P - 47151Building BUILDING ��='�N��6
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date Rec'd:l �� /
763-502-4977 FAX EFFECT]VE 1-1-201I
DATE `� /71��1 YOURE-MAILADDRESS �OUI�S Gri �l�I��OI�J�S. COM
SITE ADDRESS G G�I } V"
THIS APPLICANT IS: ❑ OWNER '�CONTRACTOR
PROPERTY OWNER/ NAME: l'11 � K� �
TENANT qDDRESS: `� j G��A Y�G / Y� CITY
PHONE: %� 3 r S T a• O Z O q
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
', DESCRIBE WORK BEING DON
� SIZE OF IMPROVEMENT
N�E THD At- Hoine Service, Inc,
STATE 2690 Cumberland Pkwy, Ste 300 �EAD CERT NUMBEF
a�DR: Atlanta, GA 30339-3913 c►Tv
r�HONL Lic # 20268257 Ph. 763/542-8826 F,�
`B.$INGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
❑ ADDITION ❑ GARAGE/SNED C�WINDOWS
❑ BASEMENT FMISN ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
O SWIMMING POOL
❑ NEW HOME CONSTRUCTION ❑ ADDITION
"�MAINTENANCE/REPAIR ❑ REMODELING
�� ROOFINC
I NUMBER OF SQUARES
'I GARAGES
, PROPOSED SIZE:
I PROPOSED HE►GHT:
SIDING
� Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENTNGS�JYes ❑No
OR FOR NEW OPENTNGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED �
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACNED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
L CATION OF WINDOWS
/viA �
C�� NUMBEROFWINDOWS
WI
AT� �ZIP�S�i37
STATE ZIP
� �n �
FT
BASEMENT REMODELING SUBMIT:
I. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
I. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
FOR WINDOWS — PROVIDE U-VALUE AND
MANUFACTURE STICKER ON WINDOW.
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
( SING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 3( �• OCCUPANCY TYPE
Permit Fee $ „2 �= See Back Page for Fee Schedule
Plan Review $ --� 65% of Building Permit Fee
Fire Surcharge $ �'�, Z �a .001'times the total job valuation
Surcharge $ l, �, (`j .0005 x Permit Valuation Minimum $5.00
License Surcharge $ LC""' A�,,, $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 $ 0 . D S Make checks pavable to: Citv of Fridlev Attach Stip�lations
THIS [S AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
[ 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 an work is not to st rt without a permit on site; that the work will be in accordance with the
approved plan in the case of all wor hi�fi rey i review and proval of pl� [ l �/ ,.,� ���
SIGNATURE OF APPLICAN Z� RINT NA�r(E //� S C n/�l �C DATE
APPROVAL INSPECTOR SIG ATURE ,_, l� i i .. �