P - 37258From: 6122165528 Page: 1/3 Date: 8/19/2011 8:01:38 AM ,�
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vPermit No.:
Tnspections ��I������,, �PpLI�CATI�N Received By: �
��3-s72-��0� CITY QF FRIDLEY �� �d ;�
763-542-4977 FAX EFFECTiVE 2-�-w�x �� �"� 7
i; 1 tZ ��t�
DATE_ ��Y�''`If YOFlR E-MAIL AE7D32ESS �lAI$�� CL1tR C/!'�r /1�"
5TTE Ab]�RESS ii �!� /� �
THES APPL[GANT IS: pO'WldEit �CON'f'RACTC)R �
TENANT
CUNTR�CTOR
SUHMIT A COPY OF
YOUR STATE LICENSE
AND CERT'i�'ICA�'E OF
IN5URANCE
PRQPERTY TYPE
TYPE
TYPE OF W ORI�s
��
rxo��• �G �=--��--GeQ_�7
STATE LICBNtSE M? tf �Z�f��/�+�"'� LEAD CEIiT
.ADDRESS:�����^-e^��'�r�e�—�.�+� �,,,/%
PHO!DIE �I�/2 ^- 21�(+�^�i �7"� FAX /
[�T.E FAMiLY1NEW GONSTI{UCTIfJN S1ZE
❑ TWO FAMILYMEiW CONSTRi1GTIbI�T cTnurFe
❑ BASEhiSIVT FiTiISH Bit90F
O DSCK ❑ SiDINCT
fl ASEW li()ME CONSTREJCT[ON
❑ MAINTEI3ANCElREFAIR
0 ADDiTIOM
B-R�fOQELINt3
DESCRIBB WbttK BEING DONE:�,�����^ �_ �� ,.,��r.,� f/"�..�
NUMH�ER OF SQUARE$ �
GARAGE3
PR(3POS�D SfZE:
PRt3POSBD I-iEIG}[I:
O��
❑ Atwrdnum
0 od�
C�1 HOUSE ONLY
�BCHOtdSB & Gr1RAGE
0 AiTACfi�D GARAQE
❑ DETkCHED GARAGE
Q3trffit
Q Trim
❑ �����
WIlVD�W9
IIJEXI5ITNG OPE7�tING5 i7YCS i1�3o LOGATIOI3 OF WINDOWS
OR FOR NEW OPLNTAJE}3-DESCRIEE SIZE OF
o�vnvo ci�axc�s �
ALL
'QTAL JOB VALt
Permit Fee
Plan Revicw
Fire Sw�eharge
Suroharge
Lio�se Surcharge
SAC Charge
Curb C�t Esr•row
Erosion CoNroi
PaEic Fee
Sewea Main C#iarge
❑ I3RA[N TILE
� C)THER
r�
B.4SE24fENT REMbD �.iN(} g ��
1. Hxisting Floor Pl�
2. Pmpcas�d floar plaa
3, Lisc of suuclur� m�nlx�s to baused
FOR NE4V CONSTELiJC37pN Ii1Q.UDihiG DEsCK$,
�?17fTIO1VS � PCfRCH�S��,il']1T:
]. Si�t PladSur�ey showing Ehe existi� structures
aad prapoBed projed.
2. Two set� of eomstrndion pl ans
3. Energy Celculstions
FpR WIND01V5 — PftOVIDE U-V.4LUE AND
iYfAMJF'AC'FURE STiCKFR ON WINDOW,
VALiJ�TidN, iNCLUDiNG THE CUST OF LABC
(IJS�NG THE 1947 U.$.0 FEE SCHEDULE)
y t) . ca U OCCUPANCY
$ (��'` (��`.� See Back Page far Fee Scheduts
$ SS°lo of Bu��ding Permit Fee
$ � .DOI times #he total job valuation
� 4�' .OU�S x Permit Yaivat�ion �Iinim�n $S.Op
� �' ' $S.OU (S#ate iicaensed Itesidential Contractars)
$ $�230 per SAC Unit (Plans �a MWCC for deteiminatiun)
$ ii t 6 tt = ft x$25= S
$ $450 Canservation Ptan R�view
� Eee Dcbeimmined by Engi=s�ring
$ Ageement nacessar�' ( } Non 1*lecessarY ( )
77-It5 iS AN APPf.�CATI(3N EOR A PERMiT-I��T VALID UNTIL PRQCESSED
I hereby apgly for a buitding permit and I acknowIecige thac the infarmatioa above is compiete and aecurate; that the wark �vill be i�n
canfarmance with the ordinances and cc�des o the City of Fridley and with the Minnesota Construction �odes; tflat [ nnderst�nd this is not a
permit but only an app6csiion f a work is not to start witieout a parmit t�n site; thaf ttte work will 6e in accon{ance wit}a the
approved glan in the case of o uires review and approval af glans.
SIQNATUR� OF APE�LICANT PiLINC NAME '"A r� i�v'fa ne-rc �'�� �/ /