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P - 47258Building Inspections 763-572-3604 763-502-4977 FAX DATE I � � I —� BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 11-2011 SITE ADDRESS �� � ` �j }�' THIS APPLICANT 1S: ❑ OWNER PROPERTY OWNER/ NAME: TENANT � ADDRESS: '� PHONE: � o V �l CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: Permit No.: Received By: l�+t� � � Date��: '' � YOUR E-MAiL ADDRESS _ � a�1��� „� � �� �,°��%>.7 ��� U 0V�. � .-� � ��. � c �„-, STATE LICENSE # ADDRESS: PHONE SINGLE FAMILY/NEW CONSTRUCTION TWO FAMILY/NEW CONSTRUCTION ❑ ADDITION ❑ GARAG ❑ BASEMENT FINISH ❑ �i00F ❑ DECK �$IDING ❑ swrMM NEW HOME CONSTRUCTTON AT�_ZIP. CERT NUMBER EXP: CITY FAX SIZE STORIES — E/SHED ❑ WINDOWS ❑ DRAIN TILE !NG POOL O OTHER ❑ ADDITION ❑ REMODELING DESCRIBE WORK BEING DONE: 'S j d� hR- SIZE OF IMPROVEMENT �� , ROOFING NUMBER OF SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: ING Vinyl Aluminum ❑ Other WINDOWS IN EXISITNG OPENINGS ❑Yes ONo OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit SIDING/SOFFIT/FASCIA ❑ Trim REMOVED? �YES ❑ NO ❑ Fascia LOCATION OF WINDOWS ATE ZIP ncivn � SQ FT BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural 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 pians 3. Energy Calculations FOR WINDOWS — PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW, - ��i:nvr W1IVUVWJ ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: TOTAL JOB VALUATION $����USING THE 1997 U.B.0 FEE SCHEDULE) Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Pazk Fee Sewer Main Charge Total Due $ /.`� '� $ $ �� � $ $ $ ANCY 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 THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED ~ a�■�i,� 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 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 m the case of a r h' SIGNATURE OF APPLICANT r iew and approval , �(� APPROVAL INSPECTOR SIGN�I4�E P�NT NAME_. il'r'�`i�i 1 i� DATE \�'��--- �- l t �x�� .., ... ,�,, „