P - 36698Buiiding
Ir�spectians
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763-572-3604
763-502-4977 FAX
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TFifS APPLICANT IS:
PROPERTY OVVNER!
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COi1TRAC'TOR
SL'Bl�11T A COPY OF
YOUR STATE LICENSE
AND CERTIF{CATB OF
iNSURANCE
PROi'ERTY TYPE
PERMIT TYPE
AESCRIBE tiVORK BF.�NG
From: 920 831 3352 Page: 1/2 Date: 2l10/2011 4:38:39 PM
BUILDING
RESIDENTIA.L APPLICATION
CITY OF FRIDLEY
EFFECTTVE t•1-2011
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Permit No. � x
Received By:
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ADDRESS: .�'`�� � ��� � CITY STAT6 ZIP.
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STA'fE LICENS� #_
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{$SihrGLE FAAifLYmT�'W CONSTRUCTION
D TWO FAMII.1CrNEW CONSTRU(.'170N
C1 ADDTl'[pN ❑ GARnG
❑ SASCMEN'C FLN[SH U AOOF
❑ pECK O SfDtNG
O NEW HOME CdNSTRUCTION
❑ MA[1VT'F,NANCFIREPAIR
�Ax 6s�- � - x�ys
SIZE
STORCES
�5HED NDOWS
O DRAIN TILE
O OTHER
NG POQL
❑ ADD17'[ON
h3'REMODELING
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�p ,ry(` 0 HOUSE ONLY RACF11dFNTRFMf1riH'r.MG SL�3MIT'
NUI�BER QP SQUARFS � HOUSE & GARAGE � �is�� F�o� �
GARAGES ❑ A7'fACHEO GrLRAGE 2. Proposed floorplan
PROPOSED S[Z�: Q DETACHED GARAGE 3. i.is► of structurol mwabas a be ased
PROPO6ED HE[GHT:
FOR NEW COAfS7'lilfC7TON INCLUDING DECKS,
� V� � ❑Sofftt ADDTI'IONC & PORCH�� &!�MIT.
Y I. Siu PlatdSurvey ahacc'ing the existing structiaos
D Aluminum ❑ Trim and Droposed projacl.
fl Olher � F�� 2. Two sets of consttndi[m plans
w�IVDOwS 3. EnergyCalcularions
TN EX1STlNGOPENINGS �Ycti ONo [ACATIONOF WWDOWS FORWiNDOWS—PROVIDEU-VAL4�AND
QR FpR N�W OPENINCS-DESCRIBE S'IZfi OF MANUFACPURE STICKER ON WINDOW.
OPEN[NG CHANGES &
TYPE OF VYTNDOW TO BE QVSTALLED NT7MBER OF WINDOWS
e#LL FEES ARE BASED O�I VALUATiON, INCLUDU'VG THE COST OF LASOR AND MA7'ERIAL5:
([lSING THE 1997 U.B.0 FEE SCHEDULE)
r�rAL JOB VALI;A FIOIV ���? l. fia _--- OCCUPANCY TYPE
Permit Fee
T'lan Review
Fit+e Surchazge
5urcharge
License Surcharge
SAC Charge
Curb Cut Escrow
$rosion Control
Perk Fee
Sewer Ma.irt C6arge
Total Due
$ /('�. 2.ff See Back Page for Fce Schedule
$ 65°r6 of Building !'ermit Fee
$ �� .OUI timcs the total jab valuatioa ,
$ .p005 x Permit Valuation Miniruum $5.00
� 5 $5.00 (5tate Licensed Residenrial Gontrac[ors)
$ $2230 per SAC Unit (Plans to MWGC for dete�mina6oa)
g ft+6ft= ftx$24-$
$ $450 Conservation Plan Review
$ Fee Determined by Engineermg
$ A�eement necessary ( ) Nan Necessary ( )
� �, �7 Ni�ke cfi�ks ua��ablc to: Citr olFridley Atta<
THlS IS AN APPLICATION FOAA PERMIT-NOT VAL[DiJNi3L PROCESSED
I hereby apply for a building pemut and 1 acknowledge that th�e iaformation above is completie and accurate; that the work will be in
conformance with the ordinances and codes af the City of Fridley and with the Minnesota Canstruction Codes; that 1 understand this is not a
perrnit but only an applicxno or a perrnit an ork is not to start without a pennit on site; that the work will be in co�ance with the
approved plan in the case q�'�� �� 'ew and approval of p�r3 �[.�G� Dnz'� �a/<
SIGI�ATURE UF' APPL[CANT� PRCNTNAME �—
NOTE: SEPARATE PERNiI3'S ARE R�QUIREi7 FOR PLUM$ING, ELECfRICAL AND
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