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P - 83517Building BUILDING Pe�it Ivo. ?.b � Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY vat � 763-502-4977 FAX EFFEC�vE,-�-ZO�z ���� DATE Y' ��` �� YOUR E-MAIL ADDRESS A���1 I Q AOJA�ccco�i�i9k�is _ CD/u SITEADDRESS �y4o ��v�-��1�, r��.. THIS APPLICANT IS: ❑ OWNER fj�CONTRACTOR PROPERTY OWNER/ NAME: SMIQ(r(,-,'�J $��Ve;�KjaN TENANT ADDRESS: SIqM CITY F%��dLC.� STATE�ZIP S�/3t PHONE: CONTRACTOR NAME: ��� % UI L� C� SUBMIT A COPY OF STATE LICENSE # yYZ3 LEAD CERT NUMBER ��'+ �`�1 YOUR STATE LICENSE / /►�, � ,,. � XP: AND CERTffICATE OF ADDRESS: bYCO �UT%2A'( /dVLi IvL CITY f'�� o� STATE�ZIP �-y3L INSURANCE PHONE %�a 3^ Z �i ' SZO'� FAX 3� 57L - 9'q 3 3 PROPERTY TYPE j�SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE O ADDITION ❑ GARAGE/SHED � WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK � SIDING �OTHER �'p� �/ ❑ SWIMMING POOL t� �L:� (����I'��lC�� TYPE OF WORK: � NEW HOME CONST CTTON ❑ ADDIT'ION e�MAINTENANC PAI ❑ REMODELING DESCRIBE WORK BEING DONE: A�� ��1T[a'�la►( �Pl.G%T�' - �'�T S�d�i+r� RC� i4��- SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S 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 GARyAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDIlVG FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit SIDING/SOFFIT/FASCIA ADDITIONS_ & PORCHES SUBMTT: ❑ Aluminum ❑ Trim REMOVED? O YES ❑ NO 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 1re�ces ONo LOCAT'ION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STlCKER ON WINDOW. OPEIdING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ / 90 OCCUPANCY TYPE Permit Fee $ i' See Back Page for Fee Schedule Plan Review $ — 65% of Building Permit Fee Fire Surcharge $ j, �(?c� .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum or .50 License Surcharge $ � $5.00 (State Licensed Residential Contractors) SAC Charge $ $2365 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 $ r'1 `� ,"1 � Make checks uavable 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 th ity of Fri and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permrt wor is no o start without a pe it on site; that the work will be in accordance with the approved plan in the case of allJ� or wh'ch e urres rev approval of pl� � SIGNATURE OF APPLICANT !�` � �.RiJ�I .�. n AR�OT�?1ME LH l�ITC� I�Al�✓ DATE ��3��i 3sNOds3a anoH bz ..._ . � •..`.J.."",.y . 000z-z� ��I S�-I��d�o ; ---.--.----_.._.._-- .._.-- � i�9L) � ��cr � �.�...�, ��:����-_.��-� �- _ �,�,. __. .. . -- , �� _ _.._ . , . __ _ ---��--- - � --- ___._ � � � --- - .,._ _..._.. . _.. _ . i � �' • � i � ..�. ; ; 3 �� �� S (�); 3,j► z ��t�l ��� �y � M .. 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