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P - 48449Building BUII,DIN(s Permit No.: Inspections RESIDENTIAL APPLICATION Re�ei�ect B: 763-572-3604 CITY OF FRIDLEY �� ` � 763-502-4977 FAX EFFECTivE �-i-zo>> DATE � /g-// YOURE-:v1AILADDRESS /IirNN�19P�uS.pi[AtG2�,��jAAio�TSayd/RGCT. �A� SITE ADDRESS 9S2 M/S,f/ts'/�r� ,S7' A/6 THIS APPLICANT IS: ❑ OWNER �ONTRACTOR PROPERTY OWNER/ NA,�tE: (')�/�RA A�O� TENANT ADDR�SS: �`5.2 lJ1iSSissirr� s'T. tiJLr ccTV ��C�/o�Y sTa.Tt�Mn/ zlrSl�/!Z PHONE: �i/,2-�70-�j/t7 CONTRACTOR NqMr: CN�lM/M�J u/iN�vw1 SUBMIT A COPY OF STATE LIC�NS� #?o �l�l9672 LEAD CERT NUMBER �i�r ,QB qLP'O YOUR STATE LICENSE / AND CERTIFICATE OF ADDRESS: S/UO �-I�J✓. llr9 I✓, . ST�. d CITY�Q�l �{/l9� STATH/%IAJIIP,g'�J$ INSURANCE PHONE - ? - •�/ FAX �- - PROPERTY TYPE �SINGLE FAMILY/NEW CONSTRUCI'ION SI'LE � TWO FAMILY/NEW CONSTRUCTION S'I'ORIES PERMIT TYP�' ❑ ADDITION ❑ GARAGE/SIiGD ❑ WINDOWS ❑ BASEMGNT FINISH ❑ ROOF ❑ DRAIN T]LL �DECK ❑ SIDING �-O"CHL;R �OICCN ��CLO,SLIRL ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR � REMODELING DF,SCRIBE WORK BEING DONE:��/flayd LsX/S7i�C A�LK � B�l/L 0 Nl.dl �L147F��/( � E�fKLBS� iJ�/Af/Idr.6 f/ Opo�t SI .7.E OF IMPROVGMENT LENGTH �'� � WIDTH IG � HEIGHT � SQ FT I�Z ROOFIIG ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGL 2. Proposcd floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS, & PORCHES SUBMIT: ❑ Aluminum ❑ Trim l. Sitc Plan/Survcy showing thc cxisting structures ❑ Other ❑ Fascia and proposcd projcct. 2. Two sets of construction plans WIhDOWS 3. Encrgy Calculations IN LXIS"I'ING OPEMVGS �Ycs ❑No LOCATION OI WINDOWS SN�SiF fAA� FOR WINDOWS - PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPEMNG CHANGES & ` I YPE OP WINDOW TO BE INSTALLED SL/O�S NUMBER OF WINDOWS ✓ ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ �O. 90o OCCUPANCY TYPE Permit Fee Plan Review Fire Surcl�arge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ L � a, "LS $ $ � 5t $ ��, $ $ $ $ $ $ 7��fni7 See Back Page Por Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $5.00 $5.00 (State Licensed Residential Contractors) S2230 per SAC Unit (Plans to MWCC far determination) ft+6ft= ftx�25—$ $450 Conservation Plan Rcview Fee Detennined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID iJTTIL PROCESSED I hereby apply for a building permit and I acknowledge that the inforniation abovc is complete and accurate; that the wark will be in conformance with the ardinances 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 r a permit and w�'k 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 ork w� ret�uire,s �leview and approval of plans. /'�� SIGNATURE OF APPLICA\T � j PRII�'T NAME S%1'U� L;(JLL/Lr l�- DATE V- Id-II APPROVAL WSPECTORSIGhATURE PLEASE NOTE: SEPARATE PERMITS �� REQUIRED"FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK _ �*� i�iE Gy� x r �" � E � �' �,ltir� r ' �r ,� �� .� ^, �. � E �1 �,� it f� . � � ` ; � , E 3 G� u�4 ^: ,-e. �, .., r N`� i t����.} . 1 � i 1 '*.,;. . 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