PRE 2010 DOCS0
City of Fridley, Minn.
i
BUILDING PERMIT N® 3425
Date: ... �..'- ..........
Owner....................................... Builder ...............
Address...................................... Address .............................................
/ LOCATION OF BUILDING
No. Z. t w � . Strut ..... � ................. Part of Lot .................. .
Lot ....4...... Block.... �.�...... ... Addition or Sub -Division R. -C) .. l .. � 07
.. ° e � o r -N
Corner Lot ............ Inside Lot X ......... Setback Sideyard .................
DESCRIPTION OF BUILDING
UUsed as:
^e
.. `.. .. Front`pth .�1. = 9� Height �.1 -.1� sq. Ft. /..7. Cu. Ft. P?,5
.................... Front ........ Depth ........Height
Height .� �� ... Sq. Ft......... Cu, Ft........ .
Type of Construction ................... lget. Cost.frJI 07V ... To be Completed ...................
. .
In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do
the proposed work in accordance with the description above set f�d in�ea;mplia with all provisions of
t
ordinances of the city of Fridley. �
��' A /
In consideration of the payment of a fee of $ .......0 permithe y grained 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. p
.. Building Inspector
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.
City of Fridley, Minn.
BUILDING PERMITA
11T. 617
Date:
Owner: soil
Address Address
O ION F BUILDING
No. Street t—. . P f Lot
Lot_ Block tiJ Addition or Sub- n .
corner Lot _ Inside Lot A&tA*f ikback S —
Sewer Elevation ____ _ F dation Elevation
DESCRIPTION OF BUILDING '"
Front Depth Height .:� �..._ Sq. Cu. Ft
Frou _. _..._ Depth _ _ eight Sqff CPL. . Ft. cu. Ft.
Type of constructic _ _ �!� Est. � To be Completed
In consideration of the issuance to me of a permit to construct the building described above I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
ill
In consideration of the payment of a fee of $ , permit 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 pari thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, constru oanr, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any timeupon viola f any of the provisions of said
ordinances. � UMV101"
NOTICE:
TM9 permb don not cover the coedtruc8on, hatailadon for wkIM p1mbhro, Bn heetb & nwer or crater. Be euro to ae
dln Bundler tndpeetor for aparate permits for thea Mena.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner Is Name
Address Address
LOCATION OF BUILDING
No. � 0 Street Part of Lot
Lot Block Addition or Subdivis
Corner Lot Inside Lot_��tback
SEWER ELEVATION
ide-Yard ,7
ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To us a as,: ,a1
—Front�Depth;! -t 14 --Height % C/
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost
To be Completed
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. Z-1) e
DATE SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
City of Fridley, Minn.
BUILDING PERMIT
Date: _ July 20, 1965
MR. LANCE HAUSER
Builder
BOYCE CONST.
Address 6863 - 7th ST. N.E. Address 1366 H1W. 100 N.E.
Fridley., Minnesota Fridley, Minnesota
AV yrs
N? 8231
LOCATION OF BUILDING
No. 6863 street 7TH STREET N.E. ,_ _ Part of Lot
Lot 6 _ Block 5 Addition or Sub -Division RC. Terrace Plat 7
Corner Lot _ Inside Lot Z Setback Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Dwelling Front 41,4n Depth r 6n Height sq. Ft,10 0 Cu, Ft
Front Depth - Height Sq. Ft. Cu. Ft.
Type of Construction Frame Est Cost $140200,00 To be Completed Oct. 15, 1265
• REBUILD DUE TO STORM DAMAGE
•
ffiSTING FOUNDA°PION AT ABOVE ADDRESS
In consideration of the issuance to me of a permit to construct the building described above I agree to do
the proposed work in accordance with the description above set forth and in compliance with ah provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 10.0 , permit is hereby granted to SCE UUSER
to construct the building or addition as described above. This permit Js 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
ALLEN G. JENSEN Building Inspector
NOTICE:
fhb puma don not cower dw consrraedoe, hnralb w for Yrkb& phmbtng, gn hearing, sewer or water. Be an to is
dw BWMieg Mqmdw [or separate perils for d wn beam
A s
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAMEAC�� 42, _ BUILDER -2.OM � \�
ADDRESS GWW ) - '?-Lk ADDRESS 1?�(rO 100
LOCATION OF BUILDING
STREET PART OF LOT
LOT (-�, BLOCK : ,�_ ADDITION OR SUBDIVISION /fc• - j�� /
CORNER LOT INSIDE LOTT�SETBACK SIDE YARD
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of__Lot and proposed
building location drawn on these Certificates. '
F-1ISt"t V%,%, J6 &Jul0�1, ... ���9-eye, �Dvess
DESCRIPTION OF BUILDIJG$T f
To be used as;
o �c
Front
4t -41Depth2-(b Height
Sq. Ft . l 0 `Z C) Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Fye.ywe/ Estimated CosOW -2,02,0-0
To be completed CPrt /5 lg (. S
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 andrulings of the Department of Buildings,, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE (0 S SIGNATURE _
(Sch ule of Fee Costs can be found on the Reverse Side).
Is 0
s
City of Fridley, Minn. 212
6431 University Ave. N.E., Minneapolis, Minn. 55432 -
BUILDING PERMIT
ate: ----- October 13, 1971
Warren Woods
6863 7th St. N.E.
Builder Rite -Way Engineering Co
Address 2654 Lvndale Ave. South
LOCATION OF BUILDING
N0, - 6863 Street 7th ST. Part of Lot
Jot - 3 Block 5 Addition or Sub -Division Rice Creek Terrace Plot 7
Corner Lot Inside Lot Setback — _ Sideyard
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Water Proofing Front Depth Height __ Sq. Ft Cu. Ft.
Front Depth Height Sq. Ft . — Cu. Ft.
Type of Construction Water Proof ing Est. Cost 1, 410.00 To be Completed — 11/1/71
In consideration of the issuance to me of a permit to construct the building es 'bed above, I agree to do
fibs proposed work in accordance with the description above set forth d in co li ce with all provisions of
Ordinances of the city of Fridley.
— 71 .Rtatc R»rnh��rgn
Inc deration of the payment of a fee of $ 9.00 Rite -Way
Engineering p ,permit 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
city limits and this permit may be revoked at any time upon violation of any of the provisions of said
:� ` itdiug Inspector
Hank Muhich
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas beating, sewer or water. Be sure to see
the Building Inspector for separate permits for those items.
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER S NAM:��BUILDER :
ADDRESS: ��=�' `� �_'/" �J '_ADDRESS: a1"7 6PIP
S
NO :. STREET • / r v� r jZ ,
LOT: BLOCK: ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
'wilding locations drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
'Front: —Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
� a
Type of Construction••` Estimated Cost: $ ,Z&V a
i'
To Be Completed: '
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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.
DATE :�,za — SIGNATURE:
(See Reverse Side For Additional Information.)
n
y',
01
SUBJECT
PE
City of Fridley
1518
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
r
ECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
t♦ PROTECTIVE INSPECTION SEC.
�S
i/'-'1 CITY HALL FRIDLEY 55432
,.j
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
1910-F15
15/11/79
JOB ADDRESS 6863 - 7th- Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6
5
Rice Creek Terrace Plat 7 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Warren Woods 6863 - 7th Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Johnson's Remodeling Inc. 6201 Colfax Avenue N. 561-3250
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
X
6 DESCRIBE WORK
Construct a 24' x 25'5" second story addition onto dwelling
9 CHANGEOFUSEFROM TO
STIPULATIONS
Call for inspection prior to starting framing.
SEPERATE PERMITS REQUIRED FOR WIRM
HEATING, PLUMBING AND SIGNS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
Wood Frame
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
612
4896
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
$ 15, OOO
$7.50
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-
$90.00
NONE
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
{�
79
$22.50
$120.00
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)L:]
PERLY VALIDATED THIS IS YOUR PERMIT
's-- i
I r BLDG INSP GATE
SIGNATURE OF OWNER lIF OWNER BUILDERI (DATEI
01
s
CITY OF FRIDLEY ,
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
NEW, ALTERATIONS, ADDITIONS,' OR REPAIRS)
OWZIER: vin' �AD 009 BUILDER: ytY� • 1�.�.m i �1tiC�
Address:
.- &)aj-L Address: (QZ01 0-01TA- ( �
Tel. No. 'S fa l 3 Ze5®
No.: Street:
LOT: (� BLOCK: �S- ADDITION:
CORNER LOT: INSIDE LOT: P,-'_ SETBACK: SIDEYARDS:
Applicant attach to this form nio Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
TUsed As :
�G Front: -L4 Depth: LS ` fir/ Height:
Square Feet: (0/Z,--- Cubic Feet: 4-!l 1
Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: Estimated Cost: $ S►O®®
To Be Completed: ��,,��� �Gj Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(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 additional information.
DATE: — �I�i SIGNATURE: , >12,
Stipulations:to
jJ �, rr�� '��([ JJ�-•�� �- �`
•�/w �.I��fi w
�aw►� r. 90. oo _ •
P e 2Z. sb
TO 0
t.
ENERGY CONSERVATION SUPPLEMENT TO BUILDING PERMIT APPLICATION
R PLANNING AND INSPECTION DEPARTMENT
CITY OF BROOKLYN PARK, MINNESOTA 55443
This supplement is provided to assist the applicant in computing
EXTERIOR ENVELOPE AVERAGE "U" FACTOR INFOR.v.A TION. This informa-
tion is required so the BUILDING OFFICIAL can determine that
submitted pians comply with the ENERGY CONSERVATION DESIGN CRITERIA
of the STATE BUILDING CGDE (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(S) 0--y rem PHONE
CONTRACTOR PHONE
A. Determine the Total Exposed W611 Area as follows:
1.. Total wall window area 41 k7i
_
2. Total door area —
3. Total sliding glass d000r area —
4. Total fireplace wall area —
5. Total wall framing area (average ift)
6. Total net wall area above floor �,� � 13
7. Total rim joist area
Subtotal: Total -exposed wall area above floor "% use , ZS
8. Total foundation window area -
9. Total net foundat4on area above grade
Subtotal: Total exposed foundation area
GRAND TOTAL EXPOSED WALL AREA UD - Z�
B. Multiply the GRAND TOTAL EXPOSED WALL AREA X .19 = Item I lq�
C. Determine the Total Exposed Roof/Ceiling Area.as follows:
10. Total skylight area --
11. Total roof/ceiling framing area 6n1-���
12. Total net insulated roof/ceiling areaSO,�p
GRAND *TOTAL EXPOSED ROOF/CEILING AREA �1•7., ®cam
D. Multiply the GRAND TOTAL EXPOSED ROOF/CEILING AREA X .04 = Item II ice__ EJ
P/I Form No ..1-B ;
E. Determine the "U" value
of'each
segment -(1-9) and
multiply by -the area as
follows:
1.
4- ► , co -7
x
fluff
� s5 =
_7.7.g.�.
a
2•
/1 x
N t 111
�J
3.
.,
A x
"UII
4•
9
x
"U"
�.
5•
Z5,o3
x
111111
®►Z =
�. oc?
6.
���5, 3o
x
"U"
• •
-zs
x
111' 11
—7. it
'
8 •
x
11 Ulf
9
x
11 Ulf
..�.
,ADD 1-9
FOR TOTAL WALL SEGMENTS
- Item III
F. Determine the "Ulf value
of
each
segment (10-12) and
multiply by the area as follows:
10.
O
x
fluff
_
11.��
t Z c'�
x
"Ulf
_7
12.
55o.`3C)
x
it Ulf
.03
ADD 10-12 FOR TOTAL ROOF/CEILING SEGMENTS
Item IV
9 33
G.- If Item No. III is the same as, or less than Item Nc. I, you have met the intent
of State Building Code 6006(c)2.
H• If Item No. IV is the same as, or less than Item No. IT, you have met the intent
. of State Building Code 6006y c)l.
I . Add Item No. I (D4,5 + Item No. II Z_4-, 4g = ��Ct,p-1
J. Add Item No. III ��, 4t + Item No. IV
K.• If the sum of Items III and IV are less than Items I and II, you have met the..-
.
he..-
Intent of rhe code fcr total envelope system.
The undersigned, -as applicant for a Building Permit,
hereby affi.rrs the abo7e 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.
JN
Signatu. e
Date 5 L
CUIDELM ZO (R)' FACMRS OF TYPICALLY USED PRDDUCTS FROM ASARAEMANUAL
1/4" Plywood Panel
3/8" Plywood Panel
1/2" Fiberboard Sheathing
25/32" Fiberboard Built Rite Shg.
Aluminum Siding
w/Backer
�. w/Backer and Foiled
1/2 x 8 lap Siding (j rood)
7/16 x 12 Hardboard Siding
Asbestos Sidings
Stucco (Bra+m & Finish Coat)
8" Concrete Block (S .& G Reg.)
12" 0oncrete-Block (S & G Reg.
8" Licht F.bight
12" Light Weight
(0
..0.68
0.17
0.61
0.61
0.61
0.17
0.31
0.47
1.32
2.06
0.61
1.82
2.96
0.81
0.67
0.21
Built-up Roofing
(Add for Insulation)
3/8" Gypsum Boards
1/2" Gypsum Boards
5/8" Gypsum Boards
3/4" Wood Subfloor or Sheathing
1/2" Plywood Sheathing
1/2" Particle Board
Insiilation - 3 1/2" Fiberglass
6" Fiberglass
6 1/2" Fiberglass
8 1/2" Fiberglass
0.33
0.32
0.45
0.56
0.94
0.62
0.66
11.00
19.00
22.00
32.00.
(All other insulation materials mast
be verified for R -Factor)
Filled with
Interior Air
Film
(Walls) -
Exterior Air
Film
(W lls)
Interior Air
Film
(Vented Ceiling)
Exterior Air
Film
(Vented Ceiling)
Interior Air
Film
(.'von -Vented) -
Exterior Air
Film
(Non -Vented)
1/4" Plywood Panel
3/8" Plywood Panel
1/2" Fiberboard Sheathing
25/32" Fiberboard Built Rite Shg.
Aluminum Siding
w/Backer
�. w/Backer and Foiled
1/2 x 8 lap Siding (j rood)
7/16 x 12 Hardboard Siding
Asbestos Sidings
Stucco (Bra+m & Finish Coat)
8" Concrete Block (S .& G Reg.)
12" 0oncrete-Block (S & G Reg.
8" Licht F.bight
12" Light Weight
(0
..0.68
0.17
0.61
0.61
0.61
0.17
0.31
0.47
1.32
2.06
0.61
1.82
2.96
0.81
0.67
0.21
Built-up Roofing
(Add for Insulation)
3/8" Gypsum Boards
1/2" Gypsum Boards
5/8" Gypsum Boards
3/4" Wood Subfloor or Sheathing
1/2" Plywood Sheathing
1/2" Particle Board
Insiilation - 3 1/2" Fiberglass
6" Fiberglass
6 1/2" Fiberglass
8 1/2" Fiberglass
0.33
0.32
0.45
0.56
0.94
0.62
0.66
11.00
19.00
22.00
32.00.
(All other insulation materials mast
be verified for R -Factor)
Note: (U) x area in sq. ft.
All llindcxvs (w/stonrs 1" to 4" space .56
Removal double glazing (RdG) .55
7 erma or welded 3/1.6" air space .69
1/4" air space .65
1/2" air space.58
(Other windows specifically tested can use better ratings)
1 3/4 Solid core door .46
w/storm, wood .31
w/storm, metal .26
Pease Steel Insl Poor (No/G1) 7.45R .13
Sliding, Glass Door, wood .65
Metal .715
Note: (R) factors & (U) factors cannot be added, they must be converted to one or the other.
Fonwl.as for conversion are U = 1/R or R = 1/U.
Paq fired (R) Factors or (U) Factors for Building Mvelopes.
Imterior Walls W': (U) (R) (U)
1 & 2 Family 5.9 .17 Floors (incl. crawl areas)
All Other Bldgs. 4.54 .22 Floor Wood 10.0 .10
Conc. Slab 7.5 .13
Ceilings & Roofs
1 & 2 Family 20.0 .05
All other Bldgs. 10.0 .10
Filled with
Vermiculite
1.11 - - - - - - - -
- - - - - - - -- 1.93
1.28 - - - - - - - -
- - - - - - - -- 3.15
2.18 - - - - - - - -
- - - - - - - -- 5.03
2.48 - - - - - - - -
- - - - - - - -- 5.82
Note: (U) x area in sq. ft.
All llindcxvs (w/stonrs 1" to 4" space .56
Removal double glazing (RdG) .55
7 erma or welded 3/1.6" air space .69
1/4" air space .65
1/2" air space.58
(Other windows specifically tested can use better ratings)
1 3/4 Solid core door .46
w/storm, wood .31
w/storm, metal .26
Pease Steel Insl Poor (No/G1) 7.45R .13
Sliding, Glass Door, wood .65
Metal .715
Note: (R) factors & (U) factors cannot be added, they must be converted to one or the other.
Fonwl.as for conversion are U = 1/R or R = 1/U.
Paq fired (R) Factors or (U) Factors for Building Mvelopes.
Imterior Walls W': (U) (R) (U)
1 & 2 Family 5.9 .17 Floors (incl. crawl areas)
All Other Bldgs. 4.54 .22 Floor Wood 10.0 .10
Conc. Slab 7.5 .13
Ceilings & Roofs
1 & 2 Family 20.0 .05
All other Bldgs. 10.0 .10
• Heat Flog %--'
-30
-C4
5 .
WA=
70
*IL. AT 2
4
3
0-00
• -. 1
FOUNDATIONWALL
- -C�04
•- __... 3
VD -41M ROOF/CEIMG
11
a� Neat Flow
0
ISN -VF=, ROOF/('.MT.
J
Neat Flow
2. Wall Finish =
3. In-Ulation = l 3
.4. Sheathing =
5. Siding =
6. Exterior air film . . . .
7btal R = 17.03 U
1.
Interior air film .
. . . 0.68
2.
Insulation =
Z�
t_ .
4.,
S.1,011thing
5.
Sidi, -r4 =
'(07
6.
Exterior air film .
. . . 0.17
Total R = -Z Sy U�-
1. Interior air film : 0.68
2. Insulation =
3. Frd. jtiall =
4. Exterior air film . 0.17'
7btal R = U =
1. Interior air file. . . _ 0.61
2. Ceiling finish .60
3. Insulation = .3o
4. EI R n- rior air fi.l n (still) 0.61.
Total R = 3/. 7'9 U =
1. Inside air film 0.61
2. Decking =
3. Insulation =
4. Foofina =
5. Outside air film - 0.17
7btal R = U =
(R = 1) (U = 1)
U) R�
m
Z9 x W 4wri.31 rVC6
ZgxZO AwrJ�^�
a
M
CITY OF FRIDLEY
s
' APPLICATION FOR POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
AIR
CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
GRAVITY 1VAR.%1 AIR:
RATE
TOTAL
�y
.7ob Address X —
Furnace Shell & Duct Work
$12,00
* Replacement of Furnace
7100
$
Repairs & Alterations -up to $500.00
7.00
$
Department of By$.14ng4
Repairs & Alterations each add. $500,00
4.00
$
C*ty of Fridley
Tel. #571-3450
KECHANICAL SMARM AIR:
The undersigned hereby makes application for a permit for the work herein
Furnace Shell & Duct Work to 100,000 BTU
$12.00
S ✓
specified agreeing to do all work in strict accordance with the City Codes
each add. 50,000 BTU
4.00$-+�-,
and rulings of the Department of Buildings, and 'hereby declares that all the
*Replacement of Furnace
7.00
$--Z'
facts and representations stated in this applicatio are true and correct.
Repairs & Alterations -up to $500.00
Repairs Alterations
7,00
x},00
$
$
& each add. $500,00
Fridley, Minn. , 19"
STEAM OR HOT S TATER SYSTLNI:
ovlrj�R � Q�(,ol.�vto
Bailer & Lines up to 100,000 BTU
$12.00
$
T PF BUILpIIjG " OP -
each addn. 50,000 BTU
4.00
$
Boiler only up to 100,000 BTU
7,.oA
$
PSE? M
each addn. 50,000 BTU
G•AA
S,
�'� ��� 7
TA F� FQMFL>+;TFA +':�A�T
OIL BURNER- to 3 gal. per hour
S,}Q. qA
S
�f �y
/ /
each add. 3 gal. per hour
}A. Aq
S
FSTT1-*' FR CAST r
GAS BURNER- from 100,000 BTU �o 1g9,SSS §TFT
/
/►
WCC PqT} RTNR PTF -ITT NQ. FFRHTT NO. /
{over 199,999 BTU see Fee Sc} eq!4W
$,
GAS FITTING FEES: -
1st 3 Fixtures x
S,AA
S
AFSpR41?TTPN pF Fj r-1jACE/BURVER
A23itiohal Fixtures x
$ },qq
aS
Gas Range to 199,000 BT•J ;C
q.1040
#Sf-ATTNq RF $pWPSi L4NTS, A1:0 { #jQt Ytat:sr, Wa{� A.}� No.
AIR CONDITIONING
FAX HEATING SYSTEMS-F-t-�—
��LL����
Trade Name Size No.
See Fee Schedule
$
"�—
VENTILATING SYSTEMS
ALTERATIONS 4 REPAIRS
$
capacity Sq. Ft. rDR BTU HP
State Surcharge
$ 0
Total Connected Load ZU /,LSD Kind of Fuel
TOTAL FEE
®
BURNER - Trade Name Size No.
MUCH INSP. REINSPECTION FEE
Capacity Sq. Ft. SDR BTU HP
•
Data (.$10.00)
FINAL INS?.
Company s
Date
� �• F
Signed By
APPROVAL FOR PERMIT " '
Tel.
NO.
YS1'Iy.:.'M FEE FOR ANY HEATING PERMIT IS $7.50
*Xttac
PLUS $.SO
STATE SURCHARGE
ed stack verification fora
CITY OF FRIDLEY
APPLICATION FOR HEATING REPLACEMENT
CHIMNEY AND STACK VERIFICATION
THIS FORM MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM.
LOCATION C� �(� �- `7 ` DATE
OWNER %C��. (,� ADDRESS
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined
2. Is free from rust or deterioration
3. No foreign objects are lodged within
4. That it is securely supported
5. That it meets all current Code requirements
for size and total BTU connected
6. Total Heating BTU
All Other BTU
TOTAL f� e
REMARKS
!J
SIGNED
Licensee
by .7 `—
Address 4 -/ire
'Telephone
HEATING PERMIT` '
Fridley City License #
CITY OF FRIDLEY
APPLICATION FOR PWMBI'NG AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
Number Fixtures
Future Fixture Opening
New Fixture, Old Opening
Catch Basin
Water Heater - to 99,000 BTU
100,000 BTU to 199,000 BTU
Water Softener
New Ground Ran Old Building
Electric Water Heater
GAS FITTING FEES:
1st 3 fixtures
Additional Fixtures
Gas Range to 199,000 BTU
REPAIRS & ALTERATIONS
First $100.00
each add. $100.00 or fraction
NO.
RATE
TOTAL
o
$3.00
$
>,
N
$
10
$2.00
o
x
kN
NNa
x
Water
$
m
m
A
x
$
�C
-+
m
$
x
4J
N
�tll
W
tp
Heater
E
-k 0
W
m
(a
W
O
O
O
-4
N
D N
U
q
p
W
a
°vto
w
froA
U
s
tro7
C7
o
as
lec
lst
2nd
3rd
4th
(R) = Future Connection Opening
Connected with Sewer
(*) = New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
Number Fixtures
Future Fixture Opening
New Fixture, Old Opening
Catch Basin
Water Heater - to 99,000 BTU
100,000 BTU to 199,000 BTU
Water Softener
New Ground Ran Old Building
Electric Water Heater
GAS FITTING FEES:
1st 3 fixtures
Additional Fixtures
Gas Range to 199,000 BTU
REPAIRS & ALTERATIONS
First $100.00
each add. $100.00 or fraction
NO.
RATE
TOTAL
x
$3.00
$
x
$2.00
$
x
$2.00
$
x
$5.00
$
x
$5.00
$
x
$10.00
$
x
$7.00
$
x
$5.00
$
x
$5.00
$
x $3.00
x $1.00
x $10.00
$5.00
$2.00
State Surcharge
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 roprosontations stated in this application are true and correct
Fridley, Mn. /'� , 192Z
WIER
KIND OF BUILDING /�� �4/�/� Z:>'
USED AS
TO BE COMPLETED ABOUT.
c
ESTIMATED COST C�
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
Company
Signed By
Tel. No.����
ROUGH INSP.
Date
FINAL INSP. P .3 ®^
$ Date
S
$ APPROVAL FOR PERMIT
0
$ .50
S .OD
MININ,UM FEE FOR ANY PLUMBING PE IS $7.50 PLUS $.50 ST SURCHARGE
ro
N
r.
D-
V)
N
rr
tD
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55482
572-3604
PLUMBING FIXTURE RATES:
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Bth < s Wash OPin Floor CC}1 < Auto.
Urine! 'TtPa Shower rpk Tray.ot1E, .;: Drain )artltt "< Washer
.:
NO, RATE TOTAL
JOB ADDRESS
Effective On March 1, 1996
I
Gas Water Heater
Ran a M ixt 541 Elec
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.
1 D96
Owner 70
Building Used As
Estimated Cost ,450101 1) PERMIT NO.—
PLUMBING COMPANY L
SIGNED B �
7 0.
Approved By Rou h—rn Date
9 Final Date
PLUS THE $.50 STATE SURCHARGE
"COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 80 INCHES.
m
a:
0
New Fixtures
$ 7.D0
Old Opening, Now Fixture
$ 4.00
Beet Dispenser
$5.00
Slow Off Basin
$7.00
Catch Basin
$ 7.00
~�
Rain Water Leader
$ 7.00
W
Sump/Receiving Tank
$ 7.00
A
Water Treating Appliance
$10.00
U-
Water Heater —Electric
$ 7.00
a
Water Heater —Gas+*
$10.00
�(Z
Das Range**
$10.00
�
Gas Dryer"*
$10.00
Back Flow Preventer Required ( )Yes () No
Type
$15.00
Reinspectlon Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.6% of Value of Fixture or Appliance
0
State Surcharge
$ .50
i
m
N
Q
TOTAL FEE
s2149
K
JOB ADDRESS
Effective On March 1, 1996
I
Gas Water Heater
Ran a M ixt 541 Elec
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.
1 D96
Owner 70
Building Used As
Estimated Cost ,450101 1) PERMIT NO.—
PLUMBING COMPANY L
SIGNED B �
7 0.
Approved By Rou h—rn Date
9 Final Date
PLUS THE $.50 STATE SURCHARGE
"COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 80 INCHES.
m
a:
0
m
SUBJECT
PERMIT NO.
City of Fridley
27101
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
-6
PROTECTIVE INSPECTION SEC.ou
/
r
1 � I
NUMBER
REV
DATE
PAGE OF
APPROVED BY
_-'-1 CITY HALL FRIDLEY 55432
612-571-3450
910-F15
8/11/98
JOB ADDRESS
6863 7 St NE
I LEGAL
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
ILOTNO.
6
5
1 Rice Creek Terrace Plat
SHEET
7
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Warren & Karen Woods 6863 7 St NE571-2970
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Warren & Karen Woods (same as above)
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 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage 6 Sq) 2nd -layer
9 CHANGE OF USE FROM TO
STIPULATIONS
Roofing may be 2nd layer but not 3rd.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING,
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 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$1629
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.
$54.00
Fire
PLAN CHECK FEE
TOTAL FEE
ZSNAT RE OFCONTRAC O=,ZEDGENT ID JEI
l lO
OPE LIDATED TKS IS YOUR PERMIT
• �
%0hWTURE OF OWNER OF OWNER BUILDERI IOATE
BL INSP
)ATE
m
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION oZ
ConstructionAddress: ca865- q erl- S.- !' `f-05,:7 rgim4o'l, Ma Y -
z --
Legal Description:
j Owner Name & Address: [ AkMJ E, 1KAwW L , Tel. # 7 L—, -3 ?0
1 Contractor: MN LICENSE #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
Length
GARAGE AREA:
Length
DECK AREA:
Length
X OTHER:
$
Construction Type:
DESCRIPTION OF IMPROVEMENT
Width
Width
Width
° _Jvv
Tel. #
Height Sq. Ft.
Height Sq. Ft.
Hgt/51round Sq. Ft.
Estimated Cost: $ 16,2 /,
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT: Tel. #
STIPULATIONS:
CITY USE ONLY
Permit Fee
$ , oi�
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1000 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 [ ]
j
TOTAL
$�7
STIPULATIONS:
'
SUBJECT
P ,
City of Fridley
2595
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
`y ....... COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC
r
i ��"' �•� CITY HALL FRIDLEY 55432
NUMBER
REV
OATE
PAGE Of
APPROVED BY
---.�
1 612-571-3450
910415
5/15/02
JOB ADDRESS 6863 7 Street NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6
5
Rice Creek Terrace Plat 7 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Warren Woods 6863 7 Street NE 763-571-2970
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Eagleview Construction Inc 16323 Edison St NE, Ham Lake, MN 55304 763-413-5115
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
20076043
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION Ij REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Reside House & Garage
9 CHANGEOFUSEFROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive
barrier be placed over exterior sheathing to protect the interior wall covering.
Exceptions for this provision would be if sheathing is an approved weatherproof
panel -or when the siding is an approved weather barrier. Vinyl siding is not a
weatherproof covering unless the manufacturer states this in their application
guidelines. Call for inspection of wrap before covering. Caulk and flash all
exterior openings.
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
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
$14'000
$7.00
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-
$237.25
Fire SC $14.00
TR CTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK E
TOTALFEE
XS'o�---
Lic se SC $5 0
/ $263.25
GNATU EOFCON'RACTOP ORAUTNORiZEDAGENT iDArTEo
H PR E Y VALID ED THIS IS YOUR PERMIT
c'��P> Z
B G .,.Sw OA TE
S.GNATURE OF OWNEROF OWNER SUROERI iDATE,
NEW [ ] CITY OF FRIDLEY Effective 1/1/2002
ADDN (J 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: 1195o- 7!
Legal Description:
Owner Name & Address: _ _���i2C `� �%S Tel. #
Contractordpi -G< MN LICENSE # ,-'200 766 -�/S
Address: Tel. # 74-3— Y13 -s/ r-9
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:
V-- 77 -
Construction Type: S j a2�5 Estimated Cost: $ /!6 0D e'
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$
DATE: �-- APPLICANT: Tel. #
Call (763) 572-3604 for Permit Fees if mai in application or 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
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
CITY USE ONLY -
$ 0S ^
$ 14100
$ 7.D6
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 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 $ 46g, z- STIPULATIONS:
CITY OF FRIDLEY INSPECTION DIViSION
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
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
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate TOTAL
$ 30.00 $®• O�
$ 10.00 $
$ 10.00 $
$ 10.00 $
$ 25.00 $
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
$ .50
Effective On January 1, 2002
JOB ADDRESS ( F &,3 i -64 X57- .U. -Z5,
OWNER W001_5
BUILDING USED AS b6)=1-L/'�'
ESTIMATED COST
5C)00—
PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water)(Warm Air
Trade Name kuva Size No. U� PKro
BTU /99ODD HP EDR
Fuel N+ -C- G AS 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.
81PEF"OROOMRACTORSINTE 6-3 -®:?
6121420 AVENUE NO.
HEATING CRYSTAL, MN am
Signed TEL # 20
FAX #
Approved By Rough -In Date Final Date
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
CQMMON VENT, VFNT CQNNFCTQR AND CQMR1ISTIM AIR RIFT ATION
When re la _ing an existing 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 �4 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 comp ,stion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes C) No( )
When required to install a new comhustion airrit will be sized and installed
to meet the current codes and manufacturer's specifications. Yes () No ( )
When ins ailing a new ventineive�, 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 KA 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 XNo( )
Appliance IMP and Sixe _
/Common Vent _
and V n onn _ctor Informr(a`'ion
Appliance #1 Type sou ji7 BTU Input /00woq;an�ss�isted
r Nat
Appliance #2 Type BTU Input or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height 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:" -- /1 ) A OR^Of G PIT^
ae� wn• �n �erann is ��n
Signed By: _,� OILY: TA., MN 5'4'�2 Date: