Loading...
P - 48502Buiilding BUILDING Pe�it Ivo.:� ' Inspections RESIDENTIAL APPLICATION Received By�� 763-572-3604 CITY OF FRIDLEY vate Rec�• .� 763-502-4977 FAX EFFECTIVE 1-1-2011 DATE ~ I I` YOUR E-MAIL ADDRESS U� �C� � (' SITE ADDRESS I � l. � THIS APPLICANT IS: ,� OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: � TENANT ADDRESS: C � CITY�j ` C.,°. STATE�ZIP .�� PHONE: 7I �S CONTRACTOR NAME: SUBMIT A COPY OF STATE LICENSE # LEAD CERT NUMBER YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE pHONE FAX PROPERTY TYPE �'SINGLE FAMILY/NEW CONSTRUCTION SIZE I ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDTTION ❑ Gn�GE/s�n wirrvows „�.BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION � MAINTENANCEJREPAIR ,J�REMODELING DESCRIBE WORK BEING DONE: l�-� 1/t O IJV 1 S1ZE OF IMPROVEMENT LENGTH � WIDTH ( HEIGHT t S FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES 0 ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. Lisi of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two seu of construction plans WINDpVVg 3. Energy Calculations IN EXISTING OPENIIdGS OYes �No LOCA O OF WIN S � !�` FOR WINDOWS — PROVIDE U-VALLTE AND OR FOR NEW OPENINGS-DESCRIBE S1Z OF �� �? f"� ,� t° Wk i� �� MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & � TYPE OF WINDOW TO BE INSTALLED r IP �NUMBER OF WINDOWS ALL FEES ARE BASED UN VALUA"1'lUN,1NCLUll1N(i "1'HN; CUS'1' Ur' LABUK ANll MA1'1�'dUAL�1': SING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION S��� OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surchazge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ � l. (l;� See Back Page for Fee Sch�ule $ 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 Conservarion Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ ' i Make checl�s aavable to: Citv 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 and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applicari per ' d work i not to start without a permit on site; that the work will be in accordance with the approved plan in the case of orl�' c uires r iew and approval of plan�. \ \ r-+�-� �{� DA� �„'r �/�� SIGNATURE OF APPLICANT L;� PRINT NAME � Cs C➢C� '�.� 1�t1O� '�__ { R APPROVAL INSPECTOR SIGNA PLEASE NOTE: SEPARATE PERMITS ARE REQUIltED FOR PLUMBING, ELECTRICAL AND MECHANICAL W(?RK _ , a � _� � v �. �l �� a� � i � � � �� � � �� � �.. � � � �� -�- . � s�� � �� � ? r" �...._ � � ' � � � � � � � � ��� � �� n �� � �it � � �0 � � �'�.. am -.:.,� � � :� � .� � �'' � �, v � a.�. � -� a � W �. � � �t � d �..i � _� � r � � .«..Y I '� � � -i' � �' �._____ ...�.�.....�.�.....�M �.. �� � l ', � � { �i y 4 y� ,�� V/, � i-...:� � --��; � Z � �.� � � � �� � �. H� � � � =o � � v L,' �� � Xv a � _ iU � � � � t . / 7�d' �' �.�..�....�.�.�...�.�... � . �'' `-� � � .. '' Y�/ L11 I � V V v ��-- -� �.. S" � � � �� I � � � � �- � � � �� �� � S� �s— ��� �. � � s a � � � � �� .. � . � a � ��G - L � � � � ��� � V=� � � � f� '� � :; � �� � �i� � �..n.�..�.. ;� � � �� � �