P - 41404�
Building BUILDING
Inspections RESIDENTIAL APPLICATION
763-572-3604 CITY OF FRIDLEY
763-502-4977 FAX EFFECTrvE i-i-zoii ,.,_
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:
❑ OWNER
NAME:
ADDRESS:
PHONE:�
NAM
STATE LICEN E
ADDRESS:
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SINGL� FAMiiY�NEW CONST�UCTIUIV
TWO FAMILY/NEW CONSTRUCTION
❑ ADDITION ❑S'iARAG
❑ BASEMENT FINISH �ROOF
❑ DECK ❑ SIDING
❑ SWIMM
HOME CONSTRUCTION
NG POOL
❑ ADDITION
SIZE
❑ DRAIN TILE
❑ OTHER
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT L GTH r WIDTH
ROOFING ❑ OUSE ONLY ~
NUMBER OF SQUARES _�__ �OUSE & GARAGE
GARAGES ❑ ATTACHED GARAGE
PROPOSED SIZE: ❑ DETACHED GARAGE
PROPOSED HEIGHT:
SIDING
❑ Vinyl ❑Soffit
❑ Aluminum ❑ Trim
❑ Other ❑ Fascia
WINDOWS
IN EXISTING OPENINGS ❑Yes �No LOCATION 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
/ (USING T�E 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $!O OO . OCCUP.
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HEIGHT
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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:
I. 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.
MA'
TYP
Permit Fee $ See Back Page for Fee Schedule V
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ `� ��_ .001 times the total job valuation
Surcharge $ �' .0005 x Permit Valuation Minimum $5.00
License Surcharge $ $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 $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary O Non Necessary O
Total Due $ ' E Make checks a able to: Ci of Fridle Attach Sti ulations
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL 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 ordinanc d codes of he City of ' ley and ith the Minnesota Construction Codes; that I understand this is not a
permit but only an applicatio fo a permit an k is not t start ithout a permit on site; that the work will be in accordance with the
approved plan in the case of 11 hi req ' es vi ap oval of plans .. '/ ���a �/�
SIGNATURE OF APPLICANT I T N \ DATE
APPR(�VAL INSPECTOR SIGNA