P - 45388Building BUILDING Permit No,�Z`1 —
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date Rec'd: �
763-502-4977 FAX EFFECTIVE I-1-2011
DATE 7-5-2011 YOUR E-MAIL ADDRESS msample@hwconstruction.com
SITEADDRESS 5324 Altura Rd NE
THIS APPLICANT IS: ❑ OWNER �[CONTRACTOR
PROPERTY OWNER/ NAME: Darlene Anderson
TENANT ADD►�ss: 5324 Altura Rd NE CITY Fridley STATE MNz�P 55432
pHONE: 763.572.9614
CONTRACTOR NAME: Hoffman Weber Construction
SUBMIT A COPY OF STATE LICENSE # 4O 'rJ432�JO LEAD CERT IYUMBER
YOUR STATE LICENSE
AND CERTIFICATE OF nDOa�ss: 7932 University Ave. NE CITY Fridley sTnTE M��P 55432
INSURANCE PHONE 763.300.65542 FAx
PROPERTY TYPE X1 SINGLE FAMILYMEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCT[ON STORIES
PERMIT Tl'PE ❑ ADDITION ❑ GARAGE/SHED ❑ WlNDOWS
� BASEMENT FINISH �I ROOF � DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK> ❑ NEW HOME CONSTRUCTION ❑ ADDITION
jZl MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: R@ C'OOf I StOilll C�aCT1aCj@
SIZE OF [MPROVEMENT LENGTH WIDTH HEIGHT S FT
R FINC ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES 21 ❑ HOUSE & GARAGE I. Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
IDING FORNEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑SoftSt ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing sWctures
❑ Other ❑ Fascia and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPEN[NGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND
OR FOR NEW OPEN[NGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WWDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALi1AT10N, INCLUllING '1'HE CUS"1' UN' LABUK ANll MA"1'EIiIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
'OTAL JOB VALUATION
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
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$
$
TYPE
See Back Fage 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: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VAL[D 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 ►n
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 and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of�'I/�ir r e' review and approval of p�n�..�,
SIGNATURE OF APPLICANT �f _� PRINT NAME �('Z— [�y�.� DATE ��Z'��