P - 50480Buxl�ing
Inspe�tions
763-5'12�3504
FA�
31TE ADDRESS _„^
7F[IS AFALICtt1VT' IS:
T�IYANT
sus�rr.� copY o�
Yovx �T�� �te�rsE
AND CERT'[FICATE OF
IIWSL'RANCE.
BVILI)ING
RESIb�NTIAi, APPLI+�A'`T'I4I�
CIT�' �pF FRIDL�Y
EFFEGTiVE 1•k-2Ql2
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STATE L[CENSE #� � r,��� �.�- -- LE�p ���T
l�S1I>lGLE FAMELI'Jh1J
❑ TVIIO FAMILY/NEW
Q AAt)1TIQN
L7 BASEMENT FINISH
O DECK
SIZG
❑ SWIM�tING POQL
TYPE OF WflRK: � KEW Hf7T4E CONSTRUCT[ON ❑ ADi�iTiOT!
�1v1A)hITENAt+(GE,'REPAIR Q R�MODELING
DES�RIBE I��RK B�Et�iG aOPlE; ��'2..� e:;e=..F� i. �`., �Q.,�;�p_ �rSP
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S12E QF iMPRC1YEM�NT LEIVGTH WtDTH
R H p _ O OUSE QNLY
1VUhI�ER OF SQUARES �t..� �IOUSE & tiARAGE
GA GES II �T'[ACHED GARAG�
PRVPOSED SiZ£: ❑ DETACHELI GARAdE
PRQPOSE�HEIGHT; .
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❑ Vinyl
❑ Aluminurn
❑ bther
r�V2NDUW,�
ITt EXISTiNC QPEN[NCrS CJYes L7No
OR �QR AfCA' OPEN[N{}S, DESCRIHE S�E OE�
OP�YIN�'i CHA�fGE3 R
Tl'PE dF VV�N[�W 7'n R� tuzTe,t i cn
i Fermit Fee
': Flan Review
Fire Suichazge
Surcharge
Lieense Surcharge
SAC Charge
Ciu'b Cut E•scrow
Erasion Cantrol
Park Fee
Sewer 1�4ain Charge
rotal Due
T hereby ap�ly %r a
conformance vrith the
permit but nniy an ap
approvet3 pla�n in the c
SiG1�FATUF� pF kPPLlC�
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❑ DR�iN TILE
❑ OTI�ER
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l.vul�t� 't HE C�ST OF
U.B.0 F�E SCHCDULE)
Pern�;it
Received $y;
B�SEME REMOD iN Stt8M1T•
1. Existing Floar Flart
2. Proposed Aaor ptan
3. List of strucYUrAI members to be,used
FOR'*[EV�' CO?�lSTitiJCTi�N ti�[+CLUI7ING DECKS,
ADD[TtONS & Pt�R E' UBtvt`T•
1. Site Pla�/Sutvey showing the existing structures
and pmposed projecf.
2. Two'sCts OFconslruction p[acis
3. Energy Caleulafions
FUR W[NDf}!VS — PR4YiDE U-VALUE AND
MANUFACTURE ST[CK�R ON vVINDOW.
See Bae[c Page far �ee Schedule
65°!o tifBuitdin� Permit Fee
.Of1I ta�mcs the total job valuatio�
.0005 x Permit Valuatian Minimum or .SO
$5.40 (Stake �,icensad R�sidential Contractc�rs}
$2.3b5 per SAC Unit {Plans to Mo4'CC for determ9nation}
tt�-bft= ftxS25=S
$450 Conserwatian Plan Review
Fee Deter�t�ined' by Engineering
Agreernent necessary ( ) Non;Ttecessary ( j
TfiIS 15 :4N APPLICATION FOR A FER�IT-TSp1' V.4LID UNT[L PRQCESSEB
l��t w dge that the informatism above is complete and accurate; ti�at the wc>rk r�ilI b� i,u
t r
�s : fl c ty�of Fridley and with the Iuiinnesota �Canstructzon Codes; that i understand #h►s is not a
fo� a pe t a d kf�s not io start without a permii an site; that the �vork wili be 'n. cordan�e with t[z�
w�1rk w r ' s evie and approvat of �s, �
i� � ARINT IUAME t]sas..�' r.�,,t.� _DA't`� "S '�J' . � ��
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Wd 0£'�tr�Z Z40ZfE/S :a��a 4!6 :�6�cf 6�06 Z�L Z49 :uao��