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P - 44966Building Inspections 763-572-3604 763-502-4977 FAX DATE i/�" 3CJ "� SITE ADDRESS _ THIS APPLiCANT [S: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DESCRIBE WORK BEING SIZE OF IMPROVEMENT BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-201I O OWNER YOUR E-MA1L ADDRESS �CONTRACTOR Permit No.: CJ�1 � V) Received B � � Date �' `��N e� � 2Q �- � �-i �clC � ��1 ADDRESS: / �� �/�I,�,�t/ � CITY PHONE: .�s-,�a%, Gt�j�_. STATE " �' ZIP STATE LiCENS� # �Z O�o 3 O$� � LEAD CERT NUMBER ADDRESS: o�� .3/ (o tiv d1-t5�/ 9'� CiTY G-�L�C Oi,Ive/l_- STATE�ZIP J� aunrir �%f _ 7, � 2 ff.�/..f/A� n ��. �SHJGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/I�IEW CONSTRUCTION STORIE� ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH .�tOOF ❑ DRAM TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENA�ICE/REPAIR ❑ REMODELING ROOFING {_ NUMBER OF SQUARES �`i' GARAGES PROPOSED SIZE: PROPOSED HEIGHT: IDING ❑ Vinyl ❑ Aluminum ❑ Other ( WINDOWS !, IN EXISTING OPENINGS ❑Yes ❑No I OR FOR NEW OPENINGS-DESCRIBE SIZE OF �� OPENING CHANGES & I TYPE OF WINDOW TO BE INSTALLED ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS NUMBER OF FT BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION iNCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: l. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans 3. Energy Calculations FOR W[NDOWS — PROVIRE U-VF.LUE AND MANUFACTURE STICKER ON WINDOW. ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 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 $ " $ b $ $ $ $ $ $ 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 ( ) Make checks aavable to: Citv of Fridlev Attach THIS IS AN APPL[CATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City f idley and with the Minnesota Construction Codes; that i understand this is not a permit but only an application for ermi o' not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all o eview and approval of plans„ / �, /,�/, �-� SIGNATURE OF APPLICANT PRINT NAME / L ��DATE APPROVAL INSPECTOR S[GNA