P - 37443Building
Inspections
76�-572-3604
763-502-4977 FAX
DATE U/ Zi/ 1 I
SITE ADDRESS `7 _I�
TH1S APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
��Z
BUILT�ING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE I-I-201I
Permit No.:,�Cj���� �
Received Ry:
Date Rec'd: � � !,
YOUR E-MA1L ADDRESS I'1 cj.�1S0�'jC F y� ���pl , c3�; Y
❑ OWNER �CONTRACTOR
NAME:
ADDRESS: �, � .� Z�Z S* �I.� CITY
PHONE: �G�� �—J/ ��3LC�
STATEI�'�N Z1P S� i �
NAME: CNl j�i - C't r' Gtn C1 i`f�✓4c��G�- 1 i n I.LC.
STATE LICENSE #!�(1(,� �'% ��Q � LEAD CERT NUMBER
ADDRESS: ��I�S �j?�ct,;n« S��` %�i CITY ;�Y1C1�'.�/ STATE ZIP
PHONE �(J � Z- Ci�L`.� �� �I �"JG"r Z FAX
,� STNGLE FAMILY/NEW CONSTRUCTION SIZE 1`j�U
❑ TWO FAMILY/NEW CONSTRUCTION STORIES j
❑ ADDITION 18 GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK � SIDING ❑ OTHER
❑ SWIMMING POOL
❑ NEW HOME CONSTRUCTION 9 ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODGLING
DESCRBE WORK BEING DONE: f�Ci� I!1G I Z.K Z� ,
SIZE OF IMPROVEMENT
LENGTH
ROOFING � ❑ HOUSE ONLY
NUMBER OF SQUARES O HOUSE & GARAGF
GARAGES �� �j,,y�te5) ❑ ATTACHED GARAGE
PROPOSED SIZE: �,DETACHED GARAC�E
PROPOSED HEIGHT:
S[DING �j���
I$ Vinyl ❑SofYit �
� Aluminum ❑ Trim �
� Other ❑ Fascia �
WINDOWS
IN EXISTiNG OPENTNGS ❑Yes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENTNG CHANGES &
TYPE OF WTNDOW TO BE INSTALLED NUMBER OF WINDOWS
C l� n -� c
HEIGHT I Z� SQ FT Z�
BASEMGNT REMODELING SUBMIT:
l. Existing Floor Plan
2. Proposed floor pian
3. List of structural members to be used
2UZJ� FOR NEW CONSTRUCTION INCLUDING DF.CKS,
-Z� � ADDI'1'IONS. & PORCHGS SUBMIT:
�c /_ L Site Plan/Survey showing the existing sVuctures
�D 7 lD� •� � and proposed project.
---- 2. Two sets of construction plans
3. Energy Calculations
FOR WINDOWS — PROVIDE U-VALUE AND
MANUFACTURE STICKER ON WINDOW.
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION �/,�;,�`t � �D�g7d OCCUPANCY TYPE
__
Permit Pee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$
$
$
$
$
$
$
$
$
$
�,,
See Back Page for Fee Schedule
65% of Building Pennit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $5.00
$5.00 (State Licensed Residential Contractors)
$2230 per SAC Unit (P(ans to MWCC for determination)
�+6ft= ftx$25=$
$450 Conservation Plan Review
Fee Determined by En�ineering
Agreement necessary ( ) Non Necessary (
Make checks oavable to: Citv of Fridlev
Attach Stipulations
TNIS IS AN APPLICATION FOR A PERMIT-NOT VAL1D UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction 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 on site; that the work will be in accordance with the
approved plan in the case of all w w h requires review and approval of pl�ns. t�I /
SIGT�ATURE OF .APPUCANT _���. PR1NT NAME�.J'F, ITC�, 1SCi—� DATE �/ �/ / I
APPROVAL INSPECTOR SIGi�ATURE
PLEASE NOTE: SEPARATE PERMITS ARE �REQUIRED FOR PLUMBING. ELECTR3CAL AND NIECHANICAL WORK
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8Z968 # u��saa
Design # 89628
tems Selected:
Gable roof wl 4112 pitch, standartl trusses 2' O.C,
Truss Design Location Zip Cotle; 55432
2z4 Wall Framing Material
24' Witle X 12' Deep X 8' High
Mainsireet Vinyl Double 4" Dutch-Lap Sitling
• Light Maple
112" OSB Wall Sheathing
Nova Wrap
12" gablel24" eave overhangs
112" OSB Roof Sheathing
20 yr, Classic, Shasta White Shingles
Slant Back Veni�Metal), Black
White Aluminum Soffit & Fascia
White Premium Roof Edge
White Vinyl Overheatl Door Jamb
Materials From Endwall On Back View Not Estimated
Da ign-lt°
.,.
Options Selected:
The options you have selectetl are;
15 LB Roof Felf
2 Aows Granular Ice & Waler Barrier
I oday's estimated base price; $1,486.59
The base price includes: 0" Eave10" Gable Overhangs, Framing Materials,
7116 OSB Roof Sheathing, 20 yr. Fiberglass Classic - Onyx
Black Shingles, Pine Fascia, Galvanizetl Regular Roof Edge,
8' Teztured Ver�ical Hartlboartl Siding, No Service Doors,
No Overheatl Doors, No Wintlows, or Any Other Options.
Front View
Pa e 1 of 2
71812011
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Back View With Open Gable Endwall
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Today's estimated price: $2,302.18
If purchased today, you save: $146.30
Monthly BIG Card payment: $64,65
��� Take this sheet to the Building Materials counter to purchase your materials, ���
all information on this form, ofher fhan price, has been provided by guest and Menards is not responsible for any e« ors in the information on this estimate, including but not limited ro quanfiry, tlimension and quality. Please ezamine
this estimale carefully. MENAROS MAKES NO REPRESENTATIONS, ORAL, WRITTEN OR OTHERWISE, THAT THE MATERIALS LISTED ARE SUITABLE FOR ANY PURPOSE BEING CONSIDERED BY THE GUEST.
BECAUSE OF THE WIDE VARIATIONS IN CODES, THERE AAE NO REPRESENTATIONS THAT THE MATERIALS LISTED HEREIN MEET YOUR CODE REQUIREMENTS.