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PRE 2010 DOCSCity of Fridley, Minn. 2035 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT Date: February 8, 1973 Owner Builder a - .tt .on ruction Address —_. 1501 - 75th Avenue N.H. _, Address 3005 Ottawa Avenue N. LOCATION OF BUILDING No. _1501_ Street75th Avenue N.E. part of Lot Lot 1,-L- _ Block — -7, __..__..._... Addition or . Sub-Division6 ke Corner Lot ___._w _ _ Inside Lot ____ Setback . _ Sl eya Sewer Elevation —_ ----Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Fire Repair to House _ Front Depth Height Sq. Ft Cu. Ft Front Depth Height Sq. Ft Cu. Ft. Type of Construction Est Cost $3,250 To be Completed March, 1973 • ` TfpFl? �. Pr , A41 TS t � f Alm In consideration of the issuance to me of a permit to cons tru a buil g escribed hove, I agree to do the proposed work in accordance with the description above set and co pliance all pro of Ordinanc ea of the city of Fridley. 1.68 State Surcharge In consideration of the payment of a fee of $ 21.00 _,permit is hereby granted to Bar-Ett Const 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 dinanthe city limits and this permit may be revoked at any time upon violation oanany �of the provisions of Bid a. CLARENCE BELISLE NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sower or water. Be sure to as the Building Inspector for separate permits for these hems. r APPLICATION FOR RESIDENTIAL, ALTERATIOND OR ADDITION BUILDING PERMIT CITY OF FRIDLEYe MINNESOTA DPW , e S NAK: BUILDER s ��� �'� �, N S "T ADDRESS ■ ADDRESS: ?� �'� (��►���� v��t ,`� (0;� Ste$ �—154 t� z ��� ■+/ �++� ■ re ss+gw BLOCKI ADDITIONi NEM LOT; XMIME LOT; SEMCK: SIDEYARD: Afftic=t at"ch Vo, dtU foam_Vo Certificates of Survpj of Lot and proposed .idiag location dry 4m these Certificates, FESCRIPTION OF BUILDING Va Be Us*4 As*. 1?'e?0 /Ate' Depth; Height- uaace feet; Cubic Feet3 Front: Depth; Height: Square Feet; Cubic Feett Tyfe of Constructions L_ ao Estimated Cost To Bet I geed; - � l (\)3 , IM undarpignerd hereby wakes application for, a pemit for the work herein #pacified# agreeing to do all work in stttct accordance with the City of jvUliW Q rdUmmces and %uUxgo of the Department BuildinHs, and hereby 4"laref t all the facts amd representation s ed this a ication axe true sued correct, pATI; —SIGNATURE: (ga# Rwwve B$de For Add#t4ona3 Infor:qatiou. ) -111- ? CITY OF FRIDLEY Effective Date January 1, 1991 . APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTE14S AND DEVICES RATE SCHEDULE RESIDENTIAL Furnace Shell and Duct Work, Burner (Also replacement furnace) Gas Piping (piping needed with new furnace) Gas Range Gas Dryer * Air Conditioning (all sizes] RATE TOTAL $ 20.00 $ ,co $ 10.00 $ 10.00 $ $ 10.00 $ $ 10.00 $ All Others/Repairs and Alterations lit of Value of Appliance or Work $ COMMERCIAL/INDUSTRIAL 1% of Value of Appliance or Work S State Surcharge S .50 TOTAL FEE $ REINSPECTION FEE $30.00. $ Rough Insp. Date Final Insp. Date Approval for Permit MINIMUM FEE FOR ANY HEATING/COOLING/VENTING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. Job Address ��®� � '%��/u� /y Ts Building Inspection Div. 6431 University Ave NE Fridley MN 55432 Tel. No. 572-3604 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. KIND OF BUILDING____,.,// USED AS TO BE COMPLETED ABOUT ESTIMATED COST _CUv7S•�U / �i C OLD - NEW BUILDING PERMIT NO. PERMIT NO. //C f } e " DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. e Trade Name Size No. Capacity Sq. Ft. EDR BTU /gip_ (OT O%✓ HP Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company tanda Signed By Tel. No. 824-2656 Fill out back side for stack verification on replacement furnaces 410 W. LAKE ST. MINNEAPOLIS, MN 55408-2998 612/824-2656 401HEATING AND AIR CONDITIONING CO Serving The Twin Cities Since /930- ADDRESS OCCUPAN DATE HT GAS LIN ORSAT TEST RECORD 1072 PAYN E AVE. ST. PAUL, MN 55101-3892 612/772-2449 CITY_e_�_L'4e OWNER �.. 0� TYPE OF HEAT: GA FA HW STEAM SPACE HTR. ,,-I GAS DEIGN MAKE MAKE MODEL ` ,� MODEL SERIAL MAX. INPUT MAKE CONTROLS MODEL UNIT HTR. OTHER CONVERSION OF BURNU BTU RATING OF FURNACE THERMOSTAT HEAT PLUG VENT SIZE � VALVE C LJ /Z KIND OF LINER SIZE T� NONE LIMIT A/al DRAFT HOOD REGULATOR .— LIMIT SETTING'o CHIMNEY CONSTRUCTION jq FAN SETTING DRAFT TEST TAG p OF PILOT TY TYPE `` c LIGH NG INST. PILOT MAKE Le-) P2 PILOT MODEL PILOT TIMING PRESSURE ,rj PERCENT CO2, DATE TESTED Z INPUT CFH PERCENT 02 STACK TEMP. PERCENT CO NAME OF TESTER City of Fridley SUBJECT .`., 24678 AT THE TOP OF THE TWINS BUILDING PERMIT r � RECEIPT NO. -------COMMUNITY DEVELOPMENT DIV. I PROTECTIVE INSPECTION SEC��� r CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY ' 612-571-3450 910415 10/15/9 / / JOB ADDRESS 1501 75 Ave NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 2 1 Spring Lake Park Lakeside SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerry/Sandy Skog 1501 75 Ave NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Groveland Craftsmen Inc 719 Myrtle St Hudson WI 54016 715-386-6550 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 8526 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑x ADDITION ❑_ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE R 8 DESCRIBE WORK Convert existing arae to living area 11' x 18' • Construct a 22' x 22' New Garage 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Provide a hard surface driveway. ' WARNING Before digging cavi for SEPARATE PERMITS REQUIRED FOR all utility locations WIRING,. HEATING, PLUMBING AND 454•OD02 SIGNS. REQUIRED BY LAW SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT $18,000 $9.00 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $262.25 Fire SC $18.00 PLAN CHECK FEE TOTAL FEE License SC $5.,DO $294.25 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERjefIVALI DATED THIS IS YOUR PERMIT w VOG INSP MATE _ S)GNATURE OF OWNER 0F OWNER BUILDER) IDATEI NEW ADDN [ J CITY OF FRIDLEY ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: r/ Legal Description: Owner Name & Address: Contract Address Tel. # Effective 3/1/96 MN LICENSE # cc� )%Tel. # y/. 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 y Width c:�Z Height 16 Sq. Ft., DECK AREA:Len Width Hgt/Ground Sq. Ft. OTHER: /� Jy f,[�l Iq Corner.Lot [ ] Inside Lo [ J . Ft. Yd Setback Side Yard Setbacks Type of Construction: d() �2I7 �� Estimated Cost: $ A Approx. Completion Date: Driveway Curb Cut Width Needed: _ DATE:', (� APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: (Cost on Back) Ft. + 6 Ft = Ft x $ Tel. # $ . 6 - CITY USE ONLY $ Fee Schedule on Reverse Side $ C�o .001 of Permit Valuation (1/10th%) $ `% $.50/$1,00, 0 Valuation $ $900 per SAC Unit $ Q0 $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 [ ] $ . 6 - P. 2 e -- COO/ SEP, 27•'96 02:55PM VOLUNTEERS OF AMER Ing. :►�. 'ti's 4 , RJE F -Z U. P. 2 e -- COO/ -SEP 27 '96 02:56PM VOLUNTEERS OF AMER rd 11r zz� � - tp v �� Vl to A\ �ry Q , p1p�y y� N 1 YZ 1 rd A `K P.3 11r zz� � - tp v �� Vl to A\ �ry Q p1p�y y� N 1 YZ A `K P.3 11r zz� � - tp v �� Vl to A\ �ry Q 1 A `K P.3 11r zz� � - tp v �� Vl to A\ �ry Q A `K P.3 ' 1 11r zz� � - tp v �� r. �ry Q ' 1 �ry Q J til �a ' 1 �ry Q SUBJECT City of Fridley 2 6 3 8 9 AT THE TOP OF THE TWINS BUILDING PERMIT RE T NO. i COMMUNITY DEVELOPMENT DIV. y r 1 PROTECTIVE INSPECTION SEC.�� / NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 6/29/98 JOB ADDRESS 1501 75 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 2 Spring Lake Park Lakeside SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerry Skog 1501 75 Avenue NE 786-6872 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Best Siding Co 1310 154 Ave NE, Ham Lake Mn 55304 413-0500 2846 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 O MOVE O REMOVE B DESCRIBE WORK Reside House; Reside 1 Garage Wall; Soffit & fascia 9 CHANGE OF USE FROM TO STIPULATIONS Install building wrap and call for inspection before covering. 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 MOT. 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 $4,600 $2.30 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE Inv. Fee SAC CHARGE PROVISIONS OF THER STATE OR LOCAL LAW REGULATING CON- $99.75 99.75 Fire SI:, $4.60 STRUCT 1T EERRFFORMANCE F C STRUCTION. PLAN CHECK FEE TOTAL FEE License SC $5.00 $211.40 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERL ALIDATED THIS IS YO PERMIT + R-- Ilp$P DATE S)GNATURE OF OWNER OF OWNER BUILDER) )DATE) NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress : Legal Description: Owner Name & Address: Contractor: Address:. 13 \6 LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: / 50 1 �Sfl AUe- - Aj E Effective 1/1/98 l(!:5(0 ` LIG Jes y S koS Tel. # +A— Sd MN LICENSE # Oae�(6 '1')'C/U , 1 .A — 1—/1 r< e �f'- 30 L%Tel. # W-30 5 vv Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EWPROVEMENT Length Length Length c� S,,-( e 4 -0r-A r Width Height Sq. Ft. Width Height Sq. Ft. Width Hgt/Groun�$q. Ft. &--e_ Com,%- ` .&41 P S d"1+1 Estimated Cost: $ -e`-//6 ® o (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: a 9 ! �' APPLICANT: f ��5� 5 d Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge g9, �nzg-CITY USE ONLY $ 99, r Fee Schedule on Reverse Side $ 4. Com© .001 of Permit Valuation (1/10th%) $ r,2,3 o $.50/$1,000 Valuation $ $1000 per SAC Unit $ S-, $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 [ ] TOTAL $ 7u . STIPULATIONS: SUBJECT City of Fridley 27071 AT THE TOP OF THE TWINS BUILDING P E R M I T r _ COMMUNITY DEVELOPMENT DIV. tr PROTECTIVE INSPECTION SEC. /] `� je NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 8/10/98 JOB ADDRESS 1501 75 Ave NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED oescR. 12 2 S rin Lake Park Lakeside SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerry Skog 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Best Sidiniz Co 1310 154 Ave413-0500 2846 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 8 DESCRIBE WORK Reroof house and arae Tear—off 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 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 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 $1167.60 .58 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- STRUCTION THE PERFORMANCE OF CONSTRUCTION. $40.25 Fire SC $1.17 o _9 PLAN CHECK FEE TO TA EE L cen 5.00/.00 S NATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI N P O ALIDAT D IS IS YOUR PER IT 001 BLD )NSP MATE S)GNATURE OF OWNER )IF OWNER BUILDER) IDATEI NEW [ J ADDN [ ] CITY OF FRIDLEY ALTER 4,[/J' SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: /!S-0 / 7S' i *v e- 7/,f- Legal Description: Effective 1/1/98 ,;Z 10 -7l Owner Name & Address: er v->,- S k- d Tel. # Contractor: &E �-� �, ca MN LICENSE # Address: 13"C' Y75 3 Tel. # 1/3 a So cl 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 GARAGE AREA: Length DECK AREA: Length nn OTHER: PC roc>4 Width Height Sq. Ft. Width Height Sq. Ft. Width Hgt/Ground Sq. Ft. J Construction Type: Estimated Cost: $ , (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6, Ft = Ft x $ = $ DATE: /D APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: t t & -CQ .S,dw�Tel. # /y e 1113- oS cX� CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 '�* 6 a � o� APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES 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 Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range** NO. RATE WAR 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 TOTAL JOB ADDRESS I5 0 / :Z 5 7/'6 IT V' ' ` E Type $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance O �� State Surcharge $ .50 TOTAL FEE $-3-0± 0 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. OH,ner S�0 /® /&O , 20 L10 Building Used As Re i tl -e-rice- / y�®O f"� Estimated Cost ! �(/ PERMIT NO. PLUMBING COMPANY P cGUIRE & Sob's 4M Avenue S ;3 RJ.9tt5, gN ____TEL N0. Jro� �q.3 /—?/a% SIGNED BY Approved By Rough -In Date Final Date—/ COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () 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 manufacturers 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) HEATING CO: Signed By: Date :