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P - 48553Building BUILDING Permit No.: �► � Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY vateRe�'d:3-2.��1 763-502-4977 FAX EFFECTIVE 1-1-2012 DATE �� 2' � Z YOUR E-MAIL ADDRESS SITE ADDRESS 6 2� C�� r�s � S-�- THIS APPLICANT IS: ❑ OWNER �CONTRACTOR PROPERTY OWNER/ NAME: �S �+-� << �i � I e� c ttic �- TENANT ADDRESS: CITY STATE ZIP PHONE: CONTRACTOR NAME: _ S"1� � (o e� ��.. r,. e rioc ,� a,., �� e,,•� d e� � 1�` ..i y SUBMIT A COPY OF STATE LICENSE # 8G C 2 7 Z G I EXP: ( S YOUR STATE LICENSE LEAD CERT NUMBER �� sy G" � AND CERTIFICATE OF ADDRESS: ��� 3 .4 i ya ;.� e o� /' CITI' �'�. �"'� S e v STATE s4. ZIP SS 3 0 3 INSURANCE PHONE � G 3` S 7 6 - I 1� 3 pp}{ PROPERTY TYPE �SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTTON STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDpW3 �BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK � SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR � REMODELING DESCRIBE WORK BEING DONE: d�2 ..ti ov-� 1.�.a.. )� S 1+-t-�.v it ��G �S c« �. � j� 5 %,P d y- y-a .� ���„ b�, s'e .•�-c �. -� SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT R� ING ❑ HOUSE ONLY BASEMENT REMODELIN SUBMIT• NiJMBER OF SQUARES � HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit SIDING/SOFFIT/FASCIA ADDITIONS_ & PORCHES S MIT: ❑ Aluminum ❑ Trim REMOVED? � YES ❑ NO �� Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 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 OPENRIGS-DESCffiBE 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 CO5T OF LABOR AND MATERiAi,S_ TOTAL JOB VALUATION Permit Fee Plan Review Fire Surcharge Surcharge License Surchazge SAC Charge Curb Cut Escrow Erosion Control ! Park Fee ! Sewer Main Charge ' Total Due (USING THE 1997 U.B.0 FEE SCHEDULE) S. �� __ OCCUPANCY $ l 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 ( ) _$ ` Make checks payabte to: City of Fridlev Attact 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 onty 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 allyuer�uvhic �quires review and approval of plans. 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