P - 43304B��iing
I ections
7�3-572-3604
763-502-4977 FAX
DA� � r� Za� �
SITE ADDRESS _
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:
DESCI2IBE WORK BEING
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
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STATE LICENSE # EXP DATE
ADDRESS: � CITY
PHONE__ _ FAX _
�,SINGLE FAM[LY/NEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUCTION
❑ BASEMENT FITIISH ❑ ROOF
i7 DECK ❑ SIbING
❑ NEW HOME CONSTRUCTION D ADDITION
❑ MAINTENANCE/REPAIR ^�REMODELI
p HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑ DRA[N TILE
❑ OTHER
HEIGHT
Permit No
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ATE ZIP
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BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl OSoffit ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim 1. Site Ptan/Survey showing the existing structwes
and proposed project.
O Other ❑ Fascia 2. Two sets of construction plans
�'�' �'�' 3. Energy Calculations
IN EXTSTING OPENINGS OYes ONo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDdW.
OPENING CHANGES &
'iYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
USING THE 1447 U.B.0 FEE SCHEDULE)
'OTAL JOB VALUATION $_� �� 0 O OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Chazge
Total Due
$ �
$
$
$
$
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 navable to: Citv of Fridlev
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 co s of t City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an applicatio or a p i�t.an wo is not to start without a permit on site; that the work will be in accordance with the
approved pian in the case a11 work hj�h re uir eview and approval of pl�us!�� r
SIGNANRE OF APPLICANT PRINT NAME ` [ ��" ( �� � �V � DqTE � �� � � J
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