P - 44982�3uilding
Inspections
763-572-3604
�ATE 3 � � / �
SiTE ADDRESS �
THIS APPLICANT IS:
PRO�ERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
Permit No.:
Received By
I� . �-,:�' .,�
OUR E-MAIL ADDRESS �. 0 Q� t" s� e(�'� r�. o n,c S,(' 0 M
a n � �C/' _F
❑ OWNER 1$CONTRACTOR
ADDRESS: � � l S V/ V C/l C%j CITY �%'! !'� �[ �/ STATEiZIP �S S��' 7
PHONE: � l, �S � S? i• 3 9 7 i
N,,�; fHD At- Home Services, Inc. �j � n,�
sTA� Lx 2690 Cumberland Pkwy, Ste 300 q$� � 3 YS -(, o y'7
.�wD�ss Cumberland Office Park crrY STATE z�
PHONE Atlanta, GA 30339-3913
ts4s�rGr.E Lic# 20268257 Ph. 763/542-8826 =E
❑ TWO FA • . .ORIES
QADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAW TILE
� DECK � SIDING `�OTI-�R
O SWIIvIIvIING POOL
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminnm
❑ C�tter
VWINDOWS
IN EXISTING OPENINGS ❑Yes �No
OR FOR NEW OP�l�IINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WiNDOW TO BE INSTALLED
LENGTH _
a xousE orrLY
D HOUSE & GARAGE
[7 ATTACHED GARAGE
O DETACHED GARAGE
�6t$offit
❑Trim p���
�Fascia
LACATION OF WINDOWS
NUMBER OF
^ f Q S c'
WIDTH HEIGHT
BASEMENT REMODELIlVG SUBIvIIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft.
FOR NEW CONSTRUCTTON 1NCLUDING DECKS,
ADDITIONS. & PORCHES SUBMTT:
l. Site Plan/Survey showing the existing struc�res
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
— --
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 3 3 l% OCCUPANCY TYPE
Fee
Plan Review
Surcharge
Fire Surcharge
License Surchazge
SAC Chazge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ 7.2
$
$ / GG
$ 3.3 /
-$ S.b�
$
$
$
$
$
$ /v'7•e7�
See Back Page for Fee Schedule
65% of Building Permit Fee
(.0005) times the total job valuation — Minimum $.50
.001 x Permit Valuation (1/10%)
$5.00 (State Licensed Residential Contractors)
$1450 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATTON FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work wilt be in accordance with the approved
plan in the case of all work whic�quir rev ew an approval o€plans. ��,
SIGNATURE OF APPLICAN� G'' ��'� PRINT NAME ( l � " � S� � O � � DATE � [ � � ` / I