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P - 48526Building BUILDING perrriit No. Inspec?�ions 763-572-3604 763-�02-4977 FAX DATE `T - /1 �' '� SITE ADDRESS /y�Y RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-I-2011 !/�C LrY� Received By:_ D����°�+:R� YOURE-MAILADDRESS �l'I�G �LJC� �i �� �1.��L? ��^�^�r�`�✓�y I'E ✓✓t�*e��-���tc�.Cc!✓� T— A�. �. �� THIS APPLICANT IS: ❑ OWNER LidCONTRACTOR PROPERTY OWNER/ N,a�v�E: �j�, /�.�. 3 , ya2�!%SS�� t-l��.eti TENANT qDDRESS: /�{ �`I `� LL�� i�a�r rne'r'c� ('�'rz PHONE: � I Z' �j�el ' �' Z `�J((P CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: STATE �✓t ZIP �JS� 4�2� NAME: � r� C Ir�%f.t. �f AI� c.{. Ccv:� �r�/ l��F'v�tCt�e.�t�"� +.� STATE LICENSE # � L j(p 3 3 C> LEAD CERT NUMBER ADDRESS: ���%�� l�vi �`ry i2.� C�� ��' CITY �1 �� C V76� STATE t$�M ZIP -rj S 3��, PHO E (r.% ( Z` ZC' Z- (c�Zl 2- FAX SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ �O FAMILY/NEW CONSTRUCTION STORIES ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAfN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING P OL ❑ NEW HOME CONSTRUCTION ❑ MAINTENANCE/REPAIR I�ESCRIBE WORK BEING DONF..: SIZE OF iMPROVEMENT ROOFING NUMBER OF SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other WINDOWS IN EXISTING OPENINGS ❑Yes ❑No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED c r1 l.t�c ✓° c H ADDITION ❑ REMODELING /t C�c�, -�f d .1 � WTDTH ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS NUMBER OF WINDOWS 3��� ' HEIGHT �3 � SQ FT � 3� BASEMENT REMODELING SUBMIT: I. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS, & PORCHES SUBMIT: l. Site Plan/Survey showing the existing structures and proposed project. 2 Two sets of construction plans 3. Energy Calculations FOR WINDOWS - PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW. ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 O.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ Z�% , � ��c • 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 $ ' �� � 1j $ .� C"� r i �� $ ��°1, �� $ f?; t��_? "', $ $ $ $ $ $ `'� � . �� C.; s See Back Page for Fee Schedule 65% of Building Pennit 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 Pian Review Fee Determined by Engineering Agreeinent necessary ( ) Non Necessary ( ) Make checks pavable to: Citv of Fridlev Attach ulatinnc THIS IS AN APPLICATION FOR A PERMIT-NOT VALID 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 mit a, 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 all � e review and approval of plans. r SlGNATURE OF :APPLICANT l��� .� '` PR1NT NAME C✓ �� ��'« 1� DATE ��� Z�' ` I� � 3 APPROVAL [NSPECTOR SIGNATURE , �"`':y �t � L /`�-; � 3OHN J. RYA�' CO. � 7�95 SELBY AVEi�JUE, ST. PAUL 55!04 :�s SCALE: 1 1NCH__ _�'�__—_— _FEET TELEPHO�lE: 6",o"-5c5E ���� �� � �s.J � i �� i f '% , % 0� PROPERTY OF �";:'�/.._s'�"�: �%��lr�,�'-:�_ �� � �%`'' j�'� � '�'�-- ------ ., ; r ,;, ; . , ,•_ , , > //�' . . � � f LO�,ATIi'��l _ 1'�!�� �' r'�'1' '�..�L�t�/�����1 :�f''�.', J.� . _ %:�� �f_" �_�1/r-- �-G-�r=r ----- 'S` - - DESCF!EED AS �lilLO'v`!4_ 4-_�4 f f _ � Sr. �'. >. -i .�.e � �a -_ '�. `_ _�� �� %''yi!:-�l_ r � ---- :.f/ _i � —T- . � j � ; ._� / f / r � :% -i- - _�->�1�-. _,, � �, � / , _y� _-..,_, = �._ . ' !� /> 7 .��T :�.. 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