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P - 48521Building BUILDING Perinit No.: ��� �t Inspections RESIDENTIAL APPLICATION Re�e��ed ay: ,. 76�-572-3604 CITY OF FRIDLEY ��'�e'c�� � 7�,3-502-4977 FAX GFFECTNE 1-1-201I DATE °'�. -`_ �' �"/ SITE ADDRESS ,.?,/ THIS APPLICANT IS; PROPERTY OWNER/ TENANT ,/% i��%�� �OWNER NAME: . ` L PHONE , YOUR E-MAIL ADDRESS `�� � G`� C�, � o�„��� ,�� , �(,� � ❑CONTRACTOR �SG' �!� ��1� ������/���� CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE LICENSE STATE LdCENSE # LEAD CERT NliMBEF AND CER"I'IFICA"I'E OF ADDRESS: _ CITY INSURANCE PHONE p� PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAG6/SHED ❑ WINDOWS �7"$ASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR �8'RGMODELING DESCRIBE WORK BEING DONE: l�"e��1/v U� G���"�Ll/ �" Li (.�ii�"I�rG`�� SIZE OF IMPROVEMENT ��� .`—>jy i ROOP'ING NUMBER OF SQUARES GARAG�S PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other V►'INDOWS IN EXISTING OPENINGS ❑Yes ❑No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & LENGTH G� ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS '�,'/7,'�l.5fi ./t-�'I` �� TATE rj� IP .� STATE ZIP �v'�iC��;-� �r�.�` � r����- % � HEIGHT SQ FT BASEMENT REMODELING SUBMIT 1. Existing Floor Plai� 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION iNCLUDING DECKS, ADDITIONS, & PORCHES SUBMIT l. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans 3. Energy Calculations FOR WINDOWS — PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW. TYPE OF WINDOW TO BE INSTALLED <' NUMBER OF WINDOWS I ALL FEES ARE BASED ON VALUATION INCLUDING THE COST OF LABOR AND MATER TOTAL JOB VALUATION � Pennit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due � IALS. • �.(y��G THE 1997 U.B.0 FEE SCHEDULE) Cs �'�' � OCCUPANCY TYPE $ $�Z See Back Page for Fee Schedule $ �. r"✓• 65% of Building Permit Fee $ .0� .00I 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 ( ) $ (� . � Mal:e checks payable to: City of Fridley Attach Stipulations 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 pennit on site; that the wark will be in accordance with the approved plan in the case of all w�irk��vhich r�u"�,-� s review and approval of pl�" , SIGNATURE OF' APPL[CANT --�� � �% � ✓`—`�'��,._. 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