P - 37428Building BUILDING Permit Ivo.: ��-�`'� --�t3� ��
Inspections RESIDENTIAL APPLICATION Received By: �''fC�
763-572-3604 CITY OF FRIDLEY vat d�d,�� �� ��
763-502-4977 FAX �� � �
EFFECTIVE i-1-2011
DATE Og�22�1 1 YOUR E-MAIL ADDRESS action ,actionroofing.net
srTE aDDxESS 4715 3RD ST NE
THIS APPLICANT IS: ❑ OWNER �CONTRACTOR
PROPERTY OWNER/ NAME: JOSEPH SINIGAGLIO
TENANT ADDRESS: SAME
CITY STATE ZIP
PHONE:
CONTRACTOR NAME: ACTI4N ROOFING & SIDING LLC
SU$MIT A COPY OF STATE LICENSE # 5421 LEAD CERT NUMBER NAT-109445-1
YOUR STATE LICENSE
AND CERTIFICATE OF aDDxESS: 1315 SOUTHVIEW BLVD CITY S ST PAUL STATE MNLIP SSO%_`
mrsut�.NCE rxorrE 651-457-2642 F.ax 651-457-0351
PROPERTY TYPE �SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH �ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION
� ❑ MAINTENANCE/REPAIR XREMODELING
DESCRiBE woxtc B�irrG DoN�: TEAR-OFF AND RE-ROOF HOUSE AND GARAGE.
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT
ROOFTNG ❑ HOUSE ONLY
NUMBER OF SQUARES 30.66 i,�HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUD[NG 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 ❑Ycs ❑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 WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 11,900.00 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
$
$
$ �
$ �
$
$
$
$
� 122.71
See Back Page for Fee Schedule
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 ( )
Make checks pavable to: Citv of Fridlev Attach
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 co of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an applicati o a permit nd work is not to s�it t.�kent�a permit on site; that the wark will be in accardance with the
approved plan in the case all ork which e' ' and approval of plans.
STGNATURE OF APPLICANT PRINT NAME KURT MERRELL DATE 08/22/ 11
APPROVAL INSPECTOR SIGNAT .
PLEASE NOTE; SE TE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK