AF - 45432�
�
�_�ii��
City of Fridley, inn N° 8547
BUILDING PERMIT
Date: OCTOBER 20, 1965
�r: DONALD F. SEI�ER $�d� SF.R�ER REALTY
Ad&�s 3600 France Avenue 1Qorth A� Same
Minneapolis 22, Minnesota
LOCATION OF BUILDING
No. 940 g�t Hathaway Lane �, Part oE Lot
Lat x _ Hlock � Afldition or Sub-Divlelon Sexter Addition
Corner Lot � Ias4de Lot R Setback �_.__ Sideyard
Sewer IIevatt� � � Foundation IIeval�on
DESCRIPTION OF BUILDING
To be veed ea: 20 20, 800
Dwellin� Fra�t �'� Depth 26 Height .� Bq. F't. 1040 C�, P't
Frant .� Depth � I�eight � 9q. F� � Cu. P't.
Type o! Construatlon Frame �� �� � 11 375.00 To be Completed
Ia co�lderation oP the issuance to me of a pern�lt to c the buildin des abave I agree to do
ths propoaed work 9a accordauce a►ith the descrip�ton above set fo and 9a o� ee th a�l pro�visfnns oP
ordiuences oP tve dty of Frldley. 1 y
In ca�deratlon of the payment oP a fee of 2�.�00 � permft fe hei�eby graated to SE$CER REA'LTY
to conatruct the build4ng or addition as deacribed ebove. Thfspe rmit fs granted upon
the express c�nditlou that theperson to whom it is graated ead h9s agent�, employees and workmen� 1n all work
done 9n, around and upon eaid buildiag, or anyp� thereoE, ahall conPorm in ell respects to the orainaaces of
�thi�a the� d� �]imita�aa�th9s p�ermi� t'ma�be oked� t�ea,ti► m�� vio a�tion�f and movla� of build9n�s
orcl9aanc�. tlaae any oE the P�vl�iona oP eaid
ALLEN G. JEIVSEN B�1dia8 Iae�ctar
� NOTICBs
1�tf pumN doa aot eewr th� eo�maH�, In�tall�lae ter �rUiao, plumbMO, oa huHno, nwu or w�r. 8� an fo a�
fin dnildino te�ater to� ppu� p�rmN� Por fha� �,
J
APgI.ICATION FOR BVtLDING PERMIT
CI'iR OF FRIIiLEY, MINNESOTA
or�x's rt� � �ONALD F. ,SEXTER � B�D� SEXTER R�ALTY
rance venue o •
�IDDRESS MINRIEAPOLIS 22, MINNESOTA A�DRESS MIIVNEAPOLIS 22, MIIVNESOTA
LOCATION OF BUII,DING
N0. � 40 � � �TREET Hat�latva � Lane ' PART OF LOT
LOT 1 BLOCK l ADDIIZOIJ OR SUBDIVISI S� xt a r Add i t i on
CORNER LOT INSIDE LOT X SETFSACR ,� 5� SIDE YARD, 10 �
SEWER ELEVATION � FODNDATION ELE�ATION
AppZicant attach to this forai Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTIOIQ OF BUiLDI1�G
To be used as; ( /
%d
0 e Front 40 � Depth �6 � Height �,`et�r�
Sq. Ft.i�'�40 � Cu. Ft . � �
Front Degt _� Height
Sq. Ft. Cu. Ft.
. �� .
Type of Construction tvood fTame Eatimaeed Cost � 37,� '�
To be completed May 1, 1966
The undersigned herebq makes application for a permiC for the work herein
specified, agreeing to do all work in stricC accordance with the City of
Fridley Ordinances and rulings of the Department of Buildinga, and hereby .
declares that all the facts and representations stated in this appiieation
are true and correct.
�
DA'TE�Q��� ��� SIGNATURE
(Schedule of Fee Costs can be found on the Reverae Side)a
�''1 � � .-. n M �
��
.: � ::. .�
BIIILDING PE1i�IIT FEE SG�EDIILB
SECTIOP 2. The Inspector df Buildings shall, before issuing any permit for
the erection of any building or structure, or for anq addition to any eaietin�
building or structure, or for any al�texatione.or repairs to any existing
buildiag or etructure, upon application therefore, require the payment by the
applicant for such permit of fees td the �mount herein below set forth and in
the manner herein provided to-wit:
2.1. For any auch peimit for the erection of any fire•proof building,
othei than a garage, warehouse, factory or grain elevator, or for the erection
of any fire-proof addition, for simi].ar oc.cupancy, to any e$iating building, -
ahall be at the rate of $1.40 for each one thousand cubic feet, or fraction.
thereof, in auch cubical contents.
2.2 For any such permit for the erection of any fire-proof garage,
warehouse, factorq or grain elevator, or fmr the erectian of any fire•p�oof
addition, for similar occupancy, to any euiating buildi�ng ahall be at the
raee of $l.25 for each one thousand cubic feet, claesified�as "fireproof"
by Section 502 of the Mian�apolis 8uilding Code.
flOIISES
2.3. For any such permit for the er�etion of any non-fireproof
building other than a garage, warehouse,�factory or grain elevator, or
any non-fireproof addition, for ��Lmilar occupancy, to aay existing building -
permit $1,00 for each one thousand cubic feet.
GARAGES ' . . . _._
2.4. For any such permit�for the erection of any aon-fireproof garage,
warehouae, factory or graia el.evator, or for the �rection of any non-fire-proof
addition, for similar occupancy, to any egisting b�uildin� or for ea�h such
building ar addition - ninety cents ($0.90) for each one thous.and cubic feeC
or fraction thereof, in the cubical contents thereof with the miaimum of $4.00.
For the purpose of computing feee for builcling permits, the cubical contents �
of any building or addition to a uniform height throughout by multiplying the
ground area covered from a point six (6) inches below the floor Iine of the
basement or cellar to the average h��ight of the upper surface or to the average
height of the roof surface of the maia gable of a pitched roof. �
2.5. For repairs or alterations to an existiag atructure, the fee ahall
be at the rate of $3.00 per each Five Hundred Dollars ($500.00) or fraction
thereof in the cost of all proposed work.
2.6. In no case sha11 the fee charged �fctr any permit as aet forth in
Section 2 be less than $+4:0(3. �
STORM REPAIR DAMAGE FEES;
Residential; Eatimated Cost of work.up.t� SS.�O�e� -$5,00 _.
Estimated Cost of �o�*k� e.��• Y 1.��:���;;1 - a�,�,�0
� Couomercial; Estime.t�Co4t of ���,�lc u� t-�-�`:e�;�:i:'0 �$?,,�na
- EatimatE Cost of wurk otirer $5!:'t�.UO -$;� ,Oa
./ - d
, ,�m.. ,; �,�-�,� ,x �x _ � �;� -- ,��.A,'..A.. ,—,,,�- -�:
�t�� � - ��_` �
. '..N +i' i - � � ` ',. � .
., . ' . . , ,.. , .. ' . _ - 3,'� . '
' . �. _ .. : .. . , * � . . ' �.. y ..
�', . . - i�:�.; t : �� - b ..
��111ti�ia�tl�JRdf7$ ' � (�%t'�� �'i'F�'
�.�Ul'�%I� . ' _ M1IlC�Q'��Li.��2, . _
.s�;����;,� �����#���r��i��►� �i��� _ ;����
�c�►�1 � ���� . � - su��a�� � � -
_; : ,
f��� . ,----; �r��i�e�r�,� ; �- � �ur��r��r� =-�-�. � �
� ���'''��►���C,���t ��' . �'�''�'±� t �oae� . ���� -�� =
.� -
�
. �. �.. .
�
���"�'����' � ��:�'���� ; ,
�.� _ � �
�` S r=
. , ' :� ', ' '" �
� � . t , � � � .� i
q�[� � �
. .%. �' .� � - t �'.1r
, p' �� � �M � � }, � �;d�1, y � �
, �.� . y Q t �.�.,� . !w-� � ' � � `�+ 4 ¢
`� �b �} SK��li"�� 21'Ral-is - 4
� � y �,�
" '�► � �- � c �. •
�' ' � � �� ` � e �
� � � � 1 �
h
+� . .. ' , 'Y ., F � �.�,�,�' �� � f � t 'f � . { l :�
. ���_ � � � � n � -0 —
. f %.
, 1� ' '1
' ' � ��+ ' w �► '� ' _
. - 14 r �� �:� � .. . � . � - -..
� � ,� ;
� . -, ,� .. f .r ' �� -
. . . . . . . .�...-.,W ' ��� 4 �. . . 1,: ' a �!:K
... .. , ' . . . . . - . . .
�� 'c . ..: ' ' �. � ' � . ' '
. - , .
� , rrr� ' , - ' � s � .. _ . .
�..,�y , F
1k ,,, .
� � -� � -;.- . ' . : . ,, � ,.�� ` . ., _ .., - : .. ::. , . . . r.. . _
�.. ... .. .. . ,-. � . .. . : ; �;, . , . ,:: , -: -. . , " . . . ... _ '. ._ ' . .
�r:
. . . . , j; . .. , . -� m . _. .
. �
, �� ' .. � ; .: :_�` _�: . , ' - � . .. ... . '_!,t . ' . ' .. .. ., _
� 1
_ .. � .Y' . � ' . ..
, . . _ � ,y . ... . .= r' . . . . - '. - _
.. +.. .. _ ., . .v; _ .. _, ;. � .. ,"
" � ' �s �+4`� �� ���� .�.� �l�i'�flY`.,"����`�'��t?�,� � ;� ti s.
� ,r: ;, ?; ' " " , �.
I �• � E ,
/ �it�t.*�� �c�r`h� �1� �13' �''t� i�r�e � �aarr�� le�d�sB�t�tt�'� o�'r� �itt�' �'iYJ��rrrrt��s, �'� a�a�e^ aF�acl�r�if �'dr�l.a�rzf " X
, �''�la�ct�r1:a�'aU��;;#�m�;�d��,�s�'ti�+i�,h�l's,��'a�',�».��r.�lz�l �s. �e��'f� �.:�.���'
I ;���s � ' , : , f,
�. �'�- � � �a.���..�"` , �
� - �r������r �v��n��l��� ��� h � ° "
�� ' � _ . � � , .� :�� �. ,: =a
•t . - . . "��.. •' `.�� '°`!" � �;�' �',�e. <, � i . �'s
.. 1 �� � � .r- � , � - - ,�, _ ;r- a �.�.
( •'`1
�, „� a� -+�
� s .. . � 4 �m. ,$,r.�j. . s- : .. . - . .. _ .
- . . . . .. . ,. . -,:�,y - .. . � ,_. , t �. - - � ._ ., . . .. . . _ . . ,. . - . ��.1
>
z � tr"
rJ i
� 0 H
M S
KO<i (/�
O ~
� � b
� `° v
� o \
� �* O
r y '7 �
'� K t��f
$ c y
�1 M
A �
N
It =r
2
a o
v
N 'O S�
rr r t+
m r� y
f�0 7 �
m A H
►] y M
n ^
a ri Z
`." 7 (A
r d
n
'7 �A
m �o
t+f
'd
m c� c� x E y x m n m ar o ro z �"
� W W O m C `C m Pi r m r F �9 �
F m m r* n 3 O� w rr O m W R E
"� C � � M b d' S E � O hl ^7 ~
� O h P� W O G E O O'O m r Z
� E 'C 7 R H '1 ►+ P� 07 M M� fp ft �
!p �O l0 M ►� r► Pi M [0 7 �+i �f ,�
I�p N m M lC 'A Q m fa �p 1► W G �„�
K a �o ��- m �e � x n
� z r► o< o a��c n m x
� m ►- co d r m m � m C
� W � ►► r m r m M �
� < < p D M .Z' m �
� � �- � a m m
~ M 'O �O M �
� '� '�1 y
� " tn
►� d k �
�'- W 7 R
"� 7 7C G �
� n h
� � �
�
m
N
2
� •
K
�
m
O
N �
N "
0
0
I I I I I I I I I � m
I I I I I I I i I
N N N N N N iA N N N N N N
r � p
0 0�n .i �, tn t,n tn v+ a r w �n „9,3
0 0 0 0 0 0� o q a �n �n o m
0 0 0 0 0 0 0 0 0 0 0 0 0
N N N N N N N N N N N N N N N N N �,,,j
� .o 0
� � '�
�"'
� i � c)
'V �.'+
.y
cz
N a
H j
m
�n
v� m
n
t11
O O
(!7 SU
H Z
[�7 �C
N 'O
na
�m
��
[+1 �
C�J
�
H
y
�
O
O
b
'v
g
C�'
�
b
�
�
!
�
�
'Y
�
Z
N
�o
W Oi
I
�
. � ��
�� �
��
�,
V
�
�
C
x
M
y
�o
fyG w O
� � �
� � '�
l�
a '�' �+ r Stories
: a � a. a n
o q er
z ClOSets
E �,� k Urinals
h� m
G O Bdih 1Ub5
K �
m
� Basins
O R
a y Sinks
$ '� Wash Trays
� Y. Drinking
a � Fol3ntdin5
Showers
� Floor Drai
O
� Catch
� Basins
m Automatic
°' %as`er
E
R Gas Appl.
7
Misc. Fixt
� y Gas Aanqe
m A
R E
�y ,fDy Other
� 0� R
r m n
n �
C�" fA O tC�iyl rXi Sy �J 7'O A w f0 O
� �-yi m G G l+l W O. c0 � r n'O Q
�,K w�o "� � a
Z�'eJ � o u�'i � p n►�- .�- a n �°�n �' a
E O � C � D O� a. r+1 � A
r �� �o � i ti n m
� � r[e]J � r� o.o � w �►°-'� u,
Cr H [+J M J M IC '� O fD � �+_1
M � . � , p f0 7 `C
2 y' K � � 0' �,,, '�,.
� � ,.
� �J 7 ip � f~0 �
m
� I �. \� � m M O '� � :.�
N
n
� �- O m r W
� v1 �1/ 5 7 ►+ F /�
z � �. \ N �' � fa A E � �
'O
MA
M
�
O
�
��b
(J� �
V ;
�
�
� w o "" � '�o �i
.� °' n�p c �- w
.� rC�.m m �
7 +� R w
� R �O M O �
� m n �
r � rr
m � n n
'�O � O �
. i . 1+� fC O. 'O �
- f1 M W m ^
R ? n B =J
W � m W �
a w E � I
p � K o
N� � S 1
K 1'► K
G m � �
� S w �
Ir O� 0� R H
�p � R "C �'
I��,a�o�
�~�"�e,
� m�
R
a
�
�
r
f7
n
-1
O
z
�
0
�
�
E "
� �
� O
T
D
Z
rj T
�
�
D C
� r
m
T �
-�
�
Z
..i �
m
� I
m
�
!D
n
�
fD
O
�
3
�C
�O
�
a
V ��
�
�
Building
Inspections
763-572-3604
DATE { V_'� T ^
-st`cE a,DD�ss .�
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNIIT TYPE
TYPE OF WORK:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDI�EY
YOUR E-MAIL ADDRESS
�' �� L� �'h �
p pWNER �CONTRACTOR
Permit No..
Received By:
Date Rec'd:
ADDRFSS: S�f{I�'� v �Tl' STATE ZIP,
PHONE:,�G� r � • � � � �
COMPANY NANIE:_
CONfACT PERSON:
STATE LICENSE #_
PHOAIE 7/ Z"S:�Sr" S B g%� FAX
�SINGLE FANIILY ❑ TWO FAMILY
❑ ��r � REPLACEN�NT
DETAILED DESCRIPTION OF WORK
E3� DATE
' CTTy ,� S/� Tl� STAT�%ZIP
❑ TOR'NHOUSE
❑ pLTERATION/REMODEL
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 fixtures. (This should reflect only the cost of labor }
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJEGTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON SI0.00 PER FIXTURE. EXCEPT WFiERE NOTED. FIXTURES' (INDICATE TOTAL
1�TTJMBER OF EACH BELOV� NIODEL: D D 7 SIZE/BTU -7�. 00 �
Equipment Installed . MFG: �E 'e!� Kf i�►. y � SIZEBTIJ
MFG: MODEL: SIZFJBTU
�G: MODEL:
A1C $25.00 FIREPLACE (C�AS) $15.QU GAS RANGFJOVEN $10.�
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOII.ER $35.00 �FURNACE $35.00 GAS UNIT HTR $10.00
CHID�II�IEY LINER $10.00 GAS DRYER $10.00 PQOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10 00 VENTILATOR $15.00
, � .. _;: ..�:.,.�.��;�;� . _.. < �YSi�ir"^�� . :;`: .�'. •"����. �t:
�a.: .,�4��.�.`�,�'j�� .+`R`er.�°�Sir�?. �4R»J�,; a,_ �,,.
3. _� f , . ..__ .. ., ..o� ..0 4, ..x_ „ ..
Permit Fee � $ < • Number of fixtures @ $10.00 x $10.00 = $
Surcharge .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= $
TEIIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PRa�ESSED
I hereby apply for a building permit and I aclaiowledge thai the information above is complete and accurate; that the work will be in
conformance with the ordinanc codes of City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a pertnit but only an appli 'o for a erm' ork is not to start without a permit; that the work will be in accorda.nce with the
approved plan in the case of ork w' re ire review and approbal of plans.
SIGNATURE OF APPLICANT
' PRINT NAME�� �S ��L_DATE �%� "��� �
City of Fridley
Building Iaspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
�
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS ❑ EXISTIN� HOME ❑ MAKE-UP AIR
REQUIRED F�R NEW/EXIST(N� HOMES
1. Combustion Air (S� note below) ,
a. Oil or solid fuel IMC Chapter 7 with MN Amendrrients
b. Natvral Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. ]MC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 vvith MN Amendm.ents
b. Fuel other than gas IMC Chapter 8 with MN Amendm.ents
REQUIRED FOR NEW HOMES
4. Heat loss & cooli.ng load. per room
a. Required on new consiruction TMC 1346.0312
5. Ven.tilation
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
�
�
•- Oet-19-2005 06:26am From-
Da�e: 10/18/2005 Revision Date: 10/18/2005
Site lnform '
Address 1, 940 Hathaway Ln N�
,�ddress 2:
City: Fridley County: Hennepin
Ayprli�;;�l�o�► I�iiu����aliui►
l:u�ii i�:�� �'d�m�: I ��J�:V�Vill�is
i�ui �iact P�►`Suti: t�i�Jidrd tngslrot�
�f�iee Ph: 763-43�-88�7 Fax: 763-444-4567
Address 9: 27589 Hwy 65 NE
City: Isanti State: MN Zip Code: 55040
T-369 P.001/001 F-290
Existing Construction: Pre 199A.
Projeet #:
Lo� Blodc:
Subdivisi�n:
MN Contractor License #:
Cell Ph: 612-978-8030
Combustion Appliance
Water Meater: Nai�ral Dr�fi� Input �TUs: 37,OUD Common Vent
FurnacelBoiler: Fan Assisted Input 67Us: 75,oC1U Commorr Vent
Make-Up Air
i�o Make-Up Air Required by Code
Combustion Air
Minfmum Combustion Air Requirements Met.
t 1
�'�`�I�I�IiV�aiil (�alii� (Nii<<lj:�\ ��''�,�� � �����v� �ignature/D
Go�e O�icial (prini): Signature/Date:
ie� 2QilA C�cnicrP�in1 R�i.:rird�'vlir���con:c�� 2f10� Mecl�anical C:�de Cuidelin�. Paoe 1
:i
Ciiy of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
Mechanical Pe�m�# ����6a �/
Residential Application
Date �- /,,�c�%
The applicant is: (c
Property Owner:_
City:
Phone: '
Contractor Infon
Company Name
Contact Person:
City:
City of Fridley
See Back Side For Required Informa#ion
Site Address:
one) Owner
Cell:
Cell:
Type of Work (circle one): New Replacement
Detailed Description of work: �, �s�"G,/ �� � n
Zip:,
Fax:
MN Bond# & Exp Date
AlteratioNRemodel
Equipment Installed: MFG: Model: Size/BTU:
MFG: Model: Size/BTU:
MFG: Model: Size/BTU:
Please check all that apply: _Fireplace (gas) $15.00 _New Gas Grill $10.00
_AJC $25.00 _Fireplace (wood) $35.00 _Gas Unit HTR $10.00
_Air to Air exchanger $15.00 _Fumace $35.00 _Pool Heater $35.00
Boiler $35.00 _Gas Dryer $10.00 _Ventilator $15.00
_Chimney Liner $10.00 _Gas Piping $10.00
Duct Work $10.00 _Gas Range/Oven $10.00
Permit Fee
Surcharge
Total Due
��' (Total from above-Minimum fee $35.00)
�, 0.50
$ J��.� v Make check payable to City of Fridley
This is an application for a permit- not valid until processed
I hereby apply for a mechanical permit and I acknowledge that the information above is complete and
accurate; that the work will be in conformance with the ordinances and codes of tha City of Fridley and
with the Minnesota Construction Codes; that I undarstand 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 tha
approved plan in case of all work which requires review and approval of plans.
Signature of Applicant
Approval Inspector Sic
Date: ,��"D�
Date� �� - �
Please Note: Separate permits are required for Building, Plumbing, and Electrical work
Revised 6/14/2005
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMESIADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. ]MC Chapter 5 with NIN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 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