P - 35763Building
Inspections
i 63-572-3604
DATE � � � � �I
SITE ADDRESS -J 7
THIS APPLICANT IS:
BUILDING Permit No.: �,r;,� (-
RE5IDENTIAL APPLICATION Received By: ���
CITY OF FRIDLEY nate ��: � � =-:
YOUR E-MAIL ADDRESS ��� Ci� �S �! d t P o� t S. l o M
5' C� �n S�rt,� �
❑ OWNER ❑�ONTR.ACTOR
PROt ERTY OWNER/ N.41vtE: � Q V!Yl d�i Q� tS �
TENANT p,DDRESS: S Z� S _�Ll ! L� C1,
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROFERTY TYPE
PERMIT TYPE
TYPE OF WORK:
�-��
N,�tE:_ I'HD At- Home Services, Inc.
sTa,� r.�c 2690 Cumberland Pkwy, Ste 300
.anDxESS Cumberland Office Park
PHONE Atlanta, GA 30339-3913
�LE Lic# 20268257 Ph. 763/542-8826
❑ TWO FA �
QADDITION ❑ GARAGE/SHED
❑ BASEMEN'T FINISH ❑ ROOF
❑ DECK ❑ SIDING
❑ SWIIvIMING POOL
DBSCRIBE WORK BEING DONE: �I d
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SEbING
❑ Vinyt
❑ Aluminum
❑ Other
Vi�INDOWS
IN EXISTING OPENINGS ❑Yes ONo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TVDC !14 II7iATil(1\7! Tfl T2C TATCT A T T L'il
�
r
LENGTH
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
C�30ffit
❑ Trim
C3-F�cia
IACATION OF WINDOWS
T.TT iL.fQCD !1�
CITY �/� J N�l ' STATE_ZII' S��/ 3�
�ax� c�� ��-�= �qa� l�-1 �xP� �/�
Jod� m F'(d�r Jon<S '
q5� 13Y5- (.oy7
CITY STATE ZIP
v. L Y�AIDOWS
❑ DRAtN TILE
❑ OTf�R
I� �' y-!J S l t GL
WIDTH HEIGHT
BASEMENT REMODELING SU$IvIIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural membcrs to be used
Ft.
�
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMTT:
1. Site PIan/Survey showing the existing structures
and proposed project.
2. Two sets of constructiot► pians
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 199 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ � 8 T� OCCUPANCY TYPE
Pemut Fee
Plan Review
Surcharge
Fire Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due _
� �;s . it S �ee t3acK Yage 2or ree 5criedule
$ 65% of Building Permit Fee
$ (.0005) times the total job valuation — Minimum $.50
$ �. $ Q .001 x Permit Valuation (1/10%)
$ S. O u $5.00 (State Licensed Residential Contractors)
$ $1450 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$20=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ 2'S� 7 Make checks nayabie to: Citv of Fridtev Attach
ulations
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID TJNTIL PROCESSED
[ hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
;onformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
�ermit but only an application for` a p d work is not to start without a permit; that the work will be in accordance with the approved
�lan in the case of all work which requir r' w ndapproval o€plans.
�IGNATURE OF APPLICANT PRINT NAME / / / ' , � � � + � n � DATE " � ///