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P - 48162
Building BUILDING Permit No.: �, 1 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Dat �C� i 763-502-4977 FAX EFFECTTVE �-�-ZO�z ��� ` DATE % /' �T `��`3l I YOUR E-MAIL ADDRESS SITE ADDRESS S G r �a_ �2 � THIS APPLICANT IS: �OWNER ❑CONTRACTOR PROPERTY OWNER/ NA�: ,ri1�,�- r .l,�I TENANT ADDRESS: �� � � 6 r`' G�/.� v CITY i—' i2 r�/, L E i� STATE�IP S �%3% PHONE: �e�� ��� 6 Z,S� CONTRACTOR N,a�tE: SUBMIT A COPY OF STATE LICENSE # LEAD CERT NUMBER EXP: YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PROPERTY TYPE O SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDrr[Ox ❑ GARAGE/SHED O WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDTTION ❑ MAINTENANCEJREPAIR �REMODELING DESCRIBE WORK BEING DONE: r. �`n i� �' �G►-S-�- �/ L��- f SIZE OF IMPROVEMENT LENGTH � WIDTH �� HEIGHT �� S FT �� ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structurai members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit SIDING/SOFF'IT/FASCIA ADDITIONS. & PORCHES SUBMTf: O Aluminum O Trim REMOVED? O YES O NO �• Site Plan/Survey showing the existing sUvctures O Other ❑ Fascia and proposed projxt. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS �Yes ONo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATlON,1NCLUDING THE COS"1' Ur' LAKUK A1Vll MA'1'1:K1AL�: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION Permit Fee Plan Review Fire Surchazge Surchazge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due � ANCY $ 9�. z S See Back Page for Fee Schedule ,� $ 3, ► 65% of Building Permit Fee � $ .001 times the total job valuation � $ , 15 x Permit Valuation Minimum o 0� $ -� $5.00 (State Licensed Residential Contractors) $ $2365 per SAC Unit (Plans to MWCC for determinarion) $ ft+6ft= ftx$25=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ �,i Make checks oavable to: Citv of Fridlev Attach Stiuul 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 Constxuction Codes; that I understand this is not a permit but only an application for a permit and ork is no to start without a permit on site; that the w k will be in accordance with the approved plan in the case of all rk w ic � view d appmval of pla SIGNATURE OF APPLICANT � PRiNT NAME Gi I� DATE �" I�"���� APPROVAL INSPECTOR SIGNAN � I � I I,I � ' � � : �� � N� `� x �� •�a � > �... $ � �� \' k S ".� � � �� r � � x� p N *� � ^^ � � i : � w �. 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