P - 47779Buildzzag
Ins�ECtions
763-572�3dQ4
763-502-4977 FAX
�U�LDYN'G
��S�DENTYA� APPLIC,A.T��N`
�iT� a� ���n�,��
DATE C)I%I�OJ I YOUR�-MAyC.,�nDRESS_ SaleS(c77,libEi'tVPfB.corn
SITE ADbFt�SS S 108 �-iu�hes Ave N� Fridley, M1V 55421
T'Ti(S APPLICANT IS; ❑ OWNER �1CONT12ACTOR Y�
PROPERTY QV
TENANT
s�u�sn�rr a capY oF
YdUCt STATE LICENSE
AND CERTIF[CATE Q�
INSURANCE
PROPERTY TYPE
PERMIT
O�
Permit N'o.:
iieceived By:
,�
�
Nar��� Mary �itzer
ADDRESS: S1OS HU�,h,��� AVe N� CITY_FCidle,�( STATE_j�j,ZtP 5542]
PHONE: �Fi�i- % .-R74Fi
N.aME: �.ibertv Exteriors L,LC
sr.arE�lc�rrs��a 246306$7 �.�ancERrrrurv���� NAT-40817-1
ADD�ESS: �40 Main $t N CITY C�ITI�?i1L'��_$TATE M+�lpSS00R
PHONE 763-6$9-�997 Fax 7F� FR9 R977
O SIIYGLE FAMILY/NEW CONSTRUCTION $�Z�
O TWO FAMILY/NEw CpN5TRUCTION QT(1RiFR
p $ASBMBNT FINI$H [d }�(jp�
C7 DECK ❑ SIDINCr
O NEW tiOMECONSTRUCTION � AT]T7CTPON
❑ MAINTENANC$/REPAIR � REM�Dfi41NCa
❑ DRAiN TILE
❑ OT��I�I2
DESCRieE waxrc $��tvc �oN�:_R.emove & 12eplace /�sohalt Shingles
Si2� 4F IMFROVEMENT LENaT� WI(}TH HEIt]HT S FT
NU�MBM r�E OF SQUARES ,,,20 O HOCJSE ONLY ��b��T REMODELIN St rRMrr•
- �I �iOUSE & GARAG�
ARAGES !. 6xisting Floor PlOn
D ATTACHED �iARAGE 2, Aro 5ed flo0r
PRQPOSED Si2$: ❑ pETACNED GARAG� � p��
PRpPOSED HET�HT: 3. iist ofsttuc[urai members to be used
SiC1iNG
❑ Vinyl
0 Aluminum
❑ Ocher
�SOf�t
❑ Trim
f3 �ascia
W�N!)OVYS
IN E?CISTiNG dPENiNC,S OYes ❑tvo LOCATION OF W[NDOwS
OR FOR N�W ppFN1�Gg_L7�gCRIgE SIZE OF
OPENING CHANGES &
}01� 7014L YNST
FEES ARE S�
fOTAL JOS VA,�,1
Permit Fee
Plaf7 Review
Fire 5urch&tge
Swcharge
Liccnse Surcharge
5AC Charae
Curb Cut Esorow
ECOSIOn �pntrol
Park Fee
Sewer Main Charge
Tptal Due
i�[�1v, INGLUDIN6 THE COS'�' O�
THE 199711.B.0 �'�� SCM���[1LE}
�����
�
�►
�i1
�'
�bR NEW �ONSTRUG"I'ION [NCL[fDlh10 if�CrCS,
ADDITIONS. & PQg,�'liES SCJ$MIT�
t. Sice PIaNSurvey showing che exisring svuccures
and praposed projecc
2. Two scu of consuuauon plar,s
3, Enetgy C91cu18ti0nS
F4R WINDpWS -PTtCVlD� U-VALUE AND
t�.axuFacru�� sriexER oN wiNnow.
MA
VL:CUPANCY_ TYPE
See Sack Page for Fee Schedule
65% of 8uilding Permit �'ee
.001 times tk�e tatal job valuation
.0005 x Permit Valtiation Minimum �S.OQ
$5.00 (State Licensed Residential Contractors)
$2230 per SAC i�nit (Plans to MWCC for determination)
�_�„___ft �- b ft = ft x $25� $
$450 Conservatron Plan l�eview
Fee betermined by Engitteerirlg
Agreernent necessary ( ) Non Necessary ( }
Make checks pxW�ble to: City of FrFdley AEtsch
TMIS 15 AN APPf.iCAT10N F�R A PERI'v1�T-NOT VALID UNTlL AROCESSET?
I hereby apply for a buiEding permit and i ackno�viedge that tha infprmation above is complete and accuraCe; that the work will bc in
conforrnanee with the ordinances and codes of the CiCy of Fridley and with thc Minnesota Canstruction Codes; that 1 understand this is not a
permit but only an application for a permit attd work is not to start without a permit on site; that the wor�C will be in accordanee with the
approved plan in the ease of ti o k whi re res review and approval of plans.
$IGNA"FUREPFAPPLICANT � PRCNTNply�_ (�,tj�aY j�Iilkinct�n DaT£�/9l2011
APPROVAL INSPECTOtZ SI URE
Wd 9£�9£�ZL 460Z/6/9 �al�a E/Z �a��d uMOU�un :wa�