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P - 41909Building Inspections 7C3-572-3604 763-502-4977 FAX DATE / / bl { l � � SITE ADDRESS � THIS APPLICANT IS: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-I-2011 YOUR E-MA1L ADDRESS �t�� .`.t�Go ❑ OWNER f�ONTRACTOR PROPERTY OWNER/ NAME: t" ��, n TENANT qDDRESS: I2 S CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE � — --- PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DESCRIBE WORK BEING SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl O Aluminum O Other PHONE: ?6„� 7� �] �S�h [ �'I CITY Permit No.:�.��i � ��3 � Received By�� Date Rec d: � H `ldti � L(/'�, > \ r� � STAT� ZIP � STATE LICENSE # �'(j lp J G S b 7 LEAD CERT NUMBER ADDRESS: 1e �' a� 1� �►()a� t�i � i'• CTTY Il ��_STATL�1_�iZIP!� PHONE Ep('Li SS ( r9 �'�i7� � FAX LE FAMILY/NEW CONSTRUCTION FAMILY/NEW CONSTRUCTION ❑ ADDITION ❑ GARAGE/SHED O WINDOWS � BASEMENT FINISH ■ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDiNG ❑ OTHER � SWiMMING POOL ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR � REMODELING .: c�t►�w�1' ��'h i s'i /.✓'�Pw k i �-th nd vV bp� � WINDOWS IN EXISTING OPENINGS ❑Yes ❑No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENMG CHANGES & TYPE OF WINDOW TO BE INSTALLED f� HOUSE ONLY ❑ HOUSE & GARAGE ' O ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS NUMBER OF F7' BASEMENT REMODELING SUBMIT: I . Existing Fioor Plan 2. Proposed floor pian 3. List of structural members to be used FOR NEW CONSTRUCTION iNCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: l. Site Plan/Survey showing the existing suuctures and proposed project. 2. Two sets of construction plans 3. Energy Calculations FOR WiNDOWS — PROVIDE U-VALUE AND MANUFACTURE ST[CKER ON WINDOW. ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: SING THE 1997 U.B.0 FEE SCHEDULE) COTAL JOB �ALUATION $��6 p� OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Paxk Fee Sewer Main Charge Total Due $ $ '��U $ S� $ $ $ $ � $ 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) $+6ft= ftx$25=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks pavable to: CitY of Fridle_y 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 conformance with the ordinances and cod s of the Ci of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permi and w 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 w ic qu' s review and approval of plan§. �� DATE JC �! 2�� SIGNATURE OF APPLICANT PRiNT NAME �1a "� APPROVAL INSPECTOR SIGNA URE � � n �- � a � � � . ' � � � � � � (� � `� � � M�� , �. N �{y � )� �i � �} � � .� � X � �� ,� a �� ,o i �`�ltc.�� y � r � � � S �+ � � N �� . ° � � 7-�-�, 3 � M s' C.� � �N , �� , N� `s � � v� € a � , � i .-�� , �� n _ J ` � � � � �. , �A �° _ � � a _ _ _ �, . - . �� 1 �`�� 1 � � . rn � � � �c � �, . -�' r G ' �� S � O � -� �� f� x `g � i p� � 4.� x � � � , . ,, ., � � �, � �� T .>" � � � � � 0 t I �I QJ � 0 < � f� �� . , � s '' C� � .; � � f � D� � c � � 1 � � T � T� � � � � � `� d � 'Ol � � � � � _ m .F �� .�` T � v �7 3 � �yG... Cc7.. V� , � w m a• � �� ` is-�► W � � e � � � V V • �{"" � �� V ' � � m � w � 19;» �I _-s __- �� - �� 0 �� c OEO£M �q� ( — � � � � � � �