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P - 43653Building BUILDING Permit No.:aO l4 Inspections ,� RESIDENTIAL APPLICATION Received By: �63-s�2-3604 . CITY OF FRIDLEY Daj�� ' 763-502-4977 FAX E�ECTrvE�-i-ZOlo DATE I�/� I2.C� �U YOUR E-MAIL ADDRESS si� .�D�ss :� y�2, �q �1 ✓� N� �r{ ia�� THIS APPLICANT IS: �OWNER �CONTRACTOR PROPERTY OWNER/ N,�: �o�AJ �ry�v�� TENANT �D��S:,�N 9� E iF_ CITY ,� �-, I�1/ .1% �R/��5� 5TATE1/jt�/ ZIP �y�.2 PHONE: %� �_ '�7 �f � �%S' � � CONTRACTOR N�: SUBMIT A COPY OF STATE LICENSE # EXP DATE YOUR STATE LICENSE AND CERTfFICATE OF �+DDRESS: CITY STATE ZIP INSURANCE PHONE FAX PROPERTY TYPE ❑ SINGLE FAMII.Y/NEW CONSTRUCTION S�ZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ DIT'ION Q GARAGE/SHED ❑ WINDOWS �BASEMENT FINISH ❑ ROOF ❑ DRAIN TII..E ❑ DECK ❑ SLDING ❑ OTf�R ❑ SWIMMING POQL TYPE OF WORK: � NEW HQME CONSTRUC'fION O ADDITION ❑ MAII+TTIN.4NCE/REPAIit 0 REMODELING ` DESCRIBE WORK BEING DONE: � � T � r k�tGs /,/,�� ������ w�s SIZE OF Ilv1PROVEMENT LENG WIDTH t,3 HEIGHT Ff O HOUSE ONLY gpg�T gEMODELING SUBMIT: NRU�MB�ERGOF SQUARES ❑ HOUSE & GARAGE 1 ���g �� P� GARAGES ❑ ATTACHED GARAGE 2. Proposed floor ptan PROPOSED S1ZE: ❑ DETACI�D GARAGE 3. List of structutal membus to be Wed PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vnryl �Soffrt ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site PIsnlSurvey siwwin� tbe e�tisting struct�s�es ❑ Of}�r ❑ Fascia � PmPo� P%I�• 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXI3TiNG OPENINCrS C]Yes QNo LOCATION OF WINDOWS FOR WII�TDOWS – PROVIDE U-VALLTE AND OR FOR NE W OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDQWS ALL FEES ARE BASED ON VALUATTON, INCLUDING TIiE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) JOB VALUATION $ °'-35�6 OCCUPANCY TYPE Permit Fee Plan Review Fire Surchar�e Surchazge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Dne E� $ $ S $ $ 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) 52100 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$24=$ $450 Conservation Plan Review Fee Determined by Engineeriug Agreement necessary ( ) Non Necessary ( ) Make checks uavsble to: Cih* of Fridley Attac THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I heretry apply for a building peimit and I acknowledge that the information above is complete an@ accurate; that the work wiil 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 and work is not to start withoitt a permit on site; that the work will be in accordsnce with the approved plan in the case of work whi requir review and approval of plan�. 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As � av�rn�r t�f the prc�perty �t �k �� /li � , �'ricl�y, I �m +�xempt �rc�r► t�e state lic��rsinc� req�airEment or�Iy if 1 arn n�xf bu��d'rr�g c�r impr�vmrg tt�� prc�percy #c�r p�rpos�s of resai�, ��r sic�r�ir�g thi� d�m�r�t, t att�t to th� f�cc� th�t i a�rn improving #his hause fs�r m� o�rn us� �nd c�a nc�t int+��d to seli i�. t f�r�b� c�airn � be ��em�t #�c►r�n �he st�te licer�sing requirement� becau� I�m r�at in t� bu�`rr�ess af bui�i�r�g c�r r�mc�deiing on sp�ulation or �or resal� and that t�e t�ou�e far w��ch ! am ��lyin� for t�i� �rtn�t, i�l tl�e �t�t r��ic�+�rtti�i s��tur� [ t��v� t�uiit t�r ir�prou�d in t� �2r�t �4 rnc�-tth�,_ f�t�t� :��k�t��g� t��t b��� � dt� �c�t tt ��t�t� Ei�n�, t f�rfiet� �rry +�t ni�'s Ei�r� rit�t�i� tv �iich I r��y c�thet�ri� h�w� !a� �ntit�� �rr�er i�inn. ��, a�4.Q"t. �u�r�h�rrn�r�, t�c�cnarnrl�dge #�at f m�� t� #��ri� �nd �r�t r,�r� e�rs t€� p��fr;� t�rt��r� ��p�� �►f th� canstru�iicrn or irr�prr�vem�ent +�f this t�c�.�� st�d ! ur�d+�r�si�€�# the�# �rrte t�f ff��a� cc�nt�actars m�y b� requuir�d ta be ti�en:� k�y #he �#ate of I��nn i �r��rs�r�� tt��t ur�Ci�nsed resid�nt�al c€�ntr�cting, r�rn�etir►g, �ndlc�r ro�frng acti�rity► is _ � rnisci�rrteanar u�de� F�{�nrresot� [av+rT �t�d that i wt�uld farfeit my ri�hfis �o e+�[tt'tburs�m�n� frt�rr� the Cc�ntractc�r's FF�+�cc�v�t�r Func1 in the e�e�t tFt�t any �at�tt`�ctors t hir� �r� unt'rcense�i. �� •-�-� w -�� » r . s � -��- � • - �• t�.: � � � . t • - � � •° ss r - • � r - • • r t «.al# . • '� � i� � !M^ �• • • � � • �..# � M— ♦ : �' . # `� •�� t �t i i " � .t� � �� ..��1�� � A / � ��� f a/���,�r �o