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P - 48467B�,,il.ding BUILDING Perm�t No.: b� �� `� Inspecti'ons RESIDENTIAL APPLICATION Re�ei�ed sy: _! 763-572-3604 CITY OF FRIDLEY Dat :� "' 763-502-4977 FAX �� .� � - EFFECTIVE 1-1-2010 DATE � Z �� Z(rl L7 YOUR E-MAIL ADDRESS �� '1 cz, ' LL �' / i C: �?� SITE ADDRESS ' � / %� �� % � . L THIS APPLICANT IS: � WNER ❑CONTRACTOR PROPERTY OWNER/ NAME: �(n t� • c, v� r� J�t I �� V' � r�'z. 5«r°� TENANT ADDRESS: (y I C`�i � (�1.�1/! �� -%�►� �i%L' CITY r� /y7L. �'/ STATE �,�`zIP�.�� PHONE: �� C% � � � `�� C CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # EXP DATE AND CERTIFICATE OF ADDRESS: CITY STATE_ZIP INSURANCE PHONE FAX PROPERTY TYPE ��SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ W[NDOWS BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ O"I'HER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR , I�,;REMODELING DESCRIBE WORK BEING DONE: � � `� G� ��'d� � � �� " L'✓`X'�j � SIZE OF IMPROVEMENT �% '�' �� LENGTH '� WIDTH HEIGHT SQ FT �� i , - ._.. ...,.._�� . _.__._._._ �' ROOFING 0 HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE l. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED S[ZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. 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 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 FEES ARE BASED ON VALUATION, INCLUDING THE COST ON LABOR ANll MA'1'�:KIALS: TOTAL JOB VALUATION $ j`�7� SING THE 1997 U.B.0 FEE SCH OCCUPANCY TYPE Permit Fee $ ,`� See Back Page for Fee Schedule Plan Review $ /� 2.C..,�� 65% of Building Permit Fee Fire Surcharge $ . S7 .001 times the total job valuation �ld J(� Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ . J C�` $ $ $ $ $ $ ` , � ,,j"�- � .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $2100 per SAC Unit (Plans to MWCC for determination) � ft+6ft= ftx$24=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) � Malce checks payable to: City of Fridley Attach Stip� THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCBSSED I hereby apply for a building permit and I acknowledge that the information above is compfete 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 all work which requires review and approval of pians. / J SIGNATUREOFAPPLICANT_�_:�=.�j — PRINTNAME �°��/�.r��'l�5<ti� DATE %�r`�f��; ,�L,� I� • b , � �� --�-f �J l �� : `��.� �'-== '� � � �� . �� < � .�\^ _2 � i, j� �_ s �� J . �-°'. �. � ��, : � _; �__. :� _�� , z � r__ _ ; �--- - -�; �� , , � �; � � -�s .� �-� c � -�- ``��► � _.. r �21�� : �-t �•.._:'� �� C�T �... .,.... '�� `ti,�. /�:s1� ; -- . _ : �. .� _ � � - , ; ,� 'i�j� � . st: � �ti� � � �� - � � , �.----.._----�'� o _.. _______- � __ _ � � -�� , q -� .� � �,� _ v � � � ,.J �,,� . �� z , w �, � l� � � �_.� 3 ,� �� ' �� : �� ,�, - ��3 , �� J � V �''') � 9 �� . ,� � � � --�J� - w� � ,. � �t (�- � � � h � I � � � f C l I � � � i .`'. �, ..` ; --- - - ,___ � �- �=.��.� -�.. � � _. �� ..-�-- � . _ .__ `� ... ... . I `� � ........... � -� __ .__ � rnl _._... __. _. . � _.._ —�- i \` ;. ''� ., � 1 • �. __ _ ___�__ J ` " �� -:-� � __ _ `�-� �- �� .:_--�- _ _ _ .._ _.._, 1 �\ . ?,(�' �� _ -�� S � t �b � ' � � _� o a � � w � � a � z i _.... . �. . � c� .. = w . __..o \ °' � � U . , \� . ��" \ `� .,� . � ,� � `�a �� ,.v � `' L t� ``� �� r -l- j ;�_.__. �� \ -J .�, '�a � � ti,_ �� , .u, � � � , �� z ` �.. , �-' �% :� �. ��. _� i �� ` L, ,,-� �� „ �` �y � C _. ` il�� f �± �__� ; � /'--- r — ! X�� L� � � 9 _'_'---��`-- r �, �_� .�,�, :� .� : � � __ _ � , _ �J,.- � �, �. - __ � C� •__--�': O-�� "�� _ � � �= �s: .. � � �'_.._...-- � ��, �'� . �C, _ � ( ' '� ..� ' � � �l � �yr� I. � , ;,� � ---�--- � ,�, _ __ _ _ -- �i -� , _ -�:�, _.� � , ,�� " � ~�� , ; 1 ' '�; , �. � __� ` }, --:'. _ ._ _��: -.� , �� _^� �.; � `�_. _ . � . f , ' ;� _� �._� _ J'.i� J � �j — �-�,. -- .''� �,—Z� . � nf — \ _` �\ � � � / �v _� V � \ "' �/ � r i'� � �-��'` � ilNrl u�'' �� \ -,:._ _ � � .� C� �-'--� .,� T�� - \� - � � � � _ � � L� - ...� . _—. � e`� J � .:� �� =� f /�f"(1^� � � �;a'Jt71 �� - '--_--------. � _ � �� I � ��. . ` J � `r. ,,-., - -�� ``�� _ , �f _ i �� :�� , � � ' ; _ �---__ __ . � -__. �.. _ _ ._ __.� ,_ � ( �� , �i.! �,,�_.._. t )-f � C., �� : 4 i` ! i � ; ♦ Laundry/Office Remodel and estimated valuation approximations ($2395) Note: All walis and ceiling areas are unfinished, making installations easily accessible. Buildine ($695) Add a wall ($300) Add a door ($275) Add he�v'en�120) Electric ($800) (Laundry Room) Add three can lights and convert pull-string light to can for four total recessed lights Add one light switch Add one outlet Move two outlets (Office) Add three four-plex outlets Add one by two-plex outlets Move two two-plex outlets Add one light switch Add three can lights and convert pull-string light to can for four total recessed lights Plumbin� ($900) t � � � -�-�j �� Move water softener, re-rouring water lines ($300) � �D Move washing machine, re-routin rain ($150) �� Move dryer, re-routing gas anc�venL $150) Move and mount drain tub (conv2sZt to wall-mount) ($300} /,� �'- G �t.�.� i �c-� ,—_ �a i - z � �rr �� s /�� l= �z ��u��v� s��