P - 45813Building BUILDING Permit No.: ' (
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY D
763-502-4977 FAX �i�'`��1 � � � � �� ��
EFFECTNE 1-1-20ll
DATE 06/23/11 YOURE-MAILADDRESS action a�actionroofing.net
s►TEaDDxESS 7419 West Cir NE
THIS APPLICANT IS: ❑ OWNER �1CONTRACTOR
PROPERTY OWNER/ NA�E: Gerald Lynk
TENANT ADDRESS: Same
CITY STATE ZIP
rxoNE: 763-783-8894
CONTRACTOR NAME: Action Roofing & Siding LLC
SUBMIT A COPY OF STATE LICENSE # 5421 LEAD CERT NUMBER NAT-109445-1
YOUR STATE LICENSE
.arrD cExTiFicaTE oF ADDRESS: 1315 Southview Blvd c�TY So St Paul sTaTEMN z�r 55075
nvsuxarrcE rxoNE 651-457-2642 Fax 651-457-0351
PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE � ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH �J ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR � REMODELING
DESCRIBE WORK BEING DONE: T@8i-OfF c'iC1CI i@-i00f iIOUS@.
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT
ROOFING BI HOUSE ONLY
NUMBER OF SQUARES 15 ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
GARAGES O 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 OSoffit ADDITIONS. & 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 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 INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 4100_00 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
$ �f� L� 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 ( )
$ r�11 'b, Make checks navable to: Citv of Fridlev Attach
THIS IS AN
I hereby apply for a building permit and I
conformance with the ordinance es
permit but only an applic �on for erm' n
approved plan in the cas
SIGNATURE OF APPLICANT
APPROVAL INSPECTOR SIGNATU E
'LICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
>wledge that the information above is complete and accurate; that the work will be in
City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
ork is not to start without a permit on site; that the work will be in accordance with the
� r.�view and approval of plans.
��-�AMF Kurt Merrell naTF. 06/23/11