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P - 84225Building BUILDING Permit No.: � � Inspections RESIDENTIAL APPLICATION xecei�ed By: j�' 763-572-3604 CITY OF FRIDLEY nate 763-502-4977 FAX ��'� M�R 2 4 2� EFFECTIVE 1-1-2012 DATE � — �� " �� YlOUR E-MAIL ADDRESS SITE ADDRESS ___ S�o lo D S� /V •L � THIS APPLICANT IS: �COWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: 4`(� p..�e."� �CJ-� v i�' � ` TENANT ADDRESS: J� g�G� �o� S� /�/ � CITY _/" '1",� d cy- STATE�ZIP J� ^ '3oZ PHONE: _ 7 C� .� � � r � ' � E� �I CONTRACTOR NAME: SUBMIT A COPY OF STATE LICENSE # LEAD CERT NUMBER EXP: YOUR STATE LICENSE AND CERTIFICAT'E OF ADDRESS: CITY STATE ZIP INSURANCE HONE FAX PROPERTY TYPE � 1rrGLE FatvtiLY/t�rEw coNS'rftUC'riotv SIZE ❑ O FAMILY/NEW CONSTRUCTION STORIES PERMTT TYPE ❑ ADDITIOrr ❑ GARAGE/SHED � WINDOWS ❑ BASEMENT FIMSH �ItOOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: Uo-� C'� O S�-'�- SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT R FING ��,� � HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES � O HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GAR¢1GE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSIRUCT'!ON INCLUDING DECKS, ❑ Vinyl ❑Soffit SIDING/SOFFIT/FASCIA ADDITIONS. & PORCHES SUBMTf: ❑ Atuminum O Trim REMOVED? ❑ YES ❑ NO �• Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOW3 3. Energy Calculations IN EXISTING OPEb1INGS ❑Yes ONo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION Permit Fee � Plan Review Fire Surcharge Surchazge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due TYPE $ '�!) °�,�7 See Back Page for Fee Schedule $ 65% of Building Permit Fee $ _.001 times the total job valuation $ .0005 x Permit Valuation Minimum or .50 $ $5.00 (State Licensed Residential Contractors) $ $2365 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: Citv of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED --- 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 in the case of I work which r ui review and approval of p ans. �►/� SIGNATURE OF APPLICANT � �f PRINT NAME �Q{YI e i 1 t �� v ti Y � DATE 3- 0�0 ^( 07- Q PPR(1V A[. iNCPR('Tf1R Ci(;N A Tf TRF r-� � � �F�i�!�.�Y' I'�ti��i3.C:I�'A�, t"E'�T�F� • 6��1 t.1NI��R�I`�`�' r��'�. ;*�.�. ��i3�Y, A+[?ti 55�4�2 R{?�i�) ��3-�454� * FA� t7�i3} S71-I2�7 : � a .. t r� y. r�w��t r � r �e . C �.,ii���r� 1r �C�:�i� C��i�� ti t�i` ���i�v � #3(A��'�w�`?�}lQ r�q�i �s t t�li r��ici�ntial b�s��cfing ean�tr�ct�rs, r�n�c�delers and r�+�fers c�bt�in a st�te ii�r►� �n��;s� tl��y t�u�lify ftar a�pecific �xemptic�� fr m th+� 4��ensin� requtremer�ts. A� �� crwr��r af th� �rc�perty �t O '� , � � , �ri�ley, I �m exe�n{�t frc� t3�� �t��e (i�ensir�� r�:q��r�ment c�n�y if i am naf bu��l�r�g €�r impr�ring thi� prr�p+�rty %r p�rpases c�f r�s�i�. �� �ic�nin� tl��� doc�m�nt, I afit�st tp th� f�� tt�at i �m imprc�vir�+� �hi� hs�use fc�r my c�wn us� �r�d c!o nc�t int�nc! tc� se1C it. � h�*reby ct�irn f� be exempt frvm tfi�e �t�te 4ic�ns�ing re��ic�m�r�t� b�cause I am nc�t in the bu��n�� cc� bui�iirr� c�r r�r�acletir�g csn �p��uiatian �r fQr ���ale and th�t th� f�c�use far whi�h I�m ��p��r�t� for t�is �ermFt, ��I tt�e �t�st resgd+er�t�a( s�ru��t�re I#�e�� E�ui1t c�� im�r�ve��f in th� {���t �4 r�st��t��. ����c� �ckn�e��� t(�t be��s� 1 d+� r�c�� ha�� ����te �i�n�, ! farfeat �r��r r��c��r�ic'� Ii�n ri�t�t� tc� wfit��i� I r���r �t�therwi� f��€�r� k��� �r�t�ti� un��r O�:ir�t�. ��t. � "! 4. t�'i . �'c�rth�rm�r�. i�c�cr�e��nr#es�ge �ha� i may i� hi�irr� i�dep�nd�r�t rc���r.��cs tc� p��c�rrn c�r#�ir� ��p�;� �f th� ��n�tr��ion c�r imp�t��e nt of ft�t�� hc�use �r�d ! und�r��nd fi��t sa�� t�f f�tes� cc�r�tr�c°tc�r� m�� be r�c�t�ir�d to �e �i�n�e� by tt�e a�at� c�f �fnn,�t�. � ur�t��r�t�n�t tt��t un(ic�ns�ed r�s�dentiat c�ntr��ctinc�y r�mc�e�inc�, �n�l�c�r r�c��ng activity is. a r�€���an�anor urrd�r Mertn�sat� i�v+r, �nc� that � vvc�uld farFeit m�r ri�hts t� r�itr�burs�m�nt frQm th�� Corrtractor's �e�ovety F�rnc� in the �ver�t ft�a€t �ny carttt�cficrrs ( F��t� �r� ur►#��en�e�. #��v� ���ca b��n �r�f�rm�c4 and ac3cr��wl�dge �h�t �y ii�tir�g rnys�If �s th� c�ntrac�r�r f�r tt°�is pr�!��c�, i�[carr� �riE{ !a� res�tansit�l� tca t� ��jr �f Fridl�y fc�r �ra�n���ar�� � ali ���lic�b� b�i�dir�c� �cad�s �r�� city c�rdi�anc�� ir� ��r�r���ic�n vvit� th� w�r�C beir� ��r��rr��i c�n �t�s �r�o�er�. � t��me � t ����_ � �- a � ��