Loading...
B - 39347�� �'�t�; � � � i '"� `�'1 4 Building BUILDING pe � ��� :r. ,- 4n r Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: 763-502-4977 FAX Er�ECTI�E 1-1-2011 DATE 1- S�( I YOUR E-MAIL ADDRESS '"" sl� �D�ss (.,U� I S th S�� �,r � . THIS APPLICANT' IS: WNER ❑CONTRACTOR PROPERTY OWNER/ NpME: -�h vM 0.� (� � � y� �� �� �-o •'� TENANT aDDxESS: �C:��: S t'� x ��Sfi I� � crTY �r ,°tx 1 z� sTaT� M,'� zir SS 3 pxorrE: (o l�- 43 7- 38 a 6° CONTRACTOR N,�„�: SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # LEAD CERT NUMBER AND CERTIFICATE OF ADDRESS: CITY STATE ZIP 1NSURANCE pHONE FAX PROPERTY TYPE ,�'SINGLE FANIILY/NEW CONSTRUCTION STZE Q TWO FAMILYINEW CONSTRUCTION STORIES ' PERNIIT TYPE ❑ �DITTON ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH b11 ROOF � DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMNIIIVG POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION � MAINTENANCE/ftEPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: N`i.i S In : o. 41 �-S � SIZE OF IMi'ROVEMENT LENGTH WIDTH HEIGHT S FT ROOFING Q HOUSE ONLY NUMt3ER OF SQUARES �� � HOUSE 8c GARAGE BASEMENT REMODELING SUBMIT: 1. E�sting Floor Plan GARAGES p ATTAGHED GARAGE 2. Proposed floor plan PROPOSED SIZE: p DETACHED GARAGE 3. List of struchual members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, O Vinyl ❑Sotiit ADDITIONS. & PORCHES SUBMIT: O Aluminum O Trim l. Site Plan/Survey showing the existing structures O Other ❑ Fascia and proposed pmject. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTTNG OPENR�TGS ❑Yes ONo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE ANI1 OR FOR NEW OPEI�IINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPErIING CHANGES & TYPE OF WINIX)W TO BE INSTALLED N[JMBER OF WINDOWS �u.L r�r:� ax�: na��:U u�v v2il..uA�1'iV�l, llvI:LUDllvIT'1'li�; C:U,`i' Ur' LABUH ANll MATERIALS: �(I,�6IN� THE 1997 U.B.0 FEE SCHEDULE} TOTAL JOB VALUATION Permit F� Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TYPE $" i,/ ,� 5 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 (Staxe 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 ( ) �%� e: - � I l!/ Make checks navable to: Citv of Fridlev Attac THIS IS AN APPLICATIaN FOR A PERMIT-NOT VALID iJNTIL 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 codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an appiication for a permit and work 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 ork which requires review and approval of plans. SIGNATURE OF APPLICAS�L1---- PFtINT NAME %M Be�n ol �S� � DATE °l S- 1( NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHArTICAL WORK