P - 41837Buildin� BUILDING Permit No.• 6 �
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date xec'd: L �
763-502-4977 FAX EFFECTIVE 1-1-20ll
na� 9-1-2011 YouxE-Mn�LADD�ss msample@hwconstruction.com
siTEtwv�ss 5851 6th Street NE
THIS APPLICANT IS: ❑ OWNER QICONIRACTOR
PROPERTY OWNER/ Nn�: Richard Ruesenberg
TENANT ADD�ss: 5851 6th Street ci-rv Fridley sTn� MNz�r 55432
Pxor�: 612.812.9695
coN�r�►c�rox N�: o an eber onstrucfion
SUBMTI' A COPY OF STATE LICENSE �! '�'0�32�JO LEAD CERT NUMBER
YOUR STATE LICENSE
AND CERTIFICATE OF anD�ss: 7932 University Ave. NE crrY Fridley sTn� M� 55432
nvsu�cE pgp� 763.3�.65542 F�
PROPERTY TYPE Il SINGLE FAMILYlNEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE ❑ ADDITION [YGARAGFJSHED ❑ WINDOWS
❑ BASEMF.NT FINISH � ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDINCr ❑ O'I�R
Q SVYAiMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDIT'ION
� MAIN'lENANCFJREFAIR � REMODELING
DESCx�Ewo�ucBEnvG, - Tear down garage and rebuild, complete roof on house
StZE OF IMPROVIIMENT i,�rrG� 22' wm� 16' �c�rr 10' s�r 352
�
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARE 22 �• .�� � j� HOUSE & GARAGE BASEMENf REMODE[.,ING SUBMIT:
I. Existing Floor Ptan
GARAGES C �f ATTACFIED GARAGE 2. Proposed floor p(an
PROPOSED SIZE: ZZX� G �'��/ (❑ DETACHED GARAGE 3. Lis[ of structival membets to be �ed
PROPOSED HEIG�� k'C� �
SIDING ' ,1 g "' ��V,c� FOR AiEW CONSTRUCTiON INCLUDING DECKS,
❑ Vinyl ��v �� ` ❑Soffit ADDITIONS_ & PORCHES SUBMIT:
�� 1. Site PlardSurvey showing t(�e existittg slructures
❑ Aluminum � O Trim �-1
0 ou�� � • o F� �.:� 3� d 5 ��� �.i�-
2. Two set� of ca�truction plans
�'VINDOyUS ,_ 3. Energy Calculations
IN EXIS1'ING OPENINGS OYes E7No LOCAITON OF WINDOWS �� ���� T� FOR WiNDDWS — PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF �` MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES & .
TYPE OF WINDOW TO BE INSTALLED NUMBER QF WINDOWS
ALL FLES AKL�' KASI�'.11 UN VALUA"1'lU1V, i1VC:LUllI1V(� ItIL+' I:VJl Vr LASVli A1VU 1vlAlEIUALJ:
(USING TAE 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
$
$
$
$
See Back Page for Fee Schedule
65% of Building P�nit Fee
.001 times the total job vatuation
.0005 x Permit Valuation Minimum $5.00
$5.0(T (State Licensad Resid+ential Contractors)
$2230 per SAC Unit (Plans to MWCC for t�termination)
ft+6ft= ftx$25=$
$450 Conserva�on Plan Review
F� Determined by Engine�ing
Agreement necessary ( ) Non Necessary ( )
Make checks pavable to: Citv of Fridley Attac
'i'HIS 1S AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge that the information above is complc�e 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 undeishand 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
appmved plan in tfie c�se o ork 'ch requires review and approval of p�
SIGNA'TURE OF APPLICANT ��t��� PRINT NAME i e Sam�le vA� 9-1-2011
APPROVAL INSPECTOR SIGN
Pi:FA!CF. N(YTF• CF.PARATF. PRRMi'f'S A�tF. RF.(7i TiRF1? Ff3R PLtJMBING_ ET.ECTR�CAI.. AND M1�.CHANTC� W`�?1%K
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