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P - 48313Building BUILDING PermitNo.• � �� Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 , 763-502-4977 FAX CITY OF FRIDLEY D�� 3 EFFECTIVE 1-1-2012 DATE Z�� YOUR E-MAIL ADDRESS SITE ADDRESS � S 3 �r �I'� � THIS APPLICANT IS: '�OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: O � �� v�iS �NANT ADDRESS: � � CITY ��i��p �.�-t STATE W%JZIP �3Z. PHONE: �Jb �� Z3Z- � � ��$ CONTRACTOR NA1v1E: SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # LEAD CERT NUMBER EXP: AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE gp7� PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUC'TION STORIES PERMTT TYPE ❑ ADDITION ❑ GARAGE/SHED O WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK O SIDING ❑ OTHER O SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION O ADDITION ❑ MAINTENANCE/REPAIR MODELING DESCRIBE WORK BEING DONE: � I��C1 �, • n s w�.("yv SIZE OF IMPROVEMINT LENGTH WIDTH HEIGHT S FT ROOFING O HOUSE ONLY BASEMINT REMODELING SUBMIT: NLTMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed soor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members W be used PROPOS�D HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit SIDING/SOFFIT/FASCIA ADDIT'IONS_ & PORCHES MIT: ❑ Aluminum ❑ Trim REMOVED? � YES � NO 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia � ProPosed project. 2. Two sets of consUvction plans WINDOWS 3. Energy Calculations IN EXISTIIdG OPENINGS ❑Yes ONo LOCAITON OF WINDOWS FOR WINDOWS— PROVIDE U-VALLTE AND OR FOR NEW OPEHINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES 8c TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: 'OTAL JOB VALUATION Permit Fee Plan Review Fire Surohazge Surcharge License Surcharge SAC Charge Curb Cut Escrow Emsion Control Park Fee Sewer Main Charge x�([iJ�I�T� THE 1997 U.B.0 FEE SCHEDULE) ) 1 OCCUPANCY S See Back Page for Fee Schedule $ 65% of Building Permit Fee $ � .001 times the total job valuation $ .0005 x Permit Valuation Minimum or .50 $ $5.00 (State Licensed Residential Contractors) $ $2365 per SAC Unit (Plans to MWCC for determinarion) $ ft+6ft= ftx$25=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ _ 5'b� Make checks psyabie to: City of Fridlev Attac6 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 ordinance code the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a t d work ' not to start without a permit on site; that the work will be in accordance with the approved plan in the case of a11 ork hie iew and approval of pl�,us.. /�� '` I SIGNATURE OF APPLICANT _�__ PRINT NAME ., �.N 1�1u+ �� DATE Z- l Q�� Z � �� .�`° c�> e"- � �--� �Cs��V��A t�.�4'�S p� E�,f �, � ,..�ss _.��.---- _ I �uf.l�..�f.�u g:'SG-2�� V� ��`5 ,�Sst, t0 2�� 1 �,,,,,� 13 i2 S� ._._,..__. l ______ v . .__ � ___� .- � i � .�,,��okG,e- � � � j. �� . • f G�. � �� j - ��-� � � �� ' � �,�� __�� _ - 1�.�. -�-��:� � �z��{ � .� � � a�s� o`� �.z. c� � j� 4,V �\ b � � s�.. . ,.� � �--� � ��^�� .'� � _Go �� .�,.�. � -� �. �. � . — �Wli IV ` � `` �.OVt � —�� -�a� ��'�S � c.� �Q,S. - st?�t �i'aw� i I�i � � S • ,5�, r,,,,6tJ �� C�,��\.��w�. �� . - -� � �� __� � rn ��. r�t� S Qo � �.� �z�. 5 a� �r�' t a � S -�a r1i4 b �.�� c��, s _ - �� f� � �� z �� - R �� r`� � �4 r�� :bf� � �� ` �G�wt �v �� i N c� '� '�-� � t1�' �''� � � r