P - 35762�uilding
rnspections
i63-572-3604
DATE v
SITE ADDRESS _
THIS APPLICANT IS
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
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❑ OWNER p!(CONTR.ACTOR
1'ROt ERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMTT TYPE
TYPE OF WORK:
Permit No.:
Received By:
DatR�te►'d� I
,�DxESS �-o�;sc+� d(dpr� onpS. �o�
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N�tE:_ I'HD At- Home Services, Inc.
sTa,TE Lic 2690 Cumberland Pkwy, Ste 300
.d,DDxESS Cumberland Office Park
PHONE Atlanta, GA 30339-3913
e's�rGr.� Lic# 20268257 Ph. 763/542-8826
o �rwo FA �
❑ BASEMENT FII�IISH ❑ ROOF
❑ DECK ❑ SIDING
❑ SWIMMINC
❑ NEW ❑ ADDTI'ION
C3�SITTTEI�ANCE/REPAIlt ❑ REMODEL]
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Odier
p� la I�1 Ct�o trf /` e�
LENGTH _
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
O DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
CITY �/� / ��� y
Jo d � [D F"(d � r
. q5� l 3Y5- (.0
V4�INDOWS
IN EXISTING OPENINGS �❑No TION OF WINDOW�
OR FOR NEW OPENINGS-DESCRIBE SIZE OF ��� a o/+'! •�? n,��o u/'
OPENING CHANGES & 1
TYPE OF WINDOW TO BE INSTALLED � C' S 0!y1 �A TS ��qgER OF WINDOWS �
� o-wn�mows
❑ DRAIN TILE
❑ OTi�R
a�_z� S' S S+3 7
7
Ft.
BASEMENT REMODELING SUBNltT':
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural membets to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. Bc PORCHES SUBMTT:
1. Site Plan/Survey showing the existing shvctures
and proposed project.
2. Two sets of conswction pians
3. Energy Calculations
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 0 n v OCCUPANCY TYPE
Pemut Fee
Plan Review
Surcharge
Fire Surcharge
License Surcharge ,
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
I'otal Due
$ • �
$
$ /, S �
$ 3 0 �o
$ 5.00
$
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
(.0005) times the total job valuation — Minimum $.50
.00I x Permit Valuation (1/10%)
$5.00 (State Licensed Residential Contractors)
$1450 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks navable to: Citv of Fridlev Attach
THIS TS AN APPLICATION FOR A PERMTT-NOT VALID UNTIL PROCESSED
[ hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in
�onformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
�ermit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
�lan in the case of all work which requires review n approval of plans. �/a ��
>IGNATURE OF APPLICAN PRINT NAME ,(� S C��` I�DATE L �