P - 36671Building
Inspections
763-572-3604
763-502-4977 FAX
DATE
SITE ADDRESS _
THIS APPLICANT IS
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECT[VE (-I-2011
❑ OWNER ❑CONTRACTOR
ITY
PHONE:
STATE LICENSE
CERT
ADDRESS�I� �O ��F�L.��.T� � CITY�
PH�JN��v�-^ cS�C�B �'�� c� � FAX _"'� � � ^
�SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILYMEW CONSTRUCTION STORIES
O ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH �OOF C] DRAIN TILE
❑ DECK ❑ SIDiNG ❑ OTHER
❑ SWIMMING POOL
❑ NEW HOME CONSTRUCTION ❑ ADDITION
�14(AINTENANCE/REPAIR ❑ REMODELING
DESCRTBE WORK BEING DONE: -
SIZE OF IMPROVEMENT���
ROOFING
NUMBBR OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
, ❑ Vinyl
❑ Aluminum
0 Other
❑ HOUSEANLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
�ETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
WINDOWS
IN EXISTING OPENMGS ❑Yes C1No LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENIIVG CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF \
1�.9T�7111:■
Permit No.: -- �
Received By:
Date Rec'd: '� �. ��
ST,
s��
�STA7
a• � 7�a
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. ProPosed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
l. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
FOR WINDOWS - PROVIDE U-VALUE AND
MANUFACTURE STICKER ON WINDOW.
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
Permit Fee $ See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ .001 times the total job valuation
Surcharge $ , ti� .0005 x Permit Valuation Minimum $5.00
License Surcharge $ , r.a''. $5.00 (State Licensed Residential Contractors)
SAC Charge $ $2230 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft+ 6 ft= ft x$25= $
Erosion Control $ $4S0 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary O Non Necessary O
Total Due $ i Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and 1 acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances an codes of the Ci of Fridley and with the Minnesota Construction Codes; that I un erstand this is not a
permit but only an app cation for e t and wor is not to start without a permit on site; that the work will be in acco a c with the
approved plan in the c f a r ir ev' w and approvai of plans. J
SIGNATURE OF APALT�ANT PR1NT NAME DATE
APPROVAL INSPECTOR SIGN URE .i
.—
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