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P - 48391Building In�pections 76'3-572-3604 763-502-4977 FAX DATE C C.'? �l�%�/ SITE ADDRESS �S � � THIS APPLICANT IS PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-201I ��t;'`� �' j . I�,OWNER NAME-� ADDRESS: r�� , PHONE: �� K'.�'.. NAME: ,�' /�1'J /s ,' � �j irK�-?1�� YOUR E-MAIL ADDRESS li.� �CONTRACTOR �"'C � STATE LICENSE # L(��,;r �'7 'T ` y ADDRESS: ! ` `3 �� T�'c� ¢ff+.1� �IC`�'-F I !t�_ PHONE ��S � ��{ � `, "�'� � �1'SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION ❑ ADDITION ❑ GARAGE/SHED ❑ BASEMENT FINISH ❑ ROOF ❑ DECK ❑ SIDING ❑ SWIMMING POOL CITY ,� Permit No.: ' "' ( _ �,( �' � �� r Received By: �'�3`�� ;�.: "/� ; �-v /'9'1 (!-�E'- STATE��L,tP , } �y�� w LEAD CERT NUMBER CITY ��'n� /`�4"ti,'- ` STATE� � IP �jS 5 �"� FAX SIZE STORIES ❑ WINDOWS ❑ DRAIN TILE ❑ OTHER I TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR �REMODELING �� >� � DESCRIBE WORK BEING DONE: �� i�L�-- 'v::.,v �3�'c.t'� tl{.�-.rr..> �J ir`7 �1--+ �t <= r°C,e�c,� �,l�r;�'��-- - f}(�z•G��,.,.� li IC� T. vis'1-I) SIZE OF [MPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING NUMBER OF SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other WINDOWS INEXISTINGOPENTNGS,P�Yes �No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENTNG CHANGES & TYPE OF WINDOW TO BE INSTALLED V` )i ALL FEES ARE BASED ON V TOTAL JOB VALUATION � ' Permit Fee ' Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS NUMBER OF WINDOWS BASEMENT REMODEL(NG SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION iNCLUDING DECKS, ADDITIONS, & PORCH�S SUBMIT: l. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans 3. Energy Calcuiations FOR WINDOWS — PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW. UATION, INCLUDING THE COST OF LABOR AND MATERIALS: NG THE 1997 U.B.0 FEE SCHEDULE) OCCUPANCY TYPE $ � �`,. ` �� r''fF. �; $ ;� .i�, $ n p �_ $ : ;�_� ;:., � , $ $ $ $ $ . � � 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 lations 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 cod '`of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a pe t and wor 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 ch requires eview and approval of plan .( SIGNATURE OF APPLICA�N��T --'"� '� r" PRINT NAME �(� ��C/' e:��-.,-+.Y �.q 4� DATE � I' APPROVAL INSPECTOR yf(JNA�U� �` f 4"^, WS y4 y � l'., _.._.. ._� i ...��...i � .�y P y...�..o,.. , y dr f)L�.r��. '... j � �v � � vt�-5 � -� V� � � N �. ��1/ � Y^ ` V � � � 1 � V ! � �i � `�'%� -�+-� � I_� v v� � -� �, �_ � � � ' `� _.. _ . .__-, vn ' � �.__ �;;: �,�; ; � a� �� , ; � � � ,�' � �� a � . . _ . � � , �� _ , ..... _ ; � � � � : , � � .' � , , _ ; w- i i � �� , � ��--- �.._ .�. _�_____f __ , �� . ..... ..... , I ...�. ,�.�. �-.,_.i � �� ^ � �.J . �. I`w�� .. 1 , ` ' I I=��i ` � ,_ � � },� �Y; / � __ � � , ' � � ` �� l � • , J i �' W � � w� /� � �� d �� w 1} �\ \ \� ,� � N � 1 --�,,, � �/ � � —� � G � � � � I V � `�i� � I � ti � �— � r,q "� �Y} ;� � M � � � ,► �, � �' ' � —� . � P r,� � � -' . � �..�' � _� � � � /f n � � N / � � � ' `! �