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PRE 2010 DOCS'3 City of Fridley, Mum N? 8942 BURDING PERMIT Date: JULY 27, 1966 Owner: Builder CHARLES E. JOHNSON$ INC. Address Address 160 HARTMAN CIRCLE N.E. FRIDLEY, MMMSOTA .55432 . LOCATION OF BUILDING No. 500 Street RICE CREEK BOULEVARD part of Lot Lot 9 ._ Block 1 Addition or Sub -Division HOLIDAY HILLS_ Corner Lot .__ Inside Lot _ _ Setback 35 _ _ Sideyard 25 Sewer Elevation — Foundation Elevation DESCRIPTION OF BUILDING To be Used as: DWELLING Front 47 Depth 37/28 Height 20 Sq. Ft. 37/28 Cu. F30,280 GARAGE Front 21 Depth 24 Height 10 Sq. Ft. 546 Cu. Ft. 5,460 Type of Construction FRANE Est. Cost _..x:001To be Completed In consideration of the issuance to me of a permit to conahru des above I agree to do the proposed work in accordance with the description above set in p wi ail provisions of ordinances of the city of Fridley. _ , ,- in consideration of the payment of a fee of3$ 6.00 , permit is herebjgianted to SES E. ,IQ►]gSO�,. TRC - 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 an 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, Minnesotalocation, construction, alteration, maintenance, repair and moving of buildings within the dty limits permit may be revoked at any time upon violation of any of the provisions of said ordinances. CLARENCE BELISLE Building Inspector NOTIC& M pom t dans net aowr the eendrucdW, MdaWen for Wkh* ph mbine, on heating, ewer or water. Be an to ae the Bulhling WgMbr, for spm" PUMI" for thea ttM& t. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER' S NAME BUILDER ADDRESS ZL . � >� .,ADDRESS LOCATION OF. B D4.. NO. ®" STREETPART OF LOT ` c LOT BLOCK` ADDITION OR SUBDIVISION 3 CORNER LOT INSIDE 'LOT SETBACK_ SIDE -YARD 2-5— SEWER -S— SEWER ELEVATION ON ELEVATION Applicant attach to this form Two Certificates frve of Lot an proposed building location drawn on these Certificates. DE�IPTION O�BUiLDING To be used -as; Front_ q Depth Height Sq. Ft. 'a f/ Cu. Ft. Front Depth Height /,-) Sq. Ft. ''s Q -Y Cu. Ft. Type of Construction Estimated Cos 7Z j o a d To be completed 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 (Schedule of Fee Costs can be found on the Reverse - 4 ti ^r f F F d f.. Ag Y AIT. Con�r.✓e�r Muctfxis 21, Seib ksfij c�r�;uarr lunsef�t-�A 9"'9--- Engineers C Sur verrs -�---- certificate of f o* F. N (E ELOPN NT CO.. N DRT14 j4'�� rs, !/ qr 3 21 //rrre�y cerfi y iYW /bis is a burs a' d =rmd repremAtwn of# s"-My efm 4es qr& tae olso4w, /Aw,&d tocol ,n oyi## hvvw, orad&Y nsAte evvadmods, ifmr , fnw or w said /ori! As Arveyed ly SU$u28A" MC71MF INN; INC. te e.-a e. �r Application for Power Plants and Heating. Cooling. Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone 560-34500 GRAVITY WARM AIR: RATE TOTAL Location e C =g=:f= ° �%, 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 ............... 3.00 $ NECK. WARM AIR ®o v Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ 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 G GAS BURNER (up to 199,000 BTU) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtureso� ® O ...................... x$ 2.00 $ Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $� ROUGH FINAL City of Fridley: The undersigned hereby makes application for a permit for the work hereir. 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, AU= P 2 J 19 (.k Owner Kind of Building Used as To be completed about 07 Estimated Cost, $�� / EO—New. Building Permit No. Permit No. DESCRIPTION OF WORN HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No Trade Name Size No.703•Zo 9�' Z1, Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load �l �® ® Kind of Fuel -4,0-2 BURNER — Trade Name Size NO_ f^ ® ® Capacity. (REMARKS -OVER) C4100.42 Sq. Ft. E.D.R BTU H.P. _XZ414V,. 0 By Business Phone i SUBJECT - PERMIT NO. City of Fridley ®131'70 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. iCOMMUNITY DEVELOPMENT DIV. - _ r � PROTECTIVE INSPECTION SEC. 1 � NUMBER REV. DATE PAGE OF APPROVED BY = "t ----1 CITY HALL FRIDLEY 55432 ---- ,'J 612-560-3450 910-F15 8-28-75 JOB ADDRESS 500 RICE CREEK BOULEVARD 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 1 1 HOLIDAY HILLS SHEET 2 PROPERTY'OWNER MAILADDRESS ZIP PHONE DONALD DIBOS 500 RICE CREEK BOULEVARD 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. AgILARJUS SWIMMIbIG POOL Co.,1 O CEDAR AVENUE SOUTH ROSEMOUNT 4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING RESIDENCE 7 CLASS OF WORK ❑ NEW XX ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK INSTALL SWIMMING POOL 16 x 32 9 CHANGE OF USE FROM TO STIPULATIONS WARNING' Before digging call local utilities TELEPHONE - ELECTRIC - GAS Etc. REQUIRED BY LAW �EPERATE PERMITS REQUIRED FOR WIRING, MEATING4 PWMBING AND SIGNS. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST._ OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENC91) 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 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 $4800 $2.50 DOES PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PR ISION OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- ST UCTIO OR THE P(kORMAry CE OF CONSTRUCTION. $27.00 PLAN CHECK FEE TOTALFEE 29.50 SIGNATUREOF CONTRACTOR OR�AUTHORIZED AGENT - (DATE) r 77 WHEN PROPERLY VALIDATED IHIS IS YOUR PERMIT - 8-28-75 BLDG INDATE SIGNATURE OF OWNER 0F OWNER BUILDER) (DATE) •APPLICATION FOR RESI•DL'NTIAL.,ALTL- ZATION, • OR ADDITION•BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA L •R: �1 S OWNE'R'S NAME BUILDER: .�(�6�1,� � � �� - ADDRESS : �\ t iia ��,� ADDRESS:t CC) NO • 5 0 C.) STREET • t IAT: BLOCK: / ADDITION: CORNER LOT: INSIDE LOT: SETBACK: - SIDL'YARD: . Applicant attach to this form . Trio Certificates -if Surve .of Lot and.proposed building location c:.:awn on these Certificates. DESCRIPTION OF BUILDING To Be Used'As: Front: Depth:• Height: Square Feet: Cubic.Feet: Front: Depth: Height: Square Feet; -Cubic Feet: Type of Construction: J (U, Estimated Cost: To Be Completed: The undersigned hereby makes applicatian for a permit for the work herein specified' agreeing to do all work in-sttict 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:SIGNATURE: .(See Aeverse Side For Additional Information.)- - � G r► 560.3450 city,rijIe ANOKA COUNTY 6431 UNIVERSITY AVENUE NE FRIDLEY, MINNESOTA 55432 August 28, 19.75, Mr. Don DiBos 500 Rice Creek Boulevard Fridley, Minnesota 55432 Re: Swimming Pool at 500 Rice Creek Boulevard Dear Mr. DiBos-0 This letter is`to reiterate my conversation with Mr. Paul Duea on August 28, 1975 and to make clear this department's requirements for the swimming pool construction at the above address: 1. As discussed, two (2) skimmers approved by fie National Sanitation Foundation will be provided. 2. As discussed, two (2) inlets of approved design for fresh and/or repurified water will be provided. 3. As discussed, a main drain of approved construction will be provided. 4. The filter and pump shall be approved by the N.S.F. and be of sufficient capacity to provide a minimum turnover of at least tw;6­12) times in 24 hours¢. This department recommends a turnover rate of -6-8 hours. 5. A deck, a minimum of 3 feet wide and sloped away from the pool, must be provided around the entire perimeter of the pool. 6. The diving area will be acceptable provided there is no overhead obstruction. 7. A fence or other suitable barrier, a minimum of four (4) feet high, that affords no external hand or foot holds and which is impenetrable by toddlers, must be.provided around the entire perimeter of the pool. All gates and other accesses shall be equipped with self-closing and latching devices which are capable of being locked. 8. An automatic chlorinator should be provided with a suit- able test kit. 9. All electrical and plumbing installations shall be inspected and approved by the City Inspection Department. Swimming Pool 500 Rice Creek Boulevard Page 2 10. All electrical lines must be 10-20 feet or more away from the pool surface. 11. The pool fill spout must be air gapped or protected by a vacuum breaker. 12. Suitable -safety equipment to include but not limited to a. ring buoy and rope that is ll� times the pool diameter, shepherds crook pole, must be provided and maintained with the pool at all times. Furthermore, these and any other requirements must meet the provisions of the Fridley City Code, Section 115, Swimming Pools. The building permit is approved contingent on final inspections and approval by the City. If any questions or problems arise from this letter, please feel free to contact me at 571-3450, Ext. 41. Sincerely, r STEVEN J./ OLS Environm I t Officer SJO/cs CC: Mr. Paul Duea Aquarius Swimming Pool Co. 16900 Cedar Avenue South Rosemount, Minnesota 55068 MMMEGASCO Cii-Y of Fridley 53-84-879.01 Applic-affan for Plumbing crid Gnu; FIW-113. Pefl*' Npt. of Bldua. Phone 5.90-3450 D.ESCRIPTILON 07 WO111M Lorne500 Rice Creek Blvd. Kum!) -or. Kind and Locrtfon of Fixtures 0 z S z jo X 0 N WATER "TR. 7GAS FLIC Bsse Iat Cc rayl 4ct Ufto4ere Pool gea erj__ tad 3rd 4th Saver 0 Nov? Fixture. Old 0youlngs Ij Ccrzpool PARTIAL RATE SCHEDULE PLUMBING. FIXTURE RATES: NO. RATE TOTAL 'Number Fixtures . 9 ........ x $2.00. $ Future Fixture Opening ........... x $1.50 $ . New Fixture Old* Opening X $1.50 $ Catch Basin.* ....... X $3.25 $ WAier Heater !Up to 99,rA ETl;)* - x 53.00 New Ground Run Old Bldg.. x '.M. 25 S Electric Water HaaW ...... 7 ....... $2.00 $ .311 FITTING FEES: No. RATE TOTAL City of Fridley,! The undersigned hereby makes application for a permit for the work her ' el 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 tact and representations stated in this application are true and correct - Fridley, Minn 10-31-75 Owner Donald Deobos Kind of Building Frame Used as Res. To be completed about 11-7-75 Estimated Cost. S 10.00 Old --== 11 . uilding Permit No. Per= No. Sig" By MUMEGASCO Business Phune N ROUGH FINAL_L0 — I j — ? 1st 3 Fixtures ...... x $2.00 Additional .Fixtin'es X S .76 $ Gas Range to 199.000 BTU ....... X $5.00 REPAIRS & ALTERATIONS—Refer to Code *50 State Surcharge Connect'Customers Pool Heater-._. 5.00 5 Desvd0lon ,50 TOTAL FZE _7 Surchargg Class " A 500 --- SUBJECT PER ity of Fridley 215 4 2 AT THE TOP OF THE TWINS BUILDING PERMIT i � IPT N I v COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. �^� r Y/ 1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE Of APPROVED 8Y 612-571-3450 910-F15 9/14/92. 10B ADDRESS 500 Rice Creek Blvd 1 LEGAL LO NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 1 Holiday Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Donald Dibos 500 Rice Creek Blvd 571-1189 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Robert F. Norberg Const, 10015 29th Ave N 544-2513 4121 4 ARCHITECT OF I DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILD NG Reside tial 7 CLASS OF WO K ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WO K Construct a 241 x 14k Garage Addition 9 CHANGE OF U E FROM TO STI PU LATI O N See notations on plan. WARNING Before digging call f®r all utility: 10tations SEPARATE. PERMITS REQUIRED FOR 45,4002 WIRING, HEATING, PLUMBING AND SIGNS. REQUIR` ,� BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY. TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED W $5,288.64 $2.64 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $81.00 Fire SC $5.29 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE License SC $5,00 TOTAL FEE $93.93 SIGNATURE OF CONTRACTOR R AUTHOwn D AGENT IbATEIH P PE Y VA %TED THIS IS .YOUR PERMIT K9 BLDG IN P DATE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI I NEW [ ] ADDN j ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Soo 17`e -a �feaag '0"b , Legal Description: t—C) I /, I '0i Effective 3/1/92 (-S Owner Name & Address: hLw-Aiz Di �3%� a &z:, Tel. # -!�?/-Z/g Contractor: peaa-t- )C:" MN LICENSE #OOD4-%2 f Address: IP ��-,Of Lo Ww Tel. # S-14 -2x`13 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 .2!1 Width M _ Height f® Sq. Ft. 9,,34 DECK AREA: Length Width Hgt/Ground ' Sq. Ft. OTHER: Corner Lot [ ] Inside Lot Ft. Yd Setback Side Yard Setbacks Type of Construction: $ 2,64 Estimated Cost: $®�� $ Approx. Completion Date: Zr Driveway Curb Cut Width Needed: Ft. + b Ft = Ft x $ (Cost on Back) DATE: i APPLICANT: Tel. # Permit Fee $ 9/,00 Fire Surcharge $ S, Z State Surcharge $ 2,64 SAC Charge $ License Surcharge $ Driveway Escrow $ Park Fee $ --- Sewer Main Charge $ CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $700 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary j ] Not Necessary [ ] TOTAL $ �'�a13 � o STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 31 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Wt�r I R ' Wash Shower Drlrt. :Floor Dr in t. Auto. >.. W shar Gas Range e MSdx Water Heater $ 4.00 GasUrin E le cStories Ba semen $ 5.00 > : Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader Floor 1 Sump/Receiving Tank $ 7.00 ,'1� /U Water Treating Appliance :::< L Water Heater -Electric *1e e.P4eaW - Gas P004 dM. Floor 2 Building Used As sl�%GGe F�yl Gas Range $10.00 <> Gas Dryer' $10.00 ::N::: Back Flow Preventer Required ( )Yes () No JK64cr�i(/-G'Lri�'2- L1�� FI r 3 00 $5.00 PLUMBING COMPANY Reinspection Fee $30.00 SIGNED BY TEL N0. 5 5 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance Flo r 4 0 Approved By .�� State Surcharge .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 '�S-60 RxE Fn,.D. D. PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 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 Sump/Receiving Tank $ 7.00 ,'1� /U Water Treating Appliance $10.00 Owner Water Heater -Electric *1e e.P4eaW - Gas P004 dM. $ 7.00 $10.00 Building Used As sl�%GGe F�yl Gas Range $10.00 Cost �l���. PERMIT NO. AIL6 9 Gas Dryer' $10.00 Estimated Back Flow Preventer Required ( )Yes () No JK64cr�i(/-G'Lri�'2- L1�� Type $5.00 PLUMBING COMPANY Reinspection Fee $30.00 SIGNED BY TEL N0. 5 5 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance Rough_ In Date Final Date Approved By .�� State Surcharge .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 TOTAL FEE $_ZL5C PLUS THE $.50 STATE SURCHARGE % SUBJECT �• City of Fridley 216 3 5 ?-, AT THE TOP OF THE TWINS BUILDING PERMIT(-: r COMMUNITY DEVELOPMENT DIV. ^� PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV, DATE PAGE OF APPROVED BY �----ilk" 612-571-3450 910-F15 11/4/92 JOB ADDRESS 500 Rice Creek Blvd NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 1 Holiday Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Donald Dibos 500 Rice Creb i Blvd NE 571-1189 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Robert Norberg Construction 10015 29th Ave N, Plymouth 55441 544-2513 4121 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 B DESCRIBE WORK Construct a 161 x 16! Addition (.Octagon) 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. 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 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 VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $11928 $5.96 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT r 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- $135.00 Fire SC $11.93 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. p f PLAN CHECK FEE TOTAL FEE License SC $5AO $157.89 SiGNATTJRE OF CONT ACTOR ORA ORIZEDAGENT (DATE) WHEN Y A DATED THIS IS YOUR PERM �R R Y 9 LDG IN P_ DATE SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI NEW [ ] Effective 3/1192 ADDN CITY OF FRIDLEY ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: S-0® A-7/� e er 42,Qa, RX Vj> Legal Description: Owner Name & Address: ad Oa& L>�,�� SA6 � *0,,7x j%jz, Tel. # .5'71 d'/YF Contractor: ",a �'�� ��� ��z✓�7. MN LICENSE # ®0t�k4 /z t Address: /',040sS' o? 9 -V 4? , �; `:�-9'�l 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 Width 1 Height .1,02 Sq. Ft. 43 GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: x1 Comer Lot [ ] Inside Lot . (] Ft. Yd Setback Type of Construction: e;; ► Approx. Completion Date:ze Driveway .Curb Cut Width Needed: Ft. + b Ft = Side Yard Setbacks _ Estimated Cost: o o/ (Cost on Back) Ft x $ _ $ DATE: !�?�T APPLICANT: Tei. # 544 2.51.E Permit Fee $ f Fire Surcharge $� r qi State Surcharge $ SAC Charge $ License Surcharge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOTAL $ J!" 4i STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.501$1,000 Valuation $700 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CITY OF FRlDLEY INSPECTION DiV, Effective On January 1;1993 6431 Unl ersity'Ave NE , Fr, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, !d0 S Sy604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS �lct- -etnk 1Y1&./ RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work In strict accordance with the City Codes and Furnace Shell and Duct Work, Burner — rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 20.00 $!_ C',C'� representations stated in this application are true and corree 3o ,1993 Gas Piping (Needed with new furnace) $10.00 $_______._ OWNER Z� /7/ to S Gas Range $ 10,00 $ BUILDING USED. AS Gas Dryer $10.00 $ ` ESTIMATED COST ®D PERMIT NO. l *Air Conditioning — Ali Sizes $10.00 12ESCRiPTiON OF FURNagE,dD OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work $ No, of Heating Units Circle One (Steam) (Hot Water rrn Trade Name Size No. S`® o� ��y/r103 T Commercialllndastrial BTU '®4:7 HP EDR 1% of Value of Appliance or Work $ Fuel % Total Connected Load State Surcharge $,�,,,,50 Burner Trade Name Size No. �-� BTU HP EDR TOTAL FEE HEATING COMPANY l/�.e r•�'✓�"�-� MINIMUM FEE FOR ANY HEAT] NG/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $16.00 Signed ` Tel No. PLUS THE $.50 STATE SURCHARGE U REINSPECTION FEE $30.00'11 ' Approved By Rough—In Date inal Date G ? *Air Conditioners can not be placed In a side yard without written permission from adjoining property owner. FiLL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE f �C 1 V Remarks L'st Alterations Being Done: 17 HEATING COMPANY Signed By Date ir_ =7 e ­%_ CHIMNEY `. AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: I. Has been carefully examined Yes ( No ( j 2. Is free from rust or deterioration Yes j No ( ) 3. Has no foreign objects lodged within Yes) No ( ) 4. Is securely supported Yes No ( ) 5. Meets all current Code requirements for size -and total BTU's connected Yes No ( ) 6. Has total heating BTU's of All other BTU's TOTAL BTU's Remarks L'st Alterations Being Done: 17 HEATING COMPANY Signed By Date ir_ =7 e ­%_ t CINOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 August 31, 1994 Peterson -Pinney 4151 Coon Rapids Blvd NW Coon Rapids, MN 55433 Re: Heating Permit #11400, Issued September 30, 1993, For 500 Rice Creek Blvd NE, Fridley, Don Dibos Residence Dear Sirs: The final inspection was conducted on October 30, 1994 for the above noted permit and the following corrections/violations were noted which shall be completed by September 30,1994: 1) Provide combustion air as per UMC Chapter 6 (copy attached). 2) Provide proper size, semirigid copper connector to furnace. It shall have 1/2 inch inside diameter per Code (copy attached). Please contact my office when corrections are completed to arrange for a final inspection. Failure to complete these corrections may result in this matter being turned over to the City Prosecutor for his legal consideration. Thank you in advance and if you have any questions, I can be contacted at 572-3605 or in writing at 6431 University Ave NE. Sincerely, EL C LLOVA Mechanical Inspector MC/mh ENC: 1 1988 EDITION 5-D-1, 5-D-2 TABLE NO. 5-D-1—CAPACITIES OF LISTED METAL APPLIANCE CONNECTORS1 For use with gas pressures 8 -Inch or more water column 'Gas connectors are certified by the testing agency as complete assemblies including the fittings and valves. Capacities shown are based on the use of fittings and valves supplied with the connector. 20utside diameter. 31ntemal diameter. `+For liquefied petroleum gas use 1.6 times the natural gas capacities shown. TABLE NO. 6-D-2—CAPACITIES OF LISTED METAL APPLIANCE CONNECTORSI For use with gas pressures less than 8 -Inch water column Flexible Maximum Capacities in Semirigid Connector Thousands Btu/h (Based on pressure drop �O.D.2 or Nominal cwater Nat Gals -TL I.D3 of 1100 Btu cu (Inch) (Inch) 1' 1+k' 2' 2'A' 3' 4' 5' 8' 1Yz2' 2W 3' 4' 5' 6'All All Gas Appliances Appliances Ranges Only Only �/4 40 33 29 27 25 17 3/8 �h 3/a 93 76 66 62 58 41 5/s 'h 189 155 134 125 116 101 90 80 — 3/4 404 330 287 226 244 174 1 803 661 573 534 500 353 'Gas connectors are certified by the testing agency as complete assemblies including the fittings and valves. Capacities shown are based on the use of fittings and valves supplied with the connector. 20utside diameter. 31ntemal diameter. `+For liquefied petroleum gas use 1.6 times the natural gas capacities shown. TABLE NO. 6-D-2—CAPACITIES OF LISTED METAL APPLIANCE CONNECTORSI For use with gas pressures less than 8 -Inch water column 'Gas connectors are certified by the testing agency as complete assemblies including the fittings and valves. Capacities shown are based on the use of fittings and valves supplied with the connector. 2Semirigid connector listings are based on outside diameter. 3Flexible connector listings are based on nominal diameter. 4For liquefied petroleum gas use 1.6 times the natural gas capacities shown. 43 Flexible Capacities for Various Lengths In Thousands Btu/h (Based on pressure drop Connector Nominal of 0.4 -Inch water column I.D3 Nat. Gas of 1100 Btu/cu. fL(Inch) gConnedctor 1' 1Yz2' 2W 3' 4' 5' 6'All Gas Appliances Ranges Only �/4 28 23 20 19 17 38 66 54 47 44 41 5/s 1h 134 110 95 88 82 72 63 57 — 3/4 285 233 202 188 174 1 567 467 405 378 353 'Gas connectors are certified by the testing agency as complete assemblies including the fittings and valves. Capacities shown are based on the use of fittings and valves supplied with the connector. 2Semirigid connector listings are based on outside diameter. 3Flexible connector listings are based on nominal diameter. 4For liquefied petroleum gas use 1.6 times the natural gas capacities shown. 43 601-603 UNIFORM MECHANICAL CODE Chapter 6 COMBUSTION AIR General Sec. 601. (a) Air Supply. Fuel -burning equipment shall be assured a sufficient supply of combustion air. The methods of providing combustion air in this chapter do not apply to direct vent appliances, appliances listed as having separated combustion systems, enclosed furnaces, listed cooking appliances, refrigerators and domestic clothes dryers. In buildings of unusually tight construction, combustion air shall be obtained from outside. With prior approval, in buildings of ordinary tightness insofar as infiltration is concerned, all or a portion of the combustion air for fuel -burning } appliances may be obtained from infiltration when the requirement for 50 cubic feet per 1000 Btu/h input is met. H (b) Existing buildings. When fuel -burning appliances are installed in an existing building containing other fuel -burning appliances, the room or space >3 shall be provided with combustion air as required by this chapter for all fuel - burning appliances contained therein. Combustion Air Openings Sec. 602. (a) Location. Approximately one half of the required combustion air opening area shall be located within the upper 12 inches of the enclosure and approximately one half of the opening area shall be located within the lower 12 inches of the enclosure. (b) Dampers Prohibited. Combustion air ducts or plenums shall not be installed so as to require openings in or penetrations through construction where fire dampers are required. Manually operated dampers shall not be installed in combustion air openings. With prior approval, power -actuated movable louvers admitting combustion air may be used and, if installed, shall be electrically " interlocked with the main burner fuel -supply valve so as to prevent fuel deliver E PP Y P Y unless the louvers are in the fully open position. £ (c) Louvers, Grilles and Screens. Combustion air openings shall be covered t+� with corrosion -resistant screen of 1/4 -inch mesh, except as provided in Section 604 (c). In calculating the free area, consideration shall be given to the blocking effect of louvers, grilles and screens protecting openings. The free area through 1Y: louvers, grilles and screens shall be used in calculating the size of opening required to provide the free area specified. Sources of Combustion Air Sec. 603. (a), Air from Outside. Combustion air obtained from outside the building shall be supplied as follows: 1. Through permanent openings of the required area directly to the outside of the building through the floor, roof or walls of the appliance enclosure; or, 2. Through continuous ducts of the required cross-sectional area extending from the appliance enclosure to the outside of the building. The required upper 44 City ®f Fridley SUBJECT 25 47 7 AT THE TOP OF THE TWINS B U I L ®I G P E R M I T r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r � � NUMBER REV DATE 9/8/97 =AGOF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 108 ADDRESS 500 Rice Creek Blvd NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 1 Holiday Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Donald Dibos 500 Rice Creek Blvd NE 571-1189 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO B & B Roofing 6760 Madison.St NE, Fridley, MN 55432 571-0248 9042 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 (29 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 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 $2,418 $1.21 WITH ETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DO S N T PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE I P OVIS IN OF ANY OTHE STATE OR LOCAL LAW REGULATING CON- ON- $ 74.75 Fire SC $2.42 TRU ION OR THE PERF MANCE O CONSTRUCTION. PLAN CHECK FEE TOTALFEE License SC $5.00 $83.38 SIGNATU OF CONTRACTDR Rau HORIZEDAGENT iDATEi WHEN PROPERLY V I ATED THIS IS YOUR PERMIT 704V BLDG NSP SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI NEW [ ] Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER ( ] SINGLE FAMILY AND DUPLEXES R -I AND R-2 BUILDING PERMIT APPLICATION 6P# a5 -V7) ConstructionAddress: kgz Legal Description:' (h 'q % Owner Name & Address: Tel. # 7/ —%d'5� Contractor:] ,�//'1J� _ MN LICENSE Address: r % i�1j}%�/.�/ %2��c �r /�� Tel. #� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: DESCRIPTION OF IMPROVEMENT Length Width Height Length Width Height Length Width Hgt/Ground. Driveway Curb Cut .Width Needed: Sq. Ft. Sq. Ft. Sq. Ft. Se Lr Estimated Cost: $ (Fee Schedule on Back) Ft. + 6 Ft = Ft x $ — =$ DATE: /r/� % �/" % APPLICANT: z/ ��'//��L Tel. # �7/-ac3�d CITY USE ONLY permit Fee Fee Schedule on Reverse Side Fire Surcharge $ _ 7 0� .001 of Permit Valuation (1/10th%) State Surcharge $ 1. / $.50/$1,000 Valuation SAC Charge $ $950 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 'ark Fee $ Fee Determined by Engineering fewer Main Charge $ Agreement Necessary j ] Not Necessary [ ) TOTAL $. ;'1'1PU1,ATfONS: Effective January 1, 2003 CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES FAX (763) 571-1287 0c) JOB ADDRESS ,+ 1,ee (2 e 3L RATE SCHEDULE OWNER 00^ b e � © 5 Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED AS Also Replacement Furnace $ 30.00 (Side Vent - Fill Out Back) $ ESTIMATED COST `��� PERMIT NO. Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Gas Dpyer $ 10.00 $ Trade Name Size No. GC. S 1�* "p- BTU HP EDR *Air Conditioning - All Sizes $ 25.00 $ Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial 1.25% of Value of Appliance or Work $ The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes an State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and TOTAL FEE $��. representations stated in this application are true and correct. DATE -7-241-e-7 MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO d, az4i ce REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE Signed TEL # REINSPECTION FEE $47.00/Hr FAX # I >� *Air Conditioners can not be placed in a side yard without Approved By2_6 Date' Final Date���3 ®J written permission from adjoining property owner. THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When m to acing an my"nfing fi Iran _e, 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 eYl_c+ing enmhunfinn air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new r-nmhi ictinn air ti will be sized and installed to meet the current codes and manufacturer's specifications. Yes( No( ) When JIn-cla inn a new venting 5= _m, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAIVIA 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 Appliance #2 Type Appliance #3 Type Total Appliances _ BTU Input _ BTU Input _ BTU Input Total Btu Input Common Vent Type Vent Height Fan Assisted or Nat Fan Assisted or Nat Fan Assisted or Nat 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 M HEATING CO: Signed By: Date CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTIIRF.R TO RF IN.RTAI I Fn CIM FAr'H PI r)r'IP Effective On Jan 1, 2000 stories Urinal Shower Wash Tray ................ Floor j��t::: Auto. Drain :Wash r I.;........:::::>:::<:= Gas Water Heater . . . . . . . . . . . Range Gas Elec Basement ... ........ ... .. . ....... . . . . . . . . . . . . . . . . . . . . . . . . . . . . --- Floor I . ...... . . . . ...... --- ----- -- - ... ...... ; Floor 2 ............... I .............. . . . . . . . . . . . . . .. ..... . ... I .... ..... . ......... ........ . Floor 3 Floor4 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water heaiar - Gas** NO. RATE Gas Range" Gas Dryer" Back Flow Preventer Required ( )Yes ( ),No Type $7.00 $4.00 $5.00 $7.00 $7.00 $7.00 $7.00 $10.00 $ 7.00 $10.00 _$10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE ,5-60 - 7a TOTAL JOB ADDRESS 54;yE fe, &4&31�p The undersigned hereby make.-.. 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 PLuilding DivL;ion, and hereby declares that all the� facts and reprP_-,Pntqfinncz ctnfarl in fkie true and correct. DIBOS, DONALD 500 RICE CREEK BOULEVARD 20 b3 FRIDLEY, MN 55432 (163) 571-1189 Owner. BuildingUsedAs Estimated Gost PERMIT NO, &louom PLUIV?a C PLUMBING COMPANY A) SIGNED BY TEL NO.,410-RZ7- Approved By Rough -in Date Final Dated $ .50 OL MINIMUM FEE FOR ANY ELUMBINGIGAS PERMIT IS $20 00 $20.540 PLUS THE LSO STATE S RCHARGE _9:CU__X - 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 O No ( ) The venting*ystem is. plastic/PVC and meets all current codes and manufacturer specifications.including sizing, length, number of elbows and termination. Yes O 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 AGR-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 correct!y after an appliance, has been -removed from the common vent and vented separately asper 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