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AF - 44915� T a� � � Q O � .� w , . � O Y � ? . �-.. z o. U a �� 2 Z a �a� p .� � ��� o � �. � m ���� U LL. �n v l!a ii� � w 0Q ¢ 0 -� Q O � ¢ a� 0 � C � � � � v � � � � m U � � � m �q� o �„ � ,C U �° t '" � €��°� m U � � Q � � � � .� � � � � � � � � � � o�.�'° ���� .� � � �'� o c�n � � � s � � o c E R �� �.ocm . � � � � �, � o m = :�1 � � � O .. a� �- o � ���� a '� � � a`•�2� ���� � I i r � _ , _� �U � G � � � m a m � �� r � a U � � N w � 0 � � � { � Z J[�,� F- � � � 1 \. r ° ='+ ui � � W � Z � Q .... ttt � � � ��Q � C� m � � � � � D � � � ?, a � � � Z N •�C � J �O U � m c� � m W m 3 � a a �n �' O � r Sg$$Sggg$g�� � r:�au�nrer.n:flr.aco eo tn � v� v� ��r �r vt v�.� a> a� � as 0 �Q ��Lll{�1�lll�zl W a � �_ , . ,. �... : . . ,. .. •. ... Q ..gl - � � a ac it! � � � z � � � d � � � �C � _ _ _ .., �. ��� _ � � g °C � .� + °� � � � � � � � 3 mh,�-�� c �O o 2�- � � c�, ui � > � Q a� � � m � G •y C � �� +'' +a. .3 1*i �c d � � �c1i ���.�'���m����� ;..W� ��o'����.ct 2z � �'° a �,� ° o �°.� ,��, �,�acoY � �o� ,�V„ C �.. �.. � . J �Uott,roLit`�cc�n���c7c�m aa r 4 F- � � � � O� � � ~ 0 u � � a � � �a o ty w ;� ti N� }"� ' � � � S� � � �� a 0 w � ¢ a �� �� m � ��� ��r v : 0•. <.� . � Q � m . o � � � � � U # NEW ADDN ALTER [) �� �� CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application � constivctionAddress: ��.5% /�/-����� �,� Legal Descrip6on: Owner Name & Address: /W ,,,r CiT� / w,v i,,lo�,�1 Tel. # A �Odh'8Ci0I' Aadress: �"z a s-- `1'i. MN LICENSE # �6�y� Attach to this application, a Certificate of Survey of t�e lot, with the� proposed construction drawn on it to sscaale. DESCRIPTION OF IMPROVEMENT Cff-ective 8/ 1 /95 -���a Tel. # SS'I'- S�Dl� � LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length �dth Hgt/Ground Sq. Ft. OTHER: /1�F� G���_'� ,�l "�-�'L.4G�" _ Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard S�a.cks 'Type of Coastniction: E�imat,ed Cest: $ /�C� � _ ,l�pprox. Completion Date: (Cost on Back) �riveway Curb G�t Width Needed: Ft. + Ft = Ft x$ _$ DATE: _ APPLICANT: �- i� 1� � Lc,U1� �-�..� Tel. #_� s q_ S� d Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge flriveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATI4NS: $ � 75 $ /. a v $ •Sa $ $ �; a v $ $ $ $ $ /� � CITY USE ONLY' Fee Schedule on Reverse Side .001 of Permit Valuation (1/i(�h%) $.SO/51,000 Valuation $850 per SAC Unit $5.00 (State Licensed Re.sidential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Nece,csary [ ] Not Necessary [ ) �, _ _ �. sue�ecT P • City of Fridley � � � � AT THE TOP OF THE TWINS B U I L D I N G P E R M I T r � � , � RECE�PT NO. � • COMMUNITY DEVELOPMENT DIV. � � LV_�����', r � � PROTECTtVE INSPECTION SEC. , � �'��1 � CITY HALL FRIDLEv 55432 � NUMBER AEV OATE PAGE OF APPROVED B� �""'�'� �'' 612-57 t-3450 910-F15 1/ 16/96 / / JOB ADDRESS 1057 Fillmore Circle NE t LEGAI LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 1 Hillwind Townhouses SHEET 2 PROPERTY OWNER MAIL ADDRESS IIP PHONE Twin Cit Townhomes 3 CONTRACTOR MAIL ADDRESS Z�F PHONE LICENSE NO Midwest Fire lace 2 H 6 P1 h 4 2 559-5900 2359 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDHESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Resid ntial 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE X 8 DESCRIBE WOFK Install wood burnin fire lace 9 CHANGE OF USE FROM TO STIPULATIONS Install per testing agency's specifications. TVPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD SEPARATE PERMITS ARE REOUIRED FOR EIECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONOITIONING. THI5 PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. 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 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STA��S GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. A�L PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO @ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �ifOOO W.SO 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- �34. %S Fire SC � 1.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK fEE TOTAL FEE License SC $5.00 $41.25 S�GNATUFlEOFCON�RACTOROAAUTH0�7�ZEDAGENT IDATE� WHEN PfiOPER VALIDATEO THIS IS VOUR PERMIT _ � (,.(/v � � ( � -/ � SiGNaTURE OF OWNER�iF OWNER OUiLDERi IDAiEi .�♦ BL G�NSP � q41E � r�w ADDN ALTER [l [l IJ Construction Addrecs: � Legal Description: Owner Name & Address: Contractor: ' Address: la�.{ 1�-Lt CiTY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-Z Buitding Permit Applica6on � �� Effective 1/i/94 �a5 � 20--�1�4 Tel. � `�'� MN LICENSE # �('��ol ��J �� �`il � Tel. # �.��% �?-f4� Atzach to this a�fplicat�on, a Certificate of Survey of the lot, with the proposed constructicm drawn on it to scale. Q� � DESCRIPTION OF IMPROVEMENT �IC �`� � � LIVING AREA: Length GARAGE AREA: Length DEGK AREA: Length OTI�ER: Width Width w�a�n Height Sq. �`t. Height Sq. Ft. Hgt/Ground Sq. Ft. Corner Lot [) Inside Lot [] Ft. Yd Setback Side Yard SetbaCks ,�„ Type of ConsEruction: Estimated Cost: $ ���D� Approa. Completion Da : —/s '' (Cost on Back) Driveway Curb G�t Width Needed: Ft. + 6 Ft — Ft a$� —$ DATE: -� � APPLICANT: /%% Tel. #�C� %�%�l1 , CITY USE ONLY. , `. Permit Fe� '., , $_���1�,,,�`'�' ._ Fee Schedule `on Reverse Side F'u�e Su�charge $ �: �� ..001 of Permit Valuation (1/lt�th%) State��ureharge : S , S,� S.SO1�1,U((ff) Valuatioa SAC Charge _ $ , $800 per SAC Unit .' License Surcharge $ J`� . D C� $5.00 {Stat� Licensed Resideatial Contcactors) Driveway Escrow $ Alt. "A" or Al�. "B" Above Erosion Control $ $450.00 Cons�rvation Ptan Review _ Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Ne+cessary [] Not Necessary (] TOTAL $� � STIPULATIONS: r J -..: � Jan-26-96 02:42P AIR MECHANICAL INC ..... ....... .. . . . ... � . � .. . � 'o c u� � `° -.:. rn � ��a^` d � � �L T W � (� T � - r= Y �j � � �`a � 2 U m � � � � ar . � .L d « +-� � Q � �i. � � � ro I _i O� o `° O r-�+- o � z �€ 3 s � Z o `. i ` G� U � � � = Z W 'O �- � a c � �s . � � w � � e° -� -� � w � .N � ` '" �' : '� � � cn -a Q � "� U 'C .,W, G1 Z ` O R � � � U p »- •- c �' � oC _ � F= ,�•� � � � � o g ayt co O V 3�=��� � a W �Y S� R ' U a� N = >� � �,�� J j � p Q � � .. �' � �n y O w � � ;o a f- � O � `�(� °' -- v�i tn � Uo �y �'�m � t�i� U a, � Z � ¢ � � � � � _ � " E d w � � W � Q � `� ° a, ¢ .o � � z 7• Ql y � ��y Q QT 0 � � F�- � .2 � V �D 11! Z � � ti �d� z � Z Z O 5Z �o (,� U O Q ao O a � z O � Q U � 0. � Q � � � Z � U � w z Z � N Q Q � � � � � � Q � m e�? (J�tiv�i � Q W _ U H � v �, � '�; � ^ c o ,-� �. � � a, � g � � o Vl 69 i C> U ► � L m .� Y � � � �y �l C � � ; C C) 3 C) ti u- m � � , � C - � a Z � N � � C c�. zs • '.mQ � °$C � a- a°'c�a"� 612-434-921°7 (� � W 0 z N � a _ , d 2 d � �- G m m � 'v1 � � � � � � � � g � � e� � � g � � � � g N � N N � a I � c ._ O � v c 0 U � � Q m Z � � v O �1 � c O �- w, O � U d Q .SI � � .� � � d 3 � ; w � o � a O � O V � �a �n. : °- N Q � O C d► � � � � •� o �� � o `�= U ~ d Q1 .0 W 7 � N � � � f� � O (� Z Q W s P.02 � � � � � I � J ro � � Q �� t� � V � Z � � � Z O • � U C �- � � s � QY � a � � W O� w 0 m � � � � Y � m m V W � . � m�� � � j U � og �� � � i� � 8 w tWi Z � U aw. z UJ a� a t � ` �. � O N � � m .� � � 4 3 � a 'c � O � � to c � v '� � .4 d '� c � � m a� _ -. C� 1 I �F FRIDLEY FRIDLEY MUNIC(PAL CENTER • 6431 UN►VERSITY AVE. ti.E. FRIDLEY', titN �S�i32 •(612) 571-3450 • FAX i61 �� 571-12K7 June 24, 1996 Twin City Townhomes Inc 1250 E Moore Lake Dr NE Fridley, MN 55432 Re: Final Inspection at 1057 Fillmore Circle NE, Fridley, MN Dear Sirs: A final inspection was conducted on June 24, 1996 of the above noted address. We found that the construction of the building unit complies to the best of our knowledge and belief, with all the requirements of the building codes of the City and the State of Minnesota relating thereto, and permission is hereby given for the occupancy of said units. If you have any questions on this matter, please feel free to contact me at 572-3602. Sincerely, RO ULKOWSKI Chie Building Official RJ/mh . � sue�ctr P City of Fridley AT TME TOP Of TME T1N�NS B � ��� ������� � T 2 8 V O 9 r � ` RECE PT � ; y ����� COMMU!'!►TY DEVEIQPMENT DIV. j � �� PRpTEC7iVE INSPECTION SEC. � _ . � �"'1 � CIFY MALL fR10LE� SSI$2 NUMBfN pEV O�TE PAGE Oi A► pOVEO Sr �----�� �•' 612-571-3450 9t0-F15 I2/31/98 � / �oe no�Aess 1057 Fillmore Circle NE 1 IEGAL �OT NO. 9LOCK TRACT Oii AOOITION SEE ATTACHED oescR. 1 1 Hl�.IW1.AC3 TOWriYlOII12S SHEET 2 PiiOPERTY OWNER MAIL A,OOR�S$ ZIP PHONE 3 CON7RACTOR MAIL AODRQSS 21P PHONE UCENSE NO _ Top Gun Inc. 5014 PARRISH Ave - 4 ARCHITECT OR OESIGNER MAIL AOORESS ZiP PHONE LICENSE NO. 5 ENGINEER MAII ADDRESS ZIP PMONE LICENSE NO 6 USE OF BUI 1 G Reside ial 7 CLASS OP WORK � O NEW Q ADDITION O ALTERATION X$ REPAiR O MOVE O REMOVE 8 DESCRIBE WORK 9 CHANGE OF USE FROM TO STIPUTATIONS Call for building wrap inspection before covering. TYP OFCONST. pCCUPANCYGROUP OCCUPANCVLOAD SEPARATE PERMITS AqE REOUIREO fOR EIECTRICAL, PIUMBING, MEATING. VENTILATING OR AIR CONOITIONING THiS PEFMIT BECOMES NULI ANO VOID If WORK Ofl CONSTRUGTION 20NING SQ. fT CU fT. AUTNORIZED IS NOT COMMENCED N/ITMIN 60 DAYS. OR IF CONS7RUCTtON OR WORK IS SUSPENDEO OR ABANOONEO POii A PER100 OF 120 OAVS A7 � ANV TIME AFTER WORK IS COMMENCED. NO OWLG. UN�7S OfFSTqEET PARKING I HEREBY CERTIFV THAT 1 HAYE R�AQ AND EXAMINEO THIS APPlICA710N STA��S GAFAGES ANO KNOW TME SAME TO BE T9UE AN0 CORRECT. ALL PROVISIONS OF LAWS VAIUATION SUHTA% AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL 9E COMPUED WITM WHETMER SPEGf1E0 MEREIN OR NOT. THE GRANTING Of A PERMIT �SOO $.SO DOES NOT PiiESUME TO GIVE AUTMORITV TO VIOLATE OFi CANCEL THE PERMIT fEE SAC CNARGE PROVISIONS OF ANY� OTHER STATE OR LOCAL LAW REGUTATING CON- STRUCTION OR TME PERFOfiMANCE Of CONSTRUCTION �ZL.00 Fire S $.SO PLAN CHECK f EE TOTA� F E Licen $5.00 $27 S�GNATUpE OF CON"�7AC.TOQ OA AU�HOQ�ZEO �GENT iO�TE� N P OPE �� ALIOATE T S IS VOUR PEQ T > / '� f $�GNStUAE O� OWNEa�i� OwNEpBw�DEA� � �O�iEi � � B�0 �NS� - � ���Tf NEW ` ' � ] ADDN [ ] ALTER [ ] ConstructionAddress: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Legal Description: Owner Name & Address: � Tel. # Contractor: Address: MN LICENSE # Ati�ach to this'application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. � �. � DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height GARAGE AREA: Length Width Height DECK AItEA: Length Width HgtlGround OTI3ER: Effective 1/1l98 / i ��� Tel. # � �--:�5�'S ,S� `i Sq. Ft. Sq. Ft. Sq. Ft. � Construction Type: � Estimated Cost: $ • � • � (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: �- —� � APPI:ICANT: Tel. # �-) `� �rs � � - CITY USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Chaxge � � License Surcharge Driveway Fscrow Erosion Control Park Fee Sewer'Main Charge TOTAL � . STIPULATIONS: � $ $ � Sa $ � Sd $� $ � $ $ $ $ � $ '�' Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation $1000 per SAC Unit $5.00 (5tate Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] > CITY OF FRIDLEY = 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE 572-36U4 N'AX: : 1057 FILLMORE CIR NE : 243024320130 : UNAVAILABLE : LOT BLOCK : HEATING : RESIDENTIAL : ADDITION/ALTERATION 571-1Zti7 PERMIT NO.: 2004-02191 DATE ISSUED: 11/29/2004 �gg��� 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. # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 2369 APPLICANT AIR MECHANICAL INC 16411 ABERDEEN ST NE HAM LAKE, MN 55304 OWNER HARSTAD FORREST K 1057 FILLMORE CIR 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 days at ariy 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 and ordinances governing this type of wor� 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 any other state or local law regulating construction or the performance of construction. App� !� Date i � Bldg Insp HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK GAS RANGE FEE GAS DRYER FEE AIR CONDITIONING FEE HEATING REPAIRS/ALTERATIONS STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 028928 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0.00 35.00 0.00 0.00 0.00 0.00 0.50 35.50 C7C7-@7- � C � � G � C 7 � � . 7 � C s c : � , � � s � ��CF11.�14 1b• G� n � * rn = 4 � � � z � � � � V�r �y ^t i �� �r; —ni � �� a ? -o � r�n � i .� � o t 0 � Q ) e 7 � m � a � �. �u j v m � : � � ' o � ? � � 1 � J ,� � 4 M � : � � � _ � � �, : gi n, 17 'a sb n K � � _ �. p m � � O � f'� M �. . � , ,. . . . - - --- �}' 3 3�� 5• t�n �° �• o a �� � � � � � � � � - � � � rn ��� ���,� t� r W � � r �, � �a � �Q°' �. b �` � o � �' �D '" � m ry 1 4� n� V'� 17 n•�.--r, sD � �a � o �ti � p sv � co � G � ro � r' � �, p � � � � n�i n ,.�� o � uo n � o � � �' u� c�'t w � �, ~ .7 � � ~ O N � m � On � � `�, ro � � � $ m w o �_s g � �' aa A v_� N � d�i �o � N ro �� � � c � � ro � rn � � � � � . � � � �- � a. � � � � � � � � Rb � � S T rn ,c�'i� o � o cwi� � C� O O S U w fr► dr 4S b9 k► H �► 6�i • Q �' � P" � � � ��ik � ` W � � , I_� i_ ' a � �v � e � � � �' w N� W Q9 '� W��k � �, � cD �� t�_D CL�-�* � ���� � `�� G� �t 5' t� � -i Z Z$�,�+ t� tn � Oi y'� � 7�' � � � � � � � � ��� � °' � N ��� � � ���� — Q �� > � ��� ���� � ����� � � � o �_ �,�-� -�° �� ° �, 5 � _ � "' a � -� � � w � �' �, o o A � %n � -. � m � � � � ' � � a 3 `� r ��'�-� � . � � � � � �' a � � ,y o n z � � � � rn S � ° � � » � � n co w � � � a � `� � p 7C ' � Ol N � � � � � 0 � � D m C7 � � � � � 'Q 3 � 0 � a O�a � � � � � �� in � � � N � �. n W ? � "t'i � � �. „ A � `Q � N � v m ��..� W � ,;� C � � F- N � � � U? ,Q m � 4 � p � � � � r'" Gi �; � '� � � � Q `f�' .:� � � A � � � � � � � d v Z � � � ...� I� � � io � Q � �� �� !,�:-- �-_�' -- � �� � p r d � � � � h � � f/� i � � � �'�' I� z A I � � � N O A+ \ M � �� �' OCT-0'7--2�a4 � 16' 22 C? 7�Y OF FF? I GLE`.�' P . C��.'0� FtLL fN CQMPL�TEi.Y FOR R�PIACEMENT FUEL �URNING A�'PLIANCE PERMITS COMMON VENT. il�Ni C�NNECTpR AND CONi�U�TlOIV AIR VERIFl�ATiON 'Whert rep�ac„�1� �n existin� furn��, ti� unde�igned hereby var�iies that th� v�nting haa been escamined and is f�e from rust, deterior�tion, obstructions, and is seCUtely supportad ar�d fi���top�d where r�quired_ Yes� � No () Ttte ve�ing system is pla�t+cdPVC �nd meets ali c.urrent codes and manufiacturer specifir.atbns induding sizing, len�th, number af eibows �nd term+nation. Yes () No �) Ttye ur�dersi�ned also verifiES that the rcplacement unit is a listrd a�$embly and meeta the wrrent a�des �n� manufactu�ar's sp�cifications. This does inClude AGA-GAN1A Ca#egory I Central Fumace Venting Table� for fan assisted and natural dra�t applianaes. / Yes �1� i, ; The exiatin,� combustiot� air is si�d �nd insta€led to meet the +cu�rent co��s . . . _ _�_�-? - - — - - --- - - -- �--� -- - _ When required to insta!! a nsvy combu�tiQn air, it will be si��d and installed to meet the curr�nt cod�s and manufa�turer's specifications. Yes �j Wf�en l�staltins� a nsvsr veotina svs�em, the undersigned hereby verifi�s that it is a tisted assembly and me�t� th�a current codes and ma�u€acturer's speafications. This does indud� AGA-GAMA Cat�gory ! Cer�ral Fu�nac� \� Venting Tables for fa� ass�steti and nakural draft appfiances. Y�s�) , ido ( ) No ( � !s the common vent and vent cannectars sized and instalted correcfly aft�r an �ppli�nr.e has been remov�d frorn the c�mmnn v�nt ar►d ;rented separately as pe� current codes. Yes (� h10 (} �� Appliance TYpe and SizrlComn�oar Veni and Yent Cannector Ireformat�on ApplianCe #1 Type S�C`fAO�n.�j�,,, BTU Inp�t ��O,UDC� F"�n Ass+stet! nr Nat „C�,_,,, Appliance #2 iype BTU inpUt __ � Fan Assisted nr Nat __�._ Appliance #3 Type BTU Input Fan Assist�� ar Nat � Tcta! Appliances r_,�____ 'T'ttal Btu Input m�► ,,,��-- Cammon Ven! Type Vent H�ight �, Diamet�r inciies Appli�nce #1 Vent Connector He3ght �ft l_eng;h �it Diarneter "�in Type �� Appli�nce #2 Vent C:onnectvr Height ft l.ength ft C3i�mete; in T}r�e � Appliance #3 Vent Corn�er,�ar Height ft Len�th ft Diarn�t�r �in Type ,� ALTERr�TfONB: ri HIEATING CO� � ('����,����.� _- - Signed By; " % „� �at8 : _ l f� % �� � ?U iF7L F. �� � � ' . .`