PRE 2010 DOCSJ
BUILDING PERMIT
Village of Fridley, Minn. N° 2977
Date ...�� ...................
Owner la". ` :.......................... Builder ... C:O�................0....
Address a2.� ?.7..�. ��......... Address �l.. .
LOBATION OF BUILDING
No. . .� . ..... 'Street AIV X .�� ........... Part of Lot .......................
Lot .... rr...... Block.... 7 , , . , ...... Addition or Sub -Division . 4-C4& e44404..... �
Corner Lot ............ Inside Lot ............ Setback ......... Sideyard ........ . ....
DESCRIPTION OF BUILDING
To be Used as:
Sq. Ft.........
i
of Constructio
Type/O
..� �.
Est Cost %��. To
. ....
Front.
Depth . y J J. Height
Sq. Ft. `f..4..® Cu. Ft........ .
............ I....... Front ........ Depth ........ Height .........
Sq. Ft.........
Cu. Ft. ........
of Constructio
Type/O
..� �.
Est Cost %��. To
be Completed ................
/,c 4, P G__"
;&- K ° o1%
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 village of Fridley.
.
In consideration of the payment of a fee of $. .. . , permit is hereby granted to .� . ........
....................... to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
I
... Puildiug Inspector
NOTICE: `'
This permit does not cover the construction, installation or alteration for wiring, plu bing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
City of Fridley, Minn.
BUILDING PERMIT N° 5813
Date:
a
Owner: Builder
Address
Address
O _
ION OF
No., io_ Street _ _ _ Part t
Lot _ 5_ Block Addition or Sub on
Corner Lot Inside Lot ,ilfback '� Sideyard
Sewer Elevation Foledation Elevation
DESCRIPTION OF BUILDING
T }
Front Depth Height { .se Sq. Ft, Cu. Ft
Fro t Depth Height Sq. Ft. Cu. Ft. of Constructions ;
Type, —Est.. Cost -», _ 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, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violatits� of any of the provisions of said
ordinances.'"°1.� .dt
Building Inspector
NOTICE:
This permit does not cover the Construction, installation for wiring, plumbing, eat heating, sewer or water. Be sun to ass
the Building Inspector for separate permits for thea hema.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Name [l��/l/�/ST��"�7 Builder
Address 2,6 0 - (o 7 - /V ,!!�7 . Address S -fi 10C
LOCATION OF BUILDING
No. L Q Street (p � "7 �Part of Lot
� - 1 ���'
Lot ,`� Block 5 Addition or Subdivision ICE 2�EX _� AZ.
Corner Lot ,Inside Lot Setback Z Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
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:
n��
Z26 % 7-C H��%,4P Front 40 Depth ZZ Height f�
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction C O D Estimated Cost ®C
Tobe Completed
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE n ��� SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
�_. /x/99
�� y
ME
m III
WKWO ZF/)
77,A4 I T/
74
1;6a5e
SUBJECT
PERMIT
City of Fridley
24053
P, AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
Ir
` COMMUNITY DEVELOPMENT DIV.
L
r PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
4/8/96
JOB ADDRESS 260 67 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
5
5
1 Rice Creek Plaza South SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Erwin Vanheel 260 67 Avenue NE 571-0998
CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
D & D Home Improvement Inc 7401 Central Avenue NE 784-7943
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
O NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Reroof House (14 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 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
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
$1,120
$.56
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISION ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$40.25
Fire SC $1.12
STRUCTI OR HE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
License SC $5.00
$46.93.
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT F IDA EI
WHEN P RROAPPERLYp THIS IS Y UR PERMIT
p-LIDDAATED
ry Vim'
BLDq INSP MATE
_
SIGNATURE OF OWNERIIF OWNER BUILDERI IDATEI
NEW Effective 8/l/95
ADDN )) CITY OF FRIDLEY �...
ALTER )) SINGLE FAMILY AND DUPLEXES R-1 AND R -Z
Building Permit Application
Construction Address: 60— '' Aee • — -
Legal Description:
Owner Name & Address:
Contractor: D & D Home Improvement, Inc
Tel.
MN LICENSE # 4840
Address: 7401 Central Ave NE Tel. # 784-7543
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LMNG AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: -
Corner Lot [ j Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: �'�� ���i� �n mat Cost: $ / /�6
Completion Date: �-�
Approx. comp ori l � r l A/
(Cost on,Back)
Driveway Cut Width Needed: Ft. + fft = Ft x
DATE: $_ APPLICANT: Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$850 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 [ l
CITY OF FRIDLEY INSPECTION DIV.
Effective On March 1, 1996
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVIdES
JOB ADDRESS-22
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work herein
Residential Rate
TOTAL
specified agreeing to do all work In strict accordance with the City Codes and
Jtr Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
6)
rulings of the Building Division, and hereby declares that all the facts and
$ 30.00
$ -36).c
representations stated in this application are true and correct.
(Side Vent - Fill Out Back)
.` ��-,1991
Gas Piping (Needed with new furnace) $ 10.00
$
OWNER �Y�-clr�.(� V&��
��
Gas Range $10.00
$
-
BUILDING USED AS
Gas Dryer $10.00
$
T
ESTIMATED COST 0 PERMIT NO.
*Air Conditioning - All Sizes $ 25.00
$ . on
All Others/Repairs & Alterations (LIST ON BACK)
DESCRIPTION OF FURNACE ANP 90[j,BURNER
1% of Value of Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Commercial/Industrial
Trade Name A - &/i2A9&R . Size No.
BTU 7��oL> HP EDR
1.25% of Value of Appliance or Work
$
Fuel Total Connected Load
State Surcharge
50
Burner Trade Name Size No.
BTU HP EDR
TOTAL FEE
HEATING CO NY C `
AAINIMUM FEE FOR ANY HEATING OOLING 1NE.NTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25 00
Signed
4
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
Approved By Rough-in Date Final Date
"Air Conditioners can not be placed in a side yard without
FILL OUT BACK SIDE F R STACK VERIFICATION ON
written permission from adjoining property owner.
REPLACEMENT FURN CE
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CIIEWNEY 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:
I/
01
suBjEcr
P IT NO.
City of Fridley
27084
2 7 0 8 4
AT THE TOP OF THE TWINS
BUILDING
PERMIT
NO.
COMMUNITY DEVELOPMENT DIV.
1 PROTECTIVE INSPECTION SEC.®�
9
r
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
8/10/98
JOB ADDRESS
260 67 Ave NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
OESCR.
5
5
1 Rice Creek Plaza South
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Erwin Vanheel
571-0998
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
MCR 829 20 Ave NE Xpls 55418 7RA-5749
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 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof hTear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
UndeHayment must comply with State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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. TIjkGRANTING OF A PERMIT
166$
.83
DOES NOT PRESUME TO GIVE AUTHORITY T OLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTAT R LO AL AW REGULATING CON-
TRUCTION OR THE PER R ANC CON T CTION.
5
1.66 Fire SC
�+
PLAN CHECK, FEE
TOTAL EE
Sc/
1-
$I AT i E F C LTRACTO R AUTMORI D A IDATEI
N P OP
r<ILD)NSP
ALIDAT HIS IS Y R PERRIT
81GNATU EOF N E R I IF OWNE R BUILDER) IDATEI
� r
DATE
I/
01
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 q
BUILDING PERMIT APPLICATION
ConstructionAddress: Z 6 62 E - I /
Legal Description: r
Owner Name & Address: /
Contractor: / v L . C— . 2.
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
h
� _Tel. #
_ MN LICENSE # �� 3�% 96
S712,/,/ bTel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF L%IPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Gi
c) () S- / etc fcei e
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: b - 'APPLICANT:
VA, Q- S , Tel. # �� S
CITY USE ONLY
/
Permit Fee
$ ��'7' Dy
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ 0'3
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$ 'UU
$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 $ 61.4
. STIPULATIONS:
Building
MECHANICAL
Permit No.
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
ACLU T 0 IV 2010
CITY OF FRIDLEY
763-502-4977 FAX
EFFECTIVE 7-1-2010
DATE ® ® YOUR E -MAI A, DRESS
SITE ADDRESS �•
-!���rr
THIS APPLICANT IS: ❑ OWNER R ONTRACTOR
PROPERTY
NAME:OWNER/ d,
ADDRESS: 0/ ''L CITY / ' TEA ing?
TENANT
PHONE:
CONTRACTOR
COMPANY NAME:
CONTACT PERSON: i'4
SUBMIT A COPY OF
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE WITH
��yyyy��
ADDRESS: Lt �, CITY �G ! STATq�W 1p
APPLICATION
3— i P FAX 24— 2� 3—
PHONE
PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW ❑ REPLACEMENT ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK.
Equipment Installed MFG: MODEL: SIZEBTU
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZEBTU
A/C $25.00 (GAS) $15.00V GAS RANGE/OVEN $10.00
_FIREPLACE
TO AIR EXCHANGEER $15 (WOOD) $35.00 NEW GAS GRILL $10.00
_AIR _FIREPLACE
$35.00 $35.00 _GAS UNIT HTR $10.00
_BOILER _FURNACE
CHIMNEY LINER $10.00 GAS DRYER $10.00 _POOL HEATER $35.00
DUCT WORK $10.00 _GAS PIPING $10.00 _VENTILATOR $15.00
A3a`�F II a44
MR -
a
'�"1 d
�''T"
_ i�i�4t w¢K` �E;� '4 ?p
" ri` L/."k� �`•wT "3, �i.
& 'fro �vRy - +. F �+'4,i 4y' L C'd .k, T 4 �s Gf ✓ ) 3
Ep..
iaA 1
R
y�
MO� ���
i,S
i.
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all wrlowhich irees re . w and approval of plans.
SIGNATURE OF APPLICANT �– / PRINT NAME /i� �l DATE P
APPROVAL INSPECTORS SIGNATURE DATE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
0 NEW HOMES/ADDITIONS VEXISTING HOME 0 MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments MN Rule 1346 Sec. 501
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
4. Heat loss & cooling load per room
a. MN Rule 1322, Sec. N1104.4.13
5. Ventilation
a. Per MN Rule Chapter 1322. Sec. 1104
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.
CITY OF F RIULLY INSHLI; I ION UIV.
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Eltective On Jan 1, 1uU2
PLUMBING FIXTURE RATES: NO.
RATE TOTAL
JOB ADDRESS lLI.�=t'g% I-jY_ /UC-.
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
�a- a Com_, 20n--)
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Owner
Water Heater -Electric
$ 7.00
Water Heater - Gas** _�
$10.00
Building Used As yi (5Y) -o
Gas Range**
Gas Dryer**
$10.00
$10.00
Estimated Cost 57 i 5 — PERMIT NO. _
Back Flow Preventer Required ( )Yes () No
Type
$15.00
PLUMBING COMPANY
Reinspection Fee $47.00/Hr
SIGNED BY TEL N0.7- �/S/
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
FAX #
1.5% of Value of Fixture or Appliance
Approved By Rough -In Date Final Da 4171�
State Surcharge
.50
MINIMUM FEE F ANY PLUMBING/GAS PERMIT IS $20.00
TOTAL FEE
$
PLUS THE $.50 STATE SURCHARGE
COMB STION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
a
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
When re larma an_xicting f amp, 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�-rNo ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination.
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
The existing rnm6 ,Minn air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new enmhi istien -*r. it will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes-4-�o ( )
Yesk--KNo ( )
Yes,V�No ( )
Yes,O'No ( )
When installing_a new vpntina systpm, 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.(rNo ( )
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. Yesj(J'No ( )
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
HEATING CO:
Signed By: Date :