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P - 45744Building BUILDING Permit No.: `�ii� �` 1 Inspections RESIDENTIAI, APPLICATION Received By� 763-572-3604 CITY OF FRIDLEY D �°�� � N!� r1 � t� 1� 763-502-4977 FAX EFFECTIVE 1-1-201 ] �� DATE 6-29-2011 YOURE-MAILADDRESS msampie@hwconstruction.com SITEADDRESS 291 S�Clvan Ln. NE THIS APPLICANT IS: ❑ OWNER Cjl,CONTRACTOR PROPERTX OWNER/ NAME: Darlene Mcphillips TENANT ADOr�ss:291 Sylvan Ln. NE c�TY Fridley STATB MNZIP 55432 PHOrvE: 763.571.8151 CONTRACTOR NAME: Hoffman Weber Con. SUBMIT A COPY OF STATE LICENSE # 40543250 LEAD CERT NUMBER YOUR STATE LICENSE AND CERTIFICATE OF noo�ss: 7932 University Ave NE CITY Fridley STATE M�IP 55432 INSURANCE PHONE 763.300.6542 FAx PROPERTY TYPE Ijd SWCLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT 'I'YPE ❑ ADDITION ❑ GARAGE/SHED ❑ W►NDOWS ❑ BASEMENT FINISH j� ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDWG ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION C9 MAINTENANCE/REAAIR ❑ REMODELING Desc�sE woRK aeiNC �oNE: Re-Roof/ Storm damage SIZE OF IMPROVEMENT LENGTH W[DTH HEIGHT S FT ROOFINC ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES � 7 ❑ HOUSE & GARAGE I. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List ofstructural members to be used PROPOSED HEIGHT: S[DINC FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITlONS. & PORC!-!ES SUBMIT: ❑ Vinyl ❑Soffit I, Site Plan/Survey showing the existing swctures ❑ Aluminum ❑ Trim and proposed project. ❑ Other C] Fascia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTWG OPEN[NGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS — 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 N'L+'�J AIZ� KASN;U UlV VALUA 17V1V, IN(:LUUIIVG I HL�' (:U5'1 UH' LAKUK A1VU MA'1'L�'1t1AL5: (USINC THE 1997 U.B.0 FEE SCHEDULE) JOB VALUATION $ OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Ma�n Charge Total Due $ $ o $ $ $ $ $ $ $ � r .,. /. See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Vatuation Minimum $5.00 $5.00 (State Licensed Residential Contractors) $223Q 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 pavable to: City of Fridlev Attach Stipulations THtS IS AN APPLICATION 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 of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applicatio for permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of r f�s re iew and approval of pla s. `�, SIGNATURE OF APPLICANT �/ PR1NT NAME_� �i�x��� // DATE APPROVAL (NSPECTOR SIGN