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P - 48363Building Inspe� ns 763-� y=3604 763,�"J2-4977 FAX DATE _�� Z .— SITE ADDRESS _ �'�/r�, THIS APPLICANT IS: PROPERTY OWNER/ TEI�TANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-2011 YOUR E-MAIL ADDRESS r _ l r�' . I ❑ OWNER Permit No.: Received By: � C°� Clj�� (T �r� STA STATE LICENSE # �� .�. � LEAD CERT NUMBEF ADDRESS: �T?�_�'� ?`4 ��' f ,. �' CITY� PHONE pq}{ . '; �'SiFiGLE FAMILY/NEW CONSTRUCTION SIZE �c S ❑ TWO FAMILY/NEW CONSTRUCTIOT�- STORIES � ❑ ADDITION �'1,ARAGElSHED ❑ WI DOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING O OTHER ❑ SWIMMING POOL ❑ NEW HOME CONSTRUCTION ❑ ADDITION {],A4�ftGTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE - `Z— .- / � A � �, • , / , STA �'��Pya4 �r HEIG1iT SO F BASEMENT REMODEL(NG SUBMIT l. 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 structuros � Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑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 WSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: U ING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $�� ' OCCUPANCY TYPE � Permit Fee � Plan Review � Fire Surcharge Surcharge License Surcharge SAC Chazge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ �-?L?-5�_ $ $ �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 pavable to: Citv of Fridlev Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VAL[D 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 o w k if h review and approval of // Q SIGNATURE OF APPLICAN��/ c,�� PRiNT NAM�'k�p.�� GZ�e!��F'�DATE �pc7 C� !% APPROVAL INSPECTOR SIGNA UR - �.� �, s� '� �, 9 � � � .,.a. �it ,� „� . � -�'� �. `� � P� "'i Q �� w �; �, �` � �; ��.. � � � � �3 (� ✓-�� } 1� �" �' � � � p � �° ' � c � � � `,:� � .� � m+ ..� �,.� M� � � �:,, �� "4s y �, :a� � .��,. ;,�,. �: . �� _ � �� .� #� �� .:. r�,.. � a �� , �� ; � � �?'4 M i .._. � �` �.w �� G � r— —A �r i \ � ��_ _ � � - ..— ,� c�- �� x- ��, �- � �� .� � � Q� � � � � � �-'I � V ) � � �