P - 84239Building
Inspections
763-572-3604
SIT'E ADDRESS _
THIS APPLICANT IS
PROPERTY OWNER/
TENANT
CONTRACTOR
n
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
�ri L 11'��n
_�.,.._
..� �,.
CITY
SUBMIT A COPY OF STATE LICENSS�C�ODo{I%3 � EXP DATE j��/ _
YOUR STATE LICENSE ADDRESS: S SSS -�`�- CITY_�
WITH APPLICATION PHONE qSZ ' 93,� •�(y� g F,,,X �sz • 935 • 9s�y
PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ BASEMENT FINISH ❑ ROOF
❑ DECK ❑ SIDING
TYPE OF WORK:
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDIlVG
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENINGS es ❑No
OR FOR NEW OPENINGS-DESCRIBE STZE OF
�
LENGTH
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
OF1
r,-
Permit No.:
Received By:
Date�ecs'�d� � �Q � t,
r"U;SCO • C v m
❑ DRAIN TILE
❑ OTHER
iOL
�i av � l>> �Ui o�v ,
WIDTH HEIGHT
'A'
A� "�P�s3�3
BASEMENT REMODELING SUBMIT:
1. Existing Fioor Plan
2. Proposed floor plan
3. List of structural members to be �sed
..
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction pians
3. Energy Calculations
OPENING CHANGES & q,�/ /� Y�l� � OO �� ' Z
TYPE OF WII�IDOW TO BE INSTALLED �- l NUMBL� OF WINDOWS I
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USIN�THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ �D �I �-" 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
$
$ �? (v�
$ 36
$ 5•00
$
$
$
$
$ , . „ ..�,
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)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks pavabie to: Citv of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building perm' and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances an 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 permit d work is not to start without a permit; that the work will be in accord ce with the approved
plan in the case of all work which uires e ew a proval of plans. �
SIGNATURE OF APPLICANT PRINT NAME U/� � � DATE v/ �
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