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P - 48400Building Inspections 7��=572-3604 763-502-4977 FAX DATE Ul� 0 SITE ADDRESS _ THIS APPLICANT IS PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-2011 YOUR E-MAIL ADDRESS ❑ OWNER ❑CONTRACTOR ' � � ' G�Tfi�i��'�! .17��t1I41 • � w � N CITY �r i . Permit No.: �� `��`� � Received By: Da��(14/�ttl � JJ r �, ATEd�/ Z[P STATE LICENSE # �' LEAD CERT NUMBER ADDRESS: s�.� D� Sp ,�a� �w. l� (�4? , CITY��t �n.� �rSTATEI�LIP �S" a PHONF/763 � 3 6 0•-0 6 7 9 . F� '�I.SING�E FAMILY'"""" ^^""T^"^T� N r��ode 1 SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STOI ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH � ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING �OTHER O SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR '��tEMODEL DESCRIBE WORK BEING DONE: �1p V� 2�� w W(( C p�i p c�'E` � lt ��'e �e v� S c.v a�!' �� e. `�S SIZE OF [MPROVEMENT LENGTH WIDTH HETGHT ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other WINDOWS IN EXISTING OPENINGS ❑Yes ❑No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS NUMBER OF WINDOWS L i.v � +nd Q w 1 avrr�n BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION RJCLUDTNG DECKS, ADDITIONS. & PORCHES SUBMIT: I. 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: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $�( 3, �1, 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 $ �L .� $ 3 �C► $ f $ �"(jt7 $ J $ $ $ $ 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 oavable to: Citv of Fridlev Attach Sti .� THIS IS AN APPLICATION FOR A PERMIT-NOT VAL[D 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 t City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and rk i n t to start without a permit on site; that the work will be in accordance with the approved plan in the case of all work �w+hic'h r uires r ie and approval of pl � --�—• / SIGNATURE OF APPLICANT �a-u-��i �NT NAME, ��1 +'^�` 1 c� J a h c� DPcTE (� ��. 2^ ZO �( APPROVAL INSPECTOR SIGNATURE li s� � � � � �? � S v o S .� \ s =�= 3 �' �` T � � < �^ 6 � ^� � � � � � O Q1 � cn , s � �J � <� � 4 �" J J -� T v. "-�-� � � � � � � + c� � f �� \_ � 3 0 � � � % � „_. � �. _•,__ _� R }V J S � `6 �� 'r3 � � . c:_.;� ,��: J- - a s�`�� . .0 .. � �. Y �' _� - `" v � o S _ `� UI c / � _ �-,___ � I � s �-2- � � � 9 E'-+'ai � .-..,�� u •, � sa� .� � � a � � � �� ,� .� u : � 3 n �� .� \� J � �X _ � 3 a� 3 � � ; � ,;:. �� _� 3 �� Z CC � m � o � W` � F" m � ° E Nacs Oa �� v � a m � °z �� gw� S�f' , �. _ i � � 1 1 ` /i �� .-�.` � 1 , 'r�✓/�cc � �iy� / / �.K s } � �,- 9E' �' ,.� f' /i � � -�� . _ ____ _ . =� ��- �� a� � � � d S � � —s ' � -- + s � 3 � n 3 � 0 1 � c!1 • — c = �_ � � ( `S�� -� G- � 3 � � r + � W s � � � I I , �� . � li � , �� 0 =a �� S� � .� ; �,> i � i ` ; '� � v� � ' I � � ! 3 � cb I,. � : { � V :a�// 3 ��.� , � . // �. -,� d�� . .r� ri � � 0 � � � ��, o..'� i �� zm: �� °� _: � � �G � ,m =': o �_ � ''D 0 � Fc _ �_ � O� . � , t� °, C � � a, �� ..� �w�,; � s�� . � _ _ ----- �, ;� o w° �4 �' ' � W° ° �" i U W � _ ---� � , � �� 0 v� �,��!� I�? J � Vv � Q � [ � � � u �� _� � � � �� `-� �, v � � � � � � � � � � � � �� I W �-.-�F- � � �U � n , W ( �- � O Vl�.s � l � �