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P - 40847Building Inspections 763-572-3604 763-502-4977 FAX BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-I-2011 Permit No.�C-�� Received By: , DATE O%—"23 —// YOUR E-MA1L ADDRESS �G G� V k' Y"1 Y1 � f�� r-'� c1 ? f� c' t'+Y}-'? SITEADDRE3S � 7; f �_�ct�--�eY'-�o✓r'i �✓/; . �!�-<��t,� , M�i� J THIS APPLICANT IS: �(1 OWNER ❑CONTRACTOR PROPERTY OWNER/ NqME: C-�rti?� .''�f �� F� '�'t_.` TENANT s ``;�y�� CITY /�%Z�/'J�EY' STATE�ZIP S54 �� ADDRESS = :: .� � � ' 9'�.., �E' ..`' � { ,� �, r^ r �'t PHONE: �i+�L-- ;��f_ �-!�G� CONTRACTOR SUBMTT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE NAME: 6��11��[�l�)�i[.Y�"J ADDRESS: PHONE ❑ SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION ❑ BASEMENT FINISH ❑ ROOF ❑ DECK ❑ SIDiNG ❑ SWIMMING POOL LEAD CERT NUMBER CiTY FAX SIZE STORIES o wn�DOws � DRAIN TILE � OTHER �ec_c-�ssd�Y TYPE OF WORK: I❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING STATE l3 �, l��r, ZIP DESCRIBE WORK BEING DONE: ! Z�X 18 � ;/1-E�� rM'f °'w �/Z /a i�c�i Yca a,� SIZE OF IMPROVEMENT LENGTH /P * WTDTH /Z � HEIGHT / Z� SQ FT ROOFING NUMBER OF SQUARES �_ GARAGES PROP05ED S1ZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Alumin ►�} � Other bCr 2� ❑ HOUSE ONLY ❑ HOUSE &, GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE QSoffit o�luH"�srr�r,'� �Trim ��h�ef =.. �,a�;-.�. �Fascia o.,/��^ � ^ �n" BASEMENT REMODELING SUBMIT: L Existing' Eloor Plan 2. Proposed floor plaq...' 3. List of structural members to be used FOR NEW CONS7'RUCTION RJCLUDING DECKS, ADDITIONS. & PORCHE� SUBMIT: I. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTMG OPENINGS ❑Yes �No LOCATION OF WINDOWS FOR WINDOWS — PROViDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF 30 �C L¢'�� 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: (US G THE 1997 U.B.0 FEE SCHEDULE) COTAL JOB VALIJATION $ � �� OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ $ $ $ $ $ /l r , � See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $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 Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks oavable to: Citv of Fridlev Attach THIS IS AN APPL[CATION FOR A PERMIT-NOT VALID 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 o Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for permit an � not to start without a permit on site; that the work will be in accordance with the approved plan in the case of rk � e' d approval of plans. /' SIGNATURE OF APPLICAN PRIT�T�AIAM �'7C!/�,YI /V I?ZSGl�K� DATE � 9'- Z 3-/� APPROVAL INSPECTOR GN / fI� � � � n� , ,� �, � �� (� � � v � � �— l � �� 1. 4. � � � c � � (_ � , �� i � VJ � 'n �� ( V J � � _ 1, ?� � 3 � .� �2 � �� _, � � � � � � � , � � % � '� � � o �� ; � J � � � � � � �i L r -' � � � � � �' � � � � 0 �� M �../ x �` � � � ,--G Y � 4 y� , ` �5C.�" 5..� � --� � � � � � �� ' 9 � ? N 0 � � � ti _r � �� fi) b � � d � � � G�' � fs � � �` � u S s � s � � � � � � � � �� r ! � � � � ; � ��` � UJ � � � � �� N � ^ � ^ _ �,1 -- �� , � �_ .� _ � Y � � � � _!1� � � ��