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P - 35349BUl�;ldlrig Ins��ections 763` 572-3604 763-502-4977 FAX BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-2011 DATE " L SITE ADDRESS _� �' O r THIS APPLICANT IS: �' PROPERTY OWNER/ NqME:_ TENANT ADDRESS: SUBMIT A COPY OF ' YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY PERMTT TYPE TYPE OF WORK: DESCRIBE WORK BEING SIZE OF IMPROVEMENT YOUR E-MAIL ADDFtESS 2y (G..�/l Q �.J �'ti ✓'�. I.---v" i fER CICONTRACTOR �� . �� I � �.y �=,. 1� — 2-it .— // � , ATE LICENSE # Permit No.:Zd� �'�V Received By:� ��R 2 �� G( �i �-t � Nce c► -� �./�,�, o� �-4 y —T CITY 1 � �., STATE � /. �� "�� • • sT � ' " � Oil� _ll� CITY_�O�f/Q STATE/� [ONE FAX GLE FAMILY/NEW CONSTRUCTION SIZE � TWO FAMILYMEW CONSTRUCTION S' O A�pHiTION ❑ GARAGE/SHED �ASEMENT FINISH ❑ ROOF ❑ DECK ❑ SIDING ❑ SWIMMING POOL ❑ NEW HOME CONSTRUCTION ❑ ADDITtON ❑ MAINTENANCE/REPAIR ❑ REMODEL►NG _. � I�ti/ � ✓'�--� ( CJ�7 � h d �; �VVJINDOWS ❑ DRAIN TILE ❑ OTHER C � Y�p � r— C J I'�-( � FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: l. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor pian PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDiNG DECKS, ❑ Vinyl OSoffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim L Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two seu of construction plans WINDOWS 3. Energy Caiculations M EXISTING OPENINGS ❑Yes DNo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WiNDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: SING THE 1997�.B.0 FEE EDULE) TOTAL JOB VALUATION $ �, C�"a 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 $ 3 � See Back Page for Fee Schedule $ a�-i q 65% of Building Permit Fee $ j� .00] times the total job valuation $ � 6 .0005 x Permit Valuation Minimum $5.00 $ S b� $�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 ( ) $ "l0 . �L Make checks navable to: Citv of Fridlev Attach THIS [S 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 o e 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 ork is n t to start without a permit on site; that the work will be in accordance with the approved plan in the case of a11 work whi h re uire re and approval of pla�j] � SIGNATURE OF APPLICANT MT NAME Jy'(/I��( � n,�t� DATE^ APPR(1VAl.TNCPF.CT(1R CirUATtiRF /i/1 � T—� 0 � �`' � f� � � • � � �� C� w � s� `0 � � w �-� � �� s�`�-1- � N�y W'J � v . � � � � � �� ! � U� .� � �� I ► I --� tl`� w � '0 �� v � __ l`J Y .� �.% � �� ----- � `� ._- ._ � cS 'f � 5 vm-- � i � J' =► s ! ��° �� \ J " j� � � � 4 � �� • �• V � -� � . � �� Y v U7 �� •J �� a � � � � � + � �J � � � _� 0 � � t � � � � � �- � ,.. , . . � �� \ �"" N o � . z � � . m � � � 3 � u� � w V1 `�, ' � � � � � � � � � � � � Z �� I � I ` � � � L• _._.,..- � � ro� � .� ' J�� J �� Iv . �y � �