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P - 41393Building Inspections 763-572-3604 763-502-4977 FAX �: DATE ���,� - SITE ADDRESS � � THIS APPLICANT IS: i PROPERTY OWNER/ TENANT i ' CONTRACTOR SUBMIT A COPY OF , YOUR STATE LICENSE AND CERTIF]CATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK DESCRIBE WORK BEING DONF SIZE OF IMPROVEMENT BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE I-I-201I YOUR �-MA1L ADDRESS ; r'L'��;1 11 ( 't' O OWNER OCONTRACTOR ` � l:, , �- _, [. ADDRESS: � j C'�J � �L _i�-,��.�i�j; , C1TY PHONE: i/_ :.. t_:� J� �'� s. ��. ,-� , NAME: � L� I�—L �• �� 5 tl`�� �j� �� 4 LL STATE LICENSE # Z ��, �� � 7� S� LEAD CERT NUMBER ADDRESS:�C% � %S Gz�'t��%� I'. CITY���%ti PHONE (- ( Z _ l%I �_ C� �(i % FAX ❑ SiNGLE FAMILY/NEW CONSTRUCTION SIZE � TWO FAMILY/NEW CONSTRUCTION STORIES � ADDITION ❑ GARAGE/SHED �W'INDOWS ❑ BASEMENT F1N1SH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER � SWIMMING POOL ❑ NEW HOME CONSTRUCTION O ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING i. L.� i �' ��(.`i;`� i� ROOFING NUMBER OF SQUARES GARAGES PROPOSED SIZ.E: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other VI'INDOWS IN EXISTING OPENINGS ❑Yes ❑No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF W(NDOW TO BE INSTALLED ;�_� ,> LENGTH WIDTH HEIGHT ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS �.� •� �"NUMBER OF --� Permit No.:%_( ' �, �' ' Received By: . � � �� ������ :� (1 2 0 �? STATE��ZIP < < '" (�, I �� �L; L f .- ( ��STATE�IP S c`%i FT BASEMENT REMODELING SUBMIT: I . Existing Ploor Plan 2. Proposed floor plan 3. List of struc!ural members to be used FOR NEW CONSTRUCTION INCLUDiNG DECKS, ADDITIONS & PORCHES SUBMIT: l. Site Plan/Survey shoti�ing the existine structures and proposed project. 2 Two sets of construction plans 3. Energy Calculations FOR WINDOWS - PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW. ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING �'�I� 1997 U.B.0 FEE SCHEDULE) I'OTAL JOB VALUATION $ _/_�'/ jL� _ 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 $ /y��l .�: L.? See Back Page for Fee Schedule $ 65% of Building Permit Fee $ f�"� i' .001 times the total job valuation $ �� Z .0005 x Permit Valuation Minimum $5.00 $ �->��� $5.00 (State Licensed Residential Contractors) $ $2230 per SAC Unit (Plans to MWCC for determination) $ �+6ft= ftx$25=$ $ $450 Conservation Plan Review $ Fee Detennined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ f'- .,' `� Make checics aavable to: Citv of Fridlev Attach lations THiS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED [ 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 permit and work is not to start without a permit on site; that the work will be �n accordance with the approved plan in the case of all �Gbrk�/ ic�, /', e uir s review and approval of plaq �i � � �' SIGNATURE OF .APPLICANT ��; /4 f C�} � ,� PRINT NAME `Y� "c� � � %�c:� ll °`�(�'j�� DATE � �".% l� aPPROVAL 1NSPLCTOR S1GNA1'UkE ' PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBI�G, ELECTRICAL AND 1VIECHANICAL WORK