P - 35761�uilding
T_nspections
763-572-3604
DATE O �
SITE ADDRESS _
THIS APPLICANT IS:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
❑ OWNER Q20NTRACTOR
PROt ERTY OWNER/ N,�:_��
TENANT ,e,DDRESS: l �l
CONTRA.CTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
�
PxorrE:_ __? � 3/ 5??•� Y 3 O
N,�: THD At- Home Services, Inc.
sT,a� r.tc 2690 Cumberland Pkwy, Ste 300
aDn�ss Cumberland Office Park
PHONE Atlanta, GA 30339-3913
G�aGLE Lic# 20268257 Ph. 763/542-8826
O TWO FA. �
❑ BASEMENT FII�IISH
❑ DECK
DESCRIBE WORK BEING DONE: / G1 i�
SIZE OF IMPROVEMENT
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SEDING
❑ Vinyl
❑ Aluminum
❑ Other
�0 c/i .i A Q /[t�t
CITY i"Y
��
Permit No. •.a'( � � I'
Received B�y:�
D���c'd:U � �
�?� S �a M
_STATE_ZIP 'S�$�/$ ;�
���a7�e-1 �iv'�: I�lrt�l
3Y5- (.oy7
CITY STATE ZIP,
❑ ROOF O DRAIN TILE
❑ SIDING ❑ O'Tf�R
� SWII��MING POOL
❑ ADDIT'ION
❑ REMODELING
ow rc p oc��'?�n /� l� /S in
dGTH WIDTH HEIGHT
❑ HOUSE ONLY
O HOUSE & GARAGE
� ATTACHED GARAGE
❑ DETACHED GARAGE
�Soffit
❑ Trim
❑ Fascia
VdINDOWS
IN EXISTING OPENINGS C�5 ONo LACQ TION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF L� V//I 9 P O �1 f�'1
OPENING CHANGES & �
TYPE OF WINDOW TO BE INSTALLED ��� FG �' � NUMBER OF WINDOWS
/
BASEMENT REMODELING SUBMIT:
1. Existing Fioor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft.
FOR NEW CONSTRUCTION 1NCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing shvctures
and proposed project
2. Two sets of constructiot� plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(LJSING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ /�T .? L OCCUPANCY TYPE
Permit Fee
Plan Review
Surchazge
Fire Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
rotal Due
$ 3./
$
$ •e�
$ � �.�
$ 5. O �
$
$
$
$
$._ 7o.7y
See Back Page for Fee Schedule
65% of Buildi.ng Permit Fee
(.0005) times the total job valuation — Minimum $.50
.001 x Permit Valuation (1/10%)
$5.00 (Staxe 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 payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMTf-NOT VALID UNTIL PROCESSED
[ hereby apply for a building permit and I aclrnowledge 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 revie dapproval o€plans.
iIGNATURE OF APPLICANf � PRINT NAME ` ` '_ ! � � � � � � DATE 8 ` '" !'