P - 45752Buildin
Inspections
'' 763-572-3604
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
DATE YOUR &MAIL ADDRESS
S�T� ADD�SS ��� 7� 1� S�- ti�-
THIS APPLICANT IS: ❑ OWNER �ONTRACTOR
PROPERTY OWNER/ NatvtE: �pv� \i�l �'l'� \� Qs
TENANT ADDRESS: S�g L/ �-�L1�. ��_ CITY
PHONE: � � � S� — S G`�%� �
CONTRACTOR IN
Permit No:
Received By: F �-r-
D a��' dd � � � � � � �
AT�i,-e� s.s- y3Z
SUBMIT A COPY OF STATE LICENSE #���G7.��� ' V EXP DAF�
YOUR STATE LICENSE ADDRES� Z-gG' ���,�Q, ��s� Q {�-�J` S� Q- / DG% CITY Ge ✓� � i/I STATE�II'.sS1/3 Z
WITH APPLICATION pHONE FAX
PROPERTY TYPE GLE FAMILY/NEW CONSTRUCTI(
❑ TWO FAMILY/NEW CONSTRUCTION
PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED
❑ BASEMENT FINISH �CROOF
❑ DECK ��IDING
❑ SWIMMING POOL
TYPE OF WORK: � NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: .�t�od I►"�
SIZE OF IMPROVEMENT
NUMBER OF SQUARES z- � ,
GARAGES
PROPOSED STZE:
PROPOSED HEIGHT:
SIZE
❑ WINDUWS
❑ DRAIN TILE
❑ OTHER
LENGTH WIDTH
❑ HOUSE ONLY
�pUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
HEIGHT
BASEMENT REMODELING SUBMIT:
l. Bxisting Floor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft.
SIAING 2- � �� FORNEW CONSTRUCTION INCLUDING DECKS,
�f�inyl � ❑Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures
❑ Other ❑ Fascia and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATTON OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
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 THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Pernut Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
� ��'I,LS
$
$ ,
$
$ �
$
$
$
$
$ �$ '
See Back Page for Fee Schedule
65% of Building Pernut Fee
.001 times the total job valuation
.0005 x Pernut Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary (
Make checks payable to: City of Fridley
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
Attach
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 and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and wo not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work whic ' re ' es red approval of plans.
SIGNATURE OF APPLICANT _� ��f'L= " i� PWNT NAME °i�T. DATE �� — r I