• FuYure Coanection Openings
* New Fixture, Old Opeai:►gs
PARTIAL RATE SCHEDULE
WATER HTR.
• t
i N GAS ELEC.
3ewer �
Cesspool j'-j
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number F`ixtures . . . . . . . . . . . . . . . . . . . . . . —� x $1.50 $ �Q, J C�J
Future Fixture Opening ................ x 1.20 $
New Fixture Old Opening . . . . . . . . . . . . . . x 1.00 $
Catch Basin ............................ x 3.25 $
Water Heater (Up to 200,000 BT[J) ......� x 2.00 $ z' �'�'
New Ground Run Old Bldg . . . . . . . . . . . . . x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
Sst 3 Fixtures ' �
.......................... x $1.50 $
Additional Fixtures . . . . . . ....... . . .. . . . x .50 � O
Gas Raage to 200,000 BTU . . . .. . . . . . . . . . x 2.00 �--,1���
. �
� /
REPAIRS 8c ALTERATIONS—Refer to Code �S� �
Description................................................f c
TOTAL FEE $ ! � �
\
L�auo� � 3 6� ✓.q� � ���'e �/ S i y�
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department oY Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
1 ,
Fridley, Minn. ��� 6 1� , 19—
Owner �, /�, d �'� /�1 �%z O /��� /c
Kind of Building ��--
Used as � W
To be completed about � d ��� � O
Estimated Cost, $
/ �
Old—New. Building Fermit No. �(o o�'— Pezmit No.�%� d�
�OiVD�i�i PLUlViGIN� CO3
Signed
By � !Z-e.s�r�.► J� i��rs-•-a-��...
Business Phone No.
ROUC3H J U N 9 19 6�
FINAL
a z 1M 7•59
.`. . a - s��� �
�
City of Fridley, Minn.
BUILDING PERMIT
Date: ._.....(l�..-..`...'.:"'---.... �.�....."...""..�._L.l ..............--........-�----.....-----.....
��..`"^
Owner: ..:. * "7..kj/'Ir.�./..�� ,
... .. . ...... . ......... . ............ .... . - -
Address .�..�..---.. �..�........:. -- - --�--. .. ...... ... .__
N° 4662�
Builder....... ......................�--.... ......._...-�-•----�•-•---....... _.
Address.......... ...................:....... •--��---..._... ..---...... .---.......�!...........:.._......._......._.
' �. ;� LOC ON OF 1 DING
No. �.�?.:�::... Street .......' ...... ..... :. .. ...��...:.ci��......:... Part of Lot ......----...................,.....----�--.......----�----...._--••---_...._._.
Lot ..-.-.. __ Block _ .. Addition or Sub-Division _ . ...........: ...- -----•-. -_-�`
_._
...... ..._ ....... . ..... ... ---
�^-� ""` � / l�" f .. -.t/
Corner I.ot _..�-!''.. . _ Inside Lot ... ...�!�.. Setback :..�,�,�..� ........:.. _ Sideyard ......I....... �!--. . ..� ......._ - �---��---•----�
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To Used t
. . _ : . ...:. . Front . Depth .I' . .. Height
... �.....
. ..... _ t . ....... Front � ......... Depth �/Z� -.. :: Hei ht ...��.....
Type f Construction ...�..... . _._.__. Est. Cos'��,,� '��.
7 /
�..G
Sq. Ft. %LJ.�i!'!!- Cu. Ft p�.� ..�..� '�
Sq. Ft. "�. *�./�.. Cu. F���� Lr'
To be Completed
/ i� .r .
�
.r ,�
1 � �
� �
In consideration of the issuance to me of a pernut to construct the building described above, I agree to do
the proposed womk in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
.... �1 ....:.....................-�--�--......_.--•---......._....-�-•---.._........_..._......._..._......._...._...._......---...............
In consideration of the payment of a fee of $.� ..�� ........................ pernut 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
done 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 r and moving of buildings
within the city limits and this permit may be revoked at any tir�e u�� vii lation f any of the provisions of said
ordinances. ! 1!�
. Building Inspector
NOTICE:
This permif does nof eovsr f6s eonafrue�ion, inslallafion for wiring, plumbing, gaa hea�ing, sawsr or wabr. !s sur� fo sts
tlie Building Inspeetor for separaN permifs fo� fheae it�ms.
•
� . �.
�04 •
,r _ __
APPLIGATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MIl�13E30TA
� r�J !G/✓ � �i�' O.v,Ue .__ Sac � �
Owners Name � - �ilder
�' 3 f- 7 � a c� s o..� .s? Address
Addre�s .. .__...--.-----�
� LOCATION OF BUILDING
No. Stree� � Part of Lot
Lot � ,_Block kddition or Sub.Div.
. Corner Lbt Inside Lot� t Back �� �T Side-Yard �� ��
SEWER ELEVATION FOUNDATION FL�,'VATION
Applicant,attach to this form Certificate of 5urvey of Lot and proposed building
1oca.tiQn. -
. DESQtIPTION OF BUILDING
To be used as:
� t.� `� ��%/� f Front ���°� � Depth � � � Height�
�� �
Sq. Ft. �� �� -- Cu. Ft.
�I TTa � e o� �j U. I- ct� ^e $'x'otlt �� ' Dep� � � � Height ,�n
� _ �
Sq. Ft. 3 3l° . Cu. Ft.._:.�����.�
Type of Construction �� Q�'e E�st3mated Cost �� D o 0
To be completed !� � ! `�` � �
. The undersigned hereby ma.kes application for a permit for the work herein apecified,
agree�.n.g to do sll work in strict accordance with the City Ordinances and ruling of
the Department of Bu3ldings, and hereby declares tha.t all the facts and repx�esents-
tions stated in this application are txue and correc ,
DATE
� � �' � d SIGNATURE � `��''"��
• (A Schedule of Fee costa can be found on the Reverse Side.)
/ Q�! L�` c 0.,%-/�ON� ��i! L�i�a� �t S C p�` 6 p�
��1,`s i .s a �e Ncw� � �'
a r r, - w//y G� v �"�/n L s T� i n s.�o !�e w t ,° O wTs; .a�p W 4. // 3' �
Q .� e V � GJ 'x- 'S /� d � � R p o F.'.v� ��� � �. ,r ,�� %!'C e s ¢ .v T
i/v s: ��e � e T,° T,� e ,✓ s �K. � � T /P ° °'� ,
D 4J N C� � dL. s � r W o' r� � P t�P SS s. !- /p'e�Y c�� r,r
u. r ��C e. r e �o p� of+�e ✓ T'y
1F Cr � ay.�,� � s' w rz ��e .�-t o. ��,e 7-o G�'` .- e cT c� e�y r d�.�� � y W e.�.T"T.es�
Q.v� Doa:- �das7i<<tcT.'o.v 6y ��, pvi �K S Qwn/�x�
/ �
, APPhcation �or �awer Plants and: He�tin9. Cooting� Ventilc�ion. ,Refrigera�ion dnd
Air Conditioning Systen�s and Device�s 5-
PARTIAL RATE S�HEDULE Dept• af Bldgs. Phone SU i-7470 � 3�
GRAVITY WARM AIR: RATE TOTAL .
Furnace Shell & Duct Work . . . . . . . . . . . . . . . . . . . . . . . . . . 8.00 �
Replacement of Furnace ............................. 5.00 �
Repairs & Alterations—up to $50Q.00 . . . . . . . . . . . . . . . . . . 5.00 $
Repairs & Alterations each add. �500.00 . . . . . . . . . . . . . . . 2.50 $
MECH. WARM AIR
Furnaee Shell & Duct Work to iZ0,00Q BT(J . . . . . . . . . . . .
. , r
each add. 60,000 BTIT . . . ., a . . . . . . . . . . . . . . . . . .
Replacement o! Furnace .............................
Repairs & Alterations—up to $500.00 . . . � . . . . . . . . . . . .
Repairs & A2terations each add. �500.00 .......:......
STEAM or iIOT WATER SYSTEM
, Furnace Shell & Lines—ta 400 sq. ft. EDR Steam, ......
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ...
� ,� Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . : .
� Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . .
/ .
OIL BURNER—to 3 gal. per hour . . . . . . . . . . . . . . . . . . . . . . . .
over 3 gal, per hour—See Fee Schedule
8.00 � �/
2.00 ; v___.
�.00 $
5.00 $
2.50 $
8.00 $
8.00 $
2.50 $
2.50 $
5.00 $
GAS BURNER (up ta 400,000 B1`IJ> . . . . . . . . . . . . . . . . . . . . . . . 5.00 $ �
GAS FITTING FEES: NO RATE TOTAL
lst 3 F�xtures ...................... x $1.5d $ ✓
Additional Fixtures ................. x .50 $
Gas R.ange to 200,000 BTLT . . . . . . . . . . . x 2.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATI1�iG SYSTEM
PiLTERATION3 & REPAIRS
ROUGH
FINAL
��
3ee Fee Schedule
$
TOTAL F$E �..�C�.�� �
Q,i�
G��
�
Location � �� 3 - �a c�s o n �7� . � � �.
City oi Fridley: .
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application true and correct.
� _ Fridley, Minn. � � , 19 ca_s�
�wner
Kind of B�ing ��-��--Q�
f�, n �
Used as
To be completed about
Estimated Cost, $
c�i 2� fl � �
Ol Ne uilding Permit No. G� Permit No. / G� "�J
�
DESCRIPTION OF WORR
HEATING or R PLANZS� Hot Water, Warm Air—No.�
Trade Name �-� ���iti.C�C.J Size No C"� ���
Capacity Sq. Ft. E.D.R. d d�Z� BTCT H.P.
Total Connected Load �� .� .�'o o Kind of Eixe `
BURNER — Trade Name Size No.
Capacity Sq. Ft. E.D.R B P -
RAY N. W E LT E� Ff�`��"` ���
4637 CHICAG❑ AVE.
MINNEAPQL�S 7• MINNES�TA
Signe
g� r d-r�-C� f.'�
��<Z zM �.sy Business Phone No '�� ''�r � � �� �
(REMARKS-OVER)
� -
� .__ ; �<. , � �r ' •
. n•s6 � � 9 ,�� � 61..�1 �" . �r�'d /!/! �/"`�.+'J' /1 ep'/''"'. , '
SM�
HEAT LOSS CALCULATIONS � DEPARTMENT OF BUILDINGS MtNNEAPOLIS. MINN.
Weatherstrips A.S.H.V.E, Construction No. Insulation
Guide
Windows I Doors Reference Out. Wall Int. Wall C,eiling Roof F1oor Kind How Applied
Yes—No Yes—No 19_
1.� „c Room � Length /„';� Width / eight � .� ' Room Length idth Heigh
Windows and Doors—Crackage and Area Windows and oors-Crackage and Area
�Vidth Height No. ot Llneal f[. Area � � Width Hefght No. oL Lineal ft. Ares
'� � No. of Dane of Dane lieh[s of crack eq. ft. � �� � � � No. of Dane ot pane liBhte of crack aq. tt.
7,Yl3 .�`.�. . O
�Gw+' i
.i
Coef. Btu Coef. Btu
Infiltration ,� %
' Glass
Exp. wall
Net exp. wall �
Int. wall
Ceiling � i
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl.� Room � Length Width �%'
Windows and Doors--Crackage and Area
Wldth Helght No. o[ Lineal ft. Area
� No. of nane ol oane liahte ot crack aq. tt.
In6ltration
F Glasa
Exp. wall
Net exp. wall
` Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Inhltration
�
Glaas
Exp. wall
� Net eap. wall /
Int. wall �
� Ceiling �i
,�, Floor
� Total Btu.
Required sq. ft. E.D.R. or aq. ins. W.A. Leader area
� 1.1 �t Room � Length Width i
Windows and Doora--Crackage and Area
Wldth He16ht No. of Lineal tt. Area
No. of pane of Osne Ilghts oL crack eq. tt.
� �-:.. 2� �.•� �, r t.�"'
�,��i In&Itration -
Li �;i Glasa
Exp. wall �
�Q � Net exp. wall Q
Int. wall
� Ceiling
�� F�loor
� Total Btu.
r Required aq. ft. E.D.R. or sq: ins. W.A. Leader area
` Room � Length'„Z Width 7,, eight �j,� � Room � Length Width /,
Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area.
� Width Hefght No. ot Lineal tt. Area � Width Helght No. ot Lfneal ft. Ares �
No. ot Dane ot pane Iighte ot crack � eq. tt. � . No. o[ Dane ot�pane Ifghta ot crack � ep. tQ �
� L � J I � Z.. ir�r � �+
i'.- 'ZI "id+' _.. _ _ ,
�t �► !�
Coef. Btu Coe
Glass � ,�o
Exp. wall �i
Net exp. wall ,Q Q
Int. wall
Ceiling � ,,�`,.%
F loor ,�
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area `
Glass
Exp. wall
Net exp. wall
Int. wafl
Ceiling
Floor
Total Btu.
Z
Btu
sq. ft. E.D.R. or sq. ins. W.A. Leader area ��` �
.
City of Fridley, Mi.n.n..
643Y University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
��:_ September 22, 1971
'��1192
�
p�: Liy.,�o_�Diutm�.n Builder ___..BQX�.,t�.],.uminum �s?m�.�njL..�
�Ad�ress _._b.36S---.Ta Address ....._.-52(a=-6.th....Auenue•-Dlox..th--
�
LOCATION OF BUILDING
Na 6$65 _ S�t Jackson_Street_.N.E. -•--------__.__:.---- Part of Lot
� 2�,30 gio�. 5 _�_:. Addition or Sub-Divisian Florence Park Addition
Corner Lot Inside Lot Setback __.._ti._.._...�. Sideyard _..._._
:5ewer Ete�ation — Foundation Elevation ___
DESCRIPTION OF BUiLDING
9co be vsea as:
R P_ R i r� P N o� Lc P Front ____ Depth Height ._.._._...w..._ Sq. Et. __r Cu. Ft
_.._: Front Depth Height .T.._...� Sq. Ft _--•_______ Cu. Ft
Type of Construction �.....�.te�]� Es� Cost .._.�._.a�.�.�.QSL�4....... To be Completed _�.. m�.t.h.
—
In consideration of the issuance to me of a permit to construct the building described above, I�gree to $o
'We proposed work in accordance with the description above set fox�h�and in cox�pliance with all provisions o!
Ord�ances of the city of Fridley. / // // n, �
In consideration of the payment of a fee of $_ 7 5_ �� �.._.__, permit is hereby granted to..�....8ci�a 1 e 1„m;,,,,.,,
_ to construct the building or addition as described above. This permit is granted upo�i
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
$one in, around and upon said building, or any part thereof, shall conform in all respecte •to the ordinances of '
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of builtlir�i
��� city ]imits and this permit may be revoked at any time upon violation of any of the provisions of Said
�
����4 �i .. � u„a�.�in¢ Ingpectp�
('T.ARF.Nf`F RFT.TST.F
NOTICE:
This psrmit does not eovar the construetion, installation for wiring, plumbing, gas he�ting, s�w�r or wahr. Bs wn to sw
th� Building Inspecto� for sepa�afe permits for theae items.
r
�
QWNEIt' S
ADARESS:
NO•.
�`
LO� :,,_,.,..�
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD;_,,,_�
Applicant attach to this form Ttao Certificatea of Survey of �,ot and proposed
bu�.�di.�ng l.ocation drawa at► these Certificates,
HESCRIPTION OF BUILAING
To Be Used As:
�> -
�
� � �g�nt ; Depth ; Height :
Square Feet: Cubic Feet:
Fxonts Depth: Height:
Squaxe Feet, Cubic Feet:
1�►pe of Construction: / Estimated Cost: $ �� ��;
To 8e► Completed; �✓��
Tfie aadersigaed hereby mskes applicatitia for a�ermit �or the work herei�
spec�.fied, agreeing to do a11 Mo�k in stlict accordance wl.th tha C�ty o�
8xidley O�diaance� aad ruliags of the Depastment of Buildings, and heraby
ciecl�.ree that all tiie facts and representatioas stated in this appllcation
are tsue and correct.
,
DATE: .�-� - i'�- SIGNAIVRB: ^ ��%
(See Reveree Side For Additiaaal Iaformation.)
� ��f/ •
� � � � ����
la' ��
_ I�� -
, �'
� � . ��
:
�
CITY OF FRIDLEY
APPLICATION FOR PWMBtNG AND �AS FITTING PERiIT
N � �
� � �^ d � . x � Matei
Y .ti w h.� �q � � rl A In pa, N' Pr� Heater
•9 �� e � a � t'� c i~� u a� c'� u °� u
q My qN .1 �p
�n U 5 Iq O vl i O I.. ul t�O. � U/0 �! 2 � ly t� O,A 9 1 eC
�
l�t � � S �n
2nd
lyd
�th
(R) � FUWr� Conn�ction opening Connacted vith Sever
(�) � Nsv PfxWre, Old Opaninq Mater
RATE SCNEDULE
PLUMBINC FIXTURE RATES:
N�v �1=tur�•
futur• ►lstus�•
Old Op�ninq, N�M fi:tur•
e��r Oi�p�n��r
elov Olf B��ln
C�tcA B��in
R�in Mat�r Laad�r
Mydr�ulic V�lv•
&u�p or R�c�lvinq Tank
M�t�r Treatinq Applianc•
Hot M�t�r tl��t�s
Ge• Ranq�
C�• Dryar
N0.
�
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1• oI V�iue ol •l:tur• os Appliance
Ivin�psctton ►ee S
s
(515.00)
RATE
S 5. 00
S 3. SO
S 1. 50
S 4.00
S 5. 00
S 5.00
S 5. 00
S 5.00
S 5.00
S 7.00
S 5.00
S 10.00
S 10.00
St�te Surch�rqe
1'OTAL PEE
TOTAL
S
S__/b.s0
S
S
S
S
S
S
S
S
S
S
S
S
S .50
5 /�
Ettee@tve /wq, 1, lytll
Job Addreas �� � s Q �� ��•
Uepartment of Bulldiogs
City of Fridley
Tel. �571-1150
The underaiqned hereby makes appllcation for • p�cnit tor tha rork,hgrnLn -
speclfied aqreeinq to do ell work in atrtct accotd�nc� vlth the Ctty Cudee
and rulinga of the Depart�ent of 8ulldtng�, a�d h�r�by d�claras that all
the tact,a and repreaentattona atated Ln this •pp1Lc� lon are tcue and correct
y
Fr1d1eY. Mn. 7�� . 19 D.�
/� �
OMNE R L'7�, r �rr �. . , - -- • � ._
r
KINO O� BUIIDING
USED AS L� LaJ t,��
7'O BE C�Ol�I%"l'ED 11BOUT
Es rEO oosr •j/d"d •" -
OLD - BUILDTNG PERMIT NO. PLIiMIT NO. �/��'f
�WnY I►/ �_
Slqnsd By
Tal . No. y�%� /.'j ` i
RWGH INSP.
Date
i--
FINAL INSP. ��Z y� ��
Date
APPROVAL POR PBRMIT �����
!1INIHUM FEE FOR ANY PLUMBING PEpMIT IS =10.00
PLUS THE S.SO ST4TE SURCNARGE
� -,�11�.5
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE �
Effective On January 1, 2000
Fridley, MN 55432 APPLICATIUN FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Bur�er -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - Atl Sizes
All Otners/Repairs & Alterations (LIST ON BACK)
lqo �f Value of Appliance or Work
Commer�ial/Industrial
1.25qo of Value of Appliance or Work
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surch�rge
TOTAL FEE
u u •L '�. � �•_ � •►
. . . , � � • • � •� i _ ' :�i ��
. , . .
._ : _ . ._.
REINSPECTiON FEE $47.00/Hr
TOTAL
$ ��oo �
$
$
JOB ADD
OWNER��,(� �5,.(�'Ul'"�.D�>J'J
BUILDING USED AS___G2�1��
ESTIMATED COST �-10�3 � PERMIT N0. �"�7�0�'
��SCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
$ Trade Name Size No.
BTU HF EDR
$.�� Fuel Total Connected Load
$
$
$ .50
� �S.So
Burner Trade Name Size No.
BTU FiP EDR
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do a!I work in strict accordance with the C;ty Codes an
rulings of the Building Divisian, and hereby declares that all the facts and
representations stated in thi�. application are true and correct.
q� ��� 'd/
��t}GV'fYICK HERTIR4a ���!#� �0�#Ot� •, .
HEATING CO ���01���t '�o� e� �'����ru� South
` C/Jo�-�iti�-��Q
Signec'� ��,���� TEL # .
�� i��
*Air Conditioners can not be placed in a side yard without Approved By
written permission from adjoining property owner. �
d
� Rou�h•In Date 1 Final Date 8'(-D �
r
n
, SEDGWICK HEATING & AIR CONDITIONING CO.
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(612) 881-9000
ADDRESS �3 rO �
nr.ri iannit Q �l.T'�!1
SOLD BY � e �
MAKE "`
SERIAL NC
THERMOS'
VALVE �
LIMIT D
LIMIT SE'
FAN SET
PILOT TV
IGNITION
PILOT TIP
PRESSUF
INPUT f
STACK
FORM 235
�a� 11�}�;� 5,1
� (,(J c'. w S � '�
lncy
�30o L OS 4G S
�.�� ti';�'C � �) �� r " �' �
HEATING �oe No.� / / a .T
TEST RECORD
CITY F r .'�1 / e�
OWNER
INSTALLED BY �
MODEL C7 2 7 il ,� ' Z�
INPUT ? S a Q a
AT � b�' S�`` �9 VENT SIZE 7�
��1 �� f�-� S� F f TYPE OF LINER e� v°��
`/ �0�1 LINER SIZE .J �
ING ��d c FILTERS: SIZE `L ��'� S �'e � o' °t NUMBER I
VG � ��'''► << WIRING s L't�g w�CiG�
- L �� f,,- � � `� TEST TAG �
IODEL G�0 4, p�� c LIGHTING INST. �
VG �/� S�- � DATE TESTED �� � 9' 0/
� -3 ��� t L PERCENT CO2 � ?a
�� PERCENT OZ ��6 COMPANY TESTING s�[ w C G fC�
�P. 3 SS� PERCENT CO ��L NAME OF TESTER � C�f�i.M��
. 17/89) . FORM DISTRIBUTION: WHITE COPY - JOB FILE VELLOW COPY - CITV