AF - 35627Building
Inspections
763-572-3604
DATE �
SITE ADD �
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMTT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
�P �I�e
❑ OWNER �CONTRACTOR
ann�ss:_ S� � .���'e �, � � �-�d c ' cinr
PHOAIE: 7� �%� p C� � 2, �
Permit No.:
� - - - . : ��9
� , ►� , � ,' � �
�nzrn.,�5 � 3 2
STATE LICENSE # �. � .� �j / �, � P% � Da� °3 / 3 / � � c� �r
annxE.ss: � 3 S .�'i �__B A c. � � �rrY_ : � � �r srA� � `� � S � 3 Z
PHONE % 3 %�C � �I�9 / 2 �ev
❑ TWO FAMII.
❑ BASEMEATT FINISH
0 DECK
DESCRIBE WORK BEING
SIZE OF
�cwruv�
NUIVBER OF SQUARES Z. S��
GARAGES
PROPOSID SfZE:
PROPOSID HEIGHT:
SIDING
O Vinyl
❑ Alumintun '
❑ Other .
ROOF
SIDING
2EPAIR 0 REMODELDdG
LENGTH
❑ HOUSE OTILY
�HOUSE 8c GARAGE
CI ATfACHED GARAGE
❑ DETACHED GARAGE
OSoffit
❑ Trim ?
�'Fascia �-/ o � 5 Q- v �,(l.y
WIIVDOWS
IN EXISTIAiG OPENINGS OYes ONo LACATION OF WINDOWS
OR FOR NEW OPEIJINGS-DESCRIBE SIZE OF
OPENING CHANGES 8c
❑ DRAW T1LE
❑ OTHER
Cg /�
HEIGHT �
� � S C? o�t/;
BASEMENT REMODELING SUBA9Tf•
1. Existing Fl�r Plan
2. Proposed fl�r plan
3. List of str�ctural membe�s to be used
F�
FOR NEW CONSTRUCTION MCLUDING DECKS,
ADD1T10NS_ & PORCHES SUBMIT•
I. Site PlanlSurvey showing tlte existing structures
and proposee�i project.
2. Two sets of conshvction plans
3. Energy Calculations
TYPE OF WIN�W TO BE INSTALLED NUMBER OF WD�IDOWS �
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(US1NG THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $_3�7`� / OCCIJPANC'Y T�PF
Permit Fee - - - - -
Plan Review
Fire Surchazge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ �!' % � �
$
$ ,3,��
$ / - ��l-
$ ti.i��'
$
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuafion Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1675 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( }
Make checks payable to: City of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMTf-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accwate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construcrion Codes; that I understand this is not a
permit but only an applica.tion for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work which requ�res review and approval of plans.
SIGNATURE OF APPLICAT�� � �� . ��- I�. pRiNT NAME V � C� I1� �Vw '7�� DATE S� �/_'a c' n�
page 2_ Building Residential Application
BUII..DING PERNIIT FEE SCHEDULE
The Chief Buildin.g Official shall, before issuing permits for the erection of any building or
structure, or for any addition to any existing buildin.g or shvcture, or for any alteration or repair
to any existing building or structure, upon application therefore, require the payment by the
a}�plicant for such permit of fees to ihe aznoun.t herein below set forth and in the manner herein
provided tv-wit: • .
VERIFICATION OF FOUNDATION
Permits for construction will be issued a m.inimum of 24 hours from the time af application to
allow for proper review of proposed. structure and of the c�nstruction site.
A Certifica.te of Survey of tlie lot, showing the location of the existing foundation will be
required before proceedi.ng with the fra.ming. New Houses Onlv
City of Fridley
Buildi.ng Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
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