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