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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