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P - 35849Building Ir�spections 763-572-3604 763-502-4977 FAX DATE �/G,C9/ %I SITE ADDRESS _ TH[S APPLICANT IS: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-(-2011 YOUR E-MAIL ADDitESS /1./�t S, 1�OWNER J$�CONTRACTOR PROPERTY OWNER/ I NAME: TENANT _ _ _ CONTRACTOR NAME:�� SUBMIT A COPY OF STATE L[CENSE # YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS:�,� INStJRANCE pHONE %�2 � PROPERTY TYPE ,EI SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION PERMIT TYPE ❑ ADDITtON �BASEMENT FINISH ❑ DECK TY.PE OF WORK: I � NEW HOME CONSTRUCTION ❑ MAINTENANCE/REPAIR DESCRIBE WORK BEING ROOFING NUMBER OF SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: DING ❑ Vinyl ❑ Aluminum C7 Other CITY Permit No.: ��6 � I� I o� Received By: (.,/�'� D��'��U L � 6 � 11 t�' � ATE%��Z[P ��/ LEAD CERT NUMBER ZZbG CITY��j,g�/ fc7//, L STATE�LIP.,� �!q FAX SIZE ❑ ROOF ❑ DRAIN TILE ❑ SIDING �OTHER ❑ SWIMMING POOL ❑ ADDITION � REMODELING ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE n HEIGHT FT BASEMENT REMODELING SUBMIT: I . Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION MCLUDING DECKS, ❑Soffit ADDITIONS. & PORCHES SUBMiT: ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Fascia and proposed project. 2. Two seu of construction plans WINDOWS 3. Energy Calculations M EXISTING OPENINGS ❑Yes �No LOCATION OF WINDOWS FOR W[NDOWS — 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 BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: /�^ (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $( 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 $' 01 ��. nl J 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 ( ) $ c Make checks qavable to: Citv oi Fridlev Attach THIS iS AN APPLICATION FOR A PERMIT-NOT VALID UNT[L PROCESSED I hereby apply for a building permit and acknowled e that the information above is complete and accurate; that the work will be in conformance with the ordinances and co of the Ci of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a p it and wo is not to start without a permit on site; that the work will be in a corda e with the approved plan in the of all wor i 'r review and approval of pl s 2 SIGNATURE OF APP PRINT NAME��St�°(.1 �H/h�2'a lc,�� DATE 7 Z� / APPROVAL INSPECTOR S[GNATU � v� � � �� r ,� � � � - p! �� --ra-----=- _ � � � �� ,``�0�0 � , �1 ' t �- - _--- � I � i tn .-i t_() `� �"' �.� � ��__._ , ., � � `''� �� ..��` , � � tij� � � � N �' i /� � .� . ,1,r ��_ .. � � J U v� � � � �� J � � � � ` � n °— � �.o � �� _ � � , - J ;,,�� ., _"'' �i � s� �3 � � � � � � \T1 � � -�� ,�� `..'� Q � � r /�I .2= \ v, �� J � �J fl � � ,----- � , � ; � ; � , ``� �' C � � � ( �� G � °- Q � � � I I�� - � � � � s �� ., �..� � Q ►- �� ° t � � `� � a�� J i . �. � � � _ �r� � � � � � r�, Gl.. � � n� � /I � 1 -..._, � 1 �p • � � � � Z C=� C� • ' -�' � � �---_ y �. � � � ° � � � � . -, ._..--- � ��. �""� c��) � v �I/�.S' � v 7 � � . � � � � �� M ',� lt � � �� . a° � , �, k � � � � � �