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P - 48533Building BUILDING Permit No.�� �ooa �O Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'ct: 2�.8 �� 763-502-4977 FAX EFFECT�ve i-�-zo�? DA'I'E p'� / �� YOUR E-MA[L ADDRESS e L( (; N�I Q! I• [ S[TE ADDRESS �� � G � �"f }�(� �II� TH[S APPLICANT IS: �OWNER ❑CON"CRACTOR PROPERTY OWNER/ N��,,E: Lowe l( TENAI�IT ADDRESS:l�7Z 6K 17f� ��CITY �I'i���G� STATE�[�/ZfP�Z PHONE: �D 3 � S71/" ZZ�7 CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # LEAD CERT YUMBER EXP: AND CERT[F[CATE OF ADDRESS: C[TY STATE ZIP INSURANCE PHONE FA�C PROPERTY TYPE � SINGLE FAM[LY/NEW CONSTRUCT[ON S[ZE 20� . ❑ TWO FAM?LY/NEW CONSTRUCT[ON STORIFS PERMIT T`YPE ❑ ADDIT[ON ❑ GARAGE/SHED ❑ W[NDOWS ❑ BASEMENT F[N[SH ❑ ROOF ❑ DRAIN T[LE ❑ DECK ❑ S[DING �O"CHER ❑ SWIMM(NG POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCT[ON ❑ ADD[TION ❑ MA[NTENANCE/REPA[R �.REMODEL[NG DESCRIBE WORK BEING DONE: !. b 7� QtJ1�� M eVC. (%� ��T SIZE OF IMPROVEMENT LENGTH �� WIDTH S�� HE[GEIT p�� S FT ROOFIYG ❑ HOUSE ONLY BASEMENT REMODEL[NG SUBM[T: NUMBER OF SQUARES ❑ HOUSE & GARAGE I. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED Sl"LE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HE[GHT: S[DIYG PORNEW CONST'RUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit S[DING/SOFFIT/FASCIA ADDITIONS. & PORCHES SUaMIT: ❑ Aluminum ❑ Trim REMOVED? ❑ YES ❑ NO I. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calcula[ions IN EXIST[NG OPEN[NGS ❑Yes ❑No LOCAT[ON OF WINDOWS FOR W[NDOWS — PROVIDE U-VALUE AND OR FOR IvEW OPEN[NGS-DESCR[BE SfZE OF MANUFACTURE ST[CKER ON W[NDOW. OPEN[NG CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES AKE BAS�ll UN VALUA'1'lUN,1NCLUll1NG'1'H�: CUS'1' UN' LABUK Ai�lll MA1�KlALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ �517• ��' OCCUPANCY TYPE Permit Fee PLan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ i� ---��r� $ ' Sr,, $ Sc," $ �Z��U $ $ $ $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum or .50 $5.00 (State Licensed Residential Contractors) $2365 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$25=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) checks oavable to: Citv of Fridlev Attach Stioulations TFIIS [S AN APPLICATION FOR A PERMIT-NOT VAL[D UNTfL PROCGSSED [ 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 �csrk �uh�t� re � ire y�ew and approval of p ns. � � . / -? y S[GNATURE OF APPUCANT ,,..�f^ c"� L��� �� " PRINT NAME ��(.�/ ` ���� ,� ��� DATE � � `/-P�' ��%Z APPROVAL INSPECTOR S�NA"CURE PLEASE NOTE: SEPAR4TE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK a W Ei w � � � -.� � � � -� O �--1 O `. � � � -rI O Q� � � n '� •� •.-I �-1 �--I � rt � �a�ro � .O 3 +� N � O r-I U ,o �� �� �� -� � � � � O U U '� � 3 . 4, � po .� ��� 3 r-1 r—i c0 x � 0 0 s� � � P� � ��� � � n � � I ^.� � +-' �.' r" � 4J �� � � � O � � ro ��� ��O � � y � � w " �� � i� . � -- � .�-1 v , ' �1r� � v� � 3 u� � � � � ���� � • — I � 4e � �, � � ''-I ^ � Csa O �� w �v z o¢ oa � 1� p � 0 0 � .� � � � m. _ � � S —� �� �/" � W �" o �1 �, � � � v / � � �^ -� -rl � � � � � � O .� 3 3 0 � �--I � � � -r-I � 3 0 � � � -� � � O 3 �F—I � � � � � � a� � s� '� TS G � � N � � � 3 '� � 0 � � � O � W '� N .x U � +� � � � � U � o ro �� �� �� �� � O tp 4-I � �� ��� .��o � -� � ��� ��� ..��� �o�� ���� � U S-i u� � � r-1 •rl � r-I '� � � � � ,� r� U � � U � � � � 5 ul -r1 • n O � �--I O � O C� S-� N O C2, ac�� rt � a� +� U .� N b� � � � O O S-a U .� +-� i-I � O � o -� � � � 4—I •r-I r—I � � .� N 3 b� o�o � � -� .� � � � � �� +� � G � -� � N +� O � u� W -r-I � X .� N � +� � � � O O �Ci�?C`'� �� � a. �_t ��=�;;, r �:- c �.s �� �2�_i•.d: C�°— U J ,�' �I'. a,�:,�, O '� l.� -= � --i '�'- G7 j '•.c_t t_.1 -r � � � L� �� r— W z N � � � � � .� � �� .� N �� O M �� W � � � m � a� r—I +� � � N O '� � � � >. 3 3 +� •ri 4-� .� U O +� -r-I -� s� +� 3 � .� U b� fA N -ri N r—I 1—i �C N .��� ��� � � 3 rn 3 ro '� � � N +� t� N � � O a� -.� � U rd N S-i � ..� 'C3 •� ;� i °� _. � •• 3 ?� O .� � �� �� �� �� .� o .� � � �_ � '� � � .�-I � � � �� �� � 3 S-i O a ,.� N r—i O N � � . � N G, � I � � 0 N a _ . _ _ .-�� � �� � �� ro � �a ,� c� � 3 � � , -,� , � Q � _ ` -✓ i � � fz- � � � �� ' I � ne OT-T OS65-851-008-T �xe� . wo��}aiy�xnois�MMM . �b6£-TZ8-008-T �laa . �(uedwo� �ui�n��e�nuew;aiU� xnois �,�y� ��S aaldepe 1dN a�e�u x a��wa� �❑ lelu! ,�'/e x lallno ,'/s £� auou p o �a�ui „z�z X 1a�]no „z�z Z❑ 2�31ddOb' 9 N011�3NN0� 3�1b'� H lallno pue lal�! �,Z/T 4�lM xo8 xp se� _��OZOZ-969'��a � J 8`d OZ-969 aaqwnN uia}� a}eaa� I �+ r _ _ ��, ��� `I ` I I ^ I'i �%Jl ��i � \ �:,� I', ,i�� I '`'�, `. 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