PRE 2010 DOCSCity of Fridley, Minn..
BUILDING PERMIT N° f57 J3
Date:
1 F
Owner'�` Builder—
Address V
_. Address
LOCATIOJ$ OF i D G
No. Past _ of Lot
Lot _ _ _.__ Block �' ____ Addition or Sub -Division" p
Corner Lot _ Inside Lot Setback 4 - Y!�,n _ Sideyard _
Sewer Elevation
Foundation IIevation
DESCRIPTION OF BUILDING
vsea
r�"f LdL
•' Front Depth , Height Sq. Ft.
Cu' F
Front Depth ght Sq. Ft. — Cu. Ft.�
Type o Construction�.,�. Est. Cost �J 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 work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 4' , permit is hereby granted to
to construct the Building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted aad his agents, employees and workmen, ffi all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
the city limits and this permit may be revoked at any time upon violati of any of the provisions of said
Building Inspector
NOTICE:
This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sower or water. Be sure to see
the Building Inspector for separate permits for thus items.
4
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner Is Name Builder LAL If - (IVL—
d _
Address L. _,^9i VA.,
LOCATION OF BUILDING
Street Part Of Lot
Lot
locka Addition or. 6bdivisionkQLg�_"
Corner LotInsid® Lot- 1/� Setback,_„�Side-Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate Of Survey of Lot and
Proposed building location.
DESCRIPTION OF BUILDING
To be used ass
sq. Ft •__pi�2 L'r nn�Cu .
Front0 Depth
Sq. Ft.
lei Cu.
Type of Construction Estimated
To be
4
!eight 'Z®
Ft . _•
Ft
Cos
The undersigned hereby makes application fora permit for th® work
herein specified, agreeing to do all work in strict accordance with
the City of Fridley Ordinances and ruling of the Department of Build-
ings, and hereby declares that all the facts and representations
stated in this application are true and correct_
Application for Power Planate and. Hearing. Cuing. Ventilation, .ReMgeraflon and
Air Conditioning Systeans and Devices
PARTIAL RATE SCHEDULE
'GRAVITY WARM AIR: .
Furnace Shell & Duct Work ..........................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 ..................
Repairs & Alterations each add. $500.00 ...............
RATE TOTAL.
8.00 $
5.00 $
5.00 $
2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU ....................... 2.00 $ _
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ................. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ......
8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ...
8.00 $
Each add. 200 sq. ft. EDR Steam ......................
2.50 $
Each add. 320 sq. ft. EDR Hot Water ..................
2.50 $
OIL BURNER—to 3 gal, per hour ................. ...... 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $
GAS FITTING FEES: NO RATE TO L
1st 3 Fixtures ...................... x $1.50 $
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
a t
FINAL
See Fee Schedule $
TOTAL FEE $ ��
Dept. of Bldgs. Phone SU 4-7470
T.nenf9nin �A �/ ®iUl/.Eo���
City of Fridley:
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 applicatiown truA aAVrrect.
Fridley,
OwneAver
0
Kind of Ling
Used as
To be completed about
301962
Estimated Cost, $�®`
Ne Building Permit No. Permit No.
DESCRIPTION OF WORK
19 —
HEATING
Water,–Warm Air—No-
Trade Name
✓ Size No—
Capacity--
Ft. E.D.Relgg BTU H.P.
/Sq.
S`
Total Connected Loa I Rind of Fuel
BURNER — Trade Nam Size o-�✓�a7 %l!
Capacity
Sq. R. E.D.RIWABTU H.P.
-Yoe
GEO. SEDGW CK HTG. & AIR-COND. CO
1001 Xenia Av. S.
Minneapolis 16, Minn.
Signe
-
By ,
s.4Z
zM 7_59 Business Phone ;0-
(REMARKS—OVER)
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS. MINN.
Weatherstrips A.S.H.V.E. Construction No. Insulation
Guide
Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How. Applied
Yes—No I Yes—No 19—
FI.I Room I L.enath Width Height II ,' FLI Room I Length:. Width Heistht:
Windows and Doors—Crackage and Area
Width Height No. of Lineal f . Area
No. of Dane of pane lights of crack eq, ft.
&p u {
s: l c .
s4' M
Coef. Btu
Infiltration
: `=
Glass
,• �d:.
Exp. wall
Net exp. wall
Int. wall
Ceiling
s'
Floor
Total Btu. r
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FI.I Room I Length,, Width i .4` Height ..'
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
&p u {
s: l c .
s4' M
JCoef.j Btu
Infiltration F:.
Glass 0;n
,• �d:.
Exp. wall
Net exp. wall
Int. wall
Ceiling
j
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl.i Room 1 Lensrth Width v ..:Heiaht
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
&p u {
s: l c .
Coef. Btu
Infiltration`
Glass
,-
Exp. wall P<'
Net exp. wall
Int. wall
Ceiling
p
%deur
Total Btu.
Reauired sa. ft. E.D.R. or so. ins. W.A. Leader area
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of Bane of pane lights of crack eq. ft.
&p u {
s: l c .
Coef. Btu
Infiltration
Glass
,-
Exp. wall
Net exp. wall
Int. wall
Ceiling
p
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I
as FIS' :9 Room I Length v' Width Height .
Windows and Doors--Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
s: l c .
Coef. Btu
Infiltration
Glass t
,-
Exp. wall
Net exp. wall
Int. wall
Ceiling
p
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. itis. WA. Leader area
Room I Length Width
Windows and Doors—Crackage and Area
Width Height No - of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Height.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceifirig
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS MINN.
Weatherstrips A.S.H.V.E. Construction No. Insulation
Guide
Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied
Yes—No I —Y—es--No—
es l-io 19—
F1.1 Room i Lenath i Width Height ,' II FI_I Room I Length Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal f . Area
No. of pane of pane lights of crack eq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu..
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Length s. Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef.1 Btu
Infiltration
Glass
Exp. wall
Net exp, wall
Int. wall
Ceiling
Floor
Total Btu. 1
7
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FIA Room I Lenath Width " Heiaht
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I
Fl.l Room I Lensfth Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. iris. W.A. Leader area
F1.1 Room I Lensfth Width Height
Windows and Doors—Crackage and Area
Width Height No. of Liof ft. Area
No. of pane of pane lights of crack eq. ft
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
City of Fridley
Application for Plumbing and Gas i= Mng Permit
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
Number Fixtures .....................
Future Fixture Opening ................
New Fixture Old Opening ..............
Catch Basin ............................
RATE
TOTAL
�NO.
�/
�
,,,
� �
u�
QC Z
� Z
0 yTw�
—
w
?
•
•
NGAS
WATER HTR.
ELEC.
Base
1st
/
2nd
3rd
4th
• Future Connection Openings I
New Fixture, Old Openings
Connected with
Sewer E]
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
Number Fixtures .....................
Future Fixture Opening ................
New Fixture Old Opening ..............
Catch Basin ............................
Water Heater (Up to 200,000 BTU) ...... x 2.00 $
New Ground Run Old Bldg. ............ x 3.25 $
Dept. of Bldgs. Phone SII 4-7470
Location -5, 3 a /' %'-/ :- 0 G A/ 'Al /s ,
City of Fridley:
The undersigned hereby .makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct.
Fridley, Minn APR 2 e 196
19—
Owner
Kind of Building / 2
Used as `D W,
To be completed about
Estimated Cost, $
Old 5ew.Building Permit No 3 Permit No. 02
LONDON PLUMBING CO,
Signed
By
Business Phone No
ROUGH � � -" L, 7'
FINAL
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
G0
Description .......................................$
TOTAL FEE It L19 'If' 94
d2 2M
RATE
TOTAL
�NO.
&V
—
x $1.50
$
Z
x 1.20
$
—
x 1.00
$
x 3.25
$
Water Heater (Up to 200,000 BTU) ...... x 2.00 $
New Ground Run Old Bldg. ............ x 3.25 $
Dept. of Bldgs. Phone SII 4-7470
Location -5, 3 a /' %'-/ :- 0 G A/ 'Al /s ,
City of Fridley:
The undersigned hereby .makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct.
Fridley, Minn APR 2 e 196
19—
Owner
Kind of Building / 2
Used as `D W,
To be completed about
Estimated Cost, $
Old 5ew.Building Permit No 3 Permit No. 02
LONDON PLUMBING CO,
Signed
By
Business Phone No
ROUGH � � -" L, 7'
FINAL
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
G0
Description .......................................$
TOTAL FEE It L19 'If' 94
d2 2M
City of Fridley
SUBJECT
j-16 6 01
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
`L ....... COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
j
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
5/27/82
JOB ADDRESS 5230 Lincoln Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
3
2
Marion Hills Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Walter Jopke 5230 Lincoln Street N.E. 571-2205
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Mike Spears (CONTRACTOR NOT LICENSED IN THE CITY)
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ADDITION El ALTERATION ❑ REPAIR ❑ MOVE E3 REMOVE
O�
8 DESCRIBE WORK
Construct a 161-x 13' Addition to Rear of Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide outside combustion air to new wood burner or existing furnace
room. Provide products of combustion alarm in the area of the existing
bedrooms.
WME0116
Before drains cap loaf utiiMes
TELEENONE - ELECTRIC - GAS Etc.
�E.KRA1'E PERMITS A`E E1� � F04 '�� REQUIRED BY LAW
N�aTrN� �.Lr�te�� q �
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS 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 CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
ISTALLS 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
$3.45
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$6,900
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-
NONE
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$62.50
PLAN CHECK FEE
TOTALFEE
$15.63
$81.58
SIGWPAEOF O r4OR AU ORI DAGENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
Q q
iNSP �A E
SIGNATURE OF OWNER OF OWNER BAItEV (DATE) IBLDG
1
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATIM FOR RESIDENTIAL BUILDING PEIV41TS
(New, Alterations, Additions, or Repairs)
OWNER: BUILDER:
P
ADDRESS:��sVc_ �/J/ 2 ADDRESS:
TEL NO: �% — �-a j J TEL NO:
Construction Location
• STMMT NO: J2� STREET: ;L1x'-CV /L
IAT: BLOCK: ADDITION:e�
Corner Lot: Inside Lot: / Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
/� :���----
DESCRIPTION OF CONSTRUCTION
G�'G%G��.� Front: / 6 Depth: �� / Height:
Square. Feet: Cubic Feet:
Front:
Depth: Height:
Square -Feet: Cubic feet:
4?03)C 4�7IQ 2 (09 19. ®c,
Type of Construction: ��f/��� /—�/✓��r�i'/lam
To Be Cbmpleted: %�%� ✓�
J�Estimated Cost: $
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired:
SEE REVERSE SIDE OF SHEET
Mie undersigned hereby makes application for a permit for the -work-herein specified,
agreeing to do,all work in strict accordance with the City of rridley Ordinances and
rulings of the Department of Buildings, and hereb declares that all the facts and
representations stated in this application are toe and correct.
-
DATE: � `�/ /�� SIGNATURE:
Stipulations:
1 f
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P. e. I s. (3
ge
e
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Tr -
IF
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_ �C Fo •D l � to _moi=tel ¢ • _�—_ ______ __ __.
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Soils Testy
[Evil b A&uiki)V/
by
Ar,
y 3�
6875 -Root y *acs AT.
Mirmmp/s v,
ENGINEERING, INC. °'a
f Slhlrfd6066
— Fnyineers 16 Surveyors —
certificate of sumVeY f er Sr cocAl • TR /'✓IBL A 77-
A(
T
N
I
o -/ ..3
.Ttc a
I —,
161.27 --
M Bks
M17e"nn f////,. �—
r,
/ hembs d srvey Arhk bavdoryes qr& e6are Asc,4bwd Iand, adyyh!ec�io�
/avl�n gl'o/l drrildrn9s , f/riecrr , arnd d/ risible aw»a�lrn�tnfs , i!'arx�, �rnm mr ensoid /mad. As wrveyed � m�e A�'3�� °by
c 1, A.D SUBURBAN ENGINEERING, INC.
6rr9inerrs Fr Sur,r,e s
i
-- ® ...--- �����75 S'R`iaT SET 7 ttnT.7.►�n
CITY OF FRIDLEY INSPECTION
6431 University Ave NE
Friuley, MN 55432
(763) 572-3604
FAX (763) 571-1287
W IMW RATE SCHEDULE
DIViSION
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs &Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Effective January 1, 2003
JOB ADDRESS _Ldao O/l(o/n n -
OWNER " UIC "fir 61�
Rate TOTAL
$ 30.00 $ ��
BUILDING USED AS LfIL&11 G2—
3�� n
ESTIMATED COST /f�M-JD PERMIT NO.
$ 10.00 $
DESCRIPTION OF FURNACE AND OR BURNER
$ 10.00 $
No. of Heating Units_ Circle One (Steam) (Hot Water) ( arm Air
$ 10.00 $ Trade Name oe6)LcL Size No.UG'P 71
BTU IM666 HP EDR
$ 25.00 $ Fuel_.3 rat Gccs Total Connected Load
Commercial/Industrial
1.25% of Value of Appliance or Work
State SurcliZge
10
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Burner Trade Name Size No.
$ BTU HP EDR
$ The undersigned hereby makes application for a permit for the work herein
specified agring to do all work in strict accordance with the City Codes an
$ .50 rulings of the.-Opilding Division, and hereby declares that all the facts and
$ 3(),30
representati o1V stated in this application are true and correct.
`- ° DATE
CenterPoint Energy Minnegasco
HEATING C013562 Central Ave NE, Anoka, MN 55304
Signed 63-757=6202
FAX # 763-757-6701
Approved By Rough -In Date' Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
Irn • EDIT CONNECTOR
AND CQMRLISTIIJN IR VFRIFICAT1f)N
When renisir-Ang "n aY;eting 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 (R� No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes (x) No ( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan Yes (x) No ( )
assisted and natural draft appliances.
The Pv'etine en+enatien a;r is sized and installed to meet the current codes Yes ) No ( )
and manufacturers specifications.
When required to inetall a opw rnmbitytinn air_ It will be sized and installed
to most the current codes and manufacturer's specifications. Yes �) No ( )
When Installing a naw var ing system, the undersigned hereby verifies that
it is'a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Furnace Yes {r) No( )
Venting Tables for fan assisted and natural draft appliances.
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented Yes (x) No ( )
separately as per current codes.
An oanma Tena and m7ptinnmmen dent and V _nt Conn c er InfermatinII
-G BTU Input Whob Fan Assisted or Nat
Appliance #1 Type rpt r _
Appliance #2 Type BTU Input 31 0VV Fan Assisted or Nat,.
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input 01
Common Vent Type C Vent Height Diameter G inches
Appliance #1 Vent Connector Height � ft Length Diameter �in Type
Appliance #2 Vent Connector Height ___L' ft Length _,2! ft Diameter V "in Type ._./-
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
HEATING CO: CenterPoint Engrc 13562 Central Ave NE, Anoka, MN 55304
o� Mi n�no�,asee
Signed By:
-Date: