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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N® C45 Date: _ r >r2Owner: aa_. Builder Address P.. ._.........,mow '' Address LOCATION_ OF RUIJLDING L No....�......._....._ Street..:.._::..�..._.�..._.��_..._._....__�..:G�.._....,�':.s.,e:.. Part,gf Lot .....__....._._._._.__...._._. ....__ ; .__.___..__. Lot ...._........ ................ Block .................-Ste ---•--_......._........ `Addition or. u b -Division j, Corner Lot .......................... ......... Inside Lot ........... " .......... Setback/ ..... i ?!k �!� � Sideyard `....._.. W_ Sewer Elevation ....._..._._._._......_._._...._.._._...___.._...._......_...._._.... Founda on Elevation .... _.......... .......... ...... ... ...... _....._._..__.............. ......_.. DESCRIPTION OF BUILDING To boj Used as: Front ..;..:.__ Depth .. .•=-_-- Height ..... #0_ Sq. Ft. _:a,,1.. :..ti Cu. Ft.j._A.._ ­- ............ Front ....._.....:.......... Depth ......... .... Height.................... _.. Sq. Ft....................... Cu. Ft. ................ -.. Type of Construction ..... .:-;?.:Est. Cost.7,,1 `f�""''"'.."" To be Completed ......... __... _............._....---..----- CAUTION THIS PERMIT DOES NOT AUTHORIZE VIOLAT- ION OF ANY PRIVATE LAND COVENANTS AND BUILDING RESTRICTIONS. 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. 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 within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances.,, 3 ''X e.°4 Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sower or water. Be sure to see the Building Inspector for separate permits for these items. w � 4 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, N 1NESOTA Owner s Name 1�� �� �� (J= alder Address Z /` s c...� �` �c.,� Al -Address LOCATION OF BUILDING No. Street / Part of T t Lot 2L Block ly Addition or Sub.Div.,JJ� •,� ����^-� Corner Lots side Lot_ Set Back Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant 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 Construction Estimated Cost s jz 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 representa- tions stated in this application are true and correct. DATE Aatj���SIGNATURE (A Schedule of Fee costs can be found on the Reverse Side. - 4 . . . 16 0 __ .. - City of Fridley AT THE TOP OF THE TWINS SUBJECT B U I L D I N G P E R M I T P N0. _ 15569' i � 1 -------- COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. 1 i i 1 -7"1 CITY HALL FRIDLEY 55432 j 612-571-3450 R NUMBER 910-F15 REV. DATE 11/20/79 PAGE OF APPROVED BY JOB ADDRESS 710 - 58th Avenue N.E. 1 LEGAL DESCR. LOT NO. 2 BLOCK 6 TRACT OR ADDITION SEE ATTACHED Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Robert Holt 710 - 58th Ave. N.E. Fridley 55432 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Milton L. johnson Co. 2513 Central Ave. NE. Mpls. 781-9548 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 $I REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install Aluminium siding, trim, gutters and reroof house and garage. 9 CHANGE OF USE FROM TO STIPULATIONS 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 AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION ZONING SQ. FT. CU. FT. 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 AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT VALUATION $5,000 SURTAX $2.50 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 CONSTRUCTION. $30.00 PLAN CHECK FEE TOTALFEE $32.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT BLDG INSP ATE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) CITY OF FIlIDl_f..Y APPLICATION FOR RESIDE"N'TIAL B1.11LDING PERMITS lOtw, ALTERATMi j OR REPAIRS) 011"NER: / . c- f )1UILDY,R- i pro ^' i`/ �'�B ••� Address: '%10 - � gra /TJ � /y � Address: c2 S / 3 Tel. No.:_• 140. 7/ _ Street: S y cs BCi LOT. 13LOCY: ADDITION: CORNER LOT: II:SIDE LOT: SETBACK: SIDI:YARDS: Applicant attach to this form Two Certificates, ofSu;.v_cy of Lot and proposed building location drawn on these Certificates. To tae Used As: DESCRIPTION OF BUILDING Front: Depth. lie ight- Square Feet: Cubic .Leet": Front: Depth: Height: Square Feet: Cubic Feet: _� iN,•-CyvrT�ti 0 Tarpe of Construction: �(�- les . A✓ouse- - Estimated Cost: $ ®-4 a• T C.- To Be Completed: Alt. A Alt. B Proposed Driveway Wid.t;h If New Opening Is Desired $ _ $ (SIL IMWERSE 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 l'uildings, and hereby declares that all the facts and representations stateA in this application are true and correct. See reverse side for additioi-xa iyatormation. DATE: .L'SIGNATURE. St apulatians o 0e �a--b SUBJECT MIT . . of Fridley 16 4 AT THE TOP OF THE TWINS BUILDING PERMIT Ir?City ECEIPT NO. � • _ COMMUNITY DEVELOPMENT DIV. I✓ � � PROTECTIVE INSPECTION SEC CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/12/97 JOB ADDRESS 710 58 Avenue NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 6 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bob Holt 710 58 Avenue NE 571-7233 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. City Wide Builders Inc 12110 61 Ave W, Plymouth MN 55442 639-1446 4968 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 0 NEW ❑ ADDITION CN ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Convert existing screen porch to garage area 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Provide a hard surface driveway. IIVAN11" Before diggiQg call for SEPARATE pERM�S all utility mations WIRWG.HEq REQUIRED FOR ING, 454.060 , PL 8I� AND REQUIRED BY LAV SIGNS, 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 SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK 1S SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME�AFTER WORK IS COMMENCEDNO. DWLG. UNITS OFFSTREET PARKING 1 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 $6'000 $3.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $112.25 Fire SC $6.00 STRUCTION HE PERFORMANCE FIf CO TRUCTION PLAN CHECK FEE TOT FEE 1 Li ense C $5. 0 $126.25 SIGNATURE OF COWRACtORO AUTHORIZED AGENT IDATEI ALIDA D HIS IS YOUR PERMIT01 Q/ [�EDATE WINIPROPIV SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI NEW [ ] Effective 1/1/97 ADDN [ ) CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 aa BUILDING PERMIT APPLICATION �D ConstructionAddress: Z% J �(>��'/�u�� Legal Description: Owner Name & Address: /-4v 7-- (5, � cS A ,6.e Tel. # �i l - % 3 3 Contractor: G1�Jz� aSG, MN LICENSE Address:../2Z/­O /A,)iP Z �4 e-� Tel. # Attach to this application, a Certificate of Survey of t1 e lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGEA: _ ngth Width Height Sq. Ft. DECK AREA r,xy� ngth Width Hgt/Ground Sq. Ft. OTHER: Construction Type: C 6 K, y, c G 6f Estimated Cost: $ C O D /�44 S 4eZ*— �✓1 c %y /41, L ,,/AAA ryy (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 6 APPLICANT: Tel. # STIPULATIONS: CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ (� eek .001 of Permit Valuation (1/10th%) State Surcharge $ 3. co $.50/$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge $ j. c® $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 STIPULATIONS: SUBJECT City of Fridley 2 6 0 3 5 AT THE TOP OF THE TWINS BUILDING PERMIT ` RECEIPT NO. `v a_____ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. ���� r NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 j 612-571-3450 910-F15 5 /11/98 JOB ADDRESS 710 58 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 6 Donnay' s Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bob Holt 710 - 58 Avenue NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Plymouth Roofing 17525 Co Rd 24, Plymouth, MN 55447 473-3397 5358 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 )p REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (25 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 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 $2,085 $1.04 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- STRUCTION OR THE P FORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE License SC $5.00 $82.87 SIGNATUR O CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PrRn,OP�ERLY LIDATED THIS IS YOUR PERMIT fp /� BLDG INSP TiATE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI ?io — s4)�a )40.,Y-- lv6rA ge(gi)- &b 6 /,/ P/y/NlJu x (00311�i r", /7sa3" C'ou,ly .4- 61"o % ll Gar -pd -l- ! erml �� /.-C d2- (SCZ 67 S-3 sy x'73 3-3Fy kc r c-.,— bc,..rri.e-r 0-tsSLN- CITY OF FRIDLEY•tNSPECTION DIVISION l �6 �,JS� S Effective On'January 1, 2001 6431 University.Ave NE': Fridley, MN 55432 APPLICATION FOR POWER PLANTS`AND HEATING, COOLING, VENTILATION, 763.572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS RATE: SCHEDULE OWNER (�l 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 Rate TOTAL BUILDING USED AS S i $ 30.00 $ 10.00 $ 10.00 $ 10.00 *Air Conditioning- AIISizes $ 25.00 All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or.Work Commercial/Industrial 1.25% of Value of Appliance or Work 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. ESTIMATED COST Zs PERMIT.NO. 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 $ .50 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. 61),i'vuADD i EATHN'G & 410 WEST LAKE S 'L. -:ET HEATING HEATING CO MINNEAPOLIS. IylN 612-821d-2sso Signed TEL # Approved By Rough -In Date Final Date IIZ —i%-C,� BACK SIDE MUF BE FILLED IN ON VENT SIZE, VENT CONNECTORS AND COMBUST N'AIR VERIFICATION 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 O 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 CIfYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 March 7, 2003 Mr. Brad DeLoye 710 58 Avenue NE Fridley, MN 55432 Re: Final Inspection at 710 58 Avenue NE Contractor: Standard Heating & Air Conditioning Co Dear Mr. DeLoye: A mechanical permit was issued on July 19, 2001 to install an air conditioner at your address. According to the 1991 Uniform Mechanical Code a final inspection shall be conducted on the work authorized by this permit. As of this date the inspection has not been requested. The permit fee that was paid covers the inspection to make sure the work was completed according to the Codes. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will mark the permit "no inspection called for by homeowner after notification" and take no further action. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. DJ/mh CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On August 1, 1995 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS �� D RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner — rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 30.00 $ representations stated in this application are true and correct. (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) $ 10.00 $ OWNER =_Gas Range $ 10.00 $ ' BUILDING USED AS Gas Dryer $ 10.Q0 $_ NO. " ESTIMATED COST PERMIT *Air Conditioning —All Sizes $ 25.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) I% of Value of Appliance or Work $ No. of Heating Units _ Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. Commercial/Industrial BTU HP EDR 1.25% of Value of Appliance or Work c $ Fuel Total Connected Load State Surcharge $ .50 TOTALFEE �d" � / a��(/�!/��' 11.x,✓ MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE_ Burner Trade Name BTU HP Size No. EDR HEATING COMPANY�'� r Signed 8y r Tel No. l/ 7/ REINSPECTION FEE $42.00/Hr Approved By & Rough—In Date Final Date *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOP STACK VERIFICATION ON written permission from adjoining property owner. REPLACEMENT FURNA E Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CHIMNEY AND SIACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes () No ( ) 2. Is free from rust or deterioration Yes () No { ) 3. Has no foreign objects Dodged within Yes () No ( ) 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 liner been provided for water heater Yes (} No ( ) 8. Has combustion air been provided for water heater Yes () No ( ) Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: