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P - 48074Building Inspections 763-572-3604 �63-502-4977 FAX DATE ' I ' � SITE ADDRESS �� THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBNIIT A COPY OF YOUR STATE LICENSE Arm c��ca� oF INSURANCE PROPERTY TYPE PERMIT TYPE �rYrE oF woKx: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE l 1-2011 YOUR E-MAII. ADDRESS ❑ OWNER NAIvtE: � � 1� ADDRESS: GJ� L PHONE: —1 lQ � NAME: STATE LICENSE # PHONE I l0 � S• �/ 1' l 1�� ❑ SINGLE FAMII.Y/NEW CONSTRUCITON ❑ TWO FAMII.Y/NEW CONSTRUCITON ❑ BASEMENT FINISH ❑ DECK ❑ NEW HOME CONSTRUCTION a Mnnv�r�nrrc�rnm nESC�E woruc BmvG norr�: ❑ SIDING LEAD CERT NUMBER [ 1� CI'I1' � > Fnx ' I� SIZE STORIES 'ISHED ❑ WINDOWS 0 DRAIN TII.E ❑ OTI�R NG POOL ❑ ADDITTON ❑ REMODELING ---- � r '—'-'-- Permit No.: Received By: Date � ROQFING ❑ HOUSE ONLY BASEMIIdTT REMODFddNG SUBMIT: NUMBER OF SQUARES O HOUSE & GARAGE 1 Existing Floa, P� GARAGES /��� � ATTACHED GARAGE 2. Ptop�ed flo� plan PROPOSED SIZE: o[.JC � � DETACHED GARAGE 3. List of stmctuial members ta be usod PROPOSID HEIGHt�7�'.���.� yJl �[d.�' Q �'�{ 6 �ING � � � Ja`� � �Lj �`�3� � W CONSTRUCTION Il�iQ.UDING DECKS, ❑ Vuryl �Soffrt SIDING/SOFFIT/FASCIA DITIONS_ & PORCFIES SUBMiT_ ❑ Aluminum ❑ Trim REMOVED? 0 YES 0 NO 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia � P�P� P�J� 2. Two sds of c�sh� plans WINDOWS 3. Faeagy Calcuiatioos IN EXISTIlJG OPEIVINGS OYes ONo LOCATION OF WINDOWS FOR W[NDOWS — PROVIDE U-VALUE AND OR FOR NEW OPIIdINGS-DESCRIBE SIZE OF MANUFACPIJRE STICKER ON WINDO�V. OPENING CHANGES 8c TYPE OF WINDOW TO BE INSTALLED NUMBER OF YVINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: ^�� (�T�SING 1'�IE 1997 U.B.0 FEE SCAEDULE) TOTAL JOB VALUATION Permit Fee Plan Review Fire Surchazge Surcharge License Surchazge SAC Charge Ctub G�t F.scrow Erosion Control Park Fee Sewet Main Charge Totat Dne $ '� 1"I � `� See Back Page for Fee Schedule $ 65% of Buiiding Pecmit Fee $ .001 times the total job valuation $ .0005 x Permit Valua6on Minimum $5.� $ $5.00 (State Licensed Resid�tial Contractors) $ $2230 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$25=5 $ $450 Conservation Plan Review $ Fee netermined by Fngine�ring $ Agreement n�essary ( ) Non Necessary ( ) THIS IS AN APPLICATION FOR A PIItMIT-NOT VALID UNTII. PItOCESSED I hereby apply for a building peimit and I ac�owledge that d►e information above is complete and accurate; that the work will be in conformance with the ordinanc d cod� of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applicati fo a permit and �v k is not to start without a pennit on site; that the work will be in accordance with the approved plan in the case of 6r1 hic t�t ' approval p� �e� SIGNATCTRE OF APPLICANT P NAME IrU DATE ��` �' t� APPROVAL INSPECTOR SI A ���a_f.-rac���r�v�.ya�:�:c�ra�a:���,�r�.�_�-:�:���in�:�au�u;�����.�.i:i�.�c�a�a�rr:�CMe\�I_�.i��,��a�:r:��`ltMc�A:•c��;�;� . � , h � � W �i n � � ti L � w � �� -�' N - �` � � � � N V : '�Ci � � O r�" � � �� . � � � � � w � l/� � _� � � � � -� 3� �� � � ��- - -a � � � 7� (�-- . � � r � � � � �t � � / � a� ��� v ,� .� _ � 02�����' ` � � `? � �i � � � w ' °� � . ,� : � � ._._...�.. - � �g � .:, � � '� u � C;a � � .� v � t..� - � ; t�" � 5 t � �� ca � � '�.�� � � � i C. �� L:.; ,�^y !'"" � � . � .. r . . �t . 4:� e � • � �� %-'� �' 11' �,� • ��i � �� �s � ���" --�� ✓ `°� � v '� ' " �.���� �� � ��i f �--� �'; ;�... ..� � � � � - . � f"�'} �� �'"�'� a� ��. � � � � - � s j Z:3 � "4S. ...` . �, �. 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