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PRE 2010 DOCSCity of Fridley, BUILDING PERMIT N° 4 s s Date: Zo 4i�l Owner: Builder ---- •-- --- Address - _ _ —Address art, � A LOCATION 01: . XWG No. Street _ Part o . t 77 Lot _ Block "A tion or Sub-Divisio— Corner Lot _ __ _ Inside Lot _%�• Setback _� _ _ Sideyard Sewer Elevation _ _ _ _ Foundation Elevation DESCRIPTION OF BUILDING To Used � , Front —7—! Depth Height Sq. Ft. Cu. Ft. Front 4 DepthHeigh Sq. Ft. Cu. Ft. Type of nsixuction 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 $ 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 pon violati ;:of any of the provisions of said prdinanece. NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sore to see the Building Inspector for separate permits for these items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA owmer 18 Name_ �� _Builder Address LOCATION OF BUILDING No. -�� Street.cam ®crr �� Part of Lot Lot Block -3 Addition or Subdivision a� c -'CL Corner Lot Inside Lot Setback—IL—Side-Yard /© ° SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. To be used as: DESCRIPTION OF BUILDING 21'r Q Sq. Ft. _ /0 A Cu. Ft. �� 0 Front LJ Depth '�°3�Height Sq. Ft. Cu. Ft. Type of Construction �� 0-ItAA ,C Estimated Cost /y ®® ® '�;'e To be Completed A /•— 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 applica on are true and correct. DATE /// &i SIGNATURE _ (A Schedule of Fee Costs can be found on the Reverse Side.) I Application for Power � . � App ants and Heating, Cooling. Ventilation, Refngert�on and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SII 4-7470 72, GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ � each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM 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 $ 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 $ i ALTERATIONS & REPAIRS TOTAL FEE $ REMARKS: 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,,?dinn F � u I 195_ Owner - P� Kind of building Used as To be completed about APR 2& o� Estimated Cost, $ New. Building Permit No. �6 195- 195_ HEATING or -POWER- , Warm Air—No- Trade Name— A v f Size No Z '- Capacity— Capacity Sq. Ft. BTU H.P. Total Connected Loa �G� Kind of Fuel - ®� J BURNER — Tr. Size No z Capacity Sq. Ft. E.D.R�^^�%%! �� vv pTggiT�o A 9�5 RH^.P. GEE. SEDd3 r ICK 1 8 A V. & AR-COND. ham® 3) ;7Zly 1001 X -1;a Av. S. Minneapolis 16, PA:Tnn. Sign �o By sa -Q51011 POST 1M-12-58 Business Phon7lNo D•56 � 9 HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS' MINNEAPOLIS. MINN. Weatherstrips A.S.H.V.E, Construction No. Insulation Guide WindowsI oors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How. Applied es No —No 19_ 1, Of / F1.1 Room l Length Width ,/i�-'sleight W" Fl Room Length Width � Height- Windows and Doors—Crackage and Area Width Height No. of Lineal f . Area No. of pane of pane lights of crack sq. ft. 177, 0 Coed Btu Glass l// -7 1 S . � A S— Exp. wall Net exp. Int. wall Ceiling d Floor Total Ktu. Required sq. ft. E.D.R.. or sq. ins. W.A. Leader area F1.1 _ 6 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area Na. of pane of pane lights of crack sq. ft. 0 -%, w. 1-7 Coef. _Btu Infiltration � ,'', Glass r w.19F a Exp. wall Net exp. wall Y° Int. wall Ceiling ' C - Floor Total Bfu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I Fl.v-' Room I Length ,/ Width Height tr Windows and Doors—Crackage and Area sy Width Height No. of Lineal ft. Area No. of Dane of pane light of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane ofPsongr lig is of crack sq. ft, i v Coef , Btu Infiltration Coef. Btu Glass ?"I. . Exp. wall y Glass Net exp. wall v Int. wall, Exp. wall n Ceiling Int. wall Floor ? Total wired sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area sy Width Height No. of Lineal ft. Area No. of pane of pane lights of crac , + sq. ft. Width Height No. of Lineal ft. Area No. of pane ofPsongr lig is of crack sq. ft, i v Coef. Btu Coef. Btu Infiltratiott ?"I. Glass` 5y y Glass Exp. wall ° v Go 0 Exp. wall n /X-/A/ Int. wall Net exp. wall ? Ceiling jr 1TVT Floor Int. wall Floor Ceiling' u'. Floor J a Total -Btu. Required sq. ft. E.D.R. or sq. 'ins. W.A. Leader area I F1 Rnnm I Length f Width I I Height a Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crac , + sq. ft. Width Height No. of Lineal ft. Area No. of mme of .-golights of crack- sq. ft. Coef. Btu Infiltration Infiltration ?"I. Glass` Glass y 1-3 0 Exp. wall ° v Net exp. wall Net exp. wall /X-/A/ Int. wall Int. wall Ceiling ' ? Ceiling jr 1TVT Floor Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 1 Fl.i -7 Ron. I Length I I Width 9 AHeight Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of mme of .-golights of crack- sq. ft. Coef. Btu Infiltration ?"I. Glass y 1-3 0 v 0 Exp. wall Net exp. wall 0 Int. wall Ceiling ' ? 1111. Floor Total M. j Required sq. ft. E.D.R. or sq. ins. W.A. Leader area D•36 7 s HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS, MINN. Weatherstrips A.S.H.V.E, Construction No. Insulation Guide Windows I Doors Reference Out. Wall Int. Wall Ceiling I Roof Floor Kind How Applied Yes—No Yes—No 19— ® Fl..W2 1,V,, Room I Length I V Width 0 Heiaht II F1.1 Room I Length Width Height indows and Doors—Crackage and Area f U, r. Width Height No. of Lineal f . Area No. of pane of pang lights of cr ek sq. ft,. m I Length Width Height Windows an Doo s—Crackage and Area Infiltration Coef.. Btu, Infiltration Glass k '' Exp. wall, Int. wall Net exp. wall Btu Infiltration Int. wall a Ceiling'-? &NQ tat Floor Exp. wall R - Total Mk- r0 . Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.V f U, r. R m I Length Width Height Windows an Doo s—Crackage and Area Infiltration Width Heigh No. of Lineal ft. Area No. ofpane of pan lights of crack sq. ft, 4 Net exp. wall Int. wall Coef. Btu Infiltration a Glass tat Exp. wall R - T Net exp. wall? Int. wall Ceiling Floor Total BUd Required sq. ft. E.D.I2. or sq. ins. W.A. Leader area 171.I Room I Length Width Heiizht Windows and Doo s—Crackage and Area Width Heigh No. of Lineal ft. Area No. of pane of pan lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor i Total Btu. Required sq. ft. E.D. . or sq' ins. W.A. Leader area Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 0 Fl.l Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. his. W.A. Leader area F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of panty ofpane lights of crack sq. ft. Coef.1 Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area � City of Fridley SUBJECT PE 13'784 1, K.- AT THE TOP OF THE TWINS PERMIT BUILDING RECEIPT NO. COMMUNITY DEVELOPMENT DIV. L r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV, DATEPAGE OF APPROVED BY L 612-560-3450 910-F15 9/28/76 JOB ADDRESS 5588 Rice Creek Terrace N.E. 1 LEGAL OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 3 Rice Creek Terrace Plat 7 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE W ren H. Olson 588 Rice Creek Terrace N.E. 3 CONTRACTOR R MAIL ADDRESS ZIP PHONE LICENSE NO. Cl*les Aasby Assoc. Inc. 5100 Eden Avenue 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUI DING Ptqsidential 7 CLASS OF W RK a�� ElNEW X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK nstruct 1613" x 9'9" greenhouse addition to back of dwelling SIVERATE PERMITS R IR D H -M WIRIlIffil 9 CHANGE OF USE FROMHEA11"% PLUMBINGAND SAN& STIPULATIONS 9 TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING O AIR CONDITIONING. metal/glass THIS PERMIT B15COMES 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 R-1 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. $5,000 $2.50 WITH WHETHER PECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRE_ME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $30.00 STRUCTION OR T E PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $32.50 SIGNATUREO CO/TTRRACTORORA T0 AGENT (DATE) ---,-,.,,WHEN PR PERLLIY VALIDATED THIS IS YOUR PERMIT BLDG. INSP DATE SIGNATURE OF OWI IIF OWNER BUILDER) (DATE) l.i I 1 ur rKiULLI APPLICATION FOR RESIDENTIAL ALTERATION, ADDITION, OR REPAIR BUILDING PERMIT OWNER'S NAME (ddCz r r 7FjI- 4I� ®NJ BUILDER: 04d"-' 134JS!l ADDRESS: Aq I\iC� &O-ei-r4cE ADDRESS : S1®� � L' NO:. � STREET: 21 -CE C Pc) -f— LOT : BLOCK: ADDITION : eC 'p 7,-,mCe CORNER LOT: INSIDE LOT: L, SETBACK: 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; I(EEM n OUSS C Front: Depth ; Height:_ A. Square Feet: Cubic Feet: Front: Depth: Square Feet; Cubic Feet: .Height: Type of Construction: MEy�_� d �'kjs_-' Estimated Cost: $ �, e®ca_ do To Be Completed:�'I The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in st-ict 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: 7' r29 SIGNATURE :.7/% % '/j dLy- (See Reverse Side For Additional Information.) • • �•�.. .,mak NUNDEa FjqGiNRRniNry Co. INC a ENGINEERS ANIS SURVEY'®RS LAND SUAVEYING SOILS TESTING CIVIL &. MUNICIPAL ENGINEERING LAND PLANNING 6418 -SG rw AVENUE N. MINNEAPOLIS 'M MILAN. KE 7- 3637 C +! Dp i 1i f 1l ita l i +t 4 r' <� i 10 OUVATrFS If I� WE HEREBY CERTIFY'THAT THIS 1$ A TRUE AND CORRECT REPRESENTATION OF K SURVEY OF THE BOUNDARIES LAND ABOVE DESCRIBED AND OF THE LOCATION OF ALL BUILDINGS, IF N4Y, THEREON q AND ALL VISIBLE ENC20At9++►'�".`H. M IF ANY, FROM OR ON SAlO LAND. MINDER ENGINEERING Co., ��=• ,', pATED TIIlS ENGI►JAtBL} uR YOB r SUBJECT23170 PC -nM -4-1- City of Fridley �` AT THE TOP OF THE TWINS BUILDING PERMIT — - r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. I y INSPECTION SEC. 9� —.;k �V r PROTECTIVE NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 612-571-3450 910-F15 1/25/95 JOB ADDRESS 588 Rice Creek Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 3 Rice Creek Terrace Plat 7 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Warren Olson 588 Rice Creek Terrace NE 571-2297 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. D & D Home Improvement Inc 7401 Central Ave NE Fridley 55432 784-7543 4840 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 > 1 REPAIR R ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling (20 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD 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 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 .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- STRUCTIO THE OF CONSTRUCTION 35.00 Fire SC 1.50 EPLAN CHECK FEE TOTALFEE 4PERFRMANCE License SC $5.00 $42.25 TUREOFCOOR OR AUTHORIZEDAGENT IDA EI WHEN PAOPE VA IDATED THIS ISYOUR PERMIT BL G')N$i'� S}' gaTE SIGNATURE OF OWNER pF OWNER BUILDER) )DATE) NEW [ J Effective 1/ 1 /94 ADDN { J CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: 5-55 xme 6�'e6�: ,Y —� Legal Description: Owner Name & Address: Tel. # Contractor: D c D Home Improvement, Inc. MN LICENSE # 4840 Address: 7401 Central Avenue NE, Fridley, MN 55432 Tel. # 784-7543 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: Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yazd Setbacks Type of Construction., ® Estimated Cost: $ -`c' ` c'o Approx. Completion Date: a,6 0 � 4 ,es (cost on Back) Driveway Curb Cu Width Needed:Ft. + Ft = , Ft x $ = $ DATE: APPLICANT: Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Fee Schedule on Reverse Side .001 of Permit Valuation (1 / 10th %) $.50/$1,000 Valuation $800 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 [ J Not Necessary [ J CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2000 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS � %C� GW A- -b,ce. RATE SCHEDULE / ( V(S'L`!ti OWNER /,ZJ(,t/fAg, Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED AS Also Replacement Furnace $ 30.00 $ (Side Vent - Fill Out Back) _ ESTIMATED COSTPERMIT NO.��e Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTIO14 OF FURNACE AND OR BURNER Gas Range $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Gas Dryer $ 10.00 $ Trade Name Size No. BTU HP EDR *Air Conditioning - All Sizes $ 25.00 $ Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner ade Name Size No. 7�� S��a 117o 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 $ D .yu AMFkaft dba Beside gnat DATE 01 _T& License #20MIt MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING t 00&faireiew Am #. REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 U30VII 6531633 tome PLUS THE $.50 STATE SURCHARGE Signed TEL # REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without Approved By Rough -In Date Final Date o? written permission from adjoining property owner. COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes (} No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( } Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( ) No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assistpd-or- N,at- Appliance #3 Type BTU Input Fan Assilk p Nate Total Appliances Total Btu Input?_ e Common Vent Type Vent Height .J, Diameter M5 inches fan Appliance #1 Vent Connector Height ft Length ft Diameter in ype 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 :