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P - 35416Building Inspections 763-572-3b04 763-502-4977 FAX BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-2011 DATE YOUR E-MAIL ADDRESS SITEADDRESS J �/� .�y��� ��� THIS APPLICANT IS: - ❑ OVJNER �ONTRACTOR PROPERTY OWNER/ NpME:__�� TENANT qpDRESS: S .3 CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TY.PE OF WORK: PHONE: r�,�--lY���'— ��'�/�� CITY Permit No.��� Received By; Dat���� d,� STATE�ZIP �S -l/�,!/ STATE LICENSE # ��o{ C�l�['S' LEAD CERT NUMBER —�, � jS��/�j —OO/�/� ADDRESS:_ �l/'01�/ �%L/�%t �i�'er-� �- CITY %r STATE/��. LIP.�S`3��= PHONE �'r�l— i'i P— S�!_.S' _ FAx 763 ���- 8�7�- .�SINGLE FAMILYJNEW C0135TRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH � ROOF ❑ DRAIN TILE .�DECK ❑ SIDING � OTHER � SWIMMING POOL ❑ NEW HOME CONSTRUCTION .�"�DDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF [MPROVEMENT ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Atuminum ❑ Other � /6 ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE �So�t ❑ Trim ❑ Fascia WINDOWS IT1 EXISTING OPENII3GS OYes CINo LOCATION OF WINDOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & o? � a HEIGHT ���� BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION ItJCLUDING DECKS, ADDiT10NS, & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing sVuctures and proposed project. 2. Two sets of construction plans 3. Energy Calculations FOR WTNDOWS - PROVIDB U-VALUE AND MANUFACTURE STICKER ON WINDOW. 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) COTAL JOB VALUATION $ . G� �� �"7 OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Chazge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ $ $ $ $ $ $ See Back Page for Fee Schedule 65% of Buitding 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 payable to: City of Fridlev Attach THIS [S AN APPLICATION FOR A PERMIT-NOT VALID UI�iT[L 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 Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit a work is t to start without a permit on site; that the work wiil be in accordance with the approved plan in the case of all w'ch requi s rev' w and approval of pla SIGNATURE OF APPLICANT T^^ P�IN�NAME ,�t�lG �/J `.Q�il DATE T�wl� bl��.l0/< �.�---� ��/ . 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