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P - 48281Building BUILDING Permit No.: � V (p Inspections RESIDENTIAL APPLICATION Received By:� �� 763-572-3604 763-502-4977 FAX CITY OF FRIDLEY Date Re�'d• -�`�� EFFECTIVE 11-2011 DATE � I i YOUR E-MAIL ADDRESS � � �! G�.Q V' � L( + t- "E'1n SITE ADDRE S �p I`� I T� f✓� (%j" �� /L THIS APPLICANT IS: �WNER ❑CONTRACTOR PROPERTY OWNER/ NAME: � �/�CGk'�sT''✓ TENANT ADDRESS: ��D/ y'�[�6��i� CiTY r�%D��%' STATE`�NZIP S 3v2 PHONE: _ ��oZ �- � � 2j -a ya 3 CONTRACTOR NAIvtE: SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # LEAD CERT NUMBER EXP: AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE pHONE FAX PROPERTY TYPE �INGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION S'CORIES wy ,�/..c.. v- a� �w,s.Gr•!yy j� PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED INDOWS �'BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE O DECK ❑ SIDING ❑ OTHER O SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDI1'ION O MAINTENANCFJREPAIR L��MODELING DESCRIBE WORK BEING DONE: A'�c�� Qd1 �� hW �`t- o�^ ��t? �� e �$ SIZE OF IMPROVEMENT —� LENGTH WIDTH HEIGHT S FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: � DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit SIDING/SOFFITlFASCIA ADDITIONS_ & PORCHES SUBMIT: ❑ Aluminum ❑ Trim REMOVED? .❑ YES O NO � Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS � 3. Energy Calculations IN EXISTING OPENINGS �Yes ONo LOCATION OF WINDOWS h�,r� FOR WINDOWS - PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF �jC'-7 Ad,�-I'I�, *�� MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & n � TYPE OF WINDOW TO BE INSTALLED y!"r/G NUMBER OF WINDOWS ALL r'r;1;5 AK� KASI:ll VN VALUA'1'IUN, 1NCLUll1NG "I'HE CUS1' UF LABUR ANll MATERIALS: � (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ �� i��D OCCUPANCY TYPE Permit Fee Plan Review Fire Suroharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $ �.�s /.O See Back Page for Fee Schedule $ f�}% 65% of Building Permit Fee $ /, .001 times the total job valuation $ � J .0005 x Permit Valuation Minimum $5.00 $ T- $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 pavable to: Citv of Fridlev Attach Stiai THIS 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 application for a 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 al ark which re uire �and-a�proval of pl /�,, SIGNATURE OF APPLICANT PRINT NAME ��ET�*,i ��GF�B�Y DATE � I3 // APPROVAL INSPECTOR SIGNATURE T _ �,� 3 �r�n m� �� t� i �� . � � � � � �--. � � �� , _ z � � � .-�c..> � � , � � � �--- � � �. �n � ' �l x� �_— � . _ �--- 7 ' �. ,',,,,',, � ' � � �` � .I �'� �� x � � � `�� .�_. :-,.- -... , _ .,.. � ,�,�,..,s,,,� _ _ . , � k � 1 � �. �, +�; �r . �. :__ � � i � �^ j C� `, ,/, V v v • � � �Q� � / v ,�` � � .� �' _ ,� c/� � r � � G � � �� - a � � �. � �� -- .,�-- � � �� n � . � n � � � �� n � , � � � � � � � �`' � � � � Z� � • . � �... �.� ��-�,�,�� y ��,�"` _ �`" - �' � � �`�,Y, �� ,� � �� . .�� ..._.,� �'� , � �� .r;� �'�" `.�` �,» ..__ � .yy{*� � �...... �1 �.v'Y.. � d «r'' �`• � � r �.;;.. � ��;. � , � � �� r �� „� _ .�... ��. �° ... �. � u __ � �......,... . �, � ' � : ., _ � � � �' __ d� p.S �vpwr r��.lp ... �� . ,. ..��``° ��~ � ��"� � �. . ...�_. �m� s�-� .,� � �°} ,. ��-. � �:�.� �� ,�.. �-0��.. ° � � . �;;� ;a, :i,;., �,�. _. � � ( , .. ,.. _ . _.. . .� _._�._...... i__,... ___ .._ g: � ` � "� '�a r � m , � `t � '�w� •� '.�; � �� ' . <3.;;�� . %^..c•'_..mi � _ � 4� �� `,,�,� �...� � � � � � � � � �..� ��