PRE 2010 DOCSm
SUBJECT
PERMIT NO.
City of Fridley
12444
AT THE TOP OF THE TWINS
BUILDING P E R
r
ECEIPT NO
COMMUNITY DEVELOPMENT DIV.
p
r PROTECTIVE INSPECTION SEC.
i
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
3/1/74
JOB ADDRESS 7132 Riverview Terrace N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
5 8
2
Riverwood Manor Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Gary D. Bettcher 4536 - 7th Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Adam Buechler Shakopee, Minn.
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
Ek NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
a DESCRIBE WORK Construct a 38' x 28' Dwelling and a 22' x 22' Garage
9 CHANGEOFUSEFROM TO
STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before
capping.
SEWER LOCATION: 97' North of Manhole (N. Inv. 832.57)
Wye Elev : 834.94
Top of Footing: 839.44 Minimum
WATER LOCATION: 11' South of Sewer Service
SEPERATE PERMITS REQUIRED
FOR WIRING,
HEATING, PLUMBING
AND SIGNS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
.SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
Wood Frame
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
R-1
2082+484
29,484+4,840
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
39 490
19.75
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMITFEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
64.00
300.00
STRUCTIO R TH ERFORMANCE OF CONSTRUCTION.
^$3
PLAN CHECK FEE
TOTALFEE
/Jq �
#
'I
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHE PROPERLY VALIDATED ISYK�p PE MIT
SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE)
BLDG. )NSP DATE
m
APPLICATION FOR RLSIDENT1AL, ALTERAT11-M,
OR ADDITION BUILDING PERMIT
CI'T'Y OF I-RIDLLY, MINNESOTA
'_Sic, 0 7
S NAME
OWNER T)
BUILDER: 93),9 M it C, -C- k
ADDRESS: z75_3�- 711 S -r NE, ADDRESS: SwKOF1_F_ 1k)A-).
NO;. 713 Z_ STREET:
r-_
IE:w 1E7QR1-)C_F_
LOT: E BLOCK:
Z_
ADDITION: FlUPER"DD
MAjfb�
CORNER LOT:. -INSIDE
LOT: ETBACK:
D
SIDEYARD,9 q
Applicant attach to this form Two Certificates of Sura of Lot and proposed
buildirig location drawn on these Certificates,
DESCRIPTION OF BUILDING
To Be Used As:
Front:Depth: do -Height: -C
0, 1, K c_ 3) Square Feet: - Cubic Feet: 4.=-�_�
AP_A9fEP_F-Front :_ 2. Z Depth:. _Z -L Height:
Square Feet; 2 Cubic Feet:— Y
Type of Construction: ft)06� T-k&yy\IF -Estimated Cost: $
To Be Completed:
a 'k � /J I ) _4
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in stticL accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and -hereby
declares that ill the facts and representations stated in this application
are trite and c.)r-r,-rt-_
DATE: L4
(See Reverse Side For
S E(;,NAIIJRE.
Additional Information.) _C
ON j'e(Oad vlosnNN�w NO@NIN,1f1Npa• bllOdV9NNlp !'t t+� �`.4,,�01� M008
8tlINNY1d IBIS ®EtlOAlAtl11S ONY1 � 8tlIINIONl ONIt10EN09 w +f S !�
` *3NI 'S31VIDOSSV NOSiml-SBWOOOW
0 Z
9906 • o -5-ah ° uu'r `Nvofia (10uv
'3161
ZL6B huvnuv j YO five Tr0'B vyy�
aw fig pafianunv vy -puv7 prvv uo vo woug `fiuv g -r `v:ruawyvvouvua
arq-rvrn 77v puv `Uozv?z:r `76U-Yp 'nq rry go uor:;vvor .a•yf go Puy
• 6urrvurw�ra a7ray�r auy? prvv puv
rddyvv'rvvyyy ay� go aur? ?VoYV �vv3 air o� Haag 56Z go avuv vrp
v vpuoaa,7gZ `varnurw b5 '`vaau6aP -36 agar a1,Pr' or bur vargaP fi7va�vam
avuay� !paq vavap aq o:;r au --r go 6u-ruur6aq go :;rurod -ay:;r o� Haag.
91-6t go avuvrvyp v S X07 prvv go aUr2 vv3 ark 6uo?v h7- ayrnos
avuay:r !S roq prvv go Vauuov :;�srnaTrltoN aY:� ry 6u;rvuaww0) -aur;
pagrvvvap 6urmor7og ayyr go fi7wa ; nos 6urhr `vrovauu-lw `firunoo v�ouy
`vpaad go a�:r go avrggo 0� :r uy puovaV go puva779 uo goauay
:�rvrd ?yr o:;� 6urp7tovvv `vouv}y Poom•uanra `Z x-0078 - `g X07 go :�ruvd rvy,L
go var-rvpunoq air go fianunv v
go uo-r v:�ruavaudau :raa?rko-opuv ani v yr vrz1 vy fig uav hgauay ,�
Ua G4�'jL/O�j/ L✓O,// S d f p[.✓ ac/
V
N
7,
06
Ob
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oo'�Snoc,
/1 O
Ill
CNS ZNol,Of
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3 ? yy
r
I e� e � � ,e r✓! G -�
1 Y/ S
PLUMBING FIXTURE RATES:
NO. RATE
TOTAL
Number Fixtures
/;:::L x $2.00
$
0
Future Fixture Opening
X $1.50
$—.
0
x $1.50
$—
0
Catch Basin ... ...
N
WATER HTR.
GAS
FLEC
Base
$
New Ground Run Old Bldg.
x $3.25
$
Electric Water Heater
z $2.00
$
GAS FITTING FEES:
NO. RATE
TOTAL
1st 3 Fixtures ...... .. . .... .........
x $2.00
$---2 - 0
Additional Fixtures ..... ..............
x $ .75
Ist
Gas Range to 199,000 BTU ..............
X $5.00
3rd
4th
PLUMBING FIXTURE RATES:
NO. RATE
TOTAL
Number Fixtures
/;:::L x $2.00
$
0
Future Fixture Opening
X $1.50
$—.
New Fixture Old Opening
x $1.50
$—
Catch Basin ... ...
x $3.25
$
J-00
Water Heater (Up to 99,000 BTU)
X $3.00
$
New Ground Run Old Bldg.
x $3.25
$
Electric Water Heater
z $2.00
$
GAS FITTING FEES:
NO. RATE
TOTAL
1st 3 Fixtures ...... .. . .... .........
x $2.00
$---2 - 0
Additional Fixtures ..... ..............
x $ .75
Gas Range to 199,000 BTU ..............
X $5.00
0044,411;,� 17-1[1t!=
Description .............................
TOTAL MM &-a?-
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- C/ — 5 0 — 19)—v
Owner
Kind of Building
Used as -T)
To be completed about
Estimated Cost, $
Old—w Building Permit No.— Permit Mo.
Signed &
By- X41Z�—'
Business Phone No 7aSY—'.574
FINAIL J- - -2- k - 2 6'
Applkafl=
PARTIAL '`' SCHEDULE Dapt. of Blftz.l`f air,
GRAvrrlr wARm Am:
Rmn 'Tvm-
}l+ urnace Shell & 1huc4 Work
3.UO $
Replacement of Furnace
6.00 A
Repairs & Alterations—up to $540.00
6.00 $
Repairs & Alterations each add. $500.00
300 S
F1u'uuace Shell & Duct Work to 120,000 BTU
..$10.00 $
each add. 60,004 BTU . .. ......
3.UO $
Replacement of Furnace
6.00 $
Repairs & Alterations—up to $500.00
6.00 $
Repairs & Alterations each add. $300.00
3.00 $
STEAM or HOT WAT= SYST u
Furnace Shell & Lines—to 400 sq. ft. FMR Steam $10.00 $
OgFurnace Shell & Line—to 640 sq, ft. EDR. Ifot Water I0.00 $, a ® 10
Each add 200 sq. ft. EDR Steam xon $.
)(:)o Each add. 320 sq. ft EDR Hot Water 3.00 $ •�
OIL SURNER—to 3 gal per hour 6.00 $__�,®
over 3 gal. per hour—See Fee Schedule
GAS BURNER Cup to 199= RM 5.00 $ �
over 199,000137V See Fee Schedule
GAS FITTING FLMS: no RATE TOTAL
1st 3 Fixtures �_ x$ 200 $• U _
Additional Fixtures a .76 $�
Gas Range tb W.000 2S 6. $
;; 1 F14l: f
r / °-. - 74
State Surcharge .56
Fee >
TOTAL Fm
a
City of rddley:
The undersigned hereby makes application for a permit for the work herds
specified, agreeing to do all work in strict accordance with the City Ordbiantev,
and ruling of the Department of Buildings, and hereby declares that an the facts- '
and representations stated in this application are true and correct.
Fridley, Mnn_
Owner 2-25-7-1—
Kind
of E
Used as
To be completed about,
Estimated Costs $
Old—New. Building Permit No. ___ Permit No.
I TING or PSD teaam,®t Water Warm Air Ido Z
Trade Na mr AJl /— — AMC L A'® Slue Pao P-�6
Capacity_.._-_- — Sq. Ft E ID.R 700 r �
Total Connected Load ® IVA o4 Fit
BURNER — Tri Name Siam leo
Zetas-.onaa8 .
4 41/®1
CITY OF FRIDLEY INSPECTION DIV,
6431 University Ave. NE
Fridley, MN x5432
572-3604
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential Rate TOTAL
Furnace Shelf and Duct Work, Burner -
Aiso Replacement Furnace $ 20.00 $
Gas Piping (Needed with new furnace) $10.00 $
Gas Range $ 10.00 $
Gas Dryer $10.00 $
*Air Conditioning - An Sizes $10,00 $
I -e n t)®x AQJ-41®/ J_/_ a
All Others/Repairs & Alterations (LIST ON BACK)
i% of Value of Appliance or Work $
CoRnmerclaf/f ndustrial
1% of Value of Appliance or Work $
State Surcharge $ .50
TOTALFEE / so
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS 115.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
*Air Conditionem.can not be placed in a side yard without
written permission from adjoining property owner.
P �
G
t
Effective On January 1, 1993
JOB ADDRESS 1V e r Q.,�rr.
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 and
rulings of the Building Division, and. hereby declares that all the facts and
representations stated in this application are true and correct.
OWNER �P421& G ��
BUILDING USED AS
ESTIMATED.COST Id,54 ® PERMIT NO
i i. � l � i 1, :_ ►. i � i
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP A EDR
SE®GWICK
HEATING COMPANY HEATING & AIR CONDITIONING CO.
8910 WtNIWORTR AVE. SO.
Signed By MINNfAF'OLIS, MN 55411QeNo.ef
88
���
Approved By Rough -In Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
Yes
(
)
No
(
j
2.
Is free from rust or deterioration
Yes
(
)
No
(
)
3.
Has no f7.oreign objects lodged within
Yes
(
)
No
(
)
4.
Is securely: supported
Yes
(_)
No
(
)
5.
Meet�3c-Ell current Code requirements quirements for
size � tptaX BTU's connected
Yes
No{
)
°b.
Has to i `Leaving BTU's of
All other , s
TOTAL BTU's
Remarks
List Alterations Being Done:
HEATING COMPANY
Signed By
Date
SUBJECT
IT N0.
City of Fridley
�9
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
Ir?
• COMMUNITY DEVELOPMENT DIV.
r � PROTECTIVE INSPECTION SEC.
�
1
NUMBER
REV
DATE
PAGE OF
APPROVED BY
i CITY HALL FRIDLEY 55432
612-571-3450
910415
11/9/94
/ /
JOB ADDRESS 7132 Riverview Terrace NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1 5
2
Riverwood Manor Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Wanda McCarra 7132 Riverview Terrace NE
571-4780
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
TCSS XK4KXXM Acquisition Inc (Twin City Storm Sash) 10825 Greenbrier Rd 20020888
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
Minnetonka MN 55305 546-8160
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR
X
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install storm windows, storm doors
9 CHANGEOFUSEFROM TO
STIPULATIONS
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 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
$3,252
$1.63
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
$63.00
Fire SC $3.25
PLAN CHECK FEE
TOTALFEE
License SC $5.00
$72.88
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPERLY V LIDATED THIS IS YOUR PERMIT
F
S)GNATURE OF OWNEROF OWNER BUILDER) IDATEI
BLD SP
DATE
NEW [ ]
ADDN [ ]
ALTER [ ]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: / j �®' V e-0- yd= e W a c
Legal Description:
Effective 1/1/93
r
-w4Jns—
Owner Name & Address: A' Tel. # S- 7/- fie®
Contractor: TCS Acquisition MM MN LICENSE # ?6)6) —2L3 ae
10-82-5 Address:
Minnetonka.. Minnesota a _ 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 Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: < AJ%Il CGU S
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback _
Type of Construction: 5"j /t 0 le --
Approx. Completion Date: Zoo,/ 9 �e
Side Yard Setbacks
�
Estimated Cost: $=��,� r
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: 16 94/ APPLICANT: Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
$
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$1 $.50/$1,040 Valuation
$ $750 per SAC Unit
$ S".OD $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
Park Fee $
Sewer Main Charge $
TOTAL
STIPULATIONS:
$� 741
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
G(
k,,1
SUBJECT
IT NO.
City of Fridley
2 5 717
AT THE TOP OF THE TWINS
BUILDING PERMIT
i
u'_____ COMMUNITY DEVELOPMENT DIV.
. PROTECTIVE INSPECTION SEC.
r ,
1 �
NUMBER
REV
DATE
12/5/97
PAGE OF
APPROVED BY
= CITY HALL FRIDLEY 55432
612-571-3450
910-FlS
JOB ADDRESS 7132 Riverview Terrace
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
2
Riverwood Manor Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
McCarra, 7132: Riverwood Terrace, Fridley, MN 55432
571-4780
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Roncor Construction, 10740 Lyndale Ave S, Bloomington 55420
888-5578 2337
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS .ZIP
PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION] REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Re-roof (tear-off)
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with 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 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
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
$2,335.20
$1.17
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 R THE PERFORMANCE O ONSTRUCTION.
$74.75
Fire SC $2.34
PLAN CHECK FEE
TOTALFEE
License SC $5.00
1$83.26
SIGNAT E FCO RACTOROR AUTHORIZED AGENT (DATEI
HEN PROPERLY ID TED THIS IS YOUR PERMIT
c
_ B31) INSP
BATE T-
SIGNATURE OF OWNER i IF OWNER BUILDERI IDATEI
NEW [ J Effective 1/1/97
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2'�/
BUILDING PERMIT APPLICATION
ConstructionAddress :
Legal Description:
Owner Name & Address:
Contractor:
Address: //� G
LIVING AREA:
GARAGE AREA:
DECD AREA:
OTHER:
Construction Type:
Tel. # 2&
MN LICENSE # ��
Tel. #,��
Attach to this application, a Cetiificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width H t/Ground Sq. Ft.
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
/ G
Estimated Cost: $ e12
(Fee Schedule on Back)
Ft x $ = $
DATE: APPLICANT: Tel. #
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ f
$.50/$1,000 Valuation
SAC Charge
$
$950 per SAC Unit
License Surcharge
$ `j,
$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
$
STIPULATIONS:
"I
su9JEcr(:VL�I
NO.
City of Frawley
31554
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
`
RECEIPT NO.
`� ______ COMMUNITY DEVELOPMENT DIV.®4
INSPECTION SEC.
A
�% r
r PROTECTIVE
1 . �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
i A ; "',•; CITY HALL FRIDLEY 55432
.---
l J` 612-571-3450
910-F15
11/13/00
JOB ADDRESS 7132 Riverview Terrace NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DEscR.
5
2
Riverwood Manor Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Wanda McCarra 7132 Riverview Terrace
NE 763-571-4780
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW Cj ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 16' x 161, two story, three season porch
9 CHANGE OF USE FROM
TO
STIPULATIONS
See notations on plan.
WARNIN
SEPARATE PEW
Before digging call for
all Utility locations
REQUIRED FOR:
450002
PLUMBING AN D G
REQUIRED `A
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 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
1 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
$16,419
$8.20
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK
TOTA FEE
$3 3.85
SiGNATUREOFCON 'RACTORORAUTHORIZED AGENT tOATEt
HEN PR P VALIDA D HIS IS Y U PERMIT
plc � 1111,5-Int
- - d
S.GNATURE OF OWNER.IF OWNER BUILDER, tDAr I
8L0 INSo OATS
"I
NEW [ ] Effective 1/1/2000
ADDN pQ CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: -7132-
Legal
7132
Legal Description:
Owner Name & Address: (A_)&y)c q ('lc„Carra--- Tel. #
Contractor: -WAnd y+yT# C vro-- MN LICENSE# b-GUMeow-ijo
Address: '71-57_ t V-Cr0 ktw --fik--v r Tel. # 76>3 - 571—q76o
qa C/ - Vd C/®
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT S6
LIVING AREA: JS -6/ Length (6 Width 1 (0 Height Sq. F� �a r u S' 07
Length j _ Width Height Sq. Ft.0 � 0
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: 5(fA: o.,- ?6 r c Estimated Cost: $ ; .00
I
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ .=$
DATE: l -10 APPLICANT: g =� . /1�1��cQ Tel. #!/,3 —,57 ] -1/T50
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $RS
•'Fee Schedule on Reverse Side
Fire Surcharge .001 of Permit Valuation (1/10th%
State Surcharge $ R!" o $.50/$1,000 Valuation
SAC Charge $_$1 100 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
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS:
%13-� Ric1Mc/iE
Land Plannin g 6875 Highway No.63 N.E.
Sulu int
Land Surveying• • ��J Minneapolis,
Soils Testing �yLl�LjIeedoL(J •J%2C• Minn. 55432
Civil Engineering Telephone 784-6066
Municipal Engineering Engineers & Surveyors Area Code 612
Mortgage Loan Survey for G. D • BETTCHER
r •I
IJ.E, CORN
Sale o 1 = 40
73t
- 222.38
.�
I
CIC ! -- - t- ►u'-
43.0
FOUNDATION ONLY
l.i � -32211974 � o
00 � .p
�e.33
a�
A
n�
r 1 75± 23).7Z
That part- 'of Lot S Block 2., Riverwood Manor, according to the plat thereof on dile.
and of record in -ihe oT� ice oP *e Reis frr a • Deeds, Anoka Counfy , ftnesoi a1 lgIn
Sovtherlyy of ihe';ollowin� described line. Commencint at the Nor+heast corner of
Said Lot 5, thence- Southerly along +fie East line of said Lai 5 a dis+once o*
79,13 4�z+ to the poin+ of be�innin� ct +he line to be described; thence West'erI4
ddlea+int -}o +he lel!t 92, deArees , 54 minAs, 26 Seconds ct dl$+ance of 295' feet fo
the 134St Shore� th
line oe, M►sslssippi River and said line Akre termin&bnm ,
This is a true and correct representation of a survey of the boundaries of the land above described and of the
location of all buildings, if.any, thereon, and all visible encroachments, if any, from or on said land. This survey is
made only in connection with a mortgage loan now being placed on the property and no liability is assumed
except to the holder of such mortgage or any other interest acquired by the reason of such mortgage. It is
understood and agreed ng monuments h�pve been laced for the purpose of establishing lot lines or boundary
corners. Dated thisZZ"P day of �1A�H A. D. 19.,
SUBURBAN ENGINEERING, INC.
L 348 Engineers S. v�.(yo, s
/v by /w t{O7trLt.., i,u �.
1107
10/29/2000 00:21 7635360194 COOK PAGE 01
FAX TRANSRXTTAL
TO: MR. DAVE JENSEN
FROM: DAN COOK
OF PAGES: �t �INCLUDING COVER
REGARDING: THREE SEASON PORCH PERKIT/PERMIT
.DAVE:
,\APROX-IMATELY TWO WEEKS AGO, MYSELF'AND A FRIEND CAME IN TO HELP
A WOMAN BY THE NAME OF WANDA PULL A PERMIT TO CONSTRUCT A THREE
SEASON PORC117. YOU INFORMED US THAT OUR CURENT DRAWINGS WERE NOT
ADEQUATE AND TO ATTEMPT TO FIND SOME COMPUTERIZED DRAWINGS. WE
HAVE TRIED ALL THE LUMBER YARDS AND THEY ONLY PROVIDE DECK DRAWINGS.
I EVEN WENT.OUT AND PURCHASED SOME COMPUTER SOFTWARE WHICH PROVED
UNFRUITFUL. IT SEEMS THE ONLY ALTERNATIVE FOR THIS WOMAN IS TO
HIRE A DRAFTSMAN; AN OPTION IN WHICH SHE DOES NOT HAVE FUNDS FOR
IN HER BUDGET.
CONSEQUENTLY, I HAVE DRAWN SOME PLANS AS TO WHAT SHE IS LOOKING FOR.
AS YOU MENTIONED DURING OUR IMPROMPTU MEETING AT THE CITY OFFICES,
HAND -DRAWINGS WOULD SUFFICE IF THEt WERE THE ONLY OPTION (THEY ARE).
PLEASE GIVE ME A CALL IF YOU HAVE ANY QUESTIONS. 763-536-0194.
HANK YOU:
f
• ti h.
THIS JOB COPY SHALL BE
AVAILABLE ON THE JOB
SITE. FOR THE FRAMING
AND FINAL INSPECTIONS
P.S. I ATTEMPTED TO FAX THESE DRAWING LAST WEEK BUT'I'MUST
OF HAD THE WRONG FAX NUMBER FOR YOUR OFFICE.
'PLAN APPROVED
SUBJECT TO FIELD
9
SUBJECT
City of FridleyAT
=0119
THE TOP OF THE TWINS
B
ILDING PERMIT
r
• DIV.
�: ___-_ COMMUNITY DEVELOPMENINSPECTION
7 o�
g6 L�
r � � PROTECTIVE INSPECTION SEC.
1 ; �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
6/22/01
JOB ADDRESS 7132 Riverview Terrace NE
1 LEGAL
LOT NO.
BLOCK
TRAC OR ADDITION SEE ATTACHED
DESCR.
1 5
2
1 Riverwood Ma or Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Wanda McCarra 7132 Riverview Terrace NE 763-571-4780
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRE$S ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Replace two windows within existing openings
9 CHANGEOFUSEFROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk
and flash all exterior openings.
TYPE 00 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 ABANQONEO 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 QF COMPLIED
@@
$•50
WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT
$1,000
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-
$38.75
Fire SC $1.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FE
TOTAL FEE
.25
/E0.�� �/E SIGNATURE OF CONTRACTOR yO^R AA'UTmoRiZZ}ED�.AGGENT (DATE,
W'a�� Aa ' , r_CW V &_ ��� 1
N P OPER LIDAT HIS IS/Y/'^UR PT
h/ 4J ;0-a
S,GNATURE OF OWNEROF OWNER BUILDER1 IDA fE,
- BLDG iNSP GATE
9
NEW [ ] Effective 1/1/2001
ADDN [ j CITY 00 FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: -7(32- � i V?YV CP.I ���(YQCe-�
Legal Description:
Owner Name & Address: LA nc a Mc Ca v f o. r.. Tel. #- 3 ^ 67/-Y-_7
&D
Contractor: 0 W h& )C MN LICENSE #
Address: 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 Height Sq. Ft
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: IN STA L.1._ Z W In cLr)t,j =�n AN e- r• tvpA i Y1 ri
Construction Type: Estimated Cost: $ /000. 00
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: �1=- 401 APPLICANT: WQVn CjQ ck Ol d':Ma. Tel. # Z raa - 5.71 --y 786
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ ®. S Fee Schedule on Reverse Side
Fire Surcharge $ 400 .001 of Permit Valuation (1/10th%)
State Surcharge $ - SCS $.50/$1,000, Valuation
SAC Charge $ $1150 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
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ]
TOTAL $�
STIPULATIONS:
FAF
SUBJECT
PERMIT NO.
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
PERMIT
32035
C
�
RECEIPT NO.
-------COMMUNITY DEVELOPMENT DIV.
r E PROTECTIVE INSPECTION SEC.
��2y�'
1 . �
CITY MALL FRIOLEY 55432
NUMBER
pEv
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
JOB ADDRESS 7132 Riverview Terrace
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
2
1 Riverwood Manor Addition
SHEET
2 PROPERTY OWNER MAIL ADORE $$
ZIP PHONE
Wanda McCarra, 7132 Riverview Terrace, Fridley, MN 55432 763-571-4780
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Wanda McCarra
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
B USE OF BUILDING
Residential
7 CLASS OF WORK
M NEW 0 ADDITION [I ALTERATION O REPAIR 0 MOVE O REMOVE
8 DESCRIBE WORK
8' X 5' back portico
9 CHANGEOFUSEFROM TO
STIPULATIONS
WARNING
See stipulations on plans.
Before digging Gall for
ell utility locations
454-0002
REQUIRE® BY LAW
SEPARATE PERMITS
REQUIRE® FOR:
WIRING,,
AND PL
aHSIGNS
SVS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING. HEATING.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAO
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
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,000.00
Fire SC $1.00
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-
$.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$26.55.
PLAN CHECK FEE
OTAL
_
$2875
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT ATE.
N FOR ERLY ATED T IS Y.QLLR PERM!
S.GNATURE OF OWNER OF OWNER BUR ERI
BLDGI)1-
- DATE
FAF
NEW []
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Effective 1/1/2001
(763) 572-3604 Bldg Insp
Owner Name & Address: t kS AM I& Me Ca (rte Tel. # 763 - 57) --S/7c3b
Contractor: O u l y1 Q V- MN LICENSE #
Address: cq. M e- 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 Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft
OTHER: tck 7'041'ro r( 8k .5' "
Construction Type: W DO(A- F--, O erne, Estimated Cost: $ 1000 . b 0
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$ _
DATE: a D 1 APPLICANT: WaadQ ok . (Y7 CIGM G— Tel. # 76 3 51I _qg O
CITY USE ONLY -
Permit -Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ SS Fee Schedule on Reverse Side
$ ae, .001 of Permit Valuation (1/10th%
$ . e G $.50/$1,000 Valuation
$ $1150 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 [ ]
s.20. or
CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1, 2001
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
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.257o of Value of Appliance or Work
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
E�
$ .50
$�o
Burner Trade Name Size No._
BTU HP _ ED
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
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE ` ';�q'd l
HEATING CO
Signed [ O/yA o o"- !1Ad&AA t TEL # -145-- 571-' q7A O
Approved By Rough -In Date Final Date !® a' 1
IAND COMBUSTION AIR VERIFICATION
JOB ADDRESS—1 132-.
R:_tefJ i le uJ kxV&C<fJ
RATE SCHEDULE
OWNER W Arn� A
(y),Cf-
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 N0.
Gas Piping (Needed with new furnace,
$ 10.00
s-.29 •oo
but�°t rep cement) /
DESCRIPTION OF FURNACE AND OR BURNER
Gas Range /'-OZ ri i GT AWS
$ 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)
1% of Value of Appliance or Work
Commercial/Industrial
1.257o of Value of Appliance or Work
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
E�
$ .50
$�o
Burner Trade Name Size No._
BTU HP _ ED
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
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE ` ';�q'd l
HEATING CO
Signed [ O/yA o o"- !1Ad&AA t TEL # -145-- 571-' q7A O
Approved By Rough -In Date Final Date !® a' 1
IAND COMBUSTION AIR VERIFICATION
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 manufacturers specifications. Yes () No ( )
When installina a new ventina 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 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 :