PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date: _. 10.1. fit'
a r ; - — — —fi! ,, f'/ Ii i. i" r.
•r •.
LOfATION OF BUILDING
Street Part-2LLot
Lot __ Block __ _ Addition or Sub-Divisn
Corner Lot _ Inside Lot — Setback Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To Used� 4V/
Front Depth o� Height Sq. Ft. A". Ca Ft. r!
Fro Depth afgae,H t_ 1 q. Ft. Cu. Ft. i
Type of ction Est, Cost, _ '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 a'll provisions of
ordinances 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 violatiop ok-any of the provisions of said
ordinances. ..., ..1t a ,f
Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to sea
the Building Inspector for separate permits for thea hems.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's . Builder eo."
Address% 2_ �► L N'J e. AVE 4 Address
LOCATION OF BUILDING
No. �� Street ho Part of Lot
Lot Block% Addition or Subdivision
Corner Lot Inside LotSetback.7,..4.SS ids -Yard /0
SEVIER 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 441" Depth 4 �A�Height
Sq. Ft Cu . Ft.
Front____Depth __Height
Sq. Ft. Cu. Ft.
Type of Construction � z Estimated Cost A,,, e
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 ruling of the Department of Build-
ings, and hereby declares that all the facts and representations
stated in this application are true and correct.
DATE _11=_j j I SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
Land Planning -
Larrd swTLy ing Minneapnlis 21.
SoilsTesty ENGINEERING, INC. Minnesota
rel & Municipal sun�t4-�o�
& 9 ineenn —Engineers Surveyors —
9
r.
certificate of stirveT,,r: _ :.�1,..: -.� Z. &-e-sTk�Jlt.' 40r..,
:'rte. ���_ � r d J
/ron
/ro+r
-- ZP4
- - JV.v �•
^) J
fL:
0 q
a �'s�c+ntQu/ 1 1
�. (op
4, — .
{
4
'rpt
retro
— ZO/ g, adc4l —
/hvv6y ceriify #W this is a kw avd awnd mprsentafion O sirvey yrfle hwndoifes qrt* abort 0ecr4bed lard,ared
#'#e location gl'ag by a7p , flmmw, , and all nsib/e a vvechmeah , ifmj. firm ar art sold And As surveyed by nee flus _ doj
✓ /T' A'0 SUBURBAN ENG/NEERINO , INC.
Ln9ineers & Sure y rtyor� -
� �'F---•�� '(,rte/-" ��1�-���.
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City of Fridley, Minn.
BUILDING PERMIT N® .72-47
Date:
e
Owner:
Address Address
// LO T O BUILDING
NO. Street L4 !2 � -�-�° Partof Lot
Lot __ Block Addition or Sub -Di —
Corner Lot _ Inside Lot `� Setback Sideyard
Sewer Elevation — Foundation Elevation
DESCRIPTION OF BUILDING
Zftw!.A-,lf
_
Front Depth Height Sq. Ft J cu. Ft
Front X DepthHeight Sq. Ft. f- GCu. Ft
Type of Construction - Fst.!1To 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 ce with all provisions of
ordinances of the city of Fridley. A / 1
In consideration of the payment of a fee of Sdi V epermit is hereby granted to
to construct the building or addition as described above. This permit is granted upon
the express condition that the pe3nn 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 reg 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.
NOTICE:
This peewit don not cover the Bond rucdon, MataMen for wirlm plumbing, gas hentho sewer or water. Be sire to see
the Building mqm for for separate permits for these hens.
.. r
APPLICATION FOR BUILDING PEPI1IIT
CITY OF FRIDLEY, MINNESOTA
OWNERS NAME � �/�/ &( &e � BUILDER M—e- i ej'rZ C ;a,R K
ADDREss 2 Ave &),r-:' ADDRESS .Ir����r
a
LOCATION OF BUILDING
No. C)- Street &,�*,Z . e Part of Lot'
Lot Block Addition or Subdivision
Corner Lot Inside Lot--Y--Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as:
/Y C-� ?,f G,#-P4/8r`0Front 30 D.�:,th Height
V
-- -
Sq. Ftto Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost
To be Completed�j ' t'
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 and correct.
DATE
j Schedule of Fee Costs can be found on the Reverse Side).
r
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RATE
SCHEDULE
H
PLUMBING FIXTURE RATES:
NO.
>1
m
New Fixtures
p
$-5.00
u
Future Fixtures
x
w
$
Water
ut
$ 1.50
q
Beer Dispenser
$ 4.00
$
--A
�
�
$
aE�+
p,
r
�
Rain Water Leader
Heater
$ 5.00
$
Hydraulic valve
c
Y
Sump or Receiving Tank
,fir
$ 5.00
S
Water Treating Appliance
L
Q
y
Not Water Heater
L.
$ 5.00
$
Gas Range
M
N
.04
M
1.
j1
+1
a
+R
.0
ywy
G C
M O
f
C
O
. 10
U .C/
4 y wy
O
] N
1�tp�
N
qw
w
0
N
U
0
1s of Value of Fixture or Appliance
N
3
Q W
to
W
U tq
Q 3
l7
U'
O
a5
leC
lot
2nd
3rd
4th
(R) Future Connection Opening
Connected with Sewer
V) New Fixture, Old Opening
Water
RATE
SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE
TOTAL
New Fixtures
$-5.00
$
Future Fixtures
$ 3.50
$
Old Opening, Nov Fixture
$ 1.50
S
Beer Dispenser
$ 4.00
$
Blow Off Basin
$ 5.00
$
Catch Basin
$ 5.00
$
Rain Water Leader
$ 5.00
$
Hydraulic valve
$ 5.00
$
Sump or Receiving Tank
$ 5.00
S
Water Treating Appliance
%
$ 7.00
y
Not Water Heater
$ 5.00
$
Gas Range
$ 10.00
$
Gas Dryer
$ 10.00
$
Back Flow Preventer Required.
Yes ( ) NO
( )
Type
$ 5.00
$
ALL OTHERS AND/OR REPAIRS AND
ALTERATIONS
1s of Value of Fixture or Appliance
$
State Surcharge
$ .50
Reinspection Fee $
(515.00)
TOTAL
FEE
Job Address �/' ak 5— _
Department of Buildings
City of Fridley
Tel. 1571-3450
Effective Hay 1, 1990.
z e'
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and oorrect
Fridley, Mn. �� ` �f/, 19 V
OWNER
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT 7 Gf GG=f!
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
Company 'ie -G32 'uc ac /3 z-,,
Signed Hy1< F�4�-:.f
i r
Tel. No. -7 - V — '? e
ROUGH INSP.
Date
FINAL INSP.
Date
APPROVAL FOR PERMIT ao
!1ININU4 FL FOR ANY PLUMBING PERMIT IS $15.00
PLUS THE S. STATE SURCHARGE
SUBJECT
P �•
City of Fridley
21369
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
' ,
R
, COMMUNITY DEVELOPMENT DIV.
_
rr PROTECTIVE INSPECTION SEC.
r ;
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
6/1/92
JOB ADDRESS 225 - 69th Avenue NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6
1
Rice Creek Plaza North Addition SHEET
2 PROPERTY OWNER MAILADDRES$ ZIP PHONE
Marvin Ruuska 225 -- 69th Avenue NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
United Siding Contractors 3009 109th Ave NW, Coon Rapids 55433 427-0569 4057
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 O REMOVE
8 DESCRIBE WORK
Reside House & Garage, add trim
9 CHANGEOFUSEFROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
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.
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS 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
$6,500
$3.25
WITH WHETiJER SPECIFIED HER I OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT�PRESUME TO GIV AUTM'ORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHERTE OR, LOCAL LAW REGULATING CON-
$90.00
Fire SC $6.50
STRUCTION OR T E PERZRMPNC CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
(� - �q�_
�EDAGENT
License SC $5.00
$104.75
SIG A PT'R RA � IDATEI
H PR ERY LID ED THIS IS YOUR PERMIT
-92-
- BLDG INSP DATE
S,GNAT22t=NE5f1F tZWNEFABU1LDERj (DATE)
NEW [ ] Effective 3/1/92
ADDN [ J CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction. Address:
&E
Legal Description:
Owner Name & Address: a VJ;
Tel. #
Contractor:
J; �`
MN
LICENSE #X60 40-c-,7
Address: -Soo
qs
�1
Tel. #
Attach to this application, a
Certif cafe !13rvey 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
H Ground
Sq. Ft.
OTHER:
&S"j C "-t
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: ll Estimated Cost: $ e q
bv.t .,. u rz.�
Approx. Completion Date:
Driveway Curb Cut Width Needed:
DATE: - I -qi>- APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Park Fee
(Cost on Back)
Fee Sched a on Reverse Side
Cel. #�k bQ q
$ .001 of Permit Valuation (1/10th%)
$ -3. -z $.50/$1,000 Valuation
$ $700 per SAC Unit
$ 5.O o $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
Sewer Main Charge $,
TOTAL
STIPULATIONS:
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
SUBJECT -
RMIT NO.
City of Fridley
30018
AT THE TOP OF THE TWINS
BUILDING
PERMIT
t
RECEIPT NO.
`COMMUNITY DEVELOPMENT DIV.
- ------
INSPECTION SEC.
LTL
gz16
� PROTECTIVE
/
1 �
=
1 "'1 CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910415
8
JOB ADDRESS 225 69th Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DIE
6
1
Rice Creek Plaza North Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Marvin Ruska
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
Richard Hastings Contr. 6331 Riverview Ter NE Fridley
55432
574-9966 4051
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 ❑ ADDITION ❑ ALTERATION YM REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garaFre 28 S Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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
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
$2447
$1.22
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
$83.25
Fire SC
$2.45
l
PLAN CHECK FEE
TOTAL FEE
- &< 6 V 9
License SC $5.00
1$91.92
SIGNATURE OF CONTRACTOR 0AUTHOR4EDAGENT IOATE,
WHEN PROPERLY
BLDG INSP
VALIDATED
THIS IS
YOUR PERMIT
MATE
S-GNATURE OF OWNERIIF OWNER BUILDER, IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION 300
ConstructionAddress: 2Zs i�,iW Auz�--
Legal Description:
Owner Name & Address: M,4 kv; N R u s It -r4 Tel. #
Contractor: R, C- k A ?-- 0 5 ��' MN LICENSE # o S
Address: G 331 T-vn� Tel. # —j -
Attach
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:
$ S 6)
�� a
Driveway Escrow
$
Construction Type:
A F- e F jF
4-12 e I? oo c=
Estimated Cost: $
Park Fee
$
140"sF * 5A
(Fee Schedule on
Back)
Driveway Curb Cut
Width Needed:
Ft. + 6 Ft =
Ft x $
_ $
DATE: � 7 7 APPLICANT: Tel. #
TOTAL
STIPULATIONS:
CITY USE ONLY
Permit Fee
$_
Fee Schedule on Reverse Side
Fire Surcharge
$ y��
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$ S 6)
$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:
k',--.
YOF FRIDLEY INSPECTION DIVISION 9431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
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
; 411 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 $ b ��
$ 10.00 $—
$10.00
$10.00 $
$10.00 $
$ 25.00
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.
$ .50
Effective On January 1, 2000
JOB ADDRESS OU -5 614 � c!!:jfAq,�- kJ;
OWNER /Z&, e–,
BUILDING USED AS 'M
ESTIMATED COST 1501 % o PERMIT N0.(5 5
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heatin U is—/ Circle One (Steam) (Hot Water)arm Air
Trade N�me�� Size No.
BTU 15.Z)Vd HP EDR
Fuel Total Connected Load
Burnerrade 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.
HEATING CO
1�
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 venting system, the undersigned hereby verges 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 #1 Type
Appliance #2 Type
Appliance #3 Type
Total Appliances
_ BTU Input
_ BTU Input
_ BTU Input
Total Btu Input
Fan Assisted or Nat
Fan Assisted or Nat
Fan Assisted or Nat
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:o
HEATING CO:
Signed By: Date:
0- S/js/— . c).zS 64 - /29
COMMON VENT VENT -CONNECTOR AND COMBUSTION AIR VERIFICATION
�e elWhen res�lacI09 an exlatIM u�nce, th 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 (Jj No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes I4 No ( )
The undersigned also verges 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 faJj' No( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes (v) -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 (v)' 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 (V/ 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 (0 -No ( )
.. ,.l_ Mill I IN
.;,
Appliance #1 Type re Lmea .rte ETU Input ®'�0 Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or plat
Total Appliances Total Btu Input
Common dent Type - P al c ent Height Diameter.f' inches
Appliance #1 dent Connector Height ft Length ft Diameter in Type
Appliance #2 dent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
., O * : s, ,,, e,
HkAPNIS (�& AIR CO IT®®t�g�,, 41 a Co
HEATING CO:— hW>nnc2oc1is, -
Signed By: C'31-000 Date
CIIYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
October 17, 2001
Ms. Barbara Ruuska
225 69 Avenue NE
Fridley, MN 55432
Re: Final Inspection at 225 69 Avenue NE
Contractor: Sedgwick Heating & Air Cond Co
Dear Ms. Ruuska:
A mechanical permit was issued on September 28, 2001 to install a furnace and an air conditioner
at your address. According to section 305 (a) of the 1991 Uniform Mechanical Code, a final
inspection shall be conducted on the mechanical work authorized by this permit. As of this date,
no inspection has been called for.
The permit fee that was paid covers the inspections to make sure the work was completed
according to the Mechanical Code. 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 expire the permit and no
further action will be taken.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
DJ/mh
9"23-a
SEDGWICK HEATING
8910 WENTWORTH AVENUE SOUTH
& AIR CONDITI
MINNEAPOLIS, MN 55420
ADDRESS
OCCUPANT �r a r
J
SOLD BY w I
MAKE N N p
SERIAL NO. 6'-T ® �� c)
THERMOSTAT -
VALVE ✓
LIMIT
LIMIT SETTING -
FAN SETTING
PILOT TYPE
IGNITION MODEL
ONING CO.
(952) 881-9000
PILOT TIMING
r)1
PRESSURE 1 ' PERCENT CO2
INPUT CFH / PERCENT 02 n�
STACK TEMP. �o PERCENT CO/
HEATING JOB NO.
TEST RECORD
cITY i I
OWNER r ��
INSTALLED BY -
MODEL
INPUT ✓ ' Q
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LINER SIZE
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FILTERS: SIZE NUMBER
WIRING
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LIGHTING INST.
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COMPANY TESTING C
NAME OF TESTER
FORM 235 (REV. 11/89) FORM DISTRIBUTION: WHITE COPY - JOB FILE YELLOW COPY - CITY
Building
BUILDING
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date M A
763-502-4977 FAX
EFFECTIVE I_I.pq
S 21 ®� S
ADDRESj�
fi`�C-� ff%_ ci/�
DATE MAIL
YOUR EE -/ ES > , ���r^ -�p��
�Z �� " � A � 404 �r
SITE ADDRESS
t (p�
/ , \ I
THIS APPLICANT IS:
OWNER OCONTRACTOR
PROPERTY OWNER/
NAME: -W2A1(jyXa"Ce
ADDRESS: �� C9� /ivy NC— CITY
STATE NI. .N idL
TENANT
PHONE: 12-22� 3i
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
ADDRESS: CITY
STATE ZIP
INSURANCE
PHONE FAX
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE
0 TWO FAMILY/NEW CONSTRUCTION STORIES_
PERMIT TYPE
0 ADDITION 0 GARAGE/SHED lam -WINDOWS
,WBASEMENT FINISH 0 ROOF 0 DRAIN TILE
0 DECK 0 SIDING 0 OTHER
0 SWIMMING POOL
TYPE OF WORD:
0 NEW HOME CONSTRUCTION O ADDITION
0 MAWTENANCEIREPAIR )KREMODELING
DESCRIBE WORK BEING DONE:N�
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT S FT
ROOFING
0 HOUSE ONLY
BASEMENT
RFMODELM SURNH:
NUMBER OF SQUARES
0 HOUSE & GARAGE
I
Existing Flom Paan
GARAGES
0 ATTACHED GARAGE
2-
Proposed floor plan
PROPOSED SIZE:
0 DETACHED GARAGE
3.
List of strucbual members to be used
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
[ISI vinyl
OSoffit
ADDITIONS
I.
& PORCHES SUBMIT:
Site Plan/Survey showing the existing structures
0 Aluminum
C3 Trim
and proposed project.
0 Other
0 Fascia
2.
Two sets of construction plans
y.INDOws
3.
Energy Calculations
IN EXISTING OPENINGS kYes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED R�OUSS NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
aTCING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL dOB VALUATION $ 4 OCA U OCCUPANCY TYPE
Permit Fee $ a See Back Page for Fee Schedule
Plan Review $ I 65% of Building Permit Fee
Fire Surcharge $ ;O,J _ .001 times the total job valuation
Surcharge $ jam— .0005 x Permit Valuation Minimum $.50
License Surcharge $ $5.00 (State Licensed Residential Contractors)
SAC Charge $ $2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft + 6 ft = ft x $21= $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( )
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit on site; that the work will be in -accordance with the
approved plan in the case of atl wo witch r es rev' and approval of plans.
SIGNATURE OF APPLICANT _ _ P AME DATE �!
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MEC;1- MIUA1. W2K&
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