P - 35452F3uilding
Inspections
763-572-3604
DATE�7 /
SITE ADDRESS �
THIS APPLICANT IS
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
�� YO E- L ADDRESS
��1 Y 7 _a n f���v c jV't
❑ OWNER QCONTRACTOR
PROt ERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
FROPERTY TYP�
PERMIT TYPE
TYPE OF WORK:
CITY
�l �Ol •93G
Permit No.
Received By:_
s �2�o�e �LO�1 s, CvM
1
TE ZIP 5 S� 37
N,�:` fHD At- Home Services, Ina Jo d�� F(d c t J b n c�
srA� Ltc 2690 Cumberland Pkwy, Ste 300 q s� l 3 YS -(, 0 y 7
aDDxESS Cumberland Office Park crrY STATE z�
PHONE Atlanta, GA 30339-3913 �
❑ sarG� Lic# 20268257 Ph. 763/542-8826 :E
Q ADDITION
17 BASEMENT FINISH
❑ DECK
❑ MAINTEAiANCE/REPAIR
DESCRIBE WORK BEING DONE: l L✓
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES
GARAGES
PROPC}SED SIZE:
PROPOSED HEIGHT:
SEDING
❑ Vinyl
❑ Aluminum
❑ Utha
❑ GARAGE/SHED
❑ ROOF
O SIDING
❑ ADDTfION
❑ REMODELING
TFi
O HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GAR.AGE
❑ �RAW TILE
❑ OTHER
HEIGHT
$ASEMENT REMODELING SUBNIIT:
i. Existing Floor Plan
2. Proposed floor plan
3. List of structura! members to be uscd
Ft.
FOR NEW CONSTRUCTTON INCLUDING DECKS,
OSofft ADDITIONS. & PORCHES SUBMTT:
O Trim 1. Sice Plan/Survey showing the existing swctures
❑ Fascia and proposed project.
2 T f 1
'Ti�INDOWS . wo sets o consWcttort p ans
IN EXISTING OPENINGS� es C]No LACATlON OF WINDOWS 3. Energy Calculations
OR FOR NEW OPENINGS-DESCRIBE SIZE OF L/ li I n�+ Ib u n'1
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED P%1 NUMBER OF WINDOWS l
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(LJSING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ �_7 'S y OCCUPANCY TYPE
Pemut Fee
Plan Review
Surcharge
Fire Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ ,3 .! See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ _ (.0005) times the total job valuation — Minimum $.50
$ •• 7 � .001 x Permit Valuation (1/10%)
$ ,g. e d $5.00 (State Licensed Residential Contractors)
$ $1450 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= 8x$20=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ '10. ? 4� Make checks navable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby appty for a building permit and I acknowledge that the information above is complete and accurate; that the work wil] 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 pernut and ork is not to start without a petmit; that the work will be in accordance with the approved
plan in the case of all work which re uires revie n approval o€plans.
SIGNATURE OF APPLICAN � PRINT NAME�( / ' � � ` ' � + I � DATE � ( l ( ` ` �