P - 44368Building BUILDING Permit No.: � U
Inspections RESIDENTIAL APPLICATION Received By: �
763-572-3604
763-502-4977 FAX CITY OF FRIDLEY Date Rec'd: j/b
EFFECTIVE 7-1-2010
DATE 712112iiit� YOURE-MAILADDRESS ��V2 Pi�q�$�.11�$
SITE ADDRESS _.14$2 C3nonda�a_St_NE, _FridleY,_MN_�5432
THIS APPLICANT IS: ff9 OWNER ❑CONTRACTOR
PROPERTY OWNER/ NAME: pav(d Andrew Young
TENANT ADD�ss:
__1482._Qnonda.ga.._5t:.._NE.... CITY__FridleY...... STATE__M_N..._ZIP__55432.__
PHONE: 612-867-5998
CONTRACTOR NAME: NA
SUBMIT A COPY OF — -
YOUR STATE LICENSE STATE LICENSE # EXP DATE
AND CERTIFICATE OF ADDRESS: CITY STATE ZIP
INSURANCE pHONE FAX
PROPERTY TYPE � SINGLE FAMILY/NEW CONSTRUCTION S1zE__1_��€�._S_F_h.Q�s� ! 750 SF garage
❑ TWO FAMILY/NEW CONSTRUCTION STORIES 1
PERMIT TYPE ❑ ADDIT'ION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK �il SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION � ADDITTON
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: F2�mave existinq viny! siding nn the house and repiace with double 4" vinyl siding nf a dif�erent calor
SIZE OF IMPROVEMENT LENGTH 50 f� WIDTH 25 ft HEIGHT 7�t S FT 900
ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES O HOUSE & GARAGE
1. Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: (81 DETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
?�Cl Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures
❑ Other ❑ Fascia �d proposed project.
2. Two sets of conshuction 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 N'�1�.J AKL� 2fA,r:li U1V VALUAI1ViV, liVC;LUll11V(� 1HL� I;VJl UN' LAKVK A1VL 1V1A'1'EKlALa:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 900 OCCUPANCY TYPE
Permit Fee $ 1 ' See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ .001 times the total job valuation
Surcharge $ � .0005 x Permit Valuation Minimum $5.00
License Surcharge $ $5.00 (State Licensed Residential Contractors)
SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft+ 6 ft= ft x$24 =$
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary O Non Necessary (x )
Total Due $ Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UN1'IL 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 ptan in the case of all wo i h es review and approval of plans.
SIGNATURE OF APPLICANT �y�/ PRINT NAME_ pavid Young DATE 712'(/2010
APPROVAL INSPECTOR SIGNATU