AF - 40878Building
Inspections
763=572-3604
763-502-4977 FAX
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SITE ADDRESS CD �o �
T'HIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBNIIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTNE 7-1-2010
YOUR /E�-M�AIL ADDRESS
r lcoY.
�'UWNER OCONTRACTOR
NANNIE: ✓� � l
�wnt�ss: <oG 7 � 6c � �- �
PHONE:�G3— ,Z�y.- �.442?
STATE LICENSE # EXP DATE
ADDRESS: CITY_
PHONE
�'SINGLE FAMILY/NEW CONSTRUCTION
❑ TWO FANIILY/NEW CONSTRUCTION
PERMIT TYPE ❑ �DTfION
❑ BASEMENT FINISH
O DECK
TYPE OF WORK: O NEW HOME CONSTRUCTION
0 MAINTENANCE/REPAIIt
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES
GARAGES i r
PROPOSED SIZE: �� ���
PROFOSED HEIGHT: �
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENINGS OYes ONo
OR FOR NEW OPENIlVGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE WSTALLED
FAX
SI7.E
STORIES
❑ ROOF ❑ DRAIN TILE
❑ SIDING ❑ OTI-IER
❑ SWIMMING POOL
�ADDITION
REMODELING
S`+'.�+ p'e
f'H 3 it � WIDTH i�i � HEIGHT
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
O Trim
0 Fascia
LOCATION OF WINDOWS
NUMBER OF
Pernut No.: Oi � �b �i
n a..
Received By: �:'j
� R��� �
� p't—�.a,.'l . C � �,
STATE�ZIP��_
STATE ZIP
F"f
BASEMENT REMODELING SiJBMIT:
l. Existing Floor Plan
2. Proposed floor plan
3. List of struchual members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing strucwres
and proposed project.
2. Two sets of construction plans
3. Enetgy Calculations
FOR WINDOWS — PROVIDE U-VALUE AND
MANUFACTURE STICKER ON WINDOW.
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
5 G THE 1997 U.B.0 FEE SCI�DULE)
TOTAL JOB VALUATION $_ �° �� OCCUPANCY TYPE
�
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Gbrb Cut Escrow
Erosion Control
Park Fee
Sewer Main Chazge
Total Due
$
$
$
$
$
$
$ _
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valua.tion Minimum $5.00
$5.00 (State Licensed Residential Contractors)
$2100 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$24=$
$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 UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge that the information above is complete and accuraze; that the work will be in
conformaace 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 application for a� ermit d work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of all wor � e' revie � approval of p �/j /
SIGNATURE OF APPLICANT PRINT NAME /��r� �r4 '.X DATE 7���s� �'d � d
APPROVAL INSPECTOR SIGNATURE �� .� � ��i
Page 2- Building Residential Application
BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or structure, or for any. alteration or repair
to any existing building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
provided to=wit:
TOTAL VALUE FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$25,000
$25,001 to $50,000 $391.25 for 1�` $25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75. for each additional $1,000 or
fraction to and includin $.1,000,000
$1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each additional $1,000 or
fracrion
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
a11ow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977