P - 48107►3uilding
Izlspections
i63-572-3604
D.ATE 5 � � (
SITE ADDRESS
THIS APPLICANT IS:
1'ROt ERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
l�
5
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR -MAIL ADDRESS 0 �F l 5� d I c( � P
4 as� �avcl'�a�1 o s S
❑ OWNER 1�ONTRACTOR
a,DDxESS: S 5 4�! ��Ci v o/' t 4l� J�S ciT
PHONE: L�.7 � S � oi • i S�: �
N,�: THD At- Home Services, Inc.
sTA� t,tc 2690 Cumberland Pkwy, Ste 300
aDDxESS Cumberland Office Park
PHONE Atlanta, GA 30339-3913
❑ s�rGiE Lic# 20268257 Ph. 763/542-8826
❑TWOFA � _.
❑ BASEMENT FINISH
❑ DECK
❑ NEW
DESCRIBE WORK BEING DONE
SIZE OF IMPROVEMENT
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
� Other
VF'INDOWS
IN EXISTING OPENINGS es �No
OR FOR NEW OP�NING - ESCRIBE SIZE OF
OPENING CHANGES & „
TYPE OF WINDOW TO BE INSTALLED_ O�
❑ ROOF
❑ SIDING
❑ SWIMMING POOL
[�.� � n�o t� f�//n C,� M�/1
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Sof�it
❑ Trim
❑ Fascia
LOC ION OF WINDOW
�• �'r o e M � �c/h.lv reo /*�
' NUMBER OF WIND(
Permit No.:
Received By:
�onc s. �oM
ATE_ZIP�S' �(�'.�
gS� �3Y5- (,oU�
' CITY STATE ZIP
❑ �RAIN TILE
❑ OTFIER �
i
,� �� s��s �n� o�.•n.n�f
TH HEIGHT S . Ft.
i
' BASEMENT REMODELING SUBIvIIT:
', 1. Existing Floor Plan
2. Proposed floor plan
; 3. List of structural members to be used
, FOR NEW CONSTRUCTTON iNCLUDING DECKS,
ADDITIONS. 8c PORCIiES SUBMIT:
1. Site Plan/Survey showing the existing strnctures
' and proposed project
� 2. Two sets of constructioh plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF Lr�BOR AND MATERIALS:
(LJSING T�E�9�7 �J.B.0 FEE SCHEDULE) i
TOTAL JOB VALUATION $ , � OCCUPANCY ' TYPE
Pemut Fee
Plan Review
Surcharge
Eire Surcharge
License Surchazge
3AC Charge
�urb Cut Escrow
3rosion Control
?ark Fee
3ewer Main Charge
�otal Due
$ /�/..� S� See Back Page for Fee Sche�
$ 65% of Building Permit Fee
$ 7/ 3 (.0005) times the total job va
$ , �? G .001 x Permit Valuation (1/1
$ S. 0 0 $5.00 (Staxe Licensed Reside
$ $1450 per SAC Unit (Plans t
$ ft+6ft= �
$ $450 Conservation Plan Rev
$ Fee Determined by Engineer
$ Agreement necessary ( ) N
$ 2• y Make checks oavable to: C
— Minimum $.50
%)
tial Contractors)
MWCC for determination)
x$20=$
Necessary ( )
� 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 an 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 re�� and approval of plans. y. ' , � , ,
I>IGNATURE OF APPLICANT �/� �/ l/ � PRINT NAME ' ! ' / _� � � � ` ' �C DATE S/� �[ �