P - 48431Building
Inspections
763-572-3604
763-502-4977 FAX
DATE � �! � �� �
SITE ADDRESS � � 7
TH1S APPLICANT IS:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE I-1-201I
YOUR MAIL ADDRESS
-�Jl f o� Y't /?t�G
❑ OWNER mCONTRACTOR
PROPERTY OWNER/ NAME:
TENANT qDDRESS:
PHONE:
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRTBE WORK BETNG
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od�'sd�4��t
CITY !` (r' !
Permit No.:�b�Z �
Received By: '
Date l� . � �
n�JlS,!'0/'�
�
STATHni�I ZIP SS�SI'�7
N,�E THD At- Home Service, Inc,
STATE 2690 Cumberland Pkwy, Ste 300 ,EAD CERT NUMBER �IT %• l�%.7 76 ��
,a�DR. Atlanta, GA 30339-3913 CITY STATE ZIP
PHONL Lic # 20268257 Ph. 763/542-8826 F,�
� STNGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
❑ ADDITION ❑ GARAGE/SHED INDOWS
� BASEMENT FINISH O ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
� NEW HOME CONSTRUCTION ❑ ADDITION
'QMAINTENANCE/REPAIR ❑ REMODELING
I SIZE OF IMPROVEMENT LENGTH WIDTH
I� ROOFING ❑ HOUSE ONLY .
I NUMBER OF SQUARES ❑ HOUSE & GARAGE
,I GARAGES ❑ ATTACNED GARAGE
PROPOSED SIZE: ❑ DETACHED GARAGE
I PROPOSED HEIGHT:
,
' SIDING
❑ Vinyl ❑SofYit
❑ Aluminum ❑ Trim
❑ Other ❑ Fascia
WINDOWS
IN EXISTING OPENINGS �Yes ❑No LOC 10r OF WINDQ WS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF �tY'� /�!-� ��(, C,I U/1: �i • I
OPENRJG CHANGES & u
TYPE OF WINDOW TO BE INSTALLED �TTS NUMBER OF WINDOWS �
�i r
T
FT
BASEMENT REMODELING SUBMIT:
l. Existing Floor Plan
2. Proposed floor plan
3. List of structural memhers to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
I. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
FOR WINDOWS — PROVIDE U-VALUE AND
MANUFACTURE STICKER ON WINDOW.
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ �I Z'N OCCUPANCY TYPE
Permit Fee $ See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ .001'times the total job valuation
Surcharge $ .0005 x Permit Valuation Minimum $5.00
License Surcharge $ $5.00 (State Licensed Residential Contractors)
SAC Charge $ $2230 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft+ 6 ft = ft x$25= $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary O Non Necessary O
Total Due $ 1 41 / Make checks payable to: City of Fridley Attach
THIS [S AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and 1 acknowledge that the infonnation above is complete and accurate; that the work will be in
conformance with the ordinances and codes of City of Fridley and with the Minnesota Construction Codes; that 1 understand this is not a
permit but only an application for a p it 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 hi uires review and approval of pla�-M �`����
SIGNATURE OF APPLICAN PRINT NAME (( �aTS �l! $� /�
APPROVAL INSPECTOR SI TURE