P - 48489Building
Inspe ,tio�s
763-5�12-3'604
763-50�-4977 FAX
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2011
Permit No.:
� - - - . : � ' -�z�a�
. ��/�•,1 : i." A�r , y �'
DATE �" S �� YOUR E-MAIL ADDRESS �I , c G,r���G/�/�Jte.PP /'G.S�v r�,�,c�.i /v�.r
SITE ADDRESS � `� � ( �jCi 7�A ( ;,,�,.�ve f r , ��% y i'1�'t �
THIS APPLICANT IS: ❑ OWNER �ONTRACTOR
PROPERTY OWNER/ NAME: �Mu r / _r�.�_
TENANT ,qDDRESS: CI? FS I I � IG 7C� Ct.(,✓' VL- CITY_�r, ,c�{ l�;/ STATE��IP �,J��,�o2
PHONE: ZO I � - �// �. - aCo. � �
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ V inyi
� Aluminum
❑ Other
NAME: /vi�cd.c.[./ �ar�7%..{ �.�'��/—�,��r�� �eS�."ct�ic�1
STATE LICENSE #�-D(p _� �� jo,$'"" LEAD CERT NUMBER
ADDRESS:�/ (%2.,,�.+kn.� �,^_ �/As...f--.� CITY �,,.ic�ex�Cn�,.v-i/ STATF/VULtLIP �S�
PHONE � , ' (ojo2° $y^7 -a�-2 FAX
O SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH O ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ;�C3`tHER
❑ SWIMMING POOL
❑ NEW HOME CONSTRUCTION ❑ ADDITION
.�AINTENANCE/REPAfR ❑ REMODELfNG
WINDOWS
IN EXISTING OPENINGS ❑Yes ❑No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
0 HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
LOCATION OF WINDOWS
NUMBER OF WINDOWS
HEIGHT
BASEMENT REMODELING SUBMIT:
l. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING 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)
COTAL JOB VALUATION $�/ t�Z� ° 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
$
$ i
$ ' �
$ � �
$ j�
$
$
$
$
$ —�b�
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$24=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: Citv of Fridlev Attach
THIS IS AN APPLICATION 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 codes 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 permit and wor c is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of or w' '"e uir ev' and approval of plans. D ` 'J
SIGNATURE OF APPLICANT PRINT NAME�%%z �G.a-� Utsr� � DATE �7-�S -/�
APPROVAL INSPECTOR SIGNA URE ,✓ /l v1 `
„_ _ .. _..
`�
,. __._. .... . I
_ _ . � . . .... i- i
-_ �.�.
.._ _ V.
__ \
�
��
_ S�
E
��.
rc�
rf�
�` ��
. t► � �
��..� ��i
�►
`�
�-�. �.�� �� � � P
G
� : _.. y
� �J
�
t..
� �
� _. . '
,
, �
� _
...,
� ��
�'_ . �
.��� ��� ��
.� . t. . ��i•. � x ,
�
�) � �c��-.�_ r-
'.� (
'��
� k `� .,- / +°"`�-,EC
�'6
r,.�� t w�t,l�L� �-
l�'�xy ' � r--�;�
�,,� �w5 ��ctit�
(,ll� �C'�"�` �,
�
��-.'�� r�
c� 1S� �
� r, ti.��k ��
1 , ” ` c�`-�' I
� /-
�l �? G �I
`—z_�i `� , � ,
,,
-•._ _ . _.._. _ �� �,
� ....._.. __ �___ . . .
.. I ' h,'. .� . .
'� . � ' . ! ��" � .
,^�%/�� e .
. . . . .. _� ` W �/� `� "� � I � , i : � .
��'--� � �
� �:
__ .0 _ �_ __
_ _ :_ _ .
, , .
� __ � ,
_ _
' _ ��` P _ `'� � � __ _
c'�
/ . ,_ ,
!�,�� � _ _
�
� _ :
,
; _ _ _ . �,
I
� i �
; ,
, � ; �..
, _ __. ._ _.._
_ _ ..._ _
__ �
_
, �
_ __ _
�
�
_. _ �__ _ ___
,
,
__ ,
_ .
,
. ; .
_
i � , � ,:`
� ' �•
.�,� N _ _ _
� ��' ���
i
, i .
__ -- ,.
I
I �
i t
. '. . � .. ...... .. ..___.. ..... �.. _ .
_ �
, �
._ _. . _ _ .
_` "� ,
_ `.
, � �r,i �-�,� : � . .
� _ '_
, _ ,
___
_� �
: �.
:
�
. . .. . .. .' .. � ... �... I.... .'...... � `
ld _ _ ;
� �'�I:
PI-A � � _ _
x
_ _ _ _ __ ,•,.
,
� ,.
�1p .1 �.. ... ___. __ _ . �.;
��� � � � � �� � .��
, ..- .
_ __.. _ ' _ �,,; :
K _
, � �;
, _ _ __ ;
9PECiOR '�,� � _ , : ,
� .,
�
_... _._._ _ . .
_ .. ,
_ i �'t;;,
, , . ' �;.� �^