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P - 36830
i3U11C�lrig BUII,�IN(i Permit No.: :,�L' (�'�C"� t� ��� Inspections RESIDENTIAL APPLICATION� Received By: 763-572-3604 CITY OF FRIDLEY D �' .or-� �� �, .:;,,, F, 763-502-4977 FAX EFFECTIVE I-I-2011 � �� , �.� �' � �� '��' DATE ,"� � ��� � l YOUR E-MAIL ADDRESS 1\�;� �� `.�1 �Z��� �-`` �� S'^ �'��M SITE ADDRESS -`�-�': C' r' � �—.M � f�L' S 7.- N i� THIS APPLICANT IS: ❑ OWNER �CONTRACTOR PROPERTY OWNER/ tvANtE: � C��- �.S I� �u'1�- l�' L f,J l'?n; TENANT qDDRESS: -?-- ��C� �� �� LY� �R `.� f � �"C C1TY PHONE���r',� __S 1 ` �-�I3-S CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CTRTIFICATE OF NAME:_ iL i _� i STATE LICENSE #_ ADDRESS: � ,,�i � L � �� �I '��� i�l�G_�% sTaTE✓�it� ziPS �"�l1 l I�EAD CERT NUMBER I � _CfTY �%,Jti�-� � �� STATFJ�%/�' ZIP�� INSURANCE PHONE v --� � ''� -�>t� 1 FAX PROPERTY TYPE ❑ STNGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ G.ARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINiSH ❑ ROOF ❑ DRAIN TILE ,� DECK ❑ SIDING ❑ OTHER ❑ Sl�'IMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/RFPAIR � REMODELING �FSCrii�F wox� �eiNC �oN�:—�L11Li� N ���_ __LJ� � b_ C�l�b �_� -�--- - SIZE OP fMPROVEMENT LENGTH Z('? WInTH I 7 ROOFING NUMBER OF SQU/ARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other WINDOWS IN E�:ISTING OPENINGS ❑Yes ❑No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WTNDOW TO BE INSTALLED ❑ HOLISE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE O DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS HEIGII7' � SO FT �-�i � [3ASEMEN"l� REMODGLING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan �. List of structural members to be used �� � FOR NEW CONSTRUCTION (NCLUDING DECKS, ADDITIONS, & PORCHGS SUBMIT: I. Site Plan/Survcy showin� the existing s[ructures and proposed pr�ject. 2 Two sets of construction plans 3. Energy Calculations FOR WINDOWS - PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW. NUMBER OF WIND01�'S ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (US�NG THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $'�'���- OCCUPANCY TYPE Permit Fee � Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ $ $ $ $ $ $ $ $ $ $ See Bacl< Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation 0005 x Perniit 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 Agree�nent necessary ( ) Non Necessary ( Make checks aavable to: Citv of Fridlev Attach Stipulations 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 �vork 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 permit''and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of�ll work w�ich requires review and approval of pla�s. , SIGN.4TL'RE OF APPLIC:A.'�'T �� ,` '� � �'�� � l� f � . 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' 1�8TAON 56�� ZBI.A�IB AVE1�itT8 �� �ti G"""��'� ��� �`�� �,e� ,.,� ° � ��� � 1 � _. T_lE:,�.��������:� �'.�2c;,u MoNUt+'���.u-r J4At..- � � = SC7 j � I �`�`�`'r'"_}�SCAIPTTOIis All that part oi I.ot Bl�wa (11) , Auditor's Subdivisioa �lo. 94 � lyiag Bastarly af tha Soatherly �:t�naion of ths W�st�rl� lin� of �wrly 8�:12s, end lrina Be�t�rly oi t.h� Weat lia� of Hlock Tvo {2), at Sv��troi's Coar� Addi�io�; �`�ilp� that part plsttad ia Hnt-8er� Additioa; sub�act to tr�sam�at• !or roads. I�s�eby aertif� that thi� snrw�r was aada uadar mp dir�ct saperviaion aad that I a�e a�ly aatl��i.�sd Bs�.4stas�d Lae� Snrve�or undsr the laas of th� Sta�e o! Minasaot�►. ��te= .T�me 3. 19T1 e..��9 i�-Z�l..G- Wills,We s. r.oy., Bts tiian. �,.g. o. 6787 :�-� - n Lc,;d Plv�inln� �;�,:�� s�,�ti-��y��'Y so,r, r�,f�;�y Civil f� Alvni�:fk7l E„�,;7t���,,.y /''�, / /� �/ �•t���� A* � E i:�� ° � . � � �' �°L-". 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