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AF - 47197`Cit of Fridle , Minn. � Y Y BIJILDING PERMIT �o � � Date: ......../ .................�......_�-.--... .......--�- �--....--�--....._............._................. 4383 Owner: ..... � ...................... � ........... - .....................---._..-----...................... ...... Builder .--. ����'.:....�-- /�_.......---.. .. ...._............._....---�--..._........ Address................ Address ......................_............ .........:....---..........................---........_......._......._......----•---.. � %�� fI � LOCATIO OF ILDING No. -��-`'.�"'y.. Street ... -... .... ...... - .._...- ...���/ZZ��p ............. Part f Lot ................ - ��--�--�--�-�- ............. ...........--�------ ... _. Lot -......../. �._ ... Block -......�..........._ ............._._. Addition or Sub-Division �%....��aUp..........��..�.'./.�'��. .i / f ) Corner Lot ..._..._ .......................... Inside Lot ..._.Ji_......---- _... ...... Setback .�`.�� ---........... `�<� .............. Sideyard .��_'.'.._a...- ....._.....- ..__......... Sewer Elevation To be Used as: � � . . .__. ....._.. -.... �.u.�� C���� -�... Type of Construction Foundation Elevation DESCRIPTION OF BUILDING ,l" O � �O '� Hei ht ��—� S �Q'3-7 , p �j Front -- -......-----_._! Depth ...._---_._...- g --....._._......._ Sq. Ft. .......--------°S Cu. Ft. .�.,r.....�_� e7 Front .�Q...`.~O�Depth •3.�_'�� Height _�� �D Sq. Ft. ..X.../..�_ Cu. Ft. ...Y9.66 _.........__.._.. _ ................__....... Est. Cost__.,/ �.../ lJ....�_:..."_'_" 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 wark in accordance with the description above set fort � and in comp ce with all pro�visions of ordinances of the city of Fridley. ��� �� ��^ In consideration of the payment of a fee of $_!�iJ......._........., permit is hereby granted to_ ..........................._........lL.._......._....... ....._..._ ......................................._...................... to construct the building or addition as described above. This pernut is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in ail work done in, around and upon said building, or any part thereof, shall cox�form in all respects to the ordinances of Fridley, Minnesota regarding location, canstruction, alteration, maintenance, repair and moving of buildings within the city limits and this pexmit may be revoked at any time upon violation of any of the provisions of said ordinances. .��1!�� ..............�.........?2��---------� -... Building Inspector NOTICE: This permit does not cover fhe wnsfruetion, installafion for wiring, plumbing, gas heafing, sewer or water. Be sure to ses the Building Inspector for separafe permits for fhese items. 4 Cifiy of Fridley App�ic�rtian for P'h�mbing and Gas Fitting Perm�t Dept. of Bldgs. Phone SU 4-7470 _ DESCRIPTION OF WORK � t�' � J i/�r�� Number, Kind and Location of Fixtures Locatioa _� � � Z W,� �= z � x} zz `a2 �� cT3Z Os j C� w <� � <� � z �� �p � �� ~7 5�i �a `�Z< `2a �i 7 O f� m VI 3 F- � LL N LL � S m � 3 C� � CJ 6' U� O Base �� V � �� 1 lst ( � 2nd _ 3rd 4th _ _ • Fuiure Conaectioa Openings� * New Fixfure, Old Openfngs PARTIAL RATE SCHEDULE WATER HTR. • M R N GAS ELEC. Sewer � Ceaspool n PLUMBING FIXTURE RATES: NO. RATE TOTAL Number F`ixtures . . . . . . . . . . . . .. . . . . .. . . � x $1.50 $ 0 D Future Fixture Opening . . . . . . . . . . . . . . . . � x 1.20 $ �. � o New Fixture Old Opening . . . . . . . . . . . . . . x 1.00 $ Catch Basin ...... ..................... x 3.25 $ Water Heater (Up to 200,000 BTU� ......�� x 2.00 $ � � Q New Ground Run Old Bldg. . . . . . . . . . . . . x 3.25 $ GAS F'ITTING FEE3: . NO. RATE TOTAL lst 3 Fixtures .. ....... x $1.50 $ , ................ Additional Fixtures . . . . . . . . . . . . . . . . . . . . x .50 $ Gas Bange to 200,000 BTU . .. . . . ... .. . .. x 2.00 � REPAIR3 & ALTERATIONS—Refer to Code Description ....... .....................$ . . . . . . . . . . . . . . . . . . . . TOTAL FEE $ � � � L City of Fridley: �a +� � � The undersigned hereby makes application 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 the facts ' and representations stated in this application are true and correct. Fridley, 1Vlinn � � , 19 � c' ` . ; Owner � � ��`� Kind of Building � –1-- � � Used as To be completed about Estimated Cost, �el--New. Building Permit No '7` '~3 � Permit ''��1 : � Signe l..G By cw�x Business Phone ROUC3H �PR 2 '� 1960 �. � . FINAL a z 2M 7-89 s` �� y�,�LJ ./y AppRcation I�or'owtr !'1a�1� and H�rtisg. Cooli�. Yentila�ioe� Rftrig�rafion a�d Air Condi�OniAg SYstwns and D�vic�s PARTIAL RATE SCHEDULE filIAVTTT WARM AIR: !l11TE TOTAL lh�rnace 3he11 d� Duct Work . . . . . . . . . . . . . . . . . . =10.00 � Replacement oi P1�rnsce . . . . . . . . . . . . . . . . . 6.00 � Repairs d� Alterations—vp to =500.00 6.pp s -- --_— Repairs d� Alterations each add. :500.00 . 3.W �__._ MZCH. WAlq�f AIA 1�lunsce Shell dc D�ct Woric to 1l0,000 HT[T . . . . . . . . . . 510.00 �_ each �d. Q0,000 BTU ............. ....... .. 3.W i �PLcement of 1+1�rnace . . . . . . . . . . . . . 6.00 � Repairs dt Alterations--up to ;500.00 .... 6.00 � Repairs dt Alterations each add. :500.00 .. S.pp : STEJ►D� or HOT WATEA SY3TEM FLrnace She�l dc Lines—to 400 sq, tt. l:DR Steem �10.00 a. �trnace Shell & Lin�-to 640 sq, ft. EDR Flot Watrr 20.00 :_ Each add. 200 sq. ft. EDR Steam S.(1(► ____ .__-- Each add. 320 sq. it. EDR Hot Water g,pp ;_ OIL BIIRIQER—to 3 gal, per hour g,pp = _ over 3 gal. per hour�ee Fee 3chedule GAS BIIRIfEA (up to 199,000 BTU) . . . . . . . . . . . . 6.00 = ove! 199.000 BT[I SK FN seMdul� G118 FITTING FEEB: 110 RATE TOTAL lst 3 FSxtures . .. .. xi 200 S Additional li�rttuea .. ; ,� _ Gas Rangie to 199.00Q .. � b 0� � �►rn co�arriosnta —�G��a L� � fD � °�� Pl1l� HHA7il�G 3TS?EM � !» fc�WoM v�►rua s�rsraM � ALTEAATiOIts t AEPJLIAi 1'OT>L �ii � ROiJOH . • • s� �. � 8�.- rj►�. aeo.�so � / / / // o �� � �� ,, � CitY o� F�idley: v The undersigaed hereby mahes appHcation for a permit !or the worlE :hereir specified, agreein� to do a11 work in strict accordance with the City Ordinance: and ruling of the Department ot Buildin�s, and hereby declares that aIl the lacts and representations stated in this application are true and oorrect. Owner Kind of Building ._ I,L.Q„/_7�J Used as _ _--- - ___ � . _ __�,�%_J To be completed about __._ __��=..1 � ' ! � Estimat Cost, a-_--.----. _-_ ��� . DQ !�d -New. Building Permit No. — P�rmit No._ �J /� I I Trade Nam - g� lde_T`� lo e2. ' d� s �Y �4-� BTU y3 Hp Total Connected Lwd �� pt � �. �w �%D'�_� /� 5� / ' (�tMI�RKf�OYER) -, _ .l / // ��� � ���� � � -_ I , /� � _� . i � r . , � � � / / sue�ecr P N City of Fridley 15 7 0 8 ATTHETOPOFTHETWINS gUILDING PERMIT � r ; � RECEIPT N . ' COMMUNITY DEVELOPMENT DIV. +� ' j y__—.�_— l rt� r � � PROTECTIVE INSPECTION SEC. 1 � , � � � � /�'�L CITY HALL FRIDIEY 55432 NUMBER REV. DATE PAGE OF APPROVED 8V �'----� • •�� 612-571-3450 910-F15 / / 5/ 7/80 JOB ADDRESS 6967 Hi.ckory Circle N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ].9 1 Ostman's 3rd Acldition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Charles Swanson 6967 Hickory Circle N.E. 571-8933 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Professi.ona.l Roofing Service 7257 Yucca Lane 425-8233 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE UCENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO. 6 USE OF BUILDING Residnetial 7 CLASS OF WORK ❑ NEW ❑ ADDITION [� ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Reroof Dwellin 9 CHANGE OF USE FROM TO STIPULATIONS g�g can be 2nd but not 3rd roof. Insta.11. ri.dged galvanized valleys. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING Ofi AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID If WORK OR CONS7FiUCTION ZONING SO. FT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONS7RUCTION 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 fiEAO AND EXAMINED THIS APPLICATION �- STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VAIUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $li 2OO $. E)O 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 TH PERF MANCE OF CONS RUCTION. �9.00 PLAN CHECK FEE TOTAL FEE �` $9. 60 I NATUREOFC N'RA TO RAUTHOR DAGENT IDATE� WHEN PROPERLY L///I���DATED T IS IS YOUR PEF±MIT t . . �" \�y^�V l9�� � �� V -_SiGNATUREOFO�NNERIIFOWNERBU�lDER1 IDATEI � BLDG iNSP � �ATE CITY OF FRIDLEY ARPLIC/1TION FOR RESIDENTII�L [3UILDIP, � (fdew, Alter�i:ions, Additions, or �, OWfdER: �� Q� l,c al `LZ�...dv,�-- BUI LDER : ADDRESS: i `� ` ' AQDRESS: TEL N0: � 7/ -��3 TEL M0: Construction Location • STRF'�T NO :`�Q��,�� STREET: � r Ci � r . ' i- / 1 G' BLOCK: l ADDITION: � • LOT: � g -. Corner Lot: Inside Lot: Setback: Sideyards: Applican� attach to this form two Certificates of Survey of lo t and proposed building location drawn on certificates to scale. DESCRIP7I0f� OF CONSTRUCTION � Front: Depth: Height: Squa�e. Feet: Cxibic Feet: Front: Depth: Height: Square• Feet: Cubic Feet: �P 00 Type of Construction : j� �- jr'O-t� Estimated Cost: $����— 7.b Be �mpleted: �_g�` � Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $� $ ' , SEE REVERSE SIDE OF SHEET . 7.�e undersigned hereby makes application for a permit for the work herein specified, agreeing to dp all work in strict.accordance with the City of Fridley Ordiiiances and rulinqs of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true an d correct. � � DATE: ''2-a � SIGNATUitE: � • • Stipulations: . � �o� < <o� _9� � � . � . -� - sue�ecT N . City of Fridley 25892 AT THE TOP OF TME TWINS g � I L D I N G P E R M I T � ` RECEIPT NO. � � COMMUNITY DEVELOPMENT DIV. r � � � PROTECTIVE INSPECTION SEC. j � � l��� i � � , t /"'1 � CITY HALL FRIDLE� 55432 NUMBER REV OATE PAGE OF APPROVEO BY �.__.1`: '•� 612-571-3450 910-F15 4/2/98 � / JOB ADDRESS 6967 Hickory Circle NE t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 19 1 Ostman's 3rd Addition SHEET 2 PROPERTY OWNEFi MAIL ADDRESS IIP PNONE Chuck Swanson 6967 Hickory Circle NE 571-8933 3 CONTRACTOR MAIL ADDRESS ZIP PMONE UCENSE NO. Up Top 2737 111 Ave NW, Coon Rapids, MN 55433 422-8785 7712 4 ARCHITECT OR DESIGNER MAIL ADDFiESS IIP PHONE LICENSE NO. 5 ENGINEER MAII AODRESS ZIP PHOP1f LICENSE NO. 6 USE OF BUILDING Residential 7 CIASS OF WOqK O NEW ❑ ADDITION ❑ ALTERATION C� REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof House (24 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIQNING. THIS PEfiM1T BECOMES NULI AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 OAYS, OR IF CONSTRUC�ION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCEO. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CENTIFV THAT 1 HAVE REAO AND EXAMINEO THIS APPLICATION 1 STA��S GARAGES AND KNOW THE SAME TO BE TRUE AND CORpECT. ALL PROVISIONS OF LAWS VAIUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK Wl�l, BE COMPLfED WITH WHETHER SPECIfIED HEREIN OR NOT. THE GRANTING OF A PERMIT �2sOO1 �I.00 DOES N E T GIVE AUTHORITV TO YIOIATE OR CANCEL TH£ pERMIT FEE SAC CNARGE PROVI ONS F AN T R STATE OR LOCAL LAW REGULATING CON- STR TIO R T PE C OF CONSTRUCTION. �%�F.%S Fire SC �L.00 PLAN CHECK FEE TO L FEE f �% c��,�'� Lice C$5. $82. 75 S� AT O CON'RACTOAO AUTHOAIZEDAGENi IOATFt� E Q VAU T THIS IS Y UR PERMI • �� r SiGNATUFlE OF OWNER UF OWNEA BUILDEAi iOATE� DG �HS� - ���TE NEW ADDN ALTER �l �] [l ConstructionAddress: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1 / 1 /98 `�� y �� �` / � ...�--. ' ' ' � Legal Description: /� ��� Owner Name & Address: ��v�K Si�.��So�✓ _ Tel. �t �7/— �9�� Contractor: �//' � MN LICENSE # 7 % / � Address: _ � �7 � �7 /// !�'� ��' ^ �.,., , �%�.,, �-� Tel. # �aa ���s LIVING AREA: GARAGE AREA: DECK AREA: OT�iER: Attach to this application, a Certi�cate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Length Width Height Length Width Hgt/Ground .��5�. ��-�� Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: � ao Estimated Cost: $ �� ° �Oc� / (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = F $ _$ DATE: •o�� APPLICANT: Tel. � �aa -�7.P f" CITY USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ , �� $ o�. 0 6 � 1.�� $ $ S. ov $ $ $ $ $ . '�f� Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.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 [ J ..� . . � CITY OF FRIDLEY 1NSPECTION DIV. 6431 University Ave NE Fridiey, MN 55432 572-3604 Stories Basement Floor 1 Floor 2 Fioor 3 Floor 4 PLUMBING FIXTURE RATES: � Effective On Jan 1, 2000 APPLICATION FORPLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR a,:::: :>::::::>;:::«:::«< :.::;,;;:�.;:>:<:.:>::»:<: ; ��;.;: ::;: :.::»�:»:: : :: �::;.:::::>::::>:<:>::> :�<r�:;:<:::_>;:;: Wash �t�c:::::;::=>:=>:: Floor �#�f>::�::>:: Auto. - :.:;-: . �;;>;;:::;;:::: Gas ��::::>:::>::::: Water Heater h :> S ow er r Ta �:���:::<:> -�� Drain ::� Wash :.�: :.::::.� ::::::.::::.:. :::.,.::::.�:::.. -: _ .................. :�:::::.-:.�>:::.;::.: .>:<.: ..::.::::..:.. ---- --� :..:.:::::: ...,:._: . .. ....... :....:: :.. . ...... ... :;::..: >;> � �:,;;;;.: _ �: : ....... .. ..... ..... . ::::; ::.::........... �..< ....:... ��:::��:>::::::<:- -��r�:,;:.::.: er ��,«::,;::><. Range �'�ct::>::`:::::>::>:: Gas Elec NO. RATE New Fixtures Old Opening, New Fixture : Beer Dispenser Blow Off Basin � Catch Basin Rain Water Leader SumplReceiving. Tank Water Treating Appliance Water Heater -Electric Wate� Heater - Gas*' �_ Gas Range"' Gas Dryer*' Back Ftow Preventer Required ()Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture orAppliance State Surcharge TOTAL FEE l�al�'1 � �4 t�o �r,�;�,�, TOTAL JOB ADDRESS `.�IK� �"s Qu3��� 0 $ —��- _'�'� The undersigned hereby makes app{ication for a permit for the work he�ein specified agreeing to do atl work in strict accordance with the city codes and rulings of the Q,uilding Divisi�n, and hereby declares that all the facts and representations stated in this application are true and correct. Owner �/ � � /�� , 20 � Building Used As �'E�\�%N C� —�-�- --- �.� �-�C� � Estimated Cost PERMIT NO. PLUMBING COMPANY �I�C�L�I� �LU/✓jCal/l�(, ( �} SIGNED BY TEL NO.��Z"S�I'�O �� , Approved By _� Rough-In Date Final Dat �i \ v ���- �_ MINIMUM FEE FOR ANY PLUMBINC��eS vFaiuir �S S20 00 PLUS THE 5.50 STATE SURCHARCF COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE ^ITY OF �RIDLEY BUILDING 1NSPECTION v 9 5431 University Ave fdE 9 =ridley, MN 55432 L 763-572-3604 FAX 763-575-1287 9 ��lol� D n RATE SCHEDULE Residential Furnace Shell and Duct Work, eurner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) � Gas Range Gas Dryer ...� � , �lX'j��C�/��'� �•��- Effective 4/1/2004 APPLICATlON FOR POWER PLANTS AND HEATING, COOUNG, VENTILATfON REFRfGERATIOi� A�1D AIR CQNDITIONI�S� SYSSEMS AND DEVICES � $35.00 $, $10.00 $. $10.00 $ $10.00 $ *Air Cflnditioning-All Siz�s $25.00 �1 � �� v'P�mC - C� a� a"� All ather Repairs ar Afterations (List on Back) } 1% of Value of Appliance or Work a Minimum Fee $15.00 for Residential or 5% of cost of Y Improvement whichever is greater on work less than $300.00 i � CQmmercial�lndustria�/Institutional ?" 1.2596 of Value of Appliance or Work (List on Back) � Minimum Fee $35.00 for Commerciaijindusiriaijictisiitutiona� � Y � State Surcharge TOTAI.FEE 10BADDRESS � e�i �n� �i0 �Co,r n � c . �i� , �' ��r�e Owner 5 ��f'IcSC��I $�� C�O $ � $ •50 , � $ o25,SC� v � REINSPECTION FEE $50.00/NOUR @*Air Conditioners can not be placed in side yard w(thout �vritten approval N from adjoining property owner - o�py to City N N '� FILL 4UT BACK SIDE FOR STACK VERIFICATION ON REPIACEMENT F'URNACE ¢ Building Used Its � ES i� E n e ESTfMAT�O COST � oZ l06 •�O PERMIT (30 �ESCRIPTION OF FURNACE AND BURNER R of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR Fuel Totat Connected Load Bumer 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 stri�t aocordance with the City Codes and rulings of the Bw'iding Division, and hereby declares that all the facts ar!c! repr8sentations srated in this application are tn�e and correct. CENTERPOINT ENERGY HEATING GO 13562 C�NTRAL AVE NE BLAINE, MN 55304 Signe� �,�� �" �"\ \� 7el # 763-757-6202 FAX �l 763-757-6701 Date �" at�"�� Approved by Rough-in Date Final Date C@ " d �C101 FILL IN COMPLETELY FOR REPLACEMENT FUEL BURN(NG APPLIANGE PERMITS COMM�N VENT VENT CONNECTOR AND COMBUSTI�N AIR VERIFICATION When replacin� an existinq furnace, the undersigned hereby verifies tl�at the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes (� No O The venting system is plasticJPVC and meets afl 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 specifcations. This do�s include AGA-GAMA Category I Central �urnace Venting Tables for fan assisted and natural draft appliances. The existinq combustion air is sized and instalied to meet the current r.odes and manufacturefs specifications. When required to install a new combustion air it will be sized and installed to meet the current codes and manufacturer's spec�cations. Yes ( �l No ( ) Yes ( � Yes � ) When installina a new veniina svstem, the undersigr+ed hereby veri��:s that it is a listed assembly and me.ets the current codes and manufacturer's speci�cations. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes (� Is the common vent and vent connector� sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes �) Appliance Tvpe and Size/Common Vent and Vent Cunnector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan flssisted or Nat Appliance #3 Type BTU lnput Fan fissisted or Nat Toial Appliances Tatal Btu tnput Common Vent Type Vent Height Diarneter 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 ALTERATIDNS• (Describe) Na ( ) No ( ) No ( ) No ( ) CENTERPOINT ENERGY HEATING CO: 13562 CENTRAL AVE NE BLAINE, MN 55304 _ Signed By: �� �'°� - �-�, Date �Gi/�Gi' �I TAJ,9J.SL Ol J.3"1Q 1�I� �0 1,11 � WO?1-1 S� :'[ Z b�JOZ-L�-�1dH -