IR - 45146� ,.�. ,�.:-r-
�
�
City of Fridle�, Miuin.
BIJII.DTNG PER.iVIIT N•° 3�'7 2
De#e: . . � ..�. . . <. .0. . �. �. . . ./ . . . . . . . . .
4wn�r ....................................... Builder '�. .. . .4a����.�/J/ ..
Adctress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . .�/. . �� . . . . . . ..�.l.' : .lf. .�.
LO�CATIO�PI OF BUILDING
No. �� iA � Street . �..nCi��fa�r�.,,.�je���� of t . . . . . . . . . . . . . . .
Lot . . �,.� . . . . Biock . . . . . y�. . . . . . . . . . . Adciition or Sub-Divisi . .1. . . • . ,a . . . . . . . .
o� ;. . . . . �
Coi ner Lot . . . . . . . . . . . . Inside Lot . . %'�. . . . . . . Setback � � : � . Sidey . . l . . . .'� �.
DESCRtPTION OF BUILDING
U� ' . . . r a ViYt .�� � D@jil,ii �:K . � t Hel�lt /. .� . � ry rlQ. � //T �yC . Vu. �?l. 9.1 �
>
... .. .. .. .... . .. .. . 1'�om . .. .. ... Depth . .... . x t sq. � tc. . .. .. .. . cu. Ft. . .. .. .. .
/ ,i d'�
Type of Construction . .. . . . . . . . . . . . . . . . . Est. Coat. . ..l. ,�i�K.,�."�'�'�o be Completed . . . . . . . . . . . . .. . . . . .
In consideration of the is�ance to me of a permit to construct the building desribed ve, I agree to do
tt�e pr�po�ed Work in accordancre with the description above set forth in complian th all provisions of
ordins�nces of the dty of Fridley.
.� ...... ... ......................................
In cansideration of the payment of a fee o! �P.��.LX..J�..�.�., 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 fa granted and his agenffi, employees and worlanen, in all work
done in, around and upon said building, or any part thereof, shall conform in a11 respects to the ordinances of
Fridley, Minnesota regarding location, construction, <eration, maintenance, repair and moving of buildings with-
in the city ]imits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. _ ��—'
Inspector
NOTICE•
Thia perm{t does not cover the conatruation, installation or.aftar�ti�n for wirinp, plumbing, gas heatinp,
#4wer ��:��ral�., ,;,�,e. s►�u?�: to sss ths BulidM� inspeator for separate permtts tor these items
'C .__
�',
� APPLIEATiON FOR BUII,DING PERMIT
� ' � �ITY OF FRIAL'EY, M�TNESOTA -
r•,` . . . . . .. � � � . �. .
A. . . . . .. . ..
� Oian.ers Name d�� 8aeer.� Builder Lrd.�ucd �hiss
Address ..� .._ Address _ 3l44 dai�$eon St. �.�.
. . LOCATION OF BUILDING .
,.� . .
No. _.....�._ Street'' �.rre _$�.D..... Part of Lot _ _ _..__ _ �
Lot 13 Block _�' Addition or 5ub. D3.v. ��,!� �iahte
Co�tie� I+ot'_ .� Inside Lot � Set Ba,ck ���
: '
Applica.��� �tta.ch to ` this: �form Certific.�,te of Survey of Lot and proposed
building location.
DFSGRIP`PION OF BUILDING ..
To 'b� � used , as � � :, �
�rnellin� _ F�ont � Depth z� Height
Sq. Ft. ,..�. �'�G.
' ' Fror�t .r.:_..�.�. Depth ______:_�:N�ight .
Sq. F`t. Gu. F`t. ,.__..,...�._ `
Type of Construction, t�� . Estimated Cost �.�l�a.�.
fio be completed �' � 15. 5�
The unders�.gned �hereby r�akes application for a pez�3.t for the work
herein specified,�agreeing to do all work in strict accordance with the.
City Ordina.nces and ruling of the Departr.►ent.of Buildings,,and hereby
declaxes tYiat� a],1. the facts and representa.tions stated in this appli.cation
are true and correct.
s' �'� �' � S Si ature c4.(r-�.+� c.��Z�..-�'-�
D�te �
(A Schedule of Fee Coats ca.n be found ori the Reverse Side)
.
� � + � _ ' _-
l�
;:d . i;nie s
V
�
�
�
�
�
�
�
�
�
��
ti
1 HtR�/Y CRIRTIFY
F. c. ��►cKSON
w�o surtv�ro�
1�:;.' -5�
Cr. ��E3
�'
�F �
�y
R[Gf�T[iiED UND�R U1Wf 0/ STATR OR MiNNR�OTA
LICtNftD �Y OROINANC� O/ CITY OI M�NlIRA�OLIi
ae�e E�sr aaTM STREET
� S�ory f=��x Ka;:�
3,� , ' fiutbcpar'st 1Ctrtfficatt
'+�
�-
� '�
�
��t
�. `. _Y�— -�� / 2 G . 8 2 '
, 3s � o
.;;.�. _ __ _
,� � I
`' r
; � � '� `•
! `!� o ti
i� �� � � `�
�� � ��
B
�
PA. 4-4681
-�_� .�
t , �1 �
i `��
, \
\�
R �
♦
�; :
�
: s�a /�: /�,- .3,0,
� 24 �
,
1 R �
� ±
� ;� �
,
� /2�•.�Z --.� `
� �
i
�
. i
1
TNt A�OVt i� A yRUt AND CORRtCT P�AT OF A$URViY t'K �
i
3� �
r
�,ot 13,:�lock 4 Horizon Iiei�hts
I
i
13tYi. "
Ai iURV�YtD �Y MR 2Mlf-------._.----�Y OF �''ay ^�.o. 1959
s � � .� "� � �
:, ,
, ..
. S{GNtO—
� g + F. C.
� �.
� �
;�-. ,
. _ Iro}�
IfTRAT10M. WO• 3dQ0
�
�'��1� ,� � a
�w
� �,
��Y
�� � � �
�c ���
` o���
� �
h ����
��
y �
� �
c����
� �� ��
a���
•a°`°��
���.o
r1 ��'
m'
�•H � �
����
� ° `° o��
� �3°.�
� � ��° �
� ��
� � ����
� .��v�
•_ �
� � a .��A o
•� �� '� ir � (C
� b � ��0 �
� � °q � � � °q v
� ,�,�;� a
� o w
,; ° H���.
C� o � „ �
y A �.7 U v¢i' cqa c�a
��
�: _. .. �
N
�
C
..�
�
� F
� � �
� �(�.j o °o, o°, �°r�
. � � 00 � �[i N
� J : : : •
� � : : :
W
� U �:::
�
. � : : : $
Q : � g °
� : o �
�. : . �
� � � �
a 4 a � � �
H B � � �
�
Q A� ��
i1. a � �
� � �
d � � y �
4 � � �
3 � � �3 �
-°� ,, � � � �,
�9 E., r. m '�
5 � � P� P�
� �
�
�
.,
v
z�
�
1
�
�
f
�
�
` � �
V �
� O �
O DC b
�
ae vs � �sr
°o °o °o o°, �°
� � � � ro
� : : : g
o : : S $
° : g �
� � � � �
,�� :��
� g � � �
�
m°
� �
OG e?J 'd w c�. s`�.
� � � � �
°/ � fi
�� a`°i � ai a3
� .�
� �
x
v � w� a �
�
�
L
�
�
�
�
0
u
.Q
E�
� o
z
� �
a
� �
h •�
U �
� �
� �
W O
� � � �r
o° °o �° �°n
� � N N
�
�
a
�
0
��
� ��
�
a
3 �
a�
�
x � '
�
� �
4 � I
�
�
z
�a z
� �
� ta
O
3
w �
0
O
i�l
V
� �
a
x �
�
�
�
� z
� b
�
�
0
O
�
x
��
o
I �
�
�
0
�
�
�
U
�
U
A
0
U
�
E�
z
N
�
x
�
�
A
�1
�
�
['�
� �
� �
� U
O ,� �
� Nh �
�' \
e�r � s� r�r �r � do-
°o, G[ �° �cn, o° t ]`
rs
tfi .-� N ��a
: � i! SQ 9C m �
' '�+ I I I � E+
E+
: : : � ' I I I
: : � � : : : :
: : : � : : : :
. . . _d . . .
: ti : w � . . .
� 3 � � � : : :
d y �
� x � � � : �
A p a�'i � ° o
�,� � : �o
WW �
0 0
. ¢1 O y 0
�'i w c� ,.; d� v� k�
y� M a° ° w�� o
N M � ir ."'S �4 � �i Gi
a,
�sb a � W x�,:°a�
�.� a a H���
W W � � ~ .�;
.] � ��
o c� �
�
�
w
�
�
.__-.r..
a
E EW., W
� � v, a
z�ya�
H Z x �''
� � � H
a '�
a � w a
� � > �
a
�
a
1
a
0
a
�
is
�
�
�
�
�
N
0
�
_ _ ._ _ _
D36 z.t��e
� HEAT LOSS C�ILCULATIONS DEPART-NIENT OF BUILDINGS FRIDLEY, MINN.
Weatherstrips A.S.H.V. , Conatruction No. ��/ I �
Guide
Windowa ( Doora Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied
No No 19_ S— C — S� �'
U` Fl.� oom Length Width // Height FI.� Room Length Width Height
Windows and Doors—Crackage and Area Windows and Doora—Crackage and Area
Width Height No. ot Ltneal tt. Area Wtdih Iieight No. of Lineel tt. Area
No. of vane oP Dane Iighte o[ crack eq. [t. No. ot pane ot�pane IfBbts ot crack sQ. ft. .
�3z R'. .cs � 4 0 /s�
! ! L
Coef. Btu Coef. Btu
Infiltration 1,, O O Inhltration �,,� 6– Q�
Glasa O Glaaa
Exp. wall Esp. wall
Net exp. wall /�r Net ezp. wall /O
Int. wall Int. wall
Ceiling ID Ceiling � Q
Floor � Floor
Total Btu. 1'otal Btu. /
Required sq. ft. E.D.R. or aq. in:. W.A. Leader area Required aq. ft. E.D.R. or aq. ina. W.A. Leader area
U� Fl.� Room Length // Width / Height 1 �,� �'�� j l,ength Z Width Height
Windows and Doors—Crackage and Area Windows and Dooca—Crackage and Area
Wtdth Hefsht No. ot Lineal ft. Area Wldth Hel�ht No. o! Lineal ft. Area
�10. ot pans ot pane ll�hts ot crack �p• tt. No. of pane of pane lliht� o[ crack W. [t.
2 � pco 32 ,D i
- - � _ -- - -1 �. � �__ _ � .- -- t�v. � _ �.� ���
eE. Bta
Exp. wall
N�c e:p. wau •
Int. wall
Ceiling ,'t /0 '
Floor �- D V �"4 � .46 / / !;
Total Btu.
Reqaired aq. ft. E.D.R. or aq. ins. W.A. Leader area
Fl• G oom � Length Width Hei
Windowa and Doors--Crackage and Area
Width Helght No. ot Llneai tt. Area
No. ot �ans ot Dane Ilahts ot crsck �p. it.
Infiltration � / s �
Glasa p �
Exp. wall
Nec e:p. wall
Int. wall
Ceiling /Q �
Nloor
Tbta! Btu.
Required aq. ft. E.D.R. or aq. ina. QI.A. L.ea�r area
Infiltration
Glaaa
Exp. wall
Net exp. walt
Int. wall
Ceiling
Floor
Total Btu.
�•I L/' iv Roon► I Length Width / Hei
Windowa and Doors---Crackage and Area
Width Hel�bt Na of Llneal [t. Area
No. ot oane ot.Dane itsht� ot erack �p. tt.
Btu
r�o Infiltration
�_ Glaaa
F�cp. wall
; G Q Nec ezp. wall
Int. wal{
� Ceiling
Floor
� %Q Total Btu. t
. �
Coef.l Btu -
�. h. E.D.R. or aq. ina. WA. Leader area
HEAT L(�.SS CALCULATION3 DEPART'MFN7 OF BUILDINCS
Weatheratrips A �� Construction Na
�indowa � Doors Reference Out. Walt Int. Wall Ceiling Roof Floor
o Yea— 0 19_
• Fl. Ftoom Length Width Height F7.�
Windows and rs--Crackage aad Area Wiadows and
Wldtp Setaht No. ot Liaeal ft. Area Wldth 7
No. of pane oi pane Itehb ot crsck sa. Lt. No. oL yane c
�.Va�. Btll
In�ltratioa In6ltration
Glasa ' Glaaa
_ Exp. wau
Net ezp. wall �
Ir�t. wall '
C�l:-or Hoor ° �. / p j
Total Btu.
Required aq. ft. E.D.R. or aq. ina. W:A. Leader area
Fl.� �J1[ Room I�eagth Width �
Windowa and Doors--Crackage .and Area
Wldt6 elght No, of Lineal ft. Area
No. of pan0 of pRns U�hts oL crsck sq. ft.
2 / ...
c
In61#ration
Gla� /
Ezp. �vail
Net exp. wa�l Q c,iq 1' e �
Int. wal! � � .
Ccil. or flcor •�
Total Btu.
Required aq. ft. E.D.R. or aq. ina. W.A. Leader area
F7. Raom � Length Width
Windowa and Qoors—Cracl�age and Arta
Width Heir^ t No. o[ Lineai ft. Area
No. of yans o[ 31aee 'llaht� ot cracic sq. tt.
�
In6ltration
Calaaa
Exp. wall
Net eap, wall
Int. wall
Ceil. or 800r
Tota1 Btu.
Required aq. ft. E.D.R. or aq, ina. W.A. Leader area
n-se iaso
� �
r .
&u I
Btu
Ezp. wall
Net eap. �
Int. wall
� Ceil. or 9oor
I Total Btu.
NIINNF.P►POLIS, MIr1N.
insulation
Kind How
Room.� Length Wiclth
ora--Crackage and Area '�
ht No. ot Llneal fG Area
ne uahta ot ciack ad: tt. I
IRequired sy. ft. E.D.R. or sq. ina. W.A. Leader area
F1.1 Room i.Length Width
Windows and Doors—Crackage and Area
Wldth Height No. of Lineal ft. Area
No. of Dane - ot yane Ifghta o! crack eq. ft.
Bill
Infiltration
Glaas
Exp. waD �
Net ezp. wall
Int. wall
Ceil. or floor
Total Btu.
Required sq. ft. E.D.R. or aq. ins. W.A. Leader area
F1.� Room ( Length Width Height
Windowa and Doors—Crackage aad Area _
Width Heleht No. of Lineal ft. Area
No. of yane of,pnas 116bts o[ crack ea. it.
,;
Coef. Btu
Infiltration
Glasa
Fzp. wall
Net ezp. wall
Int. wall
Ceil. or 9oor
Total $tu.
Required sy, k. E.D.F�; or aq."ma. W.A. Leader area
� ,
� ��
�
h
N
• �
�
�
c a.
� �
� o
C�i � A
� �LL
�
� -�
��
,.� '
�
Q
�
m
�
D6 w
oa
� �
� �z
H�
a
m�
A
�
�
�
�
..9
�)
�
0
.a� c� �
���
� � a
� '� �
a�c�
���
��y�
ti� �
����^r
..�1i y r.Lii1 V
� 3� �
cs q y �
.a
ti � � �
v
�o��
y � f� �
0
V V S�i :N
� •� QO t0
�y��
`�?�a
����
��°�
� � � �
d �
'Sy � �
oay
�"c�
�
_�o� d o
� �,y�
� �
� ��o�
� �
q
� � � �i ;� � R�i
� �zsb
CJ m cqe c�o
I Tr
+�+ N
�
.� tao
b � b
� y �
� y
� U �
o '� �
N
ti o � ° a
�� z� � � (
�C � E+ w O
� � I ❑C
FW
= W �M ,�,
B 6
a < °o �
�
• z
; LL
SJNIN3d0 . . �
sv�
3`JNVN �
sv�
naev .g
�� w
aaFisvM �
olnv
SNISVB �
Fq1YJ
swrvaa �
aooid
'San�Hs
'1NflOi
•;�waa � .
SAVLl `
NSdM �
1 �
�k�s o
�,�,e a � o
seru ` �
HlY4 �� �
51VNIan � k
��� ��
aaivM
��o�S � � ,� ,� � w x
CO � N M � • *
W
J
�
w
U
�
W
4
�
J
F�—
�
a
�
�
y
�
•� �
v.+(�/
O
�.
o�
�
�
�
O
�
C3
�
Q
ao Q
h�
E�
ua sn a�- � tsr c�s
� � N O, N O N
� �-+ � �w M N M
d4
se sc ia ia iC iC
�
\
��
�
� �
�
H
� v} da
���n, ��n, o
Vi �
� � �
� I I �
: : � : � : : : :
: : � : o : :
: : o,o : °c_ � :
: A0 '� : o � : : �
y� N
TW� N • � � p
r ' •�� � ' r'fl'' Q. ' y O
Nl
. � � � O : � � : � N
� �
� � a� � � � d � °
� � � � •� � � W � ,., a�
MS r+ � � `� � � � o cqa
� � � a � � $ z � � P�
�
� z w� z U� z H�� c�
aq �+
�
a �
\
�
h
�
�
�
0
�
�J � �
(,,,� �` �
� ,�.
aFr
. W
�
: �
Ei
'd
s �
d �
IYi .
� ;
0
F '
� o
� �
a
u
� �
aA
a
�
f .,
` .
sue�ett P NO.
c�ty of Fr�a�ey os2 �
AT THE TOP OF THE TWINS g � � L D i N� P E R M I T
r
; � RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
� ; 4 �"'• , —"/��
j � � PROTECTIVE iNSPECT10N SEC.
1 . �
� � �'�'1 � CITY MALL FRIOLE� ,5S1J2 NUt+iBER pEV D�TE P�GE O� A6PROVED 8Y
�"'"�� �'� 612-571-3450 9�Q.FtS 4/12/00 / �
J06 ADORESS 5261 Fillmore Street NE
1 LEGAI �OT NO. BLOCK TfiACT OR AOOlT10N SEE ATTACHED
oesca. 13 4 Horizon Heights sHeer
2 PROPEiiTY OWNER MAII AODRESS ZIP PHONE
3oe Bungert 5261 Fillmore Street NE 571-5366
3 CONTRACTOR MAIL ADORESS ZIP PHONE LICENSE NO
Seal Guard Systems 3770 Dunla Ave N, Arden Hills, MN 55112 (763) 717-0700
4 ARCHITECT OR DESIGNER MAtL ADDRE5S ZIP PHONE UCENSE NO.
5 ENGINEER MAII AOORESS tIP PMONE LICENSE NO
8 USE OF BUIIDING
Residential
7 CLASS OF WORK
O tJEW O ADDITiON O ALTERATION G� REPAIR O MOVE � REMOVE
8 OESCRIBE WORK
Partial reroof of house (7 Sq) Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPEOFCONST. OCCUPANCVGROUP OCCUPANC�LOAD
SEPARATE PEFiMiTS ARE REQUIHEO FO:� EIECTRICA�, PLUMBING, HEATINCa.
VENTI�ATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OA CONSTRUCTION 20NING SO. FT CU FT
AUTHORIZED IS NOT COMMENCED V�!ITHIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOEO OR ABANDONEO FOR A PER100 OF 120 OAYS AT
ANY 71ME AFTER WORK IS COMMENCED. NO DWI,G. UNITS OifSTFEET PARKING
I HEREBY CERTIFV THAT 1 HAVE NEAO ANp EXAMINEO 7MIS APP�ICATION 1 STA�LS GARAGES
AND KNOW THE SAME TO BE TiiUE ANO CORRECT. ALI. PROVISIONS Of �AWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOFK WILI BE COMP�IED
WITH WHETHEq SPECIFIED MEREIN Ofi NOT. 7ME GRANTING OF A PERMIT �612 �. SO
OOES N07 PqESUME TO GIVE AUTHORITV TO VIOLATE OF CANCEL THE pEqMIT f EE SAC CNARGE
PROVISIONS Of ANY OTHEFi STATE Op IOCAI lAW REGUTATING CON- $29 � 6O Fire SC �.61
RU TION THE PERf MANCE Of CONSTFUCTION
PI,AN CNECK FEE TOTAI fEE
License SC $5.00 $35.71
S+GN t wf CON"RA�IOpOpAUTM i2ED�GEN� iD�iE� WMEN PROPEpIY VA�IOATED THIS IS VOUQ PERMIT
�GNatUAE O� OWNEA��� OWtiEABU�lOEAi � �OATE� �
lDG NSo � ���rE
NEW j] �
ADDN [ ]
ALTER j j
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUfLDING PERMITAPPLICATION
Effective 1 /1 /2000
(763) 572-3604 Bidg Insp
��ai
Constructian Address�� i ��\\('(�(���� . � . �
Legal Description: �
Owner Name & Address: ���_ �'Q,('�" Tel. #(� /,� • � �7 ( � `�3�n (o
Contractor: �1 ��Y' 1, (�� �� �'�� MN LICENSE # ��j� �j(o � �
Address•�'°l�"1 C� � Un�C�►� i��%' % ���' SL.I�I � � ���Tel. #(� f� �� � � - d i i��
`S`� l 1 �-
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION O�F IMPROVEM�NT
Length Width Height Sq. Ft
Length Width Height Sq. Ft.
Length �_ Width Hgt/Ground Sq. Ft.
� c� � a .��
Construction Type: _�C - ('OC� � 1 �T�ci f - O �� Estimated Cost: $ _ ` •
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �� I I 1(�O APPLICANT: Tel. # j� I�'� ��1 " U7O U
CITY tlSE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Cali (763) 572-3604 for Permit Fees if mailing in application
$ 0�9 �� Fee Schedule on Reverse Side
$ �o/ .001 of Permit Valuation (1/10th%)
$ �� $.50/$1,000 Valuation
$ $1100 per SAC Unit
$ S -dD $5.00 (State Licgnsed Residential Contractors)
$ Ait. "A" or Alt. "B" Above
�
�
$450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
TOTAL
STIPULATIONS:
$ �� �/
� j ��
0
0
�
N
.--i
i
ca
�
c
m
�
c
O
a>
>
�
U
�
w
L
Z
�
N �
aW
J V
Z �
W �
> G
�, Z
Za
J y
�
O W
C� N
2 N
�
W Z
= O
� �
a Z
�v°
J Q
, ao
�,,. � z
-��?, o z
q ao
�oa
q �, a'
�'� Z i.3
O
� V �
J
a
z a
o a
�
�
0
Z
O
F--
U
W W
n' Z
�
Z > N
� ¢ M
�'
� � �
lL .� �
LL c�0
�' � a�'i M
�
Ut�pliij
�
0
Q
m
O
�
W
J
�
G
W
2
V
N
W
Q
�
w
Z
�
�
0
W
�
�
C�
Z
�
J
�
m
��
�
�
O
z
f'-
�
W
d
r
�
�
V
�
W
Q
�
cn
w
J Q
H ^�
� `` i
� �
�
� o o°
°m °
� �
�
�
�
,� 0
� a� �
� �z �
r
� o
n x �
�
� ^ Z �W N
� a� o
� � .N J
� �"' � "O
�J v 't'
� a�i
C
C
e 0 O
U
�
� i �
� U � H
� _
� ��
� ��
�
c
� �
c �
Y�
Z
o �
(a � �
ZF—m1i
�
�
w
0
z
N
�
�
_
d
�
Z
a�
�
c�a
F-
L
a�
C
m m
V 1
, u
� � � �
o °o 0
O O N
� � �
�. y
� U
C �p
�' C
�
m `+
Y v�.. C
Y U �
3 U m C U
�,, co � � co
� ���3 �
p�y-� i-
"� 'F'' LL' � O
� � C � +-'
N V � v�
� N N N � �
�+ � �' � '� �
G U � (!) 0- �p
41 c0 � � � �
O
•H 7 N (V c0
� � Q C7 C�
L
>,
�
N
m
C7
N
�
N
�
Q
.�
O
a
C
O
U
Q
Y
U
Q
m
z
0
F-
�
v �
N O
� S
� 4
� O
� U
''"' C
�2J �n
N a
i Q
(� `�-
ao
a�
� �
L p
Q �
Q �
c �
.� y �
� � R
'� O �n
�Ur-'
O � cVv
3 �' "-
� U a�
� � � �
s - a�
� �
os'� L r
+ �' � °
�3 � .0 1�
� N �
aU �
� °•.' a�i
c�
�o
L
°°�a
p �4 „p � 1—
� V � 0 �
U .�.�., � +'
R
.a y � U
a.� c a
N Y � fl,
y �C �
O N
� N .0
� j9 •> ++
.a ���C -
v �
� � ��
N +-�
s � ?� .�
C N
� � m C
eo � � o
i � *' 1C
� � O �
7 •"= CO y
� y C �
Q
�°'L�'
oP),
�
IJ 1
� �
L
0
3
O
U
c
N
� a
r.�+ a
y O
3
C �
\ ;t0
�i O
� �
� �
� N
V �
a�
�
�
'� W
7 �
� J
°� �
�
� o
Q
��
J /� �
� �� 4
�
n�
�
�
�
C
� �
J
�
�
tC
�
C
r
b0
^ O�'
` \ �'
O
V
C3
Z
QF=
W
z7
�
G
ao
N
i
�
O
r:
d
69
L.11
W
�
z
�
h
v
W
�
�
Z
w
�
'�
a�
>
O
d
a
¢
�
�
O
�
3
�
'� �
� 3
� O
��
��
cc Q
C �
� a
� �
U C
(d .
a .o
.a �
� R
C �
C L
cC '�"
U C
y O
`- 'N
N y
� �
a �
C �'
U a�i
� +
¢ 3
.
""'"`..�
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
1Nhen replacing an existing furance, the undersigned hereby verifies that the
venting has bee� 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.
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combustio�air it will be sized a�dit�stalled
To meet the current codes and manufacture�'s specifications.
Yes (�, No { )
/-
Yes ( ` ) No { )
� I _. �_
Yes (�, No ( )
�-
When ins�talling a new venting svstem, 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 natura! 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 ()
A tiance T e and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU lnput Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
ApRliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connecta� Height ft Length ft Diameter in Type ��
Appliance #3 Vent Connector Height ft Length ft Diameter in Typ�
ALTERATIONS: (Describe)
n .p -
�-
HEATING CO:
Signed By: Date :
�
� _.
0
�+
JU�J-18-2001 13 � 45 SFiLES ADM 612 3� 1 522� P.�i�5
�, - y �
DONDY RES Jot�# Zone: Entire xov:,e
s a�-:::,n,,.
MAN[1AL1:7dtEd. RIGi�'T•!; 3,O.1+L.- S�fix078
1 Name0fRo0m finCS:e House who2e howe -3
Z Running Ft. �cposed Wol! 11q, 0 Fi. 1 140. o Ft. Ft. Ft,
3 Room Dimcmions, Ft. 0. 0 L• I 2 q. 0 x 4 6. o Ft. z Ft. x Ft.
4 Cciing5, FI Condit.0ytion 9.0 d e.0 i�eaa/cool
TYPE OF 1�rM Area l3tulr Arca Dtuh Arca Biuh Areu Stuh
EXP�SUtir Np. Htg CJg Langth Ht` Clg l.eagch Htg Cig I�en�tls Htg Cig Lxnsth Htg Cig
5 Gtoss A 12C B.1 2.1 1120 •es• rw�tr :1Z0 •rrw e��� a��• •Yry ��•M •s�•
ExpOStd b i,48 13,0 2.3 13b �s�s w�►w♦ f 136 •��� ���s Wr�• •�•r •��♦ •+.•
W�ilB #nld C 15E: 7. Q 0.0 552 •�'�r ��t• � SSi ���s •�.+ ♦sa• w�s• w►s• •�s•
Pal'1,iti0ns d 158� 6.7 0.0 372 •t�s ■sr• 372 rr�• a��♦ sr�• r��r wy*s ♦s�•
C ! 0.0 0,0 D �*�• •s�+ Q •t�� rr�r •y�♦ •s�• •�s• •.•♦
t � 0.0 0.0 0•+"• ,rr• ���s� ���♦ ♦as• kw4r •r�• s��s
6 WindOw3 et�d 8 3A 49.6 '�• 1Ad 7161 •��� 144 7191 "�'�� ���f •�+•
GI&SCD9ot9 b 49.6 �'� 56 2777 '���� S 2T7? ��'�• +��w �s�s
�
Heating C 0.0 •s p �•wra G ��sr t��• wrw•
d 0.0 •• 0 0 v�.• � rr�• •��• ♦r.�
� �.t7 �. e 0 r��� � �•��w �r�r� •w�
1 0.0 •M p Q*�ss p Q•��W r��• s�s•
7 Vl+indawsand TIoId1 33.0 16 ���� 368 :6 R�K• 369 •s�• �'��"'
i'i��3S DOOrS NE/iVW 0.0 p s�s� p 0 WyW� 0 •�++ ���a
�90iing E"N�' ��.0 107 "��• �j44 102 st"` 7349 •s•• •��•
3EiSW 0.0 G �*�+ � � ��ss � •��r ♦��s
�5outtt 39.0 B2 "sv 3116 82 """'" 3116 •"• •�rs
FiOCZ Q,0 Q •i�• 0 Q W+MVr � f+►4t ♦�M�
8 Otllerdoots 8 lOF 28.6 7.6 u2 12I0 3i7 12 121tl 31�
b 0.0 0.0 0 0 e G o I
9 Nct a izc s.i x.� s�e �_iZ ieas ��v �:az :.ess
ExposeG b 148 37.0 2.3 136 17fi"s 379 136 1763 319
Weliv 8nd C 15L 7. B 4.0 552 43Z2 0 552 4322 0
PaRltiOns d 158 6. ? 0. 0 3'2 2479 0 372 2478� 0
e o.0 o.o 0 o a o 0 0
f c_o O.a o a o o� c ;
i0 Cri11Dg5 3 16G �.p 1.5 1060 3148 1534 i060 9148 353� I
b p.o o.a p o o n o
0 0.o c.o 0 0 0 0 0
I1 F1oo[s a 21A 2.2 0.0 528 12a01 0 528 lia0 �
h�00 +1.7 Q.8 528 2471 426 :28 2471 �Y8
C tl.4 0.0 0 0 0 p
i
12 tnfiltrntion a 34.8 3. B 292 8a13 93S 242 8913 935
l3 SubGot Rtuh Lnssy6+B.+� j+jZ s�rr 41S']4 �'�+• *st♦ 41474 "�tt •��w v�a• r�ss •��•
�4 DUCiB[Uhi.OSS 5° Y099 a��• 5 2059 •'��'� e •��• o ww�•
IS TOtal Btuh �.099� I3+14 r��• eC073 •��• rw�s 44C7j "'�"• •��r •s�� w{q♦ •►�•
16 Int. Galnv: People Q 30Q a •��• 1Z0 4+"•• lZdp •��� �vrs
ADD�• � 12p0 � M�"• 1200 1 •���` 12G0 •r�• ,y*�,�
17 SubtotRSHO0in=9+8�.+12+jb r•R• r��• t8631 •��• s��� 188�i ♦*ss ♦s«r �rr. s��M
iE DUCtHLthGAin S •�•• 53z� So �•�• 932 ° •••• o sfas
19 TotaIRSHGAin={t7+18j+P�,p 1.00 +��* 195621 1.00 •et�' 19562 •�st •st�
20 CFMAIrRoqull'ed +•••• 10a 1036i •�'• 109 1046 •�t• •*s• �
Printout certified by ACCA to meet all reyuirerr,ents ofManual J Form
TOTflL P.OS
O
O
N �
�
C
�
�
C
�
d
>
a�''i
W
f'
�
a
Z
�
u.
N
Q
�
�
Q
�
2
m
�
J
a
ac
0
�
z
0
�
�
J
a
o.
Q
�
0
J
Ll.
z��
J
Q
N
Z
� y
-2 0
.
q �
��
O
\
�
b
z
7
U
w
NZ�
Z
m
W Q eN+�
� � ��toD
�,dZ�
u. 'c �' c�
O> >:,�
d
��c�
�
C
•� N U
t � w
� U �
� "r U
y U f0 �
N "" O
N
p `� � '0
� � N l�9
- 3
€ d � �
a c � �
� v u�
• � '� � c`o
� � v � o
, 0 � � «.
U '��C., � d
N n
N G O !/►
a Y v► �
d O 'j
E 3 � c
o � m
���—°_ n
s a,Ci C
C y O
fn C .d � C
W � ` � N
n � `° c Q
Q � � � �
� H a m �
a
�
O
1JJ
�
z
�
H
�
�
F=-
X
�
Z
mi
�
J
a
�,
N
�
�
1 � �
O
z
� ~
� �C
V W �
� a
� � i C�1
� Q
yY 1 �
�i
+�..
o�
�o
�
O
Z C
J �
w
f-
�
A
a
C
t
� t�
�
� Z
� 0.
Q 0
N
� � V } m
�n V � m 'O
o► � m w >
c � E � � Ga.
O m W °' N 4
�
0
�
�
p O O O O O O 0 O O O O
►.: sf ui r- t� t� ti� t� p o 0
{� U! 1A W�► � V! �� H9 d`1 �
0
0
vi
H
I l I
I
I
I
�
I o
1 I
f
I �
z
�
a
N
�
v
�
.�
� Q
� x � � : �
u. � c�o o. v� �
3 v ~ Q � � >
d 4 A C� W � �
Z
u�i N �.Z � N a`� :. a
N N 3
� � �i' � m co � 1_ _ = N � �+- �i
�. p O � �- � •- � G1 �c �.
�` �`- 3� � E� m m c`�o m c`�o ~
z O m m � � � � � � � � °D
�
Z
O
Q
�
w
�
4
� u
Q N
Q..' d
Qa
= W `o
�p � 7
$��
Z 0
� 4 d
U. N 7
�
`� = o
�H o
� � �
� Q �
-
,
�
w
W
�
� �
� O
U �
�
N
a�
�
�
w
0
�
Y
a
m
Z
O
O
�
Z
H
Z
>
Z
O
�
O
Q
cn
w
�
4
�
0
z
Q
�
�
Z
O
F-
W
N
U
�
�
W
a
0
W
�
O
�
0.
w
m
J
Q
_
�
�
Q
Z
�
N
�
m
O
U