P - 35586Building
Inspections
763-572-3b04
763-502-4977 FAX
DATE �U�'��J'� '�
SITE ADDRESS ��:`
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:
BUILDING
R.ESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-I-2011
����
� �: x
❑ OWNER
ADDRESS:
PHONE:
STATE
YOUR E-MAIL ADDRESS -'��l �l�/�
)NTRACTOR
� ����-�J
� 5�: �� , CITY
7% .—. !`.%')?r�a
rri r; � � �"7;71.i?f
SINGI.E FAMILY/N W CONSTRUCTION
TWO FAMILY/NEW CONSTRUCTION
[] ADDITION ARAGE/SHED
❑ BASEMENT FINISH ROOF
O DECK ❑ SIDING
❑ SWIMMING PO(
� NEW HOME CONSTRUCTION
❑ MAINTENANCEbREPA1R
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES �'"��
GARAGES
PROPOSED SIZE:
PROPOSED HEtGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENINGS ❑Yes (7No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
■;�� •
■ ��
�r�/�ii
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHEp GARAGE
��j��- ��
❑so�tic �
� Trim �
❑ Fascia
tOCATION OF WiNDOWS
[i7o
Permit No.: �� �� �L ��"��
Received By:
D��' � U G �-�-��n
ATE�ZIP
EAD CERT NLJMBER
�CiTY STATE ZIP
FAX
StZE
STORIES
❑ wmDOws
❑ DRAIN TILE
❑ OTHER
G r� c���l��+���
H HEIGHT S FT
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structurai members to be used
FOR NEW CONSTRUCTION INCLUDING 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 STICKER 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
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
I���
—
���
�I.f
��
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 Residentia! 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 pa_yable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMTT-NOT VALID UNT[L PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be itt
conformance with the ordinances and codes o City of Fridley and with the Minnesota Constxuction Codes; that I understand this is not a
permit but only an application for a permit o is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case a 1 w r ich uir � i and approval of�,p,l3�s;r��� /�
SIGNATURE OF APPLICAN PRiNT NAM J� DATE �
APPROVAL INSPECTOR SIGNATI '