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P - 48575�►�'ding BUILDING Insp�ctions RESIDENTIAL APPLICATION 763-572-3604 CITY OF FRIDLEY 763-502�49%7 FAX EFFECTIVE I-I-2012 DATE �3 -� b���" YOUR E- L ADDRESS si�,a�DxESS �c�e`� ^ /'`-1� r.�L � �.�� jZ,z� t-� `-� , fi THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE ❑ OWNER i'-��.L i%�� C�C�f-c IZ��T c.� ADDRESS: •5 ��J' I` 3/2b Sv fi` /�� CITY PHONE:_ � �.� '--�00 �—�cYD �'' Permit No. Received By:� Date Rec'd;�; � 3 Z-- � �SS a Z NAME: ��C-td- C B�tL s��-t-� �`�i [` ti STATE LICENSE # LEAD CERT NUMBER EXP: ADDRESS: 16.5�L.5� r4� t� �-�� S✓ CITY��'i.�} ( e�E STATE!1 IP 5,� �SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCI'ION ❑ BASEMENT FINISH �ROOF ❑ DECK O SIDING ❑ NEW HOME CONSTRUCTION ❑ ADDITTON �QAINTENANCE/REPAIR „ ❑ REMODEL: DESCRIBE WORK BEING DONE: l��--/ SIZE OF IMPROVEMENT FAX SIZE ❑ WINDpWS ❑ DRAIN TILE ❑ OTHER � FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES �iZ- �'HOUSE & GARAGE BASEMENE 'RE gOD�i p�G SUBMIT: GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ,�'DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: `� \ SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vin I ADDITIONS. & PORCHES SUBMIT: Y ❑Soffit SIDING/SOFFIT/FASCIA �. Site Plan/Surve showi the existin strvctures ❑ Other�num O Trim REMOVED? 0 YES O NO �d proposed project. � g ❑ Fascia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS - PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: USING TH�l�,Q97 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ ��5.��. � ._ OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surchazge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ See Back Page for Fee Schedule $ 65% of Building Permit Fee ' $ .001 times the total job valuation $ � S Q .0005 x Permit Valuation Minimum or .50 $ $5.00 (State Licensed Residential Contractors) $ $2365 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$25=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ %% , u Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT-NOT YALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge 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 pe it work is not to start without a permit on site; that the work will be in ccor ce with the appmved plan in the case of all w e uires vi w and approval of plans. SIGNATURE OF APPLICANT NAME DATE �"� APPROVAL INSPECTOR SIGNATURE �! i� i.�, �' � � � I��ti����� �t:.�IvICt�'Ai., C'F''�`i"��t, •�i�3k iJNT�ERS�'i""t' A'l'�. t�3.�. i��.�i3�.E'Y, h�i?� ��4`�2 •(7�i�) S?�-'�4St� = FAX {.7�S3j S7i-12�+"� � � � �` 1 4� '# . } � M � M 9Y� � i! �t t.1fiC��Pvfi�t1G� ��"lc"i� ��E: �'��'�� t1� �iiilii�"�sQ� requir�� ttt�t �II r�s�ir��ntial building cc�rttt�ctc�rss, remv��i�r� �nd ror�fiers obfiain a sta`te li�n�� c�nles� th��+ qu�lify fc�r a speci�c ex�mptic�� fram tt�e i�censing req�a'rr�men#s. As ��� o�n�r c�f th� prcapertY �t , Frid�y, 1 �m exern{�t frc�� t�� �t�fie licensinc� re€��irement t��:ly if !�rn nat bu��d�n� �r imprt��ing th�� �rc�perty� f�r p�rpas�s c�# r�sa�e. B�y sig��n� t�i� c�ocurr7�r�t, t at��t tc� the f�ct th�t I am im�rc�vir�� thi� h�rus� f�r my av�n us� ar�d �#c� n�� int�nd ta s��f 'rt. E here�y� c�irn % !� ��terr�}�f f�c�m th� state [ic,�s�sing requir+�m�nis be;cause 1 am r�rat in the bu�'rrt�s..s e�� t�uiki�n� s�r r�rr�c��lir�� c�� sp+�culation �r ttar r��l� and th�t ti�� F��use tor v��i�h I am a�A1�in� fc�t t�i� �rm�t, i�l tk�e �rst re�id�r�t�a1 �tn��iure [ fi�v+� b�ai�t c�r irnprc�v��i irt #he p��t �4 r�c����, i���a �c�r��rteci�e t��t b��u� I d+� �€�t h�v� a�i�t�; ii�ns�, i€vrfi�i� �r�y ���h�r�i�'� �i�r� r��ts tc� v,�i�ht t r��y r�t�en�is� h��v� k��� +entit�ed unc�er �inr�. t. a "! 4, f�'� . F€ar`�herrn�r�, !�c�nc��ledge �at t t�ayr b� }�ir�rrg t`r��i��ettder�t c�or���a!r� tc� �r�c�rm c�r�in �s���i� r�f i�� cc�n�i�u�iion c�r ir�prc�v��e�t af ti°�i� h�us� �r�d !��d�r��a�� ih�# �te t�� t�t��� cc�ntr��tc�rs may be r�t�ir�d tc+ b� [i�nseci by th� St�ie Qf Minn�ia. � ' , ur��r�t�ntf th�t un[ic�ns�ed resid�ntiat ca�tr�etrn�, remade�ing, and/€�r r�afing sctiv� `t� a mistf�m��rsor u���r �'Cir�rre�ota I�w, �rtd th�t f wc�uld farFeit my ri�hts to r�:itr�bursern�r�E frQrn tt�e Garttr�ctor's Rect�ve� ��nd in th� ev�nt fha# an}r ct�r�t�actars I f��re �re ur�ti�r��e�3. .� �-� . �-. ,� . . : -�.- • . � . � � : " �b #i ! "' ! • ` � i i « p t i . • "" M � • � ♦ ! "" � � M � � ! � �r E �� �� � M � ` #r :' d� °i � i i— � � ., �1,�/ 1 � ���� �-- � - > �--