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PRE 2010 DOCSPER O. City of Fridley. 17902sueJECT AT THE TOP OF THE TWINS BUILDING PERMIT _ R IPL N ►y ______ COMMUNITY DEVELOPMENT DIV. r i � PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/11/85 JOB ADDRESS 1475 - 66t1i Avenue N.E. 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 Creekridge SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerry Jansen 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Brickner Builders Inc. 6170 Heather Place &E., Fridley, MN 55432 574-9871 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK C)j NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 571.x 321 Dwelling and 30.33' x 24.33' Garage and a_131, 14' 3-Season Porcri HEATING, PLUMBING AND SIGNS, 9 CHANGE OF USE FROM TO ' STIPULATIONS Provide sod in the front and side yards. Provide City with copy of the verifying survey before capping. Provide a hard surface driveway. SEWER "Y": 131 South of MANHOLE. "Y" Elev: 885.10 TOP OF FOOTING: 888.10 Minimum WATER LOCATION: In same trench as sewer. Paid Park Fee $1, 500.0p �' �' r nF� Cad I r 1l' y , �r R )SING n4F Ciil` OF FF?IJ I EY BeffaPe digging tlIQF Ing r@'�1,,I cals local ufintie TELEPHONE ELECTRLo - Eco TH!" DAI r 6i'1 V: ��� J �I�cl ��-IIJ ° AND �'��`:��i �i� _ �� RE UIRE 6 'jA,.9 VERIFY. !i HE SISI. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frame 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 1700+720+164 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 VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $165,2SO $82.63 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PR VISIONS OF HER STATE OR LOCAL LAW REGULATING CON- 00 $CREDIT STR TION H RFORMANC ONST CTION. '$!598. AN CHECK FEE TOTAL FEE -- $149.50$830.13 TUBE OF CONT RAU RIZ DAGENT IDATEI WHIN PROP L I A D THIS IS�YOUR PERMIT DATE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI BLDG INSP NEW E44/ ADDN. [ ] ALTER. [ ] Construction Address: /. Legal Description:_ Owner Name 6 Addr ss: Contractor:— Address: 6 J 7?,6 ont City of Fridley R-1 AND R-2 Building Permit Application Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Effective 4/1/84 Tel. # Tel. # S ? - LIVING AREA: Length �� Width s Height Sq. Ft. 00C) GARAGE AREA: Length 30.33 Width 3 Height Sq. Ft. DSGSrI�� Length j 3 l Width Hgt/Ground Sq. Ft. R:3S. Corner Lot [ ] Inside Lot Or] Ft. Yd. Setback Side Yardetback Type of Construction: V Estimated Cost: $ 1 T � Approx. Completion Date: 1 'j "5? �Sv Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: � g JO � APPLICANT: Tel. # �� CITY USE ONLY Permit Fee $ sq'2'64) Fee Schedule on Reverse Side Plan Check $ 25% of Building Permit Fee State Surcharge $ �2,+� $.50/$1,000 Valuation SAC Charge $ $425 per SAC Unit Park Fee $ Fee Determined by Engineering Sever Main Charge $ TOTAL $ T1s Agreement Necessary [ ] Not Necessary [ ] STIPULATIONS: Arne CITYOF FRIDLEY CIVIC CENTER • 6431 UNIVERSITY AVE. N.E., FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450 August 15, 1985 Mr. Tan Brickner Brickner Builders Inc. 6170 Heather Place N.E. Fridley, Mi 55432 Re: Final Inspection at 1475 - 66th Avenue N.E., Fridley Dear Mr. Brickner: A final inspection was conducted on August 14, 1985 of the above address and the following items were noted which must be completed before the structure can be finaled out: 1. Provide sod in the front and side yards by October 1, 1985. 2. Provide the City with a copy of the verifying survey by September 1,1985. We are also missing verifying surveys for 1436 - 66th Avenue, 1465 - 66th Avenue, 1490 - 66th Avenue, 1425 Creek Park Lane and we will also be needing 6199 Heather Place N.E. If you have any questions on these items, please feel free to contact me at 571-3450. Sincerely, (Z: �Vxat�k- DARREL G. CLARK Chief Building Official DGC/mh r . EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION OWNER d /' U SITE ADDRESS 7 I -r (O/ d- 7 CONTRACTOR., i• -DATE /• ?' 4'f PHONE L., Determine working square footage of each. 1. Total exposed wall area . 3 7 L O sq. ft. x 2. Total roof/ceiling area . / % Z sq. ft. IT x a� �6, • Total exposed wall area above floor = a. Total wall window area ........................... b. Tctal. door area ................................. 3• v c. Total sliding glass door area ................... Zg d. Total fireplade wall area ............... ......... e. Total •wall * framing area (average 10%)o ....... . 2�%• 'U3 • f. Total net wall area above floor ................. 2 3 / S• / •g. Total rim joist -area, Total exposed foundation area • h. Total foundation window area....' rea....................�[3 • a� i. Total net foundation area above grade........... 8'/ • 9 S Determine "U" value of each wall segment. a. 3 //. OL C7 X „U„ - 3 g = /2 9• • b. X ..UIs Jrore• d x "U is _ „U„ a. - 9 23. /S . e. X i X IOUs o y _ /�• v g• - h. /I.X "Un • i. / V X IOC It •• % � � �'. S// 3 - . - .Total -2 - If item #3 on previous page is the same as, or less than item #1,. you have met the intent of SBC 6006(c)2. 1 Total exposed roof/ceiling area = j. Total skylight area ......................... k.. Total roof/ceiling framing area (avera e 1 g 0%) 1. Total net insulated roof/ceiling area......,. Determine "U" value for each roof/ceiling segment. j•X "U n c k.' X flu" _ / V /....li S g .flu" . 01.-.- .......... Total ......Total • If total of #4 above is the same as, or less than #2, you have'met the intent of SBC 6006 (c) 1. Alternate Building Envelope Design To utilize the total envelope system method, the values established by the sum of items #3 and #4 shall not be greater than the sum of items #1 and #2. 1• +2. 3. +4. _ 0 lZ'' �z �• Zap 2•/3 = V7 ;If,?� . og96 rc-si p �a Sl • �� : .x193 • 43 2 ®9A9 k•il \L yl]I 1\ sffeiA ; . ?•M \. PErITION ND. :6 AMARDING INSTALIAMN OF 1475 - 66TH AVENUE-N.E.: Mr. Flora, Public Works Director, stated a petition was received for installaton of a street light on the curve of 66th Avenue in the new Creekridge development. He stated this request satisfies the criteria for the installation of a street light. Mr. Gerald Jensen, 1475 66th Avenue, stated the two lights at each end of this block are totally screened, therefore, there is no light in the middle of the block and felt it was a dangerous situaton. NDTION by Councilman Fitzpatrick to receive Petition No. 3-1986 and direct staff to proceed with ordering the installation of the street light as indicated on Page 14C of the agenda booklet. Seconded by Councilman Goodspeed. Upon a voice vote, all voting aye, Mayor Pro Tem Schneider declared the motion carried unanimously. 15. CLAIMS: NOTION by Councilman Fitzpatrick to authorize payment of Claims No. 7741 through 7897. Seconded by Councilman Goodspeed. Upon a voice vote, all b4ting aye, Mayor Pro Tem Schneider declared the motion carried unanimously. 16. LICERSES: NDTION by uncilman Goodspeed to approve the licenses as submitted and as on file in License Clerk's Office. Seconded by Councilman Fitzpatrick. Upon a voice v , all voting aye, Mayor Pro Tem Schneider declared the motion carried ously. 17. ESTIMATES• Mr. Flora, Public Works' ector, stated that Estimate No. 6 for D.H. Blattner included increased q ntities for alum and screening materials for an increased cost of $14,578. M3TION by Councilman Fitzpatrick submitted: Herrick & Newman, P.A. 6279 University Ave. N. E. Fridley, MV 55432 approve the following estimates as For services rendered as City Attorney for the date 4/1/86 to 4/24/86. . . . . . . . . $ 2,336.00 D.H. Blattner 1400 Concordia Ave. St. Paul, MV 55104 Moore Lake Restoration Project - Phase II Estimate #6 . . . . . . . . . . . . . . . . . . $41,646.48 - 11 - j CIIYOF FRIDLEY CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3.150 May 9, 1986 Mr. Larry Benson Northern States Power Co. 4501 - 68th Avenue North Minneapolis, MN 55429 Dear Larry: The City Council at their May 5, 1986 meeting approved the placement of a street light at 1475 - 66th Avenue N.E. Please proceed with the installation of a 100 watt, high pressure, sodium street light at the above address near the underground power box. Sincerely, CLYDE V. MORAVETZ Engineering Administration CVM/mh CC:1 Street Lighting File 66th Avenue File l i~�7i-1 ��.s�nb3�! O N I .71 NJ7 • � 'r 1l,, f ' yet °°e - u .is•, f7 ? , ��`".a.• % j• Y , t_ pros �E �•� a¢ r1 ° /O£F/ ra••.�::p,, t. t,�l y v lFri' C� �S lig. I r00 t �� e••+� '• olt 4 7 LAW ( f . •' ;oct�' °I ` o v° � G �� jG •fir tt `• s � � I"'' �' " cls � / J (18f i C V (Otr) �y v j CI i•: , ; .�'% �. i•',' Y� I .7 • 00 AM A3380 � o A-r--7 .. .e '•'Co � , t ' � .•c �•`� . � rat � C f1 •'. a Ab rk ___ _ _r •sil . `� sof .•� \ � �• � C•4 L l� �� C:7 _� I t t• �N .e is � i;�♦ 1��.� ����1 sfI e~. /`�_� r� !� ;' [,M•) 1tfJ •. y` �;3NV'l t �° •; ��� 1q • r�r�• �� a 1 1. c b:� :or9.i _w \ R \ �� t/7ViI /R(j • , � . :r ., ° • j �- i%. � ar. ! • �,� � •.--. Tws-�'� III — ^ — : o r1 0 0 � Q •, ` 1/�Crl+t�+ls�� rL o/ � � C �.� i = � : Y a., _G s e I .. n6A•. t8 �S: .q Tf' `i - ',.'. :. •� • ' ' '3'N '3AV Hl 99��.r� FP CE co t '.[C� 01 .l 0 Cosi ( (+9 _ _ �� C- ` a I ♦ - / rn Coi`►f% Clll sJ , °•. . Ora to re Ore ter-- .� '• •::. � .; • '-� � ,: � 2 sEog y :.�pl G i:r9 � Qa ..�� •�. + � EoB 0334. (41 D a 1 + •� N c • ti i� ��t ; j � i If r Ida, sl-os J ii n* i -- !1l" -- .. • (Ccn't) REUFST FOR A STR?ET :.IG:'.T 1 4 B Name Add--,? Dame Addy Phcne � � 1 - `5 `f a (i; � i J Phone � 7L/— ��s / ess I Flame ��.��� _-;,;Z Phone S-71- Z 2 �' :address AIC i�,, T 1.0 n" . 6c.0 C.`1 h !'hone :�ddre^^ /-/gc) G6 `A 1%crlc 671- s. ,r1 -a, i,h nc :5-'7/- 6%/,, Lll: ro S7/ _ / / ;dame Address I;are !hone ..dd^es_ :.ddre s .. 1 4A REQUEST FOR A STREET LIGHT The following signatures represent the residents of the 1400 block of 66th Ave. N. E., Fridley. We are making a request to the city council of Fridley for a street light. This block is a new street in a newly developed area. There are presently 14 young children with the families on this block and three more houses now under construction. Also, the street makes an "S" Curve, which cars seem to misjudge. Dr. and Mrs. Gerald Jensen, living at 1475 66th Ave. N. E. have signed their approval for this street light and that it can be installed on their property, near the under ground power box. Name Addre Name Addre Name Addre NamE Adds NamE Addi Name , Addre Name Addre Name Addre Name Address I q-)L.l Yf Phone S %d - / �S -) Phone !rld—1 �G-Y Phone �����3-3 Phone 511— Phone 1— Phone S Phone Phone 511A Phone 57!'9 /os Phone S 71 - SS I Z 4 14 CITY OF FRIDLEY PETITION COVER SHEET Petition No. 3-1986 Date Received April 29, 2986 Object The residents of the 1400 block of 66th Avenue Northeast request a street light be installed at 1475',66th Avenue Northeast near the underground power box. Petition Checked By Date Percent Signing Referred to City Council Disposition SuBjECT P City of Fridley , 29515 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. SEC. f PROTECTIVE INSPECTION CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY L J` 612-571-3450 910415 5/t21/99 108 ADDRESS 1475 66th Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED OESCR. 3 1 iCreekridge SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gerald Jenson571-6116 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Town & Country Roofing 7910 R 12th Ave S Bloomington 55425 545-4233 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATION )(9 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage 41 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 $3513 $1.76 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. 9 $7.25 T CTION OR THE PERFORMANCE OF CONSTRUCTION 7 Fir C $3.51 PLAN CHECK FEE TOTY 54E License $5.00 90.52 SIGNATURE OF 'RAC OR OR AUTMO GENT iDATEr N OP ALID BL—ndfiNS0 T HIS IS�OL��IT uCi v T�AtE S,GNATURE OF OWNEA,IF OWNER BUILDER1 $DATE. May -21-99 09:25A P_01 NEW i 1 Effective 1/1/99 ADDN [ ] CITY OF FRIDLEY I ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION 3 ConstructionAddress: J y'7 4�_ �„ ("'11 A e &I � Legal Description: Owner Name & Address�,Q,,r�l� �t_nyorN Tel. #_S? Contractor: �. .--- 4y' ' MN LICENSE # 20c) -5 l a- k 7� Address: `� VA Tel. /i Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. , GARAGE AREA: Length ` Width Height Sq. Ft. DECK AREA: Length ` Width Hgt/Ground Sq. Ft. OTHER: Construction Type: Estimated Cost: $ (Fee Schedule on Back) Driveway Curr Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 5 APPLICANT: S2 Tel. STIPULATIONS: r a s CITY USE ONLY Permit Fee _S/ Fee Schedule on Reverse Side Fire Surcharge $ a, .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ $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: r a s 01 SUBJECT - P City of Fridley 29931 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT N/O/%i i�y _____ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r � � PROTECTIVE 10 1 � � CITY MALL FRIDLEY 55132 NUMBER REV GATE PAGE OF APPROVED By 612-571-3450 910415 7/23/99 10B ADDRESS 1475 66th Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 Creekridge SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Carole $ Jerry Jensen 571-6116 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Renewal by Andersen 350 73rd Ave NE Fridley 55432 502-4777 d 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 MX REPAIR O MOVE 0 REMOVE 8 DESCRIBE WORK Replace 3 windows in home 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the house. Permit Inspection Cards Will Be Mailed t To Homeowner % Post SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 3216 m WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT `P $1.61 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- $97.25 Fire SC STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $3.22 PLAN CHECK FEE T/TEE Licen $5. .08 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATE.MEN P yA I T THIS I UR R f S,GNATURE OF OWNER,w OWNERSUiLDERi iDATE, BL NST' - OATE 01 P+epaid Plan Check $ Estimated Cost $ Receipt # Effective 1/1/99 CITY OF FRIDLEY R-39 COMMERCIAL & INDUSTRIAL BUILDING PERMIT APPLICATION Construction Address - �Q LQ uQ . ► Zoning Legal Owner &Address Caf &-e c�,p Kbo Tel# (o 1 a • S77) • &ll Co CCNTR=R & ADDRFM �R �LWe�D1a.c ' .a cS�z • 3-sb- gsrd A o -Yo' z.. r �I[c.Tel# � ba -11777 Architect Reg.# Engineer Reg.# BUILDING CONSTRUCTION TYPE OF WORK [] New [] AdditionAlteration -Describe VuC� � OFC. AREA: Length Width Height Sq. Ft. WHM AREA: Length Width Height Sq. Ft. OTHER AREA: Length Width Height Sq. Ft. 85 -1J -any OW7- APPLICANT QA� Tel # (111a' ! Date • �d q9 VALUATION Sq. Ft. x $ Cost/Sq. Ft. = valuation $ ) Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) 'IC7M VALUE Building Use Construction 'Type Occupancy Group Air Conditioning (]Yes [] No Fire Protection Provided [] Yes [] No Performance Bond Amount $ Permit Fee $ Fire Surcharges► a State Surcharge $ Park Fee See Reverse for Schedule Received [] Yes, [] No See Fee Schedule on Reverse Side In Excess of Prepaid Amount - See Reverse Side .001 x Permit Valuation (1/10th %) $.50/$1,000 Valuation (See Schad. for > $1 Million) $1050 per SAC Unit (Plans to MCC for determination) $450.00 Conservation Plan Review Fee Determined By Engineering Spec. Assessments $ Agreement Necessary [] Not Necessary_[] Driveway Escrow $ ,0 feet x $13.50/foot TCFML ATTACK STIPULATION 7- f4 'C—:a SUBJECT P city of Fridleyi"30 191 AT THE TOP OF THE TWINS BUILDING PERMIT r E � `v COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. f PROTECTIVE � [ E � �JJIIGGJJ KJ ` I "'1 CITY HALL FRIDLEY 55432 NUMBERREV DATE PAGE OF APPROVED BY 612-571-3450 910415 9/9/99 JOB ADDRESS 1475 66th Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 1 Creekridpre SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gerald & Carole Jensen 571-6116 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Jansick Inc. 6480 Squire Dr NE Fridley 55432 574-9679 R61R 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 AN REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK New Deck Top (decking over existing deck) 9 CHANGE OF USE FROM TO STIPULATIONS See stipulations on plan 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 ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 WITH WHETHER SPECT IED HEREIN OR NOT, THE GRANTING OF A PERMIT $3500 $1.75 DOES NOT PRESUME O GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF NY OTHER STATE OR LOLCAL LAW REGULATING CON- TRUCTION R HE ERFORMANCE OF C TRUCTION $97.25 Fire 3.50 PLAN CHECK FEETOTAI F License 5.00 0 S1GNA17 CON' RACTOROR AUTHORIZED AGENT N P PEOL IOATED 10 PSIs Y?t5 PE O SIGNATURE O� OWNER.a OWNER BUILDER. IDATEs BLDG SP E NEW[ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY \ ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: -° Legal Description: Owner Name & Address: gera tc( �r9lQ0LG - eT&NQS & A, Tel. # 6;�I— &/A 4 Contractor:-)'g0je'r -C kc . MN LICENSE # /9 Address: YSrO S G! crib //iQ. Tel. # 9>'/- 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: /14.tt) ��'�� T p Estimated Cost: $ 3,; �l . Cro Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: ?,&Z5?;!_APPLICANT: Tel. # 57 y- Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ 7 , z— $ 3. SIN $ , sZ) CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1050 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 [ ] -a/ W d -mi01 RONALD F. MEYER IA" SURVEYOR LANs EUMV"we suaemMeN o"Peh TSLVMOht i71.4Ne a" Jlan! Gy. al. PAQ6. MIN►0. metal M I hereby certify that this survey was prepared by me and that I am a duly Registered Land Surveyor under the laws of the State of Minnesota. ,� Reg. No. 9051 Date • Alee. IA. /ec. 8- /7- r -r oe/�C. a's 0 Indicates iron sonument plaosd X4t 3, Blook 1, CRBEKR M, Anoka County, Minnesota. 10/10'd 0££117LS 0i k-nalJd d0 AM W06A SS:80 6661 -80 -dm BENCH DETAIL 6X6 CEDAR POST 2-2X6 CEDAR CEDAR 2X4 ,2X8X14 STABALIZER IF NECESSARY 14' 12'-2" 9'-5" 2'-10" ' 2'-10" NOTE: i - WORK TO BE DONE: REMOVE DECK BOARDS 2X6 AND REPLACE WITH NEW 2X6 CEDAR. TREATED FRAME EXISTS. 2X8 TREATED JOISTS HANGERS EXIST JOISTS 24" 0/C FOOTINGS AND BEAMS EXIST NEW SEATS (BENCHES) TO BE REPLACED 9' 2-2X10 TREATED BEAMS a 1 22'-6" 01 SUBJECT , City of Fridley 32487 AT THE TOP OF THE TWINS BUILDING PERMIT RO. COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. f PROTECTIVE CITY HALL FRIDLEY 55432 NUMBER REV OTEPAGE OF APPROVED BY l 612-571-3450 910-F15 3/29/02 JOB ADDRESS 1475 66 AVENUE NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 1 CREEKRIDGE SHEET 2 PROPERTY OWNER MAIL ADORE" ZIP PHONE JERRY JENSEN 1475 66 AVENUE NE 763-571-6116 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO RENEWAL BY ANDERSEN 1920 CO RD C W, ROSEVILLE MN 55113 651-264-4777 20130983 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 K3 REPAIR O MOVE O REMOVE B DESCRIBE WORK REPLACE 7 WINDOWS WITHIN EXISTING OPENINGS 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310-9.1.2 of the 1997 Uniform*Building Code. Pe"n"t Inspection Ca Cards WillBe a'1 TO er To Posh SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN BO 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 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 $8,970 $4.49 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. $167.25 FIRE SC $8.97 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE LICENSE SC $5.00 $185.71 SIGNATURE OF CON'RACTOR OR AUTHORIZED AGENT IDATEi W EN PROPERLY VALIDATED THIS ISYOUR PERMIT Lk` ~ B , .NSF' OAt( S-GN4TURE OF OW NER,iF OWNER BUILDER, MATE, 01 NEW[ [ ] Effective 5/10/99 ALTER CITY OF FRIDLEY [) SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMr r APPLICATION Construction Address: Lo Rlky. N :. Legal Description: Owner Name & Address: 3-e.t f u� — ��'' Tel. # -fb3 • sn� J • & J I (P Contractor:; MN LICENSE # oi01309�'� Address: J9 a Cowrti 1t oqc nnn'1 SFS l 1� Tel. # (,A51 • a(p4 • tf L-+ Attach- for this application, a- Cerdficate� of -Survey .of -the lot, with the proposed tonstruction. dravvii-on it to scale. DESCR]! ON OF NOVVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: q Length Width Height Sq. Ft: DECK AREA: Length Width Hgt/Ground Sq. Ft. OTMR: 9 -ft e A IN, .. `i . n _ t. — Construction Type: Estimated Cost: $ $� 9 �O % Driveway Curb Cut Width Needed: Ft. + 6 Ft = _ Ft x $ _ $ DATE: r t'Q,pa APPLICANT: i�_r��e,,nr�..Tel. # cn, q+ CITY USE ONLY Permit Fee $A LQ '+- c` S Fee Schedule on Reverse Side Fire Surcharge $Ig.11 +_ .001 of Permit Valuation (1/10th%) State Surcharge $ q,qcl $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ S . QO $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 sj,652.4-1 STIPULATIONS: M CITY OF FRIDLEY INSPECTION DIVISION Effective January 1, 2003 6431 University Ave NE ��vjj h Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763),572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES box FAX (763) 571-1287 JOB ADDRESS RATE SCHEDULE (� OWNER J0Qr r) Residential Rate TOTpI. /�. Furnace Shell and Duct Work, Burner - BUILDING USED AS Also Replacement Furnace $ 30.00 $ (Side Vent - Fill Out Back) ESTIMATED COST '799 0 00 PERMIT NO. �^ Gas Pip' Needed with new furnace, $ 10.00 $ b not replacemen_) DESCRIPTION OF FURNACE AND OR BURNER Gas Range � $ 10.00 $ No. of Heating Units % Circle One (Steam) (Hot Water) Earm Air Gas Dryer $ 10.00 $ Trade Name &adr­, %m1�.y �p � Size No. BTU 10. vo ® HP EDR *Air Conditioning - All Sizes .$25.00 $ Fuel NC Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU _HP EDR Commercial/Industrial 1.25% of Value of Appliance or Work $ 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 State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. TOTAL FEE „,W DAT E ��` 63 MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO Ave. REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 M'55"3 PLUS THE $.50 STATE SURCHARGE Signed --� _ TEL # FAX # REINSPECTION FEE $47.00/Hr ' q ,�,11 *Air Conditioners can not be placed in a side yard without Approved By. � Rough -In Date' Final Date (� written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When imla _inn an exesfina fugnen, 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 exinflng cnmh uctinn air is sized and installed to meet the current codes and manufacturer's specifications. Yes( No( ) When required to onstall a now rnmhimfinn airy it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When InStaftri new venfing nystem, 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 #1 Type q(,s std l BTU Input '30, oo �� 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 j ft Length /' ft Diameter in Type ALTFRA 12NS- (Mandbel �sI-e// YKC T e iz�Ok --O 4VL/ J'- 2L )/w A t' 6'L'0J)5 ptrsavry HEATING CO: /l/ll�� �s d� ok km- A? r�'� M Signed By. Date: ✓/' �� " ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 (763) 572-3604 FAX: (763) 571-1287 1475 66 AVE NE 133024130061 CREEKRIDGE LOT 3 BLOCK I HEATING RESIDENTIAL ADDITION/ALTERATION PERMIT NO.: 2005-00026 DATE ISSUED: 01/06/2005 VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 0 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 306 APPLICANT CENTERPOINT ENERGY/MINNEGASCO 13562 CENTRAL AVE NE BRANCH 1111 LOUISIAN ANOKA, MN 55304 - OWNER HOWITZ, JOANN 1475 66TH AVE NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application 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 does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or therform ce of construction. Applicant Date Bldg Insp Iles n4 HEATING PERMIT MINEVIUM FEE 15.00 FURNACE SHELL/DUCT WORK 0.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 15.50 PAID WITH CHECK # 1025391 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 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 Gas Dryer f 11 *Air Conditioning - All Sizes All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS An b(A V_� Fee Total 'D , J , , Owner_ /ILG�/// p"/01.1/, % /, $35.00 $ Building Used As Awt-1 $10.00 $ ESTIMATED COST�PERMIT NO $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $25.00 Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. $ BTU HP EDR Fuel Total Connected Load $ 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 $ _ and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. $ HEATING CO $ SJ Signed Tel # REINSPECTION FEE $50.00/HOUR FAX lJ��°-��� l ��/�� Date /e ;7 *Air Conditioners can not be placed in side yard without written approval J! 1/ �`�� !�G '� ZJ/ fJ leper' from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE /� Approved b� +- 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 _ Appliance #2 Type _ Appliance #3 Type _ Total Appliances Common Vent Type _ BTU Input _ BTU Input _ BTU Input Total Btu Input Fan Assisted or Nat Fan Assisted or Nat Fan Assisted or Nat 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 : 431 University Ave NE .ridley, MN 55432 763) 572-3604, FAX (763) 571-1287 e -k) `-' APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MAKK NUMbtK UI- FUC I UKt:S I v tat, INSTALLED ON EACH FLOOR i al ift J,111 11 IN .....Show er ..�.:.(.��. Wash Tray p ,::::<:: Floor Drain ::<::,< :.: Auto. ::: .: Gas Water Heater Stories ...U Gas Elec.. Baseme Floor r 1 Floor 2 o r FIo 3 -- Floor 4 'LUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS sawe Z5 ©wli tl✓ 4ew Fixtures Ad Opening, New Fixture Seer Dispenser Now Off Basin ;atch Basin lain Water Leader Sump/Receiving Tank Nater Treating Appliance Nater Heater -Electric Nater Heater - Gas** Sas Range** Sas Dryer** Sack Flow Preventer Required ( )Yes () No Type. $10.00• $10.00 $10.00 $10.00 $10.00. $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 $15.00 Reinspection Fee $50.00/Hr 4LL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE $ The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE- ® 5 08 O 20 HOWITZ, ROBERT OWNER 1475 66TH AVENUE NORTHEAST FRIDLEY, MN 55432 BUILDING USED AS (763) 789-6214 -e,,�,O ekc e. ESTIMATED COST "I CU CN; PERMIT NO. NORBLOM PLUMBING CO. PLUMBING COMPANY (812)827033 2905 GARFIELD AVE. SO. SIGNED BY _ _-- -- -� _ _ -- -- _ -- - _-CFI. h1a Final Date 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 ail 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. R; 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 Tctal 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 :