P - 45210Building BUILDING Permit Ivo.: � �l - �
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 �jTY OF FRIDLEY vate Rec'ct: � 7
763-502-4977 FAX EFFECT1vE �-i-zo>>
DATE 07/07/11 YOURE-MAILADDRESS action _actionroofing.net
sirE a��xESS 1255 66th Ave N E
THIS APPLICANT IS: ❑ OWNER �CONTRACTOR
PROPERTY OWNER/ NAn,,E: Sarah Gibsan
TENANT ADDRESS: SaCTI@ CITY STATE ZIP
PHONE:
CONTRACTOR NAME: Action Roofing & Siding LLC
SUBMIT A COPY OF STATE LICENSE # 5421 LEAD CERT NUMBER NAT-109445-1
YOUR STATE LICENSE
ArrD cExTiFicATE oF aDDRESS: 1315 Southview Blvd c�TY So. St. Paul sTATE MNz�r 55075
nvsu�NCE rxoNE 651-457-2642 FAx 651-457-0351
PROPERTY TYPE �(1 SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE ❑ ADDITION ❑ GARAGE/5HED ❑ WINDOWS
❑ BASEMENT FINISH I� ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION
l� MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: TeaC'-Off aC1Cj C'@-COOf IIOUS@ aC1CI gBCag@.
S1ZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT
ROOFING � ❑ HOUSE ONLY
NUMBER OF SQUARES 24 � HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: �I DETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing stcuctures
❑ Other ❑ Fascia and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes �No LOCATION OF WINDOWS FOR WINDOWS - PROVIDE U-VALUE AND
OR FOR NEW OPENING5-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMSER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $��.� � 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
$ 7.600.00 tfil.��
$
$ i
� 4
$
$
$
$
$
$ _ ,. �
I hereby apply for a building permit
conformance with the ordinances d
permit but only an application for` a�
approved plan in the case of all work v
SIGNATURE OF APPLICANT i
;See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $5.00
$5.00 (State Licensed Residential Contractors)
$2230 per SAC Unit (Plans to MWCC far determination)
ft+6ft= ftx$25=$
$450 Conservation Plan Review
Fee Determined by Engineering
necessary ( ) Non Necessary ( )
Make ct ck able to: Citv of Fridlev Attach
TION FOR PERMIT-NOT VA D UNTIL PROCESSED
ige t the information ab e is complete and accurate; that the work will be in
ridley and with th ' nesota Construction Codes; that I understand this is not a
i out a permit on site; that the work will be in accordance with the
ie approval of plans.
T NaME Kurt Merrell DnTE 07/07/11
VAL INSPECTOR SIGNATURE "
PLEASE NOTE: SEPARAT P I UIRED F UMBING. ELECTRICAL
WORK