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P - 42130Building Inspections 763-572-3604 763-502-4977 FAX DATE , ' �= SITE ADDRESS � THIS APPLICANT IS PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE I AND CERTIFICATE OF ' INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DESCRIBE WORK BEING ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED SiZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum O Other BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTNE 1-1-2011 R E-MAIL ADDFtESS ❑ OWNER NAME: , %�i�e � ADDRESS: Co `J�,�(.� .y�,/c: c� 7— // PHONE:� �j ` 7 �� — �,� STATE LICENSE # PHONE ' % � !`' 1i' `7"'/ — c�Ca(�CJ ❑ SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILYMEW CONSTRUCTION ❑ ADDITION ❑ GARAG ❑ BASEMENT FINISH ❑ ROOF ❑ DECK ❑ SIDING ❑ SWIMM ❑ NEW HOME CONSTRUCTION ❑ MAINTENANCE/REPAIR WINDOWS IN EXISTING OPENINGS ❑Yes ❑No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS OF WINDOWS CITY Permit No.:��% � � � Received By: Date Rec'd: TAT�i,�ZIP S�°I3� ,D CERT NUMBER ' � � � � CITY STATE��Cd/GIP FAX ❑ DRAIN TILE ❑ OTHER HEIGHT FT BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures 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 (USING THE 1997 U.B.0 FEE SCHEDULE) TOTALJOB VALUATION $ 2�3� OCCUPANCY Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ $ $ $ $ $ $ $ $ .. TERIALS: TYPE See Back Page for Fee Schedule 65% of Building Permit 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 Pian Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: C�ty of Fridlev Attach lations THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT[L PROCESSED I hereby apply for a building permit and I acknahd edge at the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the Ci ridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and wor ' ot to start without a permit on site; that the work will be in accordance with the approved plan in the case of Y wor c re ' s r ' w and approval of plans. SIGNATURE OF APPLICANT RINT NAME DATE APPROVAL INSPECTOR SIGNATURE .�