PRE 2010 DOCSCity of Fridley, Mian. 11787
6431 University Ave. N.E., Minneapolis, Minn. 55432.
BUILDING PERMIT
Date:
Owner: _yI.ewcon.. 1ne. Builder ,Same
Address _.59-Ql-13 ggk_y_ BoUle-yard Address Same
LOCATION OF BUILDING
No.Street _Meeister RoadN..E. - Part of Lot
Lot . _1 _ _ Block 1 ____ Addition Addition or Sub -Division ._I sbruck North Townhouse Addn.
Corner Lot _____ _ _ Inside Lot ._ __ X Setback Sideyard
Sewer Elevation ___ _ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as: 1240'
Townhouse ______ Front 20' Depth 31' Height 28' Sq. Ft. 620' Cu. Ft. 17360
Garage—_.— Front .._20!_ _ Depth 221 Height 101 � Sq. FL 4401 Cu. Ft. 44001
Type of Construction - Wand Fri Est. Cost _42,1 -,AJ T- To be Completed Mar-Gh, 3972
Stipulations: See 5510 Meister Road N.E.
In consideration of the issuance to me of a permit to construct the building described above, I agree tg 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. Z /
In consideration of the payment of a fee of $61 • ,D , 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 ordinsnees of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
wig � city limits and this permit may be revoked at any time upon violation of any of the provisions of said
I:pectof
CLARENCE BELTSLE
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.
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME: �' Ieo" - -,ve. —BUILDER:. Sa~ e,
ADDRESS :.5" 9101 iel-OaA sym, %BaeW. ADDRESS:
s��
NO: S"S9� STREET: �'•� ®a4V
LOT; BLOCK: ADDITION: _wx..& ed Wa.-10 7. .2 NW.061W.
CORNER LOT: INSIDE LOT: &"'� SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and propoeed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
od o!,,"howre. Front: Zo Depth: 3/ height: Z8
1240
Square Feet: d Zo Cubic Feet: 17.Jg0
061 6ae:ege- ' Front: 20 Depth: a2 ® height; d0 At .
Square Feet; 440 Cubic Feet: 4400
Type of Construction: A4vd o4Pa-40va Estimated Cost: $ Z,*
i e. Fly f
To Be Completed:& e.4 14�, 1922,
The undersigned hereby sakes application for a permit for the.work #ger*&U
specified, agreeing to do all work in sttict ,accordance with the City of
Fridley Ozdinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this applicatign
are true and correct.
DgT �- �®'7� SIGNATURE6.1, 2tattt.
(See Reverse Side For Additional Information.)
d_
aso
c.C'j p.. s'fJ 'Wvandkibs. 'tltiS m
ART � k F11 1 "i PSAW
7
PAS F IAL '61AOM
1MAW"'MANN AM: DATE TOTAL
numace Shell A Duct York 410.00 $
Replacement of Fa=ce... 6.00
'Repairs &r Alterations—up to $W.00 COO—
Repairs & Alterations each acid. $500.00 3.00
WARM AM
Amnace Shell & Duct Work to 190,9M BTU ...... . $10.00
nch add. avec BM .. ........ ... .. .... SM i
Replant of Ftitrnace 6.00 $
Repairs & Alterations—up to SM.00 0.W $
Repairs & Alterations each add. 3M.00 &00 $
rtranace Shell & Lines --to 400 sap. ft. EDR Steam $10.00 $
7urnace Shell & Eine—to 640 sq. ft. EDR Hot Water 10.00
Each add. 260 sq. ft. EDR Steam &on
Each add. 320 sq. ft. EDR Hot Water 3.00 $
OIL BURNER—to 3 gal. per hour 6.00 3 _
over 3 gal. per hour—See Fee Schedule
QM BMMNER cup to 19%000 BTU) &00 $
over 189,000 BTU 8" Fce® ZdMAUIG
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures x$ zoo _
Additional Fixtures x .7 $
Gas Range to 189.00® X$ M $
Ant COIIDITION=a
FAN HKATING ST57M
VEX M-ATING STSTM
ALTERATIONS & REPAIRS
AVMH
$ /D r 4'Vtoo* Fee •
City of Fridley:
The undersigned hereby makes applicalMon for a perannit fw the work hareig
specified, agreeing to do all work in strict pordance with the Ott Ordkenew
and ruling of the Department of Building. afid hereby declare gnat an tie ffnday
and representations stated in this application are true .
0 Fridley. Kilian
JJ
Owner l9�P_�
Kind of Building A e _
Used as
To be completed about
Estimated
Old—New. Building Permit No. Permit No.
BEATFNG or POWER P1JkN S,-4 team, Hot Water. Warm "—No
Trade Name Sime Filo • —_
Capacity— Sq: Ft E.D R STU H.P
Total Connected Load Rind of lite
BURNER — Trade Name Size Na
Capadty Sq. Ft E.D BTU Mp.
(*MAiKS-0VUj
City of Fridley
AppFcaHon for Phmbing mid Gv= Rtbg Pwmit
Dept. of Bldgs. Phone NO -3480
DESCRIPTION OF WORE
Number, Kind and Location of Fixtul?"
Base
4th
PARTIAL RATE SCHEDULE 1j,1C
PLVMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ... a ............ . x $2.00 $ ® •
Future Fixture Opening ........... x $1.50 =
New Fixture Old Opening .......... x $1.50 =
Catch Basin .................... x $3.25 f
Water Heater (Up to 99.000 BTU)... e x 53.00 t `0-0
New Ground Faun Old Bldg......... x $3.25 $
Electric Water nester .............. a 52.00 5
GAS FITTING FEES: NO. RATE TOTAL
14 3 Fixtures x 52.00 $ 2
Additional Flatures .............. x $ .76 5
Gas Range to 199,000 BTU .. ,......... x $5.00 1
State Surcharge $ .50
REPAIRS & ALTERATION$—Refer to Code _
Description . e a ......... s e e . ... . .... . ...... . . .. o . e....!
TOTAL ru $ 3
City of Fridley:
The. undersigned hereby makes application for a permit for the work herei.
specified, agreeing to do aII work in strict accordance with the City Ordinance
and reeling of the Department of Buildings. and hereby declares that all the fact
and representations stated in this application are true and correct
Fridley. Min-
Owner
ieOwner y
Kind of Building,
Used as
To be completed about
Estimated Cost. $
Old New, Building Permit No. Pormtt No.
Signed
ROUGH -
ePCEY pttIM131 "
Businesyfpyne O
MINNEAPOLIS, MINN. 554.28
425-4 .', 83
City of Fridley
SUBJECT
R MfT NO.
2'2 7 0 7
AT THE TOP OF THE TWINS
?
BUILDING PERMIT
RECEIPT NO.
_ COMMUNITY DEVELOPMENT DIV,
tr PROTECTIVE INSPECTION SEC.
7S
I ,
c>-)6
NUMBER
REVDATE
PAGE Of
APPROVED BY
= CITY HALL FRIDLEY 55432
612-571-3450
910-F15
J
7/13/94
JOB ADDRESS 5594 Meister Road NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
1
1
Innsbruck North Townhouse SHEET
2 PROPERTY OWNER MAILADDRESS 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
❑ NEW ❑ ADDITION ❑ ALTERATION [J REPAIR ❑ MOVE ❑ 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
$1.14
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$ 2,270
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
Fire SC $2.27
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$54.00
PLAN CHECK FEE
TOTAL FEE
License SC $5.00
$62.41
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEIWH
DATED THIS IS YOUR PERMITSIGNATURE
Zs7a2l,
�' BLDG GATE
OF OWNER IIF OWNER BUILDER) IDATEI
NEW [ ] Effective 1/1/94
ADDN [ ] CITY OF FRIDLEY .
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND. R72��
Building Permit Application ;
ConstructionAddress:
Legal Description: _
Owner Name & Address:
5594 - Meister Rd., Fridley, Mn.
Contractor: R.J. Williams General Contractor
Tel. #
MN LICENSE # 2 4 81
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:
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type Of Construction: house and garage roof Estimated Cost: $ 2,270.00
Approx. Completion Date: gutters
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: 7/8/94 APPLICANT: R.J. Williams Gen. Contractor Tel. # 781-6170
CITY USE ONLY
Permit Fee $ Sq. . 0 0 Fee Schedule on Reverse Side
Fire Surcharge $ - .001 of Permit Valuation (1/10th%)
State Surcharge $ , l $.50/$1,000 Valuation
SAC Charge $ $800 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 $
W 49 1,
STIPULATIONS:
01
SUBJECT
PERMIT NO.
City of Fridley
3024 5
AT THE TOP OF THE TWINS
BUILDING
PERMIT
i
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
5M
1
NUMBER
REV
DATE
PAGE Of
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
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._
g
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
533-J616R
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
0 NEW 0 ADDITION 0 ALTERATION -a REPAIR 0 MOVE 0 REMOVE
8 DESCRIBE WORK
Reside Townhouse and garages
9 CHANGE OF USE FROM TO
STIPULATIONS
Call for building wrap inspection before covering.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED 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
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
$44,928
$22.46
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-
$593.25
Fire SC 4.93
STRUCTION OR THE PER RMANCE OF CONSTRUCTION
PLAN CHECK FEE
TALFEE
9 — zo - 9 i
Licens 5.00
$665.
S�GNAruP" 'PACTOPOP uTMOP�2EDAGENT �OATE�
N P OPER (DATED H IS R PERMIT
� I
8LQA (NSP
T/AtE
S,GNATUAE 00 OVVNEA,.f OWNEP BUILDER, (DATE,
01
NEW-[ ,] . _ Effective 5/10/99cF rad
ADDN [ ] CITY OF FRIDLEY \j
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
�
y S, , 86, 90, gy C�
Construction Address:— l�� �/s j ��PO4.-)
Legal Description:
Owner Name & Address: Tel. #
Contractor: ac) 07r/ Fuia grYz g ,,T-
A MN LICENSE # S�
Address:_ Tel. # 533
0
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.
h
OTHER: -4� S / A,� ') i> 6&_ A 1., t r
Construction Type:
Al
Estimated Cost: $ "�% V(S
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: 99 APPLICANT: Tel. # &"'" -4, A 6e
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
$rosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ 6. oo
CITY USE ONLY
Fee Schedule on Reverse Side
.00.1 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
T
SUBJECT
PER
City of Fridley
10 4 7
AT THE TOP OF THE TWINS
BUILDING PERMIT
o
f
1 ,
I •
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
1 �
1 I
CITY HALL FRIDLEY 58432
NUMBER
REV
DATE
PAGE Ot
APPROVED BV
�"•'� �'' 612-571-3460
910415
6/8/00
JOB ADDRESS 5566, 70, 74, 78, 82, 86, 90, 94
Meister Road NE
1LEGAL
LOT NO.
BLOCK
TRACT OR AODITION ,,
SEE ATTACHED
• DESCR.
'.1-g
1
1 Innsbruck North Townhouse Addn SHEET
2 PROPERTY OWNER MAIL ADORES$.
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 612-722-71
A ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
1423
S ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
B USE OF BUILDING
Townhouse Building
7' CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof Building
9 CHANGEOFUSEFROM
TO
STIPULATIONS
Underlayment must comply with the State Building Code.
Permit Inspection Cords
Will B® Mailed
To Homeowner TwPost
r11
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 1 HAVE READ AND EXAMINED THIS APPLICATION
8
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
r
$17980
$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
SACCHARGE
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
-.*I , /
320.22
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
N P OPE ALID 0 THIS IS Y UR PERMIT
- �d6
BLDG 111SP ' rIAIl
_
SIGNATURE 0f OWNERIIF OWNER BUILDER, IDATEI
T
CITY OF FRIDLEY INSPECTION DIViSION po Effective On January 1, 2002
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
L7)LI
JOB ADDRESS
RATE SCHEDULE
OWNER •
Residential Rate
TOTAL
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace 30.00
BUILDING USED AS
$
(Side Vent - Fill Out Back)
$_� .
r
ESTIMATED COST 6n. m,D PERMIT N0.
Gas Piping (Needed with new furnace, $ 10.00
$
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNER `
Gas Range $ 10.00
$
No. of Heating nits Circle One (Steam) (Hot Water arm A'
Gas Dryer $ 10.00
$
Trade Name_± Size No. �(
BTU S OtO HP EDR
*Air Conditioning - All Sizes $ 25.00
$ IGD
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 witli the City Codes an
State Surcharge
$ .50
rulings of the Building Division, and hereby declares that all the facts'and
-10
representations stated in this application are true and correct.
TOTAL FEE
$
DATE
ELAINE HTG. A/C ELECT., INC.
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
15562 CENTRAL AVE. N.E.
HEATING CO ANOKA, MnI 55304
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
Signed r �- TEL #
REINSPECTION FEE $47.00/Hr
FAX #
*Air Conditioners can not be placed in a side yard without
Approved By Rough -In Date Final Date.
written permission permission from adjoining property owner.
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
MMMON VENT- V NT r_nNNFCTnR AND COMMIRTInN AIR V RIFI CATION
When rQ la _i a an _Yic ing firance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. . Yes R No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination.
Yes ( No ( )
The undersigned also verifies that the replacement unit 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 ( )
The eYis ing cnmhustinn air is sized and installed to meet the current codes
and manufacturers specifications.
Yes ( No( )
When required to install a new rnmhi istion air, it will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes ( No( )
\
When inc alling a new ventina 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 current codes.
Yes m No(
per
)
Appliance Type and .i'I7P_/Cnmmnn Vent and Vent Connecter Information
Appliance #1 Type Fjjn LO- BTU Input Fan Assisted or Nat .G '
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
ELAINE HTU. AA; ELECT., .
9356?. CENTRAL AVE. N.E.
HEATING CO: ANOKA, MN 65304 a
Signed By: Date: