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PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn. N° 2295 Date I!!.(P11................................. �i Owner Builder s�"�.f�:••..��.Gi....................... .......... . .�- Address .'�/f!�744a-14frl im...��... Address ...................... LOCATION OF BUILDING No. ..+�," .....i.. Street �.r�............................... Part of Lot ....................... �rrFF.� �+lG ..:^!i CIC! . Lot .... Ill..... �� .Block .... :!........... Addition or Sub -Division �` , , , , Corner Lot ...... iI..... Inside Lot . A ......... Setback `�� Sideyard .I O'^4 ............... DESCRIPTION OF BUILDING To be Used as: • . l Front 44... Depth .0L1- . Height %s Ce Sq. Ft......... Cu. Ft. ........ .................. Front ........ Depth ........ Height Sq. Ft......... Cu. Ft......... Type of Constructlan . 44..V.. Est. Cost . , �y"!ql�+� l�.." �..... To be Completed 4 ........... In consideration!',of the issuance to me of a permit to construct the building described above, I agree to do the proposed work ix accordance with the description above set forth and in compliance with all provisions of ordinances of the vi0age of Fridley. In po deration if the payment of a fee of $. .' :.. ,. permit is hereby granted to ......4... to construct the building or addition as described above. This permit is • anted upon the express conditional 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 r garding location, construction, alteration, maintenance, repair and moving of buildings with- in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. � ..'........ Building Inspector NOTICE: 1! This permit doIeIs not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. 88 sure to see the Building Inspector for separate permits for these Items. III L-] City of Fridley, Minn. BUILDING PERMIT iv? 6740 Date: Owner: Builder Address Address �LO TION <74rDING No..— street K P t Lot .___4(-nL:._ Block Addition or Sub- vision. Corner Lot _ Inside Lot _ s ____ %otback ' Sewer Elevation Elevation DESCRIPTION OF BUILDING ToT)n as: a ot Depth Height Sq. Ft.–SOWCu. Ft�� De th Height --- Sq. Ft Cu. Ft. Type of Construction Estraliq 1. __ 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. �_1J e / 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 10, ress,thces. , II /➢ Building Inspector 77 . NOTICE: This perm& does not eww the censtwction, huftllalton for white, plumbing, gas headag, sewer or water. Bo euro to see tho BuMbig les"Mr for separate perm8s for then Rena. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER' S =49 �,,L S L i Z-- k / d lV C j - UILDER A �'►� ADDRESS ®; da��_ ADDRESS � +° LOCATION OF BUILDING No. E Street 6� �a �� Part of Lot Lot 15Block / (oriz) Addition or. Subdivision -Q\J . Corner Lot Inside Lot__X_Setback Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as: Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu, Ft. Type of Construction Estimated Cost t / ,5- To be Completed 6, 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. DATE SIGNATtME (schedule of Fee Costs can be found on the Reverse Side). . . V. Cit of Fridley y y SUBJECT ` O 135'76 AT THE TOP OF THE TWINS PERMIT BUILDING CEIPT . COMMUNITY DEVELOPMENT DIV. I r PROTECTIVE INSPECTION SEC. 1 ; � IL1 CITY HALL FRIDLEY 55432 L""A",'J NUMBER REV. DATE PAGE OF APPROVED BY 612-560-34506-7-76 910-F15 JOB ADDRESS 533 - 53&j Avenue N.E. 1 LEGAL DESCR. LOT NO. 15 BLOCK 1 TRACT OR ADDITION SEE ATTACHED Temple Terrace 2nd Add. SHEET 2 PROPE TY OW F,R MAIL ADDRESS ZIP PHONE Leslie Cinngren 533-53� Ave. NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Self 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Garage 7 CLASS OF WORK XJ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK 9 CHANGE OF USE FROM TO STIPULATIONS ®� ce jgl/' i J, C cy•�/' ~-IMPORTAIO►T,... NdTIFY THE FRIDLEy ENC DIVISION REGARDING CU REMOVAL AND REPLACENI AT DRIVEWAY OPENINGS wiRING, PERMINS. RtoUIRED FOR ;EPERATE G AND SIGNS- HEATING, PI.UI�B 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 R-1 660 6,600 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 $ 4,HH4.00 $ 2.44 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- $ 12.50 STRU NOR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE /$ 14.94 SIGNATURE OF CONTRACTOR OR AUTHO ZED AGENT IDATEIROPERL�ADAT TH S is YOUR VERWT BLDG INSP /n ATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) VT APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S . NAME : L, 6SL-1 C Ll N N6R N- BUILDER: SA M . ADDRESS X33 9'3 Aa. A vgr N . ADDRESS: NO:. 6a 3 STREET: /off AyA , -A/ 1 LOT:- / BLOCK: 1 ADDITION : rEM P L _ T i -ERR 1 Ce a /✓ 0 A ¢) j), CORNER LOT: INSIDE LOT :_SETBACK: 3S' SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates, r DESCRIPTION OF BUILDING To Be Used As: Gds RAGS Front: 30P Depth: aa� i Square Feet: fo to ® Cubic Feet:-- Front: eet• Front: Depth: Height: Height: G Square Feet; Cubic feet: Type of Construction: Wwop rkAMc estimated Cost: $ To Be Completed: DEC. "air. oo 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: 7 19 7 C SIGNATUP. : _ Sze" (See Reverse Side For Additional Information.) • 1Z. 50 • 1. if AnDWVmWWm 0 t owner of the property loca ed� /� u'� /�! , have no objection to the City allowing the construction of a G AR R G t to be located at 5 :� 3 - S-3 a A v e. A/ E-" without the required certificate of survey that the City ordinarily requires for all new construction. a dgna-t5ure. Address �Iz(.0 t J 0 1 EXISTING SNS 514 —D APPR0X lxaI 716 Wrak LOT LI K15 301 may'- -- pp, O'PoS _ - - i,u t - wr — OI -A A P2 0 ay WIDE /�RIvt W WPPRO� - :3 CASFAALT) - PATIO AND C ALK P -- APRROY, Via' x #e,' /4oLtsiE- go 3 � _S:3 3 53 iz Rve. A PPuK4, -3 SE1-s AcK- Et 1571 NG STLpS �- SI®EWAut CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures a w Future Fixtures q u $ K 41 S 1.50 Water u.w, �°vw S 4.00 $ elow Off Basin c � Catch Basin a 140. $ i. S 5.00 Heater .wi w c i~i+ w w a c! 8 d t u d5°5� ►e. $ Gas Range $ 10.00 wo o Gas Dryer $ 10.00 $ ca g u • . z O O w tgw 0U $ .50 (515.00) � FEE a �° n" u A4 i a i 0 as lac �/'w� let 2nd 3rd 4th (R) - Future Connection Opening Connected with Sever (•) - Nov Fixture, Old Opening Nater RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 S Future Fixtures $ 3.50 $ Old Opening, New Fixture S 1.50 $C7/ L�) (� Beer Dispenser S 4.00 $ elow Off Basin S 5.00 S Catch Basin $ 5.00 $ Rain Mater Leader S 5.00 $ Hydraulic valve S 5.00 $ Sump or Receiving Tank $ 5.00 S Nater Treating Appliance S 7.00 S Not water Heater S 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It Of Value of Fixture or Appliance O O Reinspection lee $ State Surcharge $ .50 (515.00) TOTAL FEE $ /D,✓LG m active Aug, i, lyes Job Address 3— Department of Buildings City of Fridley Tel. 1571-3450 The undersigned hereby makes application for a permit for the work herein specified aqreeing 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 representations stated in this application are true and correct / Fridley, Mn. % lg OWNER ' Z1 . t A P re- ✓L KIND OF BUILDINNG � USED AS i TO BE COMPLETED ABOUT ` S ESTIMATED COST f O /Jy► OLD - NEW BUILDING PERMIT NO. PERMIT NO. %.7 9l ROUGH INSP. Date Company lJ %L L �L - E1/c— Signed By Tel. No. -5— FINAL INSP. .e? �/ ry -K- Date Date APPROVAL FOR PERMIT ji4 v MINIMUM FEE FOR ANY PLUMBING PERMIT S $10.00 PLUS THE S.50 STATE SURCHARGE SUBJECT PERMIT NO. City of Fridley G 18362 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. A0 '9,0 1 � i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY j 612-571-3450 910415 4/1/86 JOB ADDRESS 533 - 53 1/2 Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 1 1 Temple Terrace Second Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS f n n � � � J ZIP PHONE Leslie & Marie�n same as above 572-9087 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING 7 CLASS OF WORK ❑ NEW lel ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK %_ 2' x 9' 9" addition to living area. q-t,-j �sIa(j 15' x 22' addition to garage area, 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wnnd Frame 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 1 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 $4,350 $2.18 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. 50.50 PLAN CHECK FEE TOTALFEE 3 $65.31 SIGNATURE R AUTHORIZED AGENT (DATE) HEN PR PE LI -ATfp THIS IS YOUR PERMIT �OFBCO�NTRACTOR nl LDG INSP 0a E SIGNATURE OF OWNER 0FO NERBUILDE IDATEI NEW [ ADDN . ALTER. [ ] Construction Address: Legal Description: Owner Name s Address: Contractor: Address: - LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Corner Lot [ ] City ,of Fridley L R-1 AND R-2 Building Permit Application 3 - 5�5 % 0tXX_-19_ __4 - �5. Effective 4/1/84 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length '� Width % Height Sq. Ft. Length Width 'L Z Height Sq. Ft. 30 Length Width Hgt/Ground . Sq. Ft. , w ✓ v 14 K4%(. 11- S Uig. A = 00 opa Inside Lot [-T Ft. Yd. Setback Type of Construction: w60 -n - FCL.64%Ac. Approx. Completion Date: K IV. iM.,(Ij z ((0 OWN s 43 St - Side Yard Setback Estimated Cost: $ (1 3 6 _ Alt. A Alt P Proposed Driveway Width If New Opening Is Desired: 0:!t--$ _ $ --- See Back Page for Explanation DATE: Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: APPLICANT: 1. -` - - - Tel. .# :�i_ % - -0 4 CITY USE ONLY Fee Schedule on Reverse Side 25$ of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] SUBJECT PERMIT NO. City of Fridley 9933 AT THE TOP OF THE TWINS BUILDING PERMIT O _ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC.460 � I CITY HALL FRIDLEY 55432 NUMBER REv DATE PAGE OF APPROVED BY 612-571-3450 910415 17/26/99 10B ADDRESS 533 53 1/2 Avenue NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 1 1 Temple Terrace 2nd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Linn ren 572-9087 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Northern Crest Inc. 8245 Polk St NIH Spring Lk Pk S9432 792-9-964 20099415 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 0 ADDITION 0 ALTERATION XM REPAIR 0 MOVE 0 REMOVE 8 DESCRIBE WORK Reroof house and gar -age C29 9q) Tsn-r_nff 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING, THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 13E COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2535 $1.27 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHA GE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- :7 STFTIO HE PERFORMANCE OF CONSTRUCTION � $83.25 Fir2.54 CHECK FEE TOTA F E Ant/PLAN Lice S S. 0 - SIGNATURE OFC N'RACTOR OR AUTHORIZED AGENT iOATE. ENRO BL INSP ALIDAT HIS I$ UR PER IT lC//r gArE S,GNATURE OF OWNER,IF OWNER BUILDER, IOATEi NEW L ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: 53 3 - 53 1/2 Ave. NE Legal Description: Owner Name & Address: Linngren Tel. # 572-9087 Contractor: Northern Crest, Inc. MN LICENSE # 20098415 Address: 8245 Polk St. NE Spring Lake Park, MN 55432 Tel. # 792-9364 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: Tear off and reroof Estimated Cost: $ 4 a� 3S�. house and garage - 29 square Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE' 7-26-9-%PPLICANT: Bill Olson Tel. # 792-9364 CITY USE ONLY Permit Fee $ (33 Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ �, ? 7 $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ _ S ®d $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 7- fo $ STIPULATIONS: CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2002 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 JOB ADDRESSt,— � [�� ®• RATE SCHEDULE OWNER,—,7enssri�. 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 $ va $ 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 BUILDING USED AS U/"??.e> ESTIMATED COST /DCAV2? PERMIT N0: � DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) rm Air Trade Namea Size No. BTU H EDR Fuel Total Connected Load Burner Trade Name Size No. BTU HP EDR The undersigned hereby makes application foraermit for the work p 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. DATE /D - -a 3 �L HEATING CO C%0 Signec[, FAX # Approved By Rough -In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE r THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When , the undersigned hereby verifies that the d is free from ettion, obstructions, venting has been examined anYes (i No ( ) and is securely supported and firestopped w required. The venting system is plastic/PVC and meets all current codes and manufacturer Yes ► No ( ) specifications including sizing, length, number of elbows and termination. The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes amanufacturer's specifications. include AGA-GAMA Categoryl Central VentingTables o a Yes( No( ) assisted and natural draft appliances. The is sized and installed to meet the current codes Yes( No( ) and manufacturer's specifications. When required to Install a "�'�` "^mh„e+i 1S1 will be sized and installed Yes () No ( ) to meet the current codes and manufacturer's specifications. When Iostallinn a'��''t'^O 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 Yes () No ( ) Venting Tables for fan assisted and natural draft appliances. Is the common vent an�moved from the commonnt connectors sized vent ent and vented installed correctly after an appliance has been Yes( )No( ) separately as per current codes. nflaore Vent and InFonnat'= BTU Input Fan Assisted or Nat... Appliance #1 Type �� C p Fan Assisted or Nat Appliance #2 Type BTU Input BTU Input Fan Assisted or Nat Total Appliances Appliance #3 Type Total Btu Input—11—M �— �> Vent Height Diameter inches Common Vent Type -�" Diameter in Type Appliance #1 Vent Connector Height b ft Length �ft ft Diameter in Type Appliance #2 Vent Connector Height _ft Length —ft Diameter in Type Appliance #3 Vent Connector Height ft Length HEATING CO: Signed BY: Date