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..�,_ _ � _ _ ..... ....,_ Building Inspections 763-572-3604 763-502-49'77 FAX DATE SITE ADDRESS ���� THiS APPLICANT !S: PROPERTY OWNER/ TENANT From: 763 413 2614 Page�1/8 Date: 9l19/2011 5:14:21 PM ....,_....,.. �..,,� .... . �.. . _.. ��_ . i BUILDING � RESIDENTIAL APPLTCATION CITY OF FRIDLEY ENFECTIVE 1-I-2011 YOUR E-MAIL ADDRESS ❑ pWNER 1�11!.�11I�1faiii/�I�I I �.►��rJ � � � ' � � �... � • ��I/I • � � � ; � � � �- • - Permit No.: 2� Received By,�L'1 t Dat�[�� dS E P 1 ATEm�1 Z1PS5�.1�3Z SUBMIT A COPY OF STATE LICENSE q� nS1S�,o� �-Ir LEAD CERT NUh1BER YOUR STATE LICENSE `,, ,�^��� ANDCBRTIFICATEOF ADDRESS: 0����' �i�(�GIWu`� ��� � CITYS�'t'YWIGIS STATE�ZIP_5��3 INSURANCE pxoNE �Q3� 3� rAx 1�`�6`6�2� �5 PROPERTV TYPE TYPE TYPE OF WORK: DESCRIBE WORK BEING ROOFING NUMBER OF SQUARfiS � GARAGES FROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl 0 Aluminum ❑ Other LE FAMILY/NEW CONSTRUCTION SIZE FAMILYMEW CONSTRUCTION STORIES ❑ BASEMENT F[NISH ❑ ROOF ' ❑ DRAIN TILE `�DECK ❑SID(NG ' ❑OTrIER /' ❑ SW[MMING POOL ❑ NEW HOME CONSTRUCTION DDITION � ❑ MAINTENANCEIREPAIR � RCMODELING �E: x h � �Gx LCNGTH WIDTH HEIGHT S PTZ O HOUSE ONLY i BASEMENT REMODELING SUBMfT: _ O HOUSE & GARAOB � L Existing Floor Alan a ATTACHED GARAGC , � 2. Proposed Roor plun ❑ DETACHCD GARAGE 3. List of structural members to be used W INDOWS [N EXiST[NG OPENINGS DYes QNo OR FOR NBW OPENfNGS-DESCK[BE 31ZE OF OPBNING CHAT3GES & TYPE OF WIT�►DOW TO BE IN5'fALLED ALL FEES ARE VALUATION Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Pazk Fee Sewer Main Charge Tatul Due i ❑Soffit �� , g � �7 ❑ Trim ` � � ^ � / O Fesciu �, _ _'1 �J a � �°,, "113 LOCATION OF WINDO S FOR NEW COVSTRUCTION INCLUDING DECKS, AQDITIONS. & PORCHES SlJ�M1T: !. Site PlsnlSurvey showing the existing structures and proposed project. 2. "fwo sets of cons[ruction plans 3. Energy Calculations FOR WINDOWS — PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW, D ON VALUATION, IIVCLUD[NC THE COST OF LABOR AND MATERIALS: (USING THE 1997�1 B.0 FEE SCHEDULE) � ) . t9 �3`7 � � OCCUPANCY�� TYPE $ ,' See Back Page for Fee Schedule $ 65% of Building Perinit Fee $ �j , .001 times the total job valuatian $ .0005 x Permit Valuation Minimum $5.00 $ $5.00 (State Licensed Residential Contractors) $ $2230 per SAC Unit�(Plans to MWCC for determination) $ ft+6ft= i ftx$25=$ $ $450 Conservation Rlan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( } S , . Make chccics oavatile to: Citv otFridlcv Attach THIS IS AN APPLICATtON FpR A PERMIT-NOT VALID UNT{L PROCESSED I hereby apply for a building permit and f acknowledge that the information above is complete and accurate; that the work wilJ be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construccion Codes; that I understand this is not a permit but only an application for a permit and work. is ot to start without a permit: on site; that the work wil) be in accordance with the approved plan in the case of o hi h uir re ' and approval ofpl s! �,'J /7�j SfGNAiURE OF APPL{CANT PR1NT NAME �Z1iL`*''� �U�Y � DA'fE V D� �'rJ ,�� « .000rn.w■ n.�cncrrno cir.w�eTi�w� i. O�_ . PERMITSEilt�l�$QUIRED FOR PLUMBING, ELECTRiCAL AND MECHANICAL WORK :/6 From: 763 413 2614 Page�3/8 Date: 9/19/2011 5:14:22 PM , ���- --- - - ..... �..,_ ��,_...... ....,.�... ....., I ...� . _.. ��_ WZIOiSaNIM'IIAI�''iV?1f11�f1!!1S � t%��) g£46-599 (898i � 9NRI33NIJN3 � IHd1999L'161IZt9i 9E4SS NW'eU±p3 I � 77`sa�in.rag !Sl l aue�7 mo4itl 0009 � (�V,' $ V" ? !�, ""� � �n � �� � �N W � _ � N o A x � m m � � •--------� � � I I I I ! I � � + , � ! ------! W � a c� =�1 � O �n c� w c � ti� Ctp J O � �, NW`�(a�p�a� � � �ap ui pauaaa�S ; � r �1�3f 02ld a w a r N� a � C � O � W tX0 ; ,Z��- � �— tp r N 0 � a+ � Q c m a 'L o `° � C � � � m 3 V � o �� � � W � N � � � O. oN �ZN� '^ � a M x a � K N �p ly �`�I � txD � . 0>007 /i��!', - ��Ci'�'i =1Yiy .�����I - ��, ��r�� a � Y Ci � Z Q J a C9 Z a u�. 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