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P - 437010 Building Inspections 763-572-3604 763-502-4977 FAX DATE !�/'/,(� SITE ADD�v THIS APPLICANT IS: BUILDING RESIDENTIAL APPLICATION CITY (?F FRIDLEY EFFECTNE 7-1-2010 PROPERTY OWNER/ N�tE:� TENANT ,�D�ss: PHONE: � CONTRACTOR SUBMTT A COPY OF YOtIR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: YOUR E-MAIL ADDRESS KV/(% 1 � N�� i��dk-�y ��i� ❑CONTRACTOR W �-r �% ` � CITY Z4i— L/ li�'t� ., /�! � STATE LICENSE # EXP DATE ADDRESS: CITY PHONE O SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION '�BASEMENT FINISH ❑ ROOF ❑ DECK O SIDING O NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR �R$MODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other 0 HOUSE ONGY ❑ HOUSE & GARAGE O ATTACHED GARAGE ❑ DETACHED GARAGE L7Soffit ❑ Trim ❑ Fascia WINDOWS IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & ❑ DRAIN TII,E ❑ OTHER Permit No.. � l� ' � Received By: ; ' Date Rec'd� �, h c�. L �.. STATE �1/V ZIP_s7'S�/3a-- STATE ZIP BASEMENT REMODELING SUBMIT: __ _ .. , __. _.. ._ _...... . 1. Existing Floor Plan 2, Progosed floor plan 3. `iist of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structums and proposed project. 2. Two sets of construction plans 3. Energy Galculations FOR WINDOWS – PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW. ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (U5IN� THE 9Z �Jj$,C FEE SCHEDULE) TOTAL JOB VALUATION $ V�� OCCUPANCY TYPE Permit Fee $ $- See Back Page for Fee Schedule Plan Review $ r�j. (. 65% of Building Permit Fee -�ireSivcharge $ , a .001 times tha total job valuation Surcharge $ .0005 x Permit Valuation Minimum $5.00 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft+ 6 ft = ft x$24 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary O Non Necessary O Total Due $ .. Make checks navable to; Ciri of Fridlev 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 �n application for rmit 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 a wor c wh re �res review and approval of plan�ys /� � �D�p� � � SIGNATURE OF APPLICANT PRINT NAME rC y/C �`�Y,� DATE �I ',� fd�'/ l7 APPRf�VAT. iNSPFCTnR CiC:NATf F � � � � , , > . � � � 4� � i �� ti e— � � ___, .,� _ � � �'1 � � � g 0 � � _ � �� N �, .- �� 7 � � � Z �, � 1 ) � 1 r � � r � �� • N t � �` � � � � � Z � n � 3 � � cS . �, � . �. \ .. �r � �°b � �' �l. ° Z �- � �' -� M � a .-� �� r�1 ��r�' �----- � - � � � ---�'.� �� ❑ � � 7 s x 3 , v -;� _, � � � f � ► ��. 4 � � � � r � 3�,�fifi �� t .�� — 'cr � . � � � � �I � ,n , .. �.,,...� ., ,.__,.. Wd ££�11�4 LIOZl9Zlti �a��0 Z2 :aBe �� , � " � � � � "' ��, .,� �� d Zb09Z6£Z69 ��o��