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P - 42139
Building BUILDING Permit No.:7O � Inspe�ctions RESIDENTIAL APPLICATION Received By: 76�-572-3604 CITY OF FRIDLEY ° 7�3-502-4977 FAX EFFECTIVE 1-1-2011 ���e DATE `� L� DI� YOUR E-MAIL ADDRESS SITE ADDRESS y rp�Z. ,. �j,�'.1� cST �C� THIS APPLICANT [S: ❑ OWNER �jCONTRACTOR PROPERTY OWNER/ NqME: �r�,,,�,,� � �'N/�'1�°,r� ���,� TENANT pDDRESS: �v 2�' �'�� ��� /�(JN /�-�FS CITY_�f�jiJ �r�L-�' STATE/LJ/�LIP 30 PHONE: ��j/ �3/ �'�G� CONTRACTOR NAME: . ,ef� o� ? ��T�a�,� c? SUBMIT A COPY OF STATE LICENSE # y%�� LEAD CERT IVUMBER • YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS: �DI rlcS � f L�� CTTY�ii�L'� STATFi�ZZIP SS�%7�' INSURANCE PHONE � D �S� FAX PROPERTY TYPE J8'SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE � �DITION ❑ GARAGE/SHED ❑ W[NDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER /(I�t>���l�S—��,,c',i�p�"�„ ❑ SWIMMING POOL p s' TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION � MAINTENANCE/REPAIR � REMODELING DESCRIBE WORK BEING DONE: �iS�J1'lo7�Liu.t� /V[9J d��7���1J 57/Zvc7uitNL /�C�l�S SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE I. 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: SIDING FOR NEW CONSTRUCTiON INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS OYes ONo 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 WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: TOTAL JOB VALUATION $ Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due (USING�'HE 1997 U.B.0 FEE SCHEDULE) ,' ��� OCCUPANCY TYPE $ "-'S • LS See Back Page for Fee Schedule $ [� l 65% of Building Permit Fee $ , .001 times the total job valuation $ .0005 x Permit Valuation Minimum $5.00 $ �^� $5.00 (State Licensed Residential Contractors) $ $2230 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$25=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ r�(n�! _ e Make checks pavable to: Citv of Fridlev Attach Stinulations THIS IS AN APPLICATION FOR A PERMIT-NOT VALID 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 work which re u�r rev�e and approval of plans. 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