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City of Fridley, Minn. BUILDING PERMIT N° 6_77 Date:_ Owner:_: _. _ .... .. Builder .......... __....... ........ _... k Address M.4 Address ............... _ °+..�•�� � .._.�._.._..._.._....__ � L ,CATION OF B DING No. ,,. •--�,f.r.:_._ Street .......... .. �. w. ..... '...+t.. Part of Lot Lot Addition or Sub-Divisionri► OFF- Corner Lot ...... ..................._. Inside Lot ....... ..----_ Setback .----, � _........ Sideyard .-, ...-� 7 4 _............... _... _. Sewer Elevation ....._.._._ ................ Foundation Elevation DESCRIPTION OF BUILDING To b Used as: r _ 0�d d' ���+�+- of Front __ Depth _-. Height -- - Sq. Ft. _...._.:WaL Ft.1.,_.,�!. � .. _.. Depth ....1.4f� Cu. Ft. ...: ..- ..... -------�'........... Fromm ... � eight_.. Sq. Ft. Type of Construction, r... •,+ ":.._ .... Est. Cost....../!.'` 4914- "...."... 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. 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, Minnesotaregarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any timet pon violation of any of the provisions of said ordinances. 7 i..� r!. ,--) 4-__ Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these hems. 0 .OQD,4 11 0 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA;, No. LOCATION OF BUILDING ,11 A zr-4-c- Part of Lo Lot .I<',4 Block Addition or Sub.Div Corner Lot Inside Lot____Set Back SEWER. ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To used as: Front Dept 5 � ZI Height / �i .. Ft. Cu. Ft. 47 Air—V Front P 9 Depth , Z Height Sq. Ft. Cu. Ft. ZL Type of Construction Estimated Cost To be completed The undersigned herebyes 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 ect. TE _ - — SIGNATURE RA ,�,�G , (A Schedule of Fee costs can be found on the Reverse Side.) EI City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Number. Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL 12 x $1.50 $,�U• Future Fixture Opening ................ 8Z. 1.20 $,a- 6 New Fixture Old Opening .............. x Z• $ • WATER HTR. 3.25 $ Water Heater (Up to 200,000 BTU) ...... f x 2.00 $ R ° d New Ground Run Old Bldg. ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..........................� �O F N GAS EIEC .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ Base vIL 1st 2nd _ 3rd 4—th::H-- ±LILCEonnecLied • Future Connection Openings with Sewer New Fixture, Old Openings Cesspool E] PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL .............. Number Fixtures .............. x $1.50 $,�U• Future Fixture Opening ................ x 1.20 $,a- 6 New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... f x 2.00 $ R ° d New Ground Run Old Bldg. ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ..........................� x $1.50 $—/-- /,Additional Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $ City of Fridley: &C 0 � Flo 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. Owner Kind of Used as To be completed about Estimated Cost, $ Old—NWBuilding Permit No� Permit No. Signe ROUGH FINAL - 0 -90042 2M 7-39 By Business Phone I, o 4Application for Power Pkmts and Heating, Coolin Ventilation, ReM ation and Air Conditioning Systemand Devices � PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SII 4-7470 GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $— MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 a pip each add. 80,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ ► �® Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $����p_�� (ALTERATIONS & REPAIRS TOTAL FEE REMARKS: L ad.. Loaailon " 5 0 l— 6 S I/ P, R r P, n City of Fridley: 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. Fridley, Minn. Owner Q Q Lq ff0 H Ali Kind 5— Kind of Building 195— Used as To be completed about9 Clap Estimated Cost, $ ®� a Permit No. DESCRIPTION OF WORN HEATING or POWER PLANTS—Steam, Hot Water, h4arm No� Trade Name // IV ZEAM I ,tip' -a N Mitt Size No. 1� �&1fTU H P. Capacity Sq. Ft. E.D.R a h Total Connected Load 5:z9'FJ/,5 Kind of Fuel ,PP/,l r 6A-5 BURNER — Trade Name 1, MAP ize No 3 6t/ ss /nevP7— Capacity Sq. Ft. E.D.R lz gret? BTU H.P. Sign1 f' iy ey n. F /-V zz�- , o 44 11 POST 1M-12-58 Business Phone No Application for Power Plants and Heating. Coding. Ventilation. 19Mgeralion and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 170,000 BTU ............ 8.00 $ each add. 60,000 BTU .... . .................. 2.00 $ Replacement of Furnace ............................. 0.00 $ Repairs & Alterations—up to $500.00 ....e ............ 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam, ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER to 3 gal, per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ 04 AIR CONDITIONING $ j2.- oFAN FANHEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ S ALTERATIONS & REPAIRS TOTAL FEE It ROUGH— OUGH FINAL— FINAL Dept. Dept. of Bldgs. Phone SII. 4-7470 City of Fridley: 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 applicati" are true -and correct. Fridley, Owner .�f Kind of Building Used as To be completed about Estimated Cost, $- ®/���• �' Old New. Building Permit No. Permit No. - DESCRIPTION OF WORK HEATING or POWER PLANTS --Steam, Hot Water, Warm Air—No 1A Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load Rind of Fuer BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R, BTU H.P. (REMARKS—OVER cte�42 2M 7_59 By Phone No.— f # y H TOMIDOgral Rawkwaam 024 Y PAr-1761 � F mss. of �MATM WARM AIM: My -E, TOTAL Ymmace Shell & Duct work ... . $10M $ Replacement of Farmee .... 6.00 $ Repairs A Alterations—ups to 8500.00 6.00 Repairs & Alterations �-&eh v6d. W00.0 3.00 Q----- - `c' mon; r, ;u„ ice Shell dDuct Work to 120,M6 STU ... Meh add. so,= 36W................ .... $1S®.V�0 @$_ Replacement of Furnace 6.00 $__6� f-- RepArs A Alterations—up to $M.00 6.00 $ Repairs & Alterations each add. SM.00 3.00 $ rnace Shell A Lines—to 400 sq. ft. EDR Steens $10.00 $. --- F'urnace Shell & Line—to 610 sq. ft. EDR Hot Rater 10.00 Each add. 300 sq. ft. EDR Stearn un Each -- Each add. 330 sq. ft. EDR Hot Water 3.00 OIL BURNER—to 3 gal. per hour over 3 gal. per hour—See Fee Schedule GAS BURNER, tup to JW000 BTU) aver 199,000 BTU See Pee Mcbeduls GAS FITTING 71=. 1st 3 Fixtures _ Additional Inxtures Gas Range to M,00 _ AIR CONDMORMO TAN NZATING ST57 [ VENT! LATMG 6TXT%11 ALTERATIOMB t REPAID ROUGH City of Frl(Day: The undersigned hereby mahes application for a permit Y®r the work beret specified, agreeing to do all work in strict aSoordance with the City - and ruling of the Department of Buildings, ammd hereby decln-Tres that a%1 Me fze�' and representations stated in this application are true and - Fridley, __-__ 2 — a e-), IB73 Kind of Building Used as To be completed about 1 L Estimated Cost, New- Building Permit NO. Permit No. or Q M 00 HZAor POW= 'r' NO RATE TOTAL - x$ 200 $ ®� - x .7a $ - Z$ &M f See !N TOTAL rye"'® Capacity—_ S 1R. E.D D, (2 -Ile) BTU ILP Total Connected Load Kind of ltire BURNER — Trade size NOL Capacity Sq. Ft. )Z.D It BTO Hr. tMaRss-oMl SUBJECT PER City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT .14680 ECEIPT ' ` COMMUNITY DEVELOPMENT DIV. 91 l PROTECTIVE INSPECTION SEC. � 1_5I i (` 11 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 5/8/78 JOB ADDRESS 51 - 65= Way NE Fridley, MN 55432 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. /S-49-a JS SHEET C�-��wyq,� (9A ��fA �"' 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE WaItAr Johnson 51- 65= Way NE Fridley, MN 55432 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Bob & Sons Roofing, Inc. 4553 Xerxes Avenue, S. 920-1251 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION 9 REPAIR ❑ MOVE ❑ REMOVE 6 DESCRIBE WORK gAronfing of dwelling and garage., 9 CHANGEOFUSEFROM TO STIPULATIONS 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 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 ISTALLS GARAGES ANDKN THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX ORK WILL BE COMPLIED. AND O DI ANCES GOVEAHE WITH HE HER SPECIFIEE GRANTING OF A PERMIT $ 1 ,000.00 -50 DOES OT PRESUME TOVIOLATE OR CANCEL THE I PERMIT FEE SACCHARGE PROVI ON OF ANY OTLAW REGULATING CON- LCONSTRUCTION. $7.50 STR O OR THE PERUCTION. PLAN CHECK FEE TOTALFEE s- �e $8.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) VArIEN PRO ERL ID TE HIS IS YOUR PERMIT F� 5 5/8/78 SIGNATURE OF OWNER (IF OWNER BUILDER) ( AEI G INSI DATE CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) QV4OWNER: IlrY h S1, BUILDER: .�.� Address: 5/_65- ,�j �Q�s /�'� Address: Tel. No J v / No.: �/ Street: /� ZJIt y . I LOT: BLOCK: ADDITION: CORNER LOT: INSIDE IAT: SETBACK.: SIDEYARDS: Applicant attach 'to this form A-io Certificates of Survey of Lot and proposed building location 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: Type of Construction: e,16b �e "„� bq1� y� Estimated Cost: $ %��, c>%} To Be Completed: ®� l 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 Fkidley Ordinances and pilings of the. partment of F 'ldings, and hereby declares that all the facts and repres nations state n this application are true and correct. See reverse sidor aclditiona 'nformation. DATE: 7�' SIGNATURE: Stipulations: ' y City of Fridley SUBJECT P ® 14'766 AT THE TOP OF THE TWINS BUILDING PERMIT r O. COMMUNITY DEVELOPMENT DIV. INSPECTION 47 r PROTECTIVE SEC. ®d� t � i ; CITY HALL F_RIDLEY 55432 � NUMBER REV. DATE PAGE OF APPROVED BY ----�' 'j 612-560-3450 910-F15 JOB ADDRESS 51 - 65% Way N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DE$CR. 15A 15B 5 Ed ewater SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Walter Johnson 51 - 65% Way N.E.Fridley, 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Bernick Roofing & Siding Delano, Minn. 972-2816 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION X REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK aluminum trim on roof 9 CHANGE OF USE FROM TO STIPULATIONS 1. Builder to have his insurance company mail us a copy/s of workmen's compensation and public liability insurances. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. al um. trim 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 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 0.50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OROCAL LAW REGULATING CON- $7.50 STRUCTION O THE FORMANCE OF ONSTRUCTION. PLAN CHECK FEE TOTAL FEE c �,� 8.00 SIGNATURE OF CONTRACTOR ORA HORIZ AGENT )DAT ;�DEI:!DATTED THIS I$ YOUR PERMIT0SIGNATURE )NSP DATE OF OWNER(IF OWNER BUILDER) (DATE) CITY 01: FRIDLEY APPLICATION FOR RESIDE-NTIAL BUILDING PERMITS W -W, ALTERATI oNs, ADDI T I ONS, OR REPAI RS) OWNER: N a1_ � �O�t�,So Iy i3UILllE32: '(os Z I�5`{ N F .Address: ZgjL-A M Address: /�� � e\-, Tel. 1Qo .: 97"11 — 2.81 6 No. Street: 5 Z A' t\j-� LOT: j5 BLOCK: _ _ ADDITION: G- k. VV A- a COl'MR LOT: INSIDE LOT: S13TBACK: SIDEYARDS: Applicant attach 'to this form Two Certificates of Survey of Lot and proposed building location 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: Type of Construction: PO-uhd _ DUM Estimated Cost: $ ®O To Be Completed: la A( 112 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.Denartment of Buildings, and hereby declares that all the facts and representations stated in this application are true and col'l'ect. See reverse side for acid tiot:al information. • a DATE: i _ SIGNATURE: � C, Stipulations: . e C� 8� SUBJECT PER City of Fridley 19023 AT THE TOP OF THE TWINS BUILDING PERMIT _ f RE PT N0. rry �_____ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. o� r PROTECTIVE � I NUMBER REV. DATE PAGE OF APPROVED BY ` - - -I CITY HALL FRIDLEY 55432 � 0 "'j 612-57.1-3450 910-F15 6/24/87 JOB ADDRESS 51 - 6511 Way N.E. 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 15A, 15B 5 Edgewater Gardens SHEET I 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Walter R. Johnson 51 -- 65' Way N.E. 574-7382 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 Cj NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 32' x 16" Above Ground Pool (Doughboy Seawindl 12,250 gallons 9 CHANGE OF USE FROM TO STIPULATIONS See stipulations on letter dated June 23, 1987. REQUIRED FOR Belme digging call local *dies. SEP A RATE PERMITS PLU NiBi`NG AND SIGNS. TELEPHONE - ELECTRIC. fll its, HEATING WIRING,, REQUIRED BY LAIN 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 SQ. 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 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 $5,000 $2.50 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- $50.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $53.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATE) r / .WHEN PROPERLY. IDATED THIS IS YOUR PE IT BLDG INSP I ATE NEIIF NER BUILDER) IDAT IO Your family has a style all its own; a style reflected in your choice of backyard design. Whether your backyard is square or rectangular, big or small, we've got the pool to meet your needs. Doughboy appreciates your family's unique style and that's why SeaWind is available in such an exciting variety of sizes. We also offer two attractive shapes designed to enhance your backyard decor, our popular round pool and the sporty oval design. With Doughboy, the choice is yours! 24`x16' Sq. Ft 329 Gal. Cap. 8,845 Exp. Gal. Cap. 10,410 Model No. 04646-049 34'x18' Sq. R 532 GaL Cap. 14300 Exp. Gal. Cap. 19340 Model No. 04648-049 16' Sq. Ft 202 GaL Cap. 5,435 Exp. Gal. Cap. 6,850 Model No. 01{616-049 ► 18' Sq. Ft 249 Gal. Cap. 6,700 Exp. Gal. Cap. 8,800 Model No. ► 0-0618-049 32`x16' Sq. Ft 456 Gal. Cap. 12,250 Exp. Gal. Cap. 14,625 Model No. 04626-049 38k18' Sq. Ft 603 Cal. Cap. 16,200 Exp. Gal. Cap. 21.240 Model No. 0468&049 21' Sq. Ft 341 Gal. Cap. 9,165 Exp. GaL Cap. 12,015 Model No. 04621-049 24' Sq. Ft 452 GaL Cap. 12,160 Exp. Gal. Cap. 16,475 Model No. 04624-049 28' Sq. FL 616 Gal. Cap. 16,550 Exp. Gal. Cap. 22,560 Model No. 04628-049 40`x16' Sq. Ft 583 Gal. Cap. 15,660 Exp. Gal. Cap. 19380 Model No. 04606049 41'x21' Sq. Ft 756 Gal. Cap. 20,325 Exp. Gal. Cap. 26215 Model No. 011611-049 Change of Design: Doughboy Recreational expressly reserves the right to change or mortify the design and construction of any product in due course of our manufacturing procedures without incurring any obligation or liability to furnish or install such changes or modifications on products previously or subsequently sold. NEW [ ] City of Fridley ADDN. [ ] �R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: 5�l 6 sr -'4 Legal Description: Ow Name - &• Address Effective 4/1/86 tk 46 Tel. # -S2 ` 23 ner "Op- Tel. # - Contractor: Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Length DESCRIPTION OF IMPROVEMENT Width Height Sq. Ft. _— Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. A _ 1.14 Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback 4—oType of Construction: Estimated Cost: $ ��©� Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation DATE: APPLICANT: !�2%� +' Tel. # CITY USE ONLY Permit Fee $n ,S D Fee Schedule on Reverse Side Plan Check $ 25% of Building Permit Fee State Surcharge $ e2 ,S_� $.50/$1,000 Valuation SAC Charge $ $ 525 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ l TOTAL $ STIPULATIONS: /Uo A/ vi,-4JI., �'' HARVEY A. CARTWRIGHT AMOK^ COUNTY SURV6T8 'ATNfiEPIN COUNTY SURvEY1< MINNEAPOLIS SURV[TS 6410 PALM STRErT N W. BUNS/• • 7653 owHca INDUSTRIAL — JUDICIAL OUS/NESS — TOPOGRAPHICAL CITY LOTS — PLATTING f r:o;zn ® am LAND SURVEYORS REGISTERED UNDER LAWS Of STATE OF la1N149SOTA LOCILN690 SY OROINANC[ OF CITY OF MINN[APOLIS 326 PLYMOUTH BUILDING FEnERAL 8.8721 HENNEPIN AT SIXTH • MINNEAPOLIS 3 MINNESOTA 6arbcpor's (rrtificate COMSIMNG THE RK -Aa 405 Of J. E. HILL. CIVIL ENGIN[ER ILSTAOLISN90 law C. F. SAND HOFF CIVIL ENQINE[R CIIADLIIH[O 19" JAMES NELSON SURVEYOR 4117Amuow90 /aaa METROPOLITAN LAND SURVEYORS. L!•AeuaHto I.ei ?Q '00 1� h.rolu" cartif that this is tru3 : 21:: Ccr:'JCt r-pm,3C:lt^ � n'' .. :Y 1 ti027 (ice y r ` O_ ! Lots 1-5-'- .A! � .., 'Dloc:. „ tcr G -.r -i n :-.ti-vn;7c.' this 2' wZ dry of 9 l SIGNED 1/ r Ce--7TWRIGHT AND OL90N 1 ■ ■ MEMO no ■ ■■■■ NOommNE MEMO ■M■■ !■■a{IEV��1aa��l�i��!! ■■■■11!■�«��,I®moi■ ■■ S CITYOF FRIDLEY CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450 June 23, 1987 Mr. Walter Johnson 51 - 65 1/2 Way N. E. Fridley, M 55432 Re: Shimming Pool Construction at 51 - 65 1/2 Way N. E. , Fridley Dear Mr. Johnson: This letter is to make clear this department's requirements for the swimming pool construction at the above address. 1. As indicated, one (1) skimmer approved by the National Sanitation Foundation will be provided. 2. As indicated, one (1) inlet of approved design for fresh and/or repurified water will be provided. 3. As indicated, a main drain of approved construction will be provided. 4. The filter and pump shall be approved by the N. S.F. and be of sufficient capacity to provide a minimum turnover of at least two (2) times in 24 hours. This department recommends a turnover rate of 6 - 8 hours. 5. A deck of at least three (3) feet wide, measured from the pool waters edge, shall be provided which extends completely around all private residential pools. Above ground private residential pools may be provided with decking of a minimum size of 4 feet by 4 feet at pool entry points and provided that such decking has the approval of the City. 6. Fencing or other effective means including but not limited to walls or buildings, acceptable to the City, shall be provided to positively control all access to public and private residential swimming pools. Fencing shall meet the following criteria: (a) The fencing shall prevent the entrance of children and be without hand or foot holds that would enable a person to climb over it. (b) The fencing shall be at least 6 feet high and entrances shall be equipped with self-closing and self -latching gates capable of being locked. (c) Self-closing and self -latching devices shall be placed at the top of the gate or otherwise inaccessible to small children. (d) The opening between the bottom of the fence and the ground or other surface shall be not more than four inches. June 23, 1987 Mr. Walter Johnson Re: 51 - 65 1/2 Way N. L Page 2 7. An automatic chlorinator should be provided with a suitable test kit. 8. All electrical and plumbing installations shall be inspected and approved by the City Inspection Department. 9. All overhead electrical lines must be a minimum of 10 feet horiz ontally from - the pool surface, and 18 feet straight line distance from the waters edge. An alternative is to bury said lines. 10. The pool fill spout must be protected by a vacuum breaker or air -gapped. 11. Suitable safety equipment to include but not limited to a ring buoy and rope that is 1-1/2 times the pool diameter and shepherds crook pole must be provided and maintained with the pool at all times. Furthermore, these and any other requirements must meet the provisions of the Fridley City Code, Section 115, Swimming Pools. The building permit is approved contingent on final inspections and approval of the City. If any questions or problems arise from this letter, please feel free to contact me at 571-3450. Sincerely, DARREL G. CLARK Chief Building Official DGC/mh 0 Sue�ECt , City of Fridley 27806 AT THE TOP OF THE TWINS BUILDING PERMIT .r? COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. % 6o -7 ll!!!! / � CITY HALL FRIDLEY 55432 NUMBER REV DATE vAGE OF APPROVED BY L 612-571-3450 910415 9/16/98 JOB ADDRESS 51 65j Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15A, 15B 5 Edgewater Gardens SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jean Johnson 574-7382 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Dan Netko Exteriors 7118 Riverdale Rd MinneaRolis 55430 566-3731 20060494 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 f7 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside house 9 CHANGE OF USE FROM TO STIPULATIONS 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 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 $2,500.00 $1.07 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 $74.75 Fire SC $2.14 PLAN CHECK FEE TOT a FEE Lice e C U0 $82.96 SIGN TUBE OF CON'RAC TOR OR AUTHORIZED AGENT IDATEI EN R P VALIDA D HIS ISP IT 9l ,NSD FR BATE S,GNATURE OF OWNEAOF OWNER BUILDER, (DATE, NEW [ ] Effective 3/1/96 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application g®(p 0ConstructionAddress:9� Jr j/1�i3' Legal Description: Owner Name & AddTel. # 5-7 41"e 7,7f -z- Contractor: DAN NETKO EXTERIORS MN LICENSE # Address: 7118 RWd0d8 Road • Mks., MN 55M Tel. # S—OX,_7 7He. 209MM94 �f 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: 4asL Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Oe of Construction: Estimated Q.5-&&2 Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: DATE: APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge DOTAL STIPULATIONS: $ fad i CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $900 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 DIVISION 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Residential Rate TOTAL Furnace Shell and Duct Work, Burner — Also Replacement Furnace $ 30.00 $ (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace, $10.00 $ but not placement) Gas Range 62 (J�� $10.00 $ Z6-- cd r� Gas Dryer $10.00 $ *AirConditioning — All Sizes $ 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 $ .50 TOTAL FEE MINIMUM FEE F( REFRIGERATION REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Effective On January 1, 1999 JOB ADDRESS I U' 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 d correct. J n% S_— ,1991P OWNER BUILDING USED AS ESTIMATED COST PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units 1 Circle One (Steam) (Hot Water) (Warm Air) Trade Name c- Size No. 2 3 BTU HP EDR Fuel o- k Total Connected Load )_ ` S CC* 0 Burner Trade Name Size No. BTU _ HP EDR Remarks: List ALTERATIONS Being Done: 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 ( ) 3. 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 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: NEW CITY OF FRIDLEY Effective 1/1/2002 ADDN [) 6431 University Ave NE, Fridley, MN 55432 (763) 5723604 Bldg Insp ALTER [ i SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION A—Cohstruction Address: 5 t e- (o5'l2 E Legal Description: Owner Name & Address:W ALTE Tel. # 7�0 ,5 ^ � Z Contractor. P/f/G7 0'1-� ZLWz - o / MN LICENSE # Tel. # 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 q. Ft OTHER: � `�flf-k, dl� ��� T� �� L Construction Type: NOEstimated Cost: $ XDriveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ DATE: 6� . �, 0 �%� APPLICANT: � c Tel. # �� �' � ��� � Call (763) 572-3604 for Permit Fees if mailing 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 TOTAL CITY USE ONLY - P 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 [ ] STIPULATIONS: O v 73s3 ;ITY OF FRIDLEY BUILDING INSPECTION Effective 4/1/2004 v 9 3431 University Ave NE 9=ridiey, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION L 763-5723604 FAX 763-5714287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES 9 JOB ADDRESS .O n RATE SCHEDUL Fee Total�'' Residential Owner \i) l A- J -p -e -n � -1ohvn5oYi Furnace Shell and Duct Work, Burner & also Replacement Furnace $35.00 $� 5' D� Building Used As �1e5� c�eYlC� Gas Piping (New Furnace, Fireplace, Insert) $10.00 $ ESTIMATED COST A - -C 1 00 PERMIT NO Gas Range $10.00 $ DESCRIPTION OF FURNACE AND BURNER Gas Dryer $10.00 $ # of Heating Units Circle One (Steam) (Hot Wate =(WarmAir) Trade Name car r � rZt �� I"Yl V P 0 l o Size No. *Air Conditioning-AllSizes $25.00 $ SOO BTU 1._06 ®Od HP EDR Q C�aS 3g �� �3 CG Fuel , �r�z -Total Connected Load All Other Repairs or Alterations (List on Back) r 1% of Value of Appliance or Work $ Burner Trade Name Size No. 1 Minimum Fee $15.00 for Residential or 6% of cost of BTU HP EDR improvement whichever is greater on work less than $300.00 V The undersigned hereby makes application for a permit for the work herein 5 Commercialjindustrial/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 J Minimum Fee $35.00 for Commercial/industrial/irisiitutionai and representations stated in this application are true and correct. CENTERPOINT ENERGY Y State Surcharge $__.1.50 HEATING CO 13562 CENTRAL AVE NE BLAINE, MN 55304 TOTAL FEE $ (co -SO Signed Tel it 763-757-6202 REINSPECTION FEE $50.00/HOUR FAX # 763-757-6701 Date m *Air Conditioners can not be placed in side yard without written approval N from adjoining property owner - copy to City N N FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Q Approved by Rough -in Date Final Date CO' d Idlul 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 No( ) specifications including sizing, length, number of elbows and termination. Yes 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 combusfion air is sized and installed to meet the current codes and manufacturer's specifications. Yes ()o 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 aystem, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA -LAMA Category I Central Furnace No( ) Venting Tables for fan assisted and natural draft appliances. Yes ( 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 _J/ Fan Assisted or Nat F� Appliance #2 Type z %6 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/S Diameter _ inches Appliance #1 Vent Connector Height ft Length 2d ft Diameter o in Type =_ Appliance #2 Vent Connector Height _.2Lft Length __aLft Diameter _ V, ' -in Type C/ -C- Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) / r B t� CENTERPOINT ENERGY HEATING CO: 13562 CENTRAL AVE NE BLAINE, MN 55304 Signed By: Date 7P1FR'r4 TVV.g1.SL Ol A310INA d0 A110 WON -1 CETT b®6Z-LZ-�JdH JITY OF FRIDLEY INSPECTION DIV. Effective April 1, 20042q qq .431 University Ave NE , Q 'ridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTAI_I_Fn ON FACN FI nr)R )LUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS_ 6aiwn.2 - a -S 0-W AAIV- Jew Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein Ad Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes leer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the fads flow Off Basin $10.00 and representations stated in this application are true and correct. ,atch Basin $10.00 r� Iain Water Leader $10.00 PATE; ^^ _ pump/Receiving Tank $10.00 JOHNSON, WALTER Vater Treating Appliance $35.00 OWNER 51 65 112 WAY NORTHEAST Vater Heater -Electric $35.00 FRIDLEY, MN 55432 Vater Heater - Gas** $35.00 11 BUILDING USED AS (763) 574-7382 Sas Range*" $10.00 Sas Dryer** $10.00 ESTIMATED COST `i PERMIT NO. lack Flow Preventer Required ( )Yes () No Type $15.00 NO f \ok o -m t PLUMBING COMPANY �annn IEJT teinspection Fee $50.00/Hr SIGNED BY TEL N0. x(012)$2%—cl033 kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge $ • 6z MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST TOTAL FEE OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. `*PROVIDE COMMON VENT INFO ON BACK SIDE 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 installina 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 :