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PRE 2010 DOCS/ I August 15, 1955 TO WHOM IT MAY CONCERN: With this letter we, Mr, and Mrs. Victor Molinaro of 6111 Rainbow Drive N. E., Village of Fridley, grant permission to our neighbors, Mr, and Mrs. Robert E. Sanborn (or future owners) of 6121 Rainbow Drive N. E., Village of Fridley, to: Construct a garage, foundation and wall up to no closer than 3 feet of our property, line providing the roof or any other extension clears our property by at least 1. foot. This permission, is granted providing it does not violate any existing local or state construction codes or safety ordinances. actor Mo I inoro Signed before = on thh 15th day of AU a 1955 r iYutarx 8"ublic, Flennepin County, Minn. hksWing at Minneapolis. Won. My rommigenion r�j�plres .4in. 101h, 195 NOTICE: This permit does not cover the sewer or water. Be sure to see t( onstrucfion, Instailetion or alteration forwiri , plumbing,_gas heating, Ming Inspector for separate permits for items. City of Fridley, Minn. BUILDING PERMIT N® 3924 Date: ... .... . �.. d !............. . Ownera ............. . ..... ... ........ .. ........... Builder ... .... ... ................. Address ...................................... Address ............................................. // LOCATION OF BUILDING No. 1. /. o [ .. Street ... .. .:�d�".. /.�.�,,.... Part o Lot ...... `�`.. .. ... ... . Lot .. f .. Block ... ........... Addition or Sub-] .:. C......... .. Corner Lot ............ Inside Lot A ......... Setback ............ ideyard ........................... DESCRIPTION OF BUILDING Th be Used as:� . gg j �, .... Front ... (.'.O Depth �� .... Height y . ,d .'. Sq. rt./.FO. Cu. F't. I �� .................... Front ........ Depth ........ Height... Sq. Ft. ....... Cm Ft. ........ Type of Construction ................... Fat. Cost... ,/.40. To be Completed .................... In consideration of the issuance to me of a permit to construct the building desribed 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. � re In consideration of the payment of a fee of $.,r ..® 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 upon violation of any of the provisions of said ordinances. a e e �1`f.�j ����i61(:IRi °-.� � _r..• tics 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. 52-84-5915-51 PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $2.00 $ Future Fixture Opening x $1.50 New Fixture Old Opening 9 3 1 *Jz 0 - 0 t V N WATER H". GAS ELEC. Base a $2.00 $— GAS PITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..... .. . ...... ....... — x $2.00 Additional Fixtures ..... ........... ...—x$.75 Gas Range to 199,000 BTU ............... I x $6.00 $ 3 -00 lot 2nd 3rd 4th PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $2.00 $ Future Fixture Opening x $1.50 New Fixture Old Opening x $1.50 Catch Basin x $3.25 Water Heater (Up to 99,000 BTU) x $3.00 $ New Ground Run Old Bldg. x $3.26 $ Electric Water hater a $2.00 $— GAS PITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..... .. . ...... ....... — x $2.00 Additional Fixtures ..... ........... ...—x$.75 Gas Range to 199,000 BTU ............... I x $6.00 $ 3 -00 RIWAM & ALTMATIONS—Refer to Code Description ............................. __ . .............$ TOTAL FM 3,00 City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Minn 12-15-69 Owner Ted Olson Kind of Building, frane Used as res To be completed about 12-20-69 Estimated Cost, $ 10*00 Old—New. Building Permit No — -- Pe No. - en, -fiignea. POLIS r _a 4Z By- If POLIS GAS Cn Business Phone No rINA1,-_ CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY 1VARV1 AIR: Furnace Shell & Duct Work ' Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500,00 MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU each add. 50,000 BTU *Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500,00 STEAM OR HOT WATER SYSMI: Boiler & Lines up to 100,000 BCU each addn. 50,000 BTU. Boiler only up to 100,000 BTU each addn. 50,000 BTU RATE TOTAL $12,00 $ 4.00 $ mob Address 49�/' Department of Bgjjg }ngs City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein $12.00 $ specified agreeing to do all work in strict accordance with the City Codes ' 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the 7.00 $ y facts and representations stated in this application are_true and correct. 7,00 440 $ Fridley, Minn. , 19 OWNER $12.00 4.00 7•PA P. PP OIL BURNER- to 3 gal. per hour each add. 3 gal. per hour }P.AA GAS BURNER- from 100,000 BTU to i`1q,jjq (over 199,999 BTU see Fee Sc4eq!4;ej GAS FITTING FEES: lst 3 Fixtures x $.QQ Additional Fixtures X $ ;:PQ Gas Range to 199,000 BTU IS 4Q,Q0 AIR CONDITIONING FAN HEATING SYSTEMS See Fee Schedule VENTILATING SYSTEMS ALTERATIONS 4 REPAIRS State Surcharge TOTAL FEE ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT REINSPECTION FEE (.510.00) MINLKtu FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE *Attached stack verification form KIND OF psED AS TqFFPC NSTTN?NA CP.ST tea, PR - W, PgTRT�NG PPF-MTT NQ. FwTT No. AESCRTPTTPN PF FURNACE/BURNER mP fir PAPIER Fj ? S; ,'qt€Z P.; #tat Plater; Warm A}r- No. Trade Name size No. capacity Sq. Ft. EDR BTU v ' o o HP Tot�a�jl nnected ad Kind of Fuel - Trade Name42!� Size No. Capacity Sq. Ft. EDR BTU 0 HP Company Signed By Tel. NO. CITY OF FRIDLEY APPLICATION FOR HEATING REPLACEMENT CHIMNEY AND STACK VERIFICATION THIS FORM MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM. LOCATION /� /�'r �-°� DATE OWNER �� ADDRESS y The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined 2. Is free from rust or deterioration 3. No foreign objects are lodged within 4. That it is securely supported 5. That it meets all current Code requirements for size and total BTU connected 6. Total Heating BTU e All Other BTU � TOTAL REMARKS . SIGNEOt Licensee by Address,/ Telephone HEATING PERMIT # Fridley -City License # City of Fridley SUBJECT 15 8 7 2 AT THE TOP OF THE TWINS BUILDING PER r 1 RECEIPT • ______ COMMUNITY DEVELOPMENT DIV. L PROTECTIVE / r INSPECTION SEC. CITY-HALL FRIDLEY 55432 C NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 8/12/80 JOB ADDRESS R191 RaInhow Dr- N_g� 1 LEGAL LOT NO.BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. ] rj 2 Sylvan Hills Add. SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Ted E. Olson 6121 Rainbow Dr. N.E. Fridley 55432 571-7149 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Owner 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 IA ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be second but not third. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE P =RMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. kBphalt THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK I SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME A TER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL 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 $1,500.00 $.75 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. $9.00 PLAN CHECK FEE TOTAL FEE SIGN TU EFCONTRACTO I ORI2ED AGENT 1XTEI WHIZ, RL ID TE � THIS IS YOUR PERMIT e, BLDG INSP DATE SIG T REOFOWN RIIFO RI (DATE) 01 OWNER: ADDRESS TEL NO: .STREET NO: LOT: c3� Corner Lot: CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) BUILDER: - -- .• STREET: ADDRESS: TEL NO: ConsUuction Location BLOCK: cZ_ ADDITION P Inside Lot: Setback: Sideyards: attach to this form two Certificates of Survey of lot and building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: Depth: Height: Squane.Feet: Cubic Feet: V Front: Depth: Height: Square - Feet: Cubic Feet: Type of Construction: Estimated Cost: $ 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 tated in this application are' co r DATE: ® ( 1 SIGNATURE: ✓' Stipulation s: 7 7r • SUBJECT City of Fridley Z28600 AT THE TOP OF THE TWINS BUILDING PERMIT L'______, COMMUNITY DEVELOPMENT DIV. j : . PROTECTIVE INSPECTION SEC. 7 715 NUMBER REY DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 L 612-571-3450 9t0-Ft5 .11117/98 JOB ADDRESS 6121 Rainbow Drive 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 15 2 ISylvan Hills Plat 1 SHEET 2 PROPERTY OWNER MAIL ADORE" ZIP PHONE Ted Olson 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO D L Builders 1166 14th Ave SE M is 55414 378-0950 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 Ox REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (23 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO 8E 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 1971 .98 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 $62.25 Fire SC $1.97 PLAN CHECK FEE TOTAL FEE ` (�'�� $70.20 S�GNAT R OF CONTRACTOR OR AUTMORi2E0 AGENT (DATE, OPER A�LIID/ATED THIS IS YOUR PERMIT �,G / DAtE S-GNATURE OF OWNER.,F OWNER SUILOM IDATE� 01) NEW' `[ ] Effective 1/1/98 ADDN [) CITY OF FRIDLEY ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ®(,1 BUILDING PERMIT APPLICATION ConstructionAddress: 'bre- Legal Description: Owner Name & Address:, t ep a Sa +.� (� I Z t 2�'��1 D cz Tel. # Contractor: •L . �,,;,`��;zs MNLICENSE#Zo09to'7il Address:_l I [, t Sip M �\g lM,� SSL411A Tel. # 37 r-r--y9S-u Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type:. Estimated Cost: $ _ 1 q % (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: I) J-1 `fig APPLICANT: Tel. # 379—Q RSti CITY USE ONLY Permit Fee $ �j� �S� Fee Schedule on Reverse Side Fire Surcharge $ f , 9�% .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ , d $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 $ / U STIPULATIONS: r CITY OF FRIDLEY PERMIT NO.: 2004-02226 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 12/02/2004 (763)572-3604 FAX: (763) 571-1287 ADDRESS : 6121 RAINBOW DR NE PIN : 143024330030 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. # INSPECTIONS I APPLICANT CENTERPOINT ENERGY/MINNEGASCO 13562 CENTRAL AVE NE ANOKA, MN 55304 - OWNER TOMAS DAVID A & ERICKSON T L 6121 RAINBOW DR NE FRIDLEY, MN 55432 STATE SURCHARGE, ELEC FLAT 0.50 ELEC PERMIT FEE - MIN (RESI) 20.00 TOTAL 20.50 PAID WITH CHECK # 6272 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. Applicant Date Bldg Insp Date SEFAKA It FEKMI IS KEQU1KEll VOK WOKK OTHEK THAN UESUKIBED ABUVE. CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 F63) 572-3604 FAX: (763) 571-1287 ADDRESS : 6121 RAINBOW DR NE PIN : 143024330030 LEGAL DESC : UNAVAILABLE LOT BLOCK PERMIT TYPE HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-02227 DATE ISSUED: 12/02/2004 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. # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS # GAS RANGES 0 VALUE (FOR MINIMUM CALC) APPLICANT CENTERPOINT ENERGY/MINNEGASCO 13562 CENTRAL AVE NE ANOKA, MN 55304 - OWNER TOMAS DAVID A & ERICKSON T L 6121 RAINBOW DR NE FRIDLEY, MN 55432 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 f any other state or local law regulating construction or the;ePZmgthce of construction. Bldg Insp HEATING PERMIT MINIMUM FEE FURNACE SHELUDUCT WORK GAS RANGE FEE GAS DRYER FEE AIR CONDITIONING FEE HEATING REPAIRS/ALTERATIONS STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 6272 SEPARATE PERMITS REQUIRI✓D FOR WORK OTHER THAN DESCRIBED ABOVE. 0 2300 0.00 35.00 0.00 0.00 0.00 0.00 0.50 35.50 ;ITY OF FRIDLEY BUILDING INSPECTION 9 3431 University Ave NE 9 =Adley, MN 55432 L 763-572-3604 FAX 763-571-1287 S1 D n RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fee Tata $35.00 $10.00 10BADDRESS (Si_a- Owner. Building Used ESTIMATED COST a300' 03 PERMIT NO Gas Range $10.00 $ DESCRIPTION OF FURNACE AND BURNER D Gas Dryer $10.00 $ # of Heating Units Circle One (Steam) (Hot Wat Warm Air Trade Name ��— 0(2P �_ 6-1 _Size No. L'Air Conditioning -Ail Sizes $25.00 $ BTU __n,00 C) HP EDR Fuel rig Total Connected Load All Other Repairs or Alterations (List on. Back) r 1% of Value of Appliance or Work $ Burner Trade Name Size No. A Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EDR Y . Improvement whichever Is greater on work less than $300.00 The undersigned hereby makes application for a permit for the work herein �53 Commercialllndustrialjlnstitutional specified agreeing to do all work in strict a000rdance 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. CENTERPOINT ENERGY Y State Surcharge � .50 HEATING CO 13562 CENTRAL AVE NE BLAINE, MN 55304 1 TOTAL FEE $ S �} vie Signed Tel # 763-757-6202 v ii q� REINSPECTION FEE $50.00/HOUR FAX # 763-757-6701 Date m*Air Conditioners can not be placed in side yard without written approval N from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE EL cc Approved by 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 (3 No( ) The venting system is plastictPVC and meets all current codes and manufacturer Yes No( ) specifications including sizing, length, number of elbows and termination. ( 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, 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 verifiers that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA -LAMA Category I Central Furnace Yes No ( ) Venting Tables for fan assisted and natural draft appliances. { 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 ,po-L� Fan Assisted or Nat Appliance #2 Type 4 BTU Input Fan Assisted or Nat° Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances _ � Total Btu Input z 1a.. cru v Common Vent Type t? Vent Height Diameter 3� inches d Ii Appliance #1 Vent Connector Height _3__ft Length Diameter n Type Appliance #2 Vent Connector Height __j Lft Length L ` ft Diameter min Type,�� Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) �.���r`�b ���� • �a��� c�e$��� �'� CENTERPOINT ENERGY HEATING CO: 13562 CENTRAL AVE NE ISI -41 NP,, MN 55304 Sign9d By: Date E ?R/M' A TGIJ.(W, L Ol A2 1G 1 dd d0 AM 140N-1 CF: T T b002-L2-Ndd