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P - 48256
Building Inspections 763-572-3604 763-502-4977 FAX BUILDING RESID�1_1T���, AppLICATION CITY OF FRIDLEY __ EFFECTIVE 11-2011 DATE �LO • D! n1I SITE ADDRESS 1 �� I LN wJe [1., � rc THIS APPLICANT IS: PROPERTY OV� TENANT SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TypE ❑ OWNER Pernut No. f)� 1 I- Received By:� Date Rec'dl� YOUR E-MAIL ADDRESS , ` � �CONTRqCTOR NAME:�� .4nnxESS _U��S � �r crrY ,...,._� � L� � _�-b _ � STATF �ro NAME: � STATE LICENSE # �.6te AK Z� AD CERT NUMBER N/V{ •�Zq7-1 EXp; y.(� .��6 AnDxESS:�Ie�iD C �;. p�,r +��� crrY�V�_ �ll�. �SiZ4 PHONE QS1. S'cAI _ 2uwn d STATE ZIP ❑ SINGLE FAMILy/AIEW CONSTRUCTION ❑ TWO FAMII,y/NEW CONSTRUCTION u vnic(il� �BASEMENT FINISH ❑ ROOF ❑ DECK ❑ SIDING TYPE OF WORK; ❑ NEW HOME CONSTRUCTION u, W�G POOL O MAINTENANCE/REPAIlt �'�D�ON 4�REMODEL] DESCRIBE WORK BEING DONE:�S � � � '� tf��..r.we � SIZE OF IMPROVEMENT LENGTH � RO F O HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE G—�S ❑ ATTACHED GARAGE PROPOSED SIZE: ❑ bETACHED GARAGE PROPOSED HEIGHT: ❑ DRAIIS TILE ❑ OTF��t c �S {ony BASE. t�NT�I FMODELIN cili��uT• 1. Existing F1oor Plan 2. Proposed floor plan 3. List of structurai members to be used � FOR NEW CONSTRUCTION INCLUDING DECKS, � V�y� OSoffit SIDING/SOFFIT/FASCIA ADDITIONS. 8c PORCHES UBMIT� � A�uminum ❑ Trim o 1. Site Plan/Surve showin the existing structures ❑ Other 12EMOVED. ❑ yES ❑ NO Y g ❑ Fascia and pmposed project. ��W� 2. Two sets of construction plans IN EXISTING OPEAIINGg ❑yes �No LOCATION OF WINDpWg 3. Energy Calculations OR FOR NEW OPETiINGS-DESCRIBE SIZE OF FOR WINDOWS - PROVIDE U-VALUE qND OPENING CHANGES & MANUFACTURE STICKER ON WINDOW. TYPE OF WINDpW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATEgIAI,S; OTAL JOB VALUATION � � QG�.s a�oG T� C9�1�'B'C FEE SCIiEDULE) Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb G�t Escrow Erosion Cotttrol Pazk Fee Sewer Main Charge '° ��°' See Back Page for Fee Schedule $ �° 65% of Building Permit Fee $ 3� '� _.001 times the total job valuation $ .0005 x Permit Valuation Muumum $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 Deternuned by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ • — *..-• • - - - THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL pRpCESSED I hereby apply for a building permit and I acl�owledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridiey and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a pernut 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 wor hich es review and approval of plans. 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