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P - 40865Building BUILDING Permit No.:� �� � � Inspections RESIDENTIAL APPLICATION Re � ed B:`° L 763-572-3b04 CITY OF FRIDLEY Da t����'c�� ' 7� 763-502-4977 FAX EFFECTNE 1-1-2011 DATE 09/27/11 YouxE-MA,LaDDRESS action@actionroofing.net siTE.aDDxESS 6520 Able St NE THIS APPLICANT IS: ❑ OWNER �(ICONTRACTOR PROPERTY OWNER/ NAME: Deanna Roth TENANT ADDRESS: Sd1112 CITY STATE ZIP PHONE: 763-432-2681 CONTRACTOR NAME: Action Roofing & Siding LLC SUBMIT A COPY OF STATE LICENSE # 5421 LEAD CERT NUMBER NAT-109445-1 YOUR STATE LICENSE arrD cERTiFicaTE oF nDDxESS: 1315 Southview Blvd cITY So. St. Paul sTaTE MNzrr 55075 �tvsuRArrcE rxorrE 651-457-2642 FAx 651-457-0351 PROPERTY TYPE I� SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH � ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION 69 MAINTENANCE/REPAIR � REMODELING DESCRIBE WORK BEING DONE: TeaC-OFF clI1CI I'e-i00f j�ItCileCI aIICI fldt COOf Oil IlOUS2. SIZ6 OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING � HOUSE ONLY NUMBER OF SQUARES 17•5 ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of stnictural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS, & PORCHES SUBMIT: O Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets ofconstruction ptans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS �Yes ❑No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER 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 $ 8,600.00 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 $ �� (� See $ack Page for Fee Schedule $ 65% of Building Permit Fee $ �7 .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 ( ) $ Q 2.l� Make checks pavable to: Citv of Fridlev Attach THIS IS I hereby apply for a building permit and conformance with the ordinances and permit but only an applicatio r a e I approved plan in the case all wor whi SIGNATURE OF APPLICANT APPROVAL INSPECTOR SIGNATUR APPLICATION FOR A PERMIT-NOT VALID UNTIL P fJCESSED ;knowledge that the information above ' omplete and accurate; that the work will be in e i f Fridley and with �nnesota Construction Codes; that I understand this is not a 3 work i no without a permit on site; that the work will be in accordance with the re ew and approval of plans. KUI't M21'I'eII DATE 09/28/11 PRINT NAME PLEASE NOTE: SEPA E PERMITS ARE REQUIRED FOR PLLTMBING, ELECTRICAL AND MECHANICAL