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PRE 2010 DOCSCity of Fridley, Minn. BU LDING PERMIT N? 3069 Date: .......................... Owner ... ...... .... Builder Address - �. ,�... ' ' Address .... SI ..�" . ....... ......... f."`!`'� !�' ` £ �CA4TION OF BUILDING No. a5. &< Street 6. .............................. Part of Lot .................. ..... 4zztLot .." ..... Block ... �l............. jddition or Sub -Division ... ...... .... ............. . Corner Lot ............ Inside Lot ............ Setback ... Sideyard .....� .��.. DESCRIPTION OF BUILDING To be Used as: ... ... 9. ... Front ! Depth .� . HeighV047.. Sq. Ft. /.. ® Cu. Ft. ........ Fr nt ! '� Depth . A. 9� ei ht Sq. Ft. /. d� . /Cu Ft. te f Construction !A-!.... Est. Cos.��.. To be Completed In consideration of the issuance to me of a permit to construct thbuilding desribed a ov , I agree to do the proposed work in accordance with the description above o in co 1 o inions of ordinances of the city of Fridley. � %? � d .a/ .... In consideration of the payment of a fee of $...,,�.., ermit is hereby granted to ..... ......................... 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 with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. ctor NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. &_ 1 4 I for Power Plank and Neeb% Cooling. VenNationR Rofd" lion and Air Condhloning S"em and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: Furnace Shell & Duct Work ... .... Replacement of Furnace ..... Repairs & Alterations—up to $500.00 Repairs & Alterations each add. $500.00 MECiL WARM AIA RATE TOTAL ..... ..$10.00 $ 6.00 $ 6.00.--- 3.00 $-- -- -- 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 & Lines—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 -wee Fee Schedule GAS BURNER (up to 199.000 BTU) &00 $ �' over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE yO�AL 1st 3 Fixtures � x$ 200 $ Additional Fixtures x .75 $ Gas Range to 199,000 x$ 600 $ AIR CONDITIONiI1a FAN HEATING SYSTEM Be* Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE ROUGH FINAL, d K— �Suac"ARcc s —A Dept. of Bldgs. Phone SM --3= �� 5 (9 City of Fridley: e The undersigned hereby makes application for a permit for the work hereir specified, agreeing to do all work in strict accordance with the City Ordinancef 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 18 Owner _J?Y Kind of Building Used as To be completed about DO 00 Estimated Cost, oNew. Building Permit No. Permit No.�p DESCRIPTION OF WORK HEATING or POWER P1.ANTS- Steam, Hot Water, Warm Air—No Trade Name Size Capacity Sq. Ft. E.D.R ��7 BT'U �Q H.P. Total Connected Load �y 7 7 7q gird of Fue �'� - BURNER — Trade Name Size No Capaci Sq, FL EMM BTU BRP. (REMARKS -OVER) HEAT LOSS CALCULATIONSDEPARTMENT OF INSPECTIONS Weatherstrips A.S.H.V. . Construction No. Guide Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind Yea —No I Yes—No 19_ 11 1 Fl.-( Room I Length Width Height II Fl.l Room I Length TWindows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Area sq. ft. Coef. , Btu Infiltration Glass C. Exp. wall Coef.1 Btu Net exp. wall Int. wall Ceiling r Floor 7 otal Btu. I t Required sq. ft. E.D.R. or sq. ins. W.A. Leadai area F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Area sq. ft. Coef-.1 Btu Infiltration Glass Exp. wall Coef.1 Btu Net exp. wall Int. wall Ceiling r Floor 1 Dial Btu. Required sq. It. L.D.R. or sq. ins. W.A. Leader area Inepectore notes: -A NEM"0 S.°MINN. Insulation How Applied Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. No. of Dans of pane llghta of crack Area sq. ft. Btu Infiltration Glass Exp. wall Coef.1 Btu Infiltration Int. wall Glass r - Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI.I Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. iris. W.A. Leader area C 0 01 SUBJECT PERMIT NO. City of Fridley o 1913 5 AT THE TOP OF THE TWINS BUILDING PERMIT � CEIPT NO. • COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. A&c) 7/ r 1 i � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 8/27/87 JOB ADDRESS 5965 - 6th Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 20 5 Bonny Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Raymond Wildmar 5965 - 6th Street N.E. 579-1014 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Merrill Moen Contractor 4441 Madison Street N.E., Mpls. 55421 788-7758 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 Gnd ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 24' x 9'1" Garage Addition 9 CHANGEOFUSEFROM TO STIPULATIONS Variance (86-25) approved side yard from 5'' to 3' for garage on 9/16/86, with the stipulations that a hard surface driveway be provided and that the north garage wall is to be a fire rated wall with no openings. See notations on plan for. 42" frost footings and 2" x 6" rafters or trusses. NING r,4'-digginaff local utilities SEPARATE PERMITS REQUIRED FOR PHONE-t�h�6AS Etc. iill MIRING, HEATING, PLUMBING AND SIGNS.' REQUIRED 9V LAVA 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 ISTALLS 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 $g 500 $1.75 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- $44.50 STRUCTION OR THE PERFO MANCE OF CONSTRUCTION. ALAN CHECK FEE TOTAL FEE $46.25 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPS BLDG INSP VALIDATED THIS IS YOUR PERMIT OA E SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI 01 NEW [ ] City of Fridley Effective 4/1/86 ADDN. [ ] R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: r r. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IMPROVEMENT Length Width Length Width Length Width Height Height lO , Hgt/Ground Sq. Ft. Sq. Ft._ Sq. Ft. Corner Lot [ ] Inside Lot [ ] Ft. T. Setback Side Yard Setback o Type of Construction: / Estimated Cost: $ Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: 7 APPLICANT %`' / �/�Tel. # CITY USE ONLY Permit Fee $ - q.sz Fee Schedule on Reverse Side Plan Check $ 25% of Building Permit Fee State Surcharge $ ��!� $•50/$1,000 Valuation SAC Charge $ $ 525 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ TOTAL STIPULATIONS:Sj q(p ree nt Q' -- # [ ] Not Necessary [ ] Legal Description: �`, Tel Owner Name & Address 4` # TVA 7 ZJ Contractor: Tel. Address: o ` Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IMPROVEMENT Length Width Length Width Length Width Height Height lO , Hgt/Ground Sq. Ft. Sq. Ft._ Sq. Ft. Corner Lot [ ] Inside Lot [ ] Ft. T. Setback Side Yard Setback o Type of Construction: / Estimated Cost: $ Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: 7 APPLICANT %`' / �/�Tel. # CITY USE ONLY Permit Fee $ - q.sz Fee Schedule on Reverse Side Plan Check $ 25% of Building Permit Fee State Surcharge $ ��!� $•50/$1,000 Valuation SAC Charge $ $ 525 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ TOTAL STIPULATIONS:Sj q(p ree nt Necessary [ ] Not Necessary [ ] p opi-2-f Ic'L 010 911e'1Cg6 . 'Sr' AS : r-jec)o btMAI 1J0P-TW CA-R-AGL WP,� rs 4 /�,2,-r- �P � Ld Li z 3:I 0 LL 0 M PROPOSED ADDITION 50.0' LOT No. 20 N w �N M 53.75' N N0. 595 Z,qZ• ZZ, Z' DWELLING 242 Z2.5�40.3� �yZ' 3' 35.4 FROM PROPF2TY LINE TO NEV ADDfTION S0.0' SCALE: I" =20' T". ST. N . E. LOT ZO BLOCK 5 e I aw GIS:` ,h _,._�kran 11eld %;I:( O� SURVEYORS' A i,91<$S? STREET oilMINNEAPOLIS, MIN � PIAOKIli�� STA ILA Ld MORTGAGE LOAN SURVEY CERTIFICATE OF SURVEY For THORPE BROS. line of 60 th Au E. N.E. "o I Eli i 2 1' /s LO 4�h !� v M Q0 L: co •'/' V\ z LO ' O z C> -+� 24 354 DESORIPtION: LOT 20, BLOCK 5, BOND A DOtT10N.. SCALE: to — 30• b LOAN Nof, 37576_F SITUATE IN THE COUNTY OF kWiKA`$ `-.r STATE OF MI NNEYOTA. We hereby certify that this is a true and correct representation -of a survey of the boundaries of the land above described and of the location of all buildings, if any, thereon, and all visible encroachments, if any, from or on said land. This survey is made only In connection with a mortgage loan now being placed on the property and no liability Is assumed except to the holder of such mortgage or any other interest acquired by the reason of such mortgage. It is understood and agreed no monuments have been placed for the purpose of establishing lot lines or boungary corners. 1 Dated this 16TH day of MARo6 , 1959. EGAN, FIELD & NOWAK Surveyorp File No. 7`696 IBook No. 14.1 j-9 Fd- SuB.;ECT ERMIT NO. City of Fridley2 9 3 3 9 AT THE TOP OF THE TWINS BUILDING P E R //`�('r M I T RECEIPT NO. L __��__ COMMUNITY DEVELOPMENT DIV. [1r W* -1, 450 A r 1 PROTECTIVE INSPECTION SEC. 1 � i CITY HALL FRIDLEY 35432 NUMBEDREv DATE PAGE OF APPROVED BY 612-571-3450 s1aF1s 4/29/99 JOB ADDRESS 5965 6 Street NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2O 5 1 Bonny Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ray Wildman 5965 6 Street NE 571-1514 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Nutzmann Bros Construction 736 1 Ave NW, New Brighton, Mn 55112 628-0128 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 20043453 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION C1 REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof House & Garage (22 Sq) Tear -off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. 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 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 ISTALLS 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 $1,885 $ . 94 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. $59.50 Fir SC $1.88 STRUC�To ORT PERF RMA CE OF CONSTRUCTION PLAN CHECK FEE TOT L EE 49� Lice SC $5 $67.32 SIGNATURE OF CONTRXCT&0 AUTHORIZED AGENT iDATE, MEN ROP VALID THIS IS YVfIR P RMIT G -NSPJF ! fI S-GNATURE OF OWNERo6 OWNER SUILOERI IDATEI Fd- NEW [ ] Effective 1/1/98 ADDN [ J CITY OF FRIDLEY ALTER [) SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ec) ConstructionAddress: � �� 3/ /1,�� a` Legal Description: Owner Name ddress: kc', r l) ?CL "� d� - � ���'� Tel. # Contractor: a z. f �. d MN LICENSE # Z(�r' %,5�' Address: 7369 /r i )-2A x.33 l 2— Tel. # ��.� / - G_� �'�' 612 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Length Length DESCRIPTION OF IMPROVEMENT Width Width Width r( r� _ Height _ Height _ Hgt/Ground a 1-9 , 7—f r, Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: (� �,� a .� '' Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: C APPLICANT: r.°,.. I T 1 _ �(,�.C'�'7�G� Tel. #f�,S% -C�/�J. G //CC Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control CITY USE ONLY $ .� - S� Fee Schedule on Reverse Side $ A, U 2 .001 of Permit Valuation (1/10th%) $ $.50/$1,000 Valuation $ $1000 per SAC Unit Park Fee $ Sewer Main Charge TOTAL STIPULATIONS: $612,32 $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 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 N'AX: (7b3) 571-1237 ADDRESS : 5965 6TH ST NE PIN : 233024210080 LEGAL DESC : BONNY ADD : LOT 20 BLOCK 5 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMI N : 2004-00584. DATE ISSUED: 04/26/2004 VALUATION : $ 4,250.00 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. INSTALL FURNACE (WARM AIR, LENNOX, 70,000 BTUS), GAS PIPING, AIR CONDITIONER, HUMIDIFIER AND AIR CLEANER # A/C UNITS 1 VALUE OF APPL OR WORK 1500 # FURNACES I # GAS DRYERS 0 # GAS RANGES APPLICANT AFFORDABLE AIR & HEATING CO 4030 HAYES ST COLUMBIA HEIGHTS, MN 55421 OWNER WILDMAN RAYMOND & LA VONNE 5965 6TH ST NE FRIDLEY, MN 55432 0 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 atter 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 any other state or local law regulating construction or the performance of construction. Annlicant_ A Date FURNACE SHELL/DUCT WORK 35.00 GAS PIPING FEE 10.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 25.00 STATE SURCHARGE, MECH FLAT 0.50 HEATING REPAIRS/ALTERATIONS 15.00 TOTAL 85.50 PAID WITH CHECK # 7048 SEPARATE PERMITS REOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. C11Y'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) �'�O Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fee Total $35.00 $ 15 $10.00 $ 10 JOB ADDRESS 59 C� �- L .S / N 0 Owner 116) A IJAma// Building Used As Ji -&L5 - ESTIMATED COST 120 PERMIT NO t C(o Gas Range $10.00 $ DESCRIPTION OF FURNACE AND BURNER Gas Dryer $10.00 $ # of Heating Units Circle One (Steam) (Hot Water)Warm Air Trade Name /.F AL AJZ'x/ Size No. -70, P6 tJ *Air Conditioning -All Sizes $25.00 $ BTU -j7 v., a V ® HP EDR Fuel NAf Total Connected Load All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Burner Trade Name Size No. Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EDR Improvement whichever is greater 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/Industrial/Institutional and representations stated in this application are true and correct. State Surcharge $ HEATING CO /��'>�O� ri ��� Ai r d- TOTAL FEE $ � Signed Tel # % 2 SOA "9?/4 REINSPECTION FEE $50.00/HOUR FAX # Date *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 (7F 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 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 (2 No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type w < lir-rA F,2 BTU Input Y0X,7 0 Fan Assisted or Nat Appliance #3 Type BTU Input I Fan Assisted or Nat Total Appliances '-- Total Btu Input I/ V4o Qe Common Vent Type G Vent Height 1l6 Diameter 5�1j inches Appliance #1 Vent Connector Height ft Length ft Diameterin Type G/� " Appliance #2 Vent Connector Height , ft Length �L ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) �4� �� /a i+- %ErA.�, h�+ fie= `2 A(r 6&1-r HEATING CO: e�r-FD n O Signed By: Date: 4�/e'z/ /a :V