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P - 37427Building Inspections 763-572-3604 763-502-4977 FAX DATE 22 ��I SITE ADDRESS v � THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE ii TYPE OF WORK: DESCRIBE WORK BEING SIZE OF fMPROVEMENT ROOFING z NUMBER flF SQUARES 2-/ i GARAGES i� PROPOSED SIZE: ! PROPOSED HE[GHT: BUILDING RESIDENTIAL APPLICATION �OWNER NAME:_ ADDRESS: CITY OF FRIDLEY EFFECTIVE 1-1-20] 1 YOUR E-MAIL ADDRESS _ /�� �"s'� tt�%3 fr , , ❑CONTRACTOR � SGQ��'� ��. �t,� �v� 1�� rs / n .- /.2G' � NAME: STATE LICENSE # ADDRESS: PHONE ❑ SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION ❑ ADDITION ❑ GARAGE/SHED ❑ BASEMENT FINISH ,�ROOF ❑ DECK ❑ SIDING ❑ SWIMMING PO( Permit No.: Received By: � . .,�,M �;► � � , � I /� � �j��'� ��/%� CL��' G� CERT NUMBE CITY FAX SIZE STORIES ❑ WINDOWS ❑ DRAIN TILE ❑ OTHER Q NEW HOME CONSTRUCTION ❑ ADDITfON ❑ MAINTENANCE/REPAIR ❑ REMODEL[NG _ t) n ril/1 T., C-f`iY'1rii1 ❑ HOUSE ONLY �IOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ATE �ZIP � � ATE ZIP FT BASEMENT REMODELMG SUBMIT: t. Existing Fioor Ptan 2. Proposed floor plan 3. List of structural members to be used � SIDING FOR NEW CONSTRUCT[ON INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ fiascia and proposed project. 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 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 $ �l' �/- LS $ $ � $ $ $ $ $ $ $ $ 1� , .�� 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 for determination) ft+6ft= ftx$25=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT[L 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 ity of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and rk 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 work h re ' es eview and approval of plans✓ �,�� ` SIGNATURE OF APPLICANT PRINT NAME /�i���� DATE Gif/ APPROVAL INSPECTOR SIGNATUR