AF - 46027{: �
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BUILDING PERMIT
Vi.11.age of Fridley, Minn.
Date . . �,/�� �.l. . �� . . . . . . . . . . . . . . . . . . . . . . . . .
A�.
Owner
Addr
N°
2174
. �!°��:� �!"�x": . . . . . . .�'.�.�. . . . . a�!l�. .�'"*. . . . . . . Builder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ess . . . :`s� .�"�:�?' � . . . . . .��. , .'� . �.'".'��. . .�, `�•�.+�'��"�,Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LOCATION OF BUILDING
�r � �
, 1Vo. . . .�. �!? �'� . Street . . . . :'�. . . .�E�� � ��C.�. Part of Lot . . . . . . . . . . . . . . . . . . . . . . .
�� / ,� ,,/�
`i Lvi . . f .�, . . . . .. . Block . . . . . ..�f. . . . . . . . Addition or Sub-Division .` f:� �r ��.�.�.�. .'��� . . . . . . . . . .
. � �� �
Corner Lot . .. .. .. . . . . . Inside Lot . .. . . .. ... . . 5etback �'� . .. . . .. . Sideyard �� .'.� . . . .. .. . . .. .. .. .
DES�CRIPTION OF BUILDING
To be Used as:
!
.. !.�.�+'���... Front .:'.��� . Depth �� .. . Height :�'.�.... Sq. Ft. ........ Cu. Ft. ........
��. . . . . . ,�: Front . . . . . . . . Depth . . . . . . . Height . . . . . . . . Sq. Ft. . . . . . . . . Cu. Ft. . . .
Type of Construction . } . : �;�:"��"� . Es�t. Cost . .�.':�`.�� � � .�.�. . . . . To be Completed ���. !�.���
�=� �.�'` '�'
In consideration of the'issuance to me of a permit to constxuct the building described
the proposed work in accordance with the description above set fo and in compliance �
ordinances of the village of Fridley. �� ��
.[�:.
I agree to do
provisions of
�.�.--
In consideration of the payment of a fee of $. �'�. .'r"�. ; `permit is hereby granted to . :'':J. . .' :�: . .�''s.'.�. . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . to construct the building or ad dition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and worlrnzen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
�'ridley, Minnesota regarding location, construction; alteration, maintenance, repair and moving of buildings with-
in �ihe village limits and this.�ermit may be revoked at any time upon violation of any of the provisions of said
ordinances.
� ��� ��"
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�"��.�.� Building 7nspector
NOTICE:
This permit does not cover the constru�tion, installation or alteration for'wiring, plumbing, gas heating�
sewer or water. Be sure to see the Buiiding Inspector for separate permPts for these items.
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sus�ecr PERMIT O.
City of Fridley � r 6 3 6 6
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � RECEIPT O.
� `v _____ COMMUNITY DEVELOPMENT DIV. �/'
r � � PROTECTIVE INSPECTION SEC. fil���
� , ; G V
i.--_ � ��'���,•� CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
L J � 612-571-3450 910-F15
9/3/81 � �
JOB ADDRESS
1315 Hi1l;crest Drive N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ].2 4 Moore Lake Hills SHEET
2 PROPEHTYOWNER MAILADDRESS ZIP PHONE
Thomas Marming 1315 Hillcrest Drive N.E. 571-5282
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDINa
Residenti.al
7 CLASS OF WORK
❑ NEW O ADDITION X ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof structure
8 CHANGE OF USE FROM TO
STIPULATIONS
Roof can be 2nd but not 3rd roof. Install ridged galvanized valleys.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. ASPY311t
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DA,YS, 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 CERTIFV 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 $69O �.SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. , $�.3.00
PLAN CHECK FEE TOTAL FEE
$13.50
SIGN O ►RACTORORA RIZEDAGENT tDaTE� WHEN PROPERL VALIDATED THIS IS YOUR PERMIT
� l✓l� !°� �� � d • F� � - , d ������ � �/
SIGNATU OFOWNERIIFOWM'E BUILDERI IDATEI BLDG INSP f TE
e
CITY �F FRIDLEY Effective Aug. 1, 1981
APPLICIITIO:J FOl; RCSIDEi�TIl1� QUILQIfiG PE(L`�fI?S
(tdet�r, Alter.�tions, Additions, or Repairs)
� �d �i� 1 �r;ole • -
p1•JIdER: ,`/O �f ��% i 1% [3UILDER: �
ADDRESS: I�/ �7//�Cf'��'S f �/': /I�� . ADDRESS:
TEL n10: vr7/— S� 8� TEL t�d0:
Consi;ruction Location
STI2I�T NO: STREET:
I,OT: . BLOQC : ADAITION :
Corner Lot: Insii3e Lot: SetbacY.: Sideyards:
Ap�licant attach to this form two Certificates of Slxrvey of lot and
prop�sed building location drawn on certificates to scale.
DESCRIPTI01� OF COP�STP,UCTIOPJ
� 0� Front: Depth: Height:
Square. Feet_ (�ibic Feet:
Front: Depth: Height:
Squar.e� Feet: Cubic I'eet:
C ' 4 �D. Od
Rype of Construction : Q ./ � /G s Estimated Cost: $
Rb Be Oor.�pleted:
Alt. A Alt. B
Proposed Drive��ay Width Yf New Opening Is Desired: $� $
, SE� Re^.VERSE SIDE OF SHEET .
ZRze undersigned hereby make� application for a permit for the �:�ork� herein specified,
agreeing to c3o ,all worl: ir� strict accordance r�ith the City of I'ridley Ordinances �id
rulings of �lte Department of Builc3ings, and hereby declares that all the facts and
representations stated in this application are true and correct.
D.3TE: � �/ SIGNI�TUItE :
Stipulations: �
,� � , ;� ,.�
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BUILDI1�iG PERM-IT F�E�E SCHEDi7LE
The Inspector of buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any
bxisting building or structure, or for any alteration or repairs
to any existing building or structure, upon application therefore,
require the payment by the applicant f or such permit of fees to the
amount herein below set forth and in the manner herein provided to-wit:
TOTAL VALUATION
$1.00 to $500.00
$501 tro $2, 000
$2,001 to $25,000
$25,001 to $50,000
FEES
$10.00 Minimum Fee $15.00 plus surcharge
$10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and
including $2,000
$32.50 for the first $2,000 plus $6.00 for each
additional $�,000 or fraction thereof, to and
including $25,000
$170.50 for the first $25,000 plus $4.50 for
each additional $1,000 or fraction thereof, to
and including $50,000
$50, 001 to $100, 000 $283. 00 for the fi.rst $50, 000 plus $3. 00 for
each additional $1,000 or fraction thereof, to
and including $100,000
$100,001 and up $443.00 for the first $100,000 plus $2.50 for
each additional $l,OQO or fraction thereof
PI+AN Cf�CR: 25 percent of building permit fee
DRIVEWAY DEPRESSION ESCROW: Concrete Cnrb Streets Only
Alternate "A": Re�oveal and replacement of curb and gutter only
Driveway width plus 6 feet x$13.50
Alternate "B": Reaoval and replacement of curb and gutter and install a 3 foot
wide approach with 6 inch depth
Driveway width plus 6 f eet x$15. 75
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimtmt of 24 hours froaa the time of
application to allow for proper review of the proposed structure and wf the
construction site.
A Certificate of S�zvey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with. the framing.
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� sue�ecr PERMIT NO.
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ��� f� �
f
� � RE
� • COMMUNITY DEVELOPMENT DIV.
� �y------ �
r � � PROTECTIVE INSPECTION SEC. �""�'1
� � �
� ' /"'1 � CITY HALL FRIDLE� SS432 NUMBER REV DATE PAGE Oc A O
�"'"��� ,'' 612-571-3450 910-F15 / /
JOB ADDRESS 1315 HILI,CREST DR
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
DESCR. 12, 4 MOORE LARE HILLS SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
THONIAS MANNING 1513 HILLCRESTFRIDLEY MN 55432 571-5282
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO
TAMS�S INC 1160 FIIiESIDE DR NE FRIDLEY MN 55432 784-4402
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
RESIDENTIAL
7 CLASS OF WORK
� NEW ❑ ADDITION C] ALTERATION ❑ REPAIR � MOVE � REMOVE
8 DESCRIBE WOHK
NEW GARAGE AND DECR
9 CHANGE OF USE FROM TO
STIPULATIONS
SEE NOTATIONS ON PLANS AND REVIEW SHEET(S).
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIFi CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTFiUCTION ZONING SO. FT CU. FT
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV TNAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of IAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOpK WILL BE.COMPLIED 6,793.9L 3.�iO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- ],2G.. ]S FIRE SC C).%9
S7RUCTION OR THE PERfORMANCE OF CONSTRUCTION.
PLAN CHECKFEE TOTALFEE
- 139.94
�GNATUAEOF CTOAOAAUTHOAIZEDAGENT IDATEI WHEN PfiOPERIY AL�DAT D THIS IS VO�R PERMIT
- � ��� ����� �� �
S�GNaTUAEO:OWNEAiiFpWNERBULLDERi iDAT6 8 DG �NSP qaTE
rrEw
ADl)�
°ALTER
{]
�
�)
�
�,,,,nstructionAddr�
�� �
I.egal D�.ccnpiion•. �
Effective 1/i/94
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �� 7�
� Building Permit Applicarioa
��/� �
Owner Name & Address: � a 1 � � Ll-. �,s�. �f b �..�/ , ��J � Tei. � �°i � ° � � � Z
Contractor: � �S �Z� � MN LICENSE # � �� �
Address: 1 I� o F7��S j 1� ��fL . 1� �� �Ri o�i ' 11� Tel. #%�'� -`� 2—
Attach to this application, a Certific�te of Survey of the
1ot, with the proposed consduction drawn on it to scale.
DESCRIPTiON OF IMPROVEMENT
LIVING AREA: Length Width Height �. Ft. ,� ��
GARAGE AREA: Length � I / Width � Height '%�6 �� Sq. F� '� � , x �- ,�, %�y,yc
DECK �REA: � Leagth ,�7 r Width 1c. t Hgt/Ground Sq. Ft. ^��;�� � ° Z
OTHER. �, 9, �
Corner Lot [] inside L.cst � Ft. Yd Setback Side Yard Se,d�acks / G� �e.
7�e of consauction: C,r,��,� ��, � E�.r�d cosc: $�_�9'�, �IZ
.yr�rox. Completion Date: (°/ c�- / S-�$ i .
(Cost oa Back) - �
Driveway Curb Cut Width Ne�e�d: Ft + 6 Ft = Ft x$ —�
DATE: � � APPLICANT: � Lr'� �lZ.���,,, Tel. # -�� � �� � Z
Permit Fe�
Fire Surcharge
$�tC SUtC�ge
SAC Charge
License Surcharge
Driveway Es�row
Erosion Control
Park Fe� .
Sewer Main Charge -
�rOTAL
STIPULATIONS:
� , ,
$ �
�
$ . ,�,y�
� �, 'y/D
� ��! `!- � �-
Fee Schedute on Reverse Side
.001 of Permit Valuation (illOth�)
�.'.���1,� ��U+a�IOII
� � �t $�C Ullit
$ '� s � $5.(m (Stai� Licens�l Re�dentiai Contractors)
$ Alt. "A° or Alt. "Bp Abave
� $450.00 C'onservation Plan Review
$ F� Determined by Engineering
$
$ � �%
Agr�me�rt Ne�ry [ ] Not Na�essary [ ]
QUiLD[NG PERMIT FEE SCHEDULE
�
1'he Cl�ict� I3uilding OHicial shall, t�efore issuing permits for the erectiio�'of any building or struclure,
or for any addition to any cxisting building or structure, or for any alteration or repair to any existin�►
Uuilding or structure, upon apPlication therefo�e, require �e payment by the applicant for such per�
c�f fcc.s to thc acnount hercin t�elow set ii�rtii and in the manner hereia provided to-wit:
`fOTAL VALUE
$1 to $S00
$501 to $2,000
FC�S
$t5 (Minimum Fee is $IS plus surcharge)
$15 for first $Si)p pius $2 foc each additional $ i00 or
fraction thereof, to and including $2,000 �
$2,001 to $25,OQ0 .$45 for Cust $Z,OOp plus $9 for each additioaal $1;000
. or fraction thexeof, to and iuclu�d�ng $25,000 •
$25;001 to $50,000 ' $252 for fust $25,000 ples $(.SQ for each additional $1;000
- or fraction thc�eof, to. and including $SU,000
$50,001 to $100,000 �$41450 for first $50,000 pius $4S0 for each addirional
.$1,000 or frac�ion theaeof, t,o and including $100,000
$100,401 to $500,000
$SOO,OOi to $1,000,000- .
$1,000,0p1 and up
$639.50 for 5rst �$100,OQ0 pins �$3S0 for each addifional �
$1,000 � or �adion d�eo� to and including $SUO,a00
$2Q39S0 for die first $500,000 plvs $3 for each � additional
$1,000 or fraction th�eof, to and including $1,000,000
$35395() for 1i�e 5rst $1,pQ0,ppp plus $2 for each additional
$l,OUQ or firadioa thereof -
DRIYEWAY DEPRESSION ESCROW
{Concrete G'tirb Streets On1y)
�
Altemate "A": Removal and replacement of c�u�b and gutter oflly - Driveway width plus 6 feet 6mes
� $13_SO_
Alternate "B"_ Removal and rep(acement of curb and gutt� and install a 3 foot wide
approach with 6 inch depth - Drivearay width pius 6 feet times $IS_75_
VERIFICATION OF FOUNDAT[ON
�
Permits for construction witl be issued a minimum of 24 hours from the time of app(ication to a(low
for proper rcview of the proposed stracture and of the constraction site_
A Certificate of Survey of the lot, showing the location of the founciation once it ha� it has heen�„�
constructeci will be rc;yuirect t�efore proceeding with the framing.
y �►
�,�,,'��,.
�
J.H. Dahlmeier Engineering Inc.
November 7, 1994
Tam's, Inc.
1106 Fireside Drive
Fridley, MN 55432
Attn: Oliver Tam
RE: Garage Addition
1315 Hillcrest Drive
Fridley, NIlV � � �
Commissi.on No. 94153
Gentlemen:
The purpose of this letter is to outline foundation wall and
design requirements and other structural information needed for
proposed garage construction.
�
ASSIGNMENT
J. H. Dahlmeier Engineering, Inc. has been retained by Oliver Tam
of Tam's,�Inc. to provide structural engineering design for the
foundation wall system for the proposed garage construction at
1315 Hillcrest Drive, Fridley, Minnesota.
BACKGROUND
Construction of an second attached garage to the residence at
1315 Hillcrest is being completed by Tam's, Inc., a general
contractor.
Drawings have been prepared by Tam's, Inc., including a plan of
the existing garage and garage addition with attachments to
existing house, the north side elevation and rear elevation sheet
and building section sheet including Sections AA and BB.
KCI Construction will be using cast-in-place concrete walls for
the foundation system. .
Standard drawings have been prepared by J. H. Dahlmeier
Engineering, Inc. for Manor Concrete providing standard cast-in-
��: pace concrete foundation.requirements consisting of Sheets S1,
S2, S3 and S4 dated 4/il/94.
2305 Commerce Boulevard Mound, MN 55364 612-472-4746 Fax 612-472-6103
. . i s
CTam's, Inc.
November 7, 1994
Page Two
DESIGN CONSIDERATIONS
1. The foundation will be.designed based on an allowable soil
bearing pressure of not more than 2000 PSF. This bearing
pressure is to be verified by a geotechnical engineer or
other authority. All footings to bear on virgin material.
2. Construction will consist of standard residential type,
consisting of cast-in-place concrete footings and concrete
foundation walls. The roof system of new garage will be
long span wood trusses, TGI trusses, or dimension joist
spanning the short direction (17 foot, 4��.)
3. Design loads for the deck should be a live load of 40 PSF
plus the actual dead load.
DESIGN
4. The following design is set forth for construction of the
foundation system and other construction for the garage
addition:
a. Footings to be 20"x8" with two #4 horizontal
longitudinally.
b. All new walls to be constructed in accordance with J.
H. Dahlmeier, InC. standard drawings prepared for KCI
Concrete.
c. Footings are to be stepped to match existing footings.
New footings to be doweled into existing footings with
#4 bars into existing footing 8" with 1 foot extension
into new footing. At intersection between new walls
and old walls, a 3"x3"xl/4" angle should be attached to
existing wall, with 1/2" Kwik Bolts 2 foot OC to
stabilize the new wall with respect to the existing
wall. Raked/caulked joint should be constructed at
these lo�ations.
d. All footings are to be placed on virgin material with
at least 42" of frost protection.
e. Walls must be braced adequately during and following
placement of backfill until floor system is constructed
and in place.
f. Backfill to be placed evenly on both sides of walls up
to grade.
�
� ��
y j
Tam's, Inc.
C November 7, 1994
Page Three
g. Slope final grade from garage 8" in first 10 feet.
h. Joist to be attached to plate as shown on Sheet 1, or
8-16d face nails total between trusses and plate.
i. Plywood subflooring to be nailed to trusses or joist in
accordance with code and a minimum of lOd nails 6" OC
at supports and 6" OC for intermediate frami.ng members.
j. Provide blocking as shown on Sheet S5.
5. Install a W8"x17" steel beam in new 10 foot wide opening
with top flan�e in contact with existing concrete slab.
Provide 8" of bearing each end. Set beam on concrete filled
jamb under bearing with 2000 PSI concrete and two #4. Fill
between steel beam and concrete slab with non-shrink grout
after installation.
6. It is required that this construction be observed by a
qualified building official.
If there are any questions, please do not hesitate to contact me.
Sincerely,
IER
Dahlmeier,
JFID/ms
94153
INEERING, INC.
0
I hereby certify that this plan,
specification or report was prepared
by me or under my direct supervision
and that I am a duly registered
professional engineer under�the laws
of the State of Minnesota.-
G /
Mi sota Registration No. 9212
�,.�
�
� .y � '
N�TES
1. MAXIMUM WALL LENGTH
�� WITHOUT A CONTR❑L
, JOINT = 50'-0"
2,FLO�R SYSTEM AND FLOOR
SLAB T❑ BE IN PLACE ❑R
WALL BRACED BEFORE
BACKFILLING. •
3, SPECIAL REVIEW REQ. FOR
HIGHER WALLS.
4. WALLS WITH EQUAL BACK
FILL ❑N BOTH SIDES REQUIRE
NO REINF�RCING FOR WALL
LENGTHS LESS THAN 25'
LONG AND H�RIZ�NTAL
REINF�RCING ❑NLY F❑R
WALLS L❑NGER THAN 25'
MATERIALS
CONCRETE; 3000 PSI @ 28 DAYS
AGGREGATE: FTG — 11/2" MAX
WALLS — 3/4 �� MAX
REINF�RCING: ASTM A615 GRADE 60
S�IL; 100 % GRANULAR —
EQUIVALENT FLUID PRESSURE
C'�eq ) = 35 PCF
GRANULAR & LIGHTCLAY —
EQUIVALENT FLUID PRESSURE
<'�eq ) = 45 PCF
HEAVYCLAY —
EQUIVALENT FLUID PRESSURE
<'�eq ) = 65 PCF
H = ' " HIGH LL �
< N> 8 8 1 1 8
Ye 45 4
<PC�
VER , N NONE N 2@
STL,
,�V�, 344 67 44 97
H =�'-0" HIGH WALL
CIN) 8 8 10 10 8
�eq 35 35 65
'CF)
�ERT. #4,�� #4 , N�NE E #4„
452 I 352 I 452
K C I CONSTRUCTI�N
9175 ISANTI ST. NE
BLAINE MN, 55449
FL�OR DIAPHRAGM F
TO BE NAILED FOR� B
DIAPHRAGM SHEAR,
<CAUSED BY HORIZ.
SHEAR "V"> T❑ BE
DETERMINED BY
�THERS,
2 x 6 TREATED / SI
WOOD PLATE W/ a A
MIN <2) A.B. WITH
❑NE WITHIN 12" E
EACH END N
�2 �� � x 12" A.B, 9,� � , @F
W/Cl) NUT & WASHER �
@ 32" ❑.C, �R SIMPS�N 3 ,
MA6 ANCH�R @ 32 ❑,C,
�
� �
SL�PE V �
GRADE AWAY
FROM FDN. � 8�� d �
0
L❑�R J�IST
Y OTHERS
MPS❑N A34
NCHOR W/4
D NAILS
ACH LEG
S, & F,S,
J�IST
16" D.C.
VERT,
a STEEL
<3) #4
HORIZ,
a
D
#4 X 2'-0" DOWEL I°
@ 6'-0" D.C. —�
a
497 8�� x 16°' FTG CMIN) �. o�
FTG TO BE SIZED
BASED ON S�IL
� C DITI�NS @ EACH SITE
, DETERMINED BY ❑THERS
65
�
_
—t
=2" CLR
FL�OR
SLAB
o a
6
0
° �
L DRAIN
TILE -
WALL SECTI�N
�J. H. Dahlmeier
Engineering Inc. S -1
Z306 Commerce Bonlevard 612-472-4746 4/11/94
Mound, MN 65864 Fax 612-472-6109
1
�
,.
�-�'.;' '
NOTES
1, MAXIMUM WALL LENGTH
WITH�UT A CONTROL
J�INT = SO'-0"
2,FLOOR SYSTEM AND FLOOR
SLAB T❑ BE IN PLACE ❑R
WALL BRACED BEFORE
BACKFILLING,
3, SPECIAL REVIEW REQ. FOR
HIGHER WALLS,
4. W�1LLS WITH EQUAL BACK
FILL ON B❑TH SIDES REQUIRE
N❑ REINFORCING F�R WALL
LENGTHS LESS THAN 25'
LC7NG AND H�RIZONTAL
REINFORCING CINLY FOR
WALLS LONGER THAN 25'
MATERIALS
CONCRETE � 3000 PSI @ 28 DAYS
AGGREGATE� FTG — l i/z" MAX
WALLS — 3/a �� MAX
REINFORCING� ASTM A615 GRADE 60
SOIL � 100 % GRANULAR —
EQUIVALENT FLUID PRESSURE
<Xeq ) = 35 PCF
GRANULAR & LIGHTCLAY —
EQUIVALENT FLUID PRESSURE
('�eq ) = 45 PCF
HEAVYCLAY —
EQUIVALENT FLUID PRESSURE
<'�eq ) = 65 PCF
H = ' " HIGH LL �
t 8 8 1 1 8
CIN>
Yeq 45 4
CPCf
VER N E NONE N N @
STL, 2
v 344 67 44 97
CPLF> �
H = '-0" HIGH WALL
�IN� 8 8 10 10
�eq 35 35
<PCF>
VERT. #4 � #4 N�NE
STL, 24' '
452 I 352 I 452
FL�OR DIAPHRAGM
TO BE NAILED F�R�
DIAPHRAGM SHEAR, .r— ,
CCAUSED BY HORIZ.
SHEAR " V" > T❑ BE �
DETERMINED BY
OTHERS.
2 x 6 TREATED /
W�OD PLATE W/ a
MIN <2) A.B. WITH
❑NE WITHIN 12" ���
EACH END
�2 �� � x 12" A.B. �„ j� `'�
L
W/C1) NUT & WASHER 3��
@ 32" D,C, ❑R SIMPSON �,,
MA6 ANCHOR @ 32" ❑,C.
SLOPE �
GRADE AWAY v .
FROM FDN. �
�„
;.
,�►-���. ��
497
�_
��
���
���
FL��R JOIST
BY ❑THERS
SIMPSON A34
ANCHOR W/4
SD NAILS
EACH LEG
N.S. & F.S.
�F JOIST
@ 16" O.C,
�--
/ �.
,
.
(3) �4
HORIZ.
�4 x 2'-0" D�WEL
@ 6' —0" ❑,C. —'�
�� i
° �i
VERT. �,
STEEL
e
d
_
0
e
a
8" x 16" FTG <MIN) A. ��
FTG T❑ BE SIZED
BASED ❑N SOIL ---'
C[�OdDITIONS @ EACH SITE
� DETERMINED BY ❑THERS
—t �
i
—2'� CLR ;
;
FLOOR �
SLAB �
0 o I
e _�
�/ .
�)
.
[� DRAIN
TILE
WALL SECTI�N
K C I CONSTRUCTION C09 037 J. H. Dahlmeier
�„�, �r � Engineering Inc. S - 1
9175 ISANTI ST, NE B�
BLAINE MN 55449 �� zso5 c�mmer�° Boulevn�d s�z-a7z-474s ,��1 lrqq
� JH� Mound, MN 5b364 Fax 61'1-472-610� __
. ,, �
�
NOTES
1. MAXIMUM WALL LENGTH
WITH OUT A C�NTROL
JOINT = 50'-0"
2,FLO�R SYSTEM AND FL�OR
SLAB TO BE IN PLACE �R
WAL� BRACED BEFORE
BACKFILLING.
MATERIALS
CONCRETE � 3000 PSI @ 28 DAYS
AGGREGATE: FTG - 11/2" MAX
WALL - 3/4" MAX
REINFORCING: ASTM A615 GRADE 60
K C I CONSTRUCTION
9175 ISANTI ST, NE
BLAINE MN, 55449
FL��R DIAPHRAGM
BY OTHERS
2 x 6 TREATED
WO�D PLATE W/
MIN <2) A.B. WITH
ONE WITHIN 12" ��
EACH END 9„ 3��
�,/z " � x 12" A.B.
W/Ci) NUT & WASHER
@ 48" �.C. OR SIMPS�N �
MA6 ANCH�R @ 48" ❑.C.
FL��R J�IST
BY OTHERS
5 - lOd NAILS
T� NAIL
J�IST T❑
PLATE
`
�
� �
V �
SLOPE
GRADE AWAY
FROM FDN, �
aJi ;,III.-I
�4 x 2'-0" DOWEL
@ 6'-0" O.C. —�
e
/ -�
� C2) �4
HORIZ.
d pll
�
e '
� COMPACTED
BACKFILL
d
�. •
S" x 16" FTG CMIN) �. �, O
FTG T� BE SIZED � °
BASED ON SDIL � DRAIN
C�NDITIONS @ EACH SITE TILE
& DETERMINED BY OTHERS
WALL SECTI�N
�J. H. Dahlmeier
Engineering Inc. S _ 2
230b Commerce Bonlevard 612-472-4746 q�ll/94
Monnd, MN b6364 Fax 612-472-6109
CONCRETE WALL @ REINFORCEMENT
SEE S-1 & S-2,
8" WIDE GRADE BEAM �
(MINIMUM DEPTH 24")
, � 2 #4 AT BOTTOM
EXTEND 1-0 �F GRADE BEAM
INTO HIGH WALL
CONCRETE FO�TING
COMPACTED FILL
i
/
/
!�1
/
/ 1
♦
�
/
i
CONCRETE F��TING
SEE S-1 & S-2 FOR
FDOTING AND WALL
CONSTRUCTION.
COMPACTED FILL
GRADE BEAM / STEP FOOTING
K C I C�NSTRUCTION
9175 ISANT3 ST, NE
BLAINE MN, 55449
�
�
�J. H. Dahlmeier -
Engineering Inc. S 3
23os Commerce aoutevard s12-472-474s 4/11/94
Monnd, MN 65364 Faa 612-472-6108
'. �
, ., ..
a. The Simpson A34 anchors shown on the standard drawings for
an 8-foot high wall and backfill with granular/light clay
(35 PCF) may be replaced with the equivalent of 5-10d nails
toenailed between plate and joist at each joist. It is
recommended that 3-lOd nails be installed between the joist
and the plate and 2-lOd nails be installed at each joist
between the rim joist and the sill plate. Anchor bolts can
be placed @ 48" OC or MA6 anchors @ 48" OC.
b. The Simpson A34 anchors shown on the standard drawings for a
9-foot high wall and backfill with granular/light clay (35
PCF) may be replaced with the equivalent of 8-16d nails
toenailed between the plate and joist or rim joist. For
example, 4-16d nails may be installed between the joist and
the plate and 4-16d nails installed between rim joist and
sill plate for each joist.
�
KCI CONSTRUCTION
9175 ISANTI STREET NE
BLAINE, MN 55449
COMM. N0.
g�p�7 � J. H. Dahlmeier
�►wN e�r Enginee.ring Inc. s-4
2305 Commerce Boulevard 612-072-4746 4/ 11 / 94
C�KED BY ' Mouad, MN SS364 Fax 612-472-6103
. � .'
� . I
�
9 Sd NAILS
INT� BL�CKING
,..>> .
2 x 10 BL�CK —�
2 24" �.C, IN FIRST
2 JOIST SPACES
W/4 lOd TOE
NAILS EACH END
T� J�IST SEE
STANDARD
DETAIL
FOR A.B,
GARAGE ADDITION
1315 HILLCREST DRIVE
FRIDLEY, MN
.a
ad .
/ -a
• a
�
. � d
WALL SECTI�N AT WALL
PARALLEL TO FRAMING
�
TRUSS BL�CKING SIMILAR
.
SIMPS�N A34 ANCHOR
A 16" RIM JOIST T�
PLATE AND SIMPS�N
ANCHOR NS & FS ❑F
BLOCKING AT 24" O.C.
2 x 10
RIM JOIST
2 x 6 TREATED
PI.ATE W/MIN
<2) A,B. WITH
❑NE WITHIN 12"
EACH END
SEE
STANDARD
DETAIL
FOR �,/ALL REINF�RCING
N0' J.H. Dahlmeier
� Engineering Inc.
S-5
30860 Canaty Rd 81, Suite Z14 � 11 /7/94
Maple (isove, Minnesota bb989 Faz 6I2�9&2292
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CHIMNEY AND STACK VERIFICATION
The undersign�i hereby verifi� that tke exisNng chimney or stack:
1. Has been carefully examined Yes (� j No ()
2. Is free from n�st or deterioration y� � Na ��
3. Has no foreign objectc lodged withia . Yes � No ()
4. Is securely supported = - Yes (�C}� No () .
5. Meets all cuirent Code requirements for size �.
and total BTU's conn� YeS �,Z ) rJo �)
-6 Has total h�ng BTU's of ��,; G��
� All other BTU's ' ' - � .
TOTAL BTU's
7. Has a liner t�en provided for water heater Yes (� No i)
8. Has combustion air been proylded for water h� Yes (,[� No ()
. � �l;LK�i`�� <'E�l�C�Gd,"Sm�.ClN�'� LC�����,��' �4���/�s��-
_� _� ' ' �_�_ :�� 1�i'
. HEATING CO:
Signed By;
Date:
"cil',�;'�j�—,C'r �'��d/rC�S �N�',
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�' � rn-- c�.a-°� c�.�b-`� S- ( 9 - g 7 � ,� � �. �
WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring ���� 9�
County Name
WELL AND BORING SEALING RECORD Minn'esota Unique No. H �
A�i+�7K� Minnesota Statutes, Ghapter f031 or W-series No.
(Leave btenk H irol Imown)
Township Name Toumship No. Renge No. Section No. Fraction (sm. � Ig.) Date Sealed Date Well or Boring Constructed
Fri.��.�g 119 21 �� u u� �113/9°�
Numerical SVeet Address or Fire Number and Ciry of Well or Boring Locadon
�. ��. J�.11. I C%� E' ��'. �t 3. V e Depth Before Sealing �. .� � ft. Original Depth �. �� ft.
Show exact locatlon of well or horing Sketch map of well or boring ApUIFER(S) STATIC WATER LEVEL
in sectlon grid with °X°. ` d� location, showing property Singte Aquffer ❑ MultiaquHer
��� d fines, roads, and bufldings.
N f�'� WELUBORING Measured ❑ Estimated
' � ; � Water Supply Well ❑ Monit. Well
-T- -T- -T- -l'-
❑ Ern. Bore Hole ❑ Other i� � ft. �] belaw ❑ ebove land surlece
� �
--'r- -i-- --'r- -i--
W � � E CASIN� TYPE(S)
'_�� � � �_ �
' __" _ j'_ _�_ sceel ❑ Plestic ❑ Ttle ❑ Other
' �� �
--�-- -�-- --I-- --i-- � CASINO
S ��-..�.�. Diameter Depth Set in oversize hote? Annualar space Midally grouted?
�fr- t mue� � in. from _�+ to 1��! ft, ❑ Yes $] No ❑ Yes ❑ No ❑ Unknown
PROPERTY OWNER'S NAME in. from to fl. ❑ Yes ❑ No ❑ Y� ❑ No ❑ Unlmown
�t?ID! �Sr3iia'1ii1
Properry wcrrers man�ng eaaress n aitrerent urmrwen �«�ation edaress b,d�cacea e�ve. - in. trom --Y�-- - n----- p ves ❑ No ❑ Yes -- -❑ Nu -❑ unimovm
SCREEWOPEN HOLE
Screen from 1 Z� to �� d R. Open Hola from to ft.
OBSTRUCTIONIDEBRISIFlLL
1NELL OWNER'S NAME Obstruction ❑ Detrris ❑ Flp ❑ No Obstruction
We0 mmePe me0i� addr�s tf rDtterem then properry owner's address Ir�cated ebove. Type of ObstructlonlDebrlalFfll !� �'1Z11�9 � �i �. �3t.'"Y a i3Cl W i I i:
Obstrudlon/Debris/FO! remwed? ❑ Yes ❑ No
PUMP
T,,� su�mer�il�a�
(iEOLOGiCAL 11ATERIAL COLOR ��NESS OF ��� T� Remwed ❑ Not Pre�rrt ❑ Other
FORlAATION
B not lawwn, imliwm esllmemd fortnation log hom nearby we0 or boring. ��OD USED TO SEAL ANNULAR SPACE 8E1'WEEN 2 CASIN�S, OR CASINO AND BORE.HOLE:
� � � � � � � � No Annular Spacs Ex(ts
❑ Annular space 9routed wlth tremie ptpe
❑ Cesing PerforatloNRemovel
In. from to fl. ❑ Pertoreted ❑ Rerrroved
in. from to R ❑ Perforated ❑ Removed
Type W perlorator
❑ Other
-- - - - --- -- (iROUTIN� YATERIAL(S) -- - -- -- -_
OroutlngMateNal�iSi�r�.c�3Z� � ��V � � � � ,��. �
from to ii. yards yags
hom to R yards ba9s
from to it yardy pflg�
REYARKS, SOURCE OF DATA, DIFFlCULTIES IN SEALINO UNSEALED WELLS AND BORINQS
Other unseal� well or boring on property7 ❑ Yes � No
LICENSED OFi REGISTERED CONTRACTOR CERTIFlCATION
This wetl or boring was sealed In ecxardance with Minn�ofa Ruiea. Chapter 4725. The trrtormadon cwntafned in this report fs
true to the best of my Imowiedge.
H.E.S. �iE2i I3rill�.r�� 27�?6
Conbscto� Buslness Name L(oense or Reg/sbsUa� No.
�-����� ����3��� ����� �
Authorized Representetive S/9neture � Date
�,T$II1C'.S F�e�3
LOCAL COPY H�`� �� 7� Name of Person Sesling Well or Boring
HE-0143402 � �R
sue�ecr PERMI
City of Fridley �, � ,A:
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �° �� 3'� �
r �
� �
COMMUNITY DEVELOPMENT DIV.
r � v � PROTECTIVE INSPECTION SEC. ��' 3
� �
� _ � �
� /"'1 � CITY NALL FRIDLE� SS432 NUMBER REV- DATE PAGE OF APPROVEO BV
�""�'� �'' 612-571-3450 910-F15 6/4/97 � �
108 ADDRESS 1315 Hillcrest Dr NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 12 4 Moore Lake Hills SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Thomas Manning 1315 Hillcrest Drive NE 571-5282
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Midwest Siding & Roofing 18979 Gladstone Blvd, Maple Grove MN 55311
4 ARCHITECT OR DESIGNER MAIL ADDf;ESS ZIP PHONE LICENSE NO.
416-4804 20010277
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION C� FiEPAIR ❑ MOVE ❑ 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.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEAT�NG, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR Alq 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
ANV TIME AFTER WOFiK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND OHDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED � 1� 98O �. 99
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $62.25 Fire SC �1.98
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TAL FEE
�,� �f � L1 � � � � License C $ .00 $70.22
SIGNATUAEOFCON'FACTOROAAUTHOAIZEDAGENT �DATEi E Pq LY VALID ED THIS IS VOUR PERMIT
�
SiGNATUAE OF OWNEA ��F OWNEA BU4DEA� iDATEi r°Bl G�NSP ��tiTE
NEW [ ]
ADDN [ ]
ALTER [ ]
ConstructionAddress:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
3�
Effective 1/1/97
a�i3
Owner Name & Address: r 1 l� (1 n � Tel. #` '�J ��`- 5� a-
Contractor: S� � MN LICENSE # a� 1(� �-� �
Address: �,� cj�C•� (-����� Q � ��/�.� Tel. # L-(�(.�? �-1�,.�(� �
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IlVIPROVEMENT
�ng� �VVidth Height Sq. Ft.
I.ength Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Construction Type: ��(',`,1� p� �O l� v � / l'� �,
Je.,. Estimated Cost: $ `-t � �Jb %, �.�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � l � � `� � APPLICANT: � J�Q l Tel- # � � � � �I fC d
�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Fscrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS: •
$ �-�. ��
� / �`
$ � ��
$
$ � . L''C ��
$
$
$
$
$ � � .,� �-
CITY USE ONLY
Fee Schedule on Reveise Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,0� Valuation
$950 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 [ ]
_t --
(�UI[,UiNG PERM["I' HEE SCHLD[;t,l:
"1'he Chief Building Ofticial shall, before issuin� permits for the erection c�f any building or structure, or f��r
any addition to any eaisting building or structure, or for any atteration or repair to any existing buildin� or
structure, upon application tlterefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit: �
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100, 001 to $500, 000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $1(}0 or
fraction thereof, to and including $2,(�0
$62.25 for first $2,0� plus $12.50 for each additional $1,0�
or fraction thereof, to and including $25,OQ0
$349.75 for first $25,� plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $SO,OQO plus $6:25 for each additional
$1, 000 or fraction thereof, to and including $1 �,000
$887.25 for first $100,� plus $5.00 for each additional
$1,DOO�or fraction ther�f, _to and including $5�,(�(}U
$2887.25 for the fust $5�,�0 plus $q.,25 for each additional
$1,OU0 or fraction thereof, to and including $1,�;�0
$5012.25 for the first $1,(�J0,0� plus $2.75 for each. additional
$1,000 or fraction thereof
�
�
DRIVEWAY DEPRESSION ESCROW ��
(Concrete Curb Streets Only) �
�Iternate "�": Removal and replacement of curb and gutter only - Drivetvay width plus 6 feet times $13.�0.
-�Iternate "B": Removai and replacement of curb and gutter and install a 3 foot vc�de
approach with 6 inch depth - Driveway width plus 6 feet times $15.75. 9
VERIFICATION OF FOUNDATION
'.'crmits for construction wil( be issued a minimum of 24 hours from the time of application to allow for pro��z��
-eview of the proposed structure and of the construction site.
1 Certificate of Survey of' tlie lot, showing the location of ihe foundation �irice it has it }�as :heen c�nstruc°:�,.i
•.'i;! h� rcyuircd hcfc�rc ��r��cccditi� ���ith ti�c framin��.
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COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When renlacina an existina 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 manufactu�er
specifications including sizing, length, number of elbows and termination.
The undersigned also verifies that the replacement unit is a listed assembly
and meets the cuRent codes and ma�ufacturers specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existing combustion air is sized and installed to meet the cuRent codes
and manufacturer's specifications.
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufa�turers specifications.
Yes (� No (
Yes � No ( )
Yes`� No ( )
I"
Yes`(/) No ( )
1�
When installina a new ventina system, the undersigr�ed hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Fumace
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 ()
Apaliance Tvae and Size/Common 1Yent and Vent Connector Information
Appliance #1 Type f1 BTU Input � Fan 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
Y� 1' � �' �,
oC�mmon Ven�t Typ 1� ��`�� Vent Height Diameter inches
ApRlia�ce #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 ����
oLTER�!►TIC)NS� /l�psr_�ih�l �/ �,�� � 9, .��� � � � _ ���
_"`� ��J ��
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HEATING CO: � r \
Signed By: ` � Date : @ I� �,(iC�
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THE 6ELOiN MUST BE FlLLED W V1�1 R�LACING Fl1EL �URNING APPLIANCES E3R THE
APPL�CATION WILL BE A�ETURNED
..��e wwu'► I�nllllRl iCT1�N
�`f'f(L�11AA1►1 �_j� ♦�wR f`AIUR�a� ■. ,
�� the undersigned hereby verifies that the
Ve�9 ��. �e� exammed and is free from est, det� tion� obstrudions, Y� �� No ()
and is securely sup�rted and firestopped wh re req
The venting system is plastic�PVC artd meets all current c�des and manufacb�rer
speatications induding s�ir►9� len9th. �un►ber of elbows and tertnination. Yes (► No O
The undersigned also verifies that the replacement unit is a listed assembly
artd meets the currertt cod o�Cen uF� c.re Ventin9 bles fo' f n�s
i n d u de AGA-GAMA Cate9 rY Y e s () f V o i)
a�ssisted and natural draft appliances.
rne is sizzed and instafled to meet the anrent codes Y� t? No �)
and:rt�anufadurers specfications.
yVh� r�equir+ed to ' wll be sized and installed
to meet the current cades and manufa�rs spe�cfic�tions. Yes () No ()
When � the undersigned hereby verifies that
it is a listed assembly and meets the cx�ment c�des and manufadurers
s�ons. This d�s indude AGA-GAMA Cate9crY 8 Ce�tral Fumace Yes () No ()
Ver�irtg Tables for fan assisted and natural dcaft appliances- . _
Is the common vent and vent connedors.sized and instaped coRectlY after
an eppfiance has �en removed from the common vent and vented Yes () No ()
separate{y as per cx�rrerrt codes.
r....e T..� -+ Sb�/t'nmmnn �pr�t and V nt Cnnn�►c+er Infermati�n
��._, -
Aapliance #1 Type BTU Input � F� A�� or Nat �
App�ance #2 Type BTU Input � Fan Assisted or Nat
App� #3 Type _ BTU Input � Fan Assisted or Nat _______
Total Applianr�es _______ Total Btu Input ,.. -
Common Vent Type Vent Height _ Diameter _����
App�an� #1 Ver�t Conn�tor Height _ ft Length ,�_ ft Diameter ___.__in TYPe -
qppliaance #2 Verrt Connector H�gM ___. ft Length ___. ft Diameter _in Type -
qppGance #3 Verrt Connedor Height _ ft Length ft Diameter _____ �n Type _
t�: i • � i..� a .,-
HEATING CO: .
�� �. Date :
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