PRE 2010 DOCS4/ X37 t
City of Fridley, .Minn.. No 10465
BURDING PERMIT
Date: October 22 1969
Owner: - Q R Erickson Builder F.rCn Tnrorpornted
Address 1315 Hillcrest N.E. Address 3231 Central Avenue
LOCATION OF BUILDING
No. 6056 Street Woody Lane N.E. ,___„_, Part of Lot
Lot _4 Block 1 Addition or Sub -Division Moore Lake Hills
Corner Lot _ Inside Lot —X Setback 45' _ _ _ Sideyard 5 & 10
Sewer Elevation 893 _ Foundation Elevation 900
DESCRIPTION OF BUILDING
To be Used as: 26' 61-611
DxaPlal i�+g Front 421 Depth '' Height 0.' Sq. Ft. 14.92''_ Cu. Ft 21r..8M'
Gar & Bedrooms Front Depth Height Sq. Ft. 30' 24' 10' 1680' Cu. Ft. 16,800'
Type of Construction Frame �� Est. Cost $ _4o, 000.00 To be Completed 4/1/70
Provide Hardsurfaced Driveway.
SEWER LOCATION: South property line. Saddle necessary
WATER LOCATION: Woody Lane.
In consideration of the issuance to me of a permit toco ding described above I agree to do
the proposed work in accordance with the description abo o compliance with a'il provisions of
ordinances of the city of Fridley.
$100.00 Sewer orm ion Charge
In consideration of the payment of a fee of $ 70.00 , permit is hereby granted to__QR, Erickson
to construct the building or addition as described above. This permit is granted upon
the express condition that 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 regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
P
CE BELISLE
NOTICE:
This perp* does not corer the construction, hatallation for wiring, phunbiae, gas hoolln& sower or water. Be sure to we
the Building Inspector for separate permits for these Nems,
I"
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
-OWNER IS MANE &12 cx:�-j 0 -BUILDER
ADDRESS 4— IV i�� 9144 ICA!e_5 -I— ADDRESS -3231
NO.
LOCATION OF BUILDING
4ZE-04
LOT 13LOCK ADDITION 01//SUBDIVISION/5/004-e-2�<C-/41-/-s
V
CORNER LOT INSIDE LOT SETBACK SIDEYARD_
SEWER ELEVATION TOP OF FOOTING___jo o
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.:
"-Front Depth Height 0
Square feet Cubic Feet
Front 4 Ze- Depth Height
Squareeet
A Cubic Feet
Type of ConstructionL2 Estimated Cost e -ye.,
To Be Completed 4 j
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 repres�t tions stated an
this application are true and correct.
DATE 16 /_1' V/6 SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side.)
vrny 1Mt rjy
ado
1 H:
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATIN TOTAL
Furnace Shell & Duct Work .........:.................$10.00
Replacement of Furnace 6.00
Repairs & Alterations—up to $500.00 ................. 6.00
Repairs & Alterations each add. $500.00 ............... 3.00
CK WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ $10.00
each add. 60,000 BTU ....................... 3.00
Replacement of Furnace ............................. 6.00
Repairs & Alterations --up to $500.00 .................6.00
Repairs & Alterations each add. $500.00 .............. 3.00
STEAM or HOT WATER SYSTEM
Furnace Shell & Dines—to 400 sq. ft. EDR Steam .... . $10.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. 10.00 $
Each add. 200 sq. ft. EDR Steam ...............:.....: 3.00 $
Each add. 320 sq. ft. EDR Hot Water ..... ............ 3.00 $
OIL BURNER—to 3 gal. per hour .....:........... ..... 6.00 $
over 3 gal. per hour ---See Fee Schedule
GAS BURNER (up to M,000 BTU) ..................... .. 8.00 $
over 199,000 BTU See. Fee Schedule
CTAS FITTING FEES: NO RATE TOF.
1st 3 Fixtures x$ 200 $
Additional Fixtures x .78 $
Gas Range to 199, $
�. x$ 8A0
71 �`� ��
AIR coNDIT><ONrilG v" >–=—
FAN BEATING SYSTEM See Fee
ATING SYSTEM $
ALTERATIONS & REPAIRS TOTAL FEE
Dept. of Bldaa. Phone 880-3450
City of Fridley:
The undersigned hereby makes application for a permit for the work herein.
specified, agreeing to do all work in strict accordance with the City Ordinancet
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley*Minn-1
Owner
Kind of
Used a.
To be completed about
Estimated Cost, $ �� r
Ol New. J3uilding Permit No. Permit No.
DESCRIPTION OF WORN
BEATING or POWER team, Hot Water, Warm Air—N
Trade Nam Size No
Capacity Sq. Ft. E.D.R BTU H.P.
Total Connected LoaA Rind of Fue
BURNER — Trade Name Size No
Capaci Sq. FL E.D.R BTU H.F.
11RDq�
8! 19 AIR C �ND(IIO
NN DRl
�E
s mouse �i,�� ..
Business Phone Ne
FINAL
(REMARKS -OYER)
Original
PERMIT for Powerplants and Heating. Cool-
ing, Ventilation. Refrigeration and lair
Conditioning Systems and Devices
DESCRIPTION OF WORK
No. Of / Heating Plants to be installed--altered—repaired
Make -L� , Size C;, _f,
Oil fired—,- Coal fired—,- Gas fired; Gas Authorization No.
Remarks `#�L vt Q3 LU_e, & 71:, W a,'L_k
Approved
Final Inspection Date , 19_
Inspector
� ; 7
Permit N° 4653
Fee $.��
OfFiice of the Inspector of Buildings
City of Fridley
City of Fridley, Minn. JAS -/ , 19:Z6
Owner EAL0 .L iJ eni' P6287 -e-6
Location & -6 CA-R)O I� V L 0 63,c_
Kind of Building �� n ► n
How Occupied A uJ1SL U �Q (:,,
Work to be Commenced—, 19
To be Completed—, 19—
Estimated Cost, $ c:11006
Old ew,)Building Permit No
Permission is hereby granted to a < r-1 Y . to install—erect—use the material and devices described in the
above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work
done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley
relating to or governing the work to be done and the operation of the devices herein named, and to the specifications set forth in the approved application for this
permit on file in the office of the Inspector of Buildings. p y
2. Inspector of Buildings
.01�42 2M 11.67 b
City of Fridley
i
fi
DESCRIP`1'ION OF WORK
Number, Kind and Location of Fixtures
Fut=* Connection Openings waa,se, aw wua
+ Now Fixtnro, Old Openings sewCe poo" El
er
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
Number Fixtures
Future Fixture Opening
New Fixture Old Opening
Catch Basin ...
NO. RATE TOTAL
x $2.00 $
.. .... x$1.50 $
x $1.50 $
x $3.25 $
Water Heater (Up to 99,000 BTU) —� x $3.00 $
New Ground Run Old Bldg. x $3.25 $
Electric Water Heater z $2.00 S.
GAS FITTING FEES: NO. RATE tTO
UUTi
lat 3 Fixtures ....... .... I ......... _ x $2.00
Additional Fixtures ..... .............. x $ .75 $
(las Range to 199,000 BTU .............. x $5.00 $
REPAIRS & ALTERATIONS—Rotor to Code
Description .............................
TOTAL FEE $
City of Fridley:
The undersigned hereby snakes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are rue and correct.
Fridley, Minn C'
Owner �` C 6 ,
Kind of Building
Used as
To be completed about
Estimated Cost,
Old—New. Building Permit No—_ 1_Fermi No.
f
Signed tt�
By_
Business n,!No- ?S S'�iJ 9 a
ROUGH
FINAL -2 _ '
g
12
8L
a§{ >j
�
-
2r��
Q �
tL �
N
gZ
WATER HTR.
GAS
ELEC.
Base
–
lot
-
2nd
3rd
4th
Fut=* Connection Openings waa,se, aw wua
+ Now Fixtnro, Old Openings sewCe poo" El
er
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
Number Fixtures
Future Fixture Opening
New Fixture Old Opening
Catch Basin ...
NO. RATE TOTAL
x $2.00 $
.. .... x$1.50 $
x $1.50 $
x $3.25 $
Water Heater (Up to 99,000 BTU) —� x $3.00 $
New Ground Run Old Bldg. x $3.25 $
Electric Water Heater z $2.00 S.
GAS FITTING FEES: NO. RATE tTO
UUTi
lat 3 Fixtures ....... .... I ......... _ x $2.00
Additional Fixtures ..... .............. x $ .75 $
(las Range to 199,000 BTU .............. x $5.00 $
REPAIRS & ALTERATIONS—Rotor to Code
Description .............................
TOTAL FEE $
City of Fridley:
The undersigned hereby snakes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are rue and correct.
Fridley, Minn C'
Owner �` C 6 ,
Kind of Building
Used as
To be completed about
Estimated Cost,
Old—New. Building Permit No—_ 1_Fermi No.
f
Signed tt�
By_
Business n,!No- ?S S'�iJ 9 a
ROUGH
FINAL -2 _ '
i
Original Permit f®r rLUMBING AND GAS FITTING -631-5-ye
N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for Permit
inspection shall be honed in to the plumbing Inspector, 560-3450 Fee ��
p p g giving number of this permit.,
DESCRIPTION OF WORK II
Number. Sind and Location of Fixtures
Stories
M
u~1
F Up
a J
U
J
z
rc
7
r m
a n
m F
z
m
a
m
to
X
Z
f4
0 a 1
a K
3 F
F
Z D
C O
D LL
W
o
I
�p
E
o Q Z
J R
LL❑
_ 0
r m
dd a
U m
Z a
Q❑
X J
m x
m y
a q
W
m z°
a a
WATER HTR.
GAS
ELEC.
Basement
1st
%
2nd
3rd
4th
Connected with Sewer -Cesspool Gas Piping for Openings
Permission is hereby granted L - A Xk-A I P's I to do the plumbing and
gas fitting in the building described in the statement hereto attached, upon the express condition that
the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing
or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and
this permit may be revoked at any time upon the violation of any of the provisions of said ordinances.
By Order Of The Inspector Of Buildings
Roughing in Inspection Date
Inspector.
Final Inspection Date
Inspector.
42 'P1—s•a9•v
City of Fridley �� 6ULA le
Owner G. SEP/c—e-&c i% �l✓oee-nAZyc
J
1 .r ►
Kind of Building ��
Used as lU uJF_L.L1 l) C
To be Completed ,19_
Estimated Cost
Old- ew) Building Permit No.
Inspector of Buildings.
City of Fridley
Application for Plumbing and Gas Fitting Permit
Dept. of Bldgs. Phone 560-3450
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ......................
x $2.00
$
Future Fixture Opening ................
x $1.50
$
New Fixture Old Opening ..............
x $1.50
$
Catch Basin ............................
~3
c�m
�3
�n
t�°d
7Z
c9o�
in0
z
�a
t�0
t
P
•
N
WATER HTR.
GAS
ELEG
Base
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..........................
x $2.00
$ 2.00
Additional Fixtures ....................
x $ .75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
install (1)
gas grill
3.00
1st
2nd
3rd
4th
• Future Connection Openings
New Fixture, Old Openings J
New
Connected with
Sewer �
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ......................
x $2.00
$
Future Fixture Opening ................
x $1.50
$
New Fixture Old Opening ..............
x $1.50
$
Catch Basin ............................
x $3.25
Water Heater (Up to 99,000 BTU) ......
x $3.00
$
New Ground Run Old Bldg . ............
x $3.25
$
Electric Water Heater
a $2.00
$
GAS FITTING FEES:
NO. RATE TOTAL
1st 3 Fixtures ..........................
x $2.00
$ 2.00
Additional Fixtures ....................
x $ .75
$
Gas Range to 199,000 BTU ..............
x $5.00
$
install (1)
gas grill
3.00
REPAIRS & ALTERATIONS—Refer to Code
Description .............................................$
TOTAL FEE $-5 e 00
Location -6056 Wooddy Lane ATS'°.
City of Fridley:
53-84-x915.51
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct.
Fridley, Minn- July 10, 1970 , 19,
Owner 011ie Erickson
Kind of Building rraMe
Used as residence
To be completed about July 15, 1970
Estimated Cost, $ 10 _00
Old-gNew. Building Pe No Permit o.
By
�\p��P0'I �S uNAS' (690
Business Ph, �t�
ROUGH
FINAL q �
S,
SuB.,ECT
PER
City ®f Fridley2
6 2 0 3
AT THE TOP OF THE TWINS
BUILDING
PERMIT
f
RECEIPT NO.
_ /U�ITY DEVELOPMENT DIV.
� I � VE INSPECTION SEC.
r S
v �® �p
6 ®y
i
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
10/13/98
JOB ADDRESS
6056 Woody Lane NE
1 LEGAL
LOT N0.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
1
Moore Lake Hills
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Oliver Erickson
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Advance Alum. Supply Inc.
-
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION jk REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage 45 S Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED '
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
'VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
3856
$1.93
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$87.25
Fire SC $3.85
PLAN CHECK FEE
TOTAL FEE
T.4 --se SC $5.00
A
98.03
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
_
WHEN PROPERLY
BLD it,
VA TED THIS IS YOUR PERMIT
�
MATE
S-GNATUREOfOWNERJFOWNER BUILDERI IDATEI
S,
A
a 612 571 2260
ADVANCE ALUMINUM
Effective 111198
M
ADDN ( ] CITY OF FRIDLEY
ALTER i ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 5 71 v %.9'7
BUILDING PERMPi APPLICATION
ConstructionAddress: O L F �2 f/—?-) C, H !LO 5 W 0 v
Legal Description: _
Owner Name & Address: LJ d 1-1,r/L- Tel.
Contractor: A d o/1,+v4 ! rd aj j''^ 5 MMI y ,_ A � c MN LICENSE # � 3
Address: 7 7 0 N<_d2 kK Tel. # 5 7/- 3y9,,Q
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.
DECD AREA:
Length
_ Width Hgt/Ground
Sq. Ft. r_
OTHER:
Construction Type /c'G G' �� ,L • Y 5 ! 4' Estimated Cost: $, 35S
(Fee Schedule on Back)
Driveway Curb Cut Width Needed. Ft. + 6 Ft = Ft x $�
r�
DATE; loz � APPLICANT:
�.. Tel. # ff2�' : 3 ���
CITY SE ONLY
Permit Fee
$
87' -?s
Fire Surcharge
$
3 •$S7
State Surcharge
$ i.
SAC Charge
$_
License Surcharge
$__--6
- 0 (D
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL
Fee Schedule on Reverse Side
.001 of Permit Valuation (1110th%)
$.50/$1,000 Valuation
$1000 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 [ )
CITY OF FRIDLEY INSPECTION DIV
6431 University Ave NE
Fridley, MN 55432
572-3604
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
V!)qb
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Shower
NO. RATE TOTAL
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
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
Effective On March 1, 1996
Wash pima Floor =1t Auto. ':#5i?> Gas V:0*01.`_.-$>�i!ii!il Water Heater
Tray ount DrainBastn Washer1kjpt Range �Flxt > Gas Elec
State Surcharge $ .50
TOTAL FEE $_X50
ERICKSON, OLIVER
6056 WOODY LANE NE
FRIDLEY, MN 55432
JOB ADDRE: (612) 571-3600
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner
Building Used As,
Estimated Cost PERMIT NO.
PLUMBING COMPANY N1
(.P.,LOM p%( � t'.A.
SIGNED BY QW-ILle'llpl— TEL NO.� TW
Approved By Rough -In Date Final Date L°' -Q�
MINIMUM FEE FOR 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.
C;I i -Y OF I-riDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604, FAX (763) 571-1287
PLUMBING FIXTURE RATES:
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
><
Auto.
Wash Floor
ain
><< Washer
«: Shower Si:IE1t``< Tray
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 () No
Type
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
1. JUi1 i. ✓s4J
Gas I,,;::.»>r> Water Heater
]Gas Ele
R 9 _.�
The undersigned hereby makes application for a pfit 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 wrrect,
/ 6 20_
Owner
Building Used
J
Estimated Corm�_PERMIT NO.
PLUMBING COMPANY__c
SIGNED BY TEL N0.
<zl-)�
Approved By Rough -In Date Final Date
MINIMUM FEE FOR 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. COMMON VENT INFO ON BACK SIDE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
r_OMMON VFNT' VFNT CONNECTOR AND COMR1 ISTION AIR VFRIFICATION
When >larar_"ina an Pxistong furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturers 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 rnmhustinn airs it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes( ) No( )
When installing a new ventinaa 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
Appliance #2 Type
BTU Input
Appliance #3 Type
BTU Input
Total Appliances
Total Btu Input
Common Vent Type Vent Height
Fan Assisted or Nat
Fan Assisted or Nat
Fan Assisted or Nat
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
HEATING CO:
Signed By: Date :