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PRE 2010 DOCSrn consideration of thea ent of a fee of :0t p ym $� !�: permit is hereby granted ...............'........ . to construct the building or addition as described above. This permit 'is granted neon; the express condition tha the ;person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building,, or any part thereof, shall `conform in all:respects to the ordinances of Fridley, - Minnesota reg g location, construction, alteration, maintenance, repair and, moving of, buildings with- - in the village limits and is permit may be revoked at any time upon violation of . any of the provisions of said ordinances. �I{F}. ; I l � W _..� • EYP - w ..rr ir.. _ _ _ - - • SUBJECT City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT f RECEIPT NO. • COMMUNITY DEVELOPMENT DIV PROTECTIVE INSPECTION SEC. r 1 1 i CITY HALL FRIDLEY 55432 NUMBER REV DATEPAGE OF APPROVED BY 612-571-3450 910-F15 7/18/96 JOB ADDRESS 6053 Woody Lane NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tim Byrne 6053 Woody Lane NE 571-3881 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 ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Construct a 16' x 16' & 9' x 14' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. WARN1116 Before digging call lbt all otii'ty' location SEPAUTE PERMITS REQUIRED FOR . •0002 WIRING, NG, HEATING, PLUMBING AND SIGNS. REQUIRED BY LAIN 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 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 $3, 388 $1.69 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 FEE T(4cIC 1 $92.33 SIGNATURE OF C04TRAC70P 00 AU ORIZED AGENT (DATEI WHEN PROPE .VALIDATED THIS ISYOUR PERMIITT, -BLOB INSP PATE SIGNATURE OF OWNER JF OWNER BUILDER) (DATEI • NEW [ ] Effective 111 /96 0 ADDN CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application I ConstructionAddress: 0 5-3 Wvod % Legal Description: Owner Name & Address: j f stn Tel. # Contractor: 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 o, Sq. Ft. i OTHER:� / 126 &2 V 8,8-7 Corner Lot [ ] Inside Lot [ ] Ft. Yd�Se�tback Side Yard Setbacks _ Dcck Type of Construction: wood Estimated Cost: $ Qo..o0 3� Approx. Completion Date: /} CC.6-- q G - (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 4 L APPLICANT: Tel. # S CITY USE USE ONLY d Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $900 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 [ ] IV•rr:" STIPULATIONS: $ 2 33 �tJC70 � / �� ins. � A 1, LOCATION OF HELL• Cr Countyva Township Nacre Township Number for �A S Numerical StWt Address and City c Intersection I W Show exact location of well (in section grid with °X N MENE Date sealed h / ME S. DRILLING METHOD (if known) ljoble tool 40 Reverse 70 Driven 100 Dug 00 8® Bored 110 30 Rotary 60 Jetted 90 Power Auger WENE )--I .n, L 2. PROPERTY OWNER'S NAME P STATE OF MINNESOTA DEPARTMENT OF HEALTH l ABANDONED WELL RECORD MINNESOTA UNIQUE WELL NO (leave blank if not known) Range Number Section No.1 Fraction E h k; or 1) pea y. Vi Well Location or Distance from Road Ir 4. WELL DEPTH (completed) Date sealed h / S. DRILLING METHOD (if known) ljoble tool 40 Reverse 70 Driven 100 Dug 20 Hollow Rod C Air 8® Bored 110 30 Rotary 60 Jetted 90 Power Auger 7 Sketch map of well lbta--tens J r 4 >,:d Mailing Address if different than property address indicated above HARDNESS OF 3. FORMATION LOG COLOR FORMATION FROM TO If not known, indicate formation log from new well or nearby well, 6. OBSTRUCTIONS Well obstructeda No Obstructions removed s [] No If obstructions cannot be removed. contact MON before sealing. 7. US 1 omestic 40 Monitoring 80 Heat Loop 20 Irrigation 5® Public g0 Industry 30 Test Well 60 Municipal 100 Commercial 70 Air Conditioning 110 8.ING(5) 1 ack 40 Threaded 70 20 Galv, So Welded 3]] Plastic 60 Stainless Steel in. to ft. in. to ft. 9. SCREEN 0 Screened well from ft' to'_ ^ft. pen Hole from t. tot. (IP known) 10. STATI W�jER LEVEL �,Y ft. low 0 above land surfacei -,r D:ete Measured,/c 11. WELLHEAD COMPLETION 10 Pitiess Adapter 4[3 Found Buried sement offset In - 313 30 Well Pit 6. REMARKS, ELEVATION. SOURCE OF DATA - CASINGS REMOVED. CASINGS PERFORATED, ETC. 12.UT NG INFORMATION a . We Cement 20 Bentonite Grout material fro ft.. e 13. NEAREST SOURCES OF CONTAMINATION Peet direction type Well disinfected before sealing? Was 7 iFFICIAL ABANDONED WELL RECORD (May be used for Property Transfer) ZNFCMWS FILB NZ22F DMW 14. PUMPved 0 Not Present Type: 1 bmersible 30 L.S. Turbine 50 Reciprocating . 20 Jet 40 Centrifugal 60 15. EXISTING WELLS (Please sketch locations of abandoned and active wells in remarks section or on back.) Other unused well(s) on property? 0 Yes, WO Aband0ned;::0 Permanent D Temporary 0 No ; CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1993 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS_ Residential Furnace Shell and Duct Work, Sumer — Also Replacement Furnace (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) A'v2 Gas Dryer ,5'4T17111e--- *Air Conditioning — All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/industrial 1 % of Value of Appliance or Work Rate TOTAL $ 20.00 $ $ 10.00 $ 6?,00 $ 10.00 $ , ds 6 C5 $ 10.00 $©� QD $10.00 $ $ State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed in a side yard without written permission from adjoining, property owner. 50 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 orrect. _ — 4-' 1994 OWNER ) 6)i ii ))-,,0 i2l A)e"— BUILDING USED AS ESTIMATED COST '� �v PERMIT NO. r� & 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 EDS HEATING COMPANY Signed Bye, rL€a�� /i',f�5��r ���eI No. Approved Rough—in Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE NOTE: #1 through #8 required when using a side vent furnace. CHIMNEY AND STACK VERIFICATI The undersigned hereby verifies that the existing chimney or stack: I . 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: W -Walt . !� HEATING CO: Signed By: Date: f CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1993 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 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 O No Type $ 7.00 The undersigned hereby makes application for a permit for the work herein $ 4:00 specified agreeing to do all work In strict accordance with the city codes $ 5.00 and rufings>of the Building Division, and hereby declares that all the facts $ 7.00 and representations stated in this application are true and correct. 7 00''' Estimated Cost qi , PERMIT NO. $ 7.00 $ 7.00 $10.00 Owner $ 7.00 $10.00 Building Used As 1�J1.1 s1 $10.00 $10.00 Estimated Cost qi , PERMIT NO. $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 11% of Value of Fixture or Appliance State Surcharge TOTAL FEE $ .50 $'Z�v,S o PLUMBING COMPANY SIGNED BYa ,TEL No. (0,37 —�-- Approved By Rough—In Date Final Date ' PLUM SU RCH 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 Tn RF INSTAL t M not MAnW Gt nncz 1 Effective On January 1, 1997 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS ®53 1�J,� j% 4,#///,�" 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 $ 7.00 The undersigned hereby makes application for a permit for the work herein $ 4.00 specified agreeing to do all work in strict accordance with the city codes $ 5.00 and rulings of the Building Division, and hereby declares that all the fads $ 7.00 and representations stated in this application are true and correct. $ 7.00 $ 7.00— . 1998 $ 7.00 $10.00 Owner r1A 4 6 /lsvE $ 7.00 ' $10.00 Building Used As�S%���C $10.00 $10.00 Estimated Cost PERMIT NO._ 112311 $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance , o® State Surcharge TOTAL FEE $ .50 PLUMBING COMPANY SIGNED BY o TEL N0. Approved By " Rough—In Date Final Date $ LLO PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES. M CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-JbU4 VAN: ADDRESS : 6053 WOODY IN NE PIN : 243024210046 LEGAL DESC : REG LAND SURVEY NO 107 : LOT TRA BLOCK B PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WINDOW/DOOR REPL PERMITO.: 20:4-0 DATE ISSUED: 09/13/2004 VALUATION : $ 2,000.00 NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS. INSTALL BASEMENT EGRESS WINDOW. STATE LICENSED CONTRACTOR APPLICANT SCHWEICH DAVID CONSTRUCTION (202626 21716 KENRICK AVE LAKEVILLE, MN 55044 (952) 469-3222 OWNER BYRNE TIMOTHY M & MARY A 6053 WOODY IN NE FRIDLEY, MN 55432 1 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 work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of other state or local law regulating construction the perf ance of construction. Bldg SEPARATE PERMITS BUILDING PERMIT FEE 69.25 FIRE SURCHARGE 2.00 STATE SURCHARGE, VALUE 1.00 LICENSE SURCHARGE 5.00 TOTAL 77.25 PAID WITH CHECK # 34549 FOR WORK OTHER THAN DESCRIBED ABOVE. j,4$5A NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1, AND R-2 (763) 571-1287 Fax BUILDING'PERMITAPPLICATION Construction Address: (P 3 D act �A e- Legal Description: Owner Name & Address:'M 60 Ma � Tel. # -71,o Contractor: i a L td SCG�w-e-tc" Cc�� Irn c�rv�C MN LICENSE #aa— Address: a1� l(d l �✓ V VI C� �v�Plnk_ Tel. # �I �a-Li�Cl`�Jaaa 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: e Construction Type: WVY dbw Estimated Cost: $ �24 too y Driveway Curb. Cut Width Needed: Ft. + 6 Ft Ft x $ _ $ DATE: ­Q1 1.®I ® APPLICANT:Ac- Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge CITY USE ONLY - Fee Schedule on Reverse `Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 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 [ ] TOTAL; $ ei STIPLILATIONS- F CITY OF FRIDLEY PERMIT NO.: 2004-02335 6431 UNIVERSITY AVENUE NE ' FRIDLEY, MN 55432 DATE ISSUED: 12/29/2004 S7L-36U4 VAX: (763) 571-IZZ17 ADDRESS 6053 WOODY LN NE PIN 243024210046 LEGAL DESC REG LAND SURVEY NO 107 LOT TRA BLOCK B PERMIT TYPE HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 300 APPLICANT BYRNE TIMOTHY M & MARY A 6053 WOODY LN NE FRIDLEY, MN 55432 OWNER BYRNE TIMOTHY M & MARY A 6053 WOODY LN NE FRIDLEY, MN 55432 HEATING PERMIT MINIMUM FEE 0.00 FURNACE SHELL/DUCT WORK 35.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 35.50 PAID WITH CHECK # 5221 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 wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY BUILDING -INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer 4 �0`a5Effective 69 4Li l ,L.' 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES �) JOB ADDRESS ��53 Fee Total Owner_ Ct V X4 r ►'v�- IS U IO pl -4L- $35.00 $-1— Building Used r'1 V Cr, e-- -�10 M Q-, $10.00 $ ESTIMATED COST PERMIT NO $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $ *Air Conditioning-AllSizes $25.00 $ All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater on work less than $300.00 # of Heating Units Circle One (Steam) (Hot Water) Warm Air) Trade NameG o c 8 WN-, v\ Size No. GY►1SR G%O BTU '70,000 HP EDR Fuel IJ�i+ . (Sas Total Connected Load 2O, 000 Burner Trade Name Size No. BTU HP EDR The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/IndustriaVinstitutional and representations stated in this application are true and correct. c State Surcharge $ kl tN��O' U �" J � V `� 77 yo, viol -QL TOTAL FEE '2 Signed Tel;7 REINSPECTION FEE $50.00/HOUR FAX # Date t -Z _ Z ` Oq *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough -in Date Final Date 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 f to meet the current codes and manufacturer's specifications. Yes () 141A 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 °j No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 TypeA6°- BTU Input 70AL'f) an A_ss7i7ste lbr Nat Appliance #2 Type wcj+j!Y- fl-erte r BTU Input L10 10VO Fan Assisted or la ) Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input I JO 60D Common Vent Type l l Ae v- Vent Height A -1 Diameter S inches 11 Appliance #1 Vent Connector Height ft Length —6—ft Diameter `f in Type Appliance #2 Vent Connector Height �ft Length �ft Diameter �in TypeG(a S V -CA VL Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) H€ATMG-GO' v 'I-) y, Pi -J T vv, .9 y - y1, . Signed By: (' Date