PRE 02010 DOCSfes,
L J
Village of Fridley, Minn.
BUILDING PERMIT
Date: `........... '. '.. ►.` .��'.....
Owner V.'.u..... Builder
Address ...... Address
No 1848
......................
c� �f L OF BUILDING
No. ..G .. 7.. Street .....I ............... Part of Lot ............................ .
Lot ....... 13. Block ................ Addition or Sub -Division ... (anivdbt_. .
d %
Corner Lot .... Inside Lot ........... Setback ........... Sideyard ... f. �... / . e . 41n........ .
DESCRIPTION OF BUILDING
T"bese s:
......... Front ... err .. Depth ... Height . ..... Sq. Ft. ........ Cu. Ft. ....... .
..................... Front ........ Depth .... Hei9ht ........ Sq. Ft. ........ Cu. Ft. ........
Type of Construction��..... Est. Cost .... 9 .............. To be Completed . .. . 6
_� —
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
j ordinances of the village of Fridley.
°..0 ...............
ell
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
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, mainttpa4 ce, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time `on violation of any of the provisions of said
ordinances.
�z
/ .. .1.. ... .... .... Building IriSpeCtOT
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.
40
Ej
City of Fridley, Minn.
BU LDING PERMIT N® 3289
Date: .. /.s ...........................
Owner....... ... .......... .......... Builder ........... ... ............
Address ...................................... Address .............................................
f LOCATION OF BUILDING
No. :. f./. Street ... f ........................ Part4q Lot ........ ........r .............
Lot ... Block . ....... Addition or Sub -Division
Corner Lot ............ Inside Lot ..... ... Setback ..... Sidey4...i .4! ......�r.. s .... ✓ . .
DESCRIPTION OF j3UILDING
To -7 Used as: Z � � � �^
. I:��...... Front .4 V:: Depth .. �. Height .... � .. Sq. FttP S� Cu F`t. � ®. ®(:�
................. ont ........ Depth ........ Height... .. Sq. Ft. ........ Cu. Ft.
... ........
... lifst. Cost. N, ..®. To be Completed .. .. ... .�.......
Type of Construction .. � ..... � r��-G
r
,41
In consideration of the issuance to me of a permit to construct the building desribed 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 city of Fridley.
In consideration of the payment of a fee of V20........ permit is hereby granted to �*44-,- C .. W40
......................... 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 with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
.
.... ding Inspector
...... .......
d
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.
City of Fridley, Minn. N° 7821
BUILDING PERMITS y
•
Date: _ June 10,1965
•
Owner: William Perkins Builder LeRoy C. Pederson
Address 5941. 5th Street N. E, Address 4.058 Nevada Ave. No.
LOCATION OF BUILDING
No. — street 5th Street N. E. Part of Lot
Lot 11 _ Block 4 Addition or Sub -Division 13W= Adda
Corner Lot Inside Lot Setback Sideyard
Sewer Elevation _ Foundation Elevation
To be Used as:
Type of Construction
DESCRIPTION OF BUILDING
Front Depth Height Sq. Ft. Cu. Ft
Front Depth height Sq. Ft Cu. Ft
Est Cost • 500-0 __ To be Completed
Storm damage Rega.ir
In consideration of the issuance to me of a permit to construct th described above I agree to do
the proposed work in accordance with the description above set f and with aft provisions of
ordlnanoea of the city of Fridley.
In consideration of the payment of a fee of $10,00 , permit is hereby granted to L. Ce Pederson
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any pmt thereof; shall conform in all respects to the ordinances of
Fridley, Minnesota ��gg location, construction, alteration, maintenance, repair and moving of buildings
within the city limitshis permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Allen Jensen Building Inspector
•
NOTICE:
71d9 permit dna not cover the com trectiee, humlon for wkine, plumbing, gas hating, sewer w water. Be wn to an
the Wdh* k*edw for opude PMUNS for than Rana.
'APPLICATION FOR`EU1LDING PERMIT
,r
CITY OF FRIDLEy', MINY�E$OTA'
OWNER'S NAME Pfe � s�/,f ` = BUitbER
ADDRESSS%� s `�' ADDRESS
LOCATION OF BUILDING ;
No._ Street ®� Parte nrf Lot
LOT , d / BLOCK ADDITION OR SUBDIVISION o
Corner Loth Inside'LOTSetback Side=Yard `' ''
SEWER ELEVATION " ' FOUNDATION ELE*AT.ION.'
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
Sq. ,Ft. Cu. Ft.
'Front Depth Height
Sq•`Ft:
Type of.Coaatruction Estimated Cost .tea
To be ' completed_ / 9 4�'
The undersigned `hereby 'makes application for a permit for the -work here ii''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 represedtations'statdd in this application are tiue'and car'edt
r,
DATE SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
/ � ti.e e O
ve All
r x.TTL-h c.
S Xe_,,oPV ��e-,v 7`4' f� e- /70'0 w 5e- //f," S �� art✓ ,D d w7�_
A// d S dL%'o aet J/Ja� 2 ist o � 1 �e�L� $ �/I Dtt �S s®� /Poo%/�/ x-
37�7,5-6;2d
City of Fridley, Minn.. N° 9509
BUILDING PERMIT
• Date: Octoberl7, 1967
•
Owner. William A. Perkins. Builder Miles Garages
Address "41 5th St. N. E Address 45 OD T'V+dti1? Ave marl -b
LOCATION OF BUILDING
No. 5 941 Street 5th St. N. E ____, part of Lot
Lot ____ 11 -- Block __A_ Addition or Sub -Division .__._ R tinny Add i t i nn
Corner Lot _ Inside Lot — Setback —_ Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Garage Front 20' Depth 22' Height 10 ' Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction _. Frame Est. Cost ^ 1450 _ 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 provisions of
ordinances of the city of Fridley. —111? _ 619
In consideration of the payment of a fee of $ 7.00 , permit is hereby granted to Miles Garages
the
to construct the building or addition as described above. This permit is granted upon
express condition that the person to whom it is granted and his agents, employees and workmen, ffi aII work.
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinsncs3s Of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
orwithin the dty limits and this permit may be revoked at any time upon violation of any of the provisions of d
dinancce.
CLARENCE BELISLE Building Inspector
NOTICE:
Uls permit does not cover the construction, hwtdlation for wiring, plumbing, ges henftg, ower or waier. Be am to as
the Building inspector for aparaie permhs Ibr thea hum
APPLICATION FOP, BUILDING PERI'dI T
CITY OF FRIDLEY, MINNESOTA
•
OWNER ` S 14-Al1E -,�� .. :,� BUILDER A. "
ADDRESS ADDRESS
_JL���k�..
LOCATION OF BUILDING
NO. v`9 L// STREET �S/L_ PART OF LOT
LOT I BLOCK y ADDITY014 OR SUBDIVISION
CORNER LOT I1SIDE LOT SETBACK SIDE -YARD
SEWER ELEVATION � .; FOU1,1DATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTIONOF BUILDING
To Bei Used Ad:
Front Depth height
Sq. Ft . '` � Cu, Ft.__
Front —Depth Height
Sq. Ft. —Cu. Ft,
r z� ;7;
Type of Construction Estimated Cost O
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 application are true d correct.
i
DATE SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
�, U ��
1 4,
1
i
ILL.
MORTGAGE NOTE
FOR VALUE R CEIVED, I jointly and severally promise to pay to the order of
nois, a corporation un er the laws of the State of Illinois, the principal sum of $
interest on said principa um of $ at the rate of- a/o per annum from date hereof
until said principal sum is 'd in full. The mortgage note is payable in mgrifif ly installments of $
or more, per month commend
day of each and every i
remaining unpaid balance of this
1-1 ,19
Homes Incorporated of Illi -
thereafter until the ffdy of
age note shall be due ar)dpayable.
continuing on the
19 when the
Privilege is reserved to prepay at any 'me, without prepilum or fee, the entire indebtedness or any part thereof.
Both principal and interest shall be payable at a office ofAILES HOMES INCORPORATED OF ILLINOIS, 4500 Lyndale
Avenue North, Minneapolis 12, Minnesota, or at uch other place as the holder herein may designate in writing, and
such payments shall be in lawful money of the Uni cl, States of America and first applied to the principal sum and
then to interest computed as provided aforesaid on principal sum.
If default be made in the payments speci d afore id, or any of them, the entire principal sum then remaining
unpaid, with interest accrued, shall become ue and paya a immediately, without notice, at the option of the legal
holder of this note. Failure to exercise t ' option shall not nstitute a waiver of the right to exercise the same in
the event of any subsequent default.
The undersigned, whether p ' cipal, surety, guarantor, endorse , or other party hereto, agrees to be jointly and
severally bound, and hereby ive any homestead exemption right a inst said debt and waive demand, protest
and notice of demand, pro st and non-payment and expressly agree tha his note may be extended from time to
time without affecting t iability of the makers, endorsers, sureties, guaranto or other party hereto.
The makers, dorsers, guarantors and other parties hereto agree to pay a r sonable collection or attorney's
fee, if suit is br ght hereon, or if said note is placed in a collector's hands when in cult.
This ote is secured by a mortgage of even date executed by the undersigned on c ain property described
th ' and represents payment as and for materials and services used in the improvement, teration and repair
of the property described in said mortgage.
(Slgnature of maker)
(Signature of wife or husband)
a . - ,
suedEcr
PE
City of Fridley
19842
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
r
RE T NO.
� • COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
--'-'I CITY HALL FRIDLEY 55432
%.j
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
42189
JOB ADDRESS 5941 - 5th Street N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
11
4
Bonny Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Bill Perkins 5941 - 5th Street N.E. 571-5281
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Panelcraft 3118 Snelling Avenue South, Mpls. MN 55406 721-6628
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW Ek ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 14' x 12' Porch; a V x 12' Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan
1?'JG SEPARATE PERMITS REQUIRED FOR
Before digging call local utilit s MIRING, HEATING, PLUMBING AND SIGNS.
TELEPHONE - ELECTRIC - GAS Etf;
REQUIRED 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
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 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
ISTALLS 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
$4,000
$2.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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.
$63.00
PLAN CHECK FEE
TOTALFEE
$65.00
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT ,(DATE) ''
WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT
�/
BLDG INSP OA
SIGNATURE OF OWNER IIF OWNER BUILDER)
NEW [ ]
ADDN [ ]
ALTER [ ]
R-1 AND R-2
Building Permit Application
Construction Address: .5-9%/ 57-1-S7` /Ucr
Effective 5/1/88
Legal Description:
Owner Name &Address: �3/�G �° /Se�✓5 .spy/ T"" 7 It<e- Tel.
Contractor: �`".�ll�Z�7r 3118 Av
Attach to this application, a Certificate of Survey of the
lot, with the prcposed construction drawn on it to scale.
7TIO N OF MEMM
MVIN ' AREA: Length Width Height Sq. Ft.
GMRAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Aength Width /Z- Hgt/Ground Sq. Ft.
ate: I
-x,132 W2—aq 4' 116 1 35-53 �G7 e 35Y6,6A
Corner Lot [ ] Inside LctK Ft. Yd Setback Side Yard Setbacks _
Type of Construction: A/&-4-1 Arec# efto ® -/e woRltstimated Cost: $ ` -. O d
Approx. Completion Date: 5-1
Proposed Driveway Width If New Opening Is Desired: Ft. $ $'
�,� Width + 6' See Back Page
DATE: %/ %/�Y� APPLSCANr:� � � �r D?r-g gvyw,, e,� Tell. # ?2.i "-Ze
Permit Fee $ 00
State Surcharge
SAC Charge $
Driveway Escrow
Park Fee $
Sewer Main Charge $
TOTAL $
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$575 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
SUBJECT
PE „
City of Fridley
L27 7 5 2
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
1 ,
COMMUNITY DEVELOPMENT DIV.
RECEIPT NO.
&07
______
r 1 PROTECTIVE INSPECTION SEC.
1 �
1
NUMBER
REV
DATE
9/14/9
PAGE OF
APPROVED BY
CITY HALL FRIDLEV 55432
612-571-3450
910-F15
JOB ADDRESS 5941 5th St NE
1 LEGALLOT
NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
11
4
Bonny Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Marie Perkins Same
571-5281
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
D.L. Builders 1166 14th Ave SE Minneapolis 55414
378-0950 20096711
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION ® REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house & garage (30SQ) Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 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
ISTALLS
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
$2,571.00
$1.29
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 PERFORMANCE OF CONSTRUCTION.
74.75
Fre SC 2.57
PLAN CHECK FEET
FEE
Lic
5 0
83.61
SIGNAT O CONTRACTOR OR AUTHORIZED AGENT IOATEI
tiKENP P
ALIDA THIS IS R PER
1M
1!
BLDG D
r�ATE
SIGNATURE OF OWNER pF OWNE4 BUILDERi IDATEi
NEW [ ] Effective l/ 1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: n V' j7`,� 5L Af . 6 .
Legal Description:
Owner Name & Address: XQJ ®6aje; Tel. #57/-52&/
Contractor: MN LICENSE # 2,a9(p 711
Address: Ill y l l ILO ,/%11 56 Ab/S gri SSLIN Tel. #378`022
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 Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: o C 1 (21 e (`, _
Construction Type'9�7 Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: t APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
$ 24
$ -, --E-7
Park Fee $
Sewer Main Charge $
TOTAL
STIPULATIONS:
Tel. # —29/ —/SdZ
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 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 [ ]
C to�3s
3TY OF FRIDLEY BUILDING INSPECTION
9 3431 University Ave NE
9=ridley, MN 55432
L
763-5723604 FAX 763-571-1287
9
D
n RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Z) Gas Range
Gas Dryer
aeo5 -
Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
10B ADDRESS
Fee, Tota
Owner Mac �('�(\
a c � �E' ` � � As—
$35.00
S$35.00 $ 35,00 Building Used As
$10.00 $ ESTIMATED COST, 5 aOC) • U G PERMIT NO
$10.00 $
*Air Conditioning-AllSizes $25.00 $_2'5.00
_` 0 08 v F� M M 0-0 L� Z- &-Z_
All Other Repairs or Alterations (List on Back)
r 1% of Value of Appliance or Work $
a Minimum Fee $15.00 for Residential or 5% of cost of
Y . Improvement whichever is greater on work less than $300.00
J_
5 Commercial/Industrial/Institutional
t 1.25% of Value of Appliance or Work (List on Back) $
Minimum Fee $35.00 for Commercial/industriaVinstitutional
Y State Surcharge
TOTAL FEE $ ceo .-So
v
a REINSPECTION FEE $50.00/HOUR
IT
*Air Conditioners can not be placed in side yard without written approval
ri from adjoining property owner - copy to City
CL
N
DESCRIPTION OF FURNACE AND BURNER
# of Heating Units Circle One (Steam) (Hot Wat (Warm Air)
Trade Name 1 Uy d UQ) ?_�k ^ 6, EM SES Size No.
BTU l,�n,0Q O HP EDR
Fuel �.Arc_ C,,,S Total Connected Load
Burner Trade Name Size No.
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
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
CENTERPOINT ENERGY
HEATING CO 13562 CENTRAL AVE NE BLAINE, MN 55304
Tel # 763-757-6202
Signed
FAX # 763-757-6701 Date CA- 3i -Cs
df FILL OUT BACKSIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
Approved by Rough -in Date Final Date
E0 ' d ld101
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and f►restopped where required. Yes 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 ( No( )
The existing air is sized and installed to meet the current codes
-combustion
and manufacturer's specifications.
Yes (io No( )
When required to install a new combustion air, will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes �) No ( )
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA -LAMA 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 No( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #11 ype BTU Input OFan Assisted or Nat
Appliance #2 Type ®ez• 4 BTU Input 35'' ov'o Fan Assisted or Nat es
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances _sem Total Btu Input
Common Vent Type ^Z Vent Height _ ®e Diameter !V inches
Appliance #1 Vent Connector Height ! ft Length '® ft Diameter `� in Type C/ -
Appliance #2 Vent Connector Height ft Length ft Diameter �in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
CENTERPOINT ENERGY
HEATING CO: 13562 CENTRAL AVE NE BLAINE, MN 55304
Signed By: Date
PA/M 1 A TAIAISL 01 A31G r NA 30 AM WON -1 qF : T T b06z-L2-�1d1�
CINOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
December 7, 2005
Traditional Homes
3545 152 Lane
Andover, MN 55304
0,554i,'
Re: Final Inspection at 5537,55nd 5545 5 Street NE, Fridley
Dear Sirs:
A final inspection was conducted on December 7, 2005 for the completion of the 4
plex at the above address. The inspection noted that the construction was
completed according to the approved plan and occupancy of the building is
approved.
If you have any questions concerning this matter, please feel free to contact me at
763-572-3602.
Sincerely,
RJ/mh