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P - 80965�t► . . Building BUILDING Inspections RESIDENTIAL APPLICATION 763-572-3604 CITY OF FRIDLEY 763-502-4977 FAX EFFECTIVE 1-1-2012 DATE � °� YOUR E-MAIL ADDRESS V r ti / SITE ADDRESS � C% � Ci � I/.(� � � Y THIS APPLICANT IS: `{�I�WNER �CONTRACTOR PROPERTY OWNER/ NAME:�� TENANT ADDRESS: % �U CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: �� r = ci� f--Y Permit No.: Received By: Date Rec' d: � � � �, /,C � . ( �Q / i` / A NAME: STATE LICENSE # LEAD CERT NUMBER EXP: ADDRESS: CITY STATE ZIP PHONE FAX :SINGLE FAMILY/NEW CONSTRUCTION TWO FAMILY/NEW CONSTRUCTION ❑ BASEMENT FINISH ❑ ROOF ❑ DECK ❑ SIDING ❑ NEW HOME CONSTRUCTION ❑ MAINTENANCE/REPAIR DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT U� r/�( 1 ROOFING NUMBER OF SQUARES GARAGES PROPOSED S1ZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other WINDOWS IN EXISTING OPENINGS ❑Yes ❑No OR FOR NEW OPENINGS-DESCRIBE SIZE OF QPENING CHANGES & ❑ ADDITTON ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GAR�,GE ❑ WINDOWS ❑ DRAIN TILE �OTHER ❑Soffit SIDING/SOFFIT/FASCIA ❑ Trim REMOVED? � YES O NO ❑ Fascia LOCATION OF WINDOWS FT BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS_ & PORCHES SUBMIT: 1. 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. � TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS � ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: USIN HE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $� ��, OCCUPANCY TYPE Permit Fee _ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surchazge $ � ! 0 •.001 times the total job valuation Surchazge $ .0005 x Permit Valuation Minimum or .50 License Surcharge $ — $5.00 (State Licensed Residential Contractors) SAC Charge $ $2365 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft+ 6 ft= ft x$25= $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary O Non Necessary O Total Due $ �.�- Make chectzs navable to: Citv of Fridlev Attact THIS IS AN APPLI�ATION 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 des of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a pe it and w k is not to start without a permit on site; that the work will be in accordance with the approved plan in the case f � �ork whic qu' review and approval of plans. ,/ SIGNATURE OF APPLICAN'� ,y�,- _PRINT NAIvfE / � j�-� PLf �DATE K � � �• � �- m T �� -_: � � G° � � � � �� ,- � �� - c � � � �; .�_ � �� { C �- �- G � �' � � � � � - .�. �� 1 � � � �� t.� - �-- ! - �;� � ��..� __� � � � �� ::� -- �-� (�j z� � , �� ` � � �--- � -�-,c,� � � --._�- � V ' _____.�.._ �` __�" �. � �0 p � � � � � �3' —U � �' �--- c � �� , �� ._ N �� `� � -� `.� � �- � � �- � C3� n � �� .- � � � �-- ��; j � -.� � � � � -� � � � � s � �- � 1 Q `/�' � � � � °``� �- -� � � `� o� � �. � � u� ` ' � � � � � �" � ,��, -#� v� � s�. . ^ � � 1! �' t� � � � ,� � F` c � � - _. � � �-� � � � � � ' � � �, � � -�-- � �- � � � � ° . �. �� . � � �- �� x �� . �,�� '-� h c � �� ` � � '� c� � x f.� v� � c � 4 � �� - � ,� �,, --- � , � b — , � � � /�� +^�. !�'� 6- � `� � � � �' '°` -_ ,. �� C �.1� � S � � S • � � " � ��.W�... Cp -� Z ..! � � � � �� O � e ,_.! O � Q °�rj 'a-� � V ' � `�, � � � _ � � � ..�.�...�.�._.._ ._ -S �-..� -�.. -� F-- �` � '� . ' J • � (� �, r- u.. a. � � ,,.. 2 � � � 1 �°"1 � �- ��.. � � � � � �� e ' `�i,,�, �' � �� ....� `� c� ` (�1 � r � � ��--� � <t � � �S`t �• �,, w a z � � J— �` ,Zj `�' V3 �- �� r�', �� `"� U- u. t� G r., v � � � ,� � �Q w �, .-� r- t� �, � � � � �� .,� Q w � .... . � u, � � �� V� �' _ � � �° � � ,�, � �, � ..� �, -- � .� � � r' �'` � � � `- � ! -- . � �,: �� L,J {� �� {b ``�` � � .� � S I�' ��t111 '�Q � � C • '� � � - � 1:.. � � ----- � �` `�" = .�- � � . � lU SA � Z U '�t./ ,.,,p � � � � �,�, c � � � M �� Q, �. �/`� �' K! — - r �,�_ �_ '�i , �� t� �' L �" t� _.;; d - �' �' N► �' r" n,� � � � � � � .e t%!-- �' n 2-- t� ` �' � � . _ r� .-.� � �.. � , � � . � � a m �� -� ��