Loading...
P - 48626Building BUILDING Perrnit Ivo.: Inspections RESIDENTIAL APPLICATION Received By:l�i�%' 763-572-3604 CITY OF FRIDLEY Date �"c� MI�R `� 2 0 763-502-4977 FAX EFFECTIVE 1-i-2012 DATE � 01- � t v� YOUR E-MAIL ADDRESS � GCL � f.�_ � I`l� F`VlA /�t �GU 1'1� C<c S�. ��� SITE ADDRESS �Z CP �'�' N THIS APPLICANT IS: �OWNER �CONTRACTOR PROPERTY OWNER/ 'NAME: • " r- C� �-[,L i I`t�LQ K, TENANT pDDRESS: "`F'Gt, S ITY �V i� �'P �STATE� IP �J�"E 32 PHONE: "-T j 17 3���`��� a-a 'rj' CONTRACTOR NAME: SUBMIT A COPY OF STATE LICENSE # LEAD CERT NUMBER EXP: YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCT'ION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED 0 WINDOWS ❑ BASEMENT FRIISH �tOOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCEJREPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: �` __ I� ,S f�G 'G� SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT ROOFING j ❑ HOUSE ONLY NUMBER OF SQUARES `�� ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARQ,GE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, O Vinyl ❑Soffit SIDINGlSO�'FIT/FASCIA ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim REMOVED? ❑ YES 0 NO �� Site Plan/Survey showing the existing structures and proposed project. ❑ Other ❑ Fascia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS FOR WINDOWS - PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE ST'ICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL N'r;�;5 AK� BASEll ON VALUATlON,1NCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) JOB VALUATION $ OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ (����j See Back Page for Fee Schedule $ 65% of Building Permit Fee $ _.001 times the total job valuation $ .0005 x Permit Valuation Minimum or .50 $ $5.00 (State Licensed Residential Contractors) $ $2365 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$25=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ - Q Make checks aavable 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 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 all o c whic r quin evi�w and approval of plan r, � . f SFGNATURE OF APPLICANT /]�� �,-� PRINT NAME �D� C F'-f �� f�� ���E ��I��l � APPROVAL INSPECTOR SIGNATURE °I�-