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P - 48552�uilding Inspections 763-572-3604 763-502-4977 FAX DATE �- 7 � � BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECT'IVE 1-1-2012 YOUR E-MAIL ADDRESS SITEADDRESS � 3 / /�'1%3Si�sS��P�/ THIS APPLICANT IS: ❑ OWNER OCONTRACTOR PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DESCRIBE WORK BEING D( SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: NAME: �CON /,�/'OW/`/ ADDRESS: � '7 3� G 3 °�-•� < PHONE:_�� 2 02 !i �j'� 9 r a�^ UJ�'�✓ C,'�j �c%s�.! --ov��, Permit No.: Received By: Date Rec'd: CITY �''�1 i`�� STAT'E��'�LLIP '�� . STATE LICENSE # LEAD CERT NUMBER EXP: ADDRESS: %%/ d G �'.t/ � CITY ��j /� STATF/�7�IIZIP PHONE %(t � l�%02 ` � f �7� FAX 0'SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION sTORrFs O ADDIIION ❑ GARAG ❑ BASEMENT FINISH ❑ ROOF .�DECK � SIDING ❑ SWIMMING POOL ❑ NEW HOME CONSTRUCTION O ADDITION O MAINTENANCE/REPAIR ❑ REMODELING ,�/�G A' i Z- !r/_�C�. �?�i��p•� ,2,I'.�' J`7` r{� li � LENGTH WIDTH O HOUSE ONLY _ ❑ HOUSE & GARAGE O ATTACHED GARAGE ❑ DETACHED GARAGE ❑ DRAIN TILE ❑ OTHER l,1�1I�7:�11 FT BASEMENT REMODELIN �i MIT• 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit SIDING/SOFFTf/FASCIA ADDITIONS & PORCHES SUBMIT• ❑ Aluminum ❑ Trim REMOVED? ❑ YES O NO �• Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia 2. T o sets of conrstru tion plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACNRE 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: (USING THE 1997 U.B.0 FEE SCHEDULE) 'OTAL JOB VALUATION $ Z`� 59 OCCUPANCY TYPE Permit Fee Plan Review Fire Surchazge Surohazge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ $ $ $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum or .50 $5.00 (State Licensed Residential Contractors) $2365 per SAC Unit (Plans to MWCC for determination) ft+68= ftx$25=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City 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 d co of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application p ' and w rk is not to start without a p rmit on si e; that the work will be in accordance with the approved plan in the case of r' d approval of pl /� SIGNATURE OF APPLICANT PRINT NAME B�'� // ��%��DATE —�"� 2- APPROVAL IN3PECTOR SIGN TURE // � i� -� �:� CERTIFiCATE OF SURVEY MILNER IN. CARLEY & ASSOCIATES CONSULTING CIVIL ENGINEERS IAND SURVEYORS 500 W. N4VY. 96 314 OAK ST. 18 4TH AYE. S.E. St. PAUL 12, MINN. SAUK CENTRE, MINN. , ST. CLOUD, MINN. 484•3301 352•3664 251 •7751 1 hereby certify that this survey, plan, or report was prepared by me or under my direct supervision and tFyqt I am a d ly Regisi4red lp�d Surveyor under the laws of the State of Minnesota. ; � , , �" ir7 i_ ,� � : ` � , / �,. � _ �. _ `> :4Gr- � _..1'.. _ Reg. No. ' .Date_ F _'_..� > � , ��. � � �,. ' _ _....._� (. ��---- . � si /C° � � , - .G•D �.. J �_, � �r.._,...- _�-�-___. ... ._., � �\ � �� ,J�' ea�� . �, � ,� h ! 1I��?' � �� ;�_�_' ,. , � i �; �-e� �r. s ��G' 3 - Y': �:.:1 •-...... .....______.._._._.._ � ``t �--� � .^�. � � n-; /Y'/ S'S � ,. _ ��.. � ,� P f - - ------�----. _ , _ �� :� ;� r. � �„�,� � � .sr,� ��-� - ��c �,, L��:.:.',. 7, kI(:E CRE�.K i ER-Z;1��!" PL�;T 1 E`;�; ='ku. CG:;C11:.Y � 1 ^!i . � �� c;?%77� n. �• , � :c' � � �� .:!� N > /�7:� �= c�. �� .e-n��'�L � _._ .._._ �. . .. _ . __.., ._. �_ _ � T' � � 9- i/d' �84-/ . �- tn �,� � �'; � � � �� G�J` 1' � � / � �.- � �._��__. �= � �� G� G � �, �2— � M �,�_ . � ._�_ �, _ �; . - o � �' � �� .__T_ � �, �C, � .,::.,: 0 � i �_l _ : � � fi��, � ,� �-�-�- � c !; �► s�� d s� �� y. �—� � �- .� - + � � � � v � no o z� 3 � " m * --� � _� � � � I �-- �— � �"'�'-.. -� � � �,� �� = �-- p � 9� �, � � � � �� -�'1- � 3 � � :� � �� = ,� �� —_ ___._ _ _ _ ._�. ___ � e�� .� �/�� s� �c��n � � . �_ __ . __�, � � � i � � � �� `� � �� r � ---� � � � __._._g -� � f � � �1 r ,�� M `\. 'V � " � � � �� ~ �� V �,� � �- � �, � �._ �� r \' �^ � �i, �- c�= ^ � � a� � � �� Q� � � � � � a � �_ � � � .� �� J �� r �' r � l� n � � � �_� - � � � fw � � �