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P - 84267� 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. 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