P - 44370Buildillg BITILDING Permit No.:+ �`' �'�-
Inspections RESIDENTIAL APPLICATION Received By;, �'
763-572-3604 CITY OF FRIDLEY D���'�
763-502-4977 FAX EFFECTivE�-l-zoio
DATE i112f2t�1�3 YOURE-MAILADDRESS i��V��Pl�.t18�
SITE ADDRESS _._�.482 C}n01�da�a St NE,_Ffldiey, _N]N 55432
THIS APPLICANT IS: I� OWNER ❑CONTRACTOR
PROPERTY OWNER/ NpME: Qa�fd pncfrew Yaunq
TENANT ADDRESS: 1_482 Ononda. a.._..S..t,....fU...E...... CITY FridleY:... STATE MN z�P__55432 ,
— ... . . ......... . _ _ . . 9 . . _..............
, 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 D9 SINGLE FANIILY/NEW CONSTRUCTTON SIZE_,1.,��,Q...(i_S_F._houSB I 750 SF gat'8g�
❑ TWO FAMILY/NEW CONSTRUCTION STORIBS 1
PERMIT TYPE � ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK �'il SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCT'ION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: Remove existint,Lsiding pn the detached garaqe and replace with double 4" Viityl Sidi�t�
SIZE OF IMPROVEMENT LENGTH 30 ft WIDTH 25 f� HEIGHT 7 ft S FT 900
ROOFING � HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: t�l DETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
kC1 Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing struchues
and proposed project.
❑ Other ❑ Fascia 2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS DYes ❑No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALLTE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTCIRE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATlON,1NCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALiJATION $ 822 OCCUPANCY TYPE
Permit Fee $ See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ .001 times the total job valuation
Surcharge $ ,-r'j .OQQS 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 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 code f 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 a d w is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of al ' h re u' review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME C}8vid YUUng DATE 7/12/2Q10
APPROVAL INSPECTOR SIGNATURE / `