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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 :