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P - 48372Building Inspections 763-572-3604 763-502-4977 FAX BUILDIN(i Permit No.�- RESIDENTIAL APPLICATION Received By: CITY OF FRIDLEY vate Rec'd:� FFFF('TIVF I_1_�(171 DATE �1.�-11 '�- V[i � c%� 1 � SITE ADDRESS I� I� � l�S ��� Y1 THIS APPLICANT 1S: ❑ OWNER PROPERTY OWNER/ Np,�tE: _._I l�C TENANT qDDRESS: i 51 ounr.i�. I/% I.� � CONTRACTOR SUk3M1'T A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE NAME: STATE YOU� \ �NTRACTOI �s '� � -J-� , � 9 5�5���1 �.�,r��1� ADDRESS � �`�_rC' {��yf) ' �[� y PHONE �'�":.� � /�-" 7. (E%: �! k ❑ SINGLE FAMILY/NEW CONSTRUC"i'ION ❑'I'WO FAMILY/NEW CONS'IRUCTION PERM[T TYPE U ADDITION LJ GARAG � BASEMENT FINISH �I ROOF ❑ DECK ❑ SIDING ❑ SWIMM TYPE OF WORK: ❑ NEW HOME CONSTRUCTION � MAINTENANCE/REPAIR �C[TY � �� (� � C' 5� Y1 _ "C _ �I'� �" �•" ` [ EAD CERT NUMBEI� � �� •- �l� � C[TY ! � CLL�'7'v FAX ��'_J "'t T / SIZE STORIES ❑ W[NDOWS ❑ DRAIN TTLE ❑ OTHER ❑ ADD[T[ON ❑ REMODELING DESCRIBE WORK BEING DONE: � V' 2' C- .LQ,i1 �-z--� l:= j` l.�Jp " Y 1 `.'Vl. f 4_.M�.�' SIZE OF IMPROVEMENT NGTH WIDTH HEIGHT S FT ROOFING ❑� USE ONLY NUMBER OF SQUARES.� 1�1-I�H3E & GARAGE BASEMENT REMODELING SUBMIT: I . Existing Floor Plan GARAGES ❑ AT'TACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FORNEW CONSTRUCTION INCLUDWG DECKS, ❑ Vinyl ❑Softit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. EnergyCalculations IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS FOR WINDOWS - PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPF, OF WINDOW TO BE INSTALLED NUMBER OF W[NDOWS ALL FEES ARE BASED ON VALUATION, [NCLUDING THE COST OF LABOR AND MATERIALS: USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ �� � OCCUPANCY TYPE Permit Fee $.;�,_3 . 5�� See Back Page for Fee Schedule Plan Review $ :d� FI- 65% of Building Permit Fee Fire Surcharge $ W�fQ .001 times the total job valuation Surcharge $ -�!}-ref� .0005 x Permit Valuation Minimum $5.00 License Surcharge $ dr . C� C�' $5.00 (State Licensed Residential Contractors) SAC Charge $ AI� �� $2230 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ �� ft + 6 ft = ft x$25= $ Erosion Control $ ��� $450 Conservation Plan Review Park Fee $ �� F} Fee Determined by Engineering Sewer Main Charge $ f,j /}� Agreement necessary O Non Necessary O Total Due � �$ Make checks a able to: Cit of Fridle Attach Sti ulations THIS IS AN APPLICATION FOR A PERMIT-NOT VAI,ID 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 permi 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 1,�r�,whicl requires review and approval of pl ns. 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