P - 44525Building BUILDING pe��tNo.: � ��l`�
Inspections RESIDENTIAL APPLICATION Received By: r�'
763-572-3604 CITY OF FRIDLEY na '.�
763-502-4977 FAX ��. T 1 8 2�1�
EFFECTIVE 1-1-2011
DATE 1��18�11 YOURE-MAILADDRESS action _actionroofing.net
siTE aDDxESS 4795 3rd St NE
THIS APPLICANT IS: � OWNER �((CONTRACTOR
PROPERTY OWNER/ NAME: Dave Sinagaglio
TENANT ADDRESS: Sd111e CITY STATE ZIP
PHONE:
CONTRACTOR NAME: Action Roofing & Siding LLC
SUBMIT A COPY OF STATE LICENSE # 5421 LEAD CERT NUMBER N14T-109445-�
YOUR STATE LICENSE
AND CERTIFICATE OF a.DD�ss: 1315 Southview Blvd CITY $O. St. Paul STATE MNZIP 5507
INSURANCE pHONE 651-457-2642 F.v� 651-457-0351
PROPERTY TYPE QYI SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE O ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH � ROOF ❑ DRAIN TILE
❑ DECK 0 SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION
$1 MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: T@dC-O�F dI1CI i2-COOf IlOUS2.
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT
ROOFING I� HOUSE ONLY
NUMBER OF SQUARES 25.33 ❑ HOUSE & GARAGE BASEMENT REMODELING StIBMIT:
1. Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of struchval members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑So�t ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing struchues
❑ Other ❑ Fascia
and proposed project.
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 MANUFACI�JRE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL Nr:LJ AKr; 13Aar:ll U1V VALUA"1'lU1V, 11V(;LUll1N(:'1'tlr: (;U�"1' Ul+' LABUK ANll MA"1'LK1AL5:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 9,000.00 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
$ fJ�?'� �-(/� 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 ( )
$ F 01 ,� Make checks pavable to: Citv of Fridlev Attach
THIS IS N APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and cod of the ' 'dley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an applic ' and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the w hi requires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME Kurt Merrell DATE lO�iH�11