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P - 84129� Inspections '763-572-3604 763-502-4977 FAX DATE '� "� I C� ' SITE ADDRESS C'J � THIS APPLICANT IS: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-2012 YOUR E-MAIL ADDRESS �. lIC,lJ � C� � ❑ OWNER �CpNTRACTOR PROPERTY OWNER/ I NAME: TENANT pDDRESS CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE C� / i�e .— 7 iL .— STATE LICENSE # !J C, (�� `t L'Si EwDxESS: 3 � 30 lS�' ' PHONE G % � — � S3 �. ` �INGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION B BASEMENT FINISH O ROOF ❑ DECK O SIDING ^ T'^ � ��y� - �I� LEAD CERT NUMBEA " ,/rV'c• / " � CITY� � Z�C� FAX �� SIZE STORIES iHED ❑ WINDOWS ❑ DRAIN TILE ❑ OTHER TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR eREMODELING DESCRIBE WORK BEING DONE: C�S� �'Nt.n'f Rc'1nO 4- SIZE OF IMPROVEMENT LENGTH WIDTH ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE GARAGES PROPOSED SIZE: PROPOSED HEIGHT: ❑ ATfACHED GARAGE ❑ DETACHED GARyAGE Permit No.:O�� U �� Received By: Date Rec'd: - l.� CJ�/ Cl /"1 STAT'E "77IP 1 . �� STATE%1�% ZIPS—Sc�d' BASENIENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used SIDIlVG FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit SIDING/SOFFIT/FASCIA �DITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim REMOVED? ❑ YES ❑ NO 1. 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 �No LOCA1'ION OF WINDOW'�S FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF t_°G 1`�,SS ^ ES�� "' �h5�-:n MANUFACNRE STICKER ON WINDOW. OPEI�iING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: �(USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION Permit Fee Plan Review Fire Surcharge Surchazge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due �r•�� $ !' .".`� See Back Page for Fee Schedule $ 65% of Building Permit Fee $ ,vf� .001 times the total job valuation $ lfb .0005 x Permit Valuation Minimum or .50 $ : 6� $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 ( ) $ � 2 � D Make checks pavable to: City of Fridley Attach . ��ti. THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UN'ITL 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 only an application for a pe ' and w k is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of al rk ich r , view and approval of pl�}?s, ` �/ / SIGNATUREOFAPPLICANT � PRINTNAME Gullj�ui�t /ll-°�-�1�1�+"�'DATE �/�a 1�2� APPROVAL INSPECTOR SIGNA � �►.. , r � a � t I �"� ' o -� �r _ 1 � � �� . �, - ' �-- ?.,,�,M �,, �� c�`� �^��, � N� � � m 2 � i � � ;��. _ ,�` �, . _. � �` . _ _ , . • �,, � ; . � �� 1 ` A1 ' c � �' � ^ �� . � l° +�.� . c � �� , �. � � �� } � � � �� .�._�.____. � � ��1�. � � �� l �'� � l-� v r� n, r.�c �c.. �,•� ----� _� ��1 �.. �? er� �::+ `�::. �l �i ( �'� -� g� �t � ��, — s_ � .-.- -�-, � � c:� 1 Q_ �,'�� .-� ):.�s �:i.% pa, Q � � j �-' .-w. t"�". C': � � � ,� � "'^�e t r...i� r \ �, �i ��' .._. �a �� "TJ "T? a-'? s F'.r) . . �� , � f � ? }� �� r '. � F � � � � �� G�� ;� ) f ` ; . i� � x' � � �� ,i► _ �LVI C�`� �� M � �� nn A p, � �° �' �►� � (�— � � �" � � �r► .�� , � � � �N � C�, � I �„ �� _._._.�._ ._ c.' ► � ^'� �. r-�" � ' � � _x�� n � �. � � • .s-� � � �__ � . � �. �.��. �� ¢ � ��.� ��-� � , � � � �. � �-- :s' R__. � � � � \ � � � � 1 � !J� � � , �� F � � �� (�1 +�"�� :� � � ,�G � c �7— � � �- .�_ �� -. �---. � � �. �.. � M ,�- � , �-..,„ � ' °� p � � �--- ��....'� � �, �, �' � �- �, r . ' �v � i. � M � _� �1� ��t�u�� ,�� ~� �� ,- � � j � 9 e ! ►� � ' t \F � � G ( 0 � � n.., � � : � �