PRE 2010 DOCS0
City of Fridley, Minn.
9
BUILDING PERMIT N® 3877
Date: I;z ®.... .......
Owner.. ��,�lddvs��...
....................................... Builder
Address...................................... Address .............................................
LOCATION OF BUILDING
No. 4� Street Z. Part of Lot ...............................
Lot ............ Block .................. Addition or Sub -Division .......................................
Corner Lot ............ Inside Lot ............. Setback ............ Sideyard ...........................
DESCRIPTION OF BUILDING
4�To be Used as: c �/^I� y ff e =� / /�
" � ..... ..� a �?epth �.�'LJ Height !� `0 Sq. Ft. !� /. Cu. Ft.�4310
.................... Fron ........Depth ........ .Heeight ........ Sq. Ft. ........ Cu. Ft. ........
Type of Construction ................• • Fast. Cost../ Pp.. !. .. .. To be Completed ...................
In consideration of the issuance to me of a permit to construct the building desribed 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.
. Act ... 1 ..................
In consideration of the payment of a fee of $.6."n" ., 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 city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. ®'
../.,0ft,ZZd' . ,jBuilding Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
c
DAIKI]I>h
ADDRZ—SS
00
z
Property Line
NEW.,Afft Act,-JLM�_
Front
Property Line
................ ......................................................
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY,. MINNESOTA
Owners Name e ' Builder..
zz
Address _ &'dress _
LOCATION OF -BUILDING
No. Street �, _Part of Lot _
— --
Lot'—',— Block Addition or Sub. Div.
Cerner dot' Inside Lot 'Set Back.
=4pplicant- attacks to this form Certificate of Survey of Llbt . and proposed
building location.
DESCRIPTION OF BUILDING
T6:be used as'
Front Depth..:_ Height
Sq. Ft. Cu. Ft.
Front , Depth Height .�._
Sq, Ft. Cu. Ft.
Type of Construction Estisna.ted Cost
0 ° �l
To be completed
The -undersigned hereby, makes application for a permit for the�work
herein specified,.agroei.ng 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 tr a and correct,
Date �'�" / nature .
..��� `�_ Si g
(A Schedule of Fee Costs can be found on the Reverse Side)
Date:
May 24, 1965
City of Fridley, Kinn.
BUILDING PERMIT
Owner: Leo T. L Mer Builder Kork Builders
Address 567th. Ave. N. E. Address 2621 We Avec No.
7503
LOCATION OF BUILDING
No. 556 street 67th. Ave. N. E. ---- Part of Lot
Lot —4 __ Block 7 Addition or Sub -Division _ Rige ChMek `.terrace Mkt --k
Corner Lot _ Inside Lot Setback Sideyard
Sewer Elevation — _ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front Depth Height Sq. Ft.
Type of Construction
Front Depth Height Sq. Ft.
Est. cost 9t 65000 _ To be Completed
0 Repair Storm Damage
0
Cu. Ft.
Cu. Ft.
In consideration of the issuance to me of a permit to construct the building described above I agree to do
theproposed work in accordance with the description above set forth and �Inlianceith aft provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of1$ 0.00 , permit is hereby granted to Mork Builders
to construct the building or addition as described above. This permit is granted upon
the ery
condition that the person to whom it is granted and his agents, employees and workmen, in all work
doneFridlnnesota regarding location, construction, alteration, maintenance, repair and movhzg of buildings
man. city limits and this permit may be revoked at any time upon violation of any of the provisions of said
None
This permit don not dorsr the dondruddon, butalldion�to; wbtng, phmnbing, gn boding, sower or water. Be ora to on
the Building Wqm for for aparde perm6e for tMso items.
,s?ti 1 I.3 7 `I
APPLICATION F0R'BtiILDING PERMIT
CITY OIC' FRIDLEY, mnwwTA '
OWNER'S NAME /. '` WILDER%!Cj
ADDRESS S—'g — nl ADDRESS
LOCATION OF BUILDING
No. % treet Part of Lot
41 t7
LOT BLOCK �ADDITION OR. SUBDiVISTO i� gP-E R-' LWT__3K
Corner Lotinside LOT + Setback Side YArd
SEWER ELEVATION FOUNDAT160 ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
D.gSC*tPIION OF -BUILDING
To be used as:
Front Depth Height..
Sq. Ft. Cu. Ft.
Front ` Dept Height
Sq. xt.' Cu. Ft. c�
Type of Construct ion....
eAwid, Estimated Cost
To be completed
The undersigned hereby makes application for i permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances
and :rulings, of to Department of Buildings,, -and, hereby declares that all the, facts
and representations stated in this application are true. and correct.
DATE S SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
0
,yes B"dJou
COMMERCIAL - RESIDENTIAL
2027 Unity Avenue North. Minneapolis. Minnesota SS422 a Telephone 888-3888
May 200 1965
Leo. T. Lymer
556 '. 67th Ave. N.E.
Repair of storm damage at above address to consist of the
following:
Clean basement and main floor of house before work to started
as per dondemnation notice.
Replace service most, receptacles, and check complete electric
on house.
New roof jacks* chimney stack, three roof louvres.
Complete new roof - remove existing shingles and re -roof house,
breezeway and garage.
He -Wild the west wall of house.
New shakes on west wall.
Remove and replace plywood on gable end.
Now shakes on two sides of house.
Replace sheathing on about half of rear of house.
Rebuild about 201 of rear wall.
Replace some faoia on front and complete rear.
Gutters across rear of house.
Replace post and straighten others on breezeway.
Adjust garage door and re -glaze service door in garage.
Remove and replace shakes on three sides of garage.
Replace plywood on gable ends of garage, also, re -build roof,
soffit and facia on rear ®f garage.
Three basement windows - storms, sash and screens.
Patch cracks in basement walls.
Check out furnace, gas line to see that it is in proper order.
Three new fixtures - kitchen, hallway and dining room.
Remove sheetrock and insulation in ceiling of living room,
Kit®herr, dining room, hall and rear bedroom. Re -tape and
spray complete ceilings In house.
Re -insulate attic.
Remove and replace all sheetrock on dining roof and kitchen
where necessary.
Replace two oasement windows in dining room and one in kitchen.
Replace Formioe counter.
Remove and re -hand; cabinets.
Remove and replace ceramic tPoksplash on counter.
Replace rear door and threshold.
M
Me4A B"dJews"
2027 Verity Avenue Pl`60h.-Wianeapolis. Minnesota 88422 3041190.4 Telephone SSS -3988
-2-
Linoleum In kitchen and dining area (Armstrong Tessara ).
New header in kitchen to dining room.
Nutone kitchen clock - check or replace.
Replace linoleum in front entry.
Remove base and base shoe in two bedrooms* hall and living
rowel and replace.
8emove oak flooring In two bedrooms, hall and living rood and
replace with select oak flooring. He -send. seal and was.
Baster bedroom:
3 new Andersen windows (awning type).
New sheetrock on rear wall.
3 new closet doors.
New Andersen unit in i bath.
bath. Teen well tile.
Front corner bedroom:
2 Andersen sash.
Replace linoleum floorlin J
Replace the in main bath. Repair damaged wall.
New awning window and new door.
Replace picture window (triple unit' in living room.
Repaint complete exterior and interior of house, breezeway,
and garage.
He -stain, shellacs and varnish new woodwork to match existing
finish. Re -varnish reminder of wood casings, doors and
windows - cabinets.
Remove all debris from premises upon completion of job.
E
Total price .. labor and materiel: 69,463.00
Mussell fork
Application for Power Planus and Heating. Cooling, Ventilation. Refrigeration 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 120,000 BTU ............ 8.00 $
each add. 60,000 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
1st 3 Fixtures ..................... �_ x $1.50 $
Additional Fixtures x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
Dept. of Bldgs. Phone SW -3450
Location �S10
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 18 4�
Owner �.1iY+��+ 1
Kind of Building
Used as
To be completed about
Estimated Cost, $ /i�
Building Permit No.'T �'® 3 Permit No. 3 6 ? i2
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No
Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
Total Connected Load Kind of Fuel
BURNER — Trade Name Size No
AIR CONDITIONING Capacity Sq. Ft. E.D.R BTU H.P.
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM J
ALTERATIONS & REPAIRS TOTAL FEE Signer] ,d��
ROUGH G��� `e�'� 4��2 e�7�t� BY
w 42 Business Phone No- 15— 2
FINAL
(REMARKS -OVER)
1
SUBJECT
P
City of Fridley
� 7 8 5
AT THE TOP OF THE TWINS
BUILDING
PERMIT
L'�_____ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r
1 . �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
9/15/98
JOB ADDRESS 556 67th Ave NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
7
1 Rice Creek Terrace Plat 4
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Mark Smith
55432
571-0368
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
Owner 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
❑ NEW ❑ ADDITION O ALTERATION
6} REPAIR
❑ MOVE O REMOVE
B DESCRIBE WORK
Reroof house & garage (25SQ) 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
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
$2,142.00
$1.07
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-
$74.75
Fire SC $2.14
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL E
$77.96
SIGNATURE OF NIRA OR OR AUTN RI D AGENT (DATE)
EN P OPE ALIDAT
HIS I$
4S.ATURF-OF-15W*e*riTF
&PEP77M
OWNER BUIL ERI IDATEI
9L
IN SP
BATE
1
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
o�
�L
ConstructionAddress: `Z � co �f h� (,�% � �
Legal Description:
Owner Name & Address: .UM, L Ste, Tel. #
Contractor: MN LICENSE #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF BIPROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: 1-40wS Z Is— S p -m
Construction Type: Estimated Cost: $ 21`%
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: ! APPLICANT: Tel. # 7 t 36
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
$1000 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 [ ]
SUBJECT
IT NO.
City of Fridley
28928
AT THE TOP OF THE TWINS
BUILDING PERMIT
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
PROTECTIVE
1 . �
l I CITY HALL FRIDLEY 55432
NUMBER
REVOATE
PAGE OF
APPROVED BY
.---
1 J\ 612-571-3450
910-F15
2/19/99
JOB ADDRESS 556 67 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
7
Rice Creek Terrace Plat 4
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Mark Smith 556 67 Avenue NE
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Beissel Window & Siding 153 E Thompson, West St Paul, MN
55118 451-6835
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
6453
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
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
SQ. FT
CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
ISTALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$6,000
$3.00
DOES NOT PRE E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS ATE OR L CAL LAW REGULATING CON-
Fire SC
STRUCTI 0 E PERFO CE OF RUCTION
$112.25
$6.00
�+
PLAN CHECK FEE
TOTAL FEE
License SC $5.00
$126.25
GNATURE OAC 'RACTOR ORAUTHOR1 GENT iDATEi
WHEN PROPER VALI ATED THIS IS YOUR PERMIT
/
V ✓ `
S,GNATURE OF OWNERoF OWNER BUILDER, iDATE�
B�0 MSP
OAft
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Effective 1/ 1/99
P, I, oz I MWA,
Owner Name Address: 'AML Tel. #
Contractor: C 5 c 1 i MN LICENSE #� �� 3
Address: /��� -73', Sr�� 0 5/IF 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
Sq. Ft.
OTHER:
IArK
d_
Construction Type:
Estimated Cost: $ �4
(Fee Schedule on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ = $
DATE• —%— q APPLIC
CITY US ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Tel. #±-7'
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 [ ]
CITY OF FRIDLEY INSPECTION DIViSION
Effective On January 1, 2000
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION
AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS 5 S 6 / A �-
RATE SCHEDULE
�k
OWNERlho.rlL Sm
Residential Rate
TOTAL
Furnace Shell and Duct Work, Burner -
BUILDING USED AS fi vv5
Also Replacement Furnace $ 30.00
$ g" • "
j/ /
(Side Vent - Fill Out Back)
c
ESTIMATED COST D00- 00 PERMIT NO._
Gas Piping (Needed with new furnace, $ 10.00
$
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNER
Gas Range $ 10.00
$
No. of Heating Units ( Circle One (Steam) (Hot Water (Warm Air
Gas Dryer $ 10.00
$
Trade Name Size No.
BTU HP % EDR
*Air Conditioning - All Sizes $ 25.00
$
Fuel tial.✓ 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
30
representations stated in this application are true and correct.
TOTAL FEE
$
DATE lr'-�3'GJ
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
''//
HEATING CO �,w, Ar -k Q-.4 A/C-
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
Signed TEL #
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
Approved BA Rough -In Date Final Date
written permission from adjoining property owner.
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes W 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 o 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. YesK) No
Appliance Tvoe and Size/Common Vent and Vent Connector Information
Appliance #1 Type l Gi UUO BTU Input `��- Fan Assisted or Nat
Appliance #2 Type
BTU Input Fan Assisted or Nat
Appliance #3 Type
Fan Assisted or
Nat
Total Appliances 170,1
Total Btu Input
Common Vent Type 1 �
Vent Height /
Diameter '�
cr inches
Appliance #1 Vent Connector Height
3 ft Length eft
Diameter �4 n
Type e—
Appliance #2 Vent Connector Height
=ft Length a ft
Diameter S in
Type C—
Appliance #3 Vent Connector Height
ft Length ft
Diameter in
Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By:
/0 /3 —OO