P - 39615Building
Inspections
763-572-3604J
763-502-4�577 HAX
DATE
SITE ADD SS �
THIS APPLICANT IS:
PROPERTY OWNER/ I N
TENANT �
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
PHONE:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECT'IVE t-1-2011
YO R E-MAIL ADDRESS _�`
� �� s�. N��
�WNER ❑CON"CRACTOR
' a
s: 3 — � �
/_ �i—flC�� /_f !'s7
Permit No.:
Received By:
��e� � �. � � � �
A
NAME:
STATE LICENSE # LEAD CERT NUMBER
ADDRESS: CITY STATE zIP
PHONE
INGLE FAMILY/NEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUCTION
❑ ADDITION ❑ GARAG
❑ BASEMENT FINISH ❑ ROOF
O DECK �.SIDING
❑ SWIMM
NEW HOME CONSTRUCT'ION
FAX
SIZE
STORIES
NG POOL
❑ ADDITION
Q REMODELING
LENGTH
❑ HOUSE ONLY
Q HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GAI2AGE
❑ DRAIN TILE
❑ OTHER
'�+ �/�! �I� �'� M ''ir
HEIGHT SO FT � `�"
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 ❑Sofiit ADDITIONS. & PORCHES SUBMIT:
❑ Aluminy� , � � ❑ Trim 1. Site Plan/Survey showing the existing structures
Q Other �cti \'L_ ���f�Q � Fascia and proposed project.
2. 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 OPEIdINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING TH 997 U.B.0 FEE SCHEDULE)
'OTAL JOB VALUATION $� O� � OCCUPANCY TYPE
Permit Fee $ See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ �,} .001 times the total job valuarion
Surchazge $ ��� .0005 x Permit Valuation Minimum $5.00
License Surcharge $ $5.00 (State Licensed Residential Conttactors)
SAC Charge $ $2230 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft+ 6 8= ft x$25= $
Erosion Control $ $450 Conservation Plan Review
Pazk Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary O Non Necessary O
Total Due $ 1����` Make checks navable to: Citv of Fridlev Attach Stiuulations
THIS S AN APPLICATION FOR A PERMIT-NOT VALID UN1'IL PROCESSED
I hereby apply fo ui 'ng permit an I acknowledge that the informa6on above is complete and accurate; that the work ill be in
conformance ' the ordin c d cod s of the City of Fridley and with the Minnesota Co huction Codes; that I under tand is is not a
permit but only an applica on r i and work is not to start without a permit on si ; h e work will be in a or ce with the
approved plan in the case 11 w ' es review and approvai of r
SIGNA'TURE OF APPLICANT PRINT N 1 ATE I
APPROVAL INSPECTOR SIGNATU
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, LECTRICAL AND MEC ICAL WORK