P - 45124►3uilding
rnspeetions
i 63-572-3604
BUILDING
RESIDENTIAL APFLICATION
CIT�' 4F FRIDLEY
Permit No.:
Received By: "�}
Da����'��js r � ����
��rs �� �� t� � / 7�� YOUR E-MAIL ADDRESS ,�'� o d! S c� Q� c%�-r �. a�.c 5.!` a�
SITE ADDRESS ? 4 y t W( S t" C! i ! r(�
THIS APPLICANT IS: ❑ OWNER 'E7CONTRACTOR
i'Rt�t ERTY OWNER/ N�: K �} -f-/j �/ [j f d W!�
TENANT ,�pn�ss: � Gf �-i 1 W t s� C/ /' N 1� C1TY
PHONE: G/ i� �'S � G -� 7 q g
CONTRACTOR N�E; , THD At- Home Services, Inc.
SUBMIT A COPY OF STATE LIC 2�9� CU111berlarid P1c�Fy, Ste 30Q _
z�oux sTATE LIC�NS� anDx�ss Cumberland Office Park _
w12�-i �pL�cAT�oN � pxorrE Atlanta, GA 30339-3913
�STATE_ZTP 5'� 4 � �
sa(3Y5-c,oy7
CITY STATE_ZIP.
PROP�RTY TYPE ❑ S�GL� Lic# 20268257 Ph. 763/542-�826 �E
❑ TWO FA . <ORIES
PERMIT TYPE Q�DITION ❑ GARAGE/SHED WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK D SIDTNG ❑ OTHER
Q SWIMMING POOI.
TYPE OF WORIC: � ��' ❑ �DITIOrr
�MAINTEt�?ANCE/REPAIR O REMODELING
DESCRIBE W4RK BEING DONE
OF IMPROVEMENT
w,n r��w /`r0/L?
----- -- - - _ _ -
�200FING ❑ HOUSE ONLY
iJUMBER OF SQUARES ❑ HOUSE & GARAGE
:�ARAGES O ATTACHED GARAGE
?ROPOSED STZE: ❑ DETACHED GARAGE
?ROPOSED HEIGHT:
>FDING
� Vinyt ❑3offit
� Aluminum ❑ Trim
� Other ❑ Fascia
n'INDOWS
N EXISTING OPETIINGS �'es ONo LOCATJOI�j OF OWS
�R FOR NEW OPENINGS-DESCRI$E SIZE OF �C/+f'G 1y ��`�i v, n q, QQ d
�PENING CHANGES & 4 y a�S �
fYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
/
WIDTH HEIGHT
---- — — -----
ALL FE�S A.RE BASED ON VALUATION, INCLUDING THE COST OF LAB
TOTAL JOB VALUATIQN ��3 '? j� 97 U.B.0 FEE �C CUPANCY
'emut Fee
'lan Review
>urcharge
� ire Surcharge
�icense Surcharge
�AC Charge
'��-" Cut Es�rc,��
irosion Control
'ark Fee
:ewer Main Charge
'otal Due
BASEMENT REMODELING SUBMIT:
1. Existing Floor P(an
2, Proposed floor plan
3. List of structural members to be used
►�
Ft.
FOR NEW CONSTRUCTtON INCLUDING DECKS,
ADDITIdNS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project
2. Two sets of consixuction plans
3. Energy Calculations
[t AND MATERIALS:
$ 7.� See Back Page for Fee Schedule
$ 65% of Building Permit Fee
� �: Q L (.OQQS) times the total job valuation — Minimum $.50
� 3, ? ? .001 x Permit Valuation (1/10%)
$ S. O u $5.00 (State Licensed Residential Contractors)
$ $1450 per SAC Unit (Plans to MWCC for determina�ion)
q� {�i��_ �,.m�n—�
_ �� ,, w� �
$ $45d Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ i o 7. $.� Make checks uavable to: Citv flf Fridlev Attach
ulations
THIS IS AN APPLICATION FOR A PER.M]T-NOT VALID IJNTIL PROCESSED
hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work will be in
onformance with the ordinancas and codes of the City of Fridley and with the Minnesota Consiruction Codes; that I understand this is not a
ermit but oniy an application for a permit and work is not to start without a permit; that the work wilI be in accordance with the approved
lan in the case of ail work which requir.,s r ze and approval of plans.
IGNATURE OF APPLICAN J C.s.-�� PRINT NAME `,' [ S C h �I n� DATE_ � A j� � l p