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PRE 2010 DOCSCity of Fridley SUBJECT PE IT 13941 AT THE TOP OF THE TWINS PERMIT r BUILDING R CEIPT NO. COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. r � 1 . i CITY HALL FRIDLEY 55432 NUMBER _7_1 EV DATE PAGE OF APPROVED BY 612-560-3450 910-F15 3/7/77 JOB ADDRESS 7565 McKinley Street N.E. 1 LEGAL LOT NO, BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 1 Bayer's Lakeside 2nd Addn. Ba Y'SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Cedar Bay Builders 1700 - 3rd Avenue N.W., New Brighton, Mn. 55112 633-8800 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. 6 USE OF BUILDING Residential 7 CLASS OF WORK Ek NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK IN Construct a 26' x 38' Dwelling and a 22' x 22' Garage EPtATE PERMITS REQUIRE?e FtR,.:WlRI�VC• TELEPHONE-ELECTRIC- 9 CHANGE OF USE FROM EATIM PLUMBING AND SIGNS. f> REQUIRED 8Y STIPULATIONS provide a hard surface driveway. Provife sod in the front and side yards. Provide a verifying survey before capping. Provide 2" x 8" rafters or trusses. SEWER LOCATION: (Approx. 10,' Deep) No Existing Wye. 8" sewer line 25' west of property line. 9-4MPORTANT-••,. WATER LOCATION: MUST BE TAPPED. 6" watermain 10' west of se1.WE FRtDI.EY ENGR. DIVISION REGARDING CARS REMOVAL-AND REPLACEMENT THE CUT OF "FXDW DMS NOT QUARAWK- " 7HE 30 DAMP"i 'R �Nt''EN ACCURACY OF UTrtttY tOCArjM AND MVAj0j, .. THIS DATA IS FOR INFORMATION PURPOSeS OPmLY AN,) SIV. REQUIRED FOR CU P» SOMS USING R 011CIULD Vl£RIFY THE INFORMARON :6:AAOVAL AND REPLACEME ON LME SITE AT DRIVEWAY OPENINGS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. WOOD FRAME 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 R-1 1118+484 13,416+4840 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 $33,295 $16.65 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- ST TI N OR THE PERFORMANCE OF CONSTRUCTION. $104.64 $375.00 I& PLAN CHECK FEE TOTALFEE `� Q 6 $2 6 $522.45 IGNATUREOFCONTRACT ROS UT RIZEDAGENT IOAT W N O r RLY VALIDATED THIS IS YK;_Az � �P BLDG. INSP ID E '- SIGNATUREOF OWNERIIF OWNER BUILDERI (DATE) dlities AS Etc. LAE CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OttiTlJER: A DD Address: AJF-uj No.: 7 ,�,j Street: LOT: '7 BLOCK: BUILDER: Address: Tel. No. �yy CORNER LOT: INSIDE IAT: _�_ SETBACK: SIDEYARDS: sU — Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. �A < DESCRIPTION OF BUILDING 7�S To Be Used As: o) 4t Front: �1p Depth: 3 Height: Square Feet: 111,R Cubic Feet: 4a V// C� Front: tea' Depth: Height: Square Feet: d%h'� Cubic Feet: Type of Construction: Estimated Cost: To Be Completed: /Alt. A Alt. B Proposed Driveway Width If few Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) The uiIderAigned 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: SIGNATURE• Stipulations: C , >,� AFSS 00, 74965 5 S ooh eV ®4� /! , 6 "r BUILDING PERMIT FEE SCHEDULE SECTION 2. The Inspector of Buildings shall, -before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repairs to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet. PLAN CHECK: 25 percent of building permit fee. DRIVEWAY DEPRESSION: (Concrete Curb Streets Only) Alternate A: Removal and replacement of concrete curb and gutter only; Driveway width plus 6 feet x $11.75 Alternate B: Removal and replacement of concrete curb and gutter and install a 3 foot wide approach with 6 inch depth; Driveway width plus 6 feet x $15.75 1 1 • _ •' • \ For the purpose of computing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or the cellar to the average heights of the upper surface or to the average height of the roof surface of the main gable of a pitched roof. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 Per each five hundred dollars ($500.00) or fraction thereof in the cost of all proposed work. In -no case shall the fee charged for any permit as set forth in Section 2 be less than $7.50 plus $.50 state surcharge. VERI_FI_CATIO"F F(ZUNDATION NOTE: Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has been constructed will be required before proceeding with the framing. VWGj;W$X411jZ11 Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. Y , _ _^ iG t fi _ § �; �/ 4 t� - _ -11111 _ �.. .> , e� - ' ' 4 x 4. _ } _ nally ,n ' { it _ - -. - -. -: -q e' .. ., r, rt _ F C '3 _ , ` L y 7 f c - �- �1, ,�:, " -, I L_ - -,-_,, , ,,.% " __g { . , . - , � � -,* 1�wl�""_ - - �,­ ,�� � ,� r., -' _ :. " � - :> G -h '�� 3 - t JI I g ,. .. ,. ,.,.. ., ,. .. , , -. _ - 1 l r . ;. _r. ... _. T 11 a .. r - -_. _d z- �; - t . yJ�- noA} !!Etltit���- n 1.- ,- ---...: -,,, - _1� , I �_ I __ -1 _ , _ - i..,: a 4 _ '' - r CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FI'T'TING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. p, M TOTAL Number Fixtures p o $3.00 x m 3 Water $2.00 q M x $2.00 0 N r.}�� r. -11 M Ll $5.00 4 p, kms, b' � $5.00 Heater 100,000 BTU to 199,000 BTU N bb+ $10.00 $ Water Softener E � 0 354 4 0� N Q $5.00 $ H +1 11 01 A GAS FITTING FEES: YM ,,l�C�. 1st 3 fixtures f x '$3,00 $ ;.CSU Additional Fixtures M $1.00 $ Gas Range to 199,000 BTU O x -S $ R N r7 "� O O i� M 0 till M M M each add. $100.00 or fraction ai U D P% a1 y 3 A W ai W U r�A 3 Cel tro7 O as lec 1st 0 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures p x $3.00 $ aA/(1 U Future Fixture Opening 3 x $2.00 $ (?. New Fixture, Old Opening x $2.00 0 $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU / x $5.00 $ �•DO 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ New Ground Run Old Building x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: 1st 3 fixtures f x '$3,00 $ ;.CSU Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ �O REINSPECTION FEE ($10.00) Job Address 7,' J G z'//Aa— a 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 Fridley, Mn. C� '19 7 OWNER KIND C USED AS /a1 TO BE COMPLETED ABOUT ES MATE ST OLDNEW BUZ ING PERMIT NO. PERMIT NO. Company Signed By Tel. No. Y C �'�� 0 2r ROUGH INSP. Date FINALINSP. a / Date APPROVAL FOR PERMIT , MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHERUIF GRAVITY WARM AIR: Furnace Shell & Duct Work Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU each add. 50,000 BTU Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 STEAM OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU each addn. 50,000 BTU Boiler only up to 100,000 BTU each addn. 50,000 BTU OIL BURNER- to 3 gal. per hour each add. 3 gal. per hour GAS BURNER- from 100,000 BTU to 199,999 BTU (over 199,999 BTU see Fee Schedule) GAS FITTING FEES: RATE TOTAL $12.00 $ 7.00 $ 4.00 $ $12.00 $ e �� 4.00 $ 7.00 $ 7.00 $ 4.00 $ $12.00 $ 4.00 $ 7.00 $ 6.00 $ $10.00 10.00 $10.00 1st 3 Fixtures x $ 3.00 Additional Fixtures x $ 1.00 Gas Range to 199,000 BTU x $10.00 AIR CONDITIONING FAN HEATING SYSTEMS See Fee Schedule VENTILATING SYSTEMS ALTERATIONS $ REPAIRS State Surcharge TOTAL FEE ROUGH INSP. REINSPECTION FEE Date (,$10.00) FINAL INSP. A - Da e in APPROVAL FOR PERMIT MOM MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE 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 Cddes.% and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. OWNER KIND OF BUILDING USED AS1/�_' " TO BE COMPLETED ABOUT ESTIMATED COST OLD -AM.AUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water Warm Air- No. Trade Name Size No.��Q Capacity sq. Ft. EDR "eSTU HP Total Connected Load �ti� Kind of Fuel 14 BURNER - Trade Name' &�nize No. A A 44 Capacity/A Ft. EDR® TU HP RAY N. SMELTER HEATING CO. Company Signed By Minneapolis. bAinn solcl 55407 Tel. No. ,� E1!7 SuBjECT N0. City of Fridley 7ERNItT n r,7 AT THE TOP OF THE TWINS BUILDING PERMIT Ir? RECEIPT NO. L _---_ COMMUNITY DEVELOPMENT DIV. -7-7 r� � PROTECTIVE INSPECTION SEC. : NUMBER REVDATE PAGE OF APPROVED BY 1 CITY HALL FRIDLEY 55432 1'J 612-571-3450 910-F15 1 J10/ 31/94 JOB ADDRESS 7565 McKinley Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 1 Bayer's Lakeside 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Larry Galdonik 7565 McKinley Street NE 786-1402 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Gates Roofing 4640 Ximines Ln N Plymouth MN 55442 550-0043 6793 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 !M REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage 24 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 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 I STALLS I 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 $.90 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,800 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 $1.80 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $41.00 PLAN CHECK FEE TOTALFEE License SC $5.00 $48.70 SIGNATURE OF CONT RACTOR OR AUTHORIZED AGENT IDATEI WHEN OPE Y VALIDATED THIS IS YOUR PERMIT /V/ a DO INSP T S,GNATUREOFOWNER,IFOWNERSUILDERI IDATEI NEW [ ] ADDN [ ] ALTER ConstructionAddress: Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R -Z Building Permit Application ?'-(o Effective 1/1/94 Wyq- 77 Owner Name & Address: i Tel. # / �( 0 Contractor: MN LICENSE # 19, '3 Address: �� ��` = C_1/ .rj Tel. # . �vo 0 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 _ Hgtl ound .t. OTHER: —��9 � 2 (5;; ';� Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ /Boo _Approx. Completion Date: (Cost on Back) = Driveway Curb Cut idth Needed: 6 Ft ; Ft x 1$ — $ DATE: (9 -2- %APPLICANT: Tel. # Permit Fee $ 41100 Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ C7 $.50/$1,000 Valuation SAC Charge $ $800 per SAC Unit License Surcharge $ . GCS $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: BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: TOTAL VALUE FEES $1 to $500 $15 (Minimum Fee is $15 plus surcharge) $501 to $2,000 $15 for first $500 plus $2 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $45 for first $2,000 plus $9 for each additional $1;000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $252 for first $25,000 plus $6.50 for each additional $1;000 or fraction thereof, to. and including $50,000 $50,001 to $100,000 $414.50 for first $50,000 plus $450 for each additional $1,000 or fraction thereof, to .and including $100;000 $104,001 to $500,000 $639.50 for first '$100,000 plus - $3.50 for each additional - $1,000 of fraction thereof, to and including $500,000 $500,001. to $1,000,000--., - $2039.50. for: the first $500,000 plus $3 for each`addrtional $1,000 or fraction thereof, to and including $1,000,000 $1,000,001 and up $353950 for the first $1,000,000 plus $2 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50 - Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. CIiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN 55432 - (612) 571-3450 - FAX (612) 571-1287 November 26, 1996 L. M. Galdonik, Jr. 7565 McKinley Street N.E. Fridley, MN 55432 RE: Home Occupations Dear Property Owner: In the zoning district where you live, home occupations are permitted as an accessory use, provided that certain criteria are met. I have enclosed a copy of this City Code section for your review. Recently, we received information suggesting that you may be operating an automobile repair garage out of your residence which is not in conformance with the restrictions. If this is correct, please comply with the City Code by discontinuing this activity immediately. Feel free to call me at 572-3595 if you have questions or wish to discuss this further. Thanks for your cooperation! Sincerely, Kurt Jensen -Schneider Code Enforcement Officer KJS:Is CEM -96-488 CITY OF FRIDLEY INSPECTION DIViSION 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 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 replacement) Gas Range 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 Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 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. JOB ADDRESS 7, OWN Effective On January 1, 2000 TOTAL 6s� BUILDING USED AS $ ESTIMATED COST j� ®� PERMIT NO. $ il DESCRIPTION OF FURNACE AND OR BURNER ti No. of Heating nits Circle One (Steam) (Hot Water) (Warm Air Trade Name Size No. BTU HP EDR Fuel 2 Total Connected Load_ 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 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE MAINE HTt3. A/C & ELECT. lVC, HEATIN C 13b62 CENTRAL AVE. N.E. 9 Signed TEL Approved By Rough -In Date Final Date,/6 � ' COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION d 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 firestcpped where required. Yes O 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 manufacturers specifications. This does include AGA -LAMA 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 airit will be sized and installed To meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes( No( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( ) No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type r BTU Input Fan Assisted or at 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: _ LAINE HHG. ASC & ELECT. N' . A�IC hi AA10Kla N 55304 Date : — Signed By: