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P - 43652Buildirig BUILDING Perm�t 1vo.:� b � Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Da��j '�� 763-502-4977 Ff�X EFFEC�rtvE �-i.zoio ��Cl. U ������'�� DATE ��- a'a � �� r YYOUR E-MAIL ADDRESS ��� l.l�' 1� Q�� � 1 F! �l �•�') SITEADDRESS �0� ��� �N�+7 'N� i' 1���'�-1 IMN �5y � z THIS APPLICANT IS: �OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: v� .� ��e. e TENANT ADDRESS: � �� �4 '` V�'�%!� CITY i�� STATE�� ZIP �302 PHONE: b�a-��r�-y3�s CONTRACTOR NAME: �?P SUBMIT A COPY OF STATE LICENSE # EXP DATE YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PROPERTY TYPE INGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILYlNE�xJ C�?NSTRUCTION STORIES � QS�.,�. PERMIT TYPE ❑ ADDITTON O GARAGE/SHED INDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION DDITTON ❑ MAINTENANCE(REPAIR ❑ REIv10DELING DESCRIBE WORK BEING DONE:' �Sc+'r1�i 0'!►� CGIq G 1 QM �� re �i °iu V SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT ROOFING p HOUSE ONLY BASEMENT REMODELWG SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Pian GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PRQPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDI7'IONS_ & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTiNG OPENINGS�,'es ❑No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACNRE STICKER ON WINDQW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS I ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: TOTAL JOB VALUATION � y t O�pNG�,THE 1997 U.B.0 FEE SCHOCCU ANCY TYPE Permit Fee Plan Review Fire Surcharge Surchazge License Surcharge SAC Charge Curb Cat Escrow Erosion Control Park Fee Sewer Main Charge Total Due S $ $ $ . $ $ $ $ $ See Back Page for Fee Schedule 65% of Building Permit Fee .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 Conservatian Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks pavable to: City of Fridley Attach THIS IS AN APPLICATION FpR 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 tu►derstand 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 a11 ork which requires review and approval of plans. SIGNATURE OF APPLICANT �� �' c�-4�-> PRINT NAME E/G�1. Ut rC �•�/ GI�ATE � �� �� ���� ��ti�:ii�,�:�` iuit�S�I�t�'AL �;F?��"E:€2 • E�31 L.�NI�%�:�.`i%"i""t' r�'���. N.E. �"R�:I:it..�Y. P�i'�3:�3 SS4�� R(i�s3� 57 i-�4S[� •�AK {��3} S�C-I2�7 : � • � & . .� , . . � . ,� � ,. �, �,�1� �- �"� und�rstt�nd th�t ti�re St�te of AAAirtt�s�t r�uir�s th�t �11 re�id+�nti�l building cc�nt�c�nrs, remc�cfelers and rt�afecs c�btarin a sta�e �i�ns� unle�� the�r qualify fr� sp�cifi� e e npii�n frc�m the l�cer�sing reqc�it�ament�. As �e vwrr�r af t#�e prap�r�y �t ����`�'h �,...� �, , �ridl�y. I �m exempt �ram the st�ie lic+�nsinc� r�quirerne t csrt�y �!�rn n�t bui�iinc� c�r irrr�rowing �� pr�}a�r�,r fQr purposes o€ r�sale. Bgr �igr�ir�� t�� c��m�rtt, !�ttest te� t� f�t� �t 1 a�s�» 'smprovir�� this ncruse f�r my awn use �rrd d� not int��d ta s�lf i�. I h�retay �im tc� be e��t~r�pf f�vm �t�� state licens�ing requir+emer�ts be�ause I�m �ot in fihe busi�� c� ��i�iit� �ar r�madeli�c� an s�+�uiatiern ar �r re�a€�e and iha�t th� ho�ose f+ar v�h� ! arn ��r�r�� far t�i� �rmit, i�t the �rst re��lenfi��i s��.ture 1 i���e %u�tt c�r i�t{�rou+�t3 in #he 24 rr�c����. [ a��t� �cknc��c�� �h�t u� I d�a ncst ha� ����te f�n�, i€�rf�it . .. . . .�. Li11� . � �iG�:# 17i✓yr�7' iF�i i �,�� 14�1J� �x✓ �i �`tiIt 1 � i E {Q� V�.E i�'��I{ ir�K7i-V I l�G71F L-F �� i �i#1 11}♦�� ��[-`/� � ����• � . � � �. CJ���..��. . F�ar��rmc�, i��rt�wi�clge that i m�y t� t��ring ��c4+�pe�d�nt cc�r�r�r�r� �o �rfcxm c�t�tsir� �����t� c�f €he ct�n�ttv�tis�n c�s irn���r nt etf #�i� ht�s� �t�! ! urtd�t��t�f ttt€�# ��#'i@ t�� �1�5�' �OCt"�t"X'c�CibC`S ft'tr',�$l �!�' F�tl1C+� �t? �?� ��G�tiSk3�f,� ��l '��i�! ����t Q� ��t1t1 � uru��rs�nt� t�t�Y unlicens�d rg�id�ntial ce�ntr�cting, r�mc�eling, andfc�r r�f�n�g ��tivftyy is � rni�tiem+��r�or under te�ir�nesot� i�w, �rtd that � wc�uld f+�rFeit my r�ghts to r��mbc�r�em�nt fr�rn ti�e G�ntractar'� F�e�overy F��d in the event tF�at any r�at�tt'at�ors t hi� �re un4�nseci. dA A "` " f ` i 4 ! . i� � ' �! !� �` • • ' i�• # R ��� � � � �"` �• • ^ ! � i� # ` • ! # �« t . � ! „. ♦ " #1 � :i � i 1 A "' i • � �r i ! �f "` t � ° i `�!� ! li # ii ' . � / � �L�. �..�A.•• ��,� 1 I - C°l --I 0