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P - 48581Building Inspections 763-572-3604 763-502-4977 FAX DATE ��Z SITE ADDRESS � 3� THIS APPLICANT IS: PROPERTY OWNER/ TENANT BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY i-i-ZOiz Pernut No.:2b 2- �� Received By: ��dt� �- �+ �� Youx E-�L ADD�ss 1a c �c�c ( � � �e� l ,S a-rc� �u «5 . �� ❑ OWNER �C,'ON'I`RACTOR NAME: �qd'�d"!� aDD�ss: �7 ' PHONE: �� Zj "' � I� � 3 71 STATE ��✓ZIP CONTRACTOR NAtv�: C�aci ��'�'uc� �tS �lC SUBMIT A COPY OF LEAD CERT NUMBER �/a EXP: YOUR STATE LICENSE STATE LICENSE # P'�.,t�13 �R��l AND CERTIFICATE OF ADDRESS: OZ D� (� CITY (��0. ✓4't�`�r STATE �'WGIP�� INSURANCE PHnNE ' I Z — Z4B�� i�L'2_ - F� PROPERTY TYPE PERMIT TYPE �INGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION ❑ ADDITION ❑ GARAG ❑ BASEMENT FINISH O ROOF ❑ DECK ❑ SIDING ❑ SWIMM POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION p MAINTENANCE/REPAIR � REMODELING ❑ WINDOWS ❑ DRAIN T'ILE E10THER DESCRIBE WORK BEING DONE: �,7��. y w� � l ►'� D�`-i+� R��'^ /4','' `�1s6� SIZE OF IMPROVEMENT LENGTH g� WIDTH �� HEIGHT �� S FT ' ROOF`ING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, S IN ADDITIONS & PORCHES SUBMIT: ❑ Vinyl ❑Soffit SIDING/SOFFIT/FASCIA 1. Site Plan/Survey showing the existing structures ❑,e,lum�num ❑ Trim REMOVED? ❑ YES ❑ NO and proposed project. ❑ Other ❑ Fascia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFAC'I'IJRE SITCKER 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: SING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $'� Z�'�7S OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $ s.�i7 $ $ $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .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 ( ) Make checks payable to: City of Fridle_y Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UN"1'IL PROCESSED I hereby apply for a building permit and I lrnowledge that the information above is complete and accurate; that the wark will be in conformance with the ordinances and codes of t City of Fridley and with the Minnesota Construction Codes; that I understand this ig not a permit but only an application for a permit and rk is t to start without a permit on site; that the work will be in accordance with the approved plan in the case of a ic e re ' and approval of plans. SIGNATURE OF APPLICANT PRINT NAME ��-C14 �. O�'� � DATE�Z�� Z APPROVAL INSPECTOR SI TURE PLEASE NOTE. SEPARATE PE TS RE UIRED FO PLUMBING, ELECTRICAL AND MECHANICAL WORK �L � � !�� °�./�f.. � � � � � � �� ✓1 , �� r �j �� x � � � t'Sa� � �� ara� �'fl a�� ;�M1r �W �ty' �� `�= � � � � (� r ' � � � � ti � � �.M G � M �--Q � �`' , . a � ,M ' �..� '� � �� I V ' Q W�f � � o �o a�s V ' � � , � # � � �� t�(1 G M �' � (� �M ��- . G � J ' � � � � � �� "� �d4.� � �i f A 1 . . . �' � � � � � �., � �� Or� �J./ �� n � �� S� � � �� —� —�-- , .� �� ,� �M �nI m C M �^E � � �� S�'_ � .. �