P - 37146�-3uilding
�nspections
763-572-3604
DATE /a (� l � v
SITE ADDRESS V c3 �
THIS APPLICANT IS:
i'Rt7t ERTY OWNER/ N�
TENANT ,.
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYP�
PERMIT TYPE
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOLTR E-MAIL ADDRESS � ��! S�� �
7-�<� nQ �rcrc�
❑ OWNER S�CONTRACTOR
PH�NE: `t L 3( s 7 i- a s a y
Na.t�tE: I'HD At- Home Services, Inc.
sTaTE r.TC 2690 Cumberland Pkwy, Ste 300
.a��xESS Cumberland Office Pa�•k
�
PxorrE Atlanta, GA 30339-3913
�s�rGLE Lic# 20268257 Ph. 763/542-8826
O TWO FA .
❑ BASEMENT FINISH ❑ ROOF
❑ DECK ❑ SIDING
❑ SWIIvIM1NG POOL
TYPE OF WORK: I � ��'�'
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
AIR ❑ REMODELING
CITY
Permit No.;pL(
Received By:
Dat��a�
L �' 0 ,� S
/ STATE �
� � �� 1�
om
5543�
.JDdt Q7 �(dct Jb(1[ S
qSa �3Y5- (.oU7
CITY STATE_ZIP
:E
. ORIES _
`QWINDOWS
❑ DRAIN TILE
❑ OT'F�R
LENGTH WIDTH
�200FTNG ❑ HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
GARAGES � ATTACHED GARAGE 1. Existing Floor Plan
PROPOSED SIZE: ❑ DETACHED GARAGE 2. Proposed floor plan
3: List of structural members to be used
Ft.
PROPOSED HEIGHT:
SIDIIVG FOR NEW CONSIRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures
� Other ❑ Fascia and proposed project.
F��INDOWS 2. Two sets of consVuction plans
IN EXISTING OPENINGS `9yes ONo LOC:a'rrntJ na �x�pW 3. Energy Calculations
OR FOR NEW OP�I�IINGS-DESCRIBE SIZE OF � L t v, {14 r�j � �, n�
�PENING CHANGES & �re�Lre �
TYPE OF WINDOW TO BE INSTALLE� � W� �'�"' n�� NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS;
(LTSING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ L� 7 V� OCCUPANCY TYPE
Permit Fee
P1an Review
surcharge
?ire Surcharge
�icense Surcharge
3AC Charge
-+i.Ll U -vu� "iJl.l OVf
�rosion Control
?ark Fee
>ewer Main Charge
Cotal Due
$ ��, G'j �� � See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ (.0005) times the total job valuation — Minimum $.50
$ .QO1 x Permit Valuation (1/10%)
$ � L7Z� $5.00 (State Licensed Residential Contractors)
$ $1450 per SAC Unit (Plans to MVJCC for determination)
�. �.. , ,. _ .� T., .,
.i> � tL - V ll - ll ii J�Lii -� .p.
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
� �! 3/ Make checks navable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work will be in
:onformance with the ordinances and codes of the:City of Fridley and with the.Minnesota Conshvction.C.odes;.that I.understand this is not a
>ermit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
�lan in the case of al] work which requires revie d approval of plans. �
IGNATURE OF APPLICANT1� �" PRINT NAME �l `-, SC / t I�/I � DATE � a l��t o
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