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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N? 4 216 Date: ...__.. SEPTI BER...11.R...1.m............-..........._......._...._.. Owner-.............................................................. ......... _.......... ............................ .... Builder ---.........L .... BM.. � Address ................................ _............ - ..... _............ _...__...._ _........ ....... Address .301 .._17rdale.... Minneapolis, Minnesota LOCATION OF BUILDING No...... ...5./+2 ...... street ...._Madison St. .._N.•..._E......_............ I ............. ............... Part of Lot .............. ....... .... ...................... _................ _ Lot ............ 12.................. Block ... .......... ....._.-�........................... Addition or Sub -Division ....-_...... Builders,,,_! th_._Add?III. Corner Lot .................................... Inside Lot ----------------- X ................. Setback ............. 3.5t .......... Sideyard..................... 15.1 -•----------------------------------- Sewer Elevation .................... _........................... -............. ........................................ Foundation Elevation .................... _............. _.__....... .............. _............. :........... - DESCRIPTION OF BUILDING To be Used as: 1i41ell�n .- ....................... Front ....3r2......... Depth ......fi t...-.. Height 19! Sq. Ft. ....... 7.60- .................... . ... - ......... ....................... 68. -...................._...-........_....................... Front ..... -................. Depth ...................._.. Height ........................ Sq. Ft....................... Type of Construction...........PraMe............................. Est. Cost .............89.tuk.................... To be Completed cu. Ft..24..,.5.92 Cu.Ft....................... 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 fort d in compliance compce with all provisions of ordinances of the city of Fridley. v In consideration of the payment of a fee of $.13.40 ............... 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 time upon violation of any oftheme �Fovisions of said ordinances. _ y - _ / / .f 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 hems. 5 ,1 APPLICATION FOR .BUILDING PERMIT •CITY OF'FFRIDLEY, MINNESOTA Owners Name . Builder_,. address . Address.... i LOCATION OF BUILDING No. Street ``� b Part of Lot Lot 1 Block. f Addition or Sub.Div.. r Corner Lot Inside Lot h,,.r So'i Back 3 J� Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attagh.tp'this form Certificate of.Survey of Lot and proposed building location ;� t DESCRIPTION OF BUILDING To, be used as % c�i. q Front Depth Height Sq. Ft. Cu. Ft. • Front epth Height Sq. Ft. Cu. Ft. Type;of;,Construction Estimated Cost To be completed 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 correct. DATE SIGNATURLE (A Schedule of Fee costs can be found on the Reverse Side.) City of Fridley Application for Plumbing and Curs Fitting Pmnit y Dept. of Bldgs. Phone SU 4-7470 DESCRIPTION OF WORK A ��� Number, Kind and Location of Fixtures Lova PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Cc�� ~ Number Fixtures ...................... Z $7-,,5777< S Z F Zk 1.20 Z Z O J $ 2 • ` WATER HTR. GAS ELEG +�'�O $ dk ' a New Ground Run Old Bldg . ............ x 3.25 $ R N6. Base ( / 1st 2nd _ 3rd — 4th • Future Connection Openings Connected with Sewer E] New Fixture, Old Openings Cesspool E] PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... - x $1.50 $7-,,5777< 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 $ dk ' a New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 r Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL F= 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 application are and correct. ,i fey, . Si'� � Minn � Owner Kind of Building Used as To be completed about — Estimated Cost, $ Old—New. Building Permit DEC 2 2 1959 ROUGH FINAL - -439042 2 2M 7-59 OWN Aple7 Wr i �,.�r IM �� City of Fridley, Minn. A BUILDING PERMIT N°4589 -8 9 ..1 Date: Owner: i�.. ''Y_ Builder Address _. , `" °' Z-04ddress C►TIO F BUILDING R _ . No. _.. '� r.'Street .......... .>� � Lot ....: _.._._ _ Lot ......, .... Block ...._... ..... Addition or Sub-Divisionr Corner Lot ................................. Inside Lot ....._----- `�...._........ Setback ............. ..._.:.....: Sideyard :...._. -__...._..._........_...___..__. Sewer Elevation TOfoNj�lae Used: Foundation Elevation DESCRIPTION OF BUILDING Front 1. ..-.. Depth -- :.. : Height ... ._.. Sq. Ft. r Cu. Ft. -- _. .............. PHeight Type of Construction -- -.....ten-° '� Est Cost.... ---. . _._ .. ..............._...._.. To be Completed -----.._.__ .. 0 THIS PERMIT DOA . ON ION OF T AUTHORIZE VIOLAT. BUILDING RESTRICTIONS. D COVENANTS AND 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. -X ............... In consideration of the payment of a fee of $-.I .....I 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 time upon violation of any of the Provisions of said ordinances. ."-) '.4 l Building Inspector a NOTICE: This permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sure to we the Building Inspector for separate permits for these items. 4 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA { Owners Name � c�.-�,�r'-1' _=� ° ,1 Builder �C_x.A -gU Address - Address LOCATION OF OF BUILDING No. Street Part of Lot Lot Z, BlockZ Addition or Sub.Div. e Corner Lot Inside Lot______Pet 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 _ Depth„�� Height Sq. Ft.cu. Ft. Front Depth Height' Sq. Ft. Cu. Ft. Type of Construction k, Estimated Cost « __ To be completed 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 correct. DATE®/ _ SIGNATURE (A Schedule of Fee costs can be found on the Reverse Side.) I . . � BIOCK' AlZ0ZSB lDAIJIA2 ION ^ ADD ° --------------------------------------------------------------------------------------' Pmperty ! ne! x � ^� AIA How S& ' Rouge rc*nert3rLize City of Fridley, Minn.. BUILDING PERMIT N°5 8 8 5 Date:' Omer: Builder � Address ___.__ _ Address L;)CMIONB►ING No. �=- Streeti1Fe��,� Partof Lot Block Addition or Sub -Division Corner Lot Inside Lot Setback — Sideyard Sewer Elevation _ __ r Foundation Elevation DESCRIPTION OF BUILDING Used as: _ 'ont * t Depth Height Sq. Ft. Cu. Ft 4�� Fro Depth eight Sq. Ft. Cu. Ft Type of Construction Est. Cost 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 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 ti u,r►lolatigf any of the provisions of said ordinances. .. fJ yh l ' r ! 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 then Items. .. A 4 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA • .Name- i moi(✓ if Address x -.,e -.--Address LOCATION OF BUILDING No. Street Part of Lot Lot Block Addition or Subdivision Corner Lot Inside Lot Setback Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To aused as: �y Front Depth�_Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. �, Type of Construction 2-zd:a�-& Estimated Cost / ' on To be Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. A DATE !fL L — 6 D- SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). - , , M G7YOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1297 October 26, 1990 Carol Johnson 5422 Madison Street N.E. Fridley, MN 55432 RE: Property at 5422 Madison Street N.E. Dear Ms. Johnson: On July 1, 1990, the City of Fridley began a new program called Systematic Code Enforcement. This program is designed to provide fair and equitable code enforcement, improve the City's appearance, and maintain property values by creating a more attractive suburban environment. Under this program, all properties in the City will be inspected approximately once each year to ensure that they are in compliance with the Fridley City Code. A recent inspection of your property revealed that not all Code requirements are presently being met. Listed below are item(s) which do not comply with the Code: 1. Discontinue outside storage of tires located on the south side of the house. Your prompt attention in correcting this problem would help us in our effort to improve the City. A reinspection will be conducted on or about November 12, 1990, at which time compliance is anticipated. Please call me at 572-3595 if you have questions or wish to discuss this further. Thanks for your cooperation! Sincerely, Steven Barg Code Enforcement Officer SB:ls C-90-917 SUBJECT - City of Fridley 9 2 2 AT THE TOP OF THE TWINS I III D I� I G ®E R A A I T BUILDING (12, r DV L 'v 1 'r1 1 • ______ COMMUNITY DEVELOPMENT DIV. ~ r PROTECTIVE INSPECTION SEC. /ic NUMBER REV DATE PAGE OF APPROVED bY CITY HALL FRIDLEY 55432 "j 612-571-3450 910415 4/10/98 JOB ADDRESS 5422 Madison Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 1 Lyndale Builders 4th Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Carol Johnson 5422 Madison Street NE 572-9221 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO JRS Construction 23555 Monroe St NE, East Bethel, MN 55005 434-2651 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20091085 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION IR REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Alterations 9 CHANGE OF USE FROM TO STIPULATIONS See notations on correction list. WARATE PERMITS REQUIRED Fop WIRINGo HEATING, PLUMBING AND SIGN, 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $13,300 $6.65 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- STRUC�ORERFORMA CE OF CONSTRUCTION. $212.25 Frie SC $13.30 R PLAN CHECK FEE TOTALFEE V—le— License SC $5.00 $237.20 GNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI WHEN PROPER VALID TED THIS IS YOUR PERMIT i v INSP GATE _ SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI41422NAG NEW [ ] Effective 1 / 1 /98 ADDN [ ] CITY OF FRIDLEY ALT [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION . ConstructionAddress: S� 1�y 91 "�- p�` S �'� S't o IVF—. Legal VF— Legal Description: Owner Name & Address: C'4ro jo �'v 50f&4 Tel. Contractor: ► I� , C 0 fV S °gU C' `fir 0 _✓ MN LICENSE # 'ZOO Address: <�,-P' S'S'A— /�7 OaIf? cue S -I /V E �S l �� f' �� Z— Tel. # LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Driveway Curb Cut Width Needed: Ft. + 6 Ft = DATE: a " APPLICANT: F 3f 3 Q0 • ou pv Estimated Cost: $ (Fee Schedule on Back) Ft x $ Tel. # /3 �'— - . STIPULATIONS: CITY USE ONLY Permit Fee $ ���• 12�— Fee Schedule on Reverse Side Fire Surcharge $ 13,30 .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ • DO $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: L FH95-07 Carol Johnson 5422 Madison St. NE Fridley, MN 55421 #572-9221 1 BID SHEET 13t e. ;ntractor ntractor's Signature S-1 LMNP ROOM ' S a. Install window replacement, vinyl framed, welded comers, insulated glass, screen, weatherstripping, locking device and hardware. Alside or equal. Set into existing openings. Reuse trim and casing. White color. (1 DH and trip unit with fixed and 2 Casement). Work includes replacing picture/fixed thermo pane. S-2 KITgHEN (with dining area) S a. Install window replacement. Refer to spec S-1 a. (3 DH) S�_� b. Repair/replace damaged flooring below kitchen sink. Sc. Install new refrigerator, upright with top freezer, 18 cu ft, white color, glass shelving and energy saver. GE or ill, , `,, equal. Haul away old unit. Assemble and install new. Specify appliance allowance $ iyr 1 I� id. Install new steel insulated exterior door, prehung unit, six panel with peephole or nine light of owner's choice, - ' new threshold, weatherstripping, hardware and locking device. $200 door allowance. Castlegate or equal. Reustr firm and casing. Apply painter's finish to primed woodwork. ° M E,pu�VATH � i Redo shower walls. Install new water resistant drywall and new fiberglass liner with molded soap dish. Kohler or equal. Seal all joints and make water tight. Reinstall glass shower doors. y Redo flooring (includes hallway area). Replace damaged substrate. Install new vinyl sheet floor covering over structural grade undedayment. Congoleum or equal. $15.00 sq yd material allowance. Owner's choice of color and pattern. Edging of floor shall be covered (confirm material and finish with owner). Reset stool with new wax seal. rovide _ S e., Install new mechanical exhaust fan, secure in ceiling, duct to exterior, insulate to meet code, size to p five air changes per hour and equip with damper. Nutone or equal. S y0 d. Install window replacement. Refer to spec S-1 a. (1 DH) 8-4 OTHER ROOMS USED FOR LIVING AND HALLS Northeast bedroom S iw/ a. Install window replacement. Refer to spec S-1 a. One window opening shall be sized to meet egress code requirements. Confirm location with owner. (2 DH/Casement) NIhwest bedroom S J b. Install window replacement. Refer to spec S-1 a. One window opening shall be sized to meet egress code requirements. Confirm location with owner. (2 DH/Casement) Upstairs - West bedroom c. Install window replacement. Refer to spec S-1 a. Size window opening to meet egress code requirements. (1 Casement) Install new wood trim around window to blend with millwork in room. Upstairs - East bedroom $ t �d. Install window replacement. Refer to spec S-1 a. Size window opening to meet egress code requirements. (1 Casement). S- BUILDING EXTERIOR a Cover entire eave area of house and garage with .019 baked enamel prefinished aluminum. Alcoa or equal. d° Replace rotted and damaged boards. Apply aerated material to vented soffit area and ensure soffit venting that � is open to attic area for unobstructed air flow. Owner's choice of color. ` Option: Replace gable wood siding with vinyl. Install with weather barrier, Tyvek or equal. Alside or equal. Rework items that interfere with the siding application. Owner's choice of color. r 7-'b. Cover entire trim area around windows and doors of house and garage with .019 baked enamel prefinished aluminum. Alcoa or equal. Replace rotted and damaged boards. Owners choice of color. Rework awnings. Remove brick planter at east side of breezeway. Properly dispose of materials. Repair damaged wall and �' restore siding to blend with adjoining work. ����d_, Install new storm/screen door (entry off living room), solid core, baked enamel prefinished aluminum. with _W weatherstripping, self -storing storm and screen inserts, hardware and locking device for complete assembly. Benada or equal. Owner's choice of color. i I ell erol Johnson. 5422 Madison St. NE, Fay Page 2 of 3 S10 Install new storm/screen door (west entry off breezeway). Refer to spec S-6 d. S" %f. Install new storm/screen door (east entry off breezeway). Refer to spec S-6 d. S g. Tear off shingles on house and garage down to are ood. Haul away debris. Replace rotted boards. Specify separate board replacement cost per sq ft $ - - . Install ice and water shield along edge of roof. Check roof vents and plumbing jacs and if damaged. rusted or missing, Install new. Ensure roof ventilation meets State energy code requirements. Install metal flashing at roof and stucco joints. Install metal drip edge where gutters or ribbon boards are not installed. Install metal valley flashing. Install 240# 3 -tab asphalt shingles laid over one layer nonperforated Type 15 felt. Certainteed or equal. Ridge shall be laid "Boston" style. Owner's choice of color. Specify total roofing squares 9- S-7 HEATING AND PLUMBING Install new water heater, 40 gallon, natural gas, AGA or UL listed and energy saver. Rheem or equal. Connect to gas and water lines with shut -offs. Vent to an approved flue. Haul away old unit. Replace proper rain cap u~—b. Install back flow preventers to laundry and exterior faucets. c. Install draftstopping around flue at ceiling penetration. i d. Install combustion air intake for furnace. e. Install new shower/tub fixture, chrome, anti -scald (thermostatic or pressure -balancing type) and with 3 gpm showerhead. Delta Monitor or equal. r% f. Install proper shut-off on dryer gas piping. S g. Correct leaky cold water piping to bathroom sink. h. Install new laundry faucet, brass type with back flow preventer. y` i Code gas space heater in upstairs bedroom. Provide proper clearances from combustible materials. Option: Disconnect space heater. Extend ductwork from furnace into upstairs area. Ensure a balance PAW —0 distribution system and the furnace is sized to adequately supply heat to area. Repair damaged areas to blend with adjoining work as close as possible. Ductwork shall include registers with individual shut- offs. Confirm ductwork with owner. :v4 '-_Rsconnect dryer vent. k. Enclose flue liner in upstairs bedroom area with drywall. -8 GEN HEALTH AND SAFETY a. nsulate side els of home (interior application). Drill holes above and below fire stops and windows. Plug holes and make ready for finishing. Use UL listed insulation and fill wall cavities to full density. Insulation shall be checked by infrared camera at completion and if areas appear without insulation, contractor shall redo at no extra cost. u _ ` tr., Inaccessible crawl spaces in attic area shall be opened and area properly insulated. Insulate kneewall and flooring to meet State energy codes. Seal all thermo by-passes prior to insulation work. Access panels shall be properly framed and insulated. Install proper roof ventilation for insulated area to meet State energy code k requirements. mac. Install proper gable louvers to ventilate peak area. e d. Insulate accessible rim joist area in utility room, UL listed fiberglas batts, R-19, friction fit. Seal all thermo by- passes prior to insulation work. �. Insulate stove exhaust vent duct in attic area. Seal leakage at roof. ` 1_1n. closet of upstairs bedroom; 4nstell-fiNshed-ceiling, make assembly air fight to insulated peak and wall area. Install batterI ope2t moke detectors in working order, UL fisted, in each bedroom. gA.4,,�6 lWs JA, /'s y-'i2sf=2i' iltbecT✓'io/xs. � S-9 ELECT -- S a. Protect wall receptacles within 6'0" of kitchen sink with GFI. Install 20 amp wall receptacle at counter top. Correct open grounds and defective wall receptacle/switch. S b. Install wall receptacle in bathroom, protect with GFI. Disconnect or ground wall receptacle on wall light fixture. S /.-- c. Correct problem of blowing fuses in living room and kitchen areas. Option: Replace fuse service panel with circuit breaker type panel with main shut off. Service and mast shall be sized a minimum of 100 amps. Tie in all circuits and ground service. Install wall switch and wire to wall receptacle for upstairs west bedroom. e. Install wall switch and wire to wall receptacle or light fixture for upstairs east bedroom. f. install smoke detector on each floor mount on ceiling in hallways between bedrooms and in basement at base -ef-steps. Interconnect and install battery back-up. .�Afiie bathroom exhaust fan to separate wall switch. Johnson. 5422 Madison St. NE, Fndley Page 3 of 3 S—moi: -Install accessible wall receptacle for garage door opener. --i-roundwall receptacles through out home. iA 0/0 TOTAL BID BID GOOD FOR 90 DAYS FROM This work write-up describes the rehabilitation work to be performed on the subject property. The contractor will be required to do all work in a trades like manner and in accordance with the building code and TECHNICAL SPECIFICATIONS. ALTERNATES: S 1. Code plumbing system. Specify all other plumbing code work not listed above and the cost per work item. 5 2. Code electrical service: Specify all other electrical code work not listed above and the cost per work item. 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: 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** NO. RATE TOTAL MA Gas Dryer** Back Flow Preventer Required ( )Yes () No Type _ $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS U 1.5% of Value of Fixture or Appliance State Surcharge $ .50 TOTAL FEE $z'20 JOB ADDRESS 5 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. Owner r .1998 ttunamg used As. Estimated Cost 506 00 PERMIT NO. PLUMBING COMPANY al & WATER SPECIALTIES, INC. e` SIGNED BY 12725 Nightingale t�1_ (612) 755-6468 5 Approved By f=&4_ Rough—In Date Final Date ►GAS PERMIT IS PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES. SUBJECT `PERMIT City of Fridley 2 6 a2"'� AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. 7-3 r , NUMBER REV DATE PAGE OF APPROVED BY � 1 CITY HALL FRIDLEY 55432 "'j 612-571-3450 910415 7-13-98 JOB ADDRESS 5422 Madison SIN Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 1 1 Lyndale Builders 4th SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Carol Johnson 572-9221 3 CONTRACTOR MAIL ADDRESS ZIP J.R.S. Construction, 23555 Monroe St NE, East Bethel, 55005, I 43V-OPfi51, 28WO95 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 52 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Siding, Soffit and Fascia, window 9 CHANGE OF USE FROM TO STIPULATIONS 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 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 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 $5,533 $2.77 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- $112.25 Fire SC $5.53 STRPERFORM CE OF CONSTRUCTION. U TION OR THE �� �� PLAN CHECK FEE Licens SC $Y-00 TOT EE $125.55 IGNATURE OF CONTRALTO RAUTHORIZEDAGENT (DATEI OP VALID BLD INSP THIS IS YOJJR P RMIT KATE S,GNATUREOFOWNER IIFOWNER BUILDER) IDATEI W [ ] Effective 1/1/98 `ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION lj L �i ConstructionAddress:�-Z Legal Description: Owner Name & Address: (24 00 Z i© hw-.� c -j Tel. #_5_ X02 Contractor: COrJ ST/Z oc T l'o /L/ MN LICENSE#Za OS�� Address:. �S /?'Io ^`2aP S r- N ,g S'�1 i�e7t � Tel. # q 3y_26_5-1 0 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 IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. r ��� /,4g(f� A� w/•✓ 013G+�" Construction Type: Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: �- /.3 -/ APPLICANT:T ✓ C ° Tel. # Permit Fee $ '� Fire Surcharge $ s �_ State Surcharge $ SAC Charge $ License Surcharge $ S� Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ /2L 5�— STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] MHFA Carol Johnson 5422 Madison St. NE Fridley, MN 55421 #572-9221 BID SHEET Cyn! //� ► / ...r�� r.v Co ractor tractor's Signature S-1 LIVING ROOM �- Repair damaged ceiling above exterior door and make ready for painting by owner. S-3 BATHROOM $ -a. Redo shower walls. Install new water resistant drywall and new fiberglass liner with molded soap dish. Kohler or equal. Seal all joints and make water tight. Reinstall glass shower doors. $•-q5 b. Redo flooring (includes hallway area). Replace damaged substrate. Install new vinyl sheet floor covering over structural grade undedayment. Congoleum or equal. $15.00 sq yd material allowance. Owner's choice of color and pattern. Edging of floor shall -be covered (confirm material and finish with owner). Reset stool with new wax seal. $ D- C. Install new mechanical exhaust fan, secure in ceiling, duct to exterior, insulate to meet code, size to provide five air changes per hour and equip with damper. Nutone or equal. S•6 BUILDING EXTERIOR Cover entire eave area of house and garage with .019 baked enamel prefinished aluminum. Alcoa or equal. Replace rotted and damaged boards. Apply aerated material to vented soffit area and ensure soffit venting that is open to attic area for unobstructed air flow. Owner's choice of color. � a `'`Qd .Option: Replace gable and breezeway wood siding with vinyl. Install with weather barrier, Ty+ek or �(�.. equal. Alside or equal. Rework items that interfere with the siding application. Owner's choice of color. b. Cover entire trim area around windows and doors of house and garage with .019 baked enamel preCnished aluminum. Alcoa or equal. Replace rotted and damaged boards. Owners choice of color, Rework awnings. $7'S A) C. Install new storm/screen door (entry off living room), solid core, baked enamel prefinished aluminum, with weatherstripping, self -storing storm and screen inserts, hardware and locking device for complete assembly. Benada or°equal. Owner's choice of color. $d. Reframe window openings in breezeway (east and west units) and replace rotted wood framing with new. Work shall include repairing rotted wall framing as needed. Reinstall existing combinations. Option: Downsize window openings and install new storm/screen combinations. Benada or equal. -� Frame interior and exterior to blend with adjoining work as close as possible. Confrim work with owner. 3 Specify new size of windows.,Q= r S41 D 6'0 13 k A,cr S $ . e. Install new gutter and downspout along west roof edge of house and garage ( ere existing), baked enamel prefinished aluminum. Alcoa or equal. Gutters shall be 5" seamless, secured to the roof edge 36" or less on center and pitched. Downspout shall be 2")G" corrugated, minimum 5' out from downspout. Owner's choice of color. Specify total linear footage 122W /I_►r T i. Install new steel service garage door, prehung unit flush without light, new threshold, weatherstripping, hardware �= and locking device. $200.00 door allowance. Castlegate or equal. Reuse trim and casing. Apply painter's finish to primed wood. S-7 HEATING AND PLUMBING �$'MAL a. Install back flow preventers to laundry and exterior faucets. ib. Install new shower/tub fixture, chrome, anti -scald (thermostatic or pressure -balancing type) and with 3 gpm showerhead. Delta Monitor or equal. Install new laundry faucet, brass type with back flow preventer. S "b: Reconnect dryer vent and ensure proper ventilation to exterior. S-8 GENERAL HEALTH AND SAFETY MInsulate sidewalls of home (interior application). Drill holes above and below fire stops and windows. Plug holes V_ OV71- and make ready for finishing. Use UL listed insulation and fill wall cavities to full density. Insulation shall be checked by infrared camera at completion and if areas appear without insulation, contractor shall redo at no extra cost. r';;�.`.?V /01 Johnson, 5422 Madison St. NE. Fridley 'JUN 0 8 RECD Page 2 of 2 01 gt�;�b: Install proper gable louvers to ventilate peak area. kx,-P �c. insulate acoessible rim joist area in utility room, UL listed fiberglas batts, R•19, friction fit. Seal all thermo by- passes prior to insulation work. ��_• % �, d. Install new steel insulated exterior door between garage and breezeway without window (fire -rated), new threshold, weatherstiping, hardware and locking device. $200.00 door allowance. Castlegate or equal. Reuse trim and cas;ng. Apply painter's finish to primed woodwork. Install self -closer. e. Install new garage overhead door, steel panel, flush with no windows,00 with weatherstripping strip at bottom of -..,. g .� door, new stops and locking device. Owner's choice of color. sig "g='vi. Install new range exhaust fan hood. Nutone or equal. Reconnect to duct that extends through roof. Size to meet proper air changes and to cover width of stove top, and equip with damper. Owner's choice of color. S-9 ELECTRICAL a. Replace fuse service panel with circuit breaker type panel with main shut off. Service and mast shall be sized a minimum of 100 amps. Tie in all circuits and ground service. Correct problem of blowing fuses in living room and kitchen areas. Install wall switch ano wire to wall receptacle for upstairs west bedroom. g.c. Install wall switch and wire to wall receptacle or light fixture for upstairs east bedroom.. g - •'d. Wire bathroom exhaust fan) separate wall switch. e. Correct deflective wall receptacle in breezeway and wire to wall switch. 5 . h. Wire new kitchen range exhaust fan. / g TOTAL BID ti �•= BID GOOD FOR 90 DAYS FROM � � G ,.,�. This work write-up describes the rehabilitation work to be performed on the subject property. The contractor will be required to do all work in a trades like manner and in accordance with the building code and TECHNICAL SPECIFICATIONS. ALTERNATES; 5 1. Code plumbing system. Specify all other plumbing code work not listed above and the cost per work item. S 2. Code electrical service. Specify all other electrical code work not listed above and the cost per work item. CITY OF FRIDLEY INSPECTION DIVISION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE 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 Commercial/Industrial 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $ 3D, DO $ 10.00 $ $ 10.00 $ $ 10.00 $ $ 25.00 $ 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 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. $ ),Z Effective On January 1, 2002 JOB ADDRESS NL OWNER BUILDING USED AS R-�' " ESTIMATED COST 4cw PERMIT NO. 16321 DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) Warm Air Trade Name Size No. 1nt\l� BTU LnQ L HP EDR Fuel L Total Connected Load Burner Trade Name Size No. BTU HP EDR The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes an rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE TEL # 70>3 '1J 1 5WO THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON V NT, VENT CONNECTOR AND COMBUSTION AIR VFRIFICATION When ra la cin9 an existingfurance, 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 n No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes l) 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 �0 No( ) The exit ing rnmhnsfinn air is sized and installed to meet the current codes and manufacturer's specifications. Yes OQ No ( ) When required to install a new cnmhustonn air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes 00 No ( ) When one alling a new venting -gy_ em, 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 K 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 W No( ) Appliance #1 Type r"'V nnaC'e— BTU Input %j 000 Fan Assisted or Nat 1i0� Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances L— Total Btu Input Common Vent Type Vent Height 5'i4te- Diameter _� inches Appliance #1 Vent Connector Height tt Length 90' 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 ar^ Com& 4(r 12> codle IU ri L ker- (, .Uf To r�xee+ Ccndleo n,ee e� Ge�fe�� La 'iz HEATING CO: bnAeJct% Avr- 62..Ur` Signed By:Date : Ic4�® CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 Stories Basement Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: 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** Urinal APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Auto. Wash t�rirtk. >:<: Floor Calich ShowerIr�C<><::<:: Trayclt0<:;;::>>° Drainastn:;::. > Washer NO :T Gas Range** Gas Dryer** Back Flow Preventer Required ( )Yes () No Type G7j>i=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 $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance TOTAL State Surcharge $ .50 TOTAL FEE '�fa� JOB ADDRES tttectivc un Jan 1, ZUU3 Gas "tC':;':,. Water Heater Ranoe FRX>QGas Elec _ 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. Owner Building Used As V -)w z , 20& Estimated Cost PERMIT NO. 9 PLUMBING COMPANY[ e AZZI SIGNED BY _ � ?� TEL N020 Approved By Rough -In Date Final Date / PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED r-QMMON VENT- VENT CONNECTOR AND COMBI ISTION AIR VIFIRIFICATHIN When ralaming an Pxentong f uran _ _, 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 r-nmht jstinn air is sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When required to inc au a new rnmhustinn air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a n _w ventin0yve�tPm_, 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 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( ) Aeolian Top- and Si7P/ nmmon Vent and Vent Connector Infonnatien 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 HEATING CO: Signed By: Date : CITY OF FRIDLEY INSPECTION 6431 University Ave NE Fridley, MN 55432 (763) 572.3604 FAX (763) 571-1287 RATE SCHEDULE 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 Commercial/Industrial 1.25% of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 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 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Effective January 1, 2003 JOB ADDRESS_5S� S -r— AJ,5--- OWNER OAR_OL lat 5e� TOTAL BUILDING USED AS�e�� ESTIMATED COST JtOP PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ Trade Name Size No. BTU HP EDR $'0 Fuel Total Connected Load Burner Trade Name Size No. $ V© BTU HP EDR $ �'®� 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 ?-11-93 HEAT ING.Q0 acs Pg* Signed TEL # FAX # Approved By, Rough -In Date Final Date ? ! J03 FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE r THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When replacing an axistingf��ra=, 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 (i No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes (1 -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 pxistin0 combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a npw combustion airy it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When iinstaliulQ a new wanting 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 #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 HEATING CO: U ,Q C­kl 0 Ic Com 7-Rke- ,CS /X, Signed By: Date 3