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P - 45775)' L^ . �� Ce�, � � _ �5 � C� " � :.:> ; Building BUIl.DINCi Permit No.: %� b �- Ins ections ` la RESIDENTIAL APPLICATION Received By: l o t� 763-572-3604 CITY OF FRIDLEY Date Rec'a: 763-502-4977 FAX E�FECTivE i-i-zol� DATE�/a� / ZD�� YOUR E-MAIL ADDRESS `G�'l 1^ G✓ SITE ADDRESS O '� THIS APPLICANT IS: ❑ OWNER �CONT CTOR PROPERTY OWNER/ NAME: r�C �r TENANT ADDRESS: Sd77� ���5 I��t �I� CITY '{�'Y��s( �Ly STAT ZIP S'syzr PHONE: CONTRACTOR NAME: S-�V SUBMIT A COPY OF STATE LICENSE # 2 O(Q '� O 5/ � LEAD CERT NUMBER � ��O�S�f � QOO lp $b YOUR STATE LICENSE / "� AND CERTIFICATE OF ADDRESS: /�/� /,J La Kt, �-� CITY%i7j�f�$' STATEI%N�IP Ss�O INSURANCE PHONE � ��� � �/S FAX �. � �Z 3 � �6 PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH (�'ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: �L�u l� T/tt e.vyta.,,r_ �� v��j Sy��.�e�Qls� SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT 5Q FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES Z �• 4 ` \�, �HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES t \/(� �� .�ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ��' � ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: � SIDING ��y ru � n� C`ftC f1 f'��r� �-�`�"t ��r �i' �Q�"� FORNEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl Soffit ADDITIONS, & PORCHES SUBMIT: ❑ Aluminum ❑ Trim l. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ ��I �0 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 $ $ �� $ $ $ $ $ $ $ �. % See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $5.00 $5.00 (State Licensed Residential Contractors) $2230 per SAC Unit (Plans to MWCC far determination) ft+6ft= ftx$25=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach 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 connplete 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 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 plan in the case of all ich requires review and approval of p�. ` SIGNANRE OF APPLICANT �s� PRINT NAMF.� /L � � DATE � �� APPROVAL INSPECTOR SIG'IVATURE