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P - 48398Building Inspections 763-572-3604 763-502-4977 FAX DATE 6 ' � I — � SITE ADDRESS � THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DESCRIBE WORK BEING I SIZE OF IMPROVEMENT_ ROOFING NUMBER OF SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other BUI�,�3IlgTG RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-2011 YOUR E-MAIL ADDRESS �OWNER ❑CONTRRCTOR ADDRESS: I J��(j��Qih.0. ��i�• CITY Fri, PHONE: } � � g 3 � � � � � NAME:�rj � STATE LICENSE # LEAD CERT NUMBEA ADDRESS: CITY_ PHONE FAX �SINGLE FAMILY/NEW CONSTRUCT]ON SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS '�BASEMENT F[N1SH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR �2EMODELING aE: F� h �'$ ,' ✓t q c�• ba#�r � a � X S� LENGTH II � ❑ HOUSE ONLY ❑ HOUSE & GARAGE WINDOWS IN EXISTING OPENINGS ❑Yes ❑No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WiNDOW TO BE INSTALLED ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS NUMBER OF WINDOWS � n b ase,�e n.r WIDTH S � HEIGHT Permit No.: Received By: Date Rec' STA ATE ZIP FT S�/. BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION TNCLUDING DECKS, ADDITIONS & PORCHES SUBMIT: I. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans 3. Energy Calculations FOR WINDOWS — PROVIDE U-VALUE AND MANUFACTIJRE STICKER ON WINDOW. ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ �%� a-�7� �', 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 $ .�`J 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 ( ) $ �► � � 0 Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PRQCESSED 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 th 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 an ork 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 ork which review and approval of pl ns. / _ /' SIGNATURE OF APPLICANT � PRiNT NAME � ��'►,/'1 f-�i � er DATE O' a� " I I APPROVAL INSPECTOR SIGN URE i � i f' / �� . r�� , « �, ,, e� c� �,� r � f.y� r : n `�`` .7 f f —' �35� �` ,,� �� f � �. �� f! � �� 0.�~ � �.��,�'. .- �- 3�' `' ;� =� � 3a3� � �,,i y ; �`" �\`~ �'�o��£�` � J ' v�+ u 3a� q� �/Z„ P < .,}ek , �r�. � �-- �� 4i �.�' � . C'» ; �, ti � '� � i =� , ,��, f` E--- �t�� '� � �� . Ft ( �' �%i �� 53 °° � �{�� . �:� � �� s. .t'F ,. j"°. , ,� �� :�'-..� . — �'�F ,^� � t .. � �� '� F �f i�4_.. _ �:�- � � ,: r�, tr" ri f � T. �,j/ / �� r � � � � �t� \ �. � � -- -� -�Z.Z�'� Ga� . � ^ � _,�� _ � Sb V�4 � S� ,�l.�` e -� -1 ^, . _ �� N �.� _� � /\ /A A T � �v►� � _.. f .� a , ,, plan f�r �a-I-�ro .�.�.� � � �u-i'��?Yl(�l � c? / `� �` ,,� " :;� ` � �a � ,�,,� F / ' �/�l, �� +� �t�.cQ . � vaf�� ` � � �i`�` �1 � . � � 0-�1+1 E �� , � � , �,. t �� ;�f� � ! -� � [.� :��,�� -� .�� . _ ��c� � �� - � �� , ,�� ; <'�"r � � ; � � ,. E �:'.. f f �.j ,r- ' "``�`` .S �! (, �" `G }'1 �� _(� � e � 7 t� �� t'1. t"''� ij ?,.� �f�. �� c�� ,� i�.�," , �c�.,��.c� �e� , _ �I�.f � " (� (u,,,,�� , _ �n �..� . ---->S�k�. d�t��.� �,� �� zNN � �� _ �' �- �s� c•o. d� �.� ��n z4�. �