PRE 2010 DOCSCity of Fridley, Minn.
WELDING PERMIT
Date: ..�Y.....C?-4?. 2. ........
Address ......................................
N® 3517
Builderffl .... ...4 6, o r.. v z 4 r v , ............
Address .............................................
AA LOCATION OF BUILDING
No.Street ..� ..�. Part of Lot ...............................
......................
.
Lot ... ^ ..... Block .... :3.......... Addition or Sub -Division aw... ........ .
... e4 a S -�
Corner Lot ............ Inside Lot � ......... Setback .�.... Sideyard ... ...............
DESCRIPTION OF BUILDING
To be Used as:
.� .. Front e/�Depth�4' Height /..7.: Sq. Ft. A4X Cu. Ft.
.................... Front ........ Depth .. ... pHeight ....... Sq. Ft. ........ Cu. Ft. ........
Type of Construction ................... est. / � .Y......... To be Completed ....................
In consideration of the issuance to me of a permit to construct desribed above, I agree to do
the proposed work in accordance with the description above set o pliance with all provisions of
ordinances of the city of Fridley.
...................................
In consideration of the payment of a fee of $1......., 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 with-
in the city limits and this permit may be revoked at any time u n violation of any of the provisions of said
ordinances.
Building Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
Owner:
Address
City of Fridley, Minn.
BUILDING PERMIT
Builder
Address. .... ..�
N® 4701 -'
LOCATION OFOUI�ING
No.Street _. ___ ._._._.---..... _ . _._.._ . _ __.._ _:.. ---..._-...M.... Part of I.ot .... _....... _._...._._.. A ........... .__.._
Lot ------------- P.2,. ...... Block - - ....__.. .................. Addition or Sub -Division o - e -rte'`_. .....
.-
ComerLot.. - ................... _....... Inside Lot .....- - Setback ..... _....... _........................ Sideyard........... .......... .................. ............. ....... - ......
Sewer Elevation ....... ___...---_--•-•--_-••-.._.......... _._...... _.... _._................ Foundation Elevation
DESCRIPTION OF BUILDING
TTO77Il�ed..l
Front Depth .._`.. Height _.../.Q....._� Sq. Ft. Cu. Ft.� e�
-....._........................ ._............
�.. Front....------......_.. Depth .......... ........._. Height ....................... Sq. Ft. ...... ............... Cu. Ft.......................
Type of Construction ... c: .
,��-�-.-:�-...—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 $...-.. G .-G..•----, 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.
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
m
Owners Name �(i ,c.�g�� Builder
Address
LOCATION OF UILD34G
No. ,l Street Part of Lot
Lot_ Block Addition or Sub.Di14;�-_..,�_
Corner Lot Inside Lot Set 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 beed ate_
Front Depth Height,_ ZZ. _,
Sq. Ft. _5 %, Cu. Ft. _=
Front Depth Height
Sq. Ft. Cu. Ft,
Type of Construction^� Estimated Cost
To be completed
The undersigned hereby makes application for 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.
DATEd�,�„ SIGNATURE
(A Schedule of Fee costs can be found on the Reverse Side.)
�"V "" v+'flC.4e , rtooltof000W
�.
f
d .._ �.
Application for Power Plants and Heating. Cooling, Ventilation. Refrigeration and yj
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work ........................... $10.00 $
Replacement of Furnace ............................. 6.00 $
Repairs & Alterations—up to $500.00 .................. 6.00 $
Repairs & Alterations each add. $500.00 1 .............. 3.00 $
MECK. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $
each add. 60,000 BTU ....................... 3.00 $
Replacement of Furnace ............................. 6.00 $ • e- o
Repairs & Alterations—up to $500.00 ................. 6.00 $
Repairs & Alterations each add. $500.00 .............. 3.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & 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
11 Bo
GAS BURNER (up to 199,000 BTU) ....................... 5.00 $
over 199,000 BTU See Fee Schedule
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x$ 2.00 $ g C)
Additional Fixtures ................. x .75 $
Gas Range to 199,000 ........... x$ 5.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
See Fee Schedule
$
TOTAL FEE
/3s
Dept. of Bldgs. Phone SM -3450
Location + e,
City of Fridley:
The undersigned hereby makes application for a permit for the work hereic
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley, Minn % 0 V 19 4 r
Owner
Kind of Building
Used as2G-�
To be completed about
Estimated Cost, $ -/
Old--NW. Building Permit No. Permit No. #w -
DESCRIPTION OF WORK
HEATING or POWER PLANTS team, Hot Water, Warm Air—No
Trade Name Size
Capacity Sq. Ft. E.D.R BTU H.P.
Total Connected Load Kind of Fuel �%
BURNER — Trade Name 9 Size No 11
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVER)
.10, e
Signed
C4110.42 Business Phone No.
PERMIT for Power Plants and Heating, Cool-
ing, Ventilation, Refrigeration and Air
Conditioning Systems and Devices
DESCRIPTION OF WORK
No. of L Heating Plants `-f J to benstalle ltered—repaired
Make
Oil fired—,— Coal fired—, Gas fired—L—; Gas Authorization No.
Remarks
Approved
Final Inspection Date , 19._
, Inspector
��Y
Pert N° 4442
Fee $ 13
Office of the Inspector of Buildings
City of Fridley
City of Fridley, Minn. , 19 �e_ 9–
Owner 69'a6 2ze--�e Ile. >7•6°
Location
Kind of Buildi
How Occupied
Work to be Commenced—, 19
To be Completed—, � / 19
Estimated Cost, $ `7` 0'2 - A-,)
Old -New, Building Permit
Permission is hereby granted to °C4%,Q-W p a L -"A "L['.eLet • to install—erect—use the material and devices described in the
above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work
done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley
relating to or governing the work to be done and the operation of the devices herein named, and to the speci ations//set forth in the approved application for this
permit on file in the office of the Inspector of Buildings. � Pe f �
Ins ctor o Buildings
42 2M11 -VV
LCL C.. LiVC ,.Uy. ♦. 17U1
63-8h-416051 CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures-
$
5.00
ro
Future Fixtures
$
>.
m
Old Opening, New Fixture
1
1.50
U
Beer Dispenser.
K
d
°
5
I Water
$
5.00
M
$
5.00
H
Rain Water Leader
$
5.00
row
u
w
wu `
$
Sump or Receiving Tank
Heater
5.00
W CI
Water Treating Appliance
$
7.00
$
Hot water Heater
$
5.00
w
.4
$
10.00
$
Gas Dryer
$
10.00
$
C
a0
d
gG
U
V
a
0
c
lst
#r
11
2nd
3rd
4th
(R) = Future Connection Opening
Connected with Sewer
(•) - New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures-
$
5.00
$
Future Fixtures
$
3.50
$
Old Opening, New Fixture
$
1.50
$
Beer Dispenser.
$
4.00
5
Blow Off Basin
$
5.00
$
Catch Basin
$
5.00
$
Rain Water Leader
$
5.00
$
Hydraulic Valve
$
5'.00
$
Sump or Receiving Tank
$
5.00
$
Water Treating Appliance
$
7.00
$
Hot water Heater
$
5.00
$
Gas Range
$
10.00
$
Gas Dryer
$
10.00
$
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
It of Value of Fixture or Appliance $
Reinspection Fee State Surcharge $ .50
$
($15.00) TOTAL FEE $' 10.50
Job Address 6820 NE Monroe
Department of Buildings
City of Fridley
Tel. #571-3450
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 Depaztment of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley. Mn. _ _ 7-21-82 , 19
OWNER RASMUSSEN
KIND OF BUILDING
USED AS res.
TO BE COMPLETED ABOUT 7-28-82
ESTIMATED COST 5n - no '-77
OLD.- NEW BUILDING PERMIT NO. PERMIT NO.�`p
Company Z_9' f
Signed By
Tel. No.
ROUGH INSP.
Date
FINAL INSP.
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00
PLUS THE $.50 STATE SURCHARGE
a
suBjECT
IT NO.
City of Fridley
29356
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
`v _.____ COMMUNITY DEVELOPMENT DIV.
f PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910415
4/30/99
JOB ADDRESS 6820 Monroe Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
3
1 Brookview Terrace
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
XNTony Hoedes 6820 MOnroe Street NE
571-3230
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Phil's Exterior Remodeling 5325 81 Ave N, Brooklyn Park, MN 55443 560-2502
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
20094441
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION] REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside House & Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Call for building wrap inspection before
covering
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday
thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
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.
NO DWLG. UNITS
OFFSTREET PARKING
1
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$6,000
$3.00
DOES NOT PRESUME TO IVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY ER STATE OR LOCAL LAW REGULATING CON-
$112.25
Fir SC 6.00
RUCTI O HE E FO MANCE OF CONSTRUCTION
PLAN CHECK FE
TOT FEE
5�
Lic e SC15//0
$126.25
IGNATUR C .AACTOR OR AUTHORIZED AGENT TEiEN
RO
IS R Ry11T
��ALDIS
I v
SGNA TUBE OF OWNER0a OWNER BUILDER, iDATE,
BL G �NSo
gAtE
a
NEW [ ]
Effective 1/1/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION Q�
ConstructionAddress: 14,2QM ed P S�
Legal Description:
Owner Nam
Contractor:
Tel. # L5 71-- 12540
MN LICENSE #,2oo
Address:�,��/g1J�6iT✓ k 9`�i9r>✓ Tel. #
Attach to this application, a Certificate of Survey of the �7
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: RG 5,4s- Estimated Cost: $ CrV
(Fee Schedule on Back)
Driveway Curb Cut Width NP-PdPd
DATE: 6
Ft. + 6 Ft = Ft x $
Tel. #--3-66 -c;Z�4a
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$ , d D
.001 of Permit Valuation (1/10th%)
State Surcharge
$
60
$.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
$
STIPULATIONS:
_.'-
CITY Or= FRIDLEY INSPECTION DIV.
6431 University Ave NE,
FAdlay, MN 55432 ] '
763 -572 -3664 --
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective On Jan 1, 2001
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
JOB ADDRESS 10890 McmYve St we
New Fixtures
$ 7.00
The undersigned hereby makes application for a permit for the work herein
Old Opening, New Fixture
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser
$ 5.00
and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin
$ 7.00
and representations stated in this application are true and correct.
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
20_01
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Owner ?�U l Rvder
Water Heater -Electric
$ 7.00
Water Heater- Gas** 1
$10.00
10./0
Building Used As Y2SldGhc_2 _
Gas Range**
$10.00
I
Gas Dryer**
$10.00
Estimated Cost Er -13.()0 PERMIT NO. / I
Back Flow Preventer Required( )Yes ( ) No
Type
$15.00
PLUMBING COMPANY Tres
() 604 a a t,°,,0& 4, ,J SS3e %
Reinspection Fee $47.00/Hr
SIGNED BY(�f Q�G�. e� oiryl i� _ TEL NO.Ct(P S)S'11.0U;;L1
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
Azw
11-C)5-01
Approved Byz Rough -In Date Final Date
State Surcharge
$ .50
TOTAL FEE
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
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes,( ) No( )
The existing combustion air is sized and installed to meet the current codes
and 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_
Appliance #2 Type _
Appliance #3 Type _
Total Appliances
_ BTU Input
BTU Input
_ BTU Input
Total Btu Input
Fan Assisted or Nat
Fan Assisted or Nat
Fan Assisted or Nat
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 :
CCIYOE
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
November 26, 2001
Mr. Bill Forder
6820 Monroe St NE
Fridley, MN 55432
Re: Final Inspection at 6820 Monroe St NE
Contractor: Tim's Quality Plumbing
Dear Mr. Forder:
A plumbing permit was issued on August 2, 2001 to install a water heater at your address.
According to section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted
on the plumbing authorized by this permit. As of this date, no inspection has been called for.
The permit fee that was paid covers the inspections to make sure the work was completed
according to the Plumbing Code. We will keep your permit open for another 30 days and if we
do not hear from you within this time to set up the inspection, we will expired the permit and no
further action will be taken.
To set up the inspection, or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Sincerely
DJ/mh
CITY OF FRIDLEY INSPECTION DIVISION
6431 University Ave NE
,
Effective On January 1, 2002
Fridley, IVIN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING. VENTILATION,
(763) 572.3604 REFRIGERATION ARID AIR CONDITIONING SYSTEMS AND DEVICES
2,
JOB ADDRESS_ G� �o7D ONQ.p Si' NG
RATE SCHEDULE
Residential Rate
TOTAL
OWNEIR, W1U-1-w� s
Furnace Shell and Duct Work, Burner -
BUILDING USED A$ 'DW -e LL I IV G.,
Also Replacement Furnace $ 30,00
$ 34.00
(Side Vent • FIJI Out Back)
ESTIMATED COST PERMIT NO.
Gas Piping (Needed with new furnace, $ 10,00:
$
but not replacement)
DESCRIPTION OF FURNO AND OR L tflgR
Gas Range $ 10.00
$
Gas Dryer $ 10,00
$
No. of Heating Units Circle One (Stearn) (Hot Water arm Air)
Trade Name. lEK Size No. bt_P—D
Air Conditioning •All Sizes $ 25.00
$
'�D-z}-y
BTU ,d- HP EORFuel Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK)
Burner Trade Name Size No.
J% of Value of Appl lance or Work
$
BTU HP EDR
".ommercial/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 an
State Surcharge
$ .50
rulings of the Building Division, and hereby declares that all the facts and
TOTAL FEE
$ � �o
�
representations stated in this application are true and correct.
1 2-"/57-/6 s/0 z
DATE
0.
0111MIUM FEE FOR ANY HEATING/COOLING/VENTILATION
'EFRIGERATION/AIR t:ONDITIONING PERMITIS $25 00
FLUS THE $ 50 STATE SURCHARGE
;EINSPECTION FEE $47.00/Hr
Air Conditioners can not be placed in a side yard without
i
-ritten permission from adjoining property owner.
M/Yi*1
HEATING CO River City Sheet Metal, Inc.
Signed ��/�
� 9928 Bluebird St. N.W.
L�,rfl T��c�-moi 43�
FAX # 70— 754-2199
Approved By Rough -in Date` Final Date Apt /--2 ®-Z
��v �j�✓zr-L S'�' RAS
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the ,
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes f -No ( )
The venting system is.pl;ZfrcJPVC 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 -LAMA Category I Central Furnace V7-nbng Tables for fan -a
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 O No O -
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 -LAMA 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 TypeBTU Input an Assiste yr Nit
Appliance #2 Type TU Input an ssrsted
Appliance #3 Type BTU Input _ Fan Assisted or at _ - --
Total Appliances = Total Btu Input
Common Vent Type 2d / ` UVent Height Diameter inches
Appliance #1 Vent Connector Height Length _eft Diameter r in Type
Appliance #2 Vent Connector Height �ft Length ft Diameter 7 in Type v
Appliance #3 Vent Connector Height ft Length ft Diameter'Tin Type r;
ALTERATIONS: (Describe) '
HEATING CO:
Signed By: Date Z