P - 44974�3uilding
Tnspections
763-572-3604
DATE a � �
SITE ADDRESS OZ
THIS APPLICANT IS:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS ,{; Q�J �-� Q�i �
' Ya n � ��.� N F_
❑ OWNElt
�ROt ERTY OWNER/ N,�:_�
TENANT �D�ss: ,? !/
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYP�
PERMIT TYPE
�CONTRACTOR
u�� C��-
PHONE: ��, 3� S 7 i'��% 7 IPi �
N,�,,�: I'HD At- Home Services; Inc. � f o�(i � F
sTATE Lic 2690 Cumberland Pkwy, Ste 300 q�� � 3 YS
aDDxESS Cumbeiland Office Park c�TY
PxorrE Atlanta, GA 30339-3913
'� s�rGLE Lic# 20268257 Ph. 763/542-8826 yE
O TWO FA. . ,_ .`ORIES
QADDITION ❑ GARAGE/SHED WINDOWS
❑ BASEMENT FINISH /�ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
Permit No.:�
Received By:
fCfL�li
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'ATE_ZIP S s u 3 %
JO(l[ 5
i7
STATE ._ZIP ,
TYPE OF WORK; ❑ NEW 0 ADDITION — _- _ _
'9 MAINTEAI CE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: G�/'0 0. .p i�i0 U G .Q Yt S � Ii ii' �
SIZE OF IIvIPROVEMENT LENGTH WIDTH HEIGHT S. Ft.
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES � d �IiOUSE & GARAGE BASEMENT REMODELING SUBMIT:
GARAGES O ATTACHED GARAGE 1. Existing Floor Plan
PROPOSED 51ZE: ❑ DETACHED GARAGE 2• Proposed floor plan
PROPOSED HEIGHT. 3. List of structural members to be used
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl �SofFit ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim L Site Plan/Survey showing the exisfSng sfrucfures
� Other ❑ Fascia and proposed project.
V4�INDOWS 2. Two sets of construction ptans
IN EXISTING OPENINGS �Yes �No LOCATION OF WINDOWS 3. Energy Calculations
OR FOR NEW OP�tINGS-DESCRIBE SIZE OF
JPEMI�G CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES A.RE BASED ON VALUATION, WCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION $ G�� 19� �.Bb.0 FEE OCICUPANCY TYPE .
Permit Fee $ k l 1 Z. See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
3urcharge $ �. ( QG� (.0005) times the total job valuation — Minimum $.50
?ire Surcharge $ p� bl .001 x Permit Valuation (1/10%)
�icense Surcharge $ $5.00 (State Licensed Residential Gontractors)
�AC Charge $ $1450 per SAC Unit (Plans to MWCC for determination)
/1..t T,. f� � II ' Cc � � l'i '1 ^. __ ('� . . . . . . ...
�.u� vu� iJCi�W .p tl ` �i LL- ll��i ��V -�.p �� .
�rosion Control $ $450 Conservation Plan Review
?ark Fee $ Fee Determined by Engineering
>ewer Main Charge $ Agreement necessary O Non Necessary O
Cotal Due $ . i Make checks a able to: Cit af Fridie Atfach Sti ulations
THIS IS AN APPLICATION F�R A PERMlT-NOT VALID UNTIL PROCESSED
hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work will be in
:onformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I. nnderstand this is not a
>errnit but only an application for a permit d work is not to start without a permit; that the work will be in accordance with the approved
�lan in the case of all work which requires re and approval of plans.
IGNATURE OF APPLICANT -��' PR1NT NAME , ' I • I � � ' " � n � DATE � � I ` �
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