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P - 48249��ilding BUILDING Permit No.: + � �"� Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 - CITY OF FRIDLEY Date Rec'ct: ��a 1 � 763-502-4977 FAX EFFECTIVE 1-1-2012 DATE YOUR E-MAIL ADDRESS � a r�i C I 9��1 D�F r+� ���. G o vv� SITE ADDRESS y' � 0 02 �a S}� N C THIS APPLICANT IS: ,�OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: !'� th on tir e�� TENANT pDDttESS: �'/7 a� ��2 S� IV � CITY Fr ���Cv STATE�ZIP� PHONE:_ %/2 — �%9b — �Sb �- CONTRACTOR NAME: SUBMIT A COPY OF STATE LICENSE # LEAD CERT NUMBER EXP: YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE pHONE FAX PROPERTY TYPE O SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEJSHED ❑ WINDOWS J� BASEMENT FR�TISH O ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDTITON ❑ MAINTENANCE/REPAIR jS'REMODELING DESCRIBE WORK BEING DONE: o 'v� N SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES O ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDIlVG FOR NEW CONSTRUCTION INCLUDING DECKS, � Vinyl ❑Soffit SIDDVG/SOFFIT/FASCIA �DI1'IONS_ & PORCHES SUBMIT: ❑ Aluminum ❑ Trim REMOVED? O YES O NO 1. Site Plan/Survey showing the existing structures O Other ❑ Fascia and pmposed proj�t. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS �Yes ❑No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOVJS ALL FEES ARE BASED ON VALiJATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $��066 • � 0 OCCUPANCY TYPE Permit Fee ; Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ I i 2. _ See Back Page for Fee Schedule $ 65% of Building Permit Fee $ � 001 times the total job valuation ���� .0005 x Permit Valua6on Minimum or .50 $ (f � $5.00 (State Licensed Residential Contractors) $ $2365 per SAC Unit (Plans to NIWCC for determinarion) $ ft+6ft= ftx$25=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ i D.(� tn Make checks aavable to: Citv of Fridlev Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building perm and I acknowledge that the information above is complete and accwate; that the work will be in conformance with the ordinances and i the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a pe it d work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all work w ic uires review and approval of pl s. 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