AF - 47108�
Village of Fridley, Minn.
BUILDING PERMIT �°• 1985
Date: .�.�.,��1' ;+'. ��f : ��f.. . . . �� ........
�
Owner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Builder ��. .�f. :��: . . %�J',3_ dfG?� ���
Address...................................... Address ......�. ........ .. .
...... .... ..... .......
�. LOCATfON OF BU�G
No. � � '. �i�. . Street . ..�t-r'"°,,�s.-;�rt'y"°= •�,,�ft:,�� Part of Lot . . . . . . . . . . . . . . . . . . . . . . . . . . . .
/ f :
Lot . .�r . . . . . . . . . Block . . .�dy. . . . . . . . . . Addition or Sub-Division �!�r.�:� .. .��.''�°`�i'�0:'� . . . . . . . . .
Corner Lot ........... Inside Lot ........... Setback ........... Sideyard .............................
DESCRIPTION OF BUILD[NG
To be Used as:
�;.�,� f • ,,/ ��'''''�
C �." ��F'.t'.'f. �!`: . . . . Front ,�1. . . . Depth .�"" Hei h r�r'�-" "' S Ft. . . . . . . . . Cu. Ft. . . . . . . . .
�" -• f �7^ , a� a.• • g t� . �r' q.
.............�....... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft ........
`;�2` '�'"°� � ,�.�r,�: �''
Type of Construction .,.� 6.i:°�..rY,r.... Est. Cost ��„�4�Q�..... .... To be Completed ��7 'F.
°'«�.'•,� -,,'�''i�,C-��.-�'"�fGr
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 and in compliance with all provisions of
ordinances of the village of Fridley.
.....................................................
In consideration of the payment of a fee of $.,,1�......., permit is hereby granted to/�`��l:�.s.�?�'!�'�
/,�i
: �.� �{�: ..„��-c :+:.��o construct the builaing or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and worl�nen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repa.ir and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of sa.id
ordinances.
':�f{�"��
� . :�� /�..�'J.'%'�,/. . . . Bwlding Inspector
NOTICE:
This pe�mit does not cover the construction, installafion or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to set�++e Buiiding Inspector for separate permits fp+�kiese items.
�
E _
SuB�ECi
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i �
� �
� `� _����_ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
�
' i '
� �"'1 � CITY NAL� FRIOLEv 5SIJ2 NUMBEi1
�'""'� � �'' 612-571-3450 s�aF�s
J08 AODRESS 5694 Jackson Street NE
1 LEGA� ��T NO. BLOCK TRACT OF ADDITION
oescR. 11 6 Donnav' s La.]
� PROPERTY OWNER MAIL AODRES$
3 CONTRACTOR
Owner
e ARCNITECT OR DESIGNER
S ENGINEER
8 USE OF BUILDING
Residential
7 CLASS OF WpRK
O NEW
8 DESCRIBE WORK
Construct a 45'S" x 22'
9 CHANdE Of USE FROM
STIPULATIONS
MAIL AOORESS
MAIL A�OqESS
REV D�TE
8/19/99
ZIP
/
30078
RECEIPT NO.
�s���
O� •vvnOVED 8�
�
SEE ATTACHED
SFIEET
:—avo
PMONE
PMONE
PNONE
UCENSE NO
LICENSE NO
LICENSE NO
❑ ADDITION �C ALTERATION ❑ REPAIR O MOVE O REMOVE
See stipulations on plan.
existin� 20' x 20'
TO
SEPARATE PERMITS ARE REOUIRED FOF ELECTfiICAL, PIUMBING, FIEATING, ��rt vr Gvnsr occuv�
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANO VOID IF WORK Oq CONSTRUCTION 20NING SO. FT
AUTHONIZED IS NOT COMMENCED WITHIN 80 OAYS, OR IF CONS7qUCTION
OR WOi;K IS SUSPENDED OR ABANDONED FOR A PERIOO OF 120 pqyS AT
ANY TIME AF7ER WORK IS COMMENCED. NO DWIG. UNITS
I MEREBY CERTIFY THAT I HAVE FiEAD ANO EXAMINED TMIS ACPLICATION S7ALLS
AND KNOW TME SAME TO BE TRUE ANO CORqECT. ALl PROVISIONS Of L,AWS yq�UATION
ANO OliDINANCES GOVERNING TNIS TVPE OF WOqK WILL BE COMPLIED
WITH WHETMER SPECIFIEO HEREIN Oii NOT. TME GRANTING OF A PERMIT ��-9, 350
DOES NOT PFESUME TO GIVE AUTMOFITY TO VIOLATE OR CANCEL THE pEqMtT CEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON-
STRUCTION OF TNE PERFORMANCE OF CONSTRUCTION $321. ZS
pACTOp
ZED +vT iD4iE�
� � � iE�
GROUP OCCUPANCV�pAD
CU fT
OffSTREET PAFKING
GARAGES
SUR7AX
$9.67
SAC CMAqGE
� Fire SC $19.35
TOTA� F�9
$351d�. 27
.
. .
NEW [ ]
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRIDLEY-
[] SINGLE FAMII�Y AND DUPLEXES R-1 AND R-2
BUII.DING PERMIT APPLICATION
l� ��
e° ��
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Construction Address: ����f �� E �tsg �� ��
Legal Description: � p� � r��L(�' r ��� �`ia�%�'�a � I"�E�sa��e�'
Owner Name & Address: ? � �► E �/ Tel. # S°/,�-- �� � �'
Contractor• �
MN LICENSE #
� �
Address: �f��y �'Ct� r���oo �`� Tel. # � 3� ° �� %
LIVING AREA:
GARAGE AREA:
DECK AREA:
Attach to this application, a Certificate of Sut�cey.:s�f the
lot, with the proposed construction drawn on it ta: scaie. ..,- _-.
DESCRIPTION OF IlVdPRO�IEll2�EN'�'` �" � � - . . � �
Length Width Height Sq. Ft.
Length `f5 t S'" Width �� ' Height Sq. Ft. ��I P�
Length Width Hgt/Ground Sq. Ft.
OTI�R: ' � '
� �v
Construction Type: / /�� Estimated Cost: $ � ��0� �
Driveway G�rb C�t Width Needed: Ft. + 6 Ft = Ft x$.
_$
�'3 � —�5�,�
DATE: ��1-� APPLICANT: � Tel. #��-�� E S"
���'-�`�3 3
CITY USE ONLY
Permit Fee $���'' �� Fee Schedule on Reverse Side
Fire Surcharge $ �.001 of Permit Valuation (1/lOth%)
State Surcharge $ � "� $.50/$1,0� Valuation
SAC Charge $ � $1050 per SAC Unit
License Surcharge $ /' $5 .00 (State, Licensed �t�sidential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$
$.
$
� ��"D. � �
$450.OU Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or structure,
upon application therefore, require the payment by the applicant for such permit of fees to the amount herein
below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $SW �
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,0(10,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additionat $1Q0 or _
fraction thereof, to and including $2,(}00 : _
$69.25 for first $2,0� plus $14.00 for eacl� additional $1,000- -=
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.Q0 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,(�0,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway wictth plus 6 feet times $15.50.
Alternate "B": �'Removal and replacement of curb and gutter and instail a 3 fac�t��tie
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation oncc it has it has been constructed �vill
be required before proceeding with the framing.
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CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes () No ()
2. Is free from rust or deterioration
3. Has no foreign objects lodged within
4. Is securely supported
5. Meets all current Code requirements for size
and total BTU's connected
6 Has total heating BTU's of
7.
�
All other BTU's
TOTAL BTU's
Has a liner been provided for water heater
Has combustion air been provided for water heater
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
�.
Yes()No()
' ' ' SUB�BCT _ - " �
c�ty of F��a���
�
AT TNE TOP OF TNE 7W�NS � u I L D I N G P E R M I T
! �` _��� COMMUNITY DEVElOPN1�NT OIV. ������0�
� �' � PROTECTIVE INSPECTION SEC.
r � ,
, . ,
� � /"'1 � CITY HAIL FRIDLE� SS�3i NUMBER pEV OATB PAGE Of
�""�' �'' 612-571-3450 910-F15 7/12/O1 / /
JOB ADDRESS 5694 Jackson Street NE �
1 LEGAL �OT N0. 9LOCK TpACT Ofi ADDITION
oesca. 11 6 Donnay's Lakeview Manor
2 PROPERTY OWNER MAIL ADQiiES$
LeRoy McCoy 5694 Jackson Street NE
3 CONTRACTOR MAII ADORESS
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER
MAII ADORESS
ZIP
21P
3 i 9�9
R CEIPT .
��
APVqOVED BY
SEE ATTACHED
SHEET
PMONE
763-572-8065
PFIONE IICENSE NO
PMONE IICENSE NO
LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS Of WORK
O NEW �] ADDITION C� ALTERATION ❑ REPAIR p MOVE O REMOVE
8 DESCRIBE WORK
Construct a 12' x 15' Addi�ion and In�erior Alterations
9 CHANGE OF USE FROM
STIPULATIONS
See no�ations on plan.
Provide smoke detectors in all sleeping rooms and on all Tevels of the
dweliing per Section 310.9.1.2 of the 1997 Uniform Bui�ding Code. Caulk
and flash all exterior openiags.
�EPaRATE PERM�T�
REQUIRED FOR:
�iAiMC, HEATING
PLUI�BONG AND StG�IS
ARN�NG
Before digging call for
all utility locations
' 454000�
RE�UIRE� �Y Lpyy
CONST. OCCUPANCY GROUP
SEPARATE PERMITS ARE FiE�U1RE0 FOfi ELECTRICA�, PLUM8IN(i, MEATINO,
VENTILATING OR AIR CONO�TIONING
THIS PERMIT BECOMES NULL ANO VOID IF WQRK OF CONSTRUCTION ZONING
AUTHOR12E0 IS NOT COMMENCED VjIITHIN 80 DAYS. OR IF CONSTRUCTION Y
OR WOFK IS SUSPENOED OR ABANQONQD FOR A PERIOD OF 120 DAYS A7
ANV TIME AFTER WORK IS COMMENCED ' NO DWLG. UNITS
I MEREBY CERTIFV 7MAT I HAVE READ AND �xAMIN�O THI$ APPUCATION 1
AND KNOW TME SAME TO BE TF1UE AND CO(iRECT. ALL PROVISIONS Oi LAWS yALUATION
ANO ORDINANCES GOVERNING THIS TYPE Of WpRK WILL Q� CQMP�IEO 1 OOO
WITM WMETMER SPECIFIED HEREIN OR NOT. TME GRANTING OF A PERMIT � � 9
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CAMCEL THE pEqMITfEE
PROVISIONS OF ANY OTNER STATE OR LOCAI LAW REGULA7ING CON-
STRUCTION OR TNE PERfORMANCE OF CONSTRUCTION �IHI.LS
$�GNAT' RE F �q C O p UTMOaiZED eGENT IOATE�
°�'l� � �. � ��� � /
e - •
SO. fT
OCCUPANCVLOAD
CU FT.
OFfSTFEET PARKING
STAILS IGAi1AGES
$5.00
SAC CMARGE
Fire SC $10.00
TO AL FEE
196.25
D TMIS IS VO�P��MIT�
• % �? �:
NEVN [ ] Effective 1/1/2001
ADDN [] , CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: �J��l � J �c�i5ean �' �
Legal Description:
Owner Name 8� Address: �«i /1'l e�� Tel. # 7(0 ,�72� ��
Contractor: �e �T' MN LICENSE # Wl 2c�� �l� �O(oG '3�Fy
Address: �`I �% ��e �.So� �'s�' Tei. # r Z `3^Zo7 �
' Attach to this application, a Certificate of Survey of the ���LL
lot, with the proposed construction drawn on it to scale. �
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length �_ Width � Height �_ Sq. Ft.
Length Width Height
Width HgUGround
��", :�
Construction Type: Estimated Cost: $
Sq. Ft
Sq. Ft.
Driveway Curb Cut Width Needed: Ft. ±, 6 Ft = Ft x$ _$
DATE: ^ZC '�� APPUCANT: Tel. # ��D� .� /�'�g���
( C Z 3� � �2��
c�rl
CITY USE ONLY - Call (763) 572-3604 for Permit Fe if mailing in application
�cg/ �5�
Permit Fee $ Fee Schedule on Reverse Side
Fire Surcharge%�!� $ .001 of Permit Valuation (1/10th%)
State Surcharge�� $.50/$1,000 Valuation
SAC Charge $ $1150 per SAC Unit
License Surcharge $ $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 []
•
�,,.r�,._:
�'.�' '
STIPULATIONS: � ��' ��
,
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, �fore issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or structure,
upon application therefore, require the payment by the applicant for such permit of fees to the amount herein
below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$SQ0,001 to $1,000,000
$1,000,001 and up
FEES
$23. SO
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional �$1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,(�0 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $5(�,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete C�rb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15 .50.
Altemate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minunum of 24 hours from tb.e time of application to allow for proper
review of the proposed structure and of the construction site. �
A Cert�cate of Survey of the lot, showing the location of the foundation once it has it has heen constructed will
be required before proceeding with the framing. New Houses Onlv
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