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P - 41822Building Inspections 763-572-3604 763-502-4977 FAX DATE__� 1 G lQ1 SITE ADDRESS � THIS APPLICANT IS PROPERTY OWNER/ TENANT COI�iTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTNE 1-1-2011 YOUR E-MAIL ADDRESS T �SIOWNER ❑CONTRACTOR S Permit No.: �� "�� Received By:. Dat�`k�c'�"d � , ' • � � ADDRESS: 1 Q � � �^� � � �— CITY �� STATE�_ZIP��_ PHONE: (cs�I�- �T� �'" �� STATE LICENSE # LEAD CERT NUMBER_ ADDRESS: CITY PHONE FAX SINGLE FAMILY/NEW CONSTRUCTION SIZE TWO FAMILYMEW CONSTRUCTION STORIES I O ADDITION ❑ GARAGE/SHED i�[ WINDOWS I,�BASEMENT FiNISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL � NEW HOME CONSTRUCTION ❑ ADDITlON ❑ MAINTENANCE/REPAIR � REMODELING ATE ZIP __ --- -- DESCRIBE WORK BEING DONE: A�1�1 N C� �'LZ'�.�� rV tZ.q(�,) 2� l.l.' � l�S SIZE OF IMPROVEMENT_ Q—�^� �_�__��(e` � LENGTH WIDTH HEIGHT SQ FT ROOFING NUMBER OF SQUARES � GARAGES PROPOSED SIZE: PROPOSED HEIGHT: ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used SIDIN FOR NEW CONSTRUCTION [NCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: O Aluminum ❑ Trim 1• Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two seu of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS t�.Yes �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 $ k� �.(� �O �� 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 $ $ • ('(J $ .�� $ $ $ $ $ $ .� „ See Back Page for Fee Schedule 65% of Building Per►nit Fee .00I 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 Stipulations THIS [S AN APPLICATION FOR A PERMIT-NOT VAL[D UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work wi11 be in conformance with the ordinances and c es of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a perntit but only an application for a pe 't an rk is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of a rk hic u' s review and approval of plans c,, ^�`� SIGNATURE OF APPLICANT RINT NAME �� IA� 13YUI.u✓I DATE d � W APPROVAL INSPECTOR S[GNATURE ' � �� V --�. { _ � _ 11(V � � � � �� t . vv�.� �4 ``s� t � �� W�.c� � �� . �,� M �� v '� -�- .�a�� t � C �� ' � �� s ,►� s�� 0 -� � ��L • << t � �� kZ� �� , f�� `� S � U I � �rz �� '�' `� , � �� • s ��-c,,.�cU��,,� . �� , c:J --- � u�� v° � �� <�� t �-�°.�.- `. � ��` , � � �� . _� � ��cs � ��'�. `C� 5�9�-5� l�' � �i �� _ Ca � .� S-�� _ �--°�� . C= �" � �.� � �� . Q�c. s ��rz�. �'2c . .� r �! C�� ,