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P - 48359
Building BUILDING Perrriit No��l���� �7�� I�ispections RESIDENTIAL APPLICATION Received By: ' �63—s�2-3604 CITY OF FRIDLEY Date ��'c� ��. � � 763-502-4977 FAX EFFECT�vE �-�-ZO� i DATE 'J�/ ( 7 �� YOUR E-MAIL ADDRESS c C�-� ' G�,� Q SITE ADT _�� � ��, 2. � d`� 2..t� ���1 C�C �—{� THIS APPLICANT IS: ❑ OWNER �ONTRACTOR PROPERTY OWNER/ NAME: � �W� (,.�. � TENANT pDDRESS: a� R�1-sZ C T�� ' ITY ���f STATEMrII ZIP�� PHONE: 7�0�— �l�o�^ S `bI � CONTRACTOR NAME: �t�4 C0.� CD�,S'�h.�tL �dow� L C. C SUBMIT A COPY OF STATE LICENSE #_�D�o3 `T3 U� LEAD CERT Nt1MBER YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS:_ `�d� sw��� Dr_ s- CITY� STAT.L�_ZIP��o? INSURANCE pHONE �- � FAX PROPERTY TYPL ,8! SINGLE FAMILY/NEW CONSTRUCTION SIZE �(000 � �2v+� ❑ TWO FAMILY/NEW CONSTRUCTION STORIES� PERMIT TYPE ❑ �DITION ❑ GARAGE/SNED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE � DECK ❑ SiDiNG ❑ OTHER ❑ SWIMMMG POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION MAINTENANCE/REPAIR (�Q � REMODELING DESCRIBE WORK BE,�ING D��ONE; S[ZE OF N'1"'�- � LENGTH o? � WIDTH b� HEIGHT S FT 1 Qol ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE I. Existing Floor P,�an �ARAGES ❑ AT"fACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDiNG DECKS, ❑ Vinyl ❑Soffit ADDiT10NS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim I. Site Plan/Survey showing the existing structures and proposed project. ❑ Other ❑ Fascia 2. Two seu of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS – PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASEU ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $��, ( �8 ,°� �S�' ��J' , 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 $ $ $ $ $ $ $ $ $ $ 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 aavable to: Citv of Fridlev Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT[L 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 perrr►it but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all wor which requires review and approval of plans. SIGNATURE OF APPLICANT �p,���"�� PRINT NAME N�(1 �h_J��f�P.a� DATE � IL `tl �� APPROVAL INSPECTOR SIGNATURE �� 0 0 �-�----= Lond Plonrnn� Lvnd Sur'veyin� Sails Tesiin9 Gvr! b Alunic;pal E,7�ineerinc� = ��s-k�yhrvoy =cs aE- Min�aeoPolis 32. EN G I NEE R i N G, I N C. M`°nes°fa S!/nset 4-6066 En ineers � Survec�ors 9 C!'1'ta,�7LGat�." O� 51�11'�V'e Fos �-_ ; �.,rt , . >,.'� . ` "'r. � lt�i '! .r �J � -�� ,�,y,- �, +' + ,,,,. `... _ � . � ry<'. J -=��n�� ` { � \ r.,. �� � . ?5 9 ✓� ! �r . ��� W / � ' L'g 1S .i ('1{ � i '� � f... .1�. % — C ya'�c � Y^ ' �� a, . - ,�G _ , "c r, � • ; � , V � '''O `� — _ + �� �r C�.�'�"�"�" '�' - �`�"�5 .. , s� ,c`. � _ ' .'s , ��- �• F, , ,, i I ; �A �:j � 5coi��l"�' 'C?. .:.. _ I � , '�,�'—''�ii ��� , �/ y� • C�I '(� j L - � -�"i_ ��.�•-'"'".-r , , ' ' ti���- ,:,,�� �..��- ,��� � �� , ' �.'�`'L'��� i•.i , �._ . _� � � � � .,.r°°'" �„r �� N ,. . � r i'' p��. � '! 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