P - 44471Builc�ing
�nspections
763-572-3604
763-502-4977 FAX
DATE 3 ��c� '" I �
SITE ADDRESS ! � A,
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2010
YOUR E-MAIL ADDRESS � C �
THIS APPLICANT IS: �OWNER � �CONTRACTOR
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
TYPE
PERMIT TYPE
TYPE OF WORK:
NAME: J C O"'T`7^ �--� r�;�,�.5 5�-nz
aDDRESS: 15�,('��i r J.. I,t,�cZ �. T=
PHONE: �% � ,7 71 � �7 �p
STATE LICENSE #
Permit No.:��j� -` ��
Received By:
Date Rec'd:� � ��
CITY ���T� l---�. y STATE�ZIP Sy
i� �i 1 eL ��' -7 4s � b
EXP DATE
ADDRESS: CITY STATE.
PHONE gq}{
GLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
❑ ADDTfION ❑ GARAGE/SHED 0 WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRA1N TILE
,�ECK ❑ SIDING �THER �.
❑ SWIMMING POOL
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIIt � REMODELING
DESCRIBE WORK BEING DONE: VtcY� �
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
� Vinyl
� Aluminum
❑ Othcr
WINDOWS
IN EXISTING OPENINGS ❑Yes ❑No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
❑ HOUSE ONLY
❑ HOUSE & GARAGE '-
O ATTACHED GARAGE ��
❑ DETACHED GARAGE , �1� J �
�/
❑Soffit � �� �
❑ Trim �i- (�i9�V E
❑ Fascia �
��5n
LOCATION OF WINDOWS
NUMBER OF
� v'�,r s�-uC lc._�F-: b vt
r
ZIP
BASEMENT REMODELING SUBMIT:
l. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDRJG DECKS,
ADDITIONS. & PORCHES SUBMIT:
? 1. Site Plan/Survey showing the existing structures
' and proposed project.
2. Two sets of construction plans
3. Energy Calculations
FOR WINDOWS — PROVIDE U-VALUE AND
MANUFACTURE STICKER ON WINDOW.
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ '3S'Ol� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surchazge
License Surcharge
SAC Chazge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$
$
$
$
$ C<N
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors) -
$2100 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$24=$
$450 Gonservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary (
Make checks pavable to: Citv of Fridlev
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 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 permit on site; that the work will be in accordance with the
approved plan in the case of all work whi h requires review and approval of plans.
SIGNATURE OF APPLICANT � � PRINT NAME �� �/�(.�'S .r/I��DATE 3- a� �o
/ S � _ �,�t G�1 �-.y
� . ,� �
.� � �,. r r�c C,� s u r2 v E v p �e �S'. �
� � s � �, �.���r� ��� ���h,r����>� �
� ��r�� ��r � C'�r1`��"���t`� � '
� � ������ �'�
:f` �� �� (���F /'r ,�V,.O �1������.�3� /��. 1 U 6? 1 F A A N(: E A V E. S O ti 7 H
'� / �� M 1 A! N EA PO L15 20. M 1 NNESOTA
rux�oo a-xioo
HAR1�2�' S. 3Gf-IN50N
P°�'U6�RT E3. MERECJtTN
---�---.__._._ -�-�° r ;����� �`�`'�-
�
w �
� �
�o ,;,
� ; �S �
,
�
� , .
h `^
� �
,
; , 3� -� � , � ��
�-/ � � �
`13r�� � �� �
�, �U � �r'�,v�� i � �, f ��
�' � � vr�a,�`'�r�� � y t� )
t� 83 ,� �3g'+t° w �' a � � �+
� r � �Y
i � . r� �
�
������ �
O��(
d .L1��rrr:�a�s 4`!/1iJ'•1`� ra..�'�'
__ l�, . .._..... �
$��,� g �'t�`
� �'�'y �''�°��f �t}uit. �h�i..s. .cr.�. a �.z�.! cc�el �tx�+.c.i -tep�.,�'u�t..�c�ra. a� a 4�,>y c� -�he G�u�t,�. +�
�� S, Cs'1,aa�. 7��(.J N � C�'. 1 C' K� r� � N 1C � Ll ��' !�1' H IY C1 �, t�+�c��, C'a�:�zy, Mi�rce��a. ;'�
«�e.�.,��.i �'�,t�ac�t.t �.7 a�v� ��.av�.�ice.r�. c� e�u�.�tv�anr�rrr�.�s.� '� c�yM /�*L �r•te�+��aG Gy �. � S�h.
� �� �a�:, i �c� i.
� :f
�� r� n., M�i.rz�a.. �t'�¢'w• lVo. S!}� S` .
- � ��asm�
`' y� � "' \� 1 y�r'
� � �� � .
S No ��.�.��-�s�. ' �z'W ` �
�: � �
� �oo ��.��. ----
s�� ���
S�) .�1 �,� x�
Sy'1 ��l =
�I �s � °� � �
?!3 � � �____.._---'' �, � .r
9 � �
, �Z 1�`�I�
� �� �"�- �'�� F; �4� � �r;s:.---�J '� �
, Ci�i' X ,�```^ C'i
.�
�! )x!✓� `�' �' , r C...r
i f / �/"j ''� � �'C,� �� fi... s°'�� ,
� -, rs..a—. �,�i.3N��rY� � �"� � rx.� :� i;� ������
—T�d � � .:.
r.. .� X i,.� �, / ' � :� � -r-� y � >� "� � �
, . ,.
_ _. _ __ _
aU!/ �00�/
„08 / ,� ZL �o
oa aapeac� „g
/ „Z u�.►M aoop
o�u� ap�ua
aq o.� nnopu�M
aoop �o ��ap ..- - ___ _ _ _ ..
,�8 ;9 X „0-,9
e
�
a
c
�1� ,,��
� . Q • � ���
� v ��
�11�V1� ��°� .,��' " c ,�ih�\
�"i S+- /''� �
�� ---.� - �
�C��J ;��C�.
—
��M 'O�- ,�bz x�u1
. _ i ......_ --�- -.--- �- - --
�\�
���'-3y � A;;
i•:
�, .
� yA�
1,��,:.::�
:...."_.,
�I� ^±' �,V
0
' � � � __�.�
w�.�:
4 � S � .
..' Lrv S �'i 'T:. 'R`'
y ��> .� .. � . .
. . : .. ::,; s � � : .
�. _. . . ..ti ..,. , ,. � � �. ' i � � �
' t�.°.;�__� �:_...'_'._.._.3 . . .
a��}s uo 6uipuadap �etle „q •zadde s� �uawaaqd a�pu�dS I!�� pu�H pa��a�l a�nssaad „�x„Z
---- ------ -- -�------ -
s�sod 6u��ie� pay��oN do�� pa�ea�l a�nssaad „8bX„tiX„b
sa�puids pu3 �bs pa�eaal aanssaad „9£X„ZX�,Z
�ui�re� �e�►�� f�;uoz�r� ,�9�'�,.
; � :suoi��a�as �ieapueH
•��ap �no�( �o� pa��a�as ane� no�( suoi�do
pue a��s Gui�ie� ay� �o uoi��as e si nno�as
s�aua�se� �uiu�e�� paziuen�e�
snnaa�s �aa�s ssa�uie�s
daap ,� s�u��oo� �ao�g aa��d
spaeo8 ��aQ pa�eaal aanssaad ��9 X ��Z
s�sr�d �ur�re.r� � �r�
�eua�e� �uiwea� pa�eaal aanssaad
:y�iM ��ap �ana� � e pa��a�as no,�
m
�.