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PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn. N? 2 R 4 6 Date............................. ..�.... : 1? Owner ......... Builder ......... Address ... Address LOCATION OF BUILDING No. &0 ..... Street ... y'w. .............. Part of Lot ....................... Lot ....... 3...... Block ..... 2......... Addition or Sub -Division ...r�� . &4a XZ,rre.... Corner Lot ............ Inside Lot ....�� Setback ............ Sideyard .......................... DESCRIPTION OF BUILDING To Dbe Used as: P ..... Front - YY.. Depth .,�. .. Height Z. . Sq. Ft./M5.(p Cu. Ft, ........ / .. .... Front .. 1., .. Depth . Z . .. Height ... . . .... Sq. Ft. Cu. Ft, ........ IF 47- Type of Construction .YAIO.� ... Est. Cost . J.q�, & 0 .......... 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 ordinances of the village of Fridley. • • •In consideration of the payment of a fee of $1116 ®� permit is hereby granted to .. �,¢�� ................. to construct the building or addition as described above. This permit i5 anted 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, repair and moving of buildings with- in the village limits and this permit may be revoked at anytWAw, upon violation of any of the provisions of said ordinances. ... ... .. Building Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. v Date: June 7, 1965 Jack Saccoman 7'0 Builder Elmer Peterson Address 6530 Washington Street N. E. Address 34.35 Buchanan Street N. E. N® '7'762 0 LOCATION OF BUILDING No. 68 30_ street Wa sh3 Ston Street N. E. Part of Lot Lot 3 _ Block Z Addition or Sub -Division Rice Creek Terrace Corner Lot Inside Lot Setback Sideyard Sewer Elevation _ _ _ Foundation Elevation •• q To be Used as: Front Depth Height Sq. Ft. Cu. Ft Front Depth height Sq. Ft Cu. Ft Type of Construction Est cost '000-00 To be Completed Storm damage repair 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 —c pliance with ail provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 30,00W _ , permit is hereby granted to Fi.'itr Petea©► 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, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances A11en Jense . n Building mmspector NOTICE Ibis ponah does not cover the construction, huftWon for whing, pkwbing, gas heettng, sewer, or water. Be core to we the Building l gwmr for sopsrste permha for these hems. Ola APPLICATION FOR BUILDING PERMIT ITY OF FRIDLEY, MINNESOTA OWNER'S ADDRESS / �( )0 wa-C � 6 S f-/ /yc- ADDRESS J LOCATION OF BUILDING No. �a� a S t Street Part of Lot` LOT BLOCK _ADDITION OR SUBDIVISION Corner Lot Inside LOTSetback Side Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as: 0 710 - - /V 11 A/ -J, /-I- .,g; s 144ront Depth Height Sq., Ft. Cu. Ft. Front Depth Height ' y �i Sq. Ft.: Cu. Ft. Type of Construction ' 6' /� ?� • .•- � Estimated Cost Doo .� 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 of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations 'stated in :this appj--gation are true and'correct. DATE (Schedule of Fee Costs can be found on the Reverse Side). y .r City of Fridley SUBJECT P 2_10 3 3 7 AT THE TOP OF THE TWINS BUILDING PERMIT r iIPT to ------- COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 ' � CITY HALL FRIDLEY 55432 j NUMBER REV. D ATE PAGE OF APPROVED BY 612-571-3450 910-F15 3/9/88 JOB ADDRESS 6830 Washington Street N.E. 1 LEGAL . LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 2 Rice Creek Terrace Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Darwin Klocker 6830 Washington Street N.E. 571-7623 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO, Merchants. Maintenance 12020 Radisson Road N.E., Blaine' 755-0904 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 7 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 21.1 x 61 Addition 9 CHANGE OF USE FROM TO StIPULATIONS See notations on plan SEPARATE PERMITS RE WIRING, HEATING, pU1RF® F®� PLS,BING AND SIGNS, 11411 "al utilities Qu-i ' t BY LAW 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 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT) HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND,ORDINANCES GOVERNING THIS TYPECOMPLIED $6.150 $3.07 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF APERMIT 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- $62.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $15.63 $81.20. SIGNATURE OF CON' CTOR OR 1 THORIZED AGENT (DATE) �:1 -- WHEN PROPERLY VNqDATED T IS IS YOUR,,PERMIT 6LDG INS AAT�� SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI NEW [ ] ADDN. [ ] ALTER. [ ] Construction Addre Legal Description: City of Fridley Effective 4/1/86 �R-1 AND R-2 Building Permit Application Owner Name & Address: Contractor Tel. # '7�i, Tej . # �5� Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length s-11 B Width � Height %` Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: I V W* Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Type of Construction:Estimated Cost: $ 0� Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation ,, —�� Tel. # if DATE. APPLICANT: CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Plan Check $ ' ° 25% of Building Permit Fee State Surcharge $ ®� $.50/$1,000 Valuation SAC Charge $ $.a per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ �� , Agreement Necessary [ ] Not Necessary [ ] TOTAL $ eo STIPULATIONS: ► 54 ®� 1� A ; A r SUBJECT City ®f Fridley 2734 7REIPT AT THE TOP OF THE TWINS BUILDING PERMIT r ' , NO. _ COMMUNITY DEVELOPMENT DIV. L PROTECTIVE INSPECTION SEC. �� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED By 612-571-3450 910-F15 7/20j94 JOB ADDRESS 6830 Washington Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 2 Rice Creek T rr SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Darwin Klockers 6830 Washin ton St NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Built By Design Inc. 4679 HmRton _ 472-5011 3853 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 J3 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Interior alterations to enlarge bedroom and change windows 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Provide egress window in bedroom to meet State Code requirements. Provide smoke detectors adjacent to all sleeping areas and in basement. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING MOT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION I 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 $2.25 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $4,500 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- $72.00 Fire SC $4.50 STR I N OR THE PERFORMA OfCONSTRUCTION. PLAN CHECK FEE TOTAL FEE n License SC $5.00 83.75 SIGNATURE OF NTRACTOR OR AUTHORIZ AGENT IDATEI HEN,�PF0 RLY, VALIDATED THIS IS YOUR PERMIT SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI BLDG f1ATE 0 NEW [ ] Effective 1/1./94 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2�� Building Permit Application Construction Address:j�- Legal Description: -- - Owner Name 8i Address: P KLp Tel. # I[ Z71 7620 Contractor: , ti MN LICENSE # Address: a, 1 !p - �S3(0. Tel. # LIVING AREA: GARAGE AREA: DECK AREA: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTIONS OF IMPROVEMENT Length Width Height Length Width Height Length Width Hgt/Ground OTHER: Se - co. -P eeon�� Corner Lot [ l Inside Lot [ ] Ft. Yd Setback Type of Construction: Approx. Completion Date: Sq. Ft.- Sq. t:Sq. Ft. Sq. Ft. �,* -/ 2, / a ° A,41 AL_ M `,� le, /9i -4Li 100.v A&&e" nzaaa� CA9V Side Yard Setbacks Estimated Cost: $ (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft t x = $ DATE:.? / 5 �-% APPLICANT: i Tel. # �/ 7.-)-�� O / Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer. Main Charge CITY USE ONLY $ - 60 Fee Schedule on Reverse Side $iY.,5 0 001 of Permit Valuation (1/10 %) O CZ- 0 0 + �% $ $ $ $ $.50/$1,000 Valuation $800 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] TOTAL $ A STIPULATIONS: ��.. � � • �% '�� 2.�" � �� e ,fir. �' � '� SUBJECT PERWT-*&:--- ' City of Fridley 22918 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. • ___ _ COMMUNITY DEVELOPMENT DIV - PROTECTIVE INSPECTION SEC r -3�� CITY HALL FRIDLEY 55432 NUMBER REV DATE OF APPROVED BY 612-571-3450 910-F15 9/19/94 r;GC / JOB ADDRESS 6830 Washington Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 2 1 Rice Creek Terrace Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Darwin/Joan Blockers 6830 Washington St NE 571-7623 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Franzen Construction Co 4250 5 Street NE, Columbia Heights MN 55421 788-4071 2744 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 a ❑ NEW X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 6 DESCRIBE WORK Construct a 21' x 7' Garage Addition and a 49.34 sf Porch Addition 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 $3,687 $1.84 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- ST C OR THE PERFORMANCE OF CONSTRUCTION $63.00 Fire SC $3.69 PLAN CHECK FEE TOTAL FEE License SC $5.00 73.53 SIG NATUREON C NTRACTOR ORL 1TfH.R1ZED AGENT (DAVE) WHEN PROPE Y VALIDATED THIS IS YOUR PERMIT BL G INSP GATE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI NEW [ ] 1 �ffective 1/1/94 ADDN M CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 I Building Permit Application ConstructiotiAddress: ( j tA&:, ' I��.��' Tofu `SST O Legal Description: Owner Name & Address: JbKIRW/0 '�pA%0 � C K GS Tel. # s-71 Contractor: , �� , Cc, MN LICENSE # Address: 612, —50 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: DESCRIPTION OF IMPROVEMENT Length^ Width _ Height Length Width �_ Height Length Width Hgt/Ground Sq. Ft.1�-� Sq. Ft. f 7 = Y1, YL Sq. Ft. A 1 T )o q9, 3q 4.20 fs Corner Lot [ ] Inside Lot [A Ft. Yd Setback Side Yard Setbacks Type of Construction: MD Ec_ 15xfs7,uCr /-/vL)� Estimated Cost: $ Approx. Completion Date: 1Jd v. (Cost on Back) Driveway Curb Cut Width Needed: —F" 6 Ft Ft x $ — $ DATEAPPLICANT: : Tel. # ISO- -7 12 v CITY USE DNLY Permit Fee $, Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1 / 10th %) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $800 per SAC Unit License Surcharge $ S. ®® $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 [ ] TOTAL STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. Effective On March 1, 1996 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS_ AID ASK 494, A) L-7 RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner — rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 30.00 $ representations stated in this application are true and correct. -- (Side Vent — Fill Out Back)` 01996 Gas Piping (Needed with new furnace) $10.00 $ OWNERS,7Q0J Gas Range _ $10.00 $ , BUILDING USED AS Gas Dryer $ 10.00 $ 00 15 �� `— ESTIMATED COST PERMIT NO.� *Air Co ditioning — All Sizes $ 25.00 � $ C;15 .00 r -' %Nxb�q a�k) DESCRIPTION OF FURNACE AND OR BURNER All Otherss epairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. Commercial/Industrial BTU HP EDR 1.25% of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge $ .50 Burner Trade Name Size No. TOTALFEE �• BTU HP EDR HEATING COMPANY ELAINE HTG. A/C & ELECT. INC. 13562- CUTRiAL-012IN.i MINIMUM FEE FOR ANY HEATING/COOLING,NENTILATION ANOKA, MN 55304 REFRIGERATION/AIR CONDITIONING PERMIT IS 125.00 �Ignfd'qtA Tel No. 'I'52� 00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr Approved By/( V Rough—in Date Final Date *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE IEbR STACK VERIFICATION ON written permission from adjoining property owner. REPLACEMENT FURNACE Remarks: CEMMY AND STACK VERIFICATION The undersigned i hereby verifies that the existing chimney or stack: I 1. Has n carefully examined Yes () No ( ) 2. Is free firoin rust or deterioration Yes () No ( ) 3. Has no foreign objects lodged within Yes () No ( ) 4. Is securely supported Yes () No ( ) 5. Meets all current Code requirements for size and to BTU's connected Yes () No ( ) 6 Has to heating BTU's of All other BTU's I TOTAL BTU's 7. Hasa liner been provided for water heater Yes () No ( ) 8. Has combustion air been provided for water heater Yes () No ( ) Remarks: CIiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 February 12, 1999 Joan Klockers 6830 Washington St NE Fridley, MN 55432 Re: Final Inspection at 6830 Washington St NE Contractor: Blaine Heating AC & Electric Inc Dear Ms. Klockers: A mechanical permit was issued on January 14, 1998 for the property located at 6830 Washington St NE for a furnace replacement installation. According to Section 305(a) of the 1991 Uniform Mechanical Code a final inspection shall be performed on the mechanical system. As of this date no inspection has been called for. You will be given thirty (30) days from receipt of this notice to respond. If we do not hear from you, we will expire the permit and any inspections on this installation will require a new permit. Any questions can be addressed to myself at (612) 572-3603. Sincerely, G'Gccy�/ Y RIESCH Building Inspector C21.HEATING LICA �a �'' ` HOUSE�OGP�TIN69 �E�� REC®R® AIR CONDITIONING AND ELECTRIC. INC. ADDRESS d crl' �� Mas �t yt J APT. CITY � �! SUBURB OCCUPANT roc �Cry -FLOOR OWNER r3nr°I° e HEAT LOSS DATE HTG. INST. SOLD BY _GSR Z2Lj;, j- A-9 INSTALLED BY Electrical Work By ::5 Gas Line By �S TYPE OF HEAT GA FA ---HW— STEAM® SPACE HTR.® UNIT HTR.® OTHER GAS DESIGN S� �i�e9F CONVERSION MAKE - �� MAKE OF BURNER Model�j�] '1 l r -F ct\\�=� Model Serial Max. BTU Rating INPUT MAKE OF FURNACE Model CONTROLS 4, THERMOSTAT 1-- 3-7 Heat Plug Vent Size Z Valve 114k7,>t'2 .S KIND OF LINER SIZE NONE Limtt�-��_ _ Draft Hood -:7�- -1ac Regulator Limit Setting Filters Size S.f-IC- Number Fan Setting Ti yu 2 A Chimney Location Inside Outside Pilot Type L--�a=k S -%ns -LIZ!, aL Chimney Construction Pilot Make Pilot Model Smoke Bomb Wiring Pilot Timing C } S Sec— Draft Test Tag L W. Cut Off Door Pressure Lighting Inst. Pressure • S Percent Co. , i Date Tested 1 -% 3 -1 J-' Input CFH Percent O -7_ ? Company Testing Stack Temp. / / % 6 — Percent CO / 3 Name of Tester T Form 235 CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1997 - 6431 University Ave NE Fridley, MN 55432. APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING -SYSTEMS AND DEVICES JOBADDRESS L350 WaS i r Ch)n aklP . RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner - rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $'30.00 $ representations stated In this application are true and correct. (Side Vent - Fill Out Back) 1g Gas Piping (Needed with new furnace) $10.00 $ / OWNER' J_06 , A 6..1 0��P Gas Range $10.00 $ 6 BUILDING USED AS Gas Dryer $10.00 $ . ESTIMATED COST 0-0 • PERMIT NO. *Air Conditioning - All Sizes $ 25.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work $ No. of Heating Units f Circle One (Steam) (Hot Water) rm A r) Trade Name Y'Ia - Size No. 3S�j )'t � DUQ D Commercial/Industrial BTU to C 10 00 HP EDR 1.25% of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge .50 Burner Trade Name Size No. TOTAL FEE $ 3b�� BTU HP EDR BLAINE HTG. AIC ELECT., INC. 13562 CENTRAL AVE. N.E. HEATING CO P Y ANOKA, MN 55304 MINIMUM FEE FOR ANY HEATINGICOOUNGIVENTILATION REFRIGERATION/AIR7CONDITIONING PERMIT IS $25.00 Signed By i o. -7b-7-baoo PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr Approved By Rough -in Date Final Date *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE F R STACK VERIFICATION ON written permission from adjoining property owner. REPLACEMENT FURNA E HEATING Signed By: Date: CEnAC4EY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. - Has been carefully examined Yes Q4 No 2. Is five ftom rust or deteriorition Yes (A' No 3. Has no foreign objects lodged within Yes No 4. Is securply supported Yes No S. Meets all current Code requirements for size and to BTU's connected Yes No 6 Has to heating BTU's of All other BTU's TOTAL BTU's 7. Hasa li aer been provided. for water heater Yes No 8. Has con ibustion air been provided for water heater Yes. ()o No Remarks: HEATING Signed By: Date: