P - 39372Building
Inspections
763-572-3604
763-502-4977 FAX
STTE ADDRESS / �5 l
THIS APPLICANT I3:
PROPERTY OWNER/
TENANT
CONTRA.CTOR
SUBNIIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMTT TYPE
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
E-MAIL ADDRESS
❑ OWNER
���o
STATE LICENSE #
[ONE l d� � 7lp_`=[ '` 1'1 L�
SINGLE FAMILY/NEW CONSTRLJCTION
TWO FAMILY/NEW CONSTRUCTION
❑ BASEMEIVT FINISH '�[200F
O DECK [7 SIDING
❑ SWIMNffNG
EAD CERT NUMB�
CITY
FAX
SIZE
s�roiu�s
❑ WINDOWS
❑ DRAIN TILE
0 OTHER
TYPE OF WORK: � NEW HOME CONSTRUCTION O ADDITION
❑ MAINTENANCE/REPAIR REMODELING
DESCRIBE WORK BEING DONE: �V-F
SiZE GF IMI'ROVEMENT LENGTH WIDTH
Rpp� ❑ HOUSE ONLY
NUMBER OF SQUARES �_ J� HOUSE & GARAGE
GARAG�S ❑ ATTACHED GARAGE
PROPOSED SIZE: ❑ DETACHED GARAGE
PROPOSED HEIGHT:
SIDING
❑ Vinyl
0 Aluminum
p Other
LlSoffit
O Trim
❑ Fascia
WINppWS
IN EXISTING OPENINGS �Yes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CFIANGES 8c
TYPE OF WINDOW TO BE INSTALLED NUMBER OF �
ALL FEES ARE
TOTAL Jt?B VALIIATION
Permit Fee
Plan Review
Fire Surcharge
Surchazge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
Permit No.i`� �� � �� �
Receiv d B : �(.�
Date R "�' ��� � �
�.
f . c:vrr
HEIGH'f
BASEMENT REMODBLING SUBMIT:
i. Existing Flaor Ptan
2. Proposed floor plan
3. List of structutal members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS_ & PORCHES SUBNIIT:
1. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
FOR WINDOWS — P1tOVIDE U-VALUE AND
MANUFACTURE STICKER ON WINDOW.
ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
OCCUPANCY TYPE
S `7 b �7
$
$
S
See Back Page for Fee Schedule j 53. '��
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $5.00
$5.00 (State Licensed Residential Contractors)
$2230 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$25=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreemem necessary ( ) Non Necessary ( )
M�ke checks navable to: Citv of Fridlev Attac
THI5 I3 AN APPLiCATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a buiiding permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances des of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
pertnit but only an applicaf for a er 't a wc► c is not to start without a rmit on site; that the work will be in accordance with the
appmved plan in the cas f all c wh' h re u' review and approval of ����-6-�t=C..`�J—�C{T� --� #-LI i �
SIGNAT[JRE OF APPLICA = — e� PRINT NAME DATE
APPROVAL INSPECTOR SI U
PLEASE NOTE: SEPARATE PE ITS ARE REQLTIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK