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P - 48480Bui�ding BUILDING Permit No. �l a a� Inspections RESIDENTIAL APPLICATION Re 763-572-3604 ITY F FRIDLEY vate��'� ��o 763-502-4977 FAX C � EFFECTIVE 7-1-2010 DATE YOUR E-MAIL A DRES L� G V� l� %l% I r� r�I �! L�' //7 y i C 0 SIT'E ADDRESS '' � a �-C �- v'fi� 1`- �� � � THIS APPLICANT IS: ❑ OWNER �CONTRACTOR � PROPERTY OWNER/ NAME: � �• � V' � I Y�)G L TENANT AnDRESS: �� I i��C �� �- i� Y�Y`l- �1 STa� ir �N�S'"2 PHONE: Ic,� , �O�' �� o�� CONTRACTOR NAME:/� � �.E' %�QG � �q SUBMIT A COPY OF STATE LICENSE # � Cl � EXP D `3 -3 I- 2 0�a YOUR STATE LICENSE � �7 AND CERTIFICATE OF ADDRESS: �'��°� � �'�� �/� " CITY lldYl STAT��� ZIP� INSURANCE PHONE� — , � � FAX � 1!�'3` -7 Cl S`O �5 PROPERTY TYPE l� SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDIT'ION ❑ GARAGE/SHED WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR � REMODELING DESCRIBE WORK BEING DONE: �EV�b1.0 CK��� t/Ly � IYl:�a� �1 �vll tti/ �L'✓ 3- I VLS ��I p C (�✓ SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED 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 ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets 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 BASL�� UN VALUAI�IUN� 1NCLUDIN(G'1'HL�' CUS'1' UN' LAI3UK AlVll MA1L� KlALa: /- (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $(!/S(i�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?� ZS $ $ $ $ $ $ $ $ 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) $2100 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 uavable to: City of Fridley 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 work is not to start without a permit e� that the work will be in accordance with the approved plan in the case of all w ' quire •.iew and proval cyf plans. � SIGNATURE OF APPLICAN i^ PRINT N ME � L�� 1��.�{��%DATE I v APPROVAL INSPECTOR SIGNATURE � l,E-r�..���5� /`L 7 L t v � � � � \. 1� � � ��� <v � \ c \ � � � �, � � � � � � � � _, � L � Op "-*r'- � � �= m � � a � � � ' � � � � � b �' Z .fl' � � � � P v � , � ��1 � �` �., � i � t�- � � ���, � � � � q �o � �, � rn C� � � Q� E�i td` � ��,, t� �' !! � G � � �.. ,,,� - � � � � � � � � � � �°l � a � �,13 � ¢ �? b ^. � � � F � � _... .�4J - .. .. . . .. . . .. .. �- Q � � Cl` � � � 1� � � � � � r � � �, �� � ' � � r` m Z m _,,. 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