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P - 43649Building $jJIj,DING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: $; ° 763-572-3604 CITY OF FRIDLEY ���� �. 2 6 763-502-4977 FAX EFFECTrvE �-i-ZOio DATE �" �l-Cc � 01 �` � YOUR E-MAIL ADDRESS SITE AbDRESS ��( � % �h S'�' NC THIS APPLICANT IS: � OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: Q TENANT pDDRESS: �f � � � .i'� N � CIT'Y �� � a �� k STA'T� ZIP �5�.3� rxorrE: 7!0 3'� 7 i•� y UO CONTRACTOR N�: SUBMIT A COPY OF STATE LICENSE # EXP DATE YOUR STATE LICENSE AND CERTIFTCATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCI'ION SIZE ❑ TWO FAM[LY/NEW CONSTRUCTION STORLES PERMIT TYPE � �DIT'ION ❑ GARAGE/SHED �WINDOWS ❑ BASEMENT FII�IISH ❑ ROOF O DRA1N TILE ❑ DECK � SIDING ❑ O'THER ❑ SWIIbf1VIING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCElREPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: �G/1 PSS �.1,trl �U Gt� �iP N1 �°� _� SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S Ff ROOFING ❑ HOUSB ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of struclural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl OSoffit ADDITIONS_ & PORCFIES SUBMIT: ❑ Aluminum ❑ Trim 1. Site PIarJSurvey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of consmiction plans WINDOWS /� 3. Energy Calculations IN EXISTING OPENINGS OYes o L TION F WINDOWS U�r� P"'�� FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESC�E SIZE OF �%`� '< F` �!�_ MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & r TYPE OF WINDOW TO BE INSTALLED 4e ay�Q NUMBER OF WINDOWS ` ALL FEES ARE BASED OiV VALUATION, INCLUDllV(G 'I'HE (,'UST UF LAI3Ult A1Vll MA'1'LKIAL�: o�iJSING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ — OCCUPANCY TYPE Permit Fee $� 3s See Back Page for Fee Schedule Plan Review $• "'� - 65% of Building Permit Fee Fire Surcharge $ . 5' .001 times the total job valuation Surchazge $ ,S� dc� .0005 x Pernut Valuation Minimum $5.00 License Surchazge $ $5.00 (State Licensed Residenrial Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft+ 6 ft= ft x$24 =$ Erosion Control $ $450 Conservarion Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ \Agreement necessary O Non Necessary O Totsl Due $ -, J Make checks aavable to: Citv of Fridlev Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building pernut and I acknowledge that the information 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 Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a pernut on site; that the work will be in accordance with the approved plan in the case of a1 r w ich uires review and approval of pjan,s. 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