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P - 41838Building Inspections ` 763-572-3604 763,-502-4977 FAX DATE / � SITE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OP YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE i-I-2011 YOUR E-MAIL ADDRESS c�.� i�� vU IC r� _CITY_ � NAME: STATE GICENSE # LEAD CERT NUMBER �E FAMILY/NEW CONSTRUCTION FAMILY/NEW CONSTRUCTION ❑ BASEMENT FINISN ❑ DECK TYPE OF WORK: ❑ NEW HOME CONSTRUCTIQN � MAINTENANCE/REPAIR DESCRIBE WORK BEING ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HE(GHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other 'rCv� � FAX SIZE STORIES ❑ ROOF ❑ SIDiNG O SW1MMfNG POOL ❑ ADDITION ❑ REMODELtNG � HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia WINDOWS IN EXISTING OPENINGS es ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS- ESCRI�E SIZE OF OPENIIJG CHANGES & �u„ �, / � M1i„� / � � CTTY Permit No.: U 1 i'� 1 i(•'� Received By: `'t� � Date �c,'�c : � � P � � � � �'�i'L-/'�.C�l�/ -�o � STATE �ZiP S�Y.�Z ATE ZIP; D DRAIN TILE �OTHER � � �'���o►-tin... F7' , r 1, BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION ►NCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: I. Site Plan/Survey showing the existing sVUCtures and proposed projoct. 2. Two sets of construction plans 3. Energy Calculations FOR WMDOWS - PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW. TYPE OF WMDOW TO BE IN TALLED NUMBER OF WINDOWS —7 � ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: j� (LT�SING THE 1997 U.B.0 FEE SCHEDULE) COTAL JOB `JALUATION' Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ $ $ $ $ $ $ $ $ 'ANCY 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 Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( Make checks pavable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMiT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acloiowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances codes f the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a rm' and work is not to start without a permit on site; thaf�the work will be in accordance with the approved plan in the case of w c w' ' e review and approval of p c !`-^ SIGNATURE OF APPLICANT . PRINT NAME �)I � S��GM�( DATE � "`CD ^ � �I _ APPROVAL INSPECTOR SIGNA RE . ` � �� �.��.�.�.� � �� .,� . Q � � �-- ��� c�..,e.� � c...�f ��-� �— �-----.--�-- �.+N�.R�-u� � �' �s � � J � C� � � c� w� � �. �-�3 c=� � � � � V s-�' � � � !2 � l ��t' ����s � n�l�--e_ � "� ._._. � t� I 41 (,� {-� (`' L G�Ls-1' °L_ �. O +,"�`�7 b , l •�S�c�. � I �t"t'1r�w+ � � v � aQ-e r✓�.e..c�`�"` • � � (,v,v1 �C oc�l�y ( �t � � �G � `'fGtx.�aX �� �-�.�. t � r�p�� � ��.s � �'(ti'�►�n,'1� c.� t u.S � `�- '�'-r'�-�__".D �—�'�+�.-�s.f�'. � _ �1 �% ��c —IA � �,J v � �� � � + 01 Q t/� G„��.-��"'l ! `TV�� � _. � �- 2� v��-��-�-- I s�-� �� �' �4 r`�o� �s �I n �.�.��- 3 j�.., ' ` � � C ���-�l` ...� r �v �S�v�`e w��Y .-��, ��i �..e Q �+�t 5 / 1 �" , I rl _+ b� r � -^J�- �� r�j � �L. `ti-�� "l, Ji � 1� �,��,�.� ��}- `"� � _ �� � `,� ��.� T� S� ��dl Y�.. � G7 v2� W� m W ' �� �� ` � � � ,� ►�.�� , � � �- tj �i���� � �a�-c. � ��S �� �c �- ek ,�- � � 3 �� � �<< �,��� p t� w�� . o ��'% �- � /� �s � ��g l �� (� � �. � �-�� i�-S��c�, e,�P�s'�-; � � � � f VlEWED F�R /�' � �OMI�-��E .�. '►.� � � \ �� ry ✓ J� i � � .� � r is � ..�- /\ 'K �� T � � � � �• � � � r� N ' � �~ � (� S