The URL can be used to link to this page

P - 84396Building BUILDING Permit No.:�O � L�I " Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY vate xe�c��. 1�.�.� 763-502-4977 FAX EFFECTIVE 1-1-2012 DATE � o� I r'J �� YOUR E-MAIL ADDRESS �W1�fS�1 �-1?+J 0�� .%O�\ -- SITE ADDRESS =j �'I `� � "1 a THIS APPLICANT IS: ❑ OWNER �CONTRACTOR PROPERTY OWNER/ N�: ' � �O'�- TENANT ,�Dx�ss: i � �, � cTTy STATE zir PHONE: 7 (e's � '�'{ J� �'"' � :1 � O CONTRACTOR N�: SUBMTT A COPY OF � • � *- ^ STATE LICENSE # � � �' GCL�� LEAD CERT NUMBER� "° �� 05 �XP:ES:) I �.O � � YAND CERTIFICATE OF ADDRESS: �'T'� G��.�� A N� �� CITY�d� � a_�S STATE M1 _ZIP rS '� INSIJRANCE PHONE �Pav^ L I '° �'J ��a FAX PROPERTY TYPE � SINGLE FAMILY/NEW CONSTRUCTION SIZE 0 TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ��DITION ❑ GAxnGFIS�D ❑ wulnows ❑ BASEMENT FIIdISH ❑ ROOF ❑ DRt1IN TILE �DECK ❑ SIDING ❑ OTHIIt ❑ SWIMIvIING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTh�TANCF/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: I' it 12 � � StZE OF IMPROVEMENT �`j ' LENGTH � 5 WIDTH i Z. HEIG � S FT 5' + ROOFING ❑ HOUSE ONLY `� ��Y'S NUMBER OF SQUARES ❑ HOUSE 8c GARAGE BASEMENT'1FE1GIUiSELING SUBMIT: 1. Exisuing F1oor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor PL1n PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structmal members to be used PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING i Ai>DITIONS. & PORCHES SUBMCT: ❑ yinyl ❑Soffit SIDING/SOFFf1YFASCIA 1. Site Plan/Survey showing the existing structures ❑ Aluminum ❑ Trim REMOVED? O YES O NO ❑ Other ❑ Fascia � ProPo� P�.lect. 2. Two sets of conshtiction plans wINpp�yg 3. Energy Calculations IN EX[STING OPENINGS OYes �No LOCATION OF WINDOWS FOR WINDOWS —PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACT[JRE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES Al� BA�LD UN V ALUA1'lU1v, i1vl:LU�l11v � 1 t� �:va i vr i.aisvx ni�L iv� i�x�i.a: _ (U�I�G THE 19y7 Ii.B�C FEE SCHEDULE) TOTAL JOB VALUATION Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Emsion Con1ro1 Park Fee Sewer Main Charge $ ��j L-�`j See Back Page for Fee Schedule $ '� �(; 65% of Building Permit Fee $ 001 times the total job valuation $ � .0005 x Pernut Valuation Minimum or .50 $ $5.00 (State Licensed Residential Contractors) � $2365 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx�25=$ $ $450 Conservation Plan Review � Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ , 3 Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERNIIT-NOT VALID UNTIL PROCESSID I hereby apply for a building permi d I ackno ledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and of t rty of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for perm 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 review and approval of p s./ry SIGNATURE OF APPLICANT PRINT NAME l'i Z �""t�Y� DATE � L�,c5 �(Z. APPROVAL INSPECTOR SIGNATURE PLEASE NOTE: SEP S ARE REQ RED FOR PLUMBING ELECTRICAL AND MECHANICAL WORK iii i�i :�ti � !4i � � � �� -; � � er cf1 r� �.: � �% i 3! Q� ,� � t� �'3 'Z7 a-�r � � � � a � t ,-� lt r.� � � Q; �-? �!} a � -� -�s t� -�-t t� C� �., �U��CI� � � �r o� � :n x.t', � �L � � � � O tU � � � � � A.� ?� -� ;s � w :-a � �sa� c� � :x � -:� � � � Q � s'.� � O � N c� t} O � L} � � t? U � � sLS tY2 � 93 i � � � 3-� ` _`� � � � � � � � � � f � [!t �tf � C� r 'I .{•} {j� r--i � u� u] tc3 QJ 3, �33 � U1 r-t 4U tG i(� }:� rti� �..4V � � � � � 4 �� g) a:2, C3': \ � EQ • -�-i t� "'� r-€ '� �S Q} O 4 °a, �,f Ci: .Q 3 � t1t �� Kr � � � � � c�.� c��,�. -� i3 � CJ G �' _ _� � �r � A � t �, `�` �G C? � � -�.� \ s� �? 3.� D .�-� � %i � � � cei v3 X X t� zri C�! r--I ; � � � , � � �� ' � � � r-� � �' � �I V' � /♦� �� 9 �� --- .. �. � � �� - � rs� -*-� � � O� �t-t � �� t U � 43 �� -� tU 03 �i3 -�i � � c�i �� L�1 � R5 � � � Ci � � �� ,n; �--i =: . �.,;- `=" � "L - � �. �� . , c x -� �s cx� ao c� cY; 0 � ' .� � -�1�.=.. 0 J CA � � ! � (� Q � � fl � � � � -rt t!3 -t-3 � .f3 4) � IIl • ctt �-3 �, -•-i c� -.-i z� �� . �'� i ��ef' \ �_ -�..� .,,., � � � i x` 1 � rX? / �� ; � ' �,° � � � � ; � � � � � � _� f : vl '� '� � W � � _ .� ,� � � -�w � `� � �� . � �` � i C� � - ��, ��. , °< � ,, � �, �.. � F �,� <.� � �� :m� � � C � --� -}' �'� � } r�i f � � �� se �� , �'�' � .,"�� -� � '� ��E � � � � ��,� � � � —� ' � - ; �, � °� � �; � �, � ,�� ,-�.,� . � �� ^ � � � �a �� `�i � � �� ; � � � � � � �- =� �y� � `�'� �� y� !. � � �f; � ��; ''�� + �� ti <6�y� � � ;�v.� � �� ,=�� . �� ,� � \ �; � � �� i � � �r , :.: � i � v � �i v __.. �� F � ;::� � �. �:� � � � ;i i �, � r ' � , � � � �� 1 � � �� a �� r � ' a� � �v� � � �� , � I. � � ��, � j t � � r' � ,�J