P - 45387Building BUILDING Permit No.: e�(,l �
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date xec'd: �`
763-502-4977 FAX EFFECTIVE 1-1-201I
DATE 7-5-2011 YOUR E-MAIL ADDRESS msample@hwconstruction.com
SITE ADDRESS 158 71 st Way N E
THIS APPLICANT 1S: ❑ OWNER �ICONTRACTOR
PROPERTY OWNER/ NAME: David Hart
TENANT ADD�ss: 158 71 st Way NE C[TY Fridle� STATE MNz�P 55432
rHONE: 763.571.6456
CONTRACTOR NAME: Hoffman Weber Construction
SUBMIT A COPY OF STATE LICENSE # 4OrJ43Zr'JO LEAD CERT NUMBER
YOUR STATE LICENSE
AND CERTIFICATE OF nDD�ss: 7932 University Ave. NE CITY Fridley s�rATE M��P 55432
INSURANCE PHONE 763.300.65542 FAx
PROPERTY TXPE X] SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE � ADD►TION ❑ GARACE/SHED ❑ WINDOWS
❑ BASEMENT FINISH � ROOF ❑ DRAIN T(LE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDIT[ON
Ijd MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: R@ i'OOf� St0it11 C�aCTlag@
SIZE OF [MPROVEMENT LENGTH WIDTH HEIGHT S FT
ROOFING L] HOUSE ONLY BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES 19 ❑ HOUSE & GARAGE I. Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED S[ZE: O DETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
S[DING FOR NEW CONSTRUCTiON ►NCLUDING DECKS,
❑ Vinyl ❑Softit ADDITIONS_ & PORCHES SUBMIT:
O Aluminum ❑ Trim �• Site Plan/Survey showing the existing sWCtures
❑ Other ❑ Fascia and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ONo LOCAT(ON OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON W INDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL N'L�5 AR� KAJ�ll UN VALUA I IU1V, I1Vl:LUlllPlli l t1E I:VJ l Vr LAlfVK A1V U 1VIA 116K1ALJ:
(US[NG THE 1997 U.B.0 FEE SCHEDULE)
AL 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
Total Due
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—
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See Back Page for Fee Schedule
65% of Building Permit Fee
.00I 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 pavable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
1 hereby appiy 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 1/�'or r quires review and approval of p a s.
SIGNATURE OF APPLICANT Y� ;'- PRINT NAME '—' DATE
APPROVAL [NSPECTOR SIGN