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City of Fridley, Minn.
BIJII.DING PERNIIT
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N° 346i
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Builder .....,�. ...................................
Address .............................................
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LC�CATIQ�V OF BUILDING
No. .:�!..1./�. Stceet .. . .. . . ....�.v!./.�. Part of t ..............................
Lot . . . � �. . . . BYoc� . . . . . . .Y. . . . . . . . . . Addition or Sub-Dfvision �Q� . . . .�:�Gle�!?� ���!'"'�"/
Coraer Lut . . Inside Lot . .�. . . . .. . Setback . .d. �� . Sideyarrl � ° �
DESCRIPTION O� BUILDING
To be U �: o ^e Q �
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. .. .. .. .. .. .. .. .. .. . Front . . .. . .. . Depth ... .. . . Height� .. . . . 5q. F`t. . . . .. .. . Cti. Ft. . .. .. .. .
Type of Construciion . . . �1�� �'� . . . . �st. Ca�� ��.T. . ."::�'"'. . To be Completed . . . . . . . . . . . . . . . . . . .
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In c�nsideration of �he issuance to me of a permit to construct the building degribed above, I agree to do
the proposed work in accordance with tlae description above set forth and in c�mpliance with all provisions of
ordinances of the dty oE Fridley.
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In consideration of the payment oP a fee oi°i$. . �..�f.. .�. •� Permit is hereby granted to . .. .. .. .. . . .. . . .. . .
. . . . . . . . . . . . . . . . . . . . . . . . . to construct the bwllding or addition as described above. 7i�is permit ia granted upon
the express crondition that the person :to whom ft ia granted and icis agents, employe� and worl�en, in all work
done in, around and upon said building, or any part thereof, shall conforai in all respects to the ordin�nces of
Fridley, Minnesota regarding location, construcl3on, alteral3on, maintenance, �p� and moving of buildings with-
in the dty limits and this permit may be revoked at ar�y time upon violation of any of the provisions oP said
ordinances. e ; ��
. ��.� ��%. : J . . . . . . . . . . . . . . Building Inspector
NOTICE: I
Thla permlt does not cover the constru�stion, Installatior� o� alteration fo� wiring, plumbing, gas heating,
sewe� o� water. Be su�e to sea the Bullding Inspector fo� separate permlt� fo� thass Itema
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. i�LTII,DING PERMIT , �°• 19 9 0
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Date�,�e�� ��`± . �'. � �:''s� .'�e�. � . �
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Qwner . . . . . .. Btiilde�,r��� � �:�-"f - _�;��"�.� �' ,�,�
Adsiress . . , . . . . . . Addre�s : . .. . � . . . . . . . . . . . ..
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J LO A'�'ION OF BU DING
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"� � +r �. Street .,�°"��►:��������rr°:� ���''�� . .�. . . . Part of Lot
- - Lot .�� � : Black f . .', ty� .� Addition ar Sub-DivisioA,,��: �C�ra+�.''s4Y. . f. �!�.'�.�: �.�`�. � '
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�taer Lot . . . . . . _ ,
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` �' _" �ESCRIPTION' t3F BUILDIN� .' . , ` . `
To be Used a.�: ' - ' �` `
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= Fron� .. Depth ` Fieight Sq. Ft. Cu. Ft. ���
Ty�pe oP' Construction .��#�:�'.�. . . Est. Cos'� �s� �.�:�'. � To be C,ompIsted � �'". +�:' •��E� ,�` � k ``��
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- ' In considera:t4on of the issuance to me of a�erniit io construet the buildi�ng described above, I a�ree to do �: r,
, the proposed w4rk in accordance with itre descrigtion above set �ortie and in compliance with a11 pro�si�nR of '-
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,� oidinances of the villag� of Frid�e3',
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� 4 ' Tn consideration of. the gayment af a fee of $:��,e�': . . . � peraut is hereby �anted to ` . . . �'�. . . . . ��
� �`� �t. �� �,� . s�: :�: r:����:�'. . to construct the building or addition as �e�scribed above._ '�b3s permit is' granted uPan �;�,�:'
: '_ the express condiiioxt thai the person to whozn it fs granted and his agents, employe� and workmen; in all work -:_
._.
�: done; in; aro�s� and u�n saicl bui�ding, or any part tbereof, shall' �onform 3n �il re�cts io the ordiaances o# , -� .��. `.
�: F`ridley, Mfnnesota regarding`loc•.ation, construciaan, altera.t3on, maintenance, rep�3r and moving of'building� with- s�'°`'
in the village limits and #his perrnit may be resroked at any tfine t�pon violation of aay of tbte provisions of �
ordinances. � ;- ��;:
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T[�is permit ctbes: not oaver t f
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;�Ctor for sepanate pt��mits nu� f lfietr�s.
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sue�ECr PERMIT
City of Fridley 16 310
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
r
� � ECEIPT NO.
� �� _ COMMUNITY DEVELOPMENT DIV. �
r i � PROTECTIVE INSPECTION SEC.
� _ �
� /'�'1 � CITY HALL FRIDLE� 55432 NUMBER HEV. DATE PAGE OF APPROVED BV
�'"'"� � ,�� 612-571-3450 910-F15
7/30/81 � �
JOB ADDRESS 5715 Jackson Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ],2 5 Donnay's ?�,k�view Manor SHEET
2 PROPERTYOWNER MAILADDRESS 21P PHONE
Beatrice & Thorwald Peterson 5715 Jackson 5treet N.E. 571-6643
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
5ame
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Res.idential
7 CLASS OF WORK
O NEW ❑ ADDITION 0 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
$
B DESCRIBE WORK
Reroof Dwellin
9 CHANC3E OF USE FROM TO
Si�l PU LATION S
Roof can be 2nd but not 3rd roof. Insta.11 ridged galvanized valleys.
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. 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 WORK IS COMMENCEO. 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 �`],�],rjO $. .Jr7
WITH WHETHER SPECIF�ED HEREIN OH NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TH6 pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGU�ATING CON- yS`9.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
$9.57
SIGNATUREOFCONTRACTORORAUTHOR DA ENT iDATEt _ ±�: WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT
I ' - .
1 � A ° � � _3� ��% � �
-�I N O OWNERiI OWNERBUILDE i iDATE� BIDG �NSP q7E
Ot�JtJER:
ADDRES
TEL NC
CITY OF FRIDLCY
APPLICI17Ia'J FOft RESIDLt�ITIR� QUILDItlG PCf��iTTS
(�Je�•r, Alter•�tions, Additions, or Repairs)
LQER: ,�� ' �
)RESS:
t�d0:
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Construction Location
STRI�T NO ��� ti � STREET: �
LOT: � BLOCK: �
Corner Lot: Insicle Lot:
_Sti /a �
�' Sideyards:
Ap�licant attach to this form two Certificates of Stitrvey of lot and
proposed building location drawn on certi.ficates to scale.
DESCRIPTIOtd OF COF�STRUCTIOPI
e� � I'ront: Depth: Height:
Squa�e. Feet: C.l.tbic Feet:
Front: Depth: Height:
Square� FePt: Cubic I'eet:
Type of Construction :�,(� � EstiunaL-ed Cost: �_�_�(/
. n
Zb Be Oor,�pleted: � ���' °
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $� $
, SE� Re^�VERSE SIDE OF SHEET
The undersigned hereby make� application for a permit for the t:�ork�herein specified,
agreeinq to da ,all work in strict accordance �rith the City of I'ridley Ordinances ziid
rulings of the Deparfiment of Buildings, and hereby declares that all the facts and
rc,�resentations stated in this applicatio are true and correct.
DhTE: ,
7' �O � �/ SIGNl�TUFtE: � �'Y�
Stipulations:
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� • TsU1LnIh�G t'Cftt1JT FCt� SC{(rI�ULE� 4 .
5);CTIOI•7 2. �'1'ti� 7n�:��ector. OS �3U].1CG1J7(J.^, ::hril.�., befor.r. i.�sui�ig pcnnits Lor t:l�e crc:ction
af .���y l�u�.l_cl:i.ncj ar :�i_ruct:UI:C� or. tax any ac�Qi.i:i.on L•a ai3y CY.I:;i:3.�icJ l�uilcliny or stzucLur.e,
.�»- l:��� aTiy �z1L-eration or. rcl�air.:� Lo •any c�:a..Ling 3�ui.)_di..�i:� or str.ucturc, nJ�w� n�pli_c:atS.on
�thcl:.:fore, rcquzre U�c Pa�►menL• }�y tlic aZ�p].i.cant: for. such per.mit of tees to tlie amount
}1CXt3Lt1 bel.cn�� sc:t for.th aiid 5.�� thc �nanncr, hcrein p�:ovidc:cl to-�•:it: •
JJI.t•I CONSTI:UCTI�N: SingJ.e lamil.y llomes and Ga1-ac{es: Y�l.00/1,0�0 cuU3.c £ect:. •
PLA?� CII1:G;: 25 percerit: of bu�.lcling �>ca.-mit icc. .
D121:��El;AY DEL'P.L•'SSIOI•I: (CvncreL-c. C�rb �Lrcets Only) �
• Alternat:e A: Itc:moval and re��lac�ment of concrete curb and
gutter only; llriveway width plus 6 feet• x$13.�0
AlternaL•e B: Removal and rep�.acem�•nt of concrete curb and
. gutter and inst�ll a 3 foot r�ide approach t►►ith �'
' _. 6 inch depth; Drivevray �•�i�th plus G feet x$la� 75
. . ADDI �' I 0�/�L I NFOR[�1l1T I ON
Por the puri�se of computing i'ees for. building permits, L-he cubical contents of any
build5.ng or addi�ion, is dctcr.mi.iied by multiplyir�g ihe qround area covered i'rorn a
poa.nt sir. (6) inches belo4� the floor l.ine of L-he basement or the cellar t-o the
average heights of the •upper surface or to the average i2eight of the roof. surf:ace
of the raain gable of a pitched rooi. �
For re�ai.rs or alterations to an exista.ng.structure, the fee shall be at the xate
of $3.00 xiex each five hundred dollars '� ($500.00) er fraction tlzereof in the cost
oi all proposed wor.k. . . �
In •no ease sha�.l the fee chargeci fcsr any pPxmit as set iorth xn Seetian 2 be less �
than $7.50 plus $.50 state surcliarge. '
VERIFIC.�ITIO� OF FOUP�InATIOt�
NOTE: Permits for construct-ion will be issued a minimim► c,i 24 hours from the time
�f application to a7.low for pro}?er review of ihe proposed structurc and of the
construction site.
�
I� Ceri:ificate � of Suxvey of the lot, shocaing the location of the foundation once it
has been cons�nicted tiTill be required be£ore procecding with the iraming.
�RTIFICATE OF OCCUPA�'C1L
?►pplication ior a Certificate oi Occu��ancy sh�ll be made ten (10) days prior to the
use or occup3ncy oi any structure for ��hich a�iuildi.ng permit has been issued; and
said structure shall not i�e used or. occu�ied unL-il a CerL-ificate oi o��urznC�� has
bcen x�sued.
0
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� SuB�EtT . � � PE �.._
c�ty of Fr�arey 30443
AT TME TOP OF TFIE TWINS g � � L D I N G P E R M I T
r
� � RECE� NO.
� ; v �_���_; COMMUNITY OEVELOPMENT O1V. � � �
PROTECTIVE INSPECTION SEC.
� . ,
i---. w �����,•� CItY MALL FRICLEr SS�3Z NUMBEh REV DATE PAGE OF APPROVED B�
L J� 612-571-3460 910-F15 10/26/99 � /
lOB ADDRESS 5715 Jackson Street NE
t LEGAL �OT NO. BLOCK TiiACT OR ADDITION SEE ATTACFIEO
DESCR. 12 5 Donna 's Lakeview Manor SNEET
2 PROPERTY OWNER MAIL AQOR�S$ 21P PMONE
Beatrice Peterson 571-6643
3 CONTqACTOR MAIL ADDRESS ZIP PFIONE LICENSE NO
Midwest Cedar Timberoof 1001 E Cliff Rd Burnsville 55337 808-1149 20147336
d AqCHITECT OR OESIGNER MAIL AODqESS ZIP PMONE LICENSE NO.
5 ENGINEER MAII ADDFiESS . ZIP PNONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WOIiK
O NEW O ADDITION O ALTERATION � REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Reroof house and gara e(24 S) Tear-off
9 CHANOE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
�ermit Insp�c�io� �ar�s
iNiio �� �����
�� �om�own�r To P��t
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, MEATING. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILA7ING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WOFlK ON CONSTRUCTION 20NIN6 SO. fT CU fT.
AUTMORIZEO IS NOT COMMENCED V�1ITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED Oti ABANDONEO fOfi A PERIOD OF 120 DAYS A7
ANY TIME AfTER WORK IS COMMENCED. NO OWLG. UNITS OFFSTREET PARKING
I HEREBV CERTIFV 7HAT I HAVE READ ANO EXAMINED TMIS APPLICA710N S7ALlS GARAGES
ANO KNOW TME SAME TO BE TRUE AND COiiRECT. A�L PqOVISIONS Of LAW$ VALUATION SURTAX
AND ORDINANCES GOVERNING TNIS TVPE Of WORK WILL BE COMP�IED @
WITM WME7HEii SPECIFIED NEREIN OR NOT. TME GRANTING OF A PERMIT �2�9H y+l .OS
OOES NOT PRESUME TO GIVE AUTHORI7V TO VIOIATE OA CANCEL TNE pEAMIT FEE SAC CHARGE
PROVISIONS OF ANV OTMER STATE OR LOCAI LAW REGULATING CON•
STRUCTION OR THE PERfORMANCE OF CONSTFUCTION �53. LS Fi e SC �2. I.O
PLAN CMECK FEE T AL FEE
Lice s C $5. 91.40
- S�GNATUpE O� CON"AACTOA Op AUTMOp�2E0OGENT �D�iE� ME P Y VA�I ED THIS I�OUR JiMIT
r D �
S�GNATUAE Of OWNEAi�F OWN Ep BUI I D Efii i DA TE� p� �p5� � r��
_ .�� . _
�w � ] - � � Effective 5/10/99
ADDN [ l CITY O�' FRIDLEY �
AI-TER I l SI�i TGLE FAl�.Y Ai�TD DUPLEXES R-1 AND R-2
BUII.,DING PERNIIT APPLICATION
Construction Address: S-�? /�" �
- � � � _ ��,�Do
Legal Description:
Owner Name & Address:
--------�- `�
Address: /DD /
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Tel. # l0/�_�7f �/�e��
MN LICENSE #�a?O ,�%� 7 3� �
Tel. # �l�-So� //��_
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Yig:,S��IP'Y'IO+Td 6F' �Ytu"►�1�i:1'Y'
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK AREA: Length Width Hgt/Ground
OTI�R:
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construcdon Type•`�-�ai1r �9� � � Estimated Cost: $ � ) $ � . � �j �3 � �3 �i
�� -0209�° �
Driveway C�rb Cut Width Needed: Ft. + 6 Ft = Ft x$
_$ . -
DATE: Jb 2p �K APPLICANT: �� °� Tel. #�()g�a I
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Fscrow
Erosion Control
Pazk Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �3�Z5
$ a• 1 c5
$ l.b�
$
$ 5 • cSZ7
$
$
$
$
$ �I�yO
CITY USE ONLY
Fee Schedule on Reverse Side
.()Ol of Permit Valuati�n {l/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservadon Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
i
��
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 stivcture,
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,�0
$2,�01 to $25,aII0 ---
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
�23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69:25 for fhst $2,Q00 plus $14.04-for eaeh additioIIai �1,Q00
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 fust $50,000 plus $7.00 for each additional
$1,000 or fracdon 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 $SOO,OQO
$3,233.75 for the fust $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 addidonal
$1,000 or fracdon thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "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
Pernuts for construcdon 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 once it has it has been constructed will
be required before proceeding with the frarning.