PRE 2010 DOCSCity of Fridley, Minn..
BUILDING PERMIT N° 5 E4:4)
Dater
Owner: t` + yW Builder
Address Address
LOCATIONvi
F B91LDING
Street". r ,�, 16 , r. f Part o t
Lot wt" Block _� Addition or Sub-Division
�___,.
Corner Lot _ Inside Lot �'"'"O Setback deyard.._
Sewer Elevation -- Foundation Elevation
DESCRIPTION OF BUILDING
Depth Height m"` Sq. Ft. A- Cu. Ft..1+2` f #
3ZN Depth �' Height , Sq. Ft. Cu. Ft.
Type o natruction %� Est. Coss _ 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 compliance with all provisions of
ordinanoEs of the city of Fridley.
In consideration of the payment of a fee of 1-t , 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
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regardiYg location, construction, alteration, maintenance, repair and moving of buildings
within the city liaaits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. ., ,•- a
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these hems.
4
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner r a Nam 'q /-_-- �'�A. Builder '
Address Address
LOCATION OF BUILDING
No. Street Part of Lot
Lot Block Addition or Subdivision
AM -
Corner Lot Inside Lot -Setback ^ Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
To be used as
DESCRIPTION OF BUILDING
Sq. Ft. &zz Cu. Ft.32- Z- Y 6
Sq. Ft. ILE Cu. Ft.„_
Type of Construction �S ��il-Pc Estimated Cos Z2=
To be Completed
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_ the s presentations
stated in this appl3cat on are trine and correct.
� r
DATE
(A Schedule of Fee Costs can be found on the Reverse Side.)
City of Fridley
Application for Plumbing and Gas F'nting Pemdt
Dept. of Bldgs. Phone SU 4-7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
Number Fixtures ......................
NO. RATE TOTAL
0
x $1.50 $ �
Future Fixture Opening ................
��
y`,
Z
N
��
Z Z
AZO
Catch Basin ............................
�Q < Z
vy+
Z
Q~y`�
O W
,
�qn
G
'v
Z
*a
+
F
`
N
WATER HTR.
GAS
ELEC.
TOTAL
3i
CJ
N
'S F-
C LL
G
{J
iJ
C1 O
Base
1st
2nd
_
3rd
4th
• Future Connection Openings
Connected withI Sewer �
New Fixture, Old Openings
Cesspool El
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
Number Fixtures ......................
NO. RATE TOTAL
0
x $1.50 $ �
Future Fixture Opening ................
x 1.20 $
New Fixture Old Opening ..............
x 1.00 $
Catch Basin ............................
x 3.25 $
Water Heater (Up to 200,000 BTU) ......
x 2.00 $
New Ground Run Old Bldg . ............
x 3.25 $
GAS FITTING FEES:
NO. RATE
TOTAL
1st 3 Fixtures .......................... x $1.50 $
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description................................................$—Ip
TOTAL FEE
e r' C e,, 1- C/ L`
City of Fridley: � S
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 are true and correct.
Fridley, Minn
® 0 19
Owner C
Kind of Building~ e
Used as ext e—
To be completed about
Estimated Cost, $
Old New.�uilding Permit No Permit No /r
Signe
ROUG / J
FINAL
az 2M 7-59
Business Phone No -
2
SUBJECT
City of Fridley
13380 ®
AT THE TOP OF THE TWINS
BUILDING PER M
r
RECEIPT NO.
� COMMUNITY DEVELOPMENT DIV.
r i PROTECTIVE INSPECTION SEC.
i
11 i
�•"',,� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
.---� 612-560-3450
910-1715
2/23/76
JOB ADDRESS 256 Mercury Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
4
2
Sylvan Hills Plat 4 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Melba Benson 256 Mercury Drive N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Meridian Waterproofing 8736 E. Research Center Road535-7111
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Waterproof structure
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
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
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
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.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$750.00
.50
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.
$5.00
PLAN CHECK FEE
TOTALFEE
5.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
HEN PROPERLY V DATED THIS IS YOU17 PERMIT
BLDG INSP DAT
' SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
2
APPLICATION FOR RESIDENTIAL, ALTP.RATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAM: 2 I e '(� Scr*—BUILDER: � , e► o-) rr C) -O i<\
OWN —
ADDRESS 6 A e c r -i r N D 6 ADDRESS: IL -z /V-01�1 2
'sc C /
NO:. STREET: 1)26eGa1-1„,e6Z '1121444
LOT: "y BLOCK: ADDITION: SVI-48 r/ A,r4 AI
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: '
Applicant attach to this form Two Certificates of Survey_ of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF ILDING
To Be Used As: U'j 44 + /gate'
Front: Depth:
Square Feet: __ Cubic Feet:
height:_
Front:__ Depth:_, Height
Square Feet; Cubic Feet:
-7 6c -
Type
c_Type of Construction: _ Estimated Cost: $ I�
To Be Completed: Z /7(
The undersigned hereby makes application for a permit for the work herein
specified, afire+=ing to do al]. .-.'Orr 7_7 st,:izt accordance with the City of
Fridley Ordinances and i-aliugs of. C. ,t. D,!partrient of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE: FJ, S" CNATUIZU :
{See Reverse Side For
o c
IL
Additional Information.)
� O o er s J
1
SUBJECT
P IT_
City of Fridley
17901
AT THE TOP OF THE TWINS
BUILDING
P E R M I T
r
CEIPT
Tr ______ COMMUNITY DEVELOPMENT DIV.
L.
INSPECTION SEC.
O
A
r PROTECTIVE
/--n CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE. OF
APPROVED BY
612-571-3450
910-F15
4/11/85
/
JOB ADDRESS 256 Mercury Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
2
Sylvan Hills Plat 4
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Clinton/Karen Coppicus. 256 Mercury Drive N.E.
571-2097
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION %❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install alumirmm soffit & Facia
9 CHANGEOFUSEFROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
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 PE910D OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$850
$.5o
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-
$16.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
LAN CHECK FEE
TOTAL FEE
$16.50
SIGNATURE OF NTRACTOR OR AUTHORIZED AGENT (DATE)
SIGNATURE
WHEN PROPERLY LI DATED THIS IS YOUR REMIT
11DA�TE
BLDG )NSP
q T�
Si OF OW )ER OF OWNEIRBUILDER)
1
NEW
[ ]
City of Fridley Effective 4/1/84
ADDN.
[ ]
�R-1 AND R-2
ALTER.
[ ]
Building Permit Application
Construction Address: z�fp to 'f`► erc is w Ln . 1._ Hn i dl p i A
Legal Tiesoription: I_nA VA R�nC & 2 'E)�j'Wara Hi Lk s. PI i 4
Owner Name a Address : 10 t ® CtYPn Onq p k-okA --s Tel. #5_1\-2_(211
Contractor: �`zaM P -_ Tel. #
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Corner Lot [ ]
Attach to this application, a Certificate of Survey of the
lot, With the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Inside Lot [ ] Ft. Yd. Setback
Type of Construction:
Approx. Completion Date:
Proposed Driveway Width If New Opening Is Desired:
Side Yard Setback
G7
Estimated Cost: $ 9�
Alt. A Alt B
� a
See Back Page for Explanation
DATE: APPLICANT Tel. # -
CITY USE ONLY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS•
Fee Schedule on Reverse Side
2% of Building Permit Fee
$•50/$1,000 Valuation
$425 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
CIlYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 • FAX (612) 571-1287
April 25, 1994
Clinton and Karen Coppicus
256 Mercury Drive N.E.
Fridley, MN 55432
RE: First Notice of Noncompliance at 256 Mercury Drive N.E.
Dear Mr. and Mrs. Coppicus:
The City of Fridley has established a City Code for the purpose of
promoting a pleasant and attractive suburban environment. A recent
inspection of the property at 256 Mercury Drive N.E. revealed that
not all Code requirements are presently being met. Listed below
are items which do not comply with the City Code:
1. Discontinue outside storage of brush and assorted materials
located along the west side of your garage.
Your prompt attention in correcting this situation would greatly
assist us in helping make Fridley a better place to live. An
inspection will be conducted on or about May 9, 1994, to determine
compliance.
If you have questions or would like to discuss this, please contact
me at 572-3595. Thank you for your cooperation!
Sincerely,
Steven Barg
Code Enforcement Officer
SB:ls
CE -94-155
O
CINOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 • FAX (612) 571-1287
May 13, 1994
Clinton and Karen Coppicus
256 Mercury Drive N.E.
Fridley, MN 55432
RE: Property at 256 Mercury Drive N.E.
Dear Mr. and Mrs. Coppicus:
On April 25, 1994, I sent you a letter (copy attached) concerning
outside storage of materials along the west side of your residence.
Subsequently, you contacted me and we discussed this matter.
On May 12, 1994, I stopped by your property to further review this
situation. While I did not observe outside storage of assorted
materials, I did notice that you appear to keeping yard waste at
this location. Fridley City Code 113 (copy enclosed) does permit
composting, provided that certain criteria are met. Please create
a compost area in accordance with these requirements or remove this
yard waste as soon as possible.
I will reinspect your property on or shortly after June 6, 1994 to
determine compliance. Feel free to call me at 572-3595 if you have
questions or would like to discuss this further. Thanks for your
cooperation!
Sincerely,
Steven Barg
Code Enforcement Officer
SB:sb
CE -94-197
SUBJECT
City of Fridley
5
AT THE TOP OF THE TWINS
BUILDING
PERMIT
Ir
RECEIPT NO.
�• _ COMMUNITY DEVELOPMENT DIV
r PROTECTIVE INSPECTION SEC
a�?
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
6/9/97
JOB ADDRESS 256 Mercury Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DEscR.
4
2
Sylvan Hills Plat 4
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Clinton/Karen Coppicus 256 Mercury Drive NE
571-2097
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION J3 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (33 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Uuderlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. 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
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS I GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$2,722
$1.36
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TAL FEE
A$78.83
I ATUR R OR AUTMORI2ED AGENT (DAT IH
P
Y VALI A ED THIS IS YOUR PERMIT
70FC'RA
DG INSP
PATE "'
SiGNATU RE OWNER OF ER BWLDERI ATEI
NEW [ ] Effective 1/1/97
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Owner Name &Address: 1(avc-, J, (Cd f Tel. # j % ZO of %
Contractor: W ri ctl MN LICENSE#
Address: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
DESCRIPTION OF IMPROVEMENT
Length
Length
31�t
Width Height
Width Height
Width Hgt/Ground
AJC- Ge�Z &Q -a e
Sq. Ft.
Sq. Ft.
Sq. Ft.
a ✓ o rg,,P
Estimated Cost: $'�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: O q 7 7 . APPLICANT: Tel. # .'37/
his �2 Vis'
CITY USE ONLY
Permit Fee $ �/ S� Fee Schedule on Reverse Side
Fire Surcharge $ .001 of Permit Valuation (1/10th%)
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $950 per SAC Unit
License Surcharge $ $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ • $450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ J
TOTAL $
STIPULATIONS:
City of Fridley
6431 University Avenue NE
Fridley, MN 55432
Property owners at 266 Mercury Drive NE, Fridley MN and the property owners at 256
Mercury Drive NE, Fridley MN 55432 agree to have both driveways closer that three
feet to the property line between the to properties.
w
Kim and Janet Herrmann
266 Mercury Drive NE
Fridley, MN 55432
y �Z,000� QA)
Clinton and Karen Coppicus
256 Mercury Drive NE
Fridley, MN 55432
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CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate TOTAL
$ 30.00 $ 3 ®' 6Z
$ 10.00 $
$ 10.00 $
$ 10.00 $
$ 25.00 $ f` 0_0
State Surcharge
Effective
JOB ADDRESS oz
OWNER.LTT/�-r�
BUILDING USED AS R65'
ESTIMATED COST
PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Wate =(Warm
Trade Name 9124A-) Size No.
BTU 0&0 HP EDR
Fuel ��1- 6-4 -C Total Connected Load
Burner Trade Name Size N
BTU HP
EDR
$ The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes an
$ .50 rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
TOTAL FEE $S�
' 0 - U 0 DATE �- 7— 0.3
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATIO 5b HEATING CO ��% 1t ���� .r
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00PLUS THE THE $.50 STATE SURCHARGE Signed / TEL #
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
FAX # Z / 0�3.7 — 6�; "�M
Approved By Rough -In Date Final Date IS—
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
COMMON VENT VENT CONNECTOR AND COMMIRTION AIR VIFIRIFICATION
When re In acing an axis ing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes K) 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 Furnace Venting Tables for fan
assisted and natural draft appliances. Yes k) No( )
The existing _nm6 uctinn air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No (�()
When required to install a new r_nmeustien air. it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes) No( )
When installing a new venting systLmm,, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes ( No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes j No ( )
Appliance #1 Type tJrcn1A a6 BTU Input ✓�� Fan Assisted or Nat
Appliance #2 Type Wig/ ZO-e-7- BTU Input 5LO.. oFan Assisted or Nat fL-JA 'r—
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances 19 Total Btu Input
Common Vent Type IWC Vent Height Diameter inches
Appliance #1 Vent Connector Height a�- ft Length a�_ft Diameter Y in Type �-
Appliance #2 Vent Connector Height e ft Length 9- ft Diameter min Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
TINGCO: J A"16``����
I By:
�o
1�
Date : 3 �`0-3
CITY OF FRWLEY PERMIT NO.: 2004-00094
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 01/22/2004
572-3604 tAX: (763) 571-1287
ADDRESS 256 MERCURY DR NE
PIN 143024320030
LEGAL DESC SYLVAN HILLS PLAT 4
LOT 4 BLOCK 2
PERMIT TYPE ELECTRICAL
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE ADDITION/ALTERATION
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE.
INSTALL XCEL ENERGY SAVERS SWITCH
# INSPECTIONS
APPLICANT
HUNT ELECTRIC CORP
2300 TERRITORIAL RD
ST PAUL, MN 55114-1614
(651) 646-2911
OWNER
COPPICUS CLINTON J & KAREN
256 MERCURY DR NE
FRIDLEY, MN 55432
1
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 governing this type of wort
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 PERMIT FEE - MIN (RESI) 20.00
STATE SURCHARGE, ELEC FLAT 0.50
TOTAL 20.50
PAID WITH CHECK # 113375
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.