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PRE 2010 DOCSSUBJECT of Fridley (PERMITNO.City 24676 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. 1 COMMUNITY DEVELOPMENT DIV L r PROTECTIVE INSPECTION SEC. �� , NUMBER REV DATE PAGE Of APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 10/15/96 JOB ADDRESS 231 Satellite Lane 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 64 2 1 Christenson Crossing SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE The Rottlund Co 2681 Long Lake Rd, Roseville MN 55113 638-0500 1335 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. Timothy Johnson 22350 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. ETS Inc 220 S Marion Rd, Sioux Falls, SD 57107 19015 6 USE OF BUILDING Residential Townhouse & Garage 7 CLASS OF WORK n X NEW ❑ ADDITION O ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a Townhouse & Garage 9 CHANGE OF USE FROM TO STIPULATIONS See stipulations on 208 Christenson Way NE. SEPARATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS. 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 1 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 See 208 Christenson Way 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- y STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE See 208 Christenson Way TORE OF CONTRA TO OR AUTHORIZEDAGENT IDATEI WHEN PROPERLY V LIDAT D THIS IS PERMIT e /YOUR ye_9 _ SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI Bl INSP MATE Prepaid Plan Check $ Effective 3/1/96 Estimated Cost $ CITY OF F MLEY Receipt # R3, CONDERCIAL & Ml MAL BUffXVG PERMU APPLICATION Alf / Construction Address _ 231 6 A_' E Lj_1-fe LAW F_ Legal - Description C Y, a, 4 ,p ei s -rem tp N. owner & Address—Tk, ed. eC Al I-nft L m6t C ie,c.iM6- M.,_ CUIIRAC'ItOR & ADDRESS Architect & Address Engineer & Address _ Zoning _ 1-61�nd ky-n Tel. #_ Cp�J� • 0�,�0.7 Tel.# Reg.# 2q3S4> Reg.# 1'9015 .5'i10 -t TYPE OF WORK New [] Addition [] Alteration -Describe WM0 1 kArnEb LW ►T �a��y I-u�oM� �.�tc.0� n1 Applicant. - �� ddjAk-e �� .6 L/Tel #(,036-6000 ■c - i Length Width c■■ ■■■�i�;i. rte Height Sq. Ft. # of Stories OFC. AREA: Length Width Height Sq. Ft. WHSE AREA: Length' Width Height Sq. Ft. OTHER AREA: Length Width Height Sq. Ft. VALUATICK Sq. Ft. x $ Oast/Sq. Ft. = Valuation $ ) Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) 'IL=L VAIN Building Use Construction Type Occupancy Group Air Conditioning XYes [] No Fire Protection Provided []yes. XNo Performance Bond Amount $ See Reverse for Schedule Received []Yes []No Permit Fee Plari Check Fire Surcharge State Surcharge SAC Change Erosion Control S Park Fee $ Spec. Assessments $ Driveway Escraq $ TOTAL $ See. Fee Schedule on Reverse Side In Excess of Prepaid Amount - See Reverse Side .001 x Permit Valuation (1/10th t) $ .50/$1, 000 Valuation (See -Schell.. for > $1 Million) $900 per SAC Unit (Plans to MCC for determination) $450.00 Conservation Plan Review Fee Determined By Engineering - Agreement Necessary [] Not Necessary [] feet x $13.50/foot CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH Ft n()R Effective On March 1, 1996 PLUMBING FIXTURE RATES: e/l>` NO. RATE TOTAL JOB ADDRESS 951 New Fixtures $ 7.00 90.001 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater —Electric $ 7.00 Water Heater - Gas** % $10.00 /0-00 Gas Range** $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes () No Type $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge $ .50 TOTAL FEE $ &..q) The undersigned hereby makes application for a perm it 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 ley f/lr..,�/ Building Used As Estimated Cost PERMIT NO. ,1996 PLUMBING COMPANY G��/� /%��.�i .�• �-� SIGNED BY ,a�t,,%�/'i1�'o TEL N0. yS;2�/a/ Approved By Rough—In Date Final Date y! % >9 7 MINIMUM FEE OR ANY PLUMBING/GAS PERMIT IS $20.00 PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. qu I I 15-3 CITY OF FRIDLEY INSPECTION DIV, ` Effective On March 1, 1996 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES MINIMUM FEE FOR ANY HEATINGj_Q OLIgQNENLLA_TION REFRIGERATION/AIR CONDITIONIIVG PERMIT IS $25.00 PLUS THE $ 50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr "Air Conditioners can not be placed in a side yard without written permission from adjoining property' owner, W HEATING COMPANY Signed ByJ L4,411A Tel No. Approved ByRough-In Date Final Date -elf FILL OUT BACK SIDE OR STACK VERIFICATION ON REPLACEMENT FURNACE JOB ADDRESS al RATE SCHEDULE Residential The undersigned hereby makes application for a permit for the work hetein Furnace Shell and Duct Work, Burner - Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Also Replacement Furnace $ 30,00 $ b ® rulings of the Building Division, and hereby declares that all the facts and (Side Vent -- Fill Out Back) a representations stated in this application are true and correct, p Gas Piping (Needed with new furnace) $ 10,00 $ ► D . ® d I -I Gas Range $ 10,00 $_R OWNER 20-Pr� 1�4A A OA hA b," I/ Gas Dryer $ 10,00 $ BUILDING USED AS ��-j` *Air Conditioning - All Sizes $ 28,00 7o $ oC� J ESTIMATED COST 30 0. 0 PERMIT N0, e All Others/Repairs &Alterations (LIST ONBACK) DESCRIPTION OF FURNACEN 7 g( gURNEg I% of Value of Appliance or Work $_ No, of Heating Units Circle One (Steam) (Hot Water) arm Air Commercial/Industrial Trade Name !� �11 9Slze No, 0 10 1.25% of Value of Appliance or Work $ BTU HP EDR Fuel , ' Total Connected Load State Surcharge ,50 Burner Trade Name Size No. TOTAL FEE �_6-0 BTU HP EDR MINIMUM FEE FOR ANY HEATINGj_Q OLIgQNENLLA_TION REFRIGERATION/AIR CONDITIONIIVG PERMIT IS $25.00 PLUS THE $ 50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr "Air Conditioners can not be placed in a side yard without written permission from adjoining property' owner, W HEATING COMPANY Signed ByJ L4,411A Tel No. Approved ByRough-In Date Final Date -elf FILL OUT BACK SIDE OR STACK VERIFICATION ON REPLACEMENT FURNACE Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: # `" CHIIVINEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes () No ( ) 2. Is free from rust or deterioration Yes () 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 7. Has a liner been provided for water heater Yes () No ( ) 8. Has combustion air been provided for water heater Yes () No ( ) Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: # `" r Z — .alit• — OATE .... � coasiLtl awl• BT OFFICr ►ROP 140-3 JOB MO WONt'1 I N N F_ T N g /`�� N" et APPROVED .E USED Fa �Et X =' Z(7 SA FT x — CU FT EiTIMATI FOR s�ATIRg t PLAt LOAD L' s AREA OR SUN GAIN OR HOURS OF OPERATION ITL• QUANTITY TENT. DIFF, FACTOR BTU/Houm CONDITIONS I DB WB [% RH I OP I G SOLAR GAIN-4{LA{S� GLASS I `5// So FTX GY GY' X - S GLASS Ill So FT x l x I. C SOLAR & TRANS. GAIN—WALLS & ROOF WALL �v � SO FT x �� x •D 4��✓ 2�� -WALL��• 4 ✓ SO FT x �'31 x • cp Y� WALL So FTX X WALL So FT X X Q 00E—SuN (pc4JC So FT X (l9 x -OZia OOF—SHADED So Fr X X TXANSj.GAIN—EXCEPT WALLS & ROOF i (:••. Zai/(r/ Ca CrY 11 Y _=_ MING 54 FT X X .00011', �>� SQ FT x ZC X FILTRATIOM CFU x x INTERNAL HEAT PEOPLE x )WER NP O2 KW X :'Tt 1'j7 -r"' X I . C1 WATTS X 3.4 X "• MCEt. ETC. )—rtOMAL HEAT GAINS X Sus TOTAL FE^r FAC -row % ROOM SENSIB:E HEAT 3 --LT slip. LT cT DU.T FAR Ar GAIN % + LCA[ LOSS % + N. P. % IT000R Arlo CFM x F x or X 1.01 EFFECTIVE ROOM SENSIBLE HEAT ■ rILTRATIOU LATENT HEAT CFN X on/to X 0.96 O►LI ^ PEOPLE X 7iJ S EAU Lt/N2 X 1050 PLIAUCIi. ETC. Ez�' OITIONAL HEAT GAINS C •. POR TRAMS. Sm Fr X 11100 X 0[rtt X Sus TOTAL rrrT FACTOR 27 C9Z�I ROOM LATENT HEAT PPLY DUCT LEAKAGE LOSS 1% TDooR AIR CFU x Goat X sF x 0.68 EFFECTIVE ROOM LATENT HEAT rENr• :r • GAIN FFECTIVE ROOM TOTAL HEAT OUTDOOR All HEAT i Cru x 11 F x (I— 3F) x 1.08 a Z/ DIFFEstrcE x x x I x x x I x x x f— VENTI.' LATIOM ATION OUTDOOR All ZGPLC X CFm/►tesom — — -- FT X C.vS• FT = — CPU VENTILATION e C7 OZ-4- �) INnL- T2ATIR41 SWINGING Rt TOLPIIIG, DOORS PEOPLI X CFr/P9NUW = _ OPEN DooNt Dwas X—CIS/0002 =_ EzNAusT FAm CRACK FEET X CF■//T - — CPU IPOPILTMArION 110 LP, Z ¢Z -A . 287 -A ✓ = ► fwo) . Ez�' CFM OUTDOOR AIR THRU APPARATUS ■ APPARATUS DEWPOINT EFFECTIVE EFFECTIVE Room SEMS. HEAT ESHF SEMS NEAT = _ FACTOR EFFECTIVE Room TOTAL HEAT AO► INDICATED ADP = F SELECTED ADP v DEHUMIDIFIED AIR QUANTITY RISC 0-- BF) x (T,N F — T,,,—F) _ — DcHu , EFFECTIVE ROOM SENS. HEAT = CFM 1.08 X F Tgap. also OUTL. T Room SENS. HEATTem — F DIFF. 1 I na v �,,, — tE■-evr ] SUPPLY Alit QUANTITY SCF»T Room SEMS. HEAT = 1.08 X F shuts 2vP BYPASS CFM CFV,, — CFr to c RESULTING EMT b LYG CONDITIONS AT APPAZ EDS T[2_F- CFM* A x (TGA_F—T2�F) = T CFMT LDS T•GP—'-F+_BF x (TEos_F — TAop._F) = T FROM PSYCH. CHART: Tc,, F, T172 F �� ✓ �� NOTES C7 OZ-4- WAL'L' 4"72;;;x a J LP, Z ¢Z -A . 287 -A ✓ = l2� �Z fwo) . Ez�' S I %i C •. 4s42 �� 4" 27 C9Z�I ¢3MF3N I CFm x'y RVLS X (1— BF) X c.e22AZ/' 'QNGi RETyau Sum TOTAL I -1# nn QT to r.. ■s—. "'64 P■ A.,.%1 .ate n. Ay.n.. P 8.9.c. t• A Da cl NP D2MNr. R "A"Orr p...*". 1 LEAN Cu■ 1 ►yv 4- PIPE leu I.. t. 0......A a 2.31rv..w . • a.a .a•u• ••., ... .•aR• IV. GRAND TOTAL MEAT ZS I Z I Was* 1-6-4r. au .Eu a.a ..•r, .At •a....n.. ar. AIR CONDITIONING LOAD ESTIMATE —FORM E-20 (3-69) CIlYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 • (612) 571-3450 • FAX (612) 571-1287 April 17, 1997 Rottlund Homes 2681 Long Lake Rd Roseville, MN 55113 Re: Final Inspection at 231 Satellite Lane NE, Fridley, MN Dear Sirs: A final inspection was conducted on April 17, 1997 for the above noted townhouse. We found that the construction of the building unit complies, to the best of our knowledge and belief, with all the requirements of the building codes of the City and the State of Minnesota relating thereto, and permission is hereby given for the occupancy of said unit. If you have any questions on this matter, please feel free to contact me at 572-3602. Sincerely, &- e't'/ �v.�66ae BARRY ESCH Building Inspector • - •• SUBJECT P M City of Fridley 28979 AT THE TOP OF THE TWINS BUILDING PERMIT i • fiEC . �• COMMUNITY DEVELOPMENT DIV. ^ nO _ PROTECTIVE INSPECTION SEC. ,. CITY HALL FRIDLEY 45432 NUMBER REV DATE PAGE 06 APPROVED BY ''' _ . 612-571-3450 910 -Fl 3/5/99 'JOB ADDRESS 208, 210, 212, 214 Christenson Way & 229 231 233, 235 Satellite Lane I., LEGAL LOT NO.BLOCK TRACTOR ADDITION SEE ATTACHED DES CR. 11 58 to 65 2 Christenson Crossing SHEET 2 PROPERTY OWNER: MAIL ADDRESq ZIP _ PHONE Rottlund Townhomes 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Town & Country Roofing 7910 12 Ave S Bloomington, HN 55425 545-4233 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20091282 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING `Townhomes Lr' CLASS.OF.WORK O NEW ❑ ADDITION O ALTERATION ! REPAIR O MOVE O REMOVE 8, DESCRIBE WORK Reroof Building (110 S) Tear -off i 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 1 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 @ $4.71 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $9,427 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- Fire SC $9.43 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $.62.25 PLAN CHECK FEE TOTAL FEE tt4 6A? License SC $5.00 1 $181.39 SIGNATURE OF CONTRACTOR OR AUTMO I DAGENT iDATEs WHEN PROP Y V LIOATED THIS IS YOUR PER IT - f/ G IhSp . — 3_ relf nATt _ S.GN4IURE OT OWNEROWNER BUILOERI IDATEI CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 f AX: ( 763) 571-1257 PERMIT N .: 2004-00514 r DATE ISSUED: 04/15/2004 '. ADDRESS : 231 SATELLITE LN NE PIN : 143024320253 LEGAL DESC : CHRISTENSON CROSSING : LOT 64 BLOCK 2 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 300.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A INSTALL WATER SOFTENER # ELEC WATER HEATERS 0 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 0 # GAS DRYERS 0 # GAS RANGES 0 # OF NEW FIXTURES 0 # WATER TRMT APPLIANCES 1 APPLICANT PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) 0.00 0.00 SHILOAH WATER CO 7319 166 AVE NW PLBG FIXTURES (EXIST OPENINGS) 0.00 RAMSEY, MN 55303- WATER TREATMENT APPLIANCE 35.00 (763) 753-9244 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 0.00 GAS RANGE FEE GAS DRYER FEE STATE SURCHARGE, PLBG FLAT 0.00 0.00 0.50 OWNER STRAND, STACEY 231 SATELLITE IN NE TOTAL 35.50 FRIDLEY, MN 55432 PAID WITH CHECK # 9803 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume give authority to violate or cancel the provisions of other tate or local law regulating constructs r the p rf manc f construction. Applicant Date_ - Bldg SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. ('d o ac_�> CITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004 641 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT (763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR .. ..... Wash I�t[#t� <> Floor G::s::::: Auto. - Oft:::<:::::> G8s :>::>::: Water Heater to Stories Urinal Shower Tra .. <> Drain ... �....... .�II�>� <::i�!4�`i.r� Washer �.�� .......:...:.:..::: :)i�.:::.::: 1;� Range . �::: � : ��:<>`> Gas Elec Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB AD 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 Heater - Gas** Gas Range** Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge $ TOTAL FEE �r 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. DATE: — C If A— , 20 OWNER BUILDIN, ESTIMATED COST PLUMBING COMPANY SIGNED BY Approved By OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () 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 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 :