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PRE 2010 DOCSCity of Fridley, Minn. 11783 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT Date: N^t.rQmbe= 1,-1.972 Owner: _S1igwcon— Inc. Builder Same Address _._5901 Brooklyn Boulevard Address Same LOCATION OF BUILDING No. - 5566 ____. Street Meister Road N.E. part of Lot Lot __8____ Block 1 ___._.._.___._ Addition or Sub -Division T ns rxir-k North Townhottge Addn. Corner Lot __—__ .._ _ Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation _ DESCRIPTION OF BUILDING To be Used as: 1496' To`znhot ___._.._.._ Front _ 24' _... Depth 31' Height - 28' _ Sq. Ft744 t Cu. Ft 20,8 32 t Garage- __.._._ Front 201 Depth _22' Height I__ Sq. Ft. 440 Cu. Ft 440 t Type of Construction Wood VrnEst Cost — $25,416 To be Completed Haxch,-1973.. Stipulation: See 5510 Meister Road N.E. 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 forth and in compliance all provisions of ordinances of the city of Fridley. 12.71 SUte Surcha In consideration of the payment of a fee of permit is hereby granted to ITewcn-n, Znr. 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. CLARENCE BELISLE NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to no the Building Inspector for separate permits for these items. APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING URMIT CITY OF FRIDLEY) MINNESOTA OWNER'S NAM: 4/ee aeon" .2-.ve. BUILDER: ADDRESS : %:MO/ AtfIl-00A /Yar >3/s+1: / ADDRESS: '34 ', e. NO :.o�iSTREET: ��� ®a d �>' LOT: $ BLOCK: / ADDITION: _7ow1Jowcd ®YS. -IJ 7-11. .��✓�% 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. DESCRIPTION OF BUILDING To Be Used As: L+ iso h4oewje_ Front: Z* Depth: 3/ Height: Z 8 Square Feet: 744 Cubic Feet: 20 493AO DW &^aa g, Front: 2 o Depth: � ° Height ; ®® Square Feet; -440 Cubic feet: �Q►400 Type of Construction: /'���►'�'°� Estimated Cost.- To ost:To Be Completed: a'�t4 . /moo /9 7, The undersigned hereby makes application for a permit for the woxIc hergin specified, agreeing to do all work in sttict accordance with the Qlty 4t Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this applict4timn are true and correct. DATZ 72-o SIGNATURE: m� (See Reverse Side For_Additional Information.) 'y J, t 0 City of Fridley AppVcgRion for m Fhtkg Para* �� Dept. of Bldg*. Phone 560-3490 DESCRIPTION OF WORE (pYU p � Number, Kind and LecaBion ®f llixtuYae e e war" Is I JI » cis ncc. Hast • las 1 44 ]::�F i � Rhin PARTIAL RATE SCHED &-,) PLUMBING FIXTURE RATES: O. RATE 4�T�6TA�L� Number Fixtures ................ �.��. x $2.00 S Future Fixture Opening .... i ...... x $1.50 = - New Fixture Old Opening .......... it $1.50 Catch Basin . . ... .. . . . .. . .... ... x $3.25 !_ • Water Heater !Up to 99.0(0 BTU) .... _,� x $3.00 $ s - New Ground Run Old Bldg......... x $3.25 S Electric W®tar heater .............. a $2.00 5 GAS FITTING FEES: NO. RATE TOTAL lot 3 Fixtures ............. • • . • • _ x 5200 $ Additional FiXtuses ................ x $ .75 $ Gas Range to 199.000 BTU ............ x $5.00 i State Surcharge $ .50 REPAIRS t ALTERATIONS—Rebs to Code _ Description ...................................... S... TOTAL FEE - City of Fridley: The undersigned hereby makes application for a permit for the work herei, speeiSied. 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. Mina Owner Kind of Building Used as To be completed about c c= Estimated Cost. $ Old ew. uilding Permit No. Permit No. Signed By Bu s M- 7217 - 77th AVE. NO. MINNEAPOLIS, MINN. 55428 ROUGH 425-4183 772"311r9!'A'g WARM AM: RATE TOTAL Shell A Duct Work ..... .. $10.00 $ Replacement of Formce ... ..... &00 Repairs & Alterations --up to $300.00 620 Repairs & Alterations each add. $M.00 &OU DMCIL WART[ AM � Shell do Duet Work to 130,000 BTU ...... . each add. 60,000 BTU ............... .... &W F Replacement of Furnace 11.00 ; Repairs & Alterations—up to SM.00 3.00 $ Rapairs & Alterations each add. SM.00 3.00 ., ,,,. `llZr`-'I mmnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $ --- P%vnace Shell & kine—to 640 sq. ft. EDR Hot Water 10.00 $_ Each add. 100 sq. ft. EDR Steam &00 Each add. 320 sq. ft. EDR Hot Water 3.00 OIL BURNER—to 3 gal. per hour 6.00 over 3 gaL per hour—See Fee Schedule GAS B cup to JA00D BTU) LOD over 199,000 FM Sw Fee Sdoduls GAS FITTING FEES. NO RATE TOTAL 1st 3 Fixtures x$ zoo $ Additional Fixtures x ,W ; Gas Range to 199,x@ 36 MD $ AIR COIIDITIOIf11101 FAN HEATUM STSTM YEN Y'1LATING ST8'1°= ALTERATIONS & REPAIRS ROUGH rwAL A -.2 0- 2 V City of rddley: The undersigned hereby makes applicallan for a permit for the work hereb specified, agreeing to do all work in strict.A nm with Vice City ee and ruling of the Department of Buildings, aFmd hereby declares that 0 tl a fiat and representations stated in this application are true Fridley, Rthm 19 — Owner /j 4aL" S a -&-- Kind of Building Used as as To be completed about _____ Estimated Cost, 01st --New. Buikling Permit No. Permit Nl.__�- DRSCIMPTIM O>r WOIt>iC' HEATING team, Not Water, Warm Air—No 1Yade Name Size No.3-q4j— /,oe Capacity— SOI. TL E.D-R S1V HB Total Connected Load Hind of F1:e BURNER — Trade Name Size No Capadty Sq. Ft JLD.R BTU ISP. TOTAL. F'i6 c - lauea�ss—Ducal �i .M P1 .� ` , City of Fridley SUBJECT 22714' AT THE TOP OF THE TWINS BUILDING PERMIT i RECEIPT NO. COMMUNITY DEVELOPMENT DIV. ______ r 1 y - PROTECTIVE INSPECTION SEC. _ 067 1 � 1 NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 7/13/94 JOB ADDRESS 5566 Meister Road NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 1 INnsbruck North Townhouse SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Dicks Fire & Storm 864 19 Ave SE, Minneapolis, MN 55414 781-6170 2481 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 O NEW 0 ADDITION O ALTERATION Ek REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof House & Garage (Tear-off); gutters 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Inform owners to install smoke detectors as per State Building Code, adjacent to all sleeping areas and in basement. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. 1 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $ 2,270 $1.14 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SACCHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $54.00 Fire SC $2.27. STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE License SC $5.00 $62.41 E ROPE LY V IDATED THIS IS YOUR PERMIT SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI 141A BLDG INSP DATE SIGNATURE OF OWNER OF OWNER BUILDERI (DATEI NEW [ l ADDN [] CITY OF FRIDLEY ALTER' [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: 5566.- Meister Rd., Fridley , Mn. Legal Description: Effective 1/1/94 Owner Name & Address: �4rr�Ce f;' r Tel. # Contractor: R.J. Williams General Contractor MN LICENSE# 2481 Address: 864 - 19th Ave. S.E., Mpls., Mn. 55414 Tel. # 781-6170 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it. to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Comer Lot [ ] Inside Lot [ I Ft. Yd Setback Type of Construction: h o u s e_ a n d Approx. Completion Date: gutters araRe roof Driveway Curb Cut Width Needed: DATE: 7/8/94 APPLICANT: Side Yard Setbacks Estimated Cost: $--2,-2-9 (Cost on Back) Ft. + 6 Ft = Ft x $ R.J. Williams General Cont. Tel. # 781-6170 y CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge = $ 7 .001 of Permit Valuation (1/10th%) State Surchar e` " '�' $ $.50/$1,000 Valuation Surcharge— SAC Charge C =� � $ $800 per SAC Unit License Surchar�ej� $ $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 v STIPULATIONS: .j�-sr ®r 01 SUBJECT PERMIT NO. City of Fridley 30245 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. I. • COMMUNITY DEVELOPMENT DIV. _ r I PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 91aFt5 9/21/99 JOB ADDRESS 5566,70,74,78,82,86,90,94 Meister Road NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1_8 1 Innsbruck North Townhouse SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO North Central Bldrs Inc 7401 42nd Ave N New HopeSS427 a 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 O NEW 0 ADDITION O ALTERATION 7a REPAIR 0 MOVE O REMOVE 8 DESCRIBE WORK Reside Townhouse and garages 9 CHANGEOFUSEFROM TO STIPULATIONS Call for building wrap inspection before covering. 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 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. I NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISION OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF �1 PERMIT $4'4',928 $22.46 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 PER RMANCE OF CONSTRUCTION 1 $593.25 Fire SC 4.93 PLAN CHECK FEE TAL FEE 9°r Licens 5.00 $665 . $IGNATUpE OF 'aACTOp OR UTHOAiZEO AGENT iDA fIE, (DATED H IS R PERMIT IVk?4N 4PIOPER gA1F ®r 01 NEW[ ] Effective 5/10/99 4Z ADDNt J CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: 0 4.-) Legal Description: Owner Name & Address: Contractor: A/v 0-7s/ Tel. # i 4.,j zrYM .TRIC MN LICENSE # *;'7 � 3 Address: —7401 Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length GARAGE AREA: Length DECK AREA: Length OTHERS DESCRIPTION OF IMPROVEMENT Width Height Sq. Ft. Width Height Sq. Ft. Width Hgt/Ground Sq. Ft. 'r Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: Zv °/ 9 APPLICANT: Tel. # &-3 3 e CITY USE ONLY Permit Fee $ S Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ 6.00 $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: 7 SUBJECT - PER City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT 31047 f O - ------COMMUNITY DEVELOPMENT DIV. � PROTECTIVE INSPECTION SEC. 3(06 1 . . CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910 -FIS 6/8/00 JOB ADDRESS 5566, 70, 74, 78, 82, 86, 90, 94 Meister Road NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1-8 1 Innsbruck North Townhouse Addn SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Innsbruck Townhome Association 651-224-5482 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Garlock -French Roofing Corp2301 E 25 Street, Minneapolis, MN 55406 612-722-712 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 1423 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Townhouse Building 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION] REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof Building 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Permit Inspection Cards Will Be Mailed To Homeowner TwPost SEPARATE PERMITS ARE REOUIREO 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 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 8 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 r $17,980 $8.99 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. 293.25 Fire SC $17.98 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE 320.22 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT ]DATE. N P OPE ALIO D THIS ISUR PERMIT rY! // - t046 SIGNATURE OF OWNER,6 OWNER BUILDER, ] ATEI SLOG I SP gAtE NEW I] ADDN [] ALTER [ ] Construction Address: Legal Description: Contractor. CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION 7D, 7L 12, Sa, S Effective 1/1/2000 612.672-3604 Bldg Insp r # fo5 (- as q - 511% 2 MN LICENSE # �Y�Tel. # -71.29 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height _ Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: Construction Type: R h Estimated Cost: $J �� • 3 Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x DATE: l0 2 APPLICANT: � - l.Lkn Tel. -712'1 CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge Call (612)'572-3604 for Permit Fees If mailing in application -;25 Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $ $1100 per SAC Unit $ $5.00 (State Licensed Residential Contractors) "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ 3.2®.0202 STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 '7 A -4'n 1 :UeA Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS,--� S (2 /f"/P�� /1f!-- /\(l/ New Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $10.00 and representations stated in this application are true and correct. Catch Basin $10.00 Rain Water Leader $10.00 DATE: Z_e T ,Z�'� .20 Sump/Receiving Tank $10.00 &;42 Water Treating Appliance $35.00 OWNER zj79 / rl 2r - Water Heater -Electric $35.00 ter - Gas" $35.00 BUILDING USED AS �� ��G+• dew Gas Range $10.00 Gas Dryer" $10.00 ESTIMATED COST f%a PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMPAN P/ Reinspection Fee $50.00/Hr SIGNED BY TEL ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge $ TOTAL FEE $ COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing 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 ( ) 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 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 ( ) 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 :