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P - 45811Building Inspections 763-572-3604 763-�02-4977 FAX DATE lJ� � Z2 � � S si� ADD�ss �3�- THIS APPLICANT IS: � Y �i►l[`� CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE I-1-2010 aV�s Permit No.: vec� � J a e ec' d: YOUR&MAILADDRESS �-�c_-<<�(�� ���e-�<-S�fOO�Iv�C�v�'L�.j(C��yy� . CQW� � OWNER ,�CONTRACTOR ADDRESS: �S� � C �'i (.-��0� �C� CITY PHONE: NAME� �Ck's Raofing and Sidin STATE LICENSE PHONE F��7B$): ,,I�SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION ❑ ADDITION ❑ GARAG ❑ BASEMENT FIAIISH 0 ROOF ❑ DECK ❑ SIDING TYPE QF WORK: (❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCEJREPAIIt �`REMODEL: DESCWBE WORK BEING DONE: �-2Gt'� O�°F� °d` ;('�' i/L cr-r SIZE OF IMPROVEMENT LENGTH WII ROOFING ��,,f O HOUSE ONLY NUMBER OF SQUARES �/ J�`HOUSE & GARAGE GARAGES J� ATTACHED GARAGE PROP05ED SIZE: ❑ DETACHED GARAGE PROPOSED HEIGHT: SIDING O Vinyl CJ Aluminum ❑ Other OSoffit ❑ Trim O Fascia WINDOWS IN EXISTING OPHNINGS DYes pNo LOCATTON OF WINDOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & ATE � il� ZIP S��I (fiC. EXP DATE S� JT I�%2 _CITY STATE ZIP SIZE STORIES n wirmows ❑ DRAIN TILE ❑ OTHER BASEMENT REMODELING SUBMIT' 1. Eatisting Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR TiEW CONSTRUCTION INCLUDING DECKS, ADDITIONS 8c PORCHES S MIT- 1. Site Plan/Survey showing the existing struchues and proposed project. 2. Two sets of construction plans 3. Energy Calculations FOR WINDOWS — PROVIDE U-VALUE AND MANUFACTLiRE STICKER ON WINDOW. � 1rrCVC W1NllUW lUt3�1NJ1ALL�ll NUMBEROFWINDOWS � ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: SING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ � __ OCCUPANCY TYPE Permit Fee Plan Review Fire Surchazge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ ltJ `7 • f���_ See Back Page for Fee Schedule $ 65% of Building Permit Fee $ _.001 times the total job valuation $ ,0005 x Permit Valuation Minimum $.50 $ $5.00 (State Licensed Residential Contractors) $ $2100 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$24=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $_ E.( d Make checks_payable to: City of Fridle_y Attach THIS IS AN APPLICATION FOR A PF1tMIT-NOT VALID UAiTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is compiete and accurate; that the work wiil be in conformance with the ordinances and codes af 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 pian in the case of al(�york�which requires review and approval of plans. SIGNAT[JRE OF APPLICANT PLEASE NOTE: SEP�;B�TE �R1�IYTTS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND 1� tX`2-Z'�� WORK