P - 39651Building BUILDING pe� . �` -4l
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date Rec'd: f
763-502-4977 FAX EFFEC-rlvE la-ZOi�
Dn� 9-1-2011 Youx E-MarL aDnxESS msample@hwconstruction.com
sITE AnDRESS 5924 7th St Ne
THIS APPLICANT IS: ❑ OWNER �[CON'L"RACTOR
PROPERTY OWNER/ N�: Matt Knoepfle
TENANT ADD,�ss: 5924 7th St Ne c�� Fridley sTn-rE MNz�P 55432
rxorrE: 763.862.6842
CONTRACTOR NAME: Hoffman eber onstruction
SUBMIT A COPY OF STATE LICENSE # 40�32�JO LEAD CERT NUMBER
YOUR STATE LICENSE
AND CERTIFICATE OF Anv�ss: 7932 Universifiy Ave. NE c�� Fridlev sTn� M�iP 55432
INSURANCE PHONE 763.300.65542 FAX
PROPERTY TYPE S1 SINGLE FAMILY/NEW CONSTRUCTION S1ZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE � ADDITION ❑ GARAGE(SHED ❑ WINDOWS
❑ BASEMENT FINISH t$ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION
KI MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: R@fOOf StOifll C�a1118g@
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT
ROOFING ❑ HOU5E ONLY
NUMBER OF SQUARES 24 ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
1. E�cisting Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposeci floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of sUuctural members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTiON INCLiJDING DECKS,
❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT:
O Aluminum ❑ Trim 1. Site Plan/Survey showing the existing sEructures
❑ Other ❑ Fascia and Proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS �Yes ONo LOCAT'ION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND
OR FOR NEW OPEIVINGS-DESCRIBE SIZE OF MANUFACT[JRE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION,INCLUDING THE COST Ul�' LA130R ANll MATERIALS:
�, ,�Jl�l� THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Swcharge
SAC Chazge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ `�7�a."S'
$ �� 3
$ /, LP Z_
$ .�S��s �
$
$
$
$
See Back Page for Fee Schedule
65% of Building Pernut Fee
.001 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 navable to: Citv of Fridlev Attac
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that tlie work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Constauction Codes; that I understand this is not a
permit but only an applicatian for a permit and work is not to start without a peimit on site; that the work will be in ac;cordance with tkie
approved plan in the case of all work which requires review and va1 of p
siGrra� oF .a,PrLicArrr T NA� �e Sample DA� 9-1- 011
APPROVAL INSPECTOR SIGNA'I'URE
PLEASE NOTE: SEPARA R PLUMBING, ELECTRICAL AND ME ORK