PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N® 4371
Date: ....._17
// ..�. ®........ .............. .... ........ ......... ..............
Owner: ------------- ---------------_---- Builder - - ---_ --.. J_
....__.
Address
Address
LOCATION OF�UILDING
No. ,-�- . Street . - -- _------------- Part of Lot ..................
.----• -•----.....-. - -
Lot ....... Block ....-_...... ..... ....... .. Addition or Sub -Division ............ _a ....... - ........_...._...._..._
CornerLot .................................... Inside Lot ...................................... Setback ...................... ............. _........ Sideyard..... _............. _......... .................. ........................
Sewer Elevation ....-_...... - ................................... _............................................... ...... Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front --- ... Depth eight . Sq. Ft. Cu. Ft - - -
�{ /® �y►
..... ........... ............. ....444i....................... Front L...: ` Depth '.. Height 1..7. '6 * Sq. Ft. /�_ �.P Cu. Ft ...�
Typeof Construction ........................... ........ -....................... 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 $_,q ."' -"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 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 ...............
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............
each add. 60,000 BTU .......................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 .................
Repairs & Alterations each add. $500.00 ..............
STEAM or HOT WATER SYSTEM
RATE TOTAL
8.00 $
5.00 $
5.00 $
2.50 $
8.00 $�
2.00
$
5.00
$
5.00
$
2.50
$
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $
OIL BURNER to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ 5 Q C!
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x $1.50 $^�
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS TOTAL FEE $T S
Lo–
REMARKS:
Dept. of Bldgs. Phone SII 4-7470
City of Fridley:
The undersigned hereby makes application for a 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 representations stated in this application are true and correct.
Owner
Kind of Building
Used as
To be completed about —
Estimated Cost, $
Old—New. Building Permit No. �Z3 7ZZ
DESCRIPTION OF WORK
19"
195-
195—
HEATING or PO R PLANTS—Steam, Hot Water, Warm Air—No
Trade Name Size No-
Capacity—
o Capacity Sq. Ft. E.D.R BTU H.P.
Total Connected Load _�� �Kind of Fuel
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
Sign e
By
11 POST IM -I2-58 Business Phone No
MEAT LOSS_'CALCULATIONS. DEPART"ir OP -BUILDINGS M1NN.t
A.S,H.V. E.
Weatherstr,.ips Construction No. Insulation
Guide
Windows Doors Reference Out. Wall Int. Wan Ceiling Roof Floor Kind How Applied_ ++
Yes—No . { Yes—No 1 19_
Fl.l -k / nom I L.enath 1U 'P'11 Width f 2. Height 9 11 FI_I Room 1 Length /i'V " Width IS"?" 3" Height P'
Windows and Doors—Craekage and Area
Coef.1
Btu
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
sy n^
211.0
Glass
Coef.
Coef.
Btu
Infiltration/
3
� >e/
7�
Glass
%
Glass
q 5-0
Exp. wall
v
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Exp. wall
Net exp. wall
Jr /
r I 7a o
/ 70
Int. wall
Floor
1k:7
®
Ceiling
Int. wall
/
a1
Floor
SO/
Ceiling
Total Btu. 1 `711 76 -
Required sq, ft. E.D.R. or sq. ins. W.A. Leader area
Fl.l "A Room I Length/i fel' Width) -?V1 Height
Windows and Doors--Crackage and Area
Coef.1
Btu
Width Height No. of Lineal ft. Area
No. of pane of pane 11ghts _ of crank eq. tt
®
211.0
Glass
Coef.
Exp. wall
Net exp. wall
Coef.
Btu
Infiltration
� >e/
7�
Ceiling
%
Glass
Floor
�3
v
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Exp. wall
Jr /
r I 7a o
/ 70
Net exp. wan
Floor
1k:7
®
/�P 3,p
Int. wall
/
3 3(
SO/
Ceiling
/
f%
Floor
Total Btu. I
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 ffiW Room I Length, //'V'Width b Height .
Windows and Doors—Crackage and Area
Width Height Na of Lineal ft' Ares
No. of pane of pane lights of crack sq. ft.
Windows and Doors--Crackage and Area
Coef.1
Btu
Infiltration
®
211.0
Glass
Coef.
Exp. wall
Net exp. wall
431
/,p
30
Int. wall
� >e/
7�
Ceiling
%
a�
Floor
�3
v
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Allf
rs
r I 7a o
Windows and Doors--Crackage and Area
z
Width Height I No. of Lineal ft. Area
No. of Daae of pane lights _ of crack sq. ft.
Width Height No. of Lineal ft. Area
No. of pane of pane lights ofcracksq. ft.
(�6 7��# /-9
Coef.
Btu
Coef.
Btu
Infiltration
Glassy
� >e/
7�
,2x -
M
ra
Exp. wall
�3
v
Net exp. wan
Net exp. wall
rs
r I 7a o
/ 70
Int. wall
Floor
Ceiling
Ceiling
/
3 3(
SO/
Floor
lye'
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FI.t V f A) Room I Lenath &�%'' Width // Heiaht .P'
Windows and Doors--Crackage and Area
z
Width Height I No. of Lineal ft. Area
No. of Daae of pane lights _ of crack sq. ft.
Width Height No. of Lineal ft. Area
No. of pane of Dane lights of crack sq. ft.
32 I s m
Coef.
Btu
Coef. Btu
Infiltration
Glass=
`Z x
Glass
7�
'g/"
rt,
Exp. wan
�3
v
Net exp. wan
Int. wall
rs
r I 7a o
Int. wan
if
Floor
Ceiling
/
3 3(
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. leader area
171 7 `�-f� R....... I 1 .nsth / X Width 7 � 14nioi t
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of Dane lights of crack sq. ft.
2—
Coef.
Btu
Infiltration y /
Glass
7�
v
Exp. wan -
Net exp. wall'
v
Int. wall
Ceiling
/
if
Floor
Total Btu.
Required sq, ft. E:D.R. or'sq. ins. WA. Leader area `
®Y11
y City of Fridley
AppRcaiion for Plumbing and Cas Frtttng PenWt
Dept. of Bldgs. Phone SQ 4-7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures Location
OQO
s
Qf°
Z
�4a
rcp
Z
04c�
w
5�
�a
w
�Z
z
*
`aa
0
F
N
WATER HTR
GAS
ELEC.
Base
A
1st
a
d
2nd
3rd
4th
• Future Connecdon Openings
Connected with
New F9xture, Old Openings
I
Sewer El
Cesspool El
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... x $1.50 $- i Z -
Future Fixture Opening ................ x 1.20 $
New Fixture Old Opening .............. x 1.00 $
Catch Basin ............................ x 3.25 $
Water Heater (Up to 200,000 BTU) ...... x 2.00 $
New Ground Run Old Bldg. ............ x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures ..........................�_ x $1.50 $
Additional Fixtures .................... x .50 $ .
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS -Refer to Code
Description ................................................$
TOTAL FEE $�C `
City of Fridley:
The undersigned hereby makes application for a 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 representations stated in this application are true and correct.
Fridley, Minn_ �` c' , I � G'
Owner�19—
Kind
9Find of Building �� — � 19—
Used as
To be completed about
A.j— st — 6
Estimated Cost, $ 0
Old Q New Building Permit No
Sem,
Business Phone
Connection Permit No . .......................................................
FEB 18 196/�2Water
— ti.
T 1-1-9� , sewer
.4510111
�\�`� Meter Deposit
� 1 "'60
J
sueJEcr
P.�i;MIT NO,'
City of Fridley
<
25617
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
`COMMUNITY DEVELOPMENT DIV.
y ______
PROTECTIVE INSPECTION SEC.
r
?5e 7
I
NUMBER
REV
DATE
PAGE OF
APPROVED BY
i CITY HALL FRIDLEY 55432
612-571-3450
910-F15
10/20/97
JOB ADDRESS 5260 PIERCE STREET NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
2
4
Horizon Heights
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Irene Kushnir 5260 Pierce Street NE
571-5286
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
Al-Ko Home Improvements 8090 4 Ave, Lino Lakes, MN
55014
788-5850 1927
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
8 DESCRIBE WORK
Reroof House & Garage (22 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS Underlayment must comply with the State
Building
Code.
SEPARATE PERMITS AAE 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
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
$1, 834
$.92
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 SATE OR LOCAL LAW REGULATING CON-
$59.50
Fire SC $1.83
STRUCTION O THE PERFONCE OF CONSTRUCTION.
R A
?
S'
PLAN CHECK FEE
TOTA FEE
e -C'
Licens C
$5.
$67.25
S1G ArURE O TR T a _HORIZEDAGENT (DATE,
N P OP
LIDATE HIS IS YOUR PERMIT
BLD iNSP
� r
DATE
SIGNATURE OF OWNER,,F OWNER BULLDERI iOATEia
J
NEW [ J Effective 1/1/97
ADDN [ J CITY OF FRIDI.EY
ALTER [. ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
i,
ConstructionAddress: ' "
r
Legal Description:
Owner r
Contract
Address:
Tel.
MN LICENSE #
Tel. # % XV 57V
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Heiaht Sq. Ft.
DECK AREA: Length idth Hgt/Ground Sq. Ft.
OTHER• "<.°7 �- -) (—,
Permit Fee Fee Schedule on Reverse Side
Fire Surcharge -$ /, e°� .001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$950 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 [ ]
State Surcharge
SAC Charge
License Surcharge
)riveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
>'nPULATIONS:
_
T G, V
Construction Type: '–
Estimated Cost:
(Fee Schedule on
Back)
Driveway Curb Cut .Width Needed: Ft. + 6 Ft =
Ft x $ _
$
DATE - 7 '� eiPPLICANT:
Tel. #
oe-e����
r`
CITY USE
ONLY
Permit Fee Fee Schedule on Reverse Side
Fire Surcharge -$ /, e°� .001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$950 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 [ ]
State Surcharge
SAC Charge
License Surcharge
)riveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
>'nPULATIONS:
From: 9528814491 Page: 2/3 Date: 7/10/200711:32:15 AM
Building MECHANICAL Permit No.•
Inspections RESIDENTIAL APPLICATION Received By'
Date KeREMLJ L I
763-572-3604 CITY OF FR,ID:LEY
DATE YOUR E-MAIL ADDRESS
-�D- LIfSN�
E93SIEADRp
THIS APPLICANT IS: 0 OWNER *ONTRACPOR
PROPERTY
NAME: r IC je +yj \ r
OWNER/
ADDRESS: �' � �.� �.0—V, " CITY • �. STAT2"`�`SZIpSSL(Z(
TENANT
PHONE:
CONTRACTOR
COMPANY NAW; SENWICK HEATING G AM CONDiTININd IM
8910 Wend AVO. SO
SUBMIT A COPY OF
CONTACT PERSON:
00 W11Il1�II: I1iA
YOUR STATE
LICENSE WITH
STATE LICENSE
ADDRESS: ffl2)��000CTTY STATE ZIP
APPLTCA17ON
PHONE ` - --- fAX
PERMIT TYPE
SINGLE FAMILY 0 TWO FAMILY O TOWNHOUSE
TYPE OF WORK.
O NEW '0rRBPT,ACTMENT 0 ALTERATION/REMODEL
DETAILED DESCRIMON OF WORK U_ �47a e -e- 4 A -C
PER MS 168.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, insWiation or replacement of a residential fixture, excluding the fixtures. (This should refieet only the cost of labor)
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 --
.O5 -FOR
FOR PROJECTS WIIM LABOR EXCEEDS $500, FEFS ARE BASH ON $10.00 PER FIXTURE, EXCEPT WEIFRE NOTED. FDCMM: (INDICATE TOTAL
NUMBER OF TACH BELOW)
F,QWpmcnt Inatned MFGMODrsL ���57 4 81ZFJBT[I %G 000
MFG: n MODEL: qM SIZEMIJ
MFG; MODEL; ST7WBTU
AIC $2100 FW.PI,ACE (GAS) 915.00 AAS RANOVOVEN $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $15.00 NEIN GAS GRTI.T. $10.00
$OILER $35.00 L FURNACE $35.00 _GAS UNIT HTR S10.00
CHIMNEY LINER$10.00 GAS DRYER $10.00POOL HEATER. $35.00
DUCT• WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
_
Permit Fee $
Number of fixtures @ $10.00 _ x $10.00 = $
Surcharge $ .50
Number of fixtures @ $15.00 X $15.00 = $
TOTAL DUE $
Number of fixtures Q $25.00 I x $25.00 — $ 25 • erft
Number of fixtures @ $35.00 1 X$35,00=$35-00
State Surcharge - $ SO
Total = $fab •So
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL. PROCESSED
1 hereby apply for a building permit and I acknowledge that the information above is eomplaw and accurate; that the work will be in
conformance with the ordinsaws and codes of, the City of Fridley and with the Mhmesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit that the work will be in accordance with the
approved plan in the 1 work w ' r review and approval of plans.
� • �� SIC-'"' DAIS L1
sIGNATURL OF APPL[CANT M1NT NAME (h0VA
1pLnAsE9t
City of Fridley --
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX. 763-502-4977
2007
Y OF FRIDLEY INSPECTION DIV.
11 University Ave NE
iley, MN 55432
:3) 572-3604, FAX (763) 571-1287
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
■awov wu ...ero nr rtvTt lncdL% Tr► oG IAIQTAI 1 CIl 11A1 CAt`u al nnD
Effective On Jan 1, 2003
.UMBING FIXTURE RATES: NO.
RATE
TOTAL
JOBAOORESS- 5oZ100
Wash -
�
- _ a Floor -
Q
_ Auto.
s Gas
... '�.J�^:
Water Heater
Stories
�:� ..fit: Urinal
o�c
�•::"�_,
Shower
13. Tray
Ciel r��
R. : w Drain
� :.-
;_ Washer
N
: .. Range
�Rx
:._... Gas Etec
Basement
and representations stated in this application are true and correct.
q
$ 7.00
$ 7.00
Z9 2003
ain Water Leader
Floor 1
?'•`'iFYC�.•^"!Yx
x-' 'ax ;_
�bFga:_ .•ys,�-
:t• ..:.._ ' " z•
ieil2' ..:....
:xss_,-mac:.
:`nyf��.'S-:
� . � .OKE:
_wx ...:. .:•n:
<'��•%yC�� i4"f'
�-.c•.•'.:.YwB±:.
..`�:•' ..
�fTl��� :..:
Floor 2
may.;,.......
:iw:riq'-i•:"'�:'
>o�xa'
-ieF
l?:
.:Fn,..it-;{i.
eeYc>'..
•• ,da•.�x. a
":C• .-'�:='a'
7oco
�r..� e4
i3: Fe
s'Sh±a
..a'x... ' .:
�; '-
:.. 'z41�3�
:' �.nac:
;egeirS�•,"
Floor 3
•i��'vr'-YF
,�_ a�<�
;�z •"Y'
Cost 0 PERMIT N0. 3251
:'�xd
Y �oF�
�'°'•'
r,'Jt•L.Mora. :.
'�. ,�
�>:
:idQ;fl�iic"
_"�:,:3$ot'.
.�:iq a5?
�s. �S:ii�;-
s� a:� .
Type
x
•.c�r•:s-"::.,.9::
2'�a�xY ��st�
oa:�y'Fr`7
'� s�ii:ias:a;:F..
`??T.>ve�}`itl`�`c.•:^.�
ne:X�Ty
':iit?teo:
�.-ai.<•'�:'°�..�.i.
'iei7L'ak2�%
`<•:g7•Yie::ii�
Floor'�i:Far..>_•::=g.::
SIGNED BY TEL N0. 710 03- -,11
z:. •..-
°'°- ...`t::
aw o rbf'e..t:
y..�
�3... it'a..:..':w:
.UMBING FIXTURE RATES: NO.
RATE
TOTAL
JOBAOORESS- 5oZ100
- aw Fixtures
$ 7.00
The undersigned hereby makes application for a permit for the work herein
id Opening, New Fixture
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
aer Dispenser
$ 5:00
and rulings of the Building Division, and hereby declares that all the facts
aw Off Basin
$ 7.00
and representations stated in this application are true and correct.
atch Basin
$ 7.00
$ 7.00
Z9 2003
ain Water Leader
umplReceiving Tank
$ 7.00
Dater Treating Appliance
$10.00
Owner J,ie 01Q U 111
later Heater -Electric
$ 7.00
Dater Heater •Gas" -4—
$10.00
e/
Building Used As U
.as Range"
$10.00
Cost 0 PERMIT N0. 3251
gas Dryer"
$10.00
Estimated
:ack Flow Preventer Required( )Yes ( ) No
nn
i 56444 Me4a
Type
$15.00
PLUMBING COMPA ►1f)JI.
leinspection Fee $47.0011 -Ir
SIGNED BY TEL N0. 710 03- -,11
kLL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
Approved 6Rough-In Date Final Date
State Surcharge
� .60MINI
TOTAL FEE
$ O.SP
UM FEE OR Y PLUM 1NGIGAS PERMIT 1S 20.0
PLUS THE 8,64 STATE SURCHARGE
:.OMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE