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P - 48456Building , BUILDING P���t No.:��o�a Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY vate Rec'd: 763-502-4977 FAX �c�rn,E �-i-2oio nA� Youx �-�L n�v�ss rPo�\ \ �-�e. ��n ��r� c�, � ,n �y�o�. � . c.ov,v� STI'E ADDRESS ��3 o W . ��0 A �► v�. � r� � � � �( , r1 � ,�5� 3 a TI-IIS APPLICANT IS: ❑ OWNER �CON'1'RACTOR , PROPERTY OWNER/ N�: '�E� J jl�U �.g� U TENANT nDD�ss: Si230 Gtl . A I�J� tA �E_ crrv fi�2 t� LE`t' STATEM I�ZIP SSy,3,� PHO�: 6/� -� rd - y�� a CONTRACTOR NAME: Real ��e I�lil} � 1� L C� SUBMIT A COPY OF STATE LICENSE # v�� �+ YOUR STATE LICENSE 3�P 7 g� EXP DATE 3/3 � 1 a�o � 1 AND CERTIFICATE OF ADDRESS: 37S0 fFLD r2� Cr/ A�/� il/ CITY MPL-S STATE�ZIP .$�'S�/a �5�� PHO t� - � o F� ��a - s- 3 PROPERTY TYPE �;SINGLE FAMILY�I+IEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ADDrt'�oN ❑ GARAGFISIIID ❑ wtNDOws ❑ BASEMENT F[Ai1SH O ROOF ❑ DRAIN TII,E ❑ DECK ❑ SIDING ❑ OTFIIIt ❑ SWIlvIn�IING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION �;ADDTI'ION ❑ MAINTINAI3CE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: .> �*n c or� �o r (C� it �,vZ � ! , SIZE OF IMPROVEMENT / LENGTH c7� WIDTH o� � HEIGHT � S FT a J ROOFING ❑ HOUSE ONLY gpg�r ggMODELING SUBMIT: NUMBER OF SQUARES C] HOUSE &c GARAGE �. ���ng Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE '/� i�� 3. List of str�tural members to be used PROPOSID HEIGHT: v 3IDING i�,�`� FORNEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑So� � � � X �v"� � � ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim —. Y. Srte Ptan(Survey showing trre eausting structures ❑ Other 0 Fascia ' �d Pr°P°sed Project. 2. Two sets of cwnstruction p►ans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS �Yes QNo LOCA1'ION OF WIND�WS FOR WINDOWS – PROVIDE IJ-VALUE AND OR FOR NEW OPENINGS-DESCRIBE StZE OF MANUFACTURE STICKIIi ON WINDOW. OPErIING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS Ai.i, rr,�� t�xr, nAa�U vi� vALUA11V1v, iPIC;LUlli1Vl� lriL�' C:VJl Vl+' LAI3VK ANU MA'1'L�'HIALS: 30B VALUATIDN $ `��S��THE 1997 U.B.0 FEE SC ����� �PE Permit Fee $ Plan Review $ Fire Surcharge $ Surcharge $ License Surchazge $ SAC Charge $ Curb Cut Escrow $ Erosion Control $ Pazk Fee $ Sewer Main Charge $ Total Due $ See Back Page for Fee Schedule 65% of Buiiding Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $5.00 $5.00 (State Licensed Residential Contractors) $2100 per SAC Unit (Pians to MWCC for determination) ft+6ft= ftx$24=$ $450 Conservation Plan Review Fee Determined bY Engin�ring Agreement necessary ( ) Nan Necessary ( ) Make checks payable to: Citv of Fridlev Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclQ►owledge 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 Canstruction Codes; that I understand this is not a permit but only an application for a permit and work is noi to start without a permit on site; that the work will be in accordance with the approved plan in the case of all ' re ires review and approval of plans. / 3IGNATURE OF APPLICAN'I' PRINT NAME �IPq✓ jj«��0� DATE ��' I t%" I� APPROVAL INSPECTOR SIGNA E _ NOTE: SEPARATE PERMi'TS ARE REQUIRED FC)R PLtIMBING, ELECTRICAL ANU � � . . . . - . � - � .. 30((# 61�tAU11�1tW ��. 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