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P - 44216Building Inspections 76?-572-3604 763-502-4977 FAX DATE �^��'�_ SITE ADDRESS —yL�— THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 8-19-09 YOUR E-MAIL ADDRESS e��-l�I �� f�.9'dP1VER ❑CONTRACTOR ::�� ' � � ' UNt�t� ESS: s ... n i z _� u - , -�-� �� 0 � �1 m PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION PERMIT TYPE � AD ❑ GARAGE/SHED SEMENT' FINISH ❑ ROOF DECK ❑ SIDING ❑ SWIMMING POOL T'YPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ A ❑"MAINTENANCE/REPAIR MOI DESCRIBE WORK BEING ROOkTNG NUMBER OF SQUARES _ GARAGES ' PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ V inyl O Aluminum ❑ Other ❑ HOUSE ONLY ❑ �IOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE SIZE STORIES WIDTH Permit No.: � - - -. : � �.�a�li . . �.�i�' .. -, �1 � ATE�ZIP� EXP DATE CITY� STATE�LIP� ❑ DRA[N T[LE ❑ OTHER BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDiNG DECKS, ❑Soffit ADDITIONS_ & PORCHES SUBMIT: ❑ Trim 1. Site Plan/Survey showing the existing structures C] Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS OYes ❑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 FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: t��USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $__�_ __ _ OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surchazge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ $ $ $ $ $ $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $2000 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$22=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks uavable to: Citv of Fridlev Attach THIS IS AN APPLICATTON 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 all w w' requ' •�eview and approval of plans. SIGNATURE OF APPLICANT _ NT NAME �� __L7��"�ATE � � % �� T .� �,.� �� ,. � r. _ ,. . ,. � ,�.� L .� .r � �. -y l� � � � � � �'�'��P 2 � � � , �� w�n� �- � 3 - � . - . ._.___. I � , � ` � ,�"��'�� , � ! �� . �� 4 � '� � 7� � ` � / — � � � � ./ � �� Z � � � � �� J'�°Z� �� , �� . �, � �� ;s---°-- �'"""� . � C� , ,` � �� c� -�� 7 � r �� .� �f��% � s� � �� J �. _ �`� � �� 1�'� � �� ,� �� N � �� a� 7� � � � 1�� ,� � �Q � � � . �� . � ��' �� "`' � �..��,�� _. �