P - 42110Building
Inspections
763-572-3604
763-502-4977 FAX
DATE � ` ( I
SITE ADDRESS �� �a "
THIS APPLICANT IS:
PROPERTY OWNER/ r
TENANT ,
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TY�E
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2011 _
❑ OWNER
STATE LIC
ADDRESS:
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� SINGLE : AMILY,^.�TEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUCTION
❑ BASEMENT FINISH �ROOF
❑ DECK ❑ SIDING
❑ NEW HOME CONSTRUCTION
CTZE
STORIES
i/SHED ❑ WINDOWS
❑ DRAIN TILE
� OTHER
NG POOL S I.tN
❑ ADDITION
� REMODELING
:: �
Permit No.:
� - -. : V�II�
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- � - -
ATE
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DESCRIBEWORKBEINGDONE� - � �,���J � r v
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT
ROOFIN � O HOUSE ONLY BASEMENT REMODELING SUBMIT
NUMBER OF SQUARES � �) HOUSE & GARAGE 1. Existing Floor Plan
GA S ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: f� DETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING ADDITION� & PORCHES SUBMIT
❑ Vinyl ❑Soffit 1. Site Plan/Survey showing the existing structutes
❑ Aluminum ❑ Trim ` �" ���° and proposed project.
❑ Other j�Fascia d.' Q p'yti, i�,pwa��..� O'yi �y Z. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS —PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SI'F OF MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS .
ALL FEES ARE BASED ON VALUA'1'ION, INCLUDING THE COST OF LABOR AND MATERIALS: 0
u (USING THE 1997 U.B.0 FEE SCHEDULE) �' �_ _ D .%%� n.�n.�.f�� �(
'OTAL JOB VALtiATIOiV
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
I hereby apply for a bui:
conformance with the ord
permit but only an applic
approved plan in the case
SIGNATURE OF APPLICANT
APPROVAL INSPECTOR SIG:
$ � , G` _ See Back Page for Fee Schedule V
$ 65% of Building Permit Fee
$ .001 times the total job valuation
$ ~r .0005 x Permit Valuation Minimum $5.00
$ $5.00 (State Licensed Residential Contractors)
$ $2230 per SAC Unit (Plans to MWCC for determination)
� �+6ft= ftx$25=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
� � Make checks payable to: City of Fridle_y Attai
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
permit and I acknowledge that the information above is complete and accurate; that the work will be in
inc and codes of the City of Fridley and with the Minnesota Construction Codes; that I undersfand this is not a
on f a per i an �rk is ot to start without a pe �t on site• that the work will be in cord ce with the
all �v ;k wl,�ch�u�re^ r�ie�hd approval of plans� � � — � � �� �� /�
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