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From: 952 808 7408 Page: 1/1 Date: 7/7/2011 7:21:18 AM .
rrom:rirst l;hoice tiuilqers lnc. ��t i3Uti 14U�i UEIUf,+�Ull Uti:�4
Bui�ding
Inspections
763-572�3604
763-502-4977 FAX
DATE /./ • ��rf i
SITE AnDR$S3 J v� U
TH1S APPLICANT IS;
TENANT
B�J�LDING
RESIDENTIAL APP�,ICATION
CITY OF FRIDLEY
YdUR �-MAtL ADDRESS
�.5�_ N�
l� OWNER jfiLCONTRACTOR
's: ��a �'iv e C) Sc�N
.ESS � l/ /9 �! �3.E'1 �±v r �
�: `7�3 - s �lr..� � a�-�.
�� ��as..�- a400 �.� �� �r�.�.s
SU$MIT A. COPY OF STATE LICENSE # �� I%`J'�' S'--'
�oux sTAT� LrcErrs�
AND CEItTIFICATE OF ADDRESS: l 2 Z�� Nl Cel � l !'iJ-c..
,�
IN5U12A.I�ICE P}IOIVE "! i z'�C�+S�'-7dGYJ
PROPERTX TYPE CJ SIN�GLE FAMILY/NEW CONSTt2UCTION
❑ TWO FAMILY/NfiW COIVSTRUCTION
P�RMIT TYPE �7 ADDITTON p GAxnGE�SHI
OF WORK:
DESCRIB� WORK BE1NG
❑ BASEMENT FINJSH �RI ROOF
O DECK C] SIDING
❑ SWIMMJNG PO�L
I� NEW HOME CONSTRUCTf�N ❑ ADDiTION
❑ MAINTENANCE/REPA[R O REMODELING
i:�f'A�/Q� OF'� �L �l'�P' +�sa'dC -
ROOFYNG
NUMBER OF SQUARES ,�
GARAGES
T'RCIPOSED S1ZE:
PROPOSED H61GHT:
NG
C] Vinyl
O Aluminum
Cl Odier
WINDOWS
IN EXISTING OPENINGS C]Yes C]No
OR FOR NEW OPENINGS-DESCRIBE SIZE Or
OPENING CHANG6S &
Q HOIJSB ONLY
,�F30USE & GARAGE
C7 ATTACHED GARAGE
J�DETACHEA GARAGE
L]Soffit
� Trim
O Fuscia
LOCATTON OF WR�IDO�VS
�•^--~ ,
8Uti1 h'. UUl/UU1
Pezmit Na.' � °' G
�
Received By: �
Date Rea'd: /
: % ��7dr'r � �i �!/f7r.t'! N� /V�=�
STATE �'y/,tiIZIP SAS'�!�'�.
CERTNUMBER i-1���^�+5�-tu-da��,7
CITY i�/�SV� �� STATE�A✓ZIP� ,�%
x 95z - o�� �+�oSg
!7 DRAiN TlL.E
C] OTHER
�ASEM6NT REM��ELING SURnnrT•
I, Existing Plooe Plan
2. Pibposed itoor plan
3. Gist of structural nre�nbe�s to be used
FOR NEW CONSTLtUCT[ON INCLUDING DECKS, �
ADDIT(ONS & PORCHE� GL9MIT•
i. Site Pian/Survey showing the existing stmchues
and riroposed project,
2. Two sats of constrnction pluns
3. Energy Cnlculations
FOR WIIVDOWS- PROVIDE U-VALUE AND
MANiJFACTURE 5T[CKER ON W)NDOW,
ALL FEES ARE BASED OlV VALUATION, INCLUDING THE COST OF LA.BUR AND MA
� , (llS1NG TH� 1997 U.B. �E SCHEDULE)
JOB VALUATION S /� o ra o_ac� '•'�'°� .`'�� nrr�r �re nrrv �
Permit Fee $ � ,�;�" See Back Page for Fee Schedule
Plan Review $ ' 65% of Building Pcim�t Fee
Fire Surcharga $ ' .001 times the total job valuation
Surcharge $ j � �.0005 x Poz�mit Valuation Minimum $5.00
License Surcharge $ $5.00 (State Licensed Resldential Confz•actors}
SAC Charge $ $2230 per SAC Unit (Plans to MWCC far determination)
Curb Cut Escrow $ ft+ 6 ft = R x$25� $
Erosion ControI $ $450 Conservatian P�an Review
Park Fee $ �ee betermined by Engineering
Sewer Main Charge $ Agreeme�nt necessary {) Non Necessary {)
Tofal Due $ ,� Ma,ke checks ap vable to: Cfty of Fridley Atkach St� uiations
'FHIS 15 AN AAPL]CATION FOR A PERMIT-NO'T VAL1D UNTIL PROCESSED
I hereby appiy for a bailding permit and I acknowIedge that ehe information above is complete and accurate; that the work will be in
conformance with the ordinanoes and codes of the City of Fnidiey a�d with the Nfinnesota Construction Codes; that I understand this is not a
perniit but on�y an application far a permit and work i not to start withont a permit on site; that tbe work wiil be in accordance with the
approved plan u� die case of k w ch i i s iew and approval of p1�a
SIGNATURE O� APPLICANT �(NT NAM@ :s a�iN' .S'�PSC �i IJ. pp� �%-� —/�
APPRf1VAL INCPFCTf1R G!• � AT1;17q , . ll
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