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P - 43363Building Inspections 763-57�-3604 763-502-4977 FAX DATE b SITE ADDRESS /cIO � ��� THIS APPLICANT IS: � PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DESCRIBE WORK BEING SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES _ BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-2010 ADDRESS: STATE LICENSE # ADDRESS: I �: YOUR E-MAIL ADDRESS �CONTRACTOR ❑ SINGLE FAMILY/NEW CONSTRUCT[ON O TWO FAMILY/NEW CONSTRUCTION ❑ BASEMENT FINISH � ROOF �DECK ❑ SIDING ❑ NEW HOME CONSTRUCTION ❑ MAINTENANCE/REPAIR � LENGTH p HOUSE ONLY ❑ HOUSE & GARAGE Permit No.:� �%� � � Received By: , � Dat�:,A►UG • Ct�I+-� CITY �'-V'rCL��.�—STATE/�IN ZIP 7: , � — T ✓p� EXP DATE � � % , r��P CITY STAT�ZIP FAx 7� 3- Z lo -�Z2o SIZE STORIES i/SHED ❑ WINDOWS ❑ DRA[N T[LE O OTHER NG POOL ❑ ADDITION 0 REMOAELING � �► WIDTH__�� HEIGHT -7 w��clecK SO FT G GARAGES ❑ ATTACHED GARAGE PROPOSED SIZE: DETACHED GARAGE PROPOSED HEIGHT: � }�' � l� SIDING i �1G� � 2Q�}� � 1�C .� ❑ Vinyl ❑Soffit ❑ Aluminum ❑ Trim ❑ Other ❑ Fascia WIIYDOWS IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPEMNG CHANGES & BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INGLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans 3. Energy Caiculations FOR WINDOWS - PROVIDE U-VALUE AND MANUFACTURE ST[CKER ON WINDOW. ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: ,, �(uS�NG THE 1997 U.B.0 FEE SCHEDULE) Permit Fee Plan Review Fire Surcharge Surchazge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Pazk Fee Sewer Main Charge $ $ $ $ $ $ 1 U I :'t See Back Page for Fee Schedule 65% of Building Permit Fee � .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $2100 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$24=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( Make checks payable to: City of Fridlev THIS IS AN APFLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED Attach 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 onty an application for a perm' and 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 at r wh' requires review and approval of plans. 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