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P - 48121Building Inspections 763-572-3604 763-502-4977 FAX DATE � `° �'� — I SITE ADDRESS �2 THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-20] 1 YOUR E-MAIL ADDRESS ❑ OWNER f�CONTRACTOR NAME:� ADDRESS: NAME: S/\ f< STf1TE LICENSE # PHONE (g / C '� `� / �` � / � �1SINGLE FAMII,Y/NEW CONSTRUCTION ❑ TWO FAMILYINEW CONSTRUCTION ❑ BASEMENT FINISH ❑ DECK TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ MAINTENANCE/REPAIR DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES � GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other WINDOWS IN EXISTING OPENINGS OYes ❑No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED .•7 }ffi'.ROOF ❑ SIDING ❑ SWIMMING POOL ❑ ADDITION I�HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS NUMBER OF WINDOWS Permit No.: Received By: .. ,� � i AT�{ZIP. ,D CERT NUMBER CITY Cr%r /3t� STAT IP� FAX SIZE STORIES ❑ WINDOWS ❑ DRAIN TILE ❑ OTHER WIDTH FT BASEMENT REMODELMG SUBMIT: 1. Existing Fioor 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 seu 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 (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ $ $ $ _, : /� i�� TERIALS: See Back Page for Fee Schedule 65% of Building Permit Fee .00] 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 payable to: City of Fridlev Attach 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 ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a perm' an r is no start without a permit on site; that the work will be in accordance with the approved plan in the case of all w wh' r u' es rev d approval of pl�•_ ������ J�i '/ �/ SIGNATURE OF APPLICANT PRiNT NAME J� DATE APPROVAL INSPECTOR SIGNA R ih