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P - 35586Building Inspections 763-572-3b04 763-502-4977 FAX DATE �U�'��J'� '� SITE ADDRESS ��:` TH[S APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: BUILDING R.ESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-I-2011 ���� � �: x ❑ OWNER ADDRESS: PHONE: STATE YOUR E-MAIL ADDRESS -'��l �l�/� )NTRACTOR � ����-�J � 5�: �� , CITY 7% .—. !`.%')?r�a rri r; � � �"7;71.i?f SINGI.E FAMILY/N W CONSTRUCTION TWO FAMILY/NEW CONSTRUCTION [] ADDITION ARAGE/SHED ❑ BASEMENT FINISH ROOF O DECK ❑ SIDING ❑ SWIMMING PO( � NEW HOME CONSTRUCTION ❑ MAINTENANCEbREPA1R DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES �'"�� GARAGES PROPOSED SIZE: PROPOSED HEtGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other WINDOWS IN EXISTING OPENINGS ❑Yes (7No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED ■;�� • ■ �� �r�/�ii ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHEp GARAGE ��j��- �� ❑so�tic � � Trim � ❑ Fascia tOCATION OF WiNDOWS [i7o Permit No.: �� �� �L ��"�� Received By: D��' � U G �-�-��n ATE�ZIP EAD CERT NLJMBER �CiTY STATE ZIP FAX StZE STORIES ❑ wmDOws ❑ DRAIN TILE ❑ OTHER G r� c���l��+��� H HEIGHT S FT BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structurai members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans 3. Energy Caiculations FOR WINDOWS — PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW. 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 I��� — ��� �I.f �� 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 Residentia! 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 pa_yable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMTT-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 itt conformance with the ordinances and codes o City of Fridley and with the Minnesota Constxuction Codes; that I understand this is not a permit but only an application for a permit o is not to start without a permit on site; that the work will be in accordance with the approved plan in the case a 1 w r ich uir � i and approval of�,p,l3�s;r��� /� SIGNATURE OF APPLICAN PRiNT NAM J� DATE � APPROVAL INSPECTOR SIGNATI '