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P - 35230Building Inspections 763-572-3604 763-502-4977 FAX BUILDING RESIDENTIAL APPLICATION DATE_�� . f � ( f - SITE ADDRESS ' � �� (� THIS APPLiCANT IS: ❑ OW1�iER CITY OF FRIDLEY EFFECTIVE 1-1-2011 E-MAIL. ADDRESS _ , -- PROP TR N A OT NER/ NAME:_�(,T�"-r �y�� /e� ADDRESS: PHONE: CITY Permit No.:��' ( I �' �-✓ �� Received By: � � r ' ��x���: � � 2011 STATE Z1P CONTRACTOR -��J ' ` NAME: � f%'� / � +� � � ii -n 7 �--� ( � ~l� '� SUBMIT A COPY OF / YOUR STATE LICENSE STATE LICENSEt# zU�p �j�;� I l� A LEAD CERT NUMBER AND CERTIFICATE OF ADDRESS: ��{ ,S `�i � i'� ^ f ,� i �� CITY /�_„� STATE.�n.�ZIP INSURANCE PHONE %C � ' i i S _ ��� ` i _ F,q}{ .>• ��.• PROPERTY TYPE ;,�SINGLE FAMILY/NEW CONSTRUCTION O TWO FAMILY/NEW CONSTRUCTION PERMIT TYPE ❑ ADDITION ❑ BASEMENT FINISH ❑ DECK TYPE OF WORK: ❑ SIDING ❑ SW'IMMING POOL SIZE STORIES ❑ WINDOWS ❑ DRAIN T1LE ❑ OTHER O NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR : . ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT F200FING l NUMBER OP SQUARGS �?`'.� GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other «'INDOWS IT! EXISTING OPENINGS ❑Yes �No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WiNDOW TO BE INSTALLED �.:= ❑ HOUSr ONLl' ❑ HOUSG & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF V✓INDOWS NUMBER OF WINDOWS WIDTH HEIGHT FT BASGMENT REMODI�LING SUI3MIT: L Existing Floor Plan 2, Proposed floor plan 3 List of structural members [o be used FOR NEW CONSTRUCTION fNCLUDTNG nECKS, ADD1TlONS. & PORCHES SUBMIT: I. Site Plan/Survey showing the existing strucmres and proposed project. 2. Two sets of construction plans 3. Energy Calculations FOR WINDOWS - PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW. ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) ['OTAL JOB VALUATION � OCCUPANCY TYPE Permit Fee P►an Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ �jrj.L�e� $ $ $ �� � $ .i�°�.� $ $ $ $ $ $ I ( ,'�� �'_ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation 0005 x Permit Valuation Minim�m $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 �avable to: Citv of Fridlev Attach Stipulations THIS IS AN APPLICATION FOR A PERMfT-NOT VAL1D UNTIL PROCESSED I hereby apply for a building permit and T 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 fo rm' 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 or re �res review and approval of plans � ( /{ � ~-7 "� S1GT�'ATURE OF APPLICANT %�=' t` ' PRINT NAME_�����1 �.�� '2-� DATE / �7C �" �� AP°ROVAL INSPECTOR SIGNATJ�`R� � ' '—� PLEASE