P - 47352Building
Inspections
763-572-3604
763-502-4977 FAX
DATE
SITE ADD SS i
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2011
YOiJR �MAIL ADDRESS
� OWNER �ONT'RACTOR
,.�� � �laJ� ( l'
PHONE:
STATE LICENSE #
ADDRESS: .� v
�SINGLL FAMILY/NEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUCTION
PERMIT TYPE I � ADDTTION ❑ GARAG
❑ BASEMENT FIhtISH ��-Rppp
� DECK ❑ SIDING
CI1'Y
CERT
FAX
SIZE
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDI1'ION
.�MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: � '- C�C) `
SIZE OF IMPROVEMENT �� LENGTH WID.I'H
.�
R FING ❑ HOUSE ONLY
NUMBER OF SQUARES _i� ❑ HOUSE & GARAGE
GARAGES ❑ ATI'ACHED GARAGE
PROPOSED SIZE: ❑ DETACHED GARAGE
PROPOSED HEIGHT: �
SIDING ��
❑ Vinyl ❑Soffit �
❑ Aluminum ❑ Trim
❑ Other � Fascia
❑ DRAIN TILE
❑ OTHER
Permit No..
Received By:_
D����:�
STATE�ZIP_���
����
M�t'L'J
FT
BASEMINT REMODELING SUBMIT�
1. Existing Floor Plan
2. Proposed floor plan
3. List of structura( members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT�
i. Site Plan(Survey showing the eausting structures
and pmposed project.
2. Two sets of construction plans
W��WS 3. Energy Calculations
IN EXISTING OPErIINGS OYes �No LOCA1'ION OF WINDOWS FOR WINDOWS — PROVIDE U-VALLTE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE S1'ICKER 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 THE 1997 U.B.0 FEE SCHEDULE)
'OTAL JOB VALUATION $ __ OCCUPANCY TvvF
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Swchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$ ,
$
$
$
$
$
$
$
$ % -
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 Residentiai Contractors)
$2230 per SAC IJnit (Plans to MWCC far determination)
ft+6ft= ftx$25=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UN'TIL PROCESSED
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 work is not to start without a permit on site; that the work will be in ccord ce with the
approved plan in the case of al�a tc'wTiic requires review and approval of pla
SIGNATURE OF APPLICANT' , PRINT NAME ��i�`L �` DATE �� �
APPROVAL INSPECTOR SIGNATURE �-
PLEASE NOTE: SEPARATE PERMITS ARE RE UIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK