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PRE 2010 DOCSOwner Architect Builder 0 0 Village of Fridley, Mim. BUILDEW PERM" 941 Office of INSrEMOR OF BUMDINGS Fridley, Minn. LOCATION OF BUILDING No. street, IAJ-d O -Part of Lot— U Lot Block— Addition bi Sub-Division��r�-t�",/r-O 14 -'CC DESCRIPTION OF BUILDING Front Depth--.- Height— Stories Manner of Construction, To be used as - completes" Estimated Cosl To be co ed,,, Permit is hereby granted to the building -- described In the above statement. This pern upon the express condition that the person to whom it is granted, and his agents, employees and w( the work done in, around and upon said building, or any part thereof, shell conform In all respect nances of Fridley, Minn., regarding the construction, alteration, maintenance, repair and moving within the city limits, and this permit may be revoked at any time upon violation of any of the pro ordinances. —IL -Inspector AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings a the above permit, I hereby agree to do the proposed work in accordance with the above set forth and according to the provisions of the ordinances of Fridley, and, be' sworn, I hereby state and say that the facts stated by me and contained in the abov4 f`` J4, true as therein stated. Subscribed and sworn to before me at Fridley, Minnesota clay of.A.D. 19-.:. City of Fridley, Munn BUILDING PERMIT No592 Date: A 'r--• `a" _ _ Owner: `t_..�r,p _._. y Builder_ Address ._.... ¢+. Address LOCATION OF BUILDING o Lot_-- No...,�f..�_..�p.___. Street __. � �.... � .f Part of � t � Lot --.....: -- Block ..... __ ...._.. ..----...... Addition or Sub on _:.: -- ..__'__.. f Corner Lot .................... -...._........ Inside Lot ... ......... Setback ....._..5 >:......... _..._ ._.... Sideyard ..._...... ;,... ...... ............. ...... _........... __...... Sewer Elevation ...... ...... ............. _... ........ _.......... _......................... .._...._......_ Foundation Elevation DESCRIPTION OF BUILDING To be�U�ed as Front .. .. -- Depth ....._ Height'-_.. Sq. Ftp__.__ Cu. Ft. _............... ....._.. .................. yFro t Depth ...:.......... Height .................. Sq. Ft. ... .................. Cu. Ft. . ................... Type of Construction . 'r x ------ Est. Cost_/° 1+crr. ..""."' To be Completed ............ _._.............................. 9A UTIO N THIS PERMIT DOES NOT AUTHORIZE VIOLAT- ION OF ANY P ATE LAN COVE Nil N TS A,I) 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 $..,6b ..... ..._.... __........ 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 and his agents, employees and workmen, in 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 within the city limits and this permit may be revoked at any tii e,u or ;violation of any of th provisions of said ordinances.' , f f'r . ..i�'iU L— d. -A _- Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. 4 APPLICATION FOR BUILDING PERMIT , CITY OF FRIDLEY, MINNESOTA Owners Name Address. Address LOCATION OF BUILDING No. Street Part of Lot Lot BlockAddition or Sub.Div. Corner Lot—Inside Lot= t Back 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 as: „ Front ZOle - Depth Height Sq. Ft. Cu. Ft. Front Depth Height�_�..,, Sq. Ft. Cu. Ft, el �— OB Type, of Construction Estimated Cost To be 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 representa- tions stated in this application are true and c rect. DATE..j r SIGNATURE (A Schedule of Fee costs can be found on the Reverse Side.) ,`�- �111-llj � D 011oe� /2- tpry Mo- City of Fridley Application for Plumbing and Gm s Fitting Permit Dept. of Bldgs. Phone SU 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location ,� in NO. RATE TOTAL I x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ = ■EMNON 3.25 L1� J�0 0 x 2.00 $ New Ground Run Old Bldg. ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x N MEN Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ _w PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg. ............ x 3.25 $ 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 Description ................................................$ TOTAL FBI $: 6 -C i City of Fridley: �I 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. 19_ Owner Kind of Building �\ Used as %> To be completed about Estimated Cost, $ _ Old—,NWaa Building Permit No Pe It No. Signe ROUGH FINAL 42 2M 7-59 By Business Phone 0 suBdEcr `PERMIT NO. City of Fridley 24304 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. � • COMMUNITY DEVELOPMENT DIV. —LO r I PROTECTIVE INSPECTION SEC �-"\ CITY HALL FRIDLEV 55432 I.' NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 6/21/96 JOB ADDRESS 101 Logan Parkway NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 1 Oak Creek Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Sandra Monette 101 Logan Parkway NE 571-8334 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 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 ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 16'8" x 28' Living Area Addition 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. WANING 'before digging call for all utility locations 454-0002 REQUIRED BY LAW ,� ARATE "R'W'TS REQUIRED Fol? WIRING, HEATING, PLUMBING AND SIGNS. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR 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 ANY TIME AFTER WORK IS COMMENCED, NO. DWLG. UNITS OFFSTREET PARKING 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 $52,000 $26'00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 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 THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TALFEE '/ �? $665.25 RE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI 4,G PA VA I ED THIS IS OUR PE MI E OF OWNER iIF OW NER BUILDERI IDATEI INSP OATE 0 NEW [ ] Effective 3/1/96 ADDN [ ] -CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application C) ConstructionAddress: & ?4X k t�dA H A( E - Legal Description: 1, e T �� � % r� / f C/%. C4 4psm Owner Name & Address: s,, Tel #-'-71-�' Contractor: JWAAA � /�� s�/ - MN LICENSE # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EWPROVEMENT Tel. # LIVING AREA: Length gcY `° Width _ Heights Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Corner Lot JC] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: dcl"8 �A,j �' Estimated Cost: $_ . O®1� o a d Approx. Completion Date: i,.,2 - / - f 4 (Cost: on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: APPLICANT: CITY USE ONLY E99 Tel. # Permit Fee $ .597. .2$" •` Fee Schedule on Reverse Side Fire Surcharge $ �.d0 .001 of Permit Valuation (1/10th%) State Surcharge $ 40 $.50/$1,000 Valuation SAC Charge $ $900 per SAC Unit .. License Surcharge $` $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. .;'B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ TOTAL $ / STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Stories Basement Floor 1 Floor 2 Floor 3 Floor 4 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR I Wash t114r � Auto. Urinal <lak':<`Shower Slrik>> Tray rlU<`` Drafn `irij Washer PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater —Electric $ 7.00 Water Heater — Gas** $10.00 Gas Range** $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes () No Type $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge $ .50 TOTAL FEE $� Effective On March 1, 1996 Gas(VI!(sG>>` Water Heater Ran e ["' as le JOBADDRESS A)/ / fjcjrJ pa"I./w4" The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. �w 1996 O lu� Owner 1 Building Used As_ Estimated Cost PLUMBIN OMF SIGNED Y S77/- 1?33 W zr/ jll PERMIT NO. J"-�- "/� N�`� — TEL N0. 7dCi�'— Approved By f—!4 Rough—In Date Final Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. May 17, 1999 Sandy Monette 101 Logan Pkwy. NE Fridley, MN 55432 Re: Final plumbing inspection at 101 Logan Pkwy. NE Contractor: Daas Plumbing Inc. Dear Ms. Monette: A plumbing permit was issued on April 2, 1998 for the property Pkwy. NE for new plumbing fixtures. According to Section 30. Plumbing Code a final inspection shall be performed on plumb! date no inspection has been called for. E � located at 101 Logan 5(a) of the 1991 Uniform ng systems. As of this You will be given thirty (30) days from receipt of this notice to r spond. If we do not hear from you, we will expire the permit and any inspections othis installation will require a new permit. Any questions can be addressed to myself at (612) 572-3603. Sincerely, Barry Riesch Building Inspector CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On January 1, 1998 PLUMBING FIXTURE RATES: NO. New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater —Electric Water Heater — Gas** Gas Range** Gas Dryer** Back Flow Preventer Required ( )Yes () No RATE TOTAL JOB ADDRESS D/ /1 ) $ 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 $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE $ .50 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. �� � , 1998 Owner �'f C4 Building Used As, Estimated Cost PLUMBIN COM SIGNED Y Approved By A_ PERMIT NO /-2/04-/ Rough -In Date $a81�z PLUS THE $.50 STATE SURCHARGE 2dr-6 " awe) Final Date I **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. SUBJECT City of Fridley 33679 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. I i v ______ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r I NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 53132 763-571-3450 9t0-Ft5 7/8/03 JOB ADDRESS 101 Logan Parkway NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 5 1 Oak Creek Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Sandra Monette 101 Logan Parkway NE 763-571-8334 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 16' x 22' Detached Deck 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan. 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 SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN '80 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $4,372 $2.18 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $111.25 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION Fire SC $4.37 PLAN CHECK FEE TOTALFEE $117.80 SIGNATURE COWRACTORORs TH aQ IZEDAGENT (DATE. '�/l 71 WHEN PROPERLY VALIDATED THIS ISSYOO P RMIT L SIGNATURE OF OWNER d0 OWNER BUiLOER, A LOGOMP n TE NEW [ ] CITY OF FRIDLEY ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: /O l /0 C'4 't." '0� 41ef — Effective 1/1/2003 (763) 572-3604 Bldg Insp (763) 5714287 Fax �( f �P[�b f Legal Description: Owner Name & Address:<5�"u � ����� Tel. ��.3 S 71 3 3� Contractor: /) , rV A/ 01f-2 MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT �nq :. LIVING AREA: Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. _ DECK AREA: Length ` Width a a- Hgt/Ground .� a Sq. Ft.' OTHER: - Construction Type:,_ Estimated Cost: $ O v Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$ DATE: /-0 3 APPLICANT: ��aL%�-� Tel.63 Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ // /' 80 Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 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 [ ] 100- AuE- OR W/V ,g8 a4 kKpj Q ,qI l ho I Es (rAL. DECK FLASHING J -I x N 7RtAT ASST 7ACA7ED DECKING/ I MAX a -C7 jS7T!�"ac �-- GRADE TYPICAL DECK DETAIL �tte (- 3C��� Ito h�� V 1 Ptc � 44 S O 1 �Qovecl Ly2uR6 eAils , , L,(Oe IW5gv h �- ,:, Z Lefs W OC ILL. 10 W Q U �1- � z • d i 0'Oz r /r-- W OC ILL. 10 W Q U �1— /T ` t� V a 1 � 4 ,� • N . N fn k"U �..o Ls : J U ir+ 4 0 1- ria 1 `n u a w viii 0'Oz U W -� u �wio V u z oc z a° %4 LLj 3E >o2 Ci S9� ccI w Ji ►� CA X 00 ! 40 i X � u • A � ' 0 01.7 �1— /T ` t� V a 1 � 4 ,� • N . N fn k"U �..o Ls : J U ir+ 4 0 1- ria 1 `n u a w viii (x-noP 1b, x lit A6.11,10 /- II II O<YS3 1JIX7LI CITY OF FRIDLEY INSPECTION DIVISION Effective Onaunt 1, 2000 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, '�)L�/ 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS LUi 4o5l�2 06�� � RATE SCHEDULE ' OWNER 54. 41, Me Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED AS RESIDENTIAL Also Replacement Furnace $ 30.00 $ (Side Vent - Fill Out Back) ESTIMATED COST '?30a 00 PERMIT NO. Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water)arm Air Gas Dryer $ 10.00 $ Trade Name N ��I� ,rte% ee� Size No. 5C--s�2s: BTU 1��®� HP EDR Air Conditioning All Sizes $ 25.00 $ _ Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) =Burne7rra:ZRame___ Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial 1.25/0 of Value of Appliance or Work State Surcharge 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 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes an $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE HEATING CO ALLIED FIRESIDE dba FIRESIDE C R Signed TEL *Air Conditioners can not be placed in a side yard without Approved By Rough -In Date Final Date written permission from adjoining property owner. COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing 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 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 specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturers specifications. Yes( ) No( ) When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new venting system, the undersigned hereby verifies that it 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 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 ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type 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 Common Vent Type Vent Height Diameter 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 ALTERATIONS: (Describe) HEATING CO: Signed By: Date: