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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