AF - 45345�
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City of Fridley, Minn.
BUII.DING PERMIT
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Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Builder . ���� � ��°E�� �`� �
Addre�ss ...................................... Address .............................................
LCaCATIO�V ��F �UILD�NC�
Q%�y ' c� rre�i� �e �,
No. . . .!. .�f� . S� 5treet . . . . . � . . . . . . . . . . . . . Part of Lo�i . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lot �� . . . . . . Black . .s� . . . . . . . . . . . . . Addition or Sub-Division �,�� . . . . . . . ./��� . . . . . . . . . .
Corner Lot �......... Inside Lot ............ Setback �`T..�... Sideyard .`�.�y .................
DESCRIPTION O� BUILDING
' ,(/ �j� 4 �/.� C�/
T be Used es•
� . . . . Front T. � s� Depth s�f�.'(� Height / l. . .� Sq. Fk ��,/. .fP. . Cu. ���4�. y
. . . . . . . . . . . . . . . . . . . Front . . . . . . . . . Depth . . . . . • • .�I���-�— . . . Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . .
/ O
Z�►pe oY Constructton . . . . . . . . . . . . . . . . F.st. Cost. J. � /. . . . . . . . . . . . To be Completed . . . . . . . . . . . . . . . . . . .
Ia consfderation of tihe is�uance to me of a permit to construct the uilding desribed above, I agree to do
the proposed work in accordance with the description above set f d in camp ce � all provisions of
or3inances of the dty of Fridley.
. .x. .. ....... � ..������.
� �
In considera.tion of tlie payment of a fee oP $. �� . . . ., permit is hereby granted to . .. .. .. .. . . .. .. .. ..
. . . . . . . . . . . . . . . . . . . . . . . . . to construct the building or addition as descrlbed above. Tbis permit is granted upon
the expresa condition that the person to whom ft ia granted and hia agents� employees and worlmnen, ffi�11 work
done in, around and u�n said building, or any part ffiereof, shall c�nform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repafr and moving of bwlldings wiih-
in the cfty limits and this pern►ft may be revoked at az►y time upon violation of any of the provisions of said
ordinances. i �
a
�...
NOTICE:
�
This permlt does not cover the construa?Jon, Insta�la#lon or alteratlon fo� wlring, plumbing, gas�heating,
sewer or water. Be sure to see the Bullding Inepe?ftor fo� �eparata pa�mits fo� theso Itama
�✓'�l/.° � /'�'',�=..°P'�!r'1�1�`� /7�/G�/TS' ,�/f�l%iTi�''Jsi✓
1NDUe�""` C� . E. C O U L T E R° �( PLATTINO
9ue�Ne99 I \1 FpR618URillY9
cirr �o�rs LAND SURVEYOR uKea►+oRe
TOPOORAPHtC MAPPINm REGISTERED UNDER LAWS OF STATE OF MINNE30TA JUD�CIAL
LICENS?D BY OROINANCE OF CITY OP MINN6APOLIB .
3300 LYNDALE AVE. 50. MINNEAPOLIS 8, MINN.
TAYLOR 4-0370 '
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I herea�y certify that the avove is a true and ¢t:rect plat of a surdey of:
Lot Thirty (30), Elock Two (2), Parkview Heights, Anoka County, Minnesota.
As� surveyed by me this 4th. day of May 1959 A, D. '�
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Signed ,�C�. �.�-1 �.i.�..���`'�.�..�_
Minnesota Registsation DTo. 2584
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SUBJECT .
City of Fridley 2 5 6 4 2
AT THE TOP OF TIiE TWINS g � I L D I N G P E R M I T
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� � COMMUNITY DEVELOPMENT DIV.
� •
� ; V �•����; � �� �
r � � PROTECTIVE INSPECTION SEC.
1 . i
� _ /'�'1 � CITY HALL FRIDLE� SS432 NUMBER REV DATE VAGE OF AVPROVED B�
�"""'� � ,�� 612-571-3450 910-F15 10/28/97 / /
JOB ADDRESS 960 Hackmann Circle NE
1 IEGAL LOT NO. BLOCK TRACT Oii ADDIT�ON SEE ATTACNED
DESCR. 3O 2 Parkview Hei h S SHEET
2 PROPERTV OWNER MAIL ADDRESS 21P PNONE
Bob/Carol Thompson 960 Hackmann Circle NE 574-2266
3 CONT.RACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Scott Anderson Const 299 17 Ave NW �New Bri hton MN 1 -
d ARCMITECT OR DESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PNONE LICENSE NO.
8 USE OF BUILDINCa
Residential, .
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION C� REPAIR ❑ MOVE O REMOVE
B DESCRIBE WORK
Reroof House & Garage (20 Sq) Tear-off
9 CHANOEOFUSEFROM TO
STIPULATIONS Underlayment must meet the State Building Code.
TYPE OFCONST. OCCUPANCY(3ROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING. NEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 20NING SQ. 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 WOqK IS COMMENCED. NO: OWLG. UNITS OFFSTHEET PARKING
I HEREBY CERTIFV THAT I HAVE REAO 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 WHETHEF; SPECIFIED MEREIN OF NOT. THE GRANTING OF A PERMIT �1,668 �.83
DOES NOT PRE UME TO GIVE A THORITY TO VIOIATE OR CANCEL THE pERMIT FEE SAC CNAiiGE
PROVISIONS O ANY OTHER E R LOCAL LAW REGULATING coN- @54.00 Fire C�I.C)�I
STRUCTIpN THE PERFO C f CONSTRUCTION `P
PLAN CHECK FEE TOTAL EE
,�r..,.� Lice e 5.00 $61.50
SIG URE OF CONTRACTOp OR AUTMOp12ED AGENT 1 TE� N P P R LIDATE IS IS YOUR PE IT
- � !O�
S�GNATUAEOFOWNEA��FpWNERBUiLDER� � iDATEi BLD SP fj4TE
.. ... ... . ... ..... ....�:.. . , ... , . ... . . .. . , . . .. _ . . .
NEW
ADDN
ALTER
� � Effective l/1/97
� 1 CITY OF FRIDLEY
[—�� S[NGLE EAMILY AND DUPLEXES R-1 AND R-2 �� ,
BUILDING PERIVIIT APPLICATION ���`�� �
ConstructionAddress:
Legal Descc
Owner Name & Address: p�- Tel. # s'� �� a a�h
Contractor: �G t �� MN LICENSE # p'Z D� � B�D�
Address: — o� ��f � ���f �/Gl/ /��/�%d %�l�'.�% SS��TeI. # 67?� /�a d�
Attach to this application, a Certificate of Survey of the G
Lot, �vith the proposed construction drawn on it to scale.
LIVING AREA:
GA,RAGE AREA:
DECK AREA:
OTHER:
Length
Length
DESCRIP'I'ION OF IlVIPROVEIV�ENT
�Vidth
Width
� �r
Height
� Height
Hgt/Ground
...� C � S � . / f°.�'� �
Sq. Ft.
Sq. Ft.
Sq. Ft_
�J ��o�o
Construction Type: `��— 6Z� Y�]L Estimated Cost: $
. - (Fee 3chedule an Back)
� Driveway C�irb ((�t Width Needed. - �:.- � Fti" + 6'Ft �= : =��: Ft x . � �_ —. $ . � � ,
DATE: ' APPLICANT: ���.�' Tel. # f� — Z
- � C'� �-�1'�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main CharQe
TOTAL
S'C[I'UL�"t'(ONS:
CITY USE ONLY
$ �'7. D6 Fee Schedule on Reverse Side
$ /, � � .�1 of Permit Valuation (1J10th%)
$ � � $.50/$1,000 Valuation
$ $950 per SAC Unit
$ �C7C� $5.00 (State Licensed Residential Contractors)
$ Alt_ "A" or Alt_ "B" Above
$ �$450_� Conservation Plan Review
$ Fe� Determinad by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ ��, �c�
a, . ,
i
(iU[t,l)l,`G PE,R�-t["[' FrE SCHEDt'[.F�,
�I�1ie Ctiief I3uildicig Of�ficial sliall, hetor� is.suing pec�uits for the erection oi� any building c�r structure, or t��r
a�iy addition to any existing building or struciurc, or for any akeration or repair to any cxiscing buildinL or
struccure, upon application theretiore, require die payntent by the applicant for such perrriit of fees to the amount
herein belocv set forth and in the manner herein provided to-�vit:
TOTAL VALUE
$1 to $500
$�al to $2,000
��,OUI to �25,000
$25,001 to $50,000
FEFS
$21 (M;nimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,ODU
�62.2� for first �2,000 plus $12_SO for each additional $1,000
or fcaction thereof, to and including �25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $SO,ppp
$SQ,001 to $�00,000 � $574.75 for fust $50,000 plus $6,25 for each additionai
. $1,0� or fraction thereof, to and including $ipp,pDp
,$100�,00� to $500,000
$500,001 to $1,000,000 -
$1,(�00,001 and up
$887.25 for first $lpp,ppp plus $S.pp for each addition�.l
$1,000 or fraction thereof,.to .and including �SQ0,000
��:>: �5`:�- �� .. -: .•.-- . . .. . _.... ..:-� �. . �-._ .., . �:: .. d,�, ,_, . .
$2887.25 � for t�e fust $S�,ppp p�' $q.:� for each additional :.
$1,(?00 or firaction thereof, to and including �1,p00;(�p
$5012.25 for the first $1,p00,pflp Pius $2.�5 for each adclitional
$1,� or fraction thereof �
DRIVEWAY DEPRESSION ESCROW
(Concrete C�urb Sireets Only)
Alternate "A": Removal and replacement of curb and gutter only - Drive�vay width plus 6 feet times $13_50..
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide �
approach with 6 inch depth - Driveway widL�i plus 6 feet times $15.7�.
VERIFICATION OF FOUNDATION
L'c�cnits for construction will be issued a minimum of 24 hours from the timc of application to ailow �or pro��r-
rc��ie«� of tlie pro�osed stc-ucture and of the construction site.
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6
Heating
Air Conditioning e
and Electric, Inc.
13562 CeMral Avenue N.E.
Anoka, Minnesota 553�
Phone (612) 757-5200
FAX (612j 757-6701
12/3/98
City of Fridley
6431 University Ave NE
Fridley, NIN 55432
Attn: Mar'r
Please note the folloa+ing changes for address 960 Hackmann Circle, Cnrolyn
and Bob Thompson.
The Air Conditioner was not installed, instead n furnnce was instnlled.
$25.50 has already been pnid and I am sending an additional $5.00 to cover
the cost for the saritch from A!C to n Furnace. Ariy questions please
contact Tina @ 757-6200.
Thnnk you
HEATING
AIR COND(TIONING
AND ELECTRIC. INC.
HEAT LaSS ' " HTO. IN IOL�YLZA
SOLD BY ' � — '�
Electrical Work By
TYPE OF HEAT GA F STEANI� SPACE HTR.
� ` . `
r
���.�j����� / .. /
*.,��: � I!
•� �,/ �� i .
M\R�fA� l�
L.W. Cut Off
Preaaure /� Peroent COz �
Input CFH Peraent ���
Smck Temp. � f Peraent CO c�l _".f�
HOUSE HEATING TEST RECORD
�
APT. FL CITY — SUBURB�
OWNER iC�
INSTALLED BY ' '� �
�
Gas Une By —
UNR HTR. �— OTHER '�
CONVERSIDN
/�
Vent Size
KIND OF UNER SIZE NONE ��
Draft F�od �—,r( �� C,� Re9ula�or
Fllmra Size � C Number 0
Chlmrrey Lacation � ide
Chimney Constructl�on �P�—��
Smoke Bomb � Widng ��
D►aft �� Test Tag ��
Door Pressure ^ Lightlng Inet �
Date Tested
Company Tesdrtg —
Name of Teater
. �` ! %�8'
Pressure Peraent COZ
input CFH Percent OZ
Stack Temp. Peraent CO
6
Building 1VIECHANICAI, Permit No,� �- ofl
Inspections RESIDENTIAL APPLICATION Received By: �
763-572-3604 CITY OF FRIDLEY Date Rec'd: .� �
DATE �` _'� �' O� YOUR E-MAIL ADDRESS M C SO-� � oT o. t ��-o �
SITE ADDRESS �`� � v i� o. C M o. �n i� c,� � � �; a-t ��4 r� Ss� � a.
THIS APPLICANT IS: �.OWNER OCONTRACTOR
PROPERTY NAN�: �s r o.� �1 �s� ,� �. i�
��E� ADDRESS: CITY STATE ZIP
TENANT PHONE: � b�- SO �- d 3.��
CONTRACTOR Co1vIP.41�rSt NAME:
SUBMTf A COPY OF CONTACT PERSON: �
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH pDDRESS: CITY STATE ZIP
APPLICATION pHONE FAX
PERNIIT TYPE SINGLE FAMII.Y ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: ��W O REPLACEMENT .�,ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK � n S�I'a�� �^1 � � �• L� � � ri � h �1 ��"° � � � � v d' a" �`�' ' �' � `Q . Y� s n T'� ' �
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixt�ues. (This should reflect only the cost of labor )
Labor cost under $300 $15.00. r cost between $300 to $500 = cost of labor � � x.OS =��� �
FOR PROJECTS Wf�RE LABOR EXCEEDS $500, FEES ARE BAS N$10.00 PER FIXTURE, EXCEPT VVHERE NOTED. FIXTURES: (WDICATE TOTAL
NUMBER OF EACH BELOV�
Equipment lnstailed MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
1V�G: MODEL: SIZFJBTU
A/C $25.00 LACE (GAS) $15.00 GAS RANGE/OVEN $10.00
AIli TO AIR EXCHANGEER $15 ,� FIREPLACE (WOOD) $35.Qa NEW GAS GRILL $10.00
BOILER $35.00 FURNACE $35.00 _GAS UNIT H1R $10.00
CHIIvINEY LII�IER $10.00 _GAS DRYER $10.00 POOL HEATER $35.00
DUGT WORK $10.00 GAS PIPING $10.Q0 VENI7I.ATOR $15.00
— ,. .. , ,—
,,. y;e y�
: ��: o .< - � ='� 1 �', " , ����°�., �����. „ `�,��1 ��.,�- � ����` ;. aF'� � �.�. ��?' �X. �.�::� . .�"'�E�� �,.,�� � -�
.., _ _ . _ ,� _. _ . . . „� < � � .� �.. < < .. .,� :.,., : . , . ,m � =- ._ ,,,.�-.. , e
Permit Fee $ �. ° Number of fixtures @ $10.00 . x $10.00 = $
Surchazge .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $�. Number of fixtures @$25.00 x$25.00 =$
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ "' .50
Tota1= $�
THIS IS AN APPLICATION FOR A PERNIIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acl�owledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Const�uction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case o 1 work which requires review and approval of plans. .
SIGNATURE OF APPLICANT �^ ��`�' PRINT NAME � a ^'"� � °` ^ s°`� � DATE � � - � 6 - U�
:� ��r � ���� r� �i��` ��;�� � � � � �� ':: : ����. �,. � �
(:ity of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
City of Fridley Residential Mechanical Application Pa.ge 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR
REOUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
� Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. -up Air (See note below)
� a. IMC Cha.pter 5 with MN Amendments
3. Venting
�Gas appliances IFGC Chapter 5 with MN Amendments
Fuel other than gas IMC Cha.pter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.
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DESIGNED T�3 STAY COOL ON T'HE
OUTSIDE, PRO�IDES A HOT DRAFT ORl
TH� INSIDE, AND HAS � FIRESAFE DESIGN
THAT PRC;TECTS BOTH THE CHIMNEY
�ND THE BUILDING.
Ilt�aPius Fi�i�q is �jn�1 f� dtra# are t�ted � li�f f� use aritt► a 2tf}�°f HT ct�mn�y
sYsiem. such a� wnod stoves, fireplaces, fumaces, �ers, stou�, ranges, water heaters, or other
a�pf'r�s f� bY �I,+�1, c�al, or gas.
����1�E��.EI? E��E�,LE�ICi
�ra�ivs�feamrast��nla��rsaf" ' Ices�u
b�cet � air �cel> � �pthe �aPlus
t;himney cnal a� the aut�de to protect the buiidmg
a� hot � the a� to �st stove �f6a�cy
dw�g r�rm� sio� �ati�n. The c�amic
�>�.;
insulatinn b6ankei is ft�zx�hle a�l compress�hle,
����;<�; � tha fm� �+e�idmutov�rdr��n hot.
� '; . ` � , ,
� "�� ��� ��� ` Th� D�aPlus Cl�nmey aut�r aua� is eithe� sh�rdess steel Qr
a ��' �� steel at�i irtner waHs are �de oi �30 s�ainfess ste�l
_ �'��' _� �`' �
��, ��`, �� r=� ' at� �aS� th2 c�r€tC re�t�ry blatt�t �d au sp�. Tl�e �
sysiem locks tightly u�ath a precisian tw�isi-lock com�ection. The ceram�
filanket insutatim� is he� �ure intn pnsition, efirninatm� hat �ots camman
�ith Ioose-fr� i�e . . lnife� �nt� aaeusate f�e. t!� bf�ec insu�iion pamits
the d�imney liner t� ex� ouc�d � a rat�al dre�tion. QuraFlus en�-rmg larer sus�ion at exh j�int
flexes w aliow Gner to e�and fengdtwise when hat
���ea�.�T�v� �i,���c ST��r�Pt��
s� � � � � � - ��� �a � ��.
I]�L ��FOVEPi��
DEl{. doubte-� stawepips �cen�neer� f� enhanc� safetya►ni � sto��e. DVl:sda�-�tl. �r-in�dated d� reduces clEEarances to
c�. Dtfl. ¢�a� �e tmf� by mas�tai�a►91ri�� ft� Bas t�nA�raiures #m' a strmeg, ste�y draft
• Av�ble � 6°, T, and 8' di�neters
• ihaa#�e .Qi6' s4arc�ess stesl in�r r�►!
' U�-fr� � � � � �9
• G'r���tav�, B' �tse� t�h tt� � ��
• � 8tE '
• U141�f14� � 4� 2i�F HT
X ��'
DL�R�F�L�C� �T�VE�'I�'E
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IIOW TO PLAN, MEASURE AND INSTALL A FIRE SAFE
��F�.�.1��.t�S �I��A�l�i�Y S�'S°I'E�.
Frst, yau must find the fixed pnsitinn of chimrtey's centerline from the stoue collar up through the ceiling �s) a� the roof. Start by drapping a plumb line from the ceiling to
�� st�� IK�p �n rr�ndtl�aty�st+lt� �� p�i s�th� d�yan1i be� � jo�s.l Ft�attl� ��iare rof�si �t w� thechimr�p�fl
��a�f�at�r�i
After selseting the location for strne, determine the height from the bottom of the support 6oz to the high point of the roof where the chi�ey �n11 ezit through the roof,
c���� �� � ��, � �n � ����€���t��r��►�������a•t����.�
This is ta a8ovu for proper draft pe�farmance. Chimney can be higher �an required. IM fl0i IOW2P.
�r��etr��a{r�t�t, ���eleetiaa�t
�s et�r+Ple s�s t�J T�-Stnry f�e ��'
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