P - 45741Building BUILDING Permit No.: 'o
Inspections RESIDENTIAL APPLICATION Received By��. �•
763-572-3604 CITY OF FRIDLEY D����a:
763-502-4977 FAX EFFECT'IVE 1-I-201I
DATE 6-29-2011 YOUR E-MA[L ADDRESS msample@hwconstruction.com
SITEADDRESS 5830 6th St. NE
THIS APPLICANT IS ❑ OWNER fffiCONTRACTOR
PROPERTY OWNER/ NAME: Rosalie Landt
TENANT ADORESS: 5830 6th St. NE C�Ty Fridley STATE MNZ�p 55432
PHOrvE: 763.571.3306
CONTRACTOR NAME: Hoffman Weber Construction
SUBMIT A COPY OF STATE LICENSE # 4O 'rJ432 'rJO LEAD CERT NUMBER
YOUR STATE LICENSE
AND CERTIFICATE OF Aoor�ss: 7932 University Ave. NE CITY Fridley sTATE M��P 55432
INSURANCE PHONE 763.300.65542 FAx
PROPERTY TYPE %I SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH �J ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION
[j'�MA[NTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: R@-ROOfI StOC'Cll CIafllag@
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT
ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES � 8 ❑ HOUSE & GARAGE 1. Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE � 3. List of structural members to be used
PROPOSED HEIGHT: ��
IDIN � FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
� Vinyl ❑Soffit 1. Site Plan/Survey showing the existing sdvctures
❑ Aluminum � Trim and proposed project.
❑ Other ❑ Fascia 2, Two sets ofconstruction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATfON OF WINDOWS FOR WINDOWS - PROVIDE U-VALUE AND
OR FOR NEW OPENINCS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL N��J AKE ISAaEU V1V VALUA l 1V1V� I1V(;LUlll1Vl: l tl� (:VJ 1' VN' LAKUIt ANll MA7�L�'lZ1ALS:
(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
$ jfi �,d5 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)
$ f�+6ft= ftx$25=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
1 hereby apply for a building permit and 1 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 and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of w,�� ' t, r 'res review and approval of pl ns.
SIGNATURE OF APPLICANT PRINT NAME�'��=� ���'x�DATE
APPROVAL INSPECTOR SIGNA F�f % _