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PRE 2010 DOCSAddress city ®f Fridley, Minm B 676 FXAM 7 No. Street t Lot Block Addition or S b -Division Corner Lot , Inside Lot �� Setback ®� S yard - - Sewer Elevation —_ — Foundation Elevation d DESCRIPTION OF BUILDING T U /�,i Front Depth _ Height _ Sq. Ft. " cu. Ft. Fro n Depth Height Sq. Ft. Cu. Ft. " Type of ctio Est. ___ __ 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 anworkmen, 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, construcbfon, alteration, maintenance, repair and moving of buildings within the dty limits and this permit may be revoked at any time urn violataton of any of the provisions oP said ordinances NOTICE: Sk pom* Ades not cover the comerud ion, iu laRaHon for wlrhig, plumbing, gas heating, sower or water. Be sore to we the BeMbe Inspector for soparcie peraft for them items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA BUILD s OWNER ° S NAME �� = ER ADDRESS ADDRESS, LOCATION OF BUILDING Street Part of Lot Lot_ lock Addition or Subdivision =, ', 1 Corner Lot Inside Lot %' Setback Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form.Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. To be used as DESCRIPTION OF BUILDING Front Depth ® Height Sq. Ft. l7Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction �_.'%Estimated Cost 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 1 0 `s ZGNATIIRE v' )'j"L"L� 6 (Sebedule of Fee Costs can be found on the Reverse Side). a 3� City of Fridley Application for. Phunbmg and Gas Feng. Permit Dept of Bldgs. Phone SU 4-7470 DESCRIPTION OF WORK Number, Kind and -Location of Fixtures Location_ 3 - / (e 1 O0 6 u� Z Zp V 1 �' � a °d w Z `a ' • F � N WATER HTR. GAS ELEC. 3 = �F? a� U (90 Base 1st C� 2nd 3rd 4th ` Future Connection Openings Connected with New Fixture, Old Openings Sewer � Cesspool E] r PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... z x $1.50 $ �� 3 -0 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 $1.5o $—Z —5-b Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description$ ........... TOTAL FEE $ Co e 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, •lvl"inn e 3 f 19 Owner 191,3- Kind 9.E -Kind of Building 19 Gv—J Used as To be completed about961— Estimated Cost, $ Old New Building Permit No Signe By Business Phone No 11-11-6-3 11 POST 1M-12-58 n Application for Power Plants and Heating. Cooling, Ventilation, ReFrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE 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 $ I, Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ 41L 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 $Lell-, 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 kh.VV—ENTILATING SYSTEM $ ZMERATIONS & REPAIRS TOTAL FEE $ Dept. of Bldgs. Phone SU 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 area true and correct. Fridley, Minn-��/ / 2/ , 1A� Owner /! C5X_4ef S c4.o I C Kind of Building/ -5 // /-' 4 X Used as> - 'Al T /ems /� "—" r ZL.,- %z .' f To be completed about f l Estimated Cost, $ e Old—New. Building Permit No. a °� Permit No. G DESCRIPTION OF WORK HEATING or POWER PLANTS— Steam, of Water Warm Air—No Trade Name 1��.�w ��A` _teas Size No "e r� Capacity 9 4 0 ®C.1 A0/ Scr-_Ft. E.D.R BTU H.P. Total Connected Load e 7 4 i a) °" Rind of Fuel BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R. BTU H.P. (REMARKS—OVER) 9 Signe s / EN 42 3M Business Phone No. 47-2- '2 for Power Plants and H Applicationg. Cooimg.:.�I/enta�on..iLe►f��rcetion 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 ............ ,y - - —each -add. 60;000- BTU Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 ................ . Repairs & Alterations each add. $500.00 ................ RATE TOTAL, 8.00 $ 5.00 $ 5.00 $ 2.50 $ 8.00 $ 2.007- ---- - 0.00 $ 5.00 $ 2.5E0 $ 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 ...................... i x $ 2 - Additional Fixtures ................. x .50 $ Gas Range to 200,000 B ........... x 2.00 $ AIR CONDITIONING je 0-0 $-� FAN HEATING SYSTEM See Fee Schedule Dept. of Bldgs. Phone SU. 4-7470 City of kddley:- The undersigned hereby makes application for a permit for the work herein specified, agreeing to da 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 pM true and correct. Fridlg, Minn - 19/110� Kind of Building Used as _�nc-,V-0 . To be completed about i Z- 4:2 Estimated Cost, $ /lam 00 Old New. Building Permit No. Permit No. A,f ®�3 % DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load Kind of BURNER — Trade Name ..Size No 3 6 "<6,5-j Capacity Sq. It. EM.R- BTU H.P. VENTILATING SYSTEM ALTERATIONS & REPAIRS TOTAL FEE $ ROUGH % - l -•E�sVI v az 2M 7-59 FINAL 7'0 A� (REMARKS—OVER) Sign L�4_� zZle, By CD2 0 Business Phone No s—9vl� PLEASE SHOW OUR JOB #G // � NUMBER ON THE PERMIT SUBJECT P City ®f Fridley 5 5 AT THE TOP OF THE TWINS BUILDING E R M I T RECEIPT NO. � 6 ______ COMMUNITY DEVELOPMENT DIV. r I � PROTECTIVE INSPECTION SEC. I NUMBER REV DATE PAGE OF APPROVED BY i CITY HALL FRIDLEY 55432 612-571-3450 910-F15 3/31/98 10B ADDRESS 53 Rice Creek Way NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 9A-9B 1 Edgewater Gardens SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dennis Otten 53 Rice Creek Way NE 571-5155 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Wm Woods Construction Co Inc 7728 Knollwood Dr, Mounds View MN 55112 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 786-2321 8737 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATION Ij REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (30 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 SO. FT. CU. FT AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT 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 $1.25 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,502 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- $74.75 Fire $2.50 STRUCTION OR THE PERFORM CE OF ONSTR CTION. A PLAN CHECK FEE TOTAL F E J CP Lice $5.0 83.50 SIGNATOR OF CONTRACT OR AUTHORIZED AGENT IDATEI UENOPE ALiDATED SIS UR ER ISIGNATURE GATE OF OWNER OF OWNER BUILDERI IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] - CITY OF FRIDLEY y ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �� \ BUILDING PERMIT APPLICATION �6 ConstructionAddress: 'S/f -47 Legal Description: Owner Name & Address: Tel. #60.)-Y71 Contractor: W9, V 700 s MN LICENSE # Address: :29(? ZfNQ4AkZ00L2 J?P,I. Adj,1&K �-V& Tel. #(�JS, 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: % Q' Construction Type: Estimated Cost: $ r (Fee Schedule on Back)' Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # % �Q Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 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 [ ] LIP, i N 4i- z r 0 LU LL 0- to rl - uJ (Cr I 0 lap F 73 ui In t�J � I 1 09, tAl t4 to c�a� E@� O� Pi I 9 8 P 8 8 8 F 0 ` - }` 7 t-1 rf : i uj co 16 P` z ,c, �I is ate P 1d 4 13 -� 0 ��?a�� iaR a O UiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 August 9, 2000 Denny Often 53 Rice Creek Way NE Fridley, MN 55432 Re: Final Inspection at 53 Rice Creek Way NE Contractor: Action Heating and Air Conditioning, Inc. Dear Mr. Often: A mechanical permit was issued on April 30, 1999 for the property located at 53 Rice Creek Way NE for an air conditioning unit. According) to Section 305(a) of the 1991 Uniform Mechanical Code a final inspection shall be performed on the mechanical system. As of this date no inspection has beep called for. You will be given thirty (30) days from receipt of this notice to respond. If we do not hear from you, we will expire the.permit and any inspections on this installation will require a new permit. Any questions can be addressed to myself at (763) 572-3603. Sincerely, DAVEIJWSEN Buildi nspector Building BUILDING Permit No Inspections RESIDENTIAL APPLICATION Received By:_ 763-572-3604 CITY OF FRIDLEY Date Rec'd:-A DATE l O �+' YOUR E-MAIL ADDRESS A KA I C�— SITE ADDRESS '53 ice C (eeK WAY K -2E THIS APPLICANT IS: ❑ OWNER JkCONTRACTOR PROPERTY OWNER/ NAME: Ma r q -W 5 TENANT ADDRESS: Sf5 6R 1 C le EfK CITY �—r (el d� STATE IP� PHONE:—1 U_� 5Oa - C 3 S CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE TYPE OF WORK: STATE LICENSE # OD 0 ff 4 3 ;� 4 EXP DATE 3 " -f annlzFSS: ( 8 - ( 0 Cid U t" !N ' PHONE 710 3 5 -) ( -a 73 0 0 :5 SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION ❑ ADDITION ❑ GARAG ❑ BASEMENT FINISH �1 ROOF ❑ DECK ❑ SIDING ❑ SWIMM ❑ NEW ❑ MAINTENANCE/REPAIR DESCRIBE WORK BEING SIZE OF IMPROVEMENT_ NUMBER OF SQUARES 3 �_ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other e 0't 04r�- I ("e - LENGTH FAX ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia ❑ WINDOWS ❑ DRAIN TILE ❑ OTHER WIDTH TMZIPSS 4 50k Ft. BASEMENTREMODELING SUBMIT: 1. fisting Floor Plan 2. Pr posed floor plan 3. Lit of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS, & PORCHES SUBMIT_ 1. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ C4 `1 Cu —7 - OCCUPANCY TYF See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 per SAC Unit (Plans to MWCC fort determination) ft--6ft= ftx$20=$,�_ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary) ( ) Make checks payable to: City of Fridley Attach Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due TERIALS: THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota 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 case of all work hich requires review and approval of plans. SIGNATURE OF APPLICANT �, `�" °� PRINT NAME DATE RECD APR 3 0 2001 CITY OF FRIDLEY BUILDING INSPECTION Effective 4/1f200A 6431 University Ave NE Fridley, MN 5543? APPLICATION FOR POWER PLANTS AND HEATING, COOUNC, VENTILATION 763-572-3604 FAX 763-571.1267 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB MWES4 �3 O�IGc -fes l �yY��✓ L® ReaftrMal RATE SCi1 E IQi owner Ahwv� ua e7 4 �ar41c;' jaa�s lc, Furnace Shell and Dud Work, Burner & / 11Palso Replacement Furre $35.Q0 $3S _ &nWir� Used As Gas Pipft(New Furnace, Fireplace, Insert) $10.00 $ Fireptace insert $15.00 $ Gas Range $9.0.00 $ Gas dryer $14.00 $ *A.ir! Contlitianing - All Sizes $25.00 $ All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $_ Minimurn Fee $15.00 for Residential or 5% of cost of Improvement whichever is gteater on worts less than $500.00 Commercial/loaf uStria Vlnstitutional 125% of Value of Appliance or Work (List on Bads) Mirrimurn Fee $35.00 for Commercial/MdustriW/Instgutiortal ESTIMATED COST A25-1-"19 vo PERMIT NO � ` •� --f _ �t _ ��i�i�=Til # of Heating Units__ Circle One (Stearn) Plot Water (Warm Air) Trade Nam Zke2Nhwa tze W.e,2o 5® BTU to HP EC1R------- Fuel Total Connected Load Burner Trade Name 13M _ Size No. HP EDR The undersigned hereby makes application for a permit for the +nark herein specified agreeing to do all work its strict accordance with the City Codes $ and rulings of the Building Divisiart, and hereby declares that all the facts atxi representations stated in this application are true and correct. State Surcharge 5 0.50 (if permit fee is over $1,000 multiply by .0005) ` - TOTAL FEE $ *Air con iitior e c m not be placed in side yard without written approval from adjoining property owner -copy to City FILL_ OUT BACK SiDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE P HEATING CO - • L Ae- Signed Tei FAX # &e� - 6'(os7r -__ Date.10 % Approved by Rough -in DateFinal Gate APR -18-2007 10:20 CENTERPOINT ENER 6120215550 P.004 Entire House Centerftlrlt ienergy/Minnegasco Y*w AdetM YCr�t . ST artono 121a FSK 121 MANUAL s: 7th Ed. Efff" Meuse whole t ouM Ls 1hOf wall fi ZO 142.0 R j4Cel1ftQ9 Room dirttensl0ns 420 X 8.0 it l�aatrea9r A Comm option 8.0 ft d TYPE OF NII Area Load (BWh) AM Load (M� Area Htg cis arae Ht Gig EXPOSURE No. iq Clg (to � � OF) leg I � 5 own a 12C 8.1 21 1139•"' "iO 1138 ..« .... ..+. .e.w •••" ••"• Exposed b 14A 45.9 8 3 236 °"" `°� 235 "°° .... +... waft a G 15A 11.30.0 710 erorr .ee. 710 0 °'.. ...e a... .... .... esm+ m■■ partltlortis d 0.0 0.0 0 c 0.0 0.0 0 f 0.0 0.0 0 6 Wlndo" and a 2A 42.8 "` 1 0 641 �•' .�. 950 0 8413 0 g4mHeath {5 w-- O 0 •"' `°"` B 0.0 0 0 0 0 .«. 0 0 .•.. .... d a 0.0 0.0 "' 0 0 '..` 0 0 """ .... 7 Wi URM arrd Narth 31.0 75 .et« 232g 7 S 6 •"° "�.' 2325 D «•■ °« gbw d rs New ENV 010 20 89.0 ...� 0 1780 20 "•" 1780C*ofi"`• S 48.0 55 puth S*Ulh raw `•,` fl 2840 D .e.e ww.. 0 2940fl a o Ham 010 0 8 Cditer doors a 10F 28.8 7.6 42 1210 317 42 1210 317 b 0.0 0.00 0 0 0 0 0 0 0 0 0.0 0.0 0 O 0 0 9 Net a 120 8.1 2.1 944 7640 2005 944 7945 2003 agma b 14A 45.9 8.3 2w 10832 1962 230 10832 1952 watts atul 0 15A 11.3 0.0 710 7088 0 710 7w 0 0 0 parting d 0.0 0-0 0 0 0 9 0 0 0 0 0 e f 0.0 0.0 0 0.0 0.0 0 0 0 0 0 fl 10 GeelrtQs a 16C i.9 3.7 1218 9047 4448 1218 W47 4448 0, b M 7.9 3.7 0 0 fl 0 0 0' c p.D 0.0 0 0 0 fl 0 0 0 0 d 0.0 0.0 0 0 0 e 0.0 0.0 0 0 0 0 0 0 f 0A 0.0 0 0 0 0 0 0'. 11 Flovig a 21A 2.2 0.0 1219 2831 0 1218 2631 0 0 (Note: nom b 0.0 0.0 0 0 0 0 0 0 perimstm a 0.0 0.0 0 0 0 0 0 0 0 is caw. d 0.0 0-0 0 0 0 Q fpr slab a 0.0 0.0 0 0 0 0 0 tl4org} f 0.0 0.0 0 0 0 0 0 0 12 Iretrst on A 56.2 0.1 192 10595 1177 102 10595 1177 •»• 13 Subtp9011GSS=6+$-+91+12 $6961 '""` �'" 589$1 "" ""` '*" �*" Less external hedn® "'"` O "" a ••• • •� •••" Less b'8 wcr "'" 0 ra.r ,... .�* «� ••� ,,,° .." 14 L1�ut9tingkMledSatn 0% 0 56981 •"` 0 0 "� .... ».. .... ""•" 1$ TOW low; ■ 13+14 16 lnt. gab* people a 300 4 - 1200 4 •"•, °.°* 1200 e.e. 1200APPL rw. 12fl0 1 .... °"t 19094 `°"' 1 «•• 19054 "" "'• Ee*+ �••` 17 Sum! RSH gau►°rit8 ,+� 72+10 agar .e•+ .set w.e 0 uss Wdemal cootlng D p ewe awa rata Ps+e Left U safer 0 CwM0 fedlm.hrmn 18 TOW RSH gain-(17*18)•RLF 1.00 "' 19064 20 Alr MgteM (ctm) 1018 1019 ""` 1019 1019 Printout certified bx ACCA to meet all re uir enta of Manua` J 7th Eci RWlaRWdenual"'5.5.12RSR3WW x007f1 18101ap'.I ight C. 000MMA slwd9hlsOR mvAdr`453 to cmk wmy ttc rsr FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITs When I i , 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. The venting system is plasticlpVC and meets all current codes and manufacturer 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-GAW Category. I Central Furnace Venting Tables for fan assisted and natural draft appliances. The Un Ion atr Is sized and installed to meet the current codes and manufacturerssperm ns. When required to Irtsktt w u air it will be sized and installed to menet the current codes and manufactu is specifications. Whena ting " *ern. the undersigned hereby verifies that �.ven it Is a listed assembly and meets the currenit codes and manufacturer's specifications. This does include AGA-oAMA Category I Central Furnace Venting Tables for fan assisted and natural I draft appliances. rs the common vent and vent connectors sized and installed correctly after an appliance has been removed from the ccpmmon vent and vented separately as per current codes. Yes ( ) No( ) Yes ( ) No( ) Yes (7 No ( ) Yes No Yes r No ( ) Yes ( ) No ( ) Yes() No() ApeliartSg�yge an-- d�. �'n Vent an Vent 9 ---- ctor lnforma�on Appliance #Z Type Btu input ApptianCe Q TypeFan Assisted o at Appliance #3 Type BTU Input ____,�_ Fan Assisted or Not Appliances- Total U Input pan Assisted or Nat — Total u Input Common Vent Type Vent HeightDiameter____ inches Appilanoe #9 Vent Connector Height Appliance #2 Vent Connector Height � Length __....ft Diameter _ in Type fi Appliance #3 Vent Connector Helght �'� Length _.ftDiameter 'in Tyle --- 9 ft Diameter Al In Type 5. HEATING CO: Signed By: -- _ Date I'M:- ,