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P - 42136Building BUILDING Pe�it No.: �� � l�' � 7�� Inspections RESIDENTIAL APPLICATION Received By 763-572-3604 CITY OF FRIDLEY Date Rec'd: ' 763-502-4977 FAX EFFECTIVE 1-1-2011 DATE l/��� � G/� YOUR E-M�A-IL ADDRESS Cs1., c GY�-L � c. S`f s/!�. 1 SrrE ADDRESS �`Cj Lir.�—� f� �" �v 1`'/�tC/ L-�i. THIS APPLICANT IS: �WNER ❑CONTRACTOR PROPERTY OWNER/ Nq�: �-S �% ( „� �� TENANT AD��ss:��/ �t �— �i� �� /vl� crrx � STATE�ZIP �S`�5�9 ,� PHONE: /6 � T7 � o� � �j �/ Or- � Io2 o�e 7 S��� �. �i corrTRacroR N,�: �-_---- SUBMIT A COPY OF STATE LICENSE # LEAD CERT NLTMBER YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PI30NE FAX PROPERTY TYPE �SINGLE FAMII.,Y/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ��DTTION ❑ GARAGE/SHED � WINDOWS ❑ BASEMENT FIDIISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING �OTHER ❑ SWIIvIlvIING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCElREPAIR � REMODELING DESCRIBE WORK BEING DONE: G G OI� . . SIZE OF IMPROVEMENT LENGTH WIDTH �� HEIGFiT S F�?� � HOUSE ONLY �""""'f� $ASEMENT REMQI�ELING S_�v� NRU�MB�ERGOF SQUARES ❑ HOUSE & GARAGE 1. Existing Ftoor Plan C,�ARAGLS ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACFIED GARAGE 3. List of struchual members to be used PROPOSED HEIGHT: SIDING FORNEW CONSTRUCTION INCLUDING DECKS, � Vinyl ❑Soffit ADDTTIONS_ & PQ�CHES SIIBMIT: ❑ Aiuminum ❑ Trim 1. Site Plan/Survey showing the existing structures and proposed project. ❑ Other � Fsscia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EX[STING OPEIVINGS OYes �No LOCATION OF WINDOWS FOR WINDOWS – PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRiBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES 8c TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASF4IZON VALUATION, INCLUDING THE COST OF LABOR AND MATEWALS: TOTAL JOB VALUA Permit Fee Plan Review Fire Surchazge Surcharge License Surchazge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge THE 199'7 U.B.0 FEE SCHEDULE) OCCUP. $ $ $ $ $ $ . 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 (Plaris to MWCC for determination) ft+6ft= ftx$25=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: Cityo uf Fridle_y Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclrnowledge that the informarion above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Constiuction Codes; that I understand this is not a ptrmit but only an application for a �ermit and work is not to start without a permit on si ; that the work will be in accordance with the appmved plan in the case o 1 • � lwhich requires review and approval of pl s. ,) � Gr SIGNATURE OF APPLICANT f PRINT NA GS � DATE'_�,�"_ ADDDAI/Ai iATQDIIl�Tl�D CT!!iJA TDII SEPARATE PERMITS ARE REQUIItED FOR PLUMBING, ELECTRICAL AND MECHANICAL WOR� .T^~ _ . � z ¢r. ,.. 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