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Building Inspections 763-572-3604 763-502-4977 FAX BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE i-I-2011 DAT�_ U q�� a I�v i� YOUR sirE a,��RESS .�`l.� C� Y�-� s�. 7i1F , THIS APPLICANT IS: ❑ OWNER ❑CONTRA PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE c� Permit No.: Received By: Date ADDRESS: �S �ISU Y �� 5 �� �lC�' CITY � i ['�lr�. STATE��Z�IP _Sr�''�.�a PHONE: ��5��— �3�5— �dEi� NAME: STATE LiCENSE # LEAD CERT ADDRESS: CTTY_ PHONE FAX �SINGLE FAMiLY/NEW CONSTRUCTION SIZE � TWO FAMILY/NEW EC3NSTRtJCTIQN • STORIES O BASEMENT FiNISH 'k� DECK TYPE OF WORK: I❑ NEW HOME CONSTRUCTION ❑ MAINTENANCE/REPAIR DESCRIBE WORK BEING SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES _ ❑ ROOF ❑ DRAIN TILE ❑ SIDING C7�THER ❑ SWIMMING POOL ❑ ADDITION � REMODEL(NG O HOLi3E QNLY ❑ HOUSE & GARAGE GARAGES ❑ ATTACHED GARAGE PROPOSED SIZE: ❑ DETAC ED ARAGE PROPOSED HEIGHT: / J� � /� ��4 SID G V ( �� _ il ��� ❑ Vinyl OSoffit �.t ❑ Aluminum ❑ Trim ❑ Oiher ❑ Fascia WINDOWS IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS OR FOR NEW OPENINGS-DESCRIBE S1ZE OF OPENING CHANGES & COT 'ATE Z!P F"f BASEMENT REMODELING SUBMIT: I . Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDTNG DECKS, RDD�'F� & PQBCHES SllBMtT: 1. Sitc 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. ' WtNDOW TO BE INSTALLED NUMBER OF WINDOWS � ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERI.4LS: (USING THE 1997 U.B.0 FEE SCHEDULE) JOB VALUATION �' �{'iO5' 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 $ $ $ $ $ $ $ $ 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+68= ftx$25=$ $450 Cons�rvation Plan Review Fee Det�rmined by Engineering Agpeement necessary ( ) Non Necessary ( 1VIake checks Qavable to: Citv of Fridlev Attach 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 permit a d w is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of whi e'r r view and approval of lans. 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