P - 42172►�uilding
Inspections
i63-572-3604
DATE a � °� �
SITE ADDRESS
THIS APPLICANT IS:
0
BUILDING P��-�it N°.: �—�-�
RESIDENTIAL APPLICATION Received By: �'�
CITY OF FRIDLEY Dat�d� � �
. YOUR E-MAIL ADDRESS ,k �Q �!'.� � d�Cj�A i f 0%I �'s, r 0 iYJ
71 '�L� AV lV �
❑ OWNER �CON ACTOR
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YKVY�Kl Y V W1V�K/ NAME: 0 I� !. `� O�' I)
TENANT �DRESS: / 0 3 7( �la W� L/ ! v f CITY �� t C ( l'S! STATE_ZII' S S�l �.%
PHONE: � (� �J ! �7 7 / • � 7 � y
CONTRACTOR Nq�,�'rHD At- Home Services, Inc. � f p�t ���d � l J b n< S
S U B M I T A C O P Y O F sTATE LI� 2690 Cumberland Pkwy, Ste 300 q��t t 3 Y5 -(► 0 y'] ;
YOUR STAT'E LICENSE ADDRESS' CUri1beT12Tld �fflCe PaTIC CITY STATE_ZIF
v✓rrx aPPLicATiorr PHO� ' Atlanta, GA 30339-3913
PROPERTY TYPE 'o Sa.rGr.E Lic# 20268257 Ph. 763/542-8826 '-E
__ _. ❑ TWO FA _ _ _. _ :`ORIES _ . _
PEt RMIT TYPE QADDITION ❑ GARAGEISHED �I�JINDOVVS _
❑ BASEMENT FINISH ❑ ROOF ❑ DRAW TILE
� DECK ❑ SIDING 0 OTHER
❑ SWiAR�ZING POOL
TYPE OF WORKc ❑ NEw ❑ ADDITION
.MAINTEDIANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BBING DONE: �I w�� cYo w �,� �ic� E.t �'1 �1� S 1 n!xi � r�T_n,D�r�� �� �Y s
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGH'� S: Ft.
ROOFING ❑ HOUSE ONLY
NLTMBER OF SQUARES ` ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
GARAGES ❑ ATTACHED GARAGE
i. Existing Floor Plan
2. Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used
PROP03ED HEIGHT:
3IDING ' . FOR NEW GONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT:
'❑ Aluminum ❑ Trim l. Site Plan/Survey showing the exis6ng structures
❑ Other ❑ Fascia and proposed project
2. Two sets of construction lans
VS�INDOWS p
IN EXISTII�IG OPENINGS �es �No LOC�TIQN OF �O�S 3. Energy Calculations
OR FORNEW OPENINGS-DESCRIBE SIZE OF Id �o.� ,_ ,//(1t}r BO l{�
�PENING CHANGES & / • a l� e�.N
PYPE OF WINDOW TO BE INSTALLED 3• fAS�� 1 A 1� I.IIJtv1BER OF WINDOWS
ALL FEES ARE BASED ON VALUATION INCLUDING THE COST OF LABOR AND MATERIALS•
, .
` ([TSING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ �i Y L 0
OCCUPANCY TYFE
Permit Fee $ //, � See Back Page for Fee Schedule
Plan Review ' $, _ 65% of Building Permit Fee
3urcharge $ ' 7� 3 (.0005) times the total job valuation — Minimum $,50 '
�ire Surchazge $ �f. Y� .001 x Permit Valuation (1/lU%).
-�icense Surcharge $ s' ,o �t $5.00 (State Licensed Residentia3 Contractors)
3AC Chazge $ $1450 per SAC Unit (Plans to MVJCC for determination)
�� o CLL� �s�: ovr � �� + b i= f� a a2� = n
:rosion Control $ $450 Conservation Plan Review
?ark Fee $ Fee Determined by Engineering
>ewer Main Charge $ Agreement necessary O Non Necessary O
Cotal Due $ 7�. Make checks a abie to: Cit of Fridle Attach Sti ulations
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work will be in
:onformance with the ordinances and codes of the City of Fridley_�nd with the NLinnesnta Construction Codes;.that I understand this is not a
>ermit but o an application for a permit d work is not to start without a permit; that the work will be in aceordance with the approved
�lan in the case work which requir° e ie and approval of plans.
IGNATURE OF �� PRINT NAME r l� ����-n � DATE a��j� �