P - 39387�, ��„��, From: 18668691333 Page: 1/1 Date: 9/12/2011 8:21:22 PM���
Building BUILD�TG Permit Na.:�
Inspeciions j�E�IDENTIAL APPLICATIQN �teceived sy:: �
7�3_s7� 'b04 F�� CITY UF FRI1DLEY D���'��
763 50.. 4977 �FFecr�vE i� __
DA'ifi���
S17'B ADD[tESS
TH1S .4PPLFCANT IS�
PRt�PERTY O�V^
TENANT
SL: B1Vi1T A CC�I'Y OF
Y"OLIR STA'CE LiCENSE
AAD CERTIFfCA?E (?F
L�IStJRAN�E
PROPERTY TYPE
PERMIT TYPE
YOUR E_tv1AIL ADDKLSS
O Oti�VNrR �CONTRACTOR
ADDRESS: ��' E� L� ��% �LC: C(TY
pxo�e: 7� 5 ��`� �''� ► !
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STA"I`ELICEi�ISESE 9t�� 'i Lf'�a % LEA�CERi'NLIMI3ER^� -, 1- �L%�`7.�' -)O••�%(_.'!��_`�
�7 (':3 �.���' IL�/��t �A'�f1�7 $TA�4Lj�jl17TP .� � li..c'�,,.
ADDRE55: �.?,/�-y�_�r.LS� f:,.� � ,. . ..� , ., . , �. ..
CKl SLNGLE F 1M1LYlNEW CONSTItUC"lii
❑ TW(J F�MILYRi�W CONS'fRUC710P:
C]'BASGNfENT PINISH �,AOOP
� DECK CI SIb7NG
I"1 SW[MbftNG POOI.
T�Y E OF WORl�: ONEVi' HOME C�:VS"CRUCTION O ADDf'T}ON
p MAIMTEVANCElR�.PAIR �REMOAELING
^ 1?ESCRIDE W'ORK BEING DONE: I� �:--� ��G�— n'�<�. t'���" �'�"'
S17_C OC 1MPl20VCMENT LGNGTH �'��T��
K�fl�;�� Q 1-IOUSF, Of1LY
hfUMBCR nC SQUARES _.�L� �-HOUSf: & GARAGF.
IARA ES L] ATTACHED CsARAG�
PROPOSi�D SIZE: O DETACHGD GARAGE
3'ROPOSED HEI�iHT:
SI DI4C QSofflt
❑ Vinv!
❑ Aluminum ❑ Trim
❑ Other CI Fascia
WIVDOI�'S
LN EJCISI'ING 4PENINGS ❑Yes ❑No LC�ATfON OF WIND01�%S
Ult FUK NE�` OF'ENIt�lGS-DESCItI6E SIZG Or
OPEN[NG CHJ�VG£S & _.....�.,,, �„ .
ALL FEES A1tE
'UT�►i� JOB VALUA'
Permit Fee
Plan Review
Fire Surcharoe
Surcharge
L,tcense Surcharge
SAC Charge
Curb Cui Escrow
Erosion Controt
Parlc Fee
Sewer DRain Charge
Tatal Due
17 DRAFN Ti1,6
❑ OTF3ER
RASF.MENT IZFIvtOnELING SUBM[l':
I . �xistine f loor P1an
2. Proposea floor pian
3. List of structural members to be used
F02 NEW CONS7'RUCTIO�t [NCLUD[NG DECKS,
AUDITIOTfS & 1'C)RCHES SUR1�11T:
1. 5ite Plar✓Survey sho�vin� the e:isung structnres
�nd pcoposed project.
2. Two sets of cnnsm�ction plans
3. Energy Calculations
FaR W[�fDOWS - PROVIDE U-VALUE AN.D
1�1AM1�i1FACIVI2£ ST►GKPR ON ly1NDOW.
YAl,UATTON, INGLUD]NG TBE COST OF LABQR AND
(USING THE 1997 U,B.0 FEE 5CHED[3LE�
r�,� ��� OCCUPANCY
TYPE
$ �;�, See Back Page for Fee Schedule
$ 65°io of BuiJding Permit Fee
S .�1 times the total job valuation
$ � .U005 x Permit Valuation I�iinimum $5.00
� �j �� $5.00 (State Licensed Residentia! Contractors)
� $2230 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= Rx$25=5
� $450 Consecvation Plan Review
$ Fee Determin�d by Engineerin�
g Agreement necessary () T�on Neaessary ()
� �<../,�- 1V[ake checks payable to: Citq� of F'ndlev Atta[
THIS 1S AN APPGICATION FUR A PEItM�T-NOT �'ALID UNTIL PROCFSSED
i hereby apply for a building permi# and f ackno ledge that the informatian above is complete and accurate; that the w�ork will be in
conformance with the nrdinances an es of th ity of Fridley and with the Minnesota Gonstruction Codes; thet 1 understand this is not a
permit but only an applicatian� f� pe it an rk is not ta stsrt without a permit on site; that the work will be in accordance �vith t.�e
appr�ved plan in thc case of a111Wvvr review and I��pP�T N�MT:P� 1'i %}''�� `r' it-%l� �,,' DATE �l� 11=--/ z c-� l
SICNATURE OF APHLICAN7� ' _
NOTE: sEPARA'