P - 48338� �
Building $jJjj,DT�j(i Permit N f —d ��
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date Rec'c1: � /�
763-502-4977 FAX EFFECTIVE �-�-ao� i
DATE July 1, 2011 YOURE-MAILADDRESS Mary@buildersandremodelers.com
SITE ADDRESS 5484 W Bavarian Pass
THIS APPLICANT IS: ❑ OWNER []CONTRACTOR
PROPERTY OWNER/ NAME: sharon Feuer
TENANT ADDRESS: 5484 west Bavarian Pass CI� Fridley STATE MN ZIp 55432
763 572-1080
PHONE:
CONTRACTOR NAME: Builders and Remodelers
SUBMIT A COPY OF BC11o0 NAT-20683-0
YOUR STATE LICENSE STATE L[CENSE # LEAD CERT NUMBER
AND CERTIFICATE OF ADDRESS: 3517 Hennepin Avenue South CI�-�, Minneapolis STATE M�`�ZIP 55408
INSURANCE pHONE 612827*5481 FAX
PROPERTY TYPE OCSINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE ❑ ADDITION ❑ GARAGF,/SHED CicWINDOWS
❑ BASEMF.NT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCT(ON ❑ ADDITION
❑ MAINTENANCE/REPA(R C�REMODELING
DESCRIBE WORK BEING DONE: remove and replace 3 windos in existig openings
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT
ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor PIa�
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 ADDITTONS, & 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 EX[STTNG OPENINGS QYes �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 AKE BAS�:ll UN VALUA'1'tUN, 1NCLUllIiVG CHI+: C:UJl UN LAl3UK AIVU 1V1A7 �KlALJ:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 424� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ ��� o� S�
$ -
$ _ _2 S'
� /a2�
S, d°
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $5.00
$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 payable to: Ci .ty of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VAL1D UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accwate; 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 a! '/ rl!/LL,h�� es review and approval of plansv.-y J
SIGNATUREOFAPPLICANT ' 3,-r�- PRINTNAME / �/GL�`� 7��� DATE �/1/2011
APPROVAL INSPECTOR SIGNATU �
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK