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PRE 2010 DOCSCity of Fridley SUBJECT P 15.3 3 5 AT THE TOP OF THE TWINS BUILDING PERMIT i � 1 • COMMUNITY DEVELOPMENT DIV. '3OS r PROTECTIVE INSPECTION SEC. ` y /---1 CITY HALL FR,IDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-511-3450 910-F15 7/13/79 JOB ADDRESS 5589 - 6th Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 30 18 Hamilton's Addn. to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Chuck Westling 2523 Woodcrest Drive, New Brighton, MN 786-4445 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 C NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 38'ix 26' Dwelling and a 22' x 24' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side yards. Provide City with copy of verifying survey. Sewer & Water available in 6th Street. Services must be extended from the mains to property line. DRIVEWAY DEPRESSION COST: 16' + 6' x $15.75 = $346.50 WARNING lout EeNdiffttail utllltl8, SEPENA fir, MOS ' vl� b f Fctltic.MS . �� ° tilEQUIRED WeAT1NG.-PLUMBING By LAW AN® SIGN& SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. Wood Frame 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 988 + 542 25,943 Total 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 $37, 600 $18.80 WITH WHETHER PECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT P S ME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS F ANY OTHER STATE OR LOCAL LAW REGULATING CON- $103.77 $425.00 STRUCTI R THE PERFORMANCE OF CONSTRU TION. PLAN CHECK FEE TOTAL FEE $ 25.94 $573.51 SIGNAIIIJRE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY VA TED THIS IS YOUR PERMIT �A J _ a BLDG INSP f1ATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) PFA 01 Y�. CITY OF FRIDI-Ey � APPLICATION FOR% RESIDENTIAL LUJI_DING PEI MI r IIEW, ALTERA-11O(!0shj)IT10I4. oiz REPAIRS) OWMER: Cf� f.�o�S I�'� ��- bUILDE' ;: Q�I j.til �;a /%elv�rro� iC1111' ✓. E:�dclress : 2 3 1A)A d�..egr� Address: r 1�� .✓. Address e Tel. No. No.� ? Street: . --_ .. ,t.�,y�yl!'� i oetil� �� ., 9ia:,� r o �Cl1�/�✓IGSwI�i� LOT: _ 5 C) W OCY.: _ ADDITION: ! ✓ •N� H/1�� ah l�.a= � 'fes ��'� ��% /� CORNER LOT: INSIDE: LOT: SETBACK: SIDEYARDS: Applicant attach 'to this form T<•�o Certificates of Survey of Lot and proposed building location drw,,;n on these Certif icates . DESCRIPTION OF BUILDING To Be Used As: Front: �(s/f Depth. �V Height: 10 Square Feet: Cubic Feet: C� Front: CZ42 Depth: --y—Height: (� Square Feet.: Cubic Feet: Type of Construction: 6z q" I Estimated Cost: $ ��-j(Q(50_ To Be Completed: Or. !2 C Alt. _.A_ Alt. }3 Prdposed Driveway Width If New Opening Is Desired !(P $ $ (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 ditional information. DATE: SIGNATURE:s11-4-1--Ile�"'� v ------ Stipulations: Pr,R- 103. p°e .zs.g4 SAG 142S. 0c SI Utt.�v4 3y 3.Sy 9 z °O �6AJ Stu -J P6QCe&AECJ00,,- s j.q-ry^i2* 0o *52 fi --aes 08 '8( XL � bSZ DO 66 A5 off' 0 �. No 2G'z.�� fifi 7) x886 4#rv-j *(Phb'SZ _IV -vo 0)13 -olf 0)SC, -z.j xEo) -=6.96 -v3j:,a3 . 0'11 ;Kge ax 896 = 8:F- -X 9z -,", V,3 -ENERGY CONSERVATION SUPPLEMENT.TO BUILDING PERMIT APPLICATION PLANNING AND INSPECTION DEPARTMENT CITY OF FRIDLEY, MINNESOTA This supplement is provided to assist the applicant in computing EXTERIOR ENVELOPE AVERAGE "U" FACTOR INFORMATION. This information is required so the BUILDING OFFICIAL can determine that submitted plans comply with the ENERGY CONSERVATION DESIGN CRITERIA of the STATE BUILDING CODE (Section 6000). It is the APPLICANT'S responsibility to accurately compute the data; reflect the proper DESIGN CRITERIA in the plans; submit product specifications, if needed to support the "R" and "U" factors used; and to assure construction is per approved plans. JOB LOCATION:> OWNER/CONTRACTOR: ADDRESS: y!�- 9- -3 LJ o © o C •e cT-1, 7- Dlz� , PHONE: 7,P6 - 94 lrzy S ! A. Determine the Total Exposed Wall Area as follows: 1. Total wall window area 2. Total door area 3. Total sliding glass door area 4. Total fireplace wall area 5. Total wall framing area (average .10%) 6. Total net wall area above floor(average 90%) 7. Total rim joist area Subtotal: Total exposed wall area above floor 8. Total foundation window area 9. Total net foundation area above grade Subtotal: Total exposed foundation area GRAND TOTAL EXPOSED WALL AREA 0 "7 Z / </'? B. Multiply the GRAND TOTAL EXPOSED WALL AREA X .17 = C. Determine the Total Exposed Roof/Ceiling Area as follows: 10. Total skylight area Ik 11. Total roof/ceiling framing area (10%) 12. Total net insulated roof/ceiling area 1417 -- GRAND TOTAL EXPOSED ROOF/CEILING AREA /057 D. Multiply the GRAND TOTAL EXPOSED ROOF/CEILING AREA X .05 = / V Ll6 I Z- Item I Item II 2,s S� E. Determine the "U" value of each segment (1-9) and multiply by the area as follows: 1. PI X "U" I 2. X fluff 3. X fluff 4. X -.lull 5. X fluff 7. `'/Z x "U" 0 8. X "U" 9. R fluff ADD 1-9 FOR TOTAL WALL SEGMENTS - ITEM III / d 9' Ok F. Determine the "U" value of each segment (10-12) and multiply by the area as follows: 10. X "U" ems® 0 X fluff s A = P I X fluff ADD 10-12 FOR TOTAL ROOF/CEILING SEGMENTS= ITEM IV 3 � G. If Item III is -the same as, or less than Item I, you have met the intent of State Building Code 6006 (c) 2. H. If Item IV is the same as, or less than Item II, you have met the intent of State Building Code 6006 (c) 1. I. Add Item I ®k + Item II J. Add Item III ®.® + Item IV K. If the sum of Items III and IV are less than Items I and II, you have met the intent of the Code for total envelope system. The undersigned, as applicant for a building permit, hereby affirms the above information has been prepared and submitted by himself or under his direction, hereby acknowledges the information to be correct and accurate; and hereby presents the information with required plans in support of the building permit application. _� BY: SATE: Surveyors Certificate COMSTOCK & DAVIS, INC. Consulting Engineers and Land Surveyors 1446 County Road J, Mpls., Minn. 55432, 784-9346 SURVEY OF: Part of Block 8, Hamiltons Add. to Mechanicsville, Anoka Co. Minn W Z 30, Ir0i rr- VACATED 5G'r 130. 20' P10+ 130.11' Maas 35 oPV 4U � 2 . 1'30.14' mems. 130.20' Plot Urr SURVEY FOR: Chuck Westling 2523 Woodcrest Dr. New Brighton, MN 55112 ®r %Z DESCRIPTION: Lot 30, Block 8, Hamiltons Addition to Mechanicsville, And the south half of vacated 56th Avenue N.E. lying east of the west line of said Lot 30 and west of the east line of. said Lot 30, all in Anoka County, Minnesota. Subject to easements of record, if any.:.• ,�ce CURB R Before digging call local utiliiies .34 ON we V'. E t�Ge? �. � ELECTSl RIC - GAS Etc'. TELEPHONE - XX �� ! UkWSPS' W SCALE: 1 i 40 fleet A5 Denotes iron monument set L70 I hereby certify that this survey, plan or report was prepared by me or under my direct Aj— supervision and that I am a duly Registered Land Surveyor under the laws of the State I of Minnesota. 10832 Sent. 26, 1978 4015 Reg. No. Date Job No. T" 0 — �o 35 oPV 4U � 2 . 1'30.14' mems. 130.20' Plot Urr SURVEY FOR: Chuck Westling 2523 Woodcrest Dr. New Brighton, MN 55112 ®r %Z DESCRIPTION: Lot 30, Block 8, Hamiltons Addition to Mechanicsville, And the south half of vacated 56th Avenue N.E. lying east of the west line of said Lot 30 and west of the east line of. said Lot 30, all in Anoka County, Minnesota. Subject to easements of record, if any.:.• ,�ce CURB R Before digging call local utiliiies .34 ON we V'. E t�Ge? �. � ELECTSl RIC - GAS Etc'. TELEPHONE - XX �� ! UkWSPS' W SCALE: 1 i 40 fleet A5 Denotes iron monument set L70 I hereby certify that this survey, plan or report was prepared by me or under my direct Aj— supervision and that I am a duly Registered Land Surveyor under the laws of the State I of Minnesota. 10832 Sent. 26, 1978 4015 Reg. No. Date Job No. T" ec- l/Z S / G Z—/ eeL, c , CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PER41T PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: RATE TOTAL Number Fixtures /NO. `Y x $3.00 $ MS -0, p - p0 Future Fixture Opening x $2.00 $ tiro New Fixture, Old Opening X d $ Water 41 o ii 14 a e $5.00 � -1 ro x � m � $4 w w � New Ground Run Old Building Heater $5.00 $ toa x $5.00 $ GAS FITTING FEES: t 0�x _ -x '� $ C Additional Fix tures x $1.00 o �o x $*0.00 $ REPAIRS & ALTERATIONS 0 8 $5.00 $ each add. $100.00 or fraction m $ State Surcharge $ .505 TOTAL FEE $ REINSPECTION FEE ($10.00) o n u a w y 3 ow° w tia 3 s lec 1st t 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (*) - New.Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: RATE TOTAL Number Fixtures /NO. `Y x $3.00 $ MS -0, p - p0 Future Fixture Opening x $2.00 $ tiro New Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU x $5.00 100,000 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 _ -x $3.00 $ C Additional Fix tures x $1.00 $ Gas Range to 199,000 BTU x $*0.00 $ REPAIRS & ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .505 TOTAL FEE $ 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 roprosentations stated in this application are true and correct Fridley, Mn. , 19 OWNER g' S '/= 4 , '- , KIND OF BUILDING FR o— E USED AS R e S fd F Al C TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company Signed By ROUGH INSP. Date FINAL INSP. S-30-90 Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 TELEPHONE ( 612)571-3450 March 7, 1980 - 'zk Mr. Chuck Westling Westling Construction 2523 Woodcrest Drive New Brighton, MN 55112 Re: Final Inspection at 5589 - 6th Street N.E. Dear Mr. Wes tli ng : A final inspection was made on March 7, 1980 of the above address and the following items were noted which must be completed before the structure can be finaled out; 1. Provide door on lower bath by April 7, 1980. 2. Provide cold air returns in lower level by April 7, 1980. 3. Install smoke alarm in basement by April 7, 1980. 4. Provide sod in the front and side yards by June 15, 1980. We will expect the above items to be completed by the scheduled dates when reinspections will be made to determine compliance. If you have - any questions on these items, please contact me at 571-3450. Sincerely, DARREL G. CLARK Chief Building Official ' DGC/mh June 17, 1980 t 4 U' 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 Mr. Chuck Westling Westling Construction 2523 Woodcrest Drive New Brighton, MN 55112 Re: Final Inspection at 5589 - 6th Street N.E. Dear Mr. Westling: TELEPHONE ( 612)571-3450 A final.reinspection was made on June 1'6, 1980 to determine compliance with our letter sent to you on March.7, 1980. We were unable to gain entrance to the structure at that time to note compliance. We would like you to.contact this office to set up a date and time for a reinspection. We would appreciate your prompt attention to this matter. Sincerely, DARREL G. Chief Building Official DGC/mh CC: Mr. Gary Boyer 5589 - 6th Street N.E. SUBJECT PERM City of Fridley 7 916 AT THE TOP OF THE TWINS BUILDING PERMIT REC COMMUNITY DEVELOPMENT DIV. >r ...... i PROTECTIVE INSPECTION SEC. 1 . r NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 9/22/98 JOB ADDRESS 5589 6th St NE 1 LEGAL ILOT N0. I BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 30 S vat 8 Hamilton's Addn. to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gary Boyer 571-7376 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Solomon 4Sons 12211 Olive St NW Coon Ra ids 20055664 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 0 NEW O ADDITION O ALTERATION REPAIR 0 MOVE O REMOVE 8 DESCRIBE WORK Reroof house & garage (24SQ) Tear-off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIREO 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 SO. 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 1 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 $2,056.00 $1.03 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- $74.75 Fire SC $2.06 STRU OR THE PERFORMANCE OF CONSTRUCTION W T PLAN CHECK FEE TOTAL FEE T License SC $5.00 $82.84 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT tDATEi WHEN PROPER ALIDATED THIS IS YOUR PERMIT ��/ � 22-0 S,GNATURE OF OWNEROF OWNER BWLDERi IDATEI SLOG iNSP riATE NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (� BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: Owner Name & Address: Tel. # -5-71- 7 -?76 Contractor: �Z 6--l"% { ��'"� , MN LICENSE #,�v Address: % �r Sl/ ltlk�) 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 Sq. Ft. OTHER: X����� W- % �Q k JVT- Construction Type: Estimated Cost: $ '�OE-6 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. #7,�/ .577.E Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: S-00 CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.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 DIVISION Effective On January 1, 2001 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 Residential Rate Furnace Shell and Duct Work, Burner Also Replacement Furnace $ 30.00 (Side Vent • Fill Out Beck) Gas Piping (Needed with new furnace, $10.00 but not replacement) Gas Range $10.00 Gas Dryer $10.00 *Air Conditioning • All Sizes $ 25,00 All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial .. 1.25% of Value of Appliance or Work C3 State Surcharge TOTAL FEE U JOB ADDRESS 5599 ` &#q /�✓� OWNER GOCn-f- LLl7G1� ►�V Gi1[Cf /1,L1�t� TOTAL v BUILDING USED AS— ESTIMATED COST 3g, PERMIT NO. _XS09&-2- $ DDENRIPTION Q[-EUUMAND�ga KmN R No. of Heating Uni Circle One (Steam) (Ho Mer) (Warm Air) $ Trade No Size No. 2 sem BTU HP EDR $ Fuel 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 S .50 rulings of the Building Division, and hereby declares that all the facts and $� representations stated in this application are true and correct. DATE-- -,90J491 AINOU"M FEE FOR ANY HEATING/COOU VENTILATION IEFRIMATION/AfR CONDITIONING PERMIT IS $29,00 rLUS THE .SO STATE SURCHARGE MINSPECTION FEE $47,00/Hr 4ir Conditioners can not be placed in a side yard without ritten permission from adjoining property owner. Signed ApprovedD. D_ to 0 R VERIFICATION :ITY OF FRIDLEY INSPECTION DIVISION Effective On January`1, 2002 •431 University Ave NE ridley, 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 ommerciai/industrial 1.25% of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL FEE IINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION EFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 LUS THE $.50 STATE SURCHARGE EINSPECTION FEE $47.00/Hr air Conditioners can not be placed in a side yard without ritten permission from adjoining property owner. JOB ADDRESS- OWNER- TOTAL DDRESSOWNERTOTAL � BUILDING USED ASS/��a ESTIMATED COST PERMIT NO.. -- $ $ $ .50 $ '50 Si DESCRIPTION OF FURNACE AND OR BURNER No., of Heating U its %Circle One (Steam) (Hot Water) Trade Name �i jT?_2 Size ft. BTU HP EDR Fuel 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. HEATING CO Signed FAX #_ DATE -� TEL # Approved By Rough -In Date Final Date _�'Ac- fg,w i-ej THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED MAMON VFUL VENT CQNNFCTQR ANn CQMR1 ISTIC IN AIR VERT (_ ATIC IN When emplacing, an p-Y-islinn fi Iran A±, 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 plastictPVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes() No C 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 j No( ) The existing r-nmhi sstinn air is sized and installed to meet the current codes and manufacturer's specifications. Yes No( ) When required to Install a new nnmhnstinn air. it will be sized and installed to meet the current codes and manufacturer's specifications. Yes( ) NoAj When inn-OnIling a now venting r, m, 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�j) 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. Appliance I= and Siza_/Qmmnn Vent and Vent Cnnnactar Ye?t ,)No( ) Infannafinn Appliance #1 Type . I BTU Input Fan Assisted or Nat Al Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances T Total Btu Input r� Common Vent Type ,,y r Vent Height Diameter_ inches Appliance #1 Vent Connector Height _ L_ft Length �r_ ft Diameter min Type 3 Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Heiighht� � ft Lengthft Diameter in Type Al TFRAMONS- (Deacrit�ej /�' C ) ilAr HEATING CO: Signed By. Date: l i