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Inspections
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763-502-4977 FAX
SUILDING
�ESIDENTIAL �iPPLIC,A,'�'��lv
CITY �F �'RIDLEY
. FFFECTIVE I-1-20u
1'ermit No.: � �� �(�C�>
�teceived By:
��te�.:
DATE !� '' ✓'9 }� ii Y�LIRE-MAILADDRESS I�G.S� C��(rSrtl1�F/4t`� N�`%
SITEADDRESS L{L'7�`�. �%Ii�� `�^'J� ��:
THIS APC'LICANT 15: ❑ OWNEF �]VTRACT[)R T
T'1701'�RT1r OWiVER/
'�'�NANT
COIVTRACTOR
SCJEMCT A COP�' OF
'YQ�it STATE L[CENSE
AND C�R.TT�TCA'i� OF
INSURANCE
PROP�RT'Y T�'pE
P��2MYT TYPE
T'�'P� O�'
DESCRiBE WORK BE1NQ
%� � � CITY ��`
PH�1�$;
NAME: l��lQ/+� �/i�SJ"i��C,�`�/ �e'�'C'1GG .�.li�f�
STATE LICEhI5� #_. ,'r� t7 k� 3[9u 5' '�,�' W �.�AU C�,TtT i��1M��,�t ���11
A17D�SS: � �7 �lI�N.'� .`,�% /1!6'`� CITY t�[1%�
FHUNE��d � °��7'' y� � � FA?: ���"�� �"�TS �y
❑ SINGLE FAMILYlh[FW CONSTRLJCTION SfZE
Q 7'VVU �'AM1LY/NEW CflNSTRUGT1pN STOR[ES
17 ADDITidN p GARAGE/SHED ❑ WRvI3UW$
❑ BAS�MENT FCNISH ❑ ROOF C] pRACN TILE
❑ BECK O SIbR4G �3�OTNER
Q SVVIMMING PI�OL
I� NEW HOME CpNSTC2UC"frON CJ A�I71T30N
C] MAfiJTENANCE/REPAfR
;: I�:MWI� iU�
Ct06�YlvG
NUMHER OF SQUARES �
GAIiAGE3
pROP05ED SIZE:
PFLOPdSED HEICrHT:
1S DINC
❑ Vinyl
f� Afuminum
❑ Chhcr
WrNbf7WS
fT! EXIST[Nr QPE1+IiNGS ❑YGS C7N0
OR FCJR NEW OPEhlINQS-DESCRf$E S1ZE OF
OPENiNG C1-CANG65 &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINdQW5 �
VALU.4TIQN, INCLUDING TH� C�Si' O� LABOR ANb MA
J(�YrS1T�l7�G T�T� ]99� C7.B.0 ��E SCHEDUL�)
�G 1lI� ' .. . . !l/""�f�iiT � I�IP'�\I
�1;:_7� ✓�6 �,� �
l% W117TH �
4 1-lOUS� ONLY
� FiC�USE �@ QARACrE
(J ATTACHED GARAGE
4 t7ETAGH�D C'sA�tAGE
�]Sotiit
E7 Trem
l� Fasci a
LOCATIQNOF Wl?dUUWS
COTAL JOB VALUATIOi�I �
Permir Fee
Plan Iteview
Fire Surcharge
Surch$rge
License Surcharge
SAC C�argc
Curb Cut �scrow
Erasaon Gantral
Park Fee
Sewer Main Charge
Total Due
�
A
A
� �— F�1n, r� � r
f i.E]GHT
FT
�
9ASEMENT REMtlI7EL1NG SCJBMTT:
1. Existing Floar Plazi
Z. Proposed floor plan
3. List of structural mcmbers to bc used
J
F(?R N�.W CONSTRUCTIQN 1NCLUDIAlQ DECKS,
ADDITIONS & PORCHFS SUBMIT:
l. Site P1an/Survey shuwing Ure exisiing structures
and proposed prpject.
2. 'hvo sets of canswctian plans
3, Fncrgy �a]culetipns
FI�R WINDpwS — PRc�V[pE U-vAI.UE AND
MANUFACTU�E STICKER ON WINDOW.
��f ���'"a
��
$ j�
� _> ��,
$
$
$ F
$
� 3
LS:
TYp�
See Back Fage for Fee Sehedule �
65"/0 of Building Pernnit Fee
.001 times the tott�l jub valuation
.0045 x Permit Valuation Minimum �5.00
�S,Qp (Staee Lic�nsed itesidential Contractors)
$2230 per SAC Unit (Plans to MWCC for dctczxnination)
ft+6ft= ftx$24=$
$450 Conservatian Plan Re.riew
Fee petermined by Enginteri�tg
Ag,-eement neeeasary ( ) Non Necessary ( )
Make checks navabie eo: Ciry af Frtcitev Attac
TH15 IS AN AT'PT,IC:ATCON FC�R A PEILMIT-NO'F VALID UNT1L PT20C�SSEl�
I hereb� apply fpr a huild'rng permit and 1 acknowiedge that the infprrxi�tian abave is complete and accurate; that the work will be in
ca��o�rrr�ance with the ordinances ac�d codes of ti�e City of Fridley and with the Minnesata Construction Godes; tltat r understand this is noe a
pertnat but only an applieation f�r a permit and work is not to s�art without a permit on site; that Che wark will be in accordance with the
approved pian in the ca� �,a11 �u which re uires revi�y✓ �id�pproval of ns. _� �
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