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P - 44116Building Inspections 763-572-3604 763-502-4977 FAX DATE 1(]I I 1/ I O�U � � SITE ADDRESS � THIS APPLICANT IS: PROPERTY OWNER/ TENAIVT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-I-2011 YOUR E-M 1L ADDRESS 1�G� ��, f i r e:� i(/ ❑ OWNER L�ONTRACTOR ,. ��( vwi. � i� c. ADDRESS: ` p� f PHONE; �p7 S ^ � / " STATE LICENSE #� au �� � yG ADDRESS: 7 PHONE '0 �! �Yd-� INGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION ❑ ADDITION ❑ GARAGE/SHED ❑ BASEMENT FINISH `�,[tOOF ❑ DECK ❑ SIDING ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR �2EMODELING DESCRIBE WORK BEING DONE: �- SIZE OF [MPROVEMENT LENGTH WIDTH ROOFINC �� �nUSE & GARAGE �''s � e� NUMBER OF SQUARES J"'^ GARAGES ❑ ATTACHED GARAGE PROPOSED SIZE: ❑ DETACHED GARAGE PROPOSED HE[GHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other WINDOWS I IN EXISTING OPENINGS OYes �No j OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & ! TYPE OF WINDOW TO BE INSTALLED ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS NUMBER OF CERT ❑ WINDOWS ❑ DRAIN TILE ❑ OTHER Permit No.: Received By: � . -' :,` � � � ATF,/�GIP A � BASEMENT REMODELING SUBMIT: L Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION (NCLUDiNG 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 MANUFACTURE 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 $ 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 $ �.'/�LJ See Back Page for Fee Schedule $ 65% of Building Permit Fee $ .001 times the total job valuation $ .0005 x Permit Valuation Minimum $5.00 $ �U $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 ( ) $ �1 � Make checks pavable to: Citv of Fridlev Attach Stiaulations 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 ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only a,n application for a permit and work is not to start without a permit on s' e; that the work will be in accordance with the approved plan in the case of all wor hic equires review and approval of pla . /` o SIGNATURE OF APPLICANT � PRINT NAME (�(� ATE � APPR(1VA1. fNSPFCT(1 � �