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P - 44559Building Inspections 763-572-3604 763-502-4977 FAX BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-I-2011 Permit No.: � Rec���B� , Date ec'd: I�i DATE YOUR E-MAIL ADDitESS E� KJ`s �l� �? U s�a yr-, �/y = n P-T ' SITE ADDRESS /�� U o n v:-� d a� a S't /v' � THIS APPLICANT IS: J�OWNER ❑CONTRACTOR PROPERTY OWNER/ N�tE: �uq e.n e E Kigch l ts �-h e�- T%� 5 TENANT qpDRESS: �Cp D vn on d ct, ct S f NF � CITY t r e PHONE: � �o ✓� ' % � 3 �- Q / � CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF iNSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DESCRIBE WORK BEING SIZE OF [MPROVEMENT RooFrnc NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum O Other ATE �%%/V ZIP ✓ -r�3� STATE UCENSE # LEAD CERT NUMBER ADDRESS: CITY STATE ZIP PHONE FAX �CSINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES O ADDITION ❑ GARAGE/SHED � WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE �8(DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL ❑ NEW HOME CONSTRUCTION J�ADDITION ❑ MAINTENANCE/REPAIR � REMODELING ❑ HOUSE ONLY ❑ HOUSE & GARAGE O ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia WINDOWS IN EXISTING OPENINGS DYes �No LOCAT[ON OF WINDOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE 1NSTALLED NUMBER OF � HEIGHT i�� BASEMENT REMODELING SUBMIT: 1. Existing Floor Pian 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION iNCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: L Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans 3. Energy Calculations FOR WINDOWS — PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW. ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: �y UJ� ING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION S '7 �(O� 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 $ $ $ 4 $ $ $ $ $ $ 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 aavable to: Citv of Fridlev Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT-NOT VALiD UNTti, 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 f a permit and work is not to start without a permit on site; that the �ork will be in accordance with the approved plan in the case of rk which req ires ' an pp5 oval of plan,,. / SIGNATURE OF APPLICANT IM NAME_���"" /_ � DATE �%% J�/� APPROVAL INSPECTOR SI , —TT—"�T �. �a: �. �, '���� � � ��: �� s,. ' �..;�. � � �: i���. r �. ;z' �i` " s 1� �� a,a �� � ,�, 1 � � �t � ,�,z��,€�:s�'a x �. ► ��.•t rr � r �' �g. � � � _. � � �; � .� �� � � e � � �a �... ��.,.m.-' �,/� � l�' r ! � � S� �. � N l�..r-N � 5 �' �' ,i �� ,,. � `:, tr'� ��� �� �"'v i � � � m J ROY J. WA,NSE'N � L�lRd Surveyor . . 139Q7 SpHn� i+�ke iiwd ,�Ha ���� � .r �� ��t j�.:� Ho�fcIrts, Wint[. �55343 Civit En�ineer ` �"' "'�: «" w•i° Triepfsone 93&5678 aF pr�o�»��rY oF �u°usi � . �un�:ro �.oca-r,oh ��'?� Ononc��pa :�t., �'rict3r; �, t;innesoF,:i o�scr��aeo As Fa��aws La�_; 1�nd 2, ?��.:.;ck i, ��arx�;,�n '�err-�ce, r�nc�kr� Ctaunt�r, ':irtnssots. -_____... _ �----���v.��--� . _ . � -d . _ �, _-_ �_ � . � . 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