PRE 2010 DOCSCity of Fridley, Mixer.
BU LDING PERMIT N° 3102
Date: ........................................
Owner .. ... ... Builder ......... .. .
Address . �`.� .�Z .... �.. ... Address ....�.- ....� '.. ".'.�.. . .
/ LOCATION OF BUILDING
No. `. �?./. Street .......` ............................... Part f
�l o Lot ..c i .
Lot ..... Block .... /.......... Addition or Sub-Divis' n 01
lr f�
Corner Lot ............ Inside Lot ............ Setback . cJ . ./ yard .. Q.
DESCRIPTION OF BUILDING
To be Use as: D` a Q p
. .......... .... Front .... ... Depth �Z. �./.. Height., Sq. Ft. /.. �v . Cu. Ft. ........
....... ....... Fr. nt ........ Depth ........ >GHeight .. Sq. Ft. ........ Cu. F`t. ... , ... .
Type of Construction ............ Est Cost.. l.r�..°�j `�®...... To be Completed .. - .......... .
iletiF—�G'°�C--
In consideration of the issuance to me of a permit to const6t the building esribed above, I agree to do
the proposed work in accordance with the description above s f rth and in c pliance with all provisions of
ordinances of the city of Fridley.
�.................................
D
In consideration of the payment of a fee of $... � ..�t 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, 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. // /%
NOTICE:
This permit does not cover the construction, Instaliatlon or alteration for wiring, pluming, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
City of Fridley, Minn.
BUILDING PERMIT
Date: 'o .0mowe
Owner: _ Builder
Address Irw Address
O N F WILDING
No.r� Street e Part ,
Lot Block Addition or Sub -Division k� -�-
Corner Lot _ _ ---- Inside Lot Setback _ _ Sideyard _ _ -_--
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To 'Used as:
Front Depth Height— Sq. Ft. Cu. Ft
t Depth Lz�T ,elg` htt Sq. Ft Cu. Ft
Type of Construction Fast Cast To be Completed _ w
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
grdinances of the city of Fridley.
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, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violati4 any of the provisions of said
ordinances. w Y'
Building Inspector
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 Items.
11
Owners N
Address
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
LOCATION OF BUILDING
11
NOStreet Pert of Lot
Lot '90 Block Addition or Sub.Div.��� L�
Corner Lot Inside Lot Set Back Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
Front Depth Height
Sq. Ft. Cu. Ft.
Front . ^ Depth Z6 Height
Sq. Ft. -Cu. Ft.
O
Type of Construction Estimated Cost , 114-5e
To be completed
The undersigned hereby makee(ap�Aca.tion 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 th facts and representa-
tions stated in this application are true
DATE
(A Schedule of Fee costs can be found kh� Reverse Side.)
0 0
� r
MEMO FROM:
RICHARD N. SOBIECH
Public Works Director
MEMO NO. TC 291
DATE 3/14/77
SUBJECT: t
Drainage Problem: 5621 6th Stree
E[ See attached
XA Review & take appro-
priate action
LU
Cn
❑ Review & comment
J
❑ Note & discuss with me
a
0
o ❑ Work with
J
3 F-1 Rush, immediate action
desired
REMARKS:
REPORT BY: 4/14/77
As you are probably aware, this has been a continual
drainage problem which apparently was caused with
the construction of apartment bldgs. east of this
address. This is a continual problem for which the
residents keep asking the City for a solution. I
believe it is a private matter but perhaps we should
make an investigation to check into the facts and
then pass on to the parties involved. I think this
is similar to the one on Hillcrest Drive where we
made a survey and gave this and the recommendations
to the property owners. Maybe -something of this
nature could be done here. Also, please check with
Virg to verify that Fridley has no liability in this
matter.
I I I Thanks for your help. DS/j
Make reports, w/background
material as complete as poss-
ible. Make interim report if
necessary.
f -
C,
J* Action completed, no
Z further review needed
0
COMMENTS:
4474
•�
14711041
-
�
❑ Further action necessary A �s /�__:_ �,�, �;,, /9G 3 �r �''�'�''� 1
IR
1576
❑ See attached letter .�O"
[] Interim report
4000
• oz.
DATE: G SIGNATURE
ff
i
t
1.�
,
;
Ii
I
STATE OF MINNESOTA DEPARTMENT OF HEALTH
p� ABANDONED WELL RECORD
1. LOCATION OF WELL MINNESOTA UNIQUE WELL NO.
(leave blank if not known)
County Name ANO.0
Township Name Township Number Range Number Section No. Fraction 4. WELL DEPTH (completed) Date sealed
N E k hof 4
FRIDLEY 30N Sr 24W Wr 32 SE NW SW 23 ft.07/18/91
Numerical Street Address and City of Well Location or Distance from Road S. DRILLING METHOD (if known)
Intersection 10 Cable tool 40 Reverse 7® Driven 10p Dug
5621 6th STREET NORTH EAST, FRIDLEY, MN 55432 20 Hollow Rod 50Air 80 Bored lip
Show exact location of well 30 Rotary 6p Jetted 90 Power Auger
(in section grid with •X•) Sketch map of well location
6. OBSTRUCTIONS
N Well obstructed 0 Yes ® No
W
ME
Obstructions removed I] Yes 0 No If obstructions cannot be
•
0
E
before sealing.
T
7. USE
ME=
IEI Domestic 4Q Monitoring 80 Heat Loop
I
210 Irrigation 50 Public gp Industry
I1
V Test Well 60 Municipal 100 Commercial
S
I'— 1 mi L --+
2. PROPERTY OWNER'S NAME Nailing Address if different than
property address indicated above
EDWARD CONLEY
HARDNESS OF
3. FORMATION LOG COLOR FORMATION FROM TO
if not known, indicate formation log from new well or nearby well.
no log
16. REMARKS, ELEVATION. SOURCE OF DATA - CASINGS REMOVED, CASINGS PERFORATED, ETC.
FFiCIAL ABANDONED WELL RECORD (May be used for Property Transfer)
XAFC0rM7r PZ19 WITH DMW
70 Air Conditioning 110
8. CASINGS)
1p Black 413 Threaded 70
21) Gal v. 50 Welded
3L1 Piastic 60 Stainless Steel
1 1/2" in, to 23 ft.
in. to ft.
9. SCREEN
Screened well from _ ft. to _ ft.
(If known)
0 Open Note from _ ft, to _ ft.
10. STATIC WATER LEVEL
22 ft. 0 below 0 above
land surface Date Measured O 7/ 1 8 /9 1
11. WELLHEAD COMPLETION
1Q Pitless Adapter 40 Found Buried
20 Basement offset q] behind garage
30 Well Pit
12. GROUTING INFORMATION
I® Neat Cement 20 Bentonite 3p
Grout material from to_ ft. cu, yds—
neat cement 0 23 1/4 ba&
13. NEAREST SOURCES OF CONTAMINATION
30 feet west direction sewer type
Well disinfected before sealing? [3 Yes
14. PUMP p Removed In Not Present
Type: 1[1 Submersible 3p L.S. Turbine !0 Reciprocating
20 Jet 4p Centrifugal 613
15. EXISTING WELLS (Please sketch locations of abandoned and
active wells in remarks section or on back.)
Other unused well($) on property? 0 Yes ® No
Abandoned: 0 Permanent 0 Temporary 0 Not sealed
17. WATER WELL CONTRACTORS CERTIFICATION
This well was sealed under my Jurisdiction and this report
is true to the best of my knowledge and belief.
MALENKE WATER SERVICES U0007
10550$ COUNTY NROAD 81 — SUITEe 206
Address MAPLE GROVYO M 55369
Signed Date
JESSE MALENKE oate07 18 91
Name of Driller
Obstructions removed I] Yes 0 No If obstructions cannot be
•
removed, contact MOH
E
before sealing.
T
7. USE
y mi.
IEI Domestic 4Q Monitoring 80 Heat Loop
I
210 Irrigation 50 Public gp Industry
I1
V Test Well 60 Municipal 100 Commercial
S
I'— 1 mi L --+
2. PROPERTY OWNER'S NAME Nailing Address if different than
property address indicated above
EDWARD CONLEY
HARDNESS OF
3. FORMATION LOG COLOR FORMATION FROM TO
if not known, indicate formation log from new well or nearby well.
no log
16. REMARKS, ELEVATION. SOURCE OF DATA - CASINGS REMOVED, CASINGS PERFORATED, ETC.
FFiCIAL ABANDONED WELL RECORD (May be used for Property Transfer)
XAFC0rM7r PZ19 WITH DMW
70 Air Conditioning 110
8. CASINGS)
1p Black 413 Threaded 70
21) Gal v. 50 Welded
3L1 Piastic 60 Stainless Steel
1 1/2" in, to 23 ft.
in. to ft.
9. SCREEN
Screened well from _ ft. to _ ft.
(If known)
0 Open Note from _ ft, to _ ft.
10. STATIC WATER LEVEL
22 ft. 0 below 0 above
land surface Date Measured O 7/ 1 8 /9 1
11. WELLHEAD COMPLETION
1Q Pitless Adapter 40 Found Buried
20 Basement offset q] behind garage
30 Well Pit
12. GROUTING INFORMATION
I® Neat Cement 20 Bentonite 3p
Grout material from to_ ft. cu, yds—
neat cement 0 23 1/4 ba&
13. NEAREST SOURCES OF CONTAMINATION
30 feet west direction sewer type
Well disinfected before sealing? [3 Yes
14. PUMP p Removed In Not Present
Type: 1[1 Submersible 3p L.S. Turbine !0 Reciprocating
20 Jet 4p Centrifugal 613
15. EXISTING WELLS (Please sketch locations of abandoned and
active wells in remarks section or on back.)
Other unused well($) on property? 0 Yes ® No
Abandoned: 0 Permanent 0 Temporary 0 Not sealed
17. WATER WELL CONTRACTORS CERTIFICATION
This well was sealed under my Jurisdiction and this report
is true to the best of my knowledge and belief.
MALENKE WATER SERVICES U0007
10550$ COUNTY NROAD 81 — SUITEe 206
Address MAPLE GROVYO M 55369
Signed Date
JESSE MALENKE oate07 18 91
Name of Driller
01
SUBJECT
City of Fridley
15984
AT THE TOP OF THE TWINS
BUILDING P E R
M I
' ,
R
1
i 6 ____ COMMUNITY DEVELOPMENT DIV.
V � �
PROTECTIVE INSPECTION SEC.
-
o Ll
r
T
NUMBER
REV
DATE
14/27/98
PAGE OF
APPROVED BY
� 1 CITY HALL FRIDLEV 55432
612-571-3450
910415
JOB ADDRESS5621 6th Street
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
10
32
Hyde Park & vacated 58th Avenue
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Anna Pennrod, 5621 6th Street, Fridley 55432
571-9187
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
John Haley #1 Roofer, 3150 Lakeshore Blvd., Diaaaimaka 55391 x -404-9386 201268
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 ❑x REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof (tear -off)
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must meet 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 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
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
$1,751.40
@
88
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
W .
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-
$56.75
ire SC $1.75
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
-2--cit?
PLAN CHECK FEE
TOTAL FEE
.94�
License $5.00
$64.38
TUREO NTRACTORORAUTHORIZEDAGENT IDATEI
WHEN PROPERLY LI DATED THIS IS YOUR PERMIT
_
BLD9r INSP
e / �� 7
rJATE
SIGNATURE OF OVVNERIIF OWNER BUILDER I IDATEI
01
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: ,Lr� / ,�( S 7-• AJ `E /'� E d t -e
Effective 1 / 1 /98
49444
)�0
Legal Description: oL.,6-+ I a rx'e� 6 d, J -t- r -`-y %-6L cA-"-e- "a -
Owner Name & Address: 19-/I,14- Pe-ftn2o C[ Tel. # 5-;7 / - "-7
Contractor. MN LICENSE#
Address: X15-6- $ L, o rc. ef/cJO Tel. # 41ell- 9�Y?S
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:
Construction Type: xeA-9--f Estimated Cost: $ 5-6
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: 'l� `"?g -APPLICANT: Jy Tel. # 1e10`'3�p
Permit Fee
$
Fire Surcharge
$
State Surcharge
$
SAC Charge
$
License Surcharge
$
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $ Eel—
STIPULATIONS:
CITY USE ONLY
Feee 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 [ ]
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURIES TO BE INSTALLED ON EACH FLOOR
Effective On Jan 1, 2000
PLUMBING FIXTURE RATES
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
NO. RATE TOTAL
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas** /
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
JOB ADDRESS `: 4 -' / 6 r r AAF -
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.
-1/23
Owner n/n/,4 ¢ .T� �� ��.✓2 e ��
Building Used As ffo'" "_
Estimated Cost Sba' PERMIT NO. /__? 9�D_
Type $15.00 PLUMBING COMPANY o���y QU,gc�c �L�r.���.✓G
Reinspection Fee $47.00/Hr SIGNED BY TEL N0.
-M)
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
Approved ByRough-In Date Final Date
State Surcharge $ .50 MINIMUM FEE 4FR ANY PLUMBINGIGAS PERMIT IS $20.00
TOTAL FEE $ a6 .5,0 PLUS THE $.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
2006
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing 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 () 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 combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No ( )
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications. Yes () No ( )
When installing a new ventina system, 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 ( ) No ( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type
Appliance #2 Type
Appliance #3 Type
Total Appliances
_ BTU Input
_ BTU Input
_ BTU Input
Total Btu Input
Common Vent Type Vent Height
Fan Assisted or Nat
Fan Assisted or Nat
Fan Assisted or Nat
Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :
BOJ/�t ��¢L . Aril SUI#0ILr ��S, 76,4V
® ) �' % b �c rVa7���
CI Y OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2001
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 l -
JOB ADDRESS
RATE SCHEDULE h ,, I I'k �/
OWNER Pj,4,ur 1 fit
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 $
$ 10.00 $—
$10.00 $10.00 $
$ 10.00 $
$ 25.00 $� )100 to
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
r
$ .50
$-E5-1 sv
U �.
BUILDING USED AS
�
ESTIMATED COST UO UPERMIT.NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) ( arm �1,
Trade Na a Size No. LG c
BTU ) Q HP EDR
Fuel_ M, (• 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 an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE
BLAINE HTG- A/C ELECT., INC.
HEATING CO
13562 VA UM ��E. N.E.
Signed' TEL 41 t Q?77 J51 �
Approved By Rough -In Date Final Date
BACK SIDE MUST13E FILLED IN ON VENT SIZE, VENT CONNECTORS
AND COMBUSTION AIR VERIFICATION
41
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing 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 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 combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes cations. ( )
When required to install a new combustion air, it 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-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 ( No ( )
Appliance Type and Size/Common Vent and Vent Connector Informationn
Appliance #1 Type A WA cz BTU Input ( L -OFan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
BLAINS HTG. A/C ELECT., INC.
13582 VENTRAL AVE. N.E.
HEATING CO: 55304
Signed By: ems, Date:
s
INEHEATING
AIR CONDITIONING
AND ELECTRIC, INC.
ADDRESS 5-04)1 & I& -'�T ' VC
OCCUPANT EAjJfV 1( its
HEAT LOSS DATE HTG. INST.
SOLD BY D48 )-D
Electrical Work By 6 1 & nA
TYPE OF HEAT GA FA -L HW STEAM SPACE HTR.
GAS DESIGN
MAKE AM 1k tJ
Model
Serial
INPUT 11i8 i 0I0
CONTROLS
HOUSE HEATING TEST RECORD
APT. --- FLOOR CITY n�`L/ - SUBURB
OWNER /f+Vrll A ? S�jkonPO/1
INSTALLEDBY j9J#,'V0-
Gas Line By 56he
UNIT HTR. OTHER
CONVERSION
Vent Size
KIND OF LINER -4 M SIZE NONE
Draft Hood vl ce if Regulator 1-01.2
Filters Size Rv A a SX I Number 1
Chimney Location Inside Outside
THERMOSTAT cxaml-S Heat Plug Chimney Construction
Value
Limit
Limit Setting
Fan Setting
Pilot Type
Pilot Make
Pilot Model
Pilot Timing
L.W. Cut Off
Pressure --'I •-'s ZJ Vj C- Percent CO2 % v®
Input CFH(gg� ®O® Percent 02 7YO
Stack Temp. Percent CO L%P®AI
Smoke Bomb Wiring
Draft Test Tag
Door Pressure Lighting Inst.
Date Tested O1
Company Testing ;'"e -
Name of Tester. A L 1p
Pressure q .S 1 1-1 V.)C- Percent CO2 % 90
Input CFH ® 00 Percent OZ 9 °In
Stack Temp. Percent COP rvl
C.IIYOf'
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
March 29, 2002
Mr. Jeffrey Penrod
56216 Street NE
Fridley, MN 55432
Re: Final Inspection at 56216 Street NE
Contractor: Blaine Heating Air Cond Electric Inc.
Dear Mr. Penrod:
A mechanical permit was issued on May 30, 2001 to install a furnace and air conditioner at
your address. According to the 1991 Uniform Mechanical Code a final inspection shall be
conducted on the work authorized by this permit. A final inspection was conducted on June
19 2001 and it was noted that the contractor needed to seal and support the plastic pipe
venting to the outside. A reinspection has not been requested.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. We will keep your permit open for another 30 days and if we do
not hear from you within this time to set up the inspection, we will mark the permit "no
inspection called for by homeowner after notification" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
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