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PRE 2010 DOCSCity of Fridley SUBJECT PE 12224 AT THE TOP OF THE TWINS BUILDING PERM l r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. "V�� r PROTECTIVE INSPECTION SEC. 1 = � IL CITY HALL FRIDLEY 55432 � ,'J NUMBER REV- DATE PAGE OF APPROVED BY ----� 612-560-3450 910-F15 7/10/73 JOB ADDRESS 5510 Matterhorn Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 k 4 1 Innsbruck North SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Robert Lau en Homes Inc 6866 East Fish Lake Road M le Grove 55369 788-238 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 IX NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBEWORK Construct 49' x 24' & 30' Dwelling and 22' x 26' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway . Provide a verifying survey before capping. Double all headers over 4 feet in exterior or bearing walls. SEWER LOCATION: 168' South ofManhole (Inv. 976.93) Wye Elev. 980.39 Top of Footing: 984.00 Minimum WATER LOCATION: 178' South of Manhole 10' South of Sewer Service SEPERATE PERMITS REQUIRED FOR WIRING,, HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMM ENCED,WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1 934 & 945 26,420 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 $26,989 13.49 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PER RMANC CONSTRUCTION. $60.00 $275.00 PLAN CHECK FEE TOTALFEE 7 48.49 SIG Ar URE OF CONTRACT 0 AUT Ho AGENT (DATE) jWHE PROPERLY VALIDAT iH IS YOUR PERNLIT , 9�4BLDG. SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) )NSP GATE .: APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME: BUILDER :LI-PErT t a C-�, /,tel �1luEg j -,I C. ADDRESS: ADDRESS: (� 8A6,Ez-r--r11w L 14A-P�E (a2ove 553��/ NO:. 5 510 STREET: / Y (AA'r 7- C— .►.- Q Z -r%1 LUE LOT : 17 _ BLOCK: ADDITION : ZNNs$,-LIC r /YeP- i 4l CORNER LOT: INSIDE LOT:—/_SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To Be Used As: DESCRIPTION OF BUILDING �� Front: Depth: � �'� � Height S/ Square Feet: �✓ S— Cubic Feet: 0 Front: 9 2 Depth: C' Height: Square Feet; Cubic Feet: /2'a Type of Construction: � storey le,4Mr Estimated Cost: $ 35 Q To Be Completed: %\/® y, / / 5 7 3 r' The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stfict 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. DATE: Ju SIGNA : G (See Reverse Side For Additional Information.) -, 715;GZ 13�Ll r GEP.AkD T. COYNE 300 BRUNSWICK AVE S. GOLDEN VALLEY. MINN. MINN. REG. NO. 4741 INDUSTRIAL -- JUDICIAL COMMERCIAL — TOPOGRAPHICAL CITY LOTS — PLATTING j,Q ER.T ,LAUGEN H Lot12, Block 4, INNSBRUCK -NORTH 1 c1 T,rrYa1 We hereby certify that this is a true and correct representation of a survey of the boundaries of the above described land and the I=cation of all builldings and visibte encroachments, if any, from or on said land. Surveyed by us this -29th day of Ju 19 "YMOND A. PRASCH 6417 IDAHO 'AVE N. BROOKLYN -PARK, MINN. MINN. REG. NO. 674-3 r MVOICE ko Q'7 ' f IL NO. .,,,_5 J SCALE I" �. .10 46,1 O —' 'DENOTES IRON I t d - Wood hubs set for excavation onl* t 46,1 I t eLA) e-(- zoclejrrd-) (%� 7 -EC ' OF AppBcd* a for Mmbbiq and Gas Mthig Pw1' - - Dept. of Blues. Phone '.�^^0-��UM DT 'BCRIPTIon or WORK * /'L -i ZY2�'�i� Number, Kind aad Location of nXturea ` PARTIAL RATE SCHEDULE PLMMING FtATO= PAT=: Tia RkTE 811MMM Number Fixtures ................. s no t a 14 ° n0mv raft= Opening ..... r . w ... , z $1.50 i`2: 66 New Fixture Old Opening..........,x MM1162"M"M Catc% Baer ............. Water Keater ",up to !GAW B @'V1.... L z nam t 3 � New Gnumd Run Old BW ........ Ir 025 f EkctdvWktwKm6w ...........•w s S Gltd FiZTEIFG ME& TBS TOTAL tat 3 FixttfHr7e� ......�......... r .. e e. MHAMTt _ j b O AddMonadtowM�y�..a..�l�.e�a .......... i/i19f.000 /�/ s * .aY S am to I� W V FM .........F-zWW 6 State Surcharge $_ 50 tiIWAM & YLTZ£BMCIIW--� to Carr _ MWEENMEMEMMEMMEEM PARTIAL RATE SCHEDULE PLMMING FtATO= PAT=: Tia RkTE TOT" Number Fixtures ................. s no t a 14 ° n0mv raft= Opening ..... r . w ... , z $1.50 i`2: 66 New Fixture Old Opening..........,x Catc% Baer ............. Water Keater ",up to !GAW B @'V1.... L z nam t 3 � New Gnumd Run Old BW ........ Ir 025 f EkctdvWktwKm6w ...........•w s S Gltd FiZTEIFG ME& TBS TOTAL tat 3 FixttfHr7e� ......�......... r .. e e. MHAMTt _ j b O AddMonadtowM�y�..a..�l�.e�a .......... i/i19f.000 /�/ s * .aY S am to I� W V FM .........F-zWW 6 State Surcharge $_ 50 tiIWAM & YLTZ£BMCIIW--� to Carr _ t+w.►........4 TOIrAAT. V= 6 3-7.5-1 city of The undersigned hereby makes application for a permit for the wak heraf- specified. agreeing to do all work in strict accordance with the City Ordinanmr' and ruling of the Department of Buidlaa and hereby declares that all the fadz: and repr+esentsUans stated in this applicatiso are true, and correct Fridley. Minn f 7 .192.3 - Kind n2.3 - Kiril of Building. /tiiz Used as ��,�, � To be completed about // - / )- - '73 Estimated Cam, Old—New. Building Permit Businvas Pbuoe for Power Phoft and bleating, Cooling, Ventilation. Rall - ation and Air Conditioning System and Device PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace SheU & Duct Work ................ .. $10.00 $ Replacement of Furnace .... . ..... .. ..... 6.00 $ Repairs & Alterations—up to $500.00 6.00 $ Repairs & Alterations each add. $500.00 3.00 $--_ _ MECH. WARM AIR Furnace SheU & Duct Work to 120,000 BTU ........ .110.00 $L 10.00 each add. 60,000 BTU .................... .. 3.00 i Replacement of Furnace .... 6.00 $ Repairs & Alterationsr-up to $50o.00 6.00 $ Repairs & Alterations each add. $500.00 .... .. 3.00 $ STEAM or HOT WATER SYSTEM Furnace SheU & Lines—to 400 sq. ft. EDR Steam $10.00 $. _ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $_ Each add. 200 sq. ft. EDR Steam 3.00 Each add. 320 sq. ft. EDR Hot Water 3.00 $� OIL BURNER—to 3 gal. per hour 6.00 $ _ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 188.000 BTL)6.00 $ 5.00 over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ..... 1 x$ 100 $ 2.00 Additional Fixtures x .76 $ Gas Range to 199,000 x$ 800 $ AIR CONDITIONIIIa FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS A ROUGH FINAL /aZ - Dept. of Bldgs. Phone 8804480 City of Fridley: The undersigned hereby makes application for a permit for the work :hereir specified, agreeing to do all work in strict accordance with the City Ordbmance; and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, luitnn- Sept. 10, 197 1g Owner Robert Laugen $owes Kind of Building __ frame Used as.. --- ___ residential To be completed about __— 10/5173 Estimated Cost, $__200.40 Old—New. Building Permit No. Permit No. 15-9912-' DESCAIP710111 OF WORK HEATING Or POWER FLAN15--S1earn, Hot Water, Warm Air—No--2-- Trade ir—No 1Trade Name Lennox Si N; Gll-110 Capacity 88y 000 Sq FL ED.R BTU H.P. Total Connected Lead b29424 Kind of gyms Gas BURNER — Trade Name S IE AS ABOVE I Size No Capacity Sq. Ft. ED.R BTU NIP. SAIESMAN: Don Bell 05753) See Fee Scheddo COPY OF HEAT LOSS ATTACHED. $ _Som CHGE TOTAL FEE 17. 0 S Business G &AIR CONDITIONING %k Louis park Nlineuota ,asass. (REMARKS -OVER) HEAT LOSS CALCULATIONS A.Guide Weatherstrips Guide Construction No Insulation Windows I Doors Reference Out. Wall Int. Wall Ceding Roof Floor Iiiiaad I dow Applied e: e1 s—No Yes— 0 19_ Room I length zo Width Heightro.�l Fl.1 e.�� �) Room Length : Width d° 6 • Height Windows and Doors—Crackane and Area Width Height No. of vane of pane No. of Linoat it. lights of track Area sq. ft. 7 I� o Area eq. ft. Area sq. ft. 4� 1-.,'. -26 Coef. Btu Infiltration --� Coef. Btu Infiltration Glass -, r , ;' ti � - Glass Exp. wall r Coef. �� . Exp. wall '' Net exp. wall Ce,ting - • ¢y ��� Net exp. wall Int. wall _- Total Btu. , Int. wall Ceiling Floor _ Room I Length z,-,, Width F= Net exp. wall-, Ceiling Floor -Total Btu. /') o Required sq. ft. E.D.R. or sq. ins. W.A. Leader area / Room Length Width f' Eleiaht 7777 Windows and Doors,—Crackage and Area L Width height No. of ,Lineal ft. No. of pane of pane lights of crack- Width Height No. of Lineal ft. No. or pane of panelights or crack Area eq. ft. Area sq. ft. 4� 1-.,'. -26 I t. wall 1�n Coef. Btu Infiltration � 5 Coef. Btu Infiltration f; ' -, r , ;' �, 4 - Glass Net exp. wall Coef. ki . Exp. wall '' Ce,ting - • ¢y ��� Net exp. wall Floor _- Total Btu. , Int. wall Int. wall Ceiling g _ Room I Length z,-,, Width F= Net exp. wall-, Ceiling Floor Floor�,,� f �' Total Btu. r p. v Required -sq. ft. E.D.R. or sy.`in : W:A. Leader area' � ' Room I Lenath Width MIX Windows and Doo rs—Craekage and Area L Width height No. of ,Lineal ft. No. of pane of pane lights of crack- Width Height No. of Lineal tt. No. of pane of pans lights of crack Area Area sq. ft. 4� 1-.,'. -26 I t. wall 1�n Coef. Btu Infiltration � 5 Coef. Btu Infiltration Glass -, r - 0 11 '(J' r Class Net exp. wall Coef. ki . Exp. wall ' Ce,ting - • ¢y ��� Floor Floor _- Total Btu. , Net exp. Well Int. wall Ceiling g _ Room I Length z,-,, Width F= Net exp. wall-, Floor�,,� Int. wall Tntal Rtt,- Ceiling ",. • y __ , Floor Total Btu. s vie, a.uLU. .. F - _ Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.�- Room Length / g Width /.� 14,.;aht Windows and Doors—Crackage and Area L Width height No. of ,Lineal ft. No. of pane of pane lights of crack- Width Hetgnt No. of Lineal ft. No. of pane of pane Ilghts of crack Areas eq. ft. Area sq. ft. 4� 1-.,'. -26 I t. wall 1�n Coef. Btu Infiltration � 5 Coef. Btu Infiltration Chas Exp. wall -2z--, ' Glass -, r - / � Net exp. wall Int. wan Net exp. wall Coef. ki . Ceiling 412 Ce,ting - • ¢y ��� Floor Floor _- Total Btu. Required sq, ft. E.D.R. or sq. ins. WA_1-4u&. area Int. wall Ceiling g _ Room I Length z,-,, Width F= Net exp. wall-, avua, t.➢ttt• � / �/ 0 Required sq. ft. E•D.R. or so. ins- W -A- i ps.t., sae Windows and D®ors—Crackase ana Area L Width height No. of ,Lineal ft. No. of pane of pane lights of crack- Area sq. ft. of Lineal ft.� lights of crack Area sq. ft. 4� 1-.,'. -26 I t. wall 1�n Coef. Btu Infiltration � 5 Infiltration �--, r Glass Glass Btu ;wl Exp. wall Exp. wall Net exp. wall Coef. ki Int. •vall - Int: wall Ce,ting - • ¢y ��� Floor Floor _- 1 otat Z$tu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area ,'V, FI.I „! .. Room I Length . F� Width ei t�,� z Windows and Doors—Crackage and Area ' Yi l No. Width HeightNo. of pane of pane of Lineal ft.� lights of crack Area sq. ft. 4� 1-.,'. -26 I t. wall 1�n j Btu Infiltration �--, �� eJ .i Glass Btu ;wl Infiltration Exp. wall Coef. ki Infiltration Glass Exp. wally Int: wall Ceiling Net exp. walls Floor -? Total Btu. Required sq, ft. E.D.R. or sq. ins. WA_1-4u&. area Int. wall Ceiling g _ Room I Length z,-,, Width F= Net exp. wall-, Floor�,,� Tntal Rtt,- Ceiling Required sq. ft. E.D.R. or sq. ifis. W.A. Leader area: Room I Lenath ?? ._Wideh la Mei,w!he Windows and Doors—Crackage and Area Width Height _ No. of pane of pane No. or Lineal It. . Area lights of crack sq.tgqt. No. of Linoal ft. Area lights of crack eq. ft. p. waA 4� 1-.,'. -26 I t. wall 1�n Coef. Btu Infiltration �--, �� eJ .i Glass Btu ;wl Infiltration Exp. wall Net exp.'wall S Int: wall Ceiling 1 Floor -? Total Btu. Required sq, ft. E.D.R. or sq. ins. WA_1-4u&. area t Heiah' t � _ Room I Length z,-,, Width F= Windows and Doors---Crackage and Area ass _ Wldth Height No. of pane of pane No. of Linoal ft. Area lights of crack eq. ft. p. waA 4� 1-.,'. -26 I t. wall 1�n Int. wall ii' Coef. Btu ;wl Infiltration C Glass Exp. wall Net exp. wall-, Inc. wall Ceiling Floor Total Btu. fired sq. ft. E.D.R. or sq. ins. WA. Leader arra equired sq. ft. E.D.R. or sq. fns. WA. Leader area Required sq. ft. E.D.R. orsq. ins.WA. Leader area �`+•el�..�S rrrrar�Ifq�ri�ef,�ll. _-.. ._ :_ ,..., •;7 .a ass _ Glass p. waA Exp, wall et exp. wall Net exp. wall t. wall 1�n Int. wall eilingCeiling oor Floor otal Btu. Total Btu. equired sq. ft. E.D.R. or sq. fns. WA. Leader area Required sq. ft. E.D.R. orsq. ins.WA. Leader area �`+•el�..�S rrrrar�Ifq�ri�ef,�ll. _-.. ._ :_ ,..., •;7 .a CITY OF FRIDLEY INSPECTION DIVISION � Effective January 1, 2003 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR GOWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES FAX (763) 571-1287 RATE SCHEDULE JOB ADDRESS 5'> OWNER Pf \ zxr 9 -Te C f, or e- � Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED ASv� I� Also Replacement Furnace $30.00$_ _ (Side Vent - Fill Out Back) ES-TIMATED COST E:� ' �-6PERMIT N0. Gas Piping (Needed with new furnace, $ 10.00 $ Gas Range but not replacement) � $ 10.00 $ DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Gas Dryer $ 10.00 $ Trade Name Size No. HP EDR *Air Conditioning - All Sizes $ 25.00 $ Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial 1.25% of Value of Appliance or Work $ 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 ar, h 4,le-k State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and TOTAL FEE representations stated in this application are true and correct. d �, S'`� G� DATE MINIMUM F E FOR ANY HEATING/COOLING/VENTILATION HEATING CO REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 oaea PLUS THE$.50 STATE SURCHARGE Signed �,�,.�"° i1 EL # 27x0 hL FaK4&w Awa. FAX # p,0qewp. Baa 55113 REINSPECTION FEE $47.00/Hr 651=34W *Air Conditioners can not be placed in a side yard without Approved By Rough-In Date' Final Date written permission from adjoining property owner. iles,IG( 461, He f- t t^ s ®c �7 t rv1 THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED . When , 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 (1 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 is sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) Whe_ n, required to install a new nmh mHnn airs it will be sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When InsbIllnn a new venfipgsT tem, 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 �- F' P�G�, HEATING CO: Signed W. Date : CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-5711287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Fumace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning -AII Sizes All Other Repairs or Alterations (List on Back) 1916 of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater Effective 4/1/2004 APPLICAI FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIG TION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS *e'd4 Fee Total Q per' Owner ZZ `i G&�� $35.00 $ 3s - $10.00 $ $10.00 $ $10.00 $25.00 $ O-S-oo Commercial/Industrial/institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR $ Building Used As Vfs !fit cc-/ ESTIMATED COST rOJ PERMIT NO DESCRIPTION OF FURNACE AND BURNER # of Heating Units Cir le One (Steam) (Hot Water)arm 'r) Trade Name G Size No. ; BTU t HP EDR FueI14_ge4,cr4 Total Connected Load Burner Trade Name BTU HP Size No. _ 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 $ and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. • HEATING CO -STANDARD HEATINGR CONDITIONING O 410 WEST LAKE STREET $ 6O ,SO MINNEAPOLIS,544B-996 *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEM..I IT FURNACE FAX #��- `y3 G Approved by Rough4n Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacina an existing furnace, 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 ( t1 No( ) The undersigned also verges 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 existina combustion air is sized and installed to meet the current codes and manufacturer's 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 (yam No When IMWIhw a new venting system, the undersigned hereby verges 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 Typed BTU Input Fan Assisted or Nat Appliance #2 Type TTT4 BTU Input 0(g® Fan Assisted or Nat - !- Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances i Total Btu Input Opt) Common Vent Type V Vent Height `-I Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type 70C�- Appliance #2 Vent Connector Height 3 ,� ft Length ft Diameter in Type 604,J Appliance #3 Vent Connector Height ft Length ft Diameter min Type 0 -C -CL /jC- d"'Z R<— HEATING CO: �N�-y f ion d Signed By: / Date / - /o"- ®jam