P - 45372„ , ` , L From: unknown PaJqe: 1/1, L Date: 7!5l2011 4:25:59 PM
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Build��g $U�LDING Permit �ro,: �
Inspections RESIDENTIt�L APPX..ICATION R�ceived By:
�s3-s�2-�604 C�'�y OF FRIDLEY �7ate Rec'd:�
763-502-4977 FAX FF�,cr�vE i-�-ao� i __
DATE ..� l,l � �” �� p I YOUR E-MAIL ADI
SITb AriDRESS O st vl ."' P�� D
7H75 APpLICANT �5; ❑ OwNER �QCON'�lL4CTOR
I'ROPERTY OWPIk'.R/ Nq�E: i t?
TENANT qDC7RESS: ~I Jd Dc� ._ a f�
CQNTRACTOR
SUBMIT A COPY OF
YOUR STATE LZC�NS�
AND CERTIFYCATE 0�
INSURANCE
�atOPER�'X TYPE
PE�MIT TYP�
TX�E OF WO�K:
PHONE: � j L " ��'O '-
NANiE'
STA7E LICENSE � r
ADDEZESS: ^I� � �—.
PHONE (j� gr=/ �1 V — �J (o !
❑ SINGLE FAMILY/N6w CONSTItUCT10N
� TWO FAMRLY/NEW CONSTRUCiION
d ADD1Ti0N ❑ GARAG
C7 pASEMEN7 FINISH �ROdP
C� DECIC ❑ 51DIl'FG
❑ SW1MM
Ct NEw HOME CaNSrR�lCTLON
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Z LEAD CERT NUNi�I
N � CITY � STATE_
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sIZE
STORIES
D ❑ �'IND4W5
❑ DRAIN T1LE
❑ �THER
� ADAITION
o �MOn�.n�o
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A�5CR1$E WC}RIC BEING DONE: � � � ��
51ZE OF IMPROVEM�.NT LENGTH WIDTkI HEICrHT S F7'
A�OOFIIYG ��% �1'HOUSE ONLY gASEMEIQT REMODELjJVG SU.9MIT:
NUMBEROF SQUARES � Q HOUSE & GARAGE ]. Existing Ploor Plan
GARAGES Q ATTACHED GARAGE 2. Ptoposed flooi plen
PROP05ED S[ZE: � Z7LTAGHED GARAGE 3. List of strvctural mcmbers to be used
PROPOSED HEiGHT:
�OR NEW CONSTRVCTIdN tNCLUDING DECI�S,
$�� ADbITIONS. & P01tCHE5 SUBMIT;
❑ Vinyl �SoFfit 1. Site PIanlSuirvey shomng �he existing structures
II Aluminum � Trim and proposed project,
a Other ❑ Fascia y_ Two sets af eonstruction plans
WIND01'�_� 3. EnergyCalculations
IN ExlSTINCr OP�NINGS QYes ONv LOCATION OP �'�'INDOWS FOR WiNDOWS – PROVlDE U-VALUE AND
OA FOR N�W OPEN�NGS-DESGRxBE 51ZE OF MANUFACTURE SnCKER ON wINDOw.
OPENING CFIANGES �
TYP6 OF WINDOW TO �� INSTALLED NUMBSR OF WINDOWS
ALL F�ES A1tE BA,SIED ON VALUATI(}N, CNCLUAING THE COST OF I�ABOR A,Np MAT��tiALS:
{USING T�# 997 �. FEE SCH�DUL�)
TOTAL JOB VALUr#TC�N $ � OCCUPANCY '��`� � " � �^^ +
Permit Fee $ .35 5ee Sack Page for Fee Sehedule
Plan Review $ 65% of Building Ferm�t Fee
Fire Surcharge � , .00 ] times the tota! job valuation
Surcharge $ ,0005 x Per�nit Valuatian Mininnum $5.00
License Surohargc � .h , _$5,00 (State Licensed Residentia] Contraetors)
SAC Charge $ $2230 per SAC Unit (Plans t�o M W�C for determination)
Curb Cut Escrow $ ft+ 6 ft= ft x$25= $
Erosioz� Control $ $450 Conservataon Plan Review
Park Fee $ �'ee Determinod by �ngineering
Sewer A�ain Charge � ,_ Agteement necessary O Non Necessary O
�'otal Du;e $ , Make checks A able to: Ci of Fxidie Attaeh Stx ulations
7HI51S AN APPLICATION FOR A PERIvaIT-NOT VALID LlNT1L PR�CESSED
i hereby apply for a building permit and I acknowledge that the information above is complete and accurate; tl�at the work will be in
conformance with tha ordinances and codes of the City of Fridiey and wich the Minnesota Coastruction Codes; that 1 un,derstand this is not a
pernnit but oaly an application for :p�ermit and work is not to start without a penmit on site; that the work will be in accordanet with the
approved plan in the case of a �� requires r��ew aind PRyNT N MEpI��ArinN� CA iZc_,v+�_ nA,'t"E. U7 �' �v l f
SIGNATURE OF APPLICANT
APPR �CTOR
GNA U
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