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(1 �.R � —c t „�'ltc� �• � �' � ; .- � _ � ` � �i�1�1 � �y �'�' � :;� ���� � " c` .�' , '�� s � � �i� �, � � ti� °°' � �:� �/ �' � d, ta � 1 � � " �Q °�F� N � � $ i�' 1 �. � �, -� - --.- �� J,� = � .�z- � 3 �2£�� � ►� ��_ ._ _ �`�o - Building Inspections 763-572-3604 763-502-4977 FAX DATE � �r �'! si� AnD�ss � THIS APPLICANT IS: PROPERTY OWNER/ TENANT 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: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-2011 , YOUR E-MAIL ADDRESS 4�1J ❑ OWNER ONTRAC OR NAME: ADDRESS: � � � �°J��_( ���. PHONE: ���� ' �s� �� NAME_ ���..�.'�. � � �ls1'y � .�lJ�� STATE LICENSE # �Q(�/ , S �C ,�S�NGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION O ADDITION ❑ GARAGE/SHED �BASEMENT FINISH ❑ ROOF ❑ DECK ❑ SIDING ❑ 3WIMMING P01 ❑ NEW HOME CONSTRUCTION ❑ ADD ❑ MAIN'tENANCF�REPAIR �EM F� _ihi� /1fiN`1tz�-'�' /� Ls[/J�; ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE FAX S1ZE ❑ DRAIN TILE ❑ OTHER Permit No.; �{� j �"C l �'"� � Received By: ��e� ra 1 2 011 AT'E ZIP. FT � S3`/al` BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1- Site Plan/Survey showing the e3cisting structures ❑ Other ❑ Pascia and proposed project. 2. Two sets of constcuction plans WINDOWS 3. Energy Calculations Ild EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPEIdINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: ',,, f(LTSING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATTON 1 ��J Permit Fee $� �(} �.LS See Back Page for Fee Schedule Plan Review $ �CJ� ,� 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ .0005 x Permit Valaation Minimum $5.00 License Swcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2230 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 checks payable to: City of Fridiey AttacL THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UN"CIL PROCESSED I hereby apply for a building permit and I acknowled e that the information above is complete and accurate; that the work will be in conformance with the ordinance d codes of the ' Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applicatio f a ' and not to start without a permit on site; that the work will be in accordance with the approved plan in the case of a rk r ui r ew and approval of plan J /� `,� �" /J SIGNATURE OF APPLICANT PRINT NAME � �%�.�I Cs �/f��� DATE G����/ APPROVAL INSPECTOR SIGNA os �� i ��� `; �tt,��,i ��.; iF :' i#.' � (', ;,�_ � � ! 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