Loading...
PRE 2010 DOCS3200 FRANCE AVE. S0. 3rd STREET N.E. >a 7f 1 x 9 d ^ �12.2 �� 40.2 - .: 'or M,1• .2 JL4 4o.Z W n 49q h 4171 p 4981 1l82 ^� 1810 h 482! ro 4 Z N x ICT v nrL LLL 17 j n w( �p r •i 1w- li.4 i N w 2 ice, 14 15 16 IT 18 19 20 /' s 777/ L — _ 3 OrIJn1 s Fr W r hm aleffl n► W 1 _ — is — _ �s_ — _ �a — _ _fa� — _ �3 _ —#S- 1 zs. z Z 10 9 8 - - �-t r. LAA a�.2 401 ►, / w I _ M 4t 40.2 o « II v 4877 � 4"9"6'6 v ,f^p � 4!4 ^ 4!2! N ro « � � w o 0 4817 `� —; _ �s} 1 0 7 IPJ • Z 242 , , ROMAN ROAD I hereby s*rtify that the above In s survey of Lots One (1) through Twenty (20), Block i Three (i)..CAW QN'G.SUWIT MANOR SOUTH ADDITION. Anoka County9 Minnesota$ showing the loostion of the houses on said lots. ? As surveyed by me this 18th day of April 1955 A. D. � J� signed„ l4innesota Hapiatration No. 2K64 s City of Fridley, Minn. PERMIT Date: ..... //'.....J�...- ............ Owner ....................................... Address...................................... N® 3854 Builder .. ........ .. . 0! Address ............................................. ``�� aa LOCATION OF BUILDING No. .�'l. 45.. Street . IV�! ........... Part of Lot ... 6 ........................... Lot ............ Block .................. Addition or Sub -Division ....................................... Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ........................... DESCRIPTION OF BUILDING To be Used as: .................... Front ........ Depth ........ Height ........ Sq. F't. ........ Cu. F't. ........ .................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........ ... Fst. Cost .... To be Completed ......... Type of Construction .......... ...... .....:... In consideration of the issuance to me of a permit to construct ie building de a above, agree to do the proposed work in accordance with the description above foandin c ns of ordinances of the city of Fridley. � � / , 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 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. .... Building Inspector NOTICE: This permit does not cover the construction, Installatio ' or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector fo separate permits for these Items. APPLICATION FOR BUILDING PERMIT CITY OF:FRIDLEY,. MINNESOTA Owners Name;JeP1��CE'Nf�L'/2 Soh/ . Builder6MMUNtr gL6,b S Vic, Address-rtiL 4 Address t LOCATION OF BUILDING Street Part of Lot Lot _—,.Block. Addition,or Sub. Div. Corner Lot Inside Lot Set Back Applicarxt.attach to this form Certificate of Survey of Lot.and proposed building location. DESCRIPTION OF BUILDING To be used as Front. Depth Height Sq.` Ft. Cu. Ft. ... Front Depth Height Sq. Ft.. :Cu. Ft. Type of Cons truction°' L1)MNaA Stbr(6 Estimated Cost. Gam" 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.Ordinances and ruling of the Department of'Buildings,-and hereby declares that all the facts and representations stated in this application are true and correct,rwL(• Date _�/ Signature (A Schedule of -Fee Costs can be found on the Reverse Side) sueJEcr PE NO. City of Fridley 2 712 0 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT COMMUNITY DEVELOPMENT DIV. 1 L PROTECTIVE INSPECTION SEC. r vvv i . I NUMBERREv DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 8 / 11/98 JOB ADDRESS 213 49 Ave NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 3 Carlson's Summit Manor South Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE David & Margie Peterson 572-8685 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Advance Dome Products 3770 West Broadway Robbinsdale 55422 521-9211 2332 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 O NEW 0 ADDITION 0 ALTERATION XX REPAIR 0 MOVE 0 REMOVE 8 DESCRIBE WORK Reroof house and garage (24 Sq) Tear-off; reside house 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State Building Code. Call for building wrap inspection before covering. 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 6426 $3.22 DOES NOT PRESUME TO GIVE AU HORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OT ER ST E OR LOCAL LAW REGULATING CON- STRUCTION R THE RM OF CONSTRUCTION. 124.75 Fire SC 6.43 0 � PLAN CHECK FEE TOTA7.440 L cense S .00 1 IGNATUREO CONTRACTOR ORAUTNORIZEDAGENT IOATE$ H PROP BLDG _19MV RLY ATED H IS YQUQ PERMIT GATE SIGNATURE OF OWNER IF OWNER BUILDER$ IDATEI NEW [ ] ADDN [) CITY OF FRIDLEY ALTER [J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: r? 13 - 4/57; . 4,,. Effective 1/1/97 S-71- 3y5�-6 o v, Legal Description: .5'a.."o Owner Name & Address: a ci-- H Tel. # S- 7,R -10 Contractor: ,a, MN LICENSE #. R33,a- Address: -- Pepe - R, 6 Tel. # �,5?/— /Z 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 OTHER: DESCRIPTION OF IMPROVEMENT Width Height Width Height Width Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: 4d� Estimated Cost: $ a? (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft i $ _ $ SDATE: �- / d - �'� APPLICANT: Tel. # JR/ 9a // CITY USE ONLY Permit Fee $ /aLt 7 5- Fee Schedule on Reverse Side Fire Surcharge $ Y3 .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge $ 57-00 $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 [ ] TOTAL $ i1 STIPULATIONS: SUBJECT P 1 O. City of Fridley 8 0 90 AT THE TOP OF THE TWINS BUILDING PERMIT r NO. 16RECEIPT • _ COMMUNITY DEVELOPMENT DIV. n r PROTECTIVE INSPECTION SEC. ��� t' � NUMBER REV DATE PAGE OF APPROVED BY i CITY HALL FRIDLEY 55432 612-571-3450 910415f' 10298 JOB ADDRESS 213 49th Avenue NE 1 LEGAL LOT NO. BLOCKTRACT OR ADDITION SEE ATTACHED DESCR. 2 3 CArlson's Summit Manor South Add'n SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Norling Exteriors Inc. 341 79th Way NE Fridley MN 55432 518-2399 20098700 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 O NEW O ADDITION 0 ALTERATION 3& REPAIR 0 MOVE 0 REMOVE 8 DESCRIBE WORK Replace storm damaged trim 9 CHANGEOFUSEFROM TO STIPULATIONS e�EY,s %3e i t-6 —B} StafieEms.; TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 $500 .50 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 JqONSTRUCTION $21.00 Fire SC .50 PLAN CHECK FEE TOTAL FEE License SC $5.01 1$27.00 SIGNATURE OF CONTRACTOR OR AUT.ORIZE4k AGENT iDATE, WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT BLGA iNSR PATE S.GNATURE OF OWNER dF OWNER BUILDER, iDATEi NEW [' ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: �, y q 4- h ,4 0 Legal Description: Owner Name & Address: 3c, , C' Tel. # Contractor: N 0-!r (%%.- a 0 )�'4e �� �, MN LICENSE # 200 9F0? ,:-:;rb Address: f q( - �-h 'VA '4 Tel. # 7 et-/— W� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type:r .4,Estimated Cost: $ O , (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: 10 APPLICANT: t) 4' ( Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ $ ✓t'D Z04) 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 DIV. 6431 University Ave NE Fridley, MN SS432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION ANb AIR CONDITIONING -SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner — Also Replacement Furnace ' (Side Vent Fill Out Sack) Gas Piping (Needed with newf(urnace) Gas Range Gas Dryer Rate $ 30.00 $1000 $10.00 * nditioni Cong-- AI Siies $.00 25 �� A hersJRepairs & Alterations (LIST ON BACK) I % of Value of Appliance or Work Commercial/Industrial 1.25% o1 Value of Appliance or Work Effective On January 1, 1997 JOBADDRESS Z /3, L�/ /4/,o The undersigned hereby makes application lot a permit for the work herein TOTAL specified agreeing to do all work in strict accordance with the City Codes and palings of the Building Division, and hereby declares that all the facts and $ representations stated In this application are true and correct, MOW - OWNER: 81JILDN(I USED AS ESTIMATEO COST PERMITNO. 7C� DESCRIPTION OF FURNACE AND OR BURNER' $ No, .of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name . Size No. BTU HP EDR Fuel,. Total -Connected Load State Surcharge .60 Burner Trade Name Size No. BTU HP EDR . TOTAL FEE$ MINIMUM FEE FOR ANY HEA11NOPMOLINOP ENTILATION REFRIGERATIONNA CONDITIONING PERMIT Is $s.00 PLUS THE 1.50 STATE .SURCHAAdE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. HEAPING COMPANY o,A� ! Signed Byy Tel No. ;6 `% Approved By Rough—in Date Final Date I FILL OUTBACK SIDE OR STACK VERIFICATION ON t od REPLACEMENT FURNACE ewS List ALTERATIQNS Being Done: HEATING CO: Signed By: Date: M McA,17�,, v- Arc to! h /400P CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Ye �) No 2. Is free from rust or deterioration s 3. Has no foreign objects lodged within. Yes j) . 4. Is securely supported Yes No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes () No ( ) 6 Has total heating BTU's of All other, BTU's TOTAL BTU's 7. Has a ling been provided for water heater Yes () No ( ) 8. Has combustion air been provided for water heater Yes () No ( ) Remarks: ewS List ALTERATIQNS Being Done: HEATING CO: Signed By: Date: M McA,17�,, v- Arc to! h /400P 01 SUBJECT City of Fridley 31844 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV.®� PROTECTIVE INSPECTION SEC..36 ® r NUMBERDATE REV PAGE OF APPROVED 9V I "'1 CITY HALL FRIDLEY 55432 612-571-3450 910-F15 5/23/01 JOB ADDRESS 213 49 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 3 Carlson's Summit Manor South Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE D Peterson 213 49 Avenue NE 572-8685 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Advance Home Products 3770 W Broadway, Robbinsdale, MN 55422 521-9211 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 O NEW 0 ADDITION 0 ALTERATION K7 REPAIR O MOVE 0 REMOVE 8 DESCRIBE WORK Replace windows within existing openings; aluminum trim 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. 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 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 OWLG. 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 $3•9O WITH WHETHER SPECIFIED HEREIN OR NOT. THE RANTING OF A PERMIT $7s798 DOES NOT PRESUME TO GIVE A HO ITY TO V LATE OR CANCEL TME PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER ST TE R LOC REGULATING CON- TION OR TIE ERFORM CE F CO CTIO $13.25 Fire SC $7.98 NAq,z-,k PLAN CHECK FEE TOTAL FEE Licens*11SQ $5.0 1 $ .13 SIGNAT RE OF CONTRACTOR OR AUTHORIZED AGENT IOATEt OP VALIDATED HIS IS YOUR PERMIT Z131k,EN �s =tel BLOVINSP BATE Lq S,GNATURE OF OVVNEROF OWNER BWLDERI IOATEI 01 NEW [ ] Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION -V�F. - Construction Address: 9 - �� �� Al' Legal Description: p Owner Name & Address: f e ---X'50 Al Tel. # Contractor: P UAN M e- f r4-0 p5 � MN LICENSE # Address: 371 D • W, 5/L4 A-PWj± j (Z.0 y46kjV Al -e /1 A-- Tel. # 76 3 - s -4-1'a11 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: Construction Type: Estimated Cost: $ -77 M, W" -N14 - Driveway -N ow Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$ DATE: - a 3— Q (f' APPLICANT: t P I \ !j,� 1v.40v5 �P�'H Tel. # 763- 5-a i 9R CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application $ Fee Schedule on Reverse Side $ .001 of Permit Valuation (1/10th%) $ $.50/$1,000 Valuation $ $1150 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 [ ] $ 1 go, 13 CITY OF FRIDLEY INSPECTION DIV: 3431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTAI I Fn nN FA HFI nr)R Effective On Jan 1, 2000 ® .� a .k8 ® c • • A _•sQ° ,&` 011y1T1-"13.fflM-1-3 PLUMBING FIXTURE RATES: 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** NO. RATE TOTAL . JOB ADDRESS NNE ite, &4131-512— MARK 4131-IZ —j– Gas Range" _ Gas Dryer** _ Back Flow Preventer Required ( )Yes () No $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 Type $15.00 . Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge $ .50 TOTAL FEE $2/-� 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. PETERSON, DAVID 213 49TH AVENUE NORTHEAST Owner FRIDLEY, MN 55421 (763)572-8685 Building Used Asst=�1� Cs� 20-01 . Estimated Cost PERMITigs- EU NNO. �PLUMBING COMPANY 6� 12,QO AJCi�( SIGNED BY TEL N0.j6jZ SZ7`�1(9 1 0-4 Approved By Rough -In Date Final Date /.)-a/ COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing 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 () 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 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( ) No ( Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance#2 Type BTU Input Fan Assisted 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 ALTERATIONS: (Describe) HEATING CO: Signed By: Date :