P - 45314Building BUILDING re�nit r1o.: �
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY UF FRIDLEY Date �tec'a: � ��
763-502-4977 FAX EFFECTIVE 1-1-2Q11
DATE 7-7-2011 YOURE-MAILADDRESS msample@hwconstruction.com
SITE ADDRESS 124 Horizan Cr.
THTS APPLTCANT TS: ❑ flWNER II€CONTRACTOR
PROPERTY OWNER/ NAME: Rita Carlson
TENANT ADDx�ss: 124 horizon Cr, c�� Fridlev STATE MN ZIP 55432
PHONE:
CONTRACTOR NAI,,�; Hoffman Weber Construction
SUBMIT A COPY OF STATE LICENSE # 4OrJ43Z 'rJO LEAD CERT NUMBER
YOUR STATE LICEPdSE A'
ANDCERTIFICATEOF ADD�ss: 7932 University Ave. NE CITY Fridle,y STATE M„�TP 5.�32
n�sux�cE PHONE 763.300.65542 F�
PROPERTY TYPE $7 SINGLE FAMIL,Y/NEW CONSTRUCTION SIZE
❑ T"WO FAMILYlNEW CONSTRUCTION STORIES
PERMIT TYPE ❑ ADDITTON �GARAGEISHED ❑ WINDOWS
� BASEMENT FINISH ROOF O DRAIN TTLE
❑ DECK ❑ SIDING ❑ �THER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTIQN ❑ ADDTTION
I�MAIN'I'ENANCE/REPAIR � REMODELING
DESCius� wo�uc s�n�c vorrE: Re- Roof/ Storm damage
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES �_ ❑ HOUSE & GARAGE B!4�MMENT REMODELING SUBMIT:
1. Existing Floor Plan
G��AGES ❑ ATTACHED GARAGE 2. Proposed floor pian
PROPOSED SIZE: ❑ DETACHED GARACrE 3. List of strucharal members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CON5TRUCTIOIV INCLUDING DECKS,
❑ dinyl ❑Soffit ADDiTIONS. & PORCHES SUBMTf:
O Aluminwn ❑ Trim 1. Site Plan/Survey showing the existing structures
❑ Other 0 Fascia and proposed project.
2. Two sets of canstruction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS �Yes �No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALL7E Al�D
OR FOR NEW OPENTNGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WIIVDOW.
OPENR3G CHAI3GES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATIQN, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.e FEE SCHEDULE)
JOB VALUATTON $ OCCUPANC� TYPE
Permit Fee
Plan Review
Fire Surcharge
Suncharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ Cl `7 ,�� See Back Page for Fee Schedute
$ 65% of Building Permit Fee
$ :�, .001 times the total job valuation
$ , '�� .0005 x Pernut Valuarion Minimum $5.00
$ $5.00 (State Licensed Residential Contractors)
$ $2230 per SAC Unit (Plans to MWCC for deternunation)
$ ft+6ft= ftx$25=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ 7� �i Make ch�ks navable to: Citv of Fridlev Attac
THIS 1S AN APPLICATION FOR A PERMIT NOT VALID LJNTIL 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 Ciry of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a pemut and work is not t tart without a peimit on site; that the work will be in accordance with the
approved plan in the case of all v rk which Tequires re � w a approval of�� s.
SIGIVATURE OF APPLICANT � � �dQME'V"^e Sample DATE � " � — � �
APPRdVAL INSPECTOR SIGNA .(/�-�
NOTE: SEPARATE PERNIITS ARE R�tJIRED FOR PLUMBING. ELECTRICAL AND MECHANiCAL WORK