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City of Fridley SUBJECT PE 13469 AT THE TOP OF THE TWINS PERMIT r � BUILDING REC T NO. • COMMUNITY DEVELOPMENT DIV. 0� e r PROTECTIVE INSPECTION SEC. 1 . , NUMBER REV. DATE PAGE OF APPROVED BY -'•'1 CITY HALL FRIDLEY 55432 ,'J ""•'�'� 512-560-3450 910-F15 4/22/76 JOB ADDRESS 1504 North Innsbruck Drive 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 g Innsbruck North SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John G. Ordway 2507 Bryant Avenue.South, Mpls. 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. OH -HO Builders Inc. 2507 Bryant Avenue South, Mpls., 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 ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 33.3' x 38' Dwelling and a 22' x 20.3' Gar +O NOTIFY THE FRIDLEY ENGR. PERMITS REQUIRE D 9 CHANGE QF 9KRATE T14 DING CURB HEATING,PLUMBING AND SIGNS. REMOVAL AND REPLACEMENT unlyt STIPULATIONS Provide a hard surface driveway. Provide a vera yang s e capping. Provide sod in the front and side yards. Garage to be 10' off lot line due to easement, 25' minimum rear yard. Builder to take special care in setting house elevation due to shallow sewer main. SEWER LOCATION (Approx. 8' Deep) 10' West of Manhole (Inv. 965.70) WYE ELEV: 965.40 TOP OF FOOTING: 969.40 Minimum WARNING WATER LOCATION: 35' South of Manhole 5' From S.W. corner of power pad. Before d3$g�n call Ioc�I �t;!�i ToiE CITY OF FRID m DOS NOT GUA!".,�ANTEr ►11` ACCURACY OF UTILITY LOCAT ONS AND ELEVATIC....:. TELEPHONE 4 ELEC NP'` a TYGB DATA IS FOR INFORAAATION PUPPOSES Oi ..LY i N:., �" �,. s .' Iai:R.c,OI�IS USING IT SHOULD VERIFY TH2 INFOIWATIGiv R ": ON THE SITE SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING $Q. 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 R-1 1089+447 21,220+4470 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. $29, 511.90 14.76 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- $ 47.53 $350.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $412.29 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) �_ S. WHEN PROPERLY ROPER1LL1Y�V.ALIDATED THIS IS YOUR PERMIT I (.a •. 412,2& ,+2. 2 — f,/— BLDG INSP DATE SI NATURE OF OWNER IIF OWNER BUILDERI 1 ATEI M APPLICATION FOR RESIDENTIAL, ALTERATION, 12 to G OR ADDITION BUILDING PERMIT , F- 0 CITY OF FRIDLEY, MINNESOTA t� OWNER'S NAM: JC -),y OR L) `;1MILDER : 011- /?G ADDRESS:d50,7 QAY,41ur. J'o 171RL.5. ADDRESS: S.4MC_ NO: 0 ¢ S TREET : d ls' IA" AIL 139 ✓` C I� � JZ � V e LOT: _ BLOCK,- % ADDITION: CORNER LOT: INSIDE LOT:.. ET$ACK:- 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: RES/ L)CNc-L Front: 3 3.3 Depth, 3 0 ___Height: C® Square Feet: A0 Cubic Feet: a �i .2 i s (5 Front: Depth: 2-43 Height: fD Square Feet; TZ Cubic Feet: Type of Construction: -FR-04 n Estimated Cost: _$ 4C2- ano To Be Completed: 5E FT, c99/ The undersigned hereby makes application for a permit for the work herein specified, agreeing to do a? l-oo;:':r in strict accordance with the City of Fridley Ordinances and rulings of the Dep;.rLme-at of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: 12- .7 CD SIGNATURE:_ (See Reverse Side For Additional Information.) S . 0 (rWW:"C �-o 6- 4 T / ^)F 'Du E_ � /h 1A! . 2FA2. y012A ,; ,6Ct f',4 /J,4e 7V 7l4E <2.,Ae,c ," s n-, d->1,z4E 70 -5-140,f 4- "c0 ,-®' v,c� To s��.✓r� s'®Eee.jL {ar$3CF5slv:€ f P, :i ,:i; ii'�c•,ii v c; :'sa J • ---- DESCRIP:1O:( G:' tilQl;�; Q? /1,�9• /�td�t//��l/s�/C - X:.�:S;:. via tr.t: T✓_•cr_irn of Fix`•�_es I-8'•a�.. C:cr..t�:o:. Wit:.. 5caurcl Ola 0 -e3=:: -'y7 PARTIAL RATE SCHEDULE city of Prd'cy:. The u: dirsiar t� hereby r:^t-,!1ts ap;1-Tcat10--) for a per.^it fcr t`:: srcry herr; pecifi.d, a� ecin. to do a;I I.vcrk in strict acco:d_^ce wl:h the Cid 3 ... and r�'mg of the D•-nartment of BuilcL''nU, and hereby declares that a:I t_Le fact • 2rd mp esent-ado^.s stated is t.h:s app'.:ca°:.---n are t: -e and co:: e -e' mid;ey, bJr,.n elV �`G- 7 I�� Qwrer (� � A V2 AY • 1.{ind of B:.ildi^.g Used as /7175 �G�lZ6G r To be completed abut Estir:'ated Cost, $ /_ / Old— 'ew. 13u :ding Permit No. P,:pie tio. v�(� ;•1m�J:j3.:i; ElXT. I Z RATES: NO. PATE TOTAL ct �Aq•/%tIG �\ i�l:.".•.b4T r bXtililS • . 1 • I • • .. • x v2•i!'�• PJ ' nsture Fixture Opening .... • • • • • • • . x $1.50 S • _.._-- By -_ x S".50 d__._:._. Busint= Phwne do :.ew F:x:ure Oct Oper•n,f..... • .... (` t I x L• fffll! x53.25 3 . tfli1( i li }�}Q.. Zi'otCC lieoter IL'? to 99.00 $T•C,l s ♦ o s X S3 1/0 $3' 14OUC3I'i lea Gre_nd Run Oli. Bldg. x .3.25 S— r'ectrc Mata: $ s�S F•:::i:iG cr.3: aO. RAT":. T07AL UC) x $'-.CO $ .2- - • Ist 3 Fixtures .................. Ad�t ; ...iznal F'xtures ............... _ x .► .r S• Gas R=ze to IE -3.000 E—M! ......... x 55.G� 5-. • . .50 State Su--chc-ge C:cr..t�:o:. Wit:.. 5caurcl Ola 0 -e3=:: -'y7 PARTIAL RATE SCHEDULE city of Prd'cy:. The u: dirsiar t� hereby r:^t-,!1ts ap;1-Tcat10--) for a per.^it fcr t`:: srcry herr; pecifi.d, a� ecin. to do a;I I.vcrk in strict acco:d_^ce wl:h the Cid 3 ... and r�'mg of the D•-nartment of BuilcL''nU, and hereby declares that a:I t_Le fact • 2rd mp esent-ado^.s stated is t.h:s app'.:ca°:.---n are t: -e and co:: e -e' mid;ey, bJr,.n elV �`G- 7 I�� Qwrer (� � A V2 AY • 1.{ind of B:.ildi^.g Used as /7175 �G�lZ6G r To be completed abut Estir:'ated Cost, $ /_ / Old— 'ew. 13u :ding Permit No. P,:pie tio. v�(� ;•1m�J:j3.:i; ElXT. I Z RATES: NO. PATE TOTAL ct �Aq•/%tIG �\ i�l:.".•.b4T r bXtililS • . 1 • I • • .. • x v2•i!'�• PJ ' nsture Fixture Opening .... • • • • • • • . x $1.50 S • _.._-- By -_ x S".50 d__._:._. Busint= Phwne do :.ew F:x:ure Oct Oper•n,f..... • .... Catch Bas. -n .................. x53.25 3 . 0. Zi'otCC lieoter IL'? to 99.00 $T•C,l s ♦ o s X S3 1/0 $3' 14OUC3I'i lea Gre_nd Run Oli. Bldg. x .3.25 S— r'ectrc Mata: $ s�S F•:::i:iG cr.3: aO. RAT":. T07AL UC) x $'-.CO $ .2- - • Ist 3 Fixtures .................. Ad�t ; ...iznal F'xtures ............... _ x .► .r S• Gas R=ze to IE -3.000 E—M! ......... x 55.G� 5-. • . .50 State Su--chc-ge v�Z;RS 8 AL:_:?ATSCY.•-?ofer :o Cady �f► e . I • • eY - - S TOT AL TME V CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: Furnace Shell & Duct Work Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 MECHANICAL WARM AIR: RATE TOTAL Job Address Irlvv s !3 Odle K 40 $12.00 $ 7.00 $ 7.00 $ Department of Buildings 4.00 $ City of Fridley Tel. #571-3450 Furnace Shell & Duct Work to 100,000 BTU $12.00 each add. 50,000 BTU 4.00 Replacement of Furnace 7.00 Repairs & Alterations -up to $500.00 7.00 Repairs & Alterations each add. $500.00 4.00 STEAM OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU $12.00 each addn. 50,000 BTU 4.00 Boiler only up to 100,000 BTU 7.00 each addn. 50,000 BTU 6.00 OIL BURNER- to 3 gal. per hour $10.00 each add. 3 gal. per hour 10.00 GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 (over 199,999 BTU see Fee Schedule) GAS FITTING FEES: 1st 3 Fixtures x $ 3.00 Additional Fixtures x $ 1.00 Gas Range to 199,000 BTU x $10.00 AIR CONDITIONING FAN HEATING SYSTEMS see Fee Schedule VENTILATING SYSTEMS _� ALTERATIONS $ REPAIRS State Surcharge TOTAL FEE ROUGH INSP. REINSPECTION FEE Date ($10.00) FINAL INSP. 7' Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. gFridley, Minn. � a. , 19 7LIP OWNER D %� © p J /✓ 5 KIND OF BUILDING �' A ',q USED AS D by 4 L L / /Nlc,` / TO BE COMPLETED ABOUT --T ESTIMATED COST f i� OLD - NEW BUILDING PERMIT NO. PERMIT NO. Cl/ GoG� $ 3 DESCRIPTION OF FURNACE/BURNER $ HEATING or POWER PLANTS, Steam, Hot Water, arm Ai No. $ Trade Name l Ir MAI 0Size No. 4!� fl 43 0 J 3 7V $ $ Capacity137Sq. Ft. EDR BTU HP $5050 Total Connected Load'� Qt 7`v oL Kind of Fuel IVA T. dW Jr BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company S V D U& &,4 hl h I k C O N Q i Signed By /Zcs11 Tel. No.i S Y 6 /0-0 • HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS ST. PAUL, MINN. WEATHERSTRIPS A.S.H•V.L Guide Reference 19 TYPE OF CONSTRUCTION INSULATION Windows Doors I I& — No Out. Well t. Wall I coiling Roof Floor Kind Ceiling Wall �•- No f I 1 Room I Length y Width q Haight g ITFL Room I Length iv 1 Width / Height WINDOWS and DOORS — CRACKAGE and AREA WINDOWS and DOORS — CRACKAGE and AREA Width Height No. of No. of pane of pane lights Linea ft. of crack Area sq. ft. Width Height No. o} No. of pane of pane lights Linea ff. of crack Area sq. ft. 01 I Cl1 4 d 10 1 Coef. Btu. Coef. Bfu. b lafiltrafios Windows Doors Infiltration Windows Door ff s Exp. Wan M, � Exp. Wall 0 Glees 43 _f 0 Glare j' L) 7 ® 0 Nat Esp. Wall 1 L 7 % Net Exp. Wall 171// 1103 M. Wall Int. Wal Ceiling oor /% 16 Ceiling oor (, L j® Total Btu. lif. /(,q Total Bfu. 17 ' y Required sq. ft. ED. R. or sq. ins. W.A. Leader area Required sq. ft. E. D. R. or sq. ins. W.A. Leader area R. I I Ity Room I Length 2 q , Width Height 8 R. I Room rLength / y I Width I Height 1 WINDOWS and DO RS — CRACKAGE and AREA Width Haight No. of Lineal ff. Area No. of pans of pans lights of crack sq. ft. l 4 ti � u WINDOWS and DOORS — CRACKAGE and AREA Width Height No. of pane of pane No. of Ilghts Lineal ft of crack Area sq. ff. n,r y t 1 Coef. Btu. Coef. Bfu. Infiltration Windows Door Infiltration Windows naDoors ff Exp. Wal — ExLu Wal Glass 29S V / S6 Glass ,` S 17 j 0 Net Esp. Wall / 1 -7 Nef Esp. Well Z 6 j' /0 Int. Wall Int. Wall Ceiling Roor It /7 ). kC6 Ceiling4-Floor a. Os G Total Btu. Total Btu. Required sq. ft. E. D. R. or sq. ins. W.A. Leader area I Required sq. ft E. D. R. or sq. ins. W.A. Leader area a 7L I fj a Room I Length ' I A Width 7 f Height f3 It I L I V) v Room Lengfh j Width 461 Height WINDOWS and DOORS — CRACKAGE and AREA WINDOWS and DOORS — CRACKAGE and AREA Width-- Height No. of Lineal ft. No. of pans of pans lights of crack Area sq. ff. Width Height. No. of pans of pane No. of lights Lineal ff. of crack Area sq. ft. 71, S1 d" Coef. Bfu. Coef. Btu. Filtration Winnows Infiltration WInclDoors l D Esp. Wal Exp. Wal Glass Glass j 3,li I! ♦: S � Net Exp. Wail % / / / Net Exp. Wall / >L 6 Int. Wal lot. Wall ®° Cellingal Floorcl ( coilingor i� 1 tri 7 Total Bfu. i.tii®� Total Btu. b 3 Required sq. ft E. D. R. or sq. ins. W. A. Leader area Required sq. ft ED. R. or sq. ins. W.A. Leader area D-56 ions ti -61 GRAND TOT !r ar 53-8b-9915 51. CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Nu.:.ber Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS & ALTERATIONS First $100.00 each add. $100.00 or fraction X $3.00 x $2.00 x $2.00 X $5.00 x $5.00 x $10.00 x $7.00 e $5.00 Wa ter $5.00 w r q ..K1 W tr r. Heater vi d b G E 14W X 11 a N H S� C �C xtl1 C C 3 O U •'1 0 .0 U N O•I vl 11 N C N •'1 0 O 11 N V N �0 N b N •.i M t6 .0 i0 •'1 N t0 3 la O A W y .-� 6. Rf b U b 7 �d 'r U <^. C7 0 O aS leC V1 U 7 R7 rQ lst c nn ct raige 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Nu.:.ber Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS & ALTERATIONS First $100.00 each add. $100.00 or fraction X $3.00 x $2.00 x $2.00 X $5.00 x $5.00 x $10.00 x $7.00 X $5.00 x $5.00 x $3.00 x $1.00 x $10.00 $5.00 $2.00 State Surcharge TOTAL FEE REINSPECTION FEE ($10.00) S S S S $ S $ .50 $ 8.00 Job Address 1504 NORTH INNS3ROOK DRIVE 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. 9-20-76 , 19 OWNER JOHN 0 TJWAY KIND OF BUILDING F AME OSED AS RES. TO BE COMPLETED ABOUT ESTIMATED COST 10.00 (;�( OLD - NEW BUILDING PERMIT NO. PERMIT NO. (S�CJLJ Company�/iA -.�G Signed By MINNEGASCO Tel. No. ROUGH INSP. Date FINAL INSP. /I' —� Date APPROVAL FOR PERMIT "'-- MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 560-3450 Cit ty Of 17riAecy ANOKA COUNTY 6431 UNIVERSITY AVENUE NE December 6, 1976 FRIDLEY, MINNESOTA 55432 Mr. John G. Ordway III 1504 North Innsbruck Drive N.E. Fridley, Mn. 55432 Re: Final Inspection at 1504 North Innsbruck Drive N.E. Dear Mr. Ordway: A final inspection was made on December 3, 1976 of 1504 North Innsbruck Drive N.E. and the following items were noted which must be completed before the structure can be finaled out; 1. Post house numbers on structure. 2. Provide a handrail on the open side of the basement stairway. We will expect the above items to be completed by January 6, 1977 when a reinspection will be conducted to determine compliance. If you have any questions on these items, please feel free to contact me at 571-3450. SincerdTy,� RONALD E. HOLDEN Building Inspection Officer REH/mh 01 SUBJECT City of Fridley 15590 CRE AT THE TOP OF THE TWINS BUILDING PERMIT ' r � •COMMUNITY DEVELOPMENT DIV. >: --'--- r 1 � PROTECTIVE INSPECTION SEC. 9d �� 1 � � 1 1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 12/21/79 JOB ADDRESS 1504 N. Innsbruck Drive 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 9 Innsbruck North SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Ordway 1504 N. Innsbruck Drive 55432 574-9963 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Oh -ho Builders, 1504 N. Innsbruck Drive 55432 574-9963 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. B USE OF BUILDING Residential 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Wood Stove 9 CHANGE OF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE IREOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD •.VENTILATING OR AIR CONDITIONING. food Stove 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 THAN 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 800.00 50 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- 7.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE wAkz_�a:�l 8.00 SIGNATURE OF CONTRACTOR OR AUfjR1ZED AGENT (DATE) I WHE PRO ER A D ED THIS IS YOUR PERMIT � � SIGNATURE OF OWNER'i IIF OWNER BUILDER) IDATEI )NSP DATE I 01 CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) OWNER: ,,'\ H I\IL)JaS�\AIAYBUILDER: -0H_-44C ADDRESS: i.�i� - i i . ��i U./ - IODDRESS: G� TEL N0: - CP TEL NO: Construction Location STRLMT NO : STREET: LOT: BLOCK: ADDITION: Corner Lot: Inside Lot: �� Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: Depth: Height: Square.Feet: Cubic Feet: Front: Depth: Height: Square - Feet: Cubic Feet: Type,'n �7� V of Construction: Estimated Cost: $ Son Tb Be Cbmpleted: =,L -� - �— Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET 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. DATE: 162-, I_ SIGNATURE: Stipulations: City of Fridley SUBJECT o AT THE TOP OF THE TWINS BUILDING PERMIT .15745 r RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. o 1 i I CITY HALL FRIDLEY 55432 1`j NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 52780 JOB ADDRESS 1504 North Innsbruck Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ] 9 11 Innsbruck North SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE J. G. Ordway 1504 North Innsbruck(Dr.ive N.E. 574-9963 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. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE x 8 DESCRIBE WORK Construct a porch. addition (20' x 11 & 13') 9 CHANGE OF USE FROM TO STIPULATIONS SEPERATE PERMITS REQUIRED FOR ► HEATING. PLUMBING AND 'an w. SIGNS. l ow REQUjjtj:l' 8,1 Lei 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 265 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 $4,000 $2.00 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 PERFORMANCE OF CONSTRUCTION. $24.00 PLAN CHECK FEE TOTAL FEE 6.00 $32.00 SIGNATURE OF CONTRACTO R AUTHORIZED AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT / • `a `=jLDG WSP BATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS / ' (New, Alterations, Additions, or Repairs) �l OWNER: ��. [ �-��I BUILDER: � 42—> ADDRESS: ��� °% �► :Fnr),,-,IOLkC.IC_,D('ADDRESS: TEL NO: " —� cI TEL NO: Construction Location • A �1 STRL'ET NO: 16704STREET: LOT:BLOCK: ADDITION: Corner Lot: Inside Lot: Setback.: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: U Depth: l3 Height: 5 Squane Feet: (�,� Cubic Feet: Front: Square -Feet: Depth: Height: Cubic Feet: Type of Construction: � �� Estimated Cost: $ 40001---- To Be Completed: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET 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 representat'ons stated in this application are true and correct. DATE: � _ SIGNATURE: / s '� � Stipulations: 9kevr J 4 x 6 = a y. oc) Pr. (. OC3 ^� k��iS-',��ius4�.Y "spy'";an 9,+� 4 � r £ •. - Y.i � i i, � t.� �� `` -. �. � � tlA+ �+� �"7+"l% ,.3 �y - V/ _ ,��ljj�� e,�'- .�l1��1�Yw'►�.fi t �'r,y v'K �,�Tr� �. i �P°.�r F`Z't� ,F ,^3"s+'� �T* ` '�' � �S a t., ��r������} �■i�6� adiRlApt � ;? si.. �� wo� '� + �'�'` � �9..,s, _Loall w f7� , ... �4�`i y ., ` � s .0 •r t3- r4 K - t x �i r .f Viel k _ OQ i� 1� * Vii., Y ♦k �':' rr $AA ! �! . Ji i "'` �, jr y� yid � � C - a .� . � ��',•, V3 ! � � � ;oj ZZ �4�Vt • Vis. k 'k ,q its Lic �,� J� .' .�� � � � X � J �• Tw"�'.4^ �� C i J t'[ a +J Y� �r • `I.�� fi�,Y` � �,-°� � �,�";:!!U as #a�e'vs �M .��4°!+4'a! �+l�MNt�r�trrt •!� � ayt+r�ryr +rt Nar r1�! �# • ° 3 ,; � 1 .� � . �7 `'���fi r'��'��:?��, � :tirr�=�lati�fl�ls�i t#�en�tr::i�ir�sr_ ru.s�t;.'s.��r.�..+...-- . ,.r�..,..�. �::.._,....:..� iai� •+Mat's �,,� �; �.. •_�..�; �,:�.; vs* '!"n a '.Y � r � t • 'F.ty�4a�'!� �. %r { Y tG CITY OF FRIDLEY INSPECTION DIViSION 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 DEMI JET // JOB ADDRESS /��=`� .1�'+^j/ncuc./� RATE SCHEDULE OWNER Z_,4.,,- J - ^s, Residential Rate TOTAL Furnace Shell and Duct Work, Burner - / I BUILDING USED AS Also Replacement Furnace $ 30.00 $ / (Side Vent - Fill Out Back) ESTIMATED COST �!o®• � / PERMIT NO. OSO Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 $ No. of Heating ni Circ)A One (Steam) (Hot Water) (Warm Air) Gas DryerP $ 10.00 $ Trade Name -a✓� L -i Mize No. 6?+ } ; j-4 fes- ��,� BTU HP EDR *Air Conditioning - All Sizes $ 25.00 $ Fuel GUS 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 an State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. TOTAL FEE $ r DATE / MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO��e�°�Gso�� REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE Signed TEL # Gni- 4-T3 —.X6-4 FAX # REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without Approved By Rough -In Date Final Da written permission from adjoining property owner. FILL OUT BACKSIDE FOI STACK VERIFICATION ON REPLACEMET F NAC l fr p .5s era THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED CY)Ihti"CN VENT-, NT CONN CTQR ANS MMMIRTICIN AIR VERIFICATIM When rg la Nna an &A -sting fi Iran _ _, 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 plastictPVC 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 tay tine cemhustinn air is sized and installed to meet the current codes and manufacturers specifications. Yes( ) No( ) When required to install a now rnmhughnn air. it will be sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When jp-gtallipa a new venting system, 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( ) 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: I CIiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 April 28, 2003 Mr. & Mrs. Richard Johnson 1504 North Innsbruck Drive Fridley MN 55432 Subject: Farr Lake Park Dear Mr. & Mrs. Johnson: PW03-024 The City of Fridley contracted with the Registered Land Survey Company, Kurth Surveying, Inc., this past winter to conduct a boundary survey of Farr Lake Park. As a result of this investigation, we found that you have constructed several screening fences and numerous retaining walls outside your property lines on City Park property. Also, your driveway has been expanded to less than 1 -foot from the property line in violation of City Code requiring a 3 -foot driveway setback. The construction on City property constitutes trespass. It is your responsibility as the property owner to identify your property lines prior to a project. This letter is hereby notice to you to remove these structures within 60 days to prevent further action against you by the City. Sincerely, Jon H. Haukaas Director of Public Works JHH:cz Enclosure cc: Fritz Knaak, City Attorney WAN lsrm4 ri y o ........... . H din \ � \ I ,fJJ-ees5 r74 Richard Johnson 15O4 North Innsbruck Drive Fridley, Minnesota 55432 June 4, 2003 Jon H. Haukass Director of Public Works 6431 University Avenue N.E. Fridley, Minnesota 55432 Dear Mr. Haukass, I received your letter dated April 28, 2003 about the fence being over the property line. This removal will be completed by Junelj 2003. A 3 When you answered my voice mail on this matter you said the terrace walls would be okay. The okay on the driveway would also be included with a memo to me for my files. I believe I have reduced the run off problems with the terracing I have completed. I appreciate your concern regarding that goal. Sincerely, Richard V. Johnson Attachment (1) FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 April 28, 2003 Mr. & Mrs. Richard Johnson 1504 North Innsbruck Drive Fridley MN 55432 Subject: Farr Lake Park Dear Mr. & Mrs. Johnson: "�` PW03-024 71 3 5 7Z_ 95"YZ The City of Fridley contracted with the Registered Land Survey Company, Kurth Surveying, Inc., this past winter to conduct a boundary survey of Farr Lake Park. As a result of this investigation, we found that you have constructed several screening fences and numerous retaining walls outside your property lines on City Park property. Also, your driveway has been expanded to less than 1 -foot from the property line in violation of City Code requiring a 3 -foot driveway setback. The construction on City property constitutes trespass. It is your responsibility as the property owner to identify your property lines prior to a project. This letter is hereby notice to you to remove these structures within 60 days to prevent further action against you by the City. Sincerely, Jon H. Haukaas Director of Public Works JHH:cz Enclosure cc: Fritz Knaak, City Attorney 43v 1'M 1)0,x /4 czlLeJ- S,, 1 j`� . 4 G7YOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 July 16, 2003 Mr. Richard Johnson 1504 North Innsbruck Drive Fridley MN 55432 Subject: Farr Lake Encroachments Dear Mr. Johnson: PW03-046 I met with you and inspected your property on Friday, July 11, 2003 to review the correction you made to the screening panels that had encroached into Farr Lake Park. Those corrections have been made to the satisfaction of the City and we consider the matter resolved. Thank you for your cooperation in this matter. Sincerely, Jon H. Haukaas Director of Public Works _11 City of Fridley SUBjECi 3 5 9 3 , AT THE TOP OF THE TWINS BUILDING PERMIT r � RECEIPT NO. ' COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. � 1 . � NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 763-571-3450 910-F15 6/10/03 JOB ADDRESS 1504 North Innsbruck Drive NE I LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 9 1 Innsbruck North SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard Johnson 1504 Innsbruck Drive NE 612-919-5526 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 ❑� ❑ NEW X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct an 18'x 14' Deck; Remove an existing 18' x 22' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on. plan. SW►RNING AiE PERMITS Before Pe REQUIRED FOR. digging call for utility locations �LU�t�� �Gt� q� p SN6�V 45a�0002 sw y LAW 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 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 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 $3,129 $1.56 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- $97.25 Fire SC $3.13 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTALFEE $101.94 IUAE 'PAC TOP OP AUTHOPIZEDAGENT IDATEI ROPERLY VALIDATED THIS IS Y UR P RMIT e &IPN BF' �-3 TIAE UP OF OWNE P IF OWNED BU I SDE PI IDATEI'` h NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 5714287 Fax BUILDING PERMIT APPLICATION Construction Address: f Z5 o R C_ Legal Description: / Owner Name & Address: I%we�� ,' Tel. # �e� Z- /� �S w Contractor. ®V�r�.(T ��i— Pra MN LICENSE: A Address: 4, Tel. # 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 Wi Height GARAGE AREA: Length Width Height ¢Sq. Ft. DECK AREA: Length % Width Hgt/Ground Sq. Ft. OTHER: RR, I r X ® tk dg C L Construction Type: ar-t_� Estimated Cost: $ '� l Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ U _ $ j�w G i -t 41 S�Zb DATE: APPLICANT: 1� �-c,� Ayc-SoTel. # W 76 3 3'--// 3�1' Od Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $ t $ e $ 15 (n $ TOTAL $ 10 1 0 914 Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 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 [ ] CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 763) 572-3604 FAX: (763) 571-1287 ADDRESS 1504 N INNSBRUCK DR NE PIN 243024420068 LEGAL DESC INNSBRUCK NORTH LOT 1 BLOCK 9 PERMIT TYPE HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMITO.: 2004-01645 DATE ISSUED: 09/22/2004 VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL GAS PIPING FOR FIREPLACE. VALUE OF APPL OR WORK 0 # GAS DRYERS 0 # GAS RANGES APPLICANT FIRESIDE HEARTH & HOME 2700 N FAIRVIEW AVE ROSEVILLE, MN 55113 r ATJL JOHNSON RICHARD V & TIA HENRY 1504 N INNSBRUCK DR NE FRIDLEY, MN 55432 0 VALUE (FOR MINIMUM CALC) AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. HEATING PERMIT MINIMUM FEE GAS RANGE FEE GAS DRYER FEE HEATING REPAIRS/ALTERATIONS STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 608250 SEPARATE PERMITS REWIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 2300 15.00 0.00 0.00 0.00 0.50 15.50 CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fee Total $35.00 $ $10.00 $ $10.00 $ $10.00 $ *Air Conditioning -All Sizes $25.00 $ All Other Repairs or Alterations (Liston Back) s 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater on work less than $500.00 JOB ADDRESS. Ownerf� i �/iv✓e�C �O� s15`a �1 Building Used As /1 D✓7--Pl ESTIMATED COST �� a PERMIT NO DESCRIPTION OF FURNACE AND BURNER # of Heating Units l ircle One (Steam) (Hot Water) arm Air) Trade Name Ouc ca Fire- Size No. BTU �?O. -,00 HP EDR Fuel /UXT Total Connected Load Burner Trade Name Size No. BTU HP EDR The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/Industrial/Institutional and representations stated in this application are true and correct. State Surcharge $ .50 HEATING CO�51 TOTAL FEE $ / S D Signed Tel #�oy� REINSPECTION FEE $50.00/HOUR FAX # Date *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 REPLACEMENT FURNACE Approved b Rough -in Date Final Date 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 :