P - 39652��
Building BUILDING pern ' .: -�l7
Inspections RESIDENTIAL APPLICATION Received By �
763-572-3604 CITY OF FRIDLEY Date Rec'd: /
763-502-4977 FAX EFFECTIVE 1-i-20ll
DATE 9-1-2011 YouR E-Mn�L aDD�ss msample@hwconstruction.com
siTE aDV�ss 5145 HuahPS VP FLidlev
THLS APPLICANT IS: ❑ OWNER I�CONTRACTOR
PROPERTY OWNER/ NA�: Allie Bernadine
TENANT ADD�ss: 5145 Huahes Av _ ci� Fridlev sTA�_�zlr 55432
rxort�: 763.222 _ 5174
corrr�cTOtt NAME: HO man eber Construction
SU$MIT A COPY OF STATE LICENSE # 4'0�32�JO LEAD CERT NUMBER
YOUR STATE LICENSE
arrD cEx�ic.a� oF Avv�ss: 7932 Universi� Ave. NE c�� Fridley sT�TE M��r 55432
�rrsu�NCE PHO� 763.300.65542 FAx
PROPERTY TYPE BI SINGLE FAMILY/NEW CONSTRUCT[ON SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE ❑ ADDITTON ❑ GARAGE/SHED ❑ WINDOWS
Cl BASEMINT FINISH � ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDiTION
Kl MAINTENANCFJREPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:��ppf $�pI't'1'1.�(�a�e
SIZE OF IMPROVEMENT LENGTH WIDTEI HEIGHT S FT
ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES �$ ❑ HOUSE & GARAGE 1. Existing Floor Plan
GARAGES � ATTACHED GARAGE 2. Proposed floor plan
PROPOSED STZE: ❑ DETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
SIDING FORNEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit ADDITIONS_ & PORCHES SUBMIT:
❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures
❑ Other ❑ Fascia and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXIST[NG OPENINGS ❑Yes �No LOCATION OF WINDOWS FOR WII3DOWS — PROVIDE U-VALLTE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW.
OPEAiING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUllING 'I'HE CUS"1' UF LAI3UK ANll MA'1'L+'KIALS:
SING Tf3E 1997 U.B.0 FEE SCHEDITI.E)
TOTAL 30B VALUATION $�li V __ OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Suroharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main C'harge
Total Dne
$ 8'3_ ��'
$ w—�-
$ �. S"'b
$ � a s--
$ � O�
$
$
$
$
$ _ d �+
See Back Page for Fee Schedule
65% of Building Pemrit Fee
.0(11 times th� total job valuation
.0005 x Permit Valuarion Minimum $5.00
$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 Engineeting
Agreement necessary ( ) Non Necessary ( )
to:
Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge that the information above is complete 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 work which requires review an�p proval of plans.
SIGNAT'URE OF APPLICANT l) ��'r�rrT �ME Mike Sample nA� 9-1-2011
APPROVAL INSPECTOR SIGNATUR�E � �__ L� __ __ G"
NOTE: SEPARA'� P OR PLiJMBING, ELEC'TRICAL AND