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suadEcr MIT NO. City of Fridley AT THE TOP OF THE TWINS BUILDING PER r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. L PROTECTIVE INSPECTION r , SEC. CITY HALL FRIDLEY 55432 ,'J NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 9/21/77 JOB ADDRESS 1505 South Bavarian Pass N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 36 1 1 1 Innsbruck North Townhouse Plat 4 SHEET 7—PROPERTY OWNER MAIL ADDRESS ZIP PHONE 11arrel A. Farr Development Corp.7286 - 72nd Lane North 560-8110 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK e ou-sea x 221 aqn(Salzburg) 9 CHANGE OF USE FROM TO STIPULATIONS 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 29, 580 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 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 $18.62 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $37,240 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- $118.32 $375.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $ 29_.,48 $541.52 SIGNATUREOF CONTRACTOR OR AUTHORIZED AGENT (DATE) WA E PER Y VALIDATED THIS IS YOUR ER T BLDG INSP 4 AATE SIGNATURE OF OWN ER IIF OWN ER BUILDER) -(DATE) 10 L1 1 Y Ur rKIDLkY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, 'ALTERATIONS, ADDITIONS, OR REPAIRS). . OWNER: hArjep . A 9&e.��I>�LOt°it1F_OJT- BUILDER: Address: _ 7a 8/� `611). 7) Met -1 Ad&X-e�: 7%'i.e.L.. Tel. No.: 5G0 — SM0 No.: Street: sy LOT: c �j (n BLOCK: _� _ ADDITION: CORNER LOT- INSIDE IAT: t/ SETBACK: SIDEYARDS: 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: /9iiw D/14�„�� Front: Depth: Height: Square Feet: Cubic Feet: 'N' L O r Front: Depth: Height: �� Square Feet: Cubic Feet: Type of Construction:/)p �Estimated Cast: $ r C2yc .To Be Completed: ���!!� t A/77 ./' /Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) 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. See reverse side for additional information. DATE: / ® 7 SIGNATURE: Stipulations: po Y7..`/0 `)�,oC) 66 -e -,i � � � v �41 � . � ` , | � / __---Ap _.___�_�_____^ -�----��—��—T--��-----------------------------~—�v------- ----'--------'----'--- --__ i0oo�~ �� ���^�� � ,��� ����_ � � ^ �� �� � � -- --------'----- CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: lst 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction NO. RATE TOTAL x $3.00 $d-� x $2.00 $ K $2.00 $ x 4 . • b+ x Water Ay ° If H 0 $7.00 EM• .�i ro w � 0,(y w a w '$3. Heater +1 W mR x $1.00 $ tl1 $10.00 u Cl LI .c: c 0 d 9 U N to V M oD W 3 Mal m ru U W 3 0 � c7 O as lec RAQ- lst 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: lst 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction NO. RATE TOTAL x $3.00 $d-� x $2.00 $ K $2.00 $ x $5.00 $ x $5.00 $ 77-� x $10.00 $ x $7.00 $ x $5.00 $ x $5.00 $ '$3. x 00 $ x $1.00 $ x $10.00 $ $5.00 $ $2.00 $ State Surcharge $ .50 TOTAL FEE $ O D REINSPECTION FEE ($10.00) . Job Address Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct KIND C Fridley, Mn. f - - 7 , 19= USED AS TO BE COMPLETED ABOUT ESTIMATED COST � OLD - NEW BUILDING PERMIT NO. PERMIT NO. U� Company Signed By Tel. No. �f f U ( V 3 ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLUS $.50 STATE SURGE CITY OF FRIDLEY ,APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE 1 ��� �L) g9 Pis Z CAVITY :tiARM AIR: .,\1T: �orAL Job address -14A) Furnace Shel'l & Duct Work $12.00 $ :_p_ace�ea o= lrnace 7.00 $ Department of Buildings :etsirs S :,_aerations -up to $500.00 4.00 $ City of Fridle{ ?.e:airs & Alterations each add. $500.00 Tel. ;`571-3450 \ EC'r.ANICAL hARN1 AIR: The undc:rsigned\,hcreby mares application for a permit for the work herein $12.00 $ /,7.00 specified agreeing to do all work in strict accordance with the City Csdes --,= ace Sell &Duct Work to 100,000 BTU 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the each ado. 5D.000 B^: 7.00 $ facts and representations stated in this application are true and correct. a'urnace te'ace_e:t cf & Alterations -up to $500.00 &e: -rs 7.00 4.00 $ $ Fridley, Minn. 197 7_ _,:, - w add. 500.00 :�:: _.s & Alterations esc.. $ D Twp•, OR :OT WATER SYSTEM: OWNER � �1141�Cd *.oiler &Lines up to 100,000 BTU $12.00 $ KIND OF BUILDING each _- dd .. 50,"30 BTU 4.00 7.00 $ $ USED AS Boiler orlyt:p to !:.0,000 BTU each ad.a.R. 50,000 BTU 6.00 $ TO BE COMPLETED ABOUT )IL BURSER- to 3 gal. per hour $10.00 $ ESTIMATED COST each add. 3 gal. per hour 10.00 $ , � ;AS BURNER- from 10.7,000 BTU to 199,999 BTU 510.00 $/0. OLD -NEW BUILDING PERMIT NO. FER4IT N0. /®� (over 199,999 BTU see Fee Schedule) $ :AS FIiiING FEES: 13t 3 F'_xtures x $ 3.00 $ DESCRIPTION OF FUP.NACE/BURNER Additional Fixtures x $ 1.00 $ )] x Gas Range to 199,000 BTU�i $10.00 $ HEATING or POWER PLANTS, Steam, Hot Water, arm Air D®io). 6 ^^�� 'IR CO::DITION:NG_��27, ��caf. $ d�+�� Trade Name lmae7 L Size No. I'A ®D�s ®3 LN HEATING SYSTEMS See Fee Schedule $ NTI .ATINu SYST^SIS $ Capacity Sq. r^t. EDR BTU ;LTERATIONS & REPAIRS State Surcharge g $ $ 50 kind of Fuel a' - Total Connected Load � � _.., -r-+s- TOTAL FEE BURNER - Trade Name Size No. wJwi ItiSF. R?.2IdSPECTION FEE Capacity Sq. Ft. F.DR BTU H? Date 010.00) Gk®. S®GWICK HTG. _& AIR COND. CO, Company Late Signed By i f .a� 116 r.ppa .:i FOR PER?:IT S a Tel. No. S%d�J�J� A'SNI!=4 FEE FOR ANY HEA^aING PER?4IT IS $7.50 HEAT LOSS CALCULATI 9nO07P C1 DNIInPllr, r -n MINNEAP®LIS. M1NN. Weatherstrips A.S.H.V,E. Construction No. Insulation Windows Doors Guide Out. Wall Int. Wall Ceiling Roof Floor Kind I-t- Reference How Applied Yes= -No Yes—No 19— 9 Fl. Fl. Room Length d Width Height /FI. ��P�Ba p� Room Length jo Width /® Height .Windows and Doors—Crackage and Area Windows nd Doors—Crackag"Area No. Width Height No. of Lineal ft. Area Wadrh Height Nn. of of pa of p e lights of crack sq. ft. No. of pa fof p e lights 2- -3 fa Coef Btu Coef Btu Infiltrations -70 0 Infiltrations Glass 4`0 Glass Exp. wall Exp. wall Net exp, wall 0.2Net exp. wall Int. wall Int, wall Ceiling Ceiling Floor • �� , �� . Floor Total Btu. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl. �qp'� s---poom Length Width Height � FI� Room Length � Width �g® Height Windows and Doors—Crackage and Area VJindo and Doors—Crackage and Area Area sq. ft. -3-3 No. Width of ane Height of pane No. of lights Lineal ft. of crack Area sq. ft. No. W,drh of pane Ha, h 9 t of pane No. of lights Lineal ft. of crack -1 a41 479 I Coef B to Coef Btu Infiltration 7 �5--7 Infiltration 41 Glass 6 3 0 Glass .2` 0 0 N� Exp. wall d Net exp. wall � •Net exp. wall Int. wall Int. wall Ceiling Ceiling ! �`s -3 -� - --Floor (J Floor Total Btu. ® Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. Ins, W.A. Leader area ' FI. Room Length Width Height �� . Room Length �(� Width / Height Windows and Doors—Crackage and Area indows a Doors—Crackage and Area TN No• ofo. nc crack q. Area of pane v pat r. No. ofnc alck• sgreft. WNht - I Coef Btu Coef Btu Infiltration Infiltration Glass _ Glass SP 14SO Exp. wall Exp. wal l d Net exp. wall �® Net exp. wall Int.wallCeiling Int. wall U3/&S"o— Ti Ceiling Floor Total Bou. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.P. or sq. ins. W.A. Leader area r '5z—' o' i HEAT LOSS CALCULATIOM L � �!`�� U U ��(� � �"U Pra Weatherstrips A.S.H.V.E. Construction No. Insulation Windows ®Dors Guido Oi. MJall Int. Wall Ceiling Roof Floor Kind Now Applied — Reference Yes—No Yes—No 19 - FI. 9 Room Length �� Width �� Height FI. QAq,S Room Length Width Height Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area No. Width Height No, of Lineal ft. Area of pane of pane lights of crack Sq. tt. Np, Width Height No. of Lineal ft. Area A.�� of pane of pane lights of crack sq. ft. B D— Cd CoefBtu Coef Btu Infiltration a " Infiltration 1° Glass/0 Exp. waIIL' Sv 150 L Glass Exp. wall zS 2— Net exp. wall `7 0 Net exp. wall Int. wall Int. wall Ceiling /%0 / /Ou -3 jo iiu Ceiling Cl ii� Floor Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 13 Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area G o V FI.13, -3 Room I Length /c Width Height Fl�J3)\-fkjRoom Length / Width Height � Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area No. Width of pane Height No. of of pane ligri s Lineal ft. of crack Area sq. ft. W deh No. of pane Height of pane No. of li hts Lineal ft. Area of crack sq. ft. Infiltration Coef Btu Infiltration Icoef Btu Glass ? 6 06) Glass Exp. wall B B Exp. wall 4 t" Net exp. wall /00 00 Net exp. wall Int. wall _6 Int. wall Ceiling J �� /� p /�dQ a, Ceiling B� Floor Floor Total Btu. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl. ,e 2 Room Length f Width /3 Height Required sq. ft. E.D.R. or sq, ins. W.A. Leader area FI. Room I Length Width Height Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area No. Width Height of pane of pane No. of lights Lineal ft of crack Asea sq, ft.. No W. of pane Height of pane No. of lights Lineal ft. of crack Area sq. ft. Coef B toCoef Btu Infiltration ��7 Q Infiltration Glass J Glass Exp. wall �/ �, Exp. wall Net exp. wall 61 Net exp. wal I Int. wall Int. wall Ceiling 3 - Ceiling Floor — Floor -- Total Btu. Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F� SUBJECT City of Fridley ® 19930 AT THE TOP OF THE TWINS BUILDING PERMIT -REQr EIPT COMMUNITY DEVELOPMENT DIV. INSPECTION SEC.y/ v/ r PROTECTIVE 1 � = CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-1715 6/5/89 JOB ADDRESS 1505 South Bavarian Pass N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 36 1 Innsbruck North Townhouse Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Frank Latouneau 1505 South Bavarian Pass N.E. 572-9341 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Al-Ko Home Improvements 8090 4th Avenue, Lino Lakes, MN 55014 788-5850 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 LR REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside Townhouse 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Vinyl 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 I 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 $4,000 $2.00 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- $63.00 STRUCTION OR TH PERFORMANCE CW CONSTRUCTION. PAN CHECK FEE TOTAL FEE $65.00 SIGNATURE OF CO RACTORORAUT IZEDAGENT (DATE) WHEN PROPERLY (DATED HIS IS YOUR PERM T �f V J•Jl BLDG )NSP DAT SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) F� NEW [ ] Effective 5/1/88 ADDN [ ] R-1 AND R-2 ALTER [ ] Building Permit Application Construction Address: Legal Description: Owner Name & Address: ,� ��' 1z �i' �/ 1 c c° 1-::, -Tel. # Contractor: Tel . # Address: Attach to this application, a Certificate of Survey of the lot, with the prgPOsed construction drawn on it to scale. LIVID AMM: Length Width Height Sq. Ft. GRRACE AMM: length Width Height Sq. Ft. DECK AREA: length Widths Hgt/Ground Sq. Ft. Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ �� Approx. Completion Date: OAVC, Proposed Driveway Width If New Opening Is Desired: Ft. $ $ Width + 61 -See Back Page DATE: o� APPISCANT: Tel. # Permit Fee $7,Od State Surcharge $,, SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ eT" CITY USE o�Y Fee Schedule on Reverse Side $.50/$1,000 Valuation $575 per SAC Unit Alt. "A" or Alt. 'B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] Zo oi•- 4S -Oct ;LP a �3 � SUBJECT PE City of Fridley � 23440 )I AT THE TOP OF THE TWINS BUILDING PERMIT Ir RECEIPT NO. DEVELOPMENT DIV -------COMMUNITY i I ti PROTECTIVE INSPECTION SEC CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/7/95 JOB ADDRESS 1505 South Bavarian Pass NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 36 1 Innsbruck North Townhouse Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Frank Letourneau 1505 South Bavarian Pass NE 572-9341 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Lifespace Construction Inc 10020 Hi hview Ct427-0157 4197 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE REMOVE X X X❑ 8 DESCRIBE WORK REmove existing 16' x 8' Deck; Construct a 28' x 8' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES 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 $.92 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1825 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- $43 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE 61-P Ay License SC $5.00 $50.75 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (GATE) WHEN PROP VALIDATED THIS IS YOUR PERMIT BL INF wet SIGNATURE OF OWNER IIF OWNER BUILDER) DATE) ' NEW [ ] Effective 1/ 1/95 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: 8 at �j 0.' a a P, sS Legal Description: Owner Name & Address: Tel. # :57Z - � 3 y Contractor: Lti-rnak fe MN LICENSE # MW 4/4] Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Tel. # Z-7-©157 Attach to this application, a Certificate 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. Leng*_ Width Hgt/Ground __�_- Sq. Ft. Z 2 Corner Lot [ ] Inside Lot Ft. Yd Setback Side Yard Setbacks Type of Construction: c1e, V Estimated Cost: $ i goo Approx. Completion Date: 9 IS7 opyk° (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: ,jL.&Ae z- qs APPLICANT: ��� cdz Tel. # TOTAL $ �� •� `1 STIPULATIONS: } CITY USE ONLY Permit Fee I $. Fee Schedule on Reverse Side Fire Surcharge $ L 93 .001 of Permit Valuation (1/10") State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $850 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 $ �� •� `1 STIPULATIONS: } 4� )DD' A.N'U,i RSFON` 4 2 7- 0 1 5 7 L I C. # 5 8 4 b } NA J (5 gOO �izC GS, Jf f5 ZZ Y r� w 572 - r�, 411 c4e(�l N X OD yam=-- `, .._�.a l l� timet=��ON MAI, Z:��� INNSBRUCK NOl ifl TOA-IOIJSES ASSOCIATIf) APPLICATION FOR EXTERIORC1lANGES Complete this form and forward it to: Architectural Control Committee 5506 Meister Road Fridley, MN 55432 Owner's Full Name: 4 xxk � f Address: �� Q, e/• i�/ii��%` '� _.. Address of Proposed Construction (if different from above): Owner's Telephone: Home: 6 Work: Proposed Construction. Use the reverse side of this forip for a drawing to show exact location, if necessary. "Th e 6 x,'5 7-; nr,a V e a,/,- 0 i // 4,4 P 7p- eo 4 A �X- r-/) �� 5np - Planned Completion Date: �17I4' 41�Jf,5 (Required for Exterior Structural Changes) PLEASE READ THE FOLLOWING COMPLETELY BEFORE SIGNING: I hereby understand and agree to the following: 1.. To obtain as required by the Committee and/or Board from any of my immediate neighbors who might be affected by my proposed exterior change, preliminary approval, in writing. This preliminary approval shall be obtained and supplied to the Committee upon request. 2. That in the event that final approval to my proposal is given to me by the Committee and/or_by'ihe Board, I hereby agree to assume and be responsible for any costs and liabilities for personal injury or property damage which might arise, both during the construction phase and thereaftcr. Furthermore, I shall indemnify and hold harmless the Innsbruck North Townhouses Association nd all other owners from any such costs or liabilities which might arise. -4- / /�jr rte✓ 3. i hereby ackizowIcd c that I will obtain certificates of insurance from any contractors hired .fo perforrrproposed constructio;r. 4. I hereby acknowledge that I must obtain a txrilaiTZg permit, when applic�l�lc, prior to bcb;nning any construction and I agree to do so and to abide by all local laws andregulations which might affect the proposed construction in any way. 5. i hereby :agree that the change will be completed in a timely fashion and that any construction project will rot continue in an uncompleted state for an indefinite period. u. 1 hereby agree to sig;T a IN faintenancc Release Fomi, if rcc;c;.stc.d by the Corrrrtice or b}, the'Board, prior to begimung any construction. 7. I understand that under Articie IX of the Declaration of Covenants, Restrictions and Eascnrents which apply to the Innsbruck North Townhouses Association, t,ie Committee and/or the Board must eiti,cr approve or rcjcct my proposal or request additional documlentrtion within thirty (30) days after my plarss and specifications have been submitted to the Committee. o. 1 further understand that a waiver by ti:c con:nrittcc or by the Board of any of the guideliT-.es or cone i -ions which aright apply to my proposal shall rot constitute a waiver .or purposes of any future proposals which nlight be' -sub -milted byrxi�,'5ZMLf or other owners. Z'cr T � 19 --———————————— — — — — DO NOT DETACH — — — — — ———— — — — — — — The undersigned hereby releases i.N.T.A. (Innsbruck North Townhouses Association) from all mainternancc responsibility to the exterior change proposed on the attached Application for Exterior Change; and further states that said change will be maintained at a time period not to exceed normal I.N.T.A. maintenance cycle (once every four years). In addition, the undersigned acknowledges that any potential future buyer shall be provided with a copy of this agreement prior to closing of sale. r t _ �wTicr 19 l —5— e, c 16 7-0 I U SUBJECT PERMIT NO. City of Fridley 24097 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. L r ; PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED B� 612-571-3450 910-F15 4/22/96 JOB ADDRESS 1505 South Bavarian Pass NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 36 1 Innsbruck North Townhouse Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Frank Latourneau 1505 South Bavarian Pass NE 572-9341 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Lifespace Construction 10020 Hi hview Ct Cham lin MN 55316-2631 427-0157 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 4197 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ADDITION ElALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X❑ 8 DESCRIBE WORK Construct a 9' x 10' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. 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 $3,184 $1.59 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- $87.25 Fire SC $3.18 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE T T L FEE l Licen a SC 5.00 A97.02 IGNATURE OF CONTRACTOR OR AUTHORIZED AGENT f IDA EI PR LY VAL A THIS IS YOU PERMIT LDG INSP SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI U NEW (] Effective 3/1/96 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application U ConstructionAddress:Q Legal Description: Owner Name & Address: �a ��,�� �Tel. # 0 7Z= f311i Contractor: ������ ��-� v�, e,,,� MN LICENSE #/i Address: jp®zo 9:* 1;�W 55 314 -Tel-#-W27-o,16-7 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 2 Width /'LD Hgt/Ground Z- Sq. Ft. 10 OTHER: Corner Lot j ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ 319' Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft.. + 6 Ft = Fttxx$ _ $ DATE: APPLICANT: Tel. Tel. # CITY USE ONLY Permit Fee $ � `l- Z- -5_, Fee'Schedule on Reverse Side Fire Surcharge $ 3.18 .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $900 per SAC Unit . License Surcharge $ S7, 0c $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 ;y STIPULATIO S: Z4-a-llz� r s Y 4 CITY OF FRIDLEY INSPECTION DIVISION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTIL"ON, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES �' - RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner – Also Replacement Furnace (Side Vent – Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning – All Sizes All Others/Repairs & Alterations (UST ON BACK I% of Value of Appliance or Work Commercial/industrial 1.25% of Value of Appliance or Work Effective On January 1 1998 C JOB ADDRESS_ State Surcharge TOTAL FEE $ .50 $ 55-1 b MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING 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 b6written permission from adjoining property owner. Burner Trade Name BTU HP Size No. EDR HEATING COMPANY L7 Q V -9—f C,,& L ! ea, ®-- Signed By Tel No. % 'p l Approved By 14 Rough–In Date Final Date I -tt FILL OUT BACK SIDE F R STACK VERIFICATION ON REPLACEMENT FURNACE The undersigned hereby makes application for a permit for the work herein Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and $ 30.00 $ ®► b'3 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. ,1998 $10.00 $ OWNER a, YVec ,; y $10.00 $ - r BUILDING USED ASG - $10.00 $ ESTIMATED COST ®� PERMIT NO. $ 25.00 $ �1 DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR $ Fuel Total Connected Load State Surcharge TOTAL FEE $ .50 $ 55-1 b MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING 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 b6written permission from adjoining property owner. Burner Trade Name BTU HP Size No. EDR HEATING COMPANY L7 Q V -9—f C,,& L ! ea, ®-- Signed By Tel No. % 'p l Approved By 14 Rough–In Date Final Date I -tt FILL OUT BACK SIDE F R STACK VERIFICATION ON REPLACEMENT FURNACE CHIIMMY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. . Has been carefully examined Yes (Vf"No ( ) 2. Is free from rust or deterioration 3. Has no foreign objects lodged within 4. Is securely supported 5. Meets all current Code requirements for size and total BTU's connected 6 Has total heating BTU's of All other BTU's Yes (VJ�No ( ) Yes ((,,�'No ( ) Yes 0/�'No ( ) Yes('/)' No ( ) TOTAL BTU's zo 4 0;2 7. Has a liner been provided for water heater Yes( ) No 8. Has combustion air been provided for water heater Yes (tr—No ( ) Remarks: . List ALTERATIONS Being_ Done_ HEATING CO: Signed By: Date: � E/ ��� - r sue,lEcraley PE City of Fr 31193 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. • COMMUNITY DEVELOPMENT DIV.(�� _ v PROTECTIVE INSPECTION SEC. r -----, Grp �(f F NUMBER REV DATE 1 PAGE OF APPROVED BY i CITY HALL FRIDLEV 55432 �a 612-571-3450 910-F15 7/14/00 JOB ADDRESS 1503 - 05 S. Bavarian Pass I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 35$36 1 1 Innsbruck North Townhouse Plat 4 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Innsbruck Townhome Association 651-224-5482 3 CONTRACTOR MAIL ADDRESS 2301 ZIP PHONE LICENSE NO Garlock-French Roofing Corp., L%xMikk E 25th St Mpls., MN 55406 612-722-7129. __.. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 00001423 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION O ALTERATION x0 REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Tear Off and Reroof Townhouse Building 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Permit Inspection cards: will Be Mailed To Homeowner T6,Post TYPE OF CONST. OCCUPANCY GROUP " OCCUPANCY COAG SEPARATE PERMITS ARE REOUIRED 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 2 tSTALLS 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 $14,590.30 $7030 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 FEE TOTAL EE $273014 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT ,DATE, ENOPE ALIDATED HIS IS YOUR PER _ I/ rwkuiriNsp., _..,. ,, .._..: .. .. .... i�ft_ .......... ...: S,GNATURE OF OWNER,IF OWNER BUILDER, ,. .IDATEI CITY OF FRIDLEY INSPECTION 6431 University Ave NE Fridley, MN 55432 (763),572-3604 FAX (763) 571-1287 RATE SCHEDULE DIViSION Effective January 1, 2003 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES, JOB ADDRESS rjOS �' ���� �,�� fi5' Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Pipinoeeded with new furnace, b t not replacement) Gas Range rle Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25of 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. $ The undersigned hereby 1,iakes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes an $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE /a�"7 c� HEATING CO 4iu Yen �-F pc,✓_�, � &,q Signed TEL # FAX # 6S1-G�33 -Ff" Approved B Rough -in Date' Final Date f Yj�) FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE OWNER &(vI A Rate TOTAL BUILDING USED AS $ 30.00 $ ESTIMATED COST 93ru` o o PERMIT N0. $ 10.00 $ DESCRIPTION OF FURNACE AND OR BURNER �_)���. �F $ 10.00 $ No. of Heating Units l Circle One (Steam) (Hot Water) (Warm Air) $ 10.00 $ Trade Name 1(rcf )v 640 Size No. SL -35c TSS BTU 9- I, dob HP EDR $ 25.00 $ Fuel AIC Total Connected Load Burner Trade Name Size No. $ BTU HP EDR 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. $ The undersigned hereby 1,iakes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes an $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE /a�"7 c� HEATING CO 4iu Yen �-F pc,✓_�, � &,q Signed TEL # FAX # 6S1-G�33 -Ff" Approved B Rough -in Date' Final Date f Yj�) FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When nla _ingani®fipu= the undersigned hereby verifies that the venting has been examined and;fs free from rust, deterioration, obstructions, and is securely, supported and firestopped where required. Yes ('; i No ( ) The venting system is piastictPVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes( No( ) The undersigned also verges that the replacement unit is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes( ) No( ) The ix sdng,cnmhustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes( No( ) When required to inabli a n -w _emh Lcfinn air. it will be sized and installed to most the current codes and manufacturer's specifications. Yes( No( ) V"n inSbilion a naw ygnfing nyS em, 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 #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 N HEATING CO: Signed By: Date: -CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR FLOWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES FAX (763) 571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not rept ment) Gas Range��C Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Effective January 1, 2003 JOB ADDRESS /.sad s� 'l �PVQri41,�, i�4W, OWNEVQekNn &Qclra� Rate TOTAL BUILDING USED ASQr $ 30.00 $ ESTIMATED COST LS ®� PERMIT NO. `_5 'i F $ 10.00 $ DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heating Units_ Circle One (Steam) (Hot Water)arm Air $ 10.00. $ Trade Name Size No. BTU 30,0(, HP EDR $ 25.00 $ Fuel Ccts Total Connected Load 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. Burner Trade Name Size No. $ BTU HP EDR $ 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 $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE 14 1(b /03 HEATING CO ?/*_X'e : 'Y -56;,,L Signed TEL # W- 5U3.19'69' FAX # Approved By Rough -In Date Final Date l� FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED rnNNFr-IQR AND nOMRtIST1ON AIR VFRIFICATION r -nM CIN VENT LENT When ropla; an fi gran _ _, 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 avinfinn rnmh -strnn air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to Install it now cnmhuctinn air- it will be sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When jpcla Ijnnas nr�nting rptpm, the undersigned hereby verifies that it is*a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA -LAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes( ) No( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( )No( ) Appliance #1 Type 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 M HEATING CO: Signed By: Date: Kline Corp. DBA: Practical Systems 43428 Shady Oak Road Hopkins, MN 55343 952-933-1868 WTO'd 69STRE6ES6 01 ATMIcIzl d0 UIO WOW TT:U £OW—T£-7U