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P - 41887Building Inspections 763-�72y3604 763-502-497'�z�AX DATE %�f�� SITE ADDRESS - TH1S APPLICANT IS: C►� BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-I-2011 Permit No.: Received By: � . - '�: � � � � • `�� YOUR E-MAIL ADDRESS �A A� W T ��►'1�71 l� . L�oy'� ❑ OWNER I�ONTRACTOR PROPERTY OWNER/ I NAME: �'Y1 i�y�u�. U�i I�tG(�i'N� TENANT qDpxESS:, (�� 3 � �a�T CITY CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE A' STATE LICENSE # LEAD CERT NUMBER �'' �" (�s� 4' l �• �0 ZDL ADDRESS: �ZYS� � .5 CiTY �1�5 STATE_/'�► lP�� PHONE �L Z 7`� �i S� Z FAX C� I 7_ �ZS Z�� j� SINGLE FAMILY/NEW CONSTRUCTION SIZE [jTWO FAMILY/NEW CONSTRUCTION � STORIES PERMIT TYPE � �DITION j�BASEMENT FINISH ❑ DECK TYPE OF WORK: DESCRIBE WORK BEiNG SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other ❑ NEW HOME CONSTRUCTION ❑ MAINTENANCE/REPAIR ❑ ROOF ❑ DRAM 7'ILE ❑ SIDiNG ❑ OTHER ❑ SWIMMING POOL ❑ ADDITfON ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE osofft S�I�N N � D ❑ Tnm ❑ Fascia HEIGHT FT BASEMENT REMODELING SUBMIT: I. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing svuctures 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 S1ZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WTNDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: NG THE 1997 U.B.0 FEE SCHEDULE) COTAL JOB VALUATION $�� OCCUPANCY TYPE Permit Fee Plan Review Fire Swchazge 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 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: City of Fridley 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 confortnance with the ordinances and codes of the City of F idley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit an " no to start without a permit on site; that the work will be in accordance with the approved plan in the case of wor uires view nd approval of pl ,�—� p SIGNATURE OF APPLICANT PRIT�7� �MAI�QE ��A TZC�iII'X DATE /�} � APAAf.1l/AI iAiCDF(`TYIA Ci(7UATIfRR %1/ C// — �-_-- ��,. �, � d��w � � � � �v ., � � P . ,, ,� � �� .. ��',.�� 5�� yi �� ..�.. �� ( _ � ...�- � :r�� . � � i � � � I �� . . .. .- „�,°cwr �,� , !1 � � la� l{ �� s' �� G,�' _ ._ 0 r� � � � , � � � � � � � � �� S �' - �� 3 _" � . �� . 1 -- d�.�:�-S �mv ��. �� 1 �--� 1 1 � .�- � �� M �'r'�'�l� �`�.��tU� t�o 3 � �`T ��+�, � 5��3Z. � C_�lf► �GC`-�v1K J � � 1 • �� FOR �� -1