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i 0 0 City of Fridley, Minn. BUILDING PERMIT Date: _. Nov. 14, 1968 •CST - Address A.L. Williams 947 86th Ave. N. W. Builder Same Address Same LOCATION OF BUILDING No. 844 Street 73rd Ave, N. E. _ Partof Lot Lot __._ 3_ Blocl1 1 Addition or Sub -Division .__Diana A d do Corner Lot —_ Inside Lot —.X Setback 35'--- Sideyard Sewer Elevation ___ _ Haman Appro. 868.75 Top of Footing DESCRIPTION OF BUILDING To be Used as: N° 10019 Dwelling_ Front _28' Depth 4 -0' _ Height 20'__ Sq. Fi. 1120 Cu, Ft, 22401 Garage Front 20' Depth 22' Height 10' Sq. Ft, 440 Cu, F, 4400 Type of Construction Frame Est. Cost $15, 000 To be Completed Sewer Location Water Location 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 in compliance with all provisions of ordinances of the city of Fridley. v7� �A $100.00 Sewer Connection Charge In consideration of the payment of a fee of $ 41.00 , permit is hereby granted to A. L. Williams the express condition that m toconstruct the building or addition as described above. This permit is granted upon 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 andmoving of buildings within the city limits and this permit may be revoked at any time upon violation of the provisions of said ordinances. c Clarence Belisle NOTICE: This pennh don not corer the construction, bm dlafion for wiring, phnnhhtg, gas hearing, sewer or water. Be sure to me the Building hapeetor for mparate permho Por then item. 0 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNEh Is NAME :`� : ADDRESS &Z - ADDRESS LOCATION OF BUILDING NO o STREET 7,�� 92 --je 0 le-- LOT 3 BLOCK ADDITION OR SUBDIVISION V %,QA1 ,E COR_NM LOT INSIDE LOT�SETBACK 'SIDEYARD SEWER ELEVATION TOP OF FOOTING 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: / R- Front Depth Height Square feet %l ';2 6 Cubic Feet -w . LSP Q I Front p Depth Height Square feet Cubic Feet Type of Construction/J�,�,-, �2Estimated Cost G 0� To Be Completed �,' /- e 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. 1 DATE � II / ,l/ - � SIGNATURE .� (Schedule of Fee Costs can be found on the Reverse Side.) 4// , 0 0 City of Fridley ` Application for Plumbing and Gas F'itti'ng Permit Dept. of Bldgs. Phone 360-3450 DESCRIPTION OF WORK Location.—II _ �/3 Number, Kind and Location of Fixtures / g uta{ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $2.00 ��/ op $ Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. x $1.50 !2� 13 x $3.25 N WATER HTR. GAS ELEC. Base �a 3 Water Heater (Up to 99,000 BTU) ...... x $3.00 $ New Ground Run Old Bldg . ............ x $3.25 $ Electric Water Heater a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... Z x $2.00 ist ? Additional Fixtures .................... 1 1 ! Gas Range to 199,000 BTU .............. x $5.00 $ 2nd 3rd 4th • Future Connection Openings e New Fixture, Old Openings I Connected with Sewer El Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $2.00 ��/ op $ Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. x $1.50 $ Catch Basin ............................ x $3.25 $ Z �a 3 Water Heater (Up to 99,000 BTU) ...... x $3.00 $ New Ground Run Old Bldg . ............ x $3.25 $ Electric Water Heater a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... Z x $2.00 $ �O �. Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description................................................$i 00 TOTAL FEE $ z 91, City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Mnn 17 19 Owner W"&� ✓J Kind of Building Used as To be completed about Estimated Cost, $ (1 ® Old New. uilding Permit No.Permit No. Signe By Business Phone No ROUGH FINAL . d2 AT° 4810 Origin Permit f®r P U RING AND GAS RITTING N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for I F t ! I inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit., DESCRIPTION OF WOKS Number, Bind and Location of Fixtures G m Stories � W Q ... ....w Z m W Y FW WATER HTR. ' W G T W Z S G y S>- Z Z O Z Z U it (j J O 4 O' rc Q= Q z Q O O Q F m a m X m a 0 Z O S J K Q Q Q D Q IL Q Q GAS ELEC. 3 U 7 M F M ra 3 t D LL N LL a U m M J E ti. O Q t9 K Basement f �_ 1st 2nd 3rd 4th Connected with Sewer -Cesspool Gas Piping for Openings i Permission is hereby granted to do the plumbing and gas fitting in the building described in the stateme t hereto attached, upon the express condition that the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and this permit may be revoked at any time upon the violation of any of the provisions of said ordinances. By Order Of The Inspector Of Buildings Roughing in Inspection Date Inspector. Final Inspection Date Inspector. City of Fridley Oaa2 ,�PO 19-0 t Owner - Location g�/ - 5, 7. 'C. Kind of Building— Used uildingUsed To be Completed '19— Estimated 19_ Estimated Cost $ Old -New. Building Permit No. / ®. O / 2 Date Inspector of Buildings. {� p O Application for Power Plants and Healing. Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone 560-3450 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 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ 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 ...... $10.00 $ 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 ........................ 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTU) ....................... 5.00 $ .- r over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x$ 200 $— e 0 Additional Fixtures x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL ek See Fee Schedule TOTAL FEE �/- � i Location � ` 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. p Fridley, Miggn—19 Owner _ Kind of Building Used as To be completed about Estimated Cost, $ Old—New. Building Permit No. Id� ®'� permit No. 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 Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) Signe1/1.4ilz✓��/ ' �. By C ` COJM�P42 Business Phone No 7 Z- Z / G 0 ° 6L0' -, 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 $ 000G ' s Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM 6.00 $ Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $ 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 ........................ 6.00 $ over 3 gal. per hour—See Fee Schedule 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 $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $g!fC.- 4712 0 - ROUGH ROUGH FINAL Dept. of Bldgs. Phone 560-3450 2 .; 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. Fridley,Mn?�/Ail.� 19OZ 1Vr; Owner -- — Kind of Building Used as To be completed about .6— Estimated Cost, $ 'Z� Old N lding Permit No. Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No Trade Nam LZZ1Z4'4 Size No- Capacity Sq. Ft. E.D.R BTU 5 A.P. Total Connected Load %,1 Kind of Fuel L"¢� BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Signed « Business Phone No PERFECTION HEATING COMPANY, INC, (REMARKS—OVER) 2936 FOURTH AVE SO. . TA. 3.5287, MINNEARO1M $ MINNESOTA f Ddb � ..� �" HEAT LOSS CALCULATIONS DEPARTMENT OF INSPECTION MINNEAPOLIS. MEA Weatherstrips A.S.H.Construction No. Guide Referen Out. Wall llnt.Wall Ceiling 19_ I Roof I Floor Insulation Windows Yes—No I Doors Yes—No Kind I How Applied 2-1A,49 Fl. Room I Length y Width I 6,Height Z F1.1 A �- +, Room I Length Width Height Windows an oors—Crackage and Area Coef. Btu Windows and Doors—Crackage and Area area Width tMeight No. of Lineal ft. Area No. of pane ofpane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. Width Height p. Q r / C � Coef. Btu Infiltration Glass P Q 6 Infiltration Glass's Exp, wall Exp. wall Net exp. wall Int. wall Net exp. wall 9. o® Int. wall Ceiling Floor Ceiling 9,0 Floor Total Btu. lZ . Z1 Total Btu. 17 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. k. . or sq. ins. W.A. Leader area ,Bmm I Length d ?-,,Width/ ZHeight 14:m a F1.1Af oom (Length Width / Height Windows and Doors—Crackage and Area Width Height No. of Lineal Lt. Area No. of pane of pane Ifghts of crack sq. Lt. I� / e t/ 6 - , / Windows and Doors—Crackage and Area Width Height No. of L1nea1 ft. Area No. of pp�ane of pa/ne ll�gjhte of crack sq.�itt.. _� �C //r. % ! _ f Infiltration Glass Exp. wall /. Net exp. wall Coef. Btu Q @ Infiltration C"Z 6,5 --el Glass Exp. wall 7i C1 Net exp. wall Int. wall Width Height No. of Lineal ft Area No. of pane of pane ligiihtss of crack eq. ft. Ceiling Floor 2-1A,49 Total Btu. t? Glass Exp. walliem �) Require s . t. E.D. Y. or sq. ins. WA—Leader area Ceiling oom I Length ZZ Width Height p. Windows and Doors--Crackage and Area Width Height No. of Llneal Lt. Area No. of vane of vane llghte of crack ea. Lt. 'ICoef.1 Btu Infiltration n Glass / ' D Exp. wall Net exp. wall Cj Int. wa Ceiling 1 Floor Vital Btu. , ed aq. ft. E.D.R. or aq. ins. W.A. Leader area Int. wall Ceiling Floor Kequire>� sq.Z s -E.K. or sq. ms. w.A. L.eauer area -��i�o Rmfn I Lenath // Width /6 Hem=h Nm Windows and Doors--Crackage and Area Width Height No. of Lineal ft Area No. of pane of pane ligiihtss of crack eq. ft. Coef. Btu Infiltration t? Glass Exp. walliem Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Original 0 0 PERMIT for Power Plants and Heating. Cool= ing, Ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of Heating Plants to be installed--altered—repaired Make , Wze ; Oil fired—,Coaled ;Gas fired ;Gas Authorization No. Remarks Approved by Final Inspection Date , 19_ Inspector Permit N° 4402 Fee $ 7. o -e Office of the Inspector of Buildings City of Fridley City of Fridley, Minn.., Owner Location 73'`x. Kind of Building A How Occupied Work to be Commenced—, 19— To be Completed ,19_ Estimated Cost, $ Old -New, Building Permit No.Z-0 ��— Permission is hereby granted to U CLO to install—erect—use the material and devices described in the above statement. This permit is granted upon tV express conditi6n that the person to whom 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 to the spec' ations set forth in the approved application for this permit on file in the office of the Inspector of Buildings. a Inspector of Buildings 42 2M11 -67V Original i • PERMIT for Power Plants and Heating. Cool- ing. ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of / Heating Plants `1-Ze_,J to be tolled ltered—repaired Make 4=7�� -' O1 Q.�� , S. / "1.0 ! o Oil fired_; Coal fired ; Gas fired ✓ ; Gas Authorization No. Remarks Approved Final Inspection Date , 19_ , Inspector Permit N° 4403 Fee Office of the Inspector of Buildings City of Fridley City of Fridley, Minn.., O , 19A21 Owner Location Y-.// 75 Ad�_ Kind of BuildinJg/ How Occupied Work to be Commenced 27- a ,19�e2 To be Completed ,19-9 Estimated Cost, $ '5:t;D • 4&e Old -New, Building Permit No. /O. 0/9 Permission is hereby granted to v /V -L4 C0 to install—erect—use the material and devices described in the above statement. This permit is granted upon the express condition At the person to whom 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 to the specifiWations set forth in the approved application for this permit on file in the office of the Inspector of Buildings. Inspector of Buildings az 2M11 -67V Northwestern Bell 6540 Shingle Creek Parkway Minneapolis, Minnesota 55430 April 5, 1976 Mr. L. R. Hoekstra 841 - 73rd Avenue Northeast Fridley, Minnesota 55432 Dear Mr. Hoekstra: This letter is to inform you that the Northwestern Bell Telephone Company does occupy a portion of the utility easement paralleling your west property line. We have no objection to your plans of constructing a fireplace on the west side of your home as long as it will not interfere with our being able to maintain, repair or reinforce our facility. ngineering Manager cc: Mr. Darryl Clark Community Development Administrator City of Fridley JLS/mo GW Cr7F3L0 GGnGraL TGLGvision, inc. OF FRIDLEY 350 -63rd Avenue N.E. Fridley, Minnesota 55432 [612] 566-6100 April 59 1976 Daryl Clark Community Developement Director Fridley, 'Minn. This letter is verification from General Television of Fridley that permission is granted Larry Hookster to infringe';on no more than three feet of our easement at 841 73rd,'ave. N.E. Chuck Hungerford n� 1 Assistant Manager Minnegasco Minnesota Gas Company 733 marquette avenue, minneapolis, minnesota 55402 April 6, 1976 Mr Darrel Clark Community Development Administrator City of Fridley 6431 N E University Avenue Minneapolis, Minnesota 55432 Dear Darrel Confirming our phone conversation on April 2, Minnegasco has no objection to the encroachment on the utility easement which is the westerly 10 feet of Lot 3, Block 1 Diane Addition. Sincerely Warner P Blake Assistant Vice President, Operations Ar c Larry Hoekstra ]*sip NORTHERN STATES POWER COMPANY 4501 SETH AVENUE NORTH BROOKLYN CENTER, MINNESOTA 55429 Apri 17, 1976 City of Fridley 6431 University Ave N E Fridley, Mn 55421 Attn Mr Darrel Clark Dear Mr Clark Larry Hoekstra of 841 - 73rd Avenue N E, is building a fireplace on the west side of his house. This fireplace will infringe two feet into the utility easement at that location. Northern States Power Company has no objection to this proposed construction. Sincerely Ox 1. J-0-� W F Laidlaw General Manager North Division WFL/rp l o� SUBJECT City of Fridley F?"'ft 13436 AT THE TOP OF THE TWINS BUILDING PERMIT r EIPT NO. '` `L -------COMMUNITY DEVELOPMENT DIV. r i PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 4/5/76 JOB ADDRESS 841 - 73rd Avenue N. E. 1 LEGAL LOT NO, BLOCK TRACT OR ADDITION SEE ATTACHED DESCR, 3 1 Diane Addition SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Laurence Hoekstra 841 - 73th Avenue N.E. 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 ❑ NEW ❑ ADDITION 51 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct fireplace 9 ,CHANGE OF USE FROM TO STIPULATIONS Letters received from utility companies allowing fireplace to encroach into easement. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Concrete 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 R-1 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 yS`] OOO • 5O 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- $6.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $6.50 SIGNATURE OF CONTR,CTOR OR AUTHORIZED AGENT (DATE) EN PROPERLYY#tAATED HIS S YOUR P RMIT BLDG INSP DATE �'IGNATU OF OVVNEA (IF OWNER BUILDERI (DATE) l o� . OR ADDITION - BUILDING PERMIT 1 CITY OF FRIDLEY, MINNESOTA . BUILDER: ' ADDRESS: ADDRESS H0:. • g �/ STREET: CLG� �, LOT: BLOCK: � . ADDITION: �iCc rl� cu�dyc CORIv'ER LOT: INSIDE LOT: SETBACK: SIDEYARD:� •. Applicant attach to this form Tvio Certificates. �f Surve of Lot and.pxoposed - building location dvuwn on these Certificates. •' •DESCRIPTION•OF BUILDING - To Be Used As: ' /1 �7�rep C Front: Depth : Height •r • Square Feet: Cubic.Feet: Front: Deptfi: Height: Square Feet; Cubic Feet: Type of Construction: Yasc-7cal"'Y Estimated Cost: To• Be Completed: JLL' The undersigned hereby makes applicativi• for a permit for the work herein . specified, agreeing to do all work in strict accordance with the City of - Wdley Ordinances and rulings of the Department of Buildings, and herAby declares *that all the facts and representations stated in this applicatiory are true and correct. , . �� • DATE: , 1 i SIGNATURE:—, GhGe % F • (See Reverse Side For Additional Information.) FI GLIZE N0. A-9 (A 6-164 ?WL5 P:R STRAP- WAER? JOINT5P ARE PAMLtLTO C+;!M- 2-A'2 _- 't KEY 5TW3 TO R CC•Y- M47CAP 2FROf.xu ;co jCaY 2' T �E Q%GN:k.4t 4- 4 x11ASNMAIG2- #2 kog4jt � FsueL,NarG, -�• AT RODF e• 'p so ir ri CGNCP�TF 3 % ; cw M/uoveY y1 - T cQ•KREiT� RAJ ill Mare: 41 SLA9 AND RAISeD 42eDZvi, Caeer rort Rrcrs To — 14EA7T1 TO 33 TIES— 3'eo So/sr, vasrem ss QWN IN Tots whir 2 /g ' ' SECTION BOLTS ce 6 ,41a Neal. I-'fi0N-LGIAbU6Ti9Ltr �/ ` tiGV•CCM3i7bLE ---I�_'1NSTEL Z$s9i 6 --li 4 L+r►T=L IXe/a.+T li/Eiawr, !per I .fYav ar /2� �' � dYg nr.:P� R I �I11 lb �� tom'—.:•.—eG-.1 RFMor14/B- u Lr • Rc�rore�/8' I• �• UNDERFLOOR•+-/ 't • UXIVERFLOOR eg . `+ . GZADE . I': • 1', r GRADE T T UML/120 CH/MNQY SECTION Z11-60 GN/MNEY SECTION DETAIL .f �ETMH/L 2 '11.0Ame-0 •/i (1NCP W/lM FIR�••BR/CX ALL f00TFNGS 710 EX?END WrO NATUM?,'L tlJVD/STUQ3,5/2 GROV,VP BELOW Fe05T 1.1MVe NOTES 1. tiVH?.RG PLATES AR -E CUT ANCHOR TO CHIMINEY aY 3/S xt' STEEL STRAPS HOOKED INTO CHIM�yEYAMD ATTACHED TO PL,ATes by 2- 31eA3' LAG SMEWSF 2-%Z' wLTS OIL G-IGd NAILS, 2. P_EINF02CWF_NT AND ANCH02AGE SHOWN AbOvI IS 7_EQW2ED NJ SrISN11CZOWE No. 3. B. wHamt MmPrR5 ARE U5ED THEY SHALL NOT bE LESS TRW' R),I2 GAUGE METAL .04D WHEN FULLY OPEN; THE DAMPLP OP=9;,N;3 ;5:A>•LL Nf_' 5E. L` 5S T AXN: 50�v OF T I.;" �2^'!C1t:?.c.^,, FLUE'. A%_ -A. PAGE 116 A Training Manua! in Field Inspection SPARK ARRESTER (12 GA. GALV-D.,1/2- MESH) t, T NOTE: CARRY ANCHORS TO 3RD JOIST, FASTEN WITH 2 VO BOLTS OR 6 16/0 NAILS. SUPPORT LINING ON MASONRY— AT 128 PLAN AT TOP OF HEARTH AT 64 SPARK ARRESTER (12 GA.GALV-D., 1/2, MESH) 1 it I- -- ,_ -- UNLINED CHINNEY SECT/ON 1/ERTICAL FLASH/NG LINED CH/MNEY SECT/ON DETA/L I DEiA.14 Z FIG. 1 KEY TO SYMBOLS ON CHIMNEY AND FIREPLACE DETAIL: ' FIREPLACE: A Hearth slab thickness Four inches B Hearth slab width (each side of opening) Twelve inches C Face of jambs Eight inches -� D Thickness of walls of Ten inches common brick, or eight firebox inches including firebrick lining E Distance from top of r opening to throat Six inches CHIMNEY: F* Vertical reinforcing Four one -half-inch full length bars. 40 -diameter lop if spliced to footing dowels. G* Horizontal reinforcing H Bond beams, five -inch minimum height J Effective flue area (based on area of fireplace opening) K Clearance from wood framing L Unlined brick flues M Flues with lining One -fourth -inch round bars at 24 inches Two one -fourth -inch round ties at the anchorage and of the top Round lining— on.e-twelffh; rec- fangular lining—one-tenth,•• un- lined --one-eighth One inchwhen outside of wall; two inches when entirely within structure No plastering � Brick with grout around lining; four -inch minimum from outside of flue lining to outside face of chimney , kt IV to 17,A �11 f)oo,"4 -ty Z -W -.0- -q p eq,::51 fw7 tl 9 - O)84 ely V -z' tp 77 05 ;�Fy— �o Y�" j IdPV 'j 4 "&-Z If U SUBJE& PE City of Fridley 2782;94) AT THE TOP OF THE TWINS B U I L D I N G P E R M I T i COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 . � NUMBER REV OATS PAGE OF APPROVED By CITY HALL FRIDLEY M432 612-571-3450 910-FIS 10/19/98 JOS ADDRESS 841 73rd Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 Diane Addition SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Larry Hoekstra 786-6255 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Dahl Builders & Rem. 451 Ma le St NE Spring P794-4830 20090777 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 O ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage 24 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 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 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 2056 $1.03 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- STRUCTIO OR THE PER F CONSTRUCTION 74.75 ire SC 2.06 RMANCE PLAN CHECK FEE TOTAL FEE cense S 5 0 1$82.84 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATE, WHEN PROPE RLYWA LIDA TED THIS IS YOUR PERMIT S f� S,GNATURE OF OWNER OF OWNER BUILDERI iDATE, BL -NSP GATE NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Jr BUILDING PERMIT APPLICATION p �: ConstructionAddress: 73 Aw 44le Legal Description: Owner Name & Address: May 4e MA Tel. # 46 de Contractor: ��_'��( MN LICENSE #—e 27a Address: � f /���/�� T Tel. # 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: 2Y Construction Type: Estimated Cost: $ 0.5 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: e-�f� APPLICANT: z2t4a& Tel. # .� W -3a CITY USE ONLY Permit Fee $ 7 4. 75" Fee Schedule on Reverse Side Fire Surcharge $ 2 0 (, .001 of Permit Valuation (1/10th%) State Surcharge $ /• 0 3 $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ 5'% c.;10 $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: a41CITY-`OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 e,'4.®U APPLICATION FORL PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURIES TO BE INSTALLED ON EACH FLOOR Effective On Jan 1, 2000 PLUMBING FIXTURE RATES;. New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader NO. RATE Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** l Gas Range** Gas Dryer" Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE r1 . TOTAL JOB ADDRESS t� © 7 j 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. ee l �20��� 1� OwnerA.i� Vi �S r7c1Z:76� — 716 Building Used As $ go . o Estimated Cost PERMIT NO. PLUMBING COMPANY 6(y) 11p,'��-V� SIGNED BY '11TEL N0. 7fof- S (- 0„ S Approved By Rough -In Date Final COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE G7YOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 February 11, 2002 Larry Hoekstra 841 73rd Avenue NE Fridley, MN 55432 Re: Final Inspection at 841 73rd Avenue NE Contractor: KCJ Enterprises — Mr. Rooter Dear Mr. Hoekstra: A plumbing permit was issued on August 24, 2000, to install a water heater at your address. According to Section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the plumbing authorized by this permit. As of this date, no inspection has been called for. The permit fee that was paid covers the inspections to make sure the work was completed according to the Code. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will mark the permit "no permit called for" and take no further action. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. Sincerely, DJ/ls CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: (763) 571-1287 ADDRESS 84173 AVE NE PIN 113024140004 LEGAL DESC DIANE ADD LOT 3 BLOCK 1 PERMIT TYPE HEATING PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION PERMIT N .:2004-01242 DATE ISSUED: 08/02/2004 VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL A FURNACE (WARM AIR, JANITROL, 70,000 BTUS) AND AN AIR CONDITIONER. # A/C UNITS 1 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) APPLICANT DEPENDABLE INDOOR AIR QUALITY INC 2619 COON RAPIDS BLVD NW COON RAPIDS, MN 55433 (763) 757-5040 OWNER HOEKSTRA LAURENCE R & NANCY 841 73RD AVE NE FRIDLEY, MN 55432 2963 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time atter work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date HEATING PERMIT MINIMUM FEE 0.00 FURNACE SHELL/DUCT WORK 35.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 25.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 60.50 PAID WITH CHECK # 66623 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. Cq_1-14408 TY OF FRIDLEY BUILDING INSPECTION 31 University Ave NE dley, MN 55432 3-572-3604 FAX 763-5711287 midentlal mace Shell and Duct Work, Burner & so Replacement Furnace is Piping (New Furnace, Fireplace, Insert) is Range is Dryer kir Conditioning - All Sizes Other Repairs or Alterations (List on Back) 6 of Value of Appliance or Work inimum Fee $15.00 for Residential or 5% of cost of iprovement whichever is greater "Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS 9 1-164 , oe - Fee Total $35.00 $_2�D $10.00 $ $10.00 $ $10.00 $ $25.00 $ aro oo )mmercial/Industrial/institutional 25% of Value of Appliance or Work (List on Back) $ inimum Fee $35.00 for Commercial/industrial/Institutional State Surcharge $ TOTAL FEE $� _INSPECTION FEE $50.00/HOUR Nir Conditioners can not be placed in side yard without written approval )m adjoining property owner - copy to City Building Used As ESTIMATED COST ' PERMIT NO ��/� 1 6/c DESCRIPTION OF FURNACE AND BURNER # of Heating Units Circle One (Steam) (Hot Water (Warm Air) Trade Name!lt., , Size No. BTU -10 ,.nth _ HP EDR Fuel Total Connected Load Burner Trade Name Size No. BTU HP EDR The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Building Division, and hereby declares that all the facts and representationsDEPENDASLEhI�I66��Nig 7ft?p orrect. HEATING CO 2&l COON RAPIDS BOULEVARD Tel # FAX# Date IZ� ILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Appr Rough -in Date Final Date _ b FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verges 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 -LAMA 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 odes 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 -LAMA 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 O No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type ��P��t�ce� BTU Input X74 .0 Z.? Fan Assisted op*4* Appliance #2 Type BTU Input 4-�Q, c, Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances �R Total Btu Input J / Common Vent Type ig Vent Height e Diametersh Appliance #1 Vent Connector Height kft Length Diameter 4r in Type � Appliance #2 Vent Connector Height _eft Length ft Diarrleier in T �_ Appliance #3 Vent Connector Height ft Length ft i ype ALTERATIONS: (Describe) HEATING CO: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 t'AX: (763) 571-1287 ADDRESS : 84173 AVE NE PIN : 113024140004 LEGAL DESC : DIANE ADD : LOT 3 BLOCK 1 -PERMIT TYPE : ELECTRICAL PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION PERMIT NO.: 2004-01256 � ) �� DATE ISSUED: 08/04/2004/�- VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL A FURNACE AND AIR CONDITIONER. # INSPECTIONS 1 APPLICANT DEPENDABLE ELECTRIC INC 2619 COON RAPIDS BLVD NW COON RAPIDS, MN 55433 OWNER HOEKSTRA LAURENCE R & NANCY 841 73RD AVE NE FRIDLEY, MN 55432 ELEC PERMIT FEE - MIN (RESI) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 28670 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp. Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY PERMIT O.: 2004-01644 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 09/22/2004 572-36U4 YAX: (763) 571-1287 ADDRESS 84173 AVE NE PIN 113024140004 LEGAL DESC DIANE ADD LOT 3 BLOCK 1 PERMIT TYPE HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL GAS PIPING FOR FIREPLACE. # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 0 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 0 APPLICANT FIRESIDE HEARTH & HOME 225 COUNTY RD 81 OSSEO, MN 55369 5.AI _ : HOEKSTRA LAURENCE R & NANCY 841 73RD AVE NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not pres a to give authority to violate or cancel the provisions of y other state or local law regulating constructio or the pe ormanc of constructio . Applicant Date_ Bldg HEATING PERMIT MINIMUM FEE 15.00 FURNACE SHELL/DUCT WORK 0.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 15.50 PAID WITH CHECK # 607825 SEPARATE PERMITSIREQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF_ FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning - All Sizes Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS �{I 73 AV 'e.' Fee Total Owner arri k& e, k 51r�- $35.00 $ Building Used As C 5' c e ei c -� $10.00 $ ESTIMATED COST PERMITNO $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name ed -,q /� l0 Size No. $25.00 $ BTU :3 Qf 0_ d HP EDR Fuel N 6 Total Connected Load All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater on work less than $500.00 Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR Burner Trade Name BTU Size EDR The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes $ and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. $ .50 $ /Sr o Sb *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE HEATING CO Signed Tel # FAX # DateT�o Allied Fireside dba Fireside ZON ,1 a Man® 270() t4. FWNIBW Ave- ROSOV" 113 ®61133' `01 Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes () No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type 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 ALTERATIONS: (Describe) r „o 1 c I l &e4s ycr;�ej2k c -e $eek : �► 1eXi3h"g1 MOReMe WWWM90911 FaIrAew Ave o.......an_ .W 55113 861/633-2561 HEATING CO: Date Signed By: