P - 45743Building BUILDING Permit No.: �� �
Inspections RESIDENTIAL APPLICATION Receiv �v �
763-572-3604 CITY OF FRIDLEY Date �".�c'c#':'
763-502-4977 FAX EFFECTIVE 1-1-201 I
DATE 6-29-2011 YOUR E-MAIL ADDRESS msample@hwconstruction.com
s�TEAOOaESS 131 Panorama Ave, Fridley
THIS APPLICANT IS: ❑ OWNER �1CONTRACTOR
PROPERTY OWNER/ NAME: Patrik Spaeth
TENANT Aoo�ss: 131 Panorama Ave c,TY Fridley sTaTE MNz�P 55432
PxoNE: 763.242.4610
CONTRACTOR NAME: Hoffman Weber Con.
SUBMIT A COPY OF STATE LICENSE # 40543250 LEAD CERT NUMBER
YOUR STATE LICENSE
AND CERTIFICATE OF ADDRESS: 7932 Ui11V@rSlt�/ AV2. CITY Fridiey STATE MNZ�p 55432
INSURANCE pHONE 763.300.6542 FAx
PROPERTY TYPE � SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH �Q ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION
f� MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: Re- ROOfI StOrtll CIaCTIag@
SIZEOFIMPROVEMENT LENGTH WIDTH HEIGHT S FT
ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES � 6 ❑ HOUSE & GARAGE I. Existing Floor Plan
GARACES ❑ ATTACHED GARAGE 2. Proposed tloor plan
PROPOSED SIZE: ❑ DETACHED GARACE 3. List of structural members to be used
PROPOSED HEIGHT:
SIDINC FOR NEW CONSTRUCTION ►NCLUDING DECKS,
❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing ihe existing structures
❑ Aluminum ❑ Trim and proposed project.
❑ Other ❑ Fascia 2. Two sets of construction 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.
OPEN(NG CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF W►NDOWS
ALL N'L� �S AR� KAJL�'ll UlV VALUA 1'lU1V, IIVC:LUU11Vl: I H� (:VJ l VN LAIfVK A1Vll IVIA 1 EKIALa;
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 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
$ ���d'� See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ .001 times the total job valuation
$ 1 .0005 x Permit Valuation Minimum $5.00
$ (`j $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 Fridley Attach Sti
THIS IS AN APPLICATION FOR A PERMIT-NOT VAL1D 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 codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an applica ion f r a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case II ork irr res review and approval of p!a
SIGNATURE QF APPLICANT � PRINT NAME ���'�L�,�TE
ADPDl1\/A1 fUCPGf`T(1R CI(: RF .