P - 48514�
Bu�lding BUILDING permitNo.:` bi�!�����d,
Inspections RESIDENTIAL APPLICATION Re�el�ea By: �) _,�
763-572-3604
763-502-4977 FAX CITY OF FRIDLEY vate Rec'ct:
EFFECTIVE 1-1-2010
DATE �� i�� �U YOURE-MA[LADDRESS L'�}"T Gd �' ✓�' .0 ' %��J� � �
SITE ADDRESS �SZ �� r� f✓"✓1 d1i
THIS APPLICANT IS: ❑ OWNER IliL:UNTRACTOR
PROPERTY OWNER/ NAME: J`� I'jc:,,�✓-- � �
TENANT f� �—=—
ADDRESS: � S'�� ,/1'I.t'�'�C7�L�� d�. CITY �Y'� STATE �1.G%GIP-=��
PHONE: !;� Z %y� ' �� 2-2
CONTRACTOR NpME: G� j' �i �: r i/l���
SUBMIT A COPY OF STATE LICENSE # LUCJ �3 Gi G> J� C EXP DATE I��%'7�
YOUR STATE LICENSE � , � �
ANDCERTIFICATEOF ADDRESS: L�S%�/ i'L�t�'c'y'C, rlj,/L. CITY �'iSr'�)O STATE:�t�Z1P `, ''''
INSURANCE pH NE ! — Z—` l FAX
PROPERTY TYPE SINGLE FAM[LY/NEW CONSTRUCTION SiZE 15Z�1_� i;_; f`;
❑ TWO FAMILY/NEW CONSTRUCTION STORIES�-�
PERMIT TYPE � ADDI7'ION ❑ GARAGE/SHED ❑ WINDOWS
� BASEMENT FINISH ❑ ROOF ❑ DRA[N TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ I�T.EW HOME CONSTRUCTION �DDITION
L�MAINTENANCE/REPAIR REMODELING
DESCRIBE WORK BEING DONE: � ?It'�c•e� h ;�/� 1i/ . J� - " '' � 7vvs ��t'�r� i%r�/� 'G <y�;�c���
SIZE OF IMPROVEMENT ��P.�Y Y �'' �� �� �� L� T � WIDTH HEIGHT SQ FT
ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT:
NUMBER OF SQIJARES ❑ 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:
SIDII�'G FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit ADDITIONS & PORCHES SUBMIT:
❑ Aluminum ❑ Trim l. Site Plan/Survey showing the existing structures
❑ Other ❑ Fascia and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR W[NDOWS — 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 BASEll UN VALUA'1'IUN, INCLUll1NG '1'HL CUS"1 UN' LA13UK ANll MA 1�KlALS:
� z(USIN�, THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ J(i�, Q���J 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
$ ��oa.�s
$ ,
$ 3 � ��
$ r-,,'
� r �.1�-
$
$
$
$
$
$
$ �"�Ca� �',`�
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2100 per SAC Unit (Plans to MWCC for determination)
�+6ft= ftx$24=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks oavable to: Citv of Fridlev Attach
THIS IS AN APPLICATION 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 of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit 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 work which re ui e's review and approval of plans.
SIGNATURE OF APPLICANT `'"r��.>�"�" __�_� PRINT NAME S�CL ✓I r'7G�'c`.,vJ DATE /�/`7,�L�
Page 1 of 1
.
Fitz, 11�ary
From: Julkowski, Ron
Sent: Monday, September 13, 2010 12:53 PM
To: Fitz, Mary; Jensen, David
Subject: FW: Matterhorn - crane coming!!
Will do
From: Otteson, Layne
Sent: Monday, September 13, 2010 12:46 PM
To: Julkowski, Ron
Cc: Kosluchar, Jim
Subject: Matterhorn - crane coming!!
�A couple builders came and wanted info on putting a crane on Matterhorn to place some gl�ie la�ns. It will block 3/4 s of the road. I
told them they would need traffic control and flaggers.
�We would like to add a couple traffic control provisions as part ofthe building permit. Can you let Jim or I know when the permit
comes in?
� Thank you,
Layne R. Otteson, P.E.
Assistant Public Works Director
City of Fridley
(763) 572-3551
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