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P - 48396Building Inspections 76�-572-3604 763-502-4977 FAX DATE ��/// S[TE ADDRESS �p p l� THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-2011 YOUR E-MAIL ADDRESS �� '.� ❑ OWNER ❑CONTRACTOR ADDRESS: PHONE: � NAME:� STATE LICENSE # ADDRESS: � � ��y� � l�,C^C�,dr. PHONE (E�r.�� ` Y� `t— � �p �c� "1 �JGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILYMEW CONSTRUCTION D ADDITION ❑ GARAGE/SHED � BASEMENT FINISH ❑ ROOF ❑ DECK „f3.S�DING ❑ SWIMMING POOL ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODEL DESCRIBE WORK BEING DONE: �I%S� ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl � Aluminum ❑ Other ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia h LEAD CERT NUMBER CITY FAX � ' � SIZE STORIES �.�-�INDO W S ❑ DRAIN TILE �'�THER N � . �TH HEIGHT WINDOWS IN EXISTING OPENINGS �s �No LOC�T� F OWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF [�/' °'"" '� ` „ OPENING CHANGES & ^� TYPE OF WINDOW TO BE INSTALLED J NUMBER OF WINDOWS ALL FEES ARE BASED 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 Permit No.:� 0 �'�� Received By: � ' ` � U Date `Rer Td: 1 ATF,I��IP A' � FT BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor pian 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDTNG DECKS, ADDITIONS & PORCHES SUBMIT: I. Site Plan/Survey showing the exis[ing structures and proposed project. 2. Two sets of construction plans 3. Energy Calculations FOR WINDOWS — PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW. ALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: 7 NtG THE 1997 U.B.0 FEE SCHEDULE) O_� _ OCCUPANCY TYPE �' 'G U, See Back Page for Fee Schedule $ , 65% of Building Permit Fee $ ), .001 times the total job valuation $ ,� .0005 x Permit Valuation Minimum $5.00 $ SQ $5.00 (State Licensed Residential Contractars) $ $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 ( ) $ (p`�. � Make checks pavable to: Citv of Fridlev Attach Stipulations 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 ordina s and codes e City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applicati n or a permit n w is not to start without a permit on site; that the work will be in accordance with the approved plan in the case o iew and approval � /" �� SIGNATURE OF APPLICANT . PRINT NAME __ C� �� DATE APPROVAL INSPECTOR SIG ATURE �—, � " 6 ��J6 .' � I �r �� // _-----��.<< __ � wc �� ' �� , „ ,, �� , � � � ► , ; � /� � � . _ �' i t `I 1 �. ��a�► .� l �-� � � �.�_. -- -�,�. �s�� f�. C B�1 l �VS �-1� �N t+�sv�� -S �t �5 2� w �� . �-_ ,... .��..� ,_.._ � -�- �� ..r-- �� ( �, �+�"s � �vs-��r << � � �� / ...----•��" �� t � --� . ,��:�t �. �-- . � �.��, � ��,,��, . ) r � G:�.f..►,� ` � �5 � _ ��-�'�- `� , �w�� ///'''�� J .�.�-� �t ��.z � �� ..� ��.-C�. I�.. � �tor ,_._ � �� G. �..� �- 1 �_ s-�-� _ --�� _�_