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PRE 2010 DOCSi SUBJECT PE City of Fridley o 20290 AT THE TOP OF THE TWINS BUILDING PERMIT _ r RECEIPT NO. W. COMMUNITY DEVELOPMENT DIV. 6%® r PROTECTIVE INSPECTION SEC. 36%09 1 i w '--,,� CITY HALL FRIDLEY 55432 L „ NUMBER REV. DATE PAGE OF APPROVED BY --•. 612-571-3450 910-F15 4/10/90 JOB ADDRESS 154 - 7111 Way N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 2 Riverwood Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerry Tollefson Construction Inc. 311 Sunrise Lane, Champlin, MN 55316 427-7745 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 jJ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct.a 42'_x 34' Dwellingy a 26� x 221 Garage SEPARATE PERMITR REQUIRED FOR 9 CHANGE OF USE FROM WIRING, HEATING, PLUMBING AND SIGN STIPULATIONS Provide a hard surface driveway. Provide sod in the frriznt and side yards. Pro*ide City with copy of verifying survey before capping. See notations on plan. SEWER LOCATION; 90" Nest of M.H.. Clnv. 847.981 WYE ELEV: 847.48 TOP OF FOOTING: 850.98 Minimum WATER LOCATION: Same trench as sewer service 4'-8' East of Sewer. DRIVEWAY DEPRESSION: 16'' + 6' = 22'X $13.50 = $29.7.00 Paid $1,5.00,0.p P ri THE CITY Cr' FR;DLEY CUES NOS GUP""ANTEE THE ACCURACY OF UTILI fY LOCATIONS, AND ELEVATIONS. Before digging call for THIS DATA IS FOR INFORMATION PURPOSES ONLY, all utility locations PERSONS USING THIS INFORMATION SHOULD AND .454-0002 IT ON THE SITE, REQUIRED BY LAWVERIFY 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 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 $85,800 $42.90 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- School STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PL N CHECK FEE TOTAL FEE V A $619.40+PF &DW 0 R DAGENT (DATE) SI NATO FCONTR v, 0 EN PROPERLY VA LI THIS YOUR PER IT SiGNATURE OF OWNER 0F OWNER BUILDER) (DATE) BLDG INSP TE i E NEW Effective 1/1/90 ADCN [] R-1 AND R-2 ALTER [ ] Building Permit Application Construction Address: /_S` Y a Gvr91/ Legal Description: 47- % �a/®e z- .2 Owner Name & Address: Q—cr-ry 9,,,s7 - ,�.ve Tel. # Contractor: Tel. J® Tel. # Address: 3// e Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIMM AREA: Length 7'� Width 3 % Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DBCR AREA: length Width Hgt/Ground Sq. Ft. 07HER: Corner Lot [ ] Inside Lot [ Ft. Yd Setback -?S / Side Yard Setbacks Type of Construction: Estimated Cost: $ Approx. Completion Date: 7- r Proposed Driveway Width If New opening Is Desired: ,lC/'Y + 61 See Back Page DATE:'- APPLICANT: �� Tel. # 51 --?el ' /'0" CITY USE ONLY Permit Fee $ State Surcharge $ SAC Marge $ Driveway Escrow $ �a Park Fee $_�j4 o d Sewer Main Charge $ S STIPUTATIMS: Fee Schedule on Reverse Side $.50/$1,000 Valuation $600 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] ISN �/ �i� 11,cJawJ 67 erbio a q,3pag 1®-L9, e� �c ��a — z,qq I `'7 u p p%A\ 42 6 Z2 -v" V— ( m 0 IRTzs-3 K I01GG — 117RIV1.0wo IC8st11 0 C^%� ?S, %Q0.4 Owner MINNESOTA STATE ENERGY :ODE CALCULATIONS BASED OV CNAPTER OF THE MO M ENERGY CODE - 1963 EDITION Adoption Effr.ctive 111184 4114t R MIL - Phone rate 1g1Ia Site Address Contractor T61t-eF,sgnl c6NS-7t. Phone Building Classification: Type Al (Single Family & Duplex) -X_ Type A2 (Residential% (3 stories orr _ (Other) (Over 3 stories) GENERAL INFORMATION 1. Building Perimeter 5 ft. 2. Wall height (ground to eave) 54 ft. 2 3. 1. x 2. (above) .gross m4 11 arga, ( (v ft. 4. Building dimensions (L)- x (W) 116V ft.2 roof s floor area 5. Square fcot arearof rim joist - Floor joist size (2 x ? ) ? x Perimeter Rim joist areaft2 -T2- 6. f26. Doors - Area "3-7, Thic nness In. U factor Type of Construction Perimeter ft. Manufacturer 7. Total door's perimeter ft 8. Windows: Manufacturer 13 /?05 State approved U factor TYPE C �,M �L SIZE AREA (Ft.2) EACH DD 2D (0 0 2 o a � _ � •tea 1-Z NUMBER OF TOTAL FEET 2 UNITS - + --3z,nc� 2 l , afl SD, D -Z as n 9. Total ft.2 Glass ((� M- Fireplace area: Width x height x - = Ft•2 11 . Exposed foundation: Height x Perimeter x = 0-1 .!2 -2- Ft. 2 COMPLETION OF THIS FORM IS REQUIRED FOR ALL NEW CONSTRUCTION, MAJOR REMODELING AND BUILDINGS BEING (MOVED WHERE ENERGY, OTHER THAN THE MINIMAL CODE ALLOWANCE, IS USED. Q. �F.•smi ng area = 10% of gross wall area. 13. Gross wall area 06 1t& ft.2 Window area A 1 �� SAO ft.2 U windows = U x A = 177,.8J Rim joist area A (Z7, i�'Z ft.2 U rim joist = � D. U x A = S,Z Door area A �� RD 2� ft. U door area = .6-7 U L7 . x A.'-- ,&5 PAT16 DR, AREA A.? U 'PA7I0 bR, x L&I A71UM -DK. AREA f+? U ATKIUM v2, Fireplace area A ft.2 U fireplace = U x A = Exposed foundation A ft.2 U foundation = . 6(6 U x A ,= r /2 Framing area A I -/0 2 ft.2 U framing area = , 61,5- U x A = 3, Net wall area A >0 ft. U wall , d�-� U x A = 3$,30 (138) TOTAL . . . . . . . . . .. U X A = .14 3R4 14. Gross wall area x 0.11 (A-1 single family & duplex = allowable U x A/Code (13. above) x 0.23 A-2 other residential) x .23 Other buildings) x .28 (Over 3 stories) BTUH Must be largerf�Qr A 14:6 1 x U Code. 7F.-138 above 15. Ceiling framing area (Af) equals 10% of ceiling area Cor the same as) ISA. Gross ceiling area = (L) x (W) _ (-Z,43 ft.2 158 Joist area (Af) = 100c ceiling area = (Z(o, 3*6 ft.2 15C. Net ceiling area (Ac) (15A - 156) _ ft. 2 U ceil ing x A c= 1136,20 x , 02 ( 23/ S: U framing x A fa 12[",30 x 150. TOTAL U x A ............................. ........ Z�,,%a 16. Ceiling area (15A) x 0.026 (A-1 single family & duplex - code allowable U x A x 0.033 (A-2 other residential) x 0.06 (other) BaUH Must be larger than 15D (above) A (15A) (26 x U (code)= 3-.7M- F (or the same as) . Oz (� NOTE: Use U and A values obtained from ops 1, 3 and 4. LAI V(49 =6'1ND, 12-13 ONSTRUCTION R VALUE WING SECTION: i Interior air film 0.66 2 Arrp-Rio WALL - 3 LL3 S17.z inches soft wood 4 5N 6A?P/IN G 2•�� 5 StDiNen 6 Exterior air film 0.17 WALL SECTION (INSULATED) �1 Interior air film -{ 2 6 R. I- --i3 1 N SULA --{4 SNEATNla16 - -(5 SiDIn1Cx {F Exterior air film RIM JOIST SECTION: —�1 Interior air film '2 I'WILATIonf _ '3P/2 ! r-WaS 54 4 5 Sh I a SIDI ,(a ---�f� Exterior air film FOUNDATION INSULATION REQUIRED: Min. R-5 on entire wall OR Min. R-10 down to frost depth .. Y ' 44 j$ v , FOUNDATION SECTION: TOTAL R - -10,53 U- 1/R- ,0 �7 TOTAL R - 23.0 U - 1/R - ,6+ TOTAL R - 24, U - 1/R - '64 t --(1 Interior air film 0.68 —{2 INSUL-T1pN 2x STUD WALL) 13.0o —� 3 FOU NDAT1AN 1 (.29 —�4 Exterior air film 0.17 (5 (6 SLAB ON GRADE MEM Heated Slabs: Minimum R = 8.5 Unheated Slabs: d Minimum R = 6.2 1 A TOTAL R - IS,13 U- 1/R- (, 04 X . •. ..4• .,a'.•p •• Page 3 E -v VENTED CONSTRUCTION R VALUE' CEILING SECTION (INSULATED): i Interior air film o.61 2 CEILIAjCI GYP SU, ,5(0 3 ,IN S U LA'f/onl O0 4 Exterior air film still 0.61 TOTAL R - 4:&2$ U - 1/11 - ,OZ( CEILING FRAMING, SECTION: 1 Interior air film 0.61 2 Cj91 LIA16 &'1P, 132, .510 3 I ,oa 4 Interior, air film still 0.61 5 31/r- inches soft wood 4.3 g TOTAL R U- 1/R- 1624 CEILING SECTION (INSULATED): V Interior air film n,Fl 2 3 4 Exterior air film st i l l O. ,l TOTAL R U- 1/R= CEILING, FRAMING, SECTION: V Interior air film �.F1 2 3 4 Exterior air film still n.AI 5 inches soft wood TOTAL R - U- 1/R= Inside air film 0.61 2 3 4 5 Outside air film x.17 TOTAL R U - 1/R - Page 4 'v_s'n Hi 10vn USAINSA03 OPOQLO AAn• *Oak N11Ya 9013LO AHvjww u"DE Hos-am 0 6C IC LE - LC 6[ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — — PC - fit It ►t ------ tt of— --- --------- - -- ----- - ---- - -- -- tt It _ OC 61 - - --- - --- - -- --- - - -- -- -- -- 69 It It It sI Ct IL- _ - - -- - - -- - - - - -- ---- - - - - - Ii - - it----- ------------- ---- -._.....------- - It -- OI _ - - - - - Oi it Ite- -- - --- --------- - - --- --- -- - - — ll It 11 -- ----- --- - -- - ._ _... _ ..----- -- tl ,,41 ft it of 6 -- - - - - - - - - - - - - - - - - - -- - - - - - --- - 6 -j \-��f --r l 01-1/ (I wn -r---- I -- -- - - ---- - - - -- -- - - - --- -s ,or ► rq -00073 Z) — r c Effective May 1, 1990. CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: New Fixtures Future Fixtures Old Opening, Nov Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic valve Sump or Receiving Tank Water Treating Appliance Not Water Heater Gas Range Gas Dryer Back Flow Preventer Required. Type NO. RATE s 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 S 5.00 S 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 Yes ( 1 No ( ) _ S 5.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance Reinspection Fee $ State Surcharge ($15.00) TOTAL FEE Job Address Department of Buildings City of Fridley Tel. 0571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct �/�/g�r Fridley, �' ' 19 9C/ / OWNER / 11A, KIND OF BUILDING USED AS TO BE COMPLETED ABOW ESTIMATED COST TOTAL OLD - NEW BUILDING PERMIT NO. PERMIT NO. D `/, 1- $ <�C50 t S 16. b Company $ Signed / 5 Tel. No. S $ ROUGH INSP. $ Date S FINAL INSP. Date s $ APPROVAL FOR PERMIT S !1INIHUM FEE FOR ANY PLUMBING PERMIT IS $15.00 S PLUS THE $.50 STATE SURCHARGE s .50 e a a u x d Water my mE w qp (Uw Heater o5qL O U 43 W 0 U 0 W V U (n 4 3 m m t O [lec to to, to l7 i� V s let 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (•) - New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: New Fixtures Future Fixtures Old Opening, Nov Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic valve Sump or Receiving Tank Water Treating Appliance Not Water Heater Gas Range Gas Dryer Back Flow Preventer Required. Type NO. RATE s 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 S 5.00 S 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 Yes ( 1 No ( ) _ S 5.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance Reinspection Fee $ State Surcharge ($15.00) TOTAL FEE Job Address Department of Buildings City of Fridley Tel. 0571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct �/�/g�r Fridley, �' ' 19 9C/ / OWNER / 11A, KIND OF BUILDING USED AS TO BE COMPLETED ABOW ESTIMATED COST TOTAL OLD - NEW BUILDING PERMIT NO. PERMIT NO. D `/, 1- $ <�C50 t S 16. b Company $ Signed / 5 Tel. No. S $ ROUGH INSP. $ Date S FINAL INSP. Date s $ APPROVAL FOR PERMIT S !1INIHUM FEE FOR ANY PLUMBING PERMIT IS $15.00 S PLUS THE $.50 STATE SURCHARGE s .50 CITY OF FRIDLEY Effective MaY 1, 1990 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL RATE TOTAL Furnace Shell and Duct Work, Burner (Also replacement furnace) Gas Piping (piping needed with new furnace) Gas Range • Gas Dryer • Air Conditioning (all sizes) $ 20.00 S, 00 $ 10.00 $©v $ 10.00 $ $ 1(1.00 $ All Others/Repairs and Alterations It of Value of Appliance or work COMMERCIAL/INDUSTRIAL It of Value of Appliance or Work $ 10.00 $ State Surcharge TOTAL !LE Reinspection Fee ($15c.-00) Rough Insp. -5/11/C) //Date Final Insp. C� m Date Approval for Permit MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00 PLUS $.50 STATE SURCHARGE *Air Conditioners can not be placed in side yard without written permission from adjoining nettjhbor. $ .50 Job Address 1 l '2-- t. �C LA, Department of Buildings 6431 University Ave. N.E., Fridley, NN 55432 City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codea and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. 1/�� 1950 OWNER � C] -A T— KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST '� ® 0 y! OLD��) UILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER, \PLANTS, Steam, Hot Mate Ware A r-1`No. -1 Trade Name C TeI Size No. Capacity `1 S(X® Sq. Ft.GEDR BTUs I HP Total Connected Load � � ,� J Kind of Fuel 1j BURNER - Trade Name V �� Size No. Capacity Sq. Ft. EDR BTU HP Company � Signed By 2L 2/� �j �/ f� % Tel. No. 47`"I `� ( 7 l Fill out back side for stack verification on replacement furnaces CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; 1. Has been carefully examined Yes (,) No ( ) 2. Is free from rust or deterioration Yes ( ) No ( ) 3. Has no foreign objects lodged within Yes ( ) No ( ) 4. Is securely supported Yes ( ) No ( ) 5. Meets all current Code requirements for size and total BTU connected Yes ( ) No ( ) 6. Has Total heating BTUs of All other BTU's TOTAL Rema rk s Company Signed By Date �i CI ■ l ®F FRI DLEY CIVIC CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 - PHONE (612) 571-3450 June 28, 1990 Jerry Tollefson Construction Inc. 311 Sunrise Lane Champlin, MN 55316 Re`: Final Inspection at 154 - 71 1/2 Way N.E., Fridley Dear Sirs: A final inspection was conducted on June 28, 1990 of the above address and the following item must be completed before the structure can be finaled: Provide sod in the front and side yards by September 15, 1990. We will expect this item to be completed by the scheduled date and a reinspection called for. If you have any questions on this matter, please feel free to contact me at 571-3450. Sin y, DARREL G. CLARK Chief Building Official DGC/mh FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 . (612) 571-3450. FAX (612) 571-1287 July 18, 1991 George Bolf 154 - 71 1/2 Way N.E. Fridley, MN 55432 RE: Extension of Time to Comply with Fridley City Code Dear Mr. Bolf: Last month I sent you two letters concerning maintenance of your property at 154 - 71 1/2 way N.E. The three issues identified at that time were weeds, brush, and a lack of sodding in the side yards. After receiving these letters, you contacted me to discuss these items. At that time, I granted you an extension until September 30, 1991, to perform the required sodding work, and you stated that the other two problems would be corrected by June 28, 1991. A reinspection conducted on June 28, 1991, revealed that the brush had been removed and the weeds/high grass cut. I will be reinspecting the property on or shortly after September 30, 1991, at which time it is expected that the sodding work will be completed. Feel free to call me at 572-3595 if you have questions or wish to discuss this further. Thanks for your prompt attention to the weeds and brush and your cooperation in this matter is greatly appreciated! Sincerely, Steven Barg Code Enforcement Officer SB:ls CE -91-279 CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective On Jan 1, 2003 V'/7 MARK NUMBER OF FIXTURES TO :.•-:f::�:::::: Urinal Wash .i.. Tray BE INSTALLED ON EACH FLOOR Floor Auto. Gas Water Heater Gas EIe c:`.�....�: in n aStones = Basement Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader NO. RATE TOTAL Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range** Gas Dryer**' Back Flow Preventer Required ( )Yes () No $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 Type $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS. 1.5% of Value of Fixture or Appliance JOB ADDR 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. L ,200 Owner Building Used As L Estimated Cost C'XX.J PERMIT NO. 7 J-/ `1 0 PLUMBING COMPANY �0_40t (1� SIGNED BY TEL N0. Approved By • ) Rough -In Date Final Date State Surcharge $ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 TOTAL FEE $�� PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPUCA71ON WILL BE RETURNED r:QMMQN VFNL VENT CQNNFCTQR AND COMM ISTION AIR VERIFICATIQN When !pplar-onn an nxis in0 fitranrp, 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 plasticfPVC 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 manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes( ) No( ) The exi_sti n cnmbaietinn as is sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When required to install a new _nmb mfinn air_ it will be sized and installed to meet the current codes and manufacturers specifications. Yes( ) No( ) When inc+allinQ,a new venting �gys _m, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers 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 � :F. INIC10e3 Signed By. Date :