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P - 37482Buildi�g Inspections 763-5'��-3604 DATE �' Z�'I ' I SITE AUDRESS _ THIS APPLICANT IS: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL 3� ' n e� � a�- /V� ❑ OWNER PROPERTY OWNERi NAME:�O� � �ll,�.. �il�Ol'�� TENANT ,,,DD�SS: " `` �_ cT� PHONE: ��P3• S7I ' �Z%3 CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE TYPE OF WORK: � Permit No.: Received By: m� n n�2so-t-�- r U, s e v� c v r�-� STATE LICENSE # � �73 � EXP DATE ��I / ADDRESS: SSSS -�'� CITY, PxorrE 95z • 935 •�(��eg F,� asz • 93�5 • qs. ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY ❑ RASEMENT FINISH � ROOF ❑ DRAIN TILE 17 UE�K ❑ �IDiNG ❑ OI HER � SWiMMING POOL DESCRIBE WORK BEING DONE: SIZE OF NUMBER OF SQUARES _ GARAGES PROPO5ED SIZE: PROPO5ED HEIGHT: t i/l LBNGTH WIDTH HEIGHT � HOUSE & GARAGE ❑ ATTACI�D GARAGE ❑ DETACHED GARAGE � A,��p553`�3 BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structurat members to be used SIDING FOR NEW CONSTRUC7'ION MCLUDING DECKS, O Vinyl ❑Soffit � ADDITIONS. & PORCHES SUBMIT: � Aluminum ❑ Trim �y�,� 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. WINDOWS 2. Two seu of construction plans IN EXISTING OPENINGS ❑Yes o IACA� N OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS-DESCRIBE SIZE OF 1�.I ��iC ./�O6YY� OPENING CHANGES & � TYPE OF WWDOW TO BE INSTALLED Bl�i NUMBER OF WINDOWS ALL FEES A.RE BASED N VALUATIOIV, INCLUDING THE COST OF LABOR AND MATERIALS: (LTSING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ ��• a° OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Chazge Curb Cut �scrow Erosion Control Park Fee Sewer Main Gharge Total Due $ ¢7• ZS $ $ � 43 $ /. $ � $ $ $ $ $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 per SAC Unit (Plans to MWCC for determination) ft+bft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach lations THIS IS AN �PLICATION 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; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. � SIGNATURE OF APPLICANT PRINT NAME W� � �� DATE � � � � Z � � 0 � � ��_�_, ��:� � �� r � �. �, � �� . �� . _,-- � � � �'j" �' � J �. '" � � � ♦ . � �- � � 0 � � � C � � � � � � N t� � � �. ., � � �,�- �� _�, - ; c� �. ; � � � �, ', �� ` a� ��A,.�� ,� _ ��:�,,�� .o �t G � � �� ' - = c� b � `� �.� �� -_ _� _`_. : O �'r � � � C �, � _ � � � -� � � � �� .w ! � �C �. N , � ,, o u �;, U � �t �` �, � �. � O � �, � 'v � �� N� �` � �_ v . - � �. � � �,- _�- � � � o �` ; G � =�. �c- -�.. � � � � � � I � �' c� �� ' �� d1 �- m � C � � _ � �� C � � � \ : ' :� s � ., . ; � f. . . : ...� �. � � E � � � � � :x i u , ;� . :� :; � S � } 6p i p i �i � � � � ,� � ': � f 2� w i} 3 � f Y; 1. � � ��y,�sFwrc,� ... � � � '�+\ � � � � � �: �� - ,�.;,. � � , = �, � � ��'.� � �.F:� �,� _� ._ ,� ..0 . � . �.��. > .... �. � :E� _. � . :� � �.,;.�,; � . �� , .. � �.w �, , _�. ..�, ..._� ,ti..,.,��.- - � ., _ .. � ,. .._,�, , .�,�..�._ �_ _ ,t. , ..,� __ �... . _ : �, -- , . r s n .,�s, �,y<�. r �, . ,,, �-.: � ~ � �' ��.�r � i� +.' , . �.. .� __�,.._. �i �� . ��P#R� � � . # .. : � al��'�.` . _..< _ � �� rt� �,.._>`�� _�i - ( � \ � \