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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. 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