P - 48397Building BUILDING
Inspe�tioris RE�IDENTIAL APPLICA I41'�
763-s�2-3604 CITY OF FRIDLEY
763-502-4977 FAX
FFFFCTIVF 1_L�(111
DATE (�/___�i d► i
l ��r-��
SITE ADDRESS ----�—�-G
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
YO/U�R E-MA[L ADDRESS
— /i /H 1,7�7/- /S�Y ��/�Y' �
� OWNER �QNTRACTOR
�
�
CONTRACTOR NAME: � � ��//�f' �'n. vi'�J ��� S �L
SUBMIT A COPY OF STATE LICENS� #_ �DG �� � Y�
YOUR STATE LICENSE
AND CERTIFICATE OF ADDRESS: vn � �r
INSURANCE PHONE
PROPERTY TYPE �SINGL FAMILY/NEW CONSTRUCTION
❑ TWO FAMILY(NEW CONSTRUCT[ON
PERMIT TYPE O ADDITION ❑ GARAC3FJSHED
❑ BASEMENT FINISH ❑ ROOF , �
❑ DECK t7 SIDING
� SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION
�D CERT
FAX
DESCRIBE WORK BEING DONB:���A-•2 !�v A'��� j�%^��'/+tD��i� �"� CG
SIZE OF IMPROVEMENT LENGTH WIDTH
RQOFING ❑ HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GARAGE
GARAGES ❑ ATTACHED GARAGE
PROPOSED 51ZE: ❑ DETACHED GARAGE
PROPOSED HEIGHT:
SIDING
❑ Vinyl CJSoffit
❑ Aluminum ❑ Trim
❑ Other � Fascia
WINDOWS
IN EXISTING OP$NINGS OYes �No LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF L
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTALJOB VALUATION e rs*+�/� • o o nr�rro.aa
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
'$ � L� .i See Back Page for Fee Schedule
$ 1' � 65% of Building Permit Fee
$ .001 times the total job valuatioi
$ .0005 x Permit Valuation Minir
$ $5.00 (State Licensed Residenti,
$ $2230 per SAC Unit (Plans to b
$ ft+6ft= 8x
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non ]
$ . Make c6ecks navabte to: Citv
TH(S IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL
I hereby appty for a building permit d I acknowled e that the information abave is c�
conformance with the ordinances and c es of the Ci f Fridley and with the Minnesota C
permit but only an application for a pe it ot to start without a permit on si�
approved plan in the case af all work w' req ' vi pproval of plan .
SIGNATUR$ OF APPLICANT / RI?i3' NAME }��/
PLEASE NOTE: SEPARATE
Permit No.; Ol O
Received By:
Date Rec'_d:
�-�s G�C.
ATE�ZIP����
i►t PL S STATE�'�+LIP�
TILE (
e.-o
HEIGHT
s�/
�FT
�ASEMENT REMODELING SUBMIT:
t. Existing �loor Plan
2. Proposed floor plan
3. List of structural members to be used
0
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
i. Site Plan/Survey showing the existing structures
and proposed project
2. Two sets of construction plans
3. Energy Calculations
FOR WINDOWS — PROVIDE U-VALUE AND
MAIVUFACTURE STICKER ON WINDOW.
AND MATERIALS:
►m $5.00
Contractors)
VCC for determination)
?5= $
ecessary ( )
plete and accurate; that the work will be in
�truetion Codes; that I understand this is not a
that the work will be in ccordance with the
1� ��. DATE G �O � � T
fZICAL AND MECHANICAL WORK
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Atl dirnonsiorte _siu �gnations given are
subjact to veri80ation on job aite snd
sdjuapnent tv tit job nditions.
— 1!
164"
is an aeiginal design and must not b� Deaigned: 6/6i20i 1
aed or copied unless appliceble fee liae Pric�ted: 6/12/2011
paid or job o�der piaaed.
1 �Drawin� M: 1