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pvvner . �uilder �.��'�� . ,����' :z.°�'� .J!�:'�'�",���� .
A dress . Address_ � .. .
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LO A,TIOI� OF B ILDING :� ;`,;
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No: . : ,. ....: Part,of i.ot : ...... ...... .:... ...:
I.ot . .�j�. . Block .� � Additian or Sub�Division���'���. .���': �: t-'� ' : a
: Carner Lot . . , . . : . . . . . ' Ins�de I.vt . . . . . . .. � . Setback �" ��,�1. Sideyasd �f,�.¢��'. .. .: , . . ... :
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' ; , ': T.iESCR�P7[4N 4� BUil..DlhiG - _ � - ,�
Ta be Used as • � � `.
� � �,�.� ,� .' y . be th '��':"� Heigh .�� S F� E,i�. F� :.
. ���1+��.�,���. Front �' : g ,� . fi� �' q. -
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. De . � : . I�ei ht . -Ft. Cu. Fi. . � .
...:.. .....: .......... Ftont ::..... pth . .,. g .. Sq.
..... ..rt.... . .• _
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Type of �onstructian�:`�r�t:a:�.. . Est.'Co$t ��,°""��"'r.�� :"� �o be Completed�� �,�;�
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IYl COIffiF�8T8.t1dI1 O� �l@ 1S5#18T1C@ iA 1Yl@ Of 8. �rlirit �Q COT18�Tilt't �l@ bL1��111P+ (�2SCCII'� BUbYC', I a�E 'tQ t10
. ' the pmPflseB work fn accardarice with the description above set forth and in cornpliance with all provisions oi '
ordinances a� fihe;vil2age;;of Fridley. � . -
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Lx ec�ns�ideration of �he payment o� a fee of $..�:r�* .�` ., permit is &Qxeby granted to ��'..�'.�.�'^.�:*� ..• -
_ R h �''� '. �
q '�:�.:�����!�°:` �to consixuct #.he 'bu�dit►g or addition as'descrii�ed above. This`permit-is gran upon ,
: .. .
the expr�ss canc�itio� that the perrs�a to �'hozn it is granted and his agents, emp�oyees aud w�lanen, in `�Il vvol�k �;'
done in,'around Rnd upoa said builcling, ar any �art-thereaP; _ shall conforrn 3n ail :respecfis to the orclinaaoes °oP :-. ,
FridleY. Alianesata regarding Yoeatton,`construction, alteratiort, maiuteanance, rePa3r and ttuiv3ng of bui,ic7iriga wi'fih-
in i3� viil�ge li�its and this perra�tt may be revoked at ar�y `Kme u a viulation of any of the prov9sions Cf saic� :•,. � >
ordin�anc�s.
. . . . . . . � . . •�c�° �� Suildi�g ?a�pt�tor
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t1i?TICE; '�s;�" ;:� - �«' ..:,� :�. t��
:F TF�is �ermit ,daes not cov�r ihe. constr,ucttan, Instaitation or atteration for wFring, plumbirtg, gas hea�ing,
' `' , ; � _ .
r sewer "or water. Be s�re to :s ` Buitding inspeotor for sepa�ate parmits f ese items.
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City of Fridley, inn
BUILDING PERMIT
Date: SEPTEMBER 29, 1966
N�
Owner: CHESTER E. ANDERSON g�� SAME
Addresa 5695 JACKSON STREET N. E. �,d�.� „�,
FRIDLEY, MIlVNESOTA 55421 __
��'�%�
9033
LOCATION OF BUILDING
No. 5695 g�t JACKSON ST. N. E. .._ part of Lot
�� 10 __ Bl� 5 Addition or Sub-Division ._ DONNAY' S LAKEVIEW MANOR
Corner Lot —_ Inaide Lot �_._.. Setback _...._ Sideyard �
Sewer Elevation
Foundation IIevation
DESCRIPTION OF BUILDING
To be vsed as: .
ATT. G�GE Front 22 Depth 22 Height 10 gq, �, 484 �, �, 840
Front Depth �Teight Sq. Ft. G�. F't.
7`ype of Construction F� Es� Cost —�? 300.00 __ To be Completed
COUNCIL APPROVED - SEPTEMBER 6, 1966
BOARD OF APPFALS - APPROVED - AUGIIST 31, 1966
In consideration oP the issuance to me of a percnft to construct the building d�crlbed above I agree to do
the proposed work in accordance with the deacriPtion above aet Yorth and in comp ce with afl proviafons of
oidinances of the dty oY Fridiey. `—� ���
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In camsfderation of the payment of a fee of $ 5. 00 ���t ��by graated to
to construct the building or addition as described abave. Thi� �ermit is granted , upon
the express c�ndition that theperaoa to whom it ia grantad aad his agenta, employees and worlmnen, ia all work
done in, around and upon said building, or anyp� thereof, ahall conPorm in all respecffi to the ordinaac� oE
Fridley� M9nr�acntA TC�BT�II� 1OC81�OD� COD8tTllCtlon, alteration, maiatenanCe, Teps3r and moving of bu11d1IIga
within the dty ]imits and this permit may be revoiced at any time upon violation of any of the provfa�tona oP eaid
ordinanc�.
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Buildin8 InsPector
NOTICE:
?hb pem+h dees not cevsr ths eoamudtoe, IestaQallon Mr wirtns, phrmbine, gp huMee, mv�e e� wMer. 8� wn to a�
the BuiWirtO lasp�stor Por aparai� porm(fs tor thsa h�ms.
APPLICATIOA FOR BUILDING PERMIT
CITY OF FRIBL�Y, MI'NNESdTA
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LOCATIOAT OF BUILDING
N0, STREET PART OF LOT
LOT BLOCK ADDITION OR SIIBDIVISIUN
CORNER LOT� INSYDE LO't SETBACK SIDE-YARD
SEWER ELEVATION FODNDATIOAT ELEVATI014
Applicant attach to this form Two Certfficates of Survey of Lot and propoaed
building location drawa on these Certifieates.
DESCRIP7.TON OF BUTLDIPG
To be used as;
� � 6
� � ,� � �, a Front o2� � Depth ,� �.l Height /�
Sq. Ft. Cu. Ft.
Froat Depth Height
L Sq. Ft. Cu. Ft.
� �l.�.e.i
Type of Construction Eatimated Cost �� 3�do
To be completed
The undersigned hereby maices application for a permit for the work herein
specified, agreeing to do al] work in strict accordance with the City of
Fridley Ordinancea and rulings of the Depaxtmeat of Buildings, and hereby
declares that all the facts and repreaentations atated in this application
are true and correct.
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DATE �� �SIGNATURE� C= , � ����-.
(Schedule of Fee Costs can be found on the Reverse Side).
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BIIILDING PE1�RT FEE SCiiEDULE . � . . .
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SECTIOR 2. The Inapactor of Build3ngs �hall, before'�iasuing any periait for �,
the erection of any building or etructure, or`for an� addition to any existing �
buiLding or etructure, or for any alteratioqs or repair�'�to any esisti'ng
building or aCructure, upon application the�efore, require:the pgj►anent,by the
applicant for such permit � of fees to the. amount .hereia below �et � forth and� in
the manner herein provided to•wit: � _
2.1. For any such �ermit for the erection.of any fire-proof buil.ding,
other th'an a gara,ge, warehouae, factory pr grain elevator, or for the erection
of any fire-proof ad�ition, for aimilar occ�ipancy, to any existiag building,
ahall be at the.rat.e:.of $1.40 for each one thousand cubic feet, or�fr8ction
theraof, in such�cubical�.�ontents.. - .
2.2 For any suct�._.permit for the erect.ion of any ffre•proof garage,
wazehou e, faetorq or �rain elevator, or for the eiect3on of any fire�proof
addition, for similar occupancy, to any�existing building shg11 be at the
rate of $1.25 for each c�ne thousand cubic feet;-elassified ae "fireproof"
by Section 502 of the I�Iin�eapolis Buildiag Ccde..
SOIISES
2.3. For any such permit for the erection of any non-fireproof
buildiag other than.a garage, warehouso, factory or grain elevator, or �
aray non-fireproof addition,�for sim3lar occupancy, to auy entsting building �.
permit $I.O� for. eazh--on� thau��ad cubic �feet. - - --- -
GARAGES
_,
2.4. For any such perm3t for the erection of aay noa-fireproof "garage•,
warehouse, factorq or grain elevator, or for the erection of any non-fire-proof
additioB, for similar occupancp, to any-egisting building or for each auch
building or addition - ninetq ceats,.($0.90)��for each one thousand c'ubic feet
or fraction thereof, in the cubical contenta thereof with the minimum of $4.00.
For the purpose of computiag feea for build�tng permits, the cubical contents
of aay buildiag or addition to a uaiform height throughaut by multiplying the
ground area covered from a point six (6) inches below the floor line 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.�i� gable of a pitched roof.
2.5. For repaira or alterations to an exis�fng etructure, the fee shall
be at the rate of. $3.00 per each Five Hundred Dollare ($500.00} o,r`fractivn
thereof in the cost of all proposed work.
2.6. . In no case sha11 tlie fee charged for any permit as set for.th in
Section 2 be lesa than $4.00.
STORM REPAIR DAMAGE FEES;
Residential;
Con�ercial;
Estimated Cost of work up to $5�?4,^� - N5e!!�
Estimated Cost of work over "'.� �::.. <' ? =� r.
_ F .e � ;� � ., . _ 0
Estima.ted�st of wor�r t�' �.�� "". , , ,.•� � �� .f:�
Eatimated ,,,st of w�2.c u: �:z� Y�+;'i.�,i�;� - Y� i%, _ �
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�FORM %�8�•�: � U.
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City of Fridley 16 3 5
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
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; � RECEIPT NO.
� ; L �____ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. � ( ��
1 . , �
� � /"'/ � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�'----� • •�� 612—b71-3450 9y o-F15 8%�-�81 / /
JOB ADDRESS 5695 Jackaan 5t. NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oesca. 10 5 Donnay's Lakefiew Manor SHEET
2 PROPERTYOWNER MAILADORESS ZIP PHONE
Chester E. Anderson 5695 Jackson St. N.E. Fridley 55432 571-6934
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
O�rner
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residenti 1
7 CLASS OF WORK
❑ NEW �7 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
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9 CHANGE OF USE FROM TO
STIPULATIONS
Roof can be second but not thirde
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. �S ha],'t
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R S
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 1 450 O %3
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. SZS.00
PLAN CHECKFEE TOTALFEE
$25s73
„�•�IGNA-TUREOFCONTRA�TORO NoR�ZEDaGEtvT -ATE� � WHEN PROPERLY IDATE THIS IS YOUR PERMIT
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SIGNATUREOFOWNEAIIFOWNEABUILDEAI 1 TEI BLDG INSP �l.TE
s
CITY QF FRIDLEY Effective Aug. 1, 1981
APPLICATIa'� FOft RCSIDEi�ITIl1� QUILDIf�G PEf��fITS
(tdc��l, Alter�tions, Additions, or Repairs)
OtJf�ER:�f,�,S%s_ ✓� �' ��,�J�;��I��sL�
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ADDRESS : � � �f /Cl�Cl�.�'� �/ � , .�� e
TEL �0: �/ - � �,y� �
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• STRI�T NO: e7 �p ���
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l3UILDER: `l`l`�`r.- i� .
ADDRESS:
TEL I�dO:
Construction Location
STIZEET: \//'�G/1�+f D'� � l /"/�•./
L07.': � SLOCTC: �/
ADDITION : �l���l/��1' ��i�-� Vl�� UIJ /�
Corner Lot: Insicle Lot: SetbacY.: Sideyards:
Ap�licant attach to tliis form two Certificates of S�rvey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIOId OF CQPJSTP.UCTIOPJ
rj�rJ'�% I'ront: Depth: Height:
Squane. r'eet: C�ibic Feet:
'v�°O�
Front: Depth: Height:
Square� Feet: Cubic I'eet:
� � / s'D� c�
Type of Construction :� (���%,�h�.� % ,.1��f���'�'� �� Estimated Cost: $ /' �
Zb Be Oonpleted: (�G r � , � ���
� Alt. A Alt. B
Proposed Drive�•ray Width If New Opening Is Desired: $� $
, SE� i�VERSE SIDE OF SHEET .
�iie undersigned hereby ma}:e� applicatian for a permit for the �vrk� here�n specified,
aqreeing to do.all work in strict accordance with the City of I'ridley Ordinances �aid
rulings of the Department of Buildings, and hereby declares that all ti�e facts and
represen�at'ons stated :n this application are true and correct.
� � �
D.'�TE: `��,� �� SIGNATURE : �� �°� -,;� �,%� �.�Z�-�
StiPulations:
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BUILDING PE�RMIT F•EE SCHEDULE
The Inspector of buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any
bxisting building or structure, or for any alteration or repairs
to any euisting building or structure, upon application therefore,
require the payment by the applicant f or such permit of fees to the
amount herein below set forth and in the manner herefn provided to-wit:
TOTAL VALUATION
$1.00 tio $500.00
$501 to $2,000
$2, 001 t,� $25, 000
$25,001 to $50,000
$50,001 to $100,000
$100,001 and up
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FEES
� $10.00 Minimum Fee $15.00 plus surcharge
$10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and
including $2,000
$32.50 for the first $2,000 plus $6.00 for each
additional $�,000 or fraction thereof, to and
including $25,000
$170.50 for the first $25,000 plus $4.50 for
each additional $1,000 or fraction thereof, to
and including $50,000
$283.00 for the first $50,000 plus $3.00 for
each additional $1,000 or fraction thereof, to
and including $100,000
$443.00 ior the first $100,000 plus $2.50 for
each additional $1,000 or fraction thereof
PLAN Ci�CK: 25 percent of building peanit fee
�
DRIVEWAY DEPRESSION ESCROW: Concrete Curb Streets Only �
Alternate "A°: Removeal and replacement of curb and gutter only
Driveway width plus 6 feet x$13.50
Alternate "B": Reaoval and replacement of curb and gutter and install a 3 foot
wide approach with 6 inch depth
Driveway width plus 6 feet x$15.75
VERIFICATION OF FOUNBATI�ON
Permits for construction will be issued a minivawn of 24 hours fr�n the time of
application to allow for proper review of the proposed structure and qf the
construction site.
A Certificate of S�zvey of the lot, showing the location of the foundation once it
has been canstructed will be requixed before proceed3ng with. the framing.
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CHIINNEY AND STACS VERIFIC,ATION
The undersigned hereby ver�fies drdt t� �existing c�imney or stack:
1. . Has been car+efiilly e�tamined °_ � Yes Q�No i)
2. Is free from rnst or detericnation Yes (�/No ()
3. Has no foreign objects lodged wid�m Y� () No (�
4. Is securelY �PP�rted Yes (�/1 �o t)
5. Meets all current Code requar�ents for size
� and total BTU's connected Yes �No ()
6 Has totai heating BTiJ's of '�%D , O o�
All other BTiJ's
TOTAL BTU's
7. Has a liner been provided _ for vv�ater heater Yes i) No .i )
8. Has eombustion air been �ovided for water heater Yes () No ()
Remarks: . �
List ALTERATIONS Being Done-
�
HEATING CO:
Signed By:
Date:
n
�
Buildillg PLUMBING Pernvt N .. ° ° � �
Inspections R�SIDEN�It�L A.PPLICATIOleT R�ived By:
763-572-3604 CITY OF FR�LE� Date Rec'd: �� �''�'
DATE S � � '
SITE ADDRESS S
TFIIS APPLICANT IS:
PROPERTY
owrrExi
TENANT
CONTRACTOR
0
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SUBNIIT A COPY OF
YOURSTATE
LICENSE WTfH
APPLICATION
PERNIIT TYPE
�E oF woRx:
YOUR E-MAIL ADDRESS
�WNER ❑CONTRACTOR
PHONE: 763 s 72 2z ��l
Ai,41J�:
STATE LICENSE #
EXP DATE
ADDRESS: CTfY STATE ZIP,
PiiONE
�SINGLE FAMII.Y
❑ t•rEw
DETAILED DESCRIPTION OF �JORK
� 55�P �Z
FAX '
❑ TWO FAIvID,Y 0 TOWNHOUSE
,�xEpLa,cEt.�rr
�. r�c (.� � �;^e�7e-v' i2 � C�I mo�t IGi �.� � D� ,3
PER MS 16B.665 the permit fee is a minimnm of $15.00 or 5% of the total cost up to 5500.00, whichever is greater, for the
improvement, installation or replacement af a residential fixture, excluding the fnttures. (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 =
FOIt PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASID ON $10.00 PER FDCT'URE. EXCEPT WHERENOTED. FIXT[TRES: (INDICATE TOTAL
NUMBER OF EACH BELOV� WATER PIPING
BATH SINK/LAV FLOOR DRAII�TS _ SHOWER _
BATHTUB _ GAS PIPIATG f� �'��'� _ SWIIvdYIING P�L _ WATER SOFINER ($3�
CLOTf�S WASHER KITCHEN SINY. WATER CLOSEf _BACKFLOW PREV. ($15)
DISHWASHER _ LAUNDRY TRAY '�R'ATER HEATER ($3� FOR IRRIGATIOAi
— WATER MECER _ OT1�R
Permit Fee
TOTAL DUE
- ;< . ,. _. , . .. ,,. ,. . . �. .� . :_,. . .: ._..... _
$ �,� Number of fixtures @ $10.00 x $10.00 = $
.50 Number of fixtures @ $15.00 x $15.00 = $
$ 3S •� 1•Tumber of fixtures @ $35.00 x $35.00 = $
State Surchazge = $ .50
Tota1= $
7WS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a build9ng permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and cvdes of the City of Fridley and with the Minnesota Consh 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 of all ork whic requires review and approval of pl s.
SIGNATURE OF APPLICAAIT pRINI NAME o h ✓°�S � DA7'E Nla �a �T �
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977