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P - 43145Bui�ldi�g BUILDING Permit 1vo.:a ° ���`a Ins�ctions RESIDENTIAL APPLICATION Received By: {� 763- 72-3604 CITY OF FRIDLEY vat 763-502-4977 FAX ���''� '� EFFECTTVE 1-]-2010 DATE � Gl ���`� �—�r YOUR E-MAIL ADDRESS SIT'E ADDRESS / :;�i / �` �c- �� ` ,�'�.,.��. �'ii� (�' THIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME:�>i.z ,�,g�,�f'/�� TENANT ADDRESS:�.f 7�% Zfr_�'� /j/�(� CITY �/l l.�/�y STATEg�ZIP ;�SY3? PHONE:_( /Z -- �'O %— �� 3� CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # EXP DATE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH O ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION J�'ADDI1'ION ❑ MAINTENANCE/REPAIR 0 REMODELING DESCRIBE WORK BEING DONE: bt k� �!J Ga� rq qe - SIZE OF IMPROVEMENT LENGTH Z WIDTH Z� HEIGHT� I� S S FT 0 R O G ❑ HOUSE ONLY BASEMENT REMODE1.tNG SUBMIT• NUMBER OF SQUARES ❑ HOUSE & GARAGE �, Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2.. Proposed floor plan PROPOSED SIZE: �° X�L �A.DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: �.uq//s y� ID G �,3% '� �%��/dk C4 L�(� t'� FOR NEW CONSTRUCTION INCLUDING DECKS, Vin t ADDITIONS. & PORCHEc ci�gM1T Y ❑Soffit ��� �4 �. Site Plan/Survey showing the existing structures Aluminum ❑ Trim and proposed project. ❑ Other �a��a 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 S'ITCKER 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 $ q,(aQ 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 3 D' `�1 �` `�_ See Back Page for Fee Schedule $ i 65% of Building Permit Fee $ l . .001 times the total job valuation $ .0005 x Permit Valuation Minimum $.50 $ $5.00 (State Licensed Residential Contractors) $ $2100 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$24=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ Make checks payable to: City of Fridle.y Attach THIS IS AN APPLICATTON 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 all work which requires review and approval of plans. 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