Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
PRE 2010 DOCS
City of Fridley, Minn. BUILDING PERMIT Date: i Owner: der Address Address y� LO ATRN OFI,,qUILDING No..... l.. . Street ,._._.. . /_ _.•,r _.. Part of ................ Lot .'r .......... Block _.._....... _.... _................. Addition or Sub -DivIsio ....._ ....1r.cr� 6 Corner Lot ................ Inside Lot ....................................... Setback .... _*.._....._ Sideyard . _ ...._....... ..._......... Sewer Elevation _..._....................... Foundation Elevation .............................. ....... ................ ... _._.......... _...._....__ DESCRIPTION OF BUILDING To Used as: s el ------..._ _ Front �!......_..:- I Depth _e�.. Height G Sq. Ft. ,r. Cu. Ft. *VD .._. ._ ..�...... Fro _ Depth :..@6._r ie ht. --/.Sq. Ft. •--ch•�- Cu.Ft.11 Tnstruction .. � ..........._.. - .......----.. Est. cost...:.... i L::::':. ...... 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 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 any7p, n olation of�any of the provisions of said ordinances. 7- / 7 Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to sea the Building Inspector for separate permits for these hems. cijjjjj�4 R. *`--" 0 . .s APPLICATION FOR BUILDING PERMIT CITY OF FRMIZY, MINNESOTA Owner's Address Address LOCATION OF BUILDING No. Street � % _� �l�a�A l� � iF Part of Lot Lot b Block Addition or Subdivision AG a e K'&'dze Mae Corner Lot P""' Inside Lot Setback_2.5: Side -Yard 5 SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILD;NG QK � To be used as: V2 Sq. Ft. Cu. Ft. Ft. Cu. Ft. Type of Construction"--,-:z:y� - Estimated Cost To be 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 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. .74 (A Schedule of Fee Costs can be found on the Reverse Side.) i, f 41 Application for Power Plaints and Heating. Cooling, Ventilation, Rervigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: Furnace Shell & Duct Work .......................... Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 .................. Repairs & Alterations each add. $500.00 ............... MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ each add. 60,000 BTU ....................... Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 ................. Repairs & Alterations each add. $500.00 .............. STEAM or HOT WATER SYSTEM RATE TOTAL 8.00 $ 5.00 $ 5.00 $ 2.50 $ &00 $� 2.00 $ 5.00 $ 5.00 $ 2.50 $ 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 h ........................ .00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOT L 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 MENTILATING SYSTEM $ ;ALTERATIONS &REPAIRS TOTAL FEE REMARKS: Dept. of Bldgs. Phone SII 4-7470 f 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 �truu� de ft Owner Kind of Building Used as 195- 195- 195— To be completed abouty. IAN 2 9�.. 00 Estimated Cost, $ OAE-!ew. uilding Permit No. DESCRIPTION OF WORK Trade Name,✓X z e t Size Capacity Sq. Ft. E. �� BTU H.P. Total Connected Loa 'w1&1'01A'04 Kind of rue BURNER — Trade Nam Size Capaci 4 Sq. Ft. E.D.R "/BTU H.P. / GEO. SEDG ICK H i G. & AiR-COSID. CC) l0 1001 Xenia A . S. Minneapolis 16, Minn. Sioned By offilyoll, POST IM -12-58 Business Phon No Og D,36 -463k-75, c 4#0, i,4 HEAT LOSS CALCULATIONS Weatherstrips ASHVE' Eui4eOut. Wan Int. Yes—No Windows Doors Reference "Yes_No Fl —, Room I Length As� Width tr* 3ARTMENT OF BUILDINGS MINNEAPOLIS. MINN. instruction No. Insulation I I Ceiling Roof - —[--Floor Kind How Applied ight 11 F1 F 7 77 Room I Length' ' Width','HeighF Windows and Doors--Crackage and Area A reti Width Height No of Lineal ft. Area No. of pane of pane lights of crack sq. ft., Width Height* No of Lineal ft. Area No. of pane of Dane lights of crack sq. ft. 'Oe, .1 Coef. Btu Infiltration Infiltration Coef. Btu Infiltration ti 77 Net exp. wall Exp. wall Int. wall Glass Ceiling >s Floor cluv Exp. wall Ceiling i Net exp. wall, Floor Int. wall Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Ceiling \., Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Lenath Width Windows and Doors—Zrackage and Area A reti Width Height No of Lineal ft. Area No. of pane of pane lights of crack sq. ft., 11 Btu Infiltration .1 Coef. Btu Infiltration Infiltration Lk _T111 71 —Glass Exp. wall ti 77 Net exp. wall Exp. wall Int. wall Ceiling Floor Int. wall Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area ight e�,' Fl. I i Room I Lenstth Width' Height Windows and Doors—Crackage and Area Width Height No of Lineal ft. Area No. of pane of pane lights of crack sq. ft. 11 Btu Infiltration Coef. B!� Coef. Btu Infiltration Lk _T111 71 Glass ti 77 Net exp. wall Exp. wall Net exp. wall Net exp. wall Int. wall Int. wall Ceiling i —Floor Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area F1.1 Room I Length Width Windows and'Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. ? 4' Lz-- i�; Windows and Doors—Crackage and Area Coef. 1 11 Btu Infiltration Coef. B!� Glass Lk W ice' Exp. wall ti 77 Net exp. wall Net exp. wall Ceiling Int. wall Ceiling 4-f 7" 7777 Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. ofp4.ne of pane lights of crack sq. ft. 0 Coef. B!� Infiltration Glass W ice' Exp. wall Net exp. wall Int. wall Ceiling 'Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area I sq No. of Dane of pane lights of crack ft. I I I . JCoel Infiltration a .r Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R or sq. ins. W.A. Leader area 0° Application ftr pay°;nor Plariam and He ng. Coaling. venfflation, risem:410a and Air Conditioning Systems and ®avj*ces PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... Rft $ $10.00 Replacement of Furnace ............................. Mk $ 6.00 Repairs & Alterations—up to $500.00 .................. k -ft $ 6000 Repairs & Alterations each add. $500.00 ...............Ea$ 3.00 MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ ka $ $10.00 each add 60,000 BTU ....................... Water, Warm Air—No $ 3.00 Replacement of Furnace ............................. $ 6.00 Repairs & Alterations—up to $500.00 ................. Total Connected Load.— $ 60� 6.00 Repairs & Alterations each add. $500.00 .............. Size No $ 3.00 STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... ftj $ $10.00 Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... $ 10.00 Each add. 200 sq. ft. EDR Steam ...................... $ 3000 Each add. 320 sq. ft. EDR Hot Water .................. ka $ 3.00 OIL BURNER—to 3 gal. per hour over 3 gal. per hour—Fee Fee Schedule 199 000 l GAS BURNER (up to BTU)..... 5.00 $ GAS FITTING fi& 199S000 BTU NO RATE TOTAL 1st 3 Fixtures x $ $ Additional Fixtures �.:.... . , x $` Gas Range to ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL See Fee Schedule TOTAL FEE $ Dept. of Bldgs. Phone SW --3450 �j i Location_ / 7`T6 / p% 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 correiK. Owner Kind of Used as Fridley, Minn- 19gi To be completed about �Y/ Estimated Cost, $ 4 �' � Old New. B,iulding Permit No. - `� /0 1 Permit No. zft DESCRIPTION OF WORK 6'oo HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No Trade Name _ Size No. Capacity Sq. FL E.D.R BTU H.P. $2000 Total Connected Load.— Kind of Fuel_ • 75 BURNER — Trade Name Size No $5.00 Capacity — Sq. FL E.D.R BTU H.P. (REMARKS—OVER) Business Phone Application for Power Plants and Healing. Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ..........................$10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ NECK. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ........... Oti0' $ each add. 60,000 BTU ....................... 3.00i $ Replacement of Furnace ............................. 6.00 It Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 ...........:.. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 110.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ....................... 3.00 $ Each add. 320 sq. ft. EDR Hot Water ............. .... 3.00 $ OIL BURNER—to 3 gal. per hour ........................1 6.00 $ over 3 gal. per hour—See Fee Schedule L GAS BURNER (up to 199,000 BTU) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x 2.00 $ Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x 5.00 $ AIR CONDITIONING Af.� FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOT FEE $_ ROUGH FINAL Dept. of Bldgs. Phone SM -3450 j L—flon / Y�/_ Co 5� 61&,� , ae City of Fridley: The undersigned hereby makes application for a permit for the work hereir. specified, agreeing to do all work in strict accordance with the City 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. 194— Owner Kind of Building Used as To be completed about Estimated Cost, $ / ©f!1 V Old ew. Building Permit No. Permit No. 2-2/ DESCRIPTION OF WORK HEATING or PO R team, Hot Water, Warm Air—No Trade Nam ' Size No .70 Capacity '� SSR BTU ffip. Total Connected Load Kind of Fuel BURNER —Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. ARKS -OVER No. Make Original 0 PERMIT for Power tiants and Heating, Cool- ing, Ventilation, Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK Plants to be installed—altered—repaired pe r Oil fired ; Coal fired ; Gas fired_; Gas Authorization No Remarks, Approved Final Inspection Date '19- Inspector 7-1 Permit AT® 4501 Fee $ Office of the Inspector of Buildings City of Fridley City of Fridley, Minn. , 19 - Owner Location Kind of Building j How Occup,ed°� Work to be Commenced ,19_ To be Completed rt -e/ � ,19� Estimated Cost, $ Old -New, Building Permit No. Permission is hereby granted to IN to install—erect—use the material and devices described in the above statement. This permit is granted upon the express condition hat the person to whod it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and Ito, the specifications set forth in the approved application for this permit on file in the office of the Inspector of Buildings. Inspector of Buildings 4z 2MiWv CITY OF FRIDC _ APPLICATION FOR PWMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: N0, RATE TOTAL trh :Ser Fixtusesx ` $3.00 $ 4 3i $2.00 S __ water x u S __ Catch Basin x $5.00 $ •� to $5.00 $ a x $10.00 $ Water Softener Heater W , • x $5.00 $ AM M at0+ -4 a ..i r Q M 0 .e(C �i ani LI N �C �N N ►� $3.00 $ r� .A . M $ .Gas Range to 199,000 BTU ,+ $10.00 $ .••CCC �o o e First $100.00$5.00 o as lec LIS`%u $ State Surcharge, a� $ .50 H x as FA w 1st c nE ct it ac 2nd 3rd 4thash (R) - Future Connection Opening Connected with Sewer (•) - New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: N0, RATE TOTAL trh :Ser Fixtusesx ` $3.00 $ Future Fixture Opening • 3i $2.00 S __ Now Fixture, old Opening ^_ x $2.00 S __ Catch Basin x $5.00 $ Water Heater - to 990000 BTU, x $5.00 $ 100;000 BTU to 199,000 BTU x $10.00 $ Water Softener x' $7.90 S New Ground -Run Old Building x $5.00 $ Electric Water Heater J x $S.00 $ !_ GAS FITTING FEES; 1st 3 fixtures' x $3.00 $ Additional Fixtures �� x $1.00 $ .Gas Range to 199,000 BTU x $10.00 $ REPAIRS B ALTERATIONS First $100.00$5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge, $ .50 TOTAL FEE $ • 8.00 REINSPECTION FEE ($]0.00) Job Address 191E f, 4-.o Wrv"+r, Department of Buildings City of Fridley Tel. #571-3450 a The undersigned hereby makes application for a permit for the work here specified agreeing -to do all work in'strict accordance with the City Code and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and cor Fridley, M.9. 1-27-77 , 19 OWNER Anthony • Krall KIND OF BUILDING frame USED AS res. TO BE COMPLETED ABOUT 2-3-77 ESTIMATED COST 10.00 OLD - NEW BUILDING PERMIT NO. PERMIT NO. A-1-10 P Company Signed By % Tel. No. ROUGH INSP. Date FINAL. INSP. l Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 Class "A" SurcharEe •-Ux 01 SUBJECT PE City of Fridley 18922 AT THE TOP OF THE TWINS BUILDING PERMIT RE COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. y J79 2 '52 1 ) ; l 1� ��'-' �,� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY ---- L 612-571-3450 910-F15 5/5/87 JOB ADDRESS 194 - 69th Avenue N.E. 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 20 4 1 Rice Creek Plaza North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Anthony Krall 194 - 69th Avenue N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Dailey Homes 8510 Central Avenue N.E. Blaine, -MN 55434 784-3910 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 2 ADDITION j] ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 301x 20' Attached Garage; Convert existing 20 ' x 22' Garage to living area, 9 CHANGE OF USE FROM TO STIPULATIONS Rear yard variance to 4.45' approved by Appeals Commission on April 14, 1987 with stipulation that no windows to be placed in west wall of new garage. I AM ARNIING SEPARATE PERMITS REQUIRED FOR ' )digging call local utilities WIRING, HEATING, PLUMBING AND SIGNS, VlliHONE - ELECTRIC - GAS Eta.. REQUIRED BY LAW 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 $9.30 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $18,600 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- STRUCT) N OR THE PERFORMANCE OF CONSTRUCTION. $134.50 r4 PLAN CHECK FEE TOTAL FEE \16 "s, $ 33.63 $177.43 NAIVP OF NTRACTOROR TMORI DAG T IDATEI WHEN PRO PE VALIDATED THIS IS YOUR PERMIT � J BLDG )NSP/0ATjF SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI 01 NEW [ ] City of Fridley Effective 4/1/86 ADDN. [`r-] R-1 AND R-2 ALTER. Building Permit Application Construction Address: f j [ *` �� �� �g Legal Description: Owner Name & Address: `U -��D A- l [ Tel. # Contractor: ` eti 40 r S Tel. # Address: g5(0 L° eNh�1 AVE - Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width 0� b Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Cis +je-Nn P AvC) R=&Ci— -- Corner Lot [ Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Type of Construction:�'�q� �Iar�ci� Estimated Cost: ��$. Approx. Completion Date: v c, �. Sfi lam— �®,c�v• -f $6/6DC) , f /0,00u z 19,60() Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: LPf APPLICANT:�j Tel. #�_L_ CITY USE ONLY $ / _50 Fee Schedule on Reverse Side $ 25% of Building Permit Fee $ Q $.50/$1,000 Valuation $ $ 525 per SAC Unit $ `..OR Fee Determined by Engineering tR Agreement Necessary [ ] Not Necessary [ ] $ t�7, 6 6 y.3 �)o Lei, sJDocuS To '9IL, /9, G®a Iba,00 Land Annin9 Laid S�yimy Sods ksfinq (rwl t- A"Mu of jolt)X6� yrs-Hq>S,� Ks ME. Mrnrru/lo/s ?l. EN G I NEE R I N G, INC. *w-vla SUrrx'� Q•e0rr — En ineers E Sur vecyors — fn�rnecrrny �% , certif caste of SU3pVey�3FRG S T!'OM 6 9 —" A Vf -IV OF N. E, , f T.. 9 — J02.24 — CGlV " r CC' — 1Z5.0/ - 35.0 o � G V R/CE CREE f� �L�4 Z�4 NoR rH ADD/ T/O/V /herby cerfify &d /his s o hw and owitcf representation *TO survey el& bemdoryes &wybed land o{'1Ys► largtiivn spa!/ brnfSn9S ,1YWrw , add! v sib/e arnwh owls , i`aay, {,a�n or erg sold /and. As surveyed by n r !Ms SUB URBAN ENGINEERING , INC. X00.41$ SGOT ry 0 i� x 6` � � n v � � a o o r ° v 0 1 x 6'N M i'l v 0 0 v n 0 r m v L9� WIN miC) 1p 1J I �1 N A n r r W p r O n ITI Z r,rr,o N i-13 — –� - G) i G1 N o =' D P iTI � N Lnv tj =Z m c) z C% qW 7=o To CONC. FUR. o ,711:0Z n�� 6P CO 0 g L� - ��-q rjZ �G) o= R_ Z: to r o — –� - G) T iTt -�1 u -mac i O cis ' �►'�. v n � 7=o To CONC. FUR. o ,711:0Z n�� 6P CO 0 g L� - ��-q rjZ �G) o= R_ Z: to 40��� S CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1993 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 l4 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 Furnace Shell and Duct Work, Burner - 6V rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 20.00 $ � representations stated in this application are true and correct. / _— Z/ /e ,199 !'✓ Gas Piping (Needed with new furnace) $10.00 $ �j OWNER / 0�'+-'ice �� Gas Range $ 10.00 $' BUILDING USED AS �� f� Ir Gas Dryer $ 10.00 $ �� ESTIMATED COST SU r® PERMIT NO. *Air Conditioning —All Sizes $10,00 $ All Others/Repairs & Alterations (LIST ON BACK) DESCRIPTION OF FURNAQE AND OR BURNER 1% of Value of Appliance or Work $ No. of Heating Unfts--L Circle One (Steam) (Hot Water) rm Trade Name Iry c e a o Size No. -2SfV A's-L;e", 'ai v Commercial/Industrial BTUHP EDR 1% of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge 50 Burner Trade Name Size No. BTU HP EDR TOTAL FEE HEATING COMPANY -5 4 Z -A #' C_ MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 Signed Bf' Tel No, 45 � r 4/S PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 Approved ou h -in Date Final Date ; � Air Conditioners can not be placed in a side yard without d� written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes ( j 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 Remarks List Alterations Bei.nq Done: HEATING COMPANY Signed By t ��/i�f'l� ���/U ce x, Date g a i SUBJECT City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. ' -------- - PROTECTIVE INSPECTION SEC. r � i �'--1 CITY HALL FRIDLEY 55432 NUMBER REV DATEPAGE OF APPROVED BY ,.J 612-571-3450 910-F15 1/6/97 JOB ADDRESS 194 69 Avenue NE T LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 20 4 Rice Creek Plaza North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Anthony Krau 194 69 Avenue NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Artisan Carpentry Inc 15060 Cobalt St NW Ramsey MN 55303 427-5331 1741 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 ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Install basement bathroom in existing room 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. 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 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KN THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND RDI ANCES GOVERNING T IS TYPE OF WORK WILL BE COMPLIED W H WH THE SPECIFIED HE OR OT. THE GRANTING OF A PERMIT $5,000 $2.50 OES N PRESUME Tf UTH ITV TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE ROVISI N OF ANY OTATE R LOCAL LAW REGULATING CON- S O THE PEC OF CONSTRUCTION. $99.75 Fire SC $5.00 PLAN CHECK FEETAL FEE 1 Licens SC 5.00 $112.25 S ATUREOFCONTRACTORORAUTHORIZEDAGENT (OATEi P RLY VALI ED THIS IS YOUR PERMIT It f —27- " OG i P gaTE _ SIGNATURE OF OWNEROF OWNER BUiLDERi tDATI a i NEW [ ] Effective 3/1/96 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: r�1 �� 6c% AV. -v (~ Legal Description: Lo , , ,C�� {/0F- Q.4 Owner Name & Address: Y 1('-,2 A -4-t- Tel. # Contractor: _A-ernsA-vj C A?t—W1--Xy, i-ri C . MN LICENSE # I N / Address: l SZ 6 O Lo$A-L-r 5/7—, 44v"56—/PAJ Ss 303 Tel. #, W2 -S77/ 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: gms in, n) r 6" Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Type of Construction: Approx. Completion Date: Side Yard Setbacks Estimated Cost: $�� (Cost on Back) Driveway Curb Cut Width Needed: 6 Ft = F $ _ $ DATE: f —3— 15 ir APPLICANT: Permit Fee $ �?775- Fire Surcharge $ 15-04) State Surcharge $ SAC Charge $ License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ Z/ .d. - STIPULATIONS: 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 [ ] A as / n Ni co A/—n w M CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Stories Basement Floor 1 Floor 2 Floor 3 Floor 4 I APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR h... Wash Floor. 11119*11"M 111111111Auto. Urinal I... .............:...�Sho werI....�. � Tray ..............Was her Effective On March 1, 1996 Gas !'i#rG:: Water Heater Range t Gas I Elec PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS_ I I / � 4 Ayt New Fixtures $7.00 v�! � 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 J 199 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner Water Heater —Electric $ 7.00 r� Water Heater — Gas** $10.00 Building Used As Gas Range** $10.00 Gas Dryer** $10.00 Estimated Cost 11560 PERMIT NO. Back Flow Preventer Required ( )Yes O No kb� TYPe $15.00 PLUMBING COMPANY / ,.�/ It Reinspection Fee $42.00/Hr SIGNED B TEL No. -3✓ �� ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance ,700 ' Approved By Rough—In Date Final Date State Surcharge $ .50 _ MINIMUM FE FOR ANY PLUMBING/GAS PERMIT IS $20.00 TOTAL FEE $a��SV PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES. SUBJECT O.` City of Fridley 250 "4' � AT THE TOP OF THE TWINS BUILDING PERMIT r ` ______ COMMUNITY DEVELOPMENT DIV. tr 1 PROTECTIVE INSPECTION SEC. r � , NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 ''j 612-571-3450 910-F15 5/7/97 JOB ADDRESS 194 69 Avenue NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 20 4 Rice Creek Plaza North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Anthony Krall 194 69 Avenue NE 574-9545 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Woods Construction Co 7728 Knollwood Dr, Mounds View MN 55112 786-2321 8737 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 J7 REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Partial reroof of 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 OCCUPANCYLOAD 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 1 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 $1,155 ` @ .58 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- $40.25 Fire SC $1.16 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE � License SC $5.00 $46.99 SIGNATURE OFC NT OCT OR OR AUTHORIZEDAGENT ID TE) WHEN PROPE Y,ALID TED THIS IS YOUR PERMIT ' BLDA INSP 1r_ 1 f -f Fla TE SIGNATURE OF OWNERIIF OWNER BUILDER) IDATEI NEW [ ) Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES .R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: G Legal Description: Owner Name & Address: 5s& iG Contrac Address fim • tiif� . _ �_y.0 .'MN LICENSE#i t • 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 GARAGE AREA: Length Width Height DECK AREA: Length Width Hgt/Ground _ OTHER: Pvzoj MA410� Sq. Ft. Sq. Ft. Sq. Ft. v � Construction Type: �' p1 Estimated Cost: $ 0,p V246 o 4100 AQV 0/4--�� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: �% J� APPLICANT: ��/ Tel. # if CITY USE ONLY Tg a&) � G( Permit Feey� / 04 $ , Z� Fee Schedule on Reverse Side c Fire Surcharge $ .001 of Permit Valuation (1/10th%) 4 f*v/State Surcharge $ $.50/$1,000 ValuationG ' SAC Charge $ $950 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 [ J TOTAL $ lC STIPULATIONS: SUBJECT ERMIT NO. City of Fridley , 265 1 4 AT THE TOP OF THE TWINS BUILDING PERMIT r REC • COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. � 1 f( J NUMBER RE" DATE PAGE OF AnvnovED BY CITY HALL FRIDLEY 55432 �"•'� j 612-571-3450 910-F15 7-9-98 JOB ADDRESS 194 69th Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 20 1 4 Rice Creek Plaza North Addition SHEET Ne 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE tism Anthony Krall 574-9545 20138780 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Four Seasons Roofing & Remodeling, 7930 University Ave Fridley, MN 55432 795-9410 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 j7 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Remove and replace roof (35 Sq) -tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment 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 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 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 $1.46 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,919 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 $2.92 ,-SLRUCTLON OR THE PERFORMANCE OF CONSTRUCTION. 7' 9� PLAN CHECK FEE License SC 5.00 OTAL FE $84/3 SIGNATURE OF COCXACToRbR AUTHORIZED AGENT IDATEI _ PRO RL ATED T I IS Y RPE 10 UX U ga7E SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEIBlz-DG•IN NEW [ ] Effective 1/1/98 ADDN [ ] CITY.OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ' BUILDING PERMIT APPLICATION�`J ConstructionAddress: 10 c/ Legal Description: Owner Name & Address: A 0-n ca Tel.- Contractor: el:Contractor: �DU� �S®mss �a�-�� ��t d /moi c vnerie.�� ✓�a !� (L MN LICENSE # JO 138_7 8 Address: ��� C.,(w� �5� le, IU ,�� Tel. # __77 �1/® Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EUPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: J�me_ - Q, -n J&,4 .a 3 57 " t- Sh I ng le- C Construction Type. -M 6 ye�.-���ar _ Estimated Cost: $�1 (Fee Schedule on Back).. Driveway Curb Cut Width Needed: DATE: Ft. + 6 Ft = Ft x $ = $ APPLICANT: LTel. # ITY USE ONLY TOTAL $ /_3 STIPULATIONS: Permit Fee $ l Fee Schedule on Reverse Side Fire Surcharge $ ..001 of Permit Valuation (1/10th%) State Surcharge $ l- _ $.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 $ /_3 STIPULATIONS: Lbc�- A11-7 C6 � !/-- 0 t CI,YOF FRIDLEY INSPECTION DIVISION 6431 University Ave NE Fridley, MN 55432 APPUCATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $.50- $10.00 50r$10.00 $ $10.00 $ $10.00 $ $ 25.00 $ State Surcharge TOTAL FEE $ .50 MINIMUM FEE FOR ANY HEATING/GOOUNG/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. �j rjr 5v Effective On January 1, 1998 JOB ADDRESS pct 4 The undersigned hereby makes application for a permit for the work herein specked 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. ,1998 OWNER A -U L BUILDING USED AS ESTIMATED COST b om PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units_ Circle One (Steam) (Hot Water (Warm Air Trade Name j c r Size No. `7 5 0 BTU -? --za a HP EDR Fuel ,vR-: Gas Total Connected Load Burner Trade Name ( C� Size No. -7 -7:5,70 0 a BTU_ N --E:> co HP EDR HEATING MP Y Signed Approved By Rough -In Date _ FILL OUT BACKSIDE FOR STAC VERIFICATION ON REPLACEMENT FURNACE HOME ENERGY Co' e,JT;ci 15200 25TH AVE. N. 0123 PLYMOUTH, MN 55447 Tel No. (D 12- ? (p 1 Ci X10 Final Date 1 CITY OF FRIDLEY INSPECTION 6431 University Ave NE Fridley, MN 55432 (763) 572-3604 RATE SCHEDULE DIVISION APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Residential Rate Furnace Shell and Duct Work, Burner - Also Replacement Furnace $ 30.00 (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, qk3 $ 10.00 but not replacement) Gas Range 1 iv5e /if flow — $ 10.00 Gas Dryer $ 10.00 *Air Conditioning - 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 TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. JOB AD Effective On January 1, 2002 GO "x)& OWNER �' T It a �"� K TOTAL pro BUILDING USED AS iro v—L C�' $ � ESTIMATED COST PERMIT N0.____LS DESCRIPTION OF FURNACE AND OR BURNER No. 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 an $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE'`�� HEATING CO _ o a4 Signed I Aidq- TEL # FAX # Approved By � Rough -In Date Final 1)44_j�'4 THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When r I� acing an existong Branae, 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 axle ing rnmht,stien air is sized and installed to meet the current codes and manufacturers specifications. Yes( ) No( ) When required to install a new cembistinn air. it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When ine alling a new ventina ny_gtem, 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 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: