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AF - 45179City of Fridley, Mi�nn.. BUILDING PERMIT N� 6302 DBte: �,I�'''�'��R'�' � � Owaer: 8uilder _ � Ad�ireas � Addrese ,�, LO TION BUILDIWG No. :�� Street ��; Part o t ,• Lot _,,�.-.__ 81ock �_: Addition or Sub-Divlsion '' �„ �' �" '` ,�'' Corner Lot _ Inside Lot T.� Setback .��-� Sideynrd �� +�+r ti,"�h Sewer IIevation __._- _ Fotmdatlon Elevation DESCRIPTION OF BUILDING To U Front �� Depth ��i�c� Height �� Sq. F'L ��C�. Ft,��..�+� _ n Depth fTef �t y��Sq. F't. '�� Cu. FL ��•� �` V Type of ctton F�� '�`" Ta be Completed . , �, In consideration of the issuance to me of a permft to construct the building described above, I agree to do the proposed work in accrordance with the description above set forth and in complisnce witt► all provisions oP ordinances oP the dty of Frfdley. � In consfderation oP the payment oP a fee,oP $ �, permit is hereby �ranted to to construct the building or addition as described above. Thispe rmit is gra.nted u�n the express condition that the peraon to whom ft ia granted and his agents, employees and worl�nen, in all work done in, around and u�n said buildiug, or any part thereof, shall oonform in all respects to the ordinancea oP FricIIey, Minnesota regarding location, construction, alteration, maintenance, repair aad moving of buil�inga withiu the dty lim�its aad this permit may be �voked at aqy f3me upon violatio��aay of the P��ons of said ordinanc�s. �+"°�'� � .. Ar "1 �� fi,r!�,'�.:� : , , _ No�ce: ihis permh doa eof eowr ths coa�trudioe, iestallaMoe to� vrteieo, �lum6tea �as 6..Nna a�w.r or wa�.a 8� sun to � th� Buildieg lesp�etoe for aparah p�rmMs for Hta� (t�nn. �� - — m^. '`` � � - � ,' 1f APPLICATION FOR;BUILDING PERMIT � CITY OF FRIDLEY, MINNESOTA OW1e�ER ° S 1'Tl�ME �� . � �'� � � ! �✓ B�j�,D '� � ` � � ,,� C� � ' ADDRESS , . ..ADDRESS �2`�� "��%��tP1° �/�- No. �� LOCA7."LOId Ol� BUILDING ��@� A � e� a�/� Part of Lot Loe � Block Addition or 3ubdivisionf��cN� %%E�O��}_s�I� ��.*e��+�s i Cor*ser Lot Inside Lot Setback �S Side-Yard ��/o� , -.--_ SEWER ELEVATION � �, FOUND�TiON ELE9ATION App.l,icant.attach to this.form Two C�.rtificates of Surveq of Lot and proposed:build- ing locat;ioa drawa on these C�rtificatea. . . To be used as: ��i �� DESCRIPTIOIV OF BUILDING i �� Height ..._ ; Sq. Ft. Cu. Ft. � ��°�� Front w Depth ?� Height . ":; Sq. Ft. Cu. Ft. Type of Construction �'/+M� Estimated Cost � �� To be Completed �� / �'�,� The undersigned�hereby makes application fo� a permit for the work herein spec�fied, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the pepartment of $uildings, and hereby declares that all the fac�s and representations stated in this application are�true and correct. 6' DA?'E C iGR1ATLIRE � �s=P,� � (c�t,Qdule of Fee Costs can be found on the Reverae Side). ��- - � �""� �'--� � �_ e BUILDING PEItMIT FEE SCi�EDULE �ec�ion 2. �he Inspector o£ Buildin�a sh�.11, befose issuiag any pe�mit for t�h� erection of aay buildiag or structure, or for aay addition to any Ax3st� i�� bu�lding or atrucCure, or for any alter�tions or repairs to any e�i��a� buildin� or st�ructure, upon application therefor, require the payment by the agplicant for such permit of feea t0 the annount herein below set £orth aa�d in the manner herein provided Co-wit; 2.1. For any such permit for Che erection o,f any fire-proof building, other th�a a garage� warehouse, factory or graia elevator, or for the erection of any fire-proof addition, for aimilar occupancy, to any esisting buildia� shall be at the rate of $1.40 for each one thausand cubic feet, or fracrion �hereof, in such cubical coatents. 2.2. For any such permit for Che erection of sIIy fire-proof garage, warehouse? iactory or grain elevator, or for the erection of any fire-proof �ldition, for similas occupancy, to any exiati�g building shall be at the rate of $1.25 for each oae thousand cubic feet, clasaified as °1fireproof" by Section 502 of the Mianesgolls Buildiag Code. �OUSES 2.3. For aay such permit for the erection of any non-firegroof building other than a gara�e, warehouae, factorq or grain elevator, or any non-fireproof addition, for similar occupancy, to any enistiag build3ng - permit $1.00 for each on� thousand cubic feet. �ARACES 2.[s. For any such permit for the erection of any non-fireproo� garage, w�rehouse, factory or grain eZevator, or for the erection of any non-fireproof additio�s, for similar occupancy, to a�ay ex3sti.ng buildiag or for each auch . buiiding or addition - nineCy centa ($0.90) fos each one thousand cubic feet oz� fraction thereof, in the cubical cantents thereof with a minimum of $4.00. �or the purpose of comput3ng fees for building parmits, the cubical contents o£ any building or additioa to a uniform height throughout by multiplying the ground area covesed from a point sis (6) inches below the floor line of the basement or cellar to the average height of the upper suxface or to the average height of the roof surface of the main gable of a p�,tched roof. 2.5. For repairs or alterations to an exis�ing structure, the fee sha.11 be a� the rate of $3.00 per each Five Hundred Dollars ($500.00) or fractioa thereof in the cost of all proposed work. 2.6. Ia no case shall the fee, chargc�d for any perantr as ,set fosth in Section 2 be less than $4.00. S 9u. � � ^ ^ ih � ' : �f HARVEY A. CARTWRIGHT ANOKA COUNTY BYRVEYS NEMNBPIN COUNTY 6URVEYB MlNN6APdF.18 BURY6I�B 8410 PALM STREET N_W. sunser a-�sea OWNER INDUfTRUL � J1IDICIAL BUSINHSS - TOPOORAPMICAL GITY LOTS - PLATTING Sam T�snplirz � CARTWi�I6BT & OLSON LAN4. SURVEYORS R6GISTERtO UNDi11 LAIMS Oi iTAT[ OF MINN[80TA LICEN�ED BY ORDINANCS OF CITY OR NIINN6APOLIB 328 PLYMOUTN BUILDING FEofiRn� 8-8721 HENNEPIN AT SIXTH • MINNEAPOLIS 3. MINNESOTA �xirbcpor'g Certiftcatc COMBINING THE liEGORDS OF J. E. HILL, CIVIL ENGINEER ¢BTABLIBNRD teYb C. F. SANDHOFF . CIVIL ENGINEER ESTABLI9MED IOOB JAMES NEL50N Surtvgroa 66TABLl8M6D fYB� METROPOLITAN LAND SURVEYORS, CBTABLIBMED 19St ?nvoice 2287b r— I hex��by cer-�ify that this is a true �nd corr�ct rQprssen�ati�n of a s�rvey of 4 _ Lot 5, B1ock 1� Ga.rdena Y�Ieloland Garderts �.s �tirv�y�ed by r:ze th3.s 9th d�.y o� Idavenber,��tb2. � ��;� A.��,� � ��#►`�"' . � 'c•� StGNBD WRIGNT AND OL90N �¢°' i. ,,r _ � r i� . '°, ^ _3 n r �+� -� � 0 � E� T 3 > a x � O < ° 0 � x r�� x x � � � o °xx� ��c�o RP � � Z � � � Q � `�' � � � � o � � � :� 4p fJi ' � N • � � ��L� ��i �� CA7 � � � � � � � v y w � � � f'" � I�i �� ~ �� N1 o � N N � � ° � . a � o � : � . . � . . � oa ,e ,e o N � p o p � {l! {fl 'Ci3 � W `y ��Y r b0 � � i � � � � 0 � � a � � � ^� O � 0 0 0 0 O � cn 0 O V) � / 0 r 00 a�o C � � o w � w � � � � 'S' y O � y O � � fD . � fD • � • p' : � � �� cn 0 O &9 o w � � `� � a �, m `D � � � � � � � � " � � � O�� y ♦ � � N � �� u � O � � h � � h � � � � � � � � � o �' O N ` b h r . _. � � � �r � � �. �. s a. a i o °o C � � � � � � � � � � x � � � t � �o � � � � � ; � M ' � � � � Y , � � 1 a � 0 1, � , n� � � � N �° x � o � '� � � R° y � � � � � �°o � � � �g t3 � n� w w en en o 0 O O O O 4n " {fl � � � � M O � � ��"'. � �� ro 6 �. � z � O I . �4 ,� o � � � z O � � � �� O m 0 b � � g �- � � � � �b �, �� `� � � � o � � � m id I��yr� pa, � p O .rj o � ° �; � � � � �'� o� � � • y O a � : Q � O : ' � � � . . O p . . . m . � , . � N � �x� N � o °o °o °o °o fA iA f9 �Yf 1 IQ Q I � � � � w m R� � � °�, � � �• ,\ � M � ��b _S � m m �' � � � � � � � � � � � � a � � � � � � � � � � �� y � �&' b � ° P� � : 7''' � � : : � . . � O ; : O 0 . . Gp . . O : : : � � � � � Fa o 0 0 p O O O {� � � �� aa;; � � �� "�� p �� . � � �!j � �.* �, nj • • � Fn d��. �� • G�+�p � Ff p ��C � �� . � m � v� b ��'� �� kxrqe�n p� �� m �� ' o �y ro �� r � \ �'��. � � � ��y Sh ¢� n �� m Q � ►7 H iYi �+ � � � m � ��o v. 0 � V ) � D � r � � m y _ m C r m d b M � � a � Q P � V O � � � � � � r i � � �. �� _ �O `t� . �� A � `• � � � �i � � � � � � �� O � �� /i*1 � /L't �?� / /b` .� � D�S6 �9 �� ftR�Fli, � /�1-��: •. � r a� ��J� o HEAT LOSS CALCULATIONS DEPARTIV�NT � OF BUILDINGS ��3'. NII1N1e1• .�/ /� � Weatherstrips A.S.H.V.E, Construction No. Insulation Guide Windows Doo Reference Out. Wall Int. Wall Ceiling Roof F1oor Kiad How. Applied ' s�-� I Y —No 19_ Fl.� ,: �. /� Room � Length Width �/Height Fl.� Room Length �idth /a Height � Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area \Vldth Helght No. oP Llneal f. Area Wldth Hetght No. of Lineal ft. Area No. of pane o[ pane lighta ot crack eq. ft. No. ot pane ot pane Ilghte ot crack eq. ft. 2C3 ?� � , Cv / .l�o ,.? � �a �10 � f 9 +` 1 / �, �' /�/• ! � _�G' _� � ,�� /d, Coef. Btu Coef. Btu Infiltration � �1�� Infiltration ��, � � �%� Glass , � � � � Glass % �' ..� 9� � Eap. wall � � F..sp. wall � Net exp. wal � �� .�� Net esp. wall � L� �� Int. wall � . Int. wall -- - - Ceiling �� /,�.. / � �� Ceiling � X � � ?�' Floor Floor � Total Btu. / Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.� Room � Length Wideh�� Height Windows and Doors—Crackage and Area Wtdth HelBht No. o[ Lineal tt. Aree No. o[ pane ot pane llghte ot crack eq. tt. �s � �n .o! � . � /� o � � ,3 /% /� � �, ,� ' Coef. Btu Ia6ltration l' �' � �� Glass � , p . � .� O Exp. Wall 3� � Net egp. wall � � � � � Int. wall Ceiling �Or _�1/ � Floor Total Btu. , � Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl. Room � Length Width �Ieight Wiadows an Doors—Crackage and Area Width Hefght No. ol Lineal ft. Area No. ot Dane oY pane Ilghte ot crack eq. ft. �2 � l ,- ��"6 l / �' Coef. Btu Inhltration ' jG+ � � � Glass �y p �� , Exp. wall � Net exp. wall � /� �� dnt. wall Ceiling ,� � �� Floor Total Btu. p`r Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Ft.� Room I 1-ength Width ' Windows and Doors—Crackage and Area Wldth Helght No. ot Lfneal ft. Area No. ot pene ot pane llgbte of crack eq. ft. � Infiltration Glass Esp. wall Net esp. � Int. wall Ceiling Floor Total Btu. . A � � Required sq. k. E.D.R. or sq. ins. W.A. Leader area .� Room I Length ?lWidth � Windows and Doora—Crackage and Area W(dth HelBht No. oY Llneal ft. Area NO. ot pane ot�Dane Ilghte o[ crack ep. tt. � � �� / � Infiltration Glass Eap. wall Net exp. wall � Int. wall I Ceiling .�� c�'3 �� a '� �� _� �� % �� f/1��I Floor �' � � � rI� I � � � Total Btu. IRequired sq. k. E.D.R. or sq. ins. WA. l.eader area �o %' � �. ' � D36 ° E/`'i�r3 � / � _ h � �T LOSS C,q�,��TIONS � � � ' ` ' Weatherstrips A.S.H.V,E, DEPAR�1. �Windgws I Doors Guide Y�' �,� Reference Out. Wall �°stn'�tioa N .' � No j9�_ 1nt. Wall Ceilin8 � �� R�m � Length Wiadows and ao�� ✓idth � �v�a�n Cracka$e and Area �He�ght � N� oP Pane oP Aane IlShte oP crac �� Areg . � �� y � /k a9. ft. � �j � � // iC� ° � � � � � � . s Infiltration Coef. Glass %{ 7, Btu �� Exp. wall r� � `� � � �� U .� Net exp, N,a�� i Int. wall �� d' � /�6 � Ceiling Floor � Total Btu. �� Required s . � `/ �`q 9 ft. E.D.R. or sq. �g, W,A. ro .S',� �,I Leader area Windows and Doo�� I �ngth �7' �r'd�h s--Crackage and Area / ��Height � � No. �'�dth �Helght Nghta l'�nea1 ft Area ot pgne pane � �� of crack eq, ft, " � .✓ � � � � � �a � ,� • / 3 1n61tration Coef. B� �fl83 �s� �^� a:�Cp. WB�� tis�p �' �ta� � � � �`�f � s—� S Net e$p, wall ��- Iat. wall �� / 5� � . Ceiling Floor �� Total Btu. � � � Required sq. ft. E.D.R. or s.' �'�f f 9 "�s' �!�►. Leader area �� R�m � Length Windows and Doors—Cracka e Width He�ght 1�� N,. w�acn xe�gbt S and Area ot Dane of Aane llBhte L1nea1 Pt. Area �� of crack a9. ft. ^ �� / �S _ _ � Infiltration Coef. Btu C1ass � �p. wall `�� °L— ' �� Net exp, N,au �a �� 1nt. wall � � Ceiling �� Floor � � �, Total Btu. � � Required sq, ft. E.D.R. � or sq. �ps, �jA. (�ader area � � F / � e �° Y b � � �° � � o� p � . M : x : � : � • M : o . a � ' � � '\ ifl � � ♦ � � N � � ►i �+ !'� � � � � o � � � �' � � � o � �° � N � o � o � : o . G � : � � � � � N N � O Q Q � i�A i!i {A O � � ^�' �.X � S � � � � @ � � x g � � � n �'� �� o � � ,d O' p m � � � a p : � �- : t� � . �" . � o : � � : �A � . . . . � . . . . ' Gd : : : : : � : : : : 0 D1 ?4 k k >S DE W N W �-+ �-+ � �I �i p C�i� O O O � tA {fl ffl {fl {� bi \ y �N � ^ Q� L 0 a x �� y � � y � � � O �� 0 S� °N � D —��i r � '� m � _ m C r m o � Q i � � � a o � � m a. ia+ �5 �' � � � � 0 � T � c � m � 0 � � � Q * � � o. � "+ W x � � � � StorYes � � WATER � � � �a�� e�rH o � � p � awsln6 t! � I SINKS � �, W�►, � °� rannrs DRINK. FOUNT. sHwas. FLOOR DRAINS CATCH 4i BAStNS � Au7o WASFIER � GAS APPL GAS � RANGE GAS i OPENINGS I � • � � b � 8 M � � � �i, � 2 • N � A m � � p � a�� ' � � � � ° " � �,� bd � 04 w � p o � � � � � � �• �� o� b � � ��°" � � �- � � � � � � �°M��.� W � � � � � � � � � � � p� � � O �a o p � O � � � y a, w �� a� � � o�� y �� w� � r. � co \^ w M' � Q ry ir �' .. �o � I .,, co � 3�� `�ll � �' � xA � �y wM Rx % �°n p � ��i. � � � � � � Q � � � � � � ;� 0 � '�'\ � � � � � � � � � �� M be �� . -V �or � � I� � � 0 � , � � '� � � ' � SuBJEC� . - � , ---- City of Fridley 2 8 5 2 0. ; �572�T��FT"E�'"S gUILDIN� PERMIT R IPTN . � ; � _.��_ COMMUNITY QEVELOPMENT DIV. �� PROTECTIVE INSPECTION SEC. i--_-� ��"','� CITV MALL FRIOLE� 5SIJ2 NUMBEi1 nEV O�TE vAGE O: �CaROVED Bv t 612-571-3450 810-Ft5 11/4/98 � � JOB ADDRESS 6005 Gardena Lane ` t IEGAL �OT NO. BLOCK TRACT OF ADDITION SEE ATTACHED oescA. 5 1 Gardena Meloland Gardens SHEET 2 PROPERTY OWNER MAIL AOOR�S$ ZIP PHONE Mike uinn 571-2584 3 CONTRACTOH MAIL ADORESS ZIP PHONE LICENSE NO Town & Countr Roofin 7910 12th Ave S Blo a ARCMITECT OR OESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PNONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WOHK ❑ NEW O ADDITION � ALTERATION �c REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WOfiK Reroof house and ara e 9 CHANGE OF USE FROM TO STiPULATIONS � Underlayment must comply with the State Building Code. SEPARA7E PERMITS ARE REOUIqED FOR ELECTRICAL, PLUMBING, FIEATING. TYP� OF CONST. OCCUPANCY GFOUP OCCUPANCV LOAD VENTILATING OR AIq CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION jONING SQ. fT CU fT. AUTHOR12ED IS NOT COMMENCEO V�IITHIN 60 OAYS. Op IF CONSTRUCTION OR WORK IS SUSPENDEO OR ABANQONEO fOfi A PERIOD OF 120 DAYS A7 ` ANY TIME AfTER WORK IS COMMENCED. NO DWLG. UNITS OffSTREET PARKING I MEREBY CERTIFY TNAT I NAVE FiEAD ANp EXAMIN�D THIS APPLICA710N S7A�LS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIQNS QF LpW$ yq�UATION SUiiTAX AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPI.IEO WITH WMETMER SPECIFIED MEREIN OR NOT. TME GRANTING OF A PERMIT $1971 �,98 DOES NOT PRESUME TO GIVE AUTHOR�TY TO VIOLATE OR CANCEL TNE pEqMIT fEE SAC CMARGE PROVISIONS OF ANY OTMER STATE OR LOCAL LAW REGUTATING GON- STRUCTION OR TME PERFOFiMANCE OF CONSTRUC710N $62.25 F e SC �1.97 � /% PI,AN CMECK FEE T A FEE - �-/!��,�c' v-� � a�.l-. ��— �F �9 � Lice 5. 0. 20 S�GNATUFlE OF CON'AACTOp OA AU MON�2ED AGENT iD�iE� E FiiO V VALI TMIS I$ YOUR PERMIT � � • � S�GN4TUAE O� OWNEA��f OWNEpBUILOEtii iDA�E� � 8 G�NSP � y ry�tE � � RLJG-13-1998 ...�.. � � ADDN [ ] �-T� [ ] --- - -- _- -_ -- - -- 08�42 FROM CITY OF FRIDLEY CoasaucaonAddr�s: � _� Legal Description: � P� gy�� _ _ � 2� TO 8589320 P.01i02 LLiC�:LLVC l/!l�18 CITY OF FRIDLEY SINGLE FAMII.Y AND pUPLEXES Yi 1 AND R-2 BUYLDING PERNIIT APPLICATION Owner Name & Address: � ' � Tel. � .�%l -oZS �Q � � Connaccor. — 1vIIV LICE1�tsE ��09/ �'-Sc2 Address• `�'�'� , D�w� fiD TcI. #�,/,�'- y� Attach co this application, a Cer 't�ficate of Survey of the loc, wich the proposed consauction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: 01'SER: DF�SC�'fYON OF ID�RO�'FMENT � _ Length . Length Width ileight Sq. Ft. � Width Height Sq. ft. Width Hgt/Ground Sq. Ft. � '>7.�Z �S� % %�i%�u� Consnuction TYPe:� �� Fstimated Cost: $ ��%(P . � (Fee Schedule on Back) Driveway G�rb Cut Width Needed: Ft. + 6 Ft � Ft x$ _$ DATE: � - � �'J APPLICANT: Tel. � J�f,� '�,3 Permit Fee Fire Surcharge State Surcharge SAC Charge Lice� Surchargc Driveway Fsetow Erosion Control Yark Fee Sewer Main Charge roT�. . STIPULATIONS: � _11.11 � � v $ ;�� Fec Schalulc on Reverse Side $ 1 .001 of Permit Valuation (1/lOth°b) $ , $.SOI$1,000 Valuation $ $lODO per SAC Unit $ ;�'� � $S.� (Statc Lic�nsod Rcsidcntial Contractors} $ Alt. "A° ar Alt. "B° Above $ $450.00 Conservadon Plaa Review $ Fee I?etermin� by Engin�ering $ Agreement Necessary [ J Not Necessary [) $ �� Z!� CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 PERMIT NO.: 2004-00179 DATE ISSUED: 02/09/2004 :�� . (763) 572-3604 FAX: (763) 571-1287 � , ADDRESS : 6005 GARDENA CIR NE ��, PIN : 243024120002 � LEGAL DESC : GARDENA MELOLAND GARDENS : LOT 5 BLOCK 1 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION . NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A REPLACE FLTRNACE (WARM AIR, GOODMAN, 70,000 BTLT) AND AIR CONDITIONER # A/C iJNITS 1 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 ENTER VALUATION 3626 APPLICANT HEATING PERMIT MINIMUM FEE 0.00 ASPEN AIlt INC FURNACE SHELL/DUCT WORK 30.00 308 16 ST SW STE 25 GAS RANGE FEE 0.00 FOREST LAKE, MN 55025 GAS DRYER FEE 0.00 AIR CONDITIONII�TG FEE 25.00 HEATING REPAIRS/ALTERATTONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 OWNER TOTAL 55.50 QUINN MICHAEL R& LOUISE D PE1ID WITH CHECK # 8821 6005 GARDENA CIR NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 da.ys at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws a.nd ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of y other te or local law regulating construction or the pe ormanc f construction. Applicant Date Bldg Ins SEPARATE PERNIIT UIRED FOR WORK OTI�R THAN DESCRIBED ABOVE. e. n ; g N .-� M � m ti � tl u u W w W Z � N r �� 'a }� � � Z N dp � !� ~ � � y H � �a A F' '� Z H Q v a o. � �� $ � O Z �.a, o a� � � � ~ W V� J � p � n ./ m 0 � Z d O � ? 0 2 0 U a z �. z � n, � � � �' � � � N�� m M Iai.C�� a O� m,�„�� 'n� � -d'�r. L0/Z ' d W d � � � t � � W N 7 C7 2 � O o m� .� ,? (' ��\ �, O z � W a � � � E- � c.i � w H � N w �t � � I � m 7 0 �o� ��W� � W N J � � � N � v j m �C 0 O a� U � � V p. � x � N Q �CT� O � �d i`° � Z.� O p,1 C � H � zf-m�. � � �� o � � � � � � � d a °o o °o � O C !A W 8Fi ` d d � � � � .-. m Y � � � m m � m � u ., u �0 � y N , ��o3d o u'_ — � 'v �, u" � o c . -$ .. � OV�I�ZD �ywa�m � G. � •- � "a �a � ro � � H h m � •�c ca c7 ZS6SZ86iS °o o° � N � � � N a e .� 0 a. � � c � U �� d Ol � 0 W A 2 d � � a z m � Z 'C � H `m c mm � Y U m Z O y N p G� O i=. O A1 t�J � l0 a� Q �a '�a � O � 7 N � � O O ¢� c C �a �' N e a' °� �o � � N � V 3 ».-�' '� V d 'C 6� +'�% u « t `++� d O � � ►. �+ � � U � a► N c d�d� O. W � y �'� V � .b c°� v°� m Q �p � A �' ('�.1 ►�- O u r L wtp �Q�� U a�cQ �x�°� � Yyou► � �t � p .� ... �O°� d� �.. � °._•- sp��H 1�I �Q1 m N G m�� 'y � °' .o o �c c d v� N 7 •- � W � m c � � � � O � , �r d� b0 ti � � W N � w � +° O cn E- � 3 O G � ,O. �d '" o � C � �} lo �V., � 0 � E �`�'. Q .-� FW- � O � � '�D 11CJ � I� .� � H r � U C9 Z .o W � x in �l3�ti 1 a� �0 �U. I� W021� \ � � m � 0 a � � •.d. 0 � c � ) � �° �I � � O a � a � c t r � � R` C A ^�' � 7� 'O � H � �a a � o -� Q' d � . V ►. W C ` ac � � � .�+ � O 6¢A C O W � C �+- ,n o O � N c �E 0 W � � '� a � C,�� m z »- =� W :r �- SS:bt b00Z-S0-H3� � THE BELOW MUST 8E FILLED (N WHEN REPLACING FUEL 8Ul7NING APPtJANC�S OR THE APPLlCAT�ON VYfLI. 8E REIIJRNED � � , � • � �A�i r J�� 1 • � � ��. • : t_�- � • � i : 1 • � ! ' �1 : 7 � 1 •l� VVl�n the �cndersigne� hereby verities that the ven�irt� has t�n examirt� � is free fr�m �ust, deterbration, obstructions, ar� is Sec�r��y 5s�ppotted and fuestop�d where requited. Yes � No O The veri�ng s�rsiem � plastk/PVC and meets atl current codes and manuFac.turer \� speCi�rati�ns �tdudalg simng, length, number of elbows and tennination. Yes ( i No ( j� Tha �ur�dersigrred also veri�s th�t Iha re�tacement unit is a �sted asserr�bly and tn�is fhe cwnent aodes and ma�ufac�urers spedfications. This does ir�e AGA-GAMA Category I Cer�tral Furrtace V�ting Tables fo� fan a� artd rwhu�! dtaR appliances. The ' is sized and insfalled to meet the aurent codes ar� manut�s s�aGons. V11hen required to w�l be s�ed and mstalled fo n�eet fhe current aodes and manufadurne�s specificadons. � h�et911�in a n�uv u n4inn �S;n� �}i@ U�idPdS1g11Ed tie'f�y V�I�@S ih8i it is�a Q� assembly and meeffi t�e curren! c�es artd manufadur�s spe "�icatians. This d� ind�e AGA-GANW Category I Ccntrat Fumace Ve�ng Tables for fan assisted and nataira! draft appliances. Is the rAmmon vent and vent connedors sized and instap�d comedly aRer an appliance has been removed from the common vent and vented seFara�eiy as per a,arent codes. Y�.s No ( ) Yes ( � No � � •��\� Yes�No ( ) Yes ) No ( � Yes(.)No(;) � _ • • : / �t;- I�:� : 1 1 • .Il 11 ♦ 1 ' li . 1 1 ' I • / 11" N 1 / � 1.1f� , 1.• 1 A� #'1 Type _��c� BTU Input �d , o v b Fan Assisted or Nat,� App�ce #2 Type �,l� BTU fnput o Qo Fan Ass'sted or Nat �� ! S� �,,Q,�, r�� App�rlCe � TYpe B7U Input Fan Assisted or Nat � TO�'ilAppCte!'iCeS � Total Btu Input_i_�Oro�b , �, i Common Vent Ty�� % ,�„�,�,� Vent Height �� Diam�ter irtcFtes Ap�tce #1 Vi�rt! Conrtactor Height ft Lengtl� � ft Di�meter,�� TYpe � Ap� �02 Vent CQnnecxor HeigM ft Lertgth fl �iameter,�in Type AppGer�e �Ki Ver�t C�nnec�or Hetght ft Lertigth R Diameter in TY� e ��: �,• � l.,_ ,�.,� HEATINC3 CO: � Bv: � L0i£0'd iT6SZ86SS9 Ol ua�: �-a�-ot� .13�Q I a.� �D Al I� WD21� SS : b T b00Z-S0-H3�