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P - 41908Buil'ding Inspections 763-572-3604 763-502-4977 FAX DATE � �' � ? - I I SITE ADDRESS G iC�� G THIS APPLICANT IS: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-I-2011 Permit No�-��� Received By: Date Rec'd: YOUR E-MAIL ADDRESS P�`c� (-t v,�e. '7.y, ��� �. C G.�-c, .0 �_ � OWNER �ONTRACTOR PROPERTY OWNER/ Np�E: `4�-� �t*„ TENANT ,qDDRES5: _ G %U�' C �.�*n� � � � :i�� CITY__ _� „ j� I e� STATE ��ZIP PHONE:__� i Z- G�G ' 7 I�0 6 • CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DESCRIBE WORK BEING D SIZE OF IMPROVEMENT_ NAME: �.- d l�/.ti.r- S Li-,� � Fi GS STATE LICENSE # 2G 6 3 R o I 3 LEAD CERT NUMBER /�'/�t =1 �� 3��.-� ADDRESS:_ 3.'2.C.IU /L�•, i• �i: S��'� d�R U CiTY Cqv� /!c„�, "rJ.> STATE is. v'ZIPS�s'� f/' PHONE _ _'� - C / 2 . �2 �/2 .. `� 3 �� % FAX 7 :C 3 � 32 1 ^ 9' ?o �/� �SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES ❑ BASEMENT FINISH � DECK ❑ NEW HOME CONSTRUCTION �MAINTENANCE/REPAIR i200FING NUMBER OF SQUARES �_ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl O Aluminum ❑ Other ❑ GARAGE/SHED ❑ WINDOWS �ROOF ❑ DRAIN TILE O SIDING �-0THER ❑ SWIMMING POOL . 0 (G c� � G �- � /it/ / ��. � ADDITION ❑ REMODELING S�J � WIDTH ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia WINDOWS IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & �/� BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: l. Site Plan/Survey showing the existing structures and proposed project. 2. Two seu of constrvction plans 3. Energy Calculations FOR WINDOWS - PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW. TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS � ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 3.ovu 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 �:� �— _ . � ���(1 � �1 See Back Page 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 APPL[CAT10N 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 th City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a pe ' and ork 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 work w ich u' s review and approval of plans. 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