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P - 45753�uilding 7nspections i 63-572-3604 DATE G! a y l i/ SiTE ADDRESS $ 3 6 THIS APPLICANT IS: i'RO�ERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE BUILDING Permit No.: RESIDENTIAL APPLICATION Received By: V t'�- CITY OF FRIDLEY Date �'� � `"v ,� � � YOUR E-MAIL ADDRESS �'a d� 's �v c l�' � r�" o n.� s. � 0� 1� l%' 0 il 0/�. IV E ❑ OWNER '�CONTRACTOR U l' . • t,3 /S�r. s�q� N,,,ME: CHD At- Hoine Services, Inc. sTATE Lic 2690 Cumberland Pkwy, Ste 300 aDDt�ss Cuinberland Office Park PxorrE Atlanta, GA 30339-3913 ❑ s�rGLE Lic# 20268257 Ph. 763/542-8826 ❑ TWO FA ❑ BASEMENT FINISH ❑ DECK TYPE OF WORK: I _ � �u' DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT ROOFING NLJMBER OF SQUARES GARAGES ?ROPOSED SIZE: PROPOSED HEIGHT: SEDING Vinyl ❑ Aluminum O Other ❑ GARAGE/SHED ❑ ROOF tp SIDING ❑ SWIMMING POOL ❑ ADDITION AIR ❑ REMODELING LENGTH ❑ HOUSE ONLY ❑ HOUSE & GAR.AGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE �Coffit ❑ Trim � Fascia CITY STATE � �zrP �SSY 3 � � Q�a 13Y5- Loy7 CITY STATE_ZIP, �E .ORIES �wnlDOws ❑ DRAIN TILE ❑ OTHER 11 � /SGt �F' �►/'i WIDTH HEIGHT �'INDOWS IN EXISTING OPENINGS�es ONo L CAT ON O yj11,�1DOWS / OR FOR NEW OP£NINGS-DESCRIBE SIZE OF �! �. �7�'�'J (,� . D� R.0 � B4'+��, CdUA! � OPENING CHANGES & / � i TYPE OF WINDOW TQ BE INSTALLED NUMBER OF WINDOWS � a� ho/�'? BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used Ft. FOR NEW COt�iSTRUCTION INCLUDING DECKS, ADDTTIONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of conswction plans 3. Energy Calculations ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MA' (USING THE 1997 U.B.0 FEE SCHEDULE) ' TOTAL JOB VALUATION $ � 0� Y a'S OCCUPANCY ' TYPE Permit Fee Plan Review Surcharge Fire Surcharge License Surcharge 5AC Charge �urb Cut Escrow 3rosion Control ?ark Fee 3ewer Main Charge I'otal Due _ _ $ 3i. �S' $ � a. i $ �- Y 3 $ 5. �0 $ $ $ $ $ $ 37a. � 4 See Back Page for Fee Schedule 65% of Building Permit Fee ''; (.0005) times the total job valuation — Minimum $.50 .001 x Permit Valuation (1/10%) $5.00 (State Licensed Residential Contractors) $1450 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED : hereby apply for a building permit and I aclrnowledge that the information above is! complete and accurate; that the work will be in ;onformance with the ordinances and codes of the City of Fridley and with the Minnesotal Construction Codes; that I understand this is not a >ermit but only an application for a permit and work is not to start without a permit; that', the work will be in accordance with the approved >lan in the case of all work which requires review pproval of plans. �IGNATURE OF APPLICANT PRINT NAME �/' L ��� 1� I� DATE � l� 4 C !�