Loading...
P - 35770Building Inspections 763-572-3604 763-502-4977 FAX DATE I l� SITE ADDRESS _�D TH[S 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 D( SIZE OF IMPROVEMENT BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-201I Permit No.: � � � � � y� � Received By: ' Date R�' q RC. YOUR E-MAIL ADDRESS Gri� cci��cs�t�rlr�e-� �kg� ; � nr£ ❑ OWN R �ONTRACTOR NAME: � �h-CJ ADDRESS: �D� � �7� !�✓�ti1 /I/C/� CITY � ; PHONE: �� J T4I 1 � l�� NAME: �JI�Y'� to,/7G�J � �.L.G STATE LICENSE # 2�nr7 D /. LEAD CERT NUMBE ' ADDRESS:/� EJ• /��r Ik- F�' fy,� r,_ �� CITY ��i PHONE FAX �SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH �ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL ❑ NEW HOME CONSTRUCTION ❑ ADDITION � MAINTENANCE/REPAIR ❑ REMODELING ROOFING NUMBER OF SQUARES _' � GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl O Aluminum ❑ Other WINDOWS IN EXISTING OPENINGS ❑Yes ONo OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED �. � v� ❑ HOUSE ONLY �HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim � Fascia LOCATION OF WINDOWS NUMBER OF HEIGHT ,�7� Ld� ATE ZIP_ � _STAT ; BASEMENT REMODEL[NG SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTfON INCLUDiNG DECKS, ADDITIONS. & PORCHES SUBMIT: ' 1. 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 STICK�R ON WINDOW. ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: . (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee Plan Review Fir� Surcharge Surcharge Licens� Surcharge SAC Charge Curb Cut �scrow Erosion Con�rol Park Fee Sewer Main Chax�e Total Due $ Cll.��' $ , $ $ $ $ $ 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 pavable 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 ordina,nces and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applicatiorr for rmit 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 all which requires review and approval of pla %� SIGNATURE OF APPLICANT PRfNT NAME �� G��'1 DATE �/ � J APPROVAL INSPECTOR SIG URE