P - 45313�urld�ng BUILDING Permit r1o.:
Tnspections RESIDENTIAL APPLICATION Received By:
i 63-572-3604 CITY OF FRIDLEY nate xec'd: '1 � i r
DATE °� � �! YOUR E-MAIL ADDRESS /. O Q( S a L` Q/ i� 0 i� ,l S� �O M
SiTE ADDRESS 3 G o? "`� � Cl i�
THIS APPLICANT IS: ❑ OWNER flCONTRACTOR
�Rt7t ERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YQUR STATE LICENSE
WITH A.PPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
N.�: Yn u! ��1 � i•� � w� o�� r
ADDRESS:_� G 7� a GtI �'/ CITY
PHONE: 3 O 3 j 7 � 4 • � b
N,,,iviE: rHD At- Home Services, Inc.
sTa.TE t,u 2690 Cumberland Pkwy, Ste 300
t�DxESS Cumberland Office Park
PxoNE Atlanta, GA 30339-3913
❑ sarGLE Lic# 20268257 Ph. 763/542-8826 '�
❑ TWO FA .0
❑ BASEMENT FINISH ❑ ROOF
❑ DECK O SIDING
❑ SWIMMING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
NUMBER OF SQUARES _
GARAGES
?ROPOSED SIZE:
PROPOSED HEIGHT:
'ENANCE/REPAIR O REMODELII3G
3 t.� ��1 dn w� e�%a �
SIDING
❑ Vinyl
Q Aluminum
❑ Other
F�'INDOWS
IN EXISTING OPENINGS �Yes ONo
�R FOR NEW OP£NINGS-DESCRIBE SIZE OF
OPENING CHANGES &
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
LOCg�'ION OF WINDOWS
�f� dro e M
l Ci�l !�/ STATE_ZIP S S�/ 3;7
.JO[it a r.�a�r JO(1< �_
qS� �3Y5- (,0�17
CITY STATE ZIP
ES
Q WINDOW5
��RAIN TILE
❑ OTHER
s �� � r� .� n� �5 c��_�
WIDTH
BASEMENT REMODELING SUBMIT:
, 1. Existing Floor Plan
2. Proposed floor plan
I 3. List of structural members to be used
Ft.
' FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBNIIT•
l. Site Plan/Survey showing the existing structures
and proposed project
2. Two sets of construction plans
3. Energy Caiculations
TYPE OF WINDOW TO BE INSTALLED D�T S NUMBER OF WINDOWS 3 "
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LE
(CTSING THE 1997 U.B.0 FEE SCHEDULE) '.
TOTAL JOB VALUATION $ � � OCCUPANCY '
°ermit Fee �
Plan Review
Surcharge
Fire Surcharge
License Surcharge
3AC Charge
�urb Cut Escrow
�rosion Control
?ark Fee
3ewer Main Charge
I'otal Due
$
$
$ � .
$
$ S. o � -
$
$
$
$
$
R AND MATERIALS:
TYPE
See Back Page for Fee Schedule
65% of Building Permit Fee ','
(.0005) times the total job valuation — Minimum $.50
.001 x Permit Valuation (1/10%)
$5.00 (State Licensed Residential Contractors)
$1450 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
ulations
THIS IS I�1V APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
hereby apply for a building permit and I aclrnowledge that the information above is' complete and accurate; that the work will be in
;onformance with the ordinances and codes of the City of Fridley and with the Minnesota'; Construction Codes; that I understand this is not a
>ermit but only an application for a permit and work is not to start without a permit; thati the work will be in accordance with the approved
�lan in the case of all work which requir°s review and approval of plans. /
>IGNATURE OF APPLICANT�"+f� �� PRINT NAME `(� S��� n f� DATE V �� l[ /