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P - 40007Building Inspections 763-572-3604 763-502-4977 FAX BUILD;NG ��,5��� RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-I-2011 Permit NoC�t 1 ""�� � 3� Received By: '� r � Date Rec'd:� �'� � ___ -- -- /'` DATE (ZS �I ' l � YOUR E-MAIL ADDRESS �i �_ �}�t �7C D(n � � (� �� � /U( CI�- S % � /�7 C % siTE fw�RESS �G.� G� �� Gt.�Ck�,C)�r' ,O� �°-2 t. THIS APPLICANT IS: ❑ OWNER �ONTRACTOR PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE ADDRESS:_ S,�t�c) AJ� ZCi (,L E% M/FL� S!c 2�� PHONE:��/'Z � �{ � S O �Q C� NAME: CI %aI2_K IC�MtD/i�L/A�r� LLC` STATE LICENSE # ��L S STATB�/� ZIP S SS�U Z CERTNUMBER �- �'— �r'�3�5� �(�~ d ADDRESS:,�(� �c:�/ S�N..S�..� �Y'�?/"2 • I�-,t CiTY�i���Lj'N P�C STATFD�Y LUZIPy�� � PHONE !rrlZ- Z�'�c� -%S �� F,ax 7�3--�r-��--�Z73 � PROPERTY TYPE I�SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION PERMIT TYPE I ❑ �DITION ❑ BASEMENT FINISH ❑ DECK TYPE OF WORK: I❑ NEW HOME CONSTRUCTION ❑ MAINTENANCE/REPAIR DESCRIBE WORK BEING SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Alominum ❑ Other WINDOWS IN EXISTING OPENINGS ❑Yes ❑No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED ❑ GARAGE/SHED ❑ ROOF ❑ SIDTNG ❑ SWIMMING POOL ❑ ADD(TION ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS NUMBER OF SIZE STORIES ❑ WINDOWS ❑ DRAIN TILE �OTHER '� D� A%� IZM �NOn% S%2vC •?l9 R L j� HEIGHT SO FT BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed Floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: I. Site Plan/Survey showing the existing structures and proposed project. 2. Two seu 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 U.B.0 FEE SCHEDULE) COTAL JOB �ALUATION $ DD � a O 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 $ �?3 .,S'."O $ 'eg-- $ ._ G $ . S"(� $ �� a� $ $ 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 payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and 1 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 start without a permit on site; that the work will be in accordance with the approved plan in the case of work h' r 'res re ' w d ap oval of plans. SIGNATURE OF APPLICANT P T NAME �i t. ��D G �LA�K DATE ��3 �"� I APPROVAL INSPECTOR SIGNATURE , i .�-� _ _ r+ fi? �► . , . r___--- � � s � � . � � � 1 � � � ..�.,.�.�-•_'""... "� . ..� �� � � `<°-=� L� � �� �� � �s� '� y.l �/' Q� s -� - � �� '�� � � `/ � � �� �7 �� �%�vS,�S � � � � � � � � � � n � 5 � s � � �J v C� � � G (� • � � � � � � � � � � � � � � � 5