PRE 2010 DOCSu
0
City of Fridley, Minn.
BUILDING PERMIT
N® 6755
I-P`���, /&DC N O UI ING
No. � Street 7` J A Pof Lot -
Lot _ Block Addition or Sub -Division .
If
Corner Lot , Inside Lot Setback Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be�U'41�fd_Front
,�EDepth Height Sq. Ft�.� cu. Ft. ��n�
FrontDepth Height 00 Sq. Ft. Cu. Ft.
Type of Construction Esst. `�To be Completed
In consideration of the issuance to me of a permit to cons ct the building described above I agree to do
the proposed work in accordance with the description above se prth and in compliable with I provisions of
ordinanoea of the city of Fridley. ' 1 I
In consideration of the payment of a fee of $-4tg7-., , permit is hereby grdnted to
thtion thto construct the building or addition as described above. This permit is granted upon
e express condiat the person to whom it is granted and his agents, employees and workmen, in all work
Bone in, around and upon said buildffig, 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 dty linnita and this permit may be revoked at any tt� upon o of any of the provisions of said
ordinances. �l
Building Inspector
• NOTICE:
i6b peen it does not corer the construction, hntatlsfien for whine, phm hing, gas heating, sower or water. Be sues to as
the Building Impeder for aperafs perm0s for than Items.
.r _ d .,.%
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNE- R' S
ADDRESS r% ADDRESS
LOCATION ��3U�LDING
No. Streets C> e„�_ Part of Lot
Lot Block Addition or Subdivision .
Corner Lot Inside Lot 1,--' Setback,��-�—�� Side Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as:
_Front. E�' Depth9 e� Height��
E
Sq: Ft.Cu. Ft.
Front Depth Height
Sq..Ft. Cu. Ft
Type of Construction A Estimated Cos
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 of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE__,�7:74J _SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
x . . A
COMMERCIAL OR INDUSTRIAL BUILDING CHECK LIST
1. Zoning AXI
2. Area Requirements
3. Parking Requirements Ise
4. Front Yard Requirements ,fjAll
5. Side Yard Requirements
6. Rear Yard Requirements
7. Dwelling Unit Requirements
8.
General Construction
ALLEN G. JENSEN
Building Inspector
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RAW
Application for Power Plants and Heating. Cooling, Ventilation. Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
RATE TOTAL
Furnace Shell & Duct Work ..........................
8.00 $
Replacement of Furnace .............................
5.00 $
Repairs & Alterations—up to $500.00 ..................
5.00 $
Repairs & Alterations each add. $500.00
............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............
8.00 $
each add. 60,000 BTU .......................
2.00 $
Replacement of Furnace .............................
5.00 $
Repairs & Alterations—up to $500.00 .................
5.00 $
Repairs & Alterations each add. $500.00 ..............
2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $
Dept. of Bldgs. Phone SII 4-7470
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 "e and correct.
Fridley, Minn 19
Owner
Kind of Building
Used as
To be completed about
Ing Permit No. - (!; !� Permit No.
`� Q
DESCRIPTION OF WORK
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
HEATING or POWER PLANTS -Steam, Hot Water, Warm Air—No
over 3 gal. per hour—See Fee Schedule
me
GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ Trade NaSize No
Capacity. Sq. Ft. E.D.R BTU H.P.
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x $1.50 $ o Total Connected Load Kind of Fuer
Additional Fixtures ................. x .50 $
BURNER —Trade Name Size No
Gas Range to 200,000 BTU ........... x 2.00 $
Capacity Sq. Ft. E.D.R BTU H.P.
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
ALTERATIONS &REPAIRSTOTAL FEE $ Signe
ROUGH ® 4 2M Business Phone NoFINAL OWV
,
(REMARKS—OVER)
SUBJECT
PER
City of Fridley22633C
AT THE TOP OF THE TWINS
BUILDING PERMIT
�
RECEIPT NO.
�• _ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
����
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
1 J` 612-571-3450
910-F15
6/23/94
JOB ADDRESS 415 74 Avenue NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
4,5
1
Melody Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Har -Will Inc 825 1st St NW, St Paul MN 55112
3 CONTRACTOR MAIL ADDRESS ZIP PHONE s LICENSE NO.
Dodge Roofing 10267 University Ave NE, Blaine MN 55434 780-8547
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Apartment
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Repair roof plywood
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SQ. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION
11
STALLS GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$1.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2,000
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$45.00
Fire SC $2.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$48.00
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEIHEN
PROPERLY V IDATED THIS IS YOUR PERMIT
.Vod. '�
BLDG I SP DA�
SIGNATURE OF OWNERIIF OWNER BUILDERI IOATEI
Prepaid Plan Check $
Estimated Cost $ &00
Receipt # C93 C::��
Effective 1/1/94
CyAM1=1111CF4
R 3, O MA MCM,L & IND 9MM,L " C� 7j L L 1100
BUILDING PIItM[r APMXATION
•�' Y' •' �. 1')' �. ��1' ]Ir!'�L� �1._/ / I i � .ilk- ! �
Wro
�TQDI Wz DIl IOi<15
Width Height Sq. Ft. # of Stories
OFC. AREA: length Width
GUISE AREA: length Width
aIHM AREA: Length Width
Height Sq. Ft.
Height Sq. Ft.
Height Sq. Ft.
VAILMMOR
Sq. Ft. X $ Cost/Sq. Ft. = Valuation $ )
Sq. Ft. X $ Cost/Sq. Ft. = Valuation $
Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) TOTAL VALUE
Building Use Construction Type
Air Conditioning []Yes []No Fire Protection Provided []Yes []No
Performance Bond Amount $ See Reverse for Schedule Received []Yes []No
Permit Fee $ - See Fee Schedule on Reverse Side
Plan Check $ in Excess of Prepaid Amount - See Reverse Side
Fire urge $`� .001 x Permit Valuation (1/10th %)
State Surcharge $ %� L� G% $.50/$1,000 Valuation (See Schad. for > $1 Million)
SAC Charge $ $800 per SAC Unit (Plans to NNCC for determination)
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ Fee Determined By Engineering
Spec. Ass is $ Agreement Necessary [] Not Necessary []
Driveway Escrow $ feet x $13.50/foot
9AL $ S- 110 ,
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
APPLICATION FOR .POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
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)
I% of Value of Appliance or Work
Commercial/industrial
1.25% of Value of Appliance or Work
Rate 1. TOTAL
$ 30.00
$
$10.00' •
$
$10 .0d. .
$
$10.00.
$
$ 2540
$
State Surcharge
TOTAL FEE
$
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATIONlAIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
.50
Effective On August 1, 1995
JOB ADDRESS A-V�
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.
3 - 2 Z - ,1995
u -J/ L
D
.MO�
BUILDING USED AS
ESTIMATED COST :2 GG f/ r PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water (Warm Air)
—Trade—Name—A4, K�?9'I`7 Size No.
BTU J¢G Z,Ia c c HP EDR
Fuel A�)A-r- Total Connected Loadc.-
Burner Trade Name
BTU
Size No.
HP EDR
HEATINGCOMPANY
Signed By�"— Tel No. C/' — CMCJ
Approved By Rough -In Date Final Date
*Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDEI,FOR STACK VERIFICATION ON
written permission from adjoining property owner. REPLACEMENT FURNACE
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes bd No ( )
2. Is free from rust or deterioration
3. Has no foreign objects lodged within
4.- Is securely supported
5.. Meets all current Code requirements for size
and total BTU's connected
6 Has total heating BTU's of C/ G
All other BTU's:
TOTAL BTU's
7. Has a liner been provided for water heater
8. Has combustion air been provided for water heater
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
V
Yes �4 No ( )
Yes No ( )
Yes ( No { )
Yes (?� No ( )
Yes () Noj
Yes � No ( )
C'G 17 ro A C
OF
sueiEtr
P T NO.
City of Fridley
2 9 i
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
�
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
f PROTECTIVE
1
NU Is
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
L J\ 612-571-3450
TpEv
910-F15
7/26/99
JOB ADDRESS 415 74th Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4,5
1
Melody Manor
SHEET
2 PROPERTY OWNER MAIL AOORES,5
ZIP PHONE
Harwell Inc.
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
J. Benson Const. 7020 Walker St. St. Louis Pk 55426
920-0717
ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Commercial
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION XjP REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof 11 Unit Apt. (60 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
$5244
$2.62
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE$r, 24
PROVISIONS OF NY OTHER ST TE OR LOC L LAW REGULATING CON-
ION OR HE PERFORMA CE OF TRUCTION
$125.25
S
Fire uw
/��
1r'-GNA7TURE0"
PLAN CHECK FEE
TOTA
.11
CTOR OR AUTHORIZED AGENT IDATEI
EN ROP
- ALID E HIS I UER ;T�oe
SIGNATUAE OF OVVNERIIF OWNER BUILDEAI IDATE,
a+
SLOt INSP
MATE
OF
Prepaid.Plan Check $
Estimated Cost $
Receipt #
Effective 5/.10199
CITY OF FRIDLEY /�
R-39 COMMERCIAL & INDUSTRIAL �Vl //�� � 1
BUILDING PERMIT APPLICATION �(?
Construction Address
Legal
1
Owner & Address— ,4/ �/�� L .� ao Tel#
CDNTRACITOR & ADDRESS J, 13,c A/ S a 4l 6k/f-- 7P,1 P W94;c� A Si STAT 'A4- Tel# /v!,1 fJ a -0717
Architect Reg.# Engineer Reg.#
BUILDING CONSTRUCTION (60/
TYPE OF WORK ^ X New
[] Addition []
OFC. AREA:
Length
Width
Height
Sq. Ft.
WH AREA:
Length
Width
Height
Sq. Ft.
OTHER AREA:
Length
Width
Height
Sq. Ft.
APPLICANT
1�i9/u/
J�G
Tel # 10P y -20-d71%
Date 7 a��y
VALUATION
Sq. Ft.
x $
Cost/Sq.
Ft. = Valuation $
)
Sq. Ft.
x $
Cost/Sq.
Ft. = Valuation $
) _ $
Sq. Ft.
x $
Cost/Sq.
Ft. = Valuation $
) TOTAL VALUE
Building Use
Air Conditioning [] Yes (]No
Performance Bond Amount S
Construction Type Occupancy Group
Fire Protection Provided [] Yes [] No
See Reverse for Schedule Received []Yes []No
Permit Fee
Plan Check $
Fire Surchazge�'''- },-d- -
State Surcharg .6o
SAC Charge $
Erosion Control $
Park Fee $
See Fee Schedule on Reverse Side
In Excess of Prepaid Amount - See Reverse Side
.001 x Permit Valuation (1/10th %)
$.50/$1,000 Valuation (See Sched. for > $1 Million)
$1050 per SAC Unit (Plans to MWCC for determination)
$450.00 Conservation Plan Review
Fee Determined By Engineering
Spec. Assessments $ Agreement Necessary [] Not Necessary []
Driveway Escrow $ 133 J1 feet x $13.50/foot
TOTAL $
ADD Lee&iSL ATTACH STIPULATIONS
.169. �/
CITY OF FRWLEY PERMIT O.: 2004-00895
6431 UNIVERSITY AVENUE NE
FMLEY, MN 55432 DATE ISSUED: 1/2004
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 415 74TH AVE NE
PIN : 113024240005
LEGAL DESC : UNAVAILABLE
: LOT BLOCK
PERMIT TYPE : HEATING
PROPERTY TYPE : MULTI DWELL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION : $ 7,000.00
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 BOILER (HOT WATER, BURNHAM, 463,000 BTUS). INSTALL RPZ IF REQUIRED.
APPLICANT HEATING PERMIT FEE, COMM 87.50
AAZTEC HEATING & AIR COND STATE SURCHARGE, VALUE 0.50
12920 JAMES AVE S TOTAL 88.00
BURNSVILLE, MN 55337
OWNER
SHAW WILIAM A JR & MARSHA E
7400 LYRIC IN
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 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
regulatin constryction or the performance of construction.
Applicant Date
e
Bldg Ins p Da
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
C17Y OF FRIDLEY BUILDING INSPECTION
6431 UnirersityAve NE
Frkley, MN 55432
- 763-572-3004 FAX 763.511-1297
IRS ATE SCHEDULE
FurrraoeSINN aril Dud Work, burner &
alsoReplacement Furrmce
Gas Piping (New Furnace, Firepiaoa, Inserp
Gas Range
Gas Dryer
*Ak Conditioning -AIL Sizes
40AW) oft LAI?
Effective 4/InOO4
APPLICATION FOR POWER PLANTSAND HEA71NG, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONINQ SYSTEMS AND DEVICES
EPA 199
$35.00
$
$10.00
$
$1.0.00
$
510.00
$
$25.00
$_
Ah Other Repairs orAfl:M ions (List on eacic)
1% oMfue of Appitanoe or Work
Minimum Fee $1.5.00 for Resklential or 5% of ct of
fr_%1p7&4Cment 4rt1iCh_Cv8LiS-gRa*0r ro work IESS than $3DD.00
1_Qorrrmerolalllnd�trl�ilflnsiltu orl�,b
X1.25% of Vatue of Appilance or work (Liston eaciq
Min9munr Fee $35.00 for Comavreiai/inclustrlal/Institutional
State Surcharge
TOTAL FEE
JOB AODRESS
Owner_! lL �f7G1 Gc�
HuildingUsedAs_AA0ttr ImQ!'�
ESTIMATED 006T Q��� PERMIT NO 021
DESCRIPTION OF FURNACE AMU BURNER
# of Heating Units Circle One (Steam) (Hot W (Warn Air)
Trade Mame Alif 7 h 4i /-tSize No.
BTU - q63, HP EDR
Fuel /(cr, k r c4 tf Total Connected Load
Burner Trade Name
BTU
Side No.
HP_ EDR
The undersigned hereby makes-appdoation for a permit for the work herein
specified agveingto do all -work in strict accordance with the City Codas
and rulings of the IkikIng Diftlon, and hereby de*mthatall the faces
and representations stated in this application are true and correct.
REINSPECTION FEE $50.00/1-IOUR_
*Air Cfl!!ditio!!erS C'!n not ter: rks:ui5'R!r4 :!a'!t!v.!t lViftAi1 anmstnr
from adjoining property+ owner - oopy to City . .
:®0
FILL OUT BACK SIDE FOR STACK VERIFIcATioN ON REPLACEMENT FURNACE
Approved by Rough4n Date Final Date
MA`( -1 g—'._.00 4 09:23 FROM CITY OF FR I DLEY TO�ae_+�y�o
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
S;QXNON VENT, VENY WNNECTO AND COMBU$TI ON AIR VERIFICATION
When teplaciarin an amist W fume , the undersigned hereby verifies that the
venting has be-�n examined and Is free from rust, deterioration, obstructions,
and is securely supported and flrestopped where required. YesA No ( )
The venting sy dem Is plasticWC and meets all current codes and manufacturer
specifications i,icluding sung, length, number of elbows and termination, Yes
The undersigmLd also verifies that the replacement unit Is a !lsted assembly
and meets,the rurrent oodes and man es -specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and c4?tural draft appliances. Yes (.j'j
No ( )
The eXlWinayQrnbustion air is sized and Installed to meet the current odes
end manufacturer's specifications. Yes
No( )
When requilred:to install a araaw combustion air, it vAI be sized and installed
to meat the curivnt codes and manufacturer's apedficabons. yes(
No PC)
When J�1Iin13 a new vent;nsr system, the undersigned hereby verifies that
it is a fisted assiambly and meets the current odes 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 ventand vented
separately as per current codes. Yes Qq)
No( )
Appliance Type and Siae/Gommon Vent and Vent Connector Information
Appliance #17',,pe p
Appliance #2 T,�pe w''� � h e ' TU In ut i�� �`D Fen Assisted or Nat,�,,,,�„
o,`f a, r BTU Input ?� P Fart Assisted or Nat
6. 7
_,�_
Appliance 03 Type BTU Input Fan Assisted or Not
Total Applis nces _E� Tctal Btu I nput
Common Vent 655. f e%nt Height Diameter inches
Appliance #1 Wnt Connector Height _:t.__.ft. Length 10ft Diameter % in Type ,
Appliance #2 Wrtt Connector Height._k ft Length .S tt Diameterin Type
Appliance #3 Vint Connector Height ' ft Length ft DiameW in Type
in f
HEATING CO:_
Signed By;
0
Date:
Td Wa6b:£0 £00Z ST '1-00 : 'ON Mad : Word