P - 48448Building
�nspecti�ns
763=�72-3604
763-502-4977 FAX
DATE ��� � .' � � "`_
SITE ADDRESS _�
TH[S 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
EFFECTNE 1-1-20] 1
YOUR E-MAIL ADDRESS � � � �-�'���`� �'�'� �� �
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❑ OWNER ❑CONTRACTOR
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ADDRESS:
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PHONE: �
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NAME:
STATE LICENSE #
ADDRESS�
PHONE
�SINGLE FAMILY/NEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUCTION
❑ ADDITION ❑ GARAGE/SHED
❑ BASEMENT FINISH ❑ ROOF
❑ DECK ❑ SIDING
❑ SWIMMING POOL
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR � REMODEL
� f'- � C.f 1 �_ i.
DESCRIBE WORK BEING DONE
STZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SID[NG
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENtNGS ❑Yes �No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TvpF nF wrr.innw Tn RF rnieTat .t .Fn
,�,...
Permit No.:�i;
Received By:
Dat��� d:. k� i�T� �� i 1
,`.' -f� ��C"� � �f�"� l� �i
��.:,
STAT�
LEAD CERT NUMBER
CiTY STATE ZIP
FAX
SIZE
STORIES
❑ WINDOWS
❑ DRAIN TILE
�OTHER
GTH WIDTH NEIGHT
❑ HOUSE ONLY
❑ HOU3E & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
LOCATION OF WINDOWS
NUMBER OF WINDOV✓S
FT
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION fNCLUDiNG 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.
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
COTAL JOB VALUATION �� �� OCCUPANCY TYPE
Permit Fee �
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
I hereby apply for a building
conformance with the ordinanc
permit but only an application
approved plan in the case of all
SIGNATURE OF APPLICAN7, _
APPROVAL INSPECTOR SIGNATU
$
$
$
$
$
$
$
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $5.00
$5.00 (State Licensed Residential Contractors)
$2230 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$25=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks aavable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
i�, and I acknowledge that the information above is complete and accurate; that the work will be in
I dodes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
�ermit and work is not to start witho�t a permit on site; that the work will be in accordance with the
� i �quires}�Peview and pproval of plans. t �,
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