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PRE 2010 DOCSApPlieat0n for Pewer Plants and Heating. Cooling. Vemadoe. Its lgeratioe and Air Conditioning System and Devices PARTIAL RATE SCHEDULE tet• of Bldg& Phone B NW GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ................ .. $10.00 ; Replacement of Furnace .... . . ..... .. 6.00 $ Repairs & Alterations—up to $500.00 6.00 $ _ Repairs & Alterations each add. $500.00 3.00 $---. MECH. WARM AMR Furnace Shell & Duct Work to 120,000 BTU $10.00.0 0 each add. 60,000 BTU .................... 3.00 = Replacement of Furnace . .. ... 6.00 Repairs & Alterations—up to $500.00 6.00 $ Repairs & Alterations each add. $500.00 .... .. 3.00 ; STEAM or HOT WATER SYSTEM Furnace She11 & Lines—to 400 sq. ft. EDR Steam $10.00 Furnace Shell & Line --to 640 sq. ft. EDR Hot Water 10.00 $_ Each add. 200 sq. ft. EDR Steam 3.00 Each add. 320 sq. ft. EDR Hot Water 3,00 $_ OIL BURNER—to 3 gal. per hour 6.00 $ — over 3 gal. per hour --See Fee Schedule GAS BURNER (up to 199,000 BTU) I I .... ... _ &00 $ 5. 00 over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x$ 200 Additional Fhrtures x .75 $ Gas Range to 199,000 x$ 5.00 $ AIR coNDrrioatlNa Westin house $,10.00 FAN HEATING SYSTE!! SL036 3 t.ecagion 1601 61st. Ave. N.E. City of Fridley: The undersigned hereby makes application for a permit for the work hereir specified, agreeing to do all work in strict accordance with the city ordinance. and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn_ 1-11-74 1—'7 4 owner Richard Miller Homes Kind of Building _ residential Used as - . --- frame — -- To be completed about ___ 3-30-74 Estimated Cost, $--1418.00 Old—New. Building Permit No. Permit No. 6�Ce DiTON OF WORK HEATING or POWER PLANTS --Stearn, Hot Water, Warm Air—No Trade Name_ Westinghouse Size NaFGUB-110 Capacity 110M Sq. Ft E.D.R BTU HP. Total Connected Load 62,808 Kind of Fuel gas BURNER — Trade Name Westinghouse size No FGUB110 Capacity 11n M Sq. FL E.D-rt BTU HiP. See Fes Sehoduls SALESMAN VENTILATING SYSTEM g .50 surcharge ALTERATIONS ! REPAIRS TOTAL FEE $27.50 ROUGH + (REMARKS—OVER) John V. Borry #4592B Heat loss ttac e Signed -4 ?, V� IREATING & AIR CONDITIONING Budnm Ph=e M3 Gorham Ave. 9o.67a7 Ap- heals Parke Minneaola 55423 City of Fridley Application for Plug and Gas R Nbg Panoif Dept. of B1dQe. Phone NO - DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ ZQ x $2.00 $ a2 Q , Future Fixture Opening ........... _ x $1.50 $-- New_ New Fixture Old Opening .......... x $1.50 $ Catch Basin .................... x $3.25 $ Water Heater :Up to 99,000 BTU) .... _ x $3.00 $ New Ground Run Old Bldg. ........ x $3.25 $ Electric Water heater .............. x $zoo $ :;AS FITTING FEES: NO. RATE TOTAL 1st3Fixtures •••••••••••••••.••�—x$2.00 $ Additional Fixtures .................. x $ .75 $ Gas Range to 199,000 BTU,. . x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................. ,......... . 4 5--D ,Q ( TOTAL FEE $ 22-5^ City of Fridley: e"r 0 The .undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct Fridley, Minn . Owner Kind of Buildingil�^ Used as E/ '�I G To be completed about Estimated Cost, $ M&—New. Building Permit No. /�– Permit No Signed J ' ROUGH Bye i -1r Business Phone -4—' /7` - - 18z_/ ` " 7 e I e N WATER M".~ GAS ELIC. Base 1st / 2nd 3rd 44th_ • Future Comect" Openings * New Fixture, Old Openings Connected wilt Sawa ❑ Cosspool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ ZQ x $2.00 $ a2 Q , Future Fixture Opening ........... _ x $1.50 $-- New_ New Fixture Old Opening .......... x $1.50 $ Catch Basin .................... x $3.25 $ Water Heater :Up to 99,000 BTU) .... _ x $3.00 $ New Ground Run Old Bldg. ........ x $3.25 $ Electric Water heater .............. x $zoo $ :;AS FITTING FEES: NO. RATE TOTAL 1st3Fixtures •••••••••••••••.••�—x$2.00 $ Additional Fixtures .................. x $ .75 $ Gas Range to 199,000 BTU,. . x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................. ,......... . 4 5--D ,Q ( TOTAL FEE $ 22-5^ City of Fridley: e"r 0 The .undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct Fridley, Minn . Owner Kind of Buildingil�^ Used as E/ '�I G To be completed about Estimated Cost, $ M&—New. Building Permit No. /�– Permit No Signed J ' ROUGH Bye i -1r Business Phone -4—' /7` - - 18z_/ City of Fridley, Minn_ 11.917 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUH DING PERMIT Owner: -__.Richard Miller Homes Builder Same Address __ 1 00 ,fie Gree] Road, Fridley.,,_,_„ Address Same LOCATION OF BUILDING No. .._.._1601 _ Street 61st Avenue__Aa_.____ Part of Lot Lot ._._23_._._.__ Block 3— _.. Addition or Sub -Division _Sriardale Addition Corner Lot X.._..___ Inside Lot _ Setback 3 5L Sideyard 5' & 18° 86*AJ Elevation _ 928.48 u F7' �ltda 7 alk 1� 932.00_Minimum Wye Top of Footing DESCRIPTION OF BUILDING To be Used as: Dwelling Front 40' Depth 26' Height 20' Sq, Ft. 1040' Cu, Ft. 25.660 Total Garage _ Front. 20' Depth 26' Height 10' Sq. Ft. 486' CiL rL 860' Type of Construction Wood Frame Est. Cost AA 1 9Q I To be Completed June 1971 _ 0 a , Stipulations: Provide a hard surface driveway. Provide a verifying survey before capping. $273.60 storm sewer escrow to be paid when water mater is taken out. Set elevation at garage slab between 18" and 48" to provide dr&in agm—_ fm==wa1kout door at rear. WATER LOCATION. Stop box 48.8' N.E. of Sanitary Manhole. 75.2' N.E. of Storm Manhole SEWER LOCATION: 57' East of Manhole (serviced off 61st) Inv. 928.71 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. nn nn 15.95 State Surcharge In consideration of the payment of a fee of $ 48 OQ —, permit is hereby granted to Ri nbar Mi 11-a Homes 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 ordinlinees of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of build3II_ within the city limits and this permit may be revoked at any time upon violation of any of the provisions of Said ordinances. Building Inspector DARREL CLARK NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Builcrang Inspector for separate permits for these hems. m APPLICATION FOR RESIDENTIALt ALTERATION, OR ADDITION BUILDING PERMIT w 786 —073/ CITY OF FRIDLEY s MINKSOTA 0/ OWNERS NAS: Pl(tel e. 1 A° BUILDER: Ric)44IGD �M I Z' WOMGPei ADDRESS: l� ®� ADMWS:1(o00 &ICE CZEEV �ca`D �RiDLEY i e ems.: m 103 4 &0/ Ste; Cil sr 6yE "j5 LI, C_ - LOT t 2-3 FLOCK& Z AUAITIM §P_IAP_DALL QXRER LOT: ?(X SIDE LOT; SETRACRy �a5 SIDEYARD: S ISI :A, i.i,vmt attach to tbU f bio Certificates of Survey of Lot and proposed U14ftX location dram on these CertificAtes, V9SCRIPTION OF BUILDING Sia Be vs" As we 40 D"th. 2.1c F Refight: 2W o Squaze treat;- 109-0 Cubic ftetj. - gel4jaZ , J,. ( 66 Q&,MaF..,, IFraAtt 20 Depth; Height: 1® $quare Peet; / Cubic Feet: V(9 / Tye of Constructions Estimated Cost: Ta se Qw 14ted; - ee.T_e1'1m The underpigned hereby amkes appltcat an for. a pe=it for the work herein ;off #.sd# agreeing to do all, work to stti.ct accordance with the City of FrUte ' O r6, *aaces aad snttW of the Department of Buildings, mW hereby &atareq oat all the jActs representations stated ta this appItcation ex$ true aa$ corrects D&TR; pec, ZI 1972 SIGNATURE: � !• ea o �1 ■ I ee el 1 p` ' (Oft Rowena Side For Addit4onal Infostpatiaa.) �� a �'' '' (j U0 d 0 n 't- 560-3450 ANOKA COUNTY 6431 UNIVERSITY AVENUE NE December-�9, 1972 FRIDLEY, MINNESOTA 55421 TO WHOM IT MAY CONCERN: Whereas the ,City of Fridley has issued a building permit to construct a structure at %lop% -6/.,-& Whereas the permit is dated prior to January 1, 1973 and the City of Fridley did not collect or receive any "Service Availability Charge". Therefore if for any reason the Metropolitan Council and or the Metropolitan Sewer Board assess or bill the City of Fridley a Service Availability Charge for this structure or sewer hook up, we the undersigned agree to and will pay the City of Fridley for said charges. / 0 Z--)� -// ' Witness Signa W Land Planning r�1 �r101E Land Surveying // • / Soils TrstinA it it•roiiotoi��i� , •/ /lie Civil Engineer ng (/ Municipal Engineering Engineer® & Surveyors Certificate of Survey for i::,y4A"'a s� L I 75.73 40,-0` 120 n1 N Uwe=�ly�, -J 46.34 0 E31 5T AVENUE 6875 Highway No. 6S N. E. Minneapolis, Minn. 55432 Telephone 784-6066 Area Code 612 NOG�Z N 1 `1 I 1 N �, O - �J ' ✓ r3 NIF. LOT 23 BLOCK. 3 BRIA-RDALE 0 ,mole; Iron monument L�-,nQkQ County ------- enOlf;DI'0111a�1Q f U1IIi} E®1WI�,an1 I hereby certify that this cor is a (rue and rect representation of a survey of the boundaries of the above dc.cr.bed land, and of the location of all build' s, thereq-n, and all visible encroachments, if any, from or on said land As surveyed by me this day of tt .r-1, A.O. 14?2_ SUBURBAN ENGiINEERINa, INC. `,colt - Inc�1 _ Qo �1Q} Engineers Surveyors bye r . 57 -ra (' OF:-' (7G C r r t/C M , tlr. ��� ° F 5 t ( A( V, (-2�Lr-- Lo. 0 P 4, %,�Y .7t bl/ /� -T P, a- 576 �+ N, All, l�l. 5Te, Nml ,tt • Land Plapo`snq Sam Testing Civil Inminearin- Fit A I f, a la It 49eltiffqp kly1wo ?*In'*. 53432 Certificate of Survey for lc��w4,; RLt 1A 7573 M U) r4 4D IT d. LLJ >46,0' 3r, 4r.34 ST AVENUE LQ --F 23 -UQC 3 -9R 1AR M LE Dalinken rMMIMIA ,LmLa COUZi DMI14 D40OU rebY cwvti#Y shat this 110 ime and terrao rapr",poteplon o1' survey of the boundaries of the describsd landr and of thAi bu Ober and bit risible 0"'frea4hWeits, If soy, from 4w, so sold kind. As swrw*yed by� nx0: ,&44Z -- -SUISUMBAN INOINZARING, Jr4C. e Ch tj 7 3 57 f2 7T City of Fridley AT TK TOP OF THE TWIN$ COMwyNITY DEVELOPMENT MY, 1 PROTECTIVE 0909CTON KK CM HALL FO OLRY 0607; 1601 N. E. 61st. Ave. 53 -8h -S-915-51 W l q PLUMBING PERMIT APPLICATION ---- -- Richard Miller Homes eaaress Phone Contractor MEQ NU73ASC® 7.3? fv;h :. ,, ess Phone Kind of Building MPLS, h0s614N.Use on Frame Res. EstimatedCost 5-21-7Ll0 00 eve 'DEIN 'sa01 •MNlra m y, sN18Y8 ! N I JfO W sNlraa O U00 -1A 3 0 wV ,O V I Sa3MOFi$I ix :0V '1NflOdl to NNIaO A (� 8AYlIlI NSYM S)iN lH l x sN16V@ sant "L" O w I I i II I W 1 _lWI . W I —' -- _4 W n I sra I I '� 'IddV I I I I O eve 'DEIN 'sa01 •MNlra m y, sN18Y8 ! N I JfO W sNlraa O U00 -1A 3 0 wV ,O V I Sa3MOFi$I ix :0V '1NflOdl to NNIaO A (� 8AYlIlI NSYM S)iN lH l x sN16V@ sant "L" O w I I I I I J Plumbing Fixture Rates: NO RATE TOTAL Number Fixtures x $2.00 $ 1' Future Fixtures x $1.50 New Fixture -Old Open. x $1.50 Catch Bastn x $3.25 Water Heater -99,000 BTU x $3.00 �i Ground Run Old Bldg. x3.2 $ 5 Elec. Water Heater x $2.00 jGas Fitting Fees: 1st 3 Fixtures x $2.00 I - Additional Fixtures x $ .75 I lGas Range -199,000 BTU 1 x $5.00 X00 Repairs & Alterations See Description: Code State Surcharge Class "A" Surcharge .50r .50 TOTAL FEE $ 5.50 !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 declare that all'the facts and representations stated in this applic,.ation-.are true and correct. Signature Date CITY OF FRIDLEY INSPECTION DIV. Effective On August 1, 1995 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION_AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS �rIoE RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner — Also Replacement Furnace (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) 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 -The undersigned hereby makes application for a permit for the work herein Rate TOTAL specfied 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 $ 30.00.• $ 3l%' representations stated in this application are trup @D4c ct. ,1995 $10.00• OW $10.00 $ BUILDING USED AS $10.00 $ ESTIMATED COST �C/Ul PERMIT NO. $25.00$ ')5 -SP $ State Surcharge $50 TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. DESCRIPTION OF FURNACE AND OR BURNER �� No. of..Heating Units_ Circle One (Steam) (Hot Water) arm Afr) I Trade.Name Size No. BTU HF EDR t, Fuel Total Connected Load Burne[ Trade Name KLrSize No. �J TC S—L 01) BTU' HP EDR HEATING COMPANY Signed By- z� Tel No. Approved By Rough—In Date Final Date FILL OUT BACK SIDE OR STACK VERIFICATION ON REPLACEMENT FURNACE 6 Has total head., BTU's of 40 All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes () No (�) S. Has combustion air been provided for water heater Yes () No ( ) Remarks: HEATING CO: Signed By: Date: CHIMNEY AND STACK 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 ( ) I Has no foreign objects lodged 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 head., BTU's of 40 All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes () No (�) S. Has combustion air been provided for water heater Yes () No ( ) Remarks: HEATING CO: Signed By: Date: CITY OF FRTDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 99 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective On May 10, 1999 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Stones :.... Urinal .............. : "�'tt�{:::::. Shower Wash Tray I � .:. ��:.;• o Drain : Auto. :::��': :�!#>�: ..:. X11::: Washer ': :. Gas Ran a >:::�..::: )�ti:;:::::::::::> Water Heater ;. Gas Elec; Basement $ 7.00 Rain Water Leader $ 7.00 ,1999 Sump/Receiving Tank $ 7.00 Water Treating Appliance Floor Owner - W,4 n AJ PJ € L L_ Water Heater -Electric $ 7.00 Water Heater - Gas— $10.00 D Building Used As Gas Range'" $10.00 Floor 2 Gas Dryer** $10.00 Estimated Cost a OG ` PERMIT NO. /._)9/a Back Flow Preventer Required ( )Yes () No f� _ AJ of S Type $15.00 PLUMBING COMPA iC • • �� o �� S a o� a Floor loo 3 SIGNED BY TEL N0. 6 -3 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Floor 4 El $ .50 MINIM M FEE R ANY PLIIMBINGIGAS PERMIT TOTAL FEE $_2L__ 2510 PLUS THE S.50 STATE SURCHARGE PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS l / t' A d # New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 ,1999 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner - W,4 n AJ PJ € L L_ Water Heater -Electric $ 7.00 Water Heater - Gas— $10.00 D Building Used As Gas Range'" $10.00 Gas Dryer** $10.00 Estimated Cost a OG ` PERMIT NO. /._)9/a Back Flow Preventer Required ( )Yes () No f� _ AJ of S Type $15.00 PLUMBING COMPA iC • • �� o �� S a o� a Reinspection Fee $47.00/Hr SIGNED BY TEL N0. 6 -3 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved By Rough -In Date Final Dat��C State Surcharge $ .50 MINIM M FEE R ANY PLIIMBINGIGAS PERMIT TOTAL FEE $_2L__ 2510 PLUS THE S.50 STATE SURCHARGE "COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. CIIYOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 October 17, 2001 Mr. Richard O'Donnell 160161 Avenue NE Fridley, MN 55432 Re: Final Inspection at 160161 Avenue NE Contractor: R A Johnson & Son Dear Mr. O'Donnell: A plumbing permit was issued on December 15, 1999 to install a water heater at your address. According to section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the plumbing authorized by this permit. As of this date, no inspection has been called for. The permit fee that was paid covers the inspections to make sure the work was completed according to the Plumbing Code. 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 expire the permit and no further action will be taken. To set up the inspection, or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. DAVE JENSEN Building Inspect( DJ/mh CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fee Total $35.00 $ $10.00 $ $10.00 $ JOB ADDRESS Owner s�/�!�/L17 �J✓��� Building Used As��E?S ESTIMATED COST GO PERMIT NO DESCRIPTION OF FURNACE AND BURNER Gas Dryer $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. *Air Conditioning-AllSizes $25.00 $ BTU HP EDR Fuel Total Connected Load All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ f ®� Burner Trade Name Size No. Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EDR Improvement whichever is greater The undersigned hereby makes application for a permit for the work herein Commercial/Industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/Industrial/Institutional and representations stated in this application are true and correct. State Surcharge $ [ `' HEATING CO TOTAL FEE Signed Tel # REINSPECTION FEE $50.00/HOUR FAX #�!o/2 -7 Date��� *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () 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 :