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P - 48339Building Inspections 763-572-3604 763-502-4977 FAX DATE i �� � ` � BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-2011 i SITE ADDRESS J I�-I t�n�; L�^ � f � THIS APPLICANT IS: ❑ OWNER PROPERTY OWNER/ N,�tE: � TENANT ppDRESS PHONE: CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE YOUR E-MAIL ADDRESS YBCONTRACTOR T�f�"'��'� Z� �}�r�' 1�1 �j �, �',�-L" c C[TY � ����c� STATE LICENSE #�(,�� �j Z1v b�+ LEAD CERT NLIMBER � �� ADDRESS: � ( ^ ' �� CITYI�t?I PHONE �� — Fq}� � - (— SINGLE FAMILY/NEW CONSTRUCTION SIZE )prr �.. F, ❑ TWO FAMILY/NEW CONSTRUCTION STORIES�_ ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH �SROOF ❑ DRAIN T]LE ❑ DECK ❑ SIDiNG ❑ OTHER ❑ SWIMMING POOL TY.PE OF WORK: ❑ NEW HOME CONSTRUCT]ON ❑ ADDITION i�.MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: ��- �M*' �- � � �;„�C SIZE OF IMPROVEMENT LENGTH 11-'� iC �'t' L7 WiDTH � 1 �-2 I� HEIGHT ROOFING � � ❑ HOUSE ONLY NUMBER OF SQUARES �3.HOUSE & GARAGE GARAGES ❑ ATTACHED GARAGE PROPOSED SIZE: -�DETACHED GARAGE PROPOSED HEIGHT: SIDING ❑ Vinyl ❑Soffit ❑ Aluminum ❑ Trim ❑ Other ❑ Fascia WINDOWS iN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE RJSTALLED NUMBER OF WINDOWS Permit No.: � Received By:_ Date Rec' d: � TATEf�P �Z]P A FT ��"'�� BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION �NCLUDiNG DECKS, ADDITIONS. & PORCHES SUBMIT l. 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 N'�;�;5 AK�; BASEll ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) COTAL 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 $ �,� j See Back Page for Fee Schedule $ 65% of Building Permit Fee $ �] .001 times the total job valuation $ .0005 x Permit Valuation Minimum $5.00 $ � f (_` $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 ( ) $ � , J� Make checks aavable to: Citv of Fridlev Attach ulations 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 ordinance ° od of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application mit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all � �hich r uires review and approval of plans^�'��' � �l � "`� _'') .� �� SIGNATURE OF APPLICANT � PRINT NAME -� 1��i DATE APPROVAL INSPECTOR SIGNAT E "'� ! 7 (� � ��x�