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P - 47962Building BUILDING Inspections RESIDENTIAL APPLICATION 763-572-3604 CITY OF FRIDLEY 763-502-4977 FAX EFFECTrvE �-i-ZOi t DATE C�� ` YOUR E-MAfL ADDRESS � t\o�iJ� ,�� � 7, s►TE a��xess ( �cS�Y� ��t�J {"t7 � ,`">�° � �...i� ,i�a tr'Y�� THIS APPLICANT IS: PROPERTY OWNER/ TENAIVT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE ❑ OWNER bCONTRACTOR NAME: � CITY NAME: L �'�. i.G�i��-�. I .�'i'`lJ� ,'�J� (��\ �.i�.- �� � STATE LICENSE # 4� ���� ��� � LEAD CERT NUMBER ADDRESS: �� C(j���_� C.� i S�ts-C� �J �� • CITY �Gj= PHONE_�!i��J`°'�5,�"'�'S��-V FAX � (p '°°; �INGLE FAMILY/NEW CONSTRUCTION S[ZE ❑ TWO FAMILY(NEW CONSTRUCTION STORIES ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH �'kFOOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER _ ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION �'1GIAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: � PIa �.�,,y✓'�.,���','Tor1 1�rc�(>.�� SIZE OF IMPROVEMENT '% � �1� LENGTH WIDTH ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES �(� ❑ HOUSE & GARAGE GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ V inyl ❑ Aluminum ❑ Other ❑ ATTACHED GARAGE ❑ DETACHED GARAGE Permit No.: '`�� Received By: � �- � _ ; ; � v-� STATE�ZIP�� A' FT BASEMENT REMODELING SUBMIT: l. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION MCLUDING DECKS, ❑Soffit ADDITIONS_ & PORCHES SUBMIT: ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Fascia and proposed project. 2. Two sets of construction 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 MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATIQN, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ [(`1' ,�� 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 $ �i1.Z.'i $ $ (,;, r $ � $ $ $ $ $ $ See Back Page for 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) $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 ( Make checks pavable to: Citv of Fridlev Attach Stipulations THIS [S AN APPLICATION FOR A PERMIT-NOT VALID UNT[L 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 pian in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT=���� �' C--r_,_�-- PRINT NAME �'1�'�'yZ (� �irz--�- DATE (�—i— L� APPROVAL 1NSPECTOR SIGNATURE