AF - 47140�
Date
Owner
Addre
BUILDING PERMIT
Village of Fridley, Mi.nn. N� 2���
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Builder...........................................
� Address .........................................
"'"�O TION F BUILDING
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No. . . .'��.. .�. . � .�. . . Street �'� . . . . . . ..� . . .. . . . . . . . . . . . . . . . . . . . P of Lot . . . . . . . . . . . . . . . . . . . . . . .
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$ � �
Loi ........� ..... Block ..�:"`. �........ Addition or Sub-Division ..... ...��:�:�'`:.: .. .... ..
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Corner Lot ............ Inside Lot ...�.. Setback ..��'...... Sideyard ................�......
To be Used as:
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DESCRIPTION OF BUILDING
Front . . f . '� . . Depth r��. `: �,. Height �, :� Sq. Ft. . , . . . . . . Cu. Ft. . . . . . . . .
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Type of Construction . ..
s f
........ Depth ...� Height .........
:'�"�'° Est Cost . .. . . �*�� . . . . . . . . . . . .
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•..*��^'.�,�,
Sq. Ft. ........ Cu. Ft, ... .. ...
To be Completed .�:��..�............
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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. �
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�o • : e.ration of the payment of a fee of $.,� !"�. , permit is hereby granted to . . .:.e-.�,- � • . . . . . .
.... t"'�` ........ to construct the building or ad dition as described above. This permit ie 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, repair 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 said
ordiaances.
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------------ — ------------ ---... .... �.. .;..t�• ..„,. �. '��I..��..�.�l. �:�'Suilding Inspector
NOTICE:
This permit does not cover ihe construction, installation or alteration for wiring, plumbing, gas heating,
sewe� or water. Be sure to see the Building Inspector for separate permits for these items.
, '�
sue�ECT PERMIT.A4�3:"'�-- -.
City of Fridley �2'743.
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r °�
; � RE �.
� `L _ COMMUNITY DEVELOPMENT DIV. �� � �
r � � PROTECTIVE INSPECTION SEC.
1 . �
� � /'�'1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�""� ♦ ,'� 612-580-3450
910-F15 ��-.�-� � �
JOB ADDRESS 5724 Jackson Street N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. $ 6 Donna Lakevier� Manor SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Donald Wi.nter 5724 Jackson Street 55432
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS 21P PHONE LICENSE NO.
6 USE OF BUILDING
Gara e
7 CLASS OF WORK
[� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
21'9" x 25'7" fr a ac
9 CHANGE OF USE FROM TO
STI PU LATION S
1. Must provide hardsurface driveway.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATINO,
VENTILATING OR AIR CONDITIONING. FY'�►g
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1 SSG 5 560
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. 3 19''.00 I.. SZ
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT ��
DOES NOT PRESUME TO GIVE AUTNORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 11.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECKFEE TOTALFEE
12.52 �
eSIG UREOFCONTFACTORORAUTHORIZEOAGENT (DATEI z.WHE PROPERLY VALIDAT T IS IS YO R PERMIT
~` � �}�"'u,� �,�� /v ° S,� ? 6 - �.
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SIGNATUREOFOWNERUF0INNERBUILDERI IDATEI BLOG INSP D -
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APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
ow� � s Nar� :��<0 N A f D �et� /�/ ��z S BLi ILDER : 5�4� �
anDxESS :�7Z S� �?A-e i�So �1 ST N� anDxESS : S��
NO:.�?L� STREET: ��e I�S o ai ST /lJ�
LOT: Q BLOCK: b ADDITION: �6N�dl�� �1�Ked��tJ /1'1��10 {�
CORNER LOT: INSIDE LOT: � SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
HESCRIPTION OF BUILDING
To Be IIsed As :
,
C� wR ��� Front :a 21 / 9' ` neprh : Z� P%" xeight :/ �
Square Feet: �, '�, Cubia Feet: `�, ����� �,�
Front: Depth: Height:
Square Feet; Cubic Feet: •
�ipe of Construction: �I�w-IM � Est�a�ated Cost: $ ���� �
To Be Completed: �a ' 3 ° 7.� . j� � � �:• "r
The undersigned hereby makes applicativn for a permit for the work herein
specif ied, agreeing to do all work in stiict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated i.n this application
are true and correct.
DATE: �� ' �- � T SIGNATURE: V�'��Z��i�
(See Reverse Side For Additianal Information.)
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings 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.repairs to any existi.ng
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:
UNIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such eubical contents. Type 3& 5�$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of aziy building or addiCion, is determined by multiplying the ground area
covered from a- point si.x (6) inches i�elow the floor line of the basement
or the cellar to the average heights of the upper surface or to the average.�
•height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
Ia no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00.
V�RIFICATION OF FOUNDATION
NOTEo Permits for construction will be issued a mi.nimum of 24 liours from the
Cime of application, to allow for proper review of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceedin� with the framing.
CERTIFICATE OF OCCUPANCY
Appliaation for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a buildi.ng permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
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SUBJECT pE . . � �
City of Fridley � 13234
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � RECEIPT NO
COMMUNITY DEVELOPMENT DIV. �
r� � L � � PROTECTIVE INSPECTION SEC. `
, ,
� . ,
� � /'�'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�•��'� � �`� 612-580-3450
9t0-F15 9/30/75 � �
JOB ADDRESS 5724 Jackson Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. $ 6 Donnay's Lakeview M3riOr SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Donald Winters 5724 Jackson Street N.E.
3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO.
Same
0 ARCHITECT OR DESI(iNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
R2S1C�Pd1't].1�.
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK �
Construct a 18' x 12' Addition to dwellin
9 CHANGE OF USE FROM TO
STIPULATIONS
As marked in red on submitted plan �y
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Before digging ca�i local utiiiii�s
TELEPHONE - ELECTR�C. � �¢�,
R������� ��f �V1�
SEPERATE P�RM9TS REQUIRED F�R �liRf��,
HEATING, PLUMBlNG AND SIGNSe
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOCI FiBIDe
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 R-�. Z�.F) Z�.CO
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. 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 (3RANTING OF A PERMIT S4i8S�..CO 2.44
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. � $}-9. �.6
PLAN CHECKFEE TOTALFEE
$21.60
SIGNATUREOFCONTRACTOHORAUTHORIZEDAGENT IDATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT .-
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��.r,t'�' � G��� 9 �� �� �? ;�9 � �; � : O 'I � :
SIGNATURE OF OWNER IIF OWNER BUILDERI ATEI BLDG INSP flA E
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OWNER' S NAME :�0/�✓}L i� W/ ���7Z1 BUTLDER : S�� f' _
annxES s: S 2 z K ��-c /�S o rJ S? itl � �nDxES s: S�- /`'► �
APpLICATION POR RESIDENTIAL, AL`I'ERATION,
OR AllllITTON BUILDING PERMIT
CITY OF I'RIDLEY, h1INNESOTA
NO :.`5 7�- 7 S TREET : �� C IC S o µ� S� KJ L�
LOT : d BLOCK a f� ADDITION : d e��1 A� �' G� � KE (/�t u1 i� 14jtlOR
CORNER LOT: INSIDE LOT: `� SETBACK: SIDEYARD:
Applicant at�ach to this form Two Certificates of Sunrey, of Lot and pxoposE i
building location drawn on these Certi�Eicaices.
DESCRIPTION OF BUILDING
To Be Used As:
�,�p�Tion; To p , � � r
��i 1'� H��.' FronL- • 0 Depth • �� Heigh� • % Z-
Square Feet : .�`� Cubic Feet : ��� �'
Frant: Depth: Height:q_ r
Squaxe Feet; �ubic Feet:
Type of Constxuction: k) Ck�,� �,���� Estianated Cosi: - �
�� ,, �
To Be Completed: � ��� �
c� �e� �
The undexsigned hereby ma.kes applicatinn for a pexmit for the work herein
speeified, agree�_ng L-o do all worlc in �;:�ict acc.oxdance with the City of
Fridley Ordinances and rulings of the Department of Lui�da.ngs, and hereby
declares that all tlze facts and representations stated in i.his application
are txue and correct.
DATE : / - � � - 7 J�— S IGNATURE : �y ���"l,�Lfi�/ ��(/ -��-rzt-�c�
(See Reverse Side Fox Ad.ditional Information.)
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BUILDING PERMIT FEE SCHEllULE
SECTION 2. The Inspector of Buildings shall, before issuing pe�cmits for the
erection of any building or structure, or for any addition to any existing
building ox structure, or for any alteration or repairs to any existing
building or structure, upon application therefore, require the payment by the
applicant fox such permit of fees to the amount herein below set forth and in
the ma.nner herein provided to-wit:
iJrTIFORM BUILDING COD�: �pe 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the Uasement
ox the cellar to the average heights of the uppex surface or to the average,�
�height of the roof surface of the ma.in gable of a pitched roof,
For repairs or alterations to an existing structure, the fee sha11 be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be
less than $5e00.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours from the
time of application, to allow for proper review o� the proposed structure and
of the construction site.
A Certified Survey of the lot, sh��ving the location of the foundation, once it
has been constructed, will be required before proceeding with the framing.
CERTIFICATE OF OCCliPANCY
Application fox a Certificate of Occupancy sha11 be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
ot Occupancy has been issued.
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� � � . � � 1 �---� s--�- BUARD OF APP�ALS # 1 ],l '�
THE E. e. M9�S�ONC _ . _ PE. s.�a�. _ C
�/� ID39 UNIVEq51TY AVE., SAtNT PAUL ♦ TL'�F1MCN8B MI. 6.8�39
BCALi� I INCM�..REgT 406 NATIONAL BUILDINp, p��PiNEAPpl13 2 Mf. �,SCa2 "
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OF PROPERTY OF �•�•��/,�/ �'„��'r/�? �; /r�x�<2�.5-- s72� GT�.C�so�► �r�..rC//�, .
DESGRISEO AS FOLLOWS �_!��8�_. �OG _�y �/7/�d 1IS � 7,��'�!`/Q1/t/�'///f]/!Q/` �
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CEI�tTIFICATE OF L�CATIOh OF BUILDING
I hereby certify that on �� " 2�18 �•
I marle a ourvcy of the loc:ition of the buildinq(s) on the
ab�ve desr.ribed Property and that the lacation of said
bvildin61e; is correctly ehowq,pn the aiwve plat `
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CEBTIFICATE OF SURVEY
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I hereby eertity that o� 19 °
I surveyed the propertp described above and that the ,above
pL-t ia a correet repreaentatioa of said surve3. °
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CHII�II�TEY AND BTACR VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes (�,Y) No ()
2. Is free from rust or deterioration Yes (,�) No ()
3. Has no foreign objects lodged within Yes (� No ()
4. Is securely supported Yes (�c) ' No ()
5. Meets all current Code requirements for
size and total BTU's connected Yes (�!) No ()
6. H�s tatal heating BTITT � s of ��� �O
Al1 other BTII' s �� � �Q (�
TOTAL BTU' s ��� � �-�[�
Remarks
List Alterations Beinq Done:
HEATING COMPANY
Signed By
Date
�
�
�
h
A
suu�ncr �
City of Fridley
, ,5�,�,� �,�FTMETIMINS g��LDi�I� PERMIT
,�
� • COMMUNITY pEVELOPMENT DIV.
� i V ��.�� ,
r � � PROTECTIVE INSPECTION SEC.
i . �
i_---� ��'�' �'� CITY NALL FRIDLE� S343Z NuMBER
L 61�-571-3450 9t0-F15
JOB ADDRESS
5724 Jackson Street NE `
t LEGAI �07 NO. BLOCK TRACT OR ADDITION
DESCR. 8 6 Donnav' s Laki
2 PROPERTY OWNER MAIL AOORES$
Gerald Guse
J CONTRACTOR MAIL ADORESS
Town & Country Roofin� 7910 12th Ave S B
�4 AFCMITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER
8 USE OF BUILDING
ResidenY.ial
7 CLASS OF WORK
❑ NEW
8 DESCRIBE WOHK
Reroof house and �ar,
9 CHANGE OF USE PROM
STiPULATIONS
MAIL--�ADORESS
NEV DATE
11/4/98
ZIP
ZIP
� ADDITION ❑ ALTERATION {� REPAIR
TO
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING.
VENTIIATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK Ofi CONSTRUCTION ZONING
AUTHONI2ED IS NOT COMMENCED WITNIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANqONEO FOF A PERIOD OF 120 DAYS AT '
ANY TIME AFTER WOpK IS COMMENCED. ` NO. DWL
I MEREBY CERTIFY TNAT I MAVE READ ANO EXAMINED THIS APPLICA710N
ANO KNOW THE SAME TO BE TF1UE AND CORRECT. AlL PROVtSIQNS Oi LAWS VALUATIC
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL 8E COMP�IED
WITH WHETMER SPECIFIEO MEREIN OF NOT. THE GRANTING OF A PERMIT $2]�FL
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pEqMIT F
PROVISIONS OF ANY OTHER STATE OF LOCAL lAW REGULATING GON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION �]/,}. ]
� , %��-��
Si N4TUpE OF CON'RACTOp Op OUTM �ZED OGENT IOAfE�
S�GN4TUaE O� OWNEp��F OWNEpBUILDEp� �DAfE�
UN
SO.
STA��S
PAGE OF
� �
PFiR'FIIT NO.
�28523
�`
APVROVED BY
SEE ATTACMED
SNEET
PMONE
574-0070
PHONE LICENSE NO
���� 90091782
PFIONE LICENSE NO.
PHONE IICENSE NO
❑ MOVE O REMOVE
P OCCUPANCVLOAO
CU FT.
STiiEET PARKING
IGARAGES
$1.37
SAC CMARGE
Fir SC $2.74
TOT � EE
3.86
r� is is roua aEa�y,L
�.- /_�, .
qatE
�
AUG-13-1998
....... � �
ADDN I ]
ALT�R [ ]
08�42 FRQM CITY �F FRIDLEY TO
���o�aa��: 5�
Legal Descripcion: �
Owner Name & Address:
� (
Coatract�r. 1 �.�1 0�
Address:
LIVING AREA:
GARAGE AREA:
D�CS AREA:
o�x:
1�'h
CITY OF �'RIDLEY
SINGLE FAMYY.Y AND DUPLEXES R 1 AND R-2
BUYLI7YNG PERNIIT APPLICATION
�
�
8589320 P.01/02
r.�t�c:uvC li i�ya
� �� �
� a`
)�.�� 1�SD�1��-Tel. �r �j�l -a0 � C7
� Mlv LICENSE �t ?1�l� g 1 �g�
�
Tcl. # ��.fS�' �� �
Attach to titis application, a Cortificate of Survey of the
loc, wich the propased consauction drawn on u to scale.
DESCRIPTION QF IDRPROVEN�NT
Length _ Width Height Sq. Ft. _
Length . Width Height Sq. Ft.
Length Width _____ Hgt/Ground Sq. Ft.
��, � � S � _ %� 7yZ .�
- -- aa
Consuucaon Type• Fscimat� Cost: $ ��7,3,`J
(Fee Schedule on Back)
Dtiveway Gi�rb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: — ^ APPLICANT: Tel. � �'��lS' �'o� �
Permit Fee
Fire Surcharge
State Surtcharge
SAC Cbarge
Licease Surchazge
Driveway Escrow
Erosion Control
Park Fee
Se�ver Main Charge
TOTAL
STIPULATTONS:
y_M.M. '� � �1 `�
�
$���� Fee Schedulc on R,everse Side
$ q .001 of Per�mic Valuation (l/lOch%)
$ � � $.50/$1,000 Valuatioa
$ $1QD0 per SAC Uait
$ ►- � $�5.� {State liuns�d Rosidcntial Conuactors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Aetermiaed by Engia�ring
$ Agreement Nece�sary I J, Not Necessar�' I l
,�
1 � ,� ,
sue�ecT P O.
City of Fridley 2 8 939
AT THE TOP OF THE TWINS g � I L D i N G P E R M I T
�
RECEIPT NO.
� � COMMUNITY DEVEIOPMENT OIV. ��
� j V � �
r � • � PROTECTIVE INSPECTION SEC
� �' .
l-_-- =��'��,'� CITY HALL FRIOLE� SS132 NUMBEF pEV OATE PAGE OF AVPRpVEO BY
L J\ 612-571-3450 9/0-Ft5 2/2�/99 � �
J09 ADDRESS 5724 Jackson Street NE
1 LEGAL LOT NO. BLOCK TRACT Oii ADDITION SEE ATTACMED
oesca. 8 6 Donnay's Lakeview Manor SFIEET
2 PROPERTY OWNER MAIL ADORESS ZIP PMONE
Gerald Guse 5724 Jackson Street NE 574-0070
3 CONTHACTOR MAIL ADORESS 21P PNONE LICENSE NO
Quality Contracting 11380 W River Rd, Champlin, MN 55316 427-7733 7035
4 ARCNITECT OR OESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO
5 ENGINEEq MAII ADDRESS 2�P PHONE IICENSE NO
8 USE OF BUILDINO
Residential
7 CLASS OF WOFK
p NEW O ADDITION ❑ ALTERATION � REPAIR D MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Garage (27 Sq) Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE Of CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTFICAL, PLUMBING, MEATING,
VENTII.ATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. fT CU FT
AUTMORIZED IS NOT COMMENCED WITNIN 80 DAYS. OR IF CONSTRUCTION
OR WOFK IS SUSPENDED OR ABANDONEO fOp A PERI00 OF 120 OAYS AT
ANY TIME AFTEii WOqK IS COMMENCED. N0 DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT 1 HAVE READ ANO EXAMINED TNIS APPLICATION 1 STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VA�UATION SURTAX
ANO ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED $2 313 �1. iC
WITH WMETMER SPECIFIEO MEREIN OR NOT. TME GRANTING OF A PERMIT �
DOES NOT PRESUME TO GIVE AUTMONITY TO VIOLATE OR CANCEL TME pEqMlt f EE SAC CMARGE
PROVISIONS F ANY OTMEFi STATE OR LOCAL LAW REGULATING CON• $74.75 Fire C�L.31
STRUCTION R TNE PERFOfiMANCE Of CONSTRUCTION
� PLAN CMECK FEE TOTA E
,2 License $5. 0 83.22
S�GNATUAE F CON'AACTOA Op AUTN D eGENT IOAT EN ROP A DA HI§ IS V UF PERMIT
�-��s=
S�GNGfUpE Of QVyNEA ��� ON�NEp BU0.0Ep� �DAiE� iNSP ���T E
NEW
ADDN
ALTER
�]
Il
[l
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/99
ConstructionAddress: � 7Z `f � � aC 1� �O C� � `t� / V � ,
Legal Description:
Owner Name &
Contractor:
Address: � 1� 4� a
LIVING AREA:
GARAGE AREA:
DECK AREA:
OT'I�R:
� `� v�a� ��C � � S �
c �. � ,2 °�'V' ,Cs i
�� ���ev� ��
Te1. # ,� 7 �- �C� � O
MN LICENSE # % � � S�
Tel. # �j�'7-773 �
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
�
Construction Type: �� Gt �' U �'� � �� �'� �`�Estimated Cost: $ � ��
a 7 S�'s � (Fee Schedul e on Back)
Driveway G�rb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: o� � APPLICANT: Tel. #�Z %� 7�.S �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �� �
$ �- d� �
$ i. /�
$
$ �" �t�
$
$
$
$
� 3.� �.
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
d
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 appl'ication 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
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction 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 $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for ea.ch additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof °
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only) ,:
Alternate "A": ��temoval and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate °B": Retnoval and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
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 Cert�cate 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 f�aming.
L
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