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P - 46713Building Inspections 763-572-3604 763-502-4977 FAX DATETI�[y[__ SITE ADDRESS I� IiJ� THIS APPLICANT IS: PROPERTY OWNER/ TENANT I CONTRACTOR SUBMIT A COPY OF I YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DESCRIBE WORK BEING DO i SIZE OF IMPROVEMENT ROOFING ' NUMBER OF SQUARES�- � ', GARAGES i PROPOSED SIZE: ' PROPOSED HEIGHT: SIDING O Vinyl ❑ Aluminum ❑ Other BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-2011 ❑ OWNER YOUR E-MAIL ADD}tESS _ �71-2�3 Permit No.: � - - � : �%.. 1 i.1. � .' , ` ` � it.s►�.cc CITY�y'��(I �^t^n STATF�J�ZIP ��,5, y-�� NAME: �I�S %� L.-pv���'�,,:5 .,��,��,- i�rs,�1,L STATE LICENSE #_I�C G�I C� I% LEAD CERT NUMBER ADDRESS: 33�9� •i�,,,, � S C,�., C�] n�_,�I , CITY �� � STAT�1/V ZIP��"l� PHO�1E Z. - 5 3 Z- 2� �� F,,�{ GLE FAMILY/NEW CONSTRUCTION SIZE �.� ❑ TWO FAMILY/NEW CONSTRUCTION STORIES ❑ ADDITION � G�RAGE/SHED ❑ WINDOWS ❑ BASEMENT FIN[SH IC�OF ❑ DRATN TILE ❑ DECK ❑ SIDING � OTHER ❑ SWIMMING POOL ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING WINDOWS IN EXISTING OPENINGS ❑Yes ONo OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WiNDOW TO BE INSTALLED ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS OF HEIGHT BASEMENT REMODELMG SUBMIT: I . Existing Floor Plan 2. Proposed floor pCan 3. List of structural members to be used Oo FOR NEW CONSTRUCTION tNCLUDING 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 ANQ 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 $ �J OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $5.00 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2230 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft+ 6 ft= ft x$25= $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary O Non Necessary O Total Due $ �%5��— Make checks pavable to: Citv of Fridlev Attach Stipu lations THIS IS AN APPLICATION FOR A PERIvtIT-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 pe 't 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 w, quires review and approval of planss � ) SIGNATURE OF APPLICANT PR1NT NAME /-�e.A /G.�„� 1 h DATE ��/ rI � APPROVAL INSPECTOR SIGNA RE