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P - 48198
Building Inspections 763-572-3604 763-502-4977 FAX DA� ! /S/1 Z SITE ADDRESS � 9 Z� THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE OF WORK: DESCRIBE WORK BEING $OOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY 0 STATE LICENSE ADDRESS: j Permit No.. Received 0 EFFECTIVE 1-1-2012 � v YOUR �E+-MAIL ADDRESS �'T0.-VICD✓I C�Y�0.✓l G Q YtiO�t 1� CO� � li'.l�,�..��n� / � I�CONTRACTOR PHONE (91 L Le loY 7Y�CP' L 6� SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCITON � BASEMENT FITiISH ❑ ROOF O DECK ❑ SIDING ❑ SWIMM ❑ NEW HOME CONSTRUCTION O ADDTITON [8 MAINTENANCE/REPAIR O REMODELING :: (�•e,�ui u�l o a�e,�' Pi���9 LENGTH WIDTH ❑ HOUSE ONLY _ ❑ HOUSE & GARAGE � ATTACHED GARAGE ❑ DETACHED GARAGE CERT N[JMBER EXP: CITY �'Y1� STATE/�'�LIP��2 ❑ DRAIN TILE ❑ OTHER BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of sVuctural membcrs to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ❑Soffit SIDING/SOFFTT/FASCIA �DITIONS_ & PORCHES SUBMTi: 0 Trim REMOVED? 0 YES O NO 1. Site Plan/Survey showing the existing structures ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ONo 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 $ Zd00 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 $ ��J •�5 See Back Page for Fee Schedule $ 65% of Building Permit Fee $ .001 times the total job valuation $ .0005 x Permit Valuation Minimum or .50 $ $5.00 (State Licensed Residential Contractors) $ � $2365 per SAC Unit (Plans to MWCC for determination) $ ft+68= ftx$25=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) _$ (a Make checks pavable to: Citv of Fridlev Attach Stii 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 code�of the i of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit aud or is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of a work which req . res eview and approval of plans. i�' l l/ SIGNATURE OF APPLICANT PRINT NAME G r� o, f"7�1 �'1 DATE S I 2. 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