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P - 48193Building Inspections 763-572-3604 763-502-4977 FAX DATE L SITE ADD SS S—% �� THIS APPLICANT IS: PROPERTY OWNER/� TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMTT TYPE TYPE OF WORK: DESCRIBE WORK BEING n BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTTVE 1-1-2012 c Y UR c STATELICENSE# ZU �P>/O � f ADDRES • � z % 3 �� .¢�/L°' � PHONE 3 — %�Z Z ❑ LE FAMIL lNEW CONSTRUCTION ❑ TWO`FAMiLi' EW CONSTRUCTION ❑ ADDITION ❑ GARAGE/SHED ❑ BASEMENT FINISH ❑ ROOF ❑ DECK 0 SIDING SIZE STORIES ❑ NEW HOME CONSTRUCTION O ADDTITON ❑ MAINTENANCE/REPAII� ❑ REMODELING ROOFING NUMBER OF SQUARES GARAGES PROPOSED S1ZE: PROPOSED HEIGHT: SIDING O Vinyl � Aluminum ❑ Other WINDOWS IN EXISTING OPENINGS OYes ONo OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE Permit No.:,�(�1 � Received By• Date Rec'd: J � — � �fi A (l C/Jt/�/'.0 r �ri1/I � NUMBER EXP: CITY f STATEf�ZIP�S�<�i ❑ DRAIN TILE L�Y�1TI-IER ❑Soffit SIDING/SOF'FIT/FASCIA ❑ Trim REMOVED? 0 YES ❑ NO ❑ Fascia LOCATION OF WINDOWS 3=ZS tS� 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural mcmbers to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS_ 8c 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 MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ I � OCCUPANCY TYPE Permit Fee $ . See Back Page for Fee Schedule Plan Review $ ^--- 65% of Building Permit Fee Fire Surcharge $ � .001 times the total job valuation Surcharge $ 0 .0005 x Permit Valuation Minimum or .50 License Surchazge � $5.00 (State Licensed Residential Contractors) SAC Charge $ $2365 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft+ 6 ft= ft x$25= $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary O Non Necessary O Total Due $ .-�'�r _ Make checks navable to: Citv of Fridlev Attach THIS IS AN APPLICATION FOR 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 Frid ey and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work ot start without a permit on site; at the work will be in accordance with the approved plan in the case of all work 'ch re uires review approval of plaps, / � / / SIGNATURE OF APPLICANT /�l �f � n 'L tS/U� DATE 2� (`� APPROVAL INSPECTOR SI RE 1�I ��a — 1 �L .� ;�e.^, 4, L1��2 i; %OFM N�, OqO1 P. ' ���u�ru��L a�s�G� �ss�ciar�s, r�c: 109[� �a'obie Avenue Ncrth, Ghamplin, Mi!�nesata 55316 517 N4�1 �ourth St�eat, Ste i 13, Brainerd, �!N 564�1 7$3-56�J-53�D ► Fax:763-580-54Q0 218-824-1585 • F&x:218-82d-1586 ��. �;� : i� �. � � �� v � ,. ,�.«. ' % A�+ � �Y. � . �� � � z.. � � y � _ ��� � °� •. .� i � y' � � � . � � � . .... � .. � � �� � `� �.' C. t— ,. .. ,c� v ,� i r � � �i � : �. � ,� t' � _ ,� � # � � � � �� � r � I � I-�-� � �� i z� . �� � w : ��. � .� - �.� �- . } ...� �, ; .. � � �� �� i � . ii":" � � � � �_, � I .f ,� f � � �`'' � I � cr; f , � � :+� . � L � I�--...._ } : f I t. �-� � l : ! 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' `v f _�- � tD LC� M r.� �� 43 � SHr #: l CUENT: rn �!L S kl..I BY: M N v DATE: � I�' I Zf� ! 2. � _ , . �..__. � ��d(1, �, Z���G 3:11G1� � �0. �%�.;� f; 1 ST�U�TURAL DESfGN AS�OC(ATES, lNC. to800 Nable Avenue t�urih, Chatrplin, Minnesota 55316 517 fVW Four�h Street, Ste 113, Brainsrd MN 5o4G1 i63-560-534Q ��'ax:763•560-5400 218-824•1685 o Fax:218-8"c4-15fi8 �� �, r�- � I ' 0 ��' F� �..�ty. .��t-�+ ,� t.� w� i"� 2,� �- S i v,� � 4 �_ t b r� a, t� + '�Q M A� T L.E.1 F'� ' S i"1 rr+ (;7 ! N� L v ip ��(� �--Ti' A-^C�{� M i�rs ( J -tr� �a v w o�-�"� o �a ,��-_� o� P n C� �: ��;-s'� �w C� 'r-o �o: P P tr�-�"� � 1 r� : S��-�t..�+,� t�+^i�Cr ��o o r•r ��-�N S i o� d'�' 7`� P t:�i� i� �' � 4• t C l� .T A�r�o S E� � nrr �� �.� � t` 7Z� �a ,� r.ro �-"�' + n � � �o : ��' � � t.�'�`f � , � o �rC� � 2 � � .� � � � (� � � � '� � I' V i �-� � l�/'� �J�''�LQ`�`j l'�`-�.1h�'� �X i � �'i � ►� C� ��.� �-,� � �("� �C�. , � . 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