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P - 83509Building BUILDING Permit No.��:�1�-Cu��/ Inspections RESIDENTIAL APPLICATION Received By: '�'1�� 763-572-3604 CITY OF FRIDLEY va ct:p,�?� �. �► ��Y 763-502-4977 FAX � eF�ECT�vE �-�-2o�z �� DATE t,�i� I G� � �� YOUR E-MAIL ADDRESS � �-� � � � �-• � �_ ,z�mU.. � � C` �„�.r� r � � � S[TE ADDRESS �--,., •, - THIS APPLICANT IS: � OWNER ❑CONTRACTOR PROPERTY OWNER/ NAMt: � " f TENANT a��Ress: I� ,:�•, ' ciTV �,,.. ��,- �� sTaTE t�z�e—C,-S`�! Z,J PHONE: �. CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # LEAD CERT tVUMBER EXP: AND CF,RTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE pHONE FAX PROPERTY TYPE �SINGLE FAM[LY/NEW CONSTRUCTION SIZE � IO� S ��` ❑ TWO FAMILY/NEW CONS'T'RUCT[ON STORfES PERMIT TYPE � ADDITION �GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FIN[SH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: ��;.� � � � ��� �- � � �.� SIZEOFIMPROVEMENT LRNGTH � WIDTH ! � HEIGHT � S FT � ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: � 1. Existing Floor Plan GARAGES ❑ A7'TACHED GARAGE 2. Proposed floor plan PROPOSF.D SIZE: ❑ DETACHED GARAGE 3. List of strucwral members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit SIDING/SOFFIT/FASCIA ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim REMOVF,D? ❑ YES ❑ NO 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans W[NDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR W[NDOWS - PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON W[NDOW. OPENING CHANGF.S & TYPE OF WINDOW TO BE [NSTALLGD NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: USINC THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ � h�� 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 �_' See Back Page for Fee Schedule , f� 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 ( ) l.%�; Make checks aavable to: Citv of Fridlev Attacl THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED 1 hereby apply for a building permit and I aclrnowledge 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 [ understand this is not a permit but only an application for a permit a d 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,work w�ich r,q i e review and approval of ns. SIGNATURE OF APPIJCAN"I • � PRINT NAME 7F y.�; �� DATE :>���/� APPROVAL INSPECTOR SIGNA°i'C7 , PLEASE NOTE: SEPARATE P RE REQU RED FOR PLUMBING, ELECTRICAL AND MECHAMCAL WORK � 9 ; � � � � ---�.-. l� L, V�1 � � � � ; � r � � � Z � � � M �� � ___. � � �' , - - . i ; G � , .`��� � � � P i° .5 �i :��� ; Q � "t ; � �` � �S , i � ! { , �! � � 2 r � --_��,—�.-`.� �°? s� � } � �- �� , I � � � �� L ` � � �-� ��� I � '� � �, x � �, � � � 1 + � � � � � -�, � �► ��, �N ✓ D' �� . �� , `Zl i � i N.- O � � M � , � � �� � M N► � �--� N �` G � ,- � v- � �� � �� � �, � � � � � I � � � 4� , � �> � �� i �� A� �' 0 "F-'� j L�. l, �� � =tr► � , � �� I � ' v � "> � fi-g � ��' �, n , ���� � � ���� rrt v � � � "R � � ��� ������ � � �- , � `z-; � � ��c�``v �- Z � cs�s �``3 � —< i} -�; , G'� { � a :� �� °'� � � N �' � i `- � . �.__,_ �.��.�_���. � t 1 �� � �� LN; �� O K �� r � �� �� O � k x � � °,L- � � M � � � t� �A � . -� ., � , .. ��,�, . . _ •-�� .,� � � �� - � �� �� � � �� � � �` �� � � � � � � � � �� � � � � Z Z. d� �� ^U � s� � �-.Q OT 1✓ �� Q �� � 1�-- � � f ► � �� - � °� � �� � �� � � / �r � � � � � � �� � �, � �-' �: � �� � � � r-1 �U � � � � �� � `� �� Z 4� � � �. � � � 1`�` � �"I � �..# �- � � � -� ,� � � � � fi '